ABSTRACT
Objective To explore the clinical curative effects of non-weight-bearing area osteotomy of anterior lateral tibial condyle in treating posterior-lateral condyle fracture of tibial plateau.Methods A retrospective analysis was carried out on 24 cases of posterior-lateral condyle fracture of tibial plateau treated by osteotomy of anterior lateral tibial condyle in this hospital from December 2012 to December 2015,including 15 males and 9 females,aged 26-59 years old with an average age of 42.2 years old.Fracture Schatker classification:type Ⅱ in 16 cases,type Ⅴ in 3 cases and type Ⅵ in 5 cases.All 24 cases adopted surgical treatment via the approach of anterior lateral tibial condyle.During operation,the non-bearing area of lateral tibial condyle was cut to expose and reset the posterior-lateral fractured condyle and fix it with lateral raft steel plate.At the time of last follow-up,the recovery of the knee joint function was evaluated according to the knee scoring system of Hospital for Special Surgery (HSS) in USA.Results Twenty-four patients were postoperatively followed up for 12-24 months,with an average of 13.1 months.The Rasmussen score for the postoperative immediate fracture reduction quality averaged (17.3 ± 0.8)points;there were 19 cases of excellent results and 5 cases of good results,with the excellent and good rate of 100 ％.Twenty-four cases had no incision infection,no internal fixation loosening or breakage.The X ray film showed that the fracture got healing,and the average healing time was (13.1 ± 1.1) weeks(12-15 weeks).No surgery related complications including blood vessel and nerve damage occurred;2 cases appeared small area of superficial necrosis at the edge of the posterior incision,which was healed after dressing.At the last follow-up,the HSS knee score was(93.0±6.4) points,excellent in 19 cases,good in 4 cases,and fair in 1 case,with the excellent and good rate of 95.8％.Conclusion For the patients with posterior-lateral condyle fracture of tibial platform,non-weight-bearing area osteotomy approach of lateral tibial condyle allows enough space to directly expose the fracture area and carry out operation;combined with lateral raft locking steel plate fixation is more reliableto fixthe fractured bone,with convenient operation positioning,good postoperative functional recovery,fewer complications,and satisfied curative effects.
ABSTRACT
Objective To compare the effects of two surgical procedures via comparison on tibial fractures with/without proximal fibula fractures ,and to explore the reference importance of proximal fibula fractures in surgery for complex tibial plateau fracturesinvolvingposterior and lateral spine .Methods Totally 69 cases of patients with complex tibial plateau fracturesinvolving‐posterior and lateral spine (Schatzker Ⅴ and Ⅵ) were selected ,who accepted treatment between January 2008 and October 2012 . The patients were screed according to the quality of fracture reduction immediately after operation .39 cases were screened whose scores were excellent and the general condition was similar .The patients were divided into group A1 ,A2 and B1 and B2 according to the whether there was proximal fibula fractures and whether accepted posterior lateral support steel plate:group A1 (n=10):without proximal fibula fractures but with posterior lateral support steel plate;group A2 (n=11):without proximal fibula fractures and without posterior lateral support steel plate;group B1 (n=9):with proximal fibula fractures and with posterior lateral support steel plate;group B2 (n=9):with proximal fibula fractures but without posterior lateral support steel plate .According to the knee scoring system of American Hospital for Special Surgery (HSS) ,a total of 39 cases of patients were followed up for 12-14 months (average 12 .8 months) to evaluate the recovery condition of knee function .And correlations between the scores of the 4 groups were compared .Results There were statistically significant differences between group B1 and group B2 on HSS scores (P0 .05) .Conclusion For patients with complex tibial plateau fracturesin‐volvingposterior and lateral spine and with proximal fibula fractures ,posterior lateral support steel plate can achieve more satisfac‐tory rehabilitation function .
ABSTRACT
BACKGROUND AND PURPOSE: This study aimed to determine whether there are clinicoelectrical differences between anterior lateral temporal lobe epilepsy (ALTLE) and posterior lateral temporal lobe epilepsy (PLTLE), taking medial temporal lobe epilepsy (MTLE) as a reference. METHODS: We analyzed the historical information, ictal semiologies, and ictal EEGs of temporal lobe epilepsy patients with a documented favorable surgical outcome (Engel class I or II) at follow-up after more than one year. LTLE was defined when a discrete lesion on MRI or an ictal onset zone in invasive study was located outside the collateral sulcus. LTLE was further divided into ALTLE and PLTLE by reference to the line across the cerebral peduncle. Total 107 seizures of 13 ALTLE, 8 PLTLE and 21 MTLE patients were reviewed. RESULTS: Initial hypomotor symptom was frequently observed in PLTLE (P<0.001). Oroalimentary automatism (OAA) was not observed initially in PLTLE. Generalized tonic-clonic seizures occurred significantly earlier in PLTLE than in ALTLE or MTLE (P< 0.001). Ictal scalp EEG was not helpful in differentiating between ALTLE and PLTLE. CONCLUSIONS: Frequent hypomotor onset, the absence of initial oroalimentary automatism, and early generalization are characteristic findings of PLTLE, although they are insufficient to differentiate it from ALTLE or MTLE.
Subject(s)
Humans , Automatism , Electroencephalography , Epilepsy, Temporal Lobe , Follow-Up Studies , Generalization, Psychological , Magnetic Resonance Imaging , Scalp , Seizures , Tegmentum Mesencephali , Temporal LobeABSTRACT
PURPOSE: To analyze the pain intensity and characteristics of patients in posterior- lateral thoracotomy (PLT) and esternotomy (EST). METHODS: The sample was composed by 40 individuals submitted to PLT and EST, 12 males and 08 females for each surgical proceeding with average of 47 years old. The instruments used were physiotherapeutic evaluation forms, pain numerical scale and McGill questionnaire pain. The proceeding have consisted on apply of the instruments. RESULTS: The pain intensity of numerical scale has ranged from 2 to 10 with average of 5.1 for male and 5.7 for female. The descriptors of the McGill questionnaire selected with higher frequency were: pointed1 e thin1 (sensorial group), tired1, sickening1, punishment1 e miserable1 (affective group) and e tidy1, cold1 e bored1 (miscellany group). The average of the number and the plus of the descriptors were compared between males patients submitted to PLT and EST, these values haven't showed statistical significance. The same results also were found between females patients. CONCLUSION: There weren't statistical significance of pain quantitative answers when compared the patients submitted to PLT and EST. About the qualitative aspects, it was observed at McGill questionnaire a predominance the same descriptors of the affective group for both sexes.
OBJETIVOS: analisar a intensidade e características da dor em pacientes submetidos a toracotomia póstero-lateral (TPL) e esternotomia (EST). MÉTODOS: a amostra foi constituída por 40 indivíduos submetidos a toracotomia póstero-lateral e esternotomia, dos quais 12 eram do sexo masculino e 8 do sexo feminino para cada procedimento cirúrgico, com média de idade de 47 anos. Como instrumentos utilizou-se a ficha de avaliação fisioterapêutica, escala numérica da dor e questionário para dor McGill. Os procedimentos consistiram na aplicação dos instrumentos. RESULTADOS: a intensidade dolorosa na escala numérica variou de 2 a 10, com média de 5,1para o sexo masculino e de 5,7 para o feminino. Os descritores do questionário para dor McGill escolhidos com maior freqüência pelos pacientes foram: pontada1 e fina1 (grupo sensorial), cansativa1, enjoada1, castigante1 e miserável1 (grupo afetivo) e aperta1, fria1 e aborrecida1 (grupo miscelânea). As médias do número e somatório dos descritores escolhidos foram comparadas entre os pacientes do sexo masculino submetidos a TPL e EST, estes valores não apresentaram diferenças estatisticamente significativas. Resultados semelhantes também foram encontrados entre as pacientes do sexo feminino. CONCLUSÃO: não foram observadas diferenças estatísticas significantes entre as respostas quantitativas da dor quando comparadas as respostas dos pacientes submetidos a toracotomia póstero-lateral e esternotomia. No que diz respeito ao aspecto qualitativo observou-se uma predominância dos mesmos descritores verbais do grupo afetivo do McGill para ambos os sexos.
ABSTRACT
BACKGROUND AND OBJECTIVES: With the recent development of endoscopic nasal surgery, endoscopic sphenopalatine artery ligation allows for secure control of posterior epistaxis with considerably low recurrence and complications. Surgical approaches to the sphenopalatine foramen to ligate the sphenopalatine artery are transantral, intranasal, and transseptal. However, the procedures have considerable limitations. Therefore, we have revised the transturbinal approach, which was described by Togawa for intranasal vidian neurectomy in 1977, to ligate the sphenopalatine artery in two patients of intractable posterior epistaxis, and describe our technique of the trans-inferior turbinate approach for endoscopic sphenopalatine artery ligation. SURGICAL TECHNIQUE: A longitudinal incision is made along the lower border of the inferior turbinate, and the mucoperiosteal flaps are developed to the lateral nasal wall. The posterior two-thirds of the inferior turbinate bone is removed from the lateral nasal wall. The posterior lateral nasal artery on the upper flap is positively identified, and followed to the posterior end of the middle turbinate bone. The sphenopalatine foramen can be localized after removing the posterior end of the middle turbinate bone, and the sphenopalatine artery is ligated with hemoclips or divided with bipolar electrocautery. RESULTS: With the trans-inferior turbinate approach, it was possible to identify and ligate the sphenopalatine artery and its branches in the sphenopalatine foramen with no immediate or delayed complications. CONCLUSION: The trans-inferior turbinate approach provides unobscured surgical access to the posterior nasal cavity, and enough working space for endoscopic manipulation. The posterior lateral nasal artery is a reliable surgical landmark leading to the sphenopalatine foramen.