Anatomic Reduction Rate Research Articles

Evaluation of Response to Neoadjuvant Chemotherapy for Esophageal Cancer: PET Response Criteria in Solid Tumors Versus Response Evaluation Criteria in Solid Tumors

Recently, PET response criteria in solid tumors (PERCIST) have been proposed as a new standardized method to assess chemotherapeutic response metabolically and quantitatively. The aim of this study was to evaluate therapeutic response to neoadjuvant chemotherapy for locally advanced esophageal cancer, comparing PERCIST with the currently widely used response evaluation criteria in solid tumors (RECIST). Fifty-one patients with locally advanced esophageal cancer who received neoadjuvant chemotherapy (5-fluorouracil, adriamycin, and cisplatin), followed by surgery were studied. Chemotherapeutic lesion responses were evaluated using (18)F-FDG PET and CT according to the RECIST and PERCIST methods. The PET/CT scans were obtained before chemotherapy and about 2 wk after completion of chemotherapy. Associations were statistically analyzed between survival (overall and disease-free survival) and clinicopathologic results (histology [well-, moderately, and poorly differentiated squamous cell carcinoma], lymphatic invasion, venous invasion, clinical stage, pathologic stage, resection level, reduction rate of tumor diameter, reduction rate of tumor uptake, chemotherapeutic responses in RECIST and PERCIST, and pathologic response). There was a significant difference in response classification between RECIST and PERCIST (Wilcoxon signed-rank test, P < 0.0001). Univariate analysis showed that lymphatic invasion, venous invasion, resection level, pathologic stage, and PERCIST were significant factors associated with disease-free or overall survival in this study. Although multivariate analysis demonstrated that venous invasion (disease-free survival: hazard ratio [HR] = 4.519, P = 0.002; overall survival: HR = 5.591, P = 0.003) and resection level (disease-free survival: HR = 11.078, P = 0.001) were the significant predictors, PERCIST was also significant in noninvasive therapy response assessment before surgery (disease-free survival: HR = 4.060, P = 0.025; overall survival: HR = 8.953, P = 0.034). RECIST based on the anatomic size reduction rate did not demonstrate the correlation between therapeutic responses and prognosis in patients with esophageal cancer receiving neoadjuvant chemotherapy. However, PERCIST was found to be the strongest independent predictor of outcomes. Given the significance of noninvasive radiologic imaging in formulating clinical treatment strategies, PERCIST might be considered more suitable for evaluation of chemotherapeutic response to esophageal cancer than RECIST.

Fracture of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury

The results of 262 displaced acetabular fractures in 259 patients treated with open reduction and internal fixation (ORIF) within 3 weeks after injury were reviewed after a mean follow-up of 6 years. Anatomical reduction was achieved in 71% (n = 185) of cases. Greater fracture complexity, age > 40 years, and a longer interval between injury and surgical reduction were significantly associated with a decreased rate of anatomical reduction. The overall clinical results were excellent / good for 76% of patients. Significant predictors of a better clinical result were the achievement of an anatomical reduction, postoperative congruence with the acetabular roof, and an excellent or good radiographic result. A worse clinical outcome was associated with damage of the femoral head, age > 40 years, and operative complications. Based on these results, the goal of treatment for these complex fracture types should be an increased rate of anatomical reduction and a decreased rate of operative complications.

Radiological and clinical outcomes of posterolateral fusion versus posterior lumbar interbody fusion for spondylolisthesis

Objective To compare two different kinds of operation: instrumented posterolateral lumbar fusion (PLF) and instrumented posterior lumbar interbody fusion (PLIF) in the treatment of low grade spondylolisthesis. Methods We retrospectively analyzed patients who received these two kinds of operation for low grade spondylolisthesis between June 2004 and December 2006, including PLF in 53 and PLIF in 60. Disc height, Boxall index, segment angle and area of intervertebral foramen were compared both before and after the operation and during the follow-ups as radiological measurement. The Oswestry disability index(OPI) and visual analogue scale (VAS) were measured to compare low back pain, leg pain, and disability. Anatomical reduction rate and fusion rate were also calculated. The radiological measurements and the clinical indexes were compared at the last follow-up. Results The average operation time and blood loss was: PLIF, (194.3±54.7) min, (402.2±123.9) ml; PLF, (179.3±45.7) min, (367.2±102.3) mi, which were of no statistical significance. PLIF group turned up better results in all the post operation radiological measurements, which was statistically significant. The fusion rate was 96.7% and 86.8% respectively, which was not statistically different. The VAS for both lumbar and leg pain as well as the ODI were improved either post operation or in the one year follow-up. The excellent rate for subjective evaluation was 56.7% in PLIF group and 37.7% in PLF group. Conclusion Instrumented PLIF is an effective treatment for low grade spondylolisthesis. It has yield superiority over PLF in correction of spondylolisthesis, maintenance of disc height, regaining of lumbar lordosis and enlargement of intervertebral foramen area, and contributes to a higher rate of excellent results. Key words: Spondylolisthesis; Lumbar vertebrae; Spinal fusion

The influence of timing of surgery on soft tissue complications in closed ankle fractures

Background The timing of surgery for closed ankle fracture is controversial. Conventional teaching recommends either immediate surgery or a delay of 5–7 days in order to minimise soft tissue complications. However, there have been no large studies to produce clear guidelines and the literature is conflicting. Some authors suggest that delayed surgery results in increased risk of wound complications, less satisfactory rate of anatomical reduction, increased hospital stay and health service cost.

Operative treatment of compound acetabular fractures through single posterior approach with percutaneous eannulated screws and reconstruction plates

Objective To discuss the efficacy of a modified single posterior fixation of complicated acetabular fractures with a percutaneous cannulated screw and a reconstruction plate in comparison with traditional bilateral approaches (ilioinguinal and Kocher-Langerbeek). Methods From April 2004 to May 2007, 48 cases of complicated acetabular fracture were treated surgically. By Letoumel classification, 22 were transverse and posterior wall fractures, 16 fractures of both columns, 3 fractures of anterior column and posterior wall, 3 T shape fractures and 4 anterior column and posterior hemi-transverse fractures. Of them, 22 cases were treated through the bilateral approaches and 26 cases through the modified single posterior approach by which a percutuneous cannulated screw was applied, going askew through skin and ischial tuberosity, to fix the anterior column and a reconstruction plate to fix the posterior column. Results Forty patients were followed up for 6 to 37 months(average, 18 months) . There was no statistical difference between the 2 groups as fax as the following factors were concerned: anatomic reduction rate and functional good-to-excellent rate. But there were significant differences in operation time and volume of hemorrhage during operation. Conclusion In treatment of complicated acetabular fractures, the modified singl eposterior approach simplifies traditional bilateral approaches so that surgery procedures, perioperative bleeding and postoperative complications can be reduced without sacrificing the treatment efficacy. Key words: Hip fracture; Fracture fixation, internal; Cunnulated screws

Analysis of the Selection and Prognosis of Approach of Acetabulum Fracture

目的 提高髋臼骨折的治疗质量,减少术后并发症.方法对65例髋臼骨折进行回顾性研究.结果按Matta评分法评价髋痛、行走及髋关节功能,经6个月～6年,平均3.3年48例55髋获得随访,其中非手术治疗14例14髋,优6髋,良4髋,可4髋,优良率71.4%;手术治疗34例41髋,优12髋,良19髋,可8髋,差2髋,优良率75%.结论髋臼骨折应力求解剖复位,并正确选择手术入路和内固定材料,提高手术技巧和解剖复位率,尽量减少剥离,合理的早期功能锻炼是防治移位髋白骨折手术并发症的关键。

Extensile triradiate approach in the management of combined acetabular fractures.

We investigated the results of combined acetabular fractures that were treated through the extensile triradiate approach in this study. Between January 1996 and January 2001, a total of 48 acetabular fractures were treated surgically (mainly combined fractures). Twenty-five of the combined acetabular fractures that were surgically treated through the triradiate approach with a minimum of 2 years' follow-up were included in the study. The mean patient age was 42 years. There were 8 both-column, 6 T-shaped, 2 anterior column/posterior hemitransverse, 4 transverse with comminuted roof area, 4 posterior wall with comminuted roof area, and 1 posterior column/posterior wall fracture. Associated injuries included two full-thickness chondral injuries of the head, one Pipkin type II fracture, five posterior and one central dislocation of the ipsilateral femoral head, and acetabular marginal impaction in four hips. The average follow-up was 44 months. The postoperative reduction was graded as excellent in 68% and imperfect in 8% of the patients. The hips were evaluated functionally according to the modified Postel-D'Aubigne score and rated as excellent in 7 patients (28%), good in 13 patients (52%), fair in 3 patients (12%) and poor in 2 patients (8%). There were 2 deep infections (8%), 2 avascular necroses of the head (8%), and 4 (16%) non-disabling heterotopic ossifications. Our results support the idea that open reduction with the triradiate approach provides good visualization and direct reduction of combined acetabular fractures. Its learning curve for combined fractures is shorter than that for single approaches and provides at least the same rate of anatomical reduction. It should be in the armamentarium of a surgeon dealing with such fractures.

Fractures of the Acetabulum

The results were reviewed for 259 patients who had open reduction and internal fixation of 262 displaced acetabular fractures within twenty-one days after the injury. Two hundred and fifty-five hips were followed for a mean of six years (range, two to fourteen years) after the injury; the remaining seven, which clearly had a poor result, were followed for less than two years. According to the classification of Letournel and Judet, associated fracture types accounted for 208 (79 per cent) of the fractures, with both-column fractures being the most common type (ninety-two hips; 35 per cent). Two hundred and fifty-eight hips were operated on with a single operative approach (Kocher-Langenbeck, ilioinguinal, or extended iliofemoral). The four remaining hips were operated on with a Kocher-Langenbeck as well as an ilioinguinal approach. The reduction was graded as anatomical in 185 hips (71 per cent). The rate of anatomical reduction decreased with increases in the complexity of the fracture, the age of the patient, and the interval between the injury and the reduction. The over-all clinical result was excellent for 104 hips (40 per cent), good for ninety-five (36 per cent), fair for twenty-one (8 per cent), and poor for forty-two (16 per cent). The clinical result was related closely to the radiographic result. The clinical result was adversely affected by associated injuries of the femoral head, an older age of the patient, and operative complications. It was positively affected by an anatomical reduction and postoperative congruity between the femoral head and the acetabular roof. Osteonecrosis of the femoral head was noted in eight hips (3 per cent), and progressive wear of the femoral head was seen in thirteen (5 per cent). Subsequent operations included a total replacement of seventeen hips (6 per cent), an arthrodesis in four (2 per cent), and excision of ectopic bone in twelve (5 per cent). These findings indicate that in many patients who have a complex acetabular fracture the hip joint can be preserved and post-traumatic osteoarthrosis can be avoided if an anatomical reduction is achieved. An increase in the rate of anatomical reduction and a decrease in the rate of operative complications should be the goals of surgeons who treat these fractures.