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:The aim of this study is to evaluate the application value of virtual surgical planning in the management of mandibular condylar fractures and to provide a reliable reference.Methods:This was a prospective randomized controlled study and recruited 50 patients requiring surgical treatment for their mandibular condylar fractures. The inclusion criteria were patients (1) diagnosed with a condylar fracture by two clinically experienced doctors and required surgical treatment; (2) have given consent for the surgical treatment; and (3) had no contraindications to the surgery. Patients were excluded from this study if: (1) they were diagnosed with a non-dislocated or only slightly dislocated condylar fracture; (2) the comminuted condylar fracture was too severe to be treated with internal reduction and fixation; or (3) patients could not complete follow-up for 3 months. There were 33 male and 17 female patients with 33 unilateral condylar fractures and 17 bilateral condylar fractures included. The 50 patients were randomly (random number) divided into control group (25 patients with 35 sides of condylar fractures) and experimental group (25 patients with 32 sides of condylar fractures). Virtual surgical planning was used in the experimental group, but only clinical experience was used in the control group. The patients were followed up for 1, 3, 6 and 12 months after operation. Variables including the rate of perfect reduction by radiological analysis, the average distance of deviation between preoperative and postoperative CT measurements using Geomagic software and postoperative clinical examinations (e.g., mouth opening, occlusion) were investigated for outcome measurement. SPSS 19 was adopted for data analysis.Results:The average operation time was 180.60 min in the experimental group and 223.2 min in the control group. One week postoperatively, CT images showed that the anatomic reduction rate was 90.63% (29/32) in the experimental group and 68.57% (24/35) in the control group, revealing significant difference (X2= 4.919, p = 0.027). Geomagic comparative analysis revealed that the average distance of deviation was also much smaller in the experimental group than that in the control group (0.639 mm vs. 0.995 mm; t = 3.824, p < 0.001).Conclusion:These findings suggest that virtual surgical planning can assist surgeons in surgical procedures, reduce operative time, and improve the anatomic reduction rate & accuracy, and thus of value in the diagnosis and treatment of condylar fractures.

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

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：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：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.

简介：AbstractPurpose:The main aim is to provide clinical reference for the application of mini suture anchor in the reduction and fixation of displaced temporomandibular joint (TMJ) disc with intracapsular condylar fracture.Methods:From October 2018 to October 2019, 21 patients (31 sides) with intracapsular condylar fractures and articular disc displacement from West China Hospital of Stomatology, Sichuan University were included. The selection criteria were: (1) mandibular condylar fractures accompanied by displacement of the TMJ disc, confirmed by clinical examination, CT scan and other auxiliary examinations; (2) indication for surgical treatment; (3) no surgical contraindications; (4) no previous history of surgery in the operative area; (5) no facial nerve injury before the surgery; (6) informed consent to participate in the research program and (7) complete data. Patients without surgical treatment were excluded. The employed patients were followed up at 1, 3, 6 and 12 months after operation. Outcomes were assessed by success rate of operation, TMJ function and radiological examination results at 3 months after operation. Data were expressed as number and percent and analyzed using SPSS 19.0.Results:All the surgical procedures were completed successfully and all the articular discs were firmly attached to the condyles. The articular disc sufficiently covered the condylar head after the fixation. The fixation remained stable when the mandible was moved in each direction by the surgeons. No complications occurred. The functions of the TMJ were well-recovered postoperatively in most cases. CT scan revealed that the screws were completely embedded in the bone without loosening or displacement.Conclusion:Mini suture anchor can provide satisfactory stabilization for the reduced articular disc and also promote the recovery of TMJ functions.

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简介：AbstractPurpose:Hemodynamically unstable patients with pelvic fractures still represent a challenge to trauma surgeons and have a very high mortality. This study was designed to explore the effect of the interventions of direct preperitoneal pelvic packing for the hemodynamically unstable pelvic fractures.Methods:This retrospective study enrolled 67 cases of severe pelvic fractures with unstable hemodynamics from October 2011 to December 2019. All patients presented in our emergency center and received preperitoneal pelvic packing were included in this study. The indication was persistent systolic blood pressure ≤90 mmHg during initial resuscitation and after transfusion of two units of red blood cells. Patients with hemodynamic stability who need no preperitoneal pelvic packing to control bleeding were excluded. Their demographic characteristics, clinical features, laboratory results, therapeutic interventions, adverse events, and prognostic outcomes were collected from digital information system of electronic medical records. Statistics were described as mean ± standard deviation or medium and analyzed using pair sample t-test or Mann-Whitney U-test.Results:The patients’ average age was 41.6 years, ranging from 10 to 88 years. Among them, 45 cases were male (67.2%) and 22 cases were female (32.8%). Significant difference was found regarding the systolic blood pressure (mmHg) in the emergency department (78.4 ± 13.9) and after preperitoneal pelvic packing in the surgery intensive care unit (100.1 ± 17.6) (p < 0.05). Simultaneously, the arterial base deficit (mmol/L) were significantly lower in the surgery intensive care unit (median -6, interquartile range -8 to -2) than in the emergency department (median -10, interquartile range -14 to -8) (p < 0.05). After preperitoneal pelvic packing, 15 patients (22.4%) underwent pelvic angiography for persistent hypotension or suspected ongoing haemorrhage. The overall mortality rate was 29.5% (20 of 67).Conclusions:Preperitoneal pelvic packing, as a useful surgical technique, is less invasive and can be very efficient in early intra-pelvic bleed control.

简介：水力的断裂是过去常从水库刺激uid生产的一种强大的技术。充分3-D水力的断裂进程的数字模拟对这种技术的effcient应用程序很重要，但是因为，也是大挑战强壮的非线性的联合在之间粘滞uid和破裂繁殖的ow。由利用一个连贯的地区方法模仿破裂过程，一个有限元素模型基于存在毛孔压力，连贯的有限元素被建立了在无限的有弹性的媒介调查塑造便士的水力的破裂的繁殖。水力的破裂行为上的连贯的材料参数和uid粘性的效果被调查了。在破裂过程被岩石破裂坚韧统治的限制案例的有限元素结果和分析答案之间的优秀同意表明连贯的地区的能力在为这个案例模仿水力的破裂生长的有限元素模型。

简介：Objective:Toretrospectivelyanalyzetheeffectofunilateralexternalfixatorsinthetreatmentoflowerthirdhumeralshaftfractures.Methods:FromOctober1997toOctober2003,33patientsaged15-70years(average31years)withlowerthirdhumeralshaftfracturesweretreatedwithunilateralexternalfixators.Therewere9spiralfractures(typeA1),1obliquefracture(typeA2),3transversesfractures(typeA3)and20comminutedfractures(11typeB1,9typeB2)accordingtoAOclassification.Fifteencasesweretreatedwithopenreductionandlimitedinternalfixationandfixationwithexternalfixators,10casestreatedwithopenreductionandfixationwithexternalfixators,and8casestreatedwithclosedreductionandfixationwithexternalfixators.Nerveexplorationwasundertakenin9caseswithpreoperativeradialnerveinjury.Externalfixatorswereremovedafterbonehealing.Theaveragefollow-upwas18monthswitharangefrom8to24months.Results:Thetimeofbonehealingranged11-22weeks(average14weeks).Thelatestfollow-upshowedthefunctionsof9casesofpreoperativeradialnerveinjuryandof2casespostoperativeradialnerveinjuryandthefunctionofelbowwererecoveredtonormal.Therewereonly7casesofsuperficialinfectionatpinhole,whichwassubsidedbyusingoralantibioticsandpin-holecarewithmilddisinfectants.Conclusions:Fixationwithunilateralexternalfixatorscombinedwithopenreductionandlimitedinternalfixationhasagoodeffectinthetreatmentoflowerthirdhumeralshaftfractures.