Objective To study the effect of various doses of estrogen on tissue injury, blood supply and survival area of skin flap and to investigate its mechanism. Methods Thirty New Zealand white rabbits aged 3-4 months old and weighing 1.5-2.2 kg (male or female) were used. Random pattern skin flap (12 cm × 3 cm in size) taking the central l ine of the rabbit dorsum as axis and with the pedicle attached at the proximal end was prepared, and the flap pedicle division was performed 7 days after operation. The rabbits were divided randomly into three groups (n=10 rabbits per group). At 2, 4, and 6 days after operation, the proximal edge of flap in group A and B received 100 ?g/kg and 50 ?g/kg subcutaneous injection ofestradiol benzoate, respectively, while group C received no further treatment serving as control group. General condition ofthe rabbits was observed after injection, gross observation was performed 3 and 7 days after injection, survival area of the skin flap was measured 7 days after injection, contents of malondialdehyde (MDA) and nitric oxide (NO) were tested 5 days after injection, and the flaps were harvested 4 and 7 days after injection to receive histology and no significant difference was noted between group A and group B (P gt; 0.05). The NEU counts 4 days after injection were (18.20 ±6.24) cells/HP in group A, (21.27 ± 5.34) cells/HP in group B, and (28.78 ± 7.92) cells/HP in group C, and at 7 days after injection, there were (15.16 ± 7.02) cells/HP in group A, (18.12 ± 6.44) cells/HP in group B, and (29.67 ± 9.12) cells/HP in group C. The VEGF score 4 days after injection was (4.02 ± 0.48) points in group A, (4.19 ± 0.66) points in group B and (3.67 ± 0.49) points in group C, and at 7 day after injection, it was (4.96 ± 0.69) points in group A, (5.12 ± 0.77) points in group B, and (3.81 ± 0.54) points in group C. Significant difference was evident between 4 days and 7 days after injection in group A or B in terms of NEU counts and VEGF score (P lt; 0.05), and difference between 4 days and 7 days after injection in group C was not significant (P gt; 0.05), and the differences among 3 groups were significant (P lt; 0.05). Conclusion Estrogen injection can increase VEGF expression and NO content of flap, decrease MDA content and NEU infiltration of flat, and improve survival area of flap.
Objective To compare effects, advantages and disadvantages of simple internal fixation to that of l imited internal fixation with external supporting frame fixation in the treatment of complex fractures of tibial plateau. Methods From July 2002 to August 2006, 66 cases of complex fractures of the tibial plateau were divided into the internal fixation group (n=39) and the external fixator group (n=27). The interal fixation group had 18 cases of IV, 7 cases V and 14 cases VI according to Schatzker, including 25 males and 14 females aged 18-79 years with an average of 45.4 years. The external fixator group had 13 cases of IV, 6 cases V and 8 cases VI according to Schatzker, including 18 males and 9 femles aged 18-64 years with an average of 44.2 years. No significant difference was evident between the two groups (P gt; 0.05). Patients were treated by using screws, steel plates or external supporting frame fixation strictly based on the princi ple of internalfixation. Results All patients were followed up for 1-5 years. Fracture healed with no occurrence of nonunion. Two cases inthe internal fixation group presented partial skin infection and necrosis, and were cured through the dressing change and flap displacement. Fracture heal ing time was 6-14 months with an average of 7.3 months. The time of internal fixator removal was 6-15 months with an average of 8.3 months. In the external fixation group, 11 cases had nail treated fluid 7 days to 3 months after operation, combining with red local skin; 3 cases had skin necrosis; and 3 cases had loose bolts during follow-up. Through debridement, dressing change and flap displacement, the skin wounds healed. Fracture heal ing time was 3-11 months with an average of 5.1 months. The time of external fixator removal was 5-11 months with an average of 6.4 months. At 8-14 months after operation, the knee function was assessed according to Merchant criteria. In the internal fixation group, 29 cases were excellent, 4 good, 5 fair and 1 poor, while in the external fixation group, 20 cases were excellent, 3 good, 2 fair and 2 poor. There was no significant difference between the two groups (P gt; 0.05). Conclusion The therapeutic effects of simple internal fixation and l imited internal fixation with external supporting frame fixation were similar in the treatment of complex fractures of tibial plateau. Fixation materials should be selected according to the state of injury and bone conditions for the treatment of tibial plateau fracture of type IV, V and VI based on Sehatzker classification.
Objective To exploere the effectiveness and advantages of elastic stable intramedullary nail (ESIN) combined with curettage and graft for the treatment of benign lesions of humerus complicating by pathological fracture in children. Methods ESIN internal fixation combined with curettage and graft was used to treat benign lesions of the humerus complicating by pathological fracture in 11 children patients between January 2007 and January 2011. Of 11 patients, 7 were boy and 4 were girl, aged from 5 to 14 years (mean, 9.4 years). The disease duration ranged from 2 to 14 days (mean, 6 days). All fractures were closed fracture, which locations were the proximal humerus in 6 cases, the humeral shaft in 4 cases, and the distal humerus in 1 case; benign lesions of the humerus included aneurysmal bone cyst in 1 case, simple bone cyst in 7 cases, and fibrous dysplasia in 3 cases. Based on imaging studies, preoperative diagnosis was almost clear. The time from hospitalization to operation was 3-5 days Results Healing of incision by first intention was obtained in all cases, with no infection. The mean follow-up was 25.6 months (range, 12-36 months). All patients achieved pain relief at 6 weeks postoperatively and fractures healed completely at 3 to 4 months after operation (mean, 3.3 months). No recurrence or re-fracture was observed during follow-up. The ESIN was removed at 10-14 months after operation (mean, 12.5 months). The lesion disappeared completely in 8 cases and partially in 3 cases. No pain of affected limb or motion limitation of shoulder and elbows was observed. One patient had limb shortening of 2 cm at last follow-up, but he had no function problem. According to Neer shoulder and Mayo elbow function scores, the results were excellent in 11 cases. Conclusion It is a good method to treat benign lesions of the humerus complicating by pathological fracture in children to use ESIN internal fixation combined with curettage and graft. After only a single operation intervention, it can provide early mechanical stability and rapid fracture healing and allow early rehabilitation exercise.
To evaluate the effectiveness of tumor-segmental resection and autologous il iac bone graft reconstruction combined with internal fixation in treating hand-foot-giant cell tumor of bone. Methods Between August 1997 and April 2008, 8 cases of hand-foot-giant cell tumor of bone were treated, including 3 males and 5 females with an average age of 28.5 years (range, 16-42 years). The locations were metacarpal bones in 3 cases, metatarsal bones in 4 cases, and phalanges of toes in 1 case. According to Campanacci’s gradation of X-ray films, there were 1 case of grade I and 7 cases of gradeII; according to pathological examination before opration, there were 3 cases of grade I to II, 4 cases of grade II, and 1 case of grade II to III; and according to TNM staging, there were 1 case of TisN0M0, 4 cases of T1N0M0, and 3 cases of T2N0M0. There were 2 cases of recurrence, the time from the first operation to recurrence were 11 and 14 months, respectively. The tumor size was 1.8 cm × 1.0 cm to 6.0 cm × 2.0 cm, the cortical bone became thinner, and the boundary between tumor and periosteum was clear. All patients underwent tumor-segmental resection combined with autologous il iac bone graft reconstruction, and miniplate internal fixation by lumbar anesthesia or trachea cannula anesthesia. Results All incision healed by first intention. Eight patients were followed up 10 to 84 months with an average of 46 months. Radiographs showed that fracture union was achieved at 3 to 9 months (mean, 5 months). No significant rotation, angular, and shortening deformity occurred in il iac bone graft. The function of il iac bone donor site recovered excellently. The pathological examination showed giant cell tumor of bone in all cases, including 2 case of grade I-II, 5 cases of grade II, and 1 case of grade II-III. The hand or foot function recovered excellently. No tumor recurrence or lung metastasis occurred during follow-up. Conclusion Tumor-segmental resection combined with autologous il iac bone graft reconstruction plus internal fixation has excellent effectiveness for hand-foot-gaint cell tumor of bone.
Objective To analyze the cl inical appl ication and effect of three operation methods in treatment of senile intertrochanteric fracture. Methods From July 2004 to February 2007, 73 patients with intertrochanteric fracture were treated. Of 73 patients, 33 patients were treated by artificial bipolar femoral head (ABFH group), 18 patients by dynamic hip screw (DHS group) and 22 by proximal femoral nail anti-rotation (PFNA group). In ABFH group, there were 19 males and 14 females with age of (72.5 ± 3.8) years. The injury was by tumbl ing in 19 cases, by accident traffic in 7 cases, fall ing from height in 4 cases and others in 3 cases, including 6 cases of type I, 9 cases of type II, 11 cases of type III and 7 cases of type IV accordingto Evans classification. The Harris hip score was 16.8 ± 4.8, and the disease course was (21.2 ± 7.8) hours. In DHS group, there were 10 males and 8 females with age of (69.5 ± 3.2) years. The injury was by tumbl ing in 11 cases, by accident traffic in 5 cases, fall ing from height in 1 case and other in 1 case, including 6 cases of type I, 3 cases of type II, 5 cases of type III and 4 cases of type IV according to Evans classification. The Harris hip score of was 18.6 ± 5.5, and the disease course was (19.8 ± 6.5) hours. In PFNA group, there were 13 males and 9 females with age of (70.3 ± 3.5) years. The injury was by tumbl ing in 11 cases, by accident traffic in 6 cases, fall ing from height in 3 cases and others in 2 cases, including 5 cases of type I, 6 cases of type II, 6 cases of type III and 5 cases of type IV according to Evans classification. The Harris hip score was 20.4 ± 6.6, and the disease course was (20.0 ± 5.8) hours. All fractures were fresh. There were no significant difference in general data between three groups (P gt; 0.05). Results In ABFH group, all incisions healed by first intention, but deep vein thrombosis occurred in 1 case on the postoperative third day. In DHS group, incisions healed by first intention in 16 cases and by second intention in 2 cases, coxa adducta occurred in 2 cases after operation. In PFNA group, all incisions healed by first intention. Cacothesis in pate occurred in 1 case after operation. There were significant differences in operation time, blood loss, and out-of-bed time (P lt; 0.05). The patients were followed up (30.5 ± 6.5) months in ABFH group, (27.6 ± 6.2) months in DHS group, and (24.8 ± 5.4) months inPFNA group. The union time of fracture was (7.5 ± 2.5) months in ABFH group, (8.4 ± 2.2) months in DHS group and (7.2 ± 2.4) months in PFNA group. There were significant differences in Harris score between before operation and after operation and between different time after operation in three groups (P lt; 0.05). Conculsion The three operative methods have some their superiority, but the replacement of artificial bipolar femoral head is more suitable for the senile unstable intertrochanteric fracture because of simply procedure, short operation time, less blood loss and early ambulation.
To evaluate the initial cl inical effect of the autologous bone marrow integrating artificial bone and il ium periosteum transplantation in treatment of problematic nonunion. Methods From January 2004 to July 2006, 12 patients (13 l imbs)with problematic nonunion were treated with autologous bone marrow integrating artificial bone and il iumperiosteum. There were 8 males and 4 females, aged 17-58 years old. The position of nonunion were the tibia in 7 l imbs, the femur in 3 l imbs, the humerus in 2 l imbs. The operated number was 1-4, mean 2.5. The time from injury to therapy was 13 months to 9 years, mean 47.6 months. The bone defect distance was 6-30 mm (mean 15 mm) through 1 ∶ 1 X-rays before operation. Eleven l imbs were treated by internal fixation (10 l imbs by the bone nail and 1 l imb by the l imited contact-dynamic compression plate), 2 l imbs were treated by the external fixation. The X-ray films were taken at 1 day, 1, 3, 6, 9, 12 months after operation to observe fracture union. Results All patients were followed up for 12-26 months (mean 17.5 months) and achieved union within 4-7 months (mean 6 months). No deformity of rotation, angulation and crispation occurred in 13 l imbs, but functional impairment occurred in 6 l imbs after union of fracture. Conclusion Autologous bone marrow integrating artificial bone and il ium periosteum transplantation for treatment of problematic nonunion has the satisfactory result.
【Abstract】 Objective To evaluate the effectiveness of artifical humeral head replacement in treatment of complicatedfractures of the proximal humerus. Method Between January 2005 and January 2011, 18 patients with proximal humerusfracture were treated with artifical humeral head replacement. There were 8 males and 10 females with a mean age of 71 years (range, 52-84 years). Fractures were caused by falling in 11 cases, by traffic accident in 3 cases, and by bruise in 4 cases. The time between injury and admission was 2 hours to 3 days (mean, 1.5 days). According to Neer classification, 8 cases had three-part fracture, 7 four-part fracture, and 3 cleavage fracture of humeral head; 5 cases complicated by shoulder joint subluxation, 2 cases by femoral fracture, 1 case by radial fracture, and 11 cases by osteoporosis. All the patients were treated with modular cemented prostheses. Results The operation time was 60-180 minutes with an average of 80 minutes; the blood loss was 100-400 mL with an average of 200 mL. All incisions healed by first intention without infection or neurovascular injury. Sixteen patients were followed up 3 years on average (range, 1-6 years). No loosening, dislocation of prothesis or heterotopic ossification occurred. According to the Neer scores, the results were excellent in 5 cases, good in 8 cases, moderate in 2 cases, and poor in 1 case at 1 year after operation. The excellent and good rate was 81.2%. Conclusion Artificial humeral head replacement is a good therapy for patients with complicated fractures of the proximal humerus, especially for elderly patients.
Objective To develop a new type of tail cap for closing the tail of the central hole of the interlocking intramedullary nail so as to reduce difficulty in implantation of the tail cap into intramedullary nail, and ensure the accuracy of implantation, as well as reduce unnecessary operation time. Methods In 2014, the new type of intramedullary nail tail cap (" new tail cap” for short) was successfully developed, and has been granted national utility model patent. A randomized controlled clinical trial was conducted in 34 patients with non pathological femoral shaft fractures treated between August 2014 and March 2016. The patients were randomly divided into groups A and B, 17 patients each group. There was no significant difference in gender, age, side, body mass index, cause of injury, injury to operation time, and fracture AO classification between groups (P>0.05), with comparability. All patients underwent fixation with interlocking intramedullary nail, and the new tail cap and original tail cap were used in groups A and B respectively. The blood loss and operation time during tail cap implantation, fracture healing time, and complications were recorded and compared between 2 groups; the limb function was evaluated by Klemm function evaluation standard. Results The blood loss and operation time during tail cap implantation of group A [(3.5±0.8) mL and (10.57±3.15) s] were significantly less than those of group B [(5.5±1.7) mL and (21.99±6.90) s] (t=–8.281,P=0.010;t=–10.743,P=0.009). All new tail caps were successfully implanted by one-time in group A, and the one-time success rate was 100%; the original tail cap exfoliation occurred in 3 cases of group B, and the one-time success rate was 82.4%. All the patients were followed up 6-16 months (mean, 9.7 months); there was no deep infection, loosening or breakage of internal fixation, and other serious complications. The time of fracture healing was (16.4±3.2) weeks in group A and (15.8±3.5) weeks in group B, showing no significant difference (t=0.514,P=0.611). At last follow-up, according to the Klemm function evaluation standard, the results were excellent in 14 cases and good in 3 cases in group A, and were excellent in 11 cases and good in 6 cases in group B, showing no significant difference between 2 groups (χ2=0.142,P=0.707). Conclusion The new type of femoral intramedullary nail tail cap can simplify operation, shorten operation time, and reduce blood loss, and it has satisfactory effectiveness.
ObjectiveTo report a new type of anatomical locking plate for sternocalvicular joint, and investigate its effectiveness in treatment of sternoclavicular joint fracture and dislocation.MethodsA new type of anatomical locking plate for sternoclavicular joint was developed, which accorded with the anatomical features and biomechanical characteristics of Chinese sternoclavicular joint. By adopting the method of clinical randomized controlled study, 32 patients with the sternoclavicular joint fracture and dislocation who met the selection criteria between June 2008 and May 2015 were randomly divided into groups A and B (n=16), and the patients were treated with new anatomic locking plate and distal radial T locking plate internal fixation, respectively. There was no significant difference between 2 groups in gender, age, injured side, body mass index, cause of injury, type of injury, the time from injury to operation, and preoperative Rockwood grading score (P>0.05). The operation time, intraoperative blood loss, incision length, hospitalization time, and postoperative complications in 2 groups were recorded, and the effectiveness was evaluated by Rockwood grading score.ResultsThe operations of 2 groups completed successfully. The operation time, intraoperative blood loss, and hospitalization time in group A were significantly less than those in group B (P<0.05), but there was no significant difference in the incision length between 2 groups (t=0.672, P=0.507). All the patients were followed up 18-30 months (mean, 24 months). In group A, there were 1 case of sternoclavicular joint pain and 2 cases of wound infection; in group B, there were 1 case of sternoclavicular joint pain, 1 case of internal fixation loosening, and 1 case of sternoclavicular joint re-dislocation; there was no significant difference in complication incidence between 2 groups (P=1.000). The Rockwood grading scores at each time point after operation in 2 groups were significantly higher than those before operation. At 1 month after operation, the Rockwood grading score in group A was significantly higher than that in group B (t=2.270, P=0.031); but there was no significant difference in the Rockwood grading scores between the 2 groups at 6 months and at last follow-up (P>0.05). At last follow-up, according to the Rockwood scoring standard, the results of group A were excellent in 13 cases, good in 2 cases, poor in 1 case, the excellent and good rate was 93.75%; the results of group B were excellent in 11 cases, good in 4 cases, poor in 1 case, and the excellent and good rate was 93.75%; there was no significant difference between 2 groups (Z=–0.748, P=0.455).ConclusionThe new type of anatomic locking plate accords with the Chinese anatomical characteristics. It has the advantages of easy operative procedure, less surgical trauma, shorter operation time, less intraoperative blood loss, shorter hospitalization time, and it can achieve better results in the treatment of sternoclavicular joint fracture and dislocation.
ObjectiveTo investigate the effectiveness of double internal fixations of clavicle and scapula and intraoperative reduction of glenopolar angle in the treatment of floating shoulder injuries.MethodsBetween January 2010 and June 2019, 13 patients with floating shoulder injury were treated with double internal fixation of clavicle and scapula and intraoperative reduction of glenopolar angle. There were 11 males and 2 females with an average age of 48 years (range, 25-65 years). The causes of injury included falling from height in 2 cases, traffic accident injury in 3 cases, heavy object injury in 2 cases, and other injuries in 6 cases. There were 2 cases of Ⅰ-B-3 type, 1 case of Ⅰ-C-2 type, 1 case of Ⅰ-C-3 type, 3 cases of Ⅱ-B-2 type, 1 case of Ⅱ-B-3 type, 1 case of Ⅱ-B-4 type, 2 cases of Ⅱ-C-2 type, 1 case of Ⅱ-C-4 type, and 1 case of Ⅱ-D-3 type according to the classification of floating shoulder injury. All patients had unilateral clavicle fracture with scapular neck fracture, 1-4 superior shoulder suspensory complex (SSSC) injuries. The time from injury to operation was 7-17 days, with an average of 12 days. The glenopolar angle, subacromail space, anteroposterior inclination angle of scapular glenoid, scapular glenoid up and down angle were measured before and after operation; Constant-Murly score and Herscovici score were used to evaluate the recovery of shoulder joint function.ResultsAll incisions healed by first intention, and there was no early postoperative complications such as infection. All 13 cases were followed up 12-48 months, with an average of 25.2 months. Both the clavicle and the scapula had bone union, and the average healing time was 6 months and 4 months respectively. There were no complications such as nonunion, shoulder deformity, plate fracture or failure of internal fixation, acromion impingement syndrome, and frozen shoulder. At last follow-up, the glenopolar angle, subacromail space, anteroposterior inclination angle of scapular glenoid, and scapular glenoid up and down angle were all corrected significantly (P<0.05). The pain, function, activity, muscle strength scores, and total score in Constant-Murly score were significantly improved when compared with preoperative scores (P<0.05). According to the Herscovici scoring standard, the shoulder joint function was evaluated as excellent in 8 cases, good in 3 cases, and fair in 2 cases. The excellent and good rate was 84.6%.ConclusionDouble internal fixation of clavicle and scapula to stabilize SSSC and reduct glenopolar angle during operation is an effective method for treating the floating shoulder injury.