2014年 · 第17卷第05期

Abstract：Objective:Intertrochanteric femur fracture is a common injury in elderly patients.The dynamic hip screw (DHS) has served as the standard choice for fixation; however it has several drawbacks.Studies of the percutaneous compression plate (PCCP) are still inconclusive in regards to its efficacy and safety.By comparing the two methods,we assessed their clinical therapeutic outcome.Methods:Atotal of 121 elderly patients with intertrochanteric femur fractures (type AO/OTA 31.A 1-A2,Evans type 1) were divided randomly into two groups undergoing either a minimally invasive PCCP procedure or a conventional DHS fixation.Results:The mean operation duration was significantly shorter in the PCCP group (55.2 min versus 88.5 min,P＜0.01).The blood loss was 156.5 ml±18.3 ml in the PCCP group and 513.2 ml±66.2 ml in the DHS group (P＜0.01).Among the patients treated with PCCP,3.1％ needed blood transfusions,compared with 44.6％ of those that had DHS surgery (P＜0.01).The PCCP group displayed less postoperative complications (P＜0.05).The mean American Society of Anesthesiologists score and Harris hip score in the PCCP group were better than those in the DHS group.There were no significant differences in the mean hospital stay,mortality rates,or fracture healing.Conclusion:Due to several advantages,PCCP has the potential to become the ideal choice for treating intertrochanteric fractures (type AO/OTA 31.A1-A2,Evans type 1),particularly in the elderly。

Abstract：Objective:To explore a surgical model of utilizing consecutive free scapular flap and adjacent pedicled flap transfer for repairing massive soft tissue defects on the dorsum of the hand while minimizing the donor site morbidity.Methods:Six patients with massive soft tissue injuries on the opisthenar and forearm were treated with free scapular flaps.Afterwards,a pedicled flap adjacent to the donor site was transferred to cover the donor site defect by direct closure.Results:All six free scapular flaps survived without signs of infection.Three adjacent pedicled flaps presented minor signs of insufficient blood flow on the distal apex,which resolved after six weeks with only conservative therapy.All the incisions healed without other complications.At six-month follow-up,the patients regained full shoulder function.Conclusion:With the assistance of an adjacent pedicled flap,the scapular flap is a highly applicable approach in repairing massive soft tissue defects in the opisthenar.It can achieve positive outcomes in both reconstructive and aesthetic aspects。

Abstract：Objective:Free-hand pedicle screw placement has a high incidence of pedicle perforation which can be reduced with fluoroscopy,navigation or an alternative rapid prototyping drill guide template.In our study the error rate of multi-level templates for pedicle screw placement in lumbar and sacral regions was evaluated.Methods:A case series study was performed on 11 patients.Seventy-two screws were implanted using multilevel drill guide templates manufactured with selective laser sintering.According to the optimal screw direction preoperatively defined,an analysis of screw misplacement was performed.Displacement,deviation and screw length difference were measured.The learning curve was also estimated.Results:Twelve screws (17％) were placed more than 3.125 mm out of its optimal position in the centre of pedicle.The tip of the 16 screws (22％) was misplaced more than 6.25 mm out of the predicted optimal position.According to our predefined goal,19 screws (26％) were implanted inaccurately.In 10 cases the screw length was selected incorrectly:1 (1％) screw was too long and 9 (13％) were too short.No clinical signs of neurovascular lesion were observed.Learning curve was insignificantly noticeable (P=0.129).Conclusion:In our study,the procedure of manufacturing and applying multi-level drill guide templates has a 26％ chance of screw misplacement.However,that rate does not coincide with pedicle perforation incidence and neurovascular injury.These facts along with a comparison to compatible studies make it possible to summarize that multi-level templates are satisfactorily accurate and allow precise screw placement with a clinically irrelevant mistake factor.Therefore templates could potentially represent a useful tool for routine pedicle screw placement。

Abstract：Objective:To investigate the effect of electrical stimulation to sacral spinal nerve 3 (S3 stimulation) on gastrointestinal dysfunction after spinal cord injury (SCI).Methods:Six rabbits were taken as normal controls to record their gastrointestinal multipoint biological discharge,colon pressure and rectoanal inhibitory reflex.Electrodes were implanted into S3 in another 18 rabbits.Then the model of SCI was conducted following Fehling's method:the rabbit S3 was clamped to induce transverse injury,which was claimed by both somatosensory evoked potential and motion evoked potential.Two hours after SCI,S3 stimulation was conducted.The 18 rabbits were subdivided into 3 groups to respectively record their gastrointestinal electric activities (n=6),colon pressure (n=6),and rectum pressure (n=6).Firstly the wave frequency was fixed at 15 Hz and pulse width at 400 μs and three stimulus intensities (6 V,8 V,10 V) were tested.Then the voltage was fixed at 6 V and the pulse width changed from 200 μs,400 μs to 600 μs.The response was recorded and analyzed.The condition of defecation was also investigated.Results:After SCI,the mainly demonstrated change was dyskinesia of the single haustrum and distal colon.The rectoanal inhibitory reflex almost disappeared.S3 stimulation partly recovered the intestinal movement after denervation,promoting defecation.The proper stimulus parameters were 15 Hz,400 μs,6 V,10 s with 20 s intervals and 10 min with 10 min intervals,total 2 h.Conclusion:S3 stimulation is able to restore the intestinal movement after denervation (especially single haustrum and distal colon),which promotes defecation。

Abstract：Objective:To discuss the curative effect of the dynamic hip system blade (DHS-blade) on the treatment of femoral neck fractures in elderly patients with osteoporosis.Methods:A retrospective study was conducted to analyse the clinical data of 60 elderly patients with osteoporosis who had been treated for femoral neck fractures with DHS-blade in our department between September 2012 and February 2014.There were 22 males and 38 females with a mean age of (66.8±3.2) years.According to the Singh Index Classification,all the patients' Singh index was below level 3.The Harris criterion and function recovery after operation were analysed.Results:All patients were followed up for 12-17 months (mean 14 months).No femoral head necrosis,femoral neck shortening,internal fixation loosening or backing out of the nails occurred.Bone nonunion was found in one case and he had a good recovery after total hip arthroplasty.The time for fracture healing ranged from 3-6 months (average 3.5 months).According to Harris criterion,35 cases were rated as excellent,22 good,2 fair and 1 poor.The Harris scale was significantly improved from 28.46±2.35 preoperatively to 91.98±3.26 at 6 months postoperatively (P＜0.05).Conclusion:DHS-blade,being minimally invasive,allowing earlier postoperative exercise and avoiding the complications elicited by traditional internal fixation,is advisable for treatment of femoral neck fractured patients with osteoporosis。

Abstract：Objective:To evaluate functional outcome and complications of open reduction and internal fixation with proximal humeral internal locking system (PHILOS) plate for proximal humerus fractures.Methods:We reviewed 51 patients who underwent open reduction and internal fixation with PHILOS plate between the years 2007 to 2012.There were 35 men and 16 women with a mean age of 38 years (range 24-68).There were 41 patients in the age group of ＜60 years and 10 patients in the age group of ＞60 years.According to Neer classification system,8,15 and 23 patients had 2-part,3-part,and 4-part fractures,respectively and 5 patients had 4-part fracture dislocation.All surgeries were carried out at our tertiary care trauma centre.Functional evaluation of the shoulder at final follow-up was done using Constant-Murley score.Results:The mean follow-up period was 30 months (range 12-44 months).Two patients were lost to followup.Of the remaining 49 patients,all fractures were united clinically and radiologically.The mean time for radiological union was 12 weeks (range 8-20 weeks).At the final follow-up the mean Constant-Murley score was 79 (range 50-100).The results were excellent in 25 patients,good in 13 patients,fair in 6 patients and poor in 5 patients.During the follow-up,four cases of varus malunion,one case of subacromial impingement,one case of deep infection,one case of intraarticular screw penetration and one case of failure of fixation were noted.No cases of avascular necrosis,hardware failure,locking screw loosening or nonunion were noted.Conclusion:PHILOS provides stable fixation in proximal humerus fractures.To prevent potential complications like avascular necrosis,meticulous surgical dissection to preserve vascularity of humeral head is necessary。

Abstract：Objective:To summarize our experience in surgical treatment of traumatic lower limb pseudoaneurysm.Methods:Twenty patients with traumatic lower limb pseudoaneurysm were surgically treated in our department from January 2007 to January 2012.The treatment protocols included interventional covered-stent placement (10 cases),spring coil embolization (2 cases),and surgical operation (8 cases).Surgical operations included pseudoaneurysm repair (2 cases),autologousvein transplantation (1 case),and artificial-vessel bypass graft (5 cases).Results:All the patients were successfully treated without aggravating lower limb ischemia.Pseudoaneurysm disappeared after treatment.A surgical operation is suitable to most pseudoaneurysms,but its damage is relatively obvious and usually leads to more bleeding.It also requires a longer operating time.Compared to a surgical operation,interventional therapy is less traumatic and patients usually have a quicker recovery (P＜0.05).All patients were followed up once per month for 12-36 months by color Doppler ultrasound examination.There were no cases of pseudoaneurysm recurrence.Conclusion:Both surgical operation and interventional therapy are safe and effective in the treatment of pseudoaneurysm。

Abstract：Objective:To evaluate the efficacy of a first aid training course for a group of drivers.Methods:This study comprised 500 drivers,randomly selected from the road transport companies.They underwent a course of first aid training and the results were evaluated at 0-3 and 4-6 months after training.Results:Both quantitative and qualitative improvements were observed in the drivers' efficacy in giving first aid.Also the rate of correct interventions was higher at 4-6 months than at 0-3 months.The exception was airway management which was not favorably improved after training.Conclusion:The first aid training course for drivers is beneficial and helpful for prehospital care system in road traffic accidents。

Abstract：Controlling postoperative pain after total hip replacement is important and controversy remains regarding different regimens.By reviewing 18 studies,we attempt to find whether local infiltration analgesia after total hip replacement has any effect on postoperative pain,length of hospital stay and opioid consumption.We conclude that local infiltration analgesia is an effective method for decreasing postoperative pain。

Abstract：Fall from height is a common cause of unintentional injuries in children and accounts for 6％ of all trauma-related childhood deaths,usually from head injury.We report a case of a 2-year-old child with multiple fractures of the bilateral lower limbs due to this reason.A child fell from a height of around 15 feet after toppling from a balcony.He developed multiple fractures involving the right femoral shaft,right distal femoral epiphysis (Salter Harris type 2),right distal metaphysis of the tibia and fibula,and undisplaced Salter Harris type 2 epiphyseal injury of the left distal tibia.There were no head,abdominal or spinal injuries.The patient was taken into emergency operation theatre after initial management which consisted of intravenous fluids,blood transfusion,and splintage of both lower limbs.Fracture of the femoral shaft was treated by closed reduction and fixation using two titanium elastic nails.Distal femoral physeal injury required open reduction and fixation with K wires.Distal tibia fractures were closely reduced and managed nonoperatively in both the lower limbs.All the fractures united in four weeks.At the last follow-up,the child had no disability and was able to perform daily activities comfortably.We also proposed the unique mechanism of injury in this report。