Objective Based on the disadvantages of NUSS procedure, we design a new type of funnel chest orthodontic steel bars for clinical application to simplify surgery operation , reduce the surgical trauma, improve operation effect, enhance the safety of operation, and relieve the suffering of the patients, etc.Methods From June 2010 to July 2015, 1020 patients used the new type of funnel chest orthodontic metal plates, including 706 cases of males and 314 cases of females, aged 3-40(aver-age age 11.38 ±5.31).Haller index of 3.36 to 15.45(average index 4.97 ±1.58).668 symmetrical funnel chest cases, 281 cases of asymmetry and 71 recurrent funnel chest cases are involved.Surgical steel bars, having 15 specifications, are arc-shaped, the lengths of which are from 12cm to 26cm.The two ends of steel bars have fixed piece, one end of the bar was fused with a stabilizer and the other end connected to an introducer or a stabilizer and use screws to fix two ends .Steel plates, as the design product, are finalized in the factory.Therefore we need not make intraoperative reprocess.Front tip of introducer and the back-end can be connected to the metal plate.Patients were placed supine position under general anesthesia.Two inci-sions, with length about 2cm and deep to the rib periosteum were made along axillary midline line on the both sides .In the di-rection of high blunt slightly medial free for subcutaneous tunnel to the highest point .Fixed wires were worn around the ribs on both sides.A thoracoscope to guide the bar was inserted from the highest point on the right side of the rear of the medial by sternum low into the chest from the left corresponds to the highest point of the medial , remove the introducer to connect another stator, use screws to fix the connection, with a fixed stator and steel plate stabilized.At the end of the surgery, the stabilizer on either side was secured with sutures.Results The median first operation time was 23 -45(32.31 ±3.57)min, second op-eration time was about 34-147(68.27 ±30.25)min..The bleeding volume(first operation) was 0-2(0.40 ±0.36)ml, the bleeding of second operation time was 1-630(144.00 ±57.00)ml.The hospital stay was 3-9(4.22 ±0.61)days after the operation.All the cases were followed up for 34-48(34.4 ±6.1)months.Steel plate was fixed at the bottom of the sternum in 957 of them,with slight shifting in 58 patients.There was another 5 cases who need re-operation because of the obvious shift-ing.Conclusion The new type of funnel chest orthodontic steel bars simplify surgery operation, reduce the surgical trauma, improve operation effect, relieve the suffering of the patients and enhance the safety of operation.

Objective To investigate the efficacy of calf self weight traction reduction combined with locking plate fixation for the treatment of intertrochanteric fractures in the elderly.Methods A retrospective case series study was conducted on the clinical records of 174 elderly patients with the modified Evans Ⅰ-Ⅲ types of fresh intertrochanteric fractures treated with locking plate from January 2012 to December 2015.According to treatment method,the patients were assigned to traction bed reduction with locking plate fixation (Group A,62 patients) and calf self weight traction reduction with locking plate fixation (Group B,112 patients).Group A comprised 32 males and 30 females,with age range of 65-91 years [(72.47 ± 6.35) years].Group B comprised 68 males and 44 females,with age range of 65-95 years [(73.23 ± 6.05) years].The time of reduction,operation time,incision length,intraoperative blood loss,frequency of fluoroscopy,postoperative drainage volume,hospital stay,postoperative weightbearing standing time or walking time (ambulation time),surgical complications,and fracture healing were recorded.Harris and modified Barthel index score in Chinese (MBI-C) were used to evaluate the functional recovery of hip joint.Results All patients were followed up for 5-61 months (mean,15 months),and noted with fracture healing.The time of reduction in Group A was (13.27 ± 3.03) minutes,longer than that in Group B (0 minute) (P ＜0.05).The operation time in Group A was (63.63 ± 13.90)minutes,longer than that in Group B [(59.62 ± 8.38) minutes] (P ＜ 0.05).Fluoroscopy in Group A was (5.35 ± 2.36) times,more than (4.28 ± 3.11) times in Group B (P ＜ 0.05).There were no significant differences in the incision length,intraoperative blood loss,postoperative drainage volume,ambulation time,fracture healing time,Harris score,and MBI-C index between the two groups (P ＞0.05).There were no significant differences in the postoperative complications such as deep venous thrombosis,pulmonary infection,incisional infection,urinary tract infection,delirium,bed sores,cardiac insufficiency,electrolyte disturbance,and postoperative plate rupture between the two groups (P＞0.05).The incidence of deep vein thrombosis was 9.7％ (6/62) in Group A,and 4.5％ (5/112) in Group B (P ＞0.05).No screw fracture,nail and plate combination failure,bone nonunion,or screw cut out of the femoral head were observed in both groups.Conclusions For the modified Evans Ⅰ-Ⅲ types of intertrochanteric fractures,both traction bed reduction and calf weight reduction with locking plate have equivalent efficacy.However,the latter method has advantages of shorter reduction and operation time and less intraoperative X-ray exposure,and hence is worthy of clinical application.

Objective To systematically evaluate the postoperative complications following open reduction and internal fixation combined with vascularized bone flap graft versus only reduction and internal fixation for femoral neck fractures.Methods CNKI,Wan Fang Chinese database,Pubmed,EMBASE and Google Scholar English database were searched for the randomized controlled trials from January 1,2000 through October 31,2017 which compared open reduction and internal fixation combined with vascularized bone flap graft (combined surgery group) with only reduction and internal fixation (simple surgery group) for femoral neck fractures.The data concerning postoperative nonunion and avascular necrosis of the femoral head were extracted.The 2 surgical treatments of the patients with femoral neck fracture were compared in terms of the 2 complications.Statistical analyses were conducted using software Stata 12 by relative risk (RR) and corresponding 95％ confidence intervals (95％ CI).Results According to our inclusion and exclusion criteria,a total of 23 studies were included,involving 2,162 cases (1,048 cases receiving combined surgery and 1,114 cases simple surgery).The Meta analyses showed that the fracture nonunion rate for the combined surgery group was significantly lower than that for the simple surgery group [RR =0.27,95％ CI(0.19,0.38),P ＜ 0.001] and the rate of avascular necrosis was also significantly lower for the former than for the latter [RR =0.31,95 ％ CI(0.24,0.42),P ＜ 0.001].Conclusion In the treatment of femoral neck fractures,open reduction and internal fixation combined with vascularied bone graft may lead to lower rates of nonunion and avascular necrosis of the femoral head than simple open reduction and internal fixation.