Objective To analyze the correlation between postoperative complications and combined deflection angle classification adduction type (CDAC-ADT) of femoral neck fractures after cannulated screw internal fixation. MethodsThe clinical data of 121 patients with CDAC-ADT femoral neck fracture admitted between January 2018 and December 2021 and met the selected criteria were retrospectively analyzed. There were 69 males and 52 females, the age ranged from 19 to 79 years (mean, 48.1 years). The causes of injury included 52 cases of traffic accident, 24 cases of falling from height, and 45 cases of fall. The time from injury to operation ranged from 2 to 12 days, with an average of 6.0 days. Among them, there were 18 cases of CDAC-ADT type Ⅰ, 46 cases of type Ⅱ, and 57 cases of type Ⅲ; 6 cases of Garden type Ⅱ, 103 cases of type Ⅲ, and 12 cases of type Ⅳ; and according to the location of the fracture line, there were 26 cases of subcapitate type, 88 cases of transcervical type, and 7 cases of basal type. All patients were treated with cannulated screw internal fixation. The occurrence of complications (including internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head) was recorded, and the correlation between complications and CDAC-ADT typing, Garden typing, and fracture line location were analyzed. Results The patients were followed up 8-44 months, with a mean of 24.9 months. There were 10 cases of internal fixation failure, 7 cases of fracture nonunion, and 30 cases of osteonecrosis of the femoral head after operation. Correlation analysis showed that patients’ CDAC-ADT typing was significantly correlated with the overall incidence of complication and the incidence of internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head (P<0.05), and the Pearson coefficient of contingency were 0.435, 0.251, 0.254, and 0.241, respectively. Garden typing did not correlate with the overall incidence of complication and the incidence of internal fixation failure and fracture nonunion (P>0.05), but correlated with the incidence of osteonecrosis of the femoral head (P<0.05), and the Pearson coefficient of contingency was 0.251. Fracture line position typing had no correlation with the overall incidence of complication and the incidence of internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head (P>0.05). Conclusion CDAC-ADT typing has obvious correlation with postoperative complications of femoral neck fracture and can be used to predict complications of femoral neck fracture.
Objective To investigate the features of optic disc formation and retinal nerve fiber layer(RNFL) changes in primary open-angle glaucoma with myopia (M-POAG). Methods On 63 eyes of 38 patients with M-POAG were imaged of the fundus,and were evaluated with the microcomputer image analyser,and were compared with the simple POAG (S-POAG) eyes. Results Variant features of the optic disc and RNFL atrophy were found in this M-POAG eyes.The shapes of the optic disc were revealed to be vertically or horizontally oval,obliquely inserted and irregular,the color of the most of optic disc was pallor.The pattern of glaucomatous cupping was saucer-like (28.6%),vertical (25.4%),oblique (23.8%),pot-like (9.5%),and focally or concentrically cupped.The quotient of the neuroretinal rim area and horizontal C/D ratio were significantly lower than those in S-POAG eyes (Plt;0.05,Plt;0.001).The focal point of the optic disc excavtions tended to be inferior.Most of the incidence in the focal atrophy of RNFL was located inferiorly,and the diffuse atrophy of RNFL was correlated positively with middle or late high-myopia POAG eyes (P＜0.005). Conclusion The variant features of the optic discs,glaucomatous cupping and RNFL atrophy formation in M-POAG eyes found in this series might be helpful in clinical diagnosis. (Chin J Ocul Fundus Dis,2000,16:81-84)
ObjectiveTo evaluate the influence of the shell angle of cervical artificial disc on long-term effectiveness of cervical artificial disc replacement (CADR).MethodsThe clinical data of 71 patients who were treated with single-level CADR with Bryan prosthesis between December 2003 and December 2007 and followed up more than 10 years, were retrospectively analyzed. There were 44 males and 27 females with an age of 26-69 years (mean, 45.9 years). According to the shell angle of the cervical artificial disc which was measured on the postoperative lateral X-ray film, the patients were divided into kyphotic group (shell angle was negative) and non-kyphotic group. The following evaluation indexes before operation and at last follow-up were compared between 2 groups. Radiographic indexes included the range of motion (ROM) of cervical spine, the ROM of operated level, Cobb angle of operated level (the negative value indicated that the segmental kyphosis occurred at operated level), paravertebral ossification (PO) grades (grades 3 and 4 were high grade PO). Clinical indexes included Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), and overall effectiveness evaluation (Odom criteria).ResultsThere were 24 patients in kyphotic group and 47 patients in non-kyphotic group. There was no significant difference in baseline data including gender, age, and operated level between 2 groups (P>0.05). All the patients in 2 groups were followed up 121-165 months (mean, 128 months). There was no significant difference in preoperative ROM of cervical spine and ROM of operated level between 2 groups (P>0.05); but the preoperative Cobb angle of operated level in kyphosis group was significantly lower than that in non-kyphotic group (t=2.636, P=0.013). There was no significant difference in ROM of cervical spine at last follow-up between 2 groups (t=1.393, P=0.168), however, the ROM and the Cobb angle of operated level in kyphotic group were significantly lower than those in non-kyphotic group (P<0.05). According to the Cobb angle of operated level at last follow-up, there were 9 patients (37.5%) with segmental kyphosis in kyphotic group and 7 patients (14.9%) in non-kyphotic group, showing significant difference (χ2=4.651, P=0.031). There was a significant difference in PO grades between 2 groups (Z=2.894, P=0.004) at last follow-up. In kyphotic group, there were 10 patients (41.7%) with low grade PO and 14 patients (58.3%) with high grade PO; and in non-kyphosis group, there were 36 patients (76.6%) with low grade PO and 11 patients (23.4%) with high grade PO. There was no significant difference in JOA scores and NDI before operation and at last follow-up, and the JOA improvement rate, NDI decline, and Odom criteria score at last follow-up between 2 groups (P>0.05).ConclusionThe shell angle of cervical artificial disc may lead to a decrease in the postoperative segmental ROM, and an increased occurrence of segmental kyphosis and high incidence of PO.
The method of directly using speed information and angle information to drive attractors model of grid cells to encode environment has poor anti-interference ability and is not bionic. In response to the problem, this paper proposes a grid field calculation model based on perceived speed and perceived angle. The model has the following characteristics. Firstly, visual stream is decoded to obtain visual speed, and speed cell is modeled and decoded to obtain body speed. Visual speed and body speed are integrated to obtain perceived speed information. Secondly, a one-dimensional circularly connected cell model with excitatory connection is used to simulate the firing mechanism of head direction cells, so that the robot obtains current perception angle information in a biomimetic manner. Finally, the two kinds of perceptual information of speed and angle are combined to realize the driving of grid cell attractors model. The proposed model was experimentally verified. The results showed that this model could realize periodic hexagonal firing field mode of grid cells and precise path integration function. The proposed algorithm may provide a foundation for the research on construction method of robot cognitive map based on hippocampal cognition mechanism.
Objective To compare the difference in the inclination and anteversion angles of the acetabular cup measured by intraoperative robot-assisted total hip arthroplasty (THA) and postoperative X-ray films and CT imaging. MethodsThe clinical data of 54 patients (54 hips) who underwent robot-assisted THA between May 2020 and December 2020 were retrospectively analyzed. Among them, there were 26 males (26 hips) and 28 females (28 hips), with an average age of 58.4 years (range, 39-71 years). The body mass index was 19.2-29.3 kg/m2, with an average of 25.2 kg/m2. All the patients had their first THA, including 31 cases of osteonecrosis of the femoral head, 12 cases of hip arthritis, 8 cases of femoral neck fracture, and 3 cases of developmental dysplasia of the hip. The anteversion and inclination angles of the acetabular cup were obtained through the surgical data in the robot host system. All patients underwent X-ray and CT scan examination within 2-7 days after operation to obtain the postoperative anteversion and inclination angles of the acetabular cup. According to the concept of “Lewinnek safe zone”, the proportion of acetabular in the safe zone intra- and post-operation were compared. ResultsThe operation time was 57.8-89.2 minutes, with an average of 68.3 minutes; the intraoperative blood loss was 125.0-450.0 mL, with an average of 204.8 mL. No adverse events such as dislocation of hip joint and infection occurred during hospitalization. The anteversion angle of acetabular cup was (40.8±0.6)° during operation and (41.2±2.8)° after operation, with no significant difference (t=1.026, P=0.307). The anteversion angle of acetabular cup measured during operation was (17.6±1.4)°, which was significantly smaller than that measured after operation (23.4±3.8)°(t=10.520, P=0.000). According to “Lewinnek safe zone”, 54 hips (100%) were in the safety zone during operation, and 16 hips were out of the safety zone, 38 hips were in the safty zone after operation, the ratio of the hips in the safty zone was 70.4%, showing a significant difference (χ2=18.783, P=0.000). ConclusionRobot-assisted THA can obtain accurate placement of the acetabular cup, but there is a large deviation between the anteversion angle of the acetabular cup in the lateral position during operation and the supine position after operation. Further study is needed to define the intraoperative placement position of the acetabular cup.
ObjectiveTo introduce a new occipitocervical angle parameter, occipito-odontoid angle (O-Da), for predicting dysphagia after occipitocervical fusion (OCF) in patients with C2, 3 Klippel-Feil syndrome (KFS) and analyze its effectiveness. Methods A total of 119 patients met selective criteria between April 2010 and November 2019 were retrospectively included as the study subjects. There were 56 males and 63 females. The age ranged from 14 to 76 years, with a median age of 51 years. There were 44 cases of basilar invagination and 75 cases of atlantoaxial subluxation. Forty patients were combined with C2, 3 KFS. Seven patients underwent anterior decompression combined with posterior OCF and 112 patients underwent posterior OCF. The fixed segments were O-C2 in 36 cases, O-C3 in 51 cases, O-C4 in 25 cases, and O-C5 in 7 cases. All patients were followed up 21-136 months, with a median time of 79 months. The lateral cervical X-ray films before operation and at last follow-up were used to measure the occipital to C2 angle (O-C2a), the occipital and external acoustic meatus to axis angle (O-EAa), the occipital protuberance to axial angle (Oc-Axa), the O-Da, and the narrowest oropharyngeal airway space (nPAS). The differences of the above parameters between the last follow-up and the preoperative values were calculated (represented as dO-C2a, dO-EAa, dOc-Axa, dO-Da, and dnPAS). Patients were divided into two groups according to whether they suffered dysphagia after operation, and the differences in clinical data and radiographic parameters were compared between the two groups. The correlation between occipitocervical angle parameters and nPAS in 40 patients with C2, 3 KFS was analyzed respectively. In addition, sensitivity and specificity analyses were used to assess the effectiveness of dO-Da≤−5° for the prediction of postoperative dysphagia. ResultsThirty-one patients (26.1%) suffered dysphagia after OCF (dysphagia group), including 10 patients with C2, 3 KFS; no dysphagia occurred in 88 patients (non-dysphagia group). There was no significant difference in age, follow-up time, fixed segment, proportion of patients with rheumatoid arthritis, proportion of patients with atlantoaxial subluxation, and proportion of patients with C2, 3 KFS between the two groups (P>0.05). The proportion of female patients was significantly higher in dysphagia group than in non-dysphagia group (χ2=7.600, P=0.006). The difference in preoperative O-C2a between the two groups was significant (t=2.528, P=0.014). No significant differences were observed in preoperative O-EAa, Oc-Axa, O-Da, and nPAS (P>0.05). There was no significant difference in dO-C2a, dO-EAa, dOc-Axa, dO-Da, and dnPAS between the two groups (P>0.05). The dO-C2a, dO-EAa, dOc-Axa, and dO-Da were positively correlated with dnPAS in 40 patients with C2, 3 KFS (r=0.604, P<0.001; r=0.649, P<0.001; r=0.615, P<0.001; r=0.672, P<0.001). Taking dO-Da≤−5° as the standard, the sensitivity and specificity of dO-Da to predict postoperative dysphagia in patients with C2, 3 KFS were 80.0% (8/10) and 93.3% (28/30), respectively. ConclusionThe dO-Da is a reliable indicator for predicting dysphagia after OCF in patients with C2, 3 KFS.
Objective To investigate the cl inical directive significance of three-dimensional reconstruction of CT in treating mandibular angle hypertrophy. Methods Between March 2009 and January 2011, 18 patients with mandibular angle hypertrophy were treated using the three-dimensional reconstruction technology of CT. All patients were female, aged20-36 years with an average of 25 years. Eighteen patients included: 14 single mandibular angle hypertrophy, 3 mandibular angle hypertrophy with masseter hypertrophy, and 1 mandibular angle hypertrophy with bilateral asymmetry; 6 cases of ptosis of mandibular angle, 9 cases of prominent mandibular angle, and 3 cases of introversive mandibular angle. According to the types of mandibular angle hypertrophy, the surgical methods could be correctly chosen. The procedure was planned and simulated; the osteotomy l ine was marked and the osteotomy was measured on the workstations of three-dimensional reconstruction. Results No fracture of mandible occurred in the operation. Facial nerve temporary attack occurred in 1 case and recovered at 3 months after operation. All patients were followed up 6-12 months (mean, 7.6 months). After 6 months of operation, the effectiveness was satisfactory in 15 cases, basically satisfactory in 2 cases, and unsatisfactory in 1 case (bilateral asymmetry). Conclusion Based on three-dimensional reconstruction technology of CT, surgical design performed on the model will promote the accuracy of operation. Basically symmetrical appearances can be achieved with satisfactory results.
ObjectiveTo compare the effectiveness of the femoral neck system (FNS) and inverted triangle cannulated screws (ITCS) for the treatment of Pauwels type Ⅲ femoral neck fractures.MethodsThe clinical data of 59 patients with Pauwels type Ⅲ femoral neck fractures treated between May 2019 and November 2020 were retrospectively analysed. The patients were divided into FNS group (28 cases) and ITCS group (31 cases) according to the different internal fixation. There was no significant difference in gender, age, affected side, body mass index, cause of injury, smoking history, alcohol abuse history, Pauwels angle, Garden classification, AO/Orthopaedic Trauma Association (AO/OTA) classification, and time from injury to operation between the two groups (P>0.05). The operation time, incision length, intraoperative blood loss, extra assisted reduction procedures (Kirschner wire prying reduction or open reduction), hospitalization stay, and early complications were recorded and compared between the two groups. Garden index and Haidukewych score were used to evaluate fracture reduction. Fracture healing time, lateral thigh irritation, time of partial or total weight-bearing postoperatively, shortening length and degree of femoral neck, change of caput-collum-diaphysis (CCD) angle (the difference of CCD angle between immediate after operation and last follow-up), incidence of osteonecrosis of femoral head and revision surgery were recorded and compared between the two groups. Hip joint function were evaluated by Harris score.ResultsThe operation time of FNS group was significantly shorter than ITCS group, and the incision length was significantly longer than ITCS group (P<0.05). There was no significant difference in intraoperative blood loss, assisted reduction, Garden index, Haidukewych score, and hospitalization stay between the two groups (P>0.05). All the incisions healed by first intention. There were 2 deep vein thrombosis in the FNS group and 1 pulmonary infection and 1 deep vein thrombosis in the ITCS group. No significant difference was found in the incidence of early postoperative complications (7.1% vs. 6.5%) between the two groups (P=1.000). Patients in both groups were followed up 3-14 months, and there was no significant difference in follow-up time between the two groups (t=–0.553, P=0.582). The fracture healing time, Harris score, and the partial weight-bearing time after operation of the FNS group were significantly better than those of the ITCS group (P<0.05). However, there was no significant difference in total weight-bearing time between the two groups (Z=–1.298, P=0.194). No lateral thigh irritation was found in the FNS group, while 10 patients in the ITCS group had lateral thigh irritation, and the incidence between the two groups (0 vs. 32.3%) was significant (P=0.001). At last follow-up, the shortening length and degree of femoral neck and the change of CCD angle in FNS group were significantly less than those in ITCS group (P<0.05). There was no patient with osteonecrosis of femoral head or reoperation in the FNS group, while 4 patients in the ITCS group underwent reoperation (including 2 cases of osteonecrosis of the femoral head). However, the incidences (0 vs. 6.5%; 0 vs. 12.9%) between the two groups were not significant (P=0.493; P=0.114).ConclusionUsing FNS to treat Pauwels type Ⅲ femoral neck fracture is simple as well as able to reduce the shortening of the femoral neck and the change of the CCD angle. Also, FNS is conducive to the recovery of hip joint function, which should be considered as a new choice for the treatment of young femoral neck fracture patients.
ObjectiveTo compare the lamina cribrosa parameters between primary open angle glaucoma (POAG) and chronic primary angle closure glaucoma (CPACG) eyes. MethodsA total of 73 POAG eyes (73 subjects), 64 CPACG eyes (64 subjects), and 40 normal control eyes (40 subjects) with matched ages were included in this cross-sectional observational study. No significant difference was found in sex (χ2=2.07) and age (F=0.38) among three groups (P > 0.05). The intraocular pressure, average retinal nerve fiber layer (RNFL) thickness and average visual field defect were not significantly different between POAG and CPACG patients (F=15.67, 21.15, 44.40, 27.99; P < 0.05). All subjects underwent spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging (EDI). The optic nerve head was scanned radially at the angle of 20; six high resolution B-scan images were obtained from each eye. The center and para-center lamina cribrosa thickness (LCT) and anterior lamina cribrosa surface depth (ALCSD) were measured in each image. The mean LCT and ALCSD were recorded as the average of the LCT and ALCSD of the 6 images and compared among POAG, CPACG and normal control eyes. ResultsThe average LCT of normal control eyes were (211.48±12.07) μm, while those of the POAG eyes were (145.43±34.33) μm, CPACG eyes were (156.79±33.66) μm. The mean LCT of the POAG and CPACG eyes were thinner than those of the control eyes (t=-11.76, -9.88; P < 0.01). All LCT of the POAG eyes were significantly thinner than those of the CPACG eyes (t=-1.96, P=0.03).The average ALCSD of normal control eyes were (390.73±84.40) μm, while those of the POAG eyes were (558.51±176.66) μm, CPACG eyes were (539.39±177.30) μm, respectively. The average ALCSD of the POAG and CPACG eyes were deeper than those of the control eyes (t=5.65, 4.96; P < 0.01). But no significantly different ALCSD was shown between POAG and CPACG eyes (t=0.63, P=0.49). ConclusionsPOAG and CPACG eyes have thinner LCT and deeper ALCSD than normal eyes. POAG eyes have thinner LCT than CPACG eyes when their visual field defect and damage of RNFL were in the same degree.
Objective To investigate the synergistic interaction between the deltoid muscle and the rotator cuff muscle group in patients with rotator cuff tears (RCT), as well as the impact of the critical shoulder angle (CSA) on deltoid muscle strength. Methods A retrospective analysis was conducted on clinical data from 42 RCT patients who met the selection criteria and were treated between March 2022 and March 2023. There were 13 males and 29 females, with an age range of 42-77 years (mean, 60.5 years). Preoperative visual analogue scale (VAS) score was 6.0±1.6. CSA measurements were obtained from standard anteroposterior X-ray films before operation, and patients were divided into two groups based on CSA measurements: CSA>35° group (group A) and CSA≤35° group (group B). Handheld dynamometry was used to measure the muscle strength of various muscle group in the shoulder (including the supraspinatus, infraspinatus, subscapularis, and anterior, middle, and posterior bundles of the deltoid). The muscle strength of the unaffected side was compared to the affected side, and muscle imbalance indices were calculated. Muscle imbalance indices between male and female patients, dominant and non-dominant sides, and groups A and B were compared. Pearson correlation analysis was used to examine the relationship between muscle imbalance indices and CSA as well as VAS scores. Results Muscle strength in all muscle groups on the affected side was significantly lower than on the unaffected side (P<0.05). The muscle imbalance indices for the supraspinatus, subscapularis, infraspinatus, and anterior, middle, and posterior bundles of the deltoid were 14.8%±24.4%, 5.9%±9.7%, 7.2% (0, 9.1%), 17.2% (5.9%, 26.9%), 8.3%±21.3%, and 10.2% (2.8%, 15.4%), respectively. The muscle imbalance indices of the anterior bundle of the deltoid, supraspinatus, and infraspinatus were significantly lower in male patients compared to female patients (P<0.05); however, there was no significant difference in muscle imbalance indices among other muscle groups between male and female patients or between the dominant and non-dominant sides (P>0.05). There was a positive correlation between the muscle imbalance indices of infraspinatus and VAS score (P<0.05), and a positive correlation between CSA and the muscle imbalance indices of middle bundle of deltoid (P<0.05). There was no correlation between the muscle imbalance indices of other muscle groups and VAS score or CSA (P>0.05). Preoperative CSA ranged from 17.6° to 39.4°, with a mean of 31.1°. There were 9 cases in group A and 33 cases in group B. The muscle imbalance indices of the anterior bundle of the deltoid was significantly lower in group A compared to group B (P<0.05), while there was no significant difference in muscle imbalance indices among other muscle groups between group A and group B (P>0.05). ConclusionPatients with RCT have a phenomenon of deltoid muscle strength reduction, which is more pronounced in the population with a larger CSA.