Risk factors concerning postoperative deep wound infection in patients with closed calcaneal fracture / 中华创伤骨科杂志

Objective To investigate the risk factors for postoperative deep wound infection after open reduction and internal fixation for closed calcaneal fractures.Methods From January 2014 to January 2017,190 patients with closed calcaneal fracture were treated at Department of Traumatic Orthopaedics,Taihe Hospital.They were 118 males and 72 females with an average of 39.8 years (range,from 18 to 73 years).They were divided into a deep infection group and a non deep infection group according to the presence or absence of deep wound infection in the follow-up period.The 2 groups were compared in the general clinical data.In statistical analysis,the related risk factors were first screened by single factor analysis and followed by multivariate logistic regression analysis to identify the independent risk factors associated with the postoperative deep wound infection in patients with closed calcaneal fracture.Results The 190 patients were followed up for an average of 21.3 months(range,from 13 to 31 months).Postoperative deep wound infection occurred in 11 patients,giving an overall incidence of 5.7％ (11 / 190).The single factor analysis showed that the deep infection group incurred significantly longer time for tourniquet and used significantly more conventional extensile lateral approach than the non deep infection group (P ＜ 0.05).There were no significant differences between the 2 groups in general data,injury cause,fracture type,drainage,or incision closure technique (P ＞ 0.05).The multivariate logistic regression analysis revealed that tourniquet time ＞ 80 min (OR=5.949,95％ CI:1.216～ 29.108,P=0.028) and conventional extensile lateral approach (OR =5.414,95％ CI:1.507 ～ 19.452,P =0.01) were independent risk factors fo r the postoperative deep wound infection in patients with closed calcaneal fracture after open reduction and internal fixation.Conclusions Tourniquet time and conventional extensile lateral approach may be the independent risk factors for postoperative deep wound infection in patients with closed calcaneal fracture after open reduction and internal fixation.Therefore,it is important to adopt the sinus tarsi approach and control tourniquet time within 80 minutes for prevention of deep wound infection as long as the surgical quality is ensured.

Surgical treatment of complex acetabular fractures through the lateral-rectus approach with pelvic reconstructive plate and antegrade posterior-column lag screws / 中华创伤骨科杂志

Objective To evaluate the surgical treatment of complex acetabular fractures through the lateral-rectus approach with pelvic reconstructive plate and antegrade posterior-column lag screws.Methods Between January 2014 and April 2018,29 patients were surgically treated for complex acetabular fractures at Department of Orthopaedic and Trauma,Taihe Hospital.They were 22 males and 7 females,aged from 19 to 72 years(mean,41.7 years).According to the Letournel-Judet classification,there were 4 transverse fractures,7 T-shape fractures,15 both column fractures and 3 anterior plus posterior hemitransverse fractures.In all the patients,the lateral-rectus approach was adopted;their anterior column fractures were fixated with pelvic reconstructive plate and screws and their posterior column fractures with antegrade lag screws.The operation time,intraoperative bleeding,fracture reduction,fracture union time,function of the affected hip and complications were recorded.Results The operation time ranged from 50 to 140 min,averaging 85 min;the volume of intraoperative bleeding ranged from 150 to 1,100 mL,averaging 315 mL.By the Matta criteria,the reduction was rated as excellent in 21 cases,as good in 7 and as poor in one,giving an excellent to good rate of 96.6％.The average follow-up was 16.2 months (from 6 to 30 months) for the 29 patients.Their fractures got united after an average of 11 weeks (from 7 to 13 weeks).According to the Merle d'Aubigné & Postel scoring system at the last follow-up,the function of the affected hip was excellent in 20 cases,good in 7 and fair in 2,yielding an excellent to good rate of 93.1％.There was one case of vasospasm of external iliac artery.No such complications were observed by follow-up as infection,deep venous thrombosis,heterotopic ossification,osteoarthritis or avascular necrosis of the femoral head.Conclusions The lateral-rectus approach with pelvic reconstructive plate and antegrade posterior-column lag screws is a suitable surgical treatment for complex acetabular fractures,leading to satisfactory clinical results.The lateral-rectus approach provides adequate exposure of the quadrilateral surface and facilitates insertion of the posterior column antegrade lag screws.

Endoscopic calcaneoplasty for Haglund disease / 中国医师进修杂志

Objective To study the technique, clinical effect and safety of endoscopic calcaneoplasty for Haglund disease. Methods Clinical data of 12 patients with Haglund disease having underwent endoscopic calcaneoplasty were collected and retrospectively reviewed. All the patients experienced conservative treatment for 3 to 6 months which was failed and then turned to endoscopic calcaneoplasty. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score before and after operation, patient′s satisfaction and complication were recorded. Postoperative complications were also observed. Results All the patients underwent the operation successfully within 70 min, with 42 min on average, and no complications occurred. All the patients were followed up for 12.4 (8-16) months, the AOFAS ankle-hindfoot score after operation was significantly higher than before operation:94.6 (86-100) scores vs. 58.6 (32-72) scores, and there was statistical difference (P<0.05). After operation, 10 cases were excellent, and 2 cases were good. All patients were satisfied with the surgery, and no recurrence occurred during the follow-up period. Conclusions Endoscopic calcaneoplasty appears to be a safe, minimal invasive and effective surgical procedure for the treatment of Haglund disease.

Study on extracting process and formulation of Mashi Granules / 中成药

Objective: To ascertain the process condition of extraction Mashi Granules(Herba Ephedrae, Gypsum Fibrosum, Radix Puerariae, Herba Methal, Semen Armeniacae Amerum, etc.) Methods: In combination with area under the curve of hypothermy in rabbits, process water, macerating time and boiling times were used as parameters in uniformidy design. And then appropriate excipients were selected on the basis of hygroscopicity and granulation. Results: 20 times amount of water as much as herbs was added, macerating time reached as far as 40 min, and extracted 3 times, 2h a time. Excipient formula consisted of lactose and mannitol(4∶1, w/w). Conclusion: The experimental results provide the basis for the ascertainment of extracting process and formulation of Mashi Granules.