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OBJECTIVE@#To establish the finite element model of varus-type ankle arthritis and to implement the finite element mechanical analysis of different correction models for tibial anterior surface angle (TAS) in supramalleolar osteotomy.@*METHODS@#A female patient with left varus-type ankle arthritis (Takakura stage Ⅱ, TAS 78°) was taken as the study object. Based on the CT data, the three-dimensional model of varus-type ankle arthritis (TAS 78°) and different TAS correction models [normal (TAS 89°), 5° valgus (TAS 94°), and 10° valgus (TAS 99°)] were created by software Mimics 21.0, Geomagic Wrap 2021, Solidworks 2017, and Workbench 17.0. The 290 N vertical downward force was applied to the upper surface of the tibia and 60 N vertical downward force to the upper surface of the fibula. Von Mises stress distribution and stress peak were calculated.@*RESULTS@#The finite element model of normal TAS was basically consistent with biomechanics of the foot. According to biomechanical analysis, the maximum stress of the varus model appeared in the medial tibiotalar joint surface and the medial part of the top tibiotalar joint surface. The stress distribution of talofibular joint surface and the lateral part of the top tibiotalar joint surface were uniform. In the normal model, the stress distributions of the talofibular joint surface and the tibiotalar joint surface were uniform, and no obvious stress concentration was observed. The maximum stress in the 5° valgus model appeared at the posterior part of the talofibular joint surface and the lateral part of the top tibiotalar joint surface. The stress distribution of medial tibiotalar joint surface was uniform. The maximum stress of the 10° valgus model appeared at the posterior part of the talofibular joint surface and the lateral part of the top tibiotalar joint surface. The stress on the medial tibiotalar joint surface increased.@*CONCLUSION@#With the increase of valgus, the stress of ankle joint gradually shift outwards, and the stress concentration tends to appear. There was no obvious obstruction of fibula with 10° TAS correction. However, when TAS correction exceeds 10° and continues to increase, the obstruction effect of fibula becomes increasingly significant.
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Humans , Female , Tibia/surgery , Finite Element Analysis , Ankle , Arthritis , Fibula/surgery , Ankle Joint/surgeryABSTRACT
Objective:To compare the biomechanical characteristics of screw only spatial weaving fixation and calcaneal plate fixation in calcaneal fractures.Methods:Sanders type III calcaneus fracture model was established by using calcaneus model specimens: the physiological model group were the normal calcaneal models; the steel plate group were conventional steel plate fixation fracture models; the metal screw group were fracture models with only metal screw weaving fixation; seven and nine absorbable screw spatial weaving groups (seven absorbable screw group, nine absorbable screw group) were used to weave and fix fracture models with seven and nine absorbable screws. Cyclic test and mechanical compression test were carried out, and load-displacement curves were recorded. The material properties of metal screw spatial weaving and calcaneal anatomical plate system were replicated, finite element fracture models were established, and the calcaneal internal fixation models of plate screw group and spatial weaving screw group were completed by reverse processing. The changes of biomechanical characteristics of calcaneal bone in human (70 kg) standing on one foot were simulated, and the distribution of structural strength was analyzed by Von Mises equivalent stress cloud diagram and displacement cloud diagram.Results:In the cyclic test of 20-200 N load, the physiological model group, the plate group, the metal screw group, the absorbable 7 screw group, the absorbable 9 screw group were 0.87±0.22, 0.82±0.08, 0.70±0.12, 1.04±0.13 and 0.83±1.76 mm, the difference in model gap was statistically significant ( F=3.16, P=0.037). Among them, the absorbable 7 screws group was larger than the metal screws group ( t=4.28, P=0.003), and the other pin-two comparisons were not statistically significant ( P>0.05). The deformation of the five groups was 0.37±0.06, 0.38±0.07, 0.38±0.06, 0.52±0.07 and 0.42±0.07 mm, and the difference was statistically significant ( F=4.39, P=0.010). The deformation of absorbable 7 screws group was greater than that of physiological model group, the plate group and metal screw group ( t=3.69, P=0.006; t=3.25, P=0.012; t=3.51, P=0.008). In static test, compression displacement was 7.14±0.79, 7.30±0.66, 6.95±0.28, 8.19±0.61 and 7.16±0.55 mm, the difference was statistically significant ( F=3.28, P=0.032). The displacement of the absorbable 7 screws group was greater than that of the metal screws group ( t=4.13, P=0.003). The stiffness changes were 570.60±122.62, 512.86±80.77, 497.40±66.50, 456.21±58.19 and 560.39±94.40 N/mm, respectively, with no statistical significance ( F=1.44, P=0.258). The results of finite element analysis showed that under 3 500 N axial pressure load, the maximum compression displacement and stiffness of the plate and screw set were 6.47 mm, 540.96 N/mm, and the Von Mises equivalent stress peaks were 450.31 and 353.15 MPa, respectively. The maximum compression displacement and stiffness of the braided screw group were 5.25 mm, 666.67 N/mm, and the peak Von Mises equivalent stress of the screw was 396.20 MPa. Conclusion:Compared with lateral plate fixation, spatial weaving fixation can provide sufficient biomechanical stability for calcaneal healing and is superior to plate fixation in terms of structural stability, which may help to improve the effectiveness of calcaneal fracture fixation.
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Objective:To determine the anatomical parameters concerning the length, width and height of the sustentaculum fragment of the calcaneus using CT imaging data and their clinical significance.Methods:A retrospective study was conducted to analyze the CT imaging data of normal calcaneus in 96 patients (100 feet) which had been collected by Department of Orthopedics, Shanghai Tongji Hospital from January 2019 to September 2020. There were 45 males (48 feet) and 51 females (52 feet) with an age of (42.1±13.6) years, and 56 left feet and 44 right feet. After 3D models were reconstructed with the CT data using software Mimics 22.0, the calcaneus was viewed layer by layer at each level of the scan. After the first continuous bone trabecula on the medial side of the calcaneal central triangle was taken as the boundary, the model of the sustentaculum fragment was segmented. The length, width, and height of the sustentaculum fragment were measured. The outer contour of the sustentaculum fragment was projected onto the lateral wall of the calcaneus to draw the contour line using software Materialise 3-Matic 22.0. By overlaying projection line diagrams, a summary of projection line diagrams of 100 sustentaculum fragments was obtained. Seven screw insertion points were selected in the summary region of the projection line diagrams of the lateral wall of the calcaneus, and the distance from each point to the medial side of the calcaneus were measureed. The length, width, and height of the sustentaculum fragment, as well as the distance from the 7 insertion points to the medial side of the calcaneus, were compared between different feet and genders.Results:The length, width, and height of the sustentaculum fragment were (45.19±4.60) mm, (38.57±4.59) mm and (40.76±5.48) mm, respectively. There were no significant differences in the length, width or height of the sustentaculum fragment between different feet or in the height of the sustentaculum fragment between different genders ( P>0.05), but the length and width of the sustentaculum fragment in females were significantly smaller than those in the males ( P<0.05). The projection of the sustentaculum fragment was approximately ellipse on the summary region of the projection line diagrams on the lateral wall of the calcaneus, with the long axis approximately parallel to the midpoint tangent of the lateral edge of the calcaneal posterior articular surface, ranging from 2 to 20 mm from the posterior articular surface. The distances from the 7 insertion points to the medial surface of the calcaneus were (39.91±3.77) mm at point A, (40.89±3.55) mm at point B, (36.42±5.98) mm at point C, (39.12±5.52) mm at point D, (40.04±4.84) mm at point E, (33.00±3.96) mm at point F, and (33.04±3.82) mm at point H. There was no significant difference in the distances from the 7 insertion points to the medial surface of the calcaneus between different feet ( P>0.05), but the distances from the 7 insertion points to the medial surface of the calcaneus in the females were significantly smaller than those in the males ( P<0.05). Conclusions:Anatomical measurements of the sustentaculum fragment can provide a theoretical basis for the range of fixation of the sustentaculum screws. A summary of projection line diagrams of the sustentaculum fragment on the lateral surface of the calcaneus can serve as a reference for placement of sustentaculum screws. Measurement of the distances from 7 insertion points to the medial surface of the calcaneus can facilitate determination of the lengths of sustentaculum screws.
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Objective:To compare the efficacy of staged versus elective operation for treating acute closed fracture-dislocation of tarsometatarsal joint complex.Methods:A retrospective cohort study was used to analyze the clinical data of 26 patients with acute closed fracture-dislocation of tarsometatarsal joint complex admitted to Tongji Hospital of Tongji University from January 2017 to January 2021, of whom 18 were males and 8 were females, aged 32-52 years [(44.3±5.2)years]. According to the time from injury to admission, 14 patients admitted within 8 hours after injury underwent staged surgical treatment (staged group), and 12 patients admitted more than 8 hours after injury underwent elective surgery (elective group). In the staged group, emergency reduction and temporary internal fixation with K-wire were done under the supervision of a C-arm X-ray machine in the first stage, while after the swelling subsided, open reduction and internal fixation were done for tarsometatarsal joint fracture-dislocation in the second stage. In the elective group, open reduction and internal fixation were performed for tarsometatarsal joint fracture-dislocation on a scheduled basis after the swelling subsided. The operation time, hospitalization time and fracture healing time were recorded. The visual analogue score (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) midfoot score were evaluated before operation, at 1, 6, 12 months after operation and at the final follow-up. The rate of complications was observed after operation.Results:All patients were followed up for 12-24 months [(18.5±3.8)months]. The operation time, hospitalization time and fracture healing time in the staged group were (77.3±5.6)minutes, (14.3±2.2)days and (12.3±1.2)weeks, respectively, significantly shorter than those in the elective group [(101.5±7.5)minutes, (20.3±5.2)days and (14.3±2.2)weeks] (all P<0.01). VAS significantly decreased and AOFAS midfoot score significantly increased in both groups as postoperative time increased (all P<0.05). There were no significant differences in VAS between the two groups before operation, at 12 months after operation or at the final follow-up (all P>0.05). The VAS at 1, 6 months after operation was (4.4±0.8)points and (2.1±0.4)points in the staged group, significantly lower than those in the elective group [(6.0±1.0)points and (3.5±0.6)points] (all P<0.01). There was no significant difference in preoperative AOFAS midfoot score between the two groups ( P>0.05). The AOFAS midfoot score at 1, 6, 12 months after operation and at the final follow-up was (67.6±4.5)points, (75.7±5.2)points, (83.6±2.2)points and (85.9±4.3)points in the staged group, significantly higher than those in the elective group [(60.2±3.9)points, (70.2±3.4)points, (75.4±3.3)points and (78.7±4.4)points] (all P<0.01). The rate of complications was 14.3% (2/14) in the staged group, significantly lower than that in the elective group [33.3% (4/12)] ( P<0.05). Conclusion:Compared to traditional elective surgery, staged surgery for acute closed fracture-dislocation of tarsometatarsal joint complex has the advantages of shortened operation time, hospitalization time and fracture healing time, eary pain relief, improved functional recovery of the foot and reduced postoperative complications.
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Osteochondral lesion of talus (OLT) is a foot and ankle disease characterized by ankle pain, which may impact the joint function and life quality. If managed improperly, it may lead to a further ankle arthritis, severely compromising the prognosis. The therapeutic effect of conservative treatment for OLT is still uncertain. Surgery is still the main treatment modality for OLT with various techniques. However, the optimized surgical technique is still inconclusive, furthermore, regeneration and repair of cartilage after debridement is also a great challenge for the treatment of OLT. Platelet-rich plasma (PRP) with good repair effect on cartilage injury is gradually applied in the treatment of OLT. However, there still lacks the unified understanding of the technique and specification of PRP for the treatment of OLT. Therefore, National Orthopedics Center of Shanghai Sixth People′s Hospital allied Foot Ankle Basic Research & Orthopedics Group, Chinese Association of Orthopedic Surgeons; Foot and Ankle Committee of Chinese Association of Sports Medicine Physicians; and Foot and Ankle Group of Orthopedic Specialized Branch of Shanghai Medical Association to organize related experts to formulate the Expert consensus on platelet- rich plasma treatment for osteochondral lesion of talus ( version2023). Fifteen recommendations were put forward upon PRP preparation, indications, contraindications and treatment methods of PRP for OLT, so as to standardize the PRP treatment for OLT.
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Objective:To compare the clinical efficacy of bundle suture and Krackow suture in the treatment of acute closed Achilles tendon rupture.Methods:A retrospective cohort study was used to analyze the clinical data of 58 patients with acute closed Achilles tendon rupture admitted to Tongji Hospital of Tongji University from August 2014 to August 2021, including 53 males and 5 females, aged 27-55 years [(39.6±7.1)years]. The patients were treated with open repair and were assigned to bundle suture group ( n=30) and Krackow suture group ( n=28). The incision length and operative time were compared between the two groups. The healing of the Achilles tendon was observed. The difference in circumference between the affected and healthy side of the calf, ratio of width to anterior-posterior diameter at the cross-sectional area of Achilles tendon rupture, and ratio of scar tissue to tendinous fibrous tissue at the cross-sectional area of Achilles tendon rupture were measured at 12 months after surgery. At the same time, the complete Achilles tendon rupture score (ATRS) and American Foot and Ankle Surgery Society (AOFAS) ankle-hindfoot score were performed. The occurrence of complications was observed at follow-up. Results:All patients were followed up for 12-28 months [(17.9±4.2)months]. The incision length and operative time in bundle suture group [6.0(4.5, 9.0)cm, 77.5(60.0, 95.0)minutes] were significantly shorter or longer than those in Krackow suture group [8.0(7.0, 11.0)cm, 68.5(55.0, 86.0)minutes] (all P<0.01). After 3 months, healing of the Achilles tendon was obtained in both groups. After 12 months, the difference in circumference between the affected and healthy side of the calf was (2.0±0.9)cm in bundle suture group and was (1.9±0.9)cm in Krackow suture group ( P>0.05); the ratio of width to anterior-posterior diameter at the cross-sectional area of Achilles tendon rupture was 1.42±0.20 in bundle suture group, significantly greater than 1.27±0.16 in Krackow suture group ( P<0.01); the ratio of scar tissue to tendinous fibrous tissue at the cross-sectional area of Achilles tendon rupture was 8.6%(6.0%, 24.0%) in bundle suture group, significantly lower than 11.9%(9.0%, 33.0%) in Krackow suture group ( P<0.01); the ATRS and AOFAS ankle-hindfoot score were 91.5(80.0, 99.0)points and 93.0(82.0, 100)points in bundle suture group, similar to 89.0(75.0, 99.0)points and 91.5(77.0, 99.0)points in Krackow suture group (all P>0.05). During the follow-up period, the occurrence of complications were not significantly different between bundle suture group [no deep infection, early Achilles tendon rerupture in 2 patients (7%) ] and Krackow suture group [deep infection in 1 patient (4%), early Achilles tendon rerupture in 1 patient (4%)] (all P>0.05). Conclusions:Both bundle suture and Krackow suture can achieve satisfactory clinical efficacy in the treatment of acute closed Achilles tendon rupture. However, the bundle suture is more conducive to restoring normal anatomical shape of the Achilles tendon and reducing scar formation at the end of the Achilles tendon rupture.
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Objective:To analyze the correlation between the posterior malleolus fracture and fixation and the rotational stability of the ankle and to explore the surgical indications for posterior malleolus fracture aiming to provide the theories for the diagnosis and treatment of disorder.Methods:Twenty fresh frozen cadaver specimens were selected. Further, the extent of the tibial insertion of the posterior inferior tibiofibular ligament (PITFL) and inferior transverse tibiofibular ligament (ITTFL) complex was dissected and measured. Based on the tibial insertion of the ligament complex, the model for the supination-external rotation degree 3 ankle fracture with a posterior malleolar fragment and syndesmosis diastasis was created. Moreover, the area threshold of the posterior tibial insertion of posterior malleolus fracture was biomechanically assessed. The difference of the antirotating ability of the ankle-stiffness between simple posterior malleolus fixation and simple syndesmotic fixation was analyzed statistically.Results:The PITFL and ITTFL were presented in all specimens with relatively broad in PITFL tibial insertion. The PITFL was attached to the posterolateral tibia. The distance between the highest point of the tibial insertion and the articular line was 45.2±5.6 mm, while the ITTFL was attached to the posterior distal tibia. The distance between the highest point of the tibial insertion and the articular line was 5.5±1.0 mm. The width of the tibial insertion of the PITFL and ITTFL complex decreased as the distance from the joint line increased. Biomechanical analysis showed that the threshold of posterior area of posterior malleolus fracture was 1/4S. The stiffnesses of posterior malleolus fixation and syndesmosis stabilization were 0.264±0.080 N·m/° and 0.164 ± 0.061 N·m/°, respectively. The percentage of stiffness restored by posterior ankle fixation was 60.9%±10.2%, which was greater than that by syndesmosis stabilization 37.5%±7.9% ( t=17.09, P<0.001) . Conclusion:The surgical technique for posterior malleolus fracture should consider restoration of the axial and rotational stability of the ankle simultaneously. Posterior malleolus fracture fixation is recommended when the syndesmosis is unstable with the area ratio of posterior tibial insertion of posterior malleolus fracture greater than or equal to 1/4. Syndesmotic fixation is proposed to restore and maintain the rotational stability of the ankle when the syndesmosis is unstable with the area ratio less than 1/4. Regardless of the area ratio, the surgical indications for stable syndesmosis depend on the impact of the posterior malleolus fracture on the axial stability of tibiotalar joint, on the involved articular surface area and on the displacement degree of posterior malleolus fragment.
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Objective:To propose a new classification of posterior malleolus fracture to further clarify its pathoanatomy.Methods:Twenty fresh frozen cadaver specimens of normal morphology of lower limbs were selected and dissected and the extent of the tibial insertion of posterior malleolus associated ligaments was measured. At the same time, a retrospective case series analysis was made on the clinical and CT information of 296 patients with posterior malleolus fracture treated at Tongji Hospital of Tongji University from January 2012 to July 2020 or at Karamay Central Hospital from January 2018 to July 2020. The percentage of articular involvement of the fracture, proximal displacement of the posterior malleolus fracture and extent of posterior talar subluxation were measured. A clinically practical new classification system for posterior malleolus fracture was created by correlating posterior malleolus associated ligaments with CT images of posterior malleolus fracture. The new classification included three types: type I was posterior malleolus fracture with only the tibial insertion of inferior transverse tibiofibular ligament involved; type II was posterior malleolus fracture with both the tibial insertions of inferior transverse tibiofibular ligament and posterior inferior tibiofibular ligament involved, which was divided into subtypes IIA and IIB based on the presence of articular cartilage and subchondral bone damage, compression or Die-Punch fragments; type III was posterior malleolus fracture that involved all the tibial insertions of inferior transverse tibiofibular ligament, posterior inferior tibiofibular ligament and posterior tibiotalar ligament, which was sub-classified into subtypes III A and III B according to number of fracture fragments. Anatomic characteristics of the extent of the tibial insertion of posterior malleolus associated ligament, CT imaging parameters for posterior malleolus fracture and corresponding fracture typing were determined. In addition, the new classification system for posterior malleolus fracture was compared with Haraguci classification and Mason classification.Results:Posterior malleolus associated ligaments included the posterior inferior tibiofibular ligament, inferior transverse tibiofibular ligament and posterior tibiotalar ligament from posterolateral to posteromedial tibia. The posterior inferior tibiofibular ligament was attached to the posterolateral tibia and the distance between the highest point of its tibial insertion and the joint line was (45.2±5.6)mm. The inferior transverse tibiofibular ligament was attached to the posterior distal tibia and the distance between the highest point of its tibial insertion and the joint line was (5.5±1.0)mm. The posterior tibiotalar ligament was attached to the posterior colliculus and intercollicular groove of the medial malleolus and the distance between the center of its tibial insertion and the intercollicular groove was (2.5±0.6)mm. Among 296 patients with posterior malleolus fracture, there were 36 patients with type I, 229 with type II (150 type IIA, 79 type IIB) and 31 with type III (11 type IIIA, 20 type IIIB). The percentage of articular involvement of the fracture, proximal displacement of posterior malleolus fracture and extent of posterior talar subluxation in type IIB fracture were significantly greater than those in type II A fracture [23.7(18.6, 28.8)% vs. 18.4(12.7, 21.7)%, 4.1(2.1, 6.0)mm vs. 1.9(0.2, 3.0)mm, 4.7(1.5, 6.2)mm vs. 2.3(1.1, 3.0)mm] (all P<0.01). The proximal displacement of posterior malleolus fracture and extent of posterior talar subluxation in type III fracture were significantly greater than those in type II fracture [7.2(6.0, 8.2)mm vs. 2.7(0.4, 4.0)mm, 10.1(6.0, 15.0)mm vs. 3.1(1.1, 5.0)mm] (all P<0.01). The new classification for posterior malleolus fracture combined the posterior malleolus ligament and injury mechanism of posterior malleolus fracture as compared with Haraguchi classification, which not only further detailed the classification, but also was more practical in clinic for increased the severity of injury was elevated with higher classification level. The new classification was more comprehensive as compared with Mason classification for it mainly added the type of simple-rotation-type posterior malleolus fracture (type IIA of the new classification). Conclusions:In combination with posterior malleolus associated ligaments, injury mechanism and fracture morphology, posterior malleolus fracture is divided into three types. The new classification system more comprehensively describes pathoanatomy of posterior malleolus fracture that contributes to related basic research and clinical diagnosis and treatment.
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Objective:To evaluate the clinical significance of the coincidence test with 3D mirror image of unaffected side in the treatment of contralateral calcaneal fracture.Methods:A retrospective analysis was performed of the 35 patients who had been treated for single calcaneal fracture by coincidence test with 3D mirror image of unaffected side from January 2016 to June 2018 at Department of Trauma Orthopedics, The Sixth Hospital of Ningbo. They were 29 males and 6 females with an average age of 44 years (from 18 to 71 years). By Sanders classification, 19 cases were type Ⅱ and 16 cases type Ⅲ. CT scan and reconstruction of both calcaneuses was performed. The image of unaffected calcaneus was mirrored by Mimics software to guide virtual treatment of contralateral calcaneal fracture. Preoperatively the virtual bilateral calcaneuses and the reduced calcaneus were 3D printed to guide the actual operation. The coincidence test with 3D mirror image of unaffected side was used to evaluate fracture reduction after operation. Postoperative parameters such as B?hler Angle, Gissane Angle, calcaneal width, and coincidence of the affected calcaneal bone were recorded at 12 months after surgery. The clinical outcomes were assessed by American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) score.Results:In this cohort, operation time averaged 43.9 min (from 30 to 55 min), time from admission to operation 3.6 d (from 0 to 14 d), and hospital stay 6.3 d (from 3 to 11 d). The patients were followed up for an average of 18.8 months (from 13 to 24 months). All patients achieved bone union after an average of 17 weeks (from 12 to 26 weeks). Re-collapse of subtalar articular surface, talocalcaneal joint fusion, loss of calcaneal height or length, and calcaneal width increase were observed in none of the patients. The VAS scores averaged 2 (from 0 to 4), and the AOFAS scores 93.3 (from 76 to 98). The total coincidence was 95.2%±3.5%. Spearman test indicated a positive correlation between postoperative total coincidence and AOFAS score ( ρ=0.588, P<0.05). Conclusion:The coincidence test with 3D mirror image of unaffected side can be used to treat contralateral calcaneal fracture, with advantages of reduced surgical time, increased surgical accuracy and fine clinical outcomes.
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New-onset refractory status epilepticus is a rare and special clinical manifestation with high mortality. About half of the patients have no clear cause. At present, the pathogenesis is unclear, and the treatment plan is controversial. In recent years, it has been found that inflammatory and immune responses of the body may be involved in the pathogenic process, and it is called “inflammatory-immune mediated epileptic encephalopathy” based on the perspective of pathogenesis. There have also been many treatment attempts based on the inflammatory and immunological mechanisms, some of which have achieved satisfactory results. However, most of them are based on the review of small sample cases, and relevant guidelines are still lacking at present. In this paper, the definition, etiology, pathogenesis, clinical manifestations and treatment of persistent status of new-onset refractory status epilepticus are reviewed.
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Objective@#To analyze the clinical value of capsule endoscopy (CE) in small intestinal diseases and to explore the correlation between the diagnosis and clinical characteristics.@*Methods@#From June 2016 to April 2019, a total of 194 patients receiving CE were enrolled in the Department of Gastroenterology, Shanxi People′s Hospital, including 68 patients with obscure gastrointestinal bleeding, 104 with chronic abdominal pain and 22 with diarrhea.@*Results@#The detection rate of small intestinal lesions by CE was 53.6%(104/194), of which gastrointestinal bleeding was 66.2% (45/68), chronic abdominal pain was 53.8%(56/104), and diarrhea was 13.6%(3/22). The first three positive diagnostic criteria of CE for gastrointestinal bleeding were non-specific inflammation, small intestinal ulcer and vascular malformation. CE findings in patients with abdominal pain were non-specific inflammation, small intestinal ulcer and Crohn′s disease; while the major endoscopic presentations in patients with diarrhea were small intestinal ulcer and non-specific inflammation. Logistic regression analysis suggested that the clinical manifestations and gender were correlated with positive diagnosis by CE (P<0.05), and the positive diagnostic rate of CE in female patients was significantly lower than that in male patients [31.6%(25/79) vs. 51.3%(59/115), P<0.05]. The diagnostic rates of CE in patients with gastrointestinal bleeding and chronic abdominal pain were similar [55.9%(38/68) vs. 41.4%(43/104)], which was significantly higher than those with diarrhea [9.1%(2/22), P<0.05].@*Conclusions@#Capsule endoscopy has a high detection rate for small intestinal diseases, which could be the first choice in patients with unexplained gastrointestinal bleeding. Male patients and gastrointestinal bleeding are predictors of positive findings by CE.
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Since the key point of prevention and control of new coronavirus infection (COVID-19) in the community is to block the spread, the centralized quarantine for close contacts with confirmed or suspected cases is the most effective way in breaking the chain of transmission. A community centralized quarantine site was set up by Fenglin Community Health Service Center for medical observation of close contacts. The detailed plan and management of the centralized quarantine site, and the implementation experiences are introduced in this article to provide reference for medical institutions involved in the prevention and control of COVID-19 epidemic.
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Since the key point of prevention and control of new coronavirus infection (COVID-19) in the community is to block the spread, the centralized quarantine for close contacts with confirmed or suspected cases is the most effective way in breaking the chain of transmission. A community centralized quarantine site was set up by Fenglin Community Health Service Center for medical observation of close contacts. The detailed plan and management of the centralized quarantine site, and the implementation experiences are introduced in this article to provide reference for medical institutions involved in the prevention and control of COVID-19 epidemic.
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Objective:To analyze the clinical value of capsule endoscopy (CE) in small intestinal diseases and to explore the correlation between the diagnosis and clinical characteristics.Methods:From June 2016 to April 2019, a total of 194 patients receiving CE were enrolled in the Department of Gastroenterology, Shanxi People′s Hospital, including 68 patients with obscure gastrointestinal bleeding, 104 with chronic abdominal pain and 22 with diarrhea.Results:The detection rate of small intestinal lesions by CE was 53.6%(104/194), of which gastrointestinal bleeding was 66.2% (45/68), chronic abdominal pain was 53.8%(56/104), and diarrhea was 13.6%(3/22). The first three positive diagnostic criteria of CE for gastrointestinal bleeding were non-specific inflammation, small intestinal ulcer and vascular malformation. CE findings in patients with abdominal pain were non-specific inflammation, small intestinal ulcer and Crohn′s disease; while the major endoscopic presentations in patients with diarrhea were small intestinal ulcer and non-specific inflammation. Logistic regression analysis suggested that the clinical manifestations and gender were correlated with positive diagnosis by CE ( P<0.05), and the positive diagnostic rate of CE in female patients was significantly lower than that in male patients [31.6%(25/79) vs. 51.3%(59/115), P<0.05]. The diagnostic rates of CE in patients with gastrointestinal bleeding and chronic abdominal pain were similar [55.9%(38/68) vs. 41.4%(43/104)], which was significantly higher than those with diarrhea [9.1%(2/22), P<0.05]. Conclusions:Capsule endoscopy has a high detection rate for small intestinal diseases, which could be the first choice in patients with unexplained gastrointestinal bleeding. Male patients and gastrointestinal bleeding are predictors of positive findings by CE.
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Objective To evaluate the treatment of posterior malleolar two-part fractures complicated with medial and lateral malleolar fractures via a combination of posterolateral and posteromedial approaches.Methods From January 2014 to January 2017,26 patients were operatively treated at Department of Orthopaedics,Tongji Hospital for posterior malleolar two-part fractures complicated with medial and lateral malleolar fractures via a combination of posterolateral and posteromedial approaches.They were 10 men and 16 women,aged from 53 to 67 years(average,61.5 years).The surgery was conducted in prone position via the posterolateral and posteromedial approaches to expose simultaneously the fractures ends at medial,lateral and posterior malleoli for open reduction.The lateral malleolar fractures were fixated with plate,the medial malleolar fractures with screws and posterior malleolar fractures with plate or cannulated screws depending on the size of the fracture blocks.The outcomes were assessed using the ankle-hindfoot scores of American Orthopaedic Foot and Ankle Society(AOFAS) and the visual analogue scale(VAS).Results Of this cohort,22 were followed up for 30 months on average(range,from 18 to 48 months).All the cases healed by the first intension without any infection.Their postoperative X-ray showed bone union after an average of 12.5 weeks(range,from 10 to 15 weeks).No nonunion,loosening or breakage of implants was found.The mean time for walking with full weight-bearing was 13 weeks(range,from 11 to 16 weeks).Their AOFAS ankle-hindfoot scores at the final follow-ups were 85.4(range,from 80 to 92),yielding 13 excellent and 9 good cases with a good to excellent rate of 100%.Their mean VAS scores were decreased significantly from preoperative 8.6±0.6 to postoperative 1.7±0.3(f=153.000,P=0.000).Conclusion In treatment of posterior malleolar two-part fractures complicated with medial and lateral malleolar fractures,a combination of posterolateral and posteromedial approaches in prone position can expose and reduce simultaneously the fractures ends at medial,lateral and posterior malleoli,leading to satisfactory clinical outcomes.
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Community health service is an important part of the health system reform in the new period in China,the community health service institutions play important roles in promoting the health reform and the development ofthe national medical and health service.Shanghai Fenglin Subdistrict Community Health Service Center has integrated general practice with specialist care for the patients in community health service,this article summarizes the exploration and practice of the "combination of general practice with specialties" model in the community health service in order to provide reference for relevant medical institutions.
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Objective To compare the effect and prognosis outcome of open reduction internal fixation and primary arthrodesis in treatment of Lisfranc injuries combined with the first tarsal jointdislocation.Methods A retrospective case control study was conducted on the clinical data with complete follow up data of 126 patients with Lisfranc injuries combined with the first tarsal joint dislocation in nine ankle surgery centers of China from January 2009 to June 2015.There were 76 males (60.3％) and 50 females (39.7％) with an average age of 45.5 years (range,20-87 years).Among the 126 cases,simple dislocation occurred in 41 cases (32.5％),and fracture dislocation in 85 cases (67.5％).The duration from injury to surgery was 11.7 days (range,4-26 days).According to surgery method,the patients were divided into open reduction internal fixation group (n =92) and primary arthrodesis group (n =34).The outcomes were evaluated by American Orthopedic Foot and Ankle Society(AOFAS) score,36-items short form health survey (SF-36),and visual analogue score (VAS).Complications were also followed up.Results All patients were followed up for 18-80 months,with an average of 29.5 months.Primary union was seen in all the patients.At the last follow up,the mean AOFAS midfoot score was (79.4 ± 6.7) points in open reduction and internal fixation group and (85.1 ±8.3) points in primary arthrodesis group (P ＜ 0.05).The mean VAS was (3.1 ± 0.6) points in open reduction and internal fixation group and (2.2± 0.3)points in primary arthrodesis group(P ＜ 0.05).The physiological function of SF-36 was (80.3 ± 5.3) points in open reduction and internal fixation group and (83.5 ± 6.9) points in primary arthrodesis group(P ＞ 0.05).The body pain score of SF-36 was (76.1 ±4.6) points in open reduction and internal fixation group and (84.6 ± 8.7) points in primary arthrodesis group (P ＜ 0.05).In open reduction and internal fixation group,there were five cases (5％) with internal fixator loosening or fracture,16 cases (17％) with redislocation,36 cases (39％) with obvious pain of the middle foot during walking,and eight cases (6％) with tarsal joint traumatic arthritis which was given phase Ⅱ arthrodesis.In primary arthrodesis group,two patients (6％) reported pain due to internal fixation,and the pain was relieved after fixator removal.No re-dislocation,loosening of internal fixation,or traumatic arthritis were found (P ＜ 0.05).Conclusion For Lisfranc injuries combined with first tarsal joint dislocation,primary arthrodesis can stabilize the first tarsal joint and avoid complications or adverse consequences such as redislocation,pain,internal fixation failure,or reoperation.
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Carrying out researches in urban community health service centers can effectively promote the improvement of management system, the cultivation of talents and the formation of characteristic service, leading to the institutional development.This paper summarizes the role and significance of researches in promoting the overall development of urban community health service center in order to provide reference for the relevant medical institutions based on the experiences in Shanghai Fenglin Community Health Service Center.
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Objective To study the distribution of intra-articular posterior malleolus fracture lines in ankle fracture of supination-external rotation.Methods Computed tomography scans of a consecutive series of 70 ankle fractures of supination-external rotation were used for this study.The DICOM files were loaded into Mimics 16.0 for 3D reconstruction of distal tibial articular surface.The intra-articular posterior malleolus fracture lines were identified after virtual fracture reduction.All the fracture lines were drawn on one picture of distal tibial articular surface after standardization before a heat map was created based on the frequency of fracture lines.Results Although the distribution of posterior malleolus intra-articular fracture lines varied,most of them were concentrated in an arcuate zone.The ratios of the area of posterior fracture fragment to the total area of articular surface averaged 14.96％ (range,from 2.23％ to 38.45％).They were most likely to enter the articular surface at 20.4％ of the tangent of the posterior edge in a standardized image and exit at 58.7％ of the tangent of the lateral edge.Conclusion In ankle fractures of supination-external rotation,most intra-articular posterior malleolus fracture lines may be distributed regularly in an arcuate zone of the articular surface.
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The palliative care has become an important part of social civilization. Its treatment of advanced patients with no response to the treatment of patients with positive and comprehensive care, paying attention to the people-oriented conforms to the Chinese nationHeperfectly. In palliative care practice,Heconcept penetrates in the happening of the disease and development, treatment and special and complex and changeful in interpersonal relationship. The ultimate goal of He is also a palliative care. The concept of reconciliation will promote the development of palliative care.