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1.
Zhongguo Gu Shang ; 34(11): 1072-6, 2021 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-34812027

RESUMO

OBJECTIVE: To evaluate the safety and feasibility of single-segment lumbar microdiscectomy without drainage. METHODS: The clinical data of 135 patients with single-segment lumbar disc herniation treated by microdiscectomy surgery from January 2018 to August 2019 were retrospectively analyzed. There were 95 males and 40 females, aged from 18 to 40 years old, with a mean of (28.3±5.4) years. They were divided into drainage group (78 cases) and non-drainage group (57 cases) according to whether the drainage tube was placed during operation. The general conditions of patients were recorded such as age, gender, operation segment, body mass index(BMI), symptom duration, follow-up time, operation time, intraoperative blood loss, out-of-bed time, hospital stay, postoperative drainage removal time and drainage volume of drainage group, postoperative body temperature. VAS of incisional pain in supine resting state on the 1 and 3 days after operation, the VAS of low back pain and lower extremity radiating pain during ground exercise before operation, 3 days, 1 month and 3 months after operation were compared. Oswestry Disability Index (ODI) was collected before operation, 1 month and 3 months after operation. The ratio of complications was calculated such as symptomatic incision hematoma, poor incision healing, incision infection, exacerbation and progressive aggravation of neurological dysfunction, and unplanned secondary surgery. RESULTS: There were no significant differences in age, gender, operation segment, BMI, symptom duration, follow-up time, operation time, intraoperative blood loss, and postoperative body temperature between two groups. The average hospital stay and out-of-bed time in non-drainage group were shorter than in drainage group(P=0.0000). VAS of incision pain in non-drainage group was lower than that in control group at 1 and 3 days after surgery (P<0.05). Postoperative low back pain VAS and ODI of all patients were significantly reduced compared with those before surgery. No symptomatic hematoma occurred in two groups. Postoperative neurological dysfunction immediately aggravated each one patient in two groups, and no progressive aggravation of neurological function was found in two groups. Incision infection occurred in one case in each of the two groups, and both were cured by drug treatment; poor incision healing occurred in one case in each of the two groups, and both were healed after repeated dressing changes. There was one case of unplanned second operation in drainage group, the patient received a second operation due to disc protrusion recurrence within 1 month. CONCLUSION: Single-segment lumbar microdiscectomy without drainage can shorten the average hospital stay and promote early exercise out of bed, and reduce the trauma and stress reaction of drainage. No drainage may be an option for patients with enhanced recovery after lumbar microdiscectomy.


Assuntos
Deslocamento do Disco Intervertebral , Vértebras Lombares , Adolescente , Adulto , Drenagem , Feminino , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
3.
J Orthop Surg Res ; 16(1): 422, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215290

RESUMO

BACKGROUND: When symptomatic spondylolysis fail to respond to nonoperative treatment, surgical management may be required. A number of techniques have been described for repair by intrasegmental fixation with good results; however, there are still some problems. We reported a repair technique with temporary intersegmental pedicle screw fixation and autogenous iliac crest graft. The aim of present study is to assess the clinical outcomes of L5 symptomatic spondylolysis with this technique. METHODS: A retrospective analysis of 128 patients with L5 spondylolysis treated with this method was performed. According to CT scan, the spondylolysis were classified into 3 categories: line, intermediate, and sclerosis type. The diagnostic block test of L5 bilateral pars defect was done in all patients preoperatively. The sagittal and axial CT images were used to determine the bone union. The healing time, complications, number of spina bifida occulta, Japanese Orthopedic Association (JOA) score, and VAS for back pain were recorded. After fixation removal, the rate of ROM preservation at L5S1 was calculated. RESULTS: There were 97 patients (194 pars) followed with mean follow-up of 23 months (range, 12-36 months). The union rate of pars was 82.0% at 12 months and 94.3% at 24 months postoperatively. Low back pain VAS significantly (P < 0.05) improved from preoperative mean value of 7.2 to 1.3 at the final follow-up postoperatively (P < 0.05). JOA score increased significantly postoperatively (P < 0.05) with average improvement rate of 79.3%. The rates of L5S1 ROM preservation were 79.8% and 64.0% after fixation removal at 1 and 2 years postoperatively. There were 3 patients of delayed incision healing without other complications. CONCLUSIONS: Although sacrificing L5S1 segment motion temporarily, more stability was obtained with intersegmental fixation. This technique is reliable for spondylolysis repair which has satisfactory symptom relief, high healing rate, low incidence of complications, and preserve a large part of ROM for fixed segment.


Assuntos
Transplante Ósseo/métodos , Ílio/transplante , Parafusos Pediculares , Fusão Vertebral/métodos , Espondilólise/cirurgia , Adolescente , Adulto , Autoenxertos , Remoção de Dispositivo/métodos , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
4.
Zhongguo Gu Shang ; 33(12): 1128-33, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33369320

RESUMO

OBJECTIVE: To explore the effect of anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach for severe thoracolumbar burst fractures with spinal cord injury. METHODS: From January 2016 to June 2018, 16 patients with severe thoracolumbar burst fractures (more than 50% of ratio of spinal canal encroachment, reverse fragment at the posterior edge of the vertebral body) with spinal cord injury were retrospectively analyzed, including 10 males and 6 females, ranging in age from 19 to 57 years old. Causes of injury:8 cases of fall injury, 6 cases of traffic accident injury and 2 cases of other injuries. Fracture site:T11 in 4 cases, T12 in 5 cases, L1 in 5 cases, L2 in 2 cases. All the patients underwent anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach. The curative imaging effects were evaluated by measuring the loss height of the anterior edge of the injured vertebra, Cobb angle of the adjacent segment of the injured vertebra, and ratio of spinal canal encroachment. The clinical effects were evaluated by Frankel spinal cord injury rating and visual analogue scale (VAS). RESULTS: All 16 patients were followed up, and the average follow up time was (15.9±5.4) months. The average operation time was (234±41) minutes and the average amount of bleeding was (431±93) ml. The loss of anterior height of injured vertebrae was (52.25±10.10)% before operation, (8.93± 3.61)% at 3 days after operation, and (9.25±2.88)% at the latest follow up. The results of 3 days after operation and the latest follow up were better than that before operation, and there was no significant differencesbetween results at the latest follow up and 3 days after operation (P<0.01). Cobb angle of adjacent segment of injured vertebrae was (28.19±10.89)°before operation, (5.31±5.14)° 3 days after operation, and (6.81±4.59)°at the latest follow-up. The ratio of spinal canal encroachment was (67.68±12.45)% before operation, (7.69±4.46)% at 3 days after operation, and (4.75±1.63)% at the latest follow-up. At 3 days and the latest follow-up, the rate recovered to a certain extent (P<0.05). At the latest follow up, spinal nerve function was improved in 12 patients, no improvement in 4 patients and no deterioration in nerve function. VSA score was improved from preoperative 7.8±0.9 to final follow-up 1.8±0.7. CONCLUSION: For severe thoracolumbar burst fracture and spinal cord injury, with more than 50% of ratio of spinal canal encroachment and reverse fragment at the posterior edge of the vertebral body, the anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach has the characteristics of accurate reduction, complete decompression and firm fixation, and the clinical effect is satisfactory.


Assuntos
Traumatismos da Medula Espinal , Fraturas da Coluna Vertebral , Adulto , Parafusos Ósseos , Descompressão , Feminino , Fixação Interna de Fraturas , Humanos , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Canal Medular , Traumatismos da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Adulto Jovem
5.
Chin J Traumatol ; 23(4): 196-201, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32674856

RESUMO

Outbreak of COVID-19 is ongoing all over the world. Spine trauma is one of the most common types of trauma and will probably be encountered during the fight against COVID-19 and resumption of work and production. Patients with unstable spine fractures or continuous deterioration of neurological function require emergency surgery. The COVID-19 epidemic has brought tremendous challenges to the diagnosis and treatment of such patients. To coordinate the diagnosis and treatment of infectious disease prevention and spine trauma so as to formulate a rigorous diagnosis and treatment plan and to reduce the disability and mortality of the disease, multidisciplinary collaboration is needed. This expert consensus is formulated in order to (1) prevent and control the epidemic, (2) diagnose and treat patients with spine trauma reasonably, and (3) reduce the risk of cross-infection between patients and medical personnel during the treatment.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos da Coluna Vertebral/terapia , COVID-19 , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Serviço Hospitalar de Emergência , Humanos , Pandemias/prevenção & controle , Equipe de Assistência ao Paciente , Pneumonia Viral/prevenção & controle , SARS-CoV-2 , Transporte de Pacientes
6.
Chin Med J (Engl) ; 131(21): 2537-2543, 2018 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-30381586

RESUMO

Background: Many clinical studies over the past decade have indicated positive outcomes for patients treated with Dynesys dynamic stabilization for lumbar degenerative disease. However, long-term outcomes of Dynesys for lumbar spinal stenosis are rarely reported. The aim of this study was to analyze the long-term clinical and radiologic outcomes for patients with lumbar spinal stenosis treated with Dynesys stabilization. Methods: Thirty-eight patients with lumbar spinal stenosis were treated with Dynesys stabilization from July 2008 to March 2010. The minimal duration of follow-up was 72 months. The patients were divided into stenosis and spondylolisthesis groups according to degenerative spondylolisthesis. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS). Radiographic evaluations included range of motion (ROM) and the disc heights of stabilized segments and the upper adjacent segments. We also evaluated the occurrence of radiographic and symptomatic adjacent segment degeneration (ASD). Results: There were 23 patients in stenosis group and 15 patients in spondylolisthesis group. The ODI scores were significantly improved at the final follow-up evaluation, as compared to the baseline values (16.1 ± 5.7 vs. 57. 2 ± 14.2, t = 61.41, P < 0.01). The VAS scores for back and leg pain were significantly improved from 4.82 ± 0.89 and 4.04 ± 0.82 preoperatively to 0.93 ± 0.61 and 0.54 ± 0.51 postoperatively (t = 6.59, P < 0.01, and t = 5.91, P < 0.01, respectively). There were no differences between the two groups with respect to VAS and ODI scores. The ROM of stabilized segments decreased significantly from 7.8° ± 2.4° to 4.5° ± 1.5° (t = 7.18, P < 0.05), while the upper adjacent segments increased significantly from 8.3° ± 2.4° to 10.4° ± 2.4° (t = 2.87, P = 0.01). The change in disc height of stabilized segments was not significant (11.9 ± 2.1 preoperatively vs. 12.5 ± 1.5 postoperatively, t = 1.43, P = 0.15), whereas the decrease in disc height of the upper adjacent segments was significant (12.5 ± 2.0 preoperatively vs. 11.0 ± 1.7 postoperatively, t = 2.94, P = 0.01). The occurrence of radiographic and symptomatic ASD was 16% (6/38) and 3% (1/38), respectively. Conclusions: Decompression and Dynesys stabilization for lumbar stenosis with or without spondylolisthesis showed good long-term clinical and radiographic results. Lumbar stenosis with or without Grade I spondylolisthesis, particularly in patients <60 years of age with mild-to-moderate lumbar disc degeneration, would be one of the main indications for the Dynesys system.


Assuntos
Vértebras Lombares/cirurgia , Estenose Espinal/cirurgia , Espondilolistese/cirurgia , Adulto , Descompressão Cirúrgica/métodos , Feminino , Humanos , Degeneração do Disco Intervertebral/cirurgia , Degeneração do Disco Intervertebral/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estenose Espinal/terapia , Espondilolistese/terapia , Resultado do Tratamento
8.
Zhongguo Gu Shang ; 31(6): 569-576, 2018 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-29945416

RESUMO

OBJECTIVE: Meta analysis was used to evaluate the efficacy and safety of Dynesys and posterior decompression and fusion internal fixation for lumbar degenerative diseases. METHODS: The computer was used to retrieve the Cochrane library, Medline, Embase, CNKI, Wanfang database and Chinese biomedical literature database; and the references and main Chinese and English Department of orthopedics journals were manually searched. All the prospective or retrospective comparative studies on the clinical efficacy and safety of Dynesys and posterior decompression and fusion internal fixation were collected, so as to evaluate the methodological quality of the study and to extract the data. The RevMan 5.2 software provided by Cochrane collaboration was used for systematic evaluation. RESULTS: A total of 9 clinical studies were included, including 3 prospective randomized controlled trials(RCT) and 6 retrospective controlled observational studies, which included 692 patients, with 336 cases in Dynesys group, and 356 cases in posterior decompression and fusion internal fixation (PLIF) group. The results showed that compared with PLIF, Dynesys system significantly decreased operation time(P<0.01), intraoperative blood loss (P<0.01). Both Dynesys and PLIF groups experienced improved ODI and back/leg pain VAS scores at final follow-up, and no statistically significant difference was noted according to the two surgical procedures(P>0.05). Dynesys could remain the range of motion (ROM) of surgical segments with less increased ROM of adjacent segments compared with that of PLIF group(P<0.01). Regarding the disc height of surgical segments, no statistically significant difference was noted according to the two groups(P>0.05), but postoperative complications incidence rate in PLIF group was higher than that in Dynesys group (P<0.05). CONCLUSIONS: Both Dynesys system and PLIF can improve clinical outcomes of lumbar degenerative diseases effectively. Compared with PLIF, Dynesys could remain the range of motion(ROM) of surgical segments with less increased ROM of adjacent segments and lower complication incidence rate. But the ability to prevent adjacent segments degeneration needs more RCTs with long-term follow-up to confirm.


Assuntos
Região Lombossacral , Fusão Vertebral , Humanos , Vértebras Lombares , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
9.
Zhongguo Gu Shang ; 31(2): 103-110, 2018 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-29536677

RESUMO

OBJECTIVE: To compare of clinical effects of different surgical methods in the treatment of elderly femoral neck fractures. METHODS: From January 2013 to June 2016, 144 elderly patients with femoral neck were treated and divided into artificial hip replacement group and cannulated screw fixation group according to the surgical methods. In the total hip arthroplasty group, there were 89 cases, 28 males and 61 females, with an average age of(84.10±3.10) years old;Hollow nail fixation group 55 cases, 20 males and 35 females, with an average age of (86.80±2.88) years. Preoperative patients data, postoperative complications, mortality and postoperative Harris hip score were compared between the two groups. RESULTS: A total of 144 cases were followed up for 12 to 36 months with an average of 18 months. There was no significant difference between two groups in gender, fracture side, preoperative complications, osteoporosis, ASA score, injury to surgery interval, the number of patients admitted to ICU and perioperative death. However, the patients in hollow screw fixation group was older than the joint replacement group(t=5.311, P<0.05);The degree of preoperative fracture displacement in the joint replacement group was higher than that in the hollow nail fixation group(χ²=6.894, P=0.009<0.05);Hollow nail fixation group in operation time, hospital stay, intraoperative blood loss, perioperative blood transfusion was significantly better than the number of joint replacement group(P<0.05);The Harris score of the joint replacement group was higher than that of the hollow screw fixation group(P<0.05). CONCLUSIONS: For elderly femoral neck patients, if there is a significant shift in the fracture (Garden III, IV), the preferred treatment is hip replacement. Postoperative complications are relatively small, satisfactory joint function recovery. If the fracture displacement is not obvious (Garden type I, II) or patients with more medical diseases, poor physical condition, poor surgical tolerance, postoperative life expectancy is not high, the first choice is closed reduction and cannulated screw fixation.


Assuntos
Artroplastia de Quadril , Parafusos Ósseos , Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Duração da Cirurgia , Resultado do Tratamento
11.
J Orthop Surg Res ; 12(1): 75, 2017 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-28521818

RESUMO

BACKGROUND: Central pain (CP) is a common clinical problem in patients with spinal cord injury (SCI). Recent studies found the pathogenesis of CP was related to the remodeling of the brain. We investigate the roles of iron overload and subsequent microglia activate in the remodeling of the brain after SCI. METHODS: An SCI-induced CP model was established in Sprague-Dawley rats that were randomly assigned to SCI, sham operation, deferoxamine (DFX), minocycline, and nitric oxide synthase inhibitor treatment groups. At 12 weeks, pain behavior and thermal pain threshold were evaluated in each group, and iron transferrin receptor (TfR)1 and ferritin (Fn) mRNA, as well as iron-regulatory protein (IRP)1, FN, lactoferrin, and nuclear factor (NF)-κB protein levels in the rat brains were measured. Microglia proliferation and differentiation and IRP1 expression were evaluated by immunohistochemistry. RESULTS: Autophagy was observed in rats after SCI, accompanied by reduced latency of thermal pain, increased iron content and IRP1 and NF-κB levels in the hindlimb sensory area, hippocampus, and thalamus, and decreased Fn levels in the hindlimb sensory area. TfR1 mRNA expression was upregulated in activated microglia. Treatment with an iron-chelating agent, or inhibitors of nitric oxide synthase or microglia suppressed microglia proliferation. CONCLUSIONS: SCI may induce intracranial iron overload, which activates microglia via NF-κB signaling. Microglia secrete inflammatory factors that induce neuronal damage and lead to CP. Treatment with an iron-chelating agent or NF-κB or microglia inhibitors can relieve CP resulting from SCI.


Assuntos
Córtex Cerebral/metabolismo , Sobrecarga de Ferro/metabolismo , Microglia/metabolismo , Dor/metabolismo , Traumatismos da Medula Espinal/metabolismo , Animais , Córtex Cerebral/patologia , Feminino , Sobrecarga de Ferro/complicações , Sobrecarga de Ferro/patologia , Microglia/patologia , Dor/etiologia , Dor/patologia , Ratos , Ratos Sprague-Dawley , Receptores da Transferrina/biossíntese , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/patologia , Vértebras Torácicas
12.
J Orthop Surg Res ; 12(1): 24, 2017 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-28178997

RESUMO

BACKGROUND: Central pain (CP) is a common clinical problem in patients with spinal cord injury (SCI). Recent studies found the pathogenesis of CP was related to the remodeling of the brain. We investigate the roles of iron overload and subsequent oxidative stress in the remodeling of the brain after SCI. METHODS: We established a rat model of central pain after SCI. Rats were divided randomly into four groups: SCI, sham operation, SCI plus deferoxamine (DFX) intervention, and SCI plus nitric oxide synthase (NOS) inhibitor treatment. Pain behavior was observed and thermal pain threshold was measured regularly, and brain levels of iron, transferrin receptor 1 (TfR1), ferritin (Fn), and lactoferrin (Lf), were detected in the different groups 12 weeks after establishment of the model. RESULTS: Rats demonstrated self-biting behavior after SCI. Furthermore, the latent period of thermal pain was reduced and iron levels in the hind limb sensory area, hippocampus, and thalamus increased after SCI. Iron-regulatory protein (IRP) 1 levels increased in the hind limb sensory area, while Fn levels decreased. TfR1 mRNA levels were also increased and oxidative stress was activated. Oxidative stress could be inhibited by ferric iron chelators and NOS inhibitors. CONCLUSIONS: SCI may cause intracranial iron overload through the NOS-iron-responsive element/IRP pathway, resulting in central pain mediated by the oxidative stress response. Iron chelators and oxidative stress inhibitors can effectively relieve SCI-associated central pain.


Assuntos
Sobrecarga de Ferro/complicações , Estresse Oxidativo/fisiologia , Dor/etiologia , Traumatismos da Medula Espinal/complicações , Animais , Encéfalo/metabolismo , Feminino , Ferritinas/metabolismo , Ferro/metabolismo , Sobrecarga de Ferro/metabolismo , Sobrecarga de Ferro/fisiopatologia , Proteína 1 Reguladora do Ferro/metabolismo , Lactoferrina/metabolismo , Malondialdeído/metabolismo , Dor/metabolismo , Dor/fisiopatologia , Medição da Dor/métodos , Limiar da Dor/fisiologia , Ratos Sprague-Dawley , Receptores da Transferrina/metabolismo , Traumatismos da Medula Espinal/metabolismo , Traumatismos da Medula Espinal/fisiopatologia , Superóxido Dismutase/metabolismo
13.
Injury ; 48(2): 454-459, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28073488

RESUMO

INTRODUCTION: Hip fracture in the elderly can induce systemic inflammatory response (SIRS) and lung injury which increases the risk of lung infection and death. Mitochondrial DNA (mtDNA) plays a role in SIRS and lung injury in patients with multi-trauma, and also in patients with hip fractures. This study evaluated the potential value of plasma mtDNA in the early prognosis of lung injury in elderly fracture patients. METHODS: This study enrolled 156 elderly patients with intertrochanteric fracture. Plasma mtDNA, IL-6, IL-10, prostaglandin E2 (PGE2) levels were measured at admission. Sixty-one and 31 patients were diagnosed with systemic inflammatory response syndrome (SIRS) and lung injury, respectively. RESULTS: Plasma mtDNA levels were higher in hip fracture patients compared to healthy controls (P<0.001) and significantly higher in the lung injury subgroup compared to the lung injury absent subgroup (P<0.001). MtDNA levels were correlated with the SIRS score (r=0.446, P<0.001), IL-6 (r=0.506, P<0.001), IL-10 (r=0.523, P<0.001), and PGE2 (r=0.360, P<0.001). Logistic regression analysis revealed that plasma mtDNA, IL-6, PGE2 and SIRS score were independent predictors of the risk of lung injury. CONCLUSION: Plasma mtDNA release induced by hip fracture in elderly patients, might be an early predictor of lung injury in these patients.


Assuntos
DNA Mitocondrial/sangue , Fraturas do Quadril/sangue , Fraturas do Quadril/complicações , Lesão Pulmonar/sangue , Lesão Pulmonar/complicações , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/complicações , Idoso , China/epidemiologia , Dinoprostona/sangue , Dinoprostona/imunologia , Feminino , Fraturas do Quadril/imunologia , Humanos , Interleucina-10/sangue , Interleucina-10/imunologia , Interleucina-6/sangue , Interleucina-6/imunologia , Lesão Pulmonar/imunologia , Lesão Pulmonar/fisiopatologia , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Síndrome de Resposta Inflamatória Sistêmica/imunologia , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia
14.
Zhongguo Gu Shang ; 30(10): 906-910, 2017 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-29457411

RESUMO

OBJECTIVE: To determine the effect of site of fracture on the prognosis for patients of elderly hip fracture. METHODS: From January 2012 to December 2014, 667 patients with hip fractures were divided into femoral neck fracture group and intertrochanteric fracture group according to the site of fracture. There were 304 cases of intertrochanteric fracture, including 96 males and 208 females, with an average age of (80.33±7.94) years old. There were 217 cases of femoral neck fracture, including 74 males and 143 females, with an average age of (79.82±9.33) years old. Patients' data, mortality and activities of daily living were compared between two groups. RESULTS: There were no significant differences in age, gender, comorbidity, ASA classification, and anesthesia between two groups, but the time of admission to surgery, duration of operation, blood loss of intra-operative, volume of drainage, and the average of transfusion were shown to have significant differences. The levels of White blood cell count (WBC) for intertrochanteric fracture group were shown to be higher than that of femoral neck fracture patients at admission, 1, 3 and 5 days after operation. The levels of hemoglobin, and albumin for intertrochanteric fracture were lower than that of femoral neck fracture patients at all period of time. The mortality of intertrochanteric fracture group during hospitalization, 1, 3, 6, and 12 months were higher than that of femoral neck fracture, but did not reach significant difference. In patients who survived, the scores of ADL for femoral neck fracture were higher than that of intertrochanteric fracture at discharge, 1, 3 months after operation, but there was no significant difference for ADL at 6 and 12 months between two groups. CONCLUSIONS: The response of stress for intertrochanteric fracture were more than femoral neck fracture, but the mortality was similar than that of femoral neck fracture after excluding the influence of age, sex, comorbidity, and other factors. Compared to intertrochanteric fracture, the femoral neck fracture patients had a better functional recovery during early stage, and the two groups reached a similar functional recovery at 1 year after operation.


Assuntos
Fraturas do Colo Femoral/mortalidade , Fraturas do Quadril/mortalidade , Atividades Cotidianas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Colo Femoral/sangue , Fraturas do Colo Femoral/classificação , Fraturas do Quadril/sangue , Fraturas do Quadril/classificação , Humanos , Masculino , Prognóstico , Recuperação de Função Fisiológica , Fatores Sexuais
15.
Medicine (Baltimore) ; 95(36): e4628, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27603354

RESUMO

BACKGROUND: We conducted a prospective randomized clinical trial to compare the clinical and radiological outcomes of the sinus tarsi and extended lateral approaches for the surgical treatment of displaced intraarticular calcaneal fractures. METHODS: Between January 2009 and January 2014, patients with displaced intraarticular calcaneal fracture were randomly assigned to receive surgical treatment by the sinus tarsi approach or the extended lateral approach using block randomization. We recorded and analyzed data on demographics, time to surgery, wound complications, Böhler angles pre- and postoperatively, and American Orthopedic Foot & Ankle Society score. RESULTS: Sixty-four patients met the inclusion criteria and were randomly assigned to the 2 groups: 32 patients underwent sinus tarsi approach, and 32 patients the extended lateral approach. Baseline characteristics of both groups were similar. The time to surgery in the sinus tarsi approach group was significantly shorter than in the extended lateral approach group (P = 0.04). The wound complication rates were 6.3% and 31.2% in the sinus tarsi approach and extended lateral approach groups, respectively, which was significantly different (P = 0.01). Regarding the clinical outcomes, the groups did not differ significantly on walking visual analogue scale or American Orthopedic Foot & Ankle Society scores at 6 months and 1 year postoperatively. No significant differences existed between groups regarding the Böhler angle at different times and reduction quality of the articular surface and the medial wall. CONCLUSION: Compared with the extended lateral approach, the sinus tarsi approach decreased wound complications and preoperative waiting time, and achieved similar functional and radiological outcomes for displaced intraarticular calcaneal fractures.


Assuntos
Calcâneo/lesões , Traumatismos do Pé/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Calcâneo/diagnóstico por imagem , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X
16.
PLoS One ; 11(1): e0148071, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26824851

RESUMO

BACKGROUND: There have been few studies comparing the clinical and radiographic outcomes between the Dynesys dynamic stabilization system and posterior lumbar interbody fusion (PLIF). The objective of this study is to compare the clinical and radiographic outcomes of Dynesys and PLIF for lumbar degenerative disease. METHODS: Of 96 patients with lumbar degenerative disease included in this retrospectively analysis, 46 were treated with the Dynesys system and 50 underwent PLIF from July 2008 to March 2011. Clinical and radiographic outcomes were evaluated. We also evaluated the occurrence of radiographic and symptomatic adjacent segment degeneration (ASD). RESULTS: The mean follow-up time in the Dynesys group was 53.6 ± 5.3 months, while that in the PLIF group was 55.2 ± 6.8 months. At the final follow-up, the Oswestry disability index and visual analogue scale score were significantly improved in both groups. The range of motion (ROM) of stabilized segments in Dynesys group decreased from 7.1 ± 2.2° to 4.9 ± 2.2° (P < 0.05), while that of in PLIF group decreased from 7.3 ± 2.3° to 0° (P < 0.05). The ROM of the upper segments increased significantly in both groups at the final follow-up, the ROM was higher in the PLIF group. There were significantly more radiographic ASDs in the PLIF group than in the Dynesys group. The incidence of complications was comparable between groups. CONCLUSIONS: Both Dynesys and PLIF can improve the clinical outcomes for lumbar degenerative disease. Compared to PLIF, Dynesys stabilization partially preserves the ROM of the stabilized segments, limits hypermobility in the upper adjacent segment, and may prevent the occurrence of ASD.


Assuntos
Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Região Lombossacral/cirurgia , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Deslocamento do Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/reabilitação , Vértebras Lombares/patologia , Região Lombossacral/patologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/fisiopatologia , Dor Pós-Operatória/prevenção & controle , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Estenose Espinal/patologia , Estenose Espinal/reabilitação , Resultado do Tratamento
18.
Knee Surg Sports Traumatol Arthrosc ; 24(9): 2806-2810, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25583655

RESUMO

The discoid medial meniscus is an extremely rare anomaly. Bilateral discoid medial menisci are much more rare but intermittently reported. We report the first case of bilateral discoid medial menisci with positive double PCL sign, which typically indicates a bucket-handle tear of medial meniscus. A literature review was also conducted on bilateral discoid medial menisci.


Assuntos
Doenças das Cartilagens/congênito , Deformidades Congênitas das Extremidades Inferiores/diagnóstico por imagem , Imageamento por Ressonância Magnética , Meniscos Tibiais/anormalidades , Ligamento Cruzado Posterior/diagnóstico por imagem , Lesões do Menisco Tibial/diagnóstico por imagem , Adolescente , Artroscopia , Doenças das Cartilagens/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Masculino , Meniscos Tibiais/diagnóstico por imagem
20.
Chin Med J (Engl) ; 128(15): 2054-8, 2015 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-26228218

RESUMO

BACKGROUND: Posterior cervical decompression is an accepted treatment for multilevel cervical spondylotic myelopathy (CSM). Each posterior technique has its own advantages and disadvantages. In the present study, we compared the functional and radiological outcomes of expansive hemilaminectomy and laminoplasty with mini titanium plate in the treatment of multilevel CSM. METHODS: Forty-four patients with multilevel CSM treated with posterior cervical surgery in Department of Orthopedic Surgery, Beijing Army General Hospital from March 2011 to June 2012 were enrolled in this retrospective study. Patients were divided into two groups by surgical procedure: Laminoplasty (Group L) and hemilaminectomy (Group H). Perioperative parameters including age, sex, duration of symptoms, operative duration, and intraoperative blood loss were recorded and compared. Spinal canal area, calculated using AutoCAD ® software(Autodesk Inc., San Rafael, CA, USA), and neurological improvement, evaluated with Japanese Orthopedic Association score, were also compared. RESULTS: Neurological improvement did not differ significantly between groups. Group H had a significantly shorter operative duration and significantly less blood loss. Mean expansion ratio was significantly greater in Group L (77.83 ± 6.41%) than in Group H (62.72 ± 3.86%) (P < 0.01). CONCLUSIONS: Both surgical approaches are safe and effective in treating multilevel CSM. Laminoplasty provides a greater degree of enlargement of the spinal canal, whereas expansive hemilaminectomy has the advantages of shorter operative duration and less intraoperative blood loss.


Assuntos
Vértebras Cervicais/patologia , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/métodos , Doenças da Medula Espinal/patologia , Doenças da Medula Espinal/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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