Conservative treatment of supination and external rotation for type Ⅲ and Ⅳankle fracture by bone setting / 中国骨伤

OBJECTIVE@#To explore curative effect of conservative treatment of supination-lateral rotation (SER) with type Ⅲ and Ⅳ ankle fracture by bone setting technique.@*METHODS@#From January 2017 to December 2019, 64 patients diagnosed with SER with type Ⅲ and Ⅳ ankle fracture were treated with manipulative reduction and conservative treatment (manipulation group) and surgical treatment with open reduction and internal fixation (operation group), 32 patients in each group. In manipulation group, there were 17 males and 15 females, aged from 15 to 79 years old with an average of (51.42±13.68) years old;according to Lauge-Hansen classification, there were 8 patients with supination external rotation type Ⅲ and 24 patients with type Ⅳ. In operation group, there were 13 males and 19 females, aged from 18 to 76 years old with an average of (47.36±15.02) years old;7 patients with type Ⅲ and 25 patients with type Ⅳ. Displacement of ankle fracture was measured by Digimizer software, and compared before treatment, 3 and 12 months after treatment between two groups. Lateral medial malleolus displacement, lateral medial malleolus displacement, lateral malleolus displacement, lateral malleolus displacement, lateral malleolus contraction displacement and posterior malleolus displacement were measured and compared between two groups. Mazur score was used to evaluate ankle joint function.@*RESULTS@#All patients were followed up from 12 to 36 months with an average of (17.16±9.36) months. There were statistical differences in lateral medial malleolus displacement, lateral medial malleolus displacement, lateral malleolus displacement, lateral malleolus displacement, lateral malleolus contraction displacement and posterior malleolus displacement in manipulation group before and after reduction(P<0.05). Compared with operation group, there were no statistically significant differences in lateral malleolus shift, lateral malleolus shift, lateral malleolus contraction shift(P>0.05), while there were statistically significant differences in lateral malleolus shift, posterior malleolus shift up and down (P<0.05). Mazur scores of ankle joint at 3 months after treatment in manipulation group and operation group were 68.84±13.08 and 82.53±7.31, respectively, and had statistical differences(P<0.05), while there was no difference in evaluation of clnical effect(P>0.05). There were no differences in Mazur score and evaluation of clnical effect between two groups at 12 months after treatment (P>0.05).@*CONCLUSION@#Bone setting technique could effectively correct lateral displacement of medial malleolus, lateral displacement of medial malleolus, lateral displacement of lateral malleolus and lateral contraction displacement of lateral malleolus in supination lateral rotation type Ⅲ and Ⅳ ankle fracture, and has good long-term clinical effect, which could avoid operation for some patients and restore ankle function after fracture.

Clinical diagnosis and treatment features of Maisonneuve fracture and analysis of clinical outcome of 15 patients / 中国骨伤

OBJECTIVE@#To explore clinical diagnosis and treatment features of Maisonneuve fractures (maisonneuve fractures of the fibula, MFF), and evaluate its clinical effects.@*METHODS@#From March 2017 to June 2018, 15 patients with MFF were treated with operation, including 9 males and 6 females, aged from 27 to 54 years old with an average of (35.00±7.46) years old, the time from injury to operation ranged from 5 to 8 days with an average of (6.33±1.04) days. All the fractures were fresh and closed injury. The time of bone union and postoperative complications were observed, and AOFAS score was used to evaluate recovery of ankle joint function at 12 months after operation.@*RESULTS@#All patients were followed up from12 to 28 months with an average of (17.00±3.79) months. Four patients were misdiagnosed. All fractures were obtained bone union from 4 to 6 months with an average of (4.80±0.94) months. No postoperative complications such as infection, delayed union or nonunion occurred. Postoperative AOFAS score at 12 months was 90.23±7.27, among which 9 patients got excellent result, 3 good, and 3 fair.@*CONCLUSION@#Maisonneuve fracture is an unstable fracture. High fibular fracture and the separation of the lower tibia and fibula could be easily neglected, which could lead to misdiagnosis and missed care. Surgical treatment could recover anatomical relation of the lower tibia and fibula and ankle mortise, and obtain satisfying clinical effect.

Analysis of clinical effect of Xiaosui Huahe decoction for the treatment of 130 patients with giant lumbar intervertebral disc herniation / 中国骨伤

OBJECTIVE@#To explore the clinical effect of conservative treatment for giant lumbar intervertebral disc herniation and analyze the factors affecting its resorption.@*METHODS@#From January 2013 to December 2016, the clinical data of 130 patients with giant lumbar intervertebral disc herniation were collected. The patients were classified according to the characteristics of Iwabuchi displacement and "bull eye sign", Xiaosui Huahe decoction of traditional Chinese medicine conservative treatment was used in the patients. There were 93 males and 37 females, aged from 15 to 64 years old with an average of(37.11±13.96) years old; with the disease duration ranging from 1 day to 8 years with an average of(11.82±20.45) months. Rate of intervertebral disc herniation was measured by Futian's method, and clinical effect was evaluated by JOA score.@*RESULTS@#All the patients were followed up from 13 to 48 months with an average of(21.45±11.87) months, and there were no significant differences in follow-up time between different imaging types(>0.05). The absorption rate 95 patients with persistent conservative treatment was(44.08±35.70)%. The absorption rate of Iwabuchi displacement positive group and "bull eye sign" positive group was significantly higher than the average value(<0.05). The rate of excellent and good JOA scores in 95 patients was 78.95%, 81.05% and 78.95% at 3, 6 and 12 months after treatment, respectively(<0.05). Finally 35 patients accepted surgical treatment, the rate of excellent and good JOA scores was 100% at 3, 6, 12 months after treatment(<0.05).@*CONCLUSIONS@#The clinical effect of Xiaosui Huahe decoction conservative treatment is satisfactory for giant lumbar intervertebral disc herniation. Patients with Iwabuchi displacement and "bull's eye sign" had significant herniation resorption.

Logistic regression analysis on the outcome predictive factors of ruptured lumbar disc herniation / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the outcome predictive factors of ruptured lumbar disc herniation after conservative treatment.</p><p><b>METHODS</b>From June 2009 to June 2016, 147 patients with ruptured lumbar intervertebral disc herniation were treated with conservative treatment in the orthopedics department of Suzhou Traditional Chinese Medicine Hospital for clinical efficacy and MRI follow-up. Multivariate Logistic regression analysis(Stepwise regression method)was used to analyze the relationship between the 11 categorical variables and absorptivity of protrusions: sex(X1), age(X2), course of disease(X3) , the rate of protrusion(X4), the Komori type(X5), the MSU type(X6), the Iwabuchi type(X7), the Pfirrmann grade(X8), the Modic change on adjacent vertebrae(X9), spinal canal morphology(X10), the Schizas types of cauda equina sedimentation sign(X11).</p><p><b>RESULTS</b>A total of 64 cases of prominent reabsorption among all cases followed-up (absorption rate>=30%), accounting for 43.5%. The reabsorption of protrusions is more likely to occur in patients with a duration of less than 1 year(0.006), MSU type 3 (0.001), Iwabuchi type 1 or 5 (0.000), the Schizas type of cauda equina sedimentation sign A or B(0.004). Regression equation Y=-10.363+1.916X3+1.446X4-1.445X5+2.070X6+4.679X7+1.125X9+1.023X10+2.223X11. Such factors as age, gender, Pfirrmann classification and spinal canal morphology had no significant effect on reabsorption of protrusions.</p><p><b>CONCLUSIONS</b>Ruptured lumbar disc herniation can be reabsorbed after nonoperative treatment. And the reabsorption of protrusions is more likely to occur in patients with a duration of less than 1 year, MSU type 3, Iwabuchi type 1 or 5, the Schizas type of cauda equina sedimentation sign A or B, which can be used as the key reference factors for predicting the outcome of the projections.</p>