PURPOSE: This study aims to investigate the efficacy of novel distraction support (DS) in intramedullary nailing treatment for tibial shaft fracture. METHODS: The random controlled trial included adult patients with tibial shaft fractures who were treated with intramedullary nailing at the trauma center between July 2013 and December 2018. Participants were randomly assigned to either control group (n=43) or DS group (n=42) based on whether DS was used during the operation. All surgical procedures were conducted by a single, experienced surgeon. Parameters such as hospital stay, blood loss, operative time, infection, delayed union, and malalignment were recorded for assessment. Shapiro-Wilk test was used to assess normality, and the F test was adopted to measure variance homogeneity. Continuous variables were presented as mean±standard deviation and compared via independent samples t-tests. Categorical variables are expressed as percentages. The Pearson's Chi-squared or Fisher's exact test was used for categorical variables n (%). Two-sided p<0.05 indicated statistical significance. RESULTS: A total of 85 participants were enrolled in the study. All cases achieved acceptable reduction. The operative time was significantly shorter in the DS group than in control group ((75.3±10.5) min vs. (90.4±15.5) min, p<0.001). Additionally, the DS group showed lesser blood loss ((60.1±27.2) mL vs. (85.4±25.4) mL, p<0.001). No significant differences were observed between the 2 groups in terms of hospital stay ((9.4±2.7) days vs. (10.2±3.1) days, p=0.370), infection (3 (7.1%) vs. 2 (4.7%), p=0.978), delayed union (2 (4.8%) vs. 5 (11.6%), p=0.450), and malalignment (3 (7.1%) vs. 5 (11.6%), p=0.713). CONCLUSION The use of DS in intramedullary nailing surgery is effective. The application of this DS system may represent a valuable addition to future clinical practice.
Humans ; Fracture Fixation, Intramedullary/methods* ; Tibial Fractures/surgery* ; Male ; Female ; Adult ; Middle Aged ; Operative Time ; Length of Stay ; Young Adult ; Osteogenesis, Distraction/methods*

Posterior process fractures of the talus are rare so that they are likely to be overlooked. In recent years, a deeper understanding of the diagnosis, treatment and prognosis of these fractures has led to increasing treatment methods for them, but there are still no standard treatment guidelines. This article reviews the anatomy, classification, and treatment methods (including conservative management, open reduction and internal fixation, arthroscopic techniques, percutaneous closed reduction and internal fixation and robot-assisted reduction and fixation) of posterior process fractures of the talus, hoping to provide references for those surgeons who may select optimal treatment options for various kinds of the fractures.

The ideal scaffold material can reconstruct the morphology, structure and function of tissues and organs. Thus, it has received extensive attention in the field of tissue engineering. With the rapid development of the theories and technologies of naturally-derived biomaterials, it has gradually become a research hotspot in the field of regenerative medicine. Natural biomaterials have high bionics, good biocompatibility and a wide range of sources. Thus, they are very suitable to be used as scaffolds for tissue engineering. According to ingredients and source of raw materials, they can be roughly divided into protein-based biomaterials (collagen, gelatin, silk and fibrin), carbohydrate-based biomaterials (cellulose, chitin/chitosan, alginate and agarose), glycosaminoglycans (hyaluronic acid, chondroitin sulfate) and decellularized extracellular matrix (amniotic membrane, small intestinal submucosa, tendons). Different scaffold materials have unique natural structures and properties. Protein-based biomaterials can affect cell migration and differentiation through polymerization to form a network structure. They can be made into stents alone or used with other synthetic materials based on certain mechanical properties. Carbohydrate biomaterials can carry a large amount of liquid due to their high specific surface area. However, their mechanical properties are poor. Therefore, it is often used in the form of gel with other materials to control the release of cells and growth factors in tendon tissue engineering. Regularly, the anti-inflammatory, viscoelastic, lubricating and highly hydrating properties of glycosaminoglycan biomaterials can be combined with synthetic materials to increase their biocompatibility and hydrophilicity. Compared with the above materials, the decellularized extracellular matrix not only has a more similar extracellular structure and nutrients, but also has certain mechanical properties. Therefore, it can better reconstruct the morphology, structure and function of tissue and organ lesions. Ultimately, the above materials have been paid more and more attention in tissue engineering. The ingenious combination of different materials makes the repair of tendons show better results. In future, naturally-derived biomaterials could have broader clinical prospects and application value.

Lipids are important components of living organisms that participate in and regulate a variety of life activities. Lipids in plants also play important physiological functions in response to a variety of abiotic stresses (e.g. salt stress, drought stress, temperature stress). However, most research on lipids focused on animal cells and medical fields, while the functions of lipids in plants were overlooked. With the rapid development of "omics" technologies and biotechnology, the lipidomics has received much attention in recent years because it can reveal the composition and function of lipids in a deep and comprehensive way. This review summarizes the recent advances in the functions and classification of lipids, the development of lipidomics technology, and the responses of plant lipids against drought stress, salt stress and temperature stress. In addition, challenges and prospects were proposed for future lipidomics research and further exploration of the physiological functions of lipids in plant stress resistance.
Droughts ; Gene Expression Regulation, Plant ; Lipids ; Plants ; Stress, Physiological

Objective:To introduce a new operative technique of mini-invasive plating of midshaft clavicle fractures with lateral clavicle anatomic locking plate and evaluate its clinical outcomes.Methods:From August 2017 to March 2019, 30 midshaft clavicular fracture patients were included in this study and retrospectively analyzed. There were 22 males and eight females with an average of 44.63±13.22 years (range 14-65 years). According to Robinson classification nine patients were classified as Type 2A2, 17 patients were classified as Type 2B1 and four patients were classified as Type 2B2. Before operation no symptoms of neurovascular injury was observed in this group. Operations were performed on an average of 2.33±1.75 d (range 0-7 d) after the injury. By comparing the injured clavicle lengths with the opposite healthy side pre and postoperatively on anteroposterior chest x-ray to evaluate the effect of indirect reduction. Shoulder function was evaluated using the Constant-Murley score at 6th month after the operation. Meanwhile, 32 patients with midshaft clavicular fracture treated with open reduction and internal fixation using clavicle reconstruction locking plate treated by the same group surgerons were compared in incision length, surgical duration, intraoperative fluoroscopy times, blood loss, fracture reduction, fracture healing time, Constant-Murley score and other complications. There were 25 males and seven females with an average of 42.63±14.18 years (range 16-70 years). According to Robinson classification six patients were classified as Type 2A2, 19 patients were classified as Type 2B1 and seven patients were classified as Type 2B2.Results:In mini-invasive group all patients were treated successfully with minimally invasive percutaneous osteosynthesis (MIPO) technique using lateral clavicle anatomic locking plate. The mean surgical duration was 63.40±7.82 minutes (range 48-92 min), The mean intraoperative fluoroscopy was 4.83±1.58 times (range 3-8 times). The mean blood lose was 15.67±4.13ml (range 10-30 ml). In open reduction group the mean surgical duration was 56.22±10.11 min (range 42-80 min), the mean intraoperative fluoroscopy was 3.91±1.49 times (range 2-5 times). The mean blood lose was 56.88±13.93 ml (range 40-100 ml). There was a significant difference in statistic by comparing surgical duration, intraoperative fluoroscopy times, blood loss ( P<0.05). In mini-invasive group the average proportional difference of the clavicular length was 12.15%±2.69% (range 5.2%-15.1%) preoperative and 0.45%±0.44% (range -0.2%-1.6%) postoperative comparing with the opposite healthy side, in open reduction group the average proportional difference of the clavicular length was 11.58%±2.67% (range 4.5%-16.1%) preoperative and 0.62%±0.41% (range -0.2%-1.2%) postoperative comparing with the opposite healthy side. There was no difference in statistic by comparing the fracture reduction in these two groups ( P>0.05). The mean follow-up period was 11.3±2.8 months (range 10-18 months) in mini-invasive group. Radiographic healing of the fracture was achieved at a mean time of 3.57±0.90 months (range 3-5 months). In open reduction group the mean follow-up period was 11.8±2.2 months (range 10-18 months), fracture healing time was 4.27±1.12 months (range 3-6 months), and there was significant difference in fracture union ( P<0.05). In mini-invasive group the mean total incision length was 2.8±0.48 cm (range 2.5-4.0 cm), no patient complained of numbness or paresthesia on subclavicular region or anterior chest wall, and all patients were satisfied with the cosmesis of the wounds and showed excellent shoulder joint function with a mean Constant-Murley score of 94.83±2.55 (range 89-97) at sixth month after the operation. In open reduction group the mean incision length was 11.0±1.08 cm (range 10-14 cm), 9 patients complained of numbness or paresthesia on subclavicular region or anterior chest wall, and only 5 patients were satisfied with the cosmesis of the wounds with a mean Constant-Murley score of 90.59±4.23 (range 78-97). There was a significant difference in statistic by comparing incision length, satisfactory cosmesis results, Constant-Murley score and paresthesia on subclavicular region ( P<0.05). Conclusion:Mini-invasive percutaneous plating of midshaft clavicle fractures with lateral clavicle anatomic locking plate is a good option for the treatment of midshaft clavicle fractures with satisfactory cosmesis results and excellent return to function.

Objective To investigate the effect of iliac flap pedicled with superficial circumflex iliac artery and sartorius in the treatment of femoral neck fracture of the young adults.Methods From April,2012 to March,2017,50 cadaveric lower limbs were injected with red latex,and the origin,diameter,course and distribution of the superficial circumflex iliac artery and arteries of the sartorius were observed.The iliac flap pedicled with superficial circumflex iliac artery and sartorius was used to treat the femoral neck fracture in young adults in 11 cases.There were 9 males and 2 females with an average age of 34.5(ranged from 16 to 54) years.The fractures were classified ac cording to Garden:4 cases of type Ⅲ and 7 cases of type Ⅳ.Regular outpatient follow-up was made.Results The superficial circumflex iliac artery originated from the femoral artery and the initial diameter was (1.2±0.3) mm.The length of the superficial circumflex iliac artery to the anterior superior iliac spine was (8.8±1.3) cm.The superficial circumflex iliac artery run to the anterior superior iliac spine and sent 1-3 periosteal branches into the iliac crest.The sartorius originates from the anterior superior iliac spine,and its proximal artery arises from the superficial circumflex iliac artery and the femoral artery.Link-pattern arterial anastomosises were formed in sartorius by branches of adja cent vascular pedicles,which nourished the ilium flap.All incisions healed by first intention.All cases were followedup from 16 to 42 months,with an average of 32.3 months.All fractures healed for 3-7 months,with an average of 4.6 months.No fracture nonunion,femoral head necrosis and other complications occurred.Harris hip scores was 93.02± 5.33.Seven cases were excellent and 4 cases were good.Conclusion The iliac flap pedicled with superficial cir cumflex iliac artery and sartorius has rich blood supply,easily performed conducive to promoting fracture healing,and reducing the occurrence of femoral head necrosis.It is an effective method for the treatment of femoral neck fracture in young adults.

Objective To introduce an indirect reduction technique using a modified tibial distraction support in minimally invasive percutaneous plate osteosynthesis (MIPPO) of distal femur fractures and investigate its clinical effect.Methods Between April 2014 and March 2016,26 distal femur fractures treated with MIPPO technique using a modified tibial distractionsupport were reviewed.There were 18 males and 8 females with an average age of (50±10.1) years (25-76 years).Among them,nineteen patients were type A and 7 patients were type C according to AO classification.Operations were performed on an average of (5.6±3.1) d (2-14 d) after the trauma.All the patients were performed indirect reduction with a modified tibial distraction support before using the MIPPO technique.Angular deformity was obtained from preoperative and postoperative for all subjects.In each case,intraoperative image intensification shots to confirm reduction and the operating time were recorded.Functional outcome was evaluated using the Schatzker-Lambert criteria 1 year postoperative.Results All the patients completed closed reduction using the modified tibia] distraction support.Preoperative anteroposterior radiographs revealed amean of 8.0°±3.1° (0-16°) angulation in the coronal plane.Lateral radiographs revealed a mean of 16.8°±8.4° (5°-8.6°) angulation in the sagittal plane.Postoperative anteroposterior and lateral radiographs showed a mean angulation of 1.8°±0.6° (0-3.2°) and 2.5°±0.6° (0-3.8°) of varus/valgus and apex posterior angulation,respectively.The mean operating time was (100±11.6) min (80-120 min).No intraoperative or postoperative complications were encountered.Twenty-five patients were followed up and the mean follow up time was (18±3.9) months (12-28 months).There were one delayed union and one non-union.The average time of radiographic evidence of bridging callous was present at (4±0.7) months (3-6 months) in the remained patients.There were 22 excellent patients and 3 good patients according to Schatzker-Lambert criteria one year postoperative.The excellent rate was 100％.Conclusion The modified tibial distraction support is simple and easy to manipulate which is a good option in MIPPO for distal femur fractures and has good clinical effects.

Objective: To introduce the surgical method of lateral dorsalis pedis chain-linked artery based flap for repairing foot, ankle, and posterior heel wounds, and to evaluate its clinical outcome. Methods: From June 2013 to February 2016, 11 cases with skin defects of foot, ankle, and posterior heel wounds were reviewed. The defects were repaired using the lateral dorsalis pedis chain-linked artery based flap.The wounds in 7 cases were repaired using the island flap based on the descending branch of the anterior lateral malleolar artery. The wounds in 3 cases were repaired using the island flap based on the lateral calcaneal branch of the posterior lateral malleolar artery. The reversed flap based on the forth metatarsal artery was used in one patient. The wound defects ranged from 1.5 cm×2.0 cm to 6.0 cm×13.0 cm.The area of the flap ranged from 2 cm×3 cm to 7 cm×15 cm were used to repair the wound.The donor site was skin grafted with split-thickness skin harvested from the abdomen. Results: Circulations of the all 11 cases were stable, with good wound healing after 2 weeks.10 patients had clinical follow-up. The patients were followed up from 2 months to 18 months, average of 8 months.All flap grafts survived with no bloated menifestion in pedical or "cat′s ear" deformity.Flaps were soft. Color was consistent with normal skin.Skin graft donor sites had no obvious scars.Patients were extremely satisfied with the result of repair. Conclusions The use of the lateral dorsalis pedis chain-linked artery based flap has many advantages, such as no sacrifice of the main vessels, extended coverage area and thin flap. It is a simple and effective method to repair wounds of the foot, ankle, and posterior heel.

Objective To evaluate the effectiveness of flexor hallucis longus tendon transfer in treatment of chronic Achilles tendinopathy using different technique.Methods Sixty-four embalmed feet of 32 cadavers were analyzed and classified anatomically with respect to the individual cross links in the Henry's knot.These three techniques were then combined to determine the total potential tendon graft length obtainable using single incision,double incision and minimally invasive incision.From January,2012 to June,2015,10 patients (10 feet) with chronic Achilles tendinopathy were treated with double incision technique.The score was 63.04 ±7.75 according to American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score system.Results Only two different configurations were found.Type 1,a tendinous slip branched from the FHLT to the FDLT was 96.9％(62 of 64 feet).Type 2,a slip branched from the FHLT to the FDLT and another slip from the FDLT to FHLT was 3.1％(2 of 64).The average length of the FHLT graft available from a single incision measured (5.08±1.09)cm,double incision technique measured (6.72 ± 1.02) cm,and minimally invasive incision measured (17.49 ± 1.80)cm.The difference between the lengths obtained from these three techniques was statistically significant.Ten patients were followed-up 12-36 months (mean,13.7 months).At 12 months after operation,the AOFAS ankle and hindfoot score was 93.28 ± 3.72,showing significant difference when compared with that before operation.The results were excellent in 6 cases,good in 3 cases,and fair in 1 case with an excellent and good rate of 90％.No sural nerve injury,posterior tibial nerve injury,medial plantar nerve injury,and lateral plantar nerve injury occurred.Conclusion In over 96 ％ of the feet,a proximal to distal connection from the FHLT to the FDLT was found,which might contribute to the residual function of the lesser toes after FDLT transfer.The distal stump of the FHLT tendon should be sutured onto the FDLT tendon under tension to en able a co-activation of the great toe,preserved hallux plantar flexion.Chronic Achilles tendinopathy reconstruction with flexor hallucis longus tendon harvested using double incision technique offers a desirable outcome in operative recovery,tendon fixation,preserved hallux plantar flexion and less complications.

Objective To investigate the effect of retrograde sartorius myocutaneous flap for reparing skin defects of leg.Methods In the anatomic study,50 cadaveric lower limb were injected with red latex and the origin,diameter,course,distribution and anastomosis of sartorius's arteries were observed.Arteriographies were made in 4 sides of fresh specimens to study the arterial anastomosis in sartorius.Based on anatomic research results,we designed the retrograde sartorius myocutaneous flap for reparing skin defects of leg.Results Nutrient arteries of sartorius represented segnental distribution,Link-pattern arterial anastomosises were formed in sartorius by branches of adjacent vascular pedicles.Cutaneous arteries and musculocutaneous arteries above deep fascia formed interlocking arterial anastomosises net which provided blood supply for the skin on sartorius.The arterial branches in the distal 2/5 of sartorius came from saphenous artery,composed an arterial network around knee joint,which consist of anatomic basis for the blood supply of retrograde sartorius myocutaneous flap.Form February,2010 to April,2014,the retrograde sartorius myocutaneous flap were used to repair skin defects of leg in 2 cases.The flap size ranged from 7 cn×18 cm to 12 cm×25 cm.All flaps survived successfully with no ulcer.2 cases were followed up for 7 to 16 months.The skin color and texture were satisfactory.Conclusion the retrograde sartorius myocutaneous flap has constantly,reliable blood supply,and easily performed.It is an effective method for the reconstruction skin defects of leg.