Intramedullary plus extramedullary fixation for fracture of distal radial diametaphyseal transition zone in children / 中华创伤骨科杂志

Objective:To investigate the efficacy of intramedullary plus extramedullary fixation in the treatment of fractures of distal radial diametaphyseal transition zone in children.Methods:The data were retrospectively analyzed of the 49 children who had been admitted to Pediatric Orthopedic Hospital, Honghui Hospital Affiliated to Xi'an Jiaotong University from July 2018 to April 2020 for fractures of distal radial diametaphyseal transition zone. There were 30 males and 19 females; 21 left sides, 27 right sides, and one case of bilateral sides. In the operation, an elastic intramedullary nail or Kirschner wire was used for intramedullary fixation while another Kirschner wire was used to fix the cortex at the distal and proximal ends of the fracture. The ranges of wrist motion and Disabilities of the Arm, Shoulder and Hand (DASH) scores at 1 and 9 months after operation were recorded and compared; the incidence of postoperative complications was also recorded.Results:The operation time for the 49 children averaged 45.0 min (from 39 to 51 min). The patients were followed up for 6 to 36 months (mean, 18.6 months). The fracture union time averaged 8.6 weeks (from 6.8 to 10.4 weeks). Needle tract infection developed in one case but the wound was healed after removal of the K-wire after callus formation and oral use of antibiotics for 3 days. Another case reported skin irritation the symptoms of which disappeared after the child reduced activities. The ranges of pronation, supination, flexion and extension of the wrist and DASH score were 47.9°±2.5°, 45.5°±3.0°, 51.2°±1.6°, 53.4°±1.7° and (36.7±4.5) points at one month after operation while they were 85.6°±3.1°, 87.6°±2.1°, 88.8°±2.0°, 88.0°±1.2° and (23.2±8.6) points at 9 months after operation. There were statistically significant differences in the above indexes between one and 9 months after operation ( P<0.05). Conclusion:In the treatment of fractures of distal radial diametaphyseal transition zone in children, intramedullary plus extramedullary fixation is simple in surgical techniques, easily repeatable, slightly invasive, and reliable in fixation.

Clinical characteristics and treatment of complex fracture-dislocations of the elbow in children / 中华骨科杂志

Objective:To summarize and discuss the concept and clinical manifestations of complex fracture-dislocations of the elbow in children, and compare its injury characteristics, treatment and clinical effect with adults.Methods:From September 2015 to January 2020, 34 patients seen and treated at our institution for complex fracture-dislocations of the elbow were identified, and their medical records and radiographs were reviewed retrospectively. The inclusion criteria were elbow dislocation combined with one or more fractures at the proximal ulna and radius. There were 25 boys and 9 girls, with an average age of 8.3±3.2 years. The left arm was involved in 27 cases, and the right arm was involved in 7 cases. The causes of injury included falling from a scooter in 16 cases, falling from height in 10 cases, cycling in 5 cases and traffic accident in 3 cases. All patients were treated with closed reduction and the application of plaster under local anaesthesia in the emergency room. Then, X-ray, CT and MRI were performed to evaluate the fracture-dislocation and ligament injury. The following treatment plan was comprehensively evaluated according to the size and displacement of the combined fracture block and the stability of the elbow, for example, open reduction with K-wires and tension band or plate fixation for olecranon fracture, open reduction with loop plate fixation for coronal process fracture, closed reduction or open reduction with K-wires or elasticstable intramedullary nail for radial neck fracture.Results:Among the 34 patients, there were 16 cases of transolecranon fracture-dislocation, 1 case of varus posteromedial rotational instability, 4 cases of valgus posterolateral rotatory instability and 13 cases of divergent dislocation of elbow. All patients were followed up for 13(8, 15) months, and the average fracture healing time was 3.5±0.8 weeks, with no failure of internal fixation. In 2 cases of elbow dislocation combined radial neck fracture, one case had ischemic necrosis of the radial head and one case had early closure of epiphyseal plate of the proximal radius. At the last follow-up, all patients had no subluxation, dislocation or instability of the elbow. The therapeutic efficacy was evaluated at the final follow-up by the Mayo elbow performance score (MEPS) as excellent in 25 cases, good in 5 cases, fair in 3 cases, and poor in one case, with excellent and good rate 88%.Conclusion:The complex fracture-dislocations of the elbow is rare in children. We have the opinion that the clinical characteristics are dislocation combined with one or more fractures of the proximal ulna and radius. Compared with adults, its pathological characteristics and the scope of injury are similar, but most of the injuries are mild. The clinical manifestations are mainly transolecranon fracture-dislocation and divergent dislocation of elbow. Good results can be achieved in most cases through open reduction with internal fixation for fractures.

Transolecranon fracture-dislocation of the elbow in children - pathological characteristics and strategy for diagnosis and treatment / 中华创伤骨科杂志

Objective:To discuss the pathological characteristics and strategy for diagnosis and treatment of the transolecranon fracture-dislocation of the elbow in children.Methods:Retrospectively reviewed were the 15 patients who had been treated at Hospital of Pediatric Orthopedics, Xi'an Honghui Hospital from October 2016 to March 2019 for transolecranon fracture-dislocation of the elbow. They were 11 boys and 4 girls, with an average age of 8.3 years (from 5 to 14 years) and 10 left and 5 right arms injured. Type Ⅰ (simple fracture) was found in 11 cases and type Ⅱ (comminuted fracture) in 4 cases in 3 of which the coronoid process was affected. Of them, 14 were treated successfully with closed reduction and plaster fixation under local anesthesia in emergency but one was unsuccessfully. Of the 11 simple fractures, 10 received tension band fixation with Kirschner wire and a short oblique one underwent bone plate fixation; the 4 comminuted fractures were treated by fixation with a combination of Kirschner wire and bone plate.Results:The 15 patients obtained follow-up for 8 to 15 months (average, 11 months). The final follow-up observed fine anatomical relationship of the elbow in all patients, and no such complications as relapse of radial head dislocation, avascular necrosis of the trochlea or early closure of the epiphyseal plate. The transolecranon fracture-dislocation of the elbow obtained bony union in all patients after 5 to 7 weeks (average, 5.6 weeks). The therapeutic efficacy was evaluated at the final follow-up by the Mayo elbow performance score as excellent in 11 cases, as good in 3 and as fair in one.Conclusions:As a type of complicated fracture-dislocation of the elbow, the transolecranon fracture-dislocation of the elbow is rare in children, mainly manifested as simple ones. Treatment options depend on the type of fracture-dislocation. Only anatomical reduction of the olecranon fracture and restoration of a normal trochlear notch can lead to a stable humeroradial joint and thus fine clinical efficacy.

Treatment of nonunion of lateral humeral condyle complicated with cubitus valgus with primary fixation in situ and secondary supracondylar varus osteotomy / 中华创伤骨科杂志

Objective:To evaluate the treatment of nonunion of lateral humeral condyle complicated with cubitus valgus with primary fixation in situ and secondary supracondylar varus osteotomy.Methods:A retrospective analysis was made of the 8 children who had been treated for nonunion of lateral humeral condyle complicated with cubitus valgus at Department of Pediatric Orthopedics, Honghui Hospital from January 2016 to March 2018. They were 5 boys and 3 girls with 5 left and 3 right sides involved. Their age at injury ranged from 6 to 14 years (average, 10 years) and the duration from injury to operation from 2 to 6 years (average, 4 years). At the primary stage, the fragments were fixated in situ with compressive cannulated screws after cleaning the nonunion ends, followed by iliac autograft. At the secondary stage, the humeral supracondylar varus osteotomy was performed after the nonunion was healed and the elbow range of motion recovered. The therapeutic effects were assessed by comparing the elbow range of motion, carrying angle and Mayo elbow performance score (MEPS) between preoperation and the final follow-up.Results:All the patients were followed up for an average of 44.5 months (range, from 27 to 64 months). The average healing time for obsolete nonunion of lateral humeral condyle was 81.3 days (range, from 55 to 120 days) after the primary operation and that for supracondylar varus osteotomy 51.1 days (range, from 45 to 60 days) after the secondary operation. The elbow range of motion was 129.0°±4.6° before operation and 138.0°±5.4° at the final follow-up, showing a significant difference ( P<0.001). The average carrying angle at the healthy side in 8 children was 5.4° (range, from 3° to 8°). The carrying angle at the affected side was 31.9°±4.7° (range, from 25° to 42°) before operation and 4.0°±2.2°(range, from 1° to 8°) at the final follow-up, showing a significant difference ( P<0.05). Their preoperative MEPS was 57.5 ± 6.5 (4 good cases and 4 poor ones) but 95.9±3.4 (6 excellent cases and 2 good ones) at the final follow-up, showing a significant difference ( P<0.05). Conclusions:Treatment of nonunion of lateral humeral condyle complicated with cubitus valgus can be effectively carried out by cleaning fibrous tissue in the nonunion gap, iliac autograft and fragments fixation in situ with compressive cannulated screws at the primary stage and supracondylar varus osteotomy at the secondary stage. Intraoperative preservation of the blood supply to the nonunited fragments is the key to successful management.

Arthrography in treatment of humeral condyle fractures with displacement of less than 2 mm in children / 中华创伤骨科杂志

Objective To evaluate the clinical efficacy of arthrography in the treatment of lateral condylar fracture of humerus with displacement of ≤ 2 mm in children.Methods A retrospective study was performed in the 21 children with lateral condylar fracture of humerus who had received arthrography in their surgery at Department of Pediatric Orthopedics,Honghui Hospital,Xi'an Jiaotong University College of Medicine from April 2015 to December 2016.They were 14 boys and 7 girls,aged from 5 to 12 years (average,8.6 years).Their primary diagnosis was made within one week from injury and they all had a displacement of ≤ 2 mm.Of them,2 were treated by plaster fixation because intraoperative arthrography found no fracture of articular cartilage (group A),11 by simple closed pining because intraoperative arthrography found fracture of articular cartilage involving the joint space (group B),and 8 by open reduction and fixation with kirschner wire because intraoperative arthrography found displacement of the involved articular surface (group C).The therapeutic efficacy was evaluated at final follow-ups by the Dhillon scoring system.Results All the 21 children were followed up from 9 to 23 months (average,16 months).The fracture union time ranged from 8 to 10 weeks (average,9 weeks) for groups A and B and from 11 to 13 weeks (average,12 weeks) for group C.By the Dhillon scores at final follow-ups,the therapeutic efficacy was evaluated as excellent in one and as good in one in group A,as excellent in 8 cases,as good in 2 cases and as fair in one in group B,and as excellent in 6 cases,as good in one and as fair in one in group C.No early closure of epiphysis,osteonecrosis or fishtail deformity was found in either group A or group B;one case of partial limitation of elbow flexion or extension,one case of fishtail deformity and one case of femoral head necrosis were observed in group C.No infection or skin necrosis was found in any of the 3 groups.Conclusions Because intraoperative arthrography can definitely judge whether the articular surface is intact or unstable,it can make up for the insufficiency of X-rays in judging integrity of the articular surface.In combination with closed reduction,percutaneous puncture or open reduction and internal fixation,intraoperative arthrography can contribute to an increased rate of successful surgery,and reduced complications due to redisplacement.

Use of Suspension Laryngoscopy CO2 Laser Combined with Placement of Silastic Keel for the Treatment of the Vocal Cords Adhesion / 听力学及言语疾病杂志

Objective To investigate the use of suspension laryngoscopy CO2 laser combined with the placement of laryngeal stent for the treatment of the vocal cords adhesion.Methods A total of 21 patients with acquired vocal cords of adhesion patients(The causes were previous vocal fold surgery for benign lesions in 16 cases,the laryngeal surgery for recurrent papilloma in 4 cases,the laryngeal trauma in 1 case)were included in this retrospective study.Under general anesthesia with intubation,following glottis exposure under suspension laryngoscopy,a CO2 laser incision was performed under microscopy on the superior face of one vocal fold,from the anterior commissure to the posterior part of the web.The keel was placed into the larynx to the appropriate location and fixed with sutures.Results The keels were removed after 3 weeks of operation in 20 patients.The keels were removed after 2 weeks of operation because of subcutaneous emphysema in 1 patient.After a follow-up of 6 months,the reformation of the web happened in 1 case,while the remaining 20 patients recovered with normal triangle shaped anterior commissure anatomy and no granulation or scar tissue were formed.Conclusion Our study shows that the use of suspension laryngoscopy CO2 laser combined with the placement of laryngeal stent is successful for the treatment of the vocal cords adhesion.This procedure has the advantages of micro trauma to patients with avoiding laryngofissure,it provides simple effective treatment of vocal cords adhesion.

Proton Pump Inhibitor and Prokinetic Drug on the Treatment of Laryngopharyngeal Reflex Diseases:A Meta-analysis / 听力学及言语疾病杂志

Objective To evaluate the efficacy and safety of proton pump inhibitor (PPI)plus prokinetic drug on the treatment of laryngopharyngeal reflex .Methods According to predetermined criteria of inclusion and exclu-sion ,Cochrane Central Register of Controlled Trails(CENTRAL) ,Embase ,Elsevier ,Pubmed ,VIP ,Wanfang Data , CNKI and CBM were searched for the randomized controlled trails of proton pump inhibitor and prokinetic drug on the treatment of laryngopharyngeal reflex diseases from the date of establishment of the datebases to November 2012 .Revman 5 .1 software and GRAED profiler 3 .6 software were applied to analysis the data ,which was extrac-ted by three independent evaluators .Results A total of 346 related articles were obtained ,7 trails were included , 614 patients in total .The results of Meta -analysis showed that :the overall effictive rate of combination therapy with proton pump inhibitors plus prokinetic drug in patients with laryngopharyngeal reflex was higher than those in the control group [RR=1 .18 ,95% CI(1 .10 ,1 .28) ,P<0 .0001] .The rate of improvement of laryngeal signs exam-ined by fiberoptic laryngoscope was higher than those in the control group [RR= 1 .38 ,95% CI(1 .16 ,1 .65) ,P<0 .001] .The average relief time of dysphonia symptoms was shorter than those in the control group [MD = -1 .70 , 95 CI (-2 .95 ,-0 .45) ,P<0 .001] .Conclusion The effect of proton pump inhibitor plus prokinetic drug on the treatment of laryngopharyngeal reflex is superior to those of proton pump inhibitors or prokinetic drug only ,but in terms of safety ,more large-sample ,high-quality randomized controlled trails are required .

The application of the CO2 laser combined with pingyangmycin in the management of pharyngeal and laryngeal hemangioma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To review our experience with the use of the CO2 laser combined with pingyangmycin in the treatment of pharyngeal and laryngeal hemangioma.@*METHOD@#A retrospective review of 18 patients with pharyngeal and laryngeal hemangioma treated with CO2 laser combined with pingyangmycin was carried out in our hospital: patients medical charts were evaluated for factors such as age, sex, location of hemangioma, number of laser procedures performed, and postoperative results, including short and long term complications.@*RESULT@#All the 18 patients were underwent operation without any complications such as pharyngeal and laryngeal hemorrhage, infection of incisional wound,laryngeal edema, etc. Data of follow-up for 7 months to 5 years, showed that excellent local control was achieved in all cases with the exception of one case of recurrence. The one case recurred 4 months after operation and treated with CO2 laser again.@*CONCLUSION@#With careful selection of patients, the CO2 laser combined with pingyangmycin pingyangmycin is a safe and effective treatment for pharyngeal and laryngeal hemangioma with the following advantages: precise location for treating, less bleeding, clear operating field, simple management, low risk of infection, less post-operation reaction, protection of laryngeal and pharyngeal structures and avoidance of tracheostomy.

The Study of the Postoperative Voice Rest Treatment for Patients with Vocal Fold Polyps / 听力学及言语疾病杂志

Objective To study the voice rest treatment after laryngomicrosurgery in patients with vocal fold polyps .Methods Eighty -five patients with vocal fold polyps were divided into two groups randomly :Group A (48 cases) and Group B ( 37 cases) ,receiving 1 or 2 weeks voice rest postoperation ,respectively .Vocal acoustic analy-sis and fiberlaryngoscopy were performed in all patients before the surgery and 1 ,2 ,3 and 4 weeks after surgery . Results When compared with the preoperative data ,there were no significant differences in jitter ,shimmer and NHR 1 week after surgery in patients of two groups (P>0 .05) .Two weeks after surgery ,all the parameters im-proved significantly in Group B(P<0 .05) ,but only jitter improved in Group A (P<0 .05) .All the data in two groups returned to normal 4 weeks after surgery .Laryngoscopic examination showed varying degrees of vocal fold hyperemia and edema one week after surgery ,which then gradually subsided and gone .At 4 weeks after surgery , the appearance of the operative vocal fold completely returned to normal .Conclusion Patients with vocal fold polyps should be treated with complete voice rest for 2 weeks after surgery ,followed by 2 weeks of relative voice rest .This is beneficial to the voice recovering and the wound healing .

The Voice Acoustic Analysis of Unilateral Thyroid Adenoma Patient Underwent Thyroid Gland Lobectomy / 听力学及言语疾病杂志

Objective To investigate the characteristics of voice changes by multi-dimensional acoustic analysis in patients who underwent thyroid gland lobectomy without laryngeal nerve injury.Methods To observe vocal cord movement and evaluate voice quality,32 patients with unilateral thyroid adenoma received the examinations of fiberlaryngscopy and Multi-Dimensional Voice Program before and after operation,respectively.Forty subjects with normal voice were used as cantrol group.Results Fiberlaryngscopy examinations were normal in all patients before and after surgery.In thyroid group,the preoperative acoustic parameters in male patients showed no significant difference(P＞0.05) compared with the control group.There was no significant difference between preoperative and postoperative acoustic parameters(P＞0.05).While the postoperative acoustic parameters of female patients was significantly lower than those of preoperative and in control group(P＜0.05).There was significant improvement 3 months after the operation compared with that of preoperative group(P＜0.05).Fhi of 3 months after operation was still lower than those of preoperation and in control group in male and female patients that continues to be significant after 3 months.Conclusion Voice changes may occur after unilateral thyroid gland lobectomy without any laryngeal nerve injury,and there is little voice change in male patients,while in female patients,voice improvement is observed after operation.Fhi still remaines lower level for a certain of time.

CO2 laser tenotomy and vocal process resection for treatment of bilateral vocal cord paralysis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the clinical value of the treatment of bilateral vocal cord paralysis by tenotomy and vocal process resection with CO2 laser.@*METHOD@#Eighteen cases of bilateral vocal cord paralysis after thyroidectomy from March 2004 to June 2006 were retrospectively analyzed. Preoperative tracheotomy and CO2 laser tenotomy and vocal process resection were performed.@*RESULT@#All patients were able to breathe through the mouth and nose immediately after the operation. Fifteen patients were extubated within 8 weeks. Three patients were operated again after 4-6 weeks because of granulation hyperblastosis. All patients were followed up for 1.6 years to 2.3 years without breathing difficulties, aspiration and with satisfactory voice.@*CONCLUSION@#The approach of CO2 laser tenotomy and vocal process resection can effectively relieve breathing difficulty resulted from bilateral vocal cord paralysis, achieve satisfactory voice and avoid aspiration.

CO_2 laser tenotomy and vocal process resection for treatment of bilateral vocal cord paralysis / 临床耳鼻咽喉头颈外科杂志

Objective: To explore the clinical value of the treatment of bilateral vocal cord paralysis by tenoto-my and vocal process resection with CO_2 laser. Method: Eighteen cases of bilateral vocal cord paralysis after thy-roidectomy from March 2004 to June 2006 were retrospectively analyzed. Preoperative tracheotomy and CO_2 laser tenotomy and vocal process resection were performed. Result: All patients were able to breathe through the mouth and nose immediately after the operation. Fifteen patients were extubated within 8 weeks. Three patients were op-erated again after 4-6 weeks because of granulation hyperblastosis. All patients were followed up for 1. 6 years to 2. 3 years without breathing difficulties, aspiration and with satisfactory voice. Conclusion: The approach of CO_2 la-ser tenotomy and vocal process resection can effectively relieve breathing difficulty resulted from bilateral vocal cord paralysis, achieve satisfactory voice and avoid aspiration.

Psychotherapy combined with breathing training on the treatment of spasmodic dysphonia / 中国组织工程研究

BACKGROUND: The mechanism of spasmodic dysphonia(SD) is still unclear and lacks of confirmed diagnostic standards. Limited reports on the treatment mainly focused on botulinum toxin infiltration; recurrent laryngeal nerve section, and voice training, amongst which voice training has been considered as one of the ideal complementary therapeutic means for SD because of less side effects and complications.OBJECTIVE: To investigate the significance of voice training in the treatment of SD and provide a method for the clinical treatment.DESIGN: Clinical case analysis and retrospective study based on patients.SETTING: Department of otolaryngology and cerebral surgery in a university hospital.PARTICIPANTS: Thirty-six confirmed SD patients in Wuhan College affiliated Renmin Hospital from February 1985 to December 2002.METHODS: Psychological consultation combined with breathing and voice training was adopted to make patients breathe freely and coordinately, with breath pattern changed from deep chest breathing and reversal breathing to normal chest-abdominal combined breathing, which helped decreasing larynx muscle straining. All patients were followed up for one to two years and their therapeutic effects were assessed by normal phonation, improvement, and ineffectiveness.MAIN OUTCOME MEASURES: Assessment of therapeutic effects.RESULTS: All 36 SD patients achieved satisfactory outcomes after voice training, with SD completely recovered in 30 cases and obviously improved in 6 cases.CONCLUSION: Psychological consultation combined with voice training is an ideal approach for the rehabilitation of SD.

The vocal rehabilitation training for patients with spasmodic dysphonia / 中华物理医学与康复杂志

Objective To explore the effect of vocal rehabilitation training on patients with spasmodic dys-phonia. Methods Thirty-six patients with spasmodic dysphonia were recruited, and psychotherapy, acupuncture,respiratory and vocal training were performed according to the patients condition to improve the coordination of the vo-cal organs. Interventions were also employed to convert the patients reverse or high locational pattern of respiration in-to the normal associated chest and abdomen respiration, so as to reduce the tone of the laryngeal muscle. ResultsSatisfactory effects were achieved by the rehabilitation training. 30 out of 36 cases recovered and the other 6 cases im-proved. Conclusion It indicated that the comprehensive vocal rehabilitation should be adopted for the treatment ofpatients with spasmodic dysphonia.

Correlation between Voice Handicap Index (VHI) and Voice Acoustic Analysis in Patients with Vocal Cord Polyps / 听力学及言语疾病杂志

Objective To study the relationship between voice acoustic analysis(VAA) and voice handicap index (VHI) in patients with vocal cord polyps,and to investigate the characteristic of the VHI.Methods 35 subjects with normal voice and 35 patients with vocal cord polyps underwent VHI,were tested by VAA.Results The parameters such as APQ、jitter、shimmer、NHR in patients with vocal cord polys were much higher than those in the normal voice group.The average score of VHI was 43.32?4.66,while the average score of the normal voice group was 12.51?1.88.There was no correlation between VHI and VAA.Conclusion Since there is no correlation between VHI and VAA in patients with vocal cord polys.One can not speculate the VHI score by the voice acoustic analysis.

The Observation of the Voice Recovery from the Removal of Vocal Cord Polyp by Laryngomicrosurgery / 听力学及言语疾病杂志

Objective To investigate the voice recovery by means of observing the changes of the acoustic parameters in the patients after vocal cord polyp operation by microlaryngoscope.Methods Follow up on the voice changes by means of morphology evaluations and voice analysis applied to 30 cases of patient with vocal cord polyp before the operation and in each week for 4 weeks after the operation.Results 86.67% patients were observed to have improved external appearance of their vocal cords 2 weeks after surgery.There is statistically significant difference in 2-,3-,4-week respectively after the operation compared with the preoperative group(P0.05).Conclusion 2 weeks is needed for the patients with vocal cord polyp to have improved vocal cords and one month needed at least to have the voicing functions recovered.Therefore the resting time should be proposed to patients with vocal cord polyp as a resting guideline.