Transpedicular intracorporeal hydroxyapatite grafting and pedicle screw fixation via paraspinal approach for thoracolumbar fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and safety of the treatment for thoracolumbar fractures with transpedicular intracorporeal hydroxyapatite grafting and pedicle screw fixation via paraspinal approach.</p><p><b>METHODS</b>From June 2007 to December 2008, 19 cases of thoracolumbar fractures were treated with transpedicular intracorporeal hydroxyapatite grafting and pedicle screw fixation via paraspinal approach. There were 7 female and 12 male, ranging from 21 to 57 years of age (mean 40.8 years) at surgery. The time from injury to surgery varied from 1 d to 5 d (mean 2.9 d). Nineteen patients all suffered from single thoracolumbar fracture with the distribution of injury level being T(11) in 1, T(12) in 5, L(1) in 9, and L(2) in 4. According to Denis fracture classification, there were 5 compression fractures and 14 burst fractures. The mean preoperative ratio of the anterior height of the body was 57.2%, kyphosis angle was 17.6° and occupation of spinal canal was 27.7%. The mean preoperative load-sharing classification of spine fractures was 5.2. Based on the ASIA neurologic grading system, preoperative neurological function was grade B in 2 cases, C in 9 and D in 8.</p><p><b>RESULTS</b>Median operating time was 83.8 min (range 60-95 min) and median blood loss was 133 ml (range 90 - 200 ml). Infection did not occur in any of the patients and the operative incisions were healing well. Average follow-up time was 19.2 months (range 12 - 36 months). At the latest follow-up, the height of the anterior border was corrected to 88.4%, the kyphosis angle was 6.1°, and the occupation of spinal canal was 8.2% on average. The postoperative neurologic function of all 19 patients was improved with grade D in 2 cases and E in 17. There were no instances of instrumentation failure and no patient had persistent postoperative back pain.</p><p><b>CONCLUSIONS</b>Transpedicular intracorporeal hydroxyapatite grafting and pedicle screw fixation via paraspinal approach could provide reliable neurologic improvement in patients with incomplete neurologic deficit, and could prevent the development of kyphosis.Furthermore, it has the obvious advantages of less invasive and blood loss, and decreases the risks of postoperative lumbodorsal pain.</p>

Application of absorbable screw in treatment of scaphoid fracture by retrograde internal fixation / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the surgical effects of treatment of scaphoid fracture with retrograde internal fixation using absorbable screw.</p><p><b>METHODS</b>From December 2001 to December 2007, 18 cases of scaphoid fracture were treated with absorbable screw by retrograde internal fixation. There were 12 males and 6 females with an average age of 26 years ranging from 17 to 40 years. Ten cases were medium fractures of scaphoid and 8 cases were proximal fraxtures.</p><p><b>RESULTS</b>All patients were followed-up for from 12 to 36 months (means 25 months). Among them, 17 cases were union and 1 case was nonunion. The mean time of union was 13 weeks. The mean range of motion of wrist was about 90% and mean scratch strength of wrist was about 95% to fine lateral. There were no pain in 14 cases, and slight pain in 3, medial pain in 1 casea of ununion. According to Cooney's clinical evaluation system, the score was increased from (68.2 +/- 1.5) before operation to (88.7 +/- 1.2) after operation, the postoperative score was higher than preoperative remarkable; 9 patients were fine, 8 were good and 1 was bad.</p><p><b>CONCLUSION</b>This technology had some advantage such as simple surgery, decreasing demonstrate rest blood circulation, stable fixation, reducing bone healing time and increasing healing time. It is an effective way to treat scaphoid fracture.</p>

Controlled clinical study of treatment of non-operation and surgical operation for scapular fracture / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effect of treatment methods of non-operation and surgical operation for scapular fracture.</p><p><b>METHODS</b>A retrospective analysis of 52 patients (male 37, female 15, ranging in age from 20 to 48 years, meanly 31 years)with scapular fractures was done. According to Hardegger classification: the scapular body fracture in 24 cases, the surgical neck fracture in 12 cases, the anatomical neck fracture in 3 cases, the glenoidal lip fracture in 6 cases, the scapular spine fracrure in 7 cases. Of all 52 patients,17 cases were treated conservatively, and 35 were undergone surgical internal fixation. When followed up,the clinical examination was done and the X-ray films were taken to measure glenopolar angle (GPA). Hardegger function evaluation system was adopted. The results were analysed statiscally.</p><p><b>RESULTS</b>Fifty-two cases were all followed up for 9 weeks to 48 months. Among 17 patients treated by non-operation, Hardegger function evaluation system showed that the result were excellent in 7 cases, good in 6, fair in 2 and poor in 2; the X-ray film results showed that there were 14 cases of GPA > 20 degrees and 3 cases of GPA < 20 degrees. Of 35 patients treated by surgical operation, Hardegger function evaluation system showed that the result were excellent in 20 cases,good in 12 and fair in 3; the X-ray film results showed that there were 33 cases of GPA > 20 degrees and 2 cases of GPA < 20 degrees. There was no significant difference between the two groups (P = 0.27).</p><p><b>CONCLUSION</b>Before treatment of scapular fracture, with CT 3D -recontruction, complete understanding of fragments displacement, and correction indication selection, and perform early exercises, both of the two procedures can provide satisfactory outcome.</p>

Treatment of refracture in plate-screw fixation of femoral shaft with plate and xenogenic bony plate / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate curative effect of plate and xenogenic bony plate were applied in refracture in plate-screw fixation of femoral shaft.</p><p><b>METHODS</b>Thirteen cases of refracture in plate-screw fixation of femoral shaft included 8 males and 5 females, average age was 31.2 years ranging from 14 to 57. Fracture type was comminuted fracture in 7 cases, oblique fracture in 4 cases, transverse fracture in 2 cases. Fixation type used eight holes femoral LC-DCP in 5 cases, eight holes epipodite LC-DCP in 2 cases, six holes femoral LC-DCP in 2 cases, 8 holes La-Plate in 4 cases. All the patients were treated by femoral LC-DCP and xenogenic bony plate.</p><p><b>RESULTS</b>All of the patients were followed up from 16 to 40 months with average of 32 months. All cases had undergone only one operation and achieved bony union. Average time of bony union was 9 months. The lower limbs resumed walk and beared a heavy burden. According to criterion of Merchan, the results were excellent in 7 cases,good in 4,fair in 1 and poor in 1, the excellent and good rate of knee function was 84.6% (11/13) in one year after operation.</p><p><b>CONCLUSION</b>Treatment of refracture in plate-screw fixation of femoral shaft with armor plate and xenogenic bony plate is a reliable treatment.</p>

Comparative study on treating complete dislocation of acromioclavicular joint with three different methods / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To comparatively study complete dislocation of acromioclavicular joint treated with three different methods.</p><p><b>METHODS</b>A total of 96 patients (81 males and 15 females, aged 16-59 years, mean=45 years) with complete dislocation of acromioclavicular joint were treated with Dewar's operation (Group A, n=32), internal fixation with Kirschner tension band wires (Group B, n=44), or internal fixation with Wolter plates (Group C, n=20), respectively, in this study. Eighty-five patients suffered from acute dislocations and eleven from chronic dislocations.</p><p><b>RESULTS</b>The patients were followed up for 50 months on an average. According to Karlsson's standard, in Group A, 26 patients were assessed as good, 5 as fair and 1 as poor. In Group B, 20 patients were assessed as good, 13 as fair and 11 as poor. In Group C, 15 patients were assessed as good, 4 as fair and 1 as poor. The good and fair rates were significantly different between Group A and Group B, and between Group C and Group B, but no statistical difference was found between Group A and Group C. The operating time was (52.36+/-7.24) minutes, (67.43+/-8.11) minutes and (69.73+/-8.04) minutes in Groups A, B and C, respectively. And the hospitalizing fees were (2400+/-270) yuan, (2100+/-190) yuan and (8450+/-360) yuan in Groups A, B and C, respectively.</p><p><b>CONCLUSIONS</b>Dewar's operation is a good and safe method with shorter operating time and lower hospitalizing fee for treating complete dislocation of acromioclavicular joint. The method is simple without the need of a second operation to remove the implants and with few complications.</p>