RESUMO
Objective:To investigate the clinical effect of Dynamic neutralization system applied to the treatment of lumbar degenerative diseases with fatty infiltration of multifidus muscle.Methods:From Jan 2015 to Dec 2017, a total of 53 patients of lumbar degenerative diseases with multifidus fatty infiltration treated by Dynesys in our hospital were analyzed, included 21 males and 32 females, aged 66.2±7.4 (range 48-81) years. There were lumbar spinal stenosis in 37 casesand lumbar disc herniationin 16 cases; the index level included L 2-S 1 in 3 cases, L 3-S 1 in 13 cases, L 2-L 5 in 5 cases, L 4-S 1 in 17 cases, and L 3-L 5 in 15 cases. The pedicle screws were inserted at the point of intersection of the outer edge of superior articular process and the midline of transverse process. After discectomy of herniated disc and hyperplastic ligamentum flavum, the distance between the upper and lower pedicle screws was measured and then the spacer of the corresponding length was cut out. Finally, the spacer was placed and fixed between the upper and lower pedicle screws by the elastic rope. The degree of multifidus fat infiltration, lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slop (SS), range of motion (ROM), intervertebral height (IH), Japanese Orthopaedic Association (JOA) score, Oswestry disability index (ODI), the MOS 36-item short-form health survey (SF-36) and visual analog scale (VAS) were evaluated postoperatively. Results:The operation was performed successfully in all the patients. The operation duration was 173.5±64.7 (range 125-240) min. Intraoperative blood loss was 469.5±118.2 (range 380-620) ml. The patients were followed up for 47.9±6.7 (range 38-62) months averagely. At the last follow-up, the degree of fatty infiltration of the multifidus muscle showed no further progress by MR scan. There was no significant difference in ROM and IH at different time points preoperativelyand postoperatively. The LL recovered from 37.6°±8.8° to 43.2°±9.1°, the PT decreased from 24.7°±9.3° to 20.5°±5.1°, and the SS increased from 22.1°±7.7°to 26.3°±8.0°. The JOA score increased from preoperative 6.4±1.2 to 20.6±2.8, ODI decreased from preoperative 50.6%±11.3% to 13.0%±3.4%, SF-36 increased from preoperative 81.5±3.6 to 95.5±4.2, and the VAS decreased from preoperative 4.2±1.0 to 1.1±0.6. One patient experienced loosening and displacement on the left side pedicle screw of the L2 vertebral body 3.5 years after operation, and herclinical symptom improved significantly after conservative treatment.Conclusion:Dynesysis is safe and effective for the treatment of lumbar degenerative diseases with fatty infiltration of multifidus muscle, and it can restore the complete structure and function of tension band at lower back and prevent the progress of multifidus muscle fat infiltration combined with postoperative rehabilitation training.
RESUMO
Objective To investigate the effect of medial collateral ligament (MCL) repair and coronoid process fracture fixation on stability of the Terrible Triad of the elbow. Methods CT and MRI scan images of elbow joints from one healthy 28-year-old male volunteer were used to establish three elbow models. Model A: normal model. Model B: repair of coronoid process fractures, without MCL repair. Model C: repair of MCL, without repair of ulnar coronoid processes. Longitudinal loads were applied on the three models to analyze the displacement and stress distributions of the elbow joint under different working conditions and compare the stability of the elbow joint. Results The displacement and stress distributions of the three models were similar. The maximum displacement and maximum stress of the articular surface were located at the ulna pulley notch, while the minimum displacement was located at the coronoid process and its medial side. The minimum stress was located at the lower lateral side of the coronoid process. There were no statistical differences in the maximum displacement and stress among the three models (P>0.05). Conclusions When the lateral column is stable, the effect of repairing the MCL and fixing the fracture block of ulnar coronoid process is similar.
RESUMO
BACKGROUND: The extramedulary fixation system including dynamic hip screw (DHS) is commonly used in treatment of Intertrochanteric fracture. However, in patients with unstable intertrochanteric fracture, extramedulary fixation system often leads to the failure of fracture fixation. Intramedulary fixation system including both proximal femoral nail antirotation (PFNA) and InterTan nail has been widely used in the treatment of unstable intertrochanteric fractures. OBJECTIVE:To compare the therapeutic effects of extramedulary fixation system containing DHS, PFNA and InterTan nail in the treatment of intertrochanteric fracture. METHODS:Literatures were searched in Wanfang, PubMed, Embase, Medline, the Cochrane library to screen literatures published from January 1990 to November 2014. Relevant studies addressing extramedulary fixation system containing DHS, PFNA and InterTan nail were screened. RESULTS AND CONCLUSION: 346 articles were screened, and 13 of them were in accordance with the inclusion criteria. 1 271 patients with different types of intertrochanteric fracture were assessed in this study. Compared to DHS group, patients treated with PFNA and InterTan nail had shorter operation time and less blood loss. No significant difference in rehabilitation time and Harris score was detected among three kinds of fixation methods. Additionaly, PFNA and InterTan nail had a similar effect. These findings verify that compared with DHS, PFNA and InterTan nail can optimize the surgery, but cannot elevate postoperative outcomes.
RESUMO
BACKGROUND:Repair programs of posterolateral tibial plateau fracture included posterior plate screws, lateral plate screw and anterior and posterior lag screw fixation. To choose which fixation methods depends on clinical experiences of physicians. Study results are mainly clinical reports, and lack of mechanical evidence. OBJECTIVE:To compare biomechanical changes in three fixed manners (lateral plate screw group, posterior plate screw group and anterior and posterior lag screw group) in the repair of posterolateral fracture of tibial plateau from the angle of biomechanics. METHODS:A total of tibial specimens of six adult male antisepsis corpses (12 samples) were used for measuring bone mineral density of metaphysis. 1/2 posterolateral tibial plateau fracture model was established by electric pendulum saw. The model was randomly divided into three groups:lateral plate screw group, posterior plate screw group and anterior and posterior lag screw group. Finite element method and biomechanics were used to test axial displacement value and the maximal displacement distribution area under the axial loads of 250, 500, and 1 000 N. RESULTS AND CONCLUSION:There was no significant difference in average bone density in three groups of metaphysis (P>0.05). The minimum axial displacement of the fracture fragments was in the anterior and posterior lag screw group (0.013 521 mm), fol owed by posterior plate screw group (0.016 991 mm), and the maximum was visible in the lateral plate screw group (0.138 200 mm) under 250 N load. Displacement value was similar to the 250 N under 500 and 1 000 N. According to the results of biomechanics, displacement values of anterior and posterior lag screw was obviously less than the lateral plate screw group and posterior plate screw group (P0.05). The maximal displacement distribution area was proximal tibiofibular joint border zone in two methods. These data indicated that the biomechanical stability was most advantageous in the anterior and posterior lag screw group, and poorest in the lateral plate screw group. In the clinic, anterior and posterior lag screw fixation can be used as a first choice for repair of posterolateral tibial plateau fracture.
RESUMO
BACKGROUND:Studies on tibial plateau fractures had gradualy focused on “360° stereochemical structure” from medial and lateral “double track structure” nowadays. Scholars pay great attention on the stability and reposition of posterior plateau and functional recovery after reduction. The choice of fixation material of posterior plateau was controversial. OBJECTIVE:To discuss the biomechanical characteristics of posterolateral fracture of tibial plateau using three types of internal fixation. METHODS:Using three-dimensional finite element analysis, we simulated 1/2 and 1/4 posterolateral tibial plateau fractures. Three types of internal fixation were used: two anterior 6.5 mm lag screws, lateral 4.5 mm L-shape plate, and posterior 3.5 mm T-shape plate. 500 N was loaded at the center of the tibial plateau verticaly, and biomechanical status of three types of fixation was compared. RESULTS AND CONCLUSION: In 1/2 fracture model, anterior lag screw group and posterior plate group gained least displacement in al directions, as lateral plate group gained more. In 1/4 model, the advantage in displacement of anterior lag screw group was more apparent, the second was posterior plate group, and the last was lateral plate group. In 1/2 fracture model, the maximum stress of anterior lag screw was 36.523 MPa, which of lateral plate group was 153.372 MPa and posterior plate group was 115.922 MPa. The maximum stress left in the separate bone of lag screw group was 4.309 MPa, which of lateral plate group was 4.37 MPa and posterior plate group was 3.124 MPa. In 1/4 fracture model, the maximum stress of anterior lag screw was 36.803 MPa, which of lateral plate group was 153.336 MPa and posterior plate group was 104.234 MPa. The maximum stress left in the separate bone of lag screw group was 1.195 MPa, which of lateral plate group was 0.827 MPa and posterior plate group was 1.196 MPa. Results indicated that anterior lag screw could bear more stress and gained least displacement after loading, and the fixation was more stable. Posterior plate can give more stabilization when the separate bone was bigger (1/2), similar to anterior lag screw. When the separate bone was smaler (1/4), posterior plate model was less stable than anterior lag screw. Lateral plate model, with poor stabilization, was the worst choice in three types of fixation.
RESUMO
BACKGROUND:Proximal humeral internal locking system fixation for complex humeral fractures via deltoid splitting approach provides good clinical results, but certain complications stil existed. OBJECTIVE:To explore the postoperative complications and the related risk factors for displaced three-part and four-part fractures of proximal humerus treated with proximal humeral internal locking system fixation via deltoid-splitting approach, and to propose the corresponding countermeasures. METHODS:106 cases with displaced three-part and four-part fractures of proximal humerus were retrospectively analyzed. The relationship between postoperative complications and the related risk factors was analyzed with Logistic regression analysis. RESULTS AND CONCLUSION:A total of 81 patients were fol owed-up for 12 to 30 months. The mean Constant score at 12 months after operation was (76.57±4.70) points. The postoperative complications occurred in 31 patients (38.3%) of which impingement syndrome involved in 16 cases (19.8%), head-shaft angle loss in six cases (7.4%), head-shaft angle loss combined with screws cut-out in two cases (2.5%), pure screws cut-out in two cases (2.5%), humeral head necrosis in two cases (2.5%), fat liquefaction in five cases (6.2%). Single factor analysis showed that there were significant differences in the superiorly located greater tuberosity, superiorly located plate and Neer classification between impingement group and un-impinged group (P<0.05). There were statistical y significant differences in age, postoperative medial cortical defects and Neer classification between head-shaft angle loss group and un-loss group (P<0.05). By means of logistic regression analysis, the superiorly located greater tuberosity, superiorly located plate and Neer classification were the individual predictors for postoperative impingement syndrome;postoperative medial cortical defect and Neer classification were the individual predictors for postoperative head-shaft angle loss.
RESUMO
BACKGROUND:Patients with elder hip fracture has more complications, poor affordability and high perioperative risk, so the preoperative ful preparation and evaluation are needed. OBJECTIVE:To predict the accuracy of the prognosis of elderly patients with hip fracture through comparing the difference between American Society of Anesthesiologists score and Daping orthopedics operation risk scoring system for senile patients. METHODS:A retrospective study was performed on 300 cases with elderly hip fracture selected from January 2011 to December 2012 from Department of Orthopedics, Gongli Hospital of Pudong. American Society of Anesthesiology score and Daping orthopedics operation risk scoring system for senile patients were conducted before treatment, and the predictive values of two scoring systems on the incidence of complications and mortality were compared. RESULTS AND CONCLUSION:According to the American Society of Anesthesiology score and Daping orthopedics operation risk scoring system for senile patients, 148 cases and 97 cases had complications respectively. On the contrary, the actual number of complications was 89. The former predicted value was significantly higher than the actual value, and there was no significant difference between the latter forecast value and the actual value. The numbers of death predicted by American Society of Anesthesiology score and Daping orthopedics operation risk scoring system for senile patients were 27 cases and six cases, but the actual number of death was three cases, indicating that former predicted value was significantly higher than the actual value, and there was no significant difference between the latter predicted value and the actual value. The American Society of Anesthesiology score has a certain errors in predicting the postoperative complications and mortality of patients with elderly hip fractures, but it is simple and useful in clinic. The Daping orthopedics operation risk scoring system for senile patients can accurately evaluate elderly hip fracture operation risk, and can predict the postoperative complications and mortality more objective when compared with the American Society of Anesthesiology score.
RESUMO
ObjectiveTo evaluate the applicable value of attitude control system combined with attitude controllable intelligent capsule endoscope for stomach examination.MethodsA total of 15 patients were recruited to the study.Manipulability of movement and posture change of capsule endoscope,diagnostic efficacy for such locations as gastric cavity,bulb and descending duodenum,image quality and patients'compliance were assessed.ResultsThe procedure was completed in 14 patients.One failed due to downfall of the endoscope to duodenum within 5 min. Mean operation time was ( 23.7 ± 6.5 ) min ( from 5 to 30 min).Ten cases of superficial gastritis,one case of superficial gastritis with bile regurgitation and 1 case of ulceration of the duodenal bulb were diagnosed.No abnormalities were found in 3 others.Endoscopic images were of high quality and only a few were influenced by gastrointestinal peristalsis.All patients showed compliance with no discomfort.Capsule endoscopes were discharged within 2 or 3 days.ConclusionAttitude control system combined with attitude controllable intelligent capsule endoscope in stomach examination is feasible and valuable in clinic.
RESUMO
[Objective]To investigate the effect of minimally invasive treating proximal humeral fracture with PHILOS plate under acromial anterior lateral deltoid splitting approach.[Method]A retrospective analysis was done on 31 patients treated with minimally invasively with Philos plate under modified approach from April 2005 to March 2009.There were 17 males and 14 females,12 of them were injured in a traffic accident and 19 in daily life,with their ages ranging from 42 to 89 years.According to Neer classification,there were 5 cases of two-part fractures,11 cases of three-part fractures,and 15 cases of four part fractures.[Result]The postoperative radiographs verified good position of all screws,with satisfactory bone fracture reduction.Follow-up for 8-36 months(average 18.8 months) showed no necrosis of head of humerus and injury of axillary nerve and all patients gained bone union,supficial infection occurred in two patients but relieved by care.According to Neer scoring,the excellent to good result rate was 87.1%.[Conclusion]Philos plate for proxima humeral fracture using acromial anterior lateral deltoid splitting approach possesses such advantages as better individuation,less disturbance of the blood supply,stable fixation of the fracture.It is an new method to treat proximal humeral fractures.
RESUMO
Objective To explore clinical results of arthroscopically assisted treatment for tibial plateau fractures.Methods Thirty-eight cases of tibial plateau fractures were treated under arthoscope.According to the Schatzker classification,there were 8 cases of type Ⅰ, 10 cases of type Ⅱ,11 cases of type Ⅲ,4 cases of type Ⅳ,3 cases of type Ⅴ,and 2 cases of type Ⅵ,respectively.Routine arthoscopic examination of the knee found 15 cases of meniscus injury,12 cases of partial or complete rupture of anterior cruciate ligament(ACL),and 7 cases of medial collateral ligament (MCL) injury.Fracture reduction and fixation was performed under arthroscopic surveillance.The tibia plateau fracture was fixed with the cancellous bone screws(Schatzker Ⅰ~Ⅲ) or minimally invasive plate osteosynthesis(Schatzker Ⅳ~Ⅵ).Results The operation time was 30~72 min(mean,40 min) and the intraoperative blood loss was less than 20 ml.A follow-up was carried out in 36 cases for 4~36 months(mean,15 months).The X-ray findings at the 3 postoperative month showed bone union in all the 36 cases.There were no wound or joint infection,skin necrosis,or delayed union.The Hospital for Special Surgery(HSS) knee scores 3 months after operation revealed excellent results in 28 cases,good in 6 cases,and fair in 2.The main untoward manifestations at this period were lacking of muscle force and limited extension and incurvation of the knee joint.The HSS scores 6 months after operation showed excellent result in 33 cases and good in 3 cases. Conclusions Arthroscopically assisted treatment of tibial plateau fractures has advantages of accurate reduction and fixation and early detection and management of associated intraarticular injuries.Different methods of internal fixation should be chosen according to different types of facture.
RESUMO
Objective To study the clinical value of serum SA,EMA and GPDA in the diagnosis of gastric cancer.Methods To detect serum SA,EMA and GPDA in 30 patients with gastric cancer patients,25 patients with gastric precancerous lesions and 35 patients with non-atrophic gastritis with electronic gastroscope and pathological examination confirmed,compared the differences betwwen the groups,and analyze the relationship between the expressions of them and clinical biology of gastric carcinoma.Results The serum concentrations of SA and GPDA in gastric carcinoma are remarkably higher than those in non-atrophic gastritis and gastric precancerous lesions(P0.05).The concentrations of GPDA in non-atrophic gastritis group are age-related(P0.05).Conclusion It has an important reference value for the diagnosis of gastric cancer to detect serum SA and GPDA.SA and GPDA together can improve the accuracy of the diagnosis of gastric cancer.EMA serum possibly has no diagnostic value for gastric cancer.The expressions of SA,GPDA in serum are related to the biology behaviors of gastric carcinoma,and the concentrations of SA,GPDA in serum is helpful in judging metastasis and recrudescence,and monitoring prognosis.