Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics.The ...Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics.The various treatment options that have been described can be broadly divided according to the aim of improving either biology or biomechanics. Surgeries aimed at improving the biology, such as vascularized fibula grafting, have good success rates but require high levels of expertise and substantial resources. A popular surgical treatment aimed at improving the biomechanics-valgus intertrochanteric osteotomyoptimizes conditions for fracture healing by converting shear forces across the fracture site into compressive forces. Numerous variations of this surgical procedure have been developed and successfully applied in clinical practice. As a result, the proximal femoral orientation for obtaining a good functional outcome has evolved over the years, and the present concept of altering the proximal femoral anatomy as little as possible has arisen. This technical objective supports attaining union as well as a good functional outcome, since excessive valgus can lead to increased joint reaction forces. This review summarizes the historical and current literature on valgus intertrochanteric osteotomy treatment of nonunion neck of femur, with a focus on factors predictive of good functional outcome and potential pitfalls to be avoided as well as controversies surrounding this procedure.展开更多
Spatial neglect syndrome with cerebral lesions is characterized by the ina-bility to orient, report, or respond to relevant visual stimuli contralateral to the lesions. In this study, we investigated the pattern of ho...Spatial neglect syndrome with cerebral lesions is characterized by the ina-bility to orient, report, or respond to relevant visual stimuli contralateral to the lesions. In this study, we investigated the pattern of horizontal visual search in a large space;this search was performed by patients with right hemisphere damage caused by cerebrovascular disease. The neck rotation angle and search time in each increment were continuously recorded during the task, and quantitative data of the measurements were collected. Head position during the visual search task in a large space (%) was then calculated. We set angular bands in increments of 5 degrees from the midline on the left and right sides, and calculated the total search time in each angular band. In patients with unilateral spatial neglect (USN), the search time in the angular band of 5 - 9 on the right side was significantly longer (with USN 16.7%, without USN 4.5%, t = 2.52, df = 16, p < 0.05). Furthermore, in patients with neglect in the leftmost end area in a large space, the search time was significantly shorter in the angular band of 1 - 4 degrees to the left (with neglect 13.1%, without neglect 23.7%, t = 2.13, df = 16, p < 0.05), and tended to be long in the angular band of 5 - 9 to the right. The neck rotation angle and pattern during the search task in a large field deviated slightly to the right, and the search time slightly to the left was short. We believe that these results support the rightward deviation of the search pattern and frame of USN patients.展开更多
文摘目的:对存在头前伸姿势的肌源性颞下颌关节紊乱病(temporomandibular disorders,TMD)患者进行头颈姿势训练,探索头颈姿势训练对患者头颈姿势的影响。方法:采用前瞻性对照研究设计,门诊招募2019年1月—2021年2月就诊于上海交通大学医学院附属第九人民医院的肌源性TMD患者45例(男性:6例,女性:39例;年龄29.24±6.13岁),随机分为试验组(23例)和对照组(22例)。试验组进行为期3周的头颈姿势训练,每次训练30min;对照组仅接受健康教育,3周后门诊随访。测定治疗前后患者的张口度大小、疼痛程度,并采用矢状面照片法测定头部旋转角及头颈角。结果:治疗后,试验组(n=22)患者头颈角度增加,与对照组(n=20)相比有显著性差异(55.3°±2.3°vs 48.4°±4.4°,P<0.001);试验组疼痛评分显著低于对照组(1.9±0.7 vs 2.9±0.8,P<0.001),2组的头部旋转角及张口度改善无显著性差异(P=0.437,P=0.313)。结论:头颈姿势训练可以改善肌源性TMD患者的头前伸姿势,更有助于改善患者的疼痛症状。
文摘Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics.The various treatment options that have been described can be broadly divided according to the aim of improving either biology or biomechanics. Surgeries aimed at improving the biology, such as vascularized fibula grafting, have good success rates but require high levels of expertise and substantial resources. A popular surgical treatment aimed at improving the biomechanics-valgus intertrochanteric osteotomyoptimizes conditions for fracture healing by converting shear forces across the fracture site into compressive forces. Numerous variations of this surgical procedure have been developed and successfully applied in clinical practice. As a result, the proximal femoral orientation for obtaining a good functional outcome has evolved over the years, and the present concept of altering the proximal femoral anatomy as little as possible has arisen. This technical objective supports attaining union as well as a good functional outcome, since excessive valgus can lead to increased joint reaction forces. This review summarizes the historical and current literature on valgus intertrochanteric osteotomy treatment of nonunion neck of femur, with a focus on factors predictive of good functional outcome and potential pitfalls to be avoided as well as controversies surrounding this procedure.
文摘Spatial neglect syndrome with cerebral lesions is characterized by the ina-bility to orient, report, or respond to relevant visual stimuli contralateral to the lesions. In this study, we investigated the pattern of horizontal visual search in a large space;this search was performed by patients with right hemisphere damage caused by cerebrovascular disease. The neck rotation angle and search time in each increment were continuously recorded during the task, and quantitative data of the measurements were collected. Head position during the visual search task in a large space (%) was then calculated. We set angular bands in increments of 5 degrees from the midline on the left and right sides, and calculated the total search time in each angular band. In patients with unilateral spatial neglect (USN), the search time in the angular band of 5 - 9 on the right side was significantly longer (with USN 16.7%, without USN 4.5%, t = 2.52, df = 16, p < 0.05). Furthermore, in patients with neglect in the leftmost end area in a large space, the search time was significantly shorter in the angular band of 1 - 4 degrees to the left (with neglect 13.1%, without neglect 23.7%, t = 2.13, df = 16, p < 0.05), and tended to be long in the angular band of 5 - 9 to the right. The neck rotation angle and pattern during the search task in a large field deviated slightly to the right, and the search time slightly to the left was short. We believe that these results support the rightward deviation of the search pattern and frame of USN patients.
