Application of reverse dermal revascularization combined with vacuum sealing drainage in the large area of skin avulsion of the lower extremities / 中国骨伤

OBJECTIVE@#To summarize the clinical effect of emergency subcutaneous vascular network reverse skin replantation combined with vacuum sealing after drainage of large area skin avulsion injury.@*METHODS@#Clinical data of 30 patients with extensive skin avulsion of the lower limb treated between July 2010 and March 2018 were collected. There were 20 males and 10 females, ranging in age from 16 to 67 years old, with an average of(48±13) years old. Cause of injury: 19 cases of car accident injury, 11 cases of crush injury. The surgery time was 3 to 10 h, with an average of (5±1) h. All cases were completely debrided in stage I. The subdermal vascular network was reversed and skin grafted with multiple incision drainage combined with negative pressure closed drainage technique for 7 to 10 days. The wounds were removed by VSD observation:if the necrotic area is large, debridement is required. After the granulation growth of the wound is satisfactory, the skin grafting is performed again after electrification; the small area of necrotic skin strengthens the dressing and heals.@*RESULTS@#30 patients were followed up for 7 to 48 months, with an average of (20±11) months.No infection in 1 case appeared, 30 patients, living area more than 85% of the wound after treatment survival in the stage I; The skin necrosis ranged from about 12% in 5 patients in the stage II. The second stage was healed after redebriding free skin grafts. The other patients were healed after the dressing, capillary meshwork layer of skin color, good elasticity, feeling, wearable pressure, each joint activities is good, no obvious skin adhesion cause physical activity is limited.@*CONCLUSIONS@#Reverse skin grafting combined with VSD for the treatment of large skin avulsion of lower limb can greatly reduce wound infection rate, promote the application of skin and wound, conducive to drainage, improve the survival rate of reverse skin grafting and improve the function of lower limb joints.

Meta analysis of unilateral condylar replacement and high tibial osteotomy in the treatment of medial compartment osteoarthritis of the knee / 中国骨伤

OBJECTIVE@#Meta-analysis was used to compare the clinical efficacy of high tibial osteotomy(HTO) and unicondylar arthroplasty (UKA) in the treatment of medial compartment osteoarthritis (MIOA) and provide a better surgical choice for patients with MIOA.@*METHODS@#The Cochrane Library (Issue 6, 2017), PubMed, Ovid, ELSIVE, CNKI and Wanfang databases were searched by a computer. Literatures on HTO and UKA for MIOA from January 1, 1970 to June 30, 2017, including complications, knee joint score, knee mobility, revision rate and excellent and good rate, were searched and screened out according to the inclusion criteria, and strict quality evaluation was carried out. RevMan 5.0 software provided by Cochrane collaboration network was used to conduct the meta-analysis of the included research results and to test the heterogeneity of the data.@*RESULTS@#Total 13 articles met the inclusion criteria, and the total sample size was 1 043. Among them, 462 were HTO treatment group and 581 were UKA treatment group. By comparison between HTO treatment group and UKA treatment group, there were significant differences in the contralateral deterioration rate[WMD=3.21, 95%CI(1.13, 9.10)], pre-operative knee range of motion[WMD=6.55, 95%CI(1.44, 11.66)], Lysholm knee score[WMD=-3.15, 95%CI(-4.77, -1.53)], complications[WMD=2.78, 95%CI(1.52, 5.11], revision rate[WMD=1.81, 95%CI(1.17, 2.80)], the rate of excellent and good[WMD=0.49, 95%CI(0.30, 0.80)], and femorotibial angle changes[WMD=-2.37, 95%CI, (-3.63, -1.11)](0.05).@*CONCLUSIONS@#Based on the limited data, high tibial osteotomy is a better choice for the treatment of medial compartment osteoarthritis in the comparison of short and medium-term clinical outcomes, and long-term clinical outcomes may need further study.

biomechanical study of rupture of achilles tendon and repair by different suture techniques

Objective: To study the biomechanical properties of different suture methods, and to provide evidence for the clinical application of this suture methods in repairing acute Achilles tendon rupture

Methods: Twenty four fresh frozen cadaver Achilles tendon specimens were collected and randomly divided into three groups [n=8], Group-A Bunnell suture method, Group-B Bosworth suture and Group-C anchor suture respectively. 5 N tensions were applied to tighten the tendon. The actual length of the tendon between the upper and lower clips was measured with a ruler. The length of the long axis and the short axis of the three sections of the tendon was measured by vernier caliper. The cross sectional area of the tendon was calculated according to the elliptical area formula and the mean value was obtained

Results: There was no significant difference in the length and cross-sectional area of each tendon among three groups [F=0.26, P=0.86; F=0.09, P=0.96]. There was no significant difference in the maximum load of tendon and failure displacement in Group A and B [P>0.05]. The maximal load of Group-C was significantly larger than that of Group A and B [P<0.05], and there was no significant difference between the failure displacement and Group A and B [P>0.05]

Conclusion: Three suture methods can provide good biomechanical properties, but the anchor suture is more effective in solving the shortcomings of traditional methods. It is a safe and effective method, and is worthy of promotion