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Objective To evaluate the computer-aided design of digital plating for acetabular fracture of posterior wall associated with hip dislocation.Methods A retrospective study was conducted to analyze the 32 patients who had been admitted for acetabular fracture of posterior wall associated with hip dislocation between June 2012 and August 2016.They were 22 men and 10 women with a mean age of 42.1 years (from 21 to 57 years).They were divided according to the treatment methods into 2 groups:an observational group (n =15) subjected to digital plating and a control group (n =17) subjected to conventional plating.All the patients were treated through the Kocher-Langenbeck approach.For the patients in the observational group,patient-specific digital steel plates were manufactured after simulation of fracture reduction,design of individualized steel plate and simulation of steel plating in the computer software before operation.The 2 groups were compared in terms of operation time,intraoperative bleeding,intraoperative fluoroscopy,hospital stay,fracture reduction and hip joint function at the last follow-up and postoperative complications as well.Results For the observational group,the operation time (73.3 ± 15.2 min) was significantly shorter than that for the control group (93.2 ± 14.7 min),the intraoperative bleeding (254.3 ±63.lmL) and the intraoperative fluoroscopy (2.4 ± 0.7 times) were significantly less than those for the control group (334.6 ±70.3 mL;3.2 ±0.8 times) (P ＜ 0.05).There were no significant difference between the 2 groups in the good to excellent rate of reduction [93.3％ (14/15) versus 88.2％ (15/17)] (P ＞ 0.05).All the patients were followed up for an average of 28.1 months (from 8 to 48 months).There was no significant difference either between the 2 groups in the modified Merle d'Aubigné-Postel scores at the last follow-up (16.4 ± 1.8 versus 15.8 ± 1.6) (P ＞ 0.05).There was a significant difference between the observational and control groups in the incidence of heterotopic ossification [6.7％ (1/1) versus 17.6％ (3/17)] (P ＜0.05).Conclusions In the treatment ofacetabular fracture of posterior wall associated with hip dislocation,computer-aided design of digital plating may have advantages of shorter operation time,less intraoperative blood loss,less intraoperative fluoroscopy and lower incidence of heterotopic ossification.
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Objective To analyze the factors that influence joint function after plate fixation of unstable pelvic fractures.Methods A retrospective study was conducted to analyze the 109 patients with unstable pelvic fracture who had been treated with plate fixation from January 2007 to September 2014.They were 69 men and 40 women,23 to 72 years of age (average,46.3 years).By the Tile classification,15 cases were type B1,37 type B2,14 type B3,19 type C1,16 type C2,and 8 type C3.Their postoperative joint function was evaluated according to the Majeed criteria for functional evaluation.There were 86 cases in the good-to-excellent group (78.9％) and 23 in the fair-to-poor group (21.1％).Their data were analyzed in terms of gender,age,preoperative injury severity scale (ISS),body mass index (BMI),operation time,fracture type,reduction quality,postoperative complications,bone density,and postoperative weight bearing time.The influential factors were determined using Logistic regression analysis.Results All the 109 patients obtained a mean follow-up of 18.7 months (from 12 to 53 months).Preoperative ISS (P =0.000),fracture type (P =0.008),reduction quality (P =0.009) and postoperative complications (P =0.000) were identified as the factors influencing joint function after plate fixation of unstable pelvic fractures.Conclusion Preoperative assessment by ISS,a clear understanding of the pelvic fracture type,anatomical reduction of the fracture and efforts to reduce postoperative complications can effectively improve functional recovery of the joint after plate fixation of unstable pelvic fractures.
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Objective To evaluate the effect of proximal femoral nail antirotation (PFNA) with autogenous bone grafting for salvage of failed internal fixation of intertrochanteric hip fracture.Methods Between January 2007 and June 2012,21 cases of intertrochanteric fractures who had failed internal fixation initially were treated with revision open reduction and PFNA internal fixation and autogenous bone grafting.There were 9 men and 12 women with the mean age of 54 years (range,27-76 years).In the initially failed internal fixation,dynamic hip screw (DHS) was used in 7 cases,locking proximal femoral plate (LPFP) in 8 cases,Gamma nail in 2 cases,proximal femoral nail (PFN) in 2 cases and home-made reconstruction nail in 2 cases.Results Mean operation time was 150 minutes (range,100-240 minutes) and mean blood loss was 800 ml (range,400-2,000 ml).There were no serious complications during operation.Mean follow-up was 26 months (range,6-66 months).Bone healing was achieved at mean 4 months (range,3-8 months) in all cases.Harris hip score was (42.1 ±3.2) points (range,36-48 points) before operation and (87.2 ± 3.8) points (range,62-94 points) at the final follow-up,with significant improvement in hip function (P ＜ 0.05).At the final follow-up,no avascular necrosis of the femoral head or hip degeneration occurred and mean neck-shaft angle was 130° (range,110°-142°).Conclusions Once the fracture patients with strong ability of action,massive proximal femoral residuals,and non-serious hip injury,revision PFNA internal fixation with autogenous bone grafting is effective.Complete preoperative evaluation and attention to specific technical details may improve success rate and reduce complications.
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OBJECTIVE@#To evaluate the value of multi-slice CT angiography (MSCTA) in the diagnosis of super mesenteric artery (SMA) and super mesenteric vein (SMV), and discuss the 3D reconstruction method for detecting mesenteric vessel lesions.@*METHODS@#Thirty-three patients suffering from mesenteric vessel diseases were analyzed. There were 14 SMA lesions, including 9 thromboses, 3 dissecting aneurysms, 1 pseudoaneurysm, and 1 malrotation. There were 19 SMV thromboses. The 3D reconstruction included volume rendering (VR), maximum intensity projection (MIP), and multi-planner reformation (MPR).@*RESULTS@#The lesions appeared clear by MSCTA in the 33 patients. The SMA thrombosis was shown clear in the MIP in all 9 patients, and only 4 of them were detected in the VR. There was significant difference between MIP andVR in detecting SMA thrombosis (P=0.0294). Three dissecting aneurysms were best shown in the MPR; 1 pseudoaneurysm and 1 malrotation were clearly manifested in the VR. The thrombosis of SMV was clearly shown by both MIP and MPR in all 19 patients. Collateral vessels were clearly shown in the MIP in 12 patients; the collateral vessels were detected by VR only in 5, and the other 7 failed to show the collateral vessels. There was significant difference between the MIP and the VR in showing lateral collateral vessels (P=0.0046).@*CONCLUSION@#Both lesions of SMA and SMV can be detected by MSCTA. MIP is an ideal reconstruction method for SMA thrombosis and collateral vessels around the SMV.