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BACKGROUND: The fracture of femoral neck in adults is very common. Most of them can be cured by operation or conservative treatment, but a few can develop into old fracture. At present, there is no clear and effective treatment for old fracture of femoral neck in adults. OBJECTIVE: To explore the clinical effect of sartorius pedicle iliac bone flap combined with proximal femoral locking plate in the treatment of old femoral neck fracture in adults. METHODS: Twelve adult patients with old femoral neck fracture were treated with sartorius pedicle iliac bone flap combined with proximal femoral locking plate, 9 males and 3 females, aged 18-47 years, with an average age of 33. 5 years. Garden classification: Type I in 0 cases, type II in 1 case, type III in 7 cases, and type IV in 4 cases. All of them were incised by Smith Petersen (S-P) approach. The 2/3 sartorius pedicle iliac bone flap of the anterior superior iliac spine was chiseled with a bone knife, about 4. 0 cm×1. 0 cm×1. 0 cm in size. After reduction, the proximal femur was fixed with steel plate and screw. Finally, the sartorius pedicle iliac bone flap was implanted into the defect of the femoral neck and fixed. At 3, 6, 12, and 24 months after the operation, X-ray films were reexamined to evaluate the fracture healing and Harris score of hip joint was used to evaluate the recovery of hip joint function. RESULTS AND CONCLUSION: (1) Twelve patients were followed up for at least 24 months. (2) Harris scores of hip were significantly higher at 3, 6, 12, and 24 months after surgery (54. 4±6. 4, 68. 7±6. 8, 82. 3±4. 2, 90. 3±4. 6) than those before surgery (46. 3±6. 1) (P < 0. 05). (3) There were no complications, such as wound nonunion, infection, or venous thrombosis. Finally, 11 patients finally achieved bony healing at the fracture site. One patient had nonunion at 28 months postoperatively with avascular necrosis of the femoral head (ARCO stage IV), followed by artificial hip replacement. Harris score before operation was 38, and Harris score at 3 months postoperatively was 98. (4) The results show that the combination of sartorius pedicle iliac bone flap and proximal femoral locking plate is a good method for the treatment of old femoral neck fracture in adults, with high healing rate and low necrosis rate of femoral head.
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Objective To investigate the clinical effect of platelet-rich plasma combined with flap transplantation in treatment of refractory wounds.Methods Sixty patients of refractory wounds who were admitted into our hospital from April 2016 to February 2017 were enrolled in the observation group,and another sixty patients with refractory wounds who had been discharged from the hospital before April 2016 were trea-ted as the control group.All the patients accepted debridement and disinfection.Then the observation group were managed with PRP and flap transplantation,while the control group were treated with flap transplantation directly without PRP.Observed the frequency of dressing changes, rate of wound infection,healing time and recovering rate of the two groups.Measurement data were analyzed with t inspection and analysis of va-riance,and count data were compared by χ2test,and repeat data was analyzed with repeat data variance analysis.Results After one weeks' treatment,the number of wet gauze layers were(20.5 ±1.6)in the observation group,which was less than(23.3 ±6.1)in the control group with statistically significant difference(t=-3.439,P=0.001).The healing time of the observation group was(25 ±2)d,which was shorter than(43 ±5)d in the control group(t=-25.891,P=0.000).The frequency of dressing changes was(7.1 ±1.0)times in observation group, which was less than(9.3 ±1.4)times in the control group(t=-9.905,P=0.000).There were 5 cases of inflammation reaction in the obser-vation group,which was less than 18 cases in the control group(χ2=9.090,P=0.003).The cases of the skin flap survival in the observation group was 55,which was more than 41 cases in the control group,and the difference of the two groups was statistically significant(χ2=10.208, P=0.001).The average healing rate of the two groups both increased at different time points.And the average healing rate of the observation group was higher than that in the control group at different time points,and the difference was statistically significant(P<0.05).Conclusion Platelet-rich plasma can remarkably shorten the healing time,improve healing rate,reduce frequency of dressing change and promote wound healing for refractory wound.
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Objective To investigate the effect of platelet-rich plasma (PRP) combined with negative pressure wound therapy (NPWT) on orthopedic refractory wound.Methods A total of 84 patients with chronic refractory wound were selected from January 2014 to December 2016 in Department of Osteology,Jizhong Energy Xingtai Mining Group General Hospital.The patients were divided into control group and observation group according to the admission time,42 cases in each group.The patients in the control group were treated with NPWT,and the patients in the observation group were treated with PRP and NPWT.The power of hydrogen (pH) of wound exudate,wound temperature and wound pressure ulcer scale for healing (PUSH) were compared between the two groups before and after treatment.The bacterial cuhure result was compared between the two groups after two weeks of treatment.The change of serum erythropoietin (EPO) level were observed before and four weeks after treatment,and the suitable skingrafting time,wound healing time and cure rate were observed in the two groups.Results After two weeks of treatment,the positive rate of bacterial culture in the observation group was significantly lower than that in the control group (x2 =4.850,P ＜ 0.05).The pH value of wound exudate and the wound PUSH score in the observation group were significantly lower than those in the control group(P ＜0.05),but the wound temperature in the observation group was higher than that in the control group after two weeks of treatment (P ＜ 0.05).The results of intra group comparison showed that the serum EPO level showed an upward trend within four weeks of treatment,and the difference was statistically significant at different time points in the two groups (F =7.356,8.264;P ＜ 0.05).The level of serum EPO in the observation group was significantly higher than that in the control group at the treatment of 1,2,3 and 4 weeks (P ＜ 0.05).Compared with the control group,the suitable skingrafting time was early (P ＜ 0.05),the wound healing was fast (P ＜ 0.05),and the cure rate was high in the observation group (x2 =4.720,P ＜ 0.05).Conclusion The combination of PRP and NPWT has good antibacterial effect,and can promote the EPO level and wound healing.
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Objective:To explore the therapeutic effect and safety of thrombus aspiration catheter in young patients with acute ST-segment elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI) .Methods :According to using thrombus aspiration catheter during emergency PCI or not ,a total of 79 young patients with acute STEMI were divided into aspiration group (n= 37 ,received thrombus aspiration ) and routine treatment group (n=42 ,didn't receive aspiration catheter ) .Coronary TIMI flow ,angina pectoris symptoms ,cardi-ac function and major adverse cardiovascular events (MACE) etc .after PCI were observed and compared between two groups .Results:Compared with routine treatment group after treatment ,there were significant rise in TIMI flow [ (2.33 ± 0.48) grade vs .(3.00 ± 0.00) grade] ,2h ST segment regression >50% rate (45.24% vs .70.27% ) and left ventricular ejection fraction on the first week [ (47.21 ± 9.28)% vs .(52.16 ± 7.87)% ];significant reduc-tion in angina pectoris symptom (50.00% vs .27.03% ) ,and NYHA cardiac function during follow-up [ (1.52 ± 0.71) class vs .(1.22 ± 0.42) class] in aspiration group , P0.05 all .Conclusion:Application of thrombus aspiration catheter could improve coronary blood flow ,reduce symptoms of angina pectoris and improve cardiac function during primary PCI in young patients with acute STEMI ,and it's safe .