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ABSTRACT Introduction: The modulation of post-training fatigue in colleges and universities is an important part of today's physical education. The adjustment of sports fatigue is a fundamental aspect of modern college physical education, and its control is of great importance for the elevation in the sport level of athletes. Objective: Explore the effects of nutritional intervention on post-training fatigue in college athletes. Methods: 40 athletes were randomly selected as volunteers for the research, divided into control and experimental group, and practiced the same type of exercise and same intensity. The athletes in the experimental group took food in strict accordance with the food mixture described in the article, while the control group kept their regular diet unchanged. After the experiment, sports training was performed, followed by muscle creatine enzyme measurement and laboratory analysis of blood urea. These data were compared and analyzed with those before the experiment. Results: After adjusting the dietary structure, the CK and Bu indices of the athletes in the experimental group showed a downward trend, indicating that adjusting the nutritional structure can effectively improve the post-training fatigue of college athletes. Conclusion: It is recommended that physical education teachers and college coaches adjust the lifestyle and dietary structure according to the actual situation of the students, aiming to promote integral development and improved sports performance. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.
RESUMO Introdução: A modulação da fadiga pós-treino nas faculdades e universidades é uma parte importante da atual educação física universitária. O ajuste da fadiga esportiva é um aspecto fundamental da educação física universitária moderna e seu controle é de grande importância para a elevação no nível esportivo dos atletas. Objetivo: Explorar os efeitos da intervenção nutricional sobre a fadiga pós-treino dos atletas universitários. Métodos: Foram selecionados 40 atletas aleatoriamente como voluntários para a pesquisa, divididos em grupo controle e experimental, praticaram o mesmo tipo de exercício físico e com a mesma intensidade. Os atletas do grupo experimental tomaram alimentos em estrita conformidade com a mistura alimentar descrita no artigo, enquanto o grupo de controle manteve sua alimentação regular inalterada. Após o experimento, foi realizado um treinamento esportivo, seguido de aferição da enzima creatina muscular e análise laboratorial de ureia no sangue. Esses dados foram comparados e analisados com os anteriores ao experimento. Resultados: Após o ajuste da estrutura dietética, os índices de CK e Bu dos atletas do grupo experimental mostraram uma tendência descendente, indicando que o ajuste da estrutura nutricional pode efetivamente melhorar a fadiga pós-treino dos atletas universitários. Conclusão: Recomenda-se aos professores de educação física e treinadores universitários ajustarem os hábitos de vida e estrutura alimentar de acordo com a situação real dos alunos, visando a promoção do desenvolvimento integral e melhora no desempenho esportivo. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.
Resumen Introducción: La modulación de la fatiga post-entrenamiento en colegios y universidades es una parte importante de la educación física universitaria actual. El ajuste de la fatiga deportiva es un aspecto fundamental de la educación física universitaria moderna y su control es de gran importancia para la elevación del nivel deportivo de los atletas. Objetivo: Explorar los efectos de la intervención nutricional sobre la fatiga post-entrenamiento en atletas universitarios. Métodos: 40 atletas fueron seleccionados al azar como voluntarios para la investigación, divididos en grupo control y experimental, practicaron el mismo tipo de ejercicio físico y con la misma intensidad. Los atletas del grupo experimental tomaron alimentos siguiendo estrictamente la mezcla de alimentos descrita en el artículo, mientras que el grupo de control mantuvo su dieta habitual sin cambios. Tras el experimento, se llevó a cabo una sesión de entrenamiento deportivo, seguida de la medición de la enzima creatina muscular y el análisis de laboratorio de la urea en sangre. Estos datos se compararon y analizaron con los anteriores al experimento. Resultados: Tras ajustar la estructura dietética, los índices de CK y Bu de los atletas del grupo experimental mostraron una tendencia descendente, lo que indica que el ajuste de la estructura nutricional puede mejorar eficazmente la fatiga post-entrenamiento de los atletas universitarios. Conclusión: Se recomienda que los profesores de educación física y los entrenadores universitarios ajusten el estilo de vida y la estructura nutricional de acuerdo con la situación real de los estudiantes, con el objetivo de promover el desarrollo integral y la mejora del rendimiento deportivo. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.
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Objective:To investigate the clinical efficacy of robot-assisted sacroiliac screw implantation in the treatment of proximal dysplasia sacral fractures.Methods:A retrospective analysis was conducted on 191 patients admitted to the Pelvic Department of Tianjin Hospital from May 2016 to January 2021 who underwent robot assisted sacroiliac screw implantation with sacral fractures, including 105 males and 86 females, aged 38.5±6.5 years (ranging from 19 to 69 years old). Among them, there were 85 patients with dysplasia of proximal sacrum. According to the classification of proximal sacral dysplasia, the patients were divided into five groups: the steep sacral alar slope group ( n=60), the mastoid protrusion group ( n=30), the lumbar sacralization group ( n=25), the sacral foramen oval degeneration group ( n=23) and the S 1 anterior cortical depression group ( n=10). The remaining 106 patients were normal group. Iliac cortical density (ICD) line typing was recorded in the 85 patients. The the completion of sacroiliac screw implantation, the Gras score of screw position after operation, the postoperative complications, the minimum diameter of S 1 screw channel (R1), the angle ∠A between the S 1 sacroiliac screw in the coronal plane and the cephalic side, and the angle ∠B between the S 1 sacroiliac screw in the water plane and the ventral side were recorded and compared with those of normal development patients. Results:The incidence of steep sacral alar slope was the highest (31.4%, 60/191). There were 2 or more developmental abnormalities in 24 cases. In 85 cases with dysplasia of proximal sacrum, ICD line type I was found in 8 cases, type II in 12 cases and type III in 65 cases. 49 patients (58.8%, 49/85) were able to complete the implantation of S 1 sacroiliac screw, while 36 patients (35.3%, 36/85) were only able to complete the implantation of S 2 sacroiliac screw. The Gras score of postoperative screw position was 90.05% for grade I, 9.94% for grade II, and 0 for grade III. In 1 case the sacroiliac screw pierced through the anterior cortex of the sacrum, and in 1 case the screw partially threaded into the sacral foramen, and there were no symptoms of iatrogenic nerve injury. The R1 values of the preoperative steep sacral alar slope group, the mastoid protrusion group, the sacral foramen oval degeneration group, the lumbar sacralization group, the sacral foramen oval degeneration group and normal development patient group were 11.4±3.0, 11.6±3.2, 9.8±3.0, 8.8±4.2, 6.5±4.4, and 11.4±3.4 mm, respectively. The differences between the lumbar sacralization group, the sacral foramen oval degeneration group, and the S1 anterior cortical depression group with the normal development patients were statistically significant, respectively ( t=-3.05, P=0.005; t=-2.32, P=0.022; t=-3.45, P=0.006). The postoperative angle ∠A of the above six groups were 33.8°±4.2°, 20.8°±3.5°, 25.8°±2.5°, 35.5°±4.5, 27.8°±3.5° and 26.8°±5.0°, respectively. The postoperative angle ∠B of the above six groups were 27.8°±3.5°, 36.2°±3°, 26.3°±1.8°, 29.8°±2.7°, 14.8°±1.5° and 37.2±4.2°, respectively. The differences between the ∠A of the steep sacral alar slope group, the mastoid protrusion group, and tthe lumbar sacralization group with that of the normal development patients were statistically significant, respectively ( t=9.17, -7.48, 7.97, P<0.001). The differences between the ∠B of the steep sacral alar slope group, the lumbar sacralization group, the sacral foramen oval degeneration group, and the S 1 anterior cortical depression group with that of the normal development patients were statistically significant, respectively ( t=-14.68, -10.93, -19.79, -35.8, P<0.001). Conclusion:This study proposes the "absolute stenosis" of the S 1 screw channel; In the treatment of patients with abnormal proximal sacral fracture, attention should be paid to S 1 anterior cortical depression and lumbar sacralization, and robot-assisted sacroiliac screw implantation can further improve the safety and accuracy of sacroiliac screw implantation.
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Objective:To evaluate the clinical outcome of Robot-assisted sacroiliac screw fixation in the treatment of fragility fracture of the sacrum in the elderly.Methods:From March 2016 to June 2022, a retrospective analysis was performed on 30 patients with fragility fractures of the sacrum in the elderly who accepted robot-assisted sacroiliac screw to treat fragility fractures of the sacrum in our hospital. There were 12 males and 18 females with average age 71.03±8.25 years (range, 60-89 years). According to the classification of fragility fractures of the pelvis (FFP) in the elderly, there were 22 patients with FFP II, 2 patients with FFP III, and 6 patients with FFP IV. Surgical planning was based on the average CT value of S 1 channel and whether there is a transsacral screw channel. Robot-assisted sacroiliac screw fixation was performed during surgery. The pain of pre-operation and post-operation was evaluated using the visual analogue scale (VAS), the position of sacroiliac screws was evaluated by Gras grading, and the degree of functional recovery after surgery was evaluated using the Majeed function score. Results:All 30 patients successfully completed the operation. The mean operation time was 27.00±6.68 min (range, 18-35 min), the mean fluoroscopy times were 27.13±5.16 (range, 18-34), and the mean blood loss was 30.53±6.61 ml (range, 23-38 ml). All patients were followed up, and the mean follow-up time was 19.03±7.8 months (range, 8-25 months). The VAS was 5(5, 6), 4(3, 4), 3(2, 3), 0(0, 1) points before surgery, 1 week, 2 months and 6 months after surgery, respectively, and the difference was statistically significant ( H=103.26, P<0.001). After the surgery of 2 months, 6 months and the last follow-up time, the Majeed function scores were 88(83, 90), 91(87, 92), 92(90, 93) points, respectively, and the difference was statistically significant ( H=19.59, P<0.001). Screw position was evaluated according to Gras grading at 3 days after surgery, including 28 cases of level I, 2 cases of level II, and no screw penetrated the cortical bone or entered the sacral canal or sacral foramen. No vascular or nerve injury occured during the operation. 28 patients with FFS met the fracture healing criteria, and the healing time was 4.54±1.57 months (range, 3-7 months). Two patients had bone nonunion, one of whom underwent anterior ring plate removal due to infection of the pelvic anterior wound, and one month later, pelvic CT scan revealed loosening of the sacroiliac screw; the other one is considered to be related to too early weight bearing. Conclusion:For fragility fractures of the sacrum in elderly, Robot-assisted sacroiliac screw is an effective minimally invasive treatment, with high accuracy of screw placement, effective pain reduction, improved fracture healing rate, and achieve the satisfactory clinical efficacy.
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Objective:To measure the anatomical parameters of three-dimensional available space of S 1 and S 2 vestibules on Chinese adults by imaging methods, and discuss their clinical values. Methods:Data of 200 cases of pelvic CT with complete posterior ring were collected from January 2015 to January 2021, included 110 males and 90 females. The ages ranged from 21 to 63 years (average, 40.72±10.70 years). Then the parameters of both the left vestibule and the right vestibule of S 1 and S 2 such as vestibular width, vestibular height and vestibular area were measured by the three-dimensional CT reconstructions. Statistical analyses were performed among the groups which were classified according to the gender, side of vestibule to compare the difference of vestibular morphological characteristics among different groups. Results:The average vestibular area of S 1 was 425.71± 45.07 mm 2 (range, 296.3-604.4 mm 2), which was 449.80±28.62 mm 2 (range, 338.3-604.4 mm 2) in males and 388.25±34.01 mm 2 (range, 296.3-498.4 mm 2) in females. The average vestibular width was 28.52±4.34 mm (range, 17.1-36.3 mm), 31.77±2.33 mm (range, 22.46-36.30 mm) in males and 24.55±2.55 mm (range, 17.1-26.1 mm) in females. The mean vestibular height was 21.05±2.29 mm (range, 17.5-32.0 mm), with 21.34±2.37 mm (range, 18.5-32.0 mm) of men and 20.69±1.60 mm (range, 17.5-25.6 mm) of women. The mean S 2 vestibular area was 230.19±35.57 mm 2 (range, 142.5-297.3 mm 2), which was 258.91±28.04 mm 2 (range, 218.3-297.3 mm 2) in males and 205.61±24.12 mm 2 (range, 142.5-258.6 mm 2) in females. The average vestibular width was 15.94±1.72 mm (range, 12.4-20.3 mm), 16.51±1.59 mm (range, 14.4-20.3 mm) in male and 15.25±1.63 mm (range, 12.4-18.1 mm) in female. The mean vestibular height was 14.30±1.20 mm (range, 12.9-17.8 mm), 15.49±1.46 mm (range, 13.6-17.8 mm) in males and 13.73±0.93 mm (range, 12.9-16.1 mm) in females. There were significant differences in vestibular width, height and area between S 1 and S 2 (vestibular width t=3.934, P< 0.001; vestibular height t=3.692, P< 0.001; vestibular area t=4.816, P< 0.001). There were significant differences in S 1 vestibular width, S 1 vestibular height, S 1 and S 2 vestibular area between male groups and female groups (S 1 vestibular width: t=2.969, P=0.003; S 1 vestibular height: t=0.316, P=0.049; S 1 vestibular area: t=1.975, P=0.049; S 2 vestibular area: t=2.023, P=0.044). While there was no significant difference in S 2 vestibular width and height between the two gender groups. There were significant differences in S 1 and S 2 vestibular width, height and area between male and female groups ( P < 0.001). There were no significant difference in parameters between the left and right values of the same vestibular site. Conclusion:The parameters of S 1 sacral vestibule are larger than that of S 2. It implies that S 1 was more feasible to insert iliosacral screws than S 2; lesser diameter iliosacral screws should be selected to insert into S 2. The female S 1 vestibule is smaller than the male, so the iliosacral screws placement has more stringent requirements on the selection of the insertion point and the direction of the screw. And the surgeon can utilize the intact contralateral sacral vestibule as the damaged side to proceed the iliosacral screw inserted simulation.
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Objective:To investigate the clinical efficacy of MIPO combined with non-contact bridging periprosthesis fracture plate (NCB.PP) in the treatment of re-fracture around the nail after intramedullary fixation of intertrochanteric fracture.Methods:From October 2015 to January 2020, 12 patients with re-fracture around the nail after intramedullary fixation of intertrochanteric fracture were treated in our hospital. There were 7 males and 5 females with an average age of 74.88±12.1 years (range, 65-83 years old); 8 patients on the left side and 4 patients on the right side received short nail of proximal femoral nail (PFN), 6-36 months after operation, they fell down and caused closed fracture around the nail body. According to Vancouver classification system, all the patients were Vancouver type B; preoperative bone mineral density examination showed that 1 case had normal bone mass, 10 cases had osteoporosis, and 1 case had low bone mass. All patients were treated with minimally invasive plate osteosynthesis (MIPO) technique for reduction and fixation, and fixed with proximal femur NCB.PP. The visual analogue scale (VAS) and Harris hip score at 1 day, 3 months and the last follow-up were compared.Results:The average operation time was 68.7±4.33 min (range, 65-75 min); the average intraoperative blood loss was 291.67±114.48 ml (range, 150-400 ml); the average postoperative drainage volume was 79.17±17.17 ml (range, 50-100 ml). After fracture reduction, all patients were able to obtain 2-5 bicortical screws fixation, with an average of 3.25±0.96. Among them, 3 cases were fixed with additional binding straps; 3 cases underwent autologous iliac bone grafting during the operation. All cases were followed up for 9-60 months, with an average of 16 months. At the last follow-up, 10 patients had fracture healing, the healing time was 7.75±2.83 months (range, 4-13 months), and the fracture healing rate was 83.3% (10/12). Among the other two patients, one was an 83 years old patient with severe osteoporosis, who was bedridden after operation and remained unhealed after 12 months of follow-up; a 68 years old patient had bone restoration at the broken end of the fracture 6 months after operation. The second operation was performed. Iliac combined with allogeneic bone graft was taken from the broken end. At the end of 13 months after operation, the fracture was partially healed. The VAS at one week, three months and the last follow-up were 8.00 (8.00, 9.00), 2.50 (2.00, 3.00) and 0.00 (0.00, 0.75), respectively. There were significant differences in VAS scores between 1 week after operation and 3 months after operation, 1 week after operation and the last follow-up, and 3 months after operation and the last follow-up ( Z=-3.129, -3.097, -3.134, all P < 0.05). The Harris scores at 3 months after operation and at the last follow-up were 72.50±2.91 and 86.67±5.30 respectively. After statistical analysis, the difference was statistically significant ( t=8.857, P< 0.001). At the last follow-up, except for 1 case of fracture nonunion and 1 case of reoperation, the Harris score of hip joint of the other 10 patients was excellent in 6 cases and good in 4 cases, and the excellent and good rate was 83.3% (10/12). One case of superficial wound infection was healed by intravenous drip of sensitive antibiotics. One patient had incision fat liquefaction and was given local dressing change to heal the incision. Conclusion:MIPO combined proximal femoral NCB.PP in the treatment of re-fracture around the nail after intramedullary fixation of intertrochanteric fracture has the advantage of less surgical damage, less blood loss, higher healing rate, and it can obtain satisfactory short and medium-term clinical efficacy.
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Objective:To evaluate the clinical outcomes of traumatic spinopelvic dissociation treated with robot-assisted bilateral triangular fixation.Methods:From March 2016 to March 2020, 30 patients with traumatic spinopelvic dissociation were retrospectively analyzed. According to operation and fixation methods, the patients were divided into robot-assisted minimally invasive bilateral triangular fixation group (Robot triangular group) and traditional open reduction lumbopelvic fixation group (Lumbopelvic group). There were 16 patients in the Robot triangular group, 4 males and 12 females, average age 35.7±13.3 years (range, 16-58 years). There were 10 cases of U-shaped, 4 cases of H-shaped, 2 cases of Y-shaped sacral fractures according to shape classification of sacral fractures. According to ROY-Camille classification, there were 4 cases of type I, 9 cases of type II, 3 cases of type III. There were 13 cases with sacral nerve injuries, including 10 cases of Gibbons grade II, 3 cases of grade III. There were 14 patients in the Lumbopelvic group, 4 males and 10 females, average age 37.4±15.1 years (range, 18-66 years), there were 10 cases of U-shaped, 3 cases of H-shaped, 1 case of Y-shaped sacral fractures according to shape classification of sacral fractures. According to ROY-Camille classification, there were 1 case of type I, 10 cases of type II, 3 cases of type III. There were 10 cases with sacral nerve injuries, 7 cases of Gibbons grade II, 3 cases of grade III. The patients' age, operation time, intraoperative blood loss, and Majeed score of the two groups were compared by independent sample t-test; gender, sacral fracture classification, ROY-Camille classification, fracture reduction quality, postoperative wound infection, and sacral nerve recovery were compared by Chi-square test. Results:All patients were followed up for 23.6 months (range, 12-54 months). In the Robot triangular group, the operation time was 95.3±27.5 min (range, 70-180 min), and intraoperative blood loss was 98.7±47.5 ml (range, 50-250 ml). According to Mears and Velyvis imaging evaluation criteria, anatomical reduction was achieved in 6 cases, satisfactory reduction was achieved in 9 cases and unsatisfactory reduction in 1 case. The Majeed score was 85.5±7.7 points. 8 cases of Gibbons grade II sacral nerve injury were recovered to grade I after surgery, 1 case of grade III recovered to grade I, and 1 case recovered to grade II. In the Iliolumbar fixation group, the operation time was 148.6±59.1 min (range, 90-240 min), and intraoperative blood loss was 582.1±244.6 ml (range, 300-1 200 ml). According to Mears and Velyvis imaging evaluation criteria, anatomical reduction was achieved in 7 cases, satisfactory reduction was achieved in 6 case and unsatisfactory in 1 case. The Majeed score was 77.6±7.7 points. 5 of 7 cases of Gibbons grade II sacral nerve injury were recovered to grade I after surgery, and 2 of 3 cases of grade III recovered to grade I. Compared with the Iliolumbar fixation group, the Robot triangular group has shorter operation time ( t=3.23, P<0.05), less bleeding ( t=7.76, P<0.05), and higher postoperative Majeed score ( t=2.83, P<0.05). There are statistical differences in the above indicators significance. Conclusion:For traumatic spinopelvic dissociation, especially fractures involving the lumbosacral junction, those who do not require sacral nerve decompression, Robot-assisted bilateral triangular fixation shows satisfactory clinical outcomes, which is minimally invasive, with fewer postoperative complications.
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Objective:To explore the efficacy of posterior iliac screw rod for unilateral unstable Denis I and II sacral fractures.Methods:Data of 50 patients with unilateral unstable Denis I, II sacral fractures treated from March 2016 to October 2018 were retrospectively analyzed. According to fixation methods, the patients were divided into posterior iliac screw rod group (Iliac screw rod group) and robot-assisted iliosacral screw group (Iliosacral screw group). There were 20 patients in the Iliac screw rod group, 13 males and 7 females, with an average age of 41.10±14.07 years (range, 22-76 years), and there were 5 cases of Denis type I and 15 cases of type II sacral fractures. All of them had anterior pelvic ring injuries, and according to pelvic Tile classification, there were 2 B1 type, 12 B2 type, 6 C1 type, and 3 cases of Gibbons grade II sacral nerve injuries. There were 30 patients in the Iliosacral screw group, 18 males and 12 females, with an average age of 44.70±13.35 years (range,16-78 years), and there were 6 cases of type I and 24 cases of type II sacral fractures. There were 2 cases of type B1, 20 cases of B2, 8 cases of C1 pelvic fractures, 4 cases combined with sacral nerve injuries including 3 cases of Gibbons grade II and 1 case of grade III. The patients’ age, operation time, amount of bleeding, times of fluoroscopy, postoperative Majeed score were compared by the independent t test. The quality of fracture reduction was compared by Chi-square test, and the postoperative Gibbons grade was compared by the rank sum test.Results:All patients were followed up for 22.8 months (range, 12-40 months). In the Iliac screw rod group, the operation time was 41.40±7.30 min, intraoperative blood loss 105.00±61.94 ml, intraoperative times of fluoroscopy 19.10±7.33, and according to Mears and Velyvis valuation criterion, there were 9 cases of anatomical reduction, 10 cases of satisfactory reduction, and 1 case of unsatisfactory reduction, with the Majeed score of 84.25±8.29. There were 3 cases with Gibbons grade II sacral nerve injury, and 2 of them recovered to grade I. In the Iliosacral screw group, the operation time was 18.27±5.89 min, intraoperative blood loss 33.00±17.54 ml, intraoperative times of fluoroscopy 14.93±4.49, and according to Mears and Velyvis valuation criterion, there were 15 cases of anatomical reduction, 13 cases of satisfactory reduction and 2 cases of unsatisfactory reduction, with the Majeed score of 86.43±7.43. There were 3 cases with Gibbons grade II sacral nerve injury, and 2 of them recovered to grade I, and 1 case with grade III recovered to grade II postoperation. Compared to Iliosacral screw group, the Iliac screw rod group has longer operation time ( t=-12.36, P<0.001), more blood loss ( t=-6.04, P<0.001) and more intraoperative times of fluoroscopy ( t=-2.50, P=0.016). There were no statistical differences for quality of fracture reduction ( χ2=0.23, P=0.89), Majeed score ( t=0.97, P=0.34), and the Gibbons grade ( Z=-0.224, P=0.82) between the two groups. In the Iliac screw rod group, 1 patient had a unilateral superficial wound infection and 1 patient complained of discomfort because of the nail. In the Iliosacral screw group 1 patient had iatrogenic S 1 neurological injury. Conclusion:For the unstable sacral fractures, who are not suitable for iliosacral screw fixation, posterior iliac screw rod fixation is an effective alternative with similar clinical effect as robot assisted iliosacral screw fixation.
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Objective:To compare the clinical outcomes between minimal-invasive triangular fixation with orthopedic robot and traditional open fixation method for unilateral unstable sacral fracture patients.Methods:Data of 24 consecutive patients with unilateral unstable sacral fracture who were treated from August 2014 to February 2018 were retrospectively analyzed. All patients were associated with anterior ring injuries of pelvis and received magnetic resonance of nerve (MRN) preoperatively to exclude the compression of sacral nerve by bone. All patients received surgical treatment of sacral fractures with triangular fixation and the fixation of pelvic anterior ring injuries simultaneously and two groups were divided according to the different surgical methods of sacral fractures. There were 10 males and 2 females with an average age of 36.3±1.2 years in the orthopaedic robot group. According to Dennis classification, there were 4 type I and 8 type II fractures. Two patients were associated with nerve injuries (Gibbons II 1 case, III 1 case). In traditional posterior-midline open fixation group, there were 11 males and 1 female with an average age of 38.2±1.6 years. According to Dennis classification, there were 3 type I and 9 type II fractures. Three patients were associated with nerve injuries (Gibbons II 2 cases, III 1 case). The clinical data of two group patients were collected and compared statistically. T test was used to compare the operation time, intraoperative bleeding, intraoperative fluoroscopy times, Majeed function assessment which was to evaluate the patients' clinical prognosis and healing time of fracture. χ2 test was used to compare the healing rate of fracture, accuracy assessment of fixation insertion, and Mears radiological assessment which was applied to evaluate the reduction quality of fractures. The rank sum test was used to compare Gibbons score which was applied as the index of neurological deficiency recovery. The Fisher exact test was used to compare the infection rate. Results:All patients were followed up continuously for an average time of 21.2±3.2 months. The average operation time of robot group was 100.3±14.5 minutes, meanwhile the open fixation group was 202.0±18.5 min. The average intraoperative bleeding of robot group was 180.0±17.4 ml, meanwhile the open fixation group was 850.0±15.2 ml. The average intraoperative fluoroscopy time of robot group was 23.3±4.5 s, meanwhile the open fixation group was 90.0±7.7 s. All fractures were healed and no loss of reduction or fail of fixation occurred in both groups. The healing time of fracture of robot group was 8.5±1.9 months, meanwhile the open fixation group was 12.8±2.4 months. The satisfaction rates of reduction which was based on Mears-Velyvis radiological criterion of both groups were 91.7%. The accuracy rate of fixation insertion of robot group was 100% meanwhile the open fixation group was 77.78%. Majeed function assessment score of robot group was 86.2±3.4, meanwhile the open fixation group was 84.2±2.7. There was no infection occurred in robot group, meanwhile 3 patients infected in open fixation group. The Gibbons score of one patient changed from II preoperative to I postoperative and one case changed from III preoperative to II postoperative in robot group, meanwhile two patients changed from II preoperative to I postoperative and one case changed from III preoperative to II postoperative in open fixation group. The healing rate of fracture, infection rate, Majeed function assessment, Mears-Velyvis radiological evaluation criterion and Gibbons score of two groups had no significant statistical difference ( P >0.05), meanwhile the operation time ( t=14.99), intraoperative bleeding ( t=100.46), intraoperative fluoroscopy time ( t=32.13), healing time of fracture ( t=4.87) and accuracy rate of fixation insertion ( χ2=9.00) of orthopedic robot group were better than traditional open group and had the significant difference ( P< 0.05). Conclusion:The minimal-invasive triangular fixation with orthopedic robot for unilateral unstable sacral fracture had the advantages of less operation time, less intraoperative bleeding and less times of fluoroscopy, more accurate of fixation insertion and less healing time of sacral fractures compared to traditional open fixation method and should be recommended as an effective and advanced choice.
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Objective@#To explore the treatment outcome of triangular osteosynthesis (TOS) for the treatment of unilateral Isler type II lumbosacral junction injuries (LSJIs).@*Methods@#Data of sixteen patients with unilateral Isler type II LSJIs surgically who were treated in our Hospital from March 2015 to February 2017 were retrospectively analyzed. There were 13 males and 3 females with an average age of 35.5 years (range, 24-61 years). Seven patients were multiple injuries including head, thoracic, musculoskeletal and nerve injuries. According to Isler classification of LSJIs, there were 5 cases of type IIa, 9 of type IIb and 2 of type IIc. All the LSJIs combined with ipsilateral sacral fractures. The sacral fractures were classified by Denis classification with 1 case of zone I, 13 cases of zone II and 2 cases of zone III. According to Tile classification of pelvic fractures, there were 3 cases of type B2, 11 of type C1 and 2 of type C3. There were 3 cases combined with sacral nerve injury among which there were 2 cases of grade II and 1 case of grade III according to Gibbons classification of neurologic deficits. All cases were surgically treated with triangular osteosynthesis. There were 14 cases combined with iliosacral screws fixation in S1 and 2 cases combined with posterior locking plates.@*Results@#All patients were followed up for 20.6 months (range, 16-30 months). CT scan was conducted 12 to 24 months after surgery which showed all the sacral fractures were union, and 2 cases achieved bony fusion in L5S1 facets while the other 14 didn’t. According to Majeed’s pelvic injury evaluation, clinical outcomes were rated with excellent in 12 cases, good in 2 cases, fair in 2 cases. The excellent and good rate was 87.5% (14/16) . According to Mears-Velyvis evaluation criterion, there were 14 cases with anatomical reduction and 2 cases with satisfactory reduction. Among the 3 cases with sacral nerve injury, 2 cases were improved from Gibbons grade II to grade I and the other 1 case was improved from Gibbons grade III to grade II, still feeling numbness on the lateral foot. There were no intraoperative complications in all patients such as neurovascular injuries. No incision infection, fat liquefaction and other incision related complications occurred postoperatively. Irritation and pain in iliac spine about prominent implant occurred in 1 case and lumboscaral stiffness in 1 case, in which the symptom relieved and disappeared after implants removal.@*Conclusion@#Triangular osteosynthesis can provide enough stabilization for Isler type II LSJIs and achieve satisfactory outcomes.
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Objective To investigate the clinical characteristics of upper respiratory tract infection in hospita-lized children with mental disorders,and to analyze the risk factors for nosocomial infection,so as to provide reference for clinical treatment and prevention and control of nosocomial infection(NI). Methods The NI of 1 587 hospitalized children at the Second Affiliated Hospital of xinxiang Medical University from January to December 2016 was investiga-ted and a retrospective study was conducted on 78 hospitalized children with nosocomial upper respiratory tract infec-tion. In a ratio of 1: 2,the patients with mental disorders during the same time at hospital,without the occurrence of hospital infection,with same gender and same age group,were selected as the control group,then the univariate regres-sion analysis and multivariate conditional Logistic regression analysis were carried out. Results Of the 1 587 cases,86 cases were NI,and the incidence of NI infection was 5. 42%. Among them,the upper respiratory tract infection accoun-ted for 83. 87%(78 cases). Univariate conditional Logistic regression analysis indicated that the type of disease,hospi-talization days,insight,rehabilitation activities,hand hygiene habits,self -support ability,eating habits,management mode,seasonal and environmental conditions were the risk factors for upper respiratory tract infection in hospitalized children with mental disorders(all P<0. 05). Multivariate analysis showed that the odds ratio( OR)of autumn and winter,poor self-support ability,no insight,poor hand hygiene habits,longer hospitalization days( over 14 d),severe mental illness were 19. 627( 5. 391 -23. 518 ),12. 835( 3. 436 -18. 715 ),5. 427( 1. 879 -16. 921 ),3. 752 (1. 743-16. 864),3. 618( 1. 659 -12. 671 ),3. 361( 1. 478 -10. 527 ),respectively,which were significantly associated with the occurrence of upper respiratory infection,and the differences were statistically significant( all P<0. 05). Conclusions The season,self-support ability,insight,hand hygiene habits,days hospitalization,and disease type are the independent risk factors for upper respiratory infection in hospitalized children with mental disorders,posi-tively controlling and eliminating of independent risk factors for upper respiratory tract may reduce its incidence in the inpationt children.
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Objective To explore the treatment outcome of triangular osteosynthesis (TOS) for the treatment of unilateral Isler type II lumbosacral junction injuries (LSJIs). Methods Data of sixteen patients with unilateral Isler type II LSJIs surgically who were treated in our Hospital from March 2015 to February 2017 were retrospectively analyzed. There were 13 males and 3 fe?males with an average age of 35.5 years (range, 24-61 years). Seven patients were multiple injuries including head, thoracic, mus?culoskeletal and nerve injuries. According to Isler classification of LSJIs, there were 5 cases of type IIa, 9 of type IIb and 2 of type IIc. All the LSJIs combined with ipsilateral sacral fractures. The sacral fractures were classified by Denis classification with 1 case of zone I, 13 cases of zone II and 2 cases of zone III. According to Tile classification of pelvic fractures, there were 3 cases of type B2, 11 of type C1 and 2 of type C3. There were 3 cases combined with sacral nerve injury among which there were 2 cases of grade II and 1 case of grade III according to Gibbons classification of neurologic deficits. All cases were surgically treated with triangular osteosynthesis. There were 14 cases combined with iliosacral screws fixation in S1 and 2 cases combined with posterior locking plates. Results All patients were followed up for 20.6 months (range, 16-30 months). CT scan was conducted 12 to 24 months af?ter surgery which showed all the sacral fractures were union, and 2 cases achieved bony fusion in L5S1 facets while the other 14 didn’t. According to Majeed’s pelvic injury evaluation, clinical outcomes were rated with excellent in 12 cases, good in 2 cases, fair in 2 cases. The excellent and good rate was 87.5%(14/16). According to Mears?Velyvis evaluation criterion, there were 14 cas?es with anatomical reduction and 2 cases with satisfactory reduction. Among the 3 cases with sacral nerve injury, 2 cases were im?proved from Gibbons grade II to grade I and the other 1 case was improved from Gibbons grade III to grade II, still feeling numb?ness on the lateral foot. There were no intraoperative complications in all patients such as neurovascular injuries. No incision infec?tion, fat liquefaction and other incision related complications occurred postoperatively. Irritation and pain in iliac spine about prominent implant occurred in 1 case and lumboscaral stiffness in 1 case, in which the symptom relieved and disappeared after im? plants removal. Conclusion Triangular osteosynthesis can provide enough stabilization for Isler type II LSJIs and achieve satis?factory outcomes.
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Objective To investigate the indication of approach,type of fixation and the clinical outcome of minimally invasive internal fixation for treatment of pelvic anterior ring injury.Methods From January 2012 to August 2016,data of 32 patients with 44 pelvic anterior ring injuries who had been treated with minimally invasive internal fixation were retrospectively analyzed.There were 22 males and 10 females with an average age of 38.2 years old (range,20-65 years).14 patients were injured by traffic accident,12 patients by falling and 6 patients by crush injury.There were 4 cases of pubic symphysis diastasis,27 fractures of anterior ring which included 12 billatral fractures and 1 combined vertical displacement of pubic symphysis associated with pubic fracture.According to AO classification,there were 3 cases in A2.3,3 cases in B1.2,4 cases in B2.2,4 cases in B2.3,2cases in C1.1,1 case in C1.2,5 cases in C1.3,4 cases in C2,6 cases in C3.There were 25 patients associated with other injuries,including brain injury in 2,thoracic injury in 17,abdominal injury in 8,urogenital system injury in 5,lumbosacral nerve plexus injury in 4 and the extremity or lumbar fracture in 19.The average period from injury to operation was 9.2 d (range,5-32 d).4 patients who had the pubic symphysis diastasis,3 had pelvic anterior ring fracture medial obturator foramen and 1 combined vertical displacement of pubic symphysis associated with pubic fracture were reduced by modified Pfannenstiel incision and fixed with cannulated screws,while 36 patients with fractures of lateral obturator foramen were reduced by modified Pfannenstiel incision associated with small ilial crest incision and fixed with locking reconstruction plates,and 25 patients received the fixation of pelvic posterior ring injury simultaneously.Results The average time of operation was 44.5 min (range,30-65 min),and the average amount of blood loss intraoperative was 56.2 ml (range,20-150 ml).All patients were followed up successfully,with an average time of 28.2 months (range,16-42 months).All the fractures were healed with an average time of 4.5 months (range,3-9 months).According to Matta standard of reduction assessment,30 fractures' reduction were excellent,12 were good and 2 were fair,which the rate of satisfaction was 95.5％ (42/44).Neither reduction loss or fixation failure nor infection occurred,and the occurrence rate of complication was 9.1％ (4/44),including one patient with fatal liquefaction and was cured 3 weeks after wound dressing,one patient with lateral femoral cutaneous nerve injury who was cured within 3 months by oral drug and 2 patients who complained discomfort of inguinal area because of the fixation prominence and were lessened by physical therapy.Conclusion Minimally invasive internal fixation can be recommended for treatment of pelvic anterior ring injury because of the advantages of less damage,safer manipulation,less complications and good prognosis.
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Objective To investigate the clinical results and summarize the advantages and surgical indications in the treatment of femoral head fractures (Pipkin type Ⅰ and Ⅱ) via medial hip approach.Methods From October 2014 to August 2015,sixteen patients of femoral head fracture (Pipkin type Ⅰ and Ⅱ) surgically treated via medial hip approach were retrospectively analyzed in our Hospital.There were 13 males and 3 females with an average age of 44.8 years (range,22-62 years old).According to Pipkin classification,12 femoral head fractures were classified as type Ⅰ and 4 type Ⅱ.Thirteen patients were injured by traffic accidents,two patients by falling down from height and one patient was injured by collapses of a heavy objective.All femoral head fractures were combined with posterior hip dislocation.The skeletal traction was performed in each patient after successful close reduction of the hip joint under general anesthesia.Computed Tomography scans of hip joints were performed routinely.All femoral head fractures were fixed with absorbable screws via medial hip approach.The mean time from injury to operation was 5.3 days (range,2-14 days).Results The average duration of the operations was 75 min (range,60-110 min).The average length of incisions was 7.1 cm (range,6-9 cm).The average blood loss was 160 ml (range,80-300 ml).All the patients were followed up for an average period of 26.3 months (range,24 to 30 months).Eight femoral head fractures with Pipkin Ⅰ and three with Pipkin Ⅱ were union and the healing time was 3-12 months,with an average time of 8.8 months.Three femoral head fractures with Pipkin Ⅰ were incomplete union at the latest follow-up of 24 months after surgery.One femoral head fracture with Pipkin Ⅰ and one with Pipkin Ⅱ didn't get union at the latest follow-up of 24 months after surgery.According to Thompson and Epstein function evaluation,the clinical outcomes were rated as excellent in 12 cases,good in 1,fair in 3.The excellent and good rate was 81.3％ (13/16).According to Merled'Aubigne-Postel evaluation criterion,there were 13 cases excellent,1 good and 2 fair.The excellent and good rate was 87.5％ (14/16).There were no intraoperative complications in all patients such as neurovascular injury injuries.No incision infection,fat liquefaction and other incision related complications occurred postoperatively.Avascular necrosis of the affected femoral head occurred in one case whose symptom didn't aggravate after appropriate conservation.Fractures were nonunion in 2 cases but the patients' functions were satisfactory in daily living.Traumatic arthritis of the affected hip occurred in 2 cases.The patients felt uncomfortable with long walking but could get better after taking NSAIDs.The fracture fragment absorption occurred in 3 cases but these patients had a good function and needed no further treatment.Conclusion Good exposure could be achieved for reduction and fixation in the treatment of femoral head fractures (Pipkin Ⅰ、Ⅱ) via hip medial approach.The operation is a minimally invasive procedure and the treatment outcome is satisfactory,but the indication should be strictly controlled.
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BACKGROUND:Col um Femoris Preserving prosthesis is developed by Pipino, an Italian surgeon, and LINK (Germany). Whether the femoral osteotomy plane recommended in the surgical manual is suitable for Chinese people and whether the osteotomy method can cause stress changes of the prosthesis and femur has not been yet reported. OBJECTIVE:Based on clinical reviews and three-dimensional finite element model, to analyze the clinical efficacy of total hip arthroplasty with Col um Femoris Preserving prosthesis and relevant stress distribution. METHODS:We retrospectively analyzed 36 patients undergoing total hip arthroplasty with neck-retaining femoral prosthesis and 36 patients receiving total hip arthroplasty with biotype prosthesis in terms of Harris scores, visual analog scale scores, preoperative and postoperative measurements of eccentricity changes, IDES-Engh radiological evaluation and the incidence of complications. Two different osteotomy plane finite element analysis models were created to analyze the eccentricity difference and changes in the stress distribution of prosthesis and femur when the osteotomy plane was set 1.5 cm above the intertrochanteric fossa or at the junction of femoral head and neck. RESULTS AND CONCLUSION:Neck-retaining total hip arthroplasty with the osteotomy plane set at the junction between the head and neck achieved good short-term outcomes, showing no difference from total hip arthroplasty with normal biological prosthesis. The finite element analysis showed that the eccentricity increased and the stress on the prosthesis and femur also increased when the osteotomy plane was set at the junction of femoral head and neck compared with that set 1.5 cm above the intertrochanteric fossa. But there was no difference in stress distribution between two osteotomy planes.