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1.
Article in Chinese | WPRIM | ID: wpr-910057

ABSTRACT

A 3D printed patient-specific surgical guide plate is an auxiliary device made with the help of computer-aided design and 3D printing technology according to a surgical plan. It is used in reduction and internal fixation of fracture and specific corrective osteotomy as well. It is very adaptive as it has been widely used in trauma surgery, joint surgery and spine surgery, as well as in surgical treatment of bone tumors. Digital orthopedic technology is an important means to realize orthopedic precision medicine. This paper reviews the technical advantages, applications, main problems and future prospects of 3D printed patient-specific surgical guide plates in the field of orthopedics based on the recent literature.

2.
Article in Chinese | WPRIM | ID: wpr-910040

ABSTRACT

Objective:To investigate the effects of cortical comminution on therapeutic outcomes and postoperative complications in young patients with femoral neck fracture after fixation with femoral neck system (FNS).Methods:A retrospective study was conducted of the 86 patients with femoral neck fracture who had been treated by FNS fixation from January 2020 to December 2020 at Department of Hip Orthopaedic Trauma, Tianjin Hospital. Of them, 41 had cortical comminution at the fracture ends of the femoral neck. They were 16 males and 25 females with a mean age of 53.0 (40.5, 57.0) years. The other 45 patients had intact cortical bone at the fracture ends of the femoral neck. They were 21 males and 24 females with a mean age of 55.0 (44.5, 62.5) years. The 2 groups were compared in terms of incidence of postoperative complications, Harris hip score, Barthel index and visual analogue scale (VAS) pain score after 6-month follow-up.Results:There were no statistically significant differences between the 2 groups in baseline data or reduction mode except for fracture classification, showing comparability between groups ( P>0.05). In the cortical comminution group, the incidences of nonunion [17.1%(7/41)] and femoral neck shortening [29.3%(12/41)] were significantly higher than those in the cortical intact group [0% (0/45) and 11.1% (5/45)], the Harris hip score and Barthel index [82.0 (72.5, 91.5) points and 100.0 (90.0, 100.0)] at 6 months postoperatively were significantly lower than those in the cortical intact group [94.0 (88.0, 98.0) points and 100.0 (100.0, 100.0)], the VAS pain score [1.5 (0, 4.5) points] was significantly higher than that in the cortical intact group [0 (0, 1.0) points] (all P<0.05). However, there was no significant difference between the 2 groups in osteonecrosis of the femoral head or internal fixation failure ( P> 0.05). Conclusions:Cortical comminution following femoral neck fracture is a major risk factor for post-operative complications after FNS fixation, because it may seriously affect the recovery of hip function and quality of life in young patients.

3.
Chinese Journal of Trauma ; (12): 366-372, 2021.
Article in Chinese | WPRIM | ID: wpr-909877

ABSTRACT

The tibial plateau fractures is basically characterized by the collapse and split of the articular surface, increasing the difficulty of surgical reduction and fixation.The complex soft tissue structure adjacent to the tibial plateau prevents the reduction and fixation of tibial plateau fractures. The injuries associated with the fracture and surgical approach also aggravate the loss of knee joint stability. Therefore, the bony reconstruction and soft tissue protection of the knee joint have been the difficulties during the operation of tibial plateau fractures. The authors review the literatures relevant to the progress in surgical management of tibial plateau fractures from aspects of surgical approach, internal and external fixation technology, application of arthroscopic technique, balloon angioplasty, total knee arthroplasty, digital orthopedic technology and repair of soft tissue injury, hoping to provide references for clinical treatment of tibial plateau fractures.

4.
Journal of Medical Biomechanics ; (6): E284-E289, 2021.
Article in Chinese | WPRIM | ID: wpr-904399

ABSTRACT

Objective To investigate biomechanical characteristics of femoral neck fracture with different reduction qualities. Methods Three cases of Sawbones artificial femoral models were selected, and two cases of Pauwel III femoral neck fracture were modeled. Three cannulated screws were inserted into the models in the form of inverted triangle to fix the fracture. Two cases maintained different reduction qualities (defined as Model 1 and Model 2). In the 3 third case, no modeling operation was performed (defined as intact model). Then the strain gauges were respectively pasted on regions of interest of the 3 femoral models. Finally, the femur model was applied with the vertical load on mechanical testing machine. Results When the displacement of femoral head reached 4 mm, the average load of intact model, Model 1 and Model 2 was (236.30±5.35), (196.57±3.56), (69.50±2.95) N, showing significant differences. When the displacement of femoral head reached 5 mm, the average load of intact model, Model 1 and Model 2 was (276.7±3.40),(232.93±2.64),(80.83±4.54) N, showing significant differences. Conclusions The lower the reduction quality of the femoral neck fracture, the weaker the ability of the femur to bear stress, the higher the probability of nonunion, re-fracture and femoral head necrosis in the process of postoperative rehabilitation.

5.
Chinese Journal of Geriatrics ; (12): 962-966, 2021.
Article in Chinese | WPRIM | ID: wpr-910948

ABSTRACT

Sarcopenia, referred to as myopenia, is a systemic syndrome characterized by decreased muscle mass and muscle strength, and decline of motor function.The elderly are a high incidence group of myopenia.With the aging of the world's population becoming increasingly severe, the incidence rate of sarcopenia has also increased, which has brought a heavy burden to the elderly family and society, and has become an important social health problem for the elderly.At present, there are more and more researches on sarcopenia, but the pathogenic factors of sarcopenia are complex and diverse.The prevention and treatment of sarcopenia still need to be further explored and studied.The establishment of an ideal animal model is the key premise and basis for the related research of sarcopenia.In this paper, the different modeling methods, advantages and disadvantages as well as the scope of application of sarcopenia animal models are described, which can provide reference and help for the subsequent animal experimental research of sarcopenia.

6.
Chinese Journal of Orthopaedics ; (12): 1795-1802, 2021.
Article in Chinese | WPRIM | ID: wpr-910774

ABSTRACT

Objective:To compare the biomechanical properties of traditional surface hip prosthesis and bionic surface hip prosthesis.Methods:The Sawbone digital model (#3908, Left, Medium) was selected as the research object. Mimics 21.0 software was used to reconstruct the physical model of femur. Solidworks 16.0 software was used to build the model of prostheses, including the traditional and bionic (type 1-4) protheses and their assembly. The distances from the screw cross position to the top of pressure screw of type 1 to type 4 protheses were 20.22 mm, 30.12 mm, 32.17 mm and 37.76 mm, respectively. The mechanical distribution characteristics of the whole model were measured and the stress distribution cloud map was obtained.Results:The peak stresses at bone-stem junction of traditional prosthesis and type 1-4 hip prostheses were 32.18 MPa, 13.80 MPa, 15.01 MPa, 23.46 MPa and 34.51 MPa, respectively. With the fulcrums away from the top of the femur, the peak stresses at the fulcrums of type 1-4 hip protheses were 37.98 MPa, 48.60 MPa, 54.80 MPa, and 53.87 MPa, respectively. The maximum stress above femoral neck of traditional prosthesis and type 1-4 hip prostheses were 8.00 MPa, 7.80 MPa, 7.04 MPa, 7.03 MPa and 7.51 MPa, respectively. The maximum stresses under femoral neck was 15.38 MPa, 14.20 MPa, 11.11 MPa, 13.10 MPa and 12.18 MPa, respectively. The maximum stresses in the greater trochanter region of femur were 13.08 MPa, 11.61 MPa, 13.09 MPa, 11.02 MPa and 39.51 MPa, respectively.Conclusion:Compared with the traditional surface hip prosthesis, the type I bionic surface hip prosthesis is designed based on the lever balance reconstruction theory. With the bionic reconstruction of the tension trabeculae and compression trabeculae through reasonable screw placement angles and the inward movement of the fulcrum closer to the center of the femoral head, the new type prothesis make up for the design defects of the traditional surface hip prosthesis, optimize the stress distribution in the proximal femur, and improve the stability of the prosthesis after replacement, which help reduce the risk of femoral neck fracture and prosthesis loosening, and extend the service life of the prosthesis.

7.
Chinese Journal of Orthopaedics ; (12): 1046-1051, 2021.
Article in Chinese | WPRIM | ID: wpr-910689

ABSTRACT

Objective:To explore the influencing factors of delayed surgery for hip fracture in the elderly patients.Methods:A totally 779 elderly hip fracture patients who were hospitalized and operated in the first ward of the Department of Trauma and Hip Arthritis of Tianjin Hospital from January 2018 to December 2018 were collected. According to the time from admission to surgery, the patients were divided into early surgery group (received surgery within 48 hours after admission) 213 cases, delayed surgery group (received surgery more than 48 hours after admission) 566 cases. In this study, the following parameters were collected as potential factors affecting surgery, including: age, gender, fracture type, American Society of Anesthesiologists (ASA) classification, blood test indicators, chest radiograph, urine routine indicators, lower extremity venous thrombosis, and basic comorbidities, mental state, surgical methods, combined medication.Results:In the early operation group, there were 213 cases, 81 males and 132 females; age 69.9±10.2 years (range, 60-74 years); 95 cases of femoral neck, 118 of femoral intertrochanteric or subtrochanteric fractures; 128 cases of ASA I-II grade, 85 of III-V grade; 26 cases of abnormal cardiac function, 187 of normal; 23 cases of abnormal liver function, 190 of normal; 35 cases of abnormal renal function, 178 of normal; 104 cases of abnormal respiratory system, 109 of normal; 110 cases of electrolyte imbalance, 103 of normal; 96 cases were positive for urinary ketone bodies and 117 cases were negative; 86 cases had lower extremity venous thrombosis, 127 cases had no lower extremity venous thrombosis; 32 cases had mental disorders, and 181 cases had no mental disorders; internal fixation was selected in 102 cases, and artificial hip replacement was selected in 111 cases. There were 48 cases with combined medication and 165 cases without combined medication. In the delayed operation group, there were 566 cases, including 262 males and 304 females; age 71.7±15.6 years (range, 58-91 years); 224 cases of femoral neck fractures, 342 of femoral intertrochanteric or subtrochanteric fractures; 169 cases of ASA I-II, 397 of grade III-V; 169 cases of abnormal heart function and 397 of normal; 52 cases of abnormal liver function and 514 of normal; 90 cases of abnormal renal function and 476 of normal; 368 cases of abnormal respiratory system and 198 of normal; electrolyte imbalance 203 cases, 363 cases were normal; 261 cases were positive for urine ketone body, 305 cases were negative; 197 cases had lower extremity venous thrombosis, 369 cases had no lower extremity venous thrombosis; 141 cases had mental disorders, and 425 cases had no mental disorders; 226 cases had internal fixation as surgical method, 340 cases of artificial hip replacement were selected; 311 cases were combined with drugs, and 255 cases were not combined with drugs. There was no statistically significant difference between the early operation group and the delayed operation group in terms of age, gender, fracture type, abnormal liver function, abnormal renal function, urine ketone body, lower extremity venous thrombosis, and choice of surgical methods. There were statistically significant differences between the early operation group and the delayed operation group in terms of ASA classification, abnormal cardiac function, abnormal respiratory system, electrolyte disturbance, mental disorder, and combined medication. Multivariate Logistic regression analysis indicated that abnormal cardiac function, mental disorder, and combined medication were the influencing factors of delayed surgery for hip fracture in the elderly.Conclusion:The influencing factors of delayed surgery for hip fractures in the elderly are abnormal heart function, mental disorders, taking reserpine, clopidogrel and abnormal coagulation function.

8.
Chinese Journal of Orthopaedics ; (12): 405-411, 2021.
Article in Chinese | WPRIM | ID: wpr-884727

ABSTRACT

Objective:To investigate the feasibility and clinical effects of thoracic endoscopic-assisted anterior-lateral decompression and fusion for thoracolumbar or upper lumbar disc herniation (LDH) associated with vertebral osteochondrosis (VO).Methods:From December 2017 to December 2019, 10 patients of thoracolumbar or upper LDH associated with VO were treated with thoracic endoscopic-assisted anterior-lateral decompression and fusion, including 6 men and 4 women, with an average 49.2 years old (range, 37 to 65 years old). The involved levels included T 12L 1 in 5 cases, L 1, 2 in 2 cases and L 2, 3 in 3 cases. There were 4 cases of simple thoracolumbar or upper LDH associated with VO and 6 cases of thoracolumbar or upper LDH associated with VO combined with ligamentum flavum hyperplasia and ossification or kyphosis (combined with posterior decompression and internal fixation or posterior correction surgery). The visual analogue scale (VAS), Oswestry disability index (ODI) and anterior and posterior height of intervertebral space were evaluated at follow-up. The clinical effects were evaluated according to the modified MacNab criteria. Results:The operation was performed successfully in all the patients. During the operation, the herniated disc and ossification were clearly exposed and completely removed, with the sufficient decompression of spinal cord, nerve root and dural sac. The operation duration was 115.4±23.8 minutes (range, 70 to 180 mins). Intraoperative bleed loss was 122.6±21.3 ml (range, 40 to 310 ml). The patients were followed up for averagely 21.6 months (range, 12 to 36 months). At the final follow-up, VAS score decreased from preoperative 7.2±1.9 to 1.8±1.1, and ODI decreased from preoperative 64.3%±13.9% to 16.3%±5.1% ( P<0.05). The anterior height of intervertebral space recovered from preoperative 7.8±1.5 mm to 11.9±2.3 mm, and the posterior height of intervertebral space recovered from preoperative 4.5±1.1 mm to 7.4±1.6 mm ( P<0.05). According to modified MacNab criteria, the results were excellent in 9 cases and good in 1 case. Conclusion:For thoracolumbar or upper LDH associated with VO, thoracic endoscopic-assisted anterior-lateral decompression and fusion provided clear vision of the surgical field, fully exposed and completely removed the herniated disc and ossification, which achieved satisfactory short-term results.

9.
Chinese Journal of Orthopaedics ; (12): 157-164, 2021.
Article in Chinese | WPRIM | ID: wpr-884701

ABSTRACT

Objective:To analyze the clinical characteristics of patients with femoral neck fracture in Tianjin Hospital.Methods:Data of femoral neck fracture patients discharged from Tianjin Hospital from January 1, 2016 to December 31, 2017 were retrospectively analyzed. The gender, age, fracture type, injury mechanism and treatment method were collected.Results:Total of 2,150 eligible patients including 736 males and 1414 females were selected. There were significant differences in the gender distribution in different age groups ( χ2=91.63, P<0.001). Among young patients, males were more than females, while among middle-aged and elderly patients, females were more than males. The main type of fracture was displaced type (75.56%, 1,646/2,150), the displaced rate was the lowest in young patients (55.17%, 64/116), while it was the highest in old patients (81.91%, 1,159/1,415). The main injury mechanism of the three age groups were falls [young 61.21% (71/116), middle 80.29% (497/619), eldly 91.24% (1,291/1,415)]. There was a significant difference in the treatment methods between different age groups ( χ2=1,057.11, P<0.001). The main treatment method for young and middle-aged patients was internal fixation, no matter whether the fracture was displaced or not. The proportion of undisplaced patients with internal fixation (86.22%, 169/196) was higher than that of displaced patients with internal fixation (62.88%, 266/423) in middle-aged group ( χ2=34.93, P<0.001). In the elderly, more patients used internal fixation in undisplaced group, while more patients used hemiarthroplasty in displaced group. The age of old femoral neck fracture (median age was 74) was older than that of fresh fracture (median age was 70) ( Z=-2.777, P=0.005). And the displaced rate of patients with old femoral neck fracture (92.41%, 73/79) was higher than that of the fresh ones (75.95%, 1,573/2,071)( χ2=11.48, P=0.001). The patients with old femoral neck fracture usually adopt total hip replacement, while the proportion of three kinds of operation (internal fixation, hemiarthroplasty, total hip replacement) were similar among the fresh ones, and the internal fixation was the most. Conclusion:Femoral neck fracture is the most common in elderly women. The patients with displaced fracture are more than that with undisplaced fracture. Falling is the main injury mechanism in both young and old people. Internal fixation is commonly used in young and middle-aged patients, while arthroplasty is often used in elderly patients.

10.
Chinese Journal of Orthopaedics ; (12): 1019-1029, 2020.
Article in Chinese | WPRIM | ID: wpr-869055

ABSTRACT

Objective:To investigate the feasibility and accuracy of inserting two pedicle screws through different trajectories in the same pedicle.Methods:3D image data of 100 adults lumbar spine in the database of radiology department from March 2019 to October 2019 were randomly selected. The cancellous bone width and height of pedicles were measured by using Mimics software. The diameters of pedicle screws and revision screws were chosen according to the width of pedicles. A revision screw was implanted into the same vertebral pedicle after inserting a traditional pedicle screw. The successful rates were analyzed. The head inclination angles and outer inclination angles were measured.Results:1) Pedicle morphology: the height of L 1-L 5 pedicle cancellous bone were 10.94±2.22 mm, 9.76±1.82 mm, 9.47±1.77 mm, 8.71±1.52 mm, and 8.66±1.62 mm respectively, showing a trend of gradually decreasing. The width of L 1-L 5 pedicle cancellous bone were 5.01±1.61 mm, 5.48±1.69 mm, 6.95±1.79 mm, 8.58±1.85 mm, and 11.72±2.25 mm respectively, showing a trend of gradually increasing. 2) The successful rates of dual pedicle screws fixation: 57.2% dual pedicle screws fixation were successfully planned in 500 pedicles of 100 people. The successful rates of L 1-L 5 were 100%, 93.2%, 79.8%, 27.6%, and 11.0% respectively, showing a trend of gradually increasing. As the width of pedicles increased, the successful rates gradually decreased. (3) The angle of revision screws: the head inclination angles of L 1-L 4 revision screws were 9.73°±3.96°, 9.57°±4.58°, 9.13°±4.11°, and 6.10°±3.00° respectively, showing a decreasing trend; the outer inclination angles were 9.57°±3.85°, 8.76°±4.83°, 6.61°±4.93°, and 5.03°±5.80° respectively, showing a decreasing trend. The head inclination angle of L 5 revision screw was 28.42°±6.06° and the outer inclination angle was 150.58°±2.08°. Conclusion:CBW is related to the successful rate of dual trajectory pedicle screws fixation. Measurement of CBW is of great significance for the feasibility and accuracy of double-channel pedicle screws fixation before operation. The digital simulation of pedicle screw fixation provides reference for the clinical application of double-channel pedicle screws fixation.

11.
Chinese Journal of Orthopaedics ; (12): 893-901, 2020.
Article in Chinese | WPRIM | ID: wpr-869040

ABSTRACT

Objective:To evaluate the value and efficacy of self-anchored anterior lumbar discectomy and fusion (SA-ALDF) for L 5 isthmic spondylolisthesis. Methods:From June 2018 to December 2019, a total of 11 cases of L 5 isthmic spondylolisthesis were treated with SA-ALDF, including 4 men and 7 women, aged 43.2±12.6 (range 29-63) years. All patients had intractable low back pain aggravating during standing activities and alleviating during rest, without lower extremity radicular symptoms. Imaging examination showed bilateral isthmus cleft of L 5 with spondylolisthesis of 1 degree in 10 cases and 2 degree in 1 case according to Meyerding grading system. Under general anesthesia and supine French position, transverse 6 cm incision was made. Then, the L 5S 1 intervertebral disc was exposed via extraperitoneal approach between the bifurcation of abdominal aorta and vena cava. The intervertebral disc was sufficiently removed. The intervertebral space was released and distracted followed by canal ventral decompression and sequential mold testing. Suitable self-anchoring cage filled with auto iliac cancellous bone was implanted to restore intervertebral height and lordosis as well as reduction of spondylolisthesis. Under fluoroscopic guidance, the distal anchoring plate was knocked into the sacrum followed by direct reduction and proximal anchoring plate locking in the L 5 vertebral body. The patients were followed up for 12.1±4.7 (range 6-18) months. The visual analogue score (VAS) and Oswestry dysfunction index (ODI) were evaluated. The reduction and fusion were evaluated on the X-ray films. Furthermore, the rate of spondylolisthesis, the height and the lordosis of intervertebral space were measured. Results:The operation was performed successfully in all the patients with operation duration 90±18 (range 70-120) min, intraoperative blood loss 30±16 (range 10-60) ml. No severe complication such as nerve and blood vessel injury occurred. All patients experienced alleviation of symptom during follow-up. X-rays confirmed that the spondylolisthesis and alignment were recovered obviously without obvious cage displacement. However, the loss of reduction was 63.2% for the grade 2 spondylolisthesis. At the final follow-up, VAS decreased from 6.1±2.1 to 0.9±0.5, ODI decreased from 43.6%±14.2% to 6.0%±3.4%. The spondylolisthesis recovered from 17.7%±10.3% to 8.0%±7.2% with reduction rate of 54.8%±21.6%. The interverbral height recovered from 6.4±2.1 mm to 9.8±3.9 mm and intervertebral lordosis recovered from 4.8°±2.9° to 9.6°±4.7°.Conclusion:SA-ALDF can provide satisfactory outcomes for selected L 5 isthmic spondylolisthesis of degree 1 without neurological compromise. However, its mechanical stability may be insufficient for isthmic spondylolisthesis of degree 2.

12.
Chinese Journal of Orthopaedics ; (12): 536-545, 2020.
Article in Chinese | WPRIM | ID: wpr-868998

ABSTRACT

Objective:To evaluate the efficacy of self-anchored lateral lumbar interbody fusion (SA-LLIF) for lumbar degenerative diseases.Methods:During January to December in 2019, a total of 41 patients with lumbar degenerative disease were treated with SA-LLIF, included 18 males and 23 females, aged 59.6±11.3 (range 49-77) years. There were lumbar stenosis and instability in 17 cases, disc degenerative disease in 8 cases, degenerative spondylolisthesis in 8 cases, degenerative scoliosis in 5 cases, postoperative revision in 3 cases. And osteoporosis was diagnosed in 5 of them. The index level included L 2, 3 in 2 cases, L 3, 4 in 11 cases, L 4, 5 in 20 cases, L 2-L 4 in 3 cases and L 3-L 5 in 5 cases. After general anesthesia, the patient was placed in decubitus position. The anterior edge of psoas major muscle was exposed through 6 cm incision and extraperitoneal approach. Further, the psoas major muscle was properly retracted to expose the disc. After discectomy, the intervertebral space was prepared and moderately distracted. A suitable fusion cage filled with auto iliac graft was implanted. Two anchoring plates were inserted into the cage. Then, the caudal and cephalic vertebral body and the fusion cage were locked. Results:The operation was performed successfully in all the patients. The operation duration was 79.0±19.5 (range 60-100) min. Intraoperative bleed loss was 38.0±28.2 (range 15-70) ml. The patients were followed up for averagely 10.6±4.6 (range 4-15) months. The visual analogue scale decreased from preoperative 6.2±2.1 to 1.6±1.1 and Oswestry disability index decreased from 47.8%±15.1% to 11.0%±7.3%. X-ray showed that the spine alignment recovered satisfactorily. No cage displacement was found. Sinking (2-3 mm) of cage was found in 7 patients without obvious symptom despite transient lumbar pain in an obesity woman. The lumbar lordosis recovered from 36.4°±10.2° to 48.0°±10.7°, and intervertebral height recovered from 8.3±2.5 mm to 11.3±3.3 mm. The rate of spondylolisthesis recovered from 19.7%±4.4% to 9.3%±5.3%.Conclusion:SA-LLIF can provide immediate stability and good results for lumbar degenerative diseases with stand-alone anchoring cage without posterior internal fixation.

13.
Chinese Journal of Orthopaedics ; (12): 154-159, 2020.
Article in Chinese | WPRIM | ID: wpr-868958

ABSTRACT

Objective To explore the clinical effects of Nice knot combined with elastic compress and stretch in treating skin and soft tissue defect.Methods From August 2017 to April 2019,a total of 23 patients,10 males and 13 females,aged 36.5±5.3 years (range 26-76 years),were retrospectively analyzed.The defect size was 60±5.3 cm2 (28-96 cm2).Under local anesthesia,the wound was debrided thoroughly,sutured and fixed by Nice knot.The wound was fixed by elastic dressing and traction.The wound was retracted every 3 days during dressing change.The wound healing grade,healing rate,healing time,and postoperative Vancouver Scar Scale (VSS) were observed and recorded.Results All operations were performed successfully in the debridement room.The operation time was 42±10.5 min (range 30-50 min),intraoperative bleeding 30±2.5 ml (range 20-60 ml),and the operation cost 180±11.5 RMB (range 160-240 RMB).Twenty patients were followed up for 4±2.5 months (range 3-6 months).The wound healing rate of 23 patients was 50%±3.5% (range 40%-56%).For the 20 patients,the wound healing rate was 65%±4.3% (range 53%-75%),74%±4.5% (range 65%-80%),83%±1.8% (range 76%-85%),90%±1.6% (range 84%-95%) and 95%±3.5% (range 94%-98%) at 3,6,9,12 and 15 days,respectively.The wound healing rate of 20 patients was 100% at the 42nd days of follow-up.Wound healing rate of Grade A and grade B was 95% (19/20) with scar VSS score 4(3,6).The excellent and good rate of grade B was 80% (16/20).Two cases were sutured and fixed with Nice knot after 10 days because of the partial loss of the sutures.One case was treated with vacuum sealing drainage (VSD) on-line junction because infection was not completely controlled.Local infection was controlled and the wound was contracted by Nice junction at 1 week.Conclusion The treatment of skin and soft tissue defect with Nice combination with elastic dressing and traction has the advantages of simple operation,low operation condition,short operation time,less bleeding,low cost,high wound healing grade and healing rate,suitable for basic level hospital application and promotion.

14.
Article in Chinese | WPRIM | ID: wpr-867855

ABSTRACT

Posttraumatic ankle arthritis caused by trauma, a common articular disease, mainly destroys the biomechanical balance of the ankle joint and results in degeneration of the joint.It often occurs in young people, leading to articular pain and stiffness and other symptoms which may deteriorate to end-stage posttrau-matic ankle arthritis with no intervention.At present, a variety of therapies are available for the disease. However, no domestic literature has addressed the choice and application of its treatment methods.To be useful in clinic, this review deals with the etiology, diagnosis and treatment (including choice, efficacy, indications and contraindications) of the disease.

15.
Chinese Journal of Trauma ; (12): 577-586, 2020.
Article in Chinese | WPRIM | ID: wpr-867755

ABSTRACT

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.

16.
Chinese Critical Care Medicine ; (12): 513-517, 2020.
Article in Chinese | WPRIM | ID: wpr-866883

ABSTRACT

With the rapid development of modern society, high energy injury has greatly increase as compared with the past, and the number of trauma patients seeking medical treatments has risen year by year. Trauma emergency medicine has become the reflection of the service level and medical quality of medical institutions, as well as the hospital administrators' attention and concern to this discipline. This paper aims to elaborate the status and role of emergent medicine of trauma in the development of hospitals, to review the significant experience in the construction and reform of Tianjin Trauma Emergence Center, and put forward the prospect of future disciplines and center construction in combination with the practice.

17.
Chinese Journal of Orthopaedics ; (12): 154-159, 2020.
Article in Chinese | WPRIM | ID: wpr-799740

ABSTRACT

Objective@#To explore the clinical effects of Nice knot combined with elastic compress and stretch in treating skin and soft tissue defect.@*Methods@#From August 2017 to April 2019, a total of 23 patients, 10 males and 13 females, aged 36.5±5.3 years (range 26-76 years), were retrospectively analyzed. The defect size was 60±5.3 cm2 (28-96 cm2). Under local anesthesia, the wound was debrided thoroughly, sutured and fixed by Nice knot. The wound was fixed by elastic dressing and traction. The wound was retracted every 3 days during dressing change. The wound healing grade, healing rate, healing time, and postoperative Vancouver Scar Scale (VSS) were observed and recorded.@*Results@#All operations were performed successfully in the debridement room. The operation time was 42±10.5 min (range 30-50 min), intraoperative bleeding 30±2.5 ml (range 20-60 ml), and the operation cost 180±11.5 RMB (range 160-240 RMB). Twenty patients were followed up for 4±2.5 months (range 3-6 months). The wound healing rate of 23 patients was 50%±3.5% (range 40%-56%). For the 20 patients, the wound healing rate was 65%±4.3% (range 53%-75%), 74%±4.5% (range 65%-80%), 83%±1.8% (range 76%-85%), 90%±1.6% (range 84%-95%) and 95%±3.5% (range 94%-98%) at 3, 6, 9, 12 and 15 days, respectively. The wound healing rate of 20 patients was 100% at the 42nd days of follow-up. Wound healing rate of Grade A and grade B was 95% (19/20) with scar VSS score 4(3, 6). The excellent and good rate of grade B was 80% (16/20). Two cases were sutured and fixed with Nice knot after 10 days because of the partial loss of the sutures. One case was treated with vacuum sealing drainage (VSD) on-line junction because infection was not completely controlled. Local infection was controlled and the wound was contracted by Nice junction at 1 week.@*Conclusion@#The treatment of skin and soft tis sue defect with Nice combination with elastic dressing and traction has the advantages of simple operation, low operation condition, short operation time, less bleeding, low cost, high wound healing grade and healing rate, suitable for basic level hospital application and promotion.

18.
Chinese Journal of Orthopaedics ; (12): 1413-1420, 2019.
Article in Chinese | WPRIM | ID: wpr-803257

ABSTRACT

Osteochondral defects caused by various factors are still difficult clinical problems. With the development of tissue engineering, the strategies and methods for repairing osteochondral defects in the past decade have made great progress, and some osteochondral tissue stratified stent products have gradually entered the clinical trial stage.. The related articles on tissue engineering for the treatment of osteochondral defects were retrieved by searching databases with key words osteochondral defects, cartilage repair and hierarchical scaffolds. This paper discussed the research status of hierarchical scaffolds in osteochondral tissue engineering during recent five years. In this work, the classification of hierarchical scaffold including monophasic scaffolds, bilayered scaffolds, multilayered scaffolds and gradient scaffolds, are summarized by comparing different experiment researches. Furthermore, the advantages and disadvantages of different types of hierarchical scaffolds were introduced through analyzing relevant studies. Monophasic scaffolds can support the adhesion and proliferation of osteoblasts and chondrocytes, but lack the inherent stratified structure features required for osteochondral regeneration.. Bilayered scaffolds consist of a chondral layer and subchondral layer which base on the biocompatibility of monophasic scaffolds. Biphasic scaffolds are significantly better than monophasic scaffolds in simulating natural cartilage, but the interface between chondral and subchondral layer is poor binding. Compared with bilayered scaffold, trilayered scaffolds are added with an intermediate layer which simulates the calcification of normal cartilage between the two layers, so as to obtain better connection of the bone and cartilage layer. Unlike hierarchical scaffolds, gradient scaffolds provide a gradient connection between the layers, which is more similar to the native osteochondral tissue. In the past five years, the development of osteochondral layered scaffolds mainly depended on the novel structure and fabrication methods of scaffolds. However, correlational clinical studies are quite few. Further high quality and large clinical studies are still required.

19.
Chinese Journal of Orthopaedics ; (12): 1293-1300, 2019.
Article in Chinese | WPRIM | ID: wpr-803176

ABSTRACT

Objective@#To investigate the clinical characteristics and outcomes of Maisonneuve fractures.@*Methods@#Data of 21 cases of Maisonneuve fractures from February 2015 to December 2017 were retrospectively analyzed. There were 16 males and 5 females with an average age of 38.8 years (range, 21 to 61 years). The fractures occurred on the left side in 11 patients and on the right side in 10 patients. The causes of injuries were traffic accident in 4 patients, sprain injury in 9 patients and falling injury from height in 8 patients. There were 16 cases of medial malleolar fractures and 5 cases of ruptures of deltoid ligament (4 entirely and 1 partial). There were 17 cases of fractures of the posterior malleolus, among which there were 5 of typeⅠ, 8 of typeⅡ and 4 of type Ⅲ according to the Bartonícek classification of posterior malleolus. There were 4 cases without fracture of posterior malleolus including 1 complete disruption of posterior inferior tibiofibular ligament. Four cases were overlooked of Maisonneuve fracture at the first time. The interval between injury and operation was 2-12 days (mean, 4.9 days).@*Results@#Stabilization of proximal fibular fractures were achieved with plate in 3 cases. There were 16 cases of medial malleolar fractures, and the fixation were achieved with cannulated screws in 13 cases and with anti-glide plates in 3 cases. The entirely rupture of deltoid ligament was repaired in 4 cases with suture anchors, the partial rupture of deltoid ligament was not repaired. There were 17 cases of posterior malleolar fractures, 12 cases treated with open reduction and internal fixation including cannulated screws in 9 cases and anti-glide plates in 3 cases. Stabilization of syndesmosis was achieved with syndesmotic plate in 1 case; the medial and posterior malleolar fractures were stabilized and anterior inferior tibiofibular ligament was repaired with suture anchor in 1 case; the other 19 cases were stabilized with syndesmotic screws, 2 screws in 11 cases and 1 screw in 8. Twenty-one patients were followed up for 13-48 months with an average of 25.6 months. The time of bony union was from 3 to 6 months with an average time of 4.9 months after operation. All patients received anatomical reduction without postoperative complications such as incision infection, reduction lose, breakage of screw and posttraumatic arthritis. In 13 cases, the syndesmotic screw was removed at the mean time of 15.38 weeks postoperative (range, 13-25 weeks). At the latest follow up, AOFAS score was from 84 to 100, with excellent in 13 cases, good in 8 cases, and the excellent and good rate was 100% (21/21). Baird-Jackson score was from 83 to 100, with excellent in 11 cases, good in 8 and fair in 2, and the excellent and good rate was 90.48%(19/21).@*Conclusion@#The diagnosis of proximal fibular fracture of Maisonneuve fracture is easily missed. The complete rupture of deep deltoid ligament and displaced obviously of posterior malleolar fracture should be reduction and stabilization. The accuracy of reduction of the syndesmosis is of great concern. The outcome of operation is satisfied.

20.
Article in Chinese | WPRIM | ID: wpr-734406

ABSTRACT

Objective To evaluate the clinical outcomes and correction accuracy of deformities around the knee joint using external fixator-assisted internal fixation (FAIF).Methods From January 2014 to March 2018,data of 15 patients (17 bone segments) with deformities around the knee joint who had been corrected with external fixator-assisted internal fixation were retrospectively analyzed.There were 6 males and 9 females,with an average age of 39 years (range,21-60 years).There were 9 patients with genu varus and 6 with genu valgus.All the 15 patients had shortening ranging from 5 to 22 mm,with an average of 12 mm.Unilateral external fixator was used to stabilize the osteotomy site intraoperatively until the satisfied mechanical axis was acquired.Then the plate or Intramedullary nail was inserted and fixed,the external fixator was removed after internal fixation.Results Femur osteotomy was done in 7 patients and tibia osteotomy was done in 6 patients,while 2 patients had osteotomy in both tibia and femur.Intramedullary nailing was used in 2 bone segments,and plate was used in 15 bone segments.The correction of angle ranged from 7° to 22°,with an average of 12.5°.The correction of the 9 cases of genua varus ranged from 10° to 22°,with an average of 17.6°.The correction of the 6 cases of genu valgum ranged from 7° to 13°,with an average of 10.4°.The mean time to achieve union of the osteotomy sites was 3.5 months (range,2.5-5.0 months).All the 15 patients were followed up for 8-48 months (average,23 months).The mechanical axis deviation (MAD) was 5.93 mm (range,0-15 mm) after operation which was 34.8 mm (range,8-55 mm) before operation.The mean post-operative mechanical lateral distal femoral angle (mLDFA) was 87.5° (range,84°-90°) which was 76.1° (range,66°-82°) before operation.The mean medial proximal tibia angle (MPTA) was 87.8° (range,86°-89°) which was 76.8° (range,68°-80°) before operation.There were no deep infection and neurovascular injury.Conclusion The FAIF not only has the advantage of minimal invasiveness and easy adjustment,but also can avoid uncomfortableness and complications of long-term of wearing the external fixator.It is an accurate and safe method to correct the deformities around the knee joint.

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