A comparative study of absorbable screw fixation and absorbable screw combined with suture anchor fixation in treatment of avulsion fracture of posterior cruciate ligament at tibial insertion of knee joint / 中国修复重建外科杂志

OBJECTIVE@#To compare the effectiveness of open reduction of posterior cruciate ligament (PCL) avulsion fracture at tibial insertion of knee joint with absorbable screws fixation and absorbable screw combined with suture anchor fixation.@*METHODS@#The clinical data of 26 patients with PCL avulsion fracture at tibial insertion who met the selection criteria between March 2015 and October 2021 were retrospectively analyzed. Among them, 14 patients were fixed with simple absorbable screw (group A), and 12 patients were fixed with absorbable screw combined with suture anchors (group B). All patients were confirmed by X-ray film, CT, or MRI preoperatively, and got positive results in preoperative posterior drawer tests. There was no significant difference in gender, age, side of affected limb, time from injury to operation, comorbidities, and preoperative Meyers & McKeever classification, Lysholm score, and International Knee Documentation Committee (IKDC) score between the two groups ( P>0.05). The operation time and postoperative complications were recorded and compared between the two groups. At last follow-up, Lysholm score and IKDC score were used to evaluate the improvement of knee function.@*RESULTS@#There was no significant difference in operation time between the two groups ( P>0.05). All incisions healed by first intention, and no complication such as vascular and nerve injury or venous thrombosis occurred. All 26 patients were followed up 9-89 months, with an average of 55.3 months. The follow-up time of group A and group B was (55.7±23.2) and (56.8±29.3) months, respectively, with no significant difference ( t=-0.106, P=0.916). Radiographs showed bone healing in both groups at 3 months after operation, and no complication such as infection and traumatic arthritis occurred. At last follow-up, the posterior drawer test was negative in both groups, and the Lysholm score and IKDC score significantly improved when compared with the pre-operative values ( P<0.05). However, there was no significant difference in the improvement value between the two groups ( P>0.05).@*CONCLUSION@#For PCL avulsion fracture at tibial insertion of the knee joint, the open reduction and absorbable screw combined with suture anchor fixation can achieve reliable fracture reduction and fixation, which is conducive to the early rehabilitation and functional exercise, and the postoperative functional recovery of the knee joint is satisfactory.

Survey of Chinese orthopedists' cognition on the Chinese Osteoarthritis Guideline (2018 Edition) / 中华骨科杂志

Objective:To investigate the orthopedists' cognition on Chinese Osteoarthritis Guideline (2018 Edition).Methods:Questionnaire about Chinese Osteoarthritis Guideline (2018 Edition) was developed and sent to orthopedists via an invitation link to fill out after authorization from Chinese Osteoarthritis Association. The content of the questionnaire included the basic personal information of the physician, the awareness rate of the guidelines, the evaluation of the guidelines, and its application effects. The survey duration was from September 2019 to December 2019. Multivariate logistic regression and linear regression analysis were performed for the guideline awareness rate and comprehensive score, respectively.Results:A total of 628 physicians completed the questionnaire, of which 623 of 628 (99.2%) were available. About 72.4% of the orthopedists knew the guideline. The awareness rate was statistically related to the education of the physicians ( P<0.05). Respondents' overall score for the guideline was 8.39 with methodological score 8.28. A total of 41.2% of orthopedists thought that the guideline was very good compared with the European and American guidelines, and the clinical problem coverage rate was 78.6%. There is a statistically significant difference in the appraisal of the recommendations ( χ2=138.9, P<0.05) . More than 40% of orthopedists believed that the guidelines were of great help to orthopedists and patients, and that the guide could be promoted to the primary hospitals. Conclusion:After one year publication of Chinese Osteoarthritis Guideline (2018 Edition), most orthopedists have understood the present guideline and applied recommendations in clinical practice. However, the guideline need to be further promoted and disseminated in the future.

Analysis of the incidence and epidemic trend of gallbladder cancer in China / 中华消化外科杂志

Many clinicians have the following 4 misconceptions about the incidence and epedemil trend of gallbladder cancer.(1) The incidence of gallbladder cancer and extrahepatic bile duct carcinoma is considered as the incidence of gallbladder cancer.(2) The gallbladder cancer is the common malignant tumor of the digestive system.(3) The gallbladder cancer is the most common malignant tumor of biliary tract system.(4) The incidence of gallbladder cancer is increasing year by year.Based on the latest annual report of the 2016 Chinese Cancer Registry Annual Report,published by the National Cancer Center (NCCR),combined with previous annual reports and the data of the incidence of gallbladder and extrahepatic bile duct cancer in the related articles,supplemented by clinical data,the author points out that the incidence of gallbladder cancer in China is about 1.00-1.30 per 100 000.It is pointed out that gallbladder cancer is not the most common cancer in the digestive and biliary systems.The incidence of gallbladder cancer has not been significantly increased in recent years,and its 5-year relative survival rate has been reduced by 0.9％ since 2003.Although the incidence of gallbladder cancer is low,the malignant degree is high and the prognosis is poor.It highlights the lack of effective treatment for the disease,and further hints that we should strengthen the necessity of early diagnosis and treatment of gallbladder cancer.

Clinical application and research progress of allograft tendon in reconstruction of the anterior cruciate ligament / 中国组织工程研究

BACKGROUND: The use of allograft tendon promotes the development of anterior cruciate ligament reconstruction, which is of great importance in the relevant basic research and clinical practice. OBJECTIVE: To summarize the current application and progress of allograft tendon in the anterior cruciate ligament reconstruction. METHODS: We searched relevant articles about the use of allograft tendon in PubMed and Embase published from January 2012 to February 2018 using the keywords of "allograft tends OR allografts, intra-articular knee ligament OR anterior cruciate ligament OR ACL". RESULTS AND CONCLUSION: China's use of allogeneic tendon in the reconstruction of the anterior cruciate ligament is still in the developmental stage. The current pros and cons of using allografts or autografts in anterior cruciate ligament reconstruction are inconclusive. Concerns about the choice of allografts are mainly due to possible infections and slow healing. A huge difference exists in different trials concerning the effects of allografts versus autografts. The conclusions are therefore roughly as follows: there is no difference in knee function after implantation of the two grafts, or the knee joint function is better after autograft. Studies have shown that allografts may increase the risk of secondary surgery. Therefore, the use of allograft tendon faces many clinical challenges in the anterior cruciate ligament reconstruction.

Surgical treatment strategy of gallbladder polyps based on high risk factors of gallbladder cancer / 中华肝胆外科杂志

In order to prevent the canceration of gallbladder polyps or avoid the misdiagnosis of gallbladder cancer,the mainstream practice is cholecystectomy for polyps larger than 1 cm,while gallbladder polyps larger than 0.5 cm as an indication of gallbladder preserving surgery.The reasons for this result is that we put the diameter of more than 1 cm of gallbladder polyps as high risk factors for prediction of gallbladder carcinoma,and we ignored the characteristics of gallbladder polyps that most of them are not gallbladder cancer or are not cancerous even larger than 1 cm.We analysed the high risk factors for gallbladder cancer on the basis of variety of clinical data,and we believe that the most valuable indicator of gallbladder cancer are the growth time of gallbladder polyps,the age of the patients,the combination of gallstones,the single polyps,and the sex.Polyps diameter greater than 1 cm are not a high risk factor for gallbladder cancer.We can use these five high risk factors to manage gallbladder polyps and reduce unnecessary cholecystectomy and gallbladder preserving surgery.

Meniscus and cartilage injuries concomitant with isolated rupture of posterior cruciate ligament and its risk factors / 中南大学学报(医学版)

OBJECTIVE@#To investigate the risk factors associated with meniscus and cartilage lesions concomitant with isolated rupture of posterior cruciate ligament (PCL).
@*METHODS@#A total of 147 patients with rupture of PCL from January, 2005 to June, 2013 were retrospectively analyzed for associations of distribution, incidence of meniscal tears or cartilage injuries with gender, age, sides, duration, body mass index, cause or degree of instability.
@*RESULTS@#Incidence for meniscal injuries was 14.3%, which was statistically different among groups in gender, age, sides, duration and degree of instability (P<0.05). Chondral lesions were mainly appeared in medial tibiofemoral compartment and patellofemoral compartment, and the incidence was statistically different among groups in gender, age, duration, and degree of instability (P<0.05). No independent risk factor was found to be associated with meniscal and chondral injuries.
@*CONCLUSION@#Severe cartilage lesions and less meniscal tears can be induced by the rupture of PCL. Medical treatment at the early stage is necessary to restore stability and reduce chondral injuries.

Toxicity effect of cadmium stress exposure to insects and defense mechanism of insects / 中国药理学与毒理学杂志

Cadmium is one of the important heavy metal pollutants with strong toxicity and wide distribution. It poses a threat to human health and invertebrates,especially to insects. It has been demonstrated that cadmium can infiltrate into insects through respiration ,food intake and so on. It can affect their development,and even induce apoptosis via oxidative damage. Insects can gradually develop defense mechanisms against cadmium with the help of metallothionein,antioxidant enzymes, excretion and heat shock protein. Toxicity effect varies among different species. This paper reviewsed the effect of cadmium on development,cell apoptosis mechanism and defense mechanism in insects.

Evaluating gallbladder preservation / 中华肝胆外科杂志

A new minimally invasive gallbladder-preserving operation has emerged for the treatment of gallbladder stones,but fundamentally it is a replica of the previous gallbladder preservation method.The gallbladder aids in digestion but is not essential for life.Its function should not be exaggerated and should not instigate trivial reasons for its preservation.Most patients undergoing cholecystectomy maintain a good quality of life.The causes,mechanisms,and prevention of gallstone formation remains mysterious,so a high recurrence rate after gallbladder-preserving operation is difficult to avoid.A full cholecystectomy can avoid recurrence complications and the benefits outweigh the risks.A discussion of the benefits and complications must be initiated to evaluate both treatment modalities for gallstones.

Curative effect of arthroscopic treatment for lateral discord meniscus tear in children / 中华创伤杂志

Objective To investigate the curative effect of arthroscopic treatment for lateral dis-cord meniscus tear in children. Methods The study involved 229 child patients with lateral discord meniscal tear treated arthroscopically from March 1996 to March 2008. There were 133 males and 96 fe-males, at age of (9±3.5) years (range 4-14 years). The treatment methods included meniscus-plasty in 219 patients (including two children with postoperative recurrence), meniscus-plasty-suture in eight and partial meniscectomy in two. The function of the knees was assessed pre-operationally and post-operation-ally by using Lysholm score. Results Of all, 221 patients were followed up for a period of (65±48.9) months (range 5-144 months). The pain and swelling were alleviated, with obvious improvement in range of motion and knee function in all patients six months after operation. There were no complica-tions including intra-articular infection, iatrogenic injury, fibroarthritis or loss of range of motion. Ly-sholm score was (61.85±7.65) points (range 45-73) before operation, which was improved to (95.30±3.50) points (range 87-100 points) six months after operation (t= 26.778, P < 0.01). Conclusion Treatment of lateral discord meniscus tear under arthroscopic guidance in children has the advantages of minor trauma, satisfactory results, can maintain good shape of the meniscus and good func-tion of knee and reduce incidence rate of osteoarthritis.

Recent progress of researches on scaffolds for tissue engineered meniscus / 生物医学工程学杂志

Tissue engineered meniscus provides a novel approach for the treatment of severe meniscus injury. The researches on scaffold for tissue engineered meniscus is an essential element. The researches on scaffolds for tissue engineered meniscus, including natural biomaterials and synthetic polymer, have made great advances in recent years. At present, collagen meniscus implants have been used in clinical practice. As hydrogel is characterized by having high water content and good biocompatibility, being similar to extracellular matrix in structure, and being able to provide access to microsurgery, it has become the hotspot field in recent years. Meanwhile, the combinatorial scaffold material advantages of biological composite tissue engineered scaffolds also illuminate the key point of research on meniscal scaffolds. This paper reviews the recent progress in betterment of the scaffolds so as to provide a theoretical and practical basis for further researches of tissue engineered meniscus.

Mechanism about bile duct strictures after liver transplantation / 国际外科学杂志

Biliary complications are a serious problem in patients after liver transplantation, which often results in graft loss, the causes of bile duct stricture are complex. This paper reviewed the mechanism of bile duet stricture after liver transplantation. This complication maybe related with various factors such as liver arterial thrombosis, loss of blood supply of bile duct, warm iscbemia/preservation injury, chronic ductopenic rejection, cytomegalovirus infection, ABO incompatibility, and recurrence of primary sclerosing cholangitis.

Pathological changes of bile duct injury after orthotopic liver transplantation / 中国组织工程研究

BACKGROUND: Complications, caused by bile duct injury after liver transplantation, are difficult for diagnosis and treatmerit and the bottlenecks for the development of liver transplantation. OBJECTIVE: To observe and record bile duct injury and do biopsy in parallel with treating biliary complications following liver transplantation successfully with choledochoscope, and to analyze the relationships between various bile duct injuries, histopathological types and biliary complications following liver transplantation. DESIGN, TIME AND SETTING: Case analysis was carried out at Dalian Institute of Hepatobiliary Surgery, Department of Hepatobiliary Surgery. Dalian Friendship Hospital between July 2001 and October 2005. PARTICIPANTS: Nineteen patients after liver transplantation were divided into three groups according to the occurrence of biliary complications: four cases for normal group, twelve cases for bile duct injury group, three cases for hepatic artery miury group. METHODS: They were observed. diagnosed and recorded respectively and take biopsy for pathological analysis through the choledochoscope. With regard to the cases without T-tube. Choledochoscope combined duodenoscope were used to take biopsies. MAIN OUTCOME MEASURES: Choledochoscope was used to observe T-tube cholangiography, the appearances and pathological changes of intemal and external bile duct mucous membrane. healing of the donor-receptor bile duct stoma. Patients in the bile duct injury group were done examinations described above after endoscopic stone extraction and stenosis expansion. RESULTS: The intemal and extemal bile duct anatomy of the patients in the normal group were normal, without bile ductstenosis and scar, their bile duct mucous membrane lookcd good, and the anastomosis of the donor-receptor bile duct healed well. Restored mucous tissue coating with intact epithelium was found by pathological examination. Various kinds of bile duct stones, simple, multiple and casting mould stones, were found in patients of the bile duct injury group. Bile duct mucous membranes were injured at different degrees and repaired after removing stones and relieving obstruction by endoscope. Contrast examination demonstrated that bile duct tree regained normal. In hepatic artery injury group, patients had bile duct wall ischemic necrosis and lost bile duct normal structure, congestion was obvious, biliary sludge and stones completely filled in the bile duct tree. Interrupted bile duct structure were found in Ⅲ grade bile ducts.Pathological examination revealed extensive bile duct wall necrosis,indistinct strcture,more bile infiltration,proliferative granulation tissue and suppuration focus.CONCLUSION:Bile ducts are injured at different degrees in orthotopic liver transplantation;cold preservation/repeffusion injury is the most important initiating agent leading to bile duct tree injuries;the vessel plexus damage and microcirculatory disturbance surrounding the bile ducts maybe one of the mechanisms of the bile duct injury.

Diagnosis and treatment of 6 patients with biliary complications following orthotopic liver transplantation by choledochofiberscopy / 中华器官移植杂志

Objective To explore the role of choledochofiberscopy in the diagnosis and treatment of biliary complication after orthotopic liver transplantation.Methods The patients with continuous biliary infection and obstructive jaundice in 6 cases subject to orthotopic liver transplantation were treated by choledochofiberscopy through T tube sinus tract. The findings from choledochofiberscope at different periods after operation were recorded.Results Three to five months after operation, there were a lot of flocs in the bile duct cavity under the choledochofiberscopy, and mucous membrane of bile duct was pale or coarse. On the postoperative month 6, 11 and 18, choledochofiberscopy revealed there were funicular, columned and brown biliary stones in bile duct cavity which mostly located in porta hepatis, and there existed stenosis in anastomotic stoma of bile duct to varying degrees; the wall of bile duct was coarse, with congestion of the mucous membrane. The flocs and stones could be extracted conveniently by the choledochofiberscope.Conclusion We can observe the transplanted liver’s bile duct through the T tube sinus tract by the choledochofiberscopy and treat the biliary complications conveniently.