ObjectiveTo introduce the surgery method to reset and fix tibial plateau fracture without opening joint capsule, and evaluate the safety and effectiveness of this method. MethodsBetween July 2011 and July 2013, 51 patients with tibial plateau fracture accorded with the inclusion criteria were included. All of 51 patients, 17 cases underwent open reduction and internal fixation without opening joint capsule in trial group, and 34 cases underwent traditional surgery method in control group. There was no significant difference in gender, age, cause of injury, time from injury to admission, side of injury, and types of fracture between 2 groups (P>0.05). The operation time, intraoperative blood loss, incision length, incision heal ing, and fracture healing were compared between 2 groups. The tibial-femoral angle and collapse of joint surface were measured on X-ray film. At last follow-up, joint function was evaluated with Hospital for Special Surgery (HSS) knee function scale. ResultsThe intraoperative blood loss in trial group was significantly less than that in control group (P<0.05). The incision length in trial group was significantly shorter than that in control group (P<0.05). Difference was not significant in operation time and the rate of incision heal ing between 2 groups (P>0.05). The patients were followed up 12-30 months (mean, 20.4 months) in trial group and 12-31 months (mean, 18.2 months) in control group. X-ray films indicated that all cases in 2 groups obtained fracture heal ing; there was no significant difference in the fracture healing time between 2 groups (t=1.382, P=0.173). On X-ray films, difference was not significant in tibial-femoral angle and collapse of joint surface between 2 groups (P>0.05). HSS score of the knee in trial group was significantly higher than that of control group (t=3.161, P=0.003). ConclusionIt can reduce the intraoperative blood loss and shorten the incision length to use open reduction and internal fixation without opening joint capsule for tibial plateau fracture. Traction of joint capsule is helpful in the reduction and good recovery of joint surface collapse. In addition, the surgery without opening joint capsule can avoid joint stiffness and obtain better joint function.
目的:总结空心螺钉、DHS或人工关节置换治疗股骨颈骨折的适应证及效果。方法:分别用空心螺钉、DHS固定和人工关节置换3种方法治疗获得随访的中老年股骨颈骨折29例。年龄51～85岁,平均68.3岁。空心螺钉组8例,DHS组15例,人工关节组6例。结果:随访29例,随访时间1～3年,平均2~3年。围手术期无1例死亡,无切口感染,无内固定断裂,无关节脱位。发生退钉2例,股骨头坏死1例。功能评定:优20例,良6例,差3例。结论:根据患者的年龄、经济状况、骨折部位、骨折分型合理地选择治疗方法,是减少并发症,提高治疗效果和老年人生活质量的关键。
This study aims to analyze the biomechanical stability of Magic screw in the treatment of acetabular posterior column fractures by finite element analysis. A three-dimensional finite element model of the pelvis was established based on the computed tomography (CT) and magnetic resonance imaging (MRI) data of a volunteer and its effectiveness was verified. Then, the posterior column fracture model of the acetabulum was generated. The biomechanical stability of the four internal fixation models was compared. The 500 N force was applied to the upper surface of the sacrum to simulate human gravity. The maximum implant stresses of retrograde screw fixation, single-plate fixation, double-plate fixation and Magic screw fixation model in standing and sitting position were as follows: 114.10, 113.40 MPa; 58.93, 55.72 MPa; 58.76, 47.47 MPa; and 24.36, 27.50 MPa, respectively. The maximum stresses at the fracture end were as follows: 72.71, 70.51 MPa; 48.18, 22.80 MPa; 52.38, 27.14 MPa; and 34.05, 30.78 MPa, respectively. The fracture end displacement of the retrograde tension screw fixation model was the largest in both states, and the Magic screw had the smallest displacement variation in the standing state, but it was significantly higher than the two plate fixations in the sitting state. Magic screw can satisfy the biomechanical stability of posterior column fracture. Compared with traditional fixations, Magic screw has the advantages of more uniform stress distribution and less stress, and should be recommended.
目的探讨同种异体骨对多发性肋骨骨折内固定的治疗疗效。 方法回顾性分析我院2011年1月至2013年9月多发性肋骨骨折40例患者的临床资料，其中男33例、女7例，年龄23～67岁。 结果全组无1例死亡，手术时间为55～120 min，出血量30～120 ml，骨折矫形效果满意，浮动胸壁控制良好，反常呼吸消失，胸廓塑形满意，活动后疼痛减轻。随访3～24个月，内固定材料无明显移位、无折断，无明显急性或慢性排异反应，无骨折不愈合或延迟愈合，近远期无严重并发症发生。 结论用同种异体冻干骨对多发性肋骨骨折进行内固定治疗安全、有效。
Objective To compare the efficacy of plating versus intramedullary nailing in the treatment of adult humeral shaft fracture. Methods We identified eligible studies in PubMed (1950 to September 2007), MEDLINE (1950 to September 2007), OVID CINAHL (1950 to September 2007), OVID EBM (3rd Quarter 2007), CBMdisk (1978 to June 2007) and CNKI (1981 to June 2007). We also handsearched several Chinese orthopedic journals. Data were extracted and evaluated by two reviewers independently. Randomized controlled trials (RCTs) comparing plating versus intramedullary nailing for humeral shaft fracture in adults were included and the quality of these trials was critically assessed. Data analyses were conducted with Stata 10.0. Results Six RCTs involving 425 patients were included, among which the statistical heterogeneity was not significant (Pgt;0.1). Cumulative meta-analyses showed that intramedullary nailing might increase the re-operation rate in studies conducted before the year of 2000 (OR=0.39, 95%CI 0.17 to 0.90, P=0.03), but the difference was not significant in studies conducted after 2000 (OR=0.54, 95%CI 0.27 to 1.08, P=0.08). Intramedullary nailing might increase the incidence of shoulder impingement compared with plating (OR=0.13, 95%CI 0.03 to 0.65, P=0.01). The rates of non-union, deep infection, iatrogenic radial nerve injury and internal fixation failure were similar between plating and intramedullary nailing. Meta-analyses were not conducted for union time, operation time and bleeding (transfusion) volume, because the relevant data were not available from the included trials. Conclusion Intramedullary nailing may increase the incidence of shoulder impingement. The rates of re-operation, non-union, deep infection, iatrogenic radial nerve injury and internal fixation failure are similar between plating and intramedullary nailing. Further well-designed and large-scale randomized controlled trials are required to determine the effects of plating and intramedullary nailing on these outcomes.
Objective To evaluate the primary cl inical effect of proximal femoral nail anti-rotation (PFNAR) in treating femoral intertrochanteric fractures, to summarize operation skills and to analyze correlated curative effective influentialfactors. Methods From July 2006 to May 2007, 19 cases of intertrochanteric fractures (including 8 males, 11 females, aged45-87 years old) were treated with closed reduction and PFNAR fixation. Fractures were caused by fall ing. The locations were left sides in 10 cases and right sides in 9 cases. According to AO classification, there were 14 cases of type A2 and 5 cases of type A3. Operative time, volume of blood loss and weight bear time were analyzed, the condition of fracture union was observed and the hip function was evaluated using Harris criterion after 9 months of follow-up. Results Operative time ranged 23-78 minutes with an average time of 47 minutes, the volume of blood loss ranged 50-120 mL with an average volume of 85 mL, getting-outof- bed time ranged 2-14 days with an average time of 7.4 days; the weight bearing time ranged 10-14 weeks with an average time of 12.4 weeks. No intra-operative femoral fractures and no regional or deep infection occurred during hospital ization period. Seventeen cases were followed up from 3 months to 12 months with an average time of 9.4 months, and achieved bone heal ing within 15-18 weeks with an average time of 16.5 weeks. No compl ications such as delay heal ing, coxa vara or coxa valga, cut-out and screw extraction occurred. Fifteen cases were followed up over 9 months; according to the Harris criterion for evaluation, the results were excellent in 13 cases, good in 1 case and fair in 1 case, the excellent and good rate was 93.3%. Conclusion PFNAR has the advantages of micro invasion, easy-to-perform, less blood loss, less bone loss and stable fixation in treatment of unstable comminuted intertrochanteric fracture, especially in old patients with osteoporosis.