ABSTRACT
Osteoporotic proximal humeral fracture (OPHF) is one of the common osteoporotic fractures in the aged, with an incidence only lower than vertebral compression fracture, hip fracture, and distal radius fracture. OPHF, secondary to osteoporosis and characterized by poor bone quality, comminuted fracture pattern, slow healing, and severely impaired shoulder joint function, poses a big challenge to the current clinical diagnosis and treatment. In the field of diagnosis, treatment, and rehabilitation of OPHF, traditional Chinese and Western medicine have accumulated rich experience and evidence from evidence-based medicine and achieved favorable outcomes. However, there is still a lack of guidance from a relevant consensus as to how to integrate the advantages of the two medical systems and achieve the integrated diagnosis and treatment. To promote the diagnosis and treatment of OPHF with integrated traditional Chinese and Western medicine, relevant experts from Orthopedic Expert Committee of Geriatric Branch of Chinese Association of Gerontology and Geriatrics, Youth Osteoporosis Group of Orthopedic Branch of Chinese Medical Association, Osteoporosis Group of Orthopedic Surgeon Branch of Chinese Medical Doctor Association, and Osteoporosis Committee of Shanghai Association of Integrated Traditional Chinese and Western Medicine have been organized to formulate Expert consensus on the diagnosis and treatment of osteoporotic proximal humeral fracture with integrated traditional Chinese and Western medicine ( version 2024) by searching related literatures and based on the evidences from evidence-based medicine. This consensus consists of 13 recommendations about the diagnosis, treatment and rehabilitation of OPHF with integrated traditional Chinese medicine and Western medicine, aimed at standardizing, systematizing, and personalizing the diagnosis and treatment of OPHF with integrated traditional Chinse and Western medicine to improve the patients ′ function.
ABSTRACT
With the spread of novel coronavirus pneumonia (NCP) in December 2019, the management and rehabilitation of elderly patients with hip fractures and protection of medical staff face new challenges, and need to be adjusted appropriately under this very circumstances. Hip fractures in the elderly account for more than half of osteoporotic fractures. Expert group formulate this consensus so as to make better decision against this epidemic and protect patients' families and medical staff. This consensus elaborates not only epidemic condition of NCP, but also general principles of medical admission, treatment and protection for both medical staff and patients, in order to provide some reference and promote the standardization of clinical diagnosis and treatment of elderly patients with hip fractures under the condition of NCP.
ABSTRACT
With the spread of corona virus disease 2019 (COVID-19) in December 2019, the management and rehabilitation of elderly patients with hip fractures and protection of medical staff face new challenges, and need to be adjusted appropriately under this very circumstances. Hip fractures in the elderly account for more than half of osteoporotic fractures. Expert group formulate this consensus to make better decision against this epidemic and protect patients and medical staff. This consensus elaborates not only epidemic condition of COVID-19, but also general principles of medical admission, treatment and protection for both medical staff and patients, so as to provide some reference and promote the standardization of clinical diagnosis and treatment of elderly patients with hip fractures under the condition of COVID-19.
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TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.
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<p><b>OBJECTIVE</b>To compare the clinical effects between closed reduction and internal fixation (CRIF) and total hip arthroplasty (THA) for displaced femoral neck fracture.</p><p><b>METHODS</b>In this prospective randomized study, 285 patients aged above 65 years with hip fractures (Garden III or IV) were included from January 2001 to December 2005. The cases were randomly allocated to either the CRIF group or THA group. Patients with pathological fractures (bone tumors or metabolic bone disease), preoperative avascular necrosis of the femoral head, osteoarthritis, rheumatoid arthritis, hemiplegia, long-term bed rest and complications affecting hip functions were excluded.</p><p><b>RESULTS</b>During the 5-year follow-up, CRIF group had significantly higher rates of complication in hip joint, general complication and reoperation than THA group (38.3% vs. 12.7%, P<0.01; 45.3% vs. 21.7%, P<0.01; 33.6% vs. 10.2%, P<0.05 respectively). There was no difference in mortality between the two groups. Postoperative function of the hip joint in THA group recovered favorably with higher Harris scores.</p><p><b>CONCLUSION</b>For displaced fractures of the femoral neck in elderly patients, THA can achieve a lower rate of complication and reoperation, as well as better postoperative recovery of hip joint function compared with CRIF.</p>
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Arthroplasty, Replacement, Hip , Methods , Femoral Neck Fractures , General Surgery , Fracture Fixation, Internal , Methods , Postoperative Complications , Epidemiology , Prospective Studies , Treatment Failure , WalkingABSTRACT
Objective To explore the best scheme of clinical diagnosis and treatment of neonatal severe disease complicated with hyponatremia.Methods 120 severe disease neonatal with hyponatremia were randomly divided into observation group and control group,60 cases in each group.The observation group was given special care and treatment for the cause,the control group was given conventional treatment in intensive care and conventional sodium.The incidence rate of severe disease and the treatment effect of hyponatremia were compared.Results After treatment,the total incidence rate of severe disease of the observation group was 8.3％,that was 23.3％ in the control group,there was significant difference between two groups (x2 =3.858,P ＜ 0.05).In observation group,the markedly effective rate of hyponatremia was 83.3％,that was 63.3％ in the control group,there was significant difference between two groups (x2 =10.231,P ＜ 0.05).Conclusion Special intensive care and aimed at pathogeny cure can obviously reduce the probability of hyponatremia complicated with severe disease,and it can significantly improve the treatment effect of hyponatremia,it has fairly well clinical value.
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Objective To discuss and analyze the diagnosis,management and surgical techniques for cranioplasty of skull vault defects and skull base reconstruction in order to raise the therapeutic effect. Methods The clinical data of 169 cases of skull vault and skull base defects treated with cranioplasty of skull vault defect and skull base reconstruction were retrospectively analyzed.Results Overlay tech- nique or inlay technique with imported titanium alloy mesh was used in 160 cases,and homologous bone was used in 9 cases.The surgical time ranged from 3 months to 8 years after injury.Eight cases presented with complications such as hematoma,subcutaneous effusion,infection and epilepsy postoperatively,but no operative death occurred.Conclusion For patients with skull vault defect with the diameter≥3 cm the best operative time is 3 months after injury,and for patients with intracranial and extracranial communica- ting tumors,skull base reconstruction can be performed when tumors are removed.Much attention should be paid to perioperative management and surgical skills.
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Within three years ,86 cases of tumors in the pineal region were treated by X－ Knife radiosurgical technique,using the standard axial serial CT scan for stereotactic localization,the target were localized by the BRW coordinate system.Radionics RSA－ 3 X－ Knife treatment planning system were used to make plan,Philips SL－ 75－ 14 Linac was used to produce X－ ray.After treatment, follow－ up ranged 6～ 42 months (meanly 24 months),most of the patients showed improvements within 1｀ 6 months. The results of this report proved that the X－ Knife treatment for tumors in the pineal region might be an effective,economical and reliable method.
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OBJECTIVE: The brain TXA(2) and PGI(2) levels in a new rodent model of impact acceleration diffuse brain injury alone and with hypotention and hyperthermia in combination were observed to look into the relationship between TXA(2), PGI(2) levels and different types of head injury. METHODS: Thirty-two SD rats were randomized into sham, head injury alone, secondary insult alone and head injury with secondary insult groups. At 4 hours after injury or experiment, all the rats were decapitated and their brains were sampled for radioimmunoassay (RIA) measurement. RESULTS: Compared with that of sham group there were no changes in TXA(2) and PGI(2) levels in injury alone group while there was a significant augmentation in PGI(2) level in insult alone group. Both TXA(2) and PGI(2) level in injury with secondary insult group increased significantly in comparison with that of sham at 4 hours postimpact. CONCLUSIONS: PGI(2) providing energy and precursors to the injured tissue and producing some vasoactive arachidonic products, especially TXA(2), is closely connected to the severity of brain damage.