Introduction: Intra-articular distal radial fractures in young patients occur in high energy trauma which can lead to a combination of bone and ligaments lesions. An articular step superior to 2 mm is pejorative, for ...Introduction: Intra-articular distal radial fractures in young patients occur in high energy trauma which can lead to a combination of bone and ligaments lesions. An articular step superior to 2 mm is pejorative, for that an adequate radiologic analysis is necessary accessing to the best surgical treatment. The purpose of our study was to investigate this type of fracture and expose radiologic analysis (radiograph and CT-scan) of bone and ligamentous associated lesions of this specific twisted lunate facet fracture for recognizing it and accessing to the best surgical treatment. Patients and Methods: Seven patients with severely displaced type 4 articular fractures of the distal radius whose wrists had been exposed to violent compression are reported in our series, they are required open treatment for the reduction and fixation of disrupted articular surfaces by using an antero-medial approach which allows direct access to the fragment of the lunate facet and easier visualization of the distal radio-ulnar joint. Results: All the patients were clinically examined with antero-posterior and lateral X ray, completed by a CT scan, all the fractures were type IV according to Melone classification. In all of our seven cases there was a lesion of the distal radioulnar joint (DRUJ) identified in the CT scan. The CT scan allowed us to individualize well the void of the lunate fossa and calculate his exact degree of rotation, which is very important for planning therapeutic management. Discussion: In all of our cases the CT scan was to expose all of the osseous and ligamentous injuries;in the sagittal reconstruction we were able to objectify and calculate the exact degree of the rotation of the lunate fossa fragment;in the frontal reconstruction the void of the lunate fossa is visible and in the axial reconstruction we can determine the incongruence of the distal radio-ulnar joint (DRUJ). Intra-articular involvement has long been recognized as a poor prognostic factor in fractures of the distal radius. However, despite early studies reporting poor results with non operative treatment for these injuries, most authors opposed operative intervention, due to lack of a good radiological analysis and the CT scan;knowledge that a number of studies have shown that inadequate reduction of intra-articular distal radius fractures leads to the development of arthritis.展开更多
目的:探讨几丁糖联合小剂量糖皮质激素关节腔注射治疗早中期膝骨关节炎的临床疗效。方法:回顾性分析2021年6月—2022年12月在南京医科大学第一附属医院骨科门诊就诊并随访的膝骨关节炎患者共164例。按治疗方式分为3组:A组(对照组,口服给...目的:探讨几丁糖联合小剂量糖皮质激素关节腔注射治疗早中期膝骨关节炎的临床疗效。方法:回顾性分析2021年6月—2022年12月在南京医科大学第一附属医院骨科门诊就诊并随访的膝骨关节炎患者共164例。按治疗方式分为3组:A组(对照组,口服给药)55例,B组(几丁糖关节腔注射+口服给药)53例,C组(几丁糖联合小剂量糖皮质激素关节腔注射给药)56例。比较3组治疗前后的疼痛视觉模拟评分(visual analogue scale,VAS)、Lysholm评分、美国特种外科医院(Hospital for Special Surgery,HSS)评分和关节液炎性细胞因子白介素(interleukin,IL)-1、IL-6和肿瘤坏死因子(tumor necrosis factor,TNF)-α水平的变化,并对临床疗效进行评价。结果:所有病例均获得随访,随访时间7~12个月,无失访病例。每组治疗后的VAS评分、Lysholm评分、HSS评分和关节液炎性细胞因子IL-1、IL-6和TNF-α水平均优于治疗前,差异有统计学意义(P<0.05)。治疗前VAS评分、Lysholm评分、HSS评分和关节液炎性细胞因子IL-1、IL-6和TNF-α水平在3组间的差异无统计学意义(P>0.05);但治疗后各项指标在3组间的差异有统计学意义(P<0.05);两两比较显示,C组优于A、B两组,B组优于A组,差异均有统计学意义(P<0.05)。3组临床疗效评价比较,差异有统计学意义(P<0.05)。结论:几丁糖联合小剂量糖皮质激素关节腔注射治疗早中期膝骨关节炎临床疗效显著,具有创伤小,起效迅速,疗效持久的特点,同时避免了外用或口服非甾体类抗炎药的不良反应,作为一线治疗方案,建议在临床推广和使用。展开更多
文摘Introduction: Intra-articular distal radial fractures in young patients occur in high energy trauma which can lead to a combination of bone and ligaments lesions. An articular step superior to 2 mm is pejorative, for that an adequate radiologic analysis is necessary accessing to the best surgical treatment. The purpose of our study was to investigate this type of fracture and expose radiologic analysis (radiograph and CT-scan) of bone and ligamentous associated lesions of this specific twisted lunate facet fracture for recognizing it and accessing to the best surgical treatment. Patients and Methods: Seven patients with severely displaced type 4 articular fractures of the distal radius whose wrists had been exposed to violent compression are reported in our series, they are required open treatment for the reduction and fixation of disrupted articular surfaces by using an antero-medial approach which allows direct access to the fragment of the lunate facet and easier visualization of the distal radio-ulnar joint. Results: All the patients were clinically examined with antero-posterior and lateral X ray, completed by a CT scan, all the fractures were type IV according to Melone classification. In all of our seven cases there was a lesion of the distal radioulnar joint (DRUJ) identified in the CT scan. The CT scan allowed us to individualize well the void of the lunate fossa and calculate his exact degree of rotation, which is very important for planning therapeutic management. Discussion: In all of our cases the CT scan was to expose all of the osseous and ligamentous injuries;in the sagittal reconstruction we were able to objectify and calculate the exact degree of the rotation of the lunate fossa fragment;in the frontal reconstruction the void of the lunate fossa is visible and in the axial reconstruction we can determine the incongruence of the distal radio-ulnar joint (DRUJ). Intra-articular involvement has long been recognized as a poor prognostic factor in fractures of the distal radius. However, despite early studies reporting poor results with non operative treatment for these injuries, most authors opposed operative intervention, due to lack of a good radiological analysis and the CT scan;knowledge that a number of studies have shown that inadequate reduction of intra-articular distal radius fractures leads to the development of arthritis.
文摘目的:探讨几丁糖联合小剂量糖皮质激素关节腔注射治疗早中期膝骨关节炎的临床疗效。方法:回顾性分析2021年6月—2022年12月在南京医科大学第一附属医院骨科门诊就诊并随访的膝骨关节炎患者共164例。按治疗方式分为3组:A组(对照组,口服给药)55例,B组(几丁糖关节腔注射+口服给药)53例,C组(几丁糖联合小剂量糖皮质激素关节腔注射给药)56例。比较3组治疗前后的疼痛视觉模拟评分(visual analogue scale,VAS)、Lysholm评分、美国特种外科医院(Hospital for Special Surgery,HSS)评分和关节液炎性细胞因子白介素(interleukin,IL)-1、IL-6和肿瘤坏死因子(tumor necrosis factor,TNF)-α水平的变化,并对临床疗效进行评价。结果:所有病例均获得随访,随访时间7~12个月,无失访病例。每组治疗后的VAS评分、Lysholm评分、HSS评分和关节液炎性细胞因子IL-1、IL-6和TNF-α水平均优于治疗前,差异有统计学意义(P<0.05)。治疗前VAS评分、Lysholm评分、HSS评分和关节液炎性细胞因子IL-1、IL-6和TNF-α水平在3组间的差异无统计学意义(P>0.05);但治疗后各项指标在3组间的差异有统计学意义(P<0.05);两两比较显示,C组优于A、B两组,B组优于A组,差异均有统计学意义(P<0.05)。3组临床疗效评价比较,差异有统计学意义(P<0.05)。结论:几丁糖联合小剂量糖皮质激素关节腔注射治疗早中期膝骨关节炎临床疗效显著,具有创伤小,起效迅速,疗效持久的特点,同时避免了外用或口服非甾体类抗炎药的不良反应,作为一线治疗方案,建议在临床推广和使用。
