99Tcm-MDP SPECT/CT in diagnosis of pelvic insufficiency fracture of cervical cancer after radiotherapy / 中国医学影像技术

Objective: To explore the value of 99Tcm-MDP SPECT/CT in diagnosis of pelvic insufficiency fracture (PIF) of cervical cancer after radiotherapy. Methods Whole body scan (WBS) and 99Tcm-MDP SPECT/CT data of 37 suspected PIF patients with cervical cancer after radiotherapy were retrospectively analyzed. The diagnosis standard of PIF was based on radiologic investigation, clinical information and follow up for at least 12 months. The efficiency in diagnosis of PIF was compared between WBS and SPECT/CT. Results Among 37 patients (50 pelvic lesions ), 42 PIF lesions were diagnosed in 30 patients. The diagnostic sensitivity, specificity and accuracy of WBS diagnosis of PIF were 45.24% (19/42), 50.00% (4/8) and 46.00% (23/50), while of SPECT/CT diagnosis of PIF were 92.86% (39/42), 75.00% (6/8) and 90.00% (45/50), respectively. The diagnostic sensitivity and accuracy of SPECT/CT were significantly higher than those of WBS (χ2=22.28, 22.24, both P<0.01), and no significant difference of specificity was found between WBS and SPECT/CT (P=0.31). Conclusion: 99Tcm-MDP SPECT/CT can be used for diagnosis of PIF.

Effects of intracanal medicaments and the remaining cavity wall on fracture strength of endodontically treated molars / Efeitos dos medicamentos intracanais e do muro de cavidade remanescente na força de fratura dos molares endodonticamente tratados

Objective: The aim of this study was to investigate the effects of the short-term intracanal application of two medicaments on the fracture strength of root-filled molar teeth with different levels of tooth structure loss. Material and Methods: Standard access cavities of totally 84 intact maxillary molar teeth were prepared in 72 teeth and were divided into 3 main groups. Standard access cavities were kept in the first group, while mesio-occlusal-distal cavities (MOD) were prepared in the second and third groups. One-half of the palatinal walls were removed in the third group. Twelve sound teeth were used in the fourth group as control. Each group was then assigned into two subgroups according to the medicament used (n=12): 2% chlorhexidine gel and calcium hydroxide. Samples were stored at 37°C and 100% humidity for 1 week. Then the teeth were inserted into a universal testing machine and vertically loaded (5 mm/min) from the occlusal surface. The data was recorded in Newtons and statistically evaluated using a Univariate ANOVA and a Tukey as post hoc test. Results: A significant difference was found among the test groups (p <0.01). No significant difference was found according to the medicament used (p>0.05), however the number of remaining walls significantly affected the fracture strength (p <0.01). The first group with access cavity showed mostly repairable fractures (60%­80%) whereas the others showed mostly nonrepairable fracture patterns s (60%­90%). Conclusion: In conclusion, the fracture strength of endodontically treated teeth is related to the structure loss rather than the intracanal medicament used. (AU)

Objetivo: O objetivo deste estudo foi investigar os efeitos da aplicação intracanal de curto prazo de dois medicamentos sobre a resistência à fratura de dentes molares preenchidos com raízes com diferentes níveis de perda de estrutura dentária. Material e Métodos: cavidades de acesso padrão de totalmente 84 dentes molar maxilares intactos foram preparadas em 72, dentes e foram divididas em 3 grupos principais. As cavidades de acesso padrão foram mantidas no primeiro grupo, enquanto as cavidades mesooclusais-distal (MOD) foram preparadas no segundo e terceiro grupos. A metade das paredes palatinas foi removida no terceiro grupo. Doze dentes de som foram utilizados no quarto grupo como controle. Cada grupo foi então atribuído em dois subgrupos de acordo com o medicamento utilizado (n = 12): 2% de gel de clorhexidina e hidróxido de cálcio. As amostras foram armazenadas a 37 ° C e 100% de umidade por 1 semana. Em seguida, os dentes foram inseridos em uma máquina de teste universal e carregados verticalmente (5 mm / min) da superfície oclusal. Os dados foram registrados em Newtons e avaliados estatisticamente usando uma ANOVA Univariada e um Tukey como teste post hoc. Resultados: uma diferença significativa foi encontrada entre os grupos de teste (p <0,01), no entanto, o número de paredes restantes afetou significativamente a resistência à fratura (p <0,01). O primeiro grupo com cavidade de acesso apresentou fracturas principalmente reparáveis (60% -80%), enquanto as demais apresentaram padrões de fratura não reparáveis (60% -90%). Conclusão: Em conclusão, a resistência à fratura dos dentes tratados endodonticamente está relacionada à perda da estrutura em vez do medicamento intracanal utilizado.(AU)

Minimally invasive surgical treatment for unstable fractures of the proximal phalanx: intramedullary screw / Tratamento cirúrgico minimamente invasivo das fraturas instáveis da falange proximal: parafuso intramedular

To analyze the clinical-functional parameters and quality of life of patients undergoing minimally invasive surgical treatment for extra-articular fractures of the proximal phalanx, using an intramedullary screw (Acutrak(r)). METHODS: Between January 2011 and September 2014, a prospective study was conducted on 41 patients (48 fingers) with unstable extra-articular fractures of the proximal phalanx, who underwent minimally invasive surgical treatment using an intramedullary screw (Acutrak(r)). These patients were evaluated 12 months after the surgery by means of the DASH quality-of-life questionnaire, VAS pain scale, measurement of range of motion (ROM, in degrees) and radiographic assessment. RESULTS: All the patients achieved adequate reduction and consolidation of their fractures. There were statistically significant improvements in quality of life on the DASH scale, pain on the VAS scale and range of motion. CONCLUSION: The minimally invasive technique for treating unstable extra-articular fractures of the proximal phalanx using an intramedullary screw (Acutrak(r)) is effective and safe, and it presents satisfactory clinical-functional results.

Analisar os parâmetros clínico-funcionais e a qualidade de vida de pacientes submetidos ao tratamento cirúrgico minimamente invasivo das fraturas extra-articulares da falange proximal com uso do parafuso intramedular (Acutrak(r)). MÉTODOS: Um estudo prospectivo foi feito de janeiro de 2011 a setembro de 2014 e incluiu 41 pacientes e 48 dedos acometidos com fratura da falange proximal extra- articular e instável submetidos ao tratamento cirúrgico minimamente invasivo com parafuso intramedular (Acutrak(r)). Esses pacientes foram avaliados 12 meses após a cirurgia por meio do questionário DASH de qualidade de vida, escala de dor VAS, arco de movimento (adm em graus) e avaliação radiográfica. RESULTADOS: Todos os pacientes obtiveram redução adequada e consolidação das fraturas. Houve melhoria estatisticamente significativa da qualidade de vida (DASH), escala de dor (VAS) e arco de movimento. CONCLUSÃO: A técnica minimamente invasiva no tratamento das fraturas instáveis e extra-articulares da falange proximal com o parafuso intramedular Acutrak(r) é eficaz e segura e apresenta resultados clínico-funcionais satisfatórios.

Nursing care to elderly patients with fracture complicated with diabetes mellitus / 现代临床护理

Objective To explore the blood sugar controlling for elderly patients with fracture and diabetes mellitus. Methods Twenty patients with fracture complicated with diabetes were managed with mental education and diet controlling. Meanwhile nursing measures were done to prevent infections, bedsores and deep vein thrombosis (DVT). Results The fasting blood sugar levels of the 20 elderly patients were well controlled below 7.8 mmol / L. There were no related complications. Conclusion Such nursing measures as psychological counseling and diet control are helpful for a steady maintenance of blood sugar for feasibility of surgical operation, to ensure successful manipulation of the surgical operation. Prevention of infection, bedsore and DVT is critical for ensuring the success of operations.

Analysis of the treatment of distal humeral fractures by double plate fixation / 重庆医学

Objective To investigate the internal fixation for distal humeral fractures and its outcome .Methods A total of 74 patients with distal humeral fractures were performed surgical operation between Jan 2006 and Jun 2009 .According to AO/ASIF classification ,the factures were classified as type A (n=26) ,B(n=34)and C(n=14) .Internal fixation was applied to the patients , who did functional exercises after operation ,on the basis of classification .The healing of the fractures and the function the joints was examined via follow-up and X-ray films 1 ,3 and 6 months after operation .Results According to the Jupiter elbow score ,40 ca-ses were excellent ,22 cases were good ,12 cases were fair and 0 case was poor ,and the good rate was 83% .Conclusion Internal fix-ation with double plate ,is an effective therapeutic approach to distal humeral fractures in adults .Influencing factors of the efficacy include severity of the initial trauma ,operative scheme ,and post-operation functional recover .

Minimally Invasive Plate Osteosynthesis for Fractures of Distal Tibia / 고신대학교의과대학학술지

OBJECTIVES: This study analyzed clinical and radiologic results, and complications of minimally invasive plate osteosynthesis(MIPO) for distal tibia fracture. METHODS: 16 patients (17 cases) who were performed MIPO for distal tibia fractures between January 2007 and June 2011, post-operative followed up at least for one year, were selected for this study. The average age was 55.0(26-76) years old and the average period of follow-up was 15.1(6-27) months. Most of the patients were encouraged to perform ankle dorsiflexion and straight leg raising exercise on splints, from the next day of the operation. As radiologic evaluation, we checked period until bone union, degree of angulation. And post-operative complications were also checked. For functional evaluation of the ankles, American Orthopaedic Foot and Ankle Society(AOFAS) score was used. RESULTS: 16 of the 17 cases were achieved primary bone union, and average period of bone union in all the cases was 17.4 (12-42) weeks. Mean varus/valgus angulation after the bone union was 0.8 degrees and mean anteroposterior(AP) angulation was 1.8 degrees. Mean AOFAS score was 85.2(71-95) points; 5 cases of excellent, 10 cases of good, 1 case of fair, showing that 93.8% of the patients represented at least good AOFAS scores. As complications, there were 2 cases of superficial infection, and each 1 case of nonunion and skin irritation. There were no cases of deep infection, metal breakage, nor limb length discrepancy. CONCLUSIONS: MIPO for distal tibia fracture is considered to be an effective operative method, because of its high bone union rate and low complications by minimal disruption of soft tissue and improved bone fixation strength. Also, for earlier return to daily life, ankle joint exercise should be started as soon as possible after the operation.

Comparative study on the effects of suspension and pillow elevation on limb swelling after elbow surgery / 现代临床护理

Objective To compare the clinic effects of suspension and pillow elevation on limb swelling after elbow surgery. Methods One hundred patients receiving operations on elbow fracture were randomly divided into experiment group(suspension elevation)and the control group(pillow elevation)to eliminate limb swelling,50 cases in each group.The forearm circumference(10 cm below elbow)were measured 1-5d after operation,the circumferences on the first day and the fifth day recorded for comparing effects of the limb swelling elimination.Results The circumferences on the 1st day and 5th day of the suspension elevation group and the pillow elevation group were(2?53±0?76)cm,and(4?19±2?36)cm,respectively.The differences in circumference between the two groups were statistically significant(P<0?05).Conclusion The suspension elevation is more effective in promoting venous circulation and eliminating swelling,so it is conducive for the elbow fracture patients in early functional exercise?

Clinical Analysis of the Nasal Bone Fracture

PURPOSE: Nasal bone fracture is the most common facial fracture. Although nasal bone fractures are considered to be minor injuries, the incidence of post-traumatic nasal deformity remains high. This study is designed to support management and patient satisfaction by classifying the simple nasal bone fracture, and survey the care method and result, which is compared with other studies. METHODS: From May 2008 to April 2010, 334 patients with simple nasal bone fractures visited our hospital. The incidence, cause, types of nasal bone fracture, treatment, and complications are analyzed according to clinical examination, patient's record and radiographic images. RESULTS: The mean age of patients was 30 years old, with 74% of the patients having been male, and 26% were female. The highest incidence of this fracture was between late teens to late twenties. The causes of nasal bone fracture were the following: having slipped or fallen down(39%), violence(16%), sports accident(14%), traffic accident(11%), industrial accident(6%), and others(16%). Patient's radiographic images were analyzed by Stranc and Robertson classification, frontal impact plane I was 38%, plane II was 16%, plane III was 1%, lateral impact plane I was 21%, plane II was 21%, and plane III was 3%. On average, surgical treatment was performed 7.2 days after trauma under general anesthesia. Closed reduction of nasal bone fracture was performed in 99% of patients. In patients with septal injuries, septal management was performed in 76.7% of cases. Aesthetic surgery was done on same time in 24% of patients. There were some complications, such as residual nasal deformity(7.2%), nasal obstruction(0.9%) and hyposmia(0.3%). CONCLUSION: According to this study, nasal bone fractures occurred commonly in physically active age groups(age 15~29 years), as a result of having slipped or fallen down, at afternoon and at night time. And it could be treated successfully by closed reduction and septoplasty by 7 days after trauma.

Manufacture and application study of the portable,pollution-prevention and high-pressure-vapor disinfection basket / 中国实用护理杂志

Objective The high-pressure-vapor disinfection basket was made to take precautions against the sterile article pollution after disinfection from boiler disinfection and also for convenience. Methods Items after disinfection from 100 pots were randomly allocated to the observation group and the control group, each group had 50 pots.The observation group used the high-pressure-vapor disinfection basket to take the items from the sterilization room to the disinfection room directly. The control group used conventional disinfection cart, re-moved the items to the cart,thon took them to the disinfection room. Time cost for convey of the disinfection items was observed,and surface sampling for gormiculture was obtained from the last item conveyed to the disinfection room. Results After germiculture,2 pollution packets were found in the observation group,the polluting rate was 4%;49 pollution packets in the control group,the polluting rate was 98%,which was statistically different from that of the observation group(P<0.01). Time cost of the observation group was 8 minutes,of the control group was 13 minutes. Conclusions Use of the portable,pollution-prevention and high-pressure-vapor disinfection basket can prevent the surface of disinfection items from pollution,besides,it is convenient and costs less labor and time.

Configuración cavitária: Análisis fotoelástico de la concentración y distribución de tensiones / Configuração cavitária: análise fotoelástica da concentração e distribuição de tensões / Cavity configuration: photoelastic analisis of concentration and distribution of stress

El presente trabajo tiene por objetivo evaluar la respuesta de dientes pré-molares superiores sanos y preparados a través de la análisis cualitativo de la distribución y concentración de las tensiones, de la luz polarizada en modelos fotoelásticos de los mismos. Fueron creados modelos fotoelásticos con diferentes configuraciones de preparación cavitaria y esos cuerpos se sometieron a carga oclusal en maquina de ensayo universal asociado al polariscopio circular para el análisis de una distribución de las tensiones. Los resultados obtenidos demuestran que, en los dientes sanos, las tensiones están concentradas en el esmalte de la cúspide palatina, diferentemente de los modelos con preparaciones cavitarias donde la concentración de las tensiones se produjo en regiones diversas del modelo fotoelástico. La configuración cavitaria influye directamente en la distribución de las tensiones, pues cuan mayor sea la remoción de la estructura dentaría, peor será el comportamiento mecánico del remanente

The aim of this study was evaluate the behavior of upper first premolars with different cavity configurations using a qualitative analysis of distribution and stress concentration through polarized light in photoelastic models. Photoelastic models were created with different cavity preparations and these samples were submitted to oclusal stress using an universal testing machine associated to circular polariscope that analyzed the stress distribution. The results showed that stress is concentrated in enamel of palatal cuspid in sound teeth. Differently, in the prepared models, stress concentration occurred in different areas of the photoelasticity model. The cavity configuration has a direct influence on the stress distribution. As much tooth structure is removed, worst is the mechanical behavior of the reminiscent

O presente trabalho tem por objetivo avaliar a resposta de dentes pré-molares superiores hígidos e preparados através da análise qualitativa da distribuição e concentração das tensões através da luz polarizada em modelos fotoelásticos dos mesmos. Foram criados modelos fotoelásticos com diferentes configurações de preparo cavitário e esses corpos foram submetidos a carregamento oclusal em maquina de ensaio universal associado ao polariscopio circular para análise da distribuição das tensões. Os resultados obtidos demonstram que, nos dentes hígidos, as tensões estão concentradas no esmalte da cúspide palatina, diferentemente dos modelos com preparos cavitários onde a concentração das tensões se deu em regiões diversas do modelo fotoelástico. A configuração cavitária influencia diretamente a distribuição das tensões, pois quanto maior a remoção da estrutura dentária, pior se torna o comportamento mecânico do remanescente

Fixation for Reattachment of Trochanteric Fragment in Pertrochanteric Fracture Treated with Bipolar Hemiarthroplasty

Purpose: To retrospectively compare the fixation methods for reattaching a trochanteric fragment in a pertrochanteric fracture treated with bipolar hemiarthroplasty. Materials and methods: Forty cases of an unstable femur pertrochanteric fracture were analyzed and followed up for average of 19(6~40) months. There were 18 cases fixed with tension band wiring (group 1), 7 cases treated using modified tension band wiring with K-wires (group 2) and 15 cases treated with the GTRD (Greater Trochanteric Reattachment Device) (group 3). Result: Group 1 was treated with simple a surgical procedure and the results were good. The second group had firm fixation postoperatively but required additional surgery in two cases to remove the K-wires because of wire migration after ambulation. Group 3 had relatively good results but required more dissection and a longer operating time. Conclusion: Tension band wiring or GTRD are good fixation methods for reattaching trochanteric fragments in pertrochanteric fractures. Moreover, tension band wiring is recommended for old osteoporotic patients due to a simple procedure and firm fixation. The use of modified tension band wiring using K-wire or a Steinmann-pin should not be used due to the possibility of distant migration.

The Efficacy of the Treatment of Thoracolumbar Spine Fractures with Short-segment Posterior Instrumentation and Fusion

PURPOSE: To evaluate the safety and usefulness of the short-segment posterior instrumentation and fusion in the treatment of thoracolumbar spine fractures. MATERIALS AND METHODS: Forty-two patients were treated by short-segment pedicle screw instrumentation and fusion between Oct. 1998. and Jan. 2004 by single surgeon. All patients were treated posteriorly and all the pedicle screws are monoaxial. Intraoperative rod bending and fixation technique was used to reduce the collapsed vertebral body and correct the kyphotic angle. The follow up duration is mean 2.1 year (1~6 year). The mean age is 40.2 year (18~60 year) old. The fractures were classified by Denis' classification and Load-Sharing Classification. Preoperative and postoperative changes of kyphotic angle and vertebral body height were measured. Denis' Pain Score and Work scales, Frankel neurologic grade were obtained during follow-up evaluation for patients. RESULTS: All the cases got solid bony union. Mean Load-Sharing Score was 7.3. Clinical results were good. The mean kyphotic angle was preoperatively 14.5 degree, immediate postoperatively 7.5 degree, and last follow up 9.2 degree. The mean anterior vertebral heights s were 60.8% preoperatively, 83.4% immediate postoperatively, and 79.5% last follow up. There was only one case of screw breakage but no revision operation due to loss of reduction. All the cases showed satisfactory clinical results. CONCLUSION: This study suggest that short-segment instrumentation and fusion using pedicle screw system for thoracolumbar spine fractures could lead to good results, if comminution of vertebral body is considered in the selection of approach.

Intramedullary nailing of the femur,tibia,and humerus fractures / 中华骨科杂志

Objective To evaluate the clinical results of femoral, tibial and humeral fractures treated with locked intramedullary nailing. Methods 546 fractures of femur, tibia, and humerus in 526 patients treated with locked intramedullary nailing from April 1994 to September 2004 were retrospectively reviewed. There were 430 fractures in 412 males, 116 fractures in 114 females, with an average age of 36.4 years. 432 were close fractures, 76 old fractures, and 38 open fractures. With image intensifier, 196 fractures were reduced closely, while 350 fractures failed to be reduced by close manipulation and required open reduction. Bone grafting were undertaken in 161 fractures of the latter group. 485 fractures were reamed, and 61 unreamed. 539 fractures were stabilized statically, and 7 dynamically. The nails were inserted antegradely in 519 fractures, and retrogradely in 27. Dynamization was undertaken in 10 statically locked fractures due to delayed union. The early postoperative weight-bearing was directed. The patients were followed up with an average of 31.6 months (9~123 months). Results Among the 546 fractures, 543 fractures(99.5%) were eventurally healed, with an average union time of 4.4 months. 530 fractures(97.1%)primarily healed, and 13 fractures(2.4%) healed after secondary operation. The complications were 11 delayed unions(2.0%), 4 nonunions(0.7%), 3 malunions(0.5%), 5 bone infections(0.9%), 2 traumatic fractures(0.4%), 9 hip heterotopic ossifications(1.6%), 6 implant failures(1.0%), with 3 nail breakages(0.5%), 3 interlocking screw breakages or back-outs, 1 radial nerve palsy, and 1 fatal pulmonary embolism. The ROM of the hips and the knees were excellent in patients with femoral or tibial fractures. Flexion restriction(90?~125?) of the knee were found in 10 patients. There were 5 and 10 anterior knee pains in femoral and tibial fracture patients respectively. The ratio of excellent and good function of the shoulder was high in the humeral shaft fracture patients, with the abduction less than 90? in 2 patients, extension loss of 15? in 2 elbows, and shoulder pain in 6 patients. Conclusion Interlocking intramedullary nailing is one of the good alternatives in treating long bone fractures, with a higher union rate and a lower complication rate. Close reduction for fresh fracture, open reduction for old fracture, static locking, reaming or unreaming in regard to the site and severity of the fracture, and individualized rehabilitation protocols all contribute to the excellence of the results.