Objective To investigate the feasibility of Drawtex hydroconductive dressing in treatment of early implantation-associated infection and soft tissue defect after internal fixation of tibial fracture. Methods Thirty-six New Zealand rabbits were used to prepare the model of early implantation-associated infection after internal fixation of tibial fracture, and randomly divided into 3 groups (n=12) . The infected wounds were covered with Drawtex hydroconductive dressing (group A), chitosan solution gauze (group B), and normal saline gauze (group C), respectively. The dressing was changed every 2 days. X-ray films were performed at 1, 14, and 21 days. The gross observation, microbiological evaluation, and histological observation were done at 21 days. Results There was no significant difference in the wound grading according to the Jamesʾ grading criteria between groups at 21 days (χ2=3.713, P=0.156). X-ray films showed no bone destruction in all groups at 1 day; and there was no significant difference in radiographic scores between groups (P>0.05). At 14 days, the mild osteolysis was observed in group B; the radiographic score was significantly lower in groups A and C than in group B (P<0.05), but there was no significant difference between groups A and C (P>0.05). At 21 days, the osteolysis and osteomyelitis were observed in groups B and C; the radiographic score was significantly lower in group A than in groups B and C (P<0.05), but there was no significant difference between groups B and C (P>0.05). Also, the microorganism in bone tissue of group A was less than that of groups B and C (P<0.05); and the difference between group B and group C was not significant (P>0.05). Histological observation showed the mild inflammatory cell infiltration in group A and many inflammatory cells in groups B and C. The Smeltzer histological score was significant lower in group A than in groups B and C (P<0.05); and there was no significant difference between groups B and C (P>0.05). Conclusion Drawtex hydroconductive dressing can be used for the implantation-associated infection after tibial fracture internal fixation. And the effectiveness of Drawtex hydroconductive dressing is better than that of chitosan solution gauze and normal saline gauze.
Objective To explore the effectiveness of Nice knot technique for wound closure in Gustilo type ⅢA and ⅢB open tibial fractures. Methods A retrospective study was performed on 22 patients with Gustilo type ⅢA and ⅢB open tibial fractures, who underwent wound closure using the Nice knot technique and were admitted between June 2021 and June 2022. There were 15 males and 7 females. The age ranged from 18 to 67 years, with an average of 41.9 years. The causes of injury included traffic accident in 11 cases, falling from height in 7 cases, and heavy object injuries in 4 cases. Fractures were located on the left side in 9 cases and on the right side in 13 cases. And 9 cases were type ⅢA fractures and 13 were type ⅢB fractures according to Gustilo classification. All patients had extensive soft tissue injuries, and no vascular or neurological damage was observed. The time from injury to debridement was 3-8 hours (mean, 6.5 hours). The sizes of wounds before operation and at 2 weeks after operation were measured and wound healing rate at 2 weeks after operation were calculated. The wound healing time and wound healing grading were recorded. The Vancouver Scar Scale (VSS) score was used to assess the wound scar after wound healed and the excellent and good rate was calculated. Results The wound area was 21.0-180.0 cm2 (mean, 57.82 cm2) before operation, and it was 1.2-27.0 cm2 (mean, 6.57 cm2) at 2 weeks after operation. The wound healing rate at 2 weeks after operation was 76%-98% (mean, 88.6%). After operation, 2 cases needed to adjust Nice knot due to skin cutting and 1 case occurred soft tissue infection on the wound. The other patient’s wounds healed. The average wound healing time was 27.8 days (range, 18-44 days). And the wound healing were grade A in 13 cases and grade B in 9 cases. VSS score was 2-9, with an average of 4.1; 10 cases were rated as excellent, 10 as good, and 2 as poor, with an excellent and good rate of 90.9%. All patients were followed up 9-24 months (mean, 14.6 months). During follow-up, no deep infection or osteomyelitis occurred. Two cases experienced fracture non-union, and were treated with compression fixation and bone grafting. The fractures of the other patients all healed, with a healing time of 85-190 days (mean, 148.2 days). ConclusionNice knot technique can be used in wound closure of Gustilo type ⅢA and ⅢB open tibial fractures effectively, which is easy to operate.
ObjectiveTo explore the therapeutic effect of using locking compression plate (LCP) as an external fixator and using an external fixator on open fractures of the tibia. MethodsBetween September 2010 and December 2012, 56 patients with the open tibia fractures underwent external fixation using LCP as an external fixator (LCP group, n=22) or external fixator (external fixator group, n=34). We compared the healing time, the rate of postoperative complication and the postoperative function between two groups. ResultsThe mean healing time was 11 weeks (8-28 weeks) and there was 1 case of delayed healing in the LCP group. The mean healing time was 14 weeks and there was 4 cases of delayed healing in the external fixator group. We found significant difference in the healing time (t=2.740, P=0.008) and the infection rate of pin track (13.6% vs 32.4%; χ2=2.496, P=0.114) between the LCP and external fixator group. ConclusionFor open fractures of the tibia, using LCP as an external fixator may increase the healing time and decrease the rate of postoperative complications.
目的 观察盐酸氨基葡萄糖对Pilon骨折的辅助治疗作用。 方法 2007年6月－2010年9月，将43例接受手术治疗的Pilon骨折患者随机分成两组，A组术后口服盐酸氨基葡萄糖，B组作为对照组（仅服用安慰剂）。A组21例患者，平均年龄（35.7± 8.0）岁，B组22例患者，平均年龄（36.7 ± 7.1）岁。两组患者年龄、性别、骨折分型及手术时机相比较，无统计学差异（P＞0.05）。定期随诊（术后6、12、18个月），根据美国足与踝关节协会踝与后足功能评分（AOFAS）评分系统对患者进行功能评分，进行前瞻、对照、双盲研究。 结果 术后6、12、18个月，A组患者的AOFAS评分均明显高于B组，差异有统计学意义（t=2.530，2.856，2.881；P=0.015，0.007，0.006）；术后18个月，A组临床疗效优良率为95.2%，B组优良率为72.3%，差异有统计学意义（χ2=3.995，P=0.046）。A组2例患者分别发生轻度头晕及恶心，无严重不良反应发生。 结论 盐酸氨基葡萄糖辅助治疗Pilon骨折可改善踝关节功能，减少创伤性骨关节炎的发生。
ObjectiveTo investigate the effectiveness difference between bone transport with a locking plate (BTLP) and conventional bone transport with Ilizarov/Orthofix fixators in treatment of tibial defect. MethodsThe clinical data of 60 patients with tibial fractures who met the selection criteria between January 2016 and September 2020 were retrospectively analyzed, and patients were treated with BTLP (BTLP group, n=20), Ilizarov fixator (Ilizarov group, n=23), or Orthofix fixator (Orthofix group, n=17) for bone transport. There was no significant difference in gender, age, cause of injury, time from injury to admission, length of bone defect, tibial fracture typing, and comorbidities between groups (P>0.05). The osteotomy time, the retention time of external fixator, the external fixation index, and the occurrence of postoperative complications were recorded and compared between groups. The bone healing and functional recovery were evaluated by the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. Results All patients of 3 groups were followed up 13-45 months, with a mean of 20.4 months. The osteotomy time was significantly shorter in the BTLP group than in the Ilizarov group, and the retention time of external fixator and the external fixation index were significantly lower in the BTLP group than in the Ilizarov and Orthofix groups (P<0.05). Twenty-two fractures healed in the Ilizarov group and 1 case of delayed healing; 16 fractures healed in the Orthofix group and 1 case of delayed healing; 18 fractures healed in the BTLP group and 2 cases of delayed healing. There was no significant difference between groups in fracture healing distribution (P=0.824). After completing bone reconstruction treatment according to ASAMI criteria, the BTLP group had better bone healing than the Orthofix group and better function than the Ilizarov groups, showing significant differences (P<0.05). Postoperative complications occurred in 4 cases (20%) in the BLTP group, 18 cases (78%) in the Ilizarov group, and 12 cases (70%) in the Orthofix group. The incidence of complication in the BTLP group was significantly lower than that in other groups (P<0.05). Conclusion BTLP is safe and effective in the treatment of tibial defects. BTLP has apparent advantages over the conventional bone transport technique in osteotomy time, external fixation index, and lower limb functional recovery.
Objective To study the effect of the human umbilical cord blood on the content of trace elements in whole blood during fracture healing in rabbits and to explore the mechanism of promoting fracture healing. Methods The right tibial fracture model was made in 63 white New Zealand rabbits (aged, 4-5 months; weighing, 2.0-2.5 kg). The fracture site was treated with 3 mL human umbilical cord blood (group A, n=21) and 3 mL normal saline (group B, n=21) at 3 and 8 days after operation, and was not treated as a control (group C, n=21). At 1, 2, 3, 4, 5, and 6 weeks after operation, the X-ray and histological observations were done; the contents of zinc, copper, magnesium, ferrum, calcium, and phosphorus were detected. Results X-ray observation showed that the fracture healing speed of group A was significantly faster than that of groups B and C; the fracture healing X-ray score of group A was significantly higher than that of groups B and C at 2-6 weeks (P lt; 0.05). The histological observation indicated that new trabeculae and osteoid of group A were significantly more than those of groups B and C; at 2-5 weeks, the histological score of group A was significantly higher than that of groups B and C (P lt; 0.05); at 6 weeks, the score of group A was significantly higher than that of group B (P lt; 0.05), but no significant difference was found between groups A and C (P gt; 0.05). Changes trend of the trace elements in 3 groups after operation was basically consistent. The content of copper first decreased and then gradually increased; the contents of ferrum, zinc, and magnesium at different time points decreased, but were basically stable; the content of calcium first increased and then decreased; the content of phosphorus first decreased and then increased. The contents of copper, zinc, magnesium, ferrum, calcium, and phosphorus in group A were significantly higher than those in groups B and C at different time points (P lt; 0.05), but there was no significant difference between groups B and C (P gt; 0.05). Conclusion Injection of the human umbilical cord blood at the fracture end of rabbits can significantly slow down the loss of trace elements in whole blood, ensure the contents of necessary trace elements during fracture healing, which may be one of the mechanisms of the umbilical cord blood promoting fracture healing.
Objective To compare the clinical effect of reamed and nonreamed intramedullary interlocking nails on treating open tibial fractures. Methods From February 2002 to February 2004, 92 cases of open tibial fractures (86 patients) were treated with intramedullary interlocking nails. Of the 86 patients, 65 were male and 21 were female. Their age ranged from 18 to 68 years (36.5 on average). Of the 92 cases, 54 were in the reamed group and 38 in the nonreamed group. Patients moved with the support of crutch after their wounds were healed. Results All patients were followed up regularly for 6 to 24months. Infection rate in the reamed group and nonreamed group was 20.3% and 5.3% respectively, and there was significant difference between them (Ｐlt;0.05). The averagehealing time of the fractures was 22.5 weeks in reamed group and 19 weeks in nonreamed group, and there was no significant difference between them (Ｐ＞0.05). Delayed unions occurred in 8 cases and 3 cases in reamed group and nonreamed group respectively. Conclusion Compared with reamed group, nonreamed intramedullary interlocking nails have lowerinfection rate and fewer delayed unions and ununions.