Objective Supracondylar humerus fractures are the most frequent fractures of the paediatric elbow.The present study introduced a modified surgical procedure for treatment of supracondylar humerus fractures in children...Objective Supracondylar humerus fractures are the most frequent fractures of the paediatric elbow.The present study introduced a modified surgical procedure for treatment of supracondylar humerus fractures in children.Methods From February 2015 to August 2019,73 patients with Gartland’s type II and III supracondylar fractures were treated with this modified method.Totally,68 of all patients were followed up for 3–12 months(mean 8.25 months).The evaluation results included fracture nonunion,ulnar nerve injury,pin track infection,carrying angle and elbow joint Flynn score.Results The results showed that bone union was observed in all children,one case had an iatrogenic ulnar nerve injury,and the symptoms were completely relieved in 4 months after removing of the medial-side pin.All children had no cubitus varus deformity and no pin track infection,and the rate of satisfactory results according to Flynn’s criteria score was 100%.Conclusion The modified closed reduction and Kirschner wires internal fixation could effectively reduce the rate of open reduction,the risk of iatrogenic ulnar nerve injury,and the incidence of cubitus varus deformity in treatment of supracondylar humerus fractures in children.展开更多
Objective:To compare the efficacy of open reduction and volar locking plate internal fixation with closed reduction and external fixation in the treatment of distal radius fractures by using meta analysis.Methods:The ...Objective:To compare the efficacy of open reduction and volar locking plate internal fixation with closed reduction and external fixation in the treatment of distal radius fractures by using meta analysis.Methods:The databases of CNKI,Wanfang,Weipu,Chinese biomedical literature,Pubmed,Embase,and Cochrane Library were retrieved,and the randomized controlled studies that directly compared the efficacy of plate internal fixation and closed reduction external fixation in the treatment of distal radius fractures published publicly from the establishment of the database to April 2023 were collected.The two researchers independently screened the retrieved literature according to the inclusion and exclusion criteria,extracted data,used Cochrane risk bias assessment tool for quality assessment,and used RevMan 5.4 software for meta analysis.Results:A total of 10 randomized controlled trials were included,all of which were in English.There were 1042 patients in total,and 9 of them were rated as low risk.Meta analysis results showed that one year after the treatment of distal radius fracture with volar locking plate internal fixation,DASH score[MD=-5.64,95%CI(-7.21,-4.06),P<0.00001];One year later,PRWE score[MD=-5.90,95%CI(-8.88,-2.92),P=0.001];Palm flexion[MD=5.92,95%CI(1.29,10.55),P=0.01];Pronation[MD=2.48,95%CI(0.59,4.36),P=0.01];Postrotation[MD=4.73,95%CI(2.15,7.31),P=0.0003];Grip strength[MD=0.61,95%CI(0.12,1.10),P=0.02];palmar tilt angle[MD=9.84,95%CI(5.66,14.02),P<0.00001];Radial inclination[MD=4.33,95%CI(2.97,5.69),P<0.00001]was superior to closed reduction plaster or splint external fixation.One year later,the European Five dimensional Health Scale(EQ-5D-5L)score[MD=0.02,95%CI(-0.01,0.05),P=0.27];Back extension[MD=2.22,95%CI(-4.15,8.59),P=0.49];Ulnar deviation[MD=3.49,95%CI(-0.80,7.78),P=0.11];Radial deviation[MD=2.05,95%CI(-2.39,6.50),P=0.37];Ulnar variance[MD=-1.14,95%CI(-3.16,0.88),P=0.27];There was no significant difference in complications[MD=0.77,95%CI(0.54,1.10),P=0.16](P>0.05).Conclusion:Based on the current clinical data,internal fixation with volar locking plate is more conducive to mid-term DASH score and grip strength recovery than closed reduction plaster or splint external fixation,but there is no significant difference in the quality of life and complications of patients.For adult distal radius fractures,surgical indications should be carefully grasped,and non operative treatment should be given priority.展开更多
目的探讨快速康复外科(ERAS)在防旋股骨近端髓内钉(PFNA)治疗老年股骨转子间骨折中的临床应用。方法将接受手术治疗的105例老年股骨转子间骨折患者纳入研究,所有患者均接受PFNA微创髓内固定。根据治疗方案将患者分为实验组和对照组,实验...目的探讨快速康复外科(ERAS)在防旋股骨近端髓内钉(PFNA)治疗老年股骨转子间骨折中的临床应用。方法将接受手术治疗的105例老年股骨转子间骨折患者纳入研究,所有患者均接受PFNA微创髓内固定。根据治疗方案将患者分为实验组和对照组,实验组50例,围手术期采用ERAS模式进行管理;对照组55例,采用常规治疗和护理措施。比较2组患者手术时间、住院时间、住院费用、护理满意度、骨折愈合时间、1年内病死率等指标。围手术期采用疼痛视觉模拟评分(VAS)对患者髋关节疼痛程度进行评定。采用Harris髋关节功能评分表和五维健康量表(EQ-5D)对术后1、3、6个月,1年患者进行评估。结果所有患者均顺利完成手术,所有患者均获得1年随访。与对照组相比,实验组患者住院时间短(P<0.05)、总体花费少(P>0.05);2组术前、术后1 d VAS评分差异有统计学意义(P<0.05)。实验组患者术后1个月内关节功能明显优于对照组(P<0.05)。2组术后骨折愈合时间比较差异无统计学意义(P>0.05)。结论老年股骨转子间骨折行微创PFNA固定,围手术期应用ERAS方法能降低患者疼痛、减少手术应激、缩短住院时间、减少医疗费用、促进髋关节功能早期康复、降低病死率、患者满意度高,值得推广应用。展开更多
基金supported by Program of the National Natural Science Foundation of China(No.82074233)Scientific Research Foundation for Advanced Talents,Xiang’an Hospital of Xiamen University(No.PM201809170009).
文摘Objective Supracondylar humerus fractures are the most frequent fractures of the paediatric elbow.The present study introduced a modified surgical procedure for treatment of supracondylar humerus fractures in children.Methods From February 2015 to August 2019,73 patients with Gartland’s type II and III supracondylar fractures were treated with this modified method.Totally,68 of all patients were followed up for 3–12 months(mean 8.25 months).The evaluation results included fracture nonunion,ulnar nerve injury,pin track infection,carrying angle and elbow joint Flynn score.Results The results showed that bone union was observed in all children,one case had an iatrogenic ulnar nerve injury,and the symptoms were completely relieved in 4 months after removing of the medial-side pin.All children had no cubitus varus deformity and no pin track infection,and the rate of satisfactory results according to Flynn’s criteria score was 100%.Conclusion The modified closed reduction and Kirschner wires internal fixation could effectively reduce the rate of open reduction,the risk of iatrogenic ulnar nerve injury,and the incidence of cubitus varus deformity in treatment of supracondylar humerus fractures in children.
基金2022 Key Specialty Construction Project of Traditional Chinese Medicine:Traditional Chinese Orthopedics and Traumatology Department (No.962042)2020 Regional Traditional Chinese Medicine (Orthopedics and Traumatology)Diagnosis and Treatment Center (Jin Wei Zhong[2020]No.5)。
文摘Objective:To compare the efficacy of open reduction and volar locking plate internal fixation with closed reduction and external fixation in the treatment of distal radius fractures by using meta analysis.Methods:The databases of CNKI,Wanfang,Weipu,Chinese biomedical literature,Pubmed,Embase,and Cochrane Library were retrieved,and the randomized controlled studies that directly compared the efficacy of plate internal fixation and closed reduction external fixation in the treatment of distal radius fractures published publicly from the establishment of the database to April 2023 were collected.The two researchers independently screened the retrieved literature according to the inclusion and exclusion criteria,extracted data,used Cochrane risk bias assessment tool for quality assessment,and used RevMan 5.4 software for meta analysis.Results:A total of 10 randomized controlled trials were included,all of which were in English.There were 1042 patients in total,and 9 of them were rated as low risk.Meta analysis results showed that one year after the treatment of distal radius fracture with volar locking plate internal fixation,DASH score[MD=-5.64,95%CI(-7.21,-4.06),P<0.00001];One year later,PRWE score[MD=-5.90,95%CI(-8.88,-2.92),P=0.001];Palm flexion[MD=5.92,95%CI(1.29,10.55),P=0.01];Pronation[MD=2.48,95%CI(0.59,4.36),P=0.01];Postrotation[MD=4.73,95%CI(2.15,7.31),P=0.0003];Grip strength[MD=0.61,95%CI(0.12,1.10),P=0.02];palmar tilt angle[MD=9.84,95%CI(5.66,14.02),P<0.00001];Radial inclination[MD=4.33,95%CI(2.97,5.69),P<0.00001]was superior to closed reduction plaster or splint external fixation.One year later,the European Five dimensional Health Scale(EQ-5D-5L)score[MD=0.02,95%CI(-0.01,0.05),P=0.27];Back extension[MD=2.22,95%CI(-4.15,8.59),P=0.49];Ulnar deviation[MD=3.49,95%CI(-0.80,7.78),P=0.11];Radial deviation[MD=2.05,95%CI(-2.39,6.50),P=0.37];Ulnar variance[MD=-1.14,95%CI(-3.16,0.88),P=0.27];There was no significant difference in complications[MD=0.77,95%CI(0.54,1.10),P=0.16](P>0.05).Conclusion:Based on the current clinical data,internal fixation with volar locking plate is more conducive to mid-term DASH score and grip strength recovery than closed reduction plaster or splint external fixation,but there is no significant difference in the quality of life and complications of patients.For adult distal radius fractures,surgical indications should be carefully grasped,and non operative treatment should be given priority.
文摘目的探讨快速康复外科(ERAS)在防旋股骨近端髓内钉(PFNA)治疗老年股骨转子间骨折中的临床应用。方法将接受手术治疗的105例老年股骨转子间骨折患者纳入研究,所有患者均接受PFNA微创髓内固定。根据治疗方案将患者分为实验组和对照组,实验组50例,围手术期采用ERAS模式进行管理;对照组55例,采用常规治疗和护理措施。比较2组患者手术时间、住院时间、住院费用、护理满意度、骨折愈合时间、1年内病死率等指标。围手术期采用疼痛视觉模拟评分(VAS)对患者髋关节疼痛程度进行评定。采用Harris髋关节功能评分表和五维健康量表(EQ-5D)对术后1、3、6个月,1年患者进行评估。结果所有患者均顺利完成手术,所有患者均获得1年随访。与对照组相比,实验组患者住院时间短(P<0.05)、总体花费少(P>0.05);2组术前、术后1 d VAS评分差异有统计学意义(P<0.05)。实验组患者术后1个月内关节功能明显优于对照组(P<0.05)。2组术后骨折愈合时间比较差异无统计学意义(P>0.05)。结论老年股骨转子间骨折行微创PFNA固定,围手术期应用ERAS方法能降低患者疼痛、减少手术应激、缩短住院时间、减少医疗费用、促进髋关节功能早期康复、降低病死率、患者满意度高,值得推广应用。
