Treatment of unstable middle 1/3 of clavicular fractures with composite external fixator in adult patients / 中国骨伤

<p><b>OBJECTIVE</b>To explore methods and clinical effects of composite external fixtor in treating adult patients with unstable middle 1/3 of clavicular fractures.</p><p><b>METHODS</b>From March 2008 to March 2011,36 patients with unstable middle 1/3 of clavicular fractures were treated with composite external fixtor. There were 24 males and 12 females, aged from 18 to 55 years old with an average of 43 years old. Twenty cases on the left side and 16 cases on the right side. Time from injury to operation was 2 to 6 days (averaged 3.5 days). According to Robinson classification, there were 7 cases with type 2A2, 18 cases with type 2B1, and 11 cases with type 2B2. No vessels and nerve damage occurred before opreation. The clinical effects were evaluated according to Neer scoring.</p><p><b>RESULTS</b>All cases were followed up from 6 to 12 months with an average of 8 months. The mean Neer score was 88.3 +/- 6.2, which included pain 31.6 +/- 3.2, functional score 25.7 +/- 2.2, range of motion score 21.1 +/- 1.7, and anatomy score 8.8 +/- 0.8. There were 22 cases in excellent, good in 13, fair in 1. Two cases occurred pin tract infection.</p><p><b>CONCLUSION</b>Composite external fixtor is an optional method in treating unstable middle 1/3 of clavicular fracture, and can obtain a good clinical effects.</p>

Effect of cyclic training model on terminal structure of rabbit Achilles tendon: An experimental study / 解放军医学杂志

Objective To observe the effect of cyclic training on histomorphology of the terminal structure of rabbit Achilles tendon, and explore its preventive effect on training-based enthesiopathy. Methods Seventy-two Japanese white rabbits were randomly assigned to four groups: control group, jumping group, running group and cyclic training group, 18 for each. Three rabbits of each group were sacrificed at the 2nd, 3rd, 4th, 6th, 8th and 10th week. The terminal insertion tissues of bilateral Achilles tendons were harvested from these rabbits for observing the pathomorphological changes under light microscope, and pathological scoring and statistical analysis were carried out. Results Light microscopy showed that the tendon fibers and fibrocartilage in the Achilles tendon insertion region were severely damaged in the jumping group, and though the tendon fibers were damaged severely, the injury to the fibrocartilage was comparatively less serious in the running group. The injuries to the tendon fibers and fibrocartilage were milder in the cyclic training group than in the jumping group and running group. In the 2nd, 3rd, 4th, 6th and 8th week, the histopathology score of insertion of Achilles tendon was 1.17±0.12, 2.19±0.15, 3.23±0.20, 4.66±0.16, 4.71±0.18, 4.63±0.13 respectively in the jumping group, and 1.16±0.13, 1.15±0.14, 2.18±0.12, 2.99±0.15, 3.98±0.16, 4.01±0.12 respectively in the running group. Increase in pathological score appeared earlier in the jumping group than in the running group, and a significant increase began at the 3rd week. The difference in pathological score between the two groups originated mainly from the changes in the tidemark. In the 2nd, 3rd, 4th, 6th, 8th and 10th week, the pathological score of Achilles tendon insertion was 1.13±0.14, 1.16±0.17, 1.15±0.13, 2.18±0.13, 2.17±0.12, 2.92±0.11 respectively in the cyclic training group, and they showed no significant changes as compared with control group at the early stage, but there was an increase at the late stage of the training (6 weeks later), however the score values were lower than those in the jumping group and running group. These changes in score were originated mainly from pathological changes in the paratenon and tidemark. Conclusions Jumping training could lead to severe injury to the fiber tissue and fibrocartilage, while running training might result in severe injury to Achilles tendon insertion structure and lighter injury to the fibrocartilage part. Cyclic training model provides suffcient time for repair and reconstruction of Achilles tendon insertion structure, and decrease the severity of the injury to Achilles tendon insertion region. Therefore, use of cyclic training could not only effectively prevent training-based enthesiopathy, but also accelerate the remodeling of the tissue in the insertion region, thus strengthen the repair ability of Achilles tendon against injury.

Epidemiological sampling survey on military training-related injuries in PLA during 2009 and 2010 / 解放军医学杂志

Objective To conduct a random sampling survey in occurrence and distribution of military training-related injuries in the troops as the monitoring sites of the injury in the years of 2009 and 2010 for analyzing the epidemiological features and trend of the injury. Methods Ten troops as the monitoring site were randomly selected for the survey, and soldiers who participated in military training in the years 2009 and 2010 served as the objects of the survey. Data concerning military trainingrelated injuries were collected and analyzed according to the "Diagnostic Criteria and Treatment Principle on Military Training- Related Injury". Results Among the 63132 soldiers who participated in various military trainings, 10775 suffered from military training-related injuries in 2009 and 2010. Among which, 4076 out of the 27230 soldiers who participated in military training in 2009 suffered from training-related injury, with an incidence of 15%; while 6699 out of the 35902 soldiers who participated in military training in 2010 suffered the injury, with an incidence of 18.7%. There was a significantly higher incidence of military training-related injuries in 2010 (P<0.01). The composition ratios of osteoarticular, soft tissue, and organ injuries were 33.5%, 48.4%, and 18.1% in 2009, and 19.7%, 73.3%, and 7% in 2010, respectively. The composition ratio of organ and osteoarticular injury decreased, while that of soft tissue injuries increased significantly. Two peaks of training injuries were seen both in 2009 and 2010. Conclusions More attention should be paid to the prevention of injuries related to military training. The key to reducing the incidence of military training-related injuries is to enhance the dissemination of information about military training-related injuries and strictly carry out the "Rule for Health Protection in Military Training".

Influences of perioperative metoprolol on hemodynamics and myocardial ischaemia in elderly patients undergoing noncardiac surgery / 中南大学学报(医学版)

OBJECTIVE@#To observe the influences of metoprolol on hemodynamics and myocardial ischaemia in elderly patients undergoing noncardiac surgery.@*METHODS@#Thrity patients (60 approximately 75 years) undergoing elective noncardiac surgery were randomly divided into a metoprolol group (n = 15) and a control group (n = 15). In the metoprolol group, metoprolol (0. 5 mg and 1.5 mg) was slowly injected into the vein of patients before the induction of intravenous anesthesia and after the tracheal intubation. The hemodynamic indice (invasive BP, HR and rate pressure product-RPP), the myocardial ischaemia indice (reversible ST segment depression of ECG II, V5 leads more than 0.1 mv or reversible ST segment elevation more than 0.2 mv from the baseline, ST segment depression or elevation over 1 min), the myocardial damage indice (serum cardiac troponin I, cTn I), and the indice of metoprolol cardiac and the respiratory adverse effects (incidence of HR below 50 beats/min, average doses of atropine, airway peak pressure) were observed intraoperatively.@*RESULTS@#The HR and RPP were lower before the tracheal induction than the baseline (before anesthesia) in all patients, but there is no significant difference between the two groups (P > 0.05). During the tracheal intubation, the HR and RPP of the control group significantly increased, compared with the baseline (P 0.05).@*CONCLUSION@#Intravenous administration of 0.5 mg and 1. 5 mg metoprolol before the induction of anesthesia and after the tracheal intubation has several advantages, including the decrease of myocardial oxygen consumption, the improvement of hemodynamic stability, and the lowering perioperative incidence of myocardial ischeamia and damage, but the tendency of high bradycardia incidence caused by peritoneal traction should be noticed.