A meta-analysis of the secondary fractures for osteoporotic vertebral compression fractures after percutaneous vertebroplasty.

ABSTRACT: To identify the risk factors of the secondary fractures for osteoporotic vertebral compression fractures (OVCFs) after percutaneous vertebroplasty (PVP).We conducted a search of relevant articles using Cochrane Library, PubMed, Medline, Science Direct, Embase, the Web of Science and other databases. The time range we retrieved from establishment of the electronic database to November 2017. Gray studies were found in the references of included literature reports. STATA version 11.0 (Stata Corporation, College Station, Texas) was used to analyze the pooled data.Fourteen studies involving 1910 patients, 395 of whom had fracture secondary to the surgery were included in this meta-analysis. The result of meta-analyses showed the risk factors of the secondary fractures for OVCFs after PVP was related to bone mineral density (BMD) [95%CI (-0.650, -0.164), SMD=-0.407, P=.001], cement leakage ((RR=0.596, 95%CI (0.444,0.798), P = .001)), and kyphosis after primary operation ((SMD=0.741, 95%CI (0.449,1.032), P = .000)), but not to gender, age, body mass index, cement volume, thoracolumbar spine, and cement injection approaches.Bone mineral density, cement leakage, and kyphosis after primary operation are the risk factors closely correlative to the secondary fracture after PVP. There have not been enough evidences to support the association between the secondary fracture and gender, age, body mass index, cement volume, thoracolumbar spine, and cement injection approaches.

[Application of anterior subcutaneous internal fixator combined with posterior plate in treatment of unstable pelvic fractures].

OBJECTIVE: To investigate the effectiveness of anterior subcutaneous internal fixator combined with posterior plate in the treatment of unstable pelvic fractures. METHODS: Between January 2015 and January 2019, 26 cases of unstable pelvic fractures were treated with anterior subcutaneous internal fixator combined with posterior plate. There were 16 males and 10 females, with an average age of 42.8 years (range, 25-66 years). According to the Tile classification, 9 of them belonged to type B2, 6 to type B3, 7 to type C1, 3 to type C2, 1 to type C3. The injury severity score (ISS) was 6-43 (mean, 18.3). Four cases combined with brain injury, 7 with limb fractures, 3 with hemopneumothorax, 1 with sciatic nerve injury. The time from injury to operation was 4-12 days (mean, 6.4 days). The intraoperative blood loss, operation time, and the complications were recorded. The fracture reduction and the postoperative function of patients were evaluated. RESULTS: All patients were followed up 12-26 months (mean, 16.8 months). The operation time was 65-142 minutes (mean, 72.5 minutes) and the intraoperative blood loss was 42-124 mL (mean, 64.2 mL). There were 2 cases of unilateral lateral femoral cutaneous nerve stimulation, 1 case of femoral nerve paralysis, and 1 case of superficial infection of incision, which were cured after corresponding treatment. X-ray films showed that all fractures healed at 3 months after operation. At last follow-up, according to Matta criteria for fracture reduction, the results were excellent in 8 cases, good in 15 cases, fair in 2 cases, and poor in 1 case, with an excellent and good rate of 88.5%. According to Majeed scoring system for pelvic function, the results were excellent in 10 cases, good in 12 cases, and fair in 4 cases, with an excellent and good rate of 84.6%. CONCLUSION: For unstable pelvic fractures, the anterior subcutaneous internal fixator combined with posterior plate has fewer operative complications, high security, and achieve good effectiveness.

Morphometry of iliac anchorage for transiliac screws: a cadaver and CT study of the Eastern population.

OBJECTIVES: To describe the morphometry of iliac columns for transiliac screw and to testify the conformity among the anatomic measurement, two-dimensional (2D) and three-dimensional (3D) computed tomography. METHODS: We evaluated the length, inner width, and angle of three screw trajectories starting at the iliac tubercle, posterior superior iliac spine, and posterior inferior iliac spine toward the anterior inferior iliac spine. Measurements were made on specimen, two- and 3D computed tomography using 18 embalmed cadaveric pelves. RESULTS: There was no significant difference among three measure methods. The path between the posterior superior iliac spine and anterior inferior iliac spine had the largest iliac column length, with 135 mm in male and 110 mm in female. The canal allowed placement of 8-mm screw in male and 6.5 mm in female with the angle of 25 degrees laterally directed from the midsagittal plane. The line between the posterior inferior iliac spine and anterior inferior iliac spine was below or just located at the top of greater sciatic notch in the majority measurements. The safe section for transiliac screw approximately located above the greater sciatic notch and could be divided into anterior and posterior parts. CONCLUSION: The measurements among anatomic measurement, 2D and 3D computed tomography are consistent. The screw path from the posterior superior iliac spine toward anterior inferior iliac spine provided the longest anchor site. At the same time, the line between the posterior inferior iliac spine and anterior inferior iliac spine is not available for transiliac screw insertion of eastern population. The posterior of the safe section also can be regarded as another ilium anchorage area for transiliac screws.

Measurement and analysis of the perforator arteries in upper extremity for the flap design.

The aim of this study was to provide the anatomical basis for the skin flap pedicled with the nutrient vessels of the cutaneous nerves and cutaneous veins of the upper extremity. Radio-opaque material was injected into the common carotid arteries of five fresh cadavers. The skin and the fascia were meticulously dissected, removed, and radiographed. The Photoshop CS and Scion image 4.02 were used to analyze the cutaneous arteries, the density of vessels, and the vascular territories of the perforator arteries. The results showed that the cutaneous arteries of the upper extremity came from 16 original arteries, and accordingly, the superficial tissue of the upper extremity could be divided into 16 vascular territories. The external diameter and the area of blood supply of each perforator were growing downwards from the proximum to the distal end. But the points at which the perforator arteries came out from the deep tissue were concentrated near the cutaneous nerves and cutaneous veins, and the arteries formed vascular chains. The density of the arteries near the cutaneous nerves and cutaneous veins was much higher than that of other areas. This article discussed the regularity of the nutrient vessels of the cutaneous nerves and veins on the basis of the experimental results.

A new technique for lag screw placement in the dynamic hip screw fixation of intertrochanteric fractures: decreasing radiation time dramatically.

The goal of this study was to confirm the decrease in radiation time required for a new technique to place dynamic hip screws (DHS) in intertrochanteric fractures. Seventy-six patients were treated with DHS by either the new technique (NT) or the conventional technique (CT). The width of femoral shaft, the length of the hip screw to be implanted into the injured side, and the distance between the tip of the greater trochanter and the entry point of the guide wire were measured at the uninjured side on the anteroposterior pelvic radiograph preoperatively, and the actual width of the injured femoral shaft was measured intra-operatively. Finally, the entry point and the length of hip screw were obtained through an equation. Mean radiation time of the NT patients (24.57 +/- 7.80 s) was significantly shorter than the CT patients (54.2 +/- 18.26 s) (P < 0.001). The new technique decreased radiation time dramatically in DHS fixation.