BACKGROUND:Avulsion fractures of the tibial attachment of the posterior cruciate ligament have been repaired using open reduction and rivet fixation, hol ow screw fixation, or arthroscopic reconstruction of the posterior cruciate ligament. These methods ignore the importance of early tension reconstruction of the posterior cruciate ligament, so their efficacies are uncertain. Determining the optimal fixation method and how best to restore knee stability remain controversial. OBJECTIVE:To observe the stability of new bone fixation plate for the repair of avulsion fracture of the tibial attachment of the posterior cruciate ligament. METHODS/DESIGN:We wil conduct a prospective, single-center, self-control ed, clinical trial at the Cangzhou Central Hospital, Hebei Province, China. Fracture fragments and the injured posterior cruciate ligament wil be exposed in 20 patients with avulsion fracture of the tibial attachment of the posterior cruciate ligament through a posterior approach and open reduction. The posterior cruciate ligament wil be reconstructed with a new type of bone plate. Al patients wil be fol owed for 3 and 12 months. Primary outcome:The Hospital for Special Surgery knee score wil be used to evaluate knee function preoperatively and 3 and 12 months postoperatively. Secondary outcomes:Lysholm Knee Scoring Scale, X-ray, computed tomography, and magnetic resonance imaging wil be used to assess knee morphology preoperatively and 3 and 12 months postoperatively. Patient satisfaction wil also be assessed at 3 and 12 months postoperatively. The study protaol was registered at clinicaltrials.gov.NCT03059368. The study protocol has been approved by the Ethics Committee of Cangzhou Central Hospital of China. Al protocols wil be conducted in accordance with Declaration of Helsinki, formulated by the World Medical Association. Written informed consent wil be provided by al participants. DISCUSSION:This trial wil evaluate a newly-designed plate fixation device for early tension reconstruction of the posterior cruciate ligament to repair avulsion fractures of the tibial attachment of the posterior cruciate ligament and restore knee stability. This trial wil verify the plate's efficacy, provide an experimental basis for treating avulsion fractures of the tibial attachment of the posterior cruciate ligament, and provide a method of maximizing knee stability.

ObjectiveTo demonstrate the project scope of the afferent nerves of the lumbar intervertebral disc,on which basis to explore the mechanism of the symptoms of discgenic low back pain.MethodsThirty Wistar rats were divided randomly into three groups of 10 rats each:the L4-5,L5-6,and L6 S1 group.Each group was further divided randomly into two subgroups,the experimental group and the control group,5 rats for each group.Intervertebral disc was exposed through the posterior approach under peritoneal cavity anesthesia,after the nerve roots were pull away,2 μl of 30％ cholera toxin-horseradish peroxidase (CT-HRP) was injected into the inner layer of the intervertebral disc in the experimental group,while 2 μl of 0.9％ Nacl was used in the control group.Forty-eight hours after the surgery,all rats were perfused and bilateral dorsal root ganglions(DRGs) of T10-L3 were resected and fixxied.Each DRG was sectioned at 30 μm thickness and processed by DAB method.The sections of DRGs were coverslipped and observed by optical microscopy for the neurons or axons labelled by CT-HRP.It was judged as positive that brownish-black particles were in the neurons or axons.ResultsNot in a single dorsal root ganglions,but in a scope of dorsal root ganglions axons labled by CT-HRP could be seen in the rats in the experimental groups.No CT-HRP labled neurons or axons were seen in dorsal root ganglions in the contral groups.ConclusionAfferent nerves of the lumbar intervertebral disc project to a scope of dorsal root ganglions,which is the anatomic basis of the mechanism of the symptoms of discgenic low back pain.

Objective:To compare the efficacy and safety of CT and ultrasound-guided percutaneous biopsy of lung or pleural lesions.Methods:The clinical data of 193 patients with lung space occupying lesions near the pleura who underwent CT or ultrasound-guided percutaneous puncture in Shiyan People's Hospital Affiliated to Hubei University of Medicine from February 2017 to October 2020 were analyzed retrospectively. According to the puncture mode, the patients were divided into CT-guided group ( n=115) and ultrasound-guided group ( n=78) . The general clinical data, pathological examination results, puncture success rate and complication rate were compared between the two groups. Logistic regression was used for univariate and multivariate regression analysis. Results:The detection rate of malignant tumors in the CT-guided group (60.00%, 69/115) was higher than that in the ultrasound-guided group (50.00%, 39/78) , with no statistically significant difference ( χ2=1.89, P=0.170) . The puncture success rate in the CT-guided group (88.70%, 102/115) was slightly lower than that in the ultrasound-guided group (93.59%, 73/78) , with no statistically significant difference ( χ2=1.32, P=0.251) . The incidence of postoperative complications in the CT-guided group (18.26%, 21/115) was higher than that in the ultrasound-guided group (6.41%, 5/78) , with a statistically significant difference ( χ2=5.60, P=0.018) . The incidence of pneumothorax in the CT-guided group (13.04%, 15/115) was higher than that in the ultrasound-guided group (3.85%, 3/78) , with a statistically significant difference ( χ2=4.65, P=0.031) . The incidence rate of bleeding in the CT-guided group (5.22%, 6/115) was higher than that in the ultrasound-guided group (2.56%, 2/78) , with no statistically significant difference ( χ2=0.82, P=0.364) . In the CT-guided group, 1 patient (0.87%) had severe bleeding requiring surgical treatment, 5 patients (4.35%) required closed thoracic drainage for treatment. In the ultrasound-guided group, no patients had pneumothorax or bleeding requiring drainage or surgery. Univariate analysis showed that the puncture method was an independent risk factor for the puncture success rate in patients with lesion-pleura contact arc length (LPCAL) ≥38 mm ( OR=7.82, 95% CI: 1.57-35.50, P=0.039) . Multivariate analysis showed that puncture method is an independent risk factor affecting the puncture success rate in patients with LPCAL≥38 mm ( OR=7.75, 95% CI: 1.44-41.36, P=0.042) . Among patients with LPCAL≥38 mm, the puncture success rates of CT- and ultrasound-guided puncture were 84.38% (54/64) and 98.00% (49/50) , respectively, and the puncture success rate of CT-guided puncture was lower than that of ultrasound-guided puncture, with a statistically significant difference ( χ2=4.52, P=0.034) . In LPCAL<38 mm patients, the puncture success rates of CT- and ultrasound-guided puncture were 94.12% (48/51) and 85.71% (24/28) , respectively, and the CT-guided puncture success rate was higher than that of the ultrasound-guided puncture, with a statistically significant difference ( χ2=0.71, P=0.399) . Conclusion:Ultrasound-guided percutaneous puncture biopsy of lung or pleural lesions has the advantages of high diagnostic rate and few complications. Both ultrasound-guided and CT-guided puncture biopsy are feasible methods for puncture of chest wall lesions. When LPCAL≥38 mm, ultrasound-guided puncture biopsy may have more advantages.