Treatment of old acetabular posterior wall fracture with 3D printing combined with composite plate internal fixation / 中国骨伤

OBJECTIVE@#To explore the application value and clinical effect of three-dimensional printing combined with composite plate internal fixation in the treatment of old acetabular posterior wall fracture.@*METHODS@#From May 2010 to October 2016, Mimics 19.0 software was used to plan preoperatively according to a 1:1 print pelvic 3D model. At the same time, 23 patients with old acetabular posterior wall fractures were treated with combined plate internal fixation, including 15 males and 8 females, aged 20 to 63 (43.0±5.1) years old, and the time from injury to operation was 23 to 101(47.0±10.5) days. According to Letournel-Judet classification, 11 cases were posterior wall fracture, 7 cases were transverse with posterior wall fracture, and 5 cases were posterior column with posterior wall fracture. All patients were treated with single Kocher-Langenbeck approach combined plate internal fixation, and the evaluation indexes were recorded during operation, after operation and during follow-up.@*RESULTS@#The operation time of 23 patients was (113.5±11.5) min, bleeding was (550.0±104.7) ml and fluoroscopy was (12.7±0.8) s. Matta radiographic reduction criteria were used: excellent in 14 cases, good in 7 cases and poor in 2 cases; 23 patients were followed up for 10 to 24 (16.0±5.6) months. The hip function was evaluated according to the modified Merle d'Aubingne and Postal scoring system at the last follow-up: excellent in 11 cases, good in 8 cases, fair in 3 cases and poor in 1 case. There were 3 cases of traumatic arthritis, 1 case of femoral head necrosis, 2 cases of heterotopic ossification and 5 cases of sciatic nerve irritation.@*CONCLUSIONS@#3D printing technique is an effective and fast method for the treatment of old acetabular posterior wall fractures. In addition, the printing model can provide three-dimensional morphological structure for the operator, combined with preoperative simulation, facilitate intraoperative reduction, and effectively improve the efficiency of surgery.

Therapeutic effect of exercise acupuncture and osteopathy on traumatic knee arthritis / 中国骨伤

OBJECTIVE@#To explore the clinical efficacy of exercise acupuncture and osteopathy in the treatment of traumatic knee arthritis.@*METHODS@#Fifty-one patients with traumatic knee arthritis were divided into three groups:routine group, exercise acupuncture group and osteopathy group. In the routine group, there were 17 cases, 12 males and 5 females, with a mean age of (49.4±8.9) years old; the averaged course of disease was (4.89±1.52) years; total WOMAC score before treatment was 100.77±15.48. Seventeen patients (11 males and 6 females) in the exercise acupuncture group were aged (48.6±10.1) years old; the course of disease was (4.21±1.37) years; and the total WOMAC score before treatment was 106.16±14.95. In the osteopathy group, there were 17 cases, 8 males and 9 females, with a mean age of (52.3±8.4) years old; the average course of disease was (4.79±1.50) years; total WOMAC score before treatment was 103.87±10.14. The patients in the routine group were treated with routine rehabilitation; the patients in the exercise acupuncture group were treated with routine rehabilitation combined with exercise acupuncture, and the patients in the osteopathy group were treated with osteopathy combined with routine rehabilitation. The changes of WOMAC score and ROM in three groups were compared before treatment and 4 weeks after treatment.@*RESULTS@#The overall effect of osteopathy group was better than that of routine group (=3.151, =0.005). The scores of WOMAC before and after treatment:pain of 23.84±4.66, 11.98±2.66, stiffness of 10.44±1.71, 6.42±0.74, daily life of 66.49±11.85, 35.80±4.44 in the routine group; pain of 22.64±3.22, 8.90±2.19, stiffness of 11.82±2.57 , 6.03±1.06, daily life of 71.72±13.59, 32.94±4.73 in the exercise acupuncture group; pain of 22.38±3.68, 10.66±2.75, stiffness of 11.81±2.08, 5.63±1.69, daily life of 69.69±8.96, 28.84±5.76 in the osteopathy group. Compared with the other two groups after treatment, the improvement of pain score in the exercise acupuncture group was better than those in the other two groups. There were no significant differences in stiffness score among the three groups. The degree of difficulty in daily life in the osteopathy group was better than that in the other two groups. The total score of WOMAC in the exercise acupuncture group and the osteopathy group were better than that in the conventional group, but there was no significant difference between the two groups.@*CONCLUSIONS@#On the basis of routine rehabilitation treatment, exercise needling and osteopathy have positive significance for the improvement of joint pain and dysfunction of joint movement in patients with traumatic knee arthritis, with certain popularlized value in the treatment of traumatic knee arthritis.

Finite element analysis on anterior and posterior internal fixation for treating type ⅡHangman’s fracture / 医用生物力学

Objective To evaluate biomechanical differences between anterior titanium plate internal fixation and posterior pedicle screw internal fixation for treating type Ⅱ unstable Hangman’s fracture by finite element analysis. Methods An intact finite element model of the upper cervical spine (C0-3) was established and validated, and an unstable model was also established. Two different internal fixation models, i.e. anterior titanium plate+Cage with bone graft (Plate+Cage) and C2 pedicle screws+C3 lateral mass screws (C2PS+C3LMS) were established, respectively, based on the unstable model. The vertical load of 40 N was applied on the occiput to simulate head weight and 1.5 N•m torque was applied on the occiput to simulate loading conditions of flexion, extension, lateral bending and rotation. Range of motion (ROM) of C2-3, force pathway and strain at the fractured line were calculated and analyzed. ResultsCompared with the unstable model, the Plate+Cage model could decrease the ROM by 92.4%, 97.1%, 96.5% and 90.0%, while the C2PS+C3LMS model could decrease the ROM by 88.6%, 90.2%, 95.7% and 90.3%, in flexion, extension, lateral bending and axial rotation, respectively. The maximum stress of the Plate+Cage model was smaller than that of the C2PS+C3LMS model under 4 loading conditions. Conclusions The anterior Plate+Cage fixation possesses better stability than the posterior C2PS+C3LMS fixation in flexion and extension, while both fixation methods show similar stability in lateral bending and axial rotation. The anterior Plate+Cage fixation is more reasonable in structure and stress distributions, and can achieve reduction, decompression, fixation and fusion in one step, thus it is an effective operative procedure for treating typeⅡ Hangman’s fracture.

Surgical strategy for upper cervical vertebrae instability through the anterior approach / 中国骨伤

<p><b>OBJECTIVE</b>To explore the choice and effect of internal fixation in treating upper cervical vertebrae instability through anterior approach.</p><p><b>METHODS</b>From March 2000 to September 2010,83 patients with upper cervical vertebrae instability were treated with internal fixation through anterior approach. There were 59 males and 24 females with a mean age of 42 years old (ranged, 20 to 68). Among these patients, 36 patients were treated with odontoid screw fixation, 16 patients with C1,2 transarticular screw fixation, 23 patients with C2,3 steel plate fixation, 5 patients with odontoid screw and transarticular screw fixation,2 patients with odontoid screw and C2.3 steel plate fixation, 1 patient with C1,2 transarticular screw and C2,3 steel plate fixation.</p><p><b>RESULTS</b>One patient with completely cervical vertebrae cord injury died of pulmonary infection after C1,2 transarticular screw fixation. Other patients were followed up from 8 to 36 months with an average of 15 months. Upper cervical vertebrae stability were restored without vertebral artery and spinal cord injury. Thirty-six patients were treated with odontoid screw fixation and 5 patients were treated with screw combined with transarticular screw fixation obtained bone union in the dentations without bone graft. Among the 16 patients treated with C1,2 transarticular screw fixation, 13 patients obtained bone union after bone graft; 1 patient died of pulmonary infection after surgery; 1 patient with comminuted odontoid fracture of type II C and atlantoaxial anterior dislocation did not obtain bone union after bone graft,but the fibrous healing was strong enough to maintain the atlantoaixal joint stability; 1 patient with obsolete atlantoaxial anterior dislocation were re-treated with Brooks stainless steel wire fixation and bone graft through posterior approach, and finally obtained bone union.</p><p><b>CONCLUSION</b>It could obtain satisfactory effects depending on the difference of cervical vertebrae instability to choose the correctly surgical method.</p>

Analysis of iodine nutritional status of pregnant women and level of neonatal heel blood thyroid stimulating hormone in Zhoupu and Kangqiao districts of Pudong New Area of Shanghai / 中国地方病学杂志

ObjectiveTo investigate the iodine nutritional status of pregnant women,newborn heel blood thyroid stimulating hormone(TSH) level and their relationship with urinary iodine(UI) level during pregnancy in Zhoupu and Kangqiao districts of Pudong New Area of Shanghai.Methods A total of 993 urinary samples(the first,second and third trimesters of pregnancy were 200 people,respectively),breast feeding(193 people) and non-pregnant women (200 people) in Zhoupu and Kangqiao districts of Pudong New area were collected from Apr 2009 to Dec 2010.Two hundred copies of neonatal heel blood samples were collected.Median of UI was measured by arsenic-cerium catalysis.TSH in neonatal heel blood was analyzed 72 h after birth by time resolved fluoroisnmunoassay(TRFIA).ResultsMedian UI of all pregnant women was 161.35 μg/L,and that in third trimesters of pregnancy( 126.35 μg/L) was lower than that of the first,the second,the breast feeding and non-pregnant women (178.80,180.50,167.90,163.40 μg/L,all P＜ 0.05).The percentage of UI level less than 150 μg/L in the third trimester[57.5％(115/200) ] was higher than that of the first[39.0％(78/200) ],the second[39.5％(79/200) ],the breast feeding [ 16.6％ (32/193) ] and non-pregnant women [ 23.0％ (46/200) ],respectively (all P ＜ 0.05).The percentage of UI level higher than 300 μg/L in the first [9.0％(18/200)],the second[8.0％(16/200) ] and the third trimester [ 5.0％ ( 10/200 ) ] of pregnancy was lower than that of the breast feeding [ 20.2％ (39/193) ] and nonpregnant [20.5％(41/200) ] women,respectively(all P ＜ 0.05).The level of neonatal heel blood TSH was(2.92 ± 1.83)mU/L,the range was 0.01 - 9.76 mU/L,11.0％(22/200) of the neonates heel blood TSH level(5 mU/L)exceeded the ratio of World Health Organization (WHO) standard ( ＜ 3％ ) suitable for iodine nutrition.Conclusions The overall level of iodine nutrition among pregnant women in Zhoupu and Kangqiao districts of Pudong New Area of Shanghai is in the appropriate range,but the pregnant women in the third trimester is in mild iodine deficiencies,and the neonates in these districts may be prone to iodine deficiency.Monitoring of iodine nutrition of pregnant women should be strengthened and iodine supplementation should be done scientifically.

Treatment strategy of rotatory dislocation of atlantoaxial articulation in children / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze appropriate strategy about treatment of rotatory dislocation of atlantoaxial articulation in children.</p><p><b>METHODS</b>From March 2005 to February 2009, 36 patients with rotatory dislocation of atlantoaxial articulation were retrospectively analyzed, including 25 males and 11 females, with the average age of 7.8 years (ranged 3 - 14 years). According to Fielding-Hawkins clinical classification, type I 24 cases, type II 8 cases, type III 2 cases, type IV 2 cases. All of the patients were assessed rotatory dislocation of atlantoaxial articulation and whether or not upper cervical spine malformation by X-ray, MRI and CT scan and three-dimensional reconstruction. Thirty-two cases received observational treatments which were reduction after cervical traction, without appearance of the deformity, without neurological symptoms. And another 4 serious cases (irreducible atlantoaxial dislocation or with os odontoideum) received posterior atlantoaxial fixed autograft fusion.</p><p><b>RESULTS</b>Rotation of atlas decreased from 16.0° ± 4.4° (range, 5° to 26°) pre-therapy to 4.5° ± 1.5° (range, 0° to 8°) post-therapy in 35 cases, rotation of atlas had significant difference between pre-therapy and post-therapy (t = 14.75, P < 0.05). One patient pre-therapy rotation of atlas was 45°, post-therapy was 4°. All patients were followed up for 14 - 38 months (mean, 18 months), 32 cases who received cervical traction and external fixation resulted in satisfactory outcome in which all the ankylodeire were disappear, bilateral masses were symmetrical on anterior-posterior and good functional activities of cervical. All the 4 cases surgically treated obtained reduction, sound bony fusion and neural symptoms were improved obviously after operation.</p><p><b>CONCLUSIONS</b>Conservative treatment has been proved to be very effective in most of rotatory dislocation of atlantoaxial articulation in children. However, operative treatment should be considered in the following situations: irreducible atlantoaxial dislocation or patients with os odontoideum.</p>

Design of ABC damage variable and positioning system for acetabular fractures and 1122 cases multi-center statistic analysis / 中国骨伤

<p><b>OBJECTIVE</b>To design ABC damage variable and positioning system for acetabular fracture and explore the feasibility and clinical practical value of the system through the multi-center analysis of 1122 acetabular fractures.</p><p><b>METHODS</b>According to acetabular three-column conception, and pelvic ring lesions damage direction caused by acetabular fracture domino effect and injury degree of proximal femur joint, it defined class A as any column acetabular fracture; class B as any two-column acetabular fracture; class C as front, dome and posterior mixture acetabular fracture. Lower case English letters a, m, p represented front, dome, posterior fracture, respectively. Acetabular damage variables: 1 was simple displaced fractures; 2 was comminuted fractures; 3 was compression fractures. Pelvic ring lesions damage variables: alpha was sacroiliac joints or sacroiliac fracture horizontal separation deflection; beta was sacroiliac joints or sacroiliac fracture vertical separation deflection; gamma was pubic symphysis separation/superior and inferior ramus of pubis fracture deflection; alpha beta gamma delta was compound floating damage. Proximal humerus joint damage variables: I was femoral head fracture; II was femoral neck fracture; II was intertrochanteric fractures of femur; IV was I to III compound fracture. The ABC damage variable positioning system for acetabular fracture was made up by the above-mentioned variables. The statistics from March 1997 to February 2010 showed 1122 cases acetabular fractures with 18 cases of double side acetabular fracture and 1140 cases of acetabular fractures. The pelvics anterior-posterior view, ilium and obturator oblique view, and 2/3D-CT materials were analyzed and researched.</p><p><b>RESULTS</b>Each damage variables distribution situation in 1140 cases of acetabular fracture involved A in 237 cases (20.8%), B in 605 cases (53.1%), C in 298 cases (26.1%);front column fracture in 808 cases(70.9%), dome fracture in 507 cases (44.5%), posterior fracture in 1026 cases (90%). Acetabular variables: variabe 1 in 203 cases of simple displaced fracture (17.8%); variabe 2 in 516 cases of comminuted fracture(45.3%); variabe 3 in 421 cases of compression fracture (36.9%); 249 cases of pelvic ring lesions damage (21.8%), 75 cases femoral head fracture (6.6%); 18 cases of double side acetabular fracture and relative pelvic ring and proximal humerus joint variables (1.58%). Key part and curative effect elements of 1140 cases acetabular fracture: 507 cases of dome or posterior acetabular fracture (44.5%); 421 cases of compression fracture (36.9%); 249 cases of pelvic ring variables (21.8%); 75 cases of proximal humerus joint variables (6.6%); 486 cases of simple Aa/pl/2,Bapl/2 acetabular fracture (42.6% ).</p><p><b>CONCLUSION</b>Compression fracture, especially defected compression fracture, takes important part in acetabular damage variables, and also presents that acetabular fracture with pelvic ring and proximal femoral damage variables are not rare at all. The relationship of the acetabular fracture damage variables, and its percentage shows the key points and elements in clinical treatment: weight-bearing to dome accounts for 44.5%; compression to defects account for 36.9%, pelvic ring to float accounts for 21.8%; dome fracture to double side fracture account for 6.6%. The system has significant guiding effects on clinic in terms of evaluation of injury severity, anatomic localization, difficulty index, alternative strategy, operative approach, effect of treatment,and prognosis. And the most important thing is that the system creates the comparison of damage variables in same type of fracture and the communication of homo-language and explores a new method.</p>

Retrospective study on staged treatment of long bone shaft fractures with severe thoracic trauma / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the feasibility and efficacy of staged treatment of patients with long bone shaft fractures and severe thoracic trauma.</p><p><b>METHODS</b>A retrospective study was performed on 41 patients with long bone shaft fractures and severe thoracic trauma who underwent staged treatment under the guidance of damage control orthopedics from January 2005 to October 2009 in our department. Among the patients,29 patients were male and 12 patients were female,with an average age of (37.2 +/- 6.1 ) years (ranged, 17 to 65 years). On admission, the value of injury severity score (ISS) for these patients was above 16 and the average value was 27.4. The therapy process included three stages: first stage,controlling thoracic symptoms and provisionally fixing fracture; second stage, resuscitating and optimizing physiological condition in intensive care unit;third stage, operating for fractures when pathogenic condition was equable.</p><p><b>RESULTS</b>There was no dead case. Pathogenic condition of thorax in all patients regained equable in 5 d to 23 d and long bone shaft fractures were fixed in 10 d to 25 d after injury. There was no seriously operative or postoperative complication. All the patients were followed up, the duration ranged from 6 to 36 months, with an average of 19.4 months. Their respiratory functions were good. The long bone shaft fractures were healed in 10 to 16 weeks among 38 patients. The bone nonunion happened in 1 patient with closed fracture and 2 patients with opened fracture.</p><p><b>CONCLUSION</b>Damage control orthopedics is a safe strategy for treatment of long bone shaft fractures with severe thoracic trauma. It is suggested that the surgeons should take a staged approach to perform damage control and definitive surgery.</p>