The correlations of infection rates with the administration timing of prophylactic antibiotics after hip arthroplasty / 实用医学杂志

Objective To assess the effects of different administration timing of prophylactic antibiotics on infections after hip arthroplasty. Methods 535 patients having undergone arthroplasty were divided into two groups: the experiment group (n=273)and the control group (n=262): The former groupwere administered with antibiotics until 24 hours postoperatively and the latter until 72 hours postoperatively. The two groups were compared in terms of postoperative infection rate. Results The infection rates in the experimental groupand the control group were 4.396%and 3..817%, with insignificant differencebetween them. Conclusion For those patients undergoing hip arthroplasty, extended administration of antibiotics after operation (over 48 hours) may not reduce the risk of recent the infection rate.

The role of thoracolumbar injury classification and severity score in the gudience of anterior, posterior or combined surgery for thoracolumbar fractures / 中国综合临床

Objective To investigate the guidance role and effect of the thoracolumbar injury classification and severity score (TLICS) in the choice of anterior,posterior or combined surgery for thoracolumbar fractures.Methods Thirty-one consecutive patients with acute thoracolumbar burst fractures who were treated in an our unit were selected as our subjects who hospitalized from Oct.2006 to Sep 2010,There were 20 male and 11 female patients.The average age was 44.7 years (range from 35.0 to 56.0 of all patients 3 was injured T11,6 at T12,7 at L1,8 at L 2 and 7 at L3.The reasons of injury include motor vehicle accident (10 cases)and falling from a height (24).All patients had preoperative anteroposterior and lateral radiographs,computed tomography (CT) scan,and magnetic resonance imaging (MRI) examination to more fully assess vertebral pieces and nerve compression.According to the Classification of Maged,there were 8 cases with type A3,8 cases with B1,9 cases with B2,3 cases with C1,3 case with C2.Neurologic status based on Frankel classification showed that 4 cases were with grade A 8 with grade B,9 with grade C 6 with grade D and 4 with grade E.Of the 31 patients,11 received posterior surgeries,12 anterior surgeries,and 8 combined anterior and posterior surgeries.Results Twenty-eight cases were followed up with averaged 13.7 months (range from 12.0-17.0 months).The kyphosis angle was measured from the superior endplate to the inferior end plate of the fractured vertebral body using the Cobb technique.The mean cobb's angle was (23.7 ± 11.3) ° (range,13.0 ～ 38.0°) preoperatively,(5.8 ± 0.6°) (-4.0 ～ 6.0) ° lordotic post operatively and (11.3 ± 10.6) ° lordotic at the final observation.The average surgical time was 190 minutes (range,90-380 minutes).and blood loss was 1680 ml (range,1260-2540 ml),and hospital stay was 17.4 days (range,10-24 days).No eloosening or motion was observed in the final follow-up patients.Conclusion TLICS has facilitate treatment decision making of thoracolumbar spinal column injuries and proved to be an effective treatment for serious thoracolumbar fracture.

A comparative study of two treatment approaches on femoral shaft fractures of polytrauma patients / 中国综合临床

Objective To compare the effect of two different treatment approaches on femoral shaft fractures in polytrauma patients.Methods One hundred and forty-eight polytrauma patients were selected as our subjects,who were hospitalized from Jan.2000 to Dec.2009.They were randomly divided into cast group and external fixation group.Patients in cast group were fixed with cast within the first 24 h after the injury and patients in external fixation group were stabilized with a unilateral external fix stent within the first 24 h after the injury.Results In cast group,71 of 75 patients were followed up and follow up periods was 26.4 months.Follow up data showed that 18 patients developed multiple organ failure (MOF) and 26 patients developed ARDS.The average healed periods was 5.9 month.Three patients developed nonunion and 4 cases developed wound infection.The average of the knee motion angle was 107 degrees (60 to 110 degrees).In external fixation group,68 patients were followed up and the follow-up period was 27.5 months.Of which,13 patients developed MOF and 12 patients developed ARDS.The average healed periods was 5.6 months.2 patients developed nonunion and 3 cases developed for.wound infection.The average of the knee motion angle was 120 degrees (60 to 140 degrees).Conclusion The damage control orthopedics surgery was proved as a safe and effective treatment approach for fractures of the shaft of the femur in selected multiply injured patients compared with cast methods.

Anterior open reduction and internal fixation to treat the lower cervical irreducible dislocation / 中国基层医药

Objective To explore the possibility of anterior open reduction and internal fixation to treat the lower cervical irreducible dislocation. Methods 15 cases of lower cervical irreducible dislocation were treated by the anterior open reduction and internal fixation, 11 cases were male and 4 cases were female, 10 cases were unilateral facet locked and 5 eases were bilateral facet locked which were confirmed by the MRI and CT scan. All the cases were failed to the skull traction before operation and received anterior open reduction and plate fixation, and interver-tebral fusion. All the cases were followed up, the recovery of neurological function and the fusion rate were evaluated. Results 15 cases were completely reduction and none of them got a worse neurological function. Conclusion The treatment effect of anterior open reduction and fixation for the lower cervical irreducible dislocation were good.

Choice of Treatment and Clinical Analysis of Femoral Neck Fracture in Children / 中山大学学报(医学科学版)

【Objective】To compare different approaches and their effectiveness on the treatment of the femoral neck fracture in children,in order to provide a reliable and effective way for the treatment of the disease.【Methods】Clinical data of 21 cases with femoral neck fracture from 1983 to 1993 were analyzed retrospectively.【Results】21 cases were divided into three groups:① group Ⅰ:14 cases underwent closed reduction and internal fixation with multiple Kirscher′s pins or cannulate compression screws under C-arm X-ray monitor.Of the 14 cases,11 cases were healed,3 cases developed ischemic necrosis of femoral head;② group Ⅱ:4 cases was treated with skin traction and hip spica cast plaster fixation,3 cases was healed,1 case developed ischemic necrosis of femoral head;③ group Ⅲ:3 cases underwent opened reduction and internal fixation with multiple pins or cannulate compression screws,1 case was healed,2 cases developed ischemic necrosis of femoral head.【Conclusion】Closed reduction and multiple pins internal fixation under C-arm X-ray monitor may be the best choice of treatment of femoral neck fracture in children.

Open reduction and internal fixation for intercondylar comminuted fractures of the humerus by AO reconstructive plate / 中华骨科杂志

Objective To study the method and outcome for intercondylar comminuted fractures of the humerus through open reduction and internal fixation with AO reconstructive plate. Methods From March 1997 to September 2000, 31 cases of intercondylar comminuted fracture of humerus were reviewed, which involved 24 males and 7 females with an average age of 37.4 years (range, 18-67 years). The fracture was located on left side in 17 and on right side in 14. According to AO/ASIF classification, there were C1 in 11, C2 in 12, and C3 in 8, among them, 9 cases were open fractures including of Cusstilo and Aderson typeⅠin 5 and Ⅱ in 4. Posterior trans-olecranon osteotomy with open reduction and internal fixation by AO reconstructive plate or plus 1/3 tube plate were performed in all the cases within 48 hours after injury. The osteotomy was "V" shape at 2 cm to proximal end of ulna. All the patients began the passive motion exercise within 24-48 h, and active training at one week postoperatively. X-ray was taken in 1, 3, 6 and 12 months after operation to observe the bony union. 5 cases with ulnar nerve injury underwent nerve exploration and anterior transposition. Results All the cases were followed up 1-3.4 years (average, 1.5 years), the fractures healed well, and the elbow function recovered satisfactorily. According to the Cassebaum scoring system, 11 were assessed as excellent 11, good 14 and fair 6, and the excellent-good rate was 80.6%. The complications included 1 infection, 1 heterotopic ossification and 2 injuries of the radial nerve, which recovered with dressings, antibiotics and neural nutrients. Conclusion The technique of AO reconstruction plating for the intercondylar comminuted fractures of the humerus through trans-olecranon approach offers many advantages, such as sufficient exposure, anatomical reduction, stable fixation, earlier exercise and satisfactory elbow function.