1.Effects of glucocorticoid stent implantation combined with nasal endoscopic surgery on nasal ventilation function and nasal mucosa recovery in patients with chronic sinusitis with nasal polyps
Yunfeng CHU ; Lei HU ; Liang SHAO ; Dandan TAO ; Xiaoting JIANG
China Journal of Endoscopy 2024;30(7):24-30
Objective To analyze the effects of glucocorticoid stent implantation combined with nasal endoscopic surgery on nasal ventilation function and serum levels of eosinophil cationic protein(ECP),fibronectin(Fn)and aquaporin-1(AQP-1)in patients with chronic sinusitis with nasal polyp(CSwNP).Methods 60 patients with CSwNP from January 2022 to February 2023 were included in the study,and then they were divided into experimental group and control group,with 30 cases in each,using random number table method.The experimental group was treated with glucocorticoid stent implantation based on the original nasal endoscopic surgery,and the control group was treated with nasal endoscopic surgery,and both groups were treated until 12 weeks after surgery.The two groups of nasal symptoms,quality of life,nasal structure and ventilation function,serum levels of ECP,Fn,AQP-1,and adverse reactions were compared.Results Compared before the treatment,scores of nasal mucosal structure(Lund-Mackay scale),nasal symptom visual analogue scale(VAS)(including:nasal obstruction,runny nose,stuffy head,decreased sense of smell,nasal dryness/scab)and serum levels of ECP were decreased,distance from minimum nasal cross section to anterior nostril(DCAN)was shortened in two groups 12 weeks after treatment,and the experimental group was lower than the control group,the differences were statistically significant(P<0.05).Compared before the treatment,12 weeks after treatment,the nasal minimum cross-sectional area(NMCA),score of world health organization abbreviated quality of life(WHOQOL-100),nasal cavity volume(NCV),serum levels of Fn,AQP-1 were increased in two groups,and the experimental group was higher than the control group,the differences were statistically significant(P<0.05).During treatment,the incidence of adverse reactions was similar between the two groups(P>0.05).Conclusion Glucocorticoid stent implantation combined with nasal endoscopic surgery can control nasal symptoms in patients with CSwNP,improve nasal structure and ventilation function,regulate serum levels of ECP,Fn,AQP-1,and improve patients'quality of life.
2.Influence of curative-intent resection with textbook outcomes on long-term prognosis of gall-bladder carcinoma: a national multicenter study
Zhipeng LIU ; Zimu LI ; Yule LUO ; Xiaolin ZHAO ; Jie BAI ; Yan JIANG ; Yunfeng LI ; Chao YU ; Fan HUANG ; Zhaoping WU ; Jinxue ZHOU ; Dalong YIN ; Rui DING ; Wei GUO ; Yi ZHU ; Wei CHEN ; Kecan LIN ; Ping YUE ; Yao CHENG ; Haisu DAI ; Dong ZHANG ; Zhiyu CHEN
Chinese Journal of Digestive Surgery 2024;23(7):926-933
Objective:To investigate the influence of curative-intent resection with textbook outcomes of liver surgery (TOLS) on long-term prognosis of gallbladder carcinoma (GBC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 824 patients with GBC in the national multicenter database of Biliary Surgery Group of Elite Group of Chinese Journal of Digestive Surgery, who were admitted to 15 medical centers from January 2014 to January 2021, were collected. There were 285 males and 539 females, aged (62±11)years. According to the evalua-tion criteria of TOLS, patients were divided into those who achieved TOLS and those who did not achieve TOLS. Measurement data with normal distribution were represented as Mean± SD, and com-parison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data were conduc-ted using the Mann-Whitney U test. The Kaplan-Meier method was used to calculate survival rate and draw survival curve, and the Log-rank test was used for survival analysis. The COX stepwise regression model with backward Wald method was used for univariate and multivariate analyses. Results:(1) Achievement of TOLS. Of the 824 patients undergoing curative-intent resection for GBC, there were 510 cases achieving TOLS and 314 cases not achieving TOLS. (2) Follow-up. Of the 824 patients undergoing curative-intent resection for GBC, after excluding 112 deaths within 90 days after discharge, 712 cases were included for the survival analysis. The median follow-up time, median overall survival time and 5-year overall survival rate of the 510 patients achieving TOLS were 22.1(11.4,30.1)months, 47.6(30.6,64.6)months and 47.5%. The median follow-up time, median overall survival time and 5-year overall survival rate of the 202 patients not achieving TOLS were 14.0(6.8,25.5)months, 24.3(20.0,28.6)months and 21.0%. There was a significant difference in overall survival between patients achieving TOLS and patients not achieving TOLS ( χ2=58.491, P<0.05). (3) Analysis of factors influencing prognosis of patients. Results of multivariate analysis showed that TOLS, carcinoembryonic antigen (CEA), CA19-9, poorly differentiation of tumor, T2 stage of eighth edition of American Joint Committee on Cancer (AJCC) staging, T3 and T4 stage of eighth edition of AJCC staging, N1 stage of the eighth edition of AJCC staging, N2 stage of the eighth edition of AJCC staging, adjuvant therapy were independent factors influencing overall survival time of patients undergoing curative-intent resection for GBC ( hazard ratio=0.452, 1.479, 1.373, 1.612, 1.455, 1.481, 1.835, 1.978, 0.538, 95% c onfidence interval as 0.352-0.581, 1.141-1.964, 1.052-1.791, 1.259-2.063, 1.102-1.920, 1.022-2.147, 1.380-2.441, 1.342-2.915, 0.382-0.758, P<0.05). Conclusion:Patients under-going curative-intent resection for GBC with TOLS can achieve better long-term prognosis.
3.Repetitive magnetic stimulation of S3 nerve root and M1 area for treating urinary retention after spinal cord injury
Zihan XU ; Yunfeng BI ; Jiang LI ; Zongliang ZHANG ; Chen SONG ; Jie DONG ; Dong LIU
Chinese Journal of Tissue Engineering Research 2024;28(11):1719-1723
BACKGROUND:Repetitive magnetic stimulation of either S3 nerve root or M1 area can improve the urination function of patients with urinary retention after spinal cord injury,but there are few reports on the repetitive magnetic stimulation of both sites in patients with urinary retention after spinal cord injury. OBJECTIVE:To observe the effect of repetitive magnetic stimulation of both S3 nerve root and M1 area on urinary retention after spinal cord injury. METHODS:Forty patients with urinary retention after spinal cord injury were enrolled and were randomly divided into two groups(n=20 per group):group A(repetitive magnetic stimulation in both S3 nerve root and M1 area)and group B(repetitive magnetic stimulation in the S3 nerve root and sham stimulation in the M1 area).Patients in both groups were given 4-week repetitive magnetic stimulation based on conventional bladder function intervention.The stimulation time and duration of treatment were same in both groups,with a treatment time of 21 minutes daily,5 days per week,for 4 weeks in total.The urination diary and urodynamics were compared between two groups. RESULTS AND CONCLUSION:Before treatment,there were no statistically significant differences in the average daily catheterization times,average daily catheterization volume,average single urinary volume,urinary storage period(maximum bladder volume,bladder pressure),and urinary voiding period(detrusor pressure,residual urine volume)between the two groups(P>0.05).After 4 weeks of treatment,the average daily catheterization times in group A were lower than before treatment(P<0.05),while the average single urination volume in group A was higher than that before treatment(P<0.05);and the average daily catheterization times in group B were lower than before treatment(P<0.05).After 4 weeks of treatment,the average daily catheterization times in group A were lower than those in group B,and the average single urination volume was higher than that in group B(P<0.05).After 4 weeks of treatment,the maximum bladder volume and detrusor pressure during urination were increased in both groups compared with before treatment(P<0.05),while the bladder pressure and residual urine volume at the maximum volume of the two groups were decreased compared with those before treatment(P<0.05).Compared with group B,the maximum bladder volume and detrusor pressure during urination were higher in group A,while the bladder pressure and residual urine volume at maximum volume were lower in group A(P<0.05).To conclude,two treatments can both improve the urination function of patients with urinary retention after spinal cord injury,and repetitive magnetic stimulation of both S3 nerve root and M1 area is superior to repetitive magnetic stimulation of S3 nerve root alone.Repetitive magnetic stimulation of both S3 nerve root and M1 area can effectively improve the urination function of patients with urinary retention after spinal cord injury.
4.Correlation between time in range and glycated hemoglobin in patients with newly-diagnosed type 2 diabetes mellitus
Le JIANG ; Lei WANG ; Dongmei LI ; Rihan AO ; Yunfeng LI ; Yuqing GAO ; Yuanyuan LI ; Shiwei LIU
Chinese Journal of Health Management 2024;18(1):29-34
Objective:To explore the correlation between time in range (TIR) after short-term treatment and glycated hemoglobin after 3 months (HbA lc-3m) in patients with newly-diagnosed type 2 diabetes mellitus (T2DM). Methods:In this cross-sectional study, a total of 94 patients with newly-diagnosed T2DM who received treatment in the Department of Endocrinology of Inner Mongolia Autonomous Region People′s Hospital were enrolled from January 2018 to September 2022. The patients were followed-up for 3 months and had complete medical record. TIR was divided into three groups according to different target ranges of blood glucose (TIR1: TIR with blood glucose between 3.9 and 10.0 mmol/L, TIR2: TIR with blood glucose between 3.9 and 7.8 mmol/L, TIR3: TIR with fasting, premeal or bedtime blood glucose <6.1 mmol/L and 2 h postprandial blood glucose <8.0 mmol/L). The patients were divided into two groups based on whether their HbA 1c-3m level was less than 6.5%, and the baseline data and variations in TIR for distinct target glucose levels were compared between the two groups. Spearman′s correlation analysis and binary logistic regression analysis were used to analyze the relationship between baseline indicators, TIR after short-term treatment and HbA 1c-3m. Receiver operating characteristic curve (ROC) was drawn to evaluate the predictive ability of different TIR after short-term therapy for HbA 1c-3m. Results:There were statistically significant differences in TIR1 [81.0 (67.5, 94.6)% vs 71.4 (51.7, 85.7)%], TIR2 [57.7 (29.7, 70.8)% vs 40.9 (22.4, 52.3)%] and TIR3 [23.8 (10.2, 39.5)% vs 13.0 (4.8, 25.0)%] between patients with a HbA 1c-3m<6.5% and patients with a HbA 1c-3m≥6.5% (all P<0.05). Spearman correlation analysis showed that among all the patients with newly-diagnosed T2DM, TIR1, TIR2 and TIR3 were all negatively correlated with HbA 1c-3m [6.4 (6.1, 6.9)%] ( r=-0.322, -0.348, -0.303, respectively, all P<0.01). Logistic regression analysis showed that after adjusting for the confounding factors, TIR1 ( OR=1.021, 95% CI: 1.002-1.041; P=0.034), TIR2 ( OR=1.024, 95% CI: 1.006-1.043; P=0.011), TIR3 ( OR=1.037, 95% CI: 1.010-1.065; P=0.008) were all independently related to HbA 1c-3m. When HbA lc-3m<6.5% was taken as the target value, the area under the ROC curve: TIR1 was 0.639 (95% CI: 0.528-0.751), TIR2 was 0.671 (95% CI: 0.560-0.782), TIR3 was 0.659 (95% CI: 0.549-0.770), respectively. When HbA lc-3m<7.0% was taken as the target value, the area under the ROC curve: TIR1 was 0. 730 (95% CI: 0.619-0.841), TIR2 was 0.744 (95% CI: 0.642-0.846), TIR3 was 0.701 (95% CI: 0.588-0.814). There was no significant difference in the area among the three statistics ( P>0.05). Conclusions:For newly-diagnosed T2DM patients, TIR after short-term treatment is negatively correlated with HbA 1c after 3 months and has good predictive value for it.
5.Design and R&D of anatomic posterior malleolus locking plate for chinese people and its biomechanical analysis
Yongqi LI ; Yi LIAO ; Jiang XIA ; Bing LI ; Haichao ZHOU ; Youguang ZHAO ; Yunfeng YANG
Chinese Journal of Orthopaedics 2024;44(10):692-699
Objective:A novel anatomic posterior malleolus locking plate for Chinese people was designed, researched, developed, and tested biomechanically.Methods:An anatomic parameter database of posterior malleolus of Chinese people was established by collecting CT images of ankle joints from 100 healthy volunteers in Shanghai Tongji hospital from June 2022 to May 2023. Combined with relevant computer-aided technologies, a novel anatomic posterior malleolus locking plate for Chinese people was designed and produced. In addition, model verification and biomechanical test were carried out on vertical displacements under different fixation modes and different axial loads (500, 1 000, and 1 500 N). Failure loads at a displacement of 2 mm and maximum failure loads at the complete failure of internal fixation were also tested and recorded.Results:Based on the imaging anatomic measurement, the width quartile of posterior malleolus was 19.4, 26.6, 35.0 mm. The 3D reconstruction models of ankle joint CT corresponded to small, medium, and large basic posterior malleolus plates. Height of the screw safety zone was 5.5(5.3, 5.7) mm. The tip-back angle was 153.0°(148.5°, 157.5°) and tip-back height was 20.0(19.7, 20.9) mm. The novel anatomic posterior malleolus locking plate based on tibiofibular and ankle joint CT scan and relevant computer-aided technologies fit well with posterior malleolus of tibia, showing anatomic fitting. Based on the associate biomechanical test, the novel plate fixation had smaller vertical displacements of posterior malleolus fragment under axial loads of 500, 1 000, and 1 500 N compared with the control plate, but greater failure loads when the vertical displacement of the posterior malleolus fragment was 2 mm and greater maximum failure loads at complete failure of the internal fixation. At an axial load of 500 N, the vertical displacements of the posterior malleolus fragment after posterior malleolus fixation with a control plate, a 6-hole anatomical locking plate, and a 5-hole anatomical locking plate were 0.60±0.02, 0.45±0.04, and 0.52±0.04 mm, respectively with significant difference ( F=88.287, P<0.001); at an axial load of 1 000 N, the vertical displacements were 2.22±0.03, 1.10±0.03, and 1.15±0.03 mm for the three fixation modes, respectively, and the difference was statistically significant ( F=10 061.890, P<0.001); At an axial load of 1 500 N, the vertical displacements were 2.81±0.04, 1.50±0.03 and 1.67±0.03 mm for the three fixation modes, respectively with significant difference ( F=9 774.019, P<0.001). When the vertical displacement of the posterior malleolus fragment was 2 mm, the failure loads for the three fixation modes were 0.80(0.73, 0.80)、2.00(1.93, 2.00) and 1.70(1.70, 1.70) kN, respectively with significant differences ( H=54.245, P<0.001). The maximum failure loads at complete failure of the internal fixation for the three fixation modes were 1.90(1.90, 1.98)、4.30(4.30, 4.30) and 3.70(3.63, 3.70) kN, respectively with significant differences ( H=53.863, P<0.001). Conclusions:The novel anatomic posterior malleolus locking plate for Chinese people was well matched to the posterior malleolus with high mechanical strength and good stability, showing a promising future for clinical application.
6.A novel defined risk signature of endoplasmic reticulum stress-related genes for predicting the prognosis and immune infiltration status of ovarian cancer.
Jiahang MO ; Shunyi RUAN ; Baicai YANG ; Yunfeng JIN ; Keyi LIU ; Xukai LUO ; Hua JIANG
Journal of Zhejiang University. Science. B 2023;24(1):64-77
Endoplasmic reticulum (ER) stress, as an emerging hallmark feature of cancer, has a considerable impact on cell proliferation, metastasis, invasion, and chemotherapy resistance. Ovarian cancer (OvCa) is one of the leading causes of cancer-related mortality across the world due to the late stage of disease at diagnosis. Studies have explored the influence of ER stress on OvCa in recent years, while the predictive role of ER stress-related genes in OvCa prognosis remains unexplored. Here, we enrolled 552 cases of ER stress-related genes involved in OvCa from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) cohorts for the screening of prognosis-related genes. The least absolute shrinkage and selection operator (LASSO) regression was applied to establish an ER stress-related risk signature based on the TCGA cohort. A seven-gene signature revealed a favorable predictive efficacy for the TCGA, International Cancer Genome Consortium (ICGC), and another GEO cohort (P<0.001, P<0.001, and P=0.04, respectively). Moreover, functional annotation indicated that this signature was enriched in cellular response and senescence, cytokines interaction, as well as multiple immune-associated terms. The immune infiltration profiles further delineated an immunologic unresponsive status in the high-risk group. In conclusion, ER stress-related genes are vital factors predicting the prognosis of OvCa, and possess great application potential in the clinic.
Humans
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Female
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Ovarian Neoplasms/genetics*
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Cell Proliferation
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Cytokines
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Endoplasmic Reticulum Stress/genetics*
7.Influencing factors of textbook outcomes in liver surgery after radical resection of gallbladder carcinoma: a national multicenter study
Zhipeng LIU ; Xuelei LI ; Haisu DAI ; Weiyue CHEN ; Yuhan XIA ; Wei WANG ; Xianghao YE ; Zhihua LONG ; Yi ZHU ; Fan HUANG ; Chao YU ; Zhaoping WU ; Jinxue ZHOU ; Dong ZHANG ; Rui DING ; Wei CHEN ; Kecan LIN ; Yao CHENG ; Ping YUE ; Yunfeng LI ; Tian YANG ; Jie BAI ; Yan JIANG ; Wei GUO ; Dalong YIN ; Zhiyu CHEN
Chinese Journal of Digestive Surgery 2023;22(7):866-872
Objective:To investigate the influencing factors of textbook outcomes in liver surgery (TOLS) after radical resection of gallbladder carcinoma.Methods:The retrospective case-control study was conducted. The clinicopathological data of 530 patients who underwent radical resection of gallbladder carcinoma in 15 medical centers, including the First Affiliated Hospital of Army Medical University et al, from January 2014 to January 2020 were collected. There were 209 males and 321 females, aged (61±10)years. Patients underwent radical resection of gallbladder carcinoma, including cholecystectomy, hepatectomy, invasive bile duct resection, and lymph node dissection. Observation indicators: (1) situations of TOLS; (2) influencing factors of TOLS. Measure-ment data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data between groups was conducted using the Mann-Whitney U test. The univariate analysis was conducted using the corresponding statistical methods based on data type, and variables with P<0.10 were included in multivariate analysis. Multivariate analysis was conducted using the Logistic stepwise regression model. Results:(1) Situations of TOLS. All 530 patients underwent radical resection of gallbladder carcinoma, and there were 498 cases achieving R 0 resection, 508 cases without ≥grade 2 intra-operative adverse events, 456 cases without postoperative grade B and grade C biliary leakage, 513 cases without postoperative grade B and grade C liver failure, 395 cases without severe com-plications within postoperative 90 days, 501 cases did not being re-admission caused by severe com-plications within postoperative 90 days. Of the 530 patients, 54.53%(289/530) of patients achieved postoperative TOLS, while 45.47%(241/530) of patients did not achieve postoperative TOLS. (2) Influencing factors of TOLS. Results of multivariate analysis showed that American Society of Anesthesiologists classification >grade Ⅱ, preoperative jaundice, T staging as T3?T4 stage, N staging as N2 stage, liver resection as right hemi-hepatectomy, and neoadjuvant therapy were independent factors influencing TOLS in patients undergoing radical resection of gallbladder carcinoma ( odds ratio=2.65, 1.87, 5.67, 5.65, 2.55, 3.34, 95% confidence interval as 1.22?5.72, 1.18?2.95, 2.51?12.82, 2.83?11.27, 1.41?4.63, 1.88?5.92, P<0.05). Conclusion:American Society of Anesthesiologists classification >grade Ⅱ, preoperative jaundice, T staging as T3?T4 stage, N staging as N2 stage, liver resection as right hemi-hepatectomy, and neoadjuvant therapy are independent factors influencing TOLS in patients undergoing radical resection of gallbladder carcinoma.
8.Efficacy of pedicle screws combined with vertebroplasty or intermediate screws for the treatment of osteoporotic thoracolumbar fracture: a Meta-analysis
Mingzhe FENG ; Jinpeng DU ; Jiang WANG ; Zhiyi TANG ; Yunfeng MIAO ; Jialang ZHANG ; Shuai LI ; Zechao QU ; Baorong HE
Chinese Journal of Trauma 2023;39(2):127-137
Objective:To evaluate the efficacy between pedicle screws combined with vertebroplasty (PSV) and pedicle screws combined with intermediate screws (PSIS) for the treatment of osteoporotic thoracolumbar fracture (OTLF).Methods:PubMed, Cochrane Library, Web of Science, CNKI, VIP and Wanfang database were searched for all randomized controlled trial (RCT) or case-control trial (CCT) studies that comparing PSV and PSIS for the treatment of OTLF. Two reviewers independently screened the studies in the light of the inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies. The Meta-analysis was performed using the RevMan 5.4 software. The subjects were divided into PSV group and PSIS group according to different treatment methods. Operation time, intraoperative blood loss, postoperative incision infection rate, postoperative short-, mid- and long-term visual analogue scale (VAS) score, postoperative short- and mid-term Oswestry disability index (ODI), hospitalization time, postoperative short-, mid- and long-term Cobb angle, postoperative short-, mid- and long-term anterior vertebral height ratio (VBH) and implant failure rate were compared between the two groups.Results:A total of 12 studies were enrolled for review, involving 870 subjects (433 in PSV group and 437 in PSIS group). The results showed insignificant difference between the two groups in operation time ( WMD=7.07, 95% CI -4.00, 18.13, P>0.05), intraoperative blood loss ( WMD=0.62, 95% CI -7.19, 8.43, P>0.05), postoperative incision infection rate ( OR=0.65, 95% CI 0.10, 4.08, P>0.05), postoperative short-term Cobb angle ( WMD=-0.19, 95% CI -0.43, 0.05, P>0.05) and postoperative short-term VBH ( WMD=0.91, 95% CI -1.30, 3.13, P>0.05). However, there was significant difference between the two groups in postoperative short-term VAS score ( WMD=-0.59, 95% CI -1.02, -0.15, P<0.05), mid-term VAS score ( WMD=-0.41, 95% CI -0.65, -0.16, P<0.05), long-term VAS score ( WMD=-0.51, 95% CI -0.59, -0.43, P<0.05), postoperative short-term ODI ( WMD=-6.26, 95% CI -9.65, -2.87, P<0.05), postoperative mid-term ODI ( WMD=-2.44, 95% CI -3.43, -1.45, P<0.05), hospitalization time ( WMD=-2.65, 95% CI -4.61, -0.68, P<0.05), postoperative mid-term Cobb angle ( WMD=-1.40, 95% CI -2.41, -0.39, P<0.05), postoperative long-term Cobb angle ( WMD=-1.06, 95% CI -1.59, -0.52, P<0.05), postoperative mid-term VBH ( WMD=3.06, 95% CI 1.31, 4.81, P<0.05), postoperative long-term VBH ( WMD=4.11, 95% CI 2.44, 5.77, P<0.05) and implant failure rate ( OR=2.06, 95% CI 0.11, 0.59, P<0.05). Conclusion:Compared with PSIS, PSV can not reduce the operation time, intraoperative blood loss and incision infection in the treatment of OTLF, but it can significantly relieve pain, improve function, decrease reduce hospitalization time, help to maintain Cobb angle and anterior vertebral height after operation, and reduce implant failure rate.
9.Comparison of efficacy of staged versus elective operation for treating acute closed fracture-dislocation of tarsometatarsal joint complex
Bing LI ; Wenbao HE ; Jiang XIA ; Youguang ZHAO ; Haichao ZHOU ; Yunfeng YANG ; Guangrong YU
Chinese Journal of Trauma 2023;39(6):508-513
Objective:To compare the efficacy of staged versus elective operation for treating acute closed fracture-dislocation of tarsometatarsal joint complex.Methods:A retrospective cohort study was used to analyze the clinical data of 26 patients with acute closed fracture-dislocation of tarsometatarsal joint complex admitted to Tongji Hospital of Tongji University from January 2017 to January 2021, of whom 18 were males and 8 were females, aged 32-52 years [(44.3±5.2)years]. According to the time from injury to admission, 14 patients admitted within 8 hours after injury underwent staged surgical treatment (staged group), and 12 patients admitted more than 8 hours after injury underwent elective surgery (elective group). In the staged group, emergency reduction and temporary internal fixation with K-wire were done under the supervision of a C-arm X-ray machine in the first stage, while after the swelling subsided, open reduction and internal fixation were done for tarsometatarsal joint fracture-dislocation in the second stage. In the elective group, open reduction and internal fixation were performed for tarsometatarsal joint fracture-dislocation on a scheduled basis after the swelling subsided. The operation time, hospitalization time and fracture healing time were recorded. The visual analogue score (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) midfoot score were evaluated before operation, at 1, 6, 12 months after operation and at the final follow-up. The rate of complications was observed after operation.Results:All patients were followed up for 12-24 months [(18.5±3.8)months]. The operation time, hospitalization time and fracture healing time in the staged group were (77.3±5.6)minutes, (14.3±2.2)days and (12.3±1.2)weeks, respectively, significantly shorter than those in the elective group [(101.5±7.5)minutes, (20.3±5.2)days and (14.3±2.2)weeks] (all P<0.01). VAS significantly decreased and AOFAS midfoot score significantly increased in both groups as postoperative time increased (all P<0.05). There were no significant differences in VAS between the two groups before operation, at 12 months after operation or at the final follow-up (all P>0.05). The VAS at 1, 6 months after operation was (4.4±0.8)points and (2.1±0.4)points in the staged group, significantly lower than those in the elective group [(6.0±1.0)points and (3.5±0.6)points] (all P<0.01). There was no significant difference in preoperative AOFAS midfoot score between the two groups ( P>0.05). The AOFAS midfoot score at 1, 6, 12 months after operation and at the final follow-up was (67.6±4.5)points, (75.7±5.2)points, (83.6±2.2)points and (85.9±4.3)points in the staged group, significantly higher than those in the elective group [(60.2±3.9)points, (70.2±3.4)points, (75.4±3.3)points and (78.7±4.4)points] (all P<0.01). The rate of complications was 14.3% (2/14) in the staged group, significantly lower than that in the elective group [33.3% (4/12)] ( P<0.05). Conclusion:Compared to traditional elective surgery, staged surgery for acute closed fracture-dislocation of tarsometatarsal joint complex has the advantages of shortened operation time, hospitalization time and fracture healing time, eary pain relief, improved functional recovery of the foot and reduced postoperative complications.
10.CT anatomical features of the sustentaculum fragment and their clinical significance
Fajiao XIAO ; Hui HUANG ; Zihua LI ; Jiang XIA ; Bing LI ; Yunfeng YANG
Chinese Journal of Orthopaedic Trauma 2023;25(7):556-561
Objective:To determine the anatomical parameters concerning the length, width and height of the sustentaculum fragment of the calcaneus using CT imaging data and their clinical significance.Methods:A retrospective study was conducted to analyze the CT imaging data of normal calcaneus in 96 patients (100 feet) which had been collected by Department of Orthopedics, Shanghai Tongji Hospital from January 2019 to September 2020. There were 45 males (48 feet) and 51 females (52 feet) with an age of (42.1±13.6) years, and 56 left feet and 44 right feet. After 3D models were reconstructed with the CT data using software Mimics 22.0, the calcaneus was viewed layer by layer at each level of the scan. After the first continuous bone trabecula on the medial side of the calcaneal central triangle was taken as the boundary, the model of the sustentaculum fragment was segmented. The length, width, and height of the sustentaculum fragment were measured. The outer contour of the sustentaculum fragment was projected onto the lateral wall of the calcaneus to draw the contour line using software Materialise 3-Matic 22.0. By overlaying projection line diagrams, a summary of projection line diagrams of 100 sustentaculum fragments was obtained. Seven screw insertion points were selected in the summary region of the projection line diagrams of the lateral wall of the calcaneus, and the distance from each point to the medial side of the calcaneus were measureed. The length, width, and height of the sustentaculum fragment, as well as the distance from the 7 insertion points to the medial side of the calcaneus, were compared between different feet and genders.Results:The length, width, and height of the sustentaculum fragment were (45.19±4.60) mm, (38.57±4.59) mm and (40.76±5.48) mm, respectively. There were no significant differences in the length, width or height of the sustentaculum fragment between different feet or in the height of the sustentaculum fragment between different genders ( P>0.05), but the length and width of the sustentaculum fragment in females were significantly smaller than those in the males ( P<0.05). The projection of the sustentaculum fragment was approximately ellipse on the summary region of the projection line diagrams on the lateral wall of the calcaneus, with the long axis approximately parallel to the midpoint tangent of the lateral edge of the calcaneal posterior articular surface, ranging from 2 to 20 mm from the posterior articular surface. The distances from the 7 insertion points to the medial surface of the calcaneus were (39.91±3.77) mm at point A, (40.89±3.55) mm at point B, (36.42±5.98) mm at point C, (39.12±5.52) mm at point D, (40.04±4.84) mm at point E, (33.00±3.96) mm at point F, and (33.04±3.82) mm at point H. There was no significant difference in the distances from the 7 insertion points to the medial surface of the calcaneus between different feet ( P>0.05), but the distances from the 7 insertion points to the medial surface of the calcaneus in the females were significantly smaller than those in the males ( P<0.05). Conclusions:Anatomical measurements of the sustentaculum fragment can provide a theoretical basis for the range of fixation of the sustentaculum screws. A summary of projection line diagrams of the sustentaculum fragment on the lateral surface of the calcaneus can serve as a reference for placement of sustentaculum screws. Measurement of the distances from 7 insertion points to the medial surface of the calcaneus can facilitate determination of the lengths of sustentaculum screws.

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