Multiple-ligament injured knee / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To explore the clinical characteristic of the multiple-ligament injured knee and evaluate the protocol, technique and outcome of treatment for the multiple-ligament injured knee.</p><p><b>METHODS</b>From October 2001 to March 2005, 9 knees with combined anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears in 9 patients were identified with clinical and arthroscopic examinations. Of them, 5 knees were combined with ruptures of posteromedial corner (PMC) and medial collateral ligament (MCL), 4 with disruptions of posterolateral corner (PLC), 2 with popliteal vascular injuries and 1 with peroneal nerve injuries. Six patients were hospitalized in acute phase of trauma, 2 received repairs of popliteal artery and 4 had repairs of PMC and MCL. Reconstructions of ACL and PCL with autografts under arthroscope were performed in all patients at 4 to 10 weeks after trauma, including reconstruction of PLC with the posterior half of biceps femoris tendon tenodesis in 4 patients and reconstructions of PMC and MCL with femoral fascia in 1 patient.</p><p><b>RESULTS</b>No severe complications occurred at early stage after operation in the 9 patients. All of them were followed-up for 10-39 months with an average of 23.00 months+/-9.46 months. Lysholm score was 70-95 with an average of 85.00+/-8.29. International Knee Documentation Committee (IKDC) score was from severely abnormal (Grade D) in 9 knees at initial examination to normal (Grade A) in 2 knees, nearly normal (Grade B) in 6 knees and abnormal in 1 knee at the last follow-up. Of the 9 patients, 7 returned to the same activity level before injury and 2 were under the level.</p><p><b>CONCLUSIONS</b>The multiple-ligament injured knee with severe instability is usually combined with other important structure damages. Therefore, careful assessment and treatment of the combined injuries are essential. Reconstructions of ACL and PCL under arthroscope, combined with repairs or reconstructions of the extraarticular ligaments simultaneously or in stages, have advantage of minimal trauma in surgery and satisfactory outcome.</p>

Socioeconomic impact of AIDS on households of AIDS patients admitted to the Infectious Diseases Hospital, Yangon

This study attempts to analyse the socioeconomic impact of AIDS, particularly to determine the economic cost of AIDS to households of 64 AIDS patients seeking medical care at the Yangon Infectious Diseases Hospital during November 1996 to February 1997. This cross-sectional descriptive study used purposive sampling and interviewed AIDS patients and/or member of their house holds using structured questionnaire. The conceptual framework for the study was based on ideas expounded by Desmond Cohan (1993), Over et al (1991) and Whiteside and FitzSimons (1992). The majority of the AIDS patients were between 26 and 40 years of age and had middle and above education. Because of AIDS victims in their households, the households' monthly income was halved while monthly household expenditure increased 1.35 times. The dependency ratio in the households also increased two told. The direct cost of AIDS (including medical care abroad) was Kyats 69.306 and was 3.87 times a household's current monthly income. Cost of medical care contributed the highest proportion of direct cost, and cost of medical care at Infectious Diseases Hospital was only half of that incurred at private clinics. The average duration of illness was 7.56 months. Direct cost of illness per month was therefore Kyats 9,167 and 51 per cent of monthly household income. various strategies were used by the households to cope with the situation. Direct cost was borne mainly by the patient's brothers/sisters and relatives, by selling household assets and spending from the household's savings. Indirect cost of illness (loss of income) per month was Kyats 19,964 and 2.17 times the direct cost of illness or 1.11 times a household's monthly income. the total indirect cost of illness was Kyats 126,973 and was 7.1 times a household's monthly income. therefore, a household of an AIDS patient incurs a total of kyats 29,131 per month for the AIDS patient, or 1.63 times a household's monthly income. The families of AIDS patients usually take care for the AIDS victims, but are reluctant to share their predicament with others, the children of 10 AIDS patients were also looked after by relatives. This study makes recommendations such as providing some forms of financial help to AIDS victims, encouraging them to seek medical care at government hospitals, stepping up health education on prevention of HIV/AIDS, and conducting more socio-economic and behavioural research on HIV/AIDS.