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Objective:To study the risk factors for contralateral hip fracture within 2 years after primary hip fracture surgery in elderly patients.Methods:A retrospective study was conducted of the 1,962 elderly patients who had been surgically treated for hip fractures at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from May 2015 to April 2018. They were 573 males and 1,389 females; the median age of primary hip fracture was 81 (75, 86) years. They were divided into 2 groups according to whether a contralateral hip fracture occurred or not within 2 years after primary hip surgery: 134 patients in the contralateral fracture group and 1,828 ones in the contralateral fracture-free group. The duration from primary hip fracture to secondary contralateral fracture was recorded. The χ2 test and Mann-Whitney U test were used to compare between the 2 groups their gender, age, walking ability, laboratory indexes upon admission, concomitant internal diseases, Charlson comorbidity index (CCI), duration from admission to surgery, duration from admission to discharge and complications during follow-up. The risk factors for contralateral hip fracture within 2 years after primary hip surgery were determined by the Cox's proportional hazard regression model. Results:In the elderly patients with hip fracture, the 2-year cumulative incidence of secondary contralateral hip fracture was 6.83%(134/1,962) and the median duration from primary surgery to secondary contralateral hip fracture was 365 (189, 611) d. The risk factors for contralateral hip fracture were female ( RR=2.081, 95% CI: 1.351 to 3.207, P=0.001), concomitant peripheral vascular disease ( RR=5.876, 95% CI: 2.922 to 11.818, P< 0.001), concomitant chronic obstructive pulmonary disease ( RR=3.750, 95% CI: 1.897 to 7.413, P< 0.001), progressively higher CCI ( RR=1.363, 95% CI: 1.223 to 1.519, P<0.001), complicated pneumonia ( RR=3.606, 95% CI: 2.054 to 6.332, P<0.001), complicated urinary infection ( RR=7.670, 95% CI: 4.441 to 13.248, P<0.001), and complicated deep venous thrombosis (DVT) ( RR=7.389, 95% CI: 3.992 to 13.677, P<0.001). Conclusions:The risk factors for contralateral hip fracture within 2 years after primary hip fracture surgery in elderly patients may be female, concomitant peripheral vascular disease and chronic obstructive pulmonary disease, progressively higher CCI, and complicated pneumonia, urinary infection and DVT.
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Objective To evaluate the safety and efficiency of robot assisted surgery guided by damage control orthopaedics(DCO) in polytraumatised patients with pelvic ring injuries.Methods A retrospective review of the pelvic fracture database was performed.Twenty-six patients who had sustained a pelvic fracture from September 2012 to December 2015 were suitable for robot-assisted minimally invasive internal fixation.They were 17 men and 9 women,aged from 23 to 58 years (average,42.6 years).Their Injury Severity Score(ISS) ranged from 20 to 31 points (average,21.3 years).According to Tile classification,6 cases were type B2,3 type B3,9 type C2 and 8 type C3.Guided by DCO,the vital signs were stabilized by all means and the fractures treated by simple and temporary external fixation before the pelvic and other fractures were managed by the robot-assisted minimally invasive internal fixation.Demographics,times to operating room (TOR),time from acute stabilization to late definitive internal fixation (TAL),time for bone union,type of robot-assisted surgery for major fractures,length of stay (LOS),postoperative complications and mortality were recorded.The outcomes of the pelvis were evaluated at the final follow-up according to the Matta criteria.Results Of the 26 patients,robot-navigated percutaneous screwing was conducted with 23 sacroiliac screws in 19,with 9 ramus pubicus screws in 9,with 6 supraacetabular screws in 4,and with 4 both-column screws in 2 cases.TOR averaged 2.7 times,TAL 5.9 days,LOS at ICU 2.1 days,ICU admission rate 46.2％ (12 of 26),hospital LOS 7.3 days,and time for pelvic bone union 79.0 days.None patients had postoperative complications related to the pelvic fracture and no one died.According to the Matta criteria at the final follow-ups,8 cases were excellent,11 good,5 fair and 2 poor,yielding an excellent and good rate of 73.1％.Conclusion Robot-navigated minimally invasive surgery plus DCO is effective,time saving and safe treatment for polytraumatised patients with pelvic ring injuries.
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Objective:To evaluate the security and efficiency of a surgical robotic assisted percutaneous screw fixation for the treatment of pelvic and acetabular fractures.Methods: In the study,12 patients with pelvic and acetabular fractures who were treated in Beijing Jishuitan Hospital from January to April in 2016 were involved in this research.The research subjects were randomly divided into two groups: the experimental group and the control group.Robotic-assisted percutaneous sacroiliac screw internal fixations were performed under the guidance of fluoroscopy navigation in the experimental group;in the control group,doctors operated manually guided by fluoroscopy.Statistical analysis was performed on the total operation time,the intraoperative fluoroscopy time,the adjustment numbers of intraoperative guide wires,the excellent rate of screw placement and the incidence of adverse events in order to evaluate the security and efficiency of a surgical robotic assisted percutaneous screw fixation for the treatment of pelvic and acetabular fractures.Results: Eleven screws were placed in 7 patients from the experimental group,while 7 screws were placed in 5 patients from the control group in total.All the screw placement positions were satisfactory according to postoperative CT images.The excellent rates of screw placement position were 100％ in both groups.However,the P value was 0.016 based on the comparison between the screws' distribution in the two groups which meant that the screw distribution of the experimental group was better than that of the control group.The average fluoroscopy time needed for screw insertion was (7.36±2.63) s in the experimental group while (41.80±13.99) s in the control group (P<0.001).This suggested that the difference between the two groups had statistical significances.Intra-operative fluoroscopy time of the experimental group was significantly smaller than that of the control group.The number of the average screw adjustment was (0.36±0.48) times in the experimental group while (9.00±3.06) times in the control group (P=0.003).This suggested that the difference of the number of the guide needle adjustment between the two groups had statistical significances,and the number of the experimental group was smaller than that of the control group.The average operation time was (43.86±49.06) min in the experimental group while only (29.00±12.14) min were needed in the control group (P=0.528).This suggested that the difference between the two groups had no statistical significance.That is,the total operation time of the two groups was equal.All the screws were in satisfactory positions according to validation results of CT scans.No complications such as screw breaking out the bone cortex and entering into the knee joint cavity,wound infection occurred.Conclusion: Surgical robots are suitable for robot-assisted percutaneous screw fixation in pelvic and acetabular fractures.Robot-assisted treatment of pelvic and acetabular fractures has significant advantages over manual operations including high accuracy,small perspective radiation,safety and efficiency.
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Objective To investigate the clinical results of Bi-plane robot navigation for cannulated screw fixation in the treatment of femoral neck fractures.Methods Between May 2011 and May 2015,86 patients with femoral neck fracture who were fixed with cannulated screws were retrospectively analyzed.The patients were divided into navigation group and non-navigation group according to whether the Bi-planar robot used for navigation or not.The patients were matched concerning gender,age and Garden classification.A total of 64 patients were included in the study.In navigation group,there were 32 cases,including 10 males and 22 females.The average age was 59.4±5.6 yr (range,51-68 yr).According to Garden classification,there were 1 case of type Ⅰ,7 cases of type Ⅱ,14 cases of type Ⅲ and 10 cases of type Ⅳ.In non-navigation group,there were 32 cases,including 12 males and 20 females.The average age was 59.1±4.9 yr (range,53-70 yr).According to Garden classification,there were 1 case of type Ⅰ,5 cases of type Ⅱ,18 cases of type Ⅲ and 8 cases of type Ⅳ.Sixty-four cases were all fixed with cannulated screws.The fluoroscopy time,fluoroscopy times,drilling times,times of cannulated screw replacement,cannulated screw insertion time,blood loss,relative position between any two cannulated screws in postoperative AP view and lateral view,the angle between each cannulated screw and the femoral neck axis,fracture healing time and functional score were recorded.Results The parameters in navigation group versus non-navigation group were as follows:the average fluoroscopy time was 10.1±2.9 s vs 36.8±7.5 s,the average fluoroscopy times was 11.4±3.2 vs 43.9±11.0,the average drilling times was 3.9±1.1 vs 18.5±3.2,the average times of cannulated screw replacement was 0.4±0.6 vs 1.0±0.7;the average blood loss was 29.4± 14.7 ml vs 50.2± 17.1 ml,cannulated screws placement time averaged 28.8±7.3 min vs 43.8±7.9 min.The angle between any of two cannulated screws averaged 3.1°±1.1° vs 7.3°± 1.2° in AP view and 2.9°±1.0° vs 4.4°±2.3° in lateral view,the angle between the cannulated screw and the femoral neck axis averaged 4.4°±1.6° vs 7.5°±1.7° in AP view and 4.9°±1.6° vs 8.0°±1.3° in lateral view.Significant differences were found concerning all above parameters between the two groups.Conclusion Bi-plane robot navigation technique helps more accurate cannulated screw fixation in the treatment of femoral neck fracture.This technique is less invasive.It decreases the time of screw insertion and reduces the radiation exposure.
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Septic shock is one of the most serious diseases threatening the critically ill patients in Intensive Care Unit.How to improve the survival rate has now been most concerned and directed by critical care doctors.For that case,it is necessary to summarize and investigate the clinical cases about how to manage elderly patients with septic shock.
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1 1 patients with moderate or severe crowding in the anterior arch were treated with 4 premolar extraction.After canine distaliza-tion first approach,the teeth were aligned and leveled.The results of the study suggest that,with strict implementation of indication,this method may be a viable treatment for the moderate or severe crowding anterior.
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Recent related researches pointed out that a series of adverse reactions may occur when homocysteine (Hcy) level exceeded normal range .More and more studies indicated that Hcy level abnormal elevating was an inde‐pendent risk factor for cardiovascular diseases .This article summarized its related research situation .
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<p><b>BACKGROUND</b>The trochanteric fixation nail (TFN) can be used to treat stable and unstable fractures of intertrochanteric hip fractures. We study the common lateral migration that occurs with telescoping of intertrochanteric hip fractures treated with TFN and identify the predictors and relationships to clinical outcomes.</p><p><b>METHODS</b>Patient demographic information, fracture type (Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopaedic Trauma Association (OTA) classification), radiographic data, and clinical data were collected. Lateral migration with telescoping was measured. Statistical analyses were performed to determine which variables predicted lateral migration with telescoping. Patient outcome scores were recorded using the Modified Harris Hip Score (MHHS), Hip Outcome Score-Activity of Daily Living (HOS-ADL), and Visual Analog Scale for pain.</p><p><b>RESULTS</b>Two hundred and twenty-three patients (67 males, 156 females) fitted the radiographic and follow-up (average 24.6 months) criteria. The average age was 77.2 years. The average lateral migration with telescoping was 4.8 mm. Twenty-one patients (9.4%) had excessive lateral migration with telescoping ( = 10 mm). The quality of calcar reduction (P = 0.01) and unstable fracture patterns (P = 0.006) were significant predictive factors of lateral migration with telescoping. The mean outcome scores (MHHS and HOS-ADL) were 80.1 points and 78.7 points, respectively. All subjects had no significant relationship to lateral migration with telescoping (P > 0.05). Of all the patients who developed lateral migration with telescoping, only one required removal of the blade for hip pain and all patients went on to uneventful union at an average time of 4.5 months.</p><p><b>CONCLUSIONS</b>Lateral migration with telescoping is a common mechanical complication of intertrochanteric hip fracture treated with the TFN procedure. It was predicted by the quality of calcar reduction and fracture type. However, this did not affect stable fixation and fracture healing, so rarely leads to clinical problems.</p>
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Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bone Nails , Follow-Up Studies , Fracture Fixation, Internal , Methods , Hip Fractures , Classification , General Surgery , Retrospective Studies , Treatment OutcomeABSTRACT
The term epigenetics refers to a number of biochemical modifications of chromatin that, without altering the primary sequence of DNA, play a role in genomic regulation and in control of particular gene expression. These modifications involve several kinds, such as DNA methylation, histone code modifications and chromatin remodeling. It is accepted that these modifications is as common in solid tumors as it is in hematologic malignancies such as myelodysplastic syndromes(MDS). So many specialists suggest that the study of this area is very valuable. The current clinical information regarding different forms of epigenetic therapy in patients with MDS were focused in this review.
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A medical robot that is used for closed reduction and the internal fixation of intramedullary locking nailing in treatment of tibial fracture is designed.The system is primarily composed of stereotaxic frame and computer system.Using C-shaped arm-taken X-ray images containing various marked points and keyhole-two-end-center of intramedullary nail,the system calculates the actual position of keyhole in the coordinate system of stereotaxic frame according to space mapping relation and locates the pilot hole on the reference coordinate according to computation.Electric-traction system can realize the precise reduction and remote control operation by network transmission of operation data.In the closed reduction and the internal fixation of intramedullary nail for treatment of tibial fracture in 17 patients,robot reducing fracture and computer-assisted localization of distal keyhole were used.Remote control operation was applied in 4 of them.All operations were performed according to the preset procedure and planning of robot and navigation system.All distal lock nails were successfully implanted at one time.Results demonstrated that both medical robot and computer-assisted localization and navigation system can satisfy fracture reduction and distal Iock nail implantation in the closed reduction and the internal fixation of intramedullary nail for treatment of tibial fracture and shorten intraoperative fluoroscopy time;in addition,remote control operation is reliable and easily mastered due to its simple systemic structure.
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The International Society for Computer Assisted Orthopaedic Surgery (CAOS-International) is an organization, which aims at bringing together those individuals throughout the world, who, by their contributions and activities in the areas of biomechanical engineering, research, clinical study, and use, have indicated or are indicating interest in computer assisted orthopaedic surgery. CAOS-International has held annual meetings and related workshops and disseminated information to its members either at these meetings or independently, since its foundation in 2001. Its further purpose is to serve as a forum for the exchange of information of both an investigative and clinical nature, which relates to preoperative planning, intraoperative execution, and postoperative follow-up by means of computer assistance. The Society aims at promoting a new partnership between orthopaedic surgeons and technologists as a necessary basis for the successful integration of computer assisted surgical tools and techniques into the daily clinical routine. In China, this integration is at an early stage. Participation in CAOS-International' s activities to obtain the information helps China track the international current development and promote related research.
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Objective To assess effects and security of the insertion of sacroiliac screws by the bi-planar navigation robot system. Methods In a simulated surgical setup, 12 AO cannulated screws were placed into the S1 vertebral bodies of 4 human pelvic bone under the guidance of the bi-planar navigation robot system which was developed jointly by Beijing Aeronautics and Space University and our hospital. To compare this new technique with the conventional technique, another 12 cannulated screws were placed into 4 Synbone pelvic models under fluoroscopic control. The fluoroscopic times, the radiation exposure time and operation time between image acquisition and guide-wire insertion were recorded. Results With the guidance of the bi-planar navigation robot system, the average fluoroscopic times were 2.5, the average radiation exposure time was 1.5 seconds, and the average operation time was 253 seconds. All the screws were in the safe area. Under the fluoroscopic control, the average fluoroscopic times were 20.3, the average radiation exposure time was 13.7 seconds, and the average operation time was 246 seconds. Two screws (16.7%) were misplaced. The fluoroscopic times and the radiation exposure time were reduced significantly when the bi-planar navigation robot system was used (P0.05). Conclusions The bi-planar navigation robot system can provide precise navigation for insertion of sacroiliac screws within several minutes, and reduce the radiation exposure to the patient and the staff significantly. The results of this prospectively controlled experimental study are encouraging for further clinical trials.
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Objective To investigate clinical feasibility, security, and effects of cannulated screw fixation of femoral neck fractures aided by the bi-planar navigation robot system. Methods Under the guidance of the robot system which was developed jointly by Beijing Aeronautics and Space University and our hospital, 15 pins were inserted into the femoral necks of 5 Synbone models. The difference between the distance of any 2 points at the entry point and that at the outlet point was measured in the 5 cases. The ratio (P) of the difference to the length of the pin within the femoral neck of the Synbone models was calculated to evaluate how parallel the 2 pins were. The fluoroscopic times and the radiation exposure time in the robot-aided treatment were recorded and compared with those in the 12 cases of conventional operations which were conducted in our department from June to September, 2005. Results P was about 0.003 7 to 0.018 1, and the X-ray exposure time in robot aided system was 2.32 s vs 28.30 s in the conventional operations. The average fluoroscopic times in robot aided system were 4.4 vs 54.3 in the conventional operations. Conclusion As the bi-planar navigation robot system can provide accurate space orientation and stable navigation route, and can decrease the X-ray radiation to the patient and staff, it has a significant value in clinical application.
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Objective To evaluate and investigate the clinical feasibility and curative effects of the computer-assisted auto-frame navigation system for distal locking of tibial intramedullary nails. Methods The hardware components of the system consisted of a PC computer with a moniter, an auto mechanical stereotactical localization cubic frame, foot holder and localization apparatus; Self-designed navigation software was used for registration and real-time tool navigation control. 21 patients of tibial and fibluar fractures were treated with closed intramedullary nailing, all fractures were close, 6 in middle third, 12 in middle and lower third, 3 in lower third; C-arm alignment, registration time, fluoroscopic time and drilling time throughtout the locking procedure were recorded. Unreamed or reamed tibial nail sizes ranged from 8/300-11/330. Results All distal holes except 1 were locked successfully, in 9 of 41 holes(21.95%), the drilling ends were in contact with the locking canal, but without any damage to the nail and drilling ends and no adverse effects. The fluoroscopy time for a couple of screws was (2.23?0.31) seconds. Conclusion The computer-assisted auto-frame navigation system for distal locking is well designed, easy to operate and additional instruments are not necessary during the procedure; the developed system enables the physician to precisely navigate surgical instruments throughout the operation using just a few computer-calibrated radiographs. The total radiation exposure time for the procedure can be significantly reduced because additional X-ray exposure is not required. The cost is less expensive and apt to be extended.
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0 05), and there was no significant influence on function of median nerve Conclusion Experiment study in rats showed that the distal nerves can be regenerated after multi nerves end to side neurorrhaphy on a trunk