BACKGROUND:Ilizarov technique is an effective treatment method which can solve various complications that occurred in the process of treatment, especial y for the treatment of nonunion associated with soft tissue defects or severe infection. OBJECTIVE:To review the research progress of nonunion treatment with the Ilizarov technique. METHODS:A computer-based search was performed on the CNKI database and PubMed database from January 1992 to April 2013 for the articles related to the Ilizarov technology for the treatment of nonunion. The key words of“nonunion, external fixator, Ilizarov”in English and“nonunion, fracture nonunion, external fixation, Ilizarov”in Chinese were used to search the articles in the title and the abstract. Final y, a total of 37 articles were included to review. RESULTS AND CONCLUSION:Ilizarov technique is an effective method to treat limbs nonunion with the infection and severe bone defect. It has become an international y recognized gold standard. Due to the firmly fixation of the Ilizarov ring external fixator, it can not only eliminate the shear force and rotation stress, thus playing a role of stretch tension and compression, but also has the cyclical micro-axialmotion characteristic during weight-bearing walking which can better promote bone union. Based on the reviews of the research progress of Ilizarov technique in the treatment of nonunion in recent years, we further investigate the advantages and methods of Ilizarov technique in the treatment of limbs nonunion. The clinical application of the method should fol ow the individual principle, and then choose the best and suitable method based on the analysis of advantages and disadvantages about the patient’s condition.

BACKGROUND:Many scholars researched the biomechanics of middle clavicle fracture plate fixation, but little researched the plate position. OBJECTIVE:To observe the biomechanical characteristics ofanterior and superior plates for clavicle fracture with three-dimensional finite element models. METHODS:Three-dimensional finite element models of clavicle fracture with anterior and superior plates were established. The stress after anterior and superior plate fixation was analyzed. The maximum stress and displacement of plate fixation for clavicular fracture were observed under compression, torsion and three-point bending. RESULTS AND CONCLUSION:(1) In the compressed condition, the maximum stressand maximum fracture displacement were similar between the superior and anterior plate fixation (P> 0.05). (2) Under clockwise twist condition, the maximum stress and maximum fracture displacement were smaler in the superior plate fixation group than inthe anterior plate fixation group (P< 0.05). (3) Under counterclockwise twist condition, the maximum stress and maximum fracture displacement were similar between the anterior and superior plate fixation groups (P> 0.05). (4) Under three-point bending condition, the maximum stress was similar between the superior and anterior plate fixation groups (P> 0.05). The maximum fracture displacement was bigger in the superior plate fixation group than in the anterior plate fixation group (P< 0.05). (5) These findings suggest that superior fixation of clavicle fracture reconstruction plate has more advantages than the anterior plate fixation.

ObjectiveTo determine the potential natural foci of new bunyavirus,and isolate and identify the new bunyavirus strain in sera from suspected new bunyavirus-infected patients.MethodsImmunofluorescence assay was used to detect the antigens of new bunyavirus in different tissue specimens of wild rodent animals in Tiantai area of Zhejiang province.Fluorescence quantitative real-time RT-PCR was applied to detect the viral nucleic acid in sera of suspected new bunyavirus-infected patients and the amplification products were analyzed by sequencing.The new bunyavirus in the pateints'sera was isolated using Vero cells.Using nucleocapsid protein encoding gene of new bunyavirus as the target gene,the isolated suspected new bunyavirus strain was identified by RT-PCR and sequencing of the amplification product.Moreover,sequence identity of the amplification product of nucleocapsid protein encoding gene of new bunyavirus was analyzed and compared.ResultsOf the 70 wild rodent animals,5.71% were positive in the immunofluorescence assay.The fluorescence quantitative real-time RT-PCR confirmed that two of the four detected patients'serum specimens were positive.One suspected strain of new bunyavirus was isolated from one pf the two positive patients'serum specimens.The results of RT-PCR and sequencing confirmed that the viral strain exactly belongs to new bunyavirus with 92.2% sequence identity to that of the new bunyavirus isolates in Hubei province but distinct with the new bunyavirus isolates from other areas in China.ConclusionThe presence of natural foci of new bunyavirus and new bunyavirus-infected patients in Zhejiang province are firstly confirmed by this study.There is a geographical diversity of the distribution of new bunyavirus in different groups.

Objective To understand the relationship between the dietary patterns and metabolic syndrome among elderly people in Zhejiang province,in order to provide scientific basis and reference for nutrition interventions.Methods Data were obtained from the 2010-2012 Chinese National Nutrition and Health Survey,and factor analysis was used to obtain food patterns among elderly people in Zhejiang province.The Logistic regression was used to explore the association of the food patterns with metabolic syndrome and its components.Results The intakes of bean products,nuts,fruits,eggs,and milk in elderly people were generally low,and the intakes of livestock and poultry meat,cooking oil and salt were relatively high.5 dietary patterns were derived by factor analysis:high-quality protein diet,mediterranean diet,condiments diet,traditional dietary pattern and western dietary pattern.The medical test results in 780 elderly people showed that the standardized prevalence of metabolic syndrome in the elderly was 28.8％,standardized central obesity rate was 41.2％,standardized hypertension rate was 50.3％ and standardized hyperglycemia rate was 39.5％.Logistic regression analysis showed that different dietary patterns had different effects on the metabolic syndrome and its components.Conclusions The prevalence rate of metabolic syndrome and the abnormal rates of its components are high in the elderly in Zhejiang.The intakes of fruits and milk are generally low,and intakes of livestock and poultry meat,cooking oil and salt are relatively high.The relationship between dietary patterns and MS or its components is complicated,so it is necessary to guide the elderly people to adopt reasonable diet by referring to the Diet Pagoda in order to reduce the risk of MS or its components.

Objective To introduce a novel femoral distractor which is applied in close reduction and internal fixation (CRIF) with antegrade intramedullary nail for femoral shaft fractures.Methods From September 2010 to March 2015,85 patients with femoral shaft fracture were treated by CRIF with antegrade intramedullary nail in which our self-designed novel distractor was used.They were 64 males and 21 females,with an average age of 36.6 years.By AO classification,we had 32 cases of type 32-A,40 cases of type 32-B,and 13 cases of type 32-C.The intervals between injury and surgery averaged 7.5 days (range,from 1 to 16 days).The fracture was located at the upper shaft in 26 cases,at the middle shaft in 57 cases,at the middle shaft and ipsilateral neck in one,and at the lower shaft and ipsilateral intertrochanteric site in one.Their operation time,intraoperative blood loss,intra-and post-operative complications,and fracture union time were recorded and analyzed.Results Successful close reduction was achieved in all the 85 patients with no iatrogenic injury to major vessels or nerves.Operation time averaged 105.5 minutes;time for X-ray exposure averaged 25.8 seconds;intraoperative blood loss averaged 209.2 mL.The 85 patients received follow-ups from 8 to 24 months (mean,16.3 months).Fracture union was achieved in 83 cases after an average duration of 7.8 weeks (range,from 4 to 12 weeks),but nonunion occurred in 2 cases.One-year follow-ups revealed recovery of normal function of the affected knee in all,with no limb shortening ＞ 10 mm,rotational angulation ＞ 15°,or lateral or anteroposterior angulation ＞ 10°.No incision infection,deep vein thrombosis or pulmonary embolism happened during the entire follow-up.Conclusion Our self-designed novel distractor can facilitate CRIF with antegrade intramedullary nail for femoral shaft fractures,and avoid the complications and inconvenience associated with a traction table.

Objective To construct a recombinant adenovirus carrying UL138 gene, which was re-lated to the latent infection of human cytomegalovirus, and to investigate the effects of UL138 gene on the functions of THP-1 mononuclear cells. Methods The recombinant adenovirus expressing the UL138 gene was packaged. The titer of the recombinant adenovirus was determined by calculating 50% tissue culture in-fective dose ( TCID50 ) . THP-1 mononuclear cells were infected with the recombinant adenovirus at different multiplicity of infection (MOI) and the optimal MOI was determined (100 PFU/cell) by observing the ex-pression of green fluorescent protein ( GFP ) . Changes in the expression of proinflammatory cytokines by THP-1 mononuclear cells that was induced by overexpressed UL138 were analyzed by quantitative PCR. The expression of chemokines and their receptors were measured by quantitative PCR array. Results The re-combinant adenovirus carrying the UL138 gene was successfully constructed with a titer of 1×1011 PFU/ml. The rate of THP-1 mononuclear cells that was infected with the recombinant adenovirus was 60% at the MOI of 1 ∶ 100. Results of the RT-PCR analysis and Western blot assay further confirmed that the recombinant adenovirus could infect THP-1 mononuclear cells successfully and the expression of UL138 protein increased gradually over time. The overexpressed UL138 in THP-1 mononuclear cells significantly inhibited the expres-sion of IL-18, IL-1β, IL-6, IL-8 and TNF-α as indicated by the results of quantitative PCR. Results ob-tained from the quantitative PCR array analysis showed that most of the chemokines and their receptors were downregulated in the transfected THP-1 mononuclear cells except for the chemokines of CCL17, CCL21, CCL2 and XCL2 and the receptors of CCR2, CXCR1, CXCR2, CXCR4 and CX3CR1 which were upregulat-ed. Conclusion We successfully constructed the recombinant adenovirus carrying UL138 gene which could be used to infect THP-1 mononuclear cells. Overexpressed UL138 in THP-1 mononuclear cells significantly affected the functions of THP-1 mononuclear cells.

Objective To compare proximal humeral internal locking system (PHILOS) combined with fibular strut allograft versus simple PHILOS for the treatment of Neer 3-and 4-part factures of proximal humerus in the elderly.Methods A retrospective study was conducted of 157 elderly patients with Neer 3-or 4-part facture of proximal humerus who had been treated at Department of Orthopaedics,Ningbo No.6 Hospital from May 2013 to October 2016.They were 76 males and 81 females,aged from 60 to 88 years (average,76.1 years).According to the Neer classification,100 cases were 3-part fractures and 57 4-part fractures.Of them,35 were treated by PHILOS combined with fibular strut allograft (group A) and 122 by PHILOS alone (group B).At the last follow-up,the 2 groups were compared in terms of shoulder joint activity (anteflexion,abduction,internal rotation and external rotation),visual analogue scale (VAS),American Shoulder and Elbow Surgeons (ASES) score,Constant-Murley score,postoperative height loss of the humeral head,humeral head varus angle,complication rate and secondary surgery rate.Results The 157 patients were followed up for 12 to 22 months (mean,16.8 months).The fracture healing time was 13.0 ± 3.8 weeks in group A and 15.6 ± 4.2 weeks in group B,showing a statistically significant difference (P ＜ 0.05).At the last follow-up,for groups A and B respectively,anteflexion was 135.6° ± 17.7° versus 125.4° ± 23.6°,abduction 132.5°±22.7° versus 117.5°±32.7°,external rotation 30.2°± 18.7° versus 21.6°± 17.2°,internal rotation T9 versus T11,VAS score 0.6 ±0.9 points versus 0.9 ± 1.2 points,ASES score 90.2 ±6.8 points versus 82.2 ± 12.3 points,Constant-Murley score 88.5 ±3.6 points versus 72 ±4.9 points,postoperative height loss of the humeral head 0.9 ± 0.1 mm versus 4.2 ± 0.4 mm,and humeral head varus angle 1.2° ± 0.2° versus 4.5° ± 1.9°.The differences between the 2 groups were all statistically significant (P ＜ 0.05).There were no significant differences between the 2 groups in complication rate [14.28％ (5/35) versus 22.13％ (27/122)] or in secondary operation rate[2.85％ (1/35) versus 8.19％ (27/122)] (P ＞ 0.05).Conclusions In the treatment of Neer 3-and 4-part factures of proximal humerus in the elderly,PHILOS combined with fibular strut allograft can improve therapeutic efficacy,because it can provide good support for the medial column of the proximal humerus and the humeral head and thus facilitate the intraoperative reduction of the fracture.

Objective:To investigate the clinical effect of perforated kirschner wire tension band in the treatment of olecranon fractures in adults.Methods:A retrospective case-control study was conducted on 56 adult patients with olecranon fractures admitted in Ningbo NO.6 Hospital from May 2013 to February 2017. The perforated Kirschner wire tension band fixation was used in Group A ( n=24), while the common Kirschner wire tension band fixation was used in Group B ( n=32). Group A was composed of 16 males and 8 females at age of (34.0±12.1)years, and Group B was composed of 19 males and 13 females at age of (36.5±11.4)years. According to the Mayo classification, there were 7 patients with type I and 17 with type II in Group A, 15 with type I and 17 with type II in Group B. The operation time, bleeding volume, X transmission times, postoperative visual analogue score (VAS), fracture union time, loosening or failure of internal fixation, skin irritation and elbow joint function Broberg-Morrey score were compared between the two groups. Results:All patients were followed up for 15-21 months (mean, 18 months). In Group A, the operation time, bleeding volume, Xray transmission times, fracture union time and skin irritation were (79.6±22.5)minutes, (111.3±26.2)ml, (7.2±2.2)times, (3.7±0.6)months, 1 case, respectively. In Group B, the operation time, intraoperative hemorrhage, transmission times, fracture healing time and skin irritation were (94.3±27.5)minutes, (152.0±31.4)ml, (11.0±3.4)times, (4. 7±2.2)months, 9 cases, respectively. The difference between the two groups were all significant ( P<0.05). There were no significant difference in VAS, failure of internal fixation and elbow function Broberg-Morrey score between the two groups ( P>0.05). Conclusions:Compared with the anatomic plate, the perforated Kirschner wire tension band in the treatment of adult patients with olecranon fractures cannot only reduce the operation time and transmission times, reduce the intraoperative bleeding volume, but also shorten the fracture union time and avoid the occurrence of skin irritation and other complications.

Objective:To compare 3 internal fixation methods for the treatment of distal femoral fractures of Müller types C2 and C3.Methods:The clinical data of 58 patients were retrospectively analyzed who had been treated for distal femoral fractures of Müller types C2 and C3 at Department of Orthopaedic Trauma, Ningbo No. 6 Hospital from February 2013 to February 2017. They were divided into 3 groups according to the internal fixation method they had used. In the single incision locking plate group (group A) of 21 cases, there were 13 males and 8 females with an age of 50.6 years±12.9 years. In the double-incision locking plate combined with reconstruction plate group (group B) of 18 cases, there were 11 males and 7 females with an age of 53.5 years±13.0 years. In the single incision locking plate combined with reconstruction plate group(group C) of 19 cases, there were 10 males and 9 females with an age of 48.1 years±12.2 years. The 3 groups were compared in terms of operation time, intraoperative blood loss, intraoperative C-arm fluoroscopy, fracture healing time, incidence of postoperative complications, range of motion of the knee and knee functional recovery.Results:The 3 groups were compatible because there were no significant differences between them in their preoperative general data ( P>0.05). There were no significant differences between groups in the frequency of C-arm fluoroscopy, follow-up time, or incidence of postoperative complications ( P>0.05). The operation time in groups A and C (96.7 min±16.4 min and 101.9 min±16.5 min) and intraoperative blood loss for groups A and C (237.8 mL±47.5 mL and 253.6 mL±46.6 mL) were significantly less than in group B (114.9 min±20.1 min and 290.1 mL±60.9 mL) ( P<0.05); the fracture healing time for groups B and C (6.9 months±1.6 months and 6.6 months±1.7 months) was significantly shorter than for group A (8.4 months±1.9 months) ( P<0.05); the ranges of knee motion 12 months after operation in groups B and C (91.7°±16.7° and 90.9°±14.4°) were significantly larger than that in group A (78.8°±14.4°) ( P<0.05); the excellent and good rates of knee function 12 months after operation in groups B and C [77.8% (14/18) and 73.7% (14/19)] were significantly higher than that in group A [57.1%(12/21)] ( P<0.05). Conclusion:In the treatment of distal femoral fractures of Müller types C2 and C3, application of lateral locking plate and additional anterior locking reconstruction plate via the anterolateral incision at the distal femur can achieve rigid fixation without much damage to the surrounding soft tissues and lead to fine functional recovery of the knee joint because it has the advantages of single incision locking plate and double incision medial and lateral locking plates.

OBJECTIVETo compare the applicative effect of four diagnostic criteria of metabolic syndrome (MS) among the urban adult population of Zhejiang Province.

METHODSAccording to multi-stage stratified and proportional to size, cluster, random sampling principle, 3 417 adults population at urban areas were extracted by random number method from 320 families of Shangcheng and Jianggan community in Hangzhou,Jiangdong community in Ningbo and Wucheng community in Jinhua in 2009 and 2010 respectively, which excluded pregnant, wet nurse, children, and those who were at least 18 years of age. Height, weight, waist, blood pressure, fasting plasma glucose (FBG) , 2-hour postprandial blood glucose (2h-PBG), TG and HDL-C of all the subjects were measured by standard method. MS was diagnosed and compared according to four diagnostic criteria:Chinese Medical Association Diabetic Society (CDS), Joint Committee for Developing Chinese Guidelines (JCDCG), American National Cholesterol Education Program Adult Treatment PaneI II in 2005 (ATPIII) and International Diabetes Federation (IDF), respectively.

RESULTSThe high prevalence of MS diagnosed by the criteria of ATPIII was 21.6% (737/3 417) , while the lowest prevalence diagnosed by CDS was 9.8% (335/3 417), the result of consistency check demonstrated the MS diagnostic criteria of ATPIII and IDF, ATPIII and JCDCG were in strong and the same accordance with the concordance rate, Kappa value was 0.75, while the consistency of the criteria of ATP III and CDS were in relatively weak agreement, Kappa value was 0.53; the detection result of MS abnormal components showed the highest proportion of having ≥ 3 risk factors was presented by ATPIII among subjects diagnosed as MS (100.0%) , meanwhile, the lowest proportion of having ≥ 3 risk factors was also found by ATPIII among those MS-free (0.8%) .

CONCLUSIONSThe criteria of ATPIII may have more sensitivity when screening MS and its abnormal components.However, it's limited to extrapolate the results from the cross-sectional survey to the total population.

Adult ; Blood Glucose ; Body Weight ; Body Weights and Measures ; Cholesterol ; Cross-Sectional Studies ; Diabetes Mellitus ; Diagnostic Techniques and Procedures ; Humans ; Metabolic Syndrome ; Prevalence ; Risk Factors ; Urban Population