Arthroscopic minimally invasive reduction for talus posterior process fractures / 中华创伤骨科杂志

Objective:To evaluate the efficacy of arthroscopic minimally invasive reduction in the treatment of talus posterior process fractures.Methods:The clinical data were retrospectively studied of the 42 patients with talus posterior process fracture who had been admitted to Department of Orthopedics, The Fourth Hospital of Wuhan from January 2010 to June 2021. There were 25 males and 17 females, aged from 21 to 60 years (average, 40.5 years). They were assigned into 2 groups according to their different treatments. In the arthroscopic group of 15 cases, arthroscopic reduction and internal fixation (ARIF) were conducted via the posteromedial and posterolateral approaches; in the open reduction group of 27 cases, open reduction and internal fixation (ORIF) were conducted via the posteromedial para-Achilles approach. The 2 groups were compared in terms of operation time, blood loss, hospital stay, fracture clinical healing time, postoperative complications, and the American Society for Foot and Ankle Surgery (AOFAS) ankle-hindfoot score at one year postoperation.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P> 0.05). The arthroscopic group incurred significantly less blood loss [(32.0±11.5) mL], hospital stay [(5.3±1.8) d], and fracture clinical healing time [(4.6±1.0) months], and a significantly lower incidence of postoperative complications [20.0% (3/15)] than the open reduction group did [(80.0±15.2) mL, (8.4±2.4) d, (6.3±2.2) months, and 29.6% (8/27)], but significantly longer operation time [(74.0±8.9) min] than the open reduction group [(62.9±5.1) min] ( P<0.05). The AOFAS ankle-hindfoot scores at one year postoperation in both groups were higher than those before operation. The AOFAS ankle-hindfoot scores in the arthroscopic group [(83.0±13.0) points] were significantly higher than those in the open reduction group [(72.3±16.0) points] ( P<0.05). Conclusion:ARIF is a preferred minimally invasive treatment for talus posterior process fractures, because it leads to a smaller incision, less blood loss, shorter hospital stay, quicker clinical healing, a lower incidence of postoperative complications, and better functional improvement of the ankle and hindfoot than ORIF.

Treatment of Gustilo ⅢC open tibiofibular fractures by microsurgery combined with Ilizarov technique / 中华创伤骨科杂志

Objective:To explore the clinical efficacy of microsurgery combined with Ilizarov technique in the treatment of Gustilo ⅢC open tibiofibular fractures.Methods:From January 2014 to December 2016, 20 patients with Gustilo ⅢC open tibiofibular fracture were treated at Department of Hand Surgery 2, Repair and Reconstruction, Wuhan NO. 4 Hospital, Wuhan Puai Hospital. They were 13 men and 7 women, aged from 36 to 56 years (average, 42.6 years). The time from injury to operation ranged from 2 to 6 hours (average, 4.3 hours). The defects were at the proximal bone in 6 cases, at the middle bone in 9 cases and at the distal bone in 5 cases. The area of soft tissue defect ranged from 10 cm×6 cm to 12 cm×9 cm, and the lengths of bone defects averaged 10.3 cm. Microsurgery was conducted at the first stage to repair blood vessels and nerves and to reconstruct blood circulation, and an Ilizarov circular external fixator was installed at the second stage to repair bone and soft tissue defects by two-way bone transport. Bone transport time, wound healing time, bone transport distance, external fixation time, external fixation index, solidification time for the extended area and complications were recorded after operation. The curative efficacy was evaluated by Palay evaluation.Results:All patients were followed up for 12 to 30 months (average, 24 months). After the bone and soft tissue defects were well repaired, all the patients returned to daily life. The time from bone transport to apposition of fracture ends ranged from 50 to 160 days, averaging 75.8 days; the wound healing time ranged from 60 to 150 days, averaging 100.6 days; the bone transport distance ranged from 8 to 13 cm, averaging 10.3 cm; the external fixation time ranged from 12 to 20 months, averaging 14.0 months; the external fixation index was 1.6 months/cm; the solidification time for the extended area ranged from 5 to 16 months, averaging 10.9 months. No infection, malunion or re-fracture was observed; postoperative axis deviation was observed in 2 cases and ankle stiffness in 3 cases. According to the Palay evaluation, 5 cases were excellent, 12 cases good, and 3 cases fair.Conclusion:As microsurgery combined with Ilizarov technique can treat Gustilo ⅢC open tibiofibular fractures effectively by reconstructing limb blood circulation, it is worthy of clinical promotion.

Primary shortening plus secondary lengthening for Gustilo ⅢC open fractures in the lower limb / 中华创伤骨科杂志

Objective:To evaluate the treatment strategy of primary shortening plus secondary lengthening for Gustilo ⅢC open fractures in the lower limb.Methods:From January 2010 to January 2018, 12 patients (8 males and 4 females) with complex Gustilo ⅢC open fracture in the lower limb received emergency treatment at Department of Orthopaedic Surgery, Wuhan Fourth Hospital. Their ages ranged from 22 to 67 years (average, 41.2 years). All patients were complicated with bone and soft tissue defects associated with nerve and vascular injury in the lower limb. The sizes of soft tissue defects ranged from 4 cm × 2 cm to 17 cm × 12 cm; the main arteries were shortened after debridement by an average of 4.2 cm (from 1.2 cm to 8.3 cm); the broken nerves were shortened after debridement by an average of 4.0 cm (from 1.0 cm to 8.1 cm); the tibial shaft defects averaged 6.3 cm in length (from 2.0 to 9.6 cm). All cases were treated at the first stage by emergency debridement and shortening at the fracture site to directly repair the damaged bone, blood vessels and nerves before the wound was covered. After the limb survived and the wound completely healed, an Ilizarov external fixator was installed to lengthen the limb by bone transport. Recorded were speed of bone lengthening, time with external fixation and complications. The lower limb functions were evaluated at the last follow-up by Paley criteria.Results:The 12 patients were followed up for 14 to 32 months (average, 19.1 months). All the limbs survived with no serious infection. The shortening ranged from 2.0 to 8.2 cm (average, 3.6 cm); the mean speed of bone transport was 0.87 mm/day; the time with external fixation ranged from 11 to 16 months (average, 13.2 months); the bony union was achieved after 10 to 14 months (average, 11.2 months). Postoperative horseshoe inversion was reported in 7 patients, and needle tract infection below Dahl grade 3 in 2 cases. According to Paley criteria, the function of lower limb was rated as excellent in 8 cases, as good in 3 cases, and as fair in one.Conclusion:The treatment strategy of primary shortening plus secondary lengthening using Ilizarov technique has lowered the risk for limb salvage and the surgical difficulty, leading to fine clinical outcomes.

Arthroscopic repair of chronic ankle instability: preliminary results / 中华创伤骨科杂志

Objective To evaluate the efficacy of arthroscopic Brostr(o)m technique in the treatment of chronic ankle instability.Methods Seventeen patients with chronic ankle instability were treated at Department of Foot and Ankle Surgery,Wuhan Fourth Hospital from March to December 2016.They were 5 males and 12 females,aged from 18 to 52 years (mean,28 years).The ankle instability confirmed preoperatively involved the left side in 9 cases and the right side in 8 ones.Arthroscopic Brostr(o)m technique was used to repair the anterior talofibular ligament.All the patients were evaluated preoperatively and at the last follow-up using American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS).The talar tilt angle and anterior translation were also assessed radiographically in pre-and postoperative ankle stress views.Results They obtained a mean follow-up of 12 months (range,from 10 to 18 months).Wound infection occurred in none of the patients;paresthesia appeared in the superficial fibular nerve area in one case which was recovered spontaneously.At the last follow-up,their AOFAS scores were improved from preoperative 47.5 ± 3.4 to 95.7 ± 2.1,VAS pain scores were decreased from preoperative 5.7 ± 1.8 to 1.6 ± 1.4,anterior talar translation was reduced from preoperative 10.12 ± 3.23 mm to 4.02 ± 1.68 mm,and talar tilt angle decreased from 15.20° ± 3.43° to 6.02° ± 2.64°.All the above differences were statistically significant (P ＜ 0.05).Conclusion Arthroscopic Brostr(o)m technique may be considered as a valid option for treatment of chronic ankle instability,because it can well restore the stability of ankle joint and lead to satisfactory short-term results.

The strategy of diagnosis and treatment of endovascular graft exclusion in treating thoracic aortic dissection / 重庆医学

Objective To analyse the preoperative diagnose and treatment experience of applying endovascular graft exclusion (EVGE)curing thoracic aortic dissection(AD) ,thus provide experience of diagnose and treatment for cure AD in clinical .Methods Review the clinical data ,therapeutic measures and follow‐up results of 226 AD patients .All patients were treated by EVGE ,coun‐terchecked by DSA post‐operation and reviewed .Results CTA and MRA in the diagnosis of crevasse position coincidence rate was 96 .8% and 95 .2% respectively .One case failed ,the remaining 225 cases were successfully placed graft ,success rate was 99 .6% .It showed that 93 .8% (211/225) complete disappearance of the false lumen or remarkable decrease of the endoleak was noted on the angiograms after stent implantation .No severe procedure‐related complications and death was observed .Conclusion CTA and MRA are important for us to choose appropriate routes ,can be the first choice of pre‐operation examination .EVGE is small trauma , short recovery time and effective in curing AD .

A Study on the Relationship Between Self-esteem and Depression:Mediator Role of Rumination / 中国临床心理学杂志

Objective:To investigate the relationship of explicit self-esteem,implicit self-esteem,rumination and depression in a sample of adolescents.Methods:171 adolescents were investigated by Rosenberg Self-esteem Scale,CES-D,Ruminative Responses Scale and self-esteem IAT.Results:Pearson's correlation analysis showed a significant and negative relationship between explicit self-esteem and rumination (r=-0.394,P

Research on Relationship Between Self-esteem Structure and Mental Health / 中国临床心理学杂志

Objective: To explore the relationship between individual's self-esteem structure and mental health. Methods: 136 middle school students were tested with Rosenberg Self-esteem Scale(SES), Implicit Association Test(IAT), Adolescent Self-rating Life Events Checklist(ASLEC) and Mental Health Test-CR(MHT-CR). Results: Compared with implicit self-esteem, explicit self-esteem correlates moderately to mental health. Results of hierarchical multiple regression with metal health as the dependent variables showed that explicit self-esteem, negative life events, explicit self-esteem?implicit self-esteem interaction, implicit self-esteem?negative life events interaction, and explicit self-esteem?implicit self-esteem?negative life events interaction is significant. Conclusion: This research supports the view that implicit and explicit self-esteem are distinct mental structures. Individual's self-esteem structure affects the relationship between negative life events and mental health.

Relationship Between Social Support and Subjective Well-being: Mediator Role of Self-consistency and Congruence / 中国临床心理学杂志

Objective: To study the relationship between social support,self-consistency and congruence,and subjective well-being of university students.Methods: 360 college students were measured with SSRS,SCCS,SWLS and PANAS.Results: ①Correlation analysis showed that,social support,self-harmony,life satisfaction and positive effects correlated positively with each other(r=0.12~0.28,P