Surgical methods and curative effect of tibial plateau fracture with medial large block split / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effects of protecting the internal structure of the knee and internal fixation through two different directions for the treatment of tibial plateau fractures with medial large block split.</p><p><b>METHODS</b>From January 2010 to January 2016, data of 21 patients of tibial plateau with medial large block split fractures who were treated with protecting the internal structure of the knee and internal fixation through two different directions were retrospectively analyzed, including 17 males and 4 females, with an average age of (39.2±3.2) years old ranging from 27 to 63 years. Anteroposterior and lateral radiographs as well as computed tomography(CT) images were obtained in the course of preoperative. It was made in the operation to protect medial knee structure, combining with internal fixation via two different directions plates(medial and posteromedial). If the posterolateral condyle fracture was involved, a plate was applied through posterolateral approach. Rasmussen score was used for radiological assessment, and HSS knee score was used for efficacy assessment at 1 year after operation. The fracture healing time was judged by X-ray and clinical examinations, additionally, the complications and corresponding outcomes were also recorded.</p><p><b>RESULTS</b>All patients were followed up for 10 to 24 months with an average of(17.2±1.7) months. All fractures were healed, the healing time was 9 to 16 weeks with an average of(11.1±3.2) weeks. The Rasmussen score after surgery was 1 to 18 points with an average of(16.7±1.5) points. Sixteen cases got excellent, 3 good and 2 fair. At the final follow-up, HSS functional scores ranged from 60 to 100 points with an average of (87.3±6.7) points, the result was excellent in 18 cases, good in 2 cases and fair in 1 case.</p><p><b>CONCLUSIONS</b>For a split fracture of the medial tibial plateau, the medial incision, full protection of the medial knee structure, and two different directions of supporting plate fixation are feasible, and the short-term effect is satisfactory.</p>

Study on clinical anatomy of calcaneal fractures and its applications / 中国骨伤

<p><b>OBJECTIVE</b>To observe and analyze the intraoperative state of calcaneal fractures, and summarize the law of displacement after calcaneal fractures, so as to guide fracture reduction and fixation.</p><p><b>METHODS</b>From March 2002 to March 2009, among 572 patients with calcaneal fractures, 427 patients were male and 145 patients were female, ranging in age from 17 to 73 years, averaged 37 years. The patients were injured from falling or road accidents, and all the patients were closed fracture. The 189 patients with complete clinical data were treated with reduction and fixation through the lateral approach after observation of displacement type of the fractures.</p><p><b>RESULTS</b>Among 189 patients,the fractures were found at the lower part of the articular surface in all patients, which was hillock point of calcaneus; the fractures were found at the Gissans Corner in 134 patients, and the type include cross-sectional fracture or oblique fracture; the fractures were found at calcaneal tubercle in 118 patients, and the fractures were divided into two parts from top to bottom; the fractures were found at the distal part of calcaneus only in 67 patients.</p><p><b>CONCLUSION</b>Calcaneal fractures show clear law of dislocation. Preoperative and intra-operative detailed analysis and evaluation, as well as reduction and fixation according to certain sequences can insure to get better operative effects.</p>

Clinical application of thoracic transverse process using as the position for thoracic pedicle screw implantation / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the anatomy and clinical application of thoracic transverse process using as the position for thoracic pedicle screw implantation.</p><p><b>METHODS</b>A total of 132 patients were subjected to thoracic pedicle screws fixation and the pedicle screws implantation position was the basis of transverse process. The data of anatomy, operation method for position and their periopereative complications were reviewed. There were 84 male and 48 female with their age ranging from 12 to 77 years, with an average of 32 +/- 9 years, of which 85 patients sufferents from thoracic vertebral fracture, 27 were thoracic degenerative disease, 12 were thoracic tuberculosis and 8 were thoracic tumor.</p><p><b>RESULTS</b>A total of 788 thoracic pedicle screws were placed by free hand technique, and the most of screws were implanted in low thoracic segments (T10-T12) while the least in T1. Massive hemorrhoea, leakage of cerebrospinal fluid and air leakage didn't occurre during operation. Thirteen thoracic pedicle screws were re-implanted during operation due to malposition. There are no perioperative complications expect for intercostal numbness founded in 2 patients and the symptom disappeared after 2 months therapy.</p><p><b>CONCLUSION</b>It is a reliable technique to use the basis of transverse process as the position for pedicle screw implantation, which solve the difficulty of ascertainment the entry point of thoracic pedicle screws. Thoracic pedicle screws can be managed accurately, safely and reliably based on careful manipulation and imageology data.</p>

Analysis of safety and effect of the technique of reconstructing anterior and middle columns by single posterior approach / 中国骨伤

<p><b>OBJECTIVE</b>To explore the safety and effect of the technique of reconstructing anterior and middle column by posterior approach in treatment of lumbar burst fractures.</p><p><b>METHODS</b>From July 2005 to January 2007, 22 patients of lumbar burst fractures (18 males and 4 females, the age was from 28- to 57-years-old with an average of 42.7 years) were treated as the following surgical procedures: based on the routinal posterior approach, one of the transverse process of the injured vertebral was incised to get access to the lateral side of the injured vertebral body. After cleaning of all the displaced fracture fragments and decompressing the spinal canal, the titanium mesh packed with autografts were implanted from lateral side to reconstruct the anterior and middle column. The above and below adjacent vertebral body were fixed by transpedicular screws. The operative time, intraoperative blood loss, vertebral height, degree of kyphotic deformity and comprised spinal canal were recorded.</p><p><b>RESULTS</b>The average operative time was 3.5 h (2.8-5.8 h) and the average blood loss was 820 ml (650-2100 ml). All the patients were followed up with an average 17.2 months (from 12 to 28 months). The height of the injured vertebral body were restored from (23.70 +/- 9.31)% preoperative to (95.77 +/- 1.93 )% postoperative (P<0.05). The natural spinal curvatures and spinal canal were restored. Three cases were involved in transient iatrogenic nerve root injury. And 1 case was involved in the loosening of the connected rod of the pedicle screw system at 3 months after operation.</p><p><b>CONCLUSION</b>The technique of implanting the titanium mesh by posterior approach was effective and safe enough to reconstruct the anterior and middle column in treating lumbar burst fracture. With this technique, good results could be achieved.</p>

Problems and solutions of plate internal fixation for the treatment of calcaneal fractures / 中国骨伤

<p><b>OBJECTIVE</b>To retrospective analysis operating procedures and results of calcaneal fractures treated with plate fixation, identify problems and propose measures to reduce surgical complications.</p><p><b>METHODS</b>From June 2008 to April 2009, 156 patients were reviewed, including 121 males and 35 females, ranging in age from 18 to 59 years, with an average of 41 years. Thirty-two patients had bilateral calcaneal fractures. Twenty-three patients were surgically treated on both calcaneus at the same time. Total 179 calcaneus were treated with operation. The operation records of all patients were analyzed in order to find the problems and deficiencies.</p><p><b>RESULTS</b>Among 179 calcaneal fractures, 31 feet (17.3%) had postoperative wound problems: wound infection and non-healing were found in 26 feet (14.5%), skin flap necrosis in 5 feet (2.8%). There were a lot of problems of plate internal fixation for the treatment of calcaneal fractures, including operation design, operative technique, as well as fracture reduction and fixation.</p><p><b>CONCLUSION</b>The following methods are the only way to avoid operative complications for the treatment of calcaneal fractures: improved surgical technique, minimally invasive operation, simple and effective internal fixation.</p>

Application of the pedicle screws for cervicothoracic fracture-dislocation / 中国骨伤

<p><b>OBJECTIVE</b>To explore pedicle screw implantation for fracture-dislocation injuries at cervicothoracic junction (C6-T2).</p><p><b>METHODS</b>Pedicle screw implantation was used for twenty-six patients with cervicothoracic fracture-dislocation from May 2001 to Jan 2008. There were 17 males and 9 females with an average of 48.5 years (range,20 to 75 years). Single posterior pedicle screw fixation was performed for 17 cases, and posterior screw fixation combined with anterior reduction and plate fixation for the other nine. The accuracy of the pedicle screws were evaluated by CT views after surgery. Complications and neurological recovery were also recorded after the procedures.</p><p><b>RESULTS</b>All subjects were followed up from 3 to 74 months with average 36.5 months. Four cases of complete paraplegia died of cardiovascular or pulmonary failure within half a year after surgery. There were 104 pedicle screws implanted totallythe including 74 pedicle screws in cervical vertebrae, 16 at C5, 16 at C6, 42 at C7, and 30 pedicle screws in upper thoracic vertebrae,in which 22 at T1, 8 at T2. No injury of spinal cord, nerve roots and vertebral artery was found during operation. Eleven screws (14.9%) were perforated out of the pedicles in cervical spine, in which 7(9.5%) through lateral cortex, 1 (1.4%) through the superior and 3 (4.1%) through the inferior. Three screws (10%) were perforated in upper thoracic spine, in which 2 (6.7%) by lateral cortex and 1(3.3%) by the medial (within 2 mm). Bony fusion was achieved for all cases and all internal fixator was good except 1 screw broken at C5. JOA score increased from preoperative (7.5 +/- 2.0) to postoperative (14.5 +/- 2.3) evaluated in 6 months after operation,with statistic difference (t = 6.34, P < 0.05). Neurological improvement was gotten in all patients according to ASIA classification but three cases who suffered from complete neurological injuries.</p><p><b>CONCLUSION</b>Implantation of pedicle screws at cervicothoracic junction can be safe and reliable if the urgeonis familiar with the local anatomy of cervicothoracic spine, and the technique for implantation of the screws. Related radiological parameters should be measured for each subject before the operation in attempt to get a therapy individually.</p>

Analysis of safety and effect of reconstructing anterior and middle columns by single posterior approach in treating lumbar burst fractures / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To explore the safety and effect of the technique of reconstructing anterior and middle columns by posterior approach in treating lumbar burst fractures.</p><p><b>METHODS</b>From July 2005 to January 2007, 22 cases (18 males and 4 females, aged 28-57 years, 42.7 years on average) of lumbar burst fractures were treated with surgical procedures in our hospital. Based on the routine posterior approach, one of the transverse processes of the injured vertebra was incised to get access to the lateral side of the injured vetebral body. After all the displaced fracture fragments were cleared away and the spinal canal was decompressed, the titanium mesh packed with autografts was implanted from the lateral side to reconstruct the anterior and middle columns. The adjacent above and below segments of the vetebral body were fixed with transpedicular screws. The operation time, intraoperative blood loss, vertebral height, degree of kyphotic deformity and comprised spinal canal were documented.</p><p><b>RESULTS</b>The average operation time was 3.5 hours (ranging 2.8-5.8 hours) and the average blood loss was 820 ml (ranging 650-2 100 ml). All the cases were followed up for 17.2 months on average ( ranging 12-28 months). The height of the injured vetebral body was restored from 24 % (12%- 45%) preoperatively to 96% (95%-99%) postoperatively (P less than 0.05). The natural spinal curvatures and spinal canal were restored. Three cases were involved in transient iatrogenic nerve root injury and 1 case was involved in the loosening of the connected rod of the pedicle screw system 3 months postoperatively.</p><p><b>CONCLUSIONS</b>The technique of implanting the titanium mesh by posterior approach is effective and safe enough to reconstruct the anterior and middle columns in treating lumbar burst fractures.</p>

Therapeutic strategies of grade-III open fractures of tibia and fibula / 中国骨伤

<p><b>OBJECTIVE</b>To explore early treatment and technique of grade-III open fracture of tibia and fibula and to summarize the experience of the treatment with external fixation.</p><p><b>METHODS</b>The retrospective analysis were carried out in 168 cases of grade-III open tibial and fibular fractures. One hundred and twenty cases were treated with external fixation,and others were treated with intramedullary nail or amputated. Among 120 patients treated with external fixation in early stage, 86 were male and 34 were female. The age ranged from 18 to 67 years with an average of 36.8 years.</p><p><b>RESULTS</b>One hundred and eleven patients achieved the excellent or good results, some of them underwent later repair of soft tissues. One case was nonunion because of infection and malreduction, and amputation in later stage in 8 cases.</p><p><b>CONCLUSION</b>Treatment with external fixation in early stage is an ideal method for grade-III open fractures of tibia and fibula. Good reduction integrated with simple internal and external fixation is favorable for the repair of soft tissue and union of fracture.</p>

Imaging diagnose and clinical meaning for easy neglect occult posterior pelvic ring injury / 中国骨伤

<p><b>OBJECTIVE</b>To study the value of imaging diagnose and clinical meaning for easy neglect occult posterior pelvic ring injury.</p><p><b>METHODS</b>From Jan. 2003 to Jan. 2008, 178 patients with trauma of pelvic ring were reviewed. Routine AP view of pelvic computed radiographs (CR), axial, sagittal, coronal and curve multiplanar reconstruction CT (MPR) were performed. Spiral CT, slice thickness 3 mm,was carried out in all patients. There were 17 patients (11 males, 6 females, aged 19 to 71 years, mean 34.5 years) with obturator foramen aera fracture obviously but suspecting fracture or normal in posterior pelvic ring in AP view, which had imperceptible fracture changes in MPR. Routine radiographs and CT images studies and clinical physical examination correlation were evaluated retrospectively by anatomical region and classified using the Young-Burgess classification, Tile and AO classification.</p><p><b>RESULTS</b>In the remaining 17 patients with suspected fracture or normal in posterior pelvic ring, 5 cases of Denis I type of sacral fracture, 5 cases of Denis II type, 2 cases of Denis III type, 1 case of sacroilliac joint dislocation, 4 cases of sacral combined with posterior illiac fracture were diagnosed by MPR. Pelvic fracture categories were derived by adapting the Young-Burgess pelvic fracture classification scheme: lateral compression (LC) I and II, anteroposterior compression (APC) I. By adapting the Tile and AO classification schemes, the fracture were B1 and B2 type seperately. From the mechanism of trauma and assessment of pelvic stability point view, 15 cases were internal rotational unstability by lateral compression force, 2 cases were external rotation unstability by anteroposterior force. The omitted rate of posterior pelvic ring was 11% (17 of 128) by routine AP view of CR. 4D imaging reconstruction technique of spiral CT could detect all type of pelvic ring fractures (100%).</p><p><b>CONCLUSION</b>MPR CT could detect imperceptible fractures not been seen on AP view of CR of posterior pelvic ring and visualized sacral fractures better than the axial source images. MPR CT is accurate and reliable in occult posterior pelvic ring fracture for correct fracture detection and classification and guide therapeutic decision-making in patients with pelvic ring trauma.</p>

Percutaneous lag screw internal fixation of LX technique for the sacroiliac joint injury / 中国骨伤

<p><b>OBJECTIVE</b>To study the percutaneous lag screw internal fixation of LX technique for sacroiliac joint diseases or injuries.</p><p><b>METHODS</b>There were 38 patients (25 male and 13 female) with an average age of 35.6 years ranged from 18 to 59 years. Among them, thirty-one cases with trauma of Tile B type, five cases with sacroiliitis and two cases with sacral cystis degeneration. There were 11, 15, 5 cases of Tile B1, B2, B3 type respectively. Pelvic anterior-posterior radiography and spiral computed tomography (CT) were undertaken for all patients. Axis planar, coronal planar, sagittal planar and curve planar of sacral reconstruction of spiral CT images were obtained for every patient. There were 28 cases with delitescence posterior ring injury. All these patients were performed percutaneous lag screw fixation procedures of LX technique under epidural anesthesia. Localization with spiral CT guidance was performed by the radiologist using spiral CT followed by the orthopaedic surgeon. Percutaneous fusion of sacroiliac joint was performed for seven patients who suffered from sacroiliac joint diseases.</p><p><b>RESULTS</b>The blood loss were from 25 to 70 ml (means 36 ml) during operation. All patients were followed up for 3 to 39 months (means 15.6 months). There were no postoperative complications such as infection, fracture nonunion, iatrogenic injuries of nerve and blood vessel, breakage and slippage of fixtors. According to the evaluation of pelvic injuries, the results of imageology were excellent in 34 cases and good in 4, the results of clinical were excellent in 32 and good in 6.</p><p><b>CONCLUSION</b>Percutaneous lag screw internal fixation of LX technique minimizes operation injury during a short procedure with few subsequent complications and allows early mobilization of the patients. That is an ideally safe and effetive operation technique for the sacroiliac joint diseases and injuries.</p>

Quantitative anatomic study on atlas and designation of bionic plating of anterior arch of atlas / 中国骨伤

<p><b>OBJECTIVE</b>To observe and measure specimen of Chinese atlas to obtain morphological parameter, providing anatomic data for designing bionic plating of anterior arch of atlas.</p><p><b>METHODS</b>The anatomic parameters of 48 sets of fresh Chinese adults' atlas specimens were measured with a electric digital caliper and a goniometer, including width of anterior arch of atlas (AW), thickness of atlas at the junction of anterior arch and lateral mass (AD), thickness and height of anterior tubercle of atlas (AT and AH), middle height, length and width of the lateral mass (MHL, L and LW), the extraversion angle of lateral mass of atlas (alpha degrees) and so on. The data were statistically analyzed in order to ascertain the range of morphological parameter of bionic plating of anterior arch of atlas.</p><p><b>RESULTS</b>The measurement results showed that AW was (20.68 +/- 1.38) mm, AD was (3.86 +/- 1.42) mm, AT was (8.65 +/- 1.88) mm, AH was (10.36 +/- 1.49) mm, MHL was (12.82 +/- 1.76) mm, LW was (12.86 +/- 1.63) mm, the extraversion angle of lateral mass of atlas (alpha degrees) was (13.84 +/- 1.73) degrees. The plating was composed of connecting plate of anterior arch of atlas and fixing plate of atlas lateral mass in bilateral.</p><p><b>CONCLUSION</b>The designation of bionic plating of anterior arch of atlas is feasible on morphology. The bionic plating of anterior arch of atlas can not only rebuild the stability of atlas, but also reserve the rotation function between atlas and axis. The plating could be used for patient suffering from instability of upper cervical because of atlas affection.</p>