Objective To compare the clinical outcomes between percutaneous minimally invasive suture versus conventional open suture for acute closed rupture of Achilles tendon.Methods A prospective study was performed in the 68 patients who had been treated for acute occlusive rupture of Achilles tendon from November 2010 to November 2013 at Department of Orthopedic Trauma, The Third Affiliated Hospital to Soochow University. They were randomly assigned by the sequence of medical attention to receive percutaneous minimally invasive suture or conventional open suture. In the conventional group, there were 31 men and 3 women with an average age of 37.0 ± 10.0 years; in the minimally invasive group, there were 30 men and 4 women with an average age of 36.4 ± 9.4 years. The 2 groups were compared in terms of operation time, intraoperative bleeding, postoperative wound infection, postoperative skin necrosis and ankle-hindfoot score of American Orthopaedic Foot and Ankle Society ( AOFAS ) . Results All the 68 cases were fol-lowed up for an average of 21.26 months ( from 6 to 36 months ). There were no significant differences between the 2 groups in operation time ( 75.0 ± 5.3 min versus 64.8 ± 3.8 min ) or in rate of postoperative local in-fection [ 2.9% ( 1/34 ) versus 14.7% ( 5/34 ) ] ( P ＞ 0.05 ). The minimally invasive group had significantly less intraoperative bleeding ( 12.0 mL ) , a significantly lower rate of skin necrosis [ 2.9% ( 1/34 ) ] and significantly higher AOFAS scores at 6 ( 90.5 ) , 12 ( 91.5 ) and 24 months ( 93.5 ) postoperatively than the conventional group did ( 80.0, 81.0 and 82.5, respectively ) ( all P ＜0.05 ). Conclusion Percuta-neous minimally invasive suture is recommendable for treatment of acute closed rupture of Achilles tendon because it leads to less intraoperative bleeding, better postoperative functional recovery and lower incidence of postoperative skin necrosis.

Objective:To investigate the precautions and clinical effects of minimally invasive lateral bone transfer of tibia in the treatment of diabetic foot.Methods:A retrospective analysis was performed on 82 patients with diabetic foot admitted to the Trauma Department of Changzhou First People's Hospital from January 2019 to December 2022. According to the Wagner grade of diabetic foot, there were 12 cases of grade 2, 50 cases of grade 3, and 20 cases of grade 4. According to the surgical method, 45 patients were divided into bone transfer group. There were 29 males and 16 females, with an average age of 65.27±10.74 years (ranging from 44-87 years), who underwent minimally invasive bone transfer of tibia combined with local debridement treatment. In the non-bone transfer group, there were 37 cases (26 males and 11 females) with an average age of 66.05±11.08 years (ranging from 44 to 86 years), who were treated with local debridement. Gender, age, Wagner grade, surface temperature difference of the affected limb, visual analogue scale (VAS) score of the affected limb before and 1 month after surgery, wound healing rate 1 month after surgery, and recurrence rate of the affected foot 1 year after surgery were compared between the two groups. Outcomes of the cases of different Wagner grades were compared.Result:All 82 patients were followed up for 14.23±1.20 months. There was no significant difference in gender, age, Wagner grade and preoperative VAS between the two groups ( P>0.05). The skin temperature of the affected limb before and after surgery in the bone transfer group was significantly higher than that in the non-bone transfer group 1.93±0.31 ℃ ( P<0.05), and the VAS of the bone transfer group was 2.18±0.58 points 1 month after surgery, which was lower than that in the non-bone transfer group of 5.41±0.93. The VAS difference before and after surgery in the bone transfer group was 4.80±1.24 points, which was greater than that in the non-bone transfer group of 1.62±1.48 points with significant difference ( P<0.05). The wound healing rate was over 98.78%±2.17% in the bone transfer group and 52.57%±6.41% in the non-bone transfer group one month after surgery. No recurrence or recurrence was found in the bone transfer group one year after surgery, and the recurrence rate was 86% (32/37) in the non-bone transfer group with significant difference ( P<0.05). There was no difference in preoperative VAS for different grades of diabetic foot (grades 2, 3, and 4). There were significant differences in VAS, VAS decrease, postoperative limb surface temperature increase, local wound healing rate at 1 month, and lower limb ulcer recurrence or recurrence rate at 12 months in the bone transfer groups of Wagner grade 2, 3, and 4 ( P<0.05). Conclusion:Minimally invasive lateral bone transfer of tibia combined with local precision debridement could significantly increase the healing rate of diabetic foot ulcer, improve the peripheral microcirculation of the affected limb, reduce the pain of the affected limb, and decrease the recurrence rate of diabetic foot ulcer.

Objective To investigate the morphologic characteristics of gonococcal inflammation of paraurethral glands in males. Methods Eleven male patients with gonococcal inflammation of paraurethral glands were examined by both real-time ultrasound imaging (Siemens Acuson X300) and 3.0 T magnetic resonance imaging (MRI, Philips Achieva). Results High-frequency ultrasound imaging revealed tubular echoic areas with well-defined borders and smooth margins in all the patients. The inside of these tubular areas was weak-echoic. These tubular echoic areas were blind in one end, but open in the other end, and ran in parallel with the urethra. The mean lumen diameter was 1.1 ± 0.2 mm (range, 0.7 - 1.3 mm) , and the mean lumen length was 8.4 ± 0.6 mm (range, 7.0 - 12.0 mm). Anechoic liquid-filled areas were seen in the tubular echoic areas in two patients. Paraurethral ducts were not detected by 3.0 T MRI in these patients. Conclusions High-frequency ultrasound imaging can clearly show the morphologic characteristics of gonococcal inflammation of paraurethral glands in males, and provide valuable ultrasound images for surgery.

Objective To evaluate therapeutic effects of wedge resection on male paraurethral duct dilatation following gonococcal paraurethral duct infection. Methods With the aid of high-frequency ultrasound images, 11 male patients with paraurethral duct dilatation following gonococcal paraurethral duct infection were treated with wedge resection. The data were collected, including the surgical duration, amount of bleeding during the surgery, period of wound healing and complications. If the ostium beside the external urethral orifice disappeared within 4 weeks after the surgery, there was no discharge from the ostium with pressure, and no tubular echoic area was observed by high-frequency ultrasound imaging, the patient was considered to be recovered. If none of the above three conditions could be met, the surgical treatment was considered to be ineffective. Results The average surgical duration was 19.19 ± 2.71 minutes(range, 14-23 minutes), the average amount of bleeding during the surgery was 11.09 ± 2.07 ml (range, 8-14 ml), and the average period of wound healing was 14.91 ± 1.45 days(range, 13-17 days). Of the 11 patients, 10 were cured, and 1 showed no response. No complications were observed in any of the 11 patients, and no defects formed in the glans penis. Conclusion Wedge resection is a kind of effective therapy for paraurethral duct dilatation following gonococcal paraurethral duct infection in males.

Objective: To analyze the premature death probability and cause-eliminated life expectancy of cardiovascular disease, cancer, chronic respiratory disease and diabetes in Chongqing residents in 2016 so as to provide recommendation for non-communicable diseases (NCDs) prevention and control in Chongqing. Methods: Death cases of Chongqing Municipality between January 1^st and December 31^st, 2016 were reported through death case registry system of national center for disease prevention and control. Death cases were sorted by international classification of disease (ICD-10). Mortality rate, standardized mortality rate, constituent ratio, premature death probability, life expectancy, and cause-eliminated life expectancy of four major NCDs were analyzed. Results: A total of 218 004 death cases were reported in Chongqing, 2016, and the mortality rate was 731.73/100 000. Of them, a total of 179 637 death cases of the four major NCDs including cardiovascular disease, cancer, chronic respiratory disease and diabetes were reported, accounting for 82.40% of all death cases. The mortality rate and standardized mortality rate of four major NCDs was 602.95/100 000 and 455.82/100 000, respectively. The premature death probability of four major NCDs was 15.96%, and males (25.39%) had a higher premature death probability than females (10.78%). The premature death probability of cardiovascular disease, cancer, chronic respiratory disease, and diabetes were 6.01%, 8.32%, 2.05%, and 0.43%, respectively. Life expectancy would increase by 6.02, 3.19, 1.89, and 0.19 years, after eliminating cardiovascular disease, cancer, chronic respiratory disease and diabetes respectively. Conclusion The premature death probability of major NCDs was high in Chongqing, and males had a higher premature death probability than females did. Intervention and health management of the population should be conducted according to different gender-based risk factors to reduce the premature death probability.

Objective: To analyze the prevalence and related factors of pediatric flexible flatfoot (PFF) among 7-8 year old children in Changzhou, so as to provide a feasible basis for the prevention and treatment of PFF. Methods: From December 2023 to February 2024, a total of 1 685 children aged 7-8 from 10 primary schools in Changzhou were selected by stratified cluster random sampling method, and screened for PFF by using a foot optical assessment recording device. Information including sex, body mass index (BMI), diet, exercise and shoe wearing habits were collected. The valgus angle of the hindfoot was measured on the body surface by using an orthopedic measuring ruler in the standing position. Pain levels were evaluated by using visual analogue score (VAS) for children with flatfoot syndrome. Multivariate Logistic analysis was used to analyze related factors of PFF. Results: The overall detection rate of PFF was 27.4%, and there was a significant difference in the detection rate of PFF between boys and girls, with 30.3% and 24.1% respectively ( χ 2=7.96, P < 0.01 ). Most cases of PFF were mild flatfoot (60.8%) and bilateral ( 60.4% ). Approximately 13.2% of children with PFF had flatfoot syndrome, with a mean VAS of (2.86±0.73). About 56.1% of children with PFF had a normal valgus angle of the hindfoot. Sex, high BMI and preference for shoe last with front upturned shoe shape were positively correlated with the detection of PFF ( OR= 1.74, 1.54, 1.13, P <0.05). After stratified by sex, regular exercise in boys and age in girls were negatively correlated with the detection of PFF ( OR=0.40, 0.64, P <0.05). Conclusions The detection rate of PFF in 7-8 year old children is high. Additionally, PFF combined with flatfoot syndrome or valgus hindfoot is relatively rare and is likely to be underestimated, which emphasizes the importance of early detection and intervention for PFF.

Objective:To investigate the one-stage surgical treatment method and short-term therapeutic effect for combined anterior cruciate ligament (ACL) injury in Schatzker IV-VI tibial plateau fractures.Methods:A retrospective study was conducted on 79 patients with Schatzker IV-VI tibial plateau fractures who underwent surgical treatment at the Department of Traumatic Orthopedics in The Third Affiliated Hospital of Soochow University from April 2016 to February 2021 and there were 47 males and 32 females with a mean age of 51.5±13.2 years (ranging from 21 to 73 years old). Combined with preoperative MRI manifestations, meniscus injuries and avulsion fractures of collateral ligament complex were all repaired in one stage, primary reconstruction was not performed for the combined substantive injury of ACL body, and the displaced avulsion fracture of ACL insertion was only reduced without separate fixation during open reduction and internal fixation for fractures. Visual analogue scale (VAS), knee flexion range of motion, and American Hospital for Special Surgery Knee Joint (HSS) scores were used to evaluate the treatment outcomes at 3, 6, and 12 months postoperatively and the last follow-up.Results:All 79 patients successfully completed the surgery and were followed up for 23.6±2.2 months. The incidence of combined ACL injury was approximately 23% (18/79) with the main manifestation being intercondylar ridge avulsion fracture of ACL (10/18, 56%), which was more common in SchatzkerIV fractures (60%, 6/10). Postoperative KT-1000 measurements on the side-to-side difference in forward displacement of the healthy and affected knee joint showed no significant change in patients with ACL avulsion fracture and body injury, and there was no statistically significant difference compared to the normal range ( P>0.05). No statistically significant difference could be observed in postoperative VAS between ACL avulsion fracture, ACL body injury, and non-ACL injury groups ( P>0.05). At 3, 6, 12 months and the last follow-up after surgery, knee flexion range of motion in patients with intercondylar eminence avulsion fracture of ACL 99.7°±8.9°, 110.5°±10.3°, 120.9°±10.5°, and 121.5°±10.2° was lower than that in patients without ACL injury 106.5°±10.1°, 119.1°±9.8°, 128.3°±10.4°, and 128.3°±9.3°, and the differences were statistically significant ( P<0.05). At 3 and 6 months after surgery, patients with intercondylar eminence avulsion fracture of ACL had lower HSS scores 72.7±5.3 and 80.4±4.6 points compared to those without ACL injury 76.3±4.1 and 83.6±4.5 points, and the differences were statistically significant ( P<0.05). Conclusion:During the surgical treatment of Schatzker IV-VI tibial plateau fractures, it is feasible to treat possible concomitant injuries such as meniscus on the basis of reduction and fixation of the fracture without reconstructing the ACL in one stage, and to treat displaced ACL intercondylar eminence avulsion fractures by correct reduction without separate fixation. This treatment method can achieve good short-term postoperative outcomes.

Objective To investigate the healing degree of lesions of herpes zoster in the head and face and the risk factor of the discosmetic sequelae.Methods 92 case of herpes zoster in the head and face were enrolled in this study.The patients were treated in dermatological clinic of Changshu No.1 People's Hospital from Jan.2017 to Jun.2018.The clinical data were recorded,such as the time of control,improving and healing of lesion,sex,age,position,the time of therapy starting and the behavior of scratching,extrusion and divest crust.The blood glucose and serum albumin of patients were measured.We observed the remained scars and performed statistic analysis.Results In diabetes group,the control and healing time was (2.40±1.28) d and (10.38+2.47) d respectively,meanwhile the control and healing time was (1.72 ± 0.94) d and (8.32 ± 2.66) d respectively in non-diabetes group (P＜0.05).The single factor analysis indicated that the age,position,diabetes,lesion extrusion,divest crust were the correlation factors of the zoster scar in head and face (P＜0.05).Nevertheless the multifactor logistic regression indicated that the position,diabetes and divest crust were independent risk factors of the zoster scar in head and face (P＜0.05).Conclusions The healing of herpes zoster is affected by diabetes.The independent risk factors of zoster scar in head and face are non-trigeminal nerves positions,diabetes and divest crust.

Objective: To observe the changes of skin lesion, neuralgia and blood pressure in hypertension patients and non-hyperension patients before and after the early formal treatment on herpes zoster in the head and face. Methods: Clinical data were collected from June 2015 to May 2018 in the Department of Dermatology, the First People＇s Hospital, Changshu, Jiangsu province. In 104 cases of hospitalized patients with herpes zoster, 46 cases had high blood pressure (hypertension group); 58 cases did not have high blood pressure (non-hypertension group). The skin lesion, numerical rating scale (NRS) and blood pressure changes were compared between the two groups before and after treatment. Results: A total of 99 patients completed treatment; 45 cases in the hypertensive group included 25 males, 20 females, aged 35 to 71 (52.40±12.51) years; 54 cases in the non-hypertensive group included 30 males and 24 females, aged 36 to 75 (52.62±12.67) years. There was no statistically significant difference in the time of control, improving and healing of skin lesion (t=-0.457, -0.607 and 1.399, P>0.05) . There was no statistically significant difference in NRS between the two groups before treatment (t=-0.009, P=0.993 >0.05). After treatment, the NRS of both groups decreased compared with those before treatment, and the difference was statistically significant (F=151.130, 181.444, P<0.05). There was no significant difference in NRS between the two groups after treatment (Z=-0.032, -0.154, -0.149 and -0.426, P>0.05). In the hypertension group, the rate of blood pressure increase before treatment was 62.22%, and the blood pressure decreased after treatment compared with that before treatment. The difference was statistically significant (P<0.05). In the non-hypertension group, the rate of increase of blood pressure before treatment was 5.56%, and the blood pressure after treatment was lower than before treatment. The difference was not statistically significant before and after treatment (P>0.05). Conclusions Blood pressure can be increased when herpes zoster occurs. After early formal treatment of herpes zoster, skin lesion healed, neuralgia reduced and blood pressure can return to normal. The history of hypertension and the increase of blood pressurd before treatment has no effect on the recovery of skin lesion and neuralgia.

Objective:To investigate the specific types of lateral meniscus injury in Schatzker type II tibial plateau fractures and its potential correlation with CT features of the lateral plateau.Methods:The data of 213 patients with Schatzker II tibial plateau fractures from August 2014 to June 2021 were retrospectively analyzed, including 132 males and 81 females, aged from 29 to 61 years, with an average of 44.9 years. All patients underwent arthroscopic evaluation of fracture reduction immediately after open reduction and internal fixation (ORIF). According to the actual situation during the operation, the types and locations of lateral meniscus injury were determined and the patients were divided into the meniscus injury group and non-injury group. By measuring lateral plateau depression (LPD) and lateral plateau widening (LPW) of the lateral tibial plateau on CT images, the correlation of which and lateral meniscus injury was analyzed. The optimal critical values of LPD and LPW for predicting lateral meniscus injury were obtained by drawing the relevant receiver operating characteristic (ROC) curves.Results:The meniscus injury group (109 patients) mainly showed injuries involving the mid-body and posterior horn of lateral meniscus (98.2%, 107/109) and LPD was 13.1±3.2 mm; while the LPD of 104 patients without meniscus injury was 9.1±3.0 mm with a statistical difference ( t=3.98, P<0.001). The LPW of meniscus injury group and non-injury groups was 8.0±1.3 mm and 6.7±1.6 mm, respectively, and the difference was statistically significant ( t=2.68, P=0.011). The optimal predictive critical point of LPD and LPW was 7.6 mm (sensitivity 90.3%, specificity 64.7%, area under the curve 0.834) and 7.3 mm (sensitivity 80.5%, specificity 58.8%, area under the curve 0.722). Conclusion:Schatzker II tibial plateau fractures combined with lateral meniscus injury is usually characterized by meniscus-joint capsule separation, rupture and longitudinal fracture. The mid-body and posterior horn of lateral meniscus injury is more likely to occur when LPD> 7.6 mm and/or LPW> 7.3 mm on coronal CT images.