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Objective:To study the efficacy of minimally PCWO combined with Akin osteotomy on severe hallux valgus.Methods:This retrospective study was conducted on 45 patients (50 feet) with severe hallux valgus treated by minimally PCWO combined with Akin osteotomy in Eight Department of Bone, Foshan Hospital of traditional Chinese Medicine from August 2016 to August 2018. HVA, IMA, DMAA, DASA, IPA were measured by X-ray examination preoperatively and after operative 3, 6, 12 months and at the final follow-up. The efficacy was evaluated in accordance with the American Orthopaedic Foot and Ankle Association (AOFAS) Ankle Hindfoot Scale and the Olerud-Molander Ankle (OMA) Score. The absolute and relative lengths of the first metatarsus were measured by X-ray examination preoperatively and at the last follow-up, with calculating the differences.Result:All patients were followed up within 18.20±2.04 months. There was no recurrence during follow-up period. HVA was 42.83°±4.63°, 12.83°±1.53°, 13.49°±1.33°, 14.08°±1.49° and 14.12°±1.35° at the preoperative, postoperative 3 months, 6 months, 12 months and the last follow-up, respectively, and the difference between pre-operation and post-operation was statistically significant ( P<0.05). IMA was 18.29°±0.94°, 7.84°±1.22°, 8.31°±1.03°, 9.01°±1.08° and 9.09°±1.11° at the preoperative, postoperative 3 months, 6 months, 12 months and the last follow-up, respectively, and the difference between pre-operation and post-operation was statistically significant ( P<0.05). AOFAS scores were 50.64±7.94, 88.80±2.68, 90.10±3.51, 91.20±3.89 and 91.37±3.71 points at the preoperative, postoperative 3 months, 6 months, 12 months and the last follow-up, respectively, and the difference between pre-operation and post-operation was statistically significant ( P<0.05). The OMA scores were 61.00±7.00, 90.90±5.02, 91.60±4.57, 93.20±3.61 and 93.48±4.91 at preoperative, postoperative 3 months, 6 months, 12 months and the last follow-up, respectively, and the difference between pre-operation and post-operation was statistically significant ( P<0.05). The absolute shortening of the first metatarsal was 3.03 mm and relative shortening was 0.72 mm. Conclusion:For severe hallux valgus, minimally PCWO combined with Akin osteotomy can effectively correct the hallux valgus deformity with small surgical incision, high safety and curative effect, which is worthy of popularization and application in clinical.
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Objective:To evaluate three-stage induced membrane technique combined with anterior and posterior double-plate fixation in the treatment of a total talus defect after infection.Methods:Included in this study were 11 patients with talus infection who had been treated at Department of Orthopaedics, Foshan Hospital of Traditional Chinese Medicine from January 2014 to December 2018. They were 8 males and 3 females, aged from 23 to 63 years (mean, 37.0 years). The infection followed re-implantation after open dislocation of total talus in 4 cases, internal fixation for open talus fracture of Gustilo type Ⅲa in 3 cases and surgery of open ankle fracture of Gustilo type Ⅲc in 2 cases, and was complicated with ankle intraarticular tuberculosis in 2 cases. The three-stage operations consisted of debridement, total talus resection, implantation of antibiotic bone cement and vacuum sealing drainage at the first stage, change of bone cement, re-debridement, wound closure or flap covering at the second stage 7 to 10 days later, and reconstruction after infection control using anterior and posterior double-plate fixation and induced membrane technique at the third stage 6 to 12 weeks later. Assessment of lower limb shortening was performed by comparing the full length of the leg between the normal and affected sides; the functions were assessed by comparing the ankle-hindfoot scores of American Orthopedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) between preoperation and the final follow-up.Results:The 11 patients were followed up for an average of 24.3 months (from 12.2 to 37.5 months). Superficial skin necrosis was observed in 2 patients and injury to superficial peroneal nerve in one. Absolute calcification of the autograft area was observed in all patients, leading to ankle fusion. The final follow-ups observed no significant difference in the full length of the leg between the normal and affected sides [(380.4±35.5) mm versus (376.3±32.8) mm] ( P>0.05) , a significant increase in the ankle-hindfoot AOFAS scores from preoperative 28.0±3.4 to 72.8±5.4, and a significant decrease in VAS scores from preoperative 5(5,6) to 0(0,1) (all P<0.05). Slight varus developed in 2 patients and slight ankle stiffness in 3; recurrence of infection or breakage of implants was found in none of the patients. Conclusion:Three-stage induced membrane technique combined with anterior and posterior double-plate fixation can effectively control infection of the talus, maintain the length and reconstruct the function of the lower limb after a total talus defect.
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Objective To investigate the clinical outcomes of treating fractures of the middle-inferior humerus with double plate fixation via the upper arm posterior approach through the inner edge of the joint triceps tendon.Methods From May 2013 through May 2015,32 fractures of the middle-inferior humerus were treated with open reduction and double plate fixation by the upper arm posterior approach via the inner edge of the joint triceps tendon.They were 19 males and 13 females,aged from 17 to 54 years (mean,36.8 years).Involved were 14 left sides and 18 right sides.By AO classification,21 cases were type B and 11 type C,all closed fractures.X-ray examinations were regularly conducted at postoperative follow-ups;function of the elbow joint was assessed according to the Jupiter elbow joint grading system at the final follow-up.Results All the 32 patients were followed up for 6 to 20 months (average,11.5 months).The fractures healed after 4 to 7 months (average,5.0 months).The flexion ranged from 120° to 135° (average,125°),and the extension ranged from 0 to 8° (average,5°).There were no such complications as postoperative infection,plate breakage,or nonunion.According to the Jupiter elbow joint grading system at the final follow-up,there were 15 excellent cases,14 good ones,and 3 fair ones,giving a good to excellent rate of 90.6％.Conclusion Open reduction and double plate fixation by the upper arm posterior approach via the inner edge of the joint triceps tendon is simple for fractures of the middle-inferior humerus and leads to satisfactory reduction,reliable fixation,and fine outcomes.
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Objective To investigate the feasibility and clinical effect of damage control theory for patients with high?energy Pilon fracture?Methods Fifty?three cases patients with high?energy Pilon fracture were selected in the Traditional Chinese Medical Hospital of Foshan from March 2013 to June 2014 as observation group ( DCO group ) , 46 cases of non?DCO guidance high?energy Pilon fracture as the control group?Intraoperative blood loss,operative time,hospital stay,complications,fractures and function were compared between two groups?Results After the treatments,the intraoperative blood loss,operative time in the DCO group were significantly better than those in the non?DCO group((88?79±4?96) ml vs?(117?74±6?74) ml,(67?44 ±4?75) min vs?(81?43±3?66) min),theses differences were statistically significant between the two groups(t=3?720,5?601,P<0?05)?The complications in the DCO group were significantly less than those in the non?DCO group(22?6%(12/53) vs?52?2%(24/46)),the difference was statistically significant between the two groups(χ2=5?013,P=0?014)?The excellent rate of in the DCO group were significantly better than those in the non?DCO group( 64?15%( 34/53) vs?41?30%( 19/46) ) ,the difference was statistically significant between the two groups (χ2 =6?097, P=0?000 )?Conclusion Reasonable application of the DCT can be quickly and effectively to save the patient's life and improve stability fracture,and reduce the incidence of complications?It is a safe and effective method.
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Objective To study the possible mechanisms by which repetitive transcranial magnetic stimulation (rTMS) pretreatment antagonizes seizures induced by lithium chloride-pilocarpine and any correlation with antiapoptosis in hippocampal CA1 neurons.Methods Thirty rats were randomly divided into a control group, a sham stimulation group and an rTMS pretreatment group. The rTMS pretreatment group was pretreated on 7 consecutive days with low-frequency rTMS (0.5 Hz, 75％ of threshold intensity, 20 times/bundle, and 5 bundles/d), while the sham-stimulation group was sham-stimulated with a similar sound. Lithium chloride-pilocarpine ( LPC ) was used to induce a model epileptic state.Epileptic stroke latency and severity were recorded ; neuronal morphology was observed using hematoxylin and eosin (HE) staining; mean positive-reactive cell number and mean optical density and absorbance of B cell lymphoma/leukemia gene-2 (Bcl-2) were recorded, and Fas and Caspase-3 protein in the hippocampal CA1 region were observed with immunohistochemistry.Results Compared with the sham stimulation group, epileptic latency in the rTMS pretreatment group was significantly longer. Seizures in the rTMS pretreatment group were less severe, and a number of degenerated neurons were observed to be apoptotic. Bcl-2 protein expression increased at each time point, but Fas and Caspase-3 protein expression decreased.Conclusions rTMS pretreatment has an anti-epilepsy effect. The possible neuronal protection might be produced by regulating the expression of Bcl-2, Fas and Caspase-3 protein in the hippocampus.
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Parkinson's disease (PD) is a neurodegenerative disease commonly found in middle-aged and elderly people,and its onset is attributable to both genetic and environmental factors. The gene mutation and oxidative damage of DJ-1 correlate with familial and sporadic PD,respectively. The mechanisms by which DJ-1 gene mutation and oxidative damage lead to PD include oxidative stress,mitochondrial dysfunction and proteasome dysfunction.Furthermore,DJ-1 is a biomarker of sporadic PD and it may become a new potential target of anti-PD drugs.