ABSTRACT
Objective:To evaluate the precise guidance of intraoperative ultrasound for closed reduction and fixation with intramedullary titanium elastic nail (TEN) in the treatment of clavicle fractures.Methods:The data of 40 patients with fresh clavicle fracture were retrospectively analyzed who had undergone closed reduction and TEN fixation under precise guidance of intraoperative ultrasound at Department of Emergency Trauma, Shandong Wendeng Osteopathic Hospital from January 2017 to March 2019. They were 25 males and 15 females, aged from 25 to 68 years (average, 52.1 years), with 27 cases on the left side and 13 on the right. Reduction and fixation of the fracture was monitored during operation to avoid iatrogenic injuries to the subclavian brachial plexus nerve, subclavian artery and vein and thoracic cavity. The Neer scoring was used at the last follow-up to assess shoulder joint function and complications were recorded.Results:Closed reduction and TEN fixation was completed uneventfully in all the 40 patients under precise guidance of intraoperative ultrasound. The operation time ranged from 20 to 56 min, averaging 36 min; the blood loss from 10 to 35 mL, averaging 22 mL. No injury occurred to the subclavian brachial plexus, subclavian artery or vein, or thoracic cavity. The 40 patients were followed up for 4 to 6 months (average, 4.8 months). All fractures achieved bony union, with no displacement or breakage of internal fixation, or fracture malunion. At the last follow-up, the shoulder joint function was good, with Neer scores ranging from 85 to 95 points (average, 93.1 points).Conclusion:The precise guidance of intraoperative ultrasound improves surgical accuracy and safety, making the closed reduction and TEN fixation a safe and minimally invasive treatment for clavicle fractures.
ABSTRACT
BACKGROUND:There is a high morbidity after spinal cord injury, and the therapeutic strategy is limited to early surgical intervention, medication and post-treatment exercise that only can improve the motor function slightly. However, there is no effective cure method. OBJECTIVE:To study the effect of partition-type spinal cord catheter combined with bone marrow stromal stem cels on T8 spinal cord transection damage in rats. METHODS:Fifty rats were randomized into five groups (n=10 per group): group I, T8 spinal cord transection (5 mm) was made in rats with no treatment; group II, the partition-type tube was inserted into the injured site after modeling; group III, partition-type tube combined with bone marrow stromal stem cels was implanted into the injured site after modeling; group IV, partition-type tube combined with polyglycolic acid fibers was implanted into the injured site after modeling; group V, partition-type tube combined with bone marrow stromal stem cels and polyglycolic acid fibers was implanted into the injured site after modeling. RESULTS AND CONCLUSION:At 2 and 12 weeks postoperatively, Basso, Beattie and Bresnahan scores were significantly higher in the groups III and IV than the groups I, II, IV (P < 0.05). At 12 weeks postoperatively, the latency of motor evoked potential below the injury plane was significantly decreased in group V compared with groups I, II, III, IV (P < 0.05). Immunohistochemical results displayed that in the groups III and V, regenerated nerve fibers grew positively and arranged orderly among the tubes, and there was no obvious winding phenomenon. Under transmission electron microscopy, a certain number of myelinated nerve fibers were found as bridges among groups. These findings indicate that the partition-type chitosan tube combined with bone marrow stromal stem cels has a good connection with the injured spinal cord a good connection to restore part of electrophysiological properties, accelerate the axon regeneration, recover the motor function, thereby providing a new direction for the treatment of spinal cord injury. Cite this article:Zhao XW, Liu X, Yu DP, Rong H, Yu XS, Yang CS, Liu T, Zhao TB. Partition-type spinal cord catheter combined with bone marrow stromal stem cels in the repair of spinal cord transection injury in rats. Zhongguo Zuzhi Gongcheng Yanjiu. 2016;20(1):42-48.