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Purpose@#To evaluate the effectiveness of advanced practice nurse–guided home-based rehabilitation exercise program (HREPro) among patients with lower limb spasticity post-stroke. @*Methods@#This randomized controlled study recruited 121 patients with lower limb spasticity post-stroke. Intervention (n = 59) and control (n = 62) groups underwent 12-month HREPro and conventional rehabilitation, respectively, after discharge. The Fugl–Meyer assessment of spasticity measurement, modified Ashworth scale of motor function, 10-Meter Walk Test of walking ability, and Barthel index of activities of daily living (ADL) were evaluated at 0, 3, 6, and 12 months after discharge. @*Results@#Significant differences were found in spasticity degree, motor function, walking ability, and ADL at 6 and 12 months after discharge between the control and intervention groups. Lower limb spasticity and ADL in the intervention group were significantly improved. @*Conclusion@#HREPro is effective for rehabilitation of patients with lower limb spasticity post-stroke and has favorable home application.
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Purpose@#To evaluate the effectiveness of advanced practice nurse–guided home-based rehabilitation exercise program (HREPro) among patients with lower limb spasticity post-stroke. @*Methods@#This randomized controlled study recruited 121 patients with lower limb spasticity post-stroke. Intervention (n = 59) and control (n = 62) groups underwent 12-month HREPro and conventional rehabilitation, respectively, after discharge. The Fugl–Meyer assessment of spasticity measurement, modified Ashworth scale of motor function, 10-Meter Walk Test of walking ability, and Barthel index of activities of daily living (ADL) were evaluated at 0, 3, 6, and 12 months after discharge. @*Results@#Significant differences were found in spasticity degree, motor function, walking ability, and ADL at 6 and 12 months after discharge between the control and intervention groups. Lower limb spasticity and ADL in the intervention group were significantly improved. @*Conclusion@#HREPro is effective for rehabilitation of patients with lower limb spasticity post-stroke and has favorable home application.
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Objective@#To compare the clinical results between arthroscopic anchor suture bridge and Ethibond suture bone tunnel for anterior cruciate ligament (ACL) tibial avulsion fractures.@*Methods@#A retrospective case control study was conducted to analyze the clinical data of 18 patients with ACL tibial avulsion fracture admitted to Wenzhou Central Hospital from June 2012 to June 2017. There were 14 males and four females, aged 12-57 years, with an average age of 31.4 years. According to the Meyers-McKeever classification, there were six patients with type II and 12 patients with type III. Seven patients underwent anchor suture bridge fixation (anchor group), and 11 patients underwent Ethibond suture bone tunnel fixation (Ethibond suture group). The operation time, range of motion (ROM) of knee joint, Lysholm knee score and International Knee Documentation Committee (IKDC) knee score of the two groups were compared before operation and 3, 6 and 12 months after operation.@*Results@#All patients were followed up for 12-36 months, with an average of 20.18 months. The operation time of anchor group [(87.14±8.59)minutes]was longer than that of Ethibond suture group [(71.1±11.5)minutes](P<0.05). The ROM of anchor group and Ethibond suture group was (127.1±8.6)° and (124.1±7.4)° respectively at 3 months after surgery, showing no statistical difference between the two groups (P>0.05). But the functional knee scores (Lysholm score and the IKDC score) revealed better clinical results in anchor group [(91.9±3.0)points, (85.6±4.1) points respectively] than Ethibond suture group [(88.6±3.3)points, (79.9±4.9)points respectively] at 3 months after surgery (P<0.05). There were significant differences between before and after operation within two groups regarding the knee function scores including ROM, Lysholm knee score and IKDC score (P<0.05). Three months after operation, there were significant differences between the two groups in terms of the Lysholm score and IKDC score (P<0.05), but there were no statistical differences between two groups at 6 months and 12 months after surgery (P>0.05).@*Conclusions@#Both arthroscopic anchor and Ethibond suture can achieve plane fixation of fracture, but there is no significant difference in the long-term effect of improving knee joint mobility and restoring knee joint function between the two approaches. However, the anchor group can achieve early recovery of knee joint function.
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Objective To compare the clinical results between arthroscopic anchor suture bridge and Ethibond suture bone tunnel for anterior cruciate ligament (ACL) tibial avulsion fractures.Methods A retrospective case control study was conducted to analyze the clinical data of 18 patients with ACL tibial avulsion fracture admitted to Wenzhou Central Hospital from June 2012 to June 2017.There were 14 males and four females,aged 12-57 years,with an average age of 31.4 years.According to the Meyers-McKeever classification,there were six patients with type Ⅱ and 12 patients with type Ⅲ.Seven patients underwent anchor suture bridge fixation (anchor group),and 11 patients underwent Ethibond suture bone tunnel fixation (Ethibond suture group).The operation time,range of motion (ROM) of knee joint,Lysholm knee score and International Knee Documentation Committee (IKDC)knee score of the two groups were compared before operation and 3,6 and 12 months after operation.Results All patients were followed up for 12-36 months,with an average of 20.18 months.The operation time of anchor group [(87.14 ±8.59)minutes] was longer than that of Ethibond suture group [(71.1 ± 11.5)minutes] (P ＜ 0.05).The ROM of anchor group and Ethibond suture group was (127.1 ±8.6)° and (124.1 ±7.4)° respectively at 3 months after surgery,showing no statistical difference between the two groups (P ＞ 0.05).But the functional knee scores (Lysholm score and the IKDC score) revealed better clinical results in anchor group [(9 1.9 ± 3.0) points,(85.6 ± 4.1) points respectively] than Ethibond suture group [(88.6 ± 3.3) points,(79.9 ± 4.9) points respectively] at 3 months after surgery (P ＜ O.05).There were significant differences between before and after operation within two groups regarding the knee function scores including ROM,Lysholm knee score and IKDC score (P ＜ 0.05).Three months after operation,there were significant differences between the two groups in terms of the Lysholm score and IKDC score (P ＜ 0.05),but there were no statistical differences between two groups at 6 months and 12 months after surgery (P ＞ 0.05).Conclusions Both arthroscopic anchor and Ethibond suture can achieve plane fixation of fracture,but there is no significant difference in the long-term effect of improving knee joint mobility and restoring knee joint function between the two approaches.However,the anchor group can achieve early recovery of knee joint function.
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Objective To investigate the injury and disruption of anterior sacroiliac ligament (ASIL) and sacrotuberous/sacrospinous ligament complex(STL/SSL),as well as the displacement of pubic symphysis (PS) and sacroiliac joint (SIJ),associated with anterior-posterior compression (APC) of Young-Burgess type Ⅱ.Methods Test models of APC of Young-Burgess type Ⅱ were created in 10 fresh human pelvic cadaveric specimens which were randomized into 2 equal groups (n =5).The fight hemipelvis in one group was fixed to a table (the limited group) while that in the other was not (the unlimited group).At the disruption point of ASIL during external rotation of the hemipelvis,displacement of PS,separation distance between the anterior parts of the sacroiliac joint,and injury and disruption of STL/SSL were recorded.When STL/SSL was gradually made to breakdown and fracture with continuous external rotation of the hemipelvis,bony changes and injuries to the posterior pelvic ligaments were observed and recorded.Results At the failure point of ASIL,the mean displacement of PS was 23.8 ± 2.8 mm and that of SIJ was 10.9 ± 4.4 mm,showing no significant difference between the limited and unlimited groups (P ＞ 0.05);the mean external rotation angle was 40.1°± 9.8° and the mean torsion was 646.7 ± 131.5 N,showing significant differences between the limited and unlimited groups (P ＜ 0.05).At the disruption point of ASIL,obvious injuries or disruption of STL/SSL were not observed in the unlimited group but observed in the limited group.With extreme external rotation,obvious disruption of STL/SSL was not found in the unlimited group but observed in the limited group.When ASIL and STL/SSL were all fractured,the mean displacement of PS was 41.8 mm and that of SIJ was 16.8 mm in the limited group.Conclusions Since APC injury can lead to 2 situations,limited or unlimited hemipelvis,external rotation injuries to the ligaments differ in the 2 different situations.When ASIL fails,the displacement of PS will fluctuate greatly.
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Objective To investigate radiological characteristics of the posterior tibial plateau fracture and operative treatments for the fracture.Methods Thirty-one cases of posterior tibial plateau fracture treated between February 2009 and February 2014 were enrolled.There were 19 men and 12 women aged 24-72 years (mean,42.5 years).Injury arose from traffic accidents (13 cases),falls from a height (9 cases),fall on the ground (5 cases),and crash (4 cases).Type Ⅴ in 15 cases and type Ⅵ in 15 cases were classified by the Schatzker classification.Meanwhile,all fractures were identified as three-column pattern.According to the X-ray and CT manifestations of fracture displacement,the cases with minor displacement were grouped as Group A (22 cases) and the cases with major displacement group as Group B (9 cases).Depending on the radiographic characteristics of fracture size and angle off fracture line,anterior approach for reduction and fixation was performed in Group A and combined anterolateral and posteromedial approaches in Group B.Radiographic and functional outcomes were evaluated using the Rasmussen score.Results All cases underwent one-stage surgery uneventfully.Operation time was 80-120 minutes (mean,98 minutes) in group A and was 110-165 minutes (mean,110 minutes) in Group B.Mean total operation time was 105 minutes.Period of follow-up was 6-48 months (mean,21.5 months).Rasmussen radiographic results showed total excellent to good rate of 84％ with 86％ in Group A and 78％ in Group B respectively.Rasmussen functional results showed total excellent to good rate of 87％ with 91％ in Group A and 78％ in Group B respectively.Conclusions Anterior approach or anterolateral approach combined with posteromedial approach for reduction and internal fixation is developed according the radiographic findings and degree of fracture displacement.Clinical outcome is good and associated intraarticular soft tissue injury can be managed concurrently.
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Objective To perform a mechanical test of fresh cadaver specimens and compare the biomechanical properties of the novel minimal invasion dynamic hip plate (MIDHP) and the dynamic condylar screw (DCS) in treatment of subtrochanteric fractures of the femur.Methods All specimens were firstly used to simulate models of Seinsheimer type ⅡA subtrochanteric fractures of the femur,which were later divided into DCS group and MIDHP group.Based on experimental requirements,the femoral head and distal femur were embedded using seff-freezing type dental base acrylic resin powder.Torsion strength test was given in the first place,succeeded by compression strength test.Finally,destructive test was made to record the limit load.All experimental data were analyzed statistically.Results Torsion strength test showed that specimens of both groups were basically stable as the reverse was within 3°.Torque for specimens in DCS and MIDHP groups was (3.16 ± 0.13) N · m and (3.31 ± 0.27) N · m respectively as the reverse was 1.5°.Both torque and torsion stiffness had no statistical significance between the two groups,and the anti-rotation features of the two internal fixations were similar.Compression strength test showed that compression stiffness of specimens in DCS group was (532.27 ±61.02) N/mm and (581.98 ±77.56) N/mm in MIDHP group at a load of 800 N,with evidently higher compression displacement and stiffness in MIDHP group (P ＜ 0.05).Destructive test showed the maximum load of specimens in DCS and MIDHP groups was (2 994.38 ±244.81) N and (3 322.13 ± 141.21) N respectively,far higher in MIDHP group (P ＜ 0.01).Conclusions MIDHP is characterized by reasonable design,strong anti-rotation property and anti-compression property over DCS.In comparison with DCS,MIDHP has biomechanical advantage in treatment of femoral subtrochanteric fractures,for it can be performed minimally invasive and is worthy of further application.
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Objective To investigate the possibility,surgical methods,outcome and surgical indications of minimal invasion dynamic hip plate (MIDHP) through percutaneous limited open reduction in treatment of subtrochanteric femur fractures.Methods All cases underwent percutaneous limited open reduction with MIDHP.Duration of operation,intraoperative bleeding volume,length of incision,incidence of intra-or post-operative complications of all case were recorded.X-ray films were reviewed periodically after operation to analyze aspects of fracture displacement,loosening of intemal fixation,screw cutting femoral neck,screw penetrating out of or withdrawing from femoral head,bending or breaking of internal fixation,and fracture healing.Hip joint function was evaluated according to Huang' s criteria.Results Operation lasted for 45-55 minutes (average 50 minutes),showing the incision length of 4.0-5.0 cm (average 4.5 cm) and blood loss of 50-200 ml (average 150 ml).A total of 21 cases were enrolled in the study and were followed up for 6-28 months (average 18 months).In the follow-up,loosening or bending of internal fixation,fracture displacement,screw cut-out,and screw penetrating or withdrawing from femoral head did not occur.In the meantime,incision,bone,and joint were not infected.All cases had bony fusion within 3 months with the fracture healing rate of 100％.According to Huang' s criteria,hip function was excellent in 19 cases and good in two.Conclusions MIDHP with percutaneous limited open reduction is characterized by less trauma,small incision,less blood loss,less postoperative complications,firm fixation,early functional exercise,free load,and good hip functional recovery and hence is suitable for cases of different subtrochanteric femur fractures,especially for cases combined with osteoporosis.
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Objective To explore different treatment choices for unilateral cervical facet locking. Methods The study involved 32 patients with cervical unilateral facet locking. Successful reduction by the skull traction was done in eight patients, of whom three were fixated by the head and neck chest plas-ter after a month of traction. Five patients were treated with anterior decompression and internal fusion fixation. The other 23 patients resulted in failure of traction and then were treated with anterior reduction, discectomy and internal fusion fixation in 14 patients, subtotal vertebral decompression and bone graft fix-ation in three, posterior open reduction and anterior bone graft fixation in one, posterior reduction, fixation and internal fusion fixation in three and posterior reduction and decompression plus anterior discectomy decompression and bone graft fixation in two. Due to misdiagnosis, one patient was treated with anterior decompression and fusion eight months after injury. Results A follow-up for average 18 months showed cervical instability in two patients who were treated with only traction, without fusion. The patients treated with anterior cervical fusion obtained bone union after 12 weeks, with satisfactory cervical physiological curvature and vertebral height. There were no internal fixation complications or neurological complications. Conclusions The treatment of lower cervical unilateral facet locking needs a compre-hensive considerations on whether there associates with disc injury, posterior column fractures or spinal cord injuries. As for patients with lower cervical unilateral facet locking combined with traumatic cervical disc herniation, the anterior reduction and decompression is the choice of treatment. While for those with-out disc herniation, traction or posterior open reduction and fixation can be carried out directly.
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Objective To investigate the anatomical features, operative method and efficacy of internal fixation in the treatment of iutra-articular fractures of caleaneum via the sinus tarsi approach. Methods The pathway, branches distribution and anastomosis of perforating descending branch of peroneal artery were observed on 18 adult cadaveric lower limbs. A sinus tarsi approach was designed. From July 2001 to January 2008, 71 intra-articular calcaneal fractures in 68 patients were treated with open reduction and internal fixation via sinus tarsi approach at lateral sides of calcaneus. According to the Sanders classification, there were 26 type Ⅱ fractures, 32 type Ⅲ fractures and 13 type Ⅳ fractures. Results All patients were followed up for a mean period of 39.3 months (13-85 months), and the fractures were completely healed. There was a significant difference in the length, width and height of the calcaneus, Bohler angle and Gissane angle before and after operation (P < 0.01). According to Maryland Foot Score, the operative effect was excellent in 33 feet, good in 29 feet, fair in 6 feet and poor in 3 feet. Conclusion Open reduction and internal fixation via sinus tarsi approach is an effective method for minimally invasive treatment of intraarticular fractures of the calcaneus, with the advantages of good clinical results and causing minimal damage to soft tissues.
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Objective To study the feasibility and clinical effect of percutaneous C2 pedicle lag screw in treatment of Hangman's fracture and define the indications of the technique. Methods There were 9 patients including 5 males and 4 females at average age of 36 years (26-68 years). According to a Levine and Edwards System, there were 5 patients with type Ⅰ hangman' s fracture, 3 with type Ⅱ hangman' s fracture and 1 with type Ⅱ A hangman' s fracture. According to American spinal injury association (ASIA) system, the spinal cord function was ranked at Type D in 2 patients and Type E in 7. All patients achieved anatomic reduction by skull traction. Under general anesthesia, 9 patients were fixed with percutaneons C2 pedicle lag screw. The whole procedure was done under monitoring of "C"-arm fluoroscopy for safety and accuracy. Results All patients obtained bony fusion within 2-3 months, with no infection, neurological deficits, vertebra artery injury or other complications. CondusionsThe percutaneous C2 pedicle lag screw fixation is minimally invasive and effective for treatment of Hangman's fracture. During the course of treatment, the function of upper cervical spine remains unaffected.
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[Objective]Supracondylar fracture of the humerus is the most common fracture around elbow in children.In recent years,with the progress of minimally invasive technique,closed reduction and percutaneous Kirschner wire fixation has been widely applied in clinics to reduce the complications and surgical trauma.The relative literature concerning supracondylar fracture of the humerus in children was reviewed to find out the latest progress in classification criteria,the manipulation and reference standard of closed reduction,the configuration and effects of different percutaneous Kirschner wire fixation,and the complications and prevention measures for closed reduction and percutaneous pinning fixation.