Objective: To evaluate the effect of open reduction and internal fixation on radial head fracture and assess the post-operative function. Methods: This prospective observational study was conducted from June 2016 to J...Objective: To evaluate the effect of open reduction and internal fixation on radial head fracture and assess the post-operative function. Methods: This prospective observational study was conducted from June 2016 to July 2017 at Liaquat National Hospital and Medical College, Karachi. Altogether, 28 patients with radial head and neck fractures were enrolled in our study. These patients were admitted to the hospital and their fractures were fixed with open reduction and internal fixation. Baseline information of the patients was collected, and patient-rated elbow evaluation scores were calculated. Results: Out of the 28 patients, 21 were male and 7 were female. Besides, 16 fractures were on the right side and 12 were on the left side and 17 involving the dominant hands. In addition, 8 patients had Mason type Ⅱ fracture and 20 had Mason type Ⅲ fracture. The mean age of patients was (31.0 ± 8.0) years, and the mean follow-up is (1.2 ± 0.5) years. The mean average patient-rated elbow evaluation scores were (27.64 ± 1.60) at 1-year follow-up. Conclusions:The majority of the patients who had radial head fractures and treated by open reduction and internal fixation have attained an excellent range of motion postoperatively.展开更多
Objective: Acetabular fractures are common injuries in Iran. We assess the functional outcome of open reduction and internal fixation management of displaced Complex acetabular fractures. Materials and Methods: We ana...Objective: Acetabular fractures are common injuries in Iran. We assess the functional outcome of open reduction and internal fixation management of displaced Complex acetabular fractures. Materials and Methods: We analyzed a case series of patients with open reduction and internal fixation (ORIF) for complex acetabular fractures. Two hundred patients (132 men, 68 women) in four age groups including with a mean age of 43.39 ± 6.18 years (range 20 - 59 years) and a mean follow-up of 82.34 ± 12.48 months (range 18 - 109 months) met the inclusion criteria. Functional outcome at final follow-up was graded assessed according to Harris score. Factors affecting were defined. Results: Anatomic reduction was achieved in 192 hips, imperfect in 8 and poor in none. Radiological outcome revealed excellent results in 128 (64%) hips, good in eight, fair in five and none in poor. Harris score were excellent in 139 (69.5%) hips, good in 43 (21.5%) and fair in 18 (9%) and poor in none. The anatomical reduction results had a favorable final functional outcome. (0.003) However, BMI (P Conclusion: Optimal functional and radiological outcomes have been achieved with anatomic postoperative reduction. Also experience of specialist, on time surgery and good recovery lead to receiving excellent functional outcome with at least complications.展开更多
Objective: To evaluate the clinical effects of closed reduction and external fixation and open reduction and internal fixation for distal radius fractures. Methods: 60 patients with distal radius fractures treated in ...Objective: To evaluate the clinical effects of closed reduction and external fixation and open reduction and internal fixation for distal radius fractures. Methods: 60 patients with distal radius fractures treated in Ningxia zhongwei People's Hospital from October 2019 to December 2021 were selected as the research samples, and randomly divided into the conventional group (treated with open reduction and internal fixation) and the research group (treated with closed reduction and external fixator) with 30 patients in each group. The operation, pain score and recovery of the two groups of distal radius fractures were compared, and the two groups of distal radius fractures were counted. Results: The operation conditions of the patients with distal radius fractures in the two groups were counted by multiple dimensions, including the amount of blood loss during operation, the time of activity, the time of operation and the time of hospitalization. After inspection, the comparison between the two groups was made between the study group and the routine group, P < 0.05;Before treatment, the pain symptoms of the patients with distal radius fractures were scored, and after examination, the pain symptoms of the patients with distal radius fractures were compared between the two groups (P>0.05). After examination, the pain symptoms of the patients with distal radius fractures were scored between the two groups (P < 0.05). After treatment, the functional recovery of the patients with distal radius fractures in the two groups was compared. After examination, there was a comparison between the study group and the routine group (P < 0.05). After the statistics of the curative effect data of two groups of distal radius fractures, the comparison between the study group and the routine group at the time of inspection, P < 0.05;According to the statistics of complications from three dimensions, such as traumatic arthritis, fracture displacement and carpal tunnel syndrome, only 3.33%(1 case) was found in the study group, which was lower than 26.66%(8 cases) in the routine group after examination, with statistical significance (P < 0.05). Conclusion: Closed reduction and external support fixation for patients with distal radius fractures can improve the treatment outcome, increase the treatment efficiency, relieve the pain symptoms, prevent the fracture displacement and other problems, and promote the rapid recovery of patients. It has significant application value and is recommended to be popularized.展开更多
BACKGROUND Open reduction and internal fixation(ORIF)is the traditional surgical treatment for patellar fractures,and unicompartmental knee arthroplasty(UKA),especially Oxford UKA,has been increasingly used in patient...BACKGROUND Open reduction and internal fixation(ORIF)is the traditional surgical treatment for patellar fractures,and unicompartmental knee arthroplasty(UKA),especially Oxford UKA,has been increasingly used in patients with medial knee osteoarthritis(OA).However,the process of choosing treatment for patients with both patellar fractures and anteromedial knee OA remains unclear.We present the case of a patient with a patellar fracture and anteromedial OA.CASE SUMMARY We present the case of a 72-year-old woman with a history of bilateral medial compartment OA of the knees and a right Oxford UKA.She also experienced a recent left patellar fracture.ORIF and Oxford UKA were performed in a single stage.The patient showed excellent postoperative clinical results.CONCLUSION ORIF and Oxford UKA can be performed simultaneously for patients with patellar fracture and anteromedial OA on the same knee.展开更多
Background For some specific comminuted unstable intra-articular fracture,the plaster cast can not maintain the alignment of the articular surface effectively.The aim of this study was to evaluate the clinical effects...Background For some specific comminuted unstable intra-articular fracture,the plaster cast can not maintain the alignment of the articular surface effectively.The aim of this study was to evaluate the clinical effects of distal radius fracture treated with open reduction and internal plate fixation retrospectively.Methods From January 2002 to March 2010,539 cases of distal radius fracture were treated with open reduction and internal fixation,including 184 males and 355 females aging 21-72 years （mean 57 years）.Fractures were caused by falling to the ground in 459 cases,by traffic accident in 62 cases and by athletic injuries in 18 cases.Of 539 cases,there were 523 cases of closed fracture and 16 cases of open fracture.According to Arbeitsgemeinschaft fur Osteosynthesefragen （AO） standards of classification,there were 14 cases of A2 type,22 of A3 type,18 of B1 type,24 of B2 type,62 of B3 type,91 of C1 type,162 of C2 type and 146 of C3 type.The time from injury to operation was 1-16 days （mean 5 days）.All patitents received open reduction and internal plate screw fixation.Forty-seven patients with bone defect were given 6-15 g autologous ilium and 75 cases were given 5 ml calcium sulphate artificial aggregate after reduction.Results All incisions healed by first intention after operation.Patients were followed up for 15 to 32 months postoperatively （mean 22 months）.The fractures healed within 10-18 weeks after operation （mean 12 weeks）.During the last follow-up,the mean palmar tilt was （7.0±0.9）° and the mean ulnar variance was （21.0±4.2）°,showing significant difference when compared with preoperation （（-5.0±1.2）° and （8.0±3.8）°）.The radial heights were not abbreviated.According to Gartland and Werley assessment system,the results were excellent in 314 cases,good in 163 cases,fair in 46 cases,and poor in 16 cases 12 weeks after operation,the excellent and good rate was 88.5%.Conclusions The clinical effect of distal radius fracture treated with open reduction and internal plate fixation was relatively satisfactory.Meticulous operation procedure and individual rehabilitation strategy contribute to the wrist joint functional recovery.展开更多
Purpose： To investigate efficacy of open reduction and internal fixation with the miniplate and hollow screw in the treatment of Lisfranc injury. Methods： Ten cases of Lisfranc injury treated by open reduction, mini...Purpose： To investigate efficacy of open reduction and internal fixation with the miniplate and hollow screw in the treatment of Lisfranc injury. Methods： Ten cases of Lisfranc injury treated by open reduction, miniplate and hollow screw in our hospital were retrospectively analyzed. There were 6 males and 4 females with age ranging from 25 to 45 years （mean 32 years）. Among them, one case was classified as Type A, six Type B and three Type C. Injury mechanism included road traffic accidents （3 cases）, fall from height （5 cases） and hit by heavy object （2 cases）. All injuries were closed without cerebral trauma or other complicated injuries. The time interval between injury and operation was 6-10 days （average 6.6 days）. Postoperatively, the foot function was assessed using Visual Analogue Scales （VAS） and American Orthopaedic Foot and Ankle Society （AOFAS） Scales. Healing time and complications were observed. Results： All patients were followed up for 18-24 months （average 20 months）. Anatomic reduction was achieved in all patients on images. There was statistical significance between preoperative score （Z89 ± 0.34） and score at postoperative 8 weeks （0.67 ± 0.13）. According to the AOFAS score, 5 cases were defined as excellent, 3 cases as good and 2 cases as fair. During follow-up, there was no wound infection or complications except for osteoarthritis in 2 cases. Healing time ranged from 3 to 6 months with an average of 3.6 months. Conclusion： Anatomical reduction of Lisfranc injury can be achieved by open reduction and internal fixation with the miniplate and hollow screw. Normal structure of Lisfranc joint is regained to a great extent; injured ligaments were also repaired. Therefore, this method offers excellent curative effect and can avoid postoperative complications and improve the patients＇ quality of life.展开更多
Purpose:This meta-analysis compared the clinical outcome of three-dimensional(3D)printing combined with open reduction and internal fixation(ORIF)to traditional ORIF in the treatment of acetabular fractures.Methods:We...Purpose:This meta-analysis compared the clinical outcome of three-dimensional(3D)printing combined with open reduction and internal fixation(ORIF)to traditional ORIF in the treatment of acetabular fractures.Methods:We searched the Cochrane Library,PubMed,Embase,VIP database,CNKI,and Wanfang data-base with keywords"acetabular fracture","3D printing","three-dimensional printing","open reduction and internal fixation","Acetabulum","Acetabula"from January 2000 to March 2020.Two reviewers independently selected articles,extracted data,assessed the quality evidence and risk bias of included trials using the Cochrane Collaboration’s tools and/or Newcastle-Ottawa scale.When the two analysts had different opinions,they would ask the third analyst for opinion.Randomized controlled trials or retrospective comparative studies of 3D printing combined with ORIF(3D printing group)versus traditional ORIF(conventional group)in the treatment of acetabular fractures were selected.The data of operation time,intraoperative blood loss,intraoperative fluoroscopy times,incidence of complications,excellent and good rate of Matta score for reduction,and excellent and good rate of hip function score were extracted.Stata14.0 statistical software was used for data analysis.Results:Altogether 9 articles were selected,including 5 randomized controlled trials and 4 retrospective studies.A total of 467 patients were analyzed,250 in the conventional group,and 217 in the 3D printing group.The operation time in the 3D printing group was less than that in the conventional group and the difference was statistically significant(standardized mean difference(SMD)=-1.19,95%CI:-1.55 to-0.82,p<0.05).The intraoperative bleeding volume of the 3D printing group was significantly lower than that of the conventional group(SMD=-1.08,95%CI:-1.65 to-0.51,p<0.05).The fluoroscopy times were less in the 3D printing group than in the conventional group and the difference was statistically significant(SMD=-1.64,95%CI:-2.35 to-0.93,p<0.05).The total incidence of complications in the 3D printing group was significantly lower than that in the conventional group(OR=0.43,95%CI:0.24-0.79,p<0.05).There was no significant difference in the excellent and good rate of Matta score for reduction between the two groups(OR=0.60,95%CI:0.34-1.06,p>0.05).There was no significant difference in the excellent and good rate of hip function score at the end of postoperative follow-up between the two groups(OR=0.84,95%CI:0.46-1.56,p>0.05),but the follow-up time varies from 6 months to 40 months.Conclusion:Compared with traditional ORIF,3D printing combined with ORIF has certain advantages in terms that 3D printing not only helps surgeons to understand acetabular fractures more intuitively,but also effectively reduces operation time,intraoperative blood loss,intraoperative fluoroscopy times,and postoperative complications.However,there were no significant differences in the excellent and good rate of Matta score for reduction and the excellent and good rate of hip function score at the end of follow-up.展开更多
目的:系统评价不同手术方法治疗桡骨远端骨折的临床疗效和安全性。方法:应用计算机检索中国知网、维普网、万方数据库、中国生物医学文献服务系统、PubMed、Embase、Cochrane Library、Web of Science中关于手术方法治疗桡骨远端骨折的...目的:系统评价不同手术方法治疗桡骨远端骨折的临床疗效和安全性。方法:应用计算机检索中国知网、维普网、万方数据库、中国生物医学文献服务系统、PubMed、Embase、Cochrane Library、Web of Science中关于手术方法治疗桡骨远端骨折的随机对照试验,检索时限均为建库至2024年6月1日。试验组和对照组均采用手术方法治疗。依据文献检索及筛选方案筛选出符合要求的文献后,由2名研究人员分别独立进行数据提取和质量评价。采用Stata15.0软件绘制网状关系图,对疗效优良率、并发症发生情况及腕关节桡偏、尺偏、掌屈、背伸、旋前、旋后活动度进行网状Meta分析,并根据累计概率排名曲线下面积(the surface under the cumulative ranking curve,SUCRA)对手术方法的疗效进行排序。采用比较-校正漏斗图进行发表偏倚检验。结果:共检索到10320篇文献,通过逐层筛选最终纳入34篇文献,涉及切开复位钢板内固定、闭合复位支架外固定、闭合复位克氏针内固定、闭合复位髓内钉内固定、腕关节镜技术联合切开复位钢板内固定、切开复位钢板内固定联合局部植骨6种手术方法。网状Meta分析结果显示,在疗效优良率方面,不同手术方法治疗桡骨远端骨折的疗效排序为腕关节镜技术联合切开复位钢板内固定(SUCRA=99.90%)>切开复位钢板内固定(SUCRA=49.80%)>闭合复位支架外固定(SUCRA=41.50%)>闭合复位克氏针内固定(SUCRA=8.80%);在腕关节桡偏活动度方面,不同手术方法治疗桡骨远端骨折的疗效排序为腕关节镜技术联合切开复位钢板内固定(SUCRA=85.10%)>闭合复位克氏针内固定(SUCRA=84.70%)>闭合复位髓内钉内固定(SUCRA=41.90%)>切开复位钢板内固定(SUCRA=36.20%)>闭合复位支架外固定(SUCRA=2.00%);在腕关节尺偏活动度方面,不同手术方法治疗桡骨远端骨折的疗效排序为切开复位钢板内固定(SUCRA=86.90%)>闭合复位髓内钉内固定(SUCRA=67.90%)>闭合复位克氏针内固定(SUCRA=43.50%)>闭合复位支架外固定(SUCRA=36.90%)>腕关节镜技术联合切开复位钢板内固定(SUCRA=14.70%);在腕关节掌屈活动度方面,不同手术方法治疗桡骨远端骨折的疗效排序为腕关节镜技术联合切开复位钢板内固定(SUCRA=87.10%)>闭合复位髓内钉内固定(SUCRA=65.90%)>闭合复位克氏针内固定(SUCRA=62.30%)>切开复位钢板内固定(SUCRA=34.00%)>闭合复位支架外固定(SUCRA=0.70%);在腕关节背伸活动度方面,不同手术方法治疗桡骨远端骨折的疗效排序为切开复位钢板内固定(SUCRA=90.80%)>闭合复位髓内钉内固定(SUCRA=69.40%)>闭合复位克氏针内固定(SUCRA=33.90%)>闭合复位支架外固定(SUCRA=32.90%)>腕关节镜技术联合切开复位钢板内固定(SUCRA=23.10%);在腕关节旋前活动度方面,不同手术方法治疗桡骨远端骨折的疗效排序为切开复位钢板内固定(SUCRA=93.50%)>闭合复位髓内钉内固定(SUCRA=59.00%)>闭合复位支架外固定(SUCRA=41.30%)>闭合复位克氏针内固定(SUCRA=32.50%)>腕关节镜技术联合切开复位钢板内固定(SUCRA=23.80%);在腕关节旋后活动度方面,不同手术方法治疗桡骨远端骨折的疗效排序为切开复位钢板内固定(SUCRA=89.80%)>闭合复位支架外固定(SUCRA=55.80%)>闭合复位髓内钉内固定(SUCRA=54.80%)>闭合复位克氏针内固定(SUCRA=27.60%)>腕关节镜技术联合切开复位钢板内固定(SUCRA=22.00%);在并发症发生情况方面,不同手术方法治疗桡骨远端骨折的安全性排序为切开复位钢板内固定联合局部植骨(SUCRA=85.70%)>腕关节镜技术联合切开复位钢板内固定(SUCRA=71.40%)>闭合复位髓内钉内固定(SUCRA=58.30%)>闭合复位克氏针内固定(SUCRA=47.30%)>切开复位钢板内固定(SUCRA=25.00%)>闭合复位支架外固定(SUCRA=12.30%)。结论:现有的证据表明,采用切开复位钢板内固定是治疗桡骨远端骨折的优选手术方法,能够改善腕关节活动度,获得良好的临床疗效,而切开复位钢板内固定联合腕关节镜技术、局部植骨等手术方法在一定程度上能够减少切开复位钢板内固定的并发症。展开更多
文摘Objective: To evaluate the effect of open reduction and internal fixation on radial head fracture and assess the post-operative function. Methods: This prospective observational study was conducted from June 2016 to July 2017 at Liaquat National Hospital and Medical College, Karachi. Altogether, 28 patients with radial head and neck fractures were enrolled in our study. These patients were admitted to the hospital and their fractures were fixed with open reduction and internal fixation. Baseline information of the patients was collected, and patient-rated elbow evaluation scores were calculated. Results: Out of the 28 patients, 21 were male and 7 were female. Besides, 16 fractures were on the right side and 12 were on the left side and 17 involving the dominant hands. In addition, 8 patients had Mason type Ⅱ fracture and 20 had Mason type Ⅲ fracture. The mean age of patients was (31.0 ± 8.0) years, and the mean follow-up is (1.2 ± 0.5) years. The mean average patient-rated elbow evaluation scores were (27.64 ± 1.60) at 1-year follow-up. Conclusions:The majority of the patients who had radial head fractures and treated by open reduction and internal fixation have attained an excellent range of motion postoperatively.
文摘Objective: Acetabular fractures are common injuries in Iran. We assess the functional outcome of open reduction and internal fixation management of displaced Complex acetabular fractures. Materials and Methods: We analyzed a case series of patients with open reduction and internal fixation (ORIF) for complex acetabular fractures. Two hundred patients (132 men, 68 women) in four age groups including with a mean age of 43.39 ± 6.18 years (range 20 - 59 years) and a mean follow-up of 82.34 ± 12.48 months (range 18 - 109 months) met the inclusion criteria. Functional outcome at final follow-up was graded assessed according to Harris score. Factors affecting were defined. Results: Anatomic reduction was achieved in 192 hips, imperfect in 8 and poor in none. Radiological outcome revealed excellent results in 128 (64%) hips, good in eight, fair in five and none in poor. Harris score were excellent in 139 (69.5%) hips, good in 43 (21.5%) and fair in 18 (9%) and poor in none. The anatomical reduction results had a favorable final functional outcome. (0.003) However, BMI (P Conclusion: Optimal functional and radiological outcomes have been achieved with anatomic postoperative reduction. Also experience of specialist, on time surgery and good recovery lead to receiving excellent functional outcome with at least complications.
文摘Objective: To evaluate the clinical effects of closed reduction and external fixation and open reduction and internal fixation for distal radius fractures. Methods: 60 patients with distal radius fractures treated in Ningxia zhongwei People's Hospital from October 2019 to December 2021 were selected as the research samples, and randomly divided into the conventional group (treated with open reduction and internal fixation) and the research group (treated with closed reduction and external fixator) with 30 patients in each group. The operation, pain score and recovery of the two groups of distal radius fractures were compared, and the two groups of distal radius fractures were counted. Results: The operation conditions of the patients with distal radius fractures in the two groups were counted by multiple dimensions, including the amount of blood loss during operation, the time of activity, the time of operation and the time of hospitalization. After inspection, the comparison between the two groups was made between the study group and the routine group, P < 0.05;Before treatment, the pain symptoms of the patients with distal radius fractures were scored, and after examination, the pain symptoms of the patients with distal radius fractures were compared between the two groups (P>0.05). After examination, the pain symptoms of the patients with distal radius fractures were scored between the two groups (P < 0.05). After treatment, the functional recovery of the patients with distal radius fractures in the two groups was compared. After examination, there was a comparison between the study group and the routine group (P < 0.05). After the statistics of the curative effect data of two groups of distal radius fractures, the comparison between the study group and the routine group at the time of inspection, P < 0.05;According to the statistics of complications from three dimensions, such as traumatic arthritis, fracture displacement and carpal tunnel syndrome, only 3.33%(1 case) was found in the study group, which was lower than 26.66%(8 cases) in the routine group after examination, with statistical significance (P < 0.05). Conclusion: Closed reduction and external support fixation for patients with distal radius fractures can improve the treatment outcome, increase the treatment efficiency, relieve the pain symptoms, prevent the fracture displacement and other problems, and promote the rapid recovery of patients. It has significant application value and is recommended to be popularized.
文摘BACKGROUND Open reduction and internal fixation(ORIF)is the traditional surgical treatment for patellar fractures,and unicompartmental knee arthroplasty(UKA),especially Oxford UKA,has been increasingly used in patients with medial knee osteoarthritis(OA).However,the process of choosing treatment for patients with both patellar fractures and anteromedial knee OA remains unclear.We present the case of a patient with a patellar fracture and anteromedial OA.CASE SUMMARY We present the case of a 72-year-old woman with a history of bilateral medial compartment OA of the knees and a right Oxford UKA.She also experienced a recent left patellar fracture.ORIF and Oxford UKA were performed in a single stage.The patient showed excellent postoperative clinical results.CONCLUSION ORIF and Oxford UKA can be performed simultaneously for patients with patellar fracture and anteromedial OA on the same knee.
文摘Background For some specific comminuted unstable intra-articular fracture,the plaster cast can not maintain the alignment of the articular surface effectively.The aim of this study was to evaluate the clinical effects of distal radius fracture treated with open reduction and internal plate fixation retrospectively.Methods From January 2002 to March 2010,539 cases of distal radius fracture were treated with open reduction and internal fixation,including 184 males and 355 females aging 21-72 years （mean 57 years）.Fractures were caused by falling to the ground in 459 cases,by traffic accident in 62 cases and by athletic injuries in 18 cases.Of 539 cases,there were 523 cases of closed fracture and 16 cases of open fracture.According to Arbeitsgemeinschaft fur Osteosynthesefragen （AO） standards of classification,there were 14 cases of A2 type,22 of A3 type,18 of B1 type,24 of B2 type,62 of B3 type,91 of C1 type,162 of C2 type and 146 of C3 type.The time from injury to operation was 1-16 days （mean 5 days）.All patitents received open reduction and internal plate screw fixation.Forty-seven patients with bone defect were given 6-15 g autologous ilium and 75 cases were given 5 ml calcium sulphate artificial aggregate after reduction.Results All incisions healed by first intention after operation.Patients were followed up for 15 to 32 months postoperatively （mean 22 months）.The fractures healed within 10-18 weeks after operation （mean 12 weeks）.During the last follow-up,the mean palmar tilt was （7.0±0.9）° and the mean ulnar variance was （21.0±4.2）°,showing significant difference when compared with preoperation （（-5.0±1.2）° and （8.0±3.8）°）.The radial heights were not abbreviated.According to Gartland and Werley assessment system,the results were excellent in 314 cases,good in 163 cases,fair in 46 cases,and poor in 16 cases 12 weeks after operation,the excellent and good rate was 88.5%.Conclusions The clinical effect of distal radius fracture treated with open reduction and internal plate fixation was relatively satisfactory.Meticulous operation procedure and individual rehabilitation strategy contribute to the wrist joint functional recovery.
文摘Purpose： To investigate efficacy of open reduction and internal fixation with the miniplate and hollow screw in the treatment of Lisfranc injury. Methods： Ten cases of Lisfranc injury treated by open reduction, miniplate and hollow screw in our hospital were retrospectively analyzed. There were 6 males and 4 females with age ranging from 25 to 45 years （mean 32 years）. Among them, one case was classified as Type A, six Type B and three Type C. Injury mechanism included road traffic accidents （3 cases）, fall from height （5 cases） and hit by heavy object （2 cases）. All injuries were closed without cerebral trauma or other complicated injuries. The time interval between injury and operation was 6-10 days （average 6.6 days）. Postoperatively, the foot function was assessed using Visual Analogue Scales （VAS） and American Orthopaedic Foot and Ankle Society （AOFAS） Scales. Healing time and complications were observed. Results： All patients were followed up for 18-24 months （average 20 months）. Anatomic reduction was achieved in all patients on images. There was statistical significance between preoperative score （Z89 ± 0.34） and score at postoperative 8 weeks （0.67 ± 0.13）. According to the AOFAS score, 5 cases were defined as excellent, 3 cases as good and 2 cases as fair. During follow-up, there was no wound infection or complications except for osteoarthritis in 2 cases. Healing time ranged from 3 to 6 months with an average of 3.6 months. Conclusion： Anatomical reduction of Lisfranc injury can be achieved by open reduction and internal fixation with the miniplate and hollow screw. Normal structure of Lisfranc joint is regained to a great extent; injured ligaments were also repaired. Therefore, this method offers excellent curative effect and can avoid postoperative complications and improve the patients＇ quality of life.
文摘Purpose:This meta-analysis compared the clinical outcome of three-dimensional(3D)printing combined with open reduction and internal fixation(ORIF)to traditional ORIF in the treatment of acetabular fractures.Methods:We searched the Cochrane Library,PubMed,Embase,VIP database,CNKI,and Wanfang data-base with keywords"acetabular fracture","3D printing","three-dimensional printing","open reduction and internal fixation","Acetabulum","Acetabula"from January 2000 to March 2020.Two reviewers independently selected articles,extracted data,assessed the quality evidence and risk bias of included trials using the Cochrane Collaboration’s tools and/or Newcastle-Ottawa scale.When the two analysts had different opinions,they would ask the third analyst for opinion.Randomized controlled trials or retrospective comparative studies of 3D printing combined with ORIF(3D printing group)versus traditional ORIF(conventional group)in the treatment of acetabular fractures were selected.The data of operation time,intraoperative blood loss,intraoperative fluoroscopy times,incidence of complications,excellent and good rate of Matta score for reduction,and excellent and good rate of hip function score were extracted.Stata14.0 statistical software was used for data analysis.Results:Altogether 9 articles were selected,including 5 randomized controlled trials and 4 retrospective studies.A total of 467 patients were analyzed,250 in the conventional group,and 217 in the 3D printing group.The operation time in the 3D printing group was less than that in the conventional group and the difference was statistically significant(standardized mean difference(SMD)=-1.19,95%CI:-1.55 to-0.82,p<0.05).The intraoperative bleeding volume of the 3D printing group was significantly lower than that of the conventional group(SMD=-1.08,95%CI:-1.65 to-0.51,p<0.05).The fluoroscopy times were less in the 3D printing group than in the conventional group and the difference was statistically significant(SMD=-1.64,95%CI:-2.35 to-0.93,p<0.05).The total incidence of complications in the 3D printing group was significantly lower than that in the conventional group(OR=0.43,95%CI:0.24-0.79,p<0.05).There was no significant difference in the excellent and good rate of Matta score for reduction between the two groups(OR=0.60,95%CI:0.34-1.06,p>0.05).There was no significant difference in the excellent and good rate of hip function score at the end of postoperative follow-up between the two groups(OR=0.84,95%CI:0.46-1.56,p>0.05),but the follow-up time varies from 6 months to 40 months.Conclusion:Compared with traditional ORIF,3D printing combined with ORIF has certain advantages in terms that 3D printing not only helps surgeons to understand acetabular fractures more intuitively,but also effectively reduces operation time,intraoperative blood loss,intraoperative fluoroscopy times,and postoperative complications.However,there were no significant differences in the excellent and good rate of Matta score for reduction and the excellent and good rate of hip function score at the end of follow-up.
文摘目的:系统评价不同手术方法治疗桡骨远端骨折的临床疗效和安全性。方法:应用计算机检索中国知网、维普网、万方数据库、中国生物医学文献服务系统、PubMed、Embase、Cochrane Library、Web of Science中关于手术方法治疗桡骨远端骨折的随机对照试验,检索时限均为建库至2024年6月1日。试验组和对照组均采用手术方法治疗。依据文献检索及筛选方案筛选出符合要求的文献后,由2名研究人员分别独立进行数据提取和质量评价。采用Stata15.0软件绘制网状关系图,对疗效优良率、并发症发生情况及腕关节桡偏、尺偏、掌屈、背伸、旋前、旋后活动度进行网状Meta分析,并根据累计概率排名曲线下面积(the surface under the cumulative ranking curve,SUCRA)对手术方法的疗效进行排序。采用比较-校正漏斗图进行发表偏倚检验。结果:共检索到10320篇文献,通过逐层筛选最终纳入34篇文献,涉及切开复位钢板内固定、闭合复位支架外固定、闭合复位克氏针内固定、闭合复位髓内钉内固定、腕关节镜技术联合切开复位钢板内固定、切开复位钢板内固定联合局部植骨6种手术方法。网状Meta分析结果显示,在疗效优良率方面,不同手术方法治疗桡骨远端骨折的疗效排序为腕关节镜技术联合切开复位钢板内固定(SUCRA=99.90%)>切开复位钢板内固定(SUCRA=49.80%)>闭合复位支架外固定(SUCRA=41.50%)>闭合复位克氏针内固定(SUCRA=8.80%);在腕关节桡偏活动度方面,不同手术方法治疗桡骨远端骨折的疗效排序为腕关节镜技术联合切开复位钢板内固定(SUCRA=85.10%)>闭合复位克氏针内固定(SUCRA=84.70%)>闭合复位髓内钉内固定(SUCRA=41.90%)>切开复位钢板内固定(SUCRA=36.20%)>闭合复位支架外固定(SUCRA=2.00%);在腕关节尺偏活动度方面,不同手术方法治疗桡骨远端骨折的疗效排序为切开复位钢板内固定(SUCRA=86.90%)>闭合复位髓内钉内固定(SUCRA=67.90%)>闭合复位克氏针内固定(SUCRA=43.50%)>闭合复位支架外固定(SUCRA=36.90%)>腕关节镜技术联合切开复位钢板内固定(SUCRA=14.70%);在腕关节掌屈活动度方面,不同手术方法治疗桡骨远端骨折的疗效排序为腕关节镜技术联合切开复位钢板内固定(SUCRA=87.10%)>闭合复位髓内钉内固定(SUCRA=65.90%)>闭合复位克氏针内固定(SUCRA=62.30%)>切开复位钢板内固定(SUCRA=34.00%)>闭合复位支架外固定(SUCRA=0.70%);在腕关节背伸活动度方面,不同手术方法治疗桡骨远端骨折的疗效排序为切开复位钢板内固定(SUCRA=90.80%)>闭合复位髓内钉内固定(SUCRA=69.40%)>闭合复位克氏针内固定(SUCRA=33.90%)>闭合复位支架外固定(SUCRA=32.90%)>腕关节镜技术联合切开复位钢板内固定(SUCRA=23.10%);在腕关节旋前活动度方面,不同手术方法治疗桡骨远端骨折的疗效排序为切开复位钢板内固定(SUCRA=93.50%)>闭合复位髓内钉内固定(SUCRA=59.00%)>闭合复位支架外固定(SUCRA=41.30%)>闭合复位克氏针内固定(SUCRA=32.50%)>腕关节镜技术联合切开复位钢板内固定(SUCRA=23.80%);在腕关节旋后活动度方面,不同手术方法治疗桡骨远端骨折的疗效排序为切开复位钢板内固定(SUCRA=89.80%)>闭合复位支架外固定(SUCRA=55.80%)>闭合复位髓内钉内固定(SUCRA=54.80%)>闭合复位克氏针内固定(SUCRA=27.60%)>腕关节镜技术联合切开复位钢板内固定(SUCRA=22.00%);在并发症发生情况方面,不同手术方法治疗桡骨远端骨折的安全性排序为切开复位钢板内固定联合局部植骨(SUCRA=85.70%)>腕关节镜技术联合切开复位钢板内固定(SUCRA=71.40%)>闭合复位髓内钉内固定(SUCRA=58.30%)>闭合复位克氏针内固定(SUCRA=47.30%)>切开复位钢板内固定(SUCRA=25.00%)>闭合复位支架外固定(SUCRA=12.30%)。结论:现有的证据表明,采用切开复位钢板内固定是治疗桡骨远端骨折的优选手术方法,能够改善腕关节活动度,获得良好的临床疗效,而切开复位钢板内固定联合腕关节镜技术、局部植骨等手术方法在一定程度上能够减少切开复位钢板内固定的并发症。
