RESUMO
BACKGROUND: The morbidity rate of thoracolumbar burst fracture is high; however, the simple posterior distraction and reduction technique has poor patient satisfaction on maintaining vertebral height and reducing complications. Therefore, we attempt to explore a better therapeutic regimen. OBJECTIVE: To assess the efficacy of inverse arch roof breaking technique combined with pedicle screw and bone graft in treatment of thoracolumbar burst fractures. METHODS: This was a retrospective study of 78 patients with thoracolumbar burst fractures. All the patients suffered from fresh closed fractures, and all of them were operated by posterior approach. The time from injury to surgery ranged from 4 to 14 days, with an average of 7.8 days. They were randomly assigned to two groups. The 38 cases in the simple distraction group were treated with simple vertebra pedicle screw-rod system distraction and reduction fixation. The 40 cases in the inverse arch roof breaking and bone graft group were treated with inverse arch roof breaking technique combined with pedicle screw and bone graft in fractured vertebra. All patients signed the informed consent. The study was approved by the Hospital Ethics Committee. Operation time, intraoperative blood loss, fracture healing time, anterior height ratio of injured vertebrae, Cobb angle, visual analogue score, Barthel Index and postoperative complications were measured between the two groups. RESULTS AND CONCLUSION: (1) The follow-up period for all patients was 10-22 months. (2) Operation time and intraoperative blood loss were better in the simple distraction group than in the inverse arch roof breaking and bone graft group (P < 0.01). (3) The ratio of anterior height of injured vertebra and Cobb angle were significantly different between the two groups (P < 0.01). Above indexes were better in the inverse arch roof breaking and bone graft group than in the simple distraction group. (4) There were significant differences in fracture healing time and life activity function (Barthel index) between the two groups (P < 0.01), and above indexes were better in the inverse arch roof breaking and bone graft group than in the simple distraction group. (5) No deep infection was found in both groups. There were no complications such as internal fixation failure and excessive loss of vertebral height in arch roof breaking and bone graft group. In the simple distraction group, there were 3 cases of screw pull-out because of failed internal fixation, 2 cases of titanium rod breakage, and 10 cases of obvious vertebral height loss. (6) These findings suggest that compared with simple distraction and reduction fixation, inverse arch roof breaking technique combined with pedicle screw and bone graft can provide bony support to compression center of fractured vertebra. The efficacy was identified in reconstructing the height of anterior and middle columns. This method has the advantages of high mechanical strength, strong vertebral height maintenance, high bone healing rate and few complications, which will be the ideal choice in the treatment of thoracolumbar burst fracture.
RESUMO
Objeetive To investigate the clinical efficacy of inverted intmmedullary nail combined with medial minimally invasive plate in treatment of type C2 and C3 distal femoral fractures.Methods A retrospective case control study was conducted on 38 patients with complex distal fractures of the femur treated from January 2015 to January 2017.There were 22 males and 16 females,aged 24-72 years [(45.6 ± 2.5)years].AO fracture classification was type C2 in 24 patients and type C3 in 14.All of them were fresh closed fractures.The time duration from injury to operation was 4-16 days (average,7.5 days).Based on the different surgical methods,the patients were divided into lateral single plate fixation group (single plate group,20 patients) and inverted intramedullary nail combined with medial minimally invasive locked plate fixation group (locked plate group,18 patients).The two groups were compared in terms of operation condition,early weight bearing time,fracture healing time,postoperative complications,postoperative knee function and activity of living.Hospital for Special Surgery (HSS) score was used for evaluating postoperative knee function and Barthel index for activity of living.Results The patients were followed up for 10-24 months [(12.2 ± 1.8) months].The operation duration was (110.5 ± 35.4) min for single plate group and (116.7 ± 42.3) min min for locked plate group(P ＞0.05).Intraoperative blood loss in single plate group was [(450.5 ± 120.7)ml] and [(455.2 ± 130.4) ml] in locked plate group (P ＞ 0.05).The early weight bearing time in single plate group was (28.5 ± 8.6)days and 18.7 ± 4.9 (P ＜ 0.01)days in the locked plate group.The fracture healing time in single plate group was (8.5 ± 2.2) months,and [(6.5 ± 1.6) months] in locked plate group (P ＜ 0.01).After 3 weeks,6 months and 12 months,HSS scores of knee joint function of the locked plate group was significantly better than that of single plate group (P ＜ 0.01).At 6 months and 12 months after operation,Barthel index score of locked plate group was significantly better than that of single plate group (P ＜ 0.01).No infection occurred in two groups after operation.There were no complications such as internal fixation failure,knee valgus,external rotation deformity or fat embolism in locked plate group.There were two cases of internal fixation failure,one knee eversion,and two knee varus in single plate group (P ＜ 0.01).Conclusion Compared with single plate fixation,the therapeutic method of inverted intramedullary nail combined with medial minimally invasive locked plate has the advantages of early weight bearing time,quick recovery,better function restoration and fewer complications,and hence is a preferable choice for treatment of type C2 and C3 complex distal femoral fractures.
RESUMO
Objective To investigate the related risk factors of the previous cemented vertebral body re-wedge after percutaneous kyphoplasty (PKP).Methods In this retrospective case-control study,clinical data of 617 patients treated by PKP from December 2008 to November 2014 were analyzed.According to whether the cemented vertebra wedged again,the patients were divided into cemented vertebral re-wedge group (n =12) and non-cemented vertebral re-wedge group (n =605).The data of age,preoperative bone density,preoperative vertebral osteonecrosis,intraoperative bone cement injection amount,postoperative bone cement leakage,postoperative bone cement filling,postoperative recovery rate of vertebral wedge angle,and presence or absence of adjacent old vertebral wedging were recorded in two groups.All patients were followed up for one year,and the data were summarized and statistically analyzed.Results Single factor analysis showed the factors of whether there were adjacent old vertebral wedge,preoperative vertebral osteonecrosis,cystic bone cement filling,different wedge angle recovery rate,and emergence of previous cemented vertebral body re-wedge after PKP were statistically significant between two groups (P ＜ 0.05).There was no obvious statistical difference in age,preoperative bone density,intraoperative bone cement injection amount,and intervertebral bone cement leakage between two groups (P ＞ 0.05).Multivariate Logistic stepwise regression analysis showed cystic bone cement filling,preoperative vertebral osteonecrosis,adjacent old vertebral wedging,and higher recovery rate of vertebral wedge angle were prone to appear previous cemented vertebral body rewedge (P ＜ 0.05).Conclusions Relatively higher recovery rate of vertebral wedge angle,previous adjacent old vertebral wedge,vertebral osteonecrosis,and cystic bone cement filling are risk factors closely related to cemented vertebral re-wedge after PKP,which gives a good reference to assess surgical risk,avoid risk factors and choose right surgical techniques.
RESUMO
BACKGROUND:Several studies have attempted to apply mouse nerve growth factor to local lesions of peripheral nerve and found that local injection of mouse nerve growth factor can promote nerve recovery, which is superior to systematic application. OBJECTIVE:To evaluate the clinical effects of gelatin sponge infiltrated by mouse nerve growth factor in the repair of peripheral nerve injury. METHODS:Thirty-six patients with single peripheral nerve injury, including 16 males and 20 females, aged 18-48 years, were randomly divided into two groups: 18 patients in case group underwent debridement and neuroanastomosis, and then the injured nerve was wrapped by gelatin sponge which was infiltrated by mouse nerve growth factor and folowed by plaster fixation, anti-inflammatory therapy, neurotrophy and circulation improvement therapy; the other 18 patients in control group were treated only with debridement and neuroanastomosis and other conventional therapies. At 4 weeks after treatment, electrophysiological examination was performed. In addition, sensory and motor function of the distal end of injured nerve was evaluated at 6 months after treatment. RESULTS AND CONCLUSION: Sensory evoked potential and motor evoked potential showed that the recovery rate was 78% (n=14) and 83% (n=15) respectively in the case group, while 57% (n=10) and 66% (n=12) in the control group. There was significant difference between the two groups (P < 0.05). The total effective rate was 94.4% (n=17) in the case group and 83.3% (n=15) in the control group, which were statisticaly better in the case group than the control group (P < 0.05). These findings indicate that it is significantly effective to treat peripheral nerve injury by gelatin sponge infiltrated by mouse nerve growth factor that has good biocompatibility.
RESUMO
BACKGROUND: Expectant treatment for intertrochanteric fractures in elderly patients with osteoporosis and other chronic diseases can easily lead to complications of lying in bed.OBJECTIVE: To evaluate the results of percutaneous compression plating system (PCCP) for intertrochanteric fractures in elderly patients. METHODS: Thirty-two cases of elderly intertrochanteric fractures treated with PCCP admitted from June 2007 to June 2009 and 40 cases of elderly intertrochanteric fractures treated with dynamic hip screw system (DHS) were reviewed. The operative bleeding, operative time and curative effect were compared.RESULTS AND CONCLUSION: The operative bleeding and operative time in the patients receiving PCCP were significantly lower than those in the patients receiving DHS. There was not statistical significance between the curative effects about the two methods. PCCP applied in elderly patients with intertrochanteric fracture can get satisfactory effects, and the system is operated simply with minimally invasive surgery, which is beneficial to reduce surgical complications.
RESUMO
Objective To evaluate the curative effect of percutaneous compression plating system in treatment of intertrochanteric fractures of the elderly patients.Methods The clinical data of 18 elderly patients(aged 68-89 years)with intertrochanteric fractures were retrospectively analyzed.According to Evans classification,there were seven patients with type Ⅰ fractures,nine with type Ⅱ fractures and two with type Ⅲa fractures.Percutaneous compression plating system was applied to all patients from June 2007 to June 2009,and the therapeutic effect was evaluated by Harris hip function evaluation criteria.Results All the fractures were healed,with excellent results in 15 patients and good results in the rest three patients.Conclusions The percutaneous compression plating system is easy to manipulate with minimal invasion,has minor side effect and is beneficial to reducing surgical complications in the elderly patients with intertrochanteric fractures.