Analysis of vertical and horizontal offsets in displaced femoral neck fracture in elderly treated with indigenous bicentric bipolar hip device

ObjectivesTo analyze the effect of indigenous bicentric bipolar prosthesis on horizontal and vertical offsets in fracture neck of femur when compared to contralateral normal hip and to evaluate functional outcomes. We hypothesized that our non-modular bipolar device restores satisfactory offsets in such patients.MethodsAll active elderly patients with displaced fracture NOF having contralateral normal hip were included. We used an indigenous bicentric bipolar hip-prosthesis, which is a non-modular single-piece device in all cases by lateral Hardinge approach. Postoperative radiograph AP view was taken in 15° internal rotation to decrease the effect of limb rotation on offset. CT scan was also used to evaluate offsets using ADW4.6 ADVANCED GE optima 128 slice software system. Subjects were followed for a minimum of 12 months postoperatively and functional outcome of effect of offsets change were evaluated by modified Harris Hip Score.ResultsThere is minimal difference in horizontal and vertical offset after bicentric bipolar hemi-replacement which is statistically insignificant supporting our hypothesis. The clinical outcomes were good to fair according to modified Harris Hip Score. The mean value of horizontal offset after our bipolar hemireplacement was 42.4 ± 2.04 mm and of normal hip was 41.8 ± 1.81 mm and P-value=0.08 in plain radiographs and value of horizontal offset in CT scan was 40.73 ± 0.27on bipolar side and 41.19 ± 0.77 on normal side. Vertical offset after bicentric bipolar was 32.67 ± 2.85 mm and vertical offset of normal hip was 32.53 ± 2.73 mm. Mean 9.77 ± 1.09 mm of calcar was preserved. Modified Harris Hip Score at 6 and 12 months postoperatively was 75.78 ± 4.16 and 79.53 ± 3.95 respectively. There was no incidence of hip dislocation.ConclusionOur study data clearly demonstrates that vertical and horizontal offsets are effectively maintained by the indigenous bicentric hip device. There was insignificant change in offsets as compared to contralateral normal side due to its design modifications. Indigenous bicentric non-modular bipolar device offers an excellent option for femur neck fractures in elderly patients in resource constrained situations. It allows rapid rehabilitation due to reduced surgical time, minimal blood loss and early return to function and activities of daily living.     

The measurement of neck strength: A guide for sports medicine clinicians

This masterclass aims to provide an overview of the measurement of neck strength and the factors which can increase the ecological validity of the testing protocol within an athletic population. Adopting a ‘gold standard’ method for measuring neck strength is of vital importance when determining strength differences across sports, ages and sexes. Without a ‘gold standard’ method current variations in testing procedure and equipment have created challenges in establishing normative neck strength data. With encouraging evidence that higher neck strength can have a protective effect against sports-related head and neck injuries, including concussion, new injury prevention knowledge may be impeded by a lack of consensus on how to accurately measure neck strength, with a number of different methods available. This masterclass will outline the factors clinicians should consider when selecting a device and measurement protocol when measuring maximal neck strength as well as how to interpret the results.     

Postoperative compensation after neurotomy in Meniere's disease: Retrospective study of 15 cases

Introduction

Vestibular neurotomy is a functional surgery for Meniere's disease in the event of medical treatment failure. The aim of the study was to assess the efficacy and complications of vestibular neurotomy, and to address the question of postoperative compensation.

补脾益肾方联合温针灸治疗重症肌无力疗效及对患者免疫功能的影响

目的:探讨补脾益肾方联合温针灸治疗对重症肌无力(MG)疗效及对免疫功能的影响。方法:随机分配84例MG病例为西药组和针药组,每组各42例,西药组给予常规西药治疗,即泼尼松片中剂量冲击,小剂量隔日维持治疗,针药组基于以上用药基础给予补脾益肾方联合温针灸治疗,治疗3个月后,统计两组治疗前后的中医证候积分,评估两组中医证候疗效,对比治疗前后的颈部血管流速、T淋巴细胞亚群水平和血清可溶性白细胞介素6受体水平。结果:治疗后,两组中医证候积分显著降低,针药组的变化幅度大于西药组(P<0.05); 针药组的中医证候总有效率低于西药组(P<0.05); 治疗后,两组颈内动脉(ICA)、颈总动脉(CCA)、颈外动脉(ECA)显著提高(P<0.05),两组T淋巴细胞中CD₃⁺、CD₄⁺亚群所占比和CD₈⁺、CD₄⁺比值显著降低(P<0.05),两组血清slL-6R水平均显著降低(P<0.05),以上指标针药组变化幅度大于西药组(P<0.05)。结论:补脾益肾方联合温针灸治疗能缓解MG患者的中医证候症状,提高疗效,促进其颈部血管循环,纠正患者自身机体免疫功能紊乱。     

揿针疗法分经论治神经根型颈椎病的临床研究

目的:观察揿针疗法分经论治神经根型颈椎病的临床疗效及可行性.方法:将70例神经根型颈椎病患者随机分为观察组与对照组,每组35例.对照组采用常规取穴的揿针疗法,观察组采用分经辨证取穴的揿针疗法.在治疗前后对两组患者的视觉模拟量表(VAS)评分及临床症状评分进行评价,并观察两组治疗方案的临床疗效.结果:治疗后,两组患者的VAS评分均较治疗前降低(均P<0.01),且观察组患者VAS评分低于对照组(P<0.01);两组患者的临床症状评分均较治疗前降低(均P<0.01),且观察组患者的临床症状评分低于对照组(P<0.01);观察组的临床总有效率高于对照组(P<0.05).结论:分经辨证取穴的揿针疗法能够降低神经根型颈椎病患者的疼痛评分,改善患者的临床症状,疗效优于常规揿针疗法.     

益气逐瘀方治疗早期脊髓型颈椎病临床研究

目的:观察益气逐瘀方治疗早期脊髓型颈椎病的临床疗效。方法:选取40例早期脊髓型颈椎病患者为研究对象,按照区组随机化方法分为对照组和治疗组,每组20例。对照组给予美洛昔康片、盐酸乙哌立松片治疗,治疗组给予益气逐瘀方治疗。对比观察2组患者治疗前后日本骨科协会(JOA)颈椎病评分和视觉模拟评分法(VAS)评分,采用富田庄司提出的方法检测颈椎突出物吸收率和突出率。结果:2组JOA颈椎病评分在治疗2周、3个月、6个月后与治疗前比较,差异均有统计学意义(P<0.05)。治疗组治疗3个月、6个月JOA颈椎病评分均高于同期对照组,差异均有统计学意义(P<0.05)。2组VAS评分在治疗2周、3个月、6个月后与治疗前比较,差异均有统计学意义(P<0.05)。治疗组治疗3个月、6个月VAS评分均低于同期对照组,差异均有统计学意义(P<0.05)。治疗后,治疗组颈椎间盘突出率较治疗前减小,对照组颈椎间盘突出率较治疗前增大,差异均有统计学意义(P<0.05)。治疗组颈椎间盘突出物吸收率高于对照组,差异有统计学意义(P<0.05)。结论:益气逐瘀方能有效缓解早期脊髓型颈椎病患者的颈痛症状,延缓病情进展,具有更好的远期疗效。     

A decade of head,neck and facial cricket injury hospitalisations in Victoria,Australia: From 2007/08 to 2016/17

ObjectivesTo present an epidemiological profile of hospital-treated head, neck and facial cricket injuries from 2007/08 to 2016/17 in Victoria, Australia.DesignRetrospective analysis of emergency department and hospital admission data.MethodsAn analysis of Victorian hospital-treated head, neck and facial cricket injuries of all cricket participants over 5 years old between July 2007 and June 2017.ResultsOver the decade, 3907 head, neck, facial (HNF) cricket injuries were treated in Victorian hospitals. The number of HNF cricket injuries substantially increased in the 2014/15 season from 367 to 435 injuries and remained over 400 in the subsequent years. More injuries were reported for male compared to female participants, 3583 compared to 324 injuries. When adjusted for participation in competitive cricket, the injury incidence rate was 1.3 per 1000 participants for males and 0.4 per 1000 participants for females. The 10−14 year age group most frequently required hospital treatment. Open wounds were the most common type of injury (1166, 29.8%) and the main mechanism for HNF cricket injury for this decade was hit/struck/crush (3361, 86.0%).ConclusionsThis study provides a novel and current insight of the incidence and details of HNF injuries among cricket participants in Victoria over a decade. It is evident that males and younger participants, regardless of gender, have a higher risk of sustaining a HNF injury. This study provides a solid evidence base for stakeholders in developing strategies to minimise head, neck and facial injuries to make cricket a safe sport for all.