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Objective:To evaluate the outcomes of posterior-column dominating three-column tibial plateau fractures treated by raft-nailing and cannulated screwing via the posteromedian approach.Methods:From October 2017 to June 2019, 15 patients with posterior-column dominating three-column tibial plateau fracture were surgically treated at Department of Orthopedics, The First Affiliated Hospital to Harbin Medical University. They are 11 males and 4 females, aged from 26 to 65 years (average, 41.2 years). All patients were operated on under general anesthesia or spinal anesthesia. After full exposure via the posteromedian approach using a popliteal S-shaped incision, their fractures were treated with raft-nailing and cannulated screwing. Wound healing and neurovascular injury were observed after operation. X-ray films were taken regularly to monitor fracture union and measure the tibial plateau angle (TPA) and posterior slope angle (PA) of the tibial plateau. The knee function was assessed using The Hospital for Special Surgery (HSS) scoring system at 12 months after operation.Results:Incisions healed by the first intention after surgery in 14 patients but the healing was delayed due to fat liquefaction in one patient. No symptoms of neurovascular injury were observed in the 15 patients who were followed up for 12 to 29 months (average, 16.5 months). All fractures united after 12 to 20 weeks (average, 15.4 weeks). At 3 days and 12 months after operation, respectively, their PA was 9.3°±2.1° and 9.7°±1.6° and their TPA 4.3°±1.2° and 4.1°±1.1°, showing no significant difference ( P>0.05). At 12 months after operation, their HSS scores ranged from 84 to 95 (average, 89.3), their knee flexion from 105° to 138° (average, 126.5°) and their knee extension from 0° to 8° (average, 3.4°). Conclusions:In the treatment of posterior-column dominating three-column tibial plateau fractures, raft-nailing combined with cannulated screwing via the posteromedian approach can achieve not only full exposure by a single incision but also stable plateau fixation, reduce operative invasion, and simplify operative procedures, leading to fine surgical outcomes.
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Objective:To evaluate the efficacy of individualized preoperative planning combined with various fixations in the treatment of complex multiplanar deformities at lower extremity.Methods:Four patients with complex multiplanar deformities at lower extremity were treated at Department of Orthopedics, The First Affiliated Hospital to Harbin Medical University from January 2018 to May 2019. They were one male and 3 females, aged from 12 to 65 years (average, 28.8 years). All patients underwent thin-layer (1 mm) CT scan before surgery. Individualized preoperative planning and surgical simulation were conducted using the CT data. 3D printing technology was used to fabricate individualized surgical templates to facilitate osteotomy. Recorded were operation time, frequency of intraoperative fluoroscopy, fracture healing time, Lysholm scores before and after operation, Hospital for Special Surgery (HSS) knee function scores, pain scores of visual analogue scale (VAS) and postoperative complications in this cohort.Results:The operation time averaged 160.0 min, the frequency of intraoperative fluoroscopy 5.0 times, the follow-up duration for the 4 patients 8.8 months, the fracture healing time 6.3 months, the Lysholm scores before and after operation 55.8 and 80.5 points respectively, the HSS scores before and after operation 61.0 and 80.8 points respectively, and the VAS scores before and after operation 3.8 and 1.0 points respectively. Accurate osteotomy was achieved with assistance of the templates and no deformation or breakage of the templates was observed. Follow-ups showed fine alignment of the lower extremities by the full-length X-ray films and no recurrence of deformity, infection, implant breakage, or delayed union or non-union of the osteotomy sites.Conclusions:For patients with multiplanar deformities at lower extremity, individualized preoperative planning can be made before surgery to obtain the accurate parameters relevant to the osteotomy. In combination with various fixations, a patient-specific template made by 3D printing can be used to achieve accurate osteotomy, ensuring good efficacy, safety, efficiency and accuracy of the surgery.
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Objective@#To investigate the changes of internal fixation stress under different angles of interior fracture line and different screw placement modes in the case of A-type distal femoral fracture.@*Methods@#A 24-year-old healthy male volunteer was recruited to collect the right femur data. CATIA V5R21 software produced a 10 mm fracture gap at the external side of the femur 6.5 cm proximal to the joint line and different angle fracture lines were generated on the internal of the femur at the same height. Based on the actual measured dimensions, the three-dimensional (3D) model of the locking plate and screw was reconstructed using CATIA V5R21 software, ignoring the screw surface threads and then the assembly of the internal fixation of the titanium plate, screws and femur was done. All models were meshed using Hypermesh 13.0 software. The assembled 3D model was input into ABAQUS 6.14 to generate a finite element model. Preliminary finite element biomechanical analysis was performed using the four medial fracture line angles and the stress distribution of the internal fixation under the three screw placement modes, and then the analysis was continued after the optimal screw placement method was re-determined.@*Results@#Under an axial loading of 700 N, with the increase of the angle of the fracture line, the stress of the lateral internal fixation gradually increased, and the displacement of the proximal end of the fracture gradually increased. The sequential screw placement method was superior to the leaping screw placement method. The placement of the first screw at the proximal end of the fracture was critical to the distribution of the internal fixation stress.@*Conclusions@#The operation plan of the type A of distal femoral fracture needs to be confirmed according to the internal and external fracture′s condition. When the fracture line is at a excessive positive angle or a negative angle, a simple lateral fixation may not provide a stable fracture fixation so that other fixation methods are needed.
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Objective To compare the clinical results of two surgery for medial compartment osteoarthritis of theknee.Methods We choosed 49 patients with medial compartment osteoarthritis knee joint who were accessed to the hospital in the corresponding standards from January 2013 to January 2016.All the patients were divided into two groups according to the different surgery:unicompartmental knee athroplasty U group(21 patients)and proximal fibular osteotomy F group(28 patients).We recorded and compared the two groups with the operative incisionlength,bloodloss,operationtime,hospitalization time,totalcost during hospitalization,HSS and VAS.Results After oper ating 3 months,the HSS knee score of the two groups increased significantly and the VAS decreased significantly(P ＜ 0.05).While compared between the two groups in the same period,there were no significant differences in HSS and VAS(P ＞ 0.05).The operative incision length,the amount of blood loss,operation time,hospitalization time,total cost during hospitalization in F group were significantly better than those in U group,and the difference was statistically significant (P ＜ 0.05).Conclusion Proximal fibula osteotomy has the similar effect with the UKA and has the advantages of less trauma,less blood loss,low cost,shorter duration of operation and shorter hospitalization time etc.It has a good prospect.
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BACKGROUND:There are various therapies for children limb fractures involving the epiphysis or the metaphysis. According to the different methods, studies on the growth of the epiphyseal plate are a lot, most of which focus on the effects of Kirschner wires with different diameters or holow screw internal fixation on the development of epiphyseal plate. However, there are rare studies on the influence of cross-epiphyseal plate internal fixation on the growth of epiphyseal plate as wel as the influence level. OBJECTIVE:To prepare a peri-epiphyseal fracture model in young rabbits and to observe the effects of cross-epiphyseal plate implantation and removal on the growth of epiphyseal plate. METHODS: Traverse fracture models were made 5 mm above the right femoral distal epiphyseal plate of 60 young rabbits, and then fixed with suitable “L” steel plate and four screws across the epiphyseal plate and peri-epiphyseal fracture line. The left side served as control. Eight rabbits were kiled and observed at 2, 4, 8, 12 weeks after modeling, respectively, to take out the femoral specimens for measurement of femoral length, thickness of the epiphyseal plate, and number of mastocytes per unit column. Histopathology observation was done and changes in mastocytes and thickness of the epiphyseal plate were detected. Another seven rabbits were selected to remove the metal plate, continued to feed for 2 weeks and finaly executed to observe the above-mentioned indexes. RESULTS AND CONCLUSION: (1) There were significant differences in the above indexes between the plate and control groups at 4, 8, 12 weeks after modeling (P 0.05). These findings indicate that within 2 weeks after cross-epiphyseal plate internal fixation, proper pressue has no remarkable influence on the growth of epiphyseal plate; but after persistent internal fixation (> 4 weeks), the growth of epiphyseal plate can be partialy or completed retarded. (2) At 2 and 4 weeks after modeling, the plate was removed, and 2 weeks later, the femoral length, thickness of the epiphyseal plate and mastocyte counting per unit column were improved to different extents, and there were no differences between the plate and control group (P > 0.05). At 8 and 12 weeks after modeling, the plate was removed, and 2 weeks later, the femoral length and thickness of the epiphyseal plate were shortened, and the number of mastocytes per unit column was decreased obviously, which significantly differed from the control group (P < 0.001). These findings indicate that the chondrocytes in the proliferative and hypertrophy layers lose the differentiation and proliferation abilities, and the femoral length and epiphyseal plate thickness are difficult to recover.
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Objective To analyze prophylactic chemotherapy outcome and clinical characteristics in patients of high-risk hydatidiform mole. Methods Twenty-three patients who were diagnosed as high-risk hydatidiform mole and undergone prophylactic chemotherapy in our hospital were retrospectively analyzed.After prophylactic chemotherapy, 11 patients didn't develop to gestational trophoblastic neoplasia (GTN),while the other 12 patients developed to GTN and needed a regimen change to combination chemotherapy.The clinical characteristics of these patients and outcome of prophylactic chemotherapy were compared between two groups. Results There was no significant difference between the two groups on patients' age,weeks of delayed menses, enlarged uterine size excessive for gestational age, and incidence of theca-lutein cysts of ovaries. However,the median levels of pre-evacuation serum β-hCG in two groups were 469 144 U/L and 768 044 U/L respectively, and median days needed for β-hCG declining to normal(≤2U/L) at the first time were 71 and 120 days respectively, which were both significantly different between two groups.Analyzed with receiver operating charactristic(ROC), the level of serum β-hCG could be a predictor for prognosis. Choosing 750 000 U/L as the cut-off value, we could expect the serum β-hCG to have a specificity of 91% and a sensitivity of 58% to predict whether prophylactic chemotherapy will be successful.Conclusions For those patients who have to receive prophylactic chemotherapy because of risk factors and unavailable hCG assessments for follow-up, it's better to use double-agent or combination chemotherapy if the level of serum β-hCG reached 750 000 U/L so as to reduce therapy duration and prevent relevant chemoresistance.
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After the concept of damage control resuscitation is introduced, in the most severely injured casualties, when the lethal triad of hypothennia, acidosis, and coagulopathy are present, resuscitation prac-tice for damage control usually focuses on rapid reversal of acidosis and prevention of hypothermia, while di-rect treatment of eoagulopathy has been relatively neglected. Recent studies have brought back to light the importance of treating the coagulopathy of trauma at an earlier stage. This review focused on the importance and the right time of treating this disorder, analyzed the methods of addressing the early coagalopathy in damage control resuscitation and gave some advices.