Gongji classification and treatment strategies for lateral clavicle fractures / 中华骨科杂志

Objective:To establish a new classification of lateral clavicle fractures and to evaluate its clinical value.Methods:The data of 67 patients with lateral clavicle fractures admitted from January 2016 to December 2020 were included. Thirty-seven cases were from Shanghai First People's Hospital, including 22 males and 15 females, with an average age of 49.1 years (22-78 years). Thirty cases were from the Second Upper Limb Ward of Tianjin Hospital of Tianjin, including 20 males and 10 females, with an average age of 47.6 years (19-76 years). The ligament injury was determined by measuring the coracoclavicular space on Zanca view X-ray and the distance between the fracture fragment on the inferior surface of the 3D-CT and the distal end of the clavicle. All patients were classified according to the new classification (based on the measurement on Zanca view X-ray and 3D-CT reconstruction, the relationship between the fracture and the coracoclavicular ligament footprint, coracoclavicular ligament injury, the injury of the acromioclavicular joint and the stability of the fracture), conservative treatment is preferable for stable fractures, and surgical treatment for unstable fractures. Three experienced orthopaedic surgeons and three radiologists independently observed the imaging data of 67 patients with distal clavicle fractures, determined the fracture type according to the new classification, and randomly reclassified after 4 weeks interval. Finally, 15 cases were randomly selected for internal control (2 junior orthopedic physicians), and the ICC value was used to assess the reliability. Results:The lateral clavicle fractures were divided into 5 types according to the Gongji classification. Type 1: isolated conical tubercle avulsion fracture, and the fracture line is located medial to the coracoid process; Type 2: complete involvement of the trapezoid & conical ligament at the clavicle insertion, and the fracture line extends to the middle of the clavicle, mean while the acromioclavicular joint is intact; Type 3: fracture fragments on the inferior surface involving the trapezoidal/conical ligament, respectively; Type 4: rupture of the conical ligament, and avulsion fracture of the trapezoid ligament; Type 5: conical ligament intact, and avulsion fracture of clavicle insertion of the trapezoid ligament. There were 18 cases of type 1, 4 cases of type 2, 8 cases of type 3, 32 cases of type 4, and 5 cases of type 5. The inter-observer and intra-observer agreement of all included cases was good (inter-group: first ICC=0.764, second ICC=0.778; intra-group: shoulder specialist ICC=0.782, radiologist ICC=0.750, internal control ICC=0.793). Types 1 and 2 fractures were fixed with anatomical plate and coracoid anchor. Type 3 and 4 fractures were fixed with clavicle hook plate and coracoid anchor. And type 5 underwent conservative treatment. At the last follow-up, all patients had no obvious shoulder joint instability and pain, and no internal fixation failure or fixation breakage was found. Conclusion:The Gongji classification has moderate reliability between observers and intra-observers, and the Gongji distal clavicle fracture classification has a good significance for evaluating the stability of the fracture and guiding the selection of the treatment.

Reconstruction of coracoclavicular ligament combined with hook plate technique for treatment of distal clavicle fractures involving avulsion of coracoclavicular ligament / 中华骨科杂志

Objective@#To explore the operative strategy of distal clavicle fracture involving coracoclavicular ligament.@*Methods@#Data of 17 cases of distal clavicle fracture involving coracoclavicular ligament in our hospital from January 2013 to December 2018 were analyzed retrospectively. According to whether the coracoclavicular ligament was reconstructed or not, the patients were divided into two groups: non reconstruction group (10 cases), male (7 cases), female (3 cases), 19-60 years old (37.9±11.9). In the reconstruction group, 7 cases were male 5, female 2, 25-62 years old (44.9±13.0). Three dimensional CT was used to judge the ligament injury and X-ray was used to evaluate the fracture reduction and healing after operation. The time of fracture healing was compared between the two groups. The function of shoulder joint was evaluated by visual analog scale (VAS) and Constant score of shoulder joint.@*Results@#The patients in both groups were followed up for (18.7±6.7) months (range, 9-27 months). At the latest follow-up, the time of fracture healing in the reconstruction group was 12.6±0.7 weeks (range, 12-14 weeks); VAS score was 3.0±1.3 and Constant-Murley score was 85±11. While those in the non reconstruction group were 23.7±7.9 (range, 16- 48 weeks), 3.1±1.8 and 77±10 respectively. The time of fracture healing was statistically significant (t=3.361, P=0.004). There was no significant difference in VAS score and Constant score (P> 0.05). In the non reconstruction group, there were 1 case of delayed union of fracture (healed 48 weeks after operation), 1 case of loosening of clavicular hook plate, 5 cases of acromioclavicular joint dislocation (Rockwood type II) after removal of internal fixation, and the overall complication rate was 70% (7/10). Reconstruction group: 1 case of acromial fracture, the overall complication rate was 14.3% (1/7). There was significant difference between the two groups (χ2=5.13, P=0.024).@*Conclusion@#Reconstruction of clavicular insertion of coracoclavicular ligament can effectively reduce the postoperative complications of distal clavicular fracture involving the coracoclavicular insertion. Attention should be paid to the repair and reconstruction of coracoclavicular ligament injury during fracture treatment.

Reconstruction of coracoclavicular ligament combined with hook plate technique for treatment of distal clavicle fractures involving avulsion of coracoclavicular ligament / 中华骨科杂志

Objective To explore the operative strategy of distal clavicle fracture involving coracoclavicular ligament.Methods Data of 17 cases of distal clavicle fracture involving coracoclavicular ligament in our hospital from January 2013 to December 2018 were analyzed retrospectively.According to whether the coracoclavicular ligament was reconstructed or not,the patients were divided into two groups:non reconstruction group (10 cases),male (7 cases),female (3 cases),19-60 years old (37.9± 11.9).In the reconstruction group,7 cases were male 5,female 2,25-62 years old (44.9± 13.0).Three dimensional CT was used to judge the ligament injury and X-ray was used to evaluate the fracture reduction and healing after operation.The time of fracture healing was compared between the two groups.The function of shoulder joint was evaluated by visual analog scale (VAS) and Constant score of shoulder joint.Results The patients in both groups were followed up for (18.7±6.7) months (range,9-27 months).At the latest follow-up,the time of fracture healing in the reconstruction group was 12.6±0.7 weeks (range,12-14 weeks);VAS score was 3.0± 1.3 and Constant-Murley score was 85± 11.While those in the non reconstruction group were 23.7±7.9 (range,16-48 weeks),3.1± 1.8 and 77± 10 respectively.The time of fracture healing was statistically significant (t=3.361,P=0.004).There was no significant difference in VAS score and Constant score (P＞ 0.05).In the non reconstruction group,there were 1 case of delayed union of fracture (healed 48 weeks after operation),1 case of loosening of clavicular hook plate,5 cases of acromioclavicular joint dislocation (Rockwood type Ⅱ) after removal of internal fixation,and the overall complication rate was 70％ (7/10).Reconstruction group:1 case of acromial fracture,the overall complication rate was 14.3％ (1/7).There was significant difference between the two groups (x2=5.13,P=0.024).Conclusion Reconstruction of clavicular insertion of coracoclavicular ligament can effectively reduce the postoperative complications of distal clavicular fracture involving the coracoclavicular insertion.Attention should be paid to the repair and reconstruction of coracoclavicular ligament injury during fracture treatment.

Research progress of septic cardiomyopathy / 中国中西医结合急救杂志

Septic cardiomyopathy is one of the most common complications of sepsis in clinics. Up to now, the pathogenesis of septic cardiomyopathy has not been fully elucidated, and the clinical mortality has been at a relatively high level in patients with organ injury caused by sepsis, so that improving the cardiac dysfunction and myocardial injury of septic patients is of great significance in improving their prognoses. In this article, the related literatures regarding the research and therapeutic progress of septic cardiomyopathy in traditional Chinese and western medicine in recent years were read and summarized.

Relationship between von Willebrand factor level and cardiovascular events in patients with stable coro-nary heart disease / 心血管康复医学杂志

Objective:To explore the relationship between arterial plasma levels of von Willebrand factor (vWF) and cardiovascular events in patients with stable coronary heart disease (CHD) .Methods :A total of 88 stable CHD pa‐tients from Aug 2007 to Dec 2008 , were enrolled ,their clinical ,coronary angiography (CAG) and percutaneous coronary intervention (PCI) data were collected .Enzyme linked immunosorbent assay was used to measure arterial (aortic root) plasma vWF level before PCI .Except two lost cases ,according to baseline vWF level ,other patients were divided into high vWF level group (vWF≥13.5 ng/ml ,n=43) and low vWF level group (vWF 0.05 all .Conclu‐sion:In patients with stable coronary heart disease ,level of von Willebrand factor is not significantly related to long-term cardiovascular events .

Preliminary investigation into clinical values of intravascular ultrasound in carotid artery narrowing of transient ischemia attack / 中华超声影像学杂志

ObjectiveTo investigate preliminary applic ation values of intravascular ultrasound(IVUS)in the carotid artery narrowing of transient ischemia attack (TIA) patients. MethodsIVUS has been used to 4 TIA patients with carotid artery narrowing identified by carotid artery echo, following carotid stenting and completion angiogram to detect evidence of inappropriate stent deployment. ResultsIVUS revealed the vessel wall structure, plaque morphology, measured accurately the narrowing degree of carotid artery. The narrowing percent identified by IVUS was larger than angiogram, and IVUS was more sensitive in detecting plaque than digital subtraction angiography(DSA). Four patients accepted stent deployment successfully.ConclusionsDSA underestimated the severity of the lesion. IVUS more accurately evaluates the extent and characteristics of the lesions than DSA, it is an important and useful component of carotid artery stent procedures.

THE TECHNOLOGICAL CONDITIONS OF PRODUCING 2-KETO-LGULONIC ACID FROM D-GLUCOSE BY DIRECT FERMENTATION / 微生物学通报

2-Keto-L-gulonic acid (2-KLG), the precurcor of L-ascorbic acid synthesis, was prepared directly from D-glucose by tandem fermentation. In the first step fermentation Erwinia sp. SCB 247 translated D-glucose to 2,5-diketo-D-gluconate (2,5-DKG), which accumenlated 180 mg 2,5-DKG per ml in the broth. In the second step fermentation Corynebacterium sp. SCB 3058 reduced 2,5-DKG to 2-KLG, which accumulated 35 mg 2-KLG per ml in the broth. This reductive fermentation was obtained under aerobic conditions by adding a hydrogen donor such as glucose.The average yield of five batches fermentation was 56.3 mol%, from D-glucose to 2-KLG in 10 L fermentor.