Objective To assess the possibility of placing the posterior pedicle screw on atlas. Methods Twenty human cadaver specimens were used to insert pedicle screws in atlas, through the posterior arch or the pedicle of C1 into the lateral mass. The screw entry point was on the posterior surface of C1 posterior arch and at the intersection of the vertical line through the center of C2 inferior articular process and the horizontal line at least 3 mm below the superior rim of the C1 lamina. The screw of 3.5 mm in diameter was placed in a direction of 10° medial angle and 5° upwardangle. After placement of C1 pedicle screw, the distance from C1 screw entry point to the mediallateral midpoint of C1 pedicle, the maximum length of screw trajectory and the actual screw trajectory angles were measured. The direction of screw penetrating through the cortical of C1 pedicle or lateral mass and the injuries to the vertebral artery and spinal cord were observed.Results Forty pedicle screws were placed on atlas, the mean distance from C1 screw entry point to the medial-lateral midpoint of C1 pedicle was (2.20±0.42)mm, the maximum length of screw trajectory averaged (30.51±1.59)mm, and the actual screw trajectory angle measured (9.7±0.67)° in a medial direction and (4.6±0.59) ° in a upward direction. Only 1 screw penetrated the upper cortical bone of the atlas pedicle because the upward angle was too large, and 8 screws were inserted so deep that the inferior cortical bone of the C1 lateral mass was penetrated. But no injuries to the vertebral artery and spinal cord wereobserved. Conclusion C1 posterior pedicle screw fixation is quite accessible and safe, but the su
Objective To evaluate the effectiveness of InterTan in the treatment of femoral intertrochanteric fractures. Methods Between April 2009 and July 2009, 57 patients with femoral intertrochanteric fracture were treated with InterTan. There were 33 males and 24 females with an average age of 68 years (range, 45-88 years). The locations were left side in 31 cases and right side in 26 cases and all fractures were closed fractures. According to Association for Osteosynthesis/Orthopaedic Trauma Association (AO/OTA) classification, there were 23 cases of type 31-A1, 27 of type 31-A2, and 7 of type 31-A3. The disease duration was 2 to 8 days with an average of 3.3 days. The data of operative time, blood loss, perioperative blood transfusion, hospital ization day, fracture heal ing time, and Harris hip score were recorded. Results The operative time and the blood loss were (74.5 ± 19.7) minutes and (148.8 ± 79.6) mL, respectively. There were significant differences in the operative time and the blood loss among the AO/OTA subgroups (P lt; 0.05). Twenty-five patients required a blood transfusion and the transfusion volume was (264.0 ± 90.7) mL. The average hospital ization days were 7 days (range, 6-9 days). Thirty-five patients were followed up 12 to 15 months (13.3 months on average). X-ray films showed that all fractures healed within (2.8 ± 0.8) months. The heal ing time of fracture was (2.4 ± 0.6), (2.9 ± 0.9), and (3.8 ± 0.5) months in 31-A1 subgroup, 31-A2 subgroup, and 31-A3 subgroup, respectively. There was no significant difference in heal ing time of fracture between 31-A1 subgroup and 31-A2 subgroup (P gt; 0.05), and there were significant differences between 31-A3 group and 31-A1 subgroup, 31-A2 subgroup (P lt; 0.05). No shortening, cut-out, varus malposition, femoral shaft fracture, or implant failures was found. The Harris score at the final follow-up was 84.5 ± 8.2 with an excellent and good rate of 80% (15 cases of excellent, 13 of good, 6 of fair, and 1 of poor). Twenty patients (57%) recovered the walking abil ity. Conclusion The new intertrochanteric antegrade nail of InterTan can be used to treat femoral intertrochanteric fractures with good cl inical outcomes, high union rate, and less compl ications.
Objective To illustrate the effect and complication of orthopedic applications for biodegradable and absorbable internal fixation of fractures, and to indicate the existent problem and research aspect currently. Methods The recent literatures on orthopedic applications and study of biodegradable and absorbable internal fixation for fractures were reviewed. The effect of biodegradable materials on bone healing was summarized. Results It is good for the stability of fracture fixation and result of treeatment. The biodegradable and absorbable internal fixation fractures had no adverse effect on bone healing. Conclusion There will be more widespread application for biodegradable and absorbable materials in orthopedics, but the intensive research should be carried out to prevent its complication.
Objective To study the cl inical effect of expert tibial nail (ETN) in the treatment of the complex tibial fractures of type C. Methods From May to October 2008, 10 cases of complex tibial fractures of type C were treated with unreamed ETN and closed reduction. There were 7 males and 3 females aging from 23 to 50 years with an average age of 39 years. Fracture was caused by traffic accident in 6 cases, by crush in 2 cases, and by fall ing from height in 2 cases. According to Association for the Study of Internal Fixation (AO/ASIF) classification, there were 2 cases of 42-C1 fractures, 4 cases of42-C2 fractures, and 4 cases of 42-C3 fractures; including 4 cases of closed fractures and 6 cases of open fractures (2 cases of Gustilo type I and 4 cases of Gustilo type II). Results The mean duration of surgery and blood loss were 75 minutes (range, 60-110 minutes) and 55 mL (range, 20-100 mL), respectively. All the incision healed by first intension without compl ication of infection. All cases were followed up for 12-17 months (average 14 months). X-ray films showed that no breakage of nail, iatrogenic fracture, l imb shortening, and angulation deformity occurred. All fractures healed after 3-8 months (average 4.2 months). At last follow-up according to Johner-Wruhs standard for the functional recovery, the results were excellent in 8 cases and good in 2 cases. Conclusion ETN has an angular stable locking system for intramedullary nails, which can enhance axial and transverse stabil ity for the treatment of complex tibial fractures of type C. It will provide firm fixation and minimal invasion.
Objective To observe ultrastructural changes of the intervertebraldisk in the corresponding area after internal fixation of spinal column. Methods Twenty-four Japanese big ear rabbits were divided into internal fixation of spinal column group (n=12) and control group (n=12). The internal fixation model was made as follows: The spinous processes and erector spinal muscle were exposed and the T10L3 spinous processes and the relevant two-side articular processes under the periosteumwere isolated. With the help of L-shaped Kirschner wires, the steel wire was threaded through the articular of T11,T12,L1 and L2, and were connected with L-shaped Kirschner wries. After 6 months of operation, the following intervertebral disk tissues were observed with transmission electeon microscope: nucleus pulposus, internal annlus fibrosus and external anulus fibrosus of L1 intervertebraldisk. The T12and L2 intervertebal disk surface structure was observedhorizontally and longitudinally with scanning electron microscope, respectively. Results After internal fixation of spinal column, the structural changes of cells in nucleus pulposus and internal annulus fibrosus occurred earlier than that in the external annulus fibrosus. Proteoglycan and special structure were found in nucleus pulposus and matix of annulus fibrosus. However, the forms of special structure in nucleus pulposus and internal layer of annulus fibrosus were different. In the degeneration matrix of intervertebral disc, the proteoglycan particles and special structure were obviously decreased. Conclusion Abnormal stress environment can result in the degeneration of intervertebral disk. There is a regular distribution of the special structure in nucleus pulposus and matrix of annulus fibrosus, which is related to biology behaviour of proteoglycan particles in the degeneration of intervertebral disk.
Objective To evaluate the fixation technique of using the cervical lateral mass plate in the cervical posterior approach operation. Methods Eight patients in this group were admitted from September 2001 to November 2006. Among the 8 patients, there were 6 males and 2 females, with their ages ranging from 28 to 78 years. Cervical vertebral fracture with dislocation was found in 4 patients, C2 spinal cord injury in 1, C1 fracture in 1, cervical spinal stenosis in 1, and C2-5 spinal cord neurofibroma in 1. Muscle strength 3-4. TheFrankel grading system was usedin 6 patients with traumatic injury. Before operation, Grade C was observed in 2patients，Grade D in 3，and Grade E in 1. All the operations were performed according to requirements of the Margel’s method. We positioned 40 screws in all the patients, including 4 screws at C2，6 screws at C3，12 screws at C4，4 screws at C5，4 screws at C6，2 screws at C7，and 6 screws at T1. Results The followingup for an average of 14.1 months (range,645 months) revealed that there was no malposition of the screws in the patients. One of the 8 patients developed spinal instability in the fixed segment at 3 months after operation. The headchestbrace was applied to the patient for 3 months, and the spinal fusion was achieved. The further followingup to 45 months indicated that there was no instability occurring. The remaining patients recovered to their spinal stability by the spinal fusion. The patients also recovered in their neurological function after operation. The Frankel assessment showed that 1 patient had Grade E, 3 from Grade D to Grade E, 1 from Grade C to Grade D, and 1 from Grade C to Grade E. Conclusion The cervical lateral mass plate fixation can provide the immediate and b segmental immobilization for the good cervical spine stability.
ObjectiveTo explore the effectiveness of high strength suture fixation in treatment of patellar transverse fracture.MethodsBetween June 2014 and June 2016, 38 patients with the patellar transverse fracture were treated with high strength suture internal fixation. There were 24 males and 14 females with the age of 26 to 64 years (mean, 45 years). There were 6 cases of accident injury and 32 cases of crashing injury. The time interval between injury and surgery was 2-8 days (mean, 5 days). The preoperative visual analogue scale (VAS) score, Lysholm score, and range of motion (ROM) of patients were 84.3±8.4, 44.5±7.2, and (62±12)°, respectively.ResultsAll patients’ incisions healed by first intention after operation. There was no neurovascular injury, deep venous thrombosis of lower limbs, or local foreign matter irritation reaction. The X-ray films showed that the reduction of patella and the location of internal fixator were good at 2 days after operation. All the 38 patients were followed up 12-18 months (mean, 16 months). All fractures healed and the healing time was 2-4 months (mean, 3 months). At last follow-up, according to the B?stman criteria, 36 patients were rated as excellent and 2 as good, with an excellent and good rate of 100%. The VAS score, Lysholm score, and ROM of patients were 10.2±6.6, 93.1±6.4, and (124±14)°, respectively, showing significant differences when compared with preoperative ones (t=42.759, P=0.000; t=31.099, P=0.000; t=20.727, P=0.000).ConclusionApplication of high strength suture fixation in the treatment of patellar transverse fracture has advantages of simple to operate, effective fixation, and less complication. It can avoid reoperation of removing the internal fixators. The satisfied ROM and function of the knee joint can be obtained after operation.
Objective To study the cl inical outcomes of Numelock II polyaxial system in treatment of type C fractures of the distal radius. Methods From March 2006 to June 2007, 12 cases of type C distal radial fractures (6 males and 6 females)were treated with open reduction and internal fixation. The mean age of the patients was 48.2 years (34-64 years)．The locations were left wrist in 5 cases and right wrist in 7 cases, including 1 case of old fracture and 11 cases of fresh fractures. All fractures were closed. The mean course of disease was 9 days and 7 hours (4 hours to 60 days). According to AO/ASIF classification, there were 4 cases of C1 type, 5 cases of C2 type and 3 cases of C3 type. Preoperatively, the palmar tilt angle was —30° to 30° (— 5° on average), and the radial inclination angle was 5° to 13° (7.7° on average), and the radial shortening was 5 mm to 15 mm (9 mm on average). One case combined with dislocation of elbow joint and 2 cases combined with multi ple injuries. Results All incision healed by first intention. Postoperative follow-up ranged from 14 months to 29 months (15.6 months on average). The X-ray films showed that the union of fractures was achieved 6-8 weeks (6.6 weeks on average). No screws breakage occurred. The articular facets weresmooth in 11 of 12 patients. After operation, the palmar tilt angle was 0° to 15° (6.7° on average), and the radial inclination angle was 5° to 15° (10.2° on average), showing significant differences when compared with those before operation (P lt; 0.05). All the radial shortening was corrected. The ROM of the wrist was 55%-100% of the normal side. The grip strength was 55%-90% of the normal side. The results were excellent in 9 cases, good in 2 cases, and poor in 1 cases by X-ray film and wrist function assessment, the excellent and good rate was 91.7%. Conclusion Numelock II polyaxial system fixation is an ideal method to treat type C fractures of the distal radius. Numelock II polyaxial mechanism may provide the free adjustabil ity of screw trajectories and a higher degree of overall stabil ity compared to monoaxial locking plates.
ObjectiveTo investigate the effectiveness of the extended Carlson approach in the treatment of lateral femoral condylar Hoffa fractures.MethodsThe clinical data of 17 patients with lateral femoral condyle Hoffa fractures between September 2012 and January 2019 were retrospectively analyzed. There were 10 males and 7 females, with a mean age of 43 years (range, 32-68 years). Fractures were caused by traffic accident in 9 cases, by falling from height in 6 cases, and by the other mechanism in 2 cases. According to the Letenneur’s classification, there were 8 cases of typeⅠ, 6 cases of type Ⅱ, and 3 cases of type Ⅲ. The mean time from injury to operation was 7 days (range, 3-32 days). All patients were treated with extended Carlson approach. Patients with Letenneur types Ⅰ and Ⅲ were fixed by a posterior antigliding plate combined with headless compression screws from anteroposterior direction, and patients with Letenneur typeⅡ were fixed by headless compression screws from anteroposterior direction. The anteroposterior and lateral X-ray films, CT and three-dimensional reconstruction of the knee joint were taken after operation to assess fracture healing and position of the internal fixators. The knee function was evaluated according to Letenneur’s functional assessment system.ResultsAll patients were followed up 13-28 months (mean, 15 months). All the incisions healed by first intention, and no complication such as fracture redisplacement, fracture nonunion, internal fixator fracture, and common peroneal nerve injury occurred. The mean time of fracture healing was 18 weeks (range, 16-32 weeks). At last follow-up, according to Letenneur’s functional assessment system, the knee function was excellent in 12 cases and good in 5 cases, with an excellent and good rate of 100%.ConclusionThe extended Carlson approach for the treatment of lateral femoral condylar Hoffa fractures has the advantages of clear exposure, easy reduction and fixation, high fracture healing rate, few complications, and good recovery of knee joint function.
ObjectiveTo investigate the effectiveness of cervical pedicle screw implantation technique under regional method.MethodsThe clinical data of 85 patients who met the selection criteria between April 2010 and May 2018 were retrospectively analyzed. There were 57 males and 28 females, aged 35-68 years, with an average of 57.6 years. Among them, there were 10 cases of ossification of posterior longitudinal ligament, 68 cases of cervical spondylosis with multilevel stenosis, 3 cases of cervical tumor, 1 case of congenital malformation, and 3 cases of cervical trauma; the lower cervical spine lesions involved C3-C7. Preoperative Frankel spinal cord injury grading: 2 cases of grade C, 51 cases of grade D, and 32 cases of grade E. Cervical pedicle screw implantation technique under regional method was performed with a total of 618 pedicle screws. Postoperative changes in neurological symptoms were observed; cervical mouth opening anteroposterior and lateral X-ray films and cervical CT examinations were performed to evaluate the pedicle screws position.ResultsThe operation time was 2.5-4.0 hours, with an average of 3.0 hours. The intraoperative blood loss was 180-550 mL, with an average of 345 mL. No intraoperative vascular or nerve injury occurred. The patients with neurological symptoms were relieved to varying degrees. There were 2 cases of superficial incision infection after operation, the wound healed after enhanced dressing change. The postoperative hospital stay was 5-14 days, with an average of 8.4 days. At discharge, Frankel neurological grading was grade D in 26 patients and grade E in 59 patients. All the patients were followed up 6-24 months, with an average of 13 months. At last follow-up, cervical X-ray films showed the good pedicle screw fixation without loosening. Cervical CT evaluated the position of pedicle screws: 523 pedicle screws (84.7%) in grade Ⅰ, 80 (12.9%) in grade Ⅱ, and 15 (2.4%) in grade Ⅲ; the accuracy rate of the screw position was 97.6%.ConclusionCervical pedicle screw implantation technique under regional method can significantly improve the success rate of screw implantation. It is easy to operate, does not destroy the bone cortex, and has stable fixation.