Objective To compare the effectiveness between operative and non-operative treatment for 3- and 4-part proximal humeral fractures in elderly patients. Methods Between January 2009 and January 2011, 35 patients with 3- or 4-part proximal humeral fractures were treated with open reduction and locking plate internal fixation (n=20, operative group) and with closed reduction and splint or cast fixation (n=15, non-operative group). There was no significant difference in gender, age, etiology, fracture type, and disease duration between 2 groups (P gt; 0.05). The postoperative rehabilitation protocol was performed in 2 groups. Results All patients of the operative group achieved healing of incision by first intention. All patients were followed up 16 months on average (range, 12-20 months). The X-ray films showed that the other fractures healed except 1 case (5.0%) nonunion in operative group. Varus malunion was found in 1 case (6.7%) of non-operative group and 2 cases (10.0%) of operative group. Humeral head necrosis was found in 1 case respectively in 2 groups (5.0% and 6.7%). There was no significant difference in complication incidence between 2 groups (P gt; 0.05). The Constant-Murley scores of non-operative group and operative group were 64.7 ± 9.9 and 66.8 ± 11.8 at last follow-up respectively, showing no significant difference (t=0.59, P=0.47). Conclusion Operative treatment has similar effectiveness to non-operative treatment for 3- and 4-part proximal humeral fractures. In elderly patients, non-operative treatment should be chosen.
Objective To investigate the operative procedure and the therapeutic effects of minimally invasive incision and percutaneous pinning in operative treatment of Gartland type III humeral supracondylar fracture in children. Methods From September 2002 to July 2009, 189 patients with Gartland type III humeral supracondylar fracture were treated with minimally invasive incision and percutaneous pinning. There were 137 males and 52 females, aged from 1 to 13 years (6.2 years on average). Injury was caused by sports in 173 cases, by traffic accident in 9 cases, by fall ing from height in 5 cases, and by earthquake in 2 cases. All fractures were closed fractures, compl icating others fracture in 11 cases, radial nerve injury in 36 cases, median nerve injury in 5 cases, ulnar nerve injury in 2 cases, and brachial artery injuryin 2 cases. The time from injury to hospital ization was 1 hour to 10 days. Neurovascular repair was performed at the same period. Results All incisions healed by first intention, no related compl ications occurred. A total of 143 patients were followed up 5 months to 5 years (12 months on average). X-ray films showed fracture healed within 2-4 months (2.5 months on average). Cubitus varus occurred in 6 cases, but the functions of elbow flexion and extension were good; 2 cases were given distal humeral wedge osteotomy and 4 cases continued keeping the functional training. According to the Flynn et al criteria, the results were excellent in 121 cases, good in 15 cases, and fair in 7 cases; the excellent and good rate was 95.1%. Only a small incision scar was found, the function returned to normal in the cases compl icated by nerve and blood vessel injury. Conclusion Minimally invasive incision and percutaneous pinning for operative treatment of Gartland type III humeral supracondylar fracture in children is a safe and effective surgical procedure, which has minimal trauma, short surgery time, quick recovery, simple operation, and can be effective in reducing the compl ications.
Objective To review present situation and progress in cl inically treating floating shoulder injury. Methods Recent l iterature concerned treatment of floating shoulder injury was reviewed and analyzed in terms of anatomy, pathogenesis, diagnosis, and treatment. Results Conservative treatment and operative treatment can get good outcome. But the value of the results was l imited, because different evaluation criteria were used in the l iterature. Conclusion There is no uniform standards about the treatment of the floating shoulder injury. Both conservative treatment and operative treatment have advantages and disadvantages, which method will be used to treat the floating shoulder injury based on local damage and the patient’s general condition.
Objective To compare the effects of operative versus nonoperative treatment for displaced intra-articular calcaneal fractures. Methods All randomized controlled trials (RCTs) of operative versus nonoperative treatment for displaced intra-articular calcaneal fractures were identified. Quality assessment and data extraction were performed by two reviewers independently. Results Four published trials involving 530 patients were included. All studies compared operative with nonoperative treatment. It was clear that operative treatment was superior to nonoperative treatment in terms of helping patients back to work, reducing problems wearing shoes, expanding the range of motion of subtalar joint, and improving the recovery of Bohler’s angle. As for foot pain, there was no difference between the two methods. Because the outcome measures varied across the trials, a meta-analysis could not be performed. Conclusions Both operative and nonoperative treatments produce comparable long-term outcomes in the treatment of displaced intra-articular calcaneal fractures. Because of the poor reporting of outcomes, it is not possible to determine if there is any significant difference in outcome measures apart from those listed above. More trials with high methodological quality are needed.
Objective To approach the surgical therapeutic efficacy of local recurrence of rectal cancer. Methods Fifty-six patients with local recurrence of rectal cancer suffered from reoperation from January 2003 to January2011 in this hospital were collected. Chi-square test was performed to analyze the complete excision rates of reoperation for different recurrent time after radical resection and different surgical procedures after primary radical resection of rectalcancer. The method of log-rank test was used for survival analysis of the Miles and Dixon procedure. Results ①The opera-tion time and intraoperative bleeding of reoperation for local recurrence of rectal cancer were more than those of the primary radical resection of rectal cancer （P＜0.05）. ②The complete resection rate of the local recurrence of rectal cancer in 5 years after primary radical resection of rectal cancer was higher than that of the local recurrence of rectal cancer within 2 years after primary radical resection of rectal cancer， and the difference was statistically significant （P＜0.01）. ③The complete resection rate of the local recurrence of rectal cancer of the technique of Dixon in the primary radical resection of rectal cancer was higher than that of Miles， and the difference was statistically significant （P＜0.05）. ④The median survival time and 2-year survival rate and 5-year survival rate of the technique of Dixon in the reoperation were longer or higher than those of Miles， and the differences were statistically significant （P＜0.05）. Conclusions Surgical procedure and postoperative recurrence time after primary operation can both influence complete excision rate of reoperation for local recurrence of rectal cancer. And reoperation for local recurrence of rectal cancer can prolong the survival time.
Objective To study the neural mechanism of hypotension or shock state in acute cholangitis in severe type (ACST) and its value of clinical application. Methods A technique of blocking abdominal splanchnic nervi via right adipose capsule of kidney was carried out on 28 patients by injecting 1% lidocaine before urgent operation. Results After blocking the relevant nervi, hypotension or shock state in 23 patients were improved significantly (Ｐ＜0.05). The death rate was lower (14.3%) after having performed biliary decompressions with laparotomy. Conclusion Patients′ hypotension or shock state at the early phase of ACST is the result of neural reflex in which the splanchnic nervi is its afferent pathway. Blocking the relevant nervi before urgent operation, the valuable opportunity of emergency treatment can be obtainded and the complication and death rate are reduced significantly.
ObjectiveTo systematically review the efficacy and safety of operative treatment versus nonoperative treatment in patients with adult spinal deformity (ASD).MethodsPubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, WanFang Data, and CQVIP databases were searched for controlled studies about operative treatment versus nonoperative treatment for ASD published up till June 2019. ClinicalTrials.gov was searched for grey literatures informally published up till June 2019. Two reviewers independently screened literatures, extracted data, and assessed risk of bias. Meta-analysis was performed by using RevMan 5.3 and Stata 14.0 softwares.ResultsA total of 10 non-randomized controlled studies were included, including 1 601 patients. The pooled results indicated that the operative group was superior to the nonoperative group in ability improvement [the increment of Scoliosis Research Society-22 score: weighted mean difference (WMD)=0.70, 95% confidence interval (CI) (0.69, 0.70), P<0.000 01; the decrement of Oswestry Disability Index score: WMD=11.12, 95%CI (10.74, 11.50), P<0.000 01], pain relief [the decrement of Numeric Rating Scale score: WMD=3.25, 95%CI (3.16, 3.35), P<0.000 01], and Cobb correction [WMD=14.06°, 95%CI (13.60, 14.53)°, P<0.000 01]. The incidence of complications was higher in the operative group than that in the nonoperative group [relative risk=5.38, 95%CI (3.67, 7.88), P<0.000 01].ConclusionsSurgery shows superior efficacy on ability improvement, pain relief, and Cobb correction compared with nonoperative treatment in ASD patients, though its incidence of complications is high. Nonoperative treatment is also an effective treatment for patients with poor physical condition and intolerance to surgery. Due to the limited quantity and quality of included studies, more high-quality studies are required to verify the above conclusions.