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Objective:To observe the effect of customized orthotic insoles on the gait and balance of hemiplegic stroke survivors.Methods:Sixty stroke survivors with gait abnormalities were randomly divided into a group fitted with ankle foot orthoses (AFO) ( n=30) and a group who received customized orthotic insoles ( n=30). All received conventional rehabilitation training for 4 weeks. Before the fitting, as well as 8 hours and 4 weeks afterward, both groups were evaluated using the Tinetti gait scale (TGS), the plantar pressure balance index, the difference in length between their right and left step, step width, the Timed Up and Go test (TUGT), the Fugl-Meyer lower extremity assessment (FMA-LE), the 6-minute walk test (6MWT), a trunk impairment scale (TIS), the Berg Balance Scale (BBS) and the Barthel Index (BI). Results:At 8 hours after the fitting all of the insole group′s measurements were better than those of the AFO group, on average, but the differences were not statistically significant. After 4 weeks the average TGS, balance index barefoot and wearing the orthosis, step length difference, BBS and BI of the insoles group were significantly better than the AFO group′s averages. The other indicators were not significantly different.Conclusions:Customized orthotic insoles are more effective than an AFO in relieving the biomechanical abnormalities in hemiplegic patients′ feet and ankles, and enhancing their balance and gait.
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Objective:To establish a new classification of lateral clavicle fractures and to evaluate its clinical value.Methods:The data of 67 patients with lateral clavicle fractures admitted from January 2016 to December 2020 were included. Thirty-seven cases were from Shanghai First People's Hospital, including 22 males and 15 females, with an average age of 49.1 years (22-78 years). Thirty cases were from the Second Upper Limb Ward of Tianjin Hospital of Tianjin, including 20 males and 10 females, with an average age of 47.6 years (19-76 years). The ligament injury was determined by measuring the coracoclavicular space on Zanca view X-ray and the distance between the fracture fragment on the inferior surface of the 3D-CT and the distal end of the clavicle. All patients were classified according to the new classification (based on the measurement on Zanca view X-ray and 3D-CT reconstruction, the relationship between the fracture and the coracoclavicular ligament footprint, coracoclavicular ligament injury, the injury of the acromioclavicular joint and the stability of the fracture), conservative treatment is preferable for stable fractures, and surgical treatment for unstable fractures. Three experienced orthopaedic surgeons and three radiologists independently observed the imaging data of 67 patients with distal clavicle fractures, determined the fracture type according to the new classification, and randomly reclassified after 4 weeks interval. Finally, 15 cases were randomly selected for internal control (2 junior orthopedic physicians), and the ICC value was used to assess the reliability. Results:The lateral clavicle fractures were divided into 5 types according to the Gongji classification. Type 1: isolated conical tubercle avulsion fracture, and the fracture line is located medial to the coracoid process; Type 2: complete involvement of the trapezoid & conical ligament at the clavicle insertion, and the fracture line extends to the middle of the clavicle, mean while the acromioclavicular joint is intact; Type 3: fracture fragments on the inferior surface involving the trapezoidal/conical ligament, respectively; Type 4: rupture of the conical ligament, and avulsion fracture of the trapezoid ligament; Type 5: conical ligament intact, and avulsion fracture of clavicle insertion of the trapezoid ligament. There were 18 cases of type 1, 4 cases of type 2, 8 cases of type 3, 32 cases of type 4, and 5 cases of type 5. The inter-observer and intra-observer agreement of all included cases was good (inter-group: first ICC=0.764, second ICC=0.778; intra-group: shoulder specialist ICC=0.782, radiologist ICC=0.750, internal control ICC=0.793). Types 1 and 2 fractures were fixed with anatomical plate and coracoid anchor. Type 3 and 4 fractures were fixed with clavicle hook plate and coracoid anchor. And type 5 underwent conservative treatment. At the last follow-up, all patients had no obvious shoulder joint instability and pain, and no internal fixation failure or fixation breakage was found. Conclusion:The Gongji classification has moderate reliability between observers and intra-observers, and the Gongji distal clavicle fracture classification has a good significance for evaluating the stability of the fracture and guiding the selection of the treatment.
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Objective:To evaluate our self-made distraction reductor used in the percutaneous minimally invasive treatment of calcaneal fractures.Methods:A retrospective study was conducted of the 32 patients (37 feet) who had been treated at Department of Orthopaedics, The First Affiliated Hospital to Chongqing Medical University from January 2017 to December 2019 for calcaneal fractures. They were 26 males and 6 females, aged from 20 to 67 years (average, 46.5 years). The height and length of the calcaneus were restored by our self-made tri-plane distraction reductor in all patients; the displaced fracture blocks were reset in a minimally invasive manner in patients with intra-articular fracture; final fixation was performed with a minimally invasive plate and screws. Time for reductor installation, operation time and intraoperative blood loss were recorded; complications, fracture union and reduction were observed; height, length and width of the calcaneus, ankle-hindfoot scores of American Society of Foot and Ankle Surgery (AOFAS), Maryland scores, and visual analogue scale (VAS) were recorded at the last follow-up; B?hler and Gissane angles were compared between pre- and post-operation.Results:All patients were followed up for 12 to 36 months (average, 17.2 months). Time for reductor installation averaged 5.0 min (from 3 to 8 min), operation time 91.5 min(from 70 to 110 min), and intraoperative blood loss 25.2 mL (15 to 50 mL). Superficial infection of traction track occurred in one patient and sural nerve injury in one patient. All fractures united without any reduction loss by the last follow-up. On average, the last follow-up observed a calcaneal height of 39.3 mm, a calcaneal length of 70.6 mm, a calcaneal width of 32.7 mm, an AOFAS score of 87.8, a Maryland score of 86.7 and a VAS score of 2.2. The calcaneal B?hler angle was recovered significantly from 3.7°±13.7° preoperatively to 25.8°±6.4° at the last follow-up, and the calcaneal Gissane angle from 112.2°±21.3° preoperatively to 125.8°±5.7° at the last follow-up ( P< 0.05). Conclusion:In percutaneous minimally invasive treatment of calcaneal fractures, application of our self-made tri-plane distraction reductor can lead to fine clinical efficacy.
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Objective:To compare the clinical outcomes of percutaneous screw fixation at the key points using a self-made calcaneal distraction device with traditional open reduction plate internal fixation for the treatment of patients with displaced intra-articular calcaneal fractures (DIACFs).Methods:A retrospective case-control study was made on clinical data of 60 patients (69 feet) with DIACFs admitted to First Affiliated Hospital of Chongqing Medical University between January 2015 and January 2019. There were 51 males and 9 females, with an average age of 47.2 years [(47.2±8.7)years]. According to the Sanders classification, there were 42 feet of type II, 15 feet of type III and 12 feet of type IV. According to the Essex-Lopresti classification, there were 43 feet of tongue type fractures and 23 feet of joint depression fractures. Another 3 feet were not applicable to this classification system. In Group A, 30 patients (35 feet) were treated by percutaneous reduction or reduction using tarsal sinus approach with the self-made calcaneal distraction device followed by percutaneous screw fixation. In Group B, 30 patients (34 feet) were treated by open reduction and internal fixation with plates using the traditional extended lateral approach. Waiting time for surgery, operation time, length of hospital stay, efficacy of reduction and fracture healing, American Orthopedic Foot and Ankle Society (AOFAS) score, Maryland score, visual analog scale (VAS), and incidence of surgical site related complications were compared between groups. The efficacy of reduction was evaluated by measuring the height, length and width as well as the B?hler angle of the calcaneus.Results:All patients were followed up for an average of 28.2 months [(28.2±11.3)months]. The waiting time for surgery in Group A was (3.4±1.3)days, significantly shorter than that in Group B [(6.9±1.9)days] ( P<0.05). The operation time was (91.7±10.3)minutes in Group A and (92.8±11.5)minutes in Group B ( P>0.05). The length of hospital stay in Group A was (7.0±1.4)days, significantly shorter than that in Group B [(12.7±1.7)days] ( P<0.05). At the final follow-up, all fractures were healed, with no reduction loss of fixation observed. The height of the calcaneus was (48.9±2.0)mm in Group A and (49.3±2.6)mm in Group B ( P>0.05). The length of the calcaneus was (83.2±2.9)mm in Group A and (83.5±2.7)mm in Group B ( P>0.05). The width of the calcaneus was (35.8±2.3)mm in Group A and (35.1±1.3)mm in Group B ( P>0.05). The B?hler angle of the calcaneus was (24.7±6.4)° in Group A and (25.9±5.8)° in Group B ( P>0.05). At the final follow-up, the AOFAS score was (87.1±8.5)points in Group A and (86.7±7.8)points in Group B, with the good and excellent rate of 89% (31/35) and 88% (30/34) respectively ( P>0.05). The Maryland score was (85.3±9.5)points in Group A and (84.9±9.5)points in Group B, with the good and excellent rate of 86% (30/35) and 85% (29/34), respectively ( P>0.05). The VAS was (2.3±1.5)points in Group A and (2.5±1.5)points in Group B ( P>0.05). No surgical site related complication was observed in Group A. While in Group B, there was one foot of superficial incision infection, three necrosis of the skin at the edge of the incision, and one deep infection ( P<0.05). Conclusions:For the treatment of DIACFs, percutaneous screw fixation at the key point using the self-made calcaneal distraction device can achieve the same clinical outcome as traditional open reduction plate internal fixation, but it has advantages like significant shorter waiting time for surgery, less invasiveness, faster recovery and lower incidence of incision-related complications. This method is especially suitable for patients with contraindications of open reduction and internal fixation.
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Objective@#To discuss the clinical outcomes of treating delayed acetabular fractures by combined anterior and posterior approach.@*Methods@#A retrospective analysis was conducted of 31 delayed acetabular fractures from February 2012 to February 2017 in the First Affiliated Hospital of Chongqing Medical University, including 18 males and 13 females with age of 48.5 years(23 to 67 years) .The injury to the operation time was 35.9 days(22 to 183 days). Of these 31 cases, there were 6 cases of transverse and posterior wall fracture, 8 cases with anterior column+ posterior half transverse fracture, 12 cases with double column fracture and 5 cases of "T" type fracture according to Letournel-Judet classification.All fractures were treated combined anterior and Kocher-Langenbeck approaches, including 13 cases of ilioinguinal approach+ Kocher-Langenbeck(K-L approach), 4 cases of extensile acetabular approach, 7 cases of stoppa approach + K-L approach and 7 cases of side rectus femoris approach.Correlation was analyzed by Pearson correlation regression testing.@*Results@#Follow up to August 2017, all patients were followed up with 36.0 months(from 6 to 55 months). As calculated, the restorational effect was positively with result of the X-ray film and the clinical effect(r=0.823, 0.856; both P<0.05). The evaluation was conducted with Matta′s reduction criteria: there were 11 cases classified as anatomic reduction(35.5%), 13 cases as satisfactory reduction(41.9%), and 7 cases as unsatisfactory reduction(22.6%). Excellent and good rate was 77.4%. Functional reductions were categorized by the standard of Matta hip score: 8 excellent cases(25.8%), 11 good cases(35.5%), 8 fail cases(25.8%), and 4 poor cases(12.9%).@*Conclusion@#The treatment of delayed acetabular fracture by combined anterior and posterior approach can fully exposure the anterior and posterior acetabular fcloumns, which is beneficial to the release and fixation of the old acetabular fractures.
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Objective To evaluate the effect and safety of postoperative intravenous infusion of tranexamic acid on the perioperative blood loss in elderly patients with femoral intertrochanteric fractures treated with proximal femoral nail antirotation.Methods A retrospective case-control study was conducted on 60 aged patients with unilateral intertrochanteric fracture who were treated with proximate femoral nail annotation from January 2015 to March 2017.Patients were divided into two groups according to method of administration,with 30 cases in each group.Patients in the single administration group were given 15 mg per kilogram of tranexamic acid 20 minutes before surgery by intravenous drip (Group A),whereas patients in the twice administration group were given 15 mg per kilogram 20 minutes before surgery and 1 g 7 hours later by intravenous drip (Group B).There were 11 males and 19 females in Group A,with the age of (78.57 ±7.60)years.Group B included 12 males and 18 females,and the age was (76.80 ± 7.90) years.Perioperative data including operation time,intraoperative blood loss,total blood loss,recessive blood loss,postoperative drainage volume,mean blood transfusion volume,blood transfusion rate,maximum hemoglobin drop after surgery,and postoperative hospitalization time as well as complications including deep vein thrombosis,pulmonary embolism,wound infection,intermuscular venous thrombosis,exudate,hematoma,fat liquefaction were compared between the two groups.Results The operation time was (85.00 ± 19.17)minutes in Group A and (81.10 ± 19.23)minutes in Group B (P ＞ 0.05).The intraoperative blood loss was (113.33 ± 56.77) ml in Group A and (129.33 ± 93.70) ml in Group B (P ＞ 0.05).The total blood loss was (748.47 ± 246.71) ml in Group A and (477.83 ± 213.78) ml in Group B (P ＜ 0.05).The recessive blood loss was (715.00 ± 289.48) ml in Group A and (357.00 ± 237.54) ml in Group B (P ＜ 0.05).The postoperative drainage volume was (58.50 ±32.22)ml in Group A and (29.83 ± 13.03)ml in Group B (P ＜0.05).The blood transfusion was O(0,200)ml in Group A and 0(0,0)ml in Group B (P ＜0.05).The blood transfusion rate was 33％ (10/30) in Group A and 7％ (2/30) in Group B (P ＜0.05).The maximum hemoglobin drop after surgery was (25.5 ±6.5)g/L in Group A and (17.4 ±5.1)g/L in Group B (P＜O.05).The postoperative hospitalization time was (7.30 ± 1.26) days in Group A and (5.53 ± 0.73) days in Group B (P ＜ 0.05).Moreover,no deep vein thrombosis,pulmonary embolism or wound infection occurred in either group.There were no significant differences in the incidence of intramuscular venous thrombosis,exudate,hematoma or fat liquefaction between the two groups (P ＞ 0.05).Conclusion Compared with the single administration of tranexamic acid,the twice administration is more effective in controlling perioperative blood loss,which is worthy of clinical application.
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Surgical treatment of acetabular fractures is very difficult,and the choice of surgical approach is of crucial importance.The ilioinguinal approach is a classic anterior approach for acetabular fracture surgery,but it has disadvantages such as complicated procedure,much operative wound,postoperative complications and steep learning curve.Therefore,it drives many researchers to seek new approaches.The modified Stoppa approach simplifies the operation approach of acetabular fractures,but the approach through medioventral line is far away from the acetabulum and very difficult to expose fractures in the involved quadrilateral area.Based on the modified Stoppa approach,the pararectus approach moves incision closer to the affected acetabulum,which provides direct vision for surgeons to perform anatomical reduction and rigid fixation in the quadrilateral and surrounding area,so as to reduce adjacent vascular and nerve.The progress of treatment of acetabular fractures through pararectus approach is reviewed in this paper,providing guidance and assistance to clinical practices.
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Objective To evaluate the clinical outcomes of lumbopelvic fixation of vertically unstable Tile type C pelvic fractures combined with complex sacral fractures.Methods A prospective study was made on 21 cases of vertically unstable type C pelvic fractures combined with complex sacral fractures admitted between May 2014 and December 2015.There were 10 males and 11 females, with a mean age of 35.9 years (range, 14-59 years).Tile classification of pelvic fractures was type C1 in five cases, type C2 in four and type C3 in 12.Denis classification of sacral fractures was zone I in five cases, zone Ⅱ in seven and zone Ⅲ in nine.Twelve cases had neurological deficits.Operation time, intraoperative blood loss, bone healing time, pelvis vertical displacement and postoperative complications were recorded.Vertical displacement and functional outcome were assessed by Matta method and Majeed score respectively.Results All cases were followed up for (12.5±5.4)months (range, 7-26 months).Operation time was (108.0±49.4) min (range, 64-225 min).Intraoperative blood loss was 150-3 000 ml[400(225-500)ml].All fractures were healed at (19.0±4.6) weeks (range, 15-32 weeks).Vertical displacement of the pelvis was (8.76±5.46)mm (2.54-21.80 mm) before operation and (4.20±3.22)mm (0-12.57 mm) after lumbopelvic fixation (P<0.05), showing the reduction distance of-4.45-17.86 mm [4.09(1.74-5.58)mm].According to the Matta method, the results were excellent in 13 cases, good in six, and fair in two, with the excellent and good rate of 90%.Majeed score evaluation at last follow-up was 51-98 points and the results were excellent in nine cases, good in nine, fair in two and poor in one, with the excellent and good rate of 86%.Deep infection occurred in two cases who were cured by debridement and antibiotics, and the internal instruments of the two cases were removed after fracture healing.Screw loosening occurred in five cases with no evidence of screw breakage.Four cases complained of foreign body sensation and discomfort in sacral area due to the prominence of the iliac hardware.Four cases had limited range of motion of the lumbar spine, especially in anterior flexion range, and lumbar range of motion was recovered in three of them after removal of the internal fixator.Conclusion Lumbopelvic fixation can restore vertical stability of the pelvis, but removal of the internal fixator is suggested after fracture healing due to the high rate of screw loosening.
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Objective To analyze treatment strategies for complications following lumbopelvic fixation for unstable sacral fractures.Methods Between May 2014 and December 2015,20 patients diagnosed with unstable sacral fracture were treated by lumbopelvic fixation.They were 9 males and 11 females,with an average age of 35.5 years (range,from 14 to 59 years).According to the Denis classification,5 fractures were type Ⅰ,7 type Ⅱ and 8 type Ⅲ.Complications related to lumbopelvic fixation were recorded and followed up.Results All the patients were followed up for an average of 18 months (range,from 12 to 31 months).All the fractures healed after an average of 19 weeks (range,from 15 to 32 weeks).Early complications included neural injury in 2 cases,incision infection in one and pressure ulcer in 2;late complications included prominence of internal implants in 7 cases,loosening of internal implants in 5,lumbopelvic pain or discomfort in 3,limited motion of lumbar vertebrae in 4,limb discrepancy in 3 and rotation deformity of lower limb in one.Conclusions Complications related to wound and internal implants are common following lumbopelvic fixation for sacral fractures.Careful planning and correct choice of internal fixators are the key to decreasing complications.Internal implants should be removed as soon as a sacral fracture unites to decrease the risk of long-term complications.
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Objective:To evaluate the effect of Extracorporeal Shock Wave combined percutaneous injection of enhanced fibrin glue loaded bone growth factor in accelerating the bone nonunion healing and promoting osteogenesis process .Methods: 48 radius model rabbits were randomly divided into four groups.Group A rabbits were treated with ESW;Group B rabbits were treated with ESW combined with FG;Group C rabbits were treated with ESW combined with FG/rhBMP-2/rhbFGF;Group D rabbits were treated with ESW combined with FG/rhBMP-2/rhbFGF/rhVEGF.After a combination therapy of 8 week,conventional X-ray radiography,optical in-spection organization form and biomechanical test were applied to evaluate the therapeutic effect .Results:Compared with the group B , the X-ray group C showed that the fracture line was fuzzy ,bony callus area began to increased ,fracture end range reduced.The histo-morphology showed that cartilage began to form , cartilage cell began to proliferate actively , and new blood vessels were forming surrounding fibrous connective tissue.Biomechanical determination found there was no statistical significance between the two groups ( P>0.05 ).FG/rhBMP-2/rhbFGF+ESW group showed the fracture line was still fuzzy , bony callus disappeared and apparent proliferative bone trabecula ,and biomechanical results showed that there was statistical significance between the two groups compared to the group B(P<0.01).FG/rhBMP-2/rhbFGF/rhVEGF+ESW group showed the fracture line was slightly fuzzy ,apparent proliferative bone trabecula in 4 week,and in 8 week,the fracture line was disappeared and moulding of healing was good.The histomorphology showed that the distribution was filled with fibrous connective tissue and many bone tissue .Biomechanical results showed that it could resistance to bending ,there was statistical significance between the two groups compared to the group C ( P<0.01 ).Conclusion: ESW therapy combined percutaneous injection of enhanced fibrin glue loaded bone growth factor can promote fracture healing and the method of combination is expected to be a good choice of non-surgical treatment of bone nonunion.
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BACKGROUND:Posterior maleolar fractures are often accompanied by ankle joint instability,if the stability of ankle joint is not recovered,it is prone to traumatic arthritis of the ankle.However,the indications of internal fixation of posterior maleolar fractures remain controversial.OBJECTIVE:To explore the indications for internal fixation of posterior maleolar fractures by comparing the clinical effects of posterior maleolar fractures treated with internal fixation or not.METHODS:42 patients with maleolar fractures involving posterior ankle were recruited from the First Affiliated Hospital of Chongqing Medical University from January 2007 to January 2012.According to preoperative CT scans of ankle joint,42 cases were divided into the internal fixation group and the non-fixation group.27 cases in the fixation group had posterior maleolar fractures in more than 10％of the distal tibial articular surface and/or dislocation of the posterior maleolar fractures greater than 2 mm,and were treated with screws.15 cases in the non-fixation group had posterior maleolar fractures in less than 10％of the distal tibial articular surface anddislocation of the posterior maleolar fractures less than 2 mm,and were treated with non-operation.The average healing time of posterior maleolar fractures,postoperative complications,ankle-hindfoot scores of American Orthopedic Foot and Ankle Society were compared during the folow-up postoperatively.RESULTS AND CONCLUSION:Al of 42 patients with ankle fractures achieved bony union within 6 months.In the fixation group,1 case had postoperative superficial infection of the wounds in the medial ankle and lateral ankle,and the wound got healed completely with anti-infection therapy.One case in each group had postoperative superficial necrosis in the incisional edges,and got healed by dress changing.For the other cases,there was no wound infection,internal fixation loosening,breakage or failure and other adverse events during the folow-ups.Ankle functions were evaluated one year after operations according to the ankle-hindfoot score standard of American Orthopedic Foot and Ankle Society.The score of the fixation group was (83.74±10.35) points,with excelent ankle functions in 10 cases,good in 12 cases,fair in 5 cases,and no poor case,and the rate of patients achieving excelent and good ankle functions reached 82％; the score of non-fixation group was (85.60±10.40) points,with excelent ankle functions in 7 cases,good in 5 cases,fair in 3 cases and no poor case.The rate of patients achieving excelent and good ankle functions reached 80％.The ankle function evaluation results of both groups showed no statistical difference (P＞0.05).It is reasonable to consider posterior maleolar fractures is higher than 10％of the distal tibial articular surface and/or dislocation of the posterior maleolar fractures greater than 2 mm as the indications for internal fixation of posterior maleolar fractures.
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Objective To observe expression of human beta-defensin-3 (HBD-3) in tissues around the infected artificial prostheses and investigate its value in treatment and diagnosis of periprosthetic joint infection (PJI).Methods According to clinical diagnosis,periprosthetic tissues and normal synovial membrane excised in operation were collected and divided into the following four groups:PJI group (n =13),aseptic loosening group (loosening group,n =9),spacer treatment group (treatment group,n =12),and normal group (n =15).HE staining was used to observe infiltration of inflammatory cells.Immunofluorescence staining was used to detect positive cells number and fluorescence intensity.Image-pro plus (IPP) 7.0C software was used to measure the average value of absorbance.Preoperative peripheral white blood cell count,erythrocyte sedimentation rate (ESR),and C-reactive protein (CRP) results were documented.Then,differences of those parameters were analyzed and compared among groups.Results HE staining revealed that all groups had different degree of inflammatory cell infiltration except for normal group.Immunofluorescence staining revealed that the most number of positive cells and highest fluorescence intensity existed in PJI group.Value of absorbance in PJI group was 0.430 ± 0.013,followed by 0.308 ±0.005 in loosening group,0.234 ± 0.009 in treatment group,and 0.089 ± 0.019 in normal group.Preoperative peripheral white blood cell count,ESR and CRP were the highest in PFI group,but were not significantly different among the remaining three groups.Conclusion HBD-3 is highly expressed in tissues around the prostheses which had infection or aseptic loosening,but its expression in response to infection and loosening has difference.
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Objective To summarize the clinical effect of open reduction and internal fixation for the proximal humeral fracture with locking proximal humerus plate (LPHP). Methods A total of 45 cases with complex humeral fractures were operated via deltoid-pectoral approach. According to the Neer classification, there were 33 cases with three-part fractures and 12 with four-part fractures. Neer nu- merical rating system was employed to evaluate postoperative function of the involved shoulder. Results Of all, 38 cases were followed up for a mean 14.7 months, which showed fracture union within 3 months in 35 cases and fracture union within 4 months in 3. According to the Neer numerical rating system, re- suh was excellent in 20 eases and satisfactory in 15, with total excellence rate of 92%. Conclusion LPHP is characterized by stable fixation, minor complication and high satisfaction, and hence is an effec- tive method for proximal humeral fractures.
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Objective To analyze the clinical features of patients with open injuries combined with infections in Chinese Wenchuan earthquake and summarize the therapeutic experience. Methods An analysis was done on 54 patients with open injuries combined with infection transferred to our depart-ment from May 13, 2008 to June 10, 2008. Thorough debridement was performed based on general sup-porting management and anti-bacterial thempies done on the basis of results of bacteria culture and sus-ceptibility test. In the meantime, other managements including high-pressure oxygen therapy and external fixation were done for open fractures. Results Infection could be found in all open injuries, primarily combined infections with G+ coccus and G- bacillus or anaerobic. Moreover, most of the patients were infected by anaerobia. Of all, 1 patient with amputation received multiple debridement and repair because of severe infection of the amputation site and no death occurred. All patients recovered uneventfully, with sound wound healing, except for 2 patients. External fixation was stable and in good position. Conclu-sions The repeated and thorough debridement and the timely closure of wounds on the basis of energeti-cally anti-infection measures are key to diminishing the mortality rate and mutilation rate. Appropriate ad-junctive therapy can dramatically improve the curative effect.
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Objective To evaluate the clinical efficacy of radial head prosthesis replacement in treatment of comminuted fracture of the radial head and discuss relative operative announcements.Methods There were 27 patients with comminuted fracture of the radial head who were treated with radial head prosthesis replacement. Results Of all,26 patients were followed up for averaged 14months.According to Broberg score,the post-operative function was excellent in 9 patients(35%),good in 13(50%)and fair in 4(15%),with no poor results and with excellence rate of 85%. Conclusion Radial head prosthesis replacement can better restore the stability,flexion and extension of the elbow as well as the rotational motion of the forearm and is worthy of clinical application.
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Objective To observe clinical results and indications of open reduction and internal fixation by bold canal titanium screws for treatment of radial head fractures. Methods From May 2003to February 2007,18 cases of radial head fractures were treated by open reduction and intemal fixation with bold canal titanium screws.There were 12 males and 6 females at age range of 15-53 years(mean 28.6 years).Of all,13 cases had Mason typeⅡ fractures,3 Mason typeⅣ and 2 Mason typeⅣ.Rehabilitation began as early as possible after operation if the internal fixation was secure;otherwise,rehabilitation began 2 weeks after operation.Postoperative plain radiography was made to observe fracture healing and complications. Results After operation,the rehabilitation was done at the first day in 15 cases and at 2 weeks in 3,with mean fracture healing time of 3 months.Function of elbows and rotation of forearnls were excellent except for 2 eases with Mason Ⅳ fractures.No deep branch of radial nerve injury occurred. Conclusion Open reduction and internal fixation with bold titanium canal screws can attain satisfactory clinical results in treatment of Mason type Ⅱ and Mason typeⅢradial head fractures.
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Objective:To study the effects of Yiqi Huoxue Huayu Chinese medicine on neogenesis of blood vessels and basic fibroblast growth factor(bFGF)expression in benign prostatic hyperplasia(BPH)rats.Methods:7 days after being castrated,fifty SD rats were injected with testosterone(5 mg?kg-1?d-1),the decoction of Yiqi Huoxue Huayu and Zerguilongshuang were orally administrated respectively,after 30 days'treatment,the rats were sacrificed,the prostate volume were measured,and the prostate index(PI)were analyzed,the micro-vessels density(MVD)and level of bFGF were measured.Results:The prostate volume and index of rats in model group was obviously higher than those in normal group(P
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Objective:To explore a better method for treatment of open rupture of Achilles tendon.Methods:32 cases of open rupture of Achilles tendon were treated by debridement and modified Kessler′s methods were used to repair injured Achilles tendon.Plaster immobilization remained for 6 weeks after operation.Then ankle joint movement was started.Results:25 cases had been followed up for 1 to 8 years.The rate of excellent and good results was 92%.Conclusion:The method has the advantages of convenient procedure,excellent clinical results,less complications.It would be widely used in clinical practice.
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Objective To explore the curative effects of open reduction and internal fixation with Cable Pin or tension band wire for patellar transverse fractures.Methods Totally 28 cases and another 30 cases were enrolled in the Cable Pin group(8 months for average follow-up time) and the tension band wire group respectively(16 months for average follow-up time).The operative time,the average clinical healing time and the average range of the knee flexion between the 2 groups were compared.Results Obvious superiority was observed in the Cable Pin group over the tension band wire group concerning the average clinical healing time and the average range of the knee flexion 6 months postoperatively (P
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Objective:To investigate the therapeutic effect of Chinese medicine combined with small dose of antidepressant on prospermia.Methods:150 cases of prospermia conformed to the diagnostic criteria were divided into 3 groups according to their wishes,50 cases in each group.Group I were treated with Zhibai Gujing Decoction,group Ⅱ with Sertraline hydrochloride,and group Ⅲ with Zhibai Gujing Decoction plus Sertraline hydrochloride,for 4 consecutive weeks.The ejaculatory latency,satisfaction degrees of sexual life,and the adverse effect of the medicine were observed.Results:After treatment,the ejaculatory latency was significantly prolonged and the satisfaction degree of sexual life was significantly increased in the 3 groups(P