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Objective:To investigate the clinical effect of Ilizarov technique with compression and distraction osteogenesis in treatment of traumatic femoral shaft defects.Methods:A retrospective case series study was conducted to analyze the clinical data of 52 patients with traumatic femoral shaft defects admitted to West China Hospital of Sichuan University from September 2015 to September 2019，including 32 males and 20 females at age of 19-60 years［（40.3 ± 12.1）years］. There were 15 patients with fractures at the proximal 1/3，20 at middle 1/3 and 17 at distal 1/3 part of femoral shaft. Types of bone defects were bone defect after open fracture in 2 patients，infectious nonunion in 29 and atrophic nonunion in 21. Length of bone defects after debridement and osteotomy was 3.0-5.8 cm［（4.2 ± 0.8）cm］. A total of 24 patients underwent primary direct shortening and compression as well as re-lengthening of the broken ends；28 patients were operated by osteotomy and compression，and then by re-lengthening of the broken ends at Ⅱ stage with the average interval of 2.8 months. Postoperative wound healing，bone healing time，external fixation index（EFI）and complications were observed. Preoperative and postoperative levels of white blood cell count（WBC），C-reactive protein（CRP）and erythrocyte sedimentation rate（ESR）were measured. Association for the study and application of the method of Ilizarov（ASAMI）score was used to evaluate bone healing and functional recovery at the latest follow-up.Results:All patients were followed up for 20-60 months［（36.5 ± 10.3）months］. All wounds were healed at Ⅰ stage，with no infection or sinus tract recurrence. Bone healing time was 9-20 months［（14.5 ± 3.8）months］，and EFI was 1.2-1.9 months/cm［（1.5 ± 0.2）months/cm］. Nail tract infection was found in 14 patients，with the infection rate of 27%. Poor healing of broken ends fracture occurred in 4 patients，out of which 3 with infectious nonunion and 1 with atrophic nonunion. Axial deviation was observed in 2 patients and poor mineralization was observed in 1 patient. In 2 patients，the affected side was shortened by 1.8 cm and 2.0 cm when compared to the healthy side. At the latest follow-up，levels of WBC［（6.0 ± 1.4）× 10 9/L］，CRP［（6.8 ±1.7）mg/L］and ESR［（10.5 ± 6.1）mm/h］were lower than those before surgery［（9.2 ± 2.2）× 10 9/L，（31.7 ± 22.1）mg/L，（45.8 ± 31.3）mm/h］（ P < 0.01）. At the latest follow-up，bone healing rated on ASAMI score was excellent in 31 patients，good in 13 and fair in 8，with the excellent and good rate of 85%；limb function rated on ASAMI score was excellent in 28 patients，good in 14，fair in and good in 3，with the excellent and good rate of 81%. Conclusions:For traumatic femoral shaft defects，Ilizarov technique with compression and distraction osteogenesis can fully remove infection or ischemic bone lesions. Distraction osteogenesis technology can complete continuous compression of broken ends to further promote healing of broken ends and limb lengthening and attain limb reconstruction and bone healing and functional recovery.
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@#Objective To investigate the value of chest high-resolution computed tomography (HRCT) score in evaluating the severity of hip fracture-induced early acute lung injury (ALI) in the elderly patients. Methods The clinical data of 289 elderly hip fracture patients in Chongqing Traditional Chinese Medicine Hospital from July 2014 to April 2020 were retrospectively analyzed. All patients were divided into two groups, including an ALI group (n=114, 36 males and 78 females at age of 82.94±6.85 years) and a non-ALI group (n=175, 51 males and 124 females at age of 84.42±6.31 years). General information, chest HRCT scores and PaO2/FiO2 were compared between the two groups. Correlation analysis was used to compare the relationship between chest HRCT scores and PaO2/FiO2. Multiple linear stepwise regression analysis was applied to evaluate the effective extent of the diffuse ground glass opacity (DGGO), intense parenchymal opacification (IPO), and reticulation HRCT scores to the overall HRCT scores. Results The DGGO scores, IPO scores, reticulation scores, overall HRCT scores and PaO2/FiO2 were higher in the ALI group than those in the non-ALI group (P<0.001). In the ALI group, correlation analysis showed that DGGO, overall HRCT scores were in significantly negative correlation with PaO2/FiO2 (P<0.001). In addition, the correlation among PaO2/FiO2 and overall HRCT scores was more significant than that of DGGO scores. Multiple stepwise regression analysis indicated that DGGO, IPO, and reticulation scores were independent influencing factors for overall HRCT scores. Among the influencing factors, DGGO scores had the greatest impact, then IPO scores and reticulation scores. The HRCT signs of DGGO, IPO, and reticulation appeared simultaneously had the greatest effects on the overall HRCT scores. Conclusion The chest HRCT score, which is associated with PaO2/FiO2, also can be used in the severity assessment of elderly patients with early ALI caused by hip fracture.
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Objective:To explore the perioperative management strategy for the elderly with hip fractures during the epidemic of corona virus disease 2019 (COVID-19) and evaluate its clinical effect.Methods:A retrospective case series study was conducted on 33 elderly patients with hip fractures admitted to Chongqing General Hospital, University of Chinese Academy of Sciences, from January 20 to February 29, 2020, including 14 males and 19 females, aged 65-92 years [(76.5±6.3)years]. There were 20 patients with intertrochanteric fractures and 14 with femoral neck fractures. In total, 15 patients were combined with hypertension and 9 with diabetes. A total of 19 patients were treated with open reduction and internal fixation and 14 with total hip/semi-hip replacement. The time from injury to admission was 2-14 hours. The temperature measurement, routine blood test and chest CT examination were performed to exclude COVID-19 in all patients, which showed 12 patients with pulmonary infection. The medical staff received different levels of protection: first level protection for those in the special ward, secondary level protection for the emergency isolation ward and tertiary level protection for those collecting the throat swab samples. The time from admission to operation, intensive care unit (ICU) stay time, hospitalization time, visual analogue score (VAS), perioperative complications as well as infection of patients and medical staff were observed and recorded.Results:The time from admission to operation was (3.18±0.19)days for all patients, with (2.24±0.28)days for 21 patients with no obvious pulmonary abnormality and (4.83±0.39)days for 12 with pulmonary infection. The hospitalization time was (10.97±0.31)days in all patients, with (9.71±0.27)days for 21 patients with no obvious pulmonary abnormality and (12.51±0.78)days for 12 with pulmonary infection. After operation, 12 patients were treated in ICU for 1-3 days, and the rest 21 patients were treated in general wards. The pain of all patients was effectively controlled. The time for exercise was (4.0±1.4)days after operation in all patients, among which 19 treated with fracture reduction and internal fixation started at (4.3±1.3)days after operation and 14 treated with total hip/semi-hip replacement started at (3.6±1.3)days after operation. VAS was (4.55±0.29)points at 12 hours before operation, (5.62±1.12)points at 6 hours, (3.54±0.39)points at 24 hours, and (2.42±0.11)points at 72 hours after operation ( P<0.05). Chest CT showed that the pulmonary inflammation was significantly improved one day before discharge. There was no indication of nucleic acid detection, with no urinary tract infection, pressure sore, deep vein thrombosis or other complications were found. No infection of patients or medical staff occurred. Conclusion:During pandemic of COVID-19, early surgical treatment for the elderly with hip fractures can be done in the general wards, based on strictly following the principle of infection prevention and control and carefully evaluating the perioperative risks, which can avoid the probability of infection of patients and medical staff without prolonging the hospitalization time or increasing the incidence of complications.