The feasibility of three-dimensional (3D) printing technology cgmbined with minimally invasive surgery in the treatment of pubic rami fractures was explored.From August 2015 to October 2017,a series of 30 patients who...The feasibility of three-dimensional (3D) printing technology cgmbined with minimally invasive surgery in the treatment of pubic rami fractures was explored.From August 2015 to October 2017,a series of 30 patients who underwent surgical stabilization of their anterior pelvic ring (all utilizing the 3D printing technology)by one surgeon at a single hospital were studied.The minimally invasive incisions were made through anterior inferior cilia spine and pubic nodule.Data collected included the operative duration,the blood loss,the damage of the important tissue,the biographic union and therecovery of the function after the operation.Measurements on inlet and outlet pelvic cardiograph were made immediately post-operation and at all follow-up clinic visits.The scores of reduction and function were measured during follow-up.Results showed that the wounds of 30 patients were healed in the first stage,and there was no injury of important structures such as blood vessels and nerves.According to the Matta criteria,excellent effectiveness was obtained in 22 cases and good in 8 cases.According to the functional evaluation criteria of Majeed,excellent effectiveness was obtained in 21 cases and good in 9 cases.It was suggested that the 3D printing technology assisted by minimally invasive surgery can better evaluate the pelvic fracture before operation,which was helpful in plate modeling, and can shorten surgery duration and reduce intraoperative blood loss and complications. The positioning accuracy was improved,and better surgical result was finally achieved.展开更多
Background: Traditional open instrumentation may cause surgical complications due to fragile bones and induce medical comorbidities in senile patients. Vertebroplasty and kyphoplasty are palliative augmentation proced...Background: Traditional open instrumentation may cause surgical complications due to fragile bones and induce medical comorbidities in senile patients. Vertebroplasty and kyphoplasty are palliative augmentation procedures that have been associated with increased risks of cement leakage, adjacent fractures and non-union. Objective: The aim of this study was to describe a novel approach for the union of osteoporotic vertebral compression fractures with minimally invasive open reduction and internal fixation. Patients and Methods: Seven consecutive patients with intractable back pain without neurological deficits due to osteoporotic vertebral compression fractures were treated using minimally invasive fixation with intra-vertebral expandable pillars and artificial bone substitute. The clinical symptoms and image findings were recorded. Results: All of the patients reported relief of back pain, and the height of the vertebral bodies was well restored. X-ray findings obtained 2 to 4 years after the procedures showed fracture healing and favorable formation of the callus confirmed in the anterior longitudinal ligament. Conclusion: This mini-open procedure with intravertebral devices is an effective and reliable technique for osteoporotic vertebral compression fractures and may avoid complications related to traditional open spinal instrumentation procedures and augmentation with bone cement.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
Objective:To investigate and analyze the long-term clinical effects of acupoint application combined with pneumatic compression therapy in the prevention of deep venous thrombosis after hip fracture surgery among the ...Objective:To investigate and analyze the long-term clinical effects of acupoint application combined with pneumatic compression therapy in the prevention of deep venous thrombosis after hip fracture surgery among the elderly.Methods:Sixty elderly patients who had undergone hip fracture surgery from February 2021 to February 2022 were selected as the research subjects.The patients were divided into two groups via drawing lots.Both the groups received nursing care,but the patients in the observation group were treated with TCM acupoint application combined with pneumatic compression therapy,whereas the control group received pneumatic compression therapy.The evaluation indicators included the patients’quality of life and complications.Results:The incidence of lower extremity deep vein thrombosis in the observation group was more than twice(0.3%),whereas the incidence of lower extremity complications in the control group was more than 6 times(20%).There was a significant difference between the two groups(p<0.05).Conclusion:Traditional Chinese medicine acupoint application combined with pneumatic compression therapy is beneficial for the prevention of postoperative lower extremity deep vein thrombosis among elderly patients.In addition,the patients’overall quality-of-life scores in both physiological and psychological aspects improved significantly,which carries significant clinical reference value.展开更多
Study Design: Original article. Objective: Guidelines for deciding whether to perform open or percutaneous surgery in burst fractures. Summary of Background Data: The authors propose an algorithm for deciding whether ...Study Design: Original article. Objective: Guidelines for deciding whether to perform open or percutaneous surgery in burst fractures. Summary of Background Data: The authors propose an algorithm for deciding whether to perform open surgery or percutaneous surgery with short fixation in patients with fractures of the thoracolumbar junction and lumbar spine. Methods: Between July 2005 and July 2009, 72 patients underwent surgical stabilization by posterior route for fractures of the thoracolumbar junction and lumbar spine. In 44 the lesion involved the thoracolumbar junction, in 28 the lumbar spine (L2 in6 cases, L3 in15 cases, L5 in7 cases). The fractures were assessed morphologically according to Magerl’s classification (52 type A, 12 type B, 8 type C). All patients were analyzed according to the algorithm proposed, according to which patients must fulfil certain criteria: the fracture must be Magerl type A.3, it must involve one level, McCormack score must be 6 or less, invasion of the spinal canal must be 25% or less according to Hashimoto’s formula, Magnetic Resonance Imating (MRI) must confirm discoligamentous integrity. Neurologically, the patient must be ASIA E. 25 patients (17 thoracolumbar junction, 8 lumbar spine) fulfilled these criteria and were treated by percutaneous short fixation. Results: The average length of the surgical procedure was 80 minutes and the loss of blood 10 cc. All patients were dismissed without brace and were submitted to follow-upComputed Tomography CTscan 3 and 6 months after surgery. Follow-up ranged from 6 months to 4 years. In all cases CT scan confirmed fusion and there were no cases of rupture of the device. None of the patients presented neurological deficits. Conclusion: The algorithm described permits a proper selection of patients with thoracolumbar fractures who can be treated by percutaneous short fixation, thus avoiding the risks connected with failure of the stabilization system.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
目的探讨骨质疏松性椎体压缩骨折(OVCF)合并胸腰筋膜损伤(TFI)患者在椎体强化术后的临床疗效。方法选取2022年11月至2023年8月川北医学院附属医院骨科收治的81例采用经皮椎体球囊后凸成形术(PKP)治疗的OVCF患者为研究对象,根据是否合并...目的探讨骨质疏松性椎体压缩骨折(OVCF)合并胸腰筋膜损伤(TFI)患者在椎体强化术后的临床疗效。方法选取2022年11月至2023年8月川北医学院附属医院骨科收治的81例采用经皮椎体球囊后凸成形术(PKP)治疗的OVCF患者为研究对象,根据是否合并TFI进行分组,将合并TFI的患者作为TFI组(n=36),未合并TFI患者作为NTFI组(n=45)。比较两组患者年龄、性别、住院时间、骨密度等一般资料;手术时间、术中出血量、伤椎节段(T10-L2、L3-I5)占比、单侧或双侧穿刺占比、骨水泥注射量等术中指标。分别采用视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评估患者腰部疼痛程度和腰椎功能改善情况。结果两组患者伤椎节段占比、手术时间、术中出血量、单或双侧穿刺占比比较,差异均无统计学意义(P>0.05)。两组患者术前、术后3 d VAS、ODI评分比较,差异均无统计学意义(P>0.05)。TFI组患者术后1、3个月VAS、ODI评分均高于NTFI组患者(P<0.05)。结论TFI组患者在采用PKP治疗后3个月内,腰椎疼痛缓解程度和腰椎功能改善情况均较NTFI组患者差,TFI可作为OVCF合并TFI患者在椎体强化术后临床疗效观察的有效指标。展开更多
文摘The feasibility of three-dimensional (3D) printing technology cgmbined with minimally invasive surgery in the treatment of pubic rami fractures was explored.From August 2015 to October 2017,a series of 30 patients who underwent surgical stabilization of their anterior pelvic ring (all utilizing the 3D printing technology)by one surgeon at a single hospital were studied.The minimally invasive incisions were made through anterior inferior cilia spine and pubic nodule.Data collected included the operative duration,the blood loss,the damage of the important tissue,the biographic union and therecovery of the function after the operation.Measurements on inlet and outlet pelvic cardiograph were made immediately post-operation and at all follow-up clinic visits.The scores of reduction and function were measured during follow-up.Results showed that the wounds of 30 patients were healed in the first stage,and there was no injury of important structures such as blood vessels and nerves.According to the Matta criteria,excellent effectiveness was obtained in 22 cases and good in 8 cases.According to the functional evaluation criteria of Majeed,excellent effectiveness was obtained in 21 cases and good in 9 cases.It was suggested that the 3D printing technology assisted by minimally invasive surgery can better evaluate the pelvic fracture before operation,which was helpful in plate modeling, and can shorten surgery duration and reduce intraoperative blood loss and complications. The positioning accuracy was improved,and better surgical result was finally achieved.
文摘Background: Traditional open instrumentation may cause surgical complications due to fragile bones and induce medical comorbidities in senile patients. Vertebroplasty and kyphoplasty are palliative augmentation procedures that have been associated with increased risks of cement leakage, adjacent fractures and non-union. Objective: The aim of this study was to describe a novel approach for the union of osteoporotic vertebral compression fractures with minimally invasive open reduction and internal fixation. Patients and Methods: Seven consecutive patients with intractable back pain without neurological deficits due to osteoporotic vertebral compression fractures were treated using minimally invasive fixation with intra-vertebral expandable pillars and artificial bone substitute. The clinical symptoms and image findings were recorded. Results: All of the patients reported relief of back pain, and the height of the vertebral bodies was well restored. X-ray findings obtained 2 to 4 years after the procedures showed fracture healing and favorable formation of the callus confirmed in the anterior longitudinal ligament. Conclusion: This mini-open procedure with intravertebral devices is an effective and reliable technique for osteoporotic vertebral compression fractures and may avoid complications related to traditional open spinal instrumentation procedures and augmentation with bone cement.
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Objective:To investigate and analyze the long-term clinical effects of acupoint application combined with pneumatic compression therapy in the prevention of deep venous thrombosis after hip fracture surgery among the elderly.Methods:Sixty elderly patients who had undergone hip fracture surgery from February 2021 to February 2022 were selected as the research subjects.The patients were divided into two groups via drawing lots.Both the groups received nursing care,but the patients in the observation group were treated with TCM acupoint application combined with pneumatic compression therapy,whereas the control group received pneumatic compression therapy.The evaluation indicators included the patients’quality of life and complications.Results:The incidence of lower extremity deep vein thrombosis in the observation group was more than twice(0.3%),whereas the incidence of lower extremity complications in the control group was more than 6 times(20%).There was a significant difference between the two groups(p<0.05).Conclusion:Traditional Chinese medicine acupoint application combined with pneumatic compression therapy is beneficial for the prevention of postoperative lower extremity deep vein thrombosis among elderly patients.In addition,the patients’overall quality-of-life scores in both physiological and psychological aspects improved significantly,which carries significant clinical reference value.
文摘Study Design: Original article. Objective: Guidelines for deciding whether to perform open or percutaneous surgery in burst fractures. Summary of Background Data: The authors propose an algorithm for deciding whether to perform open surgery or percutaneous surgery with short fixation in patients with fractures of the thoracolumbar junction and lumbar spine. Methods: Between July 2005 and July 2009, 72 patients underwent surgical stabilization by posterior route for fractures of the thoracolumbar junction and lumbar spine. In 44 the lesion involved the thoracolumbar junction, in 28 the lumbar spine (L2 in6 cases, L3 in15 cases, L5 in7 cases). The fractures were assessed morphologically according to Magerl’s classification (52 type A, 12 type B, 8 type C). All patients were analyzed according to the algorithm proposed, according to which patients must fulfil certain criteria: the fracture must be Magerl type A.3, it must involve one level, McCormack score must be 6 or less, invasion of the spinal canal must be 25% or less according to Hashimoto’s formula, Magnetic Resonance Imating (MRI) must confirm discoligamentous integrity. Neurologically, the patient must be ASIA E. 25 patients (17 thoracolumbar junction, 8 lumbar spine) fulfilled these criteria and were treated by percutaneous short fixation. Results: The average length of the surgical procedure was 80 minutes and the loss of blood 10 cc. All patients were dismissed without brace and were submitted to follow-upComputed Tomography CTscan 3 and 6 months after surgery. Follow-up ranged from 6 months to 4 years. In all cases CT scan confirmed fusion and there were no cases of rupture of the device. None of the patients presented neurological deficits. Conclusion: The algorithm described permits a proper selection of patients with thoracolumbar fractures who can be treated by percutaneous short fixation, thus avoiding the risks connected with failure of the stabilization system.
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。
文摘目的探讨骨质疏松性椎体压缩骨折(OVCF)合并胸腰筋膜损伤(TFI)患者在椎体强化术后的临床疗效。方法选取2022年11月至2023年8月川北医学院附属医院骨科收治的81例采用经皮椎体球囊后凸成形术(PKP)治疗的OVCF患者为研究对象,根据是否合并TFI进行分组,将合并TFI的患者作为TFI组(n=36),未合并TFI患者作为NTFI组(n=45)。比较两组患者年龄、性别、住院时间、骨密度等一般资料;手术时间、术中出血量、伤椎节段(T10-L2、L3-I5)占比、单侧或双侧穿刺占比、骨水泥注射量等术中指标。分别采用视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评估患者腰部疼痛程度和腰椎功能改善情况。结果两组患者伤椎节段占比、手术时间、术中出血量、单或双侧穿刺占比比较,差异均无统计学意义(P>0.05)。两组患者术前、术后3 d VAS、ODI评分比较,差异均无统计学意义(P>0.05)。TFI组患者术后1、3个月VAS、ODI评分均高于NTFI组患者(P<0.05)。结论TFI组患者在采用PKP治疗后3个月内,腰椎疼痛缓解程度和腰椎功能改善情况均较NTFI组患者差,TFI可作为OVCF合并TFI患者在椎体强化术后临床疗效观察的有效指标。