Objective To evaluate the application of tranexamic acid in perioperative period of intertrochanter fracture of femur.Methods 46 cases of patients with intertrochanter fracture of femur were randomLy divided into the control group and treatment group,23 cases in each group.All patients underwent partial hip replacement,10min before operation,the control group was given 0.9％sodium chloride injection100mL,intravenous drip; the experimental group was treated with tranexamic acid injection 10mg/kg,soluble in 100mL 0.9％sodium chloride injection,intravenous drip;Before and after operation,compared between the two groups of patients with blood t hematocrit(HCT),hemoglobin(Hb)levels,volume of blood loss,volume of blood transfusion and incidence of postoperative complications.Results After operation,compared with the control group,the serum levels of HCT、Hb were higher in the experimental group(P<0.05).The total blood loss,hidden blood loss,intraoperative blood loss,postoperative drainage volume and blood transfusion volume were lower in the experimental group(P<0.05).There was no significant difference in the incidence of complications between the 2 groups.Conclusion The tranexamic acid can significantly reduce the volume of blood loss and volume of blood transfusion in perioperative period of patients with intertrochanter fracture of femur,and do not increase the incidence of postoperative complications of thrombosis,and have high security.

Objective To discuss the perioperative management of cirrhotic patients undergoing abdominal operation. Methods From Jan. 2000 to Jul. 2007, 93 patients with PHT underwent operation in our hospital. We retrospectively analyzed the data according to different therapy result. Results 21 cases developed postoperative ascites. The occurrence of ascites in patients dealt with PHT and coexistent other abdominal disease was 7% and 12% respectively for Child A and B grade patients. The occurrence of ascites in patients dealt with only abdominal disease was 13% and 17% respectively for Child A and B grade patients. The occurrence of ascites in patients dealt with PHT and abdominal disease was amazingly 83% for Child C cases. Patients suffered from tumors didn't have more risk of ascites than the other patients. Conclusion The proper perioperative management of patients can decrease the mortality. To deal with PHT together with abdominal operation is reasonable for patients in Child A or B liver function, and it would not increase the postoperative ascites. For the selective patients, we must try our best to decrease the ascites preoperatively to improve the condition.

Objective To investigate the augmentation plating for femoral fractures and postoperative femoral nonunion. Methods A retrospective analysis was conducted of 60 patients with femoral fracture or postoperative femoral nonunion who had been treated with augmentation plating from January 2008 to July 2015. They were 36 males and 24 females, aged from 15 to 79 years ( average, 43. 4 years ) . Of them, 20 cases suffered nonunion following intramedullary nailing of femoral shaft fracture, 18 nonunion following lateral plating for femoral distal or lower fracture, and 22 femoral distal or lower fracture complicated with comminuted fracture of medial column. An incision ranging from 6 to 10 cm was made around the fracture ends for augmentative plating for all the patients. Autogenous iliac bone graft was performed in patients with atrophic nonunion or ob-vious gap after reduction of the comminuted fracture. Operation time, intraoperative bleeding, healing time, complications, and functionary recovery of the affected knee were recorded. Results The operation time averaged 121. 5 min and the intraoperative bleeding 356. 3 mL. All the patients were followed up for 12 to 36 months ( average, 16. 9 months ) . All the fractures and nonunions healed after an average time of 4. 2 months ( from 3 to 4 months ) . The time for initial partial weight-bearing averaged 4. 5 weeks ( from 2 to 6 weeks ) and the time for initial full weight bearing 3. 3 months ( from 2 to 4 months ) . Evaluation according to the Karlstrom and Olerud criteria at the last follow-up revealed 29 excellent, 24 good and 7 fair cases, yielding an excellent and good rate of 88. 3％. No infection, loosening, bending or breaking of internal implants, or refracture was noted during follow-ups. Conclusion Augmentation plating through a small incision can lead to fine outcomes for femoral fractures and postoperative femoral nonunion, because it makes up the deficient stability of original in-ternal fixation, reduces the dislocated bone blocks and provides bone grafting to improve defective local bone structure and defective osteogenesis.

BACKGROUND: Lateral locking plate is a classical fixation method to treat lower and distal femoral fractures. However,the incidences of delayed healing, nonunion, plate extubation, and internal fixation rupture exceed 20% after internal fixation.OBJECTIVE: To compare the effectiveness of augmentation plating and single plating for distal and lower femoral fractures with medial comminution.METHODS: Totally 60 patients of lower and distal femoral fractures with medial comminution treated with open reduction and plate fixation were divided into augmentation plating (treatment group, 28 cases) and single lateral plating (control group, 32 cases). We observed the operation time and blood loss, recorded the out-off-bed rehabilitation time, full weight bearing time and complication. The functionary recovery of knee joint was evaluated according to Schatzker-Lambert method for distal femoral fractures in final follow-up.RESULTS AND CONCLUSION: (1) All patients were followed for at least 12 months. All incisions were healed by first intention. (2) The operation time and blood loss in the treatment group were greater than those in the control group (P <0.05). (3) The healing time (3.11±0.31 months), out-off-bed rehabilitation time (4.36±0.91 weeks), full weight bearing time (3.67±0.62 months), complication (0) and excellent and good rate of knee functionary recovery (100%) in the treatment group were better than those in the control group [(5.65±2.33), (7.25±1.02), (6.03±2.61) months, 8, 65.6%] (P < 0.05). (4)Although augmentation plating for treatment of lower and distal femoral fractures with medial comminution prolongs operation time and increases surgical blood loss, the results including the healing rate, complication and satisfaction rate are superior to those treated with single lateral plating.

Objective To analyze the therapeutic effect of Masquelet technique in the treatment of bone defects.Methods From January 2008 to December 2014,20 patients with bone defects were treated by Masquelet technique.There were 15 males and 5 females,from 18 to 69 years of age (average,38.4 years).Four cases had open bone defects and 16 infectious ones.At the first stage,radical debridement of the bone defects and soft tissue was conducted via conventional approaches.The bone defects ranged from 2 to 9 cm,averaging 6.1 cm.At the second stage,internal fixation was applied in 18 cases and external fixation in 2.The interval from the second stage to the first stage operation ranged from 6 to 23 weeks (average,11.5 weeks).The healing of bone defects and the functional recovery of adjacent joint were evaluated by Paley scoring at the last follow-up.Results The 20 patients were followed up for 12 to 50 months (average,19.7 months) after the second stage operation.All the patients obtained uneventful wound healing and control of infection after the first stage operation except the one with infectious defects who had to receive 2 operations to control the infection at the first stage operation.At the second stage operation,obvious injury and defect of the induced membrane occurred in 4 cases.All the patients achieved clinical healing of bone defects after 3 to 6 months (average,4.8 months).The bone defect healing was graded as excellent in all.After bone healing,all the patients resumed weight-bearing activities,with no breakage or infection of fixators,or recurrence of infection.By the Paley scoring at the last follow-up,the functional recovery of the adjacent joint was excellent in 8 cases,good in 10 and fair in 2,yielding an excellent and good rate of 90.0％.Conclusion As a kind of modified free bone grafting,Masquelet technique has advantages of simplicity,limited complications,a high rate of healing,and good control of bone infection.

Objective To investigate the influencing factors and technical points of induced membrane technique for treatment of bone defect.Methods All of 20 patients of bone defect were treated by induced membrane technique in our hospital from January 2008 to November 2014,including 15 males and 5 females;aged 13-69,average 38.5;infectious bone defect in 16 cases and non-infectious bone defect in 4 cases.Record the complications,evaluate the healing of bone defect and functional recovery of adjacent joints by Paley method,respectively,and grade the range of movement (ROM) of adjacent joints by authors's method.Results In the first stage of surgery,1 case needed a second operation as the wound gradually spitted and bone cement contaminated after tighten closure of the skin flap,while others had no infection or recurrence of infection.In the second stage of surgery,3 cases had induced membrane damage and defect.All were followed-up from 12 to 50 months (average 19.7 months);all the bone defects healed,the clinical healing time was 3.0 to 7.0 months (average 4.7 months).The healing time in the 3 cases with induced membrane damage and defect (average 6.0 months) was longer than that in patients without induced membrane damage and defect(average 4.6 months).1 case of infectious bone defect with induced membrane damage and defect had local infection in 6 months after the second stage of surgery,for whom the conservative treatment was invalid but got controlled after second operation while 1 case of infectious bone defect without induced membrane damage and defect had local infection in 12 months after second stage of surgery,in whom the infection was controlled by the conservative treatment,the others had no infection or recurrence of infection,no broken of fixators noted;at the last follow-up,all the bone defect healing graded excellent,the functional recovery of the adjacent joints graded:excellent in 8 cases,good in 10 cases,and fair in 2 cases (the excellent and good rate was 90％),the ROM of the adjacent joints graded:excellent and good in 8 cases,respectively,fair and poor in 2 cases,respectively (the excellent and good rate was 80％).Conclusion Induced membrane technique has advantages of simple surgery,faster healing of bone defect,no correlation between the healing time and the length of bone defect,fewer complications,etc,but in clinical application,the operators must understand the therapy principle and pay attention to the influencing factors and technical points so as to avoid operation errors,reduce complications and improve therapeutic effect.

Objective To investigate the principles and effects of cancellous bone wrapping grafting for treatment of segmental defects of long bone.Methods From January 2008 to December 2015,50 patients with segmental long bone defect were treated by various wrapping grafting with rich autogenous cancellous bone.They were 31 males and 19 females,aged from 13 to 69 years (average,34.6 years).The cancellous bone was wrapped by titanium mesh in 8 cases,by wire mesh in 10,by line binding in 13,and by induced membrane in 19.The bone defect was located at tibia in 22 cases,at radius in 10,at humerus in 8,at ulna in 7 and at femur in 3.The length of bone defect ranged from 3 to 9 cm,averaging 5.9 em.Bone healing,complications and functionary recovery of adjacent joint were recorded.The bone defect healing and functionary recovery of adjacent joint were evaluated according to the Paley criteria.Results The incisions healed by the first intention in 48 cases and by the second in 2.All were followed up for 12 to 48 months (average,19.1 months).All the bone defects healed by the first intention but one treated by induced membrane wrapping which was healed 15 months later by the secondary grafting due to nonunion at ends.The total clinical healing time ranged from 3 to 16 months (average,6.1 months).The last follow-ups showed that all the affected limbs resumed weight-bearing activities.The healing of bone defects was graded as excellent in all but one in the group of induced membrane wrapping.Totally,the functionary recovery of adjacent joint was excellent in 18,good in 22,fair in 7 and poor in 3 cases (an excellent and good rate of 80.0％).Conclusions Cancellous bone wrapping grafting can avoid or significantly reduce loosening and absorption of cancellous bone graft after traditional bone grafting.Although it is effective for treatment of large segmental bone defect,its methods should vary according to the specific conditions of the patient.

Objective To study the surgical treatment of hepatic hemangiomas and the timing of surgery.Methods A retrospective study was conducted on 908 patients with giant hemangiomas who underwent surgery between December 1997 and December 2017.The clinical data,surgical indications,surgical outcomes,lesion size,and the effect of TAE were compared.Results The diameter (mean + /-S.D.)of the resected hepatic cavernous hemangiomas was (11.1 ± 6.2) cm (the longest diameter was 60 cm).585 patients (64.4％) underwent enucleation of hepatic hemangiomas and 323 patients (35.6％) underwent anatomical hepatectomy.Six patients died perioperatively (mortality rate 0.7％).The incidence of severe complication (Clavien-Dindo grade 3 ～ 5) was 3.8％.The incidence of severe postoperative complication for enucleation (2.7％) was significantly less than anatomic liver resection (5.6％,P ＜0.05).When the lesion was more than 20 cm,the complication and mortality rates were significantly higher than those less than 20 cm (P ＜ 0.05).The complication and mortality rates in patients who underwent TAE before surgery were significantly higher than those without TAE (P ＜ 0.05).Conclusions Surgical enucleation of hemangiomas was superior to anatomical hepatectomy.With increase in tumor size,the risk of surgery increased.Surgical treatment was safe and effective for giant hepatic hemangiomas.For giant hepatic hemangiomas with significant increase in size,prompt surgical treatment is recommended.

Objective:To characterize the radial head fracture combined with capitulum cartilage injury (CCI).Methods:The data of 110 patients were analyzed retrospectively who had been treated for radial head fracture at Department of Orthopaedics, The Ninth People's Hospital of Wuxi from January 2011 to May 2020. They were 62 males and 48 females, aged from 17 to 74 years (average, 44.10 years). According to the finding of intraoperative exploration whether CCI was complicated or not, they were assigned into a CCI group and a CCI-free group. The diagnosis, location, size, type, operation method and postoperative recovery of CCI were observed in CCI group. The 2 groups were compared in terms of preoperative general data, range of forearm motion before and after operation and functional recovery of the limb by Mayo elbow performance score (MEPS).Results:CCI was complicated in 25 cases (type Ⅰ in 7 ones, type Ⅱ in 12 ones and type Ⅲ in 6 ones), involving all Mason types of radial head fracture, and located at the lateral capitellum in 13 cases, at the posterolateral capitellum in 9 cases and at the anterolateral capitellum in 3 cases. CCI was diagnosed before operation in 13 cases by physical examination after local anesthesia and imaging examination with a rate of 48% (12/25) for missed diagnosis. The preoperative flexion and extension (61.8°±13.7°) and rotation (60.0°±24.2°) in CCI group were significantly less than those in CCI-free group (77.7°±23.0° and 79.9°±21.9°) ( P<0.05); the Mason types of radial head fracture in CCI group were significantly more serious than those in CCI-free group ( P<0.05). There was no significant difference between the 2 groups in age, gender, combined injury, treatment of radial head fracture, follow-up time, range of forearm motion at the last follow-up or MEPS score ( P>0.05). Conclusions:CCI was complicated in 22.73%(25/110) of the radial head fractures in this cohort and found in all Mason types of radial head fracture, and mostly located at the lateral and posterolateral capitellum. CCI is likely to be missed by imaging examination. In patients with mild radial head fracture and suspected CCI, positive physical examination after local anesthesia is valuable for diagnosis of CCI complication and operative indication. Care should be taken to detect CCI complication by intraoperative exploration in surgery of radial head fracture.

Objective To investigate the clinical efficacy of free flap transplantation in repairing the Gustilo type ⅢB and ⅢC fractures of tibia and fibula combined with soft tissue defects.Methods A retrospective case series study was conducted on the clinical data of 46 patients who had Gustilo type ⅢB and ⅢC fractures of tibia and fibula with soft tissue defects admitted from June 2013 to January 2017.There were 34 males and 12 females,aged 1-67 years (mean,39 years).The wound defect areas ranged from 6 cm × 20 cm to 7 cm × 38 cm.According to the Gustilo fracture classification,there were 31 cases of type ⅢB and 15 cases of type ⅢC.According to the AO fracture typing,there were five cases of type A,23 type B,and 18 type C.All patients were repaired with free flap transplantation,among which 40 patients were treated with anterolateral thigh flap and six with latissimus dorsi flap.The areas of anterolateral thigh flap ranged from 6 cm × 13 cm to 14 cm ×32 cm,and those of the latissimus dorsi flap from 6 cm × 22 cm to 7 cm × 40 cm.Efficacy was evaluated by flap survival rate,complications,fracture healing time,lower limb function scoring system (LEFS),and skin flap function.Results All limbs were salvaged successfully.One case of total flap necrosis and eight cases of postoperative crisis occurred.After active exploration and treatment,three cases were seen distal local necrosis,and the total survival rate was 91％.Infection at the donor site was found in two cases.The complication incidence rate was 4％.All patients were followed up for 7-42 months,with an average of 19 months.The fracture healing time averaged 43.5 weeks,and the LEFS score averaged 54 points.According to the seven indexes of flap function,the results were excellent in 1 1 cases,good in 29 cases,fair in four cases,and poor in two cases,with an excellent and good rate of 87％.Conclusion Free flap transplantation can achieve satisfactory efficacy in treating Gustilo type ⅢB and ⅢC of tibia and fibula combined with soft tissue defects,with high limb salvage rate and good function recovery.