目的探讨动力髋螺钉(dynamic hip screw,DHS)、股骨近端内固防旋髓内钉(proximal femoral nail antirotation,PFN-A)与联合加压交锁髓内钉系统(Inter TAN)治疗老年股骨粗隆间骨折疗效及对患者远期预后的影响。方法从广州市黄埔区中医医...目的探讨动力髋螺钉(dynamic hip screw,DHS)、股骨近端内固防旋髓内钉(proximal femoral nail antirotation,PFN-A)与联合加压交锁髓内钉系统(Inter TAN)治疗老年股骨粗隆间骨折疗效及对患者远期预后的影响。方法从广州市黄埔区中医医院、龙港市人民医院和都匀市人民医骨科2017年12月—2020年12月收治的老年股骨粗隆间骨折老年患者中随机抽取90例,以随机数字表法分为DHS组、PFN-A组和Inter TAN组,各30例,并行对应的内固定治疗,分析比较患者疗效以及远期预后情况。结果PFN-A组和Inter TAN组术中出血量较DHS组少,手术用时、切口长度、负重时间、骨折愈合时间均较DHS组短(P<0.05);PFN-A组和Inter TAN组术中及术后各项指标对比,差异无统计学意义(P>0.05)。随访过程中Inter TAN组和PFN-A组均未发生严重不良事件;DHS组有2例因内固定失败、3例因骨不连,接受了人工股骨头置换翻修术治疗。Inter TAN组和PFN-A组术后12个月Harris评分、髋屈伸活动度(range of motion,ROM)明显高于DHS组,视觉模拟评分量表(visual analogue scale,VAS)评分较DHS组低(P<0.05);Inter TAN组和PFN-A组上述指标对比,差异无统计学意义(P>0.05)。DHS组远期并发症发生情况明显多于其他2组(P<0.05)。结论PFN-A和Inter TAN治疗老年股骨粗隆间骨折,在加速骨折愈合方面优势更明显,不仅能缩短手术时间,减少术中出血,还能帮助患者获得良好的远期预后;相较于PFN-A,Inter TAN手术相对较复杂,不会明显增加手术时间和术中出血量,价格更为昂贵,但术后负重、骨折愈合、并发症及疼痛程度均较有优势。展开更多
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...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.展开更多
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 treat...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.展开更多
Purpose： To investigate efficacy of open reduction and internal fixation with the miniplate and hollow screw in the treatment of Lisfranc injury. Methods： Ten cases of Lisfranc injury treated by open reduction, mini...Purpose： To investigate efficacy of open reduction and internal fixation with the miniplate and hollow screw in the treatment of Lisfranc injury. Methods： Ten cases of Lisfranc injury treated by open reduction, miniplate and hollow screw in our hospital were retrospectively analyzed. There were 6 males and 4 females with age ranging from 25 to 45 years （mean 32 years）. Among them, one case was classified as Type A, six Type B and three Type C. Injury mechanism included road traffic accidents （3 cases）, fall from height （5 cases） and hit by heavy object （2 cases）. All injuries were closed without cerebral trauma or other complicated injuries. The time interval between injury and operation was 6-10 days （average 6.6 days）. Postoperatively, the foot function was assessed using Visual Analogue Scales （VAS） and American Orthopaedic Foot and Ankle Society （AOFAS） Scales. Healing time and complications were observed. Results： All patients were followed up for 18-24 months （average 20 months）. Anatomic reduction was achieved in all patients on images. There was statistical significance between preoperative score （Z89 ± 0.34） and score at postoperative 8 weeks （0.67 ± 0.13）. According to the AOFAS score, 5 cases were defined as excellent, 3 cases as good and 2 cases as fair. During follow-up, there was no wound infection or complications except for osteoarthritis in 2 cases. Healing time ranged from 3 to 6 months with an average of 3.6 months. Conclusion： Anatomical reduction of Lisfranc injury can be achieved by open reduction and internal fixation with the miniplate and hollow screw. Normal structure of Lisfranc joint is regained to a great extent; injured ligaments were also repaired. Therefore, this method offers excellent curative effect and can avoid postoperative complications and improve the patients＇ quality of life.展开更多
Objectives： To explore the clinical fea- tures of traumatic atlantoaxial instability combined with subaxial cervical spinal cord injury （CSCI）, and to analyze the feasibility, indication and therapeutic effects of ...Objectives： To explore the clinical fea- tures of traumatic atlantoaxial instability combined with subaxial cervical spinal cord injury （CSCI）, and to analyze the feasibility, indication and therapeutic effects of anterior-posterior approach in such cases. Methods： From March 2004 to September 2009, 16 cases with this trauma were admitted and surgically treated in our department. Before surgery, skull traction was performed. Posterior atlantoaxial pedicle screw internal fixation and bone graft fusion were conducted to manage traumatic atlantoaxial instability. As for subaxial CSCI, anterior cervical corpectomy or discectomy decompression, bone grafting and internal fixation with steel plates were applied. Results： All operations were successful. The average operation time was 3 hours and operative blood loss 400 ml. Satisfactory reduction of both the upper and lower cervical spine and complete decompression were achieved. All patients were followed up for 12 to 36 months. Their clinical symptoms were improved by various levels. The Japanese Orthopaedic Association （JOA） scores ranged from 10（improvement rate=70.10%）. X-rays, spiral CT and MRI confirmed normal cervical alignments, complete decompression and fine implants＇ position. There was no breakage or loosening of screws, nor exodus of titanium mesh or implanted bone blocks. The grafted bone achieved fusion 3-6 months postoperatively and no atlantoaxial instability was observed. Conclusions： Traumatic atlantoaxial instability may combine with subaxial CSCI, misdiagnosis of which should be especially alerted and avoided. For severe cases, one stage anterior-posterior approach to decompress the upper and lower cervical spine, together with reposition, bone grafting and fusion, as well as internal fixation can immediately restore the normal alignments and stability of the cervical spine and effectively improve the spinal nervous function, thus being an ideal approach.展开更多
Objective： To evaluate the effectiveness of the rigid internal fixation for comminuted and redisplaced zygomatic arch fractures by modified preauriculartemporal approach with the resorbable bone fixation. Methods： ...Objective： To evaluate the effectiveness of the rigid internal fixation for comminuted and redisplaced zygomatic arch fractures by modified preauriculartemporal approach with the resorbable bone fixation. Methods： Totally twenty patients aged from 14 to 68 years and admitted to our hospital between September 2006 and June 2011 were reviewed, of whom seventeen had a unilateral comminuted zygomatic arch fracture and three re displaced arch fracture after failed closed reduction. The fracture segments were aligned to restore the preinjury form of the arch by rigid fixation with resorbable plates and screws through a modified preauriculartemporal incision. Results： The fractures were well reduced, preauricu lartemporal scar and lateral facial contour were aestheti cally satisfying, and no case had limited mouth opening as well as facial palsy. The resorbable plates were not palpated one year after the operation. Conclusion： The rigid internal fixation through the preauriculartemporal approach with the resorbable bone is an effective method for the comminuted and redisplaced zyomatic arch fractures.展开更多
Objective: To investigate appropriate ways for screw placement of pedicle of vertebral arch in the horizontal plane. Methods: Fifteen preserved thoracolumbar spine specimens (T 11 L 5) were used and divided into three...Objective: To investigate appropriate ways for screw placement of pedicle of vertebral arch in the horizontal plane. Methods: Fifteen preserved thoracolumbar spine specimens (T 11 L 5) were used and divided into three groups at random. Firstly four anatomic parameters indicating screw positions in the horizontal plane were measured. Secondly the methods of Roy camille, Magerl, and authors’segmental differences were used to place successively the screws of the pedicles with 5 mm, 6 mm, and 7 mm in diameter. Coincidences between the drilling point, drilling direction and pedicle axis, and ruptures of the pedicle as well as the length of the screw in the vertebral body were observed. Results: Four anatomic parameters at various segments showed significant differences (P < 0.05 ). The drilling point by the Roy camille’s method deviated medial to pedicle axis in most segments, and its drilling direction did not coincide well with most E angles of the pedicles. The drilling point by Magerl’s method coincided relatively well with pedicle axis in lumbar vertebrae, but there were still some differences between its drilling direction and E angles of the pedicles. The method of segmental differences coincided the best with the pedicle axis. The lengths of screw in the vertebra were relatively long by both Magerl and segmental difference methods. When 5 mm diametral screw was used by the three methods, the rupture rate was very low. When 6 mm and 7 mm diametral screws were placed, the rupture rate was accordingly increased. Of the three methods, Roy camilles method showed a relatively high rupture rate, while the method of segmental differences a comparatively low rupture rate. Various degrees of rupture of the pedicle of vertebral arch were found at the juncture of the thoracic and lumbar vertebrae when 6 mm or 7 mm diametral screws was used by any screw placement method. In contrast, the rupture was seldom seen at the lower lumbar vertebrae when 7 mm diametral screws were used.Conclusions: The segmental difference method is proved to have the anatomic safety and screw biomechanical stability. It is appropriate to choose different diametral screws, different drilling points and directions according to different segments of the vertebra.展开更多
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 buttre...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.展开更多
Objective：To compare the treating effects of different intramedullary nailing methods on tibial fractures in adults.Methods：Literature reports in both Chinese and English languages were retrieved （from the earliest...Objective：To compare the treating effects of different intramedullary nailing methods on tibial fractures in adults.Methods：Literature reports in both Chinese and English languages were retrieved （from the earliest available records to October 1,2013） from the PubMed,FMJS,CNKI,Wanfang Data using randomized controlled trials （RCTs） to compare reamed and unreamed intramedullary nailing for treatment of tibial fractures.Methodological quality of the trials was critically assessed,and relevant data were extracted.Statistical software Revman 5.0 was used for data-analysis.Results：A total of 12 randomized controlled trials,comprising 985 patients （475 in the unreamed group and 510 in the reamed group）,were eligible for inclusion in this meta-analysis.The results of metaanalysis showed that there were no statistically significant differences between the two methods in the reported outcomes of infection （RR=0.64; 95％CI,0.39 to 1.07;P=0.09）,compartment syndrome （RR=1.44; 95％CI,0.8to 2.41; P=0.16）,thrombosis （RR=1.29; 95％CI,0.43to 3.87; P=0.64）,time to union （WMD=5.01; 95％CI,-1.78 to 11.80; P=0.15）,delayed union （nonunion）（RR=1.56; 95％CI,0.97 to 2.49; P=0.06）,malunion （RR=1.75; 95％CI,1.00 to 3.08; P=0.05） and knee pain （RR=0.94; 95％CI,0.73 to 1.22; P=0.66）.But there was a significantly higher fixation failure rate in the unreamed group than in the reamed group （RR=4.29; 95％CI,2.58to 7.14; P＜0.00001）.Conclusion：There is no significant difference in the reamed and unreamed intramedullary nailing for the treatment of tibial fractures,but our result recommends reamed nails for the treatment of closed tibial fractures for their lower fixation failure rate.展开更多
文摘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.
文摘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.
文摘Purpose： To investigate efficacy of open reduction and internal fixation with the miniplate and hollow screw in the treatment of Lisfranc injury. Methods： Ten cases of Lisfranc injury treated by open reduction, miniplate and hollow screw in our hospital were retrospectively analyzed. There were 6 males and 4 females with age ranging from 25 to 45 years （mean 32 years）. Among them, one case was classified as Type A, six Type B and three Type C. Injury mechanism included road traffic accidents （3 cases）, fall from height （5 cases） and hit by heavy object （2 cases）. All injuries were closed without cerebral trauma or other complicated injuries. The time interval between injury and operation was 6-10 days （average 6.6 days）. Postoperatively, the foot function was assessed using Visual Analogue Scales （VAS） and American Orthopaedic Foot and Ankle Society （AOFAS） Scales. Healing time and complications were observed. Results： All patients were followed up for 18-24 months （average 20 months）. Anatomic reduction was achieved in all patients on images. There was statistical significance between preoperative score （Z89 ± 0.34） and score at postoperative 8 weeks （0.67 ± 0.13）. According to the AOFAS score, 5 cases were defined as excellent, 3 cases as good and 2 cases as fair. During follow-up, there was no wound infection or complications except for osteoarthritis in 2 cases. Healing time ranged from 3 to 6 months with an average of 3.6 months. Conclusion： Anatomical reduction of Lisfranc injury can be achieved by open reduction and internal fixation with the miniplate and hollow screw. Normal structure of Lisfranc joint is regained to a great extent; injured ligaments were also repaired. Therefore, this method offers excellent curative effect and can avoid postoperative complications and improve the patients＇ quality of life.
文摘Objectives： To explore the clinical fea- tures of traumatic atlantoaxial instability combined with subaxial cervical spinal cord injury （CSCI）, and to analyze the feasibility, indication and therapeutic effects of anterior-posterior approach in such cases. Methods： From March 2004 to September 2009, 16 cases with this trauma were admitted and surgically treated in our department. Before surgery, skull traction was performed. Posterior atlantoaxial pedicle screw internal fixation and bone graft fusion were conducted to manage traumatic atlantoaxial instability. As for subaxial CSCI, anterior cervical corpectomy or discectomy decompression, bone grafting and internal fixation with steel plates were applied. Results： All operations were successful. The average operation time was 3 hours and operative blood loss 400 ml. Satisfactory reduction of both the upper and lower cervical spine and complete decompression were achieved. All patients were followed up for 12 to 36 months. Their clinical symptoms were improved by various levels. The Japanese Orthopaedic Association （JOA） scores ranged from 10（improvement rate=70.10%）. X-rays, spiral CT and MRI confirmed normal cervical alignments, complete decompression and fine implants＇ position. There was no breakage or loosening of screws, nor exodus of titanium mesh or implanted bone blocks. The grafted bone achieved fusion 3-6 months postoperatively and no atlantoaxial instability was observed. Conclusions： Traumatic atlantoaxial instability may combine with subaxial CSCI, misdiagnosis of which should be especially alerted and avoided. For severe cases, one stage anterior-posterior approach to decompress the upper and lower cervical spine, together with reposition, bone grafting and fusion, as well as internal fixation can immediately restore the normal alignments and stability of the cervical spine and effectively improve the spinal nervous function, thus being an ideal approach.
文摘Objective： To evaluate the effectiveness of the rigid internal fixation for comminuted and redisplaced zygomatic arch fractures by modified preauriculartemporal approach with the resorbable bone fixation. Methods： Totally twenty patients aged from 14 to 68 years and admitted to our hospital between September 2006 and June 2011 were reviewed, of whom seventeen had a unilateral comminuted zygomatic arch fracture and three re displaced arch fracture after failed closed reduction. The fracture segments were aligned to restore the preinjury form of the arch by rigid fixation with resorbable plates and screws through a modified preauriculartemporal incision. Results： The fractures were well reduced, preauricu lartemporal scar and lateral facial contour were aestheti cally satisfying, and no case had limited mouth opening as well as facial palsy. The resorbable plates were not palpated one year after the operation. Conclusion： The rigid internal fixation through the preauriculartemporal approach with the resorbable bone is an effective method for the comminuted and redisplaced zyomatic arch fractures.
文摘Objective: To investigate appropriate ways for screw placement of pedicle of vertebral arch in the horizontal plane. Methods: Fifteen preserved thoracolumbar spine specimens (T 11 L 5) were used and divided into three groups at random. Firstly four anatomic parameters indicating screw positions in the horizontal plane were measured. Secondly the methods of Roy camille, Magerl, and authors’segmental differences were used to place successively the screws of the pedicles with 5 mm, 6 mm, and 7 mm in diameter. Coincidences between the drilling point, drilling direction and pedicle axis, and ruptures of the pedicle as well as the length of the screw in the vertebral body were observed. Results: Four anatomic parameters at various segments showed significant differences (P < 0.05 ). The drilling point by the Roy camille’s method deviated medial to pedicle axis in most segments, and its drilling direction did not coincide well with most E angles of the pedicles. The drilling point by Magerl’s method coincided relatively well with pedicle axis in lumbar vertebrae, but there were still some differences between its drilling direction and E angles of the pedicles. The method of segmental differences coincided the best with the pedicle axis. The lengths of screw in the vertebra were relatively long by both Magerl and segmental difference methods. When 5 mm diametral screw was used by the three methods, the rupture rate was very low. When 6 mm and 7 mm diametral screws were placed, the rupture rate was accordingly increased. Of the three methods, Roy camilles method showed a relatively high rupture rate, while the method of segmental differences a comparatively low rupture rate. Various degrees of rupture of the pedicle of vertebral arch were found at the juncture of the thoracic and lumbar vertebrae when 6 mm or 7 mm diametral screws was used by any screw placement method. In contrast, the rupture was seldom seen at the lower lumbar vertebrae when 7 mm diametral screws were used.Conclusions: The segmental difference method is proved to have the anatomic safety and screw biomechanical stability. It is appropriate to choose different diametral screws, different drilling points and directions according to different segments of the vertebra.
文摘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.
文摘Objective：To compare the treating effects of different intramedullary nailing methods on tibial fractures in adults.Methods：Literature reports in both Chinese and English languages were retrieved （from the earliest available records to October 1,2013） from the PubMed,FMJS,CNKI,Wanfang Data using randomized controlled trials （RCTs） to compare reamed and unreamed intramedullary nailing for treatment of tibial fractures.Methodological quality of the trials was critically assessed,and relevant data were extracted.Statistical software Revman 5.0 was used for data-analysis.Results：A total of 12 randomized controlled trials,comprising 985 patients （475 in the unreamed group and 510 in the reamed group）,were eligible for inclusion in this meta-analysis.The results of metaanalysis showed that there were no statistically significant differences between the two methods in the reported outcomes of infection （RR=0.64; 95％CI,0.39 to 1.07;P=0.09）,compartment syndrome （RR=1.44; 95％CI,0.8to 2.41; P=0.16）,thrombosis （RR=1.29; 95％CI,0.43to 3.87; P=0.64）,time to union （WMD=5.01; 95％CI,-1.78 to 11.80; P=0.15）,delayed union （nonunion）（RR=1.56; 95％CI,0.97 to 2.49; P=0.06）,malunion （RR=1.75; 95％CI,1.00 to 3.08; P=0.05） and knee pain （RR=0.94; 95％CI,0.73 to 1.22; P=0.66）.But there was a significantly higher fixation failure rate in the unreamed group than in the reamed group （RR=4.29; 95％CI,2.58to 7.14; P＜0.00001）.Conclusion：There is no significant difference in the reamed and unreamed intramedullary nailing for the treatment of tibial fractures,but our result recommends reamed nails for the treatment of closed tibial fractures for their lower fixation failure rate.
