OBJECTIVE: To investigate the effectiveness of using 3 hollow compression screws combined with 1 screw off-axis fixation under the guidance of three-dimensional (3D) printed guide plate with mortise-tenon joint structure (mortise-tenon joint plate) for the treatment of Pauwels type Ⅲ femoral neck fractures. METHODS: A clinical data of 78 patients with Pauwels type Ⅲ femoral neck fractures, who were admitted between August 2022 and August 2023 and met the selection criteria, was retrospectively analyzed. The operations were assisted with mortise-tenon joint plates in 26 cases (mortise-tenon joint plate group) and traditional guide plates in 28 cases (traditional plate group), and without guide plates in 24 cases (control group). There was no significant difference in the baseline data of gender, age, body mass index, cause of injury, and fracture side between groups ( P>0.05). The operation time, intraoperative blood loss, frequency of intraoperative fluoroscopy, incision length, incidence of postoperative deep vein thrombosis of lower extremity, pain visual analogue scale (VAS) score at 1 week after operation, and Harris score of hip joint at 3 months after operation were recorded and compared. X-ray re-examination was taken to check the quality of fracture reduction, fracture healing, and the shortening length of the femoral neck at 3 months after operation, and the incidences of internal fixation failure and osteonecrosis of the femoral head during operation. RESULTS: Compared with the control group, the operation time, intraoperative blood loss, and frequency of intraoperative fluoroscopy reduced in the two plate groups, and the quality of fracture reduction was better, but the incision was longer, and the differences were significant ( P<0.05). The operation time and intraoperative blood loss were significantly higher in the traditional plate group than in the mortise-tenon joint plate group ( P<0.05), the incision was significantly longer ( P<0.05); and the difference in fracture reduction quality and the frequency of intraoperative fluoroscopy was not significant between two plate groups ( P>0.05). There was 1 case of deep vein thrombosis of lower extremity in the traditional plate group and 1 case in the control group, while there was no thrombosis in the mortise-tenon joint plate group. There was no significant difference in the incidence between groups ( P>0.05). All patients were followed up 12-15 months (mean, 13 months). There was no significant difference in VAS score at 1 week and Harris score at 3 months between groups ( P>0.05). Compared with the control group, the fracture healing time and the length of femoral neck shortening at 3 months after operation were significantly shorter in the two plate groups ( P<0.05). There was no significant difference between the two plate groups ( P>0.05). There was no significant difference in the incidences of non-union fractures, osteonecrosis of the femoral head, or internal fixation failure between groups ( P>0.05). CONCLUSION For Pauwels type Ⅲ femoral neck fractures, the use of 3D printed guide plate assisted reduction and fixation can shorten the fracture healing time, reduce the incidence of postoperative complications, and be more conducive to the early functional exercise of the affected limb. Compared with the traditional guide plate, the mortise-tenon joint plate can reduce the intraoperative bleeding and shorten the operation time.
Humans ; Femoral Neck Fractures/diagnostic imaging* ; Bone Plates ; Fracture Fixation, Internal/instrumentation* ; Male ; Female ; Retrospective Studies ; Middle Aged ; Bone Screws ; Adult ; Aged ; Treatment Outcome ; Printing, Three-Dimensional ; Operative Time

Objective To study the lesion patterns of hemorrhagic type of moyamoya disease (MMD) in adults. Methods Seventy-two consecutive cases of hemorrhagic type of MMD, confirmed by digital cerebral angiography in Jinling hospital between January 2004 and February 2010, were retrieved from the Nanjing Stroke Registry Program. MMD patients were classified according to the hemorrhagic sites into 4 types: non-thalamic parenchymal, thalamic, primary ventricular and subarachnoid. The ipsilateral anterior choroidal artery and posterior communicating artery (AChA-PComA) were evaluated by the modified Morioka's 3-points grading system: normal or mild to moderate dilation, severe dilation with abnormal extension and non-visualization. The relationship between lesion patterns and the angiographic findings was analyzed. Results In the stage of normal or mild to moderate dilation of AChA-PComA, non-thalamic parenchymal hemorrhage was the more frequent type (51.6%, 16/31 ;Z = -3.266,P =0.001 ), and there was a high incidence of intrastriatal hemorrhage occurred (22.6%, 7/31 ). In the stage of severe dilation with abnormal extension, intraventricular hemorrhage was most common ( 58.8%, 20/34 ;Z = -2.696 ,P =0.008). In addition, posterior circulation subarachnoid hemorrhage (SAH) was associated with a higher grade of AChA-PComA than anterior circulation SAH (Z = -4.655 ,P ＜ 0.01 ). Furthermore, posterior circulation SAH was the only type of SAH in the stage of non-visualization(9.7% ,7/72; x2 =42.999,P ＜0.01 ). Conclusion In adult patients with MMD, different subtypes of hemorrhagic stroke were associated with angiographic changes of AChA-PComA, and the angiographic characteristics may predict the location of hemorrhage.

Objective To investigate the related risk factors for small artery occlusion (SAO) and its 2 subtypes. Methods The clinical and imaging data in 291 patients with first-ever stroke who met the TOAST criteria of large artery atherosclerotic stroke (LAA) or SAO were collected from the Nanjing Stroke Registry Prog-am from December 2009 to November 2010. All the patients were divided into a LAA group (n = 120) and a SAO group (n = 171). The latter was redivided into either a lacunar infarction with ischemic leukoaraiosis (ILA) subgroup (n = 84)or an isolated lacunar infarction (ILI) subgroup (n = 87). The risk factors of the LAA group and SAO group and its subgroups were compared. Multivariate logistic regression analysis was conducted and the independent risk factors were screened. Results The mean age in the SAO group was larger than that in the LAA group. The proportion of the patients with hypertension and the serum homocysteine (Hcy) level were significantly higher than those in the LAA group (all P ＜0. 05). Multivariate logistic analysis showed that the advanced age (odds ratio, [OR] = 1.041,95% confidence interval [CI] 1.02-1.06, P = 0.045), hypertension (OR = 2. 912,95% CI 1. 11-6. 46, P =0. 031) and increased plasma Hcy (OR = 1. 109, 95% CI 1. 11-1. 32, P =0. 001) were the independent risk factors for SAO. The advanced age (OR = 1. 047,95% CI 1.00-1.09, P = 0.043), hypertension (OR = 2. 632, 95% CI 1.08-6.41, P= 0.033) and increased plasma Hcy (OR = 1. 211, 95% CI 1. 11-1. 32, P ＜0. 001) were the independent risk factors for ILA, while the hypercholesterolemia (OR =0. 136, 95% CI 0. 05-0. 37, P ＜0. 001) was the independent risk factor for ILI. Conclusions The advanced age, hypertension and increased plasma Hcy level may play important roles in the pathogenesis of SAO. The hypercholesterolemia is an independent risk factor for ILI, while advanced age, hypertension and increased plasma Hcy level are the independent risk factors for ILA.

Objective To investigate the relationship between isehemic lesion patterns and Suzuki's vessel grades in adult moyamoya disease(MMD).Methods Forty-four consecutive MMD patients,12 with transient ischemic attack(TIA),30 with cerebral infarct(CI)and 2 with combined TIA and CI,who were diagnosed in Jinling hospital between January of 2004 and July of 2009,were retrieved from Nanjing Stroke Registry Program.Ischemic lesions patterns of CI type of MMD were further divided into two paired subgroups including subcortical subgroup versus cortical subgroup, and subgroup of anterior cerebral circulation versus subgroup of posterior cerebral circulation.In addition,the ipsilateral vessel grades of all symptomatic hemispheres were evaluated by Suzuki's 6-grade system according to the results of cerebral angiography of internal carotid arteries.The percentage of number of hemispheres with ischemic events among the paired groups,including TIA group versus CI group,subcortical subgroup versus cortical subgroup,and subgroup of anterior cerebral circulation versus subgroup of posterior cerebral circulation,were analyzed respectively with changes of the Suzuki's grading.Results For above-mentioned each paired groups.the percentage of number of hemispheres with ischemic events was gradually decreased in the former (namely,11/26,2/13,1/8,0 and 0;15/15,9/11,1/7,0 and 0;15/15,10/11,4/7,0 and 0)and increased in the latter(namely,15/26,11/13,7/8,2/2 and 1/1;0,2/11,6/7,2/2 and 1/1;0,1/11,3/7,2/2 and 1/1 ) from grade 2 to grade 6, and the differences were statistically significant (Z = -2. 33 and P =0. 019,Z = - 4.49 and 0. 00, Z = - 3.66 and 0. 01, respectively ). Moreover, the mean value of Suzuki' s grade was lower in the former than the latter for above-mentioned three groups (2. 29 vs 2. 97, 2. 44 vs 4. 18 and 2. 62 vs 4. 13, respectively). Conclusion The ischemic lesion patterns of adult MMD is changing with the change of Suzuki' s vessel grading. The higher the Suzuki' s grade, the greater the likelihood of ischemic lesions involving the cortical areas of posterior cerebral circulation.