[Clinical effect of allogeneic peroneal bone marrow support combined with plate fixation for the treatment of Neer type â £ proximal humeral fractures].

OBJECTIVE: To explore clinical effect of allogeneic peroneal bone marrow support combined with plate internal fixation in treating Neer type Ⅳproximal humeral fractures. METHODS: From December 2017 to December 2020,12 patients with Neer type Ⅳ proximal humeral fractures were treated with allogeneic peroneal bone marrow support combined with plate internal fixation,including 7 males and 5 females,aged from 56 to 78 years old;the time from injury to operation ranged from 1 to7 days. Operative time,fracture healing time and complications during follow-up were observed,and clinical efficacy was evaluated by Constant-Murley score at the latest follow-up. RESULTS: All patients were obtained follow up for 20 to 29 months. All patients got bone healing and incisicons were healed at stageⅠ,operative time ranged from 95 to 138 min,blood loss ranged from 210 to 275 ml,fracture healing time ranged from 14 to 18 weeks. Two patients occurred postoperative shoulder stiffness and recovered after 2 weeks of passive exercise. There were no complications such as infection,poor wound healing,and failure (fracture and loosening) of internal fixators occurred. Constant-Murley shoulder function score ranged from 69 to 89 at the latest follow up,2 patients got excellent results,9 good and 1 fair. CONCLUSION: The application of allogeneic fibular bone marrow placement could provide effective support for medial humerus,which is conducive to assisting reduction of fracture end,reducing occurrence of internal fixation failure caused by collapse of humerus head and screw perforation,and significantly improving function of shoulder joint.

[A follow up study on the treatment of tibial fractures with intramedullary interlocking nail through the suprapatellar approach].

OBJECTIVE: To investigate the short-term effect of suprapatellar interlocking intramedullary nail in the treatment of tibial fractures. METHODS: Eighty patients with tibial fractures treated from January 2016 to June 2018 were treated with interlocking intramedullary nail, who were divided into observation group (suprapatellar approach) and control group (patellar ligament approach) according to different surgical approaches. There were 40 cases in the observation group, including 28 males and 12 females, aged 28 to 67 years with a mean of (46.70±10.34) years. There were 40 cases in the control group, including 30 males and 10 females, aged 31 to 69 years with a mean of(49.38±10.74) years. The operation time, incision length, intraoperative C-arm X-ray fluoroscopy times, intraoperative blood loss, fracture healing time, postoperative active straight leg raise (SLR) time, hospital stay, visual analogue scale (VAS), knee pain rate and postoperative Hospital for Special Surgery (HSS) score were recorded and compared between two groups. RESULTS: All the patients were followed up, and the duration ranged from 19 to 38 months, with an average of(24.60±4.52) months. In the observation group, the operation time was(53.83± 7.01) min;the incision length was (3.98±0.83) cm;the number of intraoperative C-arm X-ray fluoroscopy was (18.90±1.75) times;the fracture healing time was (10.03±0.89) weeks;the postoperative active SLR time was (1.19±0.25) days;and the hospital stay was(6.73±1.06) days. The above indexes were better than those in the control group (P<0.05). In the latest follow-up, 34 cases got an excellent result, 5 good, 1 fair and 0 poorin the observation group. In the control group, 25 cases got an excellent result, 9 good, 6 fair and 0 poor. The curative effect of the observation group was better than that of the control group(P< 0.05). CONCLUSION: The treatment of tibial fractures with suprapatellar interlocking intramedullary nail has the advantages of less trauma and better recovery of knee function. It can obtain more satisfactory clinical results and can be further widely used.

[Value of quantitative CT in vertebroplasty for osteoporotic fracture combined with scoliosis].

OBJECTIVE: To investigate the value of lumbar quantitative CT (QCT) in vertebroplasty for osteoporotic fracture combined with scoliosis. METHODS: The clinical data of 60 patients with osteoporotic fractures combined with different degrees of scoliosis treated by vertebroplasty from December 2017 to December 2019 were retrospectively analyzed. There were 18 males and 42 females, aged from 65 to 81 (72.63±3.34)years old. All patients were received QCT examination before surgery. According to the QCT value, the patients were divided into osteopenia group(QCT>80 g/L, 10 cases, 12 vertebrae), osteoporosis group(QCT 40-80 g/L, 35 cases, 48 vertebrae) and severe osteoporosis group(QCT<40 g/L, 15 cases, 22 vertebrae). The dispersion and leakage of bone cement in the injured vertebrae of patients with different degrees of QCT value were observed, and the QCT value in the selection of puncture point, correction of Cobb angle and recovery of vertebral height were analyzed in the patients. RESULTS: Among 60 cases of 82 vertebrae, 41 cases of 55 vertebrae were punctured by concave unilateral puncture, according for 67.07%. Among them, there were 2 cases with 2 vertebrae in osteopenia group, 26 cases with 35 vertebrae in osteoporosis group, and 13 cases with 18 vertebrae in severe osteoporosis group. There was significant difference in the number of cases with unilateral or bilateral puncture among the three groups (χ2=13.699, P=0.001); there was no significant difference in the number of cases with bone cement leakage among the three groups (χ2=1.403, P=0.496). The Cobb angle of scoliosis was significantly differentbetween preoperative and postoperative follow-up(P<0.05);the height of injured vertebral body was significantly different between preoperative and postoperative follow-up (P<0.05). CONCLUSION: For patients with osteoporotic fracture combined with scoliosis undergoing vertebroplasty, the severity of osteoporosis should be determined according to lumbar QCT detection, and the concave side of scoliosis should be selected for puncture, which is conducive to improving scoliosis, restoring spinal stability and improving surgical safety.

[Guiding significance of lumbar quantitative computed tomography in percutaneous vertebroplasty for osteoporotic vertebral compression fractures].

OBJECTIVE: To investigate the guiding significance of lumbar quantitative computed tomography (QCT) in percutaneous vertebroplasty (PKP) for osteoporotic vertebral compression fractures (OVCF). METHODS: The clinical data of 90 patients with OVCF underwent PKP from December 2017 to December 2018 were retrospectively analyzed. There were 24 femalesand66males, withanaverage agedof (74.47±6.60) yearsold. Allpatientswere received QCT examination before surgery, andaccording to the QCT value oflumbarspine, the patientswere dividedinto osteopenia decrease group (80 to 120 g/L, 17 cases, 30 vertebrae), osteoporosis group (40 to 80 g/L, 44 cases, 66 vertebrae) and severe osteoporosis group (<40 g/L, 29 cases, 39 vertebrae). Bone cement was injected into vertebral body, AP and lateral X-rays were done during operation. The diffusion and leakage of bone cement in injured vertebrae of patients with different QCT values were observed. Unilateral approach was used for patients whose bone cement diffused beyond the midline of the vertebral body, otherwise, and bilateral approach was adopted, and guiding significance of QCT in PKP for OVCF was analyzed. RESULTS: In 90 cases of 135 vertebrae, 72 cases of 98 vertebral bone cement diffused beyond the midline, accounting for 72.59%. Unilateral approach was used for the 72 patients whose bone cement diffused beyond the midline of the vertebral body, among them, there were 5 cases with 8 vertebrae in osteopenia group, 40 cases with 55 vertebrae in osteoporosis group and 27 cases with 35 vertebrae in severe osteoporosis group. There was significant difference in the bone cement dispersion between three groups (χ2=41.397, P=0.000). Moreover, no bone cement leakage occurred in osteopenia group, 3 cases of 4 vertebrae occurred in osteoporosis group and 2 cases of 3 vertebrae in severe osteoporosis group. However, none of the patients with bone cement leakage caused nerve injury and other symptoms, and there was no significant difference in bone cement leakage between the three groups (χ2=2.242, P=0.326). CONCLUSION: According to the QCT examination of lumbar spine, defining the degree of osteoporosis and guiding the puncture method can shorten the operation time, reduce the number of fluoroscopy, and effectively improve the safety of vertebroplasty.