Comparison among three cannulated screws and dynamic hip screw combined with antirotation screw for comminut- ed fractures of femoral neck / 中国骨伤

<p><b>OBJECTIVE</b>To compare the effect of three cannulated screws and dynamic hip screw (DHS) combined with antirotation screw in treating patients with comminuted fractures of femoral neck.</p><p><b>METHODS</b>From January 2008 to December 2012,67 patients with comminuted fractures of femoral neck were treated with three cannulated screws or DHS combined with antirotation screw. Among them, 36 patients were treated with DHS combined with antirotation screw including 24 males and 12 females with an average of 43.7 years old ranging from 22 to 58 years old; 31 patients were treated with three cannulated screws including 22 males and 9 females with an average of 43.0 years old ranging from 24 to 56 years old. The incision size, operation time, blood loss, blood transfusion rate, postoperative hospital stay, walking time, weight-bearing time, union time, incidence of complication were recorded and compared between two groups, and functional outcomes were evaluated by Harris scoring.</p><p><b>RESULTS</b>All incision healed at stage I. The differences in operation time, blood loss, blood transfusion rate and postoperative hospital stay between two groups were not significant (P > 0.05). Incision size of DHS group (5.00 ± 0.86) cm was larger than that of cannulated screw group (3.30 ± 0.57) cm (P < 0.01). All patients were followed up more than one year, and the follow-up time showed no significant difference between two groups (P > 0.05). Walking time of DHS group (19.0 ± 3.5) d was less than that of cannulated screw group (37.0 ± 6.3) d (P < 0.01. Partial and full weight-bearing time of DHS group (23.0 ± 7.0) d and (138.0 ± 13.0) d was less than that of cannulated screw group (38.0 ± 5.7) d and (164.0 ± 12.0) d (P < 0.01). Union time of DHS group (151 ± 11) d was less than that of cannulated screw group (162 ± 11) d (P < 0.01). Harris hip score of DHS group (91.0 ± 5.7) was higher than that of cannulated screw group (85.0 ± 12.0) (P < 0.01). No significant differences were found in the incidence of postoperative complications between two groups (P > 0.05).</p><p><b>CONCLUSION</b>The DHS combined with antirotation screw is superior to three cannulated screws for treatment of comminuted fractures of femoral neck due to earlier weight-bearing, faster fracture healing and better hip function</p>

The evaluation of posterior ligament complex injury as well as the analysis of its effects in thoracic-lumbar fractures / 中华外科杂志

<p><b>OBJECTIVES</b>To evaluate and analyze the role of posterior ligament complex (PLC) in determining therapeutic principle for traumatic thoracic-lumbar fracture.</p><p><b>METHODS</b>From August 2005 to May 2008, 60 patients (38 male, 22 female) who suffered from the traumatic thoracic-lumbar fracture were carried out posterior operations. According to the Magerl traumatic thoracic-lumbar fracture classification system, these cases were classified to subtype A, B and C. The average age was 34 years (21 - 65 years). Magnetic resonance imaging (MRI) scan, which including both T1/T2 weight and fat-stir sequence, as well as the MRI negative film reading technique were used to evaluate the state of PLC. Furthermore, related physical or neurological examinations (such as severe skin bruising and sinking, broadening spinous process gap and tenderness, spinal cord or nerve root injury) and another X-ray or CT reconstruction films were taken to evaluate the the state of PLC synthetically. Above-mentioned results were compared with the final exploration results during operation and some parameters were analyzed.</p><p><b>RESULTS</b>The sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), misdiagnosis rate and rate of missed diagnosis of these sixty patients were 85.3%, 80.8%, 83.3%, 85.3%, 80.8%, 19.2%, 14.7% respectively. After 13 cases of thoracic-lumbar fracture-dislocation were eliminated, the sensitivity, specificity, accuracy, PPV, NPV, misdiagnosis rate and rate of missed diagnosis of remaining 47 cases were 81.0%, 80.8%, 80.9%, 77.3%, 84.0%, 19.2%, 19.0% respectively. There were 5 cases with MRI negative results before operation but positive results during operation. Contrarily, 5 cases with MRI positive results before operation but negative results during operation occurred.</p><p><b>CONCLUSIONS</b>MRI is a main means for evaluating the state of PLC. Although the MRI fat-stir sequence as well as the MRI negative film reading technique are adopted, the state of PLC can not be estimated exactly before operation (especially for those unfracture dislocation cases). In order to estimate the state of PLC exactly, the related local physical examination and image technology as well as the location of the abnormal image signal in MRI film and time of injury must be analyzed synthetically.</p>