Objective To compare the loss of anterior column heightand cervical Cobb angle with three different types of anterior cervical discectomy and fusion(ACDF). Methods A prospective randomized study was performed on 60 patients who had undergone ACDF with the autologous iliac crest graft (group A, n=20), the autogenous bone and the anterior cervical locking plates (group B, n=20), and Syncage-C filled with the local autograft reamings (group C, n=20) from January 1998 to January 2003. The patients diagnosed as having cervical radiculopathy (RP) and cervical spondylotic myelopathy (CSM) were indicated for ACDF. Of the patients, 41 were male and 19 female with a mean age of 57 years (range, 36-68) and their average course of disease was 6.2 months (range, 1-36). There were 36 one-level and 24 two-level fusions from C3,4 to C7,T1. Radiological measurements were performed on the cervical radiographs taken before operation, 7 days and 3 months after operation, and on the last day of the follow-up; then, the height and Cobb angle of the fused segment, functional restoration, and clinical outcome were evaluated in the three groups. Results The followup of more than 2 years (range,2-7) showed that the average loss of anterior column height and Cobb angle of the fused segments in groups A and B, which had not preserved the-endplate, hada greater increase than that in group C, which had preserved the endplate. Of the patients, 12 had autograft collapse, 3 autograft displacement, and 10 postural abnormality between the fused segments, most of which happened in groups A andB. The fusion rate was 93.3% (56 cases) according the strict arthrodesis critera; their excellent and good rate in the functional assessment was 83.3% (RP 90.4%, CSM 79.5%); the overall satisfactory (excellent and good) rates in groups A,B and C were 75%, 85% and 90%, respectively. Conclusion To increase the resistance to graft subsidence, which is a major reason for narrowness of the fused segments, and to maintain normal cervical curvature, we should improve our skills of bone grafting performance, preserve the endplate, carefully evaluate the degree of osteoporosis before operation, and use anterior cervical locking plate and /or fusion with Syncage-C when necessary.
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.
ObjectiveTo investigate the time relationship of the change, and diagnostic accuracy and sensitivity between retinal light threshold fluctuations (LTF) and retinal nerve fiber layer (RNFL) and ganglion cell complex(GCC) thickness on high-risk primary open-angle glaucoma (POAG). MethodsTotally 319 patients (319 eyes) with high-risk in POAG from the First Affiliated Hospital of Kunming Medical Universityand during December 2009 and December 2017, 50 healthy individuals (50 eyes) as control were collected in this longitudinal cohort study. Visual field and OCT were reviewed every 6 months on the high-risk group and every 12 months on the control group. High-risk groups inclusion criteria: vertical C/D≥0.6; early visual field defect (according to glaucoma visual field damage GSS2 quantitative grading standards, mean deviation and pattern standard deviation of central field exceeds the border as an early visual field defect); continuous repeatable results. The first field and OCT results in the absence of visual field defects and C/D≥0.6, which were conformed reliability indicators and removed learning effects as a baseline. When patients achieve POAG diagnosis criteria first time which was recorded as a turning point. And they were divided into early group meanwhile were ended of follow-up. After the last follow-up, the inspection data was segmented counted in yearly interval. The changes of LTF, thickness of RNFL and GCC during the follow-up period in the early POAG group and the control group were observed. The loss rate and change rate in each period were compared for the assessment of their trends with time. Followed by calculation of the area under receiver operating curves (AUC) to compare the predicted value of POAG and the sensitivity at 95% specificity in each period. ResultsAfter last follow-up, totally 67 patients 67 eyes (early POAG group, 37 males and 30 females) were entered the turning point. The mean follow-up of the early POAG group and the control group were 6.6 and 6.4 years. The average RNFL thickness was 79.05±8.09 μm, GCC thickness was 71.58±8.41 μm, LTF was −6.05±7.02 dB in early POAG group. The average RNFL thickness was 93.49±6.24 μm, GCC thickness was 79.72±6.32 μm, LTF was −0.31±0.58 dB in the control group. The differences of LTF and the thickness of RNFL and GCC were statistically significant (t=−5.97, −10.42, −5.60; P＜0.001). The AUC of RNFL, GCC thickness and LTF increased with time in the early POAG group. The sensitivity was gradually increased at 95% specificity: 5th year before to at turning point, RNFL thickness AUC was 0.15, 0.65, 0.71, 0.77, 0.85, 0.92, and sensitivity was 20%, 56%, 61%, 65%, 70%, 76%, respectively; GCC thickness AUC was 0.12, 0.53, 0.69, 0.74, 0.82, 0.90, and sensitivity was 14%, 53%, 69%, 74%, 82%, 90%, respectively; the AUC of LTF was 0.10, 0.21, 0.33, 0.75, 0.86, 0.91, and sensitivity was 7%, 17%, 44%, 65%, 78%, 87%, respectively. ConclusionsThe earliest time of structural functional damage of POAG is at the 4th year before confirmed, simultaneous RNFL diagnosis accuracy and sensitivity are better than GCC and LTF. The earliest time of visual functional damage of POAG is at the 2th year before confirmed, simultaneous LTF diagnosis accuracy and sensitivity are better than RNFL and GCC.
ObjectiveTo systematically review the diagnostic value of optical coherence tomography angiography (OCTA) for primary open-angle glaucoma (POAG). MethodsThe CNKI, WanFang Data, VIP, CBM, PubMed, Embase, Web of Science, and Cochrane Library databases were electronically searched to collect diagnostic test on OCTA for POAG from inception to February 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using Stata 15.0 software. ResultsA total of 12 diagnostic tests involving 993 subjects were included. Meta-analysis results showed that the sensitivity/specificity of OCTA for diagnosing peripapillary vessel density, retinal vessel density, and optic nerve fiber changes in patients with POAG were 0.77/0.92, 0.56/0.92, and 0.85/0.91, respectively, and the AUC of the SROC curve was 0.94, 0.92 and 0.95, respectively. ConclusionOCTA has high diagnostic accuracy for POAG. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo observe the changes of subfoveal choroidal thickness (SFCT) under the macular center recess after trabeculectomy in eyes with open-angle glaucoma (POAG), and to preliminarily analyze its relationship with visual function. MethodsA retrospective case-control study. 117 patients with POAG who were diagnosed by ophthalmologic examination and treated with trabeculectomy in Department of Ophthalmology of Shangluo Hospital of Traditional Chinese Medicine from January 2021 to December 2023 were included in the study. Among them, 63 cases were male; 54 cases were female. All of them underwent naked-eye visual acuity, best-corrected visual acuity (BCVA), refraction, optical coherence tomography (OCT) examination, and axial length measurement. SFCT was measured using enhanced deep imaging with an OCT instrument. Based on the visual function reduction at 1 month after surgery, the patients were categorized into a visual function unreduced group and a visual function reduced group of 67 and 50 cases, respectively. Visual function included binocular adjustment amplitude and sensitivity; visual quality included objective scattering index (OSI) and modulation transfer function (MTF). Changes in SFCT and visual function-related indexes were analyzed by repeated-measures analysis of variance; the risk associated with changes in SFCT and visual function-related indexes was evaluated by a binary logistic regression model; and the relationship between SFCT and post-surgical visual function loss was analyzed by a Joint model; the SFCT and post-surgical visual function reduction was analyzed by a Joint model; the dose-response relationship between SFCT and post-surgical visual function decompensation was analyzed by applying the restricted cubic spline (RCS). Decision curve (DCA) was used to predict visual hypoplasia. ResultsComparison of the percentage of patients with different ages, anterior chamber hemorrhage, and post-surgical anterior chamber inflammatory response in the unreduced visual function group and the reduced visual function group showed statistically significant differences (P＜0.05). The results of the main effect test showed that the differences between SFCT and visual function adjustment amplitude, sensitivity time effect, between-group effect, and interaction effect were statistically significant in both groups (P＜0.05). The results of the separate effects test showed that compared with the preoperative period, the SFCT, accommodation amplitude, and sensitivity of the affected eyes of the two groups were significantly increased at different times after surgery, and the differences were statistically significant (P＜0.05). The results of multivariate ANOVA showed that SFCT, accommodation amplitude, and sensitivity at different times before and after surgery were significantly lower in the group with reduced visual function than in the group without reduced visual function, and the differences were statistically significant (P＜0.05). The △naked-eye visual acuity, △BCVA, △OSI, and △MTF of the patients in the group with reduced visual function were significantly lower than those in the group without reduced visual function, and the differences were all statistically significant (P＜0.05). Correlation analysis showed that SFCT was positively correlated with △adjustment amplitude, △sensitivity, △naked-eye visual acuity, △BCVA, △OSI, and △MTF (r=0.426, 0.419, 0.311, 0.315, 0.325, 0.285; P＜0.05). Multiple linear regression analysis showed that △SFCT was positively correlated with △adjustment amplitude, △sensitivity, △naked-eye visual acuity, △BCVA, △OSI, and △MTF before and after adjusting for confounders (P＜0.05). The results of Joint modeling analysis showed that the risk of visual function decompensation was increased by 5% for every 1 µm increase in SFCT. The results of RCS analysis showed a nonlinear correlation between SFCT and surgical The RCS analysis showed that there was a nonlinear relationship between SFCT and post-surgical visual impairment for nonlinear test (P＜0.001); the threshold effect analysis showed that the fold point at which SFCT affected post-surgical visual impairment was 243.25 µm.The DCA analysis showed that SFCT predicted a significant increase in the net clinical benefit rate of post-surgical visual impairment for risk thresholds ranging from 0.00 to 0.84. ConclusionsAfter POAG trabeculectomy, SFCT of those with or without reduced visual function are significantly thickened compared to pre-surgery; the magnitude of visual function adjustment and sensitivity tended to increase significantly after surgery. Naked eye visual acuity, BCVA, OSI, and MTF all have a significant effect on postoperative visual function.
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.
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 investigate the clinical significance of Q-angle measuring under different conditions in female recurrent patellar dislocation female patients. MethodsBetween August 2012 and March 2013, 10 female patients (11 knees) with recurrent patellar dislocation were collected as trial group; 20 female patients (20 knees) with simple meniscus injury were collected as control group at the same time. Q-angle was measured in extension, 30° flexion, 30° flexion with manual correction, and surgical correction in the trial group, and only in extension and 30° flexion in the control group. Then the difference value of Q-angle between extension and 30° flexion (Q-angle in extension subtracts Q-angle in 30 flexion) were calculated. Independent sample t-test was used to analyze Q-angle degrees in extension, 30° flexion, and the changed degrees of 2 groups. The Q-angle between manual correction and surgical correction of the trial group was analyzed by paired t-test. ResultsThe Q-angle in extension, Q-angle in 30° flexion, and difference value of Q-angle between extension and 30° flexion were (17.2±3.6), (14.3±3.0), and (2.9±1.9)° in the trial group and were (15.2±3.4), (14.4±3.5), and (0.8±1.7)° in the control group. No significant difference was found in Q-angle of extension or Q-angle of 30° flexion between 2 groups (P>0.05), but the difference value of Q-angle between extension and 30° flexion in the trial group was significantly larger than that in the control group (t=3.253, P=0.003). The Q-angle in 30° flexion with manual correction and surgical correction in the trial group was (19.8±3.4)° and (18.9±3.8)° respectively, showing no significant difference (t=2.193, P=0.053). ConclusionWhen a female patient's Q-angle in 30° flexion knee changes obviously compared with Q-angle in extension position, recurrent patellar dislocation should be considered. For female patients with recurrent patellar dislocation, the preoperative Q-angle in 30° flexion with manual correction should be measured, which can help increasing the accuracy of evaluation whether rearrangement should be performed.
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 compare the antireflux effects of lip reinforcement, His angle reconstruction with fundoplication, and mechanical anastomosis only in mechanical anastomosis for esophageal and cardiac carcinoma. MethodsOne hundred and seventysix patients with esophageal or cardiac carcinoma admitted to this hospital between March 2008 and October 2009 were included, which were divided into mechanical anastomosis group (n=42), His angle reconstruction group(n=56), and lip reinforcement group (n=78) according to the sequence of admission. Mechanical anastomosis only, mechanical anastomosis His angle reconstruction with fundoplication, and mechanical anastomosis liptype reinforcement were performed in the corresponding group, respectively. Endoscopy and biopsy were conducted to evaluate the antireflux effects on 3 months after operation. ResultsThere were no differences on the gender, age, tumor location, anastomosis site, and incision among three groups (Pgt;0.05). The reflux rates of the mechanical anastomosis group, His angle reconstruction group, and lip reinforcement group were 69.05%, 28.57%, and 14.10%, respectively. The reflux rates in the lip reinforcement group and His angle reconstruction group were significantly lower than those in the mechanical anastomosis group (χ2=37.088, P=0.000; χ2=15.833, P=0.000), moreover, the rate in the lip reinforcement group was significantly lower than that in the His angle reconstruction group (χ2=4.241, P=0.039). There was no anastomotic leakage in the lip reinforcement group and all patients safely discharged from hospital after surgery, only 2 patients had moderately anastomotic stenosis and both of them had good recovery with endoscopic dilatationl. The reflux after operation was independent of anastomosis sites (Pgt;0.05). ConclusionBoth liptype reinforcement and His angle reconstruction can improve the ability of antireflux, liptype reinforcement is better and simple to mainpulate.