Objective To investigate the value of using Footscan system to evaluate the therapeutic effect of two internal fixation methods on calcaneus fractures. Methods From February 2006 to September 2006, 64 patients with fresh unilateral closed calcaneus fractures were randomly divided into two groups. The experimental group: 32 patients underwentminimally invasive open reduction and internal fixation with improved compressing plate and screw, including 28 males and 4 females aged 20-53 years old (average 36.7 years old); the course of disease was 3-14 days; there were 19 cases of type II, 11 of type III, and 2 of type IV according to Sanders fracture classification system. The control group: 32 patients underwent internal fixation of standard AO plate via L-shaped incision, including 29 males and 3 females aged 18-56 years old (average 37.1 years old); the course of disease was 4-15 days; there were 18 cases of type II, 11 of type III and 23 of type IV according to Sanders fracture classification system. No significant difference was noted between two groups in the general information (P gt; 0.05). At 1 and 2 years after operation, dynamic plantar pressure was measured using Footscan system, Maryland foot scores of two groups was compared, and statistical analysis was performed. Results All patients were followed up for 2 years. No infection, cuticular border necrosis, and sural nerve distal end injury occurred in the experimental group, whereas in the control group, 3 patients suffered from cuticular border necrosis and recovered after dressing, and 1 patient had sural nerve distal end injury with decreased sensation in local skin. At 1 and 2 years after operation, in the control group, there were significant differences between the injured foot and the normal foot in terms of impulse, instep index, motion range of subtalar joint, lateral displacement of footplate pressure center, and calcaneal width when patients stood on both feet (P lt; 0.05), whereas in the experimental group, no significant differences were noted between the injured foot and the normal foot in terms of the above parameters (P gt; 0.05). Significant differences were noted between two groups in terms of the above parameters (P lt; 0.05). The Maryland score 1 yearafter operation was (86.74 ± 8.56) points for the experimental group and (71.24 ± 10.06) points for the control group; at 2 years after operation, it was increased to (87.35 ± 8.49) points and (72.41 ± 9.69) points, respectively, indicating there was a significant difference between two groups (P lt; 0.05). Conclusion Operative outcomes of internal fixation with improved compressing plate are superior to those of standard AO plate. Footscan system can provide a quantitative assessment on the operative effect of calcaneus fractures.
Objective To review the biomechanical research progress of internal fixation of tibial plateau fracture in recent years and provide a reference for the selection of internal fixation in clinic. Methods The literature related to the biomechanical research of internal fixation of tibial plateau fracture at home and abroad was extensively reviewed, and the biomechanical characteristics of the internal fixation mode and position as well as the biomechanical characteristics of different internal fixators, such as screws, plates, and intramedullary nails were summarized and analyzed. Results Tibial plateau fracture is one of the common types of knee fractures. The conventional surgical treatment for tibial plateau fracture is open or closed reduction and internal fixation, which requires anatomical reduction and strong fixation. Anatomical reduction can restore the normal shape of the knee joint; strong fixation provides good biomechanical stability, so that the patient can have early functional exercise, restore knee mobility as early as possible, and avoid knee stiffness. Different internal fixators have their own biomechanical strengths and characteristics. The screw fixation has the advantage of being minimally invasive, but the fixation strength is limited, and it is mostly applied to Schatzker typeⅠfracture. For Schatzker Ⅰ-Ⅳ fracture, unilateral plate fixation can be used; for Schatzker Ⅴand Ⅵ fracture, bilateral plates fixation can be used to provide stronger fixation strength and avoid the stress concentration. The intramedullary nails fixation has the advantages of less trauma and less influence on the blood flow of the fracture end, but the fixation strength of the medial and lateral plateau is limited; so it is more suitable for tibial plateau fracture that involves only the metaphysis. Choosing the most appropriate internal fixation according to the patient’s condition is still a major difficulty in the surgical treatment of tibial plateau fractures. Conclusion Each internal fixator has good fixation effect on tibial plateau fracture within the applicable range, and it is an important research direction to improve and innovate the existing internal fixator from various aspects, such as manufacturing process, material, and morphology.
Objective To explore the occurrence condition of the neck axial symptom (AS) after cervical Bryan artificial disc replacement combined with anterior cervical discectomy and fusion (Hybrid surgery) and traditional anterior cervical discectomy and fusion (ACDF surgery) to treat the two-level cervical disease, and to do contrastive analysis. Methods Between August 2006 and March 2010, 18 patients underwent Hybrid surgery (group A) and 30 patients underwent two-level ACDF surgery (group B). There was no significant difference in age, gender, disease duration, type, and operated segment between 2 groups (P gt; 0.05). The Japanese Orthopaedic Association (JOA) score, neck disability index (NDI) score, cervical curvature of the operated segment, total range of motion (ROM) of C2-7, ROM of the adjacent segment, and incidence of neck AS were recorded and compared between before operation and at last follow-up. Results All the patients were followed up 18-34 months (24.1 months on average). In both groups, the JOA and NDI scores at last follow-up had significantly improvement when compared with preoperative scores (P lt; 0.01), but there was no significant difference between 2 groups at preoperation and last follow-up (P gt; 0.05). The kyphosis incidence of the operated segment in group B was significantly higher than that in group A (χ2=5.333, P=0.021). There was no significant difference in the total ROM of C2-7 between at preoperation and last follow-up in group A (t=0.410, P=0.685); the total ROM of C2-7 at last follow-up was significantly lower than that at preoperation in group B (t=3.007, P=0.006); and significant difference was found between 2 groups at last follow-up (t=2.664, P=0.013). At last follow-up, ROM of the superior and inferior adjacent segments in group B increased obviously (P lt; 0.05) and was significantly higher than that in group A (t=2.252, P=0.033; t=2.203, P=0.037). The incidence of neck AS were 16.7% in group A and 46.7% in group B, showing significant difference at last follow-up (χ2=4.427, P=0.035). Conclusion Compared with two-level ACDF surgery, Hybrid surgery has good outcomes. At the same time, it can maintain the curvature of operated segments and total ROM, avoid excessive increased ROM of the adjacent segments, and reduce the incidence of neck AS.
To explore a new approach to treat old scaphoid fracture by grafting bones from distal radius and fixing absorbable screws. Methods From January 2002 to May 2007, 18 patients with old scaphoid fractures were treated by grafting bones from distal radius and fixing absorbable screws. All of the 18 patients (13 males and 5 females, aged from 17 to 41 years old) had the injury history of the palm of hand touching the ground. They felt tenderness on the anatomical snuff-box and tubercle of scaphoid bone. The grasping force decreased. The range of motion of the wrist was (36 ± 2)° extension/(30 ± 3)° flexion, (8 ± 3)° radial is/(13 ± 2)° ulnaris. Results The average postoperative follow-up period was 15.7 months．A total of 18 cases achieved bone union. The range of motion of the wrist in the 16 healed cases was (68 ± 2)° extension/(65 ± 3)° flexion, (15 ± 3)° radial is/(28 ± 5)° ulnaris. There was no pain of motion and symptom of powerlessness. As to the other 2 cases, the range of motion of the wrist was (40 ± 8)° extension/(35 ± 6)° flexion, (8 ± 5)° radial is/(12 ± 5)° ulnaris; no obvious improvement was found; the patients occasionally felt painful in daily l ife; the extension force decreased. No infection and break of internal fixation were seen. Conclusion The absorbable screw as a new biomaterial for internal fixation has obvious advantages of good biocompatibil ity, promoting union of the fracture and no need of a second operation for removal．
ObjectiveTo evaluate the effectiveness of the leverage reduction with proximal femoral nail antirotation (PFNA) ball head screw driver for difficult-reducing intertrochanteric fracture.MethodsThe clinical data of 8 patients with difficult-reducing intertrochanteric fractures between July 2015 and February 2018 were retrospectively analysed. There were 3 males and 5 females, aged 66-89 years, with an average age of 76.3 years. According to Evans classification, there were 3 cases of type Ⅲ and 5 cases of type Ⅳ. The time from injury to operation was 2-8 days (mean, 3.9 days). All patients were reducted with ball head screw driver leverage through PFNA proximal incision during operation. The operation time, intraoperative blood loss, reduction time, and fluoroscopy times were recorded. Harris hip function score was used to evaluate the effectiveness at last follow-up.ResultsThe operation time was 52.5-83.7 minutes (mean, 68.1 minutes), the intraoperative blood loss was 49.8-96.4 mL (mean, 73.1 mL), the reduction time was 3.7-9.1 minutes (mean, 6.4 minutes), and the fluoroscopy times were 18.4-27.4 times (mean, 22.9 times). Patients were followed up 6-18 months (mean, 9.6 months). Postoperative X-ray films showed that the fracture obtained good reduction. No fracture displacement, fixation failure, and coxa vara occurred after operation. Fracture healing time was 3-6 months (mean, 4.6 months). At last follow-up, the Harris hip function score was 85-96 (mean, 91.6), with a result of excellent in 6 cases and good in 2 cases.ConclusionThe reduction of difficult-reducing intertrochanteric fracture by using ball head screw driver can obtain good reduction and reliable fixation. The method has such advantages as no more incision, and less blood loss and soft tissue injury.
Objective Tri ptol ide can suppress immunological rejection reaction. To investigate the effect of tri ptol ide on allogenic tendon transplantation in repairing tendon defect in chicken. Methods The defect model of the third toes tendon was establ ished in 64 healthy-cleaning male Leghorn chickens (4-month-old, weighing 1.9-2.3 kg), which underwent allogenic tendon transplantation for repairing and were divided into 2 groups randomly (n=32). Tri ptol ide feeding[100 μg/(kg·d)] was given for 3 weeks in the experimental group and normal feeding in the control group. General condition of the chickens was observed after operation. The transplanted tendons were harvested from 4 chickens in each group for gross observation at 1, 2, 3, and 4 weeks after operation; the histological observation was performed at 1 and 3 weeks, and transmission electron microscope observation at 2 and 4 weeks. The blood and tendon were harvested from another 8 chickens in each group for flow cytometry and biomechanical tests respectively at 3 and 6 weeks. Results All chickens survived to the experiment end. Gross observation: with time extending, hyperemia and edema around transplanted tendon were rel ieved. Rarefaction adhering zone was seen in experimental group, and pyknotic adhering zone in control group. Histological observation: inflammatory reaction in experimental group was sl ighter than that in control group at 1 and 3 weeks. Transmission electron microscope observation: at 2 and 4 weeks, fibroblasts had big cell nucleus, more euchromatin, and l ittle heterochromatin in experimental group; however, there were small amount of rough endocytoplasmic reticulums with gentle expanded capsular space in control group, which contained sparse content. Flow cytometry test: at 3 and 6 weeks, peri pheral blood contained less CD4+ and CD8+ T lymphocytes in experimental group than in control group, and the ratio of CD4+ to CD8+ T lymphocyte significantly decreased in experimental group when compared with control group (P lt; 0.05). Biomechanical examination: at 3and 6 weeks, the maximum tensile strength in experimental group was bigger than that in control group, and tensile adhesion power in experimental group was smaller than that in control group. There were significant differences in the indexes between 2 groups (P lt; 0.05). Conclusion Tri ptol ide can suppress immunological rejection reaction, strengthen tendon healing strength, and reduce tendon adhesion in allogenic tendon transplantation.
Objective To explore the correlative factors affecting the compl ications resulting from cement leakage after percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral body compression fractures (OVCF). Methods From February 2005 to October 2008, 71 patients with OVCF were treated by PKP and were retrospectively analyzed. There were 16 males and 55 females, and the average age was 71.5 years (range, 52-91 years). The average duration of disease was 5.7 months (range, 1-11 months). A total of 171 vertebra were involved in fracture including 19 cases of single vertebral fractures, 21 cases of double vertebral fractures, 20 cases of three vertebral fractures, and 11 cases of more than three vertebral fractures. All the treated vertebra were divided into acute (86 vertebra) or subacute (85 vertebra) state based on changes in MRI signal intensity. There was no radiculopathy or myelopathy. The average injected cement volumewas 4.6 mL (range, 1.5-6.5 mL). The treatment efficacy was assessed by observing the change in anterior and middle vertebral column height, Cobb angle, visual analogue scale (VAS) and Oswestry functional score at preoperation, 3 days after operation and last follow-up. The patients were divided into cement leakage group and no cement leakage group. All the compl ications were recorded, and then the correlative factors affecting the compl ications were analyzed. Results All the cases had rapid and significant improvement in back pain following PKP. All patients were followed up for 14 months (range, 7-18 months). There was no cement extravasation resulting in radiculopathy or myelopathy. Four patients (5.63%) had lung-related compl ications. During the follow-up, 9 recurrence vertebral fractures were observed in 6 patients (8.45%). The anterior and middle vertebral column height, Cobb angle, VAS and Oswestry score were significantly improved when compared with preoperation (P lt; 0.05). Cement leakage occurred in 17 (9.94%) vertebral bodies; of 17 cases, the cement leaked into the paravertebral space in 7 cases, intervertebral space in 6 cases, channel of needl ing insertion in 3 cases, and spinal canal in 1 case. Univariate analysis showed statistically significant differences (P lt; 0.05) in preoperative anterior and middle vertebral column height, injected cement volume and vertebral body wall incompetence between the cement leakage group and no cement leakage group. There were no significant differences (P gt; 0.05) in preoperative Cobb angle, freshness of vertebral fracture, location of operative vertebrae and operative approach between the two groups. Multiple logistic regression analysis showed that the injected cement volume [odds ratio (OR)=3.105, 95% confidence interval (CI)=1.674-5.759, P lt; 0.01] and vertebral body wall incompetence (OR=11.960, 95%CI=3.512-40.729, P lt; 0.01) were the predominant variable associated with the compl ications resulted fromcement leakage. Conclusion The injected cement volume and vertebral body wall incompetence were the factors affecting the compl ications. The improvement of surgical technique is the capital factor that may reduce the compl ications in the PKP.
Objective To assess the effect of topical appl ication of 5-fluorouracil (5-FU) on intimal hyperplasia in rabbit vein graft. Methods Sixty-four male New Zealand white rabbits, aged 5 months and weighing 2.8-3.0 kg, were randomly divided into group A, B, C, and D (n=16 rabbits per group). Artery defect model was establ ished by cutting about 1 cm artery from the middle part of the dissociated left common carotid artery. A section about 3 cm was cut from the right external jugular vein, and the harvested vein was inverted and end-to-end anastomosed to the artery defect with 9-0 non-traumatic suture. After anastomosis, the extima of the grafted veins in group A, B, and C was completely wrapped with cotton sheet (12 mm × 30 mm × 1 mm in size) immersed by 5-FU at a concentration of 50.0, 25.0, and 12.5 mg/mL, respectively, and eachvein was treated 5 times (1 minute at a time). In group D, the extima of the graft veins was treated with normal sal ine instead of 5-FU. The grafted veins were obtained 1, 2, 4, and 6 weeks after operation, HE staining and Masson staining were preformed for histological changes of grafted vein wall, prol iferating cell nuclear antigen (PCNA) immunohistochemistry staining and TUNEL label ing staining were conducted for prol iferation and apoptosis of smooth muscle cell of the grafted vein, and transmission electron microscope observation was performed for cellular ultrastructure. Results The HE staining, Masson staining, and PCNA immunohistochemistry staining showed that the thickness of intima in group A and B was obviously less than that in group C and D at 1, 2, 4, and 6 weeks after operation, and the prol iferation cells in group A and B were less than that in group C and D at 1, 2, and 4 weeks after operation. The thickness of the intima, the degree of intima hyperplasia, the degree of vessel lumen stenosis of four groups at different time points were as follows: at 1 week after operation, group A [(12.69 ± 1.68) μm, 0.73 ± 0.05, 0.025 ± 0.003], group B [(17.52 ± 2.01) μm, 0.86 ± 0.06, 0.027 ± 0.004], group C [(21.92 ± 1.85) μm, 1.06 ± 0.09, 0.036 ± 0.006] and group D [(26.45 ± 3.86) μm, 1.18 ± 0.08, 0.041 ± 0.005]; at 2 weeks after operation, group A [(24.61 ± 2.91) μm, 0.86 ± 0.06, 0.047 ± 0.003], group B [(37.28 ± 2.78) μm, 1.17 ± 0.09, 0.060 ± 0.004], group C [(46.52 ± 2.25) μm, 1.44 ± 0.08, 0.073 ± 0.003], and group D [(52.07 ± 3.29) μm, 1.45 ± 0.05, 0.081 ± 0.006]; at 4 weeks after operation, group A [(61.09 ± 6.84) μm, 1.38 ± 0.08, 0.106 ± 0.007], group B [(63.61 ± 8.25) μm, 1.40 ± 0.07, 0.107 ± 0.010], group C [(80.04 ± 7.65) μm, 1.64 ± 0.07, 0.129 ± 0.011], and group D [(84.45 ± 9.39) μm, 1.68 ± 0.10, 0.139 ± 0.014]; at 6 weeks after operation, group A [(65.27 ± 5.25) μm, 1.46 ± 0.07, 0.113 ± 0.005], group B [(65.82 ± 7.12) μm, 1.45 ± 0.05, 0.112 ± 0.011], group C [(84.45 ± 9.39) μm, 1.69 ± 0.09, 0.135 ± 0.007], and group D [(87.27 ± 8.96) μm, 1.76 ± 0.05, 0.140 ± 0.012]. Group A and B were inferior to group C and D in terms of the above three parameters and cell prol iferation index 1, 2 and 4 weeks after operation (P lt; 0.05). Group A and B were superior to group C and D in terms of cell apoptosis index of intima and media 1 and 2 weeks after operation (P lt; 0.05). Transmission electron microscope observation showed that the synthetic cell organelles such as rough endoplasmic reticulum, golgi apparatus, and ribosome in group A and B were obviously less than those in group C and D (P lt; 0.05). Conclusion Topicalappl ication of 5-FU can effectively inhibit intima hyperplasia of the vein grafts.
Objective To investigate epidemiological characteristics of geriatric hip fractures between 2010 and 2011 in Hebei province. Methods The digital radiography image data and basic information of patients above 60 years old with hip fractures (femoral neck fracture, femoral intertrochanteric fracture, and femoral head fracture) in 5 hospitals of Hebei province between January 2010 and December 2011 were analyzed retrospectively. All the data including patients’ gender, age, and AO types were abstracted and analyzed to investigate the epidemiologic characteristics of geriatric hip fractures in Hebei province. Results A total of 4 207 hip fracture patients above 60 years old were included, accounting for 59.61% of all patients with hip fractures and 26.24% of all fractures patients over 60 years old in the same period. There were 1 703 (40.48%) males and 2 504 (59.52%) females (M∶F=1∶1.47). The patients ranged in age from 61 to 99 years, with an average of 75.4 years; the majority of patients aged 70-79 years (43.97%) and the minority of the patients aged 90-99 years (2.02%); women of all ages were more than men, but the difference was not significant (P>0.05). According to AO classification, there were 2 118 cases (50.34%) of type 31-A, 2 004 case (47.63%) of type 31-B, and 85 cases (2.02%) of type 31-C. Except for the type 31-A1, 31-A3, and 31-C1 of 60-69 age group, and the type 31-A3 of 80-89 age groups, women were significantly more than men. Conclusion There are more women than men in hip fractures in Hebei province, and 70-79 age group is the high-risk age group of geriatric hip fractures. Among them, intertrochanteric comminuted fractures are common types.
To evaluate the effect of 5-fluorouracil (5-FU) appl ied topically on preventing adhesion andpromoting functional recovery after tendon repair. Methods From August 2003 to June 2007, 48 patients with flexor tendonrupture of the fingers by sharp instrument were treated and randomly divided into two groups. In 5-FU group, 39 fingers of 26 patients included 17 males and 9 females, aged (29.3 ± 9.8) years; the locations were zone I in 19 fingers and zone II in 20 fingers; single finger was involved in 12 cases and more than 2 fingers were involved in 14 cases; and the time from injury to operation was (2.4 ± 1.6) hours. In control group, 36 fingers of 22 patients included 14 males and 8 females; aged (26.1 ± 8.7) years; the locations were zone I in 16 fingers and zone II in 20 fingers; single finger was involved in 10 cases and more than 2 fingers were involved in 12 cases; and the time from injury to operation was (2.1 ± 1.8) hours. No statistically significant difference was found in constituent ratio of age, gender, injured fingers and their zones, between two groups (P gt; 0.05). The repair site in 5-FU group was given 5-FU at a concentration of 25 mg/mL with a soaked sponge, and the synovial sheath of the repaired site was wrapped with the 5-FU-soaked sponge for 1 minute for 4 times after the tendons were repaired; normal sal ine was used in the control group. Results Wound healed by first intention and no infection and tendon rupture occurred in two groups. The patients were followed up for 3-8 months (mean 4.1 months) and 3-8 months (mean 3.9 months) in 5-FU group and in control group respectively. The functional recovery degrees of the fingers were evaluated with total active movement (TAM) evaluation system. In 5-FU group, the results were excellent in 22 fingers, good in 13 fingers, fair in 3 fingers and poor in 1 finger; the excellentand good rate was 89.7%. In control group, the results were excellent in 11 fingers, good in 15 fingers, fair in 9 fingers andpoor in 1 finger; the excellent and good rate was 72.2%. There was statistically significant difference in the functional recovery degrees of fingers between two groups (P lt; 0.05). The 2 fingers which had a poor result in 5-FU group and control group were served with tenolysis was performed in 2 cases having poor results after 6 months of operation and had an excellent result at last. Conclusion 5-FU appl ied topically can reduce tendon adhesions after the ruptured tendon repair.