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Objective:To anatomically study the external bone graft axis from the pedicle (canal) to the endplate designed for compression healing fractures of the anterior vertebral column in freshly dried vertebral specimens from T10 to L5.Methods:Eight groups of freshly dried vertebral specimens from T10 to L5 (128 vertebral bodies and 256 lateral pedicles and lateral vertebral bodies) were used to observe the vertebral axis of the pedicle (canal), the internal sagittal diameter of the pedicle (canal), and the sagittal diameter of the vertebral body, and the position of vertebral pedicle (canal) axis (f-angle) before design of the external bone graft axis from the pedicle (canal) to the endplate of the compression healing vertebral body. (1) The internal sagittal diameter of the pedicle (canal) was divided into 3 segments. The lateral segment of the vertebral plate was wide, the middle segment of the isthmus of the vertebral arch was narrow and the medial segment of the terminal segment of the vertebral arch was wide. The narrow isthmus of the middle arch (canal) was used as a transposition axis in the design of the axis of the bone graft from the vertebral arch (canal) to the endplate of the compression healing vertebral body. (2) The axis of the vertebral body of the pedicle (canal) was located medial to the transposition axis, parallel to the f-angle at 0° as described by Saillant G. (3) The compression degree of the vertebral body was measured at the outer edge of the lateral anterior column, with Ⅰ° for less than 1/4 compression of the anterior column of the vertebral body, Ⅱ° for 1/4 to 2/4, Ⅲ° for 2/4 to 3/4 and Ⅳ° for more than 3/4 of the compression. (4) The f-angle described by Salliant G at the entry end which was corresponding to the endplate of the compression healing vertebral body was used to design the pedicle (canal) to the outer implant axis of the endplate of the compression healing vertebral body.Results:At an f-angle of 8° to 10°, the bone graft axis was aligned with the Ⅱ° compression healing vertebral endplate on the superior endplate side of the vertebral body axis of the arch; at an f-angle of 16° to 18°, the bone graft axis corresponded to the superior endplate of the Ⅰ° compression healing vertebral body. At an f-angle of -10°~-8°, the bone graft axis corresponded to the Ⅲ° compression healing vertebral endplate on the inferior endplate side of the vertebral body axis of the arch; at an f-angle of -18°~-16°, the bone graft axis corresponded to the inferior endplate of the Ⅳ° compression healing vertebral body.Conclusions:The external axis from the pedicle (canal) to the endplate designed in the present anatomic study for compression healing fractures of the anterior vertebral column allows for safe and easy granular bone implantation due to the toughness of the cortical bone around the arch root (canal) in addition to the precise design of the bone graft axis from the pedicle to the endplate from T10 to L5.
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Objective To investigate the clinical effect of old thoracolumbar vertebral fracturekyphosis with spinal stenosis by pedicle of vertebral archosteotomy and internal fixation.Methods Twenty patients with old thoracolumbar fracture with kyphosis,and associated with spinal stenosis,were treated by using transpedicular osteotomy and internal fixation treatment in the First People's Hospital of Shangqiu from June 2012 to May 2014.Radiographical assessments including localized kyphosis,thoracic kyphosis,lumber lordosis,sacral tilt angle,sagittal vertical axis,bony fusion and the relative height of the ifiterbody fusion vertebra.Visual analogue scale(VAS),and ASIA were evaluated before and after surgery,and the operative duration,blood loss were recorded.Results The operation carried out in 120-200 min,800-1600 ml of bleeding statistics through operation process.Localized kyphosis was reduced from an average of (42.6±4.2) ° to (8.2± 1.6) °,the difference was statistically significant (P =0.012).All patients were followed up for 10.0 -26.0 months,average (18.0±6.2) months.The average VAS score was 6.88±0.82 before operation and 2.10 ±0.84 at final follow-up,the difference was statistically significant(P=0.023).The bone healed well,no false joints.Neurological function improved from C to D in 2 patients,from C to E in 4 patients,and from D to E in 14 patients.Conclusion Old thoracolumbar vertebral fracture kyphosis with spinal stenosis by transpedicularosteotomy and internal fixation in the treatment of simple operation,definite effect,less complications and can effectively improve the prognosis.
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Objective To investigate the clinical effect of high developmental dislocation of the hip in patients with total hip replacement operation to take biology.Methods Thirty-six cases of high developmental dislocation of the hip by patients as the object of study from January 2011 to February 2014 in the First People' s Hospital of Shangqiu, all patients underwent cementless total hip joint replacement operation, 6 months to 2 years after surgery, observed the clinical effect of all patients before and after treatemnt.Results The operation time was 1.20-3.0 h,the average operation time was (2.13±1.01) h,amount of bleeding during the operation of 300.00-700.00 ml,the average amount of bleeding was (342.43±34.23) ml;follow up of 6 months to 2 years, all patients had no prosthesis loosening and dislocation of the hip;all patients after treatment, Harris score (81.56± 14.34) points, better than that before treatment, the difference was statistically significant ((54.34 ± ±9.78) points,P=0.009);The excellent and good rate of all the patients after the treatment (97.22％) .Conclusion The clinical effect of high developmental dislocation of the hip by total hip replacement operation in patients taking biological type significantly, has the advantages of simple operation, effectively relieve pain, improve the life quality of patients and other advantages, the ideal treatment method can be used as high developmental dislocation of hip.
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Objective To investigate the clinical effect internal fixation combined with external fixator incision in the treatment of intra-articular fractures of the distal radius.Methods 80 cases of intra-articular distal radius fracture patients underwent cut internal fixation combined with external fixator in the treatment of orthopedic were chosen,postoperative rehabilitation exercises,fracture healing after the removal of the external fixator.All patients were followed up for 8 months to 12 months,an average of 9.2 months.Results 80 patients were intraarticular fractures healed,the time required was 4 to 10 months,an average of 6.3 months.In accordance with the assessment of functional systems Dienst wrist,51 cases wrist function were excellent,21 cases were good,the good rate was 90％ (72/80).There were no clinical fractures common complication after surgery.Conclusion Open internal fixation combined with external fixator treatment of intra-articular fractures of the distal radius fractures not only makes reduction of fracture and immobilization satisfaction,but also conducive to the wrist of early postoperative functional rehabilitation exercise.
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Objective To investigate the effect of improved bone plate fixation and bone grafting in the treat ment of intra-articular calcaneal fracture.Methods 80 patients with intra-articular calcaneal fractures were randomly divided into the two groups.The non-bone graft group(47 feet in 40 patients)was given improved bone plate fixation.The bone graft group(50 feet in 40 patients)was given improved bone plate fixation and bone grafting.Results The incidence rate of complication in the non-bone graft group was 25.0％ and that in the bone graft group was 19.1％.The difference between the two groups was not significant(x2 =0.21,P ＞ 0.05).Postoperative Bhler's angle and calcaneal height between the two groups had significant differences (t =14.5,16.99,all P ＜ 0.05).The excellent rate of Maryland functionality in non-bone graft group was 66.0％,which was significantly lower than 86.0％ in the bone graft group(x2 =5.38,P ＜ 0.05).The average full weight bearing time between the two groups had significant difference (t =11.17,P ＜ 0.05).Bhler's angle after 1 year and forwa rd Bhler's angle loss of the non-bone graft group had significant differences compared with the bone graft group (t =29.76,9.81,all P ＜ 0.05).Conclusion Improved bone plate fixation and bone grafting in the treatment of intra-articular calcaneal fracture can obtain better results and avoid the long-term loss of reduction.
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Objective To compare the outcomes of total hip replacement and minimally invasive dynamic hip screw in treating osteoporotic femoral intertrochanterie fractures.Methods Retrospectively analyze the clinical data of 56 patients with osteoporotic femoral intertrochanteric fractures who came to our hospital from July,2008-June,2012.Twenty eight cases who accepted minimally invasive dynamic hip screw were divided into the control group while 28 cases who accepted total hip replacement were divided into the experimental group.The blood loss and postoperative drainage,operative time,situation of implant loosening,the occurrence of postoperative complications and the clinical curative effect were compared between two groups.Results The differences in operative time,blood loss,and postoperative drainage flow,limited weight-bearing after operation was statistically significant between two group[(96.37 ± 20.42)min,(529.85±73.82) ml,(7.46±1.23) dvs (66.84±18.63)min,(152.79±37.35) ml,(14.32±2.62)d,t=5.653,24.117,12.542,P＜0.05].The differences in FRS score and Harris score between twogroups was not statistically significant [(27.75±3.59),(89.84±4.17) vs (26.41±3.16),(88.68±3.92),P＞ 0.05].The incidence in internal fixation loosening varied significantly with different degree of osteoporosis in the control group (66.7％vs18.8％,x2 =4.745,P ＜ 0.05) but not in the experimental group (11.1％ vs 10.0％,P＞0.05).Complication rate of the experimental group was significantly lower than the control group (3.6％vs 28.6％,x2 =4.766,P ＜ 0.05).Conclusions For the elder patients with osteoporotic femoral intertrochanteric fractures,the selection of surgical approach should be based on the patient's individual circumstances and the degree of osteoporosis.In the same time,attention should be paid to anti-osteoporosis therapy after operation.
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Objective To investigate the curative effect for lumbar spondylolisthesis by posterior lumbar intervertebral compression bone graft fusion and pedicle screw internal fixation.Method All 39 cases with lumbar spondylolisthesis accepted treatment during January 2003 to October 2007.There were cataplasia spondylolisthesis in 14 cases and isthmic spondylolisthesis in 25 cases.Twenty-two cases had spondylolisthesis in L4 and 17 cases had spondylolisthesis in L5.According to Meyerding grading,11 patients were classified as degree Ⅰ lesion.27 patients as degree Ⅱ lesion and 1 patient as degree Ⅲ lesion.By the help of X-ray machine,pedicle screw Was embedded in the vertebral spondylolisthesis and it Was lower vertebra.Laminectomy decompress was administered in vertebral spondylolisthesis and hold-down bars was placed to open intervertebral space.Then restored the vertebral spondylolisthesis and fixed it temporary.Next,intervertebral compression bone graft fusion was finished and was adjusted.Results Follow-up period was 5 months to 4 years.Clinical outcomes were measured with Prolo evaluation scale,35 cases were cured,4 cases were good effect.Conclusions This operation has been found to be asafe,rapid and effective method for lumbar spondylolisthesis and it produces a high fusion rate and lower expense.
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Objective To investigate the experiences of total hip replacement in the treatment of different types of osteoarthritis secondary to acetabular dysplasia, and evaluate its effect. Methods From January 1999 to December 2006, 37 hips in 35 cases with osteoarthritis secondary to acetabular dysplasia undergoing total hip replacement were included in this study. Preoperative Harris score was 30-64 points, with an average score of 45 points. Undergoing total hip replacement with complete release, of soft tissue, original acetabular, and no femoral osteotomy. Crowe Ⅰ , Ⅱ-type acetabular dysplasia chose conventional cementless press-fit prosthesis;Crowe Ⅲ,Ⅳ-type,chose the appropriate trumpet,Zweymüller system cementless acetabular biconical spiral surface and thin and straight SL rectangular hip stems. Results The duration of follow-up ranged from 12 to 60 months (average 24 months). No case appeared dislocation, periprosthetic fractures, femoral nerve and sciatic nerve injury and other complications, no clinical and X-ray findings of prosthesis loosening occurred. Postoperative Harris score was 60-95 points, and average was 85 points. Conclusion Adequate preoperative preparation, intraoperative complete release, is the key of the treatment and restoration of limb length.