Identification of injury type using somatosensory and motor evoked potentials in a rat spinal cord injury model

The spinal cord is at risk of injury during spinal surgery.If intraoperative spinal co rd injury is identified early,irreve rsible impairment or loss of neurological function can be prevented.Different types of spinal cord injury result in damage to diffe rent spinal cord regions,which may cause diffe rent somatosensory and motor evoked potential signal res ponses.In this study,we examined electrophysiological and histopathological changes between contusion,distra ction,and dislocation spinal cord injuries in a rat model.We found that contusion led to the most severe dorsal white matter injury and caused considerable attenuation of both somatosensory and motor evoked potentials.Dislocation resulted in loss of myelinated axons in the lateral region of the injured spinal cord along the rostrocaudal axis.The amplitude of attenuation in motor evoked potential responses caused by dislocation was greater than that caused by contusion.After distraction injury,extracellular spaces were slightly but not significantly enlarged;somatosensory evoked potential res ponses slightly decreased and motor evoked potential responses were lost.Correlation analysis showed that histological and electrophysiological findings we re significantly correlated and related to injury type.Intraope rative monitoring of both somatosensory and motor evoked potentials has the potential to identify iatrogenic spinal cord injury type during surgery.

Knowledge and attitudes of orthopedic surgeons regarding prosthesis joint infection

BACKGROUND Periprosthetic joint infection(PJI)is a critical complication after joint arthroplasty and is accompanied by increasing rates of morbidity and mortality.Several studies have aimed at preventing PJI.AIM To research the knowledge level and attitudes of orthopedic surgeons,who play a key role in both preventing and managing PJI.METHODS We conducted a web-based survey to evaluate orthopedic surgeons'knowledge level and attitudes regarding PJI.The Likert scale survey utilized consisted of 30 questions which were prepared based on the"Proceedings of the International Consensus on Periprosthetic Joint Infection".RESULTS A total of 264 surgeons participated in the survey.Their average age was 44.8,and 173 participants(65.5%)had more than 10 years of experience.No statistically significant relationship was found between the PJI knowledge of the surgeons and their years of experience.However,participants who worked in training and research hospitals demonstrated higher levels of knowledge than the ones in the state hospitals.It was also noticed that surgeons'knowledge concerning the duration of antibiotic therapy and urinary infections was not consistent with their attitudes.CONCLUSION Even though orthopedic surgeons have adequate knowledge about preventing and managing PJI,their attitudes might contradict their knowledge.Future studies are required to examine the causes and solutions of the contradictions between orthopedic surgeons'knowledge and attitudes.

Meta-analysis of the efficacy of volar plate internal fixation versus closed reduction and external fixation in the treatment of adult distal radius fractures

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.

Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review

BACKGROUND Hemorrhoidal disease(HD)is considered a low-severity pathology by both general population and physicians,but the lengthy conservative therapy and postoperative complications suggest otherwise.AIM To assess the effectiveness of different treatment options,both conservative and surgical,in contrast with some preexisting comorbidities.METHODS We conducted a retrospective,10-yearlong study between January 2011 and December 2021 in two surgical centers,a private and a state-owned hospital.We compared the efficacy and safety of several treatment options,such as open hemorrhoidectomy,stapled hemorrhoidopexy,rubber band ligation and infrared coagulation in terms of complication rates and types and their correlation with different preexisting comorbidities such as inflammatory bowel disease(IBD),use of anticoagulant medication(AM)and liver cirrhosis.We also conducted a 20-years long PubMed research(1.263 articles)for relevant comparisons.RESULTS Our study recorded 10940 patients with HD,10241 with conservative and 699 with surgical treatment.Out of these,the male-to-female ratio of 1.3,and a peak in age distribution between 59 and 68 years old(32%of patients).For the entire study,we recorded a 90%incidence of immediate pain,immediate bleeding in 1.5%(11 cases),delayed bleeding in 1.0%(7 cases),and 0.6%surgical site infections.Urinary retention was also present,with 0.2%of patients,anal stricture in 1%and fecal incontinence for 0.5%of patients(4 cases).We recorded no severe complications such as Fournier`s gangrene or rectovaginal perforations.IBD accounted for 6%of the patients,with ulcerative colitis in 12%and Chron`s disease in 10.5%.6.6%of the patients had AM,determining 4%immediate and 2%delayed bleeding,in surgically treated patients.CONCLUSION Our study determined that most common complications(pain,urinary retention,bleeding,and stricture)are correlated with each surgical technique and pre-existing comorbidities.

Surgical Treatment of Recent Traumatic Epiphyseal Detachments of the Distal Femur in the Orthopedic and Traumatological Surgery Department of the CHU Bocar Sidy Sall de Kati: About 20 Cases

Introduction: To our knowledge, no scientific study has been conducted at the university hospital of Kati on recent traumatic epiphyseal detachment fractures of the distal femur. However, every day, children present in consultation for knee trauma. Conjugal plate fractures are by definition single to children. Any break in any solution of continuity of this plate is called an epiphyseal fracture or detachment. Objectives: To evaluate the results of surgical treatment of traumatic epiphyseal in detachments of the distal femur recent in children and adolescents. Patients and Method: This was a 13-month prospectively collected longitudinal descriptive study from September 1, 2016 to September 30, 2017. We identified and reviewed 20 medical records of recent traumatic epiphyseal detachments of the distal femur. The parameters studied were sociodemographic, lesion, surgical technique and evolutionary. Results: During the study period, the most affected group age was 12 to 17 years (85%) with an average of 14.65 ± 1.61 years (6 and 20 years). The victims were male (95%). The most frequent etiology was road traffic accident (95%), with a mean time to care of 26.42 ± 10.21 hours and Type II was frequently encountered (85%) with 35% of immediate complications. Cross-bracketing was the most commonly used surgical technique (85%). The result was good (65%). Conclusion: This study allowed us to observe a significant hospital incidence of epiphyseal detachment fractures of the distal femur. Cross pinning was the most commonly used surgical technique with fewer complications (35%) and a satisfactory result in 90% of cases.

Total Hip Replacement: Short- and Medium-Term Morbidity and Mortality in the Department of Orthopedic Traumatology of Donka University Hospital, Guinea-Conakry

Introduction: Total hip prostheses are a reliable means of treating hip disorders. It is indicated when pain and reduced mobility of the hip become incompatible with the patient’s daily activities. In low-income countries, the risk factors for hip disease are numerous, but the means for its management, such as total hip prostheses, are not. The aim of this work was to determine the morbi-mortality of total hip prostheses in the short and medium term in our department and to review the literature. Patients and Method: This was a prospective and descriptive study over a period of 9 years. It involved 50 THPs performed on 45 patients. Patients who had received a THP and were followed up for at least two years were included. We excluded patients who were lost to follow-up. The Moore-type posterolateral minimally invasive approach was used. Complications were investigated from the immediate postoperative period and in the medium term. The final functional results were evaluated according to the Postel Merle d’Aubigné score. Results: We performed 50 THPs out of 750 procedures, i.e. , 6.6%. The indications were: primary coxarthrosis 60%, necrosis of the femoral head 26%, post-infectious balloon hip 4%, and pseudarthrosis of the femoral neck 10%. The average time to the consultation was 2.4 years with extremes of 1 and 5 years. According to the terrain, sickle cell disease represented 18%, tuberculosis 12%. Postoperative complications were lameness 12%, dislocation 6%, suppuration 6%, death 4%, peri-prosthetic fracture 8%, loosening 2%, peri-articular ossification 2%, and paralysis of the external popliteal nerve 2%. Conclusion: Whoever performs a THP is obliged to monitor the patient as long as he/she is alive. Complications are possible at any time and can negatively change the assigned goal and force the surgeon to be expensive and sometimes inconclusive secondary interventions.

Recurrent anterior shoulder instability: Review of the literature and current concepts

The purpose of this review article is to discuss the clinical spectrum of recurrent traumatic anterior shoulder instability with the current concepts and controversies at the scientific level. Because of increasing participation of people from any age group of the population in sports activities, health care professionals dealing with the care of trauma patients must have a thorough understanding of the anatomy, patho-physiology, risk factors, and management of anterior shoulder instability. The risk factors for recurrent shoulder dislocation are young age, participation in high demand contact sports activities, presence of Hill-Sachs or osseous Bankart lesion, previous history of ipsilateral traumatic dislocation, ipsilateral rotator cuff or deltoid muscle insufficiency, and underlying ligamentous laxity. Achieving the best result for any particular patient depends onthe procedure that allows observation of the joint surfaces, provides the anatomical repair, maintains range of motion, and also can be applied with low rates of complications and recurrence. Although various surgical techniques have been described, a consensus does not exist and thus, orthopedic surgeons should follow and try to improve the current evidence-based treatment modalities for the patients.

Neurological recovery and antioxidant effects of resveratrol in rats with spinal cord injury: a meta-analysis

Objective:To critically assess the neurological recovery and antioxidant effects of resveratrol in rat models of spinal cord injury.Data sources:Using“spinal cord injury”,“resveratrol”and“animal experiment”as the main search terms,all studies on the treatment of spinal cord injury in rats by resveratrol were searched for in PubMed,EMBASE,MEDLINE,Web of Science,Science Direct,China National Knowledge Infrastructure,Wanfang,VIP,and SinoMed databases by computer.The search was conducted from their inception date to April 2017.No language restriction was used in the literature search.Data selection:The methodological quality of each study was assessed by the initial Stroke Therapy Academic Industry Roundtable recommendations.Two reviewers independently selected studies according to the title,abstract and full text.The risk of bias in the included studies was also evaluated.Meta-analyses were performed with Review Manager 5.3 software.Outcome measures:Neurological function was assessed by the Basso,Beattie,and Bresnahan scale score,inclined plane score and Gale’s motor function score.Molecular-biological analysis of antioxidative effects was conducted to determine superoxide dismutase levels,malondialdehyde levels,nitric oxide synthase activity,nitric oxide levels,xanthine oxidase and glutathione levels in spinal cord tissues.Results:The methodological quality of the 12 included studies was poor.The results of meta-analysis showed that compared with the control group,resveratrol significantly increased the Basso,Beattie,and Bresnahan scale scores after spinal cord injury(n=300,mean difference(MD)=3.85,95%confidence interval(CI)[2.10,5.59],P<0.0001).Compared with the control group,superoxide dismutase levels were significantly elevated(n=138,standardized mean difference(SMD)=5.22,95%CI[2.98,7.45],P<0.00001),but malondialdehyde levels were significantly diminished(n=84,SMD=–3.64,95%CI[–5.84,–1.43],P=0.001)in the spinal cord of the resveratrol treatment group.Conclusions:Resveratrol promoted neurological recovery and exerted antioxidative effects in rat models of spinal cord injury.The limited quality of the included studies reduces the application of this meta-analysis.Therefore,more high-quality studies are needed to provide more rigorous and objective evidence for the pre-clinical treatment of spinal cord injury.

Emergent and delayed hybrid external fixation management of tibial pilon fractures: A multicentric retrospective analysis of 80 patients

Objective:To report our experience with the hybrid external fixator in emergency.Methods:We assessed 80 cases of pilon fracture treated with the external fixator during the period of January 2009 and December 2016:55 men (69%) and 30 women (33%) with a mean age of 40 years (range between 16 and 70 ). About 45 occurred as isolated trauma, 35 instead were politrauma. Each patient underwent standard radiographic examination and a CT examination. There were 28 open fractures (35%), (Gustilo type 1, 2 and 3) while closed fractures showed soft tissue involvement of various grade (2-3 Tscherne classification). In all cases, the external fixation, sometimes associated with other reduction and synthesis techniques, was used. The timing of surgery was dictated by the condition of the soft tissues. For clinical evaluation, the Mazur score with mean follow-ups at 12 months was utilized.Results:The final range of ankle motion was 15 dorsal and 10 plantar flexion. In about 80 cases there was an average Mazur score of83. The mean score was 90;in open fractures 85 to 72. Radiographic healing of fractures in 60 patients occurred in 120 days (mean 105 days), at the time when the external fixator was removed.Conclusion:Pilon fractures are complex and often present complications;the definitive treatment, in emergency or delayed, with hybrid external fixator permits a stable synthesis with minimal soft tissue damage. Weight bearing maybe allowed early and functional recovery is generally good.

Postpartum pubic symphysis diastasis-conservative and surgical treatment methods, incidence of complications: Two case reports and a review of the literature

BACKGROUND Widening of the pubic joint of more than 10 mm is diagnostic and defined as pubic symphysis diastasis and is considered a complication of vaginal childbirth or pregnancy.As it is a rare pathology(ranging from 1 in 300 to 1 in 30000 pregnancies),no gold standard treatment has been defined.CASE SUMMARY This study examines two cases,a 27-year-old woman(gravida 1,para 1)and a 32-year-old woman(gravida 2,para 2),who presented to the clinic after uneventful vaginal deliveries.A normal pregnancy with no complications was observed in both patients.Severe pain in the pubic region occurred after labour and was accompanied by complicated locomotion.Pubic symphysis diastasis was confirmed radiologically and bed rest with lateral decubitus positioning was recommended.Oral non-steroidal antiinflammatory drugs were administered to relieve pain exacerbations.The symptoms decreased after treatment.Posttreatment magnetic resonance imaging(MRI)in the first case showed a reduction in symphyseal separation with no signs of osteitis.Three years later the symptoms recurred;MRI examination showed no further symphyseal widening or signs of osteitis.A relapse of symphyseal separation was diagnosed and conservative treatment was re-administered resulting in successful recovery.In the second case,pain recurred when the patient conceived for the second time.This time no benefit following conservative treatment was observed.Persistent pain and complicated locomotion led to scoliotic deformation of the lumbar part of the spine and leg length discrepancy,thus surgical treatment was chosen and internal pubic synthesis was performed.CONCLUSION Overall,surgical treatment resulting from insufficient conservative treatment showed a high risk of postoperative complications following the treatment of postpartum pubic symphysis diastasis.

Superior labrum anterior to posterior lesions of the shoulder: Diagnosis and arthroscopic management

After the improvement in arthroscopic shoulder surgery,superior labrum anterior to posterior(SLAP)tears are increasingly recognized and treated in persons with excessive overhead activities like throwers.Several potential mechanisms for the pathophysiology of superior labral tears have been proposed.The diagnosis of this condition can be possible by history,physical examination and magnetic resonance imaging combination.The treatment of type 1 SLAP tears in many cases especially in older patients is non-operative but some cases need arthroscopic intervention.The arthroscopic management of type 2 lesions in older patients can be biceps tenodesis,but young and active patients like throwers will need an arthroscopic repair.The results of arthroscopic repair in older patients are not encouraging.The purpose of this study is to perform an overview of the diagnosis of the SLAP tears and to help decision making for the surgical management.

Open reduction of a total talar dislocation: A case report and review of the literature

BACKGROUND Total talar dislocation (TTD) is very uncommon for many orthopedic surgeons and emergency/trauma specialists. Scarce cases of TTD have been reported, mainly in the form of open fracture-dislocation injury. CASE SUMMARY We report a very rare injury of closed TTD with a follow-up period of 36 mo. Initial closed reduction was not successful because of a fractured highly unstable medial malleolus displaced into the ankle mortise, blocking the relocation of the talus. The patient was able to walk pain-free after the 3rd month of surgery. At the 36-mo follow-up, there were 10 degrees of flexion loss and 10 degrees of extension loss in the tibiotalar joint. Furthermore, 5 degrees of subtalar joint inversion-eversion loss was present. CONCLUSION Open reduction should be performed for closed TTDs unless closed reduction is successful.

Total hip arthroplastyvs. osteosynthesis in acute complex acetabular fractures in the elderly:Evaluation of surgical management and outcomes

Objective: To retrospectively evaluate the open reduction internal fixation and total hip arthroplasty directions, results and complications associated with internal fixation in managing these fractures. <br> Methods: In 8 years at 4 centers, 61 patients with associated acetabular fractures (Letournel classification) were treated. The patients were divided into two groups. The total hip arthoplasty (THA) group consisted of 30 patients, while the open reduction internal fixation group had 31 patients. The average age of the patients was 74.7 years. The following parameters were compared: the duration of surgery and hospitalization, the international unit of red blood cell concentrate transfusion, the time for the verticalization of the patient, perioperative complications, Harris hip score, and the short form (12) health survey. The clinical and radiographic follow-up was performed at 1 month, 3 months, 6 months and 12 months and annually thereafter. Patients with post-traumatic osteoarthritis formed the third comparison group.P≤ 0.05 was considered statistically significant according to the analytical Student’s t-test. <br> Results: TheP < 0.05 in favor of theTHAgroup was: surgical time, length of stay, number of the international unit of red blood cell concentrate transfusions, verticalization, quality of life and hip function, a reduction of perioperative complications and reinterventions. <br> Conclusions: Our experience shows that theTHA treatment for acetabular fractures in the elderly is to be preferred.

Mechanisms of action of neuropeptide Y on stem cells and its potential applications in orthopaedic disorders

Musculoskeletal disorders are the leading causes of disability and result in reduced quality of life.The neuro-osteogenic network is one of the most promising fields in orthopaedic research.Neuropeptide Y(NPY)system has been reported to be involved in the regulations of bone metabolism and homeostasis,which also provide feedback to the central NPY system via NPY receptors.Currently,potential roles of peripheral NPY in bone metabolism remain unclear.Growing evidence suggests that NPY can regulate biological actions of bone marrow mesenchymal stem cells,hematopoietic stem cells,endothelial cells,and chondrocytes via a local autocrine or paracrine manner by different NPY receptors.The regulative activities of NPY may be achieved through the plasticity of NPY receptors,and interactions among the targeted cells as well.In general,NPY can influence proliferation,apoptosis,differentiation,migration,mobilization,and cytokine secretion of different types of cells,and play crucial roles in the development of bone delayed/non-union,osteoporosis,and osteoarthritis.Further basic research should clarify detailed mechanisms of action of NPY on stem cells,and clinical investigations are also necessary to comprehensively evaluate potential applications of NPY and its receptor-targeted drugs in management of musculoskeletal disorders.

Internet and social media usage of orthopaedic patients:A questionnaire-based survey

AIM To evaluate social media usage of orthopaedic patients to search for solutions to their health problems. METHODS The study data were collected using face-to-face questionnaire with randomly selected 1890 patients aged over 18 years who had been admitted to the orthopaedic clinics in different cities and provinces across Turkey. The questionnaire consists of a total of 16 questions pertaining to internet and social media usage and demographics of patients, patients' choice of institution for treatment, patient complaints on admission, online hospital and physician ratings, communication between the patient and the physician and its effects.RESULTS It was found that 34.2%(n = 647) of the participants consulted with an orthopaedist using the internet and 48.7%(n = 315) of them preferred websites that allow users to ask questions to a physician. Of all questionaskers, 48.5%(n = 314) reported having found the answers helpful. Based on the educational level of the participants, there was a highly significant difference between the rates of asking questions to an orthopaedist using the internet(P = 0.001). The rate of questionasking was significantly lower in patients with an elementary education than that in those with secondary, high school and undergraduate education(P = 0.001) The rate of reporting that the answers given was helpful was significantly higher in participants with an undergraduate degree compared to those who were illiterate, those with primary, elementary or high school education(P = 0.001). It was also found that the usage of the internet for health problems was higher among managers-qualified participants than unemployed-housewives, officers, workers-intermediate staff(P < 0.05).CONCLUSION We concluded that patients have been increasingly using the internet and social media to select a specific physician or to seek solution to their health problems in an effective way. Even though the internet and social media offer beneficial effects for physicians or patients, there is still much obscurity regarding their harms and further studies are warranted for necessary arrangements to be made.

Prevalence and Incidence of Hand Osteoarthritis and Upper Limb Complaints in Patients with Knee Osteoarthritis. Correlations among Functionality, Grip Strength, Changes in Body Mass Index and Symptoms among Patients in an Educational Osteoarthritis Program

Objective: To evaluate the prevalence of hand osteoarthritis (hOA) in a population with knee osteoarthritis (KOA) at baseline and one year following the administration of a multi-professional OA educational program correlating symptoms and changes in BMI with function questionnaires of the upper limbs and direct grip strength measurements. Design: Epidemiological study of the prevalence of hand OA in patients with knee osteoarthritis. The Stanford Health Assessment Questionnaire instruments (HAQ);Disabilities of the Arm, Shoulder and Hand* (DASH);grip strength;and finger pinch were utilized, and the upper limbs symptoms were verified at baseline and one year following the educational program. Results: The prevalence of hOA was 23.7% at baseline and 47.4% at one year (incidence of 31.8% per year). The HAQ indicated that patients who did not alter or increased their BMI experienced worsened global strength, whereas patients who reduced BMI improved global strength (p = 0.041). Patients with higher initial BMIs experienced less improvement in the HAQ (r = -0.148, p = 0.041). The DASH results improved, but the right and left tripod grip worsened in all patients, irrespective of BMI change (p < 0.05) or symptoms at baseline and reassessment (p < 0.05). Pinch strength (right and left tripod and left pulp-pulp) was higher in patients without symptoms at baseline (p = 0.048, p = 0.045 and 0.033, respectively). Conclusions: The prevalence of hand OA increased for patients with OA undergoing an educational program irrespective of improved upper function and regardless of BMI change. Patients who decreased their BMI improved their global strength.

Utility of somatosensory and motor-evoked potentials in reflecting gross and fine motor functions after unilateral cervical spinal cord contusion injury

Fine motor skills are thought to rely on the integrity of ascending sensory pathways in the spinal dorsal column as well as descending motor pathways that have a neocortical origin.However, the neurophysiological processes underlying communication between the somatosensory and motor pathways that regulate fine motor skills during spontaneous recovery after spinal cord contusion injury remain unclear.Here, we established a rat model of cervical hemicontusive injury using C5 laminectomy followed by contusional displacement of 1.2 mm(mild injury) or 2.0 mm(severe injury) to the C5 spinal cord.Electrophysiological recordings were performed on the brachial muscles up to 12 weeks after injury to investigate the mechanisms by which spinal cord pathways participate in motor function.After spinal cord contusion injury, the amplitudes of somatosensory and motor-evoked potentials were reduced, and the latencies were increased.The forelimb open field locomotion test, grooming test, rearing test and Montoya staircase test revealed improvement in functions.With increasing time after injury, the amplitudes of somatosensory and motor-evoked potentials in rats with mild spinal cord injury increased gradually, and the latencies gradually shortened.In comparison, the recovery times of somatosensory and motor-evoked potential amplitudes and latencies were longer, and the recovery of motor function was delayed in rats with severe spinal cord injury.Correlation analysis revealed that somatosensoryevoked potential and motor-evoked potential parameters were correlated with gross and fine motor function in rats with mild spinal cord contusion injury.In contrast, only somatosensory-evoked potential amplitude was correlated with fine motor skills in rats with severe spinal cord injury.Our results show that changes in both somatosensory and motor-evoked potentials can reflect the changes in gross and fine motor functions after mild spinal cord contusion injury, and that the change in somatosensory-evoked potential amplitude can also reflect the change in fine motor function after severe spinal cord contusion injury.This study was approved by the Animal Ethics Committee of Nanfang Hospital, Southern Medical University, China(approval No.NFYY-2017-67) on June 11, 2017.

Contralateral trapezius transfer to treat scapular winging: A case report and review of literature

BACKGROUND No dynamic technique, such as tendon transfer, has been described for scapular winging due to levator scapulae or rhomboid major and minor palsies resulting from an isolated dorsal scapular nerve injury. Thus, we evaluated how the contralateral trapezius compound osteomuscular flap transfer would work in stabilizing lateral scapular winging, and the case is reported here. A literature review was also conducted, and articles relevant to the case are presented.CASE SUMMARY A 37-year-old male patient who had sustained an isolated dorsal scapular nerve injury underwent reconstructive surgery using the contralateral trapezius compound osteomuscular flap transfer technique to treat scapular winging and the consequent pain, and to restore function from the shoulder impairment. As a result, the involved shoulder showed an improved Constant-Murley score, from19.5% to 81.88%.CONCLUSION Contralateral trapezius osteomuscular flap transfer succeeded in stabilizing scapular winging in this case, improving shoulder function and affording pain relief.

Treatment of knee osteochondritis dissecans with autologous tendon transplantation:Clinical and radiological results

BACKGROUND Defect treatment with tendon autograft in osteochondral lesions has been published in the literature with an experimental study in dogs.To demonstrate that it is possible to treat knee osteochondral lesions with the technique of autologous tendon transplantation.AIM To evaluate the clinical and radiological results of patients with knee osteochondral lesions who were treated with autologous tendon transplantation.METHODS Twenty patients(22 knees)with osteochondritis dissecans(OCD)lesions involving the knee were treated with autologous tendon transplantation between 2005-2018.All lesions were International Cartilage Repair Society grade IV.All patients were evaluated clinically at final follow-up with knee injury and osteoarthritis outcome score(KOOS);and radiologically with magnetic resonance observation and cartilage repair tissue(MOCART)and Kellgren-Lawrence(KL)classification.RESULTS A total of 20 patients(22 knees)with a mean age of 25.5±6.8 years were included.The average defect size was 4.2±2.1 cm^(2),and the average defect depth was 0.9±0.4 cm.Total KOOS score was preoperatively 29.4±5.5 and was later found to be 81.5±5.9 after an average of 68.7±37.7 mo follow-up.The mean MOCART score was 56.2±10.7.Preoperatively,all of the patients had KL grades of 0-1;during the follow-up period,80% of the patients showed no radiological progress of osteoarthritis.Patients with less than 4 cm^(2) lesion had statistically significantly better overall KOOS than patients whose more than 4 cm^(2) lesion,particularly in sport and quality of life subscales.CONCLUSION The autologous tendon transplantation is a single-step,safe,simple,cost-effective method for the treatment of knee OCD with satisfactory clinical and radiological outcomes,particularly in patients with less than 4 cm^(2) lesion.

Clinical symptoms of cervical and shoulder MTrPs combined with the "third stage" dialectical traction in the treatment of cervical radiculopathy and its effect on the serum inflammatory factors of patients

Objective:To observe the clinical efficacy of acupotomology in the treatment of cervical and shoulder myofascial pain trigger point for cervical radiculopathy,and to detect its effect on COX-2,PGE2,5-HT,TNF-α and other inflammatory factors.Methods:A total of 110 CSR patients were selected as the research objects and divided into observation group(Acupotomology to release the trigger points of myofascial pain in neck and shoulder combined with"three-stage"dialectical traction method)and control group(conventional acupuncture combined with"Stage 3"dialectical traction)with 55 cases.Before and after treatment,the two groups were compared by improving the efficacy of MacNab,simplifying the SCORE of Mc Gill Pain Scale,measuring cervical curvature and serum levels of inflammatory factors such as COX-2,PGE2,5-HT and TNF-α.Results:After two weeks of treatment,the total effective rate of the observation group was 96.36%,higher than that of the control group(83.63%),and the difference was statistically significant(P<0.05).After the treatment,PRI,VAS,PPI and other scores of the two groups were all lower than those before the treatment,with statistical significance(P<0.05).However,there was no statistically significant difference in PRI,VAS and PPI scores between the two groups after treatment(P>0.05).The serum inflammatory factors of coX-2,PGE2,5-HT and TNF-αin the two groups were significantly lower after treatment than before treatment(P<0.05).However,the comparison of cox-2,PGE2,5-ht and TNF-αbetween the two groups showed no statistical significance(P>0.05).The cervical curvature values measured after treatment were significantly increased compared with those before treatment,and the difference was statistically significant(P<0.05).There was no statistically significant difference between the two groups(P>0.05).Conclusion:The combination of acumotomology and"three-stage"dialectical traction method can significantly improve the pain and discomfort of patients with cervical radiculopathy,significantly reduce the symptoms,restore the physiological curvature of cervical vertebra,and reduce the inflammatory factors in serum.