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Objective:To investigate the clinical significance of excessive inlet view in fluoroscopy-assisted placement of sacroiliac screws.Methods:Included for this prospective study were 47 patients with unstable pelvic fracture who had been admitted to Department of Orthopaedic Trauma, Xi'an Honghui Hospital between January 2020 and January 2021. There were 30 males and 17 females, with a mean age of 39.4 years (from 25 to 66 years). By the Tile classification, 21 fractures were type B and 26 ones type C. The inlet view and the angle of excessive inlet view were measured before operation. The intraoperative placement of sacroiliac screws was assisted by C-arm fluoroscopy navigation in the excessive inlet view. The positions of sacroiliac screws were verified by CT or O-arm fluoroscopy after operation. The screw placement time, fracture reduction quality, fracture healing time, and pelvic function at the last follow-up were recorded.Results:A total of 67 screws were implanted in the 47 patients, including 56 sacroiliac screws. The insertion time for each screw averaged 19.9 min (from 9 to 31 min); the angle of excessive inlet view averaged 17.38° (from 12.1° to 24.8°). Verification by O-arm fluoroscopy or CT revealed that all sacroiliac screws were located in the sacral canal without dislocation or breaking through the cortical bone. By the postoperative Matta scoring, the reduction was excellent in 22 cases, good in 17, acceptable in 6, and poor in 2, giving an excellent to good rate of 83.0%(39/47). The average follow-up time for the 47 patients was 9.5 months (from 5 to 15 months); fracture healing time averaged 10.5 weeks (from 7 to 16 weeks). By the Mejeed scoring at the last follow-up, the pelvic function was excellent in 26 cases, good in 15 and acceptable in 6, giving an excellent to good rate of 87.2% (41/47).Conclusions:Fluoroscopy in the excessive inlet view is a simple and easy intraoperative technique. It can improve accuracy and safety of sacroiliac screw placement because it allows clear identification of the posterior border of the sacrum and effectively avoids iatrogenic injury to the sacral nerve caused by screws breaking through the bone cortex.
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Objective:To analyze the epidemiological characteristics of geriatric acetabular fractures in western China.Methods:A retrospective case series study was made on data of geriatric patients with acetabular fracture hospitalized in 4 grade A hospitals in western China from 2015 to 2020. The investigation content included gender, age, incidence rate, injury mechanism, combined injuries, comorbidities, fracture types and treatment plans.Results:A total of 299 geriatric patients with acetabular fractures were included, including 203 males and 96 females, aged 60-97 years [(68.6±7.6)years]. The mean age of the patients was increased from 67.5 years to 71.1 years. The incidence rate was increased from 36 cases per year to 64 cases per year. The injury mechanism was mainly traffic accidents (42.47%), followed by falls (30.44%). Thoracic injury was the most common type of combined injuries (39.81%). Hypertension was the main comorbidity (28.76%). The most common fracture type was anterior column posterior hemitransverse fracture (31.32%). Of 299 patients, 210 received surgical treatment, with the surgery rate of 70.23%.Conclusions:Geriatric acetabular fracture is characterized by gradually increased age and incidence rate, traffic accidents as the main cause of injury, thoracic injury as the main combined injury, hypertension as the main comorbidity, anterior column posterior hemitransverse fracture as the main fracture type and surgery as the main treatment option.
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Objective:To investigate the role of TiRobot combined with O-arm assisted closed reduction and percutaneous screw fixation in unstable pelvic fracture surgery.Methods:Twelve patients with unstable pelvic fractures, 7 males and 5 females, aged 39.41±12.56 years (range 25-60 years), admitted from January 2020 to January 2021, were retrospectively analyzed. The duration between injury and surgery was 9.67±5.81 d (range 4-24 d). The following are the causes of injury, namely traffic injury in 6 cases, fall from height injury in 4 cases, crush injury in 2 cases. Tile type of pelvic fractures were 3 cases of type B (2 cases of type B2, 1 case of type B3), 9 cases of type C (4 cases of type C1, 3 cases of type C2, 2 cases of type C3). Sacral fractures with Denis division were 5 cases of zone I, 7 cases of zone II. Seven patients were repositioned by intraoperative traction on the injured side of the limb and maintained by fixation with a Starr frame. Two cases were repositioned by intraoperative longitudinal bone traction on each lower limb for fracture displacement. The other 3 B-type fractures were repositioned by inserting Schanz nails into the anterior inferior iliac spine bilaterally. Then, the fractures were maintained with external pelvic fixators. The fractures were assessed by O-arm fluoroscopy. Hollow screws were placed with the aid of orthopedic robotic guidance, and the screw positions were verified by O-arm fluoroscopy again after the nail placement. The duration of each screw placement and operation were recorded. The quality of fracture repositioning, hip function and postoperative complications were observed at the follow-up.Results:All patients were followed up for 8.17±1.99 months (range, 6-12 months). There were 27 screws inserted in 12 patients, with a single screw insertion duration of 19.9±1.8 min (range, 9-31 min). In all patients, one O-arm fluoroscopy was performed in each row after closed reduction and after completion of nail placement. The operative duration was 257.78±80.63 min (range, 160-450 min). The O-arm fluoroscopy after nail placement verified that 23 screws were placed in a satisfactory position at one time, with satisfactory rate of 85% (23/27) for the first nail placement. Two patients with preoperative grade II sacral plexus nerve injury recovered to grade I in one case and grade II in one case. However, the numbness was reduced after operation. No further aggravation of nerve injury occurred after surgery. The quality of fracture repositioning was evaluated according to the Matta score, including excellent in 9 cases, good in 2 cases, and acceptable in 1 case, with an excellent rate of 92% (11/12). At the last follow-up, the Majeed pelvic fracture quantitative assessment system scored 85.75±5.82 (range, 74-96). There were 8 cases in excellent and 4 cases in good. Twelve patients had one-stage wound healing. No complications, such as incision infection, nerve injury, loosening and breaking of the internal fixation occurred during the follow-up.Conclusion:TiRobot combined with O-arm assisted closed reduction and percutaneous screw fixation for unstable pelvic fractures has some advantages, including safety, precision, convenient nail placement, and less fluoroscopic radiation.
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Objective To study the effect of thymosin beta4 on the expression of matrix metalloproteinase‐2(MMP‐2) and MMP‐9 of human hypertrophic scar fibroblasts and explore mechanism of thymosin beta4 on hypertrophic scar .Methods Fibro‐blasts were cultured in vitro from the orthopaedic patients(within 6 months after burns) admitted in the first affiliated hospital of Nanchang university from June to September 2013 .The Fibroblasts were divided into experiment group :0 .05 ,0 .1 ,1 .0 μg/mL and 5 .0 μg/mL ,and control group :no thymosin beta4 .The expression levels of MMP‐2 ,MMP‐9 were observed by RT‐PCR and West‐ern blot .Results The expression levels of MMP‐2 and MMP‐9 were increased after the thymosin beta4 took effect ,and it was espe‐cially significant in 1 .0 μg/mL and 5 .0 μg/mL group ,there was statistical difference between experiment group and control group (P<0 .05) .Conclusion Thymosin beta4 can dose‐dependently promote the expression of MMP‐2 and MMP‐9 and inhibit the pro‐liferation of hypertrophic scar .
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OBJECTIVE:To screen and identify endophytic fungi from Schisandra chinensis with antioxidant activity. METH-ODS:The tissue isolation skill was used to isolate endophytic fungi from roots,leaves,stems and fruits of S. chinensis. And anti-oxidant activity of endophytic fungi were screened by DPPH radical scavenging assay and hydroxyl radical scavenging assay. The to-tal DNA were extracted;the 18S rDNA ITS were amplified and sequenced with primer ITS1 and ITS4;the results of sequencing were analyzed comparatively based on homology to confirm the classification of active strains. RESULTS:23 strains were isolated from S. chinensis. GSR-12,isolated from roots of S. chinensis,had strong antioxidant activities. The scavenging rate on DPPH and the hydroxyl radical were 87.96% and 82.31% respectively. GSR-12 strain was identified as Clonostachys rosea by analyzed com-paratively. CONCLUSIONS:1 strain of C. rosea,isolated from roots of S. chinensis,has strong antioxidant activity.
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Objective To summarize the clinical features and treatment of male urethral duplication.Methods The clinical data of 2 cases treated in June 2011 and April 2014 were analyzed retrospectively.The first case was a 5-year-old boy presented with passages of urine from two orifices in the penis.The second case was a 15-year-old boy presented with dorsal chordee and a sinus on the dorsum of the penis.The patient had a small amount of watery discharge occasionally dripping out of the opening for 10 years.The 2 patients underwent retrograde urethrography, which revealed a complete duplicated urethra with the channel arising from the proximal prostatic urethra ( class ⅡA2 according to the classification of Effman) .The 2 patients underwent excision of the accessory urethra under general anesthesia.Results The pathology reports of the 2 cases were hyperplasia of squamous epithelium and urothelial mucosa.Pathological diagnosis was urethral duplication.The first case was followed up for 1 year with a satisfactory functional and cosmetic outcome.The second case was followed up for 6 months and no watery discharge noticed from the residual dorsal chordee.Conclusions Urethral duplication is a rare congenital anomality affecting mainly boys.Clinical presentation varies depending on the different anatomical patterns of the urethral anatomy. Surgical management must be evaluated for each different anatomical variation.
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Objective To discuss the indication and efficacy for treating hypospadias with ure-throplasty of Pedicled preputial double-faced island flap(PPDIF). Methods Records of 99 children (mean age, 5.1 years; age range, 4 months-12 years)with hypospadias who underwent PPDIF oper-ation were reviewed. Of them, 56 cases were penile type of hypospadias, 24 cases of penile root type, 13 cases of scrotal type and 6 cases of perineal type according to Barcat classification. Based on Duck-ett technique, the partial preputial cortical plate remained and was displaced to gastr-penis with ure-thra. , and finally the new urethra would be covered by the cortical plate. Results During follow-up of average 2 years, 8 patients(8. 1%) developed urethral fistula, 1 (1.0 %) developed mild meatal ste-nosis, and 1(1.0 %) developed flap necrosis. The success rate for total PPDIF procedure was 89.90 % (89/99). And the success rate of simple PPDIF for cases with penile and penile root hypospadias, and PPDIF+Duplay for cases with serotal and perineal hypospadias were respectively 91.25 % (73/80) and 84.21%(16/19). respectively. Conclusions PPDIF is good for treating most hypospadias. Furth-more it make penis better shape. In the severe cases, PPDIF+Duplay prededure is recommended and the effect was affirmative.
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Objective To study the expression of PIM-1 in prostate cancer (PCa) and its clinical significance. Methods Reverse transcription polymerase chain reaction ( RT-PCR) analysis was used to determine the expression level of PIM-1 mRNA in 2 cases of benign prostatic hyperplasia ( BPH) samples and 5 cases of PCa samples, and immunohistochemical analysis was used to investigate PIM-1 protein expression in 20 cases of BPH, 20 cases of high grade-prostatic intraepithelial neoplasia ( HGPIN) and 42 cases of PCa tissues. The immunohistochemical staining intensity was scored as negative, weak, moderate and strong positive. Results The expression level of PIM-1 mRNA in 5 cases of PCa was 0. 63 , 0. 55 , 0. 42, 0. 91 and 0. 76 ; the level in 2 cases of BPH was 0. 26 and 0. 27 , respectively. The negative rates of expression of PIM-1 protein in BPH, HGPIN and PCa tissues were 60% ( 12/20) , 20% (4/20) and 2% (1/42) ,the weak positive rates of the expression were 40% (8/12) , 20% (4/20) and 12% (5/42) , while the moderate to strong positive rates of the expression of PIM-1 protein was 0 (0/20) , 60% ( 12/20) and 86% (36/42) , respectively. Immunohistochemical analysis showed PIM-1 protein expression in PCa was higher than those in HGPIN and BPH(all P