BACKGROUND Older adults are at high risk of femoral neck fractures(FNFs).Elderly patients face and adapt to significant psychological burdens,resulting in different degrees of psychological stress response.Total hip r...BACKGROUND Older adults are at high risk of femoral neck fractures(FNFs).Elderly patients face and adapt to significant psychological burdens,resulting in different degrees of psychological stress response.Total hip replacement is the preferred treatment for FNF in elderly patients;however,some patients have poor postoperative prognoses,and the underlying mechanism is unknown.We speculated that the postoperative prognosis of elderly patients with FNF may be related to preoperative psychological stress.AIM To explore the relationship between preoperative psychological stress and the short-term prognosis of elderly patients with FNF.METHODS In this retrospective analysis,the baseline data,preoperative 90-item Symptom Checklist score,and Harris score within 6 months of surgery of 120 elderly patients with FNF who underwent total hip arthroplasty were collected.We analyzed the indicators of poor short-term postoperative prognosis and the ability of the indicators to predict poor prognosis and compared the correlation between the indicators and the Harris score.RESULTS Anxiety,depression,garden classification of FNF,cause of fracture,FNF reduction quality,and length of hospital stay were independent influencing factors for poor short-term postoperative prognoses in elderly patients with FNF(P<0.05).The areas under the curve for anxiety,depression,and length of hospital stay were 0.742,0.854,and 0.749,respectively.The sensitivities of anxiety,depression,garden classification of FNF,and prediction of the cause of fracture were 0.857,0.786,0.821,and 0.821,respectively.The specificities of depression,FNF quality reduction,and length of hospital stay were the highest at 0.880,0.783,and 0.761,respectively.Anxiety,depression,and somatization scores correlated moderately with Harris scores(r=-0.523,-0.625,and-0.554;all P<0.001).CONCLUSION Preoperative anxiety,depression,and somatization are correlated with poor short-term prognosis in elderly patients with FNF and warrant consideration.展开更多
Objective To explore the clinical effect of the trans-atlantoaxial pedicle screw-rod internal fixation and fusion in treatment of old odontoid fracture combined with atlantoaxial instability. Methods The study involve...Objective To explore the clinical effect of the trans-atlantoaxial pedicle screw-rod internal fixation and fusion in treatment of old odontoid fracture combined with atlantoaxial instability. Methods The study involved 48 patients with展开更多
Purpose:This study evaluated the methods and clinical effects of multidisciplinary collaborative treatment for occlusal reconstruction in patients with old jaw fractures and dentition defects.Methods:Patients with old...Purpose:This study evaluated the methods and clinical effects of multidisciplinary collaborative treatment for occlusal reconstruction in patients with old jaw fractures and dentition defects.Methods:Patients with old jaw fractures and dentition defects who underwent occlusal reconstruction at the Third Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2022 were enrolled.Clinical treatment was classified into 3 phases.In phase I,techniques such as orthognathic surgery,microsurgery,and distraction osteogenesis were employed to reconstruct the correct 3-dimensional(3D)jaw position relationship.In phase II,bone augmentation and soft tissue management techniques were utilized to address insufficient alveolar bone mass and poor gingival soft tissue conditions.In phase III,implant-supported overdentures or fixed dentures were used for occlusal reconstruction.A summary of treatment methods,clinical efficacy evaluation,comparative analysis of imageological examinations,and satisfaction questionnaire survey were utilized to evaluate the therapeutic efficacy in patients with traumatic old jaw fractures and dentition defects.All data are summarized using the arithmetic mean±standard deviation and compared using independent samplet-tests.Results:In 15 patients with old jaw fractures and dentition defects(an average age of 32 years,ranging from 18 to 53 years),there were 7 cases of malocclusion of single maxillary fracture,6 of malocclusion of single mandible fracture,and 2 of malocclusion of both maxillary and mandible fractures.There were 5 patients with single maxillary dentition defects,2 with single mandibular dentition defects,and 8 with both maxillary and mandibular dentition defects.To reconstruct the correct 3D jaw positional relationship,5 patients underwent Le Fort I osteotomy of the maxilla,3 underwent bilateral sagittal split ramus osteotomy of the mandible,4 underwent open reduction and internal fixation for old jaw fractures,3 underwent temporomandibular joint surgery,and 4 underwent distraction osteogenesis.All patients underwent jawbone augmentation,of whom 4 patients underwent a free composite vascularized bone flap(26.66%)and the remaining patients underwent local alveolar bone augmentation.Free gingival graft and connective tissue graft were the main methods for soft tissue augmentation(73.33%).The 15 patients received 81 implants,of whom 11 patients received implant-supported fixed dentures and 4 received implant-supported removable dentures.The survival rate of all implants was 93.82%.The final imageological examination of 15 patients confirmed that the malocclusion was corrected,and the clinical treatment ultimately achieved occlusal function reconstruction.The patient satisfaction questionnaire survey showed that they were satisfied with the efficacy,phonetics,aesthetics,and comfort after treatment.Conclusion:Occlusal reconstruction of old jaw fractures and dentition defects requires a phased sequential comprehensive treatment,consisting of 3D spatial jaw correction,alveolar bone augmentation and soft tissue augmentation,and implant-supported occlusal reconstruction,achieving satisfactory clinical therapeutic efficacy.展开更多
Objective:To compare the clinical therapeutic effect of bridge combined internal fixation system and locking compression plate internal fixation in the treatment of displaced midshaft clavicle fractures by emphaticall...Objective:To compare the clinical therapeutic effect of bridge combined internal fixation system and locking compression plate internal fixation in the treatment of displaced midshaft clavicle fractures by emphatically observing fracture healing and shoulder joint function.Methods:Totally 44 elderly patients with Robinson type 2B displaced midshaft clavicle fractures were included from the Department of Orthopaedics,Shenyang Fourth People's Hospital during February 2016 and December 2018,including 23 males and 21 females,mean age(69.8±10.2)years old.The patients were divided into a bridge combined internal fixation system group(bridge group,n=22)and a locking compression plate internal fixation group(plate group,n=22)according to the internal fixation methods.The operation time,intraoperative blood loss,fracture healing time,and postoperative complications were recorded.At 12 months after surgery,the shoulder joint Constant-Murley score and DASH score were used to assess the recovery of joint function.The serum levels of bone turnover biochemical markers procollagen I N-terminal peptide(P1NP),cross-linked Carboxy-terminal telopeptide of typeⅠcollagen(CTX-I),and osteoblast specific factor(OSF)were measured before and 3 months after surgery.Results:The operation time,intraoperative blood loss and fracture healing time of the bridge group were significantly shorter than those of the plate group(P<0.05).Constant scores and DASH scores in the bridge group were significantly better than those of the plate group at 12 months after surgery(P<0.05).Serum levels of CTX-I was significantly decreased,while the P1NP and OSF were significantly increased compared with before surgery in the both groups(P<0.05),and the changes were more obvious in the bridge group(P<0.05).The incidence of complications was similar between the two groups(P<0.05).Conclusion:Compared with the locking plate system,the bridge combined internal fixation system can effectively improve the operation efficiency,have more benefits on fracture healing,better promote the recovery of patients'function,and reduce the failure rate of internal fixation,thus providing a better choice to treat displaced midshaft clavicle fractures by intraoperative internal fixation.展开更多
文摘BACKGROUND Older adults are at high risk of femoral neck fractures(FNFs).Elderly patients face and adapt to significant psychological burdens,resulting in different degrees of psychological stress response.Total hip replacement is the preferred treatment for FNF in elderly patients;however,some patients have poor postoperative prognoses,and the underlying mechanism is unknown.We speculated that the postoperative prognosis of elderly patients with FNF may be related to preoperative psychological stress.AIM To explore the relationship between preoperative psychological stress and the short-term prognosis of elderly patients with FNF.METHODS In this retrospective analysis,the baseline data,preoperative 90-item Symptom Checklist score,and Harris score within 6 months of surgery of 120 elderly patients with FNF who underwent total hip arthroplasty were collected.We analyzed the indicators of poor short-term postoperative prognosis and the ability of the indicators to predict poor prognosis and compared the correlation between the indicators and the Harris score.RESULTS Anxiety,depression,garden classification of FNF,cause of fracture,FNF reduction quality,and length of hospital stay were independent influencing factors for poor short-term postoperative prognoses in elderly patients with FNF(P<0.05).The areas under the curve for anxiety,depression,and length of hospital stay were 0.742,0.854,and 0.749,respectively.The sensitivities of anxiety,depression,garden classification of FNF,and prediction of the cause of fracture were 0.857,0.786,0.821,and 0.821,respectively.The specificities of depression,FNF quality reduction,and length of hospital stay were the highest at 0.880,0.783,and 0.761,respectively.Anxiety,depression,and somatization scores correlated moderately with Harris scores(r=-0.523,-0.625,and-0.554;all P<0.001).CONCLUSION Preoperative anxiety,depression,and somatization are correlated with poor short-term prognosis in elderly patients with FNF and warrant consideration.
文摘Objective To explore the clinical effect of the trans-atlantoaxial pedicle screw-rod internal fixation and fusion in treatment of old odontoid fracture combined with atlantoaxial instability. Methods The study involved 48 patients with
基金Project of State Key Laboratory of Military Stomatology(2021ZA07)Shaanxi Provincial Key Research and Development Program(2023-YBSF-291)The Science and Technology Project of Xi'an City(22YXYJ0116).
文摘Purpose:This study evaluated the methods and clinical effects of multidisciplinary collaborative treatment for occlusal reconstruction in patients with old jaw fractures and dentition defects.Methods:Patients with old jaw fractures and dentition defects who underwent occlusal reconstruction at the Third Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2022 were enrolled.Clinical treatment was classified into 3 phases.In phase I,techniques such as orthognathic surgery,microsurgery,and distraction osteogenesis were employed to reconstruct the correct 3-dimensional(3D)jaw position relationship.In phase II,bone augmentation and soft tissue management techniques were utilized to address insufficient alveolar bone mass and poor gingival soft tissue conditions.In phase III,implant-supported overdentures or fixed dentures were used for occlusal reconstruction.A summary of treatment methods,clinical efficacy evaluation,comparative analysis of imageological examinations,and satisfaction questionnaire survey were utilized to evaluate the therapeutic efficacy in patients with traumatic old jaw fractures and dentition defects.All data are summarized using the arithmetic mean±standard deviation and compared using independent samplet-tests.Results:In 15 patients with old jaw fractures and dentition defects(an average age of 32 years,ranging from 18 to 53 years),there were 7 cases of malocclusion of single maxillary fracture,6 of malocclusion of single mandible fracture,and 2 of malocclusion of both maxillary and mandible fractures.There were 5 patients with single maxillary dentition defects,2 with single mandibular dentition defects,and 8 with both maxillary and mandibular dentition defects.To reconstruct the correct 3D jaw positional relationship,5 patients underwent Le Fort I osteotomy of the maxilla,3 underwent bilateral sagittal split ramus osteotomy of the mandible,4 underwent open reduction and internal fixation for old jaw fractures,3 underwent temporomandibular joint surgery,and 4 underwent distraction osteogenesis.All patients underwent jawbone augmentation,of whom 4 patients underwent a free composite vascularized bone flap(26.66%)and the remaining patients underwent local alveolar bone augmentation.Free gingival graft and connective tissue graft were the main methods for soft tissue augmentation(73.33%).The 15 patients received 81 implants,of whom 11 patients received implant-supported fixed dentures and 4 received implant-supported removable dentures.The survival rate of all implants was 93.82%.The final imageological examination of 15 patients confirmed that the malocclusion was corrected,and the clinical treatment ultimately achieved occlusal function reconstruction.The patient satisfaction questionnaire survey showed that they were satisfied with the efficacy,phonetics,aesthetics,and comfort after treatment.Conclusion:Occlusal reconstruction of old jaw fractures and dentition defects requires a phased sequential comprehensive treatment,consisting of 3D spatial jaw correction,alveolar bone augmentation and soft tissue augmentation,and implant-supported occlusal reconstruction,achieving satisfactory clinical therapeutic efficacy.
文摘Objective:To compare the clinical therapeutic effect of bridge combined internal fixation system and locking compression plate internal fixation in the treatment of displaced midshaft clavicle fractures by emphatically observing fracture healing and shoulder joint function.Methods:Totally 44 elderly patients with Robinson type 2B displaced midshaft clavicle fractures were included from the Department of Orthopaedics,Shenyang Fourth People's Hospital during February 2016 and December 2018,including 23 males and 21 females,mean age(69.8±10.2)years old.The patients were divided into a bridge combined internal fixation system group(bridge group,n=22)and a locking compression plate internal fixation group(plate group,n=22)according to the internal fixation methods.The operation time,intraoperative blood loss,fracture healing time,and postoperative complications were recorded.At 12 months after surgery,the shoulder joint Constant-Murley score and DASH score were used to assess the recovery of joint function.The serum levels of bone turnover biochemical markers procollagen I N-terminal peptide(P1NP),cross-linked Carboxy-terminal telopeptide of typeⅠcollagen(CTX-I),and osteoblast specific factor(OSF)were measured before and 3 months after surgery.Results:The operation time,intraoperative blood loss and fracture healing time of the bridge group were significantly shorter than those of the plate group(P<0.05).Constant scores and DASH scores in the bridge group were significantly better than those of the plate group at 12 months after surgery(P<0.05).Serum levels of CTX-I was significantly decreased,while the P1NP and OSF were significantly increased compared with before surgery in the both groups(P<0.05),and the changes were more obvious in the bridge group(P<0.05).The incidence of complications was similar between the two groups(P<0.05).Conclusion:Compared with the locking plate system,the bridge combined internal fixation system can effectively improve the operation efficiency,have more benefits on fracture healing,better promote the recovery of patients'function,and reduce the failure rate of internal fixation,thus providing a better choice to treat displaced midshaft clavicle fractures by intraoperative internal fixation.
