RESUMO
BACKGROUND:The distal tibia shaft fracture is prone to be comminuted after trauma due to the absence of muscle covering and the thin soft tissue, and intraoperative reduction and fixation are difficult. Clinical efficacy is closely related to the type of fracture, degree of soft tissue injury, choice of therapy and internal fixation. Internal fixation is the main treatment for the distal tibia shaft fracture, and a microinvasive, strong fixation is the focus of tibial fracture treatment although many methods for internal fixation are present. ＜br> OBJECTIVE:To explore clinical efficacy of the treatment of distal tibia shaft fracture using percutaneous locking compression plate, interlocking intramedul ary nail and open reduction with internal fixation. ＜br> METHODS:A total of 180 patients with distal tibia shaft fracture were randomized into three groups, receiving internal fixation treatment using percutaneous locking compression plate, interlocking intramedul ary nail or open reduction. Al patients were fol owed up for 12-24 months. The clinical outcomes of the treated patients in three ＜br> groups were compared through the observations of incision length, operation time, intraoperative fluoroscopy time, intraoperative blood loss, complications after fixation. ＜br> RESULTS AND CONCLUSION:After excluding the loss of fol ow-up, 56 cases receiving percutaneous locking compression plate, 52 cases receiving interlocking intramedul ary nail and 48 cases receiving open reduction were involved in the final analysis. The incision length and intraoperative blood loss in the groups of percutaneous locking compression plate and interlocking intramedul ary nail were significantly better than that of open reduction (P＜0.05). Intraoperative fluoroscopy time in the group of percutaneous locking compression plate was significantly longer than that in other two groups (P＜0.05). The operation time showed no significant differences among three groups. The rate of complications was 11%in the group of percutaneous locking compression plate, and 27%in the groups of interlocking intramedul ary nail and open reduction with internal fixation. Percutaneous locking compression plate is a good choice for the distal tibia shaft fracture due to smal injury, good biomechanical stability, and no influence on blood supply at fracture end;interlocking intramedul ary nail is also a useful technique due to simple operations. Open reduction with internal fixation should be chosen careful y due to great dissection, great influence on blood supply and high complication rate.
RESUMO
Twelve cases of pelvis sarcoma around acetabulum were selected from Department of Orthopaedics, Wuxi Second Hospital, Nanjing Medical University between January 2001 and December 2007 including 5 males and 7 females, aged 51-72 years. According to pathological diagnosis, there were 3 cases of sarcoenchondroma, 2 cases of osteosarcoma, 3 cases of giant cell tumor of bone, 2 cases of adenocarcinoma, and 2 cases of osteoblastoma. According to tumor position by Enneking dividatur sectors, there were 5 cases of Ⅰsector, 4 cases of Ⅱsector, and 3 cases of Ⅲ sector. The Harris score of pre-replacement was 88.5?8.8. All cases were treated by saddle prosthetic replacement successfully, and no accidents happened. The operation time was 2.5-3.5 hours; blood volume was (1 250?407) mL. Twelve cases were followed up for 18 months (range 5-36 months). One case died of tumor metastasis and body exhaustion 5 months postoperation. Infection of incision took place in 1 case, and cured by operation with antibiotic combined with bone cement chain pearls. The Harris scores 4 months post-replacement: 6 cases were between 40-49, 3 cases between 50-59, and 3 cases between 60-69. Twelve cases could walk with double orthosis 3 months postoperation, and 3 cases could walk with single orthosis 6 months postoperation; 1 case walked with near normal walking, but major walking was bad. No artificial joint loosening or dislocation occurred. Although the joint function of major cases treated by saddle prosthetic replacement was not fairly satisfactory, it is a better treating method for malignant tumor whose limbs can be reserved and live their daily life by orthosis.