中西医结合治疗眼眶骨折致眼眶瘀肿及眶下神经知觉障碍临床观察

目的 :观察早期运用中西医结合疗法治疗眼眶骨折致眼眶瘀肿及眶下神经知觉障碍的临床疗效。方法 :将76例(82眼)眶骨骨折患者按随机数字表法分为对照组和治疗组各38例(41眼)。对照组予抗生素、地塞米松静脉滴注,B族维生素及甲钴胺片口服,并对症治疗;治疗组在对照组的基础上辨证运用自拟经验方眼眶骨折1号方、眼眶骨折2号方。观察两组治疗后眼眶瘀肿及眶下神经知觉障碍改善情况,综合评价疗效。结果:治疗组软组织肿胀、眼睑瘀血、结膜下瘀血平均消退时间均短于对照组,差异有统计学意义(P<0.05)。眶下神经知觉障碍改善情况,治疗组显效6例,有效12例,无效0例,总有效率100%;对照组显效2例,有效12例,无效6例,总有效率70%;治疗组疗效明显优于对照组,差异有统计学意义(P<0.05)。结论:早期运用中西医结合疗法治疗眶骨骨折安全、有效,能加快眶周软组织损伤修复,缩短眼眶瘀肿消退时间,改善眶下神经知觉障碍。与单纯西医治疗比较,中西医结合疗法能缩短疗程、提高临床疗效。     

Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years

IntroductionThe aim of our study was to identify the risk factors for avascular necrosis of the femoral head (AVN) and fixation failure (FF) after screw osteosynthesis in patients with valgus angulated femoral neck fractures.Patients and methodsWe conducted a retrospective study of 308 patients (mean age, 72.5 years, range, 50–97 years), with a mean follow-up of 21.4 months (range, 12–64 months). The risk for failure in treatment (FIT) associated with patient- and fracture-related factors was evaluated by logistic regression analyses.ResultsFIT was identified in 32 cases (10.3%): 22 cases (7.1%) of AVN and 10 cases (3.2%) of FF. Initial valgus tilt > 15° (p = 0.023), posterior tilt > 15° (p = 0.012), and screw sliding distance (p = 0.037) were significantly associated with FIT. FIT occurred in 7 patients (5.2%) with B1.2.1 fractures and 17 patients (48.6%) with B1.1.2 fractures (p < 0.001). The odds of FIT were 17-fold higher in patients with initial valgus and posterior tilts > 15° (B1.1.2) compared to patients with <15° of tilt in both planes (B1.2.1).ConclusionThe severity of initial deformity predicts AVN and FF in patients with valgus angulated femoral neck fractures. Patients with an initial valgus and posterior tilt > 15° are reasonable candidates for primary arthroplasty due to high risk of FIT.     

(iii) Principles of acetabular fractures

Acetabular fractures are rare, significant injuries involving the articular surface of the acetabulum. They are typically associated with a high-energy mechanism of injury, though fragility type fractures are now increasingly seen. Associated injuries to another organ system are seen in half of all cases. Radiographic assessment is performed using antero-posterior pelvic radiographs and Judet views, as well as computerized tomography (CT). Classification is based on the column theory and describes fracture anatomy in relation to the anterior and posterior columns. Non-operative treatment is indicated when there is less than 2 mm of articular displacement or when patient factors (such as associated injuries/co-morbidities) or soft tissue injury are incompatible with surgery. Open reduction and internal fixation is indicated in displaced fractures, total hip arthroplasty being used in unreconstructable injuries. Operative treatment involves difficult exposures and technically demanding reduction and fixation techniques. Significant associated injuries include neurovascular injury, bleeding, open fracture wounds, soft tissue injury, hip dislocation and femoral fractures. Late complications include post-traumatic osteoarthritis, avascular necrosis and heterotopic ossification. The goals of treatment should be to give the patient a congruent, functional hip whilst minimizing the complications from both the injury and surgery. Poor results are more likely if the reduction is non-anatomical.     

Local vanadium release from a calcium sulfate carrier accelerates fracture healing

This study evaluated the efficacy of using calcium sulfate (CaSO₄) as a carrier for intramedullary delivery of an organic vanadium salt, vanadyl acetylacetonate (VAC) after femoral fracture. VAC can act as an insulin‐mimetic and can be used to accelerate fracture healing in rats. A heterogenous mixture of VAC and CaSO₄ was delivered to the fracture site of BB Wistar rats, and mechanical testing, histomorphometry, micro‐computed tomography (micro‐CT) were performed to measure healing. At 4 weeks after fracture, maximum torque to failure, effective shear modulus, and effective shear stress were all significantly higher (p < 0.05) in rats treated with 0.25 mg/kg VAC–CaSO₄ as compared to carrier control rats. Histomorphometry found a 71% increase in percent cartilage matrix (p < 0.05) and a 64% decrease in percent mineralized tissue (p < 0.05) at 2 weeks after fracture in rats treated with 0.25 mg/kg of VAC–CaSO₄. Micro‐CT analyses at 4 weeks found a more organized callus structure and higher trending maximum connected z‐ray. fraction for VAC–CaSO₄ groups. Evaluation of radiographs and serial histological sections at 12 weeks did not show any evidence of ectopic bone formation. As compared to previous studies, CaSO₄ was an effective carrier for reducing the dose of VAC required to accelerate femoral fracture healing in rats. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:727–734, 2014.     

Inferior alveolar and mental nerve injuries associated with open reduction and internal fixation of mandibular fractures: A Seven Year retrospective study

PurposeTo document adverse neurosensory changes in the inferior alveolar nerve (IAN) and mental nerve (MN) after surgical mandibular fracture treatment and to identify risk factors associated with these changes.Materials and methodsA retrospective study of patients surgically treated for mandibular fractures. The primary study variable was the postoperative change in IAN/MN neurosensory examination after fracture fixation. Risk factors were categorized as demographic, anatomic, experience of the operator, fracture displacement and number of miniplates placed at each fracture site. Appropriate statistics were computed.Results209 patients with 293 fractures were analysed. One hundred twenty fractures (41%) were located between the lingula and mental foramen, and 173 fractures (59%) were located distal to the mental foramen. Two hundred seventeen (41%) were displaced by 5 mm or more. In 38 fractures (13%), the IAN/MN neurosensory status worsened after treatment. In a multivariate model, fracture displacement, operator inexperience and two plate fixation were associated with a statistically significant risk (P ≤ 0.05) for postoperative deterioration of IAN/MN sensation.ConclusionFixation with two miniplates, fracture displacement of 5 mm or more and operator inexperience were associated with an increased risk for deterioration of the IAN/MN neurosensory status after treatment of mandibular fractures.     

A case-controlled,retrospective, comparative study on the use of biodegradable synthetic polyurethane foam versus polyvinyl acetate sponge after nasal fracture reduction

One of the most frequently used packing materials in closed reduction of a nasal bone fracture is the hydroxylated polyvinyl acetate sponge (PVAS; Merocel^®); however this may cause synechia, epistaxis, and pain. Synthetic polyurethane foam (SPF; Nasopore^® Forte) has recently been used in septoplasty to prevent synechia or restenosis and haematoma formation. The purpose of this study was to compare the effects of PVAS and SPF on postoperative appearance and discomfort following the reduction of nasal bone fractures. We retrospectively reviewed all patient questionnaires and medical histories, and clinical photographs and computed tomography scans obtained before and after surgery. Outcomes were assessed using the Global Aesthetic Improvement Scale (GAIS) score and visual analogue scale (VAS) scores, which were used to assess discomfort during the 6-month follow-up period. Postoperatively, there was no statistically significant difference in the GAIS for the two packing materials (P > 0.05). Postoperative epistaxis was observed at a significantly lower rate in the SPF group than in the PVAS group, whereas anterior rhinorrhea and posterior nasal drip occurred at significantly higher rates following removal of packing in the SPF group (P < 0.05). The results of this study suggest that synthetic dissolvable polyurethane may be a reliable alternative material for nasal packing and postoperative management following the reduction of nasal bone fractures.     

Effectiveness of ‘in-cast’ pneumatic intermittent pedal compression for the pre-operative management of closed ankle fractures: A clinical audit

BackgroundTiming of surgery for ankle fractures is largely dependent on the condition of the surrounding soft-tissues. This study aimed to determine the clinical effectiveness of a pre-operative in-cast artero-venous (AV) impulse device in the management of closed ankle fractures requiring surgery.MethodsA consecutive series of 64 closed ankle fractures were managed using the AV impulse system prior to surgery. Patients were compared to 73 consecutive closed ankle fractures managed surgically in the same unit immediately prior to the implementation of the AV impulse device study. Outcomes measured were time to surgery, length of hospital stay and surgical site infections.ResultsMedian length of time to surgery, hospital stay duration and surgical site infections were all significantly reduced in the study group as compared to the control group.ConclusionsIn-cast intermittent AV compression foot pumps in the pre-operative management of closed ankle fractures were associated with earlier surgery, earlier discharge and reduced complications.