Myogenic elephant skin cream combined with Vacuum sealing drainage (VSD) for the treatment of bedsores / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the efficacy of the myogenic elephant skin cream combining with VSD for treating severe bedsores.</p><p><b>METHODS</b>Twenty-nine cases of III and IV degree bedsores were treated from June 2009 to June 2013. Among them, 15 cases were treated by myogenic elephant skin cream combined with VSD (VSD group) including 7 males and 8 females with an average age of (69.0±5.3) years old ranging from 17 to 96 years;other 14 cases were treated by the treatment of conventional dressing change (control group) including 6 males and 8 females with an average age of (71.0±4.2) years old ranging from 40 to 86 years. At 7, 14, 21, 28 d after treatments, specimens of wound two groups were respectively taken to examine immunohistochemical CD34 adopted SABC, the number of wild vascular cross were observed as capillary density value under high magnification microscope. It was used to assess the hyperplasia of granulation tissue of wound. The capillary density value and the visual wound observation were indicators for evaluation of clinical efficacy.</p><p><b>RESULTS</b>Seventeen of 19 cases got complete data of specimens of wound at 7, 14, 21, 28 d,included 9 cases of VSD group,8 of control group. In the microscope view, the capillary density of VSD group was higher than that of control group significantly (P<0.05), it showed the application of VSD technology improved hyperplasia of granulation tissue much faster than conventional dressing change. In VSD group, 13 cases with 15 wounds healed, 2 cases with 3 wounds improved; in control group,3 cases with 3 wounds healed,7 cases with 9 wounds improved, 4 cases with 5 wounds were unhealed.</p><p><b>CONCLUSION</b>Using the VSD technology with continuous high pressure suction to clean the drainage of wound and lacuna thoroughly can effectively control infection,promote the growth of granulation tissue, and then applying myogenic elephant skin cream to improve partial blood supply while prompting rapid growth of new granulation tissue and epithelial cell. The risk of this treatment is low,and the course of treatment is short, this provides a safe and effective method for treating bedsores.</p>

Case control study on open reduction internal fixation (ORIF) and minimally invasive percutaneous plate osteosynthesis (MIPPO) for the treatment of proximal humerus fractures in aged / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effects of close reduction and minimally invasive percutaneous plate osteosynthesis in treating proximal humerus fractures in the aged.</p><p><b>METHODS</b>From February 2012 to December 2013,39 patients with proximal humerus fractures were treated with minimally invasive percutaneous plate osteosynthesis (MIPPO group, 21 cases) and open reduction internal fixation (ORIF group, 18 cases). Including 17 males and 22 females in the study, and aged from 67 to 88 years old with an average of (71.8 ± 5.2) years old. In MIPPO group, there were 11 males and 10 females with an average age of (70.0 ± 5.3) years old;and in ORIF group, there were 10 males and 8 females with an average age of (72.0 ± 4.2) years old. Operation time, blood loss during operation, fracture healing time and postoperative complications were recorded. The functions of the shoulder joints were assessed according to Constant-Murley score at final follow-up.</p><p><b>RESULTS</b>All the patients were followed up from 11 to 27 months with an average of 18.1 months. The mean blood loss of the MIPPO group was (176.0 ± 57.4) ml,while the ORIF group was (356.0 ± 66.9) ml (t = 7.22,P = 0.01). The operation time of the MIPPO group was (47.4 ± 14.9) min, while the ORIF group was (92.7 ± 15.8) min (t = 0.79, P = 0.03). Fracture healing time in the MIPPO group and ORIF group was (17.6 ± 5.8), ( 21.7 ± 4.9) weeks, respectively (P < 0.05). The mean Constant-Murley score at final follow-up was 89.7 ± 14.5 in MIPPO group, and 81.8 ± 13.2 in ORIF group (P < 0.05).</p><p><b>CONCLUSION</b>MIPPO has advantages of little trauma, less blood loss, rapid recovery, less vascular damage and so on and can effectively treat the proximal humerus fracture in the aged.</p>

Individualized internal fixation plate for tibial fracture by digital customization and template for minimally invasive surgery / 医用生物力学

Objective To investigate the process and method of making an individualized limited contact dynamic compression plate (LC-DCP) and template for fixing tibial fracture, as well as its preliminary effect in clinic. Methods The custom-made tibia LC-DCP and the template used in minimally invasive percutaneous plate osteosynthesis (MIPPO) surgery were developed by 3D reconstruction of CT images, computer-aided design/manufacturing (CAD/CAM) and computer numerical control (CNC) technology, and then applied in 6 patients with tibial fractures. Results The individualized tibia LC-DCP was successfully used in clinic. The average 20-month follow-up showed that all fractures were healed in 6 patients, with 5 reaching excellent and 1 reaching good standard, according to criteria of Johner-Wruhs. Conclusions The production process of such individualized plate is simple and practicable, and has the advantages of simple operation, less injury, satisfactory reduction and fixation, high healing rate, less complexity when treating tibial fracture in MIPPO surgery. Therefore, it is worth of clinical application.

Biomechanical test and clinical application of EZ extraction screws device / 医用生物力学

Objective To evaluate the effect of EZ extraction screws device on screwing out the reduced screws，broken screws, skidded screws in biomechanical test and clinical application. Method 4 femurs, tibias, radius, ulnas of 4 fresh skeleton specimen were divided into two big groups randomly as Group A and Group B1, B2 and B3: In Group A the screws were taken out by screwdriver; In Group B, the screws were clamped in medulla cavity filled with the bone cement,;B1 was the group of measuring skidded screws with the biggest torsion; B2 was the group of measuring skidded screws with the biggest torsion by one handle; B3 was by two handles. Four mechanics test models were made, and the clamping screws were divided into two types of 4.5 mm and 3.5 mm each for 60. The experiment specimen were tested on the universal testing machines with exerting 2 kN axial loading, and surveyed the greatest torque, the torsion angle and the power loss as well as the efficiency when drawing out. The empirical datum after statistics processing were compared among the groups. And EZ was also used for 12 example patients in the preliminary clinical practice. ResultsGroup A showed the biggest torque as 1.42～1.96 N·m for drawing out; Group B1 as 2.87～3.27 N·m; Group B2 as 3.06～4.83 N·m; Group B3 as 4.12～8.36 N·m. The significant difference （P<0.05）was found in each group. The average value of torsion angle in each corresponding group is 1.59°,0.77°,0.28° and 0.16°, respectively with the obvious difference （P<0.05）; The average value of power loss in each group is 12, 21, 32 and 45J respectively; and the power (mechanical efficiency) in each corresponding group is 0.20, 0.35, 0.53 and 0.75 T/s, respectively, which also showed the obvious difference （P<0.05）. EZ used in 12 cases were successfully screwed out with all the broken screws and maintained the integrity of the bone without any postoperative complications. Conclusions EZ extraction screw device has sufficient torsional strength and stiffness with enough clamping force, and could pull out stably and reliably, which is an ideal tool for the stub screws, crooked screws and slipped screws in skeleton.

Treatment of Bennett's fracture with closed reduction and percutaneous Kirschner wire fixation / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate clinical effect of new method of percutaneous Kirschner wire fixation in treating Bennett's fracture.</p><p><b>METHODS</b>Thirteen patients with Bennett's fracture were treated with close reduction and percutaneous Kirschner wire fixation. There were male 8 cases and female 5 cases with an average age of 32 years (range from 20 to 45 years). The mean time from injury to operation was 4.3 days (range from 2 to 7 days). External fixation with plaster slab was applied after operation with an average of 35 days (range from 30 to 41 days). The reduction of articular surface, symptom of ache and function of thumb after operation were evaluated.</p><p><b>RESULTS</b>All the patients were followed up with an average of 6.4 months (range from 4 to 9 months). All fractures united and the articular surfaces were reduced well. Only 1 case has mild pain when activity. The grasp force decreased in all patients.</p><p><b>CONCLUSION</b>Close reduction and percutaneous Kirschner wire fixation has advantage such as simply operation, precisely fixation, high potency ratio. The method especially fits Bennett's fracture with small triangular fragment.</p>

Stress test and clinical application of the minimal-invasive dynamic hip screw / 中国骨伤

<p><b>OBJECTIVE</b>To recognize the effect of minimal-invasive dynamic hip screw (MIDHS) on the treatment of intertrochanteric fracture of the hip by biomechanical test and preliminary clinical application.</p><p><b>METHODS</b>Ten artifical made intertrochanteric fractures of femoral specimen from five cadavers were divided into two groups randomly. The fractures in first group were fixed by MIDHS and other group were fixed by dynamic hip (DHS). Biomechanical characteristics of two different devices were compared with the biomechanical character of load-straining, load-displacing, rigidity and strength of femur by statistic analysis. According to the Harris evaluation, healing effect of intertrochanteric fractures was evaluated clinically on the 15 cases.</p><p><b>RESULTS</b>Straining changes of MIDHS were 14% and 11% less than that of DHS on the tensile side and the pressure side respectively; Sinking and horizontal displacement, were 19% and 22% less than that of DHS respectivly. But external and internal stress intensity,axial and bending rigidity were all higher than that of DHS, they were 12%, 11%, 19% and 37%. Maximal destroyed twisting moment (15%) and average twisting rigidity (15%) were both higher than that of DHS, but twisting angle was 18% less. Under the force, of 1 800 N, the open angle of the fracture on transverse section was 2.28 degrees,while the DHS's was 3.60 degrees . The data above were significant differences statistically (P < 0.01). The average Harris score of the 15 cases with intertrochanteric fractures treated by MIDHS was 91, excellent and good rate was 92.7%, without complications of internal fixation failure,postoperative infection and so on.</p><p><b>CONCLUSION</b>The design of minimal-invasive dynamic hip screw is reasonable and effective against rotating, shearing and varus stress force of the fracture, and it provides possibility of implanting the internal fixation with minimal incision. So it is an ideal internal fixation device for the treatment of intertrochanteric fractures.</p>