简介：平坦破裂是的王牌的解剖结构复杂、起作用的暴露和固定是极其困难的。因为那些显然代替了王牌平坦破裂，更靠近的引出被注定引起致丑陋的愈合。有内部固定(ORIF)的开的减小不仅导致解剖减小，而且带复杂并发症。不管哪个方法将被采用，创伤的关节炎或大腿骨的头的脉管的坏死可能发生。以便treatacetabular更有效地断裂，矫形外科医生应该被要求充分为复杂并发症预防掌握theacetabular解剖，简历力学，分类和必要知识。

简介：AbstractPurpose:To compare the stability of the posterior anatomic self-locking plate (PASP) with two types of popular reconstruction plate fixation, i.e. double reconstruction plate (DRP) and cross reconstruction plate (CRP), and to explore the influence of sitting and turning right/left on implants.Methods:PASP, DRP and CRP were assembled on a finite element model of both-column fractures of the left acetabulum. A load of 600 N and a torque of 8 N·m were loaded on the S1 vertebral body to detect the change of stress and displacement when sitting and turning right/left.Results:The peak stress and displacement of the three kinds of fixation methods under all loading conditions were CRP > DRP > PASP. The peak stress and displacement of PASP are 313.5 MPa and 1.15 mm respectively when turning right; and the minimal was 234.0 Mpa and 0.619 mm when turning left.Conclusion:PASP can provide higher stability than DRP and CRP for both-column acetabular fractures. The rational movement after posterior DRP and PASP fixation for acetabular fracture is to turn to the ipsilateral side, which can avoid implant failure.

简介：AbstractBackground:Surgical treatment of both-column acetabular fractures is challenging because of the complex acetabular fracture patterns and the curved surface of the acetabulum. Seldom study has compared the application of three-dimensional (3D) printing technology and traditional methods of contouring plates intra-operatively for the surgical treatment of both-column acetabular fractures. We presented the use of both 3D printing technology and a virtual simulation in pre-operative planning for both-column acetabular fractures. We hypothesized that 3D printing technology will assist orthopedic surgeons in shortening the surgical time and improving the clinical outcomes.Methods:Forty patients with both-column acetabular fractures were recruited in the randomized prospective case-control study from September 2013 to September 2017 for this prospective study (No. ChiCTR1900028230). We allocated the patients to two groups using block randomization (3D printing group, n = 20; conventional method group, n = 20). For the 3D printing group, 1:1 scaled pelvic models were created using 3D printing, and the plates were pre-contoured according to the pelvic models. The plates for the conventional method group were contoured during the operation without 3D printed pelvic models. The operation time, instrumentation time, time of intra-operative fluoroscopy, blood loss, number of times the approach was performed, blood transfusion, post-operative fracture reduction quality, hip joint function, and complications were recorded and compared between the two groups.Results:The operation and instrumentation times in the 3D printing group were significantly shorter (130.8 ± 29.2 min, t = －7.5, P < 0.001 and 32.1 ± 9.5 min, t = －6.5, P < 0.001, respectively) than those in the conventional method group. The amount of blood loss and blood transfusion in the 3D printing group were significantly lower (500 [400, 800] mL, Mann-Whitney U= 74.5, P < 0.001 and 0 [0,400] mL, Mann-Whitney U = 59.5, P < 0.001, respectively) than those in the conventional method group. The number of the approach performed in the 3D printing group was significantly smaller than that in the conventional method group (pararectus + Kocher-Langenbeck [K-L] approach rate: 35% vs. 85%; x2 = 10.4, P < 0.05). The time of intra-operative fluoroscopy in the 3D printing group was significantly shorter than that in the conventional method group (4.2 ± 1.8 vs. 7.7 ± 2.6 s; t = －5.0, P < 0.001). The post-operative fracture reduction quality in the 3D printing group was significantly better than that in the conventional method group (good reduction rate: 80% vs. 30%; x2 = 10.1, P < 0.05). The hip joint function (based on the Harris score 1 year after the operation) in the 3D printing group was significantly better than that in the conventional method group (excellent/good rate: 75% vs. 30%; x2 = 8.1, P < 0.05). The complication was similar in both groups (5.0% vs. 25%; x2 = 3.1, P = 0.182).Conclusions:The use of a pre-operative virtual simulation and 3D printing technology is a more effective method for treating bothcolumn acetabular fractures. This method can shorten the operation and instrumentation times, reduce blood loss, blood transfusion and the time of intra-operative fluoroscopy, and improve the post-operative fracture reduction quality.Clinical trail registration:No.ChiCTR1900028230; http://www.chictr.org.cn

简介：AbstractPurpose: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.

简介：客观：为王牌探索起作用的指示和主要全部的新潮的关节造形术的起作用的方法平坦骨折并且观察临床的药品effect.Methods：我们回顾地总结了并且分析创伤的条件，破裂类型，复杂并发症，起作用的时间，起作用的技术，和11patients的短期的药品效果(10男性和1女性，与42的吝啬的年龄。4年)与王牌平坦骨折经历了主要全部的新潮的关节造形术。结果；病人被跟随在上面为6-45月(吝啬的=28月)。他们手术后的新潮的关节的普通哈里斯分数是78。结论：指示的Understrict控制，有平坦骨折可以经历的王牌的病人主要全部的新潮的关节造形术，而是稳定的王牌平坦部件应该被做。

简介：HistoricalperspectiveItwaswellknownthatin1918Takagiperformedthefirstarthroscopicinspectionofacadaver'skneeinJapan.1Hisinterestinthisarealaidthefoundationforarthroscopyandfacilitatedthedevelopmentofarthroscope.In1931,Burmanreportedanexperimentalstudyonthearthroscopicexplorationofc

简介：客观：在旧王牌上与骨膜调查免费的肠骨的冠接枝的治疗学的有效性平坦缺点。方法：从1996年2月到2005年6月，9patients与骨膜与免费的肠骨的冠接枝被对待重建旧acetabulardefects。有7男性和2女性，平均年龄是41。3年。acetabulardefects被交通事故在3种情况中在6种情况和秋天损害中引起。处理的从损害的时间是4-13月并且平均8个月。Intraoperatively，我们第一移开以后的墙的theacetabular破裂碎片。大腿骨的头当时是reducted。骨头接枝与骨膜从肠骨的冠被收获，它与骨钳被雕刻遵循缺点。凹面(肠骨的窝)接枝的方面被放向大腿骨的头。Thegraft被二～三个腿螺丝钉安全地修理。结果：手术后的症候群没在任何盒子中被发现。哈里斯“20个系统证明分数从32涨了。3pointspreoperatively手术后地指向81。新潮的功能在3种情况中作为优秀被评估，在在2种情况中的4种情况和交易会中好。结论：尽管这个过程不能确切复制新潮的关节的解剖，它启用恢复以后的稳定性，为新潮的关节的providebone股票并且阻止大腿骨的头的脱臼。

简介：AbstractFractures of the acetabulum in elderly patients were often caused by low energy trauma. Fractures involving anterior column are more common and often associated with impaction and comminution. Osteoporosis further complicates the management. Percutaneous fracture fixation has low morbidity but it is a technically demanding procedure. Open reduction and fracture fixation is done with or without simultaneous total hip replacement. Delayed total hip replacement is considered in posttraumatic arthritis patients. Patients with minimal displaced fractures, associated both-column fractures with secondary congruence of joint and patients who are medically unfit for surgery can be managed non-operatively. Whatever be the method of management, these elderly patients should be mobilised as early as possible.

简介：破坏损害被定义为avery骨头和软纸巾的严重损坏。我们在一些破裂盒子中发现了那的Butin临床的实践，软纸巾的损坏不象“destructiveinjury”一样严重显示，而弄碎破裂stillcannot表演骨头损坏的严厉。因此我们proposeda新术语“destructivefractures”在把破坏损害的定义与典型诊所盒子相结合以后。破坏破裂指谁的破裂骨状的纸巾太严重被损坏被修理，但是软纸巾，神经和静脉是严重地伤害的更少，canbe修理。从一年2001～2010，破坏破裂的75个盒子被同意进入我们的部门。根据是否与外部环境连结的破裂和破裂地点，他们被划分成6种类型：al类型，关上的骨干破坏骨折；a2类型，开的骨干破坏骨折；bl类型，关上的包含关节的破坏骨折；b2类型，开的包含关节的destructivefracture；c1类型，关上的混合破坏骨折；c2类型，开的混合破坏骨折。相应临床的治疗为破坏骨折的新分类标准是的每type.The被进行简单、实际并且thuscan被用作一个重要指南为破坏破裂做合理treatmentplans。

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简介：骨盆的破裂是严重损害。在24个小时以内的死亡最经常是尖锐的血损失的结果。这些病人的紧急情况管理挑战性、争论。在它的管理的关键问题正在识别出血的地点然后控制流血。有骨盆的骨折的血液动力学地不稳定的病人的管理要求一个多学科的队。在这个管理算法处理的问题是诊断评估，损坏控制复活，为noninvasive的指示骨盆的稳定，preperitoneal有关外科的选择和angiography的骨盆的收拾行李和批评决定。这篇评论文章在那些决心上集中于知识的最近的身体。

简介：Objective:Toinvestigatetheinfluenceofhipandpelvicfracture,especiallyacetabularfracturecomplicatedbysciaticnerveinjuryonclinicalfeaturesandprognosisofsciaticnerveinjury.Methods:FromJanuary1987toJanuary2000,17patients(14maleand3female)whohadhipandpelvicfracturescomplicatedbysciaticnerveinjuryweretreatedwithoperativereductionandinternalfixationandfollowedupfrom10monthsto5years.Theaverageagewas38years(ranging23-56years).Theleftextremitieswereinvolvedin11patientsandtherightin6.Twelvepatientsunderwentprimaryexplorationandneurolysisand5patientsunderwentsecondaryoperation.Results:Preoperatively,8patientsweretreatedwithlargedosesoforalnarcoticstocontroltheirseveresciaticpain.Threeofthe8patientsunderwentpatient-controlledanalgesiaandepiduralanalgesia.Afteroperation,excellentandgoodratesofreductionandfunctionalrecoveryofsciaticnervewere94.1%and88%respectively.Fourpatientsstillhadsciaticpainand2patientsfailedtorecover.Sciaticnervefunctionimprovedwithin3-6monthsaftersurgeryin11patients.Conclusions:Hipandpelvicfracturescanresultinsciaticnerveinjury,especiallycommonperonealnerveinjuryandprognosisispoor.Openreductionandinternalfixationcombinedwithnerveexplorationandneurolysisshouldbeusedasearlyaspossibleforseveresciaticpain.

简介：Objective:Toevaluatetheefficacyandsignificanceofposterolateralfusioninpreventingfailureofshort-segmentstabilizationforthetreatmentofthoracolumbarburstfractures.Methods:Sixtypatientswiththoracolumbarburstfractureswereincludedinthestudy.Thepatientswereclassifiedintotwogroups(n=30ineachgroup).InGroupA,patientsweretreatedinourhospitalwithshort-segmentinstrumentationviaposterolateralfusionwithiliacbone.InGroupB,patientsweretreatedinotherhospitalwithshort-segmentfixationwithoutfusion.Allcasescametoourhospitalforreexamination.Therewere18malesand12femalesinGroupAwithameanageof42.3years(range,24to52years)and16malesand14femalesinGroupBwithameanageof41.5years(range,19to54years).Radiographic(Cobbangle,kyphosisofthevertebralbody,andsagittalindex)andclinicaloutcomes(LowBackOutcomeScore)wereanalyzedafteranaveragefollow-upof16months.Results:Afteroperation,Cobbanglewasreducedfrom19.3°to3.1°inGroupAandfrom19.1°to3.3°inGroupB(P>0.05).Itwas5.9°inGroupAand11.9°inGroupBatthefinalfollow-up(P<0.01).Itsaveragelossofcorrectionwas2.8°inGroupAand8.6°inGroupB.Averagekyphosisofthevertebralbodywasreducedfrom21.3°to6.2°inGroupAandfrom21.7°to7.4°inGroupB(P>0.05).Itwasdecreasedto7.9°inGroupAand13.5°inGroupBatthefinalfollow-up(P<0.01).Itsaveragelossofcorrectionwas1.7°inGroupAand6.1°inGroupB.Sagittalindexwasreducedfrom21.3°to3.6°inGroupAandfrom20.5°to3.8°inGroupB(P<0.05).Itwasdecreasedto5.1°inGroupAand9.8°inGroupBatthefinalfollow-up(P<0.01).Itsaveragelosswas1.5°inGroupAand6.0°inGroupB.InGroupA,73.3%ofpatientshadanexcellentresultbasedonLowBackOutcomeScoresystem,whilethatinGroupBwasonly43.3%.Conclusions:Posterolateralfusionisaneffectivemeasuretopreventimplantfailure,anddecreaselo

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简介：Objective:Toinvestigatetheindication,perioperativeannouncements,selectionofprosthesisandclinicalresultsofshoulderhemiarthroplastyforthetreatmentofcomplexproximalhumeralfractures.Methods:Atotalof55patientswhosufferedfromcom-plexproximalhumeralfracturesweretreatedbyshoulderhemiarthroplasty.Themeanagewas55.6yearsandmeanfollow-upperiodwas25.1months.Thescoringsystemmodi-ficationforhemiarthroplasty(SSMH)hadbeenadoptedforevaluationatthelatestfollow-up.Results:Thepainwasobviouslyrelievedinallpatients.Fiftypatientswerepainlessand5patientshadslightpain.Themeanrangeofmotionwas100°(90°-110°)inabduction,95°(80°-100°)inforwardflexion,35°(30°-40°)inextemalrotationandinternalrotationwasconfinedatL2level(L1-L3).ThemeanSSMHscorewas27.9(24-29).Fiftypatients(90.1%)weresatisfiedwiththeclinicaloutcome.Conclusions:Shoulderhemiarthroplastyisaneffectivemethodtotreatcomplexproximalhumeralfractures.Theproperselectionofpatientsandprosthesis,goodoperationskillandenoughfunctionalexercisearethekeypointsofsuccessfultreatment.

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简介：AbstractMandibular condylar fractures are among the most common facial fractures and some of the most difficult to manage. Opinions about the management of mandibular condylar fractures differ among surgeons. With the implementation of new technology, an increased understanding of fracture management, and better functional and morphological outcomes reported in the literature, open reduction and internal fixation is becoming many surgeons’ preferred choice for the treatment of condylar fractures. Because surgical treatment of such fractures is complex, certain factors must be considered to achieve satisfactory outcomes. In this article, we summarise six key points in the management of mandibular condylar fractures: virtual evaluation of condylar fracture, a suitable surgical approach, good reduction, stable internal fixation, repair of the articular disc, and restoration of the mandibular arch width. We believe that these points will help to improve the prognosis of mandibular condyle fractures.

简介：AbstractPurpose:Pelvic fracture evaluation with abdominopelvic computed tomography (CT) and formal CT cystography for rule out of urine bladder injury have been commonly employed in pediatric trauma patients. The additional delayed imaging required to obtain optimal CT cystography is, however, associated with increased doses of ionizing radiation to pelvic organs and represent a significant risk in the pediatric population for future carcinogenic risk. We hypothesized that avoidance of routine CT cystography among pediatric pelvic fracture victims would not result in an appreciable rate of missed bladder injuries and would aid in mitigating the radiation exposure risk associated with these additional images.Methods:A retrospective cohort study involving blunt trauma pelvic fractures among pediatric trauma patients (age<14) between the years 1997 and 2016 was conducted utilizing the Israeli National Trauma Registry. Statistical analysis was performed using SAS statistical software version 9.4 via the tests of Chisquare test and two-sided Fisher's exact test. A p value of less than 0.05 was considered statistically significant.Results:A total of 1072 children were identified from the registry for inclusion. Mean age of patients was 7.7 years (range 0-14) and 713 (66.5%) were male. Overall mortality in this population was 4.1% (44/1072). Only 2.1% (23) of pediatric patients with pelvic fractures had bladder injury identified, with just 9 children having intraperitoneal bladder rupture (0.8% of all the patients).Conclusion:The vast majority of blunt pediatric trauma victims with pelvic fractures do not have urine bladder injuries. Based on our study results we do not recommend the routine utilization of CT cystography in this unique population.

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