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Objective To compare the clinical efficacy of anteroposterior approach (APA) versus anterior approach (AA) for decompression,fusion and fixation for single-level unstable thoracolumbar vertebrae fractures concomitant with incomplete neurologic symptoms and injury to posterior ligament complex (PLC).Methods From February 2006 to June 2012,55 patients were treated for single-level unstable thoracolumbar vertebrae fractures.Of them,27 were treated by only anterior decompression and lateral screw-rod instrumentation and 28 by anterior decompression and fusion combined with open posterior pedicle fixation of one to two segments above and below the fracture position.The 2 groups were compared at postoperative 3 and 12 months in terms of visual analogue scale (VAS),overall score of short-form health survey (SF-36),Japanese Orthopaedics Association (JOA) score of lower back,Oswestry disability index (ODI),loss ratio of anterior margin of vertebral height,endplate angle of kyphotic deformity of superior-inferior adjacent vertebrae,wedge angle of fractured vertebra via radiographic measurement and canal compromise rate.The neurologic functional recovery was analyzed using the American Spine Injury Association (ASIA) evaluation system at postoperative 12 months.Results There were no significant differcnces in operative time,amount of blood loss or postoperative drainage between the 2 groups (P ＞ 0.05).At postoperative 3 months,the VAS and JOA scores in the APA group were significantly better than those in the AA group (P ＜ 0.05).At 12 months after surgery,the VAS,kyphotic angle of adjacent vertebra,wedge angle of fractured vertebra and the ASIA improvements in the APA group were significantly better than those in the AA group (P ＜ 0.05).There were no significant differences between the 2 groups in the other indexes at postoperative 3 or 12 months (P ＞ 0.05).All the comparative indexes were significantly improved than the preoperative values in all the patients in the 2 groups at both 3 and 12 months (P ＜ 0.05).Conclusions Compared with the merely anterior approach,the combined antero-posterior approach may have advantages of better immediate and persistent reduction,steadily rebuilding fractured alignment,continuously maintaining injured biomechanical stability,and obviously improving neurological function.As the antero-posterior approach allows for combination of posterior auxiliary reduction and fixation with anterior definitive support and decompression,it may lead to a safe and effective treatment of unstable single-level thoracolumbar fracture concomitant with incomplete neurologic and PLC impairments.
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Objective To investigate the clinical efficacy of anterior pelvic plating plus percutaneous lumbo-iliac rod/screw fixation in the treatment of pelvic fractures which are vertically and rotationally unstable and combined with unilateral sacral fracture of Denis type Ⅱ.Methods From January 2008 to November 2012,19 patients were treated for compound injury to the anterior and posterior pelvic rings complicated with sacral fracture of unilateral Denis type Ⅱ using anterior pelvic plating plus posterior percutaneous fixation of lumbo-ilium with screws.Their improvement in neurological function,reduction outcome and clinical effectiveness were evaluated by comparing preoperation and 2 years postoperation in terms of visual analogue scale (VAS),Japanese Orthopaedic Association (JOA) score for lower back pain,MOS Item Short-form health survey (SF-36 comprehensive scale),modified Roland-Morris Disability questionnaire (RDQ),Oswestry disability index (ODI),Gibbons overall scale,Majeed total score,sacral kyphosis abnormity,bias of sagittal/coronal vertical axis (SVA/CVA),pelvic incidence,pelvic tilt,lumbar lordosis,vertical displace,and leg length discrepancy.Results The differences respectively reached statistical significance for the aforementioned clinical and imaging parameters between preoperation and 2 years postoperation (P ＜ 0.05).By Majeed scoring,13 cases were rated as excellent,4 as good and 2 as fair.By Tometta/Matto scoring postoperatively,the fracture reduction was rated as excellent in 12 cases,as good in 6 and as fair in one.The complications of incision infection or necrosis,secondary neurovascular damage,implant failure or mal-union was not observed.Perfect nerve functional recovery and sufficient imaging reduction were achieved in all but one patient who had to receive decompression and release for sacral canals or foramens.According to Mohammad criteria,15 patients were engaged in the jobs with the same intensity and property as their pre-injury ones.Conclusions The simultaneous hybrid performance of anterior reconstruction plating combined with unilateral lumbar/sacral pedicle and iliac screwing may be a safe,reliable and satisfactory treatment for pelvic fractures of AO/Tile C1 type which involve unilateral sacral Denis type Ⅱ.
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Objective To explore the causes and risk factors affecting early death in patients with traumatic cervical spinal cord injury (SCI). Methods Clinical data of 553 patients with traumatic cervical SCI were analyzed retrospectively to discuss the related factors affecting early death of patients with traumatic cervical SCI by using univariate analysis and multivariate logistic regression analysis. Results The early mortality of the patients with traumatic cervical SCI was 4.0% ( 22/553 ). The main causes of the early death were respiratory failure in nine patients (40.9%) and electrolyte disorders in five (22.7%). Univariate analysis showed that age, cervical spinal cord injury severity, complications in respiratory, cardiovascular, digestive systems and electrolyte disturbance as well as tracheotomy were considered statistically significant for early death in patients with traumatic cervical SCI ( P < 0, 05 ). Multivariate logistic regression analysis showed that age, cervical SCI severity, complications in respiratory,cardiovascular system and electrolyte disturbance as well as tracheotomy. Conclusion Severe cervical SCI, combined respiratory, cardiovascular system and electrolyte disorder complications as well as tracheotomy are high risk factors for the early death in patients with traumatic cervical SCI.
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BACKGROUND:No method is ideal for treating traumatic avascular necrosis of talus up to now.Extracorporeal shock wave therapy(ESWT)is a micro-traumatic,simple,and effective method to treat musculoskeletal diseases;however,the therapeutic effect on necrosis of talus needs to be further studied.OBJECTIVE:To evaluate the therapeutic effect of liquid-electric extracorporeal shock wave on traumatic avascular necrosis of talus,and to explore new treatments of traumatic avascular necrosis of talus METHODS:A total of 34 patients with traumatic avascular necrosis of talus were selected from the Affiliated Hospital of Medical College of Chinese Armed Police Force from September 2004 to June 2009.The patients were randomly divided into ESWT and control groups,with 17 patients per group All patients were treated with pain point positioning combined with surface X-ray localization,theworking voltage of 8-10 kV,energyflowdensity of 0.12-0.16mJ/mm2,impact frequency of 40-50 times/min,and impact of 800-1000 times,once a week,for 3-5 cycles.Pain was evaluated with VAS before and after treatment,function of ankle was evaluated with AOFAS standards,and MRI of ankle was re-checked at 18 months after treatment to compare necrotic area before and after treatment.RESULTS AND CONCLUSION:VAS pain,function of ankle,and necrotic area of ankle in the ESWT group were significantly improved compared to those in the control group at 18 months after treatment(P<0.01).Activity of one case in the control group was limited by severe pain due to traumatic arthritis in the first 15 weeks after ankle arthrodesis surgery.This suggested that significant effect and fewer complications,for treating traumatic avascular necrosis of talus.
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Objective To compare the clinical outcome of external fixation device with Kirschner wire or fragment fixation pin with mini plate and screw fixation in treatment of metacarpal and phalangeal articular fracture dislocation. Methods From October 2002 to March 2008, 106 patients with metacarpal and phalangeal articular fracture dislocation were randomly divided into A and B group. The 53 patients in A group were treated with external fixation device with Kirschner wire or fragment fixation pin. There were thumb injury in 24 cases, fracture-dislocation of proximal interphalangeal joint(PIP) in 36 cases, fracture-dislocation of metacarpophalangeal joint (MP) in 17 cases. The 53 patients in B group were treated with mini plate and screw fixation. There were thumb injury in 22 cases, fracture-dislocation of PIP in 30 cases, fracture-dislocation of MP in 23 cases. Duncan rating criteria were used to compare finger range of motion. Results The mean follow-up of 16.8 and 17.5 months in A group and B group. According to Duncan rating criteria, there were excellent in 33 cases, good in 16, fair in 3, and poor in 1 case. The excellent and good rate was 92.5% in A group. There were excellent in 30 cases, good in 17, fair in 5, and poor in 1 case. The excellent and good rate was 88.7% in B group. In A group, 1 case of wound infection was found. The average arc of motion of thumb joint was 134°±21° while the average arc of motion of other fingers was 248°±19°. In B group, no wound infection occurred. The average arc of motion of thumb joint was 122°±18° while the average arc of motion of other fingers was 225°±17°. Conclusion External fixation device with Kirschner wire or fragment fixation pin was better than the application of mini plate and screw fixation in treatment of metacarpal and phalangeal articular fracture-dislocation.
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@#ObjectiveTo investigate the characteristics of traumatic spinal cord injury (TSCI) urban inpatients of Tianjin in 2007. MethodsInpatients with TSCI of 8 hospitals in Tianjin in 2007 were reviewed. ResultsThere were 73 patients in total. Mean age was (51.34±14.597) years. Male∶Female was 3.56∶1. Falling, motor vehicle accidents （MVC） were the main causes of TSCI. The cervical spinal cord injuries were predominant. 26% were complete injury and 74% were incomplete. 6 cases were dead. Patients with ASIA grade D recover well. ConclusionFor the TSCI, the ages of patients increases and falling is the main cause.
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OBJECTIVE: To summarize literature on clinic research of locking compression plate (LCP) on fracture of distal radius, proximal humeral fracture, tibia fracture and other fracture.DATA SOURCE: The first author retrieved literatures from PubMed database (http://www.ncbi.nlm.nih.gov/PubMed and CNKI database (www.cnki.net/index.htm) published between June 1992 and May 2009 with the key words of "LCP, Fracture, Therapy,Review".DATA SELECTION: Inclusion criteria: cases undergoing LCP internal fixation; clinical of LCP internal fixation. Repetitive studies were excluded.MAIN OUTCOME MEASURES: A total of 127 literatures were selected and primarily collected by reading titles and abstract. A total of 51 literatures unrelated to study objective, and 35 studies of repetitive contents were excluded. Finally, 41 literatures were included for analysis, containing review, commentary, treatise and clinical report.RESULTS: LCP internal fixation was applied in clinical broadly in recent years. Therapeutic efficacy was significantly better than common internal fixation system. LCP internal fixation depended on minimal invasion LCP internal fixation, with characteristics of small wound, simple operation, stable internal fixation and fracture anatomical reduction. It could replace external fixation to some extents. The stability was bigger compared with the external fixation. However, intramedullary pin fixation should be firstly selected for lower limb cadre fracture. There were few studies on this aspect. Controlled studies should be performed in the future.CONCLUSION: LCP was invented as a new technology which was transition from mechanics of machinery to biomechanics. The method makes good contribution to orthopaedics by advocating elasticity, reducing hurt and promoting callus.
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BACKGROUND: Bone morphogenetic protein-2 has been previously proved to not only stimulate and different bone tissue-derived cells, but also induce differentiation from cell strain into osteoblasts; however, direct application of bone morphogenetic protein has poor effects on repairing bone defects. OBJECTIVE: To study new bone formation in a rabbit model of avascular necrosis of the femoral head (ANFH) following recombinant human bone morphogenetic protein-2 (rhBMP-2)/fibrin sealant (FS) implantation combining with core decompression. DESIGN, TIME AND SETTING: A randomized controlled animal experiment was performed at the Affiliated Hospital of Medical College of Chinese People’s Armed Police Force from January 2005 to December 2007. MATERIALS: Composite was made by rhBMP-2 and FS, and the final concentration of rhBMP-2 was 1 mg/L. METHODS: Animal models of ANFH were made by injecting hormone. The rabbits were randomly divided into three groups, including rhBMP-2/FS implantation group, rhBMP-2 implantation group, and core decompression alone group. MAIN OUTCOME MEASURES: Signal changes of femoral head and sclerotin were detected using MRI method; new bone formation was observed under optic microscopy; calcium content was measured using atomic absorrtion spectrophotometer. RESULTS: MRI indicated that new bone replaced primary bone defect channel at week 8 after rhBMP-2/FS implantation. A few of new bones were observed in the rhBMP-2 implantation group, and fiber tissue was still observed in the core decompression alone group. Morphology suggested that a great quantity of mature bone trabecula and plate-shaped bone replaced primary bone defect channel at week 8 after rhBMP-2/FS implantation. Bone defect was decreased in the rhBMP-2 implantation group, accompanying with a few of bone trabecula and blood capillary but a large quantity of fiber tissues. At week 8 after core decompression alone, bone defect was decreased, and a few of new bones were observed. Fiber tissue still existed in the center, and any bone tissue did not fill in it. Calcium content in the rhBMP-2/FS implantation group was greater than rhBMP-2 implantation group and core decompression alone group (P