系统化足踝锻炼器锻炼对胫骨pilon骨折患者术后踝关节功能影响的研究

目的 分析系统化足踝锻炼器锻炼对胫骨pilon骨折患者术后踝关节功能的影响。 方法 回顾性研究2018年5月至2020年1月南华大学附属南华医院收治的84例胫骨pilon骨折患者资料。所有患者均实施切开复位内固定治疗,按照康复方法不同分为对照组（术后分阶段开展康复功能训练, n=42）和研究组（开展系统化足踝锻炼器锻炼, n=42）。对照组：男26例,女16例;年龄（36.6±4.8）岁（20~55岁）。研究组男27例,女15例;年龄（36.4±4.5）岁（21~57岁）。比较两组患者术后恢复情况、踝关节功能恢复优良率、术后生活质量评分、并发症的发生率。 结果 两组患者术前一般资料比较差异均无统计学意义（ P>0.05）,具有可比性。研究组术后首次下床时间（3.7±0.3）周、骨折愈合时间（9.1±0.8）周、完全负重时间（6.5±0.9）周均短于对照组[（4.1±0.5）、（10.9±1.2）、（7.2±1.1）周],研究组踝关节功能恢复优良率92.9%（39/42）高于对照组的73.8%（31/42）。研究组术后物质、心理、社会、躯体等生活质量各维度评分均高于对照组,研究组术后并发症发生率2.4%（1/42）低于对照组10.9%（8/42）,以上比较差异均有统计学意义（ P<0.05）。 结论 相同术式下对胫骨pilon骨折患者开展系统化足踝锻炼器锻炼,可促进患者踝关节功能恢复并提升生活质量,且同步降低术后并发症发生的风险。     

A comparative prospective cohort health economic analysis comparing ankle fusion,isolated great toe fusion and hallux valgus surgery

Background

This study assessed the health economics and outcomes of three common foot and ankle operations.

Measuring functional and quality of life outcomes following major head injury: common scales and checklists

Traumatic brain injury (TBI) is a major public health issue, which results in significant mortality and long term disability. The profound impact of TBI is not only felt by the individuals who suffer the injury but also their care-givers and society as a whole. Clinicians and researchers require reliable and valid measures of long term outcome not only to truly quantify the burden of TBI and the scale of functional impairment in survivors, but also to allow early appropriate allocation of rehabilitation supports. In addition, clinical trials which aim to improve outcomes in this devastating condition require high quality measures to accurately assess the impact of the interventions being studied. In this article, we review the properties of an ideal measure of outcome in the TBI population. Then, we describe the key components and performance of the measurement tools most commonly used to quantify outcome in clinical studies in TBI. These measurement tools include: the Glasgow Outcome Scale (GOS) and extended Glasgow Outcome Scale (GOSe); Disability Rating Scale (DRS); Functional Independence Measure (FIM); Functional Assessment Measure (FAM); Functional Status Examination (FSE) and the TBI-specific and generic quality of life measures used in TBI patients (SF-36 and SF-12, WHOQOL-BREF, SIP, EQ-5D, EBIQ, and QOLIBRI).     

A Prospective Evaluation of Palliative Outcomes for Surgery of Advanced Malignancies

Background: We prospectively evaluated the effectiveness of major surgery in treating symptoms of advanced malignancies.Methods: Fifty-nine patients were evaluated for major symptoms of intent to treat and were followed up until death or last clinical evaluation. Surgeons identified planned operations before surgery as either curative or palliative and estimated patient survival time. An independent observer assessed symptom relief. A palliative surgery outcome score was determined for each symptomatic patient.Results: Surgeons identified 22 operations (37%) as palliative intent and 37 (63%) as curative intent. The median overall survival time was 14.9 months and did not differ between curative and palliative operations. Surgical morbidity was high but did not differ between palliative (41%) and curative (44%) operations. Thirty-three patients (56%) were symptomatic before surgery, and major symptom resolution was achieved after surgery in 26 (79%) of 33. Good to excellent palliation, defined as a palliative surgery outcome score >70, was achieved in 64% of symptomatic patients.Conclusions: Most symptomatic patients with advanced malignancies undergoing major operations attained good to excellent symptom relief. Outcome measurements other than survival are feasible and can better define the role of surgery in multimodality palliative care. A new outcome measure to evaluate major palliative operations is proposed.     

Large variation in use of patient-reported outcome measures: A survey of 188 foot and ankle surgeons

Background

There is an increasing interest in the use of patient reported outcome measures (PROMs). However, there is a large variety of PROMs and a lack of consensus regarding preference for their use. Aim of this study is to determine how often PROMS are used for foot and ankle disorders, for what purpose PROMs are used, and what the preferences of the foot and ankle surgeons are, when choosing a PROM to use.

Measuring foot and ankle injury outcomes: common scales and checklists

Functional health outcome measures are increasingly being used in both clinica trials and practice as measures of patient health. Whilst outcome measures can be generic, there are a number of foot and ankle specific measures available and in use. These are being used as not only region specific but also disease specific measures of patient function. Unfortunately not all of these outcome measures have been completely validated which leads to challenges in applying the results of outcomes research to specific patients. Continued work however is being done in this area and these challenges provide opportunities for further investigation into the role of functional outcome scores specific to the foot and ankle.     

Reliability and Validity of the Subjective Component of the American Orthopaedic Foot and Ankle Society Clinical Rating Scales

This study evaluates the criterion validity of the subjective component of the American Orthopaedic Foot and Ankle Society (AOFAS) clinical rating scales by correlating scores obtained with these rating scales to scores obtained with the Foot Function Index (FFI) in patients with foot and ankle conditions. To date, the AOFAS scoring scales have not been shown to provide valid information despite their popularity. The FFI, on the other hand, has previously been shown to provide valid information in regard to conditions affecting the foot and ankle. A moderately strong inverse criterion validity correlation (Pearson correlation coefficient = -0.68) was shown when preoperative patients were administered both the AOFAS and FFI questionnaires, and the resultant scores were compared. Test-retest reliability measurements showed no significant difference (P = .27) between preoperative AOFAS scale scores measured at least 2 weeks apart. Construct validity was shown (P = .006) when dependent preoperative and postoperative (at least 3 months) AOFAS scale scores were compared, indicative of the clinical rating scales' ability to discriminate and predict quality of life related to foot and ankle conditions. The moderate level of correlation, satisfactory degree of reliability, and responsiveness (ability to distinguish differences between preoperative and postoperative conditions in the same patient) observed in this study suggest that the subjective component of the AOFAS clinical rating scales provides quality-of-life information that conveys acceptable validity regarding conditions affecting the foot and ankle.     

Outcome after polytrauma

Background and aims: Outcome refers to the different facets of consequences resulting from an event or intervention. These consequences may be relevant for an individual patient, but also for society. There is a growing recognition that clinical research needs to define and focus on the outcomes of medical care. Outcome research should help health care professionals to better evaluate the effectiveness of specific interventions or a therapeutic concept. This broader base of evidence should then benefit the patients. Methods: The literature was reviewed with respect to concepts of outcome research as well as results of outcome research after major trauma. Results: Measuring outcome might be relevant for research purposes as well as in daily surgical practice. In the past, clinical research in trauma care has tended to focus on survival. Mortality rates are not out, complication rates are not out, but their value is limited and restricted to given scenarios with high mortality rates. New outcomes have to be added: such a functional status, emotional health, social interaction, cognitive function, degree of disability and other indicators of health. Conclusion: Despite differences in injury pattern and severity of injury, there is strong evidence from the literature that the quality of life is significantly impaired after major trauma. This is true for functional outcome as well as for psycho-social outcome in up to 70% of patients. Received: 22 February 1998     

Does the choice of outcome scale influence prognostic factors for lumbar disc surgery?: A prospective,consecutive study of 121 patients

From January to June 1994, we operated conventionally on 121 consecutive herniated lumbar disc patients as part of a prospective study. We analysed general data, case histories, neurological findings on admission and all data from imaging investigations and therapy. In addition, all patients received a questionnaire based on the Low Back Outcome Score. Most of the patients (93%) were followed-up for 1 year postoperatively in the same manner. On the Prolo Scale, we obtained a good result in 70%; 76% had a good Low Back Outcome Score. Predictive factors are different for different outcome scales. The preoperative duration of pain, the preoperative duration of paresis and smoking seem to be general predictive factors.     

Comparison between a general and a disease-specific health-related quality-of-life questionnaire in patients after pancreatic surgery

Background/Purpose The aim of this study was to compare the short-form (SF-) 36 as a general instrument and the gastrointestinal quality of life index (GIQLI) as a disease-specific instrument in patients after pancreatic surgery.Methods The questionnaires were sent to patients receiving pancreatic surgery over a time period of three years. Patients were compared with a normal population completing the SF-36 or reported normal-population values for the GIQLI. Agreement between the instruments was analyzed using Bland Altman plots.Results A total of 98 patients were included, most of them undergoing a Whipple procedure (86%). The most frequent complaints were meteorism, obstipation, stool urgency, and stress incontinence in 9% of the patients. Whereas in almost every domain of the SF-36 the HRQL was impaired in comparison to the normal population, the GIQLI showed differences in only the domain emotions. Neither the SF-36 nor the GIQLI was different between patients with early and advanced cancer stages. The SF-36 had no agreement with the GIQLI.Conclusions The results of HRQL studies depend on the instruments which were used. Whereas a general instrument may detect factors such as comorbidity more accurately, disease-specific instruments have the advantage of better clinical interpretability.Presented at the 120th Congress of the German Society for Surgery, Munich, May 2003     

Quality indicators in bariatric surgery: improving quality of care

OBJECTIVES: Bariatric surgery is one of the most common complex intraabdominal operations, and there are reports of variations in outcome among providers. There is a need to standardize the processes of care in this specialty, and, as an attempt to do so, quality indicators were developed. METHODS: Candidate indicators, covering preoperative to follow-up care (5 domains), were developed based on evidence in the literature. Indicators were formally rated as valid by use of the RAND/UCLA Validity and Appropriateness method, which quantitatively assesses the expert judgment of a group using a 9-point scale (1 = not valid; 9 = definitely valid). Fourteen individuals participated in the expert panel, including bariatric surgeons and obesity experts. The method is iterative with 2 rounds of ratings and a group discussion. Indicators with a median rating > or =7 were valid. This method has been shown to have content, construct, and predictive validity. RESULTS: Of 63 candidate indicators, 51 were rated as valid measures of good quality of care covering the spectrum of perioperative care for bariatric surgery. Of the 51 indicators rated as valid (> or =7), all had sufficient "agreement" scores among panelists. Indicators included structural measures (e.g., procedural volume requirements) as well as processes of care (e.g., receipt of preoperative antibiotics, use of clinical pathway). CONCLUSIONS: This is the first formal attempt at development of quality indicators for bariatric surgery. Adherence to the indicators should equate with better quality of care, and their implementation will allow for quantitative assessment of quality of care.     

足踝手术支架在骨科手术机器人辅助手术中的有效性与安全性研究

背景:骨科手术机器人Ti-Robot(由北京积水潭医院与北京天智航医疗科技股份有限公司等单位合作研发)已在国内骨科手术治疗中得到越来越普遍的应用,作为划时代的创新技术,医护人员在使用Ti-Robot的过程中需要逐步掌握。经过一段时间的使用和观察,并结合足踝外科的术中护理需要,自主研制开发了一种足踝手术支架在术中辅助手术。目的:分析足踝手术支架在术中辅助Ti-Robot进行手术的应用效果,与常规手术方式进行有效性和安全性的对比研究。方法:回顾性分析2018年4月至2019年4月完成的Ti-Robot足踝手术30例,其中常规手术方式的15例为对照组,使用足踝手术支架辅助手术的15例为研究组。术中分别记录患者体位固定、患者示踪器固定、机器人执行和定位所用时间,以及术中采集影像资料时C型臂X线机透视调整的次数。结果:术中两组患者的体位固定、患者示踪器固定及机器人执行引导和定位所用时间比较,差异均有统计学意义(P<0.01);两组C型臂X线机透视调整的次数比较,差异无统计学意义(P>0.05)。足踝手术支架使肢体固定更稳定牢靠,手术入路方式的选择更为自由,安全性更高。结论:足踝手术支架作为Ti-Robot在足踝外科手术的必要辅助配件,其应用显著提高手术效率,并减少患者创伤,提升术中护理的医患满意度,但仍存在不足之处,需要进一步改进。     

Laparoscopic Nissen Fundoplication Effectively Relieves Symptoms in Patients with Laryngopharyngeal Reflux

Introduction The utility of laparoscopic Nissen fundoplication in the treatment of laryngopharyngeal reflux symptoms remains controversial. We hypothesized that a carefully selected population with these symptoms would benefit from antireflux surgery. Materials and Methods Sixty-one consecutive patients have undergone antireflux surgery for laryngopharyngeal reflux at a single institution. Preoperative evaluation including upper endoscopy, laryngoscopy, and 24-h ambulatory pharyngeal pH probe monitoring confirmed the diagnosis. Patients completed two validated symptom assessment instruments preoperatively and at multiple time points postoperatively. Results Patients were followed for up to 3 years with a mean follow-up of 15.2 months. A significant improvement in reflux symptom index score (preoperative = 31.5 ± 7.4 vs 3 years = 12.4 ± 10.9, p < 0.01), laryngopharyngeal reflux health-related quality of life overall score (preoperative = 55.0 ± 26.0 vs 3 years = 11.3 ± 13.9, p < 0.01), and symptom domain scores (voice, cough, throat clearing, and swallowing) occured within 1 month of surgery and remained improved over the course ofthe study. Conclusion Laparoscopic Nissen fundoplication is effective in relieving the symptoms of laryngopharyngeal reflux in a carefully selected patient population. Benefits are seen within 1 month of surgery and persist for at least 3 years. Presented at the Digestive Disease Week 2007, May 22, 2007, Washington, DC.     

Foot and ankle infections: Debridement,early fixation and rifampicin provide earlier recovery of function and quality of life

Background

Infection after foot and ankle fractures is a major concern for orthopedic surgeons. It is widely believed that final osteosynthesis should be delayed until the infection is cured. However, there is no literature that supports this practice. In addition, the delay impairs patient function and quality of life (QoL).

Quality of life after burns in childhood (5-15 years): children experience substantial problems

The aim of our study was to assess prevalence and correlates related to sub optimal outcome after pediatric burns and to make a comparison with pediatric injuries not related to burns.We conducted a cross-sectional study on quality of life (QOL) after burns in a sample (n = 138; median 24 months post-burn) of Dutch and Flemish children (5-15 years) with an admission to a burn center. QOL was assessed with the Burn Outcomes Questionnaire (BOQ). The generic EuroQol-5D was used to allow for a comparison with children after injuries not related to burns.More than half of the children had long-term limitations. According to the BOQ, children frequently (>50%) experienced sub optimal functioning on 5 out of 12 dimensions, concerning ‘appearance’, ‘parental concern’, ‘itch’, ‘emotional health’ and ‘satisfaction with current state’.Children with a high total burned surface area (TBSA ≥10%) showed significantly more sub optimal functioning on ‘upper extremity function’ (OR = 5.3; ≥20% TBSA), ‘appearance’ (OR = 5.5; ≥10-20% TBSA), ‘satisfaction with current state’ (OR = 3.4; ≥10-20% TBSA) and ‘parental concern’ (OR = 3.4; ≥10-20% TBSA), compared to children with less than 10% TBSA.Burn victims at 9 months post-injury appeared to be worse off at several health dimensions. After 24 months generic quality of life of in pediatric burns was more comparable to pediatric injuries not related to burns.Children after burns experience substantial problems, mainly on itch and appearance and several psychosocial dimensions. More extensive burns are related to sub optimal functioning. These problems are in part specific for burns and not picked up by generic measures.