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Objective:To explore the anatomical and clinical effects of lateral-perineal approach in treating the fracture of inferior ramus of pubis-ischium ramus.Methods:The lateral approach of the perineum was simulated on 10 side of 5 intact wet adult cadavers to determine the surface symbols of incision design and to expose the operative field of the approach and to observe the anatomical characteristics of the perineal branch of the posterior femoral cutaneous nerve and the incision of the surgical approach. Five points were selected at the incision of the approach. The distance (L 1-L 5) between each point and the body surface projection of the perineal branch of the posterior femoral cutaneous nerve was measured. A total of 11 patients, including 5 males and 6 females with an average age of 41.55±14.32 years, ranging from 18 to 62 years, were treated by this approach in clinical practice. All patients had a reduction and fixation to the fracture of inferior ramus of pubis-ischium ramus. The operation duration, incision length, intraoperative blood loss and surgical complications were recorded. The quality of fracture reduction was evaluated according to Matta radiographic criteria. The strength of the adductor was measured. The pelvic function was evaluated according to Majeed Pelvic Score at the last follow-up. Results:Anatomical studies shown that the line between the two points. One point was 4 cm lateral to the level of the apex of the pubic arch. Another point was 4 cm from the ischial tubercle on the line from the ischial tuberosity to the point that 4 cm lateral to the level of the apex of the pubic arch was the axis of the approach lateral of the perineum. Anatomical studies showed that the lateral-perineal approach could expose the range from pubic symphysis to sciatic tuberculum. The distance between the points selected at the incision of the approach and the body surface projection of the perineal branch of the posterior femoral cutaneous nerve: L 1 was 19.40±1.17 mm, ranging from 18 to 21 mm; L 2 was 16.60±2.76 mm, ranging from 10 to 20 mm; L 3 was 18.30±1.89 mm, ranging from 16 to 21 mm; L 4 was 19.20±1.93 mm, ranging from 16 to 22 mm; L 5 was 14.70±1.83 mm, ranging from 13 to 18 mm. All patients were followed up for 17.91±4.09 months, ranging from 13 to 26 months. The incision length was 8.18±0.98 cm, ranging from 7 to 10 cm. The operation duration was 59.64±12.17 min, ranging from 43 to 85 min. The intraoperative blood loss was 100 ml, ranging from 50 to 130 ml. All incisions were healed in all patients. The fractures were healed in 13.36±2.06 weeks, ranging from 10 to 16 weeks. According to Matta radiographic criteria, the quality of fracture reduction was excellent in 6 cases, good in 4 cases and fair in 1 case. At the last follow-up, the adductor muscle strength reached grade 4 in 4 patients and grade 5 in 7 patients. Furthermore, according to the Majeed Pelvic Score, the score of every patient was 86.55±9.59, ranging from 66 to 100, and 8 cases were excellent, 3 cases were good at the last follow-up. The heterotopic ossification occurred in 2 patients, the pain during intercourse occurred in 2 patients. No patient had sensory disturbance or pain in the perineal area. Conclusion:A certain safe distance is between the lateral to the perineum and the perineal branch of the posterior femoral cutaneous nerve with limited risk of injuring posterior femoral cutaneous nerve via the lateral approach of the perineum. The advantages in treating the fracture of inferior ramus of pubis-ischium ramus by this approach have concealed incision, short operation duration and less bleeding with satisfied short-term clinical effects.
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Objective:To investigate the clinical efficacy of anterior approach combined with blocking plates and screws in the management of acetabular fracture involving the quadrilateral area.Methods:A retrospective case series analysis was performed for 16 patients with acetabular fracture involving the quadrilateral area admitted to First and Second Affiliated Hospital of Guangxi Medical University from January 2017 to January 2019. There were 12 males and 4 females，with the age of 21-66 years［（45.3±10.6）years］. According to Letournel-Judet classification，there were 9 patients with bi-column fracture，6 with anterior and posterior traverse fracture and 1 with anterior column fracture. A total of 9 patients were operated via the ilioinguinal approach and 7 via the lateral-rectus approach. Reduction and fixation of the pelvis and acetabulum were performed，using 3.5 mm cortical bone screws or plates to block the internal displacement of fracture in the quadrilateral body. The incision length，operation time and intraoperative blood loss were recorded. The quality of fracture reduction was assessed according to the Matta reduction criteria at postoperative 2 days and hip function by the modified Merle D'Aubigne-Postel score at postoperative 3 months and 12 months. Postoperative complications were observed.Results:All patients were followed up for 13-24 months［（16.1±2.9）months］. The ilioinguinal approach and lateral-rectus approach showed surgical incision of 12-26 cm［（18.6±4.0）cm］and 8-15 cm［（10.7±2.3）cm］，respectively. The operation time was 107-215 minutes［（159.2±27.8）minutes］and the intraoperative blood loss was 200-2，300 ml［（853.1±489.7）ml］. According to Matta reduction criteria，the results were excellent in 9 patients and good in 7. Three months after operation，the modified Merle D'Aubigne-Postel score was 11-18 points［（15.2±2.2）points］，which showed the results were excellent in 4 patients，good in 7，fair in 4 and poor in 1，with the excellent and good rate of 69%. Twelve months after operation，the modified Merle D'Aubigne-Postel score was 13-18 points［（16.9±1.4）points］，which showed the results were excellent in 7 patients，good in 8 and fair in 1，with the excellent and good rate of 94%. The liquefaction of post-surgical incision was seen in a patient，bladder injury in a patient，lateral femoral cutaneous nerve injury in a patient，and heterotopic ossification in a patient. There was no loosening or breakage of the internal fixation.Conclusion:For acetabular fracture involving the quadrilateral area，anterior approach combined with blocking plates and screws can prevent the displacement of quadrilateral fracture and attain satisfactory reductiongood hip function recovery and few complications.
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Extremity compartment syndrome can cause neuromuscular ischemia and deposition of metabolites in the compartment,leading to irreversible lesions which harm limb functions in the end.It is a great challenge for surgeons to make a timely and accurate diagnosis of the syndrome in adults and children.The key is evaluation of the clinical symptoms and intracompartmental pressure.In this paper we summarize the epidemiology,etiology,pathophysiology,and current diagnosis and treatment of acute extremity compartment syndrome of the upper and lower extremities in adults and children.
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BACKGROUND:Recently, the clinical repair methods of irregular wound on fingers primarily include local pedicled flap and free mini-flap of upper extremities or lower extremities. OBJECTIVE:To discuss the application of free mini-flap derived from upper limb in repairing the wound on fingers. METHODS:From December 2010 to February 2014, 12 patients with irregular wounds on 12 fingers were selected from Department of Traumatic Orthopaedics and Hand Surgery, First Affiliated Hospital of Guangxi Medical University, China. The size of wounds ranged from 1.5 cm × 2.0 cm to 3.0 cm × 4.5 cm with different degrees of bone or tendon exposure. After the debridement, 12 patients were treated by free mini-flaps of upper limb. The donor sites were directly sutured. RESULTS AND CONCLUSION:Among the 12 patients, al the wounds at recipient and donor sites were healed at stage I, and the free mini-flags survival completely. Al of patients were fol owed up for 3-6 months (average 4.5 months). Free mini-flags had good appearance and needn’t undergo secondary trimming. The active motion of fingers was improved dominantly. According to the criteria of Hand Surgery Association Society of Chinese Medical Association Society for the function evaluation of upper limb, three cases were excellent, eight were good, and only one was bad. The excellent and good rate was 91%. Free mini-flaps of upper limb are an ideal method for repair of wounds on fingers. It has no injury to normal tissue in hands, donor site is very secluded, and the short-term curative effect is good.
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BACKGROUND:Bone marrow mesenchymal stem cells have particularly applied prospects in tissue engineering. However, the death of transplanted cells limits the tissue regeneration. To search a new drug of anti-free radicals and protecting bone marrow mesenchymal stem cells is of great significance. OBJECTIVE:To investigate the protective effects of mangiferin on bone marrow mesenchymal stem cells against hypoxia. METHODS:Rat bone marrow mesenchymal stem cells were cultured in vitro and hypoxia cellmodel was established by cobalt chloride. cells were divided into normal control group, hypoxia group (treated with cobalt chloride), and mangiferin groups (cobalt chloride+20, 40, 80, 160 μmol/L mangiferin). After 12 and 24 hours of hypoxia, superoxide dismutase, malondialdehyde, and catalase levels in the cellsupernatant were determined. After 3, 6, 12, 24 hours of hypoxia, reactive oxygen species change was detected in each group. RESULTS AND CONCLUSION:Mangiferin significantly improved the survival rate of bone marrow mesenchymal stem cells exposed to hypoxia, increased the intracellular superoxide dismutase and catalase activities, decreased intracellular malondialdehyde and reactive oxygen species levels, thereby effectively protecting bone marrow mesenchymal stem cells against hypoxia. These findings indicate that mangiferin has effective protection against hypoxia and strong antioxidant ability, and can significantly reduce oxidative damage.
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BACKGROUND:Osteofascial compartment syndrome is usual y due to application of external fixation for fracture treatment. Vaseline gauze is used to cover and compress the wound. Frequent dressing change induces infection and is harmful to wound drainage and tissue granulation, final y causing prolonged time of hospitalization and bad results. ＜br> OBJECTIVE:To investigate the clinical efficacy of Ilizarov external fixation combined with vacuum sealing drainage treatment for limb fractures with osteofascial compartment syndrome. ＜br> METHODS:A total of 32 patients with limb fractures with osteofascial compartment syndrome were randomly divided into two groups. Al patients adopted the same fasciotomy and drug treatment. In treatment group, the fracture was fixed with Ilizarov external fixation and the wound was covered with the vacuum sealing drainage dressing. In control group, the fractures were treated by unilateral external fixation and the wound was covered with the vaseline gauze. The fracture healing, clinical effects, hospitalization duration and costs between two groups were compared. ＜br> RESULTS AND CONCLUSION:In the treatment group, there were 10 cases of healing wel , 4 cases of muscle contracture and 2 cases of amputation. In the control group, there were 7 cases of healing wel , 6 cases of muscle contracture and 3 cases of amputation. No significant difference in clinical outcome measures was detected between the two groups. Fracture healing rate and costs were higher in the treatment group than in the control group (P＜0.05), but hospitalization duration, skin grafts and the incidence of infection were lower in the treatment group than in the control group (P＜0.05). Results suggested that on the basis of timely fasciotomy and decompression, Ilizarov external fixation combined with vacuum sealing drainage treatment for limb fractures with osteofascial compartment syndrome has a high limb salvage rate, which can effectively treat fractures, elevate the healing rate of fractures, reduce infection rate and skin grafting rate, shorten hospital stays. However, the hospitalization expense is higher.
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BACKGROUND:Hypoxic death limits application of cells in transplantation and tissue regeneration. OBJECTIVE:To investigate the protective effects of mangiferin on bone marrow-derived mesenchymal stem cells against hypoxia injury-induced apoptosis resulted from cobalt chloride. METHODS:Rat bone marrow-derived mesenchymal stem cells were in vitro cultured and hypoxia cellmodel was established by cobalt chloride. Model cells were treated with mangiferin. Protective effects of mangiferin were detected using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide;cellapoptosis and mitochondrial membrane potential were detected using flow cytometry. RESULTS AND CONCLUSION:Cobalt chloride significantly inhibited growth of bone marrow-derived mesenchymal stem cells in a dose-dependent manner. The apoptosis rate of cells was (42.49±3.96)%after treated with 200μmol/L cobalt chloride for 12 hours, (46.37±4.49)%after treated for 24 hours. With increasing concentration of mangiferin, apoptosis of bone marrow-derived mesenchymal stem cells in hypoxic model was gradual y reduced (P<0.01), indicating that mangiferin has a protective effect in a concentration-dependent manner on rat bone marrow-derived mesenchymal stem cells in hypoxic injury. Cobalt chloride can induce hypoxic model successful y in bone marrow-derived mesenchymal stem cells. There are some advantages of accurate dose control, no special equipment requirements, and easy operation. Mangiferin can effectively inhibit bone marrow-derived mesenchymal stem cells apoptosis under hypoxic injury.