Novel sternoclavicular hook-plate for treatment of proximal clavicle fracture with dislocation of sternoclavicular joint / 中国骨伤

OBJECTIVE@#To explore the efficacy of a novel sternoclavicular hook-plate for treatment of proximal clavicle fracture with dislocation of sternoclavicular joint.@*METHODS@#Retrospective analysis of 13 cases of proximal clavicle fracture with dislocation of sternoclavicular joint treated with sternoclavicular hook-plate from June 2011 to January 2019 in our department. There were 9 males and 4 females, aged 26 to 78 years old, with an average age of (54.08±13.91) years old. All the patients had closed injuries without damage of blood vessels and nerves. The patient's operation time, intraoperative blood loss, hospital stay time, and postoperative complications were recorded. Fracture healing and reduction were evaluated according to X-ray and CT after operation. Constant-Murley score and Rockwood sternoclavicular joint score were used to evaluate limb function at 12 months after operation.@*RESULTS@#All the patients were treated with sternoclavicular hook-plate. The operation time ranged from 50 to 76 min, with a mean of (54.08±13.91) min. The intraoperative blood loss ranged from 20 to 56 ml, with a mean of (46.08±11.15) ml. The hospital stay time ranged from 6 to 14 d, with a mean of (8.31±2.32) d. X-ray and CT examination on the second day after operation showed that all fractures and dislocations were anatomically reduced, and shoulder joint function exercise was performed early. All patients were followed up, and the duration ranged from 12 to 24 months, with a mean of (16.77±4.63) months. The healing time ranged from 9 to 13 d, with a mean of (11.00±1.75) d;and the bone healing time ranged from 3 to 4 months, with a mean of (3.65±0.46) months. There were no complications such as infection, internal fixation failure and nerve injury. At 12 months follow-up, the constant Murley score ranged from 78 to 100, with a mean of 87.83± 11.26; and Rockwood score ranged from 9 to 15, with a mean of 13.70±1.85. Among them, 11 cases were excellent, 1 case was good, and 1 case was general.@*CONCLUSION@#The use of the novel sternoclavicular hook-plate for treatment of proximal clavicle fracture with dislocation of sternoclavicular joint is an effectively internal fixation with high safety, allowing early functional exercise for patients.

Case-control study on reduction for external and posterior malleolar fractures combined with compressive articular surface through tibiafibular fractures region / 中国骨伤

<p><b>OBJECTIVE</b>To compare clinical outcomes of external and posterior malleolar fractures associated with compressive articular surface through posteriorlateral incision and posteriormedial incision.</p><p><b>METHODS</b>From January 2012 to January 2015, 52 patients with external and posterior malleolar fractures associated with compressive articular surface were treated by interfix. Among them, 24 patients were treated through posteriourlateral incision, including 16 males and 8 females, aged from 20 to 65 years old with an average of(35.2±6.4);28 patients were treated through posteromedi and posterior lateral incision, including 18 males and 10 females, aged from 22 to 62 years old with an average of(36.4±4.8). Operation time, blood loss, length of incision, times of X-ray exposure and complications between two groups were recorded and compared, AOFAS scores were applied for evaluate clinical outcomes.</p><p><b>RESULTS</b>All patients were followed up, group A were followed up from 13 to 55 months with an average of (27.5±2.5) months;group B were followed up from 12 to 54 months with an average of (28.5±2.4) months. All fractures were obtained good reduction, and the healing time ranged from 10 to 16 weeks with an average of 12 weeks. Two patients in group B occurred incision infection, and 1 patient occurred screw loosening; while no incision infection occurred in group A, and 1 patient occurred screw loosening. There were statistical significance in operation time, blood loss, times of X-ray exposure and complications between two group;while no significant difference in ankle AOFAS score between two groups.</p><p><b>CONCLUSIONS</b>Compared with reduction through achilles tendon, reduction for external and posterior malleolar fractures combined with compressive articular surface through tibiafibular fractures region has advantages of less blood loss, shorter operation time, less times of X-ray exposure, good recovery of ankle joint function, especially in treating external and posterior malleolar combined with compressive articular surface which could not obtained good reduction through normal pathway.</p>

Comparison of therapeutic effects of three repair methods for rotator cuff tears under arthroscopy / 中国骨伤

<p><b>OBJECTIVE</b>To retrospectively study curative effects of three repair methods for rotator cuff tears under arthroscopy, and to explore relationships between different repair methods and cuff lesions.</p><p><b>METHODS</b>From January 2009 to Jaunary 2014, a total of 353 patients with rotator cuff tears treated with surgical repair under arthroscopy were included in this study. All the patients were divided into three groups according to time of visitiny hospital and it was divided into three periods. The patients on the first period were treated with single row rivet fixation(115 cases), including 51 males and 64 females, with an average age of (57.46±9.08) years old. The patients on the second period were treated with double row rivet fixation(163 cases), including 76 males and 87 females, with an average age of (56.93±9.92) years old. The patients in the third period were treated with suture bridge fixation(75 cases), including 32 males and 43 females, with an average age of (55.90±9.15) years old. There were 29 patients with huge rotator cuff injuries, who were treated with single-row suture. The shoulders were protected by a brace for 6 weeks after operations were permit ted to perform passive movement within 6 weeks, and then perform active shoulder exercise 6 to 10 weeks after operation. Constant-Murley score, UCLA score and VAS score were recorded preoperatively and postoperatively.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 12 to 62 months, with a mean of 30 months. There was no infection or nerve injury. UCLA score was improved from preoperative 10.71±2.45 to postoperative 32.07±3.16; Constant-Murley score was improved from preoperative 43.33±11.55 to postoperative 78.15±12.64; VAS score was improved from preoperative 5.81±1.27 to postoperative 0.52±0.71. There were no statistical differences among three groups in UCLA score, Constant-Murley score and VAS score. Total 337 cases were satisfied with treatment results and 16 cases were not satisfied with the results. Among the 16 cases, 3 cases had huge rotator cuff surgery, and 13 cases had no joint stiffness before operation. The main complaints that resulted in dissatisfaction were weakness of the postoperative muscles and failure to restore the labour capacity(11 cases).</p><p><b>CONCLUSIONS</b>Rotator cuff repair under arthroscopy has a reliable clinical effect for the patients with rotator cuff tears. Stable and reliable clinical results can be obtained regardless different repair methods or different rotator cuff tears. The following factors such as no stiffness before operation, too early active exercise and preoperative rotator cuff atrophy may be the risk factors for postoperative dissatisfaction of patients.</p>

A new type sternoclavicular hook plate for unstable sternoclavicular joint dislocation and fracture / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the therapeutic effect of a new type sternoclavicular hook plate fixation in treating unstable sternoclavicular joint dislocation and fracture.</p><p><b>METHODS</b>From June 2011 to December 2013, 32 patients with sternoclavicular joint dislocation and fracture were treated with a new type sternoclavicular hook plate fixation, including 24 males and 8 females with an average age of 42 years ranging from 25 to 76 years;12 patients were anterior dislocation, 5 pations were posterior dislocation, 10 patients were internal extremity of clavicle fracture and 5 patients were sternoclavicular joint dislocation combined with fracture. The anterior fracture dislocation of the sternoclavicular joint adopted standard sternoclavicular joint hook plate, and the posterior dislocation was at the distal end of the hook of the steel plate, that is, the front part of the handle of the breast was added with a nut and a gasket to prevent the re-dislocation after operation. The results were evaluated according to Rockwood score.</p><p><b>RESULTS</b>No complication happened in all patients. X-ray and CT showed that the dislocation and fracture of the sternoclavicular joint was well reduced and the plate was on right position. All patients were followed up for 6 to 24 months with an average of 10 months. At 6 to 3 months after operation, the fracture was healing without re-dislocation of the sternoclavicular joint, the medial end of the clavicle anatomical structure were restored, functional satisfaction, in which 9 patients with the swelling around sternoclavicular joint, but no pain and other symptoms. The total Rockwood score was 12.78±1.43; the results were excellent in 24 cases, good in 8 cases.</p><p><b>CONCLUSIONS</b>The use of the new type of locking hook plate for the treatment of unstable fracture of the sternoclavicular joint, internal fixation is reliable, high security, easy to operate, to provide a reliable method for the treatment of such trauma.</p>

Fenestration operation for treatment of acetabular parastyle fracture combined with articular facet compression and collapse of acetabular top involving weight-bearing dome / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the fenestration operation for treatment of acetabular parastyle fracture combined with articular facet compression and collapse of acetabular top involving weight-bearing dome.</p><p><b>METHODS</b>From July 2005 to February 2007, 52 cases of acetabular parastyle fracture combined with articular facet compression and collapse of acetabular top involving weight-bearing dome were treated by two methods. Among them, 24 cases were treated by fenestration operation for articular facet reduction, bone grafing, anatomical reconstruction of the acetabular parastyle with internal fixation, included 17 males and 7 females with an average age of (35.2 +/- 6.4) years old; the other 28 cases were treated only anatomical reconstruction of the acetabular parastyle with internal fixation, included 19 males and 9 females with an average age of (36.4 +/- 4.8) years old. All the patients were evaluated with modified d'Aubigne-Postel clinical evaluation standard.</p><p><b>RESULTS</b>All patients gained bone healing. There were only 1 patient occurenced femoral nerve injury and recovered 2 months later. There were no other complications. All patients were followed up from 12 to 51 months (averaged in 31.5 months). According to modified d'Aubigne-Postel clinical evaluation standard, there were statistic difference between the two groups of patients in pain, walking, range of motion and total score. In fenestration operation group, the results were excellent in 13 patients, good in 9, fair in 1, poor in 1; in parastyle reduction group,the results were excellent in 9 patients, good in 11, fair in 6, poor in 2 (u=0.613, P<0.05).</p><p><b>CONCLUSION</b>Fenestration operation for treatment of acetabular parastyle fracture combined with articular facet compression and collapse of acetabular top involving weight-bearing dome is a feasible method for the recovery of hip joint function.</p>

Construction and identification of nemo-like kinase gene recombinant adenovirus vector / 中国医学科学院学报

<p><b>OBJECTIVE</b>To construct the nemo-like kinase (NLK) gene recombinant adenovirus vector.</p><p><b>METHODS</b>The AdEasy system was used to construct the recombinant adenovirus vector. Using reverse transcriptase polymerase chain reaction (RT-PCR), the full-length gene of NLK and its mutants (K155M, T286V, and C425Y) were amplified from HEK293 cells. The FLAG tag was appended at the C-terminal of NLK. After ligation and transformation, the NLK gene and its mutants were cloned into the pAdTrack-CMV vector. It was detected by PCR, sequencing, and Western blot analysis. Using DNA recombination and homogenous recombination, the normally expressed plasmids were linearized by the restriction enzyme-PmeI and PacI, then the enzyme-digested products were recycled by using ethanol precipitation. The purified product was transfected to HEK293A packaging cells with FuGENE HD transfection reagent. After amplification of the recombinant adenovirus, Western blot analysis was performed to detect the expression of NLK gene and its mutants.</p><p><b>RESULTS</b>The successful construction of pAdtrack-CMV-NLK (and mutants) was confirmed by PCR and sequencing. Western blot analysis showed that the target genes and the recombinant adenovirus were obtained. This recombinant virus was able to express NLK protein and its mutants correctly in HCT 116 cells.</p><p><b>CONCLUSION</b>The NLK gene recombinant adenovirus vector was successfully constructed and identified.</p>

Reconstruction of posterolateral structure in knee with Müller method / 中国骨伤

<p><b>OBJECTIVE</b>To study the clinical effects of Müller method for reconstruction of posterolateral corner (PLS) of knee joint.</p><p><b>METHODS</b>From June 2005 to June 2007, 13 patients with PLS injured were treated with Müller method. Four patients complicated with injuries in anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), 7 patients complicated with injuries in PCL, 4 patient also had injuries in ACL, 1 patient complicated with ACL injury, and 1 patient complicated with avulsions fractures of the tibial ACL insertion. Among the patients, 5 patients had chronic injuries with a duration of 2 to 7 months. After the cruciate ligament was reconstructed, the popliteus tendon was reconstructed with iliotibial band and lateral collateral ligament (LCL) reconstructed with biceps femoris tendon. All the ligaments were fixed with interface screws. The patients were encouraged to do strength and motion exercise on bed immediately after operation and permit toe-touch weight-bearing till two months after operation. The brace was used till six months after operation.</p><p><b>RESULTS</b>The average follow-up period was 13 months (ranged from 6 to 27 months). There was no restriction of range of motion. External rotation range were good compared to the normal side. One year after operation, one-grade varus instability at 30 degrees flexion was found only in 2 patients. The postoperative Lysholm scores were from 77 to 94 (average 86).</p><p><b>CONCLUSION</b>The method is easier to perform, easier to get the materiar for reconstruction and promised satisfactory clinical results.</p>

Ligaments reconstruction for the treatment of lateral ankle instability / 中国骨伤

<p><b>OBJECTIVE</b>To study therapeutic effects of lateral ankle ligaments reconstruction for the treatment of chronic lateral instability of the ankle joint.</p><p><b>METHODS</b>From July 2005 to January 2008, among 13 patients with chronic lateral instability of the ankle joint, 10 patients were male and 3 patients were female, ranging in age from 24 to 45 years,with an average of 33 years. Anterior talo-fibular ligament (ATFL) and calcanea-fibular ligament (CFL) were anatomy reconstructed with a split peroneus brevis tendon graft for all patients. The ankle scoring system was used to evaluate ankle joint function before and after operation, which including stability, pain, locomotor activity and X-ray films.</p><p><b>RESULTS</b>All the patients were followed up ranged from 6 to 32 months, averaged 16.4 months. The postoperative scores of the ankles increased in respect to stability, pain and locomotor activity. The total average score increased from preoperative (43.54+/-7.04) to postoperative (73.38+/-4.17). There was significant difference between preoperative scores and postoperative scores (P<0.01). All the patients were satisfied with the results.</p><p><b>CONCLUSION</b>Anatomy reconstruct of the ATFL and CFL with a split peroneus brevis tendon graft (Sammarco method) is a practical method for lateral ankle instability and promise good results especially for patients complained of instability.</p>

Clinical controlled trial on the treatment of comminuted clavicular fracture with acromioclavicular external fixator and clavicle anatomic DCP internal fixation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the different therapeutic effects of comminuted clavicular fracture with acromioclavicular external fixtatior and DCP internal fixation.</p><p><b>METHODS</b>There were 768 cases of comminuted clavicular fracture involved in the study. Among them, 528 patients (321 male and 207 female, aged from 15 to 82 years) treated with acromioclavicular external fixator, in which there were 165 cases of three parts fracture and 363 cases of more than three parts fracture; 240 patients (152 males and 88 females, aged from 17 to 64 years) treated with the internal fixation, in which there were 178 cases of three parts fracture and 62 cases of more than three parts fracture. The time between injury and treatment was 1.3 days (range, 2 h to 8 days). The results were evaluated according to Neer scoring system.</p><p><b>RESULTS</b>All the cases were followed up from 8 to 24 months. For treatment of fracture more than three parts, there was significant difference between acromioclavicular external fixation group and internal fixation group in nonunion rate (chi2=44.17, P<0.05) and in Neer scores (t=5.284, P<0.05).</p><p><b>CONCLUSION</b>Treatment with DCP internal fixation which matching the AO principles can obtain anatomic reduction, firm fixation and early functional exercise; however, treatment with self-designed acromioclavicular external fixator is an ideal therapeutic method as it has, early union of the fracture and good functional outcome with seldom complications.</p>