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Objective:To evaluate the treatment of infected nonunion after internal fixation of subtrochanteric fracture with a reconstruction stent of external fixation.Methods:A retrospective study was conducted to analyze the data of 5 male patients with infected nonunion after internal fixation of subtrochanteric fracture who had been treated and completely followed up at The Great Wall Orthopaedics and Hand Surgery Hospital from January 2017 to October 2022. The patients were (30.0±13.5) years old. Seinsheimer fracture types: ⅢA (1 case), ⅢB (1 case), Ⅳ (2 cases), and Ⅴ (1 case); original internal fixation: intramedullary system (4 cases) and plate fixation (1 case); the Cierny-Mader anatomical classification: type Ⅳ (diffuse type) for all. After complete debridement at stage one, 2 or 3 hydroxyapatite (HA) coated screws were placed at both fracture ends from the lateral side of the femur for unilateral reconstruction external fixation. Next, a hybrid external fixation scaffold was added with a 1/3 ring at the sagittal position and 1 or 2 HA screws in 4 cases while unilateral reconstruction external fixation was constructed at both sides by inserting 2 HA screws into both fracture ends from the anterior femur at the sagittal position in 1 case. Antibiotic bone cement was used to fill bone defects of (3.8±1.8) cm. At 6 to 8 weeks after debridement when infection did not recur, antibiotic bone cement was removed before autogenous iliac bone grafting was performed in 3 patients and osteotomy bone transport in 2 patients. Infection control, bone union time, time for removal of external fixation stent, complications, Sanders hip function score and Paley bone outcome score were recorded.Results:The 5 patients were followed up for (23.4±8.1) months after surgery. Infection at the fracture ends was controlled after 1 time of debridement in 3 patients and after 2 times of debridement in 2 patients. The loosening HA screws were replaced twice due to infection at the proximal nail tract, and autologous bone grafting was performed at the opposite fracture ends in 1 case; no complications occurred in the other 4 cases. Bony union was achieved at the extended segment and fracture ends in all patients. The time for imaging union after bone reconstruction was (10.2±3.4) months. The time for wearing a stent of external fixation was (18.0±4.5) months. There was no recurrent infection or lingering infection. According to the Sanders hip function score at the last follow-up, 4 cases were excellent and 1 case was good; according to the Paley bone outcome score, the curative effect was excellent in all.Conclusion:Application of a reconstruction stent of external fixation combined with antibiotic bone cement can control infection at the first stage and conduct bone reconstruction at the second stage to successfully treat the infected nonunion and preserve the hip function after internal fixation of subtrochanteric fracture.
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Objective:To summarise the advantages and disadvantages of applying the method of retrograde replantation with an operative position of foot stepping and knee bending for replantation of rotational avulsed and fractured great toes.Methods:From January 2016 to June 2021, 11 rotational avulsed and fractured great toes were replanted with the method of retrograde replantation in an operative position of foot stepping and knee bending. Of the 11 patients, 10 were males and 1 was female, aged 18 to 50 years old with an average of 32 years old. Causes of injury: 5 of driving belt, 4 of machinery crush and 2 of car accident. Injury sites: 4 on left great toes and 7 on right great toes. All of the injuries were with fracture and exposure of proximal tendons of flexor and extensor. Seven patients had the follow-up reviews by outpatient clinic visiting, 2 over mobile phone and 2 via WeChat.Results:After surgery, 9 great toes completely survived and 2 great toes had necrosis. The survival rate of toe replantation was 81.8%(9/11). The operation time was 2 to 3 hours, with an average of 2.5 hours. Postoperative X-ray film showed that 8 to 12 weeks after the operation, the fracture and joint fusion were healed at first stage in the survived toes. All patients were entered in follow-up for 3 to 18 months with 10.5 months in average. The survived great toes were plump and the toenail grown well. At the final follow-up, the static TPD at the toes was 8-12 mm, with an average of 10 mm. There was no effect shown on either walking or running.Conclusion:The retrograde replantation method with an operative position of foot stepping and knee bending for great toe replantation has the characteristics of a good field of view and convenient in operation under microscope, a short operation time, and a high survival rate of replantation.
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Objective:To report our experience in successful limb salvage in 2 cases of femoral fracture of Gustilo type ⅢC after warm ischemia beyond 10 hours.Methods:From February 2016 to April 2017, 2 patients with femoral fracture of Gustilo type ⅢC were treated at The Great Wall Orthopaedic and Hand Surgery Hospital after warm ischemia beyond 10 hours.Both of them were male, 42 and 27 years of age.After debridement, bone shortening for 8.0 cm and 10.0 cm respectively was followed by replantation. The fractures were fixated end to end with a compression plate, the femoral artery was anastomosed directly and the muscles were sutured end to end.Secondary osteotomy was conducted 4 months after successful replanta-tion, followed by unilateral external fixation for reconstruction.Limb lengthening began one week after sec-ondary osteotomy.The efficacy was assessed by the Paley criteria.Results:Scattered irregular necrosis occurred in the leg muscles but was cured by dermatoplasty through a decompressive incision 40 days after debridement for 4 times.The affected limbs in the 2 cases were successfully saved and lengthened to the same length as the opposite one.The limbs were lengthened for 8.0 and 10.0 cm and for 3.0 and 3.5 months, respectively.The unilateral external fixator was worn for 29 and 24 months, respectively.The plantar sensation recovered to S4 one year after operation.Follow-up at 6 months after removal of external fixation showed excellent bony outcomes and good functional outcomes in both cases According to the Paley criteria.Conclusion:For femoral fracture of Gustilo type ⅢC after warm ischemia beyond 10 hours, thorough debridement, plate fixation, bone shortening and replantation at one stage, followed by secondary limb lengthening using unilateral external fixation, may be practical and effective procedures, as long as in-dications for limb salvage should be comprehensively followed.
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<p><b>OBJECTIVE</b>To observe the effects of inhaled Chuankezhi injection (CKZ) on airway inflammation in a mouse model of asthma and dilation of isolated guinea-pig airway smooth muscle in vitro, which can provide pharmacodynamic evidence for CKZ treating acute attack of asthma.</p><p><b>METHOD</b>BALB/c mice were sensitized with ovalbumin (OVA) on Days 1, 15, and then were inhaled with OVA aerosol on Days 22-28. The sensitized mice were administered with inhalation of aerosolized CKZ injection (0.2, 0.4, 0.8 mL x kg(-1), bid), or intraperitoneal injection of CKZ (0.4 mL x kg(-1), bid), dexamethsone (0.5 mg x kg(-1) x d(-1)) and saline (control) on Days 22-28. Airway inflammation was evaluated by counting cells in bronchoalveolar lavage fluid (BALF) and by lung histology. The influences of CKZ on the dilation of tracheal smooth muscle in guinea-pig and the contraction induced by carbamylcholine (CCH)/histamine in vitro were also observed.</p><p><b>RESULT</b>In vivo, OVA-sensitized mice developed a significant airway inflammatory response that was significant inhibited by inhalation of CKZ (0.8 mL x kg(-1), bid), and intraperitoneal injection of CKZ (0.4 mL x kg(-1), bid) and dexamethasone (0.5 mg x kg(-1) x d(-1)). in vitro, CKZ did not dilate tracheal smooth muscles in guinea-pigs, and did not attenuate the contraction induced by carbamylcholine (CCH)/histamine.</p><p><b>CONCLUSION</b>CKZ can modulate airway inflammation in asthma, but has no dilation effect on the tracheal smooth muscle in guinea-pig in vitro. These results demonstrate that inhaled CKZ is not a preferred administration.</p>
Subject(s)
Animals , Female , Humans , Male , Mice , Asthma , Drug Therapy , Allergy and Immunology , Bronchoalveolar Lavage Fluid , Allergy and Immunology , Cells, Cultured , Disease Models, Animal , Drugs, Chinese Herbal , Pharmacology , Guinea Pigs , Injections , Lung , Allergy and Immunology , Mice, Inbred BALB C , Muscle, Smooth , Allergy and Immunology , Respiratory System , Trachea , Cell Biology , Allergy and ImmunologyABSTRACT
[Objective]To investigate the prophylactic effects of intra-articular injection of salvia miltiorrhiza on joint adhesion. [Methods]Twenty-four Japanese male rabbits were randomly divided into 3 groups.All right hind knees were made in this way: the auterior wall of suprapatellar bursae was scraped, the posterior wall of suprapatellar bursae and the infrapatellar fat pad were cut off. Each knee was injected with physiological saline 0.3 ml for group A, sodium hyaluronate injection 0.3 ml for group B, and salvia miltiorrhiza injection 0.3 ml for group C. All right hind knees were immobilized in the extension position with a long leg plaster cast for 4 weeks, and injected weekly.[Results]After 4 weeks, the joint movement range in group B or C was larger than that in group A (P<0.01), and there was no significant difference (P>0.05)compared to group B and group C. The scoring of joint adhesions in group B or C was smaller than that in group A (P<0.01), and there was no significant difference(P>0.05)compared to group B and group C. The scoring of histological changed of the synovial membrane in group B or C was smaller than that in group A (P<0.01), and there was no significant difference(P>0.05)compared to group B and group C.Total collagens content of the synovial membrane in group B or C was smaller than that in group A (P<0.01), while that of group C was less than in group B(P<0.01). [Conclusion]Similarly to sodium hyaluronate, salvia miltiorrhiza can effectively prevent joint adhesions.