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Objective:To introduce the standard screw implantation methods and to analyze the biomechanical stability of the second-generation dynamic anterior plate-screw system for quadrilateral area (DAPSQ).Methods:Six adult formalin-preserved corpses were selected to make a complete pelvic specimen. Further, the left high double-column fracture models were made and randomly fixed with second-generation DAPSQ or anterior reconstruction titanium plate and 1/3 tube buttress-plate (ARTPB). The specimens of intact pelvis (IP) group, DAPSQ group and ARTPB group were fixed on a Zwick Z100 material machine and loaded vertically with 200 N, 300 N, 400 N, 500 N, 600 N, 700 N, and 800 N in a simulated sitting position, respectively. The axial displacement and strain changes in the anterior and posterior columns were tested in the three groups. The stiffness was calculated accordingly.Results:The axial compression displacement in the three groups showed an increase trend as well with the vertical load increased from 200 N to 800 N ( F=68.581, P<0.001; F=91.795, P<0.001; F=33.819, P=0.002). The axial displacement in ARTPB group was significantly larger than that in DAPSQ group and IP group ( P<0.05), while the difference between DAPSQ and IP groups was not significant ( P>0.05). Under the vertical load of 600 N, the pelvic axial stiffness of IP group, DAPSQ group, and ARTPB group were 220.72±70.33 N/mm, 185.68±48.49 N/mm and 135.83±60.58 N/mm, respectively. The axial stiffness of ARTPB group was significantly lower than that in DAPSQ group and IP group ( t=5.345, P=0.003; t=6.443, P=0.001), while the difference between DAPSQ and IP groups was not significant ( t=2.138, P=0.086). There were no significant differences of the strain values in anterior column among the three groups during the load increasing from 200 N to 800 N ( P>0.05). With the load increasing from 500 N to 800 N, the strain values of the posterior column in ARTPB group were significantly greater than those of IP and DAPSQ groups ( P<0.05). However, the differences between IP and DAPSQ groups were not statistically significant in strain values of the posterior column ( P>0.05). Conclusion:Compared with anterior reconstruction titanium plate and 1/3 tube buttress-plate, acetabular double-column fracture model fixed with the second-generation DAPSQ has less axial compression displacement but with greater axial stiffness. The stress change in the posterior columns of the acetabulum is like in IP. Therefore, the second-generation DAPSQ has reliable biomechanical stability.
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Objective:To compare the effect of interlocking intramedullary nail and locking plate in the treatment of varus proximal humeral fractures in the elderly.Method:A retrospective case-control study was conducted to analyze the clinical data of 46 elderly patients with varus proximal humeral fractures treated in Central Theater General Hospital of PLA from June 2016 to January 2019, including 27 males and 19 females, at age of 60-84 years［（71.9±5.7）years］. All fractures were fresh. Overall 25 patients were treated with interlocking intramedullary nail（intramedullary nail group）, and 21 patients were treated with locking plate（bone plate group）. The incision length, operation time, intraoperative bleeding and fracture healing time were compared between the two groups. Visual analogue scale（VAS）was used to evaluate the degree of pain relief at 1 week and 1 month after operation, and Constant-Murley score was used to evaluate the recovery of shoulder function at 1 month, 3 months and 1 year after operation. The cervical trunk angle was recorded at 2 days and 1 year after operation to judge whether there was a loss of cervical trunk angle. Postoperative complications were observed.Results:All patients were followed up for 12-32 months［（19.7±6.6）months］. The incision length［（7.1±0.6）cm］, operation time［（60.8±5.2）minutes］, intraoperative bleeding［（64.4±8.4）ml］and fracture healing time［（10.0±1.0）weeks］in intramedullary nail group were significantly less than those in bone plate group［（13.6±0.9）cm,（80.2±8.1）minutes,（151.0±15.2）ml,（11.0±1.5）weeks］（ P<0.05）. In both groups, the VAS decreased significantly over time, and markedly increased Constant-Murley score was detected as well（ P<0.05）. The VAS in intramedullary nail group［（2.8±0.2）points,（1.1±0.2）points］was significantly lower than that in bone plate group［（4.0±0.2）points,（1.5±0.1）points］at 1 week and 1 month after operation（ P<0.05）. The Constant-Murley score in intramedullary nail group［（59.9±6.9）points,（79.1±6.8）points］was higher than that in bone plate group［（50.1±8.5）points,（73.6±8.4）points］at 1 month and 3 months after operation（ P<0.05）, but the score showed no significant difference between intramedullary nail group［（89.1±5.3）points］and bone plate group［（86.4±6.4）points］at 1 year after operation（ P>0.05）. According to Constant-Murley score, 10 patients were evaluated as excellent and 15 patients as good in intramedullary nail group at 1 year after operation, with the excellent and good rate of 100%, while 8 patients were evaluated as excellent, 11 patients as good and 2 patients as fair in bone plate group at 1 year after operation, with the excellent and good rate of 91%（ P>0.05）. The cervical trunk angle in intramedullary nail group［（140.2±2.9）°,（139.6±2.3）°］had significant difference from that in bone plate group［（139.6±3.2）°,（138.8±3.3）°］at 2 days and 1 year after operation（ P<0.05）. In both groups, the cervical trunk angle had slight lost at 1 year after operation compared with that at 2 days after operation, but the difference was not statistically significant（ P>0.05）. In intramedullary nail group, 1 patient had subacromial impact. In bone plate group, 1 patient had screw cutting, 2 patients subacromial impact, and 2 patients delayed fracture healing. The incidence of complications in intramedullary nail group was 4%（1/25）, lower than 24%（5/21）in bone plate group（ P<0.05）. Conclusion:Compared with locking nail plate, interlocking intramedullary nail in the treatment of senile varus proximal humeral fracture has the advantages of small trauma, early fracture healing, less pain, early function recovery and less complications.
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Objective:To evaluate the clinical results of miniplates combined with reconstruction plate in treating comminuted posterior wall acetabular fractures.Methods:A retrospective case series study was conducted for 27 patients with comminuted posterior wall acetabular fractures treated in General Hospital of Central Theatre Command of PLA from October 2015 to June 2019. There were 18 males and 9 females, at age of 23-61 years［（45.9±10.9）years］. All patients were treated by using miniplates combined with the reconstruction plate. The operation time, intraoperative blood loss, intraoperative blood transfusion, length of hospital stay and time of fracture healing were recorded. The reduction quality was evaluated according to Matta radiographic standard at 2 days postoperatively. The modified Merle D'Aubigné-Postel score was adopted to evaluate the hip function at 3, 6 months postoperatively and the final follow-up. Postoperative complications were observed, and heterotopic ossification was assessed by Brooker grading standard.Results:All patients were followed up for 12-48 months［36（24, 36）months］. The operation time was 123-242 minutes［（165.4±29.8）minutes］; the intraoperative blood loss was 170-550 ml［（358.3±111.3）ml］; nine patients required intraoperative blood transfusion of 300-500 ml［（377.8±66.7）ml］. The length of hospital stay was 12-29 days［（21.4±4.7）days］. The fracture healing time was 12-24 weeks［（16.3±3.0）weeks］. According to Matta radiographic standard, the reduction quality was excellent in 21 patients, good in 3 and poor in 3 at 2 days postoperatively, with the excellent rate of 89%. The modified Merle D'Aubigné-Postel score was 9-16 points［（13.1±1.9）points］at 3 months postoperatively, was 10-18 points［（15.4±2.0）points］at 6 months postoperatively, and was 12-18 points［（16.9±1.8）points］at last follow-up（ P<0.01）. The modified Merle D'Aubigné-Postel score between 3 months and 6 months was significantly different（ P<0.01）, and the difference between 6 months and the follow-up was statistically significant（ P<0.01）. The modified Merle D'Aubigné-Postel score was graded as excellent in 0 patient, good in 7, fair in 11 and poor in 9 at 3 months postoperatively, with the excellent rate of 26%; graded as excellent in 3 patients, good in 19, fair in 2 and poor in 3 at 6 months postoperatively, with the excellent rate of 81%; graded as excellent in 18 patients, good in 5, fair in 3 and poor in 1 at the last follow-up, with the excellent rate of 85%（ P<0.01）. No iatrogenic sciatic nerve injury, deep vein thrombosis or wound infection occurred after operation. No hardware loosening or loss of reduction occurred during the follow-up. The post-traumatic arthritis was identified in 2 patients. The avascular necrosis of femoral head was observed in 1 patient and thereafter underwent total hip replacement. The heterotopic ossification occurred in 3 patients, among which 2 patients were graded as Brooker class I and 1 as class II, but there was no adverse effect on hip function. Conclusions:Miniplates combined with reconstruction plate in the treatment of comminuted posterior wall acetabular fractures have reliable fixation effect and attain good reduction, high fracture healing rate, less complications and satisfactory functional recovery.
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Objective:To compare the efficacy of 3D navigation versus C-arm fluoroscopy for placement of percutaneous double-segment long sacroiliac screws in the treatment of injury to the posterior pelvic ring.Methods:A retrospective study was conducted in the 48 patients with pelvic fracture who had been treated surgically from February 2015 to October 2020 at Department of Orthopaedics, General Hospital of Central Command of PLA. The patients were divided into a navigation group and a fluoroscopy group according to their different auxiliary ways to assist screw placement. In the navigation group of 27 patients, there were 19 males and 8 females, with an age of (45.5±7.4) years; in the fluoroscopy group of 21 patients, there were 14 males and 7 females, with an age of (44.1±10.1) years. The 2 groups were compared in terms of placement time for each screw, fluoroscopy time for each screw, adjustments of guide wire, accuracy of screw position, quality of fracture reduction, fracture union time, pelvic function, and postoperative complications.Results:The 2 groups were comparable because there was no significant difference between them in the preoperative general data ( P>0.05). The placement time for each screw [(12.7±2.2) min], fluoroscopy time for each screw [(40.7±9.3) s] and adjustments of guide wire [1 (0,1) time] in the navigation group were significantly less than those in the fluoroscopy group [(23.7±3.6) min, (71.4±14.1)s and 5 (4,6) times] (all P<0.05); the assessment of screw placement in the former (49 excellent, 4 good and one poor cases) was significantly better than that in the latter (29 excellent, 8 good and 5 poor cases) ( P<0.05). The 48 patients were followed up for 8 to 25 months (mean, 13.1 months). There were no significant differences between the 2 groups in fracture union time, quality of fracture reduction or Majeed scores for the pelvic function (all P>0.05).Symptoms of injury to the L5 nerve root were observed in one patient in the fluoroscopy group; none of the patients reported postoperative complications like wound infection, screw loosening or breaking. Conclusions:Compared with C-arm fluoroscopy, 3D navigation may better assist placement of percutaneous double-segment long sacroiliac screws in the treatment of injury to the posterior pelvic ring, because 3D navigation can significantly shorten the time for screw placement and the fluoroscopy time for screw placement, reduce adjustments of guide wire, and improve accuracy of screw placement.
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Objective:To compare the clinical efficacy between our first generation and second generation dynamic anterior plate-screw system for quadrilateral area (DAPSQ) in the treatment of T-shaped acetabular fractures.Methods:A retrospective study was conducted of the 28 patients with T-shaped acetabular fractures who had been treated at Department of Orthopaedics, General Hospital of Central Theater Command from January 2008 to December 2019. They were divided into 2 groups according to fixation methods. Group A [15 patients, 11 males and 4 females, an age of (43.5±9.1) years] were treated with the first generation DAPSQ while Group B [13 patients, 8 males and 5 females, an age of (42.5±7.0) years] with the second generation DAPSQ. Operation time, intraoperative bleeding, fracture reduction, function of the affected hip and postoperative complications were recorded and compared between the 2 groups.Results:The 2 groups were comparable because there was no significant difference between them in the preoperative general data ( P>0.05). The 28 patients were followed up for 12 to 60 months (average, 35.0 months). The operation time [(193.9±33.3) min] and intraoperative bleeding [(830.8±177.4) mL] for Group B were significantly less than those for Group A [(231.3±40.0) min and (1,043.3±190.7) mL] ( P<0.05). In Group A, according to the Matta scoring, the fracture reduction was rated as excellent in 8 cases, good in 5 and poor in 2; in Group B, the fracture reduction was rated as excellent in 8 cases, good in 4 and poor in one. According to the modified Merle d'Aubigné & Postel scoring at the final follow-up, the function of the affected hip was rated as excellent in 9 cases, as good in 3, as fair in 2 and as poor in one in Group A while as excellent in 9 cases, as good in 2 and as fair in 2 in Group B. There were no statistically significant differences between the 2 groups in reduction quality or in the function of the affected hip ( P>0.05). Follow-up observed hip traumatic arthritis in 2 cases in Group A and in one in Group B. Conclusion:In the treatment of T-shaped acetabular fractures, compared with the first generation DAPSQ, the second generation DAPSQ can shorten operation time and decrease intraoperative bleeding significantly, though both achieve comparable functional outcomes.
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Objective:To evaluate the efficacy of lateral deltoid muscle approach in the treatment of valgus-impacted three- and four-part fractures of the proximal humerus.Methods:From January 2015 to December 2017, 36 patients were treated at Department of Orthopaedics, General Hospital of Central Military Theater for valgus-impacted three- and four-part fractures of the proximal humerus via the lateral deltoid muscle approach. They were 10 men and 26 women, aged from 38 to 85 years (mean, 65.6 years). The fracture had occurred at the left side in 20 cases and at the right side in 16. According to the Neer classification, 22 cases had a three-part fracture and 14 a four-part one. Their operation time and intraoperative bleeding were recorded. The efficacy was evaluated by their Constant-Murely scores and ranges of motion of the shoulder joint one year after operation.Results:This cohort was followed up for 12 to 36 months (mean, 21.7 months). Their operation time ranged from 55 to 120 min (mean, 75.9 min); their intraoperative bleeding ranged from 50 to 200 mL (mean, 109.7 mL). Their Constant-Murely scores of the affected shoulder one year after operation ranged from 79 to 90 points (mean, 84.1points). At one year after operation, their abduction ranged from 90° to 160° (mean, 120.6°), their uplift from 90° to 170° (mean, 128.1°), their backward extension from 20° to 60° (mean, 38.8°), their internal rotation from 20° to 45° (mean, 30.5°), and their external rotation from 30° to 45° (mean, 35.6°). All patients obtained bony union with no such complications as axillary nerve injury, deep infection, nonunion or ischemic necrosis of the humeral head.Conclusion:Treatment of valgus-impacted three- and four-part fractures of the proximal humerus via the lateral deltoid muscle approach is minimally invasive, simple, safe and effective.
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Objective:To investigate the effect of modified fluoroscopic monitoring in the treatment of acetabular anterior column fractures with percutaneous retrograde screw fixation under computer-assisted 3D navigation.Methods:A retrospective case series analysis was performed on the clinical data of 42 patients with acetabular anterior column fractures admitted to Central Theater Command General Hospital of PLA from December 2013 to December 2016. There were 24 males and 18 females, with the age of 20-61 years [(41.6±12.9)years]. All patients underwent percutaneous retrograde acetabular anterior column screw fixation under computer-assisted 3D navigation. A total of 61 screws were inserted. The observation indexes included the time for insertion of each screw, intraoperative bleeding volume, fluoroscopy time, coincidence rate between intraoperative fluoroscopy and postoperative imaging, and complications. The D'Aubigné-Postel system was used to evaluate the hip joint function at postoperative 6 months. Fracture healing and complications were detected at postoperative 12 months.Results:All patients were followed up for 9-18 months [(13.1±3.2)months]. Time for insertion of each screw was (18.7±4.8)min, intraoperative bleeding volume was (16.6±3.8)ml, fluoroscopy time was (25.3±10.9)s, and coincidence rate between intraoperative fluoroscopy and postoperative imaging was 100%. There were no complications such as neurovascular injury, thrombosis, wound infection, heterotopic ossification and long-term pain. Six months after operation, D'Aubigné-Postel function score was (10.7±0.9)points, significantly improved compared with preoperative (8.7±1.6)points ( P<0.05). Two patients (3 screws) had lower limb mobility and two patients (2 screws) had screw loosening. Conclusion:For acetabular anterior column fractures, percutaneous retrograde acetabular anterior column screw placement assisted by 3D navigation is helpful to improve the accuracy of screw insertion, decrease introperative fluoroscopy time, reduce operation risk, improve screw coincidence rate, and therefore improve hip function.
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Objective:To investigate the effect of different screw and screw hole combination of locking compression plates (LCP) on axial micromotion of fracture ends.Methods:Eighteen mature male New Zealand white rabbits were enrollled and divided into Groups A, B and C according to the random number table method, with six rabbits in each group. After obtaining the whole fresh right tibial specimens, the tibia was cut off transversely at the middle part and fixed with LCP. All specimens were fixed with locking screws in locking holes at the distal side of the fracture end. In Group A, locking screws were fixed in locking holes at proximal end. In Group B, common screws were fixed in locking holes at proximal end. While in Group C, common screws were fixed in compression holes at proximal end. All specimens were subjected to a dynamic axial load of 0-50 N on a universal test machine. The distance of the micromotion of the fracture site was measured and axial compression stiffness corresponding to each fixing method was calculated through the instrument's own system.Results:All specimens generated corresponding axial displacement under the axial load. Under an axial load that approximated a body weight (25 N), the axial displacement value of the fracture end was (0.101±0.017)mm in Group A, (0.164±0.007)mm in Group B, and (0.305±0.041)mm in Group C. Under the axial load of approximately two body weights (50 N), the axial displacement value of the fracture end was (0.218±0.012)mm in Group A, (0.285±0.013)mm in Group B, and (0.513±0.051)mm in Group C. Under the same load, the average axial displacement value of fracture site was Group C>Group B>Group A ( P<0.01). The axial stiffness of LCP device was (234.36±13.28)N/mm in Group A, (203.78±16.46)N/mm in Group B, and (112.62±16.23)N/mm in Group C, namely Group A>Group B>Group C ( P<0.01). Conclusion:LCP fixed with common screws or via compression holes can significantly increase axial micromotion of the fracture end. While the combined application of the two methods has better effect and can reduce the stiffness of LCP device.
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Objective To compare the clinical efficacy of posterior minimally invasive reconstruction plate and 3D-navigated percutaneous sacroiliac screw fixation of elderly patients with posterior pelvic ring fractures.Methods A retrospective cases control study was performed to analyze the data of 75 elderly patients with posterior pelvic ring fractures admitted from January 2014 to June 2018 in Central Hospital of the PLA.There were 32 males and 43 females,with the age range of 60-83 years (mean,67.7 years).Twenty-four patients in the plate group were treated by posterior minimally invasive reconstruction plate fixation,and 51 patients in the navigation group were treated by percutaneous sacroiliac screw internal fixation with 3 D navigation.The operation time,intraoperative blood loss,X-ray exposure time,complication rate and postoperative visual analogue scale (VAS) were compared between the two groups.Postoperative Matta radiographic criteria was used to assess fracture reduction quality,and Majeed criteria was used to assess pelvic function at the last follow-up.Results All 75 patients were followed up for 6-24 months (mean,13.5 months).The operation time,intraoperative blood loss and X-ray exposure time in the plate group were (126.1 ± 20.6) minutes,(251.6 ± 50.8) ml,and (15.7 ±4.4)s,showing significant differences in comparison with the navigation groups [(49.7 ± 17.5)minutes,(22.8 ±5.1) ml,and (112.8 ± 8.8) s] (P ＜0.05).The incidence of postoperative complications was not significantly different between the plate group (4％) and the navigation group (4％) (P ＞0.05).At day 3,one week,and one month postoperatively,the VAS in the navigation group was (3.3 ± 0.7) points,(3.2 ± 0.7) points,(2.4 ± 0.6) points,better than that in the plate group [(7.2 ± 0.7) points,(6.2 ± 0.8) points and (4.5 ± 0.7) points] (P ＜ 0.05).However,there was no significant difference between the two groups at 3 months and one year after operation (P ＞ 0.05).According to the Matta radiographic criteria,the excellent and good rate was 92％ in plate group (excellent in 14 cases,good in 8,and fair in 2),and was 82％ in the navigation group (excellent in 25 cases,good in 17 and fair in 9).There was no significant difference between the two groups (P ＞0.05).According to the Majeed criteria at the follow-up,the excellent and good rate was 96％ in the plate group (excellent in 15 cases,good in 8 and fair in 1),and was 94％ in the navigation group (excellent in 35 cases,good in 13 and fair in 3).The difference between the two groups was not statistically significant (P ＞ 0.05).Conclusion For elderly patients with osteoporotic posterior pelvic ring fractures,percutaneous sacroiliac screw fixation under 3D navigation has the advantages of shorter operation time,less bleeding,less radiation dose and less postoperative pain than minimally invasive reconstruction plate internal fixation,and hence deserves clinical application.
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Objective@#To compare the clinical efficacy of posterior minimally invasive reconstruction plate and 3D-navigated percutaneous sacroiliac screw fixation of elderly patients with posterior pelvic ring fractures.@*Methods@#A retrospective cases control study was performed to analyze the data of 75 elderly patients with posterior pelvic ring fractures admitted from January 2014 to June 2018 in Central Hospital of the PLA. There were 32 males and 43 females, with the age range of 60-83 years (mean, 67.7 years). Twenty-four patients in the plate group were treated by posterior minimally invasive reconstruction plate fixation, and 51 patients in the navigation group were treated by percutaneous sacroiliac screw internal fixation with 3D navigation. The operation time, intraoperative blood loss, X-ray exposure time, complication rate and postoperative visual analogue scale (VAS) were compared between the two groups. Postoperative Matta radiographic criteria was used to assess fracture reduction quality, and Majeed criteria was used to assess pelvic function at the last follow-up.@*Results@#All 75 patients were followed up for 6-24 months (mean, 13.5 months). The operation time, intraoperative blood loss and X-ray exposure time in the plate group were (126.1±20.6)minutes, (251.6±50.8)ml, and (15.7±4.4)s, showing significant differences in comparison with the navigation groups [(49.7±17.5)minutes, (22.8±5.1)ml, and (112.8±8.8)s](P<0.05). The incidence of postoperative complications was not significantly different between the plate group (4%) and the navigation group (4%) (P>0.05). At day 3, one week, and one month postoperatively, the VAS in the navigation group was (3.3±0.7)points, (3.2±0.7)points, (2.4±0.6)points, better than that in the plate group [(7.2±0.7)points, (6.2±0.8)points and (4.5±0.7)points] (P<0.05). However, there was no significant difference between the two groups at 3 months and one year after operation (P>0.05). According to the Matta radiographic criteria, the excellent and good rate was 92% in plate group (excellent in 14 cases, good in 8, and fair in 2), and was 82% in the navigation group (excellent in 25 cases, good in 17 and fair in 9). There was no significant difference between the two groups (P>0.05). According to the Majeed criteria at the follow-up, the excellent and good rate was 96% in the plate group (excellent in 15 cases, good in 8 and fair in 1), and was 94% in the navigation group (excellent in 35 cases, good in 13 and fair in 3). The difference between the two groups was not statistically significant (P>0.05).@*Conclusion@#For elderly patients with osteoporotic posterior pelvic ring fractures, percutaneous sacroiliac screw fixation under 3D navigation has the advantages of shorter operation time, less bleeding, less radiation dose and less postoperative pain than minimally invasive reconstruction plate internal fixation, and hence deserves clinical application.
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Objective@#To investigate the clinical efficacy of dynamic anterior plate-screw system (DAPSQ) assisted by preoperative digital design in the treatment of acetabular bi-column fractures.@*Methods@#A retrospective case-control study was conducted to analyze the clinical data of 34 patients with acetabular bi-column fractures admitted to the General Hospital of Central Theater Command from January 2012 to January 2018. There were 24 males and 10 females, aged 21-65 years[(43.0±14.2)years]. According to the treatment method, the patients were divided into Group A treated with DAPSQ assisted by preoperative digital design and Group B treated with conventional DAPSQ.Group A was consisted of 17 patients, including 11 males and six females aged 22-64 years [(42.7±12.4)years]. Group B consisted of 17 patients, including 13 males and four females aged 21-65 years[(43.2±14.6)years]. The operation time, intraoperative blood loss, hospitalization time, fracture healing time, Matta radiological standard score of fracture reduction, Merle d'Aubignre-Postel score and complications were recorded and compared between the two groups.@*Results@#All patients were followed up for 12-62 months [(32.8±9.1)months]. The operation time [(160.8±38.5)minutes] and intraoperative bleeding [(455.6±190.4)ml] in Group A were significantly less than those in Group B [(216.9±59.5)minutes] and [(780.2±211.6)ml] (P<0.05). There were no significant differences in hospitalization time, fracture healing time, Matta radiological standard score, modified Merle d'Aubignre-Postel score at the last follow-up between the two groups (P>0.05). In Group A, four patients had traumatic arthritis, with one patient receiving total hip replacement. In Group B, three patients were found with traumatic arthritis, and one with avascular necrosis of femoral head who underwent total hip replacement. None of the two groups had complications such as screws' entry into articular cavity, failure of internal fixation, and incision infection.@*Conclusions@#For acetabular bi-column fractures, DAPSQ can effectively maintain the stability of the fracture, without the risk of screws entering the joint cavity, and obtain satisfactory clinical effect. Compared with conventional DAPSQ, preoperative digital design can significantly shorten the operation time and reduce intraoperative bleeding.
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Objective To investigate the clinical efficacy of dynamic anterior plate-screw system(DAPSQ)assisted by preoperative digital design in the treatment of acetabular bi-column fractures.Methods A retrospective case-control study was conducted to analyze the clinical data of 34 patients with acetabular bi-column fractures admitted to the General Hospital of Central Theater Command from January 2012 to January 2018.There were 24 males and 10 females,aged 21-65 years [(43.0±14.2)years].According to the treatment method,the patients were divided into Group A treated with DAPSQ assisted by preoperative digital design and Group B treated with conventional DAPSQ.Group A was consisted of 17 patients,including 11 males and six females aged 22-64 years [(42.7±12.4)years].Group B consisted of 17 patients,including 13 males and four females aged 21-65 years [(43.2±14.6)years].The operation time,intraoperative blood loss,hospitalization time,fracture healing time,Matta radiological standard score of fracture reduction,Merle d' Aubignre-Postel score and complications were recorded and compared between the two groups.Results All patients were followed up for 12-62 months [(32.8±9.1)months].The operation time [(160.8±38.5)minutes] and intraoperative bleeding [(455.6±190.4)ml] in Group A were significantly less than those in Group B [(216.9±59.5)minutes] and [(780.2±211.6)ml](P＜0.05).There were no significant differences in hospitalization time,fracture healing time,Matta radiological standard score,modified Merle d' Aubignre-Postel score at the last follow-up between the two groups(P＞0.05).In Group A,four patients had traumatic arthritis,with one patient receiving total hip replacement.In Group B,three patients were found with traumatic arthritis,and one with avascular necrosis of femoral head who underwent total hip replacement.None of the two groups had complications such as screws' entry into articular cavity,failure of internal fixation,and incision infection.Conclusions For acetabular bi-column fractures,DAPSQ can effectively maintain the stability of the fracture,without the risk of screws entering the joint cavity,and obtain satisfactory clinical effect.Compared with conventional DAPSQ,preoperative digital design can significantly shorten the operation time and reduce intraoperative bleeding.
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Objective To design and develop intelligent rehabilitation equipment for administering continuous passive motion (CPM) of a rabbit's knee joint after tibial plateau fracture.Methods The equipment constructed had three main parts:the core machinery,electronic control and a control program designed based on bionics principles.Twenty six-month-old New Zealand White male rabbits were randomly divided into sedentary (SED) and CPM groups after their knees had been fractured.The rabbits in the CPM group were given 30 min of early joint rehabilitation once a day for 4 weeks using the CPM equipment,while those in the SED group were kept in their cages and allowed free activity without any special exercise program.The body weight,range of motion and swelling of the affected knee joint were measured before the fracture and on the 3rd,7th,14th,21st and 28th days after the fracture.On the 28th day after the fracture the pathological structure of the articular cartilage on the operative side was observed under a light microscope.Results The equipment ran safely and reliably,and drove the rabbits to move synchronously.It could accurately and conveniently adjust the knee flexion angle,movement speed and movement time.The intelligence of the equipment met the experimental requirements.On the 3rd day after the operation the average range of motion in the joints of both groups had changed significantly compared to that before the fracture.On the 28th day after the fracture the average degree of swelling and range of motion in the CPM group were significantly different from those of the SED group.On the 28th day,deformity and the smoothness of the fracture line in the CPM group were superior to those in the SED group.Moreover,the dominant tissues in the defect area of the CPM group were mainly hyaline cartilage while those in the SED group were mainly repair fibrocartilage.The defect area and its adjacent articular cartilages,chondrocyte regeneration and arrangement,layers of cells and subchondral tidal line recovery of the CPM group were better than in the SED group on average.Conclusion The equipment for knee joint manipulation is convenient to use,reliable and effective for the early rehabilitation of tibial plateau fracture,at least in rabbits.It promotes remodeling of the fracture and cartilage repair after tibial plateau fracture,and also improves range of motion in the knee and reduces swelling.
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Objective To explore the clinical efficacy of lateral osteotomy via the supra-fibular-head approach combined with lateral locking plating for simple posterolateral tibial plateau fractures.Methods From January 2014 to February 2017,11 patients with simple posterolateral tibial plateau fracture were treated at Department of Orthopaedics,General Hospital of Middle Military Command of PLA.They were 8 males and 3 females,aged from 21 to 55 years (average 41.8 years).In all of them the supra-fibular-head approach was used for lateral osteotomy according to the size and orientation of the fracture block.After the fracture was reset,a full bone graft was implanted under direct visualization,followed by fixation of the posterolateral bone mass with a lateral locking plate which was placed as far as possible above the fibular head.The patients were encouraged 6 weeks after surgery to do knee functional exercise within 90°.The therapeutic efficacy was evaluated at the final follow-up according to the Rasmussen's criteria for knee functions.Results The average operative time was 74 minutes (from 55 to 90 minutes);the average intraoperative blood loss was 70 mL (from 40 to 120 mL).All the patients were followed up for 12 to 35 months (average,17.5 months).No neurovascular injury or incision infection was observed.Bony union was achieved in all patients after 10 to 15 weeks (average,12.5 weeks).Follow-ups found no implant loosening/breakage,genu valgum,genu varum,fracture redisplacement,or knee instability.According to the Rasmussen's function evaluation of the knee joint,10 cases were rated as excellent and one as good.Conclusion Lateral osteotomy via the supra-fibular-head approach combined with lateral locking plating is a preferred treatment for simple posterolateral tibial plateau fractures.
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BACKGROUND: Development of bone tissue engineering provides a new method to solve bone defect repair. Scaffold material and structure construction are issues of concern. OBJECTIVE: To fabricate a silk fibroin and hydroxyapatite scaffold with biomimetic interconnected macropores structure using the paraffin-sphere leaching technology and to evaluate its possibility of cytocompatibility. METHODS: The scaffold with biomimetic interconnected macropores structure was made by the paraffin-sphere leaching technology. The structure of scaffold was observed by the stereomicroscope and scanning electron microscope. The pore size and elasticity modulus were calculated. Passage 3 rabbit adipose-derived mesenchymal stem cells were seeded into the scaffold. The cell viability was detected by live/dead staining at 48 hours after culture. The cell adhesion was observed by hematoxylin-eosin staining at 1 week of culture. The scaffold-cell composite was observed under scanning electron microscope at 3 days of culture. The cell proliferation was detected by the cell counting-kit 8 assay at 1, 3, 5 and 7 days of culture. Those cells cultured alone were considered as control group. RESULTS AND CONCLUSION: (1) Stereomicroscope showed the ivory silk fibroin/hydroxyapatite scaffold. Scanning electron microscope revealed pore structures in cross-section and longitudinal-section with good connectivity. The scaffold pore size was (362.23±26.52) μm and the elasticity modulus was (54.93±5.44) kPa. (2) Scanning electron microscope showed that adipose-derived mesenchymal stem cells adhered and stretched well in the pore wall and connected pore, secreted abundant extracellular matrix, and filled in the pores of silk fibroin/hydroxyapatite scaffold. (3) Hematoxylin-eosin staining results found that adipose-derived mesenchymal stem cells evenly adhered onto the inner wall of silk fibroin/hydroxyapatite scaffold, and proliferated well. (4) Live/dead staining revealed a good viability of adipose-derived mesenchymal stem cells. (5) Cell counting-kit 8 assay results showed the good proliferation of adipose-derived mesenchymal stem cells on the scaffold. (6) To conclude, the silk fibroin/hydroxyapatite scaffold possesses good pore size and cytocompatibility.
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Objective To explore the clinical efficacy of internal fixation with dynamic anterior plate-screw system for quadrilateral area(DAPSQ) in the treatment of complex acetabular fractures involving the quadrilateral surface.Methods Between January 2005 and January 2017,a series of 143 patients with complex quadrilateral surface fracture of the acetabulum were treated at Department of Orthopaedics,General Hospital of Central Theater Command.They were 86 males 57 females,with a mean age 46.6 years (range,from 19 to 77 years).By the Letournel-Judet classification,there were 38 anterior column plus posterior hemitransverse fractures,26 T-shaped fractures and 79 double column fractures.They were all closed.The delay from injury to surgery averaged 9.6 days(range,from 3 to 21 days).All the cases were treated with DAPSQ internal fixation via the ilioinguinal approach.Their operation time,intraoperative bleeding volume,quality of fracture reduction,hip function and complications were recorded.Results The operation time for this series ranged from 2.5 to 5.0 hours,averaging 3.8 hours.The intraoperative blood bleeding ranged from 400 to 2,500 mL,with an average of 680 mL.By the Matta criteria for fracture reduction,76 cases were rated as excellent,51 as good and 16 as poor,giving an excellent and good rate of 88.8％.The 143 patients were followed up from 4 months to 10 years (mean,4.1 years).The clinical fracture union was achieved after 2 to 4 months (mean,3 months).By the modified Merle d'Aubigné & Postel criteria,the affected hips scored 9 to 18 points (mean,16.3 points) at the final follow-ups,with 64 excellent,52 good,19 fair and 8 poor cases,giving an excellent and good rate of 81.1％.The postoperative complications included lesion of lateral femoral cutaneous nerve in 7 cases,urinary tract infection in 15 ones,traumatic osteoarthritis in 20 ones 5 of whom had to receive total hip arthroplasty,and heterotopic ossification (Brooker Grade Ⅰ) in 5 ones.Conclusion Internal fixation with DAPSQ is safe and effective for the treatment of complex acetabular fractures involving the quadrilateral surface.
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Objective To investigate the therapeutic effects of navigation-guided hollow screw fixation on the treatment of elderly patients with the sacroiliac complex injury.Methods Twentyone older patients with sacroiliac complex injury received the three-dimensional images-guided percutaneous hollow screw fixation from March 2015 to May 2016.There were 14 males and 7 females with age of 60-73 years[average(63.5 ± 3.7) years].Traffic accident injury was found in 15 cases,falling injury in 5 cases,others in one case.The pelvic fractures were classified by tile classification:type B2 in 2 cases,type B3 in 6 cases,type C1 in 5 cases,type C2 in 6 cases,type C3 in 2 cases.Intraoperative observation data,the injury of nerve and blood vessel during the screw insertion,postoperative fracture reposition and so on were recorded.The quality of fracture reposition was evaluated by Matta radiological criteria after surgery,and the pelvic function was assessed by Majeed scoring criteria at the last follow-up.Results A total of 30 hollow screws in 21 elderly patients were placed under three-dimensional images navigation,and each screw fixation time was 36-45 min,average (40.5±4.7)min with a small amount of bleeding (10-20)ml.Postoperative examinations showed that S1 vertebral cortical bone screw wear was found in one patient,and the end of the bolt washer was internalized into the outer table of the ilium without breaking the medial iliac plate in another patient.The above two patients had no postoperative complications.Other screws positions were good,without nerve or vascular injury and other complications.Postoperative reposition quality evaluated by the Matta radiological criteria showed that 14 cases had excellent quality,five with good quality,two with fair quality,and no case with poor quality.Therefore,the excellent and good rates were 90.5 ％.Moreover,19 elderly patients were followed up for 7-13 months average(10.3± 2.1)months,and only one patient showed the bilateral sacroiliac joint screws outside the lateral sacroiliac joint 5 mm.However,this patient had good function in the later follow-up without further prolapse.The remaining 18 patients assessed by the pelvic X-ray and CT at the end of the follow-up showed a good fracture healing,no screw breakage,loosening,and prolapse.Meanwhile,pelvic function findings evaluated by the Majeed standard demonstrated that nine cases were with excellent function,ten with good function,and the excellent and good rates were 90.5％.Conclusions Three-dimensional images-guided hollow screw fixation for the treatment of elderly patients with the sacroiliac complex injury is safe and effective with less trauma and high nailing accurateness.However,the placing process should be cautious in the elderly with osteoporosis.
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Objective To summarize the characteristics of deltoid ligament rupture and explore the feasibility and shortterm clinical outcomes of targeted suture anchor repair technique according to the rupture site.Methods From May 2011 to October 2014,19 cases of complete deltoid ligament rupture (17 males and 2 females) were recruited in this study,with an average age of 34.15± 1.23 years (ranged from 15 to 60 years).According to Lauge-Hansen classification,there were 7 cases of pronation external rotation grade ⅣV injury,including 3 cases of Maisonnuve fracture;1 case of pronation abduction type Ⅲ degree injury,1 case of pronation abduction grade ⅣV injury;and 10 cases of supination external rotation grade ⅣV injury.According to AO / OTA classification,there were 9 cases of 43B type injury and 10 cases of 43C type injury.According to the rupture site of deltoid ligament,the targeted suture anchor repair surgery was operated respectively.Early mobilization with the help of hinged ankle brace was encouraged.The evaluation at last follow-up was based on the American Orthopedic and Ankle Association (AOFAS) criteria of ankle and hindfoot,and the visual analogue scale (VAS) scoring system.Results Nineteen patients were all followed up for 24 to 48 months,with an average of 30.42±5.11 months.Fourteen cases (73.7％,14/19) with talus end avulsion were treated by double suture anchor in the talus,with continuous locking suture of the avulsed end.Four cases (21.1％,4/19) with middle part rupture were treated by double suture anchor in the talus,with the sutures crossing three bone tunnels at the medial malleolus.One case (5.3％,1/19) with medial malleolus end avulsion was treated by single suture anchor at the medial malleolus,with continuous locking suture of the avulsed end.At the last follow-up,the AOFAS score was ranged from 70 points to 96 points,with an average of 90.53 points,and excellent in 16 cases,good in 2 cases,fair in 1 case,excellent and good rate was 94.7％.The VAS score was ranged from 0 to 2 points,with an average of 0.42 point.No wide medical clear space was detected.But traumatic arthritis was happened in 2 patients.Conclusion The targeted suture anchor repair technique according to the rupture site was a save technique in treating deltoid ligament rupture,which is conducive to early postoperative functional exercise,with excellent short-term clinical outcomes and few complications.
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Objective To investigate application of modified isosceles triangle osteotomy which is designed with the assistance of Picture Archiving and Communication System ( PACS ) in supracondylar surgery for cubitus varus. Methods We reviewed the 31 patients who had been treated for cubitus varus from January 2012 to July 2017. They were 12 males and 19 females, aged from 17 to 24 years ( average, 20. 6 years) . Their elbow varus angles ranged from 14° to 35° (average, 22. 4°) . Preoperatively, the modified isosceles triangle osteotomy was designed using the PACS. The angle of osteotomy = carrying angle of the normal arm + the angle of cubitus varus. The lateral length of the isosceles triangle osteotomy was calculated according to the osteotomy angle. All the cases were fixated with a locking plate. Results The follow-ups lasted from 12 to 40 months ( average, 16 months ) . Bony union was achieved in the osteotomy site by all cases after 7 to 12 weeks ( average, 9 weeks ) . The carrying angles ranged from 8° to 15° ( average, 11°) at final follow-ups. The affected elbow obtained a range of flexion and extension from 126° to 150° ( average, 139°) and a range of rotation from 134° to 160° ( 144°) . According to the Mayo elbow performance score ( MEPS ) one year after operation, 23 cases were rated as excellent, 7 as good and one as fair, yielding an excellent to good rate of 96. 8％. No loss of carrying angle, neural deficit, malunion, delayed union, or myositis ossifi-cans of the elbow was observed during the follow-ups. Conclusion The PACS can be used in preoperative design of the modified isosceles triangle osteotomy for cubitus varus, leading to accuracy in the angle and length of the osteotomy to guarantee fine clinical results.
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Objective To evaluate the clinical outcomes of three-dimensional navigation assisted percutaneous sacroiliac screw combined with external fixator for the treatment of the Tile B and C pelvic fractures. Methods A retrospective case-control study was conducted on 43 patients with Tile B and C pelvic fractures from January 2014 to June 2017. There were 25 males and 18 females, with an average age of 44.6 years (range, 21-68 years). According to the AO typing, there were seven cases of type B1, 13 type B2, six type B3, 15 type C1, and two type C2. The duration from injury to operation ranged from 4 to 14 days (mean, 8.0 days). Based on the operation method, patients were divided into Group A (n=20) treated by three dimensional navigation assisted percutaneous sacroiliac screw combined with external fixator, and Group B (n = 23) treated by anterior open reduction and plate internal fixation. The two groups were compared in terms of operation time, blood loss, reduction quality by Matta score, Majeed pelvic fractures function score at the last follow up, and postoperative complications. Results All patients were followed up for 6-24 months (mean, 12.7 months). The operation time [(27.5 ± 1.6) minutes] and intraoperative bleeding [(26.3 ± 3.9) ml] in Group A were significantly less than those in Group B [(166.2±3.6)minutes and (128.0 ± 8.9) ml] (＜0.05). There were no significant differences between Group A and Group B in the good and excellent rate of reduction [85％ (17/20) vs.91％ (21/23)], and Majeed score [90％ (18/20) vs.91％ (21/23)](P＞0.05). The incidence of postoperative complication in Group A (10％) was significantly lower than that in Group B (39％) (P ＜0.05). Conclusion Compared with open reduction and plate internal fixation, three dimensional navigation assisted percutaneous sacroiliac screw combined with external fixator is preferable to unstable pelvic fractures due to the shorter operation time, less intraoperative bleeding, and fewer postoperative complications.