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Objective:To investigate the clinical efficacy of proximal femoral nail anti-rotation (PFNA) assisted by the "3-2-1" surface positioning method in the treatment of femoral subtrochanteric fractures.Methods:A total of 97 patients with subtrochanteric fractures admitted to the Second Hospital of Fuzhou from January 2015 to December 2020 were retrospectively analyzed. They were divided into two groups according to whether the "3-2-1" surface positioning method (3 longitudinal axes, 2 preset incisions, and 1 auxiliary incision) was used. There were 44 patients in the surface positioning group, including 25 males and 19 females, aged 61.59±18.43 years (range, 22-90 years). According to the Seinsheimer classification, there were 13 cases of type II, 11 cases of type III, 6 cases of type IV, and 14 cases of type V. The mechanism of injury was low energy injury in 26 cases and high energy injury in 18 cases. There were 53 patients in the traditional positioning group, including 30 males and 20 females, aged 56.38±17.24 years (range, 24-90 years). According to the Seinsheimer classification, there were 9 cases of type II, 22 cases of type III, 9 cases of type IV, and 13 cases of type V. According to the mechanism of injury, there were 30 cases of low energy injury and 23 cases of high energy injury. The length of incision, operation time, and blood loss were recorded. At 1, 3, 6, and 12 months after operation, the anteroposterior and lateral X-ray films of the hip were taken to evaluate the imaging indicators (neck-shaft angle, anteroposterior and lateral displacement, and angulation), fracture healing, and complications (infection, malunion, loosening and breakage of the internal fixation, and periprosthetic fracture). The Harris hip score and EuroQol five dimensions questionnaire (EQ-5D) were evaluated.Results:All patients successfully completed the operation and were followed up for 15.12±1.54 months (range, 12-18 months). The operation time, incision length, dominant blood loss and hidden blood loss in the surface positioning group were 1.78(1.50, 2.00) h, 8(8, 9) cm, 300(200, 400) ml and 843(629, 1 130) ml, respectively, which were less than 2.10(1.69, 2.38) h, 10(9, 12) cm, 400(300, 500) ml and 1 030(954, 1 266) ml in the traditional positioning group, and the difference was statistically significant ( P<0.05). The neck-shaft angle in the surface positioning group was 135.54°±2.83°, which was larger than 132.33°±3.37° in the traditional positioning group, and the difference was statistically significant ( t=5.02, P<0.001). The anterolateral and lateral displacement and lateral image angle in the surface positioning group were 4.70±1.60 cm, 4.52±1.71 cm and 9.36°±2.94°, respectively, which were lower than 6.14±2.57 cm, 5.98±2.70 cm and 11.46°±4.68° in the traditional positioning group, and the difference was statistically significant ( P<0.05). One year after operation, the Harris hip score and EQ-5D score of the surface positioning group were 92(84, 99) points and 0.90(0.73, 1.00) points, respectively, which were higher than 88(74, 96) points and 0.81(0.72, 0.94) points of the traditional positioning group ( P<0.05). Conclusion:The "3-2-1" surface positioning method assisted PFNA internal fixation in the treatment of femoral subtrochanteric fracture can improve the quality of reduction, reduce intraoperative blood loss, and improve hip function and quality of life.
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Objective:To investigate the biomechanical properties of cannulated screws fixation in a configuration of "axial compression and lateral buttress" in the treatment of Pauwels type Ⅱ femoral neck fractures.Methods:Ten specimens of Sawbones artificial femur were first made into models of type Ⅱ femoral neck fracture with a Pauwells angle of 50° and then randomized into 2 equal groups ( n=5). The specimens in the experimental group were subjected to fixation with cannulated screws in a configuration of "axial compression and lateral buttress" in which the axial screw was 8.5 mm in diameter and the lateral screw 6.5 mm in diameter. The specimens in the control group were subjected to conventional fixation with cannulated screws in a configuration of "inverted triangle and parallel compression" in which the 3 screws was 7.3 mm in diameter. Finally, the specimens were placed onto a biomechanical testing machine to determine the parameters of static axial stiffness, displacement under 60 to 600 N load for 5,000 cycles, ultimate load and ultimate stiffness in turn. The 2 groups were compared to find out their differences. Results:The static axial stiffness was (1,492.00 ± 87.86) N/mm, significantly higher than that in the control group [(1,200.22 ± 228.06) N/mm] ( P<0.05). There was no significant difference between the 2 groups in the cyclic load displacement [(0.44 ± 0.01) mm versus (0.57 ± 0.17) mm] ( P>0.05), but the experimental group showed a lower trend. The ultimate load and ultimate stiffness were (4,292.61 ± 804.29) N and (1,623.55 ± 180.94) N/mm in the experimental group and (4,383.64 ± 1,423.24) N and (1,433.77 ± 289.93) N/mm in the control group, showing no significant difference between the 2 groups ( P>0.05). Conclusion:In the treatment of Pauwels type Ⅱ femoral neck fractures, fixation with cannulated screws in a configuration of "axial compression and lateral buttress" may exhibit better biomechanical properties than that in a conventional configuration of "inverted triangle" .
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Objective To investigate the biomechanical properties of our self-designed 4 cannulated screws in 4 configurations for fixation of extremely unstable femoral neck fractures.Methods Twelve adult cadaveric femoral specimens were randomly divided into 4 equal groups (n =3) and made into models of extremely unstable femoral neck fracture combined with comminution (Pauwels type Ⅲ).Group A was subjected to fixation in configuration of “double axial compressions plus double stabilizations”,group B to configuration of “positive triangle parallel compression plus small angle screwing”,group C to configuration of “inverted triangle parallel compression plus small angle screwing”,and group D to configuration of “diamond pattern screwing”.Static compression tests,cyclic loading tests and limit load tests were carried out for the 4 groups on a biomechanical testing machine.Results For groups A,B C and D,the axial compression stiffness was respectively 995.29 ±34.16 N/mm,509.89 ± 138.90 N/mm,559.28 ± 111.25 N/mm and 610.18 ±232.35 N/mm,and the limit load was respectively 3,225.33 ±461.31 N,2,008.67 ±237.27 N,2,705.67 ±496.39 N and 2,395.33 ±403.71 N,showing significant differences between the 4 groups (P ＜ 0.05).For groups A,B C and D,the displacement was respectively 0.46 ± 0.10 mm,1.47 ± 0.72 mm,1.14 ±0.24 mm and 1.22 ±0.22 mm,and the limit stiffness was respectively 1,139.28 ±342.09 N/mm,843.56 ±408.91 N/mm,585.98 ± 81.60 N/mm and 729.96 ±251.37 N/mm,showing no significant differences between the 4 groups (P ＞ 0.05).Conclusions In the fixation of extremely unstable femoral neck fracture with our self-designed 4 cannulated screws,the configuration of “double axial compressions plus double stabilizations” may lead to the greatest biomechanical advantage while the configuration of “positive triangle parallel compression plus small angle screwing” may result in the poorest biomechanical properties.
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<p><b>OBJECTIVE</b>To propose a new method for automatic segmentation of manually determined knee articular cartilage into 9 subregions for T2 measurement.</p><p><b>METHODS</b>The middle line and normal line were automatically obtained based on the outline of articular cartilage manually drawn by experienced radiologists. The region of articular cartilage was then equidistantly divided into 3 layers along the direction of the normal line, and each layer was further equidistantly divided into 3 segments along the direction of the middle line. Finally the mean T2 value of each subregion was calculated. Bland-Altman analysis was used to evaluate the agreement between the proposed and manual subregion segmentation methods.</p><p><b>RESULTS</b>The 95% limits of agreement of manual and automatic methods ranged from -3.04 to 3.20 ms, demonstrating a narrow 95% limits of agreement (less than half of the minimum average). The coefficient of variation between the manual and proposed subregion methods was 4.04%.</p><p><b>CONCLUSION</b>The proposed subregion segmentation method shows a good agreement with the manual segmentation method and minimizes potential subjectivity of the manual method.</p>
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Adult , Humans , Young Adult , Cartilage, Articular , Knee Joint , Magnetic Resonance Imaging , MethodsABSTRACT
A decade has passed since the terrorist attack of the World Trade Center on September 11, 2001. Tragedies such as that caused either by human or the Mother Nature result in damages not only to our physical health, but also our mental health. Although mental problems is generally not as tangible as physical ones, they do put a threat to our society especially in forms of long-term disorders such as post-traumatic stress symptoms [PTSD], depression and generalized anxiety disorder [GAD] and should not be ignored
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<p><b>OBJECTIVE</b>To evaluate the outcomes of arthroscopy-assisted treatment of severe comminuted distal radial fracture with external fixators and kirschner wire fixation.</p><p><b>METHODS</b>Twenty-seven cases of severe comminuted distal radial fracture treated between March, 2010 and January, 2012 were reviewed. During the operation, the carpal joint space was expanded with the external fixator, and the fracture was fixed by Kirschner wire after open reduction. The carpal joint was observed intraoperatively with arthroscopy to ensure full reduction, and the distal posterior interosseous nerve was then severed. The results of postoperative X-ray and wrist functional status of the carpal joints were recorded. Another 27 cases of severe comminuted distal radial fracture treated by conventional surgical approach served as the control group.</p><p><b>RESULTS</b>The patients were followed up for a mean of 13.2 (5-27) months. Compared with the conventional surgical approach, arthroscopy-assisted treatment resulted in a significantly shorter operative time with better appearance of the articular surface and also better wrist function assessed using the Krimmer system (P<0.05).</p><p><b>CONCLUSION</b>Arthroscopy-assisted external fixator treatment is effective for management of severe comminuted distal radial fracture and avoids the stair-like appearance of the articular surface to achieve the maximal functional recovery of the carpal joints and reduce traumatic arthritis.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Arthroscopy , External Fixators , Fracture Fixation , Methods , Fractures, Comminuted , General Surgery , Radius Fractures , General Surgery , Treatment OutcomeABSTRACT
Objective To explore the feasibility of fishing net repairing transverse fascia method for inguinal hernia (type Ⅰ , Ⅱ ) using laparoscopic surgical procedure. Methods A retrospective analysis of clinical data between the method of fishing net repairing transverse fascia surgery for 145 cases of inguinal hernia (typeⅠ,Ⅱ ) using laparoscopic surgical procedure from May 2004 to May 2008 (laparoscopic group) and the method of open repairing surgery 143 cases (open group) at the same period were conducted. The differences in the operative time, rehabilitation activities time, length of stay, cost of hospitalization and 0comphcations, recurrence rate were compared. Results The laparoscopic group was significantly better in the operative time [ ( 14.8 ± 11.5) min ], found hiding oblique hernia ( 15 cases), rehabilitation activities time[ ( 16.5 ± 14.3) h], use of analgesics(5 cases), scrotal edema(1 case), length of stay[ (4.2 ± 1.5) d], than those of the open group [ ( 37.6 ± 25.4) min, 0, (52.7 ± 12.6) h, 13, 14, ( 8.4 ± 2.6 ) d respectively ] ; but the recurrence rate was no significantly different. Conclusion Method of fishing net repairing transverse fascia for inguinal hernia (type Ⅰ , Ⅱ ) using laparoscopie surgical procedure is feasible.
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In the Ca - free solution .the relaxation induced by acctylcholine ( Ach ) inthe rabbit aortic strips is inhibited and the inhibition is removed when the concentration of the Ca2+ is restored. In the groupe of ME ( norepinephrine ) 0.4 ?mol ? L-1 hydro-choloride berbamine (HBA ) 1, 10?mol ? L-1 and Verapamie (Ver) 0. 1, 1?mol ? L-1 did not inhibit the relaxation induced by Ach,and HBA has tendency of promoting the relaxation. While HBA 100?mol ? L-1 and Ver 10?mol ? L-1 inhibit the relaxation obviously. In the group of KCl,the three concentration of HBA and Ver all have the tendency of promoting the relaxation. The result suggest: thatthe effection of HBA to the relaxation of in-dothelium dependence is complicated, the higher concentration inhibit the relaxation and the lower promote it. It prove that the effection of HBA to the transportation of indothelium's Ca2+ or to the release of the EDRF is complicated