[Early effect of induced membrane technique for the reconstruction of chronic osteomyelitis defects in limbs of adult patients].

OBJECTIVE: To investigate the early clinical efficacy of induced membrane technique for reconstruction of large bone defects after debridement in adults with chronic osteomyelitis of limbs. METHODS: From March 2010 to March 2012,a total of 23 adult patients with chronic osteomyelitis of limbs were treated in our department. There were 15 males and 8 females, with a mean age 35.2 years old (ranged from 26 to 49 years old). Sixteen patients had open fracture history. According to the lesion site, there were 12 cases of tibia, 7 cases of femur, 3 cases of humerus, and 1 case of both radius and ulna. Among them, 19 patients had diseases in diaphysis and 4 patients in the metaphysis. The mean interval from infection to operation was 6.9 months (ranged from 4 to 13 months). All the patients were treated by using induced membrane technique. The follow-up evaluation included clinical complications, time of bone healing and limbs function. The Chinese version of SF-36 scores was used in the assessment of quality of life pre- and post-operation. RESULTS: The average duration of follow-up was (27.6 ± 5.3) months (ranged from 18 to 43 months). Two patients had postoperative flap edge necrosis, 1 patient had superficial iliac incision infection, no obvious complications were recorded. Twenty patients obtained radiological union at a mean time of 4.6 months (ranged from 3 to 7 months). Among them, 16 patients treated with lower limbs surgery achieved full weight-bearing at about 5.2 months (ranged from 4 to 8 months) postoperatively. Four patients suffered from reinfection during follow-up, but 3 of them achieved complete bone healing after the second surgeries with induced membrane technique. At the final follow-up, there was a substantial improvement in each dimension scores and total scores of SF-36 as compared with those before surgery. CONCLUSION: When treating with adult chronic osteomyelitis of limbs, the induced membrane technique can effectively reconstruct large bone defects after debridement, significantly shorten treatment cycle, provide satisfactory results with minimal complications, promote good recovery of limbs function and require relatively simple operation technique.

A modified technique for fixation of chronic instability of the distal tibiofibular syndesmosis using a wire and button.

Distal tibiofibular syndesmosis injury accounts for 1% to 11% of soft tissue injuries of the ankle. Some acute syndesmotic injuries will fail to heal effectively owing to inadequate treatment or misdiagnosis, eventually resulting in chronic instability, which can destroy the stability of the ankle joint. Various surgical techniques have been described for fixation of the syndesmosis. Among the existing methods, the suture button has the advantage of allowing for physiologic micromotion at the syndesmosis by maintaining the reduction and preventing the risk of screw breakage. However, the "relatively" long suture between buttons can gradually relax under continuous loading, resulting in fixation failure, which we have termed electric wire phenomenon. In the present report, we have described a modified technique for flexible fixation using the Endobutton CL ULTRA fixation device by tricortical fixation, instead of quadricortical fixation, to allow for robust and reliable fixation of the distal tibiofibular syndesmosis. The modified technique is devoid of the concern regarding the use of screw fixation and can reduce the risk of displacement or elongation and skin irritation associated with the suture button.

[Acutrak headless compression screw fixation for the treatment of scaphoid non-union].

OBJECTIVE: To evaluate the early clinical and radiographic outcome of scaphoid non-unions treated with Acutrak headless compression screw. METHODS: From January 2008 to July 2011,21 patients with scaphoid non-union were treated in our department. There were 18 males and 3 females with a mean age of (23.6 +/- 4.6) years; 12 cases were on right hand and 9 were on left. According to Herbert-Fisher classification, there were 10 cases with type D1, 7 cases with type D2, 3 cases with type D3, and 1 case with type D4. The mean time from injury to operation was (12.4 +/- 2.7) months. All patients were treated with Acutrak headless compression screw fixation (6 cases received 2 screws fixation, 15 cases received 1 screw fixation, and Matti-Russe bone grafting was applied in 7 cases). The carpal height, the scaphoid index and changes of the scapholunate angle were assessed before and after the operation. Range of motion and grip strength were recorded and the wrist function was assessed according to the Patient-Rated Wrist Evaluation (PRWE). RESULTS: Average duration of follow-up was (21.3 +/- 3.6) months. All the patients attained radiological union in a mean time of (13.3 +/- 2.4) weeks following the operation. No obvious complications were recorded. The surgical treatment allowed the preoperative mean scaphoid index of 0.61 +/- 0.13 and the preoperative mean scapholunate angle of (59.4 +/- 6.8) degree to be improved to 0.69 +/- 0.10 and (44.3 +/- 8.2)degree postoperatively, respectively. There was a substantial improvement in grip strength and pain amelioration after surgery. The preoperative mean PRWE score of 45.2 +/- 4.7 was improved to 76.1 +/- 5.2 postoperatively. All patients returned back to the original work,the average time from surgery to work was (6.0 +/- 1.1) months. CONCLUSION: For scaphoid non-unions, Acutrak headless compression screw fixation can provide anatomical reduction, provide satisfactory results with a high union rate, well return of function and minimal complications in the early stage.

Expression of cyclooxygenase-2 and vascular endothelial growth factor in human prostate cancer and its significance / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate expressions of cyclooxygenase-2 (COX-2) and vascular endothelial growth factor (VEGF) in primary prostate cancer and its clinical significance.</p><p><b>METHODS</b>Expressions of COX-2 and VEGF were detected by immunohistochemical assay in tissues of 40 prostate cancer and 10 benign prostatic hyperplasia samples.</p><p><b>RESULTS</b>COX-2 and VEGF levels in prostate cancer were much higher than those in BPH. The degrees of cancer malignancy and invasion positively correlated with the expressions of COX-2 and VEGF. COX-2 level positively correlated with VEGF level.</p><p><b>CONCLUSION</b>The abnormal expression of COX-2 plays an important role in the development of primary prostate cancer. COX-2 and VEGF are good molecular markers of prostate cancer which are hopeful to be used for the assistant diagnosis and the prediction of prognosis of prostate cancer.</p>