Value of absolute quantification of myocardial perfusion by PET in detecting coronary microvascular disease in patients with non-obstructive coronaries / 中华心血管病杂志

Objective: To compare the incidence of coronary microvascular disease (CMVD) between patients with non-obstructive and obstructive coronary arteries. Methods: We retrospectively analyzed 97 patients with angina pectoris, who underwent the absolute quantitative PET examination of myocardial perfusion and coronary anatomy examination within 90 days. All patients were divided into two groups: non-obstructive group (72 cases, no stenosis ≥50% in all three coronary arteries) and obstructive group (25 cases, at least one coronary stenosis ≥50%; and at least one coronary stenosis<50%). Quantitative parameters derived from PET including rest myocardial blood flow (RMBF), stress myocardial blood flow (SMBF), coronary flow reserve (CFR) and cardiovascular risk factors were compared between the two groups. CMVD was defined as CFR<2.90 and SMBF<2.17 ml·min(-1)·g(-1). Results: Incidence of CMVD was significant higher in the non-obstructive coronary arteries of the obstructive group than in the non-obstructive coronary arteries of non-obstructive group (47.1% (16/34) vs. 25.5% (55/216), χ(2)=6.738, P=0.009) while incidence of CMVD was similar between non-obstructive and obstructive patients ((44% (11/25) vs. 33.3% (24/72), χ(2)=0.915, P=0.339). RMBF ((0.83±0.14) ml·min(-1)·g(-1) vs. (0.82±0.17) ml·min(-1)·g(-1)), SMBF ((2.13±0.60) ml·min(-1)·g(-1) vs. (1.91±0.50) ml·min(-1)·g(-1)) and CFR (2.59±0.66 vs. 2.36±0.47) were similar between the two groups (all P>0.05). Conclusions: CMVD can occur in non-obstructive coronary arteries in both patients with non-occlusive coronary arteries and patients with obstructive coronary arteries. Prevalence of CMVD is significantly higher in patients with obstructive coronary arteries than in patients with non-obstructive coronary arteries. The CMVD severity is similar between the two groups.

Application of internal fixation combined with external fixator for unstable pelvic fracture / 中国骨伤

<p><b>OBJECTIVE</b>To invesitigate the clinical effects of percutaneous closed reduction and cannulated screw internal fixation combined with external fixation in the treatment of unstable pelvic fractures.</p><p><b>METHODS</b>From April 2006 to May 2009,29 patients with pelvic fractures of rotatory instability were treated with closed reduction and screw internal fixation combined with external fixation. There were 19 males and 10 females with an average age of 31 years old (ranged from 19 to 53 years). Based on the Tile classification,17 cases were type CI and 12 case were type C2. Tornetta standard and Majeed score were used to evaluated the clinical effect after operation.</p><p><b>RESULTS</b>All patients were followed up from 10 to 24 months with an average of 16 months. There were no nerve injuries and other organ injuries, only one case of infection was found and it was cured with wound dressing. Time of fracture union was from 14 to 18 weeks with the mean of 16.2 weeks. No loosening, slippage or breakage of the screw were found. According to the Tornetta standards,14 cases obtained excellent results, 10 good, 4 fair and 1 poor. The Majeed score was 87.2 ± 11.3, 16 cases got excellent results, 9 good and 4 fair.</p><p><b>CONCLUSION</b>Closed reduction and screw internal fixation combined with external fixation is an effective way to treat unstable pelvic fractures with Tile type C1 and Tile type C2.</p>

Therapeutic effects of treatment of posterior malleolar fractures with medial-extension type through posterioromedial and posteriorlateral incision / 中国骨伤

<p><b>OBJECTIVE</b>To explore clinical outcomes of posterior malleolar fractures with medial-extension type through posterioromedial and posteriorlateral incision.</p><p><b>METHODS</b>From January 2008 to January 2011,25 patients with posterior malleolar fractures with medial-extension type were treated by hollow lag screw. Among them, 15 patients were treated through posteromedial incision,including 9 males and 6 females,aged from 21 to 67 years old with an average of 48.1 +/- 1.3; there were 5 cases with type A, 6 cases with type B and 4 cases with type C,according to Denis-Weber classification. Ten patients were treated by through posterior-lateral incision,including 6 males and 4 females, aged from 23 to 64 years old with an average of 46.9 +/- 1.5; there were 3 cases with type A, 5 cases with type B and 2 cases with type C,according to Denis-Weber classification. Operation time, blood loss, length of incision, times of X-ray exposure and complications of two groups were recorded and compared, Baird-Jackson effective evaluation were applied for evaluate clinical outcomes.</p><p><b>RESULTS</b>All patients were followed up from 12 to 49 months with an average of 20.6 months. There were significant differences in operation time, blood loss, times of X-ray exposure and complications between two group (P < 0.05). While there was no obvious meaning in clinical outcomes between two groups (P > 0.05).</p><p><b>CONCLUSION</b>Treating posterior malleolar fractures with medial-extension type through posteromedial approach can expose and fix fracture under direct vision, has advantages of shorter operation time, less X-ray exposure and blood loss, is a good choice of surgical approach.</p>

Delayed union or nonunion of the ulna after intramedullary nailing for pediatric forearm fractures / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the causes of delayed union or nonunion of the ulna after intramedullary nailing in pediatric forearm fractures.</p><p><b>METHODS</b>From February 2005 to February 2010,5 patients with forearm fractures who were treated with titanium elastic nailing (TEN) were identified to fulfill the criteria of having developed a delayed union or nonunion of the ulna. The causes of delayed union or nonunion were investigated according to mechanism of injury, fracture location, treatments methods and postoperative management. All patients were male and the age was 3 to 14 years old with an average of 9.4 years. All fractures were located on the mid-third part of forearm. Two cases had a re-fracture. Among them, 3 cases caused by high-energy injury and 2 cases by falling down. Open reduction were performed in 4 cases while the other one was treated with closed reduction. Four patients were immobilized in an above-elbow cast, postoperatively.</p><p><b>RESULTS</b>All patients were followed up from 7 to 19 months with an average of 11.4 months. There were 4 delayed union and 1 nonunion. Three patients healed after the removal of the nail and avoidance of weight-bearing. Two patients healed by replacing another fixation. No patients had soft-tissue irritation or nail-entry-site infections.. The clinical effect was evaluated according to Daruwalla and Price scores with 3 excellent and 2 good of the results.</p><p><b>CONCLUSIONS</b>Using titanium elastic nailing for the treatment of pediatric both-bone forearm fractures is a good method. However,strict indication selection should be followed to avoid delayed union or nonunion.</p>

Comparison of three fixation methods for the treatment of tibial fractures in adolescents / 中国骨伤

<p><b>OBJECTIVE</b>To explore the fixation methods in treatment of tibial fracture in adolescents by comparing the results and complications of three fixation methods and to determine the factors related to those complications.</p><p><b>METHODS</b>From January 2007 to January 2012, 83 diaphyseal tibial fractures in 79 adolescents were treated with elastic stable intramedullary nail fixation, plate fixation, or external fixation respectively. There were 55 males and 24 females with an average age of 13.9 years (ranging from 11 to 17.6 years). Outcomes were compared in terms of the hospital stay,time to union, complications, and reoperation rates.</p><p><b>RESULTS</b>All patients were followed up for 15.8 months in average. The time to union was significant associated with the pattern of fixation, energy of the injury, multiple and open fracture. The time of bone union of external fixation group was longer than that of elastic stable intramedullary nail fixation and plate fixation groups. But complication rates of external fixation group were higher than that of elastic stable intramedullary nail fixation and plate fixation groups. Four patients were treated with elastic nail fixation underwent a reoperation (loss of reduction in 2 cases, delayed union and nonunion in each 1 case). Six patients were treated with external fixation required a reoperation (loss of reduction in 3 cases, malunion in 2 cases, and replacement of a pin canal infection in 1 case). Two fractures were treated with plate fixation required refixation following nonunion and malunion. A multivariate analysis with adjustment for baseline differences showed external fixation to be associated with a 7.56 times (95% confidence interval=3.74 to 29.87) greater risk of loss of reduction and (or) malunion than elastic stable intramedullary nail fixation. At the final follow-up,there were agreeable results among three groups and no significant differences among them in final therapeutic effect (P>0.05).</p><p><b>CONCLUSION</b>External fixation for treatment of tibial fracture in adolescents has the highest rate of complications than the other two fixation methods. Elastic stable intramedullary nail fixation can achieve the same effect of other fixed system and avoid most of the complications. Operation method choice depends on the experience of doctors and patients' basic situation and the fracture types.</p>

Treatment strategy of double disruption of the superior shoulder suspensor complex (SSSC) / 中国骨伤

<p><b>OBJECTIVE</b>To discuss efficacy of the surgical treatment strategy of double disruption of the superior shoulder suspensor complex (SSSC).</p><p><b>METHODS</b>The data of 15 patients with double disruption of the SSSC were retrospectively analyzed from January 2008 to December 2009. There were 11 males and 4 females, with an average age of 45.1 years (ranged, 19 to 60). Of them, 8 patients were treated with surgery and 7 patients with conservative treatment. The short-term effectiveness was evaluated according to Constant-Murley scoring system.</p><p><b>RESULTS</b>All patients were followed up for 7 to 24 months with an average of 14.4 months. All fractures healed with a mean time of 12.3 weeks (ranged, 9 to 12). At final follow-up, the Constant-Murley scores with patients of surgical treatment was (92.37 +/- 1.99), and patients of conservative treatment was (55.52 +/- 1.29).</p><p><b>CONCLUSION</b>Surgical treatment can restore the integrality of SSSC, in favour of stability between upper limb and trunk.</p>

Analysis on morbidity factor of bilateral intertrochanteric fractures / 中国骨伤

<p><b>OBJECTIVE</b>To study the morbidity factors of bilateral intertrochanteric fractures by analyzing medical records, so as to provide evidences for preventing the multiple intertrochanteric fractures.</p><p><b>METHODS</b>From Janurary 2000 to June 2009, 68 patients with bilateral intertrochanteric fractures were studied, including 31 males and 37 females, ranging in age from 42 to 95 years with an average age of 75 years. There were type A1 in 24 hips, type A2 in 96 hips, and type B3 in 16 hips. One hundred and twenty-eight hips had received surgical treatment, 8 hips were treated with conservative method. On the first injury, 67 patients discharged after treatment, 1 patients discharged after treatment in other department. On the second injury, 58 patients discharged after treatment, 2 patients died of complications, 8 patients dischagred after treatment in other department. The risk factors including age, cause of injury, fractures type, complications, osteoporosis and treatment were analyzed.</p><p><b>RESULTS</b>The average age of two fractures were (73.6 +/- 9.25) and (76.7 +/- 6.74) years; the major injury cause was fall; the A2-type fractures went up to 80.88% on the secondary injury;and the proportion of complications was high, mainly geriatric cognitive disorders, hemiplegic paralysis, and dysopia. Bone mineral density measurement of 16 cases showed marked osteoporosis.</p><p><b>CONCLUSION</b>Osteoporosis and fall injury contribute mostly to the multiple intertrochanteric fractures. Complication was the dominating risk factor. Treatment of osteoporosis, intensive care, postoperative rehabilitation and effective initial surgery are the key to prevent the secondary intertrochanteric fractures in old people.</p>

Comparison of two minimally invasive internal fixed methods for the treatment of distal tibio-fibula fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the outcome of two minimally invasive internal fixed methods for the treatment of distal tibio-fibula fractures.</p><p><b>METHODS</b>The clinical data of 50 patients with distal tibio-fibula fractures from March 2006 to March 2009 was analyzed retrospectively. Twenty-eight patients were treated with minimally invasive percutaneous locking compression plate fixing tibia combining elastic stable intramedullary nailing fixing fibular (Group P + E). There were 18 male and 10 female patients with a mean age of (45 ± 6) years. Twenty-two patients were treated with interlocking intramedullary nail fixing tibia combining elastic stable intramedullary nailing fixing fibular (Group N + E). There were 12 male and 10 female patients with a mean age of (43 ± 9) years. The index of peri-operation, pain score at 3 d postoperative, bone union time, the clinical outcomes and complications postoperative were statistically compared.</p><p><b>RESULTS</b>There were no statistical significance on operation time, blood loss perioperative and pain score at 3 d postoperative. Bone union time in Group N + E was significantly longer than in Group P + E [(21.1 ± 3.0) weeks vs. (15.4 ± 2.9) weeks]. Meanwhile, the function of ankle score (44.3 ± 1.7 vs. 41.8 ± 2.5) and the line of foot score (8.6 ± 2.3 vs. 6.8 ± 3.6) in Group P + E were respectively significantly higher than that in Group N + E. However, there were no statistical difference on ankle pain, buckling add stretch restricted, turn inward add evaginate restricted and the rate of good and fair between the two groups. There were 3 cases of complications postoperation in Group P + E, significantly less than the 8 cases of Group N + E.</p><p><b>CONCLUSIONS</b>Minimally invasive percutaneous locking compression plate fixing tibia combining elastic stable intramedullary nailing fixing fibular shows superiority in treatment of distal tibio-fibula fractures. However, interlocking intramedullary nail fixing tibia combining elastic stable intramedullary nailing fixing fibular has the advantages in worse soft tissue and multi-step tibio-fibula fractures.</p>

Anatomical and biomechanical study on the interosseous membrane of the cadaveric forearm / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To study the anatomical and biomechanical features of the interosseous membrane (IOM) of the cadaveric forearm.</p><p><b>METHODS</b>Ten radius-IOM-ulna structures were harvested from fresh-frozen cadavers to measure the length, width and thickness of the tendinous portion of IOM. Then, the tendinous portion was isolated along with the ulnar and radial ends to which the tendon attached after measurement. The proximal portion of the radius and the distal portion of the ulna were embedded and fixed in the dental base acrylic resin powder. The embedded specimen was clamped and fixed by the MTS 858 test machine using a 10 000 N load cell for the entire tensile test. IOM was stretched at a speed of 50 mm/min until it was ruptured. The load-displacement curve was depicted with a computer and the maximum load and stiffness were recorded at the same time.</p><p><b>RESULTS</b>The IOM of the forearm was composed of three portions: central tendinous tissue, membranous tissue and dorsal affiliated oblique cord. IOM was stretched at a neutral position, and flexed at pronation and supination positions. The tendinous portion of IOM was lacerated in 6 specimens when the point of the maximum load reached to 1021.50 N+/-250.13 N, the stiffness to 138.24 N/m+/-24.29 N/m, and the length of stretch to 9.77 mm+/-1.77 mm. Fracture occurred at the fixed end of the ulna before laceration of the tendinous portion in 4 specimens when the maximum load was 744.40 N+/-109.85 N, the stiffness was 151.17 N/m+/-30.68 N/m, and the length of the stretch was 6.51 mm+/-0.51 mm.</p><p><b>CONCLUSIONS</b>The IOM of the forearm is a structure having ligamentous characteristics between the radius and the ulna. It is very important for maintenance of the longitudinal stability of the forearm. The anatomical and biomechanical data can be used as an objective criterion for evaluating the reconstructive method of IOM of the forearm.</p>

99Tcm-MIBI myocardial perfusion imaging for evaluation of the myocardial blood supply in patients with metabolic syndrome / 中华核医学杂志

Objective To evaluate the myocardial blood supply in patients with metabolic syndrome (MS) using 99Tcm-MIBI SPECT MPI. Methods A total of 342 patients were divided into four groups according to the number of abnormal metabolic indices: no abnormal metabolic index (Group 1), one abnormal index (Group 2), two abnormal indices (Group 3), three or more abnormal indices (Group 4). Each patient underwent two-day protocol of gated stress and rest 99Tcm-MIBI MPI. One hundred and three of the 342 patients were clinically diagnosed as MS and underwent CAG within 1 month after MPI. χ2test was used to evaluate the difference among the four groups and Kappa test to analyze the correlation between MPI and CAG. Results Compared with CAG, the diagnostic sensitivity, specificity, positive and negative predictive values by 99Tcm-MIBI SPECT MPI for coronary artery diseases (CAD) in 103 MS patients were 80.5% (33/41), 85.5% (53/62), 78.6% (33/42) and 86.9% (53/61), respectively. The correlation coefficient between MPI and CAG was 0.657 (P<0.001). The abnormal MPI rates in group 1, 2, 3 and 4 were 23.3% (10/43), 32.9% (26/79), 54.4% (56/103), and 57.3% (67/117), respectively (χ2=23.22, P<0.001). Conclusions In MS patients,99Tcm-MIBI SPECT MPI can be useful for evaluating myocardial blood supply and the myocardial ischemia rates may correlate positively with the number of abnormal metabolic indices.

Clinical significance of MESS scoring system in the treatment of fractures of lower limb combined with vascular injuries / 中国骨伤

<p><b>OBJECTIVE</b>To study the clinical significance of MESS scoring system in the treatment of fractures of lower limb combined with vascular injuries, and to evaluate its reliance.</p><p><b>METHODS</b>From March 2006 to March 2008, 28 patients with fractures of lower limb combined with vascular injuries were graded by MESS scoring system. There were 17 patients were male and 11 patients were female, ranging in age from 23 to 53 years, averaged 38 years. Seventeen patients had fractures at the superior segment of tibia and fibia, 7 patients had fractures at the inferior segment of femur, and other 4 patients had dislocation of knee joint. Among the patients, 18 patients had MESS scores more than 7.0 point, in which 13 patients were treated with one-stage amputation, 5 patients were treated with two-stage amputation; the other 10 patients had the MESS scores less than 7.0 point, and were treated with open reduction and internal fixation, in which 8 patients were treated with transplantation of great saphenous vein to repair blood vessles, and 2 patients were treated with vascular end to end anastomosis.</p><p><b>RESULTS</b>Among the patients, including 18 patients whose MESS scores more than 7.0 point were treated with one-stage or two-stage amputation, and 10 patients whose MESS scores less than 7.0 point were treated with limb salvage operations, all the limbs survived. During the follow-up period (ranged from 0.5 to 1 year, the movement and sensory function of the limbs recovered well.</p><p><b>CONCLUSION</b>MESS is a simple and reliable tool to determine the proper strategy for the patients suffering from vascular injuries with fractures.</p>

Progress of research on percutaneous fixation for the treatment of pelvic ring and acetabular injuries / 中国骨伤

Percutaneous pelvic fixation is possible with the advances in intraoperative fluoroscopic imaging and other technologies. Percutaneously inserted screws in medullary pubic ramus,iliac wing, and iliosacral bone can stabilize pelvic or acetabular disruptions directly mean while can diminish operative blood loss, shorten operative time, and allow patient's early activity. Complications associated with open surgical procedures are similarly avoided by using percutaneous techniques. Stable and safe percutaneous fixation techniques depend on accurate closed reduction, excellent intraoperative fluoroscopic imaging, and detailed preoperative planning. A thorough knowledge of pelvic osseous anatomy, injury patterns, deformities, and the related intraoperative imagery techniques are essential for doctors to fulfill the operation of percutaneous pelvic fixation. This paper presents an overview of the technique of percutaneous surgery of the pelvis and acetabulum.

Comparison of the biomechanical stability of cannulated screw and reconstruction plate for the fixation of symphysis pubis diastasis / 医用生物力学

Objective To test the biomechanical properties of symphysis pubis diastasis fixed by cannulated screw or reconstruction plate and provide the theoretical basis for clinical practice. Method In the experiment, fifteen normal adult specimens’ pelvis along with their intact spines from L5 to the proximal 2/3 of both femora were randomly divided into three groups. The symphysis pubis, unilateral anterior sacroiliac joint and ipsilateral sacropinous and sacrotuberous ligaments were cut; the intact major pelvic ligaments and hip joints were used to simulate Tile B1 pelvic fracture model. The fixation of five hole reconstruction plate and 6.5 mm cannulated screw were applied successively to cure symphysis pubis diastasis.The pelves were loaded vertically in the testing machine with a standing posture. The loads were applied through the L5 body to a maximum of approximately 400 N, while the displacements of the symphysis pubis were recorded. Results The study showed that two fixations were able to reduce symphysis pubis gapping and restore the biomechanical stability of pelves. Under the same condition，the displacement of symphysis pubis used 3.5 mm five hole reconstruction plate with 4 cortical screws, and the displacement by using cannulated screw were (0.944±0.983)mm and (-0.03±0.378)mm respectively. There were significant differences (P<0.05) between them. Conclusions The cannulated screw is superior to 3.5 mm five hole screw in biomechanical stability. The cannulated screw has fine biomechanical properties and is able to provide the firm fixation for symphysis pubis diastasis, which fits the principles of biological osteosynthesis.

Clinical outcome of minimally invasive internal fixation of pelvic ring injuries with cannulated screws / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the safety and reliability of percutaneous internal fixation for pelvic ring injuries with cannulated screws.</p><p><b>METHODS</b>Forty-eight patients (21 male and 27 female, aged from 17 to 61 years with an average age of 38 years) with unstable pelvic ring injuries were treated with closed reduction and percutaneous cannulated screws fixation under C-arm fluoroscopic guidance. According to Tile's classification, the patients were classified into type B1 in 4 cases, B2.1 in 8, B2.2 in 10, B3 in 4, C1 in 11, C2 in 7 and C3 in 4. Among them, 39 patients were treated with anterior and posterior fixation, 4 were treated with anterior fixation, and 5 were treated with posterior fixation alone. Anteroposterior, inlet and outlet X-ray radiographs and CT scans of the pelvis were taken preoperatively to evaluate the stability and deformities, and after surgery the plain radiographs and CT scans were taken to evaluate the reduction and the location of screws.</p><p><b>RESULTS</b>The average operative time was 55 minutes (range, 15 to 95 minutes), and the average intraoperative blood loss was 60 ml (range, 15 to 150 ml), no patient accepted blood transfusion during or after operation. All 48 patients were inserted 157 cannulated screws (mean 3.3, range 2 to 8 per patient). Forty-two patients (135 screws) underwent postoperative pelvic CT scan and 91.11% (123 screws) of them was considered in optimal location; 7 screws penetrated the wall of pelvis and acetabulam because of overlength (<0.5 cm) or deviation, 5 screws interfered with the sacral canal or foramen. Fortunately, these 12 screws did not cause any symptom to the patients. The average follow-up period was 13 months (range 8 to 49 months), the displacement of injured pelvis was satisfactorily corrected in 45 patients (93.75%) and the fractures were healed at one stage. Among all patients, 40 cases (83.33%) had returned to their original works, 4 were still in the process of recovery at the last follow-up and the other 4 were unemployed as sciatic nerve injury or amputation. According to Lindahl improved standard of functional assessment of pelvic injury, the result was excellent in 35 cases, good 10 and fair 3, the average score was 78.7.</p><p><b>CONCLUSION</b>With better understanding of the pelvic anatomy, and under C-arm fluoroscopic guidance, treatment of closed reduction and percutaneous cannulated screw internal fixation for unstable pelvic ring injuries is a safe, reliable and feasible method. The clinical outcome is satisfactory.</p>

Percutaneous fixation of pelvic ring disruptions / 中华外科杂志

<p><b>OBJECTIVE</b>To introduce the operation indication, operation fashion, operation time, mainipulation point, and treatment effect of pelvic ring disruptions with percutaneous fixation.</p><p><b>METHODS</b>Fifty-eight patients with pelvic ring disruptions were treated with sacroiliac screws, pubic ramus screws or pubic tubercle screws and iliac wing screws, and the effects was evaluated.</p><p><b>RESULTS</b>Among the 58 patients, the result of reductions in 52 cases was satisfied, 6 cases was dissatisfied; fracture point in 57 cases was healed up, 1 case disconnect; vessel and nerve was not injured in 56 cases, S(1) nerve root was injured in 2 case, bequeathing anaesthesia of lower limbs and saddle area.</p><p><b>CONCLUSIONS</b>The technique with percutaneous fixations is minitraumatic and reliable to fix the pelvic ring disruptions with little bleeding. These percutaneous techniques have a good outlook. Bone tractions with big weight before operation make for reductions in operation.</p>

The use of minimally invasive injectable graft and internal fixation in tibial plateau fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To value the use of an injectable minimally invasive calcium sulfate cement for displaced tibial plateau fractures.</p><p><b>METHODS</b>Thirteen patients with lateral tibial plateau fractures treated with internal fixation and bone grafting were matched with 13 patients treated using internal fixation and an injectable calcium sulfate cement. The clinical data were retrospectively analyzed. All patients were followed up for a minimum of one year. The peri-operative complication, quality of reduction, maintenance of reduction, function assessment and development of post-traumatic osteoarthritis was compared in both groups.</p><p><b>RESULTS</b>Ten patients in the internal fixation and bone graft group had excellent anatomical reductions as judged on immediate post-operative radiographs but some loss of reduction on follow-up at one year was observed in 8 of the 13 (61%) cases. Twelve patients from the MIIG group had an excellent reduction on immediate post-operative radiographs but 3 (23%)demonstrated some loss of reduction of the plateau at one year follow-up (P < 0.05).</p><p><b>CONCLUSIONS</b>The use of MIIG and internal fixation is associated with more favourable clinical results than conventional treatment with internal fixation and bone grafting for lateral tibial plateau fractures.</p>

Percutaneous cannulated screws internal fixation for treating the posterior portion of the iliac wing fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To present the technique for percutaneous placement of cannulated screws in the iliac wing, and to describe the surgical technique and the methods, the indication, the time, the key of operation and the clinic outcomes of the technique.</p><p><b>METHODS</b>Through the anatomy study of ilium, a wider columns structure at the posterior ilium was found, which was named "the posterior columns of pelvis", and then measure the parameter of the structure. Twelve patients with the injuries in the iliac wing and the anterior ring of pelvis were treated with percutaneous cannulated screws internal fixation.</p><p><b>RESULTS</b>All of the fractures healed in the followed up period. Vertical replacement were all completely corrected. Two of the cases left behind slight rotary replacement, and no complication were found.</p><p><b>CONCLUSIONS</b>The technique of percutaneous cannulated screws internal fixation for treating the posterior portion of the iliac wing fractures has the advantages of small trauma, less bleeding stiff fixation, which is an ideal and minimally invasive technique.</p>

Treatment of tibial plateau fracture with minimal invasion spinal surgery in 36 cases / 中华创伤杂志

Objective To investigate the clinical results of minimal invasion spinal surgery (MISS) in treating tibial plateau fractures to provide best procedure for such treatment.Methods The study involved 36 cases with tibial plateau fractures resulted from traffic injury,fall-from-height injury and strain injury including 24 males and 12 females at age of 19-65 years (average 42.6 years).According to Schatzker classification,there were seven cases of typeⅠ,five typeⅡ,five typeⅢ,five type IV,sev- en typeⅤand seven typeⅥ.All cases were treated by different methods of MISS.Results Follow up for 8-24 months in 35 cases showed fracture healing within 3-4 months,without severe complications such as poor wound healing,infection or osteofascial compartment syndrome.Meanwhile,no traumatic knee osteoarthritis,inversion or eversion of the knee were found.The mean range of knee motion was 94?,with fine knee function in 32 cases (91.4%) according to Merchant score.Conclusions Treatment of tibi- al plateau fractures should adopt limit incision,indirect reduction and biofixation to take place widespread exposure and rigid plate fixation.MISS is safe and effective for tibial plateau fractures.