[Medium term follow up outcomes of uncemented total hip arthroplasty for traumatic arthritis after intramedullary nail fixation of femoral intertrochanteric fracture].

OBJECTIVE: To evaluate the effect of uncemented total hip arthroplasty(THA) on treatment of traumatic arthritis caused by intramedullary nailing interfixation of intertrochanteric fractures. METHODS: Total of 22 patients treated with THA due to traumatic arthritis caused by intramedullary nailing interfixation of intertrochanteric fractures from January 2012 to January 2017 were studied retrospectively, including 10 males and 12 females with a mean age of (72.5±9.8) years old ranging from 61 to 84 years old. Initial internal fixation method:14 patients were treated with Gamma nails and 8 patients were treated wit PFNA.The time from internal fixation surgery to THA was 10 to 68 months with an average of (32.2±21.3) months.Harris scores of the hip joint before and after surgery were compared, and the position of the prosthesis through postoperative imaging at 3, 6, 12 months and the last follow-up were evaluated. RESULTS: One patient was died due to heart failure 1 year after operation. Two patients was died to advanced tumor 2 years after operation. The other 19 patients were followed up for 36 to 64 months with an average of (48.5±11.9) months. At final follow up, 14 patients regained the ability to walk independently, 4 patients needed support of a cane, 1 patient needed assistance of a walker. No serious complications such as joint dislocation, periprosthetic fracture and deep venous thrombosis occurred during follow-up. There were no signs of loosening and subsidence of the prosthesis at the final follow-up. Mean Harris hip score increased from (29.2±12.9) points preoperatively to (74.2±11.2) points at the final follow up(P<0.05);the score was excellent in 9 patients, good in 7 and fair in 3. CONCLUSION: Uncemented total hip arthroplasty for traumatic arthritis after intramedullary nail fixation of femoral intertrochanteric fracture can significantly improve hip function and effectively avoid bone cement implantation syndrome. The medium-term effect is satisfactory.

Effect of Total Dose Irradiation on Parasitic BJT in 130 nm PDSOI MOSFETs.

In this work, the effects of total dose irradiation on the parasitic bipolar junction transistor (BTJ) in 130 nm PDSOI MOSFETs were investigated. The experimental results demonstrate that irradiation-induced oxide-trap charges can modify the E-B junction barrier, and thereby make the common-emitter gain ß0 of the parasitic BJT in NMOS device increase, while decreasing it in a PMOS device. Additionally, irradiation-generated oxide-trap charges in shallow trench isolation (STI) elevate the surface electrostatic potential of the gate above the STI sidewall, thus providing an additional channel from the emitter to the collector. Moreover, these charges may generate parasitic reverse conductive paths at the STI/Si interface under high dose irradiation, thereby enhancing the leakage current in the front gate channel and diminishing the significance of the parasitic BJT. Under irradiation, the electric field intensity difference between two biases leads to higher ß0 of the parasitic BJT in PG-biased devices than in ON-biased ones. Furthermore, the lifting effect of irradiation on ß0 increases in wide or short channel irradiated devices, which can be explained using simulations and an emitter current crowding effect model.

[Risk factors for infections after arthroscopic rotator cuff repair].

OBJECTIVE: To explore risk factors for infections after arthroscopic rotator cuff repair, and improve the under standing for reducing infection. METHODS: Clinical data of 2 591 patients who underwent arthroscopic rotator cuff repair from January 2019 to January 2022 were retrospectively analyzed, including 1 265 males and 1 326 females, aged from 25 to 82 years old with an average age of (51.5±15.6) years old. They were divided into infection group(n=18) and uninfected group(n=2 573) according to whether or not patients had postoperative infection. Gender, age, smoking, diabetes, body mass index, local closure within 1 month before operation, operation time, preventive use of antibiotics, and internal fixation implantation between two groups were recorded. Univariate Logistic regression analysis screened factors associated with infections after arthroscopic rotator cuff repair. Theresultswere entered into the multivariate logistic regression analysis, screening the high risk factors for infections after arthroscopic rotator cuff repair. RESULTS: In 2 591 patients, 18 patients were infected after operation, infection rate was 0.69%. Univariate Logistic regression analysis showed that gender, age, operation time, antibiotic prophylaxis, internal fixation implantation were risk factors for infections after arthroscopic rotator cuff repair. Multivariate Logistic regression analysis showed male(OR=14.227), age≥65 years(OR=34.313), operation time≥2 h (OR=15.616), without antibiotic prophylaxis(OR=4.891), and internal fixation implantation(OR=5.103) were major risk factors for infection after arthroscopic rotator cuff repair(P<0.05). CONCLUSION: Male, age≥65 years, operation time≥2 h, without antibiotic prophylaxis and internal fixation implantation were independent risk factors for infection after arthroscopic rotator cuff repair. Early diagnosis and timely treatment should be carried out to reduce the incidence of infection.

Radiation-hardened silicon photonic passive devices on a 3 µm waveguide platform under gamma and proton irradiation.

Silicon photonics is considered to be an ideal solution as optical interconnect in radiation environments. Our previous study has demonstrated experimentally that radiation responses of device are related to waveguide size, and devices with thick top silicon waveguide layers are expected to be less sensitive to irradiation. Here, we design radiation-resistant arrayed waveguide gratings and Mach-Zehnder interferometers based on silicon-on-insulator with 3 µm-thick silicon optical waveguide platform. The devices are exposed to 60Co γ-ray irradiation up to 41 Mrad(Si) and 170-keV proton irradiation with total fluences from 1×1013 to 1×1016 p/cm2 to evaluate performance after irradiation. The results show that these devices can function well and have potential application in harsh radiation environments.

[Analysis of risk factors of healthy side fracture after hip fracture surgery in the elderly].

OBJECTIVE: To investigate the incidence and related risk factors of healthy side fracture after hip fracture surgery in the elderly, so as to provide basis for the prevention of re-fracture. METHODS: The data of 452 patients over 65 years old with femoral neck fracture or intertrochanteric fracture treated with hip arthroplasty or proximal femoral intramedullary nailing from June 2012 to June 2017 were analyzed, including 168 males and 284 females, the age ranged from 65 to 97(75.5±7.5) years. There were 191 cases of femoral neck fracture and 261 cases of femoral intertrochanteric fracture. According to whether there was a fracture in the healthy hip after operation, the patients were divided into fracture group and no fracture group. The gender, age, body mass index, fracture type, initial treatment method, bone mineral density, bed time, medical compliance, postoperative short-term delirium, whether there were medical diseases before injury and Harris score of hip joint in the final follow-up were recorded. Univariate Logistic regression analysis was used to screen out the risk factors of healthy side fracture after operation, and then statistically significant risk factors were included in multi factor Logistic regression analysis to screen out the independent risk factors of healthy side fracture after operation of hip fracture in the elderly. RESULTS: Among them, 42 of the 452 patients had hip fractures on the healthy side with an incidence of 9.3%. The average interval between the two fractures was (2.9±2.1) years. Univariate Logistic regression analysis showed that there were significant differences in age, bone mineral density, medical compliance, short-term postoperative deliriun, pre-injury complicated with medical diseases and Harris score of hip joint in the final follow-up (P<0.05). Multivariate Logistic analysis showed that age(OR=4.227), bone mineral density(OR=4.313), combined with medical diseases (OR=5.616) and low hip Harris score at the final follow-up (OR=3.891) were independent risk factors for healthy side fractures after hip fracture surgery in elderly(P<0.05). CONCLUSION: The age, bone mineral density, combined with medical diseases and low Harris score of hip joint in the final follow-up are the main risk factors of healthy side fracture after hip fracture in the elderly. It is necessary to strengthen the treatment of medical diseases, anti osteoporosis and improve hip joint function within 3 years after operation, so as to prevent the occurrence of healthy side hip fracture.

High energy irradiation effects on silicon photonic passive devices.

In this work, the radiation responses of silicon photonic passive devices built in silicon-on-insulator (SOI) technology are investigated through high energy neutron and 60Co γ-ray irradiation. The wavelengths of both micro-ring resonators (MRRs) and Mach-Zehnder interferometers (MZIs) exhibit blue shifts after high-energy neutron irradiation to a fluence of 1×1012 n/cm2; the blue shift is smaller in MZI devices than in MRRs due to different waveguide widths. Devices with SiO2 upper cladding layer show strong tolerance to irradiation. Neutron irradiation leads to slight changes in the crystal symmetry in the Si cores of the optical devices and accelerated oxidization for devices without SiO2 cladding. A 2-µm top cladding of SiO2 layer significantly improves the radiation tolerance of these passive photonic devices.

[Clinical study of movable external fixation for elbow tuberculosis].

OBJECTIVE: To compare clinical effect of movable external fixation and fusion fixation for the treatment of elbow tuberculosis. METHODS: From October 2013 to June 2019, 52 patients with elbow tuberculosis treated with standard antituberculosis therapy were divided into movable external fixation group and fusion fixation group according to treatment methods. In group A, there were 25 patients, including 11 males and 14 females, aged from 24 to 75 years old with an average of (42.81± 9.01) years old; the courses of diseases ranged from 2 to 9 months with an average of (3.96±1.45) months. In group B, there were 27 patients, including 15 males and 12 females, aged from 23 to 77 years old with an averageof (44.08±7.44) years old; the courses of diseases ranged from 2 to 7 months with an average of (3.88±1.67) months. All patients were performed focus debridement. Intraoperative blood loss, operative time were compared between two groups. VAS score before operation, 2 weeks and 12 months after operation were applied to evaluate pain relieve;Mayo elbow performance score (MEPS) before operation, 1 and 12 months after operation were used to evaluate clinical effect;changes of erythrocyte sedimentation rate (ESR) and Creactive protein, CRP) before operation, 3 weeks after antituberculosis therapy, 1 week and 6 months after operation were compared between two groups. RESULTS: All patients were followed up from 12 to 20 months with an average of (13.50±4.85) months. No mixed infection and recurrence of tuberculosis occurred. There were no statistical differences in intraoperative blood loss and operative time(P>0.05). There was difference in postoperative VAS score at 2 weeks between movable external fixation group (5.15±0.95) and fusion fixation group (4.04±0.84)(P<0.01);while no difference in postoperative VAS score at 12 months between two groups (P>0.05). No difference in ESR and CRP level between two groups before and after operation (P>0.05). Postoperative Mayo score at 1 and 12 months in movable external fixation group were (78.15±7.83) and (90.19±7.13);in fusion fixation group were (70.40±7.61) and (82.60±8.38);there were differences in Mayo score at different time points between two groups(P<0.01). CONCLUSION: For elbow tuberculosis, movable external fixation and fusion fixation have equal effect in operative time, amount of bleeding and control of tuberculosis infection indicator. Movable external fixation need earlier functional exercise, not conducive to pain relief at early stage, which may be better than fusion fixation, it is worth clinical promoting.

[Surgical treatment for limbs salvaged of diabetic foot ulcers].

Diabetic foot ulcers (DFUs) is a severe complication of the diabetes mellitus, which is the first leading cause of non-traumatic lower limbs amputations. The pathogenesis of diabetic foot involves a variety of mechanisms, treatment involves the department of foot and ankle surgery, department of vascular surgery, endocrinology, and infection control. Treatment need multidisciplinary diagnosis and treatment. Debridement is the basis of treating diabetic foot ulcers, and the normal anatomical structure should be maintained during the process. Vacuum sealing drainage (VSD) and antibiotic-laden bone cement (ALBC) have more advantages of controlling infection and ulceration wound healing, which could receive good clinical effect. Tendon lengthening could alleviate the problem of ulcer occurrence and progression caused by stress concentration on the bottom of foot, which has widely application and has advantages of preventing formation of foot ulcers. Flap transplantation could solve the problem of wound healing, but it is necessary to consider whether the transplanted flap could bear the same function as plantar tissue. Tibial bone transverse distraction is a relatively new technique, and the mechanism is not clear, but it has certain application prospects from the perspective of clinical efficacy.

[Progress on surgical treatment for elbow tuberculosis].

Elbow tuberculosis is a rare disease of infectious osteoarthritis. The aim of operation for elbow tuberculosis is to maintain joint function, ensure stability of joint and improve quality of life, while there were controversies about the implementation details of different procedures. For elbow tuberculosis at an advanced stage, the clinical effect of forked osteotomy arthroplasty is effective and could meet with most patients without demand of strength. However, arthrodesis is only recommended for heavy manual workers with high demand of strength, and making research on the optimal fusion angle could improve satisfaction of patients. For elbow tuberculosis at the early stage, there were few reports about interposition arthroplasty, which has a recommendation of lower degree. Otherwise, hinged external fixator with arthrolysis is main procedure for its safety, effective clinical effects, and less recurrence of inflammation, the optimal approach of arthrolysis is the research focus at present. Elbow arthroscopic surgery could not only treat the simple synovial tuberculosis of elbow joint under arthroscope, but also improve positive rate under arthroscopic, and it is recommended to be used at the early unclear diagnosis of swelling and pain of chronic elbow joint. In addition, total elbow arthroplasty may be an option for patients with high functional requirements in the future.

Association of interleukin 1 gene polymorphism with intervertebral disc degeneration risk in the Chinese Han population.

Intervertebral disc degeneration (IDD) is a major pathological process implicated in low back pain and is a prerequisite to disk herniation. Interleukin-1 α (IL-1α) was thought to be involved in the pathogenesis of disc degeneration by increasing the production of extracellular matrix degradation enzymes and by inhibiting extracellular matrix synthesis. IL-1α may provide insight about the etiology of IDD. We performed a hospital-based case-control study involving 200 IDD patients and 200 controls in the Chinese Han population. Genotyping was performed using a custom-by-design 48-Plex single nucleotide polymorphism Scan™ Kit. Our study indicated that IL-1α -899C/T polymorphism could increase the risk of IDD under the homozygous, recessive, and allelic models. Subsequently, we validated this significant association by a meta-analysis. Stratification analysis of ethnicity in this meta-analysis also obtained a significant association among Asians and Caucasians. In conclusion, the present study finds that IL-1α -899C/T polymorphism is associated with the risk of IDD. Larger studies with more diverse ethnic populations are needed to confirm these results.

[Treatment of Schatzker IV tibial plateau fractures with arthroscopy combined with MIPPO technique].

OBJECTIVE: To discusses the clinical effects of arthroscopy combined with minimally invasive percutaneous plate osteosynthesis(MIPPO) technology in treating Schatzker IV tibial plateau fractures. METHODS: From January 2012 to January 2016, 19 patients with Schatzker type IV tibial plateau fractures were treated with arthroscopy combined with minimally invasive technique including 12 males and 7 females with an average age of 46.5 years old ranging from 19 to 78 years old. Patients were suffering knee pain, swelling, flexion and extension limited, and other symptoms preoperative. Patients were followed up and assessed by Rasmussen knee function score. RESULTS: No infection, traumatic arthritis, and knee joint valgus occurred after operation. Nineteen cases were followed up for 12 to 24 months with an average of 18.6 months. Fracture healing time was 3 to 5 months with an average of 3.8 months. The knee pain and limited mobility improved significantly. The range of autonomic movement of joints was from 90 to 136 degrees. According to Rasmussen functional score criteria, the total score was 27.00±2.49, the result was excellent in 16 cases, good in 2 cases, fair in 1 case. CONCLUSIONS: Arthroscopic treatment for Schatzker type IV tibial plateau fractures combined with MIPPO can simultaneously treat internal structural injuries such as meniscus and other knee joints, with less trauma, fewer complications, and faster joint function recovery, but we must strictly grasp surgical indications and avoid expanding injuries.

[Application of three-dimensional printing technology to design individual angle section on Chevron of hallux valgus osteotomy].

OBJECTIVE: To explore clinical application of three-dimensional printing technology to design individual angle section on Chevron of hallux valgus osteotomy. METHODS: From May 2013 to May 2016, 47 patients(66 feet) with mild to moderate hallux valgus treated by Chevron osteotomy according to different preoperative design were divided into computer osteotomy group(group A) and traditional osteotomy group(group B). In group A, there were 25 patients (33 feet), including 4 males(5 feet) and 21 females(28 feet) with an average age of (47.88±6.08) years old, average weight IMA was (13.58±1.15) degree, AOFAS score was 59.00±5.86, and treated individual 3D printing technology to design operation scheme. While in group B, there were 22 patients (33 feet), including 3 males (3 feet) and 19 females (28 feet) with an average age of (48.16±6.16) years old, average weight IMA was(13.51±1.14) degree, AOFAS score was 60.67±5.85, and treated with osteotomy according to surgical experience. Operation time, blood loss, hospital stays, VAS score at 1 week after operation, wound healing and improvement of postoperative weight-bearing intermetatarsal angle(IMA) were compared between two groups, AOFAS score system was used to evaluate ankle function after surgery. RESULTS: There was no significant difference in following-up between group A 12.41±2.32 and group B 11.73±2.76. There was 1 patient in group B were excluded. Others perform good wounds healing on the first stage after operation. There were no significant differences in operation time, blood loss, hospital stays and VAS score at 1 week after operation(P<0.05); IMA in group A was (5.21±0.88)°, (6.42±0.85)° in group B, and had significant differences between two groups (t=5.68, P<0.05). There was obvious meaning in AOFAS score between group A 88.15±5.19 and group B 82.90±5.01(t=4.14, P<0.05). Fourteen feet in group A obtained excellent results and 19 feet good, while 5 feet in group B obtained excellent results and 27 feet good. CONCLUSIONS: Compared with traditional osteotomy group, three-dimensional printing technology to design individual angle section on Chevron of hallux valgus osteotomy could better correct IMA, improve postoperative foot function, and it is a kind of individualized and digital method to design operation.

[Choices of the internal fixation and approaches on unstable pelvic ring fractures].

OBJECTIVE: To discuss the suitable surgical approach and the internal fixation of unstable pelvic pelvic fractures. METHODS: From May 2010 to May 2015, 45 patients with unstable pelvic fractures were treated with different approaches and fixations, including 38 males and 7 females with an average age of 45 years ranging from 21 to 61 years. The course was within 2 weeks. According to Young-Burg classification, 23 patients were lateral compression injuries, 6 patients were vertical shearing injuries, 16 patients were anterior-posterior compression injuries. All patients had hip pain and limitation of motion, the X-rays showed the pelvic ring fracture. RESULTS: All wounds healed well without complications, 45 cases were followed up for a mean period of 13 months (ranged 9 to 21 months). Patients with hip pain had a good postoperative pain relief. The post-operative X-rays showed the reduction was satisfied and the pelvic ring shaped well. According to Majeed standards, the final follow-up score was 93.5±11.6, 35 cases got excellent results, 8 were good, 2 were fare. CONCLUSIONS: The unstable pelvic and acetabular fractures are always with compound injury. Beside the reduction, to decrease the second surgery trauma should take into consideration as well, the intra-articular reduction and the stability of the pelvic were especially valued, so combined the different approach with minimal invasive technique can get good clinical result.

[Surgical treatment of multiple ligament injuries of knee joints].

OBJECTIVE: To study operative effects for the treatment of multiple ligament injuries of knee joints. METHODS: From 2008 to 2013, 26 patients (17 males and 9 females) with multiple ligament injuries of knee joints were treated surgically. The average age was 40.7 years old, ranging from 29 to 55 years old. All the patients were treated with arthroscopic reconstruction of cruiate ligament with autogenous or allogeneic hamstrings and tendon, and at the same time received repair of medial collateral ligament and lateral collateral ligament, as well as the treatment of exterior and interior complex injuries. Nine patients received second stage operation after the initial operation for mistake or missed diagnosis, and other patients were treated at the first stage. The Lysholm scoring system was used to evaluate function and stability of knee joints before and after operation. RESULTS: All the patients were followed up for an average duration of 1.6 years (ranged, 0.8 to 3.2 years). The mean awaiting time for operation was 1.2 months. The Lysholm score was improved from preoperative 42.5 +/- 4.5 (ranged, 33 to 48) to the latest follow-up 78.1 +/- 3.9 (ranged, 57 to 95). The function of knee joint was improved obviously in the arthroscopic reconstruction patients, with joint range of motion exceeding 900 and with Varus & Valgus tests near to normal. All the patients had negative findings in the Lachman test at 70 degrees of flexion. CONCLUSION: Arthroscopic reconstruction should be the first choice in treating multiple ligament injuries of knee joints. If the anterior and posterior cruciate ligament injuries can't be treated simultaneously, the posterior cruciate ligament injuries should be treated preferentially at the first stage and the anterior cruciate ligament injuries should be treated at the second stage. The diagnosis of posterior cruciate ligament is easy to be missed.

[Surgical treatment and construction for traumatic floating shoulder].

OBJECTIVE: To explore surgical therapeutic strategies and clinical effects for floating shoulder injury. METHODS: From March 2010 to December 2013, 12 patients with floating shoulder injury were treated by open reduction and plate screw fixation,including 10 males and 2 females aged from 22 to 45 years old with an average of 31.7 years old. Preoperative X-ray and CT showed 11 cases were ipsilateral clavicle fracture with scapular neck fractures, 1 case was scapular neck fracture with ipsilateral acromioclavicular dislocation. Postoperative complications were observed and Herscvici functional scoring were used to evaluate clinical effects. RESULTS: Twelve patients were followed up from 8 to 26 months (averaged 15 months). All patients obtained bone union, and no inflammation, loosening and breakage of plate and screw were found. According to Herscvici scoring, 9 cases got excellent results, 2 good and 1 moderate. CONCLUSION: Reconstruction of anatomical structure and stability of floating shoulder joint injury could shorten time of shoulder joint brake and fixation, then got excellent clinical outcomes.

[Clinical observation of minor external fixation combined with Kirschner wire for open comminuted fracture of metacarpophalangeal joint].

OBJECTIVE: To explore the method and therapeutic effect of minor external fixation combined with Kirschner Treatment for open comminuted fracture of metacarpophalangeal joint. METHODS: From January 2013 to December 2014, 13 patients with open comminuted fracture of metacarpophalangeal joint were treated by minor external fixation combined with Kirschner wire, including 9 males and 4 females, aged from 18 to 56 years old with an average of 35 years old.According to Gustilo classification, 8 cases were type II, 4 cases were type IIIA, and 1 case was type IIIB. The time from injury to operation ranged from 2 to 7 h with an average of 5 h. All fractures were involved with metacarpal phalangeal joint surface. Fracture healing time and postoperative complications were observed, TAM scoring system by Hand Surgery Association of Chinese Medical Association was used to evaluate functional recovery. RESULTS: All patients were followed up from 3 to 12 months with an average of 7 months. All fractures were obtained bone healing, and the time ranged from 4 to 6 weeks with an average of (4.6±1.0) weeks. No broken and loose needle, pin track infections, malunion, loose bracket, reflection sexual sense of neurological malnutrition occurred. According to TAM scoring system, 7 cases obtained excellent results, 4 cases good, 1 case moderate and 1 case poor. CONCLUSIONS: Minor external fixation combined with Kirschner wire for open comminuted fracture of metacarpophalangeal joint has advantages of simple operation, good stability and which could be adjusted at the later stage, less damage for soft tissue periosteum, low inflammatory, earlier functional exercise. It is worth to be popularized and applied.

Development of nanofluorapatite polymer-based composite for bioactive orthopedic implants and prostheses.

Fluorapatite with low solubility is a promising biomaterial due to its structure, which is similar to hydroxyapatite. In this study a bioactive composite of nanofluorapatite (n-FA) and polyamide 12 (PA12) was fabricated. The results revealed that the mechanical properties (such as compressive strength and elastic modulus), hydrophilicity, and antibacterial properties of n-FA/PA12 composite were obviously improved by adding n-FA into PA12 as compared with PA12. In addition, cell proliferation of MC3T3-E1 cells cultured on n-FA/PA12 composite was significantly higher than with PA12, and alkaline phosphatase activity of MC3T3-E1 cells on the n-FA/PA12 composite was expressed at obviously higher levels as compared with PA12. The results suggest that n-FA/PA12 composite could support cell proliferation and differentiation, showing good cytocompatibility. Histological evaluation indicates that n-FA/PA12 composite enhances the efficiency of new bone formation with the introduction of n-FA into PA12, and the quantity of the newly formed bone for n-FA/PA12 composite is significantly higher than with PA12. In conclusion, n-FA/PA12 composite exhibits good biocompatibility and osteogenesis, which might be used for various orthopedic prostheses and dental implants.

[Treatment of thoracolumbar fractures with unilateral pedicle screw fixation through paraspinal approach].

OBJECTIVE: To evaluate the feasibility and efficacy of unilateral pedicle screw fixation in treating thoracolumbar fractures through paraspinal approach. METHODS: From January 2006 to January 2009,21 patients with single level thoracolumbar fracture without neurological symptoms were treated with unilateral pedicle screw fixation through paraspinal approach. There were 14 males and 7 females,aged from 21 to 65 years old with a mean of 36.4 years. The duration from injury to operation ranged from 6 h to 5 d with an average of 3 d. According to the classification of Denis fracture, compression fractures happedned in 12 cases and burst fractures happened in 9 cases,including 1 case with T5 fracture, 2 cases with T7 fracture, 2 cases with T10 fracture, 3 cases with T11 fracture, 8 cases with T12 fracture, and 5 cases with L1 fracture. Based on the Flankel grade, all patients were classified as grade E. Anterior vertebral body height ratio, sagittal Cobb angle, condition of internal fixation failure, visual analogue score (VAS) were evaluated. RESULTS: All patients were followed up from 12 to 36 months with an average of 20.5 months. No internal fixation failure was found. Anterior vertebral body height ratios at preoperative 3 days after operation and last follow-up were 54.3 +/- 2.8, 92.9 +/- 1.5, 93.8 +/- 1.7, respectively;sagittal Cobb angle at the three timepoints were (27.8 +/- 2.5) degrees, (5.3 +/- 0.8) degrees, (6.3 +/- 1.4) degrees, respectively; the difference was statistical significant (P < 0.05). VAS was (1.2 +/- 0.4) points at last follow-up and had obviously improved (P < 0.05). CONCLUSION: Treatment of thoracolumbar fractures with unilateral pedicle screw fixation through paraspinal approach is safe with the advantages of micro-trauma and less blood loss,which can not only completely retain the posterior spinal complex structure, reinforce the spinal stability, raise the reductional quality, but also improve the strength of fixation and the distribution of stress force.

[Treatment of proximal humeral fractures with percutaneous locking plate fixation through lateral deltoid approach].

OBJECTIVE: To investigate the effects of locking plate fixation through lateral deltoid approach for proximal humeral fracture combined with micro-invasive percutaneous plating (MIPPO) technique. METHODS: From April 2009 to March 2012,26 patients with proximal humeral fractures were treated with proximal humeral locking system plate fixation through lateral deltoid approach, including 17 males and 9 females with an average age of 58 years old ranging from 28 to 76 years old. The time from injury to operation was 3 to 10 days (averaged 5.6 days). According to Neer typing for the proximal humeral fractures, 7 cases had 2 parts of fracture,15 had 3 parts of fracture,and 4 had 4 parts of fracture. The Neer score for shoulder function was evaluated. RESULTS: All patients were followed up,and the duration ranged from 10 to 21 months (averaged 13.6 months). All patients were achieved bony union,the average healing time was 12.5 weeks (ranged from 10 to 21 weeks). No humeral head necrosis and axillary nerve injury occurred. According to Neer scoring system,the total score was 88.36 +/- 7.82, pain 30.82 +/- 3.24, function 23.76 +/- 5.71, activity 17.59 +/- 5.36, anatomical position 7.03 +/- 2.39; the result was excellent in 18 cases, good in 5 cases, fair in 2 cases, poor in 1 case. CONCLUSION: Lateral deltoid approach combined with locking plate fixation for treatment of proximal humeral fracture has advantages of small invasion,less blood lossing, short operative time, stable fixation, high rate of fracture healing, and satisfactory functional recovery.

[The un-healing cause of its management after operation of thoracolumbar tuberculosis].

OBJECTIVE: To analyze the un-healing cause and management after operation of thoracolumbar tuberculosis. METHODS: From January 2008 to December 2011, the data of 12 patients with postoperative un-healing thoracolumbar tuberculosis were retrospectively analyzed. There were 5 males and 7 females, with an average age of 51.3 years old (ranged, 42 to 65). All the patients occurred different degree of vertebral destruction, abscess-formation, kyphosis and nerve functional injury at the first operation. Among them, 11 patients underwent debridement and fusion with autogenous iliac bone grafting and internal fixation, 1 patient underwent debridement and fusion with autogenous iliac bone grafting. At 2-6 months after operation, internal fixation loosening, fusion failure, abscess-ormation, or erythrocyte sedimentation rate increasing occurred in the patients. For the patients to adjust anti-tuberculosis scheme, 2 patients were treated with puncture to multiple abscess combining with rifampicin local injection; 10 patients were reoperated with debridement and internal fixation adjusting. RESULTS: At 1-2.5 years (mean 1.8 years) after follow-up, 9 cases were cured finally. Re-admission had 3 cases because of re-occurred erythrocyte sedimentation rate increasing and abscess-formation at the 2-4 months after operation, whose bacterial culture showed more than 2 kinds of drug fast, and the treatment effect was still not ideal after adjusting anti-tuberculosis scheme. CONCLUSION: Insufficient anti-tuberculosis and bad nutritional status before operation,incomplete debridement and unreasonable fixation style during operation, inadequate drainage, irregular anti-tuberculosis and drug fast of Bacillus tuberculosis after operation are main reasons leading to un-healing of tuberculosis. Therefore, actively improving malnutrition, making individual operation plan before operation, ensuring complete debridement, rebuilding spinal stability, removing the compression of spinal cord, combining with postoperative effective, enough, regular combination chemotherapy are important guarantee to cure of spinal tuberculosis.