Effect of different pressure balloon dilation combined with prying reduction and bone graft fixation in the treatment of thoracolumbar fractures and the risk factors of postoperative re-fracture / 中国综合临床

Objective:To investigate the effect of different pressure balloon dilation combined with prying reduction and bone graft fixation in the treatment of thoracolumbar fractures and the risk factors of postoperative re-fracture.Methods:One hundred cases of thoracolumbar fracture patients admitted to Cangzhou Integrated Traditional Chinese and Western Medicine Hospital in Hebei Province from March 2019 to June 2021 were selected. Prospective randomized controlled study method was used and random number table method was used to divide them into three groups: incomplete expansion group (33 cases), moderate expansion group (33 cases) and complete expansion group (34 cases). All the 3 groups were treated with balloon dilation combined with prying reduction and bone graft fixation. The pressure of balloon dilation in incomplete dilation group, moderate dilation group and complete dilation group was 100 psi, 150 psi and no more than 200 psi respectively, and the volume of balloon dilation was 0.5∶1, 1∶1 and 1.5∶1 respectively. The operation time, intraoperative bleeding volume, postoperative drainage volume, vertebral anterior margin recovery rate and hospital stay, as well as local Cobb angle, visual analog scale (VAS) and Oswestry disability index (ODI) scores before and after operation were compared among the three groups. According to the follow-up of whether there is re-fracture after surgery, the clinical data of the re-fracture group and the non re-fracture group were compared, and the risk factors of the re-fracture after surgery were analyzed. The measurement data with normal distribution was expressed as: independent sample t-test was used for comparison between two groups, one-way ANOVA or repeated measurement ANOVA was used for comparison between three groups, and SNK-q test was used for comparison between two groups. Counting data were expressed in cases or cases (%), and compared between groups by χ 2 Inspection. Logistic regression was used to analyze the risk factors of refracture after thoracolumbar fracture. Results:There was no significant difference in operation time, intraoperative blood loss and postoperative drainage volume among the three groups ( P=0.096, 0.328 and 0.344, respectively). The recovery rate of vertebral anterior edge height in moderate expansion group was higher than that in incomplete expansion group and complete expansion group ((84.15±4.21)% vs (70.18±7.44)%, (75.94±6.56)%), and the hospitalization time was shorter than that in incomplete expansion group and complete expansion group ((10.38±2.35) d vs (15.18±3.44), (14.59±2.48) d) (all P<0.001). Before treatment, there was no significant difference in Cobb angle, VAS and ODI scores among the three groups (all P>0.05). After treatment, the Cobb angle, VAS and ODI scores of patients in the three groups were lower than those before treatment, and the moderate expansion group were lower than those in the incomplete expansion group and the complete expansion group ((14.08±2.15) ° vs (16.48±4.85) °, (15.06±3.45) °, (1.81±0.53)% vs (2.25±0.41), (2.31±0.42), (18.16±2.18)% vs (20.48±4.85), (20.01±4.45) points) (all P<0.001). 100 patients were followed up until the fracture was healed. They were divided into re-fracture group (15 cases) and non re-fracture group (85 cases) according to whether there was re-fracture after operation. The results of multifactor logistic regression analysis showed that body mass index and bone mineral density were protective factors for patients with thoracolumbar fracture after operation (odds ratio was 0.66 and 0.15 respectively, 95% confidence interval: 0.51~0.86, 0.05~0.42, P values were 0.006 and <0.001 respectively), The old wedge-shaped change of the vertebral body and the abnormal structure of the lumbar spine are the risk factors for postoperative re-fracture (odds ratio 4.22 and 6.36, 95% confidence interval 1.14-15.56 and 1.43-28.21, respectively, P values were 0.027 and 0.015). Conclusions:In the treatment of thoracolumbar fracture with prying reduction and bone grafting fixation, the effect of balloon expansion pressure of 150 psi is better. Body mass index (BMI) and bone mineral density (BMD) were protective factors for postoperative re-fracture of patients with thoracolumbar fracture. Old wedge-shaped change of vertebral body and abnormal lumbar structure are risk factors for postoperative re-fracture.

Research progress of tibial-graft fixation methods on anterior cruciate ligament reconstruction / 中国修复重建外科杂志

OBJECTIVE@#To review the studies about the tibial-graft fixation methods on anterior cruciate ligament (ACL) reconstruction, in order to provide clinical reference.@*METHODS@#The literature about the tibial-graft fixation methods on ACL reconstruction at home and abroad was extensively reviewed, and the factors that affect the selection of fixation methods were summarized.@*RESULTS@#The knee flexion angle, graft tension, and graft fixation device are mainly considered when the tibial-graft was fixed on ACL reconstruction. At present, the graft is mainly fixed at 0°/30° of knee flexion. The study shows that the knee joint is more stable after fixed at 30°, while the incidence of knee extension limitation decrease after fixed at 0°. In terms of graft tension, a good effectiveness can be obtained when the tension level is close to 90 N or the knee flexion is 30° to recover the affected knee over-restrained 2 mm relative to the healthy knee. In terms of the graft device, the interference screw is still the most commonly used method of tibial-graft fixation, with the development of all-inside ACL reconstruction in recent years, the cortical button fixation may become the mainstream.@*CONCLUSION@#Arthroscopic reconstruction is the main treatment of ACL rupture at present. However, there is no optimal fixation method for the tibial-graft, the advantages and disadvantages of each fixation methods need to be further studied.

The PUTRA Press-fit System as An Alternative Femoral Fixation Technique for Posterior Cruciate Ligament Reconstruction – A Technical Note and Outcome Evaluation

Abstract@#We describe our technique of single-bundle PCL reconstruction using a bony femoral press-fit system. 9 patients underwent PCL reconstruction using our pressfit system. The surgical procedure is described in detail. Post-operatively, 5 patients were available for assessment and review. Four patients gave a final Lysholm score of 92 – 100%. Three patients gave a Hospital for Special Surgery (HSS) score of excellent, one fair and one poor. Two patients gave a reduced Tegner activity score post-operatively while the other three gave a similar score post-operatively. Assessment using KT-1000 revealed four patients with a side-to-side difference of less than 3 mm (average side-to-side difference, 1.87 mm), while one patient exhibited a side-to-side difference of 5.8 mm. We believe that our technique enhances tunnel healing through usage of a bone-plug fixation and provides a cheap alternative for graft fixation on the femoral side in PCL reconstruction.

Injertos cutáneos, hábito de fumar y diabetes mellitus tipo 2 / Skin graft, smoking and diabetes mellitus type 2

El tabaco y la hiperglucemia reducen significativamente el éxito de los injertos cutáneos. El estrés oxidativo y la disfunción endotelial son factores que se asocian tanto al tabaquismo como a la diabetes mellitus (DM) tipo 2. El objetivo de este estudio fue constatar si existe una asociación entre estos factores de riesgo y el descenso en el porcentaje de éxito de los injertos en pérdidas cutáneas de diversa etiología. Estudio bicéntrico, retrospectivo, de casos y controles, llevado a cabo de enero 2000 a diciembre 2009, en los centros hospitalarios de Reina Sofía (Córdoba, España) y Birmingham (Alabama, EE.UU.), con 2457 pacientes que cumplían los criterios de inclusión. El éxito del injerto p ara cada grupo fue analizado mediante chi-cuadrado. El intervalo de confianza fue del 95%. El hábito de fumar y la DM tipo 2 disminuyeron el porcentaje de éxito de los injertos comparados con sus grupos controles, siendo el efecto de la DM tipo 2 mayor que el del tabaco. Se observó un descenso altamente significativo del porcentaje de injertos prendidos, del 18% en el grupo de fumadores (de 86% a 68%), y del 25% en el grupo de los diabéticos (de 78% a 53%). El cálculo de OR demostró asociación entre los factores de riesgo estudiados y el menor éxito de los injertos cutáneos, siendo mayor para la DM tipo 2. En conclusión: la DM tipo 2 y el hábito de fumar son factores que influyen negativamente en el éxito de los injertos cutáneos.

Smoking and hyperglycemia decrease the success of skin graft survival in specific circumstances. It is well known that smoking and diabetes mellitus (DM) type 2 increase the oxidative and impair the endothelial function. The objective of this retrospective study was to determine if smoking and DM type 2 are factors associated with lower skin graft survival, in different etiologies of the injury associated to the skin loss. It was a bicentric, retrospective, cross sectional case control study, carried out on 2457 medical patients who met the inclusion criteria. It was carried out over a 10 years period between January 2000-December 2009, at Reina Sofía University Hospital (Córdoba, Spain) and UAB Hospital at Birmingham (Alabama, USA). The percentage of successful graft for each group and its control were analyzed by Chi-square test. The confidence interval chosen for statistical differences was 95%. Smoking and DM type 2 decreased the percentage of skin graft survival when compared with their control groups. DM type 2 was associated with greater negative success on skin graft survival than smoking when compared with their control groups.. There was a statistically significant drop in skin graft of 18% in smoking group (range: 68-86%) and 25% in DM type 2 group (53-78%). The OR showed a clear association between the risk factors studied and the lower skin graft success, being stronger for DM type 2. In conclusion, DM type 2 and smoking are factors associated to lower skin graft take.

Cross Pins versus Endobutton Femoral Fixation in Hamstring Anterior Cruciate Ligament Reconstruction: Minimum 4-Year Follow-Up

PURPOSE: We aimed to compare cross-pin fixation and Endobutton femoral fixation for hamstring anterior cruciate ligament (ACL) reconstruction with respect to clinical and radiographic results, including tunnel widening and the progression of knee osteoarthritis (OA). MATERIALS AND METHODS: Between August 2002 and August 2005, 126 autogenous hamstring ACL reconstructions were performed using either cross pins or Endobutton for femoral fixation. Fifty-six of 75 patients in the cross-pin group and 35 of 51 patients in the Endobutton group were followed up for a minimum of 4 years. We compared the clinical and radiological results between the groups using the International Knee Documentation Committee (IKDC) evaluation form, the KT-2000 arthrometer side to side difference, the amount of tunnel widening and the advancement of OA on radiographs. RESULTS: There were no significant differences in the IKDC grades between the groups at the 4 year follow-up. There was no significant difference in the side to side difference according to KT-2000 arthrometer testing. Also, there were no significant differences in terms of tunnel widening or advancement of OA on radiographs. CONCLUSIONS: Endobutton femoral fixation showed good results that were comparable to those of cross pins fixation in hamstring ACL reconstruction.

Comparative study of femoral tunnel enlargement after hamstring anterior cruciate ligament reconstruction with different graft fixations / 中国矫形外科杂志

[Objective]To compare the changes in femoral bone tunnel after arthroscopically assisted hamstring ACL reconstruction with different graft fixations and investigate the relation with clinical effect.[Method]Eighty-eight cases in three groups were included and underwent hamstring ACL reconstruction with different femoral graft fixations for average 16.5 months follow-up evaluation.Twenty-six cases in group A received Endobutton fixation,twenty-two cases(group B) received interference screw,and forty cases(group C)received Rigidfix system.Femoral bone tunnel diameters at the articular line level,the widest point,1 cm away from tunnel aperture on sagittal MRI were compared at one week postoperatively.Lysholm score was used to evaluate the clinical effect.[Result]Tunnel enlargement after ACL surgery was noted in the three groups.At the femoral widest point and 1 cm away from tunnel aperture,the tunnel enlargement was larger in group B and smaller in group C.At the femoral articular line level,the bone tunnel enlargement in group C was smallest.There was no difference between those of groups A and B.The shape of femoral tunnel was lineal in groups A and C,and conical in group B.No significant difference was found by Lysholm score.[Conclusion]The type of graft fixation is a major factor in the development of tunnel enlargement after ACL surgery.No correlation between graft fixation,bone tunnel enlargement and clinical effect has been found.