Bilateral triceps tendon approach is flexible and efficient in the treatment of type C distal humerus fractures

PurposeThe purpose of this study was to assess and compare elbow range of motion, triceps extension strength and functional results of type C (AO/OTA) distal humerus fractures treated with bilateral triceps tendon (BTT) approach and olecranon osteotomy (OO). At the same time, we are also trying to know whether BTT approach can provide sufficient vision for comminuted intra-articular fractures of the distal humerus, and whether it is convenient to convert to the treatment to total elbow arthroplasty (TEA) or OO.MethodsPatients treated with OO and BTT approaches for type C distal humerus fractures between July 2014 and December 2017 were retrospectively reviewed. Inclusion criteria include: (1) patients' age were more than 18 years old, (2) follow-up was no less than 6 months, and (3) patients were diagnosed with type C fractures (based on the AO/OTA classification). Exclusion criteria include: (1) open fractures (Gustillo type 2 or type 3), (2) treated by other approaches, and (3) presented with combined injuries of ipsilateral upper extremities, such as ulnar nerve. Elbow range of motion and triceps extension strength testing were completely valuated, when the fractures had healed. Assessment of functional results using the Mayo elbow performance score and complications were conducted in final follow-up. The data were compared using the two tailed Student's t-test. All data were presented as mean ± standard deviation.ResultsEighty-six patients of type C distal humerus fractures, treated by OO and BTT approach were retrospectively reviewed between July 2014 and December 2017. Fifty-five distal humerus fractures (23 males and 32 females, mean age 52.7 years) treated by BTT approach or OO were included in this study. There were 10 fractures of type C1, 16 type C2 and 29 type C3 according to the AO/OTA classification. Patients were divided into two surgical approach groups chosen by the operators: BTT group (28 patients) and OO group (27 patients). And the mean follow-up time of all patients was 15.6 months (range, 6–36 months). Three cases in BTT group were converted to TEA, and one converted to OO. Only one case in BTT group presented poor articular reduction with a step more than 2 mm. There were not significantly different in functional outcomes according to the Mayo elbow performance score, operation time and extension flexion motion are values between BTT group and OO group (p > 0.05). Complications and reoperation rate were also similar in the two groups. Triceps manual muscle testing were no significant difference in the two groups, even subdivided in elder patients (aged >60 years old).ConclusionBTT is a safe approach to achieve similar functional result comparing with OO. BTT were not suitable for every case with severe comminuted pattern, but it avoids the potential complications related to OO, and has no complications concerning with triceps tendon. It is convenient for open reduction internal fixation and flexible to be converted to OO, as well as available to be converted to TEA in elder patients.     

双菱形缝线法阴道紧缩术

目的介绍一种即微创又有效的阴道紧缩手术。方法采用打孔器在会阴处打6个小孔,将2根双向倒齿线经小孔对盆底肌肉行双菱形法缝合,收紧盆底肌肉,缩小阴道口。结果本组20例患者手术时间为30~40 min,平均35 min。出血量较少,无瘢痕形成。获随访6个月,性生活满意度较术前有所提高。结论采用双菱形缝线法阴道紧缩术,设计科学,损伤小,不遗留瘢痕,且并发症较少,是改善阴道松弛及提高患者性生活质量的简单而有效的手术方法。     

双侧钢板置入内固定治疗复杂胫骨平台骨折的效果探析

目的探讨分析对于复杂胫骨平台骨折患者应用双侧钢板置入内固定的治疗效果。方法对我院行双侧钢板置入内固定治疗的36例复杂胫骨平台骨折患者的临床资料进行回顾分析。结果骨折患者经治疗后,均全部愈合,无感染以及其他并发症发生。患者并未出现松动、断钉以及断板等情况。根据Merchant评分标准进行评定:优20例、良14例、中2例、差1例。结论对于复杂胫骨平台骨折患者来说,采用双侧钢板置入内固定是一种行之有效的方法,促进患者术后固定的稳定性以及早期功能恢复锻炼。     

不同麻醉方式小骨窗开颅治疗高血压脑出血的临床分析

目的 比较不同麻醉方式下施行小骨窗开颅显微手术治疗高血压脑出血的疗效,探讨其临床应用价值.方法 回顾性分析2010-01-2013-01我科手术治疗的高血压脑出血并成功随访的患者296例,其中171例行局麻,125例行全麻.对比分析两组术后并发症发生率、近期GOS评分、半年后ADL分级等指标.结果 局麻病例术后肺部感染率、应激性溃疡发生率、病死率低于全麻组,再次出血、脑积水发生率以及近期、远期病残率无明显差异.结论 局麻下小骨窗手术治疗高血压脑出血,具有时间短、相对并发症少、节省住院费用等优点,值得临床推广.     

Wrist arthrodesis with intercalated iliac crest graft in mutilans rheumatoid arthritis

In mutilans rheumatoid arthritis (RA) patients with major wrist destruction, wrist arthrodesis is recommended. This type of arthrodesis needs carpal reconstruction and stable fixation. The goal of this study was to assess the functional and anatomical outcomes of an iliac crest graft and internal fixation with two medullary pins. Six wrists in three patients suffering from RA were reviewed clinically and radiologically at an average follow-up of 25 months. We assessed the fusion of the iliac graft with the radius and the metacarpus, the preoperative and postoperative carpal height, and the bone stock in front of the thumb. All the patients had improved functionally. The iliac graft fused with the radius in all cases and fused with the metacarpus in 5 out of 6 cases; the non-union occurred in the wrist where only one pin was used. Restoration of carpal height was associated with improvements in hand function. The bone stock was sufficient to allow implantation of a trapezial cup during a total arthroplasty of the thumb trapeziometacarpal (TMC) joint. No major complications occurred. An iliac graft and two pins through the 2nd and 3rd metacarpals were used to reconstruct the carpal height and to obtain wrist fusion. Internal fixation with only one pin is not recommended. Functional improvement can be attributed to the normal tension within the extrinsic flexors and extensors of fingers and thumb being restored because the carpal height was restored. A secondary TMC arthroplasty is theoretically possible.     

单侧和双侧内固定联合髓核摘除椎间融合术治疗腰椎间盘突出症的效果比较

目的：比较单侧和双侧内固定联合髓核摘除椎间融合术治疗腰椎间盘突出症的效果。方法回顾性分析本院2010年1月~2012年12月行髓核摘除椎间融合固定术治疗的49例单间隙腰椎间盘突出症患者。依据固定方式将患者分为单侧内固定组和双侧内固定组。比较两组的手术用时、术中出血量、住院时间、住院费用、疼痛VAS评分、Oswestry功能障碍指数（ODI）评分、融合率和并发症发生率等。结果两组术前的VAS、ODI评分比较差异无统计学意义（P>0.05）,末次随访时,两组的VAS、ODI评分均显著降低（P<0.05）,但两组比较差异无统计学意义（P>0.05）。单侧组的手术用时明显短于双侧内固定组,术中出血量明显少于双侧内固定组,住院费用明显低于双侧内固定组（P<0.05）。两组的融合率和并发症率发生率比较差异无统计学意义（P>0.05）。结论单侧与双侧内固定椎间融合对单间隙腰椎间盘突出症的治疗效果相当,但手术用时较短、术中出血量较少、住院费用较低。     

Are bilateral tibial shaft fractures associated with an increased risk for adverse outcome?

IntroductionLong bone fractures are assumed to be an independent risk factor for systemic complications and death after trauma. Multiple studies have identified an increased risk for mortality and morbidity in patients with bilateral femoral fractures. Data about bilateral tibial shaft fractures is rare. The aim of our study was to analyze if patients with bilateral tibial shaft fractures are at higher risk for systemic complications.MethodsWe performed a retrospective analysis of the TraumaRegister DGU^® from 1993 to 2008. Inclusion criteria were unilateral or bilateral tibial shaft fractures and an age ≥16. Additionally to the overall collective we analyzed different subgroups (divided into different injury severities and treatment periods).Results1899 patients with unilateral and 175 patients with bilateral tibial shaft fractures were included. Age, gender and mean ISS (25.8 vs. 26.2, p = 0.51) in the two groups were comparable. Regarding the entire study population, patients with bilateral tibial shaft fractures showed no significant higher incidence of respiratory organ failure (29.5% vs. 23.1%, p = 0.076) or mortality (20.0% vs. 16.3%, p = 0.203). However, subgroup analysis showed a significant higher rate of pulmonary organ failure for bilateral tibial shaft fractures as compared to unilateral tibial shaft fractures in the group ISS < 25 (20.7% vs. 11.7%, p = 0.023). Multivariate regression analysis identified the additional tibial shaft fracture as an independent risk factor for pulmonary organ failure (OR = 1.56) but not for mortality.DiscussionThe additional tibial shaft fracture is an independent risk factor for pulmonary organ failure but not for multiple organ failure or mortality. The impact of the additional tibial shaft fracture is especially pronounced in less severely injured patients (ISS < 25). These findings are comparable to results of bilateral femoral fracture studies and we therefore suggest to treat patients with bilateral tibial shaft fractures with the same caution as those with bilateral femoral fractures.     

Establishment of a bilateral femoral large segmental bone defect mouse model potentially applicable to basic research in bone tissue engineering

Background

To understand the cellular mechanism underlying bone defect healing in the context of tissue engineering, a reliable, reproducible, and standardized load-bearing large segmental bone defect model in small animals is indispensable. The aim of this study was to establish and evaluate a bilateral femoral defect model in mice.

Materials and methods

Donor mouse bone marrow mesenchymal stem cells (mBMSCs) were obtained from six mice (FVB/N) and incorporated into partially demineralized bone matrix scaffolds to construct tissue-engineered bones. In total, 36 GFP⁺ mice were used for modeling. Titanium fixation plates with locking steel wires were attached to the femurs for stabilization, and 2-mm–long segmental bone defects were created in the bilateral femoral midshafts. The defects in the left and right femurs were transplanted with tissue-engineered bones and control scaffolds, respectively. The healing process was monitored by x-ray radiography, microcomputed tomography, and histology. The capacity of the transplanted mBMSCs to recruit host CD31⁺ cells was investigated by immunofluorescence and real-time polymerase chain reaction.

Results

Postoperatively, no complication was observed, except that two mice died of unknown causes. Stable fixation of femurs and implants with full load bearing was achieved in all animals. The process of bone defect repair was significantly accelerated due to the introduction of mBMSCs. Moreover, the transplanted mBMSCs attracted more host CD31⁺ endothelial progenitors into the grafts.

Conclusions

The present study established a feasible, reproducible, and clinically relevant bilateral femoral large segmental bone defect mouse model. This model is potentially suitable for basic research in the field of bone tissue engineering.     

双侧去骨瓣减压术中脑组织医源性损伤原因分析

目的：探讨基层医院双侧去骨瓣减压术中脑组织医源性损伤的发生机制。方法回顾性分析2006年6月至2012年1月,本院133例双侧去骨瓣减压术患者的临床资料,其中97例采用气钻、铣刀开颅的患者作为观察组,另36例采用手摇颅钻、线锯开颅的患者作为对照组。记录两组患者的后手术侧手术时间,对比研究两组患者的非预期再次手术率及病死率。结果观察组术后行非预期再次手术22例,其中先手术侧再次手术17例（后手术侧手术时间118±21分钟）,后手术侧再次手术5例。对照组非预期再次手术15例,先手术侧再次手术12例（后手术侧手术时间144±25分钟）,后手术侧再次手术3例。观察组死亡25例,对照组19例。观察组的非预期再次手术率及病死率显著低于对照组。两组的先手术侧非预期再次手术率均显著高于后手术侧。差异有统计学意义（P〈0.05）。结论在双侧去骨瓣减压术中,“重力-时间”因素及后手术侧开颅时产生的暴力对先手术侧脑组织的损伤是导致术中医源性损伤的主要原因。先进手术器械的合理使用及脑保护理念的始终贯彻,能显著减少术中脑组织医源性损伤,降低术后非预期再次手术率及病死率。