Medium term follow up outcomes of uncemented total hip arthroplasty for traumatic arthritis after intramedullary nail fixation of femoral intertrochanteric fracture / 中国骨伤

OBJECTIVE@#To evaluate the effect of uncemented total hip arthroplasty(THA) on treatment of traumatic arthritis caused by intramedullary nailing interfixation of intertrochanteric fractures.@*METHODS@#Total of 22 patients treated with THA due to traumatic arthritis caused by intramedullary nailing interfixation of intertrochanteric fractures from January 2012 to January 2017 were studied retrospectively, including 10 males and 12 females with a mean age of (72.5±9.8) years old ranging from 61 to 84 years old. Initial internal fixation method:14 patients were treated with Gamma nails and 8 patients were treated wit PFNA.The time from internal fixation surgery to THA was 10 to 68 months with an average of (32.2±21.3) months.Harris scores of the hip joint before and after surgery were compared, and the position of the prosthesis through postoperative imaging at 3, 6, 12 months and the last follow-up were evaluated.@*RESULTS@#One patient was died due to heart failure 1 year after operation. Two patients was died to advanced tumor 2 years after operation. The other 19 patients were followed up for 36 to 64 months with an average of (48.5±11.9) months. At final follow up, 14 patients regained the ability to walk independently, 4 patients needed support of a cane, 1 patient needed assistance of a walker. No serious complications such as joint dislocation, periprosthetic fracture and deep venous thrombosis occurred during follow-up. There were no signs of loosening and subsidence of the prosthesis at the final follow-up. Mean Harris hip score increased from (29.2±12.9) points preoperatively to (74.2±11.2) points at the final follow up(P<0.05);the score was excellent in 9 patients, good in 7 and fair in 3.@*CONCLUSION@#Uncemented total hip arthroplasty for traumatic arthritis after intramedullary nail fixation of femoral intertrochanteric fracture can significantly improve hip function and effectively avoid bone cement implantation syndrome. The medium-term effect is satisfactory.

Percutaneous short segment pedicle screw fixation with vertebral augmentation for the treatment of single level thoracolumbar osteoporosis fracture / 中国骨伤

<p><b>OBJECTIVE</b>To explore clinical outcomes of percutaneous short segment pedical screw fixation with bone cement augmentation in treating single level thoracolumbar osteoporotic fracture.</p><p><b>METHODS</b>From January 2009 to January 2013, 48 single level thoracolumbar osteoporotic fracture patients without neurological symptoms were treated with percutaneous short segment pedicle screw fixation with bone cement augmentation. Among them, including 22 males and 26 females aged from 55 to 72 years old with an average of 62.2 years old. The time from injury to operation varied from 8 h to 9 d(mean 4.5 d). According to Denis fracture classification, 35 cases were compression fractures and 13 cases were burst fractures. Nine vertebrae located on T₁₁, 15 vertebrae on T₁₂, 14 vertebrae on L₁, 7 vertebrae on L₂, and ₃ vertebrae on L₃. Anterior vertebral body height, sagittal Cobb angle, sagittal index(SI), failure of internal fixation and recurrence of kyphosis were observed before and after operation.</p><p><b>RESULTS</b>All patients were followed up from 24 to 48 months with an average of 32.5 months. Operative time ranged from 60 to 140 min with an average of 85 min;blood loss ranged from 50 to 100 ml with an average of 75 ml. Before operation, at 3 d and 1 year after operation, anterior vertebral body height respectively was (56.4±2.6)%, (91.2±1.6)% and (86.9±3.2)%; sagittal Cobb angle respectively was(26.6±3.2)°, (6.2±1.0)° and (6.8±1.5)°; SI respectively was(51.6±4.2)%, (90.2±5.9)% and (88.7±4.2)%; VAS respectively was(7.6±1.2), (2.8±1.9), (1.1±0.4) points. There were significant differences above items between before operation and at 3 d after operation, while no significance between 1 year and 3 d after operation. No neurologic damage, internal fixation failure and recurrence of kyphosis occurred.</p><p><b>CONCLUSIONS</b>Percutaneous short segment pedicle screw fixation with bone cement augmentation in treating single level thoracolumbar osteoporotic fracture has advantages of less trauma, and could effectively restore normal physiological load transmission of spinal, avoid failure of internal fixation and recurrence of kyphosis.</p>