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Objective To explore the clinical characteristics of and surgical strategies for distal tibiofibular syndesmosis separation based on ankle axial CT scan.Methods From January 2009 to January 2016,63 patients with injury to the distal tibiofibular syndesmosis were treated.Their injuries were characterized according to the anatomic characteristics on their ankle axial CT scan images as pronation-extorsion type (28 cases),supination-extorsion type (11 cases) and abduction type (24 cases).Specific strategies of reduction and fixation depended on the specific characteristics of distal tibiofibular syndesmosis separation.After 12 months postoperatively,the reduction quality was assessed by Burwell-Charnley's radiological evaluation system and the function of ankle joint was assessed using American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score system.Results The patients were followed up for 6 to 48 months (average,19.3 months).Anatomical reduction was achieved in 19 cases,good reduction in 7 and fair reduction in 2 in the pronation-extorsion type,yielding an excellent to good rate of 92.8％;anatomical reduction was achieved in 6 cases,good reduction in 4 and fair reduction in one in the supination-extorsion type,yielding an excellent to good rate of 90.9％;anatomical reduction was achieved in 17 cases,good reduction in 6 and fair reduction in one in the abduction type,yielding an excellent to good rate of 95.8％.By the AOFAS system,the pronation-extorsion type scored 88.6 points,the supination-extorsion type 89.4 points and the abduction type 86.6 points.Conclusion In the treatment of distal tibiofibular syndesmosis separation,reduction and fixation strategies should depend on analysis of the characteristics on the ankle axial CT scan,so as to achieve positive outcomes.
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Objective To analyze the operative therapeutic effect of proximal femoral nail antirotation blade (PFNA),dynamic hip screw (DHS) and femoral proximal locking compression plate (LCP)internal fixation in treatment with femoral intertrochanteric fracture of the aged.Methods Seventy-three aged patients with femoral intertrochanteric fracture were divided into 3 groups according to different internal fixation method:PFNA group (30 cases) was treated with PFNA internal fixation,DHS group (22 cases) was treated with DHS internal Fxation,LCP group (21 cases) was treated with LCP internal fixation.The operative time,intraoperative bleeding volume,fracture healing time,bad limb load time and hip joint function score were compared among the 3 groups.Results The operative time in PFNA group,DHS group and LCP group was (73.9 ± 8.5),(82.3 ± 10.6),(79.5 ± 11.2) min,there was statistical difference between PFNA group and DHS group (P ＜ 0.05),but there was no statistical difference between PFNA group and LCP group (P＞ 0.05).The intraoperative bleeding volume in PFNA group was significantly lower than that in DHS group and LCP group [(160.2 ± 15.6) ml vs.(208.4 ± 20.2) and (216.6 ml ± 24.9) ml],there was statistical difference (P ＜0.05).The fracture healing time and bad limb load time in PFNA group were significantly shorter than those in DHS group and LCP group [(97.4 ± 5.8) d vs.(101.2 ± 4.2),(110.0 ±8.3) d and (78.0 ±5.4) d vs.(85.9 ±7.6),(90.8±6.0) d],furtbermore DHS group were significantly shorter than those in LCP group,there were statistical differences among the 3 groups (P ＜ 0.05).There were no statistical differences in excellent and good rate of hip joint function score among the 3 groups (P ＞ 0.05).Conclusions PFNA is the ideal therapeutic method for femoral intertrochanteric fracture of the aged.It has better curative effect compared to the DHS and LCP,and has less surgical trauma and can shorten the recovery time.
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Objective To explore the effect of repairing soft tissure defects of shank by anterior tibial artery periosteal perforator flap.Methods Eleven patients received the operation using anterior tibial artery periosteal perforator flap after reversing 180° repairs soft tissue defects of the same shank.The defect after the flap transfer was closed by skin-grafting.Results All the flaps of these 11 cases were successful.The fellow-up time was 3 months to 2 years.All fractures healed,and the appearance and the skin's color were satisfied.Conclusion The operation using anterior tibial artery periosteal perforator flap repairs soft tissue defects of shank has lots of merits:it is handled easily and causes small trauma and retains anterior tibial artery.It has a good success rate.The flap is thin that has a good appearance.
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Objective To explore the origin of the regenerating axons which grow into peroneal nerve after"?" fashion double end to side neurorrhaphy to tibial nerve Methods The right peroneal nerve of Wistar rat was cut about 5mm long segment off, the proximal and distal stumps of it were end to side coapted to the windows, opened by removing the epineual sheath on the tibial nerve trunk with 7～10mm distance At 18 months after the operation, the action potential(AP) between distal segment of peroneal nerve and proximal peroneal/or tibital/or sciatic nerve was tested Aftr that, the distal segment of peroneal nerve was removed and embed by resin, and semithin section and superthin section were observed by light or electronic microscope Results The morphological study clearly revealed that there were correspondent regenerating axons in the distal peroneal nerve segment, meanwhile the AP through the distal peroneal and proximal tibial/or peroneal nerve was measured clearly Conclusion "?" double end to side suturing to tibial nerve fashion neurorrhaphy can cause nerve regeneration from proximal tibial and or proximal peroneal to distal peroneal nerve