ABSTRACT
Objective:To compare the clinical effects between proximal humerus internal locking system (PHILOS) inverted and a posterior single plate in the anterior percutaneous minimally invasive internal fixation for distal humeral shaft fractures.Methods:A retrospective study was conducted to analyze the data of 65 patients with distal humeral shaft fracture who had been treated from January 2018 to May 2021 at Department of Orthopaedics, The Second Hospital of Fuzhou. The patients were assigned into 2 groups according to different treatment methods. In the observation group of 30 cases subjected to anterior percutaneous minimally invasive internal fixation with PHILOS inverted: 20 males and 10 females with an age of (41.5±11.6) years; type A in 5 cases, type B in 14 cases, and type C in 11 cases by AO fracture classification. In the control group of 35 cases subjected to anterior percutaneous minimally invasive internal fixation with a posterior single plate: 23 males and 12 females with an age of (39.9±11.2) years; type A in 7 cases, type B in 17 cases, and type C in 11 cases by AO fracture classification. The preoperative general data, operation time, intraoperative blood loss, total incision length, fracture healing time, and shoulder and elbow VAS scores, Constant-Murley shoulder function score, Mayo elbow performance score (MEPS), and complications at the last follow-up were recorded and compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). There were no significant differences either in operation time, fracture healing time, or shoulder or elbow VAS pain score, Constant-Murley shoulder function score, or MEPS at the last follow-up between the 2 groups ( P>0.05). The intraoperative blood loss was (59.7±26.6) mL in the observation group and (165.7±86.4) mL in the control group, and the total incision length was (10.7±2.1) cm in the observation group and (18.6±2.7) cm in the control group, showing statistically significant differences between the 2 groups ( P<0.01). There was no injury to the radial nerve or musculocutaneous nerves, incision infection or fracture nonunion in the observation group. There were 4 cases of iatrogenic radial nerve injury, 2 cases of incision infection and 1 case of fracture nonunion in the control group, yielding a complication rate of 20.0% (7/35). The difference in the incidence of complications was significant between the 2 groups ( P<0.01). Conclusion:In the treatment of distal humeral shaft fracture with anterior percutaneous minimally invasive internal fixation, PHILOS inverted has advantages of less soft tissue damage, less intraoperative bleeding, and a lower risk of iatrogenic radial nerve injury than the posterior single plate.
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Objective:To explore the changes in the expression of Tau protein and phosphorylated Tau (p-Tau) protein in neurons after spinal cord ischemia-reperfusion injury (SCII).Methods:Ninety-six healthy adult SD rats were randomly divided into a sham operation group ( n=48) and a SCII group ( n=48). Based on the reperfusion time of 3 h, 6 h, 12 h, 24 h, 48 h and 72 h, the SCII group was divided into 6 subgroups ( n=8 per subgroup). Immunohistochemical staining was used to observe the apoptosis of spinal cord neurons in the L 4-L 5 segments and the expression of Tau protein and p-Tau protein. Results:In the sham operation group, the neuron cells were intact, mainly concentrated in the gray matter. Tau protein was seen in a small number of neuron cells, and a small amount of filamentous p-Tau protein in the pernucleus and cytoplasm. There was no significant difference between Tau protein and p-Tau protein expression in neurons at each time point ( P>0.05). In the SCII group, scattered Tau protein was seen in the apoptotic cells while there was a strong positive expression of Tau protein in the non-apoptotic cells. The expression of Tau protein in the SCII group gradually increased after injury, reaching a peak at 48h and plateauing at 72 h, and was significantly different between any 2 time points (except for 72 h) ( P<0.05). In the SCII group, the positive expression of p-Tau protein was observed in the cytoplasm of the apoptotic cells in strips and sheets. It increased rapidly within 6 h but did not change significantly after 6 h, showing no significant difference between any 2 time points afterwards ( P>0.05). There was a statistically significant difference in the expression of Tau protein and p-Tau protein between the SCII group and the sham operation group at each time point ( P<0.05). Conclusion:It is hopeful to reduce the severity of spinal cord injury by regulating the expression of Tau protein and p-Tau protein within 6 to 48 hours after SCII.
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Objective To compare the clinical effects of conventional incision versus oblique mini-incision in the treatment of displaced midshaft clavicular fractures. Methods A prospective randomized controlled trial was performed between August 2014 and August 2016 in 79 patients with acute displaced midshaft clavicular fracture. They were randomly divided into 2 groups to receive either conventional incision or oblique mini-incision treatment. In the oblique mini-incision group, there were 37 cases, 20 males and 17 females, with an average age of 37.4 ± 13.2 years. By the Robinson fracture classification, there were 9 cases of type 2A2, 16 ones of type 2B1, and 12 ones of type 2B2. In the conventional incision group, there were 42 cases, 22 males and 20 females, with an average age of 38.2 ± 14.5 years. By the Robinson fracture classification, there were 9 cases of type 2A2, 19 ones of type 2B1, and 14 ones of type 2B2. We recorded operation time, intraoperative blood loss, scar size, clinical complications and fracture healing time. Functional assessments were conducted at l2 months using the Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley scores, and a questionnaire on numbness, scar appearance and satis-faction. Results Only 58 patients finished a complete follow-up. The preoperative general data showed no statistical significance between the 2 groups (P > 0.05). All the 58 patients were followed up for 13 to 24 months (average, 15.3 months). There were no significant differences between the 2 groups in operation time, fracture healing time, the DASH or Constant-Murley score, or clinical complications (P> 0.05). However, the intraoperative blood loss in the oblique mini-incision group (20.8 ± 10.7 mL) was significantly less than that in the conventional incision group (41.6 ± 7.6 mL), the scar size in the former (3.6 ± 1.6 cm) significantly shorter than that in the latter (10.3 ± 2.6 cm), and the rate of symptoms of residual injury to the supra-clavicular nerve in the former (10.7%, 3/28) significantly lower than that in the latter (43.3%, 13/30) (P <0.05). Moreover, the oblique mini-incision group was significantly better than the conventional incision group in numbness on the shoulder or anterior chest, scar appearance and satisfaction. Conclusions The oblique mini-incision may be advantageous over the conventional incision in intraoperative blood loss, scar size and appearance, iatrogenic supraclavicular nerve damage and satisfaction. However, the 2 incisions may lead to similar functional recovery of the shoulder.
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Objective To investigate the effects of long proximal femoral nail antirotation (PFNA-long) in treating long-segment fracture in middle-up part of femoral. Methods From June 2006 to December 2013, we treated 139 cases long-segment fracture in middle-up part of femoral with long proximal femoral nail antirotation (PFNA, 320-380 mm) by minimally invasive per-cutaneous fixation and autogenous iliac bone graft. Data of 139 patients (104 male and female 35;ages 18 to 86 years, with an aver-age age of 48.8 years). Type IA 58 cases (41.73%, 58/139), type IB 25 cases (17.99%, 25/139), type IC 4 cases (2.88%, 4/139), type II 28 cases (20.14%, 28/139), type IIIA 12 cases (8.63%, 12/139), type IIIB in 5 cases (3.60%, 5/139), type IV 7 cases (5.04%, 7/139). The duration from injury to surgery was 3 hours to 12 days, with an average of 4.2 days. The postoperative follow-up was at 1, 2, 3, 6, 9, 12 months, and annually at least. The clinical efficacy was evaluated with Harris hip function score. The postoperative pain was evaluated with visual analogue scale (VAS). Results The operative time of 139 cases was from 35 to 90 minutes, averaged 45 minutes and the blood loss during surgery averaged 78.6 ml (ranged from 30 to 200 ml). All patients walked by walking aid appliance after 4 to 10 days postoperatively, apart from 16 cases with serious long grinding fracture. All patients had been followed up for 3 to 37 months (mean 19 months). No complications, such as infection, lower limb vein infarction, cut-out and breakage of the implants, occurred. However, there were 4 patients with nail broken and 6 patients with hip internal rotation who were treated by secondary operation. There were 5 cases with slight hip external rotation and 8 cases with hip internal reverse-lamb shortening malformation. All fractures healed after 2.8-6.8 months (mean 3.9 months). According to Harris criteria, the clini-cal results were best in 108 cases, better in 22 cases, good in 8 cases, and bad in 1 case. The excellent and good rate was 93.53%(130/139). The score for VAS was 0-6 (mean 0.8), 93 cases in which no pain, mild pain in 33 cases, moderate pain in 13 cases, 25 cases occasionally need to take non-steroidal analgesics. Conclusion Closed reduction or limited open reduction with PFNA-long is an effective treatment for long-segment fracture in middle-up part of femoral, with higher strength in fixation, higher rate of fracture union, early functional recovery and lower rate of complications.