Objective To compare the effectiveness between improved anterolateral approach and lateral approach in the treatment of senile intertrochanteric fracture. Methods The clinical data were retrospectively analyzed, from 61 patients with senile intertrochanteric fracture treated between February 2008 and February 2010. Of 61 patients, 34 patients underwent improved anterolateral approach combined with fixation of dynamic hip screw (improved group), and 27 patients underwent conventional lateral approach combined with fixation of dynamic hip screw (conventional group). There was no significant difference in gender, age, injury cause, Evans classification, comorbidities, disease duration, or Harris hip scores between 2 groups (P gt; 0.05). Results The operation was successfully completed in all patients. The operation time, blood loss, perspective frequency during operation, drainage volume, hospitalization days, and out-of-bed time in the improved group were significantly less than those in the conventional group (P lt; 0.05). All patients were followed up 12-24 months (mean, 18.7 months). Bone union was achieved in both groups; the fracture healing time was (11.64 ± 1.28) weeks in the improved group and was (12.29 ± 1.12) weeks in the conventional group, showing no significant difference (t=2.15, P=0.15). Harris hip scores at 3, 6, and 12 months were significantly better than preoperative scores in 2 groups (P lt; 0.05), and significant differences were found among different time points after operation in 2 groups (P lt; 0.05), between 2 groups after operation (P lt; 0.05). There was no significant difference in the incidence of incision infection, limb shortening, coax vara, internal fixation loosening, main screw cutting-out from femoral head between 2 groups (P gt; 0.05), but the incidence of total complications in the improved group was significantly lower than that in the conventional group (P lt; 0.05). Conclusion Compared with conventional lateral approach, improved anterolateral approach has the advantages of sufficient exposure, reducing muscle damage and surgical risk in treating intertrochanteric fracture. Operating treatment of improved anterolateral approach combined with early rehabilitation after surgery can recover hip joint function as quickly as possible.
Objective To investigate the feasibil ity, safety and operative techniques of percutaneous vertebroplasty (PVP) in treating osteolytic bone metastasis of cervical vertebra and reconstructing the function of cervical vertebra. Methods From March 2005 to December 2007, 10 patients with osteolytic bone metastatic carcinoma in single cervical vertebral body received PVP, including 5 males and 5 females aged 38-75 years (mean 54.5 years). Among them, 5 patients had primary lung tumor, 1 primary renal tumor, 1 primary breast tumor, 1 primary cervical tumor and 2 unknown primary lesion. The course of disease was 2-4 years. All the patients suffered from obviously cervical pain and l imitation of activity, including 4 cases of metastatic tumor of the C2 vertebral body, 2 of C3, 2 of C6 and 2 of C7. The general condition of patients was stable before operation, and no blood coagulation dysfunction, radiculalgia and spinal cord compression were detected. Lateral PVP was performed on 6 cases, approaching between the vertebral artery and the carotid sheath under CT guidance and anterolateral PVP was performed on the rest 4 cases, approaching between the trachea and the internal carotid artery under continuously X-ray fluoroscopy. The amount of bone cement injected was 3-4 mL, and the fill ing rate was 50%-100%. Results Without obvious bleeding or organ injury, the puncture was performed successfully on all the patients. Without symptom of spinal cord compression, patients suffered from pain during operation (1 case) and such compl ications noted by immediate CT or X-rays examination after operation as paravertebral epidural cement leakage (2 ases),transverse foramen cement leakage (1 case) and pinhole reflux (3 cases). The pain of patients was improved to various degree postoperatively, the visual analogue scales score was (5.9 ± 1.2) points before operation, which was changed to (2.6 ± 1.2) points at 1 hour after PVP and (1.6 ± 1.3) points at 1 week after PVP, indicating there was a significant difference between pre- and postoperation (P lt; 0.05). During the regular follow-up at 1 week, 3 and 12 months after PVP, all patients had no dislocation of cervical vertebra body, spinal cord compression and paralysis. Five patients died from multiple organ failure due to primary tumor progression, including 3 cases at 6 months after PVP and 2 at 12 months after PVP, and the rest 5 patients’ cervical pain were under control, with sound functional recovery. Conclusion PVP can rel ieve pain quickly and reinforce the stabil ity of the vertebral body, and has sl ight compl ications; the lateral approach is safe and effective.
ObjectiveTo compare the effectiveness of anterior and lateral approaches of minimally invasive plate osteosynthesis (MIPO) in the treatment of humeral shaft fractures. MethodsThe clinical data were retrospectively analyzed and compared from 35 cases of humeral shaft fractures between January 2010 and December 2012. The patients underwent MIPO by anterior approach in 17 patients (group A) and by lateral approach in 18 patients (group B). There was no significant difference in gender, age, injury causes, type of fractures, and time from injury to operation between 2 groups (P>0.05). The operation time, fracture healing time, intra- or postoperative complications, and shoulder and elbow range of motion (ROM) values were recorded and analyzed. The functions of the affected shoulder and elbow were assessed with the University of California Los Angeles (UCLA) and Mayo elbow performance score system respectively. ResultsThe operation time was (91.35±8.00) minutes and (95.56±7.92) minutes in groups A and B respectively, showing no significant difference (t=-1.561, P=0.128). Incision healed by first intention in all patients of 2 groups. No iatrogenic radial nerve palsy occurred in group A, 2 cases had postoperative iatrogenic radial nerve palsy in group B, showing no significant difference (P=0.486). The patients were followed up 15.4 months on average (range, 11-24 months) in group A and 16.8 months on average (range, 10-23 months) in group B. The X-ray films showed bony healing in all patients. The fracture union time was (13.5±2.1) weeks in group A and (14.0±2.2) weeks in group B, showing no significant difference (t=-0.696, P=0.491). The UCLA scores were 33.4±1.9 in group A and 30.6±2.0 in group B, and the Mayo elbow performance scores were 100 in group A and 96.4±2.8 in group B; all showed significant differences (t=4.231, P=0.000; t=5.293, P=0.000). ConclusionGood clinical outcomes could be obtained when humeral shaft fractures are treated with MIPO either by anterior approach or by lateral apporach. However, anterior approach could offer better shoulder and elbow functional results.