Abstract:Objective To study the temporal pattern of deep venous thrombosis of the lower limb in patients with perioperative hip fractures,and to provide the basis for the prevention of clinical thrombosis.Methods From June 2013 to June 2016,398 cases of femoral fractures (178 cases of femoral neck fractures and 220 cases of intertrochanteric frac tures) were divided into anticoagulant group and non-anticoagulation group according to the different anticoagulation time.The patients with hip fractures treated by traumatic orthopedic surgery in Chengde Medical College Hospital All patients were treated with lower extremity venous Doppler ultrasonography on the 1st,3rd,5th day after injury,more than 5 days after injury and on the 2nd,5th,7th and 14th day after operation.The time of thrombosis and the different groups Number of thrombosis cases.The number of new cases of thrombosis and the incidence rate were analyzed statistically at different time points.The frequency distribution curve was used to analyze the peak time of perioperative thrombosis.Results 398 cases were taken in the study.The LMWH prophylaxis thrombosis before operation group were 226 cases,24 cases were diagnosed as deep vein thrombosis(DVT),and the incidence was 10.61％.The non-LMWH prophylaxis thrombosis before operation group had 172 cases,and 37 cases were diagnosed deep vein thrombosis (DVT),and the incidence was 21.5 ％.The difference between two group was significant.The numbers of the LMWH prophylaxis thrombosis before operation group of the DVT at the first day after trauma,the third day,the fifth day and more than the fifth day after trauma.,the second day,the fifth day,the seventh day,the fourteenth day post-operative were 2(0.88％)、6(2.65％)、3(1.33％)、2(0.88％)、9(3.98％)、2(0.88％)、0(0％)、0(0％) respectively.The numbers of the non-LMWH prophylaxis thrombosis before operation group of the DVT at the first day after trauma,the third day,the fifth day and more than the fifth day after trauma,the second day,the fifth day,the seventh day,the fourteenth day post-operative were were3(1.74％)、9(5.23％)、3(1.74％)、4(2.33％)、11(6.40％)、4(2.33％)、1(0.58％)、2(1.16％)respectively,the incidence of DVT at the first three day after injury and the first day after operation were hightest.Conclusion In hip fractures patients,thrombosis occurred within 3 days after injury and one day after surgery.Timely application of drug prevention can reduce the perioperative fractures of patients with perioperative lower extremity venous thrombosis rate.

Abstract:Objective To explore the feasibility and clinical value of three-dimension(3D)printing technology in the treatment of complex tibial plateau fracture. Methods Spiral CT scan was performed in patients with complex tibial plateau fracture. DICOM data were imported into Mimics software. The 3D printing technology was used to print the fracture models. The reclassilifcation was performed on the basis of three-dimensional measurements. According to 3D printing models,we de-cided the surgical approach and position,the reducted of fractures and choose the internal fixation. Results Reconstructed 3D printing models of complex tibial plateau fracture could show the characteristics of fracture accurately,help doctors to reclassify the fracture from the three-column,and decide preoperative plan in the tibial plateau fracture. Conclusion The 3D printing technology is helpful for the treatment of complex tibial plateau fracture,which should be a conventional step in the manage-ment of complex tibial plateau fracture.

Abstract:Objective Tocompareclinicalefficacybetweenpercutaneousreductionhollowscrewinternalfixationand openreductionplateinternalfixationinthetreatmentofSandersⅡ、Ⅲtypecalcanealfracture.Methods 6casesoffreshand unilateral SandersⅡ、Ⅲ type calcaneal fractures from October 2011 to September 2012 were divided into group A and group B. Both group has 28 cases. The cases of group A were treated with percutaneous reduction and hollow screw internal fixation, and the cases of group B were treated with open reduction and plate internal fixation. We compared the two groups of patients with correlated observation index:operation time,intraoperative blood loss,incision healing time,hospitalization time after oper-ation,the imaging parameters before and after operation,the postoperative complications and the functional recovery of foot, whichwasevaluatedbyMarylandscore.Thenthedataofobservedindexeswerestatisticallyanalyzed.Results 56patients had been followed up for 12 months,significant difference could be found between operation time,peri-operative bleeding, wound healing time and hospitalization time;postoperative Bolher angle. Gissane angle and the excellent rate of functional re-covery between the two groups had no significant difference(P﹥0. 05),two groups of postoperative radiographic parameters had obviously improved than that before operation(P﹤0. 05);the group A was slightly higher than the group B in Maryland score and the excellent rate of functional recovery,but the difference was not statistically significant(P﹥0. 05). There were significantdifferencesbetweenthetwogroupsinthecomplicationincidence(P﹤0.05).Conclusion Minimallyinvasiveper-cutaneous reduction and hollow screw internal fixation for the treatment of SandersⅡ、Ⅲ type calcaneal fracture also can ob-tain good reduction and reliable fixation,and can not only lower intraoperative bleeding and postoperative complications,but can also shorten operation time,wound healing time and hospitalization time. So it is a reliable,effective and practical operation technology in the treatment of calcaneal fracture.

Abstract:Objective To investigate the risk factors for recurrence after intervertebral foramen surgery in patients with lumbar disc herniation (LDH).Methods The clinical data of 130 patients with LDH who underwent transforaminal surgery received from hospital from January 2016 to February 2017 were retrospectively analyzed.According to whether there was recurrence within 1 year after surgery, they were divided into recurrent group (13 cases) and non-recurred group (117 cases).The identify factors associated with recurrence after intervertebral foramen surgery in patients with LDHwere determined by single factor and multivariate logistic linear regression analysis.Results There were no differences in the rates of gender, body mass index (BMI), hypertension, diabetes, hyperlipidemia, LDH type, prominent position, surgical procedure, operation time between the recurrent group and the non-recurred group (P＞0.05), while the rates of age≥60 years, duration≥4 years, mild or moderate degeneration of lumbar disc, L4～5 of surgical segment, postoperative intervertebral activity ≥10°, intraoperative annulus fibrosus damage, incompletednucleus pulposus removalof the recurrent group were significantly higher than those of on-recurred group (P＜0.05), which were the independent risk factors for recurrence after vertebral perforating surgery in patients with LDH (OR=6.352, 5.201, 3.317, 7.894, 3.006, 1.389, 2.476, P=0.000, 0.000, 0.001, 0.000, 0.005, 0.036, 0.000).Conclusion There are many risk factors for recurrence after intervertebral foramen surgery in patients with LDH, suggesting that patients with high risk factors should be highly regarded in clinical practice, and targeted preventive measures should be given to reduce the recurrence rate.

Abstract:Objective To compare the clinical effect of minimally invasive percutaneous pedicle screws osteosynthesis (MIPPSO)with traditional open pedicle screws osteosynthesis( TOPSO)in the treatment of thoracolumber vertebra fracture. Methods 86 consecutive inpatients with severe thoracolumbar vertebra fractures from JAN 2008 to DEC 2012 were divded randomly into two groups,MIPPSO group and TOPSO group respectively. The image result,operative time,intraoperative blood loss,and clinical outcomes were compared between the two groups. Results All of the patients had been completely followedup for 6 to 48 month(s average 18. 6 months). There were no significant difference in the recovery rate of vertebral height and sagittal cobb angle between MIPPSO group and TOPSO group(P ﹥0. 05). The rate of vertebral height and sagittal cobb angle were both significantly differen(t P ﹤0. 05)before and after operation. There was no significant difference in operative time between the two groups(P ﹥0. 05). Intraoperative blood loss was significantly different between MIPPSO group(54. 4 ± 12. 6) mL and TOPSO group(289. 1 ±20. 5)mL(P ﹤0. 05). There were no surgery-related complications in the two groups,except a case of wound infection found in TOPSO group. Conclusion The self-made auxiliary system for minimally invasive percutaneous pedicle screws osteosynthesis is very useful,it not only can achieve the same clinical effect with open surgery,but aslo has the advantages of less trauma and bleeding.

Abstract:Objective To analyze the influencing factors of femoral head necrosis after closed reduction and internal with cannulated compression screws of femoral neck fracture.Methods A total of 118 patients with femoral neck fractures underwent closed reduction and cannulated compression screws were selected according to the inclusion criteria.Statistical analysis was performed on 9 factors including age, gender, ethnicity, fracture Garden classification, timing of surgery, Garden's alignment index, triglyceride, total cholesterol and low density lipoprotein, and analyzed the relationship between femoral head necrosis and closed reduction and internal withcannulatedcompression screws of femoral neck fracture.Results According to the t-test or chi-square test of 9 factors, there was no statistical significance of femoral head necrosis after femoral neck fracture internal fixation with ethnicity and total cholesterol.Age, gender, fracture Garden classification, timing of surgery, Garden's alignment index, triglyceride, lowdensity lipoprotein were statistically significant.According to binary logisticanalysis, gender, triglyceride was not statistically significant, but age, Garden classification, timing of surgery, Garden's alignment index, low density lipoprotein has statistical significance.Conclusion For femoral neck fractures, age, fracture Garden classification, timing of surgery, Garden'salignment index, and lowdensity lipoprotein are risk factors for femoral head necrosis after closed reduction and internal withcannulatedcompression screws of femoral neck fracture.