BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are e...BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are exceedingly infrequent.Notwithstanding,patients with copious comorbidities should be carefully monitored for potential vascular injury.CASE SUMMARY This case report presents the management of a 75-year-old male patient with a history of diabetes mellitus and arterial hypertension who was admitted to the emergency room with a superior pubic ramus fracture.The patient experienced a significant drop in hematocrit and hemoglobin levels post-admission,necessi-tating urgent intervention.A computed tomography angiography revealed active bleeding,leading to the embolization of the medial femoral branch.The patient was stabilized hemodynamically and was discharged after 15 days,with recom-mendations for home-based follow-up care.CONCLUSION This report denotes the various challenges and strategies in managing simple fractures that are treated conservatively,but need prompt monitoring for occult vascular injuries that can be fatal.展开更多
Objective To compare the clinical outcomes of retrograde pubic ramus intramedullary nail(RPRIN)and percutaneous cannulated screw(PCS)in the treatment of anterior pelvic ring fractures(APRFs).Methods This retrospective...Objective To compare the clinical outcomes of retrograde pubic ramus intramedullary nail(RPRIN)and percutaneous cannulated screw(PCS)in the treatment of anterior pelvic ring fractures(APRFs).Methods This retrospective cohort study included 45 patients with APRFs treated between February 2019 and October 2022 in our trauma center.Patients were divided into two groups based on the surgical method:20 received RPRIN fixation,and 25 received PCS fixation.Key variables including operation time,fluoroscopic time,blood loss,and postoperative complications were analyzed.Fracture reduction quality was assessed using the Matta score system,and pelvic functional recovery was evaluated using the Majeed score system at the final follow-up.Quantitative variables were compared using the independent sample t test,while categorical variables were analyzed using Chisquare and Fisher’s exact tests.Results The RPRIN group had significantly shorter operation time(36.3±5.6 min vs.49.5±6.9 min,P<0.01),fluoroscopic time(32.0±2.8 s vs.48.4±3.6 s,P<0.01),and less blood loss(20.4±7.6 mL vs.34.0±5.7 mL,P<0.01)than the PCS group.Fracture reduction quality(Matta outcome)and pelvic functional recovery(Majeed outcome)were comparable between the two groups(P>0.05).No significant complications were reported in either group.Conclusions Both RPRIN and PCS are effective for treating APRFs.However,RPRIN offers distinct advantages by reducing operation time,fluoroscopic time,and blood loss,making it a more efficient and less invasive option.Further multicenter studies and biomechanical analyses are warranted to confirm these findings.展开更多
This article reviews the relationship between the spinal dorsal ramus system and low back pain, including the anatomy, clinical findings, pathogenesis and treatment of low back pain mediated by spinal dorsal ramus and...This article reviews the relationship between the spinal dorsal ramus system and low back pain, including the anatomy, clinical findings, pathogenesis and treatment of low back pain mediated by spinal dorsal ramus and zygapophysial (facet) joint syndrome. Each spinal dorsal ramus arises from the spinal nerve and then divides into a medial and lateral branch. The medial branch supplies the tissues from the midline to the zygapophysial joint line and innervates two to three adjacent zygapophysial joints and their related soft tissues. The lateral branch innervates the tissues lateral to the zygapophysial joint line. The clinical pain presentations follow these anatomic distributions, which can be used for localizing the involved dorsal ramus. The diagnosis can be confirmed by performing a single dorsal ramus block that results in relief of pain and muscle spasm. Etiologically, any factor that stimulates the spinal dorsal ramus can cause low back pain, which is distinct from zygapophysial joint syndrome. Clinically, L1 and L2 are the most common sites of dorsal rami involvement. Treatment includes spinal dorsal ramus injection therapy and percutaneous neurotomy. Summarily, irritation of the spinal dorsal ramus system is a potential source of low back pain. Based on the anatomy and clinical presentation, the involved spinal dorsal ramus can be localized and treated.展开更多
BACKGROUND Avulsion fracture of the ischial tuberosity is a relatively clinically rare type of trauma that is mainly incurred by adolescents during competitive sports activities.According to previous literature,the mo...BACKGROUND Avulsion fracture of the ischial tuberosity is a relatively clinically rare type of trauma that is mainly incurred by adolescents during competitive sports activities.According to previous literature,the most commonly involved sports are soccer,sprinting,and gymnastics,in descending order.Dance-induced avulsion fracture of the ischial tuberosity and ischial ramus is extremely clinically rare.CASE SUMMARY A case of a neglected avulsion fracture of the ischial tuberosity and ischial ramus was diagnosed in a young female dancer who complained of pain and restricted movement of her right hip.She stated that she had suffered the injury while performing a split leap during a dance performance 9 mo prior.Eventually,she underwent surgery and obtained satisfactory treatment results.CONCLUSION Early diagnosis of these fractures is important to ensuring early proper treatment towards a quicker recovery.For old fractures with nonunion and chronic buttock pain,surgery is a preferred therapeutic choice with good treatment outcomes.展开更多
Aim:To present a simple technical modification of a medial osteotomy cut which prevents its misdirection and overcomes various anatomical variations as well as technical problems.Methods:The medial osteotomy cut is mo...Aim:To present a simple technical modification of a medial osteotomy cut which prevents its misdirection and overcomes various anatomical variations as well as technical problems.Methods:The medial osteotomy cut is modified in the posterior half at an angle of 15°-20°following novel landmarks.Results:The proposed cut exclusively directs the splitting forces downwards to create a favorable lingual fracture,preventing the possibility of an upwards split which would cause a coronoid or condylar fracture.Conclusion:This modification has proven to be successful to date without encountering the complications of a bad split or nerve damage.展开更多
目的:探究双侧下颌支矢状劈开截骨术(BSSRO)+颏成型术对偏颌畸形患者面下1/3软硬组织的影响及其变化趋势,并探讨软硬组织变化量间的相关性。方法:研究对象为31例接受BSSRO+颏成型术的偏颌畸形患者,分为轻度偏斜(n=17)和重度偏斜(n=14)...目的:探究双侧下颌支矢状劈开截骨术(BSSRO)+颏成型术对偏颌畸形患者面下1/3软硬组织的影响及其变化趋势,并探讨软硬组织变化量间的相关性。方法:研究对象为31例接受BSSRO+颏成型术的偏颌畸形患者,分为轻度偏斜(n=17)和重度偏斜(n=14)。术前、术后3个月和术后6个月分别进行多维度影像学评估。采用Mimics Medical 21.0重建口腔颌面锥形束CT(CBCT)数据,并利用3-matic Medical 13.0软件测量硬组织标志点或软组织宽度等关键指标。使用SPSS 23.0对数据进行统计学分析,包括均值、标准差、相关性分析及显著性检验。结果:与术前相比,轻度偏斜患者术后双侧颏孔宽度、双侧下颌角宽度、颏下点与颏孔不对称系数差异有统计学意义(P<0.05),术后3个月偏侧口角宽度、术后6个月对侧口角宽度差异有统计学意义(P<0.05);重度偏斜患者术后偏侧口角宽度、双侧颏孔宽度、颏下点与颏孔不对称系数差异统计学意义(P<0.05),术后3个月对侧口角宽度、对侧Go-Go’及术后6个月下颌角点不对称系数差异有统计学意义(P<0.05)。此外,从术前到术后6个月,轻度和重度偏斜患者面下1/3多个软硬组织的变化量之间存在显著相关关系(P<0.05),且两组的相关性表现具有差异(P<0.05)。结论:BSSRO+颏成型术可显著改善偏颌畸形患者面部对称性,且术前至术后6个月患者面下1/3部分软硬组织的变化量之间存在相关性。展开更多
文摘BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are exceedingly infrequent.Notwithstanding,patients with copious comorbidities should be carefully monitored for potential vascular injury.CASE SUMMARY This case report presents the management of a 75-year-old male patient with a history of diabetes mellitus and arterial hypertension who was admitted to the emergency room with a superior pubic ramus fracture.The patient experienced a significant drop in hematocrit and hemoglobin levels post-admission,necessi-tating urgent intervention.A computed tomography angiography revealed active bleeding,leading to the embolization of the medial femoral branch.The patient was stabilized hemodynamically and was discharged after 15 days,with recom-mendations for home-based follow-up care.CONCLUSION This report denotes the various challenges and strategies in managing simple fractures that are treated conservatively,but need prompt monitoring for occult vascular injuries that can be fatal.
基金supported by Clinical Application-oriented Medical Innovation Foundation from National Clinical Research Center for Orthopedics,Sports Medicine&Rehabilitation and Jiangsu China-Israel Industrial Technical Research Institute Foundation(No.2021-NCRC-CXJJ-ZH-24)National Key R&D Plan of the 14th Five-Year Plan(No.2022YFC2504303).
文摘Objective To compare the clinical outcomes of retrograde pubic ramus intramedullary nail(RPRIN)and percutaneous cannulated screw(PCS)in the treatment of anterior pelvic ring fractures(APRFs).Methods This retrospective cohort study included 45 patients with APRFs treated between February 2019 and October 2022 in our trauma center.Patients were divided into two groups based on the surgical method:20 received RPRIN fixation,and 25 received PCS fixation.Key variables including operation time,fluoroscopic time,blood loss,and postoperative complications were analyzed.Fracture reduction quality was assessed using the Matta score system,and pelvic functional recovery was evaluated using the Majeed score system at the final follow-up.Quantitative variables were compared using the independent sample t test,while categorical variables were analyzed using Chisquare and Fisher’s exact tests.Results The RPRIN group had significantly shorter operation time(36.3±5.6 min vs.49.5±6.9 min,P<0.01),fluoroscopic time(32.0±2.8 s vs.48.4±3.6 s,P<0.01),and less blood loss(20.4±7.6 mL vs.34.0±5.7 mL,P<0.01)than the PCS group.Fracture reduction quality(Matta outcome)and pelvic functional recovery(Majeed outcome)were comparable between the two groups(P>0.05).No significant complications were reported in either group.Conclusions Both RPRIN and PCS are effective for treating APRFs.However,RPRIN offers distinct advantages by reducing operation time,fluoroscopic time,and blood loss,making it a more efficient and less invasive option.Further multicenter studies and biomechanical analyses are warranted to confirm these findings.
文摘This article reviews the relationship between the spinal dorsal ramus system and low back pain, including the anatomy, clinical findings, pathogenesis and treatment of low back pain mediated by spinal dorsal ramus and zygapophysial (facet) joint syndrome. Each spinal dorsal ramus arises from the spinal nerve and then divides into a medial and lateral branch. The medial branch supplies the tissues from the midline to the zygapophysial joint line and innervates two to three adjacent zygapophysial joints and their related soft tissues. The lateral branch innervates the tissues lateral to the zygapophysial joint line. The clinical pain presentations follow these anatomic distributions, which can be used for localizing the involved dorsal ramus. The diagnosis can be confirmed by performing a single dorsal ramus block that results in relief of pain and muscle spasm. Etiologically, any factor that stimulates the spinal dorsal ramus can cause low back pain, which is distinct from zygapophysial joint syndrome. Clinically, L1 and L2 are the most common sites of dorsal rami involvement. Treatment includes spinal dorsal ramus injection therapy and percutaneous neurotomy. Summarily, irritation of the spinal dorsal ramus system is a potential source of low back pain. Based on the anatomy and clinical presentation, the involved spinal dorsal ramus can be localized and treated.
文摘BACKGROUND Avulsion fracture of the ischial tuberosity is a relatively clinically rare type of trauma that is mainly incurred by adolescents during competitive sports activities.According to previous literature,the most commonly involved sports are soccer,sprinting,and gymnastics,in descending order.Dance-induced avulsion fracture of the ischial tuberosity and ischial ramus is extremely clinically rare.CASE SUMMARY A case of a neglected avulsion fracture of the ischial tuberosity and ischial ramus was diagnosed in a young female dancer who complained of pain and restricted movement of her right hip.She stated that she had suffered the injury while performing a split leap during a dance performance 9 mo prior.Eventually,she underwent surgery and obtained satisfactory treatment results.CONCLUSION Early diagnosis of these fractures is important to ensuring early proper treatment towards a quicker recovery.For old fractures with nonunion and chronic buttock pain,surgery is a preferred therapeutic choice with good treatment outcomes.
文摘Aim:To present a simple technical modification of a medial osteotomy cut which prevents its misdirection and overcomes various anatomical variations as well as technical problems.Methods:The medial osteotomy cut is modified in the posterior half at an angle of 15°-20°following novel landmarks.Results:The proposed cut exclusively directs the splitting forces downwards to create a favorable lingual fracture,preventing the possibility of an upwards split which would cause a coronoid or condylar fracture.Conclusion:This modification has proven to be successful to date without encountering the complications of a bad split or nerve damage.
文摘目的:探究双侧下颌支矢状劈开截骨术(BSSRO)+颏成型术对偏颌畸形患者面下1/3软硬组织的影响及其变化趋势,并探讨软硬组织变化量间的相关性。方法:研究对象为31例接受BSSRO+颏成型术的偏颌畸形患者,分为轻度偏斜(n=17)和重度偏斜(n=14)。术前、术后3个月和术后6个月分别进行多维度影像学评估。采用Mimics Medical 21.0重建口腔颌面锥形束CT(CBCT)数据,并利用3-matic Medical 13.0软件测量硬组织标志点或软组织宽度等关键指标。使用SPSS 23.0对数据进行统计学分析,包括均值、标准差、相关性分析及显著性检验。结果:与术前相比,轻度偏斜患者术后双侧颏孔宽度、双侧下颌角宽度、颏下点与颏孔不对称系数差异有统计学意义(P<0.05),术后3个月偏侧口角宽度、术后6个月对侧口角宽度差异有统计学意义(P<0.05);重度偏斜患者术后偏侧口角宽度、双侧颏孔宽度、颏下点与颏孔不对称系数差异统计学意义(P<0.05),术后3个月对侧口角宽度、对侧Go-Go’及术后6个月下颌角点不对称系数差异有统计学意义(P<0.05)。此外,从术前到术后6个月,轻度和重度偏斜患者面下1/3多个软硬组织的变化量之间存在显著相关关系(P<0.05),且两组的相关性表现具有差异(P<0.05)。结论:BSSRO+颏成型术可显著改善偏颌畸形患者面部对称性,且术前至术后6个月患者面下1/3部分软硬组织的变化量之间存在相关性。
