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Objective:To observe the curative effects of triplane intra-articular osteotomy in the treatment of malunion of calcaneal intra-articular fracture.Methods:The 16 patients were retrospectively analyzed who had been admitted to Foot and Ankle Surgery Department, Honghui Hospital from January 2016 to December 2019 for malunion of calcaneal intra-articular fracture. They were 12 males and 4 females, with an average age of 43.4 years (from 31 to 58 years). The left side was affected in 10 cases and the right side in 6 cases. All malunions were type Yu Ⅱ (compressed bone fragments on the posterior articular surface) and treated with triplane intra-articular osteotomy. The curative effects were assessed by comparing the radiological parameters, American Orthopaedic Foot and Ankle Surgery Society (AOFAS) ankle-hindfoot score, pain visual analog scale (VAS) and psychological and physical scores in Health Survey 12-item Short Form (SF-12) between preoperation and the final follow-up.Results:All the patients were followed up for 20 to 60 months (average, 42.9 months); the bone healing time was 10 to 14 weeks (average, 11.5 weeks). At the final follow-up, their B?hler angle (25.7°±2.3°), Gissane angle (117.1°±5.8°), Meary angle (2.9°±1.3°), talocalcaneal angle (31.3°±3.0°), hindfoot alignment angle (3.9°±1.8°), ankle height [(82.3±2.6) mm], calcaneus height [(56.9±2.4) mm], calcaneus width [(41.4±2.1) mm], AOFAS ankle-hindfoot score [(82.3±7.3) points], median VAS score [3 (2, 3) points], SF-12 psychological score [(46.6±3.6) points], and SF-12 physiological score [(43.6±3.5) points] were significantly improved than the preoperative values [8.4°±2.7°, 137.5°±9.3°, 8.3°±4.3°, 24.6°±3.7°, -4.6°±3.2°, (76.1±3.1) mm, (53.8±3.0) mm, (50.2±2.2) mm, (51.9±7.7) points, 6 (6, 7) points, (37.5±3.8) points, and (31.0±2.6) points] (all P<0.01) Conclusion:In the treatment of type Yu Ⅱ malunion of calcaneal intra-articular fracture, triplane osteotomy can anatomically reduce the bone fragments of collapsed posterior articular surface, reshape the normal anatomy of the calcaneus, and preserve the subtalar joint, leading to positive short- and mid-term follow-up effects.
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Objective To compare the outcomes of surgical treatment of ankle fracture with or without repair of deltoid ligament(DL) rupture.Methods Between March 2009 and December 2015,75 patients were treated surgically at Department of Foot and Ankle Surgery,Honghui Hospital for ankle fracture with DL rupture.Of them,the DL rupture was repaired in 20(repair group) and not in 54(non-repair group).The 2 groups were compared in terms of pre- and post-operative medial clear space(MCS),rate of radiological MCS malreduction(MCS>5mm),rate of surgical failure,the American Orthopaedic Foot and Ankle Society(AOFAS) ankle-hindfoot score and visual analogue scale(VAS).The outcomes of AO/OTA types B and C were also compared between the 2 groups.Results The 2 groups were compatible due to insignificant differences in their preoperative general data and follow-up time(46.9±22.5 months versus 56.3±23.9 months)(P>0.05).The MCSs after operation(3.3±0.3 mm) and at the last follow-up(3.2±0.3mm) in the repair group were significantly shorter than those in the non-repair group(3.8±1.0mm and 3.8±1.2mm)(P<0.05).The rate of radiological MCS malreduction in the repair group(0) was significantly lower than that in the non-repair group(20.4%)(P<0.05).There were no significant differences between the 2 group in rate of surgical failure(0 versus 7.4%),AOFAS ankle-hindfoot score(88.0±5.8 versus 85.9±8.7) or VAS(1.2±0.8 versus 1.6±1.6)(P>0.05).The rate of radiological MCS malreduction for AO/OTA type C ankle fracture in the non-repair group was significantly higher than those for AO/OTA types B and C in the repair group and AO/OTA type B in the non-repair group(P<0.05).Conclusion Surgical repair of the DL rupture may help decrease the rate of postoperative MCS malreduction,especially for AO/OTA type C ankle fractures.
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OBJECTIVE:To investigate the effects of Melilotus extract tablet on postoperative therapeutic efficacy of chronic sinusitis endoscopic surgery and the recovery of nasal mucosa. METHODS:The clinical data of 100 patients undergoing chronic si-nusitis functional endoscopic surgery in our hospital from May 2015 to Oct. 2016 were analyzed retrospectively and they were divid-ed into control group and observation group according to postoperative treatment,with 50 cases in each group. Two groups received anti-inflammatory,anti-histamine and hemostasis therapy. The control group received Eucalyptol,linonene and pinene enteric soft capsules 0.3 g,tid;observation group was additionally given Melilotus extract tablet 1.2 g,tid,for 6 weeks,on the basis of con-trol group. VAS and Lund-Kennedy endoscopic score were compared between 2 groups before and after treatment. Clinical effica-cies and the occurrence of ADR were also compared between 2 groups. RESULTS:there was no statistical significance in VAS score and its total score,Lund-Kennedy endoscopic score and its total score between 2 groups before treatment (P>0.05). After treatment,VAS score and its total score,Lund-Kennedy endoscopic score and its total score of 2 groups were significantly de-creased,and the observation group was significantly lower than the control group,with statistical significance(P0.05). CONCLU-SIONS:Melilotus extract tablet helps to improve clinical efficacy and the recovery of nasal mucosa in patients with chronic sinus-itis after endoscopic surgery,with good safety.
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Objective To study the value of serum intestinal fatty acid binding protein(I-FABP) and calcium levels for evaluating the effect of emergency surgical on the treatment of severe acute pancreatitis(SAP). Methods A total of 68 firstly diagnosed as SAP from June 2014 to October 2016 were collected into this study. The arrest time was less than 72 h and they were underwent emergency endoscopic or laparoscopic surgery. The serum I-FABP and calcium levels were detected 12 hours after surgery and analyze the values of serum I-FABP and calcium levels in evaluating the clinical effects by receiver operating characteristic curve(ROC). Results There were 33 cases with excellence, 21 cases with availability and other 14 cases with no-effect, the total efficacy rate was 79.4%. The gender, age, arrest time, APACHE Ⅱ score, derum amylase, blood glucose and total cholesterol levels were no statistical differences in effective group and no-effect group.The serum I-FABP levels 12 hours after surgery in effective group were lower and calcium levels were higher than no-effect group(P<0.05).The evaluating accuracy was 0.856, sensibility was 86.5%,specificity was 92.2%,cut-off value was 368 ng/mL of serum I-FABP by ROC analysis. And they were 0.844,83.5%,86.7% and 1.96 mmol/L of serum calcium level by ROC analysis. Conclusion Serum I-FABP combined with calcium can be used for evaluating the effects of emergency surgical on the treatment of the patients with SAP.
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Objective To study the impact of Xingnaojing (XNJ) injection (a preparation of Chinese herb medicine) on the permeability of blood-brain barrier and Caveolin-1 in cortex of brain after global ischemia-reperfusion.Methods Modified Pulsinelli method for four-vessel occlusion was employed to establish the global ischemia reperfusion model in rats.Male Wistar rats were randomly (random number) divided into three groups,namely sham group,model group and XNJ group.Each group was observed at 24 h,48 h and 72 h after ischemia reperfusion.The water content of brain tissue was determined by dry/wet weight ratio,while the Evans blue (EB) concentration in brain tissue was detected by spectrophotometer.Western blot was used to detect caveolin-1 level in the cerebral cortex.Results The water contents of brain tissue in model group and XNJ group were significantly higher than that in sham group 24 hour after ischemia-reperfusion (P ＜ 0.05).But at 48 h and 72 h after ischemia-reperfusion,the brain water content in model group was significantly higher than that in XNJ group and sham group (P ＜ 0.05).The EB concentrations in brain tissue in model group and XNJ group were higher than that in sham group 24 h after ischemia-reperfusion (P ＜ 0.05).EB levels in sham group and XNJ group were significantly lower than that in model group 48 h and 72 h after ischemia-reperfusion (P ＜ 0.05).Caveolin-1 levels in cerebral cortex in sham group and XNJ group were significantly higher than that in model group 24 h,48 h and 72 h after ischemia-reperfusion (P ＜ 0.05).Conclusions After global ischemia-reperfusion,Xingnaojing (XNJ) injection could protect blood-brain barrier in virtue of regulating caveolin-1 protein level.
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AIM:To investigate the effect of Xingnaojing (XNJ) injection on the permeability of blood-brain barrier ( BBB) and zonula occludens-1 ( ZO-1) protein expression after global ischemia-reperfusion in rats.METHODS:Improved Pulsinelli four-vessel occlusion method was adopted to establish the global ischemia-reperfusion model in the rats. Male Wistar rats were randomly divided into sham group, model group, solvent group and XNJ group.The observations were conducted at the time points of 24 h, 48 h and 72 h after ischemia reperfusion.The water content of the brain tissues was determined by dry-wet weight method, while the Evans blue ( EB) content of brain tissue was detected by spectropho-tometry.The protein levels of ZO-1 in the cerebral cortex were analyzed by Western blot.RESULTS:The water contents in the brain tissues in model group, solvent group and XNJ group were significantly higher than those in sham group ( P<0.05) 24 h after ischemia reperfusion.However, the brain water contents in model group and solvent group were signifi-cantly higher than those in XNJ group and sham group (P<0.05) 48 h and 72 h after ischemia reperfusion.The EB con-tents in the brain tissues in model group, solvent group and XNJ group were entirely higher than that in sham group 24 h af-ter ischemia reperfusion (P<0.05).The EB contents in sham group and XNJ group were significantly lower than those in model group and solvent group 48 h and 72 h after ischemia reperfusion (P<0.05).The protein expression of ZO-1 in the rat cerebral cortex in model group, solvent group and XNJ group was significantly lower than that in sham group 24 h after ischemia-reperfusion (P<0.05).Similarly, 48 h and 72 h after ischemia reperfusion, ZO-1 protein level in the cortex in sham group and XNJ group was significantly higher than that in model group and solvent group (P<0.05).CONCLU-SION:At 48 h and 72 h after global ischemia-reperfusion, Xingnaojing injection play a protective role in blood-brain barri-er and this role may be associated with the increase in ZO-1 protein expression by Xingnaojing injection.
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Objective To evaluate the effect of various reduction degrees of large posterior malleolus fracture on contact condition of the tibiotalar joint using biomechanical and finite element methods.Methods Six fresh adult cadaveric calf-foot were tested with different loadings in neutral position,10 degree of dorsiflexion,and 15 degree of plantar flexion.Models included the intact ankle and posterior malleolus fracture (not fixed,fixed with 1 mm step-off,fixed with 2 mm step-off,fixed with 1 mm gap,or fixed with 2 mm gap).Tibiotalar joint contact area,contact pressure,and peak pressure were measured using the Tek-Scan pressure sensor.In addition,a three-dimensional finite element model of the ankle joint was established and tested under the simulated biomechanical conditions.Results Mter a 500 N axial loading in the intact ankle,contact area of the tibiotalar joint was (4.94 ± 0.67) cm2 and loading strength of the tibiotalar joint was (83.4 ± 2.7) ％ of total loading strength.Contact area of the tibiotalar joint in the fracture model fixed with 1 mm gap demonstrated no significant difference in all loading conditions compared with the intact model.In 15 degree of plantar flexion,contact area of the tibiotalar joint differed between the fracture model fixed with 1 mm step-off and the intact model (P ＜ 0.05).In multiple loading conditions,contact area of the tibiotalar joint differed between the fracture models fixed with 2 mm step-off or 2 mm gap and the intact model (P ＜ 0.05).Results of finite element analysis were conformed to the related biomechanical study.Conclusions Anatomic reduction should be pursued for large posterior malleolus fracture.If difficulty exists,fracture displacement should be within 1 mm step-off and 2 mm gap so as to restore the inter-joint congruity.
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BACKGROUND:Muscle atrophy and weakness exist around the knee joint of patients with knee osteoarthritis, comprehensive treatment combined with training muscle power around knee joint can obviously relieve symptoms and restore muscle power around the knee joint. OBJECTIVE:To test the relationship between muscle function around the knee joint and the knee joint function with isokinetic muscle strength test before and after comprehensive treatment of knee osteoarthritis, and to investigate the pathological mechanisms of knee osteoarthritis in order to provide basis for the clinical rehabilitation and treatment. METHODS:We screened out 30 subjects with unilateral knee osteoarthritis (stage Ⅱ and Ⅲ). Hospital for Special Surgery was used to evaluate the knee function, and visual analogue scale score was used to assess the patient pain. The knee muscle function of knee osteoarthritis patients was measured before treatment;the patients with knee osteoarthritis at stage Ⅱ and Ⅲ received comprehensive treatment for at least 1 month (active quadriceps isometric muscle strengthening exercises, oral celecoxib capsules combined with intra-articular injection of sodium hyaluronate), and knee muscle function was measured after treatment. Hospital for Special Surgery and the visual analogue scale score were evaluated during fol ow-up period. RESULTS AND CONCLUSION:Compared with the healthy side, the muscle power of the affected side of the patients with knee osteoarthritis was decreased when the flexion and extension muscle peak torque and work volume tested at 60 (°)/s and 180 (°)/s (P between affected side and healthy side after treatment (P>0.05). There was no significant difference in the peak torque ratio of quadriceps and hamstring measured at 60 (°)/s in the knee osteoarthritis patients before and after treatment (P>0.05), and there was significant difference measured at 180 (°)/s (P<0.05). Knee osteoarthritis patients have decreased muscle strength around the knee joint, and the comprehensive treatment of muscle functional training combined with effective pain relief and nutrition joint drugs can significantly relieve symptoms, improve muscle strength and restore knee function.
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Objective To explore the role of case based learning (CBL)on Otolaryngology-Head and Neck Surgery teaching. Methods First, correct and high-quailty teaching case was selected. Then, reasonable and precise question was edited. All students needed to prepare their lessons before class and were encouraged to ask question or answer question. And some warnings should be noticed. Result After CBL being implemented, the students received higher clinical grades and more clinical skills. They were more likely to retain their initial interest in or switch their preference to careers in otolaryngology. The supervisor highly appreciated our teaching. Conclusion CBL is feasible in Otolaryngology-Head and Neck Surgery teaching and it should be applied more in future.
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Objective To evaluate the clinical result of anterior elbow approach and internal fixation for the treatment of capitulum humeri fractures. Methods From January 1997 to December 2003,11 patients of 9 males and 2 females with capitulum humeri fractures were chosen anterorredial approaches of elbow. The fractures were terated with under direct vision and were fixed with screws. The left arms in 7, right in 4, the age of the group were from 14 to 18 years old, with the average of 15 years. 7 cases of them were treated with close reduction but failed. The operative time was from 3 days to 7 days after injury. They were fresh and close fractures. According to wangyicong's classification system all were TypeⅠ. Results All operations were successful, no nerves and blood vessels injury, the incisions were all healed by first intention. The X-ray films shows that the fractures were anatomic reduction. The healing time was 6 weeks in average and all patients were followed up with an average 3.5 years, no postoperative complications such as:myositis ossificans, post-traumatic arthritis, avascular necrosis of capitulum humeri. According to Cassebanm and the percentage of elbow joints pain was measured with patient visual pain index function score system: 7 caese of excellent, 4 case of good. Conclusion Displace of capitulum-trochlea hemeri does not link with muscle and capsula articularis, blood carries supply. Without avascular necrosis probably occurs at far stage. The close manipulation of capitulum humeri fractures hardly succeeds. The treatment with accurate open reduction associated with strong fixation can decrease the rate of avascular necrosis in the capitulum humeri fractures. The capitulum humeri fractures are suitable for opening reduced direct vision and fixing with screws through anteroeedial approaches of the elbow. The patients were encouraged to proceed for active rehabilitation early such as the elbow flexion-extension. Its short-term clinical outcomes is more excellent.