RESUMEN
BACKGROUND: Many factors affect the outcomes of anterior cruciate ligament (ACL) reconstruction surgery. However, few studies have examined the effects of local bone conditions on the reconstruction of the ACL. This study investigated the changes in the local bone mineral density (BMD) of the knee after rupture of the ACL with the view of using this information to guide treatment options. METHODS: Patients with ACL rupture treated in our department from January 2017 to April 2019 were enrolled in this study. Prior to surgery, local BMD measurements were obtained from all patients and used to determine the appropriate method of ligament fixation. If the local BMD of the affected knee was not significantly lower than that of the healthy side, extrusion fixation was conducted. If the BMD was significantly lower than that of the healthy knee, suspension fixation was applied. The conditions of tunnel cutting or screw splitting, and tunnel enlargement or screw pull-out were observed during the surgery. The post-surgical function of the knee joint was evaluated regularly by physical examination, imaging data, the IKDC scale score, and the Lysholm score. RESULTS: A total of 80 patients with unilateral ACL rupture were included. There were 64 males and 16 females. Decreased BMD was observed in the affected knee compared to the healthy knee for 68 patients. Patients with an ACL history of more than 3 months had lower BMD compared to patients with a history of less than 3 months. Tunnel enlargement and screw pull-out occurred in 2 patients, screw splitting occurred in 1 patient. The fixation mode was adjusted in real-time during the surgery for 3 patients. All patients were followed up for at least 12 months (mean 20.65±5.12 months). The IKDC score increased from 43.07±2.66 pre-surgery to 89.17±3.28 at the final follow-up, and similarly, the Lysholm score increased from 43.49±2.38 pre-surgery to 89.67±2.97 post-surgery. CONCLUSIONS: The measurement of local BMD before surgery may play a significant role in guiding the type of graft fixation. It is recommended that patients undergo surgical reconstruction within 3 months after injury.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/diagnóstico por imagen , Ligamento Cruzado Anterior/cirugía , Lesiones del Ligamento Cruzado Anterior/cirugía , Densidad Ósea , Femenino , Humanos , Masculino , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate the clinical efficacy of operation methods with or without a turned-over patella for treatment of C3-type patellar fractures. METHODS: A total of 68 patients with C3-type patellar fractures undergoing open reduction and internal fixation were retrospectively selected and treated with a turned-over patella surgery (turned-over patella group, n = 30) or conventional therapy without turning over the patella (conventional group, n = 38). The intraoperative and postoperative indicators of the two groups were assessed and comparatively analyzed. RESULTS: The bedridden time was significantly shorter in the turned-over patella group than in the conventional group (P = 0.002), while the range of motion (ROM) of knee joint was significantly higher in the turned-over patella group (P = 0.044). The Lysholm score was slightly higher in the turned-over patella group than in the conventional group, but the difference was not statistically significant (P = 0.055). No significant difference was observed between the two groups in terms of the operation time (P = 0.096), intraoperative blood loss (P = 0.543), time of weight bearing (P = 0.312), fracture healing time (P = 0.272), or complications (P = 1). CONCLUSION: The turned-over patella operation method exhibited some superiority to conventional reduction-fixation approach for treatment of C3-type patellar fractures in terms of efficacy and safety by enlarging the ROM of the knee joint and promoting functional recovery.
Asunto(s)
Fijación Interna de Fracturas/instrumentación , Curación de Fractura/fisiología , Fracturas Óseas/cirugía , Traumatismos de la Rodilla/cirugía , Articulación de la Rodilla/cirugía , Rótula/lesiones , Adulto , Femenino , Fijación Interna de Fracturas/rehabilitación , Fracturas Óseas/patología , Humanos , Traumatismos de la Rodilla/fisiopatología , Articulación de la Rodilla/patología , Masculino , Persona de Mediana Edad , Reducción Abierta , Osteotomía/métodos , Rótula/diagnóstico por imagen , Rango del Movimiento Articular , Recuperación de la Función , Estudios RetrospectivosRESUMEN
OBJECTIVE: To analyze the related factors of the infection after operation of open tibiofibula fractures. METHODS: The clinical data of 141 patients with open tibiofibula fractures underwent surgical treatment from June 2009 to December 2012 were retrospectively analyzed. All the patients were male and aged from 18 to 61 years old with an average of 39.2 years; all the fractures were unilateral. According to Gustilo typing of fracure, 5 cases were type I, 44 cases were type II, 27 cases were type III a, 56 cases were type III b and 9 cases were type III c. These clinical data included patients' age, gender, body mass index (BMI), underlying diseases, time of operation, fracture site, fracture type, fixation method, postoperative drainage, debridement condition and so on. The postoperative infection conditions were recorded, and the correlation between above factors and infections were analyzed. Finally, the significant related variables were introduced into a Logistic regression model to evaluated their risk. RESULTS: Among the 141 patients, 22 cases developed with infection (15.6%). The significant relative factors with infection contained fixation method, debridement condition, underlying diseases and postoperative drainage (P < 0.05). The correlativities were stepped up in order, their odds ratios value was 2.451, 3.164, 3.414, 5.117, respectively. CONCLUSION: Active treatment for underlying diseases before operation, thorough debridement for open wound, suitable fixation method for fracture and thorough draining are effective measures in preventing postoperative infection.
Asunto(s)
Peroné/lesiones , Fracturas Abiertas/cirugía , Complicaciones Posoperatorias/etiología , Fracturas de la Tibia/cirugía , Adolescente , Adulto , Desbridamiento , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Infección de la Herida Quirúrgica/etiologíaRESUMEN
OBJECTIVE: To study clinical outcomes of serial tightening of reserved suture threads in delayed incision closure. METHODS: From January 2005 to June 2013, 67 patients with delayed incision closure were treated with serial tightening of reserved suture threads. There were 37 males and 30 females, with an average age of 40 years old (ranged from 12 to 75 years old). Among them, 36 patients suffering from leg or forearm double fractures had the incision difficult to those primarily due to high tension or mergency; 13 patients had open wound which lasted for more than routine time for debridement and closure; 9 patients had wound infection; 9 patients had decompression incisions owing to compartment syndrome. The No. 4 suture thread was used to sew up the incision, and the 4 to 6 cm long thread was reserved at two ends of each thread. The reserved thread was tightened gradually from 2 to 4 days after operation according to conditions of swelling relieving. Finally, the reserved thread was not tied until the incision was completely closed. RESULTS: After operation, the reserved threads were tightened and tied for 1 time in 6 patients, 2 times in 23 patients, 3 times in 27 patients, 4 times in 11 patients. Postoperative closure time ranged from 3 to 9 days, with an average of 6.2 days. All the incisions got delayed primary healing. CONCLUSION: The method of serial tightening of reserved suture threads to close delayed incision closure avoids a second operation, which is simple and obtains a fine result.