ObjectiveTo explore the mechanical stability of the three-dimensional (3-D) external fixator for osteoporotic fracture so as to provide the biomechanical basis for clinical application. MethodsForty-five fresh frozen adult tibial specimens were selected to rapidly prepare the extracorporal tibia osteoporotic fracture models, and were randomly divided into 3 groups (n=15). Fractures were fixed with 3-D external fixators (3-D external fixators group), intramedullary nails (intramedullary nail group), and plate (plate group) respectively. Five specimens randomly from each group were used to do axial compression test, three-point bending test, and torsion test with microcomputer control electronic universal testing machine, then the mechanical parameters were calculated. ResultsIn the axial compression test, the displacement of 3-D external fixator group and intramedullary nail group were shorter than plate group, showing significant differences (P<0.05); but no significant difference was found between 3-D external fixator group and intramedullary nail group (P>0.05). In the three-point bending test and torsion test, the deflection and the torsional angle of 3-D external fixator group and intramedullary nail group were smaller than plate group, showing significant differences (P<0.05); but no significant difference was found between 3-D external fixator group and intramedullary nail group (P>0.05). ConclusionThe 3-D external fixator can fix fracture three-dimensionally from multiple plane and it can offer strong fixing. It is biomechanically demonstrated to be suitable for osteoporotic fracture.
ObjectiveTo explore the effectiveness and operative methods to treat first metatarsal diaphysis comminuted fractures with mini-plate via medial approach. MethodsBetween January 2012 and January 2013, 15 patients with first metatarsal shaft comminuted fractures were treated. There were 11 males and 4 females (6 left feet and 9 right feet) with an average age of 38.6 years (range, 27-56 years). The injury causes included falling injury in 6 cases, crash injury of heavy object in 7 cases, and sprain in 2 cases. The left side was involved in 6 cases and the right side in 9 cases. The time from injury to operation was 8.5 days on average (range, 7-10 days). According to AO classification, all cases were rated as 81(T)-C2 type. The surgical treatments included open reduction and internal fixation with mini-plate by medial approach. ResultsPrimary healing of incision was obtained in all cases, and no infection occurred. Twelve patients were followed up 18 months on average (range, 12-24 months). All fractures healed well, and the mean time of bone union was 11.5 weeks (range, 10-14 weeks). No loosening or breakage of internal fixation was observed. At last follow-up, the patients could walk with full weight-bearing, and had no pain. According to American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale, the mean score was 85.2 (range, 76-96). ConclusionAnatomic reduction and stable internal fixation are important for first metatarsal comminuted fracture, which is the key point for recovery of foot form and foot arch function. And the medial approach could achieve full exposure and improve the cosmetic results.
ObjectiveTo design and produce a lesser trochanteric reduction fixation system and verify its value and effectiveness. MethodsA lesser trochanteric reduction fixation system was designed and produced according to the anatomical features of the lesser trochanteric fractures. Sixty-six patients with intertrochanteric fractures of Evans type Ⅲ were included between January 2010 and July 2012. Of 66 patients, 32 were treated with dynamic hip screw (DHS) assisted with the lesser trochanteric reduction fixation system (study group), and 34 cases were treated with DHS only (control group). The 2 groups were comparable with no significant difference in gender, age, the reasons, and the types of the fractures (P>0.05). The operation time, intraoperative blood loss, neck-shaft angle, bone healing time, ratio of successful fixations, and the functional evaluation of the hip joint after operation were compared between 2 groups. ResultsThe study group had shorter operation time [(58.4±5.3) minutes] and less intraoperative blood loss [(186.3±6.6) mL] than the control group[(78.5±6.2)minutes and (246.2±8.7) mL], showing significant differences (t=-14.040, P=0.000; t=-31.145, P=0.000). There was no significant difference in neck-shaft angle between study group [(138.6±3.0)°] and control group [(139.4±2.9)°] (t=-1.044, P=0.301). The wounds healed by first intention in both groups. The 30 and 31 patients were followed up 12 to 24 months (mean, 15 months) in the study group, and 13 to 25 months (mean, 16 months) in the control group, respectively. All fractures healed well in 2 groups. The study group had significantly shorter healing time [(8.8±2.0) weeks] than the control group [(10.7±3.4) weeks] (t=-2.871, P=0.006). At 12 months after operation, coxa vara happened in 2 cases of the study group with a successful fixation ratio of 93.3% and in 10 cases of the control group with a successful fixation ratio of 67.7%, showing significant difference (χ2=6.319, P=0.022). According to Harris hip score, the excellent and good rate was 83.3% in the study group (25/30) and was 58.1% in the control group (18/31), showing significant difference (χ2=4.680, P=0.049). ConclusionThe application of the lesser trochanteric reduction fixation system can reduce stripping of the soft tissue around the fracture fragments, shorten the operation time and the healing time, and preserve the function of the hip joint maximumly.
Objective To determine the efficacy and safety of external fixation versus intramedulllary nailing in the treatment of adult tibial shaft fracture. Methods We searched the specialized trials register of The Cochrane Collaboration’s Bone, Joint and Muscule Trauma Group, The Cochrane Library (CENTRAL), MEDLINE (1966 to March 2006), EMBASE (1980 to March 2006) and PUBMED (1966 to March 2006). We also handsearched some Chinese orthopedic journals. Randomized controlled trials (RCTs) and quasi-randomized trials (quasi-RCTs) comparing external fixation versus intramedullary nailing for tibial shaft fractures in adults were included. The quality of these trials was critically assessed. We used the Cochrane Collaboration’s RevMan 4.2.8 for data analyses. Result Three RCTs and two quasi-RCTs involving a total of 279 patients were included. The results of meta-analyses showed that external fixation for tibial shaft fractures in adults may increase the infection rate [RR 2.45, 95%CI (1.31,4.61), P=0.005], and the malunion rate [RR 2.85, 95%CI (1.20,6.79), P=0.02] but may reduce the duration of hospitalization [RR –5.50, 95%CI (–6.99,–4.01)]. The nonunion rate, delayed healing rate, and healing time, were comparable between external fixation and intramedulllary nailing. Conclusion The trials available for this systematic review are too few and small for reliable estimates of the relative effects of external fixation and intramedulllary nailing. Further studies are needed to determine these effects , especially for patients who have GustiloШ C fractures.
Objective To compare the effects of arthroplasty with that of intenal fixation for displaced femoral neck fractures in the elderly. Methods We searched for all randomized controlled trials and quasi-randomized controlled trials of hip arthroplasty versus internal fixation for displaced femoral neck fractures in the elderly by electronically searching MEDLINE( 1966 to September, 2006),EMbase(1966 to September, 2006), Cochrane Library( Issue 4 2006), CBM( up to September, 2006) and CNKI (September, 2006) and handsearching grey literatures. The quality of the trials was assessed and meta-analyses were conducted using The Cochrane Collaboration’s RevMan 4.2.8 software. The quality of the trials was assessed. And meta-analysis was conducted by using RevMan4.2.8 software. Results A total of 228 papers were retrieved, but only 15 published randomized controlled trials involving a total of 2 254 patients were suitable for inclusion in the review. Based on the meta-analyses, hip arthroplasty showed obvious advantages over internal fixation in terms of the incidences of major complications after 2 years (RR 0.15 ; 95%CI 0.09 to 0.23) and after 5 years (RR 0.18 ; 95%CI 0.11 to 0.30) as well as re-operation rate (RR0.12 ; 95%CI 0.08 to 0.18) after 2 years, and after 5 years (RR0.11 ; 95%CI 0.06 to 0.22), there was an advantage to performing hip asthroplasty. After one year, the mortality was the same in both groups with RR 1.05 and 95%CI 0.89 to 1.23. Conclusion There is an evidence base to support arthroplasty as a treatment for displaced femoral neck fractures in the elderly. Arthroplasty can not only decrease the rate of re-operation, but can also reduce the incidence of complications, with similar one-year mortality when compared to internal fixation.
目的 比较股骨近端抗旋髓内钉（PFNA）与动力髋螺钉（DHS）两种方法内固定治疗高龄股骨粗隆间骨折的疗效。 方法 2007年1月－2011年1月分别采用PFNA、DHS治疗高龄股骨间粗隆骨折（EvansⅠ～Ⅳ型）共68例，其中PFNA组36例，平均年龄81.5岁；DHS组32例，平均年龄82.3岁。两组患者在年龄、性别、骨折分型、合并症以及受伤至手术时间方面比较差异均无统计学意义（P＞0.05），有可比性。 结果 术后68例患者均获随访，随访时间6～26个月。与DHS组比较，PFNA组手术时间短、术中出血少，差异有统计学意义（P＜0.05）；PFNA组骨性愈合时间短，但两组差异无统计学意义（P＞0.05）。术后DHS组出现1例髋内翻、1例拉力螺钉切出股骨头颈，PFNA组出现1例主钉退钉，两组术后并发症发生率比较差异有统计学意义（P＜0.01）。术后1年PFNA组髋关节Harris评分显著高于DHS组，差异有统计学意义（P＜0.01）。 结论 PFNA与DHS两种固定方法的骨性愈合时间短、术后并发症少、髋关节功能恢复好，是治疗股骨粗隆间骨折的良好方式，尤其是PFNA能减少手术时间和术中出血量，手术创伤小，对高龄且不能耐受较大手术者可作为一种首选术式。
目的 回顾分析不同内固定方式对老年股骨粗隆间骨折的临床疗效。 方法 1999年3月－2009年5月采用内固定手术治疗121例股骨粗隆间骨折患者，根据内固定方式不同分为4组：动力髋螺钉（DHS；A组43例）、经皮加压钢板（PCCP；B组19例）、股骨近端髓内钉（PFN；C组27例）、Gamma钉（D组32例）。4组患者年龄、骨折类型（Tronzo-Evans分型）等一般资料比较差异无统计学意义（P＞0.05），具有可比性。记录手术时间、术中出血量及术后引流量、术中术后并发症、骨折临床愈合时间、术后髋关节功能恢复程度，比较评价各组临床疗效。 结果 术后各组患者切口均Ⅰ期愈合，无伤口感染等早期并发症发生。患者均获随访，随访时间18～108个月，平均56.4个月。与A组比较，B、C、D组手术时间明显缩短，术中出血量及术后引流量减少，骨折愈合时间缩短，差异均有统计学意义（P＜0.01），A组较差；B、C、D各组间两两比较差异无统计学意义（P＞0.05）。术后并发症发生率A组较高，与其余各组比较差异有统计学意义（P＜0.05）。末次随访时各组髋关节功能Harris评分比较差异无统计学意义（P＞0.05）。 结论 B、D组及C组3种手术方法在治疗老年患者股骨粗隆间骨折具有创伤小、并发症少等优势，与A组法比较更有利于老年患者术后康复，但应注意骨折的良好复位及内固定物位置。
目的 探讨人工髋关节置换术后Vancouver B1型股骨假体周围骨折的治疗方法。 方法 2006年4月－2011年2月采用记忆合金抓握式接骨板固定结合自体髂骨植骨治疗6例Vancouver B1型股骨假体周围骨折。其中男2例，女4例；年龄55～78岁，平均68.5岁。6例均为初次行人工关节置换术后6个月～3年，平均18.4个月发生假体周围骨折；骨折至手术时间为3～6 d，平均4.2 d。 结果 术后切口均Ⅰ期愈合，无深静脉血栓形成、肺部感染、肺栓塞等并发症发生。6例均获随访，随访时间13个月～4年，平均28.6个月。X线片示骨折全部愈合，愈合时间12～20周，平均14.8周。末次随访时Harris评分76～93分，平均83.6分；获优3例，良3例。无1例出现接骨板折断、松动，骨折再移位、骨不连、股骨假体松动等并发症。 结论 记忆合金抓握式接骨板结合自体髂骨植骨治疗Vancouver B1型股骨假体周围骨折具有固定可靠、操作简便的特点，可获满意临床疗效。
目的 评价微创椎弓根钉内固定技术治疗胸腰椎爆裂骨折的中期临床疗效。 方法 2002年9月－2007年9月，采用微创椎弓根钉内固定技术治疗胸腰椎爆裂骨折30例。其中男16例，女14例;年龄18～65岁，平均39.8岁。骨折节段:胸11者3例， 胸12者13例， 腰1者12例， 腰者22例。所有骨折按AO分型，均为A3型。受伤至手术时间6 h～6 d，平均45 h。分析术后影像学指标、疼痛评分及功能障碍指数。 结果 患者均获随访，随访时间3～9年，平均5.2年。术后各时间点伤椎前缘高度及后凸Cobb角均较术前明显恢复（P＜0.01）。术后伤椎高度随随访时间延长逐渐下降，后凸Cobb角逐渐增大。取出内固定物后、术后2年、末次随访时动力位X线片上骨折椎体前后相对滑移距离分别为（1.9 ± 0.3）、（2.1 ± 0.2）、（2.1 ± 0.3）mm，两两比较差异无统计学意义（P＞0.05）。术后1、2年及末次随访时疼痛视觉模拟评分分别为（2.5 ± 1.2）、（2.5 ± 1.1）、（2.4 ± 1.3）分，两两比较差异无统计学意义（P＞0.05）。末次随访时Denis腰痛分级：P1级13例，P2级12例，P3级5例。功能障碍指数为（11.4 ± 3.1）分，获优23例、良5例、可2例。 结论 单纯微创椎弓根钉内固定技术治疗胸腰椎爆裂骨折中期临床效果满意，脊柱稳定性良好。Objective To mid-term efficacy of the technique of minimally invasive pedicle screw fixation on thoracolumbar burst fracture. Methods From September 2002 to September 2007, 30 patients were treated with minimally invasive pedicle screw fixation for thoracolumbar fracture. There were 16 males and 14 females with the mean age of 39.8 years (range,18-65 years). The injured level of was T11 in 3 cases, T12 in 13 cases, L1 in 12 cases, and L2 in 2 cases. The type of thoracolumbar fractures of all the patients was A3 according to AO classification. The during from injury to operation was 6 hours to 6 days with an average of 45 hours. The index of image and pain and disability index were evaluated after operation. Results All patients were followed up for 3 to 9 years with the mean of 5.2 years. Their average sliding distance after operation for removing internal fixation was (1.9 ± 0.3), and (2.1 ± 0.2) mm 2 years after the operation and (2.1 ± 0.3) mm at the latest follow-up. There was no significant difference (P＞0.05). Their average score was (2.51 ± 1.2) 1 year after the operation, was (2.42 ± 1.1) 2 year after the operation, and was (2.36 ± 1.3) at the latest follow-up (P＞0.05). According to Denis score system to evaluate index of lumbago, there was P1 in 13 cases, P2 in 12 cases, and P3 in 5 cases. The score of Oswestry Disability Index (ODI) was 11.4 ± 3.1 at the latest follow-up. Twenty-one cases gotexcellent therapeutic result, five cases got good and two were moderate. Conclusions Minimally invasive pedicle screw fixation for the treatment of thoracolumbar burst fracture provide satisfactory clinical results. The vertebral body and adjacent vertebral body have a good stability.