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1.
Chin J Traumatol ; 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34509352

RESUMO

Intertrochanteric fractures have become a severe public health problem in elderly patients. Proximal femoral nail anti-rotation (PFNA) is a commonly used intramedullary fixation device for unstable intertrochanteric fractures. Pelvic perforation by cephalic screw is a rare complication. We reported an 84-year-old female who fell at home and sustained an intertrochanteric fracture. The patient underwent surgery with PFNA as the intramedullary fixation device. Routine postoperative examination revealed medial migration of the helical blade that eventually caused pelvic perforation. We performed a cemented total hip arthroplasty as the savage procedure. At the latest follow-up 12 months after total hip arthroplasty, the patient had no pain or loosening of the prosthesis in the left hip. Pelvic perforation should be considered when choosing PFNA as the intramedullary fixation device, especially in patients with severe osteoporosis wherein the helical blade can be easily inserted during the operation. The lack of devices to avoid oversliding of the helical blade in PFNA is an unreported cause of this complication and should be considered in such cases.

2.
BMC Musculoskelet Disord ; 21(1): 792, 2020 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-33256689

RESUMO

BACKGROUND: Vertebral augmentation is the first-line treatment for the osteoporosis vertebral compression fractures. Bone cement leakage is the most common complication of this surgery. This study aims to assess the risk factors for different types of cement leakage and provides a nomogram for predicting the cement intradiscal leakage. METHODS: We retrospectively reviewed 268 patients who underwent vertebral augmentation procedure between January 2015 and March 2019. The cement leakage risk factors were evaluated by univariate analysis. Different types of cement leakage risk factors were identified by the stepwise logistic analysis. We provided a nomogram for predicting the cement intradiscal leakage and used the concordance index to assess the prediction ability. RESULTS: A total of 295 levels of vertebrae were included, with a leakage rate of 32.5%. Univariate analysis showed delayed surgery and lower vertebral compression ratio were the independent risk factors of cement leakage. The stepwise logistic analysis revealed percutaneous vertebroplasty was a risk factor in vein cement leakage; delayed surgery, preoperative compression ratio, and upper endplate disruption were in intradiscal cement leakage; age, preoperative fracture severity, and intravertebral vacuum cleft were in perivertebral soft tissue cement leakage; no factor was in spinal canal cement leakage. The nomogram for intradiscal cement leakage had a precise prediction ability with an original concordance index of 0.75. CONCLUSIONS: Delayed surgery and more vertebral compression increase the risk of cement leakage. Different types of cement leakage have different risk factors. We provided a nomogram for precise predicting the intradiscal cement leakage.


Assuntos
Fraturas por Compressão , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Cimentos Ósseos/efeitos adversos , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/cirurgia , Humanos , Nomogramas , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/cirurgia , Estudos Retrospectivos , Fatores de Risco , Coluna Vertebral , Vertebroplastia/efeitos adversos
3.
Neural Regen Res ; 14(8): 1455-1461, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30964073

RESUMO

Small ubiquitin-like modifiers (SUMOs) have been shown to regulate axonal regeneration, signal transduction, neuronal migration, and myelination, by covalently and reversibly attaching to the protein substrates during neuronal cell growth, development, and differentiation. It has not been reported whether SUMOs play a role in peripheral nerve injury and regeneration. To investigate any association between SUMOylation and potential neuroprotective effects during peripheral nerve injury and regeneration, C57/BL mice were randomly divided into sham and experimental groups. The sciatic nerve was exposed only in the sham group. The experimental group underwent neurotomy and epineurial neurorrhaphy. Real-time quantitative polymerase chain reaction and western blot assay results revealed different mRNA and protein expression levels of SUMO1, SUMO2, SUMO3 and UBC9 in sciatic nerve tissue (containing both 5 mm of proximal and distal stumps at the injury site) at various time points after injury. Compared with the sham group, protein levels of SUMO1 and SUMO2/3 increased in both their covalent and free states after sciatic nerve injury in the experimental group, especially in the covalent state. UBC9 protein levels showed similar changes to those of SUMO1 and SUMO2/3 in the covalent states. Immunohistochemical staining demonstrated that SUMO1 and SUMO2/3 immunopositivities were higher in the experimental group than in the sham group. Our results verified that during the repair of sciatic nerve injury, the mRNA and protein expression of SUMO1, SUMO2, SUMO3 and UBC9 in injured nerve tissues changed in varying patterns and there were clear changes in the expression of SUMO-related proteins. These findings reveal that SUMOs possibly play an important role in the repair of peripheral nerve injury. All animal protocols were approved by the Institutional Animal Care and Use Committee of Tianjin Fifth Central Hospital, China (approval No. TJWZXLL2018041) on November 8, 2018.

4.
Neural Regen Res ; 14(4): 692-698, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30632510

RESUMO

Multiple regeneration of axonal buds has been shown to exist during the repair of peripheral nerve injury, which confirms a certain repair potential of the injured peripheral nerve. Therefore, a systematic nerve transposition repair technique has been proposed to treat severe peripheral nerve injury. During nerve transposition repair, the regenerated nerve fibers of motor neurons in the anterior horn of the spinal cord can effectively grow into the repaired distal nerve and target muscle tissues, which is conducive to the recovery of motor function. The aim of this study was to explore regeneration and nerve functional recovery after repairing a long-segment peripheral nerve defect by transposition of different donor nerves. A long-segment (2 mm) ulnar nerve defect in Sprague-Dawley rats was repaired by transposition of the musculocutaneous nerve, medial pectoral nerve, muscular branches of the radial nerve and anterior interosseous nerve (pronator quadratus muscle branch). In situ repair of the ulnar nerve was considered as a control. Three months later, wrist flexion function, nerve regeneration and innervation muscle recovery in rats were assessed using neuroelectrophysiological testing, osmic acid staining and hematoxylin-eosin staining, respectively. Our findings indicate that repair of a long-segment ulnar nerve defect with different donor nerve transpositions can reinnervate axonal function of motor neurons in the anterior horn of spinal cord and restore the function of affected limbs to a certain extent.

5.
Neural Regen Res ; 14(4): 699-705, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30632511

RESUMO

Our previous studies have confirmed that during nerve transposition repair to injured peripheral nerves, the regenerated nerve fibers of motor neurons in the anterior horn of the spinal cord can effectively repair distal nerve and target muscle tissue and restore muscle motor function. To observe the effect of nerve regeneration and motor function recovery after several types of nerve transposition for median nerve defect (2 mm), 30 Sprague-Dawley rats were randomly divided into sham operation group, epineurial neurorrhaphy group, musculocutaneous nerve transposition group, medial pectoral nerve transposition group, and radial nerve muscular branch transposition group. Three months after nerve repair, the wrist flexion test was used to evaluate the recovery of wrist flexion after regeneration of median nerve in the affected limbs of rats. The number of myelinated nerve fibers, the thickness of myelin sheath, the diameter of axons and the cross-sectional area of axons in the proximal and distal segments of the repaired nerves were measured by osmic acid staining. The ratio of newly produced distal myelinated nerve fibers to the number of proximal myelinated nerve fibers was calculated. Wet weights of the flexor digitorum superficialis muscles were measured. Muscle fiber morphology was detected using hematoxylin-eosin staining. The cross-sectional area of muscle fibers was calculated to assess the recovery of muscles. Results showed that wrist flexion function was restored, and the nerve grew into the distal effector in all three nerve transposition groups and the epineurial neurorrhaphy group. There were differences in the number of myelinated nerve fibers in each group. The magnification of proximal to distal nerves was 1.80, 3.00, 2.50, and 3.12 in epineurial neurorrhaphy group, musculocutaneous nerve transposition group, medial pectoral nerve transposition group, and radial nerve muscular branch transposition group, respectively. Nevertheless, axon diameters of new nerve fibers, cross-sectional areas of axons, thicknesses of myelin sheath, wet weights of flexor digitorum superficialis muscle and cross-sectional areas of muscle fibers of all three groups of donor nerves from different anterior horn motor neurons after nerve transposition were similar to those in the epineurial neurorrhaphy group. Our findings indicate that donor nerve translocation from different anterior horn motor neurons can effectively repair the target organs innervated by the median nerve. The corresponding spinal anterior horn motor neurons obtain functional reinnervation and achieve some degree of motor function in the affected limbs.

6.
Neural Regen Res ; 14(4): 706-712, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30632512

RESUMO

During peripheral nerve transposition repair, if the diameter difference between transposed nerves is large or multiple distal nerves must be repaired at the same time, traditional epineurial neurorrhaphy has the problem of high tension at the suture site, which may even lead to the failure of nerve suture. We investigated whether a small gap bio-sleeve suture with different inner diameters at both ends can be used to repair a 2-mm tibial nerve defect by proximal transposition of the common peroneal nerve in rats and compared the results with the repair seen after epineurial neurorrhaphy. Three months after surgery, neurological function, nerve regeneration, and recovery of nerve innervation muscle were assessed using the tibial nerve function index, neuroelectrophysiological testing, muscle biomechanics and wet weight measurement, osmic acid staining, and hematoxylin-eosin staining. There was no obvious inflammatory reaction and neuroma formation in the tibial nerve after repair by the small gap bio-sleeve suture with different inner diameters at both ends. The conduction velocity, muscle strength, wet muscle weight, cross-sectional area of muscle fibers, and the number of new myelinated nerve fibers in the bio-sleeve suture group were similar to those in the epineurial neurorrhaphy group. Our findings indicate that small gap bio-sleeve suture with different inner diameters at both ends can achieve surgical suture between nerves of different diameters and promote regeneration and functional recovery of injured peripheral nerves.

7.
J Int Med Res ; 46(11): 4678-4683, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30066599

RESUMO

OBJECTIVE: This study was performed to compare the clinical efficacy of three internal fixation methods for distal clavicle fractures (Neer type II): clavicular hook plate (Group A), anatomical plate (Group B), and arthroscopic Endobutton (Group C). METHODS: From 2001 to 2014, 58 patients with Neer type II distal clavicle fractures were treated at our institution. The clinical results were assessed with the visual analog scale (VAS), Constant score, and Simple Shoulder Test (SST) score. RESULTS: All patients had anatomic reduction and bone healing at the final follow-up. Groups B and C had considerably less intraoperative blood loss than Group A. The incision was significantly shorter in Group C than in Groups A and B. The mean VAS score was significantly higher in the affected than unaffected shoulder. The Constant and SST scores were significantly higher in the unaffected than affected shoulder. The VAS, Constant, and SST scores of the affected shoulders were not significantly different among the three groups. CONCLUSIONS: Arthroscopic Endobutton fixation has long-term clinical results similar to those of other surgical protocols for distal clavicle fractures (Neer type II). We recommend this technique because of less blood loss, shorter incision length, and less shoulder irritation than other methods.


Assuntos
Clavícula/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica , Clavícula/diagnóstico por imagem , Feminino , Seguimentos , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Resultado do Tratamento
8.
Neural Regen Res ; 13(2): 324-330, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29557384

RESUMO

Delay of axon regeneration after peripheral nerve injury usually leads to progressive muscle atrophy and poor functional recovery. The Wnt/ß-catenin signaling pathway is considered to be one of the main molecular mechanisms that lead to skeletal muscle atrophy in the elderly. We hold the hypothesis that the innervation of target muscle can be promoted by accelerating axon regeneration and decelerating muscle cell degeneration so as to improve functional recovery of skeletal muscle following peripheral nerve injury. This process may be associated with the Wnt/ß-catenin signaling pathway. Our study designed in vitro cell models to simulate myelin regeneration and muscle atrophy. We investigated the effects of SB216763, a glycogen synthase kinase 3 beta inhibitor, on the two major murine cell lines RSC96 and C2C12 derived from Schwann cells and muscle satellite cells. The results showed that SB216763 stimulated the Schwann cell migration and myotube contraction. Quantitative polymerase chain reaction results demonstrated that myelin related genes, myelin associated glycoprotein and cyclin-D1, muscle related gene myogenin and endplate-associated gene nicotinic acetylcholine receptors levels were stimulated by SB216763. Immunocytochemical staining revealed that the expressions of ß-catenin in the RSC96 and C2C12 cytosolic and nuclear compartments were increased in the SB216763-treated cells. These findings confirm that the glycogen synthase kinase 3 beta inhibitor, SB216763, promoted the myelination and myotube differentiation through the Wnt/ß-catenin signaling pathway and contributed to nerve remyelination and reduced denervated muscle atrophy after peripheral nerve injury.

9.
Chin Med J (Engl) ; 128(10): 1301-5, 2015 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-25963348

RESUMO

BACKGROUND: This study aimed to evaluate the effects of standard rescue procedure (SRP) in improving severe trauma treatments in China. METHODS: This study was conducted in 12 hospitals located in geographically and industrially different cities in China. A standard procedure on severe trauma rescue was established as a general rule for staff training and patient treatment. A regional network (system) efficiently integrating prehospital rescue, emergency room treatments, and hospital specialist treatments was built under the rule for information sharing and improving severe trauma treatments. Treatment outcomes were compared between before and 1 year after the implementation of the SRP. RESULTS: The outcomes of a total of 74,615 and 12,051 trauma cases were collected from 12 hospitals before and after the implementation of the SRP. Implementation of the SRP led to efficient cooperation and information sharing of different treatment services. The emergency response time, prehospital transit time, emergency rescue time, consultation call time, and mortality rate of patients were 24.24 ± 4.32 min, 45.69 ± 3.89 min, 6.38 ± 1.05 min, 17.53 ± 0.72 min, and 33.82% ± 3.87% (n = 441), respectively, before the implementation of the standardization and significantly reduced to 10.11 ± 3.21 min, 22.39 ± 4.32 min, 3.26 ± 0.89 min, 3.45 ± 0.45 min, and 20.49% ± 3.11%, separately (n = 495, P < 0.05) after that. CONCLUSIONS: Staff training and SRP can significantly improve the efficiency of severe trauma treatments in China.


Assuntos
Serviços Médicos de Emergência/normas , Ferimentos e Lesões , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , China , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem
10.
Neural Regen Res ; 10(1): 79-83, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25788924

RESUMO

Repair techniques for short-distance peripheral nerve defects, including adjacent joint flexion to reduce the distance between the nerve stump defects, "nerve splint" suturing, and nerve sleeve connection, have some disadvantages. Therefore, we designed a repair technique involving intraoperative tension-free application of a nerve elongator and obtained good outcomes in the repair of short-distance peripheral nerve defects in a previous animal study. The present study compared the clinical outcomes between the use of this nerve elongator and performance of the conventional method in the repair of short-distance transection injuries in human elbows. The 3-, 6-, and 12-month postoperative follow-up results demonstrated that early neurological function recovery was better in the nerve elongation group than in the conventional group, but no significant difference in long-term neurological function recovery was detected between the two groups. In the nerve elongation group, the nerves were sutured without tension, and the duration of postoperative immobilization of the elbow was decreased. Elbow function rehabilitation was significantly better in the nerve elongation group than in the control group. Moreover, there were no security risks. The results of this study confirm that the use of this nerve elongator for repair of short-distance peripheral nerve defects is safe and effective.

11.
Beijing Da Xue Xue Bao Yi Xue Ban ; 46(5): 766-70, 2014 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-25331402

RESUMO

OBJECTIVE: To investigate the surgical treatment results of implant failure after clavicular fracture open reduction and internal fixation (ORIF). METHODS: Fifteen cases from Jan. 2005 to Jan. 2013 were treated surgically according to fracture classification, time of implant failure and implant type. The fracture union, shoulder function and pain were evaluated postoperatively. RESULTS: All the patients had full follow-up for 5 to 101 months (mean: 43.8 months). All the fractures were united well. The constant scores to assess the shoulder function were 82 to 100 (mean: 93.3 in the fracture side) and were 85 to 100 (mean: 96.7 in the uninjured side); statistically significant difference of the constant scores between the two sides was found (P=0.02). Eight cases did not have shoulder pain in the fracture side, while the other 7 cases had mild pain, The visual analogue scale (VAS) scores to evaluate shoulder pain were 1 to 3 in the fracture side, which were statistically different from those in the uninjured side (P=0.03). CONCLUSION: Implant instability causes early implant failure after clavicular fracture ORIF and re-fixation with stable implant is effective. Fracture nonunion leads to late implant failure, and bridging fixation using locking plate associated with bony autograft with iliac crest is a successful method to treat atrophy clavicular nonunion. Surgical treatment can bring good results.


Assuntos
Clavícula/cirurgia , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Placas Ósseas , Humanos , Dor , Procedimentos Cirúrgicos Reconstrutivos
12.
Beijing Da Xue Xue Bao Yi Xue Ban ; 45(5): 693-7, 2013 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-24136260

RESUMO

OBJECTIVE: To discuss the change of blood pressure involved by pressor agents after the implantation of cement in hip replacement. METHODS: A total of 172 cases of femoral neck fracture underwent hip replacement in Department of Orthopedics and Trauma, Peking University People's Hospital between July 2008 and July 2013 were involved in this retrospective study. The blood pressure and usage of pressor agents were recorded before and after bone cement implantation. The data of blood pressure and usage of agents were collected according to anesthesia records. All the cases were divided into four groups by the application of pressor agents: Free of using agent group (Free-agent group), agents used before implantation of cement group (Pre-agent group), agents used after implantation of cement group (Post-agent group) and agent used before & after implantation of cement group (Pre and Post-agent group). Further statistic analysis was then performed. RESULTS: Free-agent group's mean systolic blood pressure decreased for (4.0 ± 10.3) mmHg. The decreasing was significant (t=3.660, P=0.000). Free-agent group's mean diastolic blood pressure decreased (1.3 ± 7.5) mmHg. The decreasing was not significant (t=2.286, P=0.149). Pre-agent group's mean systolic blood pressure decreased for (0.5 ± 20.2) mmHg. The decreasing was not significant (t=0.114, P=0.911). Pre-agent group's mean diastolic blood pressure increased (0.7 ± 10.2) mmHg. The increasing was not significant (t=-0.316, P=0.756). Post-agent group's mean systolic blood pressure decreased for (6.9 ± 15.0) mmHg. The decreasing was significant (t=3.195, P=0.002). Post-agent group's mean diastolic blood pressure decreased (3.6 ± 7.4) mmHg. The decreasing was significant (t=3.407,P=0.001). Pre & Post-agent group's mean systolic blood pressure decreased for (5.0 ± 12.2) mmHg. The decreasing was not significant (t=1.667, P=0.115). Pre & Post-agent group's mean diastolic blood pressure increased (1.3 ± 8.5) mmHg. The increasing was not significant (t=-0.656, P=0.521). CONCLUSION: Implantation of cement in hip replacement surgery causes blood pressure decreasing. The application of pressor agents before cement implantation can stabilize blood presure and shorten the period of hypotension.


Assuntos
Artroplastia de Quadril/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Cimentos Ósseos , Fraturas do Colo Femoral , Hipotensão/etiologia , Idoso , Idoso de 80 Anos ou mais , Cimentos Ósseos/efeitos adversos , Cimentos Ósseos/uso terapêutico , Efedrina/uso terapêutico , Feminino , Fraturas do Colo Femoral/fisiopatologia , Fraturas do Colo Femoral/cirurgia , Humanos , Hipotensão/prevenção & controle , Masculino , Pessoa de Meia-Idade , Fenilefrina/uso terapêutico , Estudos Retrospectivos , Vasoconstritores/uso terapêutico
13.
Beijing Da Xue Xue Bao Yi Xue Ban ; 45(5): 704-7, 2013 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-24136262

RESUMO

OBJECTIVE: To observe the clinical outcome after the surgical treatment of the deltoid ligament injury associated with ankle fractures. METHODS: From January 2005 to December 2009, 16 deltoid ligament ruptures associated with ankle fractures were repaired. According to the AO/OTA system, 2 cases belonged to fracture A, 8 to B, and 6 to C. Radiographs, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and visual analogue scale (VAS) were used for the outcome measurements. RESULTS: The 16 patients were followed up for 30 to 84 months,with the mean follow-up of 47 months. All wounds healed at the first stage. The mean time of bone union was 12.8 weeks (range: 10-14 weeks). The mean AOFAS ankle-hindfoot score in the last follow-up was 93 points (range: 85-100 points). The mean score of VAS was 0.94 points (range: 0-2 points). CONCLUSION: Surgical treatment of ankle fractures associated with deltoid ligament rupture can achieve satisfactory outcomes, but it is important to decide the operation indication.


Assuntos
Fraturas do Tornozelo , Fraturas Ósseas/cirurgia , Ligamentos Articulares/lesões , Adulto , Idoso , Feminino , Seguimentos , Fixação Interna de Fraturas/métodos , Humanos , Ligamentos Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Ruptura , Técnicas de Sutura , Resultado do Tratamento , Adulto Jovem
14.
Beijing Da Xue Xue Bao Yi Xue Ban ; 45(5): 728-31, 2013 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-24136267

RESUMO

OBJECTIVE: To investigate the clinical outcome of minimal invasive internal fixation with U-shaped break-off pedicle screws through paraspinal muscle sparing approach to treat thoracolumbar fractures, and to discuss its advantages. METHODS: From August 2010 to June 2012, we had 40 thoracolumber fractures patients (27 males and 13 females). Their ages ranged from 22 to 60 years. Of the 40 cases, 4 were T11 fractures, 13 T12 fractures ,17 L1 fractures,6 L2 fractures. According to Denis classification,all of them were burst fractures, with vertebral canal compromise less than 1/3. According to AO classification they were type A or type B1 injuries. All the cases had no nerve injury. The patients were randomly divided into two groups. With Group A (20 cases) we took the method of minimal invasive internal fixation with U-shaped break-off pedicle screws to fix one level above and below the injured vertebra through the parespinal muscle sparing approach. With Group B (20 cases), we took the traditional posterior midline approach and open procedure. Then we compared the two groups by operation time, blood loss, drainage, Visual Analogue Scales and X-ray exposure. RESULTS: Minimal invasive group had obvious advatages in operation time, bleeding control and early pain relief of post-operation. The X-ray exposure and long-term follow-up outcome were almost the same. CONCLUSION: Through paraspinal muscle sparing approach minimal invasive internal fixtation with U-shaped break-off pedicle screws to treat thoracolumber has more advantages than traditional procedure in blood control and quick recovery. The method needs no special instruments and don't increase X-ray exposure.


Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Vértebras Lombares/lesões , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Adulto , Perda Sanguínea Cirúrgica , Feminino , Humanos , Fixadores Internos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Medição da Dor , Músculos Paraespinais/cirurgia , Adulto Jovem
15.
Beijing Da Xue Xue Bao Yi Xue Ban ; 45(5): 815-8, 2013 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-24136285

RESUMO

OBJECTIVE: To discuss the operation effect of comminuted clavicle shaft fractures with provisional intramedullary K-wire fixation and bridging plate internal fixation. METHODS: From Mar. 2008 to Jul. 2012, 22 cases of comminuted clavicle shaft fractures was treated with open reduction, and provisional intramedullary K-wire fixation and bridging plate internal fixation. The fracture healing was investigated through X-rays. The 22 cases were followed up to evaluate the function of the affected shoulder with Constant score. RESULTS: Through the follow-up for average 15 months, all the fractures healed and the average healed time was 14.6 weeks. The average Constant score of the affected shoulder was 95.3. There were 13 excellent cases, 7 good cases, and 2 fair cases. The fineness rate was 90.9% (20/22). Soft tissue problem resulting from plate tilting occurred in 2 cases. At last, they accepted second operation to remove the implant. CONCLUSION: Applying provisional intramedullary K-wire fixation and bridging plate internal fixation in comminuted clavicle shaft fractures, makes procedure simple, improves healing rate and decreases the complications.


Assuntos
Placas Ósseas , Fios Ortopédicos , Clavícula/lesões , Fixação Intramedular de Fraturas , Fraturas Ósseas/cirurgia , Fraturas Cominutivas/cirurgia , Adulto , Idoso , Clavícula/cirurgia , Feminino , Seguimentos , Fixação Intramedular de Fraturas/instrumentação , Fixação Intramedular de Fraturas/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
16.
Beijing Da Xue Xue Bao Yi Xue Ban ; 45(5): 830-3, 2013 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-24136287

RESUMO

Treatment of peripheral nerve injury is a major challenge in clinical practice. With advances in molecular biology and development of microsurgical techniques and tissue engineering, peripheral nerve repair procedures have been greatly improved. In the last 10 decades, most treatments for peripheral nerve injury in animal models have achieved histological and functional recovery, the treatments in humans, however, produce insufficient recovery, especially for proximal nerve injury. Increasing attention has been paid to the Traditional Chinese Medicine (TCM) for promoting peripheral nerve regeneration, since these remedies often display effective clinical outcome, minor side effects and effectiveness for multiple targets. Although TCM has complex ingredients and the specific pharmacological mechanisms for their effectiveness are still unclear, an effective clinical outcome is welcomed by many clinicians. In the past 20 years, we have made a series of detailed studies including the toxicity tests, pharmacodynamic tests, pharmacological experiments etc, about a new traditional formula which mainly contains the Radix hedysari, Epimedium etc. RESULTS have shown that this formula is safe to be used in both animals and humans with no toxicity and adverse effect, and systemic administration of this formula could enhance the peripheral nerve regeneration.


Assuntos
Medicamentos de Ervas Chinesas/farmacologia , Fabaceae/química , Regeneração Nervosa/efeitos dos fármacos , Traumatismos dos Nervos Periféricos/tratamento farmacológico , Extratos Vegetais/farmacologia , Animais , Combinação de Medicamentos , Medicamentos de Ervas Chinesas/isolamento & purificação , Epimedium/química , Humanos , Regeneração Nervosa/fisiologia , Traumatismos dos Nervos Periféricos/fisiopatologia , Nervos Periféricos/fisiologia , Raízes de Plantas/química , Plantas Medicinais/química , Ratos
17.
Beijing Da Xue Xue Bao Yi Xue Ban ; 44(6): 842-6, 2012 Dec 18.
Artigo em Chinês | MEDLINE | ID: mdl-23247442

RESUMO

OBJECTIVE: To observe the clinical effect of biodegradable conduit small gap tublization to repair peripheral nerve injury. METHODS: In the study, 30 cases of fresh peripheral nerve injury in the upper extremities were recruited. After formally informed and obtaining the consent, the recruited patients were divided into the degradable chitin conduit tublization group (experimental group: 15 cases) and traditional epineurial neurorrhaphy group (control group: 15 cases). Their nerve functional recovery conditions were clinically observed according to the standard score methods provided by SHEN Ning-jiang and British Medical Research Council. The excellent and good rates of the overall nerve functional recovery were calculated. The electrophysiologic study was carried out after 6 months. RESULTS: Of the total 30 cases, 28 were followed up, and there were 14 cases in the degradable chitin conduit tublization group and traditional epineurial neurorrhaphy group. The operation procedure was very simple, and the mean suture time [(8.0±0.8) min] was 20% shorter than that of the traditional epineurial neurorrhaphy group [(10.0±0.6) min]. All the wounds in the degradable chitin conduit tublization group healed as expected without rejection, hypersensitive reaction or anomalous draining. Electrophysiology examination results after 6 months displayed that the sensory nerves conduction velocity recovery rate was 77.37% of the normal value, and motor nerve conduction velocity recovery rate was 70.09% in the degradable chitin conduit tublization group. The sensory nerves conduction velocity recovery rate was 61.69% of the normal value, and motor nerve conduction velocity recovery rate was 56.15% in the traditional epineurial neurorrhaphy group. The exact propability methods was applied in the comparison of sensory and motor nerve conduction velocity recovery rate, and there was no statistically significant of two groups(sensory nerve conduction velocity recovery rate P=0.678;motor nerve conduction velocity recovery rate P=0.695). The combinated functional recovery excellent and good rates after repair in the degradable chitin conduit tublization group were 78.57%, while 28.57% in the traditional epineurial neurorrhaphy group. The Fisher's exact probabilistic method was applied in the comparison of combinated functional recovery excellent and good rates, and there was statistically significant of two groups(P=0.021). CONCLUSION: The operation procedure of the degradable chitin conduit tublization is very simple and the clinical recovery effect is much better than that of the traditional epineurial neurorrhaphy. The biodegradable conduit small gap tublization methods to repair peripheral nerve injury has the possibility to substitute the traditional epineurial neurorrhaphy.


Assuntos
Implantes Absorvíveis , Nervo Mediano/lesões , Regeneração Nervosa , Traumatismos dos Nervos Periféricos/terapia , Adolescente , Adulto , Idoso , Materiais Biocompatíveis , Quitina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Nervo Ulnar/lesões , Adulto Jovem
18.
Beijing Da Xue Xue Bao Yi Xue Ban ; 44(6): 870-3, 2012 Dec 18.
Artigo em Chinês | MEDLINE | ID: mdl-23247448

RESUMO

OBJECTIVE: To investigate the treatment effect of open arthrolysis for elbow stiffness. METHODS: From Aug. 2007 to Apr. 2012, 17 cases of elbow stiffness were treated with open arthrolysis,in which, 11 were post-traumatic stiffness and 6 elbow stiffness resulted from rheumatoid arthritis and osteoarthritis. The preoperative Mayo elbow score was 65.1±16.4. Posterior middle approach was applied for 15 cases, and primary lateral approach for 2 cases. The ulnar nerve release and antedisplacement were performed for 12 cases with series limited flexion. The mobile hinged fixator were applied for 2 cases of unstable elbow after debridement of series hero ossification. RESULTS: With follow-up time for 6 to 41 months (average 13.1 months), all the patients acquired the follow-up and evaluation. According to Mayo elbow score of the last follow-up, the score was 87.5±16.7, and compared with the preoperation, the difference was significant: 9 cases were excellent, 6 good, 1 fair, and 1 poor, and the total excellent and good rate was 88.23%. The active range of motion (ROM) of flexion-extension was 110.6°±27.5°. However, 1 case developed chronic infection, and 1 ulnar nerve symptom. CONCLUSION: In applying open arthrolysis to treat elbow stiffness, as long as we release completely and assure stable elbow and early postoperative motion, we can get satisfying results.


Assuntos
Artroplastia/métodos , Contratura/cirurgia , Articulação do Cotovelo/lesões , Articulação do Cotovelo/cirurgia , Adulto , Idoso , Contratura/etiologia , Contratura/fisiopatologia , Articulação do Cotovelo/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
19.
Beijing Da Xue Xue Bao Yi Xue Ban ; 44(6): 874-7, 2012 Dec 18.
Artigo em Chinês | MEDLINE | ID: mdl-23247449

RESUMO

OBJECTIVE: To investigate the surgical treatment results of periprosthetic femur fracture after hip arthroplasty. METHODS: In the study, 10 patients from Oct. 2006 to Jan. 2012 were treated surgically according to Vancouver classification, and their fracture union, hip function, pain in fracture site and lower extremity length were evaluated postoperatively. RESULTS: All the patients had full follow-up for 6 to 69 months (mean time: 35.1 months). All fractures were united well with good alignment and no prosthesis loosing or internal fixation failure was discovered. Harris scores to assess hip function were 71 to 90 (mean: 79.8) and the excellent and good rate was 70%. VAS scores to evaluate pain in fracture site when walking were 0 to 3 (mean: 1.4). The lengths of injured lower extremity were shorter by 0 to 2.5 cm than those of the contralateral side preoperatively [mean (1.6±0.9) cm]. The shortened lengths were reduced to 0 to 1.8 cm postoperatively [mean (0.6±0.6) cm], which were statistically different from those of preoperation (P=0.002). CONCLUSION: Although treatment of periprosthetic femur fracture after hip arthroplasty is a hard work, we can make individual therapy regiment based on the patient's age, general condition, function demand and Vancouver classification. Surgical treatment can bring good results.


Assuntos
Artroplastia de Quadril/efeitos adversos , Prótese de Quadril/efeitos adversos , Fraturas Periprotéticas/etiologia , Fraturas Periprotéticas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade
20.
Beijing Da Xue Xue Bao Yi Xue Ban ; 44(6): 887-90, 2012 Dec 18.
Artigo em Chinês | MEDLINE | ID: mdl-23247452

RESUMO

OBJECTIVE: To surgically treat proximal humeral fracture involving metaphysis and humeral shaft with long locking plate osteosynthesis. METHODS: In the study, 9 proximal humeral fracture cases [6 male patients and 3 female, with an average age of (48.9±11.5) years and the average postoperation follow-up duration of 21.3 months from 12-46 months] treated with locking plate and with complete follow-up observation from May 2008 to April 2011 were recruited. Visual Analogue Score (VAS), Constant-Murley Score and shoulder range of motion (forward elvation, abduction, internal rotation) were used to evaluate postoperation shoulder joint function. RESULTS: All the cases got union of their fractures, without nonunion or delayed union. The complications were 2 cases with humeral head varus deformity, 1 with wound superficial infection and 1 with postoperation radius nerve paralysis. The last follow-up functions were that the average VAS was 0.22 (0-1), Constant-Murley score 79.7±6.5 (71-91), the average range of shoulder joint anteflexion 118°±20° (90°-160°), abduction 95°±14° (75°-120°) and internal rotation L1. CONCLUSION: Treatment of proximal humeral fracture with the fracture line implicating upper humerus metaphysis and humeral shaft is difficult because the medial cortex is injured and the longitudinal fracture line involves bone shaft. A good selection of operative approach and careful operation guarantee postoperative function restoration.


Assuntos
Fixação Interna de Fraturas/instrumentação , Fraturas do Úmero/cirurgia , Fixadores Internos , Adulto , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Complicações Pós-Operatórias/etiologia
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