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Objective:To evaluate the biomechanical stability of our slot-designed compression bolt (SCB) combined with bilateral locking compression plates (LCPs) in the treatment of intra-articular distal femur fracture.Methods:In 24 adult male knee specimens treated with formalin, the femoral bony part was preserved to establish standard models of intra-articular distal femur fracture (AO type 33-C1). According to the random number table, the fracture models were divided into 2 equal groups: an experimental group ( n=12) subjected to fixation with one SCB combined with bilateral LCPs with 10 locking screws and a control group ( n=12) subjected to fixation with bilateral LCPs with 12 locking screws. In each model, a vertical ballast test was conducted to record the maximum axial displacement of the system and a horizontal torsion test to calculate the torsional stiffness of the system. When the loading pressure was 0-1,000 N in the biomechanical machine, structural abnormalities were observed in the 2 groups of models and the system maximum axial displacement and system torsional stiffness were compared between the 2 groups. Results:When the vertical ballast pressure was 400 N, 600 N, 800 N and 1,000 N, the maximum axial displacement of the system was, respectively, (0.14±0.01) mm, (0.25±0.01) mm, (0.41±0.02) mm and (0.63 ± 0.02) mm in the experimental group, and (0.15 ± 0.01) mm, (0.26 ± 0.01) mm, (0.46 ± 0.03) mm, and (0.67 ± 0.04) mm in the control group. Compared with the control group, the average maximum axial displacement in the experimental group decreased significantly under the axial pressure of 600-1,000 N ( P<0.05). When the horizontal torsion reached 5°, the torsional stiffness was, respectively, (2.00±0.12) Nm/° and (2.02±0.07) Nm/° in the experimental group and the control group, showing no significant difference between the 2 groups ( P>0.05). Conclusions:In the treatment of intra-articular distal femur fracture, compared with simple bilateral LCPs, our SCB combined with bilateral LCPs demonstrate similar torsional stability but better axial biomechanical stability. As our SCB has advantages of bilateral compression and minimal invasion in operation, it may be a new option for the reduction and compression treatment of intra-articular fractures.
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Objective:To understand and verify the biomechanical mechanism of tibial plateau Hoffa (coronal) fracture by simulating high-altitude falls and traffic injuries using knee joint specimens.Methods:Ten specimens of lower limb knee joint were used. They were from 6 males and 4 females, with an average age of 57.4 years (from 42 to 65 years). They were divided into 2 equal groups: one subjected to simulation of high-altitude falls (fall group) and the other to simulation of traffic injury (traffic injury group). After injury simulation, standard orthographic and lateral X-ray examinations and CT scans were performed of the knee joints in the extended position to observe whether there was a fracture, where the fracture occurred, and how the fracture line went.Results:A tibial plateau coronal fracture was successfully simulated in 6 cases, but not in the other 4 cases. The failure was attributed to femoral fractures and other types of tibial plateau fracture. In the 3 successful fractures simulated by high-altitude fall, the fracture line was located all on the posterior medial side, involving the posterior 1/3, 2/5, and 1/2 of the tibial plateau, respectively. The fracture line and the coronal plane formed angles of 21°, 19° and 12°, respectively. The fracture was not shown on X-ray film in one case which was a posterior medial fracture on CT. In the other 3 successful fractures simulated by traffic injury, the fracture line involved 1/6, 1/4 and 1/3 of the posterior tibial plateau, respectively. The angles between the fracture line and the coronal plane were 47°, 56° and 63°, respectively. One case showed no obvious fracture signs on the X-ray but a coronal fracture on CT.Conclusions:This study has confirmed for the first time that both high-altitude falls and traffic injuries can cause coronal fractures of the tibial plateau which vary significantly in the extent of involvement and morphology. X-rays are not sufficient to fully diagnose this type of fractures, suggesting that patients with a clear history of knee flexion or axial violence injury should be routinely scanned by CT to reduce risks of missed diagnosis and insufficient treatment.
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Objective:To compare and analyze the epidemiological characteristics of adult tibial plateau fractures in 5 provinces and cities in north China.Methods:Picture archiving and communication system (PACS) and medical record systems were used to search for clinical data of adult tibial plateau fractures which had been treated from 2010 to 2011 in 18 hospitals in 5 provinces and cities in north China (Beijing, Tianjing, Hebei Province, Shanxi Province and Inner Mongolia Autonomous Region). The patients included were divided into 14 age groups (one age group from 16 to 19 years, every 5 years as an age group from 20 to 79 years, and one age group ≥80 years). They were also divided into 2 groups according to the Schatzker classification, a simple fracture group (types Ⅰ-Ⅳ) and a complex fracture group (types Ⅴ-Ⅵ). The gender distribution, age distribution, and complexity of adult tibial plateau fractures were compared between the 5 provinces and cities.Results:A total of 2,845 patients were included, accounting for 1.8% (2,845/155,971) of all the adult fractures, 19.5% (2,845/14,569) of tibiofibular fractures and 29.1% (2,845/9,782) of intra-knee fractures at the same period. Their average age was 45.5 years, with the age group from 40 to 44 years accounting for the largest proportion. There were statistically significant differences between the 5 provinces and cities in north China in the male to female ratio ( P<0.05) but not in the age distribution ( P>0.05). In the age groups >44 years, the proportion of female patients increased gradually, reaching 70.0% (21/30) at the age group of ≥80 years, showing statistically significant differences between them ( P<0.001). There were significant differences between the simple and complex fracture groups in the gender and age distributions ( P<0.05), but not in the mean age at fracture ( P>0.05). The male patients in the simple and complex fracture groups showed a unimodal curve which peaked at the age group from 40 to 44 years. The female patients showed a unimodal curve which peaked at the age group from 55 to 59 years in the simple fracture group but lower bimodal curves which peaked at the age groups from 35 to 39 years and from 55 to 59 years in the complex fracture group. In both fracture groups, the proportion of female patients increased steadily with age beyond the age group from 40 to 44 years, showing significant differences by the linear trend test ( P<0.001). Conclusions:Tibial plateau fractures prevailed in both males and females between 40 and 44 years old. Simple and complex fractures showed different features in terms of gender and age.
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Hoffa fracture of tibial plateau is a special type of coronal fracture of tibial plateau, among which occult fracture accounts for a large proportion, resulting in missing diagnosis and delayed treatment. The current studies are all case reports, and the incidence, diagnostic protocol, injury characteristics and injury mechanism of Hoffa fracture have not been systematically studied. The commonly used classifications such as AO type, Schatzker type, three-column classification and comprehensive classification of tibial plateau cannot cover this type. In this study, a retrospective case series study was performed for the clinical data of 3 086 patients with tibial plateau fractures. There were 13 patients with Hoffa fracture of tibial plateau, and 23% of them were occult ones. The injury mechanism of this fracture was as follows: under the state of knee joint flexion, axial violence through femur concentrated on the posterior half of tibial plateau, with the knee joint in transient varus and pronation position, leading to the posteromedial coronal splitting fracture. According to the position and degree of fracture displacement involving the joint, the fracture was divided into three type: type I involving the articular surface of tibial plateau fracture less than 1/4, type II involving the articular surface of tibial plateau equal to or more than 1/4 and less than 1/2, type III involving the joint face equal to or more than 1/2. Each fracture type was divided into three subtypes, of which subtype A was non-displaced fracture, subtype B had articular surface displacement<2 mm, and subtype C had articular surface displacement≥2 mm. According to the classification characteristics, the treatment principles were proposed. The authors systematically summarized the Hoffa fracture of tibial plateau for the first time in aspects of the incidence, injury characteristics, injury mechanism, fracture classification and treatment principles, which is helpful to avoid missed diagnosis and improve treatment efficacy.
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Objective To evaluate the effect of health education combined with lung function test on smoking cessation in smoking sanitation workers. Methods Sixty-nine sanitation workers who smoke were divided into two groups by using the table of random number, routine group (n=35) and lung function test group (n=34). The routine group was given health education. According to the lung function, those in the lung function test group were divided into normal lung function group (19 cases) and abnomal lung function group (15 cases) who received both health education and lung function test. Success rate of smoking cessation and the relapse rate were compared at 2 and 6 months follow-up. Results At 2 and 6 months follow-up, the smoking cessation rates of routine group were [10(29%), 4(11%)], which were lower than those of the normal lung function group [7(37%), 3(16%)], the differences were not statistically significant (P>0.05). The smoking cessation rates of routine group were lower than those in abnormal lung function group[11 (73%), 10(67%)] (P<0.05). The smoking cessation rates of the normal lung function group were significantly lower than those of abnormal lung function group (P<0.05). The relapse rate of routine group[6(17%) and the normal lung function group[4(21%)]at 6 months follow-up were not significantly different. The relapse rate of the normal lung function group and that of abnormal lung function group were not significantly different. Conclusion Health education combined with lung function test could help smokers with abnormal lung function to give up smoking successfully.
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Objective To explore influence and variation of smoking and occupational exposure to air pollution on lung function.Methods Ninety eight sanitation staffs from Panyu District were divided into smoking and non-smoking sanitation groups; and all subject accepted the Chronic Obstructive Pulmonary Disease Assessment Test (CAT) scales,questionnaires,lung function test,and data statistical analysis.Healthy people accepted health examination from Guangzhou Panyu medical health center were used as the control group.Results (1) Forced expiratory volume in the first second (FEV1％),forced expiratory volume in the first second/ forced vital capacity(FEV1/FVC),maximal expiratory flow in 50％ vital capacity (FEF50％),maximal expiratory flow in 75％ vital capacity (FEF75％),maximal mid-expiratory flow (MMEF) of non-smoking sanitation group was significantly lower than non-smoking healthy group (P ＜ 0.01).(2) Abnormal rates of FEF50％,FEF75％,and MMEF of non-smoking sanitation group were significantly higher than non-smoking healthy group (P ＜ 0.01).(3) Abnormal rates of FEF50％,and FEF75％ of sanitation group were significantly higher than healthy group with or without smoking.(4) Abnormal rates of FEV1％ and FEV1/FVC did not have significant difference between non-smoking sanitation group and non-smoking healthy group,but had significant difference between non-smoking and smoking healthy groups.It means smoking and occupational exposure had different impacts on pulmonary function.(5)Moderate score of nonsmoking sanitation group and smoking healthy group were significantly higher than non-smoking healthy group by P =0.049 and P =0.001,respectively.Conclusions Occupational exposure to air pollution and smoking can lead to small airway damage,which was not as obvious as pulmonary function changes.It is necessary to regularly monitor lung function for sanitation staffs who risk occupational exposure to air pollution.Increasing physical exercise would benefit to improve sport lung endurance of the people in our country.
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Objective To evaluate the efficacy of endoscopic mucosal resection (EMR) for sub-pedicle or non gastrointestinal tract polyps in primary hospital.Methods Retrospectively analyzed the data of 43 patients of EMR from November 2011 to December 2013.Results In 43 patients,84 lesions were resected,2 cases of hemorrhage during EMR immediately,1 case delaying hemorrhage,no complications such as perforation or infection occurred.Length of operation time was (6.73 ± 1.24) min per focus,hospital stay was (5.50 ± 0.61) d,there was no recurrence in any patient by endoscope during a follow-up of 6-24 months.Conclusions The technique of EMR is simple,less trauma,no pain,fast recovery for patients.As long as selecting suitable patient,EMR can be carried out widely in primary hospital.
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AIM: To determine the contents of hesperidin and salvianolic acid B in Xiaopikang Capsule(Folium Citri reticulatae,Radix et Rhizoma Salviae miltiorrhizae,etc.) by HPLC. METHODS: The HPLC system consisted of Diamonsil C_(18) column(250 mm?4.6 mm,5 ?m), metanol-acetonitrile-formicacid-water(30∶10∶1∶59) mixture as mobile phase,detection wavelength at 284 nm,flow rate of 1.0 mL/min. RESULTS: The ca-(libration) curves of two ingredients were linear within the ranges of 0.22 ?g-2.2 ?g(r=0.999 6,hesperidin),(1.62 ?g-10.2 ?g)(r=0.999 9,salvianolic acid B),respectively.The average recoveries of hesperidin was(98.9%)(RSD=1.60%),salvianolic acid B for 99.02%(RSD=0.97%). CONCLUSION: The method is rapid,sensitive and accurate.