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Objective To compare the clinical outcomes between percutaneous minimally invasive suture versus conventional open suture for acute closed rupture of Achilles tendon.Methods A prospective study was performed in the 68 patients who had been treated for acute occlusive rupture of Achilles tendon from November 2010 to November 2013 at Department of Orthopedic Trauma, The Third Affiliated Hospital to Soochow University. They were randomly assigned by the sequence of medical attention to receive percutaneous minimally invasive suture or conventional open suture. In the conventional group, there were 31 men and 3 women with an average age of 37.0 ± 10.0 years; in the minimally invasive group, there were 30 men and 4 women with an average age of 36.4 ± 9.4 years. The 2 groups were compared in terms of operation time, intraoperative bleeding, postoperative wound infection, postoperative skin necrosis and ankle-hindfoot score of American Orthopaedic Foot and Ankle Society ( AOFAS ) . Results All the 68 cases were fol-lowed up for an average of 21.26 months ( from 6 to 36 months ). There were no significant differences between the 2 groups in operation time ( 75.0 ± 5.3 min versus 64.8 ± 3.8 min ) or in rate of postoperative local in-fection [ 2.9% ( 1/34 ) versus 14.7% ( 5/34 ) ] ( P ＞ 0.05 ). The minimally invasive group had significantly less intraoperative bleeding ( 12.0 mL ) , a significantly lower rate of skin necrosis [ 2.9% ( 1/34 ) ] and significantly higher AOFAS scores at 6 ( 90.5 ) , 12 ( 91.5 ) and 24 months ( 93.5 ) postoperatively than the conventional group did ( 80.0, 81.0 and 82.5, respectively ) ( all P ＜0.05 ). Conclusion Percuta-neous minimally invasive suture is recommendable for treatment of acute closed rupture of Achilles tendon because it leads to less intraoperative bleeding, better postoperative functional recovery and lower incidence of postoperative skin necrosis.
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Objective To investigate the clinical effect of minimally invasive percutaneous repair of acute closed Achilles tendon ruptures with intraoperative ultrasound assistance.Methods A retrospective case series study was made on 24 patients with acute closed Achilles tendon ruptures hospitalized between January 2013 and June 2015.There were 19 males and five females,aged 18-50 years (mean,30.5 years).MRI showed total Achilles tendon ruptures,and time from injury to operation was 1-3 days.All patients underwent minimally invasive percutaneous repair with high-frequency ultrasound assistance.Operation time and either intraoperative or postoperative complications were documented.At last follow-up,American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Arner Lindholm system were used to evaluate ankle functional recovery.Results Operation time was 35-60 minutes (mean,42 minutes).No intraoperative injury to the major vessel and nerve occurred.Follow-up was conducted for 10-18 months (mean,14.5 months).No surgery-related complications were detected,including wound infection,skin necrosis and tendon reruptures.Ankle function was recovered to normal.AOFAS score were improved from preoperative 53-74 points [(61.5-± 6.7)points] to 91-100 points [(97.1 ± 3.2) points] at last follow-up (P ＜ 0.05).According to the Amer Lindholm system,the treatment outcome was excellent in 21 patients and good in three,with the excellence rate of 100％.Conclusion Ultrasound-assisted minimally invasive percutaneous technique improves the quality of tendon anastomosis,avoids injury to the sural nerve,minimizes the incidence rate of complications such as re-rupture,wounds infections or skin necrosis and hence is an ideal method for repair of acute closed Achilles tendon ruptures.
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BACKGROUND:Modern imaging technology, computer-aided design and processing, rapid prototyping technology and other digital technology have enabled a new era of orthopedic field. Digitalization, individualization, minimal invasion, precision and intel igence are the potential topics in future orthopedics. ＜br> OBJECTIVE:To investigate clinical efficacy of computer-aided design of digital plate in the treatment of hip dislocations associated with posterior wal acetabular fracture. ＜br> METHODS:Sixteen patients of posterior wal acetabular fractures associated with hip dislocations were repaired with customized digital plate fixation. According to Thompson-Epstein fracture type:there were 7 cases with typeⅡ, 5 cases with type Ⅲ, 2 cases with type Ⅳ, and 2 cases with type Ⅴ. Radiographic examination showed the presence of 2-5 mm displacement on the acetabular articular surface, average 3 mm. The time from the injury to hospitalization was 6 hours to 2 weeks, average 1.5 days. After admission, patients underwent femoral condyle bone traction, 12 cases achieved a reduction and three cases of femoral head entrapment were reset during surgery. At 4-10 days after admission, al patients received computer-aided design of digital plate fixation for acetabular fractures. ＜br> RESULTS AND CONCLUSION:Postoperative fracture quality was assessed according to Matta standards, 15 cases had anatomical reduction (displacement＜1 mm) and 1 case had poor reduction (displacement 2-3 mm). The findings indicate that, computer-aided design of digital customized plate has achieved individualized and precise outcomes, as wel as firm fixation in the treatment of hip dislocations associated with posterior wal acetabular fracture. It avoids intraoperative repeated shaping, effectively restores the integrity of posterior wal , al ows early functional exercise, and provides alternative internal fixation for hip dislocations associated with posterior wal acetabular fracture.
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Objective To compare the therapeutic effect between three cannulated screws and proximal femoral locking plate in treatment of femoral neck fracture.Methods A total of 75 patients were included,the three cannulated screws group contained 31 patients,and the proximal femoral locking plate group contained 44 patients.The clinical healing time,hip function score at last follow-up and postoperative complication were compared.Results All patients were followed up for 13-18 (15.3 ± 3.2) months.The excellent and good rate of proximal femoral locking plate group was 95.5％ (42/44),and three cannulated screws group was 83.9％(26/31),there was no statistical difference between the two groups (P ＞ 0.05).The clinical healing time of fracture and hip function score at last follow-up in proximal femoral locking plate group were significantly better than those in three cannulated screws group [(14.6 ± 1.7) weeks vs.(18.1 ± 4.9) weeks,(90.9 ± 3.5) scores vs.(82.3 ± 8.3) scores],there were statistical differences between the two groups (P ＜ 0.05).Conclusions Proximal femoral locking plate provides short clinical healing time of fracture,stable fixation,good biomechanical properties and a low rate of postoperative complication in treatment of femoral neck fracture.It is one of the ideal methods in treatment of femoral neck fracture.
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Objective To evaluate the early effect of Wallis interspinous dynamic stabilization system (Wallis system) in treatment of lumbar degenerative disease. Methods From January 2008 to Jan-uary 2009,21 patients(23 intervertebral spaces) with early lumbar disc herniation and lumbar spinal stenosis were treated with Wallis system. Four intervertebral spaces of L_(3-4) 19 intervertebral spaces of L_(4-5). Observed the time of total operation and implantation,the blood loss,and early recovery. The patients' visual analogue scale (VAS) and Oswestry disability index (ODI) scores were evaluated before and after operation. Results All patients were followed up for average (12.5 ± 0.4) months (7-18 months) after operation. The VAS and ODI scores at 7 days after operation dropped from (7.5 ± 1.5), (40.0 ± 2.0) scores before operation to (2.5 ± 0.5), (23.0 ± 1.5) scores (P < 0.01). Conclusion It is safe and easy to use Wallis system in the treatment of lumbar degenerative disease, with the advantage of mini-invasion and early effect.