Posterior-Stabilized Antibiotic Cement Articulating Spacer With Endoskeleton-Reinforced Cam Reduces Rate of Post-Cam Mechanical Complications in Prosthetic Knee Infection: A Preliminary Study

BackgroundPosterior-stabilized antibiotic cement articulating spacers (PS spacers) reduce spacer mechanical complications in prosthetic knee infections (PKIs); however, joint dislocation after femoral cam fracture has been reported. We hypothesized that the rate of post-cam mechanical complications is lower in PS spacers with an endoskeleton-reinforced cam.MethodA retrospective study of PKIs using PS spacers with or without a Kirschner wire–reinforced cam (K-PS or nK-PS spacers, respectively) was conducted between 2015 and 2019. The rates of post-cam mechanical complications and reoperation, as well as risk factors for post or cam failure, were analyzed.ResultsThe cohort included 118 nK-PS and 49 K-PS spacers. All patients were followed up for 2 years. The rate of joint subluxation/dislocation after femoral cam fracture was lower in K-PS (0%) than in nK-PS spacers (17.8%; P = .002). The reoperation rate for spacer mechanical complications was lower in K-PS (0%) than in nK-PS spacers (11.9%; P = .008). The identified risk factors for femoral cam fractures were body mass index ≥25 kg/m², femoral spacer size ≤2, and surgical volume ≤12 resection arthroplasties per year.ConclusionThis preliminary study highlights that K-PS spacers have a lower rate of post-cam mechanical complications than nK-PS spacers. We recommend the use of PS spacers with endoskeleton-reinforced cam when treating PKIs performed by surgeons with lower surgical volumes, especially in patients with higher body mass index and smaller femoral spacer sizes.     

Survival Rate and Application Number of Total Hip Arthroplasty in Patients With Femoral Neck Fracture: An Analysis of Clinical Studies and National Arthroplasty Registers

BackgroundTotal hip arthroplasty (THA) is an increasingly popular treatment option for fractured neck of femur (NOF). The primary aim of this study is to systematically review all literature on primary THA and hemiarthroplasty (HA) after fractured NOF to calculate an overall revision rate. Furthermore, we wanted to compare primary THA implantations after fractured NOF between different countries in terms of THA number per inhabitant.MethodsAll clinical studies on THA and HA for femoral neck fractures between 1999 and 2019 were reviewed and evaluated with a special interest on revision rate. Revision rate was calculated as “revision per 100 component years.” THA registers were compared between different countries with respect to the number of primary implantations per inhabitant.ResultsTHA studies showed a mean revision rate of 11.8% after 10 years, which was lower than a 24.6% 10-year revision rate for HA. We identified 8 arthroplasty registers that revealed an annual average incidence of THA for fractured NOF of 9.7 per 100,000 inhabitants.ConclusionThis study showed that patients with THA were less likely to be revised at 10 years compared to HA. We found similar annual numbers of THAs for fractured NOF per inhabitant across countries. The results of this analysis can be used to rank present and future national THA numbers within an international context.     

补肾壮骨汤对骨质疏松型胸腰椎压缩骨折患者椎体成形术治疗效果影响的Meta分析

[目的]采用Meta分析法系统评价补肾壮骨汤对椎体成形术治疗骨质疏松型胸腰椎压缩骨折(OTCF)临床的影响。[方法]以"补肾壮骨汤"为首输关键词,以"椎体成形术""骨质疏松""胸腰椎压缩骨折"等为次输关键词,全面搜索补肾壮骨汤对OTCF患者椎体成形术治疗效果影响的随机对照研究文献,评价纳入研究文献的一般特征,对文献资料所提取的治疗有效率、骨密度、Oswestry功能障碍(ODI)指数、治疗安全性(新发骨折率)等观察指标进行Meta分析处理与分析。[结果]共13篇文献纳入Meta分析范畴,文献总样本量1 037例。分析显示,与对照组相比,治疗组可明显提高临床有效率[OR=4.63,95%CI[2.92,7.36],P0.000 01]、改善骨密度[MD=0.08,95%CI[0.06,0.1],P0.000 01]、降低ODI指数[MD=-2.34,95%CI[-3.49,-1.19],P0.000 01]、降低新发骨折率[OR=0.08,95%CI[0.11,0.44],P0.000 01]。[结论]与单纯椎体成形术治疗相比,补肾壮骨汤辅助椎体成形术在OTCF患者治疗中,可提升患者术后骨密度、改善胸腰椎功能障碍和降低术后新发骨折率,治疗疗效确切。     

研究分析交锁髓内钉内固定术对创伤性下肢长管状骨骨折的治疗效果

目的研究分析交锁髓内钉内固定术对创伤性下肢长管状骨骨折的治疗效果。方法将2017年4月-2018年4月本院收治的180例创伤性下肢长管状骨骨折患者进行本次研究,按挂号先后顺序均分为参照组和观察组,各90例。参照组用钢板内固定术治疗,观察组用交锁髓内钉内固定术治疗,比较两组的愈合情况和并发症发生情况。结果治疗后,参照组的愈合情况显著差于观察组;参照组的并发症发生情况高于观察组,采用有统计学意义(P<0.05)。结论交锁髓内钉内固定术对创伤性下肢长管状骨骨折的治疗有非常好的效果,保障了患者的恢复情况,减少了患者治疗后的并发症情况。     

中西医结合护理对四肢远端骨折术后恢复的影响

目的:观察中西医结合护理对四肢远端骨折术后恢复的影响。方法:选取88例四肢远端骨折术后患者,按随机数字表法分为对照组与观察组各44例。对照组行常规护理,观察组行中西医结合护理,比较2组术后疼痛程度、肢体功能恢复情况及并发症发生率。结果:术后1 d,2组VAS评分比较,差异无统计学意义(P>0.05)。术后3 d、7 d,2组VAS评分均较术后1 d降低(P<0.05),观察组VAS评分均低于同期对照组(P<0.05)。观察组肢体功能恢复优良率86.36%,高于对照组的68.18%,差异有统计学意义(P<0.05)。观察组术后并发症发生率11.36%,低于对照组的29.55%,差异有统计学意义(P<0.05)。结论:中西医结合护理可有效缓解四肢远端骨折患者术后疼痛度,提升肢体功能恢复效果,减少并发症发生。     

Is computed tomography cystography indicated in children with pelvic fractures?

Purpose: Pelvic fracture evaluation with abdominopelvic computed tomography (CT) and formal CT cystography for rule out of urine bladder injury have been commonly employed in pediatric trauma patients. The additional delayed imaging required to obtain optimal CT cystography is, however, associated with increased doses of ionizing radiation to pelvic organs and represent a significant risk in the pediatric population for future carcinogenic risk. We hypothesized that avoidance of routine CT cystography among pediatric pelvic fracture victims would not result in an appreciable rate of missed bladder injuries and would aid in mitigating the radiation exposure risk associated with these additional images. Methods: A retrospective cohort study involving blunt trauma pelvic fractures among pediatric trauma patients (age<14) between the years 1997 and 2016 was conducted utilizing the Israeli National Trauma Registry. Statistical analysis was performed using SAS statistical software version 9.4 via the tests of Chisquare test and two-sided Fisher''s exact test. A p value of less than 0.05 was considered statistically significant. Results: A total of 1072 children were identified from the registry for inclusion. Mean age of patients was 7.7 years (range 0-14) and 713 (66.5%) were male. Overall mortality in this population was 4.1% (44/1072). Only 2.1% (23) of pediatric patients with pelvic fractures had bladder injury identified, with just 9 children having intraperitoneal bladder rupture (0.8% of all the patients). Conclusion: The vast majority of blunt pediatric trauma victims with pelvic fractures do not have urine bladder injuries. Based on our study results we do not recommend the routine utilization of CT cystography in this unique population.     

Associated both-column acetabular fracture: An overview of operative steps and surgical technique

The management of both-column fractures of the acetabulum is challenging for the orthopaedic surgeon. Operative treatment is usually recommended in this particular fracture pattern, as residual joint surface displacement has been shown to increase local contact stress, drastically leading to rapid cartilage destruction. In this review, we present an overview of operative steps and surgical technique for both-column acetabular fracture reconstruction. Therefore, we demonstrate how correct understanding of fracture morphology and displacement, preoperative preparation, including choice of approach and patient positioning, reduction strategies, and programmed sequential fixation, starting from superior fracture lines on the anterior acetabular column and ending on the posterior components of this fracture type, may provide satisfactory outcomes in this difficult acetabular fracture pattern.     

骨密度及骨代谢指标与同型半胱氨酸关系的研究进展

同型半胱氨酸(homocysteine,Hcy)是一种含硫氨基酸,以蛋氨酸为原料合成的,通过B族维生素,可以再循环生成蛋氨酸,或者通过转硫途径转化为半胱氨酸。通常同型半胱氨酸被认为是心脑血管的独立危险因素,现研究证实同型半胱氨酸也是骨质疏松的危险因素。目前Hcy引起骨质疏松甚至骨折的确切机制已研究出一小部分,仍有待于进一步研究。在机理上,同型半胱氨酸主要通过影响骨胶原的交联,刺激破骨细胞的形成和活性增加,及通过氧化应激产生活性氧促进成骨细胞的凋亡起作用。笔者将从同型半胱氨酸与骨密度及骨代谢指标、骨折的关系进行综述,通过提前干预Hcy的水平,预防骨折的发生,为骨质疏松症患者提供一种新的治疗方案。     

股骨近端复杂骨折的PFNA治疗方法及应用效果研究

目的:研究PFNA治疗方案在股骨近端复杂骨折中的应用价值。方法:选择2015年7月~2017年4月某院接诊的股骨近端复杂骨折病患78例,并以数字抽签的方式将之随机分成A、B两组(n=39)。其中A组实施PFNA治疗,B组实施DHS治疗,观察两组手术治疗的效果,并对其作出比较。结果:A组治疗的总有效率为92.31%,明显比B组的69.23%高,组间差异显著(P<0.05)。结论:积极采取PFNA治疗方案,对股骨近端复杂骨折病患进行施治,可促使其骨折创口的愈合,提高预后效果。