Endobutton and cortical screw fixation for the treatment of distal tibiofibular syndesmosis separated / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the treatment effect of Endobutton plate cable system for the treatment of the distal tibiofibular syndesmosis injury.</p><p><b>METHODS</b>Total 38 patients with tibiofibular syndesmosis separation treated by surgical operation from October 2011 to October 2013 were analyzed retrospectively. According to internal fixation, 38 cases were divided into two groups involving group A (cortical screw fixation) and group B (Endobutton plate cable system fixation). In group A, there were 26 patients including 16 males and 10 females with an average age of (37.90±4.67) years old ranging from 19 to 63 years old; 14 cases were on the left and 12 on the right;involving 8 cases of Weber-Denis type B, 18 cases of Weber-Denis type C; according to Lauge-Hanson typing, 9 cases of supination external rotation (SER), 10 cases of pronation abduction (PAB), 7 cases of pronation external rotation (PER). In group B, there were 12 cases including 7 males and 5 females, with an average age of (38.70±6.03) years old ranging from 20 to 55 years old;6 cases were on the left and 6 cases on the right;involving 4 cases of Weber-Denis type B and 8 cases of Weber-Denis; involving 7 cases of PER, 3 cases of SER, 2 cases of PAB. The operative time, intraoperative blood loss, surgery cost, hospital stay time, the wound healing, pain score at 1 month after operation, and the load time were recorded and evaluated. According to reviewing of X rays regulary, the healing of fracture were assessed, the function outcomes of ankle was evaluated according to the Ankle Hind Foot Scale of American Orthopaedic Foot and Ankle Society.</p><p><b>RESULTS</b>All patients were followed up for 8 to 18 months with an average of 13.5 months. There were no statistical significance in intraoperative blood loss, hospital stay time, average load time and postoperative pain score at 1 month after operation between two groups (>0.05). Duration of operation, the operative time were significantly shorter in cortical screw group;however, the average cost of hospitalization was significantly higher in Endobutton group. No significant differences were found between two groups in outcome of radiographic measurement. The X rays of 36 patients showed well healing of fracture, normal mortise and no distal tibiofibular syndesmosis separation. AOFAS score at the final follow up in group A was (87.50±8.67) scores, 18 cases got excellent result, 4 cases were good, and 4 cases were fair. AOFAS score at the final follow up in group B was (86.23±7.42) scores, 7 cases obtained excellent result, 4 cases were good and 1 case was fair; AOFAS score between two groups were no significant difference (>0.05).</p><p><b>CONCLUSIONS</b>Endobutton plate cable system is a dynamic capital equipment in treating the tibiofibular syndesmosis separation, it has a similar outcome compared with the screw, but without screw fractured and do not regular remove after operation. The patients could take the functional exercises earlier.</p>

Comparison of different diameter hollow screw for the treatment of femoral neck fractures / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate and compare the outcome of two kinds of diameter hollow screws for the treatment of femoral neck fractures.</p><p><b>METHODS</b>From June 2008 to June 2013, 117 patients with femoral neck fractures were treated by closed reduction and hollow screws fixation. Among them,48 patients were fixed by 6.5 mm screw including 30 males and 18 females with an average age of (45.61 ± 11.99) years old ranging from 19 to 60 years old, involving 17 cases in Garden I/II and 31 cases in Garden III/IV; 69 patients were fixed by 8.0 mm screw including 40 males and 29 females with an average age of (45.17 ± 9.95) years old ranging from 18 to 60 years old, involving 31 cases in Garden I/II and 38 cases in Garden III/IV. The general information, operative time, hospital stay time, reduction quality, diameter of femoral head and neck, fracture healing time, the rate of fracture healing, postoperative complications were recorded and evaluated. Harris scoring was used to evaluate the hip joint function.</p><p><b>RESULTS</b>All patients were followed up for 19.6 months (18 to 24 months). The difference of operative time, duration of hospitalization, quality of reduction were not statistically significant (P > 0.05). There was no difference between two groups about the average diameter of the femoral head and neck, the fracture healing time, the rate of healing and the postoperative complications (P > 0.05). There were no difference between two groups about Harris scale. There were significant difference between Garden III/IV and I /II (P > 0.05).</p><p><b>CONCLUSION</b>Closed reduction and internal fixation with hollow screw in treating the young adult patients with femoral neck fracture is the first choice, both different diameters hollow screws could meet the requirements of fixation of femoral neck fracture, and not affect on fracture healing time and postoperative complications.</p>

Comparison of three fixation methods for the treatment of tibial fractures in adolescents / 中国骨伤

<p><b>OBJECTIVE</b>To explore the fixation methods in treatment of tibial fracture in adolescents by comparing the results and complications of three fixation methods and to determine the factors related to those complications.</p><p><b>METHODS</b>From January 2007 to January 2012, 83 diaphyseal tibial fractures in 79 adolescents were treated with elastic stable intramedullary nail fixation, plate fixation, or external fixation respectively. There were 55 males and 24 females with an average age of 13.9 years (ranging from 11 to 17.6 years). Outcomes were compared in terms of the hospital stay,time to union, complications, and reoperation rates.</p><p><b>RESULTS</b>All patients were followed up for 15.8 months in average. The time to union was significant associated with the pattern of fixation, energy of the injury, multiple and open fracture. The time of bone union of external fixation group was longer than that of elastic stable intramedullary nail fixation and plate fixation groups. But complication rates of external fixation group were higher than that of elastic stable intramedullary nail fixation and plate fixation groups. Four patients were treated with elastic nail fixation underwent a reoperation (loss of reduction in 2 cases, delayed union and nonunion in each 1 case). Six patients were treated with external fixation required a reoperation (loss of reduction in 3 cases, malunion in 2 cases, and replacement of a pin canal infection in 1 case). Two fractures were treated with plate fixation required refixation following nonunion and malunion. A multivariate analysis with adjustment for baseline differences showed external fixation to be associated with a 7.56 times (95% confidence interval=3.74 to 29.87) greater risk of loss of reduction and (or) malunion than elastic stable intramedullary nail fixation. At the final follow-up,there were agreeable results among three groups and no significant differences among them in final therapeutic effect (P>0.05).</p><p><b>CONCLUSION</b>External fixation for treatment of tibial fracture in adolescents has the highest rate of complications than the other two fixation methods. Elastic stable intramedullary nail fixation can achieve the same effect of other fixed system and avoid most of the complications. Operation method choice depends on the experience of doctors and patients' basic situation and the fracture types.</p>

Spatial distribution and risk factors of tuberculosis in Songjiang district, Shanghai during 2006 and 2009 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To identify spatial distribution and risk factors among tuberculosis (TB) cases in Songjiang district, Shanghai, 2006 - 2009.</p><p><b>METHODS</b>All active TB cases and all bacteriologically confirmed TB cases diagnosed during the period from 2006 to 2009 were recruited into the study. Spatial scan statistics were used to identify spatial clusters. Using logistic regression, we compared the demographic and clinical characteristics of TB cases in spatial clusters versus TB cases not in spatial clusters.</p><p><b>RESULTS</b>A total of 1815 active TB cases and 730 bacteriologically confirmed TB cases were recruited during 2006 - 2009. Chedun township and Xinqiao township was detected to be a spatial cluste (RR = 1.38, LLR = 16.78, P < 0.01), which was the location of the municipal industrial zone. No spatial cluster was found during 2006 - 2007, while during 2008 - 2009 Chedun township was detected to be a spatial cluster (RR = 1.70, LLR = 15.06, P < 0.01). Among resident population, the spatial cluster of TB cases was located in the southwestern part of Songjiang district, which included five townships Xinbang, Shihudang, Xiaokunshan, Maogang and Yongfeng (RR = 1.49, LLR = 10.52, P < 0.01); while among migrant population, the spatial cluster of TB cases was located in Chedun township (RR = 1.55, LLR = 15.64, P < 0.01). There were higher proportions of resident TB cases who were farmers (AOR = 4.9, 95%CI: 1.9 - 12.3) or had other occupations (AOR = 2.6, 95%CI: 1.1 - 5.9) in the spatial cluster. There were higher proportions of migrant TB cases who lived here for less than 5 years (< 1 year: AOR = 5.9, 95%CI: 1.8 - 19.5; 1 - 5 years: AOR = 3.2, 95%CI: 1.0 - 9.9) or worked at other occupations (AOR = 2.8, 95%CI: 1.5 - 5.1) and lower proportions of migrant TB cases who came from Eastern region (AOR = 0.3, 95%CI: 0.1 - 0.8) or Middle region (AOR = 0.5, 95%CI: 0.3 - 0.9) in the spatial cluster.</p><p><b>CONCLUSION</b>In Songjiang district there was a spatial cluster in TB cases, which was Chedun township. Local residents with TB who were farmers or had other occupations were more likely to be in the spatial cluster. Migrants with TB who lived here for less than 5 years or came from Western region were more likely to be in the spatial cluster.</p>

Biomechanical comparison of Evans procedure and Chrisman-Snook technique for the treatment of II degree lateral collateral ligament of ankle joint / 中国骨伤

<p><b>OBJECTIVE</b>To measure the stability of Evans procedure and Chrisman-Snook technique in the treatment of II degree lateral collateral ligament of ankle joint, and provide basis for treatment and prognosis.</p><p><b>METHODS</b>From July 2008 to June 2009,18 frozen corpes were collected, including 10 males and 8 females, with an average age of fresh 39.3 +/- 11.2 years. The frozen corpes were randomly divided into three group, including normal controls(group A), Evans procedure (group B) and Chrisman-Snook technique ( group C), 6 specimens in each group. Anterior talofibular ligament and calcaneofibular ligament were cut off to cause II degree lateral collateral ligament in group B and C. Evans procedure or Chrisman-Snook technique were applied to restore lateral collateral ligament, and measure biomechnics. The displacement of tibiotalar joint and subtalar joint were observed.</p><p><b>RESULTS</b>(1) The lateral stress results of tibiotalar joint showed the displacement by Evans procedure (group B) was greater than other groups (P < 0.0001). There were no significant differences between group A and C (P > 0.05). (2) The lateral stress results of subtalar joint showed the displacement by Evans procedure (group B) was greater than other groups (P< 0.0001). There were no significant differences between group A and C (P > 0.05).</p><p><b>CONCLUSION</b>Ankle instability is caused by ankle joint lateral collateral ligament injury. Chrisman-Snook technique is better than Evans procedure in stability on the early stage of ankle joint restoration, and conform to principle of biomechanics.</p>

Comparison of two minimally invasive internal fixed methods for the treatment of distal tibio-fibula fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the outcome of two minimally invasive internal fixed methods for the treatment of distal tibio-fibula fractures.</p><p><b>METHODS</b>The clinical data of 50 patients with distal tibio-fibula fractures from March 2006 to March 2009 was analyzed retrospectively. Twenty-eight patients were treated with minimally invasive percutaneous locking compression plate fixing tibia combining elastic stable intramedullary nailing fixing fibular (Group P + E). There were 18 male and 10 female patients with a mean age of (45 ± 6) years. Twenty-two patients were treated with interlocking intramedullary nail fixing tibia combining elastic stable intramedullary nailing fixing fibular (Group N + E). There were 12 male and 10 female patients with a mean age of (43 ± 9) years. The index of peri-operation, pain score at 3 d postoperative, bone union time, the clinical outcomes and complications postoperative were statistically compared.</p><p><b>RESULTS</b>There were no statistical significance on operation time, blood loss perioperative and pain score at 3 d postoperative. Bone union time in Group N + E was significantly longer than in Group P + E [(21.1 ± 3.0) weeks vs. (15.4 ± 2.9) weeks]. Meanwhile, the function of ankle score (44.3 ± 1.7 vs. 41.8 ± 2.5) and the line of foot score (8.6 ± 2.3 vs. 6.8 ± 3.6) in Group P + E were respectively significantly higher than that in Group N + E. However, there were no statistical difference on ankle pain, buckling add stretch restricted, turn inward add evaginate restricted and the rate of good and fair between the two groups. There were 3 cases of complications postoperation in Group P + E, significantly less than the 8 cases of Group N + E.</p><p><b>CONCLUSIONS</b>Minimally invasive percutaneous locking compression plate fixing tibia combining elastic stable intramedullary nailing fixing fibular shows superiority in treatment of distal tibio-fibula fractures. However, interlocking intramedullary nail fixing tibia combining elastic stable intramedullary nailing fixing fibular has the advantages in worse soft tissue and multi-step tibio-fibula fractures.</p>

Comparison of the biomechanical stability of cannulated screw and reconstruction plate for the fixation of symphysis pubis diastasis / 医用生物力学

Objective To test the biomechanical properties of symphysis pubis diastasis fixed by cannulated screw or reconstruction plate and provide the theoretical basis for clinical practice. Method In the experiment, fifteen normal adult specimens’ pelvis along with their intact spines from L5 to the proximal 2/3 of both femora were randomly divided into three groups. The symphysis pubis, unilateral anterior sacroiliac joint and ipsilateral sacropinous and sacrotuberous ligaments were cut; the intact major pelvic ligaments and hip joints were used to simulate Tile B1 pelvic fracture model. The fixation of five hole reconstruction plate and 6.5 mm cannulated screw were applied successively to cure symphysis pubis diastasis.The pelves were loaded vertically in the testing machine with a standing posture. The loads were applied through the L5 body to a maximum of approximately 400 N, while the displacements of the symphysis pubis were recorded. Results The study showed that two fixations were able to reduce symphysis pubis gapping and restore the biomechanical stability of pelves. Under the same condition，the displacement of symphysis pubis used 3.5 mm five hole reconstruction plate with 4 cortical screws, and the displacement by using cannulated screw were (0.944±0.983)mm and (-0.03±0.378)mm respectively. There were significant differences (P<0.05) between them. Conclusions The cannulated screw is superior to 3.5 mm five hole screw in biomechanical stability. The cannulated screw has fine biomechanical properties and is able to provide the firm fixation for symphysis pubis diastasis, which fits the principles of biological osteosynthesis.

Significance of nerve growth factor low affinity receptor p75 in the formation of traumatic neuroma / 中华显微外科杂志

Objective To observe the expression and distribution the low affinity receptor p75 of nerve growth factor in the traumatic neuroma and investigate its significance and relationship with the growth of peripheral nerve and the formation of the traumatic neuroma.Methods Fifty-one cases of traumatic neuro- ma were collected and were divided into four groups according to its course,i.e,groupⅠ(less than one month),groupⅡ(1～3 months),groupⅢ(3～6 months) and groupⅣ(more than six months).Fifteen cases of normal nerve samples were harvested as the control group(n=15).Immunohistochemical studies were performed to observe the expression of p75.the expression level was detected by the computer graph analysis system.Results There was no significant expression of p75 in the normal nerve while in the four studied groups,significant expression of p75 waspositively observed.The level of p75 was weak in the early time and achieved its peak in three months,but the high level state was maintained even after six months.The one-way ANOVA statistic analysis manifests that there were no significant differences of the expression of p75 among the groupⅡ,ⅢandⅣ(P＞0.05),but the differences among the groupⅠand the latter three groups were signifi- cant (P＜0.05).p75 was mainly distributed in the Schwans cell.Conclusion p75 is expressed in the traumatic neuroma and may play an important role in the modulation progress of the formation of traumatic neu- roma with an unknown mechanism.