This paper reviews the advances concerning the diagnosis and treatment of carpal collapse. Systematic study on carpal collapse was launched only two decades ago. The improved roentgenologic diagnosis has deepened our understanding of the disorder. Its classification has helped doctors conduct objective follow ups of the progress and prognosis of the disease. And the related biomechanical research has made clear mechanism of the collapse which can serve as an important basis for choice of operative methods. The various partial carpal arthrodesis, of which the commonest is four corner arthrodesis, and proximal row carpectomy are proved to be effective in relieving most symptoms and ending the continuation of collapse, so they have become major treatment methods for the disease. But operative methods have to be chosen in the light of detailed conditions of radiocarpal and midcarpal joints. The silicon arthroplasty has been abandoned due to its serious complications.

Objective:To study the X-ray manifestations of distraction osteogenesis in tibial bone transfer, put for-ward the classification and formulate the standard treatment protocols.Methods:Data of 42 cases among 321 cases with dysplasia of distraction osteogenesis who had tibial bone transfer from January 2012 to December 2018 were retrospectively analyzed. There were 27 males and 15 females aged from 4-65 years old, with an average of 33.1 years. The dysplasia sites were 26 cases of proximal tibia, 3 cases of tibial shaft and 13 cases of distal tibia. The length of tibial defect ranged from 3.5 cm to 21.7 cm, with an average of 6.7 cm. The main management protocol included systemic assessment, local assessment, fixator adjusting stimulation and surgical intervention. The fixator adjusting stimulation included transport slowing, transport stopping, transport backing, and accordion techniques. The main surgical intervention was second site osteotomy and bone grafting. According to the X-films, the dysplasia of the tibia transport can be divided into four types: longitudinal defect; transverse defect; insect erosion defect; full-length defect. External fixation index (EFI) was used to evaluate the healing and mineralization of distraction osteogenesis. The limb function was evaluated by Paley method.Results:All 42 cases were followed up for 33.71 ± 11.7 months (range, 24-72 months). The types of dysplasia were as follows: 25 cases (59.5%) of longitudinal defects, 8 cases (19.0%) of transverse defect, 2 cases (4.8%) of insect erosion defect, and 7 cases (16.7%) of full-length defects. After the treatment, except for 2 cases of amputation, all the dysplasia healed and the patients recovered limb walking. External fixation index of 40 cases was 1.55-2.83 months/cm, with an average of 1.76 months/cm. According to Paley evaluation method, 27 cases were excellent, 10 cases good, 1 case fair, and 2 cases poor, thus the excellent and good rate was 92.5% (37/40). The complications after treatment included: nail tract infection (3 cases), axial displacement of transferred segment (4 cases), clubfoot (2 cases), and amputation (2 cases). The total incidence of complications was 26.2% (11/42), which was symptomatically treated.Conclusion:The X-film manifestations of dysplasia at the osteotomy site in tibial bone transport can be divided into four types: longitudinal defect, transverse defect, insect erosion defect, and full-length defect. The different types were treated by general and local evaluation, frame adjustment stimulation and surgical intervention. The remedial results of the dysplasia were excellent.

Objective To analyze risk factors for soft-tissue defects after surgery on leg trauma,to discuss methods for prevention of soft-tissue defects and its treatment.Methods A retrospective analysis was conducted on 217 cases of soft-tissue defects with bone exposure and / or internal fixation exposure after surgery on leg trauma from January,1999 to December,2012.Soft-tissue defects with various flaps were used in 201 cases,including neurocutaneous flap(89 cases),random flap(21 cases),free flap(75 cases),cross-leg flap(16 cases),and by skin grafting in 16 cases.For the 117 internal plate-fixated fractures,96 removed the plate and 21 cases did not remove the plate.For the 13 intramedullary nail fixations,4 cases of intramedullary nails were removed,9 cases were not removed.For the 56 cases of external fixation of the fractures,39 patients had unadjusted external fixation,17 cases re-adjusted external fixations.Results Of the 217 cases of soft-tissue defect after surgery on legs,201 cases were conducted flap surgery.The flap was completely necrosis in one case,and partial distal necrosis were in 14 cases,of which 6 cases healed after changing the dressing,5 underwent debridement and skin grafting,3 cases underwent flap surgery again.In cases of fracture patients,177 cases healed within 1 year,delayed union 23 cases,nonunion eight cases.Nonunion healing after bone grafting and re-fixation surgery.In 9 cases of uncontrollable osteomyelitis,6 patients underwent bone removal and bone transport surgery,3 patients underwent amputation.Conclusion Soft-tissue defects after surgery on leg trauma is a serious complication whose prevalence is associated,in a certain degree,with incorrect surgical time and methods.It is crucial for early repair of soft-tissue defects by using various kinds of proper flaps whenever soft-tissue complication occurs.In patients with early stage internal fixation,flap surgery without internal fixation removing is feasible if little soft-tissue defect,little exposed internal fixation and mild infection,otherwise it is necessary to remove internal fixation and re-fix by external fixation before flap surgery.

Objective To establish the reconstructive ladder for the leg without sufficient recipient vessels by case analysis and literature review.Methods From January,2009 to January,2015,772 cases were treated in our center using free flap for leg coverage and 129 cases were found intra-operatively to have insufficient recipient vessels.There were 113 males and 16 females,and the age ranged from 4 to 71 years,averaging 36.5 years.The wounds were post-traumatic (n=108) and non post-traumatic (n=21).The management methods included elongating incision (n=25),vessel transfer(n=22),Flow-through anastomosis(n=17),end-to-side anastomosis (n=13),useing neighboring vessels (n=1S),anastomosis distal to the injured zone (n=14),cross-leg free flap (n=7),and abandoning free flap transfer(n=13).Results Except for the cases of abandoning surgery (n=13,10.1％),there were 86 cases whose flap healed totally (66.7％),9 cases total lost(7.0％),and 11 cases marginal loss (8.5％).It established a reconstructive ladder for this special situation according to the principle of difficulty level.Conclusion The insufficient recipient vessels of the leg were had multi-causes which should be taken account generally before surgery.The optimal protocol for each case should be chosen from the reconstructive ladder based on the technical difficulty level.

Using scanning electromicroscope, seven species of anopheline mosquito eggs were studied. Among them, the microstructure of exochorion of Anopheles liangshanensis. An. kweiyangensis An. kunmingensis, An. hyrcanus and An. messeae were not reported before. The results showed that ultrastructure of plastron network, frill and tubercles of deck were useful in distinguishing sibling species of anopheline eggs. Microstructure of float had little difference between species. The micropylar area and lobed tubercles presented obvious intraspecific variations, so, it should be careful for using in classification.

Objective To evaluate the results of NiTi shape memory alloy four-corner arthrodesis concentrator (NTMA-FCAC) for carpal collapse. Methods We reviewed retrospectively 13 patients who underwent scaphoid excision with four-corner arthrodesis using NTMA-FCAC for carpal collapse from August 2006 to June 2009. There were eight males and five females, with an average age of 38 years (range, 23-61years). The cause of carpal collapse was SNAC in 7 cases, perilunate dislocations in five and SLAC in one.The injury mechanisms included traffic accidents (5 cases), falling from a height (4 cases), crashes (3 cases)and sprain (1 case). Objective measurements included grip strength and range of the wrist. Radiographs were performed in all patients. A visual analogue scale (VAS) was used to assess wrist pain. The results were evaluated according to the Krimmer wrist scores. Results The mean follow-up time was 26.5 months (range,6-36 months). Clinical evaluation yielded the mean grip strength of (32.49±6.21) kg (80.8% of opposite side).The mean range of the wrist reached over 53% of the healthy side. Non-union and wound infection were not seen. The mean VAS scores had improved from 4.46±1.27 preoperatively to 1.31 ±0.95 postoperatively. The mean pain scores under stress had improved from 7.00±1.41 preoperatively to 2.62±1.26 postoperatively.There were remarkable differences between them. The mean Krimmer wrist score was 79. Conclusion Four-corner arthrodesis using NTMA-FCAC is an effective method for carpal collapse, preserving a majority of wrist function.

Objective Retrospectively investigate the application of anterolateral thigh flow-through flap in reconstruction of the extremities,to estimate its role and characteriscts.Methods From March,2010 to January,2016,anterolateral thigh flow-through flap was performed for reconstruction of the extremities in 87 patients (56 males,and 31 females).Patient ages ranged from 13 to 68 years,average of 34.4 years.Of all cases,there were 37 legs,21 ankles or foots,1 arm,19 forearms,and 9 hands.The role and result of anterolateral thigh flow-through flap was analyzed retrospectively.Results The result showed that when anterolateral thigh flow-through flap was transferred,which simutaneously played various roles as follows:①rebuilding main vascular defect,to revascularise the distal limb.② preserving recipient vessels,to prevent flow impaired.③rebulding recepient vessel defect.④ protecting vascular anastomosis and preserving recipient flow simultaneously.⑤avoiding the dilemma of end-to-side anastomosis when recipient vessels is deep.⑥ balancing blood flow,the blood supply of the flap was more stable.⑦ linking another tissue in a series fashion,to achieve complex reconstruction.Vascular compromise occurred in 3 cases after surgery,total necrosis occurred in 1 case and partial necrosis in 1 case after reexploration.One case presented deep infection and secondary with renal failure,and received amputation.Local infection presented in 3 cases,wound dehiscence in 2 cases.All the other flaps survivled uneventfully,and its texture and color was normal.In donor site,local infection occurred in 1 case,wound dehiscence in 2 cases.Conclusion Anterolateral thigh flow-through flap has function of many sided reconstruction,which is able to play a vital role in reconstruction of the extremities.

AIM: To study the effect of salvia miltiorrhiza (SM) on cell contraction and intracellular calcium of enzymatically isolated rat ventricular myocytes during normoxia and anoxia/reoxygenation. METHODS: Contraction and intracellular calcium were determined with video tracking system and spectrofluorometric method, and the chemical anoxic method was employed. RESULTS: The ?d L /d t max , dL of cell contraction and the amplitude of [Ca 2+ ] i in the cardiomyocytes following SM treatment were decreased in a dose-dependent manner. During anoxia, the ?d L /d t max , dL and amplitude of [Ca 2+ ] i were decreased, while the diastolic Ca 2+ level was elevated compared with control group. All the contractile parameters and the diastolic Ca 2+ level were back toward pretreatment values during reoxygenation, but could not return to control level. After the treatment with SM (3 g/L), ?d L /d t max and dL of cell contraction and the amplitude of [Ca 2+ ] i were higher and the diastolic Ca 2+ level was lower than those in anoxia/reoxygenation group. CONCLUSION: SM antagonized effects of anoxia and reoxygenation on cell contraction and intracellular calcium in isolated ventricular myocytes.

Objective To investigate the role of HO-1 in the protection of rat heart from anoxia/reoxygenation induced injury and its underlying mechanism.Methods LVEDP,LVDP and dp/dtmax were analyzed by the Langendorff method in isolated rat heart.Lactate dehydrogenase(LDH), infarct area,COHb and 6-keto-PGF1? were further determined in the experiment.Results After intraperitoneal injection of HO-1 inducer hemin,CO concentration in rat blood enhanced(P

Objective To evaluate the locating effects of a portable ultrasound for leg perforator flaps,and the clinical effects of leg perforator flaps for the wounds of the extremities.Methods Since December 2009 to March 2011,thirty-one cases of soft tissue defects of the extremities were treated with free vascularized leg perforator flaps in our center.A portable ultrasound were used for the locating of the perforator arteries of the leg before the operations.These flaps include 24 cases of the fibular artery perforator flaps (4 with simultaneous fibula transfer),three cases of the posterior tibia artery perforator flap,two cases of the medial gastrocnemius artery perforator flap,and 2 cases of the lateral gastrocnemius artery perforator flap.The flap size ranged from 15.0 cm × 8.0 cm to 1.0 cm × 1.5 cm.The caliber diameter of the perforator artery ranged from 0.2 mm to 1.8 mm.The wounds included 21 cases of the hand,five cases of the forearm,and 5 cases of the leg.Results The coincidence rate intraoperatively of the portable ultrasound was 96.8％.All the flaps survived and the wounds healed uneventfully.The donor site of the flaps were either closed directly or closed with partial split-thickness skin graft.Conclusion The portable ultrasound is an effective,reliable and accurate instrument for locating the leg perforator flaps.The leg perforator flaps have the advantages of convenient harvest,satisfactory thickness,less donor site morbidity,and high survival rate.