Relationship between obesity and lumbar disc herniation in adolescents / 中国骨伤

OBJECTIVE@#To explore the relationship between obesity and lumbar disc herniation in adolescents.@*METHODS@#From January 2018 to July 2019, 581 patients (337 males, 244 females) with lumbar disc herniation were included in the surgical treatment. According to the age classification standard of the World Health Organization, they were divided into two groups:the adolescent group, 235 cases (145 males, 90 females), age 14 to 44 years old with an average of (32.2±7.3) years. The middle-aged and elderly group, 346 cases (192 males, 154 females), age 45 to 85 years old with an average age of (58.7± 9.8) years. At the time of admission, the same trained investigator measured height, waist circumference and hip circumference with tape measure and weight with electronic scale. All the data were measured twice and the average value was taken and recorded. The body mass index and the waist-hip ratio were calculated. According to each parameter standard, the patients were divided into normal, overweight and obese. The proportion of obese people in different age groups was calculated and analyzed statistically.@*RESULTS@#The normal of the BMI, waist circumference and waist-hip ratio of the young patients were 78(33.2%), 91 (38.7%) and 85(36.2%) respectively;104(44.3%), 95(40.4%), 99(42.1%) were overweight, 53(22.5%), 49(20.9%), 51 (21.7%) were obese. The normal of the BMI, waist circumference and waist-hip ratio of the middle-aged and old patients were 145 (41.9%), 138 (39.9%) and 147 ( 42.5%) respectively;153 (44.2%), 162 (46.8%), 155 (44.8%) were overweight, 48 (13.9%), 46 (13.3%), 44 (12.7%) were obese. Among the three parameters, the proportion of obese people in the adolescent group was higher than that in the middle-aged group, and the difference was significant (χ was 8.836, 6.228 7, 8.536 3 respectively, <0.05).@*CONCLUSION@#For adolescent patients, obesity may increase the load of lumbar disc, affect its metabolism and accelerate its degeneration. For adolescent, obesity is a more significant risk factor of lumbar disc herniation, so it is more important to control weight and prevent obesity in adolescent to reduce the incidence of lumbar disc herniation.

Meta-analysis of the efficacy and safety of PFNA and InterTAN for the treatment of intertrochanteric fractures / 中国骨伤

<p><b>OBJECTIVE</b>To system evaluate the clinical effect and safety of PFNA and InterTAN internal fixation methods for femoral intertrochanteric fracture.</p><p><b>METHODS</b>According to the Cochrane systemic analysis method, randomized controlled trials and quasi-randomized controlled trials which were about the comparison of PFNA and InterTAN for intertrochanteric fracture were collected from Cochrane Library(2017, issue 4), PubMed (January, 2003-May, 2017), Wanfang Med Online (January, 2003-May, 2017) and China Academic Journals Full-text Database(January, 2003-May, 2017) by computer searching. Cross-checking was done after assessing the quality of the included trials and extracting the data by two reviewers independently. Data analysis were performed with RevMan 5.3.</p><p><b>RESULTS</b>Two randomized controlled trials and five quasi-randomized controlled trials involving 611 cases met the inclusion criteria. The meta-analyses showed no significant differences between the two methods on Harris scores[MD=-1.00, 95%CI(-2.29, 0.28),=0.13], union time[MD=0.04, 95%CI (-0.70, 0.77),=0.92], full weight-bearing time[MD=1.06, 95%CI(-0.29, 2.42),=0.13], hospital stay[MD=-0.04, 95%CI (-0.52, 0.45),=0.89] and length of incision[MD=-1.00, 95%CI (-2.64, 0.65),=0.23]. There were significant differences between the two methods on operative time[MD=-25.75, 95%CI (-37.47, -14.03),<0.000 1], intraoperative blood loss[MD=-55.67, 95%CI(-108.07, -3.27),=0.04] and the internal fixation complication rate[MD=4.17, 95%CI (1.33, 13.08),=0.01].</p><p><b>CONCLUSIONS</b>Both PFNA and InterTAN could provide good effect for intertrochanteric fracture. The operation time of PFNA is shorter than that of InterTAN, and there is less blood loss during operation. PFNA may be the first choice for the treatment of patients who have many complications and can't endure long-time operation. The complications of PFNA are more than those of InterTAN. In patients with long life expectancy and high requirements, InterTAN may be preferentially selected to reduce complications. According to the patient's situation, after a comprehensive consideration, appropriate treatment can be selected.</p>