Résumé
Objective: To summarize the effectiveness of mini locking plate combined with Kirschner wire in treatment of comminuted Jones fracture. Methods: Between January 2011 and October 2016, 25 cases with comminuted Jones fracture were treated with mini locking plate combined with Kirschner wire. There were 9 males and 16 females with an average age of 31.4 years (range, 16-66 years). The fractures located on the left side in 11 cases and on the right side in 14 cases. The causes of injury included spraining in 21 cases, falling down in 3 cases, and bruise in 1 case. The bone fragment of all cases was more than 3 pieces. The fracture line was mostly Y-shape or T-shape. Twelve of them were combined with other fractures. The time from injury to operation was 1-9 days (mean, 5 days). The mini locking plate and Kirschner wire were removed at 9-12 months postoperatively. At 12 months postoperatively, the pain was evaluated by the visual analogue scale (VAS) score, and the function by the American Orthopaedic Foot & Ankle Society (AOFAS) score. Results: All incisions healed by first intention. All cases were followed up 12-36 months with an average of 21.7 months. Fracture union was observed in all patients without complications such as nonunion, delayed union, and malunion. The fracture union time was 8-12 weeks (mean, 9.4 weeks). At 12 months postoperatively, the VAS score was 1.15±0.87; the AOFAS score was 89.45±6.24, and the results were excellent in 14 cases, good in 9 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 92%. Conclusion: The procedure of mini locking plate combined with Kirschner wire for comminuted Jones fracture has such advantages as convenient operation, more rigid fixation, high rate of fracture healing, and good functional recovery in foot.
Résumé
Objective To investigate the clinical therapeutic effect of the vacuum-sealing drainage (VSD) combining with skin graft in a deep burn wound.Methods Sixty one patients were divided into two groups according to treatment method.Thirty tree patients were assigned as the VSD treatment group,which was treated by VSD after debridement; their wounds were transplanted by the split thickness skins binding up by VSD when they were fitted.Twenty eight patients were assigned as the routine treatment group,which was treated by means of traditional regular dressing change to remove necrotic tissue and promote granulation tissue; their wounds were transplanted by the split thickness skins binding up by packing when they were fitted.Results After treatment by VSD,there are no systemic hypersensitivity reactions and abnormal bleeding.Thirty three cases of VSD treatment group were treated by VSD for 7 ～ 10 days,the other 2 cases were treated by VSD for another 7 ～ 10 days because of granulation tissue badly.Until their granulation was fresh,skin grafting technique was used and the skin survived well.The treatment time before skin grafts,the pain score,and the cost of ablative therapy for wound were ( 8 ± 0.9) day,(5.7 ± 1.6) point,and ( 1.5 ± 0.4) ten thousand yuan in VSD group vs.( 14 ± 1.2) day,(3.1 ± 1.1 ) point,and (0.6± 0.2)ten thousand yuan in control group.The survival rate and the wound germiculture positive rate were 97.0％ and 6.5％ in the VSD group vs 75.0％ and 28.6％ in the control group.The differences between groups were statistically significant ( P ＜ 0.05 ).Conclusions VSD is a simple method that is easy to grasp,and that can promote granulation tissue growth,reduces the wound germiculture positive rate,shortens the wound healing period,increases the survival rate of skin grafts,and relieves patients 'pain.It is worth popularizing and applying in the deep burn wound therapy.