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Objective:To evaluate anatomical locking plate combined with bone cement intramedullary support in the treatment of proximal humeral fractures in the elderly.Methods:From May 2016 to July 2018, 19 geriatric proximal humeral fractures were treated with anatomical locking plate combined with bone cement intramedullary support at Department of Orthopaedics, General Hospital of Shenyang Northern Theater. There were 8 females and 5 males, with an average age of 71 years (from 60 to 84 years). All the fractures were closed. According to the Neer classification, there were 4 two-part, 5 three-part and 4 four-part fractures. At 6, 12, 18 and 36 weeks and one year postoperatively, anteroposterior and lateral X-ray films of the scapula were taken. At the last follow-up, the Constant-Murley shoulder score and the Disabilities of the Arm, Shoulder and Hand (DASH) score for the upper limb dysfunction were recorded.Results:The 13 patients were followed up for 3 to 12 months (6 months on average). Bony union was achieved in all the 13 patients. Local necrosis and deformation of the humeral head and partial screw perforation were observed one year after operation in 2 cases, but other patients reported no such complications or loosening of internal fixation. At the last follow-up, their mean Constant-Murley score was 82.6 (from 71 to 95) and their mean ADSH score 19.2 (from 9.2 to 48.1).Conclusion:Anatomical locking plate combined with bone cement intramedullary support may lead to fine early efficacy for the treatment of proximal humeral fractures in the elderly, since it can facilitate fracture reduction, promote rigid fixation and prevent loss of reduction.
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Objective To compare the safely between 3 ways of inserting the anteroinferior iliac spine channel screws using computer simulation.Methods The spiral pelvic CT data of 100 patients were collected who had sought medical treatment at General Hospital of The Northern Theater Command from October 2017 to October 2018.They were 61 males and 39 females,aged from 20 to 60 years (average,47.5 years).The data were imported into Mimics (Materi-alise,Belgium) software to create three-dimensional models of the pelvis.The pelvic modeling data were then imported into 3-Matic (Materi-alise,Belgium) software for post-processing.Three cylinders with a diameter of 6.7 mm were created,taking the anteroinferior iliac spine as the entry point and taking the posterosuperior iliac spine,the posteroinferior iliac spine and the midpoint between the 2 spines as the 3 exit points.The insertion of anteroinferior iliac spine channel screws was simulated to observe the screw penetration.Results In the channel from the anteroinferior iliac spine to the posterosuperior iliac spine,penetration occurred in 41 cases out of the medial ilium and in 2 cases out of the lateral ilium,giving a penetration rate of 43％ (43/100);in the channel from the anteroinferior iliac spine to the midpoint between the 2 spines,penetration occurred in 16 cases out of the medial ilium and in 2 cases out of the lateral ilium,giving a penetration rate of 18％ (18/100);in the channel from the anteroinferior iliac spine to the posteroinferior iliac spine,penetration occurred in 6 cases out of the medial ilium,in 2 cases out of the lateral ilium,in 60 cases out of the greater sciatic notch and in 8 cases out of both the medial ilium and greater sciatic notch,giving a penetration rate of 76％ (76/100).There were significant differences between the 3 ways of insertion in the screw penetration (x2 =68.219,P ＜ 0.001).The rate of screw penetration in the channel from the anteroinferior iliac spine to the posteroinferior iliac spine was significantly higher than that in the channel from the anteroinferior iliac spine to the posterosuperior iliac spine which was significantly higher than that in the channel from the anteroinferior iliac spine to the midpoint between the 2 spines (P ＜ 0.05).Conclusions The channel from the anteroinferior iliac spine to the midpoint between the posterosuperior iliac spine and the posteroinferior iliac spine may lead to a lower rate of screw penetration while the channel from the anteroinferior iliac spine to the posteroinferior iliac spine may lead to a higher rate of screw penetration.
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Objective To investigate the effect of X-ray fluoroscopy and CT guided technique in sacroiliac screw fixation for type Tile B or C sacrum pelvic fractures or dislocations.Methods A retrospective case control study was conducted to analyze the clinical data of 103 patients with type Tile B or C posterior pelvic ring fracture or dislocation admitted to the General Hospital from Northern Theater of PLA from January 2007 to December 2017.There were 58 males and 45 females,aged 28-69 years,with an average age of 43.8 years.Among the patients,84 had normal sacrums while 19 had dysmorphic sacrums.The accuracy and placement time of two kinds of sacroiliac screw were compared by X-ray fluoroscopy(46 patients with normal sacroiliac screw placement and 11 with dysmorphic sacroiliac screw placement)or CT guidance(66 patients with normal sacroiliac screw placement and 18 with dysmorphic sacroiliac screw placement)were compared.Matta standard was used evaluate the imagelogical healing and clinical prognosis 9 months after operation.Results In normal sacrum group,there was no statistical difference in placement accuracy between X-ray fluoroscopy [89％(41/46)] and CT guided technique [94％(62/66)](P＞0.05).In dysmorphic sacrum group,the placement accuracy of CT guided technique [89％(17/18)] was significantly higher than that of X-ray fluoroscopy [55％(6/11)](P＜0.05).The screw placement time of X-ray fluoroscopy [(39.1±4.9)minutes] was significantly shorter than that of CT guided technique(54.7±3.8)minutes for normal sacrums(P＜0.05),and there was no significant difference in terms of placement time by CT guided technique for dysmorphic sacrums(P＞ 0.05).Nine months after operation,in normal sacrum group,the X-ray fluoroscopy had the excellent rate of 74％(34/46),good rate of 26％(12/46)for healing and the excellent rate of 83％(38/46),good rate of 17％(8/46)for clinical prognosis,showing no significant difference from those of CT guided technique [83％(55/66),17％(11/66); 92％(61/66),8％(5/66)](P＞0.05).In dysmorphic sacrum group 9 months after operation,the excellent and good rate of X-ray fluoroscopy [excellent 9％(1/11),good 64％(7/11)] was significantly lower than that of CT guided technique in terms of imageological healing [excellent 56％(10/18),good 39％(7/18)](P＜0.05),while no signtficant difference was found in terms of clinical prognosis [excellent 55％(6/11),good 36％(4/11)vs excellent 78％(14/18),good 22％(4/18)](P＞0.05).Conclusions X-ray fluoroscopy for the fixation of type Tile B or C posterior ring fractures or dislocations of the normal sacrum takes much shorter time,although the comparable effect with CT guidance in aspects of placement accuracy and bone healing rate.For the dysmorphic sacrum,CT guidance allows more accurate screw placement and has better healing rate than X-ray fluoroscopy.
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Objective@#To investigate the effect of X-ray fluoroscopy and CT guided technique in sacroiliac screw fixation for type Tile B or C sacrum pelvic fractures or dislocations.@*Methods@#A retrospective case control study was conducted to analyze the clinical data of 103 patients with type Tile B or C posterior pelvic ring fracture or dislocation admitted to the General Hospital from Northern Theater of PLA from January 2007 to December 2017. There were 58 males and 45 females, aged 28-69 years, with an average age of 43.8 years. Among the patients, 84 had normal sacrums while 19 had dysmorphic sacrums. The accuracy and placement time of two kinds of sacroiliac screw were compared by X-ray fluoroscopy (46 patients with normal sacroiliac screw placement and 11 with dysmorphic sacroiliac screw placement) or CT guidance (66 patients with normal sacroiliac screw placement and 18 with dysmorphic sacroiliac screw placement) were compared. Matta standard was used to evaluate the imageological healing and clinical prognosis 9 months after operation.@*Results@#In normal sacrum group, there was no statistical difference in placement accuracy between X-ray fluoroscopy [89%(41/46)] and CT guided technique [94%(62/66)](P>0.05). In dysmorphic sacrum group, the placement accuracy of CT guided technique [89%(17/18)] was significantly higher than that of X-ray fluoroscopy [55%(6/11)] (P<0.05). The screw placement time of X-ray fluoroscopy [(39.1±4.9)minutes] was significantly shorter than that of CT guided technique (54.7±3.8)minutes for normal sacrums (P<0.05), and there was no significant difference in terms of placement time by CT guided technique for dysmorphic sacrums (P>0.05). Nine months after operation, in normal sacrum group, the X-ray fluoroscopy had the excellent rate of 74% (34/46), good rate of 26% (12/46) for healing and the excellent rate of 83% (38/46), good rate of 17% (8/46) for clinical prognosis, showing no significant difference from those of CT guided technique [83%(55/66), 17%(11/66); 92%(61/66), 8%(5/66)] (P>0.05). In dysmorphic sacrum group 9 months after operation, the excellent and good rate of X-ray fluoroscopy [excellent 9%(1/11), good 64%(7/11)] was significantly lower than that of CT guided technique in terms of imageological healing [excellent 56%(10/18), good 39%(7/18)](P<0.05), while no significant difference was found in terms of clinical prognosis [excellent 55%(6/11), good 36%(4/11) vs. excellent 78%(14/18), good 22%(4/18)](P>0.05).@*Conclusions@#X-ray fluoroscopy for the fixation of type Tile B or C posterior ring fractures or dislocations of the normal sacrum takes much shorter time, although the comparable effect with CT guidance in aspects of placement accuracy and bone healing rate. For the dysmorphic sacrum, CT guidance allows more accurate screw placement and has better healing rate than X-ray fluoroscopy.
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Objective To investigate the early clinical efficacy of Masquelet membrane induction technique in the treatment of traumatic long bone defects.Methods A retrospective case series study was conducted to analyze the clinical data of 41 patients with traumatic long bone defects admitted to the General Hospital of the Northern Theater Command from January 2012 to April 2017.There were 36 males and five females,aged 15-70 years,with an average of 38.2 years.There were 20 patients with bone defect at the femur,19 at the tibia,one at the fibula,and one at the ulna.All patients received staged treatment using the Masquelet membrane induction technique.In stage Ⅰ surgery,thorough debridement was first performed,and the secretions were taken for bacterial culture.The average bone defect length after debridement was 6.9 cm (2.0-18.5 cm).The bone defect was filled with antibiotic bone cement to induce the biofilm formation.If the postoperative bacterial culture showed positive results,debridement surgery was performed again.Stage Ⅱ surgery was performed after 6-12 weeks.The white blood cell count,C-reactive protein (CRP),procalcitonin (PCT),erythrocyte sedimentation rate (ESR) were measured before the operation.During the operation,bone biopsy was performed,and the bone cement placeholder was completely removed.The autologous cancellous bone and artificial bone were implanted in the bone defect areas,and the induced membrane was sutured.The healing time of bone defects was recorded,and the Paley fracture healing scoring criteria were used to evaluate the limb function.The complications were observed.The inflammatory markers were reviewed at the last follow-up.Results All patients were followed up for 7-36 months with an average of 13.6 months.A total of 37 patients obtained bone healing.The fracture healing rate of stage Ⅰ was 90％,and the healing time was 6-13 months,with an average of 9 months.According to the Paley fracture healing scoring criteria,the results were excellent in 25 patients,good in 10,and fair in two patients,with the excellent and good rate of 85％.In terms of complications,one patient with superficial infection recovered after dressing change,three patients had deep infection,of which one patient was treated with amputation and two received other treatments,and three patients were treated with membrane induction again because of bone resorption.At the last follow-up,there were significant differences between preoperative and postoperative White blood cell count,CRP,PCT and ESR(P ＜ 0.05).Conclusion For traumatic long bone defects,Masquelet membrane induction technique can promote fracture healing,restore limb function and reduce complications.
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Objective To evaluate regenerative nerve and functional recovery of target muscle in rats with sciatic nerve defect bridged by acellular nerve allograft made through chemical extraction.Methods Sciatic nerve of SD rats was processed in a volume fraction of 3％ Triton X-lO0 solution and 40 g/L sodium deoxycholate solution.Morphology of myelin sheath,axons and basal lamina tubes of sciatic nerve segments was observed under the light microscopy before and after the chemical processing.Twenty-five Wistar rats were divided into acellular nerve allograft group (n =10),autograft group (n =10) and normal control group(n =5) according to the random number table.A 1 cm sciatic nerve defect was created in acellular nerve allograft group and autograft group,and was respectively bridged by acellular nerve allograft and autograft.Sciatic nerve function index (SFI) was measured every two weeks.Twelve weeks after surgery,nerve conduction velocity (NCV),recovery rate of compound muscle action potential (CMAP) and recovery rate of muscle force were measured in each group.Results Cellular components including myelin sheath and axons were removed thoroughly,but the basal lamina tubes were preserved completely.At postoperative 2,4,6,8,10 and 12 weeks,SFI in normal control group (-1.7±5.9,-0.3 ±2.5,0.8 ±4.1,-1.4±3.6,-2.5 ±5.7 and-2.1±3.2) was superior over autograft group (-94.3±3.7,-90.1±4.1,-63.7±7.8,-51.9±8.2,-48.8±8.6 and -44.3 ± 10.5) and acellular nerve allograft group (-97.1 ± 5.3,-91.2 ± 6.1,-70.6 ± 5.5,-60.4±6.2,-58.2 ±10.2 and-56.4 ±8.0) (P ＜0.01).At postoperative 6,8,10 and 12 weeks,SFI in autograft group were better than those in acellular nerve allograft group (P ＜0.05).NCV [(61.6 ± 8.1) m/s],recovery rate of CMAP[(98.7 ± 5.9) ％] and recovery rate of muscle force [(101.8 ± 6.6) ％] in normal control group were higher than those in acellular nerve allograft group [(22.3 ± 4.7) m/s,(40.3 ± 9.2) ％ and (43.8 ± 9.3) ％] and those in autograft group [(29.0 ±5.5) m/s,(52.5 ± 10.6) ％ and (54.3 ± 10.5) ％] (P ＜ 0.01).NCV,recovery rate of CMAP and recovery rate of muscle force in autograft group were better than those in acellular nerve allograft group (P ＜ 0.05).Conclusions Acellular nerve segments are harvested satisfactorily by chemical extraction.Sciatic nerve defect in rats can be cured with the acellular nerve allograft,but the repair effect of autograft is relatively better.