Comparison of autogenous tendon reconstruction with coracoclavicular ligament combined with hook plate and simple hook plate fixation in the treatment of acromioclavicular joint dislocation / 中国组织工程研究

BACKGROUND: Hook plate is usual and satisfactory for the treatment of acromioclavicular joint dislocation, but there are still many problems. The comparative analysis is seldom reported between reconstruction of coracoclavicular ligament by autogenous tendon combined with hook plate and simple hook plate. OBJECTIVE: To compare the clinical efficacy of reconstruction of coracoclavicular ligament combined with hook plate and simple hook plate fixation for acromioclavicular joint dislocation. METHODS: A total of 38 patients with acromioclavicular dislocation were randomly divided into two groups. The patients were treated with plantar tendon "V" reconstruction with coracoclavicular ligament combined with hook plate fixation (combination group) and with a simple hook plate fixation (simple hook plate group). We compared the operation time, blood loss, hospitalization days, average hospitalization costs, the time taken for internal fixation, the motion range of shoulder joint at postoperative 12 months, the Constant-Murley function score, the reduction of shoulder joint and the Visual Analogue Scale scores between the two groups. RESULTS AND CONCLUSION: (1) Patients in both groups were followed up for 12 months. In the combination group, the hook plate was removed at postoperative 3 months. In the simple hook plate group, the hook plate was removed at approximately postoperative 12 months. In follow-up, no dislocation appeared in both groups. (2) No significant difference in hospitalization days, motion range of shoulder joint, Constant-Murley function score, the reduction of shoulder joint and the Visual Analogue Scale scores was determined between the two groups (P > 0.05). (3) Operation time was longer; blood loss was more; and average hospitalization costs were higher in the combination group than in the simple hook plate group (P < 0.05). (4) These findings indicate that plantar tendon reconstruction of coracoclavicular ligament combined with hook plate meets biomechanical requirements in the treatment of acromioclavicular joint dislocation. The plate can be removed early using a fixator. The lower extremity has an incision, but the follow-up results are satisfactory. Simple hook plate fixation for acromioclavicular joint dislocation takes a long time, and can obtain average effect, but there is the risk of re-dislocation (this case does not experience re-dislocation). The appropriate treatment can be chosen according to the patient's condition, needs, and economic conditions.

Risk factors of the failure in digit replantation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the relative factors on the failure in digit replantation in order to take preventions to control the risk factors.</p><p><b>METHODS</b>From January 2013 to December 2013, 236 consecutive patients (311 fingers) underwent digit replantation were collected to analyze retrospectively, involving 183 males and 53 females with an average age of 34.5 years old ranging from 2 to 62 years old (6 cases under 6 years old and 230 cases elder than 6 years old). There were 51 thumbs, 87 index fingers, 78 middle fingers, 63 ring fings and 32 little thumbs. Forty cases(forty fings) who were failured as the observation group, the others as the control group. The factors of age, gender, finger, cause of injury, smoking history, ischemia duration, plane of division, condition of venous drainage and condition of arterial repair we assessed.</p><p><b>RESULTS</b>All 236 cases with 311 fingers were replanted, 40 fingers were failured after operation. The relative factors on the failure in digit replantation included smoking history, cause of injury, plane of division, condition of venous drainage and condition of arterial repair (P< 0.05). There were no significant correlation between the failure and age, gender, finger and ischemia duration (P>0.05).</p><p><b>CONCLUSION</b>Smoking history, causes of injury, plane of division, condition of venous drainage and condition of arterial repair are risks of failure in digit replantation. Before choosing the type of operation, it should be think about the patient's general conditions, injury status, grasp firmly the operative indications and actively carry out surgical treatment.</p>

Analysis of risk factors of the infection after operation of open tibiofibula fractures / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the related factors of the infection after operation of open tibiofibula fractures.</p><p><b>METHODS</b>The clinical data of 141 patients with open tibiofibula fractures underwent surgical treatment from June 2009 to December 2012 were retrospectively analyzed. All the patients were male and aged from 18 to 61 years old with an average of 39.2 years; all the fractures were unilateral. According to Gustilo typing of fracure, 5 cases were type I, 44 cases were type II, 27 cases were type III a, 56 cases were type III b and 9 cases were type III c. These clinical data included patients' age, gender, body mass index (BMI), underlying diseases, time of operation, fracture site, fracture type, fixation method, postoperative drainage, debridement condition and so on. The postoperative infection conditions were recorded, and the correlation between above factors and infections were analyzed. Finally, the significant related variables were introduced into a Logistic regression model to evaluated their risk.</p><p><b>RESULTS</b>Among the 141 patients, 22 cases developed with infection (15.6%). The significant relative factors with infection contained fixation method, debridement condition, underlying diseases and postoperative drainage (P < 0.05). The correlativities were stepped up in order, their odds ratios value was 2.451, 3.164, 3.414, 5.117, respectively.</p><p><b>CONCLUSION</b>Active treatment for underlying diseases before operation, thorough debridement for open wound, suitable fixation method for fracture and thorough draining are effective measures in preventing postoperative infection.</p>

Application of serial tightening of reserved suture threads in delayed incision closure / 中国骨伤

<p><b>OBJECTIVE</b>To study clinical outcomes of serial tightening of reserved suture threads in delayed incision closure.</p><p><b>METHODS</b>From January 2005 to June 2013, 67 patients with delayed incision closure were treated with serial tightening of reserved suture threads. There were 37 males and 30 females, with an average age of 40 years old (ranged from 12 to 75 years old). Among them, 36 patients suffering from leg or forearm double fractures had the incision difficult to those primarily due to high tension or mergency; 13 patients had open wound which lasted for more than routine time for debridement and closure; 9 patients had wound infection; 9 patients had decompression incisions owing to compartment syndrome. The No. 4 suture thread was used to sew up the incision, and the 4 to 6 cm long thread was reserved at two ends of each thread. The reserved thread was tightened gradually from 2 to 4 days after operation according to conditions of swelling relieving. Finally, the reserved thread was not tied until the incision was completely closed.</p><p><b>RESULTS</b>After operation, the reserved threads were tightened and tied for 1 time in 6 patients, 2 times in 23 patients, 3 times in 27 patients, 4 times in 11 patients. Postoperative closure time ranged from 3 to 9 days, with an average of 6.2 days. All the incisions got delayed primary healing.</p><p><b>CONCLUSION</b>The method of serial tightening of reserved suture threads to close delayed incision closure avoids a second operation, which is simple and obtains a fine result.</p>

Case-control study on percutaneous compressing plating and proximal femoral nail antirotation in treating in tertrochanteric fracture with risk external wall / 中国骨伤

<p><b>OBJECTIVE</b>To compare clinical effects between percutaneous compressing plating (PCCP) and proximal femoral nail antirotation (PFNA) for the treatment of patients with intertrochanteric fracture with risk external wall.</p><p><b>METHODS</b>From September 2007 to June 2010, 43 patients with intertrochanteric fracture with risk external wall were treated by PCCP or PFNA according to different kinds of internal fixations. There were 22 cases in PCCP, including 9 males and 13 females with an average age of 68.4 (ranged, 60 to 86) years old, and 13 cases with type A2.2 and 9 cases with type A2.3; while 21 cases in PFNA, including 7 males and 14 females with an average age of 67.7 (ranged, 57 to 93) years old, and 10 cases with type A2.2 and 11 cases with type A2.3. Blood loss, operation time, hospital stay, fracture healing time, complications and Harris score after 1 years' following-up were observed and compared.</p><p><b>RESULTS</b>All patients were followed up for 12 to 22 (means 18.4) months, and all patients were obtained fracture healing, and recovered walking ability as before injury. There were no significant differences in blood loss, operation time, hospital stay, fracture healing time, complications and Harris score after 1 years' following-up (P>0.05). One case occurred displacement on the top of greater trochanter, and 1 case injuried weakness of hip abduction. One case occurred screw breakage in PCCP, while 1 case occurred hip joint pain in PFNA.</p><p><b>CONCLUSION</b>Both of PCCP and PFNA in treating patients with intertrochanteric fracture with risk external wall can receive good clinical effects, while the effects and therapy strategy for displacement of bone on the top of lateral wall should further study.</p>

Treatment of refractory sinus in the lower leg with modified VSD technique / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effects of modified vacuum sealing drainage (VSD) technique in treating refractory sinus in the lower leg.</p><p><b>METHODS</b>From January 2010 to December 2011, 11 patients with refractory sinus in the lower leg, including 7 males and 4 females, with an average age of 34.5 years (ranged,23 to 56). These patients were treated with modified VSD technique after thorough cleaning sinus and continuous washing. After 14 to 21 days of treatment, removed VSD and re-debrided the sinus and sutured wound.</p><p><b>RESULTS</b>Infections got control after operation, sinus in the lower leg healed. All patients were followed up from 6 to 14 months with an average of 10 months, no recidivations were found.</p><p><b>CONCLUSION</b>Modified VSD technique is an effective method in the treatment of stubborn sinus in the lower leg.</p>

Imaging diagnosis of lung lacerating injury / 中华放射学杂志

Objective To investigate the imaging findings of the lacerating injury of the lung. Methods Ten patients of lung lacerating injury were examined by X-ray and CT within 1—5 h after injury. X-ray(2—5 times)and CT(3—5 times)examinations were repeated for 7 patients.Results The lung lacerating injury involved 10 sides and 14 lung lobes(21 lesions in total)in the 10 cases,among which 1 case involved the right upper lobe with 1 lesion,2 cases in the right lower lobe with 2 lesions,1 case in the right upper and lower lobes with 2 lesions for each lobe,3 cases in the left lower lobe with 9 lesions,and 3 cases in both the left upper and the lower lobes with 7 lesions.The X-ray findings were cavity-like shadows with smooth margin in 9 lesions(9/21),and patchy shadows of fogging margin in 12 lesions(12/21).The CT imaging findings included 6 pulmonary hematomas(6/21),and 15 cavitary lesions with air-fluid levels (15/21).In the 15 cavitary lesions,CT revealed 14 single cavities and 2 small cavities within a big cavity. On dynamic follow-up observation,the cavity was the biggest in 1—5 h after injury,but the hematoma was the biggest in 2—3 days after injury.Hematomas tended to absorb slower than the cavities.After 16— 32 days,all lesions revolved into small patchy or stripe-like shadows with slightly increased density. Conclusion Cavitary lesion with air-fluid level is the characteristic imaging finding of lung lacerating injury.CT surpasses X-ray plain film in revealing the details of lung lacerating injury.

Clinical application of free upper limb lateral bone-skin flap in hand surgery field / 中华显微外科杂志

Objective To report the surgical method and treatment outecome of transfer of free upper limb lateral bone-skin flap for repair of bone defects and nonunion in hand and forearm.Methods 17 cases of hand composite trauma,5 cases of forearm composite trauma and 2 cases of nonunion in forearm were treated with free bone-skin flaps in distal humerus,whose pedicle was the posterior branch of radical collateral artery. Area of the flap was 2cm?3cm to 8cm?10cm,length of exseeted bone was 3～6 cm.Results All the bone-skin flaps completely survived,the donor area all achieved primary healing,On postoperative 1～4 years follow-up,the texture of the flap was excellent,and bone union was obtained in all transplants,the donor area of distal lateral humerus became thicker and thicker with new cortical bones formed.According to the upper arm function assessment criterion issued by hand surgery association of Chinese medical association.The hand function had excellent results in 17 cases and good results in 2 cases.Conclusion The bone-skin flap has following advantages:easy dissection,reliable blood supply,and no major vessel needed to be sacrificed,so it is an effective method for repair of skin and soft tissue with bone defects in hand and forearm,It.also can be used to repair refractory nonunion in ulna and radius.