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Objective:To establish a composite functional evaluation system to study the clinical efficacy of single plate and double plate internal fixation in the treatment of C3 distal radius fractures in the elderly.Methods:62 elderly patients (≥ 60 years old) with type C3 distal radius fractures who were admitted to the First Affiliated Hospital of Anhui University of Science and Technology from September 2018 to August 2021 were retrospectively selected and divided into two groups according to the surgical methods: bilateral plate internal fixation treatment group (double plate group) and unilateral plate internal fixation treatment group (single plate group); The preoperative anatomical angle, wrist mobility (flexion and extension) and radius shortening of the two groups were recorded. The anatomical angle, wrist mobility (flexion and extension), clinical Gartland-Werley, DASH Score for Upper Limb Function (DASH) , Wrist Joint Cooney Score and clinical healing time at the 3rd, 6th, 9th and 12th months after operation were followed up. A composite evaluation table was established to comprehensively evaluate the postoperative recovery of patients in the two group.Results:There was no significant difference in anatomical indexes of radius between the two groups before operation (all P>0.05). All anatomical angles and wrist range of motion were within the normal range after operation, and there was no statistical difference between the two groups in each anatomical index of radius within 3 and 6 months after operation (all P>0.05). However, the palmar inclination, ulnar deviation, wrist flexion and dorsiflexion mobility of the double plate group were relatively stable at 9 and 12 months after operation, which were better than those of the single plate group (all P<0.05). The palmar inclination and ulnar deviation of the single plate group increased with time. After operation, the radius shortening of the two groups recovered significantly, and the radius length of the double plate group was maintained better than those of the single plate group for 9 and 12 months (all P<0.05). There was no significant difference in the scores of the two groups within 3 and 6 months after operation (all P>0.05), but the Gartland Werley score, DASH score and Cooney wrist score of the double plate group were significantly better than those of the single plate group at 9 and 12 months after operation (all P<0.05). The clinical healing time of single plate treatment was (14.51±0.88)weeks, the longest was 108 days, while that of double plate treatment was (12.03±1.77)weeks, the longest was 129 days, with statistically significant difference ( P<0.05). There was no significant difference in the incidence of complications between the two groups ( P>0.05). There was no statistically significant difference between the two groups in the final composite evaluation results ( P>0.05), but the total score of the double plate group was smaller than that of the single plate group, with a difference of 39.67 points, indicating that the double plate group still had certain advantages in various scores. Conclusions:According to the composite evaluation system, both single plate and double plate treatment of C3 distal radius fractures in the elderly can achieve satisfactory results. Double plate fixation of distal radius fractures still has a certain significance in maintaining joint stability and improving joint mobility.
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Objective To explore the effect of multi-detector computed tomography (MDCT)scan parameters and imaging post-processing methods on metallic artifacts,so as to achieve the perfection in reduction of artifacts caused by metallic implants.Methods Water phantom with titanium alloy steel plate was scanned under MDCT with alternating scan parameters including tube voltage, tube current,pitch and focal spot.The areas of image artifacts were measured and correlated with the scan parameters.Another 1 5 postoperative patients with vertebral implantation scaned with the conventional scan parameters were also included in the study.Ima-ging post-processing including multi-planar reconstruction (MPR),window width and level adjustment,and volume rendering tech-nique (VRT)was performed by using optimized and conventional methods,respectively,and then the image quality was evaluated. Results The areas of image artifacts under the differnt tube voltage,pitch,and focal spot were statistically different.With the in-crease of the tube voltage or the decrease of the pitch,the area of image artifacts decreased gradually.The area of image artifacts scanned with the small focal spot was smaller than the large one.There was no significant difference for the area of image artifacts scanned with the different tube currents.The metallic artifacts decreased by using the soft tissue algorithm (Kernel B40f)in the bone window reconstruction,wide windows (2 000 HU window width,600 HU window level)in observing,and VRT.Conclusion Selection of appropriate MDCT scan parameters and imaging post-processing methods can reduce the metal artifacts,improve the image quality and diagnosis.
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Objective To observe the lumbosacral plexus nerves by diffusion tensor tractography (DTT) and quantitatively evaluate them by using diffusion tensor imaging (DTI) in healthy volunteers.Methods A total of 60 healthy volunteers (30 males and 30 females) underwent DTI scanning.Mean FA values of the lumbosacral plexus nerves (both sides of lumbar roots L3 to S1,proximal and distal to the lumbar foraminal zone) were quantified.Differences among various segments of lumbar nerve roots were compared with ANOVA test and SNK test.Differences between two sides of the lumbar nerve roots at the same lumbar segment were compared with paired-samples t test.Differences between the proximal and the distal nerve to the the lumbar foraminal zone at the same lumbar segment were compared with paired-samples t test.The lumbosacral plexus nerve was visualized with tractography.Results (1) The lumbosacral plexus nerve was clearly visualized with tractography.(2) Mean FA values of the lumbar nerve roots L3 to S1 were as followings:proximal to the left lumbar foraminal zone 0.202 ± 0.021,0.201 ± 0.026,0.201 ± 0.027,0.191 ±0.016,distal to the left lumbar foraminal zone 0.222 ± 0.034,0.250 ± 0.028,0.203 ± 0.026,0.183 ± 0.020,proximal to the right lumbar foraminal zone 0.200 ± 0.023,0.202 ± 0.023,0.205 ± 0.027,0.191 ±0.017,distal to the right lumbar foraminal zone 0.225 ±0.032,0.247 ±0.027,0.205 ± 0.033,0.183 ±0.021.Mean FA values were significantly different between the proximal nerve to the distal nerve in lumbar nerve roots L3,L4,S1 (t =-9.114-2.366,P ＜ 0.05),but not significantly different in L5 (P ＞ 0.05).Differences were not found between the right and left side nerves at the same lumbar segment (P ＞ 0.05).(3) The whole length of the lumbar roots nerve L3 to S1 can be visualized clearly by using DTT.Conclusions Diffusion tensor imaging and tractography can show and provide quantitative information of human lumbosacral plexus nerves.DTI is a potential tool for the diagnosis of lumbosacral plexus nerve disease.