ABSTRACT
Objective:To investigate the specific types of lateral meniscus injury in Schatzker type II tibial plateau fractures and its potential correlation with CT features of the lateral plateau.Methods:The data of 213 patients with Schatzker II tibial plateau fractures from August 2014 to June 2021 were retrospectively analyzed, including 132 males and 81 females, aged from 29 to 61 years, with an average of 44.9 years. All patients underwent arthroscopic evaluation of fracture reduction immediately after open reduction and internal fixation (ORIF). According to the actual situation during the operation, the types and locations of lateral meniscus injury were determined and the patients were divided into the meniscus injury group and non-injury group. By measuring lateral plateau depression (LPD) and lateral plateau widening (LPW) of the lateral tibial plateau on CT images, the correlation of which and lateral meniscus injury was analyzed. The optimal critical values of LPD and LPW for predicting lateral meniscus injury were obtained by drawing the relevant receiver operating characteristic (ROC) curves.Results:The meniscus injury group (109 patients) mainly showed injuries involving the mid-body and posterior horn of lateral meniscus (98.2%, 107/109) and LPD was 13.1±3.2 mm; while the LPD of 104 patients without meniscus injury was 9.1±3.0 mm with a statistical difference ( t=3.98, P<0.001). The LPW of meniscus injury group and non-injury groups was 8.0±1.3 mm and 6.7±1.6 mm, respectively, and the difference was statistically significant ( t=2.68, P=0.011). The optimal predictive critical point of LPD and LPW was 7.6 mm (sensitivity 90.3%, specificity 64.7%, area under the curve 0.834) and 7.3 mm (sensitivity 80.5%, specificity 58.8%, area under the curve 0.722). Conclusion:Schatzker II tibial plateau fractures combined with lateral meniscus injury is usually characterized by meniscus-joint capsule separation, rupture and longitudinal fracture. The mid-body and posterior horn of lateral meniscus injury is more likely to occur when LPD> 7.6 mm and/or LPW> 7.3 mm on coronal CT images.
ABSTRACT
Objective:To explore the sequence of reduction and fixation in the treatment of middle and lower tibiofibular fractures on the same plane using tibial intramedullary nailing plus fibular plating.Methods:A retrospective analysis was performed of the 58 patients with middle and lower tibiofibular fractures on the same plane from January 2016 to December 2017. They were 38 males and 20 females, aged from 20 to 65 years (average, 40 years). The left side was affected in 30 cases and the right in 28. By the AO classification, 27 cases were type 42-A, 18 ones type 42-B and 13 ones type 42-C. Of them, 33 had the fibula reduced and fixated first (the fibular group) while 25 had the tibia reduced and fixated first (the tibial group). The 2 groups were compared in terms of operation time, rate of tibial closed reduction, rate of dynamization of intramedullary nails, fracture healing time and postoperative complications.Results:All the patients were followed up for 12 to 24 months (average, 17.2 months). The operation time in the fibular group was 96 minutes ± 15 minutes, significantly shorter than that in the tibial group (116 minutes ± 19 minutes)( P<0.05). The rate of tibial closed reduction was 84.8% (28/33) in the fibular group and 60.0%(15/25) in the tibial group, presenting a significant difference ( P<0.05). There were no significant differences between the 2 groups in the rate of dynamization of intramedullary nails, fracture healing time or postoperative complications ( P>0.05). Conclusions:Tibial intramedullary nailing plus fibular plate osteosynthesis is an effective treatment for the middle and lower tibiofibular fractures on the same plane. When the fracture line is not located in the narrow segment of the tibia, reduction and fixation of the fibula first is advantageous over reduction and fixation of the tibia first, because it can facilitate tibial reduction and nail placement and improve surgical efficiency without increasing the fracture healing time.
ABSTRACT
Objective:To describe the treatment of the first carpometacarpal arthritis in Eaton Ⅱ, Ⅲ combining the hemi excision of trapezium with tendon ball and evaluate its clinical efficacy.Methods:Data of patients with the first carpometacarpal arthritis who were treated by hemi excision of trapezium and tamponade of the tendon ball from March 2013 to October 2018 were retrospectively analyzed. Twelve patients were all females with an average age of 55±2.8 years (range, 48-61 years). There were 3 cases of left thumbs and 9 cases of right. The study was only researched with primary osteoarthritis patients, preoperative imaging Eaton stages, including 8 cases inⅡstage, 4 cases in Ⅲ stage. Postoperative X-ray examination was performed, and the subsidence rate of the first metacarpal bone was evaluated according to height of arthroplasty. Preoperative and postoperative pain was evaluated according to visual analogue scales (VAS) score and DASH score. Preoperative and postoperative finger movement was evaluated according to the changes in preoperative and postoperative grip and pinch force.Results:The average follow-up period was 12±4.8 months (range, 6-17 months). The mean score of VAS after operation was 1.2±1.0 which was lower than 6.3±1.5 before operation ( t=13.4, P=0.0001); DASH score after operation was 26.2±9.6 which was lower than 48.9±13.0 before operation ( t=5.7, P=0.0001); Grip force after operation was 25.5±6.8 kg which was higher than 15.0±2.9 kg before operation ( t=7.3, P=0.0001); Pinch force after operation was 3.2±0.8 kg which was higher than 2.1±0.4 kg before operation ( t=3.6, P=0.0045), and all of these four above data has statistic difference. At the latest postoperative follow-up, the height index of arthroplasty was 0.299±0.022, and there was no significant change ( F=1.337, P=0.276) when compared with 0.306±0.021 before surgery and 0.313±0.024 after surgery. After the operation, 2 patients presented with incision redness and swelling and exudation. It was considered that local hematoma in the intra-articular operation could not be completely absorbed. After several dressing changes, the redness and swelling subsided and the exudation was controlled. Conclusion:Preserving the proximal joint surface of trapezium and tamponading tendon ball, could reduce the subsidence rate of the first metacarpal bone and alleviate the pain of the first carpometacarpal joint, thus may effectively improve the joint function. It has a significant effect on the treatment of Eaton Ⅱ,Ⅲ stage of the first carpometacarpal arthritis.
ABSTRACT
Objective To explore the clinical effect of endoscopic treatment of carpal tunnel syndrome(CTS) with subsynovial hyperplasia.Methods Thirty-eight wrists of idiopathic CTS (control group) without subsynovial connective tissue (SSCT) hyperplasia and 41 wrists of idiopathic CTS with SSCT hyperplasia (experimental group) were surgically treated under endoscope from May,2000 to September,2015,and they were retrospectively studied at clin ic.The endoscopic release of the transverse ligament of wrist was done in the control group.While in the experimental group,the SSCT around the flexor tendons in the carpal tunnel was removed additionally after transverse ligament re lease through the same incision.The varieties of sensory nerve conduction velocity (SNCV),distal motor lantacy(DML),two points of discrimination (TP).Tinel sign,Phalen sign,grip and pinch force before and after operation in both groups were statistically calculated and compared,then the excellent and good rate according to Kelly classification was calculated.The difference was considered as statistically signifcant when P＜0.05.Results For the control group and experimental group:①According to Kelly classification,the overall excellent and good rate were 94.7％ and 95.1％ respectively.There was no statistical difference between 2 groups (P＞0.05).②The positive rate of Tinel sign and Phalen sign were significantly reduced to 2.6％ and 2.4％ respectively (P＜0.05).But there was no statistical difference between 2 groups (P＞0.05).③The average TP were (3.7±1.1) mm and (3.5±0.9) mm respectively.There was no statistical difference between 2 groups (P＞0.05).④The SNCV of the 2 groups were (14.3±5) m/s and (16.1±6) m/s,and the DML of the 2 groups were (0.8±0.3) ms and(0.7±0.4) ms respectively,while there was no statistic differences regarding SNCV and DML before and after operation between the 2 groups (P＞0.05).Conclusion Similar and satisfactory recent clinical effect can be harvested with cutting transverse ligament under endoscope and removing SSCT around the flexor tendons for idiopathic CTS with SSCT hyperplasia or not.Classical open operation is not necessary for idiopathic CTS with SSCT hyperplasia.
ABSTRACT
Objective To study the surgical techniques and the clinical curative ettect of the reconstruction of adjacent large finger pulps with the modified sensate free proximal ulnar artery perforator flap.Methods From February,2013 to May,2016,20 fingers in 10 patients with adjacent large finger pulp defects crossing the DIP joint were reconstructed by the modified senate free proximal ulnar artery perforator flap.All the pulps of every patient were recovered by 1 flap in the first stage and the artificial syndactyly of two digits was divided in 7 weeks after the flap transfer in the second stage.In order to reconstruct the sensation of two pulps in each patient,firstly both of the proximal and distal ends of the cutaneous nerve in flaps were dissected and anastomosed with the most lateral and medial palmar digital nerves of two adjacent fingers respectively,which were divided into 2 groups.Secondly the cutaneous nerve in the middle part of flap was cut and the two ends were anastomosed with the other two palmar digital nerves in the second surgery.There were 8 fingers in 4 patients with the index and middle finger pulp defects,12 fingers in 6 patients with the middle and ring finger defects.The flap size was from 5.0 cm×3.5 cm to 5.5 cm×4.0 cm,and the perforator artery was anastomosed with the palmar digital artery in 6 cases and with the joint branch of digital artery in 4 cases.Results Nine flaps survived uneventfully except the venous congestion was found in 1 flap which was salvaged successfully by acupuncture bleeding.Also,no congestion or ischemia of all the 20 pulp flaps occurred right after releasing the artificial syndactyly.The time of followed-up was from 11 months to 32 months with the average of 17 months after the second surgery.The static two point discrimination of the 2 groups of the sensate pulp flap was (7.3 ± 1.2) mm and (8.6 ±2.4) mm respectively.There was no significant difference between groups (P ＞ 0.05).These 20 pulp flaps were also assessed by the Semmes-Weinstein monofilament test with the result of diminished light touch in 14 pulps and diminished protective touch in 6 pulps.The total active motion in all 20 fingers was (248.0±4.5) °.No patients suffered cold intolerance and local pain but 1 had hypersensitiveness in the pulp flap.Conclusion The modified sensate free proximal ulnar arte~ perforator flap is a practical alternative for the reconstruction of two large adjacent pulps with satisfactory functional and aesthetic outcomes.
ABSTRACT
Objective To identify the half-sibling relationship by comprehensive using three different methods. Methods STR genotype was performed on A, A's mother, B and B's mother by using PowerPlex21 kit, AGCU Expressmarker 21+1 kit, Microreader 23sp-B kit and AGCU X-19 STR kit respectively. Based on the results of STR genotype and X-STR, we determined half-sibling relationship by ITO, discriminant function analysis and IBS. Results HIS was between 1.36×102and 2.09×105in ITO which indicated that A and B had the same father. The IBS and discriminant function analysis also had the same conclusion. Conclusion Comprehensive using multiple methods can obtain reliable result to identify the half-sibling relationship from the same father.
ABSTRACT
Objective To investigate the mutation phenomenon of 20 autosomal STR loci in Henan Han population. Methods A total of 3011 parentage confirmed cases were collected to screen mutation events, ascertain the source of mutation, calculate mutation rate, analyze mutation rules and compare with the mutation condition of populations in different regions. Results 76 mutation events were observed in 19 STR loci, the average and accumulative mutation rate reached to 0.08% and 1.6629%, respectively. The ration of paternal versus maternal mutation was 8:1. Mutation rates of Penta E and D12S391 loci in Henan Han population were lower than the Han population of northern China(P<0.05); the mutation rate of CSF1PO locus were lower than Guangdong population and Yunan Han population(P<0.05); the mutation rates of D6S1043 and D12S391 loci were lower than Guangdong population(P<0.05). Conclusion STR mutation events were common in paternity testing. Region differences among mutation rate were significant.
ABSTRACT
Objective To evaluate the clinical outcome of reconstruction of traumatic digital arthritis by transfer of free proximal interphalangeal joint of the second toe with toe reserving technique.Methods The study enrolled nineteen patients with traumatic digital arthritis treated from May 2013 to April 2016.The patients consisted of fifteen males and four females,and mnean age was 27.3 years (range,18-52 years).Finger involved included index fingers in 10 patients,middle fingers in seven and ring fingers in two.The joint of digit was reconstructed by transplanting the proximal interphalangeal joint of the second toe with a monitoring flap,and bone defect of the second toe was repaired with autogenous iliac bone graft.Wound was closed directly in six patients and covered by island flap from the foot dorsurn in 13 patients.Evaluation indicators contained survival rate of the free joint and island flap,appearance and fracture healing of the finger and toe and mnotion of the proximal digital joint.Finger function was studied using the evaluation standard of upper limb function set up by hand surgery branch of Chinese Medical Association.Healing in the donor site,foot function and related complications were observed.Results All the free joint and island flap survived.Period of follow-up was 6-30 months (mean,14 months).The fractured finger healed at 2.5 months on average,and appearance of the finger was good.Flexion range of the proximal digital joint was 63 °-80° (mean,74°) and extension range was-20°--10° (mean,-14°).Finger function was excellent in eleven patients and good in eight patients,with the excellent-good rate of 100％.Hematoma of the dorsal region of the foot occurred in one patient and the cut healed well after taking out some stitches and drainage.All fractured toe healed at 2.6 months.Except that one patient had fracture malunion with minor outward inclination,all presented good appearance of the toe without influencing walking and running.On the part of iliac,there was only one inconspicuous linear scar without any discomfort.Conclusions Transfer of free proximal interphalangeal joint of the second toe with toe preservation restores the anatomy structure and function of the digital joint.Meantime,autogenous iliac bone grafting combined with island flap from the foot dorsum for coverage of donor site defect retains the toe length and reduces injury of the donor site.
ABSTRACT
Objective To investigate the effect of different methods of volume therapy on tissue oxygenation in elderly patients undergoing radical operation for gastrointestinal tumor.Methods Sixty ASA Ⅱ or Ⅲ patients,aged ＞ 65 yr,weighing 42 -85 kg,undergoing elective radical operation for gastrointestinal tumor,were randomized into 3 groups ( n =20 each):lactated Ringer' s solution (LR) group ( group Ⅰ ),LR + 0.6 ％ hydroxyethyl starch (HES) 130/0.4 (2 ∶ 1 ) group ( group Ⅱ ) and LR + 0.6 ％ HES 130/0.4 ( 1 ∶1 ) group ( group Ⅲ ).Anesthesia was induced with propofol,vecuronium and fentanyl and maintained with sevoflurane,remifentanil and vecuronium.The patients were mechanically ventilated after tracheal intubation.PETCO2 was maintained at 30-35 mm Hg.Transcutaneous partial pressure of oxygen (TcPO2) and transcutaneous partial pressure of carbon dioxide (TcPCO2) were measured within 5 min before fluid infusion (To ),25-30 min after beginning of fluid infusion (T1),within 5 min before skin incision (T2),within 5 min after skin incision (T3 ),within the first hour after beginning of surgery (T4),within the second hour after beginning of surgery (T5 ) and within 5 min before the end of surgery (T6 ).The average value within each time period was obtained.Blood gas analysis was performed simultaneously and PaO2 and PaCO2 were recorded.The fluid infused,urine volume,blood loss and requirement for norepinephrine,RBC and plasma were recorded during operation.The time when the patients passed the flatus,duration of stay in ICU and postoperative complications were recorded.Results There was no significant difference in TcPO2,TcPCO2,PaO2,PaCO2,the time when the patients passed the flatus,duration of stay in ICU and the incidence of postoperative complications among the three groups ( P ＞ 0.05).TcPO2 and PaO2 were significantly higher at T2-6 in the three groups and TcPCO2 was significantly lower at T3 in group Ⅲ than those at To and T1 ( P＜ 0.05 or 0.01).TcPCO2 was significantly lower at T3 than at T2 in the three groups (P ＜ 0.05).Compared with group Ⅰ,the requirement for norepinephrine was significantly lower ( P ＜ 0.05),and no significant change was found in the fluid infused,urine volume,blood loss and requirement for RBC and plasma in groups Ⅱ and Ⅲ ( P＞0.05).Conclusion When LR,LR+0.6％ HES 130/0.4 (2∶1) or LR + 0.6％ HES 130/0.4 (1∶1) is used for volume therapy,tissue oxygenation is improved,however,LR + 0.6％ HES 130/0.4 (2∶1) or LR + 0.6％ HES 130/0.4 (1∶1 ) is better in maintaining circulatory stability than LR infused alone and is more suitable for elderly patients undergoing radical operation for gastrointestinal tumor.
ABSTRACT
Objective:To explore the changes of cerebra flow in retroperitoneoscopic surgery.Methods: Twenty-two patients undergoing retroperitoneoscopic surgery were selected.We measured Vm、Delt and PI with transcranial Dopple(TCD),and measured endothelin(ET),neurol peptide Y(NPY),Calcitonin gene-related peptide(CGRP) in plasma before CO2 insufflation,after CO2 insufflation,and after CO2 deflation.Results:Vm and Delt increased significantly at 30 min after pneumoperitonenum,and reached the peak at 90 min after pneumoperitonenum.PI decreased significantly 90 min after pneumoperitonenum.The plasma concentrations of ET and NPY increased significantly 60 min after pneumoperitonenum. Conclusion:Cerebra flow changes significantly in patients undergoing retroperitoneoscopic surgery,which is correlated to the changes of plasma CO2 and vascular bioactive substances.