Expert consensus on platelet-rich plasma treatment for osteochondral lesion of talus (version 2023) / 中华创伤杂志

Osteochondral lesion of talus (OLT) is a foot and ankle disease characterized by ankle pain, which may impact the joint function and life quality. If managed improperly, it may lead to a further ankle arthritis, severely compromising the prognosis. The therapeutic effect of conservative treatment for OLT is still uncertain. Surgery is still the main treatment modality for OLT with various techniques. However, the optimized surgical technique is still inconclusive, furthermore, regeneration and repair of cartilage after debridement is also a great challenge for the treatment of OLT. Platelet-rich plasma (PRP) with good repair effect on cartilage injury is gradually applied in the treatment of OLT. However, there still lacks the unified understanding of the technique and specification of PRP for the treatment of OLT. Therefore, National Orthopedics Center of Shanghai Sixth People′s Hospital allied Foot Ankle Basic Research & Orthopedics Group, Chinese Association of Orthopedic Surgeons; Foot and Ankle Committee of Chinese Association of Sports Medicine Physicians; and Foot and Ankle Group of Orthopedic Specialized Branch of Shanghai Medical Association to organize related experts to formulate the Expert consensus on platelet- rich plasma treatment for osteochondral lesion of talus ( version2023). Fifteen recommendations were put forward upon PRP preparation, indications, contraindications and treatment methods of PRP for OLT, so as to standardize the PRP treatment for OLT.

Analysis of risk factors and establishment of prediction model for post transplantation diabetes mellitus in renal transplant recipients / 器官移植

Objective To analyze the risk factors for the occurrence of post transplantation diabetes mellitus (PTDM) in renal transplant recipients, establish a prediction model for PTDM and evaluate its prediction value. Methods Clinical data of 915 renal transplant recipients were retrospectively analyzed. According to the occurrence of PTDM, all recipients were divided into the PTDM group (n=78) and non-PTDM group (n=837). The main indexes of recipients were collected. The risk factors for the occurrence of PTDM in renal transplant recipients were analyzed by univariate and multivariate analysis. The prediction model for PTDM was established and its prediction value was evaluated. Results Family history of diabetes mellitus, body mass index (BMI), preoperative 2 h postprandial blood glucose and preoperative glycosylated hemoglobin were the independent risk factors for the occurrence of PTDM in renal transplant recipients. The prediction model for PTDM was logit (P)=2.199×family history of diabetes (yes=1, no=0)+0.109×BMI+0.151×2 h postprandial blood glucose (mmol/L)+0.508×glycosylated hemoglobin (%)-9.123. The results of receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of these 4 predictors combined for predicting PTDM in renal transplant recipients was 0.830 [95% confidence interval (CI) 0.786-0.873], the cut-off value was 0.0608, the sensitivity was 0.821, the specificity was 0.700, and the Youden index was 0.521 (P < 0.05). Conclusions Family history of diabetes mellitus, BMI, preoperative 2 h postprandial blood glucose and preoperative glycosylated hemoglobin are the independent risk factors for the occurrence of PTDM in renal transplant recipients. The prediction model for PTDM combined with4 predictors yield relatively high prediction value for PTDM.

Association of pre-transplant risk factors with post-transplantation diabetes mellitus in kidney transplant recipients / 中华器官移植杂志

Objective:To analyze the association of pre-transplant risk factors with diabetes mellitus after renal transplantation and examine the significance of preventing the occurrence in kidney transplantation recipients.Methods:A total of 290 kidney transplantation recipients were retrospectively reviewed at our transplantation center from August 2018 to May 2020.Diabetes mellitus after renal transplantation was employed as a primary outcome index.Multivariate Logistic regression model was utilized for constructing A (without adjusting for covariates)、B(covariates include: gender, dialysis mode, type of donation)and C(covariates include: gender, dialysis mode, type of donation, calcineurin inhibitor, antiproliferative drugs, primary disease, fasting blood glucose, 1 h postprandial blood glucose, fasting C peptide, 1 h and 2 h postprandial C peptide, fasting C-peptide index, 1 h postprandial C-peptide index, albumin, triglycerides, total cholesterol)to evaluate the relationship between diabetes mellitus after transplantation and age, body mass index, 2 h postprandial blood glucose(2 h-PG), HbA1c, and 2 h postprandial C-peptide index(2 h-CPI).Results:In model A, age [odds ratio(OR)1.1, 95% confidence interval( CI)1.0~1.1], BMI(OR 1.2, 95% CI 1.0~1.3), 2 h PG(OR 1.2, 95% CI 1.1~1.4), HbA1c(OR 2.7, 95% CI 1.5~4.9), 2 h-CPI(OR 0.7, 95% CI 0.5~1.0), model B/C had similar results with A. Age, BMI, 2 h PG and HbA1c were all risk factors for diabetes mellitus after transplantation while 2 h-CPI was a protective factor.Quartile stratification was analyzed by regression model.And trend test was significant( P<0.05). Conclusions:Age, BMI, 2 h PG, HbA1c and 2 h-CPI are correlated with diabetes mellitus after kidney transplantation.

Arthroscopic treatment of intraarticular displaced fractures of the calcaneus in children / 中华创伤骨科杂志

Objective:To explore the clinical effects of arthroscopic treatment of intraarticular displaced fractures of the calcaneus in children.Methods:The clinical data were analyzed retrospectively of the 11 children who had been treated for intraarticular displaced fractures of the calcaneus at Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University from January 2015 to June 2018. They were 6 boys and 5 girls, aged from 8 to 12 years (average, 10.6 years) and involving the left foot in 7 cases and the right foot in 4. By the Sanders classification, there were 10 cases of type Ⅱ and one of type Ⅲ. Preoperative evaluation of the injury was conducted by X-ray examination and three-dimensional CT reconstruction of the calcaneus. After arthroscopic prying reduction, internal fixation with mere Kirschner wire was performed for 8 cases and internal fixation with Kirschner wire plus hollow screws for 3. The affected feet were fixated with plaster bracket or brace for one month after operation. The Kirschner wires were removed 4 to 6 weeks after operation when X-ray films revealed fracture union. The clinical effects were evaluated by anatomic recovery of the calcaneus in terms of preoperative and postoperative B?hler and Gissane angles and functional recovery of the calcaneus in terms of ankle-hindfoot scores of American Orthopedic Foot Ankle Society (AOFAS) scale.Results:All the 11 pediatric patients were followed up for 12 to 19 months (average, 14 months). No bone grafting was applied. Their operation time averaged 63 min (from 50 to 75 min). Their incisions healed at one stage without infection. All their fractures healed within 2 to 3 months without any delayed union or nonunion. The B?hler angle (28.4°±2.9°) and Gissane angle (125.6°±3.1°) at the final follow-up were significantly improved than the preoperative values (11.8°±5.4° and 138.8°±6.3°) ( P< 0.05). The AOFAS ankle-hindfoot scores were 89.6 points at the final follow-up. Conclusion:Arthroscopic percutaneous prying reduction combined with internal fixation with Kirschner wire and hollow screws can effectively reduce and fixate the intraarticular displaced fracture of the calcaneus in children, leading to limited surgical trauma and fine curative effects.

Tibiotalocalcaneal arthrodesis via lateral transfibular approach to treat tibiotalar and subtalar arthropathy / 中华骨科杂志

Objective@#To observe operative results of tibiotalocalcaneal arthrodesis (TTC) via lateral transfibular ap-proach in the treatment of severe ankle and subtalar diseases.@*Methods@#Eighteen patients treated with TTC via lateral transfibu-lar approach from January 2015 to December 2017 were retrospectively analyzed. There were 11 males and 7 females from 39 to 76 years old, with an average age of 53.4 years. Preoperative diagnoses included traumatic arthritis (3 cases), osteoarthritis (10 cas-es), talar necrosis (3 cases), failure of ankle fusion (1 case) and Charcot-Marie-Tooth disease (1 case). Ankle and hindfoot deformi-ty included varus (10 cases), valgus (6 cases), equinus (1 case) and equinovarus (1 case). All cases were classified into stage-3 ar-thritis according to Morrey-Wiedeman classification. All patients sustained pain and stiffness in the ankle and hindfoot as well as walking dysfunction. Preoperative and 1 year postoperative visual analogue scale (VAS) and American Orthopaedic Foot and An-kle Society (AOFAS) ankle-hindfoot scale were collected. Postoperative joint fusion and complications were observed.@*Results@#Follow-up ranged from 12-47 months, averaging 25.4 months. Preoperative VAS scores were 6-9, averaging 7.1±1.0, while postop-erative VAS scores at 1 year follow-up were 0-2, averaging 0.9±0.8, which decreased significantly. Preoperative AOFAS scores were 24-59, averaging 40.6±11.5, while postoperative AOFAS scores at 1 year follow-up were 68-84, averaging 75.3±5.8, which increased significantly. 8 cases were good and 10 cases were fair according to AOFAS scores at 1 year follow-up. The excellent and good rate was 44.4% (8/18). All joints were fused successfully without implants loosening or breakage. All patients satisfied with operative results at 1 year follow-up. Lateral distal wound dehiscence happened in 1 case of traumatic arthritis and the wound was finally healed after debridement and vacuum assisted closure (VAC). Two cases of osteoarthritis presented with dorsal lateral foot numbness and became asymptomatic after neurotrophic medication. One case of osteoarthritis complained of discomfort in the lateral heel caused by implants prominence and implants were removed at 1 year after surgery. Postoperative complication rate was 22.2% (4/18) .@*Conclusion@#TTC via lateral transfibular approach with cannulated screws and locking plate system is safe and ef-fective. Joint fusion rate is high and complication rate is low. During operation, attention should be paid to restoring hindfoot align-ment, soft tissue balance, proper bone graft and joint compression.

Tibiotalocalcaneal arthrodesis via lateral transfibular approach to treat tibiotalar and subtalar arthropathy / 中华骨科杂志

Objective To observe operative results of tibiotalocalcaneal arthrodesis (TTC) via lateral transfibular approach in the treatment of severe ankle and subtalar diseases.Methods Eighteen patients treated with TTC via lateral transfibular approach from January 2015 to December 2017 were retrospectively analyzed.There were 11 males and 7 females from 39 to 76 years old,with an average age of 53.4 years.Preoperative diagnoses included traumatic arthritis (3 cases),osteoarthritis (10 cases),talar necrosis (3 cases),failure of ankle fusion (1 case) and Charcot-Marie-Tooth disease (1 case).Ankle and hindfoot deformity included varus (10 cases),valgus (6 cases),equinus (1 case) and equinovarus (1 case).All cases were classified into stage-3 arthritis according to Morrey-Wiedeman classification.All patients sustained pain and stiffness in the ankle and hindfoot as well as walking dysfunction.Preoperative and 1 year postoperative visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale were collected.Postoperative joint fusion and complications were observed.Results Follow-up ranged from 12-47 months,averaging 25.4 months.Preoperative VAS scores were 6-9,averaging 7.1 ± 1.0,while postoperative VAS scores at 1 year follow-up were 0-2,averaging 0.9±0.8,which decreased significantly.Preoperative AOFAS scores were 24-59,averaging 40.6± 11.5,while postoperative AOFAS scores at 1 year follow-up were 68-84,averaging 75.3±5.8,which increased significantly.8 cases were good and 10 cases were fair according to AOFAS scores at 1 year follow-up.The excellent and good rate was 44.4％ (8/18).All joints were fused successfully without implants loosening or breakage.All patients satisfied with operative results at 1 year follow-up.Lateral distal wound dehiscence happened in l case of traumatic arthritis and the wound was finally healed after debridement and vacuum assisted closure (VAC).Two cases of osteoarthritis presented with dorsal lateral foot numbness and became asymptomatic after neurotrophic medication.One case of osteoarthritis complained of discomfort in the lateral heel caused by implants prominence and implants were removed at 1 year after surgery.Postoperative complication rate was 22.2％(4/18).Conclusion TTC via lateral transfibular approach with cannulated screws and locking plate system is safe and effective.Joint fusion rate is high and complication rate is low.During operation,attention should be paid to restoring hindfoot alignment,soft tissue balance,proper bone graft and joint compression.

Suture-button technique for acute Lisfranc injury / 中华创伤骨科杂志

Objective To observe operative outcomes of suture-button technique for acute Lisfranc injury.Methods A retrospective observation was conducted of the 11 patients who had been operatively treated with suture-button technique and plate fixation for acute Lisfranc injury from January 2015 to December 2016.They were 8 men and 3 women,aged from 22 to 54 years(mean,32.1 years).By the Myerson classification for the injury,there were 9 cases of type B2 and 2 cases of type Cl;by the Chiodo classification,there were 7 cases of middle column injury,2 cases of injury to middle and lateral columns and 2 cases of injury to medial and middle columns.Their scores on the visual analogue scale(VAS),mid-foot scores of American Orthopedic Foot and Ankle Society(AOFAS),bone union and complications were observed post-operatively.Results Follow-ups for this cohort lasted for 14 to 34 months(mean,20.5 months).Follow-ups revealed that their VAS scores for the affected foot averaged 0.6(from 0 to 2),significantly higher than those for the nomal foot(Z=2.070,P=0.038).Their AOFAS scores averaged 95.2(from 87 to 100),significantly lowerer than those for the nomal foot(Z=2.121,P=0.034).All fractures were united well.Conclusion Suture-button technique can lead to satisfactory outcomes for acute Lisfranc injury.

Transfer of flexor hallucis longus tendon for obsolete Achilles tendon rupture / 中华创伤骨科杂志

Objective To report the therapeutic effects of transfer of flexor hallucis longus tendon on the treatment of obsolete Achilles tendon rupture with a defect greater than 5 cm.Methods The clinical data were retrospectively analyzed of the 39 patients with obsolete Achilles tendon rupture who had been treated at Department of Bone and Joint Surgery,Affiliated Hospital of Southwest Medical University from September 2010 to January 2017.They were 33 males and 6 females,aged from 15 to 46 years(average,31.6 years).All the defects of Achilles tendon were greater than 5 cm.The duration between injury and operation ranged from 5 to 32 weeks(mean,16 weeks).All the 39 patients underwent transfer of flexor hallucis longus tendon to reconstruct their Achilles tendons.The tendons were harvested using double incisions in 23 patients and using a single incision in 16.The functional recovery of the ankle was evaluated according to ankle-hindfood score of American Orthopaedic Foot and Ankle Society(AOFAS),Achilles tendon total rupture score(ATRS),visual analogue scale(VAS),dorsal extension and plantar flexion of the ankle and patient's satisfaction as well.Results Healing by the first intention was achieved in 38 cases.Delayed healing occurred in one patient due to wound infection.One patient had postoperative numbness in the medial plantar region which disappeared 3 months later with no special treatment.All the 39 patients were followed up for 24 to 91 months(mean,32 months).None of the tendons was re-ruptured during the follow-up.The AOFAS scores at postoperative 3 months,one year and last follow-up were significantly higher than the preoperative one(P<0.05);the postoperative VAS scores were significantly lower than the preoperative one(P<0.05);the postoperative ranges of dorsal extension and plantar flexion of the ankle were all significantly larger than the preoperative ranges(P<0.05).At the last follow-up,31 patients expressed great satisfaction,7 satisfaction,and one neutral attitude.Conclusion Reconstruction of the Achilles tendon with transfer of flexor hallucis longus tendon is an effective surgical option for obsolete rupture of Achilles tendon with a defect greater than 5 cm.

Analysis of risk factors for post-transplant diabetes mellitus in patients with renal transplants / 中华内分泌外科杂志

Objective@#To investigate the incidence and risk factors contributing to post-transplant diabetes mellitus (PTDM) in kidney transplant recipients within one year post-transplantation.@*Methods@#A total of 293 non-diabetic kidney transplant recipients were retrospectively analyzed. Patients were divided into non-PTDM group and PTDM group according to the diagnostic criteria of diabetes mellitus. The incidence of PTDM was calculated and the potential risk factors of PTDM were analyzed by univariate and multivariate Logistic regression analysis.@*Results@#Among the 293 non-diabetic patients, 36 patients developed PTDM within 1 year, with an incidence of 12.3%. Multivariate Logistic analysis showed that age (OR 1.055, 95% CI 1.014-1.098, P=0.009) , body mass index [odd ratio (OR) 1.231, 95% confidence interval (CI) 1.084-1.398, P=0.001], polycystic kidney as the primary disease (OR 1.508, 95% CI 1.006-2.262, P=0.047) , 2-hour postprandial blood glucose (OR 1.186, 95% CI 1.04-1.53, P=0.011) , HbA1c (OR 1.732, 95% CI 1.075-3.428, P=0.015) and 1-hour postprandial blood C-peptide (OR 0.869, 95% CI 0.804-0.939, P=0.001) were independent risk factors for PTDM in kidney transplant recipients within 1-year post-transplantation.@*Conclusion@#Patients with older age, obesity, polycystic kidney as the primary disease, higher level of HbA1c and 2-hour postprandial blood glucose, and lower level of 1-hour postprandial blood C-peptide may have higher risk of developing PTDM.

Analysis of risk factors for post-transplant diabetes mellitus in patients with renal transplants / 中华内分泌外科杂志

Objective To investigate the incidence and risk factors contributing to post-transplant dia-betes mellitus (PTDM) in kidney transplant recipients within one year post-transplantation. Methods A total of 293 non-diabetic kidney transplant recipients were retrospectively analyzed. Patients were divided into non-PTDM group and PTDM group according to the diagnostic criteria of diabetes mellitus. The incidence of PTDM was cal-culated and the potential risk factors of PTDM were analyzed by univariate and multivariate Logistic regression analysis. Results Among the 293 non-diabetic patients, 36 patients developed PTDM within 1 year, with an in cidence of 12.3％. Multivariate Logistic analysis showed that age (OR 1.055, 95％ CI 1.014-1.098, P=0.009), body mass index [odd ratio (OR) 1.231, 95％ confidence interval (CI) 1.084-1.398, P=0.001], polycystic kidney as the primary disease (OR 1.508, 95％ CI 1.006-2.262, P=0.047), 2-hour postprandial blood glucose (OR 1.186, 95％CI 1.04-1.53, P=0.011), HbA1c (OR 1.732, 95％ CI 1.075-3.428, P=0.015) and 1-hour postprandial blood C-pep-tide (OR 0.869, 95％ CI 0.804-0.939, P=0.001) were independent risk factors for PTDM in kidney transplant re-cipients within 1-year post-transplantation. Conclusion Patients with older age, obesity, polycystic kidney as the primary disease, higher level of HbA1c and 2-hour postprandial blood glucose, and lower level of 1-hour post-prandial blood C-peptide may have higher risk of developing PTDM.

Preliminary clinical experience of ipsilateral simultaneous pancreas and kidney transplantation / 中华器官移植杂志

Objective To preliminarily explore the clinical efficacy of ipsilateral simultaneous pancreas and kidney transplantation (SPK) .Methods Ipsilateral SPK was performed in 40 patients from September 2016 to August 2018 .During a follow-up period of 6 to 29 months ,we summarized the efficacy and complications of the technique .Results Up to now ,38 patients achieved an exceelent clinical efficacy with no major surgical complications .However ,two patients died of severe pneumonia .The postoperative serum levels of creatinine at 3 ,6 ,12 ,24 months were 107 ,102 ,107 ,110 umol/L ;creatinine clearance rate 64 ,67 ,64 ,63 ml/min;fasting glucose 4 .6 ,5 .1 ,4 .6 ,5 .2 mmol/L ;glycated hemoglobin 4 .8％ , 5 .4％ ,4 .9％ ,5 .2％ respectively .And 1/2-year pancrea and kidney graft survival rates both were 92％ . Complications included kidney graft rejection (n= 11) ,pancreas graft rejection (n= 12) ,simultaneous renal & pancreas graft rejection (n=6) ,renal graft DGF (n=1) ,pulmonary infection (n=14) ,urinary tract infections (n=18) ,gastrointestinal bleeding (n=10) diarrhea (n=6) ,splenic venous thrombosis (n=2) ,incomplete ureteric obstruction of renal allograft (n=3) ,urine leakage (n=1) and pancreas allograft dysfunction (n= 2) .There were no severe surgical complications .After aggressive interventions ,all postoperative complications were cured and none required excision of kidney or pancreas .Conclusions Ipsilateral SPK has definite therapeutic efficacy and it is worth wider popularization .

Effect comparison between open reduction internal fixation and primary arthrodesis for treatment of Lisfranc injuries combined with first tarsal joint dislocation / 中华创伤杂志

Objective To compare the effect and prognosis outcome of open reduction internal fixation and primary arthrodesis in treatment of Lisfranc injuries combined with the first tarsal jointdislocation.Methods A retrospective case control study was conducted on the clinical data with complete follow up data of 126 patients with Lisfranc injuries combined with the first tarsal joint dislocation in nine ankle surgery centers of China from January 2009 to June 2015.There were 76 males (60.3％) and 50 females (39.7％) with an average age of 45.5 years (range,20-87 years).Among the 126 cases,simple dislocation occurred in 41 cases (32.5％),and fracture dislocation in 85 cases (67.5％).The duration from injury to surgery was 11.7 days (range,4-26 days).According to surgery method,the patients were divided into open reduction internal fixation group (n =92) and primary arthrodesis group (n =34).The outcomes were evaluated by American Orthopedic Foot and Ankle Society(AOFAS) score,36-items short form health survey (SF-36),and visual analogue score (VAS).Complications were also followed up.Results All patients were followed up for 18-80 months,with an average of 29.5 months.Primary union was seen in all the patients.At the last follow up,the mean AOFAS midfoot score was (79.4 ± 6.7) points in open reduction and internal fixation group and (85.1 ±8.3) points in primary arthrodesis group (P ＜ 0.05).The mean VAS was (3.1 ± 0.6) points in open reduction and internal fixation group and (2.2± 0.3)points in primary arthrodesis group(P ＜ 0.05).The physiological function of SF-36 was (80.3 ± 5.3) points in open reduction and internal fixation group and (83.5 ± 6.9) points in primary arthrodesis group(P ＞ 0.05).The body pain score of SF-36 was (76.1 ±4.6) points in open reduction and internal fixation group and (84.6 ± 8.7) points in primary arthrodesis group (P ＜ 0.05).In open reduction and internal fixation group,there were five cases (5％) with internal fixator loosening or fracture,16 cases (17％) with redislocation,36 cases (39％) with obvious pain of the middle foot during walking,and eight cases (6％) with tarsal joint traumatic arthritis which was given phase Ⅱ arthrodesis.In primary arthrodesis group,two patients (6％) reported pain due to internal fixation,and the pain was relieved after fixator removal.No re-dislocation,loosening of internal fixation,or traumatic arthritis were found (P ＜ 0.05).Conclusion For Lisfranc injuries combined with first tarsal joint dislocation,primary arthrodesis can stabilize the first tarsal joint and avoid complications or adverse consequences such as redislocation,pain,internal fixation failure,or reoperation.

Two posteromedial approaches in treatment of posterior pilon fractures of Klammer type Ⅲ / 中华创伤骨科杂志

Objective To observe operative results of 2 posteromedial approaches in the treatment of posterior pilon fractures of Klammer type Ⅲ.Methods From January 2015 to December 2016,19 patients with posterior pilon fracture (Klammer type Ⅲ) were treated via the posteromedial approach.They were 12 men and 7 women,aged from 21 to 61 years (mean,37.4 years).Straight posteromedial incision was used in 11 cases and curved posteromedial incision in the other 8 cases.The 2 groups were compared in terms of postoperative wound complication,infection,bone union,visual analogue scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) scores.Results Follow-up ranged from 6 to 29 months (mean,11.8 months).All the fractures united after 6 to 15 months (mean,10.7 months).In the straight incision group,the VAS scores at the final follow-up ranged from 0 to 3 points,averaging 1.1 points;the AOFAS scores ranged from 83 to 100 points,averaging 90.8 points.In the curved incision group,the VAS scores at the final follow-up ranged from 0 to 3 points,averaging 1.3 points;the AOFAS scores ranged from 80 to 100 points,averaging 90.1 points.In one case in the curved incision group,the posteromedial wound failed to heal but scar healing was achieved after dressing change for 4 months.Conclusion The posteromedial approach,whether straight or curved,can provide good exposure for posterior pilon fractures of Klammer type Ⅲ,which is conductive to reduction and fixation of the fracture.

Open reduction and internal fixation plus primary subtalar arthrodesis for treatment of severely comminuted calcaneal fractures of Sanders type Ⅳ / 中华创伤骨科杂志

Objective To explore the effects of open reduction and internal fixation plus primary subtalar arthrodesis for the treatment of severely comminuted calcaneal fractures of Sanders type Ⅳ.Methods From January 2012 to December 2016,23 patients with severely comminuted calcaneal fracture of Sanders type Ⅳ were treated by open reduction and internal fixation plus primary subtalar arthrodesis at our department.They were 16 men and 7 women with an average age of 39.6 years (range,from 32 to 67 years).Auto-iliac bone graft was performed in 18 cases and allo-bone graft in the other 5 cases.B(o)hler and Gissane angles were measured preoperatively,postoperatively and at the last follow-up to evaluate anatomical morphology of the calcaneus;the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used to evaluate the functional recovery.Results All the 23 cases were followed up successfully for an average time of 21 months (range,from 6 to 39 months).The operations lasted from 40 to 100 minutes with an average of 60 minutes;the intraoperative bleeding ranged from 10 to 40 mL with an average of 20 mL.No one suffered from wound infection but partial epidermal necrosis happened in only one case.Union and fusion of the fractures was achieved after 3 to 5 months with an average of 3.5 months.At the last follow-up,no failed fusion of the subtalar joint happened.Anatomical morphology of the calcaneus was improved obviously.The B(o)hler angles were respectively 12.47° ± 1.61°,30.58° ± 5.34° and 30.09° ± 5.78° preoperatively,postoperatively and at the last follow-up;the Gissane angles were respectively 86.21° ±7.70°,127.44°± 7.61° and 129.07°± 5.47° preoperatively,postoperatively and at the last follow-up.There were significant differences between preoperation versus postoperation and the last follow-up in the above 2 values (P ＜ 0.05);there were no significant differences between postoperation and the last follow-up in the above 2 values (P ＞ 0.05).The AOFAS ankle-hindfoot scoring at the last follow-up showed 8 excellent,11 good and 4 fair cases,giving an excellent to good rate of 82.6％.Conclusion Open reduction and internal fixation plus primary subtalar arthrodesis is a safe alternative for the treatment of severely comminuted calcaneal fractures of Sanders type Ⅳ.

Learning curve for transesophageal echocardiography applied in mechanically ventilated patients in intensive care unit / 中国中西医结合急救杂志

Objective To investigate the learning curve of transesophageal echocardiography (TEE) applied in mechanically ventilated patients in intensive care unit (ICU).Methods A prospective observation study was conducted. A total of 60 consecutive patients necessary for mechanical ventilation and TEE examination admitted to the Department of Surgical ICU of the First Affiliated Hospital of Sun Yat-Sen University from December 2016 to June 2017 were enrolled. The TEE examination was performed by the same ICU physician who was skilled in transthoracic echocardiography (TTE). The TEE probe intubation (trial numbers of TEE intubation, the duration for a successful intubation at the first attempt, the total time for successful intubation), TEE examination (the scores of TEE examination, the duration of TEE examination), and the complication during examination were observed, with learning curve established. According to the date of examination, a statistical analysis was carried out for each group of 12 cases. Through the learning curve, that TEE examinations in how many cases should be performed by the ICU physician to master the skill was observed.Results With the increase of TEE examinations performed by the physician, the duration for a successful intubation at the first attempt and the total time for successful intubation were gradually reduced; the scores of TEE examination were gradually increased, and the duration of TEE examination gradually reduced. ① TEE intubation: there was no statistical significant difference among the 60 patients in the number of intubation attempts (F = 0.258,P = 0.904). After the SICU doctor completed TEE intubations in 12 cases, the duration for a successful intubation at the first attempt was significantly reduced (seconds: 22.24±18.37 vs. 34.88±1.65,P < 0.05) and then tended to stabilize in the 16 - 23 seconds. The learning curve indicated that the physician could basically master the intubation skills after performing TEE intubations in 24 cases. ② TEE examination: after the physician completed TEE intubations in 24 cases, the TEE examination scores were increased significantly (40.08±7.27 vs. 23.67±9.70,P < 0.05), and then tended to stabilize in the 40 - 47 scores; after TEE intubations were performed in 24 cases, the examination duration was significantly shortened (minutes: 39.97±6.67 vs. 58.22±14.19,P < 0.05), and after 36 cases were completed, the duration could be further shortened (minutes:31.04±7.84 vs. 39.97±6.67,P < 0.05). The learning curve indicated that the ICU physician could basically master the examination skills when TEE examinations were completed in 36 cases. In addition, no serious complications occurred during the TEE examination.Conclusions A SICU physician with skilled TTE experience can basically master the TEE technology through 36 times of examinations, and reach full mastery after 48 times, the duration for a successful intubation at the first attempt could be stabilized at 20 seconds, and the examination duration could be stabilized at 30 minutes.

Surgical treatment of posterior pilon fracture through the posteromedial approach / 中华创伤骨科杂志

Objective To review the results and complications of open reduction and internal fixation (ORIF) through the posteromedial approach for posterior pilon fractures.Methods From March 2009 through November 2013,18 consecutive posterior pilon fractures were surgically treated through the posteromedial approach,involving 12 males and 6 females.Their ages ranged from 15 to 65 years (average,42 years).All of them were complicated with fracture of external malleolus,and 6 of them with fracture of anterior colliculus of medial malleolus.The time from injury to surgery ranged from 2 to 15 days (average,7 days).Results The patients were followed up for an average of 15 months (range,from 10 to 19 months).All the fractures healed after 11 to 16 weeks (average,13 weeks).No complications like neurovascular injury,implants failure,nonunion,or malunion occurred,except one case of superficial wound infection which responded to nonoperative management.According to the AOFAS (American Orthopaedic Foot and Ankle Society) evaluation system,15 cases were excellent,2 cases good and one case fair.Conclusion It is safe,reliable and effective to treat posterior pilon fractures using anti-rotation plate ORIF through the posteromedial approach.

Two minimally invasive surgical treatments for Achilles tendon rupture: Achillon versus sponge forceps / 中华创伤骨科杂志

Objective To compare 2 mini-invasive surgical treatments,Achillon versus sponge forceps,for acute Achilles tendon rupture.Methods Between December 2010 and January 2015,35 patients with acute Achilles tendon rupture were treated at our department.They were 32 males and 3 females,with an average age of 36.4 years (range,21 to 64 years).The interval between injury and operation was 1 to 13 days (average,3.2 days).Sixteen of them were treated by Achillon while 19 by sponge forceps.The 2 groups were compatible with no significant differences in general clinical data (P ＞ 0.05).Rehabilitation was carried out 4 weeks after immobilization with brace.American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scoring system was used to evaluate the function of the affected foot at the last follow-up.The 2 groups were compared in terms of surgery time,hospital stay,AOFAS score,decrease in leg circumference,complications and rerupture rate.Results All the patients were followed up for an average of 9.6 months (from 6 to 19 months).There were no significant differences between the Achillon and sponge forceps groups regarding average AOFAS score (91.8 ± 4.4 versus 93.2 ± 5.8),surgery time (38.3 ± 13.2 min versus 42.5 ± 9.8 min),hospital stay (3.9 ± 1.5 d versus 4.1 ± 1.6 d),or decrease in leg circumference (2.1 ±0.5 cm versus 2.3 ± 0.3 cm) (P ＞ 0.05).No re-ruptures or sural nerve lesion was observed in either group.One case of delayed wound healing occurred in each group.Conclusions Both Achillon and sponge forceps can lead to limited complications and a very low rate of re-rupture in surgical treatment of acute Achilles tendon rupture.Compared with the Achillon technique,sponge forceps may have the advantages of simplicity and lower cost.

The realization way and lean management about medical consumable material in clinical use / 中国医疗器械杂志

The medical consumable material management is an important part of logistic support in the management of hospital, but the hospital has many weak links in the management of supplies. This paper aims to explore the common problems (especially in clinical use) existing in the management of medical consumables and years of management experience in Changhai hospital's practice, then discusses lean management from the perspective of lean management

Radiological characteristics and anatomical risk factors in the evaluation of hallux valgus in chinese adults / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There are no unified theories as to the anatomical changes that occur with hallux valgus, we investigated the radiological characteristics and anatomical risk factors for hallux valgus deformity in Chinese adults.</p><p><b>METHODS</b>We reviewed 141 patients with hallux valgus (206 feet; 15 males, 126 females; mean age, 58.5 years). These patients attended Peking University People's Hospital from April 2008 to March 2014. All feet had intact radiological data, obtained using the Centricity RIS/PACS system. We measured hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), proximal articular set angle (PASA), distal articular set angle, hallux interphalangeal angle, metatarsocuneiform angle, size of the medial eminence of the distal first metatarsal, tibial sesamoid position, and joint congruity of the first metatarsophalangeal joint (MTPJ).</p><p><b>RESULTS</b>We found positive correlations between the HVA and IMA (r = 0.279, P < 0.01) and HVA and PASA (r = 0.358, P < 0.01), but not for IMA and PASA (P > 0.05). Feet were divided into three groups based on HVA severity. IMA (P < 0.05) and PASA (P < 0.05) in the mild group were significantly lower than that in the moderate and severe groups, with no significant difference determined for IMA or PASA between the moderate and severe groups (P > 0.05). Feet were then grouped based on the shape of the first metatarsal head. Using this grouping, HVA was significant higher in the rounded shape (19.92°) than in a flat shape (17.66°). The size of the medial eminence of the distal first metatarsal was positively correlated with HVA (r = 0.185, P < 0.01). The medial eminence in the moderate and severe groups was significantly larger than that in the mild group; moderate and severe groups were not significantly different.</p><p><b>CONCLUSIONS</b>PASA enlargement is an adaptive change during early hallux valgus formation, and decompensation leads to subdislocation in the first MTPJ. A rounded first metatarsal head would thus predispose a foot to hallux valgus. Furthermore, bone proliferation at the medial eminence may also lead to early hallux valgus development.</p>

Characteristics and perioperative management of hemophilia patients with fractures / 北京大学学报(医学版)

Objective:To investigate the characteristics and perioperative management of hemophilia patients with fracture.Methods:Retrospectively, we analyzed 8 patients with hemophilia combined with fracture, who were admittted to our department from 2005 to 2013.Six patients were with hemophilia A and two with hemophilia B;Based on the severity of hemophilia, 2 cases were light, 3 moderate and 3 severe;Based on the location of fracture, 4 cases were femoral neck fractures, 1 femoral intertrochanteric fracture, 1 bilateral distal femur fractures, 1 tibiofibula fracture, and 1 humerus intercondylar fracture. Blood coagulation factor replacement therapy was conducted preoperatively, intraoperatively and postoper-atively, All the patients underwent closed or open reduction and internal fixation or joint replacement. Also, we analyzed the perioperative complications and observed whether the fracture healed.Results:The average age was 33.5 years (14 to 47 years); In 6 cases, fractures occurred at femur, accounting for 75%of all the fractures; Femoral neck fracture was treated by closed reduction and hollow screws fixation;Femoral intertrochanteric fracture, distal femur fracture, and tibiofibula fracture were treated by open reduction and internal fixation with plate;Humerus intercondylar fracture was treated by elbow joint replacement.Intraoperative bleeding was from 50 to 600 mL, an average of 262 mL;Perioperatively, the average use of FⅧ/activated prothrombin complex concentrates ( APCC) was 358 U/kg (125 to 554 U/kg) .Postoperatively, poor wound healing was observed in 2 patients, and the condition improved after symptomatic treatment; In patients with internal fixation, all the fractures united, and the average hea ling time was 14 weeks.No complications such as fixation loosening or rupture occurred after internal fixation.Conclusion:Hemophilia combined with fracture mainly occurred in the young, and the site of fracture was given priority to femur.With perfect preoperative preparation, on the basis of the replace-ment therapy, hemophilia combined with fractures was safe for surgical treatment, and postoperative frac-tures healing wasgood.But the risk of poor wound healing was high.