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Objective:To explore the clinical effects of arthroscopic treatment of intraarticular displaced fractures of the calcaneus in children.Methods:The clinical data were analyzed retrospectively of the 11 children who had been treated for intraarticular displaced fractures of the calcaneus at Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University from January 2015 to June 2018. They were 6 boys and 5 girls, aged from 8 to 12 years (average, 10.6 years) and involving the left foot in 7 cases and the right foot in 4. By the Sanders classification, there were 10 cases of type Ⅱ and one of type Ⅲ. Preoperative evaluation of the injury was conducted by X-ray examination and three-dimensional CT reconstruction of the calcaneus. After arthroscopic prying reduction, internal fixation with mere Kirschner wire was performed for 8 cases and internal fixation with Kirschner wire plus hollow screws for 3. The affected feet were fixated with plaster bracket or brace for one month after operation. The Kirschner wires were removed 4 to 6 weeks after operation when X-ray films revealed fracture union. The clinical effects were evaluated by anatomic recovery of the calcaneus in terms of preoperative and postoperative B?hler and Gissane angles and functional recovery of the calcaneus in terms of ankle-hindfoot scores of American Orthopedic Foot Ankle Society (AOFAS) scale.Results:All the 11 pediatric patients were followed up for 12 to 19 months (average, 14 months). No bone grafting was applied. Their operation time averaged 63 min (from 50 to 75 min). Their incisions healed at one stage without infection. All their fractures healed within 2 to 3 months without any delayed union or nonunion. The B?hler angle (28.4°±2.9°) and Gissane angle (125.6°±3.1°) at the final follow-up were significantly improved than the preoperative values (11.8°±5.4° and 138.8°±6.3°) ( P< 0.05). The AOFAS ankle-hindfoot scores were 89.6 points at the final follow-up. Conclusion:Arthroscopic percutaneous prying reduction combined with internal fixation with Kirschner wire and hollow screws can effectively reduce and fixate the intraarticular displaced fracture of the calcaneus in children, leading to limited surgical trauma and fine curative effects.
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BACKGROUND: Pilon fractures usually happened during severe injury, associated with compression and comminution of metaphysis and soft tissue injury and primary articular cartilage damage in varying degrees The treatment is difficult and the prognosis is relatively poor. OBJECTIVE: To explore the clinical effect of application of meta-plate and mini-plate internal fixation for the treatment of anterior comminuted coronal plane Pilon fractures. METHODS: From January 2013 to June 2017, 17 patients of closed anterior comminuted coronal plane Pilon fractures were admitted in Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University. There were 7 males and 10 females, aged from 24 to 62 years, with an average age of 41.3 years. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Preoperative CT scans and three-dimensional reconstruction confirmed that the main fracture line was in coronal plane and multiple fragments of distal tibial metaphysis were displaced obviously. According to Ruedi-Allgower classification, there were 3 cases of type and 14 cases of type III. Fracture fragments of articular surface were fixed with transverse metacarpophalangeal mini-plate and screws, and the distal tibial coronal fractures were fixed with anterior meta-plate. The ankle and hind foot score of the American Orthopaedic Foot and Ankle Society was used to evaluate the function after surgery. RESULTS AND CONCLUSION: (1) The 17 patients were followed up for 12 to 28 months. All incisions healed in the first stage without complications such as wound infection, skin necrosis, failure of internal fixation and neurovascular injury. Only one patient had redness on the edge of the incision after operation and healed after swelling reduction and dressing change. (2) Fractures healed within 3 to 6 months without delayed union or nonunion. (3) At the last follow-up, the American Orthopaedic Foot and Ankle Society ankle and hind foot score was excellent in 10 cases, good in 5 cases, and average in 2 cases. The excellent and good rate was 88%. (4) The application of transverse mini-plate and screws fixation can effectively support and fix the fracture fragments of articular surface. Combined with anterior meta-plate of distal tibia for the treatment of anterior comminuted coronal plane Pilon fractures can achieve good therapeutic effect, and strengthen biomechanical stability.
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Objective To report the therapeutic effects of transfer of flexor hallucis longus tendon on the treatment of obsolete Achilles tendon rupture with a defect greater than 5 cm.Methods The clinical data were retrospectively analyzed of the 39 patients with obsolete Achilles tendon rupture who had been treated at Department of Bone and Joint Surgery,Affiliated Hospital of Southwest Medical University from September 2010 to January 2017.They were 33 males and 6 females,aged from 15 to 46 years(average,31.6 years).All the defects of Achilles tendon were greater than 5 cm.The duration between injury and operation ranged from 5 to 32 weeks(mean,16 weeks).All the 39 patients underwent transfer of flexor hallucis longus tendon to reconstruct their Achilles tendons.The tendons were harvested using double incisions in 23 patients and using a single incision in 16.The functional recovery of the ankle was evaluated according to ankle-hindfood score of American Orthopaedic Foot and Ankle Society(AOFAS),Achilles tendon total rupture score(ATRS),visual analogue scale(VAS),dorsal extension and plantar flexion of the ankle and patient's satisfaction as well.Results Healing by the first intention was achieved in 38 cases.Delayed healing occurred in one patient due to wound infection.One patient had postoperative numbness in the medial plantar region which disappeared 3 months later with no special treatment.All the 39 patients were followed up for 24 to 91 months(mean,32 months).None of the tendons was re-ruptured during the follow-up.The AOFAS scores at postoperative 3 months,one year and last follow-up were significantly higher than the preoperative one(P<0.05);the postoperative VAS scores were significantly lower than the preoperative one(P<0.05);the postoperative ranges of dorsal extension and plantar flexion of the ankle were all significantly larger than the preoperative ranges(P<0.05).At the last follow-up,31 patients expressed great satisfaction,7 satisfaction,and one neutral attitude.Conclusion Reconstruction of the Achilles tendon with transfer of flexor hallucis longus tendon is an effective surgical option for obsolete rupture of Achilles tendon with a defect greater than 5 cm.
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Objective To investigate and analyze the surgical site infection rate,clinical characteristics,risk factors and pathogens in patients after type Ⅰ incision orthopedic foot and ankle surgery,which may provide a basis for preventing surgical site infection in foot and ankle surgery.Methods Patients undergoing type Ⅰ incision orthopedic foot and ankle surgery from Jun.2011 to Jun.2015 were investigated retrospectively.Clinical data of cases with surgical site infection were collected and analyzed.Incidence of surgical site infection,clinical features,risk factors and pathogen distribution were studied.Results Seven hundred and sixty-one patients were undergoing type Ⅰ incision orthopedic foot and ankle surgery,surgical site infection occurred in 42 patients with an infection rate of 5.5％.In terms of age,gender,anesthesia,smoking,drinking,rheumatoid arthritis,gout,number of incisions and recovery after open injuries,no significant difference of surgical site infection rate were found.Diabetes mellitus complicated with peripheral neuropathy increased the risk of surgical site infection compared with nondiabetic patients.Patients who had an operative time more than 3 hours had a greater risk of surgical site infection compared with those less than 1 hours.The presence of intra-operative implants increases the risk of surgical site infection compared with patients with external fixations or without implants.Conclusions Surgical site infection is a common complication for the patients after type Ⅰ incision orthopedic foot and ankle surgery.Diabetes mellitus complicated with peripheral neuropathy,long operation time and intra-operative implants may be the high risk factors for surgical site infection.
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BACKGROUND:Acellular nerve scaffolds have the three-dimensional structure of natural nerves and low immunogenicity,but their effect on long nerve defects is still not ideal.Therefore,it is necessary to construct tissueengineered nerve using acellular nerve and seed cells in order to improve the therapeutic effect.OBJECTIVE:To systemically review the efficacy of combination of acellular nerve grafts (ANGs) and mesenchymal stem cells (MSCs) or Schwann cells (SCs) transplantation in the treatment of sciatic nerve defects in a rat model.METHODS:Randomized controlled trials (RCTs) about the effects of combination of ANGs and MSCs or SCs transplantation for sciatic nerve defects in rats were searched in PubMed,The Cochrane Library,EMbase,CNKI,WanFang and VIP from inception to July 2016.Three reviewers independently screened literature according to the inclusion and exclusion criteria,extracted data,and assessed the risk of bias of included studies.Then,a Meta-analysis was performed using Review Manger5.3 software.RESULTS AND CONCLUSION:A total of 10 RCTs involving 252 rats were included.The results of meta-analysis showed that:compared with the control group (simple acellular nerve scaffold group),the sciatic functional index (SFI) of the combined group (combination of ANGs and MSCs or SCs transplantation) were superior at 2 weeks [SMD=2.73,95％ CI (1.92,3.45),P ＜ 0.000 01],4 weeks [SMD=4.57,95％ CI (3.43,5.70),P ＜ 0.000 01],6 weeks [SMD=1.62,95％CI (0.18,3.06),P=-0.03],8 weeks [SMD=4.90,95％ CI (2.96,6.84),P ＜ 0.000 01] after surgery.The nerve conduction velocity [SMD=1.39,95％ CI (0.99,1.78),P ＜ 0.000 01),latency period (MD=-0.98,95％ CI (-1.19,-0.76),P ＜ 0.000 01],and amplitude [SMD=1.23,95％ CI (0.62,1.85),P ＜ 0.000 1] were superior at 12 weeks after surgery.The myelin sheath thickness was superior at 8 weeks [MD=0.14,95％ CI (0.07,0.21),P ＜ 0.000 1],12 weeks [SMD=1.85,95％ CI (1.63,2.08),P ＜ 0.000 01] and the number of myelinated nerve fibers were superior at 12 weeks [SMD=3.59,95％CI (2.63,4.55),P ＜ 0.000 01] after surgery.The gastrocnemius wet weight was superior at 8 weeks after surgery [SMD=4.22,95％ CI (2.40,6.03),P ＜ 0.000 01].Current evidence indicates that the combination of ANGs and MSCs or SCs can promote the regeneration and functional recovery of the peripheral nerve.Due to the limited quality of the included studies,the above conclusion should be verified by conducting high-quality and large-scale RCTs.
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Objective To explore the effects of open reduction and internal fixation plus primary subtalar arthrodesis for the treatment of severely comminuted calcaneal fractures of Sanders type Ⅳ.Methods From January 2012 to December 2016,23 patients with severely comminuted calcaneal fracture of Sanders type Ⅳ were treated by open reduction and internal fixation plus primary subtalar arthrodesis at our department.They were 16 men and 7 women with an average age of 39.6 years (range,from 32 to 67 years).Auto-iliac bone graft was performed in 18 cases and allo-bone graft in the other 5 cases.B(o)hler and Gissane angles were measured preoperatively,postoperatively and at the last follow-up to evaluate anatomical morphology of the calcaneus;the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used to evaluate the functional recovery.Results All the 23 cases were followed up successfully for an average time of 21 months (range,from 6 to 39 months).The operations lasted from 40 to 100 minutes with an average of 60 minutes;the intraoperative bleeding ranged from 10 to 40 mL with an average of 20 mL.No one suffered from wound infection but partial epidermal necrosis happened in only one case.Union and fusion of the fractures was achieved after 3 to 5 months with an average of 3.5 months.At the last follow-up,no failed fusion of the subtalar joint happened.Anatomical morphology of the calcaneus was improved obviously.The B(o)hler angles were respectively 12.47° ± 1.61°,30.58° ± 5.34° and 30.09° ± 5.78° preoperatively,postoperatively and at the last follow-up;the Gissane angles were respectively 86.21° ±7.70°,127.44°± 7.61° and 129.07°± 5.47° preoperatively,postoperatively and at the last follow-up.There were significant differences between preoperation versus postoperation and the last follow-up in the above 2 values (P ＜ 0.05);there were no significant differences between postoperation and the last follow-up in the above 2 values (P ＞ 0.05).The AOFAS ankle-hindfoot scoring at the last follow-up showed 8 excellent,11 good and 4 fair cases,giving an excellent to good rate of 82.6％.Conclusion Open reduction and internal fixation plus primary subtalar arthrodesis is a safe alternative for the treatment of severely comminuted calcaneal fractures of Sanders type Ⅳ.
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The TGF-βsignaling pathway plays a crucial role in regulating cell proliferation, differentiation, and apoptosis. This pathway exerts either tumor-suppressing or tumor-promoting effects, which are cell-or context-dependent, making it simultaneously advanta-geous and disadvantageous in the process of carcinogenesis and tumor progression. Long non-coding RNAs (lncRNAs) do not encode proteins, but they are involved in the regulation of various signaling pathways and biological functions. Moreover, lncRNAs can induce tumor angiogenesis, as well as affect tumor proliferation, invasion, and metastasis by acting as oncogenes or tumor-suppressor genes. Recent studies revealed that some lncRNAs may be induced and regulated by TGF-βto form a complicated crosslinked regulatory net-work. This review focuses on the crosstalk between the TGF-βsignaling pathway and TGF-β-induced lncRNAs.