Child ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Respiratory Tract Diseases ; diagnostic imaging ; Tomography, Spiral Computed ; methods

Objective To explore the clinical effect and application value of four-point internal fixation technique (internal fixation of C_1-C_2 transarticular screws combined with Apofix laminar clamp technique) for traumatic atlantoaxial instability.Methods A total of 16 patients with traumatic atlanto- axial instability,who had reducible atlantoaxial dislocation with reduction after traction and irreducible at- lantoaxial dislocation with traction reduction after anterior laxation,were treated with four-point internal fixation technique using autologous bone grafts.Results All patients' symptoms were improved to some extent,and no severe complications,such as injury of nerve blood vessels were found.All patients were followed up for 8-26 months (average 16 months).Bony fusion was obtained in all cases.The spinal cord function improvement was marked in 5 cases (31%),good in 8(50%),mild in 2(13%),but un- changed in 1 (6%).No deterioration occurred in all cases.There was no loosening or breakage of screws and clamps.Conclusion Fixation of C_1-C_2 transarticular screws combined with Apofix laminar clamp technique can atlain four-point internal fixation,and can provide three-dimensional stability of atlantoaxial complex and excellent biomechanics environment for bony fusion if the structure of the posterior arch of C_1-C_2 is intact.

OBJECTIVETo study the clinical results of surgical treatment for Lisfranc fracture-dislocation.

METHODSFrom January 2003 to September 2009, 57 patients with Lisfranc injuries were treated by surgical operation included 41 males and 16 females with an average age of 33.8 years old ranging from 20 to 64 years. According to Myerson's classification, there were 31 cases of middle column injuries, 15 cases of medial-middle column injuries and 11 cases of three-column injuries. Among them, 25 patients accepted the emergency operation (<24 hours) and 32 patients were treated in average 7 days (3 to 11 days) after injury.

RESULTSAll the wounds were healed primarily with a mean operative time of 50 min (30 to 70 min). All patients were followed up for 4 to 70 months (averaged 35 months). The total AOFAS scores (American Orthopaedic Foot and Ankle Society) was in averaged of(84.73 +/- 14.26). All the patients returned to normal daily life after a mean time of 5.1 months (3 to 12 months). The average AOFAS scores of 52 anatomical reduction cases was (87.63 +/- 13.71), 5 non-anatomical reduction cases was (74.31 +/- 21.96), 26 multiple column trauma cases was (76.58 +/- 11.51). Complications of osteoarthritis occurred in 8 cases, confirming it was the main complication of these injuries.

CONCLUSIONLisfranc injuries can be surgically treated well. Reduction of the middle column is the key to reestablishment the stability of the tarsometatarsal joint complex. The quality of the reduction correlated with treatment outcome.

Adult ; Female ; Follow-Up Studies ; Foot Bones ; injuries ; physiopathology ; surgery ; Fractures, Bone ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Recovery of Function ; Treatment Outcome ; Young Adult

AIM:To explore efficacy of the different kinds of artificial tears treatment in patients with xerophthalmia after phacoemulsification combined with intraocular lens implantation.METHODS:Totally 280 patients (280 eyes) with xerophthalmia after operation in our hospital from January 2015 to June 2016 were selected.According to the different treatment methods, they were divided into control group (n=70;treated with tobramycin and dexamethasone eye ointment 3 times per day for 1wk, levofloxacin eye drops 3 times per day for 1wk, pranoprofen eye drops 4 times per day for 1mo), polyacrylic acid group (n=70;besides the treatment of control group, polyacrylic acid was used 4 times per for 1mo), polyethylene glycol group(n=70;besides the treatment of control group, polyethylene glycol was used 4 times per for 1mo) and sodium hyaluronate group (n=70;besides the treatment of control group, sodium hyaluronate was used 4 times per for 1mo).The tear film break up time (BUT), Schirmer Ⅰ test (SⅠt), symptoms of dry eye and corneal staining in four groups were observed.RESULTS:(1) BUT:The BUT of the four groups significantly increased after treatment(P<0.05);that of polyacrylic acid group, polyethylene glycol group, and sodium hyaluronate group was different compared with control group(P<0.05);the BUT in sodium hyaluronate group was significantly higher than the other groups after 2wk of treatment(P<0.05).(2) SⅠt:SⅠt of the four groups significant increased after treatment(P<0.05);that of polyacrylic acid group, polyethylene glycol group, and sodium hyaluronate group was different compared with control group(P<0.05);and the SⅠt in sodium hyaluronate group was significantly higher than other groups (P<0.05).(3) Xeroma score:the scores of dry eye significantly decreased after treatment in the four groups(P<0.05);that of polyacrylic acid group, polyethylene glycol group, and sodium hyaluronate group was different compared with control group(P<0.05);and the scores of the sodium hyaluronate group after 3wk was significantly lower compared with other groups(P<0.05).(4) Corneal staining score:the scores significantly decreased after treatment in the four groups(P<0.05);at 1 and 2wk after treatment the corneal staining score had not statistically different among the four groups (P>0.05);sodium hyaluronate group was significant lower than other groups in corneal staining score at 3wk and 1mo after treatment(P<0.05).CONCLUSION:Artificial tears in the treatment of xerophthalmia after cataract phacoemulsification combined with intraocular lens implantation has better clinical efficacy, which contains sodium hyaluronate may be the better than others.

OBJECTIVETo explore the operative methods and effects of treatment of old acetabular fractures.

METHODSFrom October 2001 to October 2007, 26 patients with old acetabular fractures were treated with operation including 21 males and 5 females with an average age of 34 years ranging from 18 to 65 years. On the basis of the three-dimensional computed tomography, all cases were diagnosed and classified according to Letourne-Judet classification, 9 cases were posterior wall fracture, 3 cases were lateropulsition fracture, 7 cases were lateropulsition and posterior wall fracture, 2 cases were posterior column and posterior wall fracture, 2 were T-shape fracture, 3 were dual column fracture. These patients were treated through the anterior,posterior, combined anterior-posterior approaches. The time from injured to operation was 33 to 141 days (averaged 36.4 days). All the fractures were fixed with screws and AO reconstruction plates.

RESULTSAll patients were followed up for 6 to 96 months, with an average time of 32.4 months. Evaluated according to Matta criteria, the results of scores was (5.04 +/- 1.04) on pain, (5.23 +/- 0.76) on range of motion, (4.92 +/- 1.16) on walking,and tatal (5.06 +/- 0.99) on average; The functional results of hip joints were excellent in 6 cases, good in 10 cases, fair in 6 cases, and poor in 4 cases. Sciatic nerve injury was found in 2 patients,lateral femoral cutaneus nerve injury in 3 patients, necrosis of femoral head in 1 patient,infection in 1 patient, and ectopic bone formation in 6 patients.

CONCLUSIONGood clinical results can be obtained by careful selection of operative indications of old acetabular fractures in combination with proper operative approach and correct reduction and fixation.

Acetabulum ; injuries ; surgery ; Adolescent ; Adult ; Aged ; Female ; Follow-Up Studies ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Time Factors ; Young Adult

Host genetic factors, such as human leukocyte antigen (HLA) alleles, are important in Human immunod-eficiency virus (HIV) infection and its progression to AIDS. HLA class I genes, especially highly polymorphicHLA-B genes, are involved in the activation of HLA-restricted cytotoxic T lymphocytes (CTLs) against HIV, andthus control susceptibility to or protect against this virus. The present study was aimed to determine the distributionof HLA-B alleles in the Chinese Uygur ethnic group and its association with HIV infection. One hundred ten healthycontrol (HIV negative) and 128 HIV positive Chinese Xinjiang Uygur ethnic individuals were used in this study.HLA typing for B allele was performed by polymerase chain reaction (PCR) with sequence-specific primers (SSP).Hardy-Weinberg equilibrium was calculated using POPGENE software for the healthy control group. The HLA-Bfrequency of each allele was compared between the patients and the controls using the chi-square test. In HIV-1-pos-itive group, gene frequency of allele B * 4901 was significantly higher compared to the healthy control subjects (P=0.02, OR=3.06, 95%CI=1.16～8.10 forB*4901). In contrast, the gene frequency of B * 40 in healthy controlswas significantly higher than in the HIV-positive patients (P=0.02, OR=0.39, 95%CI=0.07～0. 92 for B* 40).In this study, HLA allele B * 4901 may be associated with increased susceptibility to HIV-1 infection, whereas the B* 40 allele may be associated with resistance to H HIV-1 infection.

OBJECTIVEObservation and measurement were done on axial laminar to get the parameters of morphology in Chinese. To evaluate the possibility of the placement of axial laminar screw.

METHODSThe relative parameters of 28 sets of fresh Chinese adults' axial specimens were measured with a digital caliper, a goniometer and imageology, including the distance from superior and inferior the anchor point of the axial laminar screw to superior margin of the axial laminar, the superior,middle and inferior thickness of axial laminar, the height of axial laminar, the length and the angle of the axial laminar screw trajectory, the distance from the anchor point of the axial laminar screw to hole of vertebral artery and the central point of inferior articular process and so on. The data were statistically analyzed.

RESULTSThe distance from superior and inferior the anchoi point of the axial laminar screw to superior margin of the axial laminar was 4 mm and 8 mm respectively. The superior, middle and inferior thickness of axial laminar was 3.2, 6.7, 5.5 mm respectively. The height of axial laminar was 12.8 mm. The superior and inferior length of axial laminar screw trajectory was 26.2 mm and 25.5 mm respectively.

CONCLUSIONIt is feasible and reliable for posterior laminar screw fixation techniques of axis in Chinese. C2 laminar screw fixation techniques could be used as a supplementary method for conventional posterior screw fixation techniques of C2.

Adult ; Aged ; Axis, Cervical Vertebra ; anatomy & histology ; surgery ; Bone Screws ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged

OBJECTIVETo define the indication of C2 pedicle lag screw to treat Hangman fractures and evaluate its results.

METHODSTwenty-eight patients with Hangman fractures were enrolled from July 2003 to June 2007. Six, 17 and 5 patients classified as type I , II and IIa injuries respectively according to Levine-Edwards classification and graded as D spinal injury in 3 cases and E in 7 cases according to Frankel scale. The entry points of screws were located at middle point of lateral mass. The direction of screw is determined based on the direction of the medial and superior border of C2 pedicle, usually 25 degrees to 30 degrees cephalad to the transverse plane and 30 degrees to 35 degrees medial to the sagittal plane. The length of screws range from 24 to 30 mm.

RESULTSThere were no vertebra artery injuries or other complications during the operation. A mean follow-up time was 20 months (4 to 48 months). All cases gained bony union at the 6th postoperative month with complete neurological function recovery. The range of neck rotation was restored normal without cervicle spinal instability and lag screws loosing found.

CONCLUSIONSingle segmental pedicle lag screw internal fixation provides instantly stability to Hangman fracture and scarcely affects the physiological functions of upper cervicle spine. With appropriate indications of the techniques should be reducible Hangman fracture.

Adult ; Bone Screws ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; instrumentation ; Fractures, Bone ; diagnostic imaging ; physiopathology ; surgery ; therapy ; Humans ; Male ; Middle Aged ; Radiography ; Treatment Outcome

OBJECTIVETo compare the potential incidence of nerve root (ventral and dorsal ramus) injury caused by cervical transarticular screws and Roy-Camille lateral mass screws.

METHODSInsertion techniques with Klekamp transarticular screws and Roy-Camille lateral mass screws were respectively performed in this study. Each technique involved four specimens and 40 screws, which were inserted from C(3) to C(7). And 20-mm-long screws were used to overpenetrate the ventral cortex. The anterolateral aspect of the cervical spine was carefully dissected to allow observation of the screw-ramus relationship.

RESULTSThe overall percentage of nerve invasion was significantly lower with Klekamp (45%) technique than with Roy-Camille (85%) technique (P less than 0.05). The largest percentage of nerve invasion for Klekamp transarticular screws was found at the dorsal ramus (25%), followed by the ventral ramus (15%) and the bifurcation of the ventral dorsal ramus (5%). The largest percentage of nerve invasion for Roy-Camille lateral mass screws was found at the ventral ramus (80%).

CONCLUSIONThe potential risk of nerve root invasion is lower with Klekamp transarticular screws than with Roy-Camille lateral mass screws.

Adult ; Bone Screws ; Cervical Vertebrae ; injuries ; Female ; Fracture Fixation, Internal ; instrumentation ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fractures ; surgery

OBJECTIVETo explore pedicle screw implantation for fracture-dislocation injuries at cervicothoracic junction (C6-T2).

METHODSPedicle screw implantation was used for twenty-six patients with cervicothoracic fracture-dislocation from May 2001 to Jan 2008. There were 17 males and 9 females with an average of 48.5 years (range,20 to 75 years). Single posterior pedicle screw fixation was performed for 17 cases, and posterior screw fixation combined with anterior reduction and plate fixation for the other nine. The accuracy of the pedicle screws were evaluated by CT views after surgery. Complications and neurological recovery were also recorded after the procedures.

RESULTSAll subjects were followed up from 3 to 74 months with average 36.5 months. Four cases of complete paraplegia died of cardiovascular or pulmonary failure within half a year after surgery. There were 104 pedicle screws implanted totallythe including 74 pedicle screws in cervical vertebrae, 16 at C5, 16 at C6, 42 at C7, and 30 pedicle screws in upper thoracic vertebrae,in which 22 at T1, 8 at T2. No injury of spinal cord, nerve roots and vertebral artery was found during operation. Eleven screws (14.9%) were perforated out of the pedicles in cervical spine, in which 7(9.5%) through lateral cortex, 1 (1.4%) through the superior and 3 (4.1%) through the inferior. Three screws (10%) were perforated in upper thoracic spine, in which 2 (6.7%) by lateral cortex and 1(3.3%) by the medial (within 2 mm). Bony fusion was achieved for all cases and all internal fixator was good except 1 screw broken at C5. JOA score increased from preoperative (7.5 +/- 2.0) to postoperative (14.5 +/- 2.3) evaluated in 6 months after operation,with statistic difference (t = 6.34, P < 0.05). Neurological improvement was gotten in all patients according to ASIA classification but three cases who suffered from complete neurological injuries.

CONCLUSIONImplantation of pedicle screws at cervicothoracic junction can be safe and reliable if the urgeonis familiar with the local anatomy of cervicothoracic spine, and the technique for implantation of the screws. Related radiological parameters should be measured for each subject before the operation in attempt to get a therapy individually.

Adult ; Aged ; Bone Screws ; Cervical Vertebrae ; injuries ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Joint Dislocations ; surgery ; Male ; Middle Aged ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries