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41.
42.
Topi Laaksonen Jani Puhakka Antti Stenroos Jussi Kosola Matti Ahonen Yrjn Nietosvaara 《Journal of children's orthopaedics》2021,15(1):63
PurposeCompletely displaced distal radius fractures in children have been traditionally reduced and immobilized with a cast or pin fixed. Cast immobilization leaving the fracture displaced in the bayonet position has been recently suggested as a non-invasive and effective treatment alternative. This is a pilot comparative study between reduction and no reduction.MethodsWe assessed subjective, functional and radiographic outcome after a minimum 2.5-year follow-up in 12 children under ten years of age who had sustained a completely displaced metaphyseal radius fracture, which had been immobilized leaving the fracture in an overriding position (shortening 3 mm to 9 mm). A total of 12 age-matched patients, whose similar fractures were reduced and pin fixed, were chosen for controls. ResultsAt follow-up none of the 24 patients had visible forearm deformity and the maximal angulation in radiographs was 5° Forearm and wrist movement was restored (< 10° of discrepancy) in all 24 patients. Grip strength ratio was normal in all but three surgically treated patients. All patients had returned to their previous activities. One operatively treated boy who was re-operated on reported of pain (visual analogue scale 2).ConclusionThe results of this study do not demonstrate the superiority of reduction and pin fixation over cast immobilization in the bayonet position of closed overriding distal metaphyseal radius fractures in children under ten years with normal neurovascular findings.Level of evidenceIII 相似文献
43.
BackgroudPatients experiencing acute trauma have limited time for their involvement in shared decision making, which may lead to decisional conflict. The purpose of this study was to evaluate whether providing audiovisual surgical information can reduce decisional conflict when deciding between surgical and nonsurgical treatment in patients with distal radius fractures (DRFs) and to evaluate factors that may affect decisional conflict.MethodsWe prospectively enrolled 50 consecutive patients who presented with acute DRFs and chose to undergo surgery, for which volar plate fixation was recommended. We randomized these patients into 2 groups. The test group was given a video clip of audiovisual surgical information in addition to regular information while the control group was only given regular information. The video clip consisted of the purpose, procedure, and effect of the surgery, precautions and complications after the operation, and other treatment options that could be performed if operation was not performed. At 2 weeks after the surgery, we evaluated patients'' decisional conflict using a decisional conflict scale (DCS). In addition, we evaluated factors that might affect decisional conflict, such as age, dominant hand, comorbidities, history of previous operations, perceived disability, and provision of the video clip.ResultsThe test group showed significantly lower DCS scores than the control group (19.6 vs. 32.1, p = 0.001). In multivariate analysis, younger age and provision of the video clip were associated with lower DCS scores.ConclusionsThis study has demonstrated that providing information through audiovisual media such as video clips could reduce decisional conflict in patients who chose to undergo plate fixation for DRFs. This study also suggests that older patients may need more careful doctor-patient communication as they have more decisional conflict than younger patients. 相似文献
44.
股骨颈骨折不同角度固定的生物力学比较研究 总被引:2,自引:0,他引:2
本文通过测量20个股骨上段标本,X线片的压力骨小梁系统,按照其骨小梁系统采用低角度固定其股骨颈骨折标本,以临床常用角度固定的股骨颈骨折标本作为对照组,进行静力学测定。股骨上段骨小梁系统与股骨纵轴线所成角度均数为154.7±1.9度,骨小梁系统与股骨外侧骨皮质交点到大转子距离均数为7.3±1.0cm。低角度固定组承载力及最大承载力明显大于对照组(P<0.05),且有更小的旋转移位(P<0.05)。本研究将低角度固定概念量化,对股骨颈骨折内固定的使用有显著的临床指导意义。 相似文献
45.
Summary In this retrospective study, 28 patients who presented isolated fractures from T11 to L4 were surgically treated using a posterior approach. The fractures were reduced and stabilized in half of the cases with Louis' plates and in the other half with an internal fixator. Twelve patients had partial neurological deficits on admission. They were reviewed after a mean period of 24 months from time of injury, and 10 months after implant removal. The kyphosis of the fractured vertebral body was measured, and showed a mean value of 18° before surgery and 10.3° at the last visit. The regional statics of the spine were also studied. The residual mobility of the fixated and neighbouring spinal units was assessed, comparing long segment fixation (plates) with short segment fixation (internal fixator). The residual mobility of the adjacent, non-fixed segments was significantly better when the internal fixator had been used than with the Louis' plates. Of the 12 patients with neurological involvement, 11 had increased their Frankel score by one grade. Results were evaluated by clinical parameters (pain, neurological deficit, occupational disability); scores were as follows: 32% good, 57% satisfactory and 11% poor. There was no significant difference in clinical score between the two treatment modalities. 相似文献
46.
47.
目的 总结可吸收内固定材料自身增强聚丙交脂(SR-PLLA)的临床应用体会。方法 采用波兰进口SR-PLLA螺钉、棒、线治疗四肢松质骨骨折22例,随访摄片观察骨折愈合情况,检查关节活动功能。结果 术后有两侧出现并发症,一例局部少量积液,经2次穿刺抽液加压包扎痊愈;一例患者过早去除石膏功能锻炼,螺钉松动滑出,经手术复位石膏外固定治愈,无感染或过敏等情况发生。结论 掌握可吸收材料的生物力学特点,并选择适当的病例,可以最大限度地发挥可吸收内固定材料的优势。 相似文献
48.
Z. Milutinović 《European archives of oto-rhino-laryngology》1995,252(8):491-494
There are numerous surgical procedures now available to manage bilateral abductor paralyses of the vocal folds. These procedures have various success rates but mostly do not offer reliable and predictable postoperative results, and usually require ,tracheotomy. The technique described in this report is based on a trial study to obtain a safe airway for an affected patient and avoid tracheotomy, if possible. Submucosal cordectomy was used with lateral fixation of one vocal fold and preservation of the arytenoid. The procedure was performed by using continuous intravenous anesthesia, which does not require intubation of the patient's airway. Seven patients were operated with this technique with excellent postoperative results. The glottal airway was largely improved in all patients, with only minor temporary complications. 相似文献
49.
动力加压髁螺钉治疗股骨髁部骨折临床与实验研究 总被引:1,自引:0,他引:1
本研究结合14例股骨髁间、髁上骨折以动力加压髁螺钉(Dynamic Condylar Screw DCS)固定。目的:为临床提供应用DCS的实验数据。方法:采用成人新鲜尸体股骨髁部标本,按照AO/ASIF分类,模拟Y形骨折模型,以DCS固定,置于WD-10E万能电子力学实验机上其抗拉伸、抗扭转、抗村缩、抗剪切强度。结果:DCS有较好的固定强度。临床应用14例,随访6个月至1年,优良率为85.71%。结论:DCS适合于 相似文献
50.
The data of 48 studies (published between 1903 and 1996), presenting information of all together 107 patients (108 lesions)
regarding pre-treatment clinical and radiological factors, treatment strategies, and the outcome, plus our own experience
of nine patients were retrospectively re-analyzed. The prognostic influence of pre-treatment factors was estimated with the
chi-square statistics. Clinical evaluation before/after treatment was performed using the Frankel scale. The average bleeding
rate was obtained from the ratio of percentage of first bleeding events in the population to the mean age of the population.
There were 47 males and 69 females (aged from twelve to 88 years). Thirty nine percent of the lesions were found in the cervical,
54% in the thoracic (30% upper, 24% lower) and 7% in the lumbar cord. The peak age of presentation was in the fourth decade,
the median duration of symptoms was 32 months. Clinical symptoms before treatment were progressive in all cases. Three patterns
of clinical presentation could be identified: a) episodes of stepwise clinical deterioration (30%), b) slow progression of
neurological decline (41%), c) acute onset with rapid or gradual decline over weeks or months (26%). 58% of the lesions showed
clinical or radiological signs of haemorrhage. In 66% of surgical patients (91 efficiently documented cases), clinical improvement
was achieved, 28% remained unchanged and 6% deteriorated. Whereas age, sex and lesion location had no influence on the results,
duration of symptoms (<three years) correlated significantly to a better outcome (p<0.02).
Surgical management in symptomatic patients is recommended. Once clinical signs caused by the malformation have appeared,
the patients tend to experience progressive neurological deterioration. 相似文献