Open reduction and internal fixation via modified Stoppa approach for pelvic fractures of Tile type C combined with acetabular both-column fractures / 中华创伤骨科杂志

Objective@#To evaluate the clinical efficacy of the modified Stoppa approach in the surgical treatment of pelvic fractures of Tile type C combined with acetabular both-column fractures.@*Methods@#Between April 2014 and April 2017, a total of 14 patients were treated by open reduction and internal fixation (ORIF) through the modified Stoppa approach at Department of Orthopaedics, Foshan Gaoming Hospital for pelvic fractures of Tile type C combined with acetabular both-column fractures. They were 10 men and 4 women, with an average age of 36.4 years (from 23 to 57 years). The modified Stoppa approach was used exclusively in 4 cases, in combination with the iliac fossa approach in 3 ones, in combination with the Kocher-Langenbeck approach in 4 ones and in combination with the Kocher-Langenbeck and iliac fossa approaches in 3 ones. In all the patients, the pelvic reconstructive plate and screws and lag screws were used. The operation time, intraoperative bleeding volume, postoperative fracture reduction, fracture union time, efficacy and complications were recorded.@*Results@#The operation time averaged 170 min (from 110 to 330 min) and the intraoperative bleeding 420 mL (from 240 to 1 100 mL). There were no operative complications. By the Matta evaluation, the postoperative reduction was rated as excellent in the 14 pelvic fractures and 9 acetabular both-column fractures and as good in 5 acetabular both-column fractures. Of this series, 13 patients were followed up for an average of 19 months (from 12 to 29 months) and one was lost to the follow-up. The fractures got united after an average time of 3.4 months (from 2.7 to 4.6 months). Screw loosening was observed in one case and mild limitation to hip flexion in one. Follow-ups found no lateral ventral syndrome or femoral head necrosis. Their Harris hip scores at the last follow-up ranged from 70 to 94 points, averaging 84 points. The function of the affected hip was excellent in 6 cases, good in 5 and fair in 2.@*Conclusion@#The modified Stoppa approach may be used exclusively or in combination with other approaches to treat effectively the pelvic fractures of Tile type C combined with acetabular both-column fractures, leading to good short-term clinical outcomes.

Open reduction and internal fixation via modified Stoppa approach for pelvic fractures of Tile type C combined with acetabular both-column fractures / 中华创伤骨科杂志

Objective To evaluate the clinical efficacy of the modified Stoppa approach in the surgical treatment of pelvic fractures of Tile type C combined with acetabular both-column fractures.Methods Between April 2014 and April 2017,a total of 14 patients were treated by open reduction and internal fixation (ORIF) through the modified Stoppa approach at Department of Orthopaedics,Foshan Gaoming Hospital for pelvic fractures of Tile type C combined with acetabular both-column fractures.They were 10 men and 4 women,with an average age of 36.4 years (from 23 to 57 years).The modified Stoppa approach was used exclusively in 4 cases,in combination with the iliac fossa approach in 3 ones,in combination with the Kocher-Langenbeck approach in 4 ones and in combination with the Kocher-Langenbeck and iliac fossa approaches in 3 ones.In all the patients,the pelvic reconstructive plate and screws and lag screws were used.The operation time,intraoperative bleeding volume,postoperative fracture reduction,fracture union time,efficacy and complications were recorded.Results The operation time averaged 170 min (from 110 to 330 min) and the intraoperative bleeding 420 mL (from 240 to 1 100 mL).There were no operative complications.By the Matta evaluation,the postoperative reduction was rated as excellent in the 14 pelvic fractures and 9 acetabular both-column fractures and as good in 5 acetabular both-column fractures.Of this series,13 patients were followed up for an average of 19 months (from 12 to 29 months) and one was lost to the follow-up.The fractures got united after an average time of 3.4 months (from 2.7 to 4.6 months).Screw loosening was observed in one case and mild limitation to hip flexion in one.Follow-ups found no lateral ventral syndrome or femoral head necrosis.Their Harris hip scores at the last follow-up ranged from 70 to 94 points,averaging 84 points.The function of the affected hip was excellent in 6 cases,good in 5 and fair in 2.Conclusion The modified Stoppa approach may be used exclusively or in combination with other approaches to treat effectively the pelvic fractures of Tile type C combined with acetabular both-column fractures,leading to good short-term clinical outcomes.

Comparison of surgery and conservative treatment for senile dens fractures of Anderson-D Alonzo type Ⅱ or Ⅲ: a Meta-analysis / 中华创伤骨科杂志

Objective To compare the operative and conservative treatments for senile dens fractures of Anderson-D Alonzo type Ⅱ or Ⅲ using Meta-analysis.Methods A literature search was conducted in PubMed,Embase,Web of Science,Cochrane Library,Wanfang Data and CNKI for studies on senile dens fractures of Anderson-D Alonzo type Ⅱ or Ⅲ from the earliest records through June 2016.The relative studies identified were screened by 2 independent authors.The quality of these articles was evaluated using modified Newcastle-Ottawa scale,and the meta-analysis was conducted using Review Manager 5.3.Results A total of 22 articles were brought into this Meta-analysis.The union rate was significantly higher in the operative group than in the conservative group[OR =0.30,95％ CI(0.20,0.44),P ＜ 0.001];the mortality in the operative group was significantly lower than in the conservative group[OR =0.61,95％ CI (0.39,0.96),P=0.03];the complication rate was similar in both groups[OR=1.09,95％ CI(0.76,1.57),P ＜ 0.46].The heterogeneity of all the 3 indexes was low.In the subgroup analysis,the union rate was significantly higher in posterior operations than in anterior operations or conservative treatments (P ＜ 0.05).Conclusion For the elderly patients with dens fracture of type Ⅱ or Ⅲ who can tolerate surgery,operative treatment may be more suitable because it can lead to much better prognosis.

Percutaneous endoscopic lumbar discectomy versus microendoscopic discectomy for lumbar disc herniation: a Meta-analysis / 中国内镜杂志

Objective To compare the curative effect of percutaneous endoscopic lumbar discectomy (PELD) and microendoscopic discectomy (MED) in lumbar disc herniation.Methods A literature search was performed in PubMed, Web of Science, Embase, Wanfang, CNKI. Two authors reviewed all articles individually. The methodological quality of RCTs was assessed by the Cochrane risk of bias tool, and the quality of retrospective studies was evaluated by the modified Newcastle-Ottawa scale. The data was extracted by the Review Manager 5.30.Results A total of 19 articles were brought into this Meta-analysis. The outcomes were divided into primary outcomes and secondary outcomes. Excerpt for the short-term VAS score was lower in PELD group (P = 0.010), other index, including long-term VAS score (P = 0.120), ODI score (P = 0.260), complication (P = 0.100) and recurrence (P = 0.100), didn't had significant difference in two groups. The blood loss (P = 0.000), hospital stay (P = 0.000) and the length of incision (P = 0.000) were all superiority in PELD group. Whereas the operative time was shorter in MED group (P = 0.001).Conclusion PELD was a more minimally invasive and secure technique in lumbar disc herniation.

Long-term outcome of neoadjuvant chemoradiotherapy based on the depth of invasion in mrT3 low rectal cancer / 中国肿瘤临床

Objective:To investigate the prognosis of cT3 and the subgroups of low rectal cancer patients who underwent neoadju-vant chemoradiotherapy (CRT) and evaluate whether all patients with cT3 low rectal cancer should undergo CRT. Methods:A total of 223 patients with cT3 low rectal cancer treated in the Department of Colorectal Surgery of Fujian Medical University Union Hospital from January 2008 to December 2012 were divided into neoadjuvant chemoradiotherapy group (CRT group) (115 cases) and no neoad-juvant chemoradiotherapy group (nCRT group) (108 cases) according to whether the patients underwent CRT. Afterward, the patients were retrospectively divided into three subgroups (mrT3a, mrT3b, and mrT3c) according to the proposed criteria of the Radiologic Soci-ety of North America (RSNA) by measuring the depth of mesorectal invasion (DMI) (DMI10 mm). The prog-noses of the two groups and their subgroups were compared. Results:The CRT and nCRT groups revealed no significant differences in the 3-year disease-free survival rate and the local recurrence rate for all the mrT3 patients (78.2%vs. 71.9%, P=0.608;4.4%vs. 8.5%, P=0.120) and mrT3a patients (82.4%vs. 81.8%, P=0.837;5.8%vs. 5.9%, P=0.658). On the contrary, for the mrT3b patients, the CRT and nCRT groups revealed significant differences in the 3-year disease-free survival rate (84.4%vs. 42.4%, P=0.032) and local recurrence rate (0.0%vs. 18.2%, P=0.014). For the mrT3b,c patients, the CRT and nCRT groups revealed no significant difference in the 3-year dis-ease-free survival rate (72.8%vs. 42.4%, P=0.060) but revealed a significant difference in the local recurrence rate (2.4%vs. 18.2%, P=0.021). COX regression analysis was utilized for 3-year disease-free survival, DMI and circumferential resection margin (CRM) were significant in the univariate analysis. Additionally, the multivariate analysis indicated that CRM is an independent impact factor (OR=2.249, CI 1.067-4.742, P=0.033). Conclusion:CRT can improve the prognosis of patients with mrT3b,c low rectal cancer but may not significantly influence the prognosis of patients with mrT3a and CRM-negative low rectal cancer;surgical treatment can be performed in these patients without CRT.

Anatomy of the anal canal and staging of low rectal cancer with high resolution magnetic resonance imaging / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate high resolution MR in imaging of the anatomy and tumor invasion of the anal canal.</p><p><b>METHODS</b>Twenty-three patients with low rectal cancer confirmed by pathology results were recruited as the study group and 20 patients without history of anal canal diseases were recruited as the control group. All patients received MRI examinations containing three TSE-T2WI sequences and three 3D-VIBE sequences. The distance between the tumor and the anal margin was measured in the study group. Two radiologists finished T staging of the tumor independently.</p><p><b>RESULTS</b>MRI had a clear demonstration of the anatomy of the anal canal in all 20 control patients. The T staging of 23 patients of study group was T2 (n=8), T3 (n=7), and T4 (n=8), and the depth of anal canal invasion (T-DACI) was T0-DACI (n=10), T1-DACI (n=1), T2a-DACI (n=3), T2-DACI (n=3), T3-DACI (n=4) and T4-DACI (n=2). Eight patients received surgery and the consistency between pathological staging and imaging staging was 75%.</p><p><b>CONCLUSION</b>High resolution MRI has the capacity of demonstrating the complex anatomy of the anal canal, and can provide evidence of anal canal invasion for low rectal cancer.</p>

Comparison of therapeutic effects of implant internal fixation for the treatment of Sanders Ⅱ calcaneal fractures after poking and open reduction / 中国组织工程研究

10.3969/j.issn.2095-4344.2013.26.023