[Objective]To explore the clinical efficiency,operative methods,apparatus assembly and postoperative administration of Ilizarov technique in the correction of talipes equinovarus.[Method]From January 2003 to May 2006,32 patients were corrected with QIN Si-he's orthotics devices on the Ilizarov principle of tension-stress,which involved 15 males and 17 females,the age ranged from 10 to 25 years.Among these patients,2 were caused by peroneal nerve injury,l by tumor in the vertebral canal,5 by meningocele,11 were caused by poliomyelitis,13 by congenital talipes equino-varus.In accordance with deformities,external fixator and limitied operative methods were dertermined.The limited release of soft tissue were performed in 7 patients,limited osteotomy in 25 patients.The dynamic muscle balance operation were performed in 9 patients with imbalance of muscle strength.According to the Ilizarov technique,the fixative rods were installed.The telescopic rods on the apparatus were rotated one week after the operation,the divices had corrective function in three-dimensional directions.The deformity of talipes equinovarus,internal rotation and drooping of the forefoot were gradually corrected,and the patients could bear weight and walked on the deformed foot.The mean duration of traction were 42 days,then removed the external fixator maintained with plaster for a site time.[Result]All patients were followed up from 12 months to 37 months with an average of 17 months.There was no recurrence of the deformity and feet function was good while walking on full weight-bearing.None of the complication occurred postoperatively sush as infection in the incision,neurovascular injury and ankle dislocation.[Conclusion]With Ilizarov technique to correct talipes equinovarus is a safe,minimally invasive and effective method.Combined with limited operation Ilizarov technique can correct severe talipes equinovarus which is unattainable by traditional orthopedic surgery,and shorten the treatment period,avoid severe complications.

Objective To investigate the clinical effects of subemergency treatment of femoral intertrochanteric fractures in elderly patients.Methods From June 2013 through February 2014,47 patients older than 65 years were treated for femoral intertrochanteric fracture at our department and completed full follow-ups.Of them,20 received subemergency operation.They were 9 men and 11 women,with an average age of 72.2 ± 4.8 years.By the Evans-Jensen classification,there were 2 cases of type Ⅰ,5 of type Ⅱ,5 of type Ⅲ,5 of type Ⅳ,and 3 of type Ⅴ.The time from injury to surgery ranged from 0.5 to 1.7 days (average,0.8 days).The other 27 patients underwent selective operation.They were 11 men and 16 women,with an average age of 74.9 ± 5.7 years.By the Evans-Jensen classification,there were 3 cases of type Ⅰ,6 of type Ⅱ,6 of type Ⅲ,7 of type Ⅳ,and 5 of type Ⅴ.The time from injury to surgery ranged from 2 to 5 days (average,3.4 days).We compared the 2 groups in terms of in-hospital complications,fracture healing time,length of hospital stay,and hip scores at the last follow-up.Results All the patients were followed up for 12 to 15 months (mean,13.4 months).The rate of in-hospital complications in the subemergency operation group (35.0％,7/20) was significantly lower than that in the selective operation group (51.9％,14/27),and the length of hospital stay in the former (12.1 ± 1.6 days) was significantly shorter than in the latter (16.1 ± 1.8 days) (P ＜ 0.05).There was no significant difference between the 2 groups in fracture healing time (13.1 ± 1.8 weeks versus 13.6 ± 1.2 weeks) (P ＞ 0.05).According to the hip scores at the last follow-up,the subemergency operation group had 16 excellent,2 good,one fair and one poor cases (with an excellent to good rate of 90.0％) while the selective operation group had 21 excellent,2 good,2 fair and 2 poor cases (with an excellent to good rate of 85.2％),showing no significant difference between groups (P ＞ 0.05).Conclusion Subemergency operation can reduce not only in-hospital complications but also length of hospital stay for old patients with femoral intertrochanteric fracture.

Objective To evaluate the clinical efficacy of percutaneous kyphoplasty (PKP) in surgical treatment of osteoporotic thoracolumbar vertebral compression fracture in the elderly.Methods From March 2007 to February 2013,210 cases (100 males and 110 females;55-91 years of age,mean 72.5 years) of osteoporotic vertebral compression fracture were treated with PKP.Single-segment fracture was observed in 180 cases,two-segment fracture in 20 cases and three-segment fracture in 10 cases.Lesion involved in 250 vertebrae located in the T6-L5 segment.Bone cement injected into each vertebra was 3-5 ml (mean,4 ml).Treatment effects were assessed with vertebral height,Cobb angle and visual analogue score (VAS).Results At the follow-up of 6-15 months (mean 11 months),thoracic back pain significantly alleviated or disappeared.After operation,improvements were observed in VAS [(8.7 ± 1.2) points vs (2.6 ±0.7) points],anterior vertebral height loss [(11.0 ±3.2) mm vs(5.5 ± 0.8) mm],central vertebral height loss [(8.6 ± 1.1)mm vs (3.3 ± 1.0) mm],and Cobb angle [(29.8 ± 4.5) ° vs (16.7 ± 3.4) °] (P ＜ 0.01).Four patients appeared no pain or numbness in lower limbs although cement leak into disc.Whereas two patients had lower extremity nerve irritation because of cement leak into the spinal canal and recovered after symptomatic treatment.Conclusion PKP is an effective method for treatment of osteoporotic vertebral compression fracture in the elderly,for it can rebuild vertebral height,increase vertebral rigidity as well as stability and relieve thoracic back pain.

BACKGROUND: It has been pointed out that perioperative hypothermia can increase the incidence of coagulation, acidosis, stroke, sepsis, pneumonia and myocardial infarction, so it is of great significance to monitor and maintain normal body temperature during perioperative period. OBJECTIVE: To design a medical carbon fiber thermostatic heating pad to prevent perioperative hypothermia and reduce complications. METHODS: The carbon fiber heating technology and medical equipment standard are combined and integrated into many advanced technologies. The system mainly consisted of power supply conversion, operation system, computer control system, PWM control and output, various heating pads and temperature controlling measurement system. A total of 200 patients undergoing epidural anesthesia in Zhengzhou First People's Hospital were randomly divided into two groups: the observation group (n=100) was treated with the medical carbon fiber thermostatic heating pad (adjusting temperature 38-40 oC), and the control group (n=100) with common quilt. The body temperature and shivering were monitored before operation, 10, 30 and 60 minutes after anesthesia, and 2 hours after operation. RESULTS AND CONCLUSION: (1) The heating pad had the characteristics of explosion proof, power purification, shielding isolation, output protection, computer control, and PWM modulation. (2) In clinical application, there was no skin irritation and skin allergy reaction in the observation group. (3) During operation, the body temperature of the observation group was relatively stable, and there was no significant difference in the body temperature in the observation group before and at 2 hours after operation (P> 0.05). However, the fluctuation of body temperature in control group was visible and showed a downward trend, and the body temperature in the control group showed a significant difference before and 2 hours after operation (P < 0.05). The body temperature of 10, 30, 60 minutes after anesthesia and 2 hours after operation was significantly higher in the observation group than the control group (P < 0.05). (4) The postoperative incidence of shivering in the control group was significantly higher than that in the observation group (18％ vs. 5％, P < 0.05). To conclude, the medical carbon fiber thermostatic heating pad is advanced in technology, safe and reliable in use, providing a new way for the prevention of perioperative shivering.

Objective:To explore the clinical effects of artificial dermis combined with split-thickness skin for repairing wounds with bone and tendon exposure in hands and feet.Methods:A prospective randomized controlled study was conducted. From October 2018 to February 2020, 82 patients with bone and tendon exposed wounds in hands and feet admitted to the Department of Burns of Zhengzhou First People′s Hospital who met the inclusion criteria were selected. All the patients were divided into flap group (41 cases, including 27 males and 14 females) and artificial dermis+split-thickness skin group (41 cases, including 29 males and 12 females) according to the random number table, with age of (37±7) years. After complete debridement of wounds of patients in the two groups, the wounds of patients in flap group were transplanted with anterolateral femoral free flaps; the wounds of patients in artificial dermis+split-thickness skin group were grafted with artificial dermis with continuous negative pressure suction applied, and then grafted with split-thickness skin from autologous lateral thigh once the vascularization of artificial dermis was completed. One week after autologous skin graft/flap grafting, the survival of wound graft was observed and the graft survival rate was calculated. The complete wound healing time, number of operation, length of hospital stay, hospitalization cost, and the occurrence of surgery-related complications during hospitalization after autologous skin graft/flap grafting were recorded, and the incidence of complications was calculated. Six months after autologous skin graft/flap grafting, the scar hyperplasia of recipient area was evaluated by Vancouver Scar Scale (VSS), while the recovery of hand and foot function was evaluated by Total Action Mobility (TAM) System Rating method and American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Function Scale (AOFAS-AHS), respectively. Data were statistically analyzed with chi-square test, Fisher's exact probability test, and independent sample t test. Results:One week after autologous skin graft/flap grafting, the survival rates of wound grafts were similar in the two groups ( P>0.05). The complete wound healing time and length of hospital stay were (29±5) and (35±5) d for patients in artificial dermis+split-thickness skin group, respectively, which were significantly longer than (22±4) and (28±5) d in flap group ( t=6.96, 6.22, P<0.01). Compared with those in flap group, the number of operations was fewer ( t=7.39, P<0.01), the incidence of surgery-related complications during hospitalization after autologous skin graft/flap grafting was lower ( P<0.01), but there was no significant change in hospitalization cost of patients in artificial dermis+split-thickness skin group ( P>0.05). Six months after autologous skin graft/flap grafting, the VSS scores of recipient area of patients in the two groups were similar ( t=0.32, P>0.05); the TAM score of hand function and AOFAS-AHS score of foot function of patients in artificial dermis+split-thickness skin group were 40±6 and 62±12, respectively, which were significantly higher than 34±6 and 53±11 of flap group ( t=4.66, 3.41, P<0.01). Conclusions:The combined application of artificial dermis and split-thickness skin results in fewer number of operation compared with using flaps in the repair of wounds with bone and tendon exposure in hands and feet, reducing the incidence of surgery-related complications and improving the postoperative hand and foot joint function of patients, without significant scar hyperplasia, although it may also prolong the wound healing time and length of hospital stay accordingly.

Objective:To compare and explore the diagnostic performance of adding value of transabdominal and transvaginal contrast-enhanced ultrasound (CEUS) to Ovarian-Adnexal Reporting and Data System (O-RADS US) risk stratification and management system in differential diagnosis of adnexal masses.Methods:A total of 180 adnexal masses with solid components in 175 women were enrolled retrospectively between September 2021 and November 2022. All patients underwent routine Doppler ultrasound examinations and CEUS examinations. Among these masses, 107 masses underwent with transabdominal CEUS, 58 masses underwent with transvaginal CEUS, and 15 masses underwent both transvaginal and transabdominal CEUS. All patients were scheduled for surgery and pathological results served as the reference standard. Routine Doppler ultrasound and CEUS images and video were reviewed by a subspecialty radiologist using Vuebox software. The O-RADS US was downgraded or upgraded according to the CEUS characteristics of the masses. The diagnostic accuracy was assessed using ROC curve analysis. The area under the ROC curve (AUC) was calculated to compare the diagnostic performance of adding value of transabdominal and transvaginal CEUS to O-RADS US.Results:The diagnostic performance of adding transabdominal and transvaginal CEUS to O-RADS US were both significantly higher than of O-RADS US alone (transabdominal CEUS: AUC 0.83 vs 0.76, P=0.018; transvaginal CEUS: AUC 0.92 vs 0.81, P=0.013). Combination of transvaginal CEUS and O-RADS US was superior to that of combination of transabdominal and O-RADS US in the differential diagnosis of adnexal masses ( P=0.047). When the maximal diameter of adnexal masses ≤40 mm, transabdominal combined with O-RADS US presented the lowest diagnostic performance, with an AUC of 0.73. Conclusions:Combination of transvaginal CEUS and O-RADS US was superior to that of combination of transabdominal and O-RADS US in assessing adnexal masses with solid components. When the maximal diameter of adnexal masses ≤40 mm, transvaginal CEUS examination was recommended.