Trigeminal neuralgia is a severe,disabling pain and its deafferentation remains a challenge for health providers.Transcranial direct current stimulation is a non-invasive stimulation technique which finds new utility ...Trigeminal neuralgia is a severe,disabling pain and its deafferentation remains a challenge for health providers.Transcranial direct current stimulation is a non-invasive stimulation technique which finds new utility in managing pain.There-fore,the introduction of alternative,non-invasive,safe,and effective methods should be considered in treating patients with trigeminal neuralgia unresponsive to conventional treatment.展开更多
Aims:Although the application of ultrasound-guided vascular puncture and Z-stitch hemostasis to manage femoral access has been widely utilized,there is limited data on this combined application in adult congenital hea...Aims:Although the application of ultrasound-guided vascular puncture and Z-stitch hemostasis to manage femoral access has been widely utilized,there is limited data on this combined application in adult congenital heart disease(ACHD)patients undergoing electrophysiological(EP)procedures.We sought to evaluate the safety and efficacy of ultrasound-guided puncture and postprocedural Z-stitch hemostasis for ACHD patients under-going EP procedures.Methods and Results:The population of ACHD patients undergoing transfemoral EP pro-cedures at the University of Zurich Heart Center between January 2019 and December 2022 was observed and analyzed.During the study period,femoral access(left/right,arterial/venous)was performed under real-time ultrasound guidance.At the end of the procedure,a single Z-stitch was performed at the puncture site.We eval-uated the incidence of in-hospital complications associated with femoral access puncture in this population.Among 101 patients who had a total of 147 previous ipsilateral vascular punctures(mean 1.5 per person),100 patients underwent successful femoral vascular access for EP procedures.The median age of the patients was 47±15 years and 34(34%)were male.Z-stitches were performed after the procedure in 100 patients with 303 femoral vascular accesses(mean 3 punctures per person).No patient developed vascular puncture relevant inguinal hematoma,pseudo aneurysm,arteriovenousfistula,venous or arterial thrombosis.Conclusion:In ACHD patients undergoing EP procedures,optimal femoral access management can be achieved with ultra-sound-guided puncture and postprocedural Z-stitch hemostasis.展开更多
Introduction: Osteonecrosis of the femoral head (ONTF) is a debilitating condition. Several treatments have been proposed with controversial results. The aim of our study was to evaluate treatment by surgical drilling...Introduction: Osteonecrosis of the femoral head (ONTF) is a debilitating condition. Several treatments have been proposed with controversial results. The aim of our study was to evaluate treatment by surgical drilling coupled with in situ cancellous grafting. Materials and methods: Our study was a case-control study conducted at Brazzaville University Hospital from 1st January 2018 to 31 December 2023. It compared two groups of patients with ONTF: non-operated (13 patients, 20 hips) and operated (22 patients, 35 hips). We used the visual digital scale (VDS) for pain assessment, the Merle D’Aubigne-Postel (MDP) scoring system for clinical and functional assessment, and the evolution of necrosis. Results: The group of non-operated patients had a mean age of 35.69 ± 3.4 years, no improvement in pain with an EVN above seven at the last recoil and a mean global MDP score falling from 12.7 before offloading to 10.13 at one year. The group of patients operated on had a mean age of 37.86 ± 7.02 years, a significant reduction in pain (p = 0.00004) and a significantly increased MDP score (p = 0.0034). A comparison of the two groups of patients showed significant stabilization of the necrotic lesions in the operated patients (p = 0.00067), with better satisfaction in the same group. Conclusion: Surgical drilling combined with grafting in the treatment of early-stage ONTF has improved progress in our series. The technique is reproducible and less invasive. It has made it possible to delay unfavorable progression and, consequently, hip replacement surgery.展开更多
Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified techn...Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified technique, the Watson Jones approach (WJA) without image intensifier nor traction table, can allow open reduction and internal fixation (ORIF) of PFF using Dynamic hip screw (DHS), with satisfactory outcome. Patients and methods: Forty one consecutive patients (mean age 59.5 ± 21.6 years, 61% males) who were followed in a Teaching Hospital for PFF treated by ORIF using the WJA and DHS from January 2016 to December 2020 were reassessed. The outcome measures were the quality of the reduction, the positioning of the implants, the tip-apex distance (TAD), the rate and delay of consolidation, the functional results using Postel Merle d’Aubigné (PMA) score, the rate of surgical site infection (SSI) and the overall mortality. Logistic regression was used to determine factors associated with mechanical failure. Results: The mean follow-up period was 33.8 ± 15.0 months. Fracture reduction was good in 31 (75.6%) cases and acceptable in 8(19.5%) cases. Implant position was fair to good in 37 (90.2%) patients. The mean TAD was 26.1 ± 3.9 mm. Three patients developed SSI. Consolidation was achieved in 38 (92.6%) patients. The functional results were good to excellent in 80.5% of patients. The overall mortality rate was 7.3%. There were an association between mechanical failure and osteoporosis (p = 0.04), fracture reduction (p = 0.003), and TAD (p = 0.025). In multivariate logistic regression, no independent factors were predictive of mechanical failure. Conclusion: This study shows that ORIF using DHS for PFF via the Watson-Jones approach without an image intensifier can give satisfactory anatomical and functional outcomes in low-resource settings. It provides and validates a reliable and reproducible technique that deserves to be diffused to surgeons in austere areas over the world.展开更多
BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with ...BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with no consensus regarding the superiority of any single approach.AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches(PL)for hip hemiarthroplasty after femoral neck fractures.METHODS This is a comparative,retrospective,single-center cohort study conducted at a university hospital.Between March 2008 and December 2018,273 patients(a total of 280 hips)underwent bipolar hemiarthroplasties(n=280)for displaced femoral neck fractures using either the PL(n=171)or the minimally invasive direct anterior approach(DAA)(n=109).The choice of approach was related to the surgeons’practices;the implant types were similar and unrelated to the approach.Dislocation rates and other complications were reviewed after a minimum followup of 6 mo.RESULTS Both treatment groups had similarly aged patients(mean age:82 years),sex ratios,patient body mass indexes,and patient comorbidities.Surgical data(surgery delay time,operative time,and blood loss volume)did not differ significantly between the groups.The 30 d mortality rate was higher in the PL group(9.9%)than in the DAA group(3.7%),but the difference was not statistically significant(P=0.052).Among the one-month survivors,a significantly higher rate of dislocation was observed in the PL group(14/154;9.1%)than in the DAA group(0/105;0%)(P=0.002).Of the 14 patients with dislocation,8 underwent revision surgery for recurrent instability(posterior group),and one of them had 2 additional procedures due to a deep infection.The rate of other complications(e.g.,perioperative and early postoperative periprosthetic fractures and infection-related complications)did not differ significantly between the groups.CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate(<1%)than the PL.展开更多
BACKGROUND Hip fractures account for 23.8%of all fractures in patients over the age of 75 years.More than half of these patients are older than 80 years.Bipolar hemiarthroplasty(BHA)was established as an effective man...BACKGROUND Hip fractures account for 23.8%of all fractures in patients over the age of 75 years.More than half of these patients are older than 80 years.Bipolar hemiarthroplasty(BHA)was established as an effective management option for these patients.Various approaches can be used for the BHA procedure.However,there is a high risk of postoperative dislocation.The conjoined tendon-preserving posterior(CPP)lateral approach was introduced to reduce postoperative dislocation rates.AIM To evaluate the effectiveness and safety of the CPP lateral approach for BHA in elderly patients.METHODS We retrospectively analyzed medical data from 80 patients with displaced femoral neck fractures who underwent BHA.The patients were followed up for at least 1 year.Among the 80 patients,57(71.3%)were female.The time to operation averaged 2.3 d(range:1-5 d).The mean age was 80.5 years(range:67-90 years),and the mean body mass index was 24.9 kg/m^(2)(range:17-36 kg/m^(2)).According to the Garden classification,42.5%of patients were typeⅢand 57.5%of patients were typeⅣ.Uncemented bipolar hip prostheses were used for all patients.Torn conjoined tendons,dislocations,and adverse complications during and after surgery were recorded.RESULTS The mean postoperative follow-up time was 15.3 months(range:12-18 months).The average surgery time was 52 min(range:40-70 min)with an average blood loss of 120 mL(range:80-320 mL).The transfusion rate was 10%(8 of 80 patients).The gemellus inferior was torn in 4 patients(5%),while it was difficult to identify in 2 patients(2.5%)during surgery.The posterior capsule was punctured by the fractured femoral neck in 3 patients,but the conjoined tendon and the piriformis tendon remained intact.No patients had stem varus greater than 3 degrees or femoral fracture.There were no patients with stem subsidence more than 5 mm at the last follow-up.No postoperative dislocations were observed throughout the follow-up period.No significance was found between preoperative and postoperative mean Health Service System scores(87.30±2.98 vs 86.10±6.10,t=1.89,P=0.063).CONCLUSION The CPP lateral approach can effectively reduce the incidence of postoperative dislocation without increasing perioperative complications.For surgeons familiar with the posterior lateral approach,there is no need for additional surgical instruments,and it does not increase surgical difficulty.展开更多
BACKGROUND Celecoxib has been used to treat hip discomfort and functional difficulties associated with osteonecrosis of the femoral head(ONFH),although significant adverse reactions often follow long-term use.Extracor...BACKGROUND Celecoxib has been used to treat hip discomfort and functional difficulties associated with osteonecrosis of the femoral head(ONFH),although significant adverse reactions often follow long-term use.Extracorporeal shock wave therapy(ESWT)can delay the progression of ONFH,alleviate the pain and functional limitations it causes,and avoid the adverse effects of celecoxib.AIM To investigate the effects of individual ESWT,a treatment alternative to the use of celecoxib,in alleviating pain and dysfunction caused by ONFH.METHODS This was a randomized,controlled,double-blinded,non-inferiority trial.We examined 80 patients for eligibility in this study;8 patients were excluded based on inclusion and exclusion criteria.A total of 72 subjects with ONFH were randomly assigned to group A(n=36;celecoxib+alendronate+sham-placebo shock wave)or group B(n=36;individual focused shock wave[ESWT based on magnetic resonance imaging three-dimensional(MRI-3D)reconstruction]+alendronate).The outcomes were assessed at baseline,at the end of treatment,and at an 8-wk follow-up.The primary outcome measure was treatment efficiency after 2 wk of intervention using the Harris hip score(HHS)(improvement of 10 points or more from the baseline was deemed sufficient).Secondary outcome measures were post-treatment HHS,visual analog scale(VAS),and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)scores.RESULTS After treatment,the pain treatment efficiency of group B was greater than that of group A(69%vs 51%;95%CI:4.56%to 40.56%),with non-inferiority thresholds of-4.56%and-10%,respectively.Furthermore,the HHS,WOMAC,and VAS scores in group B dramatically improved during the follow-up period as compared to those in group A(P<0.001).After therapy,the VAS and WOMAC in group A were significantly improved from the 2nd to 8th wk(P<0.001),although HHS was only significantly altered at the 2 wk point(P<0.001).On the 1st d and 2nd wk after treatment,HHS and VAS scores were different between groups,with the difference in HHS lasting until week 4.Neither group had severe complications such as skin ulcer infection or lower limb motorsensory disturbance.CONCLUSION Individual shock wave therapy(ESWT)based on MRI-3D reconstruction was not inferior to celecoxib in managing hip pain and restrictions associated with ONFH.展开更多
Dear Editor,The patient had a history of intermittent self-resolving episodes of gross haematuria and was referred to our department for a massive bleeding.At presentation,haemoglobin was 8.6 g/dL and creatinine was 1...Dear Editor,The patient had a history of intermittent self-resolving episodes of gross haematuria and was referred to our department for a massive bleeding.At presentation,haemoglobin was 8.6 g/dL and creatinine was 1.37 mg/dL.He was hemodynamically stable,but suffered an important anemization in the subsequent days requiring multiple blood transfusions.In his medical history,it was reported that he had type II diabetes mellitus and the implantation of a right iliac-femoral stent 10 years before.展开更多
The atypical femoral fracture(AFF)has been attracting significant attention because of its increasing incidence;additionally,its treatment is challenging from biological and mechanical aspects.Although surgery is ofte...The atypical femoral fracture(AFF)has been attracting significant attention because of its increasing incidence;additionally,its treatment is challenging from biological and mechanical aspects.Although surgery is often required to manage complete AFFs,clear guidelines for the surgical treatment of AFFs are currently sparse.We reviewed and described the surgical treatment of AFFs and the surveillance of the contralateral femur.For complete AFFs,cephalomedullary intramedullary nailing spanning the entire length of the femur can be used.Various surgical techniques to overcome the femoral bowing common in AFFs include a lateral entry point,external rotation of the nail,and the use of a nail with a small radius of curvature,or a contralateral nail.In the case of a narrow medullary canal,severe femoral bowing,or pre-existing implants,plate fixation may be considered as an alternative.For incomplete AFFs,prophylactic fixation depends on several risk factors,such as a subtrochanteric location,presence of a radiolucent line,functional pain,and condition of the contralateral femur;the same surgical principles as those in complete AFFs can be applied.Finally,once AFF is diagnosed,clinicians should recognize the increased risk of contralateral AFFs,and close surveillance of the contralateral femur is recommended.展开更多
BACKGROUND Most of the first symptoms of avian influenza are respiratory symptoms,and cases with occipital neuralgia as the first manifestation are rarely reported.CASE SUMMARY A middle-aged patient complaining of par...BACKGROUND Most of the first symptoms of avian influenza are respiratory symptoms,and cases with occipital neuralgia as the first manifestation are rarely reported.CASE SUMMARY A middle-aged patient complaining of paroxysmal pain behind the ear was admitted to our hospital.The patient’s condition changed rapidly,and high fever,unexpected respiratory failure,and multiple organ failure developed rapidly.The patient was diagnosed with H7N9 avian influenza based on etiology.CONCLUSION We believe that the etiology of occipital neuralgia is complex and could be the earliest manifestation of severe diseases.The possibility of an infectious disease should be considered when occipital neuralgia is accompanied by fever.Avian influenza is one of these causative agents.展开更多
OBJECTIVE To investigate whether electroacupuncture(EA)ameliorates abnormal trigeminal neuralgia(TN)orofacial pain and anxiety-like behavior by altering synaptic plasticity in the hippocampus CA1.METHODS A mouse infra...OBJECTIVE To investigate whether electroacupuncture(EA)ameliorates abnormal trigeminal neuralgia(TN)orofacial pain and anxiety-like behavior by altering synaptic plasticity in the hippocampus CA1.METHODS A mouse infraorbital nerve transection model(pTION)of neuropathic pain was established,and EA or sham EA was used to treat ipsilateral acu⁃puncture points(GV20-Baihui and ST7-Xia⁃guan).Golgi-Cox staining and transmission elec⁃tron microscopy(TEM)were administrated to observe the changes of synaptic plasticity in the hippocampus CA1.RESULTS Stable and persistent orofacial allodynia and anxiety-like behav⁃iors induced by pT-ION were related to changes in hippocampal synaptic plasticity.Golgi stain⁃ings showed a decrease in the density of dendritic spines,especially mushroom-type dendritic spines,in hippocampal CA1 neurons of pT-ION mice.TEM results showed that the density of synapses,membrane thickness of the postsynaptic density,and length of the synaptic active zone were decreased,whereas the width of the synaptic cleft was increased in pTION mice.EA attenu⁃ated pT-ION-induced orofacial allodynia and anx⁃iety-like behaviors and effectively reversed the abnormal changes in dendritic spines and syn⁃apse of the hippocampal CA1 region.CONCLU⁃SION EA modulates synaptic plasticity of hippo⁃campal CA1 neurons,and reduces abnormal oro⁃facial pain and anxiety-like behavior,providing evidence for a TN treatment strategy.展开更多
OBJECTIVE To assess the effi⁃cacy and safety of acupuncture-related treat⁃ments for postherpetic neuralgia(PHN),identify the most effective acupuncture and related treat⁃ments.METHODS PubMed,Cochrane Central Register ...OBJECTIVE To assess the effi⁃cacy and safety of acupuncture-related treat⁃ments for postherpetic neuralgia(PHN),identify the most effective acupuncture and related treat⁃ments.METHODS PubMed,Cochrane Central Register of Controlled Trials,Embase,Web of Science,and four Chinese databases,a clinical research registration platform,and grey literature were searched.We evaluated the risk of bias and quality in the included studies and per⁃formed a Bayesian multiple network meta-analysis.RESULTS We included 29 randomized controlled trials comprising 1973 patients,of which approximately 17.24%showed a high risk of bias.According to the Jadad scale,2,16,and 11 studies were high,medium,and low quality,respectively.The pairwise meta-analysis results revealed that the efficacy of all acupuncture-related treatments for pain relief related to PHN showed the difference was statistically significant com⁃pared with that of antiepileptics.The network meta-analysis results showed that pricking and cupping plus antiepileptics were the most effective,followed by electroacupuncture(EA)plus antiepileptics for pain relief in patients with PHN.EA plus antiepileptics ranked the best regarding reduced Pittsburgh Sleep Quality Index and Self-Rating Depression Scale scores in patients with PHN.No results were found regarding total response rate or quality of life among this study.Acupuncture-related treatments showed a lower incidence of adverse events than that of antiepi⁃leptics-related treatments.CONCLUSION Acu⁃puncture-related therapies may be potential treat⁃ment options for PHN and are relatively safe.Pricking and cupping plus antiepileptics are the most effective techniques for pain relief.EA plus antiepileptics is the best approach for improving insomnia and depression symptoms of PHN.展开更多
Introduction: Superior femoral epiphysiolysis (SFE) is a most progressive but sometimes abrupt displacement of the femoral head relative to the superior femoral metaphysis through the cervicocerebral growth plate of t...Introduction: Superior femoral epiphysiolysis (SFE) is a most progressive but sometimes abrupt displacement of the femoral head relative to the superior femoral metaphysis through the cervicocerebral growth plate of the femur. The displacement of the femoral head is most often downward and backward. It is a typical pathology of the pubescent adolescent, most often overweight. It occurs on average at the age of 12 years in girls and 14 years in boys. Unstable forms with large displacements have a high risk of femoral head necrosis and chondrolysis. Although in situ fixation is the generally accepted treatment for minor SFE, the treatment of more severe cases remains controversial. When the extent of the displacement makes it impossible to pass a screw between the femoral neck and the femoral head, the only option is to reduce the displacement. This reduction must be gentle, progressive and limited to the minimum necessary for osteosynthesis. Objective: The aim of the work was to evaluate the results of the technique of progressive reduction of epiphyseal displacement by transtibial traction followed by percutaneous fixation of the femoral head by screw. Patients and Method: This was a retrospective descriptive study over a 10-years period from January 1, 2013 to December 31, 2022. It focused on the surgical treatment of unstable upper femoral epiphysiolysis with large displacement in the orthopaedic trauma department of the University Hospital of Kati. All patients operated on in our department for large displacement SFE were included in this study. Cases of secondary large displacement upper femoral epiphysiolysis and patients who had already undergone surgery on the proximal femur were excluded. Continuous progressive traction on the Boppe splint through a pin under the anterior tibial tuberosity was performed for 15 days in all patients. The hip was flexed to 45° and the knee to 35°. Fixation was performed with one or two screws. No contralateral preventive fixation was performed. Minimum follow-up was one year. Functional outcome was assessed by the Postel Merle d’Aubigné score. Anatomical outcome was assessed by the quality of reduction, the occurrence or non-occurrence of femoral head necrosis, and chondrolysis. Results: We identified nine patients with a mean age of 12.8 years and extremes of 9 and 17 years. There were three boys and six girls. Trauma was mentioned in four cases. The cause was idiopathic in five cases. Functional impotence was complete in all patients. The slippage was acute on a chronic background in all patients. The left side was affected in 7 cases and the right side in 2 cases. The patients were overweight in 7 cases. The patient’s weight was within the normal range in two cases. At final follow-up, all nine patients were asymptomatic. Anatomically, all nine patients had a femoral head free of avascular necrosis. In eight patients, the posterior tilt was absent, identical to that obtained after the traction period. Only one patient had a moderate posterior tilt with a neck uncovering of less than 25%. Functionally, the PMA score was very good in eight cases and good in one case. Conclusion: This study shows that the treatment of acute and unstable forms of upper femoral epiphysiolysis by progressive reduction with transtibial traction can lead to satisfactory results. Reduction in large displacement forms should be gentle, progressive and limited to the minimum necessary for osteosynthesis. Magnetic resonance imaging examination is an essential and indispensable prognostic element. Indications for preventive fixation should be selectively reserved for specific cases.展开更多
BACKGROUND Postherpetic neuralgia(PHN)is a typical neuropathic pain condition that appears in the lesioned skin regions following the healing of shingles.The pain condition tends to persist,which is often accompanied ...BACKGROUND Postherpetic neuralgia(PHN)is a typical neuropathic pain condition that appears in the lesioned skin regions following the healing of shingles.The pain condition tends to persist,which is often accompanied by negative emotions(e.g.,anxiety and depression)and substantially reduces the quality of life.In addition to analgesia(e.g.,pregabalin and gabapentin),nerve radiofrequency technology is an effective treatment for intractable PHN.However,there is still a significant portion of patients who do not benefit from this treatment.As a non-invasive form of brain stimulation,repetitive transcranial magnetic stimulation(rTMS)targeting the motor cortex is able to reduce neuropathic pain with grade A evidence.CASE SUMMARY Here we report two cases in which motor cortex rTMS was used to treat intractable PHN that did not respond to initial drug and radiofrequency therapies.Moreover,we specifically investigated rTMS efficacy at 3 mo following treatment.CONCLUSION Motor cortex rTMS can treat intractable PHN that did not respond to initial drug and radiofrequency therapies.展开更多
BACKGROUND Femoral trochlear dysplasia(FTD)is an important risk factor for patellar instability.Dejour classification is widely used at present and relies on standard lateral X-rays,which are not common in clinical wo...BACKGROUND Femoral trochlear dysplasia(FTD)is an important risk factor for patellar instability.Dejour classification is widely used at present and relies on standard lateral X-rays,which are not common in clinical work.Therefore,magnetic resonance imaging(MRI)has become the first choice for the diagnosis of FTD.However,manually measuring is tedious,time-consuming,and easily produces great variability.AIM To use artificial intelligence(AI)to assist diagnosing FTD on MRI images and to evaluate its reliability.METHODS We searched 464 knee MRI cases between January 2019 and December 2020,including FTD(n=202)and normal trochlea(n=252).This paper adopts the heatmap regression method to detect the key points network.For the final evaluation,several metrics(accuracy,sensitivity,specificity,etc.)were calculated.RESULTS The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of the AI model ranged from 0.74-0.96.All values were superior to junior doctors and intermediate doctors,similar to senior doctors.However,diagnostic time was much lower than that of junior doctors and intermediate doctors.CONCLUSION The diagnosis of FTD on knee MRI can be aided by AI and can be achieved with a high level of accuracy.展开更多
BACKGROUND Intractable postherpetic neuralgia(PHN)can be difficult to manage even with aggressive multimodal therapies.Patients who experience uncontrolled refractory cranial PHN despite conservative treatment may ben...BACKGROUND Intractable postherpetic neuralgia(PHN)can be difficult to manage even with aggressive multimodal therapies.Patients who experience uncontrolled refractory cranial PHN despite conservative treatment may benefit from an intrathecal drug delivery system(IDDS).For craniofacial neuropathic pain,the traditional approach has been to place the intrathecal catheter tip below the level of the cranial nerve root entry zones,which may lead to insufficient analgesia.CASE SUMMARY We describe a 69-year-old man with a 1-year history of PHN after developing a vesicular rash in the ophthalmic division of cranial nerve V(trigeminal nerve)distribution.The pain was rated 7-8 at rest and 9-10 at breakthrough pain(BTP)on a numeric rating scale.Despite receiving aggressive multimodal therapies including large doses of oral analgesics(gabapentin 150 mg q12 h,oxycodone 5 mg/acetaminophen 325 mg q6 h,and lidocaine 5%patch 700 mg q12 h)and sphenopalatine ganglion block,there was no relief of pain.Subsequently,the patient elected to have an implantable IDDS with the catheter tip placed at the interpeduncular cistern.The frequency of BTP episodes decreased.The patient’s continuous daily dose was adjusted to 0.032 mg/d after 3 mo of follow-up and stopped 5 mo later.He did not report pain or other discomfort at outpatient follow-up 6 mo and 1 year after stopping intracisternal hydromorphone.CONCLUSION The use of interpeduncular cistern intrathecal infusion with low-dose hydromorphone by IDDS may be effective for severe craniofacial PHN.展开更多
Objective: To investigate the effect of Yang-warming and Kidney-tonifying Prescription (YKP) on the treatment of steroid-induced avascular necrosis of the femoral head (SANFH) in rabbits. And to further explore whethe...Objective: To investigate the effect of Yang-warming and Kidney-tonifying Prescription (YKP) on the treatment of steroid-induced avascular necrosis of the femoral head (SANFH) in rabbits. And to further explore whether its therapeutic mechanism is related to the expression of HIF-1α and VEGF (angiogenic factors), BMP2 and Osterix (osteogenic factor), CD31 (type H vascular marker) and MMP13 (bone destruction-related factor). Methods: Twenty-seven healthy male New Zealand white rabbits were divided into a normal group, model group, traditional Chinese medcine (TCM) group (clinical equivalent dose group of YKP), miR-130a inhibitor group and TCM + inhibitor group. The SANFH model was established by combining horse serum with methylprednisolone. After the model is successfully established, TCM group was given 6.44 g/kg·d YKP by gavage, and the miR-130a gene inhibitor group was intraperitoneally injected with 25 mg/kg miR-130a inhibitor, locked nucleic acid (LNA)-anti-miR-130a. TCM + inhibitor group was treated with YKP intragastrically and miR-130a inhibitor intraperitoneally. The rabbits in the normal group and the model group were intragastrically administered with normal saline 10 ml/d. Once a day for 4 weeks. The avascular necrosis was detected by HE staining. The contents of HIF-1α, VEGF, BMP2 and Osterix in rabbit tissues were detected by qRT-PCR kit, and the expression of CD31 and MMP13 was detected by immunofluorescence staining. Results: In the normal group, the surface of the cartilage layer of the femoral head was smooth, the bone trabeculae were intact and densely arranged, the cells of each layer were neatly arranged, the morphology of the bone cells, the chondrocytes and the adipocytes were normal. In the model group, cartilage surfaces of the femoral head showed exfoliative cracks. The bone trabecular structure was loose and incomplete, chondrocytes, osteoblasts and bone marrow cells were significantly reduced, and the number of empty bone traps was significantly increased. In the TCM-treated group, more chondrocytes, thicker cartilage layer, and more regular bone trabeculae were detected as compared to model rabbits. In contrast, the cartilage layer was thinner, the destruction and fracture of bone trabeculae was more serious, chondrocytes and osteocytes were decreased as compared to model group. The expression of HIF-1α, VEGF, BMP2, and Osterix in the model group decreased significantly as compared to the normal group (P Conclusion: YKP can regulate the expression of angiogenic-related factors (VEGF and HIF-α), osteogenic-related factors (BMP2 and Osterix), and H-type vascular marker CD31, resulting in increased expressions of VEGF, HIF-α, BMP2, and Osterix, which promote intra-femoral head revascularization. Meanwhile, YKP decreased the expression of bone-destruction-related factor MMP13, thus enhancing the ability of bone tissue to repair itself. Regulation of these molecules’ expression may be one of the mechanisms of YKP in the treatment of hormonal femoral head necrosis.展开更多
Anterior cruciate ligament(ACL)injury is one of the most common types of sports injuries.People’s need to participate in sports and desire for a high quality of life promotes the continuous development of ACL reconst...Anterior cruciate ligament(ACL)injury is one of the most common types of sports injuries.People’s need to participate in sports and desire for a high quality of life promotes the continuous development of ACL reconstruction technology.Arthroscopic ACL reconstruction has been recognized as an effective method for the treatment of ACL injuries.This review analyses and summarizes the advantages and limitations of each surgical procedure for arthroscopic ACL reconstruction reported in the relevant literature so as to promote the future development of more relevant techniques.展开更多
BACKGROUND The ExeterTM Universal cemented femoral component is widely used for total hip replacement surgery.Although there have been few reports of femoral component fracture,removal of a broken femoral stem can be ...BACKGROUND The ExeterTM Universal cemented femoral component is widely used for total hip replacement surgery.Although there have been few reports of femoral component fracture,removal of a broken femoral stem can be a challenging procedure.CASE SUMMARY A 54-year-old man with a Dorr A femur sustained a refracture of a primary ExeterTM stem,two years after receiving a revision using a cement-within-cement technique(CWC)through an extended trochanteric osteotomy(ETO).The technical problems related to the CWC technique and the ETO played a major role in the stem fatigue refracture.We performed revision surgery and removed the distal cement using a cortical femoral window technique,followed by reimplantation with an uncemented,modular,distally-fixed uncemented stem.The patient experienced an uneventful postoperative recovery.CONCLUSION Re-fracture of a modern femoral ExeterTM stem is a rare event,but technical complications related to revision surgery can lead to this outcome.The cortical window osteotomy technique can facilitate the removal of a broken stem and cement,allowing for prosthetic reimplantation under direct vision and avoiding ETO-related complications.展开更多
文摘Trigeminal neuralgia is a severe,disabling pain and its deafferentation remains a challenge for health providers.Transcranial direct current stimulation is a non-invasive stimulation technique which finds new utility in managing pain.There-fore,the introduction of alternative,non-invasive,safe,and effective methods should be considered in treating patients with trigeminal neuralgia unresponsive to conventional treatment.
基金This study complied with the Declaration of Helsinki and was approved by the local Ethics Committee(Cantonal Ethics Committee Zurich,Nr.2016-00116).All patients signed informed consent for the procedure and the use of clinical data for scientific study.
文摘Aims:Although the application of ultrasound-guided vascular puncture and Z-stitch hemostasis to manage femoral access has been widely utilized,there is limited data on this combined application in adult congenital heart disease(ACHD)patients undergoing electrophysiological(EP)procedures.We sought to evaluate the safety and efficacy of ultrasound-guided puncture and postprocedural Z-stitch hemostasis for ACHD patients under-going EP procedures.Methods and Results:The population of ACHD patients undergoing transfemoral EP pro-cedures at the University of Zurich Heart Center between January 2019 and December 2022 was observed and analyzed.During the study period,femoral access(left/right,arterial/venous)was performed under real-time ultrasound guidance.At the end of the procedure,a single Z-stitch was performed at the puncture site.We eval-uated the incidence of in-hospital complications associated with femoral access puncture in this population.Among 101 patients who had a total of 147 previous ipsilateral vascular punctures(mean 1.5 per person),100 patients underwent successful femoral vascular access for EP procedures.The median age of the patients was 47±15 years and 34(34%)were male.Z-stitches were performed after the procedure in 100 patients with 303 femoral vascular accesses(mean 3 punctures per person).No patient developed vascular puncture relevant inguinal hematoma,pseudo aneurysm,arteriovenousfistula,venous or arterial thrombosis.Conclusion:In ACHD patients undergoing EP procedures,optimal femoral access management can be achieved with ultra-sound-guided puncture and postprocedural Z-stitch hemostasis.
文摘Introduction: Osteonecrosis of the femoral head (ONTF) is a debilitating condition. Several treatments have been proposed with controversial results. The aim of our study was to evaluate treatment by surgical drilling coupled with in situ cancellous grafting. Materials and methods: Our study was a case-control study conducted at Brazzaville University Hospital from 1st January 2018 to 31 December 2023. It compared two groups of patients with ONTF: non-operated (13 patients, 20 hips) and operated (22 patients, 35 hips). We used the visual digital scale (VDS) for pain assessment, the Merle D’Aubigne-Postel (MDP) scoring system for clinical and functional assessment, and the evolution of necrosis. Results: The group of non-operated patients had a mean age of 35.69 ± 3.4 years, no improvement in pain with an EVN above seven at the last recoil and a mean global MDP score falling from 12.7 before offloading to 10.13 at one year. The group of patients operated on had a mean age of 37.86 ± 7.02 years, a significant reduction in pain (p = 0.00004) and a significantly increased MDP score (p = 0.0034). A comparison of the two groups of patients showed significant stabilization of the necrotic lesions in the operated patients (p = 0.00067), with better satisfaction in the same group. Conclusion: Surgical drilling combined with grafting in the treatment of early-stage ONTF has improved progress in our series. The technique is reproducible and less invasive. It has made it possible to delay unfavorable progression and, consequently, hip replacement surgery.
文摘Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified technique, the Watson Jones approach (WJA) without image intensifier nor traction table, can allow open reduction and internal fixation (ORIF) of PFF using Dynamic hip screw (DHS), with satisfactory outcome. Patients and methods: Forty one consecutive patients (mean age 59.5 ± 21.6 years, 61% males) who were followed in a Teaching Hospital for PFF treated by ORIF using the WJA and DHS from January 2016 to December 2020 were reassessed. The outcome measures were the quality of the reduction, the positioning of the implants, the tip-apex distance (TAD), the rate and delay of consolidation, the functional results using Postel Merle d’Aubigné (PMA) score, the rate of surgical site infection (SSI) and the overall mortality. Logistic regression was used to determine factors associated with mechanical failure. Results: The mean follow-up period was 33.8 ± 15.0 months. Fracture reduction was good in 31 (75.6%) cases and acceptable in 8(19.5%) cases. Implant position was fair to good in 37 (90.2%) patients. The mean TAD was 26.1 ± 3.9 mm. Three patients developed SSI. Consolidation was achieved in 38 (92.6%) patients. The functional results were good to excellent in 80.5% of patients. The overall mortality rate was 7.3%. There were an association between mechanical failure and osteoporosis (p = 0.04), fracture reduction (p = 0.003), and TAD (p = 0.025). In multivariate logistic regression, no independent factors were predictive of mechanical failure. Conclusion: This study shows that ORIF using DHS for PFF via the Watson-Jones approach without an image intensifier can give satisfactory anatomical and functional outcomes in low-resource settings. It provides and validates a reliable and reproducible technique that deserves to be diffused to surgeons in austere areas over the world.
基金This study was reviewed and approved by the Ethics Committee of the HUB-Hospital Erasme.
文摘BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with no consensus regarding the superiority of any single approach.AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches(PL)for hip hemiarthroplasty after femoral neck fractures.METHODS This is a comparative,retrospective,single-center cohort study conducted at a university hospital.Between March 2008 and December 2018,273 patients(a total of 280 hips)underwent bipolar hemiarthroplasties(n=280)for displaced femoral neck fractures using either the PL(n=171)or the minimally invasive direct anterior approach(DAA)(n=109).The choice of approach was related to the surgeons’practices;the implant types were similar and unrelated to the approach.Dislocation rates and other complications were reviewed after a minimum followup of 6 mo.RESULTS Both treatment groups had similarly aged patients(mean age:82 years),sex ratios,patient body mass indexes,and patient comorbidities.Surgical data(surgery delay time,operative time,and blood loss volume)did not differ significantly between the groups.The 30 d mortality rate was higher in the PL group(9.9%)than in the DAA group(3.7%),but the difference was not statistically significant(P=0.052).Among the one-month survivors,a significantly higher rate of dislocation was observed in the PL group(14/154;9.1%)than in the DAA group(0/105;0%)(P=0.002).Of the 14 patients with dislocation,8 underwent revision surgery for recurrent instability(posterior group),and one of them had 2 additional procedures due to a deep infection.The rate of other complications(e.g.,perioperative and early postoperative periprosthetic fractures and infection-related complications)did not differ significantly between the groups.CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate(<1%)than the PL.
文摘BACKGROUND Hip fractures account for 23.8%of all fractures in patients over the age of 75 years.More than half of these patients are older than 80 years.Bipolar hemiarthroplasty(BHA)was established as an effective management option for these patients.Various approaches can be used for the BHA procedure.However,there is a high risk of postoperative dislocation.The conjoined tendon-preserving posterior(CPP)lateral approach was introduced to reduce postoperative dislocation rates.AIM To evaluate the effectiveness and safety of the CPP lateral approach for BHA in elderly patients.METHODS We retrospectively analyzed medical data from 80 patients with displaced femoral neck fractures who underwent BHA.The patients were followed up for at least 1 year.Among the 80 patients,57(71.3%)were female.The time to operation averaged 2.3 d(range:1-5 d).The mean age was 80.5 years(range:67-90 years),and the mean body mass index was 24.9 kg/m^(2)(range:17-36 kg/m^(2)).According to the Garden classification,42.5%of patients were typeⅢand 57.5%of patients were typeⅣ.Uncemented bipolar hip prostheses were used for all patients.Torn conjoined tendons,dislocations,and adverse complications during and after surgery were recorded.RESULTS The mean postoperative follow-up time was 15.3 months(range:12-18 months).The average surgery time was 52 min(range:40-70 min)with an average blood loss of 120 mL(range:80-320 mL).The transfusion rate was 10%(8 of 80 patients).The gemellus inferior was torn in 4 patients(5%),while it was difficult to identify in 2 patients(2.5%)during surgery.The posterior capsule was punctured by the fractured femoral neck in 3 patients,but the conjoined tendon and the piriformis tendon remained intact.No patients had stem varus greater than 3 degrees or femoral fracture.There were no patients with stem subsidence more than 5 mm at the last follow-up.No postoperative dislocations were observed throughout the follow-up period.No significance was found between preoperative and postoperative mean Health Service System scores(87.30±2.98 vs 86.10±6.10,t=1.89,P=0.063).CONCLUSION The CPP lateral approach can effectively reduce the incidence of postoperative dislocation without increasing perioperative complications.For surgeons familiar with the posterior lateral approach,there is no need for additional surgical instruments,and it does not increase surgical difficulty.
文摘BACKGROUND Celecoxib has been used to treat hip discomfort and functional difficulties associated with osteonecrosis of the femoral head(ONFH),although significant adverse reactions often follow long-term use.Extracorporeal shock wave therapy(ESWT)can delay the progression of ONFH,alleviate the pain and functional limitations it causes,and avoid the adverse effects of celecoxib.AIM To investigate the effects of individual ESWT,a treatment alternative to the use of celecoxib,in alleviating pain and dysfunction caused by ONFH.METHODS This was a randomized,controlled,double-blinded,non-inferiority trial.We examined 80 patients for eligibility in this study;8 patients were excluded based on inclusion and exclusion criteria.A total of 72 subjects with ONFH were randomly assigned to group A(n=36;celecoxib+alendronate+sham-placebo shock wave)or group B(n=36;individual focused shock wave[ESWT based on magnetic resonance imaging three-dimensional(MRI-3D)reconstruction]+alendronate).The outcomes were assessed at baseline,at the end of treatment,and at an 8-wk follow-up.The primary outcome measure was treatment efficiency after 2 wk of intervention using the Harris hip score(HHS)(improvement of 10 points or more from the baseline was deemed sufficient).Secondary outcome measures were post-treatment HHS,visual analog scale(VAS),and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)scores.RESULTS After treatment,the pain treatment efficiency of group B was greater than that of group A(69%vs 51%;95%CI:4.56%to 40.56%),with non-inferiority thresholds of-4.56%and-10%,respectively.Furthermore,the HHS,WOMAC,and VAS scores in group B dramatically improved during the follow-up period as compared to those in group A(P<0.001).After therapy,the VAS and WOMAC in group A were significantly improved from the 2nd to 8th wk(P<0.001),although HHS was only significantly altered at the 2 wk point(P<0.001).On the 1st d and 2nd wk after treatment,HHS and VAS scores were different between groups,with the difference in HHS lasting until week 4.Neither group had severe complications such as skin ulcer infection or lower limb motorsensory disturbance.CONCLUSION Individual shock wave therapy(ESWT)based on MRI-3D reconstruction was not inferior to celecoxib in managing hip pain and restrictions associated with ONFH.
文摘Dear Editor,The patient had a history of intermittent self-resolving episodes of gross haematuria and was referred to our department for a massive bleeding.At presentation,haemoglobin was 8.6 g/dL and creatinine was 1.37 mg/dL.He was hemodynamically stable,but suffered an important anemization in the subsequent days requiring multiple blood transfusions.In his medical history,it was reported that he had type II diabetes mellitus and the implantation of a right iliac-femoral stent 10 years before.
基金Supported by Korean Fund for Regenerative Medicine(KFRM)grant funded by the Korea Government(the Ministry of Science and ICT,the Ministry of Health&Welfare),No.22D0801L1 and No.22C0604L1。
文摘The atypical femoral fracture(AFF)has been attracting significant attention because of its increasing incidence;additionally,its treatment is challenging from biological and mechanical aspects.Although surgery is often required to manage complete AFFs,clear guidelines for the surgical treatment of AFFs are currently sparse.We reviewed and described the surgical treatment of AFFs and the surveillance of the contralateral femur.For complete AFFs,cephalomedullary intramedullary nailing spanning the entire length of the femur can be used.Various surgical techniques to overcome the femoral bowing common in AFFs include a lateral entry point,external rotation of the nail,and the use of a nail with a small radius of curvature,or a contralateral nail.In the case of a narrow medullary canal,severe femoral bowing,or pre-existing implants,plate fixation may be considered as an alternative.For incomplete AFFs,prophylactic fixation depends on several risk factors,such as a subtrochanteric location,presence of a radiolucent line,functional pain,and condition of the contralateral femur;the same surgical principles as those in complete AFFs can be applied.Finally,once AFF is diagnosed,clinicians should recognize the increased risk of contralateral AFFs,and close surveillance of the contralateral femur is recommended.
文摘BACKGROUND Most of the first symptoms of avian influenza are respiratory symptoms,and cases with occipital neuralgia as the first manifestation are rarely reported.CASE SUMMARY A middle-aged patient complaining of paroxysmal pain behind the ear was admitted to our hospital.The patient’s condition changed rapidly,and high fever,unexpected respiratory failure,and multiple organ failure developed rapidly.The patient was diagnosed with H7N9 avian influenza based on etiology.CONCLUSION We believe that the etiology of occipital neuralgia is complex and could be the earliest manifestation of severe diseases.The possibility of an infectious disease should be considered when occipital neuralgia is accompanied by fever.Avian influenza is one of these causative agents.
基金the National Natural Science Foundation of China(82001190)Natural Sci⁃ence Foundation of Shandong Province(ZR2021LZY016)+1 种基金Natural Science Foundation of Shandong Province(ZR2020MH348)Science and Technology Foundation of Shandong Traditional Chinese Medicine(2020Q035)。
文摘OBJECTIVE To investigate whether electroacupuncture(EA)ameliorates abnormal trigeminal neuralgia(TN)orofacial pain and anxiety-like behavior by altering synaptic plasticity in the hippocampus CA1.METHODS A mouse infraorbital nerve transection model(pTION)of neuropathic pain was established,and EA or sham EA was used to treat ipsilateral acu⁃puncture points(GV20-Baihui and ST7-Xia⁃guan).Golgi-Cox staining and transmission elec⁃tron microscopy(TEM)were administrated to observe the changes of synaptic plasticity in the hippocampus CA1.RESULTS Stable and persistent orofacial allodynia and anxiety-like behav⁃iors induced by pT-ION were related to changes in hippocampal synaptic plasticity.Golgi stain⁃ings showed a decrease in the density of dendritic spines,especially mushroom-type dendritic spines,in hippocampal CA1 neurons of pT-ION mice.TEM results showed that the density of synapses,membrane thickness of the postsynaptic density,and length of the synaptic active zone were decreased,whereas the width of the synaptic cleft was increased in pTION mice.EA attenu⁃ated pT-ION-induced orofacial allodynia and anx⁃iety-like behaviors and effectively reversed the abnormal changes in dendritic spines and syn⁃apse of the hippocampal CA1 region.CONCLU⁃SION EA modulates synaptic plasticity of hippo⁃campal CA1 neurons,and reduces abnormal oro⁃facial pain and anxiety-like behavior,providing evidence for a TN treatment strategy.
基金National Key Research and Development plan for the Modernization of Traditional Chinese Medicine (2018YFC1707700)National Key Research and Development plan for the Modernization of Traditional Chinese Medicine (2018YFC1707706)National Administration of Traditional Chinese Medicine Evidencebased Capacity Building Project (2019XZZXZJ005)
文摘OBJECTIVE To assess the effi⁃cacy and safety of acupuncture-related treat⁃ments for postherpetic neuralgia(PHN),identify the most effective acupuncture and related treat⁃ments.METHODS PubMed,Cochrane Central Register of Controlled Trials,Embase,Web of Science,and four Chinese databases,a clinical research registration platform,and grey literature were searched.We evaluated the risk of bias and quality in the included studies and per⁃formed a Bayesian multiple network meta-analysis.RESULTS We included 29 randomized controlled trials comprising 1973 patients,of which approximately 17.24%showed a high risk of bias.According to the Jadad scale,2,16,and 11 studies were high,medium,and low quality,respectively.The pairwise meta-analysis results revealed that the efficacy of all acupuncture-related treatments for pain relief related to PHN showed the difference was statistically significant com⁃pared with that of antiepileptics.The network meta-analysis results showed that pricking and cupping plus antiepileptics were the most effective,followed by electroacupuncture(EA)plus antiepileptics for pain relief in patients with PHN.EA plus antiepileptics ranked the best regarding reduced Pittsburgh Sleep Quality Index and Self-Rating Depression Scale scores in patients with PHN.No results were found regarding total response rate or quality of life among this study.Acupuncture-related treatments showed a lower incidence of adverse events than that of antiepi⁃leptics-related treatments.CONCLUSION Acu⁃puncture-related therapies may be potential treat⁃ment options for PHN and are relatively safe.Pricking and cupping plus antiepileptics are the most effective techniques for pain relief.EA plus antiepileptics is the best approach for improving insomnia and depression symptoms of PHN.
文摘Introduction: Superior femoral epiphysiolysis (SFE) is a most progressive but sometimes abrupt displacement of the femoral head relative to the superior femoral metaphysis through the cervicocerebral growth plate of the femur. The displacement of the femoral head is most often downward and backward. It is a typical pathology of the pubescent adolescent, most often overweight. It occurs on average at the age of 12 years in girls and 14 years in boys. Unstable forms with large displacements have a high risk of femoral head necrosis and chondrolysis. Although in situ fixation is the generally accepted treatment for minor SFE, the treatment of more severe cases remains controversial. When the extent of the displacement makes it impossible to pass a screw between the femoral neck and the femoral head, the only option is to reduce the displacement. This reduction must be gentle, progressive and limited to the minimum necessary for osteosynthesis. Objective: The aim of the work was to evaluate the results of the technique of progressive reduction of epiphyseal displacement by transtibial traction followed by percutaneous fixation of the femoral head by screw. Patients and Method: This was a retrospective descriptive study over a 10-years period from January 1, 2013 to December 31, 2022. It focused on the surgical treatment of unstable upper femoral epiphysiolysis with large displacement in the orthopaedic trauma department of the University Hospital of Kati. All patients operated on in our department for large displacement SFE were included in this study. Cases of secondary large displacement upper femoral epiphysiolysis and patients who had already undergone surgery on the proximal femur were excluded. Continuous progressive traction on the Boppe splint through a pin under the anterior tibial tuberosity was performed for 15 days in all patients. The hip was flexed to 45° and the knee to 35°. Fixation was performed with one or two screws. No contralateral preventive fixation was performed. Minimum follow-up was one year. Functional outcome was assessed by the Postel Merle d’Aubigné score. Anatomical outcome was assessed by the quality of reduction, the occurrence or non-occurrence of femoral head necrosis, and chondrolysis. Results: We identified nine patients with a mean age of 12.8 years and extremes of 9 and 17 years. There were three boys and six girls. Trauma was mentioned in four cases. The cause was idiopathic in five cases. Functional impotence was complete in all patients. The slippage was acute on a chronic background in all patients. The left side was affected in 7 cases and the right side in 2 cases. The patients were overweight in 7 cases. The patient’s weight was within the normal range in two cases. At final follow-up, all nine patients were asymptomatic. Anatomically, all nine patients had a femoral head free of avascular necrosis. In eight patients, the posterior tilt was absent, identical to that obtained after the traction period. Only one patient had a moderate posterior tilt with a neck uncovering of less than 25%. Functionally, the PMA score was very good in eight cases and good in one case. Conclusion: This study shows that the treatment of acute and unstable forms of upper femoral epiphysiolysis by progressive reduction with transtibial traction can lead to satisfactory results. Reduction in large displacement forms should be gentle, progressive and limited to the minimum necessary for osteosynthesis. Magnetic resonance imaging examination is an essential and indispensable prognostic element. Indications for preventive fixation should be selectively reserved for specific cases.
文摘BACKGROUND Postherpetic neuralgia(PHN)is a typical neuropathic pain condition that appears in the lesioned skin regions following the healing of shingles.The pain condition tends to persist,which is often accompanied by negative emotions(e.g.,anxiety and depression)and substantially reduces the quality of life.In addition to analgesia(e.g.,pregabalin and gabapentin),nerve radiofrequency technology is an effective treatment for intractable PHN.However,there is still a significant portion of patients who do not benefit from this treatment.As a non-invasive form of brain stimulation,repetitive transcranial magnetic stimulation(rTMS)targeting the motor cortex is able to reduce neuropathic pain with grade A evidence.CASE SUMMARY Here we report two cases in which motor cortex rTMS was used to treat intractable PHN that did not respond to initial drug and radiofrequency therapies.Moreover,we specifically investigated rTMS efficacy at 3 mo following treatment.CONCLUSION Motor cortex rTMS can treat intractable PHN that did not respond to initial drug and radiofrequency therapies.
文摘BACKGROUND Femoral trochlear dysplasia(FTD)is an important risk factor for patellar instability.Dejour classification is widely used at present and relies on standard lateral X-rays,which are not common in clinical work.Therefore,magnetic resonance imaging(MRI)has become the first choice for the diagnosis of FTD.However,manually measuring is tedious,time-consuming,and easily produces great variability.AIM To use artificial intelligence(AI)to assist diagnosing FTD on MRI images and to evaluate its reliability.METHODS We searched 464 knee MRI cases between January 2019 and December 2020,including FTD(n=202)and normal trochlea(n=252).This paper adopts the heatmap regression method to detect the key points network.For the final evaluation,several metrics(accuracy,sensitivity,specificity,etc.)were calculated.RESULTS The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of the AI model ranged from 0.74-0.96.All values were superior to junior doctors and intermediate doctors,similar to senior doctors.However,diagnostic time was much lower than that of junior doctors and intermediate doctors.CONCLUSION The diagnosis of FTD on knee MRI can be aided by AI and can be achieved with a high level of accuracy.
基金Supported by National Natural Science Foundation of China,No.81891004Tianjin Natural Science Foundation of China,No.21JCQNJC01140.
文摘BACKGROUND Intractable postherpetic neuralgia(PHN)can be difficult to manage even with aggressive multimodal therapies.Patients who experience uncontrolled refractory cranial PHN despite conservative treatment may benefit from an intrathecal drug delivery system(IDDS).For craniofacial neuropathic pain,the traditional approach has been to place the intrathecal catheter tip below the level of the cranial nerve root entry zones,which may lead to insufficient analgesia.CASE SUMMARY We describe a 69-year-old man with a 1-year history of PHN after developing a vesicular rash in the ophthalmic division of cranial nerve V(trigeminal nerve)distribution.The pain was rated 7-8 at rest and 9-10 at breakthrough pain(BTP)on a numeric rating scale.Despite receiving aggressive multimodal therapies including large doses of oral analgesics(gabapentin 150 mg q12 h,oxycodone 5 mg/acetaminophen 325 mg q6 h,and lidocaine 5%patch 700 mg q12 h)and sphenopalatine ganglion block,there was no relief of pain.Subsequently,the patient elected to have an implantable IDDS with the catheter tip placed at the interpeduncular cistern.The frequency of BTP episodes decreased.The patient’s continuous daily dose was adjusted to 0.032 mg/d after 3 mo of follow-up and stopped 5 mo later.He did not report pain or other discomfort at outpatient follow-up 6 mo and 1 year after stopping intracisternal hydromorphone.CONCLUSION The use of interpeduncular cistern intrathecal infusion with low-dose hydromorphone by IDDS may be effective for severe craniofacial PHN.
文摘Objective: To investigate the effect of Yang-warming and Kidney-tonifying Prescription (YKP) on the treatment of steroid-induced avascular necrosis of the femoral head (SANFH) in rabbits. And to further explore whether its therapeutic mechanism is related to the expression of HIF-1α and VEGF (angiogenic factors), BMP2 and Osterix (osteogenic factor), CD31 (type H vascular marker) and MMP13 (bone destruction-related factor). Methods: Twenty-seven healthy male New Zealand white rabbits were divided into a normal group, model group, traditional Chinese medcine (TCM) group (clinical equivalent dose group of YKP), miR-130a inhibitor group and TCM + inhibitor group. The SANFH model was established by combining horse serum with methylprednisolone. After the model is successfully established, TCM group was given 6.44 g/kg·d YKP by gavage, and the miR-130a gene inhibitor group was intraperitoneally injected with 25 mg/kg miR-130a inhibitor, locked nucleic acid (LNA)-anti-miR-130a. TCM + inhibitor group was treated with YKP intragastrically and miR-130a inhibitor intraperitoneally. The rabbits in the normal group and the model group were intragastrically administered with normal saline 10 ml/d. Once a day for 4 weeks. The avascular necrosis was detected by HE staining. The contents of HIF-1α, VEGF, BMP2 and Osterix in rabbit tissues were detected by qRT-PCR kit, and the expression of CD31 and MMP13 was detected by immunofluorescence staining. Results: In the normal group, the surface of the cartilage layer of the femoral head was smooth, the bone trabeculae were intact and densely arranged, the cells of each layer were neatly arranged, the morphology of the bone cells, the chondrocytes and the adipocytes were normal. In the model group, cartilage surfaces of the femoral head showed exfoliative cracks. The bone trabecular structure was loose and incomplete, chondrocytes, osteoblasts and bone marrow cells were significantly reduced, and the number of empty bone traps was significantly increased. In the TCM-treated group, more chondrocytes, thicker cartilage layer, and more regular bone trabeculae were detected as compared to model rabbits. In contrast, the cartilage layer was thinner, the destruction and fracture of bone trabeculae was more serious, chondrocytes and osteocytes were decreased as compared to model group. The expression of HIF-1α, VEGF, BMP2, and Osterix in the model group decreased significantly as compared to the normal group (P Conclusion: YKP can regulate the expression of angiogenic-related factors (VEGF and HIF-α), osteogenic-related factors (BMP2 and Osterix), and H-type vascular marker CD31, resulting in increased expressions of VEGF, HIF-α, BMP2, and Osterix, which promote intra-femoral head revascularization. Meanwhile, YKP decreased the expression of bone-destruction-related factor MMP13, thus enhancing the ability of bone tissue to repair itself. Regulation of these molecules’ expression may be one of the mechanisms of YKP in the treatment of hormonal femoral head necrosis.
文摘Anterior cruciate ligament(ACL)injury is one of the most common types of sports injuries.People’s need to participate in sports and desire for a high quality of life promotes the continuous development of ACL reconstruction technology.Arthroscopic ACL reconstruction has been recognized as an effective method for the treatment of ACL injuries.This review analyses and summarizes the advantages and limitations of each surgical procedure for arthroscopic ACL reconstruction reported in the relevant literature so as to promote the future development of more relevant techniques.
文摘BACKGROUND The ExeterTM Universal cemented femoral component is widely used for total hip replacement surgery.Although there have been few reports of femoral component fracture,removal of a broken femoral stem can be a challenging procedure.CASE SUMMARY A 54-year-old man with a Dorr A femur sustained a refracture of a primary ExeterTM stem,two years after receiving a revision using a cement-within-cement technique(CWC)through an extended trochanteric osteotomy(ETO).The technical problems related to the CWC technique and the ETO played a major role in the stem fatigue refracture.We performed revision surgery and removed the distal cement using a cortical femoral window technique,followed by reimplantation with an uncemented,modular,distally-fixed uncemented stem.The patient experienced an uneventful postoperative recovery.CONCLUSION Re-fracture of a modern femoral ExeterTM stem is a rare event,but technical complications related to revision surgery can lead to this outcome.The cortical window osteotomy technique can facilitate the removal of a broken stem and cement,allowing for prosthetic reimplantation under direct vision and avoiding ETO-related complications.
