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Objective To evaluate the analgesic effect of parecoxib in total knee arthroplasty (TKA) and total hip arthroplasty (THA).Methods The study was a prospective,randomized and double-blind trial and was operated by the same group of surgeons in 101 patients with TKA and 105 patients with THA.According to analgesic protocol,the patients were divided into three groups:Group One ( intravenous injection with parecoxib),Group Two ( periarticular injection with parecoxib) and Group Three ( the control group).The postoperative visual analog scores (VAS),range of motion ( ROM),the ability of straight leg raising and the incidence of nausea and vomiting complications were examined and compared between the three groups.Results There were no significant differences in VAS (6,12,24,36,48,72 hours after operation),ROM ( 24 hours after operation) and the ability of straight leg raising between Group One and Group Two ( P ＞ 0.05 ),but all of them were significantly higher than those in Group Three ( P ＜ 0.05 ).Nausea,vomiting and other adverse effects did not significandy increase with the use of parecoxib.Conclusions Both intraoperative intravenous injection and periarticular injection with parecoxib have a good analgesia effect on TKA and THA,which are beneficial to the rapid recovery of joint function in patients.The simple and practical method provides an effective adjunct to a multimodal analgetic approach in improving the postoperative course of TKA and THA.
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ObjectiveTo evaluate the security and effectiveness of minimal invasive fixation with 3D fluoro-images navigation in the management of acetabular fractures.MethodsFrom August 2008 to December 2010,20 patients with acetabular fractures were treated with percutaneous screw fixation under the guidance of 3D fluoro-images based on navigation system after closed reduction.There were 9 males and 11 females,aged 26-54 years old(mean,37.1±1.2 years).Fractures were caused by traffic accident in 15cases,and falling from height in 5 cases.According to AO classification,there were 2 cases of A1.1 type,3 cases of A2.2 type,4 cases of A2.3 type,2 cases of A3.2 type,2 cases of A3.3 type,2 cases of B1.1 type,2 cases of B2.2 type,1 case of B3.1 type,1 case of C2.1 type,1 case of C2.3 type.The interval from injury to hospitalization was 2-46 h (mean,8.6±0.2 h).After 3-14 days of skeletal traction through tibial tubercle,the operation was performed.ResultsTotally 46 screws were fixed.The average time for surgery was(22.6 ±1.2) min per screw.Forty-five screws were placed correctly with a successful rate of 97.8％,only one screw was reinserted for deviation.All the screws were checked by the 3D fluoro-images that they were not in the joint space after fixation.The result was same with CT scan.No incision problem and implant failure occurred.All 20 patients were followed up 12 to 28 months with an average of (22.8±1.7) months.At last follow-up,fracture union was achieved in all patients with satisfactory screw fixation.ConclusionThe minimal invasive fixation with 3D fluoro-images navigation makes the surgery for the nondisplaced acetabular fracture more precise and time-saving,minimize the surgery injury,and improves clinical results without an increasing rate of complications.
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BACKGROUND:The treatment of displaced acetabular fractures consists of formal open reduction and internal fixation.However,extensile exposure can lead to a lot of complications Percutaneous screw fixation for acetabukar fractures can decrease these complications Recently developed fluoroscopic-based computerized navigation technology not only allows the surgeon to achieve maximum accuracy of screw fixation but also significantly reduce radiation exposure time.OBJECTIVE:To evaluate the clinical application of the fluoroscopic-based computerized navigation system for percutaneous screwing for acetabular fractures.METHODS:A total of 18 adult patients with 20 non-displaced and displaced acetabular fractures were treated with percutaneous screw fixation under the guidance of a fluoroscopy-based navigation system.All acetabular fractures were acetabular anterior column fractures and posterior column fractures,which were fixed by varied hollow screws Static muscle contraction and limited active and passive motion were performed at 2 days,and weight-bearing exercise was performed at 4 weeks after operation.The time of screw implantation,screw position deviation,screw biocompatibility,as well as adverse effect after screw implantation was observed.In addition.d'Aubigne and Postel scoring was used in follow-up.RESULTS AND CONCLUSION:A total of 30 acetabular screws were inserted.The average operation time for per screw was24.1 minutes from the image acquisition to wound closure.The average fluoroscopic time for per screw was 27.6 seconds.Compared to the final position of the screw,the average wire tip error was 1.5 mm and the average trajectory difference was2.25°.One patient sustained a transient femoral nerve palsy which was attribute to reduction clamp inserting from the use of the limited open reduction method rather than screw fixation itself and resolved 2 months after the operation.No evidence was noted of secondary displacement of the fragment or screw failure Using the rating system of d'Aubigne and Postel,13 patients had excellent results,4 patients had good results,and 1 patient had a fair result.The excellent to good rate was 94%All results demonstrated that percutaneous screw fixation of acetabular fractures with fluoroscopy-based navigation can produce excellent results in selected patients with non-displaced and displaced fracture amenable to closed or limited open reduction,which becomes a safe and effective alternative to traditional open reduction and internal fixation for the treatment of certain acetabular fractures.
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Objective To evaluate minimally invasive plate osteosynthesis (MIPO) technique in the treatment of humeral shaft fractures using locking compression plate (LCP). Methods Between February 2004 and January 2005, 17 consecutive patients with 17 humeral shaft fractures were treated with LCP by MIPO technique. There were 12 men and 5 women with a mean age of 48 years (range, 18 to 75). According to AO classification, three fractures were type12-A, 10 type 12-B, and four type 12-C. Results The mean duration of follow-up was 19. 1 months (range 14 to 25) . Union occurred in all patients with a mean healing time of 11. 3 weeks (range 9 to 14) . With regard to ROM of the shoulder, the mean flexion was 174 degrees (range, 135 to 180 ), the mean extension was 38 degrees (range, 20 to 40), and the mean abduction was 87 degree (range, 70 to 90). For the elbow, the mean flexion was 133 degree (range, 115 to 135), the mean extension was -1 degree(range, - 10 to 0). Using the patient-rated functional questionnaire, the mean DASH (disabilities of the arm, shoulder and hand) score of 11 points (range, 6 to 44) at the latest follow-up indicated a mild to moderate impairment. There were three postoperative complications. One superficial infection occurred in a Custilo type MB open fracture and was uneventfully healed with conservative managements. One patient experienced transient radial nerve palsy which showed complete remission within 3 months. The third one demonstrated a dysfunction of shoulder and elbow. There were no cases of secondary malalignment or late hardware failure in this cohort. Conclusions Internal fixation using LCP in MIPO can attain a stable fixation, a high union rate as well as a low complication rate. The neurovascular structures may be at less risk of iatrogenic injuries through the anterior approach. It may be considered a reliable and efficient method for humeral shaft fractures, especially for comminuted ones and those with poor bone quality.
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Objective To evaluate the indications and clinical results of less invasive stabilizing system (LISS) in the treatment of complex fractures around the knee. Methods Screws in this system can be inserted through the aiming handle and can be locked into the plate-holes. Between Dec. 2003 and Jun. 2004, 41 cases(29 males, 12 females) of complex fractures around knee were treated with LISS. The mean age of the patients was 40.6 years (range 24 to 67 years). The proximal tibia was involved in 28 cases and distal femur in 13. In all 41 cases, there are 22 (53.7%) polytrauma, 6 (14.6%) delayed fractures and 1 revision surgery. All fresh fractures were operated in a minimal invasive way (only articualr surfaces need open reduction), fractures in metaphyseal area and tibial shaft were reduced indirectly and stabilized with minimal invasive percutaneous plate osteosynthesis(MIPPO). The delayed and revisional fractures were reduced with limited approach and stabilized with MIPPO. Results The mean operation time was 87.2 min. The follow-up averaged 16 months(range 13 to 21 months). 3 patients with bone deficit in distal femur underwent a bone graft which unioned eventually, the other patients had a mean healing time of 15.1 weeks(11 to 23 weeks) and a mean weight bearing time of 16.8 weeks (12 to 25 weeks). One pulling device broken and one screw lost in the tibial medullary cavity occured intraoperatively. Postoperatively, one loss of reduction occurred, no deep infection, loosening, breakage or failure of implants was noted. According to Rasmussen criteria of fracture reduction, excellent in 31 (75.6%) cases, good in 10 (24.4%). One year postoperatively, the mean ROM of the knees was 2.4? to 95.6?, the mean HSS knee score was 88.4 points(58 to 98 points)with 27 excellent, 10 good, 3 fair and 1 poor according to HSS scoring system. Conclusion LISS, with a novel operating concept and technique different to traditional methods, is an effective and alternative way for complex juxtaarticular fractures around the knee, especially for those difficult to deal with in traditional way. As a novel product further clinical studies are required to verify its effectiveness.