ABSTRACT
OBJECTIVE To optimize the preparation process of Soft-shelled turtle blood lyophilized powder （STBLP）， and to provide a reference for improving the availability and quality stability of soft-shelled turtle blood （STB）. METHODS STBLP was prepared with vacuum freeze-drying. Taking the solubility as the index， the preparation process parameters of STBLP were optimized by single factor experiment and Box-Behnken response surface method. RESULTS The optimal freeze-drying process for STBLP was obtained： pre-freezing time of 4 h， total drying time of 13 h （before at 0 ℃）， and resolution drying temperature of 25 ℃. The average solubility of 3 batches of STBLP prepared according to the optimal process was 95.72% （RSD＝0.68%， n＝3）， the relative error of which was －0.97% to the theoretical solubility （96.66%）. CONCLUSIONS Optimized lyophilization process in this study are stable and feasible， the solubility of the prepared sample is high.
ABSTRACT
The incidence of Crohn′s disease(CD) in children is increasing year by year.Compared with adults, children with CD face a more rapidly changing course, a larger range of intestinal involvement and growth and development problems.The advent of biological agents has broadened the treatment pathway for pediatric CD, among which the most widely used anti-TNF therapy, including Infliximab(IFX), Adalimumab(ADA), has been approved for the induction and remission therapy for pediatric CD.The efficacy and safety of biological agents from other pathways, such as the interleukin inhibitor Ustekinumab(UTK), the anti-integrin monoclonal antibody Vedolizumab(VDZ) and biosimilars have been progressively demonstrated in pediatric CD.Loss of response is a major problem in the treatment of biologic agents, and the development of more biologics as an alternative treatment is the direction that still needs to be worked on in the future.This article reviews the efficacy of biological agents in pediatric CD, aiming to provide recommendations for clinicians when making treatment decisions.
ABSTRACT
Objective:To construct an evaluation index system of perceived service quality for Internet hospitals, and to provide references for scientific evaluation and effective management of such hospitals′ service quality.Methods:Thanks to literature review and expert interviews, an index system was initially built based on the Brady and Cronin model.From August to November 2021, Delphi expert consultation method was used in three rounds of correspondence questionnaire survey, and experts were consulted to assess the importance, familiarity and judgment basis of these indexes. The importance of the indexes was expressed by ± s, and the weight value of each index was calculated using analytic hierarchy process fuzzy comprehensive evaluation method and SPSS Au software. Results:The evaluation index system of perceived service quality for such hospitals included 3 level-1 indexes, namely environmental quality, interaction quality and result quality; and 10 level-2 indexes, namely software platform, service support, social factors, attitude, behavior, professional quality, service effect, service efficiency, service cost, satisfaction; and 30 level-3 indexes. Among these indexes, result quality of level-1 indexes scored the highest weight value(0.337); Software platform, professional quality, service support and attitude of level-2 indexes scored a higher weight values, respectively 0.119, 0.119, 0.109 and 0.109. Of level-3 indexes, reputation of Internet hospitals, service attitude of their doctors and doctor-patient communication skills of doctors online scored a higher weight values, respectively 0.102, 0.057 and 0.055.Conclusions:The index system for Internet hospital perceived service quality evaluation built in this study proved scientific, contributing positively to guiding Internet hospitals to improve their quality and safety management.
ABSTRACT
Objective:To analyze the changes of common pathogens of viral diarrhea in children during the COVID-19 epidemic.Methods:A retrospective analysis was performed on children with acute diarrhea treated in Children’s Hospital affiliated to Zhejiang University School of Medicine from 2019 April to 2019 December(before COVID-19, n=407)and 2020 April to 2020 December (during COVID-19, n=645). Children were further divided into 1-6 months, >6 months-2 years, >2-5 years age groups. Detection rates of norovirus GI (NOVI), norovirus GⅡ (NOVⅡ), rotavirus A (ROVA), rotavirus C (ROVC), intestinal adenovirus (EADV), sapovirus (SAV) and astrovirus (ASV) in different age groups and seasons before and during COVID-19 were compared by χ2 or Fisher exact test. Results:The total detection rates of diarrhea-causing viruses among age groups were significantly higher before COVID-19 than those during COVID-19( χ2=8.43, 38.22 and 9.23, all P<0.05). The detection rates of NOVⅡ and EADV in infants aged 1-6 months and >6 months-2 years were decreased during the period of COVID-19 epidemic( χNOVⅡ2 =36.87 and 17.77, both P<0.001, χEADV2 =9.08, P=0.014 and 0.003); the detection rates of NOVⅡ in children aged 2-5 years was decreased during the period of COVID-19 epidemic( χ2=3.96, P=0.047); the detection rates of other diarrhea-causing viruses were not decreased during the period of COVID-19 epidemic(all P>0.05). The detection rates of diarrhea-causing viruses among 4-6 months, 7-9 months and 10-12 months were higher during the period of COVID-19 epidemic( χ2=11.62, 65.41 and 27.80, all P<0.001). Conclusion:After the outbreak of COVID-19, the detection rate of common pathogens of viral diarrhea in children is decreased, especially NOVⅡ and EADV, which may be related to the measures in response to major public health events in Zhejiang Province.
ABSTRACT
Objective:To investigate the clinical significance of serum glial fibrillary acidic protein(GFAP)level in middle-aged and elderly patients with Parkinson's disease(PD).Methods:In the prospective study, a total of 39 patients with PD hospitalized in the Department of Neurology of Zhejiang Hospital affiliated to Zhejiang University School of Medicine, and 17 healthy subjects from January 2017 to May 2021 were collected.Serum GFAP levels in the PD group and healthy control(CT)group were detected by an ultra-sensitive Simoa hypersensitive protein detection technology.The correlations of serum GFAP level with age, gender, clinical presentation type, depression score, Montreal Cognitive Assessment Scale(MOCA)score and Mini-Mental State Examination(MMSE)score were analyzed.Results:The level of serum GFAP was significantly higher in PD group(219.6±166.2)ng/L than in CT group(109.9±56.6)ng/L( P< 0.01). In PD group, there was no correlation of serum GFAP with age, gender, clinical classification, depression and MOCA score(age: r=0.042, gender: r=-0.142, depression score: r=0.076, MoCA score: r=0.014, all P>0.05); but there was a significant negative correlation between serum GFAP and MMSE score( r=-0.433, P< 0.05). Conclusions:There is a negative correlation between serum GFAP level and MMSE score, suggesting that the increase of serum GFAP might be suggestive of cognitive decline in Parkinson's disease patients to some extent, which should be paid attention to in clinical work.
ABSTRACT
Objective:To analyze the curative effect of locking compression pediatric hip plate (LCH-PHP) in the treatment tumor-like lesions of femoral neck in children.Methods:From January 2012 to June 2019, 45 children with Erol type Ⅱ-Ⅳ tumor-like lesions of femoral neck were retrospectively analyzed, involving 32 males and 13 females, aged 2-14 years.Among them, 27 cases were simple bone cyst, 15 cases were fibrous dysplasia, 3 cases were Langerhans histiocytosis, and 17 cases were accompanied with pathological fracture.Patients without pathological fracture were divided into 2 groups according to different surgical methods: lesion removal and bone grafting+ LCH-PHP preventive fixation group (group A) and lesion removal and bone grafting group (group B). Patients with pathological fracture were divided into 2 groups according to the different surgical methods: lesion removal and bone grafting+ LCH-PHP fixation and reduction group (group C) and lesion removal and bone grafting group (group D). The loss of femoral neck-stem angle, healing time and Musculoskeletal Tumor Society (MSTS) scores were compared between group A and group B. Changes of femoral neck-stem angle were compared between group C and group D at postoperative 1 day and the last follow-up.Results:Forty-five patients were followed up for an average of 2.6 (1-4) years.The loss of femoral neck-stem angle in group A and group B were (0.50 ± 0.45)°, and (2.26 ± 1.64)°, which was significantly different ( t=-3.193, P<0.05). There were no significant differences in the healing condition, healing time and MSTS scores at the last follow-up between group A and group B(all P>0.05). In group C, the ipsilateral femoral neck-stem angle at the postoperative 1 day and the last follow-up were (133.67±4.53)°and (133.00±4.32)°, respectively, which was comparable ( P>0.05). In group D, the ipsilateral femoral neck-stem angle at the postoperative 1 day and the last follow-up were (133.36±7.82)°and (130.63±8.24)°, respectively, which was significantly different ( t=7.11, P<0.05). Conclusions:LCH-PHP fixation can effectively maintain the femoral neck-stem angle and prevent the occurrence of pathological fracture children with Erol Ⅱ-Ⅳ tumor-like lesions of femoral neck.
ABSTRACT
Objective:To explore the outcomes of T?nnis triple osteotomy for developmental dysplasia of the hip (DDH) in older children.Methods:Clinical data of 21 children (22 hips, 12 left and 10 right hips) treated by T?nnis triple osteotomy from October 2016 to June 2019 were retrospectively analyzed.There were 8 males and 13 females with a mean age of operation at 13.5 (8.6-16.8) years.Based on the T?nnis classification, all the cases were in Grade Ⅰ.Statistical analysis was performed using the SPSS 22.0 statistical software.Results:All recruited patients were followed up for 1.5-3.5 years.Compared with preoperative values and those at the last follow-up visit, the mean Sharp acetabular angle of the affected side recovered from 53.5°±5.2° to 40.8°±2.3°.The mean center-edge angle increased from 10.5°±2.9° to 35.4°±5.6°.The mean acetabular roof angle decreased from 38.6°±2.8° to 6.7°±1.3°.The mean acetabular head index enhanced from (54.3±5.2)% to (86.2±2.7)%.The differences between the preoperative and postoperative values were statistically significant ( t=24.3, 17.6, 50.1, 27.5; all P<0.05). According to the Harris classification, there were 17, 3 and 2 hips achieved excellent, good and fair outcomes at the last follow-up visit, respectively, with the percentage of excellent and good outcomes up to 90.9%(20/22 hips). Accor-ding to the Severin radiographic classification, 8, 12 and 2 hips were in grade Ⅰ, Ⅱ, and Ⅲ, respectively, with the percentage of excellent and good hips at 90.9%(20/22 hips). At the last follow-up visit, the bone healing of iliac and pubic bones was well, and the nonunion of ischial bones were reported in 3 cases (13.6%). Conclusion:The outcome of the T?nnis triple osteotomy is satisfactory for DDH in older children.
ABSTRACT
Objective:To assess the clinical effect of retrograde elastic stable intramedullary nailing(ESIN) in distal humerus metaphysis-diaphyseal junction fractures in children.Methods:A total of 14 cases of children with distal humerus metaphysis-diaphyseal junction fractures treated by retrograde ESIN in Children′s Hospital of Nanjing Medical University from January 2016 to December 2018 were retrospectively analyzed.There were 9 males and 5 females, aged 3.0-13.2 years old(median: 6.4 years old). Nine cases had fractures on the left side and 5 cases on the right side.Two prebent ESINs were inserted into the proximal humerus metaphysis through the humerus marrow cavity from medial and lateral sides of the distal humerus respectively after the closed/open reduction of fractures.After surgery, the shoulder abductor stent or long arm plaster was used for fixation post-operatively.X - ray examination was performed at regular post-operative follow-up.The stability of internal fixation was analyzed by measuring the Baumann angle and checking whether humeral anterior lines passed through capitulum humeri in lateral radiographs immediately after the surgery and at the last follow-up.Meanwhile, efficacy was evaluated according to Flynn functional evaluation criteria.Results:All the 14 patients in this group were followed up for 10-27 months after the operation, with an average of 18.4 months.The Baumann angle was within the normal range at both the end of the operation and the last follow-up, and no significant difference was observed.Lateral radiographs showed humeral anterior lines passed through the capitulum humeri.According to Flynn functional scores, there were 13 excellent cases and 1 good case.No wound infection, intramedullary nailing displacement, Volkmann contracture, cubital varus deformity, or iatrogenic nerve injury occurred in any of the children.Conclusion:Retrograde ESIN technique is a safe and reliable treatment for children with distal humerus metaphysis-diaphyseal junction fractures.
ABSTRACT
Objective:To explore the feasibility of accurate localization for the acetabular direction in Salter pelvic osteotomy for the developmental dislocation of the hip joint in children by using computer aided design and 3D printing technique.Methods:The clinical data of 12 patients of unilateral hip dislocation treated with Salter pelvic osteotomy by using 3D printed navigation template in Department of Orthopedics, Children′s Hospital of Nanjing Medical University From October 2016 to April 2017 were retrospectively analyzed.Among the 12 cases, there were 4 males and 8 females, 5 hips on the left and 7 hips on the right, aged 1.5 to 5.0 years old (mean 2.3 years old). According to the CT data, the models of the healthy hip joint were mirrored to the contralateral side by Mimics software.Computer-aided simulations of Salter pelvic osteotomy on models of the affected hip joints were performed.Then, the models of the affec-ted hip joint were rotated to the mirror models of the contralateral hip joint.The navigation templates were designed according to the exposed pelvic surface morphology during the operation.The navigation templates were printed by rapid prototyping technology to guide the operation.Preoperative and postoperative acetabular index (AI) and center edge angle (CEA) of affected side were compared to postoperative AI and CEA of contralateral side respectively.Results:A method of making personalized navigation templates for Salter pelvic osteotomy was established in 12 children with developmental dislocation of the hip joint.The operation time ranged from 40.2 to 64.5 min, averaging (50.6±8.5) min.The intraoperative bleeding volume ranged from 35 to 60 mL, averaging 52 mL.No vascular and nerve injury was found in the postoperative examination, and no child had complications such as infection, residual foreign body of the guide plate and so on.There was significant difference in preoperative measurements regarding AI between the affected side [(38.4±2.8)°] and the contralateral side [(21.6±0.8)°]( t=-18.77, P<0.05), and there was significant difference in preoperative measurements regarding CEA between the affected side[(-5.8±12.6)°] and the contralateral side[(21.1±2.4)°]( t=-7.348, P<0.05). But there was no significant difference in postoperative mea-surements regarding AI between the affected side [(21.7±0.8)°] and the contralateral side ( t=-2.037, P>0.05), there was no significant difference in postoperative measurements regarding CEA between the affected side[(21.2±2.6)°] and the contralateral side( t=-0.435, P>0.05). Conclusions:The navigation template prepared by computer aided design and 3D printing technology has good accuracy, and is a new approach to accurate acetabular rotation in children with the developmental dislocation of the hip joint for Salter pelvic osteotomy.
ABSTRACT
Objective@#To investigate the early clinical outcomes of hip anterior short incision and open reduction and internal fixation for the treatment of children with Delbet Ⅱ femoral neck fracture.@*Methods@#A retrospective analysis of 12 children with DelbetⅡ femoral neck fractures was performed with the anterior short incision approach at Department of Pediatric Orthopaedic, Children′s Hospital, Nanjing Medical University from January 2014 to August 2016. There were 7 males and 5 females including 8 cases at left side and 4 cases at right side,aged (11.5±0.8) years (range: 8-14 years).Patients underwent surgery in (12.0±0.9) hours (range: 6-20 hours) after the injury. Displaced fractures were treated by open reduction if closed reduction failed.The surgical incision was performed with the anterior inferior iliac spine centered on, extending along the groin crease, and the length was 3 to 4 cm. The interval between the sartorius and the tensor fascia latae was applied, and the direct and indirect head of rectus femoris were resected to visualize the hip joint capsule. T-shaped incision was made in the capsule. After the reduction was obtained, two or three compression canulated screws were used to fix the fracture site. The healing time, complications and corresponding record outcome by X-ray and clinical examination were recorded. At the latest follow-up,the results were analyzed using the Ratliff criteria and clinical outcomes were assessed by pain, restrictive hip movement, normal activity or the avoidance of games, and the femoral neck in the radiograph.@*Results@#Twelve patients had been followed-up for (30.0±4.1)months(range: 24-36 months). X-ray showed the fractures′ healing time was (8.0±0.4) weeks(range: 7-9 weeks). Ten of the 12 fractures healed after one operation and were associated with no evidence of osteonecrosis of the femoral head. One case occurred premature physeal closure. There were no cases with fracture relocation, coaxvara, delayed union and nonunion or any significant postoperative complications. There was no infection, flexible internal fixation or ruptures. According to Ratliff grade, 9 cases of 12 patients were fine and 3 cases was acceptable.@*Conclusions@#Satisfactory short-term effects can be achieved by a mini-incision on the anterior hip for Delbet Ⅱ pediatric femur neck fractures. The anterior incision has the advantage of less trauma, smaller incision scar, better fracture reduction and fixation, and less wound complications.
ABSTRACT
Objective@#To summarize the clinical data of elastic stable intramedullary nailing(ESIN) in the treatment of long bone fracture of children in a single medical center, and to analyze the problems occurred after the ESIN surgery and corresponding solutions.@*Methods@#A retrospective analysis was conducted regarding the clinical data of 2 133 pediatric long bone fractures conforming to inclusion and exclusion criteria from June, 2005 to December, 2017 in Department of Orthopedics, Children′s Hospital of Nanjing Medical University.There were 1 191 boys and 942 girls, aged from 23 months to 14 years with mean age of (5.7 ± 3.1)years.There were 1 866 cases treated with closed reduction with ESIN, while 267 cases were treated with small incision assisted reduction with ESIN.Postoperative problems have been statistically analyzed.@*Results@#There were altogether 2 133 children, including 603 cases of femur, 311 cases of tibia, 8 cases of fibula, 219 cases of humerus, and 992 cases of ulna/radius.The postoperative complications mainly consist of 62 cases of needle tail irritation reaction, 21 cases of misalignments of fracture alignment, 11 cases of intramedullary nail deformity or angular deformity, 7 cases of limb shortening, 14 cases of limited joint activity, 4 cases of nerve injury, 2 cases of tendon injury, 14 cases of difficult nail removal, 4 cases of cortical cleavage, 8 cases of delayed union, 1 case of nonunion, 6 cases of varus/valgus deformity, 5 cases of epiphyseal injury, 6 cases of ESIN exposure, and 2 cases of metal debris of ESIN′ end.@*Conclusions@#The complications of treatment for children with long bone fractures by ESIN cannot be ignored.To master the important biomechanical properties, to get familiar with the local anatomy and to avoid obvious technical errors can reduce the occurrence of postoperative complications.
ABSTRACT
Objective To compare the therapeutic results of photodynamic therapy (PDT) combined with biliary stenting versus biliary stenting alone in the treatment of nonresectable bile duct cholangiocarcinoma.Methods The PubMed,CBM,CNKI,VIP and WanFang Data were searched from January 1990 to December 2017.Two researchers independently screened the literatures,extracted the data and performed the quality evaluation.The meta-analysis was carried out using the RevMan software 5.3.0.Results Eleven controlled clinical trials were included in the meta-analysis.There were only two randomized controlled trials.The remaining studies were non-randomized controlled trials.Finally,659 patients were enrolled in this study.293 patients were treated with photodynamic therapy and biliary stenting while 366 patients were treated with stenting alone.Analysis showed that photodynamic therapy combined with stenting significantly extended the overall survival when compared with stenting alone (P＜0.01).There was no significant differences in the incidences of cholangitis (P＞0.05),but PDT and stenting had a significantly higher total complication rate (P＜0.05).Conclusions This meta-analysis showed that photodynamic therapy combined with stenting significantly improved the survival rate of patients with nonresectable ductal cholangiocarcinoma when compared with stenting alone.Photodynamic therapy did not increase the incidence of cholangitis.
ABSTRACT
Objective To investigate the feasibility and clinical effectiveness of fixation with Kirschner wires plus pediatric hip plate (PHP) for femoral neck fracture combined with avulsion fracture of the greater trochanter in children.Methods Between February 2014 and February 2016,6 children were treated by fixation with Kirschner wires plus PHP for femoral neck fracture combined with avulsion fracture of the greater trochanter at Department of Pediatric Orthopaedics,Children's Hospital,Nanjing Medical University.They were 4 boys and 2 girls,aged from 3.5 to 11.1 years (mean,7.2 years).By the Delbet's classification,all the fractures were of type Ⅲ.Clinical efficacy was evaluated according to the Ratliff scoring system at the last follow-ups.Results The intraoperative bleeding ranged from 20 to 50 mL (average,30 mL);the operation time ranged from 45 to 60 min (average,55 min).All the patients were followed up for 12 to 36 months (average,26 months).Bony union was obtained in all cases after an average time of 7 weeks (from 5 to 8 weeks).The Ratliff scores at the last follow-ups showed 5 good and one acceptable cases.No neurovascular lesion or incision infection was observed in the children.Anatomical reduction of the greater trochanter fracture was not achieved in one child but led to no adverse effect.Conclusion Fixation with Kirschner wires plus PHP can successfully treat femoral neck fracture combined with avulsion fracture of the greater trochanter in children.
ABSTRACT
BACKGROUND: There are many studies on the physiological roles of high-molecular-weight protein in cartilage tissue, but low-molecular-weight peptides are rarely investigated. OBJECTIVE: To conduct a quantitative analysis of cartilage tissue peptide in low- and high-age population, and to screen active peptides related to cartilage development from the differential peptides. METHODS: The cartilage tissue samples from six cases of low age (< 3 years old) and eight cases of high age (6-8 years old) population were collected, cartilage peptides analyzed quantitatively by liquid chromatography tandem mass spectrometry, and the differences in the peptide composition between two groups were analyzed by isotope dimethyl labeling method. RESULTS AND CONCLUSION: We identified 588 differential peptides in the cartilage tissues of two groups, which were originated from 428 proteins. Sixteen peptides were present at higher levels in the high-age group (over 4-fold expression), and 6 were present at higher levels in the low-age group (over 4-fold expression). Through analyzing the molecular mass, isoelectric point and gene ontology of the differential peptides, we preliminarily understand the characteristics of cartilage peptides at molecular level, which provides a new perspective for searching more active cartilage peptides.
ABSTRACT
Objective To investigate the feasibility and clinical effectiveness of modified humeral supracondy-lar step－cut osteotomy(M－HSSCO)for cubitus varus in children.Methods Between June 2016 and June 2017,the study included 25 children (20 boys and 5 girls)presenting cubitus varus at the age of (8.5 ± 0.3)years old (6－11 years old)in the Children's Hospital of Nanjing Medical University.M－HSSCO was used in the osteotomy operation. The initial osteotomy was performed as a right triangle osteotomy.The inferior margin of this right triangle was outlined parallel to the joint line 0.5－1.0 cm above the olecranon fossa.Then,they were incised from the medial end of this parallel line,which made an angle between the first and second lines equal to the desired corrective humerus elbow－wrist angle.Next,from the lateral end of the second line,the third line perpendicular to the first line was cut.Finally, desired right triangle was outlined and removed.The second right triangle osteotomy from proximal line of osteotomy was similar as the above.The medial cortex and periosteum was used as a hinge and rotated to make two osteotomy parts combined steadily.The Bellemore evaluation system was used to evaluate the difference in carrying angle degree be-tween the affected side and normal side after osteotomy,and the different degree of flexion and extension in the elbow joint between preoperation and post－operation.Residual varus deformity and other complications were also evaluated. Results All patients were followed up for 6－18 months (mean 12 months).The preoperative ipsilateral carrying an-gle was－(15°－30°)[－(22.20 ± 1.40)°],the postoperative was 5°－10°[(7. 60 ± 0.47)°]and the final follow－up was 5°－9°[(7.30 ± 0.40)°].There were statistically significant differences in the flexion angles before surgery and after surgery (t＝23.34,P＝0.000).There were statistically significant differences in the flexion angles before surgery and at final follow－up (t＝23.14,P＝0.000).The mean range of joint motion of the elbow was －5°－130° [(132.5 ± 0.5)°]before surgery,0°－125°[(123.6 ± 1.4)°]after surgery and 0°－130°[(126.8 ± 1.3)°]at fi-nal follow－up.The carrying angle reduced did not happen by the final follow－up.There was no statistically significant difference between the flexion angles before surgery and after surgery or by final follow－up(P＞0. 05).Twenty－three (92.0%)patients got an excellent result,2 cases(18.0%)got a good result and no patient (0)got worse according to the criteria described by Bellemore.The first－class incision healing were achieved in all patients.There was no case with postoperative infection,instabilities,vascular and neural injury or any significant postoperative complications. Conclusions M－HSSCO is an effective osteotomy procedure which shows good feasibility and apparent therapeutic effect in treating cubitus varus in children.
ABSTRACT
Objective To evaluate the clinical efficacy of percutaneous haemostat stroke-poking reduction and elastic intramedullary nailing for pediatric radial neck fractures of O'Brien types Ⅱ & Ⅲ.Methods From January 2014 to June 2016,38 children (23 boys and 15 girls) with radial neck fracture of O'Brien type u or Ⅲ were treated by percutaneous haemostat stroke-poking reduction and elastic intramedullary nailing in our department.We had 26 left and 12 right sides.Their ages ranged from 5 to 14 years,averaging 8.6 years.All fractures were fresh.According to O'Brien classification,22 cases were type Ⅱ and 16 type Ⅲ.The operation time,frequency of intraoperative C-arm fluoroscopy,frequency of percutaneous haemostat stroke-poking reduction,and union time were recorded.The elbow function was assessed one day before removal of internal implants according to the Métaizeau scoring system.Results All operations succeeded,lasting from 12 to 25 min (average,16.4 min).The frequency of intraoperative fluoroscopy ranged from 3 to 11 times (average,6.4 times);the frequency of intraoperative percutaneous reduction ranged from 1 to 4 times (average,2.3 times).The patients were followed up for 6 to 22 months (average,1 1.2 months).Postoperative X-ray films showed satisfactory alignment of the fracture ends.All fractures demonstrated clinical and radiographic evidence of complete healing after a mean time of 58 days (from 38 to 72 days).The Métaizeau scoring showed 33 excellent,4 good and one fair cases,yielding an excellent to good rate of 97.4％.Follow-ups revealed no infection,implants breakage,nonunion,fracture redisplacement,or iatrogenic radial nerve injury.Conclusions As percutaneous haemostat stroke-poking reduction can increase the probability of successful reduction at first attempt,reduce frequency of close reduction and X-ray exposure for both children and medical staff,and shorten operation time,the procedure is effective,simple,reliable and minimally invasive,leading to fewer complications.
ABSTRACT
Objective To compare the clinical efficacy of three internal fixation techniques,namely K-wire,hollow screw and pediatric hip locking compression plate (LCP),for treating displaced femoral neck fractures in children.Methods The clinical data of 56 patients treated from January 2010 to August 2015 were retrospectively analyzed by case-control study.All the patients received open reduction after unsuccessful closed reduction.According to the methods of internal fixation,the patients were divided into K-wire group (18 cases),hollow screw group (21 cases) and LCP group (17 cases).Operation time,intraoperative blood loss,neck-shaft reduction,bone union time,and complications after surgery were recorded.Ratliff and Harris scores at final follow-up visit were evaluated.Results In K-wire group,hollow screw group and LCP group,the operation times were respective(74.2 ± 12.9) min,(90.2 ± 18.9) min and (125.1 ± 20.6) min,the intraoperative blood loss of the three groups were respective (27.3 ± 15.4) ml,(32.4 ± 18.7) ml and (57.7 ± 22.1) ml,and the neck shaft reduction of the three groups were respective (3.74 ± 0.80) °,(2.96 ± 0.74) ° and (1.22 ± 0.39) °.K-wire group were superior to other two groups in operation time and intraoperative blood loss,and PHP group were better than the other two groups in prevention of neck-shaft reduction(P ＜ 0.05).There was one case in K-wire group with bone nonunion combined with hip varus.In K-wire group,hollow screw group and LCP group,the avascular necrosis were 11％,14％ and 12％,respectively (P ＞ 0.05).There were no statistically significant differences in follow-up time,bone union time,and Ratliff as well as Harris scores among the three groups (P ＞ 0.05).The case of epiphyseal premature closure,iatrogenic injury of blood vessel and nerve as well as osteo-fascial compartment syndrome was not observed after surgery.None of the patients had epiphyseal close,neurovascular injury and osteofacial compartment syndrome.Conclusions All three internal fixation techniques can have good clinical results in children with displaced femoral neck fractures after unsuccessful closed reduction.K-wire has advantages of less blood loss,shorter operation time and easier handling.Hollow screw has no obvious advantages or disadvantages in intraoperative situation and postoperative complications.Pediatric hip LCP can reduce the loss of neck-shaft angle and decrease the occurrence of hip varus.
ABSTRACT
Objective To compare open versus closed reduction in treatment of children with displaced femoral neck fracture whose reduction is delayed by more than 24 hours.Methods We retrospectively reviewed 51 children who had been treated at our department for femoral neck fracture between May 2005 and May 2012 after their reduction had been delayed for more than 24 hours.They were 37 boys and 14 girls,1.7 to 15.5 years of age (average,9.1 years).According to Delbet's classification,27 cases belonged to type Ⅱ,18 to type Ⅲ,and 6 to type Ⅳ.Of them,18 underwent closed reduction and 33 open reduction.Their complications were recorded in detail.Their therapeutic results were evaluated according to Ratliff's criteria and compared between the 2 methods of reduction.Results The 51 children were followed up for an average of 36.7 months (range,from 17 to 61 months).Anatomic reduction was achieved in 6 cases in the closed reduction group (33.3％) and 29 cases in the open reduction group (87.9％),respectively.All fractures healed after an average of 10.9 weeks (range,from 9 to 13 weeks),with one exception of nonunion in the closed reduction group.The incidence of femoral head necrosis in the closed reduction group (27.8％,5/18) was significantly higher than that in the open reduction group (15.2％,5/33) (P ＜ 0.05).According to the Ratliff's evaluation at the final follow-ups,the good to excellent rate in the closed reduction group(66.7％,12/18) was significantly lower than that in the open reduction group (84.8％,28/33) (P ＜0.05).Coxa vara occurred in 3 children in the closed reduction group but in none in the open reduction group.Conclusion Open reduction with internal fixation may lead to better outcomes than closed reduction in the treatment of children with displaced femoral neck fracture whose reduction is delayed by more than 24 hours,probably because open reduction can result in better reduction quality.
ABSTRACT
Objective To analyze the clinical characteristics and treatment strategy of ankle supination fracture in children.Methods From January 2012 through July 2014,89 children were treated at our department for ankle fracture caused by supination sprain according to their medical history,physical examination,X-ray films and CT three-dimensional reconstruction of the ankle.Appropriate protocols were applied on the basis of Lauge-Hansen classification,type and displacement of their fractures.Of them,52 belonged to the supination-adduction type (the extramalleolus fracture was of Odgen type Ⅶ in 51 children whose epiphyseal plate of distal fibula had not been closed),35 to the supination-extorsion type (32 cases had tri-plane fracture and 3 Tillaux fracture),and the remaining 2 did not fit the Lauge-Hansen classification.Surgical treatment was applied in 32 cases and conservative treatment in 57 ones.Results All the children received outpatient follow-up from 12 to 24 months(mean,18 months).No bone nonunion,osteoarthritis,or fracture malunion was found.The American Orthopaedic Foot & Ankle Society scores averaged 92 points (range,from 88 to 100 points) at the last follow-ups.Conclusions In children whose epiphyseal plate is nearly closed,supination-adduction sprain likely causes an extramalleolus fracture of Salter-Harris type Ⅰ or type Ⅱ,but in children whose epiphyseal plate is unclosed,an epiphyseal fracture of Odgen type Ⅶ is inclined to happen.A Tillaux fracture or tri-plane fracture at the level of distal tibiofibular syndesmosis results often from supination-extorsion sprain in children.For fractures involving epiphysis or epiphyseal plate,anatomical reduction and proper fixation are critical to functional recovery and reducing complications.