Objective To explore the choice for the internal fixation in treatment of pelvic posterior lesions. Methods From May 2000 to June 2005, the treatment was given to 40 patients (28 males, 12 females,aged 21-58 years) with pelvic posterior ring fracture and dislocation. Of the patients, 23 had a traffic accident, 11 had a crush injury and 6 had a fall. As for the state of an injury to the pelvic posterior ring, 22 patients had disloation of the sacroiliac joint, 12 had a sacrum fracture dislocation, and 6 had an ala iliac fracture and disloation of the sacroiliac joint. According to the Denis(1988) classification, fracture of the (sacral region Ⅰ was found in 6 cases, fracture of the scaral) region Ⅱ in 3 cases, and fracture of the scaral region Ⅲ in 3 cases. As for the complication of the pelvic front ring fracture:separation of the symphysis pubis was found in 14 cases, fraclure of the superior ramus and inferior ramus of the pubis on one side in 10 cases. The two-side superior ramus of publis and inferion ramus of pubisin 8 cases, homopleural acetabular fracture on one side in 4 cases, acetabularfracture on one side and contralateral superior ramus and inferior ramus fracture of the pubis in 3 cases, and acetabular fracture on the opposite side in 1 case.As for the operation, 28 patients underwent the stillplate internal fixation of the sacroiliac joint from anterior at 24 h to 15 days after the injury, 2 underwent the screwinternal fixation of the sacroiliac joint from posterior, and remaining 10 underwent the internal fixation by the Galveston Technique associated with the ISOLAsystem. The therapeutic results were analyzed. Results The followup of the 40 patients for 6 months to 3 years revealed that before operation 3 had a sacral plexus nerve injury, and after operation 1 patient developed perineum numbness and urinary incontinence, 1 developed claudication，3 developed posterior urethral fragmentation, and 2 developed urinary bladderrupture; however, they had a complete recovery after the reparative surgery. Conclusion In treatment of the pelvic posterior ring lesions，an appropriate internal fixation can be chosen according to the type of the pelvic fracture，applicability of internal fixation， condition of the patient，equipment available, and the doctor’s experience.
ObjectiveTo explore the effectiveness of hollow screw for the treatment of basilar part fracture of hamate hook.MethodsFive patients with basilar part fracture of hamate hook, aged 24-47 years (mean, 31 years) were treated with open reduction and hollow screw fixation between June 2015 and February 2019. There were 4 males and 1 female. The causes of injury were athletic injury in 3 cases, falling injury in 1 case, and crushing injury in 1 case. Among them, 1 case was combined with sensory disturbance of one and a half fingers on the ulnar side of the palm. The grip strength of the affected side was significantly decreased when compared with that of the healthy side in all patients. The intervals between injury and surgery were 3-8 days (mean, 4.2 days). Postoperative follow-up was conducted regularly to measure the grip strength of the affected and healthy fingers and the total motion of ring and little fingers of the affected side. Darrow criteria was used to evaluate the effectiveness.ResultsAll the incisions healed by primary intention. All the patients were followed up 6-32 months (mean, 16 months). X-ray films showed that the basilar part fracture of hamate hook reached bony union, and the healing time was 2.0-3.5 months (mean, 2.2 months). At last follow-up, the grip strength of the affected side was (35.80±3.76) kg, showing no significant difference when compared with healthy side [(36.00±4.94) kg] (t=0.094, P=0.930); and the total motion of ring and little fingers of the affected side was (529.0±8.9)°, which was significantly different from that before operation [(232.0±34.7)°] (t=18.108, P=0.000). In 1 patient with ulnar nerve injury, the two-point discrimination of the innervation area was 4 mm, and the pain sensation and temperature sensation returned to normal. Assessed by Darrow criteria, the results were excellent in 4 cases and good in 1 case.ConclusionFor the basilar part fracture of hamate hook, hollow screw fixation can obtain secure reduction and fixation and provide sustained compression and counter-rotation for the broken end of fracture, thus allowing early joint motion and promoting fracture healing and recovery of wrist function. It is a relatively good method for the treatment of basilar part fracture of hamate hook.
目的:回顾立体定向脑深部微电极记录引导下的术治疗书写痉挛的方法及疗效,探讨治疗的机理。方法:运用脑深部微电极记录引导下立体定向技术,对10例书写痉挛患者实施了丘脑腹中间核(Vim)和丘脑腹嘴核(Vo)的毁损术,进行疗效分析。结果: 10例患者术后书写功能即刻恢复正常,2例出现的感觉异常和构音障碍的可逆性手术并症,无永久性手术并发症,1～2年的随访疗效稳定无复发。结论:选择性丘脑切开是治疗书写痉挛的有效、安全的治疗手段。
目的:探讨循证护理在气管切开术患者呼吸道管理中应用的效果及措施。方法:将104例患者随机分为观察组和对照组各52例。观察组重点从“气道湿化、肺部物理疗法、吸痰、气道感染的预防、口咽部护理”几个方面进行循证,获取最佳证据,指导临床护理,对照组按传统护理法。结果:观察组患者并发症的发生率、死亡率显著低于对照组,患者及家属对护理工作的满意率明显提高。结论:运用循证护理能减少患者并发症的发生,降低病死率,提高生存质量。
ObjectiveTo compare the clinical results between percutaneous poking reduction fixation and open reduction and internal fixation for the displaced Sanders Ⅱ type calcaneal fractures. MethodsA retrospective analysis was made on the clinical data of 122 patients with Sanders Ⅱ type calcaneal fractures between May 2007 and May 2012, who accorded with the inclusion criteria. The closed reduction and percutaneus Kirschner wire fixation were used in 61 patients (closed group), and open reduction and internal fixation were used in 61 patients (open group). There was no significant difference in gender, age, fracture side, weight, height, body mass index, the causes of injury, the fracture type, Böhler angle, Gissane angle, and the time from trauma to operation between 2 groups (P>0.05). The operation time, intraoperative blood loss, hospitalization days, wound complications, fracture healing time, American Orthopaedic Foot and Ankle Society (AOFAS) score, and radiographic results were compared between 2 groups. ResultsThe operation time, intraoperative blood loss, and hospitalization days in closed group were significantly less than those in open group (P<0.05). There was no deep infections in both group; wound dehiscence, skin flap necrosis, and wound infection occurred in 3 patients, 2 patients, and 1 patient of the open group, no wound complication happened in closed group, and there was significant difference in the incidence of wound complications between 2 groups (P=0.027). The patients were followed up 24-68 months (mean, 38.7 months) in the closed group and 26-66 months (mean, 38.7 months) in the open group. There was no significant difference in the fracture healing time between 2 groups (t=-1.562, P=0.121). The Böhler angle and Gissane angle at last follow-up were significantly improved when compared with preoperative angle in the closed group (t=-27.929, P=0.000; t=-26.351, P=0.000) and the open group (t=-32.565, P=0.000; t=-25.561, P=0.000), but there was no significant difference between 2 groups (P>0.05). AOFAS score showed no significant difference between 2 groups (t=-0.492, P=0.624). ConclusionFor the displaced Sanders Ⅱ type calcaneal fractures, the use of closed reduction and percutaneus Kirschner wire fixation or open reduction and internal fixation can both obtain satisfactory clinical function and radiographic results, but the former has the advantage of less trauma, shorter hospitalization time, and fewer wound complications.
Objective To evaluate the operative procedure and the cl inical effectiveness of open reduction and internal fixation in the treatment of posterior malleolus fractures. Methods Between June 2005 and December 2008, 46 patients with posterior malleolus fractures were treated with open reduction and internal fixation and followed up. There were 29 males and 17 females with an average age of 47.7 years (range, 19-76 years). Fractures were caused by sprain in 17 cases, by fallingin 15 cases, by traffic accident in 12 cases, and by other reasons in 2 cases. The locations were left ankle in 25 cases and right ankle in 21 cases. There were 6 simple posterior malleolus fractures, 13 lateral and posterior malleolus fractures, and 22 trimalleolar fractures, and 5 lateral and posterior malleolus fractures accompanying by injury of deltoid l igament of ankle. According to Lauge- Hansen classification system, 13 cases and 9 cases were rated as supination-external rotation type III and type IV respectively, and 18 cases as pronation-external rotation type IV. According to Naoki’s classification of posterior malleolus fractures, there were 29 cases of posterolateral-obl ique type, 11 cases of medial-extension type, and 6 cases of small-shell type. Seven patients underwent emergency operation and 39 patients underwent selective operation. Results Two patients developed superficial infection, which was cured after dressing change, and the other incisions healed by first intention. Forty-six patients were followed up 37 months on average (range, 18-63 months). All fractures healed after 3 to 6 months (mean, 4.3 months). One patient developed lateral suralcutaneous nerve injury, and 9 patients had mild weight-bearing pain or discomfort. The results of American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score were excellent in 17 cases, good in 21 cases, and fair in 8 cases with an excellent and good rate of 83%. The mean visual analogue scale (VAS) score was 1.9 (range, 0-5). Conclusion The anatomic reduction and internal fixation can achieve the satisfactory results in the treatment of posterior malleolus fractures. The best treatment and fixation methods should be chosen based on different types of posterior malleolus fractures.
Objective To evaluate the cl inical results of posterior microendoscopic foraminotomy in the treament of cervical radiculopathy and cervical intervertebral disc protrusion. Methods From February 2004 to June 2007, 24 cases of cervical radiculopathy received posterior microendoscopic foraminotomy. There were 16 males and 8 females, aging 42-68 years (59 years on average), including 16 cases of cervical radiculopathy and 8 cases of cervical intervertebral disc protrusion.The course of disease was 6-15 months. The affected intervertebral discs were C4, 5 in 8 cases, C5, 6 in 12 cases, and C6, 7 in 4 cases. The radiological examinations showed that 8 protrusions included 6 soft tissue protusions and 2 rigid tissue protusions, and that cervical radiculopathy were caused by yellow l igament hypertrophy, Luschka’s joint hyperplasia, and abnormal position of facet joint. According to Japanese Orthopedic Association (JOA), the score before operation was (12.60 ± 1.52) points. Results The operation time was 90 to 120 minutes (100 minutes on average), the bleeding during operation was 100 to 150 mL (120 mL on average). Nerve root pain were rel ieved completely in 19 cases and were rel ieved partly in 4 cases. One case of calcified nucleus pulposus had neurological traction injury and recovered completely after 3 months. All cases were followed up 24-36 months (28 months on average). The radiological examinations after operation showed the intervertebral disc site was decompressed completely and the height of intervertebral disc and the cervical segmental al ignment were normal. At 24 months postoperatively, the JOA score was (16.10 ± 0.29) points, showing significant difference when compared with that of preoperation (P lt; 0.01). Conclusion The posterior microendoscopic foraminotomy can get to the operation site with miniincision, decrease tissue damage during operation, and avoid narrow intervertebral space, so it has satisfactory cl inical results.