Evolución de la osteosíntesis de los huesos largos: fijación por enclavado intramedular con clavos rígidos

Se presenta la evolución histórica y científica de la osteosíntesis de huesos largos realizada con clavos rígidos. Mediante una revisión bibliográfica retrospectiva en revistas de Traumatología nacionales y extranjeras, así como libros relevantes de esta especialidad, se pudieron establecer tres momentos claves en la osteosíntesis intramedular con clavos rígidos y caracterizar las diferentes generaciones que aportaron a este procedimiento en la historia de la Ortopedia y la Traumatología. Destacan las innovaciones tecnológicas incorporadas a la práctica quirúrgica y el desarrollo de biomateriales para mejorar la reparación de lesiones e incorporar al paciente a su vida cotidiana. El trabajo demuestra cómo ha avanzado la técnica quirúrgica de fijación intramedular y la consolidación ósea; y gracias a ello los problemas de las fracturas han quedado prácticamente solucionados.

The historical and scientific evolution of osteosynthesis of long bones performed with rigid nails is presented. Through a retrospective bibliographic review in national and foreign Traumatology journals, as well as relevant books of this specialty, it was possible to establish three key moments in intramedullary osteosynthesis with rigid nails and characterize the different generations that contributed to this procedure in the history of Orthopedics and Traumatology. The technological innovations incorporated into surgical practice and the development of biomaterials to improve the repair of injuries and incorporate the patient into their daily lives stand out. The work demonstrates how the surgical technique of intramedullary fixation and bone consolidation has advanced; and how thanks to this the problems of fractures have been practically solved.

Evolución de la osteosíntesis de los huesos largos y fijación por enclavado intramedular flexible / Evolution of Long Bone Osteosynthesis and Flexible Intramedullary Nail Fixation

Introducción: Se presenta la evolución histórica y científica de la osteosíntesis de huesos largos realizada con dos tipos de implantes intramedulares: Pines o varillas flexibles y clavos rígidos. Objetivo: Publicar un artículo científico que sirva de soporte teórico y práctico al personal en formación y, como punto de referencia y consulta a los ortopédicos y traumatólogos. Métodos: Se realiza una revisión bibliográfica retrospectiva de artículos sobre fracturas de los miembros publicadas en revistas de traumatología nacionales y extranjeras indexadas en las bases de datos MEDLINE y certificadas por el organismo de Ciencia Tecnología y Medio Ambiente, así como libros de relevancia sobre este tema y experiencias de los autores. Dadas las diferencias entre los dos tipos de implantes se estudiaron por separado la osteosíntesis con pines flexibles (Rush) y la realizada con clavos rígidos (Küntscher). Se seleccionaron las siguientes variables para el estudio: reducción, vía de acceso, penetración del implante, estabilidad, bloqueo, metal usado y consolidación. La fecha de incorporación de las innovaciones tecnológicas a la práctica quirúrgica fue enmarcada en tres momentos generacionales en el período de tiempo comprendido desde 1939 hasta la actualidad. Conclusiones: Esta revisión permitió identificar dos tipos de implantes intramedulares: los pines flexibles y los clavos rígidos. El estudio de sus características permitió organizarlos en generaciones para poder ubicar en el tiempo su contribución a los conocimientos que permiten devolver al paciente su vida activa(AU)

Introduction: This article discuses the historical and scientific evolution of long bone osteosynthesis performed with two types of intramedullary implants, flexible pins or rods and rigid nails. Objective: To publish a scientific article that serves as theoretical and practical support for staff in training and, as a point of reference and consultation for orthopedists and traumatologists. Methods: A retrospective bibliographic review of articles is carried out on limb fractures published in local and foreign trauma journals indexed in the MEDLINE databases and certified by CITMA, as well as relevant books on this topic and experiences of the authors. Given the differences between the two types of implants, we separately studied the osteosynthesis with flexible pins (Rush) from that performed with rigid pins (Küntscher). The variables selected for the study were reduction, access route, implant penetration, stability, locking, metal used, and consolidation. The inclusion of technological innovations to surgical practice was framed in three generational moments from 1939 to the present. Conclusions: Thow types of intramedullary implants were identifies from this revision: flexible pins and rigid nails. The study of their characteristics allowed to organize them into generations in order to locate their contribution to the knowledge allowing the patient to return to an active life over time(AU)

Treatment of intra-articular distal femur fracture by our slot-designed compression bolt combined with bilateral locking compression plates: a biomechanical analysis / 中华创伤骨科杂志

Objective:To evaluate the biomechanical stability of our slot-designed compression bolt (SCB) combined with bilateral locking compression plates (LCPs) in the treatment of intra-articular distal femur fracture.Methods:In 24 adult male knee specimens treated with formalin, the femoral bony part was preserved to establish standard models of intra-articular distal femur fracture (AO type 33-C1). According to the random number table, the fracture models were divided into 2 equal groups: an experimental group ( n=12) subjected to fixation with one SCB combined with bilateral LCPs with 10 locking screws and a control group ( n=12) subjected to fixation with bilateral LCPs with 12 locking screws. In each model, a vertical ballast test was conducted to record the maximum axial displacement of the system and a horizontal torsion test to calculate the torsional stiffness of the system. When the loading pressure was 0-1,000 N in the biomechanical machine, structural abnormalities were observed in the 2 groups of models and the system maximum axial displacement and system torsional stiffness were compared between the 2 groups. Results:When the vertical ballast pressure was 400 N, 600 N, 800 N and 1,000 N, the maximum axial displacement of the system was, respectively, (0.14±0.01) mm, (0.25±0.01) mm, (0.41±0.02) mm and (0.63 ± 0.02) mm in the experimental group, and (0.15 ± 0.01) mm, (0.26 ± 0.01) mm, (0.46 ± 0.03) mm, and (0.67 ± 0.04) mm in the control group. Compared with the control group, the average maximum axial displacement in the experimental group decreased significantly under the axial pressure of 600-1,000 N ( P<0.05). When the horizontal torsion reached 5°, the torsional stiffness was, respectively, (2.00±0.12) Nm/° and (2.02±0.07) Nm/° in the experimental group and the control group, showing no significant difference between the 2 groups ( P>0.05). Conclusions:In the treatment of intra-articular distal femur fracture, compared with simple bilateral LCPs, our SCB combined with bilateral LCPs demonstrate similar torsional stability but better axial biomechanical stability. As our SCB has advantages of bilateral compression and minimal invasion in operation, it may be a new option for the reduction and compression treatment of intra-articular fractures.

Removal of locked intramedullary nails with the aid of bolts

Background: Removal of an intramedullary nail would require the extraction system of the inserted nail to be available. Sometimes the system is not available, and an alternative system would have to be utilised. Aim of the study was to document the removal of interlocked nails using bolts in the absence of appropriate fitting extraction system.Methods: A prospective study of consecutive patients seen by the authors between September 2016 and September 2018 in private clinics in Port Harcourt where the authors were invited to remove intramedullary nails. Bolts fitted to the proximal tips of the nails were utilized. With the aid of plier applied to the bolts and mallet, the nails were extracted. The patients’ socio-demographic and information relevant to the injury were obtained. Data was analysed using SPSS version 23.Results: Fifteen patients were seen. Ages ranged from 29 to 72 years, consisting of 10 males and five females. The tibia was affected in six and the femur in nine. There were five united tibial fractures and one non-united tibial fracture, six united femoral fractures and three non-united femoral fractures. Indication for removal was mostly patients’ request. Duration of surgery ranged from 1 to 4 hours. All the nails were extracted. Complications included broken nail, heterotopic calcification, bony overgrowth/ ingrowth/ongrowth around the nail and interlocking screws. There was no mortality.Conclusions: In the absence of conventional intramedullary nail extraction system, appropriate size bolts can be applied to the threaded proximal tip of nails and used for nail extraction.

Cánula rígida, alternativa en el tratamiento estético-funcional de la apicoformación por fractura complicada de corona / Rigid stems, an alternative in the esthetic-functional treatment of apex formation due to complicated crown fracture

Las edades más afectadas, por la presencia de fracturas complicadas de corona, son la niñez y la adolescencia. En la mayoría de los pacientes se afectan los incisivos centrales superiores permanentes de incompleta formación apical. Esto implica una disminución de las capacidades de masticación, dicción y trae consigo implicaciones psicológicas en la adolescencia. El tratamiento consiste en la aplicación de una técnica de apicoformación que dificulta lograr al unísono la resolución de la afección estética. Nuestro propósito es describir un caso de apicoformación en incisivo central superior izquierdo, con cementación de cánula rígida, conformación de muñón y restauración estético-funcional definitiva. Un paciente de 8 años, masculino acude a consulta tras sufrir traumatismo dentoalveolar consistente en fractura complicada de corona. Los rayos X muestran ligero ensanchamiento periodontal y ápice inmaduro. Se le aplicó anestesia local, se realizó la extirpación pulpar total del diente afectado, y se colocó medicamento intraconducto. La culminación del tratamiento de restauración total coronaria se realizó con la cementación con ionómero de vidrio tipo II de una cánula rígida No. 22 hasta las dos terceras partes de la longitud de trabajo; alrededor de esta se conformó un muñón y corona de nano composite híbrido fotopolimerizable. Se controló evolución cada 24 días, durante tres meses para comprobar el estado de maduración apical. La cementación de la cánula rígida, consituye una alternativa para el tratamiento funcional de la apicoformación por fractura complicada de corona. Supone una rápida recuperación de las funciones bucodentales y psicológico-sociales integrales del paciente(AU)

The life periods most commonly affected by complicated crown fractures are childhood and adolescence. The teeth most frequently affected are permanent upper central incisors of incomplete apical formation, resulting in limitations in chewing and speech, as well as psychological effects in adolescence. The treatment consists in the application of an apex formation technique which makes it difficult to also solve the esthetic effect. It was our purpose to describe a case of apex formation in the upper left central incisor, with rigid stem cementation, stump conformation and definitive esthetic and functional restoration. An 8-year-old male patient attends consultation after undergoing dentoalveolar trauma consisting in complicated crown fracture. Radiography revealed slight periodontal expansion and an immature apex. A local anesthetic was applied to perform total pulpal removal of the affected tooth and place intracanal medicament. At the end of the total crown restoration treatment, cementation of a No. 22 rigid stem was performed with type II glass ionomer up to two thirds of the working length, and a hybrid photopolymerizable nanocomposite crown and stump were shaped around it. Evolution was checked every 24 days for three months to verify apical maturation status until total formation was achieved. Rigid stem cementation is an alternative for the functional treatment of apex formation due to complicated crown fracture. It is characterized by a fast, complete recovery of the patients oral-dental and psycho-social functions(AU)

Cost-minimization Analysis of 3 Therapeutic Regimens for Skin Allergy / 中国药房

OBJECTIVE:To evaluate the economic effect of 3 therapeutic regimens in the treatment of skin allergy. METH-ODS:54 patients with skin allergy in our hospital were randomly divided into A,B,C groups. They were given calcium+Vc+Ma-lay bolt chlorpheniramine (Puermin),calcium+Vc+Loratadine tablets (Kairuitan),calcium+Vc+Cetirizine hydrochloride tablets (Xikewei),respectively. Short-term efficacy was observed,and analyzed with the minimum cost analysis. RESULTS:Effective rates of A,B,C groups were 94.44%,88.89% and 94.44%,respectively,there was no statistical significance (P>0.05);the cure rates of 3 groups were 55.56%,38.89% and 83.33%,there was statistical significance(P<0.05). The cost were 169.70 yu-an,195.70 yuan and 180.40 yuan,respectively. The cost of group A was the lowest. CONCLUSIONS:The regimens of A group is economical,but that of group C the best after comprehensive comparison.

Research on the application of value of tubal bolt blocking techniquein the pretreatment hydrosalpinx / 实用放射学杂志

Objective To explore the difference of the impact with different hydrosalpinx pretreatment methods in vitro fertiliza-tion-embryo transfer ﹝ IVF-ET ﹞.Methods 160 patients with routine IVF-ET’s hydrosalpinx were random divided into two groups :the first 80 patients undergoing routine bolt blocking the fallopian tubes for the study group;the other 80 patients with rou-tine salpingectomy as control group patients,after treatment,compare the difference on ovarian function between the two groups.Re-sults In the study group,although these difference,the average number of oocytes,fertilization rate,clinical pregnancy rate and other indicators,were not statistically significant (P>0.05),they were higher than the control group;early abortion rate was no significant difference either (P>0.05),but the tubal pregnancy rate was lower than the control group,and the difference was statis-tically significant (P<0.05).Conclusion Tubal bolt blocking technique is an effective method for hydrosalpinx pretreatment,and partly superior than gynecological surgery for keeping ovarian function and IVF-ET treatment targets.So,it has a broad application prospects in vitro fertilization-embryo transfer.

Diagnosis and treatment of bacteria bolt in upper urinary tract / 中华泌尿外科杂志

Objective To improve the understanding of bacteria bolt in upper urinary tract,and to investigate its diagnosis and treatment.Methods The clinical data of 11 cases with bacteria bolt in upper urinary tract were reviewed retrospectively.The clinical manifestation and treatment were summarized.Results Infection and obstruction were the clinical manifestation.Two-stage treatment was provided.Ureteral stent was indwelled in two cases,and percutaneous nephrostomy was provided at the first stage in the other 9 cases.Then the bacteria bolt was taken by ureteroscopy (1 case) or by percutaneous nephrostomy (10 cases) when the condition improved.The second stage operation took 37 min on average (ranged from 20 to 55).Estimated blood loss 60 ml on average (ranged from 10 to 200 ml).Hemoglobin decreased 5.1 g/L (3-11 g/L) 48 hours after operation in the 10 cases underwent percutaneous nephrostomy.Bolt-free rate was 100％.There was no infectious shock occurred.No relapse was observed during the 16 months of follow-up.Conclusions Bacteria bolt in upper urinary tract is not common.Infection and obstruction are its manifestation.Two-stage treatment is safe and effective.

Bone bolt for the treatment of the haplo-detached of distal tibiofibular joint / 中国基层医药

Objective To observe the results of bone bolt crews in treatment of the haplo-detached distal tibiofibular joint.Methods The haplo-detached distal tibiofibular joint were fixed with bone bolt in 7 patients.Their outcomes were evaevaluated according to Mast and Teipner criteria and X-ray.Results All 7 patients were followed up from 12 to 36 months.All were assessed as good,and no fair or poor cases were found.Conclusion Bone bolt fixation was believed to be a good method to treat the haplo-detached distal tibiofibular joint with simple operation,beared shear force and control of brew tightress and was helpful in weight loading and functional exercises in the earlier period after operation,so bone bolt fixation was good in practical value in clinc.

DHS Combined with Hollow Traction Bolt Treat Thighbone Interrotor Fracture / 浙江中医药大学学报

[Objective]To explore clinical effect of DHS combined with hollow traction bolt treating thighbone interrotor fracture. [Method]From May 2003 to July 2006,apply DHS combined with hollow traction holt to treat thighbone interrotor fracture 9 ca- ses,6 males,3 females,aged 47～72,62.6 in average,5 cases of left side,4 right side;classify under Evan's:5 cases of typeⅡ, 2 ofⅢ,2 ofⅣ.[Result]Follow up for 6～21 months,12 months in average.Appraise the clinical effect by Huang Gongyi's standard,7 cases were very good,1 good,1 bad,the good rate was 89%.[Conclusion]DHS combined with hollow traction bolt treating thighbone interrotor fracture can obviously increase stability of fracture point,reduce local rotation,helpful to fracture cure and early exercise,as well as the complication.

A Successful Case of Cardona's Prothokeratoplasty on Alkali Burn for 16 Years

PURPOSE: To report one case which has been showed successful results after prosthokeratoplasty using `Cardona Bolt and Nut' model. Even though prosthokeratoplasty has a high rate of failure within 5 years after surgery because of many complications, But there was no complications over a 16-year period in this case since surgery by one of the authors (J-H K). METHODS: This patient had an alkali burn on both his eyes due to the accidental explosion of carbamate in 1979 when he was 26 years old. His corneas were densely pacified with neo-vascularization despite undergoing keratoplasty once on his right eye, and twice on his left eye. To improve his vision, we performed ultimately a successful Cardona Bolt and Nut prosthokeratoplasty on his right eye in 1988. RESULTS: During the period of to 16-year follow-up the visual acuity of his right eye was maintained at 0.1 without correction, and 0.15 with correction (+7.0 D.), even though his visual field narrowed(within 10 degree) due to the long and narrow optical cylinder.

Compression fixation with small incision steel plate and stud bolt for calcaneal fractures / 中华创伤骨科杂志

Objective To explore a new surgical procedure of open reduction and internal fixation for intraarticular fractures of calcaneus and its clinic outcome. Methods Between August 2004 and August 2005, 54 feet in 44 patients with calcaneal fracture were treated in our department. Based on the results of X-ray and coronal CT scan before and after treatment, small incision (2-3 cm) at lateral sides of calcaneus, self-made calcaneal anatomical plate and stud bolt were used. According to Sanders classification system, there were 12 cases of type Ⅱ, 32 cases of type Ⅲand 10 cases of type Ⅳ. Results The internal fixation with the calcaneal anatomical plate almost restored the height, length, width, Blher's and Gissane's angles of the calcaneus for the 44 patients. No infection of incision happened. The results were evaluated using Maryland Foot Score. 54 fractures were followed up for 2 to 12 months (averaging 8.3 months) after treatment. Excellent results were noted in 26 fractures,good in 24,fair in 4, and the excellent and good rates were 92.6%. Conclusion The open-reduction and internal fixation with self-made calcaneal anatomical plate and stud bolt is one of the best ways for treatment of fracture of calcaneus.

Expression of heat shock protein 27 induced in the experimental rat glaucoma model / 眼科

Objective To evaluate changes in retinal expression of three heat shock proteins(HSPs)HSP27,HSP70 and HSP90 in normal and experimental glaucomatous rats's retina,and to explore the potential relationship between HSPs with glaucoma optic neuropathy.Design Experimental study.Participants 60 Wistar rats.Methods Rats were randomly divided into ocular hypertension group(n=30)and sham control group(n=30).The right eye was designed as the experimental eye,and the left as the control eyes.Intraocular pressure(IOP)was elevated by using underwater bipolar electro coagulation condensate 3 episcleral and limbal veins on the right eye of rats to establish of animal models of glaucoma.IOP were monitored twice weekly with a Tonopen.In treated eyes,IOP ranged from 27 to 35 mmHg throughout the study.Rats were killed with euthanasia at 10,20,or 60 days following the occurrence of ocular hypertension,with retina dissected free and protein isolated.Protein was used for Western blot analysis and probed with specific HSP antibodies,and normalized to ?-actin levels.Main Outcome Measures IOP,Western bolt.Results Western blot analysis demonstrated that HSP27 protein levels in the retinas were elevated as much as 197% at 10,20 and 60 days following the induction of ocular hypertension.No changes in protein levels were observed for HSP70 or HSP90 in retina from ocular hypertensive eyes.Conclusions The stress protein HSP27 is upregulated in retinas from ocular hypertensive rats.No changes in HSP70 or HSP90 were observed.The upregulation in HSP27 appears to be a gene specific event associated with elevated IOP,its expression may be a potential relationship associated with optic neuropathy in glaucoma.

Clinical study on treatment of chronic renal failure(blood silt and damp pathogen syndrome) with Shenkang Bolt / 中成药

AIM: To observe the curative efficacy of Shenkang Bolt(SKB) in treating chronic renal failure(CRF) with blood silt and damp pathogen syndrome. METHODS: The randomized,parallel and controlled trial were used.38 cases in treatment group were treated with SKB,and 40 cases in control group were clystered with Chinese herbal medicine.The changes of the cumulative scores of traditional Chinese medicine(TCM) syndrome,the levels of serum creatinine(SCr) and creatinine clearance rate(CCr) before and after treatment in both groups were observed. RESULTS: The total effective rate was 81.5% in the treatment group,but 75% in the control group.The scores of TCM syndrome and the levels of SCr were both significantly decreased(P(0.05)). CONCLUSION: SKB can markedly improve the clinical manifestations of CRF with blood silt and damp pathogen syndrome,decrease the levels of SCr,but increase CCr.There was no difference between Chinese herbal clysis and Shenkang Bolt in curative effect,but it is convenent to take Shenkang Bolt.