Administration, Oral ; Calcium Compounds ; poisoning ; Humans ; Sulfides ; poisoning

Objective To analyze the associations between long-term outcomes of fresh femoral neck fractures treated with cannulated screws and the classification based on vertical neck (VN) angle.Methods A retrospective study was conducted of the 162 fresh femoral neck fractures treated with 3 cannulated screws at Department of Orthopaedics,The Sixth People's Hospital of Shanghai from January 2012 to December 2014.The relationships were analyzed using Logistic Regression between long-term complications and VN classification,including fixation failure,fracture nonunion and osteonecrosis of femoral head (ONFH).Results All the patients were followed up for an average of 25.7 months (from 6 to 36 months).Of them,151 obtained fracture union after an average of 4.5 months (from 3 to 9 months).Internal fixation failure occurred in 23 cases,nonunion of femoral neck in 11,ONFH in 21 and femoral neck collapse in 13.Logistic Regression analysis showed no significant associations between internal fixation failure,nonunion or ONFH and gender,age or reduction method (P ＞ 0.05) but significant associations of VN classification with fixation failure (P ＜ 0.001) and nonunion (P =0.001) and insignificant association of VN classification with ONFH (P =0.109).Conclusion VN classification,a new classification method for femoral neck fractures,may be closely related with incidences of fixation failure and nonunion.

Objective:To evaluate the clinical efficacy of percutaneous channel screwing assisted by the robot navigation positioning system combined with pelvic unlocking reduction frame for pelvic fractures.Methods:A retrospective analysis was conducted of the 12 patients with pelvic fracture who had been admitted to Department of Orthopaedics, The First Affiliated Hospital to Anhui Medical University from January to October 2018. They were 7 men and 5 women with an average age of 42.3 years (from 25 to 62 years). The time from injury to operation averaged 5.1 days (from 2 to 10 days). There were 2 cases of type B1, 5 ones of type B2 and 5 ones of type C1 according to the Tile classification. After closed reduction using the pelvic unlocking reduction frame, the orthopedics robot navigation positioning system was used to guide the placement of percutaneous screws. The posterior rings were fixated with sacroiliac screws, and the anterior rings with pubis screws, pubic symphysis screws or external fixation. The placement time for each screw, fluoroscopy frequency, reduction quality, fracture union time, function of the affected hip and complications at the final follow-up were recorded.Results:A total of 25 percutaneous screws were inserted in the 12 patients with a mean fluoroscopic frequency of 4.7 times (from 3 to 8 times) and a mean placement time of 14.9 min (from 12 to 20 min). According to the Matta rating system, the fracture reduction was rated as excellent in 7 cases, as good in 4 and as fair in one. The average follow-up time was 11.3 months (from 6 to 16 months). All fractures healed after an average period of 11.8 weeks (from 10 to 14 weeks). By the Majeed scoring, the pelvic function at the final follow-up was excellent in 8 cases and good in 4. The follow-ups observed no infection, nerve injury, deep vein thrombosis, heterotopic ossification, implant looseningor traumatic arthritis in these patients.Conclusion:Percutaneous channel screwing assisted by the robot navigation positioning system combined with pelvic unlocking reduction frame can reduce operative time and risks and lead to minimal invasion for pelvic fractures.

Acetabular both-column fractures, the most complex type in acetabular fractures, are usually caused by high-energy violence, accounting for 20% of all the acetabular fractures. Most of them need surgical treatment. Because fracture fragments in the posterior column are various, controversy exists in the treatment of the posterior column. This article summarizes the modes of exposure and internal fixation, like anterior approach, posterior approach, screwing and plating, for the posterior column injury in the acetabular both-column fractures, hoping to help proper clinical choice of the modes.

Objective:To investigate the effect of Ilizarov bone transport technique combined with vancomycin bone cement for treatment of posttraumatic tibial bone infection combined with bone and soft tissue defects.Methods:A retrospective case series study was performed on 11 patients with posttraumatic tibial bone infection combined with bone and soft tissue defects admitted to First Affiliated Hospital of Anhui Medical University from June 2016 to June 2019.There were 7 males and 4 females, with age of 21-56 years [(41.5±12.1)years]. After debridement, the length of bone defect was 4-13.2 cm [(8.1±2.6)cm], and the area of soft tissue defect was 6.5-23.4 cm 2 [(16.2±4.7)cm 2]. All patients were treated firstly with debridement of bone infection and vancomycin loaded bone cement pad filling, followed by Ilizarov technique to repair bone and soft tissue defects. The soft tissue docking time, fracture docking time, external fixation time and external fixation index were recorded. At the last follow-up, Johner wruhs score was used to evaluate the curative effect and American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot score to evaluate the ankle joint function. The postoperative complications were observed. Results:All patients were followed up for 17-23 months [(17.9±4.5)months]. The soft tissue docking time was 48-155 days [(101.7±29.0)days] and fracture docking time was 55-167 days [(111.6±29.5)days]. The external fixation time was 154-450 days [(322.9±86.3)days] with an external fixation index of 31.1-61.5 cm/day [(40.8+ 7.5)cm/day]. At the last follow-up, the results were excellent in 2 patients, good in 4 and fair in 5 based on Johner-Wruhs score. At the last follow-up, the AOFAS ankle hindfoot score was 61-94 points [(76.6±12.7)points], with excellent results in 3 patients, good in 2 and fair in 6. Four patients were treated with secondary operation, and two of them bad docking site nonunion which healed after secondary bone grafting. No free or local transposition flap repair was performed in regardless of soft tissue defect. During the follow-up, there were no complications such as fever, wound weeping, soft tissue necrosis or neurovascular injury.Conclusion:For posttraumatic tibial bone infection combined with bone and soft tissue defects, the Ilizarov bone transport technique combined with vancomycin-loaded bone cement has advantage of shorter operation time, trauma and complications, and can achieve bone lengthening and soft tissue healing simultaneously.

Early hemoperfusion in poisoned patients can remove poisons rapidly and effectively, which plays an important role in improving the prognosis of patients. The key of hemoperfusion therapy is the safe and effective anticoagulation. The local citrate anticoagulation effect acid is good, it also has little effect on the systemic coagulation mechanism and internal environment of patients, so it is worthy of promotion. We retrospectively analyzed the clinical data and treatment of 273 patients who were poisoned by citrate anticoagulant in the emergency intensive care unit of the Second Affiliated Hospital of Shandong First Medical University, aiming at perfusion of citrate anticoagulant in patients with poisoning. Provide a certain clinical reference.

Objective To investigate the value of dual-exponential model intravoxel incoherent motion (IVIM) DWI and conventional single-exponential DWI model based on readout segmentation echo-planar (RS-EP) sequence in differential diagnosis of simple rhinitis and chronic hypertrophic rhinitis.Methods Totally,20 patients confirmed by pathology were enrolled in this study and all of them underwent IVIM DWI and conventional DWI.The pure diffusion (D),pseudo-diffusion (D*),perfusion fraction (f) and conventional ADC maps were obtained respectively.The quantitative parameters of anterior,middle,posterior regions of inferior nasal concha mucosa were measured.Comparative statistical analysis was performed for comparing two groups and three regions.ROC analysis was conducted to assess the diagnostic performance.Results The ADC and D values in the simple rhinitis group were (1 938.84 ± 170.46) × 10-6 mm2/s,and (1 698.91 ±145.17) × 10-6 mm2/s.In chronic hypertrophic rhinitis group,the ADC value was (1 681.76± 132.21) × 10-6 mm2/s,and the D value was (1 439.39 ± 101.26)× 10-6 mm2/s.There were significant differences between the two groups (both P＜0.05).No significant differences were found for D* and f values between two groups (both P＞0.05).ADC values increased significantly from anterior region,middle region to posterior region (all P＜0.05).No significant difference was found for D* value among three regions (P＞0.05).ROC analysis demonstrated a higher area under the curve (AUC) for D value than ADC value (0.932±0.044 vs 0.896±0.058) with sensitivity,specificity,accuracy,positive and negative predictive values of 92.31％,93.75％,90.00％,93.75％,85.71％.Conclusion Based on RS-EP sequence,both IVIM DWI model and conventional single-exponential DWI model demonstrated great value in differential diagnosis of simple rhinitis and chronic hypertrophic rhinitis,and the IVIM-derived D value exhibited a higher diagnostic performance than the conventional ADC value.

Objective:To prospectively guide the change of chemotherapy regimen in mouse 5-fluorouracil (5-FU) resistance subcutaneous xenograft tumor model derived from gastric cancer patients by the early changes of MRI apparent diffusion coefficient (ADC), and to compare the difference of tumor load between ADC guided dressing change group and volume guided dressing change group.Methods:From January to June 2020, thirty patient-derived xenografts mouse models were established using 5-FU resistant gastric cancer cells coming from patients, and were randomly divided into experimental group and control group by AdaBoost algorithm, with 15 mice in each group. On the 26th day after transplantation, all mice began chemotherapy with 5-FU as the first-line chemotherapy drug, and underwent MR examination once every two days, including T 2WI and diffusion weighted imaging (DWI). Volumes of tumors were measured using an open-source software ITK-SNAP and values of ADC were measured on ADC maps. According to the change rate of tumor ADC value in the experimental group and the tumor volume growth rate in the control group, the replacement time of chemotherapy drugs was determined, and 5-FU was replaced by paclitaxel. The end point of the experiment was the day that the mice entered the cachexia state. Independent-sample t test was used to compare the difference of tumor load between the two groups. Results:After 5-FU treatment, the ADC value of the two groups both increased. The ADC value began to decline on the 4th day after chemotherapy, and the experimental group continued chemotherapy with paclitaxel instead of 5-FU at this time point. The tumor volume growth rate of the control group increased significantly on the 6th day after chemotherapy (from 8.6% to 16.1%), and the control group used paclitaxel instead of 5-FU chemotherapy at this time point. The observed end point was on the 18th day after chemotherapy. The tumor load of the experimental group [(1.82±0.09) cm 3] was lower than that of the control group [(2.01±0.09) cm 3], and the difference was statistically significant ( t=2.25, P=0.033). On the 16th day after chemotherapy in the experimental group and the 18th day after chemotherapy in the control group, the time of paclitaxel administration in both groups was 12 days. The tumor load in the experimental group [(1.61±0.12) cm 3] was also lower than that in the control group [(2.01±0.09) cm 3], and the difference was statistically significant ( t=2.03, P=0.040). Conclusions:For the subcutaneous transplantation model of 5-FU resistant gastric cancer mice, according to the early changes of tumor ADC value after chemotherapy, the replacement of chemotherapy drugs can obtain a lower tumor load, suggesting that it is a feasible method to optimize the chemotherapy regimen.

OBJECTIVE: To explore the reduction and support effect of the subchondral screw compression technique for residual or secondary collapse of the lateral tibial plateau during operation. METHODS: Between January 2020 and June 2021, 11 patients with residual or secondary collapse of the lateral tibial plateau during operation were treated with the subchondral screw compression technique. There were 6 males and 5 females, aged 52.3 years old (range, 27-64 years). The fractures were caused by traffic accident in 10 cases and falling from height in 1 case and located at the left knee in 6 cases and the right knee in 5 cases. According to Schatzker classification, there were 5 cases of type Ⅱ fractures, 4 cases of type Ⅲ fractures, and 2 cases of type Ⅴfractures. According to the three columns classification, there were 5 cases of lateral column, 4 cases of lateral column and posterior column, and 2 cases of three columns. The time from injury to operation was 4.5 days (range, 3-7 days). During the follow-up, X-ray films were obtained and the Rasmussen standard was used to evaluate the quality of fracture reduction, meanwhile fracture healing was observed. The medial proximal tibial angle (mPTA), posterior tibial slope angle (pTSA), and articular surface collapse were measured at immediate and 12 months after operation. The knee joint range of motion was evaluated at last follow-up, and the knee joint function was evaluated using the Hospital for Special Surgery (HSS) score. RESULTS: All operations were successfully completed, with a mean operation time of 71.4 minutes (range, 55-120 minutes), and a mean hospital stay of 8.0 days (range, 5-13 days). The incisions all healed by first intention, without complications such as infection, flap necrosis, or vascular and nerve injury. All patients were followed up 16.5 months on average (range, 12-24 months). X-ray films showed that the fracture reduction score was 14-18 (mean, 16.7) according to Rasmussen score criteria; and 5 cases were rated as excellent and 6 as good. All fractures healed clinically with a mean clinical healing time of 14.9 weeks (range, 12-16 weeks), and there was no complications such as plate or screw loosening. At 12 months after operation, the mPTA and pTSA were (87.5±1.7)° and (6.2±3.1)°, respectively; there was no significant difference when compared to the values at immediate after operation [(87.6±1.8)° and (6.5±3.1)°] ( P>0.05). The articular surface of the tibial plateaus was effectively supported, and it collapsed again by 0-1.0 mm at 12 months, with an average of 0.4 mm. At last follow-up, the knee joint range of motion was 115°-135° (mean, 126.8°) and the HSS score for knee joint function was 87-98 (mean, 93.9). Five patients underwent secondary operation to remove the internal fixator at 12-18 months after operation. CONCLUSION The subchondral screw compression technique is helpful for the reduction of residual or secondary collapse of the lateral tibial plateau during operation, and can provide good support for osteochondral blocks.
Male ; Female ; Humans ; Middle Aged ; Tibial Fractures/complications* ; Fracture Fixation, Internal/methods* ; Treatment Outcome ; Knee Joint/surgery* ; Bone Screws ; Retrospective Studies

OBJECTIVETo investigate the different effect of three methods of blood purification for paraquat poisoning patients:hemoperfusion (HP), hemoperfusion combined with hemodialysis (HP + HD), hemoperfusion combined with continuous veno-venous hemofiltration (HP + CVVH).

METHODS72 cases of paraquat poisoning patients were divided into three groups after giving conventional therapy HP group, HP + HD group, HP + CVVH group. Compared the rate of decline concentrations of paraquat in blood, the liver and the kidney damage between before and after blood purification and contrast the mortality in three groups after different method of blood purification.

RESULTSThe rate of decline concentrations of paraquat in blood of the HP + HD group and HP + CVVH group were both significantly greater than the HP group, but this result of HP + HD group has no significant difference compared with HP + CVVH group; Among the three groups of patients after 72 hours, the degree of dysfunction of liver of the HP + HD group and HP + CVVH group were both significantly lower than the HP group, whilely the degree of dysfunction of kidney of the HP + HD group was significantly lower than the HP group and the HP + CVVH group. The survival time of the HP + HD group and the HP + CVVH group were significant linger than the HP group, but the comparison among the three groups had no significant difference in mortality.

CONCLUSIONThree blood purification methods can effectively remove paraquat absorbed into the blood, and the hemoperfusion combined with hemodialysis or continuous veno-venous hemofiltration can effectively reduce the degree of damage of liver and kidney and also can prolong survival time, but did not significantly improve the survival rate of patients.

Hemofiltration ; methods ; Hemoperfusion ; Humans ; Kidney ; Liver ; Paraquat ; blood ; toxicity ; Renal Dialysis ; Survival Rate ; Treatment Outcome