A modified three-incision approach to treating three-column Lisfranc injuries

Purpose:The most popular surgical approach to manage Lisfranc fracture-dislocations is the double-incision approach,which frequently causes a variety of complications,such as skin necrosis,rotational malreduction of the first tarsometatarsal joint(TMTJ)and lateral column dorsoplantar malreduction of the TMTJ.We introduce a three-incision approach to treat Lisfranc fracture-dislocations with only minor postoperative complications and good foot function.Methods:We prospectively selected 30 previously healthy patients,ranging from 18 to 60 years of age,but only 23 patients completed the follow-up and thus were finally included,with an average age of 38.1±12.9 years.All patients have sustained Lisfranc fracture-dislocations involving all three-column;13.0%(3/23)were Myerson classification type A(medial),47.8%(11/23)were type A(lateral),and 39.1%(9/23)were type C2.All patients were treated via a three-incision approach:a long incision made along the lateral border of the second ray was used as a working incision to visualize and reduce the first three TMTJs,as well as to apply internal fixation instrumentation;a 2 cm medial incision was made at the medial side of the first TMTJ as an inspecting incision,ensuring good reduction of the first TMTJ in medial and plantar view;another 1 cm inspecting incision was made at the dorsal side of the fourth/fifth TMTJ to prevent sagittal subluxation of the lateral column.Mean±SD was used for quantitative data such as operation time,follow-up time and foot function scores.Postoperative complications were documented,and foot function was evaluated using the American orthopaedic foot&ankle society score,foot function index and Maryland foot score at follow-up.The foot function of the injured foot and contralateral foot of the same patient was at the end of follow-up,and independent samplet-test was used for statistical analysis.Results:The median operation time was 117.9±14.6 min(range 93-142 min).All complications occurred within three months after the operation,and included delayed wound healing(17.4%),superficial infection(8.7%),complex regional pain syndrome(4.3%)and neuroma(4.3%).There was no case of postoperative skin necrosis or malreduction.At the end of follow-up of 14.1±1.2 months(range 12-16 months),the median American orthopaedic foot&ankle society score of the operated foot was 89.7±5.7,the median foot function index was 21.7±9.9,and the median Maryland foot score was 88.7±4.8.There were no significant differences between the operated and contralateral sides,in terms of foot function,at the end of followup(p>0.05).Conclusion:The three-incision approach can provide adequate visualization of all TMTJs to ensure anatomical reduction and offer sufficient working space to apply internal fixation instrumentation,which is effective in treating three-column Lisfranc fracture-dislocations with minor soft tissue complications and satisfactory functional recovery.

Multi-soliton solutions for the coupled modified nonlinear Schrdinger equations via Riemann–Hilbert approach

The coupled modified nonlinear Schrodinger equations are under investigation in this work. Starting from analyzing the spectral problem of the Lax pair, a Riemann-Hilbert problem for the coupled modified nonlinear Schrodinger equations is formulated. And then, through solving the obtained Riemann-Hilbert problem under the conditions of irregularity and reflectionless case, N-soliton solutions for the equations are presented. Furthermore, the localized structures and dynamic behaviors of the one-soliton solution are shown graphically.

A Hybrid Unit Commitment Approach Incorporating Modified Priority List with Charged System Search Methods

This paper presents a new hybrid approach that combines Modified Priority List (MPL) with Charged System Search (CSS), termed MPL-CSS, to solve one of the most crucial power system’s operational optimization problems, known as unit commitment (UC) scheduling. The UC scheduling problem is a mixed-integer nonlinear problem, highly-dimensional and extremely constrained. Existing meta-heuristic UC solution methods have the problems of stopping at a local optimum and slow convergence when applied to large-scale, heavily-constrained UC applications. In the first step of the proposed method, initial hourly optimum solutions of UC are obtained by Modified Priority List (MPL);however, the obtained UC solution may still be possible to be further improved. Therefore, in the second step, the CSS is utilized to achieve higher quality solutions. The UC is formulated as mixed integer linear programming to ensure the tractability of the results. The proposed method is successfully applied to a popular test system up to 100 units generators for both 24-hr and 168-hr system. Computational results show that both solution cost and execution time are superior to those of published methods.

Pseudospin symmetric solutions of the Dirac equation with the modified Rosen-Morse potential using Nikiforov-Uvarov method and supersymmetric quantum mechanics approach

Employing the Pekeris-type approximation to deal with the pseudo-centrifugal term,we analytically study the pseudospin symmetry of a Dirac nucleon subjected to equal scalar and vector modified Rosen-Morse potential including the spin-orbit coupling term by using the Nikiforov-Uvarov method and supersymmetric quantum mechanics approach.The complex eigenvalue equation and the total normalized wave functions expressed in terms of Jacobi polynomial with arbitrary spin-orbit coupling quantum number k are presented under the condition of pseudospin symmetry.The eigenvalue equations for both methods reproduce the same result to affirm the mathematical accuracy of analytical calculations.The numerical solutions obtained for different adjustable parameters produce degeneracies for some quantum number.

Modified Concrete Using Polyethylene Terephthalate Plastic Waste as a Partial Replacement for Coarse Aggregate

The present work evaluated the properties of modified concrete using polyethylene terephthalate (PET) bottle waste as a partial replacement for coarse aggregate. Modified concrete samples were designed using a water/cement (W/C) ratio of 0.50 and varying percentages of PET replacement (3%, 7%, 10%, and 15% by volume). Dreux Gorisse’s formulation approach was used to make the final products, and the mechanical properties of the samples were determined using Controlab presses. This modified concrete with PET chips has shown that with a 10% replacement of PET chips, the fresh density decreases by 3.56%, and the hardened state density decreases by 2.01%. The water absorption and thermal conductivity of the formulated concretes decreased. However, the results showed that the slump of these fresh concretes increased as the percentage of plastic aggregate replacement increased. Based on the results, incorporating PET aggregates into concrete contributes to good workability, and lightweight concrete structures, and provides some thermal comfort in concrete structures.

Functional and clinical outcome with modified lateral approach total hip arthroplasty in stiff hips with ankylosing spondylitis

BACKGROUND Ankylosing spondylitis at total hip arthroplasty(THA)has significant hip stiffness with flexion deformity,restricted mobility,and function.Range of movement(ROM)improvement with good functional outcome is seen following THA in these hips.The modified Hardinge approach without abductor compromise is helpful in these stiff hips with associated flexion deformity.AIM To assess improvement in ROM and functional outcomes with a modified lateral approach THA in ankylosing spondylitis with stiff hips.METHODS A total of 69 hips that underwent THA with a modified Hardinge approach in 40 patients were evaluated at a mean follow-up of 38.33 mo.All individuals ambulated with weight-bearing as tolerated and ROM exercises from the 1st postoperative day.Modified Harris hip score and ROM were assessed during follow-up.Quality of life assessments using the 36-item and 12-item short form health surveys were done along with clinical and functional outcomes at followup.SPSS 22.0 was used for statistical analysis.The correlation of ROM and functional score change was performed using Pearson’s correlation coefficient.RESULTS Sixty-nine hips with a significant decrease in ROM preoperatively with 32 clinically fused hips showed significant improvement in flexion range.The mean flexion in 69 hips improved from 29.35±31.38 degrees to 102.17±10.48 degrees.The mean difference of 72.82 with a P value<0.0001 was significant.In total,45 out of 69 hips had flexion deformity,with 13 hips having a deformity above 30 degrees.The flexion during the follow-up was below 90 degrees in 3 hips.Eleven hips had flexion of 90 degrees at follow-up,while the remaining 55 hips had flexion above 100 degrees.Modified Harris hip score improved from 17.03±6.02 to 90.66±7.23(P value<0.0001).The 36-item short form health survey at the follow-up indicated health status in 40 patients as excellent in 11,very good in 20,good in 5,fair in 3,and poor in 1.The mean mental health score was 84.10±11.58.Pain relief was good in all 69 hips.Altogether,28/40 patients(70%)had no pain,9 patients(22%)had occasional pain,and 3 patients(8%)had mild to moderate pain with unusual activity.Heterotopic ossification was seen in 21 hips with Brooker class 1 in 14 hips.CONCLUSION Modified Hardinge approach THA in ankylosing spondylitis with stiff hips with flexion deformity significantly improved ROM,Harris hip score,and quality of life indicated by the 36-item and 12-item short form health surveys.

THE APPLICATIONS OF A MODIFIED NORMAL FORM APPROACH

The modified normal form approach presented by ZHANG Wei-yi, K Huseyin and CHEN Yu-shu is further extended and a different procedure is introduced which lends itself readily to symbolic calculations, like MAPLE. This provides a number of significant advantages over the previous approach, and facilitates the associated calculations. To illustrate the new approach, three examples are presented.

Computer-Based Modelling of Network Functions for Linear Dynamic Circuits Using Modified Nodal Approach

In this paper,a computer-based systematic and efficient formulation method is presented for obtaining the network functions of linear or linearized time-invariant dynamic circuits.The method employs the modified nodal approach to obtain the system equations.The technique is based on developing a matrix formulation for modelling network functions.By using both symbolic manipulation of algebraic expressions and numeric processes,the network functions are expressed with a matrix-based method.Application examples are given to illustrate the features of the method.

Modified pararectus approach for treatment of atypical acetabular anterior wall fracture:A case report

BACKGROUND Acetabular anterior wall fracture with preservation of the pelvic brim is extremely rare.It is different from anterior wall fracture classified by Judet and Letournel.Few studies have reported cases treated by open reduction and internal fixation via the Smith-Petersen or iliofemoral approach.CASE SUMMARY We report a 48-year-old Chinese woman who had difficulty moving her right hip from abduction and external rotation after falling from 3 m.Pelvic radiograph and three-dimensional reconstruction of computed tomography revealed acetabular anterior wall fractures combined with fractures of the anterior inferior iliac spine and the iliac wing but not involving the pelvic brim.First,the patient underwent interim management by closed reduction of the hip dislocation and skin traction for 6 d.Then,we used a modified pararectus approach for treatment to fix the acetabular fractures with a reconstruction plate and nonlocking T-shape plate.At the 9-mo follow-up,the patient could walk painlessly without necrosis of the femoral head or heterotopic ossification,and the X-rays and computed tomography scan reconstructions showed good bone union.CONCLUSION The modified pararectus approach described here can facilitate exposure,reduction,and osteosynthesis for atypical acetabular fracture with less invasiveness.

Modified surgical techniques in total en bloc spondylectomy for thoracic and lumbar tumors with a single posterior approach

Objective To investigate the operation key points,instrument improvement and shortterm effects in total en bloc spondylectomy (TES) via a single posterior approach for thoracic and lumbar tumors.Methods A series of modified

Folded localized excitations in the (2+1)-dimensional modified dispersive water-wave system

By using a mapping approach and a linear variable separation approach, a new family of solitary wave solutions with arbitrary functions for the （2＋1）-dimensional modified dispersive water-wave system （MDWW） is derived. Based on the derived solutions and using some multi-valued functions, we obtain some novel folded localized excitations of the system.

Symmetry and Exact Solutions of (2+1)-Dimensional Generalized Sasa-Satsuma Equation via a Modified Direct Method

In this paper, first, we employ classic Lie symmetry groups approach to obtain the Lie symmetry groupsof the well-known (2+1)-dimensional Generalized Sasa-Satsuma (GSS) equation. Second, based on a modified directmethod proposed by Lou [J. Phys. A: Math. Gen. 38 (2005) L129], more general symmetry groups are obtained andthe relationship between the new solution and known solution is set up. At the same time, the Lie symmetry groupsobtained are only special cases of the more general symmetry groups. At last, some exact solutions of GSS equationsare constructed by the relationship obtained in the paper between the new solution and known solution.

改良Peyton四步教学法联合DOPS在西藏临床技能培训中的应用

目的探讨基于改良Peyton四步教学法的模拟教学联合操作技能直接观察(direct observation of procedural skills,DOPS)评估方法在西藏临床技能培训中的应用效果。方法选取西藏边坝县人民医院2021年5月—2022年5月参加临床技能培训的51名医护人员为研究对象,随机分为试验组与对照组。试验组采用结合改良Peyton四步教学法进行成人男性导尿术教学,并在培训开始前、培训中期及培训结束后,由带教教师采用DOPS评估方法对学员进行测评。对照组采用传统临床技能培训方法进行教学。在培训结束后发放满意度调查问卷,以了解学员对该教学模式的满意度。结果试验组技能考核平均成绩(90.12±5.50)分,对照组技能考核平均成绩(79.36±6.95)分,两组间成绩比较,其差异具有统计学意义(P<0.001);DOPS评估量表显示,试验组学员在培训结束后临床操作各项能力均较前有显著提高,其差异均具有统计学意义(P<0.05);课后满意度调查结果显示,在赞同“增强相关基础知识”等6个方面,试验组与对照组比较,其差异均具有统计学意义(P<0.001)。结论基于改良Peyton四步教学法的模拟教学联合DOPS评估方法的教学模式可提高西藏藏区医护人员的临床技能操作水平,适合在藏区医护人员临床技能培训中推广。

比较OCM入路与改良Hardinge入路在半髋关节置换术中治疗高龄股骨颈骨折的临床效果

目的比较OCM入路与改良Hardinge入路在双极头半髋关节置换术中对高龄股骨颈骨折患者早期临床效果的差异。方法回顾性分析2021年3月至2022年12月期间江苏省丹阳市人民医院收治的105例高龄股骨颈骨折患者进行双极头半髋关节置换术的疗效。根据手术入路的不同,将患者分为OCM组(45例)和改良Hardinge组(60例)。评价指标包括手术一般情况(手术时间、切口长度、术后住院时间、下地时间),围手术期出血情况(术前血红蛋白,术中出血量,术后1、3 d的血红蛋白下降量及隐性失血量),血清学指标(肌酸激酶和C反应蛋白),VAS疼痛评分,Harris髋关节功能评分及并发症等关键指标。结果两组患者随访6~20个月,平均(11.02±2.72)个月。两组患者在手术时间、输血率上,差异无统计学意义(P>0.05)。OCM组的切口长度、术后住院时间、下地时间、术中出血量、术后血红蛋白下降量、隐性失血量、术后3 d的血清学指标和VAS评分,以及术后3个月内的Harris评分均显著优于改良Hardinge组(P<0.05)。但术后6周的VAS评分及6个月的Harris评分比较,差异无统计学意义(P>0.05)。两组均未出现深静脉血栓形成、切口感染、脱位及神经损伤等严重并发症,两组的假体周围骨折、肌间静脉血栓、Trendelenburg步态、双下肢不等长的发生率比较,差异无统计学意义(P>0.05)。结论对于高龄股骨颈骨折患者,采用OCM入路双极头半髋关节置换术较改良Hardinge入路在减少手术创伤和加速术后恢复方面表现显著,有更优的早期临床效果,值得临床推荐。

改良踝关节后外侧入路联合内侧入路切开复位内固定治疗三踝骨折的临床效果

目的:探讨改良踝关节后外侧入路联合内侧入路切开复位内固定治疗三踝骨折的临床效果。方法:选取2020年2月—2021年12月麻城市人民医院收治的三踝骨折患者72例作为研究对象,采用双盲法分为对照组和试验组,各36例。两组患者均行切开复位内固定术治疗,对照组采用常规踝关节后外侧入路联合内侧入路,试验组采用改良踝关节后外侧入路联合内侧入路。比较两组治疗效果。结果:试验组并发症总发生率低于对照组,差异有统计学意义(P=0.006)。治疗前,两组踝关节背伸、跖屈、外翻、内翻活动度比较,差异无统计学意义(P>0.05);治疗后6个月,两组踝关节背伸、跖屈、外翻、内翻活动度均大于治疗前,且试验组大于对照组,差异有统计学意义(P<0.05)。治疗前,两组美国矫形足踝学会(AOFAS)踝-后足指数评分量表评分比较,差异无统计学意义(P>0.05);治疗后6个月,两组AOFAS踝-后足指数评分量表评分高于治疗前,且试验组高于对照组,差异有统计学意义(P<0.001)。结论:改良踝关节后外侧入路联合内侧入路切开复位内固定治疗三踝骨折的临床效果显著,能改善踝关节活动度与功能,减少并发症。

改良Wiltse入路椎弓根钉内固定术治疗无神经损伤胸腰椎骨折患者的效果

目的探讨改良Wiltse入路椎弓根钉内固定术促进无神经损伤胸腰椎骨折患者康复的临床效果。方法回顾性纳入濮阳市人民医院于2021年1月至2023年1月收治的80例无神经损伤胸腰椎骨折患者资料,患者均接受椎弓根钉内固定术治疗,将接受经皮椎弓入路治疗的患者资料纳入对照组(38例),将接受改良Wiltse入路治疗的患者资料纳入观察组(42例)。比较两组手术指标、不同时间脊柱矢状面Cobb角、伤椎前缘相对高度、视觉模拟评分法(VAS)评分及Oswestry功能障碍指数(ODI)。结果观察组手术时间、术中出血量、术后住院时间均低于对照组(P<0.05)。两组术后1、3个月时Cobb角较术前降低,伤椎前缘相对高度较术前升高,Cobb角与伤椎前缘相对高度水平时间效应有统计学意义(P<0.05);两组的组间、交互效应无统计学意义(P>0.05)。两组VAS评分组间、时间、交互效应有统计学意义(P<0.05);观察组术后1个月VAS评分低于对照组,且术后1、3个月时VAS评分较术前降低(P<0.05)。ODI指数时间效应有统计学意义(P<0.05);术后1、3个月时ODI指数较术前降低(P<0.05)。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论改良Wiltse入路与经皮椎弓根钉内固定术治疗无神经损伤胸腰椎骨折患者效果相当,两种入路方式均有较高的安全性,但相较于经皮入路,改良Wiltse入路的手术时间更短,术中出血量更少,患者恢复更快,可缓解患者术后短期疼痛程度,促进患者康复。

改良双入路法内窥镜下跖筋膜松解术联合跟骨局部减压治疗跖筋膜炎的效果

目的探究改良双入路法内窥镜下跖筋膜松解术联合跟骨局部减压治疗对跖筋膜炎患者临床疗效、足底压痛及足踝功能的影响。方法选取2020年7月至2023年7月赣州市人民医院收治的81例跖筋膜炎患者作为研究对象,按照随机数字表法分为对照组(40例)和研究组(41例)。对照组实施改良双入路法内窥镜下跖筋膜松解术治疗,研究组实施改良双入路法内窥镜下跖筋膜松解术联合跟骨局部减压治疗。比较两组的临床总有效率;分别于术前及术后3个月比较两组患者的足底压痛[视觉模拟评分法(VAS)评分]、足踝功能[美国足踝外科协会踝-后足评分(AOFAS-AH)]、踝关节功能[足踝表现评分量表(FAOS)]。结果研究组的临床总有效率高于对照组,差异有统计学意义(P<0.05);术后3个月,两组的VAS评分均低于本组术前,且研究组低于对照组,差异有统计学意义(P<0.05);术后3个月,两组的AOFAS-AH评分高于本组术前,且研究组高于对照组,差异有统计学意义(P<0.05);术后3个月,两组的FAOS评分高于本组术前,且研究组高于对照组,差异有统计学意义(P<0.05)。结论改良双入路法内窥镜下跖筋膜松解术中采取跟骨局部减压治疗不仅明显缓解跖筋膜炎患者足底压痛、肿胀及活动受限等临床症状,还有效提升跖筋膜炎患者的足踝功能及临床疗效。

侧卧位改良直接外侧入路与改良后外侧入路髋关节置换术治疗高龄股骨颈骨折的疗效分析

目的分析侧卧位改良直接外侧入路与改良后外侧入路髋关节置换术治疗高龄股骨颈骨折的疗效。方法选取2019年2月—2023年1月三亚中心医院收治的102例高龄股骨颈骨折患者,以随机数字表法分为研究组、对照组,各51例。对照组接受侧卧位改良后外侧入路,研究组接受侧卧位改良直接外侧入路。比较两组手术相关指标、疼痛程度、血清学指标、髋关节功能、平衡功能及并发症。结果研究组切口长度低于对照组(P<0.05),术后下地时间、术后住院时间短于对照组(P<0.05)。两组患者手术时间、术中出血量比较,差异均无统计学意义(P>0.05)。两组患者术前、术后12 h、术后24 h、术后48 h的视觉模拟评分(VAS)比较,结果:①不同时间点的VAS评分比较,差异有统计学意义(P<0.05);②两组患者VAS评分比较,差异有统计学意义(P<0.05),研究组术后VAS评分低于对照组;③两组患者VAS评分变化趋势比较,差异有统计学意义(P<0.05)。两组患者术前、术后12 h、术后24 h、术后48 h的降钙素原(PCT)、C反应蛋白(CRP)、红细胞沉降率(ESR)比较,结果:①不同时间点的PCT、CRP、ESR比较,差异均有统计学意义(P<0.05);②两组患者PCT、CRP、ESR评分比较,差异均有统计学意义(P<0.05),研究组术后PCT、CRP、ESR评分低于对照组;③两组患者PCT、CRP、ESR变化趋势比较,差异均有统计学意义(P<0.05)。两组患者出院当日、术后1个月、术后6个月UCLA髋关节系统评分、Harris髋关节功能评分比较,结果:①不同时间点UCLA评分、Harris评分比较,差异均有统计学意义(P<0.05);②两组患者UCLA评分、Harris评分比较,差异均有统计学意义(P<0.05),研究组出院当日、术后1个月UCLA评分、Harris评分比对照组高;③两组患者UCLA评分、Harris评分变化趋势比较,差异均有统计学意义(P<0.05)。两组患者出院当日、术后1个月、术后6个月的平衡功能评分(BBS)比较,结果:①不同时间点的BBS评分比较,差异有统计学意义(P<0.05);②两组患者BBS评分比较,差异有统计学意义(P<0.05),研究组出院当日、术后1个月BBS评分比对照组高(P<0.05);③两组患者BBS评分变化趋势比较,差异有统计学意义(P<0.05)。研究组并发症总发生率低于对照组(P<0.05)。结论相比于侧卧位改良后外侧入路,侧卧位改良直接外侧入路髋关节置换术治疗高龄股骨颈骨折效果更佳,可改善患者平衡功能与髋关节功能,促进术后康复,减轻软组织损伤与疼痛,降低并发症发生风险。

Clinical Application of Exclusive Right-Thoracic Approach in Surgery with or without Laparotomy for Mid-Upper Esophageal Cancer

OBJECTIVE To evaluate the clinical application of a right-thoracic approach with or without laparotomy for mid-upper esophageal cancer. METHODS We retrospectively reviewed the data of 34 esophageal cancer patients who received Belsey surgery or a modified Ivor-Lewis surgery from November 1992 to April 2007. Twenty of the patients underwent a Belsey prodecdure （Group A） from November 1992 to January 2001 and 14 underwent a modified Ivor-Lewis prodecdure （Group B） from May 2001 to April 2007. RESULTS Twenty patients with esophageal cancer received an esophagectomy through an exclusive right-thoracic approach （Belsey surgery）, and 14 patients received an esophagectomy through a right-thoracic approach combined with a laparotomy （modified IvorLewis surgery）. The complication rate was 15% （3/20） and 7.1% （1/14） respectively. The survival rate was 42.9% （5-year survival） and 38.7% （5-year survival） respectively for these two groups. CONCLUSION An exclusive right-thoracic approach （Belsey surgery） is associated with more complications. It is not a routine surgery for cancer of the mid-upper thorax of the esophagus, but can be selectively used as palliative esophagectomy for esophageal cancer patients with poor pulmonary function. Modified Ivor-Lewis surgery can simultaneously be utilized to resect the primary tumor and dissect lymph nodes of the thorax and abdomen. With a shorter time period of surgery and postoperative recovery period, modified Ivor-Lewis surgery can achieve better effects with patients who have midupper esophagus cancer.