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Objective:To investigate whether the Garden indexes can serve as a criterion for rotational displacement of femoral neck fracture.Methods:Ten cadaveric specimens of healthy human proximal femur were used for this study. They came from 3 males and 2 females who had died at the age from 45 to 70 years old. A Kirschner wire of 2.0 mm in diameter was implanted into the center of the femoral head. Osteotomy was conducted perpendicular to the middle line of the femoral neck. The rotational angles were marked on the distal osteotomy surface. Each cadaveric specimen was rotated sequentially at pronation and supination angles of 0°, 10°, 20°, 30°, 40°, 50°, 70° and 90°, respectively. X-ray images of anterior-posterior and lateral views were taken to record all the rotations of the specimens. Picture Archiving and Communication Systems (PACS) were used to measure the Garden indexes and compare them among anterior-posterior and lateral X-ray films of different pronation and supination angles. Changes in the area of the femoral head fovea at different rotation angles were observed as well.Results:There were no significant differences in the auterior-posterior or latera Garden indexes from 0° to pronation or supination 30°, with all the Garden values >155° ( P>0.05); from pronation of 40° to pronation of 90°, the Garden indexes were 152.36°±1.41°, 146.04°±1.64°, 143.95°±0.60° and 141.73°±0.60° for anterior-posterior views and 172.54°±0.86°, 168.57°±0.98°, 157.18°±1.17° and 156.47°±1.63° for lateral views, showing a significant difference between rotational angles ( P<0.05); from supination of 40° to supination of 90°, the Garden indexes were 151.67°±1.06°, 147.32°±1.82°, 142.77°±0.75° and 139.88°±1.48° for anterior-posterior views and 172.28°±0.79°, 166.76°±1.02°, 155.67°±1.74° and 154.16°±1.27° for lateral views, showing a significant difference between rotational angles ( P<0.05). The area of the femoral head fovea decreased gradually with the increase in pronation angle, and increased gradually with the increase in supination angle. Conclusions:The Garden indexes cannot serve as an accurate indication of rotational displacement in reduction of femoral neck fracture when the pronation or supination angles ranges from 0° to 30°. Changes in the area of the femoral head fovea can help determine the rotational displacement of the femoral neck fracture.
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Objective@#To investigate the value of 18F-fluorodeoxyglucose (FDG) PET/CT imaging and cardiac MRI (CMR) in the diagnosis of radiation-induced heart disease (RIHD) in Beagle models.@*Methods@#Twenty-four normal male Beagle dogs (1-year old) were randomly divided into control group and irradiated groups (3-month, 6-month and 12-month after radiation). The left anterior myocardium of Beagle dogs in irradiated groups was irradiated locally with a single dose of 20 Gy X-ray. Cardiac 18F-FDG PET/CT imaging and CMR were performed on all dogs, and the mean standardized uptake value (SUVmean) and the area of lesions with increased 18F-FDG uptake were obtained. After imaging examinations were finished, dogs were sacrificed and their hearts were taken out to perform Masson staining and electron microcopy. One-way analysis of variance was used for data analysis.@*Results@#There was basically no uptake in myocardium in control group. The myocardium showed increased uptake of 18F-FDG in the irradiated groups. The SUVmean of myocardium in 3-month, 6-month and 12-month after radiation groups and control group were 5.90±1.31, 4.66±2.21, 3.21±0.82 and 1.13±0.21, respectively (F=11.81, P<0.05). The area with increased 18F-FDG uptake in the irradiated groups decreased progressively with the prolongation of irradiation time (F=195.74, P<0.01). The reduction in myocardial perfusion and myocardial fibrosis were observed by CMR early at 6-month after irradiation. Compared with the control group, the 6-month and 12-month after radiation groups had increased end diastolic volume (EDV) and end systolic volume (ESV; F=15.479 and 16.908, both P<0.01), and decreased left ventricular ejection fraction (LVEF; F=63.715, P<0.01). The progressive aggravation of myocardial fibrosis was displayed in irradiated groups by Masson staining. The mitochondria degeneration, swelling and the count reduction in irradiated groups were observed by electron microscopy.@*Conclusions@#The increased 18F-FDG uptake in the irradiated myocardium may predict the risk of RIHD. 18F-FDG PET/CT imaging can detect RIHD earlier than CMR.
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Objective To investigate the value of 18F-fluorodeoxyglucose (FDG) PET/CT imaging and cardiac MRI (CMR) in the diagnosis of radiation-induced heart disease (RIHD) in Beagle models.Methods Twenty-four normal male Beagle dogs (1-year old) were randomly divided into control group and irradiated groups (3-month,6-month and 12-month after radiation).The left anterior myocardium of Beagle dogs in irradiated groups was irradiated locally with a single dose of 20 Gy X-ray.Cardiac 18F-FDG PET/CT imaging and CMR were performed on all dogs,and the mean standardized uptake value (SUVmax) and the area of lesions with increased 18F-FDG uptake were obtained.After imaging examinations were finished,dogs were sacrificed and their hearts were taken out to perform Masson staining and electron microcopy.Oneway analysis of variance was used for data analysis.Results There was basically no uptake in myocardium in control group.The myocardium showed increased uptake of 18F-FDG in the irradiated groups.The SUV of myocardium in 3-month,6-month and 12-month after radiation groups and control group were 5.90± 1.31,4.66±2.21,3.21±0.82 and 1.13±0.21,respectively (F=11.81,P＜0.05).The area with increased 18F-FDG uptake in the irradiated groups decreased progressively with the prolongation of irradiation time (F =195.74,P＜0.01).The reduction in myocardial perfusion and myocardial fibrosis were observed by CMR early at 6-month after irradiation.Compared with the control group,the 6-month and 12-month after radiation groups had increased end diastolic volume (EDV) and end systolic volume (ESV;F =15.479 and 16.908,both P＜0.01),and decreased left ventricular ejection fraction (LVEF;F=63.715,P＜0.01).The progressive aggravation of myocardial fibrosis was displayed in irradiated groups by Masson staining.The mitochondria degeneration,swelling and the count reduction in irradiated groups were observed by electron microscopy.Conclusions The increased 18F-FDG uptake in the irradiated myocardium may predict the risk of RIHD.18F-FDG PET/CT imaging can detect RIHD earlier than CMR.
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Objective@#To compare the clinical efficacy of the preserving insertion point of the rectus abdominis-Pfannenstiel approach with traditional Pfannenstiel approach in the treatment of pelvic anterior ring injuries.@*Methods@#A retrospective analysis was performed on 43 cases with pelvic anterior ring injuries treated from September 2008 to February 2016. Among them, 20 cases were treated with the preserving insertion point of the rectus abdominis-Pfannenstiel approach (modified approach group) including 14 males and 6 females, aged 18-58 years, with an average age of 36.9 years. According to Tile classification of pelvic fractures, there were 8 cases of B1 type, 4 cases of B2 type, 2 cases of B3 type, 4 cases of C1 type and 2 cases of C2 type. And 23 cases were treated with traditional Pfannenstiel approach (traditional approach group, 16 cases of males and 7 cases of females, aged 19-59 years, with an average age of 36.8 years). Tile classification of pelvic fractures: 9 cases of B1, 4 cases of B2, 3 cases of B3, 4 cases of C1 and 3 cases of C2). The operative time, intraoperative blood loss, postoperative hospital stay, postoperative reduction, postoperative functional and complications were compared between the two groups.@*Results@#43 patients were followed up for 12-40 months, with an average of 20.5 months. All fractures healed in 8-20 weeks, with an average time of 10 weeks. Duration of anterior approach: 119.0±18.3 min in the modified approach group and 93.7±17.8 min in the traditional approach group (t=4.597, P< 0.05). Intraoperative blood loss: 206.0±38.2 ml in the modified approach group and 252.4±46.1 ml in the traditional approach group (t=-3.560, P< 0.05). Postoperative hospital stay: 14.5±3.0 d in the modified approach group, and 20.0±4.4 d in the traditional approach group (t=-4.775, P< 0.05). Postoperative reduction was evaluated according to the Matta reduction criteria, among which 15 cases were excellent and 5 cases were good in the modified approach group; 17 cases were excellent and 6 cases were good in the traditional approach group. According to the Majeed score, the postoperative function of pelvic fracture was excellent in 10 cases, good in 7 cases, and acceptable in 3 cases, with an excellent and good rate of 85.0% (17/20). There were 11 excellent cases, 8 good cases and 4 fair cases in the traditional approach group, with an excellent and good rate of 82.6% (19/23). There was no statistically significant difference between the two groups (χ2=0.04, P >0.05). Complications: 2 cases of internal fixation loosening and 2 cases of coital pain occurred in the modified approach group after surgery, with a complication rate of 20.0% (4/20). Postoperatively, 1 case of superficial infection, 1 case of pulmonary infection, 1 case of internal fixation loosening, 1 case of screw broken and 4 cases of coital pain occurred in the traditional approach group, with a complication rate of 34.8% (8/23).@*Conclusion@#Both approaches can achieve satisfactory results in the treatment of anterior pelvic ring injury. The preserving insertion point of the rectus abdominis-Pfannenstiel approach for the treatment of anterior pelvic ring injuries has the advantages of less bleeding, faster recovery and shorter hospitalization time.
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Objective To evaluate the prognostic value of peak ejection rate (PER) and peak filling rate (PFR) in patients with left ventricular systolic dysfunction (LVSD) after acute myocardial infraction (AMI).Methods A total of 123 patients (103 males,20 females,age:(60.6± 11.2) years) with LVSD after AMI who underwent 99Tc-methoxyisobutylisonitnle (MIBI) gated SPECT myocardial perfusion imaging (GSMPI) from January 2014 to December 2015 were retrospectively analyzed.Summed rest score (SRS) and total perfusion deficit (TPD) were acquired by using quantitative perfusion SPECT (QPS) soft-ware.Left ventricular ejection fraction (LVEF),end-diastolic volume (EDV),end-systolic volume (ESV),PER,and PFR were calculated by using quantitative gated SPECT (QGS) software.The clinical parameters of patients were recorded and the cardiac events were taken as the endpoint of follow-up (median time:27 (range:9-50) months).Pearson correlation was used to analyze the correlation between PER and PFR.Receiver operating characteristic (ROC) curve was used to evaluate optimal cut-off values of PER and PFR for predicting cardiac events.Kaplan-Meier survival analysis and Cox proportional hazards model were also used for data analysis.Results There was a great correlation between PER and PFR (r =-0.931,P＜0.001).Optimal cut-off values of PER and PFR for predicting cardiac events were-1.10 EDV/s and 1.09 EDV/s respectively.Kaplan-Meier survival analysis showed that cumulative survival rate without cardiac events was lower in patients (n=48) with-PER≤ 1.10 EDV/s than that in patients (n=75) with-PER＞ 1.10 EDV/s (16.7％ vs 66.7％;x2=60.096,P＜0.001),and the same rate in patients (n=50) with PFR ≤ 1.09 EDV/s was lower than that in patients (n=73) with PFR＞1.09 EDV/s (16.0％ vs 68.5％;x2=74.771,P＜0.001).Cox multivariate analysis showed that PER (hazard ratio (HR)=0.40,95％ CI:0.20-0.83) and PFR (HR=0.22,95％ CI:0.12-0.47) were independent predictors for cardiac events.Conclusion There is a great correlation between PER and PFR in patients with LVSD after AMI and they are independent predictors for cardiac events.
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Objective To compare the clinical efficacy of the preserving insertion point of the rectus abdominis?Pfannen?stiel approach with traditional Pfannenstiel approach in the treatment of pelvic anterior ring injuries. Methods A retrospective analysis was performed on 43 cases with pelvic anterior ring injuries treated from September 2008 to February 2016. Among them, 20 cases were treated with the preserving insertion point of the rectus abdominis?Pfannenstiel approach (modified approach group) including 14 males and 6 females, aged 18-58 years, with an average age of 36.9 years. According to Tile classification of pelvic fractures, there were 8 cases of B1 type, 4 cases of B2 type, 2 cases of B3 type, 4 cases of C1 type and 2 cases of C2 type. And 23 cases were treated with traditional Pfannenstiel approach (traditional approach group, 16 cases of males and 7 cases of females, aged 19-59 years, with an average age of 36.8 years). Tile classification of pelvic fractures: 9 cases of B1, 4 cases of B2, 3 cases of B3, 4 cases of C1 and 3 cases of C2). The operative time, intraoperative blood loss, postoperative hospital stay, postoperative reduc?tion, postoperative functional and complications were compared between the two groups. Results 43 patients were followed up for 12-40 months, with an average of 20.5 months. All fractures healed in 8-20 weeks, with an average time of 10 weeks. Duration of anterior approach: 119.0±18.3 min in the modified approach group and 93.7±17.8 min in the traditional approach group (t=4.597, P<0.05). Intraoperative blood loss: 206.0±38.2 ml in the modified approach group and 252.4±46.1 ml in the traditional ap? proach group (t=-3.560, P<0.05). Postoperative hospital stay: 14.5±3.0 d in the modified approach group, and 20.0±4.4 d in the traditional approach group (t=-4.775, P<0.05). Postoperative reduction was evaluated according to the Matta reduction criteria, among which 15 cases were excellent and 5 cases were good in the modified approach group; 17 cases were excellent and 6 cases were good in the traditional approach group. According to the Majeed score, the postoperative function of pelvic fracture was excel?lent in 10 cases, good in 7 cases, and acceptable in 3 cases, with an excellent and good rate of 85.0% (17/20). There were 11 excel?lent cases, 8 good cases and 4 fair cases in the traditional approach group, with an excellent and good rate of 82.6% (19/23). There was no statistically significant difference between the two groups (χ2=0.04,P >0.05). Complications: 2 cases of internal fixation loosening and 2 cases of coital pain occurred in the modified approach group after surgery, with a complication rate of 20.0% (4/20). Postoperatively, 1 case of superficial infection, 1 case of pulmonary infection, 1 case of internal fixation loosening, 1 case of screw broken and 4 cases of coital pain occurred in the traditional approach group, with a complication rate of 34.8% (8/23). Conclu?sion Both approaches can achieve satisfactory results in the treatment of anterior pelvic ring injury. The preserving insertion point of the rectus abdominis?Pfannenstiel approach for the treatment of anterior pelvic ring injuries has the advantages of less bleeding, faster recovery and shorter hospitalization time.
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Objective To evaluate clinical outcomes of the Kocher-Langenbeck (K-L) approach combined with partial proximal Watson-Jones incision for the treatment of acetabular fractures involving the weight-bearing area.Methods From January 2012 to January 2017,20 patients were treated by the K-L approach combined with partial proximal Watson-Jones incision for acetabular fracture involving the weight-bearing acetabular dome.They were 13 males and 7 females,with an average age of 40.7 years (range,from 22 to 67 years).According to the Letournel-Judet classification,there were 8 posterior wall fractures,one transverse fracture,one T-shaped fracture,one transverse and posterior wall fracture,3 posterior column and posterior wall fractures,and 6 double-column fractures.All patients received open reduction and internal fixation with plates and screws.The outcomes of reduction were evaluated at follow-ups according to the Matta criteria.The hip function was evaluated according to the modified Merle d'Aubigne-Postel criteria and the abductor strength by the American Medical Research Council criteria at final follow-ups.Results All the 20 patients were followed up for an average of 8.2 months (range,from 7 to 21 months).They all obtained bony union after 10 to 18 weeks (average,11.4 weeks).No fracture displacement,internal fixation loosening or deep infection occurred.According to the Matta criteria,anatomic reduction was achieved in 13 cases,satisfactory reduction in 6 cases,and unsatisfactory in one (a satisfactory rate of 95％).The modified Merle d'Aubigne-Postel scoring for the hip function at the final follow-ups yielded 9 excellent cases,7 good cases,3 fair cases and one poor case (an excellent to good rate of 80％).Ectopic ossification of Brooker grade Ⅰ occurred in one case.The abductor strength was rated as grade Ⅳ in 3 cases and as grade Ⅴ in 17.Conclusions In the treatment of acetabular fractures involving the acetabular dome,the K-L approach combined with partial proximal Watson-Jones incision can increase the operation view of the weight-bearing area,enhance the anatomic matching of femoral head and acetabular roof,and reduce the difficulties in reduction and fixation.
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Objective To investigate the application value of time-spatial labeling inversion pulse (T-SLIP) in renal corticomedullary differentiaton and the best black blood inversion time (BBTI) value.Methods Totally 60 volunteers were included,who underwent abdominal MR scan with noncontrast-enhanced SSFP sequence combined with T-SLIP.All subjects were scanned with different BBTI (800,1 000,1 200,1 400,1 600,1 800 ms) using coronary T-SLIP SSFP sequence.The images quality was evaluated using a four-point scale method.The region of renal cortex and medulla was devised automatically based on the image training algorithm.The signal intensity ratio with the different BBTI was calculated through measuring the signal intensity of the renal cortex and medulla.And the best BBTI values were analyzed.Results When BBTI was 1 200 ms,the image score was the highest.The signal intensity ratio (SIR) had statistical difference among different BBTI groups (all P＜0.05),when BBTI was 1 200 ms,the SIR was the highest,and the contrast between the renal cortex and medulla was obvious.Conclusion T-SLIP technology can improve the visibility of renal corticomedullary without contrast agents.The optimal BBTI for the best corticomedullary differentiation is 1 200 ms.
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Objective To investigate the injury and disruption of anterior sacroiliac ligament (ASIL) and sacrotuberous/sacrospinous ligament complex(STL/SSL),as well as the displacement of pubic symphysis (PS) and sacroiliac joint (SIJ),associated with anterior-posterior compression (APC) of Young-Burgess type Ⅱ.Methods Test models of APC of Young-Burgess type Ⅱ were created in 10 fresh human pelvic cadaveric specimens which were randomized into 2 equal groups (n =5).The fight hemipelvis in one group was fixed to a table (the limited group) while that in the other was not (the unlimited group).At the disruption point of ASIL during external rotation of the hemipelvis,displacement of PS,separation distance between the anterior parts of the sacroiliac joint,and injury and disruption of STL/SSL were recorded.When STL/SSL was gradually made to breakdown and fracture with continuous external rotation of the hemipelvis,bony changes and injuries to the posterior pelvic ligaments were observed and recorded.Results At the failure point of ASIL,the mean displacement of PS was 23.8 ± 2.8 mm and that of SIJ was 10.9 ± 4.4 mm,showing no significant difference between the limited and unlimited groups (P ＞ 0.05);the mean external rotation angle was 40.1°± 9.8° and the mean torsion was 646.7 ± 131.5 N,showing significant differences between the limited and unlimited groups (P ＜ 0.05).At the disruption point of ASIL,obvious injuries or disruption of STL/SSL were not observed in the unlimited group but observed in the limited group.With extreme external rotation,obvious disruption of STL/SSL was not found in the unlimited group but observed in the limited group.When ASIL and STL/SSL were all fractured,the mean displacement of PS was 41.8 mm and that of SIJ was 16.8 mm in the limited group.Conclusions Since APC injury can lead to 2 situations,limited or unlimited hemipelvis,external rotation injuries to the ligaments differ in the 2 different situations.When ASIL fails,the displacement of PS will fluctuate greatly.
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Objective To discuss the 3D printing modeling used to assist minimally invasive fixation with hollow screws for unstable pelvic fractures.Methods From January 2014 to January 2016,137 patients with unstable pelvic fracture received minimally invasive fixation with hollow screws and obtained complete follow-up at our department.In 65 of them,the fixation was assisted by 3D printing modeling;they were 37 men and 28 women,with an average age of 33.1 ± 4.9 years.In the other 72 cases,conventional fixation was performed without assistance of 3D printing modeling;they were 45 men and 27 women,with an average age of 32.6 ±4.7 years.The 2 groups were compared in terms of operation time,frequency of intraoperative fluoroscopy,reduction quality and curative effect.Results This cohort were followed up for 6 to 15 months (average,9 months).The 3D printing modeling group needed significantly less operation time (58.6 ± 13.4 min) and intraoperative fluoroscopy (29.3 ± 3.6 frequencies) than the conventional group (72.4 ± 12.4 min and 36.6 ± 2.8 frequencies) (P ＜ 0.05).According to the Matta scoring criteria,the quality of pelvic reduction was evaluated as excellent in 21 cases,as good in 30 cases,as fair in 13 cases and as poor in one in the 3D printing group,yielding an excellent and good rate of 78.5％ while as excellent in 22 cases,as good in 36 cases,as fair in 12 cases and as poor in 2 cases in the conventional group,yielding an excellent and good rate of 80.6％.According to the Majeed scoring criteria,the curative effect was evaluated at the last follow-up as excellent in 27 cases,as good in 26 cases,as fair in 11 cases and poor in one in the 3D printing group,giving an excellent and good rate of 81.5％ while as excellent in 30 cases,as good in 28 cases,as fair in 13 cases and as poor in one in the conventional group,giving an excellent and good rate of 80.6％.There were no statistically significant differences between the 2 groups in reduction quality or curative effect (P ＞ 0.05).No nonunion or iatrogenic neurovascular lesions happened during the follow-up period.Conclusion 3D-printing modeling is helpful for a good reduction and minimally invasive fixation with hollow screws for unstable pelvic fractures by reducing operation time and intraoperative fluoroscopy.
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Objective To evaluate the clinical outcome in the treatment of humerus shaft comminuted fractures using limited open reduction and internal fixation combined with an external fixator.Methods Data of 80 patients with comminuted humerus shaft fractures treated from January 2005 to January 2013 were analysed retrospectively.All the patients underwent limited open reduction and internal fixation combined with an external fixator (treatment group) and open reduction and plate fixation (control group) according to the random number table.In the treatment group,there were 40 patients (28 males,12 females),at mean age of 33.5 years (range,21-54 years),with causes of injury including traffic accidents in five patients,falls in nine,crashes in seven and others in six.There were seven patients with open fractures and 33 with closed fractures.In the control group,there were 40 patients (25 males,15 females),at mean age of 32.9 years (range,19-55 years),with causes of injury including traffic accidents in 16 patients,tumbling in seven,crush in seven and others in ten.There were eight patients with open fractures and 32 with closed fractures.The operation time,intraoperative blood loss,bone union time and complications in both groups were recorded.Clinical efficacy was evaluated using the Stewart and Hundley standard.Results Mean follow-up was 19 months (range,15-24 months).Treatment and control groups showed significant differences in operation time [(55.5 ± 10.3) minutes vs.(120.5 ± 15.3) minutes],intraoperative blood loss [(120.4 ± 20.7) ml vs.(245.4 ± 26.7) ml] and bone union time [(11.6 ± 1.3) weeks vs.(14.9 ± 2.3) weeks] (P ＜ 0.05).Rate of incision infection was 8％ (3/40) in treatment group and 10％ (4/40) in control group (P ＞ 0.05).In treatment group the results were excellent in 31 patients and good in nine.In control group the results were excellent in 27 patients,good in nine,fair in one and poor in three.One patient with radial nerve injury after a second surgery for implant removal and two patients with osteomyelitis or bone nonunion were noted in control group.Conclusion Limited open reduction and internal fixation in combination with an external fixator is associated with small trauma,easy operation,short operation time,few bleeding,rigid fixation,early functional exercises and reduced bone nonunion for treatment of comminuted humerus shaft fractures,which exhibits great clinical value.
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Objective To compare the biomechanical properties of non-locking compression plate (DCP) and locking compression plate (LCP) in the internal fixation of humeral shaft fracture by means of finite element analysis.Methods Three-dimensional finite element models were constructed to simulate DCP and LCP internal fixation of humeral transverse fracture.The DCP and LCP groups were compared in terms of peak stress on the humeral fracture fragments (MPa),peak stress on the screws (MPa),and overall displacement peak value (mm) under 4 basic loads (bending,shear,torsion and compression).The biomechanical stability was analyzed after fracture fixation.Results The stress tended to concentrate at the connection sites of plate and screws and distributed evenly on DCP.The stress distributed in a gradient manner at the multiple screw holes and tended to concentrated on the central screws on LCP.Under the bending,shear and torsion loadings,the peak stresses on the fracture fragments and screws in the DCP fixation were larger than in the LCP fixation.However,under the compression loading,the peak stresses on the fracture fragments and screws in the DCP fixation were smaller than in the LCP fixation.DCP and LCP had similar trends in displacement.Under the bending,shear and torsion loadings,the overall displacement peak values in LCP fixation were smaller.However,under the compression loading,the overall displacement peak values in DCP fixation were smaller.Conclusions DCP and LCP have similar biomechanical properties to resist bending,shear,torsion and compression.Due to the gradient distribution of stress among the screw holes,LCP is more suitable for patients with comminuted fracture or osteoporosis.Stress distribution is more even in DCP.Surgeons should consider the advantages of both DCP and LCP to achieve better stability.
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Objective To explore the treatment and clinical outcomes of unstable combined fractures of pelvis and acetabulum.Methods From January 2013 through December 2014,21 unstable pelvic fractures associated with acetabular fractures received surgical treatment at our department.They were 18 men and 3 women,aged from 21 to 55 years (average,43.2 years).By the Tile classification for pelvic fractures,12 cases were type B and 9 type C.By the Letourel-Judet classification for acetabular fractures,11 cases were transverse fractures,5 both-column fractures,3 posterior column + posterior wall fractures,and 2 anterior column fractures.The intervals between injury and surgery averaged 6.5 days (from 4 to 15 days).Results The 21 cases were followed up for 6 to 18 months (average,9 months).According to the Matta's criteria for pelvic reduction,5 cases were excellent,12 good,and 4 fair,giving an excellent to good rate of 81.0％.According to the Matta's criteria for acetabular reduction,5 cases were excellent,11 good,and 5 poor,giving an excellent to good rate of 76.2％.The pelvic fractures healed after 12 to 18 weeks (average,14.5 weeks);the acetabular fractures healed after 12 to 22 weeks (average,15.5 weeks).According to the Majeed's functional evaluation at the last follow-ups,10 cases were excellent,8 good and 3 fair,giving an excellent to good rate of 85.7％.According to the Merle d'Aubigné-postel evaluation,8 cases were excellent,9 good,and 4 fair,giving an excellent to good rate of 81.0％.Three patients had nerve injury which was almost completely recovered 4 to 6 months after operation.Two cases had wound infection which was controlled after debridement for twice.No other complications like ectopic ossification,avascular necrosis of the femoral head,iatrogenic vascular or nerve lesion was observed during the follow-ups.Conclusion Precise diagnosis,rational plan,careful surgery,effective reduction,rigid fixation and active rehabilitation are keys to fine outcomes in the treatment of unstable pelvic fractures associated with acetabular fractures.
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Objective To measure the normal cerebrospinal fluid of the midbrain aqueduct peak velocity of different age groups by using magnetic resonance imaging (MRI) time‐spatial labeling inversion pulse (time‐SLIP) ,and to discuss the flow law of CSF . Methods Forty‐one cases of healthy volunteers ,including 23 cases of male ,18 cases of female ,aged 7 -73 .Patients were divided into 4 groups:7- 0 .05) between age .Conclusion In the midbrain aqueduct ,CSF is two‐way flow and supports the CSF of the pulsatile flow theory ;MRI sequence of time‐SLIP could measure CSF velocity and display the turbulence fluiding .
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Objective To investigate radiological characteristics of the posterior tibial plateau fracture and operative treatments for the fracture.Methods Thirty-one cases of posterior tibial plateau fracture treated between February 2009 and February 2014 were enrolled.There were 19 men and 12 women aged 24-72 years (mean,42.5 years).Injury arose from traffic accidents (13 cases),falls from a height (9 cases),fall on the ground (5 cases),and crash (4 cases).Type Ⅴ in 15 cases and type Ⅵ in 15 cases were classified by the Schatzker classification.Meanwhile,all fractures were identified as three-column pattern.According to the X-ray and CT manifestations of fracture displacement,the cases with minor displacement were grouped as Group A (22 cases) and the cases with major displacement group as Group B (9 cases).Depending on the radiographic characteristics of fracture size and angle off fracture line,anterior approach for reduction and fixation was performed in Group A and combined anterolateral and posteromedial approaches in Group B.Radiographic and functional outcomes were evaluated using the Rasmussen score.Results All cases underwent one-stage surgery uneventfully.Operation time was 80-120 minutes (mean,98 minutes) in group A and was 110-165 minutes (mean,110 minutes) in Group B.Mean total operation time was 105 minutes.Period of follow-up was 6-48 months (mean,21.5 months).Rasmussen radiographic results showed total excellent to good rate of 84％ with 86％ in Group A and 78％ in Group B respectively.Rasmussen functional results showed total excellent to good rate of 87％ with 91％ in Group A and 78％ in Group B respectively.Conclusions Anterior approach or anterolateral approach combined with posteromedial approach for reduction and internal fixation is developed according the radiographic findings and degree of fracture displacement.Clinical outcome is good and associated intraarticular soft tissue injury can be managed concurrently.
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Objective o evaluate the characteristics and treatments of the medial-extension type of posterior malleolar fractures.Methods Data of 75 patients with posterior malleolar fractures from May 2007 to December 2010were retrospectively analyzed.13 patients whose X-ray showed Cotton fracture while CT scan showed medial-extension type of posterior malleolar fractures were involved in this study.There were 8 males and 5 females,with an average age of 40.3 years old (range,15-75 years).The mechanisms of injuries were as follow:6 patients with falling injury,4 patients from motor vehicle accidents and 3 patients from severe sprain.All the patients combined with distal fibular fracture.The preoperative clinical manifestations included foot and ankle swelling,deformity and restricted movement.The fracture line could be found on coronary X-ray.10 of those patients had double lines sign in medial malleolus.According to Haraguchi CT scan classification system,8 patients were Type Ⅰ fractures (61.6％,8/13),3 with Type Ⅱ fractures (23％,3/13),and 2 with Type Ⅲ fractures (15.4％,2/13).Posterior medial incision,cannulared screws after reduction were conducted.Wound and fracture healing were recorded postoperatively.Function was evaluated according to Baird-Jackson criterion.Results All 13 cases had been followed up for 8-45 months (mean 16 months).Post-operation X-ray showed articular surface displacement was less than 1mm; widening of the medial ankle mortise was no more than lmm; anatomy reduction was achieved or approximately achieved.All cases got union and the union period was 12-20 weeks with an average of 15.1 weeks.The incisions were primary healed in all patients.According to Baird-Jackson criterion,10 cases were excellent and 3 were good.76.9％(10/13) patients got excellent results.No instrument failure,fracture displacement,and infection were found.All patients could walk without accessory appliance.Conclusion Most of medial-extension type of posterior malleolar fractures have articular cartilage damage.It may be caused by rotational force combined with axial load.It needs open reduction and internal fixation early.The posterior medial incision has certain superiority.
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Objective To investigate the possibility,surgical methods,outcome and surgical indications of minimal invasion dynamic hip plate (MIDHP) through percutaneous limited open reduction in treatment of subtrochanteric femur fractures.Methods All cases underwent percutaneous limited open reduction with MIDHP.Duration of operation,intraoperative bleeding volume,length of incision,incidence of intra-or post-operative complications of all case were recorded.X-ray films were reviewed periodically after operation to analyze aspects of fracture displacement,loosening of intemal fixation,screw cutting femoral neck,screw penetrating out of or withdrawing from femoral head,bending or breaking of internal fixation,and fracture healing.Hip joint function was evaluated according to Huang' s criteria.Results Operation lasted for 45-55 minutes (average 50 minutes),showing the incision length of 4.0-5.0 cm (average 4.5 cm) and blood loss of 50-200 ml (average 150 ml).A total of 21 cases were enrolled in the study and were followed up for 6-28 months (average 18 months).In the follow-up,loosening or bending of internal fixation,fracture displacement,screw cut-out,and screw penetrating or withdrawing from femoral head did not occur.In the meantime,incision,bone,and joint were not infected.All cases had bony fusion within 3 months with the fracture healing rate of 100％.According to Huang' s criteria,hip function was excellent in 19 cases and good in two.Conclusions MIDHP with percutaneous limited open reduction is characterized by less trauma,small incision,less blood loss,less postoperative complications,firm fixation,early functional exercise,free load,and good hip functional recovery and hence is suitable for cases of different subtrochanteric femur fractures,especially for cases combined with osteoporosis.
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Objective To investigate the methods of X-ray diagnosis of various displacement of unstable pelvic fracture in three-dimensional space and its instructive significance in closed reduction.Methods A normal adult pelvic specimen was selected and fixed in a wood-frame at supine position after soft tissue rejection and ligament preservation.With the breakage at the unilateral anterior-posterior ring,models of hemipelvic rotation in the transverse and sagittal planes and hemipelvic vertically upward displacement were induced.Anteroposterior radiographs of the pelvic specimen were made and picture archiving and communication system (PACS) was used to measure width of iliac wing,suprainferior diameter of hemipelvis,vertical displacement of iliac crest,acetabulum roof,pubic tubercle and sciatic tuber and area of obturator foramen.Methods of X-ray diagnosis of various displacements of hemipelvis were concluded and applied in treatment of 43 patients with unstable pelvic fractures.Operation time and intraoperative blood loss were recorded.Postoperative images were evaluated by Matta standard.Results Hemipelvic rotation in transverse plane included eversion and inversion.Width of iliac crest was enlarged and area of obturator foramen was shrunk while extroversion ; on the contrary,an opposite result was observed while inversion.Sagittal rotation included pronation and supination.Pubic tubercle had obvious downward shift,iliac crest presented no change or slight upward shift,suprainferior diameter of hemipelvis was lengthened,iliac roof and sciatic tuber remained their position unchanged and area of obturator foramen was shrunk while pronation; on the contrary,pubic tubercle had obvious upward shift,iliac crest presented no change or slight downward shift,suprainferior diameter of hemipelvis was shortened,iliac roof and sciatic tuber remained their position unchanged and area of obturator foramen was enlarged while supination; iliac crest,acetabular roof,pubic tubercle and sciatic tuber presented equidistant upward shift while the hemipelvis displaced upward vertically.Average operation time was 55 minutes (range,15-85 minutes) and intraoperative blood loss was 26 ml (range,10-50 ml).According to Matta standard,pelvic radiography evaluation at postoperative 3 days was excellent in 31 cases and good in 12 cases,with excellent and good rate of 100％.Conclusion Pelvis X-ray films are able to diagnose various three-dimensional displacement of unstable pelvic fractures and guide closed reduction timely and rapidly to achieve satisfactory result.
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Objective To perform a mechanical test of fresh cadaver specimens and compare the biomechanical properties of the novel minimal invasion dynamic hip plate (MIDHP) and the dynamic condylar screw (DCS) in treatment of subtrochanteric fractures of the femur.Methods All specimens were firstly used to simulate models of Seinsheimer type ⅡA subtrochanteric fractures of the femur,which were later divided into DCS group and MIDHP group.Based on experimental requirements,the femoral head and distal femur were embedded using seff-freezing type dental base acrylic resin powder.Torsion strength test was given in the first place,succeeded by compression strength test.Finally,destructive test was made to record the limit load.All experimental data were analyzed statistically.Results Torsion strength test showed that specimens of both groups were basically stable as the reverse was within 3°.Torque for specimens in DCS and MIDHP groups was (3.16 ± 0.13) N · m and (3.31 ± 0.27) N · m respectively as the reverse was 1.5°.Both torque and torsion stiffness had no statistical significance between the two groups,and the anti-rotation features of the two internal fixations were similar.Compression strength test showed that compression stiffness of specimens in DCS group was (532.27 ±61.02) N/mm and (581.98 ±77.56) N/mm in MIDHP group at a load of 800 N,with evidently higher compression displacement and stiffness in MIDHP group (P ＜ 0.05).Destructive test showed the maximum load of specimens in DCS and MIDHP groups was (2 994.38 ±244.81) N and (3 322.13 ± 141.21) N respectively,far higher in MIDHP group (P ＜ 0.01).Conclusions MIDHP is characterized by reasonable design,strong anti-rotation property and anti-compression property over DCS.In comparison with DCS,MIDHP has biomechanical advantage in treatment of femoral subtrochanteric fractures,for it can be performed minimally invasive and is worthy of further application.
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ObjectiveTo identify the curative effect of minimally invasive plate osteosynthesis (MIPO) and humeral head replacement in treatment of elderly patients with Neer four-part fractures.MethodsUsing the deltoid pectoral approach,28 patients with fresh Neer four-part fractures were treated by the locking plate combined with MIPO (Group A) and 27 by the humeral head replacement (Group B).Neer score,Constant-Murley score and simple shoulder test (SST) questionnaire were adopted for assessing the treatment outcome.ResultsGroup A was followed up for mean 32.1 months,which showed screws protruding into the joint space in two patients,tuberosity upward and backward displacement in one and femoral head ischemic necrosis in one.The mean visual analog scale (VAS) score,the mean Neer score and the mean Constant-Murley score were 2.2 points,88.6 points and 86.5 points respectively.There were average 9.0 answers for “yes” in the SST questionnaire.Group B were followed up for mean 34.6 months,which showed shoulder dislocation or subluxation in four patients,tuberosity displacement or excessive reduction in eight.The mean VAS score,the mean Neer score and the mean Constant-Murley score were 2.4 points,78.9 points and 77.3 points respectively.The mean number of answer for “yes” in SST questionnaire was 8.0 questions.There showed no statistical difference in VAS score between the two groups.While statistical difference was found in complications,Neer score,Constant-Murley score and SST score between two groups,with Group A superior to Group B.Conclusions For most elderly patients with Neer four-part fractures,MIPO has satisfactory results under strict control of surgical indications and technical tips.The humeral head replacement surgery still has many unresolved problems and needs careful consideration.