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Objective To evaluate the factors related to contralateral hip fracture in the elderly patients with hip fracture by meta analysis.Methods Pubmed,Cochrane,CBMdisc,CNKI Chinese Journal Full Text Database and Wan Fang Database were searched for publications at home and abroad from January 2005 to April 2018 on factors related to contralateral hip fracture after hip fractures in the elderly.The publication quality was strictly evaluated before the data were extracted concerning gender and age(＞ 65years) of the patients,concomitant osteoporosis (Singh sign ≥ 4),primary fracture type,concomitant Parkinson disease,concomitant stroke,concomitant senile dementia,concomitant cataract,concomitant rheumatoid arthritis,concomitant diabetes,type of internal fixation for primary fracture and therapeutic compliance.Revman5.0 was used to perform the statistical analysis and the OR value and 95％ CI were calculated fore each index.Results A total of 17 studies were included involving 1,504 patients with contralateral hip fracture among 13,717 elderly patients with hip fracture.The factors related to the refracture of the contralateral hip were the age of the patients (OR ＝-3.55,95％ CI:-5.60 ～-1.50,P ＜ 0.001),osteoporosis (OR=2.38,95％CI:1.36～4.17,P=0.002),Parkinson disease (OR=4.54,95％CI:2.74～7.53,P ＜0.001),stroke (OR=0.33,95％ C I:0.18～0.59,P ＜ 0.001),senile dementia (OR=0.43,95％CI:0.29～0.62,P ＜0.001),cataract (OR=0.37,95％CI:0.22～0.63,P ＜0.001),rheumatoid arthritis (OR =0.32,95％ CI:0.21 ～ 0.50,P ＜ 0.001),diabetes (OR =0.65,95％ CI:0.47～0.91,P=0.01),type of internal fixation for primary fracture (OR=0.51,95％ CI:0.30 ～ 0.85,P =0.01),and therapeutic compliance (OR =0.36,95％ CI:0.21 ～ 0.64,P ＜ 0.001).However,the refracture of the contralateral hip was not related to gender (OR =1.07,95％ CI:0.45 ～2.56,P=0.88),smoking (OR=0.86,95％CI:0.40～1.86,P=0.70),fracture type (OR=0.97,95％ CI:0.60～1.57,P=0.90),or hypertension (OR=0.70,95％ C I:0.41～1.21,P=0.20).Conclusions In elderly patients with hip fracture,the risks for contralateral hip fracture may be advanced age,concomitant osteoporosis,Parkinson disease,stroke,senile dementia,cataract,rheumatoid arthritis and diabetes,type of internal fixation for primary fracture,and poor therapeutic compliance.However,no sufficient evidence has suggested that gender,smoking,type of hip fracture or concomitant hypertension might be associated with the contralateral hip fracture.
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Objective@#To investigate the clinical effect of combined anterior and posterior approach revision on complex acetabular fractures.@*Methods@#A retrospective case series study was performed on the clinical data of 21 patients with complex acetabular fractures who underwent failed surgery through single approach from June 2012 to June 2017. There were 16 males and five females, averagely aged 34.6 years (range, 24-45 years). According to Letournel-Judet classification, there were seven patients with transverse+ posterior wall fracture, five patients with anterior column+ posterior semi-transverse fracture, four patients with double column fracture and five patients with "T" fracture. The first operation was performed by ilioinguinal approach in nine patients and by Kocher-Langebeck (K-L) approach in 12 patients. Revision surgery was performed using a combined anterior and posterior approach. The operation time and intraoperative blood loss were recorded, and the fracture healing was observed. The quality of fracture reduction was assessed according to Matta reduction criteria, and hip function by the modified D Aubigne and Postel score. The complications during and after operation were recorded. Heterotopic ossification was evaluated according to Brooker's criteria.@*Results@#The patients were followed up for 12 to 36 months, with an average of 27 months. The operation time ranged from 180 to 360 minutes, with an average of 270 minutes. Intraoperative bleeding was 1 000-3 800 ml, with an average of 2 000 ml. Fractures were healed, with the healing time ranging from 3.5 to 7 months, with an average of 5 months. According to Matta reduction criteria, there were eight patients with anatomical reduction, 12 with satisfactory reduction and one with unsatisfactory reduction. The improved D Aubigne and Postal score was (11.1±1.9)points preoperatively and (15.6±1.7)points six months after operation (P<0.05), the outcome of hip function was excellent in three patients, good in 14, fair in three, and poor in one, with the excellent and good rate of 81%. There were three patients with transient injury of sciatic nerve, one patient with traumatic arthritis and one with heterotopic ossification of Brooker II. No femoral head necrosis or deep venous thrombosis in the lower extremities was found.@*Conclusion@#For complex acetabular fractures, combined anterior and posterior approach revision can promote fracture reduction, fracture healing, and functional recovery, with low incidence of complications.
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Objective To investigate the clinical effect of combined anterior and posterior approach revision on complex acetabular fractures. Methods A retrospective case series study was performed on the clinical data of 21 patients with complex acetabular fractures who underwent failed surgery through single approach from June 2012 to June 2017. There were 16 males and five females, averagely aged 34. 6 years (range, 24-45 years). According to Letournel-Judet classification, there were seven patients with transverse+posterior wall fracture, five patients with anterior column+posterior semi-transverse fracture, four patients with double column fracture and five patients with "T" fracture. The first operation was performed by ilioinguinal approach in nine patients and by Kocher-Langebeck ( K-L ) approach in 12 patients. Revision surgery was performed using a combined anterior and posterior approach. The operation time and intraoperative blood loss were recorded, and the fracture healing was observed. The quality of fracture reduction was assessed according to Matta reduction criteria, and hip function by the modified D Aubigne and Postel score. The complications during and after operation were recorded. Heterotopic ossification was evaluated according to Brooker 's criteria. Results The patients were followed up for 12 to 36 months, with an average of 27 months. The operation time ranged from 180 to 360 minutes, with an average of 270 minutes. Intraoperative bleeding was 1000-3800 ml, with an average of 2000 ml. Fractures were healed, with the healing time ranging from 3. 5 to 7 months, with an average of 5 months. According to Matta reduction criteria, there were eight patients with anatomical reduction, 12 with satisfactory reduction and one with unsatisfactory reduction. The improved D Aubigne and Postal score was ( 11. 1 ± 1. 9 ) points preoperatively and ( 15. 6 ± 1. 7 ) points six months after operation (P<0. 05), the outcome of hip function was excellent in three patients, good in 14, fair in three, and poor in one, with the excellent and good rate of 81％. There were three patients with transient injury of sciatic nerve, one patient with traumatic arthritis and one with heterotopic ossification of Brooker II. No femoral head necrosis or deep venous thrombosis in the lower extremities was found. Conclusion For complex acetabular fractures, combined anterior and posterior approach revision can promote fracture reduction, fracture healing, and functional recovery, with low incidence of complications.
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Objective To analyze the effect of the fracture healing by using selective sensory radicotomy before and after the ganglion.Methods From September,2014 to August,2015,120 rats were averagely divided into 3 groups,which was the sham operate group(SO),the anterior injury of ganglion rhizotomy group (AGR) and the posterior injury of ganglion rhizotomy group (PGR).Tibial transverse fracture was performed on right or left randomly and the fracture was fixed with intramedullary.In coordination with the fractured-side,the selective radicotomy from L4 to L6 was made.The mRNA level of collagen-Ⅰ and collagen-Ⅱ in bony callus was quantified at 3,7 days and 2 weeks after the operation by RT-PCR(n=5).The histological examination,X-ray,biomechanical testing were performed at 4 and 8 weeks.The quantitative data of iconography and biomechanics was acquired by using the relative ration which resulted from fractured-side data dividing the unfractured-side one for every pair tibia in same rat.Results At 3 days after surgery,the mRNA of collagen-Ⅰ were 81.3±11.1,37.5±8.2 and 24.7±9.2,the mRNA of collagen-Ⅱ were 2.4±0.5,2.1±1.0 and 2.9±1.2 in SO,AGR and PGR group respectively;At 7 days after surgery,the mRNA of collagen-Ⅰ were 17.9±5.8,7.2±1.8 and 6.7±2.4,the mRNA of collagen-Ⅱ were 12.5±3.4,2.8±1.3 and 1.2±0.4 in SO,AGR and PGR group respectively.The SO group had significantly upregulation of collagen-Ⅰ and collagen-Ⅱ mRNA compared with the AGR and PGR groups at 3 days and 7 days respectively after surgery(P＜0.05).There was a significant difference of the collagen-Ⅱ between AGR group (2.8±1.3) and PGR group (1.2±0.4) at 7 days after injury(P＜ 0.05).The fracture bony callus in PGR group was a significantly larger and less ossified than that in the AGR group.The mechanical load of fracture in SO group was larger than that of the other 2 groups (P＜0.05).Conclusion Sensory denervation negatively affects fracture-healing.The ganglion of sensory nerve plays an important role in bone fracture healing and normal innervation is essential for the fracture repair.
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Objective:To assess the method and the curative effect of percutaneous puncture aspiration and sclerosing treatment of renal cyst under CT-guidance.Methods:58 renal cysts in 45cases diagnosed with ultrasonography or CT were treated with repeated sclerotherapy by percutaneous puncture aspiration and 99.7% ethanol injection.A 18～21G gauge aspiration needle was used for all patients;the amount of administration of ethanol was 25%～30% of the aspirated amount of cyst fluid.Its effect was reviewed and analyzed every four months after operation.Results:The puncture was completed in 53 cysts one time.The patients followed up three months to one year,35 renal cysts in 25 patients disappeared;18 renal cysts in 15 patients reduced in size;and 5 renal cysts in 5 patients had no change.The effective rate was 91.3%.The disappearance rate was 60.3%.There were no serious complications.Conclusion:The sclerosing treatment percutaneous puncture aspiration of renal cyst under CT-guidance is a safe and effective method,and it is of significant value in application.