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The rotator cuff is an important structure to maintain movement and dynamic stability of the shoulder joint. Rotator cuff injury changes its unique biomechanical effects, resulting in shoulder pain and mobility disorders. Although great progress has been made in suture technology and fixation method, the rate of postoperative retear is still very high. Understanding the biomechanical mechanism of normal rotator cuff and restoring the special biomechanical effect of rotator cuff after injury are the key to prevent postoperative retear. This article reviewed biomechanical researches on rotator cuff repair in recent years, in order to provide some theoretical guidance for clinical operation.
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@#While lobectomy is the standard surgical procedure for early-stage non-small cell lung cancer (NSCLC), sublobectomy (segmentectomy/wedge resection) has been gaining progress in early-stage peripheral NSCLC in recent years because it preserves more lung parenchyma and has the advantages of good postoperative lung function, relatively less trauma, and faster recovery. However, there has been a lack of standardized randomized clinical trials to study the survival benefits of sublobectomy. The results of a high-profile study from the USA, CALGB140503, have been the subject of intense industry debate since its presentation at the 2022 World Conference on Lung Cancer (IASLC WCLC 2022). The study, which was published in The New England Journal of Medicine on February 9, 2023, was designed to investigate whether sublobectomy was not inferior to lobectomy in terms of survival in patients with early-stage peripheral NSCLC (tumor diameter≤2 cm). The results showed that sublobectomy was not worse than lobectomy for survival in patients with T1aN0M0 peripheral NSCLC with tumor diameter≤2 cm and pathologically confirmed negative hilar and mediastinal lymph nodes. Sublobectomy, including anatomical segmentectomy and wedge resection is an effective NSCLC treatment. The results of this study provide strong evidence for the improved outcomes of sublobectomy in terms of lung function protection and are expected to promote the further use of sublobectomy. However, given the limitations of this study, whether sublobectomy, especially wedge resection, can become a standard procedure still needs to be explored. This paper presents an interpretation of this study and we invite experts in the field to discuss its usefulness in guiding clinical practice and summarise its limitations.
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Objective:To study the curative effect of platelet-rich plasma (PRP) combined with internal fixation with hollow screws on femoral neck fractures.Methods:The clinical data of 160 patients with femoral neck fracture were retrospectively analyzed who had been treated by internal fixation with hollow screws at Orthopedic Department Ⅲ, The Second Affiliated Hospital to Luohe Medical College from May 2012 to May 2018. According to whether PRP was used or not to assist their internal fixation, they were divided into a PRP group ( n=80) and a control group ( n=80). In the PRP group, there were 46 males and 34 females with an age of 52.3 years±7.6 years, and one case of type Ⅰ, 5 cases of type Ⅱ, 57 cases of type Ⅲ and 17 cases of type Ⅳ by the Garden classification. In the control group, there were 41 males and 39 females with an age of 50.6 years ± 7.3 years, and 2 cases of type Ⅰ, 7 cases of type Ⅱ, 51 cases of type Ⅲ and 20 cases of type Ⅳ by the Garden classification. The 2 groups were compared in terms of fracture healing time, nonunion, femoral head necrosis and Harris hip scores. Results:The 2 groups were comparable because their preoperative general data showed no significant differences ( P>0.05). The 160 patients obtained follow-up for 12 to 36 months. The PRP group showed significantly shorter fracture healing time (4.3 months ± 1.0 months), significantly lower incidences of nonunion [0% (0/80)] and avascular necrosis of femoral head [3.8% (3/80)] than the control group [7.3 months ± 1.3 months, 7.5% (6/80) and 15.0% (12/80), respectively] (all P< 0.05). The Harris scores at 6 and 12 months after operation for the PRP group (88.7±5.3 and 94.2±4.8) were significantly higher than those for the control group (81.4±4.6 and 84.2±5.2) (both P<0.05). Conclusion:In the treatment of femoral neck fractures, compared with internal fixation with hollow screws alone, platelet rich plasma combined with internal fixation with hollow screws can significantly shorten fracture healing time, reduce incidence of avascular necrosis of the femoral head and improve functional recovery of the hip joint.
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Objective To investigate the treatment effect of proximal femoral nail antirotation (PFNA) on unstable femoral intertrochanterie fractures in the elderly. Methods A retrospective stud- y was done on 65 patients with unstable femoral intertrochanteric fractures, who were treated with PFNA from December 2005 to October 2006 and followed up for at least half a year. There were 22 males and 43 females, at age range of 67-97 (mean 78.5 years). All the operations were carried out within a week af- ter fractures. The data of operation time, operative blood loss, complications, bone healing time and hip function scores were recorded for evaluating treatment outcomes. Results All the patients were fol- lowed up for 6-18 months (average 10.5 months). The operation lasted for (29.6±7.5) minutes, with mean blood loss of (150.5±40.2) ml and bone healing time of (9.1±2.2) weeks. All patients ob- tained satisfactory treatment results, except for 3 patients with proximal thigh pain, 2 with pulmonary in- fection occurred and 1 with thrombs of lower limb vein. Harris post trauma hip function score was (88.5 ± 6.3) points. Conclusion PFNA is an effective way for femoral unstable intertrochanteric fractures in the elderly, for it is characterized by short operation time, less blood loss and stable fixation.
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Objective To explore the significance of computed tomography in preoperative classification and surgical planning for Pilon fractures. Methods A retrospective analysis was done for 52 cases of Pilon fracture who had been admitted to our hospital from January 2000 to June 2005 and whose X-ray, Axial CT scan and follow-up data were complete. In the preoperative evaluation, the fractures were classified, the fracture angles measured and the anatomy of fragments analyzed on the basis of their plain radiographs and CT scans. The operative methods and approaches were based on the specific fracture types, fracture angles and courses of fracture line on the CT scans. Five patients received manipulative reduction and plaster splint, five closed reduction and internal fixation with lag screws coupled with plaster splint, 17 closed reduction and internal fixation with minimally invasive percutaneous plate osteosynthesis (MIPPO), 16 closed reduction and external fixation combined with limited internal fixation; and nine open reduction and internal fixation (ORIF). Results The average follow-up was 17.2 months.CT scan revealed an increased number of fragments in 21 patients. The fracture types were changed in nine patients according to new CT discoveries which revealed coronal main fracture lines in 61.5% of the cases and sagittal in 34.6% . The approaches and internal fixation positions varied according to the two different kinds of fracture. According to Mazur’ s criteria, the postoperative surgical results were evaluated as excellent in 30 cases, good in 13, fair in eight and poor in one. On average, the good to excellent rate was 82.7% for all the patients, 57.1% for patients with type Ⅲ fractures, but only 44.4% for patients with die-punch fragments in CT scan. Conclusions CT scan can increase accuracy in classification of Pilon fractures. Open reduction of articular surface is preferred for type Ⅲ fractures. Operative approaches and positions of the internal fixation should be based on the anatomy of main fracture lines and fragments. Die-punch fragments should be reduced under direct visualization and indicate unfavorable prognosis.