Functional outcomes and complications after treatment of distal radius fracture in patients sixty years and over: A systematic review and network meta-analysis

AimThis network meta-analysis aims to compare functional outcomes and complications between conservative treatment and surgery for distal radius fractures in patients aged 60 years and over.MethodsWe searched the PubMed, EMBASE, and Web of Science databases for randomized controlled trials (RCTs) assessing the effect of conservative treatment and surgery for distal radius fractures in patients aged 60 years and over. Primary outcomes included grip strength and overall complications. Secondary outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH) scores, Patient-Rated Wrist Evaluation (PRWE) scores, wrist range of motion and forearm rotation, and radiographic assessment. All continuous outcomes were assessed using standardized mean differences (SMDs) with 95% confidence intervals (CIs), and binary outcomes were assessed using odds ratio (OR) with 95% CIs. The surface under the cumulative ranking curve (SUCRA) was used to determine a hierarchy of treatments. Cluster analysis was performed for grouping treatments based on the SUCRA values of primary outcomes.ResultsFourteen RCTs were included to compare conservative treatment, volar lockedplate (VLP), K-wires fixation, and external-fixation. VLP outperformed conservative treatment for 1-year and minimum 2-year grip strength (SMD; 0.28 [0.07 to 0.48] and 0.27 [0.02 to 0.53], respectively). VLP yielded the optimal grip strength at 1-year and minimum 2-year follow-up (SUCRA; 89.8% and 86.7%, respectively). In a subgroup analysis of patients aged 60 to 80 years old, VLP outperformed conservative treatment in DASH and PRWE scores (SMD, 0.33 [0.10, 0.56] and 0.23 [0.01, 0.45], respectively). In addition, VLP had the fewest complications (SUCRA = 84.3%). Cluster analysis suggested that VLP and K-wire fixation were more effective treatment groups.ConclusionEvidence to date demonstrates that VLP provides measurable benefits in grip strength and fewer complications to those 60 years of age and over, and that benefit is not reflected in current practice guidelines. There is a subgroup of patients where K-wire fixation outcomes are similar to those of VLP; defining this subgroup may yield substantial societal benefits.     

Tracking Spinal Cord Injury Functional Outcomes Across the Lifespan: Validation of Linking Coefficients

ObjectiveValidation of linking coefficients to transform Pediatric Spinal Cord Injury Activity Measure (PEDI-SCI/AM) scores to adult Spinal Cord Injury-Functional Index (SCI-FI) scores.DesignThis cross-sectional study administered PEDI-SCI/AM and SCI-FI computerized adaptive tests (CATs) and short forms (SFs) to children with SCI and parents or caregivers.SettingHospitals, university, and rehabilitation institute.ParticipantsAbout 107 children with SCI and 96 parent or caregivers.InterventionsNot applicable.Main Outcome MeasuresLinking coefficients estimated SCI-FI (est-SCI-FI) scores from PEDI-SCI/AM scores for matched domains. Correlations between est-SCI-FI and actual SCI-FI scores were calculated. If correlations exceeded the criterion linking (0.866), the following analyses to compare est-SCI-FI and actual SCI-FI scores were conducted: paired t tests, intraclass correlation coefficients (ICCs 3, 1), percent of cases with absolute score differences at different thresholds.ResultsTwo matched domains, PEDI-SCI/AM Daily Routine/SCI-FI Self-Care and PEDI-SCI/AM General Mobility/SCI-FI Basic Mobility, met the linking criterion for both respondent-types (parent and child) and administration modes (CAT and SF). PEDI-SCI/AM Daily Routine and SCI-FI Fine Motor Function did not meet linking criterion for respondent type or mode. The linking criterion was met for wheelchair domains (child SF and CAT) and ambulation domains (child SF only). Significant differences between est-SCI-FI and actual SCI-FI scores were noted for all matched domains except Daily Routine/Self-Care (child SF only; parent SF and CAT). ICC values showed excellent agreement (range=0.75-0.89). Absolute differences between est-SCI-FI and actual SCI-FI scores were less than 1 standard deviation (except wheelchair CAT child).ConclusionsLinking coefficients applied to PEDI-SCI/AM scores can provide valid SCI-FI estimates that vary by domain, mode, and respondent type.     

青年人正常牙牙动度性别差异的研究

目的 :分析青年人正常牙牙动度参数是否有性别差异。方法 :使用自行研制的FX 1型牙动度测量系统对 2 0 0名汉族青年男性和女性右侧上下颌牙牙动度进行测量 ,得出参数TM (toothmobility)、K的均值 ,经对比分析 ,明确其有无差异。结果 :TM的均值有统计学差异 (P <0 .0 5 )。K的均值除 2 1|6 2 1|牙外 ,其余所有牙K的均值无统计学差异 (P >0 .0 5 )。结论 :参数TM被证明在青年人正常牙牙动度性别差异的研究中有明显的性别差异 ,为以后进一步研究青年人正常牙牙动度参数的参考值范围及临床应用作好铺垫。     

80 侧颞下颌关节骨性形态螺旋CT图像测量

目的揭示国人正常青年男性颞下颌关节(temporomandibular joint,TMJ)的骨性形态特征,建立该人群TMJ骨性形态参考值。方法对40例正常国人青年男性(21~24岁)的TMJ区行多排螺旋CT(multisliceCT,MSCT)扫描,在工作站上进行多平面重建(multi planar reformation,MPR)和参数测量,对结果进行统计学分析。结果反映TMJ骨性形态的各参数测量值左右侧TMJ之间无显著性差异(P>0.05),将左右侧测量结果合并得出各参数的参考值;计算各参数的变异系数显示该人群中TMJ的功能面较非功能面形态变异小,髁突纵轴倾斜角在所有的测量参数中变异系数最小(0.058);关节窝前后径(0.074),髁突左右径(0.075),髁突外1/3前后径(0.090),关节窝左右径(0.112)变异系数也比较小;在所有的测量参数中髁突垂直倾斜角、关节窝顶骨质厚度、髁突水平倾斜角变异系数最大(分别为0.663,0.638,0.390)。结论MSCT配合MPR可以实现对TMJ骨性形态进行精确而全面的测量,建立TMJ骨性形态参考值,该参考值可作为临床TMJ疾病诊断、治疗以及人工TMJ设计的参考。     

Validity and internal consistency of the American Orthopaedic Foot and Ankle Society Midfoot Scale in patients with Lisfranc injury

BackgroundThe American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Scale is an extensively used outcome measure instrument for evaluating outcomes after foot and ankle surgery or trauma.MethodsIn total, 117 patients with Lisfranc injury completed the AOFAS Midfoot Scale and the Visual Analogue Scale Foot and Ankle (VAS-FA) instruments. Internal consistency (correlation between different items), floor and ceiling values, convergent validity, item threshold distribution, and the coverage (item difficulty) of the AOFAS Midfoot scale were tested.ResultsAOFAS Midfoot Scale had high convergent validity and acceptable internal consistency (Cronbach’s alpha >0.70). The ceiling effect was confirmed. The person-item distribution indicated that the scale had a lack of coverage and targeting in our sample.ConclusionsOur data suggests that the AOFAS Midfoot Scale has acceptable validity and internal consistency. However, due to the lack of coverage and targeting, it should not be the primary outcome measure to be used to evaluate the outcomes after Lisfranc injury in the future studies.     

Prospective controlled cohort study to evaluate changes of function,activity and participation in patients with bilateral spastic cerebral palsy after Robot-enhanced repetitive treadmill therapy

BackgroundRobot-enhanced therapies are increasingly being used to improve gross motor performance in patients with cerebral palsy.AimTo evaluate gross motor function, activity and participation in patients with bilateral spastic cerebral palsy (BS-CP) after Robot-enhanced repetitive treadmill therapy (ROBERT) in a prospective, controlled cohort study.MethodsParticipants trained for 30–60 min in each of 12 sessions within a three-week-period. Changes in Gross Motor Function Measure (GMFM 66) scores, standardized walking distance, self-selected and maximum walking speed (ICF domain “Activity”), and Canadian Occupational Performance Measure (COPM; “Participation”) were measured. Outcome measures were assessed three weeks in advance (V1), the day before (V2) as well as the day after, and 8 weeks after ROBERT (V3 + V4).Results18 patients with BS-CP participated; age 11.5 (mean, range: 5.0–21.8) years, body weight 36.4 (15.0–72.0) kg. GMFCS levels I–IV were: n = 4; 5; 8; 1. There was no significant difference comparing V1 and V2. GMFM 66 (total +2.5 points, Dimension D +3.8 and E +3.2) and COPM (Performance +2.1 points, Satisfaction +1.8 points) showed statistically significant improvements for V3 or V4 compared to V1 or V2 representing clinically meaningful effect sizes. Age, GMFCS level, and repeated ROBERT blocks correlated negatively with GMFM improvement, but not with COPM improvement.InterpretationFollowing ROBERT, this prospective controlled cohort study showed significant and clinically meaningful improvements of function in ICF domains of “activity” and “participation” in patients with BS-CP. Further assessment in a larger cohort is necessary to allow more specific definition of factors that influence responsiveness to ROBERT program.     

电针配合康复训练对颈脊髓损伤术后患者功能恢复的影响

目的探讨电针配合早期康复训练对颈脊髓损伤术后患者功能恢复的影响。方法将60例颈脊髓损伤且行颈前路减压内固定手术的患者随机分为治疗组和对照组,每组30例。治疗组采用电针配合康复治疗,对照组采用单纯康复治疗。两组治疗前后分别采用Frankel分级、Barthel指数、功能独立性评定(FIM)进行评定。结果两组治疗后Frankel分级与同组治疗前比较,差异均无统计学意义(P0.05)。治疗组治疗后Frankel分级与对照组比较,差异无统计学意义(P0.05)。两组治疗后Barthel指数、FIM评分与同组治疗前比较,差异均具有统计学意义(P0.01)。治疗组治疗后Barthel指数、FIM评分与对照组比较,差异均具有统计学意义(P0.05)。结论电针配合早期康复训练能促进颈脊髓损伤术后患者的功能恢复,提高患者的生活质量。