Treating Neer two- and three-part of proximal humeral fractures through anterolateral acromial approach and deltopectoral approach / 中国骨伤

<p><b>OBJECTIVE</b>To compare clinical results of treating Neer two- and three-part of proximal humeral fractures between anterolateral acromial approach and deltopectoral approach.</p><p><b>METHODS</b>From January 2009 to December 2012, 49 patients with Neer two- and three-part of proximal humeral fractures were treated with locked plate fixation. In anterolateral acromial approach group, there were 22 patients including 9 males and 13 females with an average of (63.2±7.6) years old, while 27 patients in deltopectoral approach including 12 males and 15 females with an average of (62.9±7.0) years old. Operative time, blood loss during operation, fracture healing time and complications were observed and compared, postoperative Constant-Murley scoring and VAS scoring were applied for evaluate function of shoulder joint and pain at 3 months, 1 and 2 years respectively.</p><p><b>RESULTS</b>All patients were followed up from 24 to 41 months with an average of 34.5 months. Operative time, blood loss, fracture healing time in anterolateral acromial approach group was (68.20±7.04) min, (151.30±20.57) ml, (10.88±4.90) weeks respectively, and better than that of in deltopectoral approach group which was (75.81±13.70) min, (242.10±37.25) ml and (13.60±2.45) weeks. Three months after operation, Constant-Murley scoring and VAS score in anterolateral acromial approach group was 88.32±5.45, 0.41±0.63 and better that of in deltopectoral approach group which was 63.53±8.31, 1.65±1.02. There was no significant differences between two groups in Constant-Murley scoring and VAS score at 1 and 2 years after operation. Each group has one case occurred loss of length humerus head height, and there was 1 case with subacromial impingement, 1 case with bolt loose and 2 cases with delayed union in deltopectoral approach. No axillary nerve injury, humeral head necrosis and breakage of internal fixation occurred both of two groups.</p><p><b>CONCLUSION</b>Both of anterolateral acromial approach and deltopectoral approach are effective in treating Neer two- and three-part of proximal humeral fractures, and can obtain excellent outcomes. Moreover, anterolateral acromial approach has advantage of less trauma, less blood loss, shorter operative time, rapid recovery of shoulder joint function and fracture.</p>

Clinical screening of patients with cerebral arteriosclerosis combined with vertebral artery abnormalies / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical screening and value of vertebral artery ultrasound, Transcranial doppler (TCD), Magnetic resonance angiography (MRA) and Computed tomography angiography (CTA) in the diagnosis of cerebral arteriosclerosis combined with vertebral artery abnormalies according to vertebral artery digital subtraction angiography (DSA).</p><p><b>METHODS</b>From January 2006 to September 2010, 186 patients with cerebral arteriosclerosis were retrospectively analyzed. Among the patients, 133 cases were males and 53 cases were females,ranged from 30 to 84 years (with a mean of 63.8 years). All the patients were estimated by DSA; 172 cases were estimated vertebral artery ultrasound and TCD; 53 cases were estimated by MRA; 25 cases were estimated by CTA. The positive results by DSA were seen as case group, while the negative results were seen as control group. The sensitivity, specificity and concordance rate among four groups were calculated.</p><p><b>RESULTS</b>The abnormality rate of vertebral artery with DSA, vertebral artery ultrasound, TCD, MRA and CTA separately was 50.00% (93/186), 30.81% (53/172), 49.42% (85/172),15.10% (8/53) and 40.00% (10/25). According to DSA standard, the sensitivity of vertebral artery ultrasound in diagnosing was 50.57%, the specificity was 89.41%, and concordance rate was 69.77%; while the sensitivity of TCD was 68.48%, the specificity was 72.50%, and concordance rate was 70.35%; the sensitivity of MRA was 21.43%, specificity was 92.00%, and concordance rate was 54.72%; the sensitivity of CTA was 63.64%,the specificity was 78.57%, and concordance rate was 72.00%.</p><p><b>CONCLUSION</b>The reasonable and combined application of vertebral artery ultrasound, TCD, MRA and CTA is helpful for diagnosing cerebral arteriosclerosis combined with vertebral artery abnormalies. For the patients with cerebrovascular disease, cervical massage technique should be paid highly attention, which may cause vertebral artery injury and other complications.</p>

Application of dynamic hip screw with modified reamer in intertrochanteric fracture in the elderly / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the therapeutic effect and characteristic of dynamic hip screw with modified reamer (MDHS for short) in the treatment of the intertrochanteric fracture in the elderly.</p><p><b>METHODS</b>Fifty-four patients with intertrochanteric fracture from Aug. 2007 to Dec. 2008 were retrospectively analyzed. Among them, 27 patients were treated with MDHS, including 12 males and 15 females with an average age of 79.4 years old ranging from 69 to 93 years; according to modified Evans classification, there were 3 cases of type I , 12 cases of type II, 8 cases of type III, 4 cases of type IV. The other 27 patients (10 males and 17 females), aged from 66 to 88 years old (average 77.2), were composed of 4 cases of type I, 14 cases of type II, 6 cases of type III, 3 cases of type IV. The fracture healing time,forepart movement time,percentage of loosening screw and hip joint function were compared between two groups.</p><p><b>RESULTS</b>All 54 patients were followed up for 21 to 36 months (means 27.6 months). All fractures were bone healing. The time of fracture healing were compared between two groups,there were no significant difference (P>0.05). The forepart movement time of MDHS group (14.2 +/- 2.1) was shorter than that of DHS group (18.9 +/- 3.1) (P<0.05). The loosening screw of MDHS group (1 case) was less than that of DHS group (8 cases) (P<0.05). The Harris score of hip joint function of MDHS group (87.8 +/- 4.7) was higher than that of DHS group (83.3 +/- 7.5) (P<0.05).</p><p><b>CONCLUSION</b>MDHS has several advantages on wider indications, stronger holding power,early forepart movement time, fewer complications, which is a good choice for osteoporotic intertrochanteric fracture.</p>