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PURPOSE@#This study was designed to compare the clinical efficacy of "8" and "0" wire fixation systems combined with double-head cannulated compression screws or Kirschner wires for the treatment of transverse patellar fractures.@*METHODS@#From September 2011 to September 2018, patients with closed transverse patellar fractures treated with a double-head compression screw or Kirschner wire were included and analyzed retrospectively. Patients with patellar fractures combined with distal femoral fractures, tibial plateau fracture or preoperative lower limb dysfunction were excluded. The patients treated with the "8" tension band wire fixation system and Kirschner wire were taken as Group A; those treated with the "0" fixation system and Kirschner wire were taken as Group B; those treated with the "8" fixation system and double-head cannulated compression screw were taken as group C; and those treated with the "0" fixation system and double-head cannulated compression screw were taken as group D. Six weeks and one year after the operation and every month from the third month after the operation until the fractures healed, an X-ray examination was performed to identify fracture healing. The time of fracture healing and postoperative complications of the four groups were compared. One year after the operation, knee function was evaluated by Bostman's score.@*RESULTS@#During the study period, 168 patients with patellar fractures were treated by operations, and 88 patients were excluded because the fracture type did not meet the requirements or because there were combined fractures of the distal femur or tibial plateau. As a result, 80 patients were included in this study, 20 in each group. All the patients were followed up for an average period of 12.2 months. Compared with Group A, patients in Group D presented less postoperative discomfort in the prepatellar region, quicker fracture healing, less fixation failure and better postoperative knee function scores (all p 0.05).@*CONCLUSION@#The "0" wire fixation system combined with a double-head cannulated compression screw seems to be more beneficial than the other three fixation systems for the treatment of transverse patellar fractures.
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Purpose: The aim of this study is to compare the outcome and complications in patients who underwent double-head pterygium excision with split conjunctival autograft with and without limbus to limbus orientation. Methods: In this retrospective, comparative study, 99 eyes with double-head pterygium which underwent split conjunctival autograft with limbus to limbus orientation (Group 1) and 93 eyes which underwent without limbus to limbus orientation (Group 2) during the period of 2011�16 were included in this study. The primary outcome compared was the recurrence rate. Other complications were included as secondary outcomes. Results: Mean age in group 1 and group 2 were 46.84 +/- 10.78 years and 54.38 +/- 11.44 years respectively. M:F was 36:63 in group 1 and 45:48 in group 2 with a mean follow up of 18.30 +/- 7.48 months in group 1 and 17.04 +/- 9.98 months in group 2. Recurrence was seen in 4 cases in each of the 2 groups with the mean time of recurrence being 7 +/- 2.34 months in group 1 and 6 +/- 2.01 months in group 2. Other complications included graft edema, SCH, graft retraction, granuloma, dellen and graft loss with only graft loss being statistically significant between 2 groups. Conclusion: This study provides data that recurrence rates are not different among patients who undergo split conjunctival graft with and without limbal orientation. The strict adherence to maintaining limbus to limbus orientation while managing double-headed pterygia may not be necessary in all cases, especially in those with large defects following excision.
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BACKGROUND: There are two kinds of cannulated screws (single- and double-headed) In clinic. Common single-headed cannulated compression screw is easy to cause shortened femoral neck, and screw dropping occurs usually when osteoporosis; thereafter, choosing single- or two-headed cannulated compression screw in the treatment of femoral neck fracture remains controversial. OBJECTIVE: To investigate the biomechanical effects of two double-headed and ordinary (single-headed) cannulated compression screws and different spatial configurations in the treatment of femoral neck fractures by finite element analysis. METHODS: The original DICOM data were obtained by collecting a thin layer CT scan of the proximal femur of a healthy adult volunteer (male, 30 years old). The proximal femoral model was established in MIMICS10.01 software. The model was imported into the UG 8.0 software to establish the femur neck fracture model (Pauwels angle 60°). A three-dimensional model of double-headed and ordinary cannulated compression screw was obtained by three-dimensional scanning modeling. In the UG 8.0 software, the femoral neck fracture assembly modeling was performed according to the horizontal and vertical distribution of two screws. The established model was introduced into the ANSYS 14.5 software to calculate the opening angle of the femoral neck fracture, the relative displacement of the fracture end and the stress distribution. RESULTS AND CONCLUSION: (1) In terms of biomechanical stability: The opening angle and displacement of the fracture end in the two screws in the horizontal position group were smaller than those in the vertical position group. The opening angle and displacement of the double-headed cannulated compression screw group were smaller than those in the ordinary cannulated compression screw. (2) Stress distribution: The stress distribution of the two screws was different. The stress distribution on the screw in the double-headed group was more dispersed than that in the ordinary group, and some stress was transmitted to the tail of the screw. In the ordinary group, the stress on the screw was mainly concentrated on the fracture end. There was also a difference in the stress distribution between horizontal and vertical position groups. When the two screws were horizontally fixed, the stress distribution on the front screw was more concentrated, while the vertical position was mainly concentrated on the upper one. (3) These results imply that the double-headed cannulated compression screw is more stable and reliable than the ordinary cannulated compression screw in the treatment of femoral neck fracture. The horizontal fixation of the two screws has better biomechanical stability than the vertical fixation. Therefore, the clinical application of double-head compression screws can be used to treat femoral neck fractures. When two screws are selected, horizontal fixation should be used.
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@#AIM: To observe the clinical efficacy of limbal-conjunctival autograft transplant(LCAT)for double-head pterygium.<p>METHODS: Prospective case study. Totally 46 patients(54 eyes)diagnosed with double-head pterygium collected in PLA 474 Hospital from January 2014 to July 2015, including 8 patients(16 eyes)with binocular double-head pterygium, 11 patients(11 eyes)with monocular double-head pterygium and the other eye with nasal side pterygium, pterygiun eyes only included as study subject, and 27 patients(27 eyes)with monocular double-head pterygium. The eyes with double-head pterygium underwent pterygium resection and autologous corneal limbal stem cell transplantation, nasal conjunctival flap was gotten from the superior bulbar conjunctiva of affected eye, and temporal conjunctival flap was gotten from the inferior bulbar conjunctiva of other eye. Follow-up the patients on 1d, 7d, 1mo and 1a after operation to complete the vision and slit lamps to observe the complications and pterygium recurrence.<p>RESULTS: Forty-four patients(52 eyes)completed the follow-up of 1a, while 2 patients(2 eyes)were lost. Three patients(3 eyes)developed recurrence, and the recurrence rate was 6%. Two eyes with nasal side pterygium developed recurrence and 1 eye with temporal side pterygium developed recurrence, while there was no complication observed.<p>CONCLUSION: Nasal conjunctival flap was gotten from the superior bulbar conjunctiva of affected eye, and temporal conjunctival flap was gotten from the inferior bulbar conjunctiva of other eye for double-head pterygium had good clinical effect and low recurrence rate, which provide a better way to treat double-head pterygium.
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PURPOSE: To evaluate two surgical methods-amniotic membrane transplantation (AMT) and split-conjunctival grafts (SCG)-for double-head pterygium, with regard to the postoperative outcome and recurrence rate. METHODS: In a total of 16 eyes (14 patients), 7 eyes (6 patients) receiving amniotic membrane transplantation and 9 eyes (8 patients) receiving split-conjunctival grafts were compared to evaluate recurrence and complications. RESULTS: Within the amniotic membrane transplantation group, two eyes (29%) had corneal recurrence, and 3 eyes (43%) had conjunctival recurrence. The mean follow-up period was 21.9+/-3.5 months, and all recurrences were on the nasal side. The average period preceding the corneal recurrences was 7.2+/-1.8 months. Within the split-conjunctival grafts group, the mean follow-up was 13.6+/-2.1 months, and neither the corneal nor conjunctival recurrences were observed. In addition, the eyes of this group were more aesthetically stable, with only one eye exhibiting pseudo-pterygium at the donor site. CONCLUSIONS: In cases of double-head pterygium without contraindication of conjunctival autograft, the split-conjunctival grafts produced fewer recurrences and showed enhanced cosmetic results, as compared to the amniotic membrane transplantation, indicating that the split-conjunctival grafts is the superior choice over amniotic membrane transplantation.