短程化疗加前路病椎切除植骨内固定术治疗脊柱结核

目的：探讨短程化疗联合病椎部分切除植骨内固定手术的临床疗效。方法：对46例脊柱结核行2HRZ（E/S）/4HR化疗,前路病变椎体部分切除、大块髂骨支撑植骨、植骨钛板内固定。观察术后和随访期间患者结核中毒症状和神经功能的改善情况,植骨融合情况及治愈率。结果：1.2~5年随访,脊柱结核均治愈,无全身及局部并发症,脊髓功能损伤恢复,植骨块愈合,后凸畸形部分矫正,未发现钢板松动、断裂。结论：短程化疗加病椎切除内固定治疗脊柱结核,可加强脊柱稳定,改善畸形,减少复发和药物副作用。

病灶清除、植骨融合内固定术治疗腰骶段脊柱结核54例

目的：探讨一期后路病灶清除、植骨融合内固定术治疗腰骶段脊柱结核的临床疗效。方法：选取我院腰骶段脊柱结核患者54例,所有患者均采用一期后路病灶清除、植骨融合内固定术手术治疗,术前术后给予规范的抗结核治疗,观察患者术前,术后及随访时腰骶角、椎间隙高度等情况。结果：所有患者手术时间为160~290min,平均220.5±45.6min,出血150~1000ml,平均517.4±69.8ml,随访时间为6~36个月,平均25.6±5.2个月。切口均一期愈合,无慢性窦道形成,随访期间1例患者术后6月复发,经手术治疗后痊愈。5例患者术后出现神经根性刺激症状,对症治疗后好转。术后,末次随访中腰骶角较术前均有有明显的提高（P〈0.05）,椎间隙高度改变在术前,术后及末次随访结果具有显著性差异（P〈0.05）。结论：一期后路病灶清除、植骨融合内固定术可有效治疗腰骶段脊柱结核,恢复腰骶角正常生理曲度,增加椎间隙高度,明显改善患者腰痛等症状。

经皮与开放椎弓根螺钉内固定术治疗腰椎骨折68例对比分析

目的:探讨经皮与开放椎弓根螺钉内固定术治疗腰椎骨折的临床价值。方法:对43例腰椎骨折患者采用经皮椎弓根螺钉内固定术治疗,并与43例常规开放椎弓根螺钉内固定术患者术后肌肉受损指标肌酸激酶变化情况、术后椎体前缘高度比值、后凸Cobb角及复位丢失率和术前术后相关时间和术中出血量进行比较。结果:两组患者术后第1天肌酸激酶水平之间无显著性差异(P<0.05),术后第3天开始,两组患者肌酸激酶水平均较术后第1天显著下降,且微创组术后第3天、术后第7天、术后第10天肌酸激酶水平均显著低于开放组(P?0.05);术后微创组患者椎体前缘高度比值显著大于开放组(P?0.05);后凸Cobb角显著小于开放组(P?0.05);复位丢失率则显著低于开放组(P?0.05);微创组手术时间显著短于开放组(P?0.05);术中出血显著少于开放组(P?0.05);术后下床时间和总住院时间均显著快于开放组(P?0.05)。结论:在C臂引导下经皮椎弓根螺钉内固定术相对于开放手术,具有术中损伤小,出血少,术后恢复快等优点。

后路内固定术治疗多节段胸腰椎椎体结核近远期疗效观察

目的:探讨前路与后路内固定术治疗多节段胸腰椎椎体结核的手术效果及远期矫正效果。方法:将92例多节段胸腰椎椎体结核患者采用随机数字法分为对照组和观察组,每组各46例。所有患者均行病灶清除内固定术治疗,其中对照组患者采用前路内固定术,观察组患者采用后路内固定术。比较两组患者的手术时间、术中出血量、首次下地活动时间、腰背疼痛缓解时间、住院时间及并发症发生率,术后随访1年,比较两组患者手术前后及末次随访的畸形矫正角度。结果:观察组的手术时间、术中出血量、首次下地活动时间、腰背疼痛缓解时间、住院时间均低于对照组(P<0.01);手术后,观察组的Frankel分级A级和B级比例明显高于对照组(P<0.01);观察组的总并发症发生率为8.70%,明显低于对照组的28.2%(χ2=5.84,P<0.01);观察组在手术后和术后1年的脊柱后凸角度均明显低于对照组(P<0.01)。结论:后路内固定术治疗多节段胸腰椎椎体结核具有时间短、创伤小及并发症更低等优势,同时有利于神经功能恢复,对脊柱后凸畸形的改善效果更好。

经皮锁定钢板内固定术在胫腓骨骨干多段骨折治疗中的临床应用

目的:探讨经皮锁定钢板内固定术在胫腓骨骨干多段骨折治疗中的临床疗效。方法:选取采用经皮锁定钢板内固定手术进行治疗的38例胫腓骨骨干多段骨折患者为观察组,同期采用带锁髓内钉进行治疗的38例患者为对照组,将两组患者的手术时间、出血量、愈合率、并发症发生率及术前、术后4周、12周的血清IGF-1、sICAM-1、BGP水平进行比较。结果:观察组手术时间、出血量、愈合率、并发症发生率均显著优于对照组,术后4周、12周的血清IGF-1及BGP均高于对照组,而sICAM-1低于对照组,有显著性差异(P<0.05)。结论:经皮锁定钢板内固定术在胫腓骨骨干多段骨折治疗中的疗效显著。

不稳定性骨盆骨折临床分期手术的疗效分析

目的：研究分析不稳定性骨盆骨折临床分期手术的疗效。方法：53例不稳定性骨盆骨折患者按 Tile 分型：B1型18例，B2型9例，B3型4例，C1型12例，C2型6例，C3型4例，均合并有其它脏器不同程度的损伤；所有患者均采用临床分期手术治疗。结果：随访12-34个月，平均18个月，所以患者骨折均一期愈合，根据 Lindahl 影像学标准判断骨折复位情况：优30例，良16例，可5例，差2例，复位优良率为86．8％；按照 Majeed 骨盆骨折功能评分标准：优：34例，良：15例，可：2例，差：2例，优良率：92．7％。结论：骨盆外固定在不稳定性骨盆骨折早期救治中至关重要，二期重建选择适当的手术时机和手术方式，均能获得比较满意的临床效果。

经伤椎与跨伤椎经皮椎弓根内固定治疗胸腰椎压缩性骨折并发骨质疏松症128例疗效对比

目的:对比椎弓根内固定术两种术式治疗胸腰椎压缩性骨折并发骨质疏松症的疗效。方法:将128例胸腰椎压缩性骨折并发骨质疏松症患者(均无神经症状)随机均分为经伤椎组和跨伤椎经皮椎组,手术完成后随访48~50周(平均49周)。结果:两组患者在手术时间、切口长度、术中出血量、术后1dVAS评分、出院所需时间以及术后离床时间比较,差异有统计学意义(P<0.05)。组间比较两组患者在手术前、后随访时的伤椎前缘压缩率、伤椎后缘压缩率以及矢状面Cobb角比较,差异无统计学意义(P>0.05)。结论:对胸腰椎压缩性骨折并发骨质疏松症的治疗,经伤椎与跨伤椎经皮椎椎弓根内固定术均有很好的临床疗效,但与经伤椎椎弓根内固定术比较,跨伤椎经皮椎椎弓根内固定术在切口长度、术中出血、术后疼痛和恢复时间方面具有更大的优势。

胫骨远端后pilon骨折后内侧入路治疗的临床研究

目的:分析胫骨远端后pilon骨折采用后内侧入路治疗的临床效果。方法:回顾性分析采取后内侧入路行切开复位内固定(ORIF)治疗后pilon骨折的22例患者的临床资料。结果:术后踝关VAS疼痛评分为(2.1±0.5)分,显著小于术前评分(6.4±1.7)分,比较差异有统计学意义(P<0.05)。术后无感染、螺钉松动、内固定异常等并发症出现。手术时间为(62.6±21.3)min,住院时间为(8.8±2.7)d,骨折愈合时间为(14.2±1.1)周。踝关节功能恢复优18例,良3例,可1例,优良率为95.46%。结论:胫骨远端后pilon骨折采用后内侧入路行ORIF治疗的效果安全、可靠,能充分暴露骨折情况,有助于骨折的复位准确与固定牢靠。

Efficacy of Spinal Pia Mater Incision and Laminoplasty Combined with Internal Fixation for Old Spinal Cord Injury

Objective To evaluate the clinical efficacy of incising spinal pia mater to relieve pressure and unilateral open-door laminoplasty with internal screw fixation for treatment of the dated spinal cord injury. Methods From March, 2009 to July, 2010, 16 cases with chronic cervical cord injury underwent spinal dura mater incision and unilateral open-door laminoplasty with internal screw fixation. Nerve functions of preand postoperation were evaluated by Frankel classification and the Japanese Orthopaedic Association (JOA) scale. The improvement rate of JOA score at the indicated time was recorded. Results Postoperative Frankel classification rating of 16 patients improved obviously. JOA scores at the 1st month, 3rd month, 6th month, and 12th month after surgery were 7.9±2.3, 8.5±1.6, 8.9±2.1, and 12.4±2.5, respectively, and significantly increased compared with that prior to surgery (5.5±0.6). At the end of follow-up period, JOA score was significantly higher than that of pre-treatment (P<0.05). The recovery was relatively rapid during the first 3 months following the surgery, then entered a platform period. Conclusion It is effective for patients with dated spinal cord injury to undergo spinal decompression and laminoplasty.

AN EXPERIMENTAL STUDY OF THE INTERLEUKIN 1 LEVELS IN AQUEOUS HUMOR AFTER TRANSSCLERAL FIXATION OF INTRAOCULAR LENSES

Purpose. To study the interleukin 1 (IL-1)levels in aqueous humor after transscleral fixation of in- traocular lenses (IOLs) implantation in rabbits and discuss the effect of IL-1 on postoperative anterior ocular inflammation. Methods. Twenty-seven pigmented rabbits were divided into three groups: GI, transscleral fixation of posterior chamber (PC) IOLs implantation; G2, Lens of rabbits were removed without IOLs implanta- tion; G3, the control group, without surgical intervention. On the 1st, 3rd, 7th and 14th postoperative days, aqueous humor samples were obtained. Methyl thiazolyl tetrazolium (MTT) colormetry was used to detected for the presence of IL-1. The data were analyzed by using analysis of variance of SAS soft ware. Results’ It was found that IL-1 level in aqueous humor was increased after transscleral fixation of I- OLs implantation, IL-1 level reached its maximum on the 14th postoperative days in the IOL implanted group. IL-1 levels on 1st, 3rd, 7th and 14th days postoperatively was significantly higher (P<0. 05) in I- OLs implanted group than that of only extracapsular lenses extraction but no IOLs implantation group and that of the none surgical intervention group. COnclusions.IL-1 levels increased had a close relationship with a specific response to IOL implanta- tion. The increase of IL-1 may be suggested as the principal mediators of immunological and inflammatory responses, so that may play critical role in anterior ocular inflammative response after IOL implantation.

THE TREATMENT OF LUMBOSACRAL INSTABILITY BY THE DIAPASON SYSTEM

Objective. To introduce a new internal fixation system of spine and its characteristics. Methods. To review 16 patients with lumbosacral instability who were treated by this new technique, including their clinical outcomes and radiographic evaluation. Results. Fifteen patients gained complete recovery from their preoperative symptoms. One patient who had experienced two operations before and with problems of urinary and fecal incontinence and walking difficulty still had lower limb pain, muscle weakness and urinary incontinence after operation.There is no evidence of spine glide on X-ray, implant failure, neural complication or infection during follow up. Conclusion. Diapason system can achieve good early postoperative results with few complications and ease to use for lumbosacral instability.

CHANGES IN AIRWAY SPACE FOLLOWING MANDIBULAR SETBACK USING SAGITTAL SPLIT OSTEOTOMY AND RIGID INTERNAL FIXATION

The changes in airway space following mandibular setback using sagittal split osteotomy and rigid internal fixation were studied in 28 Japanese patients with mandibular prognathism. The correlation between the amount of mandibular setback and airway space changes,as well as the correlation between the amount of airway space changes and relapse of pognion point during the following-up period were also studied. Lateral cephalometric radiographs were taken immediately before and shortly after surgery as well as 5 to 12 months postoperation. The cephalometric evaluations of airway space width and area were based on stable craniofacial landmarks. The mean setback of mandible was 8.3 mm in the right side,and 8. 2 mm in the left side. The mean amount of relapse of pogonion point during the following-up period was 0. 52 mm horizontally,and 0. 92 mm vertically. A significant decrease in airway space width and area,especially in the lower part of airway space was found following mandibular setback shortly after surgery. Although there was some increase both in airway space width and area during the following-up period,they did not increase to their original values. This suggests that the narrowing of airway space following mandibular setback using sagittal split osteotomy can be permanent. No significant correlation was found between the amount of mandibular setback and airway space changes. Since the relapse of pogonion point during the following-up period was too small,there is no significant correlation between it and the amount of airway space changes.

Closed reduction and internal fixation versus total hip arthroplasty for displaced femoral neck fracture

Objective： To compare the clinical effects between closed reduction and internal fixation （CRIF） and total hip arthroplasty （THA） for displaced femoral neck fracture. Methods： In this prospective randomized study, 285 patients aged above 65 years with hip fractures （Garden III or IV） were included from January 2001 to December 2005. The cases were randomly allocated to either the CRIF group or THA group. Patients with pathological fractures （bone tumors or metabolic bone disease）, preoperative avascular necrosis of the femoral head, osteoarthritis, rheumatoid arthritis, hemiplegia, long-term bed rest and complications affecting hip functions were excluded. Results： During the had significantly higher 5-year follow-up, CRIF group rates of complication in hipjoint, general complication and reoperation than THA group （38.3% vs. 12.7%, P〈0.01; 45.3% vs. 21.7%, P〈0.01; 33.6% vs. 10.2%, P〈0.05 respectively）. There was no difference in mortality between the two groups. Postoperative function of the hip joint in THA group recovered favorably with higher Harris scores. Conclusion： For displaced fractures of the femoral neck in elderly patients, THA can achieve a lower rate of complication and reoperation, as well as better postoperative recovery of hip joint function compared with CRIF.

Pseudoaneurysm of profunda femoris artery following dynamic hip screw fixation for intertrochanteric femoral fracture

Dynamic hip screw fixation is a com- monly performed procedure for internal fixation of intertro- chanteric femoral fractures. Arterial injury following the operative fixation is a rare but serious event. We present a patient who developed pseudoaneurysm ofprofunda femo- ris artery after internal fixation of intertrochanteric fracture with a dynamic hip screw. The diagnosis was confirmed by angiographic study and it was successfully treated by coil embolization.

Minimally invasive plate internal fixation for calcaneal fractures

Objective： To assess the clinical efficacy of minimally invasive plate internal fixation for the treatment of calcaneal fractures. Methods： Manual reduction, rectification of deformity, and cold compress with traditional Chinese medicine were used preoperatively to relieve swelling and pain. A small incision was made to expose the articular facet and to perform anatomic reduction and plate fixation. Self-made traditional Chinese pharmaceutics were applied postoperatively on the surface of the wound to accelerate bony union. Results： All the 40 patients were followed up for at least 1 year postoperatively. According to the Maryland scoring system, the excellent and good rate was 87.5%. Conclusion： Minimally invasive plate internal fixation has the advantages of relatively mild injury, reliable fixation, good recovery, and rare complications in the treatment of intraarticular fractures.

Treatment of ipsilateral hip and femoral shaft fractures with reconstructive intramedullary interlocking nail

Objective: To evaluate the results of reconstructive intramedullary interlocking nail in the treatment of ipsilateral hip and femoral shaft fractures. Methods: From August 1997 to November 2001, 13 patients were treated with the reconstructive intramedullary interlocking nail. Nine patients were associated with ipsilateral femoral neck fractures, three with ipsilateral intertrochanteric fractures, and one with subtrochanteric fracture. Results: The follow up time was from 6 to 38 months with an average of 14 months. All the femoral shaft and hip fractures healed up well. There was no nonunion of the femoral neck, and only one varus malunion. No patient had avascular necrosis of the femoral head. The average healing time for femoral neck fracture was 4.6 months and for shaft fracture 5.8 months. The joint movement and other functions were fairly resumed. Conclusions: The reconstructive intramedullary interlocking nail, with less trauma, reliable fixation, and high rate of fracture healing, is an ideal method of choice in the treatment of ipsilateral hip and femoral shaft fractures.

Open reduction and internal fixation for displaced supracondylar fractures of the humerus in children with crossed K-wires via lateral approach

Objective： To assess the therapeutic results of open reduction and internal fixation with crossed K-wires via lateral approach for displaced supracondvlar fractures of the humerus in children. Methods： We prospectively followed 52 children who presented with Gartland type 3 displaced supraeondylar fractures of the humerus and were managed by open reduction and internal fixation with crossed K-wires via lateral approach.There were 37 male and 15 female patients; average age was 7.39 years. The most common mechanism of trauma was fall while playing （n=23）, followed by fall from height （n=20）, road traffic accidents （n-5） and fall from standing height （n=2）. In 2 cases, mode of injury was not available. The mean follow-up was 12 months and patients were assessed according to Flynn＇s criteria. Results： Lateral approach provided an excellent view of the lateral column between two nervous planes and enabled an anatomical reduction in all cases. Immobilizing the elbow at 90 degrees or more of flexion was not needed after cross K-wire fixation. Majority of patients regained full range of motion within 6 weeks of pin removal. Two patients had postoperative ulnar nerve injuries that resolved after pin removal. The common late complication of cubitus varus was not seen in any patient. Delayed presentation to the emergency department, repeated manipulations by bone setters and massage with edible oil were responsible for stiffness in 5 patients. Superficial pin tract infection was noted in 5 patients that resolved with dressings and antibiotics. No deep infection occurred. A detailed clinical examination and radiographic analysis was done at final follow-up. They included measurement of carrying angle and range of movements of both operated and normal sides, and radiographs of both upper limbs for comparison. According to Flynn＇s criteria, 90.4% patients showed satisfactory results. Conclusion： Lateral approach for open reduction and internal fixation of the widely-displaced supracondylar fracture of the humerus is safe and straightforward, ensuring anatomical reduction and excellent function. The approach is easy and familiar to most orthopedic surgeons in our setup.

Surgical treatment of proximal humerus fractures using PHILOS plate

Objective：To evaluate functional outcome and complications of open reduction and internal fixation with proximal humeral internal locking system （PHILOS） plate for proximal humerus fractures.Methods：We reviewed 51 patients who underwent open reduction and internal fixation with PHILOS plate between the years 2007 to 2012.There were 35 men and 16 women with a mean age of 38 years （range 24-68）.There were 41 patients in the age group of ＜60 years and 10 patients in the age group of ＞60 years.According to Neer classification system,8,15 and 23 patients had 2-part,3-part,and 4-part fractures,respectively and 5 patients had 4-part fracture dislocation.All surgeries were carried out at our tertiary care trauma centre.Functional evaluation of the shoulder at final follow-up was done using Constant-Murley score.Results：The mean follow-up period was 30 months （range 12-44 months）.Two patients were lost to followup.Of the remaining 49 patients,all fractures were united clinically and radiologically.The mean time for radiological union was 12 weeks （range 8-20 weeks）.At the final follow-up the mean Constant-Murley score was 79 （range 50-100）.The results were excellent in 25 patients,good in 13 patients,fair in 6 patients and poor in 5 patients.During the follow-up,four cases of varus malunion,one case of subacromial impingement,one case of deep infection,one case of intraarticular screw penetration and one case of failure of fixation were noted.No cases of avascular necrosis,hardware failure,locking screw loosening or nonunion were noted.Conclusion：PHILOS provides stable fixation in proximal humerus fractures.To prevent potential complications like avascular necrosis,meticulous surgical dissection to preserve vascularity of humeral head is necessary.

Internal fixation with headless compression screws and back buttress plate for treatment of old Hoffa fracture

Objective： To analyze the early clinical and radiographic outcomes of Hoffa fractures treated by a standard protocol of open reduction and internal fixation using headless compression screws combined with back buttress plate in a consecutive series of 8 Chinese patients. Methods： Open reduction and internal fixation was performed on all patients. The fractures were anatomical- ly reduced and held temporarily by K-wire. If the ends of fractures were atrophic, autologous bone graft from the ipsilateral iliac crest was packed between the ends. Then the fracture fragments were fixed with AO 6.5 mm headless compression cannulated screws. At least two screws were used to provide rotational stability. One pre-contoured reconstruction plate was placed on the nonarticular surface posteromedially or posterolaterally as back buttress plate. Results： All the patients were followed up for at least 12 months （range 12-25 months）. All fractures achieved anatomical reduction and healed clinically and radiographically. At recent follow-up, the mean flexion degree was 120.6° （range 110°-135°） and the mean extension degree was 2.5° （range 0°-5°）. The average visual analogue scale score was 1.6 points （range 0-3）. Six patients were assessed as excellent and 2 as good according to the hospital for special surgery knee score system. There were no superficial or deep infections, or hardware breakages. No patient had giving way or locking of the knee, though some had intermittent pain and swelling after strenuous exercise. Injury mechanism had significant influence on the functional outcome （P=0.046）. Conclusion： Headless compression screws combined with back buttress plate and/or autologous bone grafting to treat old Hoffa fracture is one of effective measures. It would be conducive to not only fracture healing but also early exercise and functional recovery.

Nonunion of coronal shear fracture of femoral condyle

Isolated coronal fractures of femoral condyle are rare in adults and nonunion of Hoffa fracture is reported only a few times in the literature. We analyzed six cases of nonunion of Hoffa fractures over a period of three years. Three patients were treated conservatively and three patients had fixation failures. Delay of presentation was 2 months to one year. Treatment protocol consisted of open reduction, excision of pseudoarthrosis, bone grafting and internal fixation along with knee arthrolysis. Union wasachieved in all patients at mean 16 weeks. The treatment of nonunion of Hoffa fractures requires careful preoperative planning and meticulous surgical technique. The literature regarding the controversies in fracture management and surgical technique are reviewed.