OBJECTIVETo study the effectiveness of pie-crusting technique in improving the stiff knee.

METHODSFrom February 2012 to December 2013, 13 patients with stiff knee were reviewed retrospectively. There were 6 males and 7 females, ranging in age from 39 to 70 years old (averaged, 55.6 years old). Of the 13 cases, 8 patients had stiffness following fracture (comminuted tibial plateau fracture in 4, femoral supracondylar fracture in 3 and patellar fracture in 1), 5 patients had TKA-related stiffness.

RESULTSA follow-up lasted 8 to 12 months (mean 10 months)in 13 cases. The mean maximum flexion increased from (37 ± 6)° preoperatively to (52 ± 7)° after arthrolysis, and (108 ± 7)° after pie-crusting. At the final follow-up, mean maximum flexion was (105 ± 6)°. According to Judet evaluation system, 10 patients got an excellent result and 3 good. No major complications, such as extensor lag, skin necrosis, deep infection, dislocation of the patella or recurrent stiffness were found.

CONCLUSIONThe percutaneous technique of pie-crusting is a simple, minimally invasive and effective treatment for knee stiffness.

Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Joint Diseases ; physiopathology ; surgery ; Knee Joint ; physiopathology ; surgery ; Male ; Middle Aged ; Range of Motion, Articular ; Treatment Outcome

OBJECTIVETo evaluate the reliability and diagnosis accuracy of 5 special tests used for the diagnosis of subacromial impingement syndrome (SAIS).

METHODSA prospective blinded cohort study was taken,in which 105 patients with shoulder pain were reviewed. All the patients took 5 special syndrome tests including Neer syndrome, Hawkins-Kennedy syndrome, painful arc empty can test and external rotation resistance test, also underwent arthroscopic surgical examination. The Nikolaus's criterion was regarded as a golden standard for SAIS. Data accuracy analysis was calculated through a receiver operating characteristic (ROC) curve, sensitivity, specificity, positive likelihood ratio (+LR) and negative likelihood ratio (-LR). The binary Logistic regression analysis was used to find out the best test combination for ruling in or out SAIS. The interrater reliability was assessed by the Kappa coefficient and percent agreement.

RESULTSThe ROC analysis indicated a significant area under the curve (AUC) (AUC=0.62 to 0.73, P<0.05) for all tests except the Hawkins-Kennedy. Tests with a +LR greater or equal to 2.0 were the painful arc,empty can,external rotation resistance, Tests with a-LR less than 0.5 were Neer,painful are ,external rotation resistance. The regression analysis found the painful arc, empty can and external rotation resistance made the best combination for diagnosis SAIS,while the painful are and external rotation resistance made the best combination for ruling out SAIS. The difference of ROC analysis was significant with a cut-off of 3 positive tests out of 5 tests. All tests had moderate to good agreement (Kappa=0.42 to 0.71).

CONCLUSIONThe single test of painful arc, empty can and external rotation resistance, as well as 3 or more positive tests of the 5 tests can help confirm the diagnosis of SAIS, while the single test of Neer, painful arc and external rotation resistance are help rule out the diagnisis of SAIS. The tests of painful arc, empty can and ex ternal rotation resistance are the best combination for the diagnosis of SAIS (when 2 or more are positive), while the tests of painful arc and external rotation resistance are the best combination for ruling out SAIS (when both are negative)

Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Female ; Humans ; Male ; Middle Aged ; Physical Examination ; methods ; Prospective Studies ; Reproducibility of Results ; Shoulder Impingement Syndrome ; diagnosis

OBJECTIVETo discuss the fracture patterns,operative procedures and clinical results of open reduction and internal fixation via a posterior approach to treat posterior fractures of tibial plateau.

METHODSFrom June 2008 to February 2011, 8 patients with posterior tibial plateau fractures treated with posterior approach, were reviewed retrospectively. There were 5 males and 3 females,with an average of 41.1 years ranging from 23 to 55. Of the 8 cases, 5 cases were caused by traffic accidents, 3 caused by fall. Two cases of posterior coronal fractures combined with avulsion of posterior cruciate ligament and 1 case of posterolateral fractures associated with collapse fractures was treated via a S-shaped approach, 2 cases of posteromedial fracture via a posteromedial reversed L-shaped approach, another 3 cases of complex fractures involving anterior and posterior of tibial plateau, and metaphsis via a posteromedial reversed L-shaped approach combined with anterolateral approach. Fractures with articular surface collapse were applied with bone grafting.

RESULTSAll the 8 cases were followed up for 8 to 39 months (means 20 months). All cases had attained bone union, the time of bone healing was 14.5 weeks in average ranging from 11 to 21 weeks. No infection, no blood vessel or nerve injuries and loosening or breakage of screw were found. There were no significant differences about the tibial plateau angle (TPA) and the posterior slope angle (PA) on radiographies between immediately after operation and 6 months after operation. According to the Rasmussen functional scoring,the results were excellent in 4, good in 3, fair in 1. Radiologic results were graded with the Rasmussen score to evaluate the reduction of the fracture, the scores at last followed-up was 14 to 18 scores (means 17.25), the results were excellent in 6, good in 2.

CONCLUSIONPosterior S-shaped or L-shaped approach can facilitate the reduction and fixation with good exposure for posterior fractures of tibial plateau.

Adult ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tibial Fractures ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

Aim To explore the optimized tree shrews model of Alzheimer's disease through comparison of the pathology changes of brain neurons between the two kinds of tree shrew models.Methods Fifty tree shrews were randomly divided into five groups with 10 in each group:control group,high dose D-galactose combined with ibotenic acid (IBO) group,low dose D-galactose combined with IBO group [intraperitoneal injection D-galactose combined with IBO injection into bilateral basal nucleus of Meynert (BNM)],high dose Aβ25-35 combined with IBO group,and low dose Aβ25-35 combined with IBO group (injection into bilateral BNM).Hematoxylin and eosin (HE) staining was used to observe the morphological changes of brain neurons.The expressions of choline acetyltransterase (ChAT) and synaptophysin(SYP) in the brains were detected by immunohistochemical staining.Western blot was used to detect the expression of amyloid beta 1-42 (Aβ1-42),amyloid precursor protein (APP) and phosphorylated tau protein (p-tau).Results The HE staining showed there were different degrees of morphological changes in the brains of model groups.The changes in the high dose D-galactose and high dose Aβ25-35 combined with IBO group were more obvious than those in low dose D-galactose and Aβ25-35 combined with IBO group.Immunohistochemical staining revealed that the levels of ChAT and SYP in the model groups decreased compared with control group,and the decline in high dose Aβ25-35 combined with IBO group was more marked than that in low dose Aβ25-35 combined with IBO group(P ＜0.01).Western blot revealed that the levels of Aβ1-42,APP,p-tau in the model groups increased compared with control group,and the rise in high dose Aβ25-35 combined with IBO group was more apparent than that in low dose Aβ25-35 combined with IBO group (P ＜ 0.05 or P ＜ 0.01).Conclusion The method of modeling by Aβ25-35 combined with IBO injection into bilateral BNM is more suitable for the establishment of Alzheimer's disease model.

OBJECTIVETo find out the incidence of early DVT in patients after knee arthroscopic surgery with routine use of tourniquet and discuss the associate risk factors.

METHODSTotal 1 561 cases undertaken primary knee arthroscopic surgery was reviewed retrospectively from January 2013 to January 2017, including 651 males and 910 females with a mean age of (65.7±8.7) years old ranging from 62 to 81 years old. The cases were divided into DVT group and non-DVT group according to ultrasonic Doppler after surgery. The DVT occurrence rate was calculated and the basic information was analyzed to filter out the risk factors through univariate analysis and multivariate analysis. The cases of DVT group received 6 months anticoagulation therapy and were undertaken a follow-up of 1, 3, 6 months by ultrasonic Doppler.

RESULTSOut of the 1 561 cases, 226(14.5%) developed early DVTs following surgery, 32(2.0%) cases had the proximal DVTs, and 194(12.4%) cases had the isolated distal DVTs. The risk factors include the age(>=73 years), female sex and gastrocnemius vein dilation (GVD), hypertension, longer tourniquet time(>=74 min). The GVD and the length of tourniquet time was considered to be the best predictor of the early DVTs after surgery, with an odds ratio of 2.337 (95% CI, 1.644-3.611) and 2.112 (95%CI, 1.452-3.301). Twelve isolated distal DVTs(6.6%) and 11 proximal DVTs(36.7%) still showed thrombus at 6-month follow-up, but exhibit decreased size and at various stage of resolution.

CONCLUSIONSThe incidence of early DVTs after knee arthroscopic surgery is 14.5%. Out of all risk factors, the GVD and the length of tourniquet time have the best power for prediction of DVTs after surgery. Both proximal and distal DVTs received accepted outcomes after formal therapy.

To establish the integration of Alzheimer's disease(AD) and blood stasis syndrome tree shrew model. Panax notoginseng saponins (PNS) was used to intervene the model to testify the stability of the model. The level of blood stasis of each group in the tree shrew model was evaluated by analyzing five traditional Chinese medicine(TCM) characterizations, four blood coagulation indexes, plasma nitric oxide (NO) level, plasma superoxide dismutase (SOD) level in each group. Hematoxylin and eosin(HE) staining was used to observe the morphological changes of brain hippocampal neuron cell of each group. Immunohistochemical staining was used to assay the ChAT and SYP levels in brain hippocampus of each group.The blood stasis characterization of the integration of disease and syndrome group was more obvious than the AD group, and that of the drug administration group was lower than that of the integration of disease and syndrome group. Aβ1-42, APP, P-Tau, ChAT and SYP level of AD group were lower than those in the blank group, which were further reduced in the model of integration of disease and syndrome. However, the administration of PNS relieved the reduction, indicating that the AD and blood stasis integration syndrome tree shrew model is stable.