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Objective:To compare the efficacy of femoral neck system (FNS) and cannulated compression screw (CCS) in the treatment of femoral neck fracture in the young and middle-aged patients.Methods:A retrospective cohort study was conducted to analyze the clinical data of 91 patients with femoral neck fracture admitted to Fuzhou Second Hospital from July 2020 to December 2021, including 52 males and 39 females; aged 23-65 years [(48.9±10.3)years]. Garden classification of the fracture found that 31 patients were with type I, 9 with type II, 12 with type III and 39 with type IV. Pauwels classification of the fracture found that 7 patients were with type I, 33 with type II and 51 with type III. A total of 53 patients were treated with FNS fixation (FNS group) and 38 patients with CCS fixation (CCS group). The operation time, intraoperative blood loss, Haidukewych fracture reduction quality, hospitalization time, Barthel index, fracture healing time, and weight-bearing time were compared between the two groups. The hip function was assessed by Harris hip score in both groups at postoperative 3 months, 6 months and 1 year and at the final follow-up. The incidences of postoperative complication and secondary surgery were also compared between the two groups.Results:All the patients were followed up for 15-31 months [(22.2±5.5)months]. There were no significant differences in the operation time, Haidukewych fracture reduction quality, hospitalization time, or Barthel index (all P>0.05). The intraoperative blood loss in the FNS group was 50.0(20.0,85.0)ml, which was more than that in the CCS group [20.0(10.0,50.0)ml] ( P<0.01). The fracture healing time, partial weight-bearing time, and full weight-bearing time in the FNS group [4.0(3.0,5.0)months, 3.0(2.0,3.0)months, 5.0(4.5,6.0)months] were shorter than those in the CCS group [6.0(5.0,7.0)months, 3.0(2.8,4.0)months, 6.0(6.0,7.0)months] (all P<0.01). The Harris hip score at postoperative 3 months, 6 months and 1 year and at the final follow-up were 74.0(71.0,77.0)points, 87.0(84.0,88.5)points, 91.0(88.0,95.0)points, and 94.0(91.0,96.0)points in the FNS group, significantly higher than those in the CCS group [73.0(70.0,74.0)points, 82.5(79.8,87.0)points, 88.0(83.5,91.0)points, 89.0(84.0,93.0)points] (all P<0.05 or 0.01). There were no statistically significant differences in the incidences of postoperative complication or secondary surgery between the two groups (all P>0.05). Conclusion:Compared with CCS, FNS can shorten fracture healing time, allow patients to carry full weight as soon as possible, and significantly improve hip function in the treatment of middle-aged and young adults with femoral neck fracture, although there is more intraoperative blood loss.
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Objective:To compare the clinical efficacy between proximal femoral biomimetic intramedullary nail (PFBN) and traditional proximal femoral anti-rotation intramedullary nail (PFNA) in the treatment of senile osteoporotic intertrochanteric fractures.Methods:The data were retrospectively analyzed of the 92 elderly patients with osteoporotic intertrochanteric fracture who had been treated at Department of Orthopedics, People's Hospital of Xinjiang Uygur Autonomous Region from April to October in 2021. According to their internal fixation methods, the patients were divided into 2 groups.In the PFBN group of 46 patients, there were 22 males and 24 females, with an age of (75.7±5.2) years and time from injury to operation of (3.1±0.4) d; in the PFNA group of 46 patients, there were 20 males and 26 females, with an age of (75.3±4.2) years and time from injury to operation of (3.3±0.5) d. Recorded were the operation time, intraoperative blood loss, hospital stay, fracture reduction quality, postoperative weight bearing time, hip function and complications at the last follow-up.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). The operation time in the PFBN group was (47.3±11.4) min, significantly longer than that in the PFNA group [(39.2±15.3) min] ( P<0.05); the postoperative weight-bearing time in the former was (7.9±2.7) d, significantly shorter than that in the PFNA group [(21.2±5.7) d] ( P<0.05). There were no significant differences between the 2 groups in the intraoperative blood loss [(130.6±21.3) mL versus (123.5±17.8) mL], hospital stay [(4.2±1.6) d versus (4.6±2.1) d], the excellent and good rate of Francisco score [89.1% (41/46) versus 87.0% (40/46)], fracture healing time [(12.3±0.5) weeks versus (12.6±0.7) weeks], or the excellent and good rate of Harris hip score at the last follow-up [89.1% (41/46) versus 87.0% (40/46)] (all P>0.05). Conclusion:Both PFBN and PFNA can achieve satisfactory clinical results in the treatment of osteoporotic intertrochanteric fractures in the elderly patients, but PFBN may provide more reliable early stability and reduce patient bedtime than PFNA.
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Introducción El movimiento de los dedos es dado por un complejo mecanismo que combina tanto extensión como flexión. La alteración del mecanismo extensor en la zona descrita como I, produce una deformidad del dedo conocida como dedo en martillo. El cual puede tener manejo conservador o inclusive quirúrgico cuando está indicado. Materiales y Métodos Estudio observacional descriptivo de tipo corte transversal retrospectivo de pacientes intervenidos por lesión de dedo en martillo en la mano entre junio de 2017 y enero de 2018, operados por cirujanos del módulo de mano a partir de la técnica quirúrgica percutánea con pin transóseo. Resultados Con un total de 48 de pacientes, el 81,25% de los casos fueron hombres, entre los 31 y los 55 años, en su gran mayoría diestros, con mayor frecuencia de lesión de la mano derecha y en el 41,67% de los casos con compromiso del segundo dedo, seguido del tercer dedo (39,58%), secundario a un trauma contuso. Adicionalmente se reportó complicaciones en 2 pacientes (4,16%). Discusión El dedo en martillo es una lesión en su mayoría secundaria a un trauma contuso, de predominio en hombres y de la mano dominante, la cual puede recibir manejo conservador a partir del uso de una férula tipo stack o quirúrgico. Los resultados reportados en el presente estudio siguen los datos descritos por la literatura internacional, encontrándose de forma adicional, la presentación de múltiples comorbilidades y siendo rara la incidencia de la lesión en poblaciones jóvenes. La población atendida presenta características demográficas y relacionadas a la lesión similares a las reportadas en la literatura internacional.
Background The movement of the fingers is given by a complex mechanism that combines both extension and flexion. The alteration of the extensor mechanism at distal interphalangeal joint of the finger is known as mallet finger. Mallet finger can be managed either surgically or not surgically with external splints. Materials and methods A retrospective cross-sectional descriptive observational study was performed including patients diagnosed with mallet finger injury between June 2017 and January 2018 surgically treated with percutaneous internal fixation surgical technique using a transosseous pin. Results A total of 48 patients were included, 81.25% of the cases were men, between 31 and 55 years old, the vast majority right-handed, with a higher frequency of injury to the right hand. 41.67% of cases involved the second finger, followed by the third finger (39.58%), secondary to a blunt trauma. Additionally, complications were reported in 2 patients (4.16%). Discussion Mallet finger is an injury mostly secondary to a blunt trauma, predominantly in men and of the dominant hand, which can receive conservative management from the use of a stack-type or surgical splint. The results reported in the present study follow the data described in the international literature, additionally finding the presentation of multiple comorbidities and the incidence of injury in young populations being rare. The population treated presents demographic and injury-related characteristics similar to those reported in the international literature.
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Humans , Hammer Toe Syndrome , Bone NailsABSTRACT
Objective:To compare the efficacy of minimally invasive percutaneous pedicle screw fixation combined with injured vertebra bone grafting (PPSF+BG) and simple percutaneous pedicle screw fixation (PPSF) in the treatment of single segmental thoracolumbar compression fracture.Methods:The data were analyzed retrospectively of the 56 patients who had undergone PPSE at Department of Spine Surgery, Wuhan Puren Hospital from February 2017 to May 2019. Of them, 29 were treated by PPSF+BG [17 males and 12 females with an age of (50.6±8.4) years] and 27 by simple PPSF [13 males and 14 females with an age of (49.3±8.2) years]. The 2 groups were compared in terms of operation time, intraoperative blood loss, hospital stay and incidence of complications. The height of anterior edge of injured vertebra, cobb angle of injured kyphosis, visual analogue scale (VAS) and Oswestry disability index (ODI) at postoperative 1, 6 and 12 months were also compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, showing they were comparable ( P>0.05). All of them were followed up for more than 12 months. There was no significant difference between the 2 groups in operation time, intraoperative blood loss, hospital stay or incidence of complications ( P>0.05). There was no significant difference between the 2 groups either in the height of anterior edge of injured vertebra, cobb angle of injured kyphosis or ODI score at 1 or 6 months after operation ( P>0.05). At 12 months after operation, PPSF+BG group had a significantly greater height of injured vertebra [(19.5±0.9) mm], a significantly smaller cobb angle of kyphosis (7.1°±0.5°) and a significantly lower ODI score (11.1±2.9) than PPSF group [(18.2±1.3) mm, 8.1°±0.5° and 19.5±1.6] ( P<0.05). At postoperative 6 and 12 months, the VAS scores in PPSF+BG group were significantly lower than those in PPSF group ( P<0.05). In all the patients, the postoperative height of anterior edge of injured vertebra, cobb angle of injured kyphosis, VAS and ODI scores were significantly improved than the preoperative values ( P<0.05). Conclusion:Although both minimally invasive percutaneous pedicle screw fixation combined with bone grafting and simple percutaneous pedicle screw fixation can achieve good therapeutic outcomes for single segmental thoracolumbar compression fractures, the former may be superior in effectively promoting rapid recovery of the patients and improving the quality of life of the patients after operation.
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ABSTRACT Objective: This study compared groups of patients with calcaneal fractures of Sanders types II and III. One group was treated with ORIF using an LCP (plate), while the second was treated with a minimally invasive method using a C-Nail. Methods: The study included 217 patients in the ORIF group and 19 patients in the minimally invasive nail osteosynthesis group. Results: In the LCP group, the outcomes were excellent for 35.7% of the patients; good, 38.9%; satisfactory, 19.7%; and poor, 5.7%. In the C-Nail group, the outcomes were excellent for 36.9% of the patients; good; 31.6%; satisfactory, 21%; and poor, 10.2%. The mean values of the restoration of Böhler's angle from post-injury were 6.8° to 32.3° in the LCP group and 7.1° to 33.3° in the C-Nail group. After 12 months, there was only a minimal decrease in Böhler's angle to 29.2° in both the LCP and C-Nail groups. Conclusion: The outcomes obtained with C-Nail fixation are statistically identical to those obtained with LCP fixation. We conclude that osteosynthesis with a C-Nail is suitable as the first-choice treatment for Sanders types II and III fractures. Level of evidence IV, retrospective observational study.
RESUMO Objetivo: Comparar grupos de pacientes com fratura intra-articular do calcâneo tipos II e III de Sanders. Métodos: Estudo retrospectivo que incluiu 217 pacientes no grupo tratado por redução aberta e fixação interna com placa de compressão (Grupo PC) e 19 pacientes que seguiram um método minimamente invasivo com C-Nail. Resultados: No Grupo PC, os resultados foram excelentes em 35,7%, bons em 38,9%, satisfatórios em 19,17% e ruins em 5,7%. Os resultados registados no grupo que recebeu implante de unha foram excelentes em 36,9%, bons em 31,6%, satisfatórios em 21% e ruins em 10,2% Os valores médios do restauro do ângulo de Böhler desde o pós-ferimento variaram entre 6,8° e 32,3°, no Grupo PC, e entre 7,1° e 33,3°, no grupo tratado com C-Nail. Ao fim de 12 meses, apenas se observou redução mínima do ângulo de Böhler para 29,2° nos dois grupos. Conclusão: Os resultados do método recentemente introduzido de osteossíntese minimamente invasiva com C-Nail são estatisticamente idênticos aos obtidos pela redução aberta e fixação interna com placa de compressão. Assim, o novo tipo de osteossíntese com C-Nail é adequado como primeira escolha em fraturas do tipo Sanders II e III. Nível de evidência IV, Estudo retrospectivo de observação.
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Objective To explore the clinical application of our self-designed controllable and portable double-pin traction device on calf in the treatment of tibiofibular fractures.Methods Our controllable and portable double-pin traction device on calf was designed to fulfill the purpose of traction and address current problems in traction for tibiofibular fractures.This device is composed of double-hole connectors,nuts of various specifications,traction pin sleeves,2 transfixion pins and 2 threaded rods for traction.The transfixion pins are fixed at conventional traction positions.The threaded rods for traction are paralleled to the long axis of lower limb and located on both sides of the calf.Bone ends can be distracted by adjusting the nut of M8 width and the speed of pulling can be controlled.This device can be used not only for rapid traction during surgery but also for slow traction preoperatively.It was applied in the 30 patients with tibiofibular fracture who had been treated at Department of Orthopaedic Surgery,920th Hospital of Joint Logistic Support Force from January to December 2017.Their radiographs were taken before traction and at 3 and 6 days after traction to observe the changes in overlapped fracture ends and fracture gap.The lengths of distraction were measured.After limited open reduction,fracture gaps and tensions of surrounding soft-tissues were observed.Results Their radiographs before and after traction demonstrated that their overlapped and displaced fracture ends were distracted more or less.The length of distraction ranged from 7.2 mm to 45.8 mm (mean,23.1 mm);it was ＜ 15 mm in 6 cases,between 15 mm and 30 mm in 18,between 31 mm and 45 mm in 5,and ＞ 45 mm in one.Their radiographs showed that regular traction for 6 days was more obvious than that for 3 days.The limited open reduction revealed that the gap between fracture ends was expanded,the soft-tissue tension effectively relaxed,the overlapping of fracture ends diminished,and the dissection of surrounding soft-tissue and periosteum decreased,leading to less difficulty in reduction.In fractures near the joint or involving the articular surface,the joint space was expanded.The 30 patients were followed up for one to 16 months (mean,5.8 months).No such complications as pin site infection,traction fracture or osteomyelitis was observed.Conclusion Our self-designed controllable and portable double-pin traction device on calf is effective and advantageous,because it is simple,easy,light in weight,and controllable for traction speed.
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Objective To compare the efficacy between intramedullary nail and plate in the internal fixation for distal tibial shaft fractures in adults.Methods A retrospective analysis was conducted of the 49 patients with distal tibial shaft fracture who had been treated by internal fixation with intramedullary nail or plate at Department of Orthopaedics,The First People's Hospital of Neijiang from September 2014 to September 2018.They were 26 males and 23 females,aged from 19 to 71 years (average,42.3 years).According to the AO/ ASIF classification,there were 34 cases of type 43A1 and 15 cases of type 43A2.There were 7 open and 42 closed fractures.Of them,23 received intramedullary nailing and 26 steel plating.The 2 groups were compared in terms of intraoperative blood loss,operation time,hospitalization time,fracture healing time,The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score,infection and fracturemalunion.Results The 2 groups were comparable because there were no significant differences in the preoperative general data between them(P ＞ 0.05).The intraoperative blood loss in the intramedullary nail group (160.3 mL ± 15.2 mL) was significantly greater than that in the plate group (110.5 mL ± 13.4 mL) (P ＜ 0.05).There were no significant differences between the 2 groups in operation time,hospitalization time,fracture healing time or AOFAS ankle-hindfoot scores at the final follow-up (P ＞ 0.05).There were no significant differences between the 2 groups either in the rates of malunion,infection or internal fixation failure (P ＞ 0.05).Five cases in the intramedullary nail group reported painful discomfort in the front of the knee joint while 7 cases in the plate group postoperative discomfort due to plate protrusion.Conclusions Both intramedullary nail and plate are effective treatments of adult distal tibial fracture.However,in order to minimize the risk of infection,intraoperative maneuvers should be as careful and gentle as possible,repeated violence be avoided and soft tissues be carefully protected.
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Objective To report the clinical efficacy of Kirschner wire combined with external fixator in the treatment of open comminuted distal tibiofibular fractures according to the concept of damage control orthopaedics.Methods A case series study was done on the clinical data of 15 open comminuted distal tibiofibular fractures which had been treated with kirschner wire combined with external fixation from January 2015 to August 2018 at Department of Orthopedics,Affiliated Hospital to Logistics College of Chinese People's Armed Police.They were 12 men and 3 women,aged from 27 to 62 years (mean,46.5 years).By the Gustilo classification,there were one case of type Ⅰ,4 cases of type Ⅱ,7 cases of type Ⅲ A,2 cases of type ⅢB and one case of type ⅢC.All the patients were treated with emergency debridement,tibial fixation using external fixator and fibular fixation using kirschner wire,followed by vacuum sealing drainage(VSD).Effective anti-inflammatory and other comprehensive treatments were given postoperatively.Regular follow-up was conducted to observe fracture healing and complications like osteomyelitis and bone disconnection.At the final follow-up,the American Orthopaedic Foot Ankle Society (AOFAS) ankle-hindfoot scale was used to evaluate the ankle function.Results All the patients were followed up for 12 to 18 months (mean,12.8 months).Primary bone union was achieved in 13 cases (86.7％),delayed healing observed in one case (6.7％) and bone nonunion in one case (6.7％).No osteomyelitis occurred.By the AOFAS ankle-hindfoot scale,the ankle function was rated as excellent in 9 cases,as good in 4,as fair in one and as poor in one.Conclusions For patients with open comminuted distal tibiofibular fracture,treatment should be conducted according to the concept of damage control orthopaedics.After early thorough debridement,the tibia should be fixated using external fixator and the fibula using kirschner wire,followed by VSD,leading to economical cost and satisfactory clinical efficacy.
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Objective To investigate the efficacy of lateral decubitus intramedullary nailing for treatment of subtrochanteric fractures of the femur.Methods From January 2012 to December 2015,23 patients with simple femoral subtrochanteric fracture were treated at Department of Orthopedic Trauma,Changhai Hospital.They were 15 males and 8 females,aged from 19 to 77 years (average,48.3 years).According to the Seinsheimer classification,there were 6 cases of type ⅡB,8 cases of type ⅡC,6 cases of type Ⅲ A,and 3 cases of type ⅢB.Their injuries were caused by traffic accident in 10 cases,falling from a height in 5 cases,and sprain in 8 cases.All patients were treated by closed reduction and anterograde intrarnedullary nailing at lateral decubitus.Their operative time,bleeding volume,fluoroscopic frequency,fracture healing time,functional recovery and complications were recorded and analyzed.Results Their operative time ranged from 55 to 80 min,averaging 65.7 min;their bleeding volumes ranged from 240 to 420 mL,averaging 304.3 mL;their fluoroscopic frequency ranged from 30 to 60 times,averaging 42.7 times.This cohort was followed up for 12 to 28 months (average,17.9 months).Their fracture healing time ranged from 4 to 10 months,averaging 5.5 months.Nonunion occurred in one patient but was cured by secondary operation.The HSS evaluation at the final follow-ups showed 17 excellent cases and 6 good ones,yielding an excellent to good rate of 100％.All the wounds healed by the first intention.No infection,deep vein thrombosis or implant failure was observed.Conclusion As lateral decubitus intramedullary nailing can achieve satisfactory clinical efficacy for subtrochanteric fractures of the femur,the body position of lateral decubitus may be a good alternative.
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Objective To evaluate the clinical outcomes of three-dimensional navigation assisted percutaneous sacroiliac screw combined with external fixator for the treatment of the Tile B and C pelvic fractures. Methods A retrospective case-control study was conducted on 43 patients with Tile B and C pelvic fractures from January 2014 to June 2017. There were 25 males and 18 females, with an average age of 44.6 years (range, 21-68 years). According to the AO typing, there were seven cases of type B1, 13 type B2, six type B3, 15 type C1, and two type C2. The duration from injury to operation ranged from 4 to 14 days (mean, 8.0 days). Based on the operation method, patients were divided into Group A (n=20) treated by three dimensional navigation assisted percutaneous sacroiliac screw combined with external fixator, and Group B (n = 23) treated by anterior open reduction and plate internal fixation. The two groups were compared in terms of operation time, blood loss, reduction quality by Matta score, Majeed pelvic fractures function score at the last follow up, and postoperative complications. Results All patients were followed up for 6-24 months (mean, 12.7 months). The operation time [(27.5 ± 1.6) minutes] and intraoperative bleeding [(26.3 ± 3.9) ml] in Group A were significantly less than those in Group B [(166.2±3.6)minutes and (128.0 ± 8.9) ml] (＜0.05). There were no significant differences between Group A and Group B in the good and excellent rate of reduction [85％ (17/20) vs.91％ (21/23)], and Majeed score [90％ (18/20) vs.91％ (21/23)](P＞0.05). The incidence of postoperative complication in Group A (10％) was significantly lower than that in Group B (39％) (P ＜0.05). Conclusion Compared with open reduction and plate internal fixation, three dimensional navigation assisted percutaneous sacroiliac screw combined with external fixator is preferable to unstable pelvic fractures due to the shorter operation time, less intraoperative bleeding, and fewer postoperative complications.
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Objective To compare the clinical effect of digital orthopedic three-dimensional visualization technology combined with image-based computer navigation and simple image-based computer navigation in percutaneous screw fixation for the treatment of sacroiliac joint complex injury. Methods A retrospective case-control analysis was conducted on 49 cases of sacroiliac complex injury from January 2015 to May 2017. There were 27 males and 22 females, with an average of 39.3 years old (range, 21-66 years). According to AO typing, there were 10 cases of type B1, 19 type B2, and 20 type C1. The duration from injury to operation ranged from 5 to 11 days (mean, 6.5 days). Based on the application of three-dimensiona digital programming, the 49 cases were assigned to Group A (n =24) which used Mimics computer assisted surgery software to simulate screw placement on the healthy side of sacroilic joint before operation and Group B (n = 25) without the simulation programming. Screw placement time, intraoperative fluoroscopy frequency, and intraoperative bleeding were compared between two groups. Fracture reduction was evaluated by modified Matta standard score, and the function of hip joint by Majeed pelvic fracture function score at the last follow-up. Fracture healing and complications were observed. Results All patients were followed up for an average of 10.4 months (range, 6-24 months). The time of sacroiliac joint screw placement [(18.4 ±3.0)min] and the intraoperative fluoroscopy frequency [(12.9 ± 3.8) times] in Group A were significantly less than those [(26.4 ±3.8) min, (19.4 ±1.5) times] in Group B (P ＜ 0.05). There were no significant differences between Group A and Group B in intraoperative bleeding [(14.1 ± 3.0) ml vs. (15.1 ± 2.2) ml](P＞0.05). According to the modified Matta reduction standard, the good and excellent rate of Group A was 92％ (22/24), and that of Group B was 92％ (23/25). At the last follow up, the Majeed pelvic function score was 96％ (23/24) in Group A and 92％ (23/25) in Group B (P ＞0.05). Bone healing was seen in all patients 4 months after operation, and no complications such as wound infection, deep venous thrombosis, or screw loosening were observed. Conclusion The digital orthopedic three-dimensiona visualization technology in preoperative planning can reduce the time of sacroiliac screw placement and the intraoperative fluoroscopy frequency. It is an effective adjuvant technique for the percutaneous screw fixation under navigation in the treatment of sacroiliac joint.
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Objective To investigate the clinical effects of tibiotalocalcaneal arthrodesis (TTCA) using a retrograde intramedullary nail with a valgus curve.Methods At our department,22 patients underwent TTCA using a retrograde intramedullary nail with a valgus curve from June 2009 to January 2014 and were available for complete follow-up.They were 12 men and 10 women,aged from 46 to 79 years (average,62.2 years).There were 3 cases of primary ankle osteoarthritis,9 ones of traumatic arthritis,one of ankle arthritis secondary to severe talar avascular necrosis,3 ones of progressive subtalar arthritis following failed ankle replacement,5 ones of progressive subtalar arthritis following failed ankle arthrodesis,and one of arthritis secondary to equinovarus.The outcome measurements included the American Foot and Ankle Society (AOFAS) ankle-hindfoot scale,EQ-5DTM functional score,radiologic assessment and clinical examination.Results The mean follow-up was 21.3 months (range,from 14 to 38 months).A plantigrade foot and bony union were achieved in all the patients after a mean time of 3.9 months (range,from 2.4 to 6.2 months).Postoperative radiologic results showed a good hindfoot alignment in all the patients.Superficial infection occurred in one patient and loosening of the distal screw in another who asked for removal.The mean postoperative EQ-5DTM functional score and AOFAS ankle-hindfoot score were 69.3 (range,from 20 to 90) and 69.9 (range,from 45 to 85),respectively.Conclusion TTCA using a retrograde curved intramedullary nail may lead to solid fusion and good hindfoot alignment.
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Objective To compare the clinical effect of PMMA bone cement augmented screw passageway and bone cement-injectable cannulated pedicle screw in treatment of degenerative lumbar disease with osteoporosis. Methods Forty-eight patients with lumbar degenerative disease accompanied with osteoporosis from June 2012 to March 2014 were selected, including 21 males and 27 females with an average age of 64.5 years ( ranged 54 -78 years).There were 17 cases of lumbar degenerative stenosis,18 cases of lumbar intervertebral disc herniation, 8 cases of lumbar degenerative spondylolisthesis,and 5 cases of lumbar degenerative scoliosis.According to the opera-tion method,the patients were divided into two groups.23 cases in group A were treated with bone cement injectable cannulated pedicle screw and 25 cases in group B were treated with PMMA bone cement augmented screw passageway by used conventional screw.Operation time, amount of bleeding and hospitalization time were used to evaluate the clinical characteristics.Visual analogue scale( VAS) score and Oswestry disability index( ODI) were used to evaluate function recovery of post-operative pain and function.The height of intervertebral space,failure rate of internal fixa-tion and bone fusion rate were analyzed by X-ray films postoperative1,3,6,12 months and per year.Results All 48 cases were followed up for 1 -3.5 years.Operation time,amount of bleeding and the time of hospitalization of group A were significantly lower than those in group B(all P0.05).One case of group A had screw fracture,but group B did not appear this kind of situation(P<0.05).Three cases of group B had screw loosening or pullout,but that did not happen in group A.The loss of intervertebral height was (2.7 ±1.7) mm in group A,which in group B was (3.7 ±2.1) mm,there was significant difference between the two groups( P<0.05).According to VAS score and ODI,pain and function in both two groups were improved,but the effect of group A was better than group B(all P<0.05).Conclusion Bone cement-augmentation bone cementinje-ctable cannu-lated pedicle screw may be a safe and effective method in treatment of degenerative lumbar disease with osteoporosis.
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Objective To evaluate the treatment effect of PFNA clinical analysis in patients with intertro-chanteric fracture application.Methods 40 cases of intertrochanteric fractures PFNA internal fixation treatment were selected,the operation time,intraoperative blood loss and fractures healing time,degree of hip joint function recovery after operation and the postoperative complications were observed.Results Operating time was 60 -120minutes,with an average of (90.0 ±12.5)minutes.Intraoperative blood loss volume was 200 -600mL,and the average volume was 380.8 plus or minus 58 ml.Fracture clinical healing time was 8 to 15 weeks,with an average of (10.5 ±2.5)weeks. According to Harris hip joint function score,the overall good rate was 85.5%.There were no postoperative complica-tions occurred.Conclusion PFNA applies to all types of intertrochanteric fractures,especially for the old type osteo-porosis bone fracture,which with simple operation,small trauma,fixed firmly,fracture healing fast and less complica-tions.It is worthy of clinical use.
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Objective To explore the fixed-effects of the treatment using transarticular screw joint lateral mass screw unilateral bi-direction fixation through posterior midline approach.Methods 16 patients,12 patients with traumatic fracture-dislocation and 4 patients with cervical disc herniation with spinal stenosis,were treated with transarticular screw(caudad) joint lateral mass screw (cephalad)unilateral bi-direction fixation in the posterior cervical.Results 32 transarticular screws were implanted,including C4-5 8 pieces,C5-6 12 pieces,C6-7 12 pieces;36 lateral mass screws were implanted,including C2 13 pieces,C3 14 pieces,C4 9 pieces.All screws were successfully implanted in operation,without injuries and other complications in vertebral artery,nerve root and spinal cord.16patients were followed up for averaged 18 months ( 10 - 30 months).Surgical incisions reduced by half than traditional ,fusion time were 2.0 to 4.5 months for an average of 3.1 months.Conclusions When through theposterior fixed cervical spine,used transarticular screw joint lateral mass screw unilateral bi-direction fixation,fixed simply and reliably,reduced internal fixation materials for implantation,reduced operative time,increased bone bed area,the bone fusion rate was high,reduced the length of surgical incision,reduced the blood vessels,nerve root injury risk ,reduced complications such as axial symptoms ,saved medical expenses,achieved good results.