ObjectiveTo investigate the curative effect of structural bone graft in treatment of high energy injury-induced complicated distal radius fractures combined with articular surface collapse and comminuted epiphyseal bone defect.MethodsThe study involved 38 patients with distal radius fractures (AO classification, type C3) treated from January 2007 to October 2010.The patients were treated with temporary Kirschner wire fixation to recover the wrist articular surface, distal radius length and palmar tilt angle at the greatest possibility.According to the form of the bone defects, the iliac bone taken from three layers of the cortical bone was embedded in the subchondral bone to support the bone graft, and a small amount of cancellous bone graft was collected to fill the articular surface collapse as much as possible for anatomical reduction of the articular surface, and anatomical form of the distal radius was reconstructed.Modified Sarmiento Gartland and Werley evaluation systems were used to evaluate the articular function recovery.ResultsThe follow-up lasted for 1-3.2 years, which showed no complications such as plate rupture or iatrogenic nerve blood vessels injuries.The fracture healing time was 15-22 weeks (mean 18.3 weeks).The wrist articular function in some patients obtained obvious improvement through functional rehabilitation training.According to the modified Gartland and Werley function evaluation systems, the curative effects reached excellence rate of 87％.During follow-up, there were two patients with high progressive loss in the height of the distal radius and two with articular surface collapse and severe carpal joint flexion and extension dysfunction.ConclusionsThe high energy injury-induced distal radius fractures with articular surface collapse and epiphyseal bone defect need recovery of the wrist articular surface, distal radius length and palmar tilt angle.Structural bone graft can effectively support the grafted bone and maintain the flatness of the radiocarpal articular surface, restore the anatomy of the distal radius and facilitate the functional recovery of the wrist.

Objective To evaluate the accuracy of 3D-CT navigation in guiding pedicle screw fixation in the thoracic spine.Methods Thoracic pedicle screw placement guided by 3D-CT navigation was performed on 24 cases,including 14 patients with thoracic spine fractures,6 thoracic tumors,and 4 scoliosis.CT data was input into the navigation system,and point-matching test was chosen.The optimal position,diameter,and length of the screw were set up using navigation stick after true-up.Then,the screw was placed dynamically in a stereo way according to navigation plan.After the operation,the position of the pedicle screw was assessed with CT using the Rampersaud grading system.Results Under the guidance of 3D-CT navigation,a total of 144 screws were successfully fixed into the 24 patients.According to the Rampersaud grading system,136 of the screws were at grade A(94.4%),6 at grade B,1 grade C,and 1 grade D.No postoperative injury of the nerve or spinal cord was observed.Of the patients,22 were followed up for a mean of 8 months(range,6-14 months).During the follow-up,no loose or breakage of the screw was detected by X-ray and CT.No delayed spinal cord injury was found.Conclusions The thoracic pedicle screw placement can be accurately guided by 3D-CT navigation.

BACKGROUND: The appearances of spiral computer tomograph (CT) and three-dimensional image processing are of very importance for fully evaluating preoperative pathological changes,which represent various cervical spondylotic myelopathy (CSM) in clinic, and choosing proper clinical therapeutic occasion and methods.OBJECTIVE: To analyze the effects of imageological image and technical advantages of three-dimensional spiral CT on the preoperative evaluation and surgical plan of CSM.DESIGN: Retrospective analysis, controlled observation.SETTING: Nanjing First Hospital Affiliated to Nanjing Medical University. PARTICIPANTS:Altogether 268 patients with CSM admitted to Nanjing First Hospital from January 2002 to January 2005 were involved in this experiment. The involved patients were randomly assigned into preoperative evaluation group (n =146) and control group (n =122). The baseline materials of two groups were comparable.METHODS:Preoperative evaluation group:① CT scan and three-dimensional reconstruction:Helical scanning was conducted at transverse plane with TOSHIBA-HiSpeed/I screw machine. After scanning, reconstruction was performed finally, three-dimensional reconstruction was conducted on computer workstation (RadworkS. 1 ). Correlative data were measured and analyzed with image analysis software (ADW3.1). ② Design of three-dimensional CT-assisted operation plan: Cervical vertebral osseous anatomic landmark and the anatomic relationship of its adjacent structure were revealed stereoscopically.Individual orthopaedic location marker could be provided.Preoperative routine CT examination was performed in the control group with conventional operation method.MAIN OUTCOME MEASURES: ① The hyperostosis of vertebral body, hamular process joint and small articular process were observed. ②The degree and type of intervertebral disc protrusion were observed. ③The changes of hyperostosis before and behind the vertebral canal. Spinal decompression was observed by CT virtual endoscopy (CT-VE).RESULTS: All the 268 patients participated in the result analysis. ① In the preoperative evaluation group, 129 patients were found with intervertebral disc protrusion,109 patients with vertebral posterior marginal hyperostosis, 61 patients with hypertrophic ligamentum flavum and corrugation, 27 patients with posterior longitudinal ligament calcification,31 patients with hyperostosis at small articular process,29 patients with vertebral plate thickening and 18 patients with vertebral olisthy.The visible anatomical structures were in accord with clinical manifestations and imageological structures. Death, laryngeal nerve injury, bone graft displacement, infection and other complications were not found in all the patients. In the postoperative 6th month, X-ray image showed that all the patients had good bone graft fusion, and no titanic plate or bolt loosening or fragmentation was found. The excellent and good rate evaluated by Odom was 95.9%.② In the control group,postoperative X-ray image and CT showed that vertebral canal decompression of 24 patients was not fully, and the positions of titanic plate or bolt of 17 patients were not satisfying. The excellent and good rate evaluated by Odom (84.4%) in the control group was lower than that in the preoperative evaluation group (P＜0.05).CONCLUSION: Preoperative observation of cervical vertebral individual three-dimensional CT is helpful to exactly and generally evaluate cervical spondylotic myelopathy and assistantly make operative plan,whick makes intraoperative manipulation more exactive, safer and easier to be controlled.

Objective To evaluate the accuracy of Intraoperative Iso-C3D navigation guiding cervical pedicle screw fixation. Methods Twenty-two cases adopted cervical pedicle screw fixation of cervical spine, including 9 cervical spine fractures, 4 cervical tumors, 6 cervical destabilizing, 3 cervical syndrome. The cervical pedicle screw position were assessed with post-operative CT by grade. Results One hundred and twelve screws were fixed in 22 cases successfully. Grade: 107 in A grade (95.5%); 3 in B grade: 1 in C grade; 1 in D grade. There were not any complication. Conclusion Intraoperative Iso-C3D navigation can improve precision of cervical petiole screw fixation distinctively.

Twenty-one rabbits were randomly divided into three groups: experimental group-filling vein with two neural segments being 0.3cm long to bridge 4cm defect of common peroneal nerve, control group-bridging vein directly to the 4cm defect of common peroneal nerve, auto-nerve-grafting group-cutting off a segment (4cm long) from common peroneal nerve and grafting it inversely.After 25 weeks, morphological, electrophysiological and histological examinations were undertaken, which revealed that the experimental group was most similar to the auto-nerve-grafting group in recovery of motion of the limbs, action potential of muscle, nerve conductive velocity, and regenerating density of nerve fibers and axons. It was a failure in control group. Satisfactory results were also achieved in 2 patients with defect of ulnar nerve treated by filling vein with two neural segments. It suggests that our method is feasible.

Objective To evaluate the application of infrared fluoroscopic navigation guiding pedicle screwfixation of thoracic-lumbarspine.Methods The pedicle screw fixation of thoraic-lumbar spine was adopted in 32 patients,including 19 cases with thoracic-lumbarspine fractures,5 cases with protrusion of lumbar intervertebral disc or vertebral canal stenosis,8 cases with lumbar spine slippage.The timefor pedicle screwfixation and amount of bleeding were recorded.The pedicle screwposition was assessed with post-operative CTby using An-drewgrade.Results Totally148 screws were fixed in 32 cases successfully,including10 screws in T11,20 in T12,18 in L1,36 in L2,16 inL3,26 in L4,28 in L5,and 14 in S1.According to andrewgrade,165 screws were inⅠgrade(98%),2 inⅡgrade,and 1 inⅢ grade.Nonerve and spinal cord damage was observed after operation.The average time of per pedicle screwfixation was(10?2.4) min.The averageamount of bleeding was(400?52.3) ml in thoracic-Lumbar Spine fractures,(200?36.8) ml in protrusion of lumbar intervertebral disc orvertebral canal stenosis,and(300?44.6) ml in Lumbar Spine slippage.Conclusion Infrared fluoroscopic navigation can improve the pre-cision of pedicle screw fixation of thoraic-lumbar spine,reduce the amount of bleeding,and shorten the operative time.

Objective To compare the clinical efficacy of external fixator and locking plate internal fixation via middle volar minimally invasive approach in the treatment of distal radius fractures.Methods A retrospective case-control study was conducted on the clinical data of 51 patients with distal radius fractures admitted from October 2014 to August 2016.There were 21 males and 30 females,aged 41-78 years (mean,57 years).According to the random number table method,the patients were divided into minimally invasive plate group (25 cases) which adopted locking plate internal fixation via middle volar minimally invasive approach and external fixator group (26 cases) with closed reduction of external fixator.The AO classification of the fractures in minimally invasive plate group was as follows:A2 in four cases,A3 in five cases,B1 in four cases,B2 in two cases,B3 in seven cases,and C1 in three cases.The AO classification of the fractures in external fixator group was as follows:A2 in three cases,A3 in six cases,B1 in five cases,B2 in three cases,B3 in seven cases,and C1 in two cases.The total incision length,operation time,intraoperative blood loss,preoperative and postoperative radial height,palmar inclination angle,ulnar deviation angle,pain visual analogue score (VAS),wrist active motion range (palmar flexion,dorsal extension,pronation,supination,radial deviation,and ulnar deviation),relative contralateral grip force,and wrist function Mayo score were compared between the two groups.Results There were no significant differences in the total length of incision,operation time,intraoperative blood loss,VAS 3 d after operation,radius height,ulnar deviation,and radius height,palm inclination and ulnar deviation at 14 months after operation between the two groups (P ＞ 0.05).The palmar inclination was (9.6-± 0.6) ° in the minimally invasive plate group and (7.9 ± 0.6) ° in the external fixator group (P ＜ 0.05).The wrist active motion range (palmar flexion,dorsal extension,pronation,supination,radial deviation,and ulnar deviation) and relative contralateral grip strength 3 months after operation in the minimally invasive plate group were significantly better than those in the external fixator group (P ＜ 0.05).However,the Mayo score of wrist function at 14 months after operation was (88.7 ± 12.7)points in the minimally invasive plate group and (88.7 ± 13.1)points in the external fixator group (P ＞ 0.05).Minimally invasive plate group showed median nerve stimulation in one case.External fixator group showed redness around the nail,increased temperature,and increase secretion of the infection in one case,and joint stiffness in one case after external fixation removal.But all symptoms were improved or resolved after treatment.Conclusion Both locking plate via minimally invasive approach and external fixator can achieve good results in the treatment of distal radius fractures,but the former method has better effects on early functional recovery than the latter one.

Objective To evaluate the effect of multi?plate reconstruction plate in the treatment of partial complex tarsometatarsal joint injury injuries. Methods Seven patients treated complex tarsometatarsal joint injuries with multi?plate reconstruction plate in Nanjing Hospital Affiliated to Nanjing Medical University from September 2014 to July 2016 were selected in this study. According to Myerson classification,3 cases were A type,3 cases were B type,1 case was C type. The therapeutic effects were observed. Results The patients were followed up for 6-12 months,with an average of (8. 6±2. 0) months. According to the foot scoring criteria in American Orthopedic Foot and Ankle Society ( AOFAS) ,the function of the foot was evaluated,3 cases were in excellent condition,4 cases were in good condition. Conclusion In the case of multiple metatarsal fractures of the metatarsal base involved in the joint surface, the use of multiple reconstructive plates for joint fixation reduces the iatrogenic damage of the joint surface. The fixation effect and the functional recovery are satisfactory