肩关节置换术手术指征

B. Meta Analyses (Cochrane database, Bhandari et al) 1. Summary Results of Meta-Analyses ◆ Arthroplasty reduces the risk of revision surgery. ◆ Internal fixation-decreased blood loss, operative time, blood transfusion and risk of deep wound infection. ◆ Unfortunately, no definitive differences were noted with respect to mortality, degree of residual pain, or functional levels between the two treatments 2. Primary Arthroplasty Versus Early Salvage After Failed Internal Fixation ◆ Conclusions: Patients undergoing internal fixation for a displaced femoral neck fracture need to be informed that if this treatment fails and that if a cemented hip is subsequently performed, the results may not be as good as a primary hip arthroplasty. (McKinley and Robinson, JBJS, 2002)
◆ 使会议参加者对当前髋关节、膝关节及肩
关节的成形进行讨论，包括设计概念、材料发 展和临床效果。
◆ 提出对疑难的髋关节，膝关节肩关节如何
解决的问题，以及相关的外科技术。
◆ 评价当前的固定方法在原发和翻修操作步
骤的应用，包括骨水泥压迫嵌入、压迫移植应 用。 发表当前一些新概念，如材料的研制、生物反 应、以及确认临床发展的方向。
III. Internal Fixation versus Prosthetic Replacement A. Clinical Data 1.Observational Studies ◆Value limited by retrospective design, potential selection bias 2.Randomized trials ◆Bias decreased by randomization ◆However, randomized trials assessed a variety of different arthroplasty options which may not be clinically relevant today ◆Small sample size: limit the ability of these trials to provide definitive guidຫໍສະໝຸດ Baidunce for the orthopaedic surgeon
II. Questions 1. Which patients with displaced femoral neck fractures should be treated with internal fixation? ◆Factors that should be considered include age, fracture type, activity level and overall health 2. Should patients being treated with an arthroplasty procedure receive a unipolar, bipolar or total hip arthroplasty? 3. Is there evidence based information to support these decisions?
CURRENT CONCEPTS IN JOINT REPLACEMENT TM SPRING 2004 The course objectives are: ◆ To facilitate faculty/participant discussion on contemporary hip, knee and shoulder arthroplasty use inclusive of design concepts, material advances and clinical results. ◆ To present solutions to difficult hip, knee and shoulder management problems as well as surgical techniques which assist their solution. ◆ To evaluate the use of current fixation methods in primary and revision procedures including cement, hydroxyapatite, porous coated, press fit and impaction grafting applications. ◆ To address current concerns regarding implant material limitations and biologic response as well as identify clinical intervention strategies.
Hip Arthroplasty: I. Introduction A. Demographics ◆More than 220,000 fractures of the hip occur each year in North America. ◆Cost-greater than 9 billion dollar health care costs per year. ◆eterogeneous patient population-some patients are active community ambulators but many are nursing home residents. B.Issues ◆Optimal treatment of displaced femoral neck fractures remains controversial. ◆General agreement that patients regardless of age with nondisplaced or valgus impacted fractures (stable) will be treated with internal fixation. ◆General agreement that healthy patients 60 years or younger are good candidates for internal fixation. ◆However, treatment of patients older than 60 years of age is controversial. C.Treatment Options ◆Internal fixation ◆Arthroplasty