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Objective To investigate the classification and its application in one-stage repair of massive posttraumatic bone defects which are infection-induced and refractory in lower extremities. Methods From March 2002 to December 2008, we treated 42 patients with massive posttraumatic refractory infection-induced bone defects in lower extremities. We classified the defects into 3 types: simple massive infection-induced bone defects (type Ⅰ), massive infection-induced bone and soft-tissue defects (type Ⅱ) and massive infection-induced bone defects plus limb shortening (type Ⅲ). After thorough debridement, various types of vascularized fibular grafts were used to repair the 3 kinds of defects accordingly. Simple fibular grafts were used in 6 cases, transplantation with fibular and skin flaps was used in 31 cases, fibular grafts combined with anterior lateral thigh flap in 4 cases, and one-stage limb lengthening and fibular graft in one. Results The follow-ups of 6 to 41 (average, 26. 3) months revealed that the refractory bone defects were repaired successfully in 38 cases, amputation due to necrosis of fibular grafts in 2 cases and uncontrolled infection in 2 cases. In the 38 cases, infections were controlled effectively, circulation of the traumatic limbs was good,contour and function were restored satisfactorily, and no obvious complication was found in donor limbs. By Johner-Wruhs evaluation, 17 cases were excellent, 18 cases good, 3 cases fair and 4 cases poor, with a total excellent and good rate of 83.33%. Conclusions Refractory and massive posttraumatic infection-induced bone defects in lower extremities can be classified into 3 types. They can be repaired using various types of vascularized fibular grafts according to the defect types at one-stage.
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Objective To compare the changes of some blood indices after treatment of intertro-chanteric fractures with conventional and minimally invasive dynamic hip scres (DHS) internal fixation so as to understand the influence of minimally invasive technique on physiology of the organism. Meth-ods The elderly patients with intertrochanteric fractures in our department from July 2004 to May 2006 were divided randomly into two groups, ie, conventional DHS internal fixation group(Conventional group, 52 patients)and the minimally invasive DHS internal fixation group(Minimal invasion group, 54 patients). A comparison was done on data including white blood cells (WBC), hemoglobin (Hb), e-rythrocyte sedimentation rate (ESR). C reactive protein (CRP) and creatine kinase (CK) as well as re-cessive blood loss. Results The indices including transfusion, blood loss, recessive blood loss, ESR and CK in minimal invasion group showed less changes compared with conventional group. With statistical difference. But WBC and CRP showed no statisfical difference between both groups. Conclusion Minimally invasive DHS internal fvtation carl reduce operative trauma during treatment of intertrochanterie fractures in the elderly.
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Objective To compare the surgical outcomes between microsurgery lumbar discectomy and microendoscopic discectomy for lumbar disc herniation. Methods A prospective study was conducted on the surgical procedures for lumbar disc herniation.The target of our study was a group of 33 patients who underwent surgery by microsurgery lumbar discectomy(MSLD group)and 36 patients who underwent surgery by microendoscopic discectomy(MED group).The items investigated were the operation time,amount of bleeding,duration of hospitalization,pre-and postoperative scores based on judgment criteria for treatment of lumbar spine disorders established by the Japanese Orthopaedic Association score,visual analog scales (VAS,0 to 10) for lumbago and sciatica before surgery and at discharge,perioperative complications.Results The mean duration of follow-up was 2 years and 2 months (11 months to 4 years).There were no significant differences between the 2 surgical procedures in the frequency of the pre-and postoperative Japanese Orthopaedic Association scores or postoperative VAS for lumbar pain and sciatica,operation time and duration of hospitalization. Statistically significant differences were observed in amount of bleeding and operation time,but the differences were not large, and may not have been clinically significant.Conclusion Both microsurgery lumbar discectomy and microendoscopic discectomy are appropriate for lumbar disc herniation.
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BACKGROUND: The effect of the treatment of long tubular bone defect by free vascularized fibular graft, especially when combined with monitoring island skin flap is definitely reliable. However, there is still the possibility of broken fibular graft with single fibular graft for repairing the long loading tubular bone.OBJECTIVE: To investigate the clinical effect on the treatment of long femoral bone defect by combinatorial fibular graft with monitoring island skin flap.DESIGN: Before and after self-controlled observation.SETTING: Department of Orthopaedic Spine Surgery, Guangzhou People's HospitalPARTICIPANTS: Totally 14 patients who wer treated for long femoral bone defect in the Department of Orthopaedic Spine Surgery were recruited between July 1995 and November 2003. Locus: distal part of the femur,5cases; middle part of the femur, 9cases.The length of bone defect was 6 to 28 cm.INTERVENTIONS: There were 7 cases of free vascularized bi-fibular graft transplantation with monitoring island skin flap. There were 7 cases of free vascularized fibular graft centralized with large segmental allograft.Monitoring island skin flap was 3 cm×5 cm, sectioned fibular was 16 to 32cm. Dry frozen bone of allograft was 12 to 28 cm. The wound and island skin were detected postoperatively.MAIN OUTCOME MEASURES: The living condition of bi-fibular graft or binding composite allograft with skin flap, morphology change of transplanted bone and loaded walking ability in patients with bone defect after operation.RESULTS: Totally 14 patients entered the result analysis. Seven cases in bi- fibular group were followed up for 3 years and 7 patients in the centralized graft group were followed up for 1 year. Fourteen cases detected by monitoring island skin flap all survived. One case in the centralized graft group presented yellow exudates 3 months after operation, and then the graft bone was taken out. Follow-up of the rest 6 patients showed that transplanted fibular bone was closely connected with allograft. The thickness of the transplanted bone was increased, shaped and similar with the diameter of the femur at the receptor. Patients in the two groups could walk with loading without walking stick. Transplanted bone has no fracture.CONCLUSION: Transplantation of free vascularized bi-fibular graft transplant or free vascularized fibular graft monitoring island skin flap binding to large segmental allograft can increase its structural strength through hypertrophy, decrease or avoid fracture of the transplanted graft fibula.
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Objective To evaluate the effectiveness of Moss Miami pedicle sc re w system in the treatment of thoracolumbar burst fractures. Methods A total of 2 7 cases of thoracolumbar burst fractures were operated on with Moss Miami pedicl e screw system through posterior approach to provide spreading, reduction and fi xation. The bilateral posterolateral bone-graft spinal fusion was also done at the same time. Results The 27 patie nts were followed up for 6 to 30 months. The heights of compressed vertebral bod y and the cross spinal canal were significantly increased after treatment (P
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<p><b>OBJECTIVE</b>To compare the effect of using partial median and ulnar nerves for treatment of C(5-6) or C(5-7) avulsion of the brachial plexus with that of using phrenic and spinal accessary nerves.</p><p><b>METHODS</b>The patients were divided into 2 groups randomly according to different surgical procedures. Twelve cases were involved in the first group. The phrenic nerve was transferred to the musculocutaneous nerve or through a sural nerve graft, and the spinal accessary nerve was to the suprascapular nerve. Eleven cases were classified into the second group. A part of the fascicles of median nerve was transferred to be coapted with the motor fascicle of musculocutaneous nerve and a part of fascicles of ulnar nerve was transferred to the axillary nerve. The cases were followed up from 1 to 3 years and the clinical outcome was compared between the two groups.</p><p><b>RESULTS</b>There were 2 cases (16.6%) who got the recovery of M4 strength of biceps muscle in the first group but 7 cases (63.6%) in the second group, and the difference was statistically significant (P<0.025). However, it was not statistically different in the recovery of shoulder function between the two groups.</p><p><b>CONCLUSIONS</b>Partial median and ulnar nerve transfer, phrenic and spinal accessary nerve transfer were all effective for the reconstruction of elbow or shoulder function in brachial plexus injury, but the neurotization using a part of median nerve could obtain more powerful biceps muscle strength than that of phrenic nerve transfer procedure.</p>
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Adolescent , Adult , Humans , Male , Middle Aged , Brachial Plexus Neuropathies , General Surgery , Median Nerve , Transplantation , Nerve Transfer , Methods , Treatment Outcome , Ulnar Nerve , TransplantationABSTRACT
Objective To investigate the relationship of uPA and uPA R protein expression in bone giant cell tumors(GCT)with their pathological grades and relapse. Methods By using Avidin biotin complex(ABC) immunohistochemistry method, monoclonal antibodies against uPA and uPA R proteins were used to measure their expression in 23 cases of GCT (including 8 cases of pathological grade Ⅰ, 10 cases of pathological grade Ⅱ and 5 cases of pathological grade Ⅲ accord to Jaffe classification). Results According to the level of these immunoreaction, over expression of uPA and uPA R were detected in 10 and 8 patients (positive rate 43.5 % and 34.8 %). In cases with relapse or not, the positive expression rate of uPA and uPA R was 66.7 %, 28.6 %, 66.7 %, 14.3 % respectively, abnormally high expression of both uPA and uPA R proteins was found in 6 cases(66.7 %). A significant correlation existed between the uPA R expression or co over expression of uPA and uPA R proteins in GCT and its relapse (P
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Objective To study the correlated mechanisms and clinical effect of hidden hemorrhage after total hip arthroplasty (THA) and total knee arthroplasty(TKA). Methods From March 2001 to May 2005, 61 patients were treated with THA and 73 patients were treated with TKA. The patients treated with THA involved 22 males and 39 females with an average age of 68 years(range 61-79 years). The patients treated with TKA involved 23 males and 50 females with an average age of 73 years(range 65-77 years). All arthroplasties were primary and unilateral, and the 24 h fluid resuscitation was not more than 2000 ml. Using Gross formula, the true total blood loss was calculated depending on height, weight and pre- and post-operation Hct, and the hidden hemorrhage was got by subtracting the visible blood loss from total loss. Results Following THA, the mean total loss was 1520 ml and the hidden hemorrhage 482 ml(32%). Following TKA, the mean total loss was 1508 ml and the hidden hemorrhage was 776 ml(52%). The difference of hidden hemorrhage between THA and TKA was significan different(P
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Objective To explore the clinical application of computer-assisted three-dimensional navigation system for thoracic pedicle screw placement. Methods From May 2003 to May 2004, the computer-assisted three-dimensional navigation system was used for thoracic pedicle screw placement in 80 screws of 15 cases, including 30 in the upper thoracic spine and 50 in the middle or lower thoracic spine. These fifteen patients included ten male and five female with a mean age of 47 years (range 13-76 years). In this series of 15 patients, thoracic spinal surgery was performed for tumor resection and reconstruction in 5, burst fracture in 4, ossification of thoracic ligamentum flavum in 2 and thoracic scoliosis in 4. The pedicle screw position was assessed with "C"-arm fluoroscopy during operation and with CT post-operation. The cost of time for pedicle screw installation and amount of bleeding were recorded. Results The cost of time averaged 15 minutes (range 10-20 min) for each pedicle screw placement. The amount of bleeding varied, it averaged 1200 ml in thoracic tumor resection and reconstruction, 800 ml in posterior fixation for burst fracture, 300 ml in resection of ossified ligamentum flavum, and 500 ml in surgery for scoliosis. The pedicle screw position was graded post-operatively with CT scanning into three groups: gradeⅠ, perfectly placed, grade Ⅱ, cortical perforation less or equal to 2 mm, and grade Ⅲ, perforation more than 2 mm. Of these 80 screws, 76 screws (96%) were found in gradeⅠ, 2 in gradeⅡ, and 2 in grade Ⅲ. All of the 4 screws in gradeⅡor Ⅲ were placed deviating to the lateral portion of pedicles, and no neurological deficit was resulted. Conclusion The computer-assisted three-dimensional navigation system is a valuable tool both for improving the accuracy of thoracic pedicle screw installation, and increasing the overall safety of the procedure during thoracic spine surgery.
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Objective To explore a new method for repairing multiple knee ligament injuries with allogenic achilles tendon. Methods Injuried anterior and posterior cruciate ligament(APCL) in 25 patients with multiple knee ligament injuries was reconstructed under arthroscopy with the bone- patellar tendon -bone which was treated with deep hypothermia and ? radiation. At the same time, injuried medial collateral ligament (MCL) or lateral tissue was repaired. Results After the disappearance of edema and inflammation in the injuried knee joints, the allogenic bone-patellar tendon-bone transplant was performed under arthroscopy. Menisci were sutured in 2 cases, and were resected or partially resected in 15 cases. All patients were followed up for more than 12 months. According to the Lysholm score method of knee function,the average score of preoperation and postoperation was 36 and 85, respectively. The satisfactory rate was 83%. The objective examination showed anterior drawer test(ADT) positive in 21 cases preoperatively, and 2 postoperatively. Lachman test was positive in 22 cases preoperatively, and 2 postoperatively. 3 patients had tolerable pain in knee, and 5 had the limitation of knee activity (5～20?). Conclusion The injury and complication caused by the autograft can be avoided by using allogenic bone- patellar tendon -bone to repair multiple knee ligament injuries. After systemic rehabilitation, the function of the knee joints can be restored reliably.
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Objective To treat upper and middle trunks or C 5～7 avulsion of brachial plexus by neurotization using a part of median nerve and ulnar nerve Methods All patients were divided into 2 groups according to the surgical procedures Eleven cases were involved in the first group The phrenic nerve was chosen to anastomose with musculocutaneous nerve or through a sural nerve graft and the spinal accessory nerve was anastomosed with suprascapular nerve Eleven cases from 1997 were classified into the second group A part of the fascicles of median nerve was transferred to coapt with the motor fascicle of musculocutaneous nerve and a part of fascicles of ulnar nerve was transferred to harvest with axillary nerve The cases were followed up from 0 5 to 3 years and the clinical outcome was compared between the two groups Results There were 2 cases(16 6%)who got the recovery of M 4 strength of biceps muscle in the first group and 7 cases(63 6%)in the second group,and the difference was statistically significant( P
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Objective To introduce a new surgical procedure for the treatment of axillary nerve injury:neurotization from one of triceps branches of radial nerve to one of axillary branches Methods To study the anatomical relationship between the nerve branches to triceps and the axillary nerve branches to deltoid muscle by anatomical dissection as well as to measure the diameters of the nerve branches,and to complete the performance in clinic in six patients and follow up for 6～16 months Results The branches to long head of triceps of radial nerve were near to branches of axillary nerve and the difference among the nerve branches are little in diameter,and there were 5 patients who got M4 recovery of the muscle strength and 1 patient M3 Conclusion The new surgical procedure is easy to manipulate,with a satisfactory result,and is suitable for the partial brachial plexus injury patient with axillary nerve dysfunction but the radial nerve function formal
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Objective To explore the treatment approach to severe l ower extremity trauma. Methods A retrospective study was ca rried out in 42 cases with severe lower extremity trauma from 1989 to 1999. Mang led extremity severity score (MESS) was 6.24?1.45 in all the cases, among which were 34 cases with MESS