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Objective:To estimate the diagnostic value of anti-cyclic citrullinated peptide (CCP) antibody for juvenile idiopathic arthritis (JIA) by Meta-analysis.Methods:The databases, including Wanfang Database, VIP citation databases, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc, Excerpta Medica Database (EMbase), PubMed, Cochrane Library, were searched for the studies related to the diagnostic value of anti-CCP antibody for JIA. After extracting literature data and assessing the articles by Quality Assessment of Diagnostic Accuracy Studies tool. The sources of heterogeneity, sensitivity (SEN), specificity (SPE), area under the curve (AUC) were calculated by the summary receiver operator characteristic (SROC) curve by Stata 12.0 software.Results:A total of 30 literature reports were included in this Meta-analysis. The heterogeneity and the threshold effect of the included articles were tested, a mixed effects model was selected to calculate the pooled weighted SEN [0.16, 95% CI(0.11, 0.22)], SPE [0.99, 95% CI(0.98, 0.99)] and AUC [0.86, 95% CI(0.83, 0.89)]. The sensitivity estimates were highly heterogeneous, which was partially explained by the higher sensitivity in the rheumatoid factor-positive polyarthritis (RF+PA) subtypes [0.65, 95% CI (0.51, 0.76)] than in the other subtypes. The ability of diagnostic differentiation between of JIA and healthy children was better than the diagnostic differentiation between JIA and other patients ( Z=7.9, P<0.01). Conclusion:Although anti-CCP antibody cannot be used as an early diagnostic indicator of JIA, it can provide a certain guiding role in the initial screening and early treatment of the disease. CCP has clinical value in the differential diagnosis of RF+PA subtypes.
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Objective To observe the feasibility and clinical curative effect of anatomical reduction and fixation of lesser trochanter through posterior-lateral approach for the treatment of comminuted femoral intertrochanteric fractures in elderly patients.Methods A total of 19 cases with comminuted femoral intertrochanteric fracture,aged 60 to 84 years were enrolled in this study.According to Evans-Jensen classification,13 cases had type Ⅱ B and 6 cases had type Ⅲ femoral fracture.Through the posterior-lateral approach,the lesser trochanter was fully exposed,reduced and fixed by screw.The proximal and distal femur were well fixed with dynamic hip screw(DHS)or proximal femoral locking plate(PFLP).The lesser trochanter reduction was observed by intraoperative vision and postoperative X-ray.The function evaluation after hip surgery was performed by using Sanders hip function score.Results All 19 patients obtained the anatomic reattachment in the lesser trochanter.All patients were followed up for an average of 18 months.After treatment,the Sanders hip function score were excellent in 7 patients (36.8 ％),fine in 12 cases (63.2 ％).And curative efficacy was good in all cases(100％).There was no significant difference in the curative effect between patients with different classification and gender.Conclusions Through the posterior-lateral approach,the surrounding structures of the lesser trochanter can be fully exposed,and the lesser trochanter can be anatomically repositioned.The posterior-lateral approach to anatomical reduction and fixation of lesser trochanter is an effective and feasible method for the treatment of comminuted intertrochanteric fracture in the elderly.
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Objective@#To observe the feasibility and clinical curative effect of anatomical reduction and fixation of lesser trochanter through posterior-lateral approach for the treatment of comminuted femoral intertrochanteric fractures in elderly patients.@*Methods@#A total of 19 cases with comminuted femoral intertrochanteric fracture, aged 60 to 84 years were enrolled in this study.According to Evans-Jensen classification, 13 cases had type Ⅱ B and 6 cases had type Ⅲ femoral fracture.Through the posterior-lateral approach, the lesser trochanter was fully exposed, reduced and fixed by screw.The proximal and distal femur were well fixed with dynamic hip screw(DHS)or proximal femoral locking plate(PFLP). The lesser trochanter reduction was observed by intraoperative vision and postoperative X-ray.The function evaluation after hip surgery was performed by using Sanders hip function score.@*Results@#All 19 patients obtained the anatomic reattachment in the lesser trochanter.All patients were followed up for an average of 18 months.After treatment, the Sanders hip function score were excellent in 7 patients(36.8%), fine in 12 cases(63.2%). And curative efficacy was good in all cases(100%). There was no significant difference in the curative effect between patients with different classification and gender.@*Conclusions@#Through the posterior-lateral approach, the surrounding structures of the lesser trochanter can be fully exposed, and the lesser trochanter can be anatomically repositioned.The posterior-lateral approach to anatomical reduction and fixation of lesser trochanter is an effective and feasible method for the treatment of comminuted intertrochanteric fracture in the elderly.
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ObjectiveTo observe the clinical effects of locking proximal humerus plate(LPHP) in the treatment of complex proximal humeral fracture of aged patients and to analyze the influencing factors. Methods Among 39 cases with complex humeral fractures (aged 60-83 years),there were 29 cases with three-part fractures and 10 with four-part fractures according to the Neer classification.They were operated by LPHP via deltoid-pectoral approach. Neer numerical rating system was employed to evaluate postoperative function of shoulders.Results39 cases were followed up for average of 16 months.According to Neer numerical rating system,the excellence rates of three-part fractures and four-part fractures were 86.2％ (25 cases) and 50.0％ (5 cases),respectively,with total excellence rate of 76.9％(30 cases). Age (OR =1.314, P＜0.05) and fracture type ( OR =1.295, P＜0.05)ofpatientswereindependentriskfactorsforprognosis of proximal humeral fracture of aged patients by multiple logistic regression. Conclusions LPHP is an effective implant for treating complex proximal humeral fracture of aged patients,with age and fracture types as important risk factors of prognosis.=humeral fractures