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Objective:To compare the minimally invasive transforaminal lumbar interbody fusion (MTLIF) with open transforaminal lumbar interbody fusion (OTLIF) in treatment of lumbar degenerative disease.Methods:Clinical data of 63 patients with single segment lumbar degenerative disease treated in Department of Orthopedics of Beijing Hospital from November 2015 to September 2016 were retrospectively analyzed, among whom 30 cases received MTLIF and 33 cases received OTLIF. The operative time, intraoperative X-ray exposure times, intraoperative blood lose, postoperative drainage,perioperative fever, adjacent segment degeneration, loosening of internal fixation and cage collapse were observed in two groups 4 years after operation, and the visual analog scale (VAS) score of the lower back and the leg, the Oswestry disability index (ODI) score were compared between two groups.Results:The operation time [(191.6±50.5) min] and radiation exposure times [(15.5±6.4) times] in MTLIF group were significantly more than those in OTLIF group [(105.8±23.1) min, (7.2±1.4)times, t=17.210, t=10.850,all P<0.01]. The intraoperative blood loss [(150.4±70.4) ml], postoperative drainage [(90.4±30.7)ml], VAS score (2.4±0.7) and ODI score (24.5±3.7) 2 weeks after surgery in MTLIF group were significantly lower than those in OTLIF group [(250.7±43.9)ml,(216.3±67.8)ml,(4.5±1.6),(30.6±4.6), t=-12.830, t=-14.070, t=-6.890, t=-5.805,all P<0.01]. There were no significant differences in the incidence of fever [1 case(3.3%) vs. 4 cases(12.1%),χ2=-1.661, P=0.20], VAS score[(1.2±0.7) vs. (1.3±0.6), t=-0.628, P=0.53], ODI score[(14.2±2.7) vs. (14.7±2.5), t=-0.756, P=0.45], fusion rate of Bridwell grade Ⅰ [86.7%(26/30) vs. 84.8%(28/33),χ2=0.042, P=0.84] 1 year after surgery; and the adjacent segment degeneration [0 case(0) vs. 1 case(3.0%),χ2=0.924, P=0.34], internal fixation loosening [1 case(3.3%) vs. 1 case(3.0%),χ2=0.005, P= 0.95] and cage collapse 4 years after surgery [1 case(3.3%) vs. 1case(3.0%),χ2=0.005, P=0.95] between MTLIF group and OTLIF group. Conclusion:Compared with OTLIF, MTLIF has longer operation time and more radiation exposure, but it can achieve full decompression, the same fusion rate, less bleeding, less trauma, faster recovery, fewer complications and satisfactory long-term effect.
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Objective:To analyze the demographic and clinical characteristics of elderly inpatients with osteoporotic femoral neck fractures(OFNF).Methods:Clinical data of 1 227 patients with OFNF treated at the department of orthopedics of Beijing Hospital from January 2010 to December 2019 were analyzed retrospectively, including 377 male and 850 female patients.Ten-year trends in the OFNF constituent ratio, patient age, average length of stay and hospitalization expenses were examined, and differences in demographic and clinical characteristics between different genders were analyzed.Results:From 2010 to 2017, the constituent ratio of OFNF patients increased each year, and the number of OFNF patients decreased slightly in 2018 and 2019.The age of onset in both male and female patients was the highest at the ages of 80-89(46.8% or 574/1 227). In the distribution of educational level, people with no education made up the highest proportion(36.7% or 450/1 227). The seasonal distribution of the disease was the highest in autumn(27.8% or 341/1 227). The constituent ratio of urban areas was higher than that of rural areas(54.6% or 670/1 227 vs.45.4% or 557/1 227). In the distribution of fracture types, the constituent ratio of 31-B2 fractures was the highest in both male and female patients.Of the causes of injury, the constituent ratio of falls and indoor activities was the highest.Hypertension, spinal degenerative diseases and knee and hip osteoarthritis ranked in the top three of concomitant diseases.The constituent ratio of previous fractures in females was significantly higher than that in males.In the past ten years, the average hospitalization length of OFNF patients showed a downward trend, and the change in average hospitalization cost showed abrupt fluctuations.From 2009 to 2016, the hospitalization cost showed an upward trend, with the highest in 2016, and then decreased year by year. Conclusions:In the past ten years, the number and constituent ratio of OFNF patients increased steadily in the first eight years, but decreased slightly or reached a plateau in the past two years.The education level, history of bone fractures, hypertension, spinal degenerative diseases and knee and hip osteoarthritis of OFNF patients were correlated with sex, while age distribution, seasonal distribution, urban and rural distribution, cause of injury, fracture classification and other concomitant diseases were not correlated with sex.In the past ten years, the average hospitalization length of OFNF patients trended downward, the average hospitalization cost showed an upward trend from 2009 to 2016, and decreased year by year after 2016.The medical policy reform in 2016 played a significant role in controlling medical expenses.
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Objective To retrospectively analyze the mid-term functional outcome and quality of life in elderly patients undergoing the mobile-bearing versus fixed-bearing total knee arthroplasty.Methods Patients aged over 65 years who underwent total knee arthroplasty during January 2002 to December 2010 were followed up.The knee joint function was assessed by Western Ontario and McMaster Universities (WOMAC) score.Quality of life was assessed by using SF-16 (Short Form36) questionnaire.Data of mobile-bearing versus fixed-bearing groups were statistically analyzed.Results 157 cases (194 knees) were followed up completely.The mean follow-up period was (5.06±2.47) years (range 2.08-10.75 years).The mean age was (72.4±4.3) years (range 65-86 years old).Preoperative versus postoperative WOMAC scores were (48.2 ± 14.9) vs.(10.7±9.1) (P＜0.01).There was no significant difference in WOMAC score between the fixed-bearing group and the mobile-bearing group during the follow up [(10.12±8.76) vs.(11.38±9.55),t=0.861,P＞0.05].The mean SF-36 score was (119.65± 12.03) in the overall population of patients,which showed no significant difference as compared with the good and moderate optimal truncation value of 117 (t =2.759,P＞0.05).There was no significant difference in SF-36 score between the fixed-bearing group and the mobile-bearing group [(120.17±11.06) vs.(119.06±13.07),t=0.575,P＞0.05].Conclusions Total knee arthroplasty can improve the knee joint function and quality of life in elderly patients with severe knee osteoarthritis.For the elderly,the mid-term functional outcome and life of quality are similar in the mobile-bearing and the fixed-bearing total knee arthroplasty,and any kind of prostheses can be chosen to use,
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Objective To observe the pathologic type and degree of traumatic recurrent anterior dislocation of the shoulder by means of arthroscopy and discuss clinical results of modified Bristow method and arthroscopic Bankart reconstruction so as to provide refeFences for selecting operation methods.Methods A retrospective study was done off 62 patients(62 shoulders,44 males and 18 females.at av-erage age of 39.8 years.ranging from 21 to 67 years)with anterior recurrent dislocation of shoulder (mean duration of 87 months)admitted into our hospital from July 1997 to Oetcher 2007.All patients un-derwent preoperative arthroscopic examination that showed pathologic changes including injury of shoulder and humerus head,Bankart injury severity and laxitas of humerus glenoid ligament of articular capsule,which were used as referenee of surgical procedures.Modified Bristow's method or arthroscopic suture anchor Bankart reconstruction were performed according to arthroscopic results(pathologic change).The patients were assessed with the University of California at Los Angeles(UCLA)shoulder rating scale.Results There were 45 patients treated with modified Bristow,s method and 17 with arthroscopic suture anchor Bankart reconstruction.The follow.uD for mean 64.2 months showed that pre-and post-operative mean UCLA scores were(22.6±4.4)points and(29.8±4.2)points respectively(P＜0.01),the mean forward flexion(136.8±14.2)°and(156.6±17.8)°respectively(P＜0.01)and the mean ex-ternal rotation in 90°abduction(52.5±16.4)°and(72.4±11.3)°(P＜0.01).There were no redis-location at final follow-up,but there were 6 patients(9.6%)with positive apprehension test.Of all,60 patients(97%)returned to their pre-injury.work. Conclusions Observation of pathologic change of surgical procedure.Both modified Bristow's method and arthruscopic Bankart reconstruction are good methtxts for treatment of recurrent anterior shoulder dislocation under conditions of successful management of pathologic change of shoulder, restoration of normal anatomic structure of shoulder ioint and strict indi-cation control.
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Objective To evaluate the efficacy of arthroscopic capsular release of frozen shoulder.Methods Twenty-five patients with frozen shoulder were treated arthroscopically from October 2001 to October 2003 in this hospital.The operation was performed under general anesthesia.The arthoscope was inserted through a posterior approach and the radiofrequency electrotome was inserted via an anterior approach.The synovitis of the biceps tendon and the rotator interval was thermo-coagulated.The superior glenohumeral ligament,the middle glenohumeral ligament,and the intra-capsular part of subscapularis tendon were cut to release the capsule.The combination manipulation was performed to release the residual contracture.The range of motion of the shoulder and the American Shoulder & Elbow Surgeons(ASES) scores were recorded at 3 and 6 postoperative months,respectively.Results The operative time was 75~95 min(mean,85 min).No intraoperative complications were found.As compared with preoperative conditions,the motion of inward rotation revealed no significant improvement at 1 week after operation(?~2=8.558,P=0.073) and other shoulder motions were significantly improved at different postoperative stages(P0.05).Conclusions Arthroscopic release for the treatment of frozen shoulder may obviously shorten the period of the disease and obtain good curative effects.
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Footballer 's ankle is anterior bony spur or anterior impingement symptom of the ankle with anterior ankle pain, limited and painful dorsiflexion. The cause is commonly seen in athletes and dancers, and is probably due to repetitive minor trauma. The condition was firstly described by Morris; McMurray reported good results from excision of the spurs, naming it footballer' s ankle. Opening resection of osteophytes of the anterior tibial and superior talar is an effective treatment for anterior impingement of the ankle.
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Adulto , Humanos , Masculino , Traumatismos do Tornozelo , Traumatismos em Atletas , Futebol AmericanoRESUMO
Objective To evaluate the T lymphocyte functions in elderly patients following major orthopedic operation. Methods From May 1998 to Feb 1999, 39 elderly patients (65 95 years old) hospitalized for orthopedic operation were studied. The patients' peripheral blood samples in the experimental group were obtained on days 1, 3, 7 and 14 postoperation, respectively. At the same days, blood samples were taken from 15 elder patients without trauma and operation (65 80 years old) within 6 months as controls. T lymphocyte subpopulations were differentiated by means of quantitative assay with autocounting method of FCM. Results CD3 T cell count was significantly decreased on day 1(54 4?11 3)% and day 14(58 5?12 6)%, compared with controls (63 9?8 3)% ( P
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Objective To determine the sensitivity and accuracy of CT do ub le-contrast arthrography (CTA) in detecting underlying soft-tissue and bony abno rmalities of recurrent anterior glenohumeral dislocations. Methods From March 19 90 to May 2003, 31 patients with the signs and symptoms of recurrent anterior in stability, which were 23 males and 8 females with an average age of 26.7 years ( ranging, 22 to 46 years), were recruited for the study. All patients suffered fr om more than three times of glenohumeral dislocations, underwent CT arthrography after intraarticular injection of air and radiographic contrast medium before o peration. The surgical procedures included open Bristow operation in 25, Bankart operation in 3, Putti-Platt operation in 2, and a combination of Bankart and ca psular tightness operation by arthroscopy in 1. Each patient also underwent arth roscopy or open surgery and the observations were compared with CTA. Results Les ions of labrum and capsulo-ligamentous complex were the two most common abnormal ities demonstrated by surgical findings, which were respectively found in 28 and 20 patients at surgery. Anterior glenoid labral abnormalities, including of tea r, detachment, degeneration, were detected on CTA in 26 of 28, 2 of glenoid labr al degeneration were undetected on CTA, and the accuracy rate diagnosis on CTA w as 93.5%, while the sensitivity of CTA was 92.8%. Capsular lesions, including of marked medial scapular insertion, glenoid marginal stripping, and loss of inter vening scapular marginal soft tissues, were detected on CTA in 19 of 20, 1 of ca psular glenoid marginal stripping was undetected on CTA, and the accuracy rate d iagnosis on CTA was 87.1%, while, the sensitivity of CTA was 95%. Subscapularis tendon abnormalities, including of tears and irregularities, were visualized in 7 cases on CTA, but only 4 of which were identified during surgery. Furthermore, all of 15 Hill-Sachs defects, 6 Bankart bony defects, and 1 rupture of supraspi natus tendon suggested by CTA, were identified during surgery. For 26 of the pat ients with above kinds of lesion resulting in recurrent anterior glenohumeral di slocation, the accuracy rate of diagnosis was 83.7%. Conclusion The utilization of CT double-contrast arthrography can improve the understanding of multiple les ions associated with recurrent shoulder dislocation, it is contributed to select proper operative procedure.