Reduction of valgus-impacted femoral neck fractures by Schanz screw combined with rod stick technique / 中华骨科杂志

Objective:To investigate the clinical efficacy of the femoral neck system (FNS) after the reduction of the Schanz screw combined with the rod stick technique in the treatment of valgus-impacted femoral neck fracture.Methods:A retrospective analysis of clinical data from 66 patients with valgus-impacted femoral neck fractures from December 2019 to November 2021 has been performed. All patients were treated with the Femoral Neck System. Auxiliary reduction group (using the Schanz screw and rod stick technique), including 32 cases, 9 males and 23 females with an average age of 52.7±12.0 years (range, 28-77 years); 14 patients on the left side and 18 patients on the right side; body mass index 23.1±2.6 kg/m 2. Manual reduction group (using the traditional Flynn closed reduction technique), including 34 cases, 18 males and 16 females with an average age of 52.1±12.7 years (range, 26-75 years); 18 patients on the left side and 16 patients on the right side; body mass index 23.4±2.3 kg/m 2. The surgery time, intraoperative blood loss, complications, and Harris hip score at the last follow-up were collected and compared between the two groups. Preoperative and postoperative abduction angle and posterior tilt angle were measured in the anterior-posterior and lateral positions of the hip, as well as the length of the femoral neck shortening at the last follow-up. Pearson analysis was used to evaluate the correlation between preoperative and postoperative abduction angle and posterior tilt angle, the length of femoral neck shortening, and Harris hip score. Results:There were no significant differences in baseline data such as gender, age, side of injury, height, weight, and body mass index, and the surgery time and intraoperative blood loss between auxiliary reduction group and manual reduction group ( P>0.05). All 66 cases with a mean follow-up of 20.4 months (ranges 12-29 mouths). The fracture healing time was 5.0±0.9 weeks in the auxiliary reduction group and 4.9±0.8 weeks in the manual reduction group ( t=-0.41, P>0.05). There were no significant statistical difference in the preoperative abduction angle and preoperative posterior tilt angle between the auxiliary reduction group and the manual reduction group ( P>0.05). The postoperative abduction angle and posterior tilt angle of the auxiliary reduction group (1.8°±3.1°, 1.2°±3.0°) were significantly lower than those of the manual reduction group (13.7°±6.5°, 6.8°±4.1°, t=-9.55, P<0.001; t=-7.42, P<0.001). Preoperatively, 61 cases (92%) were associated with a posterior tilt of the femoral head, and 30 (46%) of them had a posterior tilt angle of more than 10°. The length of femoral neck shortening at the last follow-up and the moderate and severe femoral neck shortening rate postoperatively in the auxiliary reduction group (1.4±2.1 mm, 0, and 3%) were significantly lower than those in the manual reduction group (8.1±4.8 mm, 38%, and 32%, P<0.05). Harris hip score at the last follow-up in the auxiliary reduction group 91.1±4.5 was significantly higher than those in the manual reduction group 85.5±5.4 ( t=4.54, P<0.001). The postoperative abduction angle and length of femoral neck shortening showed correlations with the Harris hip score respectively ( r=-0.551, -0.743; P<0.001). In the auxiliary reduction group, 1 case of broken temporary fixed Kirschner wire was removed by nucleus pulposus forceps, and the fracture site healed after surgery. In 2 cases, the Schanz screw loosened and pulled out during the reduction process, and the successful reduction was achieved after increasing the depth of the Schanz screw insertion, and no peri-Schanz screw fracture occurred. After surgery, 3 cases (1 case in the auxiliary reduction group and 2 cases in the manual reduction group) developed avascular necrosis of the femoral head (18 months, 18 months, and 2 years after surgery, respectively), femoral head collapse and severe shortening of the femoral neck, all of which underwent total hip arthroplasty. Conclusion:FNS after the reduction of the Schanz screw combined with the rod stick technique in the treatment of valgus-impacted femoral neck fracture has the advantages of effectively correcting preoperative abduction angle and posterior tilt angle and reducing the length of femoral neck shortening, and it can obtain satisfactory short and medium-term clinical efficacy.

Femoral neck system and cannulated compression screw fixation in the treatment of femoral neck fracture in the young and middle-aged patients: efficacy comparison / 中华创伤杂志

Objective:To compare the efficacy of femoral neck system (FNS) and cannulated compression screw (CCS) in the treatment of femoral neck fracture in the young and middle-aged patients.Methods:A retrospective cohort study was conducted to analyze the clinical data of 91 patients with femoral neck fracture admitted to Fuzhou Second Hospital from July 2020 to December 2021, including 52 males and 39 females; aged 23-65 years [(48.9±10.3)years]. Garden classification of the fracture found that 31 patients were with type I, 9 with type II, 12 with type III and 39 with type IV. Pauwels classification of the fracture found that 7 patients were with type I, 33 with type II and 51 with type III. A total of 53 patients were treated with FNS fixation (FNS group) and 38 patients with CCS fixation (CCS group). The operation time, intraoperative blood loss, Haidukewych fracture reduction quality, hospitalization time, Barthel index, fracture healing time, and weight-bearing time were compared between the two groups. The hip function was assessed by Harris hip score in both groups at postoperative 3 months, 6 months and 1 year and at the final follow-up. The incidences of postoperative complication and secondary surgery were also compared between the two groups.Results:All the patients were followed up for 15-31 months [(22.2±5.5)months]. There were no significant differences in the operation time, Haidukewych fracture reduction quality, hospitalization time, or Barthel index (all P>0.05). The intraoperative blood loss in the FNS group was 50.0(20.0,85.0)ml, which was more than that in the CCS group [20.0(10.0,50.0)ml] ( P<0.01). The fracture healing time, partial weight-bearing time, and full weight-bearing time in the FNS group [4.0(3.0,5.0)months, 3.0(2.0,3.0)months, 5.0(4.5,6.0)months] were shorter than those in the CCS group [6.0(5.0,7.0)months, 3.0(2.8,4.0)months, 6.0(6.0,7.0)months] (all P<0.01). The Harris hip score at postoperative 3 months, 6 months and 1 year and at the final follow-up were 74.0(71.0,77.0)points, 87.0(84.0,88.5)points, 91.0(88.0,95.0)points, and 94.0(91.0,96.0)points in the FNS group, significantly higher than those in the CCS group [73.0(70.0,74.0)points, 82.5(79.8,87.0)points, 88.0(83.5,91.0)points, 89.0(84.0,93.0)points] (all P<0.05 or 0.01). There were no statistically significant differences in the incidences of postoperative complication or secondary surgery between the two groups (all P>0.05). Conclusion:Compared with CCS, FNS can shorten fracture healing time, allow patients to carry full weight as soon as possible, and significantly improve hip function in the treatment of middle-aged and young adults with femoral neck fracture, although there is more intraoperative blood loss.

Analysis of risk factors for incision complications after an enlarged lateral "L" incision for open reduction and internal fixation of closed calcaneal fracture / 中华创伤杂志

Objective:To investigate the risk factors for incision complications in open reduction and internal fixation of closed calcaneal fracture via an enlarged lateral L-shaped incision.Methods:A case-control study was used to analyze the clinical data of 128 patients (139 feet) with closed calcaneal fracture treated by open reduction and internal fixation via an enlarged lateral L-shaped incision in Fuzhou Second Hospital affiliated to Xiamen University from January 2019 to January 2022, including 113 males (123 feet) and 15 females (16 feet); aged 24-79 years [(48.2±10.8)years]. The fracture was on the one side in 117 patients and on both sides in 11 patients. According to Sanders classification, type I was noted in 3 feet, type II in 92, type III in 40, and type IV in 4. All patients were treated with an enlarged lateral L-shaped shaped incision for open reduction and internal fixation. The patients were divided into complication group (33 feet) and control group (106 feet), according to the occurrence of postoperative incisional complications. Data were recorded in both groups, including gender, age, side, fracture subtype, combined fractures, diabetes history, smoking history, local blistering, preoperative waiting time, bone graft, drainage, operative time, time of tourniquet use, number of prophylactic antibiotic use, postoperative treatment to improve microcirculation and preoperative and postoperative laboratory indices (white blood cell count, haemoglobin and albumin). The correlation between the above data and postoperative incisional complications was analyzed using the univariate analysis, followed by identification of independent risk factors by the multi-factor Logistic regression analysis.Results:Univariate analysis showed that diabetes history, smoking history, number of prophylactic antibiotic use, postoperative treatment to improve microcirculation, postoperative albumin and postoperative haemoglobin were associated with postoperative incisional complications (all P<0.05). On the contrary, gender, age, side, fracture subtype, combined fractures, local blistering, preoperative waiting time, bone graft, drainage, operative time, time of tourniquet use, preoperative white blood cell count, preoperative albumin, preoperative haemoglobin and postoperative white blood cell count were not associated with postoperative incisional complications (all P>0.05). Multi-factor Logistic regression analysis showed that diabetes history ( OR=3.51, 95% CI 1.29-9.50, P<0.05), smoking history ( OR=3.53, 95% CI 1.34-9.30, P<0.05), prophylactic antibiotic use<2 times ( OR=2.52, 95% CI 1.04-6.10, P<0.05) and lack of postoperative treatment to improve microcirculation ( OR=2.97, 95% CI 1.79-12.45, P<0.05) were significantly associated with postoperative incisional complications ( P<0.05). Conclusion:Diabetes history, smoking history, prophylactic antibiotic use<2 times and lack of postoperative treatment to improve microcirculation are independent risk factors for incisional complications in open reduction and internal fixation of closed calcaneal fracture via a lateral enlarged L-shaped shaped incision.

Research progress in mechanism of H-type vessel on the coupling of angiogenesis and osteogenesis in bone microenvironment remodeling / 中华创伤杂志

The coupling effect of angiogenesis and osteogenesis is of great significance for the remodeling of bone microenvironment. As a bone-specific microvascular subtype with high expression of CD31 and Endomucin（CD31 hiEmcn hi），H-type vessels are mainly distributed in the metaphysis，surrounded by Osterix + and Runt-related transcription factor 2（Runx2 +）osteogenic progenitor cells. H-type vessels，regulated by vascular endothelial growth factor（VEGF），platelet-derived growth factor BB（PDGF-BB），slit guidance ligand 3（SLIT3），hypoxia inducible factor 1α（HIF-1α），Notch and other signals，participate in the regulation of cell proliferation and differentiation of bone marrow mesenchymal stem cells（BMSCs），osteoblasts，osteoclasts，endothelial cells，etc. The mechanism of H-type vessels in coupling osteogenesis with angiogenesis has become a hot spot in recent research. The authors explore the progress of the mechanism of H-type vessels in coupling osteogenesis with angiogenesis by reviewing the characteristics of H-type vessel，mechanism of H-type vessel regulating bone formation，regulation mechanism of H-type vessel formation and related influencing factors，to provide a reference for clinical bone injury repair and anti-osteoporosis treatment.

Current study on the relationship between single nucleotide polymorphisms and susceptibility to osteomyelitis / 中华创伤骨科杂志

Osteomyelitis (OM) is still a major problem for orthopedists. Numerous studies have shown that genetic factors may play an important role in the pathogenesis of OM. As a third generation genetic marker, single nucleotide polymorphisms (SNPs) have received increasing attention from scholars who are studying genetic susceptibility to OM. In-depth research on the SNPs of susceptibility genes will help to explore new strategies for prevention, diagnosis and treatment of OM. This article reviews the research advances concerning gene SNPs and OM susceptibility.

Current study on standardized specimens’ collection for bacterial culture of fracture-related infection / 中华创伤骨科杂志

Fracture-related infections are a major problem that plagues many orthopedic surgeons.As their diagnosis is often doubtful, treatment time-consuming, healing prolonged and expenditure huge, they se-riously damage the physical and mental health of patients.In view of the differences in injury mechanism, injury severity, bacterial origin and onset time in patients with fracture-related infection, it is particularly important to standardize the clinical collection of specimens to increase positive rate of bacterial culture and detection rate of pathogenic bacteria.This article expounds on preparation, timing, location, type, quantity and post-processing in specimens’ collection, hoping that a fine understanding of standardized procedures in specimens’ collection may better serve clinical treatment.

Surgical techniques on fixation of intertrochanteric fractures using proximal femur nail antirotation (PFNA) in lateral position without traction table / 中华骨科杂志

Objective To compare the clinical efficacy of PFNA internal fixation for the treatment of femoral intertrochanteric fracture in the lateral position without traction table and supine position with traction table.To explore the surgical techniques of fixation using PFNA in lateral supine without traction table.Methods A retrospective study was conducted on 173 patients with intertrochanteric fracture fixed with PFNA in Fuzhou Second Hospital from January 2010 to January 2017.In the lateral position group,106 were operated in lateral position without the use of a traction table,including 42 males and 64 females,with the age range of 65 ～ 98 years (the median age was 78 years);and In the supine position group,67 were operated in supine position with a traction table,including 32 males and 35 females,with the age range of 66-101 years (the median age was 76 years).The anesthesia time,operative time,length of hip incision,intraoperative dominant bleeding loss,the rate of bone hook assisted reduction,hospitalization days,fracture reduction effect,fracture healing time,and postoperative complications were analyzed and compared,and the function of hip joint was evaluated according to the Harris score system.Results The anesthesia time was 59.3± 8.7 min,operative time was 46.6±6.5 min,length of hip incision was 2.9±0.9 cm,intraoperative dominant bleeding toss was 76.4±15.6 ml,and the rate of bone hook assisted reduction was (25.4％,17/67) in the lateral position group,while the anesthesia time was 62.6±7.4 min,operative time was 51.4±9.7 min,length of hip incision was 4.2±1.1 cm,intraoperative dominant bleeding loss was 105.3±17.4 ml,and the rate of bone hook assisted reduction was (25.4％,17/67) in the supine position group.These of the lateral position group were less than those of the supine position group,and the difference was statistically significant (P ＜ 0.05).The overall incidence of complications was 24.53％ (26/106),lateral cortical disruption of the greater trochanter accompanied with extravasation of the nail point was 3.77％ (4/106),the incidence of deep venous thrombosis was 4.72％ (5/106) and the incidence of skin contusion was 0.94％ (1/106) in the lateral position group,while those of the supine position group were 56.71％ (38/67),11.94％ (8/67),10.45％ (7/67),and 10.45％ (7/67).Numerical analysis of the lateral position group was less than those of the supine position group,and the difference was statistically significant (P ＜ 0.05).The hospitalization days (t=1.75,P=0.081) and the effect of fracture reduction (x5=0.202,P=0.042),fracture healing time (t=-1.47,P=0.145) and Harris score of hip function (t=1.03,P=0.305) were not statistically different (P ＞ 0.05) between the two groups.Conclusion Fixation of intertrochanteric fractures using PFNA in the lateral position without a traction table has more advantages than those of in supine position with traction table and is worthy of promotion and application in basic hospitals.

Potassium permanganate soak combined with a negative pressure drainage device for bone and soft tissue infection / 中华创伤骨科杂志

Objective To analyze the clinical efficacy of potassium permanganate soak combined with a closed negative pressure drainage device for treatment of bone and soft tissue infection.Methods A retrospective analysis was performed of the 83 patients with bone and soft tissue infection who had been treated at Department of Orthopaedics,The Second People's Hospital of Fuzhou from July 2010 to March 2017.They were 71 males and 12 females,aged from 15 to 77 years (median,44 years).Of them,47 were subjected to soakwith 1:5,000 potassium permanganate solution and 36 to soak with 1:5,000 gentamycin solution before a negative pressure sealing drainage device was applied for them all.The 2 groups were compared in terms of complications (pain,drainage device blockage or leakage,wound bleeding,tube pressure ulcer,and new nosocomial infection),time for negative bacterial culture,time for drainage device removal,time for wound closure,healing rate and recurrence rate.Results There were no significant differences between the 2 groups in pain,drainage device blockage or leakage,wound bleeding,or tube pressure ulcer (P ＞ 0.05).The rate of new nosocomial infection was significantly lower in the potassium permanganate group (2.1％)than in the gentamicin group (13.9％).The time for negative bacterial culture,drainage device removal and wound closure in the potassium permanganate group (6 d,12 d and 18.5 ± 1.9 d,respectively) was all significantly shorter than in the gentamicin group (9 d,15 d and 20.0 ±2.2 d,respectively) (P ＜ 0.05).The healing rate for the potassium permanganate group (100％) was significantly higher than that for the gentamicin group (86.1％);the recurrence rate (0) for the former was significantly lower than that for the latter (13.9％) (P ＜ 0.05).Conclusion Potassium permanganate soak combined with a negative pressure drainage device is effective,economical,convenient and safe for the treatment of bone and sofi tissue infection,compared with gentamicin soak combined with the same device.

Effect of chemotherapy of DC combined with cinobufacini in the treatment of advanced stomach cancer / 中国基层医药

Objective To observe the therapeutic effect of the combination of cinobufacini with DC chemo-therapy in the treatment of advanced stomach cancer .Methods 65 patients who were diagnosed advanced gastric cancer on the basis of histocytology and pathology results , were randomly divided into DC chemotherapy group (31 cases) and combined treatment group (34 cases).The clinical curative effect ,adverse reaction,quality of life ( KPS questionnaire ) and the easement rate of pain were analyzed .Results The two groups had no statistically significant differences in adverse reaction (t=-0.0047,P>0.05) and clinical curative effect (χ2 =0.077,P>0.05),and the clinical response rate of the combined treatment group (35％) was similar to the DC chemotherapy group (32％).Besides,the easement rate of pain in the combined treatment group increased to 71％,which in the DC chemotherapy group increased to 45％(χ2 =19.969,P<0.05).And the improvement rate of quality of life (QOL) in the combined treatment group was 82％,which of the DC chemotherapy group was 55％,the difference was statistically significant(χ2 =13.923,P<0.05).Conclusion Cinobufaconi combined with DC chemotherapy in the treatment of advanced stomach cancer has no significant effect on increase of short -term efficacy ,but it can improve quality of life and alleviate pain obviously .

Clinical study of the total hip replacement with different materials prosthesis / 中国矫形外科杂志

[Objective] To study the clinical results of the total hip replacement with different materials prosthesis.[Methods]Eighty-five patients(nighty-two hips)undergoing total hip replacement were enrolled in this study.Through X-ray examination,the stress force of different material prosthesis on the proxmial femur and periaccetabular bone was observed.[Results]There were no clinical signs of the loose or bone absorption around the prostheses in all patients.Debris reaction was found in the metal-polyethylene group and ceramic-polyethylene group,not found in the metal-metal group and ceramic-ceramic group.[Conclusion]The stress force between different material prostheses and bone interface was not significantly different.Bone osteolysis doue to wear of polyethylene prosthesis is the key factor for the long-term outcomes of the total hip replacement.In addition,it is correlated with prosthesis manufacture,bone quanlity and surgical technique.

Stress force distribution of different artificial hip joint prosthesis on bone interface / 中国矫形外科杂志

0.05).[Conclusion]1.It showes a higher stress dodge in the calcar femorale after using various kinds of prosthesis implantation.After using CFR/PSF of lower elastic modulus as handle,the stress dodge rate is lower in femur,but the interface stress is higher,and this is the main factor and reason for the prosthesis loosening.2.The stress force rule meets the design principle that the stress force decreases gradually in the bone interface from proximal to distal.The stress value in different combination of same prosthesis handle has no significant difference,that showes mechanical factor is not the main standard for selecting prosthesis combination.