Treating Neer two- and three-part of proximal humeral fractures through anterolateral acromial approach and deltopectoral approach / 中国骨伤

<p><b>OBJECTIVE</b>To compare clinical results of treating Neer two- and three-part of proximal humeral fractures between anterolateral acromial approach and deltopectoral approach.</p><p><b>METHODS</b>From January 2009 to December 2012, 49 patients with Neer two- and three-part of proximal humeral fractures were treated with locked plate fixation. In anterolateral acromial approach group, there were 22 patients including 9 males and 13 females with an average of (63.2±7.6) years old, while 27 patients in deltopectoral approach including 12 males and 15 females with an average of (62.9±7.0) years old. Operative time, blood loss during operation, fracture healing time and complications were observed and compared, postoperative Constant-Murley scoring and VAS scoring were applied for evaluate function of shoulder joint and pain at 3 months, 1 and 2 years respectively.</p><p><b>RESULTS</b>All patients were followed up from 24 to 41 months with an average of 34.5 months. Operative time, blood loss, fracture healing time in anterolateral acromial approach group was (68.20±7.04) min, (151.30±20.57) ml, (10.88±4.90) weeks respectively, and better than that of in deltopectoral approach group which was (75.81±13.70) min, (242.10±37.25) ml and (13.60±2.45) weeks. Three months after operation, Constant-Murley scoring and VAS score in anterolateral acromial approach group was 88.32±5.45, 0.41±0.63 and better that of in deltopectoral approach group which was 63.53±8.31, 1.65±1.02. There was no significant differences between two groups in Constant-Murley scoring and VAS score at 1 and 2 years after operation. Each group has one case occurred loss of length humerus head height, and there was 1 case with subacromial impingement, 1 case with bolt loose and 2 cases with delayed union in deltopectoral approach. No axillary nerve injury, humeral head necrosis and breakage of internal fixation occurred both of two groups.</p><p><b>CONCLUSION</b>Both of anterolateral acromial approach and deltopectoral approach are effective in treating Neer two- and three-part of proximal humeral fractures, and can obtain excellent outcomes. Moreover, anterolateral acromial approach has advantage of less trauma, less blood loss, shorter operative time, rapid recovery of shoulder joint function and fracture.</p>

Analysis and strategy on the early complications of lumbar disc herniation with Coflex system / 中国骨伤

<p><b>OBJECTIVE</b>To explore the short-term effectiveness and the cause of the early complications of lumbar disc herniation with Coflex system in order to provide evidence for the prevention.</p><p><b>METHODS</b>From November 2007 to August 2008, 37 patients (20 males and 17 females) were treated with Coflex system. The age was from 33 to 70 years with an average of 52 years and the history was from 6 to 50 months with an average of 16.5 years. Complications were observed and the short-term effectiveness was evaluated by scores of JOA and ODI before and after operation.</p><p><b>RESULTS</b>All patients were followed up from 1 to 2 years with an average 20 months. The JOA score increased from 9.09 +/- 1.10 preoperatively to 25.40 +/- 1.20 in the last follow-up. ODI decreased from 24.70 +/- 4.80 preoperatively to 4.80 +/- 1.00 in the last follow-up. The VAS score decreased from 7.86 +/- 0.80 preoperatively to 3.20 +/- 0.50 in the last follow-up. The symptoms remarkably improved. Complications occurred in 4 pa-tients (10.8%), among them, persistent low back pain was in 1 case and conservative treatment did not work; opposite lower limb pain was in 1 case at the 3rd week after operation and symptomatic treatment was effective; displacement of Coflex was in 1 case and Coflex breakage happened in 1 case at the 6th month after operation, but both did not have related clinical symptom.</p><p><b>CONCLUSION</b>Coflex can obtain good clinical outcomes in treating lumbar disc herniation, but it has special complications. The indications and manipulations should be chosen properly.</p>