To investigate the therapeutic effects and the related factors during operation of the less invasive stabilization systemdistal femur（LISSDF）for Types 33A3, C2 and C3 fractures classfied on the criteria by Association of Orthopedics (AO). Methods From August 2004 to December 2005, 26 patients with distal femoral fractures were surgically treated by LISSDF, including 9 patients with Type 33A3, 11 with Type 33C2, and 6 with Type 33C3. There were 15 males and 11 females, aged 3272 years (average, 55 years). The fractures occurred on the left side in 16 patients and on the right side in 10 patients. The fractures resulted from a road traffic accident in12 patients, a fall from the height in 9, and a crush injury in 5. Of the 26 patients, 3 had an open fracture (2 Gustilo Type Ⅰ,1 Gustilo Type ⅡA), with the mean time between the injury and the operation of 4 days (range, 6 h16 d).The operation through a lateral parapatellar incision and a transarticular retrograde plate of osteosynthesis (TARPO) was performed on 17 patients for Type33C2 and 33C3 fracture of the distal femur. The locking head screw (LHS) insertion through the stab incisions and monocortical fixation was performed on 9 patients for Type 33A3 fracture. Results The followup of all the patients for 12-26 months averaged 14.5 months revealed that the bone union was completed in all the 26 patients, 1 of whom had a delayed bone union. The X-ray films showed that the time for the bone union was 1136 weeks averaged 16.1weeks, and the time for the full weight loading was 1326 weeks averaged 17.6 weeks. Superficial infection developed in 1 patient, and the infection was curedafter the dressing changes. The internal fixator attachment was performed on 5 patients 613 months after operation, who had a serious pain in the lateral part of the distal femur. No deep infection，loosening of the internal fixation，breakage or failure of the implants was found in all the patients. Evaluated by the Merchant score system for the knee joint, of the 26 patients 13 achieved an excellent result, 11 achieved a good result, and 2 achieved a fair result, with 92.3% excellent and good results. Based on the Rasmussen criteria for the fracture reduction, the 26 patients had standard scores of 1219 with an average of 17.6; of the 26 patients, 16 had an excellent result, 9 had a good result, and 1 had a fair result. Conclusion The LISS is consistent with the principles of biological osteosynthesis on the design, and the system offers a new and effective internal fixation method for treatment of AO Types A3, C2 and C3 fractures. However, its operation indications and operating instructions should be strictly followed.
Objective To study the effect of two different absorbable intramedullary nails in treatment of metacarpal and phalanx fractures.Methods From January 2002 to December 2002, open reduction and internal fixation were done with two different absorbable intramedullary nails in 60 cases of metacarpal and phalanx fractures( 52 cases of open fractures and 8 cases of closed fractures). The fracture locations were metacarpal in 24 cases, proximal phalanx in 22 casesand media phalanx in 14 cases. The emergency operation was performed in 47 cases, selective operation in 13 cases.Out of 60 patients, 24 were treated with intramedullary nails of poly-DL-lactic acid (PDLLA) (PDLLA group), 36 with intramedullary wire of PDLLA composed of chitosan(PDLLA+chitosan group). Results In the PDLLA group(n=24), the rejection occurred in 8 cases 3-4 weeks after operation. PDLLA nails were taken out in 6 of the 8 cases after 5-10 days of operation and bone healing was achieved 2 months after re-fixation by Kirschner wire; therejection subsided in the other 2 cases after 25 days of conservative treatment, and bone fracture healed after 14 weeks. No rejection was observed with primary healing in the other 16 cases of the PDLLA group. In PDLLA + chitosan group(n=36), the rejection occurred in 1 case 19 days after operation, but therejection subsided after 3 days of conservative treatment.No rejection was observed in the other 35 cases with primary healing. All patients were followed up 4-11 monthswith an average of 6 months. No rejection was observed and bone healing was achieved during the follow-up. The time of bone healing was 6-16 weeks(8 weeks onaverage). There was statistically significant difference in the curative resultbetween two groups(Plt;0.05). Conclusion Intramedullary nail of PDLLAwas verysuitable to fix fractures of metacarpal and phalanx. During the degradation of PDLLA, the acidic products can cause rejection. When PDLLA mixed with chitosan,PDLLA can not only strengthen the intensity but also neutralize the acidity. So the rejection can be decreased.PDLLA intramedullary nails composed of chitosan were better than PDLLA intramedullary nails in clinical treatment of metacarpal and phalanx fractures.
Objective To invesitigate the features of imaging of CT with high resolution (HRCT) in fracture of optic canal, and evaluate the clinical application of HRCT. Methods A total of 22 patients with facture of optic canal underwent thin layer (1.5 mm) CT scanning in axial and coronal positions. The features of the image of fractures of optic canal were analyzed. Results There were 15 cases (68.2%) of fractures in the inner wall, 1 (4.5%) in the lateral wall, 1(4.5%) in the superior wall, 2 (9.1%）in the inferior wall, and 3 (13.6%) were with the compound fracture. The direct sign of the fracture of optic canal was the osseous successional discontinuity of the wall of optic canal, including 5 types: concave (27.3%), lineal(22.7%), comminuted(27.3%), inlaid(9.1%), and mixed (13.6%) type. The indirect signs were hemorrhage of sphenoidal sinus (95.5%),hemorrhage of ethmoid sinus(50%),and optic nerve thickening(36.4%)etc. Conclusions HRCT may clearly exhibit the positions and types of the fracture of optic canal, and it can provide reliable information for the clinical diagnosis and selection of manners of the treatment. (Chin J Ocul Fundus Dis, 2006,22:387-389)
ObjectiveTo systematically review the association between acid suppressive drug use and fracture risk in children and adolescents. MethodsThe PubMed, Web of Science, EMbase, Cochrane Library, CNKI and WanFang Data databases were electronically searched to collect observational studies on the association between acid suppressive drug use and fracture risk in children and adolescents from inception to October 1, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using R4.1.2 software. ResultsA total of 6 studies involving 1 886 423 children and adolescents were included. Meta-analysis results showed that the use of proton pump inhibitors (PPIs) increased the risk of fracture (RR=1.19, 95%CI 1.10 to 1.29, P<0.01), whereas the use of histamine H2 receptor antagonists (H2RAs) did not increase the risk of fracture (P>0.05). Subgroup analysis showed that PPIs use increased risk of fracture in the lower limb and other sites (P<0.05). ConclusionCurrent evidence shows that PPIs can increase fracture risk in children and adolescents, but no association has been found between the use of H2RAs and increased fracture risk in this group. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.