RESUMEN
Objective:To study the image features in direction and quantity on CT scans of the axial safety target area of Sawbone femoral neck screw tunnels and possibility of establishing a stable spatial cartesian coordinate system.Methods:After three-dimensional reconstruction of CT data of 40 Sawbone femoral necks, the real axial CT images (perpendicular to the surgical central axis) of each femoral neck were superimposed respectively to get the intersection, called axial safe target area(ASTA). With the anterior cortex of femoral neck basilar seen as a landmark, the spatial rectangular coordinate system ( x, y, z) was established to measure superior-inferior diameters (D-SI), anterior-posterior diameters (D-AP) and the oblique angles. Each intersection was overlapped to the original axial CT images to find coronal position of ASTA boundaries. In addition, coronal CT union (equivalent to anteroposterior X-ray) and sagittal CT union (equivalent to lateral X-ray) were obtained by images in situ superposition method, from which the coronal positions of the isthmus of the perspective boundary (D-SI and D-AP) were determined. The coincidence of the boundary positions of ASTA and those of the perspective isthmus was compared. Pearson correlation coefficients were calculated for the left and right sides respectively to analyze the correlation between D-SI and D-AP. Results:Every ASTA presented an oblique rounded quadrilateral, whose front base was flat and coincided with anterior cortex of femoral neck basilar (FNB). In this coordinate system, D-SI were 35.13±0.51 mm on the left and 30.98±0.82 mm on the right, while D-AP were 26.66±0.39 mm on the left and 27.53±0.72 mm on the right. There was no significant correlation between D-SI and D-AP (left: R=0.43, P=0.060, right: R=0.32, P=0.176, respectively). All the isthmus of X-ray boundary fell at the corresponding ASTA boundary. The oblique angles ranged from 8° to 29°, and all parameters were within the range of normal femoral neck (the anterior cortex of the femoral neck basilar is flat, with a D-SI range of 26-38 mm, a D-AP range of 17-29 mm, and an oblique angle range of 5°-53°). Conclusion:The intersection method can be used to conveniently acquire directional-quantitative-stable individualized ASTA of Sawbone femoral neck. Thus, a stable spatial cartesian coordinate system can be established based on the anterior cortex of femoral neck basilar.
RESUMEN
Objective To analyze the results of treatment of complicated tibial plateau fractures with open reduction and internal fixation with bilateral plates .Methods 29 elder patients with C type tibial platform fractures underwent internal fixation with bilat-eral plates and bone grafting .Fixation with bilateral plates was performed during operation with dynamic compression plate or 1/3 Tubular steel plate placed medially and the dissection plate or LISS system ones inserted laterally after the underlying separation . Meanwhile ,sufficient bone grafting during operation could effectively support reduction of articular surface .Results All patients were followed up of an average of 13 .8 ± 2 .43 months .According to Rasmussen score standard ,the excellent and good rate was 82 .7% .There was significant difference of TPA and PA between postoperation and postoperation one year later .Conclusion It is a simple and effective method to treat complicated elder tibial platform fractures with bilateral plates .It will improve the effect and re-duce complications significantly to perform sufficient bone grafting intraoperatively ,and make the drainage unobstructed and do the early functional exercises postoperatively .
RESUMEN
Objective To explore surgical methods and their efficacy for post-traumatic Made-lung deformity complicated with dorsal or volar angulation in the adults. Methods Volar plate or exter-nal fixator, combined with the techniques osteotomy and bone grafting, were selected to treat adult pa-tients with post-traumatic Madelung deformity complicated with dorsal or volar angulation. The effects were preliminarily evaluated through comparing the volar tilting angle, ulnar inclination, radial shortening and the range of joint motion before and after the operation. Results All the patients were followed up for 6-27 months (mean 16 months). The volar tilting angle, radial inclination, radial shortening, range of joint motion of all patients were improved significantly (P<0.05). Conclusions For patients with Madelung deformity complicated with dorsal angulation, internal fixation of volar plate combined with volar osteotomy and bone grafting is recommended; while dynamic eternal fixator combined with combined with dorsal osteotomy and bone grafting is an ideal choice for patients with Madelung deformity complicated with volar angulation.
RESUMEN
Objective To explore the possible causes and treatment of nonunion of fractures of diaphysis of radius and ulna. Methods According to different personal conditions and results of X gram, 73 cases of the nonunion fractures of diaphysis of radius and ulna were treated with different internal fixations, autologus spongy bone transplantation, release of scar and interosseous membrane, or local skin flap transposition. All had early functional mobilization of the forearm after operation. Results The patients were followed up for 12 to 29 months. All the cases had bony union, and 64 cases(87.7% ) obtained satisfactory functional rehabilitation. Conclusion The major causes that may lead to the nonunion of the diaphysis of radius and ulna are conditions of local soft tissue, site and severity of the fracture, security of internal fixation, and improper early movement, rather than infection. Proper internal fixation, autologus spongy bone transplantation, and release of scar and interosseous membrane are effective in treatment of the nonunion of the fracture and in the functional rehabilitation of the forearms.