Objective To discuss the relationship between recovery of anatomical integrity and functional outcome in elderly patients with distal radius fractures by comparing the effects of open reduction and closed reduction. Methods The cl inical data were retrospectively analyzed from 78 elderly patients with distal radius fractures treating with nonoperation andoperation from February 2005 to March 2009. Thirty-seven patients underwent closed reduction and spl intlet fixation or cast appl ication (non-operation group), and forty-one patients underwent open reduction and internal fixation (operation group). In non-operation group, there were 15 males and 22 females with an average age of 73 years (60-83 years). According to the AO classification system for fracture, there were 8 cases of type A2, 7 cases of type A3, 7 cases of type B1, 4 cases of type B2, 2 cases of type B3, 4 cases of type C1, 2 cases of type C2, and 3 cases of type C3. The time from injury to admission was between 30 minutes and 3 days with a mean time of 1 day. In operation group, there were 18 males and 23 females with an average age of 71 years (62-80 years). According to the AO classification system for fracture, there were 5 cases of type A2, 7 cases of type A3, 7 cases of type B1, 6 cases of type B2, 3 cases of type B3, 4 cases of type C1, 5 cases of type C2, and 4 cases of type C3. The time from injury to admission was between 30 minutes and 7 days with a mean time of 1 day. There were no significant differences (P gt; 0.05) in sex, age, disease course and fracture classification between two groups. Results All incisions obtained heal ing by first intention after operation in operation group. All patients were followed up for 9-36 months (20 months on average). Fracture heal ing was achieved within 8 to 15 weeks, with an average of 11 weeks. There were no significant differences (P gt; 0.05) in fracture heal ing time between non-operation group [(10.8 ± 2.0) weeks] and operation group [(11.7 ± 2.5) weeks]. At last follow-up, thepalmar tilt angle was (5.6 ± 2.0)° and (8.6 ± 3.0)°, the radial incl ination angle was (19.1 ± 4.9)° and (21.8 ± 2.0)°, and the radial length was (8.3 ± 1.3) mm and (10.4 ± 1.4) mm in non-operation group and operation group, respectively; showing significant differences (P lt; 0.05) between two groups. According to the Gartland-Werley score, the results were excellent in 9 cases, good in 21 cases, fair in 5 cases, and poor in 2 cases in non-operation group, the excellent and good rate was 81.1%; in operation group, the results were excellent in 13 cases, good in 25 cases, fair in 2 cases, and poor in 1 case, the excellent and good rate was 92.7%, showing no significant difference (P gt; 0.05) between two groups. There were no significant differences (P gt; 0.05) in flexion and extension activity of wrist, radioulnar partial activity, pronation-supination activity, grip and pinch strength between two groups. Conclusion Open reduction and closed reduction can achieve satisfactory functional outcomes, but closed reduction was inferior to open reduction in anatomic reduction for treating distal radius fractures in elderly patients.
Objective To compare the short-term curative results between Nissen, Thal and Toupet fundoplications in treatment of gastroesophageal reflux(GER) and to provide the basis for operative procedure. Methods Thirty-three male Japan rabbits were randomly divided into six groups: group reflux(n=7), transabdominal Heller’s esophagomyotomy (TAHE)；group Nissen(n=7)，TAHE and Nissen fundoplication；group Thal(n=7)，TAHE and Thal fundoplication；group Toupet(n=7)，TAHE and Toupet fundoplication； control group (n=5)，ventrotomy. The anti-reflux efficacy of fundoplication was evaluated by intraesophageal pH monitoring and MGV（maximal gastric volume sustained by lower esophageal sphincter）4 weeks postoperatively. Results ① The total number of reflux episodes and the reflux ratio（0.83±0.41,2.20%±1.12%） of group Nissen were significantly lower than those of group Thal (2.20±0.45, 4.32%±0.82%) and group Toupet (1.80±0.45, 4.20%±0.57%), respectively (Plt;0.05). ② MGV of group Nissen (233.00±9.44)ml was significantly larger than those of group Thal （203.40±11.13）ml and group Toupet（197.60±10.99）ml, respectively (Plt;0.05). ③There were no significant difference in total number of reflux episodes, reflux ratio and MGV between group Thal and group Toupet (Pgt;0.05).Conclusion Nissen fundoplication was better than Thal and Toupet fundoplications,Thal and Toupet fundoplications are similar in short-term curative result.
ObjectiveTo explore the efficacy of an innovative approach of follow-up in patients implanted with permanent pacemaker (DDD). MethodsA total of 400 patients who underwent permanent pacemaker (DDD) implantation between June 2011 and June 2013 were included in the present study. Patients were randomly assigned to the innovative and conventional follow-up groups in a 1：1 manner (200 patients in each group). The baseline characteristics were well balanced with no statistically significant differences in the mean age, proportion of male sex, prevalence of hypertension, position of the electrode or the device used between the two groups. At the end of the follow-up, patient outcomes were compared between the two groups. ResultsThe outcomes of patients were better in the innovative follow-up group, with higher degree of satisfaction, better state of health, lower incidence of complications, and less frequent readmission and follow-up visits (all P<0.05). ConclusionThe innovative approach of follow-up considerably improves patient outcomes, and can be useful in future clinical practice.
Objective?To compare the double dorsal phalangeal flap (DDPF) with the combination of digital neurovascular island flap (NVIF) and first dorsal metacarpal artery flap (FDMA) in terms of repairing digit degloving injury.?Methods?From October 2005 to March 2008, DDPF was used to repair 9 patients (9 fingers) with degloving injury of the thumb and index finger and completely amputated thumb and index finger (group A). From August 1996 to June 2007, NVIF and FDMA were used to repair 13 patients (13 fingers) with the thumb degloving injury and completely amputated or necrotic thumb (group B). In group A, there were 7 males and 2 females aged 19-48 years old, there were 4 cases of thumb and index finger degloving injury repair and 5 cases of completely amputated thumb and index finger reconstruction, the skin defect ranged from 6.0 cm × 3.5 cm to 7.0 cm × 4.5 cm, and the interval between injury and operation was 3-10 hours. The size of DDPF harvested during operation was 4.0 cm × 3.5 cm-5.0 cm × 4.0 cm. In group B, there were 10 males and 3 females aged 18-50 years old, there were 5 cases of thumb degloving injury repair and 8 cases of completely amputated or necrotic thumb reconstruction, the skin defect ranged from 6.0 cm × 3.0 cm to 7.0 cm × 4.5 cm, and the interval between injury and operation was 3 hours-5 days, and the size of NVIF and FDMA harvested during operation was 3.5 cm × 3.0 cm-5.0 cm × 4.0 cm. The donor site was repaired with the full-thickness skin graft.?Results?All the flaps survived uneventfully except for 1 case in group A suffering from venous crisis 1 day after operation and 2 cases in group B suffering from FDMA artery crisis 4-12 hours after operation. Those flaps survived after symptomatic treatment. All the wounds healed by first intention. All patients in two groups were followed up for 1-12 years (average 3.2 years). All the donor sites were normal except for 3 cases in group B suffering from flexion contracture deformity of the proximal interphalangeal joint due to the scar contracture in the margin of NVIF donor site. According to Allen test, the skin temperature and color of the donor fingers in two groups were normal under room temperature; 1 case of group A and 6 NVIF donor fingers of group B were pale and cold under ice water. According to sensory recovery evaluation system, 16 fingers in group A were graded as S4, 1 as S3+, and 1 as S2; while in group B, 3 NVIF fingers were graded as S3, 6 NVIF fingers as S2, 4 NVIF fingers as S1, and 13 FDMA fingers as S4. The appearance of the recipient flap was satisfactory and the color was similar to the surrounding skin. The skin temperature and color of the flaps in two groups were normal under room temperature; 2 cases of group A and 4 recipient fingers of group B were pale and cold under ice water. In group A, all the palmar flap of the recipient finger achieved the reorientation of the recipient flap sensation; while in group B, 8 cases achieved the reorientation of the recipient flap sensation, and 5 cases had double sensation. For the two-point discrimination of the flap, group B was superior to that of group A in terms of the palmar aspect (P lt; 0.05), no significant difference was evident between two groups in terms of the dorsal aspect (P gt; 0.05), and the palmar aspect of each group was superior to the dorsal flap (P lt; 0.05).?Conclusion?DDPF is less invasive to donor finger, easy to be operated, able to partially restore the sensory of the injured finger, and suitable for the repair of the degloving injury of the thumb and the index finger. Combination of NVIF and FDMA can restore the fine sensory of recipient palmar flap better and is applicable for those patients suffering from digital nerve defects from the proximal phalanx and with high demand for the recovery of thumb sensory.
ObjectiveTo compare the curative effect of levetiracetam combined with lamotrigine and sodium valproate on postoperative patients with temporal lobe epilepsy. MethodsA total of 186 postoperative patients with temporal lobe epilepsy during August 2012 to August 2014 in our hospital were divided into levetiracetam combined with lamotrigine group (n=98), and sodium valproate group (n=88) based on postoperative different antiepileptic drugs treatment. Antiepileptic treatment were followed up for 12~48 months.Curative effect and adverse reaction were observed. Reservation rates and incidence rates of adverse reaction were calculated in the two groups. ResultsIn levetiracetam combined with lamotrigine group, EngelⅠratio was 72.4%(71), EngelⅡratio was 17.3%(17), EngelⅢratio was 7.1%(7), and EngelⅣratio was 3.2%(3);in sodium valproate group, EngelⅠratio was 67.0%(59), EngelⅡratio was 21.6%(19), EngelⅢratio was 9.1%(8), and EngelⅣratio was 2.3%(2), and the difference was not statistically significant in the same grade of two groups (P > 0.05).Reservation rate and incidence rate of adverse reaction in levetiracetam combined with lamotrigine group were 90.8%(89) and 15.3%(15) respectively.While those in sodium valproate group were 80.7%(71) and 36.4%(32) respectively.The differences were statistically significant between the two groups (P < 0.05). ConclusionsLevetiracetam combined with lamotrigine treatment on postoperative patients with temporal lobe epilepsy may have better curative effects than sodium valproate treatment, and levetiracetam combined with lamotrigine has its advantage in reservation rate and less adverse reaction.
Objective To evalute the cl inical outcomes of two different surgical treatments for arachnoid cysts in sacral canal. Methods From January 2004 to March 2009, 55 cases of arachnoid cysts in the sacral canal were treated by traditonal simple sacral laminectomies with resection of the cysts (group A, 25 cases) and novel CT-guided percutaneous fibrin glue therapy of arachnoid cysts (group B, 30 cases). Of them, there were 23 males and 32 females, aging 15-66 years with an average of 42.6 years; the duration of symptoms was 6 months to 15 years with an average of 3.5 years. L5-S1 was involved in 22 cases, S1,2 in 25 cases, S2,3 in 12 cases, S2 in 8 cases, and presacral in 2 cases. The size of cysts was 1.5 cm × 1.0 cm to 6.0 cm × 2.8 cm. The MRI examination showed that all patients had cysts in the sacral canal. There were no significant difference (P gt; 0.05) in sex, ages, disease duration and cysts size between two groups. Preoperative data and postoperative lumbosacral pain and function improvement were analyzed and compared between two groups. Results All operations were performed successfully. The operative time, blood loss and hospital ization days of group B were significantly less than those of group A (P lt; 0.01). All 55 cases were followed up from 9 to 61 months (mean 23 months). In group A, postoperative cerebrospinal fluid leakage (25 cases), intracranial infection (2 cases), nerve injury (3 cases), and nerve root irritation (8 cases) occurred; in group B, mild meningitis (3 cases) and low grade fever (5 cases) occurred. Except for nerve injury, other compl ications were cured after symptomatic management. During the follow-up, 2 recurrent cases were found in group A and 1 case in group B. Of them, 2 recurrent cases were treated with CT-guided percutaneous fibrin glue therapy of arachnoid cysts, and cysts disappeared. For two groups, there were significant differences in Oswestry functional disabil ity index and visual analogue scale score between preoperation and postoperation (P lt; 0.01), and in the rate of score improvement between two groups (P lt; 0.01). According to the rating scale, the excellent and good rates of pain improvement were 64% in group A and 100% in group B; the excellent and good rates of function improvement were 24% in group A and 97% in group B. Conclusion CT-guided percutaneous fibrin glue therapy for arachnoid cysts in the sacral canal is a mini-invasive, safe, effective, and economical method, it may be better choices for the treatment of arachnoid cysts in the sacral canal.
Objective To compare the long-term results between theMckay procedure and the musclestrength balancing procedure in treatment of congenital clubfoot (CCF).Methods Thirty-seven children with 54 clubfeet were treated by the muscle-strength balancing procedure (31 feet) or the Mckay procedure (23 feet).There were 27 males (38 feet) and 10 females (16 feet). The average age at the time of surgery was 1.2 years (range, 5 months to 3.5 years). The deformity occurred on the left side in 7 patients, on the right side in 13, and on both sides in 17. During the musclestrength balancing procedure, the anterior tibial tendonwas transplanted to the middle or the lateral cuneiform, and the Achilles tendon was lengthened. During the Mckay procedure, the complete releasing of the softtissues and the lengthening of the tendons were performed routinely; in addition, the abductor hallucis was also excised. The clinical outcomes were evaluated with the Diméglio classification method. According to the Diméglio scoring system, 3 clubfeet were at Grade Ⅱ (score, 6-10); 26 clubfeet at Grade Ⅲ (score, 11-15); 25 clubfeet at Grade Ⅳ (score, 16-20). Based on the Diméglio grading system, all the patients were divided into two groups before operation. Group Aconsisted of 29 feet at Grade Ⅱ or Ⅲ (score, 12.55±1.84); Group B consistedof 25 feet at Grade Ⅳ (score, 17.20±1.08). The score in the group undergoingthe musclestrength balancing procedure was 14.16±2.83, and the score in the group undergoing the Mckay procedure was 15.43±2.63. Results All the patients were followed up for an average of 8.2 years (range, 5.0-10.5 years). According to the Diméglio grading system, 32 patients were at Grade Ⅰand 22 patients at Grade Ⅱ, and none of the patients at Grade Ⅲ or Ⅳ. Two patients undergoing the Mckay procedure developed the postoperative incision infection, but the incision wound healed after the dressing changes. The Diméglio score was 4.07±1.25 in Group A and 6.52±1.74 in Group B after operation, with a significant difference when compared with before operation (Plt;0.05). In Group A the two procedureshad no significant difference in effectiveness (Pgt;0.05); however, in Group B they had a significant difference (Plt;0.05). Judging by the correction degrees for the deformity on the different planes, the two procedures had no significant difference for correcting the equinus of hind foot (Pgt;0.05); however, in the correction degrees for the cross-foot and supination or adduction of the anterior foot, the Mckay procedure was significantly finer than the muscle-strength balancing procedure. It has a good biocompatibility. The mechanical test has showed that the Mckay procedure had the best result in the correction of the forefoot adduction. Conclusion For treatment of congenital clubfoot at Grades Ⅰ-Ⅲ, the musclestrength balancing procedure can achieve an excellent correction result; for treatment of congenital clubfoot at Grade Ⅳ, the Mckay procedure should be performed. No matter whichprocedure, the abductor hallucis excision is recommended to prevent poor correction for the anterior foot adduction.
To compare the effectiveness of dressing by a combination of traditional Chinese medicine (TCM)-Western medicine (WM) after TCM bath and by the silver sulfadiazine cream (SD-Ag) in treating residual deep burn wound. Methods A total of 128 cases of residual deep burn wound between July 2003 and December 2009 were randomly divided into the TCM-WM treatment group (70 cases) and the WM control group (58 cases). In the treatment group, there were 45 males and 25 females with an average age of 38.6 years (range, 18-60 years), including 34 cases of flame burns, 28 cases of molten steel burns, and 8 cases of chemical burns with an average burn area of 57.6% total body surface area (TBSA) and an average residual wound of 7.4% TBSA. In the control group, there were 50 males and 8 females with an average of 37.9 years (range, 20-59 years), including 26 cases of flame burns, 12 cases of hot water burns, 16 cases of molten steel burns, and 4 cases of chemical burns with an average burn area of 56.5% TBSA and an average residual wound of 6.9%TBSA. There was no significant difference in general data between 2 groups (P gt; 0.05), so the cl inical data of 2 groups had comparabil ity. In the treatment group, the patients had a bath with TCM, and then the wounds were treated with dressing change of combined TCM-WM. In the control group, the wounds were treated with SD-Ag after cleaning the wounds with chlorhexidine solution. The pain, wound heal ing time, and the rate of scar formation were observed in 2 groups after treatment. Results According to wound pain classification after medication, the results were excellent in 23 cases, good in 30 cases, fair in 17 cases in the treatment group; were excellent in 17 cases, good in 20 cases, fair in 13 cases, poor in 5 cases, and fairly poor in 3 cases in the control group. The wound heal ing time of the treatment group (13.45 ± 4.74) days was significantly shorter than that of the control group [(23.87 ± 14.45) days, P lt; 0.05)]. After 2 weeks of treatment, scar occurred in 15 patients (21.4%) of the treatment group and 35 patients (60.3%) of the control group, showing significant difference (P lt; 0.05). Conclusion Based on TCM bath, a combination of TCM-WM for the residual burn wounds is obviously superior to SD-Ag. It has the advantages of rapid heal ing, l ight pain, no obvious scar, and short hospital ization time.
ObjectiveTo compare the effectiveness between the method of simple posterior debridement combined with bone grafting and fusion and internal fixation and the method of one-stage anterior radical debridement combined with bone grafting and fusion and posterior internal fixation in the treatment of thoracolumbar brucella spondylitis so as to provide the reference for the clinical treatment. MethodsA retrospective analysis was made on the clinical data of 148 cases of thoracolumbar brucella spondylitis between January 2002 and January 2012. Simple posterior debridement combined with bone grafting and fusion and internal fixation was used in 78 cases (group A), and one-stage anterior radical debridement combined with bone grafting and fusion and posterior internal fixation in 70 cases (group B). There was no significant difference in gender, age, disease duration, involved vertebral segments, erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) score, neural function grade of America Spinal Injury Association (ASIA), and kyphosis Cobb angle before operation between 2 groups (P > 0.05). The peri operation period indexes (hospitalization time, operation time, and intraoperative blood loss) and the clinical effectiveness indexes (VAS score, ASIA grade, Cobb angle, and ESR) were compared; the bone fusion and the internal fixation were observed. ResultsIncision infection and paravertebral and/or psoas abscess occurred in 2 and 3 cases of group A respectively. All incisions healed by first intention and 2 cases had pneumothorax in group B. The operation time and the hospitalization time of group A were significantly shorter than those of group B (P < 0.05), and the intraoperative blood lossof group A was significantly lower than that of group B (P < 0.05). All of the cases in 2 groups were followed up 14-38 months, 25 months on average. The VAS, ESR, and Cobb angle were significantly decreased at each time point after operation when compared with preoperative ones in 2 groups (P < 0.05), but no significant difference was found between 2 groups (P > 0.05). The neurological function was significantly improved at 3 months after operation; there were 1 case of ASIA grade C, 14 cases of grade D, and 63 cases of grade E in group A, and there were 1 case of grade C, 11 cases of grade D, and 58 cases of grade E in group B; and difference was not significant (Z=0.168, P=0.682). The grafting bone fusion was observed in both groups. The fusion time was (8.7±0.3) months in group A and (8.6±0.4) months in group B, showing no significant difference (t=0.591, P=0.601) was found. At last follow-up, no loosening or fracture of internal fixation was found. ConclusionBased on regular medicine therapy, the effectiveness of the two methods is satisfactory in the treatment of thoracolumbar brucella spondylitis as long as the operation indications should be controlled strictly.
ITC (Indirect Treatment Comparison) software and indirect procedure of Stata software are especially used for indirect comparison nowadays, both of which possess the characteristics of friendly concise interface and support for menu operation. ITC software needs the application of other software to yield effect estimation and its confidence interval of direct comparison firstly; while Stata-indirect procedure can complete direct comparison internally and also operate using commands, which simplifies complicated process of indirect comparison. However, both of them only perform "single-pathway" of data transferring and pooling, which is a common deficiency. From the results, their results are of high-degree similarity.