ABSTRACT
Objective To investigate the clinical value of individual design combined with 3D-guided percutaneous hollow screw fixation for patients with Herbert Ⅰb-type scaphoid fractures.Methods Totally 93 cases of Herbert Ⅰb-type scaphoid fractures patients who were admitted into our hospital from November 2015 to April 2017 were divided into the external fixation group(31 cases),the internal fixation group(29 cases)and the minimal invasion group(33 cases).The external fixation group was treated with cast immobilization;the internal fixation group was treated with open reduction and internal fixation;the minimal invasion group was treated with individual design combined with 3D-guided percutaneous hollow screw fixation.The time of bone union,return-to-work time,rateof bone union,wrist range of motion (ROM)and Mayo function score of the three groups were compared.Results The time of bone union,return-to-work time and wrist range of motion in the minimal invasion group were(6.7 ±0.9)weeks,(7.3 ±0.9)weeks and(103.8 ±5.9)°respectively,which were better than the other two groups with statistically significant difference(P<0.05).The bone union rate of the external fixation group,the internal fixation group,and the minimal invasion group were 83%,86.2%and 100%respectively.The difference between the minimal invasion group and the other two groups were statistically significant(P<0.05).The Mayo function score of the external fixation group,the internal fixation group, and the minimal invasion group were 71.0%,82.8% and 97.0% respectively.The difference between the minimal invasion group and the other two groups were statistically significant(P<0.05).Conclusion Individual design combined with 3D-guided percutaneous hollow screw fixation treatment has exact effect for Herbert Ⅰb-type scaphoid fractures with fast recovery,and it's worthy of wildly use.
ABSTRACT
<p><b>BACKGROUND</b>This study aimed to evaluate the effects of standard rescue procedure (SRP) in improving severe trauma treatments in China.</p><p><b>METHODS</b>This study was conducted in 12 hospitals located in geographically and industrially different cities in China. A standard procedure on severe trauma rescue was established as a general rule for staff training and patient treatment. A regional network (system) efficiently integrating prehospital rescue, emergency room treatments, and hospital specialist treatments was built under the rule for information sharing and improving severe trauma treatments. Treatment outcomes were compared between before and 1 year after the implementation of the SRP.</p><p><b>RESULTS</b>The outcomes of a total of 74,615 and 12,051 trauma cases were collected from 12 hospitals before and after the implementation of the SRP. Implementation of the SRP led to efficient cooperation and information sharing of different treatment services. The emergency response time, prehospital transit time, emergency rescue time, consultation call time, and mortality rate of patients were 24.24 ± 4.32 min, 45.69 ± 3.89 min, 6.38 ± 1.05 min, 17.53 ± 0.72 min, and 33.82% ± 3.87% (n = 441), respectively, before the implementation of the standardization and significantly reduced to 10.11 ± 3.21 min, 22.39 ± 4.32 min, 3.26 ± 0.89 min, 3.45 ± 0.45 min, and 20.49% ± 3.11%, separately (n = 495, P < 0.05) after that.</p><p><b>CONCLUSIONS</b>Staff training and SRP can significantly improve the efficiency of severe trauma treatments in China.</p>
Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Young Adult , China , Emergency Medical Services , Reference Standards , Wounds and InjuriesABSTRACT
Posterior lumbopelvic fixation with iliac screws is the most commonly used method for unstable spinopelvic injuries. It has certain limitations including inability to use distraction along the spinopelvic rod as an indirect reduction maneuver, need for complex 3-dimensional rod contouring and complications such as hardware prominence and soft tissue coverage. In the present case report, we described a surgical technique of lumbopelvic fixation with sacral alar screws for traumatic spinopelvic instability resulted from a unilateral Denis-III comminuted sacral fracture and the L5 burst fracture. On the opposite side of the sacral fracture, caudal screws were implanted into the pedicle of the S1, whereas on the side of sacral fracture, two sacral alar screws were placed parallel to the superior sacral endplate as well as the plane of sacroiliac joint. In addition, horizontal stabilization was conducted with cross-link connections to maintain the longitudinal traction. For sacral fracture associated with traumatic spinopelvic instability, this modified lumbopelvic fixation technique using sacral alar screws makes longitudinal reduction easier, requires less rod contouring, and reduces hardware prominence without compromising the stability.