Otimization of auxiliary lines for proximal femoral intramedullary nail in the treatment of simple femoral intertrochanteric fractures / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical outcomes of C-arm X-ray fluoroscopy before incision to make assistant lines and insert the guide wire of PFNA and PFNA blade.</p><p><b>METHODS</b>From January 1st 2012 to January 1st 2015, 132 intertrochanteric fracture patients of type 31A1 and 31A2 according to AO-classification, were retrospectively analyzed. Among them, 62 patients(14 males and 48 females) aged from 52 to 95 years with a mean age of(69.58±8.55) years in traditional group were operated by traditional procedure, while 70 patients in the skin marking group included 15 males and 55 females aged from 61 to 88 years with a mean age of(71.94±7.64) years, on the basis of the traditional operation method, the assistant line of the body surface and the C-arm X-ray was increased, and the guide pin positioning of the proximal femoral nail and the spiral blade was guided by the auxiliary line in the operation. Operative time, frequency of C-arm fluoroscopy, Harris hip score of the third months after surgery and the complications in both groups were queried for statistical analysis.</p><p><b>RESULTS</b>In addition to skin making group 1 patients had superficial wound infection complications, all patients were stage I wound healing. All patients were followed up for 3 to 18 months with an average of (6.81±3.07) months. The operative time was significantly reduced in skin marking group (56.16±6.36) minutes compared to traditional group (59.06±9.19) minutes (>=0.035). And the frequency of C-arm fluoroscopy of skin marking group was(25.89±5.81) times which was also significantly reduced compared to traditional group(31.32±9.81) times (<0.001). There was no statistical difference in Harris hip score at 3 months after operation and the complication rate between the two groups(>0.05).</p><p><b>CONCLUSIONS</b>In this study, a simple and easy method of assistant line marking can shorten the operation time and reduce the number of times of operation.</p>

Case-control study on modified femoral prosthesis in reducing the incidence of patellar clunk syndrome after the initial posterior stabilized total knee arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To explore therapeutic effects of modified femoral prosthesis applied in the initial posterior stabilized total knee arthroplasty.</p><p><b>METHODS</b>From April 1, 2012 to January 1, 2013, 156 patients with knee osteoarthritis underwent posterior stabilized total knee arthroplasty by the same director of orthopedic surgeon. Sixty-one patients were treated with modified femoral prosthesis, including 7 males and 54 females, with an average age of (68.34 +/- 5.41) years old; and 95 patients were treated with conventional designed femoral prosthesis, including 14 males and 81 females, with an average age of (69.92 +/- 5.11) years old. Indexes including age, body mass index, Insall-Salvati index, type of prosthesis, occurrence rate of patella click syndrome, postoperative line of force of lower extremity and postoperative function of the knee joint were observed and recorded. And American Knee Society (AKS) score was used to evaluate the clinical results.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 36 to 56 weeks, with a mean of 45.31 weeks. Among patients in the conventional designed femoral prosthesis group, 7 patients had patella click syndrome, but there was no patient having patellar click syndrome in the modified femoral prosthesis group. Postoperative knee activity of patients in the modified femoral prosthesis group was (110.98 +/- 10.32) degrees, which was better than (107.05 +/- 8.61) degrees in the conventional designed femoral prosthesis group. The AKS score in the modified femoral prosthesis group was 129.79 +/- 9.63 during 21 to 28 days after operation, which was higher than 126.85 +/- 7.79 in the conventional designed femoral prosthesis group.</p><p><b>CONCLUSION</b>New designed femoral components are effective to reduce the occurrence rate of postoperative patellar click syndrome and obtain better early functional recovery from knee surgery.</p>

Effects of sowthistle-leaf Ixeris seedling injection on survival of random skin flap in rats / 中国骨伤

<p><b>OBJECTIVE</b>To observe the effects of Ixeri sonhifolia injection on random skin flap survival in rats.</p><p><b>METHODS</b>Dorsal full-thickness skin flap model were harvested from 24 Sprague-Dawley rats in 2 to 3 months old. Twelve rats in experimental group were injected intraperitoneally with 5 ml/kg Ixeri sonhifolia injection immediately after the operation, the other rats in control group with an equal volume of saline. The rats were killed by cervical dislocation after 7 days' Ixeri sonhifolia injection. The area ratio of the survival tissue was measured at the 7th day,the tissue samples from proximal, middle, and distal portions were stained by HE and sectioned for histological and image analysis. VEGF was detected by immunohistochemistry.</p><p><b>RESULTS</b>Seven days later, there was statistical significance between the percentage of the survival area of the flap between the experimental group (70.432 +/- 3.867)% and the control group (50.498 +/- 2.346)% (P < 0.05). In the middle portion, edema and infiltration of tissue in the experimental group were reduced than those of the control group, and new blood vessels increased in the experimental group (P < 0.05). A statistical significance of the expression of VEGF was detected between experimental group (4867.31 +/- 452.36) and control group (2387.45 +/- 768.46) (P < 0.05).</p><p><b>CONCLUSION</b>Ixeri sonhifolia injection can promote the survival of random skin flap by increasing the quantity of capillary, reducing inflammatory infiltration of Europhiles and increasing the expression of VEGF, which promote a new approaching for the transpanting of the random flap research.</p>

Analysis on recurrence factors associate with giant cell tumor of tendon sheath in upper extremity / 中国骨伤

<p><b>OBJECTIVE</b>To study the relation of the sex, age, location and chemotherapy with recurrence of the tumor.</p><p><b>METHODS</b>From January 2000 to August 2010, 47 patients with giant cell tumor of tendon sheath in upper extremity were retrospectively analyzed. Statistical analysis of sex, age at presentation, lesion location, chemical inactivation, surgical complications, tumor recurrence and pathological findings were explored. There were 28 females and 19 males, ranging in age from 17 to 78 years, with an average of 38.15 years. All the patients underwent surgical excision. Fourteen patients received intraoperative chemically inactive treatment. All the patients had routine follow-up to observe the wound healing, pathological findings,tumor recurrence, and received necessary imaging examinations.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 22 to 129 months, with a mean time of 53.89 months. Four patients who received intraoperative alcohol inactivation appeared wound complications such as wound swelling, discharge of necrotic tissue, delayed wound healing. Fifteen patients had active growth of tumor tissue, 1 patient had low-grade malignant giant cell tumor of tendon sheath. The recurrence rate was significantly higher in the group which preoperative X-ray was found to have bone destruction (P = 0.003); patients receiving chemically inactivation had lower risk of recurrence after surgery than patients not receiving chemically inactivation (P = 0.042).</p><p><b>CONCLUSION</b>The recurrence rate of giant cell tumor of tendon sheath in upper limb was closely related to tumor growth site, bone destruction and chemical inactivation. Local excision of giant cell tumor of tendon sheath was the effective treatment. How to identify the patients at high risk of recurrence, how to reduce the recurrence rate and the functional restoration after wide resection are the priorities and difficulties of future researches.</p>