Effectiveness and safety of endoscopic versus open carpal tunnel decompression

Purpose

To evaluate the effectiveness and safety of endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR) using a meta-analysis of data from randomized controlled trials.

Materials and methods

Electronic searches of the Cochrane Register of Controlled Trials (CENTRAL, Issue 11 of 12, Nov 2012), PUBMED (1980 to Dec 2012), and EMBASE (1980 to Dec 2012) were used to identify randomized controlled trials that evaluated endoscopic vs open methods for treatment of carpal tunnel syndrome. Studies to be used were independently identified by two researchers. The methodological quality of the studies was assessed by the Cochrane Collaboration tool for assessing risk of bias.

Results

Fifteen randomized controlled trials involving 1,596 hands were included. Based on the Cochrane Collaboration tool for assessing risk of bias, four studies were rated as high quality, five studies were rated as moderate quality, and six were rated as low quality. Our meta-analysis indicated that ECTR resulted in better recovery of pinch strength, earlier time of return to work, but a higher rate of reversible nerve problems (including neurapraxia and numbness) than OCTR. ECTR also resulted in a lower rate of irreversible nerve damage (P > 0.05), wound problems (including wound infection, wound hematoma and wound dehiscence) and reflex sympathetic dystrophy (P > 0.05) compared with OCTR. Our meta-analysis revealed no obvious statistical differences in relief of symptoms (pain and paraesthesia), recovery of grip strength and reoperation rate.

Conclusion

Our meta-analysis of available randomized controlled trials demonstrated that ECTR and OCTR were similar in relief of symptoms, but ECTR resulted in better recovery of function and earlier return to work and was safer than OCTR.     

小腿假肢对线对静态站立时下肢受力的影响

目的:研究小腿截肢患者站立状态下假肢对线对下肢受力特性的影响.方法:以假肢侧承重线和重力线作为评价指标,改变假肢矢状面和额状面的对线,采用激光测力平台测量患者静态站立时残侧承重线和重力线的位置,研究下肢受力状况的变化.结果:假肢侧承重线受踝关节对线的影响大于腿管对线调节的影响,并且力线随腿管与接受腔的前倾而前移,而额状面对线的影响很小;矢状面内重力线主要受踝关节对线调节的影响,并且与变化角近似正比例相关.结论:矢状面假肢对线调整对残侧下肢受力状况的影响较大,而额状面的对线调整影响较小.     

自体富血小板血浆与人工骨混合物治疗胫骨平台骨折合并骨缺损的临床应用

背景：骨缺损修复一直是骨科临床面临的难题之一。近年来,骨组织工程学的发展为骨缺损修复开辟了新的途径,但骨髓基质细胞体外培养回植入体内修复骨缺损还仅限于实验研究。目的：评价临床上应用自体富血小板血浆（PRP）与人工骨混合物治疗胫骨平台骨折合并骨缺损的临床疗效。方法：2006年7月至2010年7月收治胫骨平台骨折合并骨缺损患者（SchatzkerⅡ~Ⅴ型）36例。随机分成：A组（17例）采用自体PRP与人工骨复合物填充骨缺损;B组（19例）采用自体髂骨填充。所有患者于术后1.5、3、6、12个月复查植骨部位的X线片观察骨折愈合时间,采用Rasmussen评分标准评价胫骨平台骨折复位及固定效果,Hss评分评价膝关节术后功能恢复情况,NRS分级法对疼痛进行量化评分,配对T检验对两组数据进行比较。结果：36例全部获得随访,随访时间11-36个月,平均16个月。A组患者平均手术时间、术中出血量及术后疼痛评分（不包括供骨区）明显低于B组（P〈0.05）,而Rasmussen评分、HSS评分及骨折平均愈合时间与B组无明显差异（P〉0.05）。结论：自体PRP与人工骨混合物填充治疗胫骨平台骨折合并骨缺损较传统自体髂骨填充显著缩短手术时间,减少术中出血,减轻术后疼痛,避免供骨区并发症,修复效果理想,为胫骨平台骨折合并骨缺损的治疗提供了一个新的方法。     

Collision malignant melanoma and medullary carcinoma of the thyroid

This report presents the case of a 54‐year‐old woman with a collision tumour of malignant melanoma and medullary thyroid carcinoma in the thyroid. Twenty four of 25 neck lymph nodes contained metastatic melanoma, with the rest having both metastatic melanoma and medullary carcinoma. Systemic chemotherapy was administered for the malignant melanoma, and a complete response was thus obtained. However, just after having the chemotherapy, multiple lung and brain metastases emerged. The simultaneous occurrence of malignant melanoma and medullary carcinoma in the same thyroid has not been previously reported in the literature. Collision tumour of malignant melanoma and medullary carcinoma of the thyroid might imply bad prognosis.     

No clinical benefit of gender-specific total knee arthroplasty: A systematic review and meta-analysis of 6 randomized controlled trials

Background and purpose

There is no consensus regarding the clinical relevance of gender-specific prostheses in total knee arthroplasty (TKA). We summarize the current best evidence in a comparison of clinical and radiographic outcomes between gender-specific prostheses and standard unisex prostheses in female patients.

Methods

We used the PubMed, Embase, Cochrane, Science Citation Index, and Scopus databases. We included randomized controlled trials published up to January 2013 that compared gender-specific prostheses with standard unisex prostheses in female patients who underwent primary TKAs.

Results

6 trials involving 423 patients with 846 knee joints met the inclusion criteria. No statistically significant differences were observed between the 2 designs regarding pain, range of motion (ROM), knee scores, satisfaction, preference, complications, and radiographic results. The gender-specific design (Gender Solutions; Zimmer Inc, Warsaw, Indiana) reduced the prevalence of overhang. However, it had less overall coverage of the femoral condyles compared to the unisex group. In fact, the femoral prosthesis in the standard unisex group matched better than that in the gender-specific group.

Interpretation

Gender-specific prostheses do not appear to confer any benefit in terms of clinician- and patient-reported outcomes for the female knee.Women account for almost two-thirds of knee arthroplasties (Kurtz et al. 2007). Recently, a possible effect of gender on functional outcomes and implant survivorship has been identified (Vincent et al. 2006, Ritter et al. 2008, Kamath et al. 2010, Parsley et al. 2010, O’Connor 2011). Gender differences in the anatomy of the distal femur are well documented (Conley et al. 2007, Yue et al. 2011a, b, Yan et al. 2012, Zeng et al. 2012). Women tend to have a less prominent anterior condyle (Conley et al. 2007, Fehring et al. 2009), a higher quadriceps angle (Q-angle) (Hsu et al. 1990, Woodland et al. 1992), and a reduced mediolateral to anteroposterior aspect ratio (Chin et al. 2002, Chaichankul et al. 2011). Investigators have found that standard unisex knee prostheses may not equally match the native anatomy in male and female knees (Clarke and Hentz 2008, Yan et al. 2012). A positive association between the femoral component size and the amount of overhang was observed in females, and femoral component overhang (≥ 3 mm) may result in postoperative knee pain or reduced ROM (Hitt et al. 2003, Lo et al. 2003, Mahoney et al. 2010).The concept of gender-specific knee prostheses was introduced to match these 3 anatomic differences in the female population (Conley et al. 2007). It includes a narrower mediolateral diameter for a given anteroposterior dimension, to match the female knee more closely. Additionally, the anterior flange of the prothesis was modified to include a recessed patellar sulcus and reduced anterior condylar height (to ovoid “overstuffing” during knee flexion) and a lateralized patellar sulcus (to accommodate the increased Q-angle associated with a wider pelvis).Several randomized controlled trials (RCTs) have failed to establish the superiority of the gender-specific prosthesis over the unisex knee prosthesis in the female knee (Kim et al. 2010a, b, Song et al. 2012a, Thomsen et al. 2012, von Roth et al. 2013). In contrast, other studies have found higher patient satisfaction and better radiographic fit in the gender-specific TKAs than in the standard unisex TKAs (Clarke and Hentz 2008, Parratte et al. 2011, Yue et al. 2014). We therefore performed a systematic review and meta-analysis to compare the clinical and radiographic results of TKA in female patients receiving gender-specific prostheses or standard unisex prostheses.     

成人胸枕高度与病人体重关系的研究

[目的]为了解胸枕高度与病人体重的关系。[方法]测量胸枕下陷值，监测皮肤温度、生命体征，观察病人舒适程度。[结果]40k～49kg病人使用高度为8cm胸枕，50kg～59kg病人使用高度为10cm胸枕，60kg-79kg病人使用高度为12cm胸枕，80k以上病人使用高度为14cm胸枕。[结论]随着人们生活水平的提高，肥胖病人越来越多，使用同一规格同一高度的胸枕已无法满足当前病人体重的需求，所以应根据病人体重改进胸枕高度。     

应用辅助沟通系统促进自闭症儿童语言和沟通能力的发展

目的:以文献研究的方法探讨应用计算机和电子技术进行图片及符号与语言转换的辅助沟通技术对自闭症儿童沟通和语言能力所起的作用。资料来源:应用计算机检索CNKI,台湾中文期刊服务网和台湾博硕士论文信息网在1997-01/2006-12与自闭症和辅助沟通相关的文章,限定文章语言种类为中文,检索词“辅助沟通、自闭症、语言”;同时检索ProQuest Psychology Journals、Education Resources Information Center和Medline在1997-01/2006-12期间相关的文章,限定文章语言种类为“English”,检索词“Augmentative and alternative communication、autism、language”。并查询与语言和沟通障碍相关的书籍和文献。资料选择:选择与自闭症语言障碍成因和辅助沟通技术在自闭症儿童语言发展中应用的文章,无论是否有对照组均纳入。资料提炼:将检索到的文章进一步查找全文,排除重复研究,纳入32篇为参考文献。文献中有24篇是探讨辅助沟通技术对自闭症儿童语言和沟通能力的作用的实验,涉及到92个个案,其中有21篇的结果表明辅助沟通技术对自闭症儿童的语言和沟通能力有促进作用,另外3篇的结论相反。资料综合:语言障碍是自闭症患者的核心障碍之一。辅助沟通技术是利用现代的计算机和电子技术,通过图片和符号与语音进行转换等方式,将沟通障碍者的信息传递给他人,实现与人交流的功能。辅助沟通技术的理念就是在自然情境中融入沟通的思维和方法,增加他们学习语言的动机,并提高其沟通的效率和准确度。结论:在教育和康复的临床实践中,可以利用辅助沟通技术来提高自闭症儿童的语言能力。