Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified techn...Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified technique, the Watson Jones approach (WJA) without image intensifier nor traction table, can allow open reduction and internal fixation (ORIF) of PFF using Dynamic hip screw (DHS), with satisfactory outcome. Patients and methods: Forty one consecutive patients (mean age 59.5 ± 21.6 years, 61% males) who were followed in a Teaching Hospital for PFF treated by ORIF using the WJA and DHS from January 2016 to December 2020 were reassessed. The outcome measures were the quality of the reduction, the positioning of the implants, the tip-apex distance (TAD), the rate and delay of consolidation, the functional results using Postel Merle d’Aubigné (PMA) score, the rate of surgical site infection (SSI) and the overall mortality. Logistic regression was used to determine factors associated with mechanical failure. Results: The mean follow-up period was 33.8 ± 15.0 months. Fracture reduction was good in 31 (75.6%) cases and acceptable in 8(19.5%) cases. Implant position was fair to good in 37 (90.2%) patients. The mean TAD was 26.1 ± 3.9 mm. Three patients developed SSI. Consolidation was achieved in 38 (92.6%) patients. The functional results were good to excellent in 80.5% of patients. The overall mortality rate was 7.3%. There were an association between mechanical failure and osteoporosis (p = 0.04), fracture reduction (p = 0.003), and TAD (p = 0.025). In multivariate logistic regression, no independent factors were predictive of mechanical failure. Conclusion: This study shows that ORIF using DHS for PFF via the Watson-Jones approach without an image intensifier can give satisfactory anatomical and functional outcomes in low-resource settings. It provides and validates a reliable and reproducible technique that deserves to be diffused to surgeons in austere areas over the world.展开更多
目的比较腹腔镜下≥10 mm trocar切口腹腔内和腹腔外2种缝合术的临床效果。方法选取2017年3月~2023年3月我院妇科腹腔镜手术138例,按入院时间顺序分为2组:2017年3月~2020年3月传统组(腹腔镜手术腹腔外缝合皮肤及皮下组织,进行10~12 mm...目的比较腹腔镜下≥10 mm trocar切口腹腔内和腹腔外2种缝合术的临床效果。方法选取2017年3月~2023年3月我院妇科腹腔镜手术138例,按入院时间顺序分为2组:2017年3月~2020年3月传统组(腹腔镜手术腹腔外缝合皮肤及皮下组织,进行10~12 mm切口关闭)53例,2020年4月~2023年3月改良组(腹腔镜下腹腔内缝合筋膜、腹膜,进行10~12 mm切口关闭)85例,比较2组术后切口并发症情况。结果改良组术后切口液化1例,无其他并发症;传统组术后切口出血1例、切口感染2例、切口液化1例、切口裂开1例、切口疝1例。改良组术后切口并发症发生率1.2%(1/85),显著低于传统组11.3%(6/53)(χ^(2)=5.029,P=0.025)。结论妇科腹腔镜手术在腹腔镜下腹腔内缝合≥10 mm切口,术后切口并发症发生率明显降低,但操作难度较大,缝合技术要求高。展开更多
目的分析距下关节镜联合后侧小切口与跗骨窦切口在跟骨骨折患者中的应用效果。方法筛选2018年12月至2022年12月聊城市第二人民医院收治的100例跟骨骨折患者,根据随机数表法分为关节镜组和跗骨窦组各50例。关节镜组男32例,女18例,平均年...目的分析距下关节镜联合后侧小切口与跗骨窦切口在跟骨骨折患者中的应用效果。方法筛选2018年12月至2022年12月聊城市第二人民医院收治的100例跟骨骨折患者,根据随机数表法分为关节镜组和跗骨窦组各50例。关节镜组男32例,女18例,平均年龄(43.58±7.13)岁;给予距下关节镜联合后侧小切口治疗。跗骨窦组男34例,女16例,平均年龄(43.12±7.46)岁;给予跗骨窦切口治疗。对比两组手术相关指标及手术前后疼痛视觉模拟评分(visual analog score,VAS)、B hler角及Gissane角变化,术后12个月踝-后足功能优良率和并发症发生率。结果术后关节镜组随访(11.16±1.02)个月,跗骨窦组随访(11.24±1.06)个月。关节镜组住院时间和骨折愈合时间明显少于跗骨窦组(P<0.05);关节镜组术后12个月VAS评分明显低于跗骨窦组,关节镜组B hler角及Gissane角均明显高于跗骨窦组(P<0.05);相较跗骨窦组,关节镜组优良率更高(P<0.05),并发症发生率更低(P<0.05)。结论相较跗骨窦切口,距下关节镜联合后侧小切口可以明显改善跟骨骨折患者手术指标及疼痛情况,值得临床广泛推广。展开更多
文摘Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified technique, the Watson Jones approach (WJA) without image intensifier nor traction table, can allow open reduction and internal fixation (ORIF) of PFF using Dynamic hip screw (DHS), with satisfactory outcome. Patients and methods: Forty one consecutive patients (mean age 59.5 ± 21.6 years, 61% males) who were followed in a Teaching Hospital for PFF treated by ORIF using the WJA and DHS from January 2016 to December 2020 were reassessed. The outcome measures were the quality of the reduction, the positioning of the implants, the tip-apex distance (TAD), the rate and delay of consolidation, the functional results using Postel Merle d’Aubigné (PMA) score, the rate of surgical site infection (SSI) and the overall mortality. Logistic regression was used to determine factors associated with mechanical failure. Results: The mean follow-up period was 33.8 ± 15.0 months. Fracture reduction was good in 31 (75.6%) cases and acceptable in 8(19.5%) cases. Implant position was fair to good in 37 (90.2%) patients. The mean TAD was 26.1 ± 3.9 mm. Three patients developed SSI. Consolidation was achieved in 38 (92.6%) patients. The functional results were good to excellent in 80.5% of patients. The overall mortality rate was 7.3%. There were an association between mechanical failure and osteoporosis (p = 0.04), fracture reduction (p = 0.003), and TAD (p = 0.025). In multivariate logistic regression, no independent factors were predictive of mechanical failure. Conclusion: This study shows that ORIF using DHS for PFF via the Watson-Jones approach without an image intensifier can give satisfactory anatomical and functional outcomes in low-resource settings. It provides and validates a reliable and reproducible technique that deserves to be diffused to surgeons in austere areas over the world.
文摘目的分析距下关节镜联合后侧小切口与跗骨窦切口在跟骨骨折患者中的应用效果。方法筛选2018年12月至2022年12月聊城市第二人民医院收治的100例跟骨骨折患者,根据随机数表法分为关节镜组和跗骨窦组各50例。关节镜组男32例,女18例,平均年龄(43.58±7.13)岁;给予距下关节镜联合后侧小切口治疗。跗骨窦组男34例,女16例,平均年龄(43.12±7.46)岁;给予跗骨窦切口治疗。对比两组手术相关指标及手术前后疼痛视觉模拟评分(visual analog score,VAS)、B hler角及Gissane角变化,术后12个月踝-后足功能优良率和并发症发生率。结果术后关节镜组随访(11.16±1.02)个月,跗骨窦组随访(11.24±1.06)个月。关节镜组住院时间和骨折愈合时间明显少于跗骨窦组(P<0.05);关节镜组术后12个月VAS评分明显低于跗骨窦组,关节镜组B hler角及Gissane角均明显高于跗骨窦组(P<0.05);相较跗骨窦组,关节镜组优良率更高(P<0.05),并发症发生率更低(P<0.05)。结论相较跗骨窦切口,距下关节镜联合后侧小切口可以明显改善跟骨骨折患者手术指标及疼痛情况,值得临床广泛推广。
