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ObjectiveTo analyze the epidemiological and clinical characteristics of children's lower extremity amputation and amputation rehabilitation, and to explain the causes of children's amputation and the complications after amputation. MethodsFrom January, 2016 to March, 2021, 51 amputation related children were retrospectively analyzed. The correlation between the cause of amputation and complications post amputation were analyzed. ResultsTraumatic amputations accounted for 58.82%, and the main cause was traffic accidents (70%). Amputations caused by diseases accounted for 41.18%, and the main cause was congenital limb deformities (80.95%). Traumatic amputation was more likely to have stump complications than expected (P < 0.05). The possibility of stump complications after disease-specific amputation was lower than expected (P < 0.05). ConclusionTraffic trauma is the main cause of amputation in children and is characterized clinically by a high incidence of unsatisfactory stumps, mainly due to soft tissue abnormalities, and most cases require stump revision to improve the poor residuals for prosthetic restoration of ambulation. Congenital pseudarthrosis of the tibia is the main cause of disease-specific amputation, and the outcome of amputation often cannot be definitely avoided even after long-term limb preservation treatment.
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Objective To investigate the perioperative characteristics of hip fractures and the effects of early rehabilitation in elderly patients. Methods Clinical data of 123 elderly patients admitted to our department from January 2012 to January 2014 were retrospectively analyzed. Patients were divided into a rehabilitation group and a control group ,based on whether rehabilitation therapy was offered.Comparison was made between the two groups on postoperative mortality and postoperative complications. Results Of 123 patients ,there were 51 males and 72 females ,with a mean age of (83.5 ± 4.8)years(aged 67~96 years).Femoral fractures were seen in 32 patients and femoral intertrochanteric fractures in 91 patients.Before operation ,112 (91.1% ) patients had concomitant diseases. There were significant differences in postoperative complications and one-year mortality after operation between patients receiving early rehabilitation and controls (5/60 or 8.3% vs.14/63 or 22.2% ,4/60 or 6.7% vs.13/63 or 20.6% ,χ2=4.539 and 5.034 ,P=0.033 and 0.025 , respectively ). Conclusions Elderly hip fracture patients have many concomitant diseases before operation.With appropriate perioperative management ,well-chosen methods of anesthesia and surgery ,and early postoperative rehabilitation measures ,the incidence of perioperative complications and one-year mortality can be decreased ,and desirable surgical outcomes can be attained.
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@#Objective To improve the clinical thinking ability and operating skills of undergraduates majored in rehabilitation therapy. Methods Fifteen students were chosen as test group and taught with case-based learning (CBL) combined with problem-based learning (PBL), while fifteen students from the same grade were chosen as control group and taught with routine teaching method. PBL method helped to remind basic knowledge while CBL helped to teach clinical thinking and operating skills. Their performance were compared after practice.Results The scores were significantly higher in the test group than in the control group (t>6.235, P<0.001).Conclusion CBL combined with PBL was helpful to consolidate the basic knowledge and operating skills, and worked effectively in the orthopedic practice for rehabilitation therapy.
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@#Objective To improve the clinical thinking ability and operating skills of undergraduates majored in rehabilitation therapy. Methods Fifteen students were chosen as test group and taught with case-based learning (CBL) combined with problem-based learning (PBL), while fifteen students from the same grade were chosen as control group and taught with routine teaching method. PBL method helped to remind basic knowledge while CBL helped to teach clinical thinking and operating skills. Their performance were compared after practice.Results The scores were significantly higher in the test group than in the control group (t>6.235, P<0.001).Conclusion CBL combined with PBL was helpful to consolidate the basic knowledge and operating skills, and worked effectively in the orthopedic practice for rehabilitation therapy.
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Orthopaedic rehabilitation is an important part of rehabilitation resident standardization training, that is complex and unique. Introduction of the discipline, as well as optimizing teaching methods, clinical practice and test are very important for a satisfactory out-come, such as combination of theory and practice, and systematical rehabilitation procedures, principles and operation.
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@#ObjectiveToexplorethemethodtoestablishanimalmodelofearlyosteonecrosisofthefemoralhead(ONFH)inducedby steroid.Methods20healthymaleBeagleswererandomlydividedintocontrolgroupandexperimentalgroupwith10dogsineachgroup. Theexperimentalgroupwasinjectedlipopolysaccharide10μg/kgandmethylprednisolone20mg/kgfor3daysconsecutively.Thecontrol groupwasinjectednormalsaline.2monthsand4monthsafteradministration,bothgroupswereperformedmagneticresonanceimaging (MRI).5animalsweresacrificedrespectivelyat2monthsand4monthsafteradministrationineachgroup,andbilateralfemoralheadspeci-menswereobtainedtoperformhistologicalexamination.Plasmaprothrombintime(PT),activatedpartialthromboplastintime(APTT),anti-thrombinIII(AT-III)weretestedbeforeand24hafteradministration.ResultsIntheexperimentalgroup,thepathologicalresultsshowed thattherewere4ONFH2monthsand6ONFH4monthsafteradministrationandMRIdidnotshowanyabnormality.Comparedwiththe controlgroup,thePT,APTT,AT-IIIintheexperimentgroupshortenedsignificantlyafteradministration(P<0.001).ConclusionModified steroid-inducedmethodcanestablishtheanimalmodelofearlyONFH.Hypercoagulationandlowfibrinolysismaybethereasonofste-roid-inducedosteonecrosis.
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BACKGROUND:Static compressure effect between the fracture fragments was generated by fixation itself (tension band wire and screw), but dynamic compression effects were generated during flexion. Mechanical strength and stability of patel ar fracture fixation have obvious advantages. However, there are lacks of quantitative comparative studies on static and dynamic compression effects of these fixation methods. OBJECTIVE:To observe strength changes and clinical significance of static and dynamic compression using four fixation techniques. METHODS:Standardized transverse patel ar fracture models were created with fresh cow patel as. The patel as were randomly divided into four groups:fixation was accomplished with modified tension band wiring (wire group);modified tension band with braided cable (cable group);interfragmentary screws (screw group);cannulated screw tension band with wire (cannulated screw group). Before fracture fixation, Fuji pressure-sensitive film was laid among fracture fragments to measure the pressure among fracture fragments after fixation, i.e., static and dynamic compression. Model of each group was measured as fol ows:(1) after fixation, the fixation was removed, and the Fuji pressure-sensitive film was taken out;(2) after fixation, material testing machine was used. Samples underwent a three-point bending test with a 5 000 N load, simulating dynamic compression during knee flexion. Subsequently, Fuji pressure-sensitive film was taken out. Each Fuji pressure-sensitive film was tested using prescale FPD-8010E software. Thus, average pressure among broken bone ends was obtained, and statistical analysis was performed. Static and dynamic compression among broken bone ends was compared in each group. RESULTS AND CONCLUSION:Average static compression was significantly lower in the wire group than in the cable group, screw group and cannulated screw group (P0.05). Dynamic compression was higher than static compression in the wire group (P<0.05). Results verified that compared with modified tension band wire fixation technique, cable or screw could evidently increase static compression among broken bone ends, but simultaneously weaken dynamic compression among broken bone ends.
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Objective To compare the efficacy and complications among three surgical treatments of femoral intertrochanteric fractures in elderly patients.Methods Totally 209 elderly patients with femoral intertrochanteric fracture were divided into 3 groups:DHS group[n =115,patients treated with dynamic hip screws (DHS)],PFNA group [n=57,patients treated with proximal femoral nails anti-rotation (PFNA)] and SEFT group [n=37,patients treated with singlearm external fixator technique (SEFT)].The length of hospitalization,operative time,bleeding volume,hip function scores and complications were compared among the three groups.Results All patients were followed up for 5-12 months (10.6 months in average).The length of hospitalization,operative time,bleeding volume,weight-bearing time and Harris hip score in postoperative 3 months were (14.3±2.7) d,(102.4±22.7) min,(240.8±38.4) ml,(50.2±7.7) d,(88.7±12.8) min in DHS group,(11.2±3.4) d,(50.3±15.6) min,(80.5±18.7) ml,(22.6±4.8) d,(92.6±15.4)min in PFNA group,(15.1±3.3) d,(35.8±10.9) min,(52.6±12.9) ml,(55.4±10.1) d,(87.3 ± 12.6) min in SEFT group,respectively.There were significant differences in the length of hospitalization,operative time,bleeding volume,weight-bearing time and Harris hip score in postoperative 3 months among the three groups (all P ＜ 0.05),while there was no significant difference in healing time among the three groups (all P＞0.05).The incidence of complications was highest in DHS group,higher in SEFT group,and lowest in PFNA group (all P＜0.05).Conclusions DHS is more suitable for patients with good physical condition and stable fractures.SEFT is suitable for patients with poor condition,who can not tolerate trauma,anesthesia and bleeding.PFNA has more advantages including stable fixation,less invasive,less complications and wide indications,which is more suitable for femoral intertrochanteric fractures than the other two treatments.
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Objective To assess the influencing factors of perioperativc delirium in the elderly with hip fracture and to define strategies for prevention and management. Methods DSM-Ⅳ was adopted to diagnosis of perioperative delirium in the elderly with hip fracture, The data of 148 elderly patients with hip fracture were analyzed retrospectively and classified according to the clinical characteristics. The differences were analyzed statistically between the delirious group and the control group. Results There were 26 (17.6%) cases diagnosed with delirium in the perioperative period, including 22 cases with postoperative delirium, and the delirious symptom lasted 3 days in average. For the type of delirium, there were 15 cases with mania type, 4 cases with inhibitory type and 7 cases with mixed type. Compared with patients in control group, patients with perioperative delirium were older [(79.67±7.7) years old vs. (75.5±7.0)years old, t=2.668, P=0.008)]. Five cases who had previous delirium occurred perioperative delirium, and five patients who received external fixator showed no perioperative delirium. Conclusions Perioperative delirium is a heterogeneous symptom on the basis of brain aging and degeneration. It affects the prognosis of the elderly patients with hip fracture and should be viewed as a separate entity, which can be prevented and treated through comprehensive management.
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@#Objective To analyze the outcome of total knee arthroplasty with retaining patellar in osteoarthritis.Methods 45 knee joints in osteoarthritis were performed operatively with posterior stabilized knee arthroplasty between January 2005 and June 2008. The series include 7 sides(males) and 38 sides(females). The mean age of patients was 65.7 years ranging from 52 to 79 years, and the data were analyzed by The Hospital for Special Surgery(HSS) score system. Results The follow-up period was averagely 25 months ranging from 8 to 51 months. According to HSS score system, 28 sides were rated as excellent（62.2%）, 12 sides as good（26.7%）, 4 fair（8.9%）and 1 poor（2.2%）, and the excellent-good rate was 88.9%. Conclusion Posterior stabilized knee arthroplasty with retaining patellar represents a simple and valuable treatment methodology for the most osteoarthritis of the knee joint.
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@#Objective To study the design and fabricating method, biomechanical effect and practicablity of the orthosis for patients suffering from large femoral bone defect and leg length discrepancy and study the effect of the orthosis on patients' equilibrium, walking function and gait. Methods By four stages we finally made ischial weight bearing orthosis with prosthetic feet, and then analysed its biomechanical effect and efficiency, evaluated balance and walking function of patients.Results The orthosis, according with principle of biomechanics, realized patients' wish of walking without crutch. The energy consumption and balanced capacity of patients wearing orthosis were much better while walking distance parameters came close to normal. Conclusion Ischial weight bearing orthosis with prosthetic feet can help patients reconstruct walking function, therefore can be recommended.
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@#Objective To investigate the effect of internal fixation of plates on displaced intra-articular fracture of the calcaneus. Methods 27 patients with calcaneal fracture and treated surgically with open reduction and internal fixation were analyzed retrospectively. Results All the cases are closed fracture. According to the Sanders classification, 18 cases were type 2 calcaneal fractures, and 9 were type 3. 6 cases (22.2%) showed wound-healing problems. The average Bohler's angle before and after surgery was 7.5° and 27.54° respectively. 20 patients were followed up for average 16.8 months, and all showed excellent walking ability and normal gait, and no shoe wear complaints. Conclusion Open reduction and internal fixation can guarantee the anatomic reduction of displaced calcaneal fractures, and the outcomes are satisfied.
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@# Objective To investigate the management of unstable pelvic fracture using external fixation and rehabilitation. Methods 31 cases with unstable pelvic fractures were analyzed retrospectively. Results All the patients accepted pelvic external fixation and early rehabilitation training. No death, deep infection or nerve injury happened. The fractures healed very well in 16 cases, well in 11 cases, satisfactory in 4 cases. Conclusion Pelvic external fixation is a simple, safe, minimally invasive and effective approach. Early physical training is an essential component of the management after external fixation.
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@# Phantom limb pain(PLP) is a common sequela of amputation. With the lucubration of the pathophysiological mechanisms underlying PLP, lots of progression for the treatment of PLP has been achieved. Combined modality therapy is very important especially in psychological, behavior and operative therapy.
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@#Objective To screen the parameter of CT scan for distinguishing patellofemoral malalignment. Methods 22 patients (42 knees) with patellofemoral pain and 12 asymptomatic volunteers (24 knees) were studied. The patellofemoral joints were examined with CT scan at 0°, 15°, 30° and 60° flexion. The parameters including femoral trochlear angle, lateral patellofemoral angle, patellar tilt angle, congruent angle and patellofemoral index were compared. Results Congruent angle and patellofemoral index in symptomatic group were bigger than those in asymptomatic group (P<0.01), but others were not different significantly between two groups (P>0.05). Conclusion CT scans is useful in diagnosis of patellofemoral malalignment. Congruent angle and patellofemoral index are more susceptible parameters for it.
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@#Most of patients received in hospital with the upper and lower extremity fracture are caused by the earthquake.These fractures have apparent characters,such as:the serious situation,complexity and lots of complications which can be divided two periods:the early and the late.These complications include shock,the nerve and vascular injury,the acute kidney failure,fat embolism,infection,deep venous thrombosis,decubitus ulcer and so on.These complications should be known completely and the therapy should be given early.Practice can not be taken because of pain and some other reasons,and this will lead to the muscle atrophy,adynamia and the joint disfuction.Finally the abilty to work was lost partly or completely.If some measures about rehabilitation were taken early,we can reduce the complication and the disability possibly.
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@#Most of patients received in hospital with the upper and lower extremity fracture are caused by the earthquake.These fractures have apparent characters,such as:the serious situation,complexity and lots of complications which can be divided two periods:the early and the late.These complications include shock,the nerve and vascular injury,the acute kidney failure,fat embolism,infection,deep venous thrombosis,decubitus ulcer and so on.These complications should be known completely and the therapy should be given early.Practice can not be taken because of pain and some other reasons,and this will lead to the muscle atrophy,adynamia and the joint disfuction.Finally the abilty to work was lost partly or completely.If some measures about rehabilitation were taken early,we can reduce the complication and the disability possibly.
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@#Objective To investigate the rehabilitation of pelvis disarticulation amputees.Methods A case report.Results and Conclusion Rehabilitation engineering,assisted with physical therapy,can rebuild hemicorporectomy amputees' standing and walking ability,make them look as normal as possible,help them return to the society.
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@# Objective To explore the efficacy of orthosis in orthopaedic rehabilitation. MethodsFrom 1992 to 2006, 420 patients involved various orthopaedic disorders were managed with different orhtosis, the clinical date were analyzed retrospectively. ResultsAll patients who was managed with orthosis got an improved functional status and were satisfied with therapeutic effect.ConclusionOrthosis is valuable in assistant managing of bone and joint functional impairment.
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Orthopaedic rehabilitation mainly focuses on the improvement and reconstruction of the musculoskeletal dysfunctions of patients with chronic diesaes and trauma of bones, joints, muscles and nervous system. It involves a multidisciplinary team approach in which the orthopaedic surgeon is considered as a main part. The therapeutic strategies of orthopaedic rehabilitation comprises three subspecialties, including kinesiotherapy, prothetic and orthotic management, and operative methods. The principal aim of this report is to present the current status and trends in bone and joint rehabilitation of limbs.