Objective To investigate surgical techniques for tibial plateau fractures involving the posterior column and the corresponding clinical effect.Methods From March 2009 to January 2012,32 patients with tibial plateau fracture involving the posterior column underwent surgical treatment in our hospital,including 21 males and 11 females,aged from 23 to 60 years (average,40.4 years).There were 30 cases of closed fracture and 2 cases of open fracture.Two patients combined with anterior cruciate ligament avulsion fracture,and 3 patients with posterior cruciate ligament avulsion fracture.Posterolateral and anteromedial approaches were used in 6 patients with posterolateral and medial columns fracture.Posteromedial and anterolateral approaches were used in 7 patients with posteromedial,medial and lateral columns fracture; a small anteromedial incision was added in 2 of them.Posteromedial and anterolateral approaches were used in 11 patients with posteromedial and lateral columns fracture.Posteromedial and posterolateral approaches were used in 2 patients with posteromedial and posterolateral columns fracture,while a single posteromedial approach was used in another patient with same fracture.Posteromedial and anterolateral approaches were used in 3 patients with posteromedial,posterolateral and lateral columns fracture,while posterolateral and anterolateral approaches were used in other 2 patients with same fracture.Results All patients obtained satisfactory exposure and reduction.They were followed up for 5 to 24 months (average,10.7 months).The average bone union time was 15.9 weeks,and the average time from operation to full weight-bearing was 18.1 weeks.The average range of motion of knee was 113.3°.According to HSS (Hospital for Special Surgery) score,the results were excellent in 22 cases,good in 6 cases,fair in 3 cases and bad in 1 case; the total excellent and good rate was 87.5％.Conclusion For tibial plateau fractures involving posterior column,satisfactory reduction and fixation can be obtained via posteromedial and posterolateral approaches which have many advantages such as earlier functional exercise,fewer complications and excellent clinical results.

BACKGROUND:Distal femur is a predilection site for primary bone tumors, most of which are treated with salvage treatment. There are many reports on the early-stage, mid-term and prognosis of the distal femur tumor-type artificial knee joint prosthesis, but reports on long-term function and prognosis are less.
OBJECTIVE:To study the long-term prognosis and limb function after treatment with rotating-hinge knee prosthesis.
METHODS:Thirty-four patients with distal femoral bone tumors admitted to the Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University between January 2000 and June 2008 were retrospectively analyzed, including 19 males and 15 females. Al patients were subjected to rotating hinge knee prosthesis replacement.
RESULTS AND CONCLUSION:The mean fol ow-up period was 62.4 months (range 11 to 126 months). At the final of fol ow-up, 23 patients were event-free alive and 11 patients were dead. Seven of 23 survival patients suffered from prosthesis related complications, including four cases of prosthesis revision and three cases of amputation. The event-free survival rate of 23 patients undergoing replacement of domestic tumor prosthesis around the knee was 67.6%in 5 years. The mean functional score of affected limb was 19.30 (7 to 27 points):excellent in 6 cases, good in 16, fine in 5 and poor in 2. The excellent-good rate was 75.9%. The clinical outcomes suggested that the satisfactory limb function and survival rate could be achieved with the application of domestic tumor prosthesis replacement for treatment of malignant bone tumors around the knee.

BACKGROUND: The effectiveness of femoral nerve block in perioperative analgesia for total knee arthroplasty has been widely recognized, but the need for combined sciatic nerve block remains controversial.OBJECTIVE: To investigate the analgesic effect and rehabilitation training of femoral and sciatic nerve block in the perioperative period of total knee arthroplasty. METHODS: 150 patients undergoing total knee arthroplasty were randomly divided into three groups: general anesthesia, femoral nerve block and femoral and sciatic nerve block groups. The visual analogue scale scores at rest and in activity, range of motion of the knee, postoperative hospitalization time, adverse effects and the Hospital for Special Surgery scores were recorded and compared among groups.RESULTS AND CONCLUSION: (1) The order of visual analogue scale scores at rest and in activity at each time point postoperatively was as follows: general anesthesia group > femoral nerve block group > femoral and sciatic nerve block group (P < 0.05). (2) The range of motion of the knee at different time points postoperatively was largest in the femoral nerve block group, followed by the femoral nerve block group, and smallest in the general anesthesia group (P < 0.05). (3) The postoperative hospitalization time in the femoral nerve block and femoral and sciatic nerve block groups was significantly less than that in the general anesthesia group, and the time in the femoral and sciatic nerve block group was significantly less than that in the femoral nerve block group (P < 0.05). (4) The Hospital for Special Surgery scores at 1 month postoperatively in the femoral nerve block and femoral and sciatic nerve block groups were significantly higher than those in the general anesthesia group, and the scores in the femoral and sciatic nerve block group were significantly higher than those in the femoral nerve block group (P < 0.05). But the Hospital for Special Surgery knee scores at 3 and 6 months postoperatively did not differ significantly among groups (P > 0.05). (5) These results indicate that the femoral and sciatic nerve block has better postoperative analgesia effect compared with general anesthesia and femoral nerve block under multimodal analgesia in total knee arthroplasty, which is favorable for early rehabilitative training.

Objective:To explore the clinical characteristics of children with Streptococcus pneumoniae cellulitis. Methods:The bacterial culture information management system in 18 children′s hospitals from January 2012 to December 2017 were reviewed.Among 1 138 children diagnosed with invasive pneumococcal disease(IPD), 7 cases were hospitalized with cellulitis.Clinical information was collected and analyzed.Results:Seven cases of Streptococcus pneumoniae cellulitis accounted for 0.6%(7/1 138 cases) of 1 138 IPD cases in 18 hospitals.There were 5 males and 2 females.The onset age was from 1 month to 6 years old, and the median age was 2 years old.There were 4 cases in rural areas and 3 cases in urban areas.Langerhans cell histiocytosis (LCH) was found in 1 case.Clinical manifestations: fever, local swelling and pain with infection.The focus of cellulitis: orbital cellulitis in 2 cases, buccal infection in 2 cases, upper extremity, head and buttock infection in 1 case, respectively.At the beginning of the disease: 2 cases of orbital cellulitis were accompanied by nasosinusitis and suppurative otitis media, 1 case was treated with acute periapical inflammation, 1 case was 10 months after chemotherapy.Type of infection: 6 cases were complicated with bloodstream infection, 2 cases with bacterial meningitis and 1 case with pneumonia.Other culture results: 6 cases of Streptococcus pneumoniae were cultured in peripheral blood, 2 cases were positive in local pus culture.Drug sensitivity test: 6 cases were sensitive to Penicillin and Cephalosporin (Cefotaxime/Ceftriaxone), 1 case was resistant.Treatment: 3 patients were treated with Cephalosporins alone, 2 cases with Cephalosporins and Penicillins, 2 cases with Vancomycin and Meropenem for meningitis, 3 cases with local abscess by incision and drainage, 2 cases with meningitis in Intensive Care Unit, and 1 case with endotracheal intubation and ventilator assisted ventilation.The average length of stay was 14.3 days(5-41 days). Discharge outcome: 6 cases improved and 1 case died. Conclusions:Cellulitis is a rare type of infection in children with IPD.It is mainly found in the head, face and around the orbit.It may be accompanied by bloodstream infection or bacterial meningitis.Most of them have a good prognosis.

Objective:To investigate the clinical features, diagnosis, treatment and prognosis of children with osteomyelitis caused by Streptococcus pneumonia. Methods:The demographic characteristics, diagnosis, clinical manifestations, imaging features, treatment and short-term prognosis of Streptococcus pneumonia osteomyelitis cases in 18 children′s hospitals from January 2012 to December 2017 were retrospectively collected and analyzed. Results:A total of 9 cases were enrolled, with a median age of 1 year and 3 months.Four children had underlying diseases.The main manifestations were local swelling, pain, limited mobility (9 cases) and fever (8 cases). Sites of infection included humerus (4 cases), femur (3 cases) and tibiofibula (2 cases), and 8 cases were complicated with septic arthritis; The laboratory tests showed increased white blood cells (8 cases, median 22.02×10 9/L), C-reactive protein (7 cases, median 55.44 mg/L) and erythrocyte sedimentation rate (6 cases, median 70 mm/1 h) of those patients.Five patients received monotherapy in the initial treatment regimen with cephalosporins. Then the therapeutic schedules were adjusted according to the culture and antibiotic sensitivity. All patients were treated with puncture, incision drainage or fenestrating decompression.Eight patients were cured and discharged finally. Conclusions:Streptococcus pneumonia osteomyelitis is more common in younger children and may have no risk factors.The common infection site is long bone metaphysis, and those patients are easily complicated with septic arthritis.Antibiotic combined with surgical treatment are crucial to a good outcome.