Surgical treatment for Müller-Weiss disease / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss operative methods and effects for Müller-Weiss disease.</p><p><b>METHODS</b>From March 2005 to May 2011, 15 patients were operated. There were 2 males and 13 females, with an average age of 51.8 years (range, 26 to 62 years). The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was (42 ± 13) points. According to the Maceira Staging system, 1 foot was grade 2, 6 feet were grade 3, 4 feet were grade 4, and 4 feet were grade 5. The technique consisted of arthrodesis of the talonaviculocuneiform joints with plate, arthrodesis of the talonavicular joint and arthrorisis of naviculocuneiform joint with plate, or triple arthrodesis with screws, according to the preoperative evaluation.</p><p><b>RESULTS</b>Ten feet were treated with arthrodesis of the talonaviculocuneiform joints, 3 feet were treated with arthrodesis of the talonavicular joint and arthrorisis of naviculocuneiform joint and 2 feet were treated with triple arthrodesis. Two patients were lost to follow-up. The average follow-up after operation was 19.2 months (range, 9 to 38 months). All feet were solid fusion and the average duration of union was 13.3 weeks (range, 12-16 weeks). The AOFAS ankle-hindfoot score at the last follow-up was (83 ± 6) points. Two feet were excellent, 10 feet were good, and 1 foot was fair. The length of feet was (14.2 ± 1.0) cm before surgery and (15.7 ± 0.9) cm at the last follow-up (t = 11.570, P < 0.05). The Meary's angle was -6.1° ± 13.1°before surgery and 1.1° ± 3.0° at the last follow-up (t = 2.248, P < 0.05). The talocalcaneal angle was 4.5° ± 2.2° before surgery and 18.0° ± 4.0° at the last follow-up (t = 11.700, P < 0.05). One foot had breakage of the plate and screws at arthrorisis of naviculocuneiform joint and none had complications related to the incision.</p><p><b>CONCLUSION</b>Operations for Müller-Weiss disease, according to concrete conditions using different therapeutic program, may achieve a satisfactory outcome.</p>

Advances in biomechanical studies of flexible adult-acquired flatfoot deformity / 医用生物力学

Adult-acquired flatfoot deformity (AAFD), which is mainly caused by posterior tibial tendon dysfunction (PTTD), is a common foot and ankle disease, and most of the deformities are flexible. How to explain the pathogenesis of AAFD and choose proper surgical treatment for the deformity has become a hot research focus nowadays. With the development of in vitro modeling technique for flatfoot, the accuracy and repeatability of the biomechanical tests have been gradually recognized, and the research results have also provided important theoretical basis for the clinical treatment of flatfoot deformity. In this article, the biomechanical mechanism of AAFD caused by PTTD, and the various modeling methods of flatfoot based on cadaver or finite element model were veviewed. The biomechanical characteristics of different reconstruction procedures in relative basic researches on flatfoot deformity were also analyzed and compared. The author believes that on the basis of simulating the dynamic stability of foot by tendon loading, the in vitro model of flexible flatfoot established by selective ligaments section is more reliable, and the reconstruction procedure adopted by various flatfoot models has different biomechanical characteristics. The soft tissue reconstruction and the bony procedures should be performed at the same time, and individual bony procedures should be chosen based on the degree and feature of the deformity.

Outcomes and complications of operative versus non-operative treatment of acute Achilles tendon rupture: a meta-analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There is lack of consensus regarding the best option for the treatment of acute Achilles tendon rupture-operation or non-operation. The purpose of this meta-analysis was to identify and summarize the randomized controlled trials comparing the operative and non-operative lines of treatment of acute Achilles tendon ruptures.</p><p><b>METHODS</b>We searched multiple databases in English (including EMBASE, PubMed, and OVID) and in Chinese (including CNKI, WANFANG, and VIP), as well as reference lists of articles and main orthopaedic and sports medical journals. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted data from eligible studies, with confirmation by cross-checking. The major results and conclusions were concluded, and the different complication rates and functional outcomes were compared. Meta-analysis was processed by RevMan 5.0 software.</p><p><b>RESULTS</b>Eight randomized controlled trials (RCTs) involving 777 patients met the inclusion criteria. The rerupture rate in non-operative group was significantly higher (Z = 3.33, P < 0.01). However, the moderate (Z = 4.27, P < 0.01) and minor (Z = 5.59, P < 0.01) complication rate in the operative group were significantly higher. No significant difference in comparing the major and total complication rates. The return to work time in the operative group was shorter (Z = 2.65, P < 0.01). The inability to return to previous level sporting rate and ankle joint decreased range of motion (ROM) rate showed no significant difference in the two groups. Other functional outcomes were similar in the two groups.</p><p><b>CONCLUSIONS</b>Operation could significantly reduce the risk of rerupture; however, it was associated with a higher risk of other complications. The functional outcomes were similar in two treatment methods except an earlier return to work in patients treated operatively. Thus operative treatment is preferable for patients with good physical condition. Non-operative treatment is an acceptable alternative especially for the older and patients with lower sporting requirements.</p>

Complications in total ankle arthroplasty: a meta analysis / 中华外科杂志

<p><b>OBJECTIVES</b>To provide a cumulative data about the complications of second or third generation ankle prostheses in the literature, and to provide a summary high-grade complications associated with implant failure.</p><p><b>METHODS</b>A comprehensive search for all relevant articles published in English from January 1995 to December 2010 was conducted. Two reviewers evaluated each study to determine whether it was eligible for inclusion and collected the data of interest. Meta-analytic pooling of results across studies was performed for the complications and failure rate.</p><p><b>RESULTS</b>Thirty-five primary studies with 4395 implants were identified. The three highest complications of total ankle arthroplasty were aseptic loosening (12.51%), intra-operative bone fracture (11.97%) and bony impingement (11.27%). The three high-grade complications associated with implant failure were aseptic loosening (45.00%), infection (33.00%) and malalignment (29.00%). The pooled mean failure rate was 10.98% (95%CI: 8.80% - 13.16%), and the pooled mean failure rate of STAR implant was 14.20% (95%CI: 10.64% - 17.76%).</p><p><b>CONCLUSIONS</b>It is found that aseptic loosening, infection and malalignment are high-grade complications associated with implant failure in total ankle arthroplasty. The orthopaedic surgeons should be more careful in the operation, and the patients should coordinate with the post-operative rehabilitation plan.</p>

Treatment of open calcaneal fractures / 中国骨伤

<p><b>OBJECTIVE</b>Review the series cases of open calcaneal fractures, to discuss the clinical outcome and evaluate the effective factors associated with the prognosis.</p><p><b>METHODS</b>Between 2004 and October 2009, 427 calcaneal fractures were treated, 22 of these fractures were open, 15 feet of 15 patients were available for the follow-up. There were 9 males and 6 females with a mean age of 34.7 years (range 18 to 66). According to the Sanders classification, there were 2 type I fractures, 3 type II, 6 type III and 4 type IV. According to the Gustilo classification, there were 1 of type 1, 4 of type II, 5 of type III A, and 5 of type III B open fracture. According to the open calcaneal injury subtypes (OCIS), there were 1 of type IA, 2 of type II A,7 of type II B, 2 of type IIIA and 3 of type III B. All patients were treated with intravenous antibiotics, immediate and repeat irrigation and debridement, temporary wound coverage, and initial stabilization of the limb. Clinical examination, radiographs and AOFAS ankle-hindfoot scores were used for outcome measurement.</p><p><b>RESULTS</b>The average follow-up time was 16.4 months (8 to 31 months). The mean AOFAS score was (74.6 +/- 10.4) (range 58 to 94). There were 4 feet required tissue transfer for wound coverage. An infection developed at the sites of 5 fractures,4 of witch were Gustilo type III, 2 deep infections with osteomyelitis developing at the site of 1 patient, no patient required amputation.</p><p><b>CONCLUSION</b>These findings do not reflect as high a deep infection and osteomyelitis rate for open calcaneal fractures as previously reported, if early and satisfying debridement, evaluate the soft tissue injury carefully, and choose the right time and indications for internal fixation. In addition, early internal fixation should be avoided for Gustilo type III and OCIS type B calcaneal fractures.</p>

Characteristics and surgical treatment of combined calcaneal fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the characteristics and experience for surgical treatment of combined calcaneal fracture.</p><p><b>METHODS</b>Between February 2004 and September 2007, 17 feet of 13 patients with combined calcaneal fractures underwent surgical operations. Among 17 calcaneal fractures, 8 combined with ipsilateral talus fractures, 5 combined with trimalleolar fractures, 4 combined with Pilon fractures. Firstly, fractures of hinder foot were treatment with open reduction and internal fixation according to the principle. Of all, 15 fractures were treated with screws or titanic plate plus open reduction and internal fixation, the rest 2 fractures were treated with subtalar arthrodesis. Postoperative X-ray assessed the internal fixation and union of fractures. The foot function was evaluated by the Maryland Foot Score.</p><p><b>RESULTS</b>A total of 13 patients were all followed up for 16.0 - 33.0 months (average 26.5 months), superficial infection was found in a patient with open wound 10 d after surgery. All the bone fractures united after surgery from 4 to 6 months. Morphous improvement of the calcaneal were proved by X-ray films and there here was no plates and screws' breakage, loosening. Mild osteoarthritis in Subtalar and ankle joints were found by X-ray after surgery from 9 months to last follow-up. Cystic degeneration and necrosis were found in 5 and 2 cases of talus fractures respectively. According to Maryland Foot Score, excellent was in 3 feet, good in 6 feet, fare in 5 feet and poor in 3 feet, with excellence rate of 52.9%.</p><p><b>CONCLUSIONS</b>Combined calcaneal is a calcaneus-based concomitant ankle and foot fractures after a high-energy injury. Good deal of soft tissue and correct design of operation pre-operatively, restoration of form and power lines of calcaneal, effective bone graft, right place of simple internal fixation or subtalar arthrodesis and good reduction and internal fixation of other fracture in hinder feet intra-operatively and correct function postoperatively are key points to have a relatively satisfied treating effect of combined calcaneal fractures.</p>

Surgical treatment of malunited or nonunited talus fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the operative methods of malunited or nonunited talus fractures.</p><p><b>METHODS</b>Twenty-two patients of malunions or nonunions after displaced talar fractures were treated from January 2000 to January 2008. There were 17 males and 5 females with an average age of 34 years (ranged from 15 to 52 years). According to classification of posttraumatic talar deformities (Zwipp 2003), there were 10 cases of type I (malunion and/or joint displacement), 8 cases of type II (nonunion with joint displacement), 4 cases of type III (type I/II with partial AVN). The surgical treatments included open reduction, osteotomy, correction and internal fixation with plate, screw or K-wire, or the ankle, subtalar arthrodesis.</p><p><b>RESULTS</b>Seventeen patients were followed up for 14 months in average (ranged from 12 to 24 months). No wound healing problems or infections were observed. Solid union was obtained without redislocation in all patients. The mean time of bone union was 14 weeks (ranged from 12 to 18 weeks). The mean time of completely weight loading was 14 weeks (ranged from 12 to 18 weeks). The mean AOFAS ankle and hindfoot score increased from 35.4 (ranged from 28.0 to 41.0) to 86.6 (ranged from 78.0 to 98.0).</p><p><b>CONCLUSIONS</b>As to posttraumatic talar deformities, surgical treatment can lead to a favorable outcome. According to concrete status of malunions or nonunions after displaced talar fractures, suitable surgical treatment should be applied to obtain satisfactory outcome.</p>

Analysis of the pelvic stability after type I resection of iliac tumor / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the pelvic stability after type I resection of iliac tumor.</p><p><b>METHODS</b>Six adult cadaveric specimens were tested. The iliac subtotal resection models were established according to Ennecking's type I resection. Markers were affixed to the key region of the pelves. Axial loading from the proximal lumbar was applied by MTS load cell in the gradient of 0-500 N in the double feet standing state. Images in front view were obtained using CCD camera. Based on Image J software, displacements of the first sacral vertebrae (S1) of the resected pelves and the intact pelves were calculated using digital marker tracing method with center-of-mass algorithm.</p><p><b>RESULTS</b>Serious instabilities were found in the resected pelves. S1 rotational movements around the normal side femoral head of the resected pelvis were found. The average vertical displacement of S1 of the resected pelvis was (7 +/- 3) mm under vertical load of 500 newtons, which were 8.3 times compared to the intact pelvis. The average angle of S1 rotation around the normal side femoral head of the resected pelvis was (4.0 +/- 1.8) degrees, which were 12.5 times compared to the intact pelvis.</p><p><b>CONCLUSIONS</b>Biomechanical model of type I resection of iliac tumor are established. Essential pelvic reconstruction must be introduced because of the serious instability of the bone defection after tumor resection.</p>

Staurospolin promotes the apoptosis of multidrug resistance tumor cell lines induced by adriamycin / 肿瘤研究与临床

Objective To investigate whether the protein kinase C inhibitor can promote the apopto- sis of multidrug resistance tumor cell lines which are induced by chemotherapy drugs.Methods Choose the KB/S(oral squamous cancer cell line)and KB/VCR(its multidrug resistant cell line)to compare the Adri- amycin-induced apoptosis with or without staurospolin(protein kinase C inhibitor).The apoptosis is stained with acridine orange,tested by flow cytometry,and approved by electron microscope.Results 36 hours after the treatment with 0.04 ?g/ml adriamycin,apoptotic cells of KB/S are 96.68%,and after 48 hours,the apop- totic cells of KB/VCR are 64.99%.When the concentration of adriamycin are augmented to 0.4?g/ml and 2.0?g/ml,the apoptotic cells of KB/VCR are 69.74% and 37.18% respectively.When treated with stau- rospolin together,the apoptotic cells of KB/VCR increased to 72.58%(?~2=4.5,P0.05)respectively.These results were testified by electron microscope and acridine orange-stain.Conclu- sion The resistance to apoptosis may be one of the mechanisms of multidrug resistance and the protein ki- nase C inhibitor may reverse this resistance by promoting the apoptosis of multidrug resistance tumor cells.

Effect of calcaneocuboid joint arthrodesis on weight-bearing area of subtalar joint and its clinical significance:a cadaveric study / 中华创伤杂志

Objective To discuss the effect of the calcaneocuboid joint arthrodesis on the weight- bearing area of subtalar joint and its clinical significance.Methods Twelve fresh-frozen cadaver foot specimens were used for determination of weight-bearing area of the subtalar joint on foot and ankle neutral position,dorsiflexion,plantoflexion,adduction,abduction,inversion and eversion motion by means of pressure sensitive film before and after calcaneocuboid joint arthrodesis under weight loading.Results Weight-bearing area of the subtalar joint averagely increased for (32.54?7.45)% in all positions after calcaneocuboid joint arthrodesis,with statistical significance (P＜0.05).Conclusion Weight-bear- ing area of the subtalar joint increases after calcaneocuboid joint arthrodesis,which contributes to decrea- sing the pressure and increasing the stability of the subtalar joint.