ObjectiveTo investigate the treatment efficacy of traumatic proximal interphalangeal (PIP)joint defects with prosthetic replacement.MethodsFrom September 2007 to November 2010, ten patients with joint defect injuries were treated by joint prosthetic replacement (5 index fingers,4 middle fingers,and 1 ring finger),including a reconstructed middle finger.Joint motion range and postoperative pain of all cases were measured to evaluate the treatment.ResultsAll cases went through a smooth operation with primary wound healing,and with neither intraoperative nor postoperative complications happened.The follow-up period was range from 8 months to 2 years.The active motion arcs of PIP joints ranged from 50° to 80°,and satisfactory appearances as well. According to assessment standard of upper extremity described by Chinese Hand Surgery Association,the treatment outcome were excellent in 6 fingers,good in 3 fingers,general in 1 finger.ConclusionJoint prosthetic replacement is a new effective method to treat traumatic proximal interphalangeal joint defect,which is a simple operation with advantages of little trauma and rapid recovery.

OBJECTIVE To evaluate the protective effect of Agaricus bisporus intracellular polysaccharides(IPS) and exopolysaccharides (EPS) on immunological liver injury induced by concanavalin A (Con A). METHODS Mice were pretreated with IPS and EPS (100, 200 and 400 mg kg- 1, ig) daily for 12 d. Immunological liver injury was induced by Con A 25 mg·kg-1 byinjection via the tail vein of mice.Eight hours after injection of Con A, the indexes of the liver, spleen and thymus, serum level of glutamicpyruvic transaminase (GPT), glutamic-oxalacetic transaminase (GOT), tumor necrosis factor-α (TNF-α) and interferon- γ (IFN- γ), splenic lymphocyte percentages of CD4 + and CD8 + , and liver homogenate content of superoxide dismutase (SOD) and malondialdehyde (MDA) were measured. Liver pathological changes were observed by HE staining. RESULTS Compared with normal group, the autoimmune liver injury in mice induced by Con A resulted in an increase in the liver index (P<0.01) , spleen index (P<0.01), the activity of GPT (P<0.01) and GOT (P<0.01), the content of TNF- α (P<0.01) and IFN- γ (P< 0.01), and the level of MDA (P<0.01), but a decrease in the thymus index (P<0.01), the percentage of CD4+ (P<0.01) , the ratio of CD4+/CD8+ (P<0.01), and SOD activity (P<0.01). Compared with model group, treatment with IPS (200 and 400 mg·kg-1) and EPS (200 and 400 mg·kg-1 ) respectively resulted in an increase in the thymus index (P<0.01) but in a decrease in the liver index and spleen index (P<0.01). Similarly, the activity of GOT and GPT was decreased obviously (P<0.01), and the content of TNF-α and IFN-γ in IPS and EPS 200 and 400 mg·kg-1 groups was decreased. Compared with model group, the activity of SOD in IPS and EPS (200 and 400 mg·kg- 1) group was increased (P<0.01) while MDA was decreased (P<0.01). Moreover, the percentage of CD4 + Iymphocytes decreased (P<0.01), whereas no significant difference was found in the ratio of CD4 +/CD8 + .Pathological changes of the liver were observed under a microscope. Pretreatment with IPS and EPS could effectively reduce the liver injury induced by Con A. CONCLUSION IPS and EPS have certain protective effect on immunological liver injury, which may be related to their ability to clean up free radicals, control lipid peroxidation and regulate the balance of the immune system.

Objective To investigate the injury mechanism, fracture characteristics, treatment strategy and prognosis of Pilon fracture without fibula fracture. Methods 28 cases of Pilon fracture without fibula fracture (29 fractures) treated in our hos?pital were adapted from January 2009 to December 2014. 22 cases were male, 6 were female, aged 46 years old (23-75). Cause of injury:tumble in 14 cases, fall from high place in 8 cases, traffic accident in 5 cases, bruise in 1 case. 10 cases had associated in?juries, and 2 cases were open injuries. The OA/ATO fracture type, Rüedi&Allgower fracture type, and characteristics of fractures were summarized. The appropriate treatments were selected, and the operative method, operative time, surgical approach, fixation, fracture healing time, ankle Mazur score, Burwell?Charnley reduction score and postoperative complications were recorded. Re?sults On the mechanism of injury, 28 cases mostly had a median?low energy injury mechanism with little open injuries. On the fracture characteristics, there was a 96.6%anterior distal tibia articular fracture involved with no other specific fracture character?istics occurred. The treatment of the fracture mostly received a single operative approach to complete open reduction and internal fixation operation. The average operation time was 119 minutes, the average fracture healing time was 7.1 months, the excellent and good rate of ankle Mazur score was 86.2%and the satisfactory rate of Burwell?Charnley fracture reduction score was 93.1%. Skin infections occurred in 3 patients after operation. After effective antibiotic and correct clinical treatment, the incisions got healed in these 3 patients. Conclusion Pilon fracture with intact fibula mostly is caused by median to low energy injury when an?kle at neutral or varus position, most with anterior distal tibia articular fracture by foot dorsal flexion. Generally use a single anteri?or approach can complete open reduction and internal fixation operation with satisfactory clinical treatment. This kind of fracture could achieve good reduction, good bone healing, good function and little complications after correct treatment.

BACKGROUND: Morphine is the first choice for the pain of medium and advanced degrees due to cancer. This is advocated in the Pain Relieving Guide of the WHO. Controlled-release morphine sulfate tablets(CRM) and sustained-release morphine sulfate tablets (SRM) all belong to oral long-acting morphine. It plays an important role in relieving cancer pain effectively and improving their quality of life(QOL).OBJECTIVE: To observe the analgesic effect of CRM and SRM and to observe how they improve the QOL of the cancer patients with severe cancer pain.SETTING: Department of oncology, department of surgery, department of internal medicine and department of traditional chinese medicine in the first affiliated hospital of a university.PARTICIPANTS: During October 1995 to June 1998, all inpatients that were pathologically proved to suffer from malignant tumor with severe pain were recruited into our study.METHODS: There were 182 patients with severe pain due to advanced cancers pathologically proven. They all met the entry criterion of the study. Totally 95 patients were treated with CRM, of which 12 cases were lost in follow-up due to side effects, death, or discharge from the hospital, and the rest 83 cases entered the stage of clinical trial. Eighty-seven patients were treated with SRM. Of them 25 cases were lost in follow-up due to side effects, death, or discharge from the hospital, and the rest 62 cases entered the stage of clinical trial. The recommended initial dosage of CRM or SRM was 30 mg every 12 hours for all patients, and then the dosage was regulated according to the effects until the ideal anesthesia was achieved.MAIN OUTCOME MEASURES: Assessments included pain severity, the effective rate, complete remission rate, remission time, adverse reactions, and the QOL before and after the treatment.RESULTS: The effective rates of CRM and SRM were 95% and 94%respectively. The complete remission rates were 82% and 80% respectively, and the remission time was(9.1 ±4.1) hours and (8.7±4.4)hours respectively. Statistically, there was no significant difference in analgesic effect and remission time between CRM and SRM. QOL was elevated for a higher degree in 62(75% ) and 47(76% ) patients after the treatment. QOL scores of CRM were (34.6 ± 11.5 ) points before treatment and (52.6 ± 13.0) points after the treatment( P = 0. 000), while QOL scores of SRM were(37.7 ± 9.7) points before the treatment and points (49.8 ± 12.9) points after the treatment (P = 0. 000). There was significant difference in QOL after the treatment. They could relicve osteocope,visceral pain, soft tissue infiltrative pain more effectively than they do about neurological pain.CONCLUSION: Oral treatment with CRM and SRM for the patients with server cancer pain shows a similar analgesic effect. They are effective, safe,and convenient, and can improve the QOL.

Objective To discuss the clinical application of free micro-flap based on the superficial palmar branch of radial artery (SPBRA) to repair the palmar soft tissue defect of the finger.Methods From October,2012 to September,2015,this flap was used in 25 patients to repair the palmar soft tissue defect of the finger.The artery,the vein and the never in the flaps was anastomosed respectively with that in the recipient site.The donor area was sutured directly.Results All patients were followed-up for a mean of 11 months (range,6-20 months).All 25 flaps survived.The character of flap was good,the appearance and sensitive function obtained satisfactory resume.At the last follow-up,the two-point discrimination was 5-10mm on the affected side.According to the Standard of Evaluation of Thumb-Finger Reconstruction of the Chinese Medical Association,there were excellent in 17 cases,and good in 8 cases.The wounds of donor site healed by 1st intention with no visible scars.The function of thumb was not damaged.Conclusion The free micro-flap based on the SPBRA is feasible for soft-tissue defects of finger bacause the undamaged major blood vessels of donor site,the inconspicuous scar,and the good appearance and sensitive function of repaired fingers.

Objective To summarize clinical experience of application of muliplefoliated flap combined with tendon graft from dorsal foot for repairing soft tissue defects of multi-fingers. Methods Based on the results of microdissection researches, muliplefoliated flap including medial foot flap, the first metatarsal dorsal flap, lateral foot flap, extensor pollicis brevis of toe and extensor proprius of the fifth toe pedicled by anterior tibial vessels and dorsal pedis vessels as trunk, anterior medial malleolus vessels, the first metatarsal vessels and anterior lateral malleolus vessels as branches respective was designed for repairing soft tissue and tendon defects of multi-fingers. Results In all 12 cases, total survival of flap was 11 cases , 1 case had partial necrosis of distal flap and it was healed by dress changing. Conclusion Transplantation of muliplefoliated flap combined with tendon graft from dorsal foot is a good method to repair soft tissue and tendon defects of multi-fingers.

Objective To develop a HPLC method for determination of baicalin .Methods The separation was carried out on a Waters XBridge C18 column(4 .6 mm × 250 mm ,5μm) ,the mobile phase was composed of acetonitrile and 0 .8% for-mic acid (25∶75) ,the detection wavelength was set at 276 nm ,the flow rate was 1 .0 ml/min ,the column temperature was 30 ℃ and the injection volume was 10 μl .Results The linearity was obtained over 1 .25-40 μg/ml(r=0 .999 9) for baicalin . The RSD of precision were less than 2% .The average recovery was between 95% and 100% .Conclusion This HPLC method was simple ,accuracy and suitable for the quality control of Biyanling capsule .

Objective:To explore the epidemiological characteristics, clinical characteristics, treatment strategies and clinical results of non-dislocated hyperextension tibial plateau fracture.Methods:A total of 25 cases of non-dislocated hyperextension tibial plateau fracture patients were collected, including 12 males and 13 females, aged 27-79 years with an average age of 51±15 years. Causes of injury: 18 cases of traffic accident, 2 cases of heavy injury, 5 cases of falling injury. Schatzker classification of tibial plateau fracture: 4 cases of type II, 5 cases of type IV, 13 cases of type V, 3 cases of type VI. Three columns theoretical classification: 4 cases of simple lateral column, 5 cases of simple medial column, 7 cases of medial column+lateral columns, 9 cases of three columns. Preoperative tibial plateau posterior slope angle was -10-0 degrees, average-5.2 degrees. Preoperative MRI showed 5 cases of medial collateral ligament (MCL) injury, 3 cases of posterolateral complex (PLC) complex injury, 2 cases of PLC+ posterior cruciate ligament (PCL) injury and 10 cases of menisci injury. The change of tibial plateau posterior slope angle was more than 10 degrees in patients with ligament injury, 5 patients had a tibial plateau posterior slope angle change more than 15 degrees, 5 patients had a tibial plateau posterior slope angle change more than 10 degrees, and the patients with a tibial plateau posterior slope angle change less than 10 degrees had no ligament injury; 6 patients with simple lateral column or medial column fracture had a ligament injury, 2 patients with medial column+lateral column fracture had a ligament injury, and 2 patients with three column fracture had a ligament injury.Results:All patients were followed up for 12-24 months, with an average of 16.4 months. The operation time was 124±33 min (65-180 min), and the bleeding volume was 106±48 ml (20-200 ml). All patients were treated by open reduction and internal fixation. According to the characteristics of fracture, targeted reduction of articular surface and restoration of lower limb force line were carried out. The plate was placed on the anterior part of tibial plateau to fix the fracture fragment. Evaluation of postoperative fracture reduction: 20 cases were anatomic reduction, 5 cases were good reduction (between 2-5 mm articular surface collapse), and the excellent rate of fracture reduction was 100%. Internal fixation: 4 cases were treated with simple lateral plate, 2 cases with simple medial plate, 15 cases with medial+ lateral plate, 1 case with medial plate+ lateral anchor suture, 1 case with medial plate+ posterior screw, 1 case with lateral plate+ fibular screw, 1 case with medial plate + lateral plate+ lateral anchor suture. The meniscus was repaired in 8 patients, including 5 medial and 3 laterals. The fracture healing time was 3-6 months (mean 3.3 months). The postoperative knee Rasmussen score was 24.9±3.5 (18-29), and the postoperative knee joint mobility was 118°±9° (90°-130°). Superficial infection occurred in 2 patients.Conclusion:The main imaging characteristic of "non-dislocated hyperextension tibial plateau fracture" is the change of tibial plateau posterior slope angle. The injury of single anteromedial column/anterolateral column fracture is easy to combine with the "diagonal" injury, and when the tibial plateau posterior slope angle changes more than 10 degrees, it is easy to be associated with peripheral ligament injury. By using open reduction and internal fixation, restoring the joint articular surface and lower limb force line, repairing the soft tissue structure and ligament, and reconstructing the stability of knee joint, we can achieve satisfactory results.

Objective To explore the clinical outcome of free chimeric anterolateral thigh cutaneotendinous flap with rectus femoris muscular flap for repairing the complex tissue defect of dorsum wrist. Methods From June, 2005 to March, 2014, free chimeric anterolateral thigh cutaneotendinous flap with rectus femoris muscular flap was used for repairing the complex tissue defect of dorsum wrist in 15 cases, which were 12 males and 3 females, and aged from 18 to 52 years old. The skin and soft tissue defect ranged from 8.0 cm×5.5 cm to 22.0 cm×12.0 cm. All ac-companied with extensor digitorum tendon loss. The tendon defect ranged from 5.0 cm to 12.0 cm (7.6 cm on average). The flap size ranged from 9.0 cm×6.5 cm to 23.0 cm×13.0 cm. The pedicle length ranged from 4.0 cm to 7.0 cm (5.3 cm on average). Results All flaps survived, and no postoperative complications occurred. The followed-up time ranged from 12 months to 36 months, and the texture of flap was flexible. No bulky was noted, and skin color was similar to the hand skin. The flexor and extensor function of wrist recovered satisfying. The 2-point discrimination of flap ranged from 9 mm to 15 mm (12.5 mm on average). Conclusion Free chimeric anterolateral thigh cutaneo-tendinous flap with rectus femoris muscular flap is a good option for repairing the complex tissue defect of dorsum wrist.

Objective To investigate the differences and clinical effects of extended anterolateral approach in the treatment of simple/complex tibial plateau fractures with posterolateral bone fragment.Methods From January 2013 to December 2015,forty-six patients with posterolateral tibial plateau fractures treated in our hospital were included in our research.The posterolateral plateau fractures were reduced and fixed by the extended anterolateral approach.According to Schatzker fracture classification,patients with type Ⅱ fractures were treated as simple group and patients with type Ⅴ and type Ⅵ fractures were treated as complex group.According to tibial plateau three column classification,patients were divided into single column group,double column group and three column group.The operative time,bleeding volume,fracture healing time,postoperative Rasmussen score,knee mobility,reduction and fixation of fractures and postoperative complications were compared among the groups.Results All 46 patients were followed up for 23-45 months,with an average of 31.9 months.There were 24 cases in simple fracture group and 22 cases in complex fracture group.The mean operation time of simple group was 124±33.8 min,and that of complex group was 175±65.5 min,with significant difference (t=2.302,P=0.025);the mean bleeding volume of simple group was 118±93.5 ml,and that of complex group was 190± 149.4 ml,with significant difference (t=1.905,P=0.028).12 cases were treated with arthroscopy.Bone union was achieved in all patients at the last follow-up,and daily activities were not limited.The average healing time was 4.58 months in simple group and 5.54 months in complex group.The excellent rate of fracture reduction was 83.3％ in simple group and 27.3％ in complex group (x2=14.679,P=0.000).Posterolateral bone fragment was not completely fixed in 4 cases (16.7％) in simple group and 8 cases (36.4％) in complex group.The average Rasmussen function score was 26.8±2.1 and the range of motion of knee joint was 100°-120° (average 115.5°±6.2°) in simple group;The average Rasmussen function score was 23.5±3.4 points and the range of motion of knee joint was 95°-115° (average 106.3°±7.4°) in complex group,neither with no significant differences.According to the three-column fracture classification system,there were 6 cases in the single-column group,24 cases in the double-column group and 16 cases in the three-column group.There were significant differences in the operative time (F=5.039,P=0.000),bleeding volume (F=5.215,P=0.000) and the excellent rate of fracture reduction (x2=7.003,P=0.030) between these three groups.But there was no significant difference in the time of fracture healing,un-fixation rate of posterolateral bone fragment,knee joint Rasmussen score and knee jointactivity.The excellent rate of fracture reduction was 83.3％ in arthroscopy assisted cases and 47.1％ in arthroscopy un-assisted cases respectively (x2=4.749,P=0.002).Postoperative wound infection occurred in 1 patient.Conclusion Extended anterolateral approach could provide good reduction and fixation of tibial plateau fractures with posterolateral bone fragment with satisfactory clinical outcomes obtained in both simple and complex fractures.The operation was relatively simple and posterolateral bone fracture could get better reduction and fixation in simple tibial plateau fractures,and arthroscopy treatment was helpful to improve fracture reduction.