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Objective To analyze the effectiveness and safety of percutaneous screw fixation assisted by an orthopedic robot for treatment of pelvic and acetabular fractures.Methods Fifteen patients with fresh closed pelvic or acetabular fracture were hospitalized from September to December 2017 at Department of Orthopaedics,Foshan Hospital of Traditional Chinese Medicine.They were 10 men and 5 women,from 22 to 69 years of age (average,65.2 years).There were 9 pelvic fractures (5 cases of Tile type B and 4 ones of Tile type C) and 6 acetabular fractures (3 anterior column fractures,2 posterior column fractures and one transverse fracture).All patients underwent percutaneous transpedicular screw fixation with the assistance of an orthopaedic robot.Fluoroscopic frequency,number of guide needle adjustment and deviation between initial planning and the final screw position were recorded intraoperatively.Postoperative CT was performed to evaluate screw positions and incidence of adverse events.Functional recovery in the patients was evaluated in regular follow-ups.Results A total of 26 screws were implanted in the operation.The fluoroscopic frequency ranged from 12 to 49 times,with a mean value of 17.3 times per screw;the number of needle adjustment ranged from 0 to 2 times(mean,0.3 times);the deviation of the actual path from its initial planning ranged from 0.82 to 1.42 mm (mean,1.06 mm).No surgery-related neurovascular injury occurred in any patient.Postoperative CT examination revealed that no screws cut out of cortical bone,yielding a 100％ rate of excellent and good screw positions.Two patients were lost to the follow-up,and the remaining 13 patients were followed up for 12 to 14 months (mean,12.6 months).Their Majeed functional scores at the final follow-up averaged 88.6 points (from 68 to 96 points).No neurological symptoms were observed during follow-up.Conclusion Since percutaneous screw fixation assisted by an orthopaedic robot is accurate and safe and needs less fluoroscopic frequency,it will became a major minimally invasive surgical technique for pelvic and acetabular fractures.
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Objective To explore the impact of blood-activatingand qi-nourishing therapy on the hypercoagulable state of rats after femur fracture.Methods One hundred and twenty SD rats were randomly divided into 4 groups,namely normal group,model group,low-molecular-weight heparin(LMWH) group,combination group (LMWH + Tongmai Decoction),30 rats in each group.The rat model of femur fracture was established.After successful modeling,LMWH group was given subcutaneous injection of LMWH 600 U/kg,and the combination group was given subcutaneous injection of LMWH 600 U/kg together with gastric gavage of Tongmai Decoction,the model group was given subcutaneous injection of the same volume of normal saline.The treatment lasted for 1-7 days after the surgery.The pathologic features of the left great saphenous vein were observed by HE staining method,and the relative volume,thickness and quantity of the blood vessels were also measured.The plasma D-dimer (D-D) and fibrinogen (FIB) levels were determined by biochemical analyzer,and the plasma levels of whole blood viscosity at low shear rate (WBV-lsr) and whole blood viscosity at high shear rate (WBV-hsr) were measured with hemodynamic detector.Results On day 7 after the modeling,less endothelium cells,agglomerative red cells,and large thrombi were found in the great saphenous vein tissue section of the model group under microscope.Compared with the normal group,the levels of D-D,FIB,WBV-lsr and WBV-hsr in the model group at various time points were increased,the difference being significant (P ＜ 0.05).After 7-day treatment,the levels of D-D,FIB,WBV-lsr and WBV-hsr in LMWH group and combination group were lower than those of the odel group,and the decrease in the combination group was superior to LMWH group(P ＜ 0.05).The blood vessel endothelium cells in the combination group were arranged neatly with same cellular width while without enlargement or swelling,the effect being superior to that of LMWH group.Conclusion Blood-activating and Qi-nourishing therapy can effectively relieve hypercoagulable state of rats after femur fracture.
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Objective To retrospectively analyze the importance of preoperative ultrasound and D-dimer determination for patients with traumatic fractures so as to evaluate the value of vascular color Doppler ultrasound in diagnosing of vein thrombosis and the correlation between D-dimer level and lower extremity vein thrombosis. Methods The study involved 1000 in-patients with multiple traumatic fractures, femoral fractures, tibial fractures or tibiofibular fractures admitted from March 2008 to April 2009 who were prepared for open reduction surgery. There were 568 males and 432 females, at age range of 20-90 years ( average 54.8 years). Vein D-dimer was examined in the morning on the second day after admission. Vascular color Doppler ultrasound was performed on the lower extremity one day before operation (after the swelling faded away, about 4-10 days after fracture). Results The vascular color Doppler ultrasound on the lower extremity showed vein thrombosis of the lower extremity in 64 patients (6.4%) including 26 patients with iliac- femoral vein thrombosis, 10 with popliteal-tibial vein thrombosis and 28 with gastrocnemius or soleus muscle vein thrombosis. On the second day after operation, out of 736 patients (73.6%) with D-dimer above normal (324 μg/L), 56 patients (7.6%) developed thrombosis afterwards;of 264 patients (26.4%) with normal D-dimer, eight patients (3.03%) developed thrombsis. Incidence of thrombosis in patients with D-dimer above 650 μg/L was higher than that in patients with D-dimer below 650 μg/L (P＜0. 01). Conclusions Preoperative lower extremity vein Doppler ultrasound in traumatic fracture patients can lower the risk of fatal lung thrombosis caused by existing deep vein thrombosis.D-dimer above normal level indicates tendency of thorombosis. However, normal D-dimer still have the possibility to develop thrombosis, which deserves attention.
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[Objective]To investigate the clinical effect of treatment of complex Pilon's fractures with limited internal fixations and external fixators.[Method]Since 2000,78 cases of complex Pilon's fractures with limited internal fixations and external fixators were treated,of which male 51cases,female 27cases,aged 20～79 years old,average 36 yrs.According to Ovadia and Beals classification,type Ⅲ 27 cases,type Ⅳ 35 cases,type Ⅴ 16 cases,fresh fracture 53cases,old fracture 25 cases,close fracture 57 cases,open fracture 21 cases.They were all treated by Kirsschner wires and screws together with external fixators.External fixator were removed at 1.5～2 months after operation and splints were used and began ankle movement.[Result]All cases were followed up after operation.The following observation time was 1～3 years,average 20 months.All fractures were ostcal concrescence.Two cases were evaginate about 5 degree.Three cases were open injury and needed flap grafting rehabilitation because skin and soft tissue were compressed severely and necrotized.Traumatic artharitis occurred in 4 cases,nitric oxide-releasing anti-inflammatory drug was needed.One case was treated with arthrodesis.The functional evaluation was completed according to standard of American Orthopedic Association of Foot and Ankle.The excellent rate was 87.2%.[Conclusion]Limited internal fixation and external fixator is one of the effective way of treatment of Pilon's fracture because it can immobilize the sections of fracture and avoid infection of soft tissue and nonunion of fracture.