One of the consequences of osteoporotic vertebral compression fractures (OVCFs) is progressive collapse of the fractured osteoporotic vertebral body. This can lead to spinal kyphosis that may cause restriction of respiratory function. The balloon kyphoplasty procedure can reduce kyphosis and relieve the pain. There are few studies that have appropriate data and follow-up to evaluate the effect of deformity correction on pulmonary function after the kyphoplasty procedure. The current study explores changes of pulmonary function of 30 older women who suffered from OVCFs in the thoracolumbar segment after kyphoplasty. After kyphoplasty was performed on these women, thoracic kyphotic angle, local kyphotic angle, pain scores, and pulmonary function parameters-vital capacity, inspiratory capacity, residual volume, functional residual capacity, total lung capacity, forced vital capacity (FVC), and maximum voluntary ventilation (MVV) were measured. All measurements were taken before, 3 days after, and 1 month after the kyphoplasty. The height of the vertebral body was restored, the local kyphotic angle was improved, and pain scores were significantly decreased after kyphoplasty. FVC and MVV were significantly increased 3 days after the procedures; whereas only MVV had gone on to improve 1 month later. The decreased values of pain scores had a remarkably positive correlation with the percentage of improvement of FVC (r=0.536) and MVV (r=0.614) measured 3 days after kyphoplasty. In patients with OVCFs, kyphoplasty could partially improve their impaired lung function.
Study design A retrospective study was conducted to evaluate anterior plate fixation of unstable atlas fractures using a transoral approach. Objective To further investigate the safety and efficacy of this surgical technique, as there is currently a paucity of available data. Summary of background data While most atlas fractures can be managed by external immobilization with favorable results, surgery is usually preferable in highly unstable cases. Surgical stabilization is most commonly achieved using a posterior approach with fixation of C1-C2 or C0-C2, but these techniques usually result in loss of joint function and cannot fully stabilize anterior arch fractures of the atlas. Although a transoral approach circumvents these issues, only nine cases were described in the literature to our knowledge. Methods Twenty patients with unstable atlas fractures were treated with this technique during a 6-year period. Screw and plate placement, bone fusion, and integrity of spinal cord and vertebral arteries were assessed via intraoperative and follow-up imaging. Neurologic function, range of motion, strength, pain levels, and signs of infection were assessed clinically upon follow-up.Results There were no incidents of screw loosening or breakage, plate displacement, spinal cord injury, or vertebral artery injury. A total of 20 plates were placed and all 40 screws were inserted into the atlas lateral masses. CT scans demonstrated that two screws were placed too close to the vertebral artery canal, but without clinical consequences. Imaging demonstrated that bone fusion was achieved in all cases by 6 months postoperatively, without intervertebral instability. No plate-related complications were observed in any patients during the follow-up period. Conclusions C1 anterior plate fixation using a transoral approach appears to be a safe, reliable, and function-preserving surgical method for the management of unstable atlas fractures. For this type of fracture, a transoral approach with anterior fixation should be considered as an alternative to posterior approaches or conservative treatments.
Background: Many systematic reviews have compared the short-term outcomes of anterior cruciate ligment (ACL)reconstruction with hamstring and patellar tendon autograft,but few differences have been observed. The purpose of this meta-analysis was to compare the medium-term outcome of bone–patellar tendon–bone and hamstring tendon autograft for anterior cruciate ligament reconstruction in terms of clinical function, knee stability, postoperativecomplications, and osteoarthritis changes. Methods: This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, Embase, and the Cochrane Library databases were searched from inception to November 2, 2019. This meta-analysis included only randomized controlled trials that compared BPTB and HT autografts for ACL reconstruction with a 5-year minimum follow-up. The Cochrane Collaboration's risk-of-bias tool was used to estimate the risk-of-bias for all included studies. RevMan 5.3 software was used to performed statistical analysis of the outcomes. Results: Fifteen RCTs, involving 1298 patients (610 patients in the BPTB group and 688 patients in the HT group) were included. In terms of clinical function, no significant difference was found in the objective International Knee Documentation Committee score (OR = 0.94, 95%CI: 0.64–1.37, P = .75), Lysholm knee score (MD = −2.26, 95%CI: −4.56 to 0.05, P = .06), return to preinjury activity level (OR = 1.01, 95%CI: 0.67–1.52, P = .96), and Tegner activity level (OR = 0.03, 95%CI: −0.36 to 0.41, P = .89). There was no statistically significant difference in the Lachman test (OR = 0.86, 95%CI: 0.5–1.32, P = .50), pivot-shift test (OR = 0.68, 95%CI: 0.44–1.06, P = .09), and side-to-side difference (MD = −0.32, 95%CI: −0.81 to 0.16, P = .19). As for postoperative complications and OA changes, there were no statistically significant difference in flexion loss (OR = 1.09, 95%CI: 0.47–2.54, P = .85) and OA changes (OR = 0.76, 95%CI: 0.52–1.10, P = .15), but we found significant differences in favor of the HT group in the domains of kneeling pain (OR = 1.67, 95%CI: 1.04–2.69, P = .03), anterior knee pain (OR = 2.90, 95%CI: 1.46–5.77, P = .002), and extension loss (OR = 1.75, 95%CI: 1.12–2.75, P = .01). There was a significant difference in favor of the BPTB group in the domain of graft failure (OR = 0.59, 95%CI: 0.38–0.91, P = .02). Conclusions: Based on the results above, HT autograft is comparable with the BPTB autograft in terms of clinical function, postoperative knee stability, and OA changes, with a medium-t...
BackgroundA few studies focused on open reduction and internal fixation (ORIF) or nonoperative treatment of displaced 3-part or 4-part proximal humeral fractures in elderly patients have been published, all of whom had a low number of patients. In this meta-analysis of randomized controlled trials (RCTs), we aimed to assess the effect of ORIF or nonoperative treatment of displaced 3-part or 4-part proximal humeral fractures in elderly patients on the clinical outcomes and re-evaluate of the potential benefits of conservative treatment.MethodsWe searched PubMed and the Cochrane Central Register of Controlled Trials databases for randomized controlled trials comparing ORIF and nonoperative treatment of displaced 3-part or 4-part proximal humeral fractures in elderly patients. Our outcome measures were the Constant scores.Results: Three randomized controlled trials with a total of 130 patients were identified and analyzed. The overall results based on fixed-effect model did not support the treatment of open reduction and internal fixation to improve the functional outcome when compared with nonoperative treatment for treating elderly patients with displaced 3-part or 4-part proximal humeral fractures (WMD −0.51, 95% CI: −7.25 to 6.22, P = 0.88, I2 = 0%).ConclusionsAlthough our meta-analysis did not support the treatment of open reduction and internal fixation to improve the functional outcome when compared with nonoperative treatment for treating elderly patients with displaced 3-part or 4-part proximal humeral fractures, this result must be considered in the context of variable patient demographics. Only a limited recommendation can be made based on current data. Considering the limitations of included studies, a large, well designed trial that incorporates the evaluation of clinically relevant outcomes in participants with different underlying risks of shoulder function is required to more adequately assess the role for ORIF or nonoperative treatment.
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