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Objective:To investigate the effect of open reduction and internal fixation assisted by computer virtual surgery in the treatment of complex proximal humeral fracture.Methods:A retrospective case series study was performed on clinical data of 36 patients with complex proximal humeral fracture admitted to Dongfang Hospital Affiliated to Tongji University from January 2018 to June 2020. There were 13 males and 23 females, aged 22-86 years [(56.4±4.8)years]. They were all closed fractures. According to Neer classification, there were 20 patients with three-part fractures and 16 with four-part fractures. Precise pre-surgical designs made by using the digital orthopedic surgery planning system of the E-3D were applied to assist the implementation of precise fracture reduction and internal fixation with the locking plate. The fracture healing was observed. The effect of the real surgery assisted by the virtual surgical designs was assessed by comparing the humeral neck shaft angle and humeral head height measured at the virtual surgery and at day 1 after the real surgery. The humeral neck shaft angle, humeral head height, shoulder range of motion (abduction, external rotation and forward flexion), Constant shoulder function score and visual analogue score (VAS) were recorded at 1 day, 3 months and 12 months after the real surgery. The stability of the medial column was assessed at 1 day after the real surgery. The complications were recorded.Results:All patients were followed up for 12-38 months [(18.5±1.8)months]. The fracture showed bony union in all patients with the union time of 6.6-17.2 weeks [(10.2±1.0)weeks]. The humeral neck shaft angle and humeral head height showed no significant differences measured at the virtual surgery and at 1 day after the real surgery, and were also not significant different at 1 day, 3 months and 12 months after the real surgery (all P>0.05). At 3 months and 12 months after the real surgery, the shoulder abduction [(119.4±11.8)°, (155.3±13.7)°], external rotation [(37.6±6.3)°, (46.8±7.4)°], forward flexion [ (94.8±10.2)°, (126.9±1.6)°] and Constant function score [(66.8±8.4)points, (82.4±9.6)points] were all higher than those at 1 day after the real surgery [(53.8±4.5)°, (21.6±3.3)°, (44.6±7.8)°, (34.3±6.1)points], while the VAS [(4.1±0.5)points, (1.2±0.2)points] was lower than that at 1 day after the real surgery [(8.3±1.4)points] (all P<0.05). The medial column was stable in 34 patients and unstable in 2 at 1 day after the real surgery. Complications included screw cutting out in the articular surface in 1 patient and humeral head necrosis in 1. Conclusion:Treatment of complex proximal humeral fractures with open reduction and internal fixation assisted by computer virtual surgery is conducive to maintaining reduction effect, promoting shoulder joint function, relieving pain and reducing complications.
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Objective To compare the efficacy of early and delayed removal of debridement implant for infection after internal fixation of tibial fracture.Methods A retrospective case control study was conducted on the clinical data of 27 patients with tibial fractures who received plate or screw internal fixation admitted to the East Hospital Affiliated to Tongji University from March 2005 to September 2016.There were 21 males and six females,aged 18-81 years [(41.6 ± 14.3)years].According to the treatment methods,the patients were divided into the delayed implant removal group (Group A,10 patients) and the early implant removal group (Group B,17 patients).Group A was given debridement and anti infection treatment followed by continuous dressing change,and the implant was removed after the fractures were healed.Group B was given debridement and implant removal after one month of anti infection treatment and continuous dressing change when the infection was not clearly controlled.Patients with stable fracture ends were given only negative pressure closed drainage (VSD),and those with instable fracture ends were given external fixation and VSD.The time from infection to implant removal,the time of infection control,the fracture nonunion rate,the chronic bone infection rate,the knee joint function score of the American Hospital for Special Surgery (HSS),and the American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scale were compared between the two groups.Results All patients were followed up for 13-47 months,with the average of 28.4 months.There were significant differences between Group A and Group B in terms of the time from infection to implant removal [(49.9 17.1) weeks ∶ (19.3 ± 9.2) weeks],the time of infection control [(85.3 ±78.3)days∶ (6.3 ±2.8)days],fracture nonunion rate (30％ ∶ 0),and the chronic osteomyelitis incidence (30％ ∶ 0) (all P ＜0.05).No significant differences were found in HSS knee joint function score and AOFAS ankle hindfoot scale between the two groups (both P ＞ 0.05).Conclusion For patients with postoperative infection after internal fixation for tibial fracture,early thorough debridement and implant removal can quickly control the infection and reduce the incidence of nonunion and osteomyelitis.
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Objective To summarize the experience in early diagnosis and emergency treatment for combined thoracoabdominal injury (CTI). Methods Clinical data of 58 cases of CTI admitted to our hospital from June 2001 to August 2009 were analyzed retrospectively.All the patients were treated by closed drainage of thoracic cavity,of which 12 cases were treated with thoracotomy,31 with laparotomy,seven with thoracic and abdominal incisions and three with combined thoracoabdominal incision.Internal fixation for long limb bones was performed in 27 cases,spinal laminectomy and pedicle screw fixation in five and amputation in one. Results After operation,six cases were found to have adult respiratory distress syndrome (ARDS) and 12 cases were complicated with multiple organ dysfunction syndrome (MODS).Fifty-three cases were cured and five died. Conclusions CTI based multiple injuries are severe and complicated.CT scan in the early stage plays a significant role in the diagnosis of CTI and closed drainage of thoracic cavity is an important assurance of the security of abdominal operation.Early diagnosis,correct choice of operation procedures and reasonable handling order of injured organs can improve the successful rescue rate for multiple injury patients.
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Objective To evaluate and compare the clinical effects of proximal femoral nail antirotation blade (PFNA) with reverse less invasive stabilization system-distal femur (LISS) in the treatment of proximal femoral fractures associated with coxa vara. Methods From June 2007 to June 2010, A retrospective study with more than 10 months follow-up of 46 patients with proximal femoral fractures associated with coxa vara underwent PFNA or reverse LISS were carried out, including 24 with PFNA and 22 patients with reverse LISS. The physical status of patient was evaluated according to the American Society of Anesthesiologists (ASA) score. After the operation, the operation duration and volume of blood loss were assessed in the two groups, respectively. At the last follow-up, full weight bearing time, fracture healing time, and neck-shaft angle discrepancy related to contralateral side without fracture of the each group were assessed, respectively.Functional recovery was evaluated according to Parker and Palmer mobility score. Results The average follow-up period was 11.2 months (range, 10-12). All the fractures healed successfully and reached bony union.There were no significant differences between PFNA group and reverse LISS group for the average ASA score, the average operating time, the average volume of intraoperative bleeding and Parker and Palmer mobility score. The patients were allowed full weight-bearing from 9.33 weeks after surgery in PFNA group and from 16.95 weeks in reverse LISS group. The patients reached bony union after 17.21 weeks after surgery in PFNA group and from 30.73 weeks in reverse LISS group. Comparing with PFNA group, neck-shaft angle discrepancy decreased in reverse LISS group. Conclusion The results of PFNA and reverse LISS in the treatment of proximal femoral fracture were satisfactory. The fracture treated by PFNA allowed earlier weight bearing. Reverse LISS could provide better support for neck-shaft angle to avoid coxa vara more effectively.
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AIM: To prepare Ganmaoqing micro-pills (Rhizomaer Radix Baphicacanthis Cusiae. Folium Isatidis, etc). METHODS: Extruded-spheronizing granulator and fluidized coating-machine were applied for Ganmaoqing micro-pills' production. RESULTS: According to the method mentioned above, the content of Ganmaoqing micro-pills wasreached 96.27% paracetauol in labelled indicator. CONCLUSION: The method is feasible and convenient, the result is extract with stable quality.