Treatment of femoral periprosthetic fracture of Vancouver type B1 and C with bridge combined internal fixation system / 中国骨伤

OBJECTIVE@#To evaluate the clinical effect of bridge combined internal fixation system in the treatment of periprosthesis fracture of femur after hip replacement.@*METHODS@#From October 2016 to June 2018, 5 patients of periprosthesis fractures of femur classified type B1 and type C in Vancouver were treated by open reduction and bridging combined with internal fixation, including 2 males and 3 females, with ages of 68, 70, 74, 75, 79 years;type B1 fractures in 4 and type C fractures in 1. Causes of injury:1 case of traffic injury, 4 cases of fall. After the operation, the patients were followed up for complications and fracture healing time by clinical and imaging examination, and Parker activity score was performed.@*RESULTS@#The wounds of 5 patients healed without infection. One case of DVT was confirmed by venography. Five patients were followed up, and the durations were 2, 8, 9, 10, 15 months. One patient died of myocardial infarction 2 months after operation. The average healing time was 12.5 weeks. No loss of reduction or failure of internal fixation was found. Two patients could walk without protection and 1 patient needed to rely on single crutch. One case of periprosthetic fracture had to walk with a single crutch before operation and move indoors with two crutches after operation. The average Parker activity score was 51.8% before operation.@*CONCLUSION@#The bridge combined internal fixation system can be used to fix the fracture after hip replacement with stable femoral prosthesis.

Outcomes of Secondary Laminoplasty for Patients with Unsatisfactory Results after Anterior Multilevel Cervical Surgery

OBJECTIVE: To investigate the causes for failed anterior cervical surgery and the outcomes of secondary laminoplasty. METHODS: Seventeen patients failed anterior multilevel cervical surgery and the following conservative treatments between Feb 2003 and May 2011 underwent secondary laminoplasty. Outcomes were evaluated by the Japanese Orthopaedic Association (JOA) Scale and visual analogue scale (VAS) before the secondary surgery, at 1 week, 2 months, 6 months, and the final visit. Cervical alignment, causes for revision and complications were also assessed. RESULTS: With a mean follow-up of 29.7+/-12.1 months, JOA score, recovery rate and excellent to good rate improved significantly at 2 months (p0.05). Mean VAS score decreased postoperatively (p0.05). The causes for secondary surgery were inappropriate approach in 3 patients, insufficient decompression in 4 patients, adjacent degeneration in 2 patients, and disease progression in 8 patients. Complications included one case of C5 palsy, axial pain and cerebrospinal fluid leakage, respectively. CONCLUSION: Laminoplasty has satisfactory results in failed multilevel anterior surgery, with a low incidence of complications.

Multi-ligaments reconstruction with single tendon with for the treatment of acute joint dislocation of the first carpometacarpal / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical outcomes of multi-ligaments reconstruction with single tendon in treating acute joint dislocation of the first carpometacarpal.</p><p><b>METHODS</b>From December 2008 to October 2012, 4 patients with acute dislocation of the first carpometacarpal were treated with single carpi radialis longus tendon to reconstruct periarticular four ligaments, which included dorsal ligament, palmar ligament, dorsal radiocarpal ligament, and intermetacarpal ligament between the first and second. There were 3 males and 1 female aged from 22 to 63 years old with an average of 38.7. X-ray, JAMAR grid strength testing, range of motion of carpometacarpal joint and VAS score were used to evaluate clinical outcomes.</p><p><b>RESULTS</b>All patients were followed up from 6 to 40 months with an average of 19 months. The wound were healed well at stage I. No dislocation of the first carpometacarpal joint and signs of joints degeneration occurred on X-ray at 1, 3 and 6 months after operation. JAMAR grip strength recovered from 60 percent to 90 percent of health wide. The results of ROM showed 3 cases recovered flexion and extension of joints and 1 case limited adduction. VAS score was 0 to 1.</p><p><b>CONCLUSION</b>For acute dislocation of the first carpometacarpal joint, reconstruction four ligaments with single carpi radialis longus tendon can be considered the selected treatment,which can restores joint stability and improve joint function.</p>

Preliminary Results for the Treatment of a Pain-Causing Osteoporotic Vertebral Compression Fracture with a Sky Bone Expander

OBJECTIVE: Vertebral compression fractures (VCFs) are common complications of osteoporosis. The expansion of VCFs with a Sky Bone Expander is a new procedure which improves kyphotic deformities and decreases pain associated with VCFs. The purpose of this study was to investigate the preliminary results for the treatment of painful osteoporotic VCFs with a Sky Bone Expander. MATERIALS AND METHODS: Twenty-six patients with pain-causing VCFs were treated with a Sky Bone Expander. This operation involved the percutaneous insertion of the Sky Bone Expander into a fractured vertebral body transpedicularly. Following the expansion, the Sky Bone Expander was contracted and removed, resulting in a cavity to be filled with bone cement. All fractures were analyzed for improvement in sagittal alignment. Clinical complications, pain relief and ambulation status were evaluated 1 day, 1 week, 1 month, and 3 months after the operation. RESULTS: Twenty-four hours after the operation, all the patients treated experienced some degree of pain relief. In addition, no postoperative neurologic complications were noted. The average operative time was 42.4 +/- 15.5 min per vertebra. Moreover, an average cement volume of 3.5 mL (range, 2.5 +/- 5.0 mL) was injected per vertebra. The average anterior height was 18.4 +/- 5.1 mm preoperatively and 20.5 +/- 5.3 mm postoperatively (p < 0.01). Furthermore, the average midline height was 15.5 +/- 5.2 mm preoperatively and 18.9 +/- 4.0 mm postoperatively (p < 0.01). The Cobb angle improved from 18.5 +/- 8.2 degrees preoperatively to 9.2 +/- 4.0 degrees postoperatively (p < 0.01). The Visual Anabog Scale scores decreased from 7.7 +/- 1.8 points preoperatively to 3.1 +/- 2.0, 2.9 +/- 1.7, 2.6 +/- 1.5 and 2.9 +/- 11.3 after 1 day, 1 week, 1 month and 3 months after the operation, respectively. Cement extrusion was observed in four patients without any neurologic symptoms. CONCLUSION: As a result of this study, we can postulate that the expansion of compressed vetrebra with a Sky Bone Expander is a safe and minimally invasive procedure resulting in the restoration of vertebral body height and the relief of pain associated with VCFs.

Immunofluorescence laser confocal expression and localization study of rat nerve growth guidance cues Netrin-1 and Slit2 after spinal cord injury / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To observe the expression and distribution of adult rat axon guidance cues Netrin-1 and Slit2 at different time points after spinal cord injury and to investigate the guidance mechanism of regenerated axons.</p><p><b>METHODS</b>Twenty adult Sprague Dawley (SD) rats were divided randomly into five groups with 4 in each. Four groups of them were used to make Allen's spinal cord punch models and we took materials randomly from one of them on the 2nd, 4th, 7th and 14th day respectively after operation. The left one group was taken as the control group. Immunofluorescence laser confocal scan was used to examine the co-expression and localization of Netrin-1 and Slit2 proteins in the injured site of the spinal cord.</p><p><b>RESULTS</b>Within two weeks after SCI, the expression of Netrin-1 and Slit2 proteins increased temporarily and there was co-expression of them on the neuron plasma membrane.</p><p><b>CONCLUSIONS</b>Synchronous high expression and co-expression of axon attractant Netrin-1 and repellent Slit2 are found in the adult rat injured spinal cord in the damaged local and vicinity parts, and probably, they act as the key regulators of axon guidance regeneration.</p>

Reconstruction of finger pulp defect with reversed fasciocutaneous island flap from same finger / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the clinical curative effect of reconstruction of finger pulp defect by anastomosis of reversed fasciocutaneous island flap with dorsal branch of the digital nerve of the same finger.</p><p><b>METHODS</b>The restoration of finger pulp defect with fasciocutaneous island flap from the same finger was conducted in 25 cases (30 fingers) from January 2002 to June 2003. Nine patients (11 fingers) whose flaps with dorsal branch of the digital nerve anastomosed with the digital inherent nerve around the surface of the wound were Group A and the others were Group B. The follow-up was carried out at 3 and 9 months after the operation to observe the shape of finger pulp and the sense restoration between two groups.</p><p><b>RESULTS</b>All flaps of 25 cases (30 fingers) survived. Three months after operation, the patients had fully grown finger pulps and recovered the superficial sensation and tactile sense of finger pulps. The two point discrimination on average was 5.00 mm+/-0.23 mm in Group A and 6.00 mm+/-0.30 mm in Group B. The difference between two groups was highly significant. Nine months later, their senses of finger pulps between two groups were recovered basically.</p><p><b>CONCLUSIONS</b>The reversed fasciocutaneous island flap from the same finger is the first choice to reconstruct the finger pulp defect, and the anastomosis of dorsal branch of the digital nerve shall be determined according to the specific condition.</p>

Application of SKy bone expander system in percutaneous kyphoplasty for treatment of osteoporotic vertebra compression fracture / 第二军医大学学报

Objective:To evaluate the clinical efficacy of SKy bone expander system in percutaneous kyphoplasty for treat- ment of osteoporotie verterbral compression fracture.Methods:Twenty-two patients(aged 62-90 years,32 vertebrae)under- went percutaneous kyphoplasty using SKy bone expander system.The bone cement was injected into the collapsed vertebrae. The vasual analogue scale(VAS)and complications were recorded during follow up.Results:The operations were successful in all patients via unilateral or bilateral approach.The operation time ranged from 30 to 120 min.The mean volume of cement in- jected into each vertebra body was(4.8?1.1)ml,ranged from 3.1 to 6.8 ml.Extravertebral leakage of bone cement was ob- served in two vertebrae with no symptoms.All patients had their pain relieved;the VAS was 7.6?0.8 before operation,3.5?0.5 one day after operation,2.8?0.6 one week after operation,and 2.4?0.6 one month after operation,with significant difference found between preoperation and postoperation(P