The traditional treatment of the hip with a slip of the capital femoral epiphysis has been an in situ fixation using a single screw.This has the sanctity of a long term result.Recent literature stresses the outcomes o...The traditional treatment of the hip with a slip of the capital femoral epiphysis has been an in situ fixation using a single screw.This has the sanctity of a long term result.Recent literature stresses the outcomes of failure to restore the upper femoral alignment and on the basis of the poor results makes a plea for capital realignment.This being a recent development,it lacks the support of long term follow up and it remains to be seen if this is a better alternative of managing displaced and unstable slipped capital femoral epiphysis.The authors look at some of the available literature on the subject to highlight these controversies and their implications for orthopedic surgeons.Other controversies pertain to contralateral fixation,duration of immobilization and amount of weight bearing after an in situ fixation.展开更多
BACKGROUND Severe spasticity may negatively impact functionality and quality of life after spinal cord injury(SCI).Intrathecal baclofen treatment(IBT)is effectively used to manage severe spasticity and reduce comorbid...BACKGROUND Severe spasticity may negatively impact functionality and quality of life after spinal cord injury(SCI).Intrathecal baclofen treatment(IBT)is effectively used to manage severe spasticity and reduce comorbidities.However,long-term IBT may have a negative effect on bone mineral content(BMC),bone mineral density(BMD)and body composition(such as percentage fat mass and lean body mass).We demonstrated the negative effects of long-term IBT use in a single case compared with two non-IBT users.CASE SUMMARY A 46-year old Caucasian male Veteran(case)with a 21 year history of complete tetraplegia(complete C6 SCI)was implanted with IBT for 20 years.The case was matched to two participants with different time since injuries[2(match 1)and 13(match 2)years]without IBT.Knee BMC and BMD at the epiphysis and metaphysis of the distal femur and proximal tibia were evaluated using dual knee and the dual femur modules of GE Lunar iDXA software.Total and leg body composition assessments were also conducted for the three participants.Potential effect of long-term IBT was demonstrated by changes in BMD,consistent with bone demineralization,at the distal femur and proximal tibia and changes in percentage fat mass and lean mass of legs.The case showed 113%lower BMD at the distal femur,and 78.1%lower at the proximal tibia compared to match 1,moreover the case showed 45%lower BMD at the distal femur,and no observed changes at the proximal tibia compared to match 2.The case had 27.1%and 16.5%greater leg%fat mass compared to match 1 and match 2,respectively.Furthermore,the case had 17.4%and 11.8%lower%leg lean mass compared to match 1 and match 2,respectively.CONCLUSION Long-term IBT may impact bone health and body composition parameters in persons with complete SCI.It may be prudent to encourage regular screening of individuals on long-term IBT considering the prevalence of osteoporosis related fractures,cardiovascular diseases,and metabolic disorders in this population.展开更多
股骨头骨骺滑脱(slipped capital femoral epiphysis,SCFE)是多发生于儿童的一种髋关节疾病,主要表现为股骨头骨骺相对干骺端向后向下移位,而骨骺仍位于髋臼内[1]。股骨头骨骺滑脱多发生于10~14岁处于快速发展时期的儿童,男性多见,男女...股骨头骨骺滑脱(slipped capital femoral epiphysis,SCFE)是多发生于儿童的一种髋关节疾病,主要表现为股骨头骨骺相对干骺端向后向下移位,而骨骺仍位于髋臼内[1]。股骨头骨骺滑脱多发生于10~14岁处于快速发展时期的儿童,男性多见,男女比例约为2:1。在美国,SCFE发病率为1.8/10000。SCFE起病隐匿,多数有明显外伤史,临床表现为跛行,髋关节疼痛伴活动受限,甚至有时膝关节疼痛为唯一症状。展开更多
Background There are few researches for the healing of metaphyseal fractures; moreover,the animal models to study the metaphyseal fractures are usually made by the oscillating saw osteotomy without reliable fixation,w...Background There are few researches for the healing of metaphyseal fractures; moreover,the animal models to study the metaphyseal fractures are usually made by the oscillating saw osteotomy without reliable fixation,which is not in accordance with our current clinical practice.In this study,we established a new model to observe the healing process of metaphyseal fractures.Methods Eighteen New Zealand rabbits were used in the study.The fracture model was created by splitting the medial tibial plateau in rabbits,then reset,and fixed with compression screws.At 1,2,3,4,6,and 8 weeks postoperatively,the tibial specimens were collected; firstly,a general observation and an X-ray examination of the specimens was done,and then they were embedded in methylmethacrylate and cut into sections with hard tissue slicer.The sections were stained with Giemsa reagent and examined under light microscopy.Results There was no fracture displacement in the tibial specimens of all time points,except for one showing a collapse.No external callus formation could be observed by X-ray and general examination.After 1 week of the operation,the fracture gap was filled by mesenchymal tissue; 2 weeks postoperatively,a large number of woven bones were formed; from the third week onwards,the woven bone began to turn into lamellar bone,and new trabecular structure began to form.In all of the slices,no obvious chondrocytes formed in fracture areas; thus,there was no endochondral ossification.Conclusions This model was an ideal fracture animal model and suitable for the study of metaphyseal fracture healing.The X-ray and histological images demonstrated that metaphyseal fracture healing was a process of direct bone healing through intramembranous bone formation under the conditions of minor trauma,good reduction,and firm fixation.展开更多
文摘The traditional treatment of the hip with a slip of the capital femoral epiphysis has been an in situ fixation using a single screw.This has the sanctity of a long term result.Recent literature stresses the outcomes of failure to restore the upper femoral alignment and on the basis of the poor results makes a plea for capital realignment.This being a recent development,it lacks the support of long term follow up and it remains to be seen if this is a better alternative of managing displaced and unstable slipped capital femoral epiphysis.The authors look at some of the available literature on the subject to highlight these controversies and their implications for orthopedic surgeons.Other controversies pertain to contralateral fixation,duration of immobilization and amount of weight bearing after an in situ fixation.
基金Supported by the DoD-CDRMP,No.W81XWH-14-SCIRP-CTA.
文摘BACKGROUND Severe spasticity may negatively impact functionality and quality of life after spinal cord injury(SCI).Intrathecal baclofen treatment(IBT)is effectively used to manage severe spasticity and reduce comorbidities.However,long-term IBT may have a negative effect on bone mineral content(BMC),bone mineral density(BMD)and body composition(such as percentage fat mass and lean body mass).We demonstrated the negative effects of long-term IBT use in a single case compared with two non-IBT users.CASE SUMMARY A 46-year old Caucasian male Veteran(case)with a 21 year history of complete tetraplegia(complete C6 SCI)was implanted with IBT for 20 years.The case was matched to two participants with different time since injuries[2(match 1)and 13(match 2)years]without IBT.Knee BMC and BMD at the epiphysis and metaphysis of the distal femur and proximal tibia were evaluated using dual knee and the dual femur modules of GE Lunar iDXA software.Total and leg body composition assessments were also conducted for the three participants.Potential effect of long-term IBT was demonstrated by changes in BMD,consistent with bone demineralization,at the distal femur and proximal tibia and changes in percentage fat mass and lean mass of legs.The case showed 113%lower BMD at the distal femur,and 78.1%lower at the proximal tibia compared to match 1,moreover the case showed 45%lower BMD at the distal femur,and no observed changes at the proximal tibia compared to match 2.The case had 27.1%and 16.5%greater leg%fat mass compared to match 1 and match 2,respectively.Furthermore,the case had 17.4%and 11.8%lower%leg lean mass compared to match 1 and match 2,respectively.CONCLUSION Long-term IBT may impact bone health and body composition parameters in persons with complete SCI.It may be prudent to encourage regular screening of individuals on long-term IBT considering the prevalence of osteoporosis related fractures,cardiovascular diseases,and metabolic disorders in this population.
文摘股骨头骨骺滑脱(slipped capital femoral epiphysis,SCFE)是多发生于儿童的一种髋关节疾病,主要表现为股骨头骨骺相对干骺端向后向下移位,而骨骺仍位于髋臼内[1]。股骨头骨骺滑脱多发生于10~14岁处于快速发展时期的儿童,男性多见,男女比例约为2:1。在美国,SCFE发病率为1.8/10000。SCFE起病隐匿,多数有明显外伤史,临床表现为跛行,髋关节疼痛伴活动受限,甚至有时膝关节疼痛为唯一症状。
基金This research was funded by grants from the Chinese National Natural Science Fund for Outstanding Youth （No.30625036）,Chinese ＂973 Project Planning＂ （No.2005CB522604）,National Natural Science Foundation of China （Nos.81171146,30971526,31040043）,Beijing Natural Science Foundation （No.7113170）,and Doctoral Fund of Ministry of Education of China （No.20090001120096）.
文摘Background There are few researches for the healing of metaphyseal fractures; moreover,the animal models to study the metaphyseal fractures are usually made by the oscillating saw osteotomy without reliable fixation,which is not in accordance with our current clinical practice.In this study,we established a new model to observe the healing process of metaphyseal fractures.Methods Eighteen New Zealand rabbits were used in the study.The fracture model was created by splitting the medial tibial plateau in rabbits,then reset,and fixed with compression screws.At 1,2,3,4,6,and 8 weeks postoperatively,the tibial specimens were collected; firstly,a general observation and an X-ray examination of the specimens was done,and then they were embedded in methylmethacrylate and cut into sections with hard tissue slicer.The sections were stained with Giemsa reagent and examined under light microscopy.Results There was no fracture displacement in the tibial specimens of all time points,except for one showing a collapse.No external callus formation could be observed by X-ray and general examination.After 1 week of the operation,the fracture gap was filled by mesenchymal tissue; 2 weeks postoperatively,a large number of woven bones were formed; from the third week onwards,the woven bone began to turn into lamellar bone,and new trabecular structure began to form.In all of the slices,no obvious chondrocytes formed in fracture areas; thus,there was no endochondral ossification.Conclusions This model was an ideal fracture animal model and suitable for the study of metaphyseal fracture healing.The X-ray and histological images demonstrated that metaphyseal fracture healing was a process of direct bone healing through intramembranous bone formation under the conditions of minor trauma,good reduction,and firm fixation.
