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Objective:To investigate the efficacy of a novel self-designed skin-stretching device for skin-soft tissue defects and bone exposure after internal fixation of calcaneal fracture.Methods:From July 2018 to January 2021, 9 patients were treated at Orthopedic Hospital, Southeast Hospital Affiliated to Xiamen University for skin-soft tissue defects and bone exposure after internal fixation of calcaneal fracture. They were 6 males and 3 females, aged from 19 to 61 years (mean, 42.6 years). The interval between their initial internal fixation and the present operation ranged from 14 to 75 days (average, 47.3 days). Of them, one developed wound dehiscence due to fat liquefaction, 2 necrosis of skin and soft tissue along the wound edges, and 6 incision infection. Their fusiform skin and soft tissue defects had formed after routine expansion of the wound, with an area of 5.0 cm×2.0 cm to 7.0 cm×3.5 cm, and all their wounds were positive by Pinch test. After a Kirschner wire with a diameter of 2.0 was placed on both sides of the wound, our novel self-designed skin-stretching device was installed. Intraoperatively, depending on the soft tissue conditions on both sides, the wound was closed acutely by about 5 mm in width. The threaded rod of the skin-stretching device was adjusted every day after operation to gradually reduce the wound surface until the wound edge was closed and sutured without tension. During wound stretch, the visual analogue scale (VAS), wound approaching time, stretch speed, wound healing time, complications and the Vancouver Scar Scale (VSS) for the wound scar at the last follow-up were recorded.Results:All the 9 patients were followed up for 8 to 18 months (average, 12.5 months). The wounds were successfully closed in all the patients. The time for wound closure (till the suture) ranged from 8 to 15 d, averaging 12.1 d; the stretch rate from 1 to 3 mm/d, averaging 2 mm/d; the time for complete wound healing (to the suture removal) from 22 to 30 d, averaging 26.8 d; the VAS score during the stretch from 3 to 7 points, averaging 4.9 points; the VSS score from 2 to 7 points, averaging 4.1 points. There was no recurrence of surgical site infection, skin re-necrosis or reoperation in the patients.Conclusions:In the treatment of skin-soft tissue defects and bone exposure caused by various reasons after internal fixation of calcaneal fracture, our novel self-designed skin-stretching device is an effective in situ wound repair instrument, showing advantages of simple operation, less trauma and high safety. It is suggested that the stretch speed should average 2 mm/d, which is well tolerated by patients.
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Objective: To evaluate the limbs shortening and re-lengthening in the treatment of tibial infectious bone defect and chronic osteomyelitis.
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Objective To compare the therapeutic effect of debridement,bony fusion and internal fixation through subscapularis transthoracic and posterolateral approach in treating upper thoracic tuberculosis.Methods Between January 2002 to February 2014,a total of 43 patients with upper thoracic tuberculosis were analyzed retrospectively.There were 21 patients in subscapularis transthoracic approach group and 22 patients in posterolateral approach group.Several parameters of the two groups were compared,including gender,age,segmental tuberculosis,intraoperative blood loss,operative time,complications of operation,hospital stay,the cure rate,the Cobb angle,Frankel scale and so on.Results There was no significant difference in gender,age,segmental tuberculosis,ESR,Frankel scale,Cobb angle between the two groups before surgery.The operative time was 196± 10 min in subscapularis transthoracic approach group,whereas it was 142±13 min in posterolateral approach group.The operative time of subscapularis transthoracic approach group was significantly longer than posterolateral approach group.There was no significant difference in intraoperative blood loss,complications of operation,hospital stay and the cure rate.The followed up of subscapularis transthoracic approach group and posterolateral approach group was 28.0± 14.7 months and 27.3± 15.5 months respectively.The preoperative Cobb angle was 36.5°±4.8° and the postoperative Cobb angle was 24.8°±5.6° in subscapularis transthoracic approach group.The correction rate was 30.9％.The preoperative Cobb angle was 34.5°±5.2° and the postoperative Cobb angle was 10.2°±2.6° in posterolateral approach group.The correction rate was 68.5％.Thus,the correction rate of posterolateral approach group was significant better than subscapularis transthoracic approach group.The neurological score of Frankel scale was significantly restored in two groups after operation,and there was no significant difference between two groups.Conclusion For upper thoracic tuberculosis,the therapeutic effect of debridement,bony fusion and internal fixation through subscapularis transthoracic and posterolateral approach could achieve the same good clinical results.However,the posterolateral approach was better than subscapularis transthoracic approach in surgical trauma,surgical duration and kyphosis correction.Therefore,it is recommended to use the posterolateral approach in treating upper thoracic tuberculosis.
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Objective To discuss role of double intramedullary nail in the treatment of floating knee injuries under minimally invasive surgery.Methods From July 2006 to July 2010,23 patients with floating knee injuries ( Fraser type Ⅰ ) were fixed with tibial intramedullary nail and femoral retrograde intramedullary nail assisted by minimally invasive method such as portable bracket,AO large distractor and Schanz screw.The postoperative continuous passive motion (CPM) was performed for functional exercises of the knee.Results The operation lasted for average 95 minutes ( range,70-160 minutes),with average blood loss of 260 ml ( range,100-600 ml).All patients were followed up for average 11 months (range,7-35 months).According to assessment systems of Karlstrom and Olerud,the clinical results were excellent in 17 patients,good in 4 and fair in 2,with excellence rate of 91％.Conclusions Combined with the methods of portable bracket of lower limb,AO large distractor and Schanz screw,the intramedullary nail is much convenient and minimally invasive for the floating knee injuries.
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Objective To evaluate the possibility and curative effect of total en bloc spondylectomy (TES) for the treatment of primary tumors of the lumbar spine. MethodsBetween June 2005 and July 2009,nine cases of primary tumor of the lumbar spine were treated with total en bloc spondylectomy through a single posterior approach performed in seven cases(L1 giant cell tumor, L1 osteosarcoma, L2 giant cell tumor,L2 solitary plasmacytoma, L2 chondrosarcoma, L2 chordoma, and L3 histiocytic sarcoma), and two cases through a single stage anterior and posterior combined approach (L4 giant cell tumor with paraspinal mass and L4 fibrosarcoma). They were performed a single stage reconstruction after removing tumors of vertebra. Neurofunction was evaluated perioperatively and recurrence of tumor was tracked for all cases.ResultsThe follow up was obtained for 3-49 months (averaging 19 months). All patients attained significant clinical improvement after surgery without any severe complications. There was no local recurrence and distal metastasis in shortterm follow-up. ConclusionThe treatment by TES to remove tumors and reconstruction of spine are reliable for primary tumors of the lumbar spine. The curative effect of short-term follow-up is satisfactory. However, the long-term curative effect remain to be further follow-up.
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Objective To explore the clinical outcome of atlantoaxial pedicle screw instrument in treatment of extension-type odontoid fracture combined with aflantoaxial subluxation. Methods From December 2002 to December 2006, seven patients with extension-type odontoid fracture combined with at-lantoaxial subluxation were reduced and fixed with atlantoaxial pedicle screw instrument of Vertex system under general anesthesia. There were five males and two females, at mean age of 39.2 years (range 21-59 years). All odontoid fractures were fresh type Aderson Ⅱ. JOA scores of spinal core function was 8.6-14.9 (average 10.7) preoperatively. The X-ray examination, CT scanning and skull traction were performed in all patients preoperatively. Results There found no severe complications such as injuries of vertebral artery, nerve root and spinal cord postoperatively. All patients obtained complete reduction and healing of the fracture and dislocation. The mean off-bed time was four days (3-6 days) after opera-tion. A follow-up for 12-36 months (average 22 months) in all patients showed that the clinical symptom was improved significantly six months postoperatively and that all screws were in proper position verified by X-ray and CT scanning. All patients obtained solid bony union on radiographs, with no loosing or breakage of instrument. The postoperative JOA scores was 13.5-16.9 (average 15.8). Conclusions Allantoaxial pedicle screw fixation has advantages of intraoperative reduction, reliable fixation and high fusion rate and can be used as an effective method for extension-type odontoid fracture combined with at-lantoaxial subluxation.
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Objective To explore the clinical effects of atlantoaxial pedicle screw instrumentation in treatment of intractable atlantoaxial dislocation in children. Methods A total of 7 patients with intractable atlantoaxial dislocations were treated with aflantoaxial pedicle screw instrumentation plus atlantoaxial bone grafting from June 2002 to January 2001. Results The dislocation in all patients reached complete reduction, with no complications. All patients were followed up for average 10 months (8-14 months). Radiographs showed successful bone fusion in all patients. Conclusion Atlantoaxial pedicle screw fixation and fusion is an effective method for treatment of intractable atlantoaxial dislocation in chil dren.
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[Objective]To investigate the clinical curative effect and superiority of subtotal corpectomy through the pedicle,titanium rete support and pedicle screws system fixation in the treatment of burst fracture of thoracic vertebrae with paralysis.[Method]Twenty-three patients who suffered from the burst fracture of thoracic vertebrae with paralysis were treated with subtotal corpectomy through pedicle,titanium rete supporting bone autograft and pedicle screws system fixation.[Result]The patients were followed up for 8 months to 2 years.All had their bone grafts fused,and no incision infection,pneumothorax,hemothorax,pulmonary infection,internal fixation loosening or breakage occurred.The mean loss of Cobb's angle was 3.5?.According to Frankel grading,6 of grade A had no obvious recovery.In 5 of grade B,3 improved to C,1 to D,and the last one to E.In 7 of grade C,3 improved to D,4 to E.Five cases of grade D improved to E.[Conclusion]There had relatively less operation wound and good clinical curative effect with subtotal corpectomy through pedicle,titanium rete supporting bone autograft and pedicle screws system fixation.
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Objective To develop and apply portable bracket of lower limb in operation of tibia interlocking intramedullary nail. Methods Portable bracket of lower limb is composed of two fir panels and support structure. The level of support and the knee flexion is controlled with it. It is used in preoperative high-pressure disinfection, and then trouble limb is placed on the bracket to complete operation of tibia interlocking intramedullary nail. Results The applications save labor, reduce iatrogenic injury, make for union of fracture and avoid radiation damage of staff. No one is used to lift up leg in operation procedure and X-ray examination. Conclusion Potable bracket of lower limb has advantages in simple production, low cost, labor-saving, minimally invasive surgery wound and so on.
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<p><b>BACKGROUND</b>To establish an ELISA method for detecting the activity of HIV-1 integrase and screening of inhibitors.</p><p><b>METHODS</b>HIV recombinant plasmid F185K/C280S IN1-288 was transformed into the E.coli strain BL21(DE3) integrase with a histag was induced by adding isopropyl-?-D?thiogalactopyranoside (IPTG)and purified by nickel affinity chromatography. The synthesized donor substrate oligonucleotide representing the HIV-1 U5LTR was immobilized onto covalink polystyrene microtiter plates, and a synthesized biotinlated 20 bp oligonucleotide was used as the target substrate. The products were detected and quantified using a colorimetic avidin?linked alkaline phosphatase reporter system,and identified by 32? autoradiography. Some natural products and chemically synthesized compounds were screened for HIV-1 integrase inhibitors.</p><p><b>RESULTS</b>The purified integrase was identified by SDS?PAGE and showed integration activity by ELISA and?32P radioisotopic assay.?Coefficients of variation (CV)of ELISA in a lot and among the lots were 4.63% and 5.89% respectively, the mean of P/N was 2.836 0.161 under the optimal experimental condition. Some plant extracts were found as potent integrase inhibitors. The IC50s for CEH and CEHL were (20.41 5.68)?g/ml and (7.56 1.86)?g/ml respectively.</p><p><b>CONCLUSIONS</b>The authors have established a simple and rapid ELISA method with stable repeatability for detecting integrase activity, which can be used for screening and studying of specific inhibitors of HIV-1 integrase.</p>