Effect of VNTR polymorphism of the Muc1 gene on litter size of pigs.

An investigation was undertaken to study the association between the variable number of tandem repeats polymorphism of the Muc1 gene and the litter size in pigs. Four different alleles were found in three breeds. The sequence analysis shows that the repetitive region of pig Muc1 gene is an array of 108-bp repeats. A total of 2,430 litter records from 897 sows genotyped at Muc1 gene were used to analyze the total number born (TNB) and number born alive (NBA). The study of the effects on litter size suggests that TNB and NBA of genotype AA are the highest in Large White, and the TNB and NBA of the third to ninth parities are 1.61 and 2.29 piglets per litter higher (P < 0.05) than those of the genotype DD, respectively. In Landrace, TNB and NBA of the genotype AA are 1.68 (P < 0.01) and 1.58 (P < 0.05) piglets per litter higher than those of the BB genotype in the third to ninth parities, but for all parities the TNB of genotype AA were 0.76 piglets per litter (P < 0.05) higher than BB. In Duroc, the TNB and NBA of genotype AA are about 1.5 piglets per litter more than those of DD in the third to ninth parities, though not significantly. The research suggests that the smaller allele tends to have higher litter size. The results indicate that Muc1 gene is significantly associated with litter size in pigs.

Effectiveness of Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor in treatment of Cho type ⅡC distal clavicle fractures / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the effectiveness of Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor in the treatment of Cho type ⅡC distal clavicle fractures.@*METHODS@#The data of 17 patients with Cho type ⅡC distal clavicular fractures, who were treated with Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor between June 2019 and June 2021, was retrospectively analyzed. There were 11 males and 6 females with an average age of 38.7 years (range, 19-72 years). The fractures were caused by falling in 12 cases and traffic accident in 5 cases. All patients had fresh closed fractures. The interval from injury to operation was 1-5 days (mean, 2.6 days). The preoperative injury severity score (ISS) was 6-27 (mean, 10.2). The operation time, intraoperative blood loss, hospital stay, fracture healing, and postoperative complications were analyzed. The shoulder joint function was evaluated by disabilities of the arm, shoulder, and hand (DASH) score and Constant score at last follow-up.@*RESULTS@#All operations were completed successfully. The operation time was 20-50 minutes (mean, 31.6 minutes). The intraoperative blood loss was 30-100 mL (mean, 50.6 mL). The hospital stay was 4-9 days (mean, 5.3 days). All incisions healed by first intention. All patients were followed up 12-16 months (mean, 13 months). All clavicle fractures healed, and the healing time was 8-15 weeks (mean, 11 weeks). No complications such as fracture displacement or nonunion caused by internal fixation failure occurred. During the follow-up, skin irritation caused by the Kirschner wire withdrawal occurred in 3 cases. The Kirschner wires were removed after fracture healing in 17 patients. At last follow-up, the Constant score of shoulder joint was 90-100 (mean, 98.2). The DASH score was 0-10 (mean, 1.5).@*CONCLUSION@#Kirschner wire fixation combined with coracoclavicular ligament reconstruction with suture anchor in the treatment of Cho type ⅡC distal clavicle fractures has less postoperative complications and slight complications. It is convenient to remove the internal fixator. The Kirschner wire does not fix the distal clavicle fracture through the acromion, which has little effect on shoulder joint function and can obtain good effectiveness.

Strategies for reduction of irreducible intertrochanteric fractures according to self-designed new classifications / 中华创伤骨科杂志

Objective:To explore the strategies for reduction of irreducible intertrochanteric fractures according to our self-designed new classifications.Methods:A retrospectively study was conducted to analyze the data of 124 patients with irreducible intertrochanteric fracture who had been admitted to Department of Minimally Invasive Orthopaedics, Zhengzhou Orthopaedics Hospital from January 2019 to December 2021. There were 56 males and 68 females with a mean age of (76.8±13.2) years. According to the displacement pattern of the proximal head-neck fragment of the fracture, the irreducible intertrochanteric fractures of the femur were classified into 3 types. In type 1 (rotational type) of 65 cases, there were 24 cases of subtype 1.1 (the lesser trochanter attached to the distal fracture fragment), 8 cases of subtype 1.2 (the lesser trochanter attached to the proximal fracture fragment), and 33 cases of subtype 1.3 (the lesser trochanter floating). In type 2 (locked type) of 18 cases, there were 13 cases of subtype 2.1 (lesser trochanter floating), no case of subtype 2.2 (the lesser trochanter attached to the proximal fracture fragment), and 5 cases of subtype 2.3 (the lesser trochanter attached to the distal fracture fragment). In type 3 (reverse trochanter type) there were 41 cases. Under the guidance of our new classification, the patients were treated by fixation with intramedullary nails after reduction with corresponding techniques (like prying, clamping, pulling, and temporary fixation with Kirschner wires). Operation time, intraoperative blood loss, fracture reduction quality and Harris hip score at the last follow-up were recorded.Results:The operation time was (53.0±20.7) min and blood loss (132.1±81.3) mL in this cohort. According to the criteria proposed by Chang and Kim et al., the quality of fracture reduction was evaluated as excellent in 101 cases, as good in 17 cases, as fair in 4 cases, and as poor in 2 cases, resulting in an excellent and good rate of 95.2% (118/124). All the 124 patients were followed up for an average of (12.4±3.7) months. First-stage fracture union was achieved in 120 patients, and fracture union was achieved in 2 patients of type 3 with breakage of the main nail only after replacement of the intramedullary nail. The mean healing time for the 122 patients was (5.1±1.4) months. In addition, hemiarthroplasty was performed in 2 patients of type 1.3 whose femoral head had been cut by a head nail. Postoperatively, urinary tract infection occurred in 5 cases but responded to appropriate symptomatic treatment. The Harris hip score was (94.2±5.4) points at the last follow-up, and 103 cases were excellent, 17 cases good, and 4 cases poor, giving an excellent and good rate of 96.8% (120/124).Conclusion:It is easy to understand and master the new classification of irreducible intertrochanteric fractures based on the displacement of the proximal head and neck bone which can directly and effectively guide the intraoperative reduction, leading to satisfactory reduction and fixation.

Sponge forceps assisted threading with Speedbridge technique for the treatment of acute closed Achilles tendon rupture / 中华创伤杂志

Objective:To explore the outcome of sponge forceps assisted threading with Speedbridge technique for the treatment of acute closed Achilles tendon rupture.Methods:A retrospective case series study was conducted on 20 patients with acute closed Achilles tendon rupture treated in Zhengzhou Orthopedic Hospital from December 2019 to December 2021. There were 18 males and 2 females, with age range of 24-43 years [(29.5±7.6)years]. All patients were with unilateral injury, involving the left side in 13 patients and right side in 7. Examinations revealed a palpable defect in the Achilles tendon and positive Thompson test. A longitudinal incision was made at the medial edge of the ruptured tendon. Three nonabsorbable sutures were passed through the proximal stump with sponge forceps, bypassed the rupture site and fixed directly into the calcaneal bone. The disrupted tendon ends were aligned by the tendon-bundle technique using 4-0 absorbable sutures. The operation time and incision length were documented. The ankle joint range of motion (dorsiflexion/plantar flexion), American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Achilles tendon total rupture score (ATRS) in the affected and healthy side were compared at 3, 6 and 12 months postoperatively. The wound healing and complications were observed.Results:All patients were followed up for 12-16 months [(13.2±2.5)months]. The operation time was 40-66 minutes [(52.0±10.3)minutes], with the incision length of 3-4 cm [(3.3±0.7)cm]. In the affected side at 3 and 6 months postoperatively, the ankle joint dorsiflexion [(5.6±1.5)°, (10.5±0.2)°] and plantar flexion [(28.4±3.2)°, (33.5±1.5)°] showed statistically significant difference compared with the healthy side (all P<0.05). The ankle joint dorsiflexion [(13.9±0.7)°] and plantar flexion [(38.3±4.4)°] in the affected side were not statistically different from that of the healthy side at 12 months postoperatively (all P>0.05). The AOFAS ankle-hindfoot score was (58.3±5.4)points, (84.9±7.1)points and (91.8±6.3)points at 3, 6 and 12 months postoperatively, showing a gradual rise (all P<0.05). The ATRS was (60.5±4.9)points, (85.5±9.0)points and (93.1±5.7)points at 3, 6 and 12 months postoperatively, showing a gradual rise (all P<0.05). All incisions were healed primarily. No patients had wound infection, nerve injury or re-rupture. Pain at the anchor insertion site occurred in 2 patients at 1 month after operation and relieved after active functional rehabilitation at 4 months after operation. Transient pain at the Achilles tendon insertion occurred in 1 patient at 6 months after operation, and relieved after 2 weeks of oral non-steroidal anti-inflammatory drugs treatment. Conclusion:For acute closed Achilles tendon rupture, sponge forceps assisted threading with Speedbridge technique can attain short operation time, small incision and good functional recovery, with few complications.

Minimally invasive repair of acute closed Achilles tendon rupture with two-way needle suture technique / 中华创伤骨科杂志

Objective:To investigate the efficacy of two-way needle suture technique (TNST) in the minimally invasive repair of acute closed Achilles tendon rupture.Methods:From June 2019 to June 2021, 26 patients with acute closed Achilles tendon rupture were treated at Zhengzhou Orthopedic Hospital. They were 20 males and 6 females, with a mean age of 28 (23, 31) years. The rupture end was (4.2±1.3) cm away from the calcaneal insertion, and the interval from injury to operation 4.3 (2.0, 5.0) d. Preoperative MRI examinations revealed in all the patients closed Achilles tendon rupture which was to be repaired by TNST. The operation time, incision length, incidence of complications, ankle dorsiflexion and plantar flexion were recorded. The Arner-Lindholm scoring was used to evaluate the clinical efficacy.Results:The operation time was (20.0±5.0) min and the incision length (2.5±0.4) cm. Postoperatively, all incisions healed by the first stage, with no complications like incision infection, skin edge necrosis, deep vein thrombosis at lower limbs, injury to the sural nerve, or re-rupture of the Achilles tendon. All patients were followed up for (12.0±6.0) months. At the last follow-up, the patients walked normally, their incisions healed well, the continuity of the Achilles tendon was good by palpation, their heel lift was strong, and all their activities were restored to the levels before rupture of the Achilles tendon. The ankle dorsiflexion was 22.6°±3.7° and the plantar flexion 25.3°±3.7°, According to the Arner-Lindholm evaluation, the clinical efficacy was rated as excellent in 25 cases and as good in 1 case, giving an excellent and good rate of 100% (26/26).Conclusion:In the minimally invasive repair of acute closed Achilles tendon rupture, TNST shows the advantages of limited surgical invasion, a low incidence of postoperative complications, and reliable curative effects.

Comparison of proximal humerus internal locking system and Multiloc intramedullary nail in treatment of proximal humerus fracture-anterior dislocation / 中华创伤骨科杂志

Objective:To compare proximal humerus internal locking system (PHILOS) and Multiloc intramedullary nail in the treatment of proximal humerus fracture-anterior dislocation.Methods:A retrospective study was performed to analyze the data of 33 patients with proximal humerus fracture-anterior dislocation who had been treated by open reduction and internal fixation from June 2015 to April 2021 at Department of Upper Limbs, Zhengzhou Orthopaedic Hospital. According to methods of internal fixation, the patients were divided into an extramedullary group and an intramedullary group. In the extramedullary group of 18 cases subjected to internal fixation with PHILOS, there were 8 males and 10 females with an age of (53.3 ± 10.6) years, and 1 2-part fracture, 15 3-part fractures and 2 4-part fractures by the Neer classification. In the intramedullary group of 15 cases subjected to internal fixation with Multiloc intramedullary nail, there were 8 males and 7 females with an age of (51.5 ± 11.2) years, and 14 3-part fractures and 1 4-part fracture by the Neer classification. The 2 groups were compared in terms of incision length, operation time, intraoperative blood loss, postoperative complications, and visual analog scale (VAS), range of shoulder motion, and Constant-Murley score at postoperative 12 months.Results:The 2 groups were comparable due to insignificant differences in their preoperative general data ( P>0.05). All patients were followed up for (20.8 ± 4.7) months. The incision length in the intramedullary group [(11.6 ± 1.7) cm] was significantly shorter than that in the extramedullary group [(17.6 ± 2.0) cm], and the intraoperative blood loss in the former [(106.7 ± 34.4) mL] was significantly lower than that in the latter [(151.7 ± 45.7) mL] ( P<0.05). The VAS scores at 1 week and 1 month after surgery [2.0 (2.0, 3.0) and 0.0 (0.0, 1.0) respectively] in the intramedullary group were significantly lower than those in the extramedullary group [3.0 (3.0, 3.3) and 1.0 (0.0, 1.3) respectively] ( P<0.05). The external rotation of the shoulder at the last follow-up in the intramedullary group (65.3° ± 15.5°) was significantly larger than that in the extramedullary group (50.6° ± 13.9°) ( P<0.05). There were no significant differences in operation time, incidence of postoperative complications, VAS score at 12 months after operation, Constant-Murley score or range of shoulder motion at the last follow-up between the 2 groups ( P>0.05). Conclusions:In the treatment of proximal humerus fracture-anterior dislocation, open reduction and internal fixation with both PHILOS and Multiloc intramedullary nail can result in a favorable prognosis when the fracture-dislocation is well reduced and fixated. However, the Multiloc intramedullary nail may lead to better early pain relief, less surgical invasion, and better functional recovery of the external rotation of the shoulder.

Guideline for the diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients (version 2023) / 中华创伤杂志

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.

Total ankle arthroscopy for osteogenic posterior ankle impingement syndrome complicated with flexor hallucis longus tenosynovitis / 中华创伤骨科杂志

Objective:To investigate the efficacy of total ankle arthroscopy for resection of the talus os trigonum and debridement of the synovium of flexor hallucis longus (FHL) in the treatment of osteogenic posterior ankle impingement syndrome (PAIS) complicated with flexor hallucis longus tenosynovitis (FHLT).Methods:The 14 patients with osteogenic PAIS and FHLT were retrospectively analyzed who had been treated at Department of Hand-Foot-Ankle Microsurgery, Xuzhou Central Hospital from July 2017 to July 2019. They were 8 men and 6 women, aged from 29 to 53 years (mean, 42.4 years). The talus os trigonum and the giant posterolateral process of the talus were resected under total ankle arthroscopy in the prone position of the posterior ankle while the FHL was released and cleared. The efficacy was evaluated by comparing the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Maryland functional score, and pain visual analog scale (VAS) between preoperation and one year postoperation.Results:All patients were followed up for 12 to 24 months (average, 15 months). For all patients, their plantar flexion and dorsal extension were improved significantly from preoperative 19.2°±4.0° and 14.2°±2.7° to postoperative 42.9°±2.7° and 24.5°±3.2°, their AOFAS score increased significantly from preoperative 42.1±4.2 to 91.6±2.7 at one year postoperation, their Maryland score increased significantly from preoperative 43.9±4.1 to 91.9±3.5 at one year postoperation, and their VAS score decreased significantly from preoperative 6 (6, 7) to 0 (0, 0) at one year postoperation (all P<0.05). Conclusion:In the treatment of osteogenic PAIS complicated with FHLT, total ankle arthroscopy for resection of the talus os trigonum and release of FHL can lead to fine efficacy and limited surgical invasion, resolving the FHL pathological inflammation and PAIS at the same time.

Endoscopic resection of symptomatic talocalcaneal coalition in adolescents using a posterior approach / 中华创伤骨科杂志

Objective:To evaluate the outcomes of endoscopic resection of symptomatic talocalcaneal coalitions in adolescents using a posterior approach.Methods:A retrospective case-series study was performed to analyze the data of 15 adolescent patients (16 feet) with symptomatic talocalcaneal coalitions (TCC) who had been treated by posterior arthroscopy from February 2017 to December 2020 at Department of Orthopaedics, Xuzhou Central Hospital. There were 11 boys and 4 girls with an average of 14.3 years (from 11 to 17 years). The left side was affected in 9 and the right side in 5 patients, and both sides were involved in one. Ten patients had a history of ankle sprain. The clinical outcomes were evaluated by visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and 36-item short form health survey (SF-36) postoperatively.Results:The 15 patients were followed up for a mean time of 19.9 months (from 12 to 36 months). At the final follow-up, the VAS significantly decreased from preoperative 6 (6, 7) points to 1 (1, 3) point, the AOFAS ankle-hindfoot score significantly increased from preoperative (54.1±10.4) points to (90.0±16.6) points, and the SF-36 score significantly improved from preoperative (55.5±12.7) points to (88.7±6.5) points ( P<0.05). Follow-ups found such complications as infection, TCC recurrence or osteoarthritis in none of the patients. Conclusion:Endoscopic TCC resection using a posterior approach is an effective surgery for symptomatic TCC in adolescents, showing advantages of limited invasion, fast recovery, a low rate of postoperative complications and precise resection.

Fixation with cannulated screws alone via the Kocher approach for humeral capitulum fractures in adults / 中华创伤骨科杂志

Objective:To investigate the efficacy of fixation with cannulated screws alone via the Kocher approach in the treatment of adult humeral capitulum fractures.Methods:From August 2016 to August 2020, 16 patients with humeral capitulum fracture were treated at Department of Upper Limb Orthopedics, Zhengzhou Orthopaedic Hospital. They were 10 males and 6 females, aged from 36 to 62 years (average, 45 years). The left side was affected in 10 cases and the right side in 6. According to the Ring classification, 3 cases were type Ⅰ, 3 cases type Ⅱ, 6 cases type Ⅲ, and 4 cases type Ⅳ. All patients were treated with the Kocher approach on the lateral side of the elbow. After reduction under direct vision, the fractures were fixated temporarily with Kirschner wires and finally with cannulated screws. On the second postoperative day, the patients started active flexion and extension of the elbow joint and took indomethacin orally to prevent heterotopic ossification. At the last follow-up, the curative efficacy was evaluated according to the Mayo elbow performance score (MEPS). The flexion and extension of the elbow joint and the rotation of the forearm were also recorded.Results:All patients were followed up for 10 to 19 months (mean, 14.3 months) after surgery. Bony union was achieved after 7 to 12 monthes (average, 11.3 monthes) in all the 16 patients, 2 of whom developed heterotopic ossification. By the MEPS evaluation at the last follow-up, 8 cases were excellent, 6 good and 2 fair, scoring an average of 89.5 points (from 73 to 95 points). At the last follow-up, the elbow flexion ranged from 80° to 130° (averaging 113°), extension from 5° to 30° (averaging 15°), forearm pronation from 62° to 75° (averaging 67°), and forearm supination from 50° to 90° (averaging 75°).Conclusion:When the fracture ends are exposed through the lateral Kocher approach, the fracture fragments fixated with cannulated screws only, and the patients encouraged to start elbow joint exercises in the early stage, the treatment of adult humeral capitulum fractures can result in satisfactory curative effects.

Treatment of scapular glenoid fracture through axillary approach / 中华创伤骨科杂志

Objective:To evaluate the clinical efficacy of the axillary approach in the treatment of scapular glenoid fracture.Methods:A retrospective analysis was performed of the 12 patients who had been treated for scapular glenoid fracture from November 2019 to April 2021 at Department of Upper Limb Orthopaedics, Zhengzhou Orthopaedic Hospital. They were 4 males and 8 females, aged from 30 to 75 years (mean, 53.5 years). According to the Ideberg classification, there were 2 cases of type Ⅰa, 9 cases of type Ⅱ and one case of type Ⅴa. All cases were treated through the axillary approach. Two patients complicated with anterior shoulder dislocation were treated with manual reduction under anesthesia before operation and the other 10 cases with special plate fixation through the axillary approach. The 3 patients complicated with fracture of greater tuberosity were fixated with a special plate through the lateral shoulder split deltoid approach. Constant-Murley score, visual analogue scale (VAS) and Hawkins grading were used at the last follow-up to evaluate shoulder function, pain and stability after operation.Results:All patients were followed up for 9 to 20 months (mean, 14.4 months). The operation time ranged from 55 to 110 min (mean, 76.3 min), intraoperative bleeding from 60 to 160 mL (mean, 103.8 mL), and hospital stay from 8 to 14 d (mean, 11.1 d). All incisions healed primarily and all scapular glenoid fractures got united 6 months after operation. The last follow-up showed no shoulder instability, neurovascular injury or internal fixation failure. At the last follow-up, the range of motion of the shoulder was 159.2°±26.1° in forward bending, 156.7°±29.6° in abduction, 48.3°± 15.3° in external rotation (neutral position), and 73.3°±12.3° in internal rotation (neutral position), and the Constant-Murley score was (94.0±5.3) points. The range of motion of the shoulder and Constant-Murley score were significantly improved compared with those before operation (10.8°±11.6°, 7.5°±11.4°, 5.8°±10.0°, 42.5°±16.0° and 4.9±4.0, respectively) (all P<0.05). The VAS score was 0 in 11 patients and 2 in one patient at the last follow-up. Conclusion:The axillary approach is feasible for the treatment of scapular glenoid fracture, because it is hidden and less invasive, leading to good clinical outcomes.

Effects of operation timing on postoperative complications and operative duration in children undergoing non-emergency operation for femoral neck fracture / 中华创伤骨科杂志

Objective:To explore the effects of operation timing on postoperative complications and operative duration in children undergoing non-emergency operation for femoral neck fracture.Methods:Fifty-nine children and adolescents with femoral neck fracture were retrospectively analyzed who had been admitted to Department of Pediatric Orthopedics, Zhengzhou Orthopedic Hospital Affiliated to Henan University from February, 2015 to September, 2019. They were 39 boys and 20 girls with a mean age of 11.7 (7.1, 13.7) years. By Delbet fracture classification, 7 cases were type Ⅰ, 27 cases type Ⅱ, 20 cases type Ⅲ, and 5 cases type Ⅳ. The patients were divided into 4 groups by the time from injury to operation (TFITO): 17 cases were assigned into group A with TFITO from 24 to 48 hours, 14 cases into group B with TFITO from 49 to 72 hours, 12 cases into group C with TFITO from 73 to 96 hours, and 16 cases into group D with TFITO>96 hours. The effects of TFITO on postoperative complications and operative duration were analyzed.Results:There were no significant differences between the 4 groups in their preoperative general data, showing they were comparable ( P>0.05). This cohort was followed up for 12 to 62 months (average, 20 months). The operation time was not included for this study in 6 cases whose associated injury had to be treated simultaneously. The median operation time for the other 53 patients was 80 (70, 105) min. The correlation coefficient between TFITO and operation time was 0.098 ( P=0.484). Postoperative complications occurred in 37.3% of the patients (22/59), including 14 cases of avascular necrosis of femoral head. For groups A, B, C and D, the incidences of complications were 47.1% (8/17), 50.0% (7/14), 25.0% (3/12) and 25.0% (4/16) while the incidences of avascular necrosis of femoral head 23.5% (4/17), 31.3% (5/16), 16.7% (2/12) and 18.8% (3/16), showing insignificant differences between the 4 groups in all the comparisons ( P>0.05). Conclusion:The time from injury to operation may not increase operative duration or postoperative complications such as avascular necrosis of femoral head in children undergoing non-emergency operation for femoral neck fracture.

Design and Implementation of Software Platform for AI-ECG Algorithm Research / 中国医疗器械杂志

A software platform for AI-ECG algorithm research is designed and implemented to better serve the research of ECG artificial intelligence classification algorithm and to solve the problem of subjects data information management. Matlab R2019b and MySQL Sever 8.0 are used to design the software platform. The software platform is divided into three modules including data management module, data receiving module and data processing module. The software platform can be used to query and set the subjects information. It has realized the functions of data receiving, signal processing and the display, analysis and storage of ECG data. The software platform is easy to operate and meets the basic needs of scientific research. It is of great significance to the research of AI-ECG algorithm.

Treatment of iatrogenic injury to medial collateral ligament in total knee arthroplasty / 中华创伤骨科杂志

Objective:To explore the treatment of iatrogenic injury to the medial collateral ligament (MCL) in total knee arthroplasty (TKA).Methods:From January 2009 to December 2016, 14 patients were treated at Department of Arthropathy, Zhengzhou Orthopedics Hospital for iatrogenic MCL injury in primary TKA (injury group). They were 3 males and 11 females with an age of (72.6±3.9) years. The MCL injury was body rapture in 9 cases and avulsion of femoral insertion in 5 ones. Interlacing suture was used for body rapture and reparative reconstruction with wire anchors or nails was performed for avulsion of femoral insertion. A restrictive condylar prosthesis was used instead in the 4 patients whose medial stability failed to be restored after repair of body rapture. A control group of 21 cases was enrolled who had suffered from no iatrogenic MCL injury in primary TKA at the corresponding period. There were 5 males and 16 females with an age of (73.2±3.9) years. The 2 groups were compared in terms of American Knee Society Score (KSS) and knee flexion.Results:There was no significant difference between the 2 groups in preoperative general data, showing comparability between groups ( P>0.05). The injury group was followed up for 18 to 36 months (mean, 33 months). Joint loosening was observed at 18 months after operation in 3 patients with nonrestrictive prosthesis who had to receive secondary revision. At the 36-month follow-up of the remaining 11 patients, normal knee extension and flexion was observed, the stress test of valgus showed no inner relaxation, their KSS increased significantly from preoperative 50.0±22.7 to 93.3±4.7, and their knee flexion was improved significantly from 90.4°±10.3° to 110.7°±8.8° ( P<0.05). There were no significant differences in KSS score or knee flexion between the 2 groups at 3, 6, 12 or 36 months after operation ( P>0.05). Conclusion:Iatrogenic MCL injury in primary TKA should be repaired and reconstructed by one-stage surgery because the patients can achieve curative results similar to those for the patients free from iatrogenic MCL injury in primary TKA.

All arthroscopic autogenous tendon suspended fixation for Myerson type III chronic noninsertional achilles tendon rupture in elderly patients / 中华骨科杂志

Objective:To evaluate the clinical outcome of all arthroscopic autogenous tendon suspended fixation for Myerson type III chronic noninsertional achilles tendon rupture in elderly patients.Methods:Data of 18 patients with Myerson type III chronic noninsertional Achilles tendon rupture who had performed all arthroscopic autogenous tendon suspended fixation from February 2016 to February 2019 in Department of Hand and Foot Microsurgery, Xuzhou Central Hospital were retrospectively analyzed. There were 12 males and 6 females (right side, 10 cases and left side, 8 cases) aged from 60 to 79 years with a median of 65.3 years. The mean injury-to-surgery time was 12 weeks (range, 6-32 weeks). All the patients were treated by all arthroscopic autogenous tendon suspended fixation. The function of the ankle and the foot was assessed using visual analogue scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) foot and ankle score and the achilles tendon total rupture score (ATRS), and the excellent and good rate was evaluated according to Arner-Lindholm score.Results:All patients healed at the first stage without any complications such as infection, sural nerve injury or tend re-rupture. The mean follow-up period was 18.6 months (range, 12-50 months). At the latest follow-up, all achilles tendons were healed with the VAS score reduced from 4 (1, 7) preoperatively to 0 (0, 1) postoperatively ( Z=2.334, P< 0.05); the AOFAS ankle and hindfoot score was improved from 60.3±9.7 (range, 40-83) preoperatively to 92.6±4.3 (range, 86-100) postoperatively ( t=34.541, P< 0.05); the ATRS score was improved from 55.7±10.6 (range, 42-80) preoperatively to 93.1±3.2 (range, 88-100) postoperatively ( t=64.773, P< 0.05); one patient was unable to stand on tiptoe of the single injured limb, because he could stand it, no further treatment was given; another patient complained of mild pain after a long time walking,which was alleviated by stretching the achilles tendon consistently. According to the score of Arner-Lindholm, 14 cases were excellent, 4 cases were good, and the excellent and good rate was 100% (18/18). Conclusion:All arthroscopic autogenous tendon suspended fixation for Myerson type III chronic noninsertional achilles tendon rupture in elderly patients is an effective method, which has the advantages of less trauma, faster recovery and fewer complications.

Biplane osteotomy assisted by 3D printing for malunion of tibial plateau fracture of Schatzker type Ⅳ / 中华创伤骨科杂志

Objective:To evaluate the biplane osteotomy assisted by 3D printing for malunion of tibial plateau fracture of Schatzker type Ⅳ.Methods:A retrospective study was conducted of the 19 patients with malunion of tibial plateau fracture of Schatzker type Ⅳ who had been treated at Department of Orthopaedics, Jiaozuo People's Hospital and Department of Foot and Ankle Surgery, Zhengzhou Orthopaedics Hospital from February 2014 to May 2018. They were 11 males and 8 females, aged from 20 to 55 years (average, 37.6 years). The interval from injury to operation ranged from 3 to 8 months. All patients were treated with biplane osteotomy assisted by 3D printing. The tibiofemoral angle, tibial plateau varus angle, posterior tilt angle and Lysholm scores of knee joint were recorded before and after treatment. Postoperative complications were observed.Results:All patients were followed up for 12 to 28 months (average, 18.5 months).The fracture healing time ranged from 12 to 24 weeks (average, 15.5 weeks).At the last follow-up, the patient's tibiofemoral angle was 173.2°±2.0°, tibial plateau varus angle was 85.6°±1.3 °, and posterior tilt angle was 11.9°± 1.1 °, which were higher than the preoperative ones (154.1°±5.0°, 76.0°±1.8°, 18.9 °±1.6°), and the differences were statistically significant ( P<0.05).The Lysholm scores at the last follow-up (89.8 ± 1.2) were significantly higher than the preoperative ones (52.0±4.4) ( P<0.05).One patient had to receive total knee arthroplasty because of difficult walking 6 months after operation. Conclusion:Biplane osteotomy assisted by 3D printing can delay development of traumatic arthritis, relieve pain and restore knee function in the treatment of malunion of tibial plateau fracture of Schatzker type Ⅳ.

Early outcome of proximal femoral nail antirotation and bipolar hemiarthroplasty in treatment of intertrochanteric fractures in elderly patients aged 90 years or more / 中华创伤杂志

Objective:To compare the early outcome of proximal femoral nail antirotation (PFNA) and bipolar hemiarthroplasty in treatment of intertrochanteric fractures in elderly patients aged 90 years or more.Methods:A retrospective case-control study was conducted to analyze the clinical data of 43 elderly patients aged 90 years or more with intertrochanteric fractures admitted to Henan Provincial People's Hospital from January 2017 to June 2018. There were 12 males and 31 females, aged 90-102 years [(92.3±2.5)years]. A total of 31 patients were treated by PFNA (PFNA group) and 12 patients by bipolar hemiarthroplasty (hemiarthroplasty group). Comparisons were made between the two groups in terms of operation time, intraoperative blood loss, time of weight bearing after operation, rate of blood transfusion, incidence of complications 2 weeks and 3 months after operation, Harris score 12 months after operation and mortality 12 months after operation.Results:All patients were followed up for 1-30 months [(19.1±9.8)months] in PFNA group and for 0.5-29 months [(18.6±10.6)months] in hemiarthroplasty group. Operative time was (95.8±31.0)minutes in PFNA group, shorter than (128.8±40.5)minutes in hemiarthroplasty group ( P<0.05). Intraoperative blood loss was (71.3±25.7)ml in PFNA group and (212.5±113.1)ml in hemiarthroplasty group ( P<0.05). Time of weight bearing after operation was (43.9±31.9)days in PFNA group, longer than (5.9±2.8)days in hemiarthroplasty group ( P<0.05). The perioperative blood transfusion rate in PFNA group (29%) was less than hemiarthroplasty group (75%) ( P<0.05). Incidence of complications 2 weeks after operation was similar between PFNA group (23%) and hemiarthroplasty group (42%) ( P>0.05). Incidence of complications 3 months after operation in PFNA group was 26%, similar with 42% in hemiarthroplasty group ( P>0.05). Harris score 12 months after operation in PFNA group was (56.3±32.3)points, comparable to (59.3±36.7)points in hemiarthroplasty group ( P>0.05). Mortality rate 12 months after operation was 19% in PFNA group and 25% in hemiarthroplasty group ( P>0.05). Conclusion:For intertrochanteric fractures in elderly patients aged 90 years or more, PFNA and bipolar hemiarthroplasty are both effective treatments, but PFNA may be a better choice with shorter operation time and less intraoperative blood loss.

A 3D printed positioner for hip rotation center used in total hip arthroplasty / 中华创伤骨科杂志

Objective:To evaluate the application of a 3D printed positioner for hip rotation center in total hip arthroplasty.Methods:From August 2015 to December 2017, 14 patients were treated by unilateral total hip arthroplasty at Department Ⅰ of Joint Surgery, Orthopaedics Hospital of Zhengzhou for avascular necrosis of femoral head or femoral neck fracture. They were 8 males and 6 females with an average age of 51.8 years (from 37 to 65 years). All their surgeries were assisted by a 3D printed positioner for hip rotation center. Postoperatively, the abduction and anteversion of acetabular cup and the hip rotation center were measured, the agreement between the hip rotation center of the affected side (O2) and the anatomical rotation center of the healthy side (O1) was assessed, and the function of the affected hip and complications were recorded at the last follow-up.Results:The 14 patients were followed up for an average of 18 months (from 6 to 24 months). The postoperative ordinates of O2 and O1 were respectively 19.36 mm±3.61 mm and 18.33 mm±3.41 mm while their abscissas 39.93 mm±2.97 mm and 39.99 mm±3.16 mm, indicating agreement between O2 and O1 ( P>0.05). The postoperative abduction and anteversion of the cup were within a normal range (39.3°±3.2°and 14.6°±1.2°, respectively). The last follow-up showed that their preoperative Harris hip scores (42.3±3.2) were significantly improved (94.3±4.7) ( t=2.873, P=0.002) and that 13 cases were rated as excellent and one as good. X-ray follow-up showed good position of their acetabular prostheses, no loosening of the cups or femoral prostheses, and no heterotopic ossification. Conclusion:A 3D printed positioner for hip rotation center can effectively assist reconstruction of the hip rotation center and accurate implantation of acetabular prosthesis in total hip arthroplasty.

Treatment strategy of traumatic posterior dislocation of shoulder joint with concomitant reverse Hill-Sachs lesion of the humeral head / 中华骨科杂志

Objective To explore the treatment strategy for traumatic posterior dislocation of shoulder joint with concomitant reverse Hill-Sachs lesion on the humeral head.Methods Data of 8 consecutive traumatic posterior shoulder dislocations with concomitant compression on anteromedial portion of the affected humeral heads (reverse Hill-Sachs lesion),which resulted from the collision between the posterior rim of the glenoid and anterior portion of the humeral head,who had undergone treatment in our department since July 2015 to June 2018 were retrospectively analyzed.Seven males and 1 female have been included in the case series,with the age between 30-70 years (mean 44.5±12.3 years),6 on the right shoulder and 2 on the left.7 were acute injuries and 1 chronic.One patient received closed reduction under brachial plexus block anesthesia,and the rest cases underwent open surgeries.Modified Judet approach was performed in one case due to the concomitant fracture on the postero-inferior glenoid.The other 6 patients received modified delto-pectoral approach.4 concomitant rotator cuffswere found during the procedures,including1 full thickness tears 3 partial.One patient received McLaughlin surgery,allograft and anchor suture fixation.2 underwent cannulated screw fixation.Allograft and PHILOS fixation was placed on 4 cases.All 8 patients were required maintaining in mild abduction and external rotation the affected arms,with the protection of the casts.All patients were followed up for 20.6±8.4 months (range,9-36 months).Constant-Murley scores and visual analogue score (VAS) were used to evaluate the clinical outcomes at the latest follow-up.Results Infection occurred in 1 case,the humeral head has been resected subsequently and antibiotic cement spacer was inserted for further arthroplasty.Necrosis of the humeral head has been observed in one CT follow up 9 months after surgery,with no limitation of the range of motion of the shoulder.Stage 1 wound closure and bony union were witnessed on the rest 6 patients.No neuromuscular injures or re-dislocations on the affected shoulders was found.The range of motion of the affected shoulder has been recorded at the latest follow-up:123.8°±30.1° (90°-180°) in flexion,124.4°±34.2° (80°-180°) in abduction,36.9°±20.9° (0°-70°) in external (neutral position),58.8°± 10.9° (50°-80°) in internal rotation (neutral position) and 83.5±12.1 (70-95) in Constant-Murley score.Among the 8 patients,7 patients were at the rank of VAS 0-3,and 1 of 4-6.Conclusion Optimal treatment options should be chosen based on the humeral head defect status,in case of traumatic posterior shoulder dislocation with concomitant reverse Hill-Sachs lesion.Closed reduction can be tried on ＜ 20％ humeral head defect with the help of anesthesia,and surgical option is the optimal one for the defect between 20％-40％.

Treatment strategy of traumatic posterior dislocation of shoulder joint with concomitant reverse Hill-Sachs lesion of the humeral head / 中华骨科杂志

Objective@#To explore the treatment strategy for traumatic posterior dislocation of shoulder joint with concomitant reverse Hill-Sachs lesion on the humeral head.@*Methods@#Data of 8 consecutive traumatic posterior shoulder dislocations with concomitant compression on anteromedial portion of the affected humeral heads (reverse Hill-Sachs lesion), which resulted from the collision between the posterior rim of the glenoid and anterior portion of the humeral head, who had undergone treatment in our department since July 2015 to June 2018 were retrospectively analyzed. Seven males and 1 female have been included in the case series, with the age between 30-70 years (mean 44.5±12.3 years), 6 on the right shoulder and 2 on the left. 7 were acute injuries and 1 chronic. One patient received closed reduction under brachial plexus block anesthesia, and the rest cases underwent open surgeries. Modified Judet approach was performed in one case due to the concomitant fracture on the postero-inferior glenoid. The other 6 patients received modified delto-pectoral approach. 4 concomitant rotator cuffswere found during the procedures, including1 full thickness tears 3 partial. One patient received McLaughlin surgery, allograft and anchor suture fixation. 2 underwent cannulated screw fixation. Allograft and PHILOS fixation was placed on 4 cases. All 8 patients were required maintaining in mild abduction and external rotation the affected arms, with the protection of the casts. All patients were followed up for 20.6±8.4 months (range, 9-36 months). Constant-Murley scores and visual analogue score (VAS) were used to evaluate the clinical outcomes at the latest follow-up.@*Results@#Infection occurred in 1 case, the humeral head has been resected subsequently and antibiotic cement spacer was inserted for further arthroplasty. Necrosis of the humeral head has been observed in one CT follow up 9 months after surgery, with no limitation of the range of motion of the shoulder. Stage 1 wound closure and bony union were witnessed on the rest 6 patients. No neuromuscular injures or re-dislocations on the affected shoulders was found. The range of motion of the affected shoulder has been recorded at the latest follow-up: 123.8°±30.1° (90°-180°) in flexion, 124.4°±34.2° (80°-180°) in abduction, 36.9°±20.9° (0°-70°) in external (neutral position), 58.8°±10.9° (50°-80°) in internal rotation (neutral position) and 83.5±12.1 (70-95) in Constant-Murley score. Among the 8 patients, 7 patients were at the rank of VAS 0-3, and 1 of 4-6.@*Conclusion@#Optimal treatment options should be chosen based on the humeral head defect status, in case of traumatic posterior shoulder dislocation with concomitant reverse Hill-Sachs lesion. Closed reduction can be tried on < 20% humeral head defect with the help of anesthesia, and surgical option is the optimal one for the defect between 20%-40%.