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1.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(1): 32-36, 2020 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-31939231

RESUMO

Objective: To compare the effectiveness of proximal femoral nail anti-rotation (PFNA) in the treatment of intertrochanteric fracture of femur in traction bed supine position and non-traction bed lateral position. Methods: A retrospective analysis of 102 elderly patients with intertrochanteric fracture of femur who met the selection criteria between January 2013 and April 2018 was made. According to the different operative positions, the patients were divided into two groups: group A (50 cases, PFNA internal fixation in traction bed supine position) and group B (52 cases, PFNA internal fixation in non-traction bed lateral position). There was no significant difference in age, gender, fracture side, cause of injury, AO classification, complications, and time from injury to operation between the two groups ( P>0.05). The preoperative preparation time, incision length, operation time, intraoperative blood loss, intraoperative X-ray fluoroscopy times, fracture healing time, and complications were recorded and compared between the two groups, and the effectiveness was evaluated by Harris hip score at 1 year after operation. Results: There was no significant difference in incision length between groups A and B ( t=1.116, P=0.268). In addition, the preoperative preparation time, operation time, intraoperative blood loss, and intraoperative X-ray fluoroscopy times in group A were significantly greater than those in group B ( P<0.05). Both groups were followed up 12-14 months, with an average of 13 months. There were 3 postoperative complications in group A and group B respectively. In group A, there were 2 cases of hip joint pain and 1 case of local fat liquefaction (healed after dressing change); in group B, there were 2 cases of hip joint pain and 1 case of deep vein thrombosis in lower extremity; there was no significant difference in the incidence of postoperative complications between the two groups ( P=0.642). The patients of the two groups had a good result of fracture reduction and the internal fixation quality, and there was no main nail loosening, screw fracture, spiral blade cutting, withdrawal, and the nail breakage occurred, and no nonunion of bone, coxa vara, and other complications occurred. X-ray showed that the fracture healed in both groups, and there was no significant difference in fracture healing time between the two groups ( t=1.515, P=0.133). There was no significant difference in Harris hip score between the two groups at 1 year after operation ( t=0.778, P=0.438). Conclusion: Compared with the traction bed supine position, PFNA internal fixation for intertrochanteric fracture of femur in the non-traction bed lateral position has the advantages of short preparation time, short operation time, less intraoperative blood loss, less X-ray fluoroscopy times, and satisfactory postoperative recovery effect.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Quadril , Idoso , Pinos Ortopédicos , Humanos , Estudos Retrospectivos , Decúbito Dorsal , Tração , Resultado do Tratamento
4.
Am J Orthod Dentofacial Orthop ; 156(6): 767-778, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31784010

RESUMO

INTRODUCTION: The aim of this study was to compare the inclination and position changes of maxillary incisors after traction of unilateral vs bilateral maxillary impacted canines in nonextraction orthodontic treatment. METHODS: This longitudinal and retrospective study evaluated 24 patients with impacted maxillary canines; 12 with unilateral impaction and 12 with bilateral impaction. All subjects had Angle Class I malocclusion and were orthodontically treated with a standardized traction protocol that did not include premolar extractions. Cone-beam computed tomographies were obtained before and after canine traction and the inclination and position of both maxillary central incisors were measured. Furthermore, dental arch, skeletal, and canine impaction characteristics were evaluated. Paired and independent t tests were used for intra and inter group comparisons, respectively. Multiple linear regressions were also used. RESULTS: After canine traction, a significant incisor labial inclination was observed in the bilateral group (10.41° right side, P = 0.008 and 12.79° left side, P = 0.001), while in the unilateral group, this was observed only on the nonaffected side (6.67°, P = 0.008). Furthermore, a significant protrusion of incisors was observed in the bilateral group (2.66 mm right side, P = 0.006, and 3.15 mm left side, P = 0.001) and in the nonaffected side of the unilateral group (1.74 mm, P = 0.022). Intergroup comparisons showed greater values of incisor labial inclination for the bilateral group when compared with the unilateral group, independently of the sides. CONCLUSIONS: Traction of maxillary impacted canines, in nonextraction treatment, produces greater labial inclination of maxillary incisors in bilateral cases and similar protrusion in both unilateral and bilateral cases. Unilateral impaction cases showed significant incisor inclination and protrusion in the nonaffected side. These treatment effects should be considered by clinicians.


Assuntos
Incisivo , Dente Impactado , Tomografia Computadorizada de Feixe Cônico , Dente Canino , Humanos , Maxila , Estudos Retrospectivos , Tração
6.
Medicine (Baltimore) ; 98(36): e17073, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490408

RESUMO

Extremely severe scoliosis patients, especially main thoracic Cobb' s angle >150°, often have severe thoracic deformity and pulmonary dysfunction, even the scoliosis is reduced by halo-pelvic traction, the improvement of pulmonary function is not satisfactory, the risk of spinal osteotomy in the next stage is still very high and left with obvious thoracic deformity. How to further improve the pulmonary function and appearance of these patients is a difficult problem to be solved.Twenty extremely severe scoliosis patients with severe pulmonary dysfunction who underwent concave-side thoracoplasty in our hospital from September 2014 to September 2017 were included, data of thoracic volume and pulmonary function were collected before and after operation. The pulmonary function value reported was predicted forced vital capacity (FVC%), T-test was used to analyze the changes of the data by the statistical software SPSS21.0.The 20 patient's averaged Cobb's angle of main thoracic was 163° ± 8° at admission and all of them with severe pulmonary dysfunction before concave-side thracoplasty. After operation, the thoracic volume of patients increased by 500.9 ±â€Š222.9 mL, FVC% increased by 8.9% ±â€Š7.5%. Both the difference has statistical significance (P < .01).Concave-side thoracoplasty based on the halo-pelvic traction cannot only enlarge the volume of the concave thoracic cavity, lighten the compression of lung and further improve the pulmonary function of extremely severe scoliosis, but also can strengthen the correction of scoliosis and spinal rotation. Therefore, it is a safe and effective surgical approach.


Assuntos
Escoliose/cirurgia , Toracoplastia/métodos , Tração/métodos , Adolescente , Adulto , Feminino , Humanos , Pulmão/fisiopatologia , Masculino , Estudos Retrospectivos , Escoliose/fisiopatologia , Adulto Jovem
7.
Jpn J Radiol ; 37(11): 773-780, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31522385

RESUMO

PURPOSE: To assess inter-observer variability in identifying traction bronchiectasis on computed tomography (CT) using additional criteria for chronic fibrosing interstitial pneumonia. METHODS: Seven experts categorized CT image set representing 39 patients into three groups on the basis of the presence of traction bronchiectasis, using a three-point scale: 3-definitely/probably yes; 2-possibly yes; and 1-definitely/probably no. This scale served as a reference standard. The image set included cases of chronic fibrosing interstitial pneumonia, non-interstitial lung disease, and difficult-to-determine cases. Forty-eight observers similarly assessed the same image set, first according to the Fleischner Society definition, and second with additional criteria, in which traction bronchiectasis was observed exclusively in chronic fibrosing interstitial pneumonia. The agreement level between the reference standard and each observer's evaluation in each session was calculated using weighted kappa values which were compared between the two sessions using a paired t test. RESULTS: The mean weighted kappa value for all observers was significantly higher in the second reading session (mean 0.75) than in the first reading session (mean 0.62) (p < 0.001). CONCLUSION: Inter-observer agreement in identifying traction bronchiectasis improves when using the additional criteria which specify chronic fibrosing interstitial pneumonia as the underlying disease.


Assuntos
Bronquiectasia/diagnóstico por imagem , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Variações Dependentes do Observador , Doença Crônica , Fibrose/diagnóstico por imagem , Humanos , Tomografia Computadorizada por Raios X/métodos , Tração
8.
World Neurosurg ; 132: e324-e332, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31476460

RESUMO

OBJECTIVE: To assess the value and limitation of cervical traction in the evaluation of the reducibility of atlantoaxial dislocation (AAD) and basilar invagination (BI) using the intraoperative O-arm. METHODS: A total of 22 patients with hyperextensive, irreducible AAD were included. The cervical traction test under general anesthesia was performed, and the degree of reduction was evaluated using the O-arm before the operation started. The traction effects both vertically and horizontally were evaluated. All cases then underwent modified direct posterior reduction and fixation. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) scale. Radiologic measurements included the anterior atlantodental interval, the distance of odontoid tip above Chamberlain line, and the clivus-canal angle. Magnetic resonance imaging signal changes, size of syringomyelia, and the space ventral to medulla also were used to evaluate the postoperative reduction result. RESULTS: After the cervical traction test, 7 patients achieved incomplete reduction, 5 achieved only vertical reduction, 6 achieved only horizontal reduction, and 4 achieved complete reduction in both horizontal and vertical orientations as assessed by the O-arm. All patients underwent a direct reduction technique. The mean JOA score increased from 11.1 to 14.5. Complete reduction of AAD and BI were achieved in 19 patients (86.4%), with partial reduction achieved in 3 (13.6%). Sufficient cerebrospinal fluid space anterior to the medulla with improved JOA score was achieved in the 3 partially reduced patients. CONCLUSIONS: With the innovations of direct posterior reduction techniques, cervical traction under anesthesia may not sufficiently predict the reducibility of BI and AAD. Cervical traction still plays an important role during the direct posterior reduction procedure.


Assuntos
Articulação Atlantoaxial/cirurgia , Imagem Tridimensional/métodos , Luxações Articulares/cirurgia , Fusão Vertebral/métodos , Tração/métodos , Adolescente , Adulto , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Luxações Articulares/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Cirurgia Assistida por Computador , Insuficiência Vertebrobasilar/diagnóstico , Adulto Jovem
9.
Am J Orthod Dentofacial Orthop ; 156(3): 391-400, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474269

RESUMO

INTRODUCTION: Orthodontic traction of a maxillary impacted canine (MIC) increases the orthodontic treatment time. Therefore, the objective of this study was to evaluate the influence of MIC characteristics and factors associated with orthodontic treatment on the duration of active orthodontic traction. METHODS: This follow-up and retrospective study included 45 MICs orthodontically tractioned into the occlusal plane with the use of a standardized protocol. MIC characteristics, including type, sector, side, location, height, and complexity of impaction, as well as α and ß angles and canine root length and area were measured. Likewise, factors associated with orthodontic treatment, including sex, age, malocclusion, premolar extractions, previous incisor root resorption, ANB, APDI, and SNA angles, and PNS-ANS distance were also evaluated. The statistical analysis included multiple linear regressions to estimate the influence of all variables on the duration of traction (α = 0.05). RESULTS: Sex had significant influence (P = 0.027) on the time of traction; in female patients, the time was 2.05 months more than in male patients. Bilateral impaction treatment increased the time by 2.74 months compared with unilateral cases (P = 0.001). Traction of bicortically centered impacted canines increased the duration of traction by 2.85 months (P = 0.001). Finally, the traction time increased in 2.35 months (P = 0.046) when the impaction sectors were 4 or 5 (close to the midline). CONCLUSIONS: The duration of active orthodontic traction of MIC is mainly influenced by sex, bilateral type, bicortically centered location, or when MIC is located in sector 4 or 5 close to midline, increasing the traction time by some months.


Assuntos
Dente Canino/cirurgia , Maxila/cirurgia , Ortodontia Corretiva/métodos , Dente Impactado/complicações , Dente Impactado/terapia , Adolescente , Dente Canino/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Incisivo , Masculino , Má Oclusão/classificação , Má Oclusão/terapia , Maxila/diagnóstico por imagem , Procedimentos Cirúrgicos Bucais , Procedimentos de Ancoragem Ortodôntica/instrumentação , Procedimentos de Ancoragem Ortodôntica/métodos , Aparelhos Ortodônticos Fixos , Ortodontia Corretiva/instrumentação , Planejamento de Assistência ao Paciente , Radiografia Dentária , Estudos Retrospectivos , Reabsorção da Raiz/complicações , Fatores Sexuais , Fatores de Tempo , Erupção Dentária , Raiz Dentária/anatomia & histologia , Raiz Dentária/diagnóstico por imagem , Dente Impactado/diagnóstico por imagem , Dente Impactado/cirurgia , Tração , Resultado do Tratamento
11.
World Neurosurg ; 131: 120-125, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31400526

RESUMO

BACKGROUND: A noninvasive approach for basilar invagination (BI) and moreover, cervical traction to reduce odontoid invagination, has not been thoroughly described in the literature. We report a case of BI with Arnold-Chiari malformation in which preoperative reduction using Gardner well cervical traction was attempted and the patient developed central hypoventilation syndrome. CASE DESCRIPTION: A 15-year-old boy presented with a 6-month history of progressive cervical myelopathy signs and symptoms, modified Japanese orthopedic association score 12 of 18. Radiology showed type A BI with occipitalization of atlas and a posterior arch defect of axis. A preoperative closed cervical traction followed by occipitocervical fusion via a posterior-only approach was planned. The patient developed 3 episodes of apnea on sleeping when on traction. Labeled as central hypoventilation, he was operated by foramen magnum decompression and occipitocervical fusion. CONCLUSIONS: Cervical traction followed by posterior fixation is an effective way to manage basilar invagination with Arnold-Chiari malformation and assimilated C1. However, patients should be monitored closely for respiratory dysfunction.


Assuntos
Malformação de Arnold-Chiari/cirurgia , Articulação Atlantoccipital/cirurgia , Apneia do Sono Tipo Central/etiologia , Doenças da Coluna Vertebral/cirurgia , Tração/efeitos adversos , Adolescente , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Articulação Atlantoccipital/diagnóstico por imagem , Descompressão Cirúrgica/métodos , Humanos , Masculino , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/diagnóstico por imagem , Fusão Vertebral/métodos
14.
Gastrointest Endosc ; 90(3): 535-536, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31439136
15.
J Craniofac Surg ; 30(8): 2490-2492, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31469740

RESUMO

BACKGROUND: Reduction malarplasty, popular among Asians, is currently performed preferably via the intraoral approach. However, to prevent complications such as malunion and cheek drooping, a rigid fixation is essential to compensate for the action of the masseter. Accordingly, the authors aimed to perform an experimental study on the optimal fixation location during intraoral reduction malarplasty using an L-shaped osteotomy. METHODS: Fixation points that are not difficult to access during an L-shaped osteotomy were selected as 1 point in the freed zygomaticomaxillary complex and 3 points in the medial part of the malar complex (low, middle, and high levels).After setting the fixation points in the medial malar complex and lateral segment of skull replicates, resistance to traction was measured at each level, and maxillary bone thickness was also measured at each level at the fixation points of the medial malar complex in a cadaveric head. RESULTS: In the medial malar complex, resistance to traction increased at higher levels, while the maxillary bone was much thicker at the high level than at the low-middle level. CONCLUSION: This study demonstrated that it is better to locate the fixation point at a higher level in the medial part of the malar complex, closer to the lateral orbital rim.


Assuntos
Osteotomia , Doenças da Língua/cirurgia , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos , Crânio/cirurgia , Tração , Zigoma/cirurgia
16.
World Neurosurg ; 130: e915-e925, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31301447

RESUMO

OBJECTIVE: To evaluate the clinical and radiographic outcomes of an anterior-only approach for the correction of severe cervical kyphotic deformities. METHODS: We performed a retrospective study of 33 consecutive patients with severe cervical kyphosis treated with an anterior cervical operation and preoperative and intraoperative skull traction. Cobb angle, kyphosis index (KI), kyphosis level, C2-7 sagittal vertical axis (SVA), and T1 slope were measured. The preoperative and postoperative Japanese Orthopedic Association (JOA) scores, visual analog scale (VAS) score for neck pain, Neck Disability Index (NDI) scores, and cervical alignment were compared. RESULTS: The mean angle of the kyphosis was 83.2 ± 20.4°. The mean Cobb angle of the operative region was 71.7 ± 18.5° preoperation, which was reduced to 10.6 ± 5.7° postoperation (mean correction, 85.2%). The mean KI was 75.1 ± 18.2 preoperation, which was reduced to 14.4 ± 9.1 postoperation (mean correction, 80.8%). The preoperative and postoperative mean C2-7 Cobb angle was 53.8 ± 16.5° and 14.7 ± 7.6°, respectively. The preoperative and postoperative mean C2-7 SVA was 3.9 ± 14.5 mm and 12.8 ± 7.3 mm, respectively. The preoperative and postoperative mean T1 slope was -9.4 ± 15.7° and 7.3 ± 13.1°, respectively. The average postoperative C2-7 Cobb angle, Cobb angle of the operative region, KI, C2-7 SVA, and T1 slope changed significantly compared with preoperative values (P < 0.05). The average postoperative JOA, VAS, and NDI scores improved significantly compared with preoperative scores (P < 0.05). CONCLUSIONS: Preoperative and intraoperative skull traction combined with anterior-only cervical operation may be a safe and effective technique for treating severe cervical kyphosis. If the postoperative correction is >80%, sufficient decompression could be achieved.


Assuntos
Vértebras Cervicais/cirurgia , Cuidados Intraoperatórios/métodos , Cifose/cirurgia , Cuidados Pré-Operatórios/métodos , Crânio/cirurgia , Tração/métodos , Adolescente , Adulto , Vértebras Cervicais/diagnóstico por imagem , Estudos de Coortes , Terapia Combinada/métodos , Terapia Combinada/tendências , Feminino , Humanos , Cuidados Intraoperatórios/tendências , Cifose/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/tendências , Estudos Retrospectivos , Índice de Gravidade de Doença , Crânio/diagnóstico por imagem , Tração/tendências , Resultado do Tratamento , Adulto Jovem
17.
Appl Ergon ; 80: 35-42, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31280808

RESUMO

Shoe wear is known to increase slipping risk, but few studies have systematically studied this relationship. This study investigated the impact of progressive shoe wear on the available coefficient of friction (ACOF) and under-shoe fluid dynamics. Five different slip-resistant shoes were progressively worn using an accelerated, abrasive, wear protocol. The ACOF and fluid forces (the load supported by the fluid) were measured as shoes were slipped across a surface contaminated with a diluted glycerol solution. As the shoes became worn, an initial increase in ACOF was followed by a steady decrease. Low fluid forces were observed prior to wear followed by increased fluid forces as the worn region became larger. Results suggest that traction performance decreases particularly when the heel region without tread exceeds a size of 800 mm2. This study supports the concept of developing shoe replacement guidelines based upon the size of the worn region to reduce occupational slips.


Assuntos
Acidentes por Quedas/prevenção & controle , Acidentes de Trabalho/prevenção & controle , Sapatos/efeitos adversos , Tração/efeitos adversos , Pisos e Cobertura de Pisos , Fricção , Humanos , Propriedades de Superfície
18.
BMC Surg ; 19(1): 82, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286901

RESUMO

BACKGROUND: An open abdomen is often necessary for survival of patients after peritonitis, compartment syndrome, or in damage control surgery. However, abdominal wall retraction relieves delays and complicates abdominal wall closure. The principle of the newly fascia preserving device (FPD) is the application of anteriorly directed traction on both fascial edges over an external support through a longitudinal beam to relieve increased abdominal pressure and prevent fascial retraction. METHODS: Twelve pigs were randomly divided into two groups. Both groups underwent midline laparotomy under general anesthesia. Group one was treated with the new device, group two served as controls. The tension for closing the abdominal fascia was measured immediately after laparotomy as well as at 24 and 48 h. Vital parameters and ventilation pressure were recorded. Post mortem, all fascial tissues were histologically examined. RESULTS: All pigs demonstrated increases in abdominal circumference. In both groups, forces for closing the abdomen increased over the observation period. Concerning the central closing force after 24 h we saw a significant lower force in the FPD group (14.4 ± 3 N) vs. control group (21.6 ± 5.7 N, p < 0.001). By testing the main effects using an ANOVA analysis we found a significant group related effect concerning closing force and abdominal circumference of the FDP-group vs. control group (p < 0.001; p < 0.001). The placement of the device on chest and pelvis did not influence vital parameters and ventilation pressure. Histologic exam detected no tissue damage. CONCLUSIONS: This trial shows the feasibility to prevent fascial retraction during the open abdomen by using the new device. Thus, it is expected that an earlier closure of the abdominal wall will be possible, and a higher rate of primary closure will be attained.


Assuntos
Parede Abdominal/cirurgia , Fáscia , Laparotomia/instrumentação , Tração/instrumentação , Técnicas de Fechamento de Ferimentos/instrumentação , Animais , Modelos Animais de Doenças , Estudos de Viabilidade , Feminino , Humanos , Estudo de Prova de Conceito , Distribuição Aleatória , Suínos
19.
World J Surg Oncol ; 17(1): 94, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31164139

RESUMO

BACKGROUND: In recent years, some traction-assisted approaches have been introduced to facilitate endoscopic submucosal dissection (ESD) procedures by reducing the procedure time and risks related to the procedure. However, the relative advantages of traction-assisted endoscopic submucosal dissection (T-ESD) are still being debated. This study aimed to assess the efficacy of T-ESD for the treatment of superficial gastrointestinal neoplasms. METHODS: We searched MEDLINE, Embase, and Cochrane library up to March 31, 2019 for randomized controlled trials (RCTs) comparing T-ESD and conventional endoscopic submucosal dissection (C-ESD) for superficial gastrointestinal neoplasms. The main endpoints are en bloc resection, complete resection, procedure time, perforation, and delayed bleeding. Pooled risk ratio (RR), Peto odds ratio (OR), and mean difference (MD) were calculated to compare T-ESD and C-ESD. This study is registered with PROSPERO, number CRD42018108135. RESULTS: A total of 7 RCTs with 1007 patients were included in this meta-analysis. There were no significant differences between the T-ESD and C-ESD groups in the pooled estimate of en bloc resection, complete resection, and delayed bleeding (RR = 1.00, 95% CI 0.99, 1.01, I2 = 0%, P = 0.66; RR = 1.00, 95% CI 0.98, 1.03, I2 = 0%, P = 0.81; OR = 0.95, 95% CI 0.48, 1.86, I2 = 19%, P = 0.87,respectively). The pooled estimate indicated that the procedure time was significantly shorter in the T-ESD group (MD = - 16.19, 95% CI - 29.24, - 3.13, I2 = 87%, P = 0.02) than in the C-ESD group. Compared to C-ESD, T-ESD was associated with lower incidence of perforation (OR = 0.32, 95% CI 0.11, 0.91, I2 = 0%, P = 0.03). CONCLUSIONS: T-ESD is a safe and effective treatment option with a low perforation rate and shorter procedure time than C-ESD for superficial gastrointestinal neoplasms. Future multi-center (including European populations), randomized controlled trials of larger sample size and long-term outcomes of T-ESD are required.


Assuntos
Ressecção Endoscópica de Mucosa/mortalidade , Neoplasias Gastrointestinais/mortalidade , Tração/mortalidade , Neoplasias Gastrointestinais/patologia , Neoplasias Gastrointestinais/cirurgia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Taxa de Sobrevida , Resultado do Tratamento
20.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(6): 671-675, 2019 Jun 15.
Artigo em Chinês | MEDLINE | ID: mdl-31197991

RESUMO

Objective: To explore the impact of preoperative traction on the osteonecrosis of the femoral head (ONFH) in patients with femoral neck fractures. Methods: Between February 2013 and May 2016, 120 patients with femoral neck fractures, who were treated with screw fixation, were collected. Sixty patients with fractures of Garden type Ⅰ and Ⅱ were non-displaced fracture group; 60 cases with fractures of Garden type Ⅲ and Ⅳ were displaced fracture group. The patients in 2 groups were randomly divided into traction and non-traction subgroups ( n=30). There was no significant difference in gender, age, injury mechanism, damage side, the time from injury to operation, and fracture classification between 2 subgroups ( P>0.05). Intracapsular pressure was recorded before operation. The quality of fracture reduction and the satisfaction ratio of screw implant were evaluated during operation. Visual analogue scale (VAS), Harris score, joint mobility, and the incidence of ONFH would be evaluated at 6 months, 1 year, and 2 years after operation. Results: All incisions of 2 groups healed by first intention after operation. There was no infection or deep vein thrombosis of lower extremity. All patients were followed up 2 years. In displaced and non-displaced fracture groups, the intracapsular pressure of traction subgroups were higher than that of non-traction group ( P<0.05); the differences of the quality of fracture reduction and the satisfaction ratio of screw implant were not significant ( P>0.05) between 2 subgroups. At 6 months, 1 year, and 2 years after operation, VAS scores were higher in traction subgroup than in non-traction subgroup ( P<0.05); and the joint mobility and Harris scores were lower in traction subgroup than in non-traction subgroup ( P<0.05). X-ray films showed all fractures healed. Except for the non-displaced group at 6 months, the incidences of ONFH were higher in traction subgroup than in non-traction subgroup at other time points ( P< 0.05). Conclusion: Preoperative traction may increase the risk of ONFH, which can increase the intracapsular pressure and affect the blood supply of femoral head.


Assuntos
Fraturas do Colo Femoral , Fixação Interna de Fraturas , Fraturas do Colo Femoral/terapia , Consolidação da Fratura , Humanos , Tração , Resultado do Tratamento
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