Clinical Effectiveness of the Plate Screw Internal Fixation Technique in the Treatment of Patients with Traumatic Fractures of Long Bones in the Lower Extremities

Objective: To investigate the effectiveness of the plate screw internal fixation technique on the clinical outcomes of patients with traumatic fractures of long bones in the lower extremities. Methods: From January 2022 to December 2023, 70 patients with traumatic fractures of long bones in the lower extremities were admitted to the hospital and randomly divided into two groups: the control group and the observation group, each consisting of 35 cases. The control group underwent traditional closed interlocking intramedullary nailing, while the observation group received internal fixation with steel plates and screws. Relevant surgical indicators, treatment effectiveness, and postoperative complication rates were compared between the two groups. Results: The observation group exhibited significantly short surgical duration (80.65 ± 5.01 vs. 88.36 ± 5.26 minutes), fracture healing time (13.27 ± 0.32 vs. 15.52 ± 0.48 weeks), and hospitalization days (10.49 ± 1.13 vs. 16.57 ± 1.15 days) compared to the control group (P = 0.000). The effective treatment rate was significantly higher in the observation group (29/82.86%) than in the control group (21/60.00%), with a significant difference observed (χ2 = 4.480, P = 0.034). Additionally, the complication rate in the observation group (2/5.71%) was significantly lower than that in the control group (8/22.86%), with a correlated difference (χ2 = 4.200, P = 0.040). Conclusion: The plate screw internal fixation technique demonstrates significant clinical efficacy in treating traumatic fractures of long bones in the lower extremities. It improves the healing rate, reduces complications, and represents a safe and effective treatment strategy worthy of widespread use and application.

Meta-analysis of the efficacy of volar plate internal fixation versus closed reduction and external fixation in the treatment of adult distal radius fractures

Objective:To compare the efficacy of open reduction and volar locking plate internal fixation with closed reduction and external fixation in the treatment of distal radius fractures by using meta analysis.Methods:The databases of CNKI,Wanfang,Weipu,Chinese biomedical literature,Pubmed,Embase,and Cochrane Library were retrieved,and the randomized controlled studies that directly compared the efficacy of plate internal fixation and closed reduction external fixation in the treatment of distal radius fractures published publicly from the establishment of the database to April 2023 were collected.The two researchers independently screened the retrieved literature according to the inclusion and exclusion criteria,extracted data,used Cochrane risk bias assessment tool for quality assessment,and used RevMan 5.4 software for meta analysis.Results:A total of 10 randomized controlled trials were included,all of which were in English.There were 1042 patients in total,and 9 of them were rated as low risk.Meta analysis results showed that one year after the treatment of distal radius fracture with volar locking plate internal fixation,DASH score[MD=-5.64,95%CI(-7.21,-4.06),P<0.00001];One year later,PRWE score[MD=-5.90,95%CI(-8.88,-2.92),P=0.001];Palm flexion[MD=5.92,95%CI(1.29,10.55),P=0.01];Pronation[MD=2.48,95%CI(0.59,4.36),P=0.01];Postrotation[MD=4.73,95%CI(2.15,7.31),P=0.0003];Grip strength[MD=0.61,95%CI(0.12,1.10),P=0.02];palmar tilt angle[MD=9.84,95%CI(5.66,14.02),P<0.00001];Radial inclination[MD=4.33,95%CI(2.97,5.69),P<0.00001]was superior to closed reduction plaster or splint external fixation.One year later,the European Five dimensional Health Scale(EQ-5D-5L)score[MD=0.02,95%CI(-0.01,0.05),P=0.27];Back extension[MD=2.22,95%CI(-4.15,8.59),P=0.49];Ulnar deviation[MD=3.49,95%CI(-0.80,7.78),P=0.11];Radial deviation[MD=2.05,95%CI(-2.39,6.50),P=0.37];Ulnar variance[MD=-1.14,95%CI(-3.16,0.88),P=0.27];There was no significant difference in complications[MD=0.77,95%CI(0.54,1.10),P=0.16](P>0.05).Conclusion:Based on the current clinical data,internal fixation with volar locking plate is more conducive to mid-term DASH score and grip strength recovery than closed reduction plaster or splint external fixation,but there is no significant difference in the quality of life and complications of patients.For adult distal radius fractures,surgical indications should be carefully grasped,and non operative treatment should be given priority.

Comparison of Clinical Effect of PFNA and Internal Fixation with Anatomical Locking Plate of Proximal Femur in Treatment of Intertrochanteric Fracture of Femur

Purpose:To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods:The study group is treated with PFNA internal fixation.The control group is treated by internal fixation with anatomical locking plate of proximal femur.Results:The time of operation,the amount of intraoperative bleeding and the time of fracture healing in the study group are significantly less than those in the control group.The incidence rate of complication in the study group(3.23%)is significantly lower than that in the control group(17.2%).Data comparison shows P<0.05.Conclusion:The curative effect and prognosis for patients with intertrochanteric fracture of femur treated by PFNA internal fixation are more ideal.

Comparison of Clinical Effect of PFNA and Internal Fixation with Anatomical Locking Plate of Proximal Femur in Treatment of Intertrochanteric Fracture of Femur

Purpose To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods The study group is treated with PFNA internal fixation.The control group is treated by internal fixation with anatomical locking plate of proximal femur.Results The time of operation,the amount of intraoperative bleeding and the time of fracture healing in the study group are significantly less than those in the control group.The incidence rate of complication in the study group(3.23%)is significantly lower than that in the control group(17.2%).Data comparison shows P<0.05.Conclusion The curative effect and prognosis for patients with intertrochanteric fracture of femur treated by PFNA internal fixation are more ideal.

Treatment of a femoral neck fracture combined with ipsilateral femoral head and intertrochanteric fractures: A case report

BACKGROUND This article presents a rare case of a complex hip fracture involving the ipsilateral femoral neck,trochanter,and femoral head,that was accompanied by hip dislocation.Currently,there is no established standard treatment method for this specific type of fracture.Therefore,it is crucial to comprehensively consider factors such as patient age,fracture type,and degree of displacement to achieve a successful outcome.CASE SUMMARY A 38-year-old man sustained a comminuted fracture of his right hip as a result of a car accident.The injuries included a fracture of the femoral head,a fracture of the femoral neck,an intertrochanteric fracture of the femur,and a posterior dislocation of the hip on the same side.We opted for a treatment approach combining the use of a proximal femoral locking plate,cannulated screws,and Kirschner wires.Following the surgery,we developed an individualized rehabil-itation program to restore patient limb function.CONCLUSION For this complex fracture,we selected appropriate internal fixation and for-mulated individualized rehabilitation,which ultimately achieved good results.

Usage of buttress plate internal fixation associated with autografting of fibula and iliac bone for the treatment of distal femoral C_3 type fracture

To assess the effect of using buttress plate associated with antografting of fibula and iliac bone for the treatment of distal femoral C3 type fracture.Methods Seventeen cases of distal femoral C3 type fracture using buttress plate associated with antografting of fibula and iliac bone were analyzed retrospectively.Results All cases were followed up for an average of 24 months（8～55 months）.The average time of octets bridge forming were 4 months（3～5 months） while the average time for bone union were 8 months （6～14 months）.According to Shelbourne rating system,result of all 18 cases were excellent and no malunion,infection were found.Conclusion Buttress plate associated with antografting of fibula and iliac bone is an effective alternative for the treatment of distal femoral C3 type fracture.It can provide more stable fixation to the bone and earlier functional exercises can be achieved.5 refs,3 figs,1 tab.

The Use of Calcaneal Anatomic Plate in Arthroscopically-assisted Open Reduction and Internal Fixation of Intra-articular Calcaneal Fractures

To discuss and evaluate the method and effect of using calcaneal anatomic plate in treatment of intra-articular fractures of the calcaneus with assistant of arthroscope, 86 intra-articular fractures of the calcaneus in 78 patients were reduced by open reduction, and rigid fixation was made with calcaneal anatomic plate under assistant of arthroscope. The average follow-up duration was 18 months （range 12-30 months）. The effect of treatment was evaluated according to AOFAS and X-ray before and after operation. The results showed that 86 patients have obtained satisfactory reduction according to X-ray, and there was significant difference before and after operation （P〈0. 01）, the total excellent and fine rate was 91.86%. Treating intra-articular fractures of the calcaneus with calcaneal anatomic plate under arthroscope may provide more chance to achieve anatomical reconstruction, which can lead to satisfied recovery of function and few complication.

Effects of bridge combined internal fixation system internal fixation on fracture healing and shoulder joint function in elderly patients with displaced midshaft clavicle fractures

Objective:To compare the clinical therapeutic effect of bridge combined internal fixation system and locking compression plate internal fixation in the treatment of displaced midshaft clavicle fractures by emphatically observing fracture healing and shoulder joint function.Methods:Totally 44 elderly patients with Robinson type 2B displaced midshaft clavicle fractures were included from the Department of Orthopaedics,Shenyang Fourth People's Hospital during February 2016 and December 2018,including 23 males and 21 females,mean age(69.8±10.2)years old.The patients were divided into a bridge combined internal fixation system group(bridge group,n=22)and a locking compression plate internal fixation group(plate group,n=22)according to the internal fixation methods.The operation time,intraoperative blood loss,fracture healing time,and postoperative complications were recorded.At 12 months after surgery,the shoulder joint Constant-Murley score and DASH score were used to assess the recovery of joint function.The serum levels of bone turnover biochemical markers procollagen I N-terminal peptide(P1NP),cross-linked Carboxy-terminal telopeptide of typeⅠcollagen(CTX-I),and osteoblast specific factor(OSF)were measured before and 3 months after surgery.Results:The operation time,intraoperative blood loss and fracture healing time of the bridge group were significantly shorter than those of the plate group(P<0.05).Constant scores and DASH scores in the bridge group were significantly better than those of the plate group at 12 months after surgery(P<0.05).Serum levels of CTX-I was significantly decreased,while the P1NP and OSF were significantly increased compared with before surgery in the both groups(P<0.05),and the changes were more obvious in the bridge group(P<0.05).The incidence of complications was similar between the two groups(P<0.05).Conclusion:Compared with the locking plate system,the bridge combined internal fixation system can effectively improve the operation efficiency,have more benefits on fracture healing,better promote the recovery of patients'function,and reduce the failure rate of internal fixation,thus providing a better choice to treat displaced midshaft clavicle fractures by intraoperative internal fixation.

Effect of locking compression plate internal fixation on the injury extent and bone metabolism of Robinson 2A and 2B middle clavicular fractures

Objective:To investigate the effect of locking compression plate internal fixation on the injury extent and bone metabolism of Robinson 2A and 2B middle clavicular fractures.Methods:Totally 80 cases of patients with Robinson 2A and 2B middle clavicular fractures admitted to our hospital between March 2017 and January 2019 were divided into the control group(n=41)receiving conventional kirschner wire internal fixation and the observation group(n=39)receiving locking compression plate internal fixation according to the operation plans.The differences in serum contents of inflammatory factors,oxidative stress indexes and bone metabolism indexes were compared between the two groups of patients before patients entered operating room,24 h after surgery and 48 h after surgery.Results:Before patients entered operating room,there were no statistically significant differences in the serum contents of inflammatory factors,oxidative stress indexes or bone metabolism indexes between the two groups(P>0.05).At 24 h and 48 h after surgery,serum inflammatory factors interleukin-1(IL-1),interleukin-17(IL-17),high-sensitivity C-reactive protein(hs-CRP)and tumor necrosis factorα(TNF-α)contents in the observation group were lower than those in the control group;serum reactive oxygen species(ROS)and lipid hydroperoxide(LHP)contents were lower than those in the control group,while catalase(CAT)and glutathione peroxidase(GSH-Px)contents were higher than those in the control group;serum N-terminal propeptide of procollagen type I(PINP),bone gla protein(BGP)and alkaline phosphatase(ALP)contents were higher than those in the control group,while N-telopeptide of typeⅠcollagen(NTX),C-telopeptide of typeⅠcollagen(CTX)and tartrate-resistant acid phosphatase 5b(TRACP5b)contents were lower than those in the control group(P<0.05).Conclusion:Locking compression plate internal fixation can reduce the postoperative trauma extent and help promote the fracture healing in patients with Robinson 2A and 2B middle clavicular fracture.

不同入路内固定在老年SandersⅢ型跟骨骨折中的应用及对骨折复位、疼痛介质的影响

目的对比不同入路内固定在老年SandersⅢ型跟骨骨折中的应用及对患者骨折复位、疼痛介质的影响。方法选取2019年3月-2022年9月确诊的老年SandersⅢ型跟骨骨折患者80例,依据随机数字表法分成跗骨窦组、传统组,各40例。其中传统组行L形切口入路钢板内固定,跗骨窦组行跗骨窦“八”字切口入路钢板内固定。对比两组围术期指标、并发症状况、跟骨恢复效果以及围术期疼痛介质[P物质(SP)、前列腺素E2(PGE2)、5-羟色胺(5-HT)]、骨折复位状况(跟骨高度、Bohler角、Gissane角)。结果跗骨窦组住院时间与术中出血量均少于传统组(P<0.05);术后6个月,跗骨窦组、传统组跟骨恢复效果对比,差异无统计学意义(P>0.05);两组术后3个月、6个月跟骨高度、Bohler角、Gissane角均高于术前(P<0.05);跗骨窦组术后24 h、72 h血清SP、PGE2、5-HT水平均低于传统组(P<0.05);跗骨窦组并发症发生率明显低于传统组(P<0.05)。结论跗骨窦“八”字切口入路钢板内固定治疗老年SandersⅢ型跟骨骨折,可促进跟骨功能恢复,缓解术后疼痛,减少并发症发生。

空心钉联合跗骨窦入路钢板固定在SandersⅡ、Ⅲ型跟骨骨折患者中的应用

目的探讨空心钉联合跗骨窦入路钢板固定在SandersⅡ、Ⅲ型跟骨骨折患者中的应用。方法选取2021年1月—2023年10月新疆生产建设兵团第三师医院收治的100例SandersⅡ、Ⅲ型跟骨骨折患者为研究对象,按随机数字表法将其分为对照组和观察组,每组50例。对照组采用外侧L形入路钢板固定治疗,观察组采用空心钉联合跗骨窦入路钢板固定治疗。对比两组患者的手术情况、影像学指标、足踝功能、日常生活能力、疼痛程度、生活质量及并发症发生情况。结果观察组手术、住院时间均短于对照组,术中出血量、术后引流量均少于对照组,组间差异有统计学意义(P<0.05)。术后,观察组美国足与踝关节协会踝与后足功能评分系统评分、Barthel指数评定量表评分、世界卫生组织生活质量测定量表简表评分均高于对照组,疼痛视觉模拟评分低于对照组,组间差异有统计学意义(P<0.05)。观察组并发症发生率为4.00%,低于对照组的16.00%,差异有统计学意义(P<0.05)。两组术前、术后影像学指标对比,组间差异无统计学意义(P>0.05)。结论空心钉联合跗骨窦入路钢板固定治疗跟骨骨折的效果更佳,可减轻手术创伤,加快足踝功能恢复,减少术后并发症的发生。

三维组架螺钉与环形钢板治疗Sanders ⅢAB型跟骨骨折的有限元分析

目的 探讨三维组架螺钉与环形钢板对SandersⅢAB型跟骨骨折的生物力学稳定性的影响。方法 收集1名26岁志愿者跟骨CT和MRI数据,建立SandersⅢAB型跟骨骨折的三维有限元模型,分别使用三维组架螺钉与环形钢板固定,施加700 N纵向载荷,比较不同模型骨块及内固定应力与位移变化情况。结果 在700 N纵向载荷下,两组模型骨块最大位移以及骨块与内固定最大应力均集中于后距关节面内固定与骨折线相交处。三维组架螺钉模型与环形钢板模型骨块整体位移相近。相较于环形钢板模型,三维组架螺钉模型骨块及内固定的最大应力和平均应力更小,位移与应力变化情况更接近完整跟骨模型。结论 SandersⅢAB型跟骨骨折固定时,三维组架螺钉与环形钢板两种固定方式均能提供良好稳定性。三维组架螺钉的生物力学性能优于环形钢板,更符合生物力学特点。

三维组架螺钉与微创钢板固定SandersⅢ型跟骨骨折的有限元分析

背景:经皮复位加压固定的三维组架螺钉内固定在治疗SandersⅢ型跟骨骨折上已经取得了满意的临床疗效,但在生物力学方面是否可以达到微创钢板内固定的稳定性,以及对比之后的优势与缺点还不得而知。目的:通过有限元分析方法探讨不同内固定装置对SandersⅢ型跟骨骨折的固定效果。方法:选择1名26岁成年健康男性志愿者,根据其跟骨CT数据制作SandersⅢ型跟骨骨折有限元模型。选用经皮微创三维组架螺钉、跗骨窦微创钢板分别固定跟骨骨折模型,分别施加350,700N纵向载荷,分析2种模型的位移、应力分布情况,比较各种模型的稳定性。结果与结论:①三维组架螺钉模型中骨块与内植物的峰值应力明显低于微创钢板模型,三维组架螺钉模型中骨块与内植物的平均应力也明显低于微创钢板模型;②2种模型的最大位移均位于后距关节面内侧,三维组架螺钉模型的最大位移小于微创钢板模型;③微创钢板模型前突骨块与内侧骨块的纵向位移更小,三维组架螺钉模型内侧骨块与中段骨块的横向与垂直位移更小;④提示2种内固定模型均能提供满意的固定效果,其中三维组架螺钉模型使应力分布更均匀、骨块综合位移更小,能提供更好的横向与垂直稳定性,而微创钢板在维持纵向稳定性上更具优势。

A Biomechanical Comparison of Conventional versus an Anatomic Plate and Compression Bolts for Fixation of Intra-articular Calcaneal Fractures

The purpose of this study was to compare the biomechanical stability obtained by using our technique featured an anatomical plate and compression bolts versus that of the conventional anatomic plate and cancellous screws in the fixation of intraarticular calcaneal fractures.Eighteen fresh frozen lower limbs of cadavers were used to create a reproductive Sanders type-Ⅲ calcaneal fracture model by using osteotomy.The calcaneus fractures were randomly selected to be fixed either using our anatomical plate and compression bolts or conventional anatomic plate and cancellous screws.Reduction of fracture was evaluated through X radiographs.Each calcaneus was successively loaded at a frequency of 1 Hz for 1000 cycles through the talus using an increasing axial force 20 N to 200 N and 20 N to 700 N,representing the partial weight bearing and full weight bearing,respectively,and then the specimens were loaded to failure.Data extracted from the mechanical testing machine were recorded and used to test for difference in the results with the Wilcoxon signed rank test.No significant difference was found between our fixation technique and conventional technique in displacement during 20-200 N cyclic loading(P=0.06),while the anatomical plate and compression bolts showed a great lower irreversible deformation during 20-700 N cyclic loading(P=0.008).The load achieved at loss of fixation of the constructs for the two groups had significant difference:anatomic plate and compression bolts at 3839.6±152.4 N and anatomic plate and cancellous screws at 3087.3±58.9 N(P=0.008).There was no significant difference between the ultimate displacements.Our technique featured anatomical plate and compression bolts for calcaneus fracture fixation was demonstrated to provide biomechanical stability as good as or better than the conventional anatomic plate and cancellous screws under the axial loading.The study supports the mechanical viability of using our plate and compression bolts for the fixation of calcaneal fracture.

PFNA2 versus 95 Degree Condylar Blade Plate in the Management of Unstable Trochanteric Fractures

Purpose: The proximal femoral nail anti-rotation (PFNA) is known to have advantages in enhancing the anchorage ability of internal fixation in elderly unstable osteoporotic intertrochanteric fracture patients. However whether it is superior to condylar blade fixation is not clear. This study aimed to determine which treatment has better clinical outcomes in older patients. Materials and Methods: A total of 86 patients over the age of 60 with unstable trochanteric fractures within the past 3 weeks, were included in this prospective study conducted from June 1, 2018, to May 31, 2021. All the intertrochanteric fractures were classified according to AO/OTA classification. Among them, 44 cases were treated with the Proximal Femoral Nail (PFNA2) with or without an augmentation screw, and 42 cases were treated with the Condylar Blade Plate. In addition, the operative time, intraoperative blood loss, intraoperative and postoperative blood transfusion, postoperative weight-bearing time, hospitalization time, Harris score of hip function, Kyle’s criteria and postoperative complications were compared between the two groups. Results: The mean duration of surgery for the PFN group was 66.8 minutes (on average), whereas for the condylar blade plate group, it was 99.30 minutes (on average). The PFNA2 group experienced less blood loss (average of 80 mL) compared to the condylar blade plate group (average of 120 mL). Union and partial weight-bearing occurred earlier in the PFNA2 group (14.1 weeks and 10.6 weeks, respectively) compared to the Condylar blade plate group (18.7 weeks and 15.8 weeks). In two patients from the PFNA2 group, screw backing out and varus collapse complications were encountered;however, these patients remained asymptomatic and did not require revision surgery. In two other patients, screw cut out and breakage of the nail at the helical screw hole leading to non-union of the proximal femur were observed during the nine-month follow-up, necessitating revision surgery with prosthetic replacement. Among the condylar blade plate group, three patients experienced complications, including blade breakage at the blade and plate junction. In two cases, the fracture united in varus, and in one case, the blade cut through, resulting in non-union of the femoral head, which required revision surgery. According to the Harris hip score and Kyle’s criteria, a good-excellent outcome was observed in 92.85% of cases in the PFNA2 group and 90.90% of cases in the condylar blade plate group. Conclusion: Both the Proximal Femoral Nail A2 and Condylar blade plate are effective implants for the treatment of unstable trochanteric fractures. The intramedullary implant promotes biological healing and allows for early ambulation with minimal complications. Similarly satisfactory restoration of anatomy and favorable radiological and functional results can be achieved with the biological fixation provided by the 95-degree condylar blade plate. However, the use of PFNA2 internal fixation technique has the advantage of less trauma in elderly patients than the 95-degree condylar blade plate.

The application of C1-C2 pedicle screw internal fixation on the upper cervical diseases of children

Objective To report five cases of puerile (【9 years) atlantoaxial instability which underwent C1-C2 pedicle screw internal fixation by posterior approach,and to introduce the surgical technique and the key point

Clinical application of improved 2D computer-assisted fluoroscopic navigation through simulating a 3D vertebrae image to guide pedicle screw internal fixation

Objective To study the effect of using improved 2D computer-assisted fluoroscopic navigation through simulating 3D vertebrae image to guide pedicle screw internal fixation.Methods Posterior pedicle screw internal fixation,distraction

传统手法结合距下关节镜复位与经跗骨窦入路治疗SandersⅡ型跟骨骨折的疗效比较

【目的】探讨中医传统手法结合距下关节镜复位与经跗骨窦入路治疗SandersⅡ型跟骨骨折的临床疗效。【方法】将80例SandersⅡ型跟骨骨折患者随机分为对照组和研究组,每组各40例。对照组给予跗骨窦切开复位钢板内固定治疗,研究组给予中医传统手法结合距下关节镜复位螺钉内固定治疗。比较2组患者的手术情况(包括术中出血量及手术时间)、术后疼痛程度视觉模拟量表(VAS)评分、骨折愈合时间、并发症发生情况的差异以及手术前后足部功能美国足踝外科学会(AOFAS)踝-后足评分、Böhler角、Gissane角的变化情况。【结果】(1)研究组的术中出血量较对照组明显减少,术后疼痛程度VAS评分较对照组明显降低,手术时间及术后骨折愈合时间较对照组明显缩短,差异均有统计学意义(P<0.05或P<0.01)。(2)术后3、6、9个月,2组患者的AOFAS踝-后足评分均较术前明显提高(P<0.05),且研究组患者术后3个月和12个月的AOFAS踝-后足评分均明显高于对照组,差异均有统计学意义(P<0.05或P<0.01)。(3)术后3、6、12个月,2组患者的Böhler角、Gissane角均较术前明显增大(P<0.05),且均逐步恢复至正常范围内;组间比较,研究组术后3、6、12个月对Böhler角的改善作用均明显优于对照组(P<0.05),而2组患者术后各时间段的Gissane角比较,差异均无统计学意义(P>0.05)。(4)研究组的并发症发生率为7.50%(3/40),明显低于对照组的27.50%(11/40),差异有统计学意义(P<0.05)。【结论】针对SandersⅡ型跟骨骨折患者,采用中医传统手法结合距下关节镜螺钉内固定及跗骨窦切口进行治疗,均有良好的效果,但相对于后者,前者更微创,可有效缩短手术时间及骨折愈合时间,降低并发症发生率,患者术后疼痛程度更轻,医疗体验更优。中医传统手法结合距下关节镜螺钉内固定治疗SandersⅡ型跟骨骨折符合当前微创的潮流,也是将中医传统手法与现代微创技术相结合的尝试。

Application of a new anatomic hook-rod-pedicle screw system in young patients with lumbar spondylolysis:A pilot study

BACKGROUND The pedicle screw-laminar hook system has strong fixation and is conducive to bone graft fusion for lumbar spondylolysis.However,the current pedicle screwlaminar hook fixation system is not specifically designed for lumbar spondylolysis.AIM To investigate the clinical effects of a new anatomical hook-rod-pedicle screw system in the treatment of lumbar spondylolysis in young adults.METHODS We designed a new anatomic hook-rod-pedicle screw system for young patients with lumbar spondylolysis.The isthmus and the corresponding pedicle screw entry point were exposed through the intermuscular approach.Autogenous iliac bone graft was obtained to bridge the isthmus defect,and then the anatomic hook-rod-pedicle screw system was used to fix the isthmus in 15 young patients.RESULTS At 24 mo follow-up,the visual analogue scale score of low back pain decreased from 6.73±0.88 to 0.73±0.59,and the Oswestry disability index score decreased from 58.20±8.99 to 7.87±4.97.Computed tomography showed bilateral isthmic bone healing in 14 cases and unilateral isthmic bone healing in 1 case.Magnetic resonance imaging showed that the lumbar disc signal of diseased segment and adjacent segments had no change compared with that before surgery.The pain visual analogue scale score of the donor site was 0.20±0.41 at the last follow-up.According to the Modified Macnab score,the excellent and good rate was 100%.CONCLUSION The application of this new anatomical hook-rod-pedicle screw system to treat young patients with lumbar spondylolysis has the advantages of less trauma,a simple operation and satisfactory clinical effects.