1.A binary logistic regression analysis of deep venous thrombosis after hip fracture surgery
Chinese Journal of Orthopaedic Trauma 2010;12(12):1104-1107
Objective To explore the incidence, etiological and protective factors, and preventive countermeasures of deep venous thrombosis (DVT) in patients undergoing hip surgery. Methods Four hundred and forty-one patients who had hip fracture surgery in our department from January, 2005 to May, 2010were analyzed retrospectively. They were 223 males and 218 females, aged 65.7 years. (range, 22 to 87). A binary logistic regression was performed, using gender, age, duration of surgery, surgery type, anesthesia type, blood transfusion, physical therapy, thrombo-prophylaxis and complication as covariates, taking DVT incidence as the dependant variable. Results The patients obtained a median follow-up of 17.2 months (range, 3 months to 4 years and 7 months). Sixty-nine patients developed DVT (incidence, 15.6%).Analysis of multiple variables showed that duration of surgery, anesthesia type, blood transfusion, hypertension and diabetes were risk factors to DVT. Physical therapy and thrombo-prophylaxis were protective factors.Age, gender and surgery type had no statistically significant influence on DVT (P > 0.05). Conclusions The DVT incidence after hip fracture surgery is high. In order to decrease the DVT incidence, surgeons should try their best to estimate risk factors for every patient perioperatively, avoid general anesthesia or blood transfusion, shorten operating duration, effectively control complications, actively perform physical therapy or thrombo-prophylaxis, and prolong the anticoagulant therapy for patients with higher risk factors.
2.Locking compression plate fixation in treatment of unstable sacral fracture
Academic Journal of Second Military Medical University 1981;0(04):-
Objective:To analyze the clinical outcomes of the locking compression plate(LCP) fixation for the unstable sacral fracture.Methods: Nine patients with unstable sacral fracture were treated with locking compression plate fixation in our department,including 7 males and 2 females,with an average age of 34.8 years(ranged from 25 to 49 years).AO classification system found 1 B_(1),4 B_(2),2 B_(3) and 2 C_(1) type.Dennis classification found 6 Ⅰ section sacral fracture and 3 Ⅱ section sacral fracture.Incisions(6-8 cm) were made from each side of superior iliac spine to ipsilateral inferior iliac spine along iliac crest.After the fractures or dislocations were exposed and reduced,LCPs were chosen and remodeled.The iliosacral posterior ligaments were restored if injured.The LCP was pushed cutaneously to the other incision,placed on both dorsal ilia and fixed with locking screws.Each side of postal LCP was fixed with 3 locking screws for effective fixation.The reduction and fixation of fractures or dislocation were assured by radiostereoscopy.The operations lasted 45 min averagely(ranged from 30-80 minutes) and no patient needed blood transfusion.The average X-ray exposure period was 4 min(from 2-10 minutes).Results: All the patients were followed-up for a mean of 13.8 months,ranged from 6 months to 21 months.There was no iatrogenic nerve injury.The function and the feeling of sacroiliac joint and low extremities recovered to normality.According to the Majeed standards,the results were excellent in 4,good in 4,and fair in 1.Conclusion: The locking compression plate fixation is a simple and effective treatment for the unstable sacral fractures,with less trauma and complications.
3.Proceedings of the international meeting of the 10th anniversary of the AADO
Chinese Journal of Orthopaedic Trauma 2002;0(04):-
The international meeting of the 10th anniversary of the AADO, convoked from Oct.8 to Oct. 10 in 2002 in Shanghai, was sponsored by AADO and organized by the two orthopedics departments of Changhai Hospital and Ruijin Hospital, Shanghai. The supporters of this meeting were Stryker Pacific, Stryker Trauma and Stryker China. There were 180 conventioneers who came from all over the mainland China, America, Germany, India, Japan, Hong Kong and Taiwan. They were clinical specialists in traumatology, managers from traffic departments and experts in vehicle design. 17 theses were selected for the meeting. The theme of the meeting was musculoskeletal trauma in developing countries with focus on road traffic injuries &geriatric fall injuries. Many experts in orthopedic trauma were invited to give presentations at the meeting on the theme.
4.Diagnosis and treatment of elbow instability
Chinese Journal of Orthopaedic Trauma 2004;0(11):-
The instability of elbow is common among patients who suffered f ro m acute fracture or dislocation or from chronic strain. It is crucial to correct ly deal with the acute injury of the elbow, otherwise it would become chronic in stability of the elbow which is difficult to treat. This paper reviews the liter ature about the clinical representation, diagnosis and treatment of elbow instab ility. The surgical principle is to convert a complex fracture-dislocation patt ern into a simple dislocation pattern. Surgery should try to restore the anatomi c structure of the elbow, including articular surfaces and soft tissues. In inju ries to the ulnohumeral joint, reconstruction of the lateral tissues is the key to restoring joint stability. The premier treatment of recurrent instability of elbow is surgical treatment.
5.Computed tomography in preoperative assessment for Pilon fractures
Zimin WANG ; Qiugen WANG ; Qian WANG
Chinese Journal of Orthopaedic Trauma 2004;0(05):-
Objective To explore the significance of computed tomography in preoperative classification and surgical planning for Pilon fractures. Methods A retrospective analysis was done for 52 cases of Pilon fracture who had been admitted to our hospital from January 2000 to June 2005 and whose X-ray, Axial CT scan and follow-up data were complete. In the preoperative evaluation, the fractures were classified, the fracture angles measured and the anatomy of fragments analyzed on the basis of their plain radiographs and CT scans. The operative methods and approaches were based on the specific fracture types, fracture angles and courses of fracture line on the CT scans. Five patients received manipulative reduction and plaster splint, five closed reduction and internal fixation with lag screws coupled with plaster splint, 17 closed reduction and internal fixation with minimally invasive percutaneous plate osteosynthesis (MIPPO), 16 closed reduction and external fixation combined with limited internal fixation; and nine open reduction and internal fixation (ORIF). Results The average follow-up was 17.2 months.CT scan revealed an increased number of fragments in 21 patients. The fracture types were changed in nine patients according to new CT discoveries which revealed coronal main fracture lines in 61.5% of the cases and sagittal in 34.6% . The approaches and internal fixation positions varied according to the two different kinds of fracture. According to Mazur’ s criteria, the postoperative surgical results were evaluated as excellent in 30 cases, good in 13, fair in eight and poor in one. On average, the good to excellent rate was 82.7% for all the patients, 57.1% for patients with type Ⅲ fractures, but only 44.4% for patients with die-punch fragments in CT scan. Conclusions CT scan can increase accuracy in classification of Pilon fractures. Open reduction of articular surface is preferred for type Ⅲ fractures. Operative approaches and positions of the internal fixation should be based on the anatomy of main fracture lines and fragments. Die-punch fragments should be reduced under direct visualization and indicate unfavorable prognosis.
6.Treatment of serious comminuted distal radius fractures by external fixator combined with limited internal fixation
Wanzong WANG ; Qiugen WANG ; Qiulin ZHANG
Chinese Journal of Orthopaedics 2001;0(03):-
Objective To discuss the clinical effects of external fixator combined with limited internal fixation in treatment of serious comminuted distal radius fractures. Methods 35 patients with serious comminuted distal radius fractures were treated by external fixator combined with limited internal fixation from January 2001 to May 2004. There were 16 males and 9 females with an average age of 47.3 years. According to AO/ASIF classification, 9 fractures were A3 type, 9 C2, and 17 C3. Reduction was achieved and maintained in 27 cases by longitudinal traction and external fixation, 5 by external fixator with percutaneous K-wire, and 3 by external fixatator combined with ulnar limited internal fixation. Results All the patients were followed up from 5 months to 30 months (12 months on average). According to the anatomical alignment, 9 were excellent, 24 good, and 2 fair. It was necessary to restore the anatomy of distal radius both on sagittal and coronal planes in order to obtain good functions. Preoperatively, the radial inclination angle was -15? to 15?(10.5? on average), and the palmar tilt angle was -30? to 0?(-10? on average). After operation, the two angels were reduced to 20? to 35?(25? on average), and 0? to 20?(11.5? on average)respectively. The joint function was assessed by Dienst criteria, the results suggested that 12 were graded as excellent, 21 good, and 2 fair. No severe complications were found. Conclusion The treatment of serious comminuted distal radius fractures using external fixator combined with limited internal fixation is of easy performance, reliable fixation, satisfactory effect, and lower complications. It offers a new method which can obviously improve the union of the fractures and decrease the infection rate postoperatively for the treatment of the fractures of distal radius.
7.Applied principles and cautions of locking compression plate
Kai CHEN ; Changwei YANG ; Qiugen WANG
Chinese Journal of Tissue Engineering Research 2008;12(17):3398-3400
Locking compression plate(LCP)functions as an internal fixator in orthopedic surgery.It is a new screw-plate system developed by combining the traditional plating techniques with the principles of AO internal fixator.Compared with them,LCP omits pre-bending,avoids large-area exposure of fracture site,minimizes the damage to soft tissue,significantly reduces implant failure and decreases the incidence of infection and bone non-union.In addition,LCP can function as internal fixator with multiple anchor points to improve stability.All these properties of LCP accord with BO internal fixation principles and expand the application in the treatment of complex fracture.However,it is still not uncertain about the appropriate application of LCP including plate length,appearance,and type,and principles of screw application such as the number,type,sequence and position of screws.
8.Treatment of traumatic anterior sternoclavicular joint dislocation with Fastin anchors
Zihui ZHOU ; Wei GAO ; Qiugen WANG
Chinese Journal of Orthopaedic Trauma 2010;12(1):40-42
Objective To discuss the treatment of traumatic anterior sternoclavicular joint disloca-tion with Fastin anchors. Methods A retrospective analysis was done for 14 patients with traumatic anterior sternoclavicular joint dislocation who had been treated with Fastin anchors from March 2006 to April 2008. They were 9 males and 5 females, with an average age of 35 years (range, 21 to 46 years) . Their diagnoses were confirmed by X-ray and CT scan. After reduction and temporary Kirschner wire fixation of the sternoclavicular joint, the anchor was driven into the manubrium sterni, with the suture at the end of the anchor securely knotted after passing through the internal extremity of clavicle. The Kirschner wire was re-moved after 3 weeks. Results All the patients were followed up for 12 to 22 months (average, 17 months). The results were excellent in 11, good in 3 according to Rockwood scale. There was no loss of re-duction or implant loosening. Conclusion Fastin anchor can fix the sternoclavicular joint reliably, avoiding potential risk of Kirschner wire migration and ensuring fine functional recovery of the joint.
9.Research Advances in the Role of Bromodomain-containing Protein 4 in Epithelial-mesenchymal Transition in Asthma.
Yan ZHENG ; Jun WANG ; Qiugen LI
Acta Academiae Medicinae Sinicae 2017;39(3):425-431
Asthma is a chronic airway disease characterized by airway inflammation and airway remodeling. Chronic airway inflammation can be involved in airway remodeling in asthmatic patients by incuding epithelial-mesenchymal transition (EMT).Bromodomain-containing protein 4 (BRD4) is a key transcriptional regulator in mammals,and many evidences have shown that BRD4 plays a pivotal role in airway remodeling via nuclear factor-κB/RelA signaling pathway. This review summarizes the recent advances in the role of BRD4 in regulating EMT,with an attempt to elucidate the molecular mechanisms of asthma and inform the prevention and control of asthma.
10.Volar LCP fixation for dorsally displaced and unstable distal radial fractures
Hao TANG ; Qiugen WANG ; Qiulin ZHANG
Orthopedic Journal of China 2006;0(22):-
[Objective]To preliminarily explore the method and evaluate the effect of volar LCP fixation for dorsally displaced and unstable distal radial fractures.[Method]Thirty-five patients with the fractures were treated with volar LCP combined with the techniques of K-wires and bone grafting, whose effects were evaluated preliminarily through comparing and analyzing the volar tilt, radial inclination, radial shortening and wrist function.[Result]Followed up from 9 to 24 months (average 17months), 20 patients achieved excellent, 12 good and 2 fair with 1 poor, according to Sarmiento scale.[Conclusion]Volar LCP fixation is a safe and effective treatment for unstable and dorsally displaced distal radial fractures, which could prevent reduction lost, reduce need for bone grafting and avoid tendon irritation.