Tibial plateau posterior column fractures treated via the posteromedial approach dissecting the gastrocnemius medial head / 中华创伤骨科杂志

Objective To discuss the treatment of tibial plateau posterior column fractures via the posteromedial approach which dissects the medial head of the gastrocnemius muscle.Methods From July 2013 to September 2016,7 patients were treated at Department of Orthopaedics and Trauma,The First Affiliated Hospital to Dalian Medical University by surgery via the posteromedial approach dissecting the medial head of the gastrocnemius muscle for tibial plateau posterior column fractures.They were 6 men and one woman,aged from 38 to 61 years (49.3 years on average).According to AO/OTA classification,4 cases belonged to type 41-B3.3,one to type 41-B3.1,one to type 41-C3.3 and one to type 41-C3.1.According to the three-column classification,3 cases were categorized into three-column fracture,2 cases into fracture of both medial and posterior columns,and 2 cases into simple posterior column fracture.Of the posterior column fractures,5 had the medial posterior column split and the lateral column collapsed,and 2 had the medial posterior column split.According to Schatzker classification,5 cases were categorized into type Ⅳ,one into type Ⅴ and one into type Ⅵ.Fracture reduction was assessed according to the Rasmussen criteria postoperation.The knee function was assessed at final follow-ups using The Hospital for Special Surgery (HSS) scoring system.The postoperative complications were documented.Results Insertion rupture of the posterior cruciate ligament was found in one case,lateral meniscus injury in 2 cases,and tibial external dislocation combined with bone fragment incarceration into the lateral femoral condyle in one case.All the lesions were repaired.All the incisions were healed at the first stage.No major neurovascular injuries were found.The 7 patients were followed up for 8 to 12 months (mean,11.4 months).Bony union was achieved in all after 12 to 16 weeks (mean,14.3 weeks).The postoperative Rasmussen reduction scores averaged 17.7 points.The average tibial plateau tilt angle was 9.5°postoperatively and 10.8° at final follow-ups;the average tibial plateau varus angle was 86.7° postoperatively and 87.3° at final follow-ups.The HSS knee scores at final follow-ups averaged 91.4 points.No significant reduction loss,implants loosening,infection or malunion was observed at final follow-ups.Conclusion The posterior medial approach which dissects the medial head of the gastrocnemius muscle is a safe and practical one for treatment of tibial plateau posterior column fractures,because it can well expose the posterior column of the entire tibial plateau so that is beneficial to the anatomical reduction of the fracture and placement of implants,leading to fine short-term curative effect.

Long-term morphologic changes in skeletal muscles of SD rats after botulinum toxin A gel injection / 第三军医大学学报

0.05).Histopathologic examination showed no changes in the right gastrocnemius muscles injected with BTXA gel,but ultrastructurally the myopathic changes were clearly visible,like diffuse sarcomere disruption and saroplasmic reticulum expanding.The myofibre degeneration showed no remission 12 months after BTXA gel injection.Conclusion BTXA is dissolved in gel evenly.The long-lasting myofibre degeneration in BTXA gel paralyzed muscles may reflect that the paralyzed muscles fail to regain their unique function and recovery of muscle contraction.

THE FORMATION OF THE pOPLITEAL VEIN / 解剖学报

Popliteal fossa dissections were performed on two hundred adult extremities and the patterns of the deep venous system were observed. Three general types were established for the popliteal vein and its branches. Single large trunk representing the popliteal vein at the level of the knee joint occurs only in 32.00％, two venous trunks at this level in 65.50％ and three venous trunks in 2.50％. Furthermore, considerable variations of the formation of popliteal veins were found. The patterns of popliteal vein were divided into three main types and eleven subtypes. Type Ⅱa occurs most frequently (41.50％). The size of each vein of the deep venous system was measured. The average calibre of the single popliteal vein is 6.89mm (ranging between 4.0-11.5 mm). The veins from the gastrocnemius muscle join the single or the two popliteal trunks respectively. The veins of the soleus muscle drain into the peroneal and posterior tibial veins. The short saphenous vein typically terminates in the popliteal vein. Variations in its termination were described.