Intra-operative three-dimensional computer navigation system assisted free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head / 中华显微外科杂志

Objective To evaluate the feasibility,technique and preliminary clinical results of the intraoperative three-dimensional (3-D) computer navigation system assisted free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head.Methods From October 2010 to April 2013,14 patients (18 hips) with osteonecrosis of the femoral head were treated by free vascularized fibular graft transfer,assisted by intraoperative3-D computer navigation system.Of 18 hips,8 were classified as stage Ⅱ ;6 as stage Ⅲ,4 as stage Ⅳ according to Steinberg system.The entire procedures were visualized and guided by the 3-D navigation system,including location of optimal entry point,exploration of the field,excision of the necrotic bone tissues,and the fibular grafting transfer with vessel anastomosis.The follow-up records included the results of X-ray,the Harris score of the hip,and the complications.Results Operations of all 14 patients (18 hips) were smooth and successful with patent vessel and umcompromised grafts evidenced by ECT scan at day 7 postoperatively.Postoperative X-ray confirmed the complete eradication of necrotic focuses with surrounding calcified bone and the accurate positioning of fibular grafts.The mean follow-up period was 23.6 months (8-29 months).Harris scores significantly improved from 57.5 ± 14.5 before operations to 87.5 ±2.5 after,with 6 hips' scores classified as Excellent,and 11 as Good.X-ray obtained more than 1 year after operation suggested improvement was achieved in 15 hips.Conclusion Intraoperative 3-D computer navigation system has multiple merits in assisting free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head,including clear anatomic structure,better accuracy,less damage,and reliable functional recovery,which imply it is a highly applicable approach.

Clinical typing of lumbosacral plexus nerve root injury caused by trauma / 中华骨科杂志

ObjectiveTo classify the type of lumbosacral plexus nerve root injury.MethodsFrom November 2004 to August 2011,36 patients suffered with lumbarsacral plexus nerve root injury underwent surgical exploration in our department.There were 24 males and 12 females,aged from 7 to 49 years(average,29.5 years).By inductively analyzing the location and amount of nerve root injury,preoperative clinical manifestations and results of physical examination,the clinical typing of lumbarsacral plexus nerve root injury was made.ResultsLumbosacral plexus nerve root injury was classified into 6 types:total lumbosacral plexus nerve root injury (4 cases),lumbar plexus and upper sacral plexus nerve root injury (6 cases),sacral plexus nerve root injury (9 cases),upper sacral plexus nerve root injury (11 cases),lower sacral plexus nerve root injury(4 cases) and lumbar plexus injury(2 cases).There were 19 patients with total lumbosacral plexus nerve root injury,lumbar plexus and upper sacral plexus nerve root injury or sacral plexus nerve root injury,among which 73.7％(14/19) nerve root injury located in the spinal canal and all of them were nerve root avulsion or rupture.There were 17 patients with upper sacral plexus nerve root injury,lower sacral plexus nerve root injury or lumbar plexus nerve root injury,among which 64.7％ (11/17) nerve root injury located in intro-pelvic or pelvic sacral foramina,and all of them were distraction injury.ConclusionThis clinical typing is useful for the accurate diagnosis of lumbosacral plexus nerve root injury.In addition,it is also beneficial for judging the location and characteristics of nerve root injury.

Treatment the fractures of the base of the first metacarpal with mini external fixator / 中华骨科杂志

Objective To introduced the clinical application and indication of treatment the fractures of the base of the first metacarpal with mini external fixator. Methods From October 2002 to December 2004, 37 cases of different typical fractures of the base of the first metacarpal were treated with mini external fixator and followed up, which included type Ⅰ (Bennett fracture) 19 cases, type Ⅱ (Rolando fracture) 10 cases, type Ⅲ 8 cases. Defferent operations were applicated accroding to the fresh degree and classification of fractures. In type Ⅰ and fresh type Ⅱ fractures, closed reduction and fixation with mini external fixator were applicated at first. If the reduction was insatisfied, open reduction and fixation with Kirschner wire and external fixator were necessary. In old type Ⅱ fractures, open reduction associating internal and external fixation was applicated. In fresh type Ⅲ fractures, close and external fixation were applicated. In old type Ⅲ fractures, open reduction and external fixation were done. Results All the cases were followed up average 15 monthes and all the fractures were union successfully. The average union time were 5.5 weeks and 7.5 weeks in the fresh and old fractures. Function evaluation was made according to pain degree, thumb joint activity and proportion of traumatic arthritis. The overall good-excellent rate was 94.6%, the clinical results were satisfactory. Conclusion Treatment of fractures of the base of the first metacarpal with mini external fixator is better than conventional methods. This method is simple and reliable, and may shorten heal time, decrerase joint pain, limitation of joint movement and proportion of traumatic arthritis. It is an effective method in treatment of fractures of the base of the first metacarpal.