Vertebral fractures following stereotactic body radiotherapy for spine metastases

Stereotactic body radiotherapy has emerged as one of the preferred treatments for patients with spine metastases, with the potential for long‐term control from lesion irradiation. Post‐treatment vertebral compression fractures are a known complication of this therapy, contributing to worsening pain and reduced quality of life, sometimes requiring surgical intervention. This review explores the current knowledge of post‐radiotherapy fractures, in terms of the rates and associated predictive factors. A search of databases including Medline, Embase and the Cochrane Library was conducted using keywords such as ‘vertebral compression fracture’, ‘stereotactic body radiotherapy’ and ‘spine metastases’. The search was limited to published studies up to March 2019, reporting clinical outcomes including both the post‐treatment fracture rate and statistical identification of associated risk factors. Rates of post‐treatment fractures ranged from 4 to 39%. A variety of factors were found to increase the risk, including the appearance of lytic vertebral disease, degree of pre‐existing compression, spinal malalignment, increased dose per fraction and a Spinal Instability Neoplastic Score >6. This knowledge can enable clinicians to counsel patients when considering management options for spine metastases, maintaining the balance between local tumour control and the risk of subsequent fracture.     

Acute total hip arthroplasty for older patients with acetabular fractures: A meta-analysis

ObjectiveMultiple treatment options for acetabular fractures in geriatric patients exist. However, no large-scale studies have reported the outcomes of acute total hip arthroplasty (THA) in this patient population. We systematically evaluated all available evidence to characterize clinical outcomes, complications, and revisions of acute THA for acetabular fractures in geriatric patients.MethodsMeta-analysis of 21 studies of 430 acetabular fractures with mean follow-up of 44 months (range, 17−97 months). Two independent researchers searched and evaluated the databases of Ovid, Embase, and United States National Library of Medicine using a Boolean search string up to December 2019. Population demographics and complications, including presence of heterotopic ossification (HO), dislocation, infection, revision rate, neurological deficits, and venous thromboembolic event (VTE), were recorded and analyzed.ResultsWeighted mean Harris Hip Score was 83.3 points, and 20% of the patients had reported complications. The most common complication was HO, with a rate of 19.5%. Brooker grade III and IV HO rates were lower at 6.8%. Hip dislocation occurred at a rate of 6.1%, 4.1% of patients developed VTE, deep infection occurred in 3.8%, and neurological complications occurred in 1.9%. Although the revision rate was described in most studies, we were unable to perform a survival analysis because the time to each revision was described in only a few studies. The revision rate was 4.3%.ConclusionsAcute THA is a viable option for treatment of acetabular fracture and can result in acceptable clinical outcomes and survivorship rates in older patients but with an associated complication rate of approximately 20%. Considering the limited treatment options, THA might be a viable alternative for appropriately selected patients.     

以胸大肌肱骨止点确定肱骨假体高度的临床体会

目的探讨胸大肌肌腱肱骨止点(pectoralismajor tendon,PMT)上缘作为半肩置换术中假体高度定位参考的临床应用。方法2014年1月至2014年12月间行切开解剖复位钢板内固定的肱骨近端骨折病例12例,男4例,女8例;年龄56~72岁,平均(65.3±5.2)岁。测量PMT上缘到肱骨头最高点的平均距离为(5.21±0.42)cm。2015年1月至2018年12月的38例老年严重肱骨近端骨折行半肩置换的患者,参照PMT上缘到肱骨头最高点的距离5.2 cm确定肱骨假体高度,男7例,女31例;年龄60~82岁,平均(72.0±6.5)岁。术后3个月拍摄双侧肱骨全长X线片并测量长度,比较双侧差异是否有统计学意义。根据对侧肱骨长度(humeruslength,HL),采用HL×0.176计算PMT到肱骨头最高点距离,与(5.21±0.42)cm比较差异是否有统计学意义。结果所有患者均随访3个月,半肩置换侧肱骨全长与对侧肱骨全长分别为(32.41±2.47)cm、(31.93±2.82)cm,比较差异无统计学意义。根据对侧HL×0.176计算PMT到肱骨头最高点距离为(5.61±2.82)cm,与(5.21±0.42)cm比较差异无统计学意义。结论PMT可以作为肱骨假体高度的可靠参照,PMT上缘到肱骨头最高点距离为(5.21±0.42)cm,可以作为参考数值之一。     

Evaluation of the short-term results of closed reduction and percutaneous K-wires fixation of displaced intra-articular calcaneal fractures (DIACF)

PurposeOptimum management of displaced intra-articular calcaneal fractures (DIACF) still controversial. Open surgery carries the risk of wound complications, while non-operative management has a high incidence of arthrosis. To avoid these complications, minimally invasive and percutaneous fixation was introduced. The purpose of this study was to prospectively evaluate the short term clinical and radiological outcomes after closed reduction and percutaneous fixation of DIACF using K-wires.Patients and methodsOutcomes of twenty patients were evaluated at the final follow up. A functional assessment using the AOFAS scoring system. Radiological parameters recorded included three angles (Böhler’s, Gissane and posterior facet inclination angles) and three distances (calcaneal length, height and width). Any complications were reported at any follow-up.ResultsThe mean patient’s age was 33 ± 15.2 years, 8 (40%) patients with type II fractures, 10 (50%) patients with type III fractures, and 2 (10%) with type IV fracture according to Sanders classification. After a mean follow-up of 9 months, the mean AOFAS score was 84, excellent in 9 patients (45%), good in 9 (45%), and fair in 2 (10%). At the final follow-up the Böhler’s angle, Gissane angle and PFIA was 25.1° ± (5.2), 119.9° ± (9.4) and 51.7° ± (5.9) respectively and the calcaneal height, length and width was 41.8 mm ± (2.1), 75.1 mm ± (3.01) and 40.9 mm ± (2.6) respectively. We had no cases of deep infection, 20% had significant subtalar arthritis.ConclusionThe closed reduction and percutaneous fixation technique for DIACF management offered acceptable clinical and radiographic outcomes, with fewer complications when compared to other management options.     

锁定钢板联合异体腓骨与锁定钢板单独使用治疗肱骨近端骨折的Meta分析

文题释义：肱骨近端骨折：属于发生率较高的骨折，骨折位置在肱骨外科颈以远1.0-2.0 cm到肱骨头关节面之间，随着人口老龄化的加剧，肱骨近端骨折发生率呈上升的趋势，肱骨近端骨折的最佳治疗方式也存在争议。   锁定钢板联合异体腓骨：依次切开皮肤、组织，暴露肱骨近端，选择合适的异体腓骨插入髓腔，利用同种异体腓骨的支撑作用及克氏针的撬拨作用临时复位肱骨近端骨折处，之后采用合适大小的锁定钢板对骨折端进行固定。 背景：肱骨近端骨折的最佳治疗方式一直存在着争议，其中使用锁定钢板的开放复位内固定是治疗肱骨近端骨折的一种常用方法，近年有许多研究指出锁定钢板联合异体腓骨可以获得更好的刚性结构。 目的：系统评价锁定钢板联合异体腓骨与锁定钢板单独使用治疗肱骨近端骨折的临床疗效。 方法：截止至2020年1月，在中国知网、万方数据库、维普、PubMed、EMBASE、Cochrane Library等数据库收集锁定钢板与锁定钢板联合异体腓骨治疗肱骨近端骨折疗效对比的文献进行质量评价。采用国际Cochrane协作组提供的RevMan 5.0软件进行Meta分析，比较锁定钢板组与锁定钢板组联合异体腓骨组在美国肩肘外科医师学会评分、Constant评分、肱骨头高度丢失值、颈干角变化值、术后并发症总发生率、二次手术率、螺钉切出率及肱骨头坏死率方面的差异。结果与结论：①纳入8项研究，共623例患者；②结果显示，锁定钢板联合异体腓骨和单纯锁定钢板在术后随访末期美国肩肘外科医师学会评分(95%CI：4.29-6.84，P < 0.05)、Constant评分(95%CI：6.46-15.10，P < 0.05)、肱骨头高度丢失值(95%CI：-3.24至-2.07，P < 0.05)、颈干角变化值(95% CI：-7.20至-5.95，P < 0.05)、并发症总发生率(95%CI：0.18-0.51，P < 0.05)及螺钉切出率(95% CI：0.13-0.65，P < 0.05)等方面差异有显著性意义；③但2种方法在二次手术率(95%CI：0.13-1.14，P > 0.05)及肱骨头坏死率(95% CI：0.41-2.11，P > 0.05)等方面差异无显著性意义；④提示锁定钢板联合异体腓骨与单纯锁定钢板治疗肱骨近端骨折在美国肩肘外科医师学会评分、Constant评分、肱骨头高度丢失值、颈干角变化值、术后并发症发生率、螺钉切出率方面更具优势，但在二次手术率及肱骨头缺血性坏死方面没有明显差异。 ORCID: 0000-0003-2626-8833(涂冬鹏) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程     

伤科接骨片联合双氯芬酸钠治疗闭合性足踝部骨折早期肿胀的疗效观察

目的探讨伤科接骨片联合双氯芬酸钠注射液治疗闭合性足踝部骨折早期肿胀的临床疗效。方法选取2016年12月—2017年12月天全县中医医院收治的100例闭合性足踝部骨折患者,按随机数字法分为对照组和治疗组,每组各50例。对照组患者肌肉注射双氯芬酸钠注射液,50 mg/次,2～3次/d。治疗组在对照组治疗的基础上以温开水或温黄酒送服伤科接骨片,4片/次,3次/d。两组患者均连续治疗4d。观察两组的临床疗效,比较两组的临床症状改善情况和视觉模拟评分法(VAS)评分。结果治疗后,对照组和治疗组的总有效率分别为82.00%、90.00%,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组踝关节背伸、踝关节屈曲均明显大于对照组,消肿止痛时间、住院时间均明显短于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者VAS评分均显著降低,同组治疗前后比较差异具有统计学意义(P0.05);且治疗后治疗组患者VAS评分均明显低于对照组,两组比较差异具有统计学意义(P0.05)。结论伤科接骨片联合双氯芬酸钠注射液治疗闭合性足踝部骨折早期肿胀具有较好的临床疗效,可改善临床症状,缓解疼痛,具有一定的临床推广应用价值。     

基于3D软组织打印技术经皮穿刺中上胸椎椎弓根入路椎体成形术导向模板的初步研制

目的:观察数字化导向模板技术和3D软组织打印制作的个体化经皮穿刺中上胸椎椎弓根入路椎体成形术数字化导向模板的可行性。方法:回顾性选择20例中上胸椎骨折患者CT扫描数据。将数据输入3D打印机打印1∶1带软组织胸椎模型,并应用Mimics 15.0软件中3-matic模块设计中上胸椎体表椎弓根钉道及相应导向模板,3D打印机打印导向模板并固定带软组织胸椎模型后置入2.0 mm克氏针,CT扫描观察穿刺针的准确性,通过穿刺管注入骨水泥并用影像学进行验证,记录带软组织中上胸椎模型的打印时间、钉道设计及体表导向模板制作时间以及费用。结果:3D打印的一体化胸椎模型及数字化经皮穿刺中上胸椎椎弓根入路数字化导向模板能够满足中上胸椎经皮穿刺椎体成形术穿刺的要求,导板与皮肤表面贴合良好,骨水泥充盈良好。中上胸椎模型的打印时间及钉道设计、手术导向模板制作时间分别为(719.00±3.03) min,(12.30±1.01) min和(55.50±10.30) min,平均费用约为3 150元。结论:基于3D软组织打印技术的个性化经皮穿刺中上胸椎椎弓根导向模板可实现经皮穿刺的精确置入。     

股骨和胫骨骨干骨折内固定术前测量评估髓内钉长度的研究进展

目的 总结股骨和胫骨骨干骨折内固定术前髓内钉长度测量评估方法的研究进展,为临床应用提供参考。方法 以“股骨”“胫骨”“ 髓内钉长度”“术前测量”以及“femur”“ tibia”“ intramedullary length”“ preoperative measurement”等为中、英文关键词,在中国知网、万方医学、PubMed、Springerlink等中英文数据库中检索2020年5月8日之前公开发表的有关股骨和胫骨骨干骨折内固定术前髓内钉长度测量评估方法研究的相关文献879篇,剔除内容不符、无法获取全文、重复性研究的文献,最终纳入28篇进行总结和分析。结果 检索到有关股骨和胫骨骨干骨折内固定术前髓内钉长度测量评估方法的研究文献相对较少,放射测量和体表标志测量是两种主要的临床应用方法。放射测量往往需要有一个完整的对侧骨骼作为参考,其中X线测量比较常用,CT测量更为准确,但都存在放射暴露等缺点;体表标志测量法无放射暴露,简便易行,但存在测量误差等缺点。结论 术前测量在评估判断髓内钉长度方面显示出很好的应用前景。采用简便的测量方法进行髓内钉固定术的术前计划是我们临床中需要努力的方向。     

Validity of computed tomography in diagnosing midfacial fractures

The aim of this study was to evaluate the sensitivity, accuracy, and reliability of two-dimensional computed tomography (2D-CT) scans (axial, coronal, sagittal planes) and three-dimensional computed tomography (3D-CT) reconstructions in diagnosing midfacial fractures in relation to actual fractures identified clinically and during surgery (gold standard). The imaging diagnosis was performed by a radiologist and an oral and maxillofacial surgeon. Sixty-two patients with a total of 429 midfacial fractures were included. Frontal sinus and nose fractures were easily diagnosed. For the three CT planes, there was a statistically significant difference between the CT examination and the gold standard for five to seven of the nine bones evaluated, while for 3D-CT, a difference was observed only for fractures of the orbital floor. The inter-observer agreement between the oral and maxillofacial surgeon and the radiologist was 75.5%. In conclusion, in this study 3D-CT reconstructions showed significantly the best sensitivity, accuracy, and reliability for the diagnosis of midfacial fractures. The sagittal reconstructions were the least diagnostic of the 2D-CT images. For areas where the parameters studied showed less agreement and hence a more difficult diagnosis, we recommend a combination of 3D and 2D-CT images to improve diagnostic accuracy.