BackgroundTo compare the efficacy and safety of K-wire tension band fixation (KTB) with other alternative approaches (cannulated screws, cable pin, and ring pin) for treatment of patella fractures by performing a meta-analysis.MethodsPubMed and EMBASE databases were searched for all relevant studies. Standardized mean difference (SMD) or relative risk (RR) and their corresponding 95% confidence intervals (CIs) were calculated for continuous or dichotomous outcomes via either a fixed- or random-effect model using Stata 13.0 software.ResultsNine literatures involving 949 patients (581 in the KTB group and 368 in the control group) were included. Pooled analysis showed there were no differences in the success rate, operative time, healing time, and number of infections between patients undergoing KTB and others. However, the incidence of complications (RR = 8.04, 95% CI = 4.45–14.53; p < 0.001) and VAS (SMD = 0.642, 95% CI = 0.22–1.06; p = 0.003) were lower, while flexion degree (SMD = − 0.70 95% CI = − 1.04–− 0.36; p < 0.001), Böstman joint function score (SMD = − 0.68, 95% CI = − 1.10–− 0.27; p = 0.001), Iowa knee score (RR = 0.88, 95% CI = 0.81–0.96; p = 0.004), and Lysholm score (SMD = − 0.71, 95% CI = − 1.10–− 0.32; p < 0.001) were significantly higher in patients undergoing alternative approaches than the KTB. Subgroup analysis also demonstrated the cannulated screw fixation was superior to KTB in reducing the incidence of complications.ConclusionsAlternative treatments may be effective for management of patella fractures and should be attempted to be popularized in clinic.
Compared with whole modeling by volume rendering method, the 3-D finite element solid model created in partial is more real and fit for finite element analysis.
Background:
Colorectal endoscopic submucosal dissection (CR-ESD) has become a promising treatment for laterally spreading tumors (LSTs), but is accompanied by great challenges. This study aimed to evaluate the efficacy and safety of CR-ESD with a hybrid knife, versus the conventional technique for LSTs ≥30 mm in diameter, and analyze the risk factors for piecemeal resection and perforation.
Methods:
Patients eligible for CR-ESD were divided into two groups according to the use of the hybrid knife (HK group) or the use of the conventional technique, with an interchange of injection and hook knife (C-group). We performed propensity score matching (PSM) to compare the HK group and the C-group. Risk predictors for perforation and piecemeal resection were identified.
Results:
PSM identified 61 (132 patients) and 61 (129 patients) patients in the C-group and the HK group, respectively. Resection speed was significantly faster in the HK group than in the C-group (18.86 vs. 13.33 mm2/min, P < 0.001). The rate of knife exchange was significantly lower in the HK group than in the C-group (1.6% vs. 49.2%, P < 0.001). Multivariate analysis revealed that unfavorable locations, including the splenic flexure, hepatic flexure, or cecum, were predictive of piecemeal resection. The presence of severe fibrosis and a semilunar fold were independent risk factors for perforation.
Conclusions:
The use of a hybrid knife appears to increase CR-ESD resection speed. The indicators for piecemeal resection or perforation in CR-ESD identified herein might help to assess the technical difficulties of CR-ESD.
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