Application of guide combined with probing the internal wall of pedicle screw trajectory for subaxial cervical pedicle screw placement / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the skill and evaluate the accuracy for application of guide combined with probing the internal wall of pedicle screw trajectory for subaxial cervical pedicle screw placement.</p><p><b>METHODS</b>Subaxial cervical pedicle screw was inserted in 11 patients by the guide combined with probing the internal wall of pedicle screw trajectory from January 2014 to October 2016, including 7 males and 4 females with an average age of 48.1 years(ranged 32 to 63 years). There were 4 cases with cervical spondylotic myelopathy, 4 with fracture and dislocation of cervical vertebrae, 1 with cervical cord injury without fracture and dislocation, and 2 with atlantoaxialfracture and dislocation. The target pedicle's diameter, optimal entry point, sagittal angle and cross-sectional angle were measured by CT before operation. During operation, the pedicle screw inserted angle was controlled by a guide with a self-designed protractor and probed the internal wall of pedicle screw trajectory as medial safety margin of insertion screw. The accuracy of cervical pedicle screw was evaluated by CT with classification of four grades and assessed whether there was injury of spine cord or vertebral artery postoperatively.</p><p><b>RESULTS</b>Seventy-one cervical pedicle screws were placed among 11 patients, and no one had been found with clinical manifestations of injury of spine cord (or nerve root) or vertebral artery after operation. According to postoperative CT scan for evaluating the grade of screw position, 52 screws were in grade 0, 13 in grade 1, 4 in grade 2, 2 in grade 3, and 91% (65/71) located in good position. In total, 6 screws were incorreted in placement, and 4 cases of them broke medial wall and 2 cases broke lateral wall.</p><p><b>CONCLUSIONS</b>The method of probing the internal wall of pedicle screw trajectory for subaxial cervical pedicle screw placement is safe and reliable, but the studying curve is long. Probing the internal wall of pedicle screw trajectory and controlling the insertion angle by guide with a protractor are key points of this technology.</p>

Bone substitutes augmentation combined with internal fixation versus internal fixation alone in treating proximal femoral fractures in the elderly: a meta-analysis / 中国骨伤

<p><b>OBJECTIVE</b>To systematically review the effectiveness of bone substitute augmentation combined with internal fixation versus internal fixation alone in treating proximal femoral fractures in the elderly.</p><p><b>METHODS</b>Subject term and keywords were searched from Pubmed, Cochrane databases and CNKI from database foundation to August 2015. Randomized controlled studies and qusi-randomized controlled studies on bone substitutes augmentation combined with internal fixation versus internal fixation alone for the treatment of proximal femoral fractures in the elderly were chosen. Postoperative re-displacement, re-operation rate, complications (infection and bone ununion), functional outcome, quality of life scores and muscle strength were seen as outcome indicators. Enumeration data were statistical analyzed by risk difference and 95% confidence interval. Measurement data were analyzed by standardized mean difference and 95% confidence interval. If the same measurement data were evaluated by different standards in different studies, standardized mean differences and 95% confidence interval were used. The methods of statistical analysis were used by Cochrane databases.</p><p><b>RESULTS</b>Eleven RCTs (677 patients) were included. Meta-analysis results indicated that bone substitutes augmentation combined with internal fixation occurred fewer re-displacement [SMD = -0.75, 95% CI (-1.03, -0.47)] and obtained better function [SMD = 0.40, 95% CI (0.20, 0.59)]. While there were no significant differences in reoperation rate [RD = 0.02, 95% CI (-0.05, -0.09)], pain at 1 week after operation [MD = -1.79, 95% CI (-13.55, -9.96)], pain ranged from 6 to 8 weeks [MD = -7.24, 95% CI (-20.07, -5.59)], postoperative pain at 12 weeks [MD = -0.32, 95% CI (-4.9, -3.55)], muscle strength [MD = 1.25, 95% CI (-6.98, -9.48)], bone ununion [RD = 0.02, 95% CI (-0.01, -0.05)] and postoperative complications [MD = 0.01, 95% CI (-0.03, -0.04)].</p><p><b>CONCLUSION</b>Compared with single internal fixation, bone substitutes augmentation combined with internal fixation for the treatment of proximal femoral fractures in the elderly less occur re-displacement and could obtain better functional recovery.</p>

Strategy by stages for preventing respiratory complications of acute cervical spinal cord injury / 中国骨伤

<p><b>OBJECTIVE</b>To investigate clinical effects of strategy by stages for preventing respiratory complications of patients with acute cervical spinal cord injury (ACSCI).</p><p><b>METHODS</b>From September 2009 to May 2013,the clinical data of 91 patients with ACSCI underwent surgery were retrospectively analyzed. Among the patients, 42 patients were divided into in-stages group, including 30 males and 12 females with an average age of 50 years old (ranged 28 to 76) which were treated with strategy by stages for preventing respiratory complications; others 49 patients which were not treated with the strategy regarded as control group, including 38 males and 11 females with an average age of 47 years old (ranged 30 to 77). All of them had definite history of trauma, and were admitted to orthopaedics within 48 h after trauma. In in-stages group, respiratory muscle strength training, high-dose ambroxol using and other treatment were performed to prevent respiratory complilcations according to preoperative, intraoperative and postoperative stage. While in control group, there were no systematic and effective measures utilized. Chi-square test was used to evaluate the difference for respiratory complications rate, the rate of tracheostomy or intubation and mortality caused by the respiratory complications between two groups.</p><p><b>RESULTS</b>Ten patients developed with respiratory complications in in-stages group (7 patients with pneumonia, 1 with atelectasis and 2 with respiratory failure), among which 3 patients underwent tracheostomy or intubation. In control group, 24 patients developed with respiratory complilcations (15 with pneumonia,3 with atelectasis and 6 with respiratory failure), among which 11 patients underwent tracheostomy or intubation. There was significant difference between two groups (χ2 = 6.12, 4.07; P = 0.013, 0.044). Five patients died because of respiratory complications, one case were in in-stages group and 4 in control group. There was significant difference between two groups (χ2 = l.39, P = 0.238).</p><p><b>CONCLUSION</b>The strategy by stages is an effective method for preventing respiratory complications of ACSCI and can reduce the respiratory complications rate and improve the prognosis of respiratory complications.</p>

Research on the reliability of the Akagi line as a reference axis to guide for rotational alignment of the proximal tibial component in total knee arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To study on the reliability of the Akagi line as a reference axis to guide for rotational alignment of the proximal tibial component in total knee arthroplasty (TKA) the rotational alignment reference bony landmarks of the proximal tibial component on magnetic resonance image (MRI) were measured.</p><p><b>METHODS</b>From January 2010 to December 2013, 80 normal knees of Chinese volunteers including 35 males and 45 females with an average age of (35.4±6.1) years were reviewed. The images of the knees were obtained by MRI. The surgical epicondylar axis (STEA) was identified in the femoral transverse sections and then was projected to the side of tibia, forming the SETA'. A line connecting the medial border of the patellar tendon and the middle of the posterior cruciate ligament insertion (Akagi line) and its vertical line (AK), as well as a line connecting the medial 1/3 of the patellar tendon and the middle of the posterior cruciate ligament insertion and its vertical line (AP), were identified in the tibial transverse sections. The angles were measured between the AK, AP and STEA'.</p><p><b>RESULTS</b>The angle between AK and STEA' was (0.59±2.07)°, and there was no significant difference between the two lines (t=-2.54, P=0.13). The mean angle between AP and STEA' was (3.21±2.04)°, and there was a significant difference between the two lines (t=14.05, P<0.05). There was a significant difference between the AK and AP (t=-11.68, P<0.05).</p><p><b>CONCLUSION</b>The reliability of the Akagi line as a reference axis to guide for rotational alignment of the proximal tibial component in TKA is good.</p>

Clinical observation on the modified external fixation with splints for double fractures of forearm in children / 中国骨伤

<p><b>OBJECTIVE</b>To explore the advantages of conservative treatment for trauma of children,and evaluate effect of external fixation for the treatment of double fractures of forearm.</p><p><b>METHODS</b>From June 2007 to June 2008, 52 patients with double fractures of forearm were treated with manipulative reduction and modified external fixation by splints. Among them, 33 males and 19 females,the age was from 4 to 15 years with an average of 8.6 years. The course of disease was from 1 hour to 7 days. All patients had a definite history of trauma, and pre-treatment X-ray film showed double fracture of ulna and radius.</p><p><b>RESULTS</b>All patients were followed up from 6 to 14 months with an average of 9.4 months. All fractures healed and the healing time was from 4 to 8 weeks with an average of 6 weeks. The clinical effect was evaluated according to Berton criteria, 37 cases obtained excellent result, 15 good.</p><p><b>CONCLUSION</b>Strict choose indication of conservative treatment can obtain satisfied effect in treating double fractures of forearm in children. The method has advantages of safe operation, less injury, cheap expense, which can well obtain functional rehabilitation of patients.</p>

Surgical treatment of displaced intra-articular fractures of the calcaneus in elderly patients / 中国骨伤

<p><b>OBJECTIVE</b>To study the clinical effects of surgical treatment of displaced intra-articular fractures of the calcaneus in elderly patients, and to discuss the operative indications.</p><p><b>METHODS</b>From January 2000 to December 2007, 24 elderly patients with 26 fractures underwent open reduction and internal fixation for a displaced intra-articular fracture of calcaneus, which included 18 feet of 18 males and 8 feet of 6 female, with an average age of 67 years (range, 60 to 75 years). According to Sanders classification based on CT scanning, 13 fractures were rated as type II, 12 as type III and 1 as type IV. Böhler angle and Gissane angle were measured preoperatively and postoperatively and foot function was assessed with Maryland foot score system.</p><p><b>RESULTS</b>Twenty-four cases with 26 feet were followed up for an average of 18.4 months (range, 12 to 26 months). Mean Böhler angle was (10.4 +/- 8.2) degrees preoperatively and (27.8 +/- 7.4) degrees postoperatively and mean Gissane angle was (136.5 +/- 10.3) degrees preoperatively and (124.3 +/- 4.2) degrees postoperatively. The difference between preoperative and postoperative values was found with statistically significant (P < 0.05). The results were excellent in 5 feet, good in 16 feet, fair in 4 feet and poor in 1 foot. There were 3 cases of wound necerosis, 2 cases of wound infection, 1 case of sural nerve injury and 6 cases of posttraumatic subtalar arthritis complications.</p><p><b>CONCLUSION</b>Good clinical result could be obtained with surgical treatment in elderly patients with displaced intra-articular fractures of the calcaneus. Open reduction appears to be an acceptable method of treatment for displaced calcaneal fractures in elderly patients if they have good general conditions.</p>