ABSTRACT
Objective:To explore the necessity of perioperative radiography by analyzing the risk factors for internal fixation loosening after closed reduction and internal fixation with Kirschner wire for supra-condylar fracture of the humerus in children.Methods:Retrospectively analyzed were the 502 patients with supracondylar fracture of the humerus who had been treated at Department of Orthopedics, Children's Hospital of Fudan University by closed reduction and internal fixation with Kirschner wire from January 1, 2019 to December 31, 2021. There were 307 boys and 195 girls, with an age of (60.0±27.2) months. There were 224 Gartland type Ⅱ supracondylar fractures and 278 Gartland type Ⅲ supracondylar fractures. Follow-ups revealed internal fixation loosening in 52 cases (set as a loosening group) and no internal fixation loosening in the other 460 cases (set as a non-loosening group). The angles between Kirschner wires (angle 1 and angle 2), the effective fixation ratios of the Kirschner wire (ratio 1, ratio 2, and ratio 3), the metaphyseal shaft angle α, and the distal anteversion angle of the humerus β were measured on the perioperative and postoperative elbow X-ray films and compared. Other data affecting the internal fixation loosening were collected. Multiple logistic regression was used to analyze the risk factors for internal fixation loosening after closed reduction and internal fixation of supracondylar fracture of the humerus. Results:There were no significant differences between the intraoperative and postoperative data in the angle 1 or angle 2 between Kirschner wires (26.58°±14.22° versus 26.75°±10.70°; 41.85°±8.67° versus 41.31°±7.79°), the effective fixation ratio 1, 2 or 3 of Kirschner wire (0.904±0.182 versus 0.887±0.206; 0.897±0.119 versus 0.895±0.142; 0.890±0.035 versus 0.889±0.076), the metaphyseal shaft angle α (86.25°±2.74° versus 85.52°±1.86°), or the distal anteversion angle of the humerus β (31.04°±0.97° versus 29.54°±0.45°) (all P>0.05). Multiple logistic regression analysis showed that fracture site ( P=0.032), fracture classification ( P=0.041) and postoperative infection ( P=0.004) were the risk factors for internal fixation loosening. Conclusions:As supracondylar fractures of the humerus remain stable in the perioperative period with little risk of fracture displacement or internal fixation loosening after closed reduction and internal fixation with Kirschner wire, postoperative radiography is not necessary. The risks for internal fixation loosening are positively correlated with fracture site, fracture type and postoperative infection.
ABSTRACT
For more than a century,the treatment of cervical disorders has been greatly improved.The researches for the complications of cervical spine surgery have been enhanced during the same period.The objective of this paper is to summarize the progressive results of researches on the complications of cervical spine surgery through literature review.Common surgical complications include hematoma,dural tear,postoperative infection,C5 nerve root palsy,recurrent/superior laryngeal nerve injury,axial pain,etc.Rare complications such as esophageal injury,Homer's syndrome,vertebral artery injury,dysphagia and dyspnea caused by posterior upper cervical spine surgery have also been reported in recent years.The application of cervical instruments provides great support for the improvement of clinical efficacy.However,reports about the related complications also increases year by year,including implant displacement or broken,and special complications associated with cervical artificial disc replacement.Prevention and treatment of complications is the key in clinical practice.For those complications which already have relatively clear causes,such as soft tissue or spinal cannel hematoma,recurrent/superior laryngeal nerve injury,dural tear,accurate and effective operation is highly suggested.However,there's still no standard of operating process for preventing the complications (C5 nerve root palsy,dysphagia,axial pain,etc.),whose pathogeny are still unclear,and further studies are needed in the future.Instrument related complications caused by mal-operation or abnormal patient condition can be effectively controlled through correct medical procedures.Those instrument shortcomings of material or design aspects need to be improved by the auxiliary of cutting-edge technology for further improvement of the results of clinical application.
ABSTRACT
BACKGROUND:Current decelularized methods have the certain damage to the extracelular matrix and reduce the biomechanical properties of acelular scaffolds. OBJECTIVE:To explore the biomechanical properties of decelularized scaffold of lyophilized bovine tendon. METHODS:Sixty lyophilized fiber bundles from fresh flexion tendon of calf toes were randomly divided into two groups: control group and experimental group. In the experimental group, serine protease inhibitors were placed asepticaly for 24 hours at room temperature, then the samples were rinsed with PBS and transferred to the low concentration of trypsin+ethanol mixed solution to remove the cel wal without destruction of the extracelular matrix at room temperature for 5 hours; after that, the fiber bundles were cultured in DNA enzyme solution for 5 hours, finaly the acelular scaffold was completed and rinsed with PBS for 48 hours and dried at room temperature in sterile room. No treatment was done in the control group. Modulus of elasticity, durability and maximum stress were determined in the two groups. RESULTS AND CONCLUSION:Similar elastic modulus and durability were found in the two groups, but the maximum stress in the experimental group was significantly lower than that in the control group (P < 0.01). These findings indicate that the lyophilized acelular tendon fibers can mimic the biological function of bovine tendon fibers to a certain extent.