Arthroplasty, Replacement, Knee ; adverse effects ; methods ; Humans ; Postoperative Complications ; therapy

Objective To understand the characteristics of subtalar joint motion and to probe a new method in evaluating the subtalar joint. Methods Eight fresh frozen adult shank-foot specimens with calcaneus marked were placed in a Cartesian coordinate system. The motion of the subtalar joint was obtained through matrix translation and Euler equation. Comparatively, the same specimens were underwent CT scan and established three dimensional reconstruction through the radiographic method. Results Both the mechanical and the radiographic methods had no significant difference in reflecting the motion of subtalar joint in coronal and transversal plane. Conclusion To evaluate the motion of subtalar joint with mechanical method was more precise, economic and easier to perform. Although the radiographic method had considerable discrepancy among examiners, as a non-invasion examination, it needs further research.

Objective To study the mechanism and characteristics of calcaneal fracture involving calcaneocuboid joint and its surgical clinical results. Methods 71 cases with 90 calcaneal fractures accompanied calcaneocuboid joint injury were reviewed in our hospital from February 1997 to April 2001, which included 61 ankles of 46 males and 29 ankles of 25 females with an average age of 38.7 years (range, 18 to 67 years). AP, lateral and axial view X-ray of both feet, broaden view X- ray of the affected foot, and CT scan were taken preoperatively. Among them, 45 ankles were examined with three dimensional reconstruction of CT as well. The calcaneocuboid joint injury were divided into 4 types as follows: typeⅠ(46/90) with one articular fracture line but no displacement; type Ⅱ(26/90) with one articular fracture line accompanied the displacement of fragment and the subluxation of calcaneocuboid joint; type Ⅲ (11/90) with two fracture articular lines, and the displacement of fragment as well as the subluxation of calcaneocuboid joint; and type Ⅳ (7/90) with three articular fracture lines and comminuted fracture or the subluxation of calcaneocuboid joint. Of 71 cases, 63 were operated at 3 to 7 days after injury, and 8 delayed at 10 to 14 days. The incision started at the middle point between the fibula and Achilles tendon proximal to the apex of lateral malleolus, and extended distally to the adjacent part of dorsal and plantar skin, then anterior to the base of fifth metatarsus. After the reduction of fractures, type Ⅰcalcaneal plate, designed by authours, was used for type Ⅰ,Ⅱand Ⅲ fractures, the anterior part of calcaneus was fixed with the vertical wing of plate; type Ⅱ calcaneal plate was used for type Ⅳfractures, the horizontal wing of plate was fixed to cuboid to stabilize the comminuted fragments of anterior calcaneus. Results Of 90 ankles, 78 were followed up for an average of 18.7 months (range, 12 to 32 months). The total excellent and good rate was 94.9% according to Marryland foot score. Furthermore, In type Ⅰ, the excellent and good rate was 100%, type Ⅱ 95.7%, type Ⅲ 88.9% and type Ⅳ 60%. Among the types Ⅳ fracture, 7 ankles obtained satisfied internal fixation, but in 4 of them the plates were broken after weight bearing walking. Conclusion The injury of calcaneocuboid joint is related with the severity of calcaneal fracture, attention should be paid and carried out with reliable internal fixation.

Objective To introduce the reconstruction of calcaneal thalamus by bone autograft and subtalar arthrodesis for severe deformities caused by malunion of calcaneal fractures and to discuss the indications and its advantages of the management. Methods From November 1998 to August 2002, 17 cases with 21 malunited calcaneal fractures were treated, which were 13 males and 4 females with an average age of 35.4 years( 25 to 45 years). Unilateral calcaneus was involved in 13 cases, and bilateral calcaneus was affected in 4 cases. The primary treatment was manipulation and immobilization with a cast in all patients. The interval from injury to the operation was on an average of 33.6 months(7 to 50.4 months). The common complaints were painful heels and walking difficulty. Furthermore, there was subluxation of talonavicular joint in 5 cases, protruded osteophyte and fragment from the lateral wall of calcaneus in 12 cases. Lateral, axial, and oblique roentgenograms were taken preoperatively, and three dimensional reconstruction of CT scan as well. Results The modified extended L-shaped approach lateral to calcaneus was used. The bulging lateral wall of calcaneus was excised and reserved for reconstruction of calcaneal thalamus if possible. While in some cases the bone autograft had to be harvested from iliac crest if the excised lateral wall was not available. After the cartilage of subtalar joint was removed completely, the calcaneal thalamus was reconstructed with the bone and fixed with 2 to 3 screws, the contour and position of calcaneus was conformed without valgus or varus by "C" arm intensifier. A short leg cast was used for immobilization one month after operation. Among the patients, 18 feet were followed up on an average of 14.5 months (9 to 22 months). The total excellent and good rate was 88.8% according to Maryland foot score system. Plain radiography showed that B hler angle, Gissane angle, talus inclining angle, width of calcaneus and height of calcaneal thalamus were restored to nearly normal. Conclusion The reconstruction of calcaneal thalamus by bone autograft combined with subtalar arthrodesis is an effective operation for severe malunion of calcaneal fractures, which can improve calcaneal abnormality, and make recovery of the shape of hind foot and functions satisfactorily.

Objective To introduce calcaneal osteotomy without subtalar fusion for calcaneal malunion and to discuss its indications, advantages and disadvantages. Methods From November 1998 to May 2003, 24 cases with 26 calcaneal malunion for 1 to 9 months were treated by calcaneal osteotomy without subtalar fusion. The average age was 32.6 years (range, 28 to 42 years). All patients underwent radiography including plain, axial and lateral views for calcaneus, oblique view for foot and three-dimensional CT imaging reconstruction. According to Sanders classification, 13 cases were of type Ⅱ(9Ⅱb, 4Ⅱc), 13 of type Ⅲ(8 Ⅲac, 5 Ⅲbc). Through the modified lateral L-shaped approach, the protruding lateral wall of calcaneus was resected and the posterior subtalar facet was reduced by elevating the fragment of the posterior subtalar facet upwards and backwards. The defect of calcaneus was filled with bone autografts. Iliac crest bone graft was used in 19 feet and the bone graft resected from the extruding lateral wall of calcaneus in 7 feet. The calcaneus was fixed with plate and screw. Results 21 feet were followed up for an average of 14.5 months (range, 9 to 22 months). No complications such as wound infection, screw breakage and calcaneum varus were found postoperatively. The average time for bone healing was 11.2 weeks (range, 10.5 to 13.3 weeks). The postoperative functional evaluation by Maryland foot score system revealed excellent result in 8 feet, good in 10, fair in 3. The rate of excellent to good results was 86%. Plain radiographs showed the nearly complete restoration of Bhler angle, Gissane angle, talus inclining angle, calcaneal width and height of the calcaneal thalamus. Conclusion Calcaneal osteotomy without subtalar fusion is an effective method for calcaneal malunion with advantages of correcting deformity markedly, restoring the function and the outer aspect of hindfoot satisfactorily.

[Objective]To introduce the experience and key points of percutaneous reduction combined with bone graft to treat calcaneal fractures.[Method]Percutaneous reduction and internal fixtion combined with bone graft was performed from April 2004 to April 2006 on 15 cases(16 sides) with intra-articular calcaneal fractures including 13 males (14 feet)and 2 females(2 feet),with average age of 36.6 years(24～61 years).All patients underwent radiography including lateral and axial views for calcaneus,oblique view for foot and three-dimensional CT imaging reconstruction. According to Sanders classification,there were 12 feet of type Ⅱ(three type Ⅱa,three type Ⅱb and eight type Ⅱc)and 2 feet of type Ⅲac. The length of caicaneus was recovered through traction by Steinmann pin which passed through calcaneal tubercle perpendicularly and the posterior facet was elevated until reduction by a curve scissors through an 0.5 cm incision along the primary fracture line of lateral calcaneus. The calcaneus was fixed with different cannulated cancellous screws according to the type of fractures.Then bone graft was injected to fill the defect of calcaneus through lateral incision.[Result]All patients were followed up for an average of 18.4 months (ranged,12 to 34 months).No complication such as wound infection,screw breakage and calcaneum varus was found postoperatively. The average time for bone healing was 10 weeks. The results were excellent in 12 cases, good in 4 cases according to the American Orthopaedic Foot and Ankle Society(AOFAS) hindfoot score. The rate of excellent and good clinical results was 100%. Radiography showed basic restoration of Bhler's angle,Gissane's angle and calcaneal shape.[Conclusion]The combination of percutaneous reduction and injectable bone graft is suitable for surgical treatment of Sanders II and III type calcaneal fractures,with advantages of simple operation,fewer complications and good clinical results.

A questionnaire survey on chronic heart failure management was conducted in 110 physicians from Xindu,Supo,Jiajiang and Xinhua community hospital in Chengdu from January 2007 to June 2010.Results showed that 77.3％ (85/110) of community physicians lacked knowledge about prevention,diagnosis and treatment of chronic heart failure,and the diagnostic accuracy rate was only 51.3％ (40/78) in these community hospitals.There was lack of awareness of the guideline of chronic heart failure:the rate of β blockers use was 15.0％ (6/40) and only 5.0％ (2/40) used the target dose; the rate of angiotensin converting enzyme inhibitor use was 17.5％ (7/40) and only 7.50％ (3/40) used the target dose.In addition,90％ (99/110) of community doctors lacked the education and management for patients with heart failure.The survey suggests that the current situation of chronic heart failure management in community physicians in Chengdu is unsatisfactory.It is necessary to strengthen the training of community physicians.

Objective To study the clinical application of the complete audiologic evaluation battery consisting of ABR,ASSR and behavioral audiometry in sound field for the identification of sensorineural losses in children.Methods In the study 48 children were divided as group PTA of the children assessed by pure tone audiometry and ABR and ASSR test,and group BA of the children unable to perform on behavioral evaluations.Results The analysis of the audiometric results of group PTA showed significant correlation between the ASSR thresholds and pure tone thresholds(P＜0.01) at various frequencies.The correlation coefficients were 0.75,0.76,0.76,and 0.83 at different frequencies.The ASSR-PTA linear regression was utilized.The comparison of the ABR and ASSR results of group BA indicated that 23 ears responded in ASSR but without responses in ABR.Those without ASSR responses also had no ABR There were 116 tests in total four frequencies for the 29 ears.83 responses were obtained from ASSR,89 responses from behavior audiometry and 96 from the use of the both tests.Conclusion The comprehensive audiologic evaluation battery could be used to test younger children with severe heating loss children as compared to the pure tone audiometry alone.More detailed data can be obtained thus from children to assist in rehabilitation in a more effective mariner.

Objective:To construct an adenovirus-mediated mouse endostatin vector (Ad-mEndo) and to observe its inhibitory effect on the pulmonary metastasis of osteosarcoma in nude mice, so as to discuss the relationship between ES expression and the pulmonary metastasis of osteosarcoma. Methods: Recombinant adenovirus plasmid pDC315-mEndo was constructed and used to prepare recombinant Ad-mEndo. Osteosarcoma MG-63 cells were subcutaneously injected into the right fore limbs to establish nude mouse model of osteosarcoma; and the models were randomly divided into 3 groups: Ad-mEndo group, Ad-EGFP group and PBS group; animals receiving no transplantation served as blank control. The corresponding agents were injected (20 ?l per time) for a consecutive of 5 times on a weekly basis. The tumor volumes, histopathological characteristics were observed; ELISA was employed to examine the serum ES level. Animals were sacrificed 7 weeks later and the pulmonary metastasis was observed. Results: Sixteen days later,the tumor volume was (1.53?0.05)cm3 in Ad-EGFP group, (1.56?0.07)cm3 in the PBS group, and (0.91?0.03)cm3 in the Ad-mEndo group, with the tumor inhibitory rate being 40.7% in the last group. The serum ES level in the Ad-mEndo group was significantly higher than that of the other groups (P

Objective To explore the protein expression of p53 and PTEN in osteosarcoma and the relationship between them and the three-year survival ratios of osteosarcoma patients.Methods The protein expression of p53 and PTEN was detected using immunohistochemical methods in 53 cases of osteosarcoma proved by surgery and pathology. Results There was significant difference between the both kind of relationship with the protein expression of PTEN and the three-year survival ratios of osteosarcoma patients who had negative expression of p53. There was no significant difference between the both kind of relationship with the protein expression of PTEN and the three-year survival ratios of osteosarcoma patients who had positive expression of p53. PTEN expression,which was analysed by logistic regression, was entered the regression model ,but p53 expression was not. Conclusion PTEN expression is more important than p53 expression in predicting the prognosis of the patient with osteosarcoma.