Pub Date : 2020-02-01DOI: 10.3760/CMA.J.ISSN.0253-2352.2020.03.001
Qingtian Li, Bofu Lin, Xuepan Chen, Yuhui Yang, J. Liao, Yuanchen Ma
Objective To investigate the early clinical effects of tantalum augment assisted with 3D technology in treating acetabular bone defects of Paprosky type III in revision total hip arthroplasty (THA). Methods From May 2013 to July 2017, a total of 16 patients (18 hips) undergoing revision THA were retrospectively analyzed, including 11 males and 5 females aged 58.06±8.29 years (range 44-69 years). There were 3 cases with infective loosening and 15 cases with aseptic loosening, 13 cases with Paprosky IIIA type bone defects and 5 cases with IIIB type bone defects. 3D technology was used for precise planning before operation. The tantalum augment and cup were used to repair acetabular bone defects during operation. Cup anteversion, abduction angle, ratio of the lateral and contralateral vertical distance of the center of rotation, ratio of the lateral and contralateral horizontal distance of the center of rotation and femoral offset were measured preoperatively and postoperatively. The percentages of hips located in Lewinnek safe zone were calculated preoperatively and postoperatively. Postoperative radiographic evidence of loosening and Harris score were collected at the end of the follow-up. Results The percentage of the hips located in Lewinnek safe zone increased from 22% (4/18) preoperatively to 61% (11/18) postoperatively. The mean anteversion of the operative side was 11.99°±6.91° (range 1.71°-26.36°) postoperatively. The mean abduction angle of the operative side was 44.91°±5.93° (range 35.6°-56.0°). The mean ratio of the lateral and contralateral vertical distance of the center of rotation was 1.10±0.20 (range 0.87-1.62). The mean ratio of the lateral and contralateral horizontal distance of the center of rotation was 1.00±0.18 (range 0.69-1.46) and the mean ratio of the lateral and contralateral femoral offset was 1.01±0.66 (range 0.51-3.56). All the patients were followed-up for an average of 27.72±12.18 months (range 14-53 months). No complications, such as periprosthetic joint infection, dislocation or aseptic loosening, were observed in all patients. The mean Harris score was 77.28±4.80 (range 65-85) at 6 months postoperatively and 80.9±5.2 (range 69-89) at the end of the follow-up. Conclusion Using tantalum augmentassisted with 3D technology to re construct Paprosky type III severe bone defects of the hip can increase the accuracy of the acetabular cup positioning. The short-term outcomes are satisfying and no early prosthetic loosening was observed. Key words: Arthroplasty, replacement, hip; Reoperation; Tantalum; Imaging, three-dimensional
{"title":"Early clinical effects of severe acetabular bone defects with 3D technology assisted tantalum augment","authors":"Qingtian Li, Bofu Lin, Xuepan Chen, Yuhui Yang, J. Liao, Yuanchen Ma","doi":"10.3760/CMA.J.ISSN.0253-2352.2020.03.001","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2020.03.001","url":null,"abstract":"Objective \u0000To investigate the early clinical effects of tantalum augment assisted with 3D technology in treating acetabular bone defects of Paprosky type III in revision total hip arthroplasty (THA). \u0000 \u0000 \u0000Methods \u0000From May 2013 to July 2017, a total of 16 patients (18 hips) undergoing revision THA were retrospectively analyzed, including 11 males and 5 females aged 58.06±8.29 years (range 44-69 years). There were 3 cases with infective loosening and 15 cases with aseptic loosening, 13 cases with Paprosky IIIA type bone defects and 5 cases with IIIB type bone defects. 3D technology was used for precise planning before operation. The tantalum augment and cup were used to repair acetabular bone defects during operation. Cup anteversion, abduction angle, ratio of the lateral and contralateral vertical distance of the center of rotation, ratio of the lateral and contralateral horizontal distance of the center of rotation and femoral offset were measured preoperatively and postoperatively. The percentages of hips located in Lewinnek safe zone were calculated preoperatively and postoperatively. Postoperative radiographic evidence of loosening and Harris score were collected at the end of the follow-up. \u0000 \u0000 \u0000Results \u0000The percentage of the hips located in Lewinnek safe zone increased from 22% (4/18) preoperatively to 61% (11/18) postoperatively. The mean anteversion of the operative side was 11.99°±6.91° (range 1.71°-26.36°) postoperatively. The mean abduction angle of the operative side was 44.91°±5.93° (range 35.6°-56.0°). The mean ratio of the lateral and contralateral vertical distance of the center of rotation was 1.10±0.20 (range 0.87-1.62). The mean ratio of the lateral and contralateral horizontal distance of the center of rotation was 1.00±0.18 (range 0.69-1.46) and the mean ratio of the lateral and contralateral femoral offset was 1.01±0.66 (range 0.51-3.56). All the patients were followed-up for an average of 27.72±12.18 months (range 14-53 months). No complications, such as periprosthetic joint infection, dislocation or aseptic loosening, were observed in all patients. The mean Harris score was 77.28±4.80 (range 65-85) at 6 months postoperatively and 80.9±5.2 (range 69-89) at the end of the follow-up. \u0000 \u0000 \u0000Conclusion \u0000Using tantalum augmentassisted with 3D technology to re construct Paprosky type III severe bone defects of the hip can increase the accuracy of the acetabular cup positioning. The short-term outcomes are satisfying and no early prosthetic loosening was observed. \u0000 \u0000 \u0000Key words: \u0000Arthroplasty, replacement, hip; Reoperation; Tantalum; Imaging, three-dimensional","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"129-137"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45213257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-01DOI: 10.3760/CMA.J.ISSN.0253-2352.2020.03.006
Xiwei Fan, Y. Nie, Yuangang Wu, F. Pei
Objective To investigate the influence of displacement of femoral and tibial components on the biomechanics of femoral or tibial bone in coronal view. Methods A series of CT and MRI of the left knee joint of a Han male volunteer was taken and a three-dimensional finite element model of the healthy knee joint was established. The femoral component and the tibial component were designed with varus 6°, varus 3°, 0°, valgus 3°, and valgus 6°, and were combined into 25 three-dimensional finite element model (FEM) of medial unicompartmental knee arthroplasty. A 1 000 N load was applied along the femoral mechanical axis. The von Mises cloud stress distribution was observed. Moreover, the lateral compartment load ratio, the high contact stress of cancellous bone and medial cortical bone below the tibial component, the upper surface of the polyethylene liner, and the femoral cartilage in the lateral compartment was measured. The statistically significant indicators compared with the neutral position (0° varus or valgus of the tibia and the femoral prosthesis, and 5° posterior slope of tibia prosthesis) were identified by scatter plots to find the dense and sparse areas of point items. The optimal position of the femoral component and the tibial component was determined by the number of items with statistical significance in the sparse area. Results When the femoral component was placed at 0° position, there was no significant difference in the high contact stress of cancellous bone below the tibial component in the five groups. When the femoral component was placed at 0° position, the tibial component was 6° varus or 6° valgus and the stress was increased by 9.21±3.38 MPa and 9.08±4.13 MPa (P<0.05), respectively. With the changes of femoral and tibial components from 6° varus to 6° valgus, the high contact stress of the medial cortical bone below the tibia was gradually decreased (P<0.05). When the femoral component was placed at 0°, the tibial component changes from 6° varus to 6° valgus without significant difference in the high contact stress on the upper surface of each group of polyethylene gasket. Compared with the neutral position group, the high contact stress of the 6° varus or 6° valgus group were increased by 2.88±2.53 MPa and 3.47±2.86 MPa, respective ly (P<0.05). The lateral compartment load ratio and the high contact stress of lateral compartment femoral cartilage was gradually decreased (P<0.05), when the femoral and tibial components changed from 6° varus to 6° valgus. The number (2.8%, 1/36) of indicators in the sparse area (the combination of all combinations of femur or tibia from 3° varus to 3° valgus) was less than that (57.8%, 37/64) in the dense area (set of all combinations except sparse area), and the difference was significant (χ2=29.61, P<0.001). Conclusion It is suggested that the position of the femoral component and the tibial component in fixed medial unicompartmental arthroplasty should not exceed 3° varu
{"title":"Finite element analysis of optimization on placement of medial fixed-bearing unicompartmental knee arthroplasty","authors":"Xiwei Fan, Y. Nie, Yuangang Wu, F. Pei","doi":"10.3760/CMA.J.ISSN.0253-2352.2020.03.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2020.03.006","url":null,"abstract":"Objective \u0000To investigate the influence of displacement of femoral and tibial components on the biomechanics of femoral or tibial bone in coronal view. \u0000 \u0000 \u0000Methods \u0000A series of CT and MRI of the left knee joint of a Han male volunteer was taken and a three-dimensional finite element model of the healthy knee joint was established. The femoral component and the tibial component were designed with varus 6°, varus 3°, 0°, valgus 3°, and valgus 6°, and were combined into 25 three-dimensional finite element model (FEM) of medial unicompartmental knee arthroplasty. A 1 000 N load was applied along the femoral mechanical axis. The von Mises cloud stress distribution was observed. Moreover, the lateral compartment load ratio, the high contact stress of cancellous bone and medial cortical bone below the tibial component, the upper surface of the polyethylene liner, and the femoral cartilage in the lateral compartment was measured. The statistically significant indicators compared with the neutral position (0° varus or valgus of the tibia and the femoral prosthesis, and 5° posterior slope of tibia prosthesis) were identified by scatter plots to find the dense and sparse areas of point items. The optimal position of the femoral component and the tibial component was determined by the number of items with statistical significance in the sparse area. \u0000 \u0000 \u0000Results \u0000When the femoral component was placed at 0° position, there was no significant difference in the high contact stress of cancellous bone below the tibial component in the five groups. When the femoral component was placed at 0° position, the tibial component was 6° varus or 6° valgus and the stress was increased by 9.21±3.38 MPa and 9.08±4.13 MPa (P<0.05), respectively. With the changes of femoral and tibial components from 6° varus to 6° valgus, the high contact stress of the medial cortical bone below the tibia was gradually decreased (P<0.05). When the femoral component was placed at 0°, the tibial component changes from 6° varus to 6° valgus without significant difference in the high contact stress on the upper surface of each group of polyethylene gasket. Compared with the neutral position group, the high contact stress of the 6° varus or 6° valgus group were increased by 2.88±2.53 MPa and 3.47±2.86 MPa, respective ly (P<0.05). The lateral compartment load ratio and the high contact stress of lateral compartment femoral cartilage was gradually decreased (P<0.05), when the femoral and tibial components changed from 6° varus to 6° valgus. The number (2.8%, 1/36) of indicators in the sparse area (the combination of all combinations of femur or tibia from 3° varus to 3° valgus) was less than that (57.8%, 37/64) in the dense area (set of all combinations except sparse area), and the difference was significant (χ2=29.61, P<0.001). \u0000 \u0000 \u0000Conclusion \u0000It is suggested that the position of the femoral component and the tibial component in fixed medial unicompartmental arthroplasty should not exceed 3° varu","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"169-177"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48541906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-01DOI: 10.3760/CMA.J.ISSN.0253-2352.2020.03.002
Wei Ding, Minzhe Zheng, Mingguang Bi, Ting Zhang, Lingxiao Pan, Zhaoxiang Peng, Peixing Hu, Jin Li
Objective To investigate the clinical outcomes of arthroscopic bridging reconstruction of irreparable massive rotator cuff tears using autogenous fascia lata. Methods From July 2015 to July 2017, a total of 10 cases (4 male and 6 female) who were treated with arthroscopic bridging reconstruction for irreparable massive rotator cuff tears using autogenous fascia lata were retrospectively analyzed. The age before surgery was 61.3±2.9 years (range 57-67 years). There were 7 patients with right shoulders and 3 with left shoulders. The dominate sides were involved in 7 cases. The trauma history was documented in 2 shoulders. The duration of preoperative symptoms was 14.0±13.5 months (1-48 months). The case with revision surgery was not included. The patients were examined with magnetic resonance imaging (MRI) to evaluate the healing of fascia lata patch bridging in the joint at one week, six months, one year and two years after operation. The motion range of shoulder and the clinical scores, including visual analogue scale (VAS), University of California Los Angeles (UCLA) score, Constant-Murley score and American Shoulder & Elbow Surgeons (ASES) score, were measured before surgery and at follow-up duration. Results All cases were reconstructed the horizontal couple. No perioperative complication was occurred and all surgery were completed safely and successfully. At the end of two years, the score of ASES was 92.2±3.5 (range 88.3-98.3), UCLA 31.6±2.0 (range 28-34), Constant-Murley 85.2±5.4 (range 78-93) with significant difference (t=11.254, P=0.000; t=12.111, P=0.000; t=8.948, P=0.00) comparing with that before surgery. The VAS pain score was 0.6±0.5 (range 0-1) which was significantly lower than that preoperatively (t=11.326, P=0.000). At 2 years after operation, MRI shows that fascia lata patches healed well in 9 patients. However, one case was with re-tear and patch absorption. The range of motion of shoulder was significantly improved in all patients but with different degrees of weakness (3-4). Conclusion Arthroscopic bridging reconstruction using autogenous fascia lata could effectively improve shoulder function in patients with irreparable massive rotator cuff tears. The autogenous fascia lata patch can heal with the help of rotator cuff tissue through bridging reconstruction. Key words: Arthroscopy; Fascia lata; Reconstructive surgical procedures; Rotator cuff; Transplants
{"title":"Arthroscopic bridging reconstruction of irreparable massive rotator cuff tears using autogenous fascia lata","authors":"Wei Ding, Minzhe Zheng, Mingguang Bi, Ting Zhang, Lingxiao Pan, Zhaoxiang Peng, Peixing Hu, Jin Li","doi":"10.3760/CMA.J.ISSN.0253-2352.2020.03.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2020.03.002","url":null,"abstract":"Objective \u0000To investigate the clinical outcomes of arthroscopic bridging reconstruction of irreparable massive rotator cuff tears using autogenous fascia lata. \u0000 \u0000 \u0000Methods \u0000From July 2015 to July 2017, a total of 10 cases (4 male and 6 female) who were treated with arthroscopic bridging reconstruction for irreparable massive rotator cuff tears using autogenous fascia lata were retrospectively analyzed. The age before surgery was 61.3±2.9 years (range 57-67 years). There were 7 patients with right shoulders and 3 with left shoulders. The dominate sides were involved in 7 cases. The trauma history was documented in 2 shoulders. The duration of preoperative symptoms was 14.0±13.5 months (1-48 months). The case with revision surgery was not included. The patients were examined with magnetic resonance imaging (MRI) to evaluate the healing of fascia lata patch bridging in the joint at one week, six months, one year and two years after operation. The motion range of shoulder and the clinical scores, including visual analogue scale (VAS), University of California Los Angeles (UCLA) score, Constant-Murley score and American Shoulder & Elbow Surgeons (ASES) score, were measured before surgery and at follow-up duration. \u0000 \u0000 \u0000Results \u0000All cases were reconstructed the horizontal couple. No perioperative complication was occurred and all surgery were completed safely and successfully. At the end of two years, the score of ASES was 92.2±3.5 (range 88.3-98.3), UCLA 31.6±2.0 (range 28-34), Constant-Murley 85.2±5.4 (range 78-93) with significant difference (t=11.254, P=0.000; t=12.111, P=0.000; t=8.948, P=0.00) comparing with that before surgery. The VAS pain score was 0.6±0.5 (range 0-1) which was significantly lower than that preoperatively (t=11.326, P=0.000). At 2 years after operation, MRI shows that fascia lata patches healed well in 9 patients. However, one case was with re-tear and patch absorption. The range of motion of shoulder was significantly improved in all patients but with different degrees of weakness (3-4). \u0000 \u0000 \u0000Conclusion \u0000Arthroscopic bridging reconstruction using autogenous fascia lata could effectively improve shoulder function in patients with irreparable massive rotator cuff tears. The autogenous fascia lata patch can heal with the help of rotator cuff tissue through bridging reconstruction. \u0000 \u0000 \u0000Key words: \u0000Arthroscopy; Fascia lata; Reconstructive surgical procedures; Rotator cuff; Transplants","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"138-145"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41533429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-01DOI: 10.3760/CMA.J.ISSN.0253-2352.2020.03.008
Jie Yuan, Jia You, Yanlin Wan, K. Sun
Due to its advantages of low wear, high stability and flexibility, the new generation metal-on-metal hip prosthesis is favored by many patients with hip diseases, especially young patients. However, in recent years, several studies have indicated that adverse reactions to metal debris (ARMD) caused the formation of inflammatory pseudotumor, which ultimately led to a higher revision rate after metal-on-metal hip arthroplasty. This aroused the widespread concern from doctors and patients. Moreover, revision surgery for metal-on-metal hip arthroplasty in the setting of inflammatory pseudotumor is faced with a great risk of failure because of the large defects of bone and surrounding soft tissue and difficulty in removing the original prosthesis and the fixing of the modified prosthesis. Therefore, the use of such products is restricted with caution in their choice. We summarized the recent developments in the research in the risk factors, diagnosis and treatment of inflammatory pseudotumor after metal-on-metal hip arthroplasty. The risk factors for the formation of inflammatory pseudotumor around the hip prosthesis mainly include the increase of metal ion concentration, the position of prosthesis implantation and the patient's own factors. The diagnosis mainly depends on physical examination, imaging examination, laboratory examination, arthroscopy and histological examination. The treatment strategies for clinical symptomatic and asymptomatic patients are also varies. Through the detailed analysis, evaluation and summary of the above contents, we may provide guidance for the selection of hip prosthesis, and lay the foundation for further exploration of the mechanism of inflammatory pseudotumor caused by ARMD.
{"title":"The inflammatory pseudotumor formed after metal-on-metal hip arthroplasty","authors":"Jie Yuan, Jia You, Yanlin Wan, K. Sun","doi":"10.3760/CMA.J.ISSN.0253-2352.2020.03.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2020.03.008","url":null,"abstract":"Due to its advantages of low wear, high stability and flexibility, the new generation metal-on-metal hip prosthesis is favored by many patients with hip diseases, especially young patients. However, in recent years, several studies have indicated that adverse reactions to metal debris (ARMD) caused the formation of inflammatory pseudotumor, which ultimately led to a higher revision rate after metal-on-metal hip arthroplasty. This aroused the widespread concern from doctors and patients. Moreover, revision surgery for metal-on-metal hip arthroplasty in the setting of inflammatory pseudotumor is faced with a great risk of failure because of the large defects of bone and surrounding soft tissue and difficulty in removing the original prosthesis and the fixing of the modified prosthesis. Therefore, the use of such products is restricted with caution in their choice. We summarized the recent developments in the research in the risk factors, diagnosis and treatment of inflammatory pseudotumor after metal-on-metal hip arthroplasty. The risk factors for the formation of inflammatory pseudotumor around the hip prosthesis mainly include the increase of metal ion concentration, the position of prosthesis implantation and the patient's own factors. The diagnosis mainly depends on physical examination, imaging examination, laboratory examination, arthroscopy and histological examination. The treatment strategies for clinical symptomatic and asymptomatic patients are also varies. Through the detailed analysis, evaluation and summary of the above contents, we may provide guidance for the selection of hip prosthesis, and lay the foundation for further exploration of the mechanism of inflammatory pseudotumor caused by ARMD.","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"186-192"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49359922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-01DOI: 10.3760/CMA.J.ISSN.0253-2352.2020.03.004
Tao Chen, Xinlong Ma, Jian-xiong Ma, Runze Yu
Objective To explore the clinical effects of Nice knot combined with elastic compress and stretch in treating skin and soft tissue defect. Methods From August 2017 to April 2019, a total of 23 patients, 10 males and 13 females, aged 36.5±5.3 years (range 26-76 years), were retrospectively analyzed. The defect size was 60±5.3 cm2 (28-96 cm2). Under local anesthesia, the wound was debrided thoroughly, sutured and fixed by Nice knot. The wound was fixed by elastic dressing and traction. The wound was retracted every 3 days during dressing change. The wound healing grade, healing rate, healing time, and postoperative Vancouver Scar Scale (VSS) were observed and recorded. Results All operations were performed successfully in the debridement room. The operation time was 42±10.5 min (range 30-50 min), intraoperative bleeding 30±2.5 ml (range 20-60 ml), and the operation cost 180±11.5 RMB (range 160-240 RMB). Twenty patients were followed up for 4±2.5 months (range 3-6 months). The wound healing rate of 23 patients was 50%±3.5% (range 40%-56%). For the 20 patients, the wound healing rate was 65%±4.3% (range 53%-75%), 74%±4.5% (range 65%-80%), 83%±1.8% (range 76%-85%), 90%±1.6% (range 84%-95%) and 95%±3.5% (range 94%-98%) at 3, 6, 9, 12 and 15 days, respectively. The wound healing rate of 20 patients was 100% at the 42nd days of follow-up. Wound healing rate of Grade A and grade B was 95% (19/20) with scar VSS score 4(3, 6). The excellent and good rate of grade B was 80% (16/20). Two cases were sutured and fixed with Nice knot after 10 days because of the partial loss of the sutures. One case was treated with vacuum sealing drainage (VSD) on-line junction because infection was not completely controlled. Local infection was controlled and the wound was contracted by Nice junction at 1 week. Conclusion The treatment of skin and soft tis sue defect with Nice combination with elastic dressing and traction has the advantages of simple operation, low operation condition, short operation time, less bleeding, low cost, high wound healing grade and healing rate, suitable for basic level hospital application and promotion. Key words: Suture techniques; Surgical tape; Soft tissue injuries; Wound healing
{"title":"Treatment of skin and soft tissue defect with Nice combination with elastic dressing and stretch","authors":"Tao Chen, Xinlong Ma, Jian-xiong Ma, Runze Yu","doi":"10.3760/CMA.J.ISSN.0253-2352.2020.03.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2020.03.004","url":null,"abstract":"Objective \u0000To explore the clinical effects of Nice knot combined with elastic compress and stretch in treating skin and soft tissue defect. \u0000 \u0000 \u0000Methods \u0000From August 2017 to April 2019, a total of 23 patients, 10 males and 13 females, aged 36.5±5.3 years (range 26-76 years), were retrospectively analyzed. The defect size was 60±5.3 cm2 (28-96 cm2). Under local anesthesia, the wound was debrided thoroughly, sutured and fixed by Nice knot. The wound was fixed by elastic dressing and traction. The wound was retracted every 3 days during dressing change. The wound healing grade, healing rate, healing time, and postoperative Vancouver Scar Scale (VSS) were observed and recorded. \u0000 \u0000 \u0000Results \u0000All operations were performed successfully in the debridement room. The operation time was 42±10.5 min (range 30-50 min), intraoperative bleeding 30±2.5 ml (range 20-60 ml), and the operation cost 180±11.5 RMB (range 160-240 RMB). Twenty patients were followed up for 4±2.5 months (range 3-6 months). The wound healing rate of 23 patients was 50%±3.5% (range 40%-56%). For the 20 patients, the wound healing rate was 65%±4.3% (range 53%-75%), 74%±4.5% (range 65%-80%), 83%±1.8% (range 76%-85%), 90%±1.6% (range 84%-95%) and 95%±3.5% (range 94%-98%) at 3, 6, 9, 12 and 15 days, respectively. The wound healing rate of 20 patients was 100% at the 42nd days of follow-up. Wound healing rate of Grade A and grade B was 95% (19/20) with scar VSS score 4(3, 6). The excellent and good rate of grade B was 80% (16/20). Two cases were sutured and fixed with Nice knot after 10 days because of the partial loss of the sutures. One case was treated with vacuum sealing drainage (VSD) on-line junction because infection was not completely controlled. Local infection was controlled and the wound was contracted by Nice junction at 1 week. \u0000 \u0000 \u0000Conclusion \u0000The treatment of skin and soft tis sue defect with Nice combination with elastic dressing and traction has the advantages of simple operation, low operation condition, short operation time, less bleeding, low cost, high wound healing grade and healing rate, suitable for basic level hospital application and promotion. \u0000 \u0000 \u0000Key words: \u0000Suture techniques; Surgical tape; Soft tissue injuries; Wound healing","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"154-159"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44960426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2020.02.007
Jianghong Tan, Guoping Chen, Y. Hao
Bone defect repairing and reconstruction has been a hot research topic in orthopedics for a long time. Tissue engineering and stem cell technology have made a series of important achievements in promoting bone regeneration to treat bone defect. In recent years, 3D bio-printing, which combining with 3D printing, tissue engineering and stem cell technology, has significant advantages in optimizing the geometry, mechanical properties and biological functions of repairing tissue for bone defect by accurately controlling the shape and internal structure of scaffolds, and printing biomaterials, stem cells and (or) cells into three-dimensional biological functional structures. A series of important progress has been achieved. The common printing methods for bio-printing related to orthopedic include: Inkjet 3D bioprinting; microextrusion 3D bioprinting; laser-assisted 3D bioprinting; stereolithography; microvalve based 3D bioprinting. Various printing methods and principles are not the same, and each has advantages and disadvantages, and the applicable "bio ink" is also different. The key technologies of orthopedic bio-3D printing include: the methods of image data acquisition and 3D structure design; development and application of composite bio-scaffold materials suitable for 3D printing, tissue engineering and bone-enhancing effect; stem cell selection for ensuring graft biological performance and induced pluripotent stem cell technology; in vitro bioreactor technology for improving the maturity and biocharacterization of bioprinted tissues. The literature published in the field of biological 3D printing research has continued to grow at a high rate since 2008. Using the bibliometric analysis software VOSviewer to create a co-word matrix for high-frequency keywords and to draw a keyword co-occurrence network map analysis, biological 3D printing research hotspots are the use of tissue engineering methods to 3D printed tissue scaffolds, while studying cell survival and drug effects. The instruments and methods of bio-3D printing are also one of the research hotspots.
{"title":"Key technology of 3D bio-printing and its application in orthopedics","authors":"Jianghong Tan, Guoping Chen, Y. Hao","doi":"10.3760/CMA.J.ISSN.0253-2352.2020.02.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2020.02.007","url":null,"abstract":"Bone defect repairing and reconstruction has been a hot research topic in orthopedics for a long time. Tissue engineering and stem cell technology have made a series of important achievements in promoting bone regeneration to treat bone defect. In recent years, 3D bio-printing, which combining with 3D printing, tissue engineering and stem cell technology, has significant advantages in optimizing the geometry, mechanical properties and biological functions of repairing tissue for bone defect by accurately controlling the shape and internal structure of scaffolds, and printing biomaterials, stem cells and (or) cells into three-dimensional biological functional structures. A series of important progress has been achieved. The common printing methods for bio-printing related to orthopedic include: Inkjet 3D bioprinting; microextrusion 3D bioprinting; laser-assisted 3D bioprinting; stereolithography; microvalve based 3D bioprinting. Various printing methods and principles are not the same, and each has advantages and disadvantages, and the applicable \"bio ink\" is also different. The key technologies of orthopedic bio-3D printing include: the methods of image data acquisition and 3D structure design; development and application of composite bio-scaffold materials suitable for 3D printing, tissue engineering and bone-enhancing effect; stem cell selection for ensuring graft biological performance and induced pluripotent stem cell technology; in vitro bioreactor technology for improving the maturity and biocharacterization of bioprinted tissues. The literature published in the field of biological 3D printing research has continued to grow at a high rate since 2008. Using the bibliometric analysis software VOSviewer to create a co-word matrix for high-frequency keywords and to draw a keyword co-occurrence network map analysis, biological 3D printing research hotspots are the use of tissue engineering methods to 3D printed tissue scaffolds, while studying cell survival and drug effects. The instruments and methods of bio-3D printing are also one of the research hotspots.","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"110-118"},"PeriodicalIF":0.0,"publicationDate":"2020-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42578003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2020.02.003
Penghui Liu, Yanping Zheng, Jun Yan, Peng-fei Chen
Objective To investigate the correlation between degree of multifidus muscle atrophy and severity in patients with degenerative lumbar spondylolisthesis. Methods A total of 103 patients with lumbar degenerative spondylolisthesis were retrospectively analyzed, including 22 male patients (21.4%) and 81 female patients (78.6%). There were 2 cases of L2 spondylolisthesis, 10 cases of L3 spondylolisthesis, 81 cases of L4 spondylolisthesis, and 10 cases of L5 spondylolisthesis. The average age was 58.55 ±0.88 years old. Each patient underwent lumbar lateral X-ray, and lumbar MRI, and the imaging data were collected. MRI images were obtained to measure and calculatethe ratio of the fat-free multifidus muscle cross sectional area to total multifidus muscle cross sectional area (LCSA/TCSA) in slipped segments and non-slipped segments. Lumbar lateral radiographs were obtained to measure and calculate slipped ratio. All data were analyzed by SPSS 23.0. Paired-samples T test was carried out to investigate whether there were LCSA/TCSA differences between in slipped segments and non-slipped segments. The correlation between LCSA/TCSA in slipped segments and slipped ratio was analyzed by using Pearson correlation coefficient system. P=0.000 was considered statistically significant. Results The degree of multifidus muscle atrophy (FCSA/TCSA) in the upper non-spondylolisthesis segments and the multifid muscle atrophy (FCSA/TCSA) in the degenerative spondylolisthesis segments (t=-12.618, P=0.000). there was significant difference between them. The degree of multifidus muscle atrophy (FCSA/TCSA) of degenerative spondylolisthesis was correlated with the spondylolisthesis ratio, and the correlation coefficient was -0.425. There was a high negative correlation between FCSA/TCSA ratio and spondylolisthesis ratio of degenerative spondylolisthesis. Conclusion The degree of multifidus muscle atrophy in degenerative spondylolisthesis is more serious than that in the upper non-spondylolisthesis segments, and there is a positive correlation between the degree of multifidus muscle atrophy in degenerative lumbar spondylolisthesis and the degree of lumbar spondylolisthesis in degenerative lumbar spondylolisthesis patients. Key words: Lumbar vertebrae; Spondylolysis; Muscular disorders, atrophic
{"title":"The correlation between degree of multifidus muscle atrophy and severity in patients with degenerative lumbar spondylolisthesis","authors":"Penghui Liu, Yanping Zheng, Jun Yan, Peng-fei Chen","doi":"10.3760/CMA.J.ISSN.0253-2352.2020.02.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2020.02.003","url":null,"abstract":"Objective \u0000To investigate the correlation between degree of multifidus muscle atrophy and severity in patients with degenerative lumbar spondylolisthesis. \u0000 \u0000 \u0000Methods \u0000A total of 103 patients with lumbar degenerative spondylolisthesis were retrospectively analyzed, including 22 male patients (21.4%) and 81 female patients (78.6%). There were 2 cases of L2 spondylolisthesis, 10 cases of L3 spondylolisthesis, 81 cases of L4 spondylolisthesis, and 10 cases of L5 spondylolisthesis. The average age was 58.55 ±0.88 years old. Each patient underwent lumbar lateral X-ray, and lumbar MRI, and the imaging data were collected. MRI images were obtained to measure and calculatethe ratio of the fat-free multifidus muscle cross sectional area to total multifidus muscle cross sectional area (LCSA/TCSA) in slipped segments and non-slipped segments. Lumbar lateral radiographs were obtained to measure and calculate slipped ratio. All data were analyzed by SPSS 23.0. Paired-samples T test was carried out to investigate whether there were LCSA/TCSA differences between in slipped segments and non-slipped segments. The correlation between LCSA/TCSA in slipped segments and slipped ratio was analyzed by using Pearson correlation coefficient system. P=0.000 was considered statistically significant. \u0000 \u0000 \u0000Results \u0000The degree of multifidus muscle atrophy (FCSA/TCSA) in the upper non-spondylolisthesis segments and the multifid muscle atrophy (FCSA/TCSA) in the degenerative spondylolisthesis segments (t=-12.618, P=0.000). there was significant difference between them. The degree of multifidus muscle atrophy (FCSA/TCSA) of degenerative spondylolisthesis was correlated with the spondylolisthesis ratio, and the correlation coefficient was -0.425. There was a high negative correlation between FCSA/TCSA ratio and spondylolisthesis ratio of degenerative spondylolisthesis. \u0000 \u0000 \u0000Conclusion \u0000The degree of multifidus muscle atrophy in degenerative spondylolisthesis is more serious than that in the upper non-spondylolisthesis segments, and there is a positive correlation between the degree of multifidus muscle atrophy in degenerative lumbar spondylolisthesis and the degree of lumbar spondylolisthesis in degenerative lumbar spondylolisthesis patients. \u0000 \u0000 \u0000Key words: \u0000Lumbar vertebrae; Spondylolysis; Muscular disorders, atrophic","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"82-87"},"PeriodicalIF":0.0,"publicationDate":"2020-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45537099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2020.02.008
Xiu-chun Yu, Yong‐cheng Hu
Epiphyseal preservation limb salvage is a method for the treatment of limb osteosarcoma in children and adolescents. The purpose is to avoid the unequal length of bilateral limbs and improve the affected limb function without increasing the occurrence of life-threatening complications. Strictly following the indications is the key to ensure the success of the operation.Before operation, epiphyseal distraction or imaging method is used to determine the position of osteotomy in operation, which has reached the safe boundary of tumor resection. Many ways were used to repair the tumor bone defect. A lot of studies confirmed that all kinds of surgical methods have achieved satisfied clinical outcomes, but there are different surgical complications. Only when the epiphyseal plate and epiphysis are kept at the same time can the length of the limb be ensured to be equal; the result of intra-epiphyseal osteotomy is that the block of bone growth leads to the unequal length of the limb. The biological reconstruction of bone defect can restore the length of limbs by bone lengthening after bone growth stops. Key words: Osteosarcoma; Extremities; Surgical procedures, operative; Treatment outcomes
{"title":"The basic principle and clinical outcomes of epiphysis preservation limb salvage in the treatment of limb osteosarcoma in children and adolescents","authors":"Xiu-chun Yu, Yong‐cheng Hu","doi":"10.3760/CMA.J.ISSN.0253-2352.2020.02.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2020.02.008","url":null,"abstract":"Epiphyseal preservation limb salvage is a method for the treatment of limb osteosarcoma in children and adolescents. The purpose is to avoid the unequal length of bilateral limbs and improve the affected limb function without increasing the occurrence of life-threatening complications. Strictly following the indications is the key to ensure the success of the operation.Before operation, epiphyseal distraction or imaging method is used to determine the position of osteotomy in operation, which has reached the safe boundary of tumor resection. Many ways were used to repair the tumor bone defect. A lot of studies confirmed that all kinds of surgical methods have achieved satisfied clinical outcomes, but there are different surgical complications. Only when the epiphyseal plate and epiphysis are kept at the same time can the length of the limb be ensured to be equal; the result of intra-epiphyseal osteotomy is that the block of bone growth leads to the unequal length of the limb. The biological reconstruction of bone defect can restore the length of limbs by bone lengthening after bone growth stops. \u0000 \u0000 \u0000Key words: \u0000Osteosarcoma; Extremities; Surgical procedures, operative; Treatment outcomes","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"119-128"},"PeriodicalIF":0.0,"publicationDate":"2020-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45860447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2020.02.001
Xuelei Wei, Jie Lu, Yandong Lu, Meng Cui, Xi Zhang
Objective To investigate the clinical features of patients with hyperextension bicondylar tibial plateau fractures (HEBTPs), and assess surgical effectiveness of HEBTP and non-HEBTP fracture patients. Methods From June 2014 to May 2017, 82 patients with bicondylar tibial plateau fracture were included in this study. There were 63 patients with 63 knees (76.8%) that had sustained non-HEBTPs, and 19 patients with 19 knees (23.2%) that had HEBTPs, including 49 males and 33 females with a mean age of 48.3 years (range, 22-76). Of the 19 HEBTPs patients, 4 cases were hyperextension valgus injury, 9 cases were hyperextension varus injury, and 6 cases were pure hyperextension injury. All patients were treated with open reduction internal fixation combined with bone grafting or non-bone grafting. All follow-up patients were evaluated clinically and radiographically, included the incidence of associated injuries, infection, posttraumatic osteoarthritis, range of motion (ROM) of knee, numeric rating scale (NRS) for assessment of pain, and Short Musculoskeletal Functional Assessment (SMFA) scores for assessment of knee function. The fracture healing and postoperative alignment were assessed with anteroposterior and lateral X-rays. Results All patients were followed up for 12-22 months, the mean follow-up time was 15.4 months. Bone union was obtained in all patients, and the bone union time was 12.6 weeks (ranged: 12-16 weeks). At the last follow up, all patients had full range of motion. The incidence of significant associated injuries was 36.8% in the HEVBTP group compared with 15.8% in the non-HEBTP group. The incidence of popliteal artery injury, common peroneal nerve injury and ligament injury that needed repair in 19 HEBTPs patients was 21.1%, 26.3% and 31.6%, respectively, while the corresponding incidence of complications in 63 non-HEBTPs patients was 3.2%, 4.8%, and 9.5%, respectively. The NRS pain score of HEBTPs and non-HEBTPs at 12 months after surgery was 3.89±1.9 and 2.76±1.88, respectively. The value of HEBTPs patients was higher than that of non-HEBTPs patients, But the difference was not statistically significant. The SMFA scores of HEBTPs and non-HEBTPs patients at 12 months after surgery were 27.27±19.44 and 17.09±15.87, respectively. Patients with HEBTP had higher functional (SMFA) scores and a trend of higher pain scores than those with non-HEBTP, indicating associated soft-tissue damage and developed posttraumatic osteoarthritis. Conclusion The present showed that the HEBTP is a unique fracture. These injuries result in worse functional outcomes than non-HEBTP. Physicians must recognize the possible associated injuries (included ligaments, vessels and nerves), and the treatment effect of HEBTP is relatively poor. Key words: Tibial fractures; Comparative study; Postoperative complications; Prognosis
{"title":"Clinical features and surgical effectiveness of hyperextension bicondylar tibial plateau fractures","authors":"Xuelei Wei, Jie Lu, Yandong Lu, Meng Cui, Xi Zhang","doi":"10.3760/CMA.J.ISSN.0253-2352.2020.02.001","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2020.02.001","url":null,"abstract":"Objective \u0000To investigate the clinical features of patients with hyperextension bicondylar tibial plateau fractures (HEBTPs), and assess surgical effectiveness of HEBTP and non-HEBTP fracture patients. \u0000 \u0000 \u0000Methods \u0000From June 2014 to May 2017, 82 patients with bicondylar tibial plateau fracture were included in this study. There were 63 patients with 63 knees (76.8%) that had sustained non-HEBTPs, and 19 patients with 19 knees (23.2%) that had HEBTPs, including 49 males and 33 females with a mean age of 48.3 years (range, 22-76). Of the 19 HEBTPs patients, 4 cases were hyperextension valgus injury, 9 cases were hyperextension varus injury, and 6 cases were pure hyperextension injury. All patients were treated with open reduction internal fixation combined with bone grafting or non-bone grafting. All follow-up patients were evaluated clinically and radiographically, included the incidence of associated injuries, infection, posttraumatic osteoarthritis, range of motion (ROM) of knee, numeric rating scale (NRS) for assessment of pain, and Short Musculoskeletal Functional Assessment (SMFA) scores for assessment of knee function. The fracture healing and postoperative alignment were assessed with anteroposterior and lateral X-rays. \u0000 \u0000 \u0000Results \u0000All patients were followed up for 12-22 months, the mean follow-up time was 15.4 months. Bone union was obtained in all patients, and the bone union time was 12.6 weeks (ranged: 12-16 weeks). At the last follow up, all patients had full range of motion. The incidence of significant associated injuries was 36.8% in the HEVBTP group compared with 15.8% in the non-HEBTP group. The incidence of popliteal artery injury, common peroneal nerve injury and ligament injury that needed repair in 19 HEBTPs patients was 21.1%, 26.3% and 31.6%, respectively, while the corresponding incidence of complications in 63 non-HEBTPs patients was 3.2%, 4.8%, and 9.5%, respectively. The NRS pain score of HEBTPs and non-HEBTPs at 12 months after surgery was 3.89±1.9 and 2.76±1.88, respectively. The value of HEBTPs patients was higher than that of non-HEBTPs patients, But the difference was not statistically significant. The SMFA scores of HEBTPs and non-HEBTPs patients at 12 months after surgery were 27.27±19.44 and 17.09±15.87, respectively. Patients with HEBTP had higher functional (SMFA) scores and a trend of higher pain scores than those with non-HEBTP, indicating associated soft-tissue damage and developed posttraumatic osteoarthritis. \u0000 \u0000 \u0000Conclusion \u0000The present showed that the HEBTP is a unique fracture. These injuries result in worse functional outcomes than non-HEBTP. Physicians must recognize the possible associated injuries (included ligaments, vessels and nerves), and the treatment effect of HEBTP is relatively poor. \u0000 \u0000 \u0000Key words: \u0000Tibial fractures; Comparative study; Postoperative complications; Prognosis","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"65-72"},"PeriodicalIF":0.0,"publicationDate":"2020-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43635398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-16DOI: 10.3760/CMA.J.ISSN.0253-2352.2020.02.004
Zheng-Hao Wang, Kainan Li, Jiang Zheng, E. Chen
Objective To study the influencing factors of fracture nonunion after intramedullary nailing for subtrochanteric fracture and construct a risk assessment model. Methods A retrospective analysis was performed on 251 patients with intramedullary nail fractures of the femoral subtrochanteric fracture from February 2006 to January 2018. According to the different treatment time, the 251 patients included in this study were divided into the modeling group and the verification group. In the modeling group, postoperative fracture nonunion rate, general data, fracture related factors, surgical reduction related factors, mechanical and biological factors were calculated, and the influencing factors of fracture nonunion were screened by univariate analysis. Indicators with statistical differences in univariate analysis were analyzed using Logistic regression model for multivariate analysis to build the risk assessment model. The influencing factors were re-evaluated through the verification group, and the differentiation and calibration of the model were evaluated. Results Fracture nonunion occurred in 34 of 149 patients in the modeling group. Among the 13 potential influencing factors, univariate analysis and logistic regression analysis showed that postoperative hip varus, intramedullary nail fixation failure and complete open reduction were the risk factors of fracture nonunion. Postoperative reduction of medial cortex was a protective factor for fracture nonunion, and a regression equation was established. Based on the logistic regression model, the Nomogram diagram was drawn. In the verification group, fracture nonunion occurred in 24 of 149 patients. The area under the ROC curve was AUC=0.883>0.7, indicating that there was a moderate differentiation to evaluate the occurrence of fracture nonunion after operation. The goodness of fit test: the H-L test (χ2=2.921, P=0.712) showed that the model had a good calibration. Conclusion The risk factors of fracture nonunion were hip varus, failure of intramedullary nail fixation and complete open reduction after intramedullary nailing of subtrochanteric fracture, and postoperative reduction of medial cortex was the protective factor. The risk assessment model has moderate differentiation and good calibration, which can provide reference for the risk assessment of fracture nonunion after subtrochanteric fracture operation. Key words: Femoral fracture; Fracture, ununited; Forecasting; Calibration
{"title":"A multicenter study on the risk assessment model of fracture nonunion after intramedullary nailing operation for subtrochanteric fracture of femur","authors":"Zheng-Hao Wang, Kainan Li, Jiang Zheng, E. Chen","doi":"10.3760/CMA.J.ISSN.0253-2352.2020.02.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-2352.2020.02.004","url":null,"abstract":"Objective \u0000To study the influencing factors of fracture nonunion after intramedullary nailing for subtrochanteric fracture and construct a risk assessment model. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was performed on 251 patients with intramedullary nail fractures of the femoral subtrochanteric fracture from February 2006 to January 2018. According to the different treatment time, the 251 patients included in this study were divided into the modeling group and the verification group. In the modeling group, postoperative fracture nonunion rate, general data, fracture related factors, surgical reduction related factors, mechanical and biological factors were calculated, and the influencing factors of fracture nonunion were screened by univariate analysis. Indicators with statistical differences in univariate analysis were analyzed using Logistic regression model for multivariate analysis to build the risk assessment model. The influencing factors were re-evaluated through the verification group, and the differentiation and calibration of the model were evaluated. \u0000 \u0000 \u0000Results \u0000Fracture nonunion occurred in 34 of 149 patients in the modeling group. Among the 13 potential influencing factors, univariate analysis and logistic regression analysis showed that postoperative hip varus, intramedullary nail fixation failure and complete open reduction were the risk factors of fracture nonunion. Postoperative reduction of medial cortex was a protective factor for fracture nonunion, and a regression equation was established. Based on the logistic regression model, the Nomogram diagram was drawn. In the verification group, fracture nonunion occurred in 24 of 149 patients. The area under the ROC curve was AUC=0.883>0.7, indicating that there was a moderate differentiation to evaluate the occurrence of fracture nonunion after operation. The goodness of fit test: the H-L test (χ2=2.921, P=0.712) showed that the model had a good calibration. \u0000 \u0000 \u0000Conclusion \u0000The risk factors of fracture nonunion were hip varus, failure of intramedullary nail fixation and complete open reduction after intramedullary nailing of subtrochanteric fracture, and postoperative reduction of medial cortex was the protective factor. The risk assessment model has moderate differentiation and good calibration, which can provide reference for the risk assessment of fracture nonunion after subtrochanteric fracture operation. \u0000 \u0000 \u0000Key words: \u0000Femoral fracture; Fracture, ununited; Forecasting; Calibration","PeriodicalId":36405,"journal":{"name":"中华骨科杂志","volume":"40 1","pages":"88-96"},"PeriodicalIF":0.0,"publicationDate":"2020-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49331040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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