Objective To treat complex fractures of the proximal tibia with the hybrid external fixation and internal fixation and to evaluate their efficiency. Methods During January 2000 to January 2005, 69 patients with complex proximal tibia fractures received operation in our hospital, which included Schatzker types Ⅳ(17 cases), Ⅴ(14 cases) and Ⅵ(9 cases) and AO A3 type 27 cases, and 2 amputation. The average age was 39 years(range from 18 to 74 years). Among them, 19 open fractures and 21 closed fractures were operated with hybrid external skeleton fixation(HESF) combined limited internal fixation, the others were treated by open reduction and internal fixation (ORIF). Results All the patients were followed from 6 months to 5 years(mean, 25 months), in the HESF group the average time of operation was 2.66 h, the bleeding in operation was 170.50 ml, while ORIF group was 3.33 h and 285.19 ml, the amount healing time of HESF group was 16.40 weeks, while the ORIF groups was 12.37 weeks; there were no deep infectious and skin necrosis patients in the HESF group. According to the HSS score system, there were excellent 31, good 5, fair 3 and bad 1 case, the rate of excellent and good was 90%. In the ORIF group, there were 1 deep infectious and 2 skin necrosis patients, 6 cases were malunion, 2 cases were nonunion. There were excellent 5, good 12, fair 7, bad 3 cases, the rate of excellent and good was 63%; and there were significantly difference between the two groups(u=219, P

[Objective]To discuss the anatomy and etiology of cubital tunnel syndrome.[Method]The clinical data and surgical findings of sixty five cubital tunnel syndrome cases were analyzed,and the per-operative electromyogram results of twenty five cases were studied.[Result]Hypertrophy of arcuate ligament resulted in compression and abrasion of ulnar nerve in sixty patients;we found that the ulnar nerve conduct velocity decreased(the average speed was 27.97 m/s),motional amplitude also decreased(the average voltage was 1.95 mv),and latent period prolonged(the average time was 5.41 ms)after pre-operative electromyogram.[Conclusion]The major etiology of cubital tunnel syndrome is chronic injury with sustained compression of ulnar nerve around elbow joint.Careful physical examination of ulnar nerve function and pre-operative electromyogram will help us to diagnose the cubital tunnel syndrome.Cubital tunnel syndrome should be differentiated from tardy ulnar nerve palsy of other sites.

BACKGROUND:The incidence of open fracture of the elbow joint is increased rapidly with an increased number of accidents. Fractures are often accompanied by severe soft tissue injuries. At present, a combined therapy of autologous skin grafting, vacuum sealing drainage and external fixation for the treatment of open fractures has been widely reported. OBJECTIVE:To investigate the characteristics of the combined therapy of autologous skin grafting, vacuum sealing drainage, and external fixation for repair of complex and severe open fracture of the elbow joint. METHODS:A total of 41 patients with complex and severe open fracture of the elbow joint who received the combined therapy of autologous skin grafting, vacuum sealing drainage and external fixation during January 2009 to December 2013 in General Hospital of Tianjin Medical University, China were selected. Al patients were treated with routine debridement, external fixation and vacuum sealing drainage to cover wound during the first period. During the second period, autologous skin grafting or flap transfer was used to repair wound when the fresh granulation tissue covered the wound. RESULTS AND CONCLUSION:The postoperative folow-up period of these 41 patients was 8-22 months, with an average period of 13 months. External fixation period was 8-13 months with an average period of 9.8 months. The open wounds were completely healed after autologous skin grafting or skin flaps transfer. Fractures were healed in 31 patients during the first period. There were 7 cases of delayed union, 3 cases of nonunion. Al fractures were completely healed during 8-12 months after iliac bone grafting. The excelent and good rate of limb function recovery was 73.1% among 41 patients with severe open fracture of the elbow joint. The limb function of Gustilo II patients better recovered. These results suggest that the clinical effect of the combined therapy of autologous skin grafting, vacuum sealing drainage and external fixation for the treatment of complex and severe open fractures of the elbow joint is satisfactory.

Objective To investigate the risk factors for nosocomial bacteremia and decrease the prevalence of nosocomial bacteremia.Methods We collected the data of bacteremia patients in our hospital from January,2006 to December,2009.According to the criterion of nosocomial infection,the patients were divided into nosocomial bacteremia group (83) and community-onset bacteremia group (119).The influence of a series of variables on the development on both types of bacteremia was analyzed by Student＇s t test and x2 test.The risk factors were performed using multivariate logistic regression.Results Compared to that of community-onset bacteremia group,the proportion of malignancy (21/83 vs 12/119,x2 =8.2846,P ＜ 0.01 ),venous catheter ( 28/83 vs 3/119,x2 =36.67,P ＜ 0.01 ),diabetes ( 37/83 vs 0/119,x2 =68.226,P ＜0.05),surgical operation(37/83 vs 0/119,x2 =68.226,P ＜0.01),previous antibiotics(78/83 vs 10/119,x2 =173.5657,P ＜ 0.01 ) in nosocomial bacteremia group were higher.Multivariable logistic regression analysis showed that only 4 factors were significantly and independently responsible for nosocomial bacteremia,They were malignancy ( P ＜ 0.05,OR =3.186),diabetes ( P ＜0.001,OR =4.821 ),venous catheter( P ＜ 0.05,OR =2.135),previous antibiotics ( P ＜ 0.05,OR =2.135 ).The bacteria in nosocomial bacteremia group showed more ability to resist to antibiotics.Conclusions We should pay more attention to the patients with diabetes or malignancy or venous catheter or previous treated with antibiotics.These patients have more chances to develop to nosocomial bacteremia and infect by the drug-resistant bacteria.

Objective To compare the clinical outcomes of different drains in total knee arthroplasty.Methods Fifty-five patients,who had accepted primary unilateral total knee arthroplasty from October 2010 to November 2012,were included in the comparative study.Based on different drainage ways,25 patients were arranged into autotransfusion drain group,18 into routine drain group,and 12 into delayed drain group.Same operative procedure and postoperative care were provided to all patients.The total amount of postoperative drainage (including intraoperative blood loss),information of allogenic blood transfusion,body temperatures of patients on postoperative 1st,3rd,7th day,pre-and post-operative hemoglobin level,and postoperative swelling,wound healing quality and range of motion were recorded and compared.Results The amount of drainage was significantly more in autotransfusion drain group (799.2±196.7ml)than those in other two groups (381.7±129.2 ml in delayed drain group and 666.1±155.0ml in routine drain group).The postoperative hemoglobin level in delayed drain group (91.50±7.92 g/L)was similar to that in autotransfusion group (91.96±9.57 g/L),while significantly higher than that in routine drain group (81.33±9.86 g/L).The highest body temperature of patients in autotransfusion drain group was higher than those in other two groups.Allogenic blood transfusion was performed in 8 patients (44.4％) in routine drain group,4 patients (16.0％) in autotransfusion drain group and 2 patients (16.7％) in delayed drain group.There were no differences between groups in swelling,wound healing quality,and range of motion.Conclusion Delayed release of drain in total knee arthroplasty could reduce blood loss,chances of allogenic blood transfusion and postoperative fever,and extra cost,which can bring more benefits to patients.

Objective To evaluate the feasibilty of modified osteogenic culturing of goat adipose derived stromal cells(ADSCs).Methods From March,2013 to September,2014,platelet-rich plasma(PRP) was made from goat autogenous vein blood,and abodimoneal fat was aspirated,following aspetic procedure,primary and series passage of ADSCs was established.Osteoinduced ADSCs was carried out according to following group:combinative osteoinduction group(PRP+rhBMP-2 +ADSCs),growth factor group(rhBMP-2+ADSCs),conventional inductive group(dexamathasone+ascorbic acid + ADSCs) and noninductive group(blank group).Converted microscope was used to observe cellular pattern,cell activity,osteocalcin and collagen type Ⅰ level were detected at 1,3,5,7,9,13,17,21 days.Red Alazarin and Von Kossa staining were also assayed at different interval.Results Under observation of converted microscopy,remarkable cell proliferation with abundant ECM was noticed in combinative osteoinduction group,compared with other groups,level of cell activity,osteocalcin,collagen type Ⅰ [(0.82 ± 2.19)AU,(79.82 ± 1.36)U/L at,(78.51 ± 4.32)μ g/ml at]were significantly higher than other groups (P ＜0.05),and remarkable ALP expression and calcifed nodules were also seen.Conclusion PRP can enhance the inductive effect of rhBMP-2,and combinative osteoinduction procedure acts as a satisfactory culturing method.

Objective To evaluate the effectiveness and safety of recombinant human endostatin combined with concurrent chemoradiotherapy versus concurrent chemoradiotherapy for advanced non small cell lung cancer ( NSCLC) . Methods Electronic databases including the Cochrane library, PubMed, the Chinese biomedical literature database, China national knowledge internet(,EMbase,VIP and Wanfang database system were searched,until August,2013. The inclusion criteria was efficacy and safety studies of randomized controlled clinical studies in which recombinant human endostatin combined with concurrent chemoradiotherapy was compared with concurrent chemoradiotherapy alone for patients with advanced NSCLC. Cochrane handbook 5. 1. 0 was applied in evaluating the quality of included trials and RevMan 5. 1. 0 software was used for data analysis.Results Five studies including 217 cases of advanced NSCLC were included. The results of the meta-analysis exhibited that compared with concurrent chemoradiotherapy alone, recombinant human endostatin combined with concurrent chemoradiotherapy could increase effective rate [OR=2. 62,95%CI(1. 41,4. 86),P=0. 002]. But there were no significant differences in clinical benefit rate [OR=2. 08,95%CI(0. 92,4. 73),P=0. 08],one year survival rate [OR=1. 18,95%CI(0. 53,2. 66),P=0. 68], improvement in quality of life [OR=1. 57,95%CI(0. 40,6. 07),P=0. 52],rate of leucopenia [OR=1. 25,95%CI(0. 72,2. 17), P=0.43],radioactive esophagitis [OR=1. 16,95%CI(0. 42,3. 21),P=0. 77] and radiation pneumonitis [OR=2. 47,95%CI (0. 34,17. 68),P=0. 37]. Conclusion Compared with concurrent chemoradiotherapy alone,recombinant human endostatin combined with concurrent chemoradiotherapy may be more effective for advanced NSCLC,whereas improvement of life quality and toxicities are similar. For the quality restriction and possible publication bias of the included studies,more high quality randomized controlled trials are required to further verify this conclusion.

Objective To study effects of multimodal analgesia on postoperative delirium (POD)in elder patients with hip fracture.Methods One hundred and eight elder patients with hip fractures were gathered in a prospective study.Fifty-nine cases were included in the group of multimodal analgesia (25 males,34 females),with an average age of 72.91±5.42 years,and 35 were treated with hip replacements,the other 24 were internal fixations.Forty-nine cases were in the group of conventional analgesia (22 males,27 females),with an average age of 72.14±4.93 years,29 were treated with hip replacements,20 were internal fixations.Assessments of delirium were based on confusion assessment method.Local infiltrated anesthesia,patient control intravenous analgesia,and intravenous nonsteroid anti-inflammatory drug were applied in the group of multimodal analgesia.For the other group,morphine would be given only when patient complained pain or there was POD.Postoperatively,visual analogue scale (VAS),onset of delirium,other correlative data were recorded by an independent researcher.All patients underwent POD were managed with intensive pain management,and then reevaluated.Results VAS in multimodal analgesia group [Day1:2.10±1.43(resting),4.74±1.45 (active) and Day 3:1.01±0.92 (resting),3.31±1.36 (active)] were significandy lower than that in the other group [Day1:4.67±1.33 (resting),7.44±1.59 (active)and Day 3:2.24±1.39 (resting),5.06±1.46 (active)].PODs were detected in 15 (30.6％) in group of conventional analgesia; while in group of multimodal analgesia,there were 7 (11.9％).All POD were given intensive pain managements by injection of 10 mg morphine and achieved relief of deliriums.Conclusion Postoperative multimodal analgesia may reduce the incidence of POD.First aid of intensive pain management may help to control POD.