ABSTRACT
<p><b>OBJECTIVE</b>To assess the clinical effectiveness and safety of anterior versus posterior approach for multilevel cervical spondylotic myelopathy.</p><p><b>METHODS</b>The following databases were searched: the Cochrane Library, PubMed, EM base, OVID, CBM, Wanfang Data, CNKI. Relevant journals were manually searched for randomized controlled trials or clinical controlled trials(CCTs) that investigated the clinical effectiveness and safety of anterior and posterior approach for multilevel cervical spondylotic myelopathy. Two reviewers independently screened the literature according to inclusion and exclusion criteria, extracted the data, and assessed the methodological quality of included studies. Meta-analysis was performed by using RevMan 5.2 software.</p><p><b>RESULTS</b>Eight CCTs, involving 1 151 patients, were included. Significant differences were found between anterior and posterior approach with respect to complications, OR=2.19, 95%CI (1.50, 3.19),<0. 000 1; and neural recovery rate, WMD=11.04, 95% CI(0.60, 21.47),=0.04 . In addition, there were no significant differences in preoperative JOA scores, WMD=0.13, 95% CI (-0.20, 0.46),=0. 44; postoperative JOA scores, WMD=0.45, 95% CI (-0.10, 1.00),=0.11; operation time, WMD=39.43, 95% CI(-5.92, 84.78),=0.09; and amount of intraoperative bleeding, WMD=5.46, 95% CI(-96.65, 107.58),=0. 92).</p><p><b>CONCLUSIONS</b>There are no significant differences between anterior and posterior approach for multilevel cervical spondylotic myelopathy in the recovery of neural function of the spinal cord, operation time and intraoperative bleeding. However, posterior appreach showed fewer complications than anterior appreach.</p>
ABSTRACT
<p><b>OBJECTIVE</b>To analyze the clinical effect and related risk factors of Gartland type II-III supracondylar fractures of humerus in children in the emergency closed reduction and percutaneous Kirschner wire fixation.</p><p><b>METHODS</b>From January 2008 to June 2013,112 children of Gartland type II to III supracondylar humeral fractures were treated in children in emergency closed reduction and percutaneous K-wire fixation, including 72 males and 40 females with an average age of 6.2 years old ranging from 2 to 11 years old. Among them,74 cases were in Gartland type II fractures,38 cases were in type III; The duration from injury to surgery time was 2.5 to 8 hours (averaged 4.6 hours). Elbow cast was applied after operation with the elbow extended of 100 degrees for 4 to 6 weeks, then the gypsum and Kirschner wires were removed.</p><p><b>RESULTS</b>All patients were follow-up from 6 to 60 months (averaged 12 months). All fractures reached clinical healing. The final follow-up was assessed by Flynn criteria, the result was excellent in 86 cases, good in 23 cases, general in 3 cases, excellent and good rate was 97.3%. Three patients had mild cubitus varus deformity without orthopedic treatment. No pin tract infections, iatrogenic ulnar nerve injury, compartment syndrome, and complications such as Volkmann ischemic contracture occurred.</p><p><b>CONCLUSION</b>Closed reduction and percutaneous Kirschner wire fixation had advantages of exact reduction, firm fixation, fewer complications ,less pain in children undergoing emergency surgery, and.high success rate, so it is a safe and efficient treatment for humeral supracondylar fracture in children.</p>
Subject(s)
Child , Child, Preschool , Female , Humans , Male , Bone Wires , Fracture Fixation, Internal , Methods , Humeral Fractures , General Surgery , Plastic Surgery ProceduresABSTRACT
<p><b>OBJECTIVE</b>To explore clinical effect of manipulative reduction and percutaneous K-wires fixation in treating supracondylar fractures of the humerus in children.</p><p><b>METHODS</b>From July 2010 to December 2012, clinical data of 52 children with supracondylar fractures of the humerus, which treated with manipulative reduction and percutaneous K-wires fixation, were retrospectively analyzed. Among them, there were 35 males and 17 females with an average age of 6.7 (ranged from 2.5 to 12) years old. All fractures were type Garland II - III fractures, and 51 cases were extension type and 1 case were flexion type. Flynn evaluation standard of elbow performance score were applied to evaluate clinical effects.</p><p><b>RESULTS</b>All patients were followed up from 12 to 18 months with average of 16 months. According to Flynn evaluation standard of elbow performance score, 41 cases obtained excellent result, 8 good and 3 moderate.</p><p><b>CONCLUSION</b>Manipulative reduction and percutaneous K-wires fixation for the treatment of supracondylar fractures of the humerus in children has many advantages, such as minimally invasive, rapid recovery, stable fixation. It could prevent osteofascial compartment syndrome, Volkmann Contracture and cubitus varus.</p>