Safety of early surgery for geriatric hip fracture patients taking clopidogrel: a retrospective case-control study of 120 patients in China / 中华医学杂志(英文版)

BACKGROUND@#Geriatric hip fracture patients receiving clopidogrel are a surgical challenge. In China, most of these patients undergo delayed surgical treatment after clopidogrel withdrawal for at least 5 to 7 days. However, delayed surgery is associated with increased complications and mortality in the older adults. This retrospective paralleled comparison study investigated the safety of early surgery for geriatric hip fracture patients within 5 days of clopidogrel withdrawal.@*METHODS@#Acute hip fracture patients (≥65 years) who were hospitalized in the orthogeriatric co-management ward of Beijing Jishuitan Hospital between November 2016 and April 2018 were retrospectively reviewed. Sixty patients taking clopidogrel before injury and discontinued  0.050). The percentages of patients with coronary heart disease (61.7% vs. 18.3%; P  0.050). There was no significant difference in perioperative complications, and 30-day and 1-year mortality rates between the groups.@*CONCLUSIONS@#Early hip fracture surgery is safe for elderly patients within 5 days of clopidogrel withdrawal, without increased perioperative blood loss, transfusion requirement, complications, and mortality compared with patients not taking antiplatelet drugs.

Long-term outcome of operative management of delayed acetabular fractures / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Surgical treatment of acetabular fracture has long been a challenging area in the field of orthopedic trauma. The aim of this research was to investigate the operative methods for delayed acetabular fractures and to assess the operation results.</p><p><b>METHODS</b>The operative approaches, procedures, results, and complications of the delayed acetabular fractures between 1995 and 2005 were retrospectively evaluated at Beijing Jishuitan Hospital. Quality of life was assessed for each patient with the Merle d'Aubingne and Postel fracture function rating scale and the radiological result was assessed using the Matta radiological score.</p><p><b>RESULTS</b>Sixty-eight cases (70 hips) were followed up with a minimal duration of five years (average of 5.8 years). Excellent functional results were observed in 10 hip joints, good results in 40, fair results in 11, and poor results in nine. The risks of poor prognosis include impact fracture or osteochondral fracture of femoral head, a time beyond 42 days from injury to operative management, and dislocation of femoral head during the injury. Some of the problems, which were observed included postoperative infection in two hips, iatrogenic sciatic nerve injury in eight hips, traumatic arthritis in 15 hips, heterotopic ossification in 17 hips, and necrosis of the femoral head in six hips.</p><p><b>CONCLUSION</b>A careful selection of operative indications for delayed acetabular fractures in combination with a proper operative approach and appropriate reduction and fixation could guarantee relatively good results.</p>

Efficacy observation of Thoroughfare Vessel theory in acupuncture for post-stroke dysphasia / 中国针灸

<p><b>OBJECTIVE</b>To compare the difference in the efficacy on post-stoke dysphagia between the point selection according to Thoroughfare Vessel theory and conventional point selection in treatment.</p><p><b>METHODS</b>Seventy-eight patients were randomly divided into an observation group (n = 42) and a control group (n = 36). In observation group, acupuncture was applied to the acupoints selected according to Thoroughfare Vessel theory such as Dazhu (BL 11), Shangjuxu (ST 37), Xiajuxu (ST 39), Neiguan (PC 6) and Gongsun (SP 4) Mainly. In control group, acupuncture was applied to the conventional acupoints such as Fengchi (GB 20), Lianquan (CV 23), Tiantu (CV 22), Neiguan (PC 6) and Zusanli (ST 36), etc. Acupuncture was given once per day in either group, 12 treatments made one session and 4 sessions of treatment were required. The water swallow test was adopted to assess the swallowing function in two groups.</p><p><b>RESULTS</b>The effective rate was 100.0% (42/42) in observation group and was 77.8% (28/36) in control group. The efficacy in observation group was superior to control group (P < 0.05). The curative time was (28.65 +/- 10.42) days in observation group and was (38.74 +/- 21.30) days in control group. The time was shorter apparently in observation group as compared with control group (P < 0.05).</p><p><b>CONCLUSION</b>The Thoroughfare Vessel theory in acupuncture treatment for post-stroke dysphasia achieves a superior efficacy as compared with the conventional acupoint selection, and this theory may quickly determine the point prescription in treatment.</p>

Surgical resection of heterotopic ossification after open reduction internal fixation of acetabular fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical effect of surgical resection of the severe heterotopic ossification (HO) after the open reduction internal fixation (ORIF) of acetabular fractures.</p><p><b>METHODS</b>Five cases of severe HO after the ORIF of acetabular fractures were treated by surgical resection from October 2005 to April 2007. All patients were male, the average age was 34 years (22 to 45 years). The average time of HO after ORIF of acetabular fractures was 14.2 months (3 to 30 months). The original surgical approaches were: Kocher-Langenbeck approach as 4, ilioinguinal combined K-L approach as 1. According to the Brooker classification, there were 4 patients with IV degree and 1 with III degree. The average total movement for all the 5 patients was 8 degrees. All patients received one time radiation therapy before or after operation, the dosage was 7-8 Gy. The surgical approach was Kocher-Langenbeck for all patients. During operation the nerve stimulator was used to explore the sciatic nerve and carefully protected it, resected all HO bone and removed all implants. For one patient, because of confusion between femoral head and acetabulum, total hip replacement were performed. The joint exercise (passively and actively) began from the second day after operation, and at the same time, all patients took the indomethacin to prevent the occurrence of HO.</p><p><b>RESULTS</b>All patients were followed up for 4 to 22 months. There was no recurrence of HO, the average total movement for all the 5 patients was 160 degrees.</p><p><b>CONCLUSION</b>Early surgical resection and combined with radiation and indomethacin for the severe HO after the ORIF of acetabular fractures can obtain excellent results.</p>

Effect of Early Induced Finger Function Training on Stroke Patients / 中国康复理论与实践

@#ObjectiveTo investigate the effect of early induced finger function training on motor function and activities of daily living (ADL) of stroke patients.Methods60 stroke patients with hemiplegia were randomly divided into the early induced finger function training group (treatment group) and control group with 30 cases in each group. The patients of the control group were treated with routine rehabilitation; while those of the treatment group were added with training of early induced flexion and extension of fingers. All patients of two groups were assessed with Brunnstorm Scale, Fugl-Meyer Assessment, scores of Neurological Functional Deficit, and Modified Barthel Index before and 8～12 weeks after treatment.ResultsAfter treatment, upper limb motor function, hand function and fingers' fine function in the sick side of the patients in the treatment group improved significantly better than that in the control group ( P<0.05～0.01).ConclusionThe early induced finger function training can obviously improve the upper limb motor function and ADL of stroke patients.

Effect of Rehabilitation of Attention on Activities of Daily Living in Hemiplegics with Disturbance of Attention / 中国康复理论与实践

@#ObjectiveTo investigate the effect of rehabilitation of attention on activities of daily living (ADL) in hemiplegics with disturbance of attention. Methods40 patients with brain injured were randomly divided into 2 groups: treatment group and control group. The control group was treated with conventional rehabilitation, while the treatment group was treated with conventional rehabilitation and strengthening training of attention.ResultsThe attention and ADL were significant improved after treatment in both groups(P<0.05).Compared with control group, the treatment group gained more improvement(P<0.05).ConclusionDisturbance of attention can influence the rehabilitation effect in hemiplegics after brain injured, so that is important to be treated during the rehabilitation.

Effect of Rehabilitation of Attention on Activities of Daily Living in Hemiplegics with Disturbance of Attention / 中国康复理论与实践

@#ObjectiveTo investigate the effect of rehabilitation of attention on activities of daily living (ADL) in hemiplegics with disturbance of attention. Methods40 patients with brain injured were randomly divided into 2 groups: treatment group and control group. The control group was treated with conventional rehabilitation, while the treatment group was treated with conventional rehabilitation and strengthening training of attention.ResultsThe attention and ADL were significant improved after treatment in both groups(P<0.05).Compared with control group, the treatment group gained more improvement(P<0.05).ConclusionDisturbance of attention can influence the rehabilitation effect in hemiplegics after brain injured, so that is important to be treated during the rehabilitation.

The application of computed tomography examination in acetabular fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical significance of computed tomography (CT) in diagnosis and treatment of acetabular fractures.</p><p><b>METHODS</b>The plain and CT films of the 66 cases of acetabular fracture from January 2001 to June 2002 were analyzed retrospectively, and the radiological characteristics and results were compared to each other.</p><p><b>RESULTS</b>The diagnosis of 6 cases were changed after CT examination, and the occurrence ratio of marginal impaction, free body in joint, femoral head fracture, sacro-iliac injury and ischial tubersoity fracture involvement were 3:17, 7:29, 6:15, 0:5 and 1:5 in plain and CT examination respectively.</p><p><b>CONCLUSIONS</b>CT examination has the determinative role in detecting weight-bearing zone, marginal impaction, free body, femoral head fracture, sacro-iliac injury, etc., and for completing the diagnosis and guiding the treatment. It should be the routine examination just as the three standard plain examinations in acetabular fractures, and should be carefully read.</p>

A clinical study on indomethacin for prevention of heterotopic ossification following surgical treatment of acetabular fractures / 中华创伤骨科杂志

Objective To investigate the effect of indomethacin on prevention of heterotopic ossification (HO)after operative treatment of acetabular fractures.Methods Fifty patients with acetabular fractures received in our department operative treatment through Kocher-langenbeck(K-L)approach and oral administration of in- domethacin afer operation from February 2001 to August 2003.Forty-eight of them were successfully followed up for incidence of HO and their clinical functions were assessed.The results were compared with those of 40 patients who had been treated with the same operative procedures but without oral administration of indomethacin in our depart- ment from March 1993 to May 1998.The patients who could not tolerate the drug were not included.Results The follow-ups averaged 22.8 months(range,6 to 39 months).HO occurred in eight cases.The incidence of HO was 16.7%(8/48).According to Brooker evaluation of HO,five cases were rated as degreeⅠ,three as degreeⅡ, and none as degreeⅢorⅣ.The incidence of severe HO was 0.In the control group,the incidence of HO was 35.0%(14/40)and the incidence of severe HO was 10.0%(4/40).The differences were statistically significant (P＜0.05).Conclusion Oral administration of indomethacin after operative treatment of acetabular fractures can inhibit HO.

Marginal impaction in acetabular fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To understand the diagnosis and treatment of marginal impaction of acetabular fractures.</p><p><b>METHOD</b>Eighteen of 26 patients with marginal impaction of acetabular fractures were retrospectively reviewed. Marginal impactions was confirmed in 15 patients by CT scan before operation, and in 3 during operation. All patients were treated by ORIF, and the impacted bones were elevated with bone grafts (Bone graft was not used in one patient). All fractures were fixed with a reconstruction plate.</p><p><b>RESULTS</b>The mean follow up was 36.7 months (5 - 71 months). The modified D'Aubingne and Postel score system showed excellent results in 6 patients, good 7, fair 2, and poor 3.</p><p><b>CONCLUSION</b>Posterior fractures and dislocations of acetabular fractures are easily combined with marginal impaction, and can diagnosed by CT scan. Cortical impaction should be recognized as a special type. The impacted bone should be elevated for bone grafting.</p>

Complications of operative treatment of acetabular fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To improve the effect of operative management of acetabular fractures.</p><p><b>METHODS</b>One hundred and seventy eight acetabular fractures were treated operatively from August 1993 to December 2000. Their functional results and complications were analyzed.</p><p><b>RESULTS</b>One hundred and twelve hips were followed up for an average of 45.7 months. Heterotopic ossification was noted in 26 hips, post-operative osteoarthritis in 22 hips, avascular necrosis of the femoral head in 8 hips, and sciatic nerve injury in 7 hips after operations. No death and infection were found in this series.</p><p><b>CONCLUSIONS</b>Ectopic bone formation develops at extended ilio-femoral and Kocher-Langeneck approaches. Cartilaginous injury of the femoral head is contributable to post-operative osteoarthritis, and imperfect reduction is an important factor in the genesis of osteoarthritis.</p>

Operative treatment of delayed acetabular fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the operative methods of delayed acetabular fractures and the operative results.</p><p><b>METHODS</b>The operative approaches, procedures, results and complications of the delayed acetabular fractures between August 1993 and August 2001 in Jishuitan Hospital were evaluated retrospectively.</p><p><b>RESULTS</b>Thirty-two patients were followed up 49.6 months on average. Sciatic nerve palsy was found in 1 patient. Excellent functional results of hip joints were found in 3 patients, good in 16, fair in 10, and poor in 3. Ectopic bone formation was observed in 6 patients and necrosis of the femoral head in 3.</p><p><b>CONCLUSION</b>Careful selection of operative indications of delayed acetabular fractures in combination with proper operative approach and appropriate reduction and fixation, good results can be obtained.</p>

Effect of Rehabilitative Ankle-Foot Orthoses on walking function of acute stroke hemiplegic patients / 中国康复理论与实践

@#ObjectiveTo study the effect of Rehabilitative Ankle-Foot Orthoses training program on walking function of hemiplegic patients after stroke .Methods95 patients were randomly divided into two groups: observed group (49 cases) and control group (46 cases). The patients of control group were trained by routine rehabilitation training program, the patients of observed group were trained by Rehabilitative Ankle-Foot Orthoses and routine rehabilitation training program.ResultsAfter training, either observed group or control group showed significant improvement at walking function and ADL(P<0.01), but the improvement on observed group were more marked than coutrol group(P<0.01 and P<0.05). ConclusionsThe ability of walking in acute stroke patients were obviously improved, and the degree of the disability of them was decreased by Rehabilitative Ankle-Foot Orthoses.