Real-time shear wave elastography and multimodal imaging for analyzing anatomical features of foot plantar fascia / 中国组织工程研究

BACKGROUND: In the clinic, 25%-35% heel pain is mostly caused by plantar fasciitis. Previous studies mainly focused on plantar fasciitis with heel pain caused by flat foot and the growth of calcaneus bone spur. There are no reports on other reasons for plantar fasciitis in large-sample studies. OBJECTIVE: Using the real-time shear wave elastography, CT scan and X-ray, the anatomic site and thickness of normal two-dimensional ultrasound standard flat plantar aponeurosis were identified to analyze the relationship between plantar elastic characteristics and plantar arch angle from non-weight-bearing to weight-bearing position so as to explore the correlation of plantar fasciitis with plantar elastics and plantar arch angle. METHODS: Fifty healthy volunteers (feet) were selected as the healthy control group. 100 cases of plantar fasciitis (one foot) were selected as the case group. Plantar arch angle from non-weight-bearing to weight-bearing position was obtained using X-ray and CT scan to identify anatomic site of plantar aponeurosis in both groups. Two-dimensional ultrasound and real-time shear wave elastography were utilized to obtain thickness and elastic modulus of plantar aponeurosis. RESULTS AND CONCLUSION: (1) From non-weight-bearing to weight-bearing, arch angle change value was (16.4±4.5)° in the healthy control group and (10.5±3.5)° in the case group. Significant differences in arch angle change were detected between the two groups (P <0.01). (2) Thickness of plantar fascia was obviously smaller in the healthy control group (2.4±0.3) mm than in the case group (3.5±0.9) mm. Elastic modulus of plantar fascia was obviously larger in the healthy control group (30.1±1.3) kPa than in the case group (9.1±1.2) kPa. Thickness of plantar fascia and elastic modulus of plantar fascia were significantly different between the two groups (P < 0.01). (3) In summary, real-time shear wave elastography combined with CT and X-ray images can investigate the morphological and elastic characteristics of the plantar aponeurosis from many aspects. Arch angle change is strongly associated with elastic modulus of plantar fascia. The decreased elastic modulus of plantar fascia is possibly one of the reasons for arch angle change from non-weight-bearing to weight-bearing conditions, and is probably one of reasons for plantar fasciitis with heel pain.

Clinical application of located subcutaneous jugular vein inserted central catheter in cancer patients / 中华护理杂志

Objective To explore the clinical application of located subcutaneous jugular vein inserted central catheter (LSJICC) in patients with malignant tumors. Methods The patients with malignant tumors treated in our hospital from January 2013 to December 2016 were enrolled and divided into the experimental group and the con-trol group according to the order of catheterization. Two groups were catheterized with LSJICC and PICC,respective-ly. Indwelling time of the catheter and incidence of complications were compared between two groups. The Kaplan-Meier survival curve was used to reflect the occurrence of CRBSIs in both groups,and the log-rank test was used to compare the results. The pathogenicity distribution of CRBSIs was analyzed and multivariate Cox regression analysis was performed. Results A total of 450 patients were enrolled in this study,including 228 patients in the experimental group and 222 patients in the control group. The average indwelling time of the catheter in the ex-perimental group(212.24 ± 79.80) was significantly longer than that in the control group(79.73 ± 34.86). The in-cidence of complications in the experimental group was significantly lower than that in the control group. The CRBSIs Kaplan-Meier survival curve of the experimental group was significantly better than that of the control group(P<0.01). The top three pathogens of CRBSIs were staphylococcus aureus,candida and klebsiella pneumoniae. Multivariate Cox regression analysis of CRBSIs showed that the site of catheter placement,the method of catheter placement and the type of tumor were independent risk factors for infection. Conclusion The incidence of compli-cations are significantly reduced with LSJICC,and indwelling time of the catheter is significantly prolonged,which is more in line with the actual needs of cancer patients undergoing chemotherapy.

One stage treatment of infected tibial defects combined with skin defects with Ilizarov technique / 中国骨伤

<p><b>OBJECTIVE</b>To explore the therapeutic effectiveness of Ilizarov technique in treatment of infected tibial defects combined with overlaying skin defects.</p><p><b>METHODS</b>Twenty-one cases with infected tibial defects combined with skin defects were treated between 2001 and 2008 includeing 18 males and 3 females with an average age of 31 years ranging from 19 to 43 years. The length of bone defect ranged from 3 to 13 cm (means 6 cm). Skin defect area was from 3 cm x 3 cm to 6 cm x 10 cm; 11 cases combined with drop foot, 5 cases with arthrocleisis of knee. Preoperative X-ray of the affected limb was performed and zone of skin necrosis was marked, then the point and length of osteotomized bone, and scope of bone and soft tissue need for removing were determined. The internal fixation were removed. Opening irrigation, vacuum sealing drainage (VSD), and dressing changing were appllied. The skin was fixed with Kirschner wire and bone was transferred with Ilizarov technique in all patients. The lengthening of bone and skin was carried out for 4 to 7 days after surgery, 1/6 to 1/4 mm once, 4 to 6 times a day. The clinical effectiveness was determined mainly through wound and lengthening of skin.</p><p><b>RESULTS</b>All patients were followed up for from 6 to 62 months (means 49.5 months). Fourteen of 21 cases received one stage treatment, there was still secretion from end of bone in 3 patients whose bone healed after debridement, the other 4 patients were cured via trimming end of bone and compression fusion. The defects of bone were extended to full length in 18 patients. Abutting end was slightly absorbed and became rattailed in 2 cases, there was lack of blood supply to abutting ends in one patient who was cured via bone graft from iliac bone. Skin defects was cured in 18 patients with one stage treatment, the other 3 patients were cured after infection was controlled. The deformity of drop foot were corrected in 11 patients, and function of knee was improved in five patients. The external fixator was removed at 1.2 to 2.6 years after surgery. At last, bone infections were cured, defects of bone and skin recovered in all patients.</p><p><b>CONCLUSION</b>One stage treatment of infected tibial defects combined with skin defects using Ilizarov technique has minimal invasion with less complex surgeries, could reduce the time and expense of treatment.</p>

Application of traditional Chinese drug soaking, continual irrigation and focus elimination for the treatment of foot osteomyelitis complicated with massive skin defect and denervation / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate therapeutic effects of traditional Chinese drug soaking,continual irrigation and focus elimination for foot osteomyelitis complicated with massive skin defect and denervation.</p><p><b>METHODS</b>There were 25 males and 28 females in the study. All the patients suffering from foot osteomyelitis complicated with massive skin defect and denervation were treated with comprehensive therapy including preoperative traditional Chinese drug soaking, skin release, focus elimination,continual irrigation, and two-stage suture if necessary. Among the patients, there were 42 cases of left foot and 11 cases of right one. Fifty-one patients complicated with skin defect and sinus tract,only 2 patients complicated with skin defect. There were 48 patients with denervation caused by spina bifida, 5 patients by other causes.</p><p><b>RESULTS</b>The follow-up duration was from 1 to 12 years,the mean time was about 5 years. Osteomyelitis recurred in 3 cases and skin defect reoccurred in original position in 9 cases.</p><p><b>CONCLUSION</b>The methods of traditional Chinese drug soaking, continual irrigation and elimination of focus have good effects for foot osteomyelitis complicated with massive skin defect and denervation. To some degree,this therapy may avoid skin flap transplantation, bone graft and amputation. It deserves further studies and promotion.</p>

Determination of strength of femoral neck in patients with hip fracture / 中国骨伤

<p><b>OBJECTIVE</b>To study the relationship between the hip fracture and osteoporosis of the aged.</p><p><b>METHODS</b>The strength of contralateral unfractured proximal femur (Singh index) in 80 patients with hip fractures from 1998 to 2003 were collected, and the patients' age were all over 50 years. At the same time, the strength of proximal femur of 90 patients without fractures were also measured, and the figures were analyzed.</p><p><b>RESULTS</b>The results showed that the fractures of proximal femur was closely related to osteoporosis in 50-60 age group and 61-70 age group (P<0.01). The relationship was not obvious when the age was over 70 (P>0.05).</p><p><b>CONCLUSION</b>The strength of proximal femur in patients with hip fracture was obvious decreased. The Singh index of proximal femur can be helpful in forecasting the possibility of proximal femur fracture.</p>