Objective To investigate the cl inical appl ication effect of the new bone harvester. Methods Between August 2006 and October 2009, 112 patients underwent autogenous il iac bone graft and were followed up. There were 71 males and 41 females with a median age of 42 years (range, 11-71 years), including 45 cases of comminuted fracture of the l imbs, 47cases of bone nonunion, and 20 cases of benign bone tumor. According to different methods of bone harvesting, the patients were divided into 5 groups: group A (n=32, with new bone harvester), group B (n=29, with tricortical bone harvester), group C (n=15, with internal lamina harvester), group D (n=23, with external lamina harvester), and group E (n=13, with bicortical il iac bone by saw). There was no significant difference in general data of 5 groups (P gt; 0.05). The incision length, operation time, and peri-operative bleeding volume were compared. At 4 days, 7 days, 60 days, and 1 year postoperatively, the pain degree was assessed using visual analogue scale (VAS), and the incidence rates of peri pheral nerve injury, fracture, haematoma, ventral hernia, il iac crest sag, and chronic pain were observed. Results The incision length and the operation time in group A was shorter than those in other groups, the peri-operative bleeding volume in group A was less than in other groups, the VAS in group A was the lowest among 5 groups, showing significant differences (P lt; 0.05). The occurrence rates of chronic pain and il iac crest sag in group A were lower than those in group B, showing significant differences at 1 year after operation (P lt; 0.01). There was no significant difference in the incidence rates of peripheral nerve injury, fracture, haematoma, ventral hernia, il iac crest sag, and chronic pain between group A and groups C, D, E (P gt; 0.05), and in the incidence rates of peri pheral nerve injury, fracture, haematoma, and ventral hernia between group A and group B (P gt; 0.05). The total compl ication in group A was the lowest among 5 groups, showing significant difference (P lt; 0.05). Conclusion The new bone harvester is minimally invasive bone harvester,which has the advantages of short operation time and incision length, less bleeding volume, low VAS and complications.
Objective To observe the complication after embolizing the bilateral internal il iac arteries and the median sacral artery of dogs by different combinations and embolization levels with gelfoam particle, and to provide a reference for safety appl ication of gelfoam in cl inic. Methods Sixteen common grade adult healthy dogs (weighing 10-13 kg, 14 males and 2females) were randomly divided into 5 groups. Under the monitoring of digital subtraction angiography (DSA), the embolization was performed with gelfoam particle (diameter, 50-150 μm) in bilateral internal il iac arteries and the main branch of the median sacral artery (group A, n=3), in bilateral internal il iac arteries and the first branch of the median sacral artery (group B, n=3), in the main branch of bilateral internal il iac arteries (group C, n=3), in the unilateral internal il iac artery and the main branch of the median sacral artery (group D, n=4), and in the main branch of unilateral internal il iac artery (group E, n=3). Under the DSA, the anatomic relationships of the abdominal aorta, bilateral external il iac arteries, bilateral internal il iac arteries, and median sacral artery were observed before embol ization. The survival dogs were observed and the specimens of bladder, rectum, sciatic nerve, and gluteal muscles were harvested for the general and histological observations at 3 days after embolization. Results In dogs, there was no common il iac artery; bilateral external il iac arteries originated from the abdominal aorta and the starting of the median sacral artery had variation. Seven dogs (3 in group A, 3 in group C, and 1 in group D) died within 2 days after embolization, and the others survived to the end of the experiment. In the dead dogs of groups A, C, and D, the darkening and necrosis of the rectum were observed; the bladder presented lamellar obfuscation and focal hemorrhage and edema; and the median urinary volume in bladder was 270.6 mL. In survival dogs, no obvious change was observed in the rectum; the bladder only manifested l ight edema; and the median urinary volume in bladder was 137.0, 220.5, and 28.0 mL, respectively in groups B, D, and E.The rectum and bladder of dead dogs in groups A, C, and D manifested the disrupted cells, generous inflammatory cells infiltration, and desquamation of epithel ial cells; the rectum and bladder of survival dogs in groups B, D, and E manifested l ight inflammatory cells infiltration and edema; the embol ized artery mainly focused on the arterioles whose diameter was 100-200 μm. The sciatic nerve and gluteal muscles of each group had no obvious change except for l ight edema. Conclusion When the internal il iac artery and median sacral artery are embol ized with gelfoam particle with a diameter of 50-150 μm, to ensure the safeness of pelvic organs, the embol ized artery can not exceed the first branch when the 3 arteries are embol ized at the same time, or reserve at least unilateral internal il iac artery when embol ized to the trunk , or it will result in pelvic organ necrosis and perforation.
Objective To investigate the reasons of failure of Gamma nail treatment for intertrochanteric fractures and define operative techniques of the revision surgery. Methods From January 1999 to January 2008, 20 cases of 432 patients treated with Gamma nails for intertrochanteric fractures were revised. There were 9 males and 11 females, aged 24-87 years (median 65 years). Among them, there were 4 cases of femoral shaft fracture, 2 cases of screw penetrating the femoral head,11 cases of screw cutting out the femoral head and neck, 2 cases of internal rotation malformation, and 1 case of nfection. The operative procedures of revision were as follows: 4 cases were treated with the long Gamma nail, 4 cases by adjusting the position of Gamma nail, 11 cases with artificial femoral head replacement, and 1 case by removing Gamma nail and debriding and reimplant the Gamma nail. Results The hospital ization days were 16-28 days (21.2 days on average); the bleeding volume during operation was 150-600 mL (380 mL on average). All wounds healed by first intention. Bed rest days were 7-15 days (12.5 days on average). All the patients were followed up for 1-8 years (5 years on average). The operations were successful, the femoral intertrochanteric fracture and femoral shaft fracture reached bony union. Compl ications such as loosening, breakage of hardware and coxa adduct were not observed. No loosening and dislocation of the prosthesis occurred. Among the patients with compl ications, 9 patients were treated with a Gamma nail again. Fracture heal ing was achieved within 2 to 5 months, with an average of 3 months. According to the WANG Fang et al. criterion for hip joint function, the results were excellent in 7 cases and good in 2 cases. In 11 patients who receieved artificial femoral head replacement, the hip joint function restored to normal. Harris score was 90-93. Conclusion Various causes such as osteoporosis, ti p-apex distance ( 25 mm), femoral shaft malformation, Gamma nail shortcomings may lead to compl ications after Gamma nail treatment for intertrochanteric fractures. Good results will be achieved by different revision techniques.
Objective To investigate the causes of the vacuum seal ing drainage (VSD) compl ications during treatment of extremity wounds. Methods Between February 2005 and February 2010, 174 patients with skin and soft tissue defect of extremities were treated with VSD. Among them, 12 patients (6.9%) had compl ications and the cl inical data were analyzed retrospectively. There were 7 males and 5 females aged from 17 to 65 years (mean, 36.1 years). Injury was caused bytraffic accident in 8 cases, and by machine extrusion in 4 cases. The locations were forearm in 3 cases, upper arm in 2 cases, thigh and calf in 1 case, calf in 4 cases, and foot in 2 cases. The size of defect ranged from 10 cm × 7 cm to 90 cm × 40 cm. The time from injury to hospital ization was 3-8 hours (mean, 4.2 hours). Results At 1 day postoperatively, moderate to severe anemia and hypokalemia occurred in 6 cases, and the hemoglobin value increased to 100 g/L and the electrolyte disorder was rectified after blood transfusion and fluid infusion. At 2 days, 2 patients had local skin allergic symptoms, and local rash disappeared after oral administration of Clarityne. At 3 days, 2 patients complained pain and the pain was released after the suction pressure was decreased by 50%; 2 patients had infection and received VSD demol ition, debridement and draining, and anti-infection treatment. Tissue necrosis occurred in 1 case at 4 days and pressure ulcer in 1 case at 5 days, VSD was immediately changed and wound was repaired by spl it thickness skin graft or local flap. Conclusion Compl ications associated with VSD therapy for the wounds of the extremities are not very common. Most causes are related to the location of wound, the technique of the operators, and the conditions of the patients.
Objective To investigate the causes and the measures for prevention and management of compl ications of supracondylar fracture of the humerus. Methods In 203 cases of supracondylar fracture of the humerus treated from July2002 to July 2008, 49 cases had compl ication, whose data were retrospectively analyzed. There were 32 males and 17 females with an average age of 9 years(range 2-14 years). Fracture was caused by tumble in 38 cases, by fall ing from height in 4 cases, and by traffic accident in 7 cases. All cases were closed fractures. According to Gartland typing for supracondylar fracture of the humerus, there were 10 cases of type II and 39 cases of type III. Compl ications included 21 cases of vascular injuries, 10 cases of neural injuries, and 3 cases of osteofascial compartment syndrome. The time from injury to operation was 1-25 days. Closed reduction was given in 13 cases, closed reduction plus percutaneous K-wire fixation in 21 cases, and open reduction plus K-wire fixation in 15 cases. After reduction, plaster external fixation was performed. The cases of manipulation which blood circulation could not improve underwent incision to exploration of blood vessel. Two cases of neural injuries were treated with incision decompression of epineurium. Three cases of osteofascial compartment syndrome were treated with incision decompression, and the incision was sutured after 7-10 days. Results All incisions healed by first intention. The duration of follow-up was 1-5 years with an average of 3.4 years. Fracture heal ing was achieved within 4-8 weeks. All vascular injuries and 9 cases of neural injures recovered thoroughly. Poor function occurred in 1 case of median nerve injury and Volkmann ischemic contracture in 1 case of osteofascial compartment syndrome. Cubitus varus deformity was found in 11 cases and myositis ossificans in 4 cases within 3 months to 1 year. According to Flynn standard of the function of elbow, the results were excellent in 21 cases, good in 7cases, fair in 3 cases, poor in 18 cases. Conclusion Early reduction is the key for prevention of further vascular injury, nerve injury and osteofascial compartment syndrome. Operation is essential when expectant treatment inval id. Satisfactory reduction, good fixation and functional rehabil itation are key points for preventing cubitus varus deformity.
Objective To investigate the etiology, diagnosis, and treatment of acute carpal tunnel syndrome (ACTS) after reduction of Colles’ fracture. Methods Between December 2006 and June 2010, 22 patients with ACTS after reduction of Colles’ fracture were treated with expectant treatment and surgical treatment. There were 9 males and 13 females with an average age of 46.2 years (range, 23-60 years). Fractures were caused by traffic accident in 9 cases, fall ing in 8 cases, fall ing from height in 2 cases, hitting in 2 cases, and crushing in 1 case. The mechanism of fracture was direct violence in 3 cases and indirect violence in 19 cases. According to Gartland ＆ Werley classification, there were 2 cases of type I, 5 cases of type II, 14 cases of type III, and 1 case of type IV. Closed reduction was performed in 19 cases and open reduction and internal fixation (ORIF) in 3 cases. The average symptom time of ACTS after reduction of Colles’ fracture was 11.6 hours (range, 1 hour 30 minutes to 48 hours) in patients undergoing closed reduction and was 24 hours in 1 patient and 2 weeks in 2 patients undergoing ORIF. Expectant treatment was performed first, the forearms were put in neutral position in closed reduction cases; if there was no rel ief of ACTS symptom 1 week later, the mixture of 1 mL glucocorticosteroid and 1 mL 2% l idocaine was injected into carpal tunnel once a week for 2 weeks. The mixture was injected into carpal tunnel directly once a week for 2 weeks in ORIF cases. In the patients who failed to expectant treatments, ORIF was performed. Results In 7 cases of type III that failed expectant treatment, ACTS symptoms were rel ief completely after ORIF. All the 22 patients were followed up 12 months on average (range, 8-18 months). The average time of complete disappearance of median nerve compression symptom was 11 days (range, 2-25 days). All the patients had normal finger motion, sensation, and opposition of thumb with no sensation of anaesthesia and pinprick. The results of Tinel test, Phalen test, and Reverse Phalen test were all negative. The X-ray film showed good fracture reduction and heal ing with an average heal ing time of 6 weeks (range, 3-14 weeks). According to GU Yudong’s criteria for functionalassessment, the results were excellent in 18 cases and good in 4 cases; the excellent and good rate was 100%. Conclusion Malposition, displacement of fracture fragments, and ulnar deviation of the wrist after plaster immobil ization are the mostimportant risk factors for ACTS. Expectant treatments are recommended in patients with Colles’ fracture of types I, II, and IV,but surgical treatment is the first choice for Colles’ fracture of type III.
Objective To investigate the donor-site compl ications of the anterolateral thigh flap and its influencing factors. Methods Between July 1988 and July 2007, 427 patients were treated with anterolateral thigh flap. Among them, 33 patients had postoperative donor-site compl ications and their cl inical data were analyzed retrospectively. There were 21 malesand 12 females aged 14-47 years old (average 32.7 years old). The size of the wound defect ranged from 16 cm × 7 cm to 28 cm × 13 cm. The area of the flap harvested during operation ranged from 16 cm × 7 cm to 30 cm × 13 cm. The donor sites were treated by direct suture in 7 cases; free spl it-thickness skin graft in 23 cases, and reverse superficial epigastric artery flap repair in 3 cases. The size of graft in the donor site ranged from 10 cm × 5 cm to 18 cm × 8 cm. The occurrence of short-term (within 4 weeks) and long-term (over 6 months) compl ications were analyzed. Results All patients were followed up for 8-54 months (average 21 months). There were 26 patients (78.8%) with short-term and long-term compl ications and 7 patients (21.2%) with long-term compl ications. The short-term compl ications included skin graft necrosis in 23 cases (69.7%), wound infection in 17 cases (51.5%), and muscle necrosis in 2 cases (6.1%). The long-term compl ications included non-heal ing wounds in 21 cases (63.6%), serious scar in 28 cases (84.8%), discomfort in 25 cases (75.8%), and dysfunction of the quadriceps femoris in 16 cases (48.5%). Conclusion The occurrence of anterolateral thigh flap donor-site compl ications is related to the anatomical structure of the anterolateral thigh region, the surgical procedure, and the patient’s physique.
Objective To investigate the causes and managements of acetabular fracture during primary total hip arthroplasty (THA). Methods Between May 2005 and July 2008, 9 patients (9 hi ps) suffered from acetabular fractures during primary THA. There were 1 male and 8 females with an average age of 63.3 years (range, 41-73 years), including 4 cases of developmental dysplasia of the hip, 2 cases of rheumatoid arthritis, 1 case of old femoral neck fracture, 1 case of avascular necrosis of femoral head, and 1 case of ankylosing spondyl itis. Three left hips and 6 right hips were involved. The preoperative Harris score was 40.4 ± 2.9. All the patients underwent cementless THA. Among nine acetabular fractures, 8 fractures were stable (2 anterior wall fractures and 6 posterior wall fractures), which were fixed by additional augmentation screws in 7 cases and accepted no special treatment in 1 case; 1 fracture was unstable (posterior wall fracture with posterior column incomplete fracture), which was treated by bone grafting and additional screws. Results The postoperative X-ray films showed that the position of the prosthesis were favorable. All incisions healed by first intention without early compl ication. Nine patients were followed up 1-4 years (mean, 2 years and 7 months). The Harris score was 87.8 ± 3.9 at last follow-up, showing significant difference when compared with the preoperative score (t=44.904, P=0.000). The X-ray films showed fracture heal ing at 8 weeks. No loosening occurred. Conclusion When primary THA is performed, the preoperative X-ray film should be studied and measured carefully, operation should be accurate and violence should be avoided. The diameter of the acetabular component should be equal to the diameter of a drill or not larger than 2 mm. In patients with severe osteoporosis, the diameter of the acetabular components should be the same diameter as a drill and additional screws are used to fix, or cemented cup is used. Once an acetabular fracture occurs during the primary THA, additional screw or bone grafting with additional screws should be chosen according to the fracture type and stabil ity, and good cl inical results can be expected.
【Abstract】 Objective To explore the cause of the perioprative period compl ication of scandinavian total anklereplacement(STAR) and to summarize the experience in the treatment and prevention. Methods From March 1999 toNovember 2006, 35 patients were given total ankle replacement(TAR) with STAR system. There were 19 males and 16 femaleswith an average age of 50.5 years (27 to 68 years), including 12 cases of posttraumatic arthritis, 8 cases of osteoarthritis and 15cases of rheumatoid arthritis. All patients had pain of ankle joint, swell ing and l imitation of joint motion. The disease coursewas 9-64 months. The curative effect was estimated by Kofoed total ankle scoring system. The mean preoperative ankle scorewas 29(6-48); the mean pain score was 18.3(0-35); the mean function score was 11.7(6-18); and the mean activity score was9.2(3-12). The type of all compl ications were record, and its cause, prevetion and treatment were analyszed. Results Thirtythreepatients achieved heal ing by first intention, 2 achieved delayed union because of infection. Twenty-eight patients werefollowed up 3-80 months (mean 43.5 months). Medial malleolus fracture occurred in 2 cases, unstable ankle joint introversion in2 cases, l imitation of ankle dorsiextension in 1 case and 1 case had hypoesthesia at intermediate dorsal skin of foot and 3rd-5thmetatarsal skin without obvious dysfunction; all were treated with symptomatic medication. The postoperative mean ankle scorewas 85.5 (58-95); the mean pain score was 48.3(35-50); the mean function score was 20.7(18-30); the mean activity score was17.2(16-20). There were statistically significant differences when compared with preoperative score(P lt; 0.01). The cl inical resultswere excellent in 16 patients, good in 9 patients and fair in 3 patients. The X-ray films showed no loosening and subsidence ofprosthesis. Conclusion Although STAR can retain the functions of the operated joint, it has its special compl ications. It isimportant to obey operation principle with proficient operative technique, to strictly control surgical indication and to intensifyperioperative period treatment so as to decrease the compl ications.
Objective To review and investigate the compl ication and the treatment in Nuss procedure for correction of pectus excavatum. Methods From September 2005 to March 2009, 221 patients with pectus excavatum were treated withNuss procedure, including 189 males and 32 females and aging 2 years old and 10 months to 25 years old (median 8 years and 7 months old). Of 18 patients with recurrent pectus excavatum, 12 patients underwent a Ravitch procedure and the recurrence time of the depression after the first operation was less than 1 year in 2 patients, 1-3 years in 3, 3-5 years in 5, and over 5 years in 2; 6 patients underwent a stemotumover operation and the recurrence time of the depression after the first operation was less than 1 year in 2 patients, 1-3 years in 1 and 3-5 years in 3. The other 203 patients had a primary Nuss procedure, and the course of disease was from 18 months to 24 years. The preoperative CT scan showed the Haller index was 4.36 ± 1.34. Results The operation in all the patients were performed successfully without compl ications of death, massive hemorrhage and intrathoracic organ injury. The time of operation was 25-80 minutes (mean 40 minutes). The bleeding volume during procedure was 5-25 mL, with an average of 10 mL. Local allergy occurred in 3 cases after 7-10 months of operation, wound reject reaction in 2 cases after 3 and 11 months respectively, and effusion in 3 cases after 6-10 months; incision healed after dressing change. Incision healed primarly in the other patients. Pneumothorax occurred in 3 cases when the operation finished and in 7 cases after 2-4 days, pleural effusion in 4 cases after 3-5 days of operation, Nuss plate displacement in 2 cases after 3 days and 9 months, respectively. The patients having compl ication recovered well after treatment. The compl ication rate was about 8.72% (17/195). The followupperiod was 2-37 months for 195 patients. The postoperative Haller index was 2.52 ± 0.32 after 3 months of operation, showing statistically significant difference when compared with that before operation (P lt; 0.05). Conclusion Nuss procedure with non-thoracoscopic assistance for correction of pectus excavatum is safe because of less trauma and compl ication.