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Objective@#To evaluate the method and curative effect of plate fixation or percutaneous screws for the treatment of calcaneal fractures of Sanders type Ⅱ and Ⅲ via a minimally invasive sinus tarsi incision combined with a variety of manipulative reduction methods.@*Methods@#Twenty-one patients with closed calcaneal fractures treated in the Department of Orthopedics, the First Affiliated Hospital of Nanchang University from January 2014 to January 2016 were collected. There were 15 men and 6 women, with an average age of 39.3 years(from 25 to 63 years). According to the Sanders classification, 16 cases were type Ⅱ and 5 were type Ⅲ.All cases were treated with internal fixation with plate and percutaneous screws via the mini-open sinus tarsi approach following reduction of the posterior articular surface of the subtalar joint and calcaneal length, width and height.Statistical analysis was performed on calcaneal width and Böhler angle, Gissane angle preoperatively and postoperatively (3 days and 3 months). All data were analyzed by ANOVA, functional recovery was evaluated according to the Ankle and Hind-foot Score of American Orthopedic Foot and Ankle Society (AOFAS).@*Results@#Twenty one patients were followed up for a mean duration of 13.4 months(6 to 24 months). All cases gained primary incision healing, without complications such as skin necrosis, wound infection, tenosynovitis of peroneus longus and brevis muscles, or fracture displacement and hardware failure.Bone union was achieved at an average of 10.5 weeks(9 to 11 weeks). No obvious malunion occurred by the last follow-up. Compared to preoperative, calcaneal width(F=25.62, 38.90) were significantly improved 3 days and 3 months after surgery, Böhler angle(F=440.24, 272.42) and Gissane angle(F=91.86, 43.74) were normal, the differences were statistically significant (all P<0.05). Compared to 3 days after surgery, calcaneal width, Böhler angle and Gissane angle kept normal 3 months after surgery, there were no statistically differences (F=0.26, 1.35, 2.60, all P>0.05). By the AOFAS scoring, 10 cases were rated as excellent, 7 were good and 4 were fair.@*Conclusions@#Fixation with plate and percutaneous screws via the mini-open sinus tarsi approach is an effective treatment for Sanders types Ⅱ and Ⅲ calcaneal fractures, which with the advantages of small wound, simple operation, reliable fixation, no incision complication, especially suitable for elderly patients and the patients with severe injury of local soft tissue.
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Objective To investigate the related mechanism of ligamentum flavum (LF) hypertrophy in diabetic pa-tients with lumbar spinal canal stenosis ( LSCS ) .Methods Twenty-four diabetes mellitus patients [ DM (+) ] and twenty normoglycemic patients [ DM (-) ] with LSCS were enrolled in this study .Sorbitol in LF was analyzed using D-Sorbitol/Xylitol test kit .The thickness of LF was measured by CT .The structure of LF was observed after HE and Masson's trichrome staining .The cell cycle and proliferation of fibroblastic cell NIH 3T3 line cultured in high glucose were analyzed .Sorbitol of NIH3T3 was detected under different backgrounds in vitro, normal glucose , high glucose and high glucose burdened with aldose reductase inhibitor ( ARI) , Epalrestat .The expression of inflammatory factors was detected by qPCR and Western blot under above different backgrounds .Results LF of diabetic patients exhibi-ted significantly higher level of sorbitol and pro-inflammatory cytokines , TGF-βand of CD68-positive staining than that of the normoglycemic subjects ( P<0.01 ) .The diabetic LF was significantly thicker than that of the controls , and showed evidence of degeneration .The high glucose-cultured fibroblasts exhibited significantly higher levels of sorbitol , pro-inflammatory factors , and TGF-βcompared to the low glucose-cultured cells , and these levels were dose-dependently reduced by treatment with the aldose reductase inhibitor (P<0.05).Conclusions Sorbitol level of the LF is significantly increased in the DM patients with LSCS .Increased sorbitol recruites inflammatory factors and fibrogenic-related factor TGF-βin LF of DM patients with LSCS which may contributes to the LF hypertrophy .
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BACKGROUND: It is necessary to keep a good cervical curvature for improving nerve symptom in patients with cervical spondylotic myelopathy (CSM). It is verified that cervical anterior plate internal fixation implant is effective to restore the physiological curvature of cervical vertebra.OBJECTIVE: To assess the physiological lordosis of cervical vertebra in CSM patients after cervical anterior plate internal fixation implantation.DESIGN: Observational study.SETTING: First Affiliated Hospital of Nanchang University.PARTICIpANTS: Totally 72 CSM patients were enrolled at Department of Orthopaedics, First Affiliated Hospital,Nanchang University from February 2003 to January 2006, including 46 males and 26 females, aged 45-70 years,averagely 54 years, with the history of 2-6 years. Inclusive criteria included ①cervical spinal cord compression shown in MRI, and ②using autogenous iliac bone. The experiment was approved by Hospital Ethics Committee, and all patients signed the informed consent. Cervical anterior plate was Orion locking plate offered by Shufamo Company. There were single segmental discectomy group (n =32) and two-level segmental discectomy group (n =40) according to experimental requirement.METHODS: ①Anterior decompression plus autogenous iliac bone implant plus titanium plate internal fixation were utilized.The patients were in supine position; shoulder and back were blocked up; neck backward, and endotracheal tube was done under general anesthesia. Transverse or oblique incision was made at right anterior neck. Discectomy decompression was performed with Caspar vertebra ecarteur. Three-dimensional autogenous iliac bone was implanted in decompressed intervertebral space. Immediate stability was obtained after Orion locking titanium plate was fixed, with placement drainage, and then the incision was sutured. ②Postoperative daily activities were conducted with cervical gear, which was removed 8 weeks later. ③Lateral cervical vertebrae X-rays were taken before operation, immediately after operation, 6 and 12 months after operation. Lordosis of the fusion segment was measured with Cobb's angle, and lordosis of cervical vertebra was assessed with D value. These data were analysed by statistic software. ④Bone fusion of the patients was followed up for 12 months after operation. Vertebral fusion standards included no abnormity between two spinous processes of the fusion segment, no lucency between implant and vertebra, as well as bone trabecula across the interface between implant bone and vertebra. ⑤Biocompatibility between material and host was observed during follow-up.MAIN OUTCOME MEASURES: ①Changes of Cobb's angle and D value at different time points before and after operation,and ②Bone fusion and rejection were followed up.RESULTS: Totally 72 patients were involved in the result analysis. ①Cobb's angle was larger and D value was higher immediately after operation, 6 and 12 months after operation than those before operation in the single segmental discectomy group and the two-level segmental discectomy group (P＜0.05). ②Findings of 12-month follow-up showed that bone fusion appeared in all patients of the two groups. ③No significant rejection was found after titanium plate internal fixation implantation. It was found that material and host had a good biocompatibility.CONCLUSION: It is satisfactory to restore physiological lordosis of cervical spine by using cervical anterior plate internal fixation plus autogenous iliac bone for CSM.
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Objective To discuss two simulation studies on the closed and open peritoneum in abdomenal operations. Meth-ods We selected 120 domestic female rabbits from animal laboratory of Qi Qi Ha’er Medical College at random and divided them into four groups(according to whether the peritoneum was open or not,the degree of peritoneum defect at the right side of incision and the existence of peritoneum hemorrhagic focus ),with 30 cases in each group. Group Ⅰ: no peritoneum suture and making a defect of 4cm?3cm at the right side of the incision; Group Ⅱ: no peritoneum suture and making a defect of 4cm?3cm at the right side of the incision,with a hemorrhagic focus at peritoneum defect;Group Ⅲ: with peritoneum suture; Group Ⅳ:with dense and compact peritoneum suture.And then we analyzed postoperative peritoneum healing progress. Results Observeations of the incision infection by the naked eye were that one case was identified in group Ⅰ,Ⅲ and Ⅳ;and a significant difference of occurrence rate was identified between the fallowing groups: groupⅠandⅡ(P