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1.
Objective
To investigate whether wearing graduated compression stockings (GCS) could affect the sympatho-adrenergic and heart rate variability (HRV) responses at rest and after a strenuous wheelchair exercise in individuals with spinal cord injury (SCI).Design
Crossover trial.Setting
Department of Physical Medicine and Rehabilitation, Saint Etienne, France.Participants
Nine men with SCI (five with low paraplegia: LP, four with high paraplegia: HP).Interventions
Two maximal wheelchair exercise tests: with and without GCS (21 mmHg).Main outcome measures
HRV measurements: high frequency (HF), low frequency (LF), and LF/HF ratio. Norepinephrine (NOR) and epinephrine (EPI), at rest and post-exercise. Secondary measures were: blood pressure, heart rate, maximal power output, oxygen uptake, stroke volume, cardiac output, at rest, during and after exercise.Results
When wearing GCS: LFnuwavelet-post significantly increased and HFnuwavelet-post significantly decreased (P < 0.05) in SCI subjects, leading to an enhance ratio of LFwavelet/HFwavelet and a significantly increased in NORrest (P < 0.05).Conclusions
GCS induces an enhanced sympathetic activity in individuals with paraplegia, regardless of the level of the injury. Enhanced post-exercise sympathetic activity with GCS may help prevent orthostatic hypotension or post-exercise hypotension. 相似文献2.
Thietje R Pouw MH Schulz AP Kienast B Hirschfeld S 《The journal of spinal cord medicine》2011,34(5):482-487
Study design
Retrospective study.Objective
To investigate the causes of death in patients who were ≤50 years at the time of traumatic spinal cord injury (tSCI).Setting
Convenience sample of a tertiary rehabilitation center.Methods
All deceased patients with tSCI who survived a minimum of 10 years post-injury, were included. In addition, causes of death were compared between subjects surviving <10 years and ≥10 years. Neurological assessments were performed according to the American Spinal Injury Association scale. Data on causes of death were analyzed using the ICD-10 classifications. Differences were calculated using the Mann–Whitney and chi-square tests.Results
A total of 100 patients, with 38 and 62 surviving <10 and ≥10 years, respectively, were included. No significant differences in causes of death were identified between these two groups. In patients surviving ≥10 years, paraplegia was associated with a higher life expectancy compared with tetraplegia, 34 and 25 years (p = 0.008), respectively, and the leading causes of death were septicemia (n = 14), ischemic heart disease (n = 10), neoplasms (n = 9), cerebrovascular diseases (n = 5), and other forms of heart diseases (n = 5). Septicemia, influenza/pneumonia, and suicide were the leading causes of death in tetraplegics, whereas ischemic heart disease, neoplasms, and septicemia were the leading causes of death in paraplegia.Conclusion
Our monocentric study showed that in 62 deceased patients with SCI, the leading causes of death were septicemia, cardiovascular diseases, neoplasms, and cerebrovascular diseases. In addition, no significant differences were identified between causes of death among patients surviving <10 years and ≥10 years post-injury. 相似文献3.
Hua Jiang Xusheng Qiu Jin Dai Huang Yan Zezhang Zhu Bangping Qian Yong Qiu 《European spine journal》2013,22(2):282-286
Purpose
To investigate whether rs11190870 near LBX1 correlates with the susceptibility or curve progression of adolescent idiopathic scoliosis (AIS) in a Han Chinese population.Methods
A total of 949 AIS patients and 976 age-matched healthy controls were recruited. All the subjects were genotyped using the PCR-based invader assay. Case–control study and case-only study were performed to define the contribution of rs11190870 to predisposition and curve severity of AIS. Additionally, we further conducted a meta-analysis of the study findings together with those of previously reported studies.Results
A significant association of rs11190870 with AIS was observed in the Han Chinese population (P = 1.8 × 10−9; odd ratio = 1.51; 95 % confidence interval = 1.33–1.71), and AIS patients with TT genotype had a larger Cobb angle than those with TC or CC genotype (P = 0.005). The meta-analysis confirmed that the positive association of this SNP with AIS in the East Asian population.Conclusions
The SNP rs11190870 near LBX1 is associated with both susceptibility and curve progression of AIS. 相似文献4.
Yu He XinJun Liang ChunQing Meng ZengWu Shao Yong Gao Qiang Wu JianXiang Liu Hong Wang ShuHua Yang 《International orthopaedics》2014,38(8):1671-1676
Purpose
Osteosarcoma is the most common childhood bone cancer. Interleukin-1 beta (IL-1B) is crucially involved in osteosarcoma carcinogenesis. Whether genetic polymorphisms of IL-1B also influence osteosarcoma risk is unknown. The aim of this study was to investigate the association between IL-1B gene polymorphisms and osteosarcoma risk in Chinese Han patients.Methods
A hospital-based case–control study involving 120 osteosarcoma patients and 120 controls was conducted. Polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) analysis was performed to detect three IL-1B gene polymorphisms (−31 T/C, −511 C/T and +3954 C/T) in these patients.Results
Patients with osteosarcoma had a significantly lower frequency of −31 CC genotype [odds ratio (OR) = 0.40, 95 % confidence interval (CI) = 0.17–0.92; P = 0.03] and −31 C allele (OR = 0.67, 95 % CI = 0.46–0.99; P = 0.04) than controls. Patients with osteosarcoma had a significantly lower frequency of −511 TT genotype (OR = 0.40, 95 % CI = 0.17–0.95; P = 0.04) than controls. The +3954 C/T gene polymorphisms were not associated with a risk of osteosarcoma. When stratified by Enneking stage, tumour location, histological type, tumour metastasis of osteosarcoma and family history of cancer, no statistically significant results were found.Conclusions
This is the first study to provide evidence for an association of IL-1B gene polymorphisms with osteosarcoma risk. 相似文献5.
Dimitri Ceroni Rebecca Anderson de la Llana Xavier Martin Léopold Lamah Geraldo De Coulon Katia Turcot Victor Dubois-Ferrière 《Journal of children's orthopaedics》2012,6(6):497-503
Background
The significance of subclinical vitamin D deficiency in the pathogenesis of fractures in children and adolescents currently remains unclear.Objective
We aimed to determine the prevalence of vitamin D insufficiency and its effect on bone mineral density (BMD) and bone mineral content (BMC) values in a collective of Swiss Caucasian children with a first episode of appendicular fracture.Design and methods
One hundred teenagers with a first episode of appendicular fracture [50 upper limb fractures (group 1) and 50 lower limb fractures (group 2)] and 50 healthy controls (group 3) were recruited into a cross-sectional study. The BMC and BMD values were measured by dual-energy X-ray absorptiometry, and serum 25 hydroxyvitamin D [25(OH)D] was assessed by electrochemiluminescence immunoassays.Results
From the 100 injured teenagers in the study, 12 % had deficient vitamin D levels (<20 ng/mL; <50 nmol/L) and 36 % had insufficient levels (≥20 <30 ng/mL; ≥50 <78 nmol/L), whereas 6 and 34 % of healthy controls were, respectively, vitamin D deficient and insufficient. There were no significant differences for serum 25(OH)D levels, L2–L4 BMD Z-score, and L2–L4 BMC Z-score variables (p = 0.216) between the three groups nor for the calcaneal BMD Z-score variables (p = 0.278) between healthy controls and lower limb fracture victims. Investigations on the influences of serum 25(OH)D on BMD and BMC showed no correlation between serum 25(OH)D and L2–L4 BMD Z-scores (r = −0.15; p = 0.135), whereas low but significant inverse correlations were, surprisingly, detected between serum 25(OH)D and calcaneal BMD Z-scores (r = −0.21; p = 0.034) and between serum 25(OH)D and L2–L4 BMC Z-scores (r = −0.22; p = 0.029).Conclusions
A significant proportion of Swiss Caucasian teenagers were vitamin D insufficient, independent of limb fracture status, in our study. However, this study failed to show an influence of low vitamin D status on BMD and/or BMC of the lumbar spine and heel. 相似文献6.
Dhindsa MS Merring CA Brandt LE Tanaka H Griffin L 《The journal of spinal cord medicine》2011,34(6):594-599
Objective
To determine the association between peripheral blood flow and spasticity in individuals with spinal cord injury (SCI).Design
A cross-sectional study with measurements of muscle spasticity and whole-limb blood flow in individuals with SCI.Setting
University of Texas at Austin and Brain & Spine Recovery Center, Austin, TX, USA.Participants
Eighteen individuals (14 males and 4 females) with SCI were classified into high (N = 7), low (N = 6), and no (N = 5) spasticity groups according to the spasticity levels determined by the modified Ashworth scale scores.Interventions
Whole-limb blood flow was measured in the femoral and brachial arteries using Doppler ultrasound and was normalized to lean limb mass obtained with dual-energy X-ray absorptiometry.Outcome measures
Limb blood flow and muscle spasticity.Results
Age, time post-SCI, and the American Spinal Injury Association impairment scale motor and sensory scores were not different among groups with different muscle spasticity. Femoral artery blood flow normalized to lean leg mass was different (P = 0.001) across the three spasticity groups (high 78.9 ± 16.7, low 98.3 ± 39.8, no 142.5 ± 24.3 ml/minute/kg). Total leg muscle spasticity scores were significantly and negatively correlated with femoral artery blood flow (r = −0.59, P < 0.01). There was no significant difference in brachial artery blood flow among the groups.Conclusions
Whole-leg blood flow was lower in individuals with greater spasticity scores. These results suggest that a reduction in lower-limb perfusion may play a role, at least in part, in the pathogenesis leading to muscle spasticity after SCI. 相似文献7.
Background
Impact forces experienced by the upper limb at the beginning of each wheelchair propulsion (WCP) cycle are among the highest forces experienced by wheelchair users.Objective
To determine whether the magnitude of hand/forearm velocity prior to impact and effectiveness of rim impact force are dependent on the type of hand trajectory pattern chosen by the user during WCP. Avoiding patterns that inherently cause higher impact force and have lower effectiveness can be another step towards preserving upper limb function in wheelchair users.Methods
Kinematic (50 Hz) and kinetic (2500 Hz) data were collected on 34 wheelchair users (16 with paraplegia and 18 with tetraplegia); all participants had motor complete spinal cord injuries ASIA A or B. The four-hand trajectory patterns were analyzed based on velocity prior to contact, peak impact force and the effectiveness of force at impact.Results
A high correlation was found between the impact force and the relative velocity of the hand with respect to the wheel (P < 0.05). The wheelchair users with paraplegia were found to have higher effectiveness of force at impact as compared to the users with tetraplegia (P < 0.05). No significant differences in the impact force magnitudes were found between the four observed hand trajectory patterns.Conclusion
The overall force effectiveness tended to be associated with the injury level of the user and was found to be independent of the hand trajectory patterns. 相似文献8.
Laurent Audigé Flurin Cagienard Christoph Martin Sprecher Norbert Suhm Marc Andreas Müller 《International orthopaedics》2014,38(4):839-845
Purpose
This study aimed to propose a technique to quantify dynamic hip screw (DHS®) migration on serial anteroposterior (AP) radiographs by accounting for femoral rotation and flexion.Methods
Femoral rotation and flexion were estimated using radiographic projections of the DHS® plate thickness and length, respectively. The method accuracy was evaluated using a synthetic femur fixed with a DHS® and positioned at pre-defined rotation and flexion settings. Standardised measurements of DHS® migration were trigonometrically adjusted for femoral rotation and flexion, and compared with unadjusted estimates in 34 patients.Results
The mean difference between the estimated and true femoral rotation and flexion values was 1.3° (95 % CI 0.9–1.7°) and −3.0° (95 % CI – 4.2° to −1.9°), respectively. Adjusted measurements of DHS® migration were significantly larger than unadjusted measurements (p = 0.045).Conclusion
The presented method allows quantification of DHS® migration with adequate bias correction due to femoral rotation and flexion.Electronic supplementary material
The online version of this article (doi:10.1007/s00264-013-2146-4) contains supplementary material, which is available to authorised users. 相似文献9.
Patricio Melean Sven Lichtenberg Fredy Montoya Stephan Riedmann Petra Magosch Peter Habermeyer 《International orthopaedics》2013,37(11):2173-2179
Background
The main objective of this study was to evaluate the association between the acromial index (AI) and the incidence of recurrent tears of the rotator cuff (RC) in a cohort of patients with full thickness tears who underwent arthroscopic primary repair.Methods
A prognostic study of a prospective case series of 103 patients with full thickness RC tears was undertaken. The average age was 59.5 years (39–74) and follow-up was 30.81 months (12–72). True anterior–posterior X-rays were obtained during the pre-operative evaluation. Pre and post-operative magnetic resonance imaging (MRI) were recorded.Results
Eighteen cases with recurrent tears (17.4 %) were seen on post-operative MRI. The average AI for patients with recurrent tears was 0.711 ± 0.065 and for patients without recurrent tears 0.710 ± 0.064 (p < 0.05). A positive association between age and recurrent tears of the RC was noted (average ages: recurrent tears group 63 ± 5.9 years; group without recurrent tears 58.8 ± 7.5 years) (r = −0.216; p = 0.029). We did not find an association between size of the primary tear and recurrent tears (r = −0.075; p < 0.05) or between degrees of retraction of the primary and recurrent tears of the cuff (r = −0.073; p < 0.05). We observed that 38.9 % of the recurrent tears cases presented with more than one tendon affected before the arthroscopy. At follow-up, none of these recurrent tears showed more than one tendon affected on MRI evaluation.Conclusion
In this study, we found that the AI radiological measurement is not a predictor for recurrent tears of the RC after primary arthroscopic repair. 相似文献10.
Matthias Lahner Nadine-Lucie Jahnke Sonja Zirke Wolfram Teske Gregor Vetter Christoph von Schulze Pellengahr Kiriakos Daniilidis Marco Hagen Lars Victor von Engelhardt 《International orthopaedics》2014,38(1):19-25
Purpose
This study was designed to evaluate whether the mechanical axis deviation (MAD) of the leg correlates with an increased hip alpha angle as described by Nötzli, which is associated with femoroacetabular impingement (FAI).Methods
In a retrospective analysis, standing full-length anteroposterior radiographs were analysed in patients who suffered from symptomatic leg alignment. The study included 85 radiographs of 80 patients with an average age of 43.11 years (range 18–60 years). Five patients underwent a bilateral long-leg X-ray examination. All radiographs were transferred as Digital Imaging and Communications in Medicine data files from the Picture Archiving and Communications System into the OrthoPlanner software version 2.3.2. The radiographs were measured by one orthopaedic surgeon and one independent radiologist.Results
The mean value of the alpha angle of Nötzli was 61.43° (49.07–74.04°). A total of 57 (67 %) radiographs showed a varus deviation, 25 (29.5 %) had a valgus malalignment and three (3.5 %) a straight leg axis. Of 82 radiographs, 40 (48.8 %) had a moderate axis deviation with a MAD <15 or > − 15 mm and a mean alpha angle of 57.81°, and 42 (51.2 %) with extended axis deviation of a MAD > 15 or < − 15 mm had a mean alpha angle of 62.93°; 40 (95.2 %) of these 42 showed an alpha angle > 55°. The alpha angle was significantly increased in extended axis deviation compared to moderate axis deviation (P = 0.001).Conclusions
This study confirmed that increased alpha angles were found significantly at higher degrees of axis deviation on the full-length radiograph. In cases of a MAD >15 or < − 15 mm and symptomatic coxalgia, diagnostic tests must be pursued for FAI. 相似文献11.
Kemp BJ Bateham AL Mulroy SJ Thompson L Adkins RH Kahan JS 《The journal of spinal cord medicine》2011,34(3):278-284
Objective/background
People with spinal cord injury (SCI) paraplegia can develop shoulder problems over time, which may also cause pain. Shoulder pain may complicate or interfere with a person''s daily activities, social events, and their overall quality of life (QOL). The purpose of this study was to examine changes in social interaction and QOL after an exercise treatment for shoulder pain in people with SCI paraplegia.Design
Fifty-eight participants with SCI paraplegia who were also experiencing shoulder pain were selected and randomized to either an exercise treatment or a control group. Participants in the treatment group participated in a 12-week, at-home, exercise and movement optimization program designed to strengthen shoulder muscles and modify movements related to upper extremity weight bearing.Methods
Participants filled out self-report measures at baseline, 12 weeks later at the end of treatment, and at a 4-week follow-up.Outcome measures
The Wheelchair User''s Shoulder Pain Index (WUSPI), the Social Interaction Inventory (SII), and the Subjective Quality of Life Scale.Results
From the baseline to the end of treatment, repeated-measures analysis of variance revealed a significant interaction between WUSPI and SII scores, P < 0.001, and between WUSPI and QOL scores, P < 0.001.Conclusion
Reductions in shoulder pain were related to significant increases in social participation and improvements in QOL. However, increases in social participation did not significantly affect improvements in QOL. 相似文献12.
Zhi Wang Jean-Marc Mac-Thiong Stefan Parent Yvan Petit Hubert Labelle 《European spine journal》2014,23(1):157-162
Study design
Retrospective study of the importance of sacral and sacro-pelvic morphology in developmental L5–S1 spondylolisthesis.Objectives
To determine and compare the importance of sacral and sacro-pelvic morphology in developmental L5–S1 spondylolisthesis.Summary and background data
Recent studies have shown abnormalities in sacral and sacro-pelvic morphology in spondylolisthesis. However, it is still unclear if sacral and sacro-pelvic morphology are correlated and if they are equally important in the progression of spondylolisthesis.Methods
Lateral radiographs of 120 controls and 131 subjects with developmental L5–S1 spondylolisthesis were analyzed. Sacral table angle (STA) and pelvic incidence (PI) were compared using Student t tests. The relationship between STA and PI was assessed separately in the control and spondylolisthesis groups using Pearson’s coefficients. The proportion of subjects with high PI but average STA was compared to the proportion of subjects with low STA but average PI using χ2 tests.Results
STA was significantly lower and PI was significantly higher in the spondylolisthesis group. STA was statistically related to PI in both control (r = −0.43) and spondylolisthesis (r = −0.57) groups. In the spondylolisthesis group, STA (r = −0.45) and PI (r = 0.35) were significantly related to slip percentage. STA remained statistically related to slip when controlling for PI. A significantly greater proportion of subjects in the spondylolisthesis group had average STA and high PI, rather than average PI and low STA.Conclusion
The significant relationship between PI and STA validates that geometrically sacral morphology depends on sacro-pelvic morphology. This study failed to demonstrate a clear predominant role of either STA or PI in the presence of spondylolisthesis. 相似文献13.
Gorgey AS Harnish CR Daniels JA Dolbow DR Keeley A Moore J Gater DR 《The journal of spinal cord medicine》2012,35(2):107-112
Background
Functional electrical stimulation (FES) has been regularly used to offset several negative body composition and metabolic adaptations following spinal cord injury (SCI). However, the outcomes of many FES trials appear to be controversial and incoherent.Objective
To document the potential consequences of several factors (e.g. pain, spasms, stress and lack of dietary control) that may have attenuated the effects on body composition and metabolic profile despite participation in 21 weeks of FES training.Participant
A 29-year-old man with T6 complete SCI participated in 21 weeks of FES, 4 days per week.Methods
Prior to and following training, the participant performed arm-crank-graded exercise testing to measure peak VO2. Tests conducted included anthropometrics and dual energy X-ray absorptiometry body composition assessments, resting energy expenditure, plasma lipid profiles and intravenous glucose tolerance tests.Results
The participant frequently reported increasing pain, stress and poor eating habits. VO2 peak decreased by 2.4 ml/kg/minute, body mass increased by 8.5 kg, and body mass index increased from 25 to 28 kg/m2. Waist and abdominal circumferences increased by 2–4 cm, while %fat mass increased by 5.5%. Absolute increases in fat mass and fat-free mass of 8.4 and 1 kg, respectively, were reported. Fasting and peak plasma glucose increased by 12 and 14.5%, while lipid panel profiles were negatively impacted.Conclusion
Failure to control for the listed negative emerging factors may obscure the expected body composition and metabolic profile adaptations anticipated from FES training. 相似文献14.
William A Bauman Steven Kirshblum Christopher Cirnigliaro Gail F Forrest Ann M Spungen 《The journal of spinal cord medicine》2010,33(3):214-220
Background:
Bone mineral density (BMD) of the lumbar spine (L-spine) has been reported to be normal by routine posterior-anterior (PA) bone density imaging in patients with chronic spinal cord injury (SCI).Objective:
To determine BMD of the L-spine by PA and lateral (LAT) dual-energy radiographic absorptiometry (DXA) in patients with chronic SCI.Design:
Prospective study.Setting:
Veterans Affairs Medical Center and a private rehabilitation facility.Methods:
Measurements of the PA and LAT L-spine and hip were performed in 15 patients with SCI: 9 with tetraplegia and 6 with paraplegia. The DXA (GE Lunar Advance DXA) images were obtained using standard software. Results are reported as mean ± SD.Results:
The mean age was 35 ± 15 years (range = 20–62 years), and the duration of injury was 57 ± 74 months (range = 3–240 months). T- and Z-scores were lower for the LAT L-spine than those for PA L-spine (T-scores L2: −0.7 ± 1.2 vs 0.0 ± 1.4, P < 0.01; L3: −0.9 ± 1.6 vs 0.3 ± 1.3, P < 0.002; L2-L3: −0.8 ± 1.3 vs 0.2 ± 1.3, P < 0.001; Z-scores L2: −0.3 ± 1.1 vs 0.2 ± 1.2, P < 0.05; L3: −0.6 ± 1.3 vs 0.5 ± 1.3, P < 0.01; L2-L3: −0.4 ± 1.1 vs 0.4 ± 1.2, P < 0.005). The T- and Z-scores for the total hip (−1.1 ± 1.0 and −1.0 ± 1.0, respectively) and L2-L3 LAT L-spine demonstrated remarkable similarity, whereas the L2-L3 PA L-spine scores were not reduced. Bone mineral density of the LAT L-spine, but not the PA L-spine, was significantly reduced with increasing duration of injury.Conclusions:
Individuals with SCI may have bone loss of the L-spine that is evident on LAT DXA that may be misdiagnosed by PA DXA, underestimating the potential risk of fracture. 相似文献15.
Purpose
The present study was performed to establish an animal model of cervical kyphosis after laminectomy (C2–C5), and to determine the role of endplate chondrocytes apoptosis in cervical kyphosis after laminectomy.Methods
Twenty-four 3-month-old sheep were randomly divided into two groups: the laminectomy group (n = 12), and the control group (n = 12). The cervical spine alignment was evaluated on a lateral cervical spine X-ray using Harrison’s posterior tangent method before surgery and at follow-up. Cartilaginous endplate chondrocyte apoptosis was confirmed using transmission electron microscopy and terminal deoxyribonucleotidyl transferase (TdT)-mediated dUTP nick-end labelling.Results
The mean preoperative cervical curvature (C2–5) in the surgery group was −15.8°. The cervical curvature was 19.1° at 3 months post-operation and decreased to 20.2° at the final follow-up postoperatively. The cervical curvature was significantly decreased in the laminectomy group compared with the control group at the last follow-up (P < 0.001), which was a direct indication of kyphotic change. The incidence of apoptotic cells in the surgery group was significantly higher at the 3- and 6-month follow-up than the incidence in the control group.Conclusions
The frequency of endplate chondrocyte apoptosis in the laminectomy group was significantly higher than in the control group, indicating that chondrocyte apoptosis may play a pivotal role in the progress of post-laminectomy cervical kyphosis. 相似文献16.
Purpose
To report the functional and cosmetic results of cases with Sprengel’s shoulder who underwent the Woodward procedure.Materials and methods
Twelve children were operated at a mean age of 5.58 years and reviewed at an average follow up of 31.83 months.Results
The mean preoperative Cavendish grade for cosmetic evaluation was 3.17, which decreased to 1.25 postoperatively (statistically significant, p < 0.0005, Wilcoxon signed-rank test). Similarly, the range of abduction at the shoulder increased from a mean of 115.83° preoperatively to 153.33° at final review (p < 0.0005). Age had a negative correlation with both functional improvement (r = −0.55, Spearman correlation coefficient) and cosmetic improvement (r = −0.11), although the latter suggested a very weak association, if any. Cavendish grade improvement and increase in abduction had a strong positive association (r = 0.713). However, there was no correlation between the increase in abduction and lowering of the scapula achieved (r = 0.131). The presence of an omovertebral bar did not affect the final functional outcome, nor did the presence of associated congenital anomalies.Conclusion
The Woodward procedure is a reliable method for obtaining uniformly predictable results in Sprengel’s shoulder. The surgery should be performed at a younger age in order to optimise the functional outcome. 相似文献17.
Daniel J. Henderson Jeremy L. Rushbrook Todd D. Stewart Paul J. Harwood 《Clinical orthopaedics and related research》2016,474(4):1041-1049
Background
Fine-wire circular frame (Ilizarov) fixators are hypothesized to generate favorable biomechanical conditions for fracture healing, allowing axial micromotion while limiting interfragmentary shear. Use of half-pins increases fixation options and may improve patient comfort by reducing muscle irritation, but they are thought to induce interfragmentary shear, converting beam-to-cantilever loading. Little evidence exists regarding the magnitude and type of strain in such constructs during weightbearing.Questions/purposes
This biomechanical study was designed to investigate the levels of interfragmentary strain occurring during physiologic loading of an Ilizarov frame and the effect on this of substituting half-pins for fine-wires.Methods
The “control” construct was comprised of a four-ring all fine-wire construct with plain wires at 90°-crossing angles in an entirely unstable acrylic pipe synthetic fracture model. Various configurations, substituting half-pins for wires, were tested under levels of axial compression, cantilever bending, and rotational torque simulating loading during gait. In total three frames were tested for each of five constructs, from all fine-wire to all half-pin.Results
Substitution of half-pins for wires was associated with increased overall construct rigidity and reduced planar interfragmentary motion, most markedly between all-wire and all-pin frames (axial: 5.9 mm ± 0.7 vs 4.2 mm ± 0.1, mean difference, 1.7 mm, 95% CI, 0.8–2.6 mm, p < 0.001; torsional: 1.4% ± 0.1 vs 1.1% ± 0.0 rotational shear, mean difference, 0.3%, 95% CI, 0.1%–0.5%, p = 0.011; bending: 7.5° ± 0.1 vs 3.4° ± 0.1, mean difference, −4.1°, 95% CI, −4.4° to −3.8°, p < 0.001). Although greater transverse shear strain was observed during axial loading (0.4% ± 0.2 vs 1.9% ± 0.1, mean difference, 1.4%, 95% CI, 1.0%–1.9%, p < 0.001), this increase is unlikely to be of clinical relevance given the current body of evidence showing bone healing under shear strains of up to 25%. The greatest transverse shear was observed under bending loads in all fine-wire frames, approaching 30% (29% ± 1.9). This was reduced to 8% (±0.2) by incorporation of sagittal plane half-pins and 7% (±0.2) in all half-pin frames (mean difference, −13.2% and −14.0%, 95% CI, −16.6% to 9.7% and −17.5% to −10.6%, both p < 0.001).Conclusions
Appropriate use of half-pins may reduce levels of shear strain on physiologic loading of circular frames without otherwise altering the fracture site mechanical environment at levels likely to be clinically important. Given the limitations of a biomechanical study using a symmetric and uniform synthetic bone model, further clinical studies are needed to confirm these conclusions in vivo.Clinical Relevance
The findings of this study add to the overall understanding of the mechanics of circular frame fixation and, if replicated in the clinical setting, may be applied to the preoperative planning of frame treatment, particularly in unstable fractures or bone transport where control of shear strain is a priority. 相似文献18.
Yanlin Tan Bayan G. Aghdasi Scott R. Montgomery Hirokazu Inoue Chang Lu Jeffrey C. Wang 《European spine journal》2012,21(12):2673-2679
Purpose
The purpose of this study was to examine lumbar segmental mobility using kinetic magnetic resonance imaging (MRI) in patients with minimal lumbar spondylosis.Methods
Mid-sagittal images of patients who underwent weight-bearing, multi-position kinetic MRI for symptomatic low back pain or radiculopathy were reviewed. Only patients with a Pfirrmann grade of I or II, indicating minimal disc disease, in all lumbar discs from L1–2 to L5–S1 were included for further analysis. Translational and angular motion was measured at each motion segment.Results
The mean translational motion of the lumbar spine at each level was 1.38 mm at L1–L2, 1.41 mm at L2–L3, 1.14 mm at L3–L4, 1.10 mm at L4–L5 and 1.01 mm at L5–S1. Translational motion at L1–L2 and L2–L3 was significantly greater than L3–4, L4–L5 and L5–S1 levels (P < 0.007). The mean angular motion at each level was 7.34° at L1–L2, 8.56° at L2–L3, 8.34° at L3–L4, 8.87° at L4–L5, and 5.87° at L5–S1. The L5–S1 segment had significantly less angular motion when compared to all other levels (P < 0.006). The mean percentage contribution of each level to the total angular mobility of the lumbar spine was highest at L2–L3 (22.45 %) and least at L5/S1 (14.71 %) (P < 0.001).Conclusion
In the current study, we evaluated lumbar segmental mobility in patients without significant degenerative disc disease and found that translational motion was greatest in the proximal lumbar levels whereas angular motion was similar in the mid-lumbar levels but decreased at L1–L2 and L5–S1. 相似文献19.
Zhi-Jun Li Xin Fu Dan Xing Hua-Feng Zhang Jia-Cheng Zang Xin-Long Ma 《European spine journal》2013,22(9):1950-1957
Purpose
The present meta-analysis aimed at assessing the effectiveness and safety of tranexamic acid (TXA) in reducing blood loss and transfusion in spinal surgery.Methods
Systematic searches of all studies published through March 2012 were identified from PubMed, EMBase, Cochrane library, Science Direct, and other databases. Only randomized controlled trials (RCTs) were included in the present study. Two independent reviewers searched and assessed the literature. Mean difference (MD) of blood loss and blood transfusions, risk ratios (RR) of transfusion rate and of deep vein thrombosis rate in the TXA-treated group versus placebo group were pooled throughout the study. The meta-analysis was conducted by RevMan 5.1 software.Results
Six placebo-controlled RCTs encompassing 411 patients met the inclusion criteria for our meta-analysis. The use of TXA significantly reduced both total blood loss [MD = −285.35, 95 % CI (−507.03 to −63.67), P = 0.01] as well as the number of patients requiring blood transfusion [RR = 0.71, 95 % CI (0.54–0.92), P = 0.01]. None of the patients in the treatment group had deep-vein thrombosis (DVT) or pulmonary embolism.Conclusions
Intravenous use of TXA for patients undergoing spinal surgery is effective and safe. It reduces total blood loss and the need for blood transfusion, particularly in the using of high dosage of TXA (≥15 mg/kg), yet does not increase the risk of postoperative DVT. Due to the limitation of the quality of the evidence currently available, high-quality RCTs are required. 相似文献20.
Hendrik Jansen Annabel Fenwick Stefanie Doht Soenke Frey Rainer Meffert 《International orthopaedics》2013,37(1):51-58