Influence of Dexmedetomidine on Cognitive Function and Inflammatory Factors in Rats and Analysis of Its Molecular Mechanism after Cardiac Surgery under Cardiopulmonary Bypass.

The study aimed to explore the influence of Dexmedetomidine (Dex) on cognitive function and inflammatory factors in rats after cardiac surgery under cardiopulmonary bypass (CPB). For this purpose, 30 healthy male SD rats were reared in a quiet and clean environment with alternating light for 12 hours. They were rolled randomly into 3 groups, each with 10 rats, namely the control (Ctrl) group, the experimental group, and the Dex group. The rats in the Ctrl were not treated, and the rats in the experimental group were intraperitoneally injected with 50µg/kg saline. After that, cardiac surgery was performed under CPB. Rats in the Dex group were injected with 50 µg/kg Dex intraperitoneally and underwent cardiac surgery under CPB. The Morris water maze (MWM) experiment was performed to test the learning and memory abilities and spatial positioning abilities of SD rats. Enzyme-linked immunosorbent assay (ELISA method) was adopted to detect the contents of TNF-α, IL-6, and IL-1ß. Fluorescence quantitative PCR was applied to determine the mRNA expression levels of TNF-α, IL-6, and IL-1ß in the hippocampus. Results showed that in the MWM experiment, in contrast with the Ctrl, the escape latency of the experimental group and the Dex group after surgery were prolonged (P<0.05), and the times they crossed platforms reduced (P<0.05). In contrast with the experimental group, the escape latency of the Dex group shortened, and the times they crossed platforms increased. ELISA suggested that in contrast with the experimental group, the concentrations of TNF-α, IL-6, and IL-1ß in the Ctrl decreased (P<0.05), and those in the Dex group decreased slightly. In the fluorescence quantitative PCR experiment, in contrast with the experimental group, the mRNA expression levels of TNF-α, IL-6, and IL-1ß in the Ctrl increased, and those in the Dex group decreased slightly. Then Dex can improve the cognitive dysfunction of rats undergoing cardiac surgery under CPB, and its molecular mechanism may be to reduce the inflammation around the heart and hippocampus.

Clinical Utility of 3-Dimensional Reconstruction Images to Predict Conservative Treatment Outcomes of Intra-Articular Distal Radius Fractures.

BACKGROUND Three-dimensional (3D) images can provide additional information on bone fractures, especially in patients with intra-articular distal radius fractures (DRFs). We aimed to identify possible risk factors for adverse outcomes using a 3D reconstruction technique. MATERIAL AND METHODS We retrospectively reviewed adult patients who underwent plaster immobilization with or without closed reduction for DRFs in our hospital between February 2016 and May 2019. The 3D reconstruction image of DRFs was viewed from multiple angles to determine the existence of gaps or steps. Then, a semiquantitative standard was used to assess the severity of fracture. The patients' basic data and radiographic data were collected, and multiple linear regression analyses were used to identify possible risk factors associated with adverse outcomes. RESULTS A total of 89 cases were analyzed in our study. There were 28, 39, and 22 patients with level 1, 2, or 3 fractures, respectively, based on the semiquantitative standard. In a multiple linear regression, preoperative severity degree (ß, 0.393; 95% confidence interval [CI], 0.260-0.526) and postoperative rehabilitation exercise (ß, 0.352; 95% CI, 0.023-0.681) were associated with the Patient-Rated Wrist Evaluation during follow-up. CONCLUSIONS Our study presents a new method based on 3D reconstruction images to assess the severity of intra-articular DRFs. Patients who were identified as having severe fractures based on this method were found to have worse functional outcome.

The Necessity of Restoration of Radiologic Parameters by Closed Reduction in Elderly Patients with Distal Radius Fractures.

BACKGROUND The aim of this study was to evaluate the influence of distal radius fractures (DRFs) malalignment on the treatment outcomes in patients over age 65 years. MATERIAL AND METHODS We retrospectively reviewed the records on fresh DRFs treated with closed reduction from December 2014 to January 2018. After treatment, patients were evaluated for the determination of grip strength, the Visual Analog Scale (VAS) during wrist movement, the Patient-Rated Wrist Evaluation (PRWE), the Disabilities of the Arm, Shoulder and Hand (DASH) score, the appearance satisfaction, and active wrist range of motion (ROM). RESULTS A total of 96 patients with complete data were included in our study. During follow-up, there were 75 patients (78.1%) with acceptable reduction and 21 patients (21.9%) with unacceptable reduction. Compared with those having acceptable alignment in the distal radius, patients with unacceptable alignment had weak grip strength, were unsatisfied appearance, and had severe flexion as well as ulnar deviation limitation at 6-month follow-up. A significant correlation was found between ulnar positive variance and grip strength (r=-0.35, P=0.03), as well as dorsal angulation and flexion movement (r=-0.31, P=0.02). CONCLUSIONS Conservative treatment should be used differently, even in elderly patients. For low-demand patients, it is not necessary to restore all anatomic radiographic parameters, as malalignment does not increase disability or pain score. However, for patients who are still healthy and active, satisfactory reduction is the first choice, as malalignment can lead to decreased grip strength, dissatisfaction with appearance, and certain wrist limitations.

Survivorship Analysis of Clinical Adjacent-Segment Pathology After Single-Level Cervical Fusion.

BACKGROUND Clinical adjacent-segment pathology (CASP) is an important problem after anterior cervical surgery. The purpose of this study was to predict prevalence of CASP and determine the possible risk factors for CASP after single-level anterior cervical discectomy and fusion surgery. MATERIAL AND METHODS We retrospectively reviewed a series of patients who underwent single-level cervical discectomy and fusion surgery (ACDF). Both basic and radiographic data of patients were collected. Life-table method and Kaplan-Meier analysis were used to calculate prevalence of CASP and disease-free survival rate. Cox analysis was performed to determine the predictive factors for it. RESULTS A total of 256 patients were included in this study. The mean length of follow-up was 70.64 months. Among them, 31 patients were diagnosed as having CASP during follow-up. Nineteen of them were at the cephalad adjacent segment, and the other 12 were at the caudal segment. After ACDF procedures, 10.01% of patients developed new symptoms of CASP within 5 years, and the incidence increased to 23.89% after 10 years. The incidence rate of CASP was an average of 2.46% per year. Multivariate Cox regression analysis showed that congenital stenosis (hazard ratio [HR], 3.250; 95% confidence interval [CI], 1.538-6.867) and degeneration of adjacent segment (HR, 2.681; 95% CI, 1.259-5.709) were correlated with the incidence of CASP. CONCLUSIONS Patients with congenital stenosis and pre-existing degenerative changes of adjacent segments had a higher risk of developing CASP after single-level anterior cervical discectomy and fusion.

Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty: a meta-analysis.

To identify risk factors for periprosthetic joint infection following primary total joint arthroplasty, a systematic search was performed in Pubmed, Embase and Cochrane library databases. Pooled odds ratios (ORs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Patient characteristics, surgical-related factors and comorbidities, as potential risk factors, were investigated. The main factors associated with infection after total joint arthroplasty (TJA) were male gender (OR, 1·48; 95% CI, 1.19-1.85), age (SMD, -0·10; 95% CI, -0.17--0.03), obesity (OR, 1·54; 95% CI, 1·25-1·90), alcohol abuse (OR, 1·88; 95% CI, 1·32-2·68), American Society of Anesthesiologists (ASA) scale > 2 (OR, 2·06; 95% CI, 1·77-2·39), operative time (SMD, 0·49; 95% CI, 0·19-0·78), drain usage (OR, 0·36; 95% CI, 0·18-0·74), diabetes mellitus (OR, 1·58; 95% CI, 1·37-1·81), urinary tract infection (OR, 1·53; 95% CI, 1.09-2.16) and rheumatoid arthritis (OR, 1·57; 95% CI, 1·30-1·88). Among these risk factors, ASA score > 2 was a high risk factor, and drain usage was a protective factor. There was positive evidence for some factors that could be used to prevent the onset of infection after TJA.

Operative versus nonoperative treatment for displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials.

INTRODUCTION: There is insufficient evidence to indicate whether operative or nonoperative treatment is better for treating displaced midshaft clavicular fractures. We undertook a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the effects of the two treatments. METHODS: We searched the PubMed, EMBASE and Cochrane Library databases, and identified RCTs to compare the Constant score, DASH score, nonunion, malunion, and adverse events between operative and nonoperative groups of patients with displaced midshaft clavicular fractures. RESULTS: A total of 507 patients from 6 RCTs were subjected to meta-analysis. Operative treatment has an effect on improving function, which is demonstrated by significantly higher Constant scores (P = 0.0003) and lower DASH scores (P = 0.03). The rate of nonunion and the rate of malunion were significantly lower in operative group compared with that in nonoperative group (both P < 0.0001). However, the rate of adverse events was significantly higher in operative group compared with that in nonoperative group (P = 0.003). CONCLUSIONS: Operative treatment provided a significantly better functional outcome, a lower rate of nonunion and malunion, but was accompanied with a higher rate of adverse events. However, the results should be interpreted with caution and further large-scale, well-designed RCTs on this topic are still needed.

Comparison of vertebroplasty and kyphoplasty in the treatment of osteoporotic vertebral compression fractures with intravertebral clefts.

BACKGROUND: Few studies have compared the surgical outcomes of vertebroplasty (VP) and kyphoplasty (KP) in the treatment of osteoporotic vertebral compression fractures (VCFs) with intravertebral clefts. METHODS: A retrospective study was conducted to review patients with a single-level osteoporotic VCF treated by VP or KP. Intravertebral clefts were assessed by preoperative computed tomography (CT) and magnetic resonance scans. All enrolled patients were followed up for 12 months. Clinical outcomes, radiological findings and complications were evaluated. RESULTS: A total of 53 patients were available for data analysis. Most of the fractures (75.5 %) occurred in the region of the thoracolumbar junction (T10-L2). Twenty-four patients received VP and 29 patients received KP. Patients in both group had significant pain relief after surgery (P < 0.01). Compared with VP group, there was a significant lower visual analogue scale (VAS) score in KP group at the 6- (P = 0.04) and 12-month follow-up (P = 0.02), but the decreased values of VAS score had no significant correlation with the magnitude of deformity correction. Restoration of vertebral body height and reduction in kyphotic angle were achieved in both groups, and the magnitude of correction was more significant in KP group (P < 0.01). Cement leakage rate in VP group (66.7 %) was higher than that in KP group (20.7 %), and there was a significant difference (P < 0.01). CONCLUSIONS: Intravertebral clefts occur primarily at the thoracolumbar junction and can be detected easily by CT and magnetic resonance imaging scans. Both VP and KP are effective in the treatment of clefts, but patients in KP group tend to have a better pain relief at the medium and long-term follow-up. However, the better pain relief effect of KP cannot be attributed to the higher magnitude of deformity correction.

Surgical treatment of distal radius fractures: impact on forearm rotation in non-elderly patients.

Forearm rotation restriction (FRR) is common after surgery for distal radius fractures (DRFs). The aim of the current study was to investigate the effect of DRFs on forearm rotation. This retrospective study reviewed patients with DRFs who underwent surgical treatment from January 2019 to December 2021. The patients' basic data and radiographic parameters were analyzed. Forearm rotation, including pronation and supination, was assessed using a standard goniometer. The Patient-Rated Wrist Evaluation (PRWE) score was evaluated, and the incidence of FRR at the 6-month follow-up was recorded. Univariate and multivariate logistic regression analyses were performed to identify risk factors correlated with FRR. A total of 127 patients with DRFs were included in this study. After surgery, 46 cases were considered to have FRR, with a rate of 36.2%, while the remaining 81 cases (63.8%) did not have FRR. The PRWE scores were 22.8 ± 5.2 and 17.9 ± 4.2 in the FRR group and non-FRR group, respectively, and the difference was statistically significant (P < 0.05). Multivariate analysis showed that the involvement of the sigmoid notch (OR, 2.88; 95% CI 1.49-5.56), post-operative volar tilt < 0° (OR, 2.16; 95% CI 1.34-3.50), and post-operative ulnar variance > 0 mm (OR, 1.37; 95% CI 1.06-1.78) were independently associated with the incidence of FRR. The FRR is associated with an increased PRWE score and may have had some impact on the patient's daily life. Fractures involving the sigmoid notch, dorsal angulation, and radial shortening deformity were found to be correlated with the incidence of FRR. Preoperative risk notification and intraoperative preventive measures are necessary for these patients.

Factors predicting complications following open reduction and internal fixation of intra-articular distal radius fracture.

Objective: This study aimed to determine the incidence and predictors of the complications after open reduction and internal fixation (ORIF) of intra-articular distal radius fracture (IADRF) with a minimum follow-up of 12 months. Methods: Medical records and outpatient follow-up records were retrospectively reviewed to collect medical, surgical, and complication data on consecutive patients who had undergone an ORIF procedure for an IADRF between January 2019 and June 2022. Data included demographics, comorbidities, injury, surgical characteristics, and laboratory findings on admission. A multivariate logistic regression model was constructed to identify the significant predictors, with a composite of any complications occurring within 12 months after the operation as the outcome variable and potentially a range of clinical data as the independent variables. The magnitude of the relationship was indicated by the odds ratio (OR) and the 95% confidence interval (CI). Results: During the study period, 474 patients were included, and 64 had documented complications (n = 73), representing an accumulated rate of 13.5%. Among them, carpal tunnel syndrome was the most common, followed by tenosynovitis caused by tendon irritation/rupture, superficial or deep wound infection, complex regional pain syndrome (CRPS) type 1, radial shortening (≥4 mm), plate/screw problems, and others. The multivariate results showed the following factors significantly associated with increased risk of complications: experience of DRF surgery with <30 cases (OR: 2.2, 95% CI: 1.6-3.5), AO type C fracture (OR: 1.7, 95% CI: 1.2-2.9), initial lunate facet collapse of ≥5 mm (OR: 4.2, 95% CI: 1.4-8.9), and use of temporary external fixation before index surgery (OR: 2.4, 95% CI: 1.5-4.3). Conclusions: These findings may aid in patient counseling and quality improvement initiatives, and IADRF should be directed by an experienced surgeon.

Predictive factors of distal radioulnar joint instability after surgical treatment of distal radius fractures.

Distal radioulnar joint (DRUJ) instability is a common postoperative complication of distal radius fractures, seriously impacting patients' quality of life. This study investigated its possible influencing factors to determine prognosis and to guide treatment better. We retrospectively included a series of patients with distal radius fractures that underwent volar locking plate fixation. Basic patient information and imaging parameters were collected. The incidence of DRUJ instability during follow-up was recorded, and factors associated with DRUJ instability were determined using univariate analysis and multifactorial logistic regression analysis. A total of 159 patients were enrolled in this study. At 6 months of follow-up, 54 patients (34.0%) had DRUJ instability, and multivariate analysis showed coronal plane displacement (OR, 1.665; 95% CI, 1.091-2.541), fracture classification (OR, 0.679; 95% CI, 0.468-0.984) and DRUJ interval (OR, 1.960; 95% CI, 1.276-3.010) were associated with DRUJ instability after volar locking plate. DRUJ interval, coronal plane displacement, and fracture classification are associated with DRUJ instability during follow-up. Therefore, preoperative risk communication and intraoperative attention to recovering relevant imaging parameters are necessary for these patients.

Electrospun Polycaprolactone (PCL)-Amnion Nanofibrous Membrane Promotes Nerve Regeneration and Prevents Fibrosis in a Rat Sciatic Nerve Transection Model.

Functional recovery after peripheral nerve injury repair is typically unsatisfactory. An anastomotically poor microenvironment and scarring at the repair site are important factors impeding nerve regeneration. In this study, an electrospun poly-e-caprolactone (PCL)-amnion nanofibrous membrane comprising an amnion membrane and nonwoven electrospun PCL was used to wrap the sciatic nerve repair site in the rat model of a sciatic nerve transection. The effect of the PCL-amnion nanofibrous membrane on improving nerve regeneration and preventing scarring at the repair site was evaluated by expression of the inflammatory cytokine, sciatic functional index (SFI), electrophysiology, and histological analyses. Four weeks after repair, the degree of nerve adhesion, collagen deposition, and intraneural macrophage invasion of the PCL-amnion nanofibrous membrane group were significantly decreased compared with those of the Control group. Moreover, the PCL-amnion nanofibrous membrane decreased the expression of pro-inflammatory cytokines such as interleukin(IL)-6, Tumor Necrosis Factor(TNF)-a and the number of pro-inflammatory M1 macrophages, and increased the expression of anti-inflammatory cytokine such as IL-10, IL-13 and anti-inflammatory M2 macrophages. At 16 weeks, the PCL-amnion nanofibrous membrane improved functional recovery, including promoting nerve Schwann cell proliferation, axon regeneration, and reducing the time of muscle denervation. In summary, the PCL-amnion nanofibrous membrane effectively improved nerve regeneration and prevent fibrosis after nerve repair, which has good clinical application prospect for tissue repair.

Incidence and risk factors for redisplacement after closed reduction and instant rigid cast immobilization for paediatric distal radius fractures: a case control study.

BACKGROUND: The aim of this study is to record the incidence of redisplacement after closed reduction and instant rigid cast immobilization and to identify possible risk factors that may be associated with the redisplacement. METHODS: We retrospectively reviewed paediatric patients who underwent closed reduction and instant rigid cast immobilization for simple distal radius fractures from 2014 to 2018. Patients were followed up at 1 week, 2 weeks, 3 weeks, and 6 weeks after casting. Redisplacement was diagnosed on the basis of image findings. Risk factors for redisplacement were evaluated in three aspects, which included patient-related, fracture-related, and cast-related factors. RESULTS: A total of 123 children were included in this study. During follow-up, 31 patients (25.2%) showed redisplacement after closed reduction and cast immobilization. Twenty-two redisplacements happened within 1 week after treatment, 8 redisplacements happened between 1 and 2 weeks, and only one redisplacement happened after 2 weeks. In the multivariate analysis, associated ulna fracture (OR, 4.278; 95% CI, 1.773-10.320), initial translation ≥ 50% (OR, 9.148; 95% CI, 3.587-23.332), and 3-point index ≥ 0.40 (OR, 1.280; 95% CI, 1.159-1.401) were three independent factors that correlated with the incidence of redisplacement during follow-up. CONCLUSIONS: About a quarter of paediatric patients would develop redisplacement after reduction and immobilization with instant rigid cast. Patients with associated ulna fracture, severe initial translation, and high 3-point index have a higher risk to develop redisplacement.

The effect of distal radius fractures involving the distal radioulnar articular joint on forearm rotation.

BACKGROUND: The objective of this study was to predict the function of the forearm rotation on the basis of the articular surface of the sigmoid notch from three-dimensional reconstruction images. METHODS: We retrospectively reviewed patients who underwent volar plate fixation for intra-articular distal radius fractures (DRFs) in our institution between January 2017 and July 2019. The 3D image of the sigmoid notch on the fractured distal radius was reconstructed and looked up from the ulnar view to determine the existence of gaps or steps. Patients with or without gaps/steps on the sigmoid notch were included in the case group or control group, respectively. The patients' basic data and postoperative data were collected and compared. RESULTS: A total of 81 patients were included. There were 33 patients in the case group, and 48 patients in the control group. There was no significant difference between the two groups at baseline. The total range of motion (ROM) of rotation in the case group and control group was 130.3 ± 6.2° and 145.3 ± 6.7°, respectively (P < 0.001). The percentage of rotation ROM of contralateral limb in the case group and control group was 72.3 ± 3.1% and 80.7 ± 3.6%, respectively (P < 0.001). VAS during forearm rotation was 2.1 ± 0.7 in the case group, which is significantly higher than that in the control group (1.5 ± 0.5, P < 0.001). CONCLUSION: This study proposed a new method to assess the articular surface of the sigmoid notch which is based on 3D reconstruction images. With the assistance of this method, we found that gaps or steps on the sigmoid notch not only limit forearm pronation rotation and supination rotation, but also cause apparent wrist pain during forearm rotation movement and poor wrist ability.

Surgical treatment of intra-articular distal radius fractures with the assistance of three-dimensional printing technique.

BACKGROUND: The aim of this study was to evaluate the effectiveness and safety of surgical treatment of intra-articular distal radius fractures (DRFs) with the assistance of three-dimensional (3D) printing technique. METHODS: Patients with intra-articular DRFs in our hospital from February 2017 to November 2018 were enrolled in this study, and were randomly assigned to 2 parallel groups to receive surgical treatment with the assistance of 3D printing technique or not. For patients in the 3D printing group, the surgical procedure was simulated with 3D physical model before surgery. Volar plate and K-wire fixation were performed in all patients. Patients in the 2 groups were compared in terms of intraoperative indexes and postoperative function. RESULTS: A total of 32 patients were included in our study. During surgery, mean operation time in the 3D model group was significantly lower than that in the routine group (P < .001). Besides, significantly less blood was lost in the 3D model group than that in the routine group (P < .001). Furthermore, the 3D model group had a significantly less times of intraoperative fluoroscopy than that in the routine group (P = .002). However, the 3D model group showed no significant difference in visual analog scale (VAS) score, the disabilities of the arm, shoulder, and hand (DASH) score, or active wrist range of motion (ROM) in comparison with the routine group (P > .05). CONCLUSION: With the assistance of 3D printing technique, the operation time, amount of intraoperative bleeding, and times of intraoperative fluoroscopy can be reduced during the surgical treatment of intra-articular DRFs with volar plating and K-wire fixation. This technique is safe and effective, and is worth spreading in other orthopedic surgeries.

Radiocarpal joint stiffness following surgical treatment for distal radius fractures: the incidence and associated factors.

BACKGROUND: Postoperative radiocarpal joint stiffness (RJS) is common in patients with distal radius fractures (DRFs). The purpose of this study was to record the incidence of RJS and to determine potential risk factors that may be associated with it. METHODS: We retrospectively included a series of patients who suffered from DRFs and underwent volar plate fixation. Patients' basic data, radiographic data, and postoperative data were collected. The incidence of RJS during follow-up was recorded, and both univariate analyses and multivariate logistic regression were used to determine factors associated with it. RESULTS: A total of 119 patients were included in this study. After surgical procedures, there were 42 (35.3%) patients with RJS and 77 (64.7%) patients without. The incidence of RJS after surgical treatment is 35.3%. Multivariate analysis showed that intra-articular fracture (OR, 1.43; 95% CI, 1.13-1.81), pre-operative severe swelling (OR, 1.35; 95% CI, 1.05-1.74), post-operative unsatisfied volar tile (OR, 1.38; 95% CI, 1.01-1.89), and improper rehabilitation exercise (OR, 1.72; 95% CI, 1.18-2.51) were correlated with the incidence of RJS during follow-up. CONCLUSIONS: Patients with intra-articular fracture, pre-operative severe swelling, post-operative unsatisfied volar tile, and improper rehabilitation exercise were factors associated with the incidence of wrist stiffness. Preoperative risk notification and postoperative precautions are necessary for relevant patients.

Volar, Splitting, and Collapsed Type of Die-Punch Fracture Treated by Volar Locking Plate (VLP): A Retrospective Study.

OBJECTIVE: To compare the results of different types of die-punch fractures treated by volar locking plate (VLP). METHODS: Between January 2013 and February 2018, a total of 71 patients with die-punch fracture of distal radius were treated by VLP and their medical records were retrospectively reviewed. Of them, 18 were classified as volar type, 24 as splitting type, and 28 as collapsed type of fracture, based on the preoperative radiographs and CT scans. The minimum follow-up period was 12 months. Radiological parameters, wrist function, range of motion (ROM), and complications were evaluated and compared. Pearson chi-square test was used to assess the difference of gender distribution, injury side, dominance, mechanism, type and classification of fracture, and postoperative complications, when necessary (P < 0.05), followed by pairwise comparisons using partitions of chi-square test. Two-tailed P value <0.05 was considered as statistically significant. For pairwise comparisons, adjustment of statistical level as P < 0.017 (0.05/3) was used. SPSS 21.0 was used to perform all the analyses. RESULTS: The mean follow-up time was 14.5 months, and at the mean of postoperative 8 weeks all patients obtained bony union, without delayed or non-union. The grip strength was 26.6 ± 7.9 kg for patients in volar fracture group, 27.0 ± 9.4 kg in splitting group, and 26.2 ± 9.4 kg in collapsed group, without significant difference (P = 0.628).The disabilities of the arm, shoulder, and hand (DASH) (9.2 ± 10.0 for volar group, 8.8 ± 7.9 for splitting group, and 10.6 ± 8.7 for collapsed group) or Gartland-Werley score (5.1 ± 2.8 for volar group, 4.8 ± 3.2 for splitting group, and 6.4 ± 2.7 for collapsed group) either did not differ among the three groups (all P > 0.05). There was a poorer ROM in the group of collapsed fractures, but the difference was non-significant for any parameter (P > 0.05). As for radiographic parameters, we did not find any significant difference for volar tilt, radial inclination, radial height, and ulnar variance (all P > 0.05), except for articular step-off (P < 0.001). Pairwise comparisons showed a significantly greater step-off (1.2 mm vs 0.4 mm, 0.5 mm) and higher rate of total complications in group of collapsed fracture (39.3%), compared to either volar (10.5%) or splitting type (12.5%). CONCLUSIONS: The collapsed type of die-punch fracture posed a greater articular step-off and a higher rate of complications, especially secondary wrist osteoarthritis, which deserved more attention in clinical treatment.

Is correction of segmental kyphosis necessary in single-level anterior cervical fusion surgery? An observational study.

BACKGROUND: This study was conducted to determine whether sagittal lordotic alignment and clinical outcomes could be improved by the correction of segmental kyphosis after single-level anterior cervical discectomy and fusion (ACDF) surgery. PATIENTS AND METHODS: We retrospectively reviewed patients who underwent single-level ACDF surgery in our hospital between January 2014 and February 2017. Basic characteristics of patients included age at surgery, gender, diagnosis, duration of symptoms, and location of target level. Pre- and postoperative radiographs at the 6-month follow-up were used to evaluate the following parameters, such as segmental angle, C2-C7 angle, T1 slope, and C2-C7 sagittal vertical axis (SVA). Postoperative clinical outcomes were assessed by the Neck Disability Index and VAS. According to the segmental angle of postoperative radiographs, patients were divided into noncorrection group and correction group. RESULTS: A total of 181 patients (99 males and 82 females) were analyzed in our study. There were 32 patients in the noncorrection group and 149 patients in the correction group. There was no significant difference in demographic and clinical data between the two groups before surgery. However, patients in the correction group showed larger C2-C7 angle and lower C2-C7 SVA after surgery in comparison with those in the noncorrection group. Besides, changes in the segmental angle were positively correlated with changes in C2-C7 angle and negatively correlated with changes in C2-C7 SVA. CONCLUSION: Surgical correction of segmental kyphosis in single-level cervical surgery contributed to balanced cervical alignment in comparison with those without satisfactory correction. However, we could not demonstrate that the correction of segmental alignment is associated with a better recovery in clinical outcomes.

The comparison of limited-incision versus standard-incision in treatment of carpal tunnel syndrome: A meta-analysis of randomized controlled trials.

BACKGROUND: Carpal tunnel syndrome is a common compressive neuropathy of the median nerve. Compared with standard release, the efficacy, safety, and postoperative complications of limited carpal tunnel release remain controversial. The purpose of this study was to compare the effects of the 2 treatments. METHODS: The English-language literature was searched using MEDLINE, Web of Science, and Embase. Randomized controlled trials that compared standard and limited incision for carpal tunnel release were included in the meta-analysis. Strength, interval to return to activities, the rate of adverse events, effectiveness, and operative time were compared. RESULTS: Thirteen randomized controlled trials (RCTs) containing 1020 patients were included. Limited incision treated patients showed better early recovery of grip strength (mean difference [MD], 4.25 [0.86-7.65]; P = .01) and pinch strength (MD, 1.37 [0.24-2.51]; P = .02) but no advantage after more than 6 months. Patients treated with limited incision showed an earlier return to activities (MD,-8.80 [-9.21 to -8.39]; P < .01) and reduced operative time (standardized mean difference [SMD], -1.68 [-3.24 to-0.12]; P = .04). The rate of adverse event was significantly higher in standard group compared with that in limited group (risk ratio [RR] 0.61, 95% CI 0.38-0.96, P = .03). CONCLUSIONS: Limited incision release allows us to return to activities early, reduces operative time, decreases rate of adverse events, and improves strength during the early postoperative period. Results at 6 months or longer are similar according to current data. However, the results of this meta-analysis should be interpreted with caution due to heterogeneity amongst the included studies.

Prevalence of and risk factors for Modic change in patients with symptomatic cervical spondylosis: an observational study.

BACKGROUND: The aim of this study was to assess the prevalence of cervical Modic change (MC) in patients with cervical spondylosis and to develop a better understanding of the possible risk factors for the prevalence of MC. METHODS: Between January 2014 and April 2017, patients with cervical spondylosis were included in our study. All patients underwent magnetic resonance imaging (MRI) to evaluate the presence of MC. The MC was classified into three types according to the Modic classification. Potential risk factors were collected from demographic data, lifestyle variables, laboratory tests, and radiographic images. Both univariate and multivariate analysis were used to detect factors associated with MC. We further compared several variables related to fat metabolism between patients with Type 1 and Type 2 MC. RESULTS: The prevalence of MC in patients with cervical spondylosis was 9.24%. The MC was most frequent at C5-6, followed by C6-7, C4-5, and C3-4. The proportion of Type 1 MC in patients with neck pain was significantly higher than that in patients without neck pain (46.2% vs 13.6%, P=0.027). However, none of the variables associated with fat metabolism showed a significant difference between Type 1 and Type 2 MC. Multivariate logistic analysis showed that age ≥55 years (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.22-2.98) and body mass index (BMI) ≥25 kg/m2 (OR, 2.41; 95% CI, 1.62-3.59) were two significant independent factors that are associated with cervical MC in patients with cervical spondylosis (P<0.05). CONCLUSION: It appears that advanced age and high BMI were two factors that may be responsible for cervical MC. Type 1 MC is associated with the prevalence of neck pain. However, we cannot confirm that Type 2 MC is correlated with fat metabolism.

Predictive factors of symptomatic lumbar canal stenosis in patients after surgery for cervical spondylotic myelopathy.

BACKGROUND: The aim of this study was to determine the incidence of coexisting symptomatic lumbar canal stenosis (LCS) in patients after surgery for cervical spondylotic myelopathy (CSM) and identify possible predictive factors associated with it. MATERIALS AND METHODS: We retrospectively reviewed patients with CSM at our institution between January 2005 and December 2015. Clinical and radiographic factors including age, gender, body mass index, Japanese Orthopedic Association scores, cervical alignment, anteroposterior diameter of cervical canal, number of levels with CSM, and percentage of cervical cord compression were investigated. Symptomatic LCS was defined as leg symptoms and a narrowing of the lumbar spinal canal at one level at least, which is confirmed by magnetic resonance images of the lumbar spine. Univariate and multivariate analyses were used to identify possible predictive factors. Pearson correlation analysis was also conducted to analyze the association between cervical parameters and percentage of LCS. RESULTS: A total of 317 patients with CSM met the criteria for inclusion. There were 39 patients (12.3%) with LCS after cervical surgery during a mean of 7.3 years' follow-up. In the multivariate logistic regression analysis, narrow diameter of cervical canal (OR, 3.96; 95% CI, 1.20-13.04) was identified as the only independent predictor of symptomatic LCS in CSM patients. The correlation coefficient between anteroposterior diameter of cervical canal and severity of LCS indicated a significantly positive linear relationship with 0.536 (P<0.001). CONCLUSION: We found that narrow diameter of cervical canal was associated with symptomatic LCS in CSM patients. Patients with this risk factor should be informed the possibility of symptomatic LCS.