Objective To evaluate the surgical treatment and its results of complex tibial plateau fractures.Methods From May 2003 to November 2004, 24 cases of complex tibial plateau fractures were treated by two-incision approaches. There were 16 males(including 1 case of bilateral), and8 females, with mean age of 40.6 years(21-65 years), eleven fractures occurred in left extremity and 14 in the right. No patients suffered open fractures. Fracture was caused by fall from height in 10 cases, by traffic accident in 12 cases and by another causes in 2 cases. According to Schatzkerclassification, type Ⅴ fracture was found in 14 extremities，type Ⅵ in 11 extremities. All cases were operated with twoincision approaches and double-plates fixation. The operation was performed 6-15 days after injury with mean 10.4 days. Results All cases were followed up from 12 to 23 months (mean 15.6 months). Time of the bone healing was 69 months, with mean 7.4 months. No reduction of anatomy was achieved because of comminuted fractures of articular surfaces in 2 limbs. The line of the lower extremity did not recover because of metaphysis comminution in 1 limb, which led to knee varus. Epidermal necrolysis was observed in 3 limbs, and the wound healedafter change dressing. The function of the knee wasevaluated according to Rasmussen’s criteria, the results were excellent in 10limbs, good in 8 limbs, fair in 3 limbs, and poor in 4 limbs. Conclusion The twoincision approaches reduced the complication of softtissueinjury, which is conductive to reduction of articular surface. Double-plates provide a sufficient internal fixation. It can permit early motion of knee joint. Therefore, two-incision approach are an effective surgical approach of treatment of complex tibial plateau fractures.
Objective To review the research progress of graphene and its derivatives in repair of peripheral nerve defect. Methods The related literature of graphene and its derivatives in repair of peripheral nerve defect in recent years was extensively reviewed. Results It is confirmed by in vitro and in vivo experiments that graphene and its derivatives can promote cell adhesion, proliferation, differentiation and neurite growth effectively. They have good electrical conductivity, excellent mechanical properties, larger specific surface area, and other advantages when compared with traditional materials. The three-dimensional scaffold can improve the effect of nerve repair. Conclusion The metabolic pathways and long-term reaction of graphene and its derivatives in the body are unclear. How to regulate their biodegradation and explain the electric coupling reaction mechanism between cells and materials also need to be further explored.
Objective To explore the shortcomings of the traditional clinical probation teaching mode, propose and implement the interactive teaching mode, so as to stimulate the students’ interest in knowledge and achieve better teaching effects. Methods The students of Grade 2017 who had clinical probation in the Orthopaedic Trauma Center of West China Hospital of Sichuan University from September 2020 to December 2021 were selected. Students were randomly divided into traditional clinical probation teaching mode group and interactive teaching mode group according to random number table method. Wechat mini program anonymous questionnaire survey was used to evaluate students’ satisfaction with the interactive teaching model of orthopaedic trauma and the teaching effect. Results A total of 110 students were enrolled, 55 in the traditional clinical probation teaching mode group and 55 in the interactive teaching mode group. There was no significant difference in gender or age between the two groups (P>0.05). The students in the interactive teaching mode group were better than those in the traditional clinical probation teaching mode group in orthopedic theory test (90.13±3.65 vs. 88.39±3.74; t=2.469, P=0.015) in the orthopedic theory test, teacher evaluation (89.15±2.94 vs. 87.56±3.12; t=2.751, P=0.007) and student self-evaluation (89.07±3.18 vs. 87.41±2.89; t=2.865, P=0.005). The teaching satisfaction of the interactive teaching group was higher than that of the traditional teaching group (96.36% vs. 87.27%; Z=−2.159, P=0.031). Conclusion Interactive teaching mode can effectively stimulate students’ interest in knowledge seeking, improve the enthusiasm and interaction of clinical probation, and effectively improve the satisfaction of undergraduate orthopaedic trauma clinical probation teaching.
ObjectivesTo systematically review the efficacy and safety of tranexamic acid (TXA) in reducing blood transfusion and total blood loss in patients undergoing orthopaedic trauma surgery.MethodsA systematic literature search was performed using PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases. A search for grey literature was also performed in American Academy of Orthopaedic Surgeons (AAOS) and Orthopaedic Trauma Association (OTA). The search time was up to June 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias, then meta-analysis was performed by using RevMan 5.3 and Stata 14.0 softwares.ResultsA total of 10 studies were included, including 936 patients. The pooled results indicated that TXA group was superior to the control group in blood transfusion (RR=0.75, 95%CI 0.63 to 0.89, P=0.001), the total blood loss (MD=–157.61, 95%CI –250.09 to –65.13, P=0.000 8) and the wound complications (RR=0.24, 95%CI 0.10 to 0.58, P=0.002). There was no significant difference in risk of thromboembolic events (RR=1.25, 95%CI 0.78 to 2.00, P=0.36) and the mortality (RR=0.81, 95%CI 0.40 to 1.66, P=0.57) between TXA and control group.ConclusionsTXA can effectively reduce blood transfusion, total blood loss and wound complications in patients undergoing orthopedic trauma surgery. Furthermore, TXA does not significantly increase the incidence of thromboembolic events and mortality. Due to the limited quality of included studies, more high quality studies are required to verify the above conclusions.
ObjectiveTo systematically review the efficacy and safety of operative treatment versus nonoperative treatment in patients with adult spinal deformity (ASD).MethodsPubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, WanFang Data, and CQVIP databases were searched for controlled studies about operative treatment versus nonoperative treatment for ASD published up till June 2019. ClinicalTrials.gov was searched for grey literatures informally published up till June 2019. Two reviewers independently screened literatures, extracted data, and assessed risk of bias. Meta-analysis was performed by using RevMan 5.3 and Stata 14.0 softwares.ResultsA total of 10 non-randomized controlled studies were included, including 1 601 patients. The pooled results indicated that the operative group was superior to the nonoperative group in ability improvement [the increment of Scoliosis Research Society-22 score: weighted mean difference (WMD)=0.70, 95% confidence interval (CI) (0.69, 0.70), P<0.000 01; the decrement of Oswestry Disability Index score: WMD=11.12, 95%CI (10.74, 11.50), P<0.000 01], pain relief [the decrement of Numeric Rating Scale score: WMD=3.25, 95%CI (3.16, 3.35), P<0.000 01], and Cobb correction [WMD=14.06°, 95%CI (13.60, 14.53)°, P<0.000 01]. The incidence of complications was higher in the operative group than that in the nonoperative group [relative risk=5.38, 95%CI (3.67, 7.88), P<0.000 01].ConclusionsSurgery shows superior efficacy on ability improvement, pain relief, and Cobb correction compared with nonoperative treatment in ASD patients, though its incidence of complications is high. Nonoperative treatment is also an effective treatment for patients with poor physical condition and intolerance to surgery. Due to the limited quantity and quality of included studies, more high-quality studies are required to verify the above conclusions.
目的 探讨锁骨钩钢板并改良Weaver-Dunn技术治疗Tossy Ⅲ型陈旧性肩锁关节脱位的疗效。 方法 2007年１月－2011年１月，对12例Tossy Ⅲ型陈旧性肩锁关节脱位采用锁骨钩钢板并改良Weaver-Dunn技术治疗。其中3例为肩锁关节脱位手术后再次发生脱位，2例合并锁骨远端骨折采用保守治疗无效，余7例单纯性陈旧性肩锁关节脱位未经任何检查治疗。 结果 术后患者切口均Ⅰ期愈合，无神经血管损伤、无切口感染等并发症。12例均获随访，随访时间12～30个月。X线片示锁骨复位情况良好，去除内固定后未见肩锁关节脱位复发。肩锁关节功能好，局部畸形消失，无肩周肌肉萎缩及肩周炎出现，锁骨位置良好。手术疗效评价：获优10例，良2例，优良率100%。 结论 锁骨钩钢板并改良Weaver-Dunn技术治疗Tossy Ⅲ型陈旧性肩锁关节脱位，复位固定满意，韧带重建易成功，肩关节功能恢复好，是一种治疗陈旧性肩锁关节脱位较理想的方法。
Objective To study the outcomes of nerve defect repair with the tissue engineered nerve, which is composed of the complex of SCs, 30% ECM gel, bFGF-PLGA sustained release microspheres, PLGA microfilaments and permeable poly (D, L-lacitic acid) (PDLLA) catheters. Methods SCs were cultured and purified from the sciatic nerves of 1-day-old neonatal SD rats. The 1st passage cells were compounded with bFGF-PLGA sustained release microspheres andECM gel, and then were injected into permeable PDLLA catheters with PLGA microfilaments inside. In this way, the tissueengineered nerve was constructed. Sixty SD rats were included. The model of 15-mm sciatic nerve defects was made, and then the rats were randomly divided into 5 groups, with 12 rats in each. In group A, autograft was adopted. In group B, the blank PDLLA catheters with PBS inside were used. In group C, PDLLA catheters, with PLGA microfilaments and 30% ECM gel inside, were used. In group D, PDLLA catheters, with PLGA microfilaments, SCs and 30% ECM gel inside, were used. In group E, the tissue engineered nerve was appl ied. After the operation, observation was made for general conditions of the rats. The sciatic function index (SFI) analysis was performed at 12, 16, 20 and 24 weeks after the operation, respectively. Eelectrophysiological detection and histological observation were performed at 12 and 24 weeks after the operation, respectively. Results All rats survived to the end of the experiment. At 12 and 16 weeks after the operation, group E was significantly different from group B in SFI (P lt; 0.05). At 20 and 24 weeks after the operation, group E was significantly different from groups B and C in SFI (P lt; 0.05). At 12 weeks after the operation, electrophysiological detection showed nerve conduct velocity (NCV) of group E was bigger than that of groups B and C (P lt; 0.05), and compound ampl itude (AMP) as well as action potential area (AREA） of group E were bigger than those of groups B, C and D (P lt; 0.05). At 24 weeks after the operation, NCV, AMP and AREA of group E were bigger than those of groups B and C (Plt; 0.05). At 12 weeks after the operation, histological observation showed the area of regenerated nerves and the number of myel inated fibers in group E were significantly differents from those in groups A, B and C (Plt; 0.05). The density and diameter of myel inated fibers in group E were smaller than those in group A (Plt; 0.05), but bigger than those in groups B, C and D (P lt; 0.05). At 24 weeks after the operation, the area of regenerative nerves in group E is bigger than those in group B (P lt; 0.05); the number of myel inated fibers in group E was significantly different from those in groups A, B, C (P lt; 0.05); and the density and diameter of myel inated fibers in group E were bigger than those in groups B and C (Plt; 0.05). Conclusion The tissue engineered nerve with the complex of SCs, ECM gel, bFGF-PLGA sustained release microspheres, PLGA microfilaments and permeables PDLLA catheters promote nerve regeneration and has similar effect to autograft in repair of nerve defects.
Objective To observe the effectiveness of posterior approaches for the treatment of posterior coronal fractures of tibial plateau, and to analyze the fracture morphology, radiographic features, and the recognition of Schatzker classification. Methods Between June 2003 and June 2009, 23 patients with posterior coronal fractures of tibial plateau were treated surgically by posterior approaches. There were 15 males and 8 females with an average age of 38 years (range, 32-56 years). All patients had closed fractures. Fracture was caused by traffic accident in 15 cases, by sports in 3 cases, and by falling from height in 5 cases. According to Moore classification, there were 10 cases of type I, 9 cases of type II, and 4 cases of type IV. The X-ray films, CT scanning, and three-dimensional reconstruction were performed. The time from injury to operation was 3-14 days (mean, 6 days). Results After operation, 17 cases had anatomical reduction and 6 had normal reduction. Incisions healed by first intention. All cases were followed up 12 to 36 months (mean, 24 months). The average fracture healing time was 7.6 months (range, 6-9 months). No related complication occurred, such as nerve and vessel injuries, failure in internal fixation, ankylosis, traumatic osteoarthritis, and malunion. According to Rasmussen’s criteria for the function of the knee, the results were excellent in 14 cases, good in 7 cases, and fair in 2 cases with an excellent and good rate of 91.3%. Conclusion Posterior coronal fracture of tibial plateau is rare, which has distinctive morphological features, and Schatzker classification can not contain it totally. The advantages of posterior approach include reduction of articular surface under visualization, firm fixation, less complications, and earlier functional exercise, so it is an ideal surgical treatment plan.
Objective To evaluate the effect of minimally invasive dynamic hip screws (MIDHS) in treating aged intertrochanteric fractures. Methods From April 2006 to March 2008, 49 aged patients with intertrochanteric fractures were treated with MIDHS. There were 22 males and 27 females, aged 65-78 years (average 70.2 years). Frature was caused by trafficaccident in 7 cases, by fall ing from height in 3 cases, and by injury from fall in 39 cases. The time from injury to operation was 2-12 days (average 5.5 days). According to Evans classification, there were 28 cases of types I, II (stable fracture) and 21 cases of types III, IV (unstable fracture). If the Singh index≤3 was defined as osteoporosis, the osteoporotic rate was 71.4% (35/49). All patients were on a radiolucent fracture traction table and their fractures had satisfactory closed reduction. After the guide wire was inserted and reamed under fluoroscopy, the lag screw and side plate were introduced through the small incision. In all unstable fractures, an additional, antirotational and large cancellous bone screw was used cranial to the DHS. Results The average operation time was 65.2 minutes. The average blood loss was 189.3 mL. All patients had satisfactory reduction and 79.6% (39/49) had adequate lag screw positions. The average postoperative hospital ization days was 5.8 days (3-12 days). All incision healed at stage I. There was no postoperative complications. Forty-nine patients were followed up 12 to 30 months (average 19.8 months). Fractures healed within 16 weeks in 47 patients and the average healing time was 13.1 weeks (12-16 weeks). The average Harris scoring was 90.8 (75-95). Implant failure and nonunion occurred in 2 cases, no serious compl ication occurred in other patients. Conclusion The MIDHS is a simple, safe and effective method for treatment of aged intertrochanteric fractures.
Objective To investigate the operative method and to evaluate the cl inical outcome of proximal femoral nail antirotation (PFNA) in treating reverse obl ique fractures of intertrochanteric region of the femur. Methods From January 2007 to February 2008, 30 cases of reverse obl ique fractures of intertrochanteric region of the femur were treated by closed reduction and fixation with PFNA, including 14 males and 16 females and aging 40-88 years old with an average of 68.6years old. All patients had closed fractures. According to AO classification, there were 6 cases of 31-A3.1 type, 7 cases of 31-A3.2 type and 17 cases of 31-A3.3 types. The time from injury to operation was 2-14 days (with an average of 5.3 days). All 31-A3.1 and 31-A3.2 type farctures and 9 cases of AO 31-A3.3 type fractures were fixed with the standard PFNA, and 8 cases of 31-A3.3 type fractures with the PFNA-long. The cl inical and radiological examinations were done at 1, 2, 3, 6, 12, and 18 months after operation. The cl inical outcomes were evaluated according to the Sanders scoring. Results Iatrogenic fracture of femoral shaft occurred in 1 case; no additional procedures were appl ied as fracture kept favorable stabil ity. Superficial infection occurred in 1 case at 5 days after operation, wound healed after dressing change and intravenous antibiotic therapy. Other wounds healed by first intention. All cases were followed up for 12-19 months (mean 14.1 months). All fractures healed uneventfully after 12-30 weeks (mean 16.2 weeks). Five patients complained of hip pain, 2 patients had lateral leg pain, and the pain was el iminated after symptomatic treatment. One case compl icated by ipsilateral fracture of the tibial plateau had functional disturbance of knee, and one case compl icated by ipsilateral fracture of the acetabulum and pelvis had functional disturbance of hip, and the function was improved after functional exercise. No compl ications such as cut-out or breakage of the implants occurred. According to Sanders criteria, the cl inical results were excellent in 22 cases, good in 6 cases, and poor in 2 cases. The excellent and good rate was 93.3%. Conclusion PFNA is an effective treatment method for reverse obl ique fractures of intertrochanteric region of the femur, with a high rate of bone union, minor soft tissue damage, early functional exercise and acceptable compl icationrelated to implant.