Systematic review of winged scapula / 中华骨科杂志

Objective To study the morbidity,pathogenesis,diagnosis and treatment of winged scapula.Methods The key words about "winged scapula" have been used to search articles which include winged scapula patients in English and Chinese literature databases from 1958 to 2017.The articles have been filtrated by title,abstract and full text.There are 36 articles used for this study.All the patients are objects of this study,but the same patients' data in different articles have not been used repeatedly.The patients' data have been collected as much as possible,including age,sex,causes,treatment,follow-up and so on.All the patients' data have been used for systematic analysis.Results All of 356 patients with winged scapula were selected from 36 literatures for systematic analysis.There were 213 cases of anterior saw muscle paralysis,among which 16 cases were physical exercise,11 cases were excellent and 5 cases were poor,with an excellent rate of 68.8％.There were 70 cases of neurolysis and transplantation,50 cases were excellent and 20 cases were poor,with an excellent rate of 71.4％.There were 3 cases of scapulectomy,1 case excellent and 2 cases poor.There were 124 cases of pectoralis major tendon metastasis,88 cases were excellent,36 cases were poor,and the excellent rate was 71％.There were 46 cases of trapezius paralysis,among which 14 cases were physical exercise,12 cases were excellent,2 cases were poor,and the excellent rate was 86％.1 case of scapulopexy and 1 case of superior,with an excellent rate of 100％;There were 31 cases of Eden-Lange 31 cases,27 cases of excellent and 4 cases of poor.One case of rhomboid myoplegia was treated,including 1 case of rehabilitation training (ultrasound guidance),1 case of excellent,with an excellent rate of 100％.There were 96 cases of muscular dystrophy,including 96 cases of scapulectomy,76 cases of excellent and 20 cases of poor,with an excellent rate of 79.1％.Conclusion Winged scapula is rare and its incidence is unknown,different causes determine different treatments:Anterior saw muscle palsy is more suitable for thoracolumbar tendon transfer,and modified Eden-Lange is more suitable for trapezius palsy.

Properties and application of embolic biomaterials / 中国组织工程研究

BACKGROUND:Endovascular embolization materials have been produced and used clinicaly, but new problems constantly occur in the clinical application and new demands are also developed for embolic materials. OBJECTIVE:To retrospectively analyze the advantages and disadvantages of various types of embolic materials and to investigate the relationship between application fields and selection of embolic materials, thereby providing a reference for clinical treatment. METHODS:CNKI and PubMed databases were retrieved for relevant literature, and then embolic materials were systemicaly reviewed based on relevant clinical application and basic research literature in the folowing aspects: embolism mechanisms, clinical applications, advantages and disadvantages of various embolic materials. In this review, the existing problems in the current study were pointed out, and the development direction of relevant research and clinical application were also prospected. RESULTS AND CONCLUSION:Embolic materials should have biodegradability and biocompatibility. Current embolic materials include absorbable gelatin sponge, Polyvinylalcohol embolic agent, micro-coils and liquid embolic materials. Gelatin embolic material has no antigenicity and good histocompatibility, as wel as has excelent compressibility and water re-expansibility. Polyvinylalcohol particles are a polymer material that is insoluble in water, has high expansion coefficient, mechanical embolization, non-alergenic reaction, no acute systemic toxicity, no intracutaneous irritation, and can be used safely and effectively. Adhesive liquid embolic material has no vascular toxicity and has been widely used. Endovascular embolization materials have been produced in succession, and meanwhile, new problems in clinical applications have been found and new demands for embolic materials have been put forward continuously. Thus, a variety of embolic materials have their own advantages and disadvantages, and none of embolic materials can be applied to al diseases. To select an appropriate embolic material is very important for safe and effective treatment.

Allograft cancellous bone combined with autologous red marrow for treatment of periarticular fractures / 中国组织工程研究

BACKGROUND:Bone defects often occur after the reduction of periarticuar fractures, and bone grafting is required to fil bone defects, thereby to make the early support of articular surface and prevent the col apse and shift of the articular surface. Al ograft cancellous bone is the transplant material for the treatment of bone defects, but its osteogenesis ability is poor. Autologous red marrow has osteogenesis ability. Therapeutic efficiency of al ograft cancellous bone combined with autologous red marrow for periarticular fractures is stil yet to be assessed. OBJECTIVE:To study clinical effect of locking plate fixation and al ograft cancellous bone combined with autologous red marrow in the treatment of periarticular fractures. METHODS:Forty-three cases of periarticular fractures were incorporated into the Orthopaedics Department of the Third Hospital of Hebei Medical University. After cutting the articular surface anatomical y, composite particles of the red marrow and al ograft cancellous bone were implanted into bone defects, and then, an anatomic locking plate was used. Medial lateral or bilateral locking plate was used for tibial plateau fractures. Dorsal or volar locking plate was used for distal radius fractures, and distal tibial medial or lateral locking plate was used for distal tibial fractures. RESULTS AND CONCLUSION:Forty-three patients were fol owed up for 12 months to 6 years, an average of 4.3 years. X-ray films and CT scans review showed that 43 patients’ col apse fracture al reached bony union. Fresh fracture healing time was 2-6 months, an average of 4 months;the healing time for old fracture was 3-7 months, an average of 5.5 months. After bone grafting, 43 patients al had no significant immune rejection, two cases showed more wound exudates, and the wound was healed by dressing after 2 weeks. One case had wound infection, the wound was healed after 4 weeks of draining and dressing, and the infection had no recurrence fol owing up for 4 years and 1 month. Forty patients were satisfied with bone grafting, accounting for 93%, and three cases dissatisfied, accounting for 7%, based on Mankin and Komender’s standard assessment. The results confirmed that al ograft cancellous bone combined with autologous red marrow transplantation can play a supporting role in treating periarticular fractures to prevent the col apse of the articular surface and fracture displacement, and to provide reconstruction materials for periarticular defects. Its long-term goal is fracture healing.

Multi-tube drainage network anatomical catheter lavage system for chronic osteomyelitis after fracture surgery / 中华骨科杂志

Objective To explore the clinical application of the multi-network anatomical lavage on the treatment of chronic osteomyelitis after fracture surgery. Methods A retrospective analysis of 40 patients (41 sites) with chronic osteomyelitis after fracture surgery was performed from June 2006 to December 2008. There were 35 males and 5 females with an average of 42.7 years (range, 16-68). All 40 cases were treated with debridement, closing the cavity, and placing the multi-tube drainage network anatomical catheter lavage system. At the same time, sensitive antibiotics were used for 3 to 4 weeks. Rechecks were scheduled every 3 months after operation, including wound healing, X-ray presentation, ESR and C-reactive protein.Cure criteria depends on the conditions of the inflammation when the lavage treatment was over, and whether it relapsed six months after operation, including wound healing, systemic symptoms, ESR and C-reactive protein. Results Judged by the clinical outcomes when the lavage treatment was over and six months after operation, the effects were categorized into 3 levels, including excellent in 37 cases with primary wound healing, and without relapse six months later;, good in 2 with poor wound healing, the wound healed after a period of treatment without recurrence; poor in one with recurrent sinus infection and a prolonged unhealed wound, after another operation he was healed. 36 cases were treated with bone graft and internal fixation operation, and the fractures were healed after surgery, the fractures were healed directly in 4 cases without bone graft. The patients were followed up for an average of 43.2 months (range, 30-50) after operation, and none relapsed. Conclusion The multi-tube drainage network anatomical method is feasible and effective on the treatment of chronic osteomyelitis after fracture surgery with a high cure rate.

Nonunion and malunion due to insidious infection after internal fixation of bone fractures / 中华创伤骨科杂志

Objective To explore an effective prevention and management of nonunion and malunion due to insidious infection after fracture internal fixation. Methods From January 2001 to January 2006,we treated 26 patients with nonunion and malunion due to insidious infection after fracture internal fixation.They were 15 cases of femoral fractures, 2 cases of ulna fractures, 3 cases of radial fracturos, 3 cases of humerus fractures, and 3 cases of tibial fractures. The patients were treated with irrigation after debridement.In 23 fractures, the internal fixation was dislodged and changed into external fixation. In the 3 cases whose internal fixation remained, instillation and drainage were conducted after debridement. Bone grafting was performed for 20 cases after replacement of internal fixation, and for 3 cases after removal of external fixation.Three patients received no bone graft. Results The preoperative X-ray findings confirmed the diagnosis of insidious infection in 21 cases, while the other 5 cases were diagnosed by bacterial culture or pathological examination of the pus and inflammatory granulation tissue found during surgery. The bacterial culture was positive in 17 cases, including 6 cases of Staphylococcus epidermidis, 8 cases of Staphylococcus aureus, and 3 cases of Escherichia coli. All the patients were followed up for 8 to 48 months, with an average of 23.5 months. Of the 26 cases, 22 obtained bony union, 2 partial union and 2 nonunion. Complications included fistula in 2 patients and infection relapse in 3 patients. Conclusions Insidious infection may be related to the bacterial toxicity, anatomical sites and surgical methods. X-ray changes may help the diagnosis of insidious infection. Surgery is necessary for management of nonunion and malunion due to insidious infection after fracture internal fixation.

Clinical analysis of percutaneous autologous bone marrow transplantation to heal malunion of fracture induced by infections in 19 cases / 中国组织工程研究

BACKGROUND: Autologous bone marrow transplantation (ABMT) has been widely used in treatment of the malunion of fracture, but this treatment to cure malunion of fracture induced by infection is still not consistent.OBJECTIVE: To observe the application and clinical outcome of ABUT for the malunion of fracture induced by infection.DESIGN, TIME AND SETTING: A retrospective analysis. The patients were all enrolled at Department of Orthopaedics in the Third Affiliated Hospital of Hebei Medical University from January 2001 to January 2006. PARTICIPANTS: A total of 19 patients with malunion of fracture induced by infection, including 13 males and 6 females aged from 18 to 50 years, with an average of 36. The lesioned site contained fracture of tibia 10, fracture of femur 5, fracture of ulna 2 and fracture of humerus 2. Among them, there were 6 cases with bone defect, 9 cases with bone fracture delayed union and 4 cases with bone fracture disunion.METHODS: Nineteen patients treated with percutaneous ABUT. Among the 19 cases, 12 patients received the transplant 3 weeks after infection was under controlled, and other 8 patients received the transplant following autologous bone transplantation.MAIN OUTCOME MEASURES: After ABMT, all patients were checked using X-ray regularly, the pacing of bone union was traced through observing the growth of callus, and the side reaction was also detected.RESULTS: Totally 19 patients were included in the follow-up visit, and 15 cases of them achieved bony union. Clinical healing time was 7-20 weeks. The patients had no obvious discomforts except local gas pains when injecting and at pristine time after injection. Five patients had a small quantity of exudation. No infection relapse or soft tissue ossification were observed at the injection position. Four patients had not achieved bony union, the reason was that bone defect in 2 patients exceed 2 cm; fracture disunion with pseudoarticulation formatted in one patient, the sclerous broken ends of fractured bone was more than 2 cm; another patient's external fixation displaced, we adjusted it and the bone healed after 12 weeks. Three patients received autoallergic ilium bone transplantation in the second time of operation, the fractured bone got bony union. CONCLUSION: ABMT by percutaneous injection into malunion site can induce ossification, repair bone fracture and bone defects. The clinical application is simple and exhibits small wounds without complications. Especially ABMT is effective for the patient with the malunion of fracture induced by infection.

Tardive hemorrhoea cause of osteofascial compartment syndrome after trauma / 中国矫形外科杂志

[Objective]To analyze the reason for osteofascial compartment syndrome caused by tardive massive bleeding and to discuss the first-aid measure to treat continuing bleeding in operation.[Method]There were 5 cases in this study.Two osteofascial compartment syndrome with tardive haematoma were caused by secondary disturbances of blood coagulation.One iliopsoas muscle haematoma was caused by over-dose of warfarin(WARF).Vitamine K was applied to anti-warfarin and depressed haematoma by ultrasonic guiding puncturation aider a pause of warfarin.The other one suffered from continuing bleeding after a depression operation on right femoral bone haematoma.The bleeding could not be stopped until carbasus obturation and a supplementary of lood coagulation factor.The carbasus were taken out 36 hours later.Three traumatic pseudoaneurysm rupture happened to superior gluteal artec,arteriae tibialis posterior and deep femoral artery separately.The bleeding artery was ligated and removed the body of the blood tumor in these three cases.In addition,arterial embolism was applied in two of them before operation.[Result]No recurrence happened to the case with iliopsoas muscle haematoma after 16 weeks as a result of absorption and degeneration.As the patient with right femoral bone haematoma referred,the bleeding stopped after treated by carbasus obturation.The wound was closed 36 hours after the operation.A satisfactory sensory recovery,pulsation of dorsal pedal artery and arteria tibialis posterior were found.Rebleeding was found in 3 weeks after the wound closed.The pathobiology inspection of bone and muscle tissue around the fracture site showed osteoma sarcomatosum in right femoral bone.The author gave the patient to the operation of high amputation.No rebleeding,nervous symptoms caused by compression,limbs necrosis and ischemic contracture was found after 3 patients suffering from traumatic pseudoaneurysm rapture with followed-up from 8 month to 3 years.[Conclusion]Hemorrhea caused by secondary disturbances of blood coagulation or pseudoaneurysm can lead to osteofascial compartment syndrome.Embolism of the bleeding artery before removal of the aneurysm and haematoma can reduce bleeding in operation.It is the best choice for the doctor to stop operation immediately and stop bleeding by effective carbasus obturation.

Diagnosis and treatment of insidious infection after the long bone fracture internal fixation / 中国矫形外科杂志

[Objective]To study diagnosis and treatment of insidious infection after the internal fixation of long bone fracture.[Method]Thirteen patients with insidious infection after internal fixation of long bone fracture were treated with irrigation after debridment. Among the 13 cases 8 fractures were dislodged internal fixation and then were fixed with the external fixation. 5 fractures were remained the internal fixation and were instilled after debridment. All of the patients were given with antibiotics for 2～3 weeks after operation.[Result]All the 13 patients were followed up. The follow-ranged from 8 to 48 months with an average of 23.5 months. Among the thirteen patients 11 fractured-bone had bony union, one nonunion and one case had fistula, Infection relapsed in two patients.[Conclusion]Bone defects, fracture nonunion often occur on patients who have insidious infection after internal fixation of long bone fracture. These patients need to be operated. In slight infections fracture can be remained after debridement. Fractures with seriously infectious have to dislodge internal fixation and to be fixed with made according to its radiographic changes.