ABSTRACT
Osteofacial compartment syndrome (OCS) is one of the serious complications in traumatic orthopedics. If not treated in time, OCS may result in irreversible damage to nerve and muscle,even amputation or death in serious condition. 5P presents to be the classic clinical diagnosis of OCS, but it is highly subjective and cannot timely and accurately judge the progression of the disease. Intracompartment pressure manometry is the main auxiliary method for the diagnosis of OCS. Although there are many manometry methods, there is still no authoritative pressure threshold as the diagnosis standard. Clinicians often aggressively perform fasciotomy to avoid serious complications, leading to unnecessary fasciotomy. The authors retrospectively reviewed the data of patients with OCS treated at Air Force Hospital of Eastern Theater of PLA from March 2010 to March 2020 and found that some patients with OCS had gradual alleviation of clinical symptoms after appropriate conservative treatments such as brace releasing, limb stabilization and swelling subsidence, with no need of fasciotomy. However, the symptoms of some patients progressively aggravated after the above-mentioned traditional treatments and timely fasciotomy was required. The authors graded the severity of OCS and proposed for the first time the OCS grading criteria according to quantitative clinical results and quantitative indicators such as ratio of mean blood flow velocity of bilateral arteries and pulse wave changes, aiming to take corresponding intervention measures for patients with different OCS classifications, carry out more precise treatment and avoid unnecessary fasciotomy.
ABSTRACT
Objective:To explore the efficacy of distracting external fixator for tibiofibular fractures combined with osteofascial compartment syndrome.Methods:A retrospective case-control study was conducted to analyze the clinical data of 62 patients with tibiofibular fractures combined with osteofascial compartment syndrome admitted to Air Force Hospital from Eastern Theater of PLA from March 2009 to March 2019, including 47 males and 15 females, aged 20-78 years［（47.1±13.4）years］. There were 30 patients with tibia shaft fractures, 17 with tibia plateau fractures and 15 with tibia distal fractures. The fractures were classified as type 4A in 18 patients, type 4B in 24 and type 4C in 20 according to AO/OT classification. Distracting external fixation was performed for 30 patients（Group A）and calcaneal tuberosity traction for 32 patients（Group B）. Levels of alanine aminotransferase（ALT）, urea nitrogen（BUN）, creatine kinase（CK）and lactate dehydrogenase（LDH）of the injured limb were compared between the two groups during traction. Additionally, the fasciotomy rate, time of damage control treatment（observation interval from trauma to stage II definitive surgery）, time of stage II definitive surgery, internal fixation modalities of stage II definitive surgery, rate of needle tract infection and rate of non-planned secondary surgery were compared between the two groups. The limb function was assessed using Johner-Wruhs scoring system at the last follow-up.Results:All patients were followed up for 12-22 months［（15.1±2.7）months］. Level of CK in Group A was 315.6（140.0, 531.5）U/L, significantly lower than that in Group B［465.5（277.0, 1240.5）U/L］（ P<0.05）. The two groups revealed no statistical differences in levels of BUN, CK and LDH（ P>0.05）. The fasciotomy rate in Group A［40%（12/30）］was higher than that in Group B［34%（11/32）］, but the difference was statistically insignificant（ P>0.05）. The time of stage II definitive surgery in Group A was（68.5±17.1）minutes, significantly lower than that in Group B［（89.0±15.1）minutes］（ P<0.05）. The rate of non-planned secondary surgery in Group A［3%（1/30）］was lower than that in Group B［25%（8/32）］（ P<0.05）. There were no statistically significant differences in time of damage control treatment, internal fixation modalities of stage II definitive surgery and rate of needle infection between the two groups（ P>0.05）. According to Johner-Wruhs scoring system, the function in Group A were excellent in 17 patients, good in 5, fair in 2 and poor in 6 at the last follow-up, with the excellent rate of 73%. However, the difference was not statistically significant when compared to Group B: excellent in 13 patients, good in 3, fair in 7 and poor in 9, with the excellent rate of 50%（ P>0.05）. Conclusion:Compared with calcaneal tuberosity traction, the distracting external fixation of tibiofibular fractures combined with osteofascial compartment syndrome can attenuate soft tissue damage during the traction and shorten the time of stage II definitive surgery by maintaining intraoperative fracture reduction.
ABSTRACT
Objective:To examine the effects of bilobalide on ischemia reperfusion injury (IRI) of skeletal muscle cells in rats.Methods:IRI of skeletal muscle cells in L6 rats was stimulated by culturing skeletal muscle cells in a hypoxia incubator for 4 hours, which were further cultured in a conventional incubator for 4 hours. The induced rat myoblasts were randomly divided into control group, ischemia reperfusion group and bilobalide group. Rat myoblasts in control group were cultured in the conventional incubator, and cells in ischemia reperfusion group were cultured in hypoxia incubator and conventional incubator alternatively to simulate IRI of skeletal muscle cells. After 4 hours of incubation in hypoxic incubator, L6 rat myoblasts in bilobalide group were replaced with medium containing 20 μmol/L bilobalide, and then put into conventional incubator for further culture. CCK-8 assay was used to test cell viability 48 hours later. Related test kits were used to examine the levels of lactate dehydrogenase (LDH), superoxide dismutase (SOD), xanthine oxidase (XOD), malondialdehyde (MDA) and intracellular calcium.Results:Compared with ischemia reperfusion group [(62.2±6.8)%], the viability of myoblasts was increased in bilobalide group [(86.5±5.6)%] ( P<0.05). Compared with ischemia reperfusion group [(265.3±35.2)U/mg], the level of LDH in myoblasts was decreased in bilobalide group [(125.4±16.9)U/mg] ( P<0.05). Compared with ischemia reperfusion group [(68.6±10.7)U/mg], the level of SOD in myoblasts was increased in bilobalide group [(98.5±8.4)U/mg] ( P<0.05). Compared with ischemia reperfusion group [(224.7±65.8)U/mg], the level of XOD in myoblasts was decreased in bilobalide group [(105.9±58.9)U/mg] ( P<0.05). Compared with ischemia reperfusion group [(198.2±35.7)U/mg], the level of MDA in myoblasts was decreased in bilobalide group [(100.4±25.3)U/mg] ( P<0.05). Compared with ischemia reperfusion group (2.5±0.3), the intracellular Ca 2+ concentration in cell supernatant was decreased in bilobalide group (1.6±0.3) ( P<0.05). But all the indexes tested above did not return to the level in control group ( P<0.05). Conclusion:Bilobalide can protect skeletal muscle cells from IRI by inhibiting oxidative stress reaction and calcium overload.
ABSTRACT
Objective@#To investigate the modification of the classic techniques of total auricle reconstruction with skin expansion, and its clinical application.@*Methods@#We performed three-dimensional measurement of the normal auricle and the expanded flap on 150 microtia patients. According to the data, we carried out total auricle reconstruction using extended postauricle expanded flap techniques for 82 patients of the group. Firstly, a 50 ml kidney-shaped expander was inserted subcutaneously in the mastoid region. Approximately 65 ml saline was injected in about 30 days, and expansion was kept without injection for another 30 days. In the second stage, we removed the expander and dissected the scalp 4-5 cm around the expanded skin, to make a composite flap consisted of expanded skin and extend scalp. Then we used the flap to encapsulate the three-dimensional rib cartilage framework to accomplish total auricle reconstruction.@*Results@#The blood supply and venous drainage of the flap was good. No obvious postoperative flap swelling was observed. Only 2 cases of helix skin necrosis happened in 48 hours after operation. Small area of skin defect was treated by debridement and suture, while larger area of skin defect was repaired with postauricular fascia flap and free skin graft. Postoperative follow-up period was 4-15 months, about 6.7 months in average. Bilateral ear size and position were similar with clear structures and shapes. Helix seemed more slim, auriculocephalic sulcus was obvious, auriculocephalic angle was similar to the other side. There was no color abberration between the front and back side of reconstructed ear. Scars of retroauricular hairline incision and costal cartilage harvesting incision were not obvious.@*Conclusions@#The novel surgical techniques is reasonable and simple without fascia flap or skin graft, which is worthy of application by more plastic surgeons.