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Objective To analyze the posterolateral minimally invasive plate osteosynthesis (MIPO) in the treatment of medial open fractures of distal tibia and tibial shaft.Methods From May 2016 to September 2017,16 medial open fractures of distal tibia and tibial shaft were treated with posterolateral MIPO at Department of Orthopaedics,The First Affiliated Hospital to Anhui University of Science and Technology.They were 10 men and 6 women,from 22 to 61 years of age(average,36.5 years).According to the Gustilo-Anderson classification,type Ⅰ fracture was identified in 5 patients,type Ⅱ fracture in 6 and type Ⅲ fracture in 5.Initially,all the patients received emergency external fixation or calcaneus traction before open reduction and internal fixation was performed when their conditions of soft tissue allowed.X-ray examination of the ankle joint with anteroposterior and lateral views was performed before and after operation.At the last follow-up,the function of ankle joint was evaluated according to the ankle-hindfoot score of American Orthopaedic Foot and Ankle Society (AOFAS).Results All the 16 patients were followed up for an average of 15.3 months (from 8 to 24 months).Fracture healing was achieved in all after an average time of 26.1 weeks (from 20 to 36weeks).There were no such complications as skin necrosis,wound dehiscence,deep infection,implants exposure or failure,or impingement of the flexor hallucis longus.The AOFAS ankle scores averaged 88.6 points (from 74 to 95 points),giving 9 excellent,6 good and one fair cases.Superficial infection occurred in 2 patients but healed after dressing care.Another case showed 5°varus deformity.Conclusion Application of posterolateral MIPO in the treatment of medial open fractures of distal tibia and tibial shaft can effectively protect the medial soft tissue,reduce postoperative wound complications,and safely expose,reduce and fixate the tibial fragments,leading to satisfactory outcomes.
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Objective To investigate the clinical application value of Quadrant system combined with percutaneous pedicle screw fixation for treatment of lumbar degenerative disease.Methods The clinical data of 40 patients who sufferred from lumbar degenerative disease,were randomly divided into two groups:Quadrant system combined with percutaneous pedicle screw fixation to do discectomy and intervertebral bone graft fusion as invasive group (n =20),traditional posterior lumbar interbody fusion as conventional group (n =20).The operation time,length of incision,blood loss,postoperative drainage,JOA score of preoperation and postoperation,and effect (reforming Macnab standard) between two groups were recorded and compared.Results Operations were all well done in two groups.The operation time in invasive group was longer than that in traditional group [(147.3 ± 8.9) min,(136.7 ± 10.2) min,t =3.5,P ＜ 0.05].The length of incision [(3.65 ± 0.68) cm,(1 1.11 ± 1.29) cm,t =22.88,P ＜ 0.05)],blood loss [(205.00 ± 63.04) mL,(270.50 ± 77.58) mL,t =2.93,P ＜ 0.05],postoperative drainage [(90.3 ± 10.8) mL,(180.6 ± 1 3.9) mL,t =22.96,P ＜ 0.05] and days in hospital [(16.9 ± 2.0) days,(18.9 ± 2.1)days,t =3.05,P ＜ 0.05] in invasive group were all less.than those in traditional group (P ＜ 0.05).All cases had been followed up for 6-18 months,average of 13 months.There were no significant differences in excellent and good rate (reforming Macnab standard) between two groups in the last following up (P ＞ 0.05).There were no significant differences of JOA scores in preoperation [(12.0 ± 1.7) points,(11.0 ± 1.5) points,P ＞ 0.05],postoperative half a year [(22.0 ± 2.3) points,(21.0 ± 2.5) points,P ＞ 0.05],and postoperative one year [(23.0 ± 1.9) points,(22.0 ± 2.0) points,P ＞ 0.05].Conclusion Quadrant system combined withpercutaneous pedicle screw fixation is a safe,effective and minimally invasive surgical technique in treating lumbar degenerative disease.Compared with conventional group,invasive group has advantages such as less injury,less blood loss,simple operation,and good curative effect,which should be popularized.