ABSTRACT
BACKGROUND:Unstable distal radius fracture is the most common fracture in the elderly patients, how to treat this kind of intra-articular distal radius fracture remains controversial. OBJECTIVE:To summarize the clinical, radiographic outcomes and complications of closed reduction and external fixation of the AO type C distal radial fracture. METHODS:From May 2009 to May 2012, we performed closed reduction and external fixation in 122 patients (122 wrists) with the AO type C distal radial fractures. According to AO fracture classification:C1 in 16 patients, C2 in 63 patients, and C3 in 43 patients. The study participants underwent clinical and radiographical evaluation at 3, 6, 12 weeks, and 1 year postoperatively and annual y thereafter. Wrist joint function of patients was anteroposterior and lateral X-ray films by palmar angulation, ulnar variance, radial height, and quality of articular reduction according to Knirck’s classification. RESULTS AND CONCLUSION:Al 122 patients were fol owed up for 13 to 28 months. The mean operative time was 19.1±11.2 minutes;the mean fluoroscopy time was 7.8±2.6 seconds;the mean bleeding loss was 45.7±14.8 mL;the mean length of hospital stay was 2.7±1.9 days;the mean union time was 3.1±0.7 months. At the final fol ow-up, the average modified McBride score was 6.7 points (range, 1 to 23 points), the rate of good to excel ent was 62%. The average palmar angulation was 11.7±2.6° (range, 10° to 15°). The average ulnar variance was 21.3±5.7° (range, 18° to 26°). The mean radial height was 12.9±2.8 mm (range, 10 to 16 mm). Quality of articular reduction based on Knirck and Jupiter’s classification shows Stage 1 in 108 patients and Stage 2 in 14 patients. Eight patients (6.6%) suffered from postoperative complications, including pin tract infection in six patients, sensory branch of the radial nerve neuritis in two patients. Results verified that closed reduction and external fixation of the AO type C distal radial fractures can achieve a satisfactory clinical function, has a less trauma, shorter hospital stay, lower rate of complications, faster fracture union, especial y is suitable for treatment of the AO type C distal radial fractures in the elderly.
ABSTRACT
BACKGROUND:The calcaneal fracture is the most common tarsal bone fracture. Approximately 75% calcaneal fractures presented as the displaced intraarticular fractures. How to treat intraarticular calcaneal fractures remains controversial. OBJECTIVE:To observe the anatomy and clinical effect of minimaly invasive percutaneous screw fixation in repair of Sander II calcaneal fractures under the arthroscope. METHODS:From May 2009 to May 2012, 61 patients (61 feet) with Sander II calcaneal fractures were repaired by minimaly invasive percutaneous screw fixation under the arthroscope. Al patients received clinical and imaging evaluation at 3, 6, 21 weeks, and 1 year after treatment. From then on, the evaluation was performed every year. American Orthopaedic Foot and Ankle Society ankle hindfoot score was used to assess ankle joint function. Simultaneously, complications such as skin necrosis and wound infection were recorded. Radiographic outcomes were assessed by Bohler angle, Gissane angle, calcaneal height and width. RESULTS AND CONCLUSION: A total of 61 patients were folowed up for 24 to 60 months. No complications were seen such as wound healing or deep infection. The time of hospitalization was 6-25 days, averagely (12.7±6.9) days. At the final folow-up, American Orthopaedic Foot and Ankle Society ankle hindfoot score was 88-100, averagely (93.6±3.1), with an excelent and good rate of 100%. The time of return to work after treatment was 8-14 weeks, averagely (10.7±2.9) weeks. Range of motion of ankle or subtalar joint of al patients was limited less than 10°. Immediate postoperative X-ray showed that anatomic reduction of the articular surface was detected in 56 patients (92%), and non-anatomic reduction was found in 5 patients (8%). At last folow-up, the mean Bohler angle was (28.4±4.9)° (range, 23°-30°); the mean Gissane angle was (119.9±7.8)° (range, 112°-124°); the mean calcaneal height was (43.4±4.2) mm (range, 39-45 mm); the mean calcaneal width was (30.4±2.5) mm (range, 27-32 mm); the average fracture healing time was (16.7±4.2) weeks (range, 12-20 weeks). Bohler angle, Gissane angle, calcaneal height, and calcaneal width at last folow-up were significantly improved compared with pretreatment (P < 0.05). These findings suggest that under the arthroscope, minimaly invasive percutaneous screw fixation for Sander II calcaneal fractures can restore calcaneal anatomy, achieve a satisfactory clinical function, without complications such as poor woundhealing or infection.
ABSTRACT
BACKGROUND:Currently, the treatment methods of lumbar burst fractures include anterior spinal approach, posterior spinal approach, and anterior combined with posterior approach. However, it is stil controversial which the best approach is for lumbar burst fracture and what are their indications. OBJECTIVE:To assess clinical outcomes of surgical treatments through anterior, posterior approaches, and anterior combined with posterior approach for lumbar vertebrae burst fractures. METHODS: A total of 79 patients with lumbar burst fractures were treated by operation. Different approaches were selected according to conditions of injury: posterior approach (57 patients), anterior approach (12 patients), and anterior combined with posterior approach (10 patients). ASIA was used to assess the recovery of neurological function before and after treatment. Cobb angle, correction loss of Cobb angle, bone fusion rate, failure rate of internal fixation, operative time and intraoperative bleeding loss were observed before and after treatment. RESULTS AND CONCLUSION:Al 79 patients were folowed up for at least 19 months. Except no changes in the 5 complete paralysis cases, the ASIA classification of postoperative nerve function in 63 incomplete paralysis cases was improved by 1 grade or more. ASIA grade and the Cobb angle were obviously improved after operation, showing significant differences between preoperation and last folow-up (P 0.05). Results suggested that the three surgical approaches can effectively treat lumbar burst fractures, and can achieve satisfactory clinical outcomes. Posterior approach easily affected fixation breakage and postoperative correlation loss. Anterior approach and anterior combined with posterior approach obtained less correlation loss. The surgeons should choose the surgical approach according to the characteristics of patients, and aim to achieve the best clinical outcomes.
ABSTRACT
BACKGROUND:Studies have suggested that high-viscosity bone cement can reduce bone cement leakage in the percutaneous vertebroplasty, but compared to the low-viscosity bone cement, there are stil some controversies on clinical advantages of high-viscosity bone cement. OBJECTIVE:To compare the bone cement leakage and clinical outcomes of high-viscosity and low-viscosity bone cement in percutaneous vertebroplasty for osteoporotic vertebral fractures. METHODS:Sixty patients with osteoporotic vertebral fractures were enroled in this study. Al patients were randomly divided into two groups: high-viscosity bone cement group and low-viscosity bone cement group. We compared the venous leakage rate, disc leak rate, visual analogue scale scores for low back pain, and Oswestry disability index between two groups. RESULTS AND CONCLUSION:Al patients were successfuly operated and low back pain and Oswestry disability index had significant improvement as compared with the preoperative status (P=0). By the final folow-up visit, there was no significant difference in disc leak rate, visual analogue scale scores, and Oswestry disability index between two groups. The venous leakage rate in the high-viscosity bone cement group was lower than that in the low-viscosity bone cement group (P=0). This study shows that high-viscosity bone cement can reduce bone cement leakage in the percutaneous vertebroplasty.
ABSTRACT
Objective To investigate the expression of COX-2 in multiple myeloma(MM)and the relationship between myeloma cells proliferation and apoptosis.To provide a new prognosis factor and therapeutic target.Methods COX-2 from the 22 newly diagnosed MM,14 relapsed MM and PCNA,HSP70 of the newly diagnosed patients were detected by immunohistochemistry method.Results All the newly diagnosed MM exhibited positive COX-2 immunoreactivity.50% had strong COX-2 and 50% showed weak COX-2.Relapsed MM exhibited strong COX-2.COX-2 was related with serum β2 microglobulin,marrow plasma cells,hemoglobin,PCNA,HSP70(P=0.019,0.003,0.048,0.006,0.034).Conclusion COX-2 was overexpressed in MM.Prognosis of patients with strong COX-2 is poorer than those with weak COX-2.COX-2 may promote the proliferation and inhibit the apoptosis of myeloma cells.