[Effect analysis of trajectory screw technique in fragility fracture of pelvic ring].

OBJECTIVE: To assess the clinical efficacy of minimally invasive technology with trajectory screw fixation for fragility fractures of pelvic(FFP). METHODS: A retrospective case control study was performed to analyze the clinical data of 35 patients with FFP who were treated and followed up between January 2016 and December 2019. There were 12 males and 23 females, aged from 65 to 99 years with an average of(75.4±7.8) years old. There were 13 cases of type Ⅱb, 7 cases of type Ⅱc, 8 cases of type Ⅲa, 2 cases of type Ⅲb, 2 cases of type Ⅲc, 1 case of type Ⅳb, and 2 cases of type Ⅳc according to Rommens FFP comprehensive classification. All patients received the treatment of minimally invasive technology with trajectory screws fixation. According to the different methods of anterior pelvic ring fixation, FFP patients were divided into two groups:12 cases were fixed with the pedicle screw rod system in the anterior pelvic subcutaneous internal fixator (INFIX) group;23 cases were fixed with hollow screws of the pubic symphysis, superior ramus of pubis or acetabular anterior column in the screw group. The operation time, intraoperative blood loss, intraoperative fluoroscopy times, length of hospital stay, cost of internal fixation, pre- and post-operative visual analogue scale(VAS) were compared between the two groups. The fracture reduction quality was evaluated according to the Matta criteria, and the clinical function was evaluated by the Majeed functional scoring system respectively. RESULTS: All patients were followed up for 12 to 39(16.5±5.4) months after surgery. There was no statistically significant difference in the operation time, intraoperative blood loss, intraoperative fluoroscopy time, and length of hospital stay between the two groups(P>0.05). As for the cost of internal fixation, the cost of internal fixation in the screw group [2 914 (2 914, 4 371) yuan] was significantly lower than that of the INFIX group [6 205 (6 205, 6 205) yuan] (P<0.05). No significant difference was observed in the incidence of postoperative complications between the two groups (P>0.05). There was no significant difference in VAS assessment at admission, 1 week, and 3 months after surgery between the two groups(P>0.05). However, the VAS assessment at 1 week and 3 months after surgery of the two groups were significantly better than those at admission(P<0.05). There was no significant difference in the quality of fracture reduction after the operation and the efficacy evaluation at the last follow-up between the two groups(P>0.05). CONCLUSION: For the treatment of fragility fractures, minimally invasive technology with trajectory screw fixation can achieve good clinical efficacy. It has the advantages of being relatively minimally invasive, less bleeding, relieving the pain. It deserves clinical application.

Association between sleep quality and general anesthesia in teenager under elective surgery: a prospective study.

OBJECTIVE: Anesthesia was reported to be associated with lowered postoperative sleep quality in adults, but its effect on teenager was less understood. This study was conducted to explore the association between postoperative sleep quality and general anesthesia in teenagers. METHODS: A prospective study was conducted. Teenagers aged from 12 to 16 years who were treated with general anesthesia and under urologic or otolaryngologic surgery were recruited. Healthy teenagers matched by sex and age (± 3 years) with the specific case were recruited as the controls. The Sleep Habits Questionnaire was applied to assess the sleep quality of the teenagers. We applied a logistic regression analysis to evaluate the association between general anesthesia in teenagers under elective surgery and poor sleep quality. Risk ratio (RR) and its corresponding 95% confidence interval (CI) were computed. RESULTS: A total of 212 teenagers were included comprising 106 patients with general anesthesia who underwent urologic or otolaryngologic surgery and 106 healthy controls. The male participants were accounting for 47.2% (100/212). Anesthesia duration and surgery duration in the patients were 103.7 ± 14.4 min and 162.1 ± 17.0 min, respectively. Positive associations between general anesthesia and poor sleep quality in the 1st, 3rd, and 7th postoperative days were found, and RRs and their corresponding 95%CIs were 4.87 (1.72-13.79), 3.33 (1.22-9.1), and 3.26 (1.07-9.93), respectively. However, there was a lack of statistical associations before surgery and after 14 postoperative days. CONCLUSIONS: Teenagers who were treated with general anesthesia and under urologic or otolaryngologic surgery might have poor sleep quality within 7 postoperative days.

[Analysis of clinical effects of iliolumbar fixation in treating U-shaped sacral fractures].

OBJECTIVE: To evaluate the efficacy of iliolumbar fixation in the treatment of U-shaped sacral fractures. METHODS: A retrospective study was conducted on the 14 complex U-shaped sacral fractures which had been treated from January 2014 to December 2019, involved 10 males and 4 females, aged 24 to 48 (35.4±6.5) years. Fracture healing time, nerve function, clinical function and complications were observed in the patients. RESULTS: All patients were followed up for 9 to 16(26.0±5.9) months. The complete weight-bearing time for bone healing was(12.4±2.0) weeks. One case of surgical incision infection occurred after operation, and one case of sacrum nailspenetrated to the outer plate of sacrum. No complications such as pressure ulcers, loosening or rupture of internal fixation occurred. According to Gibbons scoring, the neurological function recovered from preoperative 2.9±0.9 to postoperative 2.1±1.1, there were statistically significant differences between preoperative and postoperative (t=6.9, P=0.00). There was significant difference between preoperative malformation angle (41.4±11.2)° and postoperative value (28.3±7.5)° (t=4.70, P=0.00). According to Majeed scoring to evaluate the clinical function, postoperative pain, standing, sitting, sexual life, work ability, total score respectively were 23.21±3.17, 25.57± 3.94, 7.71±1.54, 2.64±0.92, 16.14±2.41, 75.30±8.10, 2 cases got excellent results, 10 good, 2 fair. CONCLUSION: Sacral lumbar fixation is an effective method for the treatment of U-shaped sacrum fractures. It has the advantages of strong internal fixation and satisfactory functional recovery.

Simvastatin reverses the harmful effects of high fat diet on titanium rod osseointegration in ovariectomized rats.

INTRODUCTION: The objectives of the present study were to determine whether simvastatin (SIM) could reverse the harmful effects on titanium rod osseointegration in ovariectomized rats fed high-fat diet (HFD). MATERIALS AND METHODS: Ovariectomized female Sprague-Dawley rats were randomly allocated to three groups and received SIM treatment plus HFD for 12 weeks. We then evaluated the microstructure parameters, histological parameters, biomechanical parameters, bone turnover, and blood lipid level. RESULTS: After 12 weeks of treatment, SIM can significantly improve bone formation around the titanium rod and osseointegration including higher values of maximum push-out force, bone area ratio (BAR), bone-to-implant contact (BIC), bone mineral density (BMD), bone volume (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), mean connective density (Conn.D) when compared with the HFD group. In addition, system administration of SIM showed positive effects on collagen type 1 cross-linked C-telopeptide (CTX-1), procollagen I N-terminal propeptide (PINP), total cholesterol (TC), triglycerides (TGL), low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol. Compared with the HFD group, lower values of CTX-1, P1NP, TC, TGL and LDL were observed in the SIM+HFD group (P < 0.05). CONCLUSION: Our findings revealed that HFD may have an adverse effect on osseointegration in osteoporotic conditions, and the harmful effect of HFD on osseointegration could be reversed by SIM.

[Comparison of different minimally invasive internal fixation in the treatment of pelvic anterior ring fracture].

OBJECTIVE: To compare the clinical efficacy of three minimally invasive methods of anterior column screw, plate and screw rod system in the treatment of anterior pelvic ring fracture. METHODS: From December 2015 to September 2018, 77 patients with pelvic anterior ring fracture were treated and followed up, including 45 males and 32 females, aged 19 to 73 years. According to AO / OTA classification, there were 26 cases of type B1, 20 cases of type B2, 17 cases of type B3 and 14 cases of type C. According to the different internal fixation methods, they were divided into three groups:anterior column screw group(35 cases), plate group(20 cases), and screw rod system group(22 cases). The operation time, intraoperative fluoroscopy times, blood loss, fracture reduction quality, complications and curative effect of the three groups were compared. RESULTS: All 77 patients were followed up for 12 to 33 (16.5±5.7) months. The operation time, intraoperative blood loss and incision length of anterior column screw group were significantly shorter than those of plate group and screw rod system group, and intraoperative fluoroscopy times of plate group were significantly less than those of anterior column screw group and screw rod system group (P<0.05). There was no significant difference in the quality of fracture reduction and curative effect among the three groups(P>0.05). The incidence of complications was significant different among three group(P<0.05). CONCLUSION: Minimally invasive internal fixation with anterior column screw, plate and screw rod system can obtain good clinical effect, but anterior column screw fixation has less trauma and lower incidence of surgicalcomplications.

Melatonin improves the osseointegration of hydroxyapatite-coated titanium implants in senile female rats.

The aim of this study was to confirm the effect of the systemic administration of melatonin on hydroxyapatite-coated titanium (HA-Ti) implants in senile osteopenic rats. For this study 24-month-old female Sprague-Dawley rats were used. The animals were randomly divided into two groups: a control group and a melatonin group and the bilateral femurs of all the rats received HA-Ti implants. Animals in the melatonin group received treatment with melatonin (30 mg/kg day). After a 12-week healing period, rats in the melatonin group revealed improved osseointegration compared to the control group, with the bone area ratio (BAR) and bone to implant contact (BIC) increased by 1.87-fold and 1.65-fold in histomorphometry, the quantitative results of implant osseointegration and peri-implant trabeculae, such as a higher bone volume per total volume (BV/TV), trabecular number (Tb.N), the mean connective density (Conn.D), trabecular thickness (Tb.Th), and a lower trabecular spacing (Tb.Sp) in micro-computed tomography (CT) evaluation and the maximum push-out force by 1.75-fold in push out tests. Additionally, compared with the control group, melatonin could significantly up-regulate the expression of the runt-related transcription factor 2 (Runx2), osteocalcin (OC) and osteoprotegerin (OPG) genes and down-regulate the expression of the RANKL gene. These findings suggest that systemic administration with melatonin is useful to improve the fixation of HA-coated implants even in osteopenic rats through promoting Runx2, OC and OPG gene expression and inhibiting RANKL gene expression.

[Case-control study on polymer polylactic acid absorbable medical film for preventing acromion adhesion after arthroscopic rotator cuff repair].

OBJECTIVE: To study effect of shoulder joint function after rotator cuff repair of polylactic acid absorbable membrane. METHODS: From September 2015 to December 2016, 50 patients diagnosed with rotator cuff tear were selected and divided into treatment group and control group. There were 25 patients in control group, including 12 males and 13 females, with an average age of (48.7±3.5) years old, who received simple arthroscopic rotator cuff repair. There were 25 patients in treatment group, including 11 males and 14 females, with an average age of(49.2±4.1) years old, who performed arthroscopic rotator cuff repair with implanting polylactic acid absorbable membraneon shoulder of rotator cuff. Preoperative and postoperative VAS score, ASES score and UCLA score were recorded and compared between two groups. RESULTS: At 6 months after operation, preoperative VAS score in control group was 5.48±1.12, and decreased as 1.28±0.84 after operation; ASES score before operation was 52.24±4.64, and improved to 86.92±3.20 after operation;preoperative UCLA score improved from 14.36±1.89 before operation to 30.72±1.28 after operation. In treatment group, VAS score decreased from 5.36±1.32 before operation to 1.40±0.71 after operation;preoperative ASES score was 51.04±4.09, and improved to 88.96±2.79 after operation; UCLA score improved from 15.12±1.81 before operation to 32.12±1.33 after operation. There was no significant difference in VAS score between two groups, and ASES score, UCLA score in treatment group was obviously better than control group. CONCLUSIONS: Application of polylactic acid absorbable medical membrane could obviously improve shoulder function, and effectively prevent acromion adhesion after arthroscopic rotator cuff repair.