Proximal femoral bionic nail versus proximal femoral nail antirotation in treatment of femoral intertrochanteric fracture: a comparison of short-term efficacy / 中华创伤骨科杂志

Objective:To compare the short-term effects of proximal femoral bionic nail (PFBN) and proximal femoral nail antirotation (PFNA) in the treatment of intertrochanteric fracture.Methods:Retrospectively analyzed were the data of 56 patients with intertrochanteric fracture of the femur who had been admitted to Department of Orthopedic Trauma, The People's Hospital of Juye County and Trauma Center, Central Hospital Affiliated to The First Medical University of Shandong from August 2020 to April 2022. The patients were divided into 2 even groups according to their internal fixation methods ( n=28). In the PFBN fixation group, there were 12 males and 16 females with an age of (70.4±7.8) years; by AO classification, there were 4 cases of type 31-A1, 16 cases of type 31-A2, and 8 cases of type 31-A3. In the PFNA fixation group, there were 10 males and 18 females with an age of (73.0±8.9) years; by AO classification, there were 2 cases of type 31-A1, 16 cases of type 31-A2, and 10 cases of type 31-A3. The operation time, intraoperative blood loss, fracture reduction, fracture healing time, Harris hip score, and complications were compared between the 2 groups. Results:There was no statistically significant difference between the 2 groups in the preoperative general data, showing comparability ( P>0.05). The follow-up time was (7.3±0.9) months for the PFBN group and (7.4±1.1) months for the PFNA group, showing no significant difference ( P>0.05). There was no significant difference either between the 2 groups in operation time, intraoperative blood loss or quality of fracture reduction ( P>0.05). The PFNA group had significantly shorter fracture healing time [(3.9±0.9) months] than the PFNA group [(4.7±1.1) months], and a significantly higher Harris hip score at the last follow-up [(83.9±4.3) points] than the PFNA group [(81.0±3.4) points] (both P<0.05). Fixation failed in one patient in the PFNA group due to cut-out of the head and neck screws while no complications were observed in the PFBN group. Conclusion:In the treatment of intertrochanteric fracture of the femur, PFBN fixation may result in stronger fixation to effectively avoid cut-out of the head and neck screws, and faster fracture healing and functional recovery of the hip than PFNA fixation.

Research progress of orthopaedic robot navigation surgery / 中华创伤杂志

After more than 30 years of development,the precise treatment technology of orthopedic surgical robot has changed the traditional orthopedic treatment methods and attracted worldwide attention.Orthopedic robotic navigation surgery is the result of multidisciplinary combination integrating computer,industrial automation,intelligent control,electronic information,ergonomics and medical technologies,so as to provide intelligent,minimally invasive and precise navigation technology for clinic surgery and high-quality service for patients.Throughout the development of orthopedic surgical robot at home and abroad,thanks to the progress of software design and automation technology as well as the improvement of accuracy and flexibility of manipulators,robots can perform more complex operations than existing surgical navigation technologies.This paper briefly reviews the history,navigation principles,types,clinical application and shortcomings,and the future development trend,hoping to provide reference for the research of robotic navigation surgery.

Research progress of orthopaedic robot navigation surgery / 中华创伤杂志

After more than 30 years of development,the precise treatment technology of orthopedic surgical robot has changed the traditional orthopedic treatment methods and attracted worldwide attention.Orthopedic robotic navigation surgery is the result of multidisciplinary combination integrating computer,industrial automation,intelligent control,electronic information,ergonomics and medical technologies,so as to provide intelligent,minimally invasive and precise navigation technology for clinic surgery and high-quality service for patients.Throughout the development of orthopedic surgical robot at home and abroad,thanks to the progress of software design and automation technology as well as the improvement of accuracy and flexibility of manipulators,robots can perform more complex operations than existing surgical navigation technologies.This paper briefly reviews the history,navigation principles,types,clinical application and shortcomings,and the future development trend,hoping to provide reference for the research of robotic navigation surgery.

Trephine transcutaneous osteotomy of talonavicular arthrodesis in the treatment of talonavicular pain / 中华骨科杂志

Objective To evaluate the clinical effect of talonavicular arthrodesis and the influence of adjacent joints use trephine percutaneous osteotomy in the treatment of talonavicular arthralgia.Methods From June 1999 to June 2009,24 patients were performed talonavicular arthrodesis due to a variety of painful disorder of talonavicular joint with trephine percutaneous osteotomy.There were 13 males and 11 females,with an average age of 45 years(range,37-72 years).The indications for the procedure included 15cases with posttraumatic arthritis,6 cases with rheumatoid arthritis,and 3 cases with degenerative arthritis.AOFAS system and visual analogue scale(VAS)were used to evaluate the change of function and arthralgia.Graves score system was used to evaluate the influence of adjacent joints.Results All patients were followed up 10-120 months,with the mean of 48 months.Only one case suffered skin brim necrosis of incision and got delayed healing after 3 weeks.The average AOFAS ankle-hind foot score improved from 45.2 points preoperatively to 84.5 points postoperatively.The excellent and good rate was 87.5%.VAS pain scores decreased from 8.1 to 2.4 postoperatively.Twenty-three patients were satisfied and one dissatisfied with the results.Postoperative radiology showed the union evidence in 23 patients at 6 months postoperatively(successful fusion rate of 95.8%).One joint nonunion occurred and required revision arthrodesis with iliac crest bone graft.There was an increase of Ⅰ grade in arthritic scores for 8 cases and Ⅱ grade for 1 case.Conclusion Talonavicular arthrodesis with trephine percutaneous osteotomy has the advantages of low trauma,high successful fusion rate and can acquire satisfactory clinical effect in the treatment of painful malalignment of talonavicular joints.

Analysis of microsurgical repair of deep wounds of the foot near the ankle joint / 中华创伤骨科杂志

Objective To evaluate simple and practical methods to repair deep wounds in the foot near the ankle joint.Methods 128cases of deep wounds near ankle jo int with exposed bone and tendons fro mJan 1990to Jan 2002were reviewed .Altogether 13types of microsurgical flaps were applied in these cases and obtained satisfactory results.Timing of sur gery:53cases of primary repair,28c ases of secondary repair,47cases of delayed repair.Results26cases of reverse skin avultion were repaired by venous anastomosis in a valsed flaps,of which19survived completely,and 7underg one partial necrosis.There were 19f ree tissue flap grafts in which 13sur vived,3failed and 3undergone partial necrosis and infection.All pedicle tissue flap grafts amounted to 83cases wi th only3partial necrosis in 58cases of sura l nerve flaps graft,and 1total necro sis in 25other types of flap grafts.Con-clusion Sural nerve flaps graft is a reliable method to repair deep wounds with exp osed bone and tendons near the ankle joint.It is easy to perform with excellent abrasion resistance and little effect on the donor limb.

Clinical application of Subtalar joint fusion with trephine / 中华骨科杂志

Objective To introduce a new technique of talocalcaneal joint fusion with trephine and evaluate its clinical effects. Methods From June 1997 to October 2001, 18 cases complained of pain, weakness, limited range of motion and tenderness of ankle were treated with subtalar joint fusion. Of 18 cases, there were 12 males and 6 females with an average age of 47 years (range, 35 to 59 years). The lesions of subtalar joint were identified as traumatic osteoarthritis in 8, degenerative osteoarthritis in 5, congenital bone bridge in 2, rheumatoid arthritis in 2 and refractory inflammation of tarsal sinus. The AP and lateral view X-ray films were taken to measure the width and length of sutalar joint and talocalcaneal angle so as to choose the trephine of appropriate diameter (?11.5 mm, 12 mm, 13 mm )and guide the direction and length of osteotomy. Posterolateral approach was used in 14, and anterolateral approach in 4 depending on the location of lesion at subtalar joint. The trephine was inserted into subtalar joint slowly, the bone block inside the trephine was removed, rotated to 90?, then reimplanted in situ in 14 cases; Autograft of iliac crest was harvested and implanted by trephine in 4. Results All of the affected feet were immobilized with a cast postoperatively for 12 to 16 weeks. The patients were followed up for an average of 25 months ranging from 5 months to 4 years. All the wounds healed well at 2 weeks, the callus appeared at 4 weeks, and the bony fusion was obtained at 16 weeks displayed by postoperative X-ray films. The scores of ankle pain by VAS measurement were improved from preoperative 83.8 to postoperative 32.5. There were no severe complications, only 1 case suffered from dropping foot and recovered 10 months later, and 1 case complained of discomfort of foot. Conclusion Subtalar joint fusion with trephination is an effective procedure with many advantages such as: minimal invasive surgery, easy to perform, higher fusion rate and preserving mechanical stability of hind foot.