Objective To evaluate the effectiveness of posterior malleolus fixation on the function of ankle in patients with ankle fracture. Methods Between June 2007 and June 2009, 110 patients with ankle fracture were treated with posteriormalleolus fixation in 59 patients (fixation group) or without fixation in 51 patients (non-fixation group). In fixation group, there were 31 males and 28 females with an average age of 62.6 years (range, 19-75 years); the causes of injury included traffic accident (20 cases), falling (18 cases), and sprain (21 cases) with a disease duration of 1-3 days (2.2 days on average); and the locations were left ankle in 32 cases and right ankle in 27 cases, including 6 cases of type I, 23 of type II, 19 of type III, and 11 of type IV according to the ankle fracture clssification. In non-fixation group, there were 38 males and 13 females with an average age of 64.5 years (range, 16-70 years); the causes of injury included traffic accident (15 cases), falling (12 cases), and sprain (24 cases) with a disease duration of 1-3 days (2.5 days on average); and the locations were left ankle in 22 cases and right ankle in 29 cases, including 8 cases of type I, 16 of type II, 19 of type III, and 8 of type IV according to the ankle fracture clssification. There was no significant difference in general data between 2 groups (P gt; 0.05). Results All patients of 2 groups achieved wound heal ing by first intention. The patients were followed up 12-18 months (16 months on average). X-ray films showed that fractures healed at 8-12 weeks (10 weeks on average) in fixation group and at 10-14 weeks (12 weeks on average) in non-fixation group. There were significant differences in the cl inical score (89.28 ± 8.62 vs. 86.88 ± 9.47, P lt; 0.05), postoperative reposition score (33.34 ± 2.15 vs. 31.24 ± 2.89, P lt; 0.05), and osteoarthritis score (13.22 ± 1.66 vs. 12.46 ± 2.03, P lt; 0.05) according to Phill i ps ankle scoring system between 2 groups at last follow-up. There was no significant difference in cl inical score of type I and II patients between 2 groups (P gt; 0.05), but significant differences were found in cl inical score and osteoarthritis score of type III and IV patients between 2 groups (P lt; 0.05). There were significant differences in the postoperative reposition score between 2 groups in all types of fractures (P lt; 0.05). Conclusion The posterior malleolus fixation may provide satisfactory cl inical functional outcomes for ankle fracture. Proper fracture classification and correct method of internal fixation are important for achieving good reduction and improving the long-term results.
Objective To compare the early analgesic effects and the impact on knee joint function recovery after unicompartmental knee arthroplasty (UKA) between single adductor canal block (SACB) and continuous adductor canal block (CACB) combined with local infiltration anesthesia (LIA) using a prospective study. Methods The patients with knee osteoarthritis admitted between April 2022 and December 2023 were enrolled as a subject. Among them, 60 patients met the selection criteria and were enrolled in the study. They were randomly assigned to the SACB group or CACB group in a ratio of 1:1 using a random number table method. There was no significant difference between the two groups (P>0.05) in terms of age, gender, height, body mass, body mass index, affected side, and preoperative resting visual analogue scale (VAS) score and active VAS score, Oxford knee score (OKS), and American Hospital of Special Surgery (HSS) score. All patients received multimodal analgesia management using LIA combined with SACB or CACB. The operation time, pain related indicators (resting and activity VAS scores, number and timing of breakthrough pain, opioid consumption), joint function related indicators (quadriceps muscle strength, knee range of motion, OKS score, and HSS score), as well as postoperative block complications and adverse events were recorded and compared between the two groups. Results There was no significant difference in the operation time between the two groups (P<0.05). All patients in the two groups were followed up with a follow-up time of (9.70±4.93) months in the SACB group and (12.23±5.05) months in the CACB group, and the difference was not significant (P>0.05). The CACB group had a significant lower resting VAS score at 24 hours after operation compared to the SACB group (P<0.05). There was no significant difference in resting and active VAS scores between the two groups at other time points (P>0.05). The CACB group had a significantly lower incidence of breakthrough pain compared to the SACB group [9 cases (30.00%) vs. 17 cases (56.67%); P<0.05). However, there was no significant difference in the timing of breakthrough pain occurrence and opioid consumption between the two groups (P>0.05). Four cases in the SACB group and 7 cases in the CACB group experienced adverse events, with no significant difference in the incidence of adverse events between the two groups (P>0.05). The CACB group had significantly better knee joint mobility than the SACB group at 1 and 2 days after operation (P<0.05). There was no significant difference between the two groups in knee joint mobility on 0 day after operation and quadriceps muscle strength and OKS and HSS scores at different time points (P>0.05). Conclusion In UKA, the analgesic effects and knee joint function recovery are similar when compared between LIA combined with SACB and LIA combined with CACB. However, SACB is simpler to perform and can avoid adverse events such as catheter displacement and dislocation. Therefore, SACB may be a better choice.
ObjectiveTo systematically review the efficacy and safety of extracorporeal shock wave therapy (ESWT) in the treatment of rotator cuff tendinopathy to provide evidence for clinical practice. MethodsDatabases including CENTRAL, MEDLINE, EMbase, CINAHL plus, PEDro, CNKI, CBM, WanFang Data, and VIP were searched to collect randomized controlled trials (RCTs) of ESWT in the treatment of rotator cuff tendinopathy from inception to January 11th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. ResultsA total of 12 RCTs from 11 articles were included, including 529 subjects (273 in the case group and 256 in the control group). Meta-analysis showed that no significant difference between ESWT and placebo in pain improvement (SMD=−1.08, 95% CI −2.45 to 0.29, P=0.12), superior pain improvement in ESWT group than electroacupuncture group (SMD=−7.15, 95%CI −8.50 to −5.80, P<0.000 01), and no significant difference in pain improvement between ESWT as adjuvant therapy and acupuncture alone (SMD=−4.32, 95%CI −11.93 to 3.29, P=0.27). Regarding the Constant–Murley score (CMS) for shoulder joint function, ESWT was associated with an improved CMS compared with placebo (SMD=1.31, 95%CI 0.08 to 2.53, P=0.04). There was no significant difference in the improvement in the CMS between ESWT and other treatments (SMD=0.13, 95%CI −2.07 to 2.53, P=0.91). There was no significant difference in the improvement in the CMS between ESWT as adjuvant therapy and acupuncture alone (SMD=1.68, 95%CI −0.69 to 4.05, P=0.16). ConclusionsESWT may improve shoulder joint function in patients with rotator cuff tendinopathy, and the alleviation of pain in patients with rotator cuff tendinopathy requires further investigation. Due to the limited quality and quantity of included studies, the above conclusions requires further investigation by more high-quality studies.
ObjectiveTo evaluate hip function and reinfection of the patients with hip infection sequelae after total hip arthroplasty (THA) treatment.MethodsA clinical data of 31 patients (31 hips) with hip infection sequelae, who were treated with THA between June 2010 and May 2017, was retrospectively analyzed. There were 18 males and 13 females, with an average age of 46.1 years (range, 20-71 years). There were pyogenic infection in 17 cases, tuberculous infection in 9 cases, and unknown source of infection in 5 cases. The average time from infection to cure was 13.9 months (range, 6-25 months). The average time from cure to operation was 23.4 years (range, 6-58 years) for patients with confirmed source of infection. According to Kim classification, 12 cases were rated as typeⅠ, 9 as typeⅡ, and 10 as type Ⅲ. There were 21 cases of osteoarthritis after dysplasia, 7 cases of pathologic dislocation, and 3 cases of hip ankylosis. After operation, the infection was assessed by physical signs and laboratory tests; X-ray film of the hip was taken to assess the skeletal structure of the hip and infectious lesion; the length of the lower limb was measured, and the function of the hip joint was evaluated by Harris score.ResultsAll patients were followed up 10-63 months (mean, 34 months). The result of bacterial culture was negative. The incisions healed by first intention. The sciatic nerve stimulation occurred in 1 case and posterior dislocation of the joint occurred in 1 case after operation. There was no recurrence of infection and no aseptic loosening of the prosthesis. According to Harris score, the function of the hip was rated as excellent in 8 cases, good in 19 cases, and fair in 4 cases at last follow-up; and the excellent and good rate of hip joint function was 87%. X-ray films showed no patchy bone density reduction, spot hardening, or light areas. The length of affected limb was not fully equal with the unaffected limb in 5 cases, and the difference between two sides ranged from 0.4 to 1.3 cm (mean, 0.6 cm). At last follow-up, all patients had no obvious claudication or sensation of unequal length.ConclusionTHA can obtain satisfactory hip function and has low risk of infection recurrence for the patients with hip infection sequelae, who were assessed as the hip infection in a dormant state.
Objective To evaluate the effect of weight-bearing time on micro-fracture therapy for small sized osteochondral lesion of the talus (OLT) by comparing early weight-bearing and postponed weight-bearing. Methods Between March 2010 and September 2011, 43 patients with small sized OLT (lt; 2 cm2) scheduled for arthroscopic micro-fracture therapy were randomly divided into early weight-bearing group (n=22) and postponed weight-bearing group (n=21). There was no significant difference in gender, age, body mass index, disease duration, disease cause, preoperative visual analogue scale (VAS) score, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score between 2 groups (P gt; 0.05). All patients of 2 groups received micro-fracture treatment under arthroscopy. Full weight bearing began under the protection of “8” figure shaped splint at immediately after operation in early weight-bearing group, and weight bearing began at 6 weeks after operation in postponed weight-bearing group. Results The size of cartilage injury was (1.24 ± 0.35) cm2 in early weight-bearing group and was (1.25 ± 0.42) cm2 in postponed weight-bearing group by arthroscopy measurement, showing no significant difference between 2 groups (t=0.09, P=0.93); and there was no significant difference in cartilage injury grading between 2 groups (Z= — 1.45, P=0.15). The follow-up time was 12-18 months (mean, 14.5 months) in 2 groups. VAS and AOFAS scores of each group at each time point after operation were all significantly improved when compared with preoperative scores (P lt; 0.05), but no significant difference was found between 2 groups at 3, 6, and 12 months after operation (P gt; 0.05). The time of returning to work in early weight-bearing group [(6.35 ± 1.93) months] was significantly shorter than that in postponed weight-bearing group [(8.75 ± 1.48) months] (t= — 4.10, P=0.00). Conclusion For patients with small sized OLT, early weight-bearing and postponed weight-bearing after micro-fracture therapy under arthroscopy have similar short-term results. But patients undergoing early weight-bearing can earlier return to work than patients undergoing postponed weight-bearing.
Objective To investigate the effects of altering the femoral offset after total hip arthroplasty on postoperative pain and function. Methods A total of 162 patients undergoing single total hip arthroplasty between March 2009 and December 2011 met the inclusion criteria. According to difference of femoral offset between operative side and contralateral side, the patients were divided into 3 groups: decreased offset group (lt; — 5 mm, 30 cases), normal offset group ( — 5-5 mm, 87 cases), and increased offset group (gt; 5 mm, 45 cases). There was no significant difference in gender, age, and disease duration among 3 groups (P gt; 0.05). The types of femoral stem and head prosthesis were compared among 3 groups. Short Form 12 Health Survey (SF-12) score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, and Harris score were used to evaluate the clinical outcomes. Results Standard offset femoral prosthesis was most used, followed by increased offset femoral prosthesis, and decreased offset femoral prosthesis was least in 3 groups. The types of femoral stem and head prosthesis showed no significant difference among 3 groups (P gt; 0.05). The patients were followed up 12-33 months (mean, 25 months). There was no significant difference in SF-12 score among 3 groups at 1 year after operation (P gt; 0.05); there was no significant difference in WOMAC pain and stiffness scores among 3 groups (P gt; 0.05) except WOMAC body function score (P lt; 0.05). According to Harris scoring criteria, the results were excellent in 13 cases, good in 8 cases, fair in 7 cases, and poor in 2 cases in decreased offset group; the results were excellent in 42 cases, good in 34 cases, fair in 9 cases, and poor in 2 cases in normal offset group; the results were excellent in 31 cases, good in 12 cases, and fair in 2 cases in increased offset group; and significant difference was found among 3 groups (Z= — 3.152, P=0.008). Conclusion Increased offset is more conducive to joint functional recovery and pain relief; decreased offset may lead to joint function deterioration and pain aggravation.
ObjectiveTo observe the effect of ultra early joint movement onthe rehabilitation of shoulder joint function in patients with breast cancer who underwent axillary lymph node dissection (ALND).MethodsA total of 100 patients with breast cancer who underwent ALND between August 2018 and December 2019 in Zhongnan Hospital of Wuhan University were randomly divided into the early movement group (n=50) and the ultra early movement group (n=50). Both groups received early rehabilitation intervention as recommended by the guidelines. Patients in the early movement group started the shoulder joint movement training on the 7th day after surgery, and patients in the ultra early movement group started the shoulder joint movement training on the 3rd day after surgery, 3 times a day, 5 days a week, for 4 weeks. The changes in pain and drainage volume 3 days, 1 week, and 2 weeks after surgery and the changes of shoulder joint range of motion 1 week, 2 weeks , and 3 weeks after surgery were compared between the two groups, changes in shoulder function and quality of life 1 week and 3, 6, and 12 weeks after surgery were compared by the Constant-Murley and the Medical Outcomes Study 36-item Short-form Health Survey (SF-36) scales, respectively.ResultsThree days, 1 week, and 2 weeks after surgery, no significant difference in the pain scores or drainage volumes was observed between the two groups (P>0.05). One week, 2 weeks, and 3 weeks after operation, the motion ranges of shoulder abduction, flexion, and external rotation in the ultra early movement group were significantly better than those in the early movement group (P<0.05), and the motion range of shoulder internal rotation 1 week after operation in the ultra early movement group was significantly better than that in the early movement group (P<0.05). One week and 3, 6, and 12 weeks after operation, the Constant-Murley scores in the ultra early movement group were 25.9±4.3, 55.4±5.3, 64.6±4.5, and 73.3±4.6, respectively, which were better than those in the early movement group (21.3±3.8, 48.9±7.8, 57.3±4.7, and 70.7±3.0, respectively; P<0.05). No significant difference in the SF-36 scale scores was observed between the two groups (P>0.05).ConclusionsUltra early joint movement can significantly improve the motion range and functions of shoulder joint in patients with breast cancer who underwent ALND. What’s more, ultra early joint movement does not increase the early drainage volume or pain, and has no significant impact on the later quality of life. It is worthy of clinical application.
Objective To explore the feasibility and short-term effectiveness of the modified radical resection and reconstruction in the treatment of malignant proximal humerus tumor. Methods The relevant anatomic data from 30 normal adult shoulder joint MRI were measured to analyze the feasibility of modified radical resection and reconstruction surgery in the treatment of malignant proximal humerus tumor. Five patients with malignant proximal humerus tumor were treated by using the modified radical resection and reconstruction surgery between March 2012 and January 2016. There were 1 male and 4 females, aged from 9 to 69 years (median, 46 years). There were 4 cases of osteosarcoma (Enneking IIA in 2 cases and Enneking IIB in 2 cases) and 1 case of metastatic carcinoma (moderately differentiated adenocarcinoma). The disease duration was 7 to 12 months (mean, 9 months). Recurrence of tumor was observed after operation, and the shoulder function was assessed according to Enneking skeletal muscle tumor function scoring system. Results Radiographic results showed that modified radical resection and reconstruction surgery was feasible, which was in allowable range of the maximum longitudinal diameter ( < 29.8 mm) and depth ( < 4 mm). The operation was successfully completed in all 5 cases, and pathological examination suggested that purposes of radical resection had achieved. All patients were followed up 3 to 49 months (mean, 15.6 months). One patient had local recurrence at 12 months after operation, and a shoulder joint amputation was performed; the other 4 patients had good prosthesis survival. At last follow-up, the function of the shoulder joint was obviously recovered when compared with preoperative function; Enneking's skeletal muscle tumor function score was 25.8 points (range, 24 to 27 points). Conclusion Modified radical resection and reconstruction surgery is feasible for the treatment of proximal humerus tumor, and it can maintain a good early shoulder function.
Objective To investigate the influencing factors of the hi p functional recovery after Pi pkin fracture surgery. Methods The cl inical data were retrospectively analysed, from 37 patients with Pi pkin fracture between May 2002 and February 2009. There were 32 males and 5 females, aged 26 to 98 years (median, 43 years). The causes of injury were traffic accident in 31 cases, a fall ing in 4 cases, and fall ing from height in 2 cases. The time from injury to operation was 1-28 days (mean, 8.6 days). According to the Pi pkin classification criteria, there were 23 cases of type II, 8 cases of type III, and 6 cases of type IV. Open reduction and internal fixation (ORIF) were performed in 27 cases, total hip arthroplasty (THA) in 10 cases.The relationships between gender, age, time from injury to surgery, type of fracture, treatment way and the hip functionalrecovery were analysed statistically. Results All patients achieved heal ing of incision by first intention, no infection anddeep venous thrombosis occurred. All patients were followed up 10 to 94 months with an average of 40.5 months. Bonefusion was observed at 5-11 months (mean, 8.9 months) in patients undergoing ORIF by X-ray examination; no prostheticloosening or subsidence occurred in patients undergoing THA. At last follow-up, Oxford Hip Score (OHS) was 16-58 points(mean, 37.2 points); the results were excellent in 12 cases, good in 13 cases, fair in 2 cases, and poor in 10 cases. The univarible analysis showed that the type of fracture and treatment way significantly affected the hip functional recovery (P lt; 0.05). The multivarible analysis showed that the type of fracture and treatment way had no significant effect on the hip functional recovery (P gt; 0.05). Conclusion Type and treatment way of Pi pkin fracture may affect postoperative hi p function recovery, so appropriate treatment should be selected based on fracture type to ensure the restoration of joint function.
ObjectiveTo explore the effect of early rehabilitation nursing on elbow joint function recovery after artificial radial head replacement. MethodsFrom June 2010 to June 2012, 42 patients with artificial radial head replacement were randomly divided into two groups:trial group and control group. The control group was treated by the doctor instructions following routine rehabilitation therapy and nursing. The trial group received the guidance of professional rehabilitation nursing and early rehabilitation training. ResultsThe patients' range of elbow joint activities, alleviation of the pain, the strength grade, and the rehabilitation effect in the trial group was obviously better than those in the control group (P<0.05). There was no statistically significant difference between two groups in joint stability (P<0.05). ConclusionThe rehabilitation nursing should start early after the surgery for the artificial radial head replacement. It can prevent joint stiffness, joint conglutination and muscle disuse atrophy, reduce complications, and improve the quality of survival.