渐进式功能锻炼对肱骨远端C 型骨折双钢板内固定术后影响

目的:探讨渐进式功能锻炼在肱骨远端C型骨折双钢板内固定术后对肘关节功能影响。方法:对纳入标准的80例肱骨远端C型骨折患者均给予双钢板内固定术,术后随机分为治疗组和对照组各40例,治疗组术后即可给予渐进式功能锻炼;对照组术后患肢于伸肘30°位石膏外固定制动,1周后(术后7~11天)开始功能锻炼。采用肘关节Mayo评分、肘关节活动度比较2组术后2周、术后3月、术后6月肘关节功能,并对术后6月并发症进行对比。结果:80例均获得随访,治疗组和对照组术后3月、术后6月肘关节疼痛、活动度、稳定性以及日常生活活动能力与术后2周比较,差异均有统计学意义(P<0.05);术后3月、术后6月治疗组肘关节疼痛评分均高于对照组(P<0.05);治疗组和对照组术后3月、术后6月肘关节屈曲度、肘关节伸直差值度、前臂旋前度及前臂旋后度与术后2周比较,差异均有统计学意义(P<0.05);术后3月、术后6月治疗组肘关节屈曲度,肘关节伸直差值度,前臂旋前度,前臂旋后度均高于对照组(P<0.05);术后3月两组优良率经Wilcoxon秩和检验(Z=–1.976,P<0.05);术后6月两组优良率经Wilcoxon秩和检验(Z=–2.042,P<0.05);2组术后6月均无出现切口感染及血管神经损伤,术后总并发症比较差异无统计学意义(P>0.05)。结论:肱骨远端C型骨折双钢板内固定术后早期渐进式功能锻炼在肘关节活动度、功能恢复、疼痛缓解方面具有明显优势,且安全可靠。     

Long-term Results of Comprehensive Clubfoot Release Versus the Ponseti Method: Which Is Better?

Background

Clubfoot can be treated nonoperatively, most commonly using a Ponseti approach, or surgically, most often with a comprehensive clubfoot release. Little is known about how these approaches compare with one another at longer term, or how patients treated with these approaches differ in terms of foot function, foot biomechanics, or quality-of-life from individuals who did not have clubfoot as a child.

Questions/purposes

We compared (1) focused physical and radiographic examinations, (2) gait analysis, and (3) quality-of-life measures at long-term followup between groups of adult patients with clubfoot treated either with the Ponseti method of nonsurgical management or a comprehensive surgical release through a Cincinnati incision, and compared these two groups with a control group without clubfoot.

Methods

This was a case control study of individuals treated for clubfoot at two separate institutions with different methods of treatment between 1983 to 1987. One hospital used only the Ponseti method and the other mainly used a comprehensive clubfoot release. There were 42 adults (24 treated surgically, 18 treated with Ponseti method) with isolated clubfoot along with 48 healthy control subjects who agreed to participate in a detailed analysis of physical function, foot biomechanics, and quality-of-life metrics.

Results

Both treatment groups had diminished strength and motion compared with the control subjects on physical examination measures; however, the Ponseti group had significantly greater ankle plantar flexion ROM (p < 0.001), greater ankle plantar flexor (p = 0.031) and evertor (p = 0.012) strength, and a decreased incidence of osteoarthritis in the ankle and foot compared with the surgical group. During gait the surgical group had reduced peak ankle plantar flexion (p = 0.002), and reduced sagittal plane hindfoot (p = 0.009) and forefoot (p = 0.008) ROM during the preswing phase compared with the Ponseti group. The surgical group had the lowest overall ankle power generation during push off compared with the control subjects (p = 0.002). Outcome tools revealed elevated pain levels in the surgical group compared with the Ponseti group (p = 0.008) and lower scores for physical function and quality-of-life for both clubfoot groups compared with age-range matched control subjects (p = 0.01).

Conclusions

Although individuals in each treatment group experienced pain, weakness, and reduced ROM, they were highly functional into early adulthood. As adults the Ponseti group fared better than the surgically treated group because of advantages including increased ROM observed at the physical examination and during gait, greater strength, and less arthritis. This study supports efforts to correct clubfoot with Ponseti casting and minimizing surgery to the joints, and highlights the need to improve methods that promote ROM and strength which are important for adult function.

Level of Evidence

Level III, prognostic study.     

Is it possible to save one lumbar segment in the treatment of thoracolumbar fractures?

Surgical treatment of unstable thoracolumbar fractures is controversial. Most authors reported that short segment fixation led to a high incidence of implant failure and correction loss. On the other hand, long segment fixation has the disadvantage of fusing more segments. We aimed to compare the outcomes of long-segment fixation versus two or three levels above and one level below fixation for acute thoracolumbar fractures. Twenty six consecutive patients were assigned to two groups. Group 1 included 14 patients treated with long fixation, whereas group 2 included 12 patients treated with two or three levels above and one level below fixation. Fractures were classified according to the Mc Cormack, Magerl and Denis classifications. Clinical (Oswestry questionnaire, Visual analog score) and radiological (Sagittal index, percentage of anterior body height compression, local kyphosis and Cobb angle) outcomes were analysed. The average follow-up for the long and hybrid fixation groups were 28 and 20 months respectively. Clinical scores of both groups at the last follow-up were not significantly different. The preoperative, postoperative and follow-up sagittal index, anterior body height compression, local kyphosis angle and Cobb angle were not significantly different. Correction loss of 3.36 degrees was seen in the long segment fixation group, versus 2.75 degrees in the other group at the last follow-up. There was no significant difference between the results achieved in the patients who had transpedicular fixation two or three levels above and one level below the fractured vertebra and those who had long segment fixation for thoracolumbar burst fractures.     

The natural history and longitudinal study of the surgically corrected clubfoot.

Surgical treatment for clubfoot has been largely directed at finding the best one-stage operation for the resistant clubfoot. Eighteen patients with 27 clubfeet (average follow-up 11 years since first surgery; range, 3.5-24 years) were reviewed. More than one clubfoot operation was required in 56% of cases. Forty-six percent were corrected after one surgery; 33% required a second surgery and 14% required a third operation. One patient with particularly severe feet required a fourth operation on each foot. The mean age at the time of surgery was 1.26 years, 5.12 years, and 8 years for the first, second, and third operations, respectively. The first operation consisted of a soft-tissue release. The second and third operations consisted of more extensive soft-tissue release and various rearfoot and forefoot procedures. Radiographic values revealed an AP talocalcaneal angle of 18 degrees, AP talo-first metatarsal angle of 6 degrees, lateral talocalcaneal angle of 29.6 degrees, lateral talo-first metatarsal angle of 15 degrees, and calcaneo-first metatarsal angle of 143 degrees. At follow-up all patients had adequate function as determined by personal interview and clinical examination. We conclude that correction of resistant congenital clubfoot often requires more than one surgery, not because of a "failed first operation," but due to dynamic muscle imbalances that may not be fully recognized in infancy and early childhood. Thus, the need for a second operation should not be perceived as a failure of the first, but as part of the natural history of congenital clubfoot.     

三种术式治疗无神经症状骨质疏松性胸腰椎爆裂骨折的疗效比较

目的比较经皮球囊扩张椎体后凸成形术(percutaneous kyphoplasty,PKP)、微创经皮复位内固定术、切开复位植骨融合内固定术三种术式治疗无神经症状骨质疏松性胸腰椎爆裂骨折的临床疗效。方法回顾性分析2015年6月至2017年6月我院收治的99例无神经症状骨质疏松性单节段胸腰椎爆裂骨折病人,根据手术方式分为PKP组(40例)、经皮复位组(27例)和切开复位组(32例)。收集各组病人的手术时间、出血量、住院时间、疼痛视觉模拟量表(visual analogue scale,VAS)评分、伤椎Cobb角及相关并发症;以随访X线片评价骨折复位情况。结果PKP组的手术时间、出血量、住院时间分别为(0.7±0.1)h、(4.6±1.6)ml、(2.4±0.9)d,均显著低于其他两组,且经皮复位组的出血量、住院时间显著低于切开复位组,差异均有统计学意义(P均<0.05)。三组病人术后、术后3个月和末次随访时的VAS评分和Cobb角均较术前显著改善,PKP组术后、术后3个月和末次随访时的Cobb角显著高于其他两组,差异均有统计学意义(P均<0.05)。PKP组术后骨水泥渗漏9例,无需处理。经皮复位组1例术后皮下血肿,处理后伤口愈合良好;2例术后钉道松动,无症状,术后1年取出。切开复位组术后病人伤口延迟愈合5例,处理后伤口延迟愈合。结论治疗无神经症状骨质疏松性胸腰椎爆裂骨折,这三种术式均可安全、有效缓解病人腰背部疼痛症状,但各有优缺点,临床应用还需根据病人诉求结合具体情况选择合适的治疗方案。     

Patient selection for lumbar arthroplasty and arthrodesis: the effect of revision surgery in a controlled, multicenter, randomized study

OBJECT: Patient selection is perhaps the most important factor in successful lumbar surgery. In this study, the authors analyzed the clinical outcomes of patients enrolled in the CHARITE investigational device exemption (IDE) trial who underwent revision surgery after primary total disc replacement with CHARITE or an anterior lumbar interbody fusion (ALIF) with placement of a BAK cage and iliac crest autograft. This revision surgery was either a supplemental posterior lumbar fixation or a 360 degrees fusion. Statistical analysis was conducted to compare clinical success in patients who underwent revision surgery with those who did not. METHODS: The patients enrolled in the CHARITE IDE study were divided into 6 groups according to treatment and repeated operation status, and their Oswestry Disability Index (ODI) and visual analog scale (VAS) scores at the 2-year follow-up and at baseline were compared. The patients had received the following treatments by group: A) ALIF without reoperation; B) ALIF with conversion to 360 degrees fusion; C) arthroplasty (randomized) without repeated operation; D) arthroplasty with supplemental posterior lumbar fixation; E) arthroplasty (nonrandomized) without repeated operation; and F) arthroplasty (nonrandomized) with supplemental posterior lumbar fixation. Outcome scores in the groups of patients who required revision surgeries (Groups B, D, and F; 23 patients) were compared with the groups that did not require revision surgery (Groups A, C, and E; 299 patients). RESULTS: Patients who required revision surgery had a significantly lower level of clinical improvement than those who did not. The mean change in ODI score was -53.0% in Groups A, C, and E, but just -12.7% in Groups B, D, and F (p < 0.0001). The mean change in VAS score was -59.1% in Groups A, C, and E, compared to -23.4% in Groups B, D, and F (p < 0.0001). No significant differences were identified in analyzing absolute change in scores and the percentage change. A comparison of outcomes in patients who had undergone arthroplasty without reoperation (Groups C and E) with all patients who had undergone revision surgery (Groups B, D, and F) demonstrated similar results (p < 0.0001). CONCLUSIONS: The 7.1% of patients who underwent a secondary stabilization procedure had poor clinical improvement. This finding may indicate that if the alternative treatment had been the initial treatment, these patients would not have benefited, and further implies a 7.1% rate of imprecision in preoperative evaluation.     

双眼外直肌后徙术与常规疗法治疗斜视临床疗效比较

目的:比较双眼外直肌后徙术与常规疗法治疗斜视的临床疗效。方法:选取2016年6月-2017年6月笔者医院收治的128例斜视患者,按治疗方式不同分成对照组和研究组,每组各64例。其中对照组患者行常规单眼外直肌后徙联合内直肌缩短术(R&R),研究组患者行双眼外直肌后徙术(BLR-rec)。术后对患者随访1年,观察术后眼位正位率、欠矫率、过矫率,视觉功能恢复情况以及并发症发生率。结果:研究组患者正位率为89.06%高于对照组的68.75%,差异有统计学意义(P<0.05)。术前,对照组和研究组患者视近度、视远度和平均斜视度比较,两组患者融合功能和立体视功能占比比较,差异均无统计学意义(P>0.05)。术后,两组患者的斜视度较治疗前均出现了明显下降(P<0.05),且研究组治疗后斜视度下降幅度明显大于对照组(P<0.05);两组患者视觉功能恢复率均明显增加(P<0.05),且研究组恢复率明显大于对照组(P<0.05)。研究组并发症发生率明显低于对照组(P<0.05)。结论:双眼外直肌后徙术较单眼外直肌后徙联合内直肌缩短术有更好地临床效果,且安全性更高,值得临床推广。     

External fixation in clubfoot treatment - a review of the literature

The treatment of neglected or relapsed clubfoot is still a challenge. Extensive open surgeries may lead to postoperative scarring and various complications.Gradual distraction using circular fixators for treatment of these cases was described by many researchers in the last decades. Different techniques were used with and without open surgeries. Recently the Taylor Spatial Frame was described for clubfoot correction using the principles of the Ponseti technique. Results of treatment using different techniques are described in this review. External fixation with soft tissue distraction even without open surgery is an effective treatment for neglected or relapsed clubfoot.     

Ponseti Idiopathic and Nonidiopathic Clubfoot Correction With Secondary Surgeries

The Ponseti method has revolutionized clubfoot treatment for not only idiopathic clubfoot but also non-idiopathic clubfoot. This study aimed to validate the existing literature with respect to the Ponseti method serving as first line treatment for clubfoot. The purpose of this study was to compare clubfoot type and recurrence with secondary surgical procedures following Ponseti method. Kaiser Permanente Northern California database was queried to identify clubfoot children under 3 years old with a consecutive 3-year membership. Associated comorbidities and operative procedure codes were identified. Chart review was performed on all surgical clubfoot patients who completed Ponseti method. Patients’ average age at time of surgery, frequency of surgeries, and types of procedures performed were recorded. A logistic regression analysis assessed the adjusted association between surgery status and clubfoot type. Clubfoot incidence was about 1 in 1000 live births. Of the 375 clubfoot children, 334 (89%) were idiopathic and 41 (11%) were non-idiopathic. In the total study population, 82% (n = 309) patients maintained Ponseti correction without a secondary surgery; 66 patients (18%) underwent subsequent secondary surgeries. The non-idiopathic clubfoot underwent surgery more frequently compared to idiopathic clubfoot patients (41.5% vs 14.7%, respectively, p = .0001). Non-idiopathic clubfoot children underwent surgery at a younger age. This study validates the Ponseti method is the first line treatment for clubfoot correction despite etiology. However, patients with recurrent clubfoot may require secondary surgery following Ponseti method. Clubfoot recurrence surveillance is key for identifying early symptomatic recurrence in order to minimize foot rigidity and the need for osseous procedures.     

Posterolateral lumbar and lumbosacral fusion with and without pedicle screw internal fixation.

Forty-seven patients who had lumbar or lumbosacral fusion with or without pedicle screw internal fixation by one surgeon for treatment of degenerative lumbar disease with clinical instability were retrospectively reviewed by an independent observer. Eighteen of the 21 patients whose fusions were internally fixed with the Variable Spinal Plating (VSP) system were available for review. A control group consisted of 27 patients who had fusion without internal fixation. The rate of pseudarthrosis did not significantly differ between the two groups (VSP group, 22%; versus control group, 26%). Twelve (67%) of the 18 patients treated with fusion and VSP instrumentation were considered to have had a good or excellent outcome, whereas 19 (70%) of the 27 patients treated by fusion without internal fixation had good or excellent results. Two VSP-instrumented patients had postoperative leg dysesthesias, whereas this complication was not observed in the control group. Bilateral posterolateral lumbar or lumbosacral fusion without internal fixation is as effective as and safer than fusion with pedicle screw instrumentation.     

关节镜下四袢与双袢固定修复急性肩锁关节Rockwood V型脱位疗效对比研究

目的对比评估双骨道四袢与单骨道双袢固定修复急性肩锁关节Rockwood Ⅴ型脱位疗效。 方法回顾性分析2010年5月至2016年5月于深圳大学第一附属医院接受关节镜下双骨道四袢与单骨道双袢固定修复急性肩锁关节Rockwood Ⅴ型脱位的所有患者,其中入选82例手术患者,四袢双骨道组与双袢单骨道组各41例。术后2年内随访观察患者的视觉模拟评分（visual analogue scale,VAS） 、患者恢复运动时间、恢复运动患者数量、Constant功能评分、Karlsson肩锁关节功能评分,并通过影像学观察评估喙锁关节和肩锁关节的间隙。 结果术后2年内末次随访X线片显示四袢双骨道组患侧平均喙锁关节和肩锁关节的间隙与双袢单骨道组对比明显减小,且差异具有统计学意义（P<0.05）;双袢单骨道组患者健侧平均喙锁关节和肩锁关节的间隙与患侧对比明显减小,且差异具有统计学意义（P<0.05）;然而四袢双骨道组患者健侧平均喙锁关节和肩锁关节的间隙与患侧对比差异无统计学意义（P>0.05）。两组患者术后末次随访患肢疼痛均有明显减轻,术前与术后VAS评分对比差异具有统计学意义,两组组间对比差异无统计学意义。四袢双骨道组重返运动的时间较双袢单骨道组明显缩短,重返患者数目明显多于双袢单骨道组,且Constant功能评分、Karlsson肩锁关节功能评分均明显优于双袢单骨道组,差异均具有统计学意义（P<0.05）。四袢双骨道组并发症明显少于双袢单骨道组。 结论采用关节镜下双骨道四袢固定治疗Rockwood V型脱位,方法固定可靠,并发症少,较双袢单骨道固定效果更佳,是治疗急性肩锁关节Rockwood V型脱位损伤较好的方法。     

恩替卡韦联合介入治疗乙型肝炎相关原发性肝癌的临床研究

目的：探讨恩替卡韦联合介入方法治疗乙型肝炎相关原发性肝癌（HBVR-HCC）的临床疗效。 方法：选择2007年2月—2011年2月85例确诊为HBVR-HCC、没有手术治疗适应证的患者,其中44例采用恩替卡韦联合肝动脉段性化疗栓塞（TACE）治疗（观察组）,41例单纯采用TACE治疗（对照组）,分析两组治疗前和治疗后4、12、24、48周HBV-DNA水平、肝功能、AFP水平和Child-Pugh评分,并比较两组的临床疗效、不良反应以及生存状况。 结果：随治疗时间延长,观察组HBV-DNA水平逐渐降低,而对照组逐渐升高,两组差异在治疗后各时间点均有统计学意义（均P<0.05）;两组谷丙转氨酶（ALT）与AFP水平、逐渐降低,但观察组在治疗24周后的降低程度明显优于对照组（均P<0.05）;两组Child-Pugh评分逐渐升高,但观察组在治疗24周后的升高程度低于对照组（P<0.05）。观察组HCC的治疗有效率明显高于对照组,并发症和不良反应均明显低于对照组（均P<0.05）。两组的1年生存率的差异无统计学意义（P>0.05）,但观察组2年生存率和中位生存期优于对照组（均P<0.05）。 结论：TACE对HBV活动存在激发作用,抗病毒联合TACE治疗HBVR-HCC可有效控制HBV,改善患者的肝功能,提高临床疗效,且不增加毒副作用。     

关节镜下单排与双排缝合桥修复技术治疗老年肩袖损伤的对照研究

目的关节镜下采取双排与单排缝合桥修复术治疗老年肩袖损伤的效果对比分析。 方法前瞻性收集简阳市人民医院2016年1月至2018年2月期间收治的118例老年肩袖损伤病患者,按随机数字表法分为对照组（关节镜下行单排锚钉固定）与观察组（关节镜下行双排缝合桥修复术）,两组各59例,比较两组不同程度损伤患者手术前后ASES评分、Constant-Murley评分、UCLA评分;并对比两组术后再撕裂发生率。 结果治疗前两组四种撕裂程度Constant-Murley、UCLA、ASES评分差异均无统计学意义（P>0.05）;治疗后两组比较,只有轻度撕裂三种评分差异均无统计学意义（P>0.05）,而巨大、重度、中度撕裂的三种评分两组间差异均具有统计学意义（P<0.05）,观察组显著优于对照组。对照组再撕裂发生率17/59（28.81%）显著高于观察组6/59（10.17%）（χ²=6.535,P=0.011）。 结论老年肩袖损伤采取双排与单排缝合桥术均可行,但双排缝合桥术应用范围较为广泛,且对于患者巨大、重度、中度撕裂改善效果更佳。     

颗粒骨经椎弓根椎体内外植骨融合内固定治疗胸腰椎骨折

目的探讨脊柱后路颗粒骨经椎弓根椎体内外植骨短节段椎弓根钉内固定治疗胸腰椎骨折可行性。方法将70例胸腰椎骨折随机分为两组:A组(n=20)采用颗粒骨经椎弓根椎体内植骨融合短节段椎弓根钉内固定;B组(n=50)采用单纯短节段椎弓根钉内固定。对后凸畸形角度及矫正角度、椎体前缘高度以及椎管矢状径进行测量,采用Frankel功能分级和Denis疼痛分级方法进行神经功能改变的评价。结果后凸畸形术后矫正度数较术前两组均很明显。随访中,A组矫正度数的丢失明显小于B组(P=0.0001)。术后伤椎前缘高度百分比增加值两组比较有显著差异(P<0.001)。术后随访中,A组伤椎椎体前缘高度无丢失(P<0.001),B组伤椎椎体前缘高度有丢失(P<0.05)。采用Denis疼痛分级,两组术后均有很好的改善。采用Frankel功能分级,术后神经功能变化,A组患者平均提高优于B组。结论脊柱后路颗粒骨经椎弓根椎体内外植骨结合内固定治疗胸腰椎骨折植骨融合率高,能有效恢复椎体高度和防止术后矫正度丢失。     

Early results of a new method of treatment for idiopathic congenital vertical talus

BACKGROUND: The treatment of idiopathic congenital vertical talus has traditionally consisted of manipulation and application of casts followed by extensive soft-tissue releases. However, this treatment is often followed by severe stiffness of the foot and other complications. The purpose of this study was to evaluate a new method of manipulation and cast immobilization, based on principles used by Ponseti for the treatment of clubfoot deformity, followed by pinning of the talonavicular joint and percutaneous tenotomy of the Achilles tendon in patients with idiopathic congenital vertical talus. METHODS: The cases of eleven consecutive patients who had a total of nineteen feet with an idiopathic congenital vertical talus deformity were retrospectively reviewed at a minimum of two years following treatment with serial manipulations and casts followed by limited surgery consisting of percutaneous Achilles tenotomy (all nineteen feet), fractional lengthening of the anterior tibial tendon (two) or the peroneal brevis tendon (one), and percutaneous pin fixation of the talonavicular joint (twelve). The principles of manipulation and application of the plaster casts were similar to those used by Ponseti to correct a clubfoot deformity, but the forces were applied in the opposite direction. Patients were evaluated clinically and radiographically at the time of presentation, immediately postoperatively, and at the time of the latest follow-up. Radiographic measurements obtained at these times were compared. In addition, the radiographic data at the final evaluation were compared with normal values for an individual of the same age as the patient. RESULTS: Initial correction was obtained both clinically and radiographically in all nineteen feet. A mean of five casts was required for correction. No patient underwent extensive surgical releases. At the final evaluation, the mean ankle dorsiflexion was 25 degrees and the mean plantar flexion was 33 degrees . Dorsal subluxation of the navicular recurred in three patients, none of whom had had pin fixation of the talonavicular joint. At the time of the latest follow-up, there was a significant improvement (p < 0.0001) in all of the measured radiographic parameters compared with the pretreatment values, and all of the measured angles were within normal values for the patient's age. CONCLUSIONS: Serial manipulation and cast immobilization followed by talonavicular pin fixation and percutaneous tenotomy of the Achilles tendon provides excellent results, in terms of the clinical appearance of the foot, foot function, and deformity correction as measured radiographically at a minimum two years, in patients with idiopathic congenital vertical talus.     

The effect of cervical plating on single-level anterior cervical discectomy and fusion

The use of anterior plates for single-level cervical fusions is controversial. Previous studies that evaluated single and multiple-level fusions have shown increased and decreased fusion rates when cervical plates are used. The purpose of this study was to compare the clinical and radiographic success of single-level discectomy performed with and without anterior cervical plate fixation. During a 6-year period, 80 patients were surgically treated with a single-level anterior cervical discectomy. Forty-four patients had cervical plates, whereas 36 had fusions without plates (average follow-up, 2.3 years). The pseudarthrosis rates were 4.5% (2 of 44) for patients with plating and 8.3% (3 of 36) without plating. This difference was not significant (p = 0.653). There was no correlation of pseudarthrosis with sex, age, level of surgery, history of tobacco use, or the presence of previous anterior surgery. The amount of graft collapse for patients with plating was 0.75 mm compared with 1.5 mm for those without a plate (p = 0.026). The amount of kyphotic deformity of the fused segment was 1.2 degrees with plating compared with 1.9 degrees for patients without plating (p = 0.079). Ninety-one percent of the patients with plating had good or excellent results compared with 88% in the group without cervical plates, based on Odom's criteria. The addition of plate fixation for single-level anterior cervical discectomy and fusion is safe and not associated with a significant increase in complication rates. The pseudarthrosis rates are not significantly different when a cervical plate is used.     

Internal fixation versus hemiarthroplasty for displaced fractures of the femoral neck in elderly patients with severe cognitive impairment

We studied 60 patients with an acute displaced fracture of the femoral neck and with a mean age of 84 years. They were randomly allocated to treatment by either internal fixation with cannulated screws or hemiarthroplasty using an uncemented Austin Moore prosthesis. All patients had severe cognitive impairment, but all were able to walk independently before the fracture. They were reviewed at four, 12 and 24 months after surgery. Outcome assessments included complications, revision surgery, the status of activities of daily living (ADL), hip function according to the Charnley score and the health-related quality of life (HRQOL) according to the Euroqol (EQ-5D) (proxy report).General complications and the rate of mortality at two years (42%) did not differ between the groups. The rate of hip complications was 30% in the internal fixation group and 23% in the hemiarthroplasty group; this was not significant. There was a trend towards an increased number of re-operated patients in the internal fixation group compared with the hemiarthroplasty group, 33% and 13%, respectively (p = 0.067), but the total number of surgical procedures which were required did not differ between the groups. Of the survivors at two years, 54% were totally dependent in ADL functions and 60% were bedridden or wheelchair-bound regardless of the surgical procedure. There was a trend towards decreased mobility in the hemiarthroplasty group (p = 0.066). All patients had a very low HRQOL even before the fracture. The EQ-5D(index) score was significantly worse in the hemiarthroplasty group compared with the internal fixation group at the final follow-up (p < 0.001).In our opinion, there is little to recommend hemiarthroplasty with an uncemented Austin Moore prosthesis compared with internal fixation, in patients with severe cognitive dysfunction.     

Screw Internal Fixation and Ilizarov External Fixation: A Comparison of Outcomes in Ankle Arthrodesis

The purpose of this study was to compare the mid-term clinical outcomes between screw internal fixation and Ilizarov external fixation in patients who underwent ankle arthrodesis and to elucidate the differences between the 2 fixation methods. This study investigated 43 ankles in 41 patients who underwent ankle arthrodesis at 1 of the 2 study institutions. There were 15 men and 26 women, and their mean age was 66.2 (range 49 to 87) years. The primary disease included osteoarthritis (OA) (79%), rheumatoid arthritis (RA) (16.3%), and Charcot joint (4.7%). Patients were divided into 2 groups depending on the surgical approach: the screw group (S) and the Ilizarov group (I). The following items were evaluated and compared between the 2 groups: patient characteristics, Tanaka-Takakura classification based on preoperative plain X-ray images, duration of surgery, blood loss, surgical complications, time to start weightbearing, and the Japanese Society of Surgery of the Foot (JSSF) standard rating system for the ankle-hindfoot. Duration of surgery was significantly shorter in the S group (162.3 versus 194.9 min), and the amount of blood loss was also significantly lower in the S group (29.2 versus 97.5 ml). Preoperative JSSF scale was significantly lower in the I group (44.8 versus 33), but postoperative JSSF scale was not significantly different between the 2 groups (82.1 versus 77.9). The S group had satisfactory clinical outcomes with a shorter duration of surgery and smaller amount of blood loss than the I group. However, severe patients in the I group achieved similar treatment outcomes.     

锁定钢板内固定联合植骨在老年肱骨近端骨折患者治疗中的应用研究

目的探究锁定钢板内固定联合植骨在老年肱骨近端骨折患者治疗中的应用。 方法将2017年5月至2019年5月入住本院接受治疗的68例老年肱骨近端骨折患者作为本次的研究对象，依据采用治疗方式的不同分为研究组与对照组，每组患者34例。对照组患者采用普通的钢板内固定术；研究组患者采用锁定钢板内固定联合植骨的治疗方式。比较两组患者的视觉模拟评分（visual analogue scale，VAS）、SF-36评分以及肩功能评分，比较两组患者的治疗效果、手术时间、术中出血量以及住院时间，比较两组患者并发症的发生及术后肱骨头内翻畸形的发生情况。 结果术后3个月，研究组患者的VAS评分与对照组比较显著较低，SF-36评分与肩功能评分显著高于对照组（P<0.05）；研究组患者的优良率与对照组比较显著较高（P<0.05）；研究组患者的手术时间以及住院时间与对照组比较显著较短，术中出血量显著少于对照组（P<0.05）；研究组患者并发症的总发生率与对照组比较显著较低（P<0.05）；研究组内翻畸形发生率显著少于对照组（P<0.05）。 结论在老年肱骨近端骨折患者临床诊疗的过程中，采用锁定钢板内固定联合植骨治疗，能够有效降低患者的疼痛程度，显著改善患者的生活质量状况，对于患者肩功能的恢复有积极的促进作用，同时能够减少并发症及内翻畸形情况出现，利于患者预后。