ObjectiveTo evaluate the radial rotation osteotomy and ulnadouble rotation osteotomy obstetric brachial plexus injury (obstetric brachial plexus palsy) forearm pronation deformity sequelae value.MethodsFrom August 2007 to August 2011, twenty cases of obstetric brachial plexus palsy sequelae in children with forearm pronation deformity, the implementation of a simple radial rotating radial osteotomy (5cases),double-rotation radius and ulna osteotomy (15 cases) and two surgical type,and by 6 to 54 months after surgery (mean 25 months) follow-up.The groupfunctions to forearm pronation angle and conscious function improvement as the evaluation criteria. ResultsThe 15 cases of radius and ulna osteotomy in children with dual function and appearance in 14 cases significandy improved,one case of supination deformity;five underwent simple radial pronation osteotomy,three patients had improved function and appearance,followed up for 6 months, eight months after the merger which radial head dislocation in 2 cases due to poor efficacy of dual-line radius and ulna osteotomy, twenty patients in this group did not appear nonunion.ConclusionSimple radial rotation osteotomy surgery in obstetric brachial plexus palsy forearm pronation deformity complications without radial head dislocation has some value, radius and ulna double osteotomy in forearm pronation deformity with radial head dislocation aftermath of the effect is more excellent.

Objective To evaluate the iodine nutritional condition among populations in Aksu after implementing free iodized salt in population of Xinjiang.Methods According to the National Iodine Deficiency Monitoring Programme (Revised),totally 45 villages (towns) of subordinated 8 counties and Aksu City,Xinjiang were selected for collecting salt samples.Meanwhile,in 27 villages (towns) primary schools,school-aged children (8-10 years old) were selected for collecting disposable urine samples,B ultrasound was used to check thyroid volume and intelligence (IQ) was evaluated by China Combined Raven Test (CRT).Pregnant women were sampled for collecting their disposable urine near the primary schools.Both the children and pregnant women were evaluated the iodine deficiency disorders (IDD) knowledge awareness by questionnaire.The urine iodine concentration was measured by the ammonium persulfate digestion-As-Ce catalytic spectrophotometer method.The salt iodine concentration was measured by the direct titrimetric method,and other kinds of iodine in salt were measured by referee method (GB/T 13025.7-2012).Results A total of 2 700 household salt samples were collected,the average of iodine concentration in household salt was (26.95 ± 5.10) mg/kg.The coverage of household iodized salt was 98.56％ (2 661/2 700).The coverage of edible iodized salt was 98.00％ (2 646/2 700).A total of 2 159 urine samples were collected,the median of urine iodine concentration (UIC) among school-aged children (8-10 years old) was 235.50 μg/L.The total goiter rate was 1.51％ (33/2 179) among children aged 8-10 years old.A total of 2 098 people were conducted IQ test,the average IQ was 88.03 ± 17.14.A total of 1 047 urine samples were collected,the median of UIC among pregnant women was 213.50 μg/L.The IDD knowledge awareness rate of children and women were 98.82％ (751/760) and 99.23％ (258/260),respectively.Conclusions The iodine nutrition is in an adequate range,awareness of IDD prevention is obviously improved among children which is representative of common people and pregnant women after implementing the free iodized salt in population of Xinjiang in Aksu.The policy of preventing IDD based on this policy has showed enormous effect.

Objective: To evaluate the long-term functional recovery after contralateral 7th cervical nerve(C₇) transfer with brachial plexus root avulsion and the effect on the contralateral limbs after operation. Methods: A total of 83 patients with injory of brachial plexus avulsion were underwent contralateral C₇ transfer from September, 2004 to December, 2014. Among them, contralateral C₇ were transferred to the median nerve in 33 cases, to radial nerve in 14 cases, to musculocutaneous nerve in 22 cases, and simultaneous transfer to median and musculocutaneous nerve in 14 cases. The followed-up contents included recovery of muscular strength and sensory innervated by the recipient nerve, bilateral limbs synergistic activity and the effect on the contralateral limbs after the surgery. Results: All 83 cases were successfully followed-up for 3.2-6.2 years (average, 4.5 years), and found no significant effect on function of the contralateral limbs. In the group of C₇ transferred to the median nerve group, 10 cases had muscle strength recovered≥M₃, and 26 cases had sensory recovered≥S₃; In the group of C₇ transferred to the radial nerve, 6 cases had muscle strength recovered≥M₃, and 9 cases had sensory recovered ≥S₃; In the group of C₇ transferred to the musculocutaneous nerve, 12 cases had muscle strength recovered≥M₃, and 17 cases had sensory recovered≥S₃. In the group of C₇ simultaneous transferred to the median and musculocutaneous nerve, 6 cases had muscle strength of wrist and digital flexion recovered≥M₃, 5 cases had elbow flexion recovered≥M₃, 9 and 10 cases had sensory of innervated area and lateral forearm region recovered≥S₃, respectively. Conclusion Contralateral C₇ transfer is an ideal procedure for the treatment of total brachial plexus root avulsion with definitive clinical outcomes.

Objective To study the clinical efficacy of two-stage bone transport combined with induced membrane technique in the treatment of post-traumatic tibial osteomyelitis.Methods A retrospective study was conducted of the 14 patients with post-traumatic tibial osteomyelitis who had been treated by two-stage bone transport combined with induced membrane technique from February 2009 to August 2015.They were 12 males and 2 females,aged from 26 to 59 years (average,40.4 years).By the Cierny & Mader classification,they all belonged to type Ⅳ.Their disease course ranged from 6 to 30 months,averaging 15.3 months.The number of their previous operations ranged from 2 to 6 times,averaging 3.3 times.In the first stage of operation,tibial extended external fixation was installed according to preoperative design,followed by early debridement and extensive removal of osteomyelitis lesion.The length of bone defect after resection of osteomyelitis lesion was from 4 to 18 cm (average,8.5 cm).10％ vancomycin-contained polymethyl methacrylate (PMMA) bone cement was molded and placed in the bone defects.In the second stage of operation,the PMMA-induced membrane was opened to remove the PMMA bone cement,the bone marrow was drilled through and the induced membrane was then sutured up.Tibial osteotomy was conducted at an appropriate part.The average interval between the first and second stages was from 4 to 7 weeks (average,4.8 weeks).The clinical efficacy was evaluated according to the Paley criteria at final follow-ups.Complications were recorded.Results All the patients were followed up for 15 to 50 months (17.5 months).No relapse of osteomyelitis occurred.The total treatment time ranged from 11 to 19 months,with an average of 14.7 months.The total time for external fixation was from 10 to 18 months,averaging 13.2 months.The external fixator indexes ranged from 31 to 75 day/cm,with an average of 48.5 day/cm.According to Paley criteria at final follow-ups,the clinical efficacy was excellent in 11 and good in 3 cases.Pin tract infection occurred in 9 patients,mal-alignment after removal of external fixation in 6,and malunion or nonunion at the docking site in 5.Conclusions Two-stage bone transport combined with induced membrane technique can cure thoroughly post-traumatic tibial osteomyelitis.Its operation procedures are simple but effective.

Objective:To explore the clinical effect of the modified Quaba flap on reconstruction of the soft tissue defects in distal hand and foot.Methods:From August 2013 to March 2022, 36 cases of soft tissue defect in distal hand and foot were reconstructed by the modified Quaba flap in the Department of Microrepair and Reconstruction of Orthopaedic Centre, the First Affiliated Hospital of Xinjiang Medical University. There were 24 males and 12 females, aged 18 to 58 years old with an average age of 35.6 years old. The sizes of defect were 1.5 cm × 0.5 cm - 5.0 cm × 3.0 cm, including 28 in hand and 8 in foot. Of the defects, 26 were traumatic soft tissue defects, 5 were chronic hand infection and 5 were after resection of hand tumour. The sizes of flap employed were 5.0 cm × 1.5 cm - 10.0 cm × 6.5 cm. Method of optimization included: (1) Extended the paddle of propeller flap or made the rotation point being further; (2) Determined the perforator vessel that entered the pedicle, and made the perforating point as the location of rotation hence to maximise a blood flow; (3) Improved the pedicle mobility and reduced the angle of rotation of the flap; (4) The superficial vein in the pedicle was retained in the modified Quaba flap; (5) Properly retained the fascia tissue of the pedicle; (6) "Skinned-tail" design for the pedicle. All patients entered scheduled follow-up reviews at outpatient clinic and by telephone or WeChat interviews. Colour, texture, wound healing, complications at donor site and hand function were evaluated.Results:All flaps survived. The donor sites were directly closed in 27 patients, and skin grafts were applied in 9 patients. All patients were entered postoperative follow-up for 3-36(mean 24) months. All flaps had good colour and texture but with poor sensation. Wounds healed at the first attention. Hand functions(28 cases) were evaluated according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association. Hand function appeared excellent in 23 patients, good in 3 and fair in 2, with an excellent and good rate at 92.9%. Motion of all metacarpophalangeal joints were satisfactory. Flexion of metacarpophalangeal joints ranged from 65° to 90°, with an average of 80°. Dorsal extension ranged from 0° to 20° (mean 8°), without obvious joint pain. Foot functions(8 cases) were evaluated according to hallux metatarsophalangeal-interphalangeal scale of the American Orthopaedic Foot and Ankle Society (AOFAS), 6 patients were in excellent and 2 in good.Conclusion:Modified Quaba flap is easy to harvest and with stable and reliable blood circulation. The optimised methods can extend the length of the paddle of the flap and shorten the rotation point. They are very effective methods in reconstruction of the soft tissue defect in distal hand and foot.

Objective:To evaluate the effect and mechanism of bone regeneration in distraction osteogenesis zone after the repair of sciatic nerve in rats.Methods:Between January 2021 and August 2021, 60 healthy adult male Sprague-Dawley rats were divided randomly into 3 groups: Group A, B, and C. In groups B and C, right sciatic nerve transection and anastomosis were performed. Then after 8 and 12 weeks, the 3 groups were treated with extension external fixation (Ilizarov technique) of right femur osteotomy to make distraction osteogenesis model. Electrophysiological changes of peripheral nerves were monitored by electromyography (EMG) pre-and postoperatively in all the femoral lengthening rats. The formation of callus was examined by X-ray every week after operation. The rats were sacrificed on 2nd, 4th, 6th weeks after the bone transport operation. Four-point bending test and histological staining examination were carried out to determine the osteogenesis in the distracted area. SPSS 21.0 was used for statistical analysis. Data of measurement were expressed as (Mean±SD). A non-parametric test was used to assess the statistical difference between groups. Graphs were plotted by GraphPad Prism 8.0 and considered statistically significant when P<0.05. Results:The results of Sciatic nerve function index (SFI), Compound muscle action potential (CMAP) and Motor nerve conduction velocity (MNCV) in group A were better than the group B and group C in both of before and after the surgery. At the 2nd and 4th weeks of the consolidation stage, X-ray showed that bone formation in group B was superior to groups A and C; HE and Safranin O staining showed that local capillary and cartilage formation in group B was significantly more than in groups A and C; Immunohistochemical staining showed that the expression levels of Osteopontin(Opn) and Osteocalcin(Ocn) in the distraction area of group B were higher than that of groups A and C. At the 6th week of the consolidation stage, the four-point bending test showed that the bone quality of group B was better than groups A and C. The differences of the results between groups shown above had statistical significance ( P<0.05). Conclusion:Bone regeneration in the distraction area of the bone lengthening group with sciatic nerve injury was better than that of the bone lengthening group without a never injury. This might be in relation to the fact that a distractive osteogenesis caused the secondary injury to the repaired nerve. The electrophysiological results showed that periodic changes took place in the repaired sciatic nerve caused by the stretch of femoral lengthening, and the injurious changes of sciatic nerve would be gradually relieved in 6th week after surgery.