Progress in diagnosis and therapy of thoracic outlet syndrome / 中国骨伤

Thoracic outlet syndrome(TOS) are constellation of symptoms caused by compression of the neurovascular bundle including the brachial plexus, the subclavian artery and the subclavian vein at the thoracic outlet region. It includes neurogenic TOS, venus TOS, arterial TOS, and neurogenic TOS is the most common type. TOS has varied manifestations and lack of confirmatory testing, therefore, the diagnosis should be conbination with thorough history, physical examination and associated supplementary examinations. Conservative and surgical treatment can be choosed for TOS and the outcomes are generally good. Conservative management is the initial treatment strategy for neurogenic TOS. In cases of symptomatic vascular TOS and neurovascular TOS, which has been failed by conservative treatment, surgery should be considered more promptly.

Clinical controlled trial on the treatment of comminuted clavicular fracture with acromioclavicular external fixator and clavicle anatomic DCP internal fixation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the different therapeutic effects of comminuted clavicular fracture with acromioclavicular external fixtatior and DCP internal fixation.</p><p><b>METHODS</b>There were 768 cases of comminuted clavicular fracture involved in the study. Among them, 528 patients (321 male and 207 female, aged from 15 to 82 years) treated with acromioclavicular external fixator, in which there were 165 cases of three parts fracture and 363 cases of more than three parts fracture; 240 patients (152 males and 88 females, aged from 17 to 64 years) treated with the internal fixation, in which there were 178 cases of three parts fracture and 62 cases of more than three parts fracture. The time between injury and treatment was 1.3 days (range, 2 h to 8 days). The results were evaluated according to Neer scoring system.</p><p><b>RESULTS</b>All the cases were followed up from 8 to 24 months. For treatment of fracture more than three parts, there was significant difference between acromioclavicular external fixation group and internal fixation group in nonunion rate (chi2=44.17, P<0.05) and in Neer scores (t=5.284, P<0.05).</p><p><b>CONCLUSION</b>Treatment with DCP internal fixation which matching the AO principles can obtain anatomic reduction, firm fixation and early functional exercise; however, treatment with self-designed acromioclavicular external fixator is an ideal therapeutic method as it has, early union of the fracture and good functional outcome with seldom complications.</p>