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A comparative study of absorbable screw fixation and absorbable screw combined with suture anchor fixation in treatment of avulsion fracture of posterior cruciate ligament at tibial insertion of knee joint

ObjectiveTo compare the effectiveness of open reduction of posterior cruciate ligament (PCL) avulsion fracture at tibial insertion of knee joint with absorbable screws fixation and absorbable screw combined with suture anchor fixation. Methods The clinical data of 26 patients with PCL avulsion fracture at tibial insertion who met the selection criteria between March 2015 and October 2021 were retrospectively analyzed. Among them, 14 patients were fixed with simple absorbable screw (group A), and 12 patients were fixed with absorbable screw combined with suture anchors (group B). All patients were confirmed by X-ray film, CT, or MRI preoperatively, and got positive results in preoperative posterior drawer tests. There was no significant difference in gender, age, side of affected limb, time from injury to operation, comorbidities, and preoperative Meyers & McKeever classification, Lysholm score, and International Knee Documentation Committee (IKDC) score between the two groups (P>0.05). The operation time and postoperative complications were recorded and compared between the two groups. At last follow-up, Lysholm score and IKDC score were used to evaluate the improvement of knee function. ResultsThere was no significant difference in operation time between the two groups (P>0.05). All incisions healed by first intention, and no complication such as vascular and nerve injury or venous thrombosis occurred. All 26 patients were followed up 9-89 months, with an average of 55.3 months. The follow-up time of group A and group B was (55.7±23.2) and (56.8±29.3) months, respectively, with no significant difference (t=−0.106, P=0.916). Radiographs showed bone healing in both groups at 3 months after operation, and no complication such as infection and traumatic arthritis occurred. At last follow-up, the posterior drawer test was negative in both groups, and the Lysholm score and IKDC score significantly improved when compared with the pre-operative values (P<0.05). However, there was no significant difference in the improvement value between the two groups (P>0.05). ConclusionFor PCL avulsion fracture at tibial insertion of the knee joint, the open reduction and absorbable screw combined with suture anchor fixation can achieve reliable fracture reduction and fixation, which is conducive to the early rehabilitation and functional exercise, and the postoperative functional recovery of the knee joint is satisfactory.

可吸收螺钉临床应用30例

可吸收螺钉结合丝线环扎加“8”字内固定治疗髌骨骨折

目的 总结可吸收螺钉结合丝线环扎加“8”字内固定治疗髌骨骨折的疗效。 方法 2003 年6 月－2009 年8 月，应用可吸收螺钉结合丝线环扎加“8”字内固定治疗32 例髌骨闭合骨折。男22 例，女10 例；年龄23 ～ 71 岁，平均36.5 岁。跌伤19 例，车祸伤12 例，棒击伤1 例。粉碎骨折3 例，横形骨折29 例。X 线片示骨折均有分离移位。受伤至手术时间2 h ～ 7 d。 结果 术后切口均Ⅰ期愈合。32 例均获随访，随访时间3 ～ 24 个月，平均9 个月。X 线片示骨折均愈合，临床愈合时间9 ～ 16 周，平均10 周。术后早期活动中未发生丝线断裂、骨折分离等并发症，未出现排斥反应。1 例术后行走时偶有疼痛。根据陆裕朴等疗效评定标准，优27 例，良4 例，可1 例，优良率为96.9%。 结论 可吸收螺钉结合丝线环扎加“8”字内固定治疗髌骨骨折疗效确切，固定牢靠，并发症少，可避免二次手术。

可吸收螺钉改良Dewar术治疗陈旧性Ⅲ度肩锁关节脱位

Comparison of short-term effectiveness of metal screws and absorbable screws in repair of distal tibiofibular syndesmosis

Objective To compare the short-term effectiveness of repairing distal tibiofibular syndesmosis with metal screws and absorbable screws. Methods A retrospective analysis was performed on the clinical data of 63 patients with ankle fracture combined with injury of the distal tibiofibular syndesmosis admitted between January 2017 and January 2020. Among them, 31 patients were treated with absorbable screw fixation of the distal tibiofibular syndesmosis (research group) and 32 patients were treated with metal screw fixation of the distal tibiofibular syndesmosis (control group). There was no significant difference in gender, age, cause of injury, surgical side, time from injury to operation, fracture type, preoperative visual analogue scale (VAS) score, and American Orthopaedic Foot & Ankle Society (AOFAS) score between the two groups (P>0.05). The operation time and fracture healing time were recorded and compared between the two groups. X-ray film was taken to evaluate the effect of ankle joint reduction and fixation. Olerud-Molander ankle fracture efficacy score (short for OM score), AOFAS score, and VAS score were used to evaluate the effectiveness. Results There was no significant difference in operation time between the two groups (t=−0.683, P=0.497). In the control group, 1 case of delayed healing and 1 case of poor healing occurred in the lateral incision after operation, which healed after dressing change; the rest of the patients had primary healing of the incision. Patients in both groups were followed up 12-24 months, with an average of 13.8 months. In the control group, 1 patient with fracture of pronation and external rotation walked with full weight bearing after removing the metal screw of the distal tibiofibular syndesmosis at 8 weeks after operation, the anatomical plate of the lateral malleolus was broken, and the lateral malleolus was fixed again and recovered after 5 months; 1 patient had mild ankle pain after operation, and the pain disappeared after removing the metal screw of the distal tibiofibular syndesmosis at 8 weeks. No complication such as nerve and blood vessel injury occurred in all patients. There was no significant difference in fracture healing time between the two groups (t=−1.128, P=0.264). The AOFAS and VAS scores significantly improved in both groups at 12 months after operation (P<0.05). There was no significant difference between the two groups in the OM scores, and the difference of AOFAS and VAS scores between before and after operation (P>0.05). Conclusion Using absorbable screws to repair the distal tibiofibular syndesmosis can effectively restore the ankle acupoint structure, prevent ankle instability, and restore good ankle function. There is no significant difference in effectiveness between absorbable screws and metal screws, and there is no need for secondary operation to remove screws.

可吸收螺钉结合可吸收缝线张力带治疗青少年髂前上棘撕脱骨折

目的 总结采用可吸收螺钉结合可吸收缝线张力带治疗青少年髂前上棘撕脱骨折的疗效。 方法 2006 年12 月－ 2009 年6 月，采用切开复位可吸收螺钉结合可吸收缝线张力带治疗15 例青少年髂前上棘撕脱骨折。患者均为男性；年龄13 ～ 16 岁，平均14.6 岁。左侧4 例，右侧10 例，双侧1 例。均为运动损伤。X 线片示髂前上棘撕脱骨折，骨折块分离移位1.5 ～ 3.0 cm。受伤至手术时间约3 d。 结果 术后切口均Ⅰ期愈合。15 例均获随访，随访时间3 ～ 12 个月，平均6 个月。患髋活动均良好，无跛行，患处及行走无疼痛，髂前上棘外观恢复满意。术后3 个月X 线片示骨折均达骨性愈合。缝匠肌肌力5 级，可参加体育锻炼。1 例术后大腿外侧皮肤感觉减弱，随访3 个月后皮肤感觉恢复正常；余无延迟愈合、感染、屈髋功能障碍等并发症。 结论 可吸收螺钉结合可吸收缝线张力带固定是治疗青少年髂前上棘撕脱骨折的一种有效方法。

OPERATIVE TREATMENT OF DISPLACED TALAR NECK FRACTURES WITH ABSORBABLE LAG SCREW

OBJECTIVE: To study a new kind of operation for displaced talar neck fractures. METHODS: From April 1996 to March 2001, 9 talar neck fractures were treated by internal fixation of absorbable lag screw with a medial approach and cut of medial malleolus to expose the fractures. A non-weight-bearing below-knee cast was applied for 6 to 12 weeks after operation. Once union of the fracture site is apparent, the patient should remain non-weight bearing in a removable short-leg and keep exercise every day. RESULTS: All the patients received follow-up from 15 to 60 months with an average of 28 months. The fractures healed from 20 to 42 weeks. The excellent and good rate of function was 77.8% (7/9) according to American Orthopedic Foot and Ankle Society Score(AOFAS). One case had the complication of superficial infection of wound and skin edge necrosis after operation, which was Hawkins type III. Late complication included two cases of avascular necrosis(AVN). Among them, one AVN of Hawkins type II was caused by early weight-bearing five weeks after operation and gained the fair score. The other AVN of Hawkins type III was inefficient to conservative therapy and proceeded ankle fusion in the end. The AOFAS of the patient was bad. CONCLUSION: Treatment of talar neck fractures by internal fixation of absorbable lag screw with a medial approach is an ideal method. It can gain a satisfactory result by the operation, strict postoperative care and rehabilitation.

可吸收螺钉治疗青壮年股骨头骨折

总结股骨头骨折治疗中手术入路选择及可吸收螺钉内固定的应用。 方法 2002 年6 月－2006 年12 月，采用可吸收螺钉内固定治疗12 例股骨头骨折患者。男9 例，女3 例；年龄16 ～ 46 岁。车祸伤10 例，高处坠落伤2 例。左侧5 例，右侧7 例。12 例均为闭合性损伤，新鲜骨折伴髋关节后脱位。股骨头骨折按Pipkin 分类：Ⅰ型5 例，Ⅱ型4 例，Ⅳ型3 例。 结果 术后切口Ⅰ期愈合。12 例患者获随访6 个月～ 5 年，平均2 年6 个月。无关节积液、滑膜炎、退钉等现象。X 线片检查骨折愈合时间为12 ～ 18 周，平均15 周。髋关节功能按Brumback 评价标准：优9 例，良3 例。 结 论 采用可吸收螺钉治疗股骨头骨折，固定可靠，疗效满意，避免了二次手术。3 种手术入路方式各有优点，应根据患者情况进行选择。

EFFECTIVENESS OF MINI INCISION AND ABSORBABLE SCREW FIXATION FOR TREATMENT OF ANTERIOR CRUCIATE LIGAMENT TIBIAL EMINENCE AVULSION FRACTURE

ObjectiveTo investigate the effectiveness of open reduction by mini incision and absorbable screw internal fixation for the treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture. MethodsBetween January 2006 and July 2012, 90 patients (90 knees) with ACL tibial eminence avulsion fracture were treated. There were 58 males and 32 females, aged from 10 to 58 years with an average of 33.7 years. The causes of injury were traffic accident injury in 60 cases, sports injury in 22 cases, and falling injury in 8 cases. The disease duration was 1-365 days with a median of 106 days. Combined injuries included 14 cases of meniscus injury, 5 cases of medial collateral ligament injury, and 3 cases of avulsion fracture of the anterior horn of the lateral meniscus. All patients underwent open reduction by mini incision and internal fixation with absorbable screw. Postoperative rehabilitation exercise was performed. ResultsTwo patients had delayed healing of incision, and others obtained primary healing. All the patients were followed up 6-72 months (mean, 40.1 months). X-ray examination showed that bone union was achieved in all patients at 3-12 months after operation; nail tail came off in 7 cases at 4-13 months after operation, and the nail tail was taken out under arthroscopy. At 6-12 months after operation, the range of motion (ROM), Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) score were significantly increased when compared with preoperative ones (P < 0.05). ConclusionA combination of open reduction by mini incision and absorbable screw internal fixation for the treatment of ACL tibial eminence avulsion fracture has the advantages of easy operation, firm fixation, and satisfactory functional rehabilitation, so it is a safe and effective method for the treatment of ACL tibial eminence avulsion fracture.

Comparison of bioabsorbable screw and metallic screw for Maisonneuve fracture

ObjectiveTo compare the clinical and radiographic outcomes of bioabsorbable screw and metallic screw for Maisonneuve fracture.MethodsThe clinical data of 68 patients of Maisonneuve fracture treated with open reduction and internal fixation between October 2012 and October 2016 were retrospectively analyzed. Metallic screw fixation was used in 37 cases (group A) and absorbable screw fixation was used in 31 cases (group B). There was no significant difference in age, gender, weight, operated side, cause of injury, time from injury to operation, and complications between the two groups (P>0.05). At last follow-up, the tibiafibular clear space (TFCS), tibiafibular overlap (TFO), medial clear space (MCS), and syndesmotic malreduction rate were recorded. And the dorsiflexion and plantar-flexion range of motion, pain visual analogue scale (VAS) score, ankle and hind foot score of American Orthopaedic Foot and Ankle Society (AOFAS), and Olerud-Molander (OM) score were recorded.ResultsAll patients were followed up 25-43 months, with an average of 32.3 months. There was no significant difference in the operation time between the two groups (t=1.229, P=0.282). All the fractures healed, and there was no significant difference in fracture healing time between the two groups (t=1.367, P=0.413). At last follow-up, the syndesmotic malreduction rate of group A was 16.2% (6/37), showing no significant difference when compared with group B [6.2% (2/31)] (χ2=1.549, P=0.213). There were 3 complications in group A, 1 was superficial wound infection, 1 was local heterotopic ossification due to failure to remove the screws in time, 1 was local heterotopic ossification of the screws; and there were 2 complications in group B, 1 was rejection and 1 was local heterotopic ossification of the screws. There was no significant difference in the incidence of complications between the two groups (χ2=0.068, P=0.794). There was no significant difference in TFCS, MCS, TFO, ankle dorsiflexion and plantar-flexion range of motion, AOFAS score, OM score, and VAS score between the two groups at last follow-up (P>0.05).ConclusionCompared with metallic screw, absorbable screws provide adequate fixation and functional recovery with avoiding screw removal and lower syndesmotic malreduction.