Spontaneous spinal epidural hematomas: One case report and rehabilitation outcome.

RATIONALE: Spontaneous spinal epidural hematoma (SSEH) is a relatively rare but potentially disabling disease, and the classical presentation of it includes an acute onset of severe, sometimes radiating back or neck pain, followed by signs and symptoms of rapidly evolving nerve root or spinal cord compression. PATIENT CONCERNS: Here, we report a 26-year-old female patient presented with weakness in bilateral lower extremities, progressing to intense paraplegia and anesthesia without recent medical history of trauma, infection, surgery, or drug use. DIAGNOSIS: A magnetic resonance imaging (MRI) scan of spinal cord was planned and a posterior epidural hematoma of the thoracic spine was observed. INTERVENTIONS: A posterior decompression and hematoma evacuation was performed after diagnosis immediately. Early rehabilitation program of the specific kind spinal cord injury was formulated and implemented. OUTCOMES: The patient finally can handle basic living activities, such as completing wheelchair locomotion, transferring from bed to wheelchair independently after 3 months of rehabilitation. LESSONS: SSEH is a rarely occurring case in emergency. Acute chest pain and paraplegia could be the initial presentation of acute spinal epidural hemorrhage, but the diagnosis of patient without classical manifestations is still a challenge for doctors. Early diagnosis, prompt decompression, and individualized rehabilitation program can improve the prognosis and outcome.

Methylprednisolone microsphere sustained-release membrane inhibits scar formation at the site of peripheral nerve lesion.

Corticosteroids are widely used for the treatment of acute central nervous system injury. However, their bioactivity is limited by their short half-life. Sustained release of glucocorticoids can prolong their efficacy and inhibit scar formation at the site of nerve injury. In the present study, we wrapped the anastomotic ends of the rat sciatic nerve with a methylprednisolone sustained-release membrane. Compared with methylprednisone alone or methylprednisone microspheres, the methylprednisolone microsphere sustained-release membrane reduced tissue adhesion and inhibited scar tissue formation at the site of anastomosis. It also increased sciatic nerve function index and the thickness of the myelin sheath. Our findings show that the methylprednisolone microsphere sustained-release membrane effectively inhibits scar formation at the site of anastomosis of the peripheral nerve, thereby promoting nerve regeneration.

Hollow-bone-graft dynamic hip screw can fix and promote bone union after femoral neck fracture: an experimental research.

BACKGROUND: Delayed bone union, nonunion or osteonecrosis often occur after femoral neck fractures in young adults. Secondary bone healing requires strong internal fixation, intramedullary pressure reduction and early functional exercise. OBJECTIVE: To compare bone healing of femoral neck fractures treated with hollow-bone-graft dynamic hip screws (Hb-DHS) and standard dynamic hip screws (DHS) in an animal model. DESIGN: Testing of specifically designed fixation devices in a pig animal model. INTERVENTIONS/METHODS: We designed Hb-DHS and DHS devices appropriate to the femoral neck and head of experimental animals and used them in eight pigs (4-month-old, male or female, 30-40 kg/each). Under anesthesia, we induced medium neck type, Garden III type femoral neck fractures in each pig with fracture gaps of 0.5 mm and then fixed each left femur with Hb-DHS and each right femur with DHS. We assessed the animals radiographically and by postmortem visual appraisal of evidence of bone healing 8 and 16 weeks postoperatively. RESULTS: There were significant differences in radiographic and general findings between the Hb-DHS and DHS groups at weeks 8 and 16 postoperatively. We found statistically significant differences between the Hb-DHS and DHS groups in bone healing scores, trabecular bone volume percentage and bone mineral density as assessed on plain radiographs and computed tomography images (P < 0.05). There were also significant differences between the Hb-DHS and DHS groups in postmortem visually assessed indicators of bone healing at both 8 and 16 weeks postoperatively. CONCLUSIONS: The Hb-DHS device promotes femoral neck bone union, stimulates trabecular bone formation, increases BMD and has advantages over DHS for internal fixation of femoral neck fractures. This animal experiment will contribute to developing optimal treatment for femoral neck fractures in young adults.

Rap system of stress stimulation can promote bone union after lower tibial bone fracture: a clinical research.

BACKGROUND: Lower tibial bone fracture may easily cause bone delayed union or nonunion because of lacking of dynamic mechanical load. OBJECTIVE: Research Group would design a new instrument as Rap System of Stress Stimulation (RSSS) to provide dynamic mechanical load which would promote lower tibial bone union postoperatively. METHODS: This clinical research was conducted from January 2008 to December 2010, 92 patients(male 61/female 31, age 16-70 years, mean 36.3 years) who suffered lower tibial bone closed fracture were given intramedullary nail fixation and randomly averagely separated into experimental group and control group(according to the successively order when patients went for the admission procedure). Then researchers analysed the clinical healing time, full weight bearing time, VAS (Visual Analogue Scales) score and callus growth score of Lane-Sandhu in 3,6,12 months postoperatively. The delayed union and nonunion rates were compared at 6 and 12 months separately. RESULTS: All the 92 patients had been followed up (mean 14 months). Clinical bone healing time in experimental group was 88.78±8.80 days but control group was 107.91±9.03 days. Full weight bearing time in experimental group was 94.07±9.81 days but control group was 113.24±13.37 days respectively (P<0.05). The delayed union rate in 6 months was 4.3% in experimental group but 10.9% in control group(P<0.05). The nonunion rate in 12 months was 6.5% in experimental group but 19.6% in control group(P<0.05). In 3, 6, 12 months postoperatively, VAS score and Lane-Sandhu score in experimental group had more significantly difference than them in control group. CONCLUSIONS: RSSS can intermittently provide dynamic mechanical load and stimulate callus formation, promote lower tibial bone union, reduce bone delayed union or nonunion rate. It is an adjuvant therapy for promoting bone union after lower tibial bone fracture.

Anterior versus posterior approach in the treatment of chronic thoracolumbar fractures.

The purpose of this study was to compare the results of anterior approach vs posterior approach in the treatment of chronic thoracolumbar fractures. A total of 36 patients with chronic thoracolumbar fractures were divided into 2 groups. Group A was treated by an anterior approach and group B was treated by a posterior approach. During the minimum 24-month follow-up period (range, 24-62 months), all patients were prospectively evaluated for clinical and radiologic outcomes. Intraoperative blood loss, operative time, operative complications, pulmonary function, Frankel scale, and American Spinal Injury Association (ASIA) motor score were used for clinical evaluation, and Cobb angle was examined for radiologic outcome. All patients in this study achieved solid fusion, with significant neurologic improvement. Operative time, perioperative blood loss, ASIA score on admission and at final follow-up, and complications of respiratory tract infection and intercostal nerve pain were not significantly different between the 2 groups (P>.05), but complications of hemopneumothorax, abdominal distension, and constipation were fewer in group B (P<.05). Postoperative pulmonary function (P<.05) and correction of posttraumatic kyphosis were better in group B (P<.05).

Effects of a sliding plate on morphology of the epiphyseal plate in goat distal femur.

The aim of this study was to observe the effects of a sliding plate on the morphology of the epiphyseal plate in goat distal femur. Eighteen premature female goats were divided randomly into sliding plate, regular plate and control groups. Radiographic analysis and histological staining were performed to evaluate the development of epiphyseal plate at 4 and 8 weeks after surgery. In the sliding plate group, the plate extended accordingly as the epiphyseal plate grows, and the epiphyseal morphology was kept essential normal. However, the phenomenon of the epiphyseal growth retardation and premature closure were very common in the regular plate group. In addition, the sliding plate group exhibited more normal histologic features and Safranin O staining compared to the regular plate group. Our results suggest that the sliding plate can provide reliable internal fixation of epiphyseal fracture without inhibiting epiphyseal growth.

Operative versus nonoperative management of Pipkin type-II fractures associated with posterior hip dislocation.

Little has been written on randomized, controlled studies of operative versus nonoperative management of Pipkin type-II fractures associated with posterior dislocation of the hip. It is difficult to validate the optimal management of these fractures. The goals of this study were to (1) evaluate the results of conservative and surgical treatment for Pipkin type-II fractures associated with posterior dislocation of the hip and supply the optimal management for these fractures and (2) identify whether the Smith-Petersen approach is a safe and reliable surgical approach for Pipkin type-II fractures.Twenty-four patients were randomly divided into 2 groups: the conservative group (n=12) was treated by closed reduction, and the surgical group (n=12) was treated by primary open reduction internal fixation (ORIF) by bioabsorbable screws via a Smith-Petersen approach. Minimum follow-up was 24 months. Functional outcome was measured using the Thompson and Epstein score and the d'Aubigné-Postel score. Heterotopic ossification was classified based on the Brooker classification. The outcome of the conservative group was worse than that of the surgical group (P=.037). Two patients in the conservative group needed joint replacement for avascular necrosis of the femoral head. Heterotopic ossification was found in 6 patients (1 patient in the conservative group and 5 in the surgical group).Primary ORIF by bioabsorbable screws via a Smith-Petersen approach is an effective treatment for Pipkin type-II fractures associated with posterior dislocation.

[Transpedicular intracorporeal hydroxyapatite grafting and pedicle screw fixation via paraspinal approach for thoracolumbar fractures].

OBJECTIVE: To investigate the feasibility and safety of the treatment for thoracolumbar fractures with transpedicular intracorporeal hydroxyapatite grafting and pedicle screw fixation via paraspinal approach. METHODS: From June 2007 to December 2008, 19 cases of thoracolumbar fractures were treated with transpedicular intracorporeal hydroxyapatite grafting and pedicle screw fixation via paraspinal approach. There were 7 female and 12 male, ranging from 21 to 57 years of age (mean 40.8 years) at surgery. The time from injury to surgery varied from 1 d to 5 d (mean 2.9 d). Nineteen patients all suffered from single thoracolumbar fracture with the distribution of injury level being T(11) in 1, T(12) in 5, L(1) in 9, and L(2) in 4. According to Denis fracture classification, there were 5 compression fractures and 14 burst fractures. The mean preoperative ratio of the anterior height of the body was 57.2%, kyphosis angle was 17.6° and occupation of spinal canal was 27.7%. The mean preoperative load-sharing classification of spine fractures was 5.2. Based on the ASIA neurologic grading system, preoperative neurological function was grade B in 2 cases, C in 9 and D in 8. RESULTS: Median operating time was 83.8 min (range 60-95 min) and median blood loss was 133 ml (range 90 - 200 ml). Infection did not occur in any of the patients and the operative incisions were healing well. Average follow-up time was 19.2 months (range 12 - 36 months). At the latest follow-up, the height of the anterior border was corrected to 88.4%, the kyphosis angle was 6.1°, and the occupation of spinal canal was 8.2% on average. The postoperative neurologic function of all 19 patients was improved with grade D in 2 cases and E in 17. There were no instances of instrumentation failure and no patient had persistent postoperative back pain. CONCLUSIONS: Transpedicular intracorporeal hydroxyapatite grafting and pedicle screw fixation via paraspinal approach could provide reliable neurologic improvement in patients with incomplete neurologic deficit, and could prevent the development of kyphosis.Furthermore, it has the obvious advantages of less invasive and blood loss, and decreases the risks of postoperative lumbodorsal pain.

Conservative versus surgical management of Pipkin type I fractures associated with posterior dislocation of the hip: a randomised controlled trial.

The aim of this study was to evaluate the long-term results of conservative and surgical fragment excision treatment in patients with Pipkin type 1 fractures of the femoral head associated with posterior dislocation of the hip by a randomised controlled trial. Sixteen patients were randomly divided into two groups: the conservative group was treated by closed reduction, and the surgical group was treated by closed reduction followed with fragment excision. Functional outcome was determined using the Thompson and Epstein score and the Merle d'Aubigne and Postel score. Outcome of the conservative group was worse than that of the surgical group (p = 0.032). The randomised controlled trial proves surgical fragment excision after closed reduction is an effective treatment for Pipkin type 1 fractures.

[Tunnel enlargement after anterior cruciate ligament reconstruction with peroneus longus muscle combined with BMP and allogeneic bone].

OBJECTIVE: To investigate the incidence and variation of tunnel enlargement after anterior cruciate ligament (ACL) reconstruction with peroneus longus muscle combined with BMP and allogeneic bone. METHODS: ACL reconstructions with peroneus longus muscle combined with BMP and allogeneic bone were performed in 18 patients (18 knees)in the study from March 2007 to July 2009. Among the patients,14 patients were male and 4 patients were female, ranging in age from 21 to 47 years, with an average of 35.5 years. Twelve patients had the injuries in the right knee and 6 patients in the left knee. The CT scans were taken in a consistent manner at the 1st week and the 3rd, 6th, 12th months after surgery to measure tibial and femoral tunnel expansion. RESULTS: Tunnel enlargement didn't happen in 18 knees. The average enlargement of 18 cases of femoral tunnel was (1.10 +/- 0.42) mm; and the average enlargement of 18 cases of tibial tunnel was (1.00 +/- 0.51) mm. There was statistical significance of femoral tunnel between the 1st week and the 3rd month after surgery (P < 0.05); and there were no significant difference of the tunnel diameters among the 3rd, 6th, and the 24th months postoperatively (P > 0.05). There was statistical significance of tibial tunnel between the 1st week and the 3rd month after surgery (P < 0.05); there were no significant differences of the tunnel diameters among the 3rd, 6th, and 24th months postoperatively (P > 0.05). CONCLUSION: Anterior cruciate ligament reconstruction with peroneus longus muscle combined with BMP and allogeneic bone could obviously reduce the incidence of tunnel enlargement. The tunnel diameter obviously increase in 3 months after surgery,and it remains basically unchanged later.

[Design and experimental study of an epiphyseal slide-traction plate].

OBJECTIVE: To develop an epiphyseal slide-traction plate in child, which can supply the fracture a sufficient internal fixation, and will not restrain the growth of epiphyses. Animal experiments were carried out with the plates to compare the slide-traction with traditional plate. METHODS: Develop a slide-traction plate for the configuration of the femur condylus of children. Thirty adolescent goats in the experiment were divided into control group (12 goats) and plate group (18 goats). In plate group, right femurs of goats were fixed with common plates and the left femurs with slide-traction plates. All the goats were given X-ray examination at different time after surgery. And the goats were sacrificed at 3 and 6 month, histological method and electron microscopy were performed to evaluate the development of epiphyseal plate. RESULTS: The both femurs of the goats in control group have no difference in evidence in length at all time we examined. And the both femurs of the goats fixed with plates have no difference in evidence in length at 1 day after surgery. However, the both femurs of the goats fixed with plates have difference in evidence in length at 1 month, 2 month, 3 month, 6 month after surgery. The increased length of the femurs at I month, 2 month, 3 month, 6 month after surgery was also compared with the length at 1 day after surgery, there was difference in evidence between the right femurs of the control group and the femurs were fixed with common plates, but no difference in evidence between the left femurs of the normal control group and the femurs were fixed with slide-traction plate (P > 0.05). More thicker epiphyseal plate were found in the left femurs than the right femurs of the group fixed with plates at 3 and 6 month after surgery (P < 0.01). In the plate group, safranine O staining showed epiphyseal plates at the left femurs had more fuscous staining than the right femurs at 3 and 6 month after surgery and electron microscopy also found that the cells of the epiphyseal plates of left femurs were more eugenic than the right femurs at 3 and 6 month after surgery. CONCLUSION: The epiphyseal slide-traction plate can slide with the growth of epiphyses, which is suitable for fixation of the fracture in this part.

[Controlled clinical study of treatment of non-operation and surgical operation for scapular fracture].

OBJECTIVE: To investigate the effect of treatment methods of non-operation and surgical operation for scapular fracture. METHODS: A retrospective analysis of 52 patients (male 37, female 15, ranging in age from 20 to 48 years, meanly 31 years)with scapular fractures was done. According to Hardegger classification: the scapular body fracture in 24 cases, the surgical neck fracture in 12 cases, the anatomical neck fracture in 3 cases, the glenoidal lip fracture in 6 cases, the scapular spine fracrure in 7 cases. Of all 52 patients,17 cases were treated conservatively, and 35 were undergone surgical internal fixation. When followed up,the clinical examination was done and the X-ray films were taken to measure glenopolar angle (GPA). Hardegger function evaluation system was adopted. The results were analysed statiscally. RESULTS: Fifty-two cases were all followed up for 9 weeks to 48 months. Among 17 patients treated by non-operation, Hardegger function evaluation system showed that the result were excellent in 7 cases, good in 6, fair in 2 and poor in 2; the X-ray film results showed that there were 14 cases of GPA > 20 degrees and 3 cases of GPA < 20 degrees. Of 35 patients treated by surgical operation, Hardegger function evaluation system showed that the result were excellent in 20 cases,good in 12 and fair in 3; the X-ray film results showed that there were 33 cases of GPA > 20 degrees and 2 cases of GPA < 20 degrees. There was no significant difference between the two groups (P = 0.27). CONCLUSION: Before treatment of scapular fracture, with CT 3D -recontruction, complete understanding of fragments displacement, and correction indication selection, and perform early exercises, both of the two procedures can provide satisfactory outcome.

[Treatment of refracture in plate-screw fixation of femoral shaft with plate and xenogenic bony plate].

OBJECTIVE: To evaluate curative effect of plate and xenogenic bony plate were applied in refracture in plate-screw fixation of femoral shaft. METHODS: Thirteen cases of refracture in plate-screw fixation of femoral shaft included 8 males and 5 females, average age was 31.2 years ranging from 14 to 57. Fracture type was comminuted fracture in 7 cases, oblique fracture in 4 cases, transverse fracture in 2 cases. Fixation type used eight holes femoral LC-DCP in 5 cases, eight holes epipodite LC-DCP in 2 cases, six holes femoral LC-DCP in 2 cases, 8 holes La-Plate in 4 cases. All the patients were treated by femoral LC-DCP and xenogenic bony plate. RESULTS: All of the patients were followed up from 16 to 40 months with average of 32 months. All cases had undergone only one operation and achieved bony union. Average time of bony union was 9 months. The lower limbs resumed walk and beared a heavy burden. According to criterion of Merchan, the results were excellent in 7 cases,good in 4,fair in 1 and poor in 1, the excellent and good rate of knee function was 84.6% (11/13) in one year after operation. CONCLUSION: Treatment of refracture in plate-screw fixation of femoral shaft with armor plate and xenogenic bony plate is a reliable treatment.

Comparative study on treating complete dislocation of acromioclavicular joint with three different methods.

OBJECTIVE: To comparatively study complete dislocation of acromioclavicular joint treated with three different methods. METHODS: A total of 96 patients (81 males and 15 females, aged 16-59 years, mean=45 years) with complete dislocation of acromioclavicular joint were treated with Dewar's operation (Group A, n=32), internal fixation with Kirschner tension band wires (Group B, n=44), or internal fixation with Wolter plates (Group C, n=20), respectively, in this study. Eighty-five patients suffered from acute dislocations and eleven from chronic dislocations. RESULTS: The patients were followed up for 50 months on an average. According to Karlsson's standard, in Group A, 26 patients were assessed as good, 5 as fair and 1 as poor. In Group B, 20 patients were assessed as good, 13 as fair and 11 as poor. In Group C, 15 patients were assessed as good, 4 as fair and 1 as poor. The good and fair rates were significantly different between Group A and Group B, and between Group C and Group B, but no statistical difference was found between Group A and Group C. The operating time was (52.36+/-7.24) minutes, (67.43+/-8.11) minutes and (69.73+/-8.04) minutes in Groups A, B and C, respectively. And the hospitalizing fees were (2400+/-270) yuan, (2100+/-190) yuan and (8450+/-360) yuan in Groups A, B and C, respectively. CONCLUSIONS: Dewar's operation is a good and safe method with shorter operating time and lower hospitalizing fee for treating complete dislocation of acromioclavicular joint. The method is simple without the need of a second operation to remove the implants and with few complications.