视觉模拟版IPSS评分表的应用评价

目的 评估视觉模拟版IPSS评分表(VAS-IPSS)对BPH患者的应用效果及影响因素分析.方法 选择未经治疗的BPH患者390例,随机分为2组,分别应用标准版IPSS和VAS-IPSS进行评分,2组分别再随机分为2个亚组,其中标准版IPSS组分为标准无讲解组(A组)和标准讲解组(B组),VAS-IPSS组分为图示无讲解组(C组)和图示讲解组(D组).讲解组在每次填写表格时接受医务人员对表格中描述性语言进行讲解,无讲解组由患者自行填写.间隔2周后,重复填写IPSS表,讲解组仍由医务人员进行讲解并协助填写.计算各组数据的组内相关系数( ICC),并用线性回归法探讨患者生活质量得分的最佳预测因子.结果 A、B、C、D组的ICC系数分别为0.87(95％ CI0.72 ～0.94 ),0.88(95％CI0.74 ～0.95),0.82(95％CI0.59 ～0.92),0.97(95％CI 0.93 ～0.99).A组的最佳预测因子为尿频(F=14.70,P=0.010),其次为夜尿(F=12.10,P=0.000)、尿急(F=11.80,p=0.000);B组最佳预测因子为夜尿(F =6.02,P=0.020),其次为尿不尽(F =5.79,P=0.008);C组最佳预测因子为夜尿(F =30.98,P=0.000),其次为尿不尽感(F=22.42,P=0.000);D组最佳预测因子为夜尿(F =20.20,P=0.000),其次为尿不尽感(F=18.00,P=0.000),尿线细(F=15.30,P=0.000).结论 VAS-IPSS的重测信度较标准版IPSS更为良好稳定,医务人员对评分条目的解释能够进一步提高VAS-IPSS的稳定性.     

Surgical treatment for elderly breast cancer patients over the age of 70

Because elderly breast cancer patients differ in various biological characteristics from younger patients, it is important to clarify the clinical characteristics and treatment results of elderly patients with this disease. A total of 332 breast cancer cases (327 patients) who received surgery were divided into three groups, consisting of a premenopause group younger than 50 years of age (group A, N = 144), a postmenopause group younger than 70 years of age (group B, N = 140), and elderly cases 70 years of age or older (group C, N = 48). A positive node involvement was seen in about 40% of all cases, but the lymph node positivity of group C was significantly lower than that of group A or B. The postoperative 5-year survival rates of groups A, B, and C were 88.9%, 87.5%, and 89.4% at all stages, and 90.2%, 86.2%, and 91.4% at stages I and II, respectively. Only in group C did survival rates show no significant difference between node status. We conclude that both radical and cosmetic surgical treatments performed in elderly breast cancer patients aged 70 years or older are as effective as in younger breast cancer patients.     

A comprehensive classification of craniofacial fractures: postmortem and clinical studies with two- and three-dimensional computed tomography

A comprehensive classification of midfacial/craniofacial fractures, based on two- and three-dimensional computed tomography (2D and 3D-CT) is presented.We performed a postmortem analysis of 24 patients who had died from trauma with signs of craniofacial fractures, based on 2D and 3D-CT studies with pathoanatomical findings. In addition, CT findings for 100 patients with craniofacial injuries requiring an emergency CT were correlated with surgical findings and follow-up results. On the basis of the analysis of a total of 377 fractures a classification system is proposed. The system is based on the use of the AO/ASIF (Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation) scheme, defining three types (A, B, C), three groups within each type (e.g. A1, A2, A3) and three subgroups within each group (e.g. A1.1, A1.2, A1.3) with increasing severity from A1.1 (lowest) to C3.3 (highest). The craniofacial region is divided into three units: the lower midface (I), the upper midface (II) and the craniobasal-facial unit (III). Lateral and central fractures are also distinguished. Type A fractures are non-displaced fractures, type B are displaced fractures and type C are complex/defect fractures. Groups A1, B1 and C1 comprise fractures of an isolated unit; groups A2, B2 and C2, combined fractures without involvement of the skull base; and groups A3, B3 and C3 are those combined fractures with involvement of the skull base. A correlation between the severity of the fracture and (i). the number of posttraumatic functional limitations (Spearman rank test, correlation coefficient r=0.42), (ii). the need for bone grafting or dural plastic (r=0.39) and (iii). facial asymmetry (r=0.37), was observed. The proposed classification system allows standardised documentation of midfacial and craniofacial fractures, including those not precisely defined by the Le Fort classification scheme.     

Computed tomography-based diagnostics might be insufficient in the determination of pancreatic cancer unresectability

AIM: To inquire into a question of an overestimation of arterial involvement in patients with pancreatic cancer (PC). METHODS: Radiology data were compared with the findings from 51 standard, 58 extended and 17 total pancreaticoduodenectomies; 9 distal resections with celiac artery (CA) excision; and 28 palliations for PC. The survival of 11 patients with controversial computed tomography (CT) and endoscopic ultrasound data with regard to arterial invasion, after R0/R1 procedures (false-positive CT results, Group A), was compared to survival after eight R2 resections (false-negative CT results, Group B) and after 12 bypass procedures for locally advanced cancer (true-positive CT results, Group C). RESULTS: In all of the cases in group A, operative exploration revealed no arterial invasion, which was predicted by CT. The one-year survival in Group A was 88.9%, and the two-year survival was 26.7%, with a median follow-up of 22 mo. One-year survival was not attained in groups B and C, with a significant difference in survival (P_a-b = 0.0029, P_b-c = 0.003). CONCLUSION: Arterial encasement on CT does not necessarily indicate arterial invasion. Whenever PC is considered unresectable, endoUS should be used. In patients with controversial CT an EUS data for peripancreatic arteries involvement radical resection might be possible, providing survival benefits as compared to R2- resections or palliative surgery.     

Pleural lavage cytology immediately after thoracotomy and before closure of the thoracic cavity for lung cancer without pleural effusion and dissemination: Clinicopathologic and prognostic analysis

Background: The significance of intraoperative pleural lavage cytology (PLC) in lung cancer patients without malignant effusion remains undetermined in terms of staging, prognosis, and local management. Methods: PLC was performed both after thoracotomy and before closure of the thoracic cavity in 325 patients with lung cancer without malignant pleurisy. Results: According to the PLC results (positive [+] or negative [−] after thoracotomy/before closure), the patients were classified as follows: group A (−/−), 262 patients; group B (+/−), 19; group C (−/+), 22; and group D (+/+), 22. In comparison with group A, group C showed more advanced stage with aggressive nodal involvement, and group D showed more advanced lung cancer related to pleural and nodal involvement, whereas group B showed characteristics similar to those of group A. The rate of pleural recurrence in group D was the highest (26%). In particular, pleural recurrence was seen in the patients with a relatively large number of adenocarcinoma cells in PLC after thoracotomy. The patients in groups C and D, especially those with adenocarcinoma, showed poorer prognosis, but in a multivariate analysis, PLC status was not an independent prognostic factor. Conclusions: PLC status after thoracotomy provides useful information in the detection of high-risk subgroup for pleural recurrence. Although PLC status is closely associated with survival, its prognostic value is not independent.     

帕瑞昔布钠用于不同年龄患儿日间手术后镇痛的适宜剂量

目的 探讨帕瑞昔布钠用于不同年龄患儿日间手术后镇痛的适宜剂量.方法 拟行腹股沟斜疝、鞘膜积液手术患儿180例,ASA分级Ⅰ级,年龄1～ 12岁,均采用七氟醚全身麻醉联合髂腹股沟神经阻滞麻醉,根据不同年龄分为3组(n=60):1～3岁组(Ⅰ组)、4～6岁组(Ⅱ组)和7～ 12岁组(Ⅲ组);采用随机数字表法,每组随机分为A亚组和B亚组(n=30),于切皮即刻分别静脉注射帕瑞昔布钠0.5和1.0 mg/kg.Ⅰ组采用面部表情加行为综合评分法(FLACC)、Ⅱ组采用语言表达与行为联合的东安大略儿童医院疼痛评分方法(CHEOPS)、Ⅲ组采用视觉模拟评分法(VAS)评价镇痛效果.FLACC评分≤3分、CHEOPS评分≤7分或VAS评分≤3分为镇痛有效.于术后6 h(T1)、12h (T2)和24 h(T3)时记录疼痛评分及术后24h内不良反应的发生情况.结果 与B亚组比较,Ⅰ-A亚组T1时疼痛评分升高(P＜0.01),其余时点差异无统计学意义,Ⅱ-A亚组和Ⅲ-A亚组各时点疼痛评分差异无统计学意义(P＞0.05);Ⅰ组术后镇痛有效率97％(Ⅰ-A亚组93％,Ⅰ-B亚组100％),Ⅱ组术后镇痛有效率100％,Ⅲ组术后镇痛有效率93％(Ⅲ-A亚组97％,Ⅲ-B亚组90％).Ⅰ组～Ⅲ组的2个亚组间不良反应发生率比较差异无统计学意义(P＞0.05).结论 帕瑞昔布钠1.0和0.5 mg/kg分别适于1～3岁和4～ 12岁患儿日间手术的术后镇痛.     

颅脑创伤后大鼠脑组织中Apelin表达变化的研究

目的研究颅脑创伤后大鼠脑组织中Apelin表达的变化规律。方法 96只雄性SD大鼠随机分为假手术组(A组)、轻型颅脑创伤组(B组)和重型颅脑创伤组(C组),每组又分6小时、24小时、72小时、168小时4亚组,RT-PCR法观测Apelin的基因表达,免疫组化法观测Apelin的表达。结果 B组和C组的Apelin表达高于A组,并在24小时达到高峰,而且在C组的升高程度大于B组。结论颅脑损伤后脑组织中Apelin的表达增加,并且与损伤严重程度相关。     

Subchondral magnetic resonance imaging changes in early osteoarthrosis associated with tibial osteonecrosis.

SUMMARY: The authors report on 41 patients with acute or subacute knee pain and early or midstage degenerative arthrosis with osteonecrotic lesions in the subchondral and metaphyseal region of the medial proximal tibia. Each lesion was identified only on magnetic resonance images (MRI). These MRI changes are classified and the clinical course is defined during a follow-up period averaging 4.5 years. Radiographically, 22 patients had minimal degenerative changes; 12 had moderate arthritis; and 7 were normal. With MRI, 3 distinct types of lesions were identified. Type A lesions had localized areas of decreased signal in the subchondral area. Type B lesions had diffuse signal changes with extension into the metaphysis. Type C lesions had metaphyseal involvement as well as a marginated serpentine subchondral rim usually associated with advanced osteonecrosis. There were 9 type A lesions, 23 type B, and 9 type C. At the end of 1 year, 33 patients (80%) had no or mild symptoms, and 8 (20%) had persistent moderate pain. At 4.5-year follow-up, most patients had symptoms consistent with progressive osteoarthrosis, 12 patients had severe symptoms (29%), 17 (41%) had mild or moderate symptoms, and only 12 (29%) were asymptomatic or had minimal symptoms. The type of MRI change seen initially was predictive of prognosis. Only 6 (19%) of the 32 patients with type A or B findings had severe symptoms at last follow-up. Six (66%) of the 9 patients with a type C MRI lesion had severe symptoms or had an operation by last follow-up. Twelve patients had follow-up MRI at a mean 15 months (range, 12 to 18 months) after the initial evaluation. The type A and B changes were either absent or significantly reduced. The type C subchondral marginated rim changes remained but metaphyseal involvement was reduced. There appears to be a spectrum of tibial subchondral MRI changes associated with sudden onset of medial knee pain in patients with early osteoarthritis of the knee. These changes may be indicative of osteonecrosis. The initial MRI classification is useful in predicting prognosis. Recognition of this problem may avoid unnecessary intra-articular surgery.     

Fluorodeoxyglucose Uptake Correlates with the Growth Pattern of Small Peripheral Pulmonary Adenocarcinoma

Purpose Noguchi and colleagues reported that the growth pattern of small-sized adenocarcinoma was related to the vascular involvement and the prognosis of the patient. Noguchi's type A/B tumors had no lymph node metastasis, rare vascular involvement, and an excellent prognosis, which meant that Noguchi's type A/B tumors were preinvasive tumors of the peripheral type. Although Noguchi's classification was usually determined based on resected specimens, it would be useful to make a decision about the therapeutic strategy if the classification could be determined preoperatively based on the fluorodeoxyglucose (FDG) uptake. Methods The FDG uptake in 61 pulmonary adenocarcinomas measuring 3 cm or smaller in diameter was compared with the mediastinal uptake and was classified into five grades. The relationship between the FDG uptake and Noguchi's classification (A to F) was analyzed. Results The FDG uptake was significantly lower in Noguchi's type A/B tumors than in type C or in type D/E/F. Eleven of 12 tumors (92%) with no increased or a weak FDG uptake were classified as type A/B, whereas 32 of 33 tumors (97%) with a strong or very strong FDG uptake were classified as type C–F. Conclusions The FDG uptake is helpful for making an accurate diagnosis of Noguchi's classification preoperatively in patients with pulmonary adenocarcinoma.     

Radical mastectomy with parasternal node dissection or radiation to the parasternal region for breast cancer of medial or central location

In order to establish a therapeutic approach for primary breast cancer of medial and central origin, we reviewed 183 patients who had been treated by one of the following three modalities at the Second Department of Surgery, Osaka University Medical School between January, 1965 and December, 1980. Group A (n=70): standard radical mastectomy alone; Group B (n=34): standard radical mastectomy followed by postoperative irradiation to the parasternal and supraclavicular regions, and; Group C (n=62): extended radical mastectomy that included removal of the parasternal lymph nodes. The background factors of the three groups were not significantly different. The overall survival five and ten years following surgery in the three groups were 91 per cent and 79 per cent in group A, 82 per cent and 67 per cent in group B, and 82 per cent and 70 per cent in group C, respectively, showing no significant difference in overall survival among the three groups. When the patients were classified according to the extent of axillary lymph node involvement, there was no difference in survival among the three treatments in patients who had less than three lymph node metastases in the axilla. However, treatment of the parasternal lymph nodes improved survival in the patients who had more than four lymph node metastases in the axilla. Parasternal lymph node involvement definitely worsened the prognosis, showing it to be a good prognostic factor. Thus, extended radical mastectomy should be considered for patients with breast cancer of medial or central location, when extended axillary lymph node involvement is found.     

Minimally displaced proximal humeral fractures

We analyzed 507 consecutive minimally displaced proximal humeral fractures and showed that, if the AO classification is used, there is variation in the incidence of minimally displaced fractures in the different AO sub-groups. Patients with Type A minimally displaced fractures are significantly younger than those with Type B or C fractures. 376 patients were followed for 1 year and 88% achieved excellent or good results with nonoperative management. Age was the main determinant of outcome, according to the Neer score and the time taken to return to activities of daily living. Subjectively, older patients felt that the results of treatment were better than the objective measurement of gleno-humeral function would indicate. Many patients with fair or poor results had co-morbidities that prevented a good result. The length of the physiotherapy course affected the outcome at 1 year.     

Minimally displaced proximal humeral fractures: epidemiology and outcome in 507 cases

We analyzed 507 consecutive minimally displaced proximal humeral fractures and showed that, if the AO classification is used, there is variation in the incidence of minimally displaced fractures in the different AO sub-groups. Patients with Type A minimally displaced fractures are significantly younger than those with Type B or C fractures. 376 patients were followed for 1 year and 88% achieved excellent or good results with nonoperative management. Age was the main determinant of outcome, according to the Neer score and the time taken to return to activities of daily living. Subjectively, older patients felt that the results of treatment were better than the objective measurement of gleno-humeral function would indicate. Many patients with fair or poor results had co-morbidities that prevented a good result. The length of the physiotherapy course affected the outcome at 1 year.     

Minimally displaced proximal humeral fracturesEpidemiology and outcome in 507 cases

We analyzed 507 consecutive minimally displaced proximal humeral fractures and showed that, if the AO classification is used, there is variation in the incidence of minimally displaced fractures in the different AO sub-groups. Patients with Type A minimally displaced fractures are significantly younger than those with Type B or C fractures. 376 patients were followed for 1 year and 88% achieved excellent or good results with nonoperative management. Age was the main determinant of outcome, according to the Neer score and the time taken to return to activities of daily living. Subjectively, older patients felt that the results of treatment were better than the objective measurement of gleno-humeral function would indicate. Many patients with fair or poor results had co-morbidities that prevented a good result. The length of the physiotherapy course affected the outcome at 1 year.     

The Addition of Radiation to Chemotherapy does not Improve Outcome When Compared to Chemotherapy in the Treatment of Resected Pancreas Cancer: The Results of a Single-Institution Experience

Background

Pancreas cancer is highly lethal even at early stages. Adjuvant therapy with chemotherapy (CT) or chemoradiation (CRT) is standard following surgery to delay recurrence and improve survival. There is no consensus on the added value of radiotherapy (RT). We conducted a retrospective analysis of clinical outcomes in pancreas cancer patients treated with CT or CRT following surgery.

Methods

Patients with resected pancreas adenocarcinoma were identified in our institutional database. Relevant clinicopathologic and demographic data were collected. Patients were grouped according to adjuvant treatment: group A: no treatment; group B: CT; group C: CRT. The primary endpoint of overall survival was compared between groups B vs. C. Univariate and multivariate analyses of potential prognostic factors were conducted including all patients.

Results

A total of 146 evaluable patients were included (group A: n = 33; group B: n = 45; group C: n = 68). Demographics and pathologic characteristics were comparable. There was no significant survival benefit for CRT compared with CT (mOS 16.8 months vs. 21.5 months, respectively, p = 0.76). Local recurrence rates were similar in all three groups. Univariate analyses identified absence of lymph node involvement (hazards ratio [HR] 1.43, p = 0.0082) and administration of adjuvant therapy (HR 0.496, p = 0.0008) as significant predictors for improved survival. Multivariate analyses suggested that patients without nodal involvement derived the most benefit from adjuvant treatment.

Conclusions

The addition of RT to CT did not improve survival over CT. Lymph node involvement predicts inferior clinical outcome.     

Intentional limited operation for minute peripheral adenocarcinoma of the lung

The purpose of this report is to evaluate the limited operation for peripheral minute adenocarcinoma of the lung. Firstly, 44 cases (47 lesions) of surgically resected minute peripheral lung adenocarcinoma, 10 mm or less in diameter, were reviewed using Noguchi's classification, and the correlation between high resolution CT (HRCT) images and the clinicopathological features was examined retrospectively. All type A and B adenocarcinomas (n = 14) had no recurrence and all cases were the air containing type by HRCT. Lymph node metastasis and lymphatic/vascular involvement were detected with type C, D, E, F and 3 cases among them were died for recurrence. Based on those results, from April 2000, intentional limited operation was prospectively performed for 14 patients (16 lesions) with peripheral nodule showing ground-glass opacity on HRCT. The pathological findings were type A (n = 9), type B (n = 5), and atypical adenomatous hyperplasia was one case (If the findings were confirmed type C, D, E, F by permanent section diagnosis, VATS lobectomy will be performed). We recommend limited operation should be performed in only type A or B adenocarcinoma and permanent section diagnosis is necessary to determine whether or not.     

The prognosis of tumors with only microscopic skin involvement without clinical T4b signs is significantly better than T4b tumors in breast carcinoma

The number of studies forming a base for tumor (T)-node (N)-metastasis (M) classification by comparing T4b tumors with only histological skin involvement in breast carcinoma is limited and results are contradictory. In this study, the survival of patients with T4b tumor and patients whose tumor had only microscopic skin involvement without clinical T4b signs were compared. The file records of 101 patients with T4b tumor (group A) and 79 patients whose tumor had only microscopic skin involvement (group B) were reviewed. The endpoint was disease recurrence. For the whole series, disease-free survival (DFS) of group B patients was significantly better compared with group A patients treated with either adjuvant (p<0.001) or neoadjuvant (p<0.001) therapies. When patients were subgrouped according to tumor size, DFS of group B patients was significantly better than group A patients receiving either adjuvant or neoadjuvant therapy for all tumor size subgroups of ≤3, >3, ≤5, and >5cm. Presence of T4b clinical signs had independent prognostic value in multivariate Cox analysis. In conclusion, tumors with only histological skin involvement without clinical T4b signs should be classified as T1-T3 according to their size instead of T4 as stated in the TNM classification.     

Characterization of Waiting Times in a Simulation of Kidney Paired Donation

A national kidney paired donation (KPD) program will substantially increase transplant opportunities for recipients with blood type incompatible or cross-match positive donors. It seems likely that donor-recipient pairs with certain blood types, races or restrictions will wait longer than others for a match, although no data exist to confirm this assumption. We simulated patients and characterized the predicted waiting times for different blood type sub-groups, as well as the effects of patient-imposed restrictions on waiting time. We also compared waiting times of different racial sub-groups. Almost all patients with panel-reactive antibody (PRA) less than 80% match within a few months in a national KPD program, with the longest waiting time seen by O recipients with AB donors. Highly sensitized patients wait considerably longer, especially those unwilling to travel or accept older donors, and those with AB or B donors may not match in a timely manner. Although patients are better served by matching in a combined pool than within their own race, racial inequalities exist and bonus points can offset some of these differences. These data provide the first waiting time predictions that can aid patients with incompatible donors in choosing between KPD and desensitization, and can also facilitate planning for a national KPD program.     

Interstitial radiation therapy for carcinoma of the prostate

Pelvic lymph node dissection and iodine 125 implantation has been systematically utilized at Memorial Sloan-Kettering Cancer Center (MSKCC) since 1970 as one form of management of selected patients with stage B or stage C prostatic cancer. Experience with the technique is reviewed on the basis of previously published data and on the basis of a five-year follow-up of the first 100 patients. The operative procedure has been generally well tolerated, with a low morbidity, with a mortality rate of 0.67% (2/300), and with minimal adverse effects on urinary, rectal, and sexual functions. Thirty-six percent of the patients had regional lymph node metastasis, and such was associated with a 71% incidence of distant metastasis at five years. However, at five years 14% of patients with positive nodes remain free of evidence of neoplasm, and 38% of patients with negative lymph nodes have evidence of bone metastasis. At five years, 11% of patients have evidence of local recurrence only; 19%, distant metastasis only; and 32%, both local recurrence and distant metastasis. Five-year survival without stratification relative to lymph node involvement is 100% (16/16) for stage B1, 88% (23/26) for stage B2, 66% (6/10) for stage B3, 33% (2/6) for stage C1, 53% (17/32) for stage C2, and 1/1 for stage C3, but endocrine therapy has presumably contributed to such survival in those patients developing intractable local recurrence and/or symptomatic distant metastasis within the five-year follow-up.     

Natural history of avascular necrosis of the femoral head in systemic lupus erythematosus

Clinical and radiographic studies were performed on 228 hips of 145 patients with avascular necrosis of the femoral head (ANFH). The patients were divided into three groups: group A consisted of 33 patients with systemic lupus erythematosus (SLE) who had been treated with systemic corticosteroids (59 hips); group B consisted of 41 patients with a history of corticosteroid treatment, excluding patients with SLE (69 hips); and group C consisted of 71 patients with no history of corticosteroid use (100 hips). Of the 228 hips, 80 hips at an early stage of the necrosis, but not showing collapse, were selected and classified by the criteria of the Japanese Investigation Committee (JIC) to define the natural history of the disease. In the SLE patients (group A), there was a predisposition to bilateral involvement and multiple sites of bone necrosis. Eighty percent of the femoral heads followed at an early stage had collapsed at the end of the follow-up, the incidence of collapse in group A being higher than that in the other groups. The collapses in group A were predominantly types 1C, 2, and 3B according to the JIC criteria. The incidence of collapse was significantly lower in type 1A and type 3A than in the other types. The classification proposed by the JIC, in terms of types with regard to size and location of the necrotic area on antero-posterior radiographs, was very useful for evaluation of the risk of collapse as well as for selecting appropriate treatment modalities, either conservative or surgical, during the early stages of ANFH.     

Comparison of functional outcomes among subtypes of Fraser’s typeⅡfloating knee

Purpose The poor prognosis in patients with floating knee injuries is mainly contributed to articular involvement(Fraser’s typeⅡ).This study aims to evaluate and compare the functional outcomes among different Fraser’s typeⅡfloating knee injuries after surgical management.Methods Twenty-seven patients with Fraser’s typeⅡfloating knee injuries(54 fractures)between September 2014 and December 2015 were enrolled prospectively in this study and were distributed according to Fraser’s floating knee classification into three different groups as typeⅡA(ipsilateral femoral shaft and tibial intra-articular involvement,n=11),typeⅡB(ipsilateral tibial shaft and femoral intra-articular involvement,n=9)and typeⅡC(both femoral and tibial intra-articular involvement,n=7).The differences among the groups were evaluated and compared.The functional outcomes of these injuries at one year were analyzed using Knee Injury and Osteoarthritis Outcome Score(KOOS)which covers 5 subscales of pain,other symptoms,activities of daily living,sports and recreation,and quality of life.The result was also compared with standardized age-sex matched healthy population using paired samples t-test.Results All the patients were male,and the injury mechanism was solely roadside accident.The mean age was 29.8 years and injury severity score 17.9(comparable in all the three groups).Most injuries were observed on the right side(20 cases,74.1%).Based on paired samples t-test,the KOOS score of patients with Fraser’s typeⅡA was found to be better than that of typeⅡB and typeⅡC.Compared with the reference age-sex matched control group,patients with Fraser’s typeⅡB andⅡC fractures had significantly lower mean score in all KOOS subscales(all p<0.01).However,Fraser’s typeⅡA only revealed significant difference regarding the subscales of activities of daily living(p<0.0001),sports and recreation(p<0.0001),and quality of life(p<0.0001).Conclusion The results of this study show that patients with Fraser’s typeⅡA fractures had a better functional outcome as compared to those with typeⅡB andⅡC fractures.This might be due to the open intra-articular involvement of the distal femur of the latter two fracture types.