[Objective]To investigate the morbidity,classification and treatment of multiple fracture around the knee in adults,and to analyze the significance of AO classification in the treatment.[Method]Multiple fractures in 167 patients from 2003 to 2007 were retrospectively analyzed and grouped according to their ages,occurring years,mechanism of injury and treatment.AO/OTA classification was assessed from the preoperative X-ray result,and healing situation was evaluated according to postoperative X-ray.[Result]All 167 multiple fractures around the knee accounted 23.69% for all lower limb fractures,with 89.2% of male and 10.8 of female.For the patient's age analysis,30-40 years old age group accounted for the largest proportion (29.34%).For the injury mechanism,traffic accident accounted for the largest proportion (53.29%).Distal femur + proximal tibia fracture accounted for 44.3%.patella + distal femur fracture accounted for 31.1%.Proximal tibia + patella accounted for 19.8%.Distal femur + proximal tibia + patella accounted for 4.8%.According to AO classification,A3 fracture was the most common in distal femoral fracture group (25.4%).B1 fracture was the most common in proximal tibia fracture group (21.7).C3 fracture was the most common in patella fracture (31.2).Tthe final good-to-excellent rate was 85.63%.[Conclusion]Distal femoral fracture combined with proximal tibia fracture was the most common in multiple fractures around the knee.The common fracture type is supracondylar fracture in femur,transverse patella and tibia.Application of nail,plate,wire and tension band,et al.can achieve good fixation.

Objective To evaluate the efficacy of surgical repair for non-circumferential defect of bile duct in Mirizzi syndrome.Method The clinical data of 32 patients with Mirizzi syndrome with non-circumferential defect of bile duct were repaired using the patient's own tissues such as gallbladder pedicle flap,umbilical venous flap and omental flap.Results All the patients were operated success fully.There was no operative mortality.The defects in the bile duct were repaired using gallbladder pedicle flap in 25 patients,umbilical venous flap in 5 patients and omental flap in 2 patients.There were 2 patients who developed postoperative complications.There was one postoperative bile leakage in a patient who was repaired using an umbilical venous flap.The other complication was residual bile duct stones.The patient with postoperative bile leakage was drained through a drainage tube which was removed after 7 days.The residual bile duct stones were removed by endoscopy through a T-tube sinus after 9 months.All patients were confirmed by T-tube cholangiography after 9 to 12 months to have no stones,bile duct stenosis or any other abnormalities.The T-tube was then removed.All patients were followed -up for 1 to 5 years.All patients had no cholangitis,abdominal pain,jaundice or fever.Conclusions Using the patients' own tissues such as gallbladder pedicle flap,umbilical venous flap and omental flap to surgical repair the defect in the bile duct of patients with Mirizzi syndrome was effective.This surgical treatment is a good choice.

Objective To summarize clinical experience of emergent surgery for severe liver trauma with rupture of major blood vessels. Methods The clinical data of 12 cases suffering from severe liver trauma with rupture of perihepatic and intrahepatic large blood vessels were retrospectively analyzed. These cases were from Dec 2000 to May 2008. All the cases underwent emergency operation, 6 cases were treated with liver lobectomy: among those 1 case with right posterior lobe liver resection, 1 case with irregular right lobe liver resection, 3 cases with left hemihepatectomy, and 1 case with left lateral lobectomy. Seven cases with rupture of major blood vessels were treated by repair or ligature and/or packing including repair of posthepatic inferior vena though the middle fissure in 2 cases, and through retrahepatic space in one case, interrupted suture of the portal vein in 2 cases, interrupted suture of the right hepatic veins in 2 cases. Mattress suture was applied to the ruptured hepatic veins in 7 cases including mattress suture of the branch of right hepatic vein and middle hepatic vein in 1 case, mattress suture of right hepatic vein in 1 case, suture of middle hepatic vein in 2 cases, and suture of left hepatic vein in 3 cases. One case was treated with ligation of hepatic artery and 3 cases with gauzes packing. Results Among all the 12 cases, 9 cases were cured, 3 cases died: two were caused by severe trauma together with hemorrhagic shock, one by sever brain injury together with hemorrhagic shock. Conclusions Prompt operation, precise stop bleeding and correct operation style are the key for successful rescue of patients suffering from severe liver trauma and massive bleeding.

Objective To analyze characteristics of severe liver trauma and efficacy of different surgical procedures. Methods Clinical data of 109 patients with severe liver trauma treated in the recent 10 years were retrospectively analyzed. Debriding suture was performed in 32 patients, gauze tamponade in 5, debridement hepatectomy in 59 and anatomical hepatectomy in 13 patients. Results In all the 109 patients, 92 were cured and 17 died. The dead patients included 3 with grade Ⅲ trauma,9 with grade Ⅳ trauma, and 5 with grade V trauma. Among the dead patients, there were 3 patients with simple liver injury (17.6%) and 14 with associated injury (82.4%). Conclusion Right hepatic serious damage is the main type of severe liver trauma and is always complicated with associated injury and needs emergency treatment. Application of the most appropriate surgical approach according to the traumatic condition is important to promote the successful rate of treatment.

Objective To evaluate the effect of debridement hepatectomy with selective hepatopetal blood occlusion in the treatment of severe hepatic trauma.Methods The clinical data of 55 patients with severe hepatic trauma treated by debridement hepatectomy with selective hepatopetal blood occlusion were retrospectively analyzed.20,20 and 15 patients were with grade Ⅲ,Ⅳ and Ⅴ hepatic trauma respectively,combined with major peripheral hepatic vascular injury in 14 cases and with other trauma in 35 cases.Additional procedures including liver suture repair in 7 cases,perihepatic gauze packing in 3 cases,inferior vena cava repair in 5 cases,hepatic vein repair in 4 cases,hepatic vein ligation in 3 cases and hepatic artery ligation in 2 cases were performed.Other operations such as craniotomy debridement in 3 cases,cholecystectomy in 6 cases,T tube drainage of common bile duct in 4 cases,splenectomy in 5 cases,pancreatic tail resection in 2 cases,left kidney resection in 1 case,thoracic cavity closed drainage in 9 cases,partial small bowel resection or repair in 4 cases and stomach repair in 1 case were performed as needed.Results The operations were successful in 47 patients.Postoperative complications were observed in 19 cases (34.5％) including coagulation disorders in 1 case,postoperative abdominal bleeding in 2 cases,intestinal obstruction in 1 case,liver and renal dysfunction in 4 cases,abdominal infection in 3 cases,incision infection in 2 cases,pulmonary infection in 4 cases,pleural effuion in 10 cases.Death occurred in 8 patients (14.5％),the cause of death were hemorrhagic shock in 3 cases,combined with severe craniocerebral injury in 2 cases,septic shock in one case,and multiple organ failure in 2 cases.Conclusions Debridement hepatectomy with slective hepatopetal blood occlusion is an effective treatment for severe hepatic trauma.

Objective To study the results of laparoscopic approach in the treatment ot gallbladder and common bile duct stones.Method The authors reviewed data of 60 patients with gallbladder and bile duct stones treated laparoscopically.Results All the 60 patients treated with laparoscopic cholecystectomy and laparoscopic transcystic common bile duct exploration (LcTDE) were successful.There were 1 bile duct stone in 32 patients,and 2 to 6 bile duct stones in 28 patients.The operation time was (38.7±15.1) min and the hospitalization time was (5.5±2.1) days.One patient developed biliary fistula postoperatively which healed after 7 days of conservative treatment.One patient had bile duct residual stone which was treated by ERCP.The remaining patients were well.Conclusion Laparoscopic transcystic common bile duct exploration using a mini incision and primary suturing of the bile duct was simple,safe and efficacious.

Objective To measure the normal sagittal and coronal diameters of thumb and great toe distal phalanx bottom by ultrasonography. Methods One hundred and twenty volunteers' sagittal and coronal diameters of thumb and great toe distal phalanx bottom were measured by ultrasonography. The measurements was analysed by the statistical method. Results The thumb and great toe distal phalanx bottom showed hyperechoic zone,clear boundary with the adjacent fascia and tendon tissue showed low echo area at cross section by high frequency ultrasound. The sagittal diameters of thumb distal phalanx bottom was (8. 07 ± 0. 67)mm in men, while that of great toe distal phalanx bottom was (8. 34 ± 1. 02) mm( t = 1.73, P =0.86).The coronal diameters of thumb distal phalanx bottom was (11.61 ±0.89)mm in men, while that of great toe distal phalanx bottom was (14. 25 ± 0. 84)mm( t = 16. 77, P = 0. 00). The sagittal diameters of thumb distal phalanx bottom was (7. 52 ± 0. 62) mm in women, while that of great toe distal phalanx bottom was (7. 72 ± 0. 67) mm( t = 1. 72, P =0. 14). The coronal diameters of thumb distal phalanx bottom was (10.94 ± 0.97) mm in women, while that of great toe distal phalanx bottom was (13. 51 ±0. 75) mm( t =16.21, P = 0.00). Conclusions The normal sagittal and coronal diameters of thumb and great toe distal phalanx bottom measured by the ultrasonography can guide the operation of wrap-around flap of a great toe with phalanx ungual for thumb II degree defect reconstruction.

Objective To investigate the biomechanicai characteristics of flexor profundus tendons repaired after decimeter wave therapy, and to observe the effect of decimeter wave therapy on early active mobilization. Methods A total of 56 Leghorn chickens were randomly divided into a therapy group and a control group with 28 chickens in each. The 3rd and 4th toes of their left feet were employed for the establishment of a tendon injury model. The flexor profundus tendons were cut and repaired. Gypsum support was applied and fixed with an adhesive plaster after the operation. The operated sites on toes Ⅲ and Ⅳ were exposed. The external fixation was removed 3 weeks later and the chickens were left free to move. Decimeter wave therapy ( frequency 915 MHz, power 8 Watts) was ap-plied for 10 minutes once daily on the left foot of each chicken in the therapy group from day 1 until 3 weeks after the operation. Sham decimeter wave therapy was applied to chickens in the control group. Four chickens from each group were randomly selected at the 1st, 7th, 10th, 14th, 18th, 21st and 28th days for biomechanical analysis. Biome-chanical parameters including tensile strength of rupture (Pmax), elongation ratio at rupture (δimax) and the tensile adhesion strength of the rupture zone (W0>) were observed at each time point. Results At the 7th, 10th, 14th, 18th, 21st and 28th day after the operation, the differences in Pmax, δmax and W0 between the therapy and control groups were statistically significant. The results of the therapy group were better than those of the control group. Conclusions Local decimeter wave therapy after flexor tendon repair can promote intrinsic healing and reduce ex-trinsic healing. The speed and quality of healing are improved. The elasticity and tenacity of the injured tendons are enhanced. Therefore decimeter wave therapy is helpful for early active mobilization training.

Objective To observe the effects of decimeter wave irradiation on the rehabilitation of the acute peripheral nerve injury of rats. Methods Eighty Sprague-Dawley rats(200～250 g)were randomly divided into 2 groups:group A,the decimeter wave irradiation group and group B,the blank control group.The right sciatic nerves of all the rats were crushed with forceps to establish the experimental animal model of acute peripheral nerve injury.Then the rats of group A were exposed to decimeter wave irradiation for 10 minutes every day for 8 weeks.The rats of group B were also fixed on a table as those in group A but receive no decimeter irradiation.At different time points observation with light and electron microscopy,immunochemical staining,axon morphometric analysis,electrophysiological examination were carried out.Results Morphometric analysis showed that at different time points after operation the recovery of nerves in group A was better than that in group B.Axon morphometric analysis showed that the number,the diameter and the thickness of sheath of myelinated nerve fibers in group A were greater than those in group B. Electrophysiological assessment showed that the latency was shorter,the amplitude was higher,and the nerve conduction velocity was faster in group A than those in group B at the end of 8 weeks of decimeter wave treatment after operation.Conclusion Decimeter wave had significant effects on the rehabilitation of the acutely injured peripheral nerves.

BACKGROUND:Experiments have demonstrated that biological membranes can be usedtorecon struct thetendon she athandin hibit exogenou shealing of thetendon.Therefore,the semembrane sprovide a good bed for tendon gliding and reduce tendon adhesion.
OBJECTIVE:To compare the effectsof acelular amniotic membrane and medical membraneagainst tendon adhesion during the repair oftendon sheath defects.
METHODS:ToesIIIfrom the bipeds of 66 leghorns were chosen to prepare tendon injury and tendon sheath defect models, which were randomly divided into three groups (n=22 per group). Amnion group were repaired with acelular amniotic membrane, medical membrane group with absorbable membrane, and control group had no treatment on tendon sheath defects. Gross, histological and biomechanical tests of each group were performed at 2, 4, 8, 12 weeks after surgery.
RESULTS AND CONCLUSION:At 12 weeks after surgery, in the amniotic membrane and medical membrane groups, the tendon sheath formed completely, and the tendon healed well, with no adhesion, but in the control group, there was serious tendon adhesion. At 8 weeks after surgery, the number of synovial cells in the false sheath was highest in the amniotic membrane group sequentially followed by the medical membrane group and control group. In the amniotic membrane group, the rough endoplasmic reticulum expanded highly and secreted exuberantly in the matrix, while in the control group, the synovial cells presented with messy arrangement, and expanded vacuoles in the matrix were weaker than those in the other two groups. At 12 weeks after surgery, fibroblasts were arrayedtidily in layerwith dense structure in the medical membrane and amniotic membrane groups;but in the control group, fibroblasts were distributed disorderly with loose structure. Tendon sliding distance and total flexor toe angle in the amniotic membrane and medical filmgroups were significantly larger than those in the control group (P < 0.05),butthere was no significant difference between the medical membrane and amniotic membrane groups. Additionally, the maximum tensile fracture strength had no significant difference among three groups at 12 weeks after surgery. These results indicate that both amniotic membrane and medical membrane can markedlyprotect the tendon from exogenous healing and adhesion.