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Objective:To explore the morphology of coronoid process fracture in terrible triad injury based on Adams classification.Methods:A retrospective cross-sectional study was used to analyze the three-dimensional CT data of 51 patients with terrible trind injury treated at First Affiliated Hospital of Fujian Medical University from January 2013 to August 2021, including 33 males and 18 females, aged 18-88 years [(44.7±12.0)years]. The model of ulna coronoid process fracture was established by three-dimensional CT reconstruction technology and was classified according to Adams coronoid process fracture classification. Type I was the coronoid process tip fracture, type II the coronoid process transverse fracture, type III the base fracture of the coronoid process, type IV anterior internal fracture the anteromedial oblique fracture of the coronoid process, and type IV anterior external fracture the anterolateral oblique fracture of the coronoid process. According to the characteristics of the coronoid fracture fragment, type IV anterior external fracture was divided into two subtypes: α subtype involving the coronoid tip and β subtype without involving the coronoid tip. Then, the proportion, height, surface area and volume of different types of coronoid fractures were measured. The proportion, height, surface area and volume of fracture fragments of two subtypes of type IV anterior external fracture were measured, as well as the area of ulnar trochlear joint, area of trochlear joint of ulnar fracture fragment, proportion of the area of trochlear joint affected by the ulnar fragment, area of proximal radioulnar joint, area of proximal radioulnar joint of ulnar fracture fragment and proportion of the area of proximal radioulnar joint affected by the ulnar fragment.Results:Among the patients with terrible triad injury, the ulnar coronoid process fracture was Adams type I in 17 patients (33%), type II in 4 (8%), type III in 4 (8%), type IV anterior internal fracture in 4 (8%) and type IV anterior external fracture in 22 (43%). The height of fracture fragment of type I, type II, type III, type IV anterior internal fracture and type IV anterior external fracture was (3.7±1.9)mm, (10.8±1.1)mm, (14.4±1.2)mm, (5.2±2.4)mm and (6.7±2.6)mm, respectively; the surface area was 63.7(21.4, 221.0)mm 2, 1 086.8(606.8, 1 434.2)mm 2, 1 658.8(1 335.6, 1 695.4)mm 2, 437.3(185.6, 437.3)mm 2 and 511.8(198.8, 646.5)mm 2, respectively; the volume was 46.3(21.4, 180.5)mm 3, 938.7(629.8, 1 011.3)mm 3, 1 797.4(1 520.2, 1 903.7)mm 3, 429.3(138.1, 992.4)mm 3 and 461.9(144.9, 707.1)mm 3, respectively. There were significant differences in the height, surface area and volume of coronoid process fracture with different Adams classification (all P<0.01). Among 22 patients with type IV anterior external fracture, 12 patients were with α subtype and 10 with β subtype. The fracture height of α and β subtypes was (8.6±2.6)mm and (5.0±2.4)mm, respectively; the surface area was 633.2 (530.3, 727.4)mm 2 and 181.4 (136.7, 450.3)mm 2, respectively; the volume was 692.8 (477.6, 778.0)mm 3 and 128.0 (74.2, 405.1)mm 3, respectively. The height, surface area and volume of fracture fragment were significantly different between the two subtypes (all P<0.01). The area of ulnar trochlear joint of α and β subtypes were 901.4(755.1, 1 060.6)mm 2 and 835.2(767.7,909.3)mm 2, respectively; the area of trochlear joint of α and β subtype fragment was 104.1(79.4, 139.9)mm 2 and 38.8(21.3, 58.1)mm 2, respectively; the proportion of the area of trochlear joint affected by α and β subtype fragment was 0.12(0.09, 0.15) and 0.05(0.03, 0.07), respectively. There was no significant difference between α and β subtypes in the area of trochlear joint of ulna ( P>0.05), but the area of trochlear joint of α subtype fragment and proportion of the area of trochlear joint affected by α subtype fragment were higher than those of β subtype fragment (all P<0.01). The area of proxima radioulnar joint of α and β subtypes was 147.9(111.7,164.2)mm 2 and 137.0(118.7,166.7)mm 2, respectively; the area of proximal radioulnar joint of α and β subtypes fragment was 17.7(13.4, 52.2)mm 2 and 6.1(2.6, 20.0)mm 2, respectively; the proportion of the area of proximal radioulnar joint affected by α and β subtypes fragment was 0.12(0.10, 0.35) and 0.05(0.03, 0.15), respectively. There were no significant differences between the two subtypes in proximal radioulnar joint damage (all P>0.05). Conclusions:Adams type IV fracture of the coronoid process of the ulna occupies a large proportion in terrible triad injury, and the type IV anterior external fracture is the main type containing two subtypes with differences in fragment size and shape. However, the injuries to the proximal radioulnar joint surface are similar for the two subtypes, so the injuries of type IV anterior external fracture with different sizes to the proximal radioulnar joint surface should not be neglected in clinical treatment.
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Objective:To analyze the types of ulnar coronoid process fractures in terrible triad injury (TTI) using three coronoid fracture classification systems and to explore the characteristics of coronoid process fractures and compare the reliability of different coronoid process fractures classification systems in TTI.Methods:A retrospective case series study was used to analyze the CT data of 43 patients with typical TTI admitted to First Affiliated Hospital of Fujian Medical University from January 2013 to October 2020. There were 26 males and 17 females, aged from 18 to 88 years [(41.8±15.6)years]. An independent three-dimensional model of the proximal ulna was established using the CT three-dimensional reconstruction technology. The characteristics of the coronoid process fractures were observed. The Regan-Morrey classification, O'Driscoll classification and Adams classification were used to classify the ulnar coronoid process fractures. The reliability of the three classification systems of coronoid fractures was analyzed.Results:The fracture line of the coronoid process was mostly located anterolaterally. Among all patients with ulnar coronoid fractures, there were 17 patients (40%) with type I, 19 (44%) with type II and 7(16%) with type III according to Regan-Morrey classification; there were 34 patients (79%) with type I, 2(5%) with type II and 7(16%) with type III according to O'Driscoll classification; there were 12 patients (28%) with type I, 3(7%) with type II, 7(16%) with type III, 18(42%) with type IV AL and 2(5%) with type IV AM according to Adams classification. Through reliability analysis, the Kappa coefficients of the inter-observer and intra-observer 1, 2, 3 of Regan-Morrey classification were 0.752, 0.813, 0.772 and 0.703, respectively; the Kappa coefficients of the inter-observer and intra-observer 1, 2, 3 of O'Driscoll classification were 0.797, 0.774, 0.837 and 0.775, respectively; the Kappa coefficients of the inter-observer and intra-observer 1, 2, 3 of Adams classification were 0.805, 0.835, 0.837 and 0.875, respectively.Conclusions:Most of the coronoid process fractures locate anterolaterally in TTI. Compared with Regan-Morrey classification and O'Driscoll classification, the reliability of Adams classification is best. Adams classification further subdivides the anterolateral fractures of the coronoid process, which may be more suitable in evaluating the classification of ulnar coronoid process fractures in TTI.
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Objective:To investigate the clinical outcome of extended Carlson approach to plate fixation of tibial plateau fracture with combined posterolateral and anterolateral fragments.Methods:A retrospective case series study was made on 16 patients with tibial plateau fracture with combined posterolateral and anterolateral fragments admitted to First Affiliated Hospital of Fujian Medical University from January 2015 to September 2019. There were 10 males and 6 females, with age of (35.2±4.3)years (range, 22-59 years). According to the Schatzker fracture classification, type II was found in 10 patients, type III in 4, type V in 1 and type VI in 1. Two-column fractures were found in 14 patients and three-column fracture in 2 patients. All patients were treated by plate fixation through the extended Carlson approach. The anterior-posterior X-ray and 3D reconstruction CT scan test were taken at every 3 months after operation to assess fracture healing and posterior tilt angle of lateral tibial plateau. The Rasmussen knee function score was performed 12 months after operation. Complications were detected as well.Results:All patients were followed up for 13-38 months [(18.3±4.6)months]. All patients showed bone healing. At postoperative 12 months, the posterior tilt angle of lateral tibial plateau was reduced to (11.5±4.7)°, compared to preoperative (28.9±3.2)° ( P<0.05). At postoperative 12 months, the Rasmussen score was (25.8±1.1)points compared with preoperative (13.1±3.8)points ( P<0.05), and the results were excellent in 9 patients (56%), good in 6 (37%), and fair in 1 (6%), with the excellent-good rate of 94%. No complications were observed, such as skin necrosis, surgical site infection, internal fixator exposure or osteomyelitis. Conclusion:For tibial plateau fracture with combined posterolateral and anterolateral fragments, plate fixation via the extended Carlson approach is effective to reduce and fix the fracture, decrease the posterior tilt angle of lateral tibial plateau and improve the recovery of postoperative knee function, with no neurovascular injury complications.
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BACKGROUND:Currently, buccal tubes are mostly preferred rather than molar bands to control posterior tooth movement. However, the buccal tube is difficult to bind the molar because of its position. Meanwhile, due to the relatively large masticatory forces on the posterior tooth, the buccal tube is easier to drop off. OBJECTIVE: To investigate the clinical effects of two kinds of adhesives bonding the buccal tube. METHODS:Sixty orthodontic patients were selected randomly. The right side of the upper and lower first molars of each patient was bonded by 3M TransbondTM light-cured resin binder, and the left side of the upper and lower first molar of each patient was bonded by 3M chemical curing adhesive. Cases of buccal tube shedding were recorded within 4 months. Meanwhile, 3M TransbondTM RESULTS AND CONCLUSION: The dropout rate of 3M Transbond light-cured resin binder and 3M chemical curing adhesive were used to bond the isolated human first molar, respectively. The normal oral environment and temperature were stimulated, and the shear bonding strength was measured after measured after 10 000 thermal cycles. TM light-cured resin binder and 3M chemical curing adhesive groups was 10.80% and 24.10% respectively, and there was a significant difference (P < 0.05). In vitro experiments confirmed that two kinds of adhesives could meet the clinical requirements, but 3M TransbondTM light-cured resin binder was better than 3M chemical curing adhesive. These findings indicate that compared with 3M chemical curing adhesive, 3M TransbondTM light-cured resin binder is more suitable for the binding between the molar and buccal tubes.
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Objective:To determine the expression of miR-17-92 cluster in osteosarcoma tissue samples and explore its associa-tion with clinical significance. Methods: Quantitative polymerase chain reactiom analysis was used to examine the expression of miR-17-92 cluster in osteosarcoma tissues. Normal bone tissues from 63 patients were matched, and the relationships between the ex-pression of miR-17-92 cluster and the clinicopathological features and prognosis of osteosarcoma were explored. Results:The relative expression of miR-17-92 cluster in osteosarcoma tissues was significantly higher than those in adjacent normal tissues (P<0.05). The high expression of miR-17-92 had a significant correlation with reduced survival (P=0.027). Conclusion:The expression of miR-17-92 cluster closely correlates with the occurrence and progress of osteosarcoma and may be used as an indicator for osteosarcoma prognosis.
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Objective:This study aims to investigate the protein expression of CD133, CD117, and Ki-67 in human osteosarcoma tissues and explore their relationships with the clinico-pathological features and risk of osteosarcoma. Methods:Immunohistochemical method was used to examine the protein expression of CD133, CD117, and Ki-67 gene in the paraffin specimens of 55 and 20 cases of osteosarcoma and osteochondroma, respectively. SPSS17.0 statistical software was used to explore the relationships among the expressions of CD133, CD117, and Ki-67 gene and the biological behavior and prognosis of osteosarcoma. Test criterion:P<0.05 was considered statistically significant. Results:The positive expression rates of CD133, CD117, and Ki-67 were significantly higher in the osteosarcoma tissues than in the benign osteochondroma tissues, and the differences were significant (P=0.016, P=0.008, and P<0.001, respectively). The mean survival and metastasis time were shorter in the CD133 or Ki-67 positively expressed osteosarcoma patients than in those with CD133 or Ki-67 negatively expressed osteosarcoma. The differences were significant (P<0.05). The expression of CD133 and Ki-67, surgical staging, and distal metastasis were relevant to the prognosis of osteosarcoma patients. The expression of CD133 and distal metastasis are the independent risk factors that affect the prognosis of these patients. Conclusion:The positive expressions of CD133 and Ki-67 closely correlated with the occurrence and progression of osteosarcoma, and may be used as an indicator for prognosis of the cancer.
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Objective To discuss the anatomy,manufacture,merit and demerit of dorsum pedis flap based on anatomic observation and comprehension using free dorsum pedis flap to repair the coloboma of oromaxillo-facial region soft tissue.Methods The courser and disposition of the skin blood vessel and nerve of dorsum of foot of 22 sides of adult cadaver lower limbs were dissected and observed under naked eye and operation microscope. 2 cases got troubled with oromaxillo-facial region malignant tumor,who were prepared 9.5 cm?7.5 cm and 8 cm?6 cm size of free dorsum pedis flap. The site of blood supply and recipient was anastomosed by blood vessel and nerve,and the coloboma of soft tissue was primary repaired after the operation of oromaxillo-facial region malignant tumor. Results Blood circulation of dorsum pedis flap was provided by dorsalis pedis artery,great saphenous vein and small saphenous vein,and fibular nerve was sensory nerve. During two years of follow-up visit,the two cases whose skin flaps were take were satisfactory with the reparation,and tumor recurrence did not take place. Conclusion The blood supply of free dorsum pedis flap is reliable,and it can become ideal skin flap to repair the soft tissue coloboma of oromaxillo-facial region.