Effects of airborne pollen on allergic rhinitis and asthma across different age groups in Beijing, China.

In the context of global warming and rapid urbanization, pollen has become a significant public health concern for Chinese citizens. However, there is a paucity of epidemiological research on the impact of pollen on allergen-linked diseases, such as allergic rhinitis and asthma, in China. Using data from the Beijing Chaoyang Hospital between 2013 and 2019, which included allergic rhinitis and asthma incidence, meteorological records, and air pollution data, we employed a Generalized Additive Model (GAM) to examine the relationship between overall and type-specific pollen concentrations in relation to varying population exposures. We found that increased overall pollen concentrations significantly increased the risks of allergic rhinitis and asthma in diverse populations. Notably, the risk of allergic rhinitis was higher than that of asthma at equivalent pollen concentrations. Seasonal trends indicated that spring pollen peaks, primarily from trees, were associated with a lower risk of both allergic rhinitis and asthma than autumn peaks, predominantly from weeds. This study underscores the importance of identifying pollen species that pose heightened risks to different demographic groups across seasons, thereby providing targeted interventions for public health agencies.

The clinical characteristics and outcomes of Maisonneuve fractures / 中华骨科杂志

Objective@#To investigate the clinical characteristics and outcomes of Maisonneuve fractures.@*Methods@#Data of 21 cases of Maisonneuve fractures from February 2015 to December 2017 were retrospectively analyzed. There were 16 males and 5 females with an average age of 38.8 years (range, 21 to 61 years). The fractures occurred on the left side in 11 patients and on the right side in 10 patients. The causes of injuries were traffic accident in 4 patients, sprain injury in 9 patients and falling injury from height in 8 patients. There were 16 cases of medial malleolar fractures and 5 cases of ruptures of deltoid ligament (4 entirely and 1 partial). There were 17 cases of fractures of the posterior malleolus, among which there were 5 of typeⅠ, 8 of typeⅡ and 4 of type Ⅲ according to the Bartonícek classification of posterior malleolus. There were 4 cases without fracture of posterior malleolus including 1 complete disruption of posterior inferior tibiofibular ligament. Four cases were overlooked of Maisonneuve fracture at the first time. The interval between injury and operation was 2-12 days (mean, 4.9 days).@*Results@#Stabilization of proximal fibular fractures were achieved with plate in 3 cases. There were 16 cases of medial malleolar fractures, and the fixation were achieved with cannulated screws in 13 cases and with anti-glide plates in 3 cases. The entirely rupture of deltoid ligament was repaired in 4 cases with suture anchors, the partial rupture of deltoid ligament was not repaired. There were 17 cases of posterior malleolar fractures, 12 cases treated with open reduction and internal fixation including cannulated screws in 9 cases and anti-glide plates in 3 cases. Stabilization of syndesmosis was achieved with syndesmotic plate in 1 case; the medial and posterior malleolar fractures were stabilized and anterior inferior tibiofibular ligament was repaired with suture anchor in 1 case; the other 19 cases were stabilized with syndesmotic screws, 2 screws in 11 cases and 1 screw in 8. Twenty-one patients were followed up for 13-48 months with an average of 25.6 months. The time of bony union was from 3 to 6 months with an average time of 4.9 months after operation. All patients received anatomical reduction without postoperative complications such as incision infection, reduction lose, breakage of screw and posttraumatic arthritis. In 13 cases, the syndesmotic screw was removed at the mean time of 15.38 weeks postoperative (range, 13-25 weeks). At the latest follow up, AOFAS score was from 84 to 100, with excellent in 13 cases, good in 8 cases, and the excellent and good rate was 100% (21/21). Baird-Jackson score was from 83 to 100, with excellent in 11 cases, good in 8 and fair in 2, and the excellent and good rate was 90.48%(19/21).@*Conclusion@#The diagnosis of proximal fibular fracture of Maisonneuve fracture is easily missed. The complete rupture of deep deltoid ligament and displaced obviously of posterior malleolar fracture should be reduction and stabilization. The accuracy of reduction of the syndesmosis is of great concern. The outcome of operation is satisfied.

Research advances of the classification and treatment of posterior malleolus fractures / 中华骨科杂志

The posterior malleolus plays an important role in the stability and function of the ankle joint. Approximately 7%to 44%of ankle joint fractures are accompanied by posterior malleolus fractures. The current published data suggest a poor outcome for ankle fractures involving the posterior malleolus. Inappropriate reduction of the posterior malleolus fragment may re?sult in symptomatic malunion requiring corrective osteotomy. The posterior malleolus fractures were categorized into three types by Haraguchi:the posterolateral?oblique fractures (Type I), the transverse medial?extension fractures (Type II) and the small?shell fractures (Type III). Mangnus divided posterior malleolus fractures into two basic types: posterolateral and posteromedial types. Bartonícek classified the posterior malleolus fractures into four types on the basis of CT scan and 3D reconstructions, and taking into account the location, shape, size of the fragment and the integrity of the fibular notch:extraincisural fragment with an intact fibular notch (Type I), posterolateral fragment extending into the fibular notch (Type II), posteromedial two?part fragment involving the medial malleolus (Type III) and large posterolateral triangular fragment (Type IV). The fracture lines associated with posterior malleolus fractures appear to be highly variable. So far, no generally accepted clinically relevant classification of posterior malleo?lus fractures exists, and the indications of the operative management of these fractures were often determined by the size of the fragment. The anteroposterior and lateral views were used to evaluate the fractures of the fibular and the medial malleolus, as well as the rupture of the ligament and the presence of subluxation or dislocation of the talus. The determination of proper surgical ap?proach and the internal fixation should take into account the size, shape and displacement of the posterior fragment by CT scans, through CT and 3D reconstructions. The aim of treatment for posterior malleolus fractures is to reduce the displaced fragments ana?tomically, and to restore the stability of the tibiotalar joint and the distal tibiofibular syndesmosis.

Curative effects of suture anchor tenodesis in repairing acute closed distal achilles tendon injuries / 天津医药

Objective To evaluate the effectiveness of the suture anchor in the treatment of acute closed distal achilles tendon rupture. Methods A retrospective review of clinical data in 25 patients with acute achilles tendon rupture was performed in the department of orthopedic trauma of Tianjin Hospital between October 2012 to January 2014. The operation was performed by standard approach, with the suture anchors to reconstruct the achilles tendon insertion, and the Krachow technique was used to suture the achilles tendon. All patients were followed up for 19~35 months. The situation of the wound healing, heel pain, and achilles tendon re-rupture were observed and analyzed. According to the passive range of motion of the bilateral ankle joint, the achilles tendon total rupture score (ATRS), the American orthopaedic foot and ankle society (AOFAS) score and functional recovery were assessed one year after operation. Results The operation was successfully completed in this group. The operation time was 25-35 min, the average time was (30.4 ± 4.8) min. No major vascular and nerve injury occurred in the operation. All patients were followed up. The wound healed well. No infection and skin necrosis, no heel pain and achilles tendon re-rupture were found during follow-up. There was no significant difference in mean passive plantar flexion between injured ankles and uninjured ankles one year after operation (44.36° ± 3.33° vs. 46.40°±4.53°, P>0.05). But mean passive dorsiflexion was lower in injured ankles than that of uninjured ankles (16.88°± 4.10° vs. 20.12°±3.21°,P<0.05). The mean ATRS score was 88.7±6.1 (range 79-97), and the mean AOFAS score was 92.4± 5.6 (range 76-100) at first postoperative year. According to the AOFAS scale, the results were excellent in 20 cases and good in 5 cases. Conclusion It was successful to repair the acute closed distal achilles tendon injuries with the suture anchors.

Complication of the less invasive stabilization system for mechanically unstable fractures of the distal femur / 中华骨科杂志

Objective To investigate the results and complications in the treatment of the mechanically unstable fractures of the distal femur when Less Invasive Stabilization System (LISS) is used.Methods From September 2011 to July 2014,81 patients with mechanically unstable fractures of the distal femur were treated with the LISS,according to the inclusion criteria and exclusion criteria,59 patients meet the condition including 31 male and 28 female.The mean age of the patients was 49.8 years (range 18-80 years).The fractures occurred on the left side in 40 cases and on the right side in 19 cases.According to AO classification,27 type 33A2,14 type 33A3,13 type 33C2,5 type 33C3.2 cases combined with ipsilateral fractures of the femoral shaft,according to AO classification,1 type 32A1,1 type 32C1.The mechanism of injury was a fall from the height in 8 cases,a traffic accident in 18 cases,a crush injury in 7 cases,a fall injury in 26 cases.55 fractures were closed,and 4 were open.According to the Gustilo-Anderson classification,there were 3 type Ⅰ,1 type Ⅱ.Results The 7-hole plate were used in 21 patients,9-hole plate in 26 patients and 13-hole plate in 12 cases.The 3.5 mm or 6.5 mm lag screw were placed around the LISS plate to stabilized the articular fracture fragment in 11 cases.The mean operation time was 105.2 min (85-145 min),the mean bleeding volume was 203 ml (130-315 ml).All patients were followed up 11-27 months (average 13.2 months).1 delayed union(13 months),the average time to union was 16 weeks (range 12-21 weeks).The average flexion of the knee was 116 degree,0 degree in extension.The functional outcome:32 had an excellent result,19 had a good result and 8 had a fair result,with 86.4％ excellent and good results.No deep infections occurred.No loss of reduction.3 cases had malalignment,2 failed fixation,4 patients with symptomatic hardware irritation.27 cases underwent implants removal after union,cold-welding occurred in 4 cases (9 screws) which resulted in difficult removal.Conclusion LISS is one of the reliable and effective methods in fixation of mechanically unstable fractures of the distal femur.However,its operation indications and operating instructions should be strictly followed.

Operative treatment of trimalleolar fractures in the elderly / 中华老年医学杂志

Objective To estimate the effect of open reduction and internal fixation for treating the trimalleolar fracture in the elderly.Methods 57 aged patients suffered from the trimalleolar fracture and were treated with internal fixation from January 2009 to June 2012.25 males and 32 females with an average age of 71.5 years ranged from 65 to 81 years were involved in this study.The supination-external rotation type were in 41 cases and pronation-external rotation type in 16 cases according to Lauge-hansen's classification.The posterior and lateral approach was taken for surgical procedure of lateral malleolar frature.The routine or locking plates were used to fix the fratures.The posterior malleolar fractures were usually fixed through the posterolateral approach as well.The screws or tension band fixation was selected for fixing the medial malleolar fragments.The parallel screwing fixation could be helpful for fixing the tibiofibular syndesmosis.Results The ankle function was evaluated by the criteria system of the American Orthopaedic Foot and Ankle Society (AOFAS).The efficacy was excellent in 23 patients,good in 24 patients,fair in 7 patients.The skin problems such as super facial infection and delayed union of incision were in 7 cases.Conclusions If choosing reasonable operation method and suitable internal plant,the open reduction and internal fixation has better effect in treating the trimalleolar fracture in the elderly,with fewer complications.

Senile Hip Fracture Treatment by Concept of Enhanced Recovery / 天津医药

In the elderly, patient who suffered from hip fracture need to stay in bed for a long time and has a higher prevalence of complications and mortality. Considering the factors of patients in the intraoperative death and postoperative re?habilitation, we take appropriate treatment measures during preoperative, intraoperative and postoperative period respective?ly based on the concept of Enhanced Recovery. Patient will benefit from rapid rehabilitation and reduction of incidence of complications and mortality. ERAS includes preoperative fasting, preventive anagelsia, intraoperative temperature control, anesthesia and surgical approach, postoperative intravenous restriction, nutritional support and painless early motion. This ar?ticle intends to review the security , reliability and clinic efficacy of ERAS.

Causes of the complications in the patients with femoral peritrochanteric fractures with gamma3 nail / 中华骨科杂志

Objective To evaluate the causes of complications of patients with femoral Intertrochanteric fractures after gamma3 nail fixation.Methods A retrospective analysis was conducted to summarize the treatment of intertrochanteric fractures in 186 cases with Gamma3 nail from May 2006 to July 2011.Complications occurred in 24 cases during the operations.19 were males,5 females,with the age from 42 to 81,the average age of 69.00±3.27 years.According to AO/OTA classification,8 cases were type A1,1 case were type A2.1,15 cases were type A3.All patients included were acute fractures,while pathological fractures were excluded.Supine position were selected during operation,close reduction were performed in traction bed.Gamma3 nail made by Stryker Company was used to fix fractures through small incisions.Operational times were from 45 to 160 minutes,averaged by 80 min.Blood lose were 300-800 ml in average.No patient need blood transfusion.The procedure from hospitalized to operation is from 3 to 12 days,6 days in average,discharged from 3 to 16 days after operation.According to the intraoperative and postoperative follow-up evaluation of the X-ray and Harris evaluation criteria,Gamma3 nail complications were summarized in the application.Results Time of surgery in 24 cases were 45-160 min,average 80 min.Blood loss were 300-800 ml,average 600 ml,walking time 35-106 d.Harris evaluation were 75-91 point,average 81 point.The anti-spiral nail dropped into inner thigh muscles occurred in 1 case,causing defects of femoral lateral wall in 3 cases.Splitting fractures occurred in the proximal femoral shaft during the operations in 5 cases,poor fracture reduction during closed reduction in 6 cases.Fracture site were shifted lately postoperative in 5 cases,lag screw cut-out in 3cases and refracture in the site of distal femoral interlocking nail in 1 case.Conclusion Higher incidence of complications were occurred in some special types of AO classification when using close reduction and short Gamma3 nail.The reduction method,wrong indication selection and unreasonable application of equipment may result in the occurence of complications.We,therefore,should use long or short Gamma nail according to their respective induction method and scope of its application,aiming to avoid complications.

Clinical characteristics and outcomes of ipsilateral talar and calcaneal fractures / 中华骨科杂志

Objective To investigate the clinical characteristics and outcomes of ipsilateral talar and calcaneal fractures.Methods From April 2003 to July 2011,22 patients with ipsilateral talar and calcaneal fractures were treated in our hospital.There were 20 males and 2 females with an average age of 30.2 years (range,17 to 51 years).The fractures occurred on the left side in 10 patients and on the right side in 12 patients.There were 8 cases of talar neck fracture,including 3 type Ⅰ,3 type Ⅱ and 2 type Ⅲ according to the Hawkins classification; there were 14 cases of talar body fracture,including 6 type Ⅱ,2 type Ⅲ and 6 type V according to the Sneppen classification.There were 13 cases of extra-articular calcaneal fracture and 9 cases of intra-articular fracture.Four patients had open fractures,including 1 type Ⅰ,2 type Ⅱ and 1 type llⅢA according to the GustiloAnderson classification.The average time from injury to surgery was 5.5 hours for patients with open fracture and 11 days for patients with close fracture.Seventeen patients underwent internal fixation and 5 patients underwent non-operative treatment.Results All patients were followed up for 25 to 89 months (average,41.5 months).Skin necrosis of the edges of the incision was found in 2 cases and wound infection in 1 case.No fracture nonunion and loss of reduction were observed in all patients.At final follow-up,the functional results were assessed according to the AOFAS score,and the average AOFAS score was 78.9 (range,53 to 95).The result was excellent in 5 patients,good in 10 and fair in 7,and the overall excellent or good rate was 68.2％.Traumatic arthritis was found in 12 patients who had undergone surgical treatment,including 5 cases in subtalar joint and 7 cases in ankle and subtalar joint.Diaz disease occurred in 1 patient who had undergone non-operative treatment.Conclusion Ipsilateral talar and calcaneal fracture is a complicated injury which has many fracture types.The fractures should be reduced anatomically,and traumatic arthritis is the most common complication.

Closed reduction assisted with Kirschner wires for irreducible femoral neck fracture / 中华骨科杂志

Objective To investigate the feasibility of closed reduction assisted with Kirschner wires for irreducible femoral neck fracture.Methods From June 2008 to April 2011,32 patients with irreducible femoral neck fracture were treated.There were 15 males and 17 females,aged from 21 to 59 years (average,46 years).According to Garden classification,there were 6 of Ⅱ,16 of Ⅲ and 10 of Ⅳ.According to displacement direction of the femoral head showed by preoperative X-rays and CT scans,irreducible femoral neck fracture was divided into 3 types:angulation-impaction (11 cases),rotation-separation (15 cases) and abduction-impaction (6 cases).One to three Kirschner wires were penetrated into the femoral head to reduce the displacement in opposite direction of fracture displacement.After reduction was satisfied,guide pins were penetrated,and then the fractures were fixed with cannulated screws.Results Anatomic or nearly anatomic reduction was achieved in 30 patients after closed reduction assisted with Kirschner wires.Two patients underwent open reduction finally due to failure of closed reduction.The operation time ranged from 40 to 80 min,and the blood loss ranged from 20 to 50 ml.According to Garden index,anatomic reduction was achieved in 29 and acceptable reduction in 1.Among 30 patients who had undergone closed reduction,29 patients were followed up for 12 to 20 months.Bone union was achieved in 28 patients,and the fracture healing time ranged from 4 to 10 months.One patient with rotation-separation displacement before closed reduction underwent total hip replacement due to avascular necrosis of femoral head occurred at 15 months after closed reduction.Conclusion Closed reduction assisted with Kirschner wires is an effective method for irreducible femoral neck fracture,which can achieve satisfactory anatomic reduction rate and fracture healing rate.

Characteristic and treatment of ankle fracture combined with Tillaux-Chaput and Volkmann fractures / 中华骨科杂志

Objective To explore the clinical characteristics and operative methods of the ankle fracture combined with Tillaux-Chaput and Volkmann fractures.Methods The data of 15 patients who were suffered the ankle fracture combined with the simultaneous fractures of Tillaux-Chaput and Volkmann between Septenber 2005 and January 2012 were analyzed.There were 8 males and 7 females with an average age of 27.3 years (range,16-57 years).All had medial malleolar and fibular fracture with Tillaux-Chaput and Volkmann tubercle avulsed fracture.X-ray film shows that there were 8 cases in which the patients had Tillaux-Chaput fracture,among whom 7 were diagnosed by CT scan.Classified by Lauge-Hansen system,ankle fracture could be divided into pronation-exterual rotation type in 4 cases,and pronation-abduction type in 11 cases.The fracture of fibula and the Volkmann tubercle were treated through the posterolateral approach.The fibular fracture was fixed with plate.The medial malleolar fracture was explored from medial curve approach.Tillaux-Chaput fracture was treated by the mierotubule cut.All patients were assessed with the ankle hindfoot clinical rating system of the American Orthopaedic Foot and Ankle Society (AOFAS).Results All patients were followed up for 8-20 months (average,12.5 months).The fracture healed 12-36 weeks later in all the 15 patients,with an average of 23.5 weeks.Twelve patients walked normally and 3 with mild claudication in the last follow-up.The AOFAS score was average 85.4 points,9 were excellent,4 were good,2were fair,with the good-excellent rate being 86.7％ (13/15).The movement of ankle joint limited in 3 patients,tenderness occurred when weight bearing in 3 patients.Conclusion The ankle fracture include the simultaneous fractures of Tillaux-Chaput and Volkmann were more seen in the type of pronation-abduction.It is often misdiagnosis by the photograph; CT scan should be helpful to find the fracture fragments.The exact reduction and stable fixation were needed in the treatment of the ankle fracture combined with Tillaux-Chaput and Volkmann fractures.Inferior tibia fibular screw was not routinely used in this fracture.

The effect of surgical treatment of displaced intra-articular calcaneal fracture via modified lateral Lshaped incision / 中华骨科杂志

Objective To explore clinical effect of surgical treatment of displaced intra-articular calcaneal fractures via modified lateral L-shaped incision.Methods From January 2005 to October 2011,133patients (143 feet) with displaced intra-articular calcaneal fractures,including 125 males and 8 females,aged from 19 years to 65 years (average,43.2 years),underwent open reduction and internal fixation via modified lateral L-shaped incision.There were 56 cases of left calcaneal fractures,67 cases of right calcaneal fractures,and 10 cases of bilateral calcaneal fractures,and all of them were closed fracture.According to Sanders classification,15 feet were classified as type Ⅱ,107 type Ⅲ,and 21 type Ⅳ.The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale were used to access outcomes.Results One hundred and twenty five patients (135 feet) were followed up for 12 to 28 months (average,18.5months).All fractures healed after an average of 13 weeks (range,8-16 weeks).There were on nerve injury or osteomyelitis.Incision dehiscence occurred in 4 feet,which healed after removing the plate.Subtalar joint traumatic arthritis occurred in 17 feet,with walking pain.Collapse of articular surface occurred in 5 feet after weight-bearing.According to AOFAS ankle-hindfoot scale,excellent result was got in 94 cases,good in 29 cases,fair in 14 cases,poor in 6 cases; and the excellent and good rate was 92.9％.Conclusion Open reduction and internal fixation via modified lateral L-shaped incision for treating displaced intra-articular calcaneal fractures can obtain satisfactory results,but the skilled surgical techniques are needed.

External fixation combined with minimal invasion internal fixation for complex diaphyses fracture combined with femur condyle fractures / 中华创伤杂志

Objective To discuss external fixation method for the complex diaphyses fracture involving condyles of femur and evaluate its clinical efficacy.Methods A retrospective study was done on 42 patietns with comminuted femur diaphyses fracture combined with distal intra-articular fractures treated surgically from January 2001 to Janurary 2007.There were 24 males and 18 females at mean age of 33 years (20-66 years).According to AO/ASIF classification,there were 18 patients with type C2 fractures and 24 with type C3 ones.Simple internal fixation plus external fixation was performed on patitents with C3 fractures but only external fixation on those with C2 fractures.Four patients were treated with intramedular fixation.Results All patients were followed up for 1-12 months.According to Kotmert's assessment standard on function of proximal femur,the knee function was satisfactory in 35 patients (83% ) ,good in six (14% ) and unsatisfactory in one (2% ).Conclusions Minimally invasive external fixation can utmostly restore relative length of the femur and regulate between articular face of the femur and longitudinal axis of femur shaft to reach a symmetrical relation with middle and inferior part of opposite femur.Postoperative exercise is important for maximal recovery of the knee function.Attention should be paid to reconstruction of tubiform structure of the femur.

Osteogenesis of collagen loaded bio-derived bone in repair of radial critical defect / 中国组织工程研究

BACKGROUND: Each matrix material alone possesses the limited ability of osteogenesis, so it is a future direction of tissue engineering that apply composite materials on the repair of bone defect by enhancing osteogenesis. OBJECTIVE: To study the osteogenesis ability of collagen loaded bio-derived bone implanted in animals. DESIGN, TIME AND SETTING: A random controlled animal experiment was completed in Tissue Engineering Laboratory of West China Center of Medical Sciences, Sichuan University between January and April in 2004. MATERIALS: Sixteen New Zealand white rabbits were adopted to prepare 1.5-cm segmental defect model at the middle part of radius. Human bone was extirpated from donators, and collagen Ⅰ was the product of Sigma Company. METHODS: Rabbit models were divided into 2 groups by randomization, experimental group and control group, with 8 rabbits in each group. The extirpated bone was made into pure bio-derived bone by means of defatting, decellularization and deproteinization. Collagen loaded bio-derived bone was established by the vacuum absorption of collagen on pure bio-derived bone. Collagen loaded bio-derived bone was implanted into the defects of experimental group, while pure bio-derived bone for the control group. MAIN OUTCOME MEASURES: At 6 and 12 weeks after operation, all specimens were examined by X-ray and histological methods. RESULTS: The result analysis included all of 16 rabbit models. X-ray results showed that, osteotylus was seen in the whole defect area of experimental group at 12 weeks postoperatively, at this time osteogenesis was more obvious compared with 6 weeks, the bridge grafting of defect area was obviously visible. In the control group, osteotylus was only observed on two ends of the defects, no osteogenesis was found in the central part of defect area. Histological results showed that, new osteoid formation could be seen in internal porous zone of the experimental group at 6 weeks postoperatively, while in control group fibrous connective tissue filled internal porous zone and no new bone formed; at 12 weeks, much more woven bone-like tissues were visible and trabecular-like structure had formed in the experimental group, while osteoid tissue could be seen in bone defect area of control group. CONCLUSION: Both pure bio-derived bone and collagen bio-derived bone can enhance osteanagenesis, but collagen loaded bio-derived bone scaffold material is more effective.

Tetracycline loaded bio-derived bone to repair bone defect / 中国组织工程研究

BACKGROUND: Compound materials have strong osteogenic ability, which reinforce the substitute materials used alone. Compound material will be commonly used to repair bone defects in tissue engineering. OBJECTIVE: To explore the osteogenic capacity of tetracycline loaded bio-derived bone in vivo. DESIGN, TIME AND SETTING: The randomized controlled observation was performed at Tissue Engineering Laboratory (State Key Laboratory) of West China Center of Medical Sciences, Sichuan University from September 2004 to January 2005. MATERIALS: Twenty-four New Zealand white rabbits were randomly divided into 2 groups (n=12). Rabbit models of radial middle segment defect (1.5 cm) were established. Tetracycline collagen bio-derived bone was made of fresh human bone. METHODS: The tetracycline collagen bio-derived bone was implanted into radial defects of experimental group, and collagen bio-derived bone was implanted into control group. All rabbits were executed 6 and 12 weeks after operation. MAIN OUTCOME MEASURES: Osteogenic condition in all specimens was examined by X-ray and histological methods. RESULTS: Twenty-four animals were included in final analysis. ①X-ray results showed that osteotylus was seen in the whole defect area of the experimental group in postoperative 6 weeks, while only in the defect ends of the control group. In 12 weeks after surgery, new bone tissue filled all defect area of the experimental group, which was basically consistent with normal bone, even medullary canal was formed. Osteogenic images were found in the control group. ②Histological results suggested that new osteoid formation was observed in internal pore zone in the experimental group in 6 weeks, while no bone tissue was found in the control group. In 12 weeks, much woven bone was seen in the experimental group, and lamellar bone structure had formed and medullary cavity of bones had transfixed. Osteoid formation was observed in the control group. CONCLUSION: Both tetracycline collagen bio-derived bone and collagen bio-derived bone can promote bone formation, but tetracycline loaded bio-derived materials show superior effect in repairing defects.

The management of femoral shaft fractures with ipsilateral femoral neck fractures / 中华创伤骨科杂志

Objective To analyze the clinical characteris tics and diagnostic outline and to elucidate the effects of different managements of femoral shaft fractures with ipsila teral femoral neck fractures.Methods A retrospective study was carried out in 18patients with ipsilateral femo ral neck and femoral shaft fractures from 1998to 2001,and their managements and final clinical outcomes were reviewed.Results The follow -up ranged from8to 40months with an average of 16mon ths.All the fractures united except one femoral shaft fracture and one femoral neck fracture.Conclusion Retrograde intramedullary nailing with multiple cancellous screws to t reat ipsilateral femoral neck and femora l shaft fractures has been proved an e ffective technique.For the cases overlooked initially,treatment with multiple nailing around the intramedullary n ail is a good choice.[

The clinical research on the technique of limited internal fixation combined with hinged super-articular external fixator for the elbow fracture / 中华骨科杂志

Objective To assess the clinical value of limited internal fixation combined with hinged super-articular external fixator for the treatment of elbow fracture. Methods 10 patents with elbow fracture were treated with hinged external fixator from March 2001 to November 2002. It involved 8 males and 2 females, aged from 22 to 46 years. There were 4 humeral intercondylar fractures of Riseborough type Ⅳ, the fractures were fixed with few cancellous or interfacial screws through the postero-medial approach, the olecranon and the attached triceps were reflected proximally after the olecranon osteotomy. Among the other 6 severe fracture-dislocations of the elbow, 2 complicated with fracture of the coronoid process; 1 fracture of the Regan type Ⅲ, whose fragments were over 50% of the coronoid process, was fixed with screws; another 1 fracture of the Regan type Ⅱ, whose comminution was less than 50%, was sutured with the joint capsule from proximal to distal part; 2 combined with radial head fracture of Mason type Ⅳ, both selected the lateral elbow approach, 1 with resection because of comminution, the other was fixed nearly the 2/3 of its whole dimension; and 2 with olecranon fracture were fixed with tension-band wire. Results All 10 patients were available at final follow up, the mean duration was 12 months (range, 6-18 months). According to the Morry scoring system, there were 6 excellent, 3 good, 1 fair, and the effective rate was 90%. 8 cases united in the first-stage, the other 2 achieved delayed union because of open fracture. Conclusion The technique of hinged external fixator for the fractures around elbow not only can help to stabilize the fractures but also allows early rehabilitation. In comparison with other methods, it can better improve the function of elbow, so it is an effective treatment for this kind of injury.

The treatment and its results of type C fractures of distal humerus / 中华骨科杂志

Objective To evaluate the surgical management and its results of type C fractures of distal humerus. Methods From January 1997 to November 2002, 30 patients of type C fractures of distal humerus were treated surgically. There were 11 males and 19 females with mean age of 41 years (range 16-67 years). Thirteen fractures occurred in left extremity and 17 in the right. Nine patients suffered open fracture, including Custilo typeⅠfracture in 5, and typeⅡin 4 cases. Twenty-one patients suffered closed fracture. The fracture were caused by falling injury in 21 cases, by traffic accident in 7 cases and by another cause in 2 cases. Associated injuries included: distal fracture of radius in 2 cases, fracture of rib in 1 case, and fracture of surgical neck of humerus in 1 case. According to AO/ASIF classification, type C1 fracture was found in 4 cases, type C2 in 14 cases and type C3 in 12 cases. Of the 30 patients, 21 cases were operated with the approach of extra-articular osteotomy of olecranon, and 9 cases with the approach of liguliform flap of musculus triceps brachii. The fractures were reduced and fixed with dual-plates(DP) in 17 cases, and double tension bands(DTB) in 13 cases. The operation was performed in 0-17 days after injury with mean 7 days. Clinical data were recorded and reviewed retrospectively according to the surgical approach, operating time, amount of bleeding, types of internal fixation, function of the elbow and the complications. Results All the patients were followed up, with the duration from 6 to 62 months(mean, 28.5 months). The function of the elbow was evaluated according to Morrey's scale, the results showed excellent in 23 cases, good in 4 cases, and poor in 3 cases. Conclusion The modified approach of extra-articular osteotomy of olecranon provide sufficient exposure without injury of articular surface, and the osteotomy healed easily with long-term stability. The type C fractures of distal humerus should be fixed with DP or DTB for two column fixation. DTB provide a new sufficient internal fixation with simple technical procedure, shortening operation time, less bleeding and reliable stability with similar results compared with DP fixation.

Limited internal fixation with hybrid external fixator for distal tibial fracture / 中华骨科杂志

Objective To assess the clinical value of hybrid external fixator combined with limited internal fixation for distal tibial fracture.Methods 22 patients with distal tibial fracture were treated with hybrid external fixator and limited internal fixation from March 2002 to January 2005.In those cases,17 patients were male and 5 patients were female,their age was from 20 to 48 years old,with an averge of 33 years old,all fracture sites were not beyond the ankle joint for 5 cm.Among those cases,18 patients were intraarticular fracture and between them 4 patients belong to Ruedi typeⅡ,14 patients belong to Ruedi type Ⅲ.4 patients were extraarticular fracture.18 patients were close injury and of them 16 patients belong to modified Tscherne typeⅡ,2 patients belong to modified Tscherne typeⅢ.4 patients were open fracture,2 patients belong to GustiloⅡand 2 patients belong to Gustilo Ⅲ.Displaced articular fragments were fixed with cannulated lag screws or Kischner wires,the reduction of extraarticular fracture by adjusting external fixator to acquire.Results All patients were followed-up from 8 to 28 months,mean 18 months and average heal time was 3.2 months.Using Tornetta criteria,excellent 10,good 5,fair 3,with 83% excellent and good rate for intraarticular fracture.Excellent 3,good 1,for extraarticular fracture.There were 20 patients with wound primary healing,2 patients delayed healing and they all were open fracture.Complications included 10? anterior angled malunion in 1 case,and pin tract infection in 2 cases.Conclusion Using this metheod treated distal tibial fracture can reduce soft tissue injury,can obviously reduce the wound infectious rate and admit early motion of ankle joint,so it is beneficial to early restore the ankle joint's function.