Background： In treatment of ankle fracture, intraoperative stress tests are used to assess the syndesmotic injury and instability. However, the optimized timing of the strees test should be applied whether in pre- or...Background： In treatment of ankle fracture, intraoperative stress tests are used to assess the syndesmotic injury and instability. However, the optimized timing of the strees test should be applied whether in pre- or post-bony fixation during operation is seldom be reported in previous studies. The different strategies on stress test timing would exhibit opposite results within a type ofpronation-external rotation （PER） fractures with supracollicular medial malleolar （SMM） fractures. This study was designed to assess the 3-year ffmctional outcomes of the special PER fractures with or without a syndesmotic transfixation based on the results of two different intraoperative stress test strategies. Methods： This retrospective cohort study included 61 PER injury-Weber C ankle fractures combined with SMM fractures who were treated in Beijing Jishuitan Hospital between 2013 and 2014 and followed up for 3 years. Stress test was performed twice intraoperatively. A positive intraoperative stress test before bony fixation and a negative intraoperative stress test after bony fixation were found in these included patients. Twenty-nine patients （Group 1 ） were treated without a supplemental syndesmotie screw fixation, according to the negative intraoperative stress test alter bony fixation, while 32 patients （Group 2） were treated with an additional syndesmotic screw fixation based on the positive intraoperative stress test before bony fixation. The American Orthopaedic Foot and Ankle Society （AOFAS）Ankle-Hindfoot Scale and Visual Analog Scale （VAS） for pain scores were the main measurements of outcome. The statistical index of demographic data, fracture morphologic data, time interval of follow-up, AOFAS and VAS were recorded and assessed by SPSS 21.0 software through Fisher exact tests and oneway analysis of variance. The associations between the main outcomes and influential factors were evaluated by linear regression models. Results： We observed no difference in the distribution of age, sex, presence of associated posterior malleolus （PM）, fracture dislocation, and fixation of associated PM between two treatment groups. With the numbers available, no statistically significant association could be detected with regard to the AOFAS （Group 1 vs. Group 2, 96.72 ± 6.20 vs. 94.63 ± 8.26, F = 1.24, P = 0.27） and VAS （Group I vs. Group 2, 1.47 ± 2.14 vs. 0.72 ± 1.49, F = 2.44, P - 0.12） in association with two strategies. Conclusions： The present study indicates no difference to the use of the syndesmotic screw in terms of the ffinctional outcome between syndesmosis transfixation and no-fixation patients among PER-Weber C ankle fi＇acture patients with SMM fracture after 3-year ibllow-up. More attention should be paid to pre- and post-bony-fixation intraoperative stress tests and the morphology of medial malleoli fractures in ankle fractures.展开更多
目的:探讨腕踝针在肩袖损伤术后康复治疗中的应用价值。方法:纳入肩袖损伤肩关节镜下肩袖修复术后患者80例,随机分为腕踝针联合康复训练组和康复训练组,每组40例。术后第1天开始,腕踝针联合康复训练组患者进行腕踝针治疗和康复训练;康...目的:探讨腕踝针在肩袖损伤术后康复治疗中的应用价值。方法:纳入肩袖损伤肩关节镜下肩袖修复术后患者80例,随机分为腕踝针联合康复训练组和康复训练组,每组40例。术后第1天开始,腕踝针联合康复训练组患者进行腕踝针治疗和康复训练;康复训练组患者单纯进行康复训练。腕踝针治疗取患侧上4穴和上5穴,留针30 min,隔日治疗1次,治疗6周后改为每3 d治疗1次;康复训练分制动康复训练期和保护康复训练期2个阶段进行;共治疗12周。分别于治疗前及治疗12周后,采用视觉模拟量表(visual analogue scale,VAS)对2组患者肩关节疼痛情况进行评分;采用Constant-Murley肩关节评分和美国加州大学洛杉矶分校(the University of California-Los Angeles,UCLA)肩关节评分对2组患者肩关节功能进行评价。结果:2组患者均顺利完成12周的康复治疗。治疗前,2组患者肩关节疼痛VAS评分及肩关节Constant-Murley评分、UCLA评分比较,组间差异均无统计学意义(t=-0.234,P=0.816;t=-0.950,P=0.345;t=-0.627,P=0.533)。治疗12周后,2组患者肩关节疼痛VAS评分较治疗前降低,肩关节Constant-Murley评分和UCLA评分均较治疗前提高[腕踝针联合康复训练组:(7.55±0.81)分,(0.88±0.79)分,t=1.207,P=0.000;(41.80±6.70)分,(90.95±4.64)分,t=8.737,P=0.000;(10.30±3.94)分,(31.53±2.82)分,t=4.288,P=0.000。康复训练组:(7.60±1.10)分,(2.40±0.81)分,t=1.305,P=0.000;(43.23±6.72)分,(88.90±3.54)分,t=7.976,P=0.000;(10.80±3.15)分,(30.20±2.39)分,t=4.290,P=0.000];且腕踝针联合康复训练组肩关节疼痛VAS评分低于康复训练组,肩关节Constant-Murley评分和UCLA评分均高于康复训练组(t=-8.520,P=0.000;t=2.221,P=0.029;t=2.268,P=0.026)。结论:腕踝针联合康复训练用于肩袖损伤术后患者的康复治疗,可缓解患肩疼痛、改善患肩功能,且疗效优于单纯康复训练。展开更多
Bosworth ankle fracture-dislocation is rare, known to be an irreducible type of ankle injury, with a high incidence of complication. We present two cases of even rarer variants of Bosworth ankle fracturedislocation. T...Bosworth ankle fracture-dislocation is rare, known to be an irreducible type of ankle injury, with a high incidence of complication. We present two cases of even rarer variants of Bosworth ankle fracturedislocation. The first case is a type of supination external rotation adduction, and the second case is a type of supination external rotati on adduction. These types have not bee n described before .In both of the cases we failed to achieve close reduction, and therefore proceeded with emergency surgeries, with open reduction and internal fixation. Both of the cases were performed with a postero-lateral approach to reduce the dislocations, and fix the fractures successfully. Unfortunately in one of the cases, acute compartment syndrome developed post-surgically. However, both cases showed good functional outcomes.展开更多
文摘Background： In treatment of ankle fracture, intraoperative stress tests are used to assess the syndesmotic injury and instability. However, the optimized timing of the strees test should be applied whether in pre- or post-bony fixation during operation is seldom be reported in previous studies. The different strategies on stress test timing would exhibit opposite results within a type ofpronation-external rotation （PER） fractures with supracollicular medial malleolar （SMM） fractures. This study was designed to assess the 3-year ffmctional outcomes of the special PER fractures with or without a syndesmotic transfixation based on the results of two different intraoperative stress test strategies. Methods： This retrospective cohort study included 61 PER injury-Weber C ankle fractures combined with SMM fractures who were treated in Beijing Jishuitan Hospital between 2013 and 2014 and followed up for 3 years. Stress test was performed twice intraoperatively. A positive intraoperative stress test before bony fixation and a negative intraoperative stress test after bony fixation were found in these included patients. Twenty-nine patients （Group 1 ） were treated without a supplemental syndesmotie screw fixation, according to the negative intraoperative stress test alter bony fixation, while 32 patients （Group 2） were treated with an additional syndesmotic screw fixation based on the positive intraoperative stress test before bony fixation. The American Orthopaedic Foot and Ankle Society （AOFAS）Ankle-Hindfoot Scale and Visual Analog Scale （VAS） for pain scores were the main measurements of outcome. The statistical index of demographic data, fracture morphologic data, time interval of follow-up, AOFAS and VAS were recorded and assessed by SPSS 21.0 software through Fisher exact tests and oneway analysis of variance. The associations between the main outcomes and influential factors were evaluated by linear regression models. Results： We observed no difference in the distribution of age, sex, presence of associated posterior malleolus （PM）, fracture dislocation, and fixation of associated PM between two treatment groups. With the numbers available, no statistically significant association could be detected with regard to the AOFAS （Group 1 vs. Group 2, 96.72 ± 6.20 vs. 94.63 ± 8.26, F = 1.24, P = 0.27） and VAS （Group I vs. Group 2, 1.47 ± 2.14 vs. 0.72 ± 1.49, F = 2.44, P - 0.12） in association with two strategies. Conclusions： The present study indicates no difference to the use of the syndesmotic screw in terms of the ffinctional outcome between syndesmosis transfixation and no-fixation patients among PER-Weber C ankle fi＇acture patients with SMM fracture after 3-year ibllow-up. More attention should be paid to pre- and post-bony-fixation intraoperative stress tests and the morphology of medial malleoli fractures in ankle fractures.
文摘目的:探讨腕踝针在肩袖损伤术后康复治疗中的应用价值。方法:纳入肩袖损伤肩关节镜下肩袖修复术后患者80例,随机分为腕踝针联合康复训练组和康复训练组,每组40例。术后第1天开始,腕踝针联合康复训练组患者进行腕踝针治疗和康复训练;康复训练组患者单纯进行康复训练。腕踝针治疗取患侧上4穴和上5穴,留针30 min,隔日治疗1次,治疗6周后改为每3 d治疗1次;康复训练分制动康复训练期和保护康复训练期2个阶段进行;共治疗12周。分别于治疗前及治疗12周后,采用视觉模拟量表(visual analogue scale,VAS)对2组患者肩关节疼痛情况进行评分;采用Constant-Murley肩关节评分和美国加州大学洛杉矶分校(the University of California-Los Angeles,UCLA)肩关节评分对2组患者肩关节功能进行评价。结果:2组患者均顺利完成12周的康复治疗。治疗前,2组患者肩关节疼痛VAS评分及肩关节Constant-Murley评分、UCLA评分比较,组间差异均无统计学意义(t=-0.234,P=0.816;t=-0.950,P=0.345;t=-0.627,P=0.533)。治疗12周后,2组患者肩关节疼痛VAS评分较治疗前降低,肩关节Constant-Murley评分和UCLA评分均较治疗前提高[腕踝针联合康复训练组:(7.55±0.81)分,(0.88±0.79)分,t=1.207,P=0.000;(41.80±6.70)分,(90.95±4.64)分,t=8.737,P=0.000;(10.30±3.94)分,(31.53±2.82)分,t=4.288,P=0.000。康复训练组:(7.60±1.10)分,(2.40±0.81)分,t=1.305,P=0.000;(43.23±6.72)分,(88.90±3.54)分,t=7.976,P=0.000;(10.80±3.15)分,(30.20±2.39)分,t=4.290,P=0.000];且腕踝针联合康复训练组肩关节疼痛VAS评分低于康复训练组,肩关节Constant-Murley评分和UCLA评分均高于康复训练组(t=-8.520,P=0.000;t=2.221,P=0.029;t=2.268,P=0.026)。结论:腕踝针联合康复训练用于肩袖损伤术后患者的康复治疗,可缓解患肩疼痛、改善患肩功能,且疗效优于单纯康复训练。
文摘Bosworth ankle fracture-dislocation is rare, known to be an irreducible type of ankle injury, with a high incidence of complication. We present two cases of even rarer variants of Bosworth ankle fracturedislocation. The first case is a type of supination external rotation adduction, and the second case is a type of supination external rotati on adduction. These types have not bee n described before .In both of the cases we failed to achieve close reduction, and therefore proceeded with emergency surgeries, with open reduction and internal fixation. Both of the cases were performed with a postero-lateral approach to reduce the dislocations, and fix the fractures successfully. Unfortunately in one of the cases, acute compartment syndrome developed post-surgically. However, both cases showed good functional outcomes.
