应用可吸收螺钉内固定治疗陈旧性腕舟状骨骨折骨不连

腕舟状骨骨折是常见的腕部骨折之一，不稳定腕舟骨骨折治疗后发生骨不连者高达46％～55％。应用可吸收螺钉内固定治疗腕舟骨骨折骨不连报道不多。1998年1月～2003年7月，我们应用可吸收螺钉治疗陈旧性腕舟状骨骨折骨不连13例，疗效满意。     

Atornillado anterior de la odontoides empleando tomografía computarizada de haz cónico intraoperatorio y navegación

ObjectiveThe purpose of this study was to asses the value of intraoperative cone-beam CT (O-arm) and stereotactic navigation for the insertion of anterior odontoid screws.Materials and methodsthis was a retrospective review of patients receiving surgical treatment for traumatic odontoid fractures during a period of 18 months.Procedures were guided with O-arm assistance in all cases. The screw position was verified with an intraoperative CT scan. Intraoperative and clinical parameters were evaluated. Odontoid fracture fusion was assessed on postoperative CT scans obtained at 3 and 6 months’ follow-upResultsFive patients were included in this series; 4 patients (80%) were male. Mean age was 63.6 years (range 35-83 years). All fractures were acute type ii odontoid fractures. The mean operative time was 116 minutes (range 60-160 minutes). Successful screw placement, judged by intraoperative computed tomography, was attained in all 5 patients (100%). The average preoperative and postoperative times were 8.6 (range 2-22 days) and 4.2 days (range 3-7 days) respectively. No neurological deterioration occurred after surgery. The rate of bone fusion was 80% (4/5).ConclusionAlthough this initial study evaluated a small number of patients, anterior odontoid screw fixation utilizing the O-arm appears to be safe and accurate. This system allows immediate CT imaging in the operating room to verify screw position.     

Does an additional antirotation U-Blade (RC) lag screw improve treatment of AO/OTA 31 A1-3 fractures with gamma 3 nail?

IntroductionPoor bone quality and unstable fractures increase the cut-out rate in implants with gliding lag screws. The U-Blade (RC) lag screw for the Gamma3^® nail was introduced to provide monoaxial rotational stability of the femoral head and neck fragment. The purpose of this study was to evaluate whether the use of the U-Blade (RC) lag screw is associated with reduced cut-out in patients with OTA/AO 31A1-3 fractures.Material & methodsBetween 2009 and 2014, 751 patients with OTA/AO 31A1-3 fractures were treated with a Gamma3^® nail at our institution. Out of this sample 199 patients were treated with U-blade (RC) lag screws. A total of 135 patients (117 female, 18 male) with standard lag screw (treatment group A) were matched equally regarding age (±4 years) sex, fracture type and location to 135 patients with U-blade (RC) lag screw (treatment group B). Within a mean follow up of 9.2 months (range 6–18 months) we assessed the cut-out rate, the calTAD, lag screw migration, the Parker's mobility score and the Parker’s ratio at postoperatively, six and 12 months following surgery. Furthermore we recorded all complications, ASA-Score, hospital stay and duration of surgery retrospectively.ResultsThe most common fracture among group B with a cut-out of the lag screw were AO/OTA 2.3 and 3.2 fractures whereas in group A cut-out was most commonly seen in AO/OTA 2.1, 2.2 and 2.3 fractures, there was no significant reduction of the cut-out rate in group B 2.2% (n = 3) compared to group A 3.7% (n = 5). The duration of surgery was significantly shorter in group A (p < 0.05). There was no significant difference in lag screw placement, the Parker’s ratio and mobilization.ConclusionIn our study the U-Blade (RC) lag screw did not reduce the cut-out in treatment of OTA/AO 31A1-3 fractures at all. Considering the longer duration of surgery and the higher costs of the U-Blade (RC) lag screw, our results do not justify its use. However, further prospective randomized studies will be necessary.     

Freehand correction of scoliosis in Rett’s syndrome

We present the case of an 18-year-old girl with a scoliosis (long C-shaped curve) in association with an atypical Rett’s syndrome. In order to attain a full correction and to provide her with adequate posture and sitting balance, segmental instrumentation was utilised from the high thoracic spine to the pelvis. We describe the procedure including the relevant pre-operative, intra-operative and post-operative imaging.     

Accuracy of computer-assisted iliosacral screw placement using a hybrid operating room

IntroductionIn recent years hybrid operating rooms were established all over the world. In our setting we combined a 3D flat-panel c-arm (Artis zeego, Siemens) with a navigation system (BrainLab curve, BrainLab). This worldwide unique combination enables the surgeon to visualise an entire pelvis in CT-like image quality with a single 3D-scan. The aim of our study was to investigate, if utilisation of a hybrid operating room increases the accuracy of SI-screws in comparison to standard 3D-navigation.Material and methodsRetrospective, not randomised single centre case series at a level I trauma centre. Inclusion criterion was insertion of a percutaneous iliosacral screw using image-guidance in the hybrid operating room. 61 patients (35 female, 26 male) were included from June 2012 till October 2014. 65 iliosacral screws were inserted. Intraoperative 3D-scans and postoperative scans were examined to investigate screw placement. The results were compared to a preceding study performed in 2012 using conventional 3D-navigation. Statistical calculations were performed with Microsoft Excel 2011 and SPSS.Results65 iliosacral screws were implanted. Two different types of screws were implanted: 1. “Standard” iliosacral screws stabilizing one joint/a unilateral fracture. 2. Single SI-screws stabilizing both SI-joints and if present a bilateral fracture. Forty one patients were included in group 1 (screws n = 45). There was no perforation in 43 screws, grade 1 perforation in 2 screws. There was no grade 2 or 3 perforation in this group. Compared to the conventional 3D-navigated screws there was a highly significant difference (p < 0.001). Twenty patients could be included in group 2. Eleven screws showed a complete intraosseous position. There was grade 1 perforation in 2 screws, grade 2 perforation in 5 screws and grade 3 perforation in 2 screws.ConclusionImprovements in image quality and enlargement of the display window lead to better intraoperative visualisation of the entire dorsal pelvis. Thereby the accuracy of computer-assisted iliosacral screws could be increased using a hybrid operating room. Furthermore difficult tasks like a single screw for both joints can be accomplished.     

Tethering technique using bone screws and wire for chronic mandibular dislocation: a preliminary study of refractory cases

A retrospective study was performed to determine the efficacy of a tethering procedure developed to achieve a more rigid fixation and more reliable outcome in patients with refractory dislocation of the temporomandibular joint. The cases of eight patients with dementia and systemic diseases who underwent this technique were reviewed. In these eight patients, the condyles of 13 joints were ligated using wire between screws placed in the eminence and condylar head. Additional screw–wire ligations were applied to reinforce the restraint of movement in five of the 13 joints with suspected uncontrolled dislocation. The procedure was performed successfully, and the patients were followed-up for an average of 25 months. In one patient, dislocation recurred 1 year postoperatively due to wire breakage. The five joints in which a double set of screw–wire tethering was applied showed no recurrence or wire disturbance. This technique may, therefore, have short-term efficacy in cases that are refractory to standard procedures, although the material used for ligation should be investigated further. This approach can contribute to the quality of life of patients, particularly those with a short life-expectancy.     

全髋关节置换术与空心钉内固定术治疗股骨颈骨折的疗效对比分析

目的探讨全髋关节置换术与空心钉内固定术治疗股骨颈骨折的临床疗效。方法回顾性分析2012年1月～2013年8月在我院进行治疗的股骨颈骨折患者40例的临床资料。其中20例患者采用全髋关节置换术治疗，20例患者采用空心钉内固定术治疗，并比较两组临床疗效。结果置换组手术时间显著较内固定组长，出血量显著较多，但其术后下地活动时间、愈合时间及住院时间显著较短（P〈0．01）。置换组优良率显著高于内固定组（P〈0．05）。结论全髋关节置换术与空心钉内固定术治疗股骨颈骨折比较，临床疗效更好，术后恢复更快，但其手术创伤相对较大，手术时间更长，术中出血量较大。