Objective To investigate the possible mechanism and fracture stability of subtypes of type B Hangman’s fracture by using imaging observation. Methods Patients with type B Hangman’s fractures admitted to multiple centers between January 2008 and October 2023 were selected as the research objects. The clinical data and imaging data of patients who met the selection criteria were extracted. The patients’ age, gender, cause of fracture, disease duration, visual analogue scale (VAS) score of neck pain, neck disability index (NDI), and American Spinal Injury Association (ASIA) classification of spinal cord function were collected. Based on the imaging data, the anatomical structure of the contralateral superior articular process fracture, the relationship between the superior articular process fracture line and the position of the odontoid process, the associated posterior vertebral wall fracture and its classification, the incidence of vertebral arch floating and C2, 3 instability were observed. The superior articular fracture angle (SAFA), superior articular fracture displacement distance (SAFD), and C2 vertebral body rotation (VBRA) were measured. According to the anatomical structure of the contralateral superior articular process fracture, the patients were divided into a pedicle fracture group (POA group), a inferior articular process fracture group (IAP group), and a laminar fracture group (CSL group). The baseline data and imaging indexes were analyzed between groups, and the imaging anatomical characteristics of each subtype of fracture were observed to explore its possible mechanism and fracture stability.Results A total of 86 cases of type B Hangman’s fractures were collected. There were 67 males and 19 females. The mean age was 51.0 years (range, 21-78 years). There were 48 cases of pedicle fracture (POA group), 25 cases of inferior articular process fracture (IAP group), and 13 cases of laminar fracture (CSL group). There was no significant difference in age, gender, cause of fracture, disease duration, VAS score of neck pain, and NDI between groups (P>0.05). However, the incidence of spinal cord injury in POA group was the highest (P<0.05). The incidences of superior articular process fracture line posterior to the odontoid process and posterior vertebral wall fracture in POA group were the highest (P<0.05). The incidences of vertebral arch floating and C2, 3 instability in IAP group were the highest (P<0.05). There were significant differences in SAFA and VBRA between groups (P<0.05). There was no significant difference in SAFD between groups (P>0.05). The differences in the incidences of fracture displacement>3 mm and VBRA>5° between groups were significant (P<0.05). There were 78 cases of unstable Hangman’s fracture, including 2 cases of simple C2、3 instability, 22 cases of simple axis rotation and displacement instability, 8 cases of simple vertebral arch floating instability, and the rest of the patients had two or more types of instability. Conclusion The mechanism of different subtypes of type B Hangman’s fracture may be that the lateral mass of the rotation of the atlas applied the overextension compression force to the unilateral superior articular process of the axis vertebra, and the contralateral pedicle, inferior articular process and lamina fractures were caused by direct violence or/and rotational violence to different degrees. The decomposition of this type of fracture into C2, 3 intervertebral, axis vertebra body displacement and rotation and vertebral arch floating instability is beneficial to the treatment and surgical approach selection.
Objective To observe the clinical outcomes of Hangman fracture treated by anterior cervical discectomy and fusion. Methods A total of 41 patients with Hangman fracture were retrospectively analyzed, who underwent anterior cervical discectomy and fusion from May 2010 to May 2016. Intervertebral bone graft fusion was observed through postoperative radiographic images, and improvement of symptoms was evaluated by Visual Analogue Scale (VAS), Neck Disability Index (NDI) and Modified Japanese Orthopaedic Association Scale (m-JOA). Surgical complications were evaluated as well. Results No severe complications occurred after surgery, but 5 patients had a transient dysphagia, which relieved spontaneously. Thirty-five patients had a fusion of intervertebral bone graft 3 months after surgery, and the remaining 6 patients did at the last follow-up. The VAS score was improved from 4.5±1.6 pre-operatively to 2.4±1.7 immediately post-operatively (P>0.05), and was further improved to 0.7±0.9 at the last follow-up (P<0.05). The NDI score was improved from 29.3±10.9 pre-operatively to 13.2±5.4 immediately post-operatively (P<0.05), and was further improved to 4.6±3.1 at the last follow-up (P<0.05). The m-JOA score was improved from 8.4±2.3 pre-operatively to 11.6±3.5 immediately post-operatively (P<0.05), and was further improved to 14.3±2.0 at the last follow-up (P<0.05). Conclusion Anterior cervical discectomy and fusion can be used in Hangman fracture, which is safe and reliable.
ObjectiveTo review the research progress of the diagnosis and treatment of Hangman fracture. MethodsThe original articles about the diagnosis and treatment of Hangman fracture were extensively reviewed and analyzed. ResultsNot only X-ray, but also MRI and CT scans are necessory for the diagnosis and assessment of Hangman fractures. The treatment of unstable Hangman fracture included posterior C2, C3 fixation, anterior C2, C3 fixation, and anterior C2, C3 fixation combined with posterior C2 pedicle screw fixation. The anterior surgical fixation is used by the anterior retropharyngeal approach or subaxial anterior approach, and it has the advantages of directly resecting the injured C2, C3 discs, getting a satisfactory cervical spine alignment, and avoiding the postoperative axial pain. However, posterior surgical fixation using C2 pedicle screw has the risks of neurovascular injuries. ConclusionThe surgical technique of Hangman fracture should be determined based on the patient's injury and surgeon's experience. Randomized control trials of different surgical techniques should be performed.
ObjectiveTo explore the effectiveness of anterior cervical plate internal fixation in the treatment of unstable Hangman fracture. MethodsBetween May 2006 and May 2010, 42 patients with unstable Hangman fracture were treated by anterior cervical plate internal fixation. There were 30 males and 12 females with an average age of 36.5 years (range, 22-64 years). According to the Levine-Edwards classification, 25 cases were rated as type Ⅱ, 15 cases as type Ⅱ A, and 2 cases as type Ⅲ. Eight patients had spinal cord injury. The average interval between injury and operation was 5 days (range, 3-14 days). The X-ray, CT, and MRI were done pre-and post-operatively to evaluate the cervical physiological curvature, the intervertebral disc height of C2,3, the fracture-healing, and bone fusion. The effectiveness was evaluated using visual analogue scale (VAS) for occipito-cervical pain, Neck Disability Index (NDI) for cervical spine function, and the Japanese Orthopaedic Association (JOA) score for neurological functional recovery. ResultsAll incisions healed by first intention. No neurological deterioration or internal fixation failure was observed. All of the patients were followed up 2-5 years (mean, 3.5 years). The complications were dysdipsia in 3 cases and dysphagia in 4 cases, which alleviated spontaneously after 1 week. All the patients were almost free from occipito-cervical pain and the limited cervical spine motion. Neurological function was improved in 8 cases of spinal cord injury, and complete decompression was observed in 6 cases who had spinal cord compression. The bone fusion was observed at 6.5 months on average (range, 6-8 months); the mean fracture-healing time was 10.5 months (range, 9-12 months). The VAS, NDI, and JOA scores were significantly improved at 3 months after operation and last follow-up when compared with preoperative scores (P<0.05), significant improvement scores were achieved at last follow-up when compared with the scores at 3 months (P<0.05). The intervertebral disc height of C2,3, the reconstructed curvature and stability of the cervical spine, and the spine movement were good. ConclusionThe method of anterior cervical plate internal fixation can achieve satisfactory reduction and fusion, less complications, negligible impact on the cervical movement. So it is an ideal method to treat unstable Hangman fracture.
Objective To summarize the clinical experiences of various types of the second dorsal metacarpal artery (SDMA) flap for hand reconstruction. Methods From 1988 to 2003, 139 SDMA flaps were transferred for hand injuries. The flaps were used in 5 types according to vascularization and technique in transplantation:orthograde pedicled island SDMA flaps in 37 cases (cutaneous in 24and teno-cutaneous in 13), retrograde pedicled island SDMA flaps in 25 cases(cutaneous in 19 and teno-cutaneous in 6),double pivot SDMA flaps in 36 cases(cutaneous in 28 and teno-cutaneous in 8), distal perforator branch pedicledflaps in 19cases (cutaneous in 16 and composite in 3), free SDMA flaps in 22 cases (cutaneous in 15 and composite in 7). The skin islands were 3.0 cm×1.5 cm to 6.3 cm×5.0 cm in size. Results Of the 139 flaps, 135 flaps survived completely, 3 survived partially, and1 failed in the operation because of intractable vascular spasm. Follow-up wasdone in 116 cases for 12 to 57 months. The flap had good texture and color match. The twopoint discrimination was 5 to 9 mm in 78 sensate flaps, while it was 10 to 15 mm in 38 nonsensate flaps. In 21 tenocutaneous flaps, the TAM score of range of motion was 60% to 70% of the healthy side. Conclusion The SDMA flap has a constant and reliable vessel and a thin, pliable, and good-quality skin. It is versatile in creatingcomposite flaps. It is a good flap resource for hand and finger reconstruction.
Objective To understand the effect of World Health Organization(WHO) multimodal hand hygiene improvement strategy on hand hygiene compliance among acupuncturists. Methods All the acupuncturists in departments (Department of Acupuncture, Department of Encephalopathy, Department of Orthopedics and Traumatology) with acupuncture programs in Xi’an Hospital of TCM were chosen in this study between September 2015 and August 2016. Based on the WHO multimodal hand hygiene improvement strategy, comprehensive measures were regulated among acupuncturists. Hand hygiene compliance and accuracy, and hand hygiene knowledge score were compared before and after the strategy intervention. Then, the effects of key strategies were evaluated. Results Overall hand hygiene compliance rate, accuracy and knowledge scores increased from 51.07%, 19.86% and 81.90±2.86 before intervention to 72.34%, 51.70%, and 98.62±2.92 after intervention (P<0.05). Hand hygiene compliance rates also increased in various occasions such as before contacting the patient, after contacting the patient, before acupuncture treatment, and before acupuncture needle manipulation (P<0.05). Conclusion Hand hygiene compliance in acupuncturists can be significantly improved by the implementation of WHO multimodal hand hygiene improvement strategy.
Objective To assess the effectiveness and safety of hand-suture vs. stapling anastomosis in esophagogastrostomy. Methods The following databases such as CBM (1978 to February 2012), VIP (1989 to February 2012), CNKI (1994 to February 2012), WanFang Data (1980 to February 2012), The Cochrane Library, PubMed (1966 to February 2012), EMbase (1974 to February 2012), and relevant webs of clinical trials were searched to collect the randomized controlled trials (RCTs) and quasi-RCTs about hand-suture vs. stapling anastomosis in the incidence of anastomotic leakage following esophagogastrostomy. Moreover, relevant references and grey literature were retrieved on web engines including Google Scholar and Medical Martix, and the Chinese periodicals e.g. Chinese Journal of Oncology were also handsearched. According to the inclusion and exclusion criteria, the literature, was screened, the data were extracted, and the quality of the included studies was assessed. Then meta-analysis was conducted using RevMan 5.0 software. Results A total of 9 RCTs involving 2 202 patients were included. The result of meta-analysis was as follows: the incidence of anastomotic leakage in the stapling anastomosis group was lower than that in the hand-suture anastomosis group (OR=0.43, 95%CI 0.26 to 0.71, Plt;0.01). Conclusion Stapling anastomosis is superior to hand-suture anastomosis in reducing the incidence of anastomotic leakage following esophagogastrostomy. For the limited quality and quantity of the included studies, this conclusion has to be further proved by more high-quality studies.
ObjectiveTo investigate the problems in the use of quick-drying hand disinfectants and formulate intervention measures to improve the hand hygiene compliance of nursing staff.MethodsFrom February 2014 to June 2016, the hand hygiene compliance of nursing staff was continuously observed according to the hand hygiene observation table recommended by the World Health Organization. The questionnaire on the use of quick-drying hand disinfectants, which passed the reliability and validity test, was used to find out the reasons leading to the low compliance rate of hand hygiene among nurses, and pertinent interventions were formulated. From November 2016 to December 2017, intervention measures were gradually implemented throughout the hospital, and the hand hygiene compliance of nursing staff was continuously observed again. Then we compared the compliance rate of hand hygiene and the compliance rate of hygienic hand disinfection among nurses in the second quarter of 2016 (before intervention) with those in the last quarter of 2017 (after intervention).ResultsThe compliance rates of hand hygiene and hygienic hand disinfection among nurses before intervention were 62.15% and 49.77%, respectively, and those after intervention were 91.64% and 90.80%, respectively. The differences were statistically significant (P<0.05).ConclusionThe factors affecting the hand hygiene compliance of nursing staff are identified through questionnaires and targeted intervention measures have effectively improved the hand hygiene compliance rate of nursing staff.
Objective To discuss the safety and feasibil ity of treating complex renal aneurysm with ex vivo aneurysmectomy and renal revascularization and renal autotransplantation after hand-assisted retroperitoneoscopic nephrectomy. Methods In October 2006, one male patient with complex renal aneurysm was treated. The preoperative color Doppler ultrasonograph, CT and DSA showed that there was an aneurysm (3.4 cm × 4.3 cm × 4.5 cm) located in the main renalartery bifurcation and its five branches of the left kidney. The patient had a history of hypertension with no response to treatment. After successful hand-assisted retroperitoneoscopic nephrectomy, the kidney off-body was perfused by the renal irrigating solution immediately to protect the kidney. Then ex vivo aneurysmectomy and renal artery revascularization were performed, the renal artery was reconstructed with an autologous right internal il iac artery. The reconstructed left kidney was re-implanted into the right il iac fossa. Results The operation was successful and the patient recovered without perioperative complications. The postoperative renal function was normal and the color Doppler ultrasonograph showed that the blood circulation in the transferred renal artery of the right il iac fossa and its branches was smooth, the blood circulation of the renal venous was smooth and no stenosis in the ureter 2 weeks after operation. Thirteen months follow-up showed the blood pressure was recovered to normal and the renal function was normal. Conclusion The method of ex vivo aneurysmectomy and autotransplantation is safe, feasible and minimally invasive for treating complex hilar renal artery aneurysms.
ObjectiveTo investigate the effectiveness of free sensate intercostal artery perforator flap for the hand soft tissue reconstruction.MethodsBetween March 2010 and September 2015, 19 cases of hand soft tissue defect were repaired with free sensate intercostal artery perforator flap, including 16 males and 3 females, aged from 18 to 53 years, with an average of 35.2 years. The defect was located in the dorsum of the hand in 15 cases and in the palm in 4 cases. The causes of injury were traffic accident injury in 8 cases, hot crush injury in 5 cases, strangulation injury in 4 cases, and avulsion injury in 2 cases. All of them were full-thickness skin and soft tissue defects of hand with exposure of phalanges, tendons, blood vessels, and nerves. The size of defect was 10.0 cm×7.0 cm to 17.0 cm×8.0 cm. There were 12 cases of emergency operation and 7 cases of selective operation. The thickness of flap was 10-25 mm, and the size of the flap ranged from 10.0 cm×7.5 cm to 17.0 cm×8.0 cm. The vascular pedicle of the flap was anastomosed with the snuff nest branch of the radial artery (12 cases), the main radial artery (7 cases), and there accompanying vein, and the intercostal nerve cutaneous branch of the flap was anastomosed with the lateral cutaneous nerve of the forearm. The donor site was closed directly (14 cases) or repaired with medium thickness skin graft (5 cases).ResultsAll of the flaps and skin grafts survived; the wounds in the donor and recipient sites healed by first intention. All 19 patients were followed up 10- 18 months, with an average of 12.7 months. After operation, the appearance and function of the hand recovered well, and there was no flap bloated. The two-point discrimination of the flap was 7-11 mm, with an average of 8.8 mm. Only linear scars left in the patients with direct closure of the donor site. The sensory function of the donor site was not significantly affected, and the hand function recovered satisfactorily. Conclusion Free sensate intercostal artery perforator flap is a valuable and reliable technique for the hand soft tissue defect.