ABSTRACT
<p><b>OBJECTIVE</b>To investigate the effect of minimally invasive mini-incision and instrumented reduction combined with interlocking intramedullary nailing in the treatment of patients with multi-segment fracture of complex femoral shaft.</p><p><b>METHODS</b>From January 2013 to January 2016, 32 patients with multiple fractures segments of femoral shaft were treated with instrumentation-assisted reduction combined with interlocking intramedullary nailing, including 22 males and 10 females with an average age of 45 years old ranging 17 to 68 years old. The time from injured to operation was 5 to 10 days with an average of 7 days. After admission, routine tibial tubercle or supracondylar bone traction was performed. The patient's general condition was evaluated, the operation time and intraoperative blood loss were recorded. According to Thorsen femoral fracture morphology evaluation criteria and Hohl knee function evaluation of postoperative efficacy, postoperative fracture healing, complications and postoperative recovery of limb function were observed.</p><p><b>RESULTS</b>All patients were followed up for 6 to 24 months with an average of 12 months. The operative time ranged from 48 to 76 minutes with an average of 67 min. The intraoperative blood loss was 150 to 400 ml with an average of 220 ml. The surgical incisions all achieved grade A healing. The fractures reached the clinical standard of healing. The fracture healing time ranged from 4.2 to 10.8 months with an average of 5.7 months. There were no nonunion, incision infection and internal fixation fracture, failure and other complications. According to Thorsen femoral fracture morphology evaluation criteria, the result was excellent in 28 cases, good in 3 cases, fair in 1 case. According to Hohl knee function evaluation criteria, the result was excellent in 30 cases, good in 2 cases.</p><p><b>CONCLUSIONS</b>Instrument-assisted reduction combined with interlocking intramedullary nail fixation is a safe and effective method for the treatment of complex femoral shaft fractures. It has advantages of small trauma, fixed fixation, quick recovery, early postoperative functional exercise.</p>
ABSTRACT
<p><b>OBJECTIVE</b>To retrospectively study postoperative Garden III femoral neck fractures in the elderly so as to explore the different degree of displacement of Garden III femoral neck fracture, and discuss the basis and clinical significance of the subtype classification.</p><p><b>METHODS</b>A total of 492 patients with complete clinical data out of the 1397 patients with femoral neck fractures treated by closed reduction and internal fixation with cannulated compression screws from September 2005 to September 2010 were included in the study. Each patient's frontal Garden Index was measured. On the basis of the frontal Garden Index, these cases were divided into three types:type A, which frontal Garden Index was more than or equal to 140°, included 53 males and 84 females with an average age of(65.3±7.2) years old ranging from 60 to 75 years old; type B, more than 120°and less than 140°, included 79 males and 172 females with an average age of (67.5±3.6) years old;and type C, less than or equal to 120°, included 38 males and 66 with an average age of(68.6±5.7) years old. Aspects were followed up including complications, consequences and hip joint function. The fracture healing and femoral head necrosis were compared among three types.</p><p><b>RESULTS</b>Operative incision of 492 cases was primary healing, and no infection and other complications occurred. All patients were followed up from 2 to 10 years with an average of 6.3 years, the healing of femoral neck fracture occurred in 432 cases, and the total union rate was 87.8%. Femoral head necrosis occurred in 83 cases, and the total necrosis rate of femoral head was 16.9%. The nonunion rate of type A was 6.6%, type B was 13.5%, and type C was 16.3%, there were significant differences among three types(²2AB=4.377,=0.036;²2AC=5.872,=0.015;²2BC=0.469, PBC=0.494). The necrosis rate of femoral head of group A was 8.8%, group B was 16.7%, and group C was 27.9%, there were significant differences among three groups(²2AB=4.704,=0.030;²2AC=15.317,=0.000;²2BC=5.715,=0.017).</p><p><b>CONCLUSIONS</b>It is different for the degree of displacement of Garden III femoral neck fracture in the elderly. Based on frontal Garden Index to differentiate degree of fracture displacement, Garden III femoral neck fracture would be divided into A, B and C subtypes. The prognosis of Garden III femoral neck fracture in the elderly is negatively related to its degree of displacement, which has clinical significance to make treatment plan for Garden III femoral neck fracture in the elderly.</p>
ABSTRACT
<p><b>OBJECTIVE</b>To explore the effect and the mechanism of Danhong Injection (DI), Ligustrazine Injection (LI), and adsorbable biomembranes in preventing the adhesion of tendons and tissues.</p><p><b>METHODS</b>Totally 120 patients all suffering from simple flexor digitorum tendon rupture on the hand zone two damaged by sharp weapons were randomly assigned to Group A (Dikang adsorbable biomembrane), Group B (Tianxinfu adsorbable biomembrane), Group C (Tianxinfu adsorbable biomembrane + Ligustrazine group), and Group D (Tianxinfu adsorbable biomembrane + DI group) in accordance with random digit table, 30 cases in each group. Indicators such as total active movement (TAM) of the hand tendon, Minnesota manual dexterity test (MMDT), and finger flex strength test (FFST) were observed.</p><p><b>RESULTS</b>The TAM and the favorable rate were higher in Group C and D than in Group A and B at post-operative 4 and 8 week (P < 0.05, P < 0.01). There was no statistical difference between Group C and D (P > 0.05). Each index of MMDT was lower in Group C and D than in Group A and B (P < 0.05). There was no statistical difference in FFST among all the 4 groups (P > 0.05).</p><p><b>CONCLUSIONS</b>Combined application of LI or DI with Tianxinfu adsorbable biomembranes could effectively prevent the adhesion of tendons. DI showed equivalent effect as LI did. Besides, the combined application was superior in preventing adhesion to using Xintianfu adsorbable biomembrane or Dikan adsorbable biomembrane alone.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Absorbable Implants , Drugs, Chinese Herbal , Therapeutic Uses , Membranes, Artificial , Musculoskeletal Diseases , Pyrazines , Therapeutic Uses , Tendon Injuries , General Surgery , Tissue Adhesions , Wound HealingABSTRACT
<p><b>OBJECTIVE</b>To study the impacts of tetramethylpyrazine (TMP) intervention on hemorheology and blood coagulation before and after free skin flap transplantation, in order to provide new clues of applying Chinese drugs for activating blood circulation and removing stasis in microsurgery.</p><p><b>METHODS</b>Sixty patients undergoing free skin flap transplantation were randomly and equally assigned to two groups, the treatment group administered with tetramethylpyrazine, the control group with low molecular dextran, both were treated for 7 days. The survival rate of transplanted flap, hemorrheologic parameters and four blood coagulation associated indices (prothrombin time, thrombin time, activated prothrombin time and fibrinogen) were detected before and after treatment.</p><p><b>RESULTS</b>Comparisons of clinical efficacy and hemorrheologic indices showed no significant difference between the two groups (P > 0.05), but TMP showed less impacts on the four blood coagulation associated indices at the 24, 48 and 72 h after operation (P < 0.05).</p><p><b>CONCLUSION</b>TMP could prevent blood vessel crisis after free skin flap transplantation, so it is valuable in microsurgical clinical application.</p>