Objective To compare the effectiveness of the proximal femoral nail anti-rotation (PFNA) and locking compression plate (LCP) in the treatment of intertrochanteric fractures with the lateral unsubstantial femoral wall in elderly patients. Methods Between May 2009 and August 2012, 69 elderly patients with intertrochanteric fractures with the lateral unsubstantial femoral wall were treated. Fractures were fixed with PFNA in 36 patients (PFNA group), and with LCP in 33 patients (LCP group). There was no significant difference in gender, age, injury cause, side of fracture, and fracture AO type between 2 groups (P > 0.05). The incision length, operation time, intraoperative blood loss, total blood loss, fluoroscopy frequency, time for ambulation, and early (within 3 months) and late (more than 12 months) complications were compared. Fracture healing was assessed according to X-ray reexamination, the function of the hip joint was assessed according to the Harris hip scoring system. Results The incision length, operation time, intraoperative blood loss, and time for ambulation of PFNA group were significantly less than those of LCP group (P < 0.05), but the fluoroscopy frequency of PFNA group was significantly more than that of LCP group (P < 0.05). There was no significant difference in total blood loss between 2 groups (t=-1.686, P=0.096). The patients were followed up 12-24 months in PFNA group and 15-30 months in LCP group. The X-ray reexamination revealed fracture healing at (12.667±2.527) weeks in patients of PFNA group, and at (13.364±1.194) weeks in the others of LCP group except 1 case of nonunion, showing no significant difference (t=-1.443, P=0.154). There was no significant difference in Harris hip score between PFNA group (84.611±7.076) and LCP group (81.785±7.500) at 12 months after operation (t=1.626, P=0.109). The early complication rate and late complication rate were 16.7% (6/36) and 5.6% (2/36) in PFNA group and were 9.1% (3/33) and 9.1% (3/33) in LCP group, all showing no significant difference between 2 groups (χ2=0.871, P=0.481; χ2=0.320, P=0.665). Conclusion Both PFNA and LCP have good effectiveness in the treatment of intertrochanteric fractures with the lateral unsubstantial femoral wall in the elderly patients. Each has its own advantages and disadvantages.
【Abstract】 Objective To investigate the feasibil ity of contralateral C7 nerve transfer via posterior spinal route fortreatment of brachial plexus root avulsion injury by anatomical study. Methods Ten cadaveric specimens of 7 men and3 women were selected, who had no obvious deformity and no tissue defect in neck neutral position. By simulating surgical exploration of brachial plexus injury, the length of contralateral C7 nerve root was elongated by dissecting its anterior and posterior divisions to the distal end, while the length of C7 nerve from the intervertebral foramen to the branching point and the length of the anterior and posterior divisions were measured. By simulating cervical posterior approach, the C7 vertebral plate and T1 spinous process were fully exposed; the hole was made near vertebral body; and the C7 nerve root lengths by posterior vertebra path to the contralateral upper trunk and lower trunk were measured. Results C7 nerve root length was (58.62 ± 8.70) mm; the length of C7 nerve root plus posterior or anterior division was (65.15 ± 9.11) mm and (70.03 ± 10.79) mm, respectively. By posterior spinal route, the distance was (72.12 ± 10.22) mm from the end of C7 nerve to the contralateral upper trunk of brachial plexus, and was (95.21 ± 12.50) mm to the contralateral lower trunk of brachial plexus. Conclusion Contralateral C7 nerve can be transferred to the contralateral side through posterior spinal route and it only needs short bridge nerve or no. The posterior spinal route can effectively prevent from neurovascular injury, so it might be the best surgery approach for the treatment of brachial plexus root avulsion injury.
ObjectiveTo investigate the effect of hamstring tendon transfected with adenovirus-mediated transforming growth factor β1 (AdTGF-β1) genes on the histomorphology of tendon-bone interface healing after anterior cruciate ligament (ACL) reconstruction in rabbits. MethodsAdTGF-β1 and AdGFP were diluted to 5×108 PFU/mL with DMEM. Forty-eight New Zealand white rabbits were divided into 3 groups randomly (n=16), weighing 1.6-2.5 kg for ACL reconstruction with hamstring tendon autograft. Hamstring tendon was cultured and transfected with AdTGF-β1 (group A) and AdGFP (group B) for 12 hours before ACL reconstruction, and was cultured with DMEM in group C. After 12 hours of transfection, the expression of green fluorescence was observed in groups A and B under fluorescence microscopy; TGF-β1 protein level was detected by ELISA in group A. At 2, 4, 8, and 12 weeks after operation, the specimens were harvested for HE and Masson staining; the number of fibroblasts was counted, and the Buark grading was used to evaluate tendon-bone interface healing. ResultsGreen fluorescence was observed after 12 hours of transfection in groups A and B. TGF-β1 protein level reached (221.0±12.2) ng/mL at 12 hours in group A. The histological observation showed that few fibroblasts and collagen fibers were found, and Sharpey fibers appeared in group A; regular Sharpey fibers were seen in the interface, and integrity interface in some areas at 12 weeks. But fibroblasts of groups B and C were less than those of group A, with loose tendon-bone interface; no integrity interface was observed at 12 weeks. The number of fibroblasts and Buark grading of group A were significantly higher than those of groups B and C (P<0.05), but no significant difference was found between groups B and C (P>0.05). ConclusionHamstring tendon transfected with AdTGF-β1 gene can promote the healing of tendon-bone interface after ACL reconstruction.
ObjectiveTo detect the expression of human transforming growth factor β1 (hTGF-β1) gene mediated by adenovirus (Ad) in hamstring tendon after anterior cruciate ligament (ACL) reconstruction in rabbits. MethodsAd-hTGF-β1 and Ad-green fluorescent protein (GFP) were diluted to 5×108 PFU/mL with DMEM. Forty-eight New Zealand white rabbits were divided into 3 groups randomly (n=16) for ACL reconstruction with hamstring tendon autograft. Hamstring tendon was cultured and transfected with Ad-hTGF-β1 (group A) and Ad-GFP (group B) for 12 hours before ACL reconstruction, and was cultured with DMEM in group C. After 12 hours of transfection, green fluorescence was observed in groups A and B under fluorescence microscopy. At 2, 4, 6, and 8 weeks after operation, the hamstring tendon was harvested to detect the mRNA and protein expressions of hTGF-β1 by real time fluorescence quantitative PCR and Western blot. ResultsGreen fluorescence was observed after 12 hours of transfection in groups A and B. TGF-β1 protein level reached (221.0±12.2) ng/mL at 12 hours in group A. The hTGF-β1 mRNA expression could be detected in group A, but it could not be detected in group B and group C. The mRNA expression levels of hTGF-β1 were 1.004±0.072 at 2 weeks, 0.785±0.038 at 4 weeks, 0.469±0.053 at 6 weeks, and 0.172±0.021 at 8 weeks in group A, showing significant difference (P<0.05). Western blot results showed weakly positive band in groups B and C; the protein expression of TGF-β1 in group A was significantly higher than that in groups B and C (P<0.05), but no significant difference was found between groups B and C P>0.05). The protein expression of TGF-β1 gradually reduced with time, showing significant difference between different time points (P<0.05). ConclusionAd-hTGF-β1 can transfect the hamstring tendon successfully, and it can effectively express for a long time after ACL reconstruction.