【Abstract】 Objective To evaluate the effectiveness of percutaneous fixation with il iosacral screw in the management of unstable pelvic fractures. Methods From March 2003 to January 2007, 15 patients with unstable pelvic fractures were treated by percutaneous fixation with il iosacral screws. There were 6 males and 9 females, aged 21-56 years. Fractures were caused by traffic accident in 8 cases, high fall ing in 6 cases and crushing injury in 1 case. The disease course ranged from 4 hours to 3 days. Of 15 patients, 7 had fractures of pubium and sacrum; 2 had fractures of il ium and sacrum; 4 had dislocation of sacroil iac joint with fractures of pubic rami; and 2 had dislocation sacroil iac joint with fracture of sacrum of pubium. Anterior fixation was performed by means of plating in 3 cases, by external fixation in 7 cases, and by both in 5 cases. Results The blood loss was from 1 000 to 1 500 mL in 4 patients with acetabular fracture and about 50 mL in the others. The average operative time was 153.6 minutes (range, 60-305 minutes). Fifteen patients were followed up 6 months to 3 years with an average of 18months. According to Matta criterion for fracture reduction, the results were excellent in 14 cases and good in 1 case. After a follow-up of 28.8 months, fracture union was achieved in all patients. Screw loosening occurred in 1 case, pain of lumbosacral region in 3 cases after tiredness and mild claudication in 2 cases. Nine patients returned to their occupation, three patients changed occupation, and 3 patients could not work at last follow-up. According to Majeed functional scoring, the results were excellent in 11 cases and good in 4 cases. Conclusion Percutaneous il iosacral screw fixation is a useful method in treatment of unstable pelvic fracture.
Objective Dexamethasone (DXM) can regulate the balance of neutrophil and cytokine and enhance the ischemia-reperfusion tolerance of the skin flap; amlodipine besylate (AB) can selectively expand the peripheral blood vesselsand rel ieve the vascular smooth muscle spasm. To investigate the percutaneous penetration abil ity of DXM/AB compound gel and evaluate its effect on survival of ischemic skin flap. Methods Sodium carboxymethylcellulose was used to make blank gel, which was mixed in DXM, AB, azone (AZ), and progylene glycol (PG) respectively to make the compound gel containing 0.3%DXM/0.5%AB only (group D), the compound gel containing 3%AZ/2%PG, 3%AZ, and 2%PG (groups A, B, and C), the 0.3%DXM gel containing 3%AZ/2%PG (group E), the 0.5%AB gel containing 3%AZ/2%PG (group F). The accumulative penetration of DXM and AB in compound gel, 0.3%DXM gel, 0.5%AB gel through excised rat skin and its penetration within flap tissue were investigated by ultraviolet spectrophotometry. Fifty SD rats were selected to make 100 mm × 10 mm random flap at the back, and were randomly divided into 5 groups according to different gels which were used to treat flaps (n=10): compound gel group (group A1), 0.3%DXM gel group (group B1), 0.5%AB gel group (group C1), blank gel group (group D1), and peritoneal injection of DXM (5 mg/kg) and AB (2 mg/kg) (group E1). The survival area of ischemic random skin flap was measured on the 7th day by planimetry. Twenty-four SD rats were selected to make 100 mm × 10 mm random flap at the back, and were randomly divided into 2 groups (n=12). The accumulative penetration of DXM and AB within skin flap were also detected at 2 and 6 hours after appl ication of 2 g of compound gel containing 3%AZ/2%PG (group A2) and peritoneal injection AB (2 mg/kg) / DXM (5 mg/kg) (group B2). Results The accumulative penetration of DXM and AB in compound gel were increased in time-dependent manner (P lt; 0.05), and it was the highest in group A, and was significantly higher than that in group B and group C (P lt; 0.01), but there was no significant difference when compared with group E or group F (P gt; 0.05). The accumulative penetration of DXM and AB in groups A, B, and C were significant higher than that in group D (P lt; 0.05). After 7 days, the survival area of flaps in groups A1, B1, C1, D1, and E1 were (695.0 ± 4.6), (439.3 ± 7.1), (477.5 ± 14.5), (215.2 ± 3.8), and (569.4 ± 9.7) mm2, respectively; group A1 was significantly higher than other groups (P lt; 0.05). After 2 and 6 hours, the quantities of DXM and AB in skin flap of group A2 were significantly higher than that of group B2 (P lt; 0.05). Conclusion In 0.3%DXM/0.5%AB compound gel, DXM and AB might penetrate into skin tissue, which could significantly increase the survivalarea of ischemic skin flap.
ObjectiveTo assess the effectiveness of percutaneous Kirschner wire poking reduction and elastic stable intramedullary nailing fixation for treating severe displaced radial neck fractures in children.
MethodsBetween November 2010 and August 2014, 17 children with severe displaced radial neck fractures were treated with percutaneous Kirschner wire poking reduction and elastic stable intramedullary nailing fixation. There were 13 boys and 4 girls with an average age of 8.7 years (range, 6-14 years). The right side was involved in 9 cases, and the left side was involved in 8 cases. The causes of injury were falling in all cases. The angular deformity at fracture was 64-102° (mean, 84°). According to the Judet classification, 7 cases were classified as grade ⅠVa and 10 cases as grade ⅠVb. The time from injury to operation was 4.2 days (range, 1-7 days). Metaizeau classification and Tibone-Stoltz elbow performance score were used to access the radiological and clinical results, respectively.
ResultsThe operation time was 20-50 minutes (mean, 30 minutes). All incisions healed by first intention. The patients were followed up 12-46 months (mean, 20 months). All fractures healed at 2 months after operation. There was no complication of malunion, early epiphyseal closure, avascular necrosis, enlargement of the radial head epiphysis, cubitus varus and valgus deformities, or proximal radioulnar joint synostosis. One case had elbow extension limitation. At last follow-up, the elbow range of motion in flexion, extension, pronation, and supination showed no significant difference between affected side and normal side (P>0.05). The clinical results were excellent in 16 cases and good in 1 case, with an excellent and good rate of 100%. The angulation was 0-12° (mean, 3.7°) on the X-ray film; anatomic reduction or nearly anatomic reduction was obtained, and the radiological results were excellent in 13 cases and good in 4 cases, with an excellent and good rate of 100%.
ConclusionPercutaneous Kirschner wire poking reduction followed by fixation with elastic stable intramedullary nailing is a simple, safe, minimally invasive, and effective method to treat severe displaced radial neck fractures in children.
Objective To summarize the experience of emergency coronary artery bypass grafting （CABG） after failed percutaneous coronary intervention. Methods From January 1998 to December 2002, 9 patients underwent emergency CABG after failed percutaneous coronary intervention. The indications of emergency CABG were coronary artery dissection （5 cases）or perforation （2 cases） and acute arterial occlusion （2 cases）. The time averaged 2 hours from onset of ischernia to revascularization. The CABG was performed under off-pump bypass in 3 cases and under CPB in 6 cases. The mean graft number was 3. Results There were no hospital death. The mean follow-up was 17 months. No death and angina occurred. The function of New York Heart Association class Ⅰ-Ⅱ were in 8 patients, class Ⅲ in 1 patient. Conclusion Emergency CABG is an effective management for failed percutaneous coronary intervention if the indication is right.
Objective To investigate the cl inical results and complications of minimally invasive anterior transarticular screw fixation and fusion for atlantoaxial instabil ity. Methods Between May 2007 and December 2010, 13 patients with atlantoaxial instabil ity were treated with minimally invasive anterior transarticular screw fixation and fusion under endoscope. There were 11 males and 2 females, aged 17-61 years (mean, 41.3 years). The time between injury and operation was 5-14 days (mean, 7.4 days). All cases included 6 patients with Jefferson fracture, 5 with odontoid fracture, and 2 with os odontoideum. According to Frankel classification of nerve functions, 2 cases were rated as grade D and 11 cases as graed E. The operation time, intra-operative blood loss, radiation exposure time, and complications were recorded and analyzed. The stabil ity was observed by X-ray films. The cl inical outcome was assessed using the Frankel scale, and the fusion rates were determined by CT scan threedimensional reconstruction at last follow-up. Results The mean operation time was 124 minutes (range, 95-156 minutes); the mean intra-operative blood loss was 65 mL (range, 30-105 mL); and the mean radiation exposure time was 41 seconds (range, 30-64 seconds). Thirteen patients were followed up 12-47 months (mean, 25.9 months). No blood vessel and nerve injuries or internal fixator failure occurred. The bone fusion time was 6 months, and the dynamic cervical radiography showed no instabil ity occured. At last follow-up, the neurological function was grade E in all patients. The fusion rate was 84.6% (11/13). No continuous bone bridge was seen in the joint space of 2 patients, but they achieved stabil ity. Conclusion Minimally invasive anterior transarticular screw fixation and fusion is a safe and effective procedure for treatment of atlantoaxial instabil ity.
Objective
To summarize the research progress of secondary fracture of adjacent vertebral body after percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP).
Methods
Recent literature concerning PVP and PKP was extensively reviewed and summarized.
Results
The main reasons of secondary fracture of adjacent vertebral body after PVP and PKP are the natural process of osteoporosis, the initial fracture type, the bone cement, the surgical approach, the bone mineral density, and other factors.
Conclusion
Secondary fracture of adjacent vertebral body after PVP and PKP is a challenge for the clinician, a variety of factors need to be suficiently considered and be confirmed by a lot of basic and clinical epidemiological studies.
Objective To investigate the clinical therapeutic effects on malignant spinal tumors treated by percutaneous vertebroplasty(PVP) under the guidance of the digital subtraction angiography(DSA). Methods A retrospective analysis was performed in 196 patients (99 males and 97 females, aged 23-85 years, averaged 60.4 years) with malignant spinal tumors, who underwent the PVP treatment combined with standard chemotherapy and other comprehensive treatment from January 2002 to January 2005. The malignant spinal tumors had their origins as follows: lung cancer (66 cases), breast cancer (55 cases), liver cancer (19 cases), colon cancer (15 cases), stomach cancer (9 cases), prostate cancer (12 cases), multiple myeloma (16 cases), and malignant lymphoma of the spine (4 cases).The metastatic tumors involved the cervical vertebra (32 cases), thoracic vertebra (93 cases), lumbar vertebra (71 cases), and spinal column, including 1 vertebral segment (135 cases), 2 segments (50 cases), and more than 3 segments (11 cases). During the follow-up survey, changes in the visual analogue pain scale(VAS) and changes in the X-ray measurements of the average anterior height, midline height, and posterior height of the diseased vertebra were observed. Results The follow-up for 6 months to 3 years revealed that the percutaneous vertebroplasty on279 vertebral segments had a success with an operational success rate of 100%. Bone cement was injected into the lesions 1-9 ml per segment of the spine. The postoperative X-ray and CT evaluations revealed that spinal stabilization was obtained in all the patients. After operation, 193（98.5%）patients had an obvious decrease or disappearance of the pain in the lower back, and only 3 (1.5%) patients had no obvious improvement in the pain. There was a significant statist-ical difference in the VAS scores between before operation and after operation (Plt;0.05). There were also significant statistical differences in the average anterior height of the diseased vertebra between before operation and after operation（15.71±2.80 mm vs 16.61±3.01 mm）, in the midline height（13.65±2.93 mm vs 14.52±2.72 mm）, and in the posterior height（23.67±2.81 mm vs 23.70±3.13 mm,Plt;0.05). The patients with lung or liver cancer had a mean survival time of 9 monthsafter PVP; the patients with breast cancer, stomach cancer, prostate cancer, lymphoma, or other metastatic tumors had a mean survival time of 18 months. The patients with multiple myeloma had a mean survival time of 27 months. The differences were statistically different (Plt;0.01). Conclusion PVP under the guidance of the DSA is an easier operation witha small wound and few complications. It can effectively alleviate the patient’s pain due to metastatic spinal tumor, stabilize the spine, improve the patient’s quality of life, and reduce the incidence of paraplegia.
Objective To systematically review the effectiveness and safety of coronary artery bypass grafting (CABG) versus percutaneous coronary stent implantation (PCI) in the treatment of patients with unprotected left main coronary artery disease (ULMCA). Methods Databases including The Cochrane Library (Issue 2, 2012), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were electronically searched from inception to September 2012 for randomized controlled trials on the effectiveness and safety of coronary artery bypass grafting (CABG) versus percutaneous coronary stent implantation (PCI) for ULMCA; References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.0. Results Four studies were included involving 1 611 cases, of which, 802 cases are in the CABG group, while 809 cases were in the PCI group. The results of meta-analysis showed that: comparing with PCI, CABG significantly reduced the postoperative repeat revascularization rate (OR=0.45, 95%CI 0.31 to 0.66, Plt;0.000 1), but there was no significant difference between the two groups in reducing the myocardial infarction incidence (OR=1.28, 95%CI 0.47 to 3.48, P=0.63), mortality rate (OR=1.36, 95%CI 0.80 to 2.34, P=0.26), and the incidence of major adverse cardio-cerebral vascular events (OR=0.92, 95%CI 0.66 to 1.28, P=0.61). Conclusion This study indicates that CABG is superior to PCI in reducing postoperative rate of target vessel revascularization. But CABG and PCI are alike in reducing myocardial infarction incidence, mortality rate, and the incidence of major adverse cardio-cerebral vascular events. Due to the limited quantity and quality of the included studies, the above conclusion needs to be verified by more high quality RCTs.
Objective To evaluate the therapeutic results of percutaneous injection of autogeous bone marrow for simple bone cyst and to analyze the prognostic factors of the treatment. Methods From March 2000 to June 2005, 31 patients with simple bone cysts were treated by percutaneous injection of autogeous bone marrow. Of 31 patients, there were 18 males and 13 females, aged 5 years and 7 months to 15 years. The locations were proximal humerus in 18 cases ,proximal femur in 7 cases and other sites in 6 cases. Two cases were treated with repeated injections. The operative process included percutaneous aspiration of fluid in the bone cysts and injection of autogenous bone marrow aspirated fromposterior superior iliac spine. The mean volume of marrow injected was 40 ml(30-70 ml).Results No complications were noted during treatment. Thirty patients were followed for an average of 2.2 years(1.5 years) with 2 cases out of follow-up. After one injection of bone marrow, 9 cysts(29.0%) were healed up completely, 7 cysts(226%)basically healed up,13 cysts (41.9%)healed up partially and 2 (6.5%) had no response.The satisfactory and effective rates were 67.7% and 93.5% respectively. There was significant difference between active stagegroup and resting stage group(P＜0.05). There were no statistically significant difference in therapeutic results between groups of different ages, lesion sites or bone marrow hyperplasia(Pgt;0.05). Conclusion Percutaneous injection of autogeous bone marrow is a safe and effective method to treat simple bone cyst, but repeated injections is necessary for some patients. The therapeutic results are better in cysts at resting stage than those at active stage.
