Adjustment of X-ray angle intraoperation based on the anatomic shape of femoral neck section / 解剖学报

[Abstract] Objective To investigate the appropriate X-ray angle which image can represent total proximal of femur according to the anatomic shape of the femoral neck section. Methods The anatomic parameter of the femoral neck section was observed and measured. Found the femoral neck was contained with three main surfaces of anterior surface, posterosuperior surface and posteroinferior surface. A model of surface fluoroscopy has been made by covering aluminum foil papers on the three surfaces of femoral neck. Taking the midpoint of the femoral neck as the fluoroscopy center, the C-arm was rotated at an interval of 10° between 0° and 170°, and the three aluminum foil paper models were taken for X-ray projection respectively. The X-ray angle with the smallest image of aluminum foil paper was taken as the appropriate X-ray angle of the surface. A penetrating model of the femoral neck internal fixation was made of three Kirschner wires penetrating through the anterior, posterosuperior and posteroinferior surfaces of femoral neck. The images of the penetrating Kirschner wires were observed through the traditional anteroposterior, lateral view and the three appropriate X-ray angle views obtained from the above test. Results The length of the three main surfaces accounts for 80. 95% of the circumference of the femoral neck. The anterior surface coronal angle was 18°, the posterosuperior surface coronal angle was 65°, and the posteroinferior surface coronal angle was 165°. The Appropriate X-ray angle of the three surfaces were 20°, 70° and 170° respectively. In the images of the three appropriate X-ray angles, the penetrating Kirschner wires of anterior surface, posterosuperior surface and posteroinferior surface of the femoral neck could be clearly observed respectively, while the penetrating Kirschner wire could not be completely found in the traditional anteroposterior and lateral images. Conclusion Traditional anteroposterior and lateral fluoroscopy can not accurately display the three-dimensional structure of femoral neck. By increasing the appropriate X-ray angle of 20°, 70° and 170°, the reduction quality and bony violation from internal fixation implants on the anterior surface, posterosuperior surface and posteroinferior surface of the femoral neck could be observed respectively.

Treatment of abduction and insertion femoral neck fracture with closed reduction technique / 中国骨伤

OBJECTIVE@#To explore feasibility of closed reduction technique under monitoring of C-arm and three screws in the fixation of abduction and insertion femoral neck fracture.@*METHODS@#Seventeen patients with abduction and insertion femoral neck fracture operated from January 2014 to December 2019 were analyzed retrospectively, including 10 males and 7 females, aged from 21 to 59(42.09±7.30) years old. According to preoperative X-ray and CT data, angle of retroversion and abduction displacement of femoral head were determined. Two 2 mm diameter Kirschner wires crossed and gently knocked into the bone of the acetabular roof from outside and front of femoral head. The proximal fracture segment was fixed on the acetabulum. Under the monitoring of C-arm, lower limb (distal fracture segment) was gradually rotated inward and retracted against direction of fracture displacement, three cannulated screws were used for internal fixation after anatomical reduction of the distal fracture end and the proximal fracture end. Garden index was evaluated, postoperative complications were observed, and Harris functional score was performed.@*RESULTS@#All 17 cases of femoral neck fracture with abduction and insertion were successfully completed closed reduction and internal fixation. The operation time was 36 to 68(43.87±7.63) min and intraoperative bleeding was 15 to 50(28.36±5.93) ml. The quality of fracture reduction was evaluated by garden index during operation. There were 12 cases of anatomical reduction, 5 cases of acceptable reduction, and no cases of unsuccessful reduction were changed to open reduction. 17 cases were followed up for 3 to 41(27.5±8.4) months. There were no complications such as femoral head necrosis, fracture nonunion, hip impingement and femoral neck shortening. MR examination showed no femoral head necrosis and articular cartilage injury. Two years after operation, Harris score of hip joint was excellent in 13 cases and good in 4 cases.@*CONCLUSION@#Closed reduction and three screws internal fixation can obtain good anatomical reduction rate and therapeutic effect in the treatment of abduction and insertion femoral neck fracture.

Anatomical imaging analysis of screw configuration for femoral neck fracture / 解剖学报

[Abstract] Objective To investigate the optimal screw configuration for internal fixation of femoral neck fractures based on anatomic analysis on radiologic imaging. Methods From January to February 2017, thirty proximal femurs of 15 nonnal adults from Picture Archiving and Communication Systems (PACS) of Paople' s Hospibal of Anji were constructed by CT. 8 males and 7 females with a mean age of (43±8. 5) years (ranging from 28 to 63 years) .The medial femoral neck sections (FNS) were projected on the lateral femoral trochanteric wall. The simulated three screw configurations in the projection of FNS include: two inverted equilateral triangles symmetrized to the axis of the FNS (IET-FNS group) or the coronal axis of the proximal femur (IET-PF group) and an obtuse triangle (OT group).The distance between the screws, the distance between the centre of the FNS and the screws, and the area ratio of the triangle/FNS were calculated. Results The projection of the FNS on the lateral femoral trochanteric wall was displayed as a rotating forward ellipse. Measurements of distance between screws

Design and application of guide device for femoral neck section / 中国骨伤

OBJECTIVE@#To explore the application effect of a new guide device designed according to the anatomical characteristics of the femoral neck cross section to assist the internal fixation of multiple screw of the femoral neck.@*METHODS@#From October to December 2016, 10 adult dry femur specimens, including 7 males and 3 females, aged 37 to 58(47.5±7.5) years old, were selected. Three hollow screws were implanted to simulate the treatment of femoral neck fracture with the new guider technology and the traditional guider technology as the control. The screw location accuracy parameters, screw puncture times, screw parallelism, operation time and fluoroscopy times of the two methods were recorded and compared.@*RESULTS@#Sixty screws were successfully implanted in 20 specimens. There was no significant difference in screw parallelism, operation time and fluoroscopy times between the two methods(>0.05). There were significant differences in the distance between screw and cortex, the distance between screw and femoral neck, the area ratio between screw and femoral neck, the distance between screws and the number of screw punctures between two methods(<0.05). It showed that the new type of guide had more advantages than the traditional method in locating screw accuracy and reducing the number of punctures.@*CONCLUSIONS@#Compared with the traditional technique, the new guider and percutaneous puncture technique under two-dimensional fluoroscopy have better localization of internal fixation screw for femoral neck fracture.

Case-control study on local injection of autoallergic platelet rich plasma or whole blood for the treatment of tennis elbow / 中国骨伤

<p><b>OBJECTIVE</b>To compare therapeutic effects of local injection with autoallergic platelet rich plasma (PRP) or autoallergic whole blood (AWB) for the treatment of chronic tennis elbow.</p><p><b>METHODS</b>From January 2011 to January 2014, 40 patients with chronic tennis elbow were divided into 2 groups, 20 cases in each group: PRP group and AWB group. There were 20 patients in PRP group treated with local injection of autoallergic platelet rich plasma, including 5 males and 15 females, with an average age of (47.50 ± 9.86) years old; and the average course of disease was (4.67 ± 3.27) months. Among the 20 patients in AWB group treated with local injection of autoallergic whole blood, 3 patients were male and 17 patients were female, with an average age of (46.50 ± 9.96) years old;and the average course of disease was (4.53 ± 2.27) months. The elbow joint was fixed with elastic stockings after injection. All the patients were guided to do strengthening and extension exercises during the follow-up period. Visual analog scale (VAS), Mayo scores for elbow and pressure pain threshold (PPT) were used to evaluate clinical effects after injection immediately and 4,8 weeks after treatment. Results:All the patients were followed up,there were no infections and swelling occurred. The VAS, Mayo and PPT scores of patients in PRP group were improved from pre-therapy 7.22 ± 1.32, 56.71 ± 10.90 and 17.47 ± 4.62 to 2.73 ± 1.00, 91.59 ± 6.95 and 21.35 ± 4.80 respectively 8 weeks after treatment. The VAS, Mayo and PPT scores of patients in AWB group were improved from pre-therapy 7.16 ±1.27, 54.72 ± 8.36 and 17.06 ± 4.83 to 3.81 ± 1.36, 82.06 ± 7.89 and 20.12 ± 4.97 respectively 8 weeks after treatment. All the pain and functional variables including VAS, PPT, and Mayo scores were improved significantly in both groups 4 weeks after injection. On the 4th week after injection, there was no statistically significant difference in PPT between two groups; while the VAS and Mayo score of AWB group were lower than those of PRP group. On the 8th week after injection, the VAS of AWB group was higher than that of PRP group; but the Mayo and PPT scores of AWB group were lower than those of PRP group.</p><p><b>CONCLUSION</b>PRP and AWB injections are both effective to treat chronic lateral epicondylitis. Compared with AWB injection, PRP injection may be more effective in releasing pain and improving function for a longer time.</p>

Balloon kyphoplasty for the treatment of osteoporotic Kummell's disease / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical efficacy of the percutaneous kyphoplasty for the treatment of osteoporotic Kummell's disease.</p><p><b>METHODS</b>From May 2010 to February 2012, 8 patients with osteoporotic Kummell's disease were treated with percutaneous balloon kyphoplasty. There were 2 males and 6 females, with a mean age of 73.4 years. All the patients suffered from lower back pain for 4.7 months, which affected seriously the patient's quality of life. The anterior vertebral height and Cobb angel was measured on standing lateral radiograph at pre- and post-operatively (2 days after operation) and during the final follow-up. Visual analog scale (VAS), Japanese Orthopedic Association (JOA) and Oswestry disability index (ODI) were used to evaluate pain and function.</p><p><b>RESULTS</b>Incision of all patients healed normally without infection. The level of back pain decreased remarkably after surgery. The mean time of ambulation was 4.3 days (ranged, 1 to 10 days). Cement leakage occurred in 1 case with no symptom. The anterior vertebral height and Cobb angel of the fractured vertebra recovered respectively from preoperative (30.4 +/- 7.4)% and (31.3 +/- 9.9) degree to (70.3 +/- 3.3)% and (9.1 +/- 3.0) degree at the 2nd day after operation. VAS and JOA scores, ODI improved from preoperative 8.7 +/- 1.2, 12.3 +/- 1.7 and (93.3 +/- 4.6)% to 3.1 +/- 1.1, 24.9 +/- 1.6 and (32.2 +/- 5.4)% respectively at the 2nd day after operation. All the patients were followed up, and the duration ranged from 3 to 24 months, with a mean of 4.7 months. At the latest follow-up, the anterior vertebral height and Cobb angel of the fractured vertebra were (69.9 +/- 3.2)% and (10.9 +/- 2.4) degree; the VAS and JOA scores and ODI were 2.2 +/- 1.0, 26.4 +/- 1.4 and (29.2 +/- 4.5)% respectively, which had no obvious difference compared to those results at the 2nd day after operation.</p><p><b>CONCLUSION</b>Balloon kyphoplasty is safe and effective treatment for osteoporotic Kummell's disease.</p>

Discerning the femoral neck anteversion (FNA) from the torsion angle on 3D CT / 中国骨伤

<p><b>OBJECTIVE</b>To discern the differences between femoral neck anteversion (FNA) and torsion angle through 3D CT reconstruction.</p><p><b>METHODS</b>From March 2010 to October 2010,30 healthy adult volunteers' femur were reconstructed by 3D CT, included 15 males and 15 females with an average age of (43.66 +/- 7.57) years old ranging from 25 to 65 years. Display the FNA and the torsion angle by image post-processing, measuring torsion angle by "Center way" and direct measurement of FNA.</p><p><b>RESULTS</b>FNA was the angle between the axle wire of femoral neck and the shape face of femoral,the angle were (13.326 +/- 6.085) degrees. Torsion angle was the angle between the macropinacoid of cross section of femoral neck and the shape face of femoral, the angle were(31.335 +/- 2.079) degrees. There was no significant difference in left and right femur.</p><p><b>CONCLUSION</b>FNA is different from torsion angle. FNA is the angle between the line and the surface with the sharp angle towards the lower outside. The torsion angle is the angle between the two surfaces with the sharp angle towards the lower back.</p>

Analysis of treatment of osteoporotic intertrochanteric fracture of femur with the locking compression plate (LCP) / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the therapeutic effect and operating technique on the treatment of osteoporotic intertrochanteric fracture of femur with the locking compression plate (LCP).</p><p><b>METHODS</b>From Feb. 2006 to Oct. 2009, 49 patients with osteoporotic intertrochanteric fracture of femur were treaded with different internal fixation methods, concluded 22 males and 27 females with an average age of (74.68 +/- 5.94) years old ranging from 63 to 90 years. Among them, 29 patients were treaded with LCP, and the other 22 cases with DHS. According to X-ray and Ultrasound bone mineral desity, all cases were diagnosed in osteoporosis. The operative time, blood loss, fluoroscopy exposure frequency, bone healing time and the time of first away from bed.</p><p><b>RESULTS</b>All patients were followed up from 6 to 35 months. The operative time, fluoroscopy exposure frequency, the bone healing time and the time of being away from bed were compared between two groups, there were no statistical differences (t=1.347, 1.603, 1.973, 1.032, P>0.05). As compared with DHS group, the intraoperative blood loss in LCP group was less than that of DHS group, there were statistical differences (t=2.14, P<0.05).</p><p><b>CONCLUSION</b>The LCP is an effective method in the treatment of intertrochanteric fracture of femur. The method has the advantages such as small wound and early recovery, especially appropriate for older patients. But the procedure as well should be demanded strictly.</p>

Reduction and fixation of fracture of pubic rami by inserting construction plate through the punctiform-incision approach / 中国骨伤

<p><b>OBJECTIVE</b>To observe the effect of pubic fractures reducted and fixed thorough the punctiform incision approach.</p><p><b>METHODS</b>From 2002 to 2005, 10 cases with 18 fractures of pubis rami (8 male and 2 female) were treated with inserting construction plate by the punctiform incision approach. The average age of these patients was 37.2 years (range, 24 to 56 years). The mean duration between injury and operation was 8.7 days (range, 4 to 14 days).</p><p><b>RESULTS</b>Internal fixation for eighteen pubis fractures were accomplished by 28 punctiform incisions. The blood loss for each incision was averagely 30 ml, operation time of each pubic was about 45 minutes. Function restoration was evaluated by Majeed' score and all patients gained excellent result.</p><p><b>CONCLUSION</b>The fracture of pubic rami can be fixed sucessfully by punctiform incision approach. It provides smaller incision, less postoperative complications and excellent function rehabilitation.</p>