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1.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 38(5): 598-601, 2020 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-33085249

RESUMO

The use of orthodontic traction to preserve healthy subgingival residual root is a classical method combining the treatment of restoration and orthodontics. Based on the target restoration space (TRS), by establishing a TRS digital model, the final traction position of the subgingival residual root can be preset. After evaluating the key parameters such as crown-to-root ratio and minimum crown height, clinicians can estimate the treatment time and exclude cases with bad preset position. The time of traction treatment can be effectively reduced, and the efficiency and efficacy of the entire treatment can also be improved.


Assuntos
Coroas , Fluxo de Trabalho , Coroa do Dente , Tração
2.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(5): 875-880, 2020 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-33047722

RESUMO

OBJECTIVE: To evaluate the clinical efficacy of short-term halo-pelvic traction (HPT) combined with surgery in the treatment of severe spinal deformities. METHODS: In the study, 24 patients diagnosed as severe spinal deformity accepted the treatment of one-stage short-term HPT and two-stage surgery from January 2015 to May 2018 in our orthopedics department. 24 cases (9 males and 15 females) were retrospectively reviewed. The average age of the cohort was (28.8±10.0) years (12-48 years). The height, scoliosis angle, kyphosis angle, the height difference of shoulders, the height difference of crista iliaca, C7PL-CSVL and the perpendicular distance of S1 and the convex point of the patients were assessed at pre-traction, post-traction and post-surgery. The paired t test was used to analyze the difference among pre-traction, post-traction and post-surgery. RESULTS: The average traction time of 24 cases was (2.5±1.1) weeks (1-5 weeks). The height of pre-traction and post-traction were (141.7±11.2) cm (116-167 cm) and (154.1±9.5) cm (136-176 cm) respectively, showing significant difference (P < 0.05), and the increased height was (12.4±4.6) cm (4-20 cm). The average scoliosis angle before traction was 104.9°±35.0°(25°ï¼158°), and it was significantly decreased in post-traction[64.8°±21.0°(19°ï¼92°)] and post-surgery[39.3°±17.0° (10°-70°)] (P < 0.05). The traction's coronal correction rate was 37.2%±10.9% (11.9%-51.2%) and the total coronal correction rate was 61.9%±12.6%(26.9%-79.0%). The average kyphosis angle before traction was 106.9°±29.2°(54°ï¼163°), and it was significantly decreased in post-traction [63.1°±17.1°(32°ï¼92°)] and post-surgery [39.0°±16.8°(10°ï¼68°)](P < 0.05). The traction's sagittal correction rate was 40.0%±10.7%(16.7%-55.5%) and the total sagittal correction rate was 64.3%±10.7%(49.0%-87.5%). The average C7PL-CSVL before traction was (3.2±2.8) cm, and it was significantly decreased in post-traction [(2.5±2.5) cm] (P < 0.05). The perpendicular distance of S1 and the convex point before traction was (10.5±4.8) cm, and it was significantly decreased in post-traction[(8.4±3.5) cm] (P < 0.05). CONCLUSION: The one-stage short-term HPT combined with two-stage surgery is a safe and effective procedure for severe spinal deformities. The clinical efficacy is satisfactory and the complication is relatively less.


Assuntos
Cifose , Escoliose , Adolescente , Adulto , Feminino , Humanos , Cifose/cirurgia , Masculino , Estudos Retrospectivos , Escoliose/cirurgia , Tração , Resultado do Tratamento , Adulto Jovem
3.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(8): 1165-1171, 2020 Aug 30.
Artigo em Chinês | MEDLINE | ID: mdl-32895182

RESUMO

OBJECTIVE: To investigate the effect of orthodontic traction on the microstructure of dental enamel. METHODS: Forty-eight isolated premolars were randomly divided into 6 groups (n=8), including Group A (blank control group), in which the teeth were bonded with the orthodontic brackets without any loading force; Groups B1, B2, and B3 where the teeth were bonded with the orthodontic brackets using clinical adhesives and loaded with 50 g force for 6 months, 200 g force for 6 months, and 200 g force for 1 month, respectively; and Groups C1 and C2, where the teeth were bonded with straight wire brackets using light curing bonding and chemical curing bonding techniques, respectively. All the teeth were embedded with non-decalcified epoxy resin. Scanning electron microscope (SEM), atomic force microscope (AFM), and energy spectrometer (EDS) were used to analyze interface morphology and elemental composition of the teeth sliced with a hard tissue microtome. RESULTS: Compared with those in Group A, the teeth in the other 5 groups showed increased adhesive residue index with microcracks and void structures on the enamel surface under SEM; AFM revealed microcracks on the enamel surface with angles to the grinding direction. A larger loading force on the bracket resulted in more microcracks on the enamel interface. The interface roughness differed significantly between Groups A and C2, and the peak-to-valley distance differed significantly between Groups A, C, and C2. CONCLUSIONS: Orthodontic traction can cause changes in the microstructure of normal dental enamel.


Assuntos
Esmalte Dentário , Teste de Materiais , Braquetes Ortodônticos , Cimentos de Resina , Propriedades de Superfície , Tração
4.
Zhongguo Gu Shang ; 33(9): 883-6, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32959580

RESUMO

OBJECTIVE: To observe the application of modified traction therapy in traumatic atlantoaxial subluxation in adults. METHODS: The clinical data of 31 patients with atlantoaxial subluxation treated from March 2018 to June 2019 were restropectively analyzed. There were 15 males and 16 females, aged from 18 to 68 years old with an average of 39 years old, including 10 cases of 18-40 years, 15 cases of 41-60 years, 6 cases of 51-68 years. The main manifestations of the patients were limited neck movement, pain, and atlantoaxial CT scan showed different degrees of atlantoaxial subluxation. Three dimensional multifunctional traction bed was used for traction for 2 min, relaxation for 10 s. The traction angle starts from the rearward extension of 5°-10° and weight from 3-6 kg. The weight increased by 1 kg every two days until the symptoms were improved. Traction time was 30 min twice a day and 10 days for a course of treatment. One course of treatment was performed in patients with 1-2 mm left and right equal width of atlantoaxial space, and two courses of treatment were performed in patients with 3-4 mm left and right equal width of atlantoaxial space, and the course of treatment could be increased to 3 months in especially patients with serious problems, such as 4 mm left and right equal width of atlantoaxial space and no improvement after conventional treatment. The criteria to evaluate the clinical effect was cure:no pain in the neck, normal range of neck movement, CT showed normal atlantoaxial space and odontoid process was in the middle, patients with normal neck movement were followed up 1 month after the end of treatment;improvement:neck pain was significantly improved and CT showed that the left and right atlantoaxial space was less than 1 mm in equal width. RESULTS: Among the 31 patients, 17 cases were cured by one course of treatment, 11 cases were cured by 2 courses of treatment, and 2 caseswere improved. CONCLUSION: The modified traction therapy has obvious effect on adult traumatic atlantoaxial subluxation, especially the subluxation of 3-4 mm equal width in left and right atlantoaxial space, and this method is safe and reliable with good efficacy and the patients without discomfort.


Assuntos
Articulação Atlantoaxial , Luxações Articulares , Processo Odontoide , Fusão Vertebral , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tração , Adulto Jovem
5.
Bone Joint J ; 102-B(8): 1062-1071, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731831

RESUMO

AIMS: To determine the effectiveness of prone traction radiographs in predicting postoperative slip distance, slip angle, changes in disc height, and lordosis after surgery for degenerative spondylolisthesis of the lumbar spine. METHODS: A total of 63 consecutive patients with a degenerative spondylolisthesis and preoperative prone traction radiographs obtained since 2010 were studied. Slip distance, slip angle, disc height, segmental lordosis, and global lordosis (L1 to S1) were measured on preoperative lateral standing radiographs, flexion-extension lateral radiographs, prone traction lateral radiographs, and postoperative lateral standing radiographs. Patients were divided into two groups: posterolateral fusion or posterolateral fusion with interbody fusion. RESULTS: The mean changes in segmental lordosis and global lordosis were 7.1° (SD 6.7°) and 2.9° (SD 9.9°) respectively for the interbody fusion group, and 0.8° (SD 5.1°) and -0.4° (SD 10.1°) respectively for the posterolateral fusion-only group. Segmental lordosis (ρ = 0.794, p < 0.001) corrected by interbody fusion correlated best with prone traction radiographs. Global lumbar lordosis (ρ = 0.788, p < 0.001) correlated best with the interbody fusion group and preoperative lateral standing radiographs. The least difference in slip distance (-0.3 mm (SD 1.7 mm), p < 0.001), slip angle (0.9° (SD 5.2°), p < 0.001), and disc height (0.02 mm (SD 2.4 mm), p < 0.001) was seen between prone traction and postoperative radiographs. Regression analyses suggested that prone traction parameters best predicted correction of slip distance (Corrected Akaike's Information Criterion (AICc) = 37.336) and disc height (AICc = 58.096), while correction of slip angle (AICc = 26.453) was best predicted by extension radiographs. Receiver operating characteristic (ROC) cut-off showed, with 68.3% sensitivity and 64.5% specificity, that to achieve a 3.0° increase in segmental lordotic angle, patients with a prone traction disc height of 8.5 mm needed an interbody fusion. CONCLUSION: Prone traction radiographs best predict the slip distance and disc height correction achieved by interbody fusion for lumbar degenerative spondylolisthesis. To achieve this maximum correction, interbody fusion should be undertaken if a disc height of more than 8.5 mm is attained on preoperative prone traction radiographs. Level of Evidence: Level II Prognostic Study Cite this article: Bone Joint J 2020;102-B(8):1062-1071.


Assuntos
Fusão Vertebral/métodos , Espondilolistese/diagnóstico por imagem , Espondilolistese/terapia , Tração/métodos , Idoso , Estudos de Coortes , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/métodos , Decúbito Ventral , Curva ROC , Radiografia/métodos , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
7.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(7): 900-906, 2020 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-32666736

RESUMO

Objective: To compare the changes of scoliosis and kyphosis angles after Halo-pelvic traction with posterior spinal osteotomy versus simple posterior spinal osteotomy for severe rigid spinal deformity. Methods: A clinical data of 28 patients with severe rigid spinal deformity between January 2015 and November 2017 was retrospectively analyzed. Sixteen patients were treated by Halo-pelvic traction with posterior spinal osteotomy (group A) and 12 patients were treated with posterior spinal osteotomy only (group B). There was no significant difference between the two groups ( P>0.05) in gender, age, body mass index, and preoperative pulmonary function, coronal and sagittal Cobb angles, and flexibility. The operation time, intraoperative blood loss, and complications were recorded. The coronal and sagittal Cobb angles were measured on X-ray films before operation (before traction in group A), at 10 days after operation, at last follow-up in the two groups and after traction in group A. The improvement rate of deformity after traction in group A, the correction rate of deformity after operation, and the loss rate of correction at last follow-up were calculated. Results: All patients were followed up 24-30 months (mean, 26.5 months). The operation time and intraoperative blood loss were significantly less in group A than in group B ( t=7.629, P=0.000; t=8.773, P=0.000). In group A, 1 patient occurred transient numbness of both legs during continuous traction and 2 patients needed ventilator support for more than 12 hours. In group B, 7 patients needed ventilator support for more than 12 hours, including 1 patient with deep incision infection. The incidence of complications was 18.75% (3/16) in group A and 58.33% (7/12) in group B, and the difference between the two groups was significant ( χ 2=4.680, P=0.031). The coronal and sagittal improvement rates of deformity after traction in group A were 40.47%±3.60% and 40.70%±4.20%, respectively. There was no significant difference between the two groups ( P>0.05) in the coronal and sagittal Cobb angles at 10 days after operation and at last follow-up, in the correction rate of deformity after operation, and in the loss rate of correction at last follow-up. Conclusion: For the severe rigid spinal deformity, Halo-pelvic traction with posterior spinal osteotomy and simple posterior spinal osteotomy can obtain the same orthopedic effect and postoperative deformity correction. However, the Halo-pelvic traction can shorten operation time, reduce blood loss and incidence of perioperative complications.


Assuntos
Cifose , Escoliose , Fusão Vertebral , Humanos , Osteotomia , Estudos Retrospectivos , Tração , Resultado do Tratamento
10.
Orthod Craniofac Res ; 23(4): 471-478, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32492259

RESUMO

OBJECTIVE: To compare the stress distribution and initial displacements during traction of palatally impacted canine between Kilroy and nickel-titanium (NiTi) closed-coil springs by means of the finite element analysis. SETTING AND SAMPLE POPULATION: A finite element method analysis of two traction methods for a maxillary impacted canine. MATERIALS AND METHODS: The corresponding periodontal ligaments (PDLs), brackets, molar tubes and a 0.019 × 0.025-in base stainless-steel (SS) wire were modelled and imported to ANSYS SpaceClaim version 2020 R1. Traction was simulated under two different set-ups with equal force magnitude (60 g); (1) the Kilroy spring, which is made of 0.016-inch SS, and (2) the NiTi closed -coil spring. Von Mises stress distributions and initial displacements of the maxillary teeth were analysed. RESULTS: In both mechanics, while the highest stress was seen on the impacted canine (Kilroy, 10.41 kPa; NiTi closed-coil, 5.27 kPa), the stress distribution decreased as the distance from the impacted canine increased. The Kilroy spring showed a greater total displacement (465.60 µm) on the impacted canine. The higher stresses on the adjacent lateral (5.29 kPa) and premolar (6.41 kPa) occurred with the Kilroy spring. CONCLUSIONS: The Kilroy spring yielded higher stresses than the NiTi closed-coil spring on the impacted canine and the adjacent teeth. The difference between distribution of the stresses over the impacted canine induced greater displacement with the Kilroy spring, particularly in the vertical direction.


Assuntos
Níquel , Dente Impactado , Análise de Elementos Finitos , Humanos , Fios Ortodônticos , Titânio , Tração
11.
Vestn Oftalmol ; 136(3): 32-38, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32504474

RESUMO

Tractional flap tears are the main cause of the development of regmatogenic retinal detachment (RRD). The main immediate treatment method for it is laser retinal coagulation. PURPOSE: Case monitoring of tractional symptomatic flap tears after laser treatment. MATERIAL AND METHODS: From 2014 to 2019 we observed 119 patients (130 eyes) with peripheral flap (horseshoe) retinal tears in acute posterior vitreous detachment. Laser coagulation of the retina was performed using Navilas 577s (577 nm), OcuLight GL (532 nm). Laser retinotomy of horseshoe tear flap and dissection of overhanging vessels were performed using Nd:YAG-ultra Q Reflex laser (1064 nm) and controlled with RTVue XR Avanti. RESULTS: At the initial examination before the preventive laser coagulation, the following conditions were found: regmatogenous retinal detachment (RRD) - 8 eyes (6.2%), partial hemophthalmus - 29 (22.3%), preretinal hemorrhage - 15 (11.5%), epiretinal membrane - 9 (6.9%), non-full-thickness macular retinal breaks - 6 (4.6%), peripheral changes: retinal holes - 16 (12.3%), tears with operculum - 5 (3.8%), retinal degenerations - 40 eyes (30.8%). Observation for 5 years after laser retinopexy revealed new pathological changes: flap tears - 13 (10.6%); holes - 9 (7.4%); tears with operculum - 5 (4.1%); vitreoretinal tuft - 6 (4.9%); RRD - 3 cases (2.5%). In 16 patients (16 eyes) with horseshoe tear and pronounced vitreoretinal traction, the flap retinotomy was performed, which eliminated the traction component and prevented the development of RRD. CONCLUSION: Follow-up of tractional symptomatic flap tears for 5 years after preventive laser retinopexy revealed the appearance of retinal detachment in 2.5% of cases. Laser retinotomy of horseshoe tear after barrier retinopexy eliminated the traction component and helped prevent the development of RRD.


Assuntos
Descolamento Retiniano , Perfurações Retinianas , Lesões do Menisco Tibial , Humanos , Retina , Tração
12.
Zhongguo Gu Shang ; 33(4): 367-70, 2020 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-32351093

RESUMO

OBJECTIVE: To explore the clinical effect of the treatment of Fernandez type Ⅲ fracture of the distal radius with hyperextension traction prying, volar reduction, bone grafting and internal fixation. METHODS: From February 2017 to March 2018, 11 cases of Fernandez type Ⅲ fracture of the distal radius were treated with intraoperative hyperextension traction and volar prying reduction and bone grafting and internal fixation, including 6 males and 5 females, aged 55 to 67 years. Preoperative X-ray and CT evaluated the distal radius fracture dorsal angulation with articular surface compression, collapse. According to Fernandez, all of them were type Ⅲ. After operation, the reduction of articular surface and fracture healing were evaluated. VAS score and Cooney wrist score were used to evaluate the curative effect. RESULTS: All the patients were followed up for 12 to 14 months. All the fractures healed. Cooney wrist score scale was used to evaluate the curative effect, 9 cases were excellent, 1 case was good and 1 case was fair. CONCLUSION: In the operation of Fernandez type Ⅲ fracture of the distal radius, hyperextension traction was used to enlarge the angle, and through the volar fracture end prying reduction and internal fixation with bone graft, the collapsed articular surface could be effectively reduced and fixed. The early functional exercise after the operation had satisfactory clinical effect.


Assuntos
Fraturas do Rádio/cirurgia , Punho , Idoso , Placas Ósseas , Transplante Ósseo , Feminino , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Rádio (Anatomia) , Amplitude de Movimento Articular , Tração , Resultado do Tratamento
13.
Int J Biometeorol ; 64(8): 1393-1400, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32361959

RESUMO

Low back pain (LBP) is one of the most costly diseases in the developed world. This study aimed to investigate the effects of underwater traction therapy on chronic low back pain. The primary objective was to prove that underwater traction therapy has favorable effects on LBP. Our secondary objective was to evaluate whether it also leads to improvement in the quality of life. This is a prospective, multicenter, follow-up study. A total of 176 patients with more than 3 months of low back pain enrolled from outpatient clinics were randomized into three groups: underwater weight bath traction therapy and non-steroidal anti-inflammatory drugs (NSAIDs); weight bath; and only NSAIDs. The following parameters were measured before, right after, and 9 weeks after the 3-week therapy: levels of low back pain in rest and during activity were tested using the visual analogue scale (VAS), the Oswestry Low Back Disability Questionnaire, and the EuroQol-5D-5L Questionnaire.The VAS levels improved significantly (p < 0.05) in both underwater weight bath traction therapy groups by the end of the treatment, whereas the improvement in the third group was not statistically significant. Furthermore, the improvements measured in the groups receiving traction therapy were persistent during the follow-up period. There were no significant changes in the Oswestry Index or the EuroQol-5D-5L without VAS parameters in any of the groups.Based on our results, for patients suffering from LBP pain who underwent underwater weight bath traction therapy, there were favorable impacts on the pain levels at rest or during activity. Clinical trial registration ID: NCT03488498, April 5, 2018.


Assuntos
Dor Crônica , Dor Lombar , Seguimentos , Humanos , Medição da Dor , Estudos Prospectivos , Qualidade de Vida , Tração , Resultado do Tratamento
14.
Spine Deform ; 8(5): 879-884, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32303999

RESUMO

STUDY DESIGN: Description of technique. OBJECTIVES: Describes the redesign of free-weight-based halo gravity traction wheelchairs and walkers to a spring-based system. The treatment of severe pediatric spinal deformities is challenging and associated with significant morbidity. Halo gravity traction (HGT) can be utilized to assist in the correction of severe spinal deformities. A time period of traction may also be used to medically optimize patients prior to surgery. Implementing HGT therapy requires specialized equipment, specially trained hospital staff, as well as significant commitment from caregivers. This study describes the transition from a free weight-based HGT equipment to a spring-based weight system. The new system is expected to decrease the burden of care and improve safety for patients and their families. METHODS: A thorough interview process was carried out to gather data on existing HGT systems. All stakeholders, including orthopedic technicians, nurses, surgeons, patients and their families were asked questions on how to improve the equipment and process. With colleagues at a partner children's hospital, new HGT wheelchairs and walkers with a spring-based weight system were designed and built. RESULTS: Spring-based weight HGT wheelchairs and walkers are more economical to build, safer, and easier to operate than free-weight-based systems. A cost analysis found that spring-based systems cost $780 less compared to free weight-based systems. In addition, the new spring-based wheelchairs and walkers are about 50% lighter with improved weight distribution making them safer to operate and easier to transport. There is consensus among surgeons, nurses, and families that the redesigned units are easier to operate. CONCLUSIONS: Spring-based weight HGT systems are economically viable and clinically effective for pre-operative traction for children with severe spinal deformities. They are well tolerated by patients and easy to care for by nursing and surgical staff. LEVELS OF EVIDENCE: III.


Assuntos
Desenho de Equipamento , Gravitação , Cuidados Pré-Operatórios/instrumentação , Escoliose/terapia , Tração/instrumentação , Andadores , Cadeiras de Rodas , Idade de Início , Criança , Humanos , Cuidados Pré-Operatórios/métodos
15.
World Neurosurg ; 139: e151-e158, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32251829

RESUMO

OBJECTIVE: To evaluate the safety and efficacy of posterior-only surgical correction with heavy halo-femoral traction for the treatment of severe and rigid congenital scoliosis (SRCS) associated with tethered spinal cord (TSC) and type II split cord malformation (SCM). METHODS: Thirteen patients with SRCS associated with TSC and type II SCM underwent posterior-only surgical correction with heavy halo-femoral traction. The preoperative mean coronal Cobb angle was 88.87° ± 12.15°; the mean flexibility was 15.28% ± 3.88%; and the mean angle of thoracic kyphosis and lumbar lordosis was 39.63° ± 18.47° and 56.99° ± 10.02°, respectively. RESULTS: The mean duration of surgery was 320 ± 43.64 minutes and the mean blood loss was 1422.31 ± 457.59 mL. The mean follow-up period was 24.46 ± 7.53 months. After heavy halo-femoral traction, the mean coronal Cobb angle was reduced to 59.14° ± 8.75°. After posterior-only surgical correction, postoperative mean coronal Cobb angle was further reduced to 33.85° ± 8.77°. The postoperative mean correction rate was 62.46% ± 5.04%. The postoperative mean angle of thoracic kyphosis and lumbar lordosis was 29.31° ± 6.75° and 47.79° ± 3.68°, respectively. At the final follow-up, the corrective loss rate of Cobb angle was only 0.69%. There were no significant differences between final follow-up and preoperative modified Japanese Orthopaedic Association total scores. The Scoliosis Research Society-22 total score improved at the final follow-up evaluation compared with the preoperative total score. CONCLUSIONS: Without prophylactic neurosurgical intervention and spine-shortening osteotomy, posterior-only surgical correction with heavy halo-femoral traction could be safe and effective for the treatment of SRCS associated with TSC and type II SCM.


Assuntos
Defeitos do Tubo Neural/complicações , Procedimentos Neurocirúrgicos/métodos , Escoliose/complicações , Escoliose/cirurgia , Tração/métodos , Adolescente , Criança , Feminino , Humanos , Masculino , Escoliose/congênito , Tração/instrumentação
16.
World Neurosurg ; 139: e245-e254, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32289511

RESUMO

OBJECTIVE: In this retrospective study, our objective was to establish a nomogram to predict the effectiveness of cervical traction in young and middle-aged chronic nonspecific neck pain (CNNP) patients with unsatisfactory nonsteroidal anti-inflammatory drug (NSAID) control. For CNNP patients with unsatisfactory NSAID control, the effectiveness of cervical traction varies. Neck muscle fat infiltration and clinical features may associate with the effectiveness. METHODS: A total of 186 suitable patients were classified into a training data set (from August 2015 to July 2018, n = 118) and a validation data set (from August 2018 to June 2019, n = 68) with time sequence. All patients were included to receive magnetic resonance imaging scan to calculate posterior cervical fat and muscle features, then undergoing unified cervical traction in an outpatient clinic. The least absolute shrinkage and selection operator (LASSO) regression model was used to select potentially relevant features to predict effectiveness possibility of cervical traction. Multivariable logistic regression analysis was used to develop the predicting model, presenting with a nomogram. The performance of the nomogram was assessed based on its calibration, discrimination, and clinical utility. RESULTS: Through the LASSO regression model, we identified 4 predictors including sex, good exercise compliance, the ratio of the cross-sectional area (CSA) between fat and muscle on C5 level (C5 fat CSA/muscle CSA), the ratio of CSA between fat and centrum on C5 level (C5 fat CSA/centrum muscle CSA). The nomogram provided good calibration and discrimination in the training cohort, showing an area under the curve (AUC) of 0.704 (95% CI, 0.608-0.799) and good concordance between the predicted and actual probabilities with Spiegelhalter's Z-test (P = 0.835). Discrimination of the model in the validation data set was acceptable, with AUC of 0.691 (95% CI, 0.564-0.817). Decision curve analysis revealed the nomogram to be clinically useful. CONCLUSIONS: Male sex, good exercise compliance, lower C5 fat CSA/centrum CSA, and and lower C5 fat CSA/muscle CSA could be favorable features to predict the effectiveness of cervical traction in CNNP patients with unsatisfactory NSAID control.


Assuntos
Cervicalgia/patologia , Cervicalgia/terapia , Nomogramas , Músculos Paraespinais/patologia , Tração/métodos , Tecido Adiposo/patologia , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Vértebras Cervicais , Dor Crônica/patologia , Dor Crônica/terapia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
20.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(4): 469-474, 2020 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-32291983

RESUMO

Objective: To investigate the effectiveness and advantages of skeletal tractor in closed reduction and proximal femoral nail antirotation (PFNA) internal fixation of intertrochanteric fracture compared with traction table. Methods: The clinical data of 86 patients with intertrochanteric fractures, who were treated with closed reduction and PFNA internal fixation between October 2016 and March 2018 and met the selection criteria, was retrospectively analysed. Among them, 44 cases were treated with skeletal tractor (trial group) and 42 cases were treated with traction table (control group). There was no significant difference between the two groups in gender, age, cause of injury, fracture side, AO classification, and degree of osteoporosis ( P>0.05). The preoperative position time, operation time, intraoperative fluoroscopy times, intraoperative blood loss, fracture healing time, intraoperative and postoperative complications, and postoperative Harris score were compared between the two groups. Results: The operation was successfully completed in both groups. Compared with the control group, the patients in the trial group had shorter preoperative position time and operation time, fewer intraoperative fluoroscopy times, and less intraoperative blood loss ( P<0.05). The patients were followed up 12-21 months in trial group (mean, 14.2 months) and 12-22 months in control group (mean, 14.3 months). Venous thrombosis of lower extremity occurred in 8 patients (3 cases of trial group and 5 cases of control group) after operation. Internal fixation failure occurred in 5 patients (2 cases of trial group and 3 cases of control group) during 1 year after operation. All fractures healed except for those with internal fixation failure, the fracture healing time was (11.6±2.9) weeks in trial group and (12.4±3.6) weeks in control group; and there was no significant difference between the two groups ( t=1.250, P=0.214). At 1 year after operation, Harris score of the trial group was 86.2±5.9 and that of the control group was 84.1±6.1. There was no significant difference between the two groups ( t=1.768, P=0.080). Conclusion: Compared with traction table, skeletal tractor in closed reduction and PFNA internal fixation of intertrochanteric fracture can significantly shorten the preoperative position time and operation time, reduce the intraoperative fluoroscopy times, improve the operation efficiency, and have similar effectiveness.


Assuntos
Fixação Interna de Fraturas , Fixação Intramedular de Fraturas , Fraturas do Quadril/cirurgia , Tração , Pinos Ortopédicos , Humanos , Estudos Retrospectivos , Tração/instrumentação , Resultado do Tratamento
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