Clinical outcome analysis on using extensor digitorum communis splitting approach for the treatment of radial head fractures / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical outcomes of internal fixation or replacement for the treatment of radial head fractures through the extensor digitorum communis splitting approach.</p><p><b>METHODS</b>From July 2012 to May 2015, 25 patients with radial head fractures were reviewed. There were 17 males and 8 females, ranging in age from 20 to 67 years old, with a mean age of 39 years old. Twenty-one patients were treated with reconstruction of plate internal fixation, and 4 patients were treated with radial head replacement. According to Mason classification, 19 cases were type II and 6 cases were type III. All the patients underwent internal fixation or replacement through the extensor digitorum communis splitting approach. The patients were followed up clinically and radiographically until the beginning of fracture union and the entrance of function recovery of elbow motion into a plateau. The functional status of the elbow was evaluated using the Mayo Elbow Performance Index(MEPI). Radiographic signs of post-traumatic arthritis were rated according to the Broberg and Morrey system.</p><p><b>RESULTS</b>All the patients were followed up, and the average duration was 29 months (ranged, 12 to 56 months). The average range of flexion and extension was 120°, the extension was limited by 10°, and the flexion was 135°. The average forearm rotation range was 142°, pronation was 75°, supination was 67°. The mean MEPI was 93±7(ranged, 80 to 100 scores); according to the MEPI scoring criceria, 19 patients got an excellent functional result, 6 good. According to the Broberg and Morrey systems of traumatic arthritis, 19 patients were in grade 0, 6 in grade 1, and no patients in grade 2 or 3. No patients with nonunion of the radial head and failure of internal fixation were found. There were no complications of nerve or vascular injuries, and obvious limitation of elbow rotation. Heterotopic ossification around the elbow occurred in 4 cases, but the motion was not significantly limited. There were no complications such as prosthesis loosening and infection in 4 cases after radial head prosthesis replacement.</p><p><b>CONCLUSIONS</b>The extensor digitorum communis splitting approach is an effective exposure method for internal fixation or replacement in the treatment of radial head fractures.</p>

Treating Neer two- and three-part of proximal humeral fractures through anterolateral acromial approach and deltopectoral approach / 中国骨伤

<p><b>OBJECTIVE</b>To compare clinical results of treating Neer two- and three-part of proximal humeral fractures between anterolateral acromial approach and deltopectoral approach.</p><p><b>METHODS</b>From January 2009 to December 2012, 49 patients with Neer two- and three-part of proximal humeral fractures were treated with locked plate fixation. In anterolateral acromial approach group, there were 22 patients including 9 males and 13 females with an average of (63.2±7.6) years old, while 27 patients in deltopectoral approach including 12 males and 15 females with an average of (62.9±7.0) years old. Operative time, blood loss during operation, fracture healing time and complications were observed and compared, postoperative Constant-Murley scoring and VAS scoring were applied for evaluate function of shoulder joint and pain at 3 months, 1 and 2 years respectively.</p><p><b>RESULTS</b>All patients were followed up from 24 to 41 months with an average of 34.5 months. Operative time, blood loss, fracture healing time in anterolateral acromial approach group was (68.20±7.04) min, (151.30±20.57) ml, (10.88±4.90) weeks respectively, and better than that of in deltopectoral approach group which was (75.81±13.70) min, (242.10±37.25) ml and (13.60±2.45) weeks. Three months after operation, Constant-Murley scoring and VAS score in anterolateral acromial approach group was 88.32±5.45, 0.41±0.63 and better that of in deltopectoral approach group which was 63.53±8.31, 1.65±1.02. There was no significant differences between two groups in Constant-Murley scoring and VAS score at 1 and 2 years after operation. Each group has one case occurred loss of length humerus head height, and there was 1 case with subacromial impingement, 1 case with bolt loose and 2 cases with delayed union in deltopectoral approach. No axillary nerve injury, humeral head necrosis and breakage of internal fixation occurred both of two groups.</p><p><b>CONCLUSION</b>Both of anterolateral acromial approach and deltopectoral approach are effective in treating Neer two- and three-part of proximal humeral fractures, and can obtain excellent outcomes. Moreover, anterolateral acromial approach has advantage of less trauma, less blood loss, shorter operative time, rapid recovery of shoulder joint function and fracture.</p>

Cause analysis of 280 case of fractures nonunion / 中国骨伤

<p><b>OBJECTIVE</b>To research many clinical data of nonunion cases and discover the reasons for low capacity of bone growth.</p><p><b>METHODS</b>From October 1999 to April 2009,the source material of 280 nonunion cases were conducted and followed up. The data of the study included 230 males and 50 females,with an average age of 39.4 years old ranging from 19 to 62 years. The fracture position was femur in 129 cases,tibia in 83 cases,humerus in 47 cases, feet radius bone in 21 cases, the ratio was 46:29.6:16.8:7.5. The survey included primary injury process,damage degree and the effect of first treatment,hospital level of first treatment,timing of surgery for the first time, the early callus growth conditions and whether there were obvious technical errors.</p><p><b>RESULTS</b>There were 129 femoral nonunion cases with complete data,121 cases derived from closed fractures, 8 cases from open fractures; 111 cases was aseptic nonunion. 90% of femoral aseptic nonunion had no obvious callus growth, 80% of first treatment performed intraday surgical internal fixation, 10% were undergone operation within three days and 90% was early surgery totally.</p><p><b>CONCLUSION</b>Low quality of bone callus growth is the main reason for current nonunion and the early surgical fixation has much to do with low quality of bone callus growth.</p>

The treatment of knee joint peripheral fractures and/or dislocations with vascular injury / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effect and influence factors on knee joint peripheral fractures and/or dislocations with an associated vascular injury through retrospectively study.</p><p><b>METHODS</b>From March 2002 to November 2007 31 patients with knee joint peripheral fractures and/or dislocations with an associated vascular injury were treated, including 24 males and 7 females with a mean age of 41 years (range from 21 to 62 years). Definite diagnosis of vascular injury by combining colored ultrasonic, CTA, operative exploration with clinical signs, fixing fractures and/or dislocations with fixators, plates and screws, reconstructing blood circulation based on the condition of the vascular injury by vascular repair, homograft vein or artificial vascular grafting separately and analysing the effects of PSI, diagnosis and treatment methods on salvage lower extremities.</p><p><b>RESULTS</b>Successful reconstruction was carried out in 31 cases, however there were 1 death because of mult-fractures and brain injury and 6 amputation, 24 cases successful salvage followed up mean 24.2 months, 6 cases bone nonunion and infected bone defect were cured by delayed bone planting or bone transportation. Ligaments repair reconstruction of 7 cases knee joint dislocation were done in delayed 3 or 4 weeks after first operation, the good functional rate was 71.4%.</p><p><b>CONCLUSIONS</b>The patients of PSI under 10 grades in knee joint peripheral fractures and/or dislocations with an associated vascular injury should been carried out treatment, early definite diagnosis and blood circulation reconstruction are the key factors of successful salvage treatment.</p>

Treatment of acute and chronic osteomyelitis with negative pressure wound therapy / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the treatment of acute and chronic osteomyelitis with negative pressure wound therapy.</p><p><b>METHOD</b>Thirty cases of acute and chronic osteomyelitis were treated with negative pressure wound therapy, assisted with debridement, autodermoplasty and myo-cutaneous flap surgery.</p><p><b>RESULTS</b>No evidence of relapse was found in all cases treated with negative pressure wound therapy. All the patients were followed up, range from 6 to 23 months, the average was 13.6 months.</p><p><b>CONCLUSION</b>The negative pressure wound therapy maybe a simple, effective and inexpensive method, and could be one of the favorable therapy in the treatment of acute and chronic osteomyelitis.</p>

Stress test and clinical application of the minimal-invasive dynamic hip screw / 中国骨伤

<p><b>OBJECTIVE</b>To recognize the effect of minimal-invasive dynamic hip screw (MIDHS) on the treatment of intertrochanteric fracture of the hip by biomechanical test and preliminary clinical application.</p><p><b>METHODS</b>Ten artifical made intertrochanteric fractures of femoral specimen from five cadavers were divided into two groups randomly. The fractures in first group were fixed by MIDHS and other group were fixed by dynamic hip (DHS). Biomechanical characteristics of two different devices were compared with the biomechanical character of load-straining, load-displacing, rigidity and strength of femur by statistic analysis. According to the Harris evaluation, healing effect of intertrochanteric fractures was evaluated clinically on the 15 cases.</p><p><b>RESULTS</b>Straining changes of MIDHS were 14% and 11% less than that of DHS on the tensile side and the pressure side respectively; Sinking and horizontal displacement, were 19% and 22% less than that of DHS respectivly. But external and internal stress intensity,axial and bending rigidity were all higher than that of DHS, they were 12%, 11%, 19% and 37%. Maximal destroyed twisting moment (15%) and average twisting rigidity (15%) were both higher than that of DHS, but twisting angle was 18% less. Under the force, of 1 800 N, the open angle of the fracture on transverse section was 2.28 degrees,while the DHS's was 3.60 degrees . The data above were significant differences statistically (P < 0.01). The average Harris score of the 15 cases with intertrochanteric fractures treated by MIDHS was 91, excellent and good rate was 92.7%, without complications of internal fixation failure,postoperative infection and so on.</p><p><b>CONCLUSION</b>The design of minimal-invasive dynamic hip screw is reasonable and effective against rotating, shearing and varus stress force of the fracture, and it provides possibility of implanting the internal fixation with minimal incision. So it is an ideal internal fixation device for the treatment of intertrochanteric fractures.</p>

Ex vivo expansion and pluripotential differentiation of cryopreserved human bone marrow mesenchymal stem cells / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

This study is aimed at investigating the potentials of ex vivo expansion and pluri-differentiation of cryopreservation of adult human bone marrow mesenchymal stem cells (hMSCs) into chondrocytes, adipocytes and neurocytes. Cryopreserved hMSCs were resuscitated and cultured for 15 passages, and then induced into chondrocytes, adipocytes and neurocytes with corresponding induction medium. The induced cells were observed for morphological properties and detected for expressions of type II collagen, triglyceride or neuron-specific enolase and nestin. The result showed that the resuscitated cells could differentiate into chondrocytes after exposure to transforming growth factor beta(1) (TGF-beta(1)), insulin-like growth factor I (IGF-I) and vitamin C (V(C)), and uniformly changed morphologically from a spindle-like fibroblastic appearance to a polygonal shape in three weeks. The induced cells were heterochromatic to safranin O and expressed cartilage matrix-procollagenal (II) mRNA. The resuscitated cells cultured in induction medium consisting of dexamethasone, 3-isobutyl-1-methylxanthine, indomethacin and IGF-I showed adipogenesis, and lipid vacuoles accumulation was detectable after 21 d. The resuscitated hMSCs were also induced into neurocytes and expressed nestin and neuron specific endolase (NSE) that were special surface markers associated with neural cells at different stage. This study suggested that the resuscitated hMSCs should be still a population of pluripotential cells and that it could be used for establishing an abundant hMSC reservoir for further experiment and treatment of various clinical diseases.

Tibial infected nonunion treated by internal bone transport using the mono-lateral external fixation / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical and functional outcomes of infected nonunion of the tibia by internal bone transport using the LRS mono-lateral external fixation.</p><p><b>METHODS</b>From June 2003 to October 2005, twenty-eight patients who underwent internal bone transport for infected nonunion in the tibia were reviewed. Twenty-three cases were open fractures: grade IIIA, 5 cases; grade IIIB, 11 cases; grade IIIC, 7 cases. The other five cases were infected nonunion after internal fixation. The results were evaluated by the classification of the Association for the Study and Application of the Method of Ilizarove (ASAMI) which divided into bone and functional categories.</p><p><b>RESULTS</b>Mean follow-up was 16 months. All the cases got primary bone union, and infection was controlled. Bone results were 14 excellent, 9 good, 2 fair and 3 poor. And functional results were 10 excellent, 13 good, 2 fair and 3 poor. The mean length of time in healing for all patients were 9 months. The mean length of regenerate bone were 6.6 cm. The most common complication was pin infection, and 2 cases refractured at the docking site.</p><p><b>CONCLUSIONS</b>Tibial infected nonunion can be successfully treated using the internal bone transport technique.</p>

A web-based biomedical image mosaicing system / 中国医疗器械杂志

This paper describes a web service for biomedical image mosaicing. A web site based on CGI (Common Gateway Interface) is implemented. The system is based on Browser/Server model and is tested in www. Finally implementation examples and experiment results are provided.

Treatment of ipsilateral hip and femoral shaft fractures with reconstructive intramedullary interlocking nail / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the results of reconstructive intramedullary interlocking nail in the treatment of ipsilateral hip and femoral shaft fractures.</p><p><b>METHODS</b>From August 1997 to November 2001, 13 patients were treated with the reconstructive intramedullary interlocking nail. Nine patients were associated with ipsilateral femoral neck fractures, three with ipsilateral intertrochanteric fractures, and one with subtrochanteric fracture.</p><p><b>RESULTS</b>The follow-up time was from 6 to 38 months with an average of 14 months. All the femoral shaft and hip fractures healed up well. There was no nonunion of the femoral neck, and only one varus malunion. No patient had avascular necrosis of the femoral head. The average healing time for femoral neck fracture was 4.6 months and for shaft fracture 5.8 months. The joint movement and other functions were fairly resumed.</p><p><b>CONCLUSIONS</b>The reconstructive intramedullary interlocking nail, with less trauma, reliable fixation, and high rate of fracture healing, is an ideal method of choice in the treatment of ipsilateral hip and femoral shaft fractures.</p>

An anatomical study of corona mortis and its clinical significance / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To provide detailed information of corona mortis for ilioinguinal approach as an anterior approach to the acetabulum and pelvis.</p><p><b>METHODS</b>The course, branches and distribution of the vascular connection between the obturator system and the external iliac or inferior epigastric systems located over the superior pubic ramus were observed on 50 hemipelvises with intact soft tissues.</p><p><b>RESULTS</b>During the dissections, 72% of the cadaveric sides had at least one communicating vessel between the obturator system and the external iliac or inferior epigastric systems on the superior pubic ramus. The average diameter of the connecting vessel was 2.6 mm (range, 2.0-4.2 mm). It coursed over the superior pubic ramus or iliopubic eminence vertically to enter the obturator foramen and exit the pelvis. The average distance from pubic symphysis to the vascular connections between the obturator and external iliac systems was 52 mm (range, 38-68 mm).</p><p><b>CONCLUSIONS</b>Vascular connections between the obturator system and the external iliac or inferior epigastric systems were found over the superior pubic ramus with a high incidence. They are prone to damage during the ilioinguinal approach as an anterior approach to the acetabulum and pelvis. Thus, corona mortis located over the superior pubic ramus deserves great attention during the ilioinguinal approach.</p>

Reinforced bar-ring Hybrid external fixator combined with limited internal fixation for complex fractures of tibial plateau / 中华创伤杂志

Objective To introduce the experience and analyze the clinical outcome of applica- tion of reinforced bar-ring hybrid external fixator combined with limited internal fixation for complex frac- turcs of tibia plateau in patients.Methods From Aug.2002 to Feb.2005,21 patients with complex fractures of tibial plateau were treated with reinforced bar-ring hybrid external fixatar combined with lim- ited internal fixation.According to Schatzker classification,there were 13 patients with typeⅤfracture and 8 with typeⅥfracture.Voluntary and non-weight beating knee joint motion to partially weight bear- ing was taken one week after operation.Progressive loading was taken continuously until there was clinical evidence of fracture stability and then full weight bearing was done.Results The mean follow-up peri- od was 15.9 months (10-24 months).All the fractures got united and the mean union time was 4.2 months(3-8 months).All the injured knees could extend to less than 5 degrees and flex to more than 90 degrees after rehabilitation.Evaluated by Merchant score system for knee joint,81% of patients achieved excellent healing (7 cases) and good healing (10 cases).Conclusion Operation by using reinforced bar-ring hybrid external fixator combined with limited internal fixation can reduce complications and avoid stiffness of the knee joint.It is an effective method for complex fractures of tibial plateau.