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Objective To investigate the efficacy of external pelvic reduction frame system combined with tunnel screw fixation in the treatment of Tile C1 pelvic fracture.Methods A retrospective case series analysis of 15 patients with Tile C1 pelvic fractures from January 2014 to October 2016 was pedormed.Clinical data included seven males and eight females,aged 26-84 years (mean,48.9 years).According to Tile classification,there were five cases of type C1.1,three cases of C1.2,and seven cases of type C1.3.The average time from injury to surgery was 9.5 days (range,4-33 days).All patients received the treatment of external pelvic reduction frame system combined with tunnel screw fixation.The operation time,intraoperative blood loss,and complications were recorded.The fracture reduction quality was evaluated according to the Matta criteria,and the clinical function and neurological function were evaluated by the Majeed functional scoring system and the Gibbons sacral nerve injury grading,respectively.Results The patients were followed up for an average of 16 months (range,12-24 months).The mean operation time was 139 minutes (range,50-250 minutes),and the mean intraoperative blood loss was 90 ml (range,20-260 ml).No complications such as wound infection,loose internal fixation,rupture or loss of reduction occurred in the patients.According to the Matta score,14 patients obtained anatomical reduction,and one obtained satisfactory reduction.At the last follow-up,according to the Majeed functional scoring criteria,the results were excellent in all 15 patients,with an excellent and good rate of 100％.According to Gibbons sacral nerve injury grading,two out of the three patients with neurologic impairment before the operation recovered completely while the remaining one did not recover.Conclusion In the treatment of Tile C 1 pelvic fractures,external pelvic frame reduction system combined with tunnel screw fixation can attain satisfactory fracture reduction,reliable fixation,and good functional recovery.
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Objective To investigate the feasibility and clinical effect of percutaneous pedicle screw fixation in the treatment of ankylosing spondylitis (AS) with thoracolumbar fractures.Methods A retrospective case-series study was performed on 12 AS patients with thoracolumbar fractures admitted from January 2013 to January 2016.There were 9 males and 3 females,aged (42.7 ± 13.0) years (range,24-63 years).All patients received percutaneous minimally invasive pedicle screw fixation.The operation duration,intraoperative blood loss,length of incision,ambulation time,and time to basic life were recorded.Visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated before and after operation.Postoperative complications and bone fracture union were observed during the followup period.Results All patients were followed up for average 22 months (range,14-36 months).All patients underwent successful surgery,with operation duration and intraoperative blood loss of (178.0 ± 60.2) min and (116.7 ± 44.2) ml respectively.No serious complications such as blood vessel or nerve injury occurred during the operation.The incision length was 1.2-1.5 cm.All the patients were able to do exercise with the help of brace 2-3 days after the operation and returned to basic life after (23.4 ± 7.3)days postoperatively.At 1,3,6 and 12 months after operation,VAS and ODI differed significantly from the preoperative detections (P ＜ 0.05).During the follow-up,bone fracture union was observed in all patients,with no nail breakage or nail loosening occurred after operation.Conclusion For AS combined with thoracolumbar fractures,minimally invasive fixation can attain satisfactory curative effect,with advantages of minor lesion,little bleeding,fast recovery and sound bone union.
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ObjectiveTo discuss the clinical application of the temporary balloon occlusion of the common iliac artery in the control of hemorrhage in the operations of the old pelvic fractures.Methods From January 2006 to June 2009,twelve patients (10 males,2 females; mean age 33.9 years) with old pelvic fractures of Tile C type were treated operatively.Three cases were treated with external fixator.Operative treatments were delayed for the treatment of the life-threatening visceral injuries in six nonunions and three malunions.A balloon catheter was placed through intravascular intervention in the common iliac artery of the affected side.The balloon catheter was infolded when the osteotomy was performed and the operations were undertaken under temporary and total occlusion of the common iliac artery.Osteotomies and internal fixations were performed in 12 cases.Decompressions of lumbosacral trunk were undertaken in 4 cases complicated with injuries of sciatic nerve.ResultsThe mean time of operations was 290 min(range,210-367min).The mean time of occlusions was 65 min (range,45-90 min).The loss of blood ranged from 700 ml to 2800 ml,with an average of 1833 ml.All cases were followed up for 12-48 months,with an average of 35 months.The mean time of bone healing was 20.6 weeks (range,16-24 weeks).No thrombosis of the common iliac artery and deep venous thrombosis of the lower extremity or ischemic necrosis happened.In the four cases complicated with injuries of sciatic nerve,three recovered partly and could walk with a crutch and one recovered completely and could walk normally.Two cases limped and other six cases could walk normally.ConclusionThe effect of temporary balloon catheter occlusion of common iliac artery is reliable.It drastically reduces hemorrhage during the operation and avoid the complications of selective arterial embolism and ligation and makes the operations of the old pelvic fractures more safer.
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Objective To investigate the cause of fracture nonunion and discuss the experience of locking plates fixation combined with autoallergic cancellous bone in the management of non-infective long bone nonunion.Methods A retrospective analysis was made in 38 patients(29 males and 9 females)with fracture nonunion treated with locking plates fixation combined with autoallergic cancellous bone from August 2006 to August 2010.Of all,22 patients were treated with plates and 16 with interlocking intramedullary nails.Results All the patients were followed up for a mean of 12 months(range,6-24 months).The bone union time for all the fractures averaged 5.3 months(range,3-7 months),with no complications like implant loosening or fracture.Conclusions Iatrogenic factor is the main cause for fracture nonunion after open reduction and internal fixation of long bone fractures and the locking plates combined with autoallergic cancellous bone are a safe and effective treatment procedure.
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Objective To assess the clinical value of high-frequency ultrasonography in diagnosis of the brachial plexus disease. Methods Forty-two patients with suspected brachial plexus disease underwent high-frequency ultrasonography. The ultrasonographic findings were compared with clinical data. Results Among the 42 patients, 33 were diagnosed as brachial plexus abnormalities, while 9 as normal according to clinical data. With high-frequency ultrasonography, 26 patients were diagnosed as abnormal brachial plexus and 16 patients as normal. The sensitivity, specificity and accuracy of ultrasonography in diagnosing brachial plexus abnormalities was 78.79%, 100% and 83.33 %, respectively. Conclusion High-frequency ultrasonography is useful in evaluating the brachial plexus disease and may become an important imaging methods for brachial plexus.
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Objective To discuss the causes of failure of transpedicular screw fixation in treatment of thoracolumbar fractures. Methods A retrospective analysis was done to analyze the failure causes of 24 patients (15 males and 9 females) who received pedicle screw fixation for their thoracolumbar fractures from June 2002 to June 2008 in our department. There were two patients with delayed infection, eight with pedicle screw breakage, one with connecting rod breakage, 10 with internal fixation loosening (including nut loosening) and three with poor screw position. Results All patients received reo-perations including removal of internal fixation plus debridement and lavage in two patients, simple removal of internal fixation in nine patients, removal of inter fixation and posterior fusion in two, replacement of the lengthened fixation plus posterior fusion in nine, and adjustment of the position and orientation of screw in two. All patients were followed up for 6-18 months (average 11 months) , which showed no any complications. Conclusion Improper surgical indication or approach, ineffective fusion, incorrect postoperative rehabilitation exercise, too late removal of the screws and improper surgical operation are main causes for failure of internal fixation.
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Objective To investigate the effectiveness of femoral troehanter reconstruction and artificial femoral head replacement in treatment of unstable intertrochanterie fractures in the elderly pa- tients. Methods Femoral trochanter reconstruction and artificial femoral head replacement was done on 106 patients with unstable intertrochanterie fractures. There were 45 males and 61 females, at age range of 80-105 years (average 88 years). Most of patients slipt in the room and got fractured. According to the Evans classification, there were 31 patients with type ⅢA fractures, 45 with type ⅢB and 30 with type IV. We used 4 kinds of methods to reconstruct the fracturad imertrochanters : (1) shape of" ∞ " ten- sion band fixation after intertrochanterie fracture reduction;(2) wire loop fixation of the lesser troehanter around proximal femur;(3)defect within the femoral ealear was filled with bone cement and remodeled; (4) for patients with relative intact base of femoral neck, the intertrochanterie fracture was transformed in- to femoral neck fracture and the femoral ealear was fixed with femoral prosthesis stem. Results All the operations continued successfully, with duration of the operation for 45-70 minutes (average 55 minutes). No artificial femoral head dislocation occurred during hospitalization. Of all, 79 patients were followed up for 6-48 months (average 16 months). No Late loosening, dislocation or infections occurred, with total excellence rate of 87.3%. Conclusions For elderly patient with unstable intertrochanterie fractures, reconstruction of femoral intertrochant and artificial femoral head replacement can restore the proximal femoral anatomy, maintain stability of the hip joint and help early functional exeereise, as can reduce ease fatality rate and improve the quality of life.
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@#Objective To explore the mechanism of percutaneous laser disc decompression (PLDD) for treating prolapse of intervertebral disc. Methods 15 rabbits were divided into 3 groups randomly: sham group, model group with PLDD treatment, model group without PLDD treatment. The nerve conduction velocity (NCV) of L6 nerve root and the activity of phospholipase A2 (PLA2) in the intervertebral disc of L5-6 were determined 2 weeks after the initial surgery. Results NCV in the group with PLDD was significantly faster than that in the group without PLDD (P<0.001); NCV in the group without PLDD was significantly lower than that in the sham group (P<0.001). The activity of PLA2 in the group with PLDD was significantly lower than that in the group without PLDD (P<0.001); The activity of PLA2 in the group without PLDD was significantly higher than that in the sham group (P<0.001). Conclusion The activity of PLA2 in the herniated discs is higher than that in normal discs, which result in NCV falls remarkably. The PLDD can reduces chemical factors such as PLA2.
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@#Objective To observe the long-term result of brachial plexus injury.Methods41 cases of brachial plexus injury were divided into the non-operation group (n=11), neurolysis group (n=17), never repair group (n=13). Retrospective analysis of the charts and follow-up survey of the functional recovery of shoulder joint and elbow joint were carried out. Gilbert score and Mallett score were adopted at the follow-up.ResultsIn the non-operation group, 9 cases were graded as excellent, 1 case as good, 1 case as bad. In the neurolysis group, 2 cases were graded as excellent and good. In the never repair group, 2 cases of shoulder joint obtained excellent, 4 cases of elbow joint were grade as good.ConclusionThe simple surgical result of brachial plexus injury is not satisfactory, it should be combined with postoperative rehabilitation.
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@#Objective To investigate the effect of passive exercise on neural functional recovery after peripheral nerve crushed injury.MethodsThe effect of passive exercise on early peripheral nerve regeneration and recovery of motor function were observed with electrophysiological and histological indexes compared with that of the splinting group.ResultsThe nerve conduction of training group was faster than that in the splinting group,and the latency of compound muscle action potentials(CMAP)was shorter(P<0.05).The thickness of myelin sheath,average numbers of myelinated nerve fibera per area and diameter of regenerating axon in training group were larger than those in the splinting group(P<0.05).The wet weight of sural triceps of training group were bigger than that of the splinting group(P<0.01).ConclusionThe passive exercise can improve the early recovery of motor function and neural regeneration after peripheral nerve crushed injury.
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Objective To discuss a new procedure to treat Pilon fractures with combined by the using of external fixation and arthroscopy. Methods The external fixation was used to keep the broken bone in line, and the facet of the ankle joint was made smooth under the arthroscope. Several lag screws were put to fix the fracture. 31 cases, 21 male and 10 female, were treated from Nov. 2002 to Mar. 2004 with this technique. There were 22 cases of type B, and 9 type C1,C2 according to AO classification. Results The follow ups ranged from 4 to 12 months, averaging 7.3 months. No nonunion or infection was found. The average bone healing time was 3.7 months. Conclusion The combined use of arthroscopy and external fixation to treat Pilon fracture is an efficient procedure, for it can provide stable fixation, cause limited incision or trauma, and allow early recovery exercises of the ankle joint.
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Objective To report the result of minimally invasive treatment of scaphoid non-union in soldiers. Methods Twenty-two soldiers 19 to 27 years of age were admitted for the treatment of non-union of fracture of scaphoid bone. The duration of non-union ranged from 11 to 54 months (average 16 months).All the non-union was located at the scaphoid waist, with a gap of 2 to 5 mm (average 2.5mm) as shown by radiological examination. Cyst-like changes occurred in 6 cases and displacement of the sclerotic fracture ends was found in 3 cases. Under local anethesia, a needle was inserted into the site of non-union under X-ray monitor, and 5-10 ml red bone marrow harvested from the iliac crest was injected into the site of non-union. The wrist was immobilized in functional position with elastic bandage or plaster of paris cast after the injection. Radiological follow-up was carried out every one month postoperatively. Bone marrow injection could be repeated 1 month later when necessary. Results Bone union was found in 19 cases 3-15 months (average 6 months ) after the operation. Non-union recurred in 3 patients in whom displacement of the sclerotic fracture ends was found. No complications, such as infection or joint stiffness, occurred. Conclusion Minimally invasive treatment of scaphoid non-union in soldiers can relieve pain, reduce the hospitalization days and cost, and the result is satisfactory.
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Objective To evaluate the causes,clinical manifestations and diagnosis of tarsal tunnel syndrome. Methods Operation was performed for 18 patients ( 21 sides) with tarsal tunnel syndrome. Preoperative Takakura index was 3-7 points with an average of 6.4 points. Ganglion was found in 15 cases (17 sides), varicosity in 2 cases (3 sides) and lipoma in 1 case. Results The symptoms disappeared without recurrence in 0.5 to 17 years' follow-up (average 7.3). Postoperative Takakura index was 9-10 points (average 9.7). Conclusion Tarsal tunnel syndrome is rare in the clinical practice with varied causes and different clinical manifestations. Operation can be performed with satisfactory results for the patients unsuitable for conservative treatment.