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Objective:To investigate the efficacy of a minimally invasive three-window incision and internal fixation with a novel anatomical locking plate in the treatment of calcaneal fractures.Methods:A retrospective analysis was performed of the 46 patients with calcaneal fracture (Sanders typeⅡ and Ⅲ) who had been admitted to Department of Orthopedics, Luoyang Orthopaedic Hospital of Henan Province from February 2015 to May 2017. They were 22 males and 24 females, aged from 19 to 59 years (average, 39.0 years) and with 16 left and 30 right sides affected. They were all treated with a minimally invasive three-window incision and internal fixation with a novel anatomic locking plate. Their B?hler and Gissane angles, and height, width and length of the calcaneus were compared between preoperation, immediate postoperation and the last follow-up. Their ankle-hindfoot functions were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring scale at the last follow-up; their complications were recorded.Results:All the 46 patients were followed up immediately after operation and for 14 to 18 months (mean, 16 months). All the fractures achieved bony union after an average of 3 months (from 2 to 4 months). At immediate postoperation and at the last follow-up, their calcaneal B?hler angles (34.20°±3.62° and 34.05°±3.65°) and Gissane angles (131.45°±6.04° and 131.25°±5.88°), and calcaneal heights [(41.05±2.76) mm and (40.90±2.86) mm], widths [(25.65±1.53) mm and (25.55±1.64) mm] and lengths [(76.82±1.70) mm and (76.73±1.78) mm] were significantly improved compared with the preoperative values [10.55°±7.51°, 95.32°±12.16°, (26.10±4.54) mm, (37.71±3.42) mm and (65.91±2.10) mm] ( P<0.05). There were no significant differences in the above indexes between immediate postoperation and the last follow-up ( P>0.05). According to AOFAS ankle-hindfoot scores at the last follow-up, the efficacy was evaluated as excellent in 28 cases, as good in 12 cases and as fair in 6 cases, yielding an excellent and good rate of 87.0%. No incision infection occurred after operation. Conclusion:In the treatment of calcaneal fractures of Sanders type Ⅱ and Ⅲ, the minimally invasive three-window incision and internal fixation with the novel calcaneal anatomical locking plate can achieve satisfactory reduction and rigid fixation, effectively reducing postoperative incision complications.
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Objective:To evaluate the curative efficacy of a buttress plate combined with Kirschner wires for treatment of Regan-Morrey type Ⅱ coronoid fracture after elbow terrible triad injury.Methods:A retrospective study was conducted of the 20 patients who had been surgically treated for Regan-Morrey type Ⅱ coronoid fracture after elbow terrible triad injury from August 2014 to August 2018 at Department of Pelvic Trauma, Henan Luoyang Orthopedic-Traumatological Hospital. They were 12 men and 8 women, aged from 18 to 60 years (average, 39 years), with 6 left and 14 right sides affected. All the coronoid fractures were fixated with Kirschner wires plus a buttress plate through the anterior approach, the radial head and lateral collateral ligaments (LCL) were repaired through the posterolateral approach, and the medial collateral ligament (MCL) was repaired or fixated with a hinged external fixator if necessary. The curative efficacy was evaluated at the last follow-up by range of motion (ROM) of the elbow, Mayo elbow performance score (MEPS), American Shoulder and Elbow Surgeons Scale (ASES) and radiographs of the elbow. Complications were also recorded.Results:The mean follow-up time was 18 months (from 12 to 24 months) and the mean healing time 5 months. At the last follow-up, ROM in flexion and extension of the affected elbow joint averaged 132.5°, ROM in elbow pronation-supination 150°, MEPS 88, and ASES 87. No subluxation or dislocation occurred after elbow surgery. The fracture of coronoid process was slightly displaced in one case but eventually healed without affecting any elbow function; fat liquefaction occurred around the posterolateral incision in 2 cases but healed after debridement; traumatic arthritic changes occurred in 5 patients but no significant dysfunction of the elbow was observed.Conclusion:A buttress plate combined with Kirschner wires can lead to fine curative efficacy for Regan-Morrey type Ⅱ coronoid fracture after elbow terrible triad injury.
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Objective:To compare the curative effects between anatomic locking plate and common reconstruction plate in the treatment of acetabular posterior wall fracture.Methods:The 50 patients with acetabular posterior wall fracture were retrospectively analyzed who had been admitted to Department of Pelvic Trauma Surgery, Luoyang Orthopaedic Hospital of Henan Province from February 2015 to February 2020. They were assigned into 2 groups according to different internal fixation methods. In the reconstruction plate group of 24 patients whose fractures were fixated by a common reconstruction plate from February 2015 to June 2017, there were 21 males and 3 females with an age of (38.9±10.9) years. In the anatomical plate group of 26 patients whose fractures were fixated by an anatomic locking plate between July 2017 and February 2020, there were 20 males and 6 females with an age of (38.0±10.0) years. The 2 groups were compared in terms of operation time, intraoperative blood loss, reduction quality, hip function and complications at the last follow-up.Results:There was no significant difference in the preoperative general data between the 2 groups, indicating the 2 groups were comparable ( P>0.05). The 50 patients were followed up for 18 to 26 months (mean, 22 months). The operation time [(132.8±8.6) min] and intraoperative blood loss [(357.0±14.7) mL] in the anatomic plate group were significantly less than those [(177.2±5.9) min and (492.0±17.6) mL] in the reconstruction plate group( P<0.05). Postoperative CT examination showed that 96.2% (25/26) of the patients in the anatomical plate group and 91.7% (22/24) of the patients in the reconstruction plate group had a fracture step ≤3 mm, showing no significant difference ( P>0.05). At the last follow-up, the excellent and good rate by Harris hip score was 92.3% (24/26) in the anatomic plate group, significantly higher than that (66.7%, 16/24) in the reconstruction plate group ( P<0.05). The incidence of complications was 3.8% (1/26) in the anatomic plate group, significantly lower than that [29.2% (7/24)] in the reconstruction plate group ( P<0.05). Conclusion:Anatomical locking plate is better than common reconstruction plate in the treatment of acetabular posterior wall fracture.
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Objective:To evaluate the efficacy of fumigation with Shujin-Jieluan Decoction combined with Pingheng-Shujin Manipulation (manipulation of balance and muscle tendon relaxing) in the treatment of chirospasm after stroke. Methods:A total of 104 patients with chirospasm after stroke who metthe inclusion criteria from July 2016 to June 2018 were selectedand divided into tow groups with the digital table methodwith 52 cases in each group. The control group was given routine rehabilitation training while the observation group was given fumigation with Shujin-Jieluan decoction combined with Pingheng-Shujin manipulation based oncontrol group, and the two groups both were treated for 8 weeks. The Modified Ashworth Scale (MAS) was used for chirospasm classification, and Key Point tabletop electromyography device was used to record the frequency, average amplitude and the shortest latency of F wave of median nerve. Fugl-Meyer motor function rating scale was used to evaluate hand motor function, and modified Barthel Index (BI) was used to evaluate life functionand clinical efficacy. Results:The effective rate was 88.5% (46/52) in observation group and was 65.4% (34/52) in control group ( χ2=7.800, P=0.005). After treatment, the frequency (15.11 ± 2.06 vs. 16.72 ± 1.95, t=4.093), average amplitude (0.52 ± 0.04 mV vs. 0.59 ± 0.05 mV, t=7.883) and the shortest latency (24.37 ± 2.85 ms vs. 25.88 ± 2.43 ms, t=2.907) of F wave in observation group were significantly lower than the control group ( P<0.01). Fugl-Meyer hand function score (6.51 ± 1.45 vs. 5.09 ± 1.22, t=5.404) and BI index score (60.87 ± 5.16 vs. 56.54 ± 4.25, t=4.671) were significantly higher than the control group ( P<0.01). The distribution of MAS classification in observation group was significantly lower than that of control group ( Z=8.410, P=0.004). Conclusions:Fumigation with Shujin-Jieluan Decoction combined with Pingheng-Shujin Manipulation can improve the neuromuscular transmission of patients with chirospasm after stroke, and facilitate the recovery of hand function and viability.
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Objective@#To evaluate the efficacy of fumigation with Shujin-Jieluan Decoction combined with Pingheng-Shujin Manipulation (manipulation of balance and muscle tendon relaxing) in the treatment of chirospasm after stroke.@*Methods@#A total of 104 patients with chirospasm after stroke who metthe inclusion criteria from July 2016 to June 2018 were selectedand divided into tow groups with the digital table methodwith 52 cases in each group. The control group was given routine rehabilitation training while the observation group was given fumigation with Shujin-Jieluan decoction combined with Pingheng-Shujin manipulation based oncontrol group, and the two groups both were treated for 8 weeks. The Modified Ashworth Scale (MAS) was used for chirospasm classification, and Key Point tabletop electromyography device was used to record the frequency, average amplitude and the shortest latency of F wave of median nerve. Fugl-Meyer motor function rating scale was used to evaluate hand motor function, and modified Barthel Index (BI) was used to evaluate life functionand clinical efficacy.@*Results@#The effective rate was 88.5% (46/52) in observation group and was 65.4% (34/52) in control group (χ2=7.800, P=0.005). After treatment, the frequency (15.11 ± 2.06 vs. 16.72 ± 1.95, t=4.093), average amplitude (0.52 ± 0.04 mV vs. 0.59 ± 0.05 mV, t=7.883) and the shortest latency (24.37 ± 2.85 ms vs. 25.88 ± 2.43 ms, t=2.907) of F wave in observation group were significantly lower than the control group (P<0.01). Fugl-Meyer hand function score (6.51 ± 1.45 vs. 5.09 ± 1.22, t=5.404) and BI index score (60.87 ± 5.16 vs. 56.54 ± 4.25, t=4.671) were significantly higher than the control group (P<0.01). The distribution of MAS classification in observation group was significantly lower than that of control group (Z=8.410, P=0.004).@*Conclusions@#Fumigation with Shujin-Jieluan Decoction combined with Pingheng-Shujin Manipulation can improve the neuromuscular transmission of patients with chirospasm after stroke, and facilitate the recovery of hand function and viability.
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BACKGROUND:Idiopathic scoliosis is most common among al the scoliosis. Accompanied by the nervous system, the endocrine system as wel as nutritional and metabolic abnormalities, patients usual y cannot be redressed and cured by conservative treatment, but often require surgical operation. Surgery for malformation is a very complicated project, and is real y of great significance for an in-depth research on treatment and turnover of idiopathic scoliosis. OBJECTIVE:To observe the correction effect of posterior screw-rod fixation for idiopathic scoliosis, and explore the relevant factors influencing its effectiveness. METHODS:We retrospectively analyzed 80 cases receiving pedicle screw fixation in the treatment of idiopathic scoliosis in the latest four years. Age, gender, disease duration, preoperative and postoperative X-ray measurement of coronal Cobb’s angle, and trunk deviation were recorded, and statistical y analyzed. RESULTS AND CONCLUSION:Univariate analysis showed that gender and disease duration were not significantly correlated with postoperative correction results (P>0.05). However, the age distribution of patients, the location of scoliosis, and scoliosis flexibility were associated with curative effects of internal fixation (P<0.05). Posterior screw-rod fixation for idiopathic scoliosis can achieve significant effects. The patient’s age, location and flexibility of scoliosis have a significant effect on the effects of fixation. The patient’s gender and disease duration had no significant effect on fixation effects.
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Objective To analyze the cause and treatment of the postoperative complications using one-stage posterior spinal osteotomy in the treatment of severe spinal deformity.Methods From September 2006 to May 2013,17 patients with severe spinal deformity (congenital scoliosis in 11 cases,congenital kyphosis in 4 cases,and congenital kyphoscoliosis in 2 cases) underwent one-stage posterior spinal osteotomy,including 5 males and 12 females with an average age of 22.6 (14-51) years.The preoperative mean coronal Cobb angle was 109° (85°-160°) while the mean sagittal Cobb angle was 104° (65°-152°).Two patients had neurological symptoms preoperatively whose spinal cord function was D,evaluated by ASIA classification.All patients were treated with pedicle subtration osteotomy and pedicle screw internal fixation,which SPO osteotomy 2 cases,PSO osteotomy 11 cases,VCR osteotomy 4 cases.Results There were 17 cases of complications in 147 patients,the complication rate was 11.6％(17/147).The causes were as followed,screw malposition in 2 cases,compromised by close of resected areas in 2 case,residual bone compression in 1 case,acute spinal cord injury in 2 cases,infection in 2 cases,broken stick or loosen hat in 3 cases,and superior mesenteric artery syndrome in 5 cases.Postoperative neurological complications occurred in 7 cases.Two cases with preoperative ASIA D became ASIA C,5 cases with normal nerve function became ASIA C in 2 cases and ASIA D in 3 cases.After surgical exploration,given Methylprednisolone and neurotrophic drugs,removal or changing of the internal fixation,anti-infection and symptomatic treatment,15 cases recovered completely and 2 cases improved partially.Conclusion One-stage posterior spinal osteotomy for severe spinal deformity is technical demanding and risky,and the postoperative complications are common.Appropriate operative procedure,close observation of sensation and motor function,timely surgical exploration and nerve decompression,and early brace wear are all required.
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Objective To investigate the effect of methylprednisolone (MP) combined with puerarin in preventing the spinal cord ischemia-reperfusion injury (SCII).Methods The model of ischemia-repeffusion injury was established by clipping the abdominal aorta of rats for 30 min.Eighty male SD rats were randomly and equally divided into 4 groups: the blank group in which the abdominal aorta was only exposed,the positive drug group in which intravenous MP injection (30 mg/kg) was conducted 30 min before the establishment of the ischemia-reperfusion injury model,the therapy group in which intravenous MP (10 mg/kg)and puerarin (30 mg/kg) injection was conducted 30 min before the establishment of the model,and the model group in which the physiological saline equivalent to the volume of MP in the positive drug group were injected into the caudal vein of rats 30 min before the establishment of the model.Ten rats were taken from each group and the homogenation of the spinal cord was used to test expression level of superoxide dismutase (SOD) and sodium-potassium adenosinetriphosphatase (Na-K ATPase).For another 10 rats in each group,the BBB scoring system was used to evaluate the neural function of the hind limb immediately after recovery from anesthesia,12 h and 24 h after reperfusion,and the spinal cord was obtained 24 h after reperfusion to observe the morphous of the spinal cord neurons.Results The expression levels of SOD and Na-K ATPase in the model group,positive drug group and therapy group 3 h after reperfusion were significantly lower than that in the blank group; the expression levels of SOD and Na-K ATPase in positive drug group and therapy group were significantly higher than that in the model group,and there was no significant difference between the positive drug group and the therapy group with regard to the levels of SOD and Na-K ATPase.The BBB score was better in the positive drug group and the therapy group than those in the blank group and model group.Microscope observation showed that the degree of injury between positive drug group and therapy group was equivalent,while each of them was lower than that in the model group.Conclusion MP combined with puerarin plays a great role in the prevention of the SCII.