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Objective To explore the common bleeding location, disease features, and the management strategies of intractable aged epistaxis. Methods 134 serious epistaxis patients were examined step by step according to nasal anatomic structure and treated by a stepwise way under endoscopy. Results The bleeding location of the intractable aged epistaxis were found as follows:2 cases (1. 49%) in anterosu-perior area, 44 cases (32. 84%) in anteroinferior area, 18 cases (13. 43%) in posterosuperior area, 22 cases (16. 42%) in posteroinferi-or area, 3 cases (2. 24%) in nasopharynx, and the bleeding site of the other 45 cases (33. 58%) were not found. All the patients were healed. The final treatment way were:46 cases (34. 33%) with pharmacotherapy or cauterization (grade Ⅰ~Ⅲ), 88 cases (65. 67%) with anterior nasal packing (grade Ⅳ), 9 cases (6. 72%) with posterior packing(gradeⅤ),1 case (0. 75%) with selective angiographic embolization (grade Ⅵ). There were 82 cases (61. 19%) succeed with the initial hemostasis methods while 52 cases (38. 81%) succeed with the upgrade therapy. Both hemostasis methods and upgrade therapy had statistical significance in different nasal position groups ( hemo-stasis methods:χ2 =16. 35,P=0. 00; upgrade therapy: χ2 =16. 35,P=0. 00). Conclusion Compartmental examination and classified treatment steps by using endoscope may locate and stop nose bleeding promptly while decrease patients' pain and medical cost.
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Objective To evaluate biomechanical properties of self-designed polyaxial self-locking anatomical plate so as to offer scientific evidence for clinical application.Methods According to anatomic characteristics of distal tibiae of domestic people,a polyaxial self-locking anatomical plate for distal tibia was designed.Six paired ( left,right) fresh cadaver tibial specimens were used to make fracture fixation models and were divided into groups A and B,six specimens per group.Common anatomical locking plates were assembled in group A and polyaxial self-locking anatomical plates were assembled in group B.The biomechanical tests were performed by using 858 Mini Bionix testing machine.Non-destructive tests were performed in both groups,including axial loading,4-point bending and torsional loading and the stiffness of the two fixation instruments was compared.SPSS 13.0 software was used for statistical analysis.Results Polyaxial self-locking anatomical plate was fit for the morphology of distal tibiae.The self-designed pelyaxial plate could increase angular regulation amplitude for the locking screw up to 30°.Compression stiffness was (557.53 ± 20.72) N/mm in group A and (562.80 ± 28.26 ) N/mm in group B.Four-point bending stiffness was ( 268.02 ± 36.77) N/mm in group A and ( 265.76 ± 27.21 ) N/mm in group B.Torsional stiffness was (0.28 ±0.01) Nm/deg in group A and (0.29 ±0.02) Nm/deg in group B.The three tests in two groups showed no statistical significance ( P ＞ 0.05 ).Conclusions The self-designed polyaxial self-locking anatomical plate of distal tibia is fit for the tibial morphology of domestic people.Its biomechanical properties are equivalent to those of common anatomical locking plate,which can meet the needs for clinical application.
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[Objective]To discuss a reasonable treatment for unstable intertrochanteric hip fractures in senile patients by comparing the effects of hemiarthroplasty and DHS fixation.[Method]Totally 126 intertrochanteric hip fractures in senile patients with complete clinical data were retrospectively analyzed,who were treated with hemiarthroplasty or DHS fixation from June 2002 to October 2005.Of the 126 patients,53 were treated with hemiarthroplasty,73 were treated with DHS fixation.All of them had multiple medical co-morbidities and were combined with severe osteoporosis.According to modified Even-Jensen classification,all of them belonged to unstable fractures.Comparison was made between the two treated groups in terms of operative time,blood transfusion during or after surgery,time for bed rest postoperatively,postoperative complications and St.Michael hip score one year after surgery.[Result]The average duration of follow-up for hemiarthroplasty and DHS fixation was 16 and 18 months respectively.Compared with the group of DHS fixation,the group of hemiarthroplasty experienced shorter time for bed rest postoperatively,fewer postoperative complications and higher St.Michael score 1 year after surgery,and the differences between two groups had statistical significance(P0.05).[Conclusion]Cemented hemiarthroplasty has the advantages of allowing early full weight bearing after surgery,low complication rate and satisfactory functional recovery.It is a reasonable treatment for unstable intertrochanteric hip fractures in senile patients.
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Objective To discuss our tentative application of the anatomic plate in the treatment of distal tibia fractures in order to develop a new effective fixation technique for this kind of fracture. Methods From November 2000 to September 2001, the authors applied Linkdistal tibia anatomical plates in the treatment of distal tibia fractures, which involved metaphysis in 12 cases, including 8 males and 4 females, aged from 18 years ～66 years, with 38 years on average. All the cases were of high energy injuries and complicated with ipsilateral fibular fracture. According to AO/ASIF classification: three were type A1, five were A2, three were A3, and one was B1; three of them were close fractures, five were type IO1 open fractures, and four were IO2. Results All the cases healed at one stage without infection or exposure of the implant. Bone callus could be found 2 3 weeks after operation. Bone union was achieved within 3～6 months, with 4 months on average. No delayed union or non union occurred. Functions of ankle joints recovered completely. Conclusion The anatomical plate for distal tibia is supperior to the traditional plates in both biomechanical and biological aspects. It is the best choice for the treatment of distal tibia fractures.
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Objective To assess the clinical value of the mi nimally invasive plate fixation technique in treatment of metaphyseal comminute d fractures of long tubular bones.Methods Sixty-eight patients with metaphyseal comminuted fractures o f femur or tibia were treated with min imally invasive percutaneous plati ng and early recovery movement from April 1999to October 2001.Results All the patients were followed up for a mean time of 10months.The postopera tive radiograph showed that reducti on and internal fixation were satisfactory in sixty-five patients.Lateral angular deformity of 8?occurred in one c ase,and 2cm shortage of the lower lim b in two cases.Sixty-eight patients obt ained bone union and satisfactory clinical function.There were no deep i nfec-tion,nonunion or other complicatio ns.Conclusion For metaphyseal comminuted fractur es of long bones of lower extremities,minimally invasive percutaneous plate fixation is o f significant value due to the advant ages of less iatrogenic trauma,rigid fixation and early movement.[