Humans ; Occupational Exposure ; Risk Assessment ; Workplace

Adult ; Ergonomics ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Musculoskeletal Physiological Phenomena ; Regression Analysis ; Workplace

Posterior pilon fracture is a special and unique type of ankle fracture,and its injury mechanism and treatment principles are different from those of the trimalleolar fracture in the Lauge-Hansen classification,and also different from those described for the classic pilon fracture.The fractures have a low incidence and generally poor prognosis.The prevalence of posterior pilon fractures is 6.4％ of all trimalleolar fractures,and 5.6％ of all pilon fractures based on computed tomography images.The pathological features of posterior pilon fractures are different from those of the traditional ankle fracture and the classic pilon fracture,and it is very important to differentiate a posterior pilon fracture from the others.Because of the low incidence and high variation in fracture morphology,there is controversy over the practicable classification of posterior pilon fractures based on clinical features,such as injury mechanism,fracture classification and surgical approach.An ideal fracture classification system can reveal the injury mechanism and severity,guide the treatment,and predict prognosis.At present,no classification method is based on the injury mechanism,and none can summarize fracture morphology and guide treatment.The purpose of this study was to review the injury mechanism,clinical characteristics,classifications,treatments,and outcomes of posterior pilon fractures,to promote surgeons’ understanding of posterior pilon fracture and reduce perioperative complication.

Objective To compare cardiac output continuously measured by transesophageal echocardiograph (TEE)with Flotrac /Vigileo system.Methods Thirty -six patients,aged 30 -60years,of American Society of Anesthesiologists physical status ⅠorⅡscheduled for laparoscopic hysterectomy (LH )were included in this study.The radial artery puncture on the left connecting the Flotrac /Vigileo system monitoring was established before anesthesia and ultrasonic probe was inserted into the esophagus after anesthesia induction.The depth of the probe was located at the middle esophagus with monitoring of transesophageal echocardiography(tee).At the same time the value of CO after anesthesia,before and after pneumoperitoneum were recorded and the application of SPSS 13.0 software package for statistical analysis was made.Monadic linear correlation and regression analysis were both used in measured CO. Results Each point,the determination of transesophageal echocardiography(tee)between the CO and the determination of the Flotrac /Vigileo CO,had high correlation(r =0.850,P =0.002).The CO at the time of T2 monitored by TEE group and Flotrac /Vigileo group were (3.3 ±0.2)L/min,(3.2 ±0.2)L/min,which were significantly lower than (5.6 ±0.3)L/min,(5.4 ±0.3)L/min(t =2.248,2.178,P =0.032,0.029).But there were no statistically significant differences at other time respectively(tT =0.102,0.199,0.201,0.124,0.198,PT =0.918,0.887,0.894, 0.908,0.898;tF =0.098,0.189,0.214,0.119,0.112,PF =0.953,0.874,0.898,0.913,0.932).Conclusion The correlation of CO monitored by transesophageal echocardiography(tee)and Flotrac /Vigileo was good,which can be safely and efficiently used in intraoperative monitoring of patients.

Objective To explore the mechanisms of posterior pilon fractures and evaluate the curative effects of different types of fixation on the treatment of posterior pilon fractures.Methods We included in this retrospective study 20 patients with posterior pilon fracture who had been treated from January 2012 to January 2015 at our department.They were 10 men and 10 women,from 23 to 77 years of age (average,50.6 years).According to the classification by Yu Guangrong,5 cases belonged to type Ⅰ,3 to type Ⅱa,4 to type Ⅱb,and 7 to type Ⅲ.One was not indentified because of lacking CT examination.The mechanisms included ground level fall in 2 cases,motor vehicle accident in 7,fall off stairs in 5,sport injury in 2,fall from a bike in one and fall from a height in 3.More than 25％ of the articular surface was involved in 13 patients.Syndesmosis injury was identified in 6 patients by Cotton test during operation.Internal fixation varied accordingly.We recorded the mechanism,classification,proportion of the articular surface involved (more or less than 25％),and syndesmosis injury to figure out the characteristics of posterior pilon fractures.We used the Burwell-Charnley radiographic criteria to assess the postoperative reduction of the articular surface,and the Olerud-Molander scoring scale and visual analogue scale (VAS) to assess the ankle function.The curative effects of different types of fixation on the treatment of posterior pilon fractures were compared.Results Of the 20 patients,17 were available for follow-up for 6 to 36 months (average,17.8 months).Two patients received reoperation because of implant failure after cannulated screw fixation from anterior to posterior.The Burwell-Charnley radiographic evaluation revealed 12 anatoinical reducations and 8 fair reductions.The mean Olerud-Molander score for the 17 patients at the final follow-ups was 81.5 (range,from 35 to 100) and the mean walking VAS was 1 (from 0 to 3).Conclusions Posterior pilon fractures are mostly caused by medium to high energy violence,resulting from a combination of rotational and vertical forces.Since there is a high risk of implant failure,the cannulated screw fixation from anterior to posterior is not recommended.Good clinical outcomes are observed in the cannulated screw fixation from posterior to anterior and the plate/cannulated screw fixation for posterior pilon fractures.

OBJECTIVETo compare the efficacy of internal fixation (including PFNA and PFN) versus hip replacement (including FHR or THA) in the treatment of trochanteric fractures in adults.

METHODSReports of studies using randomized controlled trials (RCT) to compare internal fixationg with hip replacement in the management of intertrochanteric fractures were retrieved (up to January 1, 2013) from the Cochrane Library, PUBMED Data, CNKI (China National Knowledge infrastructure), Elsevier, the Chinese Biomedical Database, Wanfang Data, and manually. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software RevMan 5.0 was used for data-analysis.

RESULTSSeven articles were included in the meta-analysis. The results showed that,compared internal fixation with hip replacement,there were statistical significance in the duration of surgery time [WMD = -2.66, 95% CI (-5.25,-0.06), P = 0.05], intra-operative blood loss [WMD = -24.20, 95% CI (-30.38, -18.02), P < 0.000 01], hospital stays time [WMD = -4.72, 95% CI (-5.18, -4.25), P < 0.000 01], bearing load time [WMD = -29.54, 95% CI (-30.77, -28.31), P < 0.000 01], total complications rate [WMD = 0.15, 95% CI (0.11, 0.22), P < 0.000 01], the good rate of Harris scores [WMD = 1.09, 95% CI (0.54,1.32), P < 0.05]. However, there were no statistical significance in the rate of deep venous thrombosis [WMD = 1.09, 95% CI (0.47, 2.55), P > 0.05]. CON- CLUSION: Hip replacement (containing FHR or THA) for the treatment of intertrochanteric fractures is superior to internal fixa- tion in regards to the duration of surgery time, the mean duration of hosipital stays, mean post-operative down time, intra-opera- tive blood loss, the rate of post-operative good Harris scores. But there is not enough evidence to show any difference between hip replacement (containing THA or FHR) and internal fixation in regards to the rate of deep venous thrombosis. However, internal fixation for the treatment of intertrochanteric fractures is superior to hip replacement (containing FHR or THA) in regards to total complications rate.

Arthroplasty, Replacement, Hip ; methods ; Fracture Fixation, Internal ; methods ; Hip Fractures ; surgery ; Humans

Objective To explore whether human umbilical venous endothelial cells could be used as feeder layer to support the growth of embryonic stem cells (ESC) and keep ESC undifferentiated.Methods The venous vessels of umbilical cord obtained from healthy puerperal were perfused with collagenase.The isolated endothelial cells went through primary culture and passages for expansion.Factor Ⅷ antigens determination was implemented.Endothelial cells with good growth and 3 or above passages were treated with mitomycin-C(10 mg/L) and prepared as feeder layer,on which E14.1 ESC was transplanted for subculturing to observe the morphological characterization and determine ESC alkaline psphatase (AKP) activity and the expression of stem cell marker Oct-4.Severe combined immune deficiency(SCID) mouse in vivo terotoma formation experiment was performed to identify its pluripotent properties.Results Human umbilical vein-derived endothelial cells grew well in culturing in vitro and regenerate in large numbers.The endothelial cells maintained normal cellular morphological and biological characterization after 10 passages.The cells stopped proliferating after being treated with mitomycin-C,but its activity and morphological properties were well-maintained with 24 hours,which was a fundamental property of serving as feeder layer.E14.1 ESC remained undifferentiated in human umbilical venous endothelial cells after 3-8 passages,the cells grew in colony and showed high expression of AKP and stem cell Oct-4.In vivo pluripotency experiment showed that 6 weeks after being transplanted to SCID mice E14.1 ESC of 6 and 10 passages in endothelial cells both could form teratoma containing 3 layers of tissue cells.Conclusions Human umbilical venous endothelial cell serve as a convenient feeder layer cell with rich sources.It can effectively support ESC growth and heterogenous and prevent the heterogeneous protein pollution and pathogenic microorganisms caused by animal cell feeder layers,thus solve the problem of biological safety of ESC clinical application.

BACKGROUND:There is controversial on which method is preferred for the treatment of humeral shaft fractures, plate or intramedul ary nail fixation? Some studies have compared the effect of those two methods, but the results are different. While the results of the systematic research and the Meta-analysis on the comparative studies is also different due to the differences in the number and the extraction of the researches.
OBJECTIVE:To systematical y evaluate the efficacy of plating versus intramedul ary nail fixation in the treatment of adult humeral shaft fracture.
METHODS:A computer-based retrieve was conducted in PubMed database, MEDLINE database, Cumulative Index to Nursing&Al ied Health Literature, Evidence-Based Medicine database, CBM database, Wanfang database and CNKI database for the randomized or quasi-randomized control ed trials on the comparison of plating and intramedul ary nail fixation in the treatment of adult humeral shaft fracture. The quality of these trials was critical y assessed according to Jadad. The effective data were extracted for Meta-analysis by Stata 12.0 software.
RESULTS AND CONCLUSION:Total y, 15 randomized or quasi-randomized control ed trials were col ected including four quasi-randomized control ed trials and 11 randomized control ed trials. The results showed that intramedul ary nail fixation may increase the risk of complications (odds ratio=0.37(0.19, 0.59), P=0.00). Bias Egger’s test of P=0.91 showed there was no significant publication bias. The risk of re-operation of intramedul ary nail fixation was increased (odds ratio=0.28(0.14, 0.57), P=0.00) with the Egger’s test of P=0.69. The incidence of shoulder impingement of intramedul ary nail fixation was significantly higher than that of pate fixation (odds ratio=0.13(0.05, 0.35), P=0.00), and there were no significant differences in postoperative infection, nonunion, implant failure, iatrogenic nerve palsy, operation time and bone union time between two methods. The results showed that compared with plate fixation, intramedul ary nail fixation may increase the incidence of shoulder impingement, complications and re-operation, while there were significant differences in postoperative infection, nonunion, implant failure, iatrogenic nerve palsy, operation time and bone union time between two methods.

OBJECTIVETo evaluate the curative effect and surigical skills of reconstruction intramedullary nailing in the treatment of ipsilateral femoral neck and shaft fractures.

METHODSFrom January 2007 to January 2013, 13 patients with ipsilateral femoral neck and shaft fractures were treated by reconstruction intramedullary nailing including 11 males and 2 females with an average age of 38.9 yeas old ranging from 25 to 53 years old. For femoral neck fractures,10 cases were basilar neck fracture, 3 were transcervical fractures and according to Garden classification,10 were type II, 2 were type III and 1 was type IV. For feormal shaft fracture, 5 were type I, 4 were type II, 3 were type III and 1 was type IV according to Winquist classification. The location of all 13 feormal shaft fractures were all in the uper 3/4 of the feormal shaft. Complications and postoperative function were recorded and evaluated.

RESULTSEleven patients were followed up for 23.45 months (12 to 36 months). Time from injury to operation was 5.9 days in average. Malunion of femoral neck fracture happened in 1 patient, nonunion of femoral shaft fracture happened in 2 patients. NO femoral head osteonecrosis, infection and malunion of femoral shaft fracture happened. According to Friedman-Wyman classification, 8 cases get good result, 2 get faii and 1 get poor.

CONCLUSIONReconstruction intramedullary nailing is a good choice for the ipsilateral femoral neck and shaft fractures with the advantages of less soft-tissue trauma and complications.

Adult ; Female ; Femoral Fractures ; surgery ; Femoral Neck Fractures ; surgery ; Fracture Fixation, Intramedullary ; methods ; Humans ; Male ; Middle Aged

BACKGROUND: Absorbable material is a hotspot in orthopedics, which is biodegradable, avoids fixation residues and second surgical trauma compared with the traditional internal fixation.OBJECTIVE: To investigate the clinical efficacy and safety of K-wires, screws and absorbable rods for the internal fixation of Mason II-III radial head fractures.METHODS: Totally 45 patients with Mason Ⅱ-Ⅲ radial head fractures were collected from January 2010 to December 2015 admited in Zhangjiagang First People's Hospital and Zhangjiagang Hospital of Traditional Chinese Medicine, and were then divided into three groups (n=15 per group), followed by implanted with K-wires (group A), screws (group B)and absorbable rods (group C), respectively. The baseline data, operation time, blood loss, healing time, Mayo and Broberg-Morrey scores were compared among groups.RESULTS AND CONCLUSION: (1) There were no significant differences in the baseline data, operation time, blood loss,and healing time among groups (P > 0.05). (2) The Mayo scores in the groups A, B, and C were (88.45±6.22),(92.37±5.60), and (90.82±6.58), respectively; the Broberg-Morrey scores in the groups A, B, and C group were ((90.82±6.83), (93.05±6.54), and (91.68±7.15), respectively; all above scores showed no significant differences among groups (P > 0.05). (4) The total incidence rate of complications in the groups A, B, and C was 20％ (2/15), 13％ (2/15),and 7％ (1/15) respectively, showing no significant difference among groups (P > 0.05). (4) These results indicate that the absorbable rods can obtain satisfactory treatment outcomes for Mason II-III radial head fractures, which is equivalent to the traditional internal fixation. Moreover, it can avoid secondary operation for removing internal fixators and the adverse impact of stress shielding, so it is recommended to be used in clinic.