Objective To compare the effects of arthroplasty with that of intenal fixation for displaced femoral neck fractures in the elderly. Methods We searched for all randomized controlled trials and quasi-randomized controlled trials of hip arthroplasty versus internal fixation for displaced femoral neck fractures in the elderly by electronically searching MEDLINE( 1966 to September, 2006),EMbase(1966 to September, 2006), Cochrane Library( Issue 4 2006), CBM( up to September, 2006) and CNKI (September, 2006) and handsearching grey literatures. The quality of the trials was assessed and meta-analyses were conducted using The Cochrane Collaboration’s RevMan 4.2.8 software. The quality of the trials was assessed. And meta-analysis was conducted by using RevMan4.2.8 software. Results A total of 228 papers were retrieved, but only 15 published randomized controlled trials involving a total of 2 254 patients were suitable for inclusion in the review. Based on the meta-analyses, hip arthroplasty showed obvious advantages over internal fixation in terms of the incidences of major complications after 2 years (RR 0.15 ; 95%CI 0.09 to 0.23) and after 5 years (RR 0.18 ; 95%CI 0.11 to 0.30) as well as re-operation rate (RR0.12 ; 95%CI 0.08 to 0.18) after 2 years, and after 5 years (RR0.11 ; 95%CI 0.06 to 0.22), there was an advantage to performing hip asthroplasty. After one year, the mortality was the same in both groups with RR 1.05 and 95%CI 0.89 to 1.23. Conclusion There is an evidence base to support arthroplasty as a treatment for displaced femoral neck fractures in the elderly. Arthroplasty can not only decrease the rate of re-operation, but can also reduce the incidence of complications, with similar one-year mortality when compared to internal fixation.
目的:探讨锁骨接骨板这一技术在治疗锁骨中段骨折中的应用及其临床效果。方法: 通过系统回顾2005年5月至2008年6月我院收治的30例锁骨中段骨折患者，其中男性24例，女性6例；年龄范围从12岁到63岁，平均年龄为34岁，行手术时间为受伤后3～5天，经患侧刀砍形切口切开复位，予锁骨接骨板内固定，术后2周内予颈腕吊带悬吊，同时进行耸肩训练。术后2周后开始肩关节不持重功能锻炼。结果:30例患者手术均获成功，术后随访时间为4～12个月（平均随访时间6.5个月），所有患者局部无疼痛，行X线检查显示均为解剖骨性愈合，外观无畸形，18例患者一年后取出内固定，无再骨折发生，患者能接受切口线状疤痕，肩关节活动度:前屈平均155°，外展平均160°。结论:切开复位锁骨接骨板内固定锁骨中段骨折是一种较好的治疗方法，值得推荐。
Objective To assess the effectiveness of the new anterolateral approach of the distal femur for the treatment of distal femoral fractures. Methods Between July 2007 and December 2009, 58 patients with distal femoral fractures were treated by new anterolateral approach of the distal femur in 28 patients (new approach group) and by conventional approach in 30 patients (conventional approach group). There was no significant difference in gender, age, cause of injury, affected side, type of fracture, disease duration, complication, or preoperative intervention (P gt; 0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, hospitalization days, and Hospital for Special Surgery (HSS) score of knee were recorded. Results Operation was successfully completed in all patients of 2 groups, and healing of incision by first intention was obtained; no vascular and nerves injuries occurred. The operation time and intraoperative fluoroscopy frequency of new approach group were significantly less than those of conventional approach group (P lt; 0.05). But the intraoperative blood loss and the hospitalization days showed no significant difference between 2 groups (P gt; 0.05). All patients were followed up 12-36 months (mean, 19.8 months). Bone union was shown on X-ray films; the fracture healing time was (12.62 ± 2.34) weeks in the new approach group and was (13.78 ± 1.94) weeks in the conventional approach group, showing no significant difference (t=2.78, P=0.10). The knee HSS score at last follow-up was 94.4 ± 4.2 in the new approach group, and was 89.2 ± 6.0 in the conventional approach group, showing significant difference between 2 groups (t=3.85, P=0.00). Conclusion New anterolateral approach of the distal femur for distal femoral fractures has the advantages of exposure plenitude, minimal tissue trauma, and early function rehabilitation training so as to enhance the function recovery of knee joint.
Objective To explore the relative prognostic factors of Tile C pelvic injury after iliolumbar fixation. Methods Between March 2007 and March 2010, 60 patients with Tile C pelvic injuries were surgically treated with iliolumbar fixation, including 39 males and 21 females with an average age of 37 years (range, 17-66 years). Of them, 27 cases were classified as Tile C1, 20 as Tile C2, and 13 as Tile C3. The preoperative injury severity score (ISS) was 12-66 (mean, 29.4). The time from injury to surgery was 2-25 days (mean, 8.1 days). Iliolumbar fixation was performed in all patients. Unconditional logistic analysis was used to analyze the relationship between the age, sex, body mass index (BMI), operation opportunity, the preoperative combined injury, classification of fracture, the postoperative complication, reduction outcome, sacral nerve injury, and the time of physical exercise and the prognosis. Results All 60 patients were followed up 12-56 months (mean, 27.3 months). Infection of incisions occurred in 12 cases and were cured after dressing change; healing of incision by first intention was obtained in the other patients. Delay sacral nerve injury was found in 15 patients, 6 patients underwent nerve decompression, and 9 underwent conservative treatment. Ten patients had nail protrusion of Schanz screws at the posterior superior illac spine, and 3 patients had pain, which was relieved after removal of the internal fixator. One patient had bone-grafting nonunion of sacroiliac joint, which was improved by pressured bone graft. Five patients had the beam breakage without significant effect. Six patients had deep vein thrombosis, among them 4 underwent filter and 2 underwent nonsurgical treatment. The healing time of fracture was 3-6 months (mean, 3.9 months). According to the Matta function score, the results were excellent in 31 cases, good in 24 cases, fair in 3 cases, and poor in 2 cases with an excellent and good rate of 91.7% at last follow-up. Majeed score was 58-100 (mean, 86), 28 were rated as excellent, 12 as good, 16 as fair, and 4 as poor with an excellent and good rate of 66.7%. The logistic analysis showed that the age, sex, BMI, and postoperative complications were not prognostic factors; early operation (within 10 days), early function exercises (within 7 days), the better reduction quality, and the less sacral nerve injury were in favor of prognosis; and the worse preoperative combined injury and pelvic injury were, the worse the prognosis was. Conclusion Operation opportunity, the preoperative combined injury, reduction outcome, sacral nerve injury, and the time of physical exercise are all significantly prognostic factors of Tile C pelvic injuries
Objective To investigate the effectiveness of percutaneous reduction by leverage and fixation using nonabsorbable suture with neckwear knot loop l igature to treat tibial intercondylar eminence avulsion fractures under the arthroscope. Methods Between February 2003 and December 2008, 28 patients with tibial intercondylar eminence avulsion fractures were treated, including 16 left knees and 12 right knees. There were 15 males and 13 females with an average age of19.5 years (range, 14-45 years). The injury causes included traffic accident injury in 11 cases, sport injury in 10 cases, and sprain injury in 7 cases. Based on Meyers-McKeever classification, there were 18 cases of type III and 10 cases of type IV. The X-ray films showed the tibial intercondylar eminence displaced fracture. The mean time between trauma and operation was 7 days (range, 4-12 days). All patients were treated surgically with an arthroscopically assisted reduction by leverage and fixation using 5-0 Ethibond suture with neckwear knot loop l igature. Results All incisions healed by first intention without infection or injuries of nerves and vessels. Twenty-eight patients were followed up 26 months on average (range, 12-66 months). The X-ray films showed fracture heal ing within 9-13 weeks (mean, 11 weeks). At last follow-up, all patients were able to return to their pre-injury activity and daily l ife. The knee joint was stable with no l imp or impingement of intercondylar fossa. The knee joint range of motion was 0-130°. The results of Lachman and anterior drawer tests were negative in all patients. At last follow-up, the Lysholm score was 93.5 ± 2.5, showing significant difference when compared with the preoperative one (29.0±2.2, t=53.000, P=0.000). Conclusion Percutaneous reduction by leverage and fixation using nonabsorbable suture with neckwear knot loop l igature is minimally invasive and satisfied reduction and fixation in treating the tibial intercondylar eminence avulsion fracture under the arthroscope, so it is benefit for early functional exercises, and can achieve excellent results.
Objective To discuss the effectiveness of antibiotic-impregnated cement temporary spacer for osteomyel itis and nonunion of bone caused by intramedullary fixation. Methods Between June 2002 and May 2006, 12 patients with chronic osteomyel itis and nonunion of bone caused by intramedullary nail ing were treated, including 8 males and 4 females with an average age of 40.2 years (range, 26-53 years). The fracture locations included tibia in 7 cases and femur in 5cases. Infection occurred within 2 weeks after intramedullary fixation in 7 cases and within 3 months in 5 cases. The mean time from infection to admission was 5 months (range, 1-24 months). The results of bacteria culture were positive in 10 cases and negative in 2 cases. White blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were higher than normal values. An antibiotic-impregnated cement temporary spacer was inserted after removal of biomembrane and internal fixator, thorough debridement and irrigation. After osteomyel itis was controlled by antibiotic therapy postoperatively, two-stage bone transplantation and internal fixation were performed after 3 to 6 months. Results All wounds healed by first intention without early compl ication. All cases were followed up 24 to 48 months (mean, 34 months). WBC count, ESR, and CRP were normal at 3 months postoperatively. The X-ray films showed the fracture heal ing at 10-14 weeks after operation (mean, 12 weeks). Expect one patient had knee range of motion of 90°, the lower l imb function of the others returned to normal. No infection recurred during follow-up. Conclusion Antibiotic-impregnated cement temporary spacer could control osteomyelitis and nonunion of bone caused by intramedullary nail ing, and two-stage bone transplantation and internal fixation after osteomyelitis is an effictive and ideal way to treat osteomyelitis and nonunion of bone caused by intramedullary nail ing.
Objective To explore the cl inical effects of different operative procedures in treatment of upper humerus fracture nonunion. Methods From May 2001 to September 2007, 43 cases of upper humerus fractures nonunion were treated, including 31 males and 12 females with an average age of 37 years (range, 20-57 years). The causes were trafficaccident injury in 14 cases, fall ing injury from height in 11 cases, tumbl ing injury in 7 cases, heavy pound injury in 6 cases, machine injury in 4 cases, and pathological injury in 1 case. The time from fracture to hospital ization was 10-52 months (23 months on average). After open reduction, patients were treated respectively by bone-graft plus locking compression plate fixation (9 cases), scapula flap rotation displacement plus locking compression plate fixation (15 cases), and scapula flap rotation displacement plus locking compression plate plus tibia bone lamella fixation (19 cases). Results All incisions healed by first intention. The X-ray films showed good fracture reduction. No symptoms of infection and nerve injury occurred. Forty-three patients were followed up 12 to 25 months with an average of 18 months. All of them achieved radiographic union within 3.0 to 7.5 months (4.9 months on average). According to comprehensive assessing standard of X-ray film and functions of shoulder and elbow, the results were excellent in 21 cases, good in 15 cases, fair in 4 cases, and poor in 3 cases; the excellent and good rate was 83.7%. Conclusion In the treatment of upper humerus fractures nonunion, locking compression plate can provide stable fixation. It can achieve satisfactory results so long as the right method of bone graft is chosen according to fracture site situation. But for patients undergoing repeated surgery or having nonunion for long times and poor fracture site situation, after open reduction, scapula flap rotation displacement plus locking compression plate plus tibia bone lamella fixation has good outcome.
Objective To investigate the cl inical outcomes of one stage debridement and closed-suction drainage for treatment of infection after lumbar instrumentation. Methods Between June 2002 and March 2008, 12 patients with infection after lumbar instrumentation were treated with one stage debridement and closed-suction drainage, including 9 males and 3females and aging 35-68 years (48.5 years on average). The disease duration varied from 7 days to 183 days (56 days on average). The segments of internal fixation included 7 cases single segment at levels of L4, 5, 4 cases of double segments at levels of L 4, 5, L5, S1 (2 cases), and L3, 4, L4, 5 (2 cases), and 1 case of three segments at levels of L3, 4, L4, 5, L5, S1. Two patients were treated with internal fixator removal. Results The bacterial culture results of intervertebral discs were positive in 8 cases for Staphylococcus aureus and in 3 cases for Enterobacter cloacae, negative in 1 case. Primary healing of incisions were achieved in all cases. Twelve patients were followed up 18-53 months (34.7 months on average). The white blood cell count, erythrocyte sedimentation rate, and C reactive protein significantly decreased after operation, showing significant differences at 15 days after operation when compared with those before operation (P lt; 0.05). No obvious low back pain was observed. Pathological-changed vertebra-space fused. No displacement and breakage of internal fixator occurred; in 2 patients who were given internal fixator removal, no removal of the instrumentation was performed again. The X-ray films showed that the average kyphosis decreased 0.8° at 18 months after operation. At last follow-up, the visual analogue scale score was 2 ± 1, showing significant difference (P lt; 0.05) when compared with that (10 ± 2) before operation. Conclusion One stage debridement and closed-suction drainage therapy is an effective method for treating infection after lumbar instrumentation. The operation is easy and can reduce hospitalization days.
Objective To compare the effectiveness of two minimally invasive methods: minimally invasive plating osteosynthesis (MIPO) and expandable intramedullary nail ing technique in treatment of middle third humeral shaft fractures. Methods The cl inical data were retrospectively analyzed and compared from 33 cases with middle third humeral shaft fractures between May 2004 and December 2008. All the patients were divided into 2 groups: 14 patients were treated with MIPOtechnique (group A) and 19 with expandable intramedullary nail ing technique (group B). In group A, there were 10 males and 4 females with an average age of 35 years (range, 21-51 years). The disease cause was traffic accident in 5 cases, tumbl ing in 6 cases, machine related trauma in 2 cases, crushed by a heavy object in 1 case. Six fractures were classified as AO type A, 6 as type B, and 2 as type C. The time from injury to operation was 3 to 11 days with an average of 5.9 days. In group B, there were 12 males and 7 females with an average age of 40 years (range, 19-68 years). The disease cause was traffic accident in 7 cases, tumbl ing in 8 cases, fall ing from height in 3 cases, crush injury in 1 case. Ten fractures were classified as AO type A, 8 as type B, and 1 as type C. The time from injury to operation was 2 to 6 days with an average of 4.2 days. There was no significant difference in general data between 2 groups (P gt; 0.05). Results The operation time was (104.6 ± 25.8) minutes in group A and (85.0 ± 35.7) minutes in group B, showing no significant difference (P gt; 0.05). Incision healed by first intention without iatrogenic radial nerve palsy in 2 groups. The patientswere followed up 21.4 months on average (range, 12-37 months) in group A and 20.5 months on average (range, 22-35 months) in group B. The X-ray films showed bony heal ing in all patients. The fracture union time was (16.4 ± 6.1) weeks in group A and (15.0 ± 2.5) weeks in group B, showing no significant difference (P gt; 0.05). The University of Cal ifornia Los Angeles (UCLA) End- Result scores were 34.1 ± 1.1 in group A and 31.8 ± 2.6 in group B and the Mayo Elbow Performance scores were 100 in group A and 97.6 ± 3.9 in group B; all showing significant differences (P lt; 0.05). Conclusion Good cl inical outcomes could be obtained when middle third humeral shaft fractures are treated by either MIPO or expandable intramedullary nail ing techniques. However, MIPO technique could offer better shoulder and elbow functional results.