[Clinical observation of different intramedullary fixation methods for the treatment of intertrochanteric fracture].

OBJECTIVE: To explore clinical efficacy of proximal femoral nail anti-rotation(PFNA),InterTan and proximal femoral bionic intramedullary nail (PFBN) in treating femoral intertrochanteric fracture. METHODS: Clinical data of 120 patients with intertrochanteric fracture who were underwent closed reduction intramedullary nail-internal fixation from January 2020 to January 2021 were retrospectively analyzed. According to methods of internal fixation,patients were divided into 3 groups. There were 25 patients in PFBN group,including 16 females and 9 males,aged from 69 to 79 years old with an average of (73.67±5.16) years old. There were 55 patients in PFNA group,including 38 females and 17 males,aged from 68 to 80 years old with an average of (74.23±5.57) years old. There were 40 patients in InterTan group,including 26 females and 14 males,aged from 68 to 79 years old with an average of (73.45±5.34) years old. Operative time,intraoperative blood loss,incision length,hospital stay,weight-bearing time,fracture healing time and complications among 3 groups were compared,and clinical effect was evaluated by Harris score of hip function before operation,1,6 and 12 months after opertaion,respectively. RESULTS: Patients among 3 groups were successfully completed operation and were followed up for more than 12 months. There were no significant difference in hospital stay,operative time,intraoperative blood loss and incision length among 3 groups (P>0.05). Weight bearing time of PFBN group (7.98±1.34) d and InterTan group (8.22±0.46) d were earlier than that of PFNA group (10.27±0.66) d(P<0.01). Fracture healing time of PFBN group (10.14±2.33) weeks and InterTan group (11.87±2.48) weeks were earlier than that of PFNA group (13.68±2.36) weeks (P<0.01). One month after operation,Harris score in PFBN group (70.52±5.34) and InterTan group (69.81±6.17) was higher than that of PFNA group (51.46±5.36),and there was no significant difference between PFBN group and InterTan group (P>0.05). There were no significant difference in Harris scores among 3 groups before operation,6 and 12 months after opertaion(P>0.05). Cases of complication of InterTan group and PFNA group were lower than that of PFNA group (P<0.05). CONCLUSION: PFBN and InterTan for the treatment of intertrochanteric fracture have advantages of faster fracture healing,earlier weight-bearing time and fewer postoperative complications than traditional PFNA,but three operations could achieve higher effective rates without significant difference in long-term results.

[Minimally invasive osteotomy and manual reduction for hallux valgus].

OBJECTIVE: To explore clinical effects of minimally invasive osteotomy and manual reduction in treating hallux valgus. METHODS: From January 2018 to May 2019, 31 patients (42 feet) with hallux valgus were treated with minimally invasive osteotomy and manual reduction, including 3 males and 28 females aged from 18 to 76 years old with an average of (50.1± 4.9) years old. Preoperative and postoperative hallux valgus (HVA), intermetatarsal angles(IMA), length difference between 1 and 2 metatarsals were recorded and compared, and American Orthopedic Foot and Ankle Society (AOFAS)score were observed and measured. RESULTS: Thirty-one patients (42 feet) were followed up from 14 to 18 months with an average of (15.1± 1.2) months. HVA, IM before operation were (38.5±5.4)°, (13.0± 1.1)°, and improved to (14.3±4.7)°and (9.1±1.5)°after operation respectively(P<0.05). Preopertaive length difference between 1 and 2 metatarsals was 2-4(-0.59±1.80) mm, and 0 to -6(-3.53±1.60) mm after operation, the average shortening of the first metatarsal was 2.94 mm. There were significant difference between preoperative and postoperative. Preoperative AOFAS score was 57.8±9.7, increased to 92.1±9.3 at the final follow-up, there was significant differences (P<0.05). According to standard of AOFAS score, 32 feet obtain excellent results, 16 good and 3 moderate. CONCLUSION: Minimally invasive osteotomy and manual reduction in treating hallux valgus have advantages of shorter operation time, less length of incision, and could correct hallux valgus deformity, improve front feet and receive good clinical effect in further.

Nickel-catalyzed product-controllable amidation and imidation of sp3 C-H bonds in substituted toluenes with sulfonamides.

A nickel-catalyzed product-controllable imidation and amidation of sp3 C-H bonds in substituted toluenes with sulfonamides were developed. Based on the change of the reaction time and atmosphere from N2 to O2, this reaction proceeded in high yields and excellent selectivity under different conditions. Mechanistic details were also described.

Nickel-Catalyzed Regioselective Cross-Dehydrogenative Coupling of Inactive C(sp(3))-H Bonds with Indole Derivatives.

A nickel-catalyzed regiosepecific C2- versus C3-oxidative cross-coupling reaction of indoles with 1,4-dioxane and other inactive C(sp(3))-H bonds is described. The divergent synthesis of C(sp(3))-C(sp(2)) bonds was achieved in satisfactory yields with di-tert-butyl peroxide (DTBP) as the oxidant, which provides an efficient strategy for the selective construction of cyclic ethers containing heteroaromatic core structures.

[Comparative study on effect and safty of treating on calcaneus fractures with manipulative reduction with percutaneous K-wire fixation].

OBJECTIVE: To explore the clinical effects and safty of manipulative reduction with percutaneous poking K-wire fixation for the treatment of the calcaneus fractures and analyze the indication of the minimal invasion. METHODS: From December 2008 to December 2011,135 closed calcaneal fractures cases were divided randomly into poking group and plate group, treated respectively by percutaneous poking reduction and operative reduction. In poking group, there were 69 cases (82 feet) including 60 males and 9 females, with an average age of (43.29+/-10.46) years ranging from 18 to 64 years; 30 cases of left, 26 cases of right and 13 cases of double; 54 feet of Essex-Lopresti classification tongue form, 28 feet of joint compression; 33 feet of Sanders type II ,49 of type III. In plate group, there were 66 cases (75 feet) including 58 males and 8 females,with an average age of (46.00+/-2.42) years ranging from 21 to 63 years; 31 cases of left, 26 cases of right and 9 cases of double; 48 feet of Essex-Lopresti classification tongue form, 27 feet of joint compression; 28 feet of Sanders type II, 47 of type III. According to Kerr scoring standard,clinical effects and complications were evaluated combining with Sanders and Essex-Lopresti classification. RESULTS: All 135 cases were followed up after 24 weeks. Fractures were recoveried in 8 to 12 weeks (means 10.2 weeks). In poking group, there were 2 cases of infection, 5 cases of wire movement; in plate group,18 cases of wound local skin necrosis, 5 cases of calf intestines nerve injured; there were statistical significant (P<0.05). Postoperative evaluation of Sanders type II after 24 weeks, the proportion of excellent results was above 70%,and there were no significant differences on effects of tongue form and compressing form of calcaneus fractures with percutaneous poking and operative redution (P>0.05). In the caes of Sanders type III, there were no significant differences on effects of tongue form fractures with percutaneous poking and operative reduction (P>0.05). There were significant differences on effects and complications of compressing form fractures (P<0.01), operative reduction better than percutaneous poking. Pain, walking,Kerr scoring of tongue form fractures of Sanders II , III with poking reduction were better than compression fractures. In compression fractures of Sanders Ill, plate internal fixation was better than poking redution in working and walking function, there were significant difference (P<0.05). CONCLUSION: For tongue form or compressing form of Sanders type II and tongue form of Sanders type III, manipulative reduction with percutaneous poking K-wire fixation has advantages of minimal invasion, minimized complications. Compressing form of Sanders type III fracture should be treated with operative redution.

[Study on the correlation between syndrome differ classification of knee osteoarthritis and X-ray image].

OBJECTIVE: To study the correlation between syndrome differ classification of knee osteoarthritis and X-ray image, so as to provide evidence for clinical diagnosis and treatment. METHODS: From Jun. 2007 to Dec. 2007, 78 patients (108 knees) with knee osteoarthritis were reviewed, including 65 females (89 knees) and 13 males (19 knees), ranging in age from 41 to 77 years. According to the standards for the differentiation of syndrome in the treatment of knee osteoarthritis defined in Principle of Clinical Research for New Traditional Herbs, the patients were divided into three types: Type I, insufficiency of the liver and kidney, with stagnation of tendons and muscles, 43 knees; Type II, insufficiency of the spleen and kidney, with dampness infusion into bone and joints, 26 knees; Type I, deficiency of the liver and kidney, with inter-obstruction of phlegm and stasis 39 knees. Normotopia and lateral plain film of knee joint of weigh loading and in erect position, and patellofemoral Skyline plain flim was taken. Joint space narrow, osteophyte generation, subchondral osteosclerosis and subchondral cystic degeneration were evaluated. All data were analyzed by K independent samples nonparametric test in order to find out the correlation between syndrome differ classification of knee osteoarthritis and X-ray image. RESULTS: It was shown that after K independent samples nonparametric test about syndrome differ classification of knee osteoarthritis and X-ray image: there were significant differences among three types about lateral patella osteophyte, condyles of tibia osteophyte and Type II was the most serious, Type I was secondary, Type II was the lightest. Other index had no obvious difference among the three groups. CONCLUSION: There is certain correlation between syndrome differ classification of knee osteoarthritis and X-ray image. There are significant differences among three types about lateral patella osteophyte, condyles of tibia osteophyte, the Type II is the most serious,Type I is secondary, Type II is the lightest. Consequently, it can be deduced that worse osteophyte is one of accordances of Type II-insufficiency of the spleen and kidney, with dampness infusion into bone and joints. And, the Type II is more serious stage in radiologic manifestation.

[Study on the relationship between clinical syndromes and X-ray manifestation of knee osteoarthritis].

OBJECTIVE: To study the relationship between clinical syndromes and X-ray manifestation of knee osteoarthritis (KOA), so as to provide evidence for clinical diagnosis and treatment. METHODS: Seventy-eight patients (108 knees) with KOA from out-patient clinic of orthopedic were collected, aged from 41 to 77, including 65 females (89 knees) and 13 males (19 knees). Questionnair investigation of Lequesne index was performed among all these patients and the Lequesne index was calculated. And all these patients were divided into two groups, mild group (Lequesne index < or = 8) and severe group (Lequesne index > 8). Weight-bearing anteriorposterior and lateral plain film of knee joint and patellofemoral Skyline plain flim was taken. Joint space narrowing, osteophyte formation, subchondral osteosclerosis and subchondral cystic degeneration were evaluated. The lower limb alignment and lateral patella angle were detected. The correlation of the Lequesne index and X-ray manifestation was analyzed by logistic regression analysis. RESULTS: There were significant differences between mild and severe groups in the following indexes: lateral tibiofemoral joint space narrowing, the medial retropatellar space narrowing, medial and lateral tibia osteophytes, medial and tibial femur femur osteophytes, medial and lateral trochlea osteophytes, lateral patella osteophytes, tibia introcondylar osteophytes (P<0.05). The results of the logistic regression analysis showed that the lateral femur osteophytes were the most important radiologic manifestation to evaluate the severity degree of KOA,with the minimum associated probability (0.009) and the maximum wald value (6.779). CONCLUSION: When evaluating the severity degree of KOA,the joint space narrowing and osteophytes are the most sigenificant radiologic manifestation which includs the lateral tibiofemoral joint space narrowing, the medial retropatellar space narrowing, medial and lateral tibia osteophytes, medial and lateral femur osteophytes, medial and lateral trochlea osteophytes, lateral patella osteophyte, tibial intercondylar osteophyte.