Application of monitoring phosphocreatine kinase continuously and dynamically in early diagnosis of compartment syndrome / 中国骨伤

<p><b>OBJECTIVE</b>To determine the efficacy of phosphocreatine kinase in the early diagnosis of compartment syndrome.</p><p><b>METHODS</b>Forty patients with compartment syndrome of limbs were reviewed from 2005 to 2008 including 34 males and 6 females with an average age of (37.03 +/- 13.02) years. Monitoring phosphocreatine kinase continuously and dynamically after injured 2, 24 hours, 1, 2, 3 and 4 weeks later. The concentration of CK were measured by using Japanese Olympus automatic biochemistry analysator. The muscle preparations from affected extremity were taken after operation and 1, 2, 3 weeks later for biopsy.</p><p><b>RESULTS</b>Two hours later after injury, the contents of CK increased sharply and the contents of CK were about 20 times more than the nomal. Twenty-four hours later, the contents of CK reached its maximum,the contents of CK were about 42 times more than the nomal. One week later, the contents of CK recovered to normal level. Pathological changes of muscle were irreversible.</p><p><b>CONCLUSION</b>The change of the contents of CK can reflect the progression of disease objectively. If it increased sharply, the chance of compartment syndrome was high. Monitored it dynamicly and continuously can provide assistant for early diagnosis of compartment syndrome and evaluating pathogenetic condition.</p>

Sagittal mobility study on the first tarsometatarsal joint in hallux valgus patients and its clinical values / 中华外科杂志

<p><b>OBJECTIVE</b>To study sagittal mobility about the FTJ (first tarsometatarsal joint) and its relationship with the pathophysiology and treatment of hallux valgus patients.</p><p><b>METHODS</b>According to Lee's method, FTJ sagittal mobility of 300 normal feet and 200 hallux valgus was measured, and its correlative factors were statistically analysed.</p><p><b>RESULTS</b>FTJ sagittal mobility of 300 normal feet was 8.4 degrees +/- 2.3 degrees , and that of 200 hallux valgus was 11.7 degrees +/- 3.2 degrees , the difference was significant. The normal range of FTJ sagittal mobility was less than 13 degrees . The sagittal overmotion of FTJ had relation to the anatomical configuration of FTJ (P < 0.05), intercuneiform splitting (P < 0.01), transferred pain under the second metatarsal head (P < 0.01), and FTJ osteoarthritis (P < 0.01) had no relation to HVA (hallux valgus angle), IMA (intermetatarsal angle), second metatarsus medial diaphyseal cortex hypertrophy (P > 0.05).</p><p><b>CONCLUSION</b>Lee's method is convenient and accurate. Both HVA and IMA can not represent the sagittal mobility measurement of FTJ, which should be routinely evaluated, especially for hallux valgus patients with type I FTJ. Lapidus procedure should be considered for patients with larger FTJ in combination with transferred pain under the second metatarsal head, intercuneiform splitting, FTJ osteoarthritis.</p>

Anatomical study about the posterior coaxial portals via posterior tibial tendon sheath for ankle arthroscopy / 中华外科杂志

<p><b>OBJECTIVE</b>To conduct the anatomical study about the posterior coaxial portals via posterior tibial tendon (PTT) sheath for ankle arthroscopy.</p><p><b>METHODS</b>Coaxial portals were established in 20 ankles by K-wires which were left in place for distance measurement between them and the posterior nerves, tendons and vessels. Ankle arthroscopy was performed in 5 fresh ankles using 2.7 mm 300 arthroscopy with the same portals as mentioned above. The maximum visible scope were recorded and the distance between the arthroscopy and the posterior nerves, tendons and vessels was also measured.</p><p><b>RESULTS</b>The medial portal was located 5 - 12 mm (average, 8 mm) above the tip of medial malleolus, and the lateral portal was located 8 - 24 mm (average, 15 mm) above the tip of lateral malleolus. The coaxial portals, which traversed the PTT sheath and passed posterior to the fibular, not only separated the arthroscopy and instrument from the posterior nerves, tendons and vessels by posterior capsule but also enlarged their distance. The medial and lateral malleolus articular gap, the posterior capsule could be viewed by these portals with as much as 1/2 - 2/3 posterior articular surface of talus. Not only the tibiotalar articular gap but also the dynamic movement between the mortise and the talus were clearly observed. Arthroscopic operation could be performed by instrument through the posterolateral portal.</p><p><b>CONCLUSIONS</b>The posterior coaxial portals via PTT sheath for ankle arthroscopy have such advantages as easy maneuverability, superior safety, clear vision and larger operation field under arthroscopy.</p>