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Objective To investigate the treatment strategies and clinical effects in treatment of floating knee in children.Methods A retrospective case series study was made on 26 cases of floating knee treated from July 2005 to June 2015.There were 22 males and four females, aged from 2-14 years (mean, 7.6 years).According to the Letts classification of the floating knee, ten cases were with type A, four with type B, two with type C, eight with type D, and two with type E.Closed fractures were noted in 16 cases and open fractures in 10 cases.According to the Gustilo classification of open fractures, one was with type ⅢA, six with type ⅢB, and three with type ⅢC.One case was amputated from the distal of the femur, eight cases were treated by traction and plaster caster, and 17 cases were treated by reduction and fixation of both femoral and tibil fractures.Wound healing, fracture union, Karsstrom criteria for functional outcome and complications were detected.Results All patients were followed up for mean 2.8 years (range, 1-6 years).One case of Gustilo type ⅢA and six cases of Gustilo type ⅢB open fractures had wound healing after one-stage debridement.Two cases of Gustilo type ⅢC showed wound healing after second-stage skin grafting.One case of Gustilo type ⅢC had amputation wound infection and was cured after a second debridement and dress change.Two had delayed union and there was no nonunion.According to the Karlstrom criteria, the excellent and good rate of functional outcome was 25% and 83% respectively in nonoperative and operative population (P<0.05).Malunion was found in four cases, genu vagum in three and overgrowth of 10-20 mm in seven.There was no premature closure of epiphysis.Conclusion Femur and tibia immobilization of floating knee in children is effective for bone union and functional recovery.
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[Objective]To explore the application of the intramedullary nails for correction of deformity in the lower limbs and decrease the opportunity of refracture in children with osteogenesis imperfecta.[Method]From Jan.2000 to Aug.2004,8 patients(3 males and 5 females),with 13 femurs and 3 tibias totally,with deformity in lower limps were corrected by multi-osteotomy and fixed with intramedullary nails,2 for K-wires;3 for Ender nails;and 3 for flexible intramedullary nails.[Result]All deformities were perfectly corrected.All patients were available at final follow up,for 9 months to 60 months,mean 30 months.None of the complications occurred postoperatively,such as infection in the incision or pin tract,nonunion,and refracture.One patient can walk by a stick from wheel-chair help preoperatively and one K-wire was disrupted near the end.[Conclusion]Multi-osteotomy and fixed intramedullary nails,can correct the deformity in the lower limbs perfectly and decrease the opportunity of refracture in children with osteogenesis imperfecta,which has been proved to be a reliable method.
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Objective To explore the expressions and the roll of p63mRNA and murine double minute 2(MDM-2) protein in esophageal squamous cell cancer and the prognosis of the cancer.Methods The expressions of p63mRNA and MDM-2 protein in 38 cases of esophageal squamous cell carcinoma tissues and the corresponding esophageal normal tissues were detected using reverse transcriptase polymerase chain reaction(RT-PCR) and immunohistochemistry. Results The positive rates of deltaNp63 mRNA in all malignant and normal tissues were 63.5% and 52.63% respectively,without significant difference.The expression of the DeltaNp63 mRNA was significantly higher in low differentiated group than in well and moderate differentiated group,without significant difference in age,gender,lymph node metastasis and clinical stage.Only 1 of 38 cases of esophageal squamous cell carcinoma tissues presented TAp63 mRNA expression and all esophageal normal tissues had no TAp63 mRNA expression.The positive rates of MDM-2 protein in esophageal squamous cell carcinoma tissues and normal tissues were 65.79% and 5% respectively,with significant difference.The expression level of the MDM-2 protein was higher significantly in low differentiated group than in well and moderate differentiated group,with significant difference in clinical stage and without significant difference in age,gender and lymph node metastasis.The DeltaNp63 mRNA expression in the esophageal squamous cell carcinoma tissues was positively related to MDM-2 protein expression.Conclusion The major isotype expressed in the esophageal cancer and epithelia is DeltaNp63,which may play an important role in the carcinogenesis,development and prognosis of the esophageal squamous cell carcinoma.TAp63 is not the major isotype expressed in the esophageal cancer and epithelia,and not related to the carcinogenesis of esophageal squamous cell carcinoma.High expression of MDM-2 protein is associated with the carcinogenesis of esophageal squamous cell cancer and related to the prognosis of esophageal squamous cell carcinoma.DeltaNp63 regulates the cell cycle and apoptosis through the pathway of MDM2 and causes the carcinogenesis of esophageal squamous cell cancer.