BACKGROUND:There are various internal fixators in treatment of distal femoral fracture. The commonly used fixators are locking compression plate, anterograde intramedul ary nails and retrograde intramedul ary nails. However, the efficacy of three common fixation is controversial.
OBJECTIVE:To compare the effect of locking compression plate, anterograde intramedul ary nails and retrograde intramedul ary nails for treatment of distal femoral fracture, and to select the appropriate internal fixation method.
METHODS:From May 2007 to November 2007, 118 patients with distal femoral fractures were treated with internal fixation in the hospital and their clinical data were analyzed retrospectively. Among them, 38 cases received locking compression plate, 21 cases received anterograde intramedul ary nails, and 59 cases received retrograde intramedul ary nails. The intraoperative blood loss, operative time, fracture healing time and rate of good postoperative recovery of knee joint in three groups were compared.
RESULTS AND CONCLUSION:Al the involved 118 patients were fol owed up for 14-26 months, average 20 months. No patients developed infection. Except one case delayed bone defect healing due to the fractures and was completely healed after bone fil ing at 19 weeks, the other cases healed within 4.5 months. There was no significant difference in fracture healing time among three groups (P>0.05). Intraoperative blood loss and operation time in anterograde intramedul ary nail group and retrograde intramedul ary nail group were superior to locking compression plate group. In addition, anterograde intramedul ary nail group was superior to retrograde intramedul ary nail group, with significant difference (P<0.05). Kolment grading fine rate in locking compression plate, anterograde intramedul ary nail and retrograde intramedul ary nail groups was 76.3%, 52.4%and 76.3%respectively. Retrograde intramedul ary nail fixation is firm, stable and reliable, with less intraoperative blood loss, shorter operation time, smal trauma, and easy fracture reset, especial y in the recovery of knee joint function. Compared with locking compression plate and anterograde intramedul ary nail, retrograde intramedul ary nailing treatment of distal femoral fractures has more advantages.

BACKGROUND:At present, it is controversial to choose methotrexate therapy alone or triple therapy in the treatment of rheumatoid arthritis.
OBJECTIVE:To systemical y evaluate the efficacy and safety of methotrexate therapy and methopterin+hydroxychloroquine+sulfasalazine triple therapy in the treatment of rheumatoid arthritis.
METHODS:Computer retrieval was performed on the Cochrane library, PubMed, EMBASE NRR (http://www.updatesoftware.com/National), CCT (http://www.control ed-trails.com) and the Chinese biomedical literature database. Manual retrieval was performed on Chinese major orthopedic journals. Randomized control ed trials of methotrexate therapy alone and methopterin+hydroxychloroquine+sulfasalazine triple therapy treatment for rheumatoid arthritis were col ected. Methodological quality of the included studies was evaluated. The statistical software Revman 5.0 provided by the Cochrane col aboration was used.
RESULTS AND CONCLUSION: A total of four literatures in a randomized control ed trial, a total of 297 cases were included;the methodological quality was al class B. Meta-analysis results showed that blood sedimentation improvements were larger in methotrexate therapy alone than in the triple therapy [mean difference=7.01, 95%confidence interval (CI) (2.82, 11.19), P=0.001). Improvements of joints were better in triple therapy than that in single therapy [OR=0.62, 95%CI (0.41, 0.95), P=0.03). There was no significant difference in adverse events. Meta analysis could not be done in ACR, because literature did not provide detailed data. Compared with the triple therapy treatment, methotrexate therapy alone obviously reduced the sedimentation of rheumatoid arthritis in adults, but in terms of joint function improvement, triple therapy was superior to methotrexate therapy alone. Moreover, on the adverse event, there was no significant difference between the two groups. Because this system evaluation included a less number of cases, it stil needs strict large-sample randomized control ed studies to increase the strength of the evidence.

OBJECTIVE: To investigate the clinical efficacy of vertebral body stent (VBS) system and percutanous kyphoplasty (PKP) combined with zoledronic acid for the treatment of severely osteoporotic compression vertebral fractures (OVCFs). METHODS: The clinical data of 48 patients with osteoporotic thoracolumbar fractures treated from December 2017 to December 2018 were retrospectively analyzed, including 13 males and 35 females, aged 55 to 92 years old with an average (71.2±10.5) years. All patients were treated with VBS system PKP surgery, and zoledronic acid injection was used for anti-osteoporosis treatment after operation. The VAS scores ODI, the height of diseasedvertebral lost were compared before operation, 3 d and half a year after operation, and whether there was re-fracture of diseased or adjacent vertevrae after operation was observed. RESULTS: Before operation, 3 d and half a year after operation, VAS scores were 7.60±0.12, 3.00±0.46, 1.20±0.23, ODI were(82.00±0.32)%, (30.00±1.50) %, (18.00±0.16) %, the height of diseased vertebral lost were (12.00±0.43) mm, (3.00± 0.15) mm, (3.60±0.51) mm respectively. Postoperative VAS score, ODI, the height of diseased vertebral lost were obviously improved (<0.05), and there was no significant difference between 3 d and half a year after operation (>0.05). All the 48 patients were followed up with an average time of (6.6±0.5) months. All the incisions healed at grade A after operation, and no re-fracture of diseased vertebrae or adjacent vertebrae was found at the final follow-up. CONCLUSION VBS system and PKP combined with zoledronic acid in the treatment of OVCFs not only may effectively relieve the pain in the thoracolumbar back, improve the mobility of the thoracolumbar, but also can restore the height of the vertebral body to the maximum extent, and prevent the re-fracture of the affected vertebrae and adjacent vertebrae, which is worthy to spread in clinic.
Aged ; Aged, 80 and over ; Bone Cements ; Female ; Fractures, Compression ; Humans ; Kyphoplasty ; Male ; Middle Aged ; Osteoporotic Fractures ; Retrospective Studies ; Spinal Fractures ; Stents ; Treatment Outcome ; Zoledronic Acid

BACKGROUND: As it results in minimal trauma and physical influence or interference, and a better curative effect, the minimally invasive surgery is preferred in clinic. However, the perioperative stress reaction of minimally invasive surgery needs further study.OBJECTIVE: To evaluate the levels of neurohormone, C-reactive protein (CRP) and the changes of resting energy expenditure (REE) resulted from the operative stress reaction due to minimally invasive surgery in arthroscopy on knee joint.DESIGN: Controlled observation and analysis.SETTING: Department of Orthopaedics, Affiliated Hospital of Xiangnan University and Department of Orthopaedics,Xiangya Hospital of Central South University.PARTICIPANTS: Sixteen patients with meniscal lesions in knee and 26 with cruciate ligament injury, which were closed injury, were selected from the Department of Orthopaedics of Affiliated Hospital of Xiangnan University and Xiangya Hospital of Central South University between January 2003 and April 2004. Meniscal lesions were diagnosed according to the physical examination, drawer test combined CT and MRI examination, and the patients were in accordance with the indication of arthrotomy; cruciate ligament injury according to the physical examination, grinding test combined CT and MRI examination. Those with open injury, body multiple injury, combined injury and emergency operation were excluded. Ten patients with meniscal lesions and 12 with cruciate ligament injuries underwent minimally invasive surgery on knee joint as minimally invasive surgery group (MIS). The others were given traditionally invasive surgery on knee joint as the traditional group. The informed consent was obtained from the patients.METHODS: Fasting venous blood was taken on the morning of 1 day before, and 1 and 3 days after operation, which was analyzed within 2 hours after sampling. ①All hormones were quantitatively assayed. Serum insulin was determined by competitive radioimmunoassay (RIA); growth hormones levels by double-antibody RIA; serum cortisol by competitive RIA; CRP by nephelometry, respectively. ②Energy metabolism detection: The energy consumption was assessed by indirect calorimeter on the morning of 1 day before, 1 day and 3 day after operation, respectively. All the detection was performed by medical graphics critical care monitor desktop analysis system. Based on the indirect calorimeter theory,REE and respiratory quotient (RQ) were figured out.MAIN OUTCOME MEASURES: ①Concentrations of insulin, growth hormones and cortisol of patients at 1 day before, 1 day and 3 day after operation; ②Resting energy consumption, RQ and CRP of patients at 1 day before, 1 day and 3 day after operation.RESULTS: Totally 42 patients were involved in the result analysis. ①On the third postoperative day, the insulin levels of the traditional group were lower than those before operation [(12.4±1.1), (17.5±2.2) mlU/L, P ＜ 0.05]; On the first postoperative day, the levels of growth hormone of the traditional group were significantly higher than the MIS group [(2.8±0.9), (5.3±2.4) μg/L, P ＜ 0.05], and on the third day after operation, the levels of the MIS group were remarkably increased compared with those before operation [(1.4±0.5), (1.0±0.3) μg/L, P ＜ 0.05]; the cortisol levels of the traditional group on the first postoperative day were higher than the MIS group [(1.12±0.25), (0.59±0.11) μmol/L, P ＜ 0.05]. ②REE levels of the traditional group and MIS group on the first day after operation were(1437.8±415.9) and (1223.8±179.9) K,higher than those before operation [(1 186.4±297.4), (1 160.7±158.6) K, P ＜ 0.05]; on the first and third days after operation, REE levels of the MIS group were higher than the traditional group [(1 223.8±179.9), (1 151.7±150.8) K;(1 437.8±415.9), (1 329.4±350.5) K, P ＜ 0.05]. ③RQ of the traditional group and MIS group on day 1 after operation were all (0.8±0.05), lower than that before operation (0.9±0.11, 0.9±0.15, P ＜ 0.05). ④On the first and third days after operation, CRP of the MIS group were lower than the traditional group [(14.8±2.5), (34.37±7.5) mg/L; (64.1±14.4),(93.87±12.7) mg/L, P ＜ 0.05], but higher than that before operation [(8.0±0.11) mg/L, P ＜ 0.05].CONCLUSION: Minimally invasive surgery on knee joint results in less trauma, low stress reaction and slight influence on metabolism of patients, moreover, it benefits the restoration of stress hormones, nitrogen balance and energy metabolism.

Objective To explore the effect of low intensity pulsed ultrasound stimulation (LI-PUS) on the maturation of regenerate bone in a rabbit limb lengthening model. Methods Sixty skeletal mature female New Zealand white rabbits were randomly divided into an LIPUS treatment group and a control group. All rabbits were underwent mid-diaphyseal tibial osteotomy and immobilized in an Orthofix M103 Mini lengther. Gradual distraction at 0. 5 mm every 12 h for 10 d was performed at day 7 postoperatively. A 4-week course of LIPUS treatment group was applied over the distraction site for 20 min daily starting immediately after the completion of the distraction only for the treatment group. Rabbits were euthanized and the mid-diaphyseal tibia was harvested for evaluation at 4, 8, and 12 wk after the completion of the bone lengthening protocol. Radiographic analysis was performed to study the formation of bone callus using the ImageJ software at 12 wk after the completion of the bone lengthening protocol. Bone mineral density (BMD) of regenerate bone was measured by Dual energy X-ray absorptiometry (DEXA) . Torsional testing to failure was performed on the tibia specimens at 8 and 12 wk after the completion of the bone lengthening protocol. Results Radio-graphic measurement showed higher relative gray scale of bone callus in the LIPUS group than that in the control group at 12 wk (P ＜ 0. 05) . BMD in the LIPUS group was significantly higher than that in control group at 8 and 12 wk (P ＜ 0. 05). Biomechanical testing showed that the ultimate torque, ultimate torsional stiffness, and energy absorption at failure of regenerated bone at 8 and 12 wk in the LIPUS treatment group were better than those in the control group (P ＜ 0. 05) Conclusion LIPUS as a biophysical stimulation may accelerate the formation and maturation of regenerate bone in rabbit tibia lengthening model.

OBJECTIVE: To analyze the epidemiological characteristics and treatment situation of pelvic fractures in 5 cities in Hunan, improve the treatment and provide epidemiological data for policymakers. METHODS: The clinical data of 65 patients with pelvic fractures were collected from 9 third-tier hospitals in Hunan from October 2012 to March 2013. The gender, age, cause, volume of blood transfusion, and prognosis were analyzed with SPSS 13.0. RESULTS: There were 44 male and 21 female patients (2.10:1.00). The age ranged from11 to 86 years and 74.6% of the patients were between 20 and 59. The main cause was traffic injury (30 cases, 46.2%) and fall injury (22 cases, 33.8%). About 73.8% patients suffered associated injuries all over the body. By Tile's classification of pelvic fractures, the average blood transfusion of type A was 483.33 mL, that of type B was 1 026.92 mL and type C was 1 905.56 mL. Compared with type A, the treatment outcome of type C patients was worse. CONCLUSION Pelvic fractures are mostly caused in young and middle-aged males by high-energy. Tile C pelvic fractures need more blood transfusion and have poor prognosis. Patients had better be taken straight to municipal hospitals by expertise. Safety education for high-risk groups should be enhanced to reduce the incidence of pelvic fractures.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; China ; epidemiology ; Cities ; Female ; Fractures, Bone ; epidemiology ; Humans ; Incidence ; Male ; Middle Aged ; Pelvic Bones ; pathology ; Tertiary Care Centers ; Treatment Outcome ; Young Adult

Objective:To establish a database for pelvic trauma in Hunan Province,and to start the work of multicenter pelvic trauma registry.Methods:To establish the database,literatures relevant to pelvic trauma were screened,the experiences from the established trauma database in China and abroad were learned,and the actual situations for pelvic trauma rescue in Hunan Province were considered.The database for pelvic trauma was established based on the PostgreSQL and the advanced programming language Java 1.6.Results:The complex procedure for pelvic trauma rescue was described structurally.The contents for the database included general patient information,injurious condition,prehospital rescue,conditions in admission,treatment in hospital,status on discharge,diagnosis,classification,complication,trauma scoring and therapeutic effect.The database can be accessed through the internet by browser/servicer.The functions for the database include patient information management,data export,history query,progress report,video-image management and personal information management.Conclusion:The database with whole life cycle pelvic trauma is successfully established for the first time in China.It is scientific,functional,practical,and user-friendly.

Lipoprotein a[Lp(a)]is a risk factor for cardiovascular disease.This paper summarizes the structure,anabolism and mechanism of action of Lp(a),and the relationship between Lp(a)and cardiovascular diseases,liver and kidney diseases,diabetes mellitus and other diseases.It focuses on the traditional lipid-low-ering regimen to reduce plasma Lp(a)level and the current popular novel therapies,such as mipomersen,pel-acarsen,olpasiran,and the interfering effect of related drugs on Lp(a)level and the degree of benefit on cardi-ovascular events.How to reduce plasma Lp(a)level and improve patient prognosis will be the key to future Lp(a)related research.

Objective:To analyze the medication characteristics and prescription law of Ye Tianshi and Wu Jutong in the treatment of spleen and stomach diseases based on data mining method; To provide reference for clinical treatment of spleen and stomach diseases.Methods:Records related to spleen and stomach diseases in the Lin Zheng Zhi Nan Yi An and Wu Ju Tong Yi An were collected. SPSS Statistics 26.0, SPSS Modeler 18.0 and other software were used to conduct statistical analysis on the frequency, properties and efficacy of Chinese materia medica. The association analysis and clustering analysis were carried out on high-frequency drugs. Results:A total of 423 medical records, 231 kinds of Chinese materia medica (2 752 times) were included in the Lin Zheng Zhi Nan Yi An. A total of 83 medical records, 115 kinds of Chinese materia medica (753 times) were included in Wu Ju Tong Yi An. The Chinese materia medica used by Ye Tianshi and Wu Jutong to treat spleen and stomach diseases was mainly warm, mild and cold, with pungent, sweet and bitter as the main tastes; they mainly belonged to the spleen, lung and stomach meridians, and their main functions included clearing heat, diverting water and dampness, regulating qi, resolving phlegm, relieving cough, and tonifying deficiency. 6 second-order association rule combinations and 5 effective clusters were obtained for Ye Tianshi's treatment of spleen and stomach diseases, and 15 second-order association rule combinations and 6 effective clusters for Wu Jutong's treatment. Conclusions:Ye Tianshi and Wu Jutong's medication attributes in the treatment of spleen and stomach diseases are basically similar. They often use the method of bitter catharsis to regulate the qi movement of spleen and stomach, and the products of sweet and mild infiltration are used to eliminate dampness and heat. Compared with Ye Tianshi, Wu Jutong used few tonic, heat-clearing, phlegm-resolving, cough-relieving and asthma-relieving drugs, and more diuretics and qi-regulating drugs.

Objective: To explore the clinical effects and key techniques of expanded super-thin perforator flaps in the shoulder, neck, and chest in reconstruction of extensive burn scars in the face. Methods: From January 2008 to November 2018, 22 patients with extensive burn scars in the face were admitted to the Department of Plastic Surgery of Dongguan Kanghua Hospital and the Department of Plastic Surgery of Dermatology Hospital of Southern Medical University, with 3 males and 19 females, aged from 4 to 48 years. There were 16 cases of type Ⅱ and 6 cases of type Ⅲ in facial scars. Before the first stage of expansion surgery, Doppler blood flow survey meter or multi-slice CT was used to locate the perforator vessels. One to four expanders with rated capacity ranged from 100 to 600 mL were placed in the patients. We gave 20% to 30% of the rated capacity of expander intro-operation and common injection with 10% to 15% of the rated capacity of expander per week post-operation until the volume reached 1.5 to 2.5 times of the rated capacity of expander during the past 3 to 4 months. At the second stage of surgery, the perforators were located again before surgery with the same method. The size of defects after the excision of facial scars ranged from 6 cm×4 cm to 18 cm×16 cm. With perforators used as nutrient vessels, narrow pedicle flaps or random flaps ranging from 6 cm×6 cm to 22 cm×18 cm were elevated as rotating or advancing to reconstruct the defects. The donor sites were sutured directly. Some of the flaps needed stage Ⅲ operation for cutting the pedicle. The survival of flaps, post-operation complications, and follow-up were assessed. Results: All flaps of 22 patients survived. All the donor sites were closed simultaneously. One patient underwent an additional surgery for 5 cm×4 cm necrosis on distal part of flap caused by subcutaneous hematoma. Two patients with epidermis blister on the flaps were healed by themselves after dressing change. Due to rapid expansion, blood capillary proliferation appeared on the central part of the flap in 3 cases, after slowing down the expansion speed properly, which had no impact on flap transfer. No ischemia or venous congestion phenomenon were observed in the other flaps. During follow-up of 5 to 48 months, the flaps of patients showed no significant bloated appearance, with good complexion and texture, and even could reproduce facial fine-grained expressions naturally. Conclusions For the reconstruction of extensive burn scars in the face, expanded super-thin perforator flaps can not only acquire large and thin flaps with high matching degree surface skin defect, but also reproduce facial fine-grained expressions. It is a simple and safe method which conforms to the facial aesthetic standard.