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OBJECTIVE@#To investigate the efficacy and clinical results of total internal protection technique in anterior cruciate ligament reconstruction.@*METHODS@#A total of 56 patients undergoing anterior cruciate ligament reconstruction treated from January 2018 to December 2019 were selected. According to the different surgical methods, they were divided into total internal reconstruction group and standard bone tunnel group. There were 21 patients in the total internal reconstruction group, including 15 males and 6 females, aged from 20 to 48 with an average of (35.6±6.7) years old, and 35 patients in the standard tibial tunnel group, including 26 males and 9 females, aged 22 to 51 years old with an average of (33.7±9.6) years old. Preoperative examination of Lachman test was positive, magnetic resonance indicated anterior cruciate ligament rupture. There were no significant differences between the two groups in age, sex, body mass index, time from injury to ACL reconstruction, combined meniscus injury and operation method, operation time, ligament diameter, ligament length and other general information. Postoperative evaluation included operation duration, length and diameter of transplanted tendon after braid. International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner score and perioperative complications 2 years after surgery.@*RESULTS@#Both groups were followed up, ranging from 24 to 30 months with an average of (26.9±3.4) months. Postoperative incision healing was good, and no failure or joint infection occurred at the last follow-up. There was no statistically significant difference between the two groups in IKDC score, Lysholm score and Tegner score before, 1 year and 2 years after surgery. However, IKDC score, Lysholm score and Tegner score at 1 year and 2 years after surgery.@*CONCLUSION@#The same postoperative function and stability of knee joint can be obtained by both the residual whole technique and the standardized reconstruction technique. In the residual whole group, only the semitendinosus muscle is taken, and the femoral thin muscle is retained, with greater tibial bone mass preserved, which is safe and effective in clinical practice.
Subject(s)
Male , Female , Humans , Adult , Young Adult , Middle Aged , Anterior Cruciate Ligament/surgery , Retrospective Studies , Treatment Outcome , Arthroscopy/methods , Knee Joint/surgery , Anterior Cruciate Ligament Injuries/surgeryABSTRACT
Objective: The study investigated the clinical distribution, antimicrobial resistance and epidemiologic characteristics of hypervirulent Carbapenem-resistant Klebsiella pneumoniae (hv-CRKP) in a hospital in Henan Province to provide a scientific basis for antibiotic use and nosocomial infection prevention and control. Methods: A retrospective analysis of the clinical data from the cases was carried out in this study. Clinical data of patients infected with the CRKP strain isolated from the clinical microbiology laboratory of Henan Provincial Hospital of Traditional Chinese Medicine from January 2020 to December 2022 were retrospectively analyzed. A string test, virulence gene screening, serum killing, and a G. mellonella infection model were used to screen hv-CRKP isolates. The clinical characteristics of hv-CRKP and the drug resistance rate of hv-CRKP to twenty-five antibiotics were analyzed using WHONET 5.6. Carbapenemase phenotypic characterization of the hv-CRKP was performed by colloidal gold immunochromatographic assay, and Carbapenemase genotyping, multi-locus sequence typing (MLST) and capsular serotyping of hv-CRKP isolates were performed by PCR and Sanger sequencing. Results: A total of non-duplicate 264 CRKP clinical isolates were detected in the hospital from 2020 to 2022, and 23 hv-CRKP isolates were detected, so the corresponding detection rate of hv-CRKP was 8.71% (23/264). The hv-CRKP isolates in this study were mainly from the intensive care unit (10/23) and neurosurgery department (8/23), and the main sources of hv-CRKP isolates were sputum (10/23) and bronchoalveolar lavage fluid (6/23). The hv-CRKP isolates in this study were highly resistant to β-lactam antibiotics, fluoroquinolones and aminoglycosides, and were only susceptible to colistin, tigecycline and ceftazidime/avibactam. The detection rate of the blaKPC-2 among 23 hv-CRKP isolates was 91.30% (21/23) and none of the class B and class D carbapenemases were detected. Results of MLST and capsular serotypes showed that ST11 type hv-CRKP was the dominant strain in the hospital, accounting for 56.52% (13/23), and K64 (9/13) and KL47 (4/13) were the major capsular serotypes. Conclusion: The hv-CRKP isolates from the hospital are mainly from lower respiratory tract specimens from patients admitted to the intensive care department and the drug resistance is relatively severe. The predominant strains with certain polymorphisms are mainly composed of the KPC-2-producing ST11-K64 and ST11-KL47 hv-CRKP isolates in the hospital.
Subject(s)
Humans , Klebsiella pneumoniae/genetics , Multilocus Sequence Typing , Retrospective Studies , Klebsiella Infections/drug therapy , Anti-Bacterial Agents/therapeutic use , Hospitals , Carbapenem-Resistant Enterobacteriaceae/genetics , Microbial Sensitivity Tests , Carbapenems/pharmacologyABSTRACT
Objective: The study investigated the clinical distribution, antimicrobial resistance and epidemiologic characteristics of hypervirulent Carbapenem-resistant Klebsiella pneumoniae (hv-CRKP) in a hospital in Henan Province to provide a scientific basis for antibiotic use and nosocomial infection prevention and control. Methods: A retrospective analysis of the clinical data from the cases was carried out in this study. Clinical data of patients infected with the CRKP strain isolated from the clinical microbiology laboratory of Henan Provincial Hospital of Traditional Chinese Medicine from January 2020 to December 2022 were retrospectively analyzed. A string test, virulence gene screening, serum killing, and a G. mellonella infection model were used to screen hv-CRKP isolates. The clinical characteristics of hv-CRKP and the drug resistance rate of hv-CRKP to twenty-five antibiotics were analyzed using WHONET 5.6. Carbapenemase phenotypic characterization of the hv-CRKP was performed by colloidal gold immunochromatographic assay, and Carbapenemase genotyping, multi-locus sequence typing (MLST) and capsular serotyping of hv-CRKP isolates were performed by PCR and Sanger sequencing. Results: A total of non-duplicate 264 CRKP clinical isolates were detected in the hospital from 2020 to 2022, and 23 hv-CRKP isolates were detected, so the corresponding detection rate of hv-CRKP was 8.71% (23/264). The hv-CRKP isolates in this study were mainly from the intensive care unit (10/23) and neurosurgery department (8/23), and the main sources of hv-CRKP isolates were sputum (10/23) and bronchoalveolar lavage fluid (6/23). The hv-CRKP isolates in this study were highly resistant to β-lactam antibiotics, fluoroquinolones and aminoglycosides, and were only susceptible to colistin, tigecycline and ceftazidime/avibactam. The detection rate of the blaKPC-2 among 23 hv-CRKP isolates was 91.30% (21/23) and none of the class B and class D carbapenemases were detected. Results of MLST and capsular serotypes showed that ST11 type hv-CRKP was the dominant strain in the hospital, accounting for 56.52% (13/23), and K64 (9/13) and KL47 (4/13) were the major capsular serotypes. Conclusion: The hv-CRKP isolates from the hospital are mainly from lower respiratory tract specimens from patients admitted to the intensive care department and the drug resistance is relatively severe. The predominant strains with certain polymorphisms are mainly composed of the KPC-2-producing ST11-K64 and ST11-KL47 hv-CRKP isolates in the hospital.
Subject(s)
Humans , Klebsiella pneumoniae/genetics , Multilocus Sequence Typing , Retrospective Studies , Klebsiella Infections/drug therapy , Anti-Bacterial Agents/therapeutic use , Hospitals , Carbapenem-Resistant Enterobacteriaceae/genetics , Microbial Sensitivity Tests , Carbapenems/pharmacologyABSTRACT
Pseudomonas aeruginosa (P. aeruginosa) is an opportunistic pathogenic bacterium with complex pathogenesis and drug resistance mechanisms. It has high morbidity and mortality and can cause acute and chronic infections in immunocompromised individuals, with lung infections, wound infections, and bloodstream infections being the most common. The animal infection model of P. aeruginosa is of great value for in-depth research on the pathogenicity, drug resistance, and therapeutic measures of P. aeruginosa by simulating the pathways of human bacterial infections. This article firstly summarizes the selection, anesthesia, and disposal of experimental animals in the construction of animal models of P. aeruginosa infection, and then reviews the methods of construction, model evaluation, and applications of animal models of P. aeruginosa pulmonary infection, wound infection, and bloodstream infection, in order to provide a reference for scientific research related to P. aeruginosa infectious diseases.
Subject(s)
Humans , Animals , Pseudomonas Infections/microbiology , Models, Animal , Virulence , Pseudomonas aeruginosa , Disease Models, AnimalABSTRACT
OBJECTIVE@#To observe the clinical efficacy of allogeneic peripheral blood stem cell transplantation(allo-HSCT) on the treatment of adult acute leukemia patients, moreover, to establish and evaluate a Logistic model to predict the risk of relapse in adult acute leukemia patients after allo-HSCT.@*METHODS@#The clinical data of 145 adult acute leukemia patients treated by peripheral blood stem cell transplantation in the First Affiliated Hospital of Xi'an Jiaotong University from January 2010 to December 2019 was enrolled and analyzed retrospectively. Complications and survival of patients were observed. The relationship between patients' age, diagnosis, leukocyte count at onset, risk stratification, time of diagnosis to transplantation, HCT-CI, minimal residual disease pre-transplantation, donor-recipient sex relationship, HLA match degree, prophylaxis of graft versus host disease(GVHD), donor age, number of transfused mononuclear cells, CD34 positive cells, engraftment time, acute and chronic GVHD, CMV, EBV infection, and hemorrhagic cystitis and recurrence after transplantation were analyzed by logistic regression. Relapse prediction model was established and evaluated according to the results.@*RESULTS@#Among 145 acute leukemia patients, 81 with acute myeloid leukemia, 64 with acute lymphocytic leukemia, 18 with EBV infection, 2 with post-transplant lymphoproliferative disorder(PTLD), 85 with CMV, 26 with hemorrhagic cystitis, 65 patients developed acute GVHD, 51 patients developed chronic GVHD and 45 patients relapsed. The overall survival (OS) rates in one and three years were 86.4% and 61.8%, and the progress-free survival (PFS) rates in one and three years were 67.5% and 62.4%, respectively. There were significant differences in OS and PFS between relapsed and non-relapsed patients, as well as AML and ALL patients. Univariate analysis revealed that patient's age, risk stratification, time to transplantation, HCT-CI index, ATG based GVHD prophylaxis, minimal residual disease pre-transplantation, GVHD prophylaxis, and acute and chronic GVHD were associated with the relapse of disease, multivariate logistic regression analysis showed that pre-transplantation minimal residual disease showed positively correlation with relapse of the disease, while chronic GVHD showed negatively correlation.@*CONCLUSION@#The relapse rate of adult acute leukemia patients treated with allo-HSCT in our hospital is 31.0%, and OS of AML patients is better than ALL patients'. OS of relapsed patients is significantly lower than non-relapsed patients'. Pre-transplantation minimal residual disease is a risk factor of relapse. The risk of relapse is reduced in patients with chronic GVHD.
Subject(s)
Adult , Humans , Graft vs Host Disease , Hematopoietic Stem Cell Transplantation , Leukemia, Myeloid, Acute/therapy , Peripheral Blood Stem Cell Transplantation , Recurrence , Retrospective Studies , Transplantation ConditioningABSTRACT
Objective To evaluate the treatment effect of the arthroscopic incomplete removal of calcifications of the supraspinatus tendinitis without acromioplasty.Methods The clinical data of 20 patients of calcified supraspinatus tendinitis with Ellman Ⅰ or Ⅱ in general hospital of Shenyang military area command from January 2014 to February 2016 were retrospectively analyzed.Of the 20 patients,4 males and 16 females,the age ranged from 45 to 62 years old,with average age (50.2 ± 6.3) years old.All the patients received removal incomplete of calcification without acromioplasty.Pre-and postoperative 3,6,9 months general situation were evaluated by the VAS score,Constant-Murley score,University of California Los Angeles (UCLA) score,X-Radiographs and CT.Results The shoulder function was evidently improved in all 20 patients.The average VAS pain score was (8.2 ± 1.4) preoperatively and (0.8 ± 0.6) at the 6 months follow-up.The average Constant-Murley score was (44.6 ± 7.4) preoperatively and (95.4± 3.4) at the 6 months follow-up.The average UCLA score was (12.2 ± 3.6) preoperatively and (33.1 ± 1.4) at the 6 months follow-up.Conclusion The arthroscopic incomplete removal of calcifications of the supraspinatus tendon without acromioplasty can lead to good results with less iatrogenic injury.
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Objective To investigate the method and effect of arthroscopic repair of recurrent anterior shoulder dislocation caused by anterior and inferior labrum complete defect.Methods Retrospective analyzed the clinical data of 23 patients with anterior and inferior la-brum complete defect who were admitted into hospital from June 2014 to October 2016 and recieved arthroscopic repair opreation with gleno-humeral ligament combined with articular capsule.Intraoperative arthroscopy was used to suture the lower glenohumeral ligament and articular capsule at the missing part of the glenoid labrum.The Rowe score,ASES score and UCLA score were compared before and after operation. Results There was no postoperative complications such as dislocation or infection occurred.All the 23 cases were followed up for 12~42 months,with an average of(19.6 ±3.4)months.The average lost angle of shoulder external rotation was(17.3 ±3.9)°.And the postopera-tive Rowe score,ASES score and UCLA score were significantly better than those before operation.Conclusion Arthroscopic repair opreation with glenohumeral ligament combined with articular capsule can effectively restore the stability of front shoulder joint,and it can be a good method for the treatment of recurrent anterior shoulder dislocation caused by anterior and inferior labrum complete defect.
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Objective To investigate the precision and clinical practicability of anchor point locating under the guidance of augmented reality (AR) navigation for anterior cruciate ligament (ACL) reconstruction.Methods A cube model was made by 3D print which contained some concentric circles of different diameters to be the target.Fifty orthopedists were chosen and numbered from 1 to 50 to locate with AR guidance.Finally,the results of precision and score of satisfaction were analyzed.Results The location precision guided by AR in different diameter concentric circle were 74% (0.25 cm),78% (0.5 cm),83% (0.75 cm),86% (1.0 cm),89% (1.25 cm),96% (1.5 cm) respectively.The average satisfaction score of the orthopedists' was (8.7 ± 1.3).Conclusion Anchor point locating under the guidance of AR navigation is a feasible and effect method for clinical ACL reconstruction,which can observe the relations of the anchor point and the adjacent structure in real time.
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Objective To explore the clinical effect of arthroscopic repair without traction for non-osseous Bankart injury.Methods From January 2009 to January 2015,the clinical data of 182 cases underwent arthroscopic Bankart repair for anterior shoulder instability in our hospital were analyzed retrospectively.They were aged from 18 to 39 years old,mean age was(26.5 ± 9.3) years.The course of disease was from 1 to 10 years,mean duration was(3.2 ±2.6) years.Recurrent dislocation was 6 to 62 times,with average of (24.2 ± 17.3) times.All cases were performed arthroscopic repair without traction.Rowes scores and UCLA scores were used for evaluation.Results All of 182 cases were followed up from 6 to 18 months,an average of (12.5 ± 6.7) months.Of the 182 patients,12 cases with postoperative limited 20°external rotation could not attend confrontational training and the other 170 cases had no adverse effect.The average loss of shoulder joint extorsion activity angle were (10.5 ± 4.1) °.Postoperative UCLA score (89 ± 3.5) was more than preoperative (25 ± 6.2),the differences were significant (P < 0.05).Postoperative Rowes score (28.7 ± 2.2) were more than preoperative (7.3 ± 1.6),the differences were significant (P < 0.05).Conclusion Curative effect of arthroscopic repair without traction for non-osseous Bankart injury caused by training is satifactory,which can provide brachial plexus,blood vessel and other tissues during surgery from traction,and be helpful to the popularization and application in basic-level hospitals.
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<p><b>OBJECTIVE</b>To evaluate the clinical outcome of accessory navicular fusion for treatment of the painful accessory navicular bone of type II in adults.</p><p><b>METHODS</b>From June 2006 to June 2012, a total of 38 feet (in 35 adult patients) with painful accessory navicular with type I underwent an fusion operation of the primary and accessory navicular bones,including 26 males and 9 females with a mean age of (32.4±7.3) years old ranging from 18 to 44 years old. The course of disease ranged from 3 to 10 months. The perioperative complications and radiological outcomes were observed and recorded. The foot function before and after operation were assessed by the American Orthopedic Foot and Ankle Society (AOFAS) midfoot score, and the easement of the pain was evaluated by visual analog score (VAS).</p><p><b>RESULTS</b>Two patients had transient superficial inflammation of the incision, no obvious perioperative complications occurred. All patients were follow-up for (53.5±14.7) months (12 to 84 months). Bone union was confirmed on plain radiography in 32 cases (35 feet). The mean time from the operation to union was (13.7±2.3) weeks (9 to 18 weeks). Postoperative pain VAS score was improved obviosly than preoperative (V=12.14,P< 0.01). The talar-to-first metatarsal angle [(9.4±3.5)° vs (8.3±2.7)°, t=0.736, P>0.05)], calcaneal tilt angle [(17.7±2.2)° vs (18.9±3.4)°, t=0.794, P>0.05],talonavicular uncoverage angle [(14.3±3.4)° vs(12.5?4.6)°,t=0.947, P>0.05) ],and height of the first tarsometatarsal joint [(14.8±3.1) mm vs (15.9±2.8) mm,t=0.814,P>0.05)] before and after operations had no statistic difference. The AOFAS midfoot score was improced from preoperative 45.6±5.3 to postoperative 82.5±7.4 (t=3.214,P< 0.01).</p><p><b>CONCLUSION</b>For the painful accessory navicular bone of type II in adults, if the patient has a large navicular bone and not complicated with rigid flatfoot, once the conservative treatment fails, fusion of the primary and accessory naviculars may be a successful intervention. Overall, the procedure provides reliable pain relief, definite foot function improvement, and good patient satisfaction.</p>
Subject(s)
Adolescent , Adult , Female , Humans , Male , Young Adult , Follow-Up Studies , Foot Diseases , General Surgery , Tarsal Bones , Congenital Abnormalities , General Surgery , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To introduce a new trochanteric osteotomy,and evaluate the outcome of the procedure combined a posterior lateral approach in treating acetabular fractures which involving the roof.</p><p><b>METHODS</b>Between March 2007 and Novmber 2010,30 patients with displaced acetabular fractures involving the dome need trochanteric osteotomy were retrospectively reviewed. There were 21 males and 9 females,ranging in age from 18 to 70 years with an average of 35.2 years at the time of injury. According to Letournel-Judet classification, there were 10 posterior wall fractures,7 posterior column fractures,5 transverse fractures, 2 T-shape fractures, 1 transverse associated with posterior wall fracture, 3 posterior column and wall fractures and 2 bicolumn fractures. The standards of Matta,the modified Merle d'Aubigne-Postel, Medical Research Council were respectively used to evaluate the reduction result, function of hip joint and the strength of hip abduction.</p><p><b>RESULTS</b>All patients were followed up with an average time of 25 months (18 to 40) and all osteotomy sites obtained bone union with an average time of 8.4 weeks (6 to 12). No bone non-union, bone block displaceing, internal fixation looseing and breaking,infection of deep part were found. Seventeen patients got anatomic reduction, 12 got satisfied reduction, and 1 got unsatisfied result according to the criteria of Matta. At final follow-up, function of hip joint obtained excellent results in 11 cases, good in 15, fair in 3 and poor in 1. The strength of the abductors of 3 patients were grade 4 and 27 patients were grade 5.</p><p><b>CONCLUSION</b>Posterior partial great trochanteric osteotomy can enhance the exposure and provide a more accurate reduction and degrade the difficulty of acetabular fracture fixation without increasing the risk of complications. The method provide a new way for the treatment of the roof involved acetabular fractures.</p>
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Acetabulum , Wounds and Injuries , General Surgery , Fracture Fixation, Internal , Fractures, Bone , General Surgery , Retrospective Studies , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To explore operative method in the treatment of syndesmosis injury of ankle fractures.</p><p><b>METHODS</b>Twenty-four patients with ankle fractures and syndesmosis diastasis were treated with shape memory fracture staples, including 10 males and 14 females ranging in age from 19 to 71 years, with an average of 43 years. All patients were diagnosised with history, body examination and image data and were operated according to classification of Lauge-Hansen.</p><p><b>RESULTS</b>All patients were followed up from 6 to 28 months with an average of 16 months, and all fractures healed, with a mean time 9.2 (8 to 14) weeks. Only one case had radiological and clinical manifestations of traumatic arthritis, but no breakage of shape memory fracture staple in all cases. Sixteen patients got excellent results, good in 5, fair in 2, poor in 1.</p><p><b>CONCLUSION</b>Shape memory staple fixation for the treatment of syndesmosis diastasis in ankle fractures not only can perseve the physical motion of ankles, but also be remove earlier before weight bearing.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Ankle Fractures , Ankle Injuries , Diagnostic Imaging , General Surgery , Ankle Joint , Diagnostic Imaging , General Surgery , Fracture Fixation, Internal , Radiography , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To investigate clinical results of percutaneous reduction and hollow screw internal fixation for the treatment of calcaneal fractures, and to compare therapeutic effects between close reduction hollow screw internal fixation and open reduction plate internal fixation.</p><p><b>METHODS</b>From August 2007 to May 2010, 53 patients with calcaneal fractures were retrospectively analyzed. All the patients were divided into two groups, 25 patients in group A (PR group) treated with percutaneous reduction and hollow screw internal fixation, including 17 males and 8 females, with an average age of (39.4 +/- 9.9) years. While 28 patients in group B (OR group) treated with open reduction and plate internal fixation, including 18 males and 10 females, with an average age of (38.6 +/- 10.2) years. According to Sanders classification, there were 18 patients with type II fractures, 29 patients with type III and 6 type IV. In both groups, operative time, blood loss, postoperative complications and radiology were recorded. Functional recovery was evaluated by Maryland score.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from nine months to thirty-five months (averaged 20.4 months). There were no significant differences in sex, age, fracture type, fracture classification, initial Böhler angle, or late complications between the two groups. But significant difference can be seen between operative time, blood loss, and skin complications (in group A no nonunion and skin complications occurred, but subtalar posttraumatic arthritis occurred in 1 case; in group B, 3 patients had complications of skin necrosis, 1 patient suffered from a delayed union due to large defect filled with artificial bone, and 1 patient got subtalar posttraumatic arthritis). No difference were found in the latest X-ray film. According to Maryland score, in group A, 8 got an excellent result and 12 good. In group B, 10 got an excellent and 14 good. There were no significant differences between the two groups in Margland score.</p><p><b>CONCLUSION</b>The results of this study suggest that in comparison with open reduction, percutaneous reduction and hollow screw internal fixation minimizes complications and achieves good results. Further study of this technique is needed.</p>
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Bone Screws , Calcaneus , General Surgery , Case-Control Studies , Follow-Up Studies , Fracture Fixation, Internal , Methods , Fractures, Bone , General Surgery , Retrospective Studies , Treatment OutcomeABSTRACT
Objective To assess the credibility of the ABC Classification for acetatbular fractures. Methods The data of 60 patients were randomly chosen from a total of 1 122 patients with acetabular fractures, who were classified according to ABC Classification, with each subtype including 20 cases. The 60 cases were divided into two groups: X-ray (Pelvis AP, oblique position of iliac bone and oblique position of obturator foramen radiographs without CT) and X-ray+CT (plain radiographs with 2D-CT). Nine surgeons, including 3 with 1-5 years' experience, 3 with 5-10 years' experience and 3 with 10-15 years' experience, were asked to make diagnosis for the two groups using ABC Classification system. Each surgeon read the radiographs twice at a 3-month interval without knowledge of other clinical data. The order of the radiographs was changed in the second review. The results of the two sessions were analyzed and the inter- and intra-observer reliability and reproducibility were evaluated using Kappa test. Results The inter-observer reliability during the two sessions were 0. 66 (0. 71) in X-ray group and 0. 67 (0. 72) in X-ray+CT group. Intra-observer reproducibility during the two sessions were 0. 75 in group X-ray and 0. 78 in X-ray+CT group. The diagnoses of surgeons with longer experience had higher credibility and reproducibility. Conclusion ABC Classification can obtain high reliability diagnosis for acetabular fractures. CT is valuable for treatment of acetabular fracture, but it can not greatly increase the credibility of ABC Classification.
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<p><b>OBJECTIVE</b>To investigate the therapeutic effects of closed reduction and percutaneous Kirschner pin fixation combined with plaster support for the treatment of supracondylar humerus fractures in children.</p><p><b>METHODS</b>From June 2007 to December 2008, 27 patients with Gartland III supracondylar fractures were treated with closed reduction and percutaneous Kirschner wire fixation combined with plaster support. Among the patients, 18 patients were male and 9 patients were female, ranging in age from 6 to 12 years,with an average of 8.1 years. Fifteen patients were extension type, 12 patients were buckling type; fourteen patients were ulnar deviation, 13 patients were radial deviation. The duration from injury to treatment ranged from 0.5 to 8 days, averaged 3.6 days.</p><p><b>RESULTS</b>Twenty-seven patients were followed up, and the duration ranged from 6 to 24 months, averaged 13.5 months. The healing time ranged from 4 to 6 weeks after surgery, with a mean of 4.5 weeks. Complications including implants loosening, fracture re-displacement, Volkmarm contraction, needle point or deep infection, ulnar nerve injury, myositis ossificans were found during follow-up. Two patients had postoperative elbow varus, but the varus angle was not more than 15 degree,which may be due to inappropriate functional exercise or early removal of external fixation. According to Flynn criteria, 19 patients got an excellent result, 5 good, 2 poor and 1 bad.</p><p><b>CONCLUSION</b>Closed reduction and percutaneous Kirschner wire fixation combined plaster support for the treatment of unstable supracondylar fractures in children has advantages including little trauma, reliable fixation, good elbow function and appearance.</p>
Subject(s)
Child , Female , Humans , Male , Bone Wires , Casts, Surgical , Fracture Fixation, Internal , Methods , Humeral Fractures , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To design ABC damage variable and positioning system for acetabular fracture and explore the feasibility and clinical practical value of the system through the multi-center analysis of 1122 acetabular fractures.</p><p><b>METHODS</b>According to acetabular three-column conception, and pelvic ring lesions damage direction caused by acetabular fracture domino effect and injury degree of proximal femur joint, it defined class A as any column acetabular fracture; class B as any two-column acetabular fracture; class C as front, dome and posterior mixture acetabular fracture. Lower case English letters a, m, p represented front, dome, posterior fracture, respectively. Acetabular damage variables: 1 was simple displaced fractures; 2 was comminuted fractures; 3 was compression fractures. Pelvic ring lesions damage variables: alpha was sacroiliac joints or sacroiliac fracture horizontal separation deflection; beta was sacroiliac joints or sacroiliac fracture vertical separation deflection; gamma was pubic symphysis separation/superior and inferior ramus of pubis fracture deflection; alpha beta gamma delta was compound floating damage. Proximal humerus joint damage variables: I was femoral head fracture; II was femoral neck fracture; II was intertrochanteric fractures of femur; IV was I to III compound fracture. The ABC damage variable positioning system for acetabular fracture was made up by the above-mentioned variables. The statistics from March 1997 to February 2010 showed 1122 cases acetabular fractures with 18 cases of double side acetabular fracture and 1140 cases of acetabular fractures. The pelvics anterior-posterior view, ilium and obturator oblique view, and 2/3D-CT materials were analyzed and researched.</p><p><b>RESULTS</b>Each damage variables distribution situation in 1140 cases of acetabular fracture involved A in 237 cases (20.8%), B in 605 cases (53.1%), C in 298 cases (26.1%);front column fracture in 808 cases(70.9%), dome fracture in 507 cases (44.5%), posterior fracture in 1026 cases (90%). Acetabular variables: variabe 1 in 203 cases of simple displaced fracture (17.8%); variabe 2 in 516 cases of comminuted fracture(45.3%); variabe 3 in 421 cases of compression fracture (36.9%); 249 cases of pelvic ring lesions damage (21.8%), 75 cases femoral head fracture (6.6%); 18 cases of double side acetabular fracture and relative pelvic ring and proximal humerus joint variables (1.58%). Key part and curative effect elements of 1140 cases acetabular fracture: 507 cases of dome or posterior acetabular fracture (44.5%); 421 cases of compression fracture (36.9%); 249 cases of pelvic ring variables (21.8%); 75 cases of proximal humerus joint variables (6.6%); 486 cases of simple Aa/pl/2,Bapl/2 acetabular fracture (42.6% ).</p><p><b>CONCLUSION</b>Compression fracture, especially defected compression fracture, takes important part in acetabular damage variables, and also presents that acetabular fracture with pelvic ring and proximal femoral damage variables are not rare at all. The relationship of the acetabular fracture damage variables, and its percentage shows the key points and elements in clinical treatment: weight-bearing to dome accounts for 44.5%; compression to defects account for 36.9%, pelvic ring to float accounts for 21.8%; dome fracture to double side fracture account for 6.6%. The system has significant guiding effects on clinic in terms of evaluation of injury severity, anatomic localization, difficulty index, alternative strategy, operative approach, effect of treatment,and prognosis. And the most important thing is that the system creates the comparison of damage variables in same type of fracture and the communication of homo-language and explores a new method.</p>
Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Acetabulum , Wounds and Injuries , Fractures, Bone , Classification , Diagnostic Imaging , Medical Informatics , Methods , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: We developed the acetabular tridimensional memory alloy-fixation system (ATMFS), which is made of NiTi shape memory alloy, according to the specific mechanical properties of biological memory material, nitinol alloy and measured distribution of contact area and pressure between the acetabulum and the femoral head of cadaveric pelvis. METHODS: Six formalin-preserved cadaveric pelvis were used for this investigation. Pressure-sensitive film was used to measure contact area and pressure within the anterior, superior, and posterior regions of the acetabulum. The pelvis were loaded under the following four conditions: (1) intact; (2) following a creation posterior wall fracture defect; (3) following reduction and standard internal fixation with reconstruction plate; (4) following reduction and internal fixation with a new shape memory alloy device named ATMFS. A posterior wall fracture was created along an arc of 40-90 degrees about the acetabular rim. FINDINGS: Creation of a posterior wall defect resulted in increased load in the superior acetabulum (1422N) as compared to the intact condition (762N, P=0.007). Following reduction and internal fixation, the load distributed to the superior acetabulum (1486N) was not statistically different from the defect condition. Following the fixation with ATMFS, the load seen at the superior region of the actabulum (936N) was less than fixation with reconstruction plate and was not different from intact state (P=0.4). INTERPRETATION: These data indicate that the use of ATMFS as a fracture internal fixation device resulted a partial restoration of joint loading parameters toward the intact state. ATMFS fixation may result in a clinical benefit.
Subject(s)
Acetabulum/physiopathology , Acetabulum/surgery , Alloys , Fracture Fixation, Internal/instrumentation , Aged , Equipment Design , Equipment Failure Analysis , Female , Friction , Humans , Male , Middle Aged , PressureABSTRACT
<p><b>OBJECTIVE</b>To investigate the clinical effect of Seinsheimer type V subtrochanteric femoral fractures with dynamic hip screw and shape memory alloy bow-teeth screw.</p><p><b>METHODS</b>Twelve patients with Seinsheimer type V subtrochanteric femoral fractures were retrospectively analyzed. There were 8 males and 4 females with an average age of 53 years (range 31 to 65 years). Seven cases were caused by traffic accident, 4 cases by falling from hight, 1 case by heavy object. According to the Seinsheimer classification, all the cases were type V fractures. All the cases accepted the surgical treatment with dynamic hip screw and shape memory alloy bow-teeth screw fixation.</p><p><b>RESULTS</b>The mean period of follow-up was 28 months (range 20 to 38 months). All the cases obtained bone union in average 3.3 months (from 3 to 4.5 months). There were no complications such as deep infection, deep vein thrombosis, pulmonary embolism and bone nonunion. The results of clinical evaluation according to Merle d'Aubigne scores were 16.75 +/- 1.14 and excellent in 4 cases, good in 8 cases.</p><p><b>CONCLUSION</b>Application of dynamic hip screw and shape memory alloy bow-teeth screw as a superior option can get satisfactory reduction with reliable fixation and will be one of a better choice for fixation of Seinsheimer type V subtrochanteric femoral fractures.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Alloys , Bone Screws , Femoral Fractures , Diagnostic Imaging , General Surgery , Therapeutics , Follow-Up Studies , Hip , General Surgery , Mechanical Phenomena , Recovery of Function , Retrospective Studies , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To investigate the clinical effects of PHILOS plate with injectable artificial bone for the treatment of proximal humeral fractures in elderly patients.</p><p><b>METHODS</b>From March 2007 to March 2009,17 patients who suffered from proximal humeral fractures were retrospectively studied. There were 7 males, 10 females, with an average age of 71 years (ranged, 66 to 81 years). Nine patients were caused by falling, seven patients were caused by traffic accidents,and one patient was hit by heavy object. According to the Neer classification, 9 patients were type III and 8 patients were type IV. All the patients were treated with PHILOS plate internal fixation combined with injectable artificial bone. Assessment was based on the Constan-Murley shoulder score and percentage Constant-Murley score.</p><p><b>RESULTS</b>The mean period of follow-up was 16 months (ranged, 8 to 25 months). All the patients obtained bone union in an average of 3 months (2.5 to 3.5 months). There were no complications such as deep infection, nonunion or failure of fixation. The Constant-Murley score of the injured side was mean (86.50 +/- 10.50) (ranged, 75 to 95). The clinical outcomes were excellent in 9 cases, good in 6 cases, moderate in 2 cases.</p><p><b>CONCLUSION</b>The treatment of proximal humeral fractures in elderly patients with application of PHILOS plate combined with injectable artificial bone can get satisfactory clinical effect especially suitable for osteoporosis and comminuted proximal humeral fractures.</p>
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Bone Plates , Bone Transplantation , Follow-Up Studies , Fracture Fixation, Internal , Retrospective Studies , Shoulder Fractures , General Surgery , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To discuss the diagnosis and treatment of the crush syndrome in the earthquake.</p><p><b>METHODS</b>Thirty-five patients with crush syndrome caused by earthquake were involved the retrospective study. The role of nutritional support, active wound treatment and hemodialysis on the patients' recovery was observed.</p><p><b>RESULTS</b>The function of the heart and kidneys were gradually improved by the planned removal of the necrotic tissue, which laid a foundation for the further repair of the wound.</p><p><b>CONCLUSION</b>The removal of necrotic tissue, which can decrease the toxic absorption, will improve the success rate for treatment of the crush syndrome patients when being assisted with the hemodialysis.</p>