Objective To evaluate clinical efficacy of treating femoral intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures using anatomic locking plate.Methods From January 2009 to June 2011,we treated 72 cases of femoral intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures using anatomic locking plate.Sixty-four cases were followed up.There were 50 males and 14 female,with an average age of 42.8 years (range,21-79).All patients suffered from closed femoral unilateral fractures.The interval between injury and surgery was 2 h-16 d (average,4.6 d).All patients were followed up at regular interval.During the follow-up period,clinical and radiographic data were recorded.The clinical efficacy was evaluated with Harris hip function score.Results The mean operative time was 65 min (range,45-120 min); the mean blood loss was 210 ml (range,50-650 ml).All patients began to walk with crutches 3-35 d after surgery.During the follow-up period,no infection,deep vein thrombosis,screwed cut-out and implant failure occurred in all patients.Coxa vara with shortening deformity was noted in 2 cases,solid bone union was found in all the cases.The mean time of fracture healing was 5.2 months (range,3.6-10.5 months).According to Harris hip score,45 cases were classified as excellent,14 as good and 5 as fair,with excellent and good rate being 92.19％ (59/64).Conclusion Anatomic locking plate fixation provides stable fixation,with a high union rate and a minimal complication rate in treatment of intertrochanteric and subtrochanteric fractures combined with femoral shaft fracture.

Objective To compare the efficacies of total gastrectomy (TG) and proximal gastrectomy (PG) for patients with upper gastric cancer.Methods Databases including Medline,Cochrane Library,Web of Science,China National Knowledge Infrastructure,Wanfang database were searched to retrieve literatures on surgical treatment of upper gastric cancer which were published from January 1980 to October 2011.According to different surgical procedures,all the patients were divided into PG group and TG group.Meta analysis were performed by RevMan 5.1.Categorical variables were presented by odds ratio (OR) and 95％ confidence interval (95％CI).Results Thirteen literatures including 2622 patients with upper gastric cancer were retrieved.There were 1464 patients in the TG group and 1158 patients in the PG group.There was no significant difference in the 1-year survival rate between the 2 groups (OR =1.23,P ＞ 0.05).The 3-and 5-year survival rates of patients in the TG group were significantly higher than those of the PG group (OR =1.74,1.45,P ＜ 0.05).There were no significant difference in the 5-year survival rates of patients in TNM Ⅰ,Ⅱ,Ⅳ stages between the 2 groups (OR =0.94,1.31,2.03,P ＞ 0.05),while the 5-year survival rate of patients in TNM Ⅲ stage of TG group was significantly higher than PG group (OR =2.29,P ＜ 0.05) The overall recurrence rate of TG group was slightly lower than that of PG group,with no significant difference OR =0.44,P ＞ 0.05).The local recurrence rate of TG group was significantly lower than that of PG group (OR =0.29,P ＜ 0.05).There was no significant difference in the distal recurrence rate between the 2 groups (OR =0.60,P ＞ 0.05).Conclusions The medium and longterm efficacies of TG are superior than that of PG.The stage of cancer should be taken into account to determine the plan of individual treatment.

Objective To investigate the stress distribution in a cemented femoral component in elderly patients with a partial marrow type Ⅰ intertrochanteric fractures and to compare differences in the stress distribution after a long-and short-stem prosthetic replacement.Methods Spiral CT images of right femur of the volunteer were obtained and processed with Mimics software and modeling software to reconstruct a three-dimensional model of the femur.Based on this,a three-dimensional physical model for partial marrow type Ⅰ intertrochanteric fractures,long-and short-stem femoral prostheses,and cement mantle was established.Subsequently,a three-dimensional finite element model of long-and short-stem prosthetic replacement for intertrochanteric fractures was established using the finite element analysis software,and biomechanical analysis was implemented for the model.Results No significant changes in stress distribution of the femur occurred after long-or short-stem prosthetic replacement.Stress on the femur still presented a gradual increase from the proximal end to the distal end,peaked at the lower 1/3 of the medial and lateral junction and then decreased at the end.A stress concentration zone formed in the medial and lateral end of cement-stem interface in short-stem prosthetic replacement.Besides,the maximum value of stress in the lateral interface reached 15.3 MPa,but without surpassing the fatigue strength of the bone cement.Whereas,a stress concentration zone formed in the distal medial and lateral part of cement-stem interface and the medial middle part of the interface in long-stem prosthetic replacement and the maximum value was also lower than the fatigue strength of bone cement.No significant stress concentration zones were found in the femoral calcar reconstructed using bone cement.Conclusions Cemented long-or short-stem prosthetic replacement achieves no significant alteration in stress distribution of the femur.Loosening probability of the cemented long-or short-stem prosthesis is almost the same,but the latter has advantages of shorter surgery time,minor trauma,and fewer complications and may be more suitable for treatment of the elderly patients with a partial marrow type Ⅰ intertrochanteric fractures.

Objective To discuss and analyze effect of biotype common handle (short handle) prosthesis in treating aged patients with femoral intertrochanteric fracture.Methods A retrospective analysis was carried out on 321 patients,among which 280 (102 males and 178 females,at age of 72-98years,average 82.5 years) obtained follow-up.According to a new fracture classification method (Piansui Classification),the typeⅠ a fracture was found in 65 cases and type Ⅰ b in 215.Most patients were combined with medical diseases,and after related medical collaborative treatment,standard biotype common handle prosthesis (artificial bipolar femoral head) replacement was applied to all patients.Early rehabilitation exercise was performed postoperatively.Results All the 321 patients lived through perioperative period successively,with no death in hospitalization.Meanwhile,postoperative complications were all cured in hospitalization.The patients could take out-of-bed activity at 1-3 weeks after operation.All 280 patients could take care of themselves at 12-46 months (average 28 months) of follow-up.According to Harris score,the results were excellent in 129 cases,good in 121,fair in 22 and poor in eight,with excellence rate of 89.3％.Conclusion Biotype common handle artificial femoral head replacement is an effective method to allow early ambulation,reduce complications and improve quality of life in treatment of intertrochanteric fractures in the elderly.

On 17th June 2017, a 50 years old man with refractory gout was admitted in our hospital. During the treatment, he was accompanied by intermittent fever (39 to 40 ℃) of unknown origin for 60 days and gastrointestinal bleeding, with difficult wound repair. After comprehensive treatment of thorough debridement, vacuum sealing drainage, skin graft, skin flap repair, and drug administration, the patient was discharged fully recovered on post hospitalization day 104.

Objective:To investigate the clinical effect of rectangular scar flap combined with autologous thinning split-thickness skin graft for repairing type Ⅳ axillary scar contracture deformity after extensive burns.Methods:From January 2015 to January 2019, patients with type Ⅳ axillary scar contracture deformity after extensive burns were admitted to the Department of Skin Wound Repair Center of Wuhan Third Hospital. Rectangular scar flaps were used to reconstruct the axillary area, Y-shaped incision was made on the short side to release the scar, the resulting defects after flap formation were repaired with autologous split-thickness skin grafts. The hyperplasia and contracture of the grafted skin, the size of rectangular scar flap, the appearance of axilla, the growth of residual axillary hair, and the range of motion of shoulder joint were observed during the follow-up of 18 months to 3 years.Results:A total of 6 cases were selected, including 2 males and 4 females, aged from 18 to 58 years, with the duration of scar contracture deformity ranging from 1 to 23 years. The rectangular scar flaps of all 6 patients survived. At the follow-up of 18 months to 3 years, the axillary scar hyperplasia and the skin graft contracture were mild. At 18 months after operation, the function of shoulder joint was restored with 180° shoulder abduction and lifting. Axillary appearance and residual axillary hair growth were satisfactory, the self-care ability and the quality of life of patients improved.Conclusions:Rectangular scar flap combined with autologous thinning split-thickness skin graft is a good method for repairing type Ⅳ axillary scar contracture in patients with lack of autologous skin sources for extensive burns.

Objective:To investigate the clinical effect of rectangular scar flap combined with autologous thinning split-thickness skin graft for repairing type Ⅳ axillary scar contracture deformity after extensive burns.Methods:From January 2015 to January 2019, patients with type Ⅳ axillary scar contracture deformity after extensive burns were admitted to the Department of Skin Wound Repair Center of Wuhan Third Hospital. Rectangular scar flaps were used to reconstruct the axillary area, Y-shaped incision was made on the short side to release the scar, the resulting defects after flap formation were repaired with autologous split-thickness skin grafts. The hyperplasia and contracture of the grafted skin, the size of rectangular scar flap, the appearance of axilla, the growth of residual axillary hair, and the range of motion of shoulder joint were observed during the follow-up of 18 months to 3 years.Results:A total of 6 cases were selected, including 2 males and 4 females, aged from 18 to 58 years, with the duration of scar contracture deformity ranging from 1 to 23 years. The rectangular scar flaps of all 6 patients survived. At the follow-up of 18 months to 3 years, the axillary scar hyperplasia and the skin graft contracture were mild. At 18 months after operation, the function of shoulder joint was restored with 180° shoulder abduction and lifting. Axillary appearance and residual axillary hair growth were satisfactory, the self-care ability and the quality of life of patients improved.Conclusions:Rectangular scar flap combined with autologous thinning split-thickness skin graft is a good method for repairing type Ⅳ axillary scar contracture in patients with lack of autologous skin sources for extensive burns.