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Objective:To investigate the risk factors for nonunion after surgery for femoral shaft fractures in order to reduce them.Methods:The clinical data were retrospectively analyzed of the 804 patients with femoral shaft fracture who had been treated from January 2014 to December 2020 at Department of Orthopaedics, Xijing Hospital. There were 575 males and 229 females, aged from 18 to 96 years (average, 43.7 years). The patients were divided into 2 groups according to whether nonunion had occurred after surgery: a nonunion group of 112 cases and a fracture healing group of 692 cases. The preoperative general data, such as age, gender and fracture type, as well as intraoperative and postoperative data, such as operation time, internal fixation method, reduction method and internal fixation failure, were compared between the 2 groups. Items with P<0.05 were included in the multivariate logistic regression analysis to identify the risk factors for nonunion. Results:There were statistically significant differences between the nonunion group and the fracture healing group in smoking history, drinking history, injury mechanism, injury type, multiple injuries, fracture AO classification, fixation method, internal fixation failure, postoperative infection and use of non-steroid anti-inflammtory drugs ( P<0.05). Multivariate logistic regression analysis showed that smoking ( OR=3.261, 95% CI: 2.072 to 5.133, P<0.001), high energy injury ( OR=2.010, 95% CI: 1.085 to 3.722, P=0.026), multiple injuries ( OR=3.354, 95% CI: 1.985 to 5.669, P<0.001), AO type 32-C fracture (type 32-C fracture used as a reference, P=0.034), internal fixation failure ( OR=3.517, 95% CI: 1.806 to 6.849, P<0.001), external stent fixation (external stent fixation used as a reference, P=0.009) were the risk factors for nonunion after femoral shaft fractures. Conclusions:After surgery for patients with femoral shaft fracture, special attention should be paid to those with a smoking habit, high-energy injury, multiple injuries, AO type 32-C fracture, external stent fixation or a failed internal fixation, because they are high-risk groups prone to postoperative nonunion.
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Objective To investigate the efficacy of anti-infective reconstituted bone xenograft (ARBX) combined with external fixation in the treatment of adult infective nonunion of humeral shaft.Methods A retrospective case series study was conducted to analyze the clinical data of 18 patients with infected nonunion of humeral shaft admitted to Xijing Hospital of Air Force Military Medical University from January 2014 to December 2016.There were 10 males and eight females,aged 19-62 years [(36.9 ± 11.8)years].According to Umiarov classification of infective nonunion,there were 11 patients with type Ⅲ and seven with type Ⅳ.All patients were treated with anti-infective reconstituted bone xenograft (ARBX) combined with external fixation.The number of operations,bone healing time,bone healing rate,infection control rate,postoperative weight bearing time,the time of external fixation removal,postoperative complications,erythrocyte sedimentation rate (ESR),and C-reactive protein (CRP) before and after operation were recorded.Fracture healing and functional recovery were evaluated using the Johner-Wruch lower limb function score.Results The patients were followed up for 12-30 months [(21.3 ±5.6)months].The operation was performed for (1.4 ±0.9) times,with time of bone healing for (16.6 ± 5.8)months,bone healing rate of 83％ (15/18),and infection control rate of 94％ (17/18).The postoperative weight bearing time in 15 patients who obtained bone healing was (3.3 ± 1.5)months after operation,and the external fixation removal time was (18.5 ± 4.2) months after operation.There were three patients with nonunion after operation including one with infection recurrence.Five patients were found with nail tract infection.ESR and CRP at postoperative 3 months [(13.1 ± 8.4)mm/h and (5.6 ± 4.6)mg/L] were significantly lower than those before operation [(47.3 ± 19.2)mm/h and (23.4 ± 7.4) mg/L] (P ＜ 0.05).According to Johner-Wruch lower limb function scores,the results were excellent in nine patients,good in four,fair in one,and poor in four,with excellent and good rate of 72％.Conclusion ARBX combined with External fixation can effectively treat infective nonunion of humeral shaft,improve bone healing rate,and promote function recovery.
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Objective@#To establish an efficient classification and treatment system for limb long bone defects.@*Methods@#Based on the length of bone defect, soft tissue injury and wound infection, a new classification and treatment system was proposed with reference to Gustilo-Anderson classification for open fractures and Orthopedic Trauma Association (OTA) classification.@*Results@#We divided the limb long bone defects into 3 types, each of which was subdivided into 4 subtypes depending on concomitant soft tissue defect and/or infection. Type Ⅰ are bone defects less than 4 cm in length, including type Ⅰa (simple bone defects with a limited extent), type Ⅰb (bone and soft tissue defects), type Ⅰc (bone defects with infection) and type Ⅰd (bone defects with infection and soft tissue defects). Type Ⅱ are bone defects ranging from 4 to 10 cm in length, including type Ⅱa (simple bone defects with a large extent), type Ⅱb (bone and soft tissue defects), type Ⅱc (bone defects with infection) and type Ⅱd (bone defects with infection and soft tissue defects). Type Ⅲ are bone defects larger than 10 cm in length, including type Ⅲa (simple bone defects with a very large extent), type Ⅲb (bone and soft tissue defects), type Ⅲc (bone defects with infection) and type Ⅲd (bone defects with infection and soft tissue defects).@*Conclusion@#Our new classification and treatment system for long limb bone defects is more efficient and intuitive, facilitating clinical diagnosis and treatment of limb long bone defects.
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Objective To establish an efficient classification and treatment system for limb long bone defects.Methods Based on the length of bone defect,soft tissue injury and wound infection,a new classification and treatment system was proposed with reference to Gustilo-Anderson classification for open fractures and Orthopedic Trauma Association (OTA) classification.Results We divided the limb long bone defects into 3 types,each of which was subdivided into 4 subtypes depending on concomitant soft tissue defect and/or infection.Type Ⅰ are bone defects less than 4 cm in length,including type Ⅰa (simple bone defects with a limited extent),type Ⅰb (bone and soft tissue defects),type Ⅰc (bone defects with infection)and type Ⅰd (bone defects with infection and soft tissue defects).Type Ⅱ are bone defects ranging from 4 to 10 cm in length,including type Ⅱa (simple bone defects with a large extent),type Ⅱb (bone and soft tissue defects),type Ⅱc (bone defects with infection) and type Ⅱd (bone defects with infection and soft tissue defects).Type Ⅲ are bone defects larger than 10 cm in length,including type Ⅲa (simple bone defects with a very large extent),type Ⅲb (bone and soft tissue defects),type Ⅲc (bone defects with infection) and type Ⅲ d (bone defects with infection and soft tissue defects).Conclusion Our new classification and treatment system for long limb bone defects is more efficient and intuitive,facilitating clinical diagnosis and treatment of limb long bone defects.
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Objective@#To study the mutation of ENG, ACVRL1, and SMAD4 genes in one of a family of hereditary hemorrhagic telangiectasia (HHT) and explore its molecular pathogenesis. @*Methods@#A family spectrum of a patient with a clinical diagnosis of HHT was surveyed. Peripheral blood samples from proband and their eldest were collected, and ENG, ACVRL1 and SMAD4 gene analysis was performed by chip capture high-throughput sequencing. The mutation detected was verified by Sanger. @*Results@#9 of the 71 family members were diagnosed with HHT with the main manifestation of recurrent nasal bleeding. Genetic analysis showed that the proband and the eldest son of ENG gene exon 9 frameshift mutation: c.1502-1503insGG (p.Gly501GlyfsX18) , and mutations in ACVRL1 and SMAD4 genes were not detected. @*Conclusion@#The frameshift mutation c.1502-1503insGG (p.Gly501GlyfsX18) of the ENG gene is the genetic basis for the pathogenesis of this HHT family.
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Objective To compare the effectiveness of expandable intramedullary nail(EIMN) versus locked compression plate (LCP) in the treatment of humeral shaft fractures of AO types A and B.Methods The clinical data were retrospectively analyzed and compared of the 44 humeral shaft fractures which had been treated between May 2012 and February 2016.There were 26 men and 18 women,from 23 to 66 years of age (average,41.5 years).By AO classification,22 cases were type 12-A and 22 type 12-B.EINM was used in 22 patients with an average age of 41.3 ± 1 1.7 years and LCP in 22 ones with an average age of 41.6 ± 10.3 years.The 2 groups were compared in terms of intraoperative blood loss,operative time,hospital stay,union time,union rate,Constant and Mayo scores at the final follow-ups,and complications as well.Results The 2 groups were compatible without significant differences in the preoperative demographic data (P ＞ 0.05).All the 44 patients were followed up for 10 to 18 months (average,12 months).The intraoperative blood loss (76.4 ± 18.66 mL),operative time (69.1 ± 13.2 min),incision length (5.8 ± 1.5 cm) and union time (13.2 ± 8.4 w) in the EIMN group were significantly better than those in the LCP group (138.6 ± 39.4 mL,96.4 ± 14.2 min,8.5 ± 1.4 cm and 18.4 ± 6.6 w,respectively) (P ＜ 0.05).There was also a significant difference between the 2 groups in the total complication rate[18.2％ (4/22) versus 50.0％ (11/22)] (P ＜0.05).No deep infection or should pain was observed in either group.Conclusions Inthe treatment of humeral shaft fractures of AO types 42-A and 42-B,compared with LCP,EIMN may have advantages of less intraoperative blood loss,operative time,union time and complications.The 2 methods are similar in hospital stay and final functional recovery of the should joint.
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A new method for noninvasive prenatal diagnosis of fetal sex was developed by using single-cell PEP-PCR techniques. Micromamipulation techniques were used to obtain single fetal cells from 273 maternal blood samples. The genome of single cells was preamplified by PEP and SRY genes were analyzed by PCR method. The SRY genes of 149 samples were detected by the new method among 153 samples carrying male fetus, while 119 out of 120 samples carrying female fetus were proved negative for SRY genes. The sensitivity and specificity of the new method were 97.39% and 99.17% respectively and the correct rate was 98.17%. The new method has the advantage of high sensitivity and specificity in noninvasive prenatal diagnosis of fetal sex and provides the basis of other researches such as sex-linked inherited diseases.
Subject(s)
Chromosomes, Human, Y , Erythroblasts/chemistry , Fetus/cytology , Genes, sry/genetics , Genetic Diseases, Inborn/diagnosis , Maternal-Fetal Exchange/genetics , Polymerase Chain Reaction/methods , Pregnancy/blood , Prenatal Diagnosis/methods , Sex Determination ProcessesABSTRACT
A new method for noninvasive prenatal diagnosis of fetal sex was developed by using single-cell PEP-PCR techniques. Micromamipulation techniques were used to obtain single fetal cells from 273 maternal blood samples. The genome of single cells was preamplified by PEP and SRY genes were analyzed by PCR method. The SRY genes of 149 samples were detected by the new method among 153 samples carrying male fetus, while 119 out of 120 samples carrying female fetus were proved negative for SRY genes. The sensitivity and specificity of the new method were 97.39% and 99.17% respectively and the correct rate was 98.17%. The new method has the advantage of high sensitivity and specificity in noninvasive prenatal diagnosis of fetal sex and provides the basis of other researches such as sex-linked inherited diseases.
Subject(s)
Adult , Female , Humans , Male , Pregnancy , Chromosomes, Human, Y , Erythroblasts , Chemistry , Fetus , Cell Biology , Genes, sry , Genetics , Genetic Diseases, Inborn , Diagnosis , Maternal-Fetal Exchange , Genetics , Polymerase Chain Reaction , Methods , Blood , Prenatal Diagnosis , Methods , Sex Determination ProcessesABSTRACT
The single cell isolation technique was used to detect fetal nucleated erythroblasts (FNRBCs) at a single cell level from the peripheral blood of pregnant women in order to investigate the feasibility of this method for noninvasive prenatal diagnosis. Single fetal nucleated erythroblasts were isolated from the peripheral blood samples from 51 pregnant women (14 to 26 weeks of gestation) by micromanipulation techniques after density gradient centrifugation. Nested polymerase chain reaction method was used to amplify the SRY gene. It was found that the concordance rate of amplification results with real fetal sex was 82.61 %. The sensitivity and specificity were 80 % and 87.50 % respectively. It was suggested that it is feasible and promising in non invasive prenatal diagnosis to detect fetal nucleated erythroblasts at a single cell level by using micromanipulation techniques.
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The single cell isolation technique was used to detect fetal nucleated erythroblasts (FNRBCs) at a single cell level from the peripheral blood of pregnant women in order to investigate the feasibility of this method for noninvasive prenatal diagnosis. Single fetal nucleated erythroblasts were isolated from the peripheral blood samples from 51 pregnant women (14 to 26 weeks of gestation) by micromanipulation techniques after density gradient centrifugation. Nested polymerase chain reaction method was used to amplify the SRY gene. It was found that the concordance rate of amplification results with real fetal sex was 82.61 %. The sensitivity and specificity were 80 % and 87.50 % respectively. It was suggested that it is feasible and promising in non invasive prenatal diagnosis to detect fetal nucleated erythroblasts at a single cell level by using micromanipulation techniques.