This paper reports 51 patients with malignant tumors (male 38, female 13). Tumor cells were found by microscopic examination of marrow aspirate smear in 21 of them. Among the patients with positive marrow smear for tumor cells, most of them had anemia, thrombocytopenia, and leucoerythrobla-stosis in peripheral blood and elevated levels of alkaline phosphatase, lactate dehydrogenase and eryth-rocyte sedimentation rate. The results showed that bone marrow examination and some hematologic parameters are of value in the diagnosis of metastatic cancer of the bone marrow. If it is necessary, marrow clot section, marrow biopsy, bone roentgenogram and bone scan should be carried out in order to further ascertain the diagnosis.

Objective To stady the clinical effects of repairing soft tissue defects on body surface by grafting free anterolateral thigh flaps. Methods 11 patients were treated for soft tissue defects on body surface by grafting free anterolateral thigh flaps from October,1986 to January,2002. Results all flaps in the 11 patients survived.Follow-up survey in the (6～18) months after the operation showed satisfactory results. Conclusions Free anterolateral thigh flap is well supplied with blood,and it is in a concealed area of the body,where flaps of large size can be cut off.It is the ideal flap to repair large areas of soft tissue defects on body surface.

Objective To compare clinical effects of mini-incision pulmonary lobectomy with or without thoracoscopic assistance. Methods A total of 64 patients, in order of precedence of the operation, were divided into two groups according to a random numbers table. The Group A was given thoracoscopy-assisted mini-incision pulmonary lobectomy while the Group B underwent simple mini-incision lobectomy. Results The length of incision was significantly shorter in the Group A (5.3?0.6 cm) than in the Group B (8.9?0.5 cm) (t=-24.360,P=0.000); the intraoperative blood loss in the Group A (279.7?74.0 ml) was significantly less than that in the Group B (331.7?42.5 ml) (t=-3.330,P=0.002); the drainage volume at the first postoperative day was remarkably less in the Group A (162.5?47.4 ml) than in the Group B (202.0?49.2 ml) (t=-3.220,P=0.002). Complications were noted in 5 patients in the Group A and 11 patients in the Group B (?~2=4.099,P=0.043). The Group A presented a significantly shorter postoperative hospital stay (8.0?2.2 d) than the Group B (9.7?1.9 d) (t=-3.280,P=0.002). There was no statistically significant difference in the operating time between the two groups (t=-1.130,P=0.262). A follow-up observation was carried out in 57 patients for 6~12 months. Local recurrence was observed in 1 patient with stage Ⅲa lung squamous carcinoma at 6 months after operation in the Group A, whereas in the Group B, distant metastasis with local recurrence was found in 2 patients with stage Ⅲa small-cell lung carcinoma and in 1 patient with lung adenocarcinoma at 7~8 months after surgery. All the 4 patients died within 1 year. Three patients ended with other diseases unassociated with the surgery. No local recurrence or distant metastasis was found in the remaining 50 patients. Conclusions As compared with simple mini-incision pulmonary lobectomy, thoracoscopy-assisted mini-incision procedure provides less surgical invasion, fewer complications, and quicker postoperative recovery.

Objective: To clarify the value of the cortical endo-button as an internal fixator in Latarjet procedure through biomechanical analysis. Methods: Ten pairs of shoulder joints from 6-7 months old male pigs were selected. Each pair was randomly divided into screw group and endo-button group. A 25% glenoid defect model was created, and the porcine infraspinatus tendon and its associated bone were used to simulate conjoint tendon and coracoid process in human body. The bone grafts were fixed with two 3.5 mm screws and double cortical endo-buttons with high-strength sutures in screw group and endo-button group, respectively. The prepared glenoid defect model was fixed on a biomechanical test bench and optical markers were fixed on the glenoid and the bone block, respectively. Then fatigue test was performed to observe whether the graft or internal fixator would failed. During the test, the standard deviations of the relative displacement between the graft and the glenoid of two groups were measured by optical motion measure system for comparison. Finally the maximum failure load comparison was conducted and the maximum failure loads of the two groups were measured and compared. Results: There was no tendon tear, bone fracture, and other graft or internal fixation failure in the two groups during the fatigue test. The standard deviation of the relative displacement of the screw group was (0.007 87±0.001 44) mm, and that of the endo-button group was (0.034 88±0.011 10) mm, showing significant difference between the two groups ( t=7.682, P=0.000). The maximum failure load was (265±39) N in screw group and (275±52) N in endo-button group, showing no significant difference between the two groups ( t=1.386, P=0.199). There were 3 ways of failure: rupture at bone graft's tunnel (6/10 from screw group, 3/10 from endo-button group), tendon tear at the cramp (2/10 from screw group, 2/10 from endo-button group), and tendon tear at the internal fixator interface (2/10 from screw group, 5/10 from endo-button group), showing no significant difference between the two groups ( P=0.395). Conclusion: Although the endo-button fixation fails to achieve the same strong fixation stability as the screw fixation, its fixation stability can achieve the clinical requirements. The two fixation methods can provide similar fixation strength when being used in Latarjet procedure.

Objective: To summarize the research progress of surgical treatment for anterior shoulder dislocation and combined injuries. Methods: The related literature was reviewed, and the surgical treatment options for the anterior shoulder dislocation and its combined injuries were summarized. Results: Anterior shoulder dislocation can combine with anteroinferior capsular ligament complex injury (Bankart injury), bony Bankart defect, and Hill-Sachs lesion. For Bankart and bony Bankart injuries, arthroscopic repair or coracoid osteotomy combined with bony graft reconstruction can be performed. For Hill-Sachs lesion, conservative treatment, soft tissue repair, or bony reconstruction should be selected based on the extent of the bone defect. For bipolar injury, the Bankart repair, Remplissage, or arthroplasty should be selected based on the extent of the glenoid defect. Conclusion: With the development of arthroscopy and the improvement of the surgical concept, there is a complete set of surgical options for various injuries of the anterior shoulder dislocation. When choosing a surgical procedure, the patient's specific injury and age, exercise level, and other relating factors should be comprehensively assessed in order to achieve the best results.

Objective:To explore the clinical effect and safety of extended debridement combined with BAM bone-induced artificial bone repair in the treatment of Cierny-Mader type IV osteomyelitis.Methods:From January 2021 to December 2022, 106 patients with Cierny-Mader type IV osteomyelitis who were treated with allogeneic bone mixed with autologous bone in department of orthopedics of Sichuan Orthopedic Hospital were retrospectively selected as the study subjects. Among them, 54 patients who were combined with BAM bone-induced artificial bone mixed with autologous bone repair were included in observation group, and 52 patients who only received allogeneic bone mixed with autologous bone repair were enrolled as control group. The clinical related indicators (bone healing time, fracture healing time), clinical efficacy (Johner-Wruh tibial shaft fracture evaluation standard) at 1 year after surgery, inflammatory factors (white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin), limb function (American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AH)) and bone healing degree before surgery and at 1 year after surgery were compared between both groups. Chi-square test was used to compare the enumeration data between groups, and the independent sample t test was performed to compare the measurement data with normal distribution between groups.Results:At 1 year after surgery, the clinical healing indicators of bone healing time and fracture healing time and inflammatory factors such as WBC, ESR, CRP and procalcitonin with (21.19±2.16) weeks, (11.35±1.01) weeks, (6.15±0.73)×10 9/L, (9.10±1.05) mm/h, (8.09±1.11) mg/L and (0.05±0.01) μg/L in observation group were significantly shorter or lower than (24.32±2.39) weeks, (12.29±1.27) weeks, (7.86±0.89)×10 9/L, (10.10±1.32) mm/h, (9.26±1.23) mg/L and (0.08±0.01) μg/L in control group,and the differences were statistically significant ( t values were 7.08, 4.23, 10.83, 4.33, 5.15, and 15.44, respectively; all P<0.001). The clinical effective rate (85.19%(46/54)), AOFAS-AH score((84.83±12.17) points) and bone healing probability (94.44%(51/54)) were higher than (67.31%(35/52)), (79.17±11.25) points and 80.77% (42/52) in control group,with statistically significant differences (statistical values were χ2=4.70, t=2.48, and χ2=4.60, respectively; P values were 0.030, 0.015, and 0.032, respectively). Conclusion:Expanded debridement combined with BAM bone-induced artificial bone repair can effectively promote the bone tissue healing in patients with Cierny-Mader type IV osteomyelitis, relieve the inflammatory response, and improve the limb function, and it has good clinical efficacy and high safety.

Objective To investigate the differences in expression of Mohawk (MKX) transcription factors and collagen of types Ⅰ and Ⅲ in anterior cruciate ligament (ACL) gratis between 2 remodeling outcomes under arthroscopy.Methods Enrolled for this study were 17 patients who had undergone arthroscopic single-bundle ACL reconstruction with autogenous hamstring tendons and secondary arthroscopic exploration 48 to 131 months (average,83.1 months) after removal of tibial internal fixator at Department of Sports Medicine,The First Affiliated Hospital to Shenzhen University from March 2017 to December 2017.They were divided into a good remodeling group (11 cases) and a fair remodeling group (6 cases) according to the graft quality under arthroscopy (synovial and vascular coverage,and apparent tension,thickness and retear of the grafts).During the secondary arthroscopic procedures,biopsy of the central ACL grafts was performed.Moreover,normal ACL tissues were harvested from 8 contemporary controls of ＜ 60 years old who underwent total knee replacement.Immunohistochemical assay and quantificational real-time polymerase chain reaction were conducted to detect the expression of transcription factors and collagen of types Ⅰ and Ⅲ in all the samples.Results In the samples from good remodeling and control groups,there were abundant well-arranged collagen fibers of types Ⅰ and Ⅲ and MKX-positive cells;in the fair remolding group,the collagen fibers of types Ⅰ and Ⅲ and MKX-positive cells were much decreased in number and the fibers were not well arranged.The former 2 groups scored in immunohistochemical assay significantly higher than the latter one (P ＜ 0.05).qRT-PCR showed that the expression levels of MKX gene (0.44 ± 0.30),COL1A1 gene (0.52 ± 0.27) and COL3A1 gene (0.60 ± 0.22) in the fair remolding group were significantly lower than in the control group (1.00 ± 0.00,1.00 ± 0.00 and 1.00 ± 0.00) and than in the good remolding group (0.97 ± 0.67,0.99 ±0.38 and 1.00 ± 0.35) (P ＜ 0.05).Conclusion Good remodeling ACL grafts with histological maturation under arthroscopy are more similar to normal ACL than fair remodeling ACL grafts in expression of MKX transcription factors and collagen of types Ⅰ and Ⅲ.

Carotid web is a rare risk factor of ischemic stroke.A total of 32 (0.54％) patients with carotid web were finally diagnosed in 5 943 patients who underwent carotid computerized tomography angiography (CTA) in two hospitals.Only one patient received carotid endarterectomy that pathological findings were fibrous tissue hyperplasia of vascular wall with mucinous degeneration.Stent implantation was administrated in two cases.Among 13 asymptomatic patients,the observational follow-up period was (20.9± 12.4) months without strokes.Carotid web is a rare aberration.Asymptomatic patients with carotid web are usually silent.Large sized cohort and long-term follow-up are further needed.

Objective:To observe the changes in acromiaohumeral distance(AHD) in patients undergoing the modified arthroscopic double-button Latarjet procedure for recurrent anterior shoulder dislocation complicated with glenoid bone defect.Methods:A retrospective study was performed of the 52 patients who had undergone the modified arthroscopic double-button Latarjet procedure from October 2014 to October 2016 at Department of Sports Medicine, The First Affiliated Hospital to Shenzhen University for recurrent anterior shoulder dislocation complicated with glenoid bone defect. They were 33 males and 19 females, having 30 left and 22 right shoulders affected. Their ages ranged from 19 to 45 years(mean, 29.6 years). Their glenoid bone defects ranged from 17% to 30%(mean, 23.4%). CT scans were performed on the surgery side to observe the healing and reshaping of the bone grafts and to measure the AHDs of healthy shoulder, immediately, 6, 18 and 36 months after operation. Their American Shoulder and Elbow Surgeons(ASES), Rowe and Walch-Duplay scores were recorded before operation and at the final follow-up for comparison.Results:The follow-up time for this series ranged from 37 to 44 months (mean, 40.6 months). The AHDs at immediate postoperation(9.6 mm ± 0.7 mm), 6 months postoperation(8.6 mm ± 0.9 mm), 18 months postoperation (8.0 cm ± 0.8 cm) and 36 months postoperation(7.9 cm ± 0.8 cm) were significantly wider than the healthy side value (7.8 mm ± 0.8 mm)( P<0.05). The ASES, Rowe and Walch-Duplay scores at the final follow-up (93.9±3.2, 94.5±2.7 and 95.7±3.6) were significantly improved than the preoperative values (67.3±9.1, 40.1±4.2 and 63.5±9.0) ( P<0.05). The final follow-ups observed no symptoms or signs of chronic shoulder pain, rotator cuff injury or acromion impingement. Conclusion:As the AHD becomes wider rather than narrower after arthroscopic double-button Latarjet procedure for recurrent anterior shoulder dislocation complicated with glenoid bone defect, no subsequent rotator cuff injury may happen due to the uplift of the humeral head after the modified arthroscopic double-button Latarjet procedure.

OBJECTIVE: To testify the spatial relationship between the subscapularis muscle splitting window and the axillary nerve in modified arthroscopic Latarjet procedure, which could provide anatomical basis for the modification of the subscapularis muscle splitting. METHODS: A total of 29 adult cadaveric shoulder specimens were dissected layer by layer, and the axillary nerve was finally confirmed to walk on the front surface of the subscapularis muscle. Keeping the shoulder joint in a neutral position, the Kirschner wire was passed through the subscapularis muscle from back to front at the 4 : 00 position of the right glenoid circle (7 : 00 position of the left glenoid circle), and the anterior exit point (point A, the point of splitting subscapularis muscle during Latarjet procedure) was recorded. The vertical and horizontal distances between point A and the axillary nerve were measured respectively. RESULTS: In the neutral position of the shoulder joint, the distance between the point A and the axillary nerve was 27.37 (19.80, 34.55) mm in the horizontal plane and 16.67 (12.85, 20.35) mm in the vertical plane. CONCLUSION In the neutral position of the shoulder joint, the possibility of axillary nerve injury will be relatively reduced when radiofrequency is taken from the 4 : 00 position of the right glenoid (7 : 00 position of the left glenoid circle), passing through the subscapularis muscle posteriorly and anteriorly and splitting outward.
Adult ; Humans ; Shoulder ; Rotator Cuff/surgery* ; Arthroscopy/methods* ; Scapula/surgery* ; Shoulder Joint/surgery* ; Cadaver ; Joint Instability/surgery*