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Objective:To investigate the effect of the placement of a drainage tube on the prognosis of patients with pelvic fractures treated by modified Stoppa approach.Methods:The medical records of patients with pelvic fractures treated with modified Stoppa approach from August 2012 to August 2017 were retrospectively analyzed. A total of 43 patients including 32 males and 11 females (mean age 47.6 years, range from16 to 69) were included in the study. According to Young-Burgess classification, there were 12 cases of Lateral Compression type LC-I type; 20 cases of Anterior and Posterior Compression type APC-I type and 11 cases of APC-II type. All patients were treated with modified Stoppa approach to reduce the fracture and fix with plate and screw. According to whether a drainage tube was placed during the operation, 22 cases were placed with a drainage tube (drainage group), and 21 cases were not placed with a drainage tube (non-drainage group). The main observation indicators were the intraoperative conditions, antibiotic application, incision suture removal time, postoperative body temperature change, hospital stay and clinical function (Harris score).Results:Wound infection was not observed in two groups. The duration of antibiotic use in the drainage group was 5.0 d (2.0, 8.0) d, and the non-drainage group was 4.0 d (2.0, 5.0) d, the difference was not statistically significant ( Z=1.161, P=0.924). The hospital stays of the two groups were 18.5 d (15.0, 24.3) d and 19.0 d (13.0, 26.0) d, respectively, and the difference was not statistically significant ( Z=0.542, P=0.591). The operation time was 150.2±52.4 min in the drainage group and 138.8±41.2 min in the non-drainage group, and the difference was not statistically significant ( t=0.791, P=0.433). The blood loss in the drainage group was 604.6±387.3 ml, and the non-drainage group was 581.0±275.0 ml. The difference was not statistically significant ( t=0.276, P=0.784). The postoperative body temperature changes of patients in the drainage group and non-drainage group were on day 1 (37.5±0.5 ℃ vs. 37.4±0.4 ℃, t=0.322, P>0.05), day 3 (37.1±0.4 ℃ vs. 37.0±0.4 ℃, t=0.286, P>0.05), day 5 (37.0± 0.3 ℃ vs. 36.8±0.2 ℃, t=2.127, P>0.05), on the 7th day (36.8±0.2 ℃ vs. 36.7±0.4 ℃, t=0.491, P>0.05), the difference was not statistically significant. The time for suture removal of surgical incision was 14.1±0.6 d in the drainage group and 13.9±0.6 d in the non-drainage group, and the difference was not statistically significant ( t=1.072, P=0.329). The Harris scores of the two groups were 96 (91, 100) points for the drainage group and 96 (93, 97) points for the non-drainage group, and the difference was not statistically significant ( Z=0.107, P=0.607). Conclusion:There is no significant influence of the application of drainage on recovery of wound or function for patients with pelvic surgery.
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Objective:To establish a model of patellar dislocation by femoral osteotomy or surgical release of medial retinaculum in immature rabbits, and observe morphological and trabecular microarchitectural changes in the trochlea.Methods:Forty rabbits at 3 months of age were included. All right knees underwent surgery, 20 knees were treated with femoral osteotomy and internal rotation of distal femur to increase femoral anteversion angle (Osteotomy group, OS group), and another 20 knees were treated with surgical release of medial retinaculum and overlap suture of lateral retinaculum (Soft tissue group, ST group). All left knees were acting as internal controls. Micro-CT scans for distal femur were acquired after 4 months post surgery. the height of Medial, central, and lateral trochlear, sulcus angle, and lateral and medial trochlear slope were measured to describe the trochlear morphology, and bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular spacing (Tb.Sp), and bone mineral density (BMD) were calculated to evaluate the microarchitectural structure. All parameters were compared between groups.Results:In OS group, one rabbit sustained a hip dislocation without patellar dislocation. Three knees developed complete patellar dislocation in daily flexion position, and the remaining 16 patellae were dislocated when the knee was placed in the maximal extension position. In ST group, 15 knees were complete patellar dislocation in daily flexion position, and 5 knees were without dislocation. A local boss was formed proximal to the entrance of the groove and the articular cartilage was smooth, and no obvious osteoarthritis was observed in OS group. In ST group no boss was formed, while obvious cartilage degeneration and defect was seen. Compared to the control group, the central trochlear height and sulcus angle were greater in both groups, but without significant difference between the two groups. The Tb.Th was increased in both medial and lateral condyle, and Tb.N was decreased in medial condyle compared with its control knees in OS group. The BV/TV, Tb.Th, Tb.N and BMD were decreased and Tb.Sp was increased in both medial and lateral condyle compared with its control knees in ST group. Compared to the OS group, the BV/TV, Tb.Th, Tb.N and BMD were smaller and Tb.Sp was greater in both medial and lateral condyle in ST group, with significant differences.Conclusion:The model of patellar dislocation could be successfully achieved by femoral rotational osteotomy to increase femoral anteversion or surgical release of medial retinaculum and overlap suture of lateral retinaculum, and subsequent morphological and trabecular microarchitectural changes in the trochlea are different. Different bony and soft tissue factors should be addressed for different patients with patellar dislocation in clinical practice.
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Objective@#To explore the clinical outcome an anatomic quadrilateral surface plate for both-column acetabular fractures through the Stoppa combined with iliac fossa approach.@*Methods@#A retrospective study of the patients with both-column acetabular fractures treated with an anatomic quadrilateral surface plate through the Stoppa combined with iliac fossa approach from November 2015 to June 2017 was performed. Nineteen patients including 16 males and 3 females met the inclusion criteria. The mean age of included patients was 49.11 years (range, 25-68 years). There were 8 cases of fall injury, 7 cases of car accident injury and 4 cases of crushing injury. There were 11 cases of C1 type injury, 7 cases of C2 type, and 1 case of C3 type according to Tile classification. Patients included in this study were both-column acetabular fractures according to Letournel-Judet classification. There were six cases associated with posterior wall detachment. Minimally Stoppa combined with iliac fossa approach was performed to manage the displaced fragments. First, the anteromedially displaced iliopubic fragment was managed with a reconstruction plate through iliac fossa approach. Then, the medially displaced ischiadic fragment could be fixed with an anatomic quadrilateral surface plate through the Stoppa approach. The reduction quality was assessed by postoperative radiographs and CT scans according to the criteria proposed by Matta. The function of hip joint was assessed by the Merle d'Aubigné-Posteal score modified by Matta.@*Results@#The average operation time and blood loss were 115.26 min (range, 90-160 min) and 534.21 ml (range, 300-1000 ml), respectively. The mean length surgical incision was 18.82 cm (range, 16-20 cm). Average follow-up time was 19.84 months (range, 12-28 months). According to Matta criteria of reduction quality, anatomic reduction was obtained in 14 cases, and satisfactory reduction was gained in 3 cases, while unsatisfactory reduction was found in 2 cases (satisfactory rate=89.47%). All fractures healed well and mean healing time was 3.32 months (range, 3-5 months). The mean Merle d’Aubigné-Posteal score modified by Matta was 16.95 (range, 13-18), including 12 cases of excellent, 4 cases of good, and 3 cases of fair (satisfactory rate=84.21%). Intraoperative injury of lateral femoral cutaneous nerve developed in a case and obturator nerve damage occurred in another patient, respectively. Relevant symptoms were totally disappeared after two months’ conservative treatment (including neurotrophic therapy combined with adduction exercise of the affected thigh). Iliac fossa hematoma occurred in a case and relevant symptom was eliminated after puncture.@*Conclusion@#Satisfactory clinical outcome of both-column acetabular fractures could be obtained by the anatomic quadrilateral surface plate through the Stoppa combined with iliac fossa approach.
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Objective To explore the clinical outcome an anatomic quadrilateral surface plate for both?column acetabu?lar fractures through the Stoppa combined with iliac fossa approach. Methods A retrospective study of the patients with both?col?umn acetabular fractures treated with an anatomic quadrilateral surface plate through the Stoppa combined with iliac fossa ap?proach from November 2015 to June 2017 was performed. Nineteen patients including 16 males and 3 females met the inclusion criteria. The mean age of included patients was 49.11 years (range, 25-68 years). There were 8 cases of fall injury, 7 cases of car accident injury and 4 cases of crushing injury. There were 11 cases of C1 type injury, 7 cases of C2 type, and 1 case of C3 type ac?cording to Tile classification. Patients included in this study were both?column acetabular fractures according to Letournel?Judet classification. There were six cases associated with posterior wall detachment. Minimally Stoppa combined with iliac fossa ap?proach was performed to manage the displaced fragments. First, the anteromedially displaced iliopubic fragment was managed with a reconstruction plate through iliac fossa approach. Then, the medially displaced ischiadic fragment could be fixed with an anatom?ic quadrilateral surface plate through the Stoppa approach. The reduction quality was assessed by postoperative radiographs and CT scans according to the criteria proposed by Matta. The function of hip joint was assessed by the Merle d’Aubigné?Posteal score modified by Matta. Results The average operation time and blood loss were 115.26 min (range, 90-160 min) and 534.21 ml (range, 300-1000 ml), respectively. The mean length surgical incision was 18.82 cm(range, 16-20 cm). Average follow?up time was 19.84 months (range, 12-28 months). According to Matta criteria of reduction quality, anatomic reduction was obtained in 14 cases, and satisfactory reduction was gained in 3 cases, while unsatisfactory reduction was found in 2 cases (satisfactory rate= 89.47%). All fractures healed well and mean healing time was 3.32 months (range, 3-5 months). The mean Merle d’Aubigné?Post?eal score modified by Matta was 16.95 (range, 13-18), including 12 cases of excellent, 4 cases of good, and 3 cases of fair (satisfac?tory rate=84.21%). Intraoperative injury of lateral femoral cutaneous nerve developed in a case and obturator nerve damage oc?curred in another patient, respectively. Relevant symptoms were totally disappeared after two months’conservative treatment (in?cluding neurotrophic therapy combined with adduction exercise of the affected thigh). Iliac fossa hematoma occurred in a case and relevant symptom was eliminated after puncture. Conclusion Satisfactory clinical outcome of both?column acetabular fractures could be obtained by the anatomic quadrilateral surface plate through the Stoppa combined with iliac fossa approach.
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Objective@#To evaluate the possibility of transverse sacroiliac screw placement in different segments of the sacrum.@*Methods@#Data of 80 pelvic CT scans (slice thickness ≤1.0 mm) archived in CT department of the Third Hospital of Hebei Medical University from September 2016 to October 2017 were retrospectively collected. Mimics software was used to rebuild the pelvis three-dimensional model. According to whether the sacral 1(S1) segment could place the transverse sacroiliac screws or not, all the sacrums were divided into normal group (n=55) and dysmorphic group (n=25). Simulation the S1, sacral 2(S2) transverse sacroiliac screw placement in 3-Matic software. Analysis whether there was any difference in maximum diameter and length of S2 transverse sacroiliac screw between the normal group and the dysmorphic group. The pelvic CT data of the dysmorphic group were measured, and the optimal tilt angle and length of the oblique S1 screw were obtained. The feasibility of transverse sacroiliac screw insertion in sacral 3(S3) segment was evaluated.t-test, rank sum test, and χ2 test was used to analyze data, respectively.@*Results@#In the dysmorphic group, the largest diameter of the S1 transverse screw was (4.9±1.6)mm, and the normal group was (13.6±3.6)mm (t=-15.07, P=0.00). In the dysmorphic group, the largest diameter of S2 transverse screw was (13.8±3.0)mm, and was (12.4±2.2)mm in the normal group(t=2.11, P=0.04). There was no significant difference in the length of S2 transverse sacroiliac screw between the two groups (t=0.47, P=0.64). In the dysmorphic group, the anterior vertebral height of S1 was (23.1±4.0)mm, which was significantly higher than that of the normal group ((14.1±4.2)mm)(t=9.01, P=0.00). The angle of S1S2 in the dysmorphic group was 10.9°(3.8°, 17.6°), which was significantly larger than that of the normal group (2.0°(1.0°, 2.0°) (Z=-4.03, P=0.00). In the dysmorphic group, the incline angle of the oblique S1 sacroiliac screw was (35.6±6.2)°, the anteversion angle was (37.2±4.4)°, and the mean screw length was (90.2±4.7)mm. In the dysmorphic group, the placement rate of S3 transverse sacroiliac screw was 48.0%, and that of the normal sacral group was 9.1%.@*Conclusions@#There is often dysmorphic in the sacrum in patients with large S1 anterior vertebral height and S1S2 angle. Sacral dysmorphic patients with posterior pelvic ring injury may be treated with S1 pedicle oblique sacroiliac screws. S3 transverse sacroiliac screws should be carefully placed, especially for the absence of sacral dysmorphic in patients.
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Objective To compare and analyze the epidemiological features of adult pelvic fractures between West China and East China from 2010 to 2011.Methods The data of adult pelvic fractures treated from January 2010 to December 2011 in 63 hospitals in West China and East China were collected through the PACS system and case reports checking system.The data from the 35 hospitals in East China were assigned into group A and those from the 28 hospitals in West China into group B.The analytic items included gender,age,age distribution and type of AO classification.Results A total of 7,896 cases were collected.In group A of 5,683 cases,there were 2,829 males and 2,854 females,with a male to female ratio of 0.99∶1 and a median age of 42 years (interquartile range,from 30 to 55 years).In group B of 2,213 cases,there were 1,123 males and 1,090 females,with a male to female ratio of 1.03∶1 and a median age of 41 years (interquartile range,from 31 to 54 years).There was no significant difference in the male to female ratio between the 2 groups (x2 =0.594,P =0.441) but there was a significant difference in the median age (Z =-4.344,P =0.000).The age distribution showed that the peak range was from 31 to 40 years in group A (with a proportion of 21.50％) and from 41 to 50 years in group B (with a proportion of 23.41％),showing no significant difference between the 2 groups (P ＞ 0.05).In both groups,type 61-A was the high risk type of fracture (82.23％ in group A and 86.08％ in group B),and type 61-A2 the high risk subtype of fracture (41.47％ in group A and 54.36％ in group B),showing significant differences (P ＜ 0.05).Conclusions East China and West China had similar male to female ratios in pelvic fractures.Generally,the patients in West China were younger,for the most patients in East China were aged from 31 to 40 years and those in West China from 41 to 50 years.In both East China and West China,type 61-A2 and subtype 61-A2 were the most common,but the proportions of type 61-A2 and subtype 61-A2 were higher in West China than in East China.
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Objective To compare and analyze the epidemiological features of adult patients with distal humerus fractures between the east and west China from 2010 to 2011.Methods The data of adult patients with distal humerus fracture treated from January 2010 to December 2011 in 63 hospitals in the east and west China were collected through the PACS system and case reports checking system.The data from 35 hospitals in the east China were classified as group A,and those from 28 hospitals in the west China as group B.The analytic items included gender,age and AO/OTA classification.Results A total of 2,668 cases were collected.The median age of the 1,852 cases in group A was 42 (IQR:33) years old.The high peak age ranged from 21 to 30 years old;the gender ratio of group A was 1.18:1.The median age of the 816 cases in group B was 37 (IQR:27) years old.The high peak age ranged from 31 to 40 years old;the gender ratio of group B was 1.80:1.Group A had a significantly lower gender ratio but a significantly higher median age than group B (P ＜ 0.05).The proportions of patients from 16 to 20 and from 31 to 40 years old in group A were significantly lower than those in group B but the proportion of patients aged above 61 years old in group A was significantly higher than that in group B (P ＜ 0.05).According to the AO/OTA classification,1,399 cases (52.44％) were type 13-A,682 ones (25.56％) type 13-B and 587 ones (22.00％) type 13-C.The proportions of type 13-A and type 13-A1 in group A were significantly lower than in group B (P ＜ 0.05).Conclusions Fractures of the distal humerus mostly occurred in the age range from 21 to 40 years old and in males.Type 13-A fractures were the most common.The east China had a significantly higher proportion of female patients,an older median age and a lower proportion of type 13-A1 fracture than the west China.
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Objective To compare the epidemiological characteristics of scapular neck fracture between the east and west areas in China from 2010 through 2011.Methods Tbe data of scapular neck fractures treated between January 2010 and December 2011 at 35 east hospitals and 28 west ones were analyzed retrospectively.The patients' gender,age and Miller classification were documented.The data from the 35 east hospitals were classified as group A while the data from the 28 west ones as group B.Comparisons were made to find out the general epidemiological characteristics.Results A total of 584 scapular neck fractures were collected.The total male/female ratio was 3.46∶ 1.The scapular neck fractures predominated in an age range from 41 to 50 years (25.17％).According to the Miller classification,there were 150 cases (25.68％) of type Ⅰ,306 ones (52.40％) of type Ⅱ and 128 ones (21.92％) of type Ⅲ.426 cases (72.95％) were stable fractures and 158 ones (27.05％) unstable fractures.The male/female ratio was 3.64∶1 in group A of 427 patients and 3.03∶1 in group B of 157 patients.There were no significant differences between the 2 groups in male/female ratio (P ＞ 0.05).The median age of group A (44 years) was significantly older than that of group B (39 years).The fractures predominated in an age range from 41 to 50 years (24.36％) in group A and in the age range from 31 to 40 years (36.31％) in group B.The most frequent fracture type was type Ⅱ in both groups,accounting for 51.52％ and 54.78％ respectively.There were no significant differences between the 2 groups in distribution of Miller classification (P ＞ 0.05).Conclusions The peak age of scapular neck fractures was from 41 to 50 years,the high-risk type was Miller type Ⅱ and stable fractures were more common.There were more male patients than female ones.The median age in the east area was older than that in the west area.
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Objective To compare the epidemiological characteristics of glenoid fractures between the east and west areas in China from 2010 through 2011.Methods The data of glenoid fractures treated between January 2010 and December 2011 at 35 east hospitals and 28 west ones in China were analyzed retrospectively.The patients' gender,age and type of Ideberg classification were documented.The data from the 35 east hospitals were classified as group A while those from the 28 west ones as group B.Comparisons were made to find out the general epidemiological characteristics.Results A total of 347 glenoid fractures were collected.The total male/female ratio was 2.69∶ 1.The glenoid fractures predominated in 2 age ranges from 41 to 50 years and from 51 to 60 years (19.60％).According to the Ideberg classification,there were 75 cases (21.61％) of type Ⅰ,152 ones (43.80％) of type Ⅱ,27 ones (7.78％) of type Ⅲ,20 ones (5.76％) of type Ⅳ,46 ones (13.26％) of type Ⅴ and 27 ones (7.78％) of type Ⅵ.The male/female ratio was 2.80∶1 in group A of 228 patients and 2.50∶1 in group B of 119 patients.The median age of group A was 47 years old and that of group B 44 years old.The differences were not statistically significant in male/female ratio,median age or distribution of age between the 2 groups (P ＞ 0.05).The fractures predominated in the age range from 51 to 60 years old (23.68％) in group A and in the age range from 31 to 40 years old (21.85％) in group B.The most frequent fracture type was type Ⅱin both groups,accounting for 41.23％ and 48.74％ respectively.There was a significant difference between the 2 groups in distribution of Ideberg classification (P ＜ 0.05).Conclusions The peak age of glenoid fractures was from 41 to 60 years,the high-risk type was Ideberg type Ⅱ and there were more male patients than female ones.The proportion of Ideberg type Ⅴ in the east area was higher than that in the west area.
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Objective To compare and analyze the epidemiological features of Colles fractures between Eastern and Western China from 2010 to 2011.Methods The data of patients with Colles fracture treated from January 2010 to December 2011 in 63 hospitals in Eastern and Western China were analyzed retrospectively.The patients from the 35 hospitals in Eastern China were defined as group A and those from the 28 hospitals in Western China as group B.The 2 groups were analyzed and compared in terms of gender,age and laterality.Results A total of 9,255 Colles fractures were collected.The total male/female ratio was 0.82:1.Their ages ranged from 1 to 110 years,with a median age of 51 years.The Colles fractures predominated in an age range from 51 to 60 years.There were 5,006 left sides and 4,249 right sides.There were 5,639 Colles fractures in group A,accounted for 2.55％ of the total body fractures and 22.09％ of the distal ultra-radius fractures.There were 3,616 Colles fractures in group B,accounted for 3.98％ of the total body fractures and 37.55％ of the distal ultra-radius fractures.The male/female ratio was 0.72:1 in group A and 0.99:1 in group B.The median age was 54 years (from 1 to 110 years) for group A and 45 years (from 1 to 99 years) for group B.There were significant differences between the 2 groups in all the above items (P ＜0.05).The largest proportion of age group was from 51 to 60 years and the smallest proportion of age group was ≥81 years for both groups.The proportions of age groups from 1 to 10 years,from 51 to 60 years,from 61 to 70 years,from 71 to 80 years and ≥81 years in group A were larger than in group B while those from 11 to 20 years,from 21 to 30 years,from 31 to 40 years and from 41 to 50 years in group A were smaller than in group B.There were significant differences between the 2 groups in all the proportions of age group (P ＜0.05).The Colles fractures predominated on the left side in both groups,showing no significant difference between the 2 groups (P ＞ 0.05).Conclusions The Colles fractures from 2010 to 2011 predominated in the elderly and female patients in China.The proportions of Colles fractures in all body fractures and distal ultra-radius fractures in Eastern China were lower than those in Western China.There were significant differences in gender and age proportions between the 2 areas.Eastern China had a larger proportion of female patients and a higher median age than Western China.
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Objective To compare and analyze the epidemiological features of adult tibial plateau fractures from 2010 to 2011 between West China and East China.Methods The data of adult patients with tibial plateau fracture treated from January 2010 to December 2011 in 63 hospitals from West China and East China were collected through the PACS system and case reports checking system.The data of 28 hospitals from West China were classified as West group while the data of 35 hospitals from East China as East group.The analytic items included gender,age,age distribution and type of Schaztker classification.Results A total of 4,603 adult tibial plateau fractures were collected.The largest age proportion was from 41 to 50 years,with 41 to 50 years in males and 51 to 60 years in females.The highest age proportion in group A was from 51 to 60 years,and that in group B was from 41 to 50 years,showing significant differences between the 2 groups in age distribution (P ＜ 0.05).There were 3,346 cases in group A,including 2,438 males and 998 females with a male to female ratio of 2.35:1;there were 1,257 cases in group A,including 821 males and 436 females with a male to female ratio of 1.88:1.There were significant differences between the 2 groups in gender distribution (P ＜ 0.05).The high-risk fracture type was Schaztker type Ⅵ in both groups,with 898 cases in group A and 411 ones in group B;the lowest fracture type was Schaztker type Ⅴ in both groups,with 214 cases in group A and 149 ones in group B.There were significant differences between the 2 groups in fracture type ratios (P ＜ 0.05).Conclusions Adult tibial plateau fractures predominated in males in both East and West China.The average age of the patients from East China was higher than that from West China.The high-risk type was Schaztker type Ⅵ in both areas.
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Objective To analyze and compare the epidemiological features of Monteggia fractures between the east and west areas in China from 2010 to 2011.Methods The data of Monteggia fractures treated from January 2010 through December 2011 in 63 hospitals in the east and west China were collected through the PACS system and case reports checking system.The data from the 35 east hospitals were classified as group A while those from the 28 west hospitals as group B.The analytic items included general situation,gender,age,and Bado classification.Results A total of 593 Monteggia fractures were included,including 428 males and 165 females,with a male to female ratio of 2.59:1.The constituent ratios of Bado classification,from high to low,were type Ⅰ (42.50％),type Ⅲ (33.22％),type Ⅱ (14.00％) and type ⅣV (10.29％).There were 376 patients in group A including 263 (69.95％) males and 113 (30.05％)females while 217 patients in group B including 165 (76.04％) males and 52 (23.96％) females.The median age in group B was 31 yearn (from 2 to 75 years),significantly older than that in group A [18 years (from 1 to 83 years)] (Z =2.877,P =0.000).The differences in constituent ratios of age and Bado classification were statistically significant between the 2 groups (P ＜ 0.05).The Monteggia fractures predominated in the age range of 0 to 10 years in group A while in the age range of 31 to 40 years in group B.The high risk fracture type was Bado type Ⅰ in group A and Bado type Ⅲ in group B.The Monteggia fractures accounted for 1.15％ of the forearm fractures and 0.19％ of the systemic fractures.Conclusions More males suffered from Monteggia fracture than females.In the east China,the high risk age range was from 0 to 10 years and the high risk type Bado type Ⅰ;in the west China,the high risk age range was from 31 to 40 years and the high risk type Bado type Ⅲ.The proportion of Bado type Ⅳ in the west China was significantly higher than in the east China.