Objective To identify the chief factors influencing the hospitalization expenses in fracture patients with health insurance so as to provide information for the control of irrational increase in medical expenses and reform in the mode of medical insurance payment. Methods A total of 113 fracture patients with medical insurance in a hospital of a certain city from September 2006 to April 2007 were included and statistical analysis was performed by using multinomial linear regression analysis. Results The major factors influencing the hospitalization expenses in fracture patients with health insurance included the proportion of material fees and drug fees, length of stay, performance of operations and blood transfusion and etc. Conclusion Lowering the proportion of material fees and drug fees reasonably, reducing the length of hospital stay and avoiding operations and blood transfusion were the key to the control of hospitalization expenses for fracture. It is imperative to speed up and deepen the reform in medical insurance system, formulate scientific diagnostic and treatment routines and clinical pathways as well as expense standards, and try out the payment on certain single disease such as fracture.
Objective To study the hook of hamate bone by anatomy and iconography methods in order to provide information for the cl inical treatment of injuries to the hook of hamate bone and the deep branch of ulnar nerve. Methods Fifty-two upper l imb specimens of adult corpses contributed voluntarily were collected, including 40 antisepticized old specimens and 12 fresh ones. The hook of hamate bone and its adjacent structure were observed. Twentyfour upper l imbs selected randomly from specimens of corpses and 24 upper l imbs from 12 healthy adults were investigated by computed tomography (CT) three-dimensional reconstruction, and then related data were measured. The measurement results of24 specimens were analyzed statistically. Results The hook of hamate bone is an important component of ulnar carpal canal and carpal canal, and the deep branch of ulnar nerve is located closely in the inner front of the hook of hamate bone. The flexor tendons of the forth and the l ittle fingers are in the innermost side, closely l ie next to the outside of the hook of hamate bone. The hamate bone located between the capitate bone and the three-cornered bone with wedge-shaped. The medial-, lateral-, and front-sides are all facies articularis. The hook of hamate bone has an approximate shape of a flat plate. The position migrated from the body of the hamate bone, the middle of the hook and the enlargement of the top of the hook were given the names of “the basis of the hook”, “the waist of the hook”, and “the coronal of the hook”, respectively. The short path of the basement are all longer than the short path of the waist. The long path of the top of the hook is the maximum length diameter of the hook of hamate bone, and is longer than the long path of the basement and the long path of the waist. The iconography shape and trait of the hook of hamate bone is similar to the anatomy result. There were no statistically significant differences (P gt; 0.05) between two methods in the seven parameters as follows: the long path of the basement of the hook, the short path of the basement of the hook, the long path of the waist of thehook, the short path of the waist of the hook, the long path of the top of the hook, the height of the hook, of hamate bone, and the distance between the top and the waist of the hook. Conclusion The hook of hamate bone can be divided into three parts: the coronal part, the waist part, and the basal part; fracture of the hamate bone can be divided into fracture of the body, fracture of the hook, and fracture of the body and the hook. Facture of the hook of hamate bone or fracture unnion can easily result in injure of the deep branch of ulnar nerve and the flexor tendons of the forth and the l ittle fingers. The measurement results of CT threedimensional reconstruction can be used as reference value directly in cl inical treatments.
From August 1986 to October 1990, 34 cases of fractures of patella were treated by the self-designed spring Kirschner wire, in which, 25 cases were followed up for an average of 1.5 years. The excellentgood rate reached 88%. In comparing with the traditional method of treatment, it gave more secure fixation for fracture, without the need or only a short time of immobilization needed, short treatment course and satisfactory return of function.
OBJECTIVE To study the difference between two internal fixation methods Kaneda and Z-plate in the operation of anterior surgical approach and decompression after thoracolumbar fractures. METHODS: The bio-mechanical structure of the internal fixture, install when operating, complications and time of the operation were compared in the cases by Kaneda and Z-plate. RESULTS: Z-plate method had the following characteristics: reasonable of the bio-mechanical structure; stability after internal fixture being installed; capability of completely propping up the injured centrum and keeping the height of middle-column; simple operation when installing internal fixture and shorter time of operation (1.1 hours, P lt; 0.05); fewer complications. CONCLUSION: Z-plate is an ideal internal fixation method in the operation of anterior surgical approach after thoracolumbar fractures.
Thoracolumbar vertebra Fracture Internal fixation
Objective To study the effect of two different absorbable intramedullary nails in treatment of metacarpal and phalanx fractures.Methods From January 2002 to December 2002, open reduction and internal fixation were done with two different absorbable intramedullary nails in 60 cases of metacarpal and phalanx fractures( 52 cases of open fractures and 8 cases of closed fractures). The fracture locations were metacarpal in 24 cases, proximal phalanx in 22 casesand media phalanx in 14 cases. The emergency operation was performed in 47 cases, selective operation in 13 cases.Out of 60 patients, 24 were treated with intramedullary nails of poly-DL-lactic acid (PDLLA) (PDLLA group), 36 with intramedullary wire of PDLLA composed of chitosan(PDLLA+chitosan group). Results In the PDLLA group(n=24), the rejection occurred in 8 cases 3-4 weeks after operation. PDLLA nails were taken out in 6 of the 8 cases after 5-10 days of operation and bone healing was achieved 2 months after re-fixation by Kirschner wire; therejection subsided in the other 2 cases after 25 days of conservative treatment, and bone fracture healed after 14 weeks. No rejection was observed with primary healing in the other 16 cases of the PDLLA group. In PDLLA + chitosan group(n=36), the rejection occurred in 1 case 19 days after operation, but therejection subsided after 3 days of conservative treatment.No rejection was observed in the other 35 cases with primary healing. All patients were followed up 4-11 monthswith an average of 6 months. No rejection was observed and bone healing was achieved during the follow-up. The time of bone healing was 6-16 weeks(8 weeks onaverage). There was statistically significant difference in the curative resultbetween two groups(Plt;0.05). Conclusion Intramedullary nail of PDLLAwas verysuitable to fix fractures of metacarpal and phalanx. During the degradation of PDLLA, the acidic products can cause rejection. When PDLLA mixed with chitosan,PDLLA can not only strengthen the intensity but also neutralize the acidity. So the rejection can be decreased.PDLLA intramedullary nails composed of chitosan were better than PDLLA intramedullary nails in clinical treatment of metacarpal and phalanx fractures.
ObjectiveTo evaluate the association between H2RA and the risk of hip fracture by performing a meta-analysis.
MethodsWe searched CNKI, PubMed and EMbase from inception to September 19th 2016, to collect case-control studies or cohort studies reporting the risk of hip fracture with H2RA. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed using Stata 13 software.
ResultsEleven studies involving 206 276 hip fracture cases were included. The result of meta-analysis showed that patients receiving H2RA therapy had approximately 1.12 times the risk of developing hip fracture compared with nonusers (OR=1.12 95%CI 1.02 to 1.24, P=0.022). Subgroup analyses by interval time indicated that the risk appeared greater with the continuous users (OR=1.11, 95%CI 1.01 to 1.24, P=0.039) whereas the discontinuous users was not significantly associated with hip fracture risk.
ConclusionH2RA therapy may be associated with an increased risk of hip fracture. For patients with intermittent medication, the side effect may disappear by discontinuation of PPI use for at least 30 days, but the study did not find time-effect relationship or dose-effect relationship. Considering the limitations of this study, more rigorous clinical trials evaluating the potential side-effect of H2RA are needed.
Objective To investigate an effect of the Fixion expandable intramedullary nail on treatment of the closed fracture of the tibial shaft, and to compare the Fixion nail with the traditional locked intramendullary nail.Methods From September 1, 2005 to August 31, 2006, 79 patients (53 men, 26 women; aged 17-57 years, 37 years on average) with the closed fracture of the tibial shaft were treated with the Fixion expandable intramedullary nail, and the effect of the nail was evaluated. According to the AO classification, the patients were typed as Type 42A or Type 42B. And the patients were divided into the following two groups: the expandable intramedullary nail group (n=31) and the traditional locked intramedullary nail group (n=48). Of the 31 patents in the first group, 24 were of Type 42A and 7 were of Type 42B; of the 48 patients in the second group, 37 were of Type 42A and 11 were of Type 42B. All the patients were followed up after operation. Observation was made on the time of the bony callus development and the time of the clinical healing of the bone,and on whether there was the bone malunion, late healing, disunion or infection. The limb function was also evaluated.Results The follow-up of all the 79 patients for 4-15 months averaged 10.3 months revealed that in the expandable intramedullary nail group, the average operating time was 35 minutes (range, 20-60 minutes), with no requirement of blood transfusion. The X-ray examination showed that the bony callus developed as early as 4 weeks after operation. The clinical healing time of the bone was 3-8 months, averaged 5 months. All the patients in this group had the healing by first intention. Evaluatedby the Johner-Wruhs method, an excellent result was found in 28 patients, goodin 3 patients, and poor in none of the patients, with an excellent/good rate of100%. In the traditional locked intramedullary nail group, the average operating time was 75 minutes (range, 45-110 minutes), with no requirement of blood transfusion. The X-ray examination showed that the bony callus developed as early as 4.5 weeks after operation. The clinical healing time was 3-12 months, averaged 5.8 months. In this group, 46 patients had the healing by first intention and 2 patients had the healing by second intention. Evaluated by the JohnerWruhs method,an excellent result was found in 35 patients, good in 11 patients, and fair in 2 patients, with an excellent/good rate of 95.8%.Conclusion The expandable intramedullary nail treatment has advantages of less invasion, simpler manipulation, earlier weightbearing of the bone, quicker healing ofthe bone fracture, and fewer complications. This kind of treatment is worth popularizing in the medical practice if the indication is strictly controlled.
Objective To evaluate the cl inical outcomes of modified posterior-anterior operation in the treatment of serious lumbar fracture and dislocation. Methods From January 2002 to February 2006, 24 patients, 17 males and 7 females aged 22-69 years, underwent reduction of posterior spatium intermuscular approach combined with modified anterioroperation. Nine cases were caused by fall ing and 15 by traffic accident, involving: L1 in 5 cases, L2 in 10 cases, L3 in 4 cases, L4 in 2 case, L1,2 in 1 case and L3,4 in 2 cases. According to the Frankel grade, there were 5 cases for grade A, 11 for grade B, 7 for grade C and 1 for grade D. The recovery of neurological function was evaluated. The imageology examination was appl ied to evaluate the condition of internal fixation and bone union. The Cobb’s angle was measured by X-ray film before operation, 3 days after operation and at the final follow-up, and the difference was estimated. Results Nineteen patients were followed up for 8-52 months, 28.4 months on average. Among the 2 cases of grade A, one improved to C and the other had no improvement. Among the 9 cases of grade B, 5 improved to C, 2 improved to D, and other two had no improvement. Among the 7 cases of grade C, 5 improved to D and 2 improved to E. One case of grade D improved to E. The average Cobb’s angle was (—11.5 ± 4.6)° preoperatively, (4.2 ± 4.7)° 3 days after operation and (4.0 ± 4.8)° at the final follow-up, indicating there was a significant difference between preoperation, 3 days after operation and the final follow-up (P lt; 0.001), but no significant difference between 3 days after operation and the final follow-up (P gt; 0.05). The position of internal fixation was good during follow-up. The compl ications such as disruption, loosening and collapse were not observed. Conclusion Reduction of posterior spatium intermuscular approach combined with modified anterior operation in the treatment of serious lumbar fracture and dislocation could complete the reduction, decompression, grafting and internal fixation in one stage, and protect the paraspinal soft tissue and minimize the trauma caused by surgery. It has the merits of short time of operation, small amount of intraoperative hemorrhage, sol id union of internal fixation and satisfactory cl inical outcome.
Objective To investigate the cl inical effect of MSCs transplantation derived from human umbil ical cord on bone nonunion. Methods From December 2005 to December 2007, 72 patients with traumatic bone nonunion were treated. Auto-il iac bone transplantation was used in 36 patients (group A), including 27 males and 9 females, aging (34.0 ± 2.1) years; including 18 cases of femoral fracture and 18 cases of tibia fracture; and the time of bone nonunion being (9.1 ± 1.7)months. Percutaneous MSCs transplantation derived from human umbil ical cord was used in 36 patients (group B), including 28 males and 8 females, aging (36.0 ± 1.6) years; including 18 cases of femoral fracture and 18 cases of tibia fracture; and the time of bone nonunion being (6.4 ± 1.9) months. There were no statistically significant differences in general data between two groups (P gt; 0.05). In group A, the site of bone nonunion was filled with relevant auto-il iac bone. In group B, the mixture of 6-8 mL platelet-rich plasma prepared by centrifugal izing venous blood and 1 × (106-107) P5 MSCs extracted from human umbil ical cord denoted by volunteers was injected into the region of bone nonunion with 0.2 g demineral ized bone powder. Results Incision healed by first intention in group A. No puncture, deep infection, rejection and general fever reaction occurred in group B. All patients in two groups were followed up for (13.2 ± 4.6) months. No loosening and breakage of internal fixation were observed in two groups. The motil ity and function of hip, knee and ankle were good. The time of bone union was (10.3 ± 2.8) months in group A and (5.6 ± 0.8) months in groups B, showing significant difference between two groups (P lt; 0.05). Conclusion The percutaneous MSCs transplantation derived from human umbil ical cord is more effective on bone nonunion than the traditional treatment, it is easily-to-operate, safe, rel iable, and rapid for union. It is one of effective methods in treating bone nonunion.
Objective To determine the effect of non-reamed versus reamed intramedullary nailing for tibial fractures in adults on the rates of nonunion, the rates of implant failure, the rates of infection, the incidence of compartment syndrome, the rates of malunion, and the time of union. Methods We searched MEDLINE （1966 -July, 2005）, EMBASE （1974 -July, 2005 ）, The Cochrane Library （Issue 2, 2005 ）and CBMdisc （1979 -July, 2005 ）, and handsearched the relevant Chinese and English orthopedic journals. Randomized controlled trials and Clinical controlled trials of nonreamed versus reamed intramedullary nailing for tibial fractures in adults were included. The quality of trials was critically assessed. RevMan 4.2.7 software was used for data analysis. Results Four RCTs and one CCT of non-reamed versus reamed intramedullary nailing for tibial fractures in adults were included. The results of meta-analysis showed that nonreamed intramedullary nailing for tibial fractures in adult increased the rates of nonunion （RR 1.87, 95% CI 1.20 to 2. 91, P =0. 006）, implant failure （RR 2.23, 95% CI 1.49 to 3.34, P〈0. 000 1 ） and the time to union （WMD 9.00, 95% CI 3.19 to 14.81, P =0. 002）. Conclusions Compared with reamed intramedullary nailing for tibial fractures in adults, non-reamed intramedullary nailing increases the rates of nonunion and implant failure is common. There is no statistical difference in the rates of post operative infection, the rates of malunited fracture and the incidence of compartment syndrome between the two groups. However, further studies are needed to determine the effects of reamed and non-reamed intramedullary nailing on these outcomes, expecially when patient has severe open fractures （Gustilo Grade Ⅲ C）and multiple injuries.
