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BACKGROUND:In recent years, with the development of minimaly invasive techniques, the application of percutaneous pedicle screw fixation techniques gradualy become widespread, but in the percutaneous pedicle screw fixation for thoracolumbar fractures, due to lack of reduction apparatus or power defect, the reduction of the injured vertebra is poor. In order to improve this deficiency, we design a percutaneous pedicle screwsystem in order to achieve the desired effect of reduction. OBJECTIVE:To investigate the two different effects for treating unstable thoracolumbar fractures by fixing RTS (rotation softened trauma fixation system) or SEXTANT screws under minimaly invasive technology. METHODS:From October 2011 to June 2013, 50 patients who suffered from single-segment thoracolumbar fractures without any nerve-injured symptoms were treated by using percutaneous pedicle screws. Among them, 25 cases used Sextant screws; the others used RTS screws. Data were compared between the two groups, including the height of injured vertebrae, Cobb’s angle, visual analogue scale scores and Oswestry disability index 1 week, 3 and 6 months postoperatively, and during final folow-up. RESULTS AND CONCLUSION:(1) Al patients were folowed upfor8-18 months. (2) The height of injured vertebrae and Cobb’s angle were restored in both groups, showing significant differences (P<0.01). The restoration of the height of injured vertebrae and Cobb’s angle was better in the RTS group than in the SEXTANT group after treatment (P< 0.05-0.01). (3) The visual analogue scale scores and Oswestry disability index were significantly better in the RTS group than in the SEXTANT group 6 months postoperatively and during final folow-up (P< 0.05). (4) These results suggest that both RTS and SEXTANT systems can effectively repair single-segment thoracolumbar fractures without any nerve-injured symptoms. However, it is clear that the recovery of the height ofthe vertebral body is more satisfied and the postoperative pain and dysfunctionweremore minor in the RTS group.
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BACKGROUND:Reduction quality is essential for the healing and function of limb. Traditional X-ray and CT scans have some limitationsin quantitatively and visualy observing the reduction quality of the remnant fracture in three-dimensional displacements. Mimics have advantages in bone rapid modeling and three-dimensional measurement, which offers the chance in quantifying the reduction quality of the displacement in three-dimensional methods. OBJECTIVE:To measure residual displacement in femoral neck fracture patients with satisfactory reduction by using three-dimensional measurement method, and to evaluate the association between residual displacement and femoral head necrosis. METHODS:We enroled 141 patients with femoral neck fracture, who were treated in the Third Department of Joint, Affiliated Hospital of Logistics University of People’s Armed Police Force from January 2012 to December 2013. Al patients were divided into undisplaced fracture group (n=44; Garden1&2) and displaced fracture group (n=97; Garden3&4). Based on DICOM data of CT files, three-dimensional models were constructed in each patient. Three parameters were measured: displacement of femoral head’s center, fossa capitis femoris and rotational displacement. Femoral head necrosis was folowed up. The correlation between residual displacement and femoral head necrosis was explored. RESULTS AND CONCLUSION:(1) The duration of folow-up in those patients ranged from 25 to 43 months. Femoral head necrosis occurred in 7 cases from the undisplaced fracture group and 21 cases from the displaced fracture group. (2) The three parameters (displacement of femoral head’s center, fossa capitis femoris and rotational displacement) were respectively (7.44±2.84) mm, (11.75±4.12) mm and (17.68±8.99)° in the undisplaced group, and (6.51±3.75) mm, (9.34±5.27) mm and (14.67±7.43)° in the displaced group. Except displacement of femoral head’s center, significant differences in the other two parameters were detected between the two groups (P< 0.05). (3) These findings suggest that poor reduction quality is the main factor causing femoral head necrosis. X ray is insufficient to describe the spatial shift and the angle, and has limitations in assessing the reductionquality of femoral neck fracture. Three-dimensional measurement has certain advantages to assess quality of fracture reduction.
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BACKGROUND:Developmental dislocation of the hip is a type of adult hip dysplasia, including Crowe III and IV type; the type of dislocation of the hip is a severe prognosis. Total hip replacement is clinicaly used for the complex reconstruction of acetabulum. For injured acetabulum, autologous bone graft is effective to reconstruct acetabulum structure, provides good coverage and stability for the acetabulum. Postoperative combination with effective exercise can ensure the recovery of acetabulum function. OBJECTIVE:To analyze the correlation of prosthesis position selection during total hip replacement with clinical short- and middle-term effects of Crowel III and Crowel IV hip dislocation. METHODS:Clinical data of 28 cases of dysplasia and dislocation of the hip joint combined with severe osteoarthritis, who were treated in the Department of Joint Surgery, the Second Affiliated Hospital, Inner Mongolia Medical University from December 2011 to December 2012, were retrospectively analyzed. Al patients received total hip replacement. Implant was biological artificial total hip joint prosthesis. During 2-year folow-up, patients were rechecked by imaging regularly to analyze the imaging changes of acetabulum prosthesis position and bone graft fusion. Harris hip score was used to assess the recovery of hip function. The correlation of prosthesis position and short- and middle-term effects was analyzed. RESULTS AND CONCLUSION: The filing rate of medulary cavity of prosthesis was above 75%. The initial position was fixed and stable. The stability rate of femur-prosthesis interface reached 100%. Compared with pre-replacement, hip function was significantly improved at 6 months post surgery (t=25.55, 9.07;P < 0.05). These results indicate that total hip replacement for Crowel III and Crowel IV hip dislocation can effectively reconstruct the acetabulum, recover hip function, and stabilize prosthesis. Total hip replacement is characterized by good filing rate, high stability of femoral prosthesis interface, and stable initial fixation. The clinical repair effect is strongly associated with the position of the prosthesis.
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BACKGROUND:Denis B thoracolumbar burst fractures are common spinal injury and may be involved in the upper end plate injury. Fracture reduction and pedicle screw fixation are used to repair above injury. This scheme can effectively achieve the aim of correcting deformity, but the trabecular bone after crushing cannot be fuly recovered. OBJECTIVE:To observe the repair effect of fracture reduction and pedicle screw fixation + artificial bone graft in vertebral body on Denis B thoracolumbar burst fracture, and compare with fracture reduction and pedicle screw fixation alone. METHODS:Clinical data of 70 cases of Denis B thoracolumbar burst fractures, who were treated in the Department of Orthopedics, Zhangjiagang Aoyang Hospital from January 2012 to December 2014, were retrospectively analyzed. According to repair scheme, they were equaly divided into two groups. Patients in the control group received fracture reduction and pedicle screw fixation. Patients in the observation group received fracture reduction and pedicle screw fixation + artificial bone graft in vertebral body. Oswsetry Disability Index, height of anterior border of injured vertebral body, lower back pain visual analogue scale and vertebral kyphosis Cobb’s angle were compared and observed between the two groups before repair, 1 week, 3 and 6 months after repair. RESULTS AND CONCLUSION:No significant difference in Visual Analogue Scale was detected at 1 week, 3 and 6 months after repair between the observation and control groups (P > 0.05). Oswsetry Disability Index was significantly lower in the observation group than in the control group (P 0.05). Cobb’s angle was significantly lower in the observation group than in the control group (P < 0.05). These findings suggest that fracture reduction and pedicle screw fixation + artificial bone graft in vertebral body obtained good repair effects on Denis B thoracolumbar burst fracture, not only effectively corrected Cobb’s angle and the height of anterior border of injured vertebral body, but also helped to restore normal spinal loads by filing bone in the injured vertebral body.
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BACKGROUND:Closed reduction and internal fixation are mostly used to treat fracture dislocation of tarsometatarsal joint, but cannot obtain satisfactory repair effect. Redisplacement easily appeared after local sweling subsidence. Therefore, open reduction and internal fixation are actively used in the clinic to treat fracture dislocation of tarsometatarsal joint so as to restore foot function and to elevate quality of life. OBJECTIVE:To explore the clinical effect of open reduction and cannulated screw and Kirschner wire fixation for fracture dislocation of tarsometatarsal joint. METHODS:A total of 42 patients with fracture dislocation of tarsometatarsal joint in the 88 Hospital of Chinese PLA from September 2012 to September 2013 were selected and were given open reduction and cannulated screw and Kirschner wire fixation. After treatment, the recovery of patients was observed, and ankle hindfoot function was assessed with American Orthopaedic Foot and Ankle Society ankle hindfoot score. RESULTS AND CONCLUSION:A total of 42 patients were folowed up for 1-12 months. American Orthopaedic Foot and Ankle Society ankle hindfoot score results showed that there were excelent in 30 cases, good in 10 cases, and poor in 2 cases, and the 2 patients were subjected to high energy soft tissue injury. 37 patients in 4-6 months after operation started weight-bearing walking. Three patients had mild pain, a certain functional limitation, but could maintain normal walking gait. The remaining two patients complicated with traumatic arthritis, and were unable to do normal weight-bearing walking. These results show that open reduction and cannulated screw and Kirschner wire fixation can achieve good effect of anatomical reduction of fracture dislocation of tarsometatarsal joint, and improve patient’s ankle function.
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BACKGROUND:The ankle is one of the most important joints of human body. Medial maleolar fractures are very common, and there are lots of surgical methods to treat it. A traditional approach is open reduction and internal fixation. As views changed, percutaneous cannulated screw internal fixation become increasingly popular, but various clinical studies are stil needed to analyze the efficacy of these two methods. OBJECTIVE:To compare the recovery of joint function after medial maleolus fracture repaired by open reduction and internal fixation and percutaneous cannulated screw fixation. METHODS:A total of 63 cases of medial maleolus fracture, who were treated in the Department of Orthopedics, People’s Hospital of Xinyi City from March 2009 to March 2013, were enroled. According to repair plan, they were divided into two groups: open reduction and internal fixation group (n=29) and percutaneous cannulated screw fixation group (n=34). Ankle function was assessed in accordance with Kofoed ankle score standard on admission and at 3 months after repair. RESULTS AND CONCLUSION:The patients were folowed up for 3 to 12 months. Among 29 cases in the open reduction and internal fixation group, the wound was healed at grade A in 27 cases and at grade B in 2 cases; 29 cases were reset, and no poor reduction was found. In the percutaneous cannulated screw fixation group, 34 cases had healing at grade A, with the presence of good reduction. Al patients experienced bone union, and no infection appeared. In accordance with Kofoed score, at 3 months of folow-up, the satisfaction rate was 97% in the open reduction and internal fixation group, and 100% in the percutaneous cannulated screw fixation group. These data suggest that both open reduction and internal fixation and percutaneous cannulated screw fixation for medial maleolus fracture obtained positive effects, but percutaneous cannulated screw fixation showed smal surgical trauma, which could reduce the rate of infection and contributed to early functional recovery of ankle joint.
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BACKGROUND:There are many methods that can repair Pilon fracture, but the effects are not ideal. With the development of science and technology, fundamental change of fracture fixation principle and innovation of technology and idea has brought new opportunities for Pilon fracture repair. Biological immobilization technology can further reduce the further damage to blood supply of bone outer membrane on the fracture end, do not disturb biomechanical environment of fracture healing, and is the new trend of present research and development. OBJECTIVE:To investigate the effect of locking compression plate fixation for repair of Pilon fracture using biological fixation technique. METHODS:Clinical data of 76 patients with Pilon fracture treated using locking compression plate fixation in the Nanhai District Economic Development Zone Guanyao Branch of the People’s Hospital from June 2008 to December 2013 were retrospectively analyzed. There were 49 males and 27 females, at the age of 39.5 years on average (range from 19 to 60 years). According to Ruedi-Algower classification, there were 54 cases of type II and 22 cases of type III. In accordance with biological fixation technique, locking compression plate fixation was applied to treat Pilon fracture. Folowing treatment, they were regularly folowed up. Reduction quality was assessed by Burwel-Charnley radiological criteria. X-ray films were reviewed to observe fracture healing. During final folow-up, ankle function was evaluated according to Baird-Jackson score. RESULTS AND CONCLUSION:A total of 76 patients were folowed up for 6 to 24 months. Reduction quality assessed by Burwel-Charnley radiological criteria was as folows: anatomic reduction of 68 cases, reduction of 8 cases, 71 cases of one-stage wound healing, and 5 cases of wound healing after dressing change, with the rate of one-stage healing of 93%. Fractures of al patients were healed. The healing time was 4 to 8.5 months, averagely 6.25 months. During final folow-up, ankle function assessed by Baird-Jackson score was as folows: there were 69 excelent cases, 5 good cases and 2 average cases. These results indicate that locking compression plate fixation for Pilon fracture obtained good stability, could effectively avoid the damage of fracture end blood supply, shorten the healing time; it was simple to operate, had smal injury to soft tissue, and was an effective fixation method to repair Pilon fracture.
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BACKGROUND:The calcaneal fracture is the most common tarsal bone fracture. Approximately 75% calcaneal fractures presented as the displaced intraarticular fractures. How to treat intraarticular calcaneal fractures remains controversial. OBJECTIVE:To observe the anatomy and clinical effect of minimaly invasive percutaneous screw fixation in repair of Sander II calcaneal fractures under the arthroscope. METHODS:From May 2009 to May 2012, 61 patients (61 feet) with Sander II calcaneal fractures were repaired by minimaly invasive percutaneous screw fixation under the arthroscope. Al patients received clinical and imaging evaluation at 3, 6, 21 weeks, and 1 year after treatment. From then on, the evaluation was performed every year. American Orthopaedic Foot and Ankle Society ankle hindfoot score was used to assess ankle joint function. Simultaneously, complications such as skin necrosis and wound infection were recorded. Radiographic outcomes were assessed by Bohler angle, Gissane angle, calcaneal height and width. RESULTS AND CONCLUSION: A total of 61 patients were folowed up for 24 to 60 months. No complications were seen such as wound healing or deep infection. The time of hospitalization was 6-25 days, averagely (12.7±6.9) days. At the final folow-up, American Orthopaedic Foot and Ankle Society ankle hindfoot score was 88-100, averagely (93.6±3.1), with an excelent and good rate of 100%. The time of return to work after treatment was 8-14 weeks, averagely (10.7±2.9) weeks. Range of motion of ankle or subtalar joint of al patients was limited less than 10°. Immediate postoperative X-ray showed that anatomic reduction of the articular surface was detected in 56 patients (92%), and non-anatomic reduction was found in 5 patients (8%). At last folow-up, the mean Bohler angle was (28.4±4.9)° (range, 23°-30°); the mean Gissane angle was (119.9±7.8)° (range, 112°-124°); the mean calcaneal height was (43.4±4.2) mm (range, 39-45 mm); the mean calcaneal width was (30.4±2.5) mm (range, 27-32 mm); the average fracture healing time was (16.7±4.2) weeks (range, 12-20 weeks). Bohler angle, Gissane angle, calcaneal height, and calcaneal width at last folow-up were significantly improved compared with pretreatment (P < 0.05). These findings suggest that under the arthroscope, minimaly invasive percutaneous screw fixation for Sander II calcaneal fractures can restore calcaneal anatomy, achieve a satisfactory clinical function, without complications such as poor woundhealing or infection.
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BACKGROUND:Clinical physicians should pay attention on how to reduce ankle fracture healing wounds, reduce bleeding, improve operating technique, and improve repair effect, especialy for comminuted fracture. It is necessary to understand how to develop a detailed plan before repair, observe specific circumstances of the fracture from multiple angles, and establish three-dimensional images using two-dimensional X-ray films or CT scan. These raise a chalenge for each physician. OBJECTIVE:To explore the application effect of three-dimensional print, minimaly invasive percutaneous screw and locking plate fixation in the repair of ankle fractures. METHODS: A total of 26 cases of fracture of ankle joint were treated from January 2012 to June 2014. There were 9 cases of double ankle fracture, 12 cases of three ankle fractures, and 5 cases of three ankle fractures involved PILON fracture on the lower tibia. They received spiral CT scanning on the ankle joint, and stored in the format of di.com. After processing with minics software, data were converted into STL format, and then input into the three-dimensional printer. Thus, models of ankle joint were made at the ratio of 1:1. The repair scheme was made. After discharge, X-ray films were checked every month to observe the healing condition of fractures. According to Mazur ankle score standard, ankle joint function was assessed. RESULTS AND CONCLUSION: Al 26 cases were folowed up for 6-12 months. The fractures were healed. The healing time was 4-6 months, averagely 5.5 months. The healing was good, without vascular and nerve damage, or plate breakage. In accordance with the Mazur ankle score standard, there were excelent in 11 cases, good in 13 cases with an excelent and good rate of 92%. The operation time was (64±15) minutes, and intraoperative blood loss was (100±15) mL. The incision was healed in stage one. These findings confirm that the simulation training and operation in fracture models of three-dimensional print have smal injuries to patients with ankle fracture. The bleeding was less, the operation was simple, the healing time was short, and the functional recovery was rapid, especialy for comminuted fracture.
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BACKGROUND:Lumbar fusion is a conventional effective measure to treat spondylolisthesis, spinal stenosis or with deformity. Bilateral pedicle screw fixation is recognized as the standard treatment for various spinal disorders, and has biomechanical and clinical advantages. OBJECTIVE:To evaluate the effects of bilateral pedicle screw fixation in the repair of lumbar disc herniation to restore disc height from the angle of imaging. METHODS: Clinical data of 42 patients with lumbar disc herniation were retrospectively analyzed. They al received bilateral pedicle screw fixation. Pain was evaluated before implantation, immediately and 1 month after implantation using Japanese Orthopaedic Association score of lower back pain and visual analog scale score. X-ray including anteriorposterior and lateral films of lumbar spine and MRI were used. CT was utilized to verify screw placement conditions and complications. RESULTS AND CONCLUSION:A total of 42 patients were folowed up for 3-6 months. Compared with pre-implantation, Japanese Orthopaedic Association score and visual analog scale score were significantly improved immediately after implantation (P 0.05). The height of intervertebral discs was significantly higher immediately and 1 month after implantation than pre-implantation (P < 0.01). The symptoms were lessened after fixation in al cases, and their qualities of life elevated. At 1 month, X-ray films and CT images revealed that no screw loosening, breakage or displacement occurred. The height of intervertebral discs was perfectly restored. No adverse events appeared in patients. These data indicate that bilateral pedicle screw fixation for lumbar intervertebral disc herniation can effectively restore the height of intervertebral discs, improve clinical symptoms and have biological and clinical superiority.
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BACKGROUND:Proximal humeral fractures are commonly treated by open reduction and internal fixation, which greatly injuries tissue and noticeably damages local blood supply. However, with the development of material and progress of repair method, complications have obviously reduced. OBJECTIVE: To compare the difference of locking plate and ordinary steel plate in the repair of proximal humeral fractures. METHODS:A total of 68 patients with great displacement and comminuted proximal humeral fractures, who were treated in the Department of Orthopedics, Affiliated Tongren Hospital, Shanghai Jiao Tong University School of Medicine from February 2012 to October 2014, were enroled in this study. According to fixation method, they were divided into two groups. 32 cases in the locking plate group were subjected to locking plate, and 36 cases in the ordinary steel plate group received fixation with T type plate and Clover plate. They were folowed up at the out-patient clinic at 2, 4, 6, 12 and 24 weeks after treatment. The satisfaction rate of shoulder function treatment was assessed using Neer scoring system. They received reexamination before withdrawal of fixator. The incidence of complications was observed in patients. RESULTS AND CONCLUSION: The satisfaction rate was significantly lower in the ordinary steel plate group than in the locking plate group (75%, 81%,P < 0.05). No screw and plate breakage, shoulder seam impact,humeral head necrosis or infection was found in the locking plate group. Six cases suffered from pain. In the ordinary steel plate group, there were screw and plate breakage in five cases, shoulder seam impact in five cases, pain in eight cases, humeral head necrosis in two cases and infection in two cases. The incidence of complications was significantly greater in the ordinary steel plate group than in the locking plate group (P < 0.05). These data suggest that locking plate can be used as the first choice for internal fixation in treatment of proximal humeral fractures. No matter satisfaction rate of repair or complications, it is better than ordinary steel plate fixation.
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BACKGROUND:The conservative treatment of humeral fracture is difficult to achieve a good reduction. Minimaly invasive percutaneous plate fixation has been widely used, and has good repair results, but the specific mechanism of action is not clear. OBJECTIVE:To compare the repair effect of different fixation methods on proximal humerus fractures. METHODS: From August 2011 to October 2014, we selected 96 patients with proximal humerus fractures from the Shougang Hospital of Peking University. These patients were equaly divided into two groups according to the principle of random draw. Patients in the control group were treated with open reduction and conventional surgery fixation. Patients in the treatment group received minimaly invasive percutaneous plate fixation. Operation time, intraoperative blood loss, incision length and postoperative hospital stay were recorded in both groups. At 8 weeks after treatment, patients received radiography to identify the reduction. Range of motion of the shoulder joint was scored. Within 8 weeks after treatment, the occurrence of complications was observed and compared in both groups. RESULTS AND CONCLUSION:Intraoperative blood loss, incision length and postoperative hospital stay were significantly less in the treatment group than in the control group (P 0.05). At 8 weeks after treatment, the excelent and good rate of reduction was significantly higher in the treatment group than in the control group (98%, 81%,P < 0.05). Flexion, abduction, external rotation and internal rotation scores were significantly higher in the treatment group than in the control group (P < 0.05). Bone compartment syndrome, vascular injury, infection and bleeding were significantly lower in the treatment group than in the control group (P < 0.05). These findings confirm that compared with open reduction and internal fixation, minimaly invasive percutaneous plate fixation of proximal humerus fractures has less impact on the body, can promote reduction of the fracture, has few complications, and contributes to the recovery of shoulder function.
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BACKGROUND:Anterior cervical discectomy and intervertebral disc replacement have been extensively used in treatment of cervical degenerative disease. Its short-term therapeutic effects are encouraging, but it lacks of long-term and comprehensive evaluation. OBJECTIVE:To observe the folow-up results of a group of cases of anterior cervical discectomy and Mobi-C intervertebral disc replacement for more than 5 years. METHODS:A total of 25 cases of cervical spondylosis were treated in the 309 Hospital of Chinese PLA from January to September 2009. 19 of them were folowed up. Al patients received anterior cervical discectomy and Mobi-C intervertebral disc replacement. Twenty-three Mobi-C intervertebral disc prostheses were implanted. The range of motion was measured using lateral X-ray films during extension and flexion. Ectopic ossification was assessed by McAfee method. According to the cervical vertebra MRI images, the degeneration of adjacent segments was determined using Pearce classification. NDI score was used to evaluate the function of cervical spine. Pain improvement was evaluated using visual analogue scale score. RESULTS AND CONCLUSION: A total of 19 patients were folowed up for 59-65 months, averagely 62 months. No significant difference in range of motion was detected before surgery and during final folow-up (P > 0.05). Ectopic ossification in two cases and the degeneration of adjacent segments in one case were found during final folow-up. No prosthesis loosening or displacement appeared. Visual analogue scale score and NDI score were significantly lower during final folow-up compared with that before surgery (P < 0.05). These results indicate that under the premise of reasonable choice of indications, the therapeutic effect of Mobi-C intervertebral disc replacement for degenerative cervical spondylosis was satisfactory in five-year folow-up. The range of motion was good, and the incidences of ectopic ossification and the degeneration of adjacent segments were low.
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BACKGROUND:Degenerative lumbar scoliosis often appeared in the elderly, who may combine with other diseases, which can cause poor repair tolerance. Degenerative lumbar scoliosis commonly has a responsible vertebral body, so local decompression and selective fusion should be conducted. This can achieve nerve decompression, spinal stability, and is relatively minimaly invasive. OBJECTIVE:To explore the efficacy of selective interbody fusion, limited neural decompression combined with pedicle screw system fixation for degenerative lumbar scoliosis. METHODS:Clinical characteristics of 53 patients with degenerative lumbar scoliosis were retrospectively analyzed, and the indication and contraindication were investigated. Selective interbody fusion, and limited neural decompression combined with pedicle screw system fixation were performed in the patients. Treatment effect and complication were analyzed. During folow-up, Suk standard was utilized to judge bone graft fusion. Before treatment and during final folow-up, lower back pain score system recommended by the Japanese Orthopaedic Association was used for assessment, and the excelent and good rate of curative effects was calculated. Cobb’s angle on the sagittal and coronal positions was compared and analyzed before and after treatment. RESULTS AND CONCLUSION:The patients were folowed up for 12 to 36 months. According to low back pain score of Japanese Orthopaedic Association Scores, the excelent and good rate of curative effect was 89% during the last folow-up. According to Suk standard, the fusion rate of vertebra was 94%. The last X-ray films revealed that Cobb’s angle was averagely (4.3±2.3)° (0°-13.5°) on the coronal plane after treatment, and the correction rate of scoliosis was 56%. The Cobb’s angle was averagely (45.1±12.5)° (10.4°-65.3°) after treatment, and the correction rate of lordosis was 36%. Complications after repair consisted of cerebrospinal fluid leakage in two cases, nerve injury in two cases, instrumental failure in one case, and pulmonary infection in one case, and symptomatic deep venous thrombosis in three cases. These findings suggest that selective interbody fusion, and limited neural decompression combined with pedicle screw system fixation were effective and safe for degenerative lumbar scoliosis. The sequence of the lumbar vertebra on the coronal and the sagittal planes received reconstruction to different degrees, and could realize the stability of the lumbar vertebrae in the scoliosis.
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BACKGROUND:In recent decades, total knee arthroplasty is widely used in the treatment of terminal knee joint diseases, such as osteoarthritis, rheumatoid arthritis, traumatic arthritis and other bone diseases. The methods of osteotomy, soft tissue balance and prosthesis rotation positioning have always been debated and discussed in total knee arthroplasty. OBJECTIVE:To explore the repair effect of total knee arthroplasty for terminal knee disease. METHODS:Total knee arthroplasty was performed for treating terminal knee disease in 31 cases (31 knees), including 26 cases of osteoarthritis (26 knees) and 5 cases of rheumatoid arthritis (5 knees). Al cases accompanied flexion contracture deformity to different degrees. The maximum angle of flexion deformity was < 25°. Al patients were scored by hospital for special surgery knee score before and after replacement. Al 31 knees were treated with fixed platform posterior-stabilized prostheses. RESULTS AND CONCLUSION:No complications, such as early infection and prosthesis dislocation, were found after surgery. Joint pain apparently lessened, flexion and varus deformity obviously improved after replacement. Postoperative X-ray films showed good prosthesis position and low limb alignment. Al cases were folowed up for 6-12 months. The hospital for special surgery knee score improved significantly from preoperatively 46.4±5.3 to postoperatively 84.6±10.5 after 6 months of folow-up. Excelent and good rate was 84%. Results indicate that total knee arthroplasty for treating terminal knee disease has a good clinical effect. However, the operation is complex and precise technique is required.
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BACKGROUND:In elderly patients with unstable intertrochanteric fracture, because of poor general condition and poor bone condition, on one hand, the internal fixation of fracture may lead to nonunion. On the other hand, patients stil need longer time in bed and hip joint fixation, and may result in complications of long-term bed rest. Artificial femoral head replacement is a safe operation mode, can solve the problem of early ambulation of patients. OBJECTIVE:To observe the repair effect of bipolar artificial femoral head replacement on unstable femoral intertrochanteric fracture in elderly patients. METHODS: A total of 39 elderly patients with unstable femoral intertrochanteric fractures, who were treated in the Department of Orthopedics, 101 Hospital of Chinese PLA from 2005 to 2014, were enroled in this study. There were 21 males and 18 females, at the age of 80-96 years old, averagely 85 years old. They al received bipolar artificial femoral head replacement. Harris score was measured to assess hip joint function at 1 year after replacement. The incidence of complications was recorded. RESULTS AND CONCLUSION:A total of 39 cases were folowed up for 1-5 years. The wound of al patients was healed in the primary stage. No cardiovascular or cerebrovascular accident appeared. Al patients passed safely through the perioperative period. No severe complications occurred. Hip joint function was assessed according to Harris score at 1 year after replacement: excelent in 13 cases, good in 20 cases, average in 4 cases, poor in 2 cases, with an excelent and good rate of 85%. No dislocation appeared. The results suggest that bipolar artificial femoral head replacement can be used to treat femoral intertrochanteric fracture in elderly patients. The postoperative recovery time was short; bleeding was less; complications were few. Hip joint function recovered wel. For elderly patients with femoral intertrochanteric fracture, bipolar artificial femoral head replacement is an ideal safe effective repair method.
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BACKGROUND:Conventional dynamic hip screw or artificial joint replacement can be used to treat unstable intertrochanteric fracture in aged patients. It remains unclear whether we should select one-stage replacement or remedial joint replacement after failture, and there is no unified standard globaly. OBJECTIVE: To observe the outcomes and prognosis of one-stage artificial joint replacement for unstable intertrochanteric fracture in aged patients. METHODS:From April 2008 to October 2011, 21 patients with unstable intertrochanteric fracture in aged patients were repaired with one-stage artificial joint replacement at the Second Department of Orthopedics, Changji Prefecture People’s Hospital. Among 21 patients, 1 patient previously combined with avascular necrosis of the femoral head and traumatic arthritis received biological artificial total hip replacement. Three cases were subjected to standard bone cement bipolar artificial femoral head replacement. 17 cases underwent biological bipolar artificial femoral head prosthesis replacement. Al artificial joint, internal fixation material and accessory joint replacement surgical instruments were purchased outside China. Al patients were folowed up regularly. Hip joint function was assessed by Harris hip score. RESULTS AND CONCLUSION: Al operations were completed by the same group of physicians. Operation time was 30-60 minutes, averagely 42 minutes. Incision length was 8 to 15 cm, averagely 11 cm. Average intraoperative blood loss was 50-300 mL, averagely 150 mL. The number of transfusion cases was 13. 1.5 U blood was transfused averagely in each patient during hospital stay. One 76-year-old patient combined with hypertension, coronary heart disease and diabetes suffered from sudden death due to acute myocardial infarction at 9 days after replacement. B ultrasound revealed venous thrombosis of calf muscle of double lower extremities at 3 days after replacement. No complications such as prosthetic loosening, sinking, infections and thrombosis were detected. Except 1 case died, the other 20 cases received folow-up for 6-49 months. Harris hip score was 73±4 before discharge and 82±6 during last folow-up. These data confirm that effects of one-stage artificial joint replacement for unstable intertrochanteric fracture in aged patients are affirmative, but the number of case is stil less, and deserves further investigations. We suggest that in patients with conformed indication, one-stage artificial joint replacement can be the first choice.
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BACKGROUND:The repair method of proximal humeral comminuted fractures in the elderly remains controversial. OBJECTIVE:To compare the recovery of shoulder joint function using the hemiarthroplasty of shoulder and locking proximal humeral plate fixation for complex proximal humeral fracture in the elderly. METHODS:A total of 22 elderly patients with complex proximal humeral fracture, who were treated from October 2012 to October 2014, were retrospectively analyzed. 12 cases underwent hemiarthroplasty, and 10 cases received locking proximal humeral plate fixation. Al patients were folowed up after treatment. X-ray films were rechecked during the folow-up. The recovery of shoulder function was evaluated with Neer score. RESULTS AND CONCLUSION:During final folow-up, no prosthetic loosening or avascular necrosis of humeral head was found in the shoulder hemiarthroplasty group, and the Neer score was (81±5) points. In the locking proximal humeral plate fixation group, there was fixator loosening in four cases and avascular necrosis of humeral head in three cases, and the Neer score was (69±5) points (P 0.05). These data suggest that locking proximal humeral plate fixation and shoulder hemiarthroplasty are effective repair methods for complex proximal humerus fractures, but the hemiarthroplasty had the advantage of early functional exercise and good recovery of shoulder joint.
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BACKGROUND:The uncemented prosthesis in primary total hip arthroplasty has obtained good outcomes, but its application in revision especialy in failed cemented hip arthroplasty deserves further investigations. OBJECTIVE: To observe the mid-term results of uncemented revision of failed cemented hip arthroplasty. METHODS: 41 patients (47 hips) with uncemented revision of failed cemented hip arthroplasty were folowed up from November 1997 to February 2013. In the 47 hips, 24 hips replaced the cemented stem component while 23 hips underwent the cemented acetabular revision. Prosthesis change was observed in radiographs. Harris functions were evaluated and prosthesis survival rate was analyzed. RESULTS AND CONCLUSION: A total of 33 patients (38 hips) were folowed up for 1.3-14.8 years. The mean preoperative Harris hip score increased from 34 (range, 11-66) points to 85 (range, 55-94) points at the time of final folow-up (P < 0.01). 36 hips (95%) had an excelent stability. Osteolysis and migration of the prosthesis were seen in 2 hips (1 in acetabulum and 1 in femur), which needed re-revision. Heterotopic ossification developed in 9 hips (24%). The mean polyethylene liner wear was 0.08 mm (range, 0-0.25 mm) per year. The wear rate only correlated with changes of abduction angle of the acetabulum (P < 0.01). Imaging verified that loosening served as a failure criterion. Kaplan-Meier survival analysis was used to calculate uncemented prosthesis for 7 years and showed that total survival rate was 89%. The survival rates of acetabular prosthesis and femoral prosthesis were respectively 93% and 92%. Results indicated that uncemented prosthesis could deal with the problem of bone deficiency and obtain satisfactory mid-term clinical results in revision of failed cemented hip arthroplasty.
ABSTRACT
BACKGROUND:The treatment of lower cervical spine fracture and dislocation is aimed to improve neurological functions of patients, the selection of surgical approach is conductive to the reduction and spinal decompression, also maintain strong fixation and bone graft fusion. OBJECTIVE:To explore the restoration approach of lower cervical spine fracture and dislocation, and investigate the effect on bone graft fusion and cervical stability. METHODS: A total of 126 patients with lower cervical spine fracture and dislocation were treated surgicaly from January 2009 to September 2013 in the First Affiliated Hospital of Xinjiang Medical University. Based on Frankel system, 7 cases were grade A, 48 were grade B, 54 were grade C, and 17 were grade D before surgery. Based on SLIC system, 15 cases were 4 points, 23 were 5 points, 25 were 6 points, 22 were 7 points, 18 were 8 points, 16 were 9 points, and 6 were 10 points. Surgical approaches were determined based on the SLIC system, with a combination of sub-axial injury classification system, the type of fracture, spinal cord compression, and cervical spine injury degree. Anterior surgery (single gap or cervical corpectomy and fusion, bone graft internal fixation) was performed on 91 cases; Posterior treatment (posterior decompression, reduction and internal fixation) was performed on 6 cases; Combined posterior and anterior approach was performed in 29 cases. The neurological function improvement was evaluated at folow-ups; fracture healing, bone graft fusion and cervical stability were determined with imaging findings. RESULTS AND CONCLUSION:Al the 126 patients underwent surgery safely without severe complications such as tracheal or esophageal injury. Four patients appeared spinal cord injury and cerebrospinal fluid leakage, which were healed after corresponsive intervention. Al patients were immobilized in a hard colar for 3 months postoperatively and were folowed up for 6-18 moths. At postoperative 6 months, 5 cases of grade A were not recovered, one case of grade B was not recovered, 1-2 degree of neurological function recovery was achieved in the remaining cases by Frankel system. X-ray finding showed the good recovery of cervical vertebrae sequence after operation. Fusion was achieved in al cases within 12 months (mean 8.5 months) except non-fusion in one case and delayed fusion in two cases. There was no pseudarthrosis or nonunion occurred. The interbody height, physiological curvature and cervical stability maintained wel. The SLIC system, with a combination of sub-axial injury classification system, the type of fracture, spinal cord compression, and cervical spine injury degree should be considered before surgery. Reasonable selection of surgical approach can reconstruct spinal stability and achieve anatomical reduction and complete decompression, which is conducive to the recovery of neurological function.