A retrospective single-center study.We aimed to compare the clinical outcomes of cervical spine fracture accompanied with ankylosing spondylitis (ASCSF) treated by single posterior approach (PA) and combined anterior-posterior approach (CA) for patients who were followed up for >1 year.For ASCSF patients, surgical treatment has been widely accepted as a recommendable therapeutic option. But the optimal surgical approach is still under controversy, and few studies have focused on the comparison between PA and CA.From February 2007 to March 2019, 53 patients were enrolled and divided into the PA group (34 cases) and CA group (19 cases). Their general characteristics and clinical materials were recorded. From the aspects of reduction distance, bone fusion, neurological functional restoration, and postoperative complications, patients' surgical outcomes were evaluated qualitatively and quantitatively.The reduction degree of dislocation (mean PA=2.05 mm, mean CA=2.36 mm, P=0.94) was close between the 2 groups. Besides, with a similar follow-up period (P=0.10), the rate of bone fusion (both 100%) and neurological functional restoration (PA=31.03%, CA=35.29%, P=0.77) were also without significant difference. The occurrence rate of postoperative complications tended to be higher in the CA group (31.58% vs. 23.53%) but with no significant difference (P=0.52). Nevertheless, the surgical duration time (mean=209.15 min) and blood loss (average=388.91 mL) of PA group were significantly less than CA group (mean duration time=285.34 min, mean blood loss=579.27 mL) (P<0.01).Compared with to the CA approach and with the equally significant outcome, surgery by single PA was feasible and should be positively recommended for ASCSF patients, especially for those accompanying with a severe chin-on-chest deformity or poor physical conditions which restrain patients from tolerating a long surgery or major surgical trauma.
To compare the clinical outcomes between use of sliding fixation (three cannulated screws, TCS) and non-sliding fixation (four cannulated screws, FCS) in the treatment of femoral neck fractures.We retrospectively analyzed 102 patients with fresh femoral neck fractures treated with TCS (60 cases) and FCS (42 cases) between January, 2018 and December, 2019. The demographic data, follow-up time, hospitalization time, operation time, blood loss, length of femoral neck shortening (LFNS), soft tissue irritation of the thigh (STIT), Harris hip score, and complications (such as internal fixation failure, non-union, and avascular necrosis of the femoral head) were also collected, recorded, and compared between the two groups.A total of 102 patients with an average age of 60.9 (range, 18-86) years were analyzed. The median follow-up time was 25 (22 to 32) months. The LFNS in the FCS group (median 1.2 mm) was significantly lower than that in the TCS group (median 2.8 mm) (P < 0.05). In the Garden classification, the number of displaced fractures in the TCS group was significantly lower than that in the FCS group (P < 0.05). The median hospitalization time, operation time, blood loss, reduction quality, internal fixation failure rate (IFFR), STIT, and Harris hip score were not statistically different between the two groups (P > 0.05). However, in the subgroup analysis of displaced fractures, the LFNS (median 1.2 mm), STIT (2/22, 13.6%), and Harris hip score (median 91.5) of the FCS group at the last follow-up were significantly better than the LFNS (median 5.7 mm), STIT (7/16, 43.8%), and Harris hip score (median 89) of the TCS group (P < 0.05). No complications such as incision infection, deep infection, pulmonary embolism, or femoral head necrosis were found in either group.TCS and FCS are effective for treating femoral neck fractures. For non-displaced fractures, there was no significant difference in the clinical outcomes between the two groups. However, for displaced fractures, the LFNS of the FCS is significantly lower than that of the TCS, which may reduce the occurrence of STIT and improve the Harris hip score.
Background: Reverse intertrochanteric fractures are usually initially treated with closed reduction. However, sometimes these fractures are not amenable to closed reduction and require open reduction. To date, few studies have been conducted on predictors of and reduction techniques for irreducible reverse intertrochanteric fractures. Therefore, this study aimed to summarize the displacement patterns of irreducible reverse intertrochanteric fractures and corresponding reduction techniques, and explore predictors of irreducibility. Methods: We reviewed 1174 cases of trochanteric fractures treated in our hospital from January 2006 to October 2018, 113 of which were reverse intertrochanteric fractures. An irreducible fracture was determined according to intra-operative fluoroscopy imaging after closed manipulation. Fractures were assessed for displacement patterns, radiographic features of irreducibility, and reduction techniques. Logistic regression analysis was performed on potential predictors for irreducibility, including gender, age, body mass index, AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification, and radiographic features. Results: Seventy-six irreducible fractures were identified, accounting for 67% of reverse intertrochanteric fractures. Six patterns of fracture displacement after closed manipulation were identified; the most common pattern was medial displacement and posterior sagging of the femoral shaft relative to the head-neck fragment. Multivariate logistic regression analysis identified three predictors of irreducibility: a medially displaced femoral shaft relative to the head-neck fragment on the anteroposterior (AP) view (odds ratio [OR], 8.00; 95% confidence interval [CI], 3.04–21.04; P < 0.001), a displaced lesser trochanter (OR, 3.61; 95% CI, 1.35–9.61; P = 0.010), and a displaced lateral femoral wall (OR, 2.92; 95% CI, 1.02–8.34; P = 0.046). Conclusions: A high proportion of reverse intertrochanteric fractures are not amenable to closed reduction. Six patterns of fracture displacement after closed manipulation were identified. Different reduction techniques are required for different displacement patterns. Predictors of irreducibility include a medially displaced femoral shaft relative to the head-neck fragment on the AP view, a displaced lesser trochanter, and a displaced lateral femoral wall. These patients warrant special consideration in terms of recognition and management.
Objective
To analyze the efficacy and complications of locking plate internal fixation for distal femoral fractures.
Methods
From March 2005 to November 2014, 59 patients with distal femoral fracture were treated with locking plates. They were 10 men and 49 women, aged from 35 to 95 years (mean, 66.6 years). According to AO/OTA classification, 16 cases were type 33-A1, 14 type 33-A2, 11 type 33-A3, 5 type 33-C1, 9 type 33-C2, and 4 type 33-C3. All were closed fractures, 9 of which were periprosthetic ones. The Hospital for Special Surgery (HSS) scores and complications were recorded at the last follow-up visit.
Results
The 53 patients were followed for 14 to 131 months (average, 65 months), but we failed to obtain the functional scores in 11 of them who had died due to causes other than fracture. Complications occurred in 12 patients (22.6%), including nonunion in 4, nonunion and genu varum in one, nonunion and genu valgum in one, malunion in 4, nonunion and implant breakage in one, and distal screw pull-out in one. Deep venous thrombosis of lower limb developed in other 9 cases (17.0%) of whom one was complicated with pulmonary embolism. Venous plexus thrombosis of the calf muscle developed in other 3 cases (5.7%) of whom one had bilateral lower limbs affected. They all responded to anticoagulation therapy. By HSS score at the last follow-up visit, the knee function was excellent in 24 cases, good in 17 and poor in one, with an excellent to good rate of 97.6% and an average score of 85.2 (from 58 to 100).
Conclusions
Locking plate internal fixation is acceptable for treatment of distal femoral fractures, but it may lead to a fairly high rate of complications which should be seriously tackled after careful analysis of their causes.
Key words:
Femoral fractures; Fracture fixation, internal; Bone plates; Post-operation complication
To investigate the comparison of curative effects in treating proximal humerus fractures' patients between minimally invasive locking plate internal fixation and open reduction with internal fixation, and to provide guidance for the operation method of the proximal humerus fracture patients.In the study, 157 patients of proximal humerus fractures from May 2006 to December 2012 in Peking University Third Hospital were analyzed retrospectively, of whom 78 were followed up, including 19 males and 59 females. They were from 15 to 90 years old, with the mean age of 60.5 years. According to Neer classification, there were 53 cases of two-part fractures, 19 cases of three-part fractures and 6 cases of four-part fractures. According to AO classification, there were 49 cases of type A,21 cases of type B and 8 cases of type C. There were 24 cases treated with minimally invasive locking plate internal fixation operation and 54 cases treated with open reduction with internal fixation operation. The patients were followed up with postoperative physical examinations and X ray examinations. Postoperative shoulder pain after 1 week and more than 6 months was assessed using the VAS score. Postoperative shoulder joint function with the use of Constant-Murley score and ASES score were evaluated after 3 months and more than 6 months. The results were analyzed by SPSS 18.0.The follow-up time was 6 to 85 months, with the mean time of 33.8 months. According to the rank sum test: there were significant differences in operation time (P=0.002), postoperative hospital day (P=0.001), the satisfaction of patients (P=0.029), postoperative shoulder pain after 1 week (P=0.024), postoperative Constant-Murley score after 3 months (P=0.012) and postoperative ASES score after 3 months (P=0.001) between minimally invasive group and non-minimally invasive group. There weren't significant differences in clinical union time of bone (P=0.446), postoperative shoulder pain after more than 6 months (P=0.894), postoperative Constant-Murley score after more than 6 months (P=0.122) and postoperative ASES score after more than 6 months (P=0.351) between minimally invasive group and non-minimally invasive group. There were no breakage of the internal fixation and humeral head osteonecrosis. Minimally invasive group had 2 cases with internal fixation loosening (8.3%) and 1 case with complete limitation of abduction (4.2%). Non-minimally invasive group had 1 case with tracture nonunion (1.9%), 1 case with internal fixation loosening (1.9%) and 1 case with complete limitation of abduction (1.9%).The operation method of proximal humerus fractures is an important factor affecting the recovery of shoulder joint function. Minimally invasive locking plate internal fixation operation in early stage (1 week) of pain control, early (3 months) functional recovery, operation time, postoperative hospital day and patient satisfaction are better than those of traditional operation.
Abstract Background: The purpose of this study was to analyze cases of AO31-A2 intertrochanteric fractures (ITFs) and to identify the relationship between the loss of the posteromedial support and implant failure. Methods: Three hundred ninety-four patients who underwent operative treatment for ITF from January 2003 to December 2017 were enrolled. Focusing on posteromedial support, the A2 ITFs were divided into two groups, namely, those with (Group A, n = 153) or without (Group B, n = 241) posteromedial support post-operatively, and the failure rates were compared. Based on the final outcomes (failed or not), we allocated all of the patients into two groups: failed (Group C, n = 66) and normal (Group D, n = 328). We separately analyzed each dataset to identify the factors that exhibited statistically significant differences between the groups. In addition, a logistic regression was conducted to identify whether the loss of posteromedial support of A2 ITFs was an independent risk factor for fixation failure. The basic factors were age, sex, American Society of Anesthesiologists (ASA) score, side of affected limb, fixation method (intramedullary or extramedullary), time from injury to operation, blood loss, operative time and length of stay. Results: The failure rate of group B (58, 24.07%) was significantly higher than that of group A (8, 5.23%) ( χ 2 = 23.814, P < 0.001). Regarding Groups C and D, the comparisons of the fixation method ( P = 0.005), operative time ( P = 0.001), blood loss ( P = 0.002) and length of stay ( P = 0.033) showed that the differences were significant. The logistic regression revealed that the loss of posteromedial support was an independent risk factor for implant failure (OR = 5.986, 95% CI: 2.667–13.432) ( P < 0.001). Conclusions: For AO31-A2 ITFs, the loss of posteromedial support was an independent risk factor for fixation failure. Therefore, posteromedial wall reconstruction might be necessary for the effective treatment of A2 fractures that lose posteromedial support.
Abstract Colorectal cancer (CRC) is one of the most prevalent and deadliest illnesses all around the world. Growing proofs demonstrate that tumor-associated macrophages (TAMs) are of critical importance in CRC pathogenesis, but their mechanisms remain yet unknown. The current research was designed to recognize underlying biomarkers associated with TAMs in CRC. We screened macrophage-related gene modules through WGCNA, selected hub genes utilizing the LASSO algorithm and COX regression, and established a model. External validation was performed by expression analysis using datasets GSE14333, GSE74602, and GSE87211. After validating the bioinformatics results using real-time quantitative reverse transcription PCR, we identified SPP1, C5AR1, MMP3, TIMP1, ADAM8 as potential biomarkers associated with macrophages in CRC.
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