Carcinoma of the posterior wall of the hypopharynx: surgical treatment with larynx preservation / Carcinoma da parede posterior da hipofaringe: tratamento cirúrgico com preservação da laringe

Abstract Introduction: Posterior pharyngeal wall is the most rare subsite for hypopharyngeal carcinomas. Because of its rarity, there are few studies published in the literature specifically concerning posterior pharyngeal wall carcinoma. Objectives: To report our functional results in patients with the carcinoma of the posterior wall of the hypopharynx after surgical treatment by resection via a lateral or infrahyoid pharyngotomy approach, with the preservation of the larynx and reconstruction with a radial forearm free flap. Methods: The study included 10 patients who underwent surgery for a carcinoma of the posterior wall of the hypopharynx over a 6 year period. The associated postoperative morbidity was investigated and functional results were analyzed. Results: Nine patients had T3 lesions and one patient had a T2 lesion. The preferred approach to access the hypopharynx was a lateral pharyngotomy in 5 patients and lateral pharyngotomy combined with infrahyoid pharyngotomy in 5 patients with superior extension to oropharynx. The pharyngeal defects were reconstructed successfully with radial forearm free flaps. Four patients received adjuvant radiotherapy only, and 4 patients with N2b and N2c neck diseases received adjuvant chemoradiotherapy. The mean duration of hospitalization was 15.6 days (range, 10-21 days). All patients achieved oral intake in a median time of 74 days (range, 15-180). Decannulation was achieved in all patients and the median time fordecannulation was 90 (range, 21-300 days). The mean followup duration was 38.3 months (range, 10-71 months) and 8 patients survived. One patient died due to regional recurrence in the retropharyngeal lymph nodes and 1 patient died due to systemic metastasis. Conclusion: Primary surgery is still a very effective treatment modality for the carcinoma of the posterior wall of the hypopharynx and does not permanently compromise the swallowing and laryngeal functions if pharyngeal reconstruction is performed with a free flap.

Resumo Introdução: A parede posterior da faringe é o subsítio mais raro para carcinomas hipofaríngeos. Devido à sua raridade, há poucos estudos publicados na literatura especificamente sobre o carcinoma da parede posterior da faringe. Objetivo: Relatar nossos resultados funcionais em pacientes com carcinoma da parede posterior da hipofaringe após tratamento cirúrgico por ressecção via faringotomia lateral ou infra-hióidea, com preservação da laringe e reconstrução com retalho livre radial do antebraço. Método: O estudo incluiu 10 pacientes submetidos à cirurgia para carcinoma da parede posterior da hipofaringe por 6 anos. A morbidade pós-operatória associada foi investigada e os resultados funcionais foram analisados. Resultados: Nove pacientes apresentaram lesões T3 e um paciente apresentou lesão T2. Avia preferida para acessar a hipofaringe foi a faringotomia lateral em 5 pacientes e a faringotomia lateral combinada com a faringotomia infra-hióidea em 5 pacientes com extensão superior até a orofaringe. Os defeitos faríngeos foram reconstruídos com sucesso com retalhos livres radiais do antebraço. Quatro pacientes receberam apenas radioterapia adjuvante e 4 pacientes com doença cervical N2b e N2c receberam quimiorradioterapia adjuvante. A duração média da hospitalização foi de 15,6 dias (variação de 10 a 21 dias). Todos os pacientes retornaram à ingestão oral em um tempo médio de 74 dias (variação de 15 a 180). A decanulação foi possível para todos os pacientes e o tempo médio foi de 90 dias (variação de 21 a 300 dias). A duração média do seguimento foi de 38,3 meses (10 a 71 meses) e 8 pacientes sobreviveram. Um paciente foi a óbito devido a recorrência regional nos linfonodos retrofaríngeos e outro devido a metástase sistêmica. Conclusão: A cirurgia primária ainda é uma modalidade de tratamento muito eficaz para o carcinoma da parede posterior da hipofaringe e não compromete de forma permanente as funções de deglutição e da laringe se a reconstrução faríngea for feita com retalho livre.

Comparison of dynamic hip screw plus anti-rotation screw versus three cannulated compression screws in treatment of femoral neck fractures with comminuted posterior wall / 中华创伤骨科杂志

Objective:To compare the efficacy of 2 fixation modes [dynamic hip screw (DHS) plus anti-rotation screw versus 3 cannulated compression screws (CCS)] in the treatment of femoral neck fractures complicated with comminuted posterior wall.Methods:The data were analyzed retrospectively of the 109 patients who had been treated for femoral neck fractures complicated with comminuted posterior wall at Department of Orthopaedics, Shenzhen Hospital, University of Chinese Academy of Sciences from February 2017 to December 2019. They were divided into 2 groups according to 2 fixation modes. There were 42 males and 16 females with an age of 48.5 (40.0, 55.3) years in CCS group of 58 cases subjected to fixation with 3 CCSs; there were 31 males and 20 females with an age of 47.0 (38.0, 53.0) years in DHS group of 51 cases subjected to fixation with DHS plus anti-rotation screw. The length of incision, operation time, intraoperative bleeding, weight-bearing time for the affected limb, visual analog scale (VAS), hip Harris score, and incidence of postoperative complications were compared between the 2 groups.Results:The comparison of preoperative general data between the 2 groups was not statistically significant, showing comparability between groups ( P>0.05). In the CCS group, the incision length [3.0 (2.9, 4.5) cm] and operation time [90.0 (73.8, 125.0) min] were significantly shorter than those in the DHS group [10.0 (9.0, 12.0) cm and 135.0 (110.0, 165.0) min], the intraoperative bleeding [40.0 (10.0, 100.0) mL] was significantly less than that in the DHS group [200.0 (150.0, 300.0) mL], the partial and complete weight-bearing durations of the affected limb [12.0 (12.0, 13.0) weeks and 24.0 (21.0, 25.0) weeks] were significantly longer than those in the DHS group [11.0 (10.0, 12.0) weeks and 19.0 (18.0, 20.0) weeks], and the perioperative VAS pain score [2.0 (2.0, 3.0) points] was significantly lower than that in the DHS group [5.0 (4.0, 6.0) points], but the incidence of follow-up complications [56.9% (33/58)] was significantly higher than that in the DHS group [33.3% (17/51)] (all P<0.05). There was no significant difference between the DHS group and the CCS group in the excellent and good rate of Harris hip score at one year after operation [94.1% (48/51) versus 91.4% (53/58)] ( P>0.05). Conclusions:In the treatment of femoral neck fractures complicated with comminuted posterior wall, DHS plus anti-rotation screw and 3 CCSs can both result in fine therapeutic outcomes but a relatively high incidence of complications at late follow-up. However, the former fixation mode can shorten the weight-bearing time for the affected limb and reduce complications but is more invasive than the latter fixation mode.

Anatomical locking plate versus common reconstruction plate in the treatment of acetabular posterior wall fracture / 中华创伤骨科杂志

Objective:To compare the curative effects between anatomic locking plate and common reconstruction plate in the treatment of acetabular posterior wall fracture.Methods:The 50 patients with acetabular posterior wall fracture were retrospectively analyzed who had been admitted to Department of Pelvic Trauma Surgery, Luoyang Orthopaedic Hospital of Henan Province from February 2015 to February 2020. They were assigned into 2 groups according to different internal fixation methods. In the reconstruction plate group of 24 patients whose fractures were fixated by a common reconstruction plate from February 2015 to June 2017, there were 21 males and 3 females with an age of (38.9±10.9) years. In the anatomical plate group of 26 patients whose fractures were fixated by an anatomic locking plate between July 2017 and February 2020, there were 20 males and 6 females with an age of (38.0±10.0) years. The 2 groups were compared in terms of operation time, intraoperative blood loss, reduction quality, hip function and complications at the last follow-up.Results:There was no significant difference in the preoperative general data between the 2 groups, indicating the 2 groups were comparable ( P>0.05). The 50 patients were followed up for 18 to 26 months (mean, 22 months). The operation time [(132.8±8.6) min] and intraoperative blood loss [(357.0±14.7) mL] in the anatomic plate group were significantly less than those [(177.2±5.9) min and (492.0±17.6) mL] in the reconstruction plate group( P<0.05). Postoperative CT examination showed that 96.2% (25/26) of the patients in the anatomical plate group and 91.7% (22/24) of the patients in the reconstruction plate group had a fracture step ≤3 mm, showing no significant difference ( P>0.05). At the last follow-up, the excellent and good rate by Harris hip score was 92.3% (24/26) in the anatomic plate group, significantly higher than that (66.7%, 16/24) in the reconstruction plate group ( P<0.05). The incidence of complications was 3.8% (1/26) in the anatomic plate group, significantly lower than that [29.2% (7/24)] in the reconstruction plate group ( P<0.05). Conclusion:Anatomical locking plate is better than common reconstruction plate in the treatment of acetabular posterior wall fracture.

Tratamiento quirúrgico de las fractura de pared posterior de acetábulo: resultados a corto y mediano plazo / Surgical treatment in acetabular posterior wall fractures: short and medium-term results

OBJETIVO: Evaluar los resultados radiológicos a corto y mediano plazo de pacientes operados de fractura de pared posterior de acetábulo, describir la morfología de la fractura, presencia de lesiones asociadas y la necesidad de artroplastia total de cadera (ATC) durante la evolución. MATERIAL Y MÉTODOS: Estudio retrospectivo-descriptivo de una serie consecutiva de 40 pacientes operados entre julio de 2012 y julio de 2017 por fractura de pared posterior de acetábulo. Treinta y siete hombres y tres mujeres con una edad promedio de 41 años fueron operados (mediana de seguimiento 17,7 meses). Se registró el mecanismo del accidente y presencia de lesiones asociadas. Se registraron el número de fragmentos que presentaba la fractura, presencia de impactación marginal, compromiso de la cabeza femoral, presencia de fragmentos intra-articulares y complicaciones postoperatorias. Para el análisis estadístico se utilizó el test de Wilcoxon. RESULTADOS: Todos los casos fueron secundarios a un accidente de alta energía. Un 70% de los pacientes presentó luxación posterior. La mayoría de los pacientes presentó una fractura entre 2 y 5 fragmentos (70%), 47,5% de los pacientes presentó impactación marginal, 37,5% compromiso de la cabeza femoral en zona de carga, 30% fragmentos intra-articulares. La complicación que más frecuente se observó fue la artrosis post-traumática la cual se presentó en un 22,5%. Cinco pacientes (12,5%) requirieron ATC. CONCLUSIÓN: Aunque se categorizan dentro de los patrones simples, las fracturas de pared posterior son lesiones complejas. La tomografía axial computada preoperatoria es esencial para determinar lesiones intra-articulares dada su alta frecuencia y también permite realizar un buen plan preoperatorio.

OBJECTIVE: Evaluate radiologic results in short and medium-term in surgically treated patients with acetabular posterior wall fracture. Describe fracture morphology, the presence of associated lesions and the necessity of total hip arthroplasty (THA) during the evolution. MATERIALS AND METHODS: A retrospective-descriptive study design of 40 patients treated during July 2012 and July 2017 for acetabular posterior wall fracture. 37 men and 3 women, 41 years old mean age. The mean follow-up was 17.7 months. Accident mechanism and presence of associated lesions were registered, as well as the number of fragments of the fracture, the presence of marginal impaction, femoral head compromise, intra-articular fragments and postoperatory complications. Wilcoxon test was used for the statistical analysis. RESULTS: Every case resulted due to a high energy accident. 70% of patients had posterior luxation of the hip. 70% of patients presented 2 to 5 fragments. 47.5% of patients presented marginal impaction, 37.5% compromised femoral head and 30% intra-articular fragments. The most frequent complication was post-traumatic arthrosis, which appeared in 22.5% of patients. Five patients required THA. CONCLUSION: Though it is categorized as simple fracture pattern, posterior wall fractures are complex. Preoperatory CT scan is essential to determine intra-articular lesions due to its high frequency and permits to plan an adequate intervention.

Application of self-made spring plate for treatment of acetabular posterior wall fractures / 中国修复重建外科杂志

Objective: To investigate the application and effectiveness of self-made spring plate in surgical treatment of acetabular posterior wall fracturejavascript:void(0)s. Methods: Between June 2013 and June 2017, 38 patients with acetabular posterior wall fractures were treated. There were 27 males and 11 females with an average age of 53 years (range, 28-68 years). The injury caused by traffic accident in 18 cases, falling from height in 15 cases, and tumble in 5 cases. There were 4 cases of simple posterior wall fracture, 18 cases of posterior wall fracture with posterior dislocation of hip joint, 10 cases of posterior wall fracture with posterior column fracture, and 6 cases of posterior wall fracture with transverse fracture. The time from injury to admission was 1-4 days (mean, 2.5 days). The time from injury to operation was 4-8 days (mean, 5 days). After fracture reduction via the Kocher-Langenbeck approach (35 cases) or the combined ilioinguinal approach (3 cases), the spring plate was used to press the posterior wall fracture, and then the reconstruction plate was pressed against the spring plate and fixed to the posterior column. Results: All the incisions healed by first intention. All patients were followed up 12-36 months (mean, 28 months). Five cases of post-traumatic sciatic nerve injury and 2 cases of sciatic nerve injury caused by traction during operation were fully recovered at 3 months after operation. The imaging examination showed that all the fractures healed. The fracture healing time was 10-16 weeks (mean, 12 weeks). There was no ruptures or failures of internal fixation during the follow-up period. There were 2 cases of femoral head necrosis, 1 case of traumatic arthritis, and 1 case of osteomyositis at last follow-up. The hip joint function was rated as excellent in 27 cases, good in 5 cases, fair in 2 cases, and poor in 4 cases according to the Harris scores at 12 months after operation. Conclusion: For the acetabular posterior wall fracture, it has the advantages of easy to use and reliable fixation that the posterior wall fracture is fixed with spring plate firstly, and the spring plate is pressed to fix the posterior column with the reconstruction plate finally.

Relationship between thoracic and lumbar vertebral posterior wall morphology and bone cement leakage into the spinal canal during the percutaneous kyphoplasty / 中国组织工程研究

BACKGROUND: Percutaneous kyphoplasty (PKP) is an effective method for treating osteoporotic vertebral compression fracture. Although satisfactory clinical outcomes can be achieved, bone cement leakage is still one of the main complications of PKP. Based on previous studies, there are many high risk factors for bone cement leakage into the spinal canal; however, less attention to the posterior wall morphology of different vertebral bodies may be an important reason for bone cement leakage into spinal canal. OBJECTIVE: To investigate the effect of thoracic and lumbar vertebral posterior wall morphology in the patients with osteoporotic vertebral compression fracture on bone cement leakage into the spinal canal during the PKP. METHODS: The clinical data of osteoporotic vertebral compression fracture patients with PKP were selected. There were 98 osteoporotic vertebral compression fracture patients with CT scan and three-dimensional reconstruction image data from T6 to L5. The three-dimensional reconstruction of CT and multiplanar reconstruction were used to measure the depth of the concave vertebral posterior wall (OC) and the corresponding middle-sagittal diameter of the vertebra (PC) of the non-fractured vertebral body, the ratio of OC to PC was calculated. All subjects were divided into thoracic group (T6-T12) and lumbar group (L1-L5) based on the location of measured vertebral, and the differences of the OC between groups were compared. 357 patients (548 vertebrae) with osteoporotic vertebral compression fracture without CT three-dimensional reconstruction underwent PKP within the same period. They were also divided into thoracic vertebra and lumbar vertebra groups. The degree of bone cement leakage into the spinal canal was compared between thoracic and lumbar vertebra groups. RESULTS AND CONCLUSION: (1)The morphological parameters of posterior vertebral wall in 98 patients showed that the depth of the concave vertebral posterior wall gradually (OC) deepened from T6toT12, with an average of 4.6 mm. The depth became gradually shallow from L1 to L5, with an average of 0.6 mm. The ratio of the depth of the concave vertebral posterior wall to the corresponding middle-sagittal diameter of the vertebra was approximately 16% (1/6) from T6toT12. The average value of ratios from Li to U was 3%. The ratios in lumbar vertebra were significantly decreased compared with thoracic vertebra (16%, 1/6). (2) Results form 357 patients who underwent PKP at the same time showed that the rate of bone cement leakage into spinal canal was 10.2% (31/304) in the thoracic vertebra group during the PKP, and the rate of lumbar vertebra group was 3.7% (9/244). In the thoracic group, the average maximal sagittal diameter of the bone cement intruded spinal canal was (3.1 ±0.2) mm, the average maximal area of the bone cement intruded spinal canal was (30.8±0.3) mm2, and the spinal canal encroachment rate was (22.5±0.2)%. In the lumbar group, the average maximal sagittal diameter of the bone cement intruded spinal canal was (1.4±0.1) mm, the average maximal area of the bone cement intruded spinal canal was (14.9±0.2) mm2, and the spinal canal encroachment rate was (11,4±0.3)%. There was significant difference between thoracic and lumbar groups (P<0.05). (3) The above results imply that due to the presence of OC structure in the middle and lower thoracic vertebra, it is possible to reduce the occurrence of bone cement leakage into spinal canal through avoiding bone cement distribution over the posterior 1/6 (16%) of vertebral body in PKP. The effect of the difference between thoracic and lumbar vertebral posterior wall morphology in osteoporotic vertebral compression fracture patients on bone cement leakage into the spinal canal during the PKP may be one of the reasons why the rate of bone cement leakage into spinal canal in thoracic vertebra significantly higher than that in lumbar vertebra. The study protocol was approved by the Ethics Committee of the Affiliated Hospital of Southwest Medical University (approval No. K2018008).

A study of echocardiographic changes in patients of thalassemia major

Background: Thalassemia major is a chronic hematological disorder. Regular blood transfusion is the only modality of long-term survival for these patients. This leads to iron overload, the heart being the most severely affected organ. The gold standard for detecting myocardial iron deposition is cardiac MRI. However, very few patients can afford this investigation. Hence, authors carried out this study to find out whether early iron overload can be detected by echocardiography which is a simple and less expensive tool. The objective of this study was to document echocardiographic changes of cardiac iron overload in patients of thalassemia major even before appearance of symptoms.Methods: A comparative cohort study conducted from January 2018 to October 2018 in the Department of Paediatrics of SSG Hospital, and Government Medical College, Vadodara. The case group consisted of 35 patients of Thalassemia major. 35 age and sex matched normal children were selected as controls. Relevant blood investigations were performed in cases. 2-Dimensional M-Mode Echocardiography was performed in both patients and controls. Thalassemia major patients were compared to normal healthy children for various parameters in echocardiography indicating the systolic and diastolic function. Proportion and percentage were calculated for descriptive analysis. Independent t-Test was applied between two groups to find out significance level.Results: For all parameters except End systolic volume and fractional shortening, p values were less than 0.05 which is significant. 85% (30/35) had increase in interventricular septal dimensions (IVSD), 97%(34/35) had increase in posterior wall dimensions (PWD),' 82%(29/35) had' increased left ventricular internal diameter diastole(LVIDD), 88%(31/35) had increased left ventricular internal diameter systole (LVIDS), 80%(28/35) had increased E/A RATIO .Ejection fraction was affected in 77%(27/35).This shows that patients of thalassemia major have significant cardiac dysfunction; possibly because of cardiac iron overload.Conclusions: Echocardiography is an effective tool for screening cardiac iron overload in patients of thalassemia major and should be done periodically in all patients.

Clinical efficacy of pelvic floor reconstruction with autologous tissue in treatment of pelvic organ prolapse / 中华全科医师杂志

One hundred and twenty nine patients with pelvic organ prolapse (stage Ⅲ to Ⅳ according to POP-Q staging) diagnosed in our hospital from January 2010 to December 2016 were enrolled,among whom 66 cases underwent vaginal hysterectomy plus vaginal anterior and posterior wall repair (TO group),63 cases underwent vaginal hysterectomy plus pelvic floor reconstruction with autologous tissue (AT group).Clinical parameters,perioperative and postoperative complications were analyzed.There was no statistically significant difference in intraoperative blood loss,indwelling urethral catheter time,length of hospital stay,and anal exhaust time between group AT and group TO (P＞O.05).The average operation time of group AT was significantly longer than that of group TO (P＜0.05).The postoperative rotation angle of urethra (UR),posterior vesicourethral angle (RVA),and bladder neck descent (BND) of group AT were significantly reduced (P＜0.05).The BND of group AT was significantly smaller than that of group TO 3 months and 12 months after the surgery (P＜0.05).There was no statistically significant difference in UR before and 12 months after surgery in group TO (P＞0.05),while the BND at 12 months after operation in group TO was increased compared to 3 months after operation (P＜0.05).There were significant differences in scores of PFIQ-7 and PISQ-12 before surgery and 12 month after surgery in both groups (P＜0.05).There was no statistically significant difference between the two groups in the incidence of postoperative recurrence and pressure incontinence (P＜0.05).It is suggested that the stability of pelvic floor anatomical structure after pelvic floor reconstruction with autologous tissue is better than that of the traditional surgery,especially for patients with severe pelvic organ prolapse.

Outcome of posterior wall blowout in anterior cruciate ligament (ACL) reconstruction via anteromedial portal approach: A retrospective research in 20 patients with 6 years follow-up / 中华创伤杂志(英文版)

PURPOSE@#To evaluate the clinical outcome in patients who received anterior cruciate ligament (ACL) reconstruction via anteromedial portal with or without posterior wall blowout.@*METHODS@#Twenty patients with ruptured ACL, who have received ACL reconstruction via anteromedial portal between Apr 2012 and Oct 2013 were enrolled. According to the conditions of posterior wall, the patients were divided into 2 groups: posterior wall blowout group (10 patients) and posterior wall intact group (10 patients). The median follow up time were 63 (range 19-75) months and 60.5 (range 25-64) months in the 2 groups respectively. The clinical outcome was evaluated by knee joint physical examination, magnetic resonance imaging (MRI), the International Knee Documentation Committee (IKDC) 2000 subjective score, Lysholm score, Tenger score, difference of thigh circumference, KT-2000 and Biodex isokinetic dynamometer system.@*RESULTS@#No significant differences were found in terms of the IKDC score, Lysholm score, Tegner score, Lachman test positive rate or Pivot Shift test positive rate between the two groups. In KT-2000 and Biodex isokinetic dynamometer tests, the difference of muscle strength between affected knees and unaffected knees in posterior wall blowout group was not significant less than that of posterior wall intact group (p > 0.05). In addition, there is no statistical difference between the two groups in signal/noise quotient (SNQ) of the graft (p > 0.05) in post operative MRI.@*CONCLUSION@#Blowout of posterior wall in ACL reconstruction via anteromedial portal does not affect the clinical outcome as long as reliable fixation is taken intraoperatively.

Progress in treatment and research of acetabular posterior wall fracture / 中华创伤骨科杂志

Fracture of the posterior wall is the most common type of acetabular fractures,but it is often associated with such injuries as dislocation of hip joint,femoral head fracture and lesion of sciatic nerve.Latest researches have found that treatments of fracture of the acetabular posterior wall often lead to unsatisfactory outcomes because its prognosis is influenced by a variety of factors,including its associated injuries,subtypes,and quality and timing of surgical reduction.This review summarizes extensive clinical experiences in treatment of the fracture and available literature concerning management and research of the fracture so as to provide enough information for junior surgeons to have a better understanding of the fracture and its treatment,improving the prognosis of the fracture and effectively avoiding the pitfalls in their clinical practice.

Use of tricortical iliac crest strut autograft in comminuted posterior wall acetabular fractures: A case series / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>The results for fixation of comminuted posterior wall acetabular fractures are not very promising with reported complications in terms of osteoarthritis, nonunion and malunion which subsequently require conversion to total hip arthroplasty. The conversion to total hip arthroplasty is possible in patients over 50 years of age but not in younger patients. So this requires new methods for salvage of the native hip in young patients.</p><p><b>METHODS</b>There were six patients in our series with highly comminuted posterior wall acetabular fractures where the fragments were excised and the gap filled with tricortical anterior iliac-crest strut autograft, fixed with screws and plate.</p><p><b>RESULTS</b>Good results were achieved in four out of six patients analyzed clinically using the Merle d'Aubinge score modified by Matta and radiologically by Matta scoring. These patients have returned to original work and are walking independently. The good result in one patient deteriorated from good to poor between one and two years. One patient developed infection and excision arthroplasty was done. The graft incorporated well in five out of six patients.</p><p><b>CONCLUSION</b>The use of iliac crest autograft is a better, advanced and promising technique as it provides a new wall to the weight bearing dome of the acetabulum for articulation with the femoral head. The rates of nonunion, malunion, post traumatic osteoarthritis are less as compared to the fixation of the comminuted fragments. The need for conversion to total hip arthroplasty is also less.</p>

The relationship of the medial roof and the posterior wall of the maxillary sinus to the sphenoid sinus: a radiologic study / Relação do teto medial e parede posterior do seio maxilar como o seio esfenoidal: estudo radiológico

Abstract Introduction: The medial maxillary sinus roof is a ridge formed by the superior margin of the maxillary sinus antrostomy. The posterior wall of the maxillary sinus is always included in operative fields. Objective: To perform a radiologic study assessing the utility of the medial maxillary sinus roof and the posterior wall of the maxillary sinus as fixed landmarks for providing a safe route of entry into the sphenoid sinus. Methods: We reviewed 115 consecutive paranasal sinus Computed Tomographic scans (230 sides) of Korean adult patients performed from January 2014 to December 2014. Using the nasal floor as a reference point, the vertical distances to the highest point of the medial maxillary sinus roof, the sphenoid ostium and anterior sphenoid roof and floor were measured. Then the vertical distances from the highest point of the medial maxillary sinus roof to the sphenoid ostium and anterior sphenoid roof and floor were calculated. The coronal distance from the posterior wall of the maxillary sinus to the sphenoid ostium was determined. Results: The average height of the highest point of the medial maxillary sinus roof relative to the nasal floor was measured to be 33.83 ± 3.40 mm. The average vertical distance from the highest point of the medial maxillary sinus roof to the sphenoid ostium and anterior sphenoid roof and floor was 1.79 ± 3.09 mm, 12.02 ± 2.93 mm, and 6.18 ± 2.88 mm respectively. The average coronal distance from the posterior wall of the maxillary sinus to the sphenoid ostium was 0.78 mm. The sphenoid ostium was behind the coronal plane of the posterior wall of the maxillary sinus most frequently in 103 sides (44.4%). It was in the same coronal plane in 68 sides (29.3%) and in front of the plane in 61 sides (26.3%). Conclusions: The medial maxillary sinus roof and the posterior wall of the maxillary sinus can be used as a reliable landmark to localize and to enable a safe entry into the sphenoid sinus.

Resumo Introdução: O teto medial do seio maxilar é uma crista formada pela margem superior da antrostomia do seio maxilar. A parede posterior do seio maxilar é sempre incluída em campos cirúrgicos. Objetivo: Fazer estudo radiológico para avaliar a utilidade do teto medial do seio maxilar e da parede posterior do seio maxilar como referências anatômicas fixas para fornecer uma via segura de abordagem ao seio esfenoidal. Método: Foram analisados 115 exames de tomografia computadorizada consecutivos dos seios paranasais (230 lados) de pacientes adultos coreanos feitos de janeiro de 2014 a dezembro de 2014. Com o uso do assoalho nasal como ponto de referência, as distâncias verticais entre o teto medial do seio maxilar e o óstio esfenoidal e entre o teto e o assoalho esfenoidal anterior foram medidos. Em seguida, as distâncias verticais do ponto mais alto do teto medial do seio maxilar e o óstio esfenoidal e entre o teto e ao assoalho esfenoidal anterior foram medidas. A distância coronal da parede posterior do seio maxilar ao óstio esfenoidal foi determinada. Resultados: A altura média do ponto mais alto do teto medial do seio maxilar em relação ao assoalho nasal foi medida como 33,83 ± 3,40 mm. A distância vertical média do ponto mais alto do teto medial do seio maxilar até o óstio esfenoidal e do teto ao assoalho esfenoidal anterior foi de 1,79 ± 3,09 mm, de 12,02 ± 2,93 mm e 6,18 ± 2,88 mm, respectivamente. A distância coronal média da parede posterior do seio maxilar ao óstio esfenoidal foi de 0,78 mm. O óstio esfenoidal estava por trás do plano coronal da parede posterior do seio maxilar com mais frequência em 103 lados (44,4%). O mesmo se encontrava no plano coronal em 68 lados (29,3%) e na frente do plano em 61 lados (26,3%). Conclusões: O teto medial do seio maxilar e a parede posterior do seio maxilar podem ser usados como pontos de referência confiáveis para localizar e possibilitar uma abordagem segura ao seio esfenoidal.

Clinical Effects of Surgical Repair with or Without Biological Mesh on Uterine Prolapse / 中国微创外科杂志

Objective To analyze the different clinical effects of colpohysterectomy combined with anterior and posterior wall colporrhaphy with or without biological mesh for uterine prolapse.Methods From January 2010 to May 2015, colpohysterectomy combined with anterior and posterior wall colporrhaphy was performed in 106 cases of uterine prolapse, including 75 cases receiving biological mesh repair (experimental group) and 31 cases of non-biological mesh (control group).Clinical and surgical information of all patients was collected, and satistial analysis was done between the two groups.Results All the operations were accomplished successfully.There were no statistical differences in bleeding amount during operation [(34.5±7.3) ml vs.(32.1±4.9) ml, t=1.973, P=0.051], time to first flatus [(29.2±4.8) d vs.(30.2±5.3) d, t=-0.907, P=0.366], postoperative hospital stay [(6.1±1.5) d vs.(6.0±1.4) d, t=0.328, P=0.744], as well as the operative time [(91.4±3.4) min vs.(95.1±10.2) min, t=-1.970, P=0.051].At one year after surgery, in the experimental group there were 74 patients cured, 1 patient improved, and no invalid or recurrence case, while in the control group there were 27 patients cured, 1 patient improved, 3 cases of recurrence and no invalid case.The treatment effect of the experimental group was significant better than that of the control group (Z=-2.571, P=0.010).Conclusions Colpohysterectomy with anterior and posterior wall colporrhaphy with biological mesh can be selected for uterine prolapse patients without contraindications.The results of surgery are better with biological mesh, with low recurrence rate.

The role of trochanteric flip osteotomy in fixation of certain acetabular fractures / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Complete visualization of certain acetabular fractures of posterior wall or column with cranial extension involving superior dome from standard surgical exposures is a challenge. Osteotomy of the greater trochanter has been used to enhance fracture visualization, especially the dome, in posterior and lateral exposures of the acetabulum. It also decreases the need for excessive muscle retraction. The purpose of the study was to investigate the outcome associated with trochanteric flip osteotomy in the management of certain acetabulum fractures.</p><p><b>METHODS</b>From January 2011 to December 2013, 25 displaced acetabular fractures were treated by open reduction and internal fixation. The fractures were managed using a Kocher-Langenbeck approach along with trochanteric flip osteotomy. At 3rd, 6th and 24th month follow-up, all patients had radiographic examination and underwent a final clinical evaluation based on the modified Merle d'Aubigne and Postel score. The strength of the abductors was assessed according to the Medical Research Council (MRC) grading system.</p><p><b>RESULTS</b>Congruent reduction was achieved in all patients and all osteotomies healed within an average period of 3.8 months. All our patients were allowed full weight bearing at the end of 3 months and with no abductor lurch at the end of 6 months follow-up. There were no cases of avascular necrosis of femoral head. None of the patients had any neurovascular complication or infection by the end of the follow-up period.</p><p><b>CONCLUSION</b>Trochanteric flip osteotomy is a very effective technique to fix certain acetabular fractures especially those with dome involvement. It is more accurate and associated with no significant complications compared with conventional way.</p>

Arthroscopic Reduction and Transportal Screw Fixation of Acetabular Posterior Wall Fracture: Technical Note / 대한고관절학회지

Acetabular fractures can be treated with variable method. In this study, acetabular posterior wall fracture was treated with arthroscopic reduction and fixation using cannulated screw. The patient recovered immediately and had a satisfactory outcome. In some case of acetabular fracture could be good indication with additional advantages of joint debridement and loose body removal. So, we report our case with technical note.

Usefulness of Spring Plate for Acetabular Posterior Wall Fracture Including Small Fragment

PURPOSE: We applied internal fixation using a spring plate against an acetabular posterior wall fracture including small fragments and then evaluated the clinical and radiological results and want to understand the usefulness of the spring plate. MATERIALS AND METHODS: Fifteen patients in whom fixation was difficult using leg screws or a metal plate because of a small bone fragment, in patients with posterior wall acetabular fractures who presented in our hospital since August of 2011 to March of 2014 were enrolled. The mean age was 42.6 years (range 24-54 years) with relatively young patients, and they were followed-up for at least one year. We analyzed the rate of reduction after surgery using the classification of Matta in radiographs, and the classification of Borrelli in 3-dimensional computed tomography (CT) and clinical results were evaluated using the clinical grading system. RESULTS: There were five cases of anatomical reduction, 9 cases of imperfect reduction, and 1 case of unsatisfactory reduction according to the classification of Matta. Except for one case during the follow-up period, the union of bone was successful without failure of fixation and the clinical results were 6 cases of excellence, 8 cases of good, and 1 case of failure. Articular displacement was also evaluated in postoperative CT scan according to Borrelli's criteria. The mean of gap and step off was 2.04 mm, 1.3 mm. CONCLUSION: Use of leg screw fixation and so on in posterior wall fractures including a small fragment of the acetabular rim is not easy. However the method using spring plate fixation enables relatively accurate reduction and fixation for a small fragment and the clinical outcome showed satisfactory results.

Usage of double fork plates in the treatment of posterior wall fracture of the acetabulum / 国际外科学杂志

Objective To explore the efficacy of double fork plate in treating the posterior wall fracture of the acetabulum.Methods Reviewed 11 patients who had treated with open reduction and internal fixation with double fork plates for posterior wall fracture of the acetabulum from July 2008 to July 2012,including 8 male cases and 3 female cases with an average age of 35.3 years(from 22 to 53 years).The average time from getting injury to operation was 7.8 days(from 1 to 19 days).The operations were performed through the Kocher-langenbeck approach.Double fork plates(formed from a three-or four-tubular plate) with an overlapping reconstruction plate used for posterior wall fragments.The functional outcomes were evaluated by the modified Merled'Aubigne and Postel'clinical garding system.The radiographs were graded according to the Matte criteria.Rmults The patients were adopted telephone or outpatient follow-up for 25 months on average(from 12 to 33 months).By the Matte criteria,7 cases achieved excellent reduction,3 good reduction,1 case fair reduction and none poor reduction,with the good and excellent rate of 90.9％.By the modified Merled'Aubigne and Postel'critria,functional recovery of the affected hip at the last followe-up was rated as excellent in 6 cases,good in 3 cases,fair in 2 cases and none poor,with the good and excellent rate of 81.8％.Heterotopic ossification was happened to 1 patient.Neither infection nor ischemic necrosis of the femoral head was recorded.Coclusion Double fork plates with an overlapping reconstruction plate can provid stable fixation and allow for early functional exercise.So the use of Double fork plates have a certain clinical value.

Operative treatment for transverse plus posterior wall fractures of the acetabulum / 国际外科学杂志

Objective To evaluate the results of patients operatively treated transverse plus posterior wall fractures of the acetabulum.Methods Review forty-five patients who had operated for transverse plus posterior wall fractures of the acetabulum 1 retrospectively with fracture displacement,from August 1993 to January 2005 in Department of Orthopaedics,Beijing Shunyi Hospital.The radiographs were graded according to the criteria described by Matta.The functional outcome was evaluated using a modification of the clinical grading system developed by Merle d'Aubigné and Postel.Result Forty-five patients were followed up 16 to 48 months with an average of 34 months.The radiographic result was excellent in seventeen patients,good in eighteen,fair in seven,and poor in four.The clinical outcome at the time of final follow- up was graded as excellent in fourteen patients,good in twenty- two,fair in eight,and poor in two.Conclusion Operative treatment for transverse plus posterior wall fractures of the acetabulum has a satisfying therapeutic effect.The appropriate operation time,reasonable operation approach,anatomic reduction and stable internal fixation is the key to obtain good results.

Traumatic Recurrent Dislocation of the Hip with Bankart Type Lesion: A Case Report / 대한고관절학회지

The recurrent dislocation of hip in adult can be uncommonly induced by neuromuscular disease or dysplasia of hip. But in the case of traumatic dislocation of hip with acetabular fracture, the possibility of recurrent dislocation can be decreased if treated with accurate fixation or traction. We have experienced a case of hip dislocation with comminuted acetabular fracture, which was treated only with soft tissue suture and without fixation because of severity of the acetabular fracture. An inappropriate conservative management was done during the post operation period, eventually result in recurrent dislocation and degeneration of posterior wall and head of femur which resembled bony Bankart lesion of the shoulder. The reduction was not able to be maintained, as a result THRA was done. A year after the operation, good prognosis was found in replaced hip without any recurrent dislocation.

Left ventricular posterior wall thickness is an independent risk factor for paroxysmal atrial fibrillation / El grosor de la pared posterior ventricular izquierda es un factor de riesgo independiente para la fibrilación atrial paroxística

BACKGROUND: Atrial fibrillation is the most common significant cardiac arrhythmia in clinical practice, but its risk factors remain to be clarified. We have hypothesized that left ventricular posterior wall thickness is an independent risk factor for paroxysmal atrial fibrillation (PAF). METHODS: A total of 166 consecutive patients with paroxysmal atrial fibrillation were included in this study. Another 166 healthy check-up people, strictly age and sex-matched, were enrolled as controls in the same period. Univariable analysis and multivariable conditional logistic stepwise regression analysis were conducted. Receiver operating characteristic (ROC) curve analysis was performed on those significant indices obtained from the multivariable logistic regression analysis. RESULTS: The multivariable stepwise analysis identified left ventricular posterior wall thickness, left atrial diameter, tricuspid insufficiency and residence (countryside) as independent predictors for paroxysmal atrial fibrillation. Receiver operating characteristic curve analysis demonstrated the cut-off values of those risk factors aforementioned. CONCLUSIONS: In this strictly age and sex-matched population-based sample, left ventricular posterior wall thickness, left atrial diameter, tricuspid insufficiency and residence were predictive risks for paroxysmal atrial fibrillation. This study offers novel information therapeutically beyond that provided by traditional clinical atrial fibrillation risk factors.

ANTECEDENTES: La fibrilación atrial o auricular, es la arritmia cardíaca significativa más común en la práctica clínica, pero sigue siendo aún necesario poner en claro sus factores de riesgo. El presente trabajo asume la hipótesis de que el grosor de la pared posterior ventricular izquierda constituye un factor de riesgo independiente para la fibrilación atrial paroxística (FAP). MÉTODOS: El estudio abarca un total de 166 pacientes consecutivos con fibrilación atrial paroxística. Otras 166 personas saludables según el reconocimiento médico, pareadas estrictamente por edad y sexo, fueron registradas como controles en el mismo periodo. Se llevó a cabo un análisis de regresión logística condicional multivariante paso a paso y un análisis univariante. El análisis de la curva característica de la operación del receptor (ROC) se realizó sobre los índices significativos obtenidos a partir del análisis de regresión logística multivariante. RESULTADOS: El análisis multivariante paso a paso identificó el grosor de la pared posterior ventricular izquierda, el diámetro atrial izquierdo, la insuficiencia tricúspide y la residencia (el campo) como predictores independientes de la fibrilación atrial paroxística. El análisis de la curva característica de la operación del receptor demostró los valores límites de los factores de riesgo mencionados arriba. CONCLUSIONES: En esta muestra basada estrictamente en una población pareada por edad y género, el grosor de la pared posterior ventricular izquierda, el diámetro atrial izquierdo, la insuficiencia tricús-pide y la residencia, fueron riesgos predictivos de la fibrilación atrial paroxística. Este estudio ofrece información novedosa, terapéuticamente más allá de la proporcionada por los factores de riesgo clínicos tradicionales de la fibrilación atrial.