Treatment of comminuted Neer IV fracture of proximal humerus with lower shoulder replacement assisted by 3D technique / 中国骨伤

OBJECTIVE@#To observe and compare the shoulder joint function, complications and clinical effects of hemiarthroplasty and open reduction and locking plate in the treatment of comminuted proximal humeral fracture (Neer IV) with 3D printing technique.@*METHODS@#From March 2012 to April 2018, 31 middle age and elderly patients with comminuted proximal humeral fractures (Neer IV) were treated, including 4 males and 27 females, aged from 55 to 94 years old with an average age of 71 years, with a course of 1 to 3 years. Among them, 20 cases were treated with open reduction and locking plate internal fixation (ORIF group) and 11 cases were treated with lower half shoulder replacement (HA group) assisted by 3D printing technology. Using CT data and Mimics software of Materialise Company in Belgium, the reconstruction of fracture was simulated on computer. The height of fracture end to humeral head, the height of tubercle to humeral head, the angle of humeral head backward obliquity were measured to assist the hemiarthroplasty. Follow-up and X-ray examination were performed, the incidence of complications were observed, and Neer score was used for the shoulder joint function.@*RESULTS@#Thirty-one patients were followed up for 1 to 3 years with an average of 2 years. In HA group, there was no prosthesis loosening, fracture and subsidence, the head of artificial humerus was intact, the fracture of nodules and nodules did not heal in 1 case, Neer score was 84.18±3.55; in ORIF group, there were 8 cases of proximal humerus bone resorption, 1 case of fracture nonunion, 1 case of internal fixation loosening, Neer score was 55.91±10.78; there was significant difference in Neer score of shoulder joint function between the two groups(<0.05).@*CONCLUSIONS@#Ultrasound-guided minimal traverse-cross technique repair for acute closed Achilles tendon ruptures, which promise minimal incision, protect sural nerve, ensure quality of tendon anastomosis and fixation, and is a ideal method for repairing acute closed Achilles tendon ruptures.

Treatment of Pauwels type III femoral neck fractures with modified percutaneous compression plate / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the preliminary effects of modified percutaneous compression plate in treating femoral neck fractures of Pauwels type III.</p><p><b>METHODS</b>From March 2012 to March 2016, 35 patients with femoral neck fracture were treated by closed reduction and internal fixation with a modified percutaneous compression plate, including 21 males and 14 females with an average age of 45 years old ranging from 23 to 62 years old. The anatomical position of fracture was divided into 8 cases of lower head type, 27 cases of head and neck. According to the Garden classification, there were 8 cases of type II, 18 of type III, and 9 of type IV fractures. All patients were closed injury. The general information, reduction quality, fracture healing time, 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 15 to 24 months with an average of 20 months. All the incisions were primary healing. The reduction quality of the femoral neck fracture was evaluated according to the Garden's alignment Index, and the quality of reduction was grade I reduction in 29 cases and grade II reduction in 6 cases. No nonunion, femoral avascular necrosis, implant failure and hip varus was observed during follow-up. Harris score was(92.70±4.60) points at final follow-up, the results of the treatment was evaluated as excellent in 26 cases, good in 8 cases, fair in 1 case. No complications such as internal fixation loosening, nail breaking, and heterotopic ossification occurred.</p><p><b>CONCLUSIONS</b>Internal fixation with modified percutaneous compression plate has an advantages of decreased trauma, simple operation, rigid fixation, good function outcome, and low risk of complications.</p>

Design of the reduction fixator and its clinical application in treating fracture of lesser trochanter of femur / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the clinical significance of the reduction and fixation for femoral lesser trochanteric fragment in treating the femoral comminuted intertrochanteric fractures.</p><p><b>METHODS</b>From January 2012 to December 2013,32 patients with intertrochanteric fractures were treated by surgery, and self-designed reduction fixators were used in the patients for the fixation of lesser trochanter of femur. There were 11 males and 21 females, ranging in age from 45 to 81 years old with an average of 64 years old. According to the Evans typing, 12 cases were type II, 13 cases were type III and 7 cases were type IV. Simple lag screw fixed in 19 cases and steel wire fixed in 13 cases. Hip joint function was evaluated according Harris score and the complications such as coxa adducta,cutting of femoral head and neck,implants breakage were observed.</p><p><b>RESULTS</b>Thirty-two patients were followed up from 9 to 24 months with an average of 13 months. Coxa adducta occurred in 1 case,no cutting of femoral head and neck occurred and implants breakage were found. The mean Harris score was 91.80 ± 3.05 in 32 patients.</p><p><b>CONCLUSION</b>The reconstruction and fixation for the posterior medial bone cortex continuity is a key factor on affect the stability of femoral intertrochanteric fracture. Self-designed reduction fixators can effective reduce and fix the lesser trochanter of femur, it has advantage of fast reduction and fixation, and simple operation.</p>

Operative treatment for proximal humeral fracture with rotator cuff tear in elderly patients / 中国骨伤

<p><b>OBJECTIVE</b>To explore operative clinical outcomes of proximal humeral fracture with rotator cuff tear in elderly patients.</p><p><b>METHODS</b>From March 2010 to August 2014,54 elderly patients with proximal humeral fractures with rotator cuff tear were performed operation, including 30 males and 24 females aged from 68 to 83 years old with an average of 71.5 years old. Thirty patients were caused by falling down, 24 cases were caused by traffic accident. According to Neer classification, 3 cases were part I, 11 cases were part II, 21 cases were part III and 19 cases were part IV. All patients were operated with open reduction and plate internal fixation, 46 cases suffered from rotator cuff tear and carried out repair of rotator cuff; 8 cases were not suffered from rotator cuff tear. Postoperative Neer evaluation of shoulder's function were used to assess clinical results.</p><p><b>RESULTS</b>Forty-six patients with rotator cuff tear were followed up from 8 to 21 months with an average of 11 months. All fractures were obtained bone union. No incision infection, axillary nerve injury,loosening screw, plate breakage, shoulder joint dislocation and humeral head osteonecrosis were occurred. According to Neer evaluation of shoulder's function, total score was 88.60 ± 5.12, and 30 cases got excellent results, 7 cases good, 7 cases moderate and 2 cases poor.</p><p><b>CONCLUSION</b>For osteoporotic proximal humeral fractures with rotator cuff tear in elderly patients' plate with rivet repair at stage I is an effective stable method, and provide advantages for earlier exercise of shoulder joint, then receive good clinical effects in further.</p>

Application of cerebral protection to carotid endarterectomy at perioperation, intraoperation, and postoperation / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the significance of cerebral protection applied at carotid endarterectomy (CEA) at perioperation, intraoperation, and postoperation.</p><p><b>METHODS</b>Thirty patients underwent CEA with application of cerebral protection at perioperation, intraoperation, and postoperation in our hospital from January 2002 to August 2005. Perioperative carotid Doppler ultrasound and computed tomography angiography (CTA) were applied in 29 patients and carotid angiography applied in only one patient. The key methods of intraoperative cerebral protection included general anaesthesia, selective shunting, monitoring of transcranial Doppler, and careful manipulation. The methods of postoperative cerebral protection included leaving tracheal cannula and brain ice-bag, maintaining normal blood pressure, and applying dehydrant under guidance by monitoring of transcranial Doppler.</p><p><b>RESULTS</b>Among all the 30 patients, shunts were used in 10 patients (33%), and angioplasty by patch was applied in 17 patients (57%). No cranial nerve-associated complications or death was documented.</p><p><b>CONCLUSION</b>Application of cerebral protection at CEA at perioperation, intraoperation, and postoperation can effectively prevent the occurance of cranial nerve-associated complications.</p>

Changes in P-selectin expression after brain injury in rats / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the relationship between expression thange of P-selectin after brain injury and secondary brain damage.</p><p><b>METHODS</b>Sixty SD rats were randomized into 3 equal groups, namely the control group, mild injury group and severe injury group and animal models of brain injury were established in SD rats according to the method of Feeney. P-selectin expression in the brain tissues were determined at 6 h and l, 3, and 7 days following brain injury (n=5 for each time point). Imaging analysis was performed using computerized imaging technique.</p><p><b>RESULTS</b>P-selectin expression and neutrophil infiltration in the brain tissues increased significantly 6 h after brain injury (P<0.05), reaching the peak level at postoperative 24 h and then gradually decreased.</p><p><b>CONCLUSION</b>P-selectin expression and neutrophil infiltration increase significantly following brain injury, and the time course and distribution of P-selectin expression are consistent with the secondary damage of the brain, strongly suggesting the involvement of P-selectin upregulation in the secondary insult after brain injury.</p>

Microsurgical resection of craniopharyngioma of the third ventricle via an improved transventricular approach / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Craniopharyngioma of the third ventricle is difficult to treat and its therapeutic regimens and operative approaches have been controversial. This study was undertaken to probe indications for microsurgical resection of craniopharyngioma of the third ventricle via an improved transventricular approach, its surgical procedures and therapeutic effects, and prevention of postoperative complications.</p><p><b>METHODS</b>Fifty-one patients with craniopharyngioma of the third ventricle were treated from January 2000 to October 2004 by an improved transventricular approach for removing the tumor via the interventricular foramen, the intermedius of the septum pellucidum or choroid fissure. Symptoms and signs of the patients, and results of imaging, operation, and follow-up were analyzed.</p><p><b>RESULTS</b>Of the 51 patients who had received the improved transventricular resection, 4 underwent a combined approach with an entrance of the pterion. Forty patients (78.43%) underwent total resection and others subtotal resection, without an operative death. Epileptic seizures were found in 3 patients (5.88%) and subdural effusion in the operative field in 4 (7.84%). All patients showed good general conditions after operation, and follow-up for an average of 27.52 months showed relapse of the tumour in 8 patients (15.69%).</p><p><b>CONCLUSIONS</b>Microsurgical resection of craniopharyngioma of the third ventricle by an improved transventricular approach has advantages of operative safety and efficacy, lower mortality and disability, and less complications.</p>