Metallic bone screws are clinically used to fix the fractured bone fragments in bone defect treatment;yet they present compromised therapeutic efficacy due to poor osseointegration and tissue support.Here,we develop a...Metallic bone screws are clinically used to fix the fractured bone fragments in bone defect treatment;yet they present compromised therapeutic efficacy due to poor osseointegration and tissue support.Here,we develop a novel thermoresponsive shape memory(SMP)bone screw with osteogenesis-angiogenesis coupling for enhanced bone regeneration.The SMP bone screws are prepared by die casting of shape memory polyurethane/hydroxyapatite(PU/HA)composite,coated with L-arginine(Arg)and calcium ions(Ca^(2+)).The SMP bone screw could shrink and be easily reshaped at room temperature(25◦C)and then rapidly recover to its original state(37℃),granting it robust internal fixation capacity(2-fold increase in pull-out force)and beneficial compressive force to nearby tissues.Additionally,the long-term release of L-arginine and calcium ions synergistically activate the nitric oxide-cyclic guanosine monophosphate(NO-cGMP)signaling pathway of native cells.Synergized with its shape memory function,the SMP bone screw activated calcium signaling pathway under the stimulation of mechanical stress,promote the activation of various osteogenic pathways(e.g.PI3K-Akt signaling pathway),and upregulate the NO-cGMP pathway by regulating the influx of calcium ions and arginine to synchronously coordinate osteogenesis and angiogenesis to accelerate bone repair.We envision that our slot-in,snap-back and homeothermal shape memory bone screw,with its easily reshaped and fast stress release properties and osteogenesis-angiogenesis coupling efficacy,can shed new light on the development of clinical bone screws.展开更多
This paper reports a series of in vitro, ex vivo and in vivo mechanical and corrosion studies of pin and screw prototype made of friction welded pure iron and 316 L type stainless steel aiming to evaluate the applicab...This paper reports a series of in vitro, ex vivo and in vivo mechanical and corrosion studies of pin and screw prototype made of friction welded pure iron and 316 L type stainless steel aiming to evaluate the applicability of the partially removable bone screws. Results showed that the pin possesses bending, tensile and torsional strengths of1706±147, 666±7 and 0.34±0.03 MPa, respectively. The pin degraded at an average weight loss rate of 17.15×10-5 g cm-2 day-1 and released Fe ions at an average concentration of 2.38 ppm. Plastic deformation induced by torsion increased the corrosion rate of the pin from 0.0014 to 0.0137 mm year-1.The maximum pull-out load of the screw prototypes was3800 N with a calculated failure strength by shear load equal to22.2 k N which is higher than the strength of the cortical bone.Detailed analysis of the rat's blood cells during 60 days of the pin implantation indicated a normal response with low neutrophils/lymphocytes ratio of 0.3-0.5. Iron ion concentration in the rat's blood slightly increased from 55 to 61 ppm without affecting the tissue recovering and healing phase. Histological evaluation confirmed the presence of macrophage cells as a normal response to the released iron particles around the iron section of the pin.展开更多
Lumbar degenerative disc disease(DDD)in the elderly population remains a global health problem,especially in patients with osteoporosis.Osteoporosis in the elderly can cause failure of internal fixation.Cortical bone ...Lumbar degenerative disc disease(DDD)in the elderly population remains a global health problem,especially in patients with osteoporosis.Osteoporosis in the elderly can cause failure of internal fixation.Cortical bone trajectory(CBT)is an effective,safe and minimally invasive technique for the treatment of lumbar DDD in patients with osteoporosis.In this review,we analyzed the anatomy,biomechanics,and advantages of the CBT technique in lumbar DDD and revision surgery.Additionally,the clinical trials and case reports,indications,advancements and limitations of this technique were further discussed and reviewed.Finally,we concluded that the CBT technique can be a practical,effective and safe alternative to traditional pedicle screw fixation,especially in DDD patients with osteoporosis.展开更多
TiO2 nanotubes(NT)has been demonstrated its potential in orthopaedic applications due to its enhanced surface wettability and bio-osteointegration.However,the fretting biocorrosion is the main concern that limited its...TiO2 nanotubes(NT)has been demonstrated its potential in orthopaedic applications due to its enhanced surface wettability and bio-osteointegration.However,the fretting biocorrosion is the main concern that limited its successfully application in orthopaedic application.In this study,a structure optimised thin TiO2 nanotube(SONT)layer was successfully created on Ti6Al4V bone screw,and its fretting corrosion performance was investigated and compared to the pristine Ti6Al4V bone screws and NT decorated screw in a bone-screw fretting simulation rig.The results have shown that the debonding TiO2 nanotube from the bone screw reduced significantly,as a result of structure optimisation.The SONT layer also exhibited enhanced bio-corrosion resistance compared pristine bone screw and conventionally NT modified bone screw.It is postulated that interfacial layer between TiO2 nanotube and Ti6Al4V substrate,generated during structure optimisation process,enhanced bonding of TiO2 nanotube layer to the Ti6Al4V bone screws that leading to the improvement in fretting corrosion resistance.The results highlighted the potential SONT in orthopaedic application as bone fracture fixation devices.展开更多
Bone screws are devices used to fix implants or bones to bones.However,conventional screws are mechanically fixed with thread and often face long-term failure due to poor osseointegration.To improve osseointegration,s...Bone screws are devices used to fix implants or bones to bones.However,conventional screws are mechanically fixed with thread and often face long-term failure due to poor osseointegration.To improve osseointegration,screws are evolving from solid and smooth to porous and rough.Additive manufacturing(AM)offers a high degree of manufacturing freedom,enabling the preparation of predesigned screws that are porous and rough.This paper provides an overview of the problems currently faced by bone screws:long-term loosening and screw breakage.Next,advances in osseointegrated screws are summarized hierarchically(sub-micro,micro,and macro).At the sub-microscale level,we describe surface-modification techniques for enhancing osseointegration.At the micro level,we summarize the micro-design parameters that affect the mechanical and biological properties of porous osseointegrated screws,including porosity,pore size,and pore shape.In addition,we highlight three promising pore shapes:triply periodic minimal surface,auxetic structure with negative Poisson ratio,and the Voronoi structure.At the macro level,we outline the strategies of graded design,gradient design,and topology optimization design to improve the mechanical strength of porous osseointegrated screws.Simultaneously,this paper outlines advances in AM technology for enhancing the mechanical properties of porous osseointegrated screws.AM osseointegrated screws with hierarchical design are expected to provide excellent long-term fixation and the required mechanical strength.展开更多
Objective To evaluate the clinical application of atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability. Methods Twenty-three cases of atlantoaxial...Objective To evaluate the clinical application of atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability. Methods Twenty-three cases of atlantoaxial joint instability were展开更多
The biocompatible metallic implants with strong osteointegration often lack the ability of anti-infection.The biocompatible niobium(Nb)containing the antibacterial copper(Cu),the obtained Nb-Cu alloy,could be a potent...The biocompatible metallic implants with strong osteointegration often lack the ability of anti-infection.The biocompatible niobium(Nb)containing the antibacterial copper(Cu),the obtained Nb-Cu alloy,could be a potential candidate to solve this issue.To test this hypothesis,ultrafine-grained Nb-Cu immiscible alloys were fabricated via mechanical alloying and spark plasma sintering.The aim of this study was to investigate the microstructure,mechanical properties,magnetic susceptibility,corrosion behavior,ion release,and the bactericidal activity,biocompatibility and osteogenic potential of the Nb-Cu alloys in vitro and their osteogenesis and osteointegration ability in vivo with a comparison with pure Nb.The rat cranial defect model and the bone screws insertion in rabbit femoral bone were used to evaluate the osteogenesis and osteointegration ability,respectively.The results showed that after the addition of 3 wt.%of Cu,the compressive strength was significantly improved from 1.57 GPa to 2.21 GPa and the magnetic susceptibility slightly decreased.The Nb-3 wt.%Cu(Nb-3Cu)alloy exhibited higher corrosion resistance than pure Nb in Hank’s solution and strong bactericidal activity against both E.coli and S.aureus.In vitro,the Nb-3Cu alloy showed comparable biocompatibility with pure Nb.The addition of 3 wt.%Cu also significantly enhanced the expression of osteogenesis-related genes(RUNX2,ALP,COLA1 and OCN)of pre-osteoblasts.In vivo,the Nb-3Cu alloy promoted bone regeneration at the defect sites and showed enhanced osteointegration after 12 weeks of implantation.Such a good combination of high mechanical strength and corrosion resistance,strong antibacterial activity and improved osteogenesis and osseointegration ability enables the present Nb-3Cu alloy a promising candidate for heavy load-bearing hard tissue repair.展开更多
BACKGROUND The incidence of lumbar tuberculosis is high worldwide,and effective treatment is a continuing problem.AIM To study the safety and efficacy of the multitrack and multianchor point screw technique combined w...BACKGROUND The incidence of lumbar tuberculosis is high worldwide,and effective treatment is a continuing problem.AIM To study the safety and efficacy of the multitrack and multianchor point screw technique combined with the contralateral Wiltse approach for lesion debridement to treat lumbar tuberculosis.METHODS The C-reactive protein(CRP)level,erythrocyte sedimentation rate(ESR),visual analogue scale(VAS)score,oswestry disability index(ODI)and American Spinal Injury Association(ASIA)grade were recorded and analysed pre-and postoperatively.RESULTS The CRP level and ESR returned to normal,and the VAS score and ODI were decreased at 3 mo postoperatively,with significant differences compared with the preoperative values(P<0.01).Neurological dysfunction was relieved,and the ASIA grade increased,with no adverse events.CONCLUSION The multitrack,multianchor point screw fixation technique combined with the contralateral Wiltse approach for debridement is an effective and safe method for the treatment of lumbar tuberculosis.展开更多
Background： Technical aspects of the correct placement of medial support locking screws in the locking plate for proximal humerus fractures remain incompletely understood. This study was to evaluate the clinical rela...Background： Technical aspects of the correct placement of medial support locking screws in the locking plate for proximal humerus fractures remain incompletely understood. This study was to evaluate the clinical relationship between the number of medial support screws and the maintenance of fracture reduction after locked plating of proximal humerus fractures. Methods： We retrospectively evaluated 181 patients who had been surgically treated for proximal humeral fractures （PHFs） with a locking plate between September 2007 and June 2013. All cases were then subdivided into one of four groups as follows： 75 patients in the medial cortical support （MCS） group, 26 patients in the medial multiscrew support （MMSS） group, 29 patients in the medial single screw support （MSSS） group, and 51 patients in the 11o medial support （NMS） group. Clinical and radiographic evaluations included the Constant-Murley score （CM）, visual analogue scale （VAS）, complications, and revision surgeries. The neck-shaft angle （NSA） was measured in a true anteroposterior radiograph immediately postoperation and at final follow-up. One-way analysis of variance or KruskaI-Wallis test was used for statistical analysis of measurement data, and Chi-square test or Fisher＇s exact test was used for categorical data. Results： The mean postoperative NSAs were 133.46°± 6.01°, 132.39° ± 7.77°. 135.17° ± 10.15°, and 132.41° ± 7.16° in the MCS, MMSS, MSSS, and NMS groups, respectively, and no significant differences were found （F = 1.02, P= 0.387）. In the final follow-up, the NSAs were 132.79° ±6.02°, 130.19° ± 9.25°, 131.28° ± 12.85°, and 127.35° ± 8.50° in the MCS, MMSS, MSSS, and NMS groups, respectively （F = 4.40, P = 0.008）. There were marked differences in the NSA at the final follow-up between the MCS and NMS groups （P = 0.004）. The median （interquartile range [IQR]） NSA losses were 0.0° （0.0-1.0）°, 1.3° （0.0-3.1）°, 1.5° （ 1.0-5.2）°, and 4.0° （ 1.2 -7.1 ）° in the MCS, MMSS, MSSS, and NMS groups, respectively （H = 60.66, P 〈 0.001 ）. There were marked differences in NSA loss between the MCS and the other three groups （MCS vs. MMSS, Z = 3.16, P = 0.002; MCS vs. MSSS, Z = 4.78, P 〈 0.001; and MCS vs. NMS, Z = 7.34, P 〈 0.001）. There was also significantly less NSA loss observed in the MMSS group compared to the NMS group （Z = -3.16, P = 0.002）. However, there were no significant differences between the MMSS and MSSS groups （Z = -1.65, P = 0.225） or the MSSS and NMS groups （Z =- 1.21, P = 0.099）. The average CM scores were 81.35 ± 9.79, 78.04± 8.97, 72.76 ± 10.98, and 67.33 ± 12.31 points in the MCS, MMSS, MSSS, and NMS groups, respectively （F = 18.68, P 〈 0.001）. The rates of excellent and good CM scores were 86.67%, 80.77%, 65.52%, and 43.14% in the MCS, MMSS, MSSS, and NMS groups, respectively （ X^2 = 29.25, P 〈 0.001 ）. The median （IQR） VAS scores were 1 （0-2）, l （0 2）,2 （ 1-3）, and 3 （1-5） points in the MCS, MMSS, MSSS, and NMS groups, respectively （H = 27.80, P 〈 0.001）. Functional recovery was markedly better and VAS values were lower in the MCS and MMSS groups （for CM scores： MCS vs. MSSS, P 〈 0.001 ; MCS vs. N MS. P 〈 0.001; MMSS vs. MSSS, P= 0.031 and MMSS vs. NMS, P 〈 0.001 and for VAS values： MCS vs. MSSS, Z=3.31, P = 0.001： MCS vs. NMS, Z = 4.64, P 〈 0.001; MMSS vs. MSSS, Z = -2.09, P = 0.037： and MMSS vs. NMS, Z=-3.16, P = 0.003）.Conclusions： Medial support screws might help enhance mechanical stability and maintain fracture reduction when used to treat PHFs with medial metaphyseal comminution or malreduction.展开更多
Purpose： Both cannulated cancellous screw （CCS） and sliding hip screw （SHS） are used in femoral neck fracture fixations, hut which is superior is yet to be determined. This study was aimed to compare the clinicor...Purpose： Both cannulated cancellous screw （CCS） and sliding hip screw （SHS） are used in femoral neck fracture fixations, hut which is superior is yet to be determined. This study was aimed to compare the clinicoradiological outcome of femoral neck fracture treated with SHS or CCS in young adults. Methods： Adults （16-60 years） with femoral neck fracture were divided into Group I fixed with SHS and Group 2 fixed with three CCS after closed reduction. Pain relief, functional recovery and postoperative radiographs at 6 weeks, 3 months, 6 months and then yearly for upto 4 years were analyzed. Results： Group 1 （n = 40） achieved radiological union at mean of Z6 months, with the union rate of 8Z5% （n = 35）, avascular necrosis （AVN） rate of 7.5% （n - 3） and mean Harris Hip Score （HHS） of 86.15 at the end of 4 years. In Group 2 （n = 45） these parameters were union at Z1 months, union rate of 82.22% （n = 37）, AVN rate of 6.67% （n = 3） and HHS of 88.65. Comparative results were statistically insignificant. Conclusion： There is no significant difference in clinicoradiological outcome between the two implants.展开更多
With rapid advancement in surgical techniques and improvement in implant materials, rate of internal fixation for pubic symphyseal disruption in rotationally and vertically unstable pelvic ring injuries has increased....With rapid advancement in surgical techniques and improvement in implant materials, rate of internal fixation for pubic symphyseal disruption in rotationally and vertically unstable pelvic ring injuries has increased. Among various modes of implant failure, screw/ plate breakage and loosening are common complications following unstable fixation. Migration of loose screws into the urinary bladder has been reported as an extremely uncommon complication of pubic symphyseal plating. Here we present a case report of a 52-year-old female who pre- sented with asymptomatic passage of screws in her urine following migration into the bladder, 2 years after symphy- seal plating for pubic diastasis in an anteroposterior compression pelvic ring injury.展开更多
We reported a 23-year-old man who was involved in a high-speed motorcycle accident. He sustained a closed fracture at the right distal femur. The primary fracture happened on February 2008. He underwent open reduction...We reported a 23-year-old man who was involved in a high-speed motorcycle accident. He sustained a closed fracture at the right distal femur. The primary fracture happened on February 2008. He underwent open reduction and internal fixation with cloverleaf plate. And one hundred days after the surgery, the proximal screws were pulled-out, but the bone union was not achieved. Treatment consisted of exchanging the cloverleaf plate with a locking compression plate and using an auto-iliac bone graft to fill the nonunion gap. In July 2009, the patient had a sharp pain in the right lower limb. The X-ray revealed that the plate implanted last year was broken, causing a nonunion at the fracture site. Immediately the plate and screws were removed and an intramedullary nail was inserted reversely from the distal femur as well as a 7 cm long bone from the right fibula was extracted and longitudinally split into two pieces to construct cortical bone plates. Then we placed them laterally and medially to fracture site, drilled two holes respectively, and fastened them with suture. We carried on auto-iliac bone grafting with the nonunion bone grafts. The follow-up at 15 months after operation showed that the treatment was successful, X-ray confirmed that there was no rotation and no angular or short deformity. We briefly reviewed the literature regarding such an unusual presentation and discussed in details the possible etiology and the advantages of autologous double-strut fibular grafts to cope with such an intractable situation.展开更多
Background Older patients with malignant spinal tumors are difficult to treat because they have many co-morbidities including osteoporosis. The purpose of this research is to discuss the technique and clinical outcome...Background Older patients with malignant spinal tumors are difficult to treat because they have many co-morbidities including osteoporosis. The purpose of this research is to discuss the technique and clinical outcome of bone cement enhanced pedicle screw fixation combined with vertebroplasty （the Sandwich Procedure） for elderly patients with severe osteoporosis and malignant spinal tumors. Methods This study includes 28 consecutive elderly patients with malignant thoracic or lumbar spinal tumors. There were nine patients with myelomas, and 19 patients with metastatic bone tumors. The Sandwich Procedure began with curettage of the tumor and a vertebroplasty with bone cement （polymethyl methacrylate, PMMA）, followed by PMMA enhanced pedicle screw fixation. Patients were evaluated with the visual analogue scale （VAS）, oswestry disability index （ODI）, American Spinal Cord Injury Association （ASIA） neurological function classification, and the radiographic degree of kyphosis （Cobb angle）. Data were analyzed using paired t-test to compare the pre- and post-operative values. The complications, local recurrences, and the survival status were also recorded. Results There was no operative mortality, and the mean operative time was 210 minutes （range 150-250 minutes）. The average blood loss was 1550 ml （range 650-3300 ml）. The average amount of cement for vertebroplasty was 3.6 ml （range 3-5 ml）. The VAS, ODI, and ASIA scores were significantly improved after surgery （P 〈0.05）. However, we found no differences between the pre and post-operative Cobb angles. The shortest survival time was 3 months, and we found no evidence of local recurrence in this group of patients. Conclusion The Sandwich Procedure is a safe operation and provides symptomatic relief in these difficult patients, permitting further treatment with chemotherapy or radiotherapy.展开更多
Objective： To prospectively evaluate the feasibility, safety and efficacy of the percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using ...Objective： To prospectively evaluate the feasibility, safety and efficacy of the percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system in the retrospective non-randomized case-control study. Methods： Atotal of 38 consecutive non-randomized patients with type A thoracolumbar fractures, which had been stabilized posteriorly from December 2006 to March 2009, were examined retrospectively more than 9 months after surgery. Twenty-one patients had been treated conventionally with open pedicle screw fixation （OPSF） and 17 patients received minimally invasive treatment with Sextant percutaneous pedicle screw fixation （SPPSF）. As a method of evaluation, the incision size, the intraoperation and post- operative volume of blood loss, operation time, postoperative hospital stay, blood transfusion, the radiological assessment of the sagittal Cobb＇s angle, vertebral body angle and vertebral body height were recorded and compared. Results： All patients were followed up for 8-24 months （average 11.6 months）. There were significant differences in the incision size, surgical blood loss, surgical draining Joss, operation time, hospital stay after operation, blood transfusion, the proportion of antalgic supplement and postoperative incisional VAS between the two groups （P〈0.05）. Mean preoperative kyphotic deformity was 16.0° and improved by 9.3° after surgery in OPSF group, but 15.2° and 10.3° respectively in SPPSF group. Mean preoperative angle of the fractured vertebral body was 15.9°and improved by 7.9° after surgery in OPSF group, but 14.9° and 6.6° respectively in SPPSF group. Mean anterior vertebral body height （% of normal） was 67.3% before surgery and 95.8% after surgery, but 69.1% and 90.1% respectively in SPPSF group. Mean posterior vertebral body height （% of normal） was 93.3% before surgery and 99.5% after surgery, but 88.9% and 93.3% respectively in SPPSF group. Among the patients whose 9-month follow-up films were available, 3.0° ofkyphosis correction was lost in OPSF group, but 3.2° in SPPSF group. And 1.0°of the angle of the fractured vertebral body correction was lost in OPSF group, but 1.5°in SPPSF group. Then 3.0% of the anterior vertebral body height correction was lost in OPSF group, but 2.2% in SPPSF group. And 3.0% of the posterior vertebral body height correction was lost in OPSF group, but 2.5% in SPPSF group. The sagittal Cobb＇s angle, vertebral body angle and anterior height of the fractured vertebra were all significantly different in each group before and after operation （P〈0.05）. There were no significant differences in the postoperative sagittal Cobb＇s angle, vertebral body angle and the improvement of the vertebral body height and the kyphotic deformity correction between OPSF and SPPSF groups （P〉0.05）, but there was significant difference in the postoperative anterior height of the fractured vertebra between the two groups （P〈0.05）. Conclusion： The percutaneous pedicle screw fixation through the pedicle of fractured vertebra using Sextant system is a good minimally-invasive surgical therapeutic choice for patients with type A thoracolumbar fracture except for that the SPPSF has a little insufficiency in resuming the anterior height of the fractured vertebra compared with OPSF.展开更多
Objective： To develop a novel method of spinal pedical stereotaxy by reverse engineering and rapid prototyping techniques, and to validate its accuracy by experimental and clinical studies. Methods： A 3D reconstruc...Objective： To develop a novel method of spinal pedical stereotaxy by reverse engineering and rapid prototyping techniques, and to validate its accuracy by experimental and clinical studies. Methods： A 3D reconstruction model for the desired lumbar vertebra was generated by using the Mimics 10.11 software, and the optimal screw size and orientation were determined using the reverse engineering software. Afterwards, a drill template was created by reverse engineering principle, whose surface was the antitemplate of the vertebral surface. The drill template and its corresponding vertebra were manufactured using the rapid prototyping technique. Results： The accuracy of the drill template was confinned by drilling screw trajectory into the vertebral biomodel preoperatively. This method also showed its ability to customize the placement and size of each screw based on the unique morphology of the lumbar vertebra.The drill template fits the postural surface of the vertebra very well in the cadaver experiment. Postoperative CT scans for controlling the pedicle bore showed that the personalized template had a high precision in cadaver experiment and clinical application. No misplacement occurred by using the personalized template. During surgery, no additional computer assistance was needed. Conclusions： The authors have developed a novel drill template for lumbar pedicle screw placement with good applicability and high accuracy. The potential use of drill templates to place lumbar pedicle screws is promising, Our methodology appears to provide an accurate technique and trajectory for pedicle screw placement in the lumbar spine.展开更多
Dynamic hip screw fixation is a com- monly performed procedure for internal fixation of intertro- chanteric femoral fractures. Arterial injury following the operative fixation is a rare but serious event. We present a...Dynamic hip screw fixation is a com- monly performed procedure for internal fixation of intertro- chanteric femoral fractures. Arterial injury following the operative fixation is a rare but serious event. We present a patient who developed pseudoaneurysm ofprofunda femo- ris artery after internal fixation of intertrochanteric fracture with a dynamic hip screw. The diagnosis was confirmed by angiographic study and it was successfully treated by coil embolization.展开更多
Objective： Dynamic hip screw （DHS） is recommended for the fixation of stable intertrochanteric fractures. Its postoperative cut-out rate ranges from I% to 6%. In osteoporotic bone, normal screws in DHS blade provid...Objective： Dynamic hip screw （DHS） is recommended for the fixation of stable intertrochanteric fractures. Its postoperative cut-out rate ranges from I% to 6%. In osteoporotic bone, normal screws in DHS blade provide less anchorage compared to locking screws. This study aims to compare DHS with locking side plate and conventional side plate. Methods： Fifty consecutive patients with intertrochanteric fractures were randomly allocated for fixation with a standard DHS （group A） and locking DHS （Combi plate, group B）. We compared the clinical and radiological outcomes for the conventional DHS and locking DHS in intertrochanteric fractures. Functional outcome was evaluated using the Parker mobility score. Results： Coxa valga was found more frequently in group A than in group B （12% vs. 0%, P=0.42）. Coxa vara showed the same trend （12% vs. 8%, P=0.81）. Rate of restoration of postoperative neck-shaft angle within 20° of sound side was higher in group B （8% cases） than in group A （4% cases, P=0.98）. The rate of anteversion angle restoration within 10° of sound side was also higher in group B （100% vs. 88%, P=0.85）. The average lag screw slippage in group A and group B was 3.2 mm and 4.2 mm, the average fracture union duration was 17.1 weeks and 16.4 weeks, and the mean Parker score was 5.6 and 5.8 respectively. Screw cut-out was seen in one patient in group A. No cut-out was seen in any of the patient in group B. No patient developed deep infection, avascular necrosis, deep vein thrombosis or any other significant complications. Conclusion： The present study demonstrated that treating intertrochanteric fracture with a locking DHS allows sound bone healing and is not associated with any major complications. Although this report is promising, it should be interpreted with caution because only a prospective study with a large sample size would allow definitive conclusion.展开更多
Objective：To compare efficacy between the modified tension band technique and the parallel titanium cannulated lag screw technique for the transverse patella fracture.Methods：Seventy-two patients were retrospectivel...Objective：To compare efficacy between the modified tension band technique and the parallel titanium cannulated lag screw technique for the transverse patella fracture.Methods：Seventy-two patients were retrospectively analyzed aged 22 to 79 years （mean,55.6 years） with transverse patella fractures,among whom 37 patients underwent the modified tension band and 35 patients received the titanium cannulated lag screw.Patients were followed up for 1-3 years.We analyzed the difference of operation time,complications,fracture reduction,fracture healing time,and the Iowa score for knee function between both groups.Results：In modified tension band group,five patients had skin irritation and seven suffered wire migration,two of whom required a second operation.In comparison,there were no complications in the titanium cannulated lag screw group,which also had a higher fracture reduction rate and less operation time.Conclusion：The parallel titanium cannulated lag screw technique has superior results and should be considered as an alternative method to treat transverse patella fracture.展开更多
Objective： To evaluate the surgical procedure of endo- scopic transforminal discectomy, bone grafting and Dynalok pedicle screw fixation under X-Tube operation system in the treatment of lumbar disc herniation combin...Objective： To evaluate the surgical procedure of endo- scopic transforminal discectomy, bone grafting and Dynalok pedicle screw fixation under X-Tube operation system in the treatment of lumbar disc herniation combined with segmental instability and/or pars defected spondylolithesis. Methods： From June 2004 to May 2006, 42 patients with classic features of lumbar disc herniation combined with segmental instability and/or pars defected spondylolithesis underwent endoscopic transforminal lumbar interbody fu- sion （TLIF）. Under the guidance of fluoroscopy, a 2.8 to 3.0 cm incision with 4.5 to 5.0 cm apart from the posterior middle line was made on the symptomatic side and the working portal （X-Tube） was docked unilaterally on the facet joint. A total facetectomy was then performed to expose neural fo- ramina and nerve root. Discectomy and endplate prepara- tion were completed through the tube. A Telamon cage was placed obliquely into the intervertebral space after interbody grafting, and then the Dynalok pedicle screw fixation system was performed. This procedure was accomplished on the lateral side when it is necessary. Results： Clinical outcomes were determined using the Oswestry Disability Index （ODI） which revealed that 62.2% of patients got excellent results, 29.2% good and 8.6% fair. The average hospital stay was 12.5 days （5-25 days）. Op- eration time averaged 240 min （110-320 min）, blood loss averaged 140 ml （80-420 ml） and incision length averaged 3 cm （2.8-3.2 cm）. Five patients had complications including wound infection in 1 case, incision dehiscence and focal skin necrosis in 1, progressive radicular pain of contralat- eral leg in 1 and residual radicular numbness after transient radicular pain in 2. Conclusions： This surgical procedure of endoscopic transforminal diskectomy, bone grafting, cage placement and pedicle screw fixation can be effectively accomplished under X-Tube operation system with predominant benefits such as small incision, less stripping of paraspinal muscles, minimal blood loss and rapid postoperative recovery.展开更多
[Abstract] Objective： To discuss the indications, surgical procedures, and curative effect of dynamic hip screw （DHS） in the treatment of femoral neck fracture in the elderly. Methods： A retrospective study was c...[Abstract] Objective： To discuss the indications, surgical procedures, and curative effect of dynamic hip screw （DHS） in the treatment of femoral neck fracture in the elderly. Methods： A retrospective study was conducted to analyse the clinical data of 42 elderly patients who had been treated for femoral neck fracture with DHS in our department between June 2009 and November 2011. There were 21 males and 21 females with a mean age of 68.5 years （range 60-75 years）. According to the Garden Classification, there were 19 cases of type II, 21 cases of type III and 2 cases of type IV fractures. By the Singh In- dex Classification, there were 3 cases of level 2, 19 cases of level 3 and 20 cases of level 4 fractures. The Harris cri- terion, complications and function recovery after operation were analysed. Results： The average hospitalization time in 42 patients was 11.2 days （range 7-21 days）. All patients were followed up for 12-26 months （mean 18 months）. No lung infection, deep venous thrombosis or other complications occurred. Partial backing-out of the screws was found in 2 cases. The internal fixation device was with- drawn after fracture healing. Internal fixation cutting was found in 1 case, and he had a good recovery after total hip arthroplasty. The time for fracture healing ranged from 3-6 months （average 4.5 months）. According to Harris criteri- on, 15 cases were rated as excellent, 24 good, 2 fair and 1 poor. The Harris scale was significantly improved from 30.52＋2.71 preoperatively to 86.61＋2.53 at 6 months post- operatively （P〈0.05）. Conclusion： DHS, being minimal invasive, al- lowing early activity and weight-bearing, is advisable for treatment of elderly patients with femoral neck fracture. In addition, it can avoid complications seen in artificial joint replacement. It is especially suitable for patients with mild osteoporosis.展开更多
基金supported by the Guangdong-Foshan Joint Fund from Guangdong Basic and Applied Basic Research Foundation(2020B15153000)the Excellent Young Scholars Projects from the National Natural Science Foundation of China(NSFC,82122002)+4 种基金General Program of NSFC(52335004,52275199)the Collaborative Research Fund(C5044-21G)NSFC/RGC Joint Research Scheme(N_PolyU526/22)from the Research Grants Council of Hong Kong,the Innovation and Technology Fund from the Innovation and Technology Commission(ITS/085/21)Beijing Natural Science Foundation(J230001,L248029)Young Scholars Program of Shandong University.
文摘Metallic bone screws are clinically used to fix the fractured bone fragments in bone defect treatment;yet they present compromised therapeutic efficacy due to poor osseointegration and tissue support.Here,we develop a novel thermoresponsive shape memory(SMP)bone screw with osteogenesis-angiogenesis coupling for enhanced bone regeneration.The SMP bone screws are prepared by die casting of shape memory polyurethane/hydroxyapatite(PU/HA)composite,coated with L-arginine(Arg)and calcium ions(Ca^(2+)).The SMP bone screw could shrink and be easily reshaped at room temperature(25◦C)and then rapidly recover to its original state(37℃),granting it robust internal fixation capacity(2-fold increase in pull-out force)and beneficial compressive force to nearby tissues.Additionally,the long-term release of L-arginine and calcium ions synergistically activate the nitric oxide-cyclic guanosine monophosphate(NO-cGMP)signaling pathway of native cells.Synergized with its shape memory function,the SMP bone screw activated calcium signaling pathway under the stimulation of mechanical stress,promote the activation of various osteogenic pathways(e.g.PI3K-Akt signaling pathway),and upregulate the NO-cGMP pathway by regulating the influx of calcium ions and arginine to synchronously coordinate osteogenesis and angiogenesis to accelerate bone repair.We envision that our slot-in,snap-back and homeothermal shape memory bone screw,with its easily reshaped and fast stress release properties and osteogenesis-angiogenesis coupling efficacy,can shed new light on the development of clinical bone screws.
基金supported by the Malaysian Ministry of Higher Education, the Indonesian Ministry of Education and Culture and the Natural Sciences and Engineering Research Council of Canada (NSERC)
文摘This paper reports a series of in vitro, ex vivo and in vivo mechanical and corrosion studies of pin and screw prototype made of friction welded pure iron and 316 L type stainless steel aiming to evaluate the applicability of the partially removable bone screws. Results showed that the pin possesses bending, tensile and torsional strengths of1706±147, 666±7 and 0.34±0.03 MPa, respectively. The pin degraded at an average weight loss rate of 17.15×10-5 g cm-2 day-1 and released Fe ions at an average concentration of 2.38 ppm. Plastic deformation induced by torsion increased the corrosion rate of the pin from 0.0014 to 0.0137 mm year-1.The maximum pull-out load of the screw prototypes was3800 N with a calculated failure strength by shear load equal to22.2 k N which is higher than the strength of the cortical bone.Detailed analysis of the rat's blood cells during 60 days of the pin implantation indicated a normal response with low neutrophils/lymphocytes ratio of 0.3-0.5. Iron ion concentration in the rat's blood slightly increased from 55 to 61 ppm without affecting the tissue recovering and healing phase. Histological evaluation confirmed the presence of macrophage cells as a normal response to the released iron particles around the iron section of the pin.
基金Supported by National Natural Science Foundation of China,No.82202694。
文摘Lumbar degenerative disc disease(DDD)in the elderly population remains a global health problem,especially in patients with osteoporosis.Osteoporosis in the elderly can cause failure of internal fixation.Cortical bone trajectory(CBT)is an effective,safe and minimally invasive technique for the treatment of lumbar DDD in patients with osteoporosis.In this review,we analyzed the anatomy,biomechanics,and advantages of the CBT technique in lumbar DDD and revision surgery.Additionally,the clinical trials and case reports,indications,advancements and limitations of this technique were further discussed and reviewed.Finally,we concluded that the CBT technique can be a practical,effective and safe alternative to traditional pedicle screw fixation,especially in DDD patients with osteoporosis.
基金financially supported by the European Union via the H2020-MSCA-RISE-2016 program(BAMOS Project,734156)Royal Society via the International Exchange Program(IE161349)+2 种基金Key Research Project from the National Key Research and Development Program of China(2016YFC1100401)National Natural Science Foundation of China(51705507)Young Elite Scientists Sponsorship Program by CAST(2017QNRC0181)。
文摘TiO2 nanotubes(NT)has been demonstrated its potential in orthopaedic applications due to its enhanced surface wettability and bio-osteointegration.However,the fretting biocorrosion is the main concern that limited its successfully application in orthopaedic application.In this study,a structure optimised thin TiO2 nanotube(SONT)layer was successfully created on Ti6Al4V bone screw,and its fretting corrosion performance was investigated and compared to the pristine Ti6Al4V bone screws and NT decorated screw in a bone-screw fretting simulation rig.The results have shown that the debonding TiO2 nanotube from the bone screw reduced significantly,as a result of structure optimisation.The SONT layer also exhibited enhanced bio-corrosion resistance compared pristine bone screw and conventionally NT modified bone screw.It is postulated that interfacial layer between TiO2 nanotube and Ti6Al4V substrate,generated during structure optimisation process,enhanced bonding of TiO2 nanotube layer to the Ti6Al4V bone screws that leading to the improvement in fretting corrosion resistance.The results highlighted the potential SONT in orthopaedic application as bone fracture fixation devices.
基金supported by the National Natural Science Foundation of China(Nos.82272504 and 82072456)the National Key R&D Program of China(No.2018YFB1105100)+4 种基金the Department of Science and Technology of Jilin Province,China(Nos.20200404202YY,20200403086SF,20210101321JC,20210204104YY,20200201453JC,20220204119YY,202201ZYTS131,202201ZYTS129,20220401084YY,202201ZYTS505,and YDZJ202301ZYTS076)the Department of Finance of Jilin Province,China(No.2020SCZT037)the Jilin Provincial Development and Reform Commission,China(Nos.2018C010 and 2022C043-5)the Interdisciplinary Integration and Cultivation Project of Jilin University(No.JLUXKJC2020307)the Central University Basic Scientific Research Fund(No.2023-JCXK-04).
文摘Bone screws are devices used to fix implants or bones to bones.However,conventional screws are mechanically fixed with thread and often face long-term failure due to poor osseointegration.To improve osseointegration,screws are evolving from solid and smooth to porous and rough.Additive manufacturing(AM)offers a high degree of manufacturing freedom,enabling the preparation of predesigned screws that are porous and rough.This paper provides an overview of the problems currently faced by bone screws:long-term loosening and screw breakage.Next,advances in osseointegrated screws are summarized hierarchically(sub-micro,micro,and macro).At the sub-microscale level,we describe surface-modification techniques for enhancing osseointegration.At the micro level,we summarize the micro-design parameters that affect the mechanical and biological properties of porous osseointegrated screws,including porosity,pore size,and pore shape.In addition,we highlight three promising pore shapes:triply periodic minimal surface,auxetic structure with negative Poisson ratio,and the Voronoi structure.At the macro level,we outline the strategies of graded design,gradient design,and topology optimization design to improve the mechanical strength of porous osseointegrated screws.Simultaneously,this paper outlines advances in AM technology for enhancing the mechanical properties of porous osseointegrated screws.AM osseointegrated screws with hierarchical design are expected to provide excellent long-term fixation and the required mechanical strength.
文摘Objective To evaluate the clinical application of atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability. Methods Twenty-three cases of atlantoaxial joint instability were
基金the National Natural Science Foundation of China(No.52122102)the Natural Science Foundation of Guangdong(No.2019A1515011755)the Shenzhen Fundamental Research Project(No.JCYJ20190809153205492)。
文摘The biocompatible metallic implants with strong osteointegration often lack the ability of anti-infection.The biocompatible niobium(Nb)containing the antibacterial copper(Cu),the obtained Nb-Cu alloy,could be a potential candidate to solve this issue.To test this hypothesis,ultrafine-grained Nb-Cu immiscible alloys were fabricated via mechanical alloying and spark plasma sintering.The aim of this study was to investigate the microstructure,mechanical properties,magnetic susceptibility,corrosion behavior,ion release,and the bactericidal activity,biocompatibility and osteogenic potential of the Nb-Cu alloys in vitro and their osteogenesis and osteointegration ability in vivo with a comparison with pure Nb.The rat cranial defect model and the bone screws insertion in rabbit femoral bone were used to evaluate the osteogenesis and osteointegration ability,respectively.The results showed that after the addition of 3 wt.%of Cu,the compressive strength was significantly improved from 1.57 GPa to 2.21 GPa and the magnetic susceptibility slightly decreased.The Nb-3 wt.%Cu(Nb-3Cu)alloy exhibited higher corrosion resistance than pure Nb in Hank’s solution and strong bactericidal activity against both E.coli and S.aureus.In vitro,the Nb-3Cu alloy showed comparable biocompatibility with pure Nb.The addition of 3 wt.%Cu also significantly enhanced the expression of osteogenesis-related genes(RUNX2,ALP,COLA1 and OCN)of pre-osteoblasts.In vivo,the Nb-3Cu alloy promoted bone regeneration at the defect sites and showed enhanced osteointegration after 12 weeks of implantation.Such a good combination of high mechanical strength and corrosion resistance,strong antibacterial activity and improved osteogenesis and osseointegration ability enables the present Nb-3Cu alloy a promising candidate for heavy load-bearing hard tissue repair.
基金Supported by 2023 Hebei Province Medical Science Research Project Plan,No.20231958。
文摘BACKGROUND The incidence of lumbar tuberculosis is high worldwide,and effective treatment is a continuing problem.AIM To study the safety and efficacy of the multitrack and multianchor point screw technique combined with the contralateral Wiltse approach for lesion debridement to treat lumbar tuberculosis.METHODS The C-reactive protein(CRP)level,erythrocyte sedimentation rate(ESR),visual analogue scale(VAS)score,oswestry disability index(ODI)and American Spinal Injury Association(ASIA)grade were recorded and analysed pre-and postoperatively.RESULTS The CRP level and ESR returned to normal,and the VAS score and ODI were decreased at 3 mo postoperatively,with significant differences compared with the preoperative values(P<0.01).Neurological dysfunction was relieved,and the ASIA grade increased,with no adverse events.CONCLUSION The multitrack,multianchor point screw fixation technique combined with the contralateral Wiltse approach for debridement is an effective and safe method for the treatment of lumbar tuberculosis.
文摘Background： Technical aspects of the correct placement of medial support locking screws in the locking plate for proximal humerus fractures remain incompletely understood. This study was to evaluate the clinical relationship between the number of medial support screws and the maintenance of fracture reduction after locked plating of proximal humerus fractures. Methods： We retrospectively evaluated 181 patients who had been surgically treated for proximal humeral fractures （PHFs） with a locking plate between September 2007 and June 2013. All cases were then subdivided into one of four groups as follows： 75 patients in the medial cortical support （MCS） group, 26 patients in the medial multiscrew support （MMSS） group, 29 patients in the medial single screw support （MSSS） group, and 51 patients in the 11o medial support （NMS） group. Clinical and radiographic evaluations included the Constant-Murley score （CM）, visual analogue scale （VAS）, complications, and revision surgeries. The neck-shaft angle （NSA） was measured in a true anteroposterior radiograph immediately postoperation and at final follow-up. One-way analysis of variance or KruskaI-Wallis test was used for statistical analysis of measurement data, and Chi-square test or Fisher＇s exact test was used for categorical data. Results： The mean postoperative NSAs were 133.46°± 6.01°, 132.39° ± 7.77°. 135.17° ± 10.15°, and 132.41° ± 7.16° in the MCS, MMSS, MSSS, and NMS groups, respectively, and no significant differences were found （F = 1.02, P= 0.387）. In the final follow-up, the NSAs were 132.79° ±6.02°, 130.19° ± 9.25°, 131.28° ± 12.85°, and 127.35° ± 8.50° in the MCS, MMSS, MSSS, and NMS groups, respectively （F = 4.40, P = 0.008）. There were marked differences in the NSA at the final follow-up between the MCS and NMS groups （P = 0.004）. The median （interquartile range [IQR]） NSA losses were 0.0° （0.0-1.0）°, 1.3° （0.0-3.1）°, 1.5° （ 1.0-5.2）°, and 4.0° （ 1.2 -7.1 ）° in the MCS, MMSS, MSSS, and NMS groups, respectively （H = 60.66, P 〈 0.001 ）. There were marked differences in NSA loss between the MCS and the other three groups （MCS vs. MMSS, Z = 3.16, P = 0.002; MCS vs. MSSS, Z = 4.78, P 〈 0.001; and MCS vs. NMS, Z = 7.34, P 〈 0.001）. There was also significantly less NSA loss observed in the MMSS group compared to the NMS group （Z = -3.16, P = 0.002）. However, there were no significant differences between the MMSS and MSSS groups （Z = -1.65, P = 0.225） or the MSSS and NMS groups （Z =- 1.21, P = 0.099）. The average CM scores were 81.35 ± 9.79, 78.04± 8.97, 72.76 ± 10.98, and 67.33 ± 12.31 points in the MCS, MMSS, MSSS, and NMS groups, respectively （F = 18.68, P 〈 0.001）. The rates of excellent and good CM scores were 86.67%, 80.77%, 65.52%, and 43.14% in the MCS, MMSS, MSSS, and NMS groups, respectively （ X^2 = 29.25, P 〈 0.001 ）. The median （IQR） VAS scores were 1 （0-2）, l （0 2）,2 （ 1-3）, and 3 （1-5） points in the MCS, MMSS, MSSS, and NMS groups, respectively （H = 27.80, P 〈 0.001）. Functional recovery was markedly better and VAS values were lower in the MCS and MMSS groups （for CM scores： MCS vs. MSSS, P 〈 0.001 ; MCS vs. N MS. P 〈 0.001; MMSS vs. MSSS, P= 0.031 and MMSS vs. NMS, P 〈 0.001 and for VAS values： MCS vs. MSSS, Z=3.31, P = 0.001： MCS vs. NMS, Z = 4.64, P 〈 0.001; MMSS vs. MSSS, Z = -2.09, P = 0.037： and MMSS vs. NMS, Z=-3.16, P = 0.003）.Conclusions： Medial support screws might help enhance mechanical stability and maintain fracture reduction when used to treat PHFs with medial metaphyseal comminution or malreduction.
文摘Purpose： Both cannulated cancellous screw （CCS） and sliding hip screw （SHS） are used in femoral neck fracture fixations, hut which is superior is yet to be determined. This study was aimed to compare the clinicoradiological outcome of femoral neck fracture treated with SHS or CCS in young adults. Methods： Adults （16-60 years） with femoral neck fracture were divided into Group I fixed with SHS and Group 2 fixed with three CCS after closed reduction. Pain relief, functional recovery and postoperative radiographs at 6 weeks, 3 months, 6 months and then yearly for upto 4 years were analyzed. Results： Group 1 （n = 40） achieved radiological union at mean of Z6 months, with the union rate of 8Z5% （n = 35）, avascular necrosis （AVN） rate of 7.5% （n - 3） and mean Harris Hip Score （HHS） of 86.15 at the end of 4 years. In Group 2 （n = 45） these parameters were union at Z1 months, union rate of 82.22% （n = 37）, AVN rate of 6.67% （n = 3） and HHS of 88.65. Comparative results were statistically insignificant. Conclusion： There is no significant difference in clinicoradiological outcome between the two implants.
文摘With rapid advancement in surgical techniques and improvement in implant materials, rate of internal fixation for pubic symphyseal disruption in rotationally and vertically unstable pelvic ring injuries has increased. Among various modes of implant failure, screw/ plate breakage and loosening are common complications following unstable fixation. Migration of loose screws into the urinary bladder has been reported as an extremely uncommon complication of pubic symphyseal plating. Here we present a case report of a 52-year-old female who pre- sented with asymptomatic passage of screws in her urine following migration into the bladder, 2 years after symphy- seal plating for pubic diastasis in an anteroposterior compression pelvic ring injury.
文摘We reported a 23-year-old man who was involved in a high-speed motorcycle accident. He sustained a closed fracture at the right distal femur. The primary fracture happened on February 2008. He underwent open reduction and internal fixation with cloverleaf plate. And one hundred days after the surgery, the proximal screws were pulled-out, but the bone union was not achieved. Treatment consisted of exchanging the cloverleaf plate with a locking compression plate and using an auto-iliac bone graft to fill the nonunion gap. In July 2009, the patient had a sharp pain in the right lower limb. The X-ray revealed that the plate implanted last year was broken, causing a nonunion at the fracture site. Immediately the plate and screws were removed and an intramedullary nail was inserted reversely from the distal femur as well as a 7 cm long bone from the right fibula was extracted and longitudinally split into two pieces to construct cortical bone plates. Then we placed them laterally and medially to fracture site, drilled two holes respectively, and fastened them with suture. We carried on auto-iliac bone grafting with the nonunion bone grafts. The follow-up at 15 months after operation showed that the treatment was successful, X-ray confirmed that there was no rotation and no angular or short deformity. We briefly reviewed the literature regarding such an unusual presentation and discussed in details the possible etiology and the advantages of autologous double-strut fibular grafts to cope with such an intractable situation.
文摘Background Older patients with malignant spinal tumors are difficult to treat because they have many co-morbidities including osteoporosis. The purpose of this research is to discuss the technique and clinical outcome of bone cement enhanced pedicle screw fixation combined with vertebroplasty （the Sandwich Procedure） for elderly patients with severe osteoporosis and malignant spinal tumors. Methods This study includes 28 consecutive elderly patients with malignant thoracic or lumbar spinal tumors. There were nine patients with myelomas, and 19 patients with metastatic bone tumors. The Sandwich Procedure began with curettage of the tumor and a vertebroplasty with bone cement （polymethyl methacrylate, PMMA）, followed by PMMA enhanced pedicle screw fixation. Patients were evaluated with the visual analogue scale （VAS）, oswestry disability index （ODI）, American Spinal Cord Injury Association （ASIA） neurological function classification, and the radiographic degree of kyphosis （Cobb angle）. Data were analyzed using paired t-test to compare the pre- and post-operative values. The complications, local recurrences, and the survival status were also recorded. Results There was no operative mortality, and the mean operative time was 210 minutes （range 150-250 minutes）. The average blood loss was 1550 ml （range 650-3300 ml）. The average amount of cement for vertebroplasty was 3.6 ml （range 3-5 ml）. The VAS, ODI, and ASIA scores were significantly improved after surgery （P 〈0.05）. However, we found no differences between the pre and post-operative Cobb angles. The shortest survival time was 3 months, and we found no evidence of local recurrence in this group of patients. Conclusion The Sandwich Procedure is a safe operation and provides symptomatic relief in these difficult patients, permitting further treatment with chemotherapy or radiotherapy.
文摘Objective： To prospectively evaluate the feasibility, safety and efficacy of the percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system in the retrospective non-randomized case-control study. Methods： Atotal of 38 consecutive non-randomized patients with type A thoracolumbar fractures, which had been stabilized posteriorly from December 2006 to March 2009, were examined retrospectively more than 9 months after surgery. Twenty-one patients had been treated conventionally with open pedicle screw fixation （OPSF） and 17 patients received minimally invasive treatment with Sextant percutaneous pedicle screw fixation （SPPSF）. As a method of evaluation, the incision size, the intraoperation and post- operative volume of blood loss, operation time, postoperative hospital stay, blood transfusion, the radiological assessment of the sagittal Cobb＇s angle, vertebral body angle and vertebral body height were recorded and compared. Results： All patients were followed up for 8-24 months （average 11.6 months）. There were significant differences in the incision size, surgical blood loss, surgical draining Joss, operation time, hospital stay after operation, blood transfusion, the proportion of antalgic supplement and postoperative incisional VAS between the two groups （P〈0.05）. Mean preoperative kyphotic deformity was 16.0° and improved by 9.3° after surgery in OPSF group, but 15.2° and 10.3° respectively in SPPSF group. Mean preoperative angle of the fractured vertebral body was 15.9°and improved by 7.9° after surgery in OPSF group, but 14.9° and 6.6° respectively in SPPSF group. Mean anterior vertebral body height （% of normal） was 67.3% before surgery and 95.8% after surgery, but 69.1% and 90.1% respectively in SPPSF group. Mean posterior vertebral body height （% of normal） was 93.3% before surgery and 99.5% after surgery, but 88.9% and 93.3% respectively in SPPSF group. Among the patients whose 9-month follow-up films were available, 3.0° ofkyphosis correction was lost in OPSF group, but 3.2° in SPPSF group. And 1.0°of the angle of the fractured vertebral body correction was lost in OPSF group, but 1.5°in SPPSF group. Then 3.0% of the anterior vertebral body height correction was lost in OPSF group, but 2.2% in SPPSF group. And 3.0% of the posterior vertebral body height correction was lost in OPSF group, but 2.5% in SPPSF group. The sagittal Cobb＇s angle, vertebral body angle and anterior height of the fractured vertebra were all significantly different in each group before and after operation （P〈0.05）. There were no significant differences in the postoperative sagittal Cobb＇s angle, vertebral body angle and the improvement of the vertebral body height and the kyphotic deformity correction between OPSF and SPPSF groups （P〉0.05）, but there was significant difference in the postoperative anterior height of the fractured vertebra between the two groups （P〈0.05）. Conclusion： The percutaneous pedicle screw fixation through the pedicle of fractured vertebra using Sextant system is a good minimally-invasive surgical therapeutic choice for patients with type A thoracolumbar fracture except for that the SPPSF has a little insufficiency in resuming the anterior height of the fractured vertebra compared with OPSF.
基金This project was supported by China Postdoctoral Science Foundation （20080431420） and Yunnan Natural Science Foundation （2008CD210）.
文摘Objective： To develop a novel method of spinal pedical stereotaxy by reverse engineering and rapid prototyping techniques, and to validate its accuracy by experimental and clinical studies. Methods： A 3D reconstruction model for the desired lumbar vertebra was generated by using the Mimics 10.11 software, and the optimal screw size and orientation were determined using the reverse engineering software. Afterwards, a drill template was created by reverse engineering principle, whose surface was the antitemplate of the vertebral surface. The drill template and its corresponding vertebra were manufactured using the rapid prototyping technique. Results： The accuracy of the drill template was confinned by drilling screw trajectory into the vertebral biomodel preoperatively. This method also showed its ability to customize the placement and size of each screw based on the unique morphology of the lumbar vertebra.The drill template fits the postural surface of the vertebra very well in the cadaver experiment. Postoperative CT scans for controlling the pedicle bore showed that the personalized template had a high precision in cadaver experiment and clinical application. No misplacement occurred by using the personalized template. During surgery, no additional computer assistance was needed. Conclusions： The authors have developed a novel drill template for lumbar pedicle screw placement with good applicability and high accuracy. The potential use of drill templates to place lumbar pedicle screws is promising, Our methodology appears to provide an accurate technique and trajectory for pedicle screw placement in the lumbar spine.
文摘Dynamic hip screw fixation is a com- monly performed procedure for internal fixation of intertro- chanteric femoral fractures. Arterial injury following the operative fixation is a rare but serious event. We present a patient who developed pseudoaneurysm ofprofunda femo- ris artery after internal fixation of intertrochanteric fracture with a dynamic hip screw. The diagnosis was confirmed by angiographic study and it was successfully treated by coil embolization.
文摘Objective： Dynamic hip screw （DHS） is recommended for the fixation of stable intertrochanteric fractures. Its postoperative cut-out rate ranges from I% to 6%. In osteoporotic bone, normal screws in DHS blade provide less anchorage compared to locking screws. This study aims to compare DHS with locking side plate and conventional side plate. Methods： Fifty consecutive patients with intertrochanteric fractures were randomly allocated for fixation with a standard DHS （group A） and locking DHS （Combi plate, group B）. We compared the clinical and radiological outcomes for the conventional DHS and locking DHS in intertrochanteric fractures. Functional outcome was evaluated using the Parker mobility score. Results： Coxa valga was found more frequently in group A than in group B （12% vs. 0%, P=0.42）. Coxa vara showed the same trend （12% vs. 8%, P=0.81）. Rate of restoration of postoperative neck-shaft angle within 20° of sound side was higher in group B （8% cases） than in group A （4% cases, P=0.98）. The rate of anteversion angle restoration within 10° of sound side was also higher in group B （100% vs. 88%, P=0.85）. The average lag screw slippage in group A and group B was 3.2 mm and 4.2 mm, the average fracture union duration was 17.1 weeks and 16.4 weeks, and the mean Parker score was 5.6 and 5.8 respectively. Screw cut-out was seen in one patient in group A. No cut-out was seen in any of the patient in group B. No patient developed deep infection, avascular necrosis, deep vein thrombosis or any other significant complications. Conclusion： The present study demonstrated that treating intertrochanteric fracture with a locking DHS allows sound bone healing and is not associated with any major complications. Although this report is promising, it should be interpreted with caution because only a prospective study with a large sample size would allow definitive conclusion.
基金This study was granted by National Natural Science Foundation of China （No. 81172183 and 30500132）.
文摘Objective：To compare efficacy between the modified tension band technique and the parallel titanium cannulated lag screw technique for the transverse patella fracture.Methods：Seventy-two patients were retrospectively analyzed aged 22 to 79 years （mean,55.6 years） with transverse patella fractures,among whom 37 patients underwent the modified tension band and 35 patients received the titanium cannulated lag screw.Patients were followed up for 1-3 years.We analyzed the difference of operation time,complications,fracture reduction,fracture healing time,and the Iowa score for knee function between both groups.Results：In modified tension band group,five patients had skin irritation and seven suffered wire migration,two of whom required a second operation.In comparison,there were no complications in the titanium cannulated lag screw group,which also had a higher fracture reduction rate and less operation time.Conclusion：The parallel titanium cannulated lag screw technique has superior results and should be considered as an alternative method to treat transverse patella fracture.
文摘Objective： To evaluate the surgical procedure of endo- scopic transforminal discectomy, bone grafting and Dynalok pedicle screw fixation under X-Tube operation system in the treatment of lumbar disc herniation combined with segmental instability and/or pars defected spondylolithesis. Methods： From June 2004 to May 2006, 42 patients with classic features of lumbar disc herniation combined with segmental instability and/or pars defected spondylolithesis underwent endoscopic transforminal lumbar interbody fu- sion （TLIF）. Under the guidance of fluoroscopy, a 2.8 to 3.0 cm incision with 4.5 to 5.0 cm apart from the posterior middle line was made on the symptomatic side and the working portal （X-Tube） was docked unilaterally on the facet joint. A total facetectomy was then performed to expose neural fo- ramina and nerve root. Discectomy and endplate prepara- tion were completed through the tube. A Telamon cage was placed obliquely into the intervertebral space after interbody grafting, and then the Dynalok pedicle screw fixation system was performed. This procedure was accomplished on the lateral side when it is necessary. Results： Clinical outcomes were determined using the Oswestry Disability Index （ODI） which revealed that 62.2% of patients got excellent results, 29.2% good and 8.6% fair. The average hospital stay was 12.5 days （5-25 days）. Op- eration time averaged 240 min （110-320 min）, blood loss averaged 140 ml （80-420 ml） and incision length averaged 3 cm （2.8-3.2 cm）. Five patients had complications including wound infection in 1 case, incision dehiscence and focal skin necrosis in 1, progressive radicular pain of contralat- eral leg in 1 and residual radicular numbness after transient radicular pain in 2. Conclusions： This surgical procedure of endoscopic transforminal diskectomy, bone grafting, cage placement and pedicle screw fixation can be effectively accomplished under X-Tube operation system with predominant benefits such as small incision, less stripping of paraspinal muscles, minimal blood loss and rapid postoperative recovery.
文摘[Abstract] Objective： To discuss the indications, surgical procedures, and curative effect of dynamic hip screw （DHS） in the treatment of femoral neck fracture in the elderly. Methods： A retrospective study was conducted to analyse the clinical data of 42 elderly patients who had been treated for femoral neck fracture with DHS in our department between June 2009 and November 2011. There were 21 males and 21 females with a mean age of 68.5 years （range 60-75 years）. According to the Garden Classification, there were 19 cases of type II, 21 cases of type III and 2 cases of type IV fractures. By the Singh In- dex Classification, there were 3 cases of level 2, 19 cases of level 3 and 20 cases of level 4 fractures. The Harris cri- terion, complications and function recovery after operation were analysed. Results： The average hospitalization time in 42 patients was 11.2 days （range 7-21 days）. All patients were followed up for 12-26 months （mean 18 months）. No lung infection, deep venous thrombosis or other complications occurred. Partial backing-out of the screws was found in 2 cases. The internal fixation device was with- drawn after fracture healing. Internal fixation cutting was found in 1 case, and he had a good recovery after total hip arthroplasty. The time for fracture healing ranged from 3-6 months （average 4.5 months）. According to Harris criteri- on, 15 cases were rated as excellent, 24 good, 2 fair and 1 poor. The Harris scale was significantly improved from 30.52＋2.71 preoperatively to 86.61＋2.53 at 6 months post- operatively （P〈0.05）. Conclusion： DHS, being minimal invasive, al- lowing early activity and weight-bearing, is advisable for treatment of elderly patients with femoral neck fracture. In addition, it can avoid complications seen in artificial joint replacement. It is especially suitable for patients with mild osteoporosis.
