目的比较不同截骨撑开角度下植骨和未植骨开放楔形胫骨高位截骨术(opening wedge high tibial osteotomy,OWHTO)在膝关节功能和愈合方面的差别。方法回顾性分析2019年10月至2022年9月首都医科大学宣武医院行OWHTO治疗的41例膝骨关节炎患...目的比较不同截骨撑开角度下植骨和未植骨开放楔形胫骨高位截骨术(opening wedge high tibial osteotomy,OWHTO)在膝关节功能和愈合方面的差别。方法回顾性分析2019年10月至2022年9月首都医科大学宣武医院行OWHTO治疗的41例膝骨关节炎患者,其中男13例,女28例;年龄43~76岁,平均(58.88±7.60)岁。定义截骨撑开角度>10°为大间隙,截骨撑开角度≤10°为小间隙。将患者分为3组,A组截骨撑开角度>10°,进行自体植骨;B组截骨撑开角度>10°,不进行植骨;C组截骨撑开角度≤10°,不进行植骨。比较三组术后骨愈合及膝关节功能方面的差异。结果患者术后随访12~24个月,平均(13.76±3.35)个月。术后3个月,三组患者的骨愈合程度差异无统计学意义(P>0.05),说明不同撑开角度并未影响早期骨愈合。术后6个月、12个月,A组的骨间隙向最内侧填充进展较B组、C组明显,差异有统计学意义(P<0.05);B组、C组骨间隙最内侧填充进展差异无统计学意义(P>0.05)。术后3个月、6个月、12个月,三组患者的膝关节功能差异无统计学意义(P>0.05)。结论植骨对患者OWHTO术后膝关节功能改善方面无显著影响,但进行自体植骨对患者骨间隙最内侧的愈合有帮助。展开更多
BACKGROUND The preferred treatment for distal humeral intercondylar fractures is open reduction and internal fixation.While there is consensus about the posterior approach,several posterior approaches have been develo...BACKGROUND The preferred treatment for distal humeral intercondylar fractures is open reduction and internal fixation.While there is consensus about the posterior approach,several posterior approaches have been developed.It is debatable as to which approach is best.AIM To compare triceps reflecting anconeus pedicle(TRAP)and olecranon osteotomy approaches for internal fixation of distal humeral intercondylar fracture.METHODS In total,40 cases of Arbeitsgemeinschaft für Osteosynthesefragen/Association of the Study of Internal Fixation type C,closed,and Gustilo type I intercondylar humeral fractures were included.Patients ranged in age from 18 years to 70 years.The patients were randomized into two groups:TRAP group and olecranon osteotomy group,with 20 cases in each.All were followed up at 6 wk,3 months,6 months,and 12 months.Functional outcomes were measured in terms of flexion-extension arc,Disabilities of Arm,Shoulder and Hand score,and Mayo Elbow Performance Score.RESULTS The mean age was 43.2 years in the TRAP group and 37.5 years in the olecranon osteotomy group.The mean operative time and mean duration of hospital stay in the TRAP group were significantly higher than in the olecranon osteotomy group(119.5 vs 111.5 min and 9.85 vs 5.45 d,respectively).The mean arc of flexion-extension,Disabilities of Arm,Shoulder and Hand score,and Mayo Elbow Performance Score were comparable without any significant difference in the groups at the 12-month follow-up(107.0 vs 106.2,18.3 vs 15.7,and 84.2 vs 86.2,respectively).Ulnar paresthesia and superficial infections were comparable in both groups(2 cases vs 3 cases and 3 cases vs 2 cases,respectively).Hardware prominence was significantly higher in the olecranon osteotomy group,mostly due to tension band wiring.CONCLUSION Both approaches were equivalent,but there is a need for further study including higher numbers of subjects and longer study duration to prove the benefits of one approach over the other.展开更多
BACKGROUND Cheilectomy of the 1^(st)metatarsophalangeal joint(MTPJ)is one of the most common procedures for the management of hallux rigidus.However,there is no consensus regarding outcomes following minimally invasiv...BACKGROUND Cheilectomy of the 1^(st)metatarsophalangeal joint(MTPJ)is one of the most common procedures for the management of hallux rigidus.However,there is no consensus regarding outcomes following minimally invasive dorsal cheilectomy(MIDC)for the management of hallux rigidus.AIM To evaluate outcomes following MIDC for the management of hallux rigidus.METHODS During November 2023,the PubMed,EMBASE and Cochrane Library databases were systematically reviewed to identify clinical studies examining outcomes following MIDC for the management of hallux rigidus.RESULTS Six studies were included.In total,348 patients(370 feet)underwent MIDC for hallux rigidus at a weighted mean follow-up of 37.9±16.5 months.The distribution of patients by Coughlin and Shurna's classification was recorded in 4 studies as follows:Ⅰ(58 patients,27.1%),Ⅱ(112 patients,52.3%),Ⅲ(44 patients,20.6%).Three studies performed an additional 1^(st)MTPJ arthroscopy and debridement following MIDC.Retained intra-articular bone debris was observed in 100%of patients in 1 study.The weighted mean American orthopedic foot and ankle society score improved from a preoperative score of 68.9±3.2 to a postoperative score of 87.1.The complication rate was 8.4%,the most common of which was persistent joint pain and stiffness.Thirty-two failures(8.7%)were observed.Thirty-three secondary procedures(8.9%)were performed at a weighted mean time of 8.6±3.2 months following the index procedure.CONCLUSION This systematic review demonstrated improvements in subjective clinical outcomes together with a moderate complication rate following MIDC for the management of hallux rigidus at short-term follow-up.A moderate reoperation rate at short-term follow-up was recorded.The marked heterogeneity between included studies and paucity of high quality comparative studies limits the generation of any robust conclusions.展开更多
目的探讨胫骨高位截骨术中截骨创面留置引流管在术后加速康复中的作用。方法纳入2018年12月至2023年3月徐州医科大学第二附属医院行胫骨高位截骨术的33例患者,根据术中是否留置引流管分为两组。引流组11例,男7例,女4例;年龄48~63岁,平均...目的探讨胫骨高位截骨术中截骨创面留置引流管在术后加速康复中的作用。方法纳入2018年12月至2023年3月徐州医科大学第二附属医院行胫骨高位截骨术的33例患者,根据术中是否留置引流管分为两组。引流组11例,男7例,女4例;年龄48~63岁,平均(54.73±4.41)岁。未引流组22例,男10例,女12例;年龄48~65岁,平均(56.00±4.81)岁。对比两组患者创面甲级愈合率、屈膝达90°时间、去拐完全负重时间、住院天数和手术前后内侧胫骨近端角(medial proximal tibial angle,MPTA)、髋-膝-踝角(hip-knee-ankle,HKA)、下肢负重线(weight-bearing line,WBL)百分比、步长、步幅、步速、大腿周径、关节切线夹角(joint line convergence angle,JLCA)、美国特种外科医院(the hospital for special surgery,HSS)评分。结果患者术后随访6~16个月,平均(9.03±2.49)个月。引流组患者创面甲级愈合率明显高于未引流组(P<0.05),屈膝达90°时间、去拐完全负重时间、住院天数均显著少于未引流组(P<0.01)。术前及术后3个月两组间HKA、MPTA、WBL差异无统计学意义(P>0.05)。术后3个月,引流组的步长、步幅、步速较未引流组改善更明显(P<0.01)。术后1个月、3个月,引流组患者大腿周径、JLCA、HSS评分均明显优于对照组(P<0.01),至术后第6个月两组间差异逐渐变小。结论胫骨高位截骨术中留置引流管增加创面甲级愈合率,缩短了住院天数,促进术后早期功能恢复及关节重塑,减少肌肉丢失,加速术后早期康复进程。展开更多
文摘目的比较不同截骨撑开角度下植骨和未植骨开放楔形胫骨高位截骨术(opening wedge high tibial osteotomy,OWHTO)在膝关节功能和愈合方面的差别。方法回顾性分析2019年10月至2022年9月首都医科大学宣武医院行OWHTO治疗的41例膝骨关节炎患者,其中男13例,女28例;年龄43~76岁,平均(58.88±7.60)岁。定义截骨撑开角度>10°为大间隙,截骨撑开角度≤10°为小间隙。将患者分为3组,A组截骨撑开角度>10°,进行自体植骨;B组截骨撑开角度>10°,不进行植骨;C组截骨撑开角度≤10°,不进行植骨。比较三组术后骨愈合及膝关节功能方面的差异。结果患者术后随访12~24个月,平均(13.76±3.35)个月。术后3个月,三组患者的骨愈合程度差异无统计学意义(P>0.05),说明不同撑开角度并未影响早期骨愈合。术后6个月、12个月,A组的骨间隙向最内侧填充进展较B组、C组明显,差异有统计学意义(P<0.05);B组、C组骨间隙最内侧填充进展差异无统计学意义(P>0.05)。术后3个月、6个月、12个月,三组患者的膝关节功能差异无统计学意义(P>0.05)。结论植骨对患者OWHTO术后膝关节功能改善方面无显著影响,但进行自体植骨对患者骨间隙最内侧的愈合有帮助。
文摘BACKGROUND The preferred treatment for distal humeral intercondylar fractures is open reduction and internal fixation.While there is consensus about the posterior approach,several posterior approaches have been developed.It is debatable as to which approach is best.AIM To compare triceps reflecting anconeus pedicle(TRAP)and olecranon osteotomy approaches for internal fixation of distal humeral intercondylar fracture.METHODS In total,40 cases of Arbeitsgemeinschaft für Osteosynthesefragen/Association of the Study of Internal Fixation type C,closed,and Gustilo type I intercondylar humeral fractures were included.Patients ranged in age from 18 years to 70 years.The patients were randomized into two groups:TRAP group and olecranon osteotomy group,with 20 cases in each.All were followed up at 6 wk,3 months,6 months,and 12 months.Functional outcomes were measured in terms of flexion-extension arc,Disabilities of Arm,Shoulder and Hand score,and Mayo Elbow Performance Score.RESULTS The mean age was 43.2 years in the TRAP group and 37.5 years in the olecranon osteotomy group.The mean operative time and mean duration of hospital stay in the TRAP group were significantly higher than in the olecranon osteotomy group(119.5 vs 111.5 min and 9.85 vs 5.45 d,respectively).The mean arc of flexion-extension,Disabilities of Arm,Shoulder and Hand score,and Mayo Elbow Performance Score were comparable without any significant difference in the groups at the 12-month follow-up(107.0 vs 106.2,18.3 vs 15.7,and 84.2 vs 86.2,respectively).Ulnar paresthesia and superficial infections were comparable in both groups(2 cases vs 3 cases and 3 cases vs 2 cases,respectively).Hardware prominence was significantly higher in the olecranon osteotomy group,mostly due to tension band wiring.CONCLUSION Both approaches were equivalent,but there is a need for further study including higher numbers of subjects and longer study duration to prove the benefits of one approach over the other.
文摘BACKGROUND Cheilectomy of the 1^(st)metatarsophalangeal joint(MTPJ)is one of the most common procedures for the management of hallux rigidus.However,there is no consensus regarding outcomes following minimally invasive dorsal cheilectomy(MIDC)for the management of hallux rigidus.AIM To evaluate outcomes following MIDC for the management of hallux rigidus.METHODS During November 2023,the PubMed,EMBASE and Cochrane Library databases were systematically reviewed to identify clinical studies examining outcomes following MIDC for the management of hallux rigidus.RESULTS Six studies were included.In total,348 patients(370 feet)underwent MIDC for hallux rigidus at a weighted mean follow-up of 37.9±16.5 months.The distribution of patients by Coughlin and Shurna's classification was recorded in 4 studies as follows:Ⅰ(58 patients,27.1%),Ⅱ(112 patients,52.3%),Ⅲ(44 patients,20.6%).Three studies performed an additional 1^(st)MTPJ arthroscopy and debridement following MIDC.Retained intra-articular bone debris was observed in 100%of patients in 1 study.The weighted mean American orthopedic foot and ankle society score improved from a preoperative score of 68.9±3.2 to a postoperative score of 87.1.The complication rate was 8.4%,the most common of which was persistent joint pain and stiffness.Thirty-two failures(8.7%)were observed.Thirty-three secondary procedures(8.9%)were performed at a weighted mean time of 8.6±3.2 months following the index procedure.CONCLUSION This systematic review demonstrated improvements in subjective clinical outcomes together with a moderate complication rate following MIDC for the management of hallux rigidus at short-term follow-up.A moderate reoperation rate at short-term follow-up was recorded.The marked heterogeneity between included studies and paucity of high quality comparative studies limits the generation of any robust conclusions.
文摘目的探讨胫骨高位截骨术中截骨创面留置引流管在术后加速康复中的作用。方法纳入2018年12月至2023年3月徐州医科大学第二附属医院行胫骨高位截骨术的33例患者,根据术中是否留置引流管分为两组。引流组11例,男7例,女4例;年龄48~63岁,平均(54.73±4.41)岁。未引流组22例,男10例,女12例;年龄48~65岁,平均(56.00±4.81)岁。对比两组患者创面甲级愈合率、屈膝达90°时间、去拐完全负重时间、住院天数和手术前后内侧胫骨近端角(medial proximal tibial angle,MPTA)、髋-膝-踝角(hip-knee-ankle,HKA)、下肢负重线(weight-bearing line,WBL)百分比、步长、步幅、步速、大腿周径、关节切线夹角(joint line convergence angle,JLCA)、美国特种外科医院(the hospital for special surgery,HSS)评分。结果患者术后随访6~16个月,平均(9.03±2.49)个月。引流组患者创面甲级愈合率明显高于未引流组(P<0.05),屈膝达90°时间、去拐完全负重时间、住院天数均显著少于未引流组(P<0.01)。术前及术后3个月两组间HKA、MPTA、WBL差异无统计学意义(P>0.05)。术后3个月,引流组的步长、步幅、步速较未引流组改善更明显(P<0.01)。术后1个月、3个月,引流组患者大腿周径、JLCA、HSS评分均明显优于对照组(P<0.01),至术后第6个月两组间差异逐渐变小。结论胫骨高位截骨术中留置引流管增加创面甲级愈合率,缩短了住院天数,促进术后早期功能恢复及关节重塑,减少肌肉丢失,加速术后早期康复进程。
