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Objective:To analyze the incidence and epidemiological characteristics of traumatic spinal cord injury in China in 2018.Methods:Multi-stage stratified cluster sampling was used to randomly select hospitals capable of treating patients with spinal cord injury from 3 regions，9 provinces and 27 cities in China to retrospectively investigate eligible patients with traumatic spinal cord injury admitted in 2018. National and regional incidence rates were calculated. The data of cause of injury，injury level，severity of injury，segment and type of fracture，complications，death and other data were collected by medical record questionnaire，and analyzed according to geographical region，age and gender.Results:Medical records of 4，134 patients were included in this study，with a male-to-female ratio of 2.99∶1. The incidence of traumatic spinal cord injury in China in 2018 was 50.484 / 1 million （95% CI 50.122-50.846）. The highest incidence in the Eastern region was 53.791 / 1 million （95% CI 53.217-54.365）. In the whole country，the main causes of injury were high falls （29.58%），as well as in the Western region （40.68%），while the main causes of injury in the Eastern and Central regions were traffic injuries （31.22%，30.10%）. The main injury level was cervical spinal cord in the whole country （64.49%），and the proportion of cervical spinal cord injury in the Central region was the highest （74.68%），and the proportion of lumbosacral spinal cord injury in the Western region was the highest （32.30%）. The highest proportion of degree of injury was incomplete quadriplegia （55.20%），and the distribution pattern was the same in each region. A total of 65.87% of the patients were complicated with fracture or dislocation，77.95% in the Western region and only 54.77% in the Central region. In the whole country，the head was the main combined injury （37.87%），as well as in the Eastern and Central regions，while the proportion of chest combined injury in the Western region was the highest （38.57%）. A total of 32.90% of the patients were complicated with respiratory complications. There were 23 patients （0.56%） died in hospital，of which 17（73.91%） died of respiratory dysfunction. Conclusions:The Eastern region of China has a high incidence of traumatic spinal cord injury. Other epidemiological features include high fall as the main cause of injury cervical spinal cord injury as the main injury level，incomplete quadriplegia as the main degree of injury，head as the main combined injury，and respiratory complications as the main complication.
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Objective:To explore different surgical treatment options and effect for intraspinal cement leakage after percutaneous vertebroplasty (PVP).Methods:A retrospective case series study was carried out to analyze the clinical data of 5 patients with intraspinal cement leakage after PVP for osteoporotic vertebral compression fracture (OVCF) admitted to People's Hospital of Shanxi between May 2016 and January 2020, including 1 male and 4 females, with the age of 65-82 years [(75.4±7.5)years]. Injured segments were located at T 12-L 1 in 1 patient, L 1 in 1, L 2-4 in 1, L 3 in 1 and L 4-5 in 1. The American Spinal Injury Association (ASIA) classification was grade C in 2 patients and grade D in 3. Muscle strength was grade II in 2 patients and grade III in 3. The leakage of bone cement in the spinal canal was strip or columnar in 3 patients, leaning to one side of the spinal canal and adjacent to the nerve root, and the bone cement was removed by transforaminal endoscope for decompression. The leakage of bone cement in the dura mater and spinal canal was found in 2 patients. The intradural bone cement leakage was removed by durotomy, and the bone cement in the spinal canal was removed by transpedicular osteotomy, bone graft fusion and internal fixation. The visual analogue scale (VAS), Oswestry dysfunction index (ODI), ASIA grade and muscle strength were observed before operation, at 3 days, 3 months after operation and at the last follow-up. Results:All patients were followed up for 12-16 months [(13.6±1.8)months]. The VAS was significantly decreased at postoperative 3 days, 3 months and at the last follow-up [(2.6±0.6)points, (2.1±0.3)points, (1.9±0.5)points] when compared to (7.1±1.5)points before operation ( P<0.01). However, the VAS had no statistical difference at different time points after operation ( P>0.05). The ODI was 42.4±10.2, 25.6±6.0 and 21.4±3.6 at postoperative 3 days, 3 months and at the last follow-up, significantly different from that before operation (74.2±7.3) ( P<0.05 or 0.01). However, the ODI had no statistical difference at postoperative 3 months and at the last follow-up ( P>0.05). Two patients with preoperative ASIA grade C recovered to grade D and 3 patients with preoperative grade D recovered to grade E at the last follow-up ( P<0.05). Two patients could walk without crutches with muscle strength improved from grade II preoperatively to grade IV at the last follow-up ( P<0.01). Three patients had completed recovery of neurological function with muscle strength improved from grade III preoperatively to grade V at the last follow-up ( P<0.01). Conclusions:For OVCF patients with intraspinal canal cement leakage and neurological symptoms after PVP, if the bone cement is located on one side of the spinal canal and adjacent to the nerve root, the bone cement should be removed by foraminal endoscope for decompression; if the cement leakage occurs in the dura mater, the dura mater should be cut to remove the bone cement for decompression, which can effectively relieve pain and promote functional recovery.
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Objective To evaluate the factors related to contralateral hip fracture in the elderly patients with hip fracture by meta analysis.Methods Pubmed,Cochrane,CBMdisc,CNKI Chinese Journal Full Text Database and Wan Fang Database were searched for publications at home and abroad from January 2005 to April 2018 on factors related to contralateral hip fracture after hip fractures in the elderly.The publication quality was strictly evaluated before the data were extracted concerning gender and age(＞ 65years) of the patients,concomitant osteoporosis (Singh sign ≥ 4),primary fracture type,concomitant Parkinson disease,concomitant stroke,concomitant senile dementia,concomitant cataract,concomitant rheumatoid arthritis,concomitant diabetes,type of internal fixation for primary fracture and therapeutic compliance.Revman5.0 was used to perform the statistical analysis and the OR value and 95％ CI were calculated fore each index.Results A total of 17 studies were included involving 1,504 patients with contralateral hip fracture among 13,717 elderly patients with hip fracture.The factors related to the refracture of the contralateral hip were the age of the patients (OR ＝-3.55,95％ CI:-5.60 ～-1.50,P ＜ 0.001),osteoporosis (OR=2.38,95％CI:1.36～4.17,P=0.002),Parkinson disease (OR=4.54,95％CI:2.74～7.53,P ＜0.001),stroke (OR=0.33,95％ C I:0.18～0.59,P ＜ 0.001),senile dementia (OR=0.43,95％CI:0.29～0.62,P ＜0.001),cataract (OR=0.37,95％CI:0.22～0.63,P ＜0.001),rheumatoid arthritis (OR =0.32,95％ CI:0.21 ～ 0.50,P ＜ 0.001),diabetes (OR =0.65,95％ CI:0.47～0.91,P=0.01),type of internal fixation for primary fracture (OR=0.51,95％ CI:0.30 ～ 0.85,P =0.01),and therapeutic compliance (OR =0.36,95％ CI:0.21 ～ 0.64,P ＜ 0.001).However,the refracture of the contralateral hip was not related to gender (OR =1.07,95％ CI:0.45 ～2.56,P=0.88),smoking (OR=0.86,95％CI:0.40～1.86,P=0.70),fracture type (OR=0.97,95％ CI:0.60～1.57,P=0.90),or hypertension (OR=0.70,95％ C I:0.41～1.21,P=0.20).Conclusions In elderly patients with hip fracture,the risks for contralateral hip fracture may be advanced age,concomitant osteoporosis,Parkinson disease,stroke,senile dementia,cataract,rheumatoid arthritis and diabetes,type of internal fixation for primary fracture,and poor therapeutic compliance.However,no sufficient evidence has suggested that gender,smoking,type of hip fracture or concomitant hypertension might be associated with the contralateral hip fracture.
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Objective@#To investigate the clinical effect of combined anterior and posterior approach revision on complex acetabular fractures.@*Methods@#A retrospective case series study was performed on the clinical data of 21 patients with complex acetabular fractures who underwent failed surgery through single approach from June 2012 to June 2017. There were 16 males and five females, averagely aged 34.6 years (range, 24-45 years). According to Letournel-Judet classification, there were seven patients with transverse+ posterior wall fracture, five patients with anterior column+ posterior semi-transverse fracture, four patients with double column fracture and five patients with "T" fracture. The first operation was performed by ilioinguinal approach in nine patients and by Kocher-Langebeck (K-L) approach in 12 patients. Revision surgery was performed using a combined anterior and posterior approach. The operation time and intraoperative blood loss were recorded, and the fracture healing was observed. The quality of fracture reduction was assessed according to Matta reduction criteria, and hip function by the modified D Aubigne and Postel score. The complications during and after operation were recorded. Heterotopic ossification was evaluated according to Brooker's criteria.@*Results@#The patients were followed up for 12 to 36 months, with an average of 27 months. The operation time ranged from 180 to 360 minutes, with an average of 270 minutes. Intraoperative bleeding was 1 000-3 800 ml, with an average of 2 000 ml. Fractures were healed, with the healing time ranging from 3.5 to 7 months, with an average of 5 months. According to Matta reduction criteria, there were eight patients with anatomical reduction, 12 with satisfactory reduction and one with unsatisfactory reduction. The improved D Aubigne and Postal score was (11.1±1.9)points preoperatively and (15.6±1.7)points six months after operation (P<0.05), the outcome of hip function was excellent in three patients, good in 14, fair in three, and poor in one, with the excellent and good rate of 81%. There were three patients with transient injury of sciatic nerve, one patient with traumatic arthritis and one with heterotopic ossification of Brooker II. No femoral head necrosis or deep venous thrombosis in the lower extremities was found.@*Conclusion@#For complex acetabular fractures, combined anterior and posterior approach revision can promote fracture reduction, fracture healing, and functional recovery, with low incidence of complications.
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Objective To observe the expression of parathyroid hormone - related peptide (PTHrp) receptor in tibial growth plate and its effects on tibial extension in chronic renal insufficiency rats. Methods Two-week-old male Sprague-Dawley rats were randomly divided into sham group, model group and enalapril group, each with 20 rats. In model group and enalapril group rats had chronic renal insufficiency induced by left ureteral obstruction, and rats were respectively given saline and enalapril by gavage after the operation. In sham group, left ureter was only exposed without ligation, and rats were given saline. The urine was collected 4 weeks after the operation and the total protein content was measured. Then all rats were killed. The concentrations of PTHrp, creatinine and urea nitrogen in intracardiac blood were detected. HE staining and Masson staining were performed on the left kidney to observe pathological changes of glomeruli and renal tubules. The total length of bilateral tibia was measured. The number of columnar cells in the growth plate proliferative zone was measured by safranin O staining and the expression of PTHrp receptor in the growth plate was detected by immunohistochemistry. Results The 24 h urine total protein, creatinine and urea nitrogen in model group were higher than those in sham group (all P＜0.05), while these 3 renal functional parameters in enalapril group were lower than those in model group (all P＜0.05). In model group and enalapril group rats had higher blood concentrations of PTHrp than that in sham group (all P＜0.05), but blood PTHrp in enalapril group was lower than that in model group (P＜0.05). HE staining and Masson staining showed that in the model group rats had severe tubular dilation, inflammatory cell infiltration and the tissue fibrosis, while in enalapril group renal tubules slightly dilated and had a few inflammatory cell infiltration and tissue fibrosis. Compared with those in the sham group, in model group the tibia length, the chondrocyte number of column structure in the growth plate proliferative zone and the PTHrp receptor decreased (all P＜0.05). But in enalapril group those indexes increased than model group (all P＜0.05). Conclusions Chronic renal insufficiency rats had increased PTHrp concentration in the blood but decreased PTHrp receptors expression in tibial growth plate, which lead to their limited tibial extension.
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Objective To investigate the clinical effect of combined anterior and posterior approach revision on complex acetabular fractures. Methods A retrospective case series study was performed on the clinical data of 21 patients with complex acetabular fractures who underwent failed surgery through single approach from June 2012 to June 2017. There were 16 males and five females, averagely aged 34. 6 years (range, 24-45 years). According to Letournel-Judet classification, there were seven patients with transverse+posterior wall fracture, five patients with anterior column+posterior semi-transverse fracture, four patients with double column fracture and five patients with "T" fracture. The first operation was performed by ilioinguinal approach in nine patients and by Kocher-Langebeck ( K-L ) approach in 12 patients. Revision surgery was performed using a combined anterior and posterior approach. The operation time and intraoperative blood loss were recorded, and the fracture healing was observed. The quality of fracture reduction was assessed according to Matta reduction criteria, and hip function by the modified D Aubigne and Postel score. The complications during and after operation were recorded. Heterotopic ossification was evaluated according to Brooker 's criteria. Results The patients were followed up for 12 to 36 months, with an average of 27 months. The operation time ranged from 180 to 360 minutes, with an average of 270 minutes. Intraoperative bleeding was 1000-3800 ml, with an average of 2000 ml. Fractures were healed, with the healing time ranging from 3. 5 to 7 months, with an average of 5 months. According to Matta reduction criteria, there were eight patients with anatomical reduction, 12 with satisfactory reduction and one with unsatisfactory reduction. The improved D Aubigne and Postal score was ( 11. 1 ± 1. 9 ) points preoperatively and ( 15. 6 ± 1. 7 ) points six months after operation (P<0. 05), the outcome of hip function was excellent in three patients, good in 14, fair in three, and poor in one, with the excellent and good rate of 81％. There were three patients with transient injury of sciatic nerve, one patient with traumatic arthritis and one with heterotopic ossification of Brooker II. No femoral head necrosis or deep venous thrombosis in the lower extremities was found. Conclusion For complex acetabular fractures, combined anterior and posterior approach revision can promote fracture reduction, fracture healing, and functional recovery, with low incidence of complications.
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Objective To evaluate the risk factors related to the failure of internal fixation for intertrochanteric fracture in Chinese patients.Methods A comprehensive Meta analysis of the clinical research from January 2005 to August 2016 on the failure of internal fixation for intertrochanteric fracture in Chinese patients was conducted after Pubmed,CNKI,Wanfang Data,et al.,had been searched.Revman5.0 was used to perform the heterogeneity test and calculate the OR value and 95％ CI after quality assessment and retrieval of the qualified data.Results Included for this analysis were 23 studies involving 4,031 patients of whom 588 failed.The factors related to the failure of internal fixation for intertrochanteric fracture included patient age [OR =0.51,95％ CI (0.30,0.90),P ＜ 0.05],osteoporosis [OR =1.91,95％ CI (1.05,3.47),P ＜0.05],fracture pattern[OR=0.23,95％ CI (0.18,0.30),P ＜0.05],quality of fracture reduction [OR =0.25,95％ CI (0.17,0.35),P ＜0.05],tip-apex distance (TAD) [OR =0.13,95％ CI (0.05,0.32),P ＜0.05],time for full weight bearing [OR=5.32,95％ CI (1.71,16.57),P ＜ 0.05],and associated internal diseases [OR =3.76,95％ CI (1.19,11.91),P ＜0.05].The relationship was not determined between the failure of internal fixation for intertrochanteric fracture and the following factors:gender [OR=0.78,95％ CI (0.54,1.11),P ＞ 0.05],injury cause [OR=1.68,95％ CI (0.66,4.25),P＞ 0.05] or type of internal fixation [OR=0.37,95％CI (0.06,2.14),P＞0.05].Conclusions High age,concomitant osteoporosis,complicated fracture pattern,unsatisfactory fracture reduction,TAD ≥ 25 mm,time for full weight bearing ＜ 6 weeks,and concomitant internal diseases may be the risk factors closely related to the failure of internal fixation for intertrochanteric fracture in Chinese patients.There has been no sufficient evidence to show that gender,injury cause or type of internal fixation may be associated with the failed internal fixation for intertrochanteric fracture.
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Objective To identify the risk factors for the fractures secondary to percutaneous vertebroplasty for osteoporotic vertebral compression fractures.Methods A comprehensive search was conducted for the studies from January 2006 to September 2016 on the risk factors for secondary fractures after percutaneous vertebroplasty in the Cochrane Library,PubMed Data,CNKI,Chinese Biomedical Database,Wanfang Data and manually as well.After retrieval of the eligible data,software Revman5.0 was used to perform the heterogeneity test and calculate the pooled odds ratio (OR),weighted mean difference(WMD) value and 95％ confidence interval (CI).Results Twenty studies involving 3,602 patients,627 of whom had fracture secondary to the surgery,were included in this meta-analysis.Meta-analyses showed the secondary fracture after percutaneous vertebroplasty for osteoporotic vertebral compression fracture was related to bone mineral density [WMD =-0.66,95％ CI (-0.97,-0.36),P ＜ 0.05] and kyphosis after primary operation [WMD =4.51,95％ CI (3.02,6.00),P ＜ 0.05],but not to gender [OR =0.98,95％ CI (0.77,1.25),P＞ 0.05],age [WMD=1.48,95％CI (-0.13,3.09),P＞ 0.05],body mass index [WMD=-0.76,95％ CI(-1.61,0.08),P＞ 0.05],cement volume [WMD=-0.15,95％CI (-0.60,0.30),P＞0.05],intradiscal cement [0R=1.11,95％CI (0.56,2.22),P＞0.05],number of vertebrae primarily treated [OR=0.74,95％ CI (0.09,6.45),P ＞ 0.05],thoracolumbar spine [OR =0.86,95％ CI (0.63,1.18),-P ＞ 0.05],or cement injection approach [OR =1.58,95％ CI (0.74,3.37),P ＞ 0.05].Conclusions Bone mineral density and kyphosis after primary operation may be the risk factors closely correlative to the secondary fracture after percutaneous vertebroplasty.There has not been enough evidence to support the associations between the secondary fracture and gender,age,body mass index,cement volume,intradiscal cement,number of vertebrae primarily treated,thoracolumbar spine,or cement injection approach.
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Objective To identify the risk factors for the fractures secondary to percutaneous vertebroplasty for osteoporotic vertebral compression fractures.Methods A comprehensive search was conducted for the studies from January 2006 to September 2016 on the risk factors for secondary fractures after percutaneous vertebroplasty in the Cochrane Library,PubMed Data,CNKI,Chinese Biomedical Database,Wanfang Data and manually as well.After retrieval of the eligible data,software Revman5.0 was used to perform the heterogeneity test and calculate the pooled odds ratio (OR),weighted mean difference(WMD) value and 95％ confidence interval (CI).Results Twenty studies involving 3,602 patients,627 of whom had fracture secondary to the surgery,were included in this meta-analysis.Meta-analyses showed the secondary fracture after percutaneous vertebroplasty for osteoporotic vertebral compression fracture was related to bone mineral density [WMD =-0.66,95％ CI (-0.97,-0.36),P ＜ 0.05] and kyphosis after primary operation [WMD =4.51,95％ CI (3.02,6.00),P ＜ 0.05],but not to gender [OR =0.98,95％ CI (0.77,1.25),P＞ 0.05],age [WMD=1.48,95％CI (-0.13,3.09),P＞ 0.05],body mass index [WMD=-0.76,95％ CI(-1.61,0.08),P＞ 0.05],cement volume [WMD=-0.15,95％CI (-0.60,0.30),P＞0.05],intradiscal cement [0R=1.11,95％CI (0.56,2.22),P＞0.05],number of vertebrae primarily treated [OR=0.74,95％ CI (0.09,6.45),P ＞ 0.05],thoracolumbar spine [OR =0.86,95％ CI (0.63,1.18),-P ＞ 0.05],or cement injection approach [OR =1.58,95％ CI (0.74,3.37),P ＞ 0.05].Conclusions Bone mineral density and kyphosis after primary operation may be the risk factors closely correlative to the secondary fracture after percutaneous vertebroplasty.There has not been enough evidence to support the associations between the secondary fracture and gender,age,body mass index,cement volume,intradiscal cement,number of vertebrae primarily treated,thoracolumbar spine,or cement injection approach.
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The process of intervertebral disc degeneration,which could result in intervertebral disc structural and functional change,is a chronic one with multiple factors.The pathophysiologic process is still not completely find out.More and more research reports manifest that certain gene polymorphism also lead to increased risk of intervertebral disc degeneration except environmental factors.Discussions about related genetic factors and their pathophysiological role in the process of degeneration could have a further understanding to disease development.Elucidating genetic components which are associated with degeneration could not only provide insights into the mechanism of the process,but also have clinical significance for early diagnosis and prevention.In order to have a thorough understanding of functional role played by different genes,this paper summarize polymorphism and disease correlation by selecting 15 genes after reviewed the related literature published in recent years.Genetic polymorphisms in 15 genes have been analyzed in association with intervertebral disc degeneration,including aggrecan,collagen Types Ⅰ,Ⅸ and Ⅺ,fibronectin,HAPLN 1,CILP,MMP-1,2 and 3,PARK2,IL-1,6 and VDR.Each genetic polymorphism codes for a protein which has a functional role in the pathogenesis of disease.Among the 15 genes analyzed,polymorphisms in aggrecan,Type Ⅸ collagen,MMP3,IL1,IL6 and VDR show the most promise as functional variants.Genetic studies are necessary for understanding the mechanism of the degeneration.Relevant genetic information could be used as a predictive model for determining individuals' risk for intervertebral disc degeneration eventually.
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Objective To compare the clinical effect of PMMA bone cement augmented screw passageway and bone cement-injectable cannulated pedicle screw in treatment of degenerative lumbar disease with osteoporosis. Methods Forty-eight patients with lumbar degenerative disease accompanied with osteoporosis from June 2012 to March 2014 were selected, including 21 males and 27 females with an average age of 64.5 years ( ranged 54 -78 years).There were 17 cases of lumbar degenerative stenosis,18 cases of lumbar intervertebral disc herniation, 8 cases of lumbar degenerative spondylolisthesis,and 5 cases of lumbar degenerative scoliosis.According to the opera-tion method,the patients were divided into two groups.23 cases in group A were treated with bone cement injectable cannulated pedicle screw and 25 cases in group B were treated with PMMA bone cement augmented screw passageway by used conventional screw.Operation time, amount of bleeding and hospitalization time were used to evaluate the clinical characteristics.Visual analogue scale( VAS) score and Oswestry disability index( ODI) were used to evaluate function recovery of post-operative pain and function.The height of intervertebral space,failure rate of internal fixa-tion and bone fusion rate were analyzed by X-ray films postoperative1,3,6,12 months and per year.Results All 48 cases were followed up for 1 -3.5 years.Operation time,amount of bleeding and the time of hospitalization of group A were significantly lower than those in group B(all P0.05).One case of group A had screw fracture,but group B did not appear this kind of situation(P<0.05).Three cases of group B had screw loosening or pullout,but that did not happen in group A.The loss of intervertebral height was (2.7 ±1.7) mm in group A,which in group B was (3.7 ±2.1) mm,there was significant difference between the two groups( P<0.05).According to VAS score and ODI,pain and function in both two groups were improved,but the effect of group A was better than group B(all P<0.05).Conclusion Bone cement-augmentation bone cementinje-ctable cannu-lated pedicle screw may be a safe and effective method in treatment of degenerative lumbar disease with osteoporosis.
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Objective To report a method of handling dural injury with cerebrospinal fluid leakage during the spinal operation process and analyze its effect,to comparatively analyze with the existing methods and to find a better way processing this problem.Methods A total of 36 patients with dural injury and cerebrospinal fluid leakage during the spinal operation process were collected.Among these clinical cases,there were 15 males,21 females,age ranged from 26 to 78 years old,average 58 years old.During the spinal operation process,the injured dura was sutured or repaired.After that,the dural wound was glued with a piece of muscle or fascia by a kind of medical glue named KangPaiTe.After the operation,broad -spectrum antibiotics and timely fresh dressing changing for the wound were applied.The nature and volume of the drainage fluid was documented and analyzed.When the volume of the drainage fluid was below 50mL per day,the drainage tube was pulled away,and the incision of the drainage tube was sutured again.Results The cerebrospinal fluid leakage lasted from 0 day to 4 days,average 1.5 days;the drainage tube was placed from 1 day to 5 days,average 2 days;no wound infection and other complications occurred among all the clini-cal cases included in this study.Conclusion After the injured dura was sutured or repaired,gluing the dural wound with a slice of muscle or fascia by a kind of medical glue named Kangpaite is a better method of handling dural injury with cerebrospinal fluid leakage.
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Objective To compare the efficiency of gauze packing , internal iliac artery ligation and tran-scatheter arterial embolization for controlling pelvic fracture hemorrhoea .Methods The clinical data of 23 consecu-tive patients with pelvic fracture hemorrhoea were retrospectively analyzed .There were 8 patients who had undergone gauze packing,6 patients undergone artery ligation ,9 patients undergone angioembolization .The ISS,the preoperative shock index ,the operation time of control the shock ,the postoperative blood transfusion ,the days in ICU after opera-tion and the complication were all recorded respectively .Results The operation time of control the shock ,the postop-erative blood transfusion and the days in ICU after operation of the packing group were ( 70.00 ±24.50 ) min, (1 050.00 ±207.02) mL and (10.12 ±1.64) d;the ligation group were (40.83 ±12.01) min,(1 800.00 ± 400.00)mL and (11.17 ±1.72)d;the angioembolization group were (91.67 ±22.64)min,(1 644.44 ±421.64) mL and (7.22 ±1.56)d.The difference between the three groups had statistical significance with the indexes above all(F=10.323,9.265,12.235,all P<0.05),and the ligation group had the shortest operation time to control the shock,the packing group had the least postoperative blood transfusion ,the angioembolization group had the shortest days in ICU after operation .There were 4 cases in the packing group suffering the infection ,the infection rates as high as 50%,one of them died on the 8d;there were one case in the ligation group died of MODS on the 11th day. Conclusion The gauze packing is a sample and effective hemostasis ,suitable for the patients with open fracture and the fist aid for pelvic fracture in the basic level hospitals;the internal iliac artery ligation can control the shock timely but the hemostatic efficacy is not better than the other two kinds of operation; the transcatheter arterial embolization has micro injury and effective hemostatic efficacy ,however ,the strong profession and the lage difficulty may delay the patients'condition .So the doctors should use the methods of hemostasis flexiblely and comprehensively .
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Objective To investigate the procedures and effects of surgical treatment for double disruption of the superior shoulder suspensory complex (SSSC).Methods Twenty-nine cases of double disruption of SSSC treated from January 2007 to October 2011 were enrolled in the study.There were 19 males and 10 females,at a mean age of 36 years (range,25-49 years).Injury causes included traffic injury in 25 cases and fall from height in 4.An open reduction and internal fixation was performed in 18 cases of scapular neck fracture combined with clavicular fracture,2 cases of scapular neck fracture combined with acromion fracture,2 cases of distal clavicular fracture combined with acromion and glenoid cavity fracture; hook plate fixation and ligament repair were performed in 3 cases of complete dislocation of acromioclavicular joint combined with complete disruption of coracoclavicular ligament ; open reduction and internal fixation and ligament repair were performed in 3 cases of scapular neck fracture combined with acromioclavicular joint dislocation and 1 case of clavicular fracture combined with coracoclavicular ligament disruption.Results All cases were followed up for a mean period of 11.5 months (range,6-30 months).Anatomic reduction of fractures was achieved for all cases and mean healing time was 8.4 weeks (range,7-12 weeks).Mean Constant-Murley score was 91 points (range,72-100 points),which indicated excellent results in 13 cases,good in 11,fair in 5,with excellence rate of 83％.ConclusionBased on the complex anatomic structure of the double disruption of SSSC,surgical management should focus mainly on respective fixation of the double injuries,which leads to good stability and therapeutic outcome.
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Objective To evaluate the method and curative effect of reconstruction with vascularized or nonvascularized autogenous fibular transplantation of radiocarpal joint after en bloc excision of giant cell tumor of distal radius.Methods Seventeen cases with giant cell tumor of distal radius bone were treated by en bloc resection and reconstruction of wrist joint with vascularized or non-vascularized autogenous fibular transplantation.Postoperative wrist joint function and radiographic outcomes were evaluated.Results Seventeen cases were followed up from 2.0 to 5.5 years (average 3.6 years).Three cases were treated by peroneal artery anastomosis and other 3 cases by inferior lateral genicular artery anastomosis.All cases achieved primary healing of incision and the radial average length that was en bloc excised was 7.6 cm.All of the transplanted fibulas were healed well.The bone healing average time of the vascularized fibular graft was 3.7 months,while that of the non-vascularized fibular graft was 7.9 months.No tumor recurrence or lung metastases was observed during the follow-up,but 1 wrist joint was narrowed and another had degeneration of the wrist.After 2 years of surgery,the average range of motion of the wrist joint was as follows:dorsiflexion 47°,flexion 30°,ulnar deviation 23°,radial deviation 14°,pronation 55°,supination 62°.The grip force was from 40％ to 80％ of the contralateral upper limb.The MSTS score averaged 87.6 ％ with 6 excellent,eight good and 3 satisfactory results.Disabilities of the Arm,Shoulder,and Hand (DASH) questionnaire score averaged 3.48.Conclusion The method of autogenous fibular transplantation and reconstruction of radiocarpal joint after en bloc excision of giant cell tumor of distal radius can save the wrist joint function in a certain extent.It is an effective method of the wrist joint function reconstruction and beneficial to bone healing with vascularized transplantation which has less complications.
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Objective To evaluate the clinical results of the Ilizarov technique for the treatment of the complex rigid talipes equinovarus deformities.Methods From July 2005 to July 2011,28 patients (41 feet) with rigid talipes equinovarus deformities which had been corrected with the Ilizarov technique were retrospectively analyzed,including 18 males (26 feet) and 10 females (15 feet) with an average age of 15.3 years.According to the classification system proposed by Diméglio,31 feet were categorized as grade Ⅲ,and 10 as grade Ⅳ.We performed corrections with a soft tissue release in 23 feet,and with a limited osteotomy in 18,and then a Ilizarov external fixator was applied.Anteroposterior and lateral X-rays were taken to compare the pre and postoperative data in terms of the angle of plantarflexion and dorsiflexion,the range of motion of the ankle joint,radiological measurements of the talocalcaneal angle.Results All the 28 patients achieved an outpatient follow-up,with an average of 25 months.All patients achieved a plantigrade foot with an almost normal appearance as the fixator was removed after applied for an average of 5.1 months (range,2-14).At the preoperative and final follow-up respectively,the angle of dorsiflexion of the foot was -45.0°±12.0° and 9.5°±5.5°,the angle of plantarflexion was 67.0°±14.0° and 45.5°±7.8°,talocalcaneal angle was 6.5°±4.5° and 22.5°±5.5° in anteroposterior radiograph and 5.5°±11.0° and 40.6°±8.5° in lateral radiograph.Spastic ischemia occurred in one foot and relieved by a slower distraction rate.Wire-hole infections occurred in 5 feet and treated by dressing changs,wire tract altering and antibiotic therapy,finally the infections were controlled.Deformity relapsed in one foot three months after the device was removed,then corrected with an additional fixator application and has not recurred till the final follow-up.Toe contracture and residual deformity occurred in 5 feet and 3 feet,respectively.Conclusion The Ilizarov technique is an effective method for correction of complex rigid talipes equinovarus deformities,with which the appearance and function of the foot could be kept as much as possible,and without impact on food development.
ABSTRACT
Objective To investigate the different operative style for the intraspinal extramedullary neoplasms in the cervical vertebrae as well as evaluate the clinical effect of titanium net for spinal canal reconstruction and bone autograft after laminectomy. Methods Since March 2002 to September 2008, 26patents (14 men, 12 women) with the intraspinal extramedullary neoplasm in the cervical vertebrae. The average age was 38 years (range, 6-76 yr). According to Frankel classification, there were 26 cases for grade B before operation, 8 cases for grade C, 11 for grade D, and 4 for grade E. All patients underwent hemilaminectomy (as group HL) or total laminectomy combined with spinal canal reconstruction with titanium net (as group TL). Recovery of nerve function and bone fusion were recorded. Preoperative and postoperative cervical curvature index and ranges of neck motion were recorded and compared. Results Among the 3cases with incomplete paraplegia, neurological status ameliorated from Frankel grade B to C; 8 cases of Frankel grade C recovered to grade D; 11 cases of Frankel grade D improved to grade E in 10 cases and 1to grade D. Bone fusion was formed on the titanium net and spinal stability was well after operation. Loss of cervical curvature indices was 2.2±2.3 in group HL and 4.3±2.5 in group of TL, and the difference was of statistically significant (t=2.05,P＜0.05). At the same time, loss of ranges of neck motion was 1.3°±1.2°ingroup of HL and 9.2°±4.1°in group TL, significant difference was also seen (t=1.71 ,P＜ 0.05). Conclusion Hemi-laminectomy approach to intradural lesions lends itself well to eccentric tumors with smaller size. For the cases of total laminectomy, it is necessary and reliable to reconstitute integrity of spinal canal with titanium net and bone autograft.