Stabilization of dorsal intra-articular fragment in distal radius fracture after volar locking plate fixation / 中华创伤骨科杂志

Objective:To explore the risk factors that may affect the stabilization of dorsal intra-articular fragment in distal radius fracture after volar internal fixation.Methods:A retrospective analysis was performed of the patients with distal radius fracture who had been treated by volar internal fixation at Department of Traumatic Orthopedics, Tongji Hospital Affiliated to Tongji University from July 2016 to July 2020. After 3D reconstruction of their preoperative CT scans by software Mimics 20.0, 66 patients with a dorsal intra-articular fragment were screened out. They were 31 males and 35 females, aged from 23 to 78 years (average, 53.4 years). By the AO classification, there were 17 case of type C1, 22 cases of type C2, and 27 cases of type C3. The displacement of dorsal intra-articular fragment was judged by X-ray observation on postoperative day 2 and X-ray follow-up at the outpatient department. The 13 patients with displacement of dorsal intra-articular fragment>2 mm were assigned into a displacement group while the other 53 ones into a displacement-free group. The 2 groups were compared in terms of preoperative general data and anatomical data of the dorsal intra-articular fragment (total preoperative displacement, radius-ulnar length, dorsal-volar length, aspect ratio, proximal-distal length and volume) to analyze the correlations between them and displacement.Results:There was no significant difference in preoperative general data (age, gender, affected side, cause of injury or AO classification) between the 2 groups, showing comparability between groups ( P>0.05). All patients were followed up for 6 to 24 months (mean, 14 months) after surgery. There were no postoperative complications like neurovascular lesion or infection. None of the patients in the displacement group underwent revision surgery, and the fractures healed successfully during the postoperative follow-up. The total preoperative displacement in the displacement group was(10.0±1.3) mm, significantly larger than that in the displacement-free group [(7.8±1.5) mm]; the radius-ulnar length in the displacement group was (8.2±1.3) mm, significantly shorter than that in the displacement-free group [(10.8±2.3) mm]; the aspect ratio of the fragment in the displacement group was 1.2±0.2, significantly lower than that in the displacement-free group (1.4±0.2); the fragment volume in the displacement group was (690.5± 201.4) mm 3, significantly smaller than that in the displacement-free group [(995.8±295.0) mm 3]. There were significant differences in the above items between the 2 groups ( P<0.05). Conclusion:The total preoperative displacement, radius-ulnar length, aspect ratio and volume of a dorsal intra-articular fragment are important factors which may affect the displacement of the dorsal fragment after volar internal fixation.

Value of CT in the Discrimination of Fatal from Non-Fatal Stercoral Colitis

OBJECTIVE: Clinical presentation and physical signs may be unreliable in the diagnosis of stercoral colitis (SC). This study evaluates the value of computed tomography (CT) in distinguishing fatal from non-fatal SC. MATERIALS AND METHODS: Ten patients diagnosed as SC were obtained from inter-specialist conferences. Additional 13 patients with suspected SC were identified via the Radiology Information System (RIS). These patients were divided into two groups; fatal and non-fatal SCs. Their CT images are reviewed by two board-certified radiologists blinded to the clinical data and radiographic reports. RESULTS: SC occurred in older patients and displayed no gender predisposition. There was significant correlation between fatal SC and CT findings of dense mucosa (p = 0.017), perfusion defects (p = 0.026), ascites (p = 0.023), or abnormal gas (p = 0.033). The sensitivity, specificity, and accuracy of dense mucosa were 71%, 86%, and 81%, respectively. These figures were 75%, 79%, and 77% for perfusion defects; 75%, 80%, and 78% for ascites; and 50%, 93%, and 78% for abnormal gas, respectively. Each CT sign of mucosal sloughing and pericolonic abscess displayed high specificity of 100% and 93% for diagnosing fatal SC, respectively. However, this did not reach statistical significance in diagnosing fatal SC. CONCLUSION: CT appears to be valuable in discriminating fatal from non-fatal SC.

Bacterial infection distribution and drug sensitivity monitoring In patients with open extremity in-juries caused by Wenchuan earthquake / 中华创伤杂志

Objective To analyze results of bacterial infection distribution and drug sensitivity monitoring in 414 patients with open extremity injuries caused by Wenchuan earthquake so as to provide advices for guiding utility of antibiotics in treatment of patients injured in natural disasters. Methods Bacterial culture of wound secretion substance and drug sensitivity monitoring were done in 414 patients with open extremity injuries. Results There were 12 patients (2.9%) with G+ coccobacteria, 66 (15.9%) with G- bacillus, 2 (0.5%)with G+ bacillus, 6 (1.5%) with multiplicitas infection(5 with dual infection and I with triplication infection). Main pathogenic bacteria were as follows: (1)G+cocco- bacteria including Staphylococcus epidermidis, Staphylococcus aureus and anthropo-staphylococci ; (2) G- bacillus including Aerobacter cloacae, banmanii, escherichia co]i, aerugo pseudomonas, proteusvul- gaffs and Ewingella americana. (3)G+ bacillus including bacillus subtilis. The drugs with high sensi0tivi- ty to G+ coccobacteria included vancomycin, rifampin, levofloxacin and cidomycin, but those with low sensitivity to G+coccobacteria included penicillin, ampicillin and erythremycin. The drugs with high sen- sitivity to G- bacillus included imipenem, amikacin, levofloxaciu and tenebrimycin, but those with low sensitivity to G-bacillus included ampicillin and piperacillin. Conclusions Patients with open ex- tremity injuries caused by earthquake have rather high bacterial infection rate, involving many kinds of in- fection strains. Therefore, we should do bacterial culture and drug sensitivity monitoring of wound excre- tion substance as early as possible to guide rational use of antibiotics.

CT perfusion imaging in quantitative monitoring for tumour microvascular responses to anti-angiogenesis therapy in rabbits / 第三军医大学学报

Objective To investigate the value of CT perfusion imaging in quantitative monitoring on microcirculation hemodynamics,differences between tumor and normal tissues,differences between mass center and edge,and on tumour microvascular responses to anti-angiogenesis therapy. Methods Fifteen male New Zealand white rabbits were established to VX2 tumor-bearing model. The animals were divided into 2 groups,anti-angiogenesis therapy (n=11,TNP-470,20 to 30 mg/kg),and control (n=4). DEC-CT scanning (80 kV,120 mA,20 cm VOF) was performed at 1 week after tumor implantation,1 week after anti-angiogenesis therapy,and 2 week after anti-angiogenesis therapy. Perfusion parameters,including blood flow (BF),blood volume (BV),mean transit time (MTT),and permeability surface (PS) were calculated for tumor mass,tumor edge,tumor center and normal tissue. Results Significant differences of the average values were observed in BF,PS and MTT between tumor and normal tissue [149.32?30.99 vs 32.18?4.10 ml/(100 g?min),28.24?5.15 vs 11.88?0.71 ml/(100 g?min),2.79?0.66 vs 6.57?0.90 s,P