Key points to execute internal horizontal mattress suture in tissue augmentation / 口腔疾病防治

@#Ideal sutures can provide great fixation, wound closure and a stable environment for healing of the surgical site. Tension-free apposition sutures are important for tissue regeneration and could tackle insufficient amounts of soft and hard tissue, especially in missing tooth sites that require implantation. The internal horizontal mattress suture, similar to the conventional horizontal mattress suture, forms a rectangle that can be bisected by the incision with both intrusion and extrusion of the needle on each side. On the basis of the rectangle, the internal horizontal mattress suture emphasizes that the suture should be located below the incision, so the eversion of the wound margin is the highlight of this procedure. The internal horizontal mattress suture could stabilize the graft on the targeting tissue, realize the fixation of the collagen membrane, apically repositioned flap and soft tissue graft, reduce the tension on the incision, and further release the tension of the incision margin. Beyond the primary need for fixation and wound closure, internal horizontal mattress sutures can also achieve stress interruption that reduces the interference of the surrounding muscle and can better master wound tension with the assistance of interrupted sutures. Given the above advantages, horizontal internal mattress sutures have great potential in the application of implant-related regenerative surgery. In this review, according to our experience in clinical practice and the literature, we summarize the advantages of internal horizontal mattress sutures in tissue augmentation. In addition, the sites and sequence to insert the needle and the spatial relationship between the suture and incision are clarified with the rationale of the naming pattern, which is conducive to experience exchange and clinical practice.

Expert consensus on the bone augmentation surgery for alveolar bone defects / 口腔疾病防治

@#Alveolar bone is an important anatomic basis for implant-supported denture restoration, and its different degrees of defects determine the choices of bone augmentation surgeries. Therefore, the reconstruction of alveolar bone defects is an important technology in the clinical practice of implant restoration. However, the final reconstructive effect of bone quality, bone quantity and bone morphology is affected by many factors. Clinicians need to master the standardized diagnosis and treatment principles and methods to improve the treatment effect and achieve the goal of both aesthetic and functional reconstruction of both jaws. Based on the current clinical experience of domestic experts and the relevant academic guidelines of foreign counterparts, this expert consensus systematically and comprehensively summarized the augmentation strategies of alveolar bone defects from two aspects: the classification of alveolar bone defects and the appropriate selection of bone augmentation surgeries. The following consensus are reached: alveolar bone defects can be divided into five types (Ⅰ-0, Ⅰ-Ⅰ, Ⅱ-0, Ⅱ-Ⅰ and Ⅱ-Ⅱ) according to the relationship between alveolar bone defects and the expected position of dental implants. A typeⅠ-0 bone defect is a bone defect on one side of the alveolar bone that does not exceed 50% of the expected implant length, and there is no obvious defect on the other side; guided bone regeneration with simultaneous implant implantation is preferred. Type Ⅰ-Ⅰ bone defects refer to bone defects on both sides of alveolar bone those do not exceed 50% of the expected implant length; the first choice is autologous bone block onlay grafting for bone increments with staged implant placement or transcrestal sinus floor elevation with simultaneous implant implantation. Type Ⅱ-0 bone defects show that the bone defect on one side of alveolar bone exceeds 50% of the expected implant length, and there’s no obvious defect on the other side; autologous bone block onlay grafting (thickness ≤ 4 mm) or alveolar ridge splitting (thickness > 4 mm) is preferred for bone augmentation with staged implant placement. Type Ⅱ-Ⅰ bone defects indicate that the bone plate defect on one side exceeds 50% of the expected implant length and the bone defect on the other side does not exceed 50% of the expected implant length; autologous bone block onlay grafting or tenting techniques is preferred for bone increments with staged implant implantation. Type Ⅱ-Ⅱ bone defects are bone plates on both sides of alveolar bone those exceed 50% of the expected implant length; guided bone regeneration with rigid mesh or maxillary sinus floor elevation or cortical autologous bone tenting is preferred for bone increments with staged implant implantation. This consensus will provide clinical physicians with appropriate augmentation strategies for alveolar bone defects.

Application of reactive soft tissue preservation in extraction sockets of periodontitis: recent progress and perspectives / 口腔疾病防治

@#Chronic periodontitis is a prevalent disease; if left untreated, it is a main indication for tooth extraction and can lead to tooth loss. The reactive soft tissue, formed as a result of the immune response to chronic inflammation, is left in the compromised socket. The major concern is how to deal with the residual reactive soft tissue. Conservative thought states that the reactive soft tissue should be completely debrided. In addition, novel practices concerning the reactive soft tissue were proposed in recent trials, which demonstrated that there might be merits for soft and hard tissue regeneration with preservation of the reactive soft tissue. Studies have shown that mesenchymal stem cells exist in inflammatory reactive soft tissue, stressing their potential in tissue regeneration. Although the therapeutic value is highly promising, the specific components of the reactive soft tissue and the standard on whether it should be preserved need further investigation.

Aplication of digitally modified fence technique in vertical bone reconstruction / 口腔疾病防治

Objective@#To propose a digitally modified and guided bone regeneration technique supported by a nonabsorbable titanium plate and explore its effect on vertical bone regeneration.@*Methods@#A total of 8 patients with severe vertical bone defects in the edentulous area who wanted to be treated with implants were included in this study. A digitally modified and guided bone regeneration technique supported by a nonabsorbable titanium plate (fence technique) was used for bone augmentation. The patient's jaw, dentition, and soft tissue data were obtained for prosthetically guided implantation and bone regeneration. After virtual bone augmentation, a model of the jaw was obtained through 3D printing technology, and the titanium plate was bent accordingly. The virtual design was transformed through the template (including the base template and the attachment of a periosteal screw and bone block), so the actual osteogenesis space consistent with the design could be realized in the operation. Guided bone regeneration was performed according to the improved procedure and technical process. After 6 ~ 8 months of bone augmentation, cone beam CT was taken to evaluate the effect of bone augmentation. The implant was implanted according to the initial implant design, and bone tissue was obtained for HE and Masson staining. @* Results@#After 6 ~ 8 months of bone augmentation, the vertical linear bone increment reached (5.44 ± 1.73) mm. The implant was implanted according to the initial implant design, and the bone tissue was obtained for histological examination to show the formation of new bone.@*Conclusion@#Digital improved fence technique can simplify the preoperative and surgical procedures, and obtain good vertical bone augmentation results. In short, it is a kind of vertical bone augmentation technique worth popularizing and applying.

Summary of combined orthodontic and implant treatment in the patients with the congenital absence of maxillary lateral incisors / 口腔疾病防治

Objective@#To summarize the treatment options for congenital maxillary lateral incisor agenesis (MLIA).@*Methods @#Review the literature, summarize the current treatment options and advantages and disadvantages of various methods of MLIA, and analyze cases. @*Results @#When a patient′s occlusion and other conditions are suitable for space closure and canine substitution, closure of the gap is the recommended method, as it has good aesthetic results and leads to good periodontal health. However, when closure cannot be performed, a dental implant has a strong advantage compared with other restoration methods. When planning implants for MLIA patients, doctors should carefully select the correct surgery time and take care with the implant position to obtain good results.@* Conclusion@#In the choice of a treatment plan for MLIA, we need to use the concept of multidisciplinary combined treatment to obtain a more satisfactory treatment effect with regard to aesthetics and function.

The application of digital technology in preclinical education for graduate students majoring in oral implantation / 口腔疾病防治

Objective@#To discuss the application of digital technology in the education of implant dentistry.@* Methods@#According to the teaching method that combines case-, problem- and team-based learning, a course on implant theory was carried out in a class of 20 students. Then, all the students in this class were divided into two groups to receive two clinical operation training courses. The first was the training of a free-hand implant, and the second was an implant operation under a digital template. The courses introduced digital technology into preclinical education and simulated implant training. After the two courses, students were organized to analyze the accuracy of the implant, the operation time and the experiences of these two courses. Through the comparison of students′ operations of free-hand and template implants, students could analyze their own faults and propose a method of improvement. The students scored the two classes. @*Results @# Through the two classes, all the students completed the implant operation under the guidance of a template and free-hand method and found their own problems and solutions. The combination of theory and practice deepened the students′ understanding of the teaching content. Finally, the classes were graded comprehensively by students, showing that the students′ satisfaction with the digital template class was higher than that with the free-hand class (P < 0.05).@*Conclusion@#The addition of a digital implant technology class significantly improved students′ comprehensive assessment, improved the teaching effect and was more acceptable to students in terms of gaining additional professional skills.

Clinical application and new progress of dynamic navigation system in the field of oral implantology / 口腔疾病防治

@#Currently, computer-aided implant surgeries include implant placement surgery under the guidance of a dynamic navigation system. With the use of software inherent in the navigation system, doctors can make a preoperative plan including the ideal position of the implant. Then the plan can be accurately transferred to the surgery, during which the real-time condition of the drill and its relationship with the surgical region will be visualized by the surgeon and the drill can be adjusted in a timely manner. Currently the dynamic navigation system is increasingly widely utilized, especially in cases of esthetic zones or surgical sites with important anatomical structures. However, the clinical workflow of the navigation system is complicated, including CBCT taken after the registration device placement, prosthetic-driven 3D design, calibration, registration, navigated borehole preparation and implant placement surgery. Many details should be considered when the device is applied, including implant position design, fixation of the tracking device, registration, and stable borehole preparation under the guidance of dynamic navigation. Therefore, this article introduces the dynamic navigation system into the clinical workflow and evaluates, the effects of the application and the clinical features. The new progress of the navigation system in the field of implantology is demonstrated at the same time, including navigated surgery in fully edentulous arches and in the zygomatic zone. Further improvements in the navigation system in terms of the accuracy and simplification of the workflow are needed in the future.

Related factors of aggravated cerebral edema after meningioma surgery / 局解手术学杂志

Objective To investigate the risk factors of aggravated cerebral edema after meningioma surgery.MethodsRespectively analyze the clinical data of 187 patients received neurosurgery operation in our hospital from January 1, 2016 to February 5, 2018 and their postoperative aggravated cerebral edema, the related risk factors for brain edema after meningioma surgery was summarized.Results The incidence of aggravated cerebral edema in patients without preoperative edema (26.23％) was higher than that in patients with preoperative edema (13.8％), the difference was not statistically significant, probably due to the small number of cases or other related factors.Multivariate analysis of all related factors found that preoperative edema was the influencing factor for the increase of brain edema after meningioma surgery (P=0.005).It was found by single factor analysis that tumor site was a risk factor for the aggravation of cerebral edema after meningioma surgery.Multivariate analysis and multiple rate comparisons revealed that the sagittal sinus falx area was an independent risk factor for the aggravation of cerebral edema after meningioma surgery.ConclusionThe presence of peritumoral edema before surgery may be a protective factor for the postoperative brain edema.The incidence of postoperative cerebral edema was significantly higher in meningiomas located near the sagittal sinus falx than that of other sites.Therefore, meningiomas located near the sagittal sinus falx should be attached great importance.During the operation, the venous drainage should be protected, the perioperative management should be strengthened, and hormone and subsequent dehydration should be given timely to improve the prognosis of patients.

Analysis and prediction of death from injury in Fengcheng residents / 预防医学

Objective@#To learn the trend of death from injury in Fengcheng residents from 2009 to 2017 and predict from 2018 to 2021,in order to provide the basis for injury prevention and control. @*Methods@#All cause of death monitoring data and demographic data of Fengcheng from 2009 to 2017 were collected,injury mortality,standardized mortality and annual change percentage（APC）were calculated,and GM（1,1）was established to predict the injury mortality from 2018 to 2021. @*Results@#From 2009 to 2017,the injury death rate in Fengcheng was 52.68 per 100 000 and the standardized death rate was 46.50 per 100 000. The APC of the total standardized mortality was -5.10%,showing a decreasing trend year by year（P<0.05）. The injury mortality and standardized mortality in males were higher than that in female（both P <0.05）. The highest injury mortality lay in the group aged 65 years and above,which was 108.13 per 100 000. The top five causes of injury death were traffic accident,suiside,poisoning,fall and drowning,their mortality rate were 27.03 per 100 000,7.84 per 100 000,5.62 per 100 000,5.08 per 100 000 and 2.36 per 100 000,respectively. The mortality of traffic accident in males and suicide in females showed a decreasing trend（P<0.05）,while the mortality of fall showed an increasing trend（all P<0.05）. The model of GM（1,1）predicted that the injury mortality from 2018 to 2021 would be 48.00 per 100 000,44.15 per 100 000,40.61 per 100 000 and 37.35 per 100 000,which showed a decreasing trend year by year.@*Conclusion@#The injury death rates in Fengcheng dropp year by year from 2009 to 2017 and will probably keep dropping from 2018 to 2021. Men and people aged 65 years or over are at high risk of death from injury,traffic accident and fall are the main causes.

Progress on the study of the transcrestal sinus augmentation technique / 口腔疾病防治

@#Transcrestal sinus floor augmentation applied for severely atrophic maxilla sinus floor augmentation is frequently performed because of posterior maxilla resorption and low bone density. The traditional perspective is that the residual bone height is a main factor influencing the selection of the augmentation technique and the transcrestal technique can only be used when the residual bone height is more than 4-5 mm. However, many researchers have used this technique with lower bone heights because of the development of better surgical instruments and clinical skills. Based on the review of the literature in recent years and the author′s understanding of clinical operation, this paper reviews the improvement progress and operation skills of the application of transalveolar ridge top maxillary sinus lift in the severely absorbed maxillary posterior tooth area.

Role of proNGF-p75NTRin isoflurane-induced cognitive impairment in aging mice / 中国病理生理杂志

AIM:To investigate the role of specific binding of precursor form of nerve growth factor(proNGF) to p75NTR(proNGF-p75NTR)in isoflurane-induced cognitive impairment in aging mice.METHODS: Aging C57BL/6J male mice were randomly divided into 3 groups:control group,isoflurane(Iso)group and p75NTR specific inhibitor 2-ami-no-3-methyl-pentanoic acid amide(LM11A-31,LM)+isoflurane(LM+Iso)group.Aging C57BL/6J mice in Iso group and LM+Iso group were exposed to isoflurane,and the mice in control group were exposed to air.The mice in LM+Iso group were treated with LM,which dissolved in normal saline water and was administered daily by oral gavage at 50 mg· kg-1· d-1for 1 month.The mice in control group and Iso group received an equivalent volume of normal saline by the same route.Arterial blood gas analysis was conducted to detect the physiological state of the mice after isoflurane exposure. Morris water maze was performed to evaluate the cognitive function.The protein levels of proNGF,p75NTR,phosphorylated p38 MAPK and cleaved caspase-3 were determined by Western blot.RESULTS: Compared with the control group, the protein expression of proNGF and p75NTR in the hippocampus of Iso group was significantly elevated(P<0.05).The phos-phorylation level of p38 MAPK was higher in Iso group than that in control group(P<0.05),which was reduced in LM +Iso group significantly(P<0.05).A significant increase in the protein level of cleaved caspase-3 was observed in Iso group as compared with control group(P<0.05), while LM11A-31 treatment reversed this elevation significantly(P<0.05).The escape latency prolonged and the number of crossing the original platform location reduced in Iso group com -pared with control group(P<0.05), which were reversed by LM11A-31 in LM+Iso group(P<0.05).CONCLU-SION:ProNGF-p75NTR probably plays an vital role in the apoptotic pathway activation and the cognitive dysfunction in ag -ing mice exposure to isoflurane,which provides a potential target for clinical intervention.

Content Determination of Phenylethanoid Glycosides and Acteoside in Plantago Herba from Different Producing Areas / 中国中医药信息杂志

Objective To establish a method for determination of phenylethanoid glycoside and acteoside in Plantago Herba. Methods UV-visible spectrophotometric method was used for the determination of the content of phenylethanoid glycosides compounds in Plantago Herba. HPLC method was used for the determination of acteoside in Plantago Herba. Chromatographic column with C18 ODS2 (4.6 mm × 150 mm, 5 μm) was used. Acetonitrile-0.1%formic acid (13:87) was as mobile phase; the flow rate was 1 mL/min; the detection wavelength was 332 nm; the column temperature was 30 ℃; the sample volume was 10 μL. Results The contents of phenylethanoid glycoside in Plantago Herba from different producing areas were among 1.03%–3.47%. Acteoside with peak area over the 0.0062–1.55 mg range showed a good linear relationship; the sample recovery rate was 98.9%, and the RSD was 1.6%. The contents of acteoside in Plantago Herba from different producing areas was among 0.18%–0.56%. Conclusion The method is simple, stable and reproducible, which can be used for the determination of phenylethanoid glycoside and acteoside in Plantago Herba from different producing areas and provide experimental basis for quality control of Plantago Herba.

Determination of Total Phenylethanoid Glycosides and Acteoside in Plantago Herba / 中国药师

Objective: To determine total phenylethanoid glycoside and acteoside in Plantago Herba to provide reference for evaluating the quality of medicinal materials.Methods: With acteoside as the control sample, a UV visible spectrophotometric method was used to determine total phenylethanoid glycosides in Plantago Herba.An HPLC method was applied to determine acteoside in Plantago Herba , and the conditions were as follows: an ODS2 C 18 (150 mm× 4.6 mm ,5 μm) chromatographic column was used with acetonitrile-0.1% formic acid (13∶87) as the mobile phase at a flow rate of 1.0 ml·min-1 , the detection wavelength was 332nm, the column temperature was 30℃, and the sample volume was 10 μl.Results: The reference solution and the sample solution had the maximum absorption at 332 nm, and the linear relationship was good within the range of 0.003 1-0.155 0 mg·ml-1 (r=0.999 5).The content of total benzene alcohol glycosides in 3 batches of samples was 2.73% , 2.61% and 2.84% , respectively;acteoside over the range of 0.000 6-0.155 0 mg·ml-1 (r=0.999 1) showed a good linear relationship with peak area,the sample recovery was 98.5% and the RSD was 1.6% (n =6), and the acteoside content in 3 batches of samples respectively was 0.54% , 0.51% and 0.56%.Conclusion: The method is simple, accurate and reproducible, and can be used for the determination of total phenylethanoid glycosides and acteoside in Plantago Herba.

Percutaneous Sacroiliac Screw Placement: A Prospective Randomized Comparison of Robot-assisted Navigation Procedures with a Conventional Technique / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sacroiliac (SI) screw fixation is a demanding technique, with a high rate of screw malposition due to the complex pelvic anatomy. TiRobot™ is an orthopedic surgery robot which can be used for SI screw fixation. This study aimed to evaluate the accuracy of robot-assisted placement of SI screws compared with a freehand technique.</p><p><b>METHODS</b>Thirty patients requiring posterior pelvic ring stabilization were randomized to receive freehand or robot-assisted SI screw fixation, between January 2016 and June 2016 at Beijing Jishuitan Hospital. Forty-five screws were placed at levels S1 and S2. In both methods, the primary end point screw position was assessed and classified using postoperative computed tomography. Fisher's exact probability test was used to analyze the screws' positions. Secondary end points, such as duration of trajectory planning, surgical time after reduction of the pelvis, insertion time for guide wire, number of guide wire attempts, and radiation exposure without pelvic reduction, were also assessed.</p><p><b>RESULTS</b>Twenty-three screws were placed in the robot-assisted group and 22 screws in the freehand group; no postoperative complications or revisions were reported. The excellent and good rate of screw placement was 100% in the robot-assisted group and 95% in the freehand group. The P value (0.009) showed the same superiority in screw distribution. The fluoroscopy time after pelvic reduction in the robot-assisted group was significantly shorter than that in the freehand group (median [Q1, Q3]: 6.0 [6.0, 9.0] s vs. median [Q1, Q3]: 36.0 [21.5, 48.0] s; χ2 = 13.590, respectively, P < 0.001); no difference in operation time after reduction of the pelvis was noted (χ2 = 1.990, P = 0.158). Time for guide wire insertion was significantly shorter for the robot-assisted group than that for the freehand group (median [Q1, Q3]: 2.0 [2.0, 2.7] min vs. median [Q1, Q3]: 19.0 [15.5, 45.0] min; χ2 = 20.952, respectively, P < 0.001). The number of guide wire attempts in the robot-assisted group was significantly less than that in the freehand group (median [Q1, Q3]: 1.0 [1.0,1.0] time vs. median [Q1, Q3]: 7.0 [1.0, 9.0] times; χ2 = 15.771, respectively, P < 0.001). The instrumented SI levels did not differ between both groups (from S1 to S2, χ2 = 4.760, P = 0.093).</p><p><b>CONCLUSIONS</b>Accuracy of the robot-assisted technique was superior to that of the freehand technique. Robot-assisted navigation is safe for unstable posterior pelvic ring stabilization, especially in S1, but also in S2. SI screw insertion with robot-assisted navigation is clinically feasible.</p>

Anterolateral thigh free flap for simultaneous reconstruction of digital extensor tendon and defect of the dorsal hand: A case report / 中华创伤杂志(英文版)

This paper describes a new technique in the repair of the hand defect with digital extensor tendon injury. The anterolateral thigh flap with the thick femoral fascia has been used in the reconstruction of the composite defect of the dorsal hand, especially the defect of tendon. This technique requires short period of treatment and hence causes less damage to the donor site but shows a better recovery of the hand function. A favorable curative effect has been obtained in this patient.

Printed three-dimensional anatomic templates for virtual preoperative planning before reconstruction of old pelvic injuries: initial results / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Old pelvis fractures are among the most challenging fractures to treat because of their complex anatomy, difficult-to-access surgical sites, and the relatively low incidence of such cases. Proper evaluation and surgical planning are necessary to achieve the pelvic ring symmetry and stable fixation of the fracture. The goal of this study was to assess the use of three-dimensional (3D) printing techniques for surgical management of old pelvic fractures.</p><p><b>METHODS</b>First, 16 dried human cadaveric pelvises were used to confirm the anatomical accuracy of the 3D models printed based on radiographic data. Next, nine clinical cases between January 2009 and April 2013 were used to evaluate the surgical reconstruction based on the 3D printed models. The pelvic injuries were all type C, and the average time from injury to reconstruction was 11 weeks (range: 8-17 weeks). The workflow consisted of: (1) Printing patient-specific bone models based on preoperative computed tomography (CT) scans, (2) virtual fracture reduction using the printed 3D anatomic template, (3) virtual fracture fixation using Kirschner wires, and (4) preoperatively measuring the osteotomy and implant position relative to landmarks using the virtually defined deformation. These models aided communication between surgical team members during the procedure. This technique was validated by comparing the preoperative planning to the intraoperative procedure.</p><p><b>RESULTS</b>The accuracy of the 3D printed models was within specification. Production of a model from standard CT DICOM data took 7 hours (range: 6-9 hours). Preoperative planning using the 3D printed models was feasible in all cases. Good correlation was found between the preoperative planning and postoperative follow-up X-ray in all nine cases. The patients were followed for 3-29 months (median: 5 months). The fracture healing time was 9-17 weeks (mean: 10 weeks). No delayed incision healing, wound infection, or nonunions occurred. The results were excellent in two cases, good in five, and poor in two based on the Majeed score.</p><p><b>CONCLUSIONS</b>The 3D printing planning technique for pelvic surgery was successfully integrated into a clinical workflow to improve patient-specific preoperative planning by providing a visual and haptic model of the injury and allowing patient-specific adaptation of each osteosynthesis implant to the virtually reduced pelvis.</p>

Comparison of two different nucleus delivery methods in small incision cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the effect of treating cataract by sodium hyaluronate injection and lens - loop nucleus extraction of small incision cataract excision and explore more suitable method to promote the use of surgery in primary hospital. METHODS: All 146 cataract patients ( 166 eyes ) were allocated to two groups in random: the control group 78 patients ( 84 eyes ) received conventional lens loop for extracapsular cataract extraction;the experiment group 68 patients (82 eyes) underwent nucleus extraction in small incision with sodium hyaluronate injection for extracapsular cataract extraction. Postoperative visual acuity and intraoperative and postoperative complications were compared between two groups. RESULTS: Incidence of posterior capsule rupture difference was statistically significant (P 0. 05 ) in postoperative visual acuity, astigmatism degree and postoperative complications compared with those of pre-operation. CONCLUSION: Compared with the lens loop nucleus extraction, sodium hyaluronate injection for extracapsular cataract extraction can effectively protect the posterior lens capsule and can be promoted in small incision cataract surgery.

Long-term outcome of operative management of delayed acetabular fractures / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Surgical treatment of acetabular fracture has long been a challenging area in the field of orthopedic trauma. The aim of this research was to investigate the operative methods for delayed acetabular fractures and to assess the operation results.</p><p><b>METHODS</b>The operative approaches, procedures, results, and complications of the delayed acetabular fractures between 1995 and 2005 were retrospectively evaluated at Beijing Jishuitan Hospital. Quality of life was assessed for each patient with the Merle d'Aubingne and Postel fracture function rating scale and the radiological result was assessed using the Matta radiological score.</p><p><b>RESULTS</b>Sixty-eight cases (70 hips) were followed up with a minimal duration of five years (average of 5.8 years). Excellent functional results were observed in 10 hip joints, good results in 40, fair results in 11, and poor results in nine. The risks of poor prognosis include impact fracture or osteochondral fracture of femoral head, a time beyond 42 days from injury to operative management, and dislocation of femoral head during the injury. Some of the problems, which were observed included postoperative infection in two hips, iatrogenic sciatic nerve injury in eight hips, traumatic arthritis in 15 hips, heterotopic ossification in 17 hips, and necrosis of the femoral head in six hips.</p><p><b>CONCLUSION</b>A careful selection of operative indications for delayed acetabular fractures in combination with a proper operative approach and appropriate reduction and fixation could guarantee relatively good results.</p>

Posterolateral approaches for treatment of pilon fractures / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the effect and complication of surgical treatment for Pilon fracture using the posterolateral approach.</p><p><b>METHODS</b>From August 2009 to March 2011, 15 patients with Pilon fractures (2 in B3,13 in C) and with a separate displaced posterior malleolar fragment was treated in two-stage: the first stage management was on stabiliztion of the soft tissue envelope with temporary external fixator of spanning arthritis, and the second stage management was open reduction and internal fixation with posterolateral approach and anteromedial or anteralateral approach.</p><p><b>RESULTS</b>All patients were followed-up for 12 to 17 months (14.2 months in average). Thirteen of the 15 fractures healed, but 2 fractures needed autologous bone graft procedure duo to nonuion. There was no wound complication related to poterolateral incion. Fourteen fractures had less than 2 mm of incongruity of distal tibia joint. According to Baired-Jackson criteria, the results were excellent in 2 cases, good in 7, fair in 4, and poor in 2.</p><p><b>CONCLUSION</b>The posterolateral approach offers direct visualization for the reduction and fixation of the fibula and posterior distal fragment of the tibia Pilon fractures, faciliate the management of this difficult fracture pattern.</p>

Effect of two intensive insulin therapy regimens on perioperative glycemic control in bone fracture patients with type 2 diabetes mellitus / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Currently, there are no uniform standards and methods for perioperative glycemic control in bone fracture patients with Type 2 diabetes mellitus (T2DM). We retrospectively analyzed the efficacy and safety of two intensive insulin therapy regimens administered to bone fracture patients with T2DM in the perioperative period, to explore the best method of achieving perioperative glycemic control.</p><p><b>METHODS</b>A number of 159 bone fracture patients with T2DM were divided into two groups. One group (n = 81) received multiple subcutaneous insulin injections (MSII group) and the other (n = 78) received continuous subcutaneous insulin infusion (CSII group). Blood glucose (BG) levels, time to achieve glycemic target, insulin dosage, and the incidence of hypoglycemia and complications were compared between groups.</p><p><b>RESULTS</b>Both regimens reduced BG to desired levels before surgery. The time to reach glycemic target in CSII group (2.5 days) was significantly shorter than that in the MSII group (7.3 days; P < 0.001). Mean insulin dosage in the CSII group (0.66 IU×kg(-1)×d(-1)) was significantly lower than that in the MSII group (0.74 IU×kg(-1)×d(-1); P = 0.005), as were the incidences of hypoglycemia (15.4% vs 32.1%) and infection (6.4% vs. 23.5%). Multiple regression analysis showed that the time to reach glycemia target was associated with the insulin therapy regimen and dosage. The insulin dosage on reaching glycemia target was positively associated with body mass index (BMI), diabetes mellitus course, glycated hemoglobin A1c (HbA1c), and β-hydroxybutyric acid, and was negatively associated with age.</p><p><b>CONCLUSION</b>The efficacy and safety of CSII was superior to that achieved with MSII, suggesting that CSII should be considered as initial therapy to control perioperative BG in bone fracture patients with T2DM.</p>