ABSTRACT
<p><b>Background</b>In a small proportion of cases, spontaneous osteonecrosis of the knee (SONK) involves the medial tibial plateau (MT). Here, we introduced the clinical characteristics of spontaneous osteonecrosis of the MT and unicompartmental knee arthroplasty (UKA) as the favorable treatment for this situation based on a retrospective case study.</p><p><b>Methods</b>Patients with spontaneous osteonecrosis of the MT, confirmed by magnetic resonance imaging (MRI) at Guangdong Provincial Hospital of Chinese Medicine (China) from March 2015 to June 2016, were included as a case serial and analyzed retrospectively. All patients underwent Oxford Medial UKA. The characteristics of their lesions, corresponding treatment, and results of follow-up were presented. The lesion scores and grade were determined according to the criteria of Ficat and Arlet.</p><p><b>Results</b>In total, 22 patients (5 men, 17 women; mean age, 64.1 years) with spontaneous osteonecrosis of the MT were analyzed. The lesion stages assessment showed that 3 (14%) were Stage II, 10 (45%) were Stage III, 7 (32%) were Stage IV, and 2 (9%) were Stage V. In the sagittal plane, 7 (32%) were in the anterior region (MTa) and 15 (68%) were central (MTc). The lesion volume averaged 2.24 ± 0.79 cm (range: 1.57-3.08 cm). Seventeen patients (77%) had Level III posterior medial meniscus root tears (MMRTs). All the patients underwent UKA. Average follow-up was 30.0 ± 6.4 months with a range of 23.0-38.0 months. The visual analog scale score was 7.78 ± 0.67 before surgery while decreased to 2.22 ± 1.09 at the final follow-up (P < 0.001). The Hospital for Special Surgery scores of pre-/post-surgery were 65.67 ± 5.45 and 84.10 ± 4.20, respectively (P < 0.001).</p><p><b>Conclusions</b>SONK often occurs in the anterior and central tibial plateau due to abnormal stresses. Most of the patients had Level III posterior medial meniscus root tears. MRI is recommended for suspected cases to identify SONK at an early stage. The use of the Oxford Medial UKA for SONK of the MT is reliable both immediately and at follow-up.</p>
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the clinical curative effect of "oblique-pulling" maneuver in patients with lumbar intervertebral disc herniation (LIDH).</p><p><b>METHODS</b>Sixty-five LIDH cases were randomly divided into experimental group and control group. In the experimental group 32 patients were treated by "oblique-pulling" maneuver, and 32 patients in the control group were treated by lumbar traction therapy. One case were excluded from the study and another one case were dropped from the study. After one course of treatment, the therapeutic effects of the two groups were compared quantitatively by using the JOA and VAS scores, including the improvement of signs, symptoms, living ability, and low back and leg pain.</p><p><b>RESULTS</b>After one course of treatment, in the experimental group, 7 cases were controlled well, 16 cases were marked effect, 8 cases were effect, 1 case was no effect. In the control group, 4 cases were controlled well, 10 cases were marked effect, 13 cases were effect, 4 cases was no effect in control group. The clinical effective rate of the experimental group was 96.86%, which was higher than 87.10% of the control group (P < 0.05). In the experimental group the scores of JOA and VAS were obviously improved after treatment (P < 0.001) and the improvement was better than that of control group (P < 0.01).</p><p><b>CONCLUSION</b>The "oblique-pulling" maneuver has the characteristics of simple operation, repeatability, good efficiency, high safety.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Intervertebral Disc Displacement , Lumbar Vertebrae , Manipulation, Spinal , Methods , Pain MeasurementABSTRACT
Objective The purpose of this retrospective research was to analyze the trend of hospitalized prevalence in the past 10 years (1998 -2007) and to estimate resource utilization associated with osteoporotic hip fractures, including hospital length of stay and inpatient costs in Guangzhou,China. Methods 3449 patients aged 50 years and older,hospitalized for primary diagnose of hip fractures in both hospitals in the past ten years were included in our study. Completed data was obtained retrospectively from the hospital medical records. Clinical parameters such as sex-specifics, hospital length of stay, inpatient costs and the constitutions of the inpatient costs were analyzed with multiple statistics methods and regrcssions Results Over the 10-year study period, the number of hospitalizations for hip fractures increased with a curve model. Male and female ratio was 1:1.95 with an average age of the patients as76.32±9.52 years old. Average hospital length of stay was 23.59±13.48 days with no significant difference between males and females, years of admission and the different diagnoses. The number of hospitalization went to the top at the age of 70 to 79 years old (38.45%), followed by 80-89 years old(33.08 % ). Femoral neck fractures was significantly more than that of inter-trochanteric fractures in those patients aged 50 to 79 years (P<0.01 ) but less than those intertrochanteric fractures aged 90 years and older (P<0.05). Average inpatient costs is about 23.52±17.00 thousand Yuan (RMB) (femoral neck fractures is about 25.09±17.62 thousand Yuan and intertrochanteric fracture is 21.44±15.92 thousand Yuan) of which treatment costs (included implants, materials used in the theatre and routinely care of the wound) contributed 52 %, pharmacy intervention 25 %, operation 6 %, ward expenditure 5 %, radiology and physical investigation 5 %, and chemistry test 4 %. The inpatient cost went to a peak at the age of 60-69 years old and were significantly correlated with the hospital length of stay. The coat increased every year in the past 10 years by 6.18%. Conclusion These results emphasized that the growing economic impact arising from the inpatient treatment of ostcoporotic hip fractures and most of which related to treatment cost(include implants, materials used in the theatre and routinely care of the wound), and drugs and always correlated to length of hospital stay. Cost control should be paid more attention to the implants and drugs.