Clinical outcome analysis on using extensor digitorum communis splitting approach for the treatment of radial head fractures / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical outcomes of internal fixation or replacement for the treatment of radial head fractures through the extensor digitorum communis splitting approach.</p><p><b>METHODS</b>From July 2012 to May 2015, 25 patients with radial head fractures were reviewed. There were 17 males and 8 females, ranging in age from 20 to 67 years old, with a mean age of 39 years old. Twenty-one patients were treated with reconstruction of plate internal fixation, and 4 patients were treated with radial head replacement. According to Mason classification, 19 cases were type II and 6 cases were type III. All the patients underwent internal fixation or replacement through the extensor digitorum communis splitting approach. The patients were followed up clinically and radiographically until the beginning of fracture union and the entrance of function recovery of elbow motion into a plateau. The functional status of the elbow was evaluated using the Mayo Elbow Performance Index(MEPI). Radiographic signs of post-traumatic arthritis were rated according to the Broberg and Morrey system.</p><p><b>RESULTS</b>All the patients were followed up, and the average duration was 29 months (ranged, 12 to 56 months). The average range of flexion and extension was 120°, the extension was limited by 10°, and the flexion was 135°. The average forearm rotation range was 142°, pronation was 75°, supination was 67°. The mean MEPI was 93±7(ranged, 80 to 100 scores); according to the MEPI scoring criceria, 19 patients got an excellent functional result, 6 good. According to the Broberg and Morrey systems of traumatic arthritis, 19 patients were in grade 0, 6 in grade 1, and no patients in grade 2 or 3. No patients with nonunion of the radial head and failure of internal fixation were found. There were no complications of nerve or vascular injuries, and obvious limitation of elbow rotation. Heterotopic ossification around the elbow occurred in 4 cases, but the motion was not significantly limited. There were no complications such as prosthesis loosening and infection in 4 cases after radial head prosthesis replacement.</p><p><b>CONCLUSIONS</b>The extensor digitorum communis splitting approach is an effective exposure method for internal fixation or replacement in the treatment of radial head fractures.</p>

Evaluation of early clinical results of two stage hip replacement after failed internal fixation for femoral neck fractures / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the early clinical results of two stage hip replacement after failed internal fixation for femoral neck fractures in young patients.</p><p><b>METHODS</b>From June 2008 to June 2010,24 patients with femoral head necrosis caused by failed internal fixation were treated with hip arthroplasty. Among them, 12 patients were male and 12 patients were female, with an average age of 42.9 years old (ranged, 18 to 58). According to Harris score and X-ray examination, the clinical result was evaluated.</p><p><b>RESULTS</b>Twenty-three cases were followed up with an average age of 34.4 months (ranged, 25 to 48). After operation, 1 case complicated with the dislocation of hip joint. No deep infection of hip joint, prosthetic loosing or peripheral fracture was found. The mean Harris score was 90.9 +/- 4.3, and 18 obtained excellent results, 4 good and 1 fair.</p><p><b>CONCLUSION</b>Although treatment of femoral head necrosis with two stage hip replacement after failed internal fixation is difficult during operation, its early result is satisfactory.</p>

Short-term result of hip resurfacing arthroplasty in the treatment of patients with femoral head necrosis / 中国骨伤

<p><b>OBJECTIVE</b>To study short-term results of hip resurfacing arthroplasty (HRA) in the treatment of patients with avascular necrosis of femoral head (ANFH), and to explore indication and strategy in this surgery.</p><p><b>METHODS</b>From December 2006 to December 2009, 37 patients (43 hips) with avascular necrosis of femoral head were treated with total hip resurfacing arthroplasty. Among the patients, 25 patients were male and 12 patients were female, with an average age of 44.5 years (ranged, 21 to 67 years). According to ARCO classification, 3 hips were 3A stage, 6 hips were 3B stage, 16 hips were 3C stage and 18 hips were 4 stage. X-ray evaluation of the patients were conducted. The clinical results were evaluated by the Harris hip score system including pain,range of motion, correction of deformity and total function.</p><p><b>RESULTS</b>Thirty-four patients (40 hips) were followed up with an average period of 32.4 months (ranged, 16 to 53 months), and 3 patients were lost. Thirty-seven hips got complete relief of joint pain and 3 patients feel aching pain after walking. There was 1 heterotopic ossification, no femoral neck fracture no dislocation, no infection and no revision in all patients. From pre-operation to present, the average Harris hip score improved significantly from (51.5 +/- 1.7) to (94.3 +/- 1.4). Thirty-seven hips got an excellent result, 3 hips good and no poor.</p><p><b>CONCLUSION</b>The total hip resurfacing arthroplasty is an effective solution for the problems of the younger and active patients with ANFH, and the short-term results are satisfying.</p>

Case-control study on acute colonic pseudo-obstruction after total hip or knee arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the incidence, predisposing factors and therapeutic modalities of acute colonic pseudo-obstruction (ACPO) in patients after total hip arthroplasties (THA) and total knee arthroplasties (TKA).</p><p><b>METHODS</b>From January 2006 to December 2009, 12 patients with ACPO after THA and TKA operation were investigated retrospectively,who were viewed as the ACPO group. There were 10 males and 2 females with an average age of (78 +/- 12) years in the ACPO group. Other 853 patients without ACPO after THA and TKA operation were viewed as the control group treated at the same period. The incidence of ACPO was calculated. The clinical data were collected and compared between the two groups including patient age, gender, procedure, anesthetic class, clinical presentation, radiographic findings, duration from index surgery to diagnosis of ACPO, treatment, postoperative mobilization time, and length of hospital stay.</p><p><b>RESULTS</b>The incidence of ACPO was 1.4%. The incidence of primary THA (1.3%) was higher than that of primary TKA (0.4%); the incidence of hip and knee revisions (5.0%) was higher than that of primary THA and TKA (1.0%); there was no difference in incidence between hip revisions (5.5%) and knee revisions (4.0%). The mean age was (78 +/- 12) years old in ACPO group and (71 +/- 13) in the control group. The male/female ratio was 5:1 in ACPO group and 2:3 in control group. There were statistical differences in mean age and gender ratio between the two groups. No association was found with respect to anesthetic class. On average, ACPO occurred at 2.5 days after index surgery. The abdominal distention occurred in all 12 cases, nausea or vomiting in 8 cases and abdominal pain in 3 cases. Radiographically cecal dilation occurred in all cases and intestinal dilation in 3 cases. All patients initially were treated conservatively with immediate cessation of oral intake,a nasogastric tube and oral mineral oil. Three patients received a rectal tube. Only 1 patient required endoscopic decompression. There were no deaths after ACPO in the series. Mean mobilization time after surgery averaged (5.0 +/- 2.2) days in ACPO group compared with (2.5 +/- 1.1) days in the control group. Mean hospital stay averaged (16.5 +/- 6.4) days in ACPO group compared with (10.5 +/- 4.5) days in the control group. There were statistical differences in mean mobilization time after surgery and mean hospital stay between two groups.</p><p><b>CONCLUSION</b>ACPO mainly happened in old male patients. The majority cases response to conservative treatment and their prognoses are good. But ACPO will delay mobilization time after surgery and increase hospital stay.</p>

Anatomic comparison between spinous process screws and pedicle screws techniques of the second cervical vertebar / 中国骨伤

<p><b>OBJECTIVE</b>To compare anatomic difference between spinous process screws and pedicle screws techniques of the second cervical vertebra.</p><p><b>METHODS</b>Ten human cadaveric of cervical spine (5 male, 5 female) were harvested and had no gross deformities such as scoliosis and/or kyphosis were found in the study. The average age of the subjects was 60.5 years. The specimens were placed in the prone position. Posterior cervical exposure was attained by dissecting all soft tissue off the posterior aspect of the second cervical vertebra. After clear exposure of the lateral mass,the spinous process screw and pedicle screw insertion techniques were performed in this study. Each technique involved ten specimens and 10 screws inserted into C2 bilaterally. The one side of C2 was randomly selected for the spinous process screw and the other side was designate for the pedicle screw. This point then was drilled with a 3 mm drill, and followed by placement of a 4.0 mm cortical screw. The starting point for spinous process screw insertion was located at the junction of the lamina and the spinous process and the direction of the screw was about 0 degrees caudally in the sagittal plane and about O0 medially in the axial plane. The starting point of pedicle screw should be the midpoint of the base of inferior articular facet of the axis. The drilling angle was 15 degrees to 20 degrees in the superior direction and 30 degrees in the medial direction. After screw placement, all the specimens were CT scaned. On the CT scan,the length of the spinous process screw and pedicle screw trajectory were measured. Results were recorded for each screw that violated impinged of the pedicle, spinal canal and transverse process foramen.</p><p><b>RESULTS</b>All the C2 spinous process screws were successfully placed, without impingement the spinal cord, the vertebral artery and the breakage of the spinous process. There was one pedicle screw breaking the pedicle into the vertebral artery foramen. The trajectory length for the spinous process screws were (21.4 +/- 1.4) mm,compared with the pedicle screws (23.7 +/- 1.0) mm. But there was no significant differences between spinous process screws and pedicle screws techniques (t = -4.387, P > 0.05).</p><p><b>CONCLUSION</b>The C2 spinous process screw fixation has the anatomic feasibility and is easier to perform than pedicle screw fixation.</p>

An anatomic study of posterior C(2) spinous process laminar screw fixation / 中华外科杂志

<p><b>OBJECTIVES</b>To explore the feasibility and the technical parameters in posterior C2 spinous process laminar screw fixation, and discuss the clinic significance of C2 spinous process laminar screws.</p><p><b>METHODS</b>Twenty cervical cadaveric spines of C2 were dissected, with care taken to expose the lamina and spinous process. After the entrance point of spinous process screw were determined, posterior C2 spinous process laminar screw implantation was performed under visual control. On the morphologic CT scan, the angle and length of the spinous process laminar screw trajectory and the distance between the tip of the screw and the spinal cord and the vertebral artery were measured.</p><p><b>RESULTS</b>The C2 spinous process laminar screws were successfully placed, without impingement of the spinal cord and the vertebral artery. There were little differences between superior and inferior screws in the angle, trajectory length and the distance between the tip of the screw and the spinal cord and the vertebral artery, but without significance (P > 0.05). The placed angles of the screws were 76.8° ± 10.6° in the axial plane. The distance between the tip of the screw and the spinal cord and the vertebral artery was (5.3 ± 1.6) mm and (17.4 ± 3.7) mm respectively. The trajectory length was (23.1 ± 3.2) mm.</p><p><b>CONCLUSIONS</b>Posterior C2 spinous process laminar screw fixation is feasible. C2 spinous process laminar screw fixation affords an alternative to standard screw placement for plate fixation and cervical stabilization.</p>

Comparison of humeral head replacement and internal fixation for the treatment of 3 parts and 4 parts fractures of proximal humerus in the elderly / 中国骨伤

<p><b>OBJECTIVES</b>To compare the indication, technical keys during surgery and early results of humeral head replacement and internal fixation for the 3 parts and 4 parts fractures of proximal humerus in the elderly.</p><p><b>METHODS</b>From July. 2004 to July. 2006,58 patients with 3 parts and 4 parts fractures of proximal humerus were randomly treated with AO locked compressive plates (LCP) or humeral head replacement. In LCP group, there were 12 males and 16 females with an average age of (66.5 +/- 1.4) years, including 24 cases of 3 parts fractures, 1 case of 3 parts fractures with dislocation, 2 cases of 4 parts fractures and 1 case of 4 parts fractures with dislocation. In the humeral head replacement group,there were 12 males and 18 females with an average age of (68.9 +/- 3.5) years, including 9 cases of 3 parts fractures, 2 cases of 3 parts fractures with dislocation, 12 cases of 4 parts fractures, 4 cases of 4 parts fractures with dislocation and 3 cases of humeral head split fractures. Trauma series X-rays of shoulder were taken after operation, 2-week, 6-week, 10-week, 16-week, 6-month and the latest followed-up. VAS, SST (simple shoulder test) questionnaire, ASES (American shoulder & elbow surgeon)score, Constant-Murley score and UCLA score had been adopted for evaluation at the latest followed-up.</p><p><b>RESULTS</b>The mean followed-up period of LCP group was 29.8 months and that of humeral head replacement group was 28.2 months. VAS of LCP group and humeral head replacement group were (2.2 +/- 1.5) and (2.6 +/- 1.9), respectively. There was a statisticaly difference between the two groups (P = 0.002). The degrees of forward elevation of shoulder in LCP group and humeral head replacement group were 110.2 degrees (81 degrees to 130 degrees) and 120.2 degrees (89 degrees to 140 degrees), respectively. There was a statistical difference between the two groups (P = 0.031). ASES score, Constant-Murley score, UCLA score and response "yes" in SST questionnaire in LCP group were 87.7 +/- 2.2, 83.9 +/- 6.8, 30.3 +/- 2.2, 8.0 +/- 0.9, and in humeral head replacement group were 86.4 +/- 4.5, 85.5 +/- 5.6, 31.2 +/- 2.1, 9.0 +/- 0.7, respectively. There was no significant difference between the two groups in ASES score, Constant-Murley score, UCLA score and SST questionnaire.</p><p><b>CONCLUSION</b>Both humeral head replacement and internal fixation are effective treatment for the 3 parts and 4 parts fracture of proximal humerus in the elderly. Humeral head replacement is more technically demanding and has a strict indications. The satisfactory results of humeral head replacement are based on the suitable placement of prostheses and the correct reconstruction of rotator cuff insertion.</p>

Biomechanical study on transarticular screw and plate fixation syetem in the lower cervical spine / 中国骨伤

<p><b>OBJECTIVE</b>To compare the cervical stabilities of transarticular screw fixation alone, and transarticular screw and plate fixation system.</p><p><b>METHODS</b>Twelve specimens of cervical vertebra containing C2-T1 were obtained from human cadaver. The three-column instability model was made at C4.5 and C5.6 levels. The specimens were stabilized with transarticular screw fixation alone, and transarticular screw and plate fixation system respectively. The ranges of motion of segments including intact group, transarticular screw fixation alone group and transarticular screw and plate fixation system group were measured under the torque of 2.0 N x m in flexion, extension, lateral bending, and torsion respectively under nonrestrictive and nondestructive condition.</p><p><b>RESULTS</b>The rang of motion (ROM) and neutral zone (NZ) of both transarticular screw fixation alone and transarticular screw and plate fixation system group were significantly smaller than those of intact group in all directions (P < 0.05). The transarticular screw and plate fixation system group allowed a very smaller ROM and NZ than transarticular screw fixation alone during extension, lateral bending and axial rotation except flexion (P < 0.05).</p><p><b>CONCLUSION</b>Cervical transarticular screw and plate fixation system provides better stability than transarticular screw fixation alone. If the transarticular fixation technique is preferred, transarticular screw and plate fixation system will be beneficial.</p>

Anatomical considerations for the placement of C₂ spinous process screws / 中华外科杂志

<p><b>OBJECTIVES</b>To quantitatively anatomically evaluate the C₂ spinous process, analyze the anatomical feasibility of the C₂ spinous process screws and its clinical significance.</p><p><b>METHODS</b>To dissect and evaluate 30 cervical cadaveric spines of C₂ which were taken to expose the lamina and spinous process. Anatomic quantitative evaluation of the C₂ spinous process included its height and width. Twenty cervical cadaveric spines of C₂ were chosen to the study of the placement of the C₂ spinous process screws. The starting point for the C₂ spinous process screw insertion was located at the base of the spinous process. After the entrance point of spinous process screws was determined, posterior C₂ spinous process screw implantation was performed bilaterally under direct visualization. On the morphologic CT scan, the width of C₂ spinous process base, the angle and length of the spinous process screw trajectory, and the distance between the tip of the screw and the spinal cord and the vertebral artery were measured.</p><p><b>RESULTS</b>The average height and width of the C₂ spinous process were (12.90 ± 1.30) mm and (18.86 ± 1.17) mm respectively. The C₂ spinous process screws were successfully placed without impingement the spinal cord or the vertebral artery and the breakage of the spinous process. On the CT scan, the average width of the base of C₂ spinous process was (20.7 ± 1.3) mm. The placed angles of the screws were 1.8° ± 1.0° in the axial plane. The distance between the tip of the screw and the spinal cord or the vertebral artery was (8.3 ± 2.6) mm and (20.2 ± 3.1) mm respectively. There were little differences between superior and inferior screws in the angle, the distance between the tip of the screw and the spinal cord or the vertebral artery, but without significance (P > 0.05). The average trajectory length of the C₂ spinous process screws was (19.7 ± 1.1) mm. The average trajectory length of the superior spinous process screws was shorter than that of inferior spinous process screws, with great differences (t = 3.566, P < 0.01).</p><p><b>CONCLUSIONS</b>There is the anatomic feasibility of the C₂ spinous process screw fixation which may afford an alternative to standard screw placement for axis fixation. The biomechanical study for the C₂ spinous process screw is also necessary.</p>

Hip resurfacing arthroplasty in patients with ankylosing spondylitis / 中国骨伤

<p><b>OBJECTIVE</b>To study the short-term results of metal on metal hip resurfacing arthroplasty (HRA) for the treatment of patients with ankylosing spondylitis (AS), to explore the indications and technology of this surgery.</p><p><b>METHODS</b>From February 2006 to April 2008, 11 patients (15 hips) with ankylosing spondylitis were treated with metal on metal total hip resurfacing arthroplasty. Among them, 9 patients were male, and 2 patients were female, with an average age of 32.5 years (ranged from 16 to 53 years). The comparative study on preoperative and postoperative pain, range of motion, correction of deformity and function evaluation were performed. The preoperative and postoperative Harris scores were compared and the feasibility and technical difficulty were analyzed.</p><p><b>RESULTS</b>Ten patients were followed up for an average period of 16.2 months (ranged from 8 to 34 months) and 1 patient was lost. Pain disappeared in 10 patients. There were no heterotopic ossification, no femoral neck fracture, no dislocation, no infection and no revision in all patients. From preoperation to present, the mean flexion angle of hip was improved from preoperative 0 degrees to 75 degrees to postoperative 35 degrees to 105 degrees; the mean abducting angle of hip was improved from preoperative 0 degrees to 30 degrees to postoperative 15 degrees to 55 degrees; and the average Harris hip score improved significantly from (30.9 +/- 3.4) (2-47) to (85.1 +/- 3.1) (46-94). According to evaluation criteria, 10 hips got an excellent result, 3 good and 1 poor.</p><p><b>CONCLUSION</b>The total hip resurfacing arthroplasty is an effective solution for the treatment of the younger and active patients with AS and it shows satisfactory short-term results. It is very significant to analysis the different conditions of patients so as to choose proper strategy.</p>

Strategy of prevention and management of intraoperative fractures of acetabulum during primary total hip arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To analyse the causes and resultes of intraoperative occurrence of an acetabular fracture in primary total hip arthroplasty and discuss propriate prevention and treatment of this problem.</p><p><b>METHODS</b>Between July 2004 and December 2006, 326 primary total hip arthroplasties were retrospectively reviewed and found that eleven patients (eleven hips) had sustained an intraoperative acetabular fracture involving 7 male and 4 female,aged from 37 to 71 years (mean 54 years). Analyzed the causes of fractures, the anatomic location, treatment and outcome of the fractures. Acetabular component designs were categorized and each design was analyzed for fracture risk.</p><p><b>RESULTS</b>Among 11 cases, the fractures occurrenced as setting the prosthesis in 6 cases, grinding and drilling in 3 cases, drawning hook in 2 cases. There were 5 cases of central type fracture, 3 of posterior-wall, 2 of anterior, 1 of posterior-upper. Nine of these patients (nine hips) had been followed-up for 12 to 29 months(mean 18 months). There were no heterotopic ossification, no dislocation, no deep venous embolism. All fractures were healing.</p><p><b>CONCLUSION</b>Acetabular fracture during primary total hip arthroplasty is a complication of acetabular fixation without cement, which should be think highly of. In the present series, retention of a stable cup is associated with uneventful osseous in growth and excellent early-term outcomes.</p>

The feasibilty study of posterior laminar screw fixation techniques in axis / 中国骨伤

<p><b>OBJECTIVE</b>Observation and measurement were done on axial laminar to get the parameters of morphology in Chinese. To evaluate the possibility of the placement of axial laminar screw.</p><p><b>METHODS</b>The relative parameters of 28 sets of fresh Chinese adults' axial specimens were measured with a digital caliper, a goniometer and imageology, including the distance from superior and inferior the anchor point of the axial laminar screw to superior margin of the axial laminar, the superior,middle and inferior thickness of axial laminar, the height of axial laminar, the length and the angle of the axial laminar screw trajectory, the distance from the anchor point of the axial laminar screw to hole of vertebral artery and the central point of inferior articular process and so on. The data were statistically analyzed.</p><p><b>RESULTS</b>The distance from superior and inferior the anchoi point of the axial laminar screw to superior margin of the axial laminar was 4 mm and 8 mm respectively. The superior, middle and inferior thickness of axial laminar was 3.2, 6.7, 5.5 mm respectively. The height of axial laminar was 12.8 mm. The superior and inferior length of axial laminar screw trajectory was 26.2 mm and 25.5 mm respectively.</p><p><b>CONCLUSION</b>It is feasible and reliable for posterior laminar screw fixation techniques of axis in Chinese. C2 laminar screw fixation techniques could be used as a supplementary method for conventional posterior screw fixation techniques of C2.</p>