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Objeetive To investigate the clinical efficacy of inverted intmmedullary nail combined with medial minimally invasive plate in treatment of type C2 and C3 distal femoral fractures.Methods A retrospective case control study was conducted on 38 patients with complex distal fractures of the femur treated from January 2015 to January 2017.There were 22 males and 16 females,aged 24-72 years [(45.6 ± 2.5)years].AO fracture classification was type C2 in 24 patients and type C3 in 14.All of them were fresh closed fractures.The time duration from injury to operation was 4-16 days (average,7.5 days).Based on the different surgical methods,the patients were divided into lateral single plate fixation group (single plate group,20 patients) and inverted intramedullary nail combined with medial minimally invasive locked plate fixation group (locked plate group,18 patients).The two groups were compared in terms of operation condition,early weight bearing time,fracture healing time,postoperative complications,postoperative knee function and activity of living.Hospital for Special Surgery (HSS) score was used for evaluating postoperative knee function and Barthel index for activity of living.Results The patients were followed up for 10-24 months [(12.2 ± 1.8) months].The operation duration was (110.5 ± 35.4) min for single plate group and (116.7 ± 42.3) min min for locked plate group(P ＞0.05).Intraoperative blood loss in single plate group was [(450.5 ± 120.7)ml] and [(455.2 ± 130.4) ml] in locked plate group (P ＞ 0.05).The early weight bearing time in single plate group was (28.5 ± 8.6)days and 18.7 ± 4.9 (P ＜ 0.01)days in the locked plate group.The fracture healing time in single plate group was (8.5 ± 2.2) months,and [(6.5 ± 1.6) months] in locked plate group (P ＜ 0.01).After 3 weeks,6 months and 12 months,HSS scores of knee joint function of the locked plate group was significantly better than that of single plate group (P ＜ 0.01).At 6 months and 12 months after operation,Barthel index score of locked plate group was significantly better than that of single plate group (P ＜ 0.01).No infection occurred in two groups after operation.There were no complications such as internal fixation failure,knee valgus,external rotation deformity or fat embolism in locked plate group.There were two cases of internal fixation failure,one knee eversion,and two knee varus in single plate group (P ＜ 0.01).Conclusion Compared with single plate fixation,the therapeutic method of inverted intramedullary nail combined with medial minimally invasive locked plate has the advantages of early weight bearing time,quick recovery,better function restoration and fewer complications,and hence is a preferable choice for treatment of type C2 and C3 complex distal femoral fractures.
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Objective To investigate the experimental effectofmagnetic mNGF nanoparticlesguided by out-side magnetic on the the sciatic nerve injury.Tianjin 300211,China.Methods As a drug carrier,PLGA connects magneticironparticles with and mNGF. The nanoparticle suspension liquid was prepared and its physicochemical properties was characterized. The model of the left sciatic nerve injury in rats was divided into 3 groups. Rats in Group A received intravenous tail vein injectionof magnetic mNGF nanoparticlesfollowed by two-hour outside mag-neticguidance once week.Group B received intravenous tail vein injection of magnetic mNGF nanoparticles without outside magnetic guidance once week. Group C received intravenous tail vein injection of the same content mNGF once week. Two months later,we measured the ischial nerve index(SFI)and madenerve electrical physiological ex-amination under anesthesia.We also measured quality ratio of triceps surae and did left sciatic nerve slice HE stain-ing.Finally,experimental data were statistically analyzed. Results The SFI,nerve conduction velocity and quality ratio of triceps surae of Group A were higher than those of Group B and Group B(P<0.05).There was no significant difference between Group B and Group C(P>0.05).The arrangement and density of the regeneration nerve in Group A were better than those of Group B and C under optical microscope. Conclusion The results showed that the magnetic mNGF nanoparticles guided by outside magnetic can promote the recovery of rat sciatic nerve injury.
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Objective To investigate the related risk factors of the previous cemented vertebral body re-wedge after percutaneous kyphoplasty (PKP).Methods In this retrospective case-control study,clinical data of 617 patients treated by PKP from December 2008 to November 2014 were analyzed.According to whether the cemented vertebra wedged again,the patients were divided into cemented vertebral re-wedge group (n =12) and non-cemented vertebral re-wedge group (n =605).The data of age,preoperative bone density,preoperative vertebral osteonecrosis,intraoperative bone cement injection amount,postoperative bone cement leakage,postoperative bone cement filling,postoperative recovery rate of vertebral wedge angle,and presence or absence of adjacent old vertebral wedging were recorded in two groups.All patients were followed up for one year,and the data were summarized and statistically analyzed.Results Single factor analysis showed the factors of whether there were adjacent old vertebral wedge,preoperative vertebral osteonecrosis,cystic bone cement filling,different wedge angle recovery rate,and emergence of previous cemented vertebral body re-wedge after PKP were statistically significant between two groups (P ＜ 0.05).There was no obvious statistical difference in age,preoperative bone density,intraoperative bone cement injection amount,and intervertebral bone cement leakage between two groups (P ＞ 0.05).Multivariate Logistic stepwise regression analysis showed cystic bone cement filling,preoperative vertebral osteonecrosis,adjacent old vertebral wedging,and higher recovery rate of vertebral wedge angle were prone to appear previous cemented vertebral body rewedge (P ＜ 0.05).Conclusions Relatively higher recovery rate of vertebral wedge angle,previous adjacent old vertebral wedge,vertebral osteonecrosis,and cystic bone cement filling are risk factors closely related to cemented vertebral re-wedge after PKP,which gives a good reference to assess surgical risk,avoid risk factors and choose right surgical techniques.
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BACKGROUND:Currently, there are large numbers of studies related to the association between colagen type I alpha1 (COL1A1) Sp1 polymorphism and bone mineral density and fracture risk, but the results are inconsistent. OBJECTIVE:To evaluate the impact of the COL1A1 Sp1 polymorphism on bone mineral density and fracture by using the Meta-analysis. METHODS:We comprehensively searched the eligible studies for the present meta-analysis through MEDLINE, PubMed, EMBASE databases. Pooled odds ratios and 95% confidence intervals of Sp1 polymorphisms for bone mineral density and fracture risk were obtained, with attention to study quality and publication bias. RESULTS AND CONCLUSION:A total of 32 studies met the inclusion criteria, among which, 22 studies evaluated the Sp1 polymorphism and fracture risk. Significant associations were found in five genetic models. In the stratified analysis by region, the same results were found in the Europeans but not Americans and Asians. Thirteen studies evaluated the Sp1 polymorphism and low bone mineral density risk. A similar result was obtained. However, the analysis of bone mineral density data showed an increased relation between Sp1 polymorphism and low bone mineral density in Europeans and Americans but not in Asians. Overal, the current meta-analysis concludes that the COL1A1 Sp1 polymorphism is associated with low bone mineral density and fracture risk, especialy in Europeans. However, susceptibility to them varies markedly among populations from different regions.
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BACKGROUND:Several studies have attempted to apply mouse nerve growth factor to local lesions of peripheral nerve and found that local injection of mouse nerve growth factor can promote nerve recovery, which is superior to systematic application. OBJECTIVE:To evaluate the clinical effects of gelatin sponge infiltrated by mouse nerve growth factor in the repair of peripheral nerve injury. METHODS:Thirty-six patients with single peripheral nerve injury, including 16 males and 20 females, aged 18-48 years, were randomly divided into two groups: 18 patients in case group underwent debridement and neuroanastomosis, and then the injured nerve was wrapped by gelatin sponge which was infiltrated by mouse nerve growth factor and folowed by plaster fixation, anti-inflammatory therapy, neurotrophy and circulation improvement therapy; the other 18 patients in control group were treated only with debridement and neuroanastomosis and other conventional therapies. At 4 weeks after treatment, electrophysiological examination was performed. In addition, sensory and motor function of the distal end of injured nerve was evaluated at 6 months after treatment. RESULTS AND CONCLUSION: Sensory evoked potential and motor evoked potential showed that the recovery rate was 78% (n=14) and 83% (n=15) respectively in the case group, while 57% (n=10) and 66% (n=12) in the control group. There was significant difference between the two groups (P < 0.05). The total effective rate was 94.4% (n=17) in the case group and 83.3% (n=15) in the control group, which were statisticaly better in the case group than the control group (P < 0.05). These findings indicate that it is significantly effective to treat peripheral nerve injury by gelatin sponge infiltrated by mouse nerve growth factor that has good biocompatibility.
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BACKGROUND: Expectant treatment for intertrochanteric fractures in elderly patients with osteoporosis and other chronic diseases can easily lead to complications of lying in bed.OBJECTIVE: To evaluate the results of percutaneous compression plating system (PCCP) for intertrochanteric fractures in elderly patients. METHODS: Thirty-two cases of elderly intertrochanteric fractures treated with PCCP admitted from June 2007 to June 2009 and 40 cases of elderly intertrochanteric fractures treated with dynamic hip screw system (DHS) were reviewed. The operative bleeding, operative time and curative effect were compared.RESULTS AND CONCLUSION: The operative bleeding and operative time in the patients receiving PCCP were significantly lower than those in the patients receiving DHS. There was not statistical significance between the curative effects about the two methods. PCCP applied in elderly patients with intertrochanteric fracture can get satisfactory effects, and the system is operated simply with minimally invasive surgery, which is beneficial to reduce surgical complications.
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Objective To explore the principle of diagnosis and treatment of intermittent claudication caused by lumbar spine disease combined with lower extremity arteriosclerosis obliterans. Method Eighteen cases of patients with intermittent claudication caused by lumbar spine disease combined with lower extremity arteriosclerosis obliterans, using MRI and MRA, to determine the main reason due to of disease, to take the treatment for the cause. Results The patients were followed up for 7 to 24 months, average (16.0 ± 4.7) months. Assessed according to the modified MacNab criteria of clinical efficacy, excellent in 7 cases, good in 8 cases, general in 3 cases,satisfactory rate was 83.3%(15/18). Intermittent claudication were improved with all patients, walking distance of more than 1000 meters, relief rate was 100%. Postoperative ankle brachial score(0.90±0.54 ) was obviously increased compared with preoperative average(0.58±0.36), there was significant statistical difference(P<0.01). All cases were not amputee due to circulation disturbance. Conclusion The diagnosis and treatment of intermittent claudication caused by lumbar spine disease combined lower extremity arteriosclerosis obliterans,it is necessary to collect a history of serious and careful investigation,combined with imaging, can accurately determine the responsibility of lesions, target to give the appropriate treatment, can get a good effect
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Objective To evaluate the curative effect of percutaneous compression plating system in treatment of intertrochanteric fractures of the elderly patients.Methods The clinical data of 18 elderly patients(aged 68-89 years)with intertrochanteric fractures were retrospectively analyzed.According to Evans classification,there were seven patients with type Ⅰ fractures,nine with type Ⅱ fractures and two with type Ⅲa fractures.Percutaneous compression plating system was applied to all patients from June 2007 to June 2009,and the therapeutic effect was evaluated by Harris hip function evaluation criteria.Results All the fractures were healed,with excellent results in 15 patients and good results in the rest three patients.Conclusions The percutaneous compression plating system is easy to manipulate with minimal invasion,has minor side effect and is beneficial to reducing surgical complications in the elderly patients with intertrochanteric fractures.
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@#ObjectiveTo investigate the characteristics of traumatic spinal cord injury (TSCI) urban inpatients of Tianjin in 2007. MethodsInpatients with TSCI of 8 hospitals in Tianjin in 2007 were reviewed. ResultsThere were 73 patients in total. Mean age was (51.34±14.597) years. Male∶Female was 3.56∶1. Falling, motor vehicle accidents （MVC） were the main causes of TSCI. The cervical spinal cord injuries were predominant. 26% were complete injury and 74% were incomplete. 6 cases were dead. Patients with ASIA grade D recover well. ConclusionFor the TSCI, the ages of patients increases and falling is the main cause.