Effect of intraoperative cell salvage on the number and viability of cancer cells in salvaged autologous blood from patients undergoing liver cancer surgery / 中华麻醉学杂志

Objective:To evaluate the effect of intraoperative cell salvage (ICS) on the number and viability of cancer cells in salvaged autologous blood from the patients undergoing liver cancer surgery.Methods:Twenty patients undergoing open radical primary hepatocellular carcinoma were selected, and blood from the operative field was collected after exposing the liver and treated with ICS. Blood specimens 20 ml from the surgical field (S 1), blood specimens 20 ml before ICS treatment-leukocyte depletion filter (LDF) filtration (S 2) and blood specimens 20 ml after LDF filtration (S 3) were collected and enriched, of which the blood sample 10 ml was used for cancer cell identification and count by immunofluorescence staining, and the remaining blood sample 10 ml was continuously cultured for 3 weeks, and then cell viability was observed by immunofluorescence method. Results:Hepatocellular carcinoma(HCC) cells were identified in 19 S 1 specimens, 18 S 2 specimens, and 16 S 3 specimens, but there was no significant difference in the detection rate among the three specimens ( P>0.05). Compared with S 1 specimens, HCC cell count was significantly reduced in S 2 and S 3 specimens ( P<0.05). There was no significant difference in the HCC cell count between S 3 specimens and S 2 specimens ( P>0.05). After 3 weeks of culture, the results of light microscopy showed that: hepatocellular carcinoma cell clusters were found in S1 specimens, and no hepatocellular carcinoma cell cluster was found in S 2 and S 3 specimens; the results of fluorescence microscopy showed that: 400 and 14 mixed epithelial-mesenchymal HCC cells and 100 and 21 mesenchymal HCC cells were found in S 1 and S 2 specimens, respectively, while no HCC cells were identified in S 3 specimens, among which HCC cells mainly presented as clusters of hepatocellular carcinoma cells in S 1 specimen, while no clusters of hepatocellular carcinoma cells were found in S 2 and S 3 specimens. Conclusions:After treatment with ICS or ICS-LDF, the number and viability of hepatocellular carcinoma cells in salvaged autologous blood are significantly reduced, and hepatocellular carcinoma cells exist as single cells and fail to develop clusters of hepatocellular carcinoma cells; LDF can reduce the risk of hepatocellular carcinoma cell autotransfusion to a certain extent, although it can not effectively filter out hepatocellular carcinoma cells continuously.

Application and risk assessment of intraoperative cell salvage in patient with malignancy / 中国输血杂志

Patients with malignant tumour often require massive transfusion. Intraoperative cell salvage(IOCS) was initially limited in cancer surgery by concerns about the possibility of dissemination of tumor cells into circulation. However, as supportive literature concerning IOCS research and application in cancer surgery are increasing, it is necessary to reassess the perioperative application of IOCS in patients with malignancy. This review summarizes the application, risks and value of IOCS during cancer operations.

Effect of stored autologous blood transfusion on function of bone marrow hematopoietic stem cells and recovery of reticulocytes in peripheral blood of rabbits / 中华麻醉学杂志

Objective:To evaluate the effect of stored autologous blood transfusion on the function of bone marrow hematopoietic stem cells and the recovery of reticulocytes in peripheral blood of rabbits.Methods:Thirty healthy male New Zealand rabbits, aged 3-6 months, weighing 2.5-3.0 kg, were divided into 5 groups ( n=6 each) using a random number table method: control group (C group), operation group (O group), blood collection group (O+ B group), stored autologous whole blood group (O+ WB group) and stored autologous component blood group (O+ CB group). In O+ B group, O+ WB group and O+ CB group, blood was collected via the right femoral artery at a rate of 3-5 ml/min at 7 days before surgery, the blood volume was 10% of the total blood volume, and blood was stored at 4-6 ℃.In O+ CB group, blood was centrifuged to remove plasma and white blood cells, and red blood cell suspension was prepared and placed in a blood storage bag.In O, O+ B, O+ WB and O+ CB groups, hepatectomy was performed, and bleeding was performed through the right femoral artery at a rate of 3-5 ml/min, and the blood volume was 10% of the total blood volume.Lactated Ringer′s solution 1 ml/min was intravenously infused during surgery in O and O+ B groups, stored autologous whole blood was intravenously infused during surgery in group O+ WB, and stored autologous red blood cell suspension 1 ml/min was intravenously infused during surgery in group O+ CB.Bone marrow blood samples were collected immediately before the start of surgery (T 2) and at 6 and 24 h after surgery (T 3, 4) to determine the percentage of CD34 + cells, cell cycle and relative expression of telomere DNA.Peripheral venous blood samples were collected before storage (T 1) and at T 4 for determination of the percentage of reticulocytes. Results:Compared with group C, the percentage of CD34 + cells was significantly increased at T 3 and T 4, the percentage of CD34 + cells in G1 phase was decreased, and the expression of telomere DNA in CD34 + cells was up-regulated in group O, and the percentage of reticulocyte in peripheral blood was increased at T 4 in the remaining 4 groups ( P<0.05). Compared with group O, the percentage of CD34 + cells was significantly increased at T 2-4, the percentage of CD34 + cells in G1 phase was decreased, and the expression of telomere DNA in CD34 + cells was up-regulated in O+ B, O+ WB and O+ CB groups, and the percentage of reticulocyte in peripheral blood was increased at T 4 in O+ WB and O+ CB groups ( P<0.05). Compared with group O+ B, the percentage of CD34 + cells was significantly increased at T 3 and T 4, the percentage of CD34 + cells in G1 phase was decreased, and the expression of telomere DNA in CD34 + cells was up-regulated in O+ WB and O+ CB groups, and the percentage of reticulocyte in peripheral blood was decreased at T 4 in O+ WB and O+ CB groups ( P<0.05). Compared with O+ WB group, the percentage of CD34 + cells was significantly decreased at T 3 and T 4, the percentage of CD34 + cells in G 1 phase was increased, the expression of telomere DNA in CD34 + cells was down-regulated, and the percentage of reticulocytes in peripheral blood was increased at T 4 in group O+ CB ( P<0.05). Conclusion:Stored autologous blood transfusion can inhibit the function of bone marrow hematopoietic stem cells and is not helpful for recovery of reticulocytes in peripheral blood of rabbits; stored autologous component blood transfusion has less effect on the hematopoietic function of bone marrow than stored autologous whole blood transfusion.

The value of fetal echocardiography in the diagnosis of isolated coronary artery fistula / 中华超声影像学杂志

Objective To investigate the ultrasonic features of fetal isolated coronary artery fistula ( CAF) . Methods A total of 13 cases of fetal isolated CAF from December 2011 to M arch 2018 were retrospectively analyzed . Data of echocardiography and follow‐up were collected .All cases were divided into retrograde group and no retrograde group based on the presence of diastolic retrograde flow in aortic arch . T he inner diameters of affected coronary arteries ( CA ) and aortic annulus ( AO ) were measured ,and the CA to AO ratios ( CA/AO ) were then calculated .Correlations between CA ,CA/AO and the presence of retrograde flow were analyzed . Adverse birth outcomes including abortion , enlarged cardiac cavity , pulmonary hypertension were recorded at follow‐up . Correlation between diastolic retrograde flow in aortic arch and the rate of adverse birth outcomes was analyzed . Results ① T hirteen cases of fetal CAF were characterized by the varying degrees of dilation of affected coronary arteries . T hirteen cases were presented with abnormal blood flow in the large arteries or cardiac cavities :biphasic continuous flow pattern in atrio‐ coronary fistula and biphasic bidirectional continuous flow pattern with a diastolic dominant flow in coronary artery to ventricle fistula . Seven cases were presented with retrograde holodiastolic flow in aortic arch . ②T he CA/AO ratios of retrograde group was higher than in no retrograde group [ ( 0 .63 ± 0 .24 ) mm vs ( 0 .39 ± 0 .09) mm , P ＝0 .047] ,there was no significant difference of CA between the two groups [ ( 3 .00 ± 1 .25) mm vs ( 2 .03 ± 0 .62) mm , P ＝0 .115] . ③T he rate of adverse birth outcomes in retrograde group was higher than in no retrograde group ( 80% vs 20% ,χ2 ＝4 .80 , P ＝0 .028) . Conclusions Fetal isolated CAF has distinct ultrasonic features . Abnormal CA/AO ratio and diastolic retrograde flow in aortic arch are significant ultrasonic features and has prognostic values .

The value of fetal echocardiography in the diagnosis of isolated coronary artery fistula / 中华超声影像学杂志

Objective@#To investigate the ultrasonic features of fetal isolated coronary artery fistula (CAF).@*Methods@#A total of 13 cases of fetal isolated CAF from December 2011 to March 2018 were retrospectively analyzed. Data of echocardiography and follow-up were collected.All cases were divided into retrograde group and no retrograde group based on the presence of diastolic retrograde flow in aortic arch. The inner diameters of affected coronary arteries (CA) and aortic annulus (AO) were measured, and the CA to AO ratios (CA/AO) were then calculated.Correlations between CA, CA/AO and the presence of retrograde flow were analyzed. Adverse birth outcomes including abortion, enlarged cardiac cavity, pulmonary hypertension were recorded at follow-up. Correlation between diastolic retrograde flow in aortic arch and the rate of adverse birth outcomes was analyzed.@*Results@#①Thirteen cases of fetal CAF were characterized by the varying degrees of dilation of affected coronary arteries. Thirteen cases were presented with abnormal blood flow in the large arteries or cardiac cavities: biphasic continuous flow pattern in atrio-coronary fistula and biphasic bidirectional continuous flow pattern with a diastolic dominant flow in coronary artery to ventricle fistula. Seven cases were presented with retrograde holodiastolic flow in aortic arch. ②The CA/AO ratios of retrograde group was higher than in no retrograde group [(0.63±0.24)mm vs (0.39±0.09)mm, P=0.047], there was no significant difference of CA between the two groups [(3.00±1.25)mm vs (2.03±0.62)mm, P=0.115]. ③The rate of adverse birth outcomes in retrograde group was higher than in no retrograde group (80% vs 20%, χ2=4.80, P=0.028).@*Conclusions@#Fetal isolated CAF has distinct ultrasonic features. Abnormal CA/AO ratio and diastolic retrograde flow in aortic arch are significant ultrasonic features and has prognostic values.

Effect of complement fragment C3a on the phenotype of mice podocytes in vitro / 中华肾脏病杂志

Objective To investigate the effect of complement C3a on mouse podocytes phenotype transformation.Methods Purified C3a recombinant protein was used to stimulate mature mouse podocytes.The expression of the mature podocyte markers synaptopodin,podocin,nephrin,CD2-associated protein (CD2AP) and the mesenchymal cell markers fibroblast specific protein 1 (FSP-1),α-smooth muscle actin (α-SMA) were detected by RT-PCR,Western blotting,immunochemistry and immunofluorescence,respectively.Some podocytes were transfected with integrin-linked kinase (ILK) siRNA before the administration of C3a,the expression of nephrin and α-SMA were accessed by Western blotting,and the expression of Snail and α-actinin 4 were accessed by Western blotting and immunochemical method.The migration ability of podocytes was observed by scratch test.Results Immunocytochemistry and immunofluorescence analysis showed that synaptopodin,podocin,nephrin,CD2AP were highly expressed by mature mouse podocytes.The expression of these podocyte markers could be markedly inhibited after 24 h of C3a (0.1 μmol/L) treatment,and accompanied by the induction of mesenchymal markers FSP-1 and α-SMA.Compared with control group,the mRNA levels of synaptopodin,podocin,CD2AP and nephrin were significantly repressed by the administration of C3a in a dose-dependent manner,whereas the transcription of FSP-1 and α-SMA were remarkably up-regulated by C3a treatment (P ＜ 0.05,respectively).Western blotting analysis also confirmed the decrease of synaptopodin,podocin,nephrin and CD2AP protein and the increase of FSP-1 and α-SMA protein were closely depend on the C3a concentration (P ＜ 0.05,respectively).To further assess the downstream of C3a,some podocytes were transfected with ILK siRNA before the administration of C3a.Compared with C3a group,the protein levels of nephrin and α-SMA were significantly changed by the administration of ILK siRNA (P ＜ 0.05,respectively).The expression of α-actinin 4 and Snail induced by C3a were inhibited by ILK knockdown (P ＜ 0.05,respectively),accompanied by a decline of cell migration potency.Conclusion Complement fragment C3a can induce transformation of mouse podocytes to mesenehymal cells,and ILK signaling pathway is involved in this cell type transformation.

Analysis of long-term renal outcome in patients after acute kidney injury / 中华肾脏病杂志

Objective To follow up the long-term prognosis of acute kidney injury (AKI) patients with normal basic renal function,and to further identify the clinical features as well as risk factors associated with the prognosis of AKI patients.Methods Clinical date of 166 patients who occurred AKI episode during hospitalization from Jan 1 2011 to Dec 31 2014 in The First Affiliated Hospital of Fujian Medical University were retrospectively analyzed.All these patients had normal basic renal function and had follow-up of more than two years after discharge.According to their renal function after two years,patients were divided into recover and non-recover group.The clinical features and risk factors associated with the prognosis of AKI patients were identified using multivariate logistic regression,and the proportion of renal function progression was calculated during follow-up period.Results One hundred and sixty-six patients were enrolled in this observational study,including 114 male,52 female with an average age of 58.1± 16.6.Eighty-seven patients were AKI stage 1,39 AKI stage 2,and 40 AKI stage 3.Thirty-seven patients were caused by pre-renal factors,113 patients by renal causes and 16 patients by post-renal causes.Renal function when discharged (P=0.002,OR=2.980) and infection (P=0.003,OR=2.786) were the risk factors of failing to restore after two years.Eighty-four patients' renal function returned to normal when discharged,but the number of patients whose renal function progressed to CKD 3 stage and even worse 1 year and two years later were 12 (14.3％) and 20 (23.8％) respectively.Fifty-four patients were diagnosed as partial recovery and 28 patients as non-recovery when discharged.One year later 22 (40.7％) and 12 (42.9％) patients' renal function progressed to CKD 3 stage and more,while those numbers became 28 (51.9％) and 16 (57.1％) two years later.Conclusions The risk factors of AKI long-term outcome include unrecovered renal function when discharged and infection.After AKI episode,even with fully recovered renal function,patients are still possible to progress to CKD,highlighting the importance of follow-up observation.

Relationship between perfusion mode of carotid plaque in CEUS and ischemic stroke in transient ischemic attack patients / 中国医学影像技术

Objective To evaluate the relationship between the perfusion mode of neovascularization of carotid plaque in CEUS and the ischemic stroke in transient ischemic attack (TIA) patient.Methods A total of 73 TIA patients according to the inclusive criteria were enrolled.All the patients underwent routine carotid ultrasonic examination.And 61 patients with plaque thicker than 2.5 mm in carotid bifurcation underwent CEUS and follow-up for at least 18 months.All the patients were divided into recurrent and non-recurrent groups.Logistic regression analysis were performed to detect the risk factors for incurrence of ischemic stroke or recurrence of TIA in 18 months.Results There were statistical differences between 2 groups in hypertension,diabetes,hyperlipemia,smoking history,family history of stroke,medication compliance,two-dimensional ultrasound and CEUS characteristics (all P＜0.05).Multivariate Logistic regression analysis showed that all the factors correlated with the recurrency,from big to small order were the CEUS characteristics of carotid plaque,hypertension,medication compliance,diabetes,two-dimensional ultrasound characteristics of carotid plaque.Conclusion CEUS could evaluate the perfusion mode of neovascularization in carotid plaques.For TIA patients,CEUS could predict the incurrence of ischemic stroke or recurrence of TIA,which can guide TIA patients targeted prophylaxis of them.

Risk factors of acute renal injury in patients with acute left heart failure / 中华肾脏病杂志

Objectives To investigate the risk factors of acute renal injury (acute kidney injury) in patients with acute left heart failure.Methods Clinical data of 188 patients with acute left heart failure who were admitted to our hospital were retrospectively analyzed.Logistic regression analysis was used to assess the risk factors for AKI.Results Among 188 patients with acute left heart failure,incidence of acute kidney injury was 33.51％.Univariate and Multivariable logistic regression analyses showed that the independent predictors of acute kidney injury were lower baseline eGFR (OR=4.294,P ＜ 0.001) and anemia (OR=3.573,P=0.006).Conclusions The incidence of acute left heart failure complicated with AKI was high.Basic state of renal function and anemia were the independent risk factors for AKI.

Design and clinical application of the instrument for percutaneous posterolateral lumbar foraminoplasty / 中华骨科杂志

ObjectiveTo introduce the design of the instrument for percutaneous posterolateral foraminoplasty and analyze long-term outcomes of percutaneous foraminoplasty and transforaminal endoscopic discectomy in the treatment of non-contained lumbar disc herniation.MethodsFifty-six patients with noncontained lumbar disc herniation confirmed by symptom,physical sign and concordant imaging underwent percutaneous foraminoplasty and transforaminal endoscopic discectomy,including 7 cases of L3-4,30 of L4-5 and 19 of L5S1.The visual analogue scales(VAS) of pre- and post-operative low back pain and sciatica were compared,and the Macnab scores were also evaluated.ResultsAll of the procedures were performed successfully,with mean operation time of 60 min(range,40-120 min),and a mean blood loss of 30 ml (range,20-50 ml).The follow-up time was more than 36 months.Postoperative VAS of low back pain and sciatica were significantly decreased compared with preoperative VAS (P＜0.01).There were 44 cases of excellent,10of good,and 2 of fair according to Macnab score system,with total successful rate (excellent and good) up to 96.4％.Only 5 cases with L5S1 disc herniation were found complicated with sun-burn syndrome,which were relieved by pulsed electro-stimulant therapy for 1 week.ConclusionPercutaneous foraminoplasty and transforaminal endoscopic discectomy is an effective and safe minimally invasive treatment alternative for non-contained lumbar disc herniation.

Effects of remifentanil on lipid peroxidation during hemorrhagic shock-induced acute lung injury in rabbits / 中华麻醉学杂志

Objective To investigate the effects of remifentanil on lipid peroxidation druing hemorrhagic shock-induced acute lung injury (ALI) in rabbits. Methods Thirty-two healthy adult rabbits weighing 2.0-2.5 kg were randomly divided into 4 groups (n = 8 each): sham operation group (group S); ALI group; low-dose remifentanil group (group LR); high-dose remifentanil group (group HR). The left femoral artery was cannulated for blood-letting and blood sampling. The right femoral artery was cannulated for remifentanil administration. The model of hemorrhagic shock was established by modified Wigger' s methods. In group S, only cannulation was performed. In group LR and HR, remifentanil was infused intraperitoneally at 0.66 and 1.32 μg·kg-1 ·min-1 15 min before blood-letting respectively, while group ALI received equal volume of normal saline instead. Arterial blood samples were taken at 0, 20,70 and 100 min after blood-letting (T1-4) for blood gas analysis. The animals were then sacrificed and the lungs were immediately removed for histological examination with light microscope and determination of W/D lung weight ratio, MDA content and SOD activity. Results W/D ratio and MDA content were significantly increased, while SOD activity was significantly decreased in group ALI compared with group S (P ＜0.05). The pH value at T2 and PaO2 at T2-4 in group LR and the pH value and PaCO2 at T2-4 in group HR were significantly higher than those in group ALI (P ＜ 0.05). W/D ratio and MDA content were significantly lower,while SOD activity was significantly higher in group LR and HR than in group ALI, and in group HR than in group LR (P ＜ 0.05). Remifentanil infusion significantly attenuated the pathologic changes in a dose-dependent manner. Conclusion Remifentanil pretreatment can attenuate hemorrhagic shock-induced ALI through inhibiting lipid peroxidation in rabbits.

Effect of liver cirrhosis on potency of propofol for sedation in rats / 中华麻醉学杂志

Objective To investigate the effect of liver cirrhosis on the potency of propofol for sedation in rats. Methods Fifty-eight male SD rats, aged 10-12 weeks, weighing 180-220 g, were randomly divided into 3 groups: control group (group C, n = 18), mild liver cirrhosis group (group M1, n =20) and severe liver cirrhosis group (group M2, n = 20). The model of liver cirrhosis was established using four factors described by Chen et al. After successful establishment of the model, propofol was injected intravenously. The dose of propofol was determined by up-and-down sequential method for loss of righting reflex. The dose of propofol was 5.912 mg/kg in the first rat and the ratio of the doses between the two consecutive rats was 0.85. ED50 of propofol was calculated using up-and-down sequential method. Results ED50 of propofol was significantly lower in group M1 and M2 than in group C and in group M2 than in group M1 ( P ＜ 0.05 or 0.01 ). Conclusion The liver cirrhosis can enhance the potency of propofol for sedation in rats.

The use of unilateral external fixators in treatment of distal shaft fractures of humerus / 中华创伤骨科杂志

Objective To retrospectively analyze the results of unilater al external fixators in the treatment of the distal third fractures of humeral s hafts. Methods From October 1997 to October 2002, 33 patients from 15y-70y (ave rage 31y) with the distal third fractures of humeral shafts were treated with un ilateral external fixators. They included 3 transverses fractures, 1 oblique fra cture, 9 spiral fractures and 20 comminuted fractures. 15 cases were treated wit h open reduction and fixation with external fixators and limited internal fixati on, 10 cases were treated with open reduction and fixation with external fixator s, and 9 cases were treated with closed reduction and fixation with external fix ators. 9 cases with radial nerve injury undewent nerve exploration. External fix ators were removed after bone healing. Duration of follow-up was 8 to 24 m (ave rage 18 m). Results The time of bone healing was 11 to 22 w (average 14 w). At t he latest follow-up, the function of injured radial nerves in 9 preoperative ca ses and 2 postoperative cases and the motion function of elbow were restored to normal. There were only 7 cases of superficial pin site infection which were cur ed with oral antibiotics and pin site care with mild disinfectants. Conclusion U nilateral external fixators can play special roles and have good results in the treatment of the distal third fractures of humeral shafts, combined with open re duction and limited internal fixation.

Transarticular fixation with external fixators in unstable distal radius fractures / 中华创伤骨科杂志

Objective To retrospectively analyze the results of closed reduction and static trans-articular fixation with unilateral external fixators in the treatment of unstable distal radius fractures.Methods From June 2000 to March 2005,45 patients with 50 unstable distal radius fractures were treated with closed reduction and static transarticular fixation by unilateral external fixators.Their average age was 44.8 years(15 to 78 years).All the fractures were classified with AO-scheme.There were five A3-fractures,four B3-fractures,three C1-fractures,nine C2-fractures and 29 C3-fractures in 24 cases.Follow-ups lasted from 8 to 48 months(averaging 20 months).Results The time of bone healing was 6 to 8 weeks(averaging 7.6 weeks).At the latest follow-up,the radiological outcomes were excellent in 42 fractures(39 patients)and good in eight fractures(six patients)according to the Sarmiento rating system modified by Ste wart et al.The functional results included 37 excellent cases(34 patients),nine good ones(eight patients)and four fair ones(three patients)according to the Gartland-Werley assessment.There were only four cases of superficial pin site infection settled with oral antibiotics and mild disinfectants.Conclusions Closed reduction by manipulation and static transarticular fixation with unilateral external fixators is an effective method to treat severely comminuted distal radius fractures caused by high-energy injury.Radial nerve injury and iatrogenic fracture of the 2nd metacarpal bone can be avoided,pin tract infection and pin loosening can be decreased,and early postoperative mobilization of hand can be facilitated by insertion of external pins at appropriate sites.It is unnecessary to apply supplementary bone grafting to promote bone healing.

Transforaminal Posterolateral Endoscopic Discectomy and Radiofrequency Annuloplasty for Discogenic Low Back Pain / 中国微创外科杂志

Objective To study the short-term outcome of transforaminal posterolateral endoscopic discectomy and radiofrequency annuloplasty in patients with discogenic low back pain. Methods A total of 25 patients with discogenic low back pain,who were diagnosed by provocative discography,received transforaminal posterolateral endoscopic discectomy and radiofrequency annuloplasty in our hospital. The VAS scores determined before and 6 months after the operation were compared in the patients. Their MacNab scores were also evaluated at 6 months postoperation. Results After the surgery,2 patients who had ruptured intervertebral discs (L5-S1) developed sunburn syndrome,and then was relieved by pulsed electrical stimulation for one week. The patients were followed up for 6-10 months,during which no other postoperative complications occurred. The mean VAS score of this series decreased significantly after the treatment,and kept being reduced in 6 months [preoperation:6.24?0.97,1,3,6 months after the operation:0(0~2); Kruskal-Wallis rank-sum test,H=61.680,P=0.000]. Four patients showed lower limbs pain before the treatment and were relieved after the surgery. The evaluation of MacNab score showed excellent in 11 pateints,good in 12,and fair in 2,suggesting an effective rate of 92.0%(23/25). Conclusions Transforaminal posterolateral endoscopic discectomy plus radiofrequency annuloplasty is effective for discogenic low back pain in a short term.

The treatment of comminuted distal radius fractures caused by high-energy injuries / 中华骨科杂志

Objective To analyze retrospectively the results of closed reduction and static transarticular fixation with unilateral external fixators in the treatment of severely comminuted distal radius fractures caused by high-energy injuries. Methods From June 2000 to June 2003, 20 patients with 24 severely comminuted distal radius fractures were treated with closed reduction and static transarticular fixation with unilateral external fixator. The injuries involved 16 males and 4 females, the age of the patients was from 15 to 48 years (average 33.4 years). All fractures were classified as Frykman's type Ⅷ or AO type C3. The operative technique consisted of reduction of the fractures by manipulation or assisted with the external fixator, then fixed them statically. The mean duration of the union was 7.4 weeks (ranged from 6-8 weeks). After the fixator removal, the patients were encouraged to proceed for the rehabilitations, such as the elbow flexion-extension, radial abduction, ulnar adduction, and the pronation as well as the supination of the forearm. Results All patients were available at the final follow-up, the mean duration was 16 months (range, 6-42 months). At the last examination, the radiological manifestations revealed excellent in 21 fractures (17 patients) and good in 3 (3 patients) according to the Sarmiento scoring system (modified by Stewart); and the functional results displaied excellent in 16 (13 patients), good in 6 (5 patients) and fair in 2 (2 patients) according to Gartland-Werley functional assessment system. There were only 2 cases of superficial pin site infection cured with oral antibiotics and local care with mild disinfectants. 7 obvious defect of mataphysis occurred in 5 patients, but the fractures united simultaneously without any additional treatment. And there was no any complication, such as pin tract infection, fixator loosening, iatrogenic fracture and injury of the superficial radial nerve. Conclusion The technique of closed reduction by manipulations or external fixators combined with static transarticular fixation plus unilateral external fixators is an effective method for the treatment of severely comminuted distal radius fracture caused by high-energy injuries, such as falling from the height. It is unnecessary to apply supplementary bone grafts to promote bone healing. The complications can be avoided by selecting the right sites for the insertion of the pins, which is beneficial for the hand to mobilize earlier after operation.