Risk factors for infections after arthroscopic rotator cuff repair / 中国骨伤

OBJECTIVE@#To explore risk factors for infections after arthroscopic rotator cuff repair, and improve the under standing for reducing infection.@*METHODS@#Clinical data of 2 591 patients who underwent arthroscopic rotator cuff repair from January 2019 to January 2022 were retrospectively analyzed, including 1 265 males and 1 326 females, aged from 25 to 82 years old with an average age of (51.5±15.6) years old. They were divided into infection group(n=18) and uninfected group(n=2 573) according to whether or not patients had postoperative infection. Gender, age, smoking, diabetes, body mass index, local closure within 1 month before operation, operation time, preventive use of antibiotics, and internal fixation implantation between two groups were recorded. Univariate Logistic regression analysis screened factors associated with infections after arthroscopic rotator cuff repair. Theresultswere entered into the multivariate logistic regression analysis, screening the high risk factors for infections after arthroscopic rotator cuff repair.@*RESULTS@#In 2 591 patients, 18 patients were infected after operation, infection rate was 0.69%. Univariate Logistic regression analysis showed that gender, age, operation time, antibiotic prophylaxis, internal fixation implantation were risk factors for infections after arthroscopic rotator cuff repair. Multivariate Logistic regression analysis showed male(OR=14.227), age≥65 years(OR=34.313), operation time≥2 h (OR=15.616), without antibiotic prophylaxis(OR=4.891), and internal fixation implantation(OR=5.103) were major risk factors for infection after arthroscopic rotator cuff repair(P<0.05).@*CONCLUSION@#Male, age≥65 years, operation time≥2 h, without antibiotic prophylaxis and internal fixation implantation were independent risk factors for infection after arthroscopic rotator cuff repair. Early diagnosis and timely treatment should be carried out to reduce the incidence of infection.

Analysis of risk factors of healthy side fracture after hip fracture surgery in the elderly / 中国骨伤

OBJECTIVE@#To investigate the incidence and related risk factors of healthy side fracture after hip fracture surgery in the elderly, so as to provide basis for the prevention of re-fracture.@*METHODS@#The data of 452 patients over 65 years old with femoral neck fracture or intertrochanteric fracture treated with hip arthroplasty or proximal femoral intramedullary nailing from June 2012 to June 2017 were analyzed, including 168 males and 284 females, the age ranged from 65 to 97(75.5±7.5) years. There were 191 cases of femoral neck fracture and 261 cases of femoral intertrochanteric fracture. According to whether there was a fracture in the healthy hip after operation, the patients were divided into fracture group and no fracture group. The gender, age, body mass index, fracture type, initial treatment method, bone mineral density, bed time, medical compliance, postoperative short-term delirium, whether there were medical diseases before injury and Harris score of hip joint in the final follow-up were recorded. Univariate Logistic regression analysis was used to screen out the risk factors of healthy side fracture after operation, and then statistically significant risk factors were included in multi factor Logistic regression analysis to screen out the independent risk factors of healthy side fracture after operation of hip fracture in the elderly.@*RESULTS@#Among them, 42 of the 452 patients had hip fractures on the healthy side with an incidence of 9.3%. The average interval between the two fractures was (2.9±2.1) years. Univariate Logistic regression analysis showed that there were significant differences in age, bone mineral density, medical compliance, short-term postoperative deliriun, pre-injury complicated with medical diseases and Harris score of hip joint in the final follow-up (P<0.05). Multivariate Logistic analysis showed that age(OR=4.227), bone mineral density(OR=4.313), combined with medical diseases (OR=5.616) and low hip Harris score at the final follow-up (OR=3.891) were independent risk factors for healthy side fractures after hip fracture surgery in elderly(P<0.05).@*CONCLUSION@#The age, bone mineral density, combined with medical diseases and low Harris score of hip joint in the final follow-up are the main risk factors of healthy side fracture after hip fracture in the elderly. It is necessary to strengthen the treatment of medical diseases, anti osteoporosis and improve hip joint function within 3 years after operation, so as to prevent the occurrence of healthy side hip fracture.

Establishment of 3D finite element model of meniscus and its mechanical analysis / 中国骨伤

OBJECTIVE@#To establish a 3D finite element model of normal knee joint involved its meniscus, which can be used to simulate the anatomical morphology and characteristics of human knee joint, to verify the validity of the model by preliminary FEA mechanical analysis, and explain partially biomechanical mechanisms of meniscus.@*METHODS@#CT and MRI data were harvested by scanning the knee joint of a healthy male volunteer, and then these data were imported into Mimics 10.01 software and Geomagic Studio software to constructed the 3D models of tissue structures of knee joint. These models were combined to constructed the 3D model of intact knee joint and meshed in ANSA software. Therefore the finite element model of intact knee joint was established. Finally, after the definitionof its material behavior, boundary conditions and loading. The finite element model of knee joint was analyzed and verified using ANSYS software. Meanwhile The biomechanical properties of meniscus were analyzed.@*RESULTS@#The complete knee finite element model composed of bone, meniscus, articular cartilage, and major ligaments was established. It could effectively simulate the anatomical morphology and characteristics of knee joint and its meniscus. The contact area of medial meniscus was 771.05 mm, while the contact area of lateral meniscus was 634.31 mm, and the ratio was 1.216. The stress distribution was uniform, but the stress of the medial meniscus was higher than that of the lateral meniscus, and the peak stress located in the posterior horn of the medial meniscus and the anterior horn of the lateral meniscus, respectively, and the peak stress value was 4.11 MPa. The maximum displacement of the meniscus was located in body, and the displacement of the medial meniscus was more remarkable than that of the lateral meniscus, and the maximum displacement value is 0.33 mm. The obtained finite element analysis results corresponded to that reported in the literature, which mean the model's reliability.@*CONCLUSION@#The established finite element model of knee joint are proved to be have validity, and is a useful model for finite element analysis of meniscus tear and menisectomy. The results of finite element analysis can explain partially biomechanical mechanisms of meniscus which can provide theoretical guidance for clinical treatment of meniscus injury.

Progress in finite element analysis of meniscus / 中国骨伤

The meniscus biomechanics is one of the hottest areas in medical research. Finite element analysis(FEA) provides a new method for biomechanical studies. Using the FEA, the stress force and strain distribution characteristics of the normal meniscus can be analysed by establishing the finite element model of the meniscus and utilizing finite element softwares. In addition, the finite simulation of the meniscus tears, meniscectomy, and knee tissue injury can assess the changes of meniscus biomechanical properties. These research results provide theoretical basis of biomechanics to prevent and treat knee joint injuries. However, the finite element analysis method has its limitations, future research will be aimed at establishing high quality finite element models, making the models offer more authentic simulations of the meniscus anatomy, and ensuring the FEA could be applied to research a variety of knee injuries.

Comparison of long Gamma 3 nail and proximal femur locking plate for the treatment of femoral subtrochanteric fractures / 中国骨伤

OBJECTIVE@#To compare clinical efficacy of long Gamma 3 nail and proximal femur locking plate (PFLP) in treating femoral subtrochanteric fractures.@*METHODS@#From January 2010 to January 2017, clinical data of 58 patients with subtrochanteric fractures followed more than 12 months were retrospective analyzed. Among them, 35 patients were treated with long Gamma 3 nail including 18 males and 17 females aged from 25 to 78 years old with an average of(66.5±23.5) years old;Causes of injury included fall on the ground in 18 cases, traffic accidents in 7 cases, and fall from height in 10 cases. The other 23 patients were treated with PFLP fixation including 8 males and 15 females aged from 31 to 81 years old with an average of (63.4±22.4) years old;Causes of injury included fall on the ground in 12 cases, traffic accidents in 6 cases, and fall from height in 5 cases. Operative time, blood loss (intraoperative and hidden blood loss), hospital stays, bone healing and complications were observed and compared. Harris hip score after 1-year following-up was used to evaluate postoperative clinical effect.@*RESULTS@#Fifty-one patients were followed up from 14 to 36 months with an average of 24.8 months, including 31 patients were treated with long Gamma 3 and 20 patients were treated with PFLP. Blood loss(intraoperative and hidden blood loss) in PFLP group was less than that of long Gamma 3 nail group(0.05). There was no significant differences in healing time of fractures between long Gamma 3 nail group (17.2±2.4) weeks and PFLP group (18.1±2.6) weeks(<0.05). At 1-year following-up, there was no significant differences in Harris hip score between long Gamma 3 nail group(80.29±10.28) and PFLP group (76.49±12.28)(<0.05). No complications such as pulmonary embolism and nonunion occurred. Two patients were treated with fitler whose occurred deep vein thrombosis. Postoperative pulmonary infection curred in 4 cases and was cured by anti-infection therapy.@*CONCLUSIONS@#Both of long Gamma 3 nail and PFLP in treating patients with femoral subtrochanteric fractures can receive good clinical effects, long Gamma 3 nail is not suitable for the patients of the narrow medullary cavity and prominent anterior arch. PFLP is eccentric fixation, so early weight-bearing was not stress.

Advanced progress on the treatment of anterior approach to the thoracolumbar vertebral fractures / 中国骨伤

Thoracolumbar fractures are common and severe traumas. Anterior approaches can achieve adirect spinal cord decompression and reconstruct anterior column height what load bearing the major load distribution of the spine. Therefore, anterior approach is an important method in the treatment of thoracolumbar fractures. With the application of pedicle screw, most of the patients were treated with posterior approaches.Because of the unique advantages of anterior approach, the posterior approach can not be replaced it.The review summarizes the biomechanical characteristics? indications? fixation devices? bone grafting method and technique of the anterior approach and in order to provide better evidence for clinical treatment of thoracolumbar fractures.

A medium term therapeutic effects of anatomic locking plate for femoral intertrochanteric with lateral femoral wall fractures / 中国骨伤

<p><b>OBJECTIVE</b>To retrospectively study medium term follow-up outcomes of the femoral intertrochanteric with lateral femoral wall fractures using anatomic locking plate fixation.</p><p><b>METHODS</b>From June 2010 to January 2013, 18 cases of the unstable femoral intertrochanteric with lateral femoral wall fractures were treated with the anatomic locking plate, included 8 males and 10 females with an average age of 75.5 years ranging from 19 to 83 years old. There were 8 cases of traffic accident injuries, 6 cases of falls injuries, and 4 cases of falling from high place. The time from injury to operation was ranged from 1 to 14 days with an average of 4.5 days. The operation time, intraoperative blood loss and the length of hospitalization were recorded and analyzed. The fracture union was assessed by follow-up radiographs and hip functional recovery by PPMS and Harris hip scoring.</p><p><b>RESULTS</b>All patients were followed up from 36 to 68 months with a mean of(44.8±8.8) months. The mean operative time was (61.02±38.28) min;the mean blood loss was (226.00±162.52) ml;the mean length of hospitalization was (10.8±9.2) days. During the follow-up period, no infection, deep veintllrombosis, screwed cut-out and implant failure occurred in all patients. Coxa vara with shortening deformity was noted in 2 cases. Bone union was found in all the cases. The bone healing time was ranged from 4 to 10 months with an average of 6.2 months. The mean PPMS score at the final follow-up was 7.22±2.36. The Harris score was 79.46±11.02, 5 cases were classified as excellent, 9 as good and 2 as fair.</p><p><b>CONCLUSIONS</b>Proximal femoral anatomic locking plate can be used in treating intertrochanteric fractures with compromised lateral wall, which has a satisfied medium term follow-up outcomes, especially for complex fractures patterns in which intramedullary nailing may be difficult, and should not emphasis on premature loading.</p>

Inversive LISS plate in treating intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures / 中国骨伤

<p><b>OBJECTIVE</b>To study clinical effects of inversive LISS(less invasive stabilization system, LISS) plate for the treatment of intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures.</p><p><b>METHODS</b>From January 2012 to January 2015, 24 patients with intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures were treated with inversive LISS plate, included 16 males and 8 females with an average age of 62.5 years old ranged from 35 to 81 years old. There were 8 cases of traffic accident injuries, 3 cases of falling from high place, and 13 cases of falls injuries. The time from injury to operation was ranged from 2 to 12 days with an average of 5.2 days. The operation time, intraoperative blood loss and the length of hospitalization were analyzed. The fracture union was assessed by follow-up radiographs and hip functional recovery by Harris hip scoring.</p><p><b>RESULTS</b>All patients were followed up for 16.2 months (ranged, 18 to 36 months). The mean operative time was (68.22±48.36) min;the mean blood loss was (256.28±182.46) ml;the mean time of hospitalization was(14.8±5.2) days. There were no complications such as deep infection, deep vein thrombosis, pulmonary embolism and bone nonunion during the follow up period. The bone healing was ranged from 3 to 8 months with an average of 4.8 months. The mean Harris score was 76.49±12.28 at the final follow-up, 15 cases were classified as excellent, 6 as good and 3 as fair.</p><p><b>CONCLUSIONS</b>Inversive LISS plate can be used in treating with intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures, and should not emphasis on premature loading.</p>

Comparison of anatomical locking plate and Gamma nail for the treatment of intertrochanteric fracture with external wall fractures / 中国骨伤

<p><b>OBJECTIVE</b>To compare clinical efficacy of anatomic locking plate and Gamma nail in treating unstable femoral intertrochanteric fractures with external wall fractures.</p><p><b>METHODS</b>From June 2010 to June 2014,clinical data of 44 patients with intertroehanteric fractures associated with lateral wall fractures (type 31A2.2-3.3) followed more than 12 months,which treated with Gamma nail or anatomic locking plate,were retrospective analyzed. Sixteen patients were treated with anatomic locking plate, including 6 males and 10 females aged from 32 to 83 years old with an average of 56.5 years old. Twenty-eight patients were treated with Gamma nail including 17 males and 11 females aged from 26 to 87 years old with an average of 60.4 years old. Operative time, intraoperative fluoroscopy times, blood loss (intraoperative and hidden blood loss), hospital stays were observed and compared. PPMS and HHS scoring were used to evaluate postoperative clinical effect.</p><p><b>RESULTS</b>All patients were followed up from 12 to 24 months with an average of 16.2 months. Operative time in Gamma nail was shorter than anatomic locking plate; while blood loss( intraoperative and hidden blood loss) and intraoperative fluoroscopy times in anatomic locking plate were less than that of in Gamma nail. There was no significant meaning in hospital stays between two groups. Postoperative full weight-bearing time in anatomic locking plate was prolonged than Gamma nail. At the final following-up, PPMS in Gamma nail was 7.50 ± 1.78 and 6.82 ± 1.38 in anatomic locking plate, and there was no obvious meaning between two groups (t = 2.341, P = 0.132); there was no significant differences in HHS score between Gamma nail (83.25 ± 11.18) and anatomic locking plate (86.14 ± 12.36) (t = 1.923, P = 0.243). The incidence of complications in Gamma nail was less than anatomic lock-ing plate (P = 0.005).</p><p><b>CONCLUSION</b>Anatomic locking plate for intertrochanteric fractures with external wall fractures could avoid re-injury of external wall, especially for severe comminuted fractures, difficult for intramedullary nailing, and there was no significant meaning in hip joint function compared with Gamma nail, while postoperative incidence of complications was higher than Gamma nail, so early weight-bearing was not stress.</p>