Early effectiveness of Ti-Robot assisted femoral neck system for minimally invasive treatment of elderly Garden type Ⅱ and Ⅲ femoral neck fractures / 中国修复重建外科杂志

OBJECTIVE@#To investigate the early effectiveness of the Ti-Robot assisted femoral neck system (FNS) in the treatment of elderly Garden type Ⅱ and Ⅲ femoral neck fractures.@*METHODS@#A retrospective analysis was conducted on the clinical data of 41 elderly patients with Garden type Ⅱ and Ⅲ femoral neck fractures who were admitted between December 2019 and August 2022 and met the selection criteria. Among them, 21 cases were treated with Ti-Robot assisted FNS internal fixation (study group), and 20 cases were treated solely with FNS internal fixation (control group). There was no significant difference in baseline data, including gender, age, side, cause of injury, time from injury to surgery, fracture Garden classification, and fracture line classification, between the two groups ( P>0.05). Surgical effectiveness was evaluated based on parameters such as operation time (including incision time and total operation time), reduction level, number of dominant pin insertions, intraoperative fluoroscopy frequency, incision length, whether to extend the incision, need for assisted reduction, postoperative hospital stay, fracture healing time, incidence of osteonecrosis of the femoral head, postoperative visual analogue scale (VAS) score at 1 day, and Harris hip score at last follow-up.@*RESULTS@#The study group showed significantly shorter incision time, fewer dominant pin insertions, fewer instances of extended incisions, fewer intraoperative fluoroscopy frequency, and smaller incisions than the control group ( P<0.05). There was no significant difference in total operation time, reduction level, and assisted reduction frequency between the two groups ( P>0.05). Both groups achieved primary wound healing postoperatively, with no complications such as incision leakage or skin infection. All patients were followed up 12-24 months with an average of 14.6 months. Fractures healed in both groups, with no significant difference in healing time ( P>0.05). There was no significant difference in postoperative hospital stay between the two groups ( P>0.05). The study group showed significantly better VAS score at 1 day after operation and Harris hip score at last follow-up when compared to the control group ( P<0.05). No complication such as internal fixation failure, fracture displacement, or hip joint varus occurred in both groups during the follow-up. Osteonecrosis of the femoral head occurred in 1 patient of the control group, while no was observed in the study group, and the difference in the incidence of osteonecrosis of the femoral head between the two groups was not significant ( P=0.488).@*CONCLUSION@#Compared to sole FNS internal fixation treatment, Ti-Robot assisted FNS internal fixation for elderly Garden typeⅡ and Ⅲ femoral neck fractures can reduce incision time, achieve minimally invasive and accurate nail implantation, and decrease intraoperative fluoroscopy frequency, leading to improved postoperative hip joint function recovery.

Study on application of ultrasonic bone curette in anterior cervical spine surgery / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effect of ultrasonic bone curette in anterior cervical spine surgery.@*METHODS@#A clinical data of 63 patients with cervical spondylosis who were admitted between September 2019 and June 2021 and met the selection criteria was retrospectively analyzed. Among them, 32 cases were operated with conventional instruments (group A) and 31 cases with ultrasonic bone curette (group B). There was no significant difference between the two groups (P>0.05) in gender, age, surgical procedure, surgical segment and number of occupied cervical space, disease type and duration, comorbidities, and preoperative Japanese Orthopaedic Association (JOA) score, cervical dysfunction index (NDI), and pain visual analogue scale (VAS) score. The operation time, intraoperative bleeding, postoperative drainage, postoperative hospital stay, and the occurrence of postoperative complications were recorded in both groups. Before operation and at 1, 3, and 6 months after operation, the JOA score and NDI were used to evaluate the function and the postoperative JOA improvement rate was calculated, and VAS score was used to evaluate the pain improvement. The anteroposterior and lateral cervical X-ray films were taken at 1, 3, and 6 months after operation to observe whether there was any significant loosening and displacement of internal fixators.@*RESULTS@#Compared with group A, group B had shorter operation time and postoperative hospital stay, less intraoperative bleeding and postoperative drainage, and the differences were significant (P<0.05). All incisions healed by first intention in the two groups, and postoperative complications occurred in 5 cases (15.6%) in group A and 2 cases (6.5%) in group B, showing no significant difference (P>0.05). All patients were followed up 6-12 months (mean, 7.9 months). The JOA score and improvement rate gradually increased in groups A and B after operation, while the VAS score and NDI gradually decreased. There was no significant difference in VAS score between 3 months and 1 month in group B (P>0.05), and there were significant differences between the other time points of each indicator in the two groups (P<0.05). At 1, 3, and 6 months after operation, the JOA score and improvement rate in group B were better than those in group A (P<0.05). X-ray films examination showed that there was no screw loosening or titanium plate displacement in the two groups after operation, and the intervertebral cage or titanium mesh significantly sank.@*CONCLUSION@#Compared with traditional instruments, the use of ultrasonic bone curette assisted osteotomy in anterior cervical spine surgery has the advantages of shorter operation time, less intraoperative bleeding, less postoperative drainage, and shorter hospital stay.

Osteoperiosteal decortication and extracortical bone-bridging for treatment of atrophic humeral nonunions / 中华创伤骨科杂志

Objective To assess the effectiveness of osteoperiosteal decortication and extracortical bone-bridging in the treatment of atrophic humeral nonunions.Methods Nineteen patients with atrophic humeral nonuninon were treated by osteoperiosteal decortication and extracortical bone-bridging between March 2008 and April 2016.They were 12 men and 7 women,aged from 23 to 68 years (mean,36.6 years).The fracture was located at the left side in 10 cases and at the right side in 9.Before admission to our hospital,8 had received surgery once,6 twice and 5 thrice.The time from fracture to hospitalization ranged from 12 to 106 months (average,26.3 months).Shoulder function was evaluated by Neer scoring and elbow function by Mayo elbow performance score (MEPS) at final follow-ups.Results All incisions healed by first intention.Two cases reported transient radial nerve symptoms of numbness.All the 19 patients were followed up for 28.9 months on average (range,from 13 to 78 months).Radiographic examinations showed signs of bone remodeling,disappearance of fracture lines and formation of extracortical bone bridge at 6 to 8 weeks after operation.All of them achieved radiographic union within 10 to 46 weeks (16.8 weeks on average).The Neer scores averaged 82.5 (range,from 70 to 98),giving 12 excellent cases,5 good ones and 2 fair ones.The MEPS averaged 84.4 (range,from 70 to 96),giving 11 excellent cases,5 good ones and 3 fair ones.Conclusion Osteoperiosteal decortication and extracortical bone-bridging in treatment of atrophic humeral nonunions can effectively induce osteogenesis and increase stability of broken ends,promoting bone healing.

Treatment experience of 20 cases of artificial total hip revision / 安徽医科大学学报

20 cases of artificial total hip joint rebuilding were selected, all of which were unilateral total hip joint rebuilding. Harris scores before and after the surgery and hip joint activity evaluation were carried out to the pa-tients. The average follow-up duration was 1 to 2 years. Up to the last follow-up,the activity of hip joint had been obviously improved compared with that before the operation. Through X-ray, the phenomena such as radiolucent zone around the prosthesis,prosthesis shift or osteolysis around the prosthesis haven't been seen. The short-term clinical effect of artificial total hip joint rebuilding was obvious for patients with hailure of first total hip joint re-placement caused by various reasons.