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1.
Chinese Journal of Traumatology ; (6): 118-121, 2022.
Article in English | WPRIM | ID: wpr-928482

ABSTRACT

Intertrochanteric fractures have become a severe public health problem in elderly patients. Proximal femoral nail anti-rotation (PFNA) is a commonly used intramedullary fixation device for unstable intertrochanteric fractures. Pelvic perforation by cephalic screw is a rare complication. We reported an 84-year-old female who fell at home and sustained an intertrochanteric fracture. The patient underwent surgery with PFNA as the intramedullary fixation device. Routine postoperative examination revealed medial migration of the helical blade that eventually caused pelvic perforation. We performed a cemented total hip arthroplasty as the savage procedure. At the latest follow-up of 12 months after total hip arthroplasty, the patient had no pain or loosening of the prosthesis in the left hip. Pelvic perforation should be considered when choosing PFNA as the intramedullary fixation device, especially in patients with severe osteoporosis wherein the helical blade can be easily inserted during the operation. The lack of devices to avoid oversliding of the helical blade in PFNA is an unreported cause of this complication and should be considered in such cases.


Subject(s)
Aged , Aged, 80 and over , Female , Humans , Bone Nails/adverse effects , Femur , Fracture Fixation, Intramedullary/adverse effects , Hip Fractures/surgery , Retrospective Studies , Treatment Outcome
2.
Article in Chinese | WPRIM | ID: wpr-942088

ABSTRACT

OBJECTIVE@#To investigate the clinical effect of a modified arthroscopic outside-in suture technique in the treatment of meniscus tear using a spinal needle.@*METHODS@#From January 2015 to October 2017, 95 patients treated with this method were followed-up. Among these cases, there were 36 males and 59 females. The age of the patients ranged from 16 to 77 years, (46.79±18.07) years in average. Among them, there were 28 patieats aged 16-35, 53 patients aged 36-65, and 14 patients aged over 65 years old. 28 cases were diagnosed with medial meniscus tear, 43 cases with lateral meniscus tear and 24 cases with both medial and lateral meniscus tear. Causes of the injury included sports, sprain, etc. According to Barrett standard, the clinical healing of meniscus tear was judged. Lysholm score, knee range of motion, visual simulation score (VAS) and magnetic resonance imaging (MRI) were used to evaluate the postoperative knee function and recovery of the patients.@*RESULTS@#The 95 patients were followed up for 22 to 36 months, with an average of (28.32±3.98) months. According to Barrett standard, 90 patients (94.7%) obtained meniscus clinical healing. Meniscal healing rates were 96.43%, 96.23% and 85.71% in the three age groups, respectively. The meniscal healing rate was lower in the elderly group, but there was no significant difference in statistical results (P=0.262). Five patients had deep tenderness in the joint space of the injured side, and the overstretch test was positive. The preoperative and postoperative VAS scores, Lysholm scores and knee motion were compared in each group, and the differences were statistically significant (P < 0.01). At the end of the last follow-up, there were no cases of knee joint effusion, swelling and interlocking, and the joint function was effectively improved in most patients. No surgical site infection, periarticular vascular/nerve injury or knotting reaction was found during the follow-up.@*CONCLUSION@#This modified arthroscopic outside-in suture technique using a spinal needle has the characteristics of simple operation, small trauma and rapid recovery, and the mid-term follow-up results were satisfactory. Therefore, we consider this method to be a safe and efficient method for the treatment of meniscus anterior horn and body tear.


Subject(s)
Aged , Female , Humans , Male , Arthroscopy , Follow-Up Studies , Knee Injuries/surgery , Punctures , Suture Techniques , Tibial Meniscus Injuries/surgery
3.
Article in Chinese | WPRIM | ID: wpr-942124

ABSTRACT

OBJECTIVE@#To evaluate the surgical technique and clinical effect of less invasive intrame-dullary nail fixation combined with titanium cable cerclage in the treatment of subtrochanteric fractures.@*METHODS@#A retrospective study was performed in 46 cases of subtrochanteric fractures in Peking University People's Hospital from January 2015 to December 2017. Among them, there were 14 males and 32 females, with an average age of (77.83±10.66) years (44-92 years); 17 cases on the left side and 29 cases on the right side. The causes of injury included crash from a height, traffic accident and accidental fall. According to Seinsheimer classification, there were 26 cases of type Ⅱ, 11 cases of type Ⅲ, 9 cases of type Ⅳ, and these cases were all closed injury. After admission, these patients underwent continuous tibial tuberosity bone traction to maintain the length and force line of the lower extremity, so as to reduce the difficulty of intraoperative fracture reduction. Anticoagulant therapy was given before operation to reduce perioperative thrombotic complications. All the patients were treated with less invasive intramedullary nail fixation combined with titanium cable cerclage. Operation time, blood loss during surgery, time of fracture healing were recorded, Harris and Sanders scoring system were used to assess hip function after operation at each follow-up time point.@*RESULTS@#All the included patients underwent surgery successfully. Average operative time and intraoperative blood loss of these patients were (131.09 ± 20.06) min and (191.96±111.03) mL, respectively. All the patients were followed up satisfactorily, with an average follow-up time of 28 months. The fractures received bone healing within 3-6 months, average hospital stay was (10.61±2.85) days. The Sanders score was excellent in 3 cases, good in 37 cases and common in 6 cases, with an excellent and good rate of 86.96%. The Harris score was excellent in 6 cases, good in 36 cases, with an excellent and good rate of 91.30%. There were no cases of wound infection, loss of reduction, nonunion of fracture or internal fixation failure. Hip pain symptoms were effectively relieved in most patients.@*CONCLUSION@#Less invasive intramedullary nail fixation combined with titanium cable cerclage can obtain good alignment and stability of fracture ends, which is an effective method for the treatment of subtrochanteric fractures.


Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Bone Nails , Fracture Fixation, Intramedullary , Fracture Healing , Hip Fractures/surgery , Retrospective Studies , Titanium , Treatment Outcome
4.
Article in Chinese | WPRIM | ID: wpr-941805

ABSTRACT

OBJECTIVE@#To evaluate the association between rotator cuff tear and the proximal migration of humeral head.@*METHODS@#In this research, we retrospectively selected 30 patients with unilateral rotator cuff tear in Peking University People's Hospital from September 2015 to May 2016, who received magnetic resonance imaging (MRI) and X-ray of the painful shoulder before enrollment in this study, the duration between the two examinations was no longer than 1 week, and also there was no past history of surgery in the selected shoulders. There was no other exclusion criteria. Upward migration index (UMI) was the ratio between the distance of humeral head center to the lower surface of acromion, and the radius of humeral head circle, which could help to minimize the effect of anatomy difference and imaging magnification, compared with the traditional acromiohumeral distance (AHD). Then we introduced this index to stratify the selected 30 patients into 3 groups, and each group contained 10 patients, UMI of group 1 was >1 and ≤1.2, UMI of group 2 was >1.2 and ≤1.4, UMI of group 3 was >1.4. As the supraspinatus was most commonly affected by pathological change among the four rotator cuff tendons, we took it as the research object. Then we used the Spearman correlation analysis to evaluate the relationship between UMI and fatty degeneration, rotator cuff tear size and the thickness of ruptured supraspinatus tendon from X-ray and MRI.@*RESULTS@#In the A-P view, the average UMI was 1.33 (1.02-1.51, SD: ±0.22). UMI and the tear size had a significant negative correlation (R=-0.584, P<0.01), and also there was a negative correlation between the fatty degeneration of the supraspinatus (R=-0.312, P=0.033). However, there was no correlation between UMI and the thickness of ruptured supraspinatus (R=0.127, P=0.071).@*CONCLUSION@#UMI is related with the fatty degeneration of supraspinatus and the tear size. The reduction of UMI is a predictable and reliable mark of rotator cuff tear and degeneration in clinic. Physicians can use physical examination and X-ray first when facing the patients with shoulder pain, which is convenient and helpful for evaluating rotator cuff tears.


Subject(s)
Humans , Humeral Head , Magnetic Resonance Imaging , Retrospective Studies , Rotator Cuff , Rotator Cuff Injuries , Shoulder Joint
5.
Chinese Medical Journal ; (24): 1301-1305, 2015.
Article in English | WPRIM | ID: wpr-231784

ABSTRACT

<p><b>BACKGROUND</b>This study aimed to evaluate the effects of standard rescue procedure (SRP) in improving severe trauma treatments in China.</p><p><b>METHODS</b>This study was conducted in 12 hospitals located in geographically and industrially different cities in China. A standard procedure on severe trauma rescue was established as a general rule for staff training and patient treatment. A regional network (system) efficiently integrating prehospital rescue, emergency room treatments, and hospital specialist treatments was built under the rule for information sharing and improving severe trauma treatments. Treatment outcomes were compared between before and 1 year after the implementation of the SRP.</p><p><b>RESULTS</b>The outcomes of a total of 74,615 and 12,051 trauma cases were collected from 12 hospitals before and after the implementation of the SRP. Implementation of the SRP led to efficient cooperation and information sharing of different treatment services. The emergency response time, prehospital transit time, emergency rescue time, consultation call time, and mortality rate of patients were 24.24 ± 4.32 min, 45.69 ± 3.89 min, 6.38 ± 1.05 min, 17.53 ± 0.72 min, and 33.82% ± 3.87% (n = 441), respectively, before the implementation of the standardization and significantly reduced to 10.11 ± 3.21 min, 22.39 ± 4.32 min, 3.26 ± 0.89 min, 3.45 ± 0.45 min, and 20.49% ± 3.11%, separately (n = 495, P < 0.05) after that.</p><p><b>CONCLUSIONS</b>Staff training and SRP can significantly improve the efficiency of severe trauma treatments in China.</p>


Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Young Adult , China , Emergency Medical Services , Reference Standards , Wounds and Injuries
6.
Chinese Medical Journal ; (24): 3966-3971, 2012.
Article in English | WPRIM | ID: wpr-339917

ABSTRACT

<p><b>BACKGROUND</b>Calcodynia is a persistent condition that podiatric surgeons frequently see among their patients, and plantar fasciitis is the main reason for pain. When systematic conservative treatments fail to alleviate these conditions, it requires surgical intervention, mainly plantar fascia release surgery, which used to be an open heel release surgery. This study aimed to investigate whether minimally invasive treatment of the KobyGard system is more safe and effective for plantar fasciitis.</p><p><b>METHODS</b>From May 2009 to May 2012, a total of nine patients, three males and six females with plantar fasciitis, were treated in the Peking University People's Hospital with minimally invasive instruments, the KobyGard system, for the release of plantar fascia. Three patients, experiencing bilateral calcaneodynia, underwent bilateral surgery. One patient had bilateral calcaneodynia with enthesiopathy of Achilles tendon, and underwent Achilles tendon surgery. Preoperative and postoperative Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scores, Roles and Maudsley scores and SF-36 questionnaires were evaluated.</p><p><b>RESULTS</b>The nine patients were successfully followed up. The average postoperative follow-up time was 13.2 months and it varied from 2.0 months to 21.0 months. Pre- and postoperative average scores of VAS was 9.3 and 1.9 (P < 0.001), respectively. Pre- and postoperative average scores of AOFAS hind foot was 36.0 and 82.0 (P < 0.001), respectively. There was also a statistically significant amelioration in SF-36 scores and the Roles and Maudlesy scores. Eight patients were satisfied with the surgery outcome.</p><p><b>CONCLUSION</b>Minimally invasive surgery treatment of the KobyGard system for plantar fasciitis has the advantages of shorter operation time, ease of operation, and similar satisfaction rates with open surgery, but with smaller surgical incision.</p>


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Fasciitis, Plantar , General Surgery , Minimally Invasive Surgical Procedures , Methods , Retrospective Studies
7.
Chinese Medical Journal ; (24): 140-143, 2012.
Article in English | WPRIM | ID: wpr-333526

ABSTRACT

<p><b>BACKGROUND</b>For some specific comminuted unstable intra-articular fracture, the plaster cast can not maintain the alignment of the articular surface effectively. The aim of this study was to evaluate the clinical effects of distal radius fracture treated with open reduction and internal plate fixation retrospectively.</p><p><b>METHODS</b>From January 2002 to March 2010, 539 cases of distal radius fracture were treated with open reduction and internal fixation, including 184 males and 355 females aging 21 - 72 years (mean 57 years). Fractures were caused by falling to the ground in 459 cases, by traffic accident in 62 cases and by athletic injuries in 18 cases. Of 539 cases, there were 523 cases of closed fracture and 16 cases of open fracture. According to Arbeitsgemeinschaft fur Osteosynthesefragen (AO) standards of classification, there were 14 cases of A2 type, 22 of A3 type, 18 of B1 type, 24 of B2 type, 62 of B3 type, 91 of C1 type, 162 of C2 type and 146 of C3 type. The time from injury to operation was 1 - 16 days (mean 5 days). All patitents received open reduction and internal plate screw fixation. Forty-seven patients with bone defect were given 6 - 15 g autologous ilium and 75 cases were given 5 ml calcium sulphate artificial aggregate after reduction.</p><p><b>RESULTS</b>All incisions healed by first intention after operation. Patients were followed up for 15 to 32 months postoperatively (mean 22 months). The fractures healed within 10 - 18 weeks after operation (mean 12 weeks). During the last follow-up, the mean palmar tilt was (7.0 ± 0.9)° and the mean ulnar variance was (21.0 ± 4.2)°, showing significant difference when compared with preoperation ((-5.0 ± 1.2)° and (8.0 ± 3.8)°). The radial heights were not abbreviated. According to Gartland and Werley assessment system, the results were excellent in 314 cases, good in 163 cases, fair in 46 cases, and poor in 16 cases 12 weeks after operation, the excellent and good rate was 88.5%.</p><p><b>CONCLUSIONS</b>The clinical effect of distal radius fracture treated with open reduction and internal plate fixation was relatively satisfactory. Meticulous operation procedure and individual rehabilitation strategy contribute to the wrist joint functional recovery.</p>


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Bone Plates , Fracture Fixation, Internal , Methods , Radius Fractures , General Surgery , Retrospective Studies , Treatment Outcome
8.
Chinese Journal of Surgery ; (12): 318-322, 2012.
Article in Chinese | WPRIM | ID: wpr-257502

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the ASES, Constant and HSS score systems and their significance on postoperative function of the shoulder.</p><p><b>METHODS</b>Totally 172 cases of proximal humeral fracture of five affiliated hospital from September 2004 to September 2008 were analyzed. All the functional outcome of the involved shoulder were evaluated by ASES, Constant, HSS score and patient self score. The correlations and agreement of three shoulder scales were analyzed with Pearson correlation test and Bland-Altman plot in different age groups and fracture types.</p><p><b>RESULTS</b>(1) The Constant score were lower than other two scores in the same age group and fracture type (F = 13.62 and 4.80, P < 0.05). (2) The correlations between three shoulder scales: ASES and Constant (r = 0.754, P = 0.0003), ASES and HSS (r = 0.755, P = 0.0001), Constant and HSS (r = 0.858, P = 0.0002). The correlations between three shoulder scales and patient self evaluation: ASES (r = 0.602, P = 0.0002), Constant (r = 0.705, P = 0.0001), HSS (r = 0.663, P = 0.0037). The Bland-Altman plot shows three shoulder scales have good agreement. (3)The correlation between Constant score and patient self evaluation decreased in the elder group and severe fracture type.</p><p><b>CONCLUSIONS</b>ASES, Constant, HSS shoulder score systems are all fit to evaluate the functional outcome of the shoulder, they have good correlation and agreement. Constant score in recommended for its high correlation coefficient with patient self evaluation score. However, its age bias must be paid attention in clinical practice. ASES shoulder score can be used in remote follow-up.</p>


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Postoperative Period , Retrospective Studies , Shoulder Fractures , General Surgery , Shoulder Joint , Trauma Severity Indices
9.
Chinese Medical Journal ; (24): 574-578, 2012.
Article in English | WPRIM | ID: wpr-262566

ABSTRACT

<p><b>BACKGROUND</b>Few data on ankle fractures in China from large multicenter epidemiological and clinical studies are available. The aim of this research was to evaluate the epidemiological features and surgical outcomes of ankle fractures by reviewing 235 patients who underwent ankle fracture surgery at five hospitals in China.</p><p><b>METHODS</b>This study included patients who underwent ankle fracture surgery at five Chinese hospitals from January 2000 to July 2009. Age, gender, mechanism of injury, Arbeitsgemeinschaft für Osteosynthesefragen (AO) fracture type, fracture pattern, length of hospital stay and treatment outcome were recorded. Statistical analyses were conducted using SPSS software. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, visual analogue scale (VAS), and arthritis scale were used to evaluate outcome.</p><p><b>RESULTS</b>Of 235 patients with ankle fractures, 105 were male with an average age of 37.8 years and 130 were female with an average age of 47.3 years. The average follow-up period was 55.7 months. There were significant differences in the ratios of patients in different age groups between males and females, and in mechanisms of injury among different age groups. There were also significant differences in the length of hospital stay among different fracture types and mechanisms of injury. In healed fractures, the average AOFAS ankle-hindfoot score was 95.5, with an excellence rate of 99.6%, the average VAS score was 0.17, and the average arthritis score was 0.18. Movement of the injured ankle was significantly different to that of the uninjured ankle. There were no significant differences between AO fracture types, fracture patterns or follow-up periods and AOFAS score, but there were some significant differences between these parameters and ankle joint movements, pain VAS score and arthritis score.</p><p><b>CONCLUSIONS</b>Ankle fractures occur most commonly in middle-aged and young males aged 20 - 39 years and in elderly females aged 50 - 69 years. The most common mechanisms of injury are twisting injuries and falls from a standing height or less. The results of surgical treatment are satisfactory.</p>


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Age Distribution , Ankle Injuries , General Surgery , Sex Distribution , Treatment Outcome
10.
Chinese Medical Journal ; (24): 2521-2524, 2012.
Article in English | WPRIM | ID: wpr-283729

ABSTRACT

<p><b>BACKGROUND</b>Safe placement of the screws is a critical aspect of trans-pedicle internal fixation, and little information on in vivo morphology of the cervical vertebrae pedicle measured with imaging methods is available. The aim of this study was to measure the dimensions of cervical vertebrae C3 to C7 and provide screw length, screw diameter and tilt angle for clinical cervical vertebra trans-pedicle internal fixation.</p><p><b>METHODS</b>Thirty Chinese men and women underwent high-speed spiral computed tomography measurements to obtain data for C3 to C7, and the morphology of the cervical vertebra pedicles was reconstructed.</p><p><b>RESULTS</b>Reconstructed computer tomography image data revealed that: (1) pedicle sponge width increased incrementally from C3 to C7, (2) pedicle depth was similar for C3 to C7, (3) pedicle angle decreased incrementally from 47.20° to 33.76° for C3 to C7, and (4) pedicle point to midline distance was similar for C3 to C7. There were no statistical differences in morphological data between the right and the left side. Men had statistically larger values than women for all morphological parameters.</p><p><b>CONCLUSIONS</b>Reconstructed computed tomography images can provide useful data for clinical cervical vertebra trans-pedicle internal fixation. The individual measurement of cervical vertebra pedicles is recommended for safe placement of trans-vertebra pedicle screws.</p>


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Bone Screws , Cervical Vertebrae , Diagnostic Imaging , General Surgery , Image Processing, Computer-Assisted , Internal Fixators , Tomography, X-Ray Computed , Methods
11.
Chinese Journal of Surgery ; (12): 729-732, 2011.
Article in Chinese | WPRIM | ID: wpr-285654

ABSTRACT

<p><b>OBJECTIVES</b>To investigate the clinical features of femoral neck fractures and analyze related causes.</p><p><b>METHODS</b>The clinical data of patients with femoral neck fractures from June 2002 to August 2009 were retrospectively analyzed. The gender, age, fracture side, fracture type, basic social data, activities before injury, injury causes and treatment were analyzed.</p><p><b>RESULTS</b>A total of 219 patients (106 male and 113 female) was analyzed. All patients were divided into children group (age < 16 years), adult group (age ranged from 16 to 60 years) and older group (> 60 years). There were 5 patients (2.3%) in the children group, 81 patients (37.0%) in the adult group and 133 patients (60.7%) in the older group. There were 11 patients (5.0%) with Garden I fractures, 32 patients (14.6%) with Garden II fractures, 90 patients (41.1%) with Garden III fractures and 86 patients (39.3%) with Garden IV fractures. Fall damage and traffic injury were the main injury types. Home and public place were the main injury sites.</p><p><b>CONCLUSIONS</b>The incidence of femoral neck fracture shows the highest in the old persons. The male patients with femoral neck fractures are more than female patients in children and adult group, while the male patients with femoral neck fractures are less than female patients in older group. The dominant fractures type according to Garden classification is Garden III fractures in children and adult groups, but Garden IV fractures in older group. Fall damage and traffic injury are the main injury types. Home and public place are the main injury sites.</p>


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Femoral Neck Fractures , Diagnosis , Diagnostic Imaging , Epidemiology , Radiography , Retrospective Studies
12.
Chinese Medical Journal ; (24): 1748-1753, 2010.
Article in English | WPRIM | ID: wpr-241726

ABSTRACT

<p><b>BACKGROUND</b>Calcitonin gene-related peptide (CGRP), a sensory neuropeptide, affects osteoblast proliferation and bone formation. However, the mechanisms are not fully understood. Monocyte chemoattractant protein-1 (MCP-1) is a chemokine that stimulates the migration of monocytes and plays important roles in regulating bone remolding during fracture repair. In this study, we investigated the effects of CGRP on proliferation and MCP-1 expression in cultured rat osteoblasts.</p><p><b>METHODS</b>Primary rat osteoblasts were isolated from fetal rats calvariae. Cells were exposed to gradient concentrations (10(-9) to 10(-7) mol/L) of CGRP. Protein and mRNA levels of MCP-1 were quantified by Western blotting and semiquantitative reverse transcription-polymerase chain reaction, respectively. The protein level of MCP-1 was investigated and compared in cell culture media by enzyme linked immunosorbent assay (ELISA). Phospho-extracellular signal-regulated kinase (ERK) expression was detected by Western blotting. Cell proliferative activity was measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) and BrdU assay. The effects of MAPK/ERK kinase (MEK)-inhibitor U0126 on CGRP-induced MCP-1 expression in primary rat osteoblasts were examined.</p><p><b>RESULTS</b>CGRP effectively enhanced primary rat osteoblast proliferation and led to significant increases in the expression of MCP-1 mRNA and protein in time- and dose-dependent manners. CGRP activated the ERK pathway. Pretreatment of cultured rat osteoblasts with MEK inhibitor U0126 resulted in dose-dependent inhibitions of CGRP-induced MCP-1 mRNA and protein levels. Thus, CGRP promoted cell proliferation and stimulated MCP-1 expression in cultured rat osteoblasts.</p><p><b>CONCLUSION</b>These studies document novel links between CGRP and MCP-1 and illuminate the effects of CGRP in regulating bone remodeling.</p>


Subject(s)
Animals , Rats , Blotting, Western , Butadienes , Pharmacology , Calcitonin Gene-Related Peptide , Pharmacology , Cell Proliferation , Cell Survival , Cells, Cultured , Chemokine CCL2 , Genetics , Metabolism , Enzyme Inhibitors , Pharmacology , Enzyme-Linked Immunosorbent Assay , Extracellular Signal-Regulated MAP Kinases , Metabolism , Nitriles , Pharmacology , Osteoblasts , Metabolism
13.
Chinese Journal of Surgery ; (12): 213-216, 2010.
Article in Chinese | WPRIM | ID: wpr-254812

ABSTRACT

<p><b>OBJECTIVE</b>To discuss the efficacy of total elbow replacement in the treatment of complex distal humeral fractures.</p><p><b>METHODS</b>From May 2005 to October 2008 12 patients were retrospectively studied who were diagnosed complex fractures of the distal humerus and treated by total elbow replacement (Coonrad-Marrey). The mean age was 60 years old, the mean follow-up time was 12 months. According to AO classification, there was 3 C2 and 9 C3. The study included: pain evaluation, range of motion, elbow stability, muscle strength, complications, Mayo elbow score, DASH score, radiological assessment of ectopic bone formation and loosening.</p><p><b>RESULTS</b>Two cases with mild pain. The mean flexion is 98.3 degrees, extension limit is 17.9 degrees, mean pronation is 82.9 degrees and supination is 70.8 degrees. All joints were stable postoperatively. All patients were satisfied with the outcome. There was 1 case of superficial soft tissue nonhealing and 2 cases of ulnar nerve symptoms. No ectopic bone formation or loosening was found. Mayo elbow score was 3 cases of excellent and 9 cases of good. The mean DASH score was 41.3.</p><p><b>CONCLUSION</b>Total elbow replacement can be used in such conditions as severe osteoporosis, severe comminution that internal plates can not get stable fixation, severe cartilage damage (because of fracture or inflammatory arthritis) that indicate traumatic or inflammatory arthritis.</p>


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Arthroplasty, Replacement, Elbow , Follow-Up Studies , Humeral Fractures , General Surgery , Retrospective Studies , Treatment Outcome
14.
Chinese Journal of Traumatology ; (6): 270-274, 2010.
Article in English | WPRIM | ID: wpr-272905

ABSTRACT

<p><b>OBJECTIVE</b>To investigate prospectively the effectiveness of kyphoplasty with SKY bone expander system in treatment of compression fracture of thoracic/lumbar vertebrae and correction of the deformity.</p><p><b>METHODS</b>Twenty-five patients with thoracic/ lumbar vertebral osteoporotic compression fracture were admitted to our hospital between March 2007 and March 2008, and treated by kyphoplasty with SKY bone expander system. Patient's pain status was rated with Visual Analogue Scale (VAS) score system 1 day before and 1 hour, 48 hours, 6 months, 12 months after surgery. In addition, Rolland-Morris and Oswestry disability questionnaires (RDQ and ODI) were used for survey 1 day before and 1, 6, 12 months after surgery. Pre- and post-operative vertebral heights and Cobb's angles were measured based on the X-ray films and statistically analyzed.</p><p><b>RESULTS</b>There were 27 fractured vertebrae in these 25 patients. After SKY kyphoplasty, the Cobb's angles (9.8 degree ± 9.76 degree) were significantly reduced compared with preoperative angles (17.18 degree ± 9.35 degree P < 0.05), and the average improvement rate was 39%. Patients'pain VAS scores were also greatly improved after operation (P < 0.05). Moreover, postoperative RDQ and ODI scores were significantly smaller than preoperative values (P < 0.05).</p><p><b>CONCLUSIONS</b>Kyphoplasty with SKY bone expander system provides an effective method for treating thoracic/ lumbar vertebral osteoporotic compression fracture, with the advantages of small surgical wound and short duration. It can effectively recover the anterior and medial heights of fractured vertebrae (33% and 50%, respectively), reduce the Cobb's angle, quickly alleviate pain and improve patients'quality of life in a relatively short time period.</p>


Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Fractures, Compression , General Surgery , Kyphoplasty , Methods , Lumbar Vertebrae , Wounds and Injuries , Osteoporotic Fractures , General Surgery , Thoracic Vertebrae , Wounds and Injuries , Tissue Expansion Devices
15.
Chinese Medical Journal ; (24): 3015-3019, 2010.
Article in English | WPRIM | ID: wpr-285738

ABSTRACT

<p><b>BACKGROUND</b>Sacral nerve injury is a common complication of pelvic or sacral fractures. As the sacral nerve courser within the sacrum and has a complex relationship with the surrounding tissues, different parts of the sacral plexus injury have similar clinical symptoms and signs. Since lack of specific imaging technique in the diagnosis of sacral nerve injury, especially on multi-segment, multi-site, how to determine the preoperative location and extent of the sacral nerve injury accurately becomes a concern of the general orthopaedic and images practitioners. This study was conducted to gain an insight into the overall anatomical features of the sacral nerve (SN) on the same slice in high resolution computed tomography (HRCT) reconstruction and to determine the value of this information for the clinical diagnosis of related diseases.</p><p><b>METHODS</b>Fifty healthy volunteers and 30 patients (40 sides) with SN lesions confirmed by surgery were scanned using a 16-slice helical CT scanner (Light Speed, GE, USA). Among the patients, 6 with intervertebral disk hernia (6 sides), 8 with spinal stenosis (12 sides), 11 with pelvic trauma (14 sides), 4 with pelvic malignancies (6 sides), and 1 with sacral vertebral tuberculosis (2 sides). The SN multiplanar reconstruction was performed using a UNIX-based SCD4.1 workstation where the image was set on the same slice. All images were stored in the Digital Imaging and Communications in Medicine format. The display of nerves in different sections was analyzed using a five-graded scale with coordinate curves of each individual score. The overall anatomic features visible on the slice were analyzed and the abnormalities of the lesions were studied.</p><p><b>RESULTS</b>The image of the same slice clearly revealed the shape, running direction, thickness, tension and adjacent anatomy of the S1-S4 nerves. The rank of display rates in different sections was: outward-rotated oblique sagittal > outward-rotated oblique coronal > oblique coronal plane > coronal > sagittal > transverse section. The S5 nerve was partially displayed from the starting point to the segment around the posterior sacral foramen. The overall anatomy of the triangular sacral plexus was only revealed in the oblique outward-rotated sagittal section, while 100% of its individual rami, as well as two or three of the adjacent rami, were displayed from their starting points to the anterior border of the piriformis. The abnormalities included 39 sides of morphological change (97.5%), 38 sides of compression (95.0%), 35 sides of adhesion (87.5%), 32 sides of displacement (80.0%), 34 sides of shrinkage (85.0%), 6 sides of thickening (15.0%), and 2 sides of abruption (5.0%).</p><p><b>CONCLUSIONS</b>The 16-slice CT multiplanar reconstruction was able to reveal the overall anatomic features of the SN on the same slice. The section of reconstruction was a crucial factor in determining the display capability of various sacral nerves. This technology was valuable in the diagnosis and management of related diseases.</p>


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Image Processing, Computer-Assisted , Methods , Sacrum , Spinal Nerves , Diagnostic Imaging , Tomography, X-Ray Computed , Methods , Trauma, Nervous System , Diagnostic Imaging
16.
Chinese Journal of Surgery ; (12): 853-856, 2009.
Article in Chinese | WPRIM | ID: wpr-299723

ABSTRACT

<p><b>OBJECTIVE</b>To identify the overall anatomical characteristics and the clinical value of the lumbar nerves under CT multiplanar reconstruction.</p><p><b>METHODS</b>Fifty normal subjects and 30 patients with LN diseases (51 sides) were selected, including 10 patients with lumber intervertebral disk hernia, eight patients with spinal stenosis, 5 patients with spondylolisthesis, 1 patient with tethered cord syndrome, 1 patient with lumbar scoliosis, and 5 patients with spinal trauma The 16-slice helical CT (Light Speed, GE Company) was used for scanning the lumbar vertebra with multiplanar reconstruction in Workstation (ADW4.1) with UNIX System in DICOM format. The image was set on the same slice for the overall anatomy and manifestations of the lesions.</p><p><b>RESULTS</b>The same-slice imaging showed the strip-like LN slightly lower than the surrounding muscle in density. Each LN went out of the dural sac at an acute angle. The course of the lumbar plexus and its major branches, including the obturator nerve, femoral nerve and reproductive nerve, and their relations to the adjacent structures were clearly revealed. The percentage of the segments displayed was well associated with the reconstruction angle, with the order being oblique coronal > outward-rotated oblique coronal > oblique sagittal > coronal > sagittal section. The major manifestations of abnormal LN included compression and displacement (50 sides, 98.0%), morphological changes (49 sides, 96.1%), adhesion (41 sides, 80.4%).</p><p><b>CONCLUSIONS</b>The CT multiplanar reconstruction is ideal for the imaging of the overall size, shape, running and tension of the LN root; it is valuable in clinical diagnosis.</p>


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Case-Control Studies , Image Processing, Computer-Assisted , Lumbosacral Plexus , Diagnostic Imaging , Spinal Nerve Roots , Diagnostic Imaging , Tomography, Spiral Computed
17.
Chinese Journal of Surgery ; (12): 437-439, 2008.
Article in Chinese | WPRIM | ID: wpr-245561

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the clinical difference of locking and non-locking plates in the treatment of distal radial fractures in the elderly.</p><p><b>METHODS</b>Forty-nine patients with an average age of 68 years were included. The mean follow-up was 30 months. Five cases were traffic related injury, and others were simple falls. Fractures were classified according to AO classification system: 9 cases of A3, 4 cases of B, 11 cases of C1, 18 cases of C2, 7 cases of C3. Patients were grouped as locking group (29 cases) and non-locking group (20 cases).</p><p><b>RESULTS</b>Significant difference was not found between the two groups in active range of motion, Gartland and Werley score, radiological measurements and score.</p><p><b>CONCLUSION</b>Locking and non-locking plates have the same clinical outcome in the treatment of distal radial fractures in the elderly.</p>


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Bone Plates , Follow-Up Studies , Fracture Fixation, Internal , Radius Fractures , General Surgery , Retrospective Studies , Treatment Outcome
18.
Chinese Journal of Surgery ; (12): 1111-1113, 2007.
Article in Chinese | WPRIM | ID: wpr-340852

ABSTRACT

<p><b>OBJECTIVE</b>To improve the safety and accuracy of trans-pedicle internal fixation for cervical vertebra by the parameter data measuring by CT reconstruction.</p><p><b>METHODS</b>Thirty volunteers were enrolled and be subjected to high-speed spiral CT for getting the data of C3-C7. The data included pedicle point-midline distance, pedicle sponge width, pedicle angle. The cervical vertebra pedicle morphology were reconstructed.</p><p><b>RESULTS</b>Reconstructed CT image data displayed that pedicle sponge width become larger and larger from C3 to C7; the pedicle depth didn't change significantly even from C3 to C7; pedicle angle become small from C3 to C7 and the range is from 33.76 degrees to 47.20 degrees; pedicle point-midline distance were almost similar even from C3 to C7. There were not statistical differences between the right side and the left side, but there were statistical differences between man and woman.</p><p><b>CONCLUSION</b>Reconstructed CT image can provide useful data for clinical cervical vertebra trans-pedicle internal fixation.</p>


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Bone Screws , Cervical Vertebrae , Diagnostic Imaging , Fracture Fixation, Internal , Methods , Image Processing, Computer-Assisted , Tomography, Spiral Computed , Methods
19.
Chinese Journal of Surgery ; (12): 1602-1604, 2005.
Article in Chinese | WPRIM | ID: wpr-317218

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the biomechanics effect due to unilateral cortical bone defect of different size in long tubular bone.</p><p><b>METHODS</b>Seventy-six pieces of Sanhuang cock tibial were randomly divided into 7 groups. The unilateral diaphyses cortical were drilled holes of different size, include 1.5, 2.0, 2.5, 3.0, 3.5, and 4.5 mm, performed three-points bend single experiment. The intact bone cortical group was control group.</p><p><b>RESULTS</b>When there were bone structure destructions, the maximum of the bend load between 3 groups which bone defect diameter were 1.5 mm, 2.0 mm, and control was not significant difference (P = 0.824, 0.865), but the maximum of the bend load between 3 groups which bone defect diameter were 2.5, 3.0, and 3.5 mm decreasing about 14 percent of the control group (P = 0.015, 0.010, 0.021). and the maximum of the bend load which bone defect diameter were 4.5 mm decrease about 23 percent of the control group (P = 0.001).</p><p><b>CONCLUSIONS</b>If the diameter of bone cortical defect is within 22.63 +/- 1.39 percent of bone cortical outer diameter, there was no reduction of the bend load. If the diameter of bone cortical defect is beyond 29.36 +/- 2.07 percent of bone cortical outer diameter, it decreases the maximum bend load of the long tubular bone, but the reduced range is not complete with direct ratio to the bone defect size.</p>


Subject(s)
Animals , Biomechanical Phenomena , Chickens , Diaphyses , Wounds and Injuries , Random Allocation , Stress, Mechanical , Tibia , Wounds and Injuries , Weight-Bearing
20.
Chinese Journal of Surgery ; (12): 1344-1347, 2005.
Article in Chinese | WPRIM | ID: wpr-306109

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the possibility of bridging small peripheral nerve gap using a de-acetyl chitosan conduit.</p><p><b>METHODS</b>The sciatic nerves of right sides were cut at SD rats. They were divided into 5 Groups randomly; Group A: epineurium suture in situ (n = 24); Group B: biological conduit with a small gap for bridging the peripheral nerve (n = 24, with 5 mm gap); Group C: epineurium suture with distal stump rotated 180 degrees (n = 24); Group D: bridging the nerve by biological conduits with a small gap, but the distal stump rotated 180 degrees (n = 24, with 5 mm gap); Group E: biological conduit with a small gap for bridging the peripheral nerve with NGF (n = 24). Electrophysiological examination, histological examination and myelinated axon counting were applied after 2, 4, 6, 8 weeks after operation respectively.</p><p><b>RESULTS</b>Regenerated nerve fibers were seen in the distal nerve segments of all 5 groups; The nerve conduction velocity of small gap group (group B, D) was faster than that of corresponding simple epineurium suture group (group A, C) at all 2, 4, 6, 8 week time point (P < 0.05). The myelinated axon counting of small gap group (group B, D) was faster than that of corresponding simple epineurium suture group (group A, C) at all 4, 6, 8 week time point (P < 0.01), and there was no statistically significant difference at 2 week time point.</p><p><b>CONCLUSION</b>The repair effects of chitin conduit bridging peripheral nerve with small gap (5 mm) are better than that of epineurium suture directly, and possess the potential to substitute the epineurium suture.</p>


Subject(s)
Animals , Male , Rats , Biocompatible Materials , Chitosan , Nerve Regeneration , Neurosurgical Procedures , Methods , Random Allocation , Rats, Sprague-Dawley , Sciatic Nerve , Wounds and Injuries , Physiology , General Surgery
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