Case control study on open reduction internal fixation (ORIF) and minimally invasive percutaneous plate osteosynthesis (MIPPO) for the treatment of proximal humerus fractures in aged / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effects of close reduction and minimally invasive percutaneous plate osteosynthesis in treating proximal humerus fractures in the aged.</p><p><b>METHODS</b>From February 2012 to December 2013,39 patients with proximal humerus fractures were treated with minimally invasive percutaneous plate osteosynthesis (MIPPO group, 21 cases) and open reduction internal fixation (ORIF group, 18 cases). Including 17 males and 22 females in the study, and aged from 67 to 88 years old with an average of (71.8 ± 5.2) years old. In MIPPO group, there were 11 males and 10 females with an average age of (70.0 ± 5.3) years old;and in ORIF group, there were 10 males and 8 females with an average age of (72.0 ± 4.2) years old. Operation time, blood loss during operation, fracture healing time and postoperative complications were recorded. The functions of the shoulder joints were assessed according to Constant-Murley score at final follow-up.</p><p><b>RESULTS</b>All the patients were followed up from 11 to 27 months with an average of 18.1 months. The mean blood loss of the MIPPO group was (176.0 ± 57.4) ml,while the ORIF group was (356.0 ± 66.9) ml (t = 7.22,P = 0.01). The operation time of the MIPPO group was (47.4 ± 14.9) min, while the ORIF group was (92.7 ± 15.8) min (t = 0.79, P = 0.03). Fracture healing time in the MIPPO group and ORIF group was (17.6 ± 5.8), ( 21.7 ± 4.9) weeks, respectively (P < 0.05). The mean Constant-Murley score at final follow-up was 89.7 ± 14.5 in MIPPO group, and 81.8 ± 13.2 in ORIF group (P < 0.05).</p><p><b>CONCLUSION</b>MIPPO has advantages of little trauma, less blood loss, rapid recovery, less vascular damage and so on and can effectively treat the proximal humerus fracture in the aged.</p>

Myogenic elephant skin cream combined with Vacuum sealing drainage (VSD) for the treatment of bedsores / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the efficacy of the myogenic elephant skin cream combining with VSD for treating severe bedsores.</p><p><b>METHODS</b>Twenty-nine cases of III and IV degree bedsores were treated from June 2009 to June 2013. Among them, 15 cases were treated by myogenic elephant skin cream combined with VSD (VSD group) including 7 males and 8 females with an average age of (69.0±5.3) years old ranging from 17 to 96 years;other 14 cases were treated by the treatment of conventional dressing change (control group) including 6 males and 8 females with an average age of (71.0±4.2) years old ranging from 40 to 86 years. At 7, 14, 21, 28 d after treatments, specimens of wound two groups were respectively taken to examine immunohistochemical CD34 adopted SABC, the number of wild vascular cross were observed as capillary density value under high magnification microscope. It was used to assess the hyperplasia of granulation tissue of wound. The capillary density value and the visual wound observation were indicators for evaluation of clinical efficacy.</p><p><b>RESULTS</b>Seventeen of 19 cases got complete data of specimens of wound at 7, 14, 21, 28 d,included 9 cases of VSD group,8 of control group. In the microscope view, the capillary density of VSD group was higher than that of control group significantly (P<0.05), it showed the application of VSD technology improved hyperplasia of granulation tissue much faster than conventional dressing change. In VSD group, 13 cases with 15 wounds healed, 2 cases with 3 wounds improved; in control group,3 cases with 3 wounds healed,7 cases with 9 wounds improved, 4 cases with 5 wounds were unhealed.</p><p><b>CONCLUSION</b>Using the VSD technology with continuous high pressure suction to clean the drainage of wound and lacuna thoroughly can effectively control infection,promote the growth of granulation tissue, and then applying myogenic elephant skin cream to improve partial blood supply while prompting rapid growth of new granulation tissue and epithelial cell. The risk of this treatment is low,and the course of treatment is short, this provides a safe and effective method for treating bedsores.</p>

Biomechanical test and clinical application of EZ extraction screws device / 医用生物力学

Objective To evaluate the effect of EZ extraction screws device on screwing out the reduced screws，broken screws, skidded screws in biomechanical test and clinical application. Method 4 femurs, tibias, radius, ulnas of 4 fresh skeleton specimen were divided into two big groups randomly as Group A and Group B1, B2 and B3: In Group A the screws were taken out by screwdriver; In Group B, the screws were clamped in medulla cavity filled with the bone cement,;B1 was the group of measuring skidded screws with the biggest torsion; B2 was the group of measuring skidded screws with the biggest torsion by one handle; B3 was by two handles. Four mechanics test models were made, and the clamping screws were divided into two types of 4.5 mm and 3.5 mm each for 60. The experiment specimen were tested on the universal testing machines with exerting 2 kN axial loading, and surveyed the greatest torque, the torsion angle and the power loss as well as the efficiency when drawing out. The empirical datum after statistics processing were compared among the groups. And EZ was also used for 12 example patients in the preliminary clinical practice. ResultsGroup A showed the biggest torque as 1.42～1.96 N·m for drawing out; Group B1 as 2.87～3.27 N·m; Group B2 as 3.06～4.83 N·m; Group B3 as 4.12～8.36 N·m. The significant difference （P<0.05）was found in each group. The average value of torsion angle in each corresponding group is 1.59°,0.77°,0.28° and 0.16°, respectively with the obvious difference （P<0.05）; The average value of power loss in each group is 12, 21, 32 and 45J respectively; and the power (mechanical efficiency) in each corresponding group is 0.20, 0.35, 0.53 and 0.75 T/s, respectively, which also showed the obvious difference （P<0.05）. EZ used in 12 cases were successfully screwed out with all the broken screws and maintained the integrity of the bone without any postoperative complications. Conclusions EZ extraction screw device has sufficient torsional strength and stiffness with enough clamping force, and could pull out stably and reliably, which is an ideal tool for the stub screws, crooked screws and slipped screws in skeleton.