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Objective:To explore the therapeutic effect on transposition of peroneal longus tendon in reconstruction of long segment defects of chronic Achilles tendon.Methods:From November 2013 to November 2018, 17 patients with long segment defects of chronic Achilles tendon(greater than 5.0 cm of defect) were admitted in the Department of Trauma and Micro-orthopaedics of Zhongnan Hospital of Wuhan University. The patients were 14 males and 3 females, aged 19-55 years old, with an average of 34.7 years old. Eleven patients had defects on left Achilles tendon and 6 on the right. The chronic defects lasted over 1-12 months with an average of 3.8 months. The broken ends of the Achilles tendon located at 0-5.0 cm from the insertion point. The defects were at 5.0-9.0 cm in length, after debridement of the broken ends. After thoroughly debridement of the scar tissue over the broken end of an Achilles tendon, an autologous peroneal tendon transposition was performed for reconstruction of an Achilles tendon. Postoperative follow-ups were conducted to observe wound healing and complications. Arner Lindholm score was employed to evaluate the therapeutic efficacy before surgery and at the final follow-up. Ankle-hindfoot score of American Orthopedic Foot and Ankle Society(AOFAS) and Achilles Tendon Total Rupture Score(ATRS) were used to evaluate functional recovery. At the final follow-up, heel raise of single affected foot and the maximum circumference of both calves were observed, gait analyses for plantar stress assessment as well as review of ankle CT and MRI scans were conducted for assessment of therapeutic efficacy. Using t test in SPSS 22.0 software to compare preoperative and postoperative AOFAS and ATRS scores, P<0.05 indicates a statistically significant difference. Results:Wounds healed in one stage, except 1 diabetic patient who had haematoma in the wound after surgery and healed after debridement combined with VSD treatment. All the 17 patients had completed the postoperative follow-up that lasted for 24-48 months, with an average of 33 months. According to Arner Lindholm score for efficacy evaluation, 11 patients were in excellent and 6 in good. The postoperative AOFAS scores increased from 62.94 ± 6.51 before surgery to 93.71 ± 6.15 after the surgery. ATRS increased from 29.00 ± 3.54 before surgery to 92.29 ± 3.02 after the surgery, and the score difference between before and after surgery was staistically significant ( P<0.05). No patient experienced a complication such as Achilles tendon rupture, wound infection or nerve injury. During follow-up, ankle functions recovered well, valgus was found powerful as well as heel raise on single foot. The circumference of the affected calf was smaller than that of the healthy side by no more than 1.5 cm. Gait analysis showed balanced distribution of plantar stress. No corpus callosum formation was found in both of the affected and the healthy feet. No obvious sign of osteoarthritis of ankle showed review in CT scans. Ankle MRI scans showed good continuity of the reconstructed Achilles tendons, which become significantly thicker after the surgery. Conclusion:The transposition of the long peroneal tendon is a relatively simple and effective surgical technique for reconstruction of a chronic Achilles tendon rupture or defect in a longer length or a rupture at the insertion point.
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Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.
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Objective:To evaluate a wound diagnosis and treatment mode with integrated medical care in the repair of chronic infectious wounds plus bone exposure at lower extremities.Methods:A retrospective analysis was conducted of the 64 patients with chronic infectious wound plus bone exposure at the lower 1/3 of the leg who had been admitted to Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University from January 2019 to December 2021. The patients were divided into 2 groups according to the wound diagnosis and treatment mode. In the observation group of 31 patients subjected to the wound diagnosis and treatment mode with integrated medical care led by specialist nurses, there were 24 males and 7 females with an age of (53.6±12.4) years, the wound was located at the tibial side in 15 cases and at the fibular side in 16 cases, the wound areas averaged [28.27 (23.56, 37.70) cm 2], and the time from injury to treatment was (27.3±4.1) d. Evaluation of the patient's condition, wound diagnosis and formulation of treatment protocols were performed jointly by a doctor-nurse team after the patients were admitted, and continuous diagnosis and treatment of the wounds were carried out mainly by specialist nurses during the doctors' follow-up. In the control group of 33 patients subjected to the conventional wound diagnosis and treatment mode led by doctors, there were 25 males and 8 females with an age of (51.3±14.3) years, the wound was located at the tibial side in 17 cases and at the fibular side in 16 cases, the wound areas averaged [27.49 (17.84, 40.45) cm 2], and the time from injury to treatment was (27.6±4.0) d. The 2 groups were compared in the wound healing rate, wound recurrence rate, hospitalization time and patients' satisfaction. Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). The observation group achieved a significantly higher wound healing rate within 1 month after treatment [83.87% (26/31)] than the control group [60.61% (20/33)], a significantly lower wound recurrence rate within 6 months after treatment [0% (0/31)] than the control group [18.18% (6/33)], significantly shorter hospitalization time [18.0 (15.1, 20.9) d] than the control group [26.8 (18.4, 40.1) d], and significantly higher patients' satisfaction [50 (50, 50) points] than the control group [50 (42, 50) points] (all P<0.05). Conclusion:In the repair of chronic infectious wounds plus bone exposure at lower extremities, the wound diagnosis and treatment mode with integrated medical care led by specialist nurses may result in a higher wound healing rate, a lower wound recurrence rate, a shorter hospital stay and higher patients' satisfaction than the conventional wound diagnosis and treatment mode led by doctors.
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Objective@#To suggest strategies for emergency diagnosis and treatment of trauma orthopedics in the epidemic period of Corona Virus Disease 2019(COVID-19).@*Methods@#In the epidemic of COVID-19 from January 21 to February 15, 2020, 128 patients with orthopaedic trauma sought emergency treatment at Department of Orthopedic Surgery, The People’s Hospital of Wuhan University. They were 71 males and 57 females with an average age of 48.7 years (from 5 to 88 years).Of them, 107 cases were treated at the outpatient department and 21 hospitalized. Emergency operations were carried out for 4 cases and selective operationsfor 17 cases. COVID-19 infections were recorded in the patients and medical staff as well. Measures taken and experiences learned were summarized since the epidemicoutbreak of COVID-19.@*Results@#Of the 107 cases treated at the outpatient department, 3 had a definite diagnosis of COVID-19 and 3 a suspected diagnosis of COVID-19. Of the 4 cases undergoing emergency surgery, one was suspected of having COVID-19. Of the 17 cases undergoing selective surgery, one was diagnosed definitely as COVID-19and 2 were suspected of COVID-19. Two nurses were diagnosed definitely as having mildCOVID-19.One doctor and one nurse were suspected of COVID-19. Since the COVID-19 infections in medical staff occurred all before the preventive and control measures for COVID-19 had been implemented,is was not ruled out that their infections might have come from communities.@*Conclusions@#It is particularly important for medical institutions of all levels to maintain safe and effective routine services while doing well in COVID-19 prevention. In the epidemic of COVID-19, front-line medical staff in emergency traumatic orthopedics is faced with great challenges in the process of diagnosing and treating patients. High-quality and safe medical services can be provided as long as nosocomial COVID-19infection is effectively controlled by rigid screening of patientsnewly admitted, classified management of inpatients, optimal management of inpatient wards, standard preventive measures in perioperative period, a perfect system for medical protection, and medical education for patients and their carers.
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Objective@#To report our experience in the prevention and control of COVID-19 in the tramatological and microsurgical wards.@*Methods@#A retrospective study was conducted of the COVID-19 infections in the 51 medical staff and patients from 31 December, 2019 to 14 February, 2020 at Department of Traumatology and Microsurgery, Zhongnan Hospital. The prevention and control measures were upgraded after 20 January, 2020 to address the serious epidemic situation, including preventive disinfection, terminal disinfection and personnel disinfection in wards, management of emergency patients, inpatients and patients suspected of COVID-19 infection, and training, management and psychological intervention of medical staff. The outcomes resulting from different prevention and control measures before and after 20 January, 2020 were compared.@*Results@#From 31 December, 2019 to 20 January, 2020, there were altogether 3 cases of definite COVID-19 infection and 2 ones of suspected COVID-19 infection at the department. One doctor, one technician and one nurse were diagnosed as definite COVID-19 infection while one nurse and one patient as suspected COVID-19 infection. The 4 medical staff members infected were cured and discharged before 14 February, 2020 but unfortunately the one patient infected died. After the prevention and control measures for COVID-19 infection had been upgraded since 20 January, 2020, 12 out of the 29 emergency patients at our wards had fever (body temperature ≥37.3℃) but none COVID-19 infection. All the 47 medical staff on duty at the department got trained and none of them was infected by COVID-19 or suffered from mental disorder.@*Conclusion@#In the epidemic of COVID-19, as our prevention and control measures for COVID-19 infection were adjusted and upgraded in response to the changing epidemic situation, they eliminated nosocomial infection scientifically and effectively and ensured life safety of the medical staff and patients at the department.
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Objective:To suggest strategies for emergency diagnosis and treatment of trauma orthopedics in the epidemic period of COVID-19.Methods:In the epidemic of COVID-19 from January 21 to February 15, 2020, 128 patients with orthopaedic trauma sought emergency treatment at Department of Orthopedic Surgery, The People's Hospital of Wuhan University. They were 71 males and 57 females with an average age of 48.7 years (from 5 to 88 years). Of them, 107 cases were treated at the outpatient department and 21 hospitalized. Emergency operations were carried out for 4 cases and selective operations for 17 cases. COVID-19 infections were recorded in the patients and medical staff as well. Measures taken and experiences learned were summarized since the epidemic outbreak of COVID-19.Results:Of the 107 cases treated at the outpatient department, 3 had a definite diagnosis of COVID-19 and 3 a suspected diagnosis of COVID-19. Of the 4 cases undergoing emergency surgery, one was suspected of having COVID-19. Of the 17 cases undergoing selective surgery, one was diagnosed definitely as COVID-19 and 2 were suspected of COVID-19. Two nurses were diagnosed definitely as having mild COVID-19. One doctor and one nurse were suspected of COVID-19. Since the COVID-19 infections in medical staff occurred all before the preventive and control measures for COVID-19 had been implemented, is was not ruled out that their infections might have come from communities.Conclusions:It is particularly important for medical institutions of all levels to maintain safe and effective routine services while doing well in COVID-19 prevention. In the epidemic of COVID-19, front-line medical staff in emergency traumatic orthopedics is faced with great challenges in the process of diagnosing and treating patients. High-quality and safe medical services can be provided as long as nosocomial COVID-19 infection is effectively controlled by rigid screening of patients newly admitted, classified management of inpatients, optimal management of inpatient wards, standard preventive measures in perioperative period, a perfect system for medical protection, and medical education for patients and their carers.
الملخص
Objective:To report our experience in the prevention and control of COVID-19 in the tramatological and microsurgical wards.Methods:A retrospective study was conducted of the COVID-19 in the 51 medical staff and patients from 31 December, 2019 to 14 February, 2020 at Department of Traumatology and Microsurgery, Zhongnan Hospital. The prevention and control measures were upgraded after 20 January, 2020 to address the serious epidemic situation, including preventive disinfection, terminal disinfection and personnel disinfection in wards, management of emergency patients, inpatients and patients suspected of COVID-19, and training, management and psychological intervention of medical staff. The outcomes resulting from different prevention and control measures before and after 20 January, 2020 were compared.Results:From 31 December, 2019 to 20 January, 2020, there were altogether 3 cases of definite COVID-19 and 2 ones of suspected COVID-19 at the department. One doctor, one technician and one nurse were diagnosed as definite COVID-19 while one nurse and one patient as suspected COVID-19. The 4 medical staff members infected were cured and discharged before 14 February, 2020 but unfortunately the one patient infected died. After the prevention and control measures for COVID-19 had been upgraded since 20 January, 2020, 12 out of the 29 emergency patients at our wards had fever (body temperature ≥37.3 ℃) but none COVID-19. All the 47 medical staff on duty at the department got trained and none of them was infected by COVID-19 or suffered from mental disorder.Conclusion:In the epidemic of COVID-19, as our prevention and control measures for COVID-19 were adjusted and upgraded in response to the changing epidemic situation, they eliminated nosocomial infection scientifically and effectively and ensured life safety of the medical staff and patients at the department.
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Objective:To summarize the preliminary experience in ward management, medical protection, standardised diagnosis and treatment procedures in trauma microsurgery during the outbreak of COVID-19.Methods:Taking an example from the Department of Trauma and Microsurgery at Zhongnan Hospital of Wuhan University, the orthopedic patients and medical staff with COVID-19 admitted from Decemberm 31, 2019 to March 1, 2020, in-cluding clinical diagnosis and confirmed cases, were analyzed retrospectively. General information, including age, gen- der, basic diseases, contact history, symptoms, lung CT and prognosis, were collected and analysed preliminarily. On January 20, 2020, the COVID-19 outbreak was confirmed as "human to human transmission". COVID-19 infection of patients and medical staff in the wards were analysed, through the update of protection awareness and control measures. Department management, medical protection and standardized control procedures of trauma microsurgery were explored.Results:Five cases with clinical diagnosis or confirmed COVID-19 were included. One was inpatient and the rest 4 were medical staff, aged 25-81 years, 3 with confirmed and 2 with clinical diagnosis of COVID-19. After the treatment by specialists from Department of Infectious Disease and Department of Respiratory Disease, 4 of infected persons were cured and 1 died. Since January 20, 2020, when it was clear that the virus transmitted to people, there was no new case of infection among the medical staff and inpatients after the multidisciplinary collaboration in the ward prevention and control procedures were standardized and took in action.Conclusion:The spread of the COVID-19 can be effectively controlled by standardised diagnosis and treatment procedurs in the word of trauma microsurgery.
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To summarize the application of enhanced recovery after surgery (ERAS) principles in treating long bone defect with free fibula graft (FVFG). Methods From January, 2012 to January, 2017, ERAS principles were applied in 26 cases of long bone defect treating with vascularized fibula flap graft, via a series of com-prehensive measures, including strengthening psychological nursing, nutrition support and pain management, optimiz-ing operation plan, and early scientific functional exercise. Surgical duration, hospital stay time, satisfaction of pa-tients, postoperative visual analogue scale (VAS) score, bone defect healing time, and Enneking score were recorded through regular outpatient follow-up after discharge. Results The average length of surgical duration and hospital stay time was(3.2±0.5) h and (10.2±1.2) d, respectively. Discharged satisfaction was greater than 95%. Postoperative VAS score was less than 3. During the follow-up period of 1.6-6.0 years, 26 fibular flap survived, and all the bone defect were healed, with an average healing time of (5.5±0.6) months.Followed-up at 1.5 years after the operation, the upper limb function of 7 patients increased by 80.1%, and the lower limb function of 19 patients increased by 82.5%. Conclusion The application of ERAS in treating long bone defect with FVFG can obtain satisfactory limb function, alleviate patients’pain, shorten the duration of hospitalization, promote the rehabilitation and satisfaction of patients.
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Objective To explore the effect of the use of flap transplantation combined with Masquelet tech-nique in the repair of long bone accompanied with soft tissue defect. Methods The retrospective study includes 16 cases of bone defects over 6.0 cm combined with soft tissue defect from March,2013 to March,2016,13 males and 3 females, of which the ages range from 16 to 65 years. The length of bone defect ranged from 6.0 to 12.0 cm, with an average of 8.5 cm,while the wound defect ranged from 5.2 cm×3.5 cm to 16.0 cm×7.5 cm. There were 8 cases out of 16 involve an infection:3 cases of Staphylococcus aureus(including 1 MRSA),2 cases of Staphylococcus epidermidis, 2 cases of Enterobacter cloacae, and 1 case of Acinetobacter baumannii. The 1 stage surgery in all patients admitted to hospital after complete debridement and external fixation, the clean wounds with bone defect received antibiotic-impregnated bone cement filling operation and a flap transplantation or transposition directly after the debridement, but the infected wounds received vacuum sealing drainage treatment firstly, associated with adequate use of antibi-otics for 1-2 weeks and then the bone cement filling and flap transplantation with infection totally controlled.After 8-12 weeks, we conducted the secondary internal fixation surgery replacing antibiotic-impregnated bone cement with autogenic cancellous bone, vancomycin artificial bone as well as rhBMP-2. All the cases were followed for 6 to 18 months. Results All patients with primary surgery are effectively controlled after 1-4 weeks of anti-infection treat-ment exclusive of the case with MRSA.As the condition of the patient with MRSA relapse,we changed to convention-al treatment: placed a continuous irrigation and suction equipment instead of the bone cement filling, the wound healed completely without fistula formation of osteomyelitis in 6 months after the treatment of Ilizarov technique. All transplantation and transposition flaps survived. As for those who received a secondary bone graft operation, all achieved a bony union in a period of 4-6 months. Conclusion The combination of flap transplantation and Masquelet technique is an effective method to repair limb long bone and soft tissue defect currently.
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Objective To compare internal fixation with hallow compression screws combined vascularized bone graft(observation group) with only three hallow compression screws(control group) in young patients' Garden III and IV femoral neck fractures. Methods The patients with femoral neck fracture were treated from January, 2004 to December, 2013 were retrospectively reviewed. A total of 417 displaced femoral neck fractures in young and mid-dle-aged patients were long term followed-up. One hundred and thirty-seven patients were underwent open reduction and internal fixation with 3 hallow compression screws combined with a greater trochanter bone graft supported by the profound branch of medial circumflex femoral artery;280 patients were treated by closed reduction with 3 hallow com-pression screws. Results Patients had been followed-up for 5-12 years. At the last follow-up point, the Harris score of flap in observation group(93.68±5.12) were higher than that in control group(92.53±6.12), while it was no sta-tistical difference(P>0.05). It was 0.7％of nonunion incidence rate in the observation group, and incidence of avascular necrosis of femoral head was 6.6％, and incidence of femoral neck shortening was 8.8％. In the control group, inci-dence of avascular necrosis of femoral head was 14.6％, nonunion incidence rate was 4.6％, and incidence of femoral neck shortening was 22.5％. The differences between two groups was statistically significance( P<0.05). Conclusion The open reduction and internal fixation which is hallow compression screws in combination with a greater trochanter bone graft supported by the profound branch of medial circumflex femoral artery is an optimal treatment for young adults with Garden III and IV femoral neck fractures.
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Objective To summarize the clinical experience of treating long bone defect with vascularized fibular graft.Methods From January,2008 to January,2015,31 cases of long bone defect were treated with vascularized fibula composite or not composite tissue flap graft.The length of transplanted fibula was 9-20 cm,and the flap area was 5 cm×3 cm to 21 cm×14 cm.All patients were followed up regularly.Limb function was assessed 12 months after surgery.Results Thirty-one cases of vascularized fibular flap survived after surgery.Thirty patients were followed up for 1.5 to 6 years (average,2.5 years).One patient was lost to follow-up.The bone defects of patients followed up were healed.There was one case fracture occurred for trauma,was treated with plaster cast for 6 months and healed.The transplanted fibular thickened for 1.3 to 2.5 years(average,1.6 years).Conclusion Vascularized fibular graft can reconstruct long bone defect for single use and shorten the duration of treatment with a good limb function.For cases combined soft tissue defect,vascularized fibula composite tissue flap can be applied to repair at the meantime.
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Objective To summarize the clinical effect and experience of vacuum sealing drainage ( VSD) technology combined with sural neurovascular flap to repair chronic and infection soft tissue defects in the foot and ankle?Methods From 2010 to 2015, the clinical effect of 58 cases patients who were treated negative pressure drainage combined with sural nerve nutrient vessel flap for repairing foot and ankle chronically infected wounds in Zhongnan Hospital of Wuhan University were retrospective analyzed?All cases were treated by debridement,negative pressure suction 1, 2 times, cleaning the wound, Wound secretions were negative after culture,then cut and take the nutrient vessels of the nutrient vessels to repair the wound?Results All flaps survived completely in 58 cases,54 cases inⅠstage healing,postoperative 4 cases were suffered with distal skin flap necrosis,and healed after dressing?The outline and function were satisfactory during 1 to 3 years follow?up?Conclusion The effect of negative pressure drainage combined with sural nerve nutrient vessel flap for repairing chronic wound of foot and ankle is exact, skin flap transposition of the wound should be thoroughly debridement,edge scar tissue should be appropriate resection.
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Objective To evaluate the clinical effect of popliteal artery perforator-based sural neurovascular flap for repairing soft tissue defects in middle and distal upper leg.Methods Between December,2011 to September,2015,18 cases with skin soft tissue defects on the middle and distal upper leg were treated with popliteal artery perforator-based sural neurovascular flap,in which 12 cases were males,and 6 cases were females.The age was from 24 to 55 years,with the average age of 35.9 years.The size of tissue defects ranged from 3.0 cm × 3.0 cm to 7.0 cm × 9.0 cm.Results All flaps survived completely in 18 cases,1 case of marginal infection heated after dressing,and the rest cases in Ⅰ healing.The outline and function of survived flap were satisfactory during 3-16 months follow-up,with two-point discrimination of 4.0-10.0 mm.Conclusion The anterograde sural neurovascular flap based on the popliteal artery perforator provides a practical option for covering tissue defects in middle and distal upper leg.This flap is characteristiced by reliable blood supply without sacrificing main vesses,good contour and texture,in addition,the operation is easy of handling.
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Objective To provide an anatomical basis for repairing the defect of cervical tracheal wall with vascularized pectoralis major tendon flaps.Methods Thirty-two lateral thoracic necrotomies were studied for the following aspects.Measurement of pectoralis major tendons' length,width and thickness.Anatomy of thoracoacromialartery,pectoral branches:origin,distribution.Measurement of length of pedicle,rotated radius of flaps and length from recipient site.An imitative operation was undergone on a specimen of corpse.One patient was undergone the operation of repairing the 3.0 cm × 1.5 cm defect of anterior cervical trachea wall,accompanying with incision infection,with pectoralis major tendon flap.Results Length of pectoralis major tendon:(22.9 ± 0.9)mm.Width of tendon:(51.0± 2.4)mm.Thickness of tendon:(5.81± 1.35)mm.Length of pedicle:(89.3 ± 5.3) mm.The radius of pedicle pectoralis major myotendinous flap:(121.7± 8.2)mm.The distance from pivot point of flap to central point of recipient:(96.5 ± 8.9)mm.Patient possessed normal pronunciation,good appearance and no emphysema at 5 months' follow-up.Tracheal lumen,measured 2.6 cm in the anteroposterior dimension and 1.8 cm in the lateral dimension,showed no recurrence of obvious stenosis in cervical computed tomography at 3 month postoperatively.Conclusion Pedicle pectoralis major tendon flaps,originated from thoracoacromial artery pectoral branches can repair cervical tracheal wall defects effectively.
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BACKGROUND:The severity of tissue injury varies with the causes of the amputated finger. Simple soft tissue, vessels or nerves injury could be easily repaired by adjacent finger flap or abdominal flaps. However, these treatments are short of long repair time, reoperation and unsatisfactory appearance of the finger. OBJECTIVE:To investigate the efficiency of Flow-through flap from the fibular side of great toe to repair skin and soft tissue defects in digital replantation. METHODS:From January 2011 to October 2013, Flow-through flap from the fibular side of great toe was applied to repair soft tissue injury in digital replantation for 11 cases (8 males and 3 females, age ranged from 23 to 42 years. Skin defects ranged from 2.0 cm ×1.5 cm to 4.0 cm×2.2 cm; vascular defect ranged from 1-3 cm, 1.5 cm averagely; and the flap size ranged from 2.2 cm×1.7 cm to 4.5 cm×2.5 cm. RESULTS AND CONCLUSION:The folow-up time of al patients was 6-18 months. Digital replantation was successful in al the 11 cases. Ten cases were healed by first intention, and one case was gradualy rescued after dressing change. Patients were satisfied with the flap and the peripheral sensation. The peripheral discrimination of patients was 4 to 10 mm. The fingers functioned wel in flexion and extension. Of the 11 cases, 9 cases were valued excelent and 2 cases was rated as good, according to the upper extremity function evaluation standard of the Hand Surgey Branch of Chinese Medical Association. Flow-through flap from the fibular side of great toe is an ideal method to repair skin soft tissue and vascular defects in digital replantation.
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Objective To compare the internal fixation methods for treatment of intertrochanteric fractures in elderly patients.Methods One hundred and sixty four elderly patients with intertrochanteric fractures were treated from June 2006 to September 2011.The fractures were fixed with dynamic hip screws (DHS,n =42),locking proximal femur plate (LPFP,n =40),Gamma nails (n =36) or proximal femoral nail anti-rotation (PFNA,n =46),respectively.The clinical data were collected and the operative time,blood loss,time of clinical healing,postoperative complications and Harris hip scores of 6 months after surgery were compared among groups.Results All patients were followed-up for 6 to 36 months.The operative times of DHS,LPFP,Gamma nails and PFNA groups were (103 ± 15),(90 ± 13),(79 ± 11)and (65 ±9)min,respectively(F =2.87,P ＜0.05).The blood loss of 4 groups was (202 ±23),(181 ±23),(98 ± 13) and (87 ± 11) ml,respectively (F =3.21,P ＜ 0.05).The times of clinical fracture healing were (16.1±1.9),(14.6±1.8),(12.9±1.7) and (11.5±1.4) weeks,respectively(F=2.66,P＜0.05).The postoperative complications of 4 groups were 4/42,3/40,2/36 and 1/46,respectively (x2 =5.67,P ＜0.05).The Harris hip scores of 6 months after surgery of 4 groups were 81％ (34/42),85％ (34/40),89％ (32/36)and 93％ (43/46),respectively(H =20.03,P ＜0.05).Conclusions In treatment for intertrochanteric fractures in elderly patients,the efficacy of intramedullary fixation (Gamma nails and PFNA) is better than extramedullary fixation DHS and LPFP).PFNA is more effective than other 3 methods and should be preferentially chosen.
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ObjectiveTo investigate the feasibility of hTGF-β1 transfected bone mrrow mesenchymal stem cell (BMSCs) combined with calcium alginate gel in three dimensional condition to construct tissue engineering cartilage.MethodsRats BMSCs were obtained and cultured by whole bone marrow method,and then the third-generation cells were seeded into cell culture plate,and were divided into 3 groups:AdhTGF-β1 transfected group, Ad-EGFP transfected group and control group. The control group was added in common medium without any treatment while the other 2 groups were respectively added in serum-free medium containing Ad-hTGF-β1 or that containing Ad-EGFP.Seven days later,real-time fluorescent quantitation PCR and Western blot were employed for detecting the expression of TGF-β1.Then,the BMSCs which successfully transfected by Ad-hTGF-β1,were continually cultured in vitro.Andthe confound of cells-calcium alginate gel,the cell density was 1.0 × l07 per ml,were prepared and cultuered in constant temperature incubator.Ten days later,examine the morphous and proliferation of cell.Last,paraffin slice of the cell-gel confound was stained by HE,toluidine blue and Masson staining,while immunohistochemical for the secretion of collagen Ⅱ.ResultsSeven days after the transfection, real-time fluorescent quantitation PCR revealed that the average relative expression of TGF-β1 was:Ad-hTGF-β1 group 0.863,and Ad-EGFP group 0.183, the control group 0.180, and the expression difference of TGF-β1 was statistically diffence(P ＜0.05). Western blot proved strong TGF-β1 expression in Ad-hTGF-β1 group while it was detected a little in the other two groups. Globose cells were observed through inverted microscope in the calcium alginate gel.MTT proved the amount of cells were not statistically diffence (P ＞ 0.05) at different time point.HE staining proved amount cartilage lacuna formation in the gel, while the secretion of cartilage matrix were proved by toluidine blue and Masson,and immunohistochemical proved the expression of collagen Ⅱ.Conclusion BMSC trnsfected by hTGF-β1 could be successfully induced to chondrocyte, as the cells morphous maintained.This three dimensional condition could preferably mimicry cell growth pattern as in vivo.
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Objective To investigate the choice of methods and time on the treatment of Gustilo type Ⅲ B and type ⅢC open tibia fractures by bone fixation and tissue flap repairing.Methods The clinic data of 136 cases of Gustilo Ⅲ B and Ⅲ C open tibia fractures were retrospectively studied.There were 102 males and 34 females,with average age of 34 years(range 14 to 68 years).Ninety-eight cases were classified as Gustilo type Ⅲ B and 38 cases were type Ⅲ C in degree.In all cases,one hundred and thirteen were treated with onestage external fixation,ninteen cases were treated with secondary bone fixation.Sixty-seven cases of all wounds were repaired by one-stage vascular pedicle skin flap.Seven wounds were repaired by one-stage free flaps with vascular anastomosis.Sixty-two cases were secondary repaired by different flaps after defect tissue under VSD (vacuum-sealing-drainage) treatment by 1 to several weeks,which contains 9 free skin graft,eleven muscle flaps based on posterior tibial artery perforator,thirteen flaps based on fibial artery perforator,fourteen gastrocnemius falps and 15 cross-leg flaps.Results Wound of all cases were healed wholly.Primary union occurred in 121 cases,twelve,cases healed after bone grafting for segmental bone defect.Three cases with delayed union healed after reoperation for infection that caused osteomyelitis and sinus tract.The period of bone healing was form 5 to 12 months.Conclusion The treatment of Gustilo Ⅲ B and Ⅲ C open tibia fractures by onestage or secondary bone fixation and tissue flap repairing get their advantages and disadvantages,but one-stage bone fixation and tissue flap repairing was better where appropriate.
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ObjectiveTo evaluate the physicochemical properties and bicompatibility of carbon-nanotubes/hydroxypatite/chitosan scafflod for bone tissue engineering. MethodsMWCNT/n-HA/CS scaffolds wre generated by solution blending and freeze-drying technology.The morphology and composition of the scaffolds were analyzed by scanning electron microscopy, X-ray diffraction and Fourier transform infrared spectroscopy, after this, the results of which mixed CNTS in scaffolds were evaluated. The effects of MWCNT/n-HA/CS scaffolds on adherence and proliferation of rabbit bone marrow stroma cells were assessed by scaffolds surface seeding methods, and using scanning electron microscopy, MTT assay to observe their adhesion and proliferation on scaffolds.Results MWCNT/n-HA/CS scaffolds showed abundant homogeneous pores with (87.26％) porosity. 66％ fracture strength of the scafflod was improved by MWCNT,and porosity decreased by 3％. Conclusion MWCNT/n-HA/CS scaffold can be prepared with solution blending and freeze drying process, which has fair poriness, good mechanical strength and tissue compatibility and can be applied as a bone graft material.