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Objective:To investigate the effect of pulsed electric field (PEF) combined with low temperature plasma (LTP) on mouse liver cancer cell.Methods:H22 mouse liver cancer cells were divided into liver cancer group, PEF treatment group, LTP treatment group, combined group A (first PEF treatment immediately after LTP treatment), combined group B (first LTP treatment immediately after PEF treatment), combined group C (same as combined group A, but 20 minutes interval) and combined group D (same as combined group B, but 20 minutes interval). Cell viability was detected by cell counting, apoptosis was detected by flow cytometry, intracellular reative oxygen species (ROS) was marked by fluorescence and counted. Twenty healthy female Kunming mouse aged 4-6 weeks without specific pathogens were subcutaneous injected with liver cancer cells, and then were randomly divided into model group, PBS control group, PEF experimental group, LTP experimental group and combined group (LTP+ PEF, no interval) ( n=4). Tumor relative volume and tumor inhibition rate were measured. Results:The survival rates were liver cancer cell group (98.3±0.9)%, PEF treatment group (66.8±4.4)%, LTP treatment group (62.1±3.9)%, combined group A (43.7±3.7)%, combined group B (31.0±1.4)%, combined group C (46.8±2.9)%, combined group D (39.0±2.3)%. Compared with liver cancer cell group, the cell survival rate of all treatment groups was decreased, and the cell survival rate of the four combined treatment group was lower than that of PEF treatment group and LTP treatment group, the differences were statistically significant (all P<0.05). The survival rate of combined B group was the lowest. The results of apoptosis detection were consistent with those of cell survival rate. Under fluorescence microscope, the ROS fluorescence of cells in the combined group B was significantly increased, and the ROS fluorescence of cells in the LTP treatment group was more than that in the PEF treatment group, and the percentage of ROS positive cells in the combined group B was higher than that in the LTP treatment group and the PEF treatment group, with statistical significance (all P<0.05). Tumor relative volume and tumor inhibition rate in the combined group were better than those in the PEF and LTP groups, and the differences were statistically significant (all P<0.05). Conclusion:LTP combined with PEF has a better killing effect on H22 cells than PEF or LTP treatment, which is expected to be a new tumor therapy.
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Objective@#To investigate the clinical outcomes and radiological results of arthroscopic autologous scapular spine bone graft transplant to treat shoulder recurrent instability.@*Methods@#Data of 27 patients diagnosed as shoulder recurrent instability with the bone defect of 10%-15% from July 2016 to August 2018 who were treated by arthroscopic autologous scapular spine bone graft transplant were retrospectively analyzed. There were 20 males and 7 females with an average age of 30.8 years old (range, 19-50). The bone loss of the glenoid was 10%-15%. The time between the first dislocation and the surgery was 24.1±15.8 months. The patients were treated with arthroscopic autologous scapular spine bone graft transplant. Postoperatively the affected shoulder was immobilized by the abduction brace for 6 weeks, after that the passive motion was applied. Strengthening exercise began at 10-12 weeks and sports was allowed after 6 months. Constant-Murley score and the Disabilities of Arm, Shoulder and Hand (DASH) score were used to evaluate the shoulder function, and visual analogue score (VAS) score was used to evaluate the degree of pain. Computed tomography scans were obtained one week post-operation and at the latest follow-up, from which the length, width, height and volume of the bone graft were measured and the absorption rate of the bone graft was calculated. The subjective satisfaction degree of patients at the latest follow-up was also recorded.@*Results@#All 27 patients were followed up for 19.8 months (range, 13-39 months). No infection or neurovascular injury was identified. At the latest follow-up, the Constant-Murley score was 85.15±5.62 (range, 76-94), the DASH score 13.39±5.51 (range, 3.19-21.95) and the VAS score 1.29±0.45 (range, 1-2), thus all of those were improved significantly compared to those of pre-operation. At the latest follow-up, the anterior flexion was 153°±24°, lateral rotation by side 38°±21°, internal rotation 70°±21°, and abduction was 139°±18°. At the latest follow-up, the absorption rate of the bone graft was 46.1%±20.6% (range, 24.0%-71.7%). Among all the 27 patients, 19 patients considered the outcome as very good, and 6 patients considered as good, 2 patients fair.@*Conclusion@#Arthroscopic autologous scapular spine bone graft transplant could successfully treat shoulder recurrent instability with glenoid bone loss at 10%-15%. This technique could achieve satisfactory clinical results, improve glenohumeral stability, decrease the re-dislocation rate.
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Objective@#To investigate the clinical results of arthroscopic double-pulley double row suture technique for the treatment of bigger Ideberg Ia glenoid fracture.@*Methods@#From January 2014 to July 2017, data of patients with Ideberg Ia glenoid fracture who were treated by arthroscopic double-pulley double row suture technique were retrospectively analyzed. Totally 24 patients were enrolled of whom 13 were males and 11 were females. The mean age was 50.14±10.60 years (range, 34-67). In those patients, there were 8 cases of glenoid fracture alone, 4 cases of glenoid fracture associated with greater tuberosity fracture, 5 cases of glenoid fracture with rotator cuff tear, 4 cases of glenoid fracture with shoulder anterior dislocation and greater tuberosity fracture, 2 cases of glenoid fracture with shoulder anterior dislocation and rotator cuff tear, and 1 case of shoulder anterior dislocation with ipsilateral distal radius fracture. The fragment accounts for 28.91±5.35% (range, 25.1%-38.5%) of the glenoid articular surface. According to the size of the fragment, one medial row anchor was used to implant at the medial edge of the fracture bed of the anterior edge of the glenoid; two to four lateral row suture anchors were used to implant at the margin of the glenoid joint surface sequentially from low level to higher level, and simplified double-pulley technique was finally used to fix the fragment. The situation of fracture reduction and healing and the post-operative complications were evaluated. The Constant-Murley, DASH and VAS were also recorded.@*Results@#Satisfactory fracture reduction and fixation were achieved in all 24 patients. The mean follow-up time was 19.5 months (range, 12-36). Mean VAS was 0.8±0.8 (range, 0-2). The range of motion at the latest follow-up was: anterior flexion 145°-180° (mean, 161.00°±5.77°), external rotation at the side 35°-60° (mean, 46.43°±6.63°), internal rotation L3-T10 level. The mean Constant-Murley score was 88.1±3.7 (range, 81-93), and mean DASH score was 8.4±4.7 (range, 0-40.4). All cases except one showed no dislocation or disability of the shoulder. The CT scans showed: 19 cases of which the step-off of articular surface was less than 2 mm; 4 cases of which the step-off was between 2 mm to 4 mm and 1 case of which the step-off was more than 4 mm. No severe osteoarthritis was identified at the latest follow-up, and only 1 patient at the age of 67 showed slight osteoarthritis. Two patients with shoulder anterior dislocation and rotator cuff tear committed significant restricted shoulder range of motion.@*Conclusion@#The arthroscopic simplified double-pulley double row suture technique was identified safe, effective and reliable for treating the bigger Ideberg Ia glenoid fracture. The technique is able to provide clear visulization of the fracture and achieve excellent clinical results.
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Objective To investigate the clinical outcomes and radiological results of arthroscopic autologous scapular spine bone graft transplant to treat shoulder recurrent instability.Methods Data of 27 patients diagnosed as shoulder recurrent instability with the bone defect of 10％-15％ from July 2016 to August 2018 who were treated by arthroscopic autologous scapular spine bone graft transplant were retrospectively analyzed.There were 20 males and 7 females with an average age of 30.8 years old (range,19-50).The bone loss of the glenoid was 10％-15％.The time between the first dislocation and the surgery was 24.1±15.8 months.The patients were treated with arthroscopic autologous scapular spine bone graft transplant.Postoperatively the affected shoulder was immobilized by the abduction brace for 6 weeks,after that the passive motion was applied.Strengthening exercise began at 10-12 weeks and sports was allowed after 6 months.Constant-Murley score and the Disabilities of Arm,Shoulder and Hand (DASH) score were used to evaluate the shoulder function,and visual analogue score (VAS) score was used to evaluate the degree of pain.Computed tomography scans were obtained one week post-operation and at the latest follow-up,from which the length,width,height and volume of the bone graft were measured and the absorption rate of the bone graft was calculated.The subjective satisfaction degree of patients at the latest follow-up was also recorded.Results All 27 patients were followed up for 19.8 months (range,13-39 months).No infection or neurovascular injury was identified.At the latest follow-up,the Constant-Murley score was 85.15±5.62 (range,76-94),the DASH score 13.39±5.51 (range,3.19-21.95) and the VAS score 1.29±0.45 (range,1-2),thus all of those were improved significantly compared to those of pre-operation.At the latest follow-up,the anterior flexion was 153°±24°,lateral rotation by side 38°±21°,internal rotation 70°±21°,and abduction was 139°± 18°.At the latest follow-up,the absorption rate of the bone graft was 46.1％±20.6％ (range,24.0％-71.7％).Among all the 27 patients,19 patients considered the outcome as very good,and 6 patients considered as good,2 patients fair.Conclusion Arthroscopic autologous scapular spine bone graft transplant could successfully treat shoulder recurrent instability with glenoid bone loss at 10％-15％.This technique could achieve satisfactory clinical results,improve glenohumeral stability,decrease the re-dislocation rate.
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Objective To investigate the clinical results of arthroscopic double-pulley double row suture technique for the treatment of bigger Ideberg Ⅰa glenoid fracture.Methods From January 2014 to July 2017,data of patients with Ideberg Ⅰa glenoid fracture who were treated by arthroscopic double-pulley double row suture technique were retrospectively analyzed.Totally 24 patients were enrolled of whom 13 were males and 11 were females.The mean age was 50.14±10.60 years (range,34-67).In those patients,there were 8 cases of glenoid fracture alone,4 cases of glenoid fracture associated with greater tuberosity fracture,5 cases of glenoid fracture with rotator cuff tear,4 cases of glenoid fracture with shoulder anterior dislocation and greater tuberosity fracture,2 cases of glenoid fracture with shoulder anterior dislocation and rotator cuff tear,and 1 case of shoulder anterior dislocation with ipsilateral distal radius fracture.The fragment accounts for 28.91±5.35％ (range,25.1％-38.5％) of the glenoid articular surface.According to the size of the fragment,one medial row anchor was used to implant at the medial edge of the fracture bed of the anterior edge of the glenoid;two to four lateral row suture anchors were used to implant at the margin of the glenoid joint surface sequentially from low level to higher level,and simplified double-pulley technique was finally used to fix the fragment.The situation of fracture reduction and healing and the post-operative complications were evaluated.The Constant-Murley,DASH and VAS were also recorded.Results Satisfactory fracture reduction and fixation were achieved in all 24 patients.The mean followup time was 19.5 months (range,12-36).Mean VAS was 0.8±0.8 (range,0-2).The range of motion at the latest follow-up was:anterior flexion 145°-180° (mean,161.00°±5.77°),external rotation at the side 35°-60° (mean,46.43°±6.63°),internal rotation L3-T10 level.The mean Constant-Murley score was 88.1±3.7 (range,81-93),and mean DASH score was 8.4±4.7 (range,0-40.4).All cases except one showed no dislocation or disability of the shoulder.The CT scans showed:19 cases of which the step-off of articular surface was less than 2 mm;4 cases of which the step-off was between 2 mm to 4 mm and 1 case of which the step-off was more than 4 mm.No severe osteoarthritis was identified at the latest follow-up,and only 1 patient at the age of 67 showed slight osteoarthritis.Two patients with shoulder anterior dislocation and rotator cuff tear committed significant restricted shoulder range of motion.Conclusion The arthroscopic simplified double-pulley double row suture technique was identified safe,effective and reliable for treating the bigger Ideberg Ⅰa glenoid fracture.The technique is able to provide clear visulization of the fracture and achieve excellent clinical results.
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Objective@#To explore the influence and mechanism of time effect of the controlled micromovement on fracture healing.@*Methods@#Forty-eight rabbit models of femoral fracture were prepared and fixed with unilateral two-bar external fixator. They were randomly divided into four groups: continuing immobilization group, instant micromovement group, 1-week micromovement group and 2-week micromovement group. Postoperative radiographs were taken at 1, 2, 3 and 5 weeks to observe callus growth. The maximum load, deflection and rigidity of callus at fracture end were measured 5 weeks after operation. At 1, 2 and 3 weeks after operation, the histological morphology of callus was observed, and the expression and distribution of osteocalcin (oc) in callus were detected.@*Results@#At 5 weeks after operation, the X-ray scores of fracture line in 1-week micromovement group and 2-week micromovement group were 10.384±0.744 mm, 10.412±0.482 mm, significantly higher than those in continuing immobilization group (7.518±0.536). The anteroposterior diameter and the exterior and interior diameter of the external callus in 1-week micromovement group and 2-week micromovement group were 14.3±3.2 mm, 14.0±2.8 mm and 14.6±2.1 mm, 15.2±3.1 mm, which were smaller than those in the continuing immobilization group 15.3±2.3 mm and 16.7±1.9 mm, but there was no significant difference. The bone mineral density value and proportion rate in the fracture site were 0.446±0.020 g/cm2, 0.416±0.021 g/cm2 and 1.171%±0.056%, 1.143%±0.040% in 1-week micromovement group and 2-week micromovement group, which were significantly higher than those in continuing immobilization group which were 0.376±0.022 g/cm2 and 0.912%±0.051%. The maximum load of callus in 1-week micromovement group and 2-week micromovement group was 415.6±27.2 N, 400.3±28.5 N, which was significantly higher than that in continuing immobilization group 329.2±18.4 N and instant micromovement group 272.8±22.7 N. There was no difference of the deflection of callus between groups. The rigidity of callus in 1-week micromovement group was 590.4±24.2 N/mm, which was significantly higher than that in other groups; the rigidity of callus in the 2-week micromovement group was 540.6±22.8 N/mm, which was significantly higher than those in the instant micromovement group and the continuing immobilization group (152.4±21.7 N/mm, 174.8±20.6 N/mm).@*Conclusion@#Micromovement begins from one or two weeks can significantly raise external callus formation and vagueness level of fracture line, accelerating bridging callus formation, and can significantly raise bone mineral density and rigidity of callus. It also accelerates the maturity, hypertrophy and mineralization of chondrocyte, resulting in the stimulation of the fracture healing through endochondral ossification; it seemingly can improve the amount and density of osteoclasts in callus to stimulate the maturity and mineralization of chondrocyte. The strengthening coupling of osteoblasts and osteoclasts can promote the transformation from soft callus to hard callus and the remolding of hard callus.
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Objective To evaluate total laparoscopic left hemihepatectomy vs open procedures for operable left hepatic lesions.Methods We retrospectively analyzed the clinical data of laparoscopic and open hepatectomy in 40 patients with left hepatic disease in Huanshan People's Hospital between January 2016 and January 2018.Among them,laparoscopic hepatectomy was performed in 24 cases,open liver resection in 16 cases.Results The postoperative fasting time,postoperative analgesic usage and length of postoperative hospital stay were all significantly different in favor of laparoscopic group (t =4.158,x2 =9.184,t =2.174,all P ＜ 0.05),while,the operative time,intraoperative blood loss,incidence of postoperative complications and the total hospitalization expense showed no statistical difference (t =0.752,t =1.186,x2 =0.000,t =0.925,all P ＞ 0.05).Conclusion Laparoscopic left liver resection is a minimally invasive,safe and effective treatment for operable left liver lesions.
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Objective To explore the efficacy and complication prevention of operative fixation of coronoid fractures via neurovascular interval of anterior elbow approach.Methods From March 2006 to September 2009,data of 21 patients with coronoid process fractures associated with complex elbow dislocation who were treated via neurovascular interval of anterior elbow approach in my ward were retrospectively analyzed.There were 14 males and 7 females.The mean age of the patients was 31.6 years (range,18-52 years).Injury was caused by walk falling in 10 cases,falling from standing-height in 3 cases and sports events in 8 cases;7 patients were left side and 14 patients were right side,including 16 prominent sides and 5 non-prominent sides.There were 3 type Ⅰa,3 type Ⅱa,8 type Ⅱb,4 type Ⅱc,3 type Ⅲa coronoid process fractures according to the O'Driscoll's classification.Pre-operative 3D-CT scans were conducted to clarify if there were subluxations or sign of instabilities in elbows.Operative fixation of coronoid process fractures with cannulated screws and/or mini plates and/or suture anchors were carried out via the anterior interval between humeral vessels and median nerve,and then lateral collateral ligaments were repaired if instability still existed.Results The average operation time was 72 min,and the follow-up time was 52-74 months.Only 1 case of type Ⅰa fracture got nonunion because of early postoperative activities from the first day after the operation and the elbow was fixed at 0 degree of extension with brace.At the latest follow-up,in suture anchor fixation group (3 cases),the average VAS was 1.8±0.5,Broberg-Morrey score 90.2±6.6,extension deficiency 11.2°±3.6°,flexion 133.4°±8.8°,and the excellent-good-rate was 66.7％ (2 cases excellent and 1 fair).In the screw-fixation group (10 cases),the average VAS was 1.6±0.8,Broberg-Morrey score 89.2±6.6,extension deficiency 15.2°±4.6°,flexion 130.8°±10.8°,and the excellent-good-rate was 90％ (6 cases excellent,3 good,and 1 fair).In the mini plate fixation group (8 cases),the average VAS score was 1.6±0.7,Broberg-Morrey score 88.6±6.7,extension deficiency 11.8°±5.6°,flexion 134.2°±8.6°,and the excellent-good-rate was 87.5％ (4 cases excellent,3 good,and 1 fair).In the lateral ligament repaired group (14 cases),the average VAS was 1.3±0.9,Broberg-Morrey score 91.5±6.3,extension deficiency 10.2°±3.4°,flexion 135.2°±4.2°,and the excellent-good-rate was 100％ (8 cases excellent,6 good).In the lateral ligament non-repaired group (7 cases),the average VAS was 2.2± 1.6,Broberg-Morrey score 80.2± 13.8,extension deficiency 13.6°±4.4°,flexion 126.6°±4.0°,and the excellent-good-rate was 71.4％ (3 cases excellent,2 good,1 fair).There were 5 cases which had early osteoarthritis changes in the elbow joint in 3 years' follow-up,with the incidence rate 23.8％ (5/21),and the incidence of mid-term osteoarthritis in the 5 and 7 years after operation was 4.8％ (1/21).Conclusion Operative fixation of coronoid fractures with suture anchor and/or cannulated screw and/or mini plate via neurovascular interval of anterior elbow approach was confirmed to be efficient and safe.Lateral collateral ligaments should be repaired if the elbow is unstable.
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Objective To compare the clinical efficacy of Philos plate and Multiloc intramedullary nail for 3-or 4-part proximal humeral fractures in the middle-aged and elderly patients.Methods A retrospective case control study was conducted to analyze the clinical data of 52 middle-aged and elderly patients with 3-or 4-part proximal humeral fractures admitted to Sichuan Orthopedic Hospital from January 2014 to January 2016.The patients were divided into Philos plate group (27 patients) and Multilloc intramedullary nail group (25 patients) according to different treatment methods.In the Philos plate group,there were 11 males and 16 females,aged (59.3 ± 4.5) years.Based on the Neer classification,there were 16 patients with 3-part fracture,11 patients with 4-part fracture including two patients with 4-part fracture dislocation.There were eight patients with varus fracture and 19 patients with valgus fracture.In the Multiloc intramedullary nail group,there were 10 males and 15 females,aged (62.2 ± 7.4) years.Based on the Neer classification,there were 18 patients with 3-part fracture,seven patients with 4-part fracture including one with 3-part fracture dislocation and one with 4-part fracture dislocation.There were 12 patients with varus fracture and 13 with valgus fracture.The operation time,intraoperative bleeding volume,fracture healing time,neck-shaft angle changes and complications of humeral head ischemic necrosis were compared between the two groups.At the last follow-up,the motion range of affected shoulder joint,American Shoulder and Elbow Surgeons (ASES) scale,Constant-Murley score and visual analogue score (VAS) were compared between the two groups.Results There was no significant difference in the operation time between the two groups (P ＞ 0.05).The intraoperative bleeding volumes were 170-350 ml [(260.1 ± 110.3) ml] in the Philos plate group and 70-250 ml [(172.2 ± 100.3)ml] in the Multiloc intramedullary nail group,with statistically significant difference (P ＜ 0.05).All incisions were healed by first intention,and no infection was found.The patients in the Philos plate group were followed up for 12-36 months [(17.2 ±6.5)months],and patients in the Multiloc intramedullary nail group for 12-36 months [(14.5 ± 4.7) months] (P ＞ 0.05).All fractures were healed,with the healing time for 2.5-4 months [(3.5 ± 0.5)months] in the Philos plate group and for 2-3.3 months [(3.0 ± 0.5) months] in the Multiloc intramedullary nail group.The neck-shaft angle was lost to some degree in both groups at the last follow-up compared with the first day after operation,but the differences were not statistically significant (P ＞ 0.05).The Philos plate group had a higher incidence rate of complication [22％ (6/27)] than the Multiloc intramedullary nail group [12％ (3/25)] (P ＜ 0.05).Three patients in the Philos plate group had partial ischemic necrosis of the humeral head,while none was found in the Multiloc intramedullary nail group.There were no significant differences in active shoulder joint ante-flexion and uplift,lateral intorsion and extorsion,ASES score,Constant-Murley score and VAS between the two groups (P ＞ 0.05).Conclusions For 3-or 4-part proximal humeral fractures in middle-aged and elderly patients,both Philos plate and Multiloc nail can obtain stable and reliable fixation and achieve satisfactory results of shoulder joint function.However,the Philos plate fixation has more intraoperative bleeding,longer fracture healing time,and higher incidence rate of humeral head ischemic necrosis than the intramedullary nail.
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Objective To evaluate the clinical and radiological results of Phlios plate and Multiloc nail in treatment of proximal humerus fractures.Methods From February 2013 to December 2015,data of 37 cases of proximal humerus fractures who were treated by reduction and fixation using Phlios plate or Multiloc nail were retrospectively analyzed.In group one (Phlios plate),there were 10 males and 8 females,with an average age of 56.3±5.8 years,including 7 cases of Neer 2-part surgical neck fracture,6 cases of Neer 3-part fracture,4 cases of Neer 4-part fracture,and 1 case of fracture-dislocation.In group two (Multiloc nail),there were 8 males and 11 females,with an average age of 57.2±7.4 years,including 8 cases of Neer 2-part surgical neck fracture,9 cases of Neer 3-part fracture,1 case of Neer 4-part fracture,and 1 case of fracture-dislocation.Operation time,range of motion of shoulder joint,visual analogue scale (VAS) pain score,American Shoulder & Elbow Surgeon (ASES) score and ConstantMurley score were collected.Results All 37 patients were followed up for an average period of 15.5 months (range,12-36 months).The average bone healing time were 2.5±0.5 months (range,2-3 months)and 2.2±0.5 months (range,1.5-3 months) in the plate and nail group respectively.At the latest follow-up,average VAS score was 0.4±0.6 (range,0-2),the ASES score aver aged 85.4±6.8 points (range,73-96),Constant-Murley score averaged 83.4±7.3 points (range,71-94),and external rotation averaged 30.8°±10.0° (range,10°-50°) in plate group,while average VAS score was 0.2±0.4 (range,0-1),ASES score averaged 89.7± 5.6 points (range,80-98),Constant-Murley score averaged 88.5±6.8 points (range,76-98),and external rotation averaged 40.3°± 7.9° (range,20°-50°) in the intramedullary nailing group.One case had partial necrosis of humeral head in the plate group,while 1 case suffered absorption of the greater tuberosity in the nail group,with the complication rate of 5.6％ (1/18) and 5.3％ (1/19) respectively,without significant difference.The internal and external rotation degrees,ASES and Constant-Murley scores were better in nail group than those in plate group for 2-part fractures,while the forward elevation and abduction degrees were similar.Conclusion Similar results were achieved for the treatment of proximal humeral fractures by Phlios plate and Multiloc nail.The Multiloc nailing group had achieved superior outcomes in Neer-2-part proximal humeral fractures.
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Objective To evaluate the short-term functional outcome of arthroscopic reduction and fixation for fractures of greater tuberosity of humerus.Methods From May 2012 to December 2016,data of 25 cases with fractures of greater tuberosity of humerus who were treated by reduction and fixation under arthroscopy were retrospectively analyzed.There were 12 males and 13 females,with an average age of 44.8 years (22-69 years),including 7 cases of left shoulder,and 18 cases of right shoulder.X-ray examinations revealed that the displacement of the greater tuberosity was 5-12 mm,with an average of 5.8 mm.There were 21 cases of fresh fractures and 4 cases of old fractures (more than 3 weeks from injury to operation).5 patients were treated only using cannulated screw fixation(Group one),while 12 patients only using suture-bridge anchor fixation(Group two) and another 8 patients were treated using combination technique with cannulated screw and suture anchor fixation(Group three).There were glenoid fractures in 11 cases before surgery,and 9 cases were found with Bankart lesion,1 case SLAP injury,8 cases rotator cuff tear found under arthroscopic examinations.At the last visit,visual analogue scale (VAS) pain score,American Shoulder & Elbow Surgeons (ASES) score and Constant-Murley score were collected to evaluate the recovery of shoulder function.Results All the incision healed primary,and no infection occurred.All 25 patients were followed up for an average period of 21.3 months (6～38 months).The X-ray showed that the fractures of the great tuberosity of humerus and the glenoid healed 2-4 months after operation,with an average time of 3.4 months.No fracture displacement and absorption were observed.At the final follow-up,the average functions of shoulder were 175.0°±6.3°,170.0°±9.5° and 160.6°±27.4° in group one,two and three respectively for forward flex-ion;57.5°±13.0°,56.1°±14.5° and 53.1°±11.2° for lateral external rotation in group one,two and three respectively;0.3±0.4,0.8± 1.1 and 1.1±1.4 points for VAS in group one,two and three respectively;98±1.6,95.6±4.0 and 93.3±7.5 points for ASES in group one,two and three respectively;and 96.5±2.3,95.0±4.3 and 92.0±9.2 points for the Constant-Murley scoring system in group one,two and three respectively.The displacement of the lateral anchor occurred in 1 patient (75 points for ASES,69 points for Constant -Murley and 3 points for VAS);and no complications such as internal fixation failure,fracture displacement and neurovascular injury occurred in the remaining patients.Conclusion It is a safe and effective method to treat the fractures of great tuberosity of humerus by reduction and fixation under the arthroscope using cannulated screws and/or suture anchors.
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Objective To evaluate the short?term functional outcome of Multiloc Proximal Humeral Nails (PHN) in the treatment of proximal humeral fractures, by retrospectively reviewing the function and complications of our institutional experi?ence. Methods 15 patients were treated operatively for displaced proximal humeral fractures using the Multiloc PHN. Fractures were classified according to Neer's classification. Male 4 cases, female 11 cases, with a mean age 63.7 years (58-73 years), and the mean follow?up was 5.2 months (3-10 months). A number of parameters including patient demographics, mechanism of injury, operative time, time to union and complications were recorded. Functional outcome was evaluated using the rating scale of the American Shoulder and Elbow Surgeons (ASES) and Constant Score, Visual Analogue Scale (VAS) scores. Results 15 patients completed the follow?up more than 3 months, the operation time was 145.3minutes (70-200 min), the blood loss was 189.3ml (50-310 ml). The union rate was 100%(mean time to union: 2.5 months). The ASES score was 83.1 and Constant Score was 81.7 , while the VAS was 1.7. The Constant score 87 (85, 92) and ASES 90 (83.5, 100) were higher for 5 cases without calcar screw than those of the other 10 cases using the calcar screw whose Constant 83 (77, 90), ASES 85 (73, 95). The average Constant score 88 (78, 92) and ASES score 91.5 (75, 100) were higher in 7 cases with 1 screw?in?screw than those with more than 2 screw?in?screw in 8 cases whose Constant 80.5 (74, 88.5), ASES 81.8 (73, 92.5). There were no complications such as hardware failure, protruded screws, infection, nonunion, avascular necrosis of humeral head or impingement syndrome, but 1 patient suffered from elbow stiff?ness (complication rate:6.7%). Conclusion The Multiloc proximal humeral nail is an effective implant for stabilisation of dis?placed proximal humeral fracture with a good short?term functional outcome. Its advantages are short operation time, small inci?sion, less trauma, less blood supply and less complications. The shoulder pain history and or with intraoperative findings of rotator cuff injuries, may have a negative impact on the prognosis.
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Objective To explore the characteristic of ACE gene I/D polymorphism in Han broad jumpers .Methods Distribu‐tion of ACE gene I/D polymorphism for broad jumpers was analyzed by PCR ,DNA sequencing ,Hardy‐Weinberg and SPSS ,and the results were compared with that of normal people .Results There were II ,DD and ID in gene ACE 16 ,and the Hard‐Weinberg re‐sults showed that the subjects were group representative .The ACE DD genotype and D allele in broad jumpers was statistically higher than normal controls (P<0 .05) .Conclusion The results suggest that ACE DD genotype and D allele are associated with training sensitivity of broad jumpers and could be the molecular marker for athletes choosing genetically .
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Objective To evaluate the clinical outcomes of primary repair of bony and ligamentous components in treatment of Mason-Johnston type Ⅳ radial head fractures.Methods From August 2007 to November 2011,16 cases of Mason-Johnston type Ⅳ radial head fractures were treated by open reduction and screw or plate fixation combined with simultaneous repair of ruptured capsular ligaments with suture anchors.There were 11 men and 5 women with a mean age of 31.6 years (range,18-52 years).Totally,left side was involved in seven cases and right side in nine； dominant side was involved in 13 cases and non-prominent side in three.Time from injury to operation averaged 6.2 days (range,2-11 days).Nine cases of partial articular fractures with 2 or 3 fragments were treated with 1.5 mm or 2.0 mm AO miniscrews and seven cases of complete articular fractures with 2-4 fragments were treated with 2.0 mm AO mini plastic plates and screws after reduction.Active and assisted functional exercise was instructed in the early period after surgery.Visual analogue scale (VAS) and Broberg-Morrey elbow performance were measured for function assessment at the latest follow-up.Results Follow-up averaged 22.6 months (range,12-38 months),which showed primary wound healing without infection.All fractures achieved bony union at an average of 4.8 months (range,3.3-6.2 months).Ten out of the 16 cases,four of partial articular fractures and six of complete articular fractures,had slight but asymptomatic ossification in the medial and lateral collateral ligament attachment.There were two excellent,six good and one fair results in partial articular fracture group,with excellent-good rate of 89％ as well as one excellent,four good and two fair results in complete articular fracture group,with excellent-good rate of 72％.Moreover,the total excellentgood rate reached 81％.Range of motion in extension,flexion and rotation,Broberg-Morrey score and VAS presented statistical differences between partial and complete articular fracture groups (P ＜ 0.05).Conclusion Primary management of bony and ligamentous components to treat Mason-Johnston type Ⅳ radial head fractures brings timely three-dimensional stability of the elbow joint,favors early functional exercise and further decreases incidence of postoperative complications,such as elbow stiffness,pain and heterotopic ossification.
ABSTRACT
ObjectiveTo analyze the therapeutic effect of open reduction with internal fixation (ORIF) and anatomic reconstruction locking plate in treatment of Neer 3-part and 4-part fracture dislocations of proximal humerus.MethodsThe study involved 30 patients with Neer 3-part and 4-part fracture dislocations treated with anatomic reconstruction locking plate from September 2004 to December 2007.Twenty patients had complete follow-up data.The treatment methods included locking proximal humeral plate (LPHP) in seven patients and proximal humeral internal locking system (PHILOS) in 13.There were 15 males and five females,at age range of 29-84 years (average 52.5 years),including nine patients younger than 65 years and 11 older than 65 years.According to Neer classification,there were 15 patients with 3-part fracture dislocations including 12 anterior and three posterior dislocations and five patients with 4-part fracture dislocations including four anterior and one posterior dislocations. VAS and Constant scoring system were adopted to evaluate the shoulder joint function postoperatively. Results All 20 patients were followed up for 36-71 months ( average 51 months),which showed avascular necrosis of humeral head in six patients (30％),plating loosening in two,screw penetration in six,nonunion in two and infection in two.The mean visual analogue score (VAS) was 2.55 poiuts and the mean Constant score for the shoulder was 80.8.According to the Neer shoulder functional evaluation standard,eight patients were graded as excellent,six as good,three as fair and three as poor,with excellence rate of 70％.ConclusionsAlthough the anatomic reconstruction locking plate and ORIF can cause a high incidence of avascular necrosis of humeral head in the treatment of Neer 3-part and 4-part fracture dislocations of proximal humerus,especially for the patients older than 65 years.However,there is no obvious correlation between necrosis of humeral head and shoulder function.Clinically,the method could be selected on the ba-sis of individual condition of the patients.