Isokinetic evaluation of muscle strength and endurance after treatment of acute Achilles tendon rupture using a tunnel beneath paratenon / 中华创伤骨科杂志

Objective:To use an isokinetic test to objectively evaluate the recovery of muscle strength and endurance after treatment of acute Achilles tendon rupture using a tunnel beneath paratenon.Methods:A retrospective study was conducted of the 23 patients who had been treated at Department of Orthopedics, The Forth Medical Center, General Hospital of Chinese PLA by a tunnel beneath paratenon for acute Achilles tendon rupture from January 2017 to January 2018. They were 22 males and one female, aged from 26 to 60 years (average, 35.7 years), with 11 right and 12 left sides involved. Surgery was performed 0.5 to 7.0 days (average, 2.7 days) after injury. Length of incision, skin necrosis, infection, re-rupture, ankle-hindfoot score of American Orthopedic Foot & Ankle Society (AOFAS) and Achilles tendon total rupture scores (ATRS) were followed up for 18 months. Surgical outcomes were objectively evaluated by an isokinetic test to compare the recovery of muscle strength and endurance between the affected and normal sides.Results:Skin necrosis, infection or re-rupture occurred in none of the patients. Incision length averaged 1.4 cm (from 1 to 2 cm), AOFAS 99.1 (from 93 to 100, giving an excellent and good rate of 100%), and ATRS 97.0 (from 88 to 100). Isokinetic evaluation showed that the peak torques of ankle plantar flexion and dorsal extension at 5 test speeds (30°/s, 60°/s, 90°/s, 120°/s and 240°/s) were not significantly different between the affected and normal sides ( P>0.05). In the endurance test, the total work of ankle plantar flexion was (691.2±258.8) J on the normal side and (670.6±304.2) J on the affected side, showing no significant difference between the 2 sides ( P>0.05); the total work of ankle dorsal extension at the normal side was (407.3±119.2) J, significantly larger than that at the affected side [(362.2±117.5) J] ( P=0.001). Conclusion:An isokinetic test can be used to objectively evaluate the recovery of muscle strength and endurance after treatment of acute Achilles tendon rupture using a tunnel beneath paratenon.

Accurate understanding of the lateral wall of intertrochanteric fracture / 中国修复重建外科杂志

With the deepening of the research on intertrochanteric fracture, the importance of "lateral wall" of femur is gradually recognized. The integrity of the lateral wall can affect the stability of intertrochanteric fractures, the choice of surgical methods and internal fixation, and the outcome of patients after surgery, which has become a research hotspot. However, there is no unified understanding on the definition of lateral wall, the judgement of injury status and the treatment of lateral wall fracture. This article reviews the literature, and combines with the clinical understanding of the role of the lateral femoral wall, in order to provide reference for orthopaedic surgeons and relevant researchers.

Management of chronic Achilles tendon rupture of Myerson type Ⅱ using a tunnel beneath paratenon / 中华创伤骨科杂志

Objective To explore the clinical efficacy of using a tunnel beneath the paratenon to repair chronic Achilles tendon rupture of Myerson type Ⅱ.Methods From August 2008 through January 2018,19 patients with chronic Achilles tendon rupture were treated with a self-designed minimally invasive suture technique at Department of Orthopaedics,The Fourth Medical Center,General Hospital of PLA.They were all male,aged from 25 to 64 years(average,40.4 years).The left side was injured in 12 patients and the right side in 7.The duration from injury to surgery ranged from 28 to 120 days,averaging 60 days.The Achilles tendon defects averaged 3.84 cm.Their clinical diagnoses were confirmed by positive results of clinical examination and magnetic resonance imaging(MRI) scans.After a 2 cm transverse incision was made at the proximal side,the proximal stump beneath the paratenon was adequately released with a periosteum elevator.The proximal stump was sutured by the Bunnell method with an Ethicon-X519 non-absorbable suture under direct vision.After a 1.0-1.5 cm transverse incision was made,percutaneous Bunnell suture was performed at the distal side.The proximal stump was then introduced into the distal incision through the paratenon tunnel.After the affected foot was fully flexed,the 2 stumps were tied closely together and buried under direct vision.Early rehabilitation was encouraged after surgery.The clinical efficacy was assessed according to the ankle-hindfoot scores of American Orthopaedic Foot&Ankle Society(AOFAS) and the Arner-Lindholm evaluation criteria.Results The 19 patients were followed up for 10 months to 9.5 years(average,2.45 years).All the wounds healed at the first stage without any complications related to incision,sural nerve injury or tendon re-rupture.Their AOFAS ankle-hindfoot scores averaged 98.4,with 19 excellent cases;according to the Arner-Lindholm criteria,13 cases were excellent and 6 cases good.Both of the evaluation systems yielded a good to excellent rate of 100%.In the 3 patients who underwent isokinetic testing,there was no significant difference between the normal and affected sides in the peak value of flexion or in the total work of fatigue.Conclusion Using a tunnel beneath the paratenon is a good self-designed minimally invasive suture technique for chronic Achilles tendon rupture of Myerson type Ⅱ because it is simple and reliable,and leads to limited tissue damage,adhesion or complications.

Characteristics on spatial and temporal distribution as well as the driving effect of meteorological factors on brucellosis in Datong city, Shanxi province, 2005-2015 / 中华流行病学杂志

Objective: To explore the spatio-temporal epidemic trends and related driving effects of meteorological factors on brucellosis in Datong city, Shanxi province, from 2005 to 2015. Methods: We collected the surveillance data on brucellosis and related meteorological data in Datong city from 2005 to 2015, to describe the epidemic characteristics of the disease. Quasi-Poisson distribution lag non-liner model (DLNM) was built to explore the driving effect of monthly meteorological data on the disease. Results: From 2005 to 2015, Datong city reported a total of 17 311 cases of brucellosis including one death, with the annual average incidence as 47.43 per 100 000 persons. A rising trend was seen during the study period. The monthly incidence of Brucellosis presented an obvious curve with a major peak from March to June, accounted for 48.40% of the total cases. The high incidence areas in the city gradually expanded from the northeast and southeast to the western areas. Results from the DLNM studies suggested that seasonality of brucellosis in Datong was significantly affected by metrological factors such as evaporation, rainfall and temperature. The peak of delayed effect appeared the highest when the monthly cumulative evaporation capacity was 140-260 mm and the monthly cumulative rainfall was 20-60 mm with lag less than 1 month or the monthly temperature was -13 ℃ with lag of 4-5 months. Conclusions: The incidence of human brucellosis in Datong city increased significantly from 2005 to 2015. Meteorological factors such as evaporation, rainfall, temperature all showed significant driving effects on the disease.

Characteristics on spatial and temporal distribution as well as the driving effect of meteorological factors on brucellosis in Datong city, Shanxi province, 2005-2015 / 中华流行病学杂志

Objective To explore the spatio-temporal epidemic trends and related driving effects of meteorological factors on brucellosis in Datong city,Shanxi province,from 2005 to 2015.Methods We collected the surveillance data on brucellosis and related meteorological data in Datong city from 2005 to 2015,to describe the epidemic characteristics of the disease.Quasi-Poisson distribution lag non-liner model (DLNM) was built to explore the driving effect of monthly meteorological data on the disease.Results From 2005 to 2015,Datong city reported a total of 17 311 cases of brucellosis including one death,with the annual average incidence as 47.43 per 100 000 persons.A rising trend was seen during the study period.The monthly incidence of Brucellosis presented an obvious curve with a major peak from March to June,accounted for 48.40％ of the total cases.The high incidence areas in the city gradually expanded from the northeast and southeast to the western areas.Results fiom the DLNM studies suggested that seasonality of brucellosis in Datong was significantly affected by metrological factors such as evaporation,rainfall and temperature.The peak of delayed effect appeared the highest when the monthly cumulative evaporation capacity was 140-260 mm and the monthly cumulative rainfall was 20-60 mm with lag less than 1 month or the monthly temperature was-13 ℃ with lag of 4-5 months.Conclusions The incidence of human brucellosis in Datong city increased significantly from 2005 to 2015.Meteorological factors such as evaporation,rainfall,temperature all showed significant driving effects on the disease.

Research development of inflammatory bowel disease therapy during perinatology / 中国综合临床

Inflammatory Bowel Disease(IBD) is concerned with heredity,dysimmunity,environment and others,its characterized by chronic or relapsing inflammation within the gastrointestinal.IBD including two independent disease ulcerative colitis and crohn′s disease.In recent years with the incidence of IBD increased year by year,more women in reproductive age facing drug treatment.This article elucidated the effect of IBD and its treatment on perinatal.

Problems needing special attention when hypothesis test is applied / 中华医学图书情报杂志

Whether to select one-tailed test or two-tailed test,how to establish null hypothesis and alternative hypothesis,how to improve the test efficacy were elaborated,and the common problems encountered when hypothesis was applied in scientific papers were pointed out with examples.

Different managements of complete rupture of the deltoid ligament associated with supination-external rotation ankle fracture / 中华创伤骨科杂志

Objective To investigate the clinical outcomes of different managements of complete rupture of the deltoid ligament associated with supination-external rotation ankle fracture.Methods From January 2010 to June 2014,33 cases of complete rupture of the deltoid ligament associated with supination-external rotation ankle fracture were treated with open reduction and internal fixation.According to the different managements of the complete rupture of the deltoid ligament,the patients were divided into 4 groups:9 cases in the non-repair group,7 cases in the superficial layer repair group,9 cases in the deep layer repair group,and 8 cases in the complete repair group.All the patients took anteroposterior,lateral and gravity stress radiographs preoperatively and postoperatively.The 4 groups were compatible in preoperative general data (P ＞ 0.05).The 4 groups were compared in terms of operation time,medial clear space and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.Results All the patients were followed up for 6 to 18 months (average,13.7 months).All wounds healed at the first stage without any infection.All fractures united primarily after 3 to 9 months (average,4.7 months).The operation time for the superficial layer repair group was significantly longer than for the non-repair group,but significantly shorter than for the deep layer repair and the complete repair groups (P ＜ 0.05).In gravity stress radiographs,there was no significant difference in medial clear space among the 4 groups (P ＞ 0.05),but there were significant differences before and after operation in the 4 groups (P ＜ 0.05).The postoperative AOFAS ankle-hindfoot score in the repair groups was significantly higher than in the non-repair group and the superficial layer repair group(P ＜ 0.05).Conclusion To achieve satisfactory outcomes for patients with complete rupture of the deltoid ligament associated with supination-external rotation ankle fractures,anatomic open reduction and rigid internal fixation is necessary,and repair of the deltoid ligament,especially its superficial layer,is a valuable contribution.

A new minimal incision suture technique for acute close rupture of Achilles tendon / 中华创伤骨科杂志

Objective To investigate the clinical efficacy of a new minimal incision suture technique in repair of acute close rupture of Achilles tendon.Methods From August 2008 through October 2014,134 patients with acute close rupture of Achilles tendon were treated with a self-designed minimally invasive suture technique at our institution.They were 130 men and 4 women,with an average age of 37.4 years (range,from 18 to 52 years).The left side was injured in 93 patients and the right side in 41.The interval from injury to surgery was 1 to 7 days (average,2.5 days).The tendon rupture was located at 4.5 to 6.3 cm proximal to its insertion in 133 patients,and at 1.2 cm in one.With the ankle held in full plantar flexion,a 1.0 to 1.5 cm transverse incision was made over the palpable defect.Forceps were then used to mobilize the tendon from beneath the paratenon.The safe puncture site was determined by course and distribution of the sural nerve indirectly located by magnetic resonance imaging (MRI).Ethicon MB66 nonabsorbable suture was passed diagonally through the tendon bulk under epidural puncture needle guidance.The proximal and distal ends of the suture were tied together and buried.The tendon ends were apposed through the transverse incision.Postoperative individual rehabilitation was established based on pathological differentiation for tendon tissue.Results All the patients were followed up for 8 to 48 months (average,19.6 months).All the wounds healed at the first stage.No complications happened related to incision.The nervus suralis was injured in 3 patients;tendon re-rupture occurred in 4 patients,3 of whom received re-operation and one of whom conservative treatment.Their American Orthopaedic Foot and Ankle Society (AOFAS) scores averaged 99.6,giving a good to excellent rate of 100％ (133excellentcasesandonegoodcase).According to the Arner-Lindholm evaluation criteria,ankle function was excellent in 99 cases,good in 34 ones and poor in one,giving a good to excellent rate of 99.3％.Conclusion The new minimal incision suture technique is worthy of promotion in repair of ruptured Achilles tendon,because it is simple and reliable,does not interfere with the blood circulation to the Achilles tendon,prevents such complications as sural nerve injury and recurrent rupture,and leads to little adhesion and quick functional recovery.

Expression of interleukin-22 and relative CD4+ T cell subsets in ulcerative colitis / 中华微生物学和免疫学杂志

Objective To detect the expression of interlenkin-22 (IL-22) and relative CD4+ T cell subsets in patients with ulcerative colitis (UC),and to explore their roles in the pathogenesis of UC.Methods Thirty-five adult UC patients were enrolled in this study and 35 healthy subjects were taken as control.Plasma IL-22 level was quantified by ELISA.The percentages of Th1,Th17 and Th22 cells in peripheral blood were determined by flow cytometry.The relationships of these results and disease activity were analyzed.Results Plasma IL-22 levels in UC patients [ (354.12±104.22 ) pg/ml ]were significantly higher than that of healthy controls ( P＜0.05 ),and the levels increased significantly in severely active patients.The percentages of Th17 cells in UC patients [ (2.36±0.94) ％ ]were elevated compared to healthy controls ( P＜0.05 ),and the percentages increased significantly in moderately active and severely active patients.The percentages of Th22 cells in UC patients [ (2.27±0.87 ) ％ ]were elevated compared to healthy controls (P±0.05),and the percentages increased significantly in severely active patients.The percentage of Th1 cells was not significantly different between UC patients and normal controls.ConclusionOur resuits demonstrate elevated IL-22 correlated to Th17 and Th22 cells may play an important role in the immunopathogenesis of UC.

Biphasic effects of propofol on the percentage of alpha2-band power of quantitative pharmaco-electroencephalography of rabbits / 中国组织工程研究

BACKGROUND: Quantitative pharmaco-electroencephalography (QPEEG) can reflect cerebral cortical function, which can be certainly affected by general anesthetics. Anesthesia depth has good correlation with the anesthetic dosage, so if we can find out the areas of brain and band of QPEEG which is relative to the anesthetic dosage, the band may be taken as the index to reflect the depth of anesthesia. OBJECTIVE: To observe the effects of propofol on the alpha2-band (α2- band) of QPEEG in rabbits. DESIGN: A randomized control animal experiment. SETTING: Jiangsu Provincial Key Laboratory of Anesthesiology, Xuzhou Medical College. MATERIALS: The experiment was carried out in the animal laboratory of Xuzhou Medical College from October 2004 to August 2005. Thirtysix healthy adult rabbits were randomly divided into propofol 2.5, 5 and 10 mg/kg groups with 12 rabbits in each, including 6 were used to observe the change of percentage of each band power of QPEEG, and the other 6 were used to observe the latency and duration for the disappearance of righting reflex in the rabbits. METHODS: The experiment was performed between 14:00-17:00 every day. Rabbits in the three groups were treated with intravenous injection of propofol of 2.5, 5 and 10 mg/kg respectively within 30 seconds. ① The conscious rabbits were fixed onto the platform in a prone osition, and the QPEEG was recorded with the method of power spectrum analysis before administration and at 20, 30, 40, 50, 60, 70, 80, 90, 100 and 110 s and 2, 5, 10, 15, 20 and 30 minutes after administration respectively. The sampling time for each time point was 5 s. ② The latency and duration for the disappearance of righting reflex in the rabbits were recorded. RESULTS: ll the 36 rabbits were involved in the analysis of esults. ① After the intravenous injection of propofol, the righting reflexes all disappeared within 1 minute. The greater the dosage, the shorter the latency and the longer the duration r=0.79, P ＜ 0.01). ② Compared with before administration, propofol of 2.5 mg/kg had no obvious influence on the percentage of α2-band power (P ＞ 0.05); The percentages of α2-band power in the brain areas were increased after administration in the propofol 5 mg/kg group (P ＜ 0.05); Except that there were no significant differences in the left and right parietal regions between the propofol 10 mg/kg group and the propofol 5 mg/kg group, the percentages of α2-band power in the other brain areas in the propofol 10 mg/kg group were decreased as compared with those before administration and those in the other two groups (P ＜ 0.05), and the changes above were more obvious in the frontal and temporal regions.CONCLUSION: The influence of propofol on the percentage of α2-band power of QPEEG is biphasic, it is suggested that α2-band would be an index to reflect the anesthesia depth of propofol.

Injuries of avulsion and severance of upper extremity caused by flexion and rotation and their functional reconstruction / 中华创伤骨科杂志

Objective To study the injuries of avulsion and severance of upper extremity caused by flexion and rotation and application of tissues of chest side and back in functional reconstruction of the upper extremity. Methods The primary or fosterage replantations were performed from 2000 July to 2003 September for 6 cases of the injuries of avulsion and severance of upper extremity caused by flexion and rotation. After the operation, the shoulder joint was immobilized at abduction of 90 degrees and elbow joint was fixated at inflexion of 100 degrees. 4 weeks later, the fixation was removed and the regular functional training was started. Results Follow-ups ranging from 3 months to 2 years revealed that all the cases of replantation were successful. After operation, the shoulder joint could abduct 50?～90?, anteflect 50?～70?, extend backwards 20?～30?, and adduct 20?～40?. The elbow joint could flex 100?～140?and extend -20?～0?. 3 months after reconstruction, the muscle strength of elbow flexion recovered to Ⅳ～Ⅴdegrees. Conclusion Application of tissues of chest side and back to repair avulsion and severance of upper extremity stage by stages and layer by layer is an ideal method to resolve the contradiction between wound coverage and functional reconstruction because it can restore both the function and appearance.

Transarticular fixation with external fixators in unstable distal radius fractures / 中华创伤骨科杂志

Objective To retrospectively analyze the results of closed reduction and static trans-articular fixation with unilateral external fixators in the treatment of unstable distal radius fractures.Methods From June 2000 to March 2005,45 patients with 50 unstable distal radius fractures were treated with closed reduction and static transarticular fixation by unilateral external fixators.Their average age was 44.8 years(15 to 78 years).All the fractures were classified with AO-scheme.There were five A3-fractures,four B3-fractures,three C1-fractures,nine C2-fractures and 29 C3-fractures in 24 cases.Follow-ups lasted from 8 to 48 months(averaging 20 months).Results The time of bone healing was 6 to 8 weeks(averaging 7.6 weeks).At the latest follow-up,the radiological outcomes were excellent in 42 fractures(39 patients)and good in eight fractures(six patients)according to the Sarmiento rating system modified by Ste wart et al.The functional results included 37 excellent cases(34 patients),nine good ones(eight patients)and four fair ones(three patients)according to the Gartland-Werley assessment.There were only four cases of superficial pin site infection settled with oral antibiotics and mild disinfectants.Conclusions Closed reduction by manipulation and static transarticular fixation with unilateral external fixators is an effective method to treat severely comminuted distal radius fractures caused by high-energy injury.Radial nerve injury and iatrogenic fracture of the 2nd metacarpal bone can be avoided,pin tract infection and pin loosening can be decreased,and early postoperative mobilization of hand can be facilitated by insertion of external pins at appropriate sites.It is unnecessary to apply supplementary bone grafting to promote bone healing.

The treatment of comminuted distal radius fractures caused by high-energy injuries / 中华骨科杂志

Objective To analyze retrospectively the results of closed reduction and static transarticular fixation with unilateral external fixators in the treatment of severely comminuted distal radius fractures caused by high-energy injuries. Methods From June 2000 to June 2003, 20 patients with 24 severely comminuted distal radius fractures were treated with closed reduction and static transarticular fixation with unilateral external fixator. The injuries involved 16 males and 4 females, the age of the patients was from 15 to 48 years (average 33.4 years). All fractures were classified as Frykman's type Ⅷ or AO type C3. The operative technique consisted of reduction of the fractures by manipulation or assisted with the external fixator, then fixed them statically. The mean duration of the union was 7.4 weeks (ranged from 6-8 weeks). After the fixator removal, the patients were encouraged to proceed for the rehabilitations, such as the elbow flexion-extension, radial abduction, ulnar adduction, and the pronation as well as the supination of the forearm. Results All patients were available at the final follow-up, the mean duration was 16 months (range, 6-42 months). At the last examination, the radiological manifestations revealed excellent in 21 fractures (17 patients) and good in 3 (3 patients) according to the Sarmiento scoring system (modified by Stewart); and the functional results displaied excellent in 16 (13 patients), good in 6 (5 patients) and fair in 2 (2 patients) according to Gartland-Werley functional assessment system. There were only 2 cases of superficial pin site infection cured with oral antibiotics and local care with mild disinfectants. 7 obvious defect of mataphysis occurred in 5 patients, but the fractures united simultaneously without any additional treatment. And there was no any complication, such as pin tract infection, fixator loosening, iatrogenic fracture and injury of the superficial radial nerve. Conclusion The technique of closed reduction by manipulations or external fixators combined with static transarticular fixation plus unilateral external fixators is an effective method for the treatment of severely comminuted distal radius fracture caused by high-energy injuries, such as falling from the height. It is unnecessary to apply supplementary bone grafts to promote bone healing. The complications can be avoided by selecting the right sites for the insertion of the pins, which is beneficial for the hand to mobilize earlier after operation.