Effects of cognitive- and motor-dual tasks on postural control regularity following anterior cruciate ligament reconstruction

BackgroundHigh injury rates following anterior cruciate ligament reconstruction (ACLR) motivate the need to better understand lingering movement deficiencies following return to sport. Athletic competition involves various types of sensory, motor, and cognitive challenges; however, postural control deficiencies during this spectrum of conditions are not well understood following ACLR.Research questionTo what extent is postural control altered following ACLR in the presence of sensory, motor, and cognitive challenges, and does postural control correlate with patient-reported symptoms?MethodsFourteen individuals following ACLR (4 m/10 f, 21.2 ± 2.4 yr, 76.9 ± 19.1 kg, 1.70 ± 0.14 m) and fourteen matched healthy controls (4 m/10 f, 21.2 ± 1.4 yr, 75.4 ± 15.3 kg, 1.70 ± 0.15 m) participated in the study. Participants completed single-leg balance, ACLR limb or matched side for controls, under four conditions: 1) eyes open, 2) eyes closed, 3) visual-cognitive dual task (i.e., reverse digit span), and 4) motor dual task (i.e., catching a ball). Sample entropy (SEn) was calculated for each balance condition to characterize regularity of center of pressure control. Participants also completed patient-reported outcomes to characterize self-reported knee function, symptoms, and fear. A mixed effects model tested for differences in SEn between balance conditions, and Spearman correlations tested for relationships between SEn and patient-reported outcomes.ResultsA significant Group-by-Condition interaction was detected (P = 0.043). While the motor dual task and eyes closed balance conditions were associated with the lowest SEn for both groups, only the visual-cognitive dual task condition demonstrated a significant difference between groups, with the ACLR group having lower SEn [95% confidence interval for ΔSEn: (0.03, 0.35)]. Lower KOOS-Sport scores were associated with decreased SEn for the ACLR group (ρ = 0.81, P < 0.001).SignificanceThese findings are consistent with ACLR individuals using a less automatic approach to postural control compared to controls, particularly when presented with a visual-cognitive challenge. Altered neuromuscular control persists well after ACLR surgery and can be related to patient-reported outcomes.     

负压封闭辅助引流技术联合锁定接骨板外用技术治疗胫骨中下段开放骨折的临床效果

背景:目前在国内锁定接骨板常作为内固定器材使用,国外仅有少数病例报道将其作为外固定器材使用,而负压封闭辅助引流技术联合锁定接骨板外用治疗开放骨折的病例,鲜有报道。目的:探讨负压封闭辅助引流技术(vacuum-assisted closure,VAC)联合锁定板外用治疗胫骨中下段开放骨折后的临床效果。方法:2010年6月至2011年6月,我院收治胫骨中下段开放骨折患者80例,随机分为A、B两组,每组40例。A组采用负压封闭辅助引流技术联合锁定接骨板外用技术,B组采用外固定架固定术后常规换药治疗。结果:80例患者随访3～12个月,平均7.5个月。A组软组织恢复时间(13.70±1.89)d,B组(18.00±2.82)d;A组肉芽生长时间(4.90±1.10)d,B组(13.40±1.89)d,外固定架持续时间A组(14.30±1.88)d,B组(40.40±5.64)d;A组骨折愈合时间(16.10±1.85)周,B组(29.40±2.91)周;A组总住院天数(4.90±1.10)周,B组(10.90±3.28)周;A组踝关节活动度为34.40°±0.69°,B组20.20°±6.07°。数据对比分析后,A组均优于B组(P<0.05)。结论:负压封闭辅助引流技术联合锁定接骨板外用技术简单,可靠,创伤小,功能恢复快,是治疗胫骨中下段开放骨折的合理方法。     

直视下微创与切开进行单节段经椎间孔腰椎融合术的临床效果比较

[目的]观察直视下微创(minimally invasive,MIS)采用普通椎弓根螺钉完成单节段经椎间孔腰椎融合(transforaminal lumbar interbody fusion,TLIF)的临床结果.[方法]2007～2009年期间26例患者直视下进行单节段腰椎MIS - TLIF手术,45例患者采用Open - TLIF进行单节段腰椎手术,均采用普通椎弓根螺钉内固定,比较两组临床效果.[结果]MIS组术中出血量、术后引流量、下地活动时间和平均住院日均明显低于Open组,术后5 d MIS组腰痛VAS评分优于Open组,而两组腿痛VAS、ODI评分和融合率无显著差异.[结论]直视下MIS与Open两组同样具有长期优良的临床治疗结果,但是MIS组的手术出血量、术后引流量、下地活动时间、术后住院时间和术后短期腰痛均优于Open组.     

Open access endoscopy in rural and remote Western Australia: Does it work?

Background: Access to diagnostic endoscopy is limited in rural and remote Western Australia. Published reports suggest open access referrals may result in over‐servicing, this is reduced by adherence to the American Society for Gastrointestinal Endoscopy (ASGE) guidelines.The aim was to assess whether an out reach surgical service offering open access endoscopy to rural areas was being over utilized. Methods: Prospective data collection from all patients undergoing upper and lower endoscopy procedures between January 1996 and June 2000 were included in the present study. Indications for referral between the general practitioners and the visiting surgeons were reviewed in patient records and assessed for compliance with the ASGE guidelines. The groups were analysed for appropriateness of referrals and frequency of positive pathology investigations. Records for all patients undergoing colonoscopy were reviewed to determine the reason and number of cancelled procedures. Results: A total of 772 endoscopies were performed and 75% were booked as open access services. The referral rate for procedures was greater for general practitioners (583) compared to the visiting surgeons (189), the overall compliance rate for approved indications using the ASGE guidelines for both groups was 92%. There was no significant difference in pathology found between groups. Conclusion: The present study shows that an outreach rural surgical service programme in Western Australia offering open access endoscopy conforms to international guidelines and does not induce unnecessary procedures. Rural patients benefit from a personal cost savings andconvenience. There is an associated reduction in government‐assisted travel costs to larger centres as well as decreased waiting lists.     

预防性肌瓣在小腿开放性骨折中的应用

目的探讨预防性肌瓣在治疗小腿Ⅱ、Ⅲ度开放性骨折中的应用效果。方法急诊一期彻底清创,选择髓内钉、外固定支架及钢板固定骨折,应用各种不同肌瓣覆盖骨折断端及缺损创面。结果临床应用15例,所有病例伤口均Ⅰ期愈合,无感染发生。随访1～3年,患者肢体功能恢复满意。结论预防性肌瓣一期应用对小腿Ⅱ、Ⅲ度开放性骨折及合并严重软组织缺损的治疗可取得良好疗效。     

Traumatic Complex Hawkins Type IV Talar Fracture: A Case Report

Fracture-dislocations of the talus are one of the most complex injuries involving the foot and ankle. These injuries are often accompanied by additional traumatic orthopedic injuries, avascular necrosis, and infection. When approaching limb reconstruction and salvage, the overall prognosis and functionality of the limb are key factors to consider. In the present report, we draw attention to the importance of a multidisciplinary team approach for formulating a treatment plan that incorporates the talar injury and associated injuries or pathologic features. We also reviewed the published data related to avascular necrosis of the talus, open talar fracture management, and treatment outcomes.     

VSD结合外固定支架在西藏高原地区胫腓骨开放性骨折分期治疗中应用

目的：探讨负压吸引敷料结合外固定支架技术在西藏高原地区胫腓骨开放性骨折分期治疗中的应用及临床疗效。方法2014年8月-2015年8月收治16胫腓骨开放性骨折患者,其中男性12例,女性4例,年龄19~66岁,平均年龄39.4岁(19~66岁);胫腓骨中上段骨折4例,下段骨折12例。待患者病情稳定后患者生命体征稳定后,无继发性损伤,予行清创、外固定支架固定骨折端,并采用负压吸引敷料覆盖创面或创腔。7 d后更换VSD或予行二期缝合或软组织覆盖。 X线检查明确骨折愈合时间并记录相关并发症。结果本组16例创面均二期愈合,未见感染、皮肤或皮瓣坏死等软组织并发症。本组共随访患者12例(电话通知来院复诊),4例失访,平均随访18个月(12~24个月)。影像学检查明确平均骨折愈合时间为5.5个月(3~7个月),其中骨折一期临床愈合9例(75%),延迟愈合3例(25%)。随访期间除2例出现钉道感染,经保守治疗后治愈,余患者未见深部感染、植皮或皮瓣坏死、畸形愈合、骨不连或骨髓炎发生。结论负压吸引敷料结合外固定支架治疗西藏高原地区胫腓骨开放性骨折,在迅速有效地稳定骨折的同时,能安全有效地封闭创面,缩短二期创面修复时间,促进骨折愈合,减少并发症。     

Open reduction of a chronic proximal dislocation after total hip arthroplasty

We report an unusual case of a chronic prosthetic dislocation that was caused by the buttonholing of a prosthetic femoral head by anterior soft tissue, which impeded reduction. A surprisingly good functional result was achieved by an open reduction and revision operation on a 56-year-old man, who had a chronic dislocation of a total hip prosthesis. Successful treatment with open reduction of a chronic proximal dislocation after total hip arthroplasty has not been reported previously in the literature.     

颌后切口入路治疗髁突骨折

目的：探讨髁突中、低位骨折开放复位手术入路.方法：采用颌后切口入路解剖复位、小型接骨板坚强内固定治疗髁突中、低位骨折.结果：本组21例（23侧）经5～52个月随访,并发症发病率低,切口瘢痕不明显,功能恢复良好.结论：对治疗髁突中、低位骨折,颌后切口入路是一种安全有效的手术切口。