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BACKGROUND:The treatment of limbs’ open fracture with severe soft tissue injury is very complicated. There are many wound exudates, high frequency of dressing change, and high infection rate. How to deal with the contradiction between wound treatment and fracture fixation is the considerable problem in clinical therapy. ＜br> OBJECTIVE:To explore the effect of external fixator combined with vacuum sealing drainage on limbs’ open fracture with severe soft tissue injuries. ＜br> METHODS:A total of 34 patients with limbs’ open fracture with severe soft tissue injuries were enrol ed in the First Affiliated Hospital, Xinxiang Medical Col ege from December 2009 to December 2010. There were 20 males and 14 females, with an average age of 36.6 years old. There were 10 cases of upper limb fracture and 24 cases of lower limb fracture. After debridement, cutaneous deficiency accounted for 1%to 6%of surface area. On the basis of external fixation, the wound received vacuum sealing drainage (treatment group;n=17) and conventional dressing (control group;n=17). According to limb swel ing and granulation growth, delayed suture, skin graft or flap to cover the wound were used. After treatment, infection rate of the wound and growth of granulation were observed. In accordance with wound healing and growth of granulation, curative effects were evaluated. ＜br> RESULTS AND CONCLUSION:In the treatment group, there were 11 cases of healing, 5 cases of effective effects, and 1 case of ineffective effect, with a total effective rate of 94%and the infection rate of about 15%. In the control group, there were 7 cases of healing, 6 cases of effective effects, and 4 cases of ineffective effects, with a total effective rate of 76%and the infection rate of about 40%. Significant differences in healing rate, total effective rate and infection rate were detected between the two groups (P＜0.05). The healing time of wound was 8.66-16.23 days in the treatment group and 15.68-22.36 days in the control group. The healing time was significantly shorter in the treatment group than in the control group (P＜0.05). It is thus clear that vacuum sealing drainage has obvious advantages in repair of limbs’ open fracture with severe soft tissue injury compared with the conventional dressing.
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BACKGROUND:Meniscus plasty and prosthesis under an arthroscopy are widely used in treating discoid meniscus or normal meniscus injury.The normal shapes of meniscus are maintained by excising medial partial tears and suturing the lateral partial tearsOBJECTIVE:Injury classification and special features of discoid meniscus and normal meniscus were observed,and corresponding trearing methods were used,to discuss the therapeutic effect of repair.METHODS:Totally 260 cases of meniscus injury in knee ioint were selected from the First Aftiliated Hospital of Xinxiang Medical University from September 2003 to June 2008.They were divided into normal meniscus injury group(n=215),and discoid lateral meniscus injury(n=45).People with complete clinical data before operation and following data,confirmed by arthroscopy were selected.Meniscus injury in 260 cases was examined by arthroscopy,and plasty,or partial excision or incomplete resection or full resection was performed according to the injury types and surgical circumstance.RESULTS AND CONCLUSION:All subjects were followed for half a year to 2 years The knee function was evaluated by the Tenger criterion.Four tear types of Discoid meniscus were as follows:73.3% horizontal,15.5% complex,4.4% radial,and 2.2% longitudinal.Five tear types of normal meniscus were as follows:47.9% longitudinal,28.8%radial,1 1.6%horizontal,6 5% transverse and 5.1% complex.In 215 cases of normal meniscus,there were 165 knees with excellentfunction,35 with good,8 with fair and 7 with poor.The excellent and good rate was 93.0%.In 45 cases of discoid meniscus.there were 25 knees with excellent function,16 with good,3 with fair and 1 with poor.The excellent and good rate was 91.1%.Discoid meniscus is different from normal meniscus in anatomical feature and histological structure,therefore,the arthroscopic surgery for discoid meniscus is also different.The most function of meniscus should be remained and the degeneration of knee ioint should be delayed.Meniscus plasty should be performed in all discoid meniscuses except the patients with severe tear of meniscus.
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BACKGROUND: A lot of important organs are worthless for clinical application because they are hard to store for a long time. In addition, tissues or organs which are dealt with cryopreservation also attack ischemia/reperfusion injury with the recovery of blood flow; especially, skeletal muscle is the most involved tissue.OBJECTIVE: To observe the protective influence of edaravone on cellular membrane and mitochondria of replanted rat extremities following ischemia/reperfusion injury due to cryopreservation and rewarming.DESIGN: Randomized contrast animal study.SETTING: Basic Medical College of Southern Medical University; Department of Hand and Foot Surgery, Shandong Provincial Hospital.MATERIALS: The experiment was carried out in the Cryopreservation Laboratory, Shandong Provincial Hospital from April to November 2006. A total of 36 healthy adult male Wistar rats were provided by Experimental Animal Center of Medical College of Shandong University. All rats were randomly divided into control group, cryopreservation group and edaravone group with 12 in each group.METHODS: Femoral artery and vein of rats in control group were exposured, but extremities were not blocked. Rats in other two groups were used to establish ischemia/reperfusion injury models of replanted extremities. Before cryopreservation, their right hindlimbs were cut off and maintained in liquid nitrogen container for 1 month. After the operation mentioned above, the broken limbs were rewarmed, perfused with routine eluant and replanted. Four hours later, blood supply of extremities was recirculated and the samples were selected. Eluant in edaravone group contained 0.5 mg/kg edaravone. Samples of skeletal muscle were selected at the same time point to establish cellular membrane and extract mitochondria. Furthermore, fluorescence polarization of cellular membrane (reflecting liquidity in cellular membrane lipid area), malondialdehyde (MDA) content of mitochondria, superoxide dismutase (SOD) activity and respiratory controlling rate were measured; meanwhile, mitochondrial ultrastructure of skeletal muscle was observed under transmission electron microscope.MAIN OUTCOME MEASURES:①Fluorescence polarization of cellular membrane, MDA content of mitochondria, SOD activity and respiratory controlling rate of skeletal muscle; ②mitochondrial ultrastructure of skeletal muscle.RESULTS: All 36 rats were involved in the final analysis without any loss. ①SOD activity and respiratory controlling rate of mitochondria in skeletal muscle: The values of these two items were higher in edaravone group that those in cryopreservation group (P＜0.05).②Fluorescence polarization of cellular membrane and MDA content of mitochondria in skeletal muscle: The values of these two items were lower in edaravone group than those in cryopreservation group (P＜0.05). ③Mitochondrial ultrastructure of skeletal muscle: Injured degree of skeletal muscle was milder in edaravone group than that in cryopreservation group.CONCLUSION: Edaravone can relieve ischemia/reperfusion injury of skeletal muscle and protect cellular membrane and mitochondria of skeletal muscle. Its mechanism may be related to directly inhibiting hydroxy free radicals, increasing SOD activity of skeletal muscle, reducing generation of MDA and promoting normal oxidative phosphorylation.
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[Objective]To observe the effect of the nonunion of humeral shaft fracture treated by bidentate intramedullary locking nails.[Method]Twenty-five cases of fracture nonunion of humeral shaft were cured by bidentate intramedullary locking nails from January 2000 to November 2004.and they received operations to remove their previous instruments.After the bidentate intramedullary nails was inserted via antegrade approach,and autogenous cancellous bone was grafted.[Result]Twenty of the 25 cases were available for follow up.The follow up lasted 10 to 26 months.All cases achieved solid union within 4 to 10 months.There were no complication such as incision infection or occurring of osteomyelitis.[Conclusion]Bidentate intramedullary locking nails can provide the effective control of harmful shearstress,it can provide firm internal fixation,And this methods is an ideal method for treatment of humeral shaft fracture nonunion.