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.

Comparative study of two operation methods on complicated fractures of the distal radius and ulna / 中国骨伤

<p><b>OBJECTIVE</b>To compare the differences between external fixator and volar T-shaped plate in the treatment of complicated fractures of the distal radius and ulna, and evaluate the appropriate operation method for the fractures.</p><p><b>METHODS</b>From July 2005 to July 2007, forty-eight cases of complicated fractures of the distal radius and ulna were treated with operation. There were 21 males and 9 females in the internal fixator group, ranged from 22 to 52 years old (with an average of 38.4 +/- 1.5 years). There were 10 mals and 8 femals in the external fixator group,ranged from 25 to 56 years old (with an average of 40.5 +/- 2.3 years). The X-ray films were measured to acquire radial length, palmar tilt and radial inclination after operations. The functional evaluation were scored with a modified Gartland and Werley's (GW) scoring system at 6 and 12 months after operation.</p><p><b>RESULTS</b>The patients were followed up for 12 to 18 months with an average of 14.2 months. The radial length was (8.82 +/- 0.55) mm, palmar tilt (9.23 +/- 0.86) degrees, radial inclination (19.66 +/- 1.38) degrees in the internal fixator group, while those were (8.25 +/- 0.36) mm, (8.56 +/- 0.72) degrees, (18.82 +/- 1.42) degrees in the external fixator group. The film parameter of internal fixator group was better than the external fixator group, but with no statistical significance (P > 0.05). In the internal fixator group, 16 cases obtained excellent, 7 good, 5 fair, 2 poor, while in the external fixator group, 4 cases obtained excellent, 2 good, 8 fair, 4 poor in 6 months. The GW scores of internal fixator group were lower than that of the external fixator group (P < 0.05). At 12 months after surgery, in the internal fixator group, 17 cases obtained excellent, 7 good, 5 fair, 1 poor; while in the external fixator group, 5 cases obtained excellent, 9 good, 2 fair, 2 poor. The GW score was similar between the two groups (P > 0.05).</p><p><b>CONCLUSION</b>The volar T-shaped plate fixation may offer effective stability,the short-term outcome is better than the external fixator group,and there are relatively fewer complications. But the treatment outcome of the two operation methods are similar for the long time follow up.</p>