ABSTRACT
Objective To investigate the clinical efficacy of microendoscopic discectomy(MED) and fanestration discectomy (FD) for treating single segement lumbar disc herniation(LDH).Methods A total of 168 patients with single segment LDH were included in this retrospective study from April 2009 to Janurary 2012.The patients were divided into MED group(81 cases) and FD group(87 cases) according to surgery mode.The operation and hospitalization indexes for each group were collected and compared respectively.The clinical outcomes were evaluated by the visual analogue scale(VAS),Japanese Orthopedic Association(JOA) scores and Oswestry Disability Index(ODD.Lumbar curves(Cobb's angle),intervertebral space height,horizontal displacement and angular displacement before and after surgery were applied to evaluate the lumbar spinal stability.Results The skin incision length,amount of intraoperative blood loss,operation time and hospitalization duration in the MED group were less than that in the FD group(P＜0.05).All cases completed follow up for more than 4 years.The each item score at last follow up in the two groups was significantly improved compared with before operation(P＜0.05),the inter-group comparison had no statistical difference(P＞0.05).The postoperative lumbar curve and intervertebral space height were decreased in both groups.The postoperative lumbar curve in the FD group was decreased compared with the MED.One case in the MED group and 3 cases in the FD group appeared lumbar vertebral instability.Conclusion Both MED and FD for treating single segment LDH can gain better clinical effect,MED has short operation time,small trauma and little influence on lumbar vertebral stability,and is an effective minimal invasive surgery.
ABSTRACT
Objective To compare the clinical outcome of internal fixation(IF)and total hip arthroplasty (THA)for the elderly patients with displaced femoral neck fracture. Methods A total of 128 patients with dis-placed femoral neck fracture admitted from January 2010 to December 2012 were selected and divided into IF group(61 cases)and THA group(67 cases). The operation and hospitalization index were compared between the 2 groups. All patients underwent follow-ups after operation. The functional recovery scale for hip fracture (FRS) and EQ-5D index were applied to evaluate the clinical outcomes periodically. Results Compared to THA group, the intraoperative trauma ,operation time and bed days were less in IF group(P0.05). Follow-ups at all time points revealed hip function in THE group is better than that in IF group(P 0.05). Within 3 years,the costs related to fracture were 41772 yuan for IF group and 61174 yuan for THA group respectively. Conclusion Both internal fixation and total hip arthroplasty can provide satisfactory outcome for elderly patients with displaced femoral neck fracture. Compared with IF ,THA causes bigger trauma and costs more ,but ends up with lower complication incidences ,and improve hip function in a shorter period.
ABSTRACT
Objective To analyze of related factors in affecting condylar buttress plate (CBP) surgical treatment of distal femoral fractures.Methods One hundred patients with distal femoral fractures were grouped according to eight related factors (gender,age,fracture type,fracture classification,surgical time,reset quality,whether bone graft and plaster braking),respectively.Operative efficacy was scored by the Neer knee functional score table,and score ≥ 72 was excellent,while ＜ 72 was good.Eight related factors were carried out single factor analysis with x2 test to compare the operative efficacy of each group,then the related factors with single factor analysis result of P＜0.05 were put in Logistic multifactor regression analysis,in order to clarify the independent risk factors for CBP treatment of distal femoral fractures.Results There was no significant difference (P＞0.05) in the operative efficacy between male and female group,open fracture and closed fracture group.The difference between youth,middle-aged and elderly group,type A and type C fracture group was statistically significant (P＜0.05).The operative efficacy of patients got surgery within 7 d was obviously better than those who got surgery 7 d later (P＜0.05).The operative efficacy of patients who had no intraoperative bone graft was better than those who had bone graft (P＜0.05).The operative efficacy of satisfactory reset group and none plaster braking group was better than that of unsatisfied reset group and plaster braking group (P＜0.05),respectively.Conclusions Age,fracture type and reset quality are CBP therapy independent risk factors for the efficacy of operation for patients with distal femoral fractures,which will provide some reference for improving the operative efficacy of CBP operation in treatment of distal femoral fractures.