Objective To investigate the feasibility and clinical effect of damage control theory for patients with high?energy Pilon fracture?Methods Fifty?three cases patients with high?energy Pilon fracture were selected in the Traditional Chinese Medical Hospital of Foshan from March 2013 to June 2014 as observation group ( DCO group ) , 46 cases of non?DCO guidance high?energy Pilon fracture as the control group?Intraoperative blood loss,operative time,hospital stay,complications,fractures and function were compared between two groups?Results After the treatments,the intraoperative blood loss,operative time in the DCO group were significantly better than those in the non?DCO group((88?79±4?96) ml vs?(117?74±6?74) ml,(67?44 ±4?75) min vs?(81?43±3?66) min),theses differences were statistically significant between the two groups(t=3?720,5?601,P<0?05)?The complications in the DCO group were significantly less than those in the non?DCO group(22?6%(12/53) vs?52?2%(24/46)),the difference was statistically significant between the two groups(χ2=5?013,P=0?014)?The excellent rate of in the DCO group were significantly better than those in the non?DCO group( 64?15%( 34/53) vs?41?30%( 19/46) ) ,the difference was statistically significant between the two groups (χ2 =6?097, P=0?000 )?Conclusion Reasonable application of the DCT can be quickly and effectively to save the patient's life and improve stability fracture,and reduce the incidence of complications?It is a safe and effective method.

Objective:To evaluate three-stage induced membrane technique combined with anterior and posterior double-plate fixation in the treatment of a total talus defect after infection.Methods:Included in this study were 11 patients with talus infection who had been treated at Department of Orthopaedics, Foshan Hospital of Traditional Chinese Medicine from January 2014 to December 2018. They were 8 males and 3 females, aged from 23 to 63 years (mean, 37.0 years). The infection followed re-implantation after open dislocation of total talus in 4 cases, internal fixation for open talus fracture of Gustilo type Ⅲa in 3 cases and surgery of open ankle fracture of Gustilo type Ⅲc in 2 cases, and was complicated with ankle intraarticular tuberculosis in 2 cases. The three-stage operations consisted of debridement, total talus resection, implantation of antibiotic bone cement and vacuum sealing drainage at the first stage, change of bone cement, re-debridement, wound closure or flap covering at the second stage 7 to 10 days later, and reconstruction after infection control using anterior and posterior double-plate fixation and induced membrane technique at the third stage 6 to 12 weeks later. Assessment of lower limb shortening was performed by comparing the full length of the leg between the normal and affected sides; the functions were assessed by comparing the ankle-hindfoot scores of American Orthopedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) between preoperation and the final follow-up.Results:The 11 patients were followed up for an average of 24.3 months (from 12.2 to 37.5 months). Superficial skin necrosis was observed in 2 patients and injury to superficial peroneal nerve in one. Absolute calcification of the autograft area was observed in all patients, leading to ankle fusion. The final follow-ups observed no significant difference in the full length of the leg between the normal and affected sides [(380.4±35.5) mm versus (376.3±32.8) mm] ( P>0.05) , a significant increase in the ankle-hindfoot AOFAS scores from preoperative 28.0±3.4 to 72.8±5.4, and a significant decrease in VAS scores from preoperative 5(5,6) to 0(0,1) (all P<0.05). Slight varus developed in 2 patients and slight ankle stiffness in 3; recurrence of infection or breakage of implants was found in none of the patients. Conclusion:Three-stage induced membrane technique combined with anterior and posterior double-plate fixation can effectively control infection of the talus, maintain the length and reconstruct the function of the lower limb after a total talus defect.

Objective:To study the efficacy of minimally PCWO combined with Akin osteotomy on severe hallux valgus.Methods:This retrospective study was conducted on 45 patients (50 feet) with severe hallux valgus treated by minimally PCWO combined with Akin osteotomy in Eight Department of Bone, Foshan Hospital of traditional Chinese Medicine from August 2016 to August 2018. HVA, IMA, DMAA, DASA, IPA were measured by X-ray examination preoperatively and after operative 3, 6, 12 months and at the final follow-up. The efficacy was evaluated in accordance with the American Orthopaedic Foot and Ankle Association (AOFAS) Ankle Hindfoot Scale and the Olerud-Molander Ankle (OMA) Score. The absolute and relative lengths of the first metatarsus were measured by X-ray examination preoperatively and at the last follow-up, with calculating the differences.Result:All patients were followed up within 18.20±2.04 months. There was no recurrence during follow-up period. HVA was 42.83°±4.63°, 12.83°±1.53°, 13.49°±1.33°, 14.08°±1.49° and 14.12°±1.35° at the preoperative, postoperative 3 months, 6 months, 12 months and the last follow-up, respectively, and the difference between pre-operation and post-operation was statistically significant ( P<0.05). IMA was 18.29°±0.94°, 7.84°±1.22°, 8.31°±1.03°, 9.01°±1.08° and 9.09°±1.11° at the preoperative, postoperative 3 months, 6 months, 12 months and the last follow-up, respectively, and the difference between pre-operation and post-operation was statistically significant ( P<0.05). AOFAS scores were 50.64±7.94, 88.80±2.68, 90.10±3.51, 91.20±3.89 and 91.37±3.71 points at the preoperative, postoperative 3 months, 6 months, 12 months and the last follow-up, respectively, and the difference between pre-operation and post-operation was statistically significant ( P<0.05). The OMA scores were 61.00±7.00, 90.90±5.02, 91.60±4.57, 93.20±3.61 and 93.48±4.91 at preoperative, postoperative 3 months, 6 months, 12 months and the last follow-up, respectively, and the difference between pre-operation and post-operation was statistically significant ( P<0.05). The absolute shortening of the first metatarsal was 3.03 mm and relative shortening was 0.72 mm. Conclusion:For severe hallux valgus, minimally PCWO combined with Akin osteotomy can effectively correct the hallux valgus deformity with small surgical incision, high safety and curative effect, which is worthy of popularization and application in clinical.

Objective:To analyze the influences of leukocytes on improving blood glucose control in patients with type 2 diabetes mellitus (T2DM) and periodontitis after periodontal mechanical therapy.Methods:Thirty-five patients visiting Peking University Third Hospital from March 2011 to August 2012, as well as thirty-four patients visiting Peking University School and Hospital of Stomatology from March 2011 to August 2012 and December 2016 to December 2018 were selected in this research. These subjects were non-smokers, and with moderate to severe chronic periodontitis and T2DM. The full set of periodontal examinations including probing depth (PD), attachment loss (AL), bleeding index (BI) and plaque index (PLI) were conducted. Besides, counts of white blood cells (WBC), parameters of glucose and lipids metabolites such as fasting blood glucose (FBG), glycosylated hemoglobin (HbA 1c), total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL) in serum were examined before treatment. Then, oral hygiene instruction, scaling and root planing (SRP) were carried out. Three months after SRP, the baseline examinations were repeated in all patients. According to the baseline leukocyte counts, the patients were divided into subgroups: low WBC group (WBC<6.19×10 9/L) and high WBC group (WBC≥6.19×10 9/L). Paired t-test for comparison of changes after treatment, analysis of co-variance for comparing the intervention effects between subgroups, and multifactor Logistic regression analysis were performed. Results:Three months after SRP, all periodontal indexes were significantly improved in both groups. Leukocyte counts decreased significantly in high WBC group (6.89±1.53 vs. 7.64±1.51, P=0.008). In high WBC group, HbA 1c (7.18±1.09 vs. 7.67±1.35, P=0.001) and LDL (2.67±0.85 vs. 3.28±0.76, P=0.042) decreased significantly, while there were no such differences in low WBC group. Influence of leukocyte level on HbA 1c ( OR=0.12, P=0.038) and LDL ( OR=0.15, P=0.001) improvement was statistically significant. Hierarchical analysis showed such improvement notably perform in female [HbA 1c ( OR=0.30, P=0.021), LDL ( OR=0.34, P=0.001)] and severe periodontitis group [HbA 1c ( OR=0.15, P=0.025), LDL ( OR=0.24, P=0.017)]. Through interaction test, female and leukocyte counts at baseline had relative excess risk affecting the effect of periodontal intervention on HbA 1c ( P=0.036) and LDL ( P=0.005). Conclusions:SRP could significantly improve the blood glucose and lipid control in patients who had T2DM and chronic periodontitis with relative higher leukocytes level. Female patients with severe periodontitis showed more obviously effects.