OBJECTIVE: To review the anatomic character of lower cervical pedicle, the placement and the biomechanical stability of the cervical pedicle screw fixation, the clinical application and the complication caused by fixation. METHODS: The literature concerned the cervical pedicle screw fixation in recent years were extensively reviewed. RESULTS: The cervical pedicle screw fixation can be widely used in the lower cervical spine instability according to the anatomic character of lower cervical pedicle, and the good biomechanical stability of the cervical pedicle screw fixation, and the complication can be controlled. CONCLUSION: The cervical pedicle screw fixation is an effective internal fixation for the lower cervical spine instability.
Objective To investigate the methods and effectiveness of surgical treatment for posteromedial corner (PMC) injury combined with anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) ruptures. Methods Between February 2009 and February 2012, 15 patients (15 knees) with PMC injury combined with ACL and PCL ruptures underwent PMC repair with suture anchor and ACL and PCL reconstruction. There were 7 males and 8 females with an average age of 39 years (range, 15-59 years). The causes of injury were traffic accident injury in 6 cases, sport injury in 7 cases, and sprain injury in 2 cases. The disease duration was 3-15 days with an average of 7 days. All patients presented positive results of anterior drawer test, posterior drawer test and valgus stress test, and dysfunction of knee joint. Of 15 cases, 3 had ACL and PCL ruptures, 5 had ACL rupture, 3 had ACL injury at the attachment point of the condyles crest, and 4 had PCL rupture; 9 had PMC tear at the femur insertion, 5 had PMC tear at the tibia insertion, and 1 had PMC tear in the body area. Results All incisions healed by first intention with no complication of infection or stiffness of knee. All cases were followed up 18.4 months on average (range, 10-36 months). At last follow-up, 14 cases had normal knee flexion and extension ranges, but 1 case had 10° limitation of the knee extension. Except 1 case which had weakly positive valgus stress test, the other patients showed negative results of anterior drawer test, posterior drawer test, and valgus stress test. Based on the improved Lysholm classification standard, the results were excellent in 8 cases, good in 5 cases, and fair in 2 cases; the excellent and good rate was 86.7%. Conclusion Early repair of the PMC and reasonable reconstruction of cruciate ligament can effectively restore the knee stability for patients with PMC injury combined with ACL and PCL ruptures.
【Abstract】 Objective To evaluate the method and the early effectiveness of total hip arthroplasty in the treatment of protrusio acetabuli. Methods Between January 2006 and February 2010, 16 cases (16 hips) of protrusio acetabuli were treated, including 6 males and 10 females with an average age of 56.5 years (range, 39-72 years). The median disease duration was 6.4 years (range, 1 year and 6 months to 35 years). Involved hips included 7 left hips and 9 right hips; 3 patients had primary protrusio acetabuli and 13 patients had secondary protrusio acetabuli. The preoperative Harris score was 49.5 ± 5.5. According to Dunlop et al. classification criterion, there were 3 cases of mild, 9 cases of moderate, and 4 cases of severe. All patients received total hip arthroplasty with bone graft and cementless prosthesis for recovery of femoral offset and acetabular center of rotation. Results All incisions healed by first intention without complication of infection, deep venous thrombosis, or nerve injury. All patients were followed up 12-62 months with an average of 37 months. The Harris score at last follow-up was 90.5 ± 4.5, showing significant difference (t=49.578, P=0.000) when compared with preoperative score. The X-ray films showed that no prosthesis loosening or subsidence was observed, and bone graft healed with no sign of re-protrusion. Conclusion In treatment of protrusio acetabuli, total hip arthroplasty with bone graft and cementless prosthesis can recover the femoral offset and acetabular center of rotation and provide satisfactory early effectiveness.
Objective To explore the situation of tendon-bone heal ing when allogenic tendon graft is wrapped with autologous periosteum around the tendon in rabbits. Methods Twenty healthy New Zealand white rabbits with the age of 4-5 months were used in the experiment, weighing 2.5-3.0 kg. One-side posterior l imb was selected randomly as the test, and thecontralateral l imb was served as the control at the same time. The allogenic tendon graft was designed as a tendon-bone model in the proximal tibial metaphysis of rabbits. The portion of tendon in the bone tunnel was wrapped with autologous periosteal graft in which the cambium layer was facing the bone tunnel in the experimental group, while the portion of tendon in the bone tunnel was not wrapped with autologous periosteal graft in the control group. The histologic examination of the tendon-bone interface (n=2) and the biomechanical test for maximal pullout load (n=8) were conducted 4 and 8 weeks after operation, respec tively. Results All specimens were observed with naked eyes 4 and 8 weeks after the operation. Many new bones around bone tunnel outlet were seen in the experimental group, while a few or few new bones were seen in the control group. Four weeks after operation, histological observation showed there were a lot of prol iferative mesenchymal cells in the periosteal germinal layer in the experimental group and conspicuous membrane bone formation was obvious. The arrangement of massive osteoblasts around newborn bone trabecula was similar to pal isade. The newborn bone trabecula was l inked with the periosteum. Some loose connective tissues and few newborn bones between the tendon graft and the bone tunnel were seen in the control group, and the connection of them was loose. Eight weeks after operation, the connection between the tendon graft and the bone tunnel was tight and no gap existed in the experimental group. The number of newborn bones was large and their arrangement was relatively regular. The tidemark l ine was seen between the tendon graft and the bone tunnel, which was similar to normal tendon-bone interface. The prol iferation of fibroblast was active in the periosteum, and there were many fibrous joints betweenthe periosteum and the tendon graft. Partial bone formation was seen between the tendon graft and the bone tunnel in thecontrol group, with disorderly arrangement, and there were many collagen fibrous joints between the tendon graft and the bone tunnel. Four and 8 weeks after operation, the pullout or pull and break loads of the experimental group were (35.03 ± 1.21) N/ cm and (42.36 ± 1.31) N/cm, respectively, and those of the control group were (26.14 ± 6.13) N/cm and (31.63 ± 6.87) N/ cm, respectively. There was significant difference between the two groups (P lt; 0.05). Conclusion The transplantation of autologous periosteum graft wrapping around allogenic tendon graft may shorten the time of osteochondral ossification between the tendon graft and the bone tunnel, improve heal ing strength and promote tendon-bone heal ing in the bone tunnel in rabbits.
目的 为贯彻落实卫生部《医院感染管理办法》、《抗菌药物合理应用指导原则》，了解成都三六三医院医院感染的现状，对医院感染控制工作进行评价，提高医务人员的感染控制意识。 方法 制定统一调查方案与措施，逐一查看2011年9月21日全院住院患者在架病历，对全院住院患者通过床旁询问和体检的方式进行调查。 结果 全院共有住院患者621例，实查621例，实查率100%。发生医院感染19例，现患率为3.06%。抗生素使用率46.38%。病原学送检率21.88%。 结论 加强医务人员医院感染知识的培训是提高其医院感染防控意识的重要手段；提高感染患者病原学送检率，减少经验性用药，依据药敏结果合理使用抗生素，达到有效减少耐药菌产生的目的。
ObjectiveTo investigate the effectiveness of arthroscopic treatment for combined injury of the posterior horn of the medial meniscus (PHMM) and the anterior horn of the lateral meniscus (AHLM). MethodsBetween September 2009 and December 2012, 36 patients (36 knees) with combined injury of PHMM and AHLM underwent arthroscope surgery. There were 16 males and 20 females with an average age of 47 years (range, 30-64 years), and a median disease duration of 30 months (range, 3 months-9 years). The left knee was involved in 14 cases and the right knee in 22 cases. Two patients had a history of sprain, and other patients had no obvious incentive. The patients had limited activity of the knee in varying degrees; posterior medial tenderness in the medial knee joint space and positive Mcmurray tests were found in all cases, and anterior tenderness in the lateral knee joint space in 26 cases. Effusion of the knee joint occurred in 5 cases. The X-ray and MRI before operation indicated injury of PHMM combined with injury of AHLM in 30 cases and simple injury of PHMM in 6 cases; meniscal cyst was found in 2 cases, and popliteal cyst in 1 case. Partial meniscectomy was used for PHMM, the external-inner suture or partial meniscectomy was used for AHLM. ResultsAll incisions healed primarily with no complication. All cases were followed up 22.5 months on average (range, 10-40 months). At last follow-up, the patients had no pain, weakness, and instability, and tenderness in medial and lateral joint space disappeared. Except 4 patients who had weakly positive Mcmurray test, the results of Mcmurray test were negative in the others. Based on the improved Lysholm classification standard, the results were excellent in 25 cases, good in 8 cases, and fair in 3 cases; the excellent and good rate was 91.7%. ConclusionArthroscopic primary repair of combined injury of PHMM and AHLM can effectively recover the knee function with a better effectiveness.
ObjectiveTo explore the technique of arthroscopic resection of benign tumor in the knee posterior septum and to evaluate its clinical results. MethodsBetween June 2008 and June 2012, 12 cases of benign tumor in the knee posterior septum were treated by arthroscopic surgery. There were 8 males and 4 females with an average age of 36.5 years (range, 22-50 years). The average disease duration was 8.4 months (range, 3 months to 2 years). Of 12 cases, there were 2 cases of chronic synovitis, 5 cases of ganglion, 4 cases of tenosynovial giant cell tumor, and 1 case of synovial hemangioma; solitary tumor involved in the knee posterior septum in 10 cases, and in the posterior septum and other part of the knee in 2 cases. All the patients underwent tumor removal under arthroscope with routine anterolateral and anteromedial portal, additional posteromedial portal and/or posterolateral portal. Trans-septal approach was used in 6 cases because the tumors located in the middle of the posterior septum. ResultsAll wounds healed by first intention with no complications such as infection, haematoma in the knee, injury of vessels and nerves, deep vein thrombosis, osteofascial compartment syndrome, or cutaneous necrosis. All patients were followed up 12-46 months with an average of 18.5 months. All patients achieved relief of knee pain and improvement of knee movement. The range of motion of the knee was significantly improved from (57.08±12.52)° at pre-operation to (120.83±13.95)° at last follow-up (t=-12.84, P=0.00). The visual analogue scale (VAS) score was significantly reduced from 5.00±1.04 at pre-operation to 1.50±0.91 at last follow-up (t=-18.00, P=0.00). The Lysholm score was significantly improved from 49.50±9.07 at pre-operation to 84.58±6.82 at last follow-up (t=-8.04, P=0.00). ConclusionThe benign tumor in the knee posterior septum can be completely resected under arthroscope, and the procedure is minimally invasive and useful to the restore knee function.
ObjectiveTo design a new type of transarticular cuboid bone plate by measuring and collecting the anatomic data of the articular surface around cuboid, and to carry out comparative biomechanical study. MethodsThe angle α (between the fifth metatarsocuboid joint and the fifth metatarsal bone) and the angle β (between the fifth metatarsocuboid joint and the calcaneocuboid joint) were measured in 100 adults on medial oblique X-ray film and 30 adult foot specimens. Based on literature data, the transarticular cuboid bone plate was designed with an angle α of 70° and an angle β of 30°. Six adult cadaver feet were chosen and were transected approximately 15 cm proximal to the ankle. Five strain gauges were placed at the calcaneus, cuboid, and the fourth and fifth metatarsal bones. The vertical pressure was loaded on the foot at 0-600 N, the strain value was measured. Then the cuboid fracture model was established and 600 N load was given on foot to measure the strain value and compare with the strain value before fracture. The specimens were randomly divided into groups A and B (n=3). Fracture was fixed with transarticular cuboid bone plate and 9 screws in group A and with double plate and 8 screws in group B, then the 600 N load was given to measure the strain value and vertical displacement of the fracture fragments. ResultsAfter loads of 0-600 N on the foot, the strain value of the 5 points showed an increased trend. No significant difference was found in the strain value between pre- and post-fracture at a, d, and e points P>0.05), but it was significantly larger at post-fracture than pre-fracture at b and c points (P<0.05). After fracture fixation, no significant difference was shown in the strain value at 5 points between groups A and B when loads of 0-600 N was given P>0.05). The experimental data showed that the strain value change mainly focused on the fracture site under the same load, so the strain value after fracture fixation was similar to that before fracture at b and c points P>0.05). The vertical displacement values of medial and lateral fracture fragments in group A[(0.804±0.011) mm and (0.672±0.036) mm] were significantly less than those in group B[(1.126±0.083) mm and (1.007±1.103) mm] (t=-6.711, P=0.003; t=-5.307, P=0.006). ConclusionThrough biomechanical study, a new type of transarticular cuboid bone plate has better fixation effect.
ObjectiveTo evaluate the effect of bundle strategies on the prevention and control of multidrug-resistant organisms (MDROs) in intensive care unit (ICU), in order to effectively prevent and control the severe situation of multiple drug-resistant bacteria in ICU.MethodsWe selected patients who admitted into the ICU from January 2016 to December 2017 as study subjects, and monitored 6 types of MDROs. Basic information was surveyed and collected from January to December 2016 (before intervention), while bundle strategies on MDROs were implemented from January to December 2017 (after intervention), including issusing isolation orders, hanging isolation marks, wearing isolation clothes, using medical articles exclusively, cleaning and disinfecting environment, implementing hand hygiene, etc. Then we compared the MDRO detection rate, nosocomial infection rate, MDRO nosocomial infection rate, and compliance rates of interventions between the two periods.ResultsThe MDRO detection rate before intervention was 77.10%, and that after intervention was 49.12%, the difference between the two periods was statistically significant (χ2=69.834, P<0.001). The nosocomial infection rate of ICU decreased from 23.51% before intervention to 15.23% after intervention, the MDRO nosocomial infection rate decreased from 13.70% before intervention to 5.84% after intervention, and the differences between the two periods were statistically significant (χ2=8.594, P=0.003; χ2=13.722, P<0.001). The compliance rates of doctor’s isolation orders, hanging isolation marks, wearing isolation clothes, using medical articles exclusively, cleaning and disinfecting environment, and hand hygiene, as well as the correct rate of hand hygiene after intervention (92.12%, 93.55%, 81.77%, 84.24%, 82.90%, 77.39%, and 96.37%) were significantly higher than those before intervention (31.94%, 52.00%, 23.43%, 48.18%, 67.16%, 59.46%, and 88.64%), and the differences were all statistically significant (P<0.001).ConclusionThe implementation of the above bundle strategies on the prevention and control of MDROs can decrease the MDRO detection rate and MDRO nosocomial infection rate.