Treatment of calcaneal fractures with a super-cutaneous calcaneal locking plate / 中华创伤骨科杂志

Objective To study advantages and disadvantages of the super-cutaneous calcaneal locking plate in the treatment of calcaneal fractures. Methods Between October 2007 to June 2008, 12cases of calcaneal fracture were treated with a super-cutaneous calcaneal locking plate. According to the Sanders classification system, 8 cases were of type ⅡA, one case of type ⅡB, one case of type ⅡC, one case of type Ⅲ AC, and one case of type Ⅳ. All the cases were fresh fractures. The skin incision was made from the distal tip of the fibula to the base of the fourth metatarsal. In direct observation of the posterior facet and anterior tuberosity, the articular fragments were reduced anatomically. Then the reduced calcaneus was fixed by a super-cutaneous calcaneal locking plate. After bone union was confirmed 3 months after the operation by the CT scans and X-ray films, the super-cutaneous plates and screws were removed in clinic. Results The average time of follow-up was 16 months with a span from 12 to 20 months. There were no incision or pin-hole infections. The reduction of the articular surface and bone union were good. One type ⅡA developed lateral wall exostosis which resulted in peroneal tendonitis and stenosis followed by obvious walking pain. The preoperative X-ray films of the 12 patients showed that the average B(o)hler angle was 11.9°±9.4° and the Gissane angle 86. 8°± 7. 7°. Their postoperative X-ray files demonstrated that the B(o)hler angle was improved to 29. 4°± 7.0° and the Gissane angle to 115.8°± 7.7°, with a significant difference ( P ＜ 0. 01 ). According to the Ankle Hindfoot Clinical Rating System of the American Orthopaedic Foot and Ankle Society (AOFAS),their average score was 91 points (68 to 100 points). Conclusions Using a super-cutaneous calcaneal locking plate to treat calcaneal fractures can result in limited invasion, a low rate of skin infection, satisfactory reduction of the articular surface and stable fixation. Since the fixation can be removed without re-hospitalization, it is a cheaper and less painful alternative for the treatment of displaced intra-articular calcaneal fractures.

Systematic Review of Clinical Efficacy of Amlodipine in the Treatment of Variant Angina / 中国药房

OBJECTIVE:To evaluate the clinical efficacy of amlodipine in treatment of vasospastic angina systematically.METHODS:Literatures were retrieved from MEDLINE,EMBASE,CNKI,CBM and Wanfang database,etc.Data of literatures were analyzed using RevMan 4.2 software.RESULTS:3 RCTs were included in meta-analysis and 1 RCT was involved in descriptive analysis.Compared with diltiazem,amlodipine was similar to benidipine in reducing the incidence of cardiovascular events;there was no statistical significance[OR=0.79,95%CI(0.57,1.10),P=0.16].Effective rate of amlodipine was significantly higher than isosorbide dinitrate,there were statistical significance[OR=7.33,95%CI(1.47,36.66),P=0.02].Compared with placebo,amlodipine could reduce occurrence times of angina significantly.CONCLUSION:Amlodipine is effective in treatment of vasospastic angina and can reduce the incidence of cardiovascular events in patients with vasospastic angina.

Conservative management of supination-eversion fractures of ankle / 中华创伤骨科杂志

Objective To study middle-and-long-term results of the conservative management of the supination-eversion fractures of ankle. Methods A retrospective study was done for the 43 patients with supination-eversion fracture of ankle who were treated from February 1999 to August 2004 in our department, and followed up. Five patients belonged to stage Ⅰ , 10 to stage Ⅱ , none to stage Ⅲ and 28 to stage Ⅳ . The average duration of follow-up was 69 months (16 to 84 months). Results The middle-and-long-term results were graded according to the Ankle Hindfoot Clinical Rating System of the American Orthopaedic Foot & Ankle Society(AOFAS). Of the stageⅠ patients, five got satisfactory results. Of the stage Ⅱ patients, nine got satisfactory results and one unsatisfactory. Of the stage Ⅳ patients, 26 got satisfactory results and two unsatisfactory. Conclusions The middle-and-long-term follow-ups show that most of the supination-eversion fractures of ankle can be treated conservatively with a satisfactory result. Surgical treatment should be indicated for those whose conservative management cannot reach satisfactory results.

The study of 60 cases of adult fresh Monteggia fractures / 中华创伤骨科杂志

Objective To explore a better treatment of fresh Monteggia fracture and factors which lead to unsatisfactory results. Methods A retrospective study was done on 60 of the 114 patients with Monteggia fractures who had been treated from 1994 to 2004 in our hospital. According to Bado classification, 26 patients were type Ⅰ, 14 type Ⅱ, 19 type Ⅲ, and 1 type Ⅳ. All the cases received operation. Fixation included plates and screws, plates with tension band, with or without plaster to immobilize the limb after operation. For the fracture of the radial head, the radial head was totally or partially removed and fixated with screw or k-wire. Results 60 patients were followed up for an average of 2 years(1 to 6 years). The average score according to the system of Broberg and Morrey was 95 points (53 to 100 points). The result was excellent for 48 patients, good for 6, fair for 4 and poor for 2. Complications included heterotopic ossification, ulnohumeral osteoarthrosis, cross-union, nonunion, radial nerve injury and dysfunction of elbow joint and forearm. Conclusions Yong adults, especial males, tend to suffer this kind of low-energy injury. Anatomic reduction and rigid fixation is the key to satisfactory results. Heterotopic ossification, ulnohumeral osteoarthrosis are the major factors leading to unsatisfactory results.

Effects of CT scan on classification and treatment of tibial plateau fractures / 中华创伤骨科杂志

0.05). Conclusion Although it is expensive, CT scan should serve as a routine examination before operation because it has significant effects on treatment plan and classification of tibial plateau fractures.

T cell receptor Vbeta gene bias in rheumatoid arthritis / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To explore the pathogenesis of rheumatoid arthritis (RA) by studying the expression of T cell receptors (TCRs).</p><p><b>METHODS</b>T cell receptor Vbeta (TCR Vbeta) gene usage and expression were analyzed from synovial membrane and peripheral blood of 8 RA patients, 2 osteoarthritis patients and 2 accident amputees. The complementary determining region 3 (CDR3) of 25 TCR Vbeta subfamily genes in unselected T cell populations were amplified semi-quantitatively by reverse transcription-polymerase chain reaction (RT-PCR). The products were further studied by genescan for frequency of Vbeta usage.</p><p><b>RESULTS</b>The numbers of Vbeta subfamilies expressed by T cells from RA peripheral blood and synovial membrane were not significantly restricted. More importantly, biased Vbeta gene expression in RA synovium was observed and Vbeta6, Vbeta17, and Vbeta22 genes were the predominant subfamilies. It was noteworthy that the expression of Vbeta17 in RA synovium was significantly increased.</p><p><b>CONCLUSION</b>Our data were consistent with the hypothesis that several antigen or superantigen-driven processes may be involved in the pathogenesis of RA.</p>

The relationship between the classification of the Monteggia dislocation-fracture in adult and its prognosis / 中华骨科杂志

Objective To study the relationship between the Bado's classification of the Monteggia fracture in adult and their prognosis. Methods Studying the 60 patients in our hospital suffering from Monteggia fracture-dislocation during 10 years between 1994 to 2004, and their clinical data of the follow-up is analysised with statistics. There were 26 cases with Bado type Ⅰ fracture-dislocations, 14 cases with Bado type Ⅱ fracture-dislocations, 19 cases with Bado type Ⅲ and 1 case with Bado type Ⅳ fracture-dislocations. The fractures of the shaft of the ulna were treated operatively with open reduction and internal fixation using plates and screws. The fractures of the radial head were operated with open reduction and internal fixation, or are treated with the resection of the partial or total radial head. For the cases of the dislocation of the radial head without fracture, the most commonly used treatment method was to reduce the dislocation closely and stable the position with external fixation by a plaster cast. For the injury of the radial nerve associated with the Monteggia fracture dislocation, no operation had been done to make an exploration. Rank Sun Test of NoSA system was adopted to analysis the clinical data gained above. Results The average duration of the follow-up was 24 months (12-72 months). The results were graded according to the score system of Broberg and Morrey. In Bado type Ⅰ, 24 cases were considered satisfactory and 2 cases unsatisfactory, satisfactory ratio is 92%; In Bado type Ⅱ, 10 cases satisfactory and 4 cases unsatisfactory, satisfactory ratio was 71%; In Bado type Ⅲ and type Ⅳ, all the cases gained satisfactory results, satisfactory ratio was 100%. Rank Sun Test showed there was no obvious difference on prognosis between every group of the Bado's classification system. But statistical obvious difference could be found between the group with the fractures of the radial head and the group without. Conclusion The classification system of Bado has no prediction prognosis. In adult Monteggia fracture, the final result largely depends on whether there is a fracture of the radial head.