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ObjectiveTo compare the outcomes and indications between exchange nailing (EN) and augmentation plating (AP) with a nail left in situ for femoral shaft hypertrophic nonunion after femoral nailing. MethodsFrom April 1998 to June 2009, 20 patients with femoral shaft hypertrophic nonunions after femoral nailing were treated with EN (11 patients) and AP (9 patients) respectively. There were no significant differences between the two groups with respect to the patient's age, gender, associated injuries, anatomical location and type of femoral fracture. Patients were evaluated by imaging and clinical function at 1, 2, 3, 4,6, and 12 months after surgery, and then every year postoperatively, to observe the callus and the recovery condition of the affected limb function. Fisher exact test and t'-test were performed to compare the outcome and complications respectively. ResultsAn unpaired t'-test showed no significant differences with respect to follow-up time, operating time, intraoperative blood loss, postoperative drainage, length of stay, time to radiographic union, time to clinical union, and AAOS score between the two groups. The cost of hospitalizations in the EN group was higher than in the AP group(t'=16.4, P=0.013). Four nonunions in the EN group failed to achieve union, which 3 patients were subsequently treated with AP and simultaneous autogenous bone grafting and 1 patient was treated with nail dynamization. All 9 hypertrophic nonunions in the AP group obtained osseous union. Fisher exact test showed a higher nonunion rate of EN compared with AP (χ2=6.01 ,P=0.008). ConclusionEN has been an excellent choice for aseptic isthmal femoral nonunion without a large bone defect subsequent to intramedullary fracture fixation, and AP can be an effective solution in cases of nonisthmal femoral nonunion and bone defect and failed exchange nailing.
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Objective To investigate the operative indications and operation techniques for augmentative plate fixation in treatment of femoral shaft atrophic nonunions subsequent to intramedullary fixation. Methods Twelve femoral nonunions after internal fixation with intramedullary nailing were treated with augmentative plate internal fixation and bone graft from June 1999 to June 2008. All femoral nonunions were caused by insecure fixation of the intramedullary nailing, in which a rotational instability of the fracture site was verified in all the patients during operation. Minimally invasive removal of the granulation tissue at fracture site and the sclerotic bone was dccorticated. The adequate lilac bone was tiled longitudinally on the nonunion gap and the cortical bone bed. The fixation involved the limited-contact dynamic titanium plate with 5-6 holes, 3.0 mm Kirschner wire and 4-6 double cortex cortical screw fixation.Protective weight-bearing was given after surgery and the tunction was evaluated at 1,3, 6 and 12 months with imaging. Results All patients were followed up for 7-26 months ( average 17.4 months), which showed radiological solid union (7-12 months, average 9.4 months) and clinical union (5-9 months, average 7.1 months ). The operation lasted for 50-120 minutes ( average 77.5 minutes), with blood volume of 150-350 ml ( average 252 ml). There were nine patients with bone pain, of whom the pain was relieved within one month in seven patients and three months in two. No infection, hardware loosening or breaking were found. Conclusion The plate augmentation and cancellous bone grafting leaving the nail in situ can be an effective solution for nonisthmal femoral nonunion, bone defect and failed exchange nailing.
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@#ObjectiveTo analysis the clinical features of thoracic spine and spinal cord injury (SCI) and summarize the inclusive standard of cellular transplant clinical trial for SCI.MethodsThe data of 72 cases with thoracic spine and spinal cord injury from 1990 to 2005 were analyzed retrospectively.ResultsMean follow-up period was 20 months (6～48 months). There was no recovery in 12 spinal cord injury without radiographic abnormality (SCIWORA) patients, but improvement of urine function in 4 cases. 5 cases of 52 fracture-dislocation complete injury were improved to grade B (sense recovery), rate of recovery was 9.6%; recovery rate was 62.5% in incomplete injury. Sense recovery of all cases was better than motor recovery. Partial cases appeared spasm paralysis relief.ConclusionIncidence rate of complete injury is high and recovery is bad in thoracic spine and spinal cord injury. The inclusive standard of cellular transplant clinical trial for SCI is old complete thoracic spinal cord injury without residual compression.
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@#Objective To analyze general and trace elements in cerebral spinal fluid (CSF)of patients with spinal cord injury (SCI). Methods To assess contents of general and trace elements (K, Na, Ca, Mg, Zn, Mn, Fe, Cu) in CSF of six SCI patients using ICP-AES. Results Compared with normal value, contents of Ca and Zn were significantly decreased (P<0.01), Fe and Mn were significantly increased (P<0.01), but no significant differences for Na, Mg, K and Cu in CSF of SCI patients. Conclusion The excitation of central nerve system in SCI patients may be higher than normal people indeed.
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The intramedullary expand self-locking nail(IESN) is a new type of solid small diameter nail consisting of the dynamic and the static types, designed on the basis of the CAIN. The mechanical experiments showed that its stiffness to resist the bending and twisting momentum was simillar to the Russell -Taylor's nail. The static nail was stable enough to prevent axial displacements of the fractured segments. The main characteristics of the IESN are as follows: 1) It is being able to be inserted without reaming the medullary cavity and without X- ray guidance; 2) a higher limit value to resist fatique and 3) no stress concentration on IESN.
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Objective To analyze the cause for complications of the long bone fractures treated with the interlocking nail and indicate the prevention and treatment measures. Methods From January 1998 to May 2000,168 patients with long bone fractures were treated with the interlocking nail. Of them, there were 77 cases of femoral fractures, 67 tibial fractures and 24 humeral fractures. Results All patients were followed up for 5-24 months. Complications occurred in 14 cases (8.33%) including 4 cases of infections, 1 lower limb necrosis, 2 internal fixation failure due to incorrect indication, 2 re-fractures during the operation, 2 distal screw misinserted,1 nail into the ankle joint, 1 distal screw broken and 1 distal screw loosening. Conclusions We should attach great importance to the following points during treatment of long bone fractures with interlocking nail:(1) The indications must be correctly handled. (2) The technique for interlocking nail must be performed strictly during operation; close inserting nail is proposed.(3) As for the comminuted fractures, bone continuity should be reconstructed and the time to start weight bearing properly delayed. (4) C-Arm X-ray supervision is necessary during operation.
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As the gun shot wound outside the vertebral canal of the spine, what is the mechanism of spinal cord injury (SCI) ? We put transducers at the cauda equina or spincal cord in the vertebral canal to estimate intracanal pressure during sun shot injury at the spine. The results showed that: in penerating wound of vertebral canal the pressure was between17?10~5Pa and 56?10~5Pa and the spinal cord was brocken directly by the bullet. In pericanal wounds, such as lamina, root of spinous process or vertebral body, the pressures were at 33. 3～95?10~5Pa. All of these wounds were complete SCI. In perispinal wounds such as tip and interspace of spinous process, anteror border of vertebral body, they were incomplete SCI, the pressures were usually 10?10~5Pa. If the intracanal pressure was not determined determinafted, there was usually no SCI.
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18 cases of atlanto-axial instability with symptoms of spinal cord compression were treated operati-vely. The reasons of instability were congenital deformity of great occipital foramen region with atlanto-axial subluxation in 7, atlantoaxial tuberculosis complicated with dislocation in 4, traumatic atlanto-axial dislocation in 5, and spontaneous dislocation of atlanto-axial joint in 2. Cranial traction was instituted preoperatively in most cases. The operations were done under local anesthesia. Open reduction of atlas, and fixation by wiring and fusion of atlanto-axial laminae with bone graft were performed in 8 cases, and occipto-cervical fusion by bone grafting with or without decompression of great occiptal foramen in 10 cases. Postoperative plaster bed or heas chest cast was stressed. All cases but one were successful, the dislocation was reduced, symptoms of spinal cord compression were relieved, the fusion was solid, and most of them returned to work.