Surgical-site-infections (SSI) prolong hospital stay, and they are leading nosocomial cause of morbidity and a source of excess cost. Recently, a waterless hand-rubbing protocol containing aqueous 1% chlorhexidine gluconate was developed before surgery, but there is no literature in orthopaedic surgery. The aim was to compare the SSI rates between waterless hand-rubbing and traditional hand-scrubbing protocol. STUDY 1: A total of 996 consecutive patients who underwent orthopaedic surgery between August 1, 2012 and January 31, 2014, were screened for SSI within 30 days after surgery. 500 patients from August 1, 2012 to April 1, 2013 were used by traditional hand-scrubbing, and 496 patients from June 1, 2013 to January 1, 2014 were by waterless hand-rubbing. STUDY 2: The twelve operating room staff members were randomly recruited, and the participants were assigned equally to use either a traditional hand-scrubbing protocol or a waterless hand-rubbing on 2 separate days. Washing times were recorded and microorganisms on hands were sampled on bacterial culture plates. Two days after sampling, the grown colonies were counted.[Introduction]
[Materials and Methods]
A Trabecular Metal Modular Acetabular System (Zimmer, Warsaw, Indiana, USA) is a peripheral rim expansion (elliptical) cup, i.e. a non-hemispherical cup. Radiologically a non-hemispherical cup may be deferent from other conventional hemispherical cups. We reviewed radiological findings of a Trabecular Metal Modular Acetabular System chronologically. Twenty six patients with osteoarthritis underwent primary total hip arthroplasty (THA) using a Trabecular Metal Modular Acetabular System from 2011 to April 2013. Twenty five patients (follow-up rate: 96.2%) 31 hips could be followed-up over a year were registered. In common, the diameter of every femoral head was 32 mm. We planned the acetabular cup inclination angle to be 45-degree, the cup coverage with host-bone (cup-CE angle) to be over 10-degree, and high hip center was allowed up to 20mm. In case of the cup-CE angle under 10-degree, an acetabular cup was placed medially using Dorr's medial protrusio technique. We established the medial protrusion angle indicating the degree of medial protrusion of an acetabular cup over the pelvic internal wall. The medial protrusion angle was defined by the center point of THA (C) and the 2 cross-points (X1, X2) which the outline of an acetabular cup crosses the Kohler's line (Figure 1). The cup anteversion angle was measured by the method of Lewinnek, and the cup fixation was evaluated according to the Tompkin's classification.Purpose
Methods
Posterior approach to the lumbar spine necessarily induces structural damage of paravertebral muscles. In order to avoid these changes, we have started to utilize a microscopic decompression of the spinal canal via an unilateral approach since 1998. The purpose of this study was to evaluate the results of this operative procedure for lumbar spinal canal stenosis. A total of 18 patients, 13 men and five women, were reviewed. The age at the time of surgery ranged from 53years to 78years with a mean of 69.0years. Follow up period averaged 12.3months ranging from one to 32months. As for operative procedure, unilateral paravertebral muscle was retracted laterally and lam-inotomy in the approached side was performed. Following complete decompression of a nerve root in the approached side, microscope was tilted and the inner aspect of lamina in the contralateral side was resected using high-speed drill with a guard of yellow ligament to dural sac and nerve root. Following the procedure, yellow ligament was resected and nerve root in the contralateral side was decompressed. Results: In operation time, blood loss and recovery rate of JOA score, there were no statistical differences compared with ordinal laminotomy cases. Dural sac was well decompressed not only in the hemilaminec-tomy side but also in the contralateral side. All cases showed intensity change of paravertebral muscle in the approached side on T2 weighted MRI. Conclusion: The procedure described here was definitely effective because paravertebral muscle in the contralateral side and midline structure of the lumbar spine could be completely preserved.
