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Objective:To compare effect of internal fixation of ribs assisted by complete thoracoscopy and thoracotomy for flail chest.Methods:A retrospective cohort study was used to analyze the clinical data of 86 patients with flail chest treated at No.2 Hospital of Nanping City and 900th Hospital of Joint Logistics Support Force between January 2019 and December 2020, including 58 males and 28 females; aged 25-69 years [(42.9±9.5)years]. A total of 45 patients underwent internal fixation of ribs assisted by complete thoracoscopy (thoracoscopy group), and 41 patients by thoracotomy (thoracotomy group). The operation time, number of fixed ribs, intraoperative blood loss, ventilation time, postoperative length of hospital stay, hemodynamic indicators [partial pressure of oxygen (PaO 2), partial pressure of carbon dioxide (PaCO 2), oxygenation index (PaO 2/FiO 2)] before surgery and at 1 day after surgery, respiratory function [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximal voluntary ventilation (MVV)] at 1, 3, 6 and 12 months after surgery and postoperative complications were compared between the two groups. Results:All patients were followed up for 12-18 months [(14.1±1.9)months]. Thoracoscopy group showed prolonged operation time [(139.5±36.4)minutes vs. (114.8±32.5)minutes], reduced intraoperative blood loss [(124.6±42.4)ml vs. (198.6±62.6)ml] as well as shortened ventilation time [(4.0±1.1)days vs. (6.7±1.6)days] and postoperative length of hospital stay [(14.9±2.4)days vs. (17.9±3.7)days] when compared with thoracotomy group (all P<0.01). There was no statistical significance in the number of fixed ribs between the two groups ( P>0.05). There were no statistical differences in PaO 2, PaCO 2 or PaO 2/FiO 2 between the two groups before surgery (all P>0.05). At day 1 after surgery, the PaO 2 and PaO 2/FiO 2 in thoracoscopy group were (86.2±5.4)mmHg and 321.4±36.1, higher than (80.1±6.2)mmHg and 286.0±29.3 in thoracotomy group (all P<0.01); the PaCO 2 was (37.4±2.4)mmHg in thoracoscopy group, lower than (40.0±3.1)mmHg in thoracotomy group ( P<0.01). At 1 month, 3 months, 6 months and 12 months after surgery, the FVC was (75.5±10.9)%, (84.5±10.5)%, (93.1±12.8)% and (102.6±17.5)% in thoracoscopy group, higher than (69.2±9.9)%, (78.3±8.9)%, (86.2±10.4)% and (92.4±14.8)% in thoracotomy group; the FEV1 was (76.9±9.3)%, (88.4±12.9)%, (92.4±13.9)% and (98.5±10.6)% in thoracoscopy group, higher than (72.9±8.5)%, (82.8±11.4)%, (86.4±12.7)% and (93.5±11.9)% in thoracotomy group; the MVV was (78.3±13.4)L/min, (87.5±13.5)L/min, (94.6±14.7)L/min and (100.1±11.9)L/min in thoracoscopy group, higher than (72.5±11.6)L/min, (80.5±12.7)L/min, (86.5±13.5)L/min and (92.8±10.3)L/min in thoracotomy group (all P<0.05). There were no thoracic deformities in the two groups after surgery. There was no statistical significance in incision infection rate between the two groups ( P>0.05). The incidence rate of pulmonary infection, atelectasis and pleural effusion was 11.1% (5/45), 6.7% (3/45) and 11.1% (5/45) in thoracoscopy group, lower than 29.3% (12/41), 24.4% (10/41) and 31.7% (13/41) in thoracotomy group (all P<0.05). Conclusion:Although internal fixation of ribs with complete thoracoscopy has longer surgical time than thoracotomy in the treatment of flail chest, it can decrease intraoperative blood loss, ventilation time and length of hospital stay and is more conducive to improving the respiratory function and reducing complication rate.
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OBJECTIVE@#The design and development of split memory alloy sternum bone plate are discussed, and the effect of split memory alloy sternum bone plate internal fixation in the treatment of sternal fractures are analysed.@*METHODS@#The structure of the product is designed according to the anatomy and physiological characteristics of human bones, and the cross section shape of the product is designed according to the cross section shape of human bones. Internal fixation is effective in the treatment of sternal fracture.@*RESULTS@#The split memory alloy sternal plate was successfully designed and developed, and all the patients with sternal fractures treated by internal fixation were clinically healed, the hospitalization and fracture healing time were significantly shortened, and no obvious complications occurred.@*CONCLUSIONS@#The application of split memory alloy sternal plate internal fixation in the treatment of sternal fracture has the advantages of small trauma, simple operation, safety, reliable fixation, good histocompatibility and less complications, and is conducive to promoting fracture healing and respiratory function improvement.
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Humanos , Aleaciones , Placas Óseas , Fijación Interna de Fracturas , Curación de Fractura , Esternón/cirugíaRESUMEN
BACKGROUND: The current internal fixation surgery for scapula fractures is limited by the complex anatomical structure of scapula, which is often difficult to operate, with much bleeding and time-consuming. OBJECTIVE: To observe the clinical efficacy of the application of 3D printing technology in scapula fracture surgery. METHODS: The clinical data of 28 cases (aged 34-70 years) with scapula fractures in the Second Affiliated Hospital of Nanjing Medical University from January 2016 to December 2018 were analyzed retrospectively. Among them, 14 cases were treated after routine preparation (control group). Another 14 patients underwent 64-slice thin-slice CT scanning and 3D reconstruction. The fracture model was printed with 3D printing technology. The surgical approach was designed and the internal fixation was customized before the operation (3D printing group). The operation time, intraoperative blood loss and intraoperative X-ray frequency of the two groups were recorded. Imaging data were followed up six weeks after the operation. The treatment effects were evaluated according to the Hardegger shoulder joint function assessment standard. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. RESULTS AND CONCLUSION: (1) All the 28 operations were successfully completed. The operation time, intraoperative blood loss and X-ray frequency of the 3D printing group were all less than those of the control group (P < 0.05). (2) The excellent and good rate of the 3D printing group was higher than that of the control group (P < 0.05). (3) The operative approach and internal fixation used in the 3D printing group were consistent with the preoperative design. The application of 3D printing technology in the surgical treatment of scapula fractures can help surgeons better understand the characteristics of scapula fractures and make surgical plans, reduce the difficulty of surgery, obtain more accurate reduction, reduce the duration of surgery, intraoperative bleeding and intraoperative X-ray fluoroscopy, and improve the surgical efficacy.
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BACKGROUND: At present, most of the treatment of unstable dislocation of sternoclavicular joint is to insert the hook plate of acromioclavicular joint into the cavity of sternal bone marrow or put it behind the sternum. The difficulty of operation is increased because of the insufficient application of steel plate, which reduces the effect of joint reduction. OBJECTIVE: The research team has developed a new type of sternoclavicular hook plate (Patent No. ZL201520515237.3), and compared the biomechanical properties of acromioclavicular hook plate and new sternoclavicular hook plate to fix sternoclavicular joint from the aspect of biomechanics. METHODS: The sternum and clavicle at both ends of the sternoclavicular joint were replaced with a rectangular artificial bone. Eighteen pairs of artificial sternoclavicular joints were randomly divided into two groups. In control group (n=6), the plate screw hole section of the shortest segment 3-hole common acromioclavicular hook plate was fixed to the artificial clavicle end; and the hook end was placed on the back side of the artificial sternum. Load and displacement changes in artificial sternal fractures were measured with MTS biomaterial test system. In the experimental group (n=12), the plate screw hole section of the shortest rod section 2 hole new sternoclavicular hook plate was fixed to the artificial clavicle end; and the hook end was inserted into the artificial sternum. The MTS biomaterial test system was used to detect changes in load and displacement of the anterior cortical bone (n=6) and posterior cortical bone (n-6). RESULTS AND CONCLUSION: In the control group, the mean of maximum destructive force was (390±51) N. The mean of maximum destructive force of anterior cortical bone was (421±55) N. In the experimental group, the mean of maximum destructive force of posterior cortical bone was (437±56) N. There were no significant differences between the three groups (P > 0.05). Results indicated that the new sternoclavicular hook plate did not increase the risk of sternum fracture, and it was a safe and effective internal fixation material.
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BACKGROUND: The non-fusion system of lumbar interspinous process distraction device provides a new treatment option for lumbar degenerative diseases. However, at present, the clinical application and research of lumbar interspinous process distraction device are reported insufficiently in China, especially for the domestic lumbar interspinous process distraction device. OBJECTIVE: To verify the scientific nature and effectiveness of the new domestic lumbar interspinous process distraction device through finite element analysis and in vitro biomechanical experiment of goat lumbar spine. METHODS: (1) Finite element analysis of new domestic lumbar interspinous process distraction device: L2-L5 three-dimensional model of vertebral body was established based on normal adult lumbar CT data. From then on, new domestic lumbar interspinous process distraction device model, new lumbar interspinous process distraction device model of lumbar non fusion system were successively built. The mechanical conditions were given under the physiological conditions of lumbar spine. Biomechanical analysis was carried out before and after the new domestic lumbar interspinous process distraction device was implanted. (2) In vitro biomechanical analysis of new domestic lumbar interspinous process distraction device: the lumbar vertebrae (L1-L5) of 24 adult male goats were obtained, and the new domestic lumbar interspinous process distraction device was implanted between the L3-4 spinous process. Before and after the placement of the lumbar interspinous process distraction device, the lumbar motion range and the pressure of the intervertebral disc under the flexion, extension, lateral bending and rotation of the lumbar specimens were detected. RESULTS AND CONCLUSION: (1) After the new lumbar interspinous process distraction device was implanted, the motion range and the pressure of the intervertebral disc of responsible segment were reduced, while the adjacent segments' mobility and the pressure of the intervertebral disc were almost unaffected. It was theoretically verified that the new domestic lumbar interspinous process distraction device could provide the biomechanical basis for the treatment of the lumbar degenerative diseases, and contribute to the theoretical reference for the prevention of the clinical diseases. (2) In the state of extension, the motion range of L3-4 vertebral body after implanting the new lumbar interspinous process distraction device was significantly lower than that before implantation (P 0. 05). In the state of flexion, lateral bending and rotation, there was no significant difference between L2-3, L3-4 and L4-5 vertebral body after implanting the lumbar interspinous process distraction device and that before implantation (P > 0. 05). In the state of extension, the pressure of intervertebral disc after L3-4 vertebral body implantation was significantly lower than that before implantation (P 0. 05). In the state of flexion, lateral bending and rotation, there was no significant difference between L2-3, L3-4 and L4-5 vertebral body implantation and that before implantation (P > 0. 05). (3) The results showed that the scientific nature and validity of the new domestic lumbar interspinous process distraction device was verified by three-dimensional finite element analysis and in vitro animal lumbar specimens experiment, which provided a strong basis for the animal experiment, clinical experiment, clinical application and clinical production of the new domestic lumbar interspinous process distraction device.
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BACKGROUND: Traditional complex of diagnosis and treatment of distal radius fractures, did not get the repair in time and clinical misdiagnosis is not uncommon, become an important reason for the wrist joint pain and dysfunction. Wrist joint complexity assisted treatment of distal radius fractures can more accurately judge complexity of the distal radius fracture damage. The microscopic surgery can protect the blood supply, can also repair intra-articular ligament, cartilage injury, and along with all the dislocation, fracture of carpal bone fixed effectively. OBJECTIVE: To retrospectively analyze clinical effects of distal radial anatomical locking plate for complex distal radius fractures by joint arthroscopy. METHODS: Totally 19 patients with complex distal radius fractures, who were treated in the Department of Trauma and Hand Surgery, Sichuan Provincial Orthopedic Hospital from September 2016 to May 2018, were included in this study. According to AO classification, there were B2 type in 1 patient, B3 type in 2 patients, C1 type in 5 patients, C2 type in 7 patients and C3 type in 4 patients. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Open reduction and internal fixation with anatomical locking plate of distal radius assisted by wrist arthroscopy were used to repair the intercarpal interosseous ligaments and triangular fibrocartilage complex, and to fix the wrist fracture. At 1 year after treatment, the range of wrist motion, grip strength, radial height, palm inclination angle and ulnar angle were compared with the healthy side, and the functional evaluation was conducted with Mayo wrist score. RESULTS AND CONCLUSION: (1) Nineteen patients received postoperative follow-up. The healing time of distal radius was 5-12 months, with an average of 7 months. (2) At 1 year after surgery, no significant difference was detected in the range of wrist motion, grip strength, radial height, palm inclination angle and ulnar angle (P > 0.05). (3) The Mayo wrist score was excellent in 9 cases, good in 8 cases, and average in 2 cases, with the excellent and good rate of 90%. (4) Treatment of complex distal radius fractures with distal radial anatomical locking plate by wrist arthroscopy can accurately restore the stability of the joint, and simultaneously repair the fracture with cartilage damage and intra-articular ligament, which is conducive to early functional exercise and has a satisfactory effect.
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Objective: To investigate the effectiveness of anterior subcutaneous internal fixator combined with posterior plate in the treatment of unstable pelvic fractures. Methods: Between January 2015 and January 2019, 26 cases of unstable pelvic fractures were treated with anterior subcutaneous internal fixator combined with posterior plate. There were 16 males and 10 females, with an average age of 42.8 years (range, 25-66 years). According to the Tile classification, 9 of them belonged to type B2, 6 to type B3, 7 to type C1, 3 to type C2, 1 to type C3. The injury severity score (ISS) was 6-43 (mean, 18.3). Four cases combined with brain injury, 7 with limb fractures, 3 with hemopneumothorax, 1 with sciatic nerve injury. The time from injury to operation was 4-12 days (mean, 6.4 days). The intraoperative blood loss, operation time, and the complications were recorded. The fracture reduction and the postoperative function of patients were evaluated. Results: All patients were followed up 12-26 months (mean, 16.8 months). The operation time was 65-142 minutes (mean, 72.5 minutes) and the intraoperative blood loss was 42-124 mL (mean, 64.2 mL). There were 2 cases of unilateral lateral femoral cutaneous nerve stimulation, 1 case of femoral nerve paralysis, and 1 case of superficial infection of incision, which were cured after corresponding treatment. X-ray films showed that all fractures healed at 3 months after operation. At last follow-up, according to Matta criteria for fracture reduction, the results were excellent in 8 cases, good in 15 cases, fair in 2 cases, and poor in 1 case, with an excellent and good rate of 88.5%. According to Majeed scoring system for pelvic function, the results were excellent in 10 cases, good in 12 cases, and fair in 4 cases, with an excellent and good rate of 84.6%. Conclusion: For unstable pelvic fractures, the anterior subcutaneous internal fixator combined with posterior plate has fewer operative complications, high security, and achieve good effectiveness.
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Objective: To evaluate the effectiveness of unstable pelvic fractures treated with minimally invasive percutaneous bridge internal fixator or traditional external fixator. Methods: The clinical data of 45 patients with unstable pelvic fractures who met the selection criteria between January 2013 and February 2018 were retrospectively analyzed. According to the different surgical methods, they were divided into two groups. In the observation group (25 cases), minimally invasive percutaneous bridge internal fixators were used, and three-dimensional printing pelvic models were used to simulate the reduction and fixation before operation to develop individual reduction strategies. In the control group (20 cases), external fixators were used. There was no significant difference between the two groups in gender, age, cause of injury, fracture type (according to Tile classification), and time from injury to operation ( P>0.05). The operation time, intraoperative blood loss, fracture healing time, and complications were recorded and compared between the two groups. The reduction quality was evaluated according to the Matta standard, and functional recovery was evaluated according to the Majeed scoring standard. Results: All patients were followed up 12-20 months (mean, 15 months). The operation time of the observation group was significantly longer than that of the control group ( t=2.719, P=0.009); no significant difference in intraoperative blood loss was found between the two groups ( t=0.784, P=0.437). There was no significant difference between the two groups in fracture healing time ( t=0.967, P=0.341). According to the Matta standard, the excellent and good rate of the observation group was 92%, and that of the control group was 70%, showing no significant difference between the two groups ( χ 2 =3.748, P=0.053). At last follow-up, according to the Majeed scoring standard, the excellent and good rate of the observation group was 88%, and that of the control group was 60%, showing significant difference between the two groups ( χ 2 =4.717, P=0.030). The incidences of incision and nailway infection, secondary displacement of fracture, and malunion in the observation group were significantly lower than those in the control group ( P0.05). Conclusion: Minimally invasive percutaneous bridge internal fixator is a safe and effective method for the treatment of unstable pelvic fractures. It has the advantages of minimal trauma, stable fixation, less interference to patients' daily life, early functional exercise, and quickly recovery after operation.
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Objective To investigate biomechanical characteristics of the modified memory alloy internal fixator for separation of pubic symphysis. Methods The model of pubic symphysis separation injury was established based on 10 pelvic specimens. The control group was fixed with the dynamic compression plate after reduction, and the experimental group was fixed with the modified memory alloy internal fixator for separation of pubic symphysis after reduction. The biomechanical stability for two kinds of internal fixation was compared. Results There were no loosening and fracture of internal fixation in both groups. The displacement of pubic symphysis in horizontal, anterio-posterior and vertical direction in the experimental group was obviously reduced compared with the control group (P<0.05). Conclusions Compared with the dynamic compression plate, the modified memory alloy internal fixator for separation of pubic symphysis shows better resistance to the tensile force against horizontal and anterio-posterior direction, as well as better resistance to the vertical shear force.
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OBJECTIVE@#To analyze the causes of vascular injury occurred in oblique lateral interbody fusion for treating lumbar degenerative diseases, and put forward preventive measures.@*METHODS@#There were 235 patients analyzed from October 2014 to May 2017 in five hospitals, who were treated with oblique lateral interbody fusion with or without posterior pedicle screw fixation. There were 79 males and 156 females with an average age of (61.9±13.5) years old (ranged from 32 to 83 years). There were 7 cases of vascular injury, including 4 cases of segmental vessel injury, 1 case of left common iliac artery injury, 1 case of left common iliac veininjury and 1 case of ovarian vein injury.@*RESULTS@#The follow up time ranged from 6 to 36 months, averagely (15.6±7.5) months. There was no pedicle screw loosen or fracture. The low back pain VAS decreased from preoperative 6.7±2.3 to 1.4±0.8 at the latest follow-up, which was statistically difference(@*CONCLUSION@#Oblique lateral interbody fusion technique provides a new method for minimally invasive fusion of lumbar internal fixation. However, it has a risk of vascular injury. In order to effectively prevent the occurrence of vascular injury, the operative indications and careful and meticulous operation should be strictly grasped.
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Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Vértebras Lumbares/cirugía , Región Lumbosacra , Tornillos Pediculares , Estudios Retrospectivos , Fusión Vertebral/efectos adversos , Resultado del Tratamiento , Lesiones del Sistema Vascular/cirugíaRESUMEN
Objective To evaluate the clinical efficacy of our self-made minimally invasive pelvic channel instrument in the treatment of pelvic ring fracture-dislocation.Methods A retrospective study was conducted of the 35 patients who had been treated for pelvic ring fracture-dislocation from December 2015 to November 2017 and fully followed up at Department I of Orthopaedis,Beijing Chaoyang Emergency Rescue Center.They were 25 males and 10 females,aged from 20 to 73 years (average,41.3 years).According to the Tile classification for pelvic fractures,there were 26 cases of type B (type B1 in 8,type B2 in 12 and type B3 in 6) and 9 cases of type C(type C1 in 5,type C2 in 3 and type C3 in 1).Infix or anterior plate combined with percutaneous internal fixation with sacroiliac cannulated screws was used in 11 patients,sacroiliac triangle fixation combined with percutaneous internal fixation with anterior ring cannulated screws in 5 ones,and internal fixation with cannulated screws for anterior and posterior rings in 19 ones.All the channels were established using our self-made minimally invasive pelvic channel instrument for internal fixation with cannulated screws.The time for each screw placement and the number of X-ray projection were recorded.Postoperative reduction,pelvic function at the final follows-ups and complications were recorded.Results A total of 84 cannulated screws were inserted in the 35 patients.The time for each cannulated screw placement ranged from 5 to 13 minutes (average,8.1 minutes);the number of X-ray projection for each screw placement ranged from 7 to 15 times (average,10.3 times).Postoperative CT showed that all the cannulated screws were located in the preset channels.According to the Matta radiological criteria,postoperative reduction quality was excellent in 29,good in 4 and fair in 2,giving a good to excellent rate of 94.3%.The follow-up time for the 35 patients ranged from 6 to 15 months (average,12.3 months).At the final follow-ups,all the patients showed fine fracture union.There was no loosening or breakage of screws in all but one patient in whom one sacroiliac screw became loose 3 months after surgery.By the Majeed criteria,the pelvic function was excellent in 27 cases,good in 5,fair in 3 and poor in one,giving a good to excellent rate of 91.4%.Conclusion Our self-made minimally invasive pelvic channel instrument can be used to establish pelvic channels,leading to more accurate placement,shorter operative time and less X-ray projection.
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Objective To compare the therapeutic effects between anterior internal fixator (INFIX) and external fixator (EXFIX) for anterior pelvic ring fracture.Methods A retrospective study was conducted on the 66 patients with anterior pelvic ring fracture who had been treated surgically from January 2016 to June 2017 at Department of Spinal Surgery,Hospital Affiliated to Southwest Medical University and at Department of Orthopedics,Union Hospital Affiliated to Tongji Medical College.They were divided into an observation group and a control group according to their fixation of the anterior pelvic ring.In the observation group of 33 cases fixated with INFIX,there were 20 males and 13 females,aged from 32 to 47 years (38.8 ±4.8 years).By the Tile's classification,15 of them belonged to type B and 18 to type C.In the control group of another 33 patients fixated with EXFIX,there were 19 males and 14 females,aged from 33 to 48 years (39.5 ±4.6 years).By the Tile's classification,14 of them belonged to type B and 19 to type C.The 2 groups were compared in terms of postoperative fracture reduction,pelvic function and complications.Results The 66 patients were followed up for an average of 13.7 months(from 12 to 18 months).According to the Matta criteria for fracture reduction,21 cases were excellent,9 good,2 fair and one poor in the observation group (excellent and good rate:90.9%);18 cases were excellent,8 good,5 fair and 2 poor in the control group (excellent and good rate:78.8%).The difference was statistically significant between the 2 groups (P < 0.05).The pelvic function assessed by the Majeed criteria at the final follow-up was excellent in 21 cases,good in 10,fair in one and poor in one in the observation group (excellent and good rate:93.9%);it was excellent in 17 cases,good in 9,fair in 4 and poor in 3 in the control group (excellent and good rate:78.8%).The difference was also statistically significant between the 2 groups (P < 0.05).The incidence of injury to the lateral femoral cutaneous nerve was 9.1% (3/33) for the observation group and 6.1% (2/33) for the control group,showing no significant difference between the 2 groups (P > 0.05).The incidences of screw loosening and pin track infection were significantly lower in the observation group than in the control group[0 versus 24.2% (8/33) and 0 versus 18.2% (6/33),respectively] (both P < 0.05).Conclusion Compared with EXFIX,INFIX can lead to better clinical outcomes and fewer operative complications in the treatment of anterior pelvic ring fractures.
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Objective To investigate biomechanical properties of the patella tension plating system in order to provide a theoretical basis for its clinical application. Methods Thirty-six models of artificial patella were randomly divided into 3 groups ( n=12 ) . After transverse patellar fractures were created in the models, the 3 groups were subjected to fixation respectively with Kirschner wire tension band ( tension band group ) , patellar concentrator ( concentrator group ) and patellar tension plate ( tension plate group ) . Next, 6 specimens from each group were placed on a mechanical testing machine to measure the fracture displacements after 100 cycles of simulated knee flexion and extension movements. Tensile strength tests were performed on the remaining 6 specimens in each group to measure the maximum load at fixation failure. Results The fracture displacement in the tension plate group ( 0. 40 ± 0. 26 mm ) was significantly smaller than those in the tension band group ( 2. 58 ± 0. 72 mm ) and in the concentrator group ( 1. 25 ± 0. 74 mm ) ( P < 0. 05 );the maximum load at fixation failure in the tension plate group ( 1 , 709 ± 206 N ) was significantly greater than those in the tension band group ( 581 ± 122 N ) and in the concentrator group ( 1, 003 ± 211 N ) ( P <0. 05 ) . Conclusion As a new treatment for patellar fractures, the patellar tension plating system can perform better in biomechanical properties than Kirschner wire tension band and patellar concentrator.
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Minimally invasive surgical techniques reduce the damages to skin and soft tissue due to a high rate of complications following open reduction and internal fixation for dorsal pelvic ring injuries. However, they can still cause iatrogenic injuries to nerves, vessels and even organs because of reduced surgical exposure. Transiliac Internal Fixator ( TIFI ) , which was first designed by Füchtmeier, has been widely used in clinics because it successfully reduces iatrogenic injuries and ensures stability of internal fixation. This paper focuses on the principles, clinical outcomes, biomechanical studies and probable improvements of TIFI.
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Objective: To summarize the selection criteria and clinical application of surgical methods for hip fractures (femoral neck fracture and intertrochanteric fracture) in the elderly. Methods: The related literature concerning the surgical methods for femoral neck fracture and intertrochanteric fracture in the elderly at home and abroad was extensively reviewed and summarized. Results: Among the elderly patients with femoral neck fracture, the closed reduction and internal fixation or dynamic hip screw (DHS), and total hip arthroplasty are recommended for patients under 65 years old and 65-80 years old respectively and without special surgical contraindication; whereas hemiarthroplasty is recommended for patients with poor physical conditions. Among the patients with intertrochanteric fracture, DHS or the 3rd generation of Gamma nails is recommended for patients with stable fracture while the intramedullary fixation systems (e.g., proximal femoral nail anti-rotation, intertrochanteric antegrade nail) and the extramedullary fixation systems (e.g., proximal femoral locking compression plate and less invasive stabilization system) can be applied to the patients with unstable fracture according to the fracture type and bone conditions. Notably, hip arthroplasty is recommended for elderly patients with comminuted fracture. Conclusion: The surgical method and internal fixator should be chosen according to the fracture type and bone condition in the elderly in order to improve the effectiveness and reduce the complication.
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Objective To describe and analyze a new method of treating fragility fractures of the pelvis in the elderly patients,a cement augmentable Transiliac Internal Fixator (TIFI).Methods We reviewed 196 patients older than 59 years with a pelvic ring fracture who had been treated in the period from January 2004 through November 2014.They were 11 men and 93 women,aged from 59 to 94 years (average,77.5 ± 7.6 years).By the Romens classification,there were 31 cases of type Ⅰ,39 ones of type Ⅱ,19 ones of type Ⅲ and 15 ones of type Ⅳ.The causes for fracture included fall from standing height (89 cases),fall from a height of less than 3 meters (8 cases) and absence of a definite trauma (7 cases).Of them,65 received conservative management and 39 surgery.TIFI was used in 17 patients in whom cannulated and perforated Schanz screws were placed from the posterior superior iliac spine to the anterior inferior iliac spine and fixated into the supraacetabular bone canal.Results Of the 65 patients receiving conservative management,on the day of discharge,one could sit on a wheel-chair,26 could walk,8 could go upstairs and downstairs,and 30 were not recorded.Of the 39 patients receiving surgery,on the day of discharge,6 could sit on a wheel-chair,26 could walk,one could go upstairs and downstairs,and 6 were not recorded.Of the 34 patients receiving fixation with Schanz screws,the sacro-iliac joint was penetrated by the screws in 2.In the 16 patients receiving fixation with Schanz screws plus cement augmentation,no cement leakage into the sacro-iliac joint was observed.The average length of TIFI placement was 100 ± 20 mm and the average length of connective rod 62 ± 16 mm.Of the 17 patients receiving TIFI fixation,postoperative haematoma occurred in 2,superfical wound infection in one,and deep infection or implant infection in none.Conclusions Fragility fractures of the pelvis in the elderly patients can be treated according to their Romens classifications.The new technique,TIFI,is a minimally invasive and safe treatment for fragility fractures of the pelvis.
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Objective In clinic, the elderly with femoral intertrochanteric fracture are suggested surgical treatment, with the continuous deepening of the research and technology innovation, the new type of internal fixator for treating this fracture are emerging?At present,a wide variety of internal fixators in clinic,but each has its advantages, disadvantages and indications, and considering?The right choice of internal fixator directly affects patient's prognosis?This article reviewed several common internal fixators in clinic, so as to provide a reference for the clinical selection.
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Objective To evaluate the mid-term effect of total hip arthroplasty (THA) after failed internal fixation of intertrochanteric fracture.Methods Twenty-one patients treated with THA due to failed internal fixation of intertrochanteric fracture from January 2007 to December 2010 were studied retrospectively.There were 10 males and 11 females,at mean age of 71.7 years (range,66-79 years).Sixteen patients were treated with dynamic hip screws/dynamic condyle screws (DHS/DCS),3 proximal femoral nails,2 hollow screws.Mean interval from internal fixation to THA was 29 months (range,10-79 months).Causes for the failed internal fixation were loosening,cutting,and breakage of screws which generated fracture displacement or nonunion in 19 patients and femoral head necrosis in 2 patients.All patients received THA with uncemented acetabulum cups and proximally long-stemmed,porous-coated titanium femoral components including AML stems for 5 patients and Solution stems for 16 patients.Moreover,greater trochanteric fracture was fixed by Luke wire.Harris hip score were measured before operation and at final follow-up.Radiographs were performed before operation,at 3,6 and 12 months after operation,and at final follow-up to assess the fracture restoration,healing,prosthesis initial fixation,and mid-term survival condition.Results One patient was died due to pulmonary infection 1.5 years after operation.Two patients were lost to follow-up and 18 patients were followed up for 3-5 years (mean,3.9 years).At final follow-up,13 patients regained the ability to walk independently,4 needed support of a cane,1 needed assistance of a walker.There were no signs of loosening,subsidence or rupture of the prosthesis.Mean Harris hip score increased from 25.3 points preoperatively to 80.6 points at final follow-up; the score was excellent in 11 patients,good in 6,good in 1,with the excellent and good rate of 94%.Conclusion THA can improve hip function,patients' quality of life and midterm outcome in salvage of failed internal fixation of intertrochanteric fractures.
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Objective To summarize the experience of diagnosis,treatment and clinical effects of Ni-Ti shape memory alloy embracing fixator for severe chest trauma complicated with multiple rib frac-tures.Methods From January 2009 to June 2013,the clinical data of 148 cases with embracing fixator and 47 cases with non-internal fixation were retrospectively analyzed and compared.Results Internal fix-ation was superior to non-internal fixation in hospital stay,pain perception,mechanical ventilation time, pulmonary function recovery and complications(P<0.05).Conclusion Ni-Ti shape memory alloy em-bracing fixator is better than other conservative therapies in the treatment of multiple rib fractures and it's worthy of spreading.
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BACKGROUND:Animal model of infection is established using bioluminescent gene-labeled bacteria, which stimulate local environment of spine infection and reveal the pathophysiological mechanism of spine infection. OBJECTIVE:To evaluate the feasibility and safety of anterior one-stage debridement, autogenous iliac bone grafting and titanium plate internal fixation in the management of pyogenic spinal infections in spine. METHODS:Total y 24 Chinese dogs were adopted in the study to develop a canine model of acute pyogenic spondylodiscitis using a bioluminescent strain of Staphylococcus aureus Xen29. The animal models were detected by X-radiography, CT and MRI examinations. After 4 weeks of modeling, al the animals underwent one-stage debridement, autogenous iliac bone grafting and anterior titanium plate internal fixation. Antibiotics contained Cefazolin and Gentamicin were administrated daily since perioperative period to 4 weeks after surgery. The titanium plate and adjacent vertebra were removed surgical y at various postoperative time points (4, 8, 12, 24 weeks) when the dogs were kil ed. The excised tissues and retrieved implants were cultured with conventional bacteria, bacteria 16S rRNA and specific Nuc gene of Staphylococcus aureus. PCR and bioluminescence imaging technique were used to detect the presence of bacteria. RESULTS AND CONCLUSION:The surgical wound was healed uneventful y. Gross observation and MRI examination of the specimens showed that there was no abscess formation or signs of infection recurrence. The infection rate was 41.7%(10/24) and 75%(18/24) in the procedure of conventional bacteria and bacteria 16S rRNA cultivation. The results showed that the sensibility of PCR technique used to detect the presence of bacteria by amplifying the highly conservative gene sequence of 16S rRNA was significantly higher than that of conventional bacterial cultivation procedure (P<0.05). The PCR detection of specific Nuc gene of Staphylococcus aureus showed the existence of Staphylococcus aureus (1/24). However, Staphylococcus aureus Xen29 with genetic marker was not detected around the implant by bioluminescence imaging technique (0/24). Al of the results showed that bacterium adhering to prosthesis in vivo is an universal phenomenon. The bacteria identified from prosthesis which was taken during the surgery and the bacteria by which the spine was infected before the surgery was not homologous. The one-stage debridement, autogenous bone grafting and anterior titanium plate internal fixation is safe and effective in the management of pyogenic spinal infections. Using of internal fixator can not lead to recurrence or persistence of infection.