ABSTRACT
<p><b>OBJECTIVE</b>To compare clinical efficacy of double titanium plate and clavicular hook plate for the treatment of Neer II distal clavicular fracture.</p><p><b>METHODS</b>From April 2013 to June 2015, 42 patients with Neer II distal clavicle fractures were non-randomly selected, including 25 males and 17 females. All patients were fresh closed fractures. Twenty patients were treated with double titanium plate with tight rope(group A), including 11 males and 9 females aged from 16 to 49 years old with an average age of(33.8±10.7) years;the time from injury to operation ranged from 2 to 5 days with an average of (3.5±1.8) days. Twenty-two patients were treated with clavicle hook plate(group B), including 14 males and 8 females aged from 27 to 53 years old with an average age of (37.7±9.9) years;the time from injury to operation ranged from 2 to 5 days with an average of (3.1±2.0) days. Operative time, blood loss, hospital stays and postoperative complications were observed and compared; fracture healing were compared among preoperative, postoperative at 1, 3 and 6 months; VAS and ASES scoring were used to evaluate shoulder function.</p><p><b>RESULTS</b>All patients were followed up from 6 to 12 months with an average of 7.2 months. All incisions were healed at stage I. Blood loss in group A were less than that of group B(<0.05); while there were no significant difference in hospital stays and operative time between two groups. No shoulder pain occurred in group A, 4 cases occurred shoulder pain in group B, and had significant difference. Fracture healing time ranged from 3 to 6 months with an average of 4.3 months. VAS score and ASES score in group A were higher than that of group B in pain, function and total score.</p><p><b>CONCLUSIONS</b>Compared with clavicle hook plate, double titanium plate has advantages of shorter incision wound, less bleeding and simply operation, less complications, and could avoid pain for removing internal fixation. Over reduction of acromioclavicular joint during operation does not affect its superior curative effect. It is better choice for the treatment of Neer II distal clavicle fracture.</p>
ABSTRACT
<p><b>OBJECTIVE</b>Intra-ventricular hemorrhage (IVH) is one of the most serious complications of preterm infants. Significant numbers of the surviving infants with severe IVH go on to develop post-hemorrhagic hydrocephalus (PHH). The management of PHH remains a very challenging problem for both neonatologists and pediatric neurosurgeons. This study aimed to evaluate the efficacy and safety of the use of Ommaya reservoirs and serial cerebrospinal fluid (CSF) drainage in the management of a series of neonates with PHH.</p><p><b>METHOD</b>Between January 1, 2003 and December 30, 2005, 15 consecutive newborn infants with IVH grades III to IV, complicated with progressive ventricular dilatation, underwent placement of an Ommaya reservoir. CSF was intermittently aspirated percutaneously from the reservoir. The amount and frequency of CSF aspiration were based on the clinical presentation and the follow-up results of serial cranial ultrasonograms or CT scans. The changes of CSF cell counts and chemistries were also followed. Patients whose progressive ventricular dilatation persisted despite serial CSF aspiration through Ommaya reservoir eventually had ventriculo-peritoneal shunts (V-P shunt) placed. All the patients were followed up in the outpatient clinic after discharge from the hospital and the neurodevelopmental outcomes were evaluated through 18-36 months of age.</p><p><b>RESULT</b>A total of 15 infants were included in this series. Of them, 11 were preterm infants who were at gestational ages of 29 to 34 weeks and 4 infants were full-term. All of the 4 full term infants presented with progressive ventricular dilatation after suffering from the intra-cranial hemorrhage (3 infants were due to vitamin K deficiency and 1 was due to birth trauma). Thirteen infants had grade III IVH, and 2 had grade IV IVH based on initial cranial ultrasonographic and CT scans. The mean age when IVH was diagnosed was (9 +/- 1) days in preterm infants and (22 +/- 7) days in full-term infants; the mean age when Ommaya reservoir was placed was (18 +/- 11) days in preterm infants and (31 +/- 7) days in full-term infants. All the infants tolerated the surgical procedure well. The Ommaya reservoir was tapped for an average of (21.5 +/- 4.6) times per patient. The mean CSF volume per tap was (10.2 +/- 1.3) ml/kg. The values of CSF protein, glucose and cell counts slowly reached normal levels at approximately 3 - 5 weeks after the placement of the reservoir. The velocity of head circumference increase per week was less than 1 cm in 13 patients in 1 - 4 weeks after the placement of the reservoir and the size of ventricles decreased gradually. By 12 - 18 months, 12 infants had normal size ventricles, and 1 patient still had mild ventricular dilation at 36 months. Two infants developed progressive hydrocephalus after serial CSF aspiration through Ommaya reservoir. One infant had a V-P shunt placed at 2 months of age and another infant died at 3 months of age at home after parents refused further therapy. Complications consisted of reservoir leaking and CSF infection at 16th day of placement in one patient after repeated tapping. By the end of 18 - 36 months of follow-up, 11 of 14 infants were considered normal, two patients had mild impairment in neurodevelopmental outcome (both had spastic bilateral lower limbs paresis, and one of whom also had amblyopia) and the other had seizure disorder.</p><p><b>CONCLUSION</b>The results from this series indicate that the placement of an Ommaya reservoir is relatively safe in newborn infants and is useful in the initial management of neonates with PHH and may be beneficial in improving their neurodevelopmental outcomes. A multicenter randomized trial may be needed to further validate the results of this report.</p>
Subject(s)
Female , Humans , Infant, Newborn , Male , Cerebral Hemorrhage , Therapeutics , Cerebral Ventricles , Drainage , Methods , Hydrocephalus , Therapeutics , Subdural Effusion , TherapeuticsABSTRACT
0.05). There was only 2/109 cases (5.8%) need a second course of antibiotics because of likely infection and 102/109 cases (93.5%)need not any moor antibiotics. The mean period of antibiotic treatment in group Ⅰ, group Ⅱa and group Ⅱb were (1.2?0.5) days,(4.8?0.8) days and (9.3?1.8) days,respectively.There were significant differences(all P