Treatment of severe acromioclavicular joint dislocation with double strand titanium cable and clavicular hook plate guided by self-made guide device / 中国骨伤

OBJECTIVE@#To compare the clinical efficacy of titanium cable biomimetic reconstruction of coracoclavicular ligament and clavicular hook plate in the treatment of acromioclavicular joint dislocation.@*METHODS@#The clinical data of 39 patients with severe acute acromioclavicular joint dislocation from January 2017 to December 2018 were retrospectively analyzed, 19 patients in double strand titanium cable group, including 13 males and 6 females, aged from 26 to 67 years old; Rockwood classification:10 cases of type Ⅲ, 4 cases of type Ⅳ and 5 cases of type Ⅴ;8 cases of traffic injury and 11 cases of fall injury;the time from injury to operation was 3 to 6 days. There were 20 patients in steel plate group, including 15 males and 5 females, aged from 25 to 71 years old. Rockwood classification:11 cases of type Ⅲ, 4 cases of typeⅣ, 5 cases of type Ⅴ;7 cases of traffic injury, 13 cases of fall injury;the time from injury to operation was 2 to 7 days. The length of incision, operation time, intraoperative blood loss, cost, VAS score before and after operation, and Constant-Murley score before and after operation were compared between two groups. Postoperative X-ray films were taken to observe the reduction and maintenance of acromioclavicular joint dislocation. Complications were recorded.@*RESULTS@#Thirty-six patients were followed up for 12 to 14 months. The amount of intraoperative blood loss in the two groups was basically the same. The operation incision in double strand titanium cable group was shorter, the operation time in steel plate group was shorter, and the operation cost in double strand titanium cable group was less. One week and one year after operation, the pain of double strand titanium cable group was less than that of steel plate group. One year after operation, the Constant-Murley score of double strand titanium cable group was higher than that of steel plate group. The postoperative X-ray showed that the acromioclavicular joint in double strand titanium cable group was well reduced, and there was 1 case with slight reduction loss. In the plate group, there was no reduction loss after removal of the clavicular hook plate, and 8 patients had distal clavicular bone atrophy or acromion bone resorption. In steel plate group, 4 cases had long-term postoperative pain, postoperative dysfunction and other complications.@*CONCLUSION@#The clinical effect of coracoclavicular ligament reconstruction with double strand titanium cable is better than that of clavicular hook plate in the treatment of severe acute acromioclavicular joint dislocation, with less trauma (no secondary operation) and lower cost.

Clinical observation on influence of vertebral fixation through or across the affected vertebra on vertebral morphology / 中国骨伤

<p><b>OBJECTIVE</b>To compare the long-term influence of vertebral fixation through or across the affected vertebra on vertebral morphology.</p><p><b>METHODS</b>Clinical data of 48 patients with simple thoracic and lumbar spinal fractures who were admitted between Jan. 2008 and Dec. 2010 were analyzed retrospectively. Among them 36 cases (28 males and 8 females) were fixed through the injured vertebra (group A) and 12 cases (8 males and 4 females) were fixed across the injured vertebra (group B). All patients were followed up for 6-36 months (mean 11.5 months). The vertebral body height, endplate angle and neurofunction were compared between the two groups before surgery, a week after surgery and at the end of the follow-up period.</p><p><b>RESULTS</b>There was no statistically significant difference in vertebral body height,endplate angle and neurofunction before operation between group A and B (P > 0.05). Vertebral body height and endplate angle improved in both groups a week after operation and at the end of the follow-up period as compared with those before operation (P < 0.05), and the efficacy in group B was significantly better than that in group A (P < 0.05). There was no significant difference in neurofunction between the two groups (P > 0.05).</p><p><b>CONCLUSION</b>The fixation method through the injured vertebra had a better reduction effect, more stable fixation, and a better long-term effect on vertebral morphology than that across the injured vertebra in the treatment of thoracolumbar vertebral fractures.</p>

Misunderstanding about the tension band principle in the treatment of patella fractures / 中国骨伤

Kirschner's wire tension band was the first choice in the treatment of patella fracture. But the principle of tension band had been misunderstood for long time. In the traditional principle, it was believed that tension band could change the separating force between fracture fragments into compressing stress when exercising. Eccentric fixation and articular surface cracking were disadvantageous. These could make the fracture fragments separate either at resting or exercising, which cause the gaps without pressure. Thus excercising could not change the separating force into compressing stress.