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1.
Int J Mol Sci ; 22(14)2021 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-34298988

RESUMO

This study evaluated the biocompatibility and biological performance of novel additive-manufactured bioabsorbable iron-based porous suture anchors (iron_SAs). Two types of bioabsorbable iron_SAs, with double- and triple-helical structures (iron_SA_2_helix and iron_SA_3_helix, respectively), were compared with the synthetic polymer-based bioabsorbable suture anchor (polymer_SAs). An in vitro mechanical test, MTT assay, and scanning electron microscope (SEM) analysis were performed. An in vivo animal study was also performed. The three types of suture anchors were randomly implanted in the outer cortex of the lateral femoral condyle. The ultimate in vitro pullout strength of the iron_SA_3_helix group was significantly higher than the iron_SA_2_helix and polymer_SA groups. The MTT assay findings demonstrated no significant cytotoxicity, and the SEM analysis showed cells attachment on implant surface. The ultimate failure load of the iron_SA_3_helix group was significantly higher than that of the polymer_SA group. The micro-CT analysis indicated the iron_SA_3_helix group showed a higher bone volume fraction (BV/TV) after surgery. Moreover, both iron SAs underwent degradation with time. Iron_SAs with triple-helical threads and a porous structure demonstrated better mechanical strength and high biocompatibility after short-term implantation. The combined advantages of the mechanical superiority of the iron metal and the possibility of absorption after implantation make the iron_SA a suitable candidate for further development.


Assuntos
Implantes Absorvíveis , Materiais Biocompatíveis , Âncoras de Sutura , Alanina Transaminase/sangue , Animais , Materiais Biocompatíveis/química , Materiais Biocompatíveis/toxicidade , Fenômenos Biomecânicos , Nitrogênio da Ureia Sanguínea , Fosfatos de Cálcio/química , Fosfatos de Cálcio/toxicidade , Sulfato de Cálcio/administração & dosagem , Sulfato de Cálcio/química , Sulfato de Cálcio/toxicidade , Creatinina/sangue , Desenho de Equipamento , Fêmur/diagnóstico por imagem , Fêmur/ultraestrutura , Ferro , Lasers , Teste de Materiais , Microscopia Eletrônica de Varredura , Estrutura Molecular , Osseointegração , Polímeros/química , Polímeros/toxicidade , Porosidade , Coelhos , Distribuição Aleatória , Resistência à Tração , Vísceras , Microtomografia por Raio-X
2.
BMC Musculoskelet Disord ; 21(1): 667, 2020 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-33032565

RESUMO

BACKGROUND: Several cup anteversion measurements for post-operative total hip arthroplasty (THA) surgery have been described. We developed the standardized Liaw's trigonometric method to eliminate the influence of patient position, which is the most accurate method for cup anteversion measurement. We then developed an ellipse method using the Elliversion software and reported an interobserver error reduction in 2013. In this study, we attempted to apply this ellipse method in the clinic and compared its accuracy with the standard trigonometric version. METHODS: In the present study, we attempted to incorporate the ellipse method with Liaw's standardized anteversion in the simulated cup position. We measured standardized Liaw's anteversion for 434 radiographs in the clinic using the ellipse method. Repeated standard deviation (RSD) was calculated for accuracy evaluation. Furthermore, paired t-test was used for comparison with the interobserver and intraobserver errors. RESULTS: We found that the standardized Liaw's anteversion measured using the ellipse method showed lower RSD than the radiographic version. RSD was 0.795 in the standardized Liaw's anteversion with ellipse method group. The p-values of the paired t-test were all higher than 0.05 when measuring the interobserver and intraobserver errors. It indicated that the ellipse method was a precise and simple tool for cup anteversion measurement. CONCLUSION: We believe that this ellipse measurement can assist surgeons while placing the acetabulum cup into the precise position and enable early diagnosis of acetabulum loosening.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Artroplastia de Quadril/efeitos adversos , Humanos , Período Pós-Operatório , Radiografia
3.
Clin Biomech (Bristol, Avon) ; 78: 105089, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32593906

RESUMO

BACKGROUND: The TomoFix plate has been extensively used in high tibial osteotomy surgery to stabilize the distracted tibial bones. However, distal pain related to plate irritation was considered one of the most relevant complications for this fixation device. This study aimed to correlate reports of distal pain with the profiles of the distracted tibia and initial plate and plate contour. METHODS: This study used the finite-element method to investigate the profile-, distraction-, and contour-induced effects on stress distribution of the distal tibia-plate contact. The associations of two tibia profiles (normal and concave), distraction angles, and two plate profiles (contoured and non-contoured) were discussed in this study. The areas and stresses of the distal tibia-plate contact were chosen as comparison indices. FINDINGS: Before weight-bearing, the non-contoured plates of the normal and concave tibia profiles consistently showed less contact area at the distal tibia-plate region. Consequently, the physiological loads make the non-contoured plate subject to more concentrated bone stresses and thus may induce more pain at the distal tibia-plate region than a contoured plate. When the distraction angle decreases, the tibia-plate gap increases. Prior to fixation, the tibia-plate gap can be evaluated by the profiles of the distracted tibia and non-contoured plate by use of anteroposterior radiograph and computer-aided simulation. INTERPRETATION: In the situations of a lower distraction angle or a large tibia-plate gap, the use of a plate bender or a lag screw is recommended in order to contour the plate for reducing the concentrated stress at the distal tibia-plate region.


Assuntos
Placas Ósseas , Análise de Elementos Finitos , Osteotomia , Estresse Mecânico , Tíbia/cirurgia , Parafusos Ósseos , Simulação por Computador , Feminino , Humanos , Tíbia/fisiologia , Suporte de Carga
4.
BMC Musculoskelet Disord ; 21(1): 92, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32041587

RESUMO

BACKGROUND: Compared to other types of surgeries, minimally invasive surgeries (MISs) of humeral shaft fractures are associated with less radial nerve injury, less soft tissue injury and higher union rate. However, malrotation often occurs in MISs when closed reduction methods are used. This study aims to define specific palpable landmarks to help surgeons determine the correct torsional angle and reduce the incidence of malrotation. METHODS: Twenty-eight normal humeral computed tomography scans were retrieved from our image database. One line was drawn through the vertices of the intertubercular sulcus of the humeral head in the coronal view, and another line was drawn through the longest axis between the medial and lateral condyles in the coronal view. The angle between these two lines was measured at least 3 times for each scan. RESULTS: The profile of the intertubercular sulcus tangent line of the humeral head and the axis of the distal humerus was identified as the most accurate method for assessing the precision of torsion during MIS for humeral shaft fractures. The transepicondylar axis line is more internally rotated than the intertubercular sulcus tangent line. The mean angle was measured to be 41.1 degrees. CONCLUSIONS: The axis of the distal humeral condyles is internally rotated by approximately 41.1 degrees compared with the intertubercular sulcus tangent line of the humeral head. Minimally invasive surgeries can be performed by using these palpable landmarks. The torsional deformities can be reduced with the proper angle adjustment without the need for fluoroscopy. It can also be used to treat unstable comminuted humeral fractures. LEVEL OF EVIDENCE: Retrospective Study, Diagnostic study, Level III.


Assuntos
Pontos de Referência Anatômicos , Fraturas do Úmero/cirurgia , Úmero/diagnóstico por imagem , Anormalidade Torcional/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fixação de Fratura/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Anormalidade Torcional/etiologia , Adulto Jovem
5.
Polymers (Basel) ; 12(2)2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32069799

RESUMO

Healing of an anterior cruciate ligament graft in bone tunnel yields weaker fibrous scar tissue, which may prolong an already prolonged healing process within the tendon-bone interface. In this study, gelatin molecules were added to thermosensitive chitosan/ß-glycerol phosphate disodium salt hydrogels to form chitosan/gelatin/ß-glycerol phosphate (C/G/GP) hydrogels, which were applied to 0.1 mg/mL collagenase carrier in the tendon-bone junction. New Zealand white rabbit's long digital extensor tendon was detached and translated into a 2.5-mm diameter tibial plateau tunnel. Thirty-six rabbits underwent bilateral surgery and hydrogel injection treatment with and without collagenase. Histological analyses revealed early healing and more bone formation at the tendon-bone interface after collagenase partial digestion. The area of metachromasia significantly increased in both 4-week and 8-week groups after collagenase treatment (p < 0.01). Micro computed tomography showed a significant increase in total bone volume and bone volume/tissue volume in the 8 weeks after collagenase treatment, compared with the control group. Load-to-failure was significantly higher in the treated group at 8 weeks (23.8 ± 8.13 N vs 14.3 ± 3.9 N; p = 0.008). Treatment with collagenase digestion resulted in a 66% increase in pull-out strength. In conclusion, injection of C/G/GP hydrogel with collagenase improves tendon-to-bone healing in a rabbit model.

6.
Eur J Public Health ; 30(1): 4-9, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31177269

RESUMO

BACKGROUND: There is a lack of evidence that shows whether a report card can improve health outcomes in terms of infection rates or unscheduled readmission by using rigorous methods to evaluate its impact. METHODS: We used the National Health Insurance Administration's claims database from 1 January 2004 to 30 December 2013 and a time series analysis to evaluate the impact of the quality report card initiative on three negative outcomes of total knee replacement for each quarter of the year, including the rates of superficial infection of a knee replacement, deep infection of knee arthroplasty and unplanned readmissions for surgical site infection. RESULTS: These negative outcomes (original scale) do not show significant decreases in terms of superficial infection (-0.05‰, -0.63 to 0.53‰, P = 0.87), deep infection (-0.003‰, -0.19 to 0.18‰, P = 0.97) and unscheduled readmission (0.02‰, -0.21 to 0.25‰, P = 0.88). CONCLUSION: The total knee replacement public report card initiative did not improve the rate of infection and unscheduled readmission for surgical site infection. This report card in Taiwan should involve physicians' participation in the design and be tailored to be suitable for reading by patients in order to further enhance the chance of improvement in these negative outcomes.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Humanos , Análise de Séries Temporais Interrompida , Readmissão do Paciente , Estudos Retrospectivos , Fatores de Risco , Taiwan
7.
J Clin Med ; 8(10)2019 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-31623300

RESUMO

BACKGROUND: Mismatch of intramedullary nails with the bowing of femur is a frequent clinical finding. Previous studies showed inconsistent results. METHODS: We present an algorithm of region growing territory method to get the radii of the anterior bowing of femur. We also tested it on ten radiographs. Plain radiographs of the lateral view of femur from five men and five women taken between January and August 2014 in Taipei Hospital were chosen randomly. The curvature of femur outline and medullary canal were measured for three times each. Radii of curvature of whole femur, proximal, middle and distal parts were calculated and analyzed. RESULTS: The coefficient of variation of the 240 measurements ranged from 0.007 to 0.295 and averaged 0.088. The average radii of curvature of the whole, proximal, middle, and distal femur were 1318 mm, 752 mm, 1379 mm, and 599 mm, respectively. At the distal part of the femur, the radius of curvature of the femur outline (452 mm) was smaller than the medullary canal (746 mm) (p < 0.05). Women's femur was straighter than men's when we compared the whole length (1435 mm vs. 1201 mm, p < 0.05). The radii we calculated were smaller than the current intramedullary nails. CONCLUSION: The results showed that the inter-observer and intra-observer differences are acceptable, support the impression that different bowing conditions existed for Asians as compared to Caucasians, and also indicate the mismatch of current instruments to the curvature of femur.

8.
Arch Gerontol Geriatr ; 70: 155-161, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28178601

RESUMO

BACKGROUND AND PURPOSE: There has been much discussion about the risk factors for osteoporosis, but studies involving elderly population in Taiwan are minimal. We aimed to describe variables related to osteoporosis among community dwelling older people in Taiwan. METHODS: This is a cross-sectional study. The 671 participants were randomly selected from 3680 examinees of the annual Senior Citizens Health Examination in year 2010. Participants were interviewed with a detailed questionnaire, and 91 of them were invited for dual-energy X-ray absorptiometry (DXA). Predictor variables included age, gender and clinical risk factors for osteoporosis. The main outcome was osteoporosis confirmed by DXA. RESULTS: The mean age of the participants was 75.7±6.4years old. Overall, the most prevalent variables for osteoporosis were height loss in adulthood (41.0%), lack of dairy products or calcium supplements (32.0%) and insufficient physical activity (10.4%). In multivariate models, we found that underweight (OR=9.80) and lack of dairy products/calcium supplements (OR=3.68) were the main variables for osteoporosis. In the subgroup analysis involving only women, underweight (OR=14.60) was the main variable. DISCUSSION: Among community-dwelling older people in Taiwan, osteoporosis was mainly associated with underweight and lack of dairy products or calcium supplements. CONCLUSION: We suggest using the key questions of underweight and dietary pattern in clinical settings to identify high risk people who are candidates for further BMD exam.


Assuntos
Osteoporose/epidemiologia , Absorciometria de Fóton , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea , Cálcio na Dieta/administração & dosagem , Estudos Transversais , Feminino , Humanos , Masculino , Fatores de Risco , Taiwan/epidemiologia , Magreza/epidemiologia
9.
J Am Med Dir Assoc ; 17(12): 1129-1135, 2016 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-27666334

RESUMO

OBJECTIVES: There is no gold standard in diagnosing sarcopenia. We aimed to assess the validity of screening sarcopenia using SARC-F (sluggishness, assistance in walking, rise from a chair, climb stairs, falls). DESIGN: Prospective cohort study. SETTING: Community hospital in Taiwan. PARTICIPANTS: Community-dwelling senior citizens. MEASUREMENTS: Participants were interviewed with a structured questionnaire annually. The questionnaire items were recoded into the 5 items of SARC-F (sluggishness, assistance in walking, rise from a chair, climb stairs, falls). In the baseline year, a subgroup was tested for grip strength and body composition. Healthcare utilization and mortality were based on self-report and hospital records. Our main outcome was 4-year mortality. Secondary outcomes included hospitalization, emergency care use, and quality of life (QOL) measured using the CASP-12 scale (control, autonomy, self-realization, pleasure (control, autonomy, self-realization, pressure). RESULTS: There were 670 participants. The mean age was 76.1 (standard deviation 6.36). One-half were men (n = 340, 50.7%). The prevalence of sarcopenia was 6.1% (n = 41). SARC-F scores were inversely associated with grip strength (P = .001) and skeletal muscle composition (P = .045). Participants with sarcopenia were mostly women (P = .005) and older (P < .001). In univariate analysis, sarcopenia was associated with 1- to 4-year mortalities (P = .033, .001, .001, <.001, respectively), overall hospitalization (P = .004), overall emergency care use (P = .017), and QOL (P < .001). In multivariate model, sarcopenia [odds ratio (OR) 7.35, 95% confidence interval (CI) 2.67-20.18], age (OR 1.19, 95% CI 1.09-1.29 for each year), and taking vitamin D supplements (OR 0.29, 95% CI 0.11-0.74) were factors associated with mortality. CONCLUSIONS: Sarcopenia screened using SARC-F was associated with subsequent QOL, overall hospitalization, overall emergency care use, and 4-year mortality. SARC-F can serve as a quick screening tool of sarcopenia.


Assuntos
Mortalidade , Qualidade de Vida , Sarcopenia/diagnóstico , Inquéritos e Questionários , Idoso , Idoso de 80 Anos ou mais , Feminino , Instituição de Longa Permanência para Idosos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taiwan
10.
J Foot Ankle Surg ; 55(1): 106-11, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26364234

RESUMO

Measuring bone angles is an important method for diagnosing disease and predicting the prognosis in orthopedics. Traditionally, the angle is measured using lines drawn manually and adjusted by the naked eye. The purpose of the present study was to propose new methods to measure the bone angles formed by the axes of the calcaneus with good reliability and low operational error. The 2 new methods used linear regression analysis of the points inside and on the "envelope" line. The traditional method used the vector of the lines drawn for calculation. Digital radiographs of the lateral view of the feet from 51 patients were collected, and the angles were measured using these 3 methods. Next, we analyzed the reliability, differences, and correlations of these 3 methods. The intra- and interobserver comparisons revealed significant differences between the results of the 2 new methods and those of the traditional method. In addition, the new methods had greater reliability and better intra- and interobserver correlations than did the traditional method. We suggest that these 2 new methods to measure bone axis should be added to the Picture Archiving and Communication System to obtain more reliable and standardized data in clinical practice and for future research purposes.


Assuntos
Calcâneo/diagnóstico por imagem , Ortopedia/métodos , Intensificação de Imagem Radiográfica/métodos , Humanos , Variações Dependentes do Observador , Reprodutibilidade dos Testes
11.
Med Eng Phys ; 37(9): 879-84, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26208430

RESUMO

Spinal pedicle screw fixations have been used extensively to treat fracture, tumor, infection, or degeneration of the spine. Cannulated spinal pedicle screws with bone cement augmentation might be a useful method to ameliorate screw loosening. However, cannulated spinal pedicle screws might also increase the risk of screw breakage. Thus, the purpose of this study was to investigate the bending performance of different spinal pedicle screws with either solid design or cannulated design. Three-dimensional finite element models, which consisted of the spinal pedicle screw and the screw's hosting material, were first constructed. Next, monotonic and cyclic cantilever bending tests were both applied to validate the results of the finite element analyses. Finally, both the numerical and experimental approaches were evaluated and compared. The results indicated that the cylindrical spinal pedicle screws with a cannulated design had significantly poorer bending performance. In addition, conical spinal pedicle screws maintained the original bending performance, whether they were solid or of cannulated design. This study may provide useful recommendations to orthopedic surgeons before surgery, and it may also provide design rationales to biomechanical engineers during the development of spinal pedicle screws.


Assuntos
Parafusos Pediculares , Coluna Vertebral/cirurgia , Simulação por Computador , Desenho de Equipamento , Falha de Equipamento , Análise de Elementos Finitos , Teste de Materiais , Modelos Teóricos
12.
Aging Ment Health ; 19(6): 548-59, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25266062

RESUMO

OBJECTIVES: Little is known about the influence of routine laboratory measurements and lifestyle factors on generic quality of life (QOL) at older ages. We aimed to study the relationship between generic QOL and laboratory measurements and lifestyle factors in community dwelling older Chinese people. METHODS: We conducted a cross-sectional analysis. Six hundred and ninety nine elders were randomly selected from the examinees of the annual health examination in Taipei City, Taiwan. Blood, urine and stool of the participants were examined and lifestyle data were collected. Participants completed the CASP-19 (control, autonomy, self-realization, pleasure) questionnaire, a 19-item QOL scale. The relationship between QOL and laboratory results and lifestyle factors was explored, using multiple linear regression and profile analysis. RESULTS: The mean age of the participants was 75.5 years (SD = 6.5), and 49.5% were female. Male gender standardized ß coefficients (ß = 0.122) and exercise habit (ß = 0.170) were associated with a better QOL, whereas advanced age (ß = -0.242), blurred vision (ß = -0.143), depression (ß = -0.125), central obesity (ß = -0.093), anemia (ß = -0.095), rheumatoid arthritis (ß = -0.073), Parkinsonism (ß = -0.079), malignancy (ß = -0.086) and motorcycle riding (ß = -0.086) were associated with a lower QOL. Profile analysis revealed that young-old males, social drinkers, regular exercisers and car drivers had the best QOL (all p < 0.001). CONCLUSION: Of the many laboratory measurements, only anemia was associated with the lower QOL. By contrast, several lifestyle factors, such as social drinking, exercise habit and car driving, were associated with better QOL, whereas abdominal obesity and motorcycle riding were associated with lower QOL.


Assuntos
Envelhecimento/fisiologia , Envelhecimento/psicologia , Avaliação Geriátrica/métodos , Vida Independente/psicologia , Estilo de Vida/etnologia , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/etnologia , Índice de Massa Corporal , Estudos Transversais , Análise Fatorial , Feminino , Indicadores Básicos de Saúde , Humanos , Vida Independente/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores Socioeconômicos , Inquéritos e Questionários , Taiwan/epidemiologia
13.
Eur Spine J ; 23(5): 999-1006, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24395004

RESUMO

STUDY DESIGN: This is a retrospective study. PURPOSE: To compare the morphometric parameters of the psoas major and lumbar multifidus muscles in lumbar spinal stenosis (LSS) patients exhibiting different functional performance. LSS refers to symptoms related to size reduction of the lumbar spinal canal; however, the degree of stenosis is poorly related to symptom severity and functional impairments. Morphometric changes in the paraspinal muscles have been correlated with chronic lower back pain in previous studies. However, correlations between the functional performance of LSS patients and the morphometric changes in paraspinal muscles have seldom been reported. METHODS: Sixty-six LSS patients without mechanical back pain or segmental instability were enrolled in the study. A review of their medical records and MRI images was performed. Morphometric parameters, including the fatty infiltration (FI) of the lumbar multifidus muscle as well as the relative cross-sectional area (RCSA) of the psoas major and lumbar multifidus muscles, were measured. Subjects were divided into high and low functional performance groups according to their Japanese Orthopedic Association (JOA) scores. RESULTS: The male LSS patients exhibited a larger psoas RCSA than the female patients, whereas the older patients exhibited a smaller psoas RCSA and higher multifidus FI than the younger patients. LSS patients in the high functional performance group exhibited a significantly larger psoas RCSA and lower multifidus FI. CONCLUSION: The psoas RCSA and multifidus FI can be used as predictive factors for functional performance in LSS patients.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Músculos Paraespinais/diagnóstico por imagem , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/fisiopatologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Dor Lombar/etiologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Sexuais
15.
Comput Methods Programs Biomed ; 113(2): 456-64, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24280626

RESUMO

Femoral shaft fractures can be treated using retrograde interlocking nailing systems; however, fracture nonunion still occurs. Dynamic fixation techniques, which remove either the proximal or distal locking screws, have been used to solve the problem of nonunion. In addition, a surgical rule for dynamic fixation techniques has been defined based on past clinical reports. However, the biomechanical performance of the retrograde interlocking nailing systems with either the traditional static fixation technique or the dynamic fixation techniques has not been investigated by using nonlinear numerical modeling. Three-dimensional nonlinear finite element models were developed, and the implant strength, fixation stability, and contact area of the fracture surfaces were evaluated. Three types of femoral shaft fractures (a proximal femoral shaft fracture, a middle femoral shaft fracture, and a distal femoral shaft fracture) fixed by three fixation techniques (insertion of all the locking screws, removal of the proximal locking screws, or removal of the distal locking screws) were analyzed. The results showed that the static fixation technique resulted in sufficient fixation stability and that the dynamic fixation techniques decreased the failure risk of the implant and produced a larger contact area of the fracture surfaces. The outcomes of the current study could assist orthopedic surgeons in comprehending the biomechanical performances of both static and dynamic fixation techniques. In addition, the surgeons could also select a fixation technique based on the specific patient situation using the numerical outcomes of this study.


Assuntos
Pinos Ortopédicos , Fêmur/cirurgia , Análise de Elementos Finitos , Dinâmica não Linear , Humanos
16.
Ann Acad Med Singap ; 42(7): 320-7, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23949261

RESUMO

INTRODUCTION: Falls are common among older people. Previous studies have shown that falls were multifactorial. However, data regarding community-dwelling Chinese population are minimal. We aimed to study factors associated with falls among community-dwelling older Chinese people. MATERIALS AND METHODS: We conducted a cross-sectional study in a community hospital in Taiwan in 2010. Our sample included 671 elders from the 3680 examinees of the free annual Senior Citizens Health Examination. Participants were interviewed with a detailed questionnaire, and 317 elders were further invited for serum vitamin D tests. The main outcome was falls in the previous 12 months. Predictor variables included sociodemographic characteristics, lifestyle risk factors, body stature, frailty, serum 25 (OH) D levels, and medications. RESULTS: The mean age of the 671 participants was 75.7 ± 6.4 years old, and 48.7% of which were female. Fallers comprised 21.0% of the study population. In multivariate models, female gender (adjusted odds ratio (aOR): 2.32), loss of height in adulthood (aOR: 1.52), low body weight (aOR: 2.69), central obesity (aOR: 1.67), frailty (aOR: 1.56), polypharmacy (aOR: 2.18) and hyperglycaemia (aOR: 1.56) were factors associated with falls. Vitamin D insufficiency (serum 25 (OH) D levels <30 ng/mL) was not associated with falls (OR: 0.78; 95% CI, 0.38 to 1.60) (n = 317) in this study. CONCLUSION: Among community-dwelling older people in Taiwan, falls were mainly associated with female gender, polypharmacy, frailty, reduced body height, low body weight or central obesity, and hyperglycaemia. In addition to other risk factors, body stature should be considered as a novel risk factor when screening elders at risk for falls.


Assuntos
Acidentes por Quedas , Vida Independente/estatística & dados numéricos , Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Constituição Corporal , Estudos Transversais , Demografia , Feminino , Avaliação Geriátrica/métodos , Humanos , Hiperglicemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Polimedicação , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Taiwan/epidemiologia
17.
Prev Med ; 57(5): 511-7, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23872174

RESUMO

OBJECTIVE: The purpose of this study is to contribute evidence towards heterogeneity in risk factors for single and recurrent falls. METHOD: This is a prospective study conducted in Taiwan. Participants were randomly selected from the examinees of the annual health examination in 2010. Participants were interviewed with a detailed questionnaire and followed up one year later. Predictor variables included socio-demographic characteristics, medical conditions, laboratory data, and risk factors for osteoporosis. The outcome was falls in the ensuing 12 months. RESULTS: The mean age of the 653 completers was 75.6 ± 6.4. Half (48.7%) were women. Fallers and recurrent fallers comprised 14.5% and 6.0% of the participants, respectively. Blurred vision (adjusted odds ratio (aOR): 1.93, 95% confidence interval (CI): 1.02-3.67), minimal outdoor activities (aOR: 2.28, 95% CI: 1.06-4.88), and overactive thyroid/parathyroid (aOR: 3.49, 95% CI: 1.29-9.50) were associated with single falls. Frailty (aOR: 2.81, 95% CI: 1.11-7.09), decreased body height (aOR: 3.15, 95% CI: 1.52-6.54) and taking sedatives/hypnotics (aOR: 4.23, 95% CI: 2.06-8.67) were associated with recurrent falls. Previous falls (aOR: 2.64, 95% CI: 1.44-4.84 for single falls; aOR: 5.26, 95% CI: 2.61-10.60 for recurrent falls) were associated with all falls. CONCLUSION: Different intervention strategies should be developed for single and recurrent fallers.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Vida Independente/estatística & dados numéricos , Acidentes por Quedas/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/epidemiologia , Estudos Transversais , Feminino , Seguimentos , Idoso Fragilizado/estatística & dados numéricos , Avaliação Geriátrica/estatística & dados numéricos , Humanos , Masculino , Estudos Prospectivos , Fatores de Risco , Prevenção Secundária , Taiwan
18.
J Arthroplasty ; 28(10): 1788-90, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23850409

RESUMO

Evaluating three-dimensional angle error is necessary because we cannot get every patient's CT or MRI at all times. Creating a method that can calculate angle error from plain radiographs is therefore important. Using vector and trigonometric mathematics, we gradually deduct our formula which can calculate angle error from goal angles (the angles we plan to achieve before operation) to result angles (the angles we get after operation) by two perpendicular radiographs. We also encode it into Micorsoft Excel (Redmond Campus, Redmond, Washington, U.S.) so that it becomes more user-friendly. We hope this tool can be used when evaluating TKR, corrective osteotomy, fracture fixation, and so on.


Assuntos
Artroplastia do Joelho/métodos , Articulação do Joelho/diagnóstico por imagem , Tíbia/diagnóstico por imagem , Humanos , Articulação do Joelho/cirurgia , Prótese do Joelho , Modelos Biológicos , Radiografia , Tíbia/cirurgia
19.
Comput Aided Surg ; 18(5-6): 195-200, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23528151

RESUMO

BACKGROUND: Previous work by our group to address the problem of acetabular positioning based on 2D methods resulted in the development of a measurement method with better precision--Liaw's version. This method may help the early diagnosis of acetabular loosening. In the present study, we hypothesized that our computerized ellipse method could improve the precision of measuring acetabular version. METHODS: We developed our Elliversion software to measure acetabular version. Using total hip replacement (THR) Simulator, 96 radiographs were synthesized with random femoral inclination and 5° to 52° version, half with the femoral head included and half without. These synthetic radiographs and 28 real radiographs were measured with both Elliversion and the trigonometric method twice by one of the authors with a one-week interval between measurements. We then calculated the difference in the repeated measurements. Student's t-test was used for statistical analysis of the measuring error and inter-measurement difference. RESULTS: In the precision study, for synthetic radiographs including the femoral head, the ellipse method was significantly better than the trigonometric method (p < 0.01). For synthetic radiographs without the femoral head, there was no significant difference between the ellipse method and the trigonometric method (p = 0.19). As for the repeated measurements, for synthetic radiographs including the femoral head, the ellipse method was significantly better than the trigonometric method (p = 0.001), whereas for synthetic radiographs without the femoral head, there was no significant difference between the two methods (p = 0.17). For real radiographs, there was no significant difference between the two measuring methods (p = 0.12). However, if we excluded the four poor-quality radiographs, there was a significant difference between the two measuring methods (p = 0.04). DISCUSSION: We developed a computerized ellipse method for measuring acetabular version on synthetic radiographs and good-quality real radiographs. This method is characterized by its superior precision as compared to the trigonometric method. With the 2D standardized method (Liaw's version), improving the precision of measurement will help earlier diagnosis of acetabular loosening.


Assuntos
Acetábulo/diagnóstico por imagem , Algoritmos , Artroplastia de Quadril , Anteversão Óssea/diagnóstico por imagem , Diagnóstico por Computador , Prótese de Quadril , Acetábulo/cirurgia , Anteversão Óssea/etiologia , Humanos , Falha de Prótese , Ajuste de Prótese , Radiografia , Reprodutibilidade dos Testes
20.
Comput Aided Surg ; 16(4): 196-201, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21675935

RESUMO

OBJECTIVE: The acetabular version following total hip arthroplasty is an important prognostic factor. Computer navigation serves as a precise tool during hip arthroplasty, which requires precise measurement to verify the effect of the procedure. Wan and colleagues have reported an innovative method for measuring acetabular radiographic version with an ordinary goniometer. Our objective was to study the precision of this method. METHODS: We derived the underlying mathematical principle of Wan's method and produced a correction formula and chart. Forty-eight computer-synthesized radiographs were used to study the method and its mathematical correction. Ten real radiographs were used to detect intra-observer difference. The paired t-test was used for statistical analysis. RESULTS: There was a significant difference between synthetic acetabular radiographic version and the measurement obtained with Wan's method (p < 0.05), but there was no difference after mathematical correction (p = 0.15). For smaller radiographic version (<20(o)), there was no statistical difference using Wan's method (p = 0.054). CONCLUSIONS: The method of Wan and colleagues can be used when acetabular radiographic version is less than 20°. For larger radiographic versions, however, mathematical correction is necessary to obtain precise results.


Assuntos
Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Artrometria Articular , Artroplastia de Quadril/métodos , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Prótese de Quadril , Humanos
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