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OBJECTIVE@#To explore the effectiveness of the percutaneous parallel screw fixation via the posterolateral "safe zone" for Hawkins type Ⅰ-Ⅲ talar neck fractures.@*METHODS@#A retrospective analysis was conducted on the clinical data from 35 patients who met the selection criteria of talar neck fractures between January 2019 and June 2021. According to the surgical method, they were divided into a study group (14 cases, using percutaneous posterolateral "safe zone" parallel screw fixation) and a control group (21 cases, using traditional open reduction and anterior cross screw internal fixation). There was no significant difference in gender, age, affected side, Hawkins classification, and time from injury to operation between the two groups ( P>0.05). The operation time, bone healing time, complications, and Hawkins sign were recorded, and the improvement of pain and ankle-foot function were evaluated by visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score at last follow-up. The overall quality of life was assessed by the short form of 12-item health survey (SF-12), which was divided into physical and psychological scores; and the satisfaction of patients was evaluated by the 5-point Likert scale.@*RESULTS@#The operation time in the study group was significantly shorter than that in the control group ( P<0.05). All patients werefollowed up 13-35 months, with an average of 20.6 months; there was no significant difference in the follow-up time between the two groups ( P>0.05). The time of bone healing in the study group was shorter than that in the control group, and the positive rate of Hawkins sign (83.33%) was higher than that in the control group (33.33%), and the differences were significant ( P<0.05). In the control group, there were 2 cases of incision delayed healing, 7 cases of avascular necrosis of bone, 3 cases of joint degeneration, 1 case of bone nonunion, and 3 cases of internal fixation irritation; while in the study group, there were only 2 cases of joint degeneration, and there was a significant difference in the incidence of complications between the two groups ( P<0.05). At last follow-up, there was no significant difference in VAS score between the two groups ( P>0.05), but the SF-12 physical and psychological scores, AOFAS ankle and hindfoot scores, and patients' satisfaction in the study group were significantly better than those in the control group ( P<0.05).@*CONCLUSION@#The treatment of Hawkins type Ⅰ-Ⅲ talar neck fractures with percutaneous parallel screw fixation via the posterolateral "safe zone" can achieve better effectiveness than traditional open surgery, with the advantages of less trauma, fewer complications, faster recovery, and higher patient satisfaction.
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Humans , Retrospective Studies , Quality of Life , Fractures, Bone/surgery , Fracture Fixation, Internal/methods , Bone Screws , Joint Dislocations , Treatment OutcomeABSTRACT
Objective: To evaluate the effectiveness of percutaneous retrograde pubic screw implantation assisted by hollow pedicle opener in pubic branch fractures. Methods: The clinical data of 42 patients with pubic branch fractures treated by hollow screw fixation between March 2008 and March 2019 were analyzed retrospectively. According to the operation method, they were divided into the traditional operation group (20 cases in group A, fixed with traditional retrograde pubic screws) and the modified operation group (22 cases in group B, fixed with percutaneous retrograde pubic screws assisted by hollow pedicle opener). There was no significant difference ( P>0.05) between the two groups in terms of gender, age, cause of injury, fracture classification, comorbidity, and time from injury to operation. The operation time, blood loss, incision length, screw length, and complications were recorded and compared between the two groups. The fracture reduction was evaluated according to Matta standard on the next day after operation, and the function was evaluated by Majeed score at 12 months after operation. Results: The operation was successfully completed in both groups. The operation time, blood loss, and incision length of group B were significantly less than those of group A ( P0.05). Conclusion: Percutaneous retrograde pubic screw implantation assisted by hollow pedicle opener is effect for the pubic branch fractures with the advantage of smaller incision, shorter operation time, and less bleeding compared with traditional methods.
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Objective To discuss the feasibility and clinical application of percutaneous internal fixation (PIF) combined with pecutaneous osteoplasty (POP) for the treatment of metastasis of proximal femur with impending pathological fracture. Methods Six consecutive patients with metastases of the proximal femur, who could not be able to tolerate conventional surgery, underwent PIF together with POP. The results were analyzed. Results The procedure was successfully accomplished in all six patients. Neither pulmonary embolism nor death occurred in all patients during and after the operation. No fracture at operated area was observed during follow-up period. Conclusion For stabilization of proximal femoral metastatic lesion with impending pathological fracture, percutaneous internal fixation combined with pecutaneous osteoplasty is a safe and effective technique.
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Objective To compare the value of arthroscopic assisted percutaneous internal fixation and open reduction and internal fixation in treatment of tibial plateau fracture.Methods The clinical data of 180 patients of tibial plateau fracture were analyzed retrospectively,including 112 patients of type Ⅱ fracture (group A) and 68 patients of type Ⅲ fracture (group B).The patients in group A and group B were divided into group A1 (56 patients),A2 (56 patients),B 1 (34 patients),B2 (34 patients) respectively according to the odd number and even number of admission date.The patients in group A1 and B1 received open reduction and internal fixation and the patients in group A2 and B2 received arthroscopic assisted percutaneous internal fixation.The postoperative functional recovery was compared and evaluated between the same type of tibial plateau fractures under different treatments.Results In group A1:the postoperative functional recovery,the excellent was 12 patients,the good was 26 patients,the middle good was 12 patients,the bad was 6 patients.The rate of the excellent and the good was 67.9％ (38/56).In group A2:the postoperative functional recovery,the excellent was 19 patients,the good was 34 patients,the middle good was 3 patients.The rate of the excellent and the good was 94.6％(53/56).The rate of the excellent and the good between group A1 and group A2 had significant difference (P ＜ 0.01).After operation for 6 months,the HSS scores of knee joint and degree of flex and extend in group A1 and A2 had significant difference [(73.21 ± 8.32) scores vs.(85.58 ±9.89) scores,(35.6 ±6.6)° vs.(55.1 ±8.8)°] (P ＜0.01).In group B1:the postoperative functional recovery,the excellent was 8 patients,the good was 16 patients,the middle good was 7 patients,the bad was 3 patiens.The rate of the excellent and the good was 70.6％(24/34).In group B2:the postoperative functional recovery,the excellent was 12 patients,the good was 21 patients,the middle good was 1 patient.The rate of the excellent and the good was 97.1％(33/34).The rate of the excellent and the good between group B1 and group B2 had significant difference(P ＜ 0.01).After operation for 6 months,the HSS scores of knee joint and degree of flex and extend in group B1 and B2 had significant difference [(75.32 ± 7.99) scores vs.(86.41 ±10.21) scores,(33.9 ±7.2)° vs.(56.6 ± 10.5)°](P＜0.01).Conclusions The efficacy of arthroscopic assisted percutaneous internal fixation is better than open reduction and internal fixation either in type Ⅱ fracture or in type Ⅲ fracture.This method is mini-invasive and is worthy to spread.
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[Objective]To explore the feasibility and effect of modified minimally invasive percutaneous pedicle screws osteosynthesis for the treatment of thoraco-lumbar vertebra compression fracture.[Method]Twelve cases of thoraco-lumbar fracture without neural impairment were enrolled who did not need laminotomy decompression from June 2005 to June 2007.With the help of C-arm image intensifier,the pedicle screws were inserted through four small longitudinal incisions(1-1.5 cm)and modified surgical instruments.Perioperative parameter,postoperative imaging index,visual analog scale(VAS)and Oswestry Disability Index(ODI)were compared with the treatment of conventional open pedicle screws osteosynthesis in other 18 cases.[Result]All cases were followed up from 8 to 25 months(mean 13.2 months).The operation time and length of stay in minimal invasive group were significantly shorter than that in conventional group,the amount of operative bleeding and drainage of postoperation decreased obviously(P
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[Objective]To analyze the clinical effect of intertrochanteric fractures treated with percutaneous proximal femoral nails(PFN).[Method]From January 2004 to May 2009,PFN using percutaneous technique was performed in 180 elderly patients of femoral intertrochanteric fractures(180 hips,80 males and 98 females),with mean age of 76 years(range from 57-99 years).According to Evans classification,12 cases were type Ⅰ,28 were type Ⅱ,62 were Ⅲa,20 were Ⅲb,49 were Ⅳ,9 were Ⅴ.Traction table and C-arm fluroscopic intensifier were used with close reduction and interlocking during the course of operation.[Result]One hundred and seventy two cases in 180 patients were followed up for 8 to 21 months with a mean of 13.5 months.Other 8 patients were lost to follow up after discharge.Of 172 patients followed up,166 cases' radiographs showed the callus during 6-8 weeks postoperatively,while they had a full range of hip motion as the original level.Partial weight bearing exercises were carried out since the 8th postoperative week.The time of clinical fracture healing was from 12 to 16 weeks,the rate of healing was 98.8%.In the function assessment of 172 patients the satisfactory rate reached to 87.8 percents.[Conclusion]Percutaneous proximal femoral nails is an ideal way for the treatment of intertrochanteric fractures in aged because of its simple procedure,minimal invasion,less fluoroscopy exposures,less complications,stable fixation,early fracture healing and satisfied functional outcomes.
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Objective To evaluate the efficacy of percutaneous internal fixation with hollow screw for femoral neck fractures.Methods From June 2001 to June 2004,48 cases of femoral neck fractures,including 22 cases of fracture without displacement(type Garden I and II) and 26 cases of fracture displacement(type Garden III and IV),were treated by close reduction and percutaneous internal fixation with 3 hollow screws forming inverse triangle.Results The intraoperative blood loss was less than 10 ml,and the average operation time was 32.5 min(range,18-54 min).48 cases were followed up for 24-61 months(mean,38.2 months),union of fracture found in 97.9%(47/48) of cases,union time being 4-12 months(mean,6.2 months).According to Harris score of hip joint function,32 cases were excellent,11 cases good,3 cases fair,2 cases bad,the rate of excellent and good results being 89.6%(43/48).In 22 cases of fracture without displacement,there was no nonunion and ischemic necrosis of head of femur.In 26 cases of fracture displacement,the rate of nonunion and ischemic necrosis of head of femur were 3.8%(1/26) and 11.5%(3/26) respectively.Conclusions Percutaneous internal fixation with hollow screw has the advantages of ideal curative effects,simple procedure,reliable fixation and less complications.