[Objective]To study the surgical technique for the treatment of acetabular fractures.[Method]Retrospective analysis on consecutive acetabular fractures operatively treated at our hospital from January 1995 to March 2005 was made to find out the correlation factors influenced on the operative approaches.[Result]A total of 107 cases had surgery for an acetabular fracture in the meamtime.Of them,44 were exposed through a Kocher-Langenbeck approach,5 through an extended iliofemoral route,30 through an ilioinguinal or an anterior extensile approach,and 28 through a combined anterior and posterior incisions.After operation,anatomic reduction was obtained in 66 cases,good reduction in 36,incomplete reduction in 5.According to AAOS score,the satisfactory rate was 89.72% after following-up 1 to 11 years.[Conclusion]To determine reasonable surgical exposure of an acetabular fracture,the key factors are fracture type and its displacement direction,and the important reference factors include associated injuries with the fracture,operative time and complications related to different operative routes.

0.05). Removal of two thirds or the entire horizontal portion of the TFCC caused a statistically significant difference in the percentage of force transmitted through the ulna compared with the intact force data (t=3.4,P

Objective To study method and timing of internal fixation for long bone fractures in polytraumatized patients with fat embolism syndrome (FES). Methods Twenty-eight cases of polytraumatized patients with FES received internal fixation for their long bone fractures in our hospital from January 1990 to August 2004. The method and timing of internal fixation were analyzed retrospectively. The long bone fractures in 27 cases were treated 5 to 7 days after their clinic FES symptoms disappeared, while one fracture was treated five days after the FES symptoms were relieved and the vital signs became stable. Eleven cases of long bone fracture were treated with open fixation by unreamed or slightly reamed intramedullary nailing while 27 cases were fixated with plate internally. Results Of the 27 patients who received open reduction and internal fixation for their fractures 5 to 7 days after disappearance of FES symptoms, 22 cases experienced no postoperative complications but fever and quickened pulse reoccurred in five cases after the first osteosynthesis. However, FES-like symptoms reoccurred in the one case who received the first operation when FES did not disappear. Conclusions Internal fixation by plate and intramedullary nailing without reaming are safe for polytraumatized patients with FES and long bone fractures. Proper timing of the first surgery for this kind of patient should be 5 to 7 days after the disappearance of FES.

Objective To assess the reliability of the modified lateral transgluteal approach (modified Bauer approach) to the hip for the joint prosthesis.Method The Bauer approach modification was used for 43 hip endoprosthetic replacement.Results The modified approach provided good exposure of the hip for arthroplasty, and early chance of function recovery.Excellent and good rate was 96.97% according to Harris result evaluation. No evidence of weakness of abductors of the hip and damage to superior glouteal nerve was found at six months.Conclusion The modified Bauer approach is reliable and recommendable for primary hip replacement because of its good exposure of the hip and the least disturbance to the abductor function.

BACKGROUND: Repair of segmental bone defects is one of the difficult problems in orthopaedics. Although the therapeutic effect on bone autograft is the best, the source is limited and there is lack of suitable substitutive materials for autologous bone.OBJECTIVE: To probe into the therapeutic effects of surface-decalcified bone matrix gelation(SDBMG) and the substitutive possibility of autologous bone on repair of segmental bone defects.DESIGN: The research was designed as completely randomized controlled experiment. The clinical research was designed as pre- and post-controlled study on the basis of diagnosis.SEETING: Department of Orthopaedics, Wuhan General Hospital of Guangzhou Military Area Command.MATERLALS and PARTICIPANTS: The experiment was accomplished in Laboratory of Wuhan General Hospital of Guangzhou Military Area Command, and Testing Center of Wuhan University of Technology. Thirty-two local healthy adult male rabbits were employed as the materials in the experiment, 2.5 kg in body mass, bought from Hubei Academy of Medical Sciences. The clinical subjects were 31 patients(male 25 and female 6, a meanage of 9 years old) with segmental bone defects hospitalized in the Department of Orthopaedics, Wuhan General Hospital of Guangzhou Military Area Command during January 1991 to May 2001.METHODS: The 32 rabbits were randomized into group A and group B. The bilateral radial bones were prepared into 1-cm bone defect in both groups. In both groups, SDBMG was grafted on the left side; in Group A, wholly-decalcffied bone matrix gelatin(WDBMG) was grafted on the right side;and in Group B, the autologous bone was grafted on the right side. Human SDBMG was provided to treat 31 cases of segmental bone defects.MAIN OUTCOME MEASURES: ① Regular X-ray and histological examinations after operation in animals(Group A) and biomechanical deterruination (Group B ). ② Regular X-ray examinations after operation.RESULTS: SDBMG induced osteogenesis process "gradually" from exterior to interior. The bone repair with SDBMG was similar to that with autologous bone, and there was no significant difference in compressive strength compared with autologous bone. After clinical follow-up, except failure in 1 case due to improper selection of indication, the other 30 cases were all cured.CONCLUSION: SDBMG provides satisfactory osteogenesis and reliable mechanical property. It can be taken as the suitable substitutive material for autologons bone in the repair of segmental bone defects. But it is cautious for the application of SDBMG to infective bone defect in the active phase.

Objective To compare broth microdilution and agar dilution methods for in vitro testing of activities of fluconazole,ketoconazole and itraconazole against clinical Malassezia isolates.Methods Broth microdilution and agar dilution methods were used to determine the minimal inhibitory concentration(MIC)of fluconazole,ketoconazole and itraconazole for 27 clinical strains(5 species)of Malassezia.Results The minimal inhibitory concentration(MIC)ranges of fluconazole,ketoconazole and itraconazole were 0.25-≥64 mg/L,≤0.03-0.5 mg/L and ≤0.03-0.125 mg/L respectively as shown by broth microdilution method,2-≥64 mg/L,≤0.03-0.5 mg/L and ≤0.03-0.25 mg/L respectively as revealed by agar dilution method.Both methods demonstrated that itraconazole possessed the strongest activity against Malassezia species,followed by ketoconazole and fluconazole.The agreement rate in MICs between the two methods was 78.8％,85.2％ and 88.9％,respectively for fluconazole,ketoconazole and itraconazole,with the intraclass correlation coefficients (ICCs)being 0.88,0.80 and 0.76 respectively.Conclusions Fluconazole,ketoconazole and itraconazole are highly active against Malassezia species in vitro,and itraconazole is the most active.Broth microdilution and agar dilution method coincide well in,and are applicable for,the antifungal susceptibility testing of Malassezia species in vitro.

Under laboratory condition, the compound materials of Poly (DL-lactic-co-glycolic acid)/Tricalcium phosphate [PLGA/TCP(L), with component ratio of 7:3] were fabricated by combining the thermally induced phase separation (TIPS) with solvent-casting particulate-leaching (SCPL) approach. On the other hand, rapid prototyping (RP) technique manufactured PLGA/TCP scaffolds [PLGA/TCP(RP)] were obtained. These two kinds of carriers were coated with collagen type I (Col I). The extracted bovine bone morphogenetic protein (bBMP) was loaded into carriers to establish biomimetic synthetic bones. PLGA/TCP(L) scaffolds, demineralized bone matrices (DBM) of bovine cancellous bone, PLGA/TCP(L) scaffolds, biomimetic synthetic bones and OsteoSet bone graft substitutes were investigated. Scanning electron microscopy revealed that the microarchitecture of PLGA/TCP(RP) scaffolds was much better than that of PLGA/TCP(L) scaffolds. The diameter of macropore of PLGA/TCP(RP) scaffold was 350 microm. The porosities of PLGA/ TCP(L) scaffolds, DBM, PLGA/TCP(RP) scaffolds and OsteoSet bone graft substitutes were 21.5%, 70.4%, 58.6% and 0%, respectively (P<0.01). Modification of PLGA/TCP scaffolds with collagen type I [PLGA/TCP(L)-Col I and PLGA/TCP(RP)-Col I] essentially increased the affinity of the carriers to bBMP. Among these synthetic materials, PLGA/TCP(RP)-Col I-bBMP composite is promising as a novel bone graft substitute due to its advanced fabrication technique, good tri-dimensional microarchitecture and ideal components.
Biocompatible Materials ; chemistry ; Bone Morphogenetic Proteins ; chemistry ; Bone Substitutes ; chemistry ; Calcium Phosphates ; chemistry ; Humans ; Lactic Acid ; chemistry ; Microscopy, Electron, Scanning ; Polyglycolic Acid ; chemistry ; Porosity ; Surface Properties ; Tissue Engineering ; methods

ObjectiveTo compare the efficacy and tolerability of 1-week 1％ terbinafine hydrochloride cream, 1- and 4-week 2％ miconazole nitrate cream in the treatment of interdigital tinea pedis, and to observe the relapse in patients treated with these regimens. MethodsA multi-center, randomized, double-blind and parallel group study was conducted. By using a stratified randomization protocol, patients were divided into 3 groups to apply terbinafine cream twice daily for 1 week and inert cream(placebo) for the next 3 weeks (1week terbinafine group), miconazole cream twice daily for 1 week and inert cream(placebo) for the next 3 weeks (1-week miconazole group), and miconazole cream twice daily for 4 weeks (4-week miconazole group),respectively. Clinical and mycological assessment was made on week 1, 3, 4, 6, 9 and 12 after the initiation of treatment. ResultsA total of 152 patients with positive baseline mycological culture were eligible for the efficacy analysis. After 4-week treatment, the mycological cure rates were 94.7％, 87.8％ and 82.6％, global effective rates 89.5％, 81.6％ and 63.0％, respectively for the 1-week terbinafine group, 4-week miconazole group and 1-week miconazole group. On week 12, the mycological relapse rates in 1-week terbinafine, 4-week miconazole and 1-week miconazole group were 13％, 14％ and 21％ respectively, and the incidence of adverse reaction was 2.38％, 2.38％ and 3.57％, respectively. ConclusionsAs far as the efficacy and recurrence in patients are concerned, the 1-week terbinafine cream regimen is similar to the 4-week miconazole cream regimen for the treatment of interdigital tinea pedis.