Repair of soft tissue defect of digit-tip with single subcutaneous pedicle V-Y advancing flap combined with skin grafting / 中华显微外科杂志

Objective:To explore the surgical method and therapeutic effect of repairing soft tissue defect of digit-tip with single subcutaneous pedicle V-Y advancing flap combined with skin grafting.Methods:From August 2013 to December 2020, 25 soft tissue defects of digit-tip were repaired by a single subcutaneous pedicle V-Y advancing flap combined with pedicle skin grafting. The area of the defects was 0.8 cm× 0.8 cm to 1.6 cm× 1.4 cm. The flaps were harvested from palm or lateral side of the wound and the area of flap was 0.5 cm×1.0 cm to 0.8 cm×2.5 cm. In order to make the flap transfer to a further distance, the subcutaneous fibre connection of the flap was cut-off during the operation. At the same time, cut off 1 side of subcutaneous pedicle. Finally, the advanced distance of the flap reached 0.5-1.2 cm. After the flap harvested, the medium thickness skin was removed for graft to close the donor site from the wrist striations. After the surgery, follow-up visits were conducted regularly by outpatient clinic, or via telephone or WeChat review or by home visit. Throughout the follow-up, the flap appearance, sensation and recovery of the function of digital joint were observed, together with the patient satisfaction. Results:After the surgery, the postoperative follow-up lasted for 4 months to 8 years. All 25 flaps and skin grafts were survived in first stage wound healing. The flaps and skin grafting areas had excellent texture. The fingerprint had been reconstructed with good appearance. The TPD was 4-9 mm, the functions of digital joint recovered well, and there was no complain about a discomfort at the donor site. According to the evaluation standard of Michigan hand function questionnaire, all 25 patients were very satisfied with the overall appearance and function of the hand. According to Total Angle of Motion (TAM) evaluation standard, finger mobility was excellent in all 25 patients.Conclusion:Subcutaneous V-Y advancing flap combined with skin grafting is an ideal method for repairing soft tissue defect of digit-tip. The surgery characterises a simple flap cutting, less traumatic damage, long advancing distance of flap and good repair effect.

Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (version 2022) / 中华创伤杂志

Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.

Comparison of pedicle subtraction osteotomy or vertebroplasty combined with long segment fixation in treating nonunion of osteoporotic vertebral fractures with kyphosis / 中华创伤杂志

Objective:To compare the clinical efficacy of pedicle subtraction osteotomy (PSO) versus vertebroplasty (VP) combined with long segment fixation for nonunion of osteoporotic vertebral fractures with kyphosis.Methods:A retrospective cohort study was conducted to analyze the clinical data of 72 patients with nonunion of osteoporotic vertebral fractures with kyphosis admitted to Jiangnan Hospital affiliated to Zhejiang University of Traditional Chinese Medicine from January 2010 to December 2017. There were 16 males and 56 females, aged 55-84 years [(68.2±5.2)years]. Level of injury was located at T 11 in 3 patients, at T 12 in 19, at L 1 in 31, and at L 2 in 19. According to the American Spinal Injury Association (ASIA) classification, 31 patients were scaled as grade D and 41 grade E. Overall, 51 patients were treated with PSO combined with long segment fixation (PSO group) and 21 patients treated with VP combined with long segment fixation (VP group). The operation time and bleeding volume were compared between the two groups. Before operation, at postoperative 2 weeks and at the last follow-up, the kyphotic Cobb angle, sagittal vertical axis (SVA), thoracic kyphosis (TK) and lumbar kyphosis (LL) were used to evaluate the osteotomy effect, and the visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the degree of pain and lumbar function recovery. The improvement of ASIA grade was observed at the last follow-up. The complications were observed as well. Results:All patients were followed up for 24-46 months [(33.2±5.9)months].The operation time and bleeding volume were more in PSO group than in VP group (all P<0.01). Before operation, the kyphotic Cobb angle, SVA, TK and LL were not significantly different between the two groups (all P>0.05). At postoperative 2 weeks, TK was not significantly different between the two groups ( P>0.05), while PSO group showed significantly decrease of kyphotic Cobb angle and SVA and increase of LL when compared with VP group ( P<0.05 or 0.01). At the last follow-up, the kyphotic Cobb angle, SVA and TK in PSO group were (8.5±1.1)°, (2.6±0.5)cm and (28.8±6.2)°, respectively, significant lower than those in VP group [(14.2±1.5)°, (4.4±0.9)cm and (32.6±5.9)°] (all P<0.05); while the LL was significantly larger in PSO group [(43.1±3.9)°] than in VP group [(36.9±5.3)°] ( P<0.01). Before operation, the VAS and ODI were not significantly different between the two groups (all P>0.05). At postoperative 2 weeks, the VAS and ODI in the two groups were also not significantly different (all P>0.05), but both were greatly decreased from the preoperative level (all P<0.05). At the last follow-up, the VAS and ODI in PSO group were (1.4±0.5)points and 22.5±2.5, significant higher than (1.8±0.6)points and 25.5±5.1 in VP group (all P<0.01). At the last follow-up, the ASIA classification was grade E in all patients. There were 1 patient suffering from dural matter tear and 1 from proximal junctional kyphosis in PSO group. Whereas 3 patients had bone cement leaking and 1 pedicle screw loosening in PVP group. The complication rate was 3.9% (2/51) in PSO group, significant lower than 19.0%(4/21) in VP group ( P<0.05). Conclusion:Compared with VP group in the treatment of osteoporotic vertebral fractures with kyphosis, PSO combined with long segment fixation is much effective in improving kyphosis angle and spinal axial imbalance correction, maintaining vertebral height and spinal axial stability in middle- to long-term, improving pain and dysfunction and minimizing complications, regardless of more operation time and bleeding volume.

Analysis on early clinical outcomes of traditional growing rod for idiopathic early-onset scoliosis / 中华骨科杂志

Objective:To explore the early outcomes surgical treatment with growing rod for idiopathic early-onset scoliosis (IEOS).Methods:Data of 11 patients with IEOS who had surgical treatment from February 2017 to December 2018 were retrospectively analyzed. There were 4 males and 7 females aged 6.45±1.63 at the time of the first operation, with preoperative Cobb angle of 74.74°±6.48° (range, 66.12°-87.85°). The imaging data and clinical data before operation, after operation instantly, 1 month after operation, 1 year after operation and 2 years after operation, and surgical-related complications were analyzed and recorded.Results:All the 11 patients were followed up for 28.82±4.77 months. The Cobb angle was 74.74°±6.48° before the initial implantation of internal fixation, and decreased to 30.30°±4.04° immediately after the operation, 30.39°±4.49° 1 month after the operation, 26.93°±3.09° 1 year after the operation, and 28.36°±2.98° 2 years after the operation. The correction rate was 61.82%±4.85% 2 years after operation. The height of T 1-T 12 thoracic vertebra was 13.69±2.05 cm before surgery, and increased to 20.74±3.10 cm immediately after surgery, and was 20.85±3.62 cm 1 month after surgery, 21.49±3.56 cm 1 year after surgery, and 22.54±3.63 cm 2 years after surgery. The height of T 1-S 1 vertebral body was 24.21±3.20 cm before surgery, and increased to 31.04±3.79 cm immediately after surgery, and was 30.85±3.64 cm 1 month after surgery, 32.91±3.24 cm 1 year after surgery, and 34.46±3.28 cm 2 years after surgery. Preoperative apical vertebral translation (AVT) was 7.45±2.00 cm before the initial operation, and shortened to 2.04±0.67 cm immediately after the operation, 2.07±0.70 cm 1 month after the operation, 2.24±0.57 cm 1 year after the operation, and 2.11±0.82 cm 2 years after the operation. There were statistically significant differences in the above indexes before surgery, 1 month after surgery, 1 year after surgery and 2 years after surgery. Compared with preoperation, pulmonary function FEV1 and FVC increased to 1.28±0.13 L and 1.49±0.10 L, respectively, 1 year after surgery, and 1.34±0.13 L and 1.54±0.12 L, respectively, 2 years after surgery. Pulmonary function was significantly improved 1 year after surgery, and pulmonary FVC was positively correlated with T 1-T 12 thoracic vertebral height ( r=0.838, P< 0.001). 13 complications were found in the 11 patients, including 2 cases of proximal screws loosening, 1 case of proximal junction kyphosis, 1 case of titanium rod fracture, 3 cases of skin swelling cause by internal fixation, and 6 cases of subcutaneous effusion, with good results after timely treatment. Conclusion:The traditional growing rod can effectively control the progression of deformity in patients with IEOS, maintain the growth and development of trunk, and promote the development and maturation of lung function.

Repair of digit tip soft tissue defect with free proximal perforator flap of proper palmar digital artery / 中华显微外科杂志

Objective:To explore the surgical method and therapeutic effect of repairing digital tip defect with free flap of proximal perforating branch of proper palmar digital artery.Methods:From March, 2009 to January, 2021, 15 patients with soft tissue defects at the tip of 16 digits were repaired with free perforator flap of proper palmar digital artery. The flap was obtained from the ulnar side of an index finger, on both sides of a middle finger and on the proximal side of the radial side of the ring finger. The size of flaps was 1.8 cm × 1.2 cm - 4.5 cm × 2.2 cm. The flap carried dorsal branch of proper palmar digital nerve and 0.5-4.5 cm of arteriae digitales palmares propriae. The donor digital artery was re-anastomosed in 3 cases 3 digits, transferred and anastomosed in 2 cases and un-anastomosed in 10 cases 11 digits. The dorsal branch of the proper palmar digital nerve in the flap was anastomosed with the proper palmar digital nerve of the finger stump at the recipient site to restore the sensation of flap, and the donor sites at the wrist transverse stripes or elbow transverse stripes were directly sutured. Regular follow-up via outpatient visit, telephone or WeChat interviews was conducted to observe the appearance, sensation and recovery of the flap and finger joint function.Results:After surgery, the flaps and donor site skin grafts of 15 cases with 16 digits were all survived, with first stage healing. A 4 months to 12 years follow-up showed that the flaps were in good texture and full shape with TPD at 7 - 11 mm. The joint function of digits was recovered well, and there was no complaint about uncomfortable donor site. According to the Michigan Hand Function Questionnaire, all 15 patients were satisfied with the overall appearance and function of the hands. According to TAM evaluation standard, all the digits of 15 patients were in excellent.Conclusion:Free flap of the proximal perforating branch of proper palmar digital artery is an ideal in the repair of digital tip soft tissue defect, as it has the advantages of an anatomical constant vessel, hidden donor site, less trauma caused, simple flap resection and good therapeutic effect.

Repair of thumb pulp defect with transposition of pedicled radial proper palmar digital artery flap of middle finger / 中华显微外科杂志

Objective:To explore the surgical method and therapeutic effect of repairing thumb pulp defect with pedicled transposition of radial proper palmar digital artery flap of middle finger.Methods:Since June, 2006 to May, 2020, 17 cases(17 fingers) with thumb pulp defect were repaired by pedicled transposition of radial proper palmar digital artery flap of middle finger. The sizes of flap ranged from 1.5 cm × 1.5 cm to 4.2 cm × 2.0 cm. The antegrade pedicled flap of radial proper palmar digital artery of middle finger was used in 2 cases and the retrograde pedicled flap of middle finger was used in 15 cases. After the flap was resected, the donor sites were covered with a medium thickness skin graft transferred from the wrist or elbow. The skin graft did not need to be packed. The dorsal branch of the digital nerve was included in the flap and it was anastomosed with the proper nerve of the injured thumb stump. After 16-22 days of the operation, the pedicles were cut off. The patients were instructed to perform digit function exercise after the pedicle was cut off. After the operation, the patients were included in regularly follow-up through outpatient visit, telephone or WeChat interview. The appearance and sensation of the thumb and finger pulps and the function recovery of the thumb and finger joints were observed through the followed-ups.Results:All 17 flaps and donor site skin grafts survived over 3 to 32 months of follow-up. The flaps achieved good texture and natural appearance. The TPD recovered to 5~11 mm. According to the Michigan Hand Function Questionnaire, all the 17 patients were very satisfied with the overall appearance and function of the hands. According to TAM, the 17 cases were all in excellent.Conclusion:Repairing thumb pulp defect with radial proper palmar digital artery pedicled flap of middle finger, the flap resection is simple, and the donor site is hidden. The appearance and texture of flap is good. It is a safe, effective and good method.

Reconstruct the distal blood supply of multiple segments of severed finger body by arterial bridge transfer / 中华显微外科杂志

Objective:To investigate the surgical method and therapeutic effect of reconstruction of distal blood supply of multiple segments of severed finger body by ortho phalanx artery bridge transfer.Methods:Between November, 2005 and February, 2019, 7 finger body was replanted in 7 cases with 3 segments. Due to the short middle finger body and severe bruising, the power could not pass through the middle section after the proximal finger artery anastomosis. For the long section of blood supply, in order to prevent the skin and blood vessels from separating too much and causing the middle internal artery to separate from the phalanx, after anastomosis of the middle artery, the blood supply was provided by anastomosis with the distal phalanx artery by means of the adjacent phalanx artery bridge. Four cases with vascular pedicle grafts. The skin was sewn into tube in 3 cases, and separate fingers between 3.5 and 6.0 months after operation. Four cases of posterior artery recalcitration and 3 cases of direct adjacent artery transposition. The appearance, sensation and total motion of finger joints were observed and the satisfaction of patients was investigated to evaluate the therapeutic effect.Results:Seven patients with replantation finger were all alive after operation, and the follow-up time was 5 to 40 months respectively. The total range of motion of flexion and extension of finger joints was 100°-170°, and the TPD of finger pulp was 7-12 mm, with an average of 9.6 mm. According to Michigan's functional questionnaire, 7 patients were satisfied with the overall appearance and function of their opponents. According to the evaluation standard of the replantation function of the broken finger of the Chinese Medical Association, 3 cases were excellent and 4 cases were good.Conclusion:It is a simple and effective way to reconstruct the blood supply of multi-segment severed fingers by means of adjacent finger artery bridge transfer.

Hydroxyapatite/zirconia scaffold by three-dimensional printing compounded with vascular endothelial growth factor 165 calcium alginate microsphere slow-release system for repairing large bone defect in dogs / 中华创伤杂志

Objective To investigate the effect of hydroxyapatite/zirconia (HA/ZrO2) scaffold by three-dimensional printing compounded with vascular endothelial growth factor (VEGF) 165 calcium alginate microsphere slow-release system on repairing femoral shaft defects in dogs.Methods The HA/ZrO2 artificial prosthesis was prepared by three-dimensional printing,and the co-culture system of slow-release system of composite VEGF 165 calcium alginate microspheres was constructed.Sixteen beagle dogs were divided into four groups according to the extent of femoral shaft interception,with four dogs in each group.Group A:no biomaterials were implanted into the middle femur of dogs after 15 mm of femur interception as blank control group;Group B:HA/ZrO2 scaffolds composite with VEGF165 calcium alginate microspheres were implanted into the middle femur of dogs after 15 mm of femur interception;Group C:the same method as Group B was adopted after 25 mm of femur interception;Group D:the same method as Group B was adopted after 35 mm of femur interception.General examination and X-ray imaging observation were taken after operation.The ability of new HA/ZrO2 gradient biocomposites to repair bone defects was evaluated by micro CT scanning,biomechanical testing,ink staining and toluidine blue staining 12 weeks after operation.Results The drug loading capacity of calcium alginate microspheres reached (23.6 ± 2.9) ng/mg,and the entrapment efficiency reached (62.4 ± 3.6) ％,showing a slow rate of release.Gross examination showed surgical incision was healed in all four groups.Postoperative X-ray imaging of experimental animals showed that nonunion was formed in Group A over time;in Group B,the artificial prosthesis was gradually filled with new bone and the boundary was blurred;in Group C,the early reaction was slower than that in Group A,and the callus passed continuously 12 weeks after operation;in Group D,new bone formation was slow,only surrounding the broken end.At 12 weeks after operation,the neonatal bone mass was (238.6 ± 19.1)mm3 in Group B,(223.3 ± 13.4) mm3 in Group C,and (110.8 ± 6.5) mm3 in Group D.There were significant differences among the three groups (P ＜ 0.05),but no significant difference was found between Group B and Group C (P ＞ 0.05).The results limit compression test at 12 weeks after operation showed no significant differences among Groups B [(49.7 ± 2.3) MPa],C [(49.81 ± 2.4) MPa] and D [(46.9 ± 3.6) MPa](P ＞ 0.05).At 12 weeks after operation,the histological sections showed that the blood vessels in Groups B and C were thickened,with obvious branches,and the surrounding new bone increased.During the period,the blood vessels were filled with vascular network.There were no obvious differences in the number and shape of blood vessels between groups.However,Group B had more new bones and blood vessel networks.New bone and small vascular networks were seen in Group D.Conclusion The hydroxyapatite/zirconia scaffold by three-dimensional printing compounded with vascular endothelial growth factor 165 calcium alginate microsphere slow-release system can repair dogs' femoral bone defect within 35 mm.

Using Flow-through flap pedicled with superficial palmar branch of radial artery for bridging finger replan-tation complex defect of soft tissue and vessel / 中华显微外科杂志

To evaluate the surgical technique and clinical effect of applying Flow-through flap pedicled with superficial palmar branch of radial artery for bridging finger replantation complex defect of soft tissue and vessel. Methods From February, 2013 to March, 2018, 9 cases of severed fingers composited defect of soft tissue and vessel were treated with Flow-through flap pedicled with superficial palmar branch of radial artery.The flap was designed from the proximal end of rasceta and the donor sites were sutured directly. The size of flaps was 3.0 cm ×1.5 cm-4.0 cm×2.2 cm. The superficial branch of the radial artery in the flap was used to bridge the finger artery. And the vein of proximal and distal ends in the finger was bridged by the subcutaneous vein. The proper palmar digi-tal nerve defect was bridged by palm skin graft of median nerve. The appearance, feeling and joint function of fingers was followed-up regularly after operation. Results All transfering flaps survived and all cases were followed-up for 7 to 33 months. The donor sites got primary healing with straight scars. The appearance and texture of the flaps were satisfactory. Two-point discrimination ranged from 8 to 11 mm. The pain sensation, warmth sensation and touch sen-sation of the flaps got better. And the appearance and functions of severed fingers recovered well. Conclusion The Flow-through flap pedicled with superficial palmar branch of radial artery is easy to harvest and anastomose, which is masked and a small incision for the donor site. It is an ideal method for bridging severed fingers and repairing of fin-ger wound.

Efficacy comparison of multi-segment and single-segment osteotomy for old osteoporotic vertebral compression fracture combined with kyphosis / 中华创伤杂志

Objective To investigate the sagittal correction effect and clinical efficacy of multisegment Smith-Peterson osteotomy (SPO) and single-segment pedicle subtraction osteotomy (PSO) in the treatment of old osteoporotic vertebral compression fracture (OVCF)combined with kyphosis.Methods A retrospective case control study was conducted to analyze the clinical data of 24 patients with old OVCF combined with kyphosis admitted to Traditional Chinese Medical Hospital of Xiaoshan from February 2014 to July 2016.There were 10 males and 14 females,aged 58-72 years,with an average of 65.6 years.Thirteen patients were treated with multi-segment SPO (Group A),six of whom underwent two-segment SPO and seven underwent three-segment SPO.Eleven patients were treated with single-segment PSO (Group B).The operation time,intraoperative bleeding volume,the number of cases using cementreinforced nail track,postoperative drainage,hospitalization time and postoperative complications were compared between the two groups.Cobb angle,sagittal vertical axis (SVA),thoracic kyphosis angle (TK) and lumbar lordosis angle (LL) of kyphosis deformity were measured before operation,after operation and at the last follow-up.Oswestry Dysfunction Index (ODI) and Visual Analogue Scale (VAS) were used to evaluate the clinical efficacy at the last follow-up.Results All patients were followed up for 6-24 months,with an average of 15.4 months.The operation time of Group A was (198.1 ± 27.3)minutes,while that of Group B was (237.6 ± 36.1)minutes (P ＜ 0.05).The amount of intraoperative bleeding in Group A was (1 256.2 ± 389.4) ml,while that in Group B was (1 525.6 ±457.1)ml (P ＜ 0.05).Two patients in Group A and five patients in Group B were treated with cement-reinforced nail track (P ＜ 0.05).There was no significant difference in drainage and hospitalization time between the two groups (P ＞ 0.05).Three patients in Group A and one patient in Group B had cerebrospinal fluid leakage (P ＜ 0.05).The postoperative SVA was (1.4 ± 0.7) cm in Group A and (-1.1 ± 0.6) cm in Group B (P ＜ 0.05).No significant differences were found between the two groups in Cobb angle,TK and LL of kyphosis (P ＞ 0.05).There was no significant difference in SVA,Cobb angle,TK and LL between the two groups at the last follow-up (P ＞ 0.05).There was no significant difference in ODI and VAS between the two groups after operation and at the last follow-up (P ＞ 0.05).No complications such as spinal cord injury,embolism caused by cement leakage,extraction or rupture of pedicle screw occurred in either group.Conclusion For old osteoporotic vertebrae compressed fractures combined with kyphosis,multi-segment SPO and single-segment PSO can achieve good sagittal correction and clinical efficacy.Single-segment PSO has better correction effect and lower incidence of cerebrospinal fluid leakage,yet accompanied with disadvantages of overcorrection,screw loosening,longer operation time and more blood loss.

Percutaneous posterior short-segment pedicle screw fixation combined with vertebroplasty for stage Ⅲ Kümmell's disease without neurological deficit / 中华创伤杂志

Objective To investigate the clinical efficacy of percutaneous posterior short-segment pedicle screw fixation combined with vertebroplasty for stage Ⅲ Kümmell's disease without neurological deficit.Methods A retrospective case series study was conducted to analyze the clinical data of 36 patients with stage Ⅲ Kümmell's disease without nerve injury admitted to Xiaoshan Hospital of Traditional Chinese Medicine from January 2012 to January 2017.There were 10 males and 26 females,aged 55-75 years,with an average of 67.5 years.The injuried vertebrae were located at T11 in 9 patients,at T12 in 12,at L1 in 10 and at L2 in 5.The course of disease ranged from 6 to 48 months,with an average of 28.5 months.X-ray,CT and MRI were performed before operation.All patients underwent percutaneous posterior short-segment pedicle screw fixation combined with vertebroplasty.The operation time,intraoperative bleeding volume,complications,visual analogue scale (VAS),Oswestry dysfunction index (ODI) and sagittal Cobb angle of the injured vertebrae were recorded before operation,1 week after operation and at the last follow-up.Results All patients were followed up for an average of 32.5 months (range,12-48 months).Operation time ranged from 0.6 to 1.5 hours [(1.1 ± 0.4) hours].The intraoperative blood loss was 50-90 ml [(62.5 ± 17.5)ml].There was no internal fixation failure or fracture of adjacent vertebra.The VAS was improved from preoperative (8.6-± 0.4) points to (2.5 ±0.7) points one week after operation and (2.9 ± 0.7) points at the last follow-up (P ＜ 0.05).The ODI was improved from preoperative 68.2 ± 3.9 to 22.7 ± 4.3 one week after operation and 25.3 ± 4.8 at the last follow-up (P ＜ 0.05).The Cobb angle was improved from preoperative (24.3 ± 9.3) ° to (8.6 ±3.2)° 1 week after operation and (10.5 ±4.1)° at the last follow-up (P＜0.05).Conclusion For stage Ⅲ Kümmell's disease without neurological deficit,percutaneous posterior short-segment pedicle screw fixation combined with vertebroplasty can significantly relieve pain,improve spinal function and maintain spinal stability.

Short-term efficacy of pedicle subtraction osteotomy plus long segment fixation for kyphosis in ankylosing spondylitis combined with thoracolumbar fractures / 中华创伤杂志

Objective To evaluate the efficacy of pedicle subtraction osteotomy (PSO) plus long-segment pedicle nail bar system in treating kyphosis in ankylosing spondylitis (AS) combined with thoracolumbar fractures.Methods A retrospective case series study was made on the clinical data of 13 patients with kyphosis in AS combined with thoracolumbar fractures admitted to Xiaoshan Hospital of Traditional Chinese Medicine from January 2012 to May 2016.There were 11 males and two females,aged 32-64 years [(44.3 ± 10.6) years].Two fractures occurred at T11,five at T12,three at L1,and three at L2.According to the American Spinal Injury Association (ASIA) classification,the spinal injuries were rated as grade B in one patient,grade C in four,grade D in five and grade E in three.All patients underwent PSO plus long-segment pedicle nail bar system.The operation duration,intraoperative blood loss,fixation segments,and complications were recorded.Thoracolumbar kyphosis angle (TL) and sagittal vertical axis (SVA) were measured to evalute the correction effect.Visual analogue scale (VAS),Oswestry disability index (ODI),ASIA grade were compared before and after operation to assess the efficacy.Results All patients were followed up for 12-18 months [(15.2 ± 1.2) months].The operation time ranged from 120 to 256 minutes [(175.2 ±40.3)minutes].The intraoperative blood loss ranged from 660 to 3 300 ml [(1 011 ±681)ml].Number of fixed seqments was 12-16 (12.2 ±0.8).Anemia occurred in one patient after operation,and the patient recovered after blood transfusion.Incision infection occurred in one patient after operation,which was improved after antibiotic treatment through osmotic culture.Compared with the detection before operation,postoperative TL was improved significantly [(52.6 ± 6.2) ° vs.(17.1 ± 3.1) °],with an average correction rate of 67.5％;final follow-up showed decreased VAS [(7.5 ± 0.7) points vs.(1.9 ± 0.6) points] and decreased ODI [(75.2 ±5.3) points vs.(22.9 ± 4.4) points] (P ＜ 0.05);SVA was improved significantly [(11.5 ± 2.1) cm vs.(3.5 ± 0.9) cm],with an average correction rate of 69.6％ (P ＜ 0.05).ASIA grade was significantly improved at the final follow-up,including grade D in three patients and grade E in ten patients (P ＜0.05).There was no case of epidural hematoma or infection after operation,and no loosening of internal fixator or pseudarthrosis formation occurred during follow-up.Conclusion For kyphosis in AS combined with thoracolumbar fractures,PSO osteotomy plus long segment pedicle nail bar system treatment can significantly reduce lower back pain and promote functional recovery.

Some controversial issues on surgical strategies for thoracolumbar fractures / 中华创伤杂志

Thoracolumbar fractures are common spinal injuries and have complicated pathological mechanism.Different types of thoracolumbar fracture have different treatment principles and methods.At the same time,many clinical treatment methods have their own indications.With the improvement of the concept of spinal surgery,the treatment of thoracolumbar vertebral fracture is also improving,and controversy over the optimal treatment strategy has never ceased,such as the surgical approach,the minimally invasive surgical technology,the selection of surgical methods for post-traumatic thoracolumbar kyphosis and the treatment of special thoracolumbar fracture types.The author summarizes the literatures on thoracolumbar injuries published in this issue so as to provide better references for clinical treatment of thoracolumbar fractures.

One case of replantation of complete severed thumb and skin defect with free superficial palmar branch of radial artery flap / 中华整形外科杂志

In July 2016, we used free superficial palmar branch of radial artery flap to repair one case of complete dissection of the thumb with skin defect, and achieved good result .

Combined anterior and posterior approaches to treat severely unstable lower lumbar burst fractures / 中华创伤杂志

Objective To evaluate the efficacy of combined anterior and posterior approaches in treatment of severely unstable lower lumbar burst fractures.Methods A retrospective case series study was made on clinical data of 14 patients with lower lumbar burst fractures collected from August 2009 to August 2014.There were 12 males and 2 females,with a mean age of 39 years.Seven fractures occurred at L3,five at L4,and two at L5.Nine patients were associated with injury to the posterior ligament complex (PLC).According to the American Spinal Injury Association (ASIA) classification,the spinal injuries were rated as grade B in two patients,grade C in four,grade D in five and grade E in three.All patients underwent posterior pedicle screw fixation combined with anterior spinal canal decompression and titanium mesh or iliac bone grafting.Lumbar lordosis angle,vertebral height,spinal canal decompression,ASIA grade and complications were evaluated after operation.Results Two patients experienced cerebrospinal fluid leakage postoperatively,which were healed after 2 weeks' local pressure treatment.Three patients experienced recurrent lumbar pain postoperatively,which were relieved after the removal of internal fixation 18 months after operation.All patients were followed up for 12-36 months (mean,18 months).Compared to the detection before operation,final follow-up showed improved lumbar lordosis [(30.2 ± 7.3) ° vs.(41.3 ± 6.5) °],decreased loss of the anterior vertebral height [(62.3 ± 21.5) ％ vs.(11.8 ± 7.8) ％] and reduced canal compromise [(65.7 ± 30.5) ％ vs.(21.9 ± 12.7)％] (all P ＜ 0.05).ASIA grade was significantly improved at the final follow-up,including grade C in one patient,grade D in three and grade E in ten (P ＜ 0.05).Follow-up showed no apparent graft loosening,pseudarthrosis,implant breakage and severe kyphosis.Conclusion Combined anterior and posterior approaches to treat severely unstable lower lumbar burst fractures can effectively reconstruct the height and stability of the vertebral body,restore the spinal canal volume,and attain satisfactory clinical outcome.

Efficacy comparison of percutaneous pedicle instrumentation combined with vertebral fracture fixation or vertebral augmentation for treatment of osteoporotic thoracolumbar fractures in elderly patients / 中华创伤杂志

Objective To compare the outcomes of percutaneous pedicle instrumentation combined with vertebral augmentation or vertebra pedicle instrumentation for treatment of osteoporotic thoracolumbar fractures (OVCF) in elderly patients.Methods A retrospective case cohort study was conducted on 62 patients with OVCF manifesting non-neurological symptoms treated from January 2009 to January 2012.There were 22 males and 30 females,with a mean age of 61.3 years (range,55 to 70 years).Fracture level was T11 in 8 patients,T12in 20,L1 in 22 and L2 in 12.Treatments included percutaneous pedicle instrumentation combined with vertebral fracture fixation in 36 patients (Group A) and percutaneous pedicle instrumentation combined with vertebral augmentation in 26 patients (Group B).Operation time,intraoperative blood loss,anterior vertebral body height,sagittal Cobb angle and visual analogue score (VAS) were compared between the two groups.Results All patients were followed up for average 46.5 months (range,36 to 58 months).Operation time in Group A [(82.6 ±16.2) min] was shorter than that in Group B [(96.8 ± 20.6) min] (P ＜ 0.05).Blood loss in Group B [(40.5 ± 10.2) ml] was less than that in Group A [(52.2 ± 15.5) ml] (P ＜ 0.05).Before operation and 3 days and 1 year after operation,the anterior vertebral body height and sagittal Cobb angle in Group A showed no significant differences compared to Group B (all P ＞ 0.05).At the final follow-up,the ratio of anterior vertebral height and Cobb angle in Group B [(87.8 ± 2.5) ％,(7.8 ± 3.5) °] were better than these in Group A [(82.6 ±3.2)％,(9.1 ± 1.8)°] (P＜0.05).VAS showed no statistical significance between the two groups before and after operation (P ＞ 0.05).Bone cement leakage was seen in four patients in Group B.During the perioperative period,there were 3 patients with lung infection in Group A and 1 patient with lower limb deep vein thrombosis in Group B.No implant failure occurred in both groups.Conclusion Both procedures are effective in treating elderly patients with OVCF,but percutaneous pedicle instrumentation combined with vertebral augmentation is associated with better results in maintaining vertebral height and preventing kyphosis.

Unstable atlas fractures treated by minitype titanium plate fixation through transoral approach / 中华创伤杂志

Objective To investigate the effect of minitype titanium plate fixation through transoral approach in the treatment of unstable atlas fractures.Methods A retrospective case series study was made on 21 patients with unstable atlas fractures treated by minitype titanium plate fixation through transoral approach from June 2008 to June 2014.There were 15 males and 6 females,at age of (40.9 ± 10.6)years (range,21 to 57 years).Anterior 1/2 Jefferson fractures were seen in 12 patients and 1/2 ring Jefferson fractures in 9 patients.Preoperative visual analogue score (VAS) was 4-9 points [(7.6 ± 1.3) points].Before operation,degree of mobility of the cervical vertebra was (15.4 ± 3.9) °in bending,(10.8 ± 2.5) °in extending,(18.3 ± 3.1) ° in left-bending,(18.9 ± 2.7) ° in right-bending,(21.8 ± 5.8) °in left-rotation and (22.4 ± 4.6) ° in right-rotation.Operation time,intraoperative blood loss,VAS,cervical mobility and bone healing were detected after operation.Results Operation time was (86.3 ±25.3)m in,and intraoperative blood loss was (120.5 ± 33.3)ml.VAS was improved to 0-2 points [(1.6 ± 0.4) points] at postoperative 3 days (P ＜ 0.05).All patients were followed up for 12 to 48 months[(23.7 ±5.9) months].VAS was improved to 0-2 points[(0.6 ± 0.1) points] at postoperative 3 months (P ＜ 0.05).Degree of mobility of the cervical vertebra was improved significantly at postoperative 3 months,with the bending of(38.6 ± 4.5) °,extending of (39.3 ± 4.0) °,left-bending of (39.2 ± 4.0) °,right-bending of (39.2 ± 2.9) °,left-rotation of (66.8 ± 8.8) ° and right-rotation of (66.3 ± 9.2) ° (P ＜ 0.05).Postoperatively,there were no surgical wound incision infections and vertebral artery or spinal injuries,Bone union was found in all patients,without the occurrence of implant loosening or breakage and the dysfunction of the cervical vertebra.Conclusion Minitype titanium plate fixation through transoral approach is associated with less trauma,high healing rate and preservation of the activity of cervical vertebra in the treatment of unstable atlas fractures.

Pedicle composite tissue flap based on superficial palmar branch of the radial artery repair the soft tissue defect of thumb / 中华显微外科杂志

Objective To explore the surgical technique of applying the pedicle composite tissue flap based on superficial palmar branch of the radial artery to repair the soft tissue defect of thumb and evaluate the clinical ef-fect. Methods From February,2013 to March, 2016, 5 cases of the soft tissue and tendon defect of thumb were treated with the pedicle composite tissue flap based on superficial palmar branch of the radial artery. The flap was de-signed at wrist not exceeding the wrist rasceta and the donor site was sutured directly. The size of the harvested flaps was between 3.0 cm ×2.2 cm to 4.2 cm ×3.2 cm, and the sensation of thumb or the flap was reconstructed via median nerve cutaneous branch. The Extensor pollicislongus muscle tendon defect was repaired via palm tendon carried by composite tissue flap. Postoperative follow-up was done termly. Results All transfering flaps survived and all cases were followed-up for 4 to 11 months. The donor site got primary healing with a linear scar. The appearance and tex-ture of the flap was satisfactory. The two-point discrimination ranged from 8 to 11 mm. The appearance of thumb re-covered well and the digit joint had a good motion. Conclusion The pedicle composite tissue flap based on superfi-cial palmar branch of the radial artery is easy to harvest and its vascular anatomy is constant, which is masked and a small incision for the donor site. When necessary, palm tendon or median nerve cutaneous branch can be contained in the flap to form a composite transplant. It is an ideal method for repair of thumb soft tissue defect.

Advances in Experimental Studies on the Mechanism of Huatuo Jiaji (Ex-B2) Point Acupuncture Treatment for Spinal Cord ;Injury / 上海针灸杂志

This article sorts out and analyzes recent years’ literature about experimental studies on Huatuo jiaji (Ex-B2) point acupuncture treatment for spinal cord injury (SCI), discusses the mechanism of Huatuo jiaji point acupuncture treatment for spinal cord injury from three aspects:improving microenvironment for nerve repair, inhibiting apoptosis and promoting nerve repair and tries to explore the possible direction of its future development.

Hydroxyapatite/zirconia gradient composite scaffolds for bone tissue engineering:current uses and perspectives / 中国组织工程研究

BACKGROUND:Porous gradient hydroxyapatite/zirconia composite, which can adhere to a variety of cel s, such as osteoblasts, bone marrow mesenchymal stem cel s and chondrocytes, can induce and promote fracture healing or replace bone defects. OBJECTIVE:To review the development and application of porous gradient hydroxyapatite/zirconia composite in bone tissue engineering. METHODS:Articles related to porous gradient hydroxyapatite/zirconia composite in bone tissue engineering were retrieved in CNKI and PubMed databases (1971-01/2014-12). The key words were“porous bioceramic, bone tissue engineering, bone morphogenetic protein-2, induced pluripotent stem cel s”in Chinese and English, respectively. A total of 54 articles based on inclusion criteria and exclusion criteria were obtained for the review. RESULTS AND CONCLUSION:Porous gradient hydroxyapatite/zirconia composite can provide a scaffold to induce natural y forming bone growing to fil the three-dimensional pores, thus realizing the perfect integration of tissue-engineered bone material and host-bone tissue. As zirconia functions as an enhancer of hydroxyapatite, high-quality artificial bone materials, which have elastic modulus, fracture toughness and structure similar to human bone, can be prepared by adjusting the proportion and porosity of materials. Additional y, the new hydroxyapatite/zirconia foamed ceramics as tissue-engineered bone carrying bone morphogenetic protein-2/chitosan gel sustained release system and bone marrow mesenchymal stem cel s derived from induced pluripotent stem cel s wil be expected to increase bone formation and bone fusion rates significantly in the future.