Treatment of open pelvic fractures with perineal laceration infection / 中华骨科杂志

ObjectiveTo evaluate the effect of external fixator,colostomy,repeated debridement and vacuum-assisted closure (VAC) to treat open pelvic fractures concomitant with perineal laceration and infection.MethodsA retrospective analysis was made about 8 cases of open pelvic fractures concomitant with perineal laceration and infection from February 2004 to January 2011.It includes 7 men and 1 woman,with the average age of 36.3 years(ranged from 22 to 59 years).Five cases were injured by traffic accident,2 cases were fall-down from height,and 1 case was crushed by weight.Fractures type according to Tile:3 cases were type B,5 cases were type C.All cases were type I according to Faringer classification.All patients were treated with external fixator according to the displacement of pelvic fractures,early colostomy,repeated debridement,and after infection be controlled,VAC was used to close wound and drainage.Results The eight cases of open pelvic fractures concomitant with perineal laceration and infection were followed up from 6 to 36 months,with the average of 16 months.The infection was healed in all patients,and the body temperature and blood routine got normal.The period from injury to wound closing was from 8 to 43 days,with the average time of 17 days.According to the Majeed evaluation system,the pelvic fractures healing was evaluated after treatment:2 cases were excellent; 3 cases were good; 2 cases were fair;,1 case was poor;,the good to excellent rate was 62.5％.ConclusionThe method of applying external fixator,colostomy,repeated debridement and VAC to treat open pelvic fractures concomitant with perineal laceration and infection is useful.The methods played an active role in controlling infection,reducing infection rates and mortality rates,and shortening the healing time.

Analysis of close reduction under the C-arm X-ray perspective for femoral neck fractures / 中华创伤骨科杂志

Objective To evaluate the actual displacement of a femoral neck fracture following close reduction under the C-arm X-ray perspective.Methods From June, 2006 to June, 2009, we managed 12 patients with femoral neck fracture by open reduction and internal fixation.They were 8 males and 4 females, aged from 23 to 65 (average, 42.3) years old.We tried close reduction of their fractures under the C-arm X-ray perspective before a temporary fixation.Next we performed open reduction, readjusted the fracture ends, and placed internal fixation.The actual displacement of the fracture measured after open reduction was carefully compared with the close reduction under the X-ray perspective.Results A substantial displacement was found after open reduction in 7 patients who had achieved anatomic reduction under the X-ray perspective.In the other 5 patients who presented with a slight displacement after close reduction under X-ray perspective, the actual displacements were larger than the X-ray observations but completely reduced after open reduction.The actual measurements after open reduction were significantly larger (3.21 ± 0.96 mm on average) in the anteroposterior displacement ( t = 11.540, P = 0.000), but insignificantly larger (0.58 ±0.93 mm on average) in the superior-inferior displacement ( t = 2.184, P = 0.346) than those after close reduction.Conclusions In general, anatomic reduction can not be achieved for a femoral neck fracture under the C-arm X-ray perspective.Consequently, open reduction may be better than close reduction in the treatment of femoral neck fracture in that improper reduction can block blood supply to the femoral neck and dissection of the capsula articularis coxae can improve blood supply as well as help decompression.

Treatment of deep wound infection with fibrin glue amikacin complex / 中华创伤杂志

Objective To discuss the efficiency of fibrin glue amikacin complex in controlling infection by observing the changes of leukocyte and neutrophilic granulocyte classifying counts after fibrin glue amikacin complex treated deep wound. Methods Clinical case-control study was used in the study. All patients were divided randomly into test group (100 patients) and control group (100 pa-tients), matched by wound location, wound size, time from injury to operation, combined injury and gen-eral antibiotics use to compare leukocyte and neutrophilic granulocyte classifying counts between both groups and observe possible toxic and side-effect in test group. Results Firstly, the test group and control group had the comparability in aspects of gender distribution, average age and injury mechanism (P >0.05). Secondly, there was statistical difference in classifying counts of leukocyte and neutrophilic granulocyte in the test group at different time points (P <0.05). The classifying counts of leukocyte and neutrophilic granalocyte peaked at 24 hours after operation, then decreased with treatment time and reached the lowest at 24 days after surgery or at day 1 before discharge. Thirdly, there existed statistical significance upon leukocyte counts in the test group and control group except for at day 1 after operation (P > 0.05), with lower counts in test group than control group. In aspect of neutrophil classifying counts, there was statistical significance (P < 0.05) at other time points in beth groups except for time points at days 1,2 and 12 (P >0.05). The test group had lower neutrophil classifying counts compared with con-trol group at different time points. Conclusion The fibrin glue amikacin complex has good clinical effort and high security, with no toxic or side effort in treatment of deep wound infection, and is worth clinical applicaiton.

Effect comparison of nonoperative and operative treatment of fracture of scapular neck / 中国医师进修杂志

Objective To explore the effective method for treatment of fracture of scapular neck.Methods A retrospective analysis of 40 patients with fractures of scapular neck was done.The patients were treated by operation or non-operation from August 1995 to August 2005.According to the degree of displacement,40 cases included 22 mild displaced fractures(≤10 mm,≤40°),and 18 severe displaced fractures (＞10 mm,＞40°),26 cases were non-operation and 14 cases by operation.Herscovici score was adopted.Results Forty patients were followed up for 1-3 years.Among 26 patients treated by non-operation,Herscovici score showed that 16 cases achieved the excellent result,2 cases good,3 cases fair and 5 cases poor.of 14 patients treated by operation,Herscovici score showed that 12 cases achieved the excellent result,2 cases good. Conclusion Fractures of scapular neck with mild displacement can be treated by non-operation while fractures of scapular with severe displacement or associated with ipsilateral clavical fractures should be treated by operation to reconstruct the stabihty of shoulder and minimize the complications.

Assessment of left ventricular function in healthy subjects by pusled wave Doppler tissue imaging / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To examine the clinical application of pulsed Doppler tissue imaging (DTI) for regional left ventricular function assessment in normal subjects.</p><p><b>METHODS</b>We examined 50 healthy subjects (range 12-42 years, mean age 28.3 +/- 6.9 years) using pulsed Doppler tissue imaging to characterize the diastolic and systolic velocity profiles of mitral annulus. Recordings were made along the long axis in the apical 4-chamber, 2-chamber, and long apical views of 6 sites (posterior-septum, lateral, anterior, inferior, anterior-septum, posterior) at the mitral annulus. Myocardial velocities were determined with use of variance F statistical analysis. Correlation analysis was employed to test the relationship between age and mitral annular velocities.</p><p><b>RESULTS</b>Both early diastolic and systolic velocities at the septum were lower than other sites. There were no differences in mitral annulus late diastolic velocities. Mean early diastolic and systolic velocities was negatively correlated with age.</p><p><b>CONCLUSIONS</b>Doppler tissue imaging can directly reflect regional left ventricular function.</p>

Treatment of Tibial Pilon Fracture by Minimally Invasive Percutaneous Plate Osteosynthesis / 昆明医科大学学报

Objective To study the methods and effect of minimally invasive percutaneous plate osteosynthesis(MIPPO) on tibial Pilon fracture.Methods 49 cases of tibial Pilon fracture hospitalized,23 cases(group A) with minimally invasive percutaneous plate osteosynthesis(MIPPO) by indirect reduction and 26 cases(group B) with open restoration internal fixation by prospective contrast investigation.Results Compared with group B,the amount of blood loss and complications in group A markedly decreased,the healing of fracture was faster,the functional rehabilitation of ankle joint was more satisfactory.Conclusion Minimally invasive percutaneous plate osteosynthesis(MIPPO)on tibial Pilon fracture can meet the requirements of biological osteosynthesis,degrade soft tissue operation injury,be beneficial to fracture healing and functional rehabilitation of ankle joint.MIPPO is a safe and effective technique of tibial Pilon fracture.