Objective:To study the clinical effect of minimally invasive single-segment reduction and internal fixation in patients with thoracolumbar fractures.Methods:From June 2013 to June 2014,100 patients with thoracolumbar ...Objective:To study the clinical effect of minimally invasive single-segment reduction and internal fixation in patients with thoracolumbar fractures.Methods:From June 2013 to June 2014,100 patients with thoracolumbar fractures were selected as the subjects and they were randomly divided into observation group(50 cases)and control group(50 cases).The patients in the observation group were treated with minimally invasive singlesegment reduction and internal fixation.The patients in the control group were treated with short segmental fixation.The clinical effects of the two groups were compared.Results:There was no significant difference in the compression rate and Cobb angle between the two groups before and after operation(P>0.05).For all patients who were followed up for the last time,the Cobb angle was significantly lower in the observation group than in the control group(P<0.05).The social function,affective function and physical pain score of the observation group were significantly better than the control group(P<0.05).The amount of bleeding in the observation group was(250.4±41.0)ml,which was significantly lower than that in the control group(267.5±32.8)ml.The time required for the operation was(90.2±35.4)min,which was significantly lower than that of the control group(104.5±22.6)min(P<0.05).After treatment,the prognosis was 70.00%and the excellent and good rate was 98.00%,which was significantly higher than that of the control group(46.00%)and 78.00%(P<0.05).Conclusion:Thoracolumbar fractures in patients with dilated channel minimally invasive single-segment reduction and internal fixation treatment can effectively repair the patient's vertebral height and Cobb angle and the degree of correction after surgery was significantly better,safer and worthy of clinical recommended use.展开更多
BACKGROUND Older people are more likely to experience pelvic fractures than younger people.Multi-slice spiral computed tomography(CT)uses three-dimensional(3D)reconstruction technology to generate 3D images that can c...BACKGROUND Older people are more likely to experience pelvic fractures than younger people.Multi-slice spiral computed tomography(CT)uses three-dimensional(3D)reconstruction technology to generate 3D images that can clearly demonstrate the 3D space of fractures and detect fractures at a higher rate.AIM To investigate the clinical value of multi-slice spiral CT 3D reconstruction in the diagnosis of unstable pelvic fractures in the elderly as well as the effect of less invasive stabilization.METHODS A total of 86 patients with unstable pelvic fractures treated between March 2016 and March 2019 underwent femoral supracondylar bone traction before surgery.Pelvic radiography and multi-row spiral CT were performed successively once the patient’s vital signs and hemodynamic indices were stable.Secondary processing of the original data was performed to obtain 3D reconstruction images and determine the vertical displacement of the pelvis.After basic or complete reduction,minimally invasive internal fixation using hollow lag screws was performed.The detection rates of fracture location and classification by X-ray and CT reconstruction were compared.Patients were divided into two groups according to the presence or absence of preoperative 3D reconstruction to compare postoperative reduction,wound healing time,fracture healing time,hospitalization time,visual analog scale(VAS)score,poor internal fixation,and functional recovery.RESULTS The diagnostic coincidence rates of X-rays for pubic symphysis,ilium wing,sacroiliac periarticular,and sacral fractures were lower than those of CT reconstruction.The coincidence rate of CT reconstruction in the clinical classification of pelvic fractures was 100%,whereas 11 cases were misdiagnosed by X-ray;the total coincidence rate was 87.21%.The total excellent and good rates of postoperative reduction were significantly higher in the study group than in the control group(P<0.05).The wound healing,fracture healing,and hospitalization times were significantly shorter in the study group than in the control group(P<0.05).The VAS scores decreased in both groups postoperatively and were lower in the study group than in the control group(P<0.05).The total incidence of poor postoperative internal fixation was significantly lower in the study group than in the control group(P<0.05).The overall rate of postoperative functional recovery was significantly higher in the study group than in the control group(P<0.05).CONCLUSION Multi-slice spiral CT has high guiding significance for the diagnosis,classification,and treatment of unstable pelvic fractures in the elderly.Preoperative 3D reconstruction can effectively shorten the operation time and promote fracture healing,while minimally invasive internal fixation can effectively reduce pain and promote functional recovery of fracture sites,making it worthy of clinical application.展开更多
Objective：Intertrochanteric femur fracture is a common injury in elderly patients.The dynamic hip screw （DHS） has served as the standard choice for fixation; however it has several drawbacks.Studies of the percutan...Objective：Intertrochanteric femur fracture is a common injury in elderly patients.The dynamic hip screw （DHS） has served as the standard choice for fixation; however it has several drawbacks.Studies of the percutaneous compression plate （PCCP） are still inconclusive in regards to its efficacy and safety.By comparing the two methods,we assessed their clinical therapeutic outcome.Methods：Atotal of 121 elderly patients with intertrochanteric femur fractures （type AO/OTA 31.A 1-A2,Evans type 1） were divided randomly into two groups undergoing either a minimally invasive PCCP procedure or a conventional DHS fixation.Results：The mean operation duration was significantly shorter in the PCCP group （55.2 min versus 88.5 min,P＜0.01）.The blood loss was 156.5 ml±18.3 ml in the PCCP group and 513.2 ml±66.2 ml in the DHS group （P＜0.01）.Among the patients treated with PCCP,3.1％ needed blood transfusions,compared with 44.6％ of those that had DHS surgery （P＜0.01）.The PCCP group displayed less postoperative complications （P＜0.05）.The mean American Society of Anesthesiologists score and Harris hip score in the PCCP group were better than those in the DHS group.There were no significant differences in the mean hospital stay,mortality rates,or fracture healing.Conclusion：Due to several advantages,PCCP has the potential to become the ideal choice for treating intertrochanteric fractures （type AO/OTA 31.A1-A2,Evans type 1）,particularly in the elderly.展开更多
Objective:To introduce the experience of treating fracture of both tibia and fibula with micro-invasive percutaneous plate internal fixation through fracture site approach. Methods:The data of 15 patients(11 males and...Objective:To introduce the experience of treating fracture of both tibia and fibula with micro-invasive percutaneous plate internal fixation through fracture site approach. Methods:The data of 15 patients(11 males and 4 females),including 14 adults(aged 22-73 years,mean=40 years)and 1 child(aged 10 years),with fracture of both tibia and fibula were studied retrospectively in this study.A small incision was made at the fracture site of tibia.Then reposition was made under direct vision,and internal fixation was employed with steel plates inserting through the small incision. Results:Anatomical reduction was obtained.No complication was found.Union occurred on time in 14 patients.One case healed after a second operation. Conclusions:Micro-invasive percutaneous plate internal fixation is beneficial to the healing of bone and soft tissues.Without X-ray examination,it is also easy to reach anatomical reduction and make tibial internal fixation with both plates with micro-invasive percutaneous plate internal fixation.展开更多
Parpose:The study aims to compare the efficacy and safety of a new minimally invasive osteosynthesis technique with those of conventional open surgery for transverse patellar fractures.Methods:It was a retrospective s...Parpose:The study aims to compare the efficacy and safety of a new minimally invasive osteosynthesis technique with those of conventional open surgery for transverse patellar fractures.Methods:It was a retrospective study.Adult patients with closed transverse patellar fracture were included,and with open comminuted patellar fracture were excluded.These patients were divided into minimally invasive osteosynthesis technique(MIOT)group and open reduction and internal fixation(ORIF)group.Surgical time,frequency of intraoperative fluoroscopy,visual analogue scale score,flexion,extension,Lysholm knee score,infection,malreduction,implant migration and implant irritation in two groups were recorded and compared.Statistical analysis was performed by the SPsS software package(version 19).A p<0.05 indicated statistical significance.Results:A total of 55 patients with transverse patellar fractures enrolled in this study,the minimally invasive technique was performed in 27 cases,and open reduction was performed in 28 cases.The surgical time in the ORIF group was shorter than that in the MIOT group(p=0.033).The visual analogue scale scores in the MIOT group were significantly lower than those in the ORIF group only in the first month after surgery(p=0.015).Flexion was restored faster in the MIOT group than that in the ORIF group at one month(p=0.001)and three months(p=0.015).Extension was recovered faster in the MIOT group than that in the ORIF group at one month(p=0.031)and three months(p=0.023).The recorded Lysholm knee scores in the MIOT group were always greater than those in the ORIF group.Complications,such as infection,malreduction,implant migration,and implant irritation,occurred more frequently in the ORIF group.Conclusion:Compared with the ORIF group,the MIOT group reduced postoperative pain and had less complications and better exercise rehabilitation.Although it requires a long operation time,MIOT may be a wise choice for transverse patellar fractures.展开更多
目的探讨关节镜辅助复位内固定(arthroscopically-assisted reduction and internal fixation,ARIF)结合加速康复外科(enhanced recovery after surgery,ERAS)理念与开放复位内固定(open reduction and internal fixation,ORIF)治疗胫...目的探讨关节镜辅助复位内固定(arthroscopically-assisted reduction and internal fixation,ARIF)结合加速康复外科(enhanced recovery after surgery,ERAS)理念与开放复位内固定(open reduction and internal fixation,ORIF)治疗胫骨平台后外侧骨折的临床疗效差异。方法回顾性选择2020年1月至2022年11月徐州市中心医院骨科胫骨平台后外侧骨折患者70例,根据治疗方法分为ARIF组(结合ERAS,n=32)和ORIF组(未结合ERAS,n=38)。所有患者住院后均通过影像学检查评估骨折类型,比较两组患者的手术时间、住院时间,采用视觉模拟量表(visual analogue scale,VAS)评估患者术后早期疼痛,美国特种外科医院(hospital for special surgery,HSS)评分评估患者术后3个月膝关节功能,比较两组患者术后6个月双侧大腿周径差值。结果ARIF组患者的手术时间显著短于ORIF组[(67.84±9.89)min vs(85.16±9.18)min,P<0.001],住院时间显著短于ORIF组[(7.13±1.41)d vs(8.74±1.84)d,P<0.001]。术后第3天,ARIF组的VAS评分显著低于ORIF组[(4.00±1.44)分vs(5.39±1.24)分,P<0.001]。术后3个月,ARIF组患者的膝关节功能显著优于ORIF组,术后6个月髌骨上10 cm大腿周径差值显著小于ORIF组(P<0.001)。结论与ORIF相比,接受ARIF结合ERAS治疗胫骨平台后外侧骨折的患者术后恢复更快、住院时间更短、临床疗效更确切。展开更多
文摘Objective:To study the clinical effect of minimally invasive single-segment reduction and internal fixation in patients with thoracolumbar fractures.Methods:From June 2013 to June 2014,100 patients with thoracolumbar fractures were selected as the subjects and they were randomly divided into observation group(50 cases)and control group(50 cases).The patients in the observation group were treated with minimally invasive singlesegment reduction and internal fixation.The patients in the control group were treated with short segmental fixation.The clinical effects of the two groups were compared.Results:There was no significant difference in the compression rate and Cobb angle between the two groups before and after operation(P>0.05).For all patients who were followed up for the last time,the Cobb angle was significantly lower in the observation group than in the control group(P<0.05).The social function,affective function and physical pain score of the observation group were significantly better than the control group(P<0.05).The amount of bleeding in the observation group was(250.4±41.0)ml,which was significantly lower than that in the control group(267.5±32.8)ml.The time required for the operation was(90.2±35.4)min,which was significantly lower than that of the control group(104.5±22.6)min(P<0.05).After treatment,the prognosis was 70.00%and the excellent and good rate was 98.00%,which was significantly higher than that of the control group(46.00%)and 78.00%(P<0.05).Conclusion:Thoracolumbar fractures in patients with dilated channel minimally invasive single-segment reduction and internal fixation treatment can effectively repair the patient's vertebral height and Cobb angle and the degree of correction after surgery was significantly better,safer and worthy of clinical recommended use.
文摘BACKGROUND Older people are more likely to experience pelvic fractures than younger people.Multi-slice spiral computed tomography(CT)uses three-dimensional(3D)reconstruction technology to generate 3D images that can clearly demonstrate the 3D space of fractures and detect fractures at a higher rate.AIM To investigate the clinical value of multi-slice spiral CT 3D reconstruction in the diagnosis of unstable pelvic fractures in the elderly as well as the effect of less invasive stabilization.METHODS A total of 86 patients with unstable pelvic fractures treated between March 2016 and March 2019 underwent femoral supracondylar bone traction before surgery.Pelvic radiography and multi-row spiral CT were performed successively once the patient’s vital signs and hemodynamic indices were stable.Secondary processing of the original data was performed to obtain 3D reconstruction images and determine the vertical displacement of the pelvis.After basic or complete reduction,minimally invasive internal fixation using hollow lag screws was performed.The detection rates of fracture location and classification by X-ray and CT reconstruction were compared.Patients were divided into two groups according to the presence or absence of preoperative 3D reconstruction to compare postoperative reduction,wound healing time,fracture healing time,hospitalization time,visual analog scale(VAS)score,poor internal fixation,and functional recovery.RESULTS The diagnostic coincidence rates of X-rays for pubic symphysis,ilium wing,sacroiliac periarticular,and sacral fractures were lower than those of CT reconstruction.The coincidence rate of CT reconstruction in the clinical classification of pelvic fractures was 100%,whereas 11 cases were misdiagnosed by X-ray;the total coincidence rate was 87.21%.The total excellent and good rates of postoperative reduction were significantly higher in the study group than in the control group(P<0.05).The wound healing,fracture healing,and hospitalization times were significantly shorter in the study group than in the control group(P<0.05).The VAS scores decreased in both groups postoperatively and were lower in the study group than in the control group(P<0.05).The total incidence of poor postoperative internal fixation was significantly lower in the study group than in the control group(P<0.05).The overall rate of postoperative functional recovery was significantly higher in the study group than in the control group(P<0.05).CONCLUSION Multi-slice spiral CT has high guiding significance for the diagnosis,classification,and treatment of unstable pelvic fractures in the elderly.Preoperative 3D reconstruction can effectively shorten the operation time and promote fracture healing,while minimally invasive internal fixation can effectively reduce pain and promote functional recovery of fracture sites,making it worthy of clinical application.
文摘Objective：Intertrochanteric femur fracture is a common injury in elderly patients.The dynamic hip screw （DHS） has served as the standard choice for fixation; however it has several drawbacks.Studies of the percutaneous compression plate （PCCP） are still inconclusive in regards to its efficacy and safety.By comparing the two methods,we assessed their clinical therapeutic outcome.Methods：Atotal of 121 elderly patients with intertrochanteric femur fractures （type AO/OTA 31.A 1-A2,Evans type 1） were divided randomly into two groups undergoing either a minimally invasive PCCP procedure or a conventional DHS fixation.Results：The mean operation duration was significantly shorter in the PCCP group （55.2 min versus 88.5 min,P＜0.01）.The blood loss was 156.5 ml±18.3 ml in the PCCP group and 513.2 ml±66.2 ml in the DHS group （P＜0.01）.Among the patients treated with PCCP,3.1％ needed blood transfusions,compared with 44.6％ of those that had DHS surgery （P＜0.01）.The PCCP group displayed less postoperative complications （P＜0.05）.The mean American Society of Anesthesiologists score and Harris hip score in the PCCP group were better than those in the DHS group.There were no significant differences in the mean hospital stay,mortality rates,or fracture healing.Conclusion：Due to several advantages,PCCP has the potential to become the ideal choice for treating intertrochanteric fractures （type AO/OTA 31.A1-A2,Evans type 1）,particularly in the elderly.
文摘Objective:To introduce the experience of treating fracture of both tibia and fibula with micro-invasive percutaneous plate internal fixation through fracture site approach. Methods:The data of 15 patients(11 males and 4 females),including 14 adults(aged 22-73 years,mean=40 years)and 1 child(aged 10 years),with fracture of both tibia and fibula were studied retrospectively in this study.A small incision was made at the fracture site of tibia.Then reposition was made under direct vision,and internal fixation was employed with steel plates inserting through the small incision. Results:Anatomical reduction was obtained.No complication was found.Union occurred on time in 14 patients.One case healed after a second operation. Conclusions:Micro-invasive percutaneous plate internal fixation is beneficial to the healing of bone and soft tissues.Without X-ray examination,it is also easy to reach anatomical reduction and make tibial internal fixation with both plates with micro-invasive percutaneous plate internal fixation.
基金funded by Basic Public Welfare Plan of Zhejiang Province(LGF20H060008)Ningbo Science and technology Service Project(2020F029).
文摘Parpose:The study aims to compare the efficacy and safety of a new minimally invasive osteosynthesis technique with those of conventional open surgery for transverse patellar fractures.Methods:It was a retrospective study.Adult patients with closed transverse patellar fracture were included,and with open comminuted patellar fracture were excluded.These patients were divided into minimally invasive osteosynthesis technique(MIOT)group and open reduction and internal fixation(ORIF)group.Surgical time,frequency of intraoperative fluoroscopy,visual analogue scale score,flexion,extension,Lysholm knee score,infection,malreduction,implant migration and implant irritation in two groups were recorded and compared.Statistical analysis was performed by the SPsS software package(version 19).A p<0.05 indicated statistical significance.Results:A total of 55 patients with transverse patellar fractures enrolled in this study,the minimally invasive technique was performed in 27 cases,and open reduction was performed in 28 cases.The surgical time in the ORIF group was shorter than that in the MIOT group(p=0.033).The visual analogue scale scores in the MIOT group were significantly lower than those in the ORIF group only in the first month after surgery(p=0.015).Flexion was restored faster in the MIOT group than that in the ORIF group at one month(p=0.001)and three months(p=0.015).Extension was recovered faster in the MIOT group than that in the ORIF group at one month(p=0.031)and three months(p=0.023).The recorded Lysholm knee scores in the MIOT group were always greater than those in the ORIF group.Complications,such as infection,malreduction,implant migration,and implant irritation,occurred more frequently in the ORIF group.Conclusion:Compared with the ORIF group,the MIOT group reduced postoperative pain and had less complications and better exercise rehabilitation.Although it requires a long operation time,MIOT may be a wise choice for transverse patellar fractures.
文摘目的探讨关节镜辅助复位内固定(arthroscopically-assisted reduction and internal fixation,ARIF)结合加速康复外科(enhanced recovery after surgery,ERAS)理念与开放复位内固定(open reduction and internal fixation,ORIF)治疗胫骨平台后外侧骨折的临床疗效差异。方法回顾性选择2020年1月至2022年11月徐州市中心医院骨科胫骨平台后外侧骨折患者70例,根据治疗方法分为ARIF组(结合ERAS,n=32)和ORIF组(未结合ERAS,n=38)。所有患者住院后均通过影像学检查评估骨折类型,比较两组患者的手术时间、住院时间,采用视觉模拟量表(visual analogue scale,VAS)评估患者术后早期疼痛,美国特种外科医院(hospital for special surgery,HSS)评分评估患者术后3个月膝关节功能,比较两组患者术后6个月双侧大腿周径差值。结果ARIF组患者的手术时间显著短于ORIF组[(67.84±9.89)min vs(85.16±9.18)min,P<0.001],住院时间显著短于ORIF组[(7.13±1.41)d vs(8.74±1.84)d,P<0.001]。术后第3天,ARIF组的VAS评分显著低于ORIF组[(4.00±1.44)分vs(5.39±1.24)分,P<0.001]。术后3个月,ARIF组患者的膝关节功能显著优于ORIF组,术后6个月髌骨上10 cm大腿周径差值显著小于ORIF组(P<0.001)。结论与ORIF相比,接受ARIF结合ERAS治疗胫骨平台后外侧骨折的患者术后恢复更快、住院时间更短、临床疗效更确切。
