Objective To assess the clinical efficacy of fibular osteotomy with autogenous iliac bone graft for treatment of nonunion of the tibia. Methods A cohort of 45 patients with postoperative nonunion of tibia between Jul. 2008 and Jun. 2013 were treated by fibular osteotomy combined with autogenous iliac bone graft in Changhai Hospital of Second Military Medical University. According to anatomical classification, there were 29 cases of hypertrophic nonunion, 17 cases of atrophic nonunion and two cases of pseudoarthrosis. For primary fixation, 32 cases had plates internal fixation, 11 had intramedullary nail and two had external fixation. Eight patients with stable plate internal fixation were treated by fibular osteotomy with autogenous iliac bone graft, 35 patients with failed internal fixation and two patients with failed external fixation were treated by removing implant and exchanging compression plate with fibular osteotomy using autogenous iliac bone graft The status of fracture healing and relative complications were assessed by lateral and frontal X-ray. Functional recovery of the ankle was evaluated by Olerud-Molander Ankle Score (OMAS). Results The operation time was 1. 3-2. 5 (1. 7 ± 0. 5) h, the intra-operation blood loss volume was 200-500 (250. 0 ± 59. 6) mL, the fibular osteotomy length was 2-3 (2. 4 ± 0. 5) cm, and the volume of iliac grafting was 3-23 (7. 8 ± 1. 3) cm3. The follow-up time was 12-48 (16. 5 ± 3. 3) months and the fraction healing time was 3-11 (5. 6 ± 2. 4) months. The healing of 26(58%) patients took 3-5 months, 13(29%) patients took 6-8 months and 6(13%) patients took 9-11 months. Twenty-seven patients had no limb shortening, nine patients had limb shortening of <11 cm, six patients had limb shortening of 1-2 cm and three patients had limb shortening of >2 cm. The function of lower limb joints was excellent in 23 cases, good in 14 cases, common in 5 cases and bad m 3 cases at last follow-up. Conclusion The fibular osteotomy with autogenous iliac bone graft can create pressure on the broken bone end and increase the broken bone end contact area, promoting fracture healing and reducing complications.

Objective To analyze the clinical data of 915 elderly patients with hip fractures (≥ 80 years old) receiving surgical treatment in our department over the past 10 years, so as to summarize the surgical strategies of hip fractures in elderly patients. Methods We included 915 patients with hip fractures aged 80 years and over from Jun. 2007 to Jun. 2016. Based on preoperative preparation and evaluation, the general condition and underlying diseases of patients were adjusted individually during the perioperation, and then the suitable anesthesia methods and reasonable internal fixation were selected and the surgery was performed as soon as possible. Active early functional exercise, specialist nursing and health education were conducted after surgery. The waiting time for operation, operation time, hospital stays, bleeding volume, postoperative systemic and local complications and 1-year mortality were analyzed. Results The mean operation time of the 915 patients was (69.5±34.2) min (range 50-120 min), the mean bleeding volume was (278.3±56.8) mL (range 150-440 mL), and the mean hospital stay was (5.6±3.2) d (range 5-31 d). There were 210 cases having systemic and local complications, with 117 cases of systemic complications and 93 cases of local complications. Fourteen patients died, accounting for 1.5% (14/915) of the total. The patients were divided into <2 d group, 2-7 d group and >7 d group according to the waiting time for operation. Our results showed that the waiting time for operation was longer, the mortalities and incidences of complications of patients were higher, with a significant difference found between the 3 groups (P<0.05). Conclusion Active preoperative preparation and evaluation, right anesthesia methods, reasonable internal fixation according to the fracture site and type, adjusting general condition and underlying disease drug during the perioperation, early surgery, active specialist nursing, preoperative health education and individualized diagnosis can all contribute to the treatment of elderly patients with hip fractures, improving the clinical efficacy and reduce the complications effectively.

Objective To observe the application of the Green channel in the treatment of elderly patients with hip fracture, so as to provide a reference for the standardized treatment. Methods We retrospectively analyzed the clinical data of 115 elderly patients (≥75 years) with hip fractures treated in hospital from Jun. 2014 to Jun. 2015. The patients were treated through the Green channel (Green channel group, n=58) or received conventional treatment (normal group, n=57). The waiting time for operation, operation time, bleeding volume, hospital stay, and postoperative systemic and local complications during hospitalization were compared between the two groups. Results The waiting time for operation of patients in the Green channel group (median 43.6 h) was significantly shorter than that in the normal group (median 136.8 h, P<0.01), and the hospital stay of patients in the Green channel group ([4.3±1.2] d) was significantly shorter than that in the normal group ([8.5±2.5] d, P<0.05). There was no significant difference in the operation time or bleeding volume between the two groups (P>0.05). The incidence of complications of patients in the Green channel group (11/58, 19.0%) was significantly higher than that in the normal group (29/57, 50.9%; P< 0.01). The incidences of pulmonary infection and pressure sores of patients in the Green channel group were significantly lower than those in the normal group (3.4% [2/58] vs 14.0% [8/57], P<0.05; 3.4% [2/58] vs 15.8% [9/57], P<0.05). There was no significant difference in the incidences of pulmonary embolism, cerebral infarction, deep vein thrombosis, myocardial infarction, or incision infection between the two groups. Conclusion Application of the Green channel in the treatment of elderly patients with hip fracture can allow early surgery under suitable conditions, which is conducive to reduce hospital stay and postoperative complications, and can promote the recovery of hip function, indicating that the Green channel has an important significance for standardized treatment of eldery patients with hip fractures.

OBJECTIVETo observe the effective of the injectable artificial bone combined with plate fixation for reconstructing the collapse tibial plateau fracture.

METHODSFrom June 2005 to January 2008,21 cases of collapse tibial plateau fracture of type Schatzker II, III were treated by injectable calcium sulfate bone substitute combined with supportive plate reconstruction including 16 males and 5 females with an average age of 35.3 years ranging from 27 to 62 years. The disease course was from 3 to 7 days (means 4 days). According to Schatzker classification, there were 17 cases of type II, 4 of type III. All patients preoperatively underwent radiography, CT scanning and three-dimensional reconstruction in order to accurately understand the extent of fracture and fracture collapse and the shattered fragments of the flip direction. All the fracture with collapse > 3 mm, without joint degeneration were selcected for surgical treatment. The knee joint function after fracture healing and recovery were evaluated by Lysholm scoring.

RESULTSAll patients were followed-up for from 6 months to 2.5 years (means 1.5 years). The X-ray films and features of all fractures showed anatomic reduction or near anatomic reduction, except one case of grade II severe comminuted fracture occurred a high degree of loss and platform reset ineffective after 6 months. The Lysholm scoring of knee function showed that the mean score was (88.3 +/- 5.2). The results were excellent in 12 cases,good in 7 cases, fair in 2 cases.

CONCLUSIONMinimally invasive injectable calcium sulfate bone combined with plate fixation for reconstructing the collapse tibial plateau fracture of type II, III can effectively prevent the further loss after reduction, to improve the long-term results. Minimally invasive injectable calcium sulfate as an artificial bone substitute materials has good prospects for clinical application.

Adult ; Bone Plates ; Bone Substitutes ; administration & dosage ; Calcium Phosphates ; administration & dosage ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Injections ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Tibial Fractures ; surgery

OBJECTIVETransfusion transmitted virus (TTV) DNA was detected in serum samples obtained from healthy infants and volunteer blood donors living in Jiujiang city in an attempt to shed light on the prevalence of TTV infection and the transmission route of TTV infection in infants.

METHODSModified untranslated region, polymerase chain reaction (UTR PCR) and N22 PCR were performed to test TTV DNA in serum samples from 86 infants and 58 blood donors.

RESULTSTTV DNA was detected by UTR PCR in 51 (53.5%) infants and 58 (100%) in blood donors, while that tested by N22 PCR was 14 (16.3%) and 22 (37.3%) in infants and blood donors, respectively. Among infants younger than 30 days, 1 - 6 months and 7 - 12 months of age, TTV DNA was detected by UTR PCR and N22 PCR at rates of 0, 33.3%, 95.0% and 0, 7.4%, 30.0%, respectively.

CONCLUSIONThe prevalence rates of TTV DNA detected by UTR PCR were 95% in infants of 7 - 12 months after birth and 100% in healthy blood donors in Jiujiang city. However the results obtained by N22 PCR were much less frequently in the same population. Results showed that significant difference did exist in the prevalence of TTV DNA detected by the two different PCR systems. Age-dependent increase of TTV infection was observed in early childhood, while environmental sources were considered to be the most common route of TTV acquisition as the primary infection in infants. However, the prevalence of TTV in infants of 7 - 12 months was similar to that in healthy adults in the same region.

Base Sequence ; China ; epidemiology ; DNA Virus Infections ; epidemiology ; virology ; DNA, Viral ; chemistry ; genetics ; Humans ; Infant ; Infant, Newborn ; Molecular Sequence Data ; Polymerase Chain Reaction ; Prevalence ; Sequence Analysis, DNA ; Sequence Homology, Nucleic Acid ; Torque teno virus ; genetics

OBJECTIVETo explore the mechanical behavior of lumbar spine loaded by stress and provide the mechanical basis for clinical analysis and judgement of lumbar spine fracture classification, mechanical distribution and static stress.

METHODSBy means of computer simulation method, the constructed lumbar spine three-dimensional model was introduced into three-dimensional finite element analysis by software Ansys 7.0. The lumbar spine mechanical behavior in different parts of the stress loading were calculated. Impact load is 0-8000 N. The peak value was 8000 N. The loading time is 0-40 minutes. The values of the main stress, stress distribution and the lumbar spine unit displacement in the direction of main stress were analyzed.

RESULTSThe lumbar spine model was divided into a total of 121 239 nodes, 112 491 units. It could objectively reflect the true anatomy of lumbar spine and its biomechanical behavior and obtain the end-plate images under different stress. The stress distribution on the lumbar intervertebral disc (L(3)-L(4)) under the axial, lateral flexion and extension stress, and the displacement trace of the corresponding processus articularis were analyzed.

CONCLUSIONIt is helpful to analyze the stress distribution of lumbar spine and units displacement in static stress loading in the clinical research of lumbar spine injury and the distribution of internal stress.

Adult ; Biomechanical Phenomena ; Female ; Finite Element Analysis ; Humans ; Lumbar Vertebrae ; physiology ; Sacrum ; physiology ; Stress, Mechanical

OBJECTIVETo investigate the clinical effects of moxibustion (Mox) in treating knee joint osteoarthritis, and to detect the change of hyaluronic acid (HA) level in serum and synovial fluid (SF) for evaluating its significance.

METHODSThirty OA patients were treated with Mox applied on inner and outer hsiyens and Ashi point for 10 min once a day, 5 times a week for 3 months and the therapeutic efficacy was evaluated. Serum and SF levels of HA were measured by radio-immunoassay before and after the 3-month treatment, and compared with those from 30 non-OA persons for normal control.

RESULTSAfter treatment, 19 patients (20 joints) out of the 30 patients were cured, the efficacy of Mox was evaluated as markedly effective in 8 patients on 10 joints, and as effective in 3 patients on 4 joints, the cure rate being 63.3%. Before treatment, HA level in serum (122.87 +/- 34.10 microg/L) was higher and in SF (0.98 +/- 0.17 g/L) was lower in OA patients than those in the normal controls (68.32 +/- 21.48 microg/L and 1.62 +/- 0.30 g/L, P<0.01), whereas after treatment, both the serum and SF levels of HA in patients changed toward normal range (70.29 +/- 27.30 microg/L and 1.58 +/- 0.26 g/L), showing insignificant difference as compared with those in the controls (P<0.01).

CONCLUSIONMox is an effective approach for treatment of OA, and the levels of HA in serum and SF can be taken as the quantitative indicators for evaluating the pathogenetic condition of OA patients.

Female ; Humans ; Hyaluronic Acid ; analysis ; blood ; Male ; Middle Aged ; Moxibustion ; Osteoarthritis, Knee ; blood ; metabolism ; therapy ; Synovial Fluid ; metabolism

OBJECTIVETo discuss the diagnosis and treatment of peripheral nerve injury in the earthquake.

METHODSFourteen patients with peripheral nerve injury injured in the earthquake were involved the retrospective study. All cases accepted the timely diagnosis and treatment including anastomosis and repair of the nerve and other conservative treatments. Then the therapeutic effects were observed.

RESULTSAll 14 patients got short-term follow-up and attained the improvement in their symptoms of nerve injury.

CONCLUSIONPeripheral nerve injury has a high incidence in the earthquake. Prevention is very important. The timely and effective treatment should be taken according to spot situations and traumatic conditions of casualties in earthquake.

China ; Earthquakes ; Female ; Follow-Up Studies ; Humans ; Male ; Peripheral Nerve Injuries ; Peripheral Nerves ; surgery ; Peripheral Nervous System Diseases ; diagnosis ; prevention & control ; surgery ; therapy ; Retrospective Studies

OBJECTIVETo explore the external fixation for treatment of supracondylar femoral fractures after total knee replacement.

METHODSFrom June 2005 to July 2007, 7 cases of supracondylar femoral fracture after total knee replacement were treated with external fixation included 4 males and 3 females with an average age of 71 years ranging from 55 to 85 years. The fracture healing were observed and the knee function were evaluated by the HSS scoring.

RESULTSAll patients were followed-up for 6 to 23 months with an average of 12.5 months. The fracture healing time was from 6 to 12 weeks after operation (averaged 8.5 weeks). During the followed-up period, there were no infection and loosening, only one case occurred nail crossing delayed healing of skin. The HSS knee score was (60.6 +/- 16.0) before treatment and (77.6 +/- 11.6) after treatment according to HSS knee score criteria, the results were excellent in 2 cases, good in 4, and fair in 1.

CONCLUSIONApplication of external fixation for treatment of supracondylar femoral fracture after total knee replacement, especially in poor physical condition, high age patients is a more appropriate treatment.

Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee ; adverse effects ; External Fixators ; Female ; Femoral Fractures ; physiopathology ; surgery ; Fracture Fixation ; methods ; Humans ; Male ; Middle Aged ; Postoperative Complications ; physiopathology ; surgery ; Recovery of Function ; Treatment Outcome

Adult ; Alloys ; Bone Screws ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Patella ; injuries ; physiopathology ; surgery ; Recovery of Function