Objective:To investigate the clinical curative effect of hyperbaric oxygen（HBO）combined with total arthroscopy in the treatment of popliteal cyst.Methods:From June 2015 to January 2020，the clinical data of 85 patients with popliteal cyst who received total arthroscopic minimally invasive surgery in Department of Orthopedics，Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and Department of Adult Orthopedics，Xinhua Hospital Chongming Branch were collected. According to different treatments，patients were divided into observation group（ n=45）and control group（ n=40）. The control group received total arthroscopic minimally invasive surgery while the observation group was additionally treated by hyperbaric oxygen therapy. Visual analogue scale（VAS）was used to evaluate the pain during the 72 hours after operation. Postoperative ambulation time and length of hospital stay were also recorded. Lysholm scoring system was used to evaluate knee function. The therapeutic efficacy was assessed by Rauschning-Lindgren grading. All the patients were followed up for one year to record the recurrence of cysts. Results:After treatment，the postoperative ambulation time and length of hospital stay of the observation group were obviously reduced compared with those of the control group，and its VAS score was lower than that of the control group，with significant statistical differences（ P<0.05）. The Lysholm scores of the two groups seven days after treatment were significantly higher than that before treatment，and the Lysholm score of the observation group markedly was higher than that of the control group after treatment，with significant statistical difference（ P<0.05）. After treatment，the total effective rate of the observation group（93.3%）was remarkably higher than that of the control group（77.5%），with significant statistical difference（ P<0.05）. The recurrence rate of popliteal cyst in the observation group（6.7%）was significant different from that in the control group（17.5%）（ P<0.05）. Conclusion:HBO combined with total arthroscopic minimally invasive surgery in the treatment of popliteal cyst has the advantages of small incision，light pain，rapid recovery，which can quickly restore the function of knee joint with low recurrence rate and significant curative effect.

Objective:To investigate the clinical curative effect of hyperbaric oxygen（HBO）combined with total arthroscopy in the treatment of popliteal cyst.Methods:From June 2015 to January 2020，the clinical data of 85 patients with popliteal cyst who received total arthroscopic minimally invasive surgery in Department of Orthopedics，Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and Department of Adult Orthopedics，Xinhua Hospital Chongming Branch were collected. According to different treatments，patients were divided into observation group（ n=45）and control group（ n=40）. The control group received total arthroscopic minimally invasive surgery while the observation group was additionally treated by hyperbaric oxygen therapy. Visual analogue scale（VAS）was used to evaluate the pain during the 72 hours after operation. Postoperative ambulation time and length of hospital stay were also recorded. Lysholm scoring system was used to evaluate knee function. The therapeutic efficacy was assessed by Rauschning-Lindgren grading. All the patients were followed up for one year to record the recurrence of cysts. Results:After treatment，the postoperative ambulation time and length of hospital stay of the observation group were obviously reduced compared with those of the control group，and its VAS score was lower than that of the control group，with significant statistical differences（ P<0.05）. The Lysholm scores of the two groups seven days after treatment were significantly higher than that before treatment，and the Lysholm score of the observation group markedly was higher than that of the control group after treatment，with significant statistical difference（ P<0.05）. After treatment，the total effective rate of the observation group（93.3%）was remarkably higher than that of the control group（77.5%），with significant statistical difference（ P<0.05）. The recurrence rate of popliteal cyst in the observation group（6.7%）was significant different from that in the control group（17.5%）（ P<0.05）. Conclusion:HBO combined with total arthroscopic minimally invasive surgery in the treatment of popliteal cyst has the advantages of small incision，light pain，rapid recovery，which can quickly restore the function of knee joint with low recurrence rate and significant curative effect.

Objective:To investigate the clinical efficacy of minimally invasive surgery combined with hyperbaric oxygen in the treatment for moderate to severe carpal tunnel syndrome.Methods:The clinical data of 86 patients with moderate to severe carpal tunnel syndrome admitted to the Department of Adult Orthopedics of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the Orthopedics Department of the Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from March 2016 to December 2019 were retrospectively analyzed. According to the treatment method, they were divided into observation group ( n=42) and control group ( n=44). The control group was treated with modified Okutsu method of endoscopic carpal tunnel release (ECTR), and the observation group was given hyperbaric oxygen on the basis of the treatment in the control group. The clinical efficacy of the two groups three months after operation was assessed by using carpal tunnel syndrome evaluation criteria, and their excellent and good recovery rates were compared. The median nerve sensory conduction velocity (SCV), motor nerve conduction velocity (MCV), sensory nerve action potential (SNAP) amplitude, and motor nerve distal motor latency (DML) of the two groups were measured by electromyography before operation, and 14 d, 30 d, and 90 d after operation. The disabilities of arm, shoulder, and hand (DASH) questionnaire was used to evaluate the upper-extremity function of the two groups before operation, and 14 d, 30 d, and 90 d after operation, and the pinch strength and grip strength of the two groups before operation, and 14 d, 30 d and 90 d after operation were measured by Jamar Pinch Gauge and Jamar Hand Dynamometer. Results:After three months of follow-up, the excellent and good recovery rate of the observation group (85.71%) was significantly higher than that of the control group (70.45%), with a significant statistical difference ( P<0.05). The DASH scores of the observation group were significantly lower than those of the control group at 14 d, 30 d, and 90 d after operation ( P<0.05). The SCV and MCV of the observation group were significantly faster than those of the control group at 14 d, 30 d, and 90 d after operation ( P<0.05). The DMLs of the observation group were significantly shorter than those of the control group at 14 d, 30 d, and 90 d after operation, while the SNAPs were significantly bigger than those of the control group ( P<0.05). The grip strength and pinch strength of the observation group were significantly stronger than those of the control group at 14 d, 30 d, and 90 d after operation ( P<0.05). Conclusion:Modified Okutsu method of ECTR combined with postoperative hyperbaric oxygen treatment can improve the clinical excellent and good recovery rate of carpal tunnel syndrome, which can enhance the electrophysiological function of their median nerves, and their daily functioning, to provide reference for treating chronic injuries caused by carpal tunnel syndrome and other peripheral nerve entrapment syndromes.

Objective:To investigate the clinical efficacy of minimally invasive surgery combined with hyperbaric oxygen in the treatment for moderate to severe carpal tunnel syndrome.Methods:The clinical data of 86 patients with moderate to severe carpal tunnel syndrome admitted to the Department of Adult Orthopedics of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the Orthopedics Department of the Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from March 2016 to December 2019 were retrospectively analyzed. According to the treatment method, they were divided into observation group ( n=42) and control group ( n=44). The control group was treated with modified Okutsu method of endoscopic carpal tunnel release (ECTR), and the observation group was given hyperbaric oxygen on the basis of the treatment in the control group. The clinical efficacy of the two groups three months after operation was assessed by using carpal tunnel syndrome evaluation criteria, and their excellent and good recovery rates were compared. The median nerve sensory conduction velocity (SCV), motor nerve conduction velocity (MCV), sensory nerve action potential (SNAP) amplitude, and motor nerve distal motor latency (DML) of the two groups were measured by electromyography before operation, and 14 d, 30 d, and 90 d after operation. The disabilities of arm, shoulder, and hand (DASH) questionnaire was used to evaluate the upper-extremity function of the two groups before operation, and 14 d, 30 d, and 90 d after operation, and the pinch strength and grip strength of the two groups before operation, and 14 d, 30 d and 90 d after operation were measured by Jamar Pinch Gauge and Jamar Hand Dynamometer. Results:After three months of follow-up, the excellent and good recovery rate of the observation group (85.71%) was significantly higher than that of the control group (70.45%), with a significant statistical difference ( P<0.05). The DASH scores of the observation group were significantly lower than those of the control group at 14 d, 30 d, and 90 d after operation ( P<0.05). The SCV and MCV of the observation group were significantly faster than those of the control group at 14 d, 30 d, and 90 d after operation ( P<0.05). The DMLs of the observation group were significantly shorter than those of the control group at 14 d, 30 d, and 90 d after operation, while the SNAPs were significantly bigger than those of the control group ( P<0.05). The grip strength and pinch strength of the observation group were significantly stronger than those of the control group at 14 d, 30 d, and 90 d after operation ( P<0.05). Conclusion:Modified Okutsu method of ECTR combined with postoperative hyperbaric oxygen treatment can improve the clinical excellent and good recovery rate of carpal tunnel syndrome, which can enhance the electrophysiological function of their median nerves, and their daily functioning, to provide reference for treating chronic injuries caused by carpal tunnel syndrome and other peripheral nerve entrapment syndromes.

Objective:To investigate the clinical efficacy of hyperbaric oxygen (HBO) therapy combined with arthroscopic minimally invasive treatment on sports traumatic ankle arthritis (STAA) during perioperative period.Methods:The clinical data of 138 patients with STAA admitted to the Department of Adult Orthopedics of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the Orthopedics Department of Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2015 to January 2020 were collected. According to the treatment methods adopted, they were divided into 3 groups, 46 cases were treated with conventional surgery (group A), 43 cases were treated with arthroscopic minimally invasive treatment (group B), and 49 cases received HBO (HBO was started 3 days before the operation and restarted the second day after the operation) combined with arthroscopic minimally invasive treatment (group C). The clinical efficacies in the 3 groups of patients were observed. The Mcguire scores and the scores of visual analogue scale (VAS) for pain before and after operation were recorded. The postoperative ankle function recovery time, postoperative recovery treatment time, postoperative joint swelling and pain symptoms subsiding time, as well as the operation time, intraoperative blood loss, and length of hospital stay, were recorded.Results:After treatment, the Mcguire scores of the patients in group B and C were significantly higher than those of the group A, and the VAS scores were significantly reduced; after treatment, the Mcguire scores of the patients in group C were significantly higher than that of the group B, and the VAS scores was significantly reduced, with significantly statistical differences ( P<0.05, or P<0.01). After treatment, the total effective rates of the group B (86.0%) and the group C (95.9%) were significantly higher than that of the group A (71.7%), and the total effective rate of the group C was significantly higher than that of the group B, all were with significantly statistical differences ( P<0.05, or P<0.01). The operation time, intraoperative blood loss, and length of hospital stay of the group B and C were significantly lower than those of the group A ( P<0.05, or P<0.01); the length of hospital stay of the patients in the group C was significantly lower than that of the patients in the group B ( P<0.05), but their operation time and intraoperative blood loss were no significant difference ( P>0.05). The postoperative pain subsiding time, postoperative joint function recovery time, and postoperative recovery treatment time of the patients in the group B and C were significantly lower than those of the patients in the group A ( P<0.05, or P<0.01); the postoperative pain subsiding time, postoperative joint function recovery time, and postoperative recovery treatment time of the patients in the group C were significantly lower than those of the patients in the group B, with significantly statistical differences ( P<0.05). Conclusion:HBO combined with arthroscopic minimally invasive treatment on STAA can significantly improve the clinical efficacy and help restore ankle joint function.

Objective:To investigate the clinical efficacy of hyperbaric oxygen (HBO) therapy combined with arthroscopic minimally invasive treatment on sports traumatic ankle arthritis (STAA) during perioperative period.Methods:The clinical data of 138 patients with STAA admitted to the Department of Adult Orthopedics of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the Orthopedics Department of Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2015 to January 2020 were collected. According to the treatment methods adopted, they were divided into 3 groups, 46 cases were treated with conventional surgery (group A), 43 cases were treated with arthroscopic minimally invasive treatment (group B), and 49 cases received HBO (HBO was started 3 days before the operation and restarted the second day after the operation) combined with arthroscopic minimally invasive treatment (group C). The clinical efficacies in the 3 groups of patients were observed. The Mcguire scores and the scores of visual analogue scale (VAS) for pain before and after operation were recorded. The postoperative ankle function recovery time, postoperative recovery treatment time, postoperative joint swelling and pain symptoms subsiding time, as well as the operation time, intraoperative blood loss, and length of hospital stay, were recorded.Results:After treatment, the Mcguire scores of the patients in group B and C were significantly higher than those of the group A, and the VAS scores were significantly reduced; after treatment, the Mcguire scores of the patients in group C were significantly higher than that of the group B, and the VAS scores was significantly reduced, with significantly statistical differences ( P<0.05, or P<0.01). After treatment, the total effective rates of the group B (86.0%) and the group C (95.9%) were significantly higher than that of the group A (71.7%), and the total effective rate of the group C was significantly higher than that of the group B, all were with significantly statistical differences ( P<0.05, or P<0.01). The operation time, intraoperative blood loss, and length of hospital stay of the group B and C were significantly lower than those of the group A ( P<0.05, or P<0.01); the length of hospital stay of the patients in the group C was significantly lower than that of the patients in the group B ( P<0.05), but their operation time and intraoperative blood loss were no significant difference ( P>0.05). The postoperative pain subsiding time, postoperative joint function recovery time, and postoperative recovery treatment time of the patients in the group B and C were significantly lower than those of the patients in the group A ( P<0.05, or P<0.01); the postoperative pain subsiding time, postoperative joint function recovery time, and postoperative recovery treatment time of the patients in the group C were significantly lower than those of the patients in the group B, with significantly statistical differences ( P<0.05). Conclusion:HBO combined with arthroscopic minimally invasive treatment on STAA can significantly improve the clinical efficacy and help restore ankle joint function.

BACKGROUND:Fracture healing in diabetic patients is usual y unsatisfactory because of hormones and metabolic disorder, and an eventual multiple organ dysfunction resulting from high blood glucose. OBJECTIVE:To dynamical y observe the changes of cytokines during the fracture healing process in diabetic rats before and after insulin treatment. METHODS:A total of 120 Sprague-Dawley rats were included in this study. Of them, 90 rats intravenously injected with 5%tetraoxypyrimidine to induce rat models of diabetes were randomized into insulin treatment and diabetes groups, respectively. The remaining 30 rats were intravenously injected with equal volume of saline and selected as control group. The next day, blood glucose was determined. Healing at 1, 4, and 8 weeks after fracture were observed by the X-ray film. Biomechanical strength of the injured right tibia was measured at 4, 6, and 8 weeks after modeling. Cytokines in the osteotylus were determined by immunohistochemical staining and in situ hybridization technique. RESULTS AND CONCLUSION:The X-ray films showed that the speed of fracture healing in the diabetes group was slower than insulin treatment and control groups. Biomechanical strength of the osteotylus in the diabetes group was significantly decreased compared with the insulin treatment and control groups. However, there were no significant differences in above-mentioned parameters between the control and insulin treatment groups. Bone morphogenetic protein 2, basic fibroblast growth factor, transforming growth factor-beta, and vascular endothelial growth factor were widely expressed in the osteotylus and their expressions in diabetes group were significantly lower and slower than those in the control and insulin treatment groups. There was no statistical difference between control and insulin treatment groups. These results indicate that osteotylus formation speed, biomechanical strength, and growth factor expressions at the fracture site in diabetes rats were decreased compared with normal rats. Insulin treatment can enhance cytokine levels at the fracture site, thereby promoting the osteoblast proliferation and fracture healing.

Objective To compare the clinical efficacy and adverse effects of photodynamic therapy (PDT) versus pulsed dye laser(PDL)for the treatment of port wine stains(PWS). Methods Forty?five patients with PWS were enrolled in this study. The PWS lesions in each patient were randomly divided into PDT and PDL areas. Hematoporphyrin monomethyl ether of 5 mg/kg was injected intravenously into the PDT area protected from light, followed by 20?minute irradiation with a 532?nm, solid?state, continuous?wave laser(power density:80-100 mw/cm2;spot diameter: 7 cm)10 minutes later. The PDL area was treated with a single session of 595?nm pulsed dye laser radiation(spot diameter:7 mm;pulse width:10 ms;energy density:10-12 J/cm2). The interval between PDT and PDL treatment was no shorter than two months. Follow up visits were scheduled on day 4 and week 8 after each treatment. Adverse reactions were recorded, and photographs were taken before and 8 weeks after the treatment for evaluation of lesion regression. Results In the case of PDT area, 10 cases(22.22%)were nearly cured, 22(48.89%)achieved marked improvement, 9(20.00%)improvement, 4(8.89%)no improvement. As far as the PDL area is concerned, 6 cases(13.33%)were nearly cured, 16(35.56%)achieved marked improvement, 18(40.00%)improvement, and 5 (11.11%)no improvement. The response rate was significantly higher in the PDT area than in the PDL area(Z=2.48, P<0.05). Hyperpigmentation, which spontaneously subsided within 3 to 6 months, was the main adverse reaction. No significant difference was found in the incidence rate of adverse reactions between the PDL and PDT areas(24.44%vs. 15.56%, Z=1.26, P>0.05). Conclusion For the treatment of PWS, both PDT and PDL are effective and safe, and single?session PDT appears to be superior to single?session PDL.

BACKGROUND:Intertrochanteric fracture can obtain good curative effects after active effective internal fixation in early stage.
OBJECTIVE:To compare dynamic hip screw+trochanter stabilizing plate and Gamma nail fixation for treatment of Evans type IIIB and type IV intertrochanteric fracture.
METHODS:A total of 67 patients with Evans type IIIB and type IV intertrochanteric fracture, including 28 cases undergoing dynamic hip screw+trochanter stabilizing plate and 39 cases undergoing Gamma nail, were selected from Chongming Branch, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from February 2009 to November 2012. Al patients received antibiotics and functional exercises after treatment. Time of therapy, intraoperative bleeding amount, fracture healing time and Harris Hip Score were retrospectively analyzed in patients of both groups.
RESULTS AND CONCLUSION:Al patients were fol owed up for 6-45 months, averagely 21 months. (1) One patient affected infection in the dynamic hip screw+trochanter stabilizing plate group. He was healed after fixation removal half a year after drug exchange. One obese patient experienced injury again during out-of-bed activity at 3 weeks after treatment in the Gamma nail group. Fracture appeared at distal end of lock pin, and healed after replaced by Gamma nail. Trochanteric stabilizing plate was unstable in four patients of the Gamma nail group. They affected severe pneumonia after over 6 weeks of lying in bed, and healed after treatment in the medical department (2) Coxa vara appeared in two cases of the dynamic hip screw+trochanter stabilizing plate group, and three cases in the Gamma nail group. Fracture healing was achieved in al patients. (3) The time of therapy was longer, and intraoperative bleeding amount was significantly more in the dynamic hip screw+trochanter stabilizing plate group compared with the Gamma nail group (P<0.05). No significant difference in healing time and Harris Hip Score was detected between the two groups (P>0.05). Dynamic hip screw+trochanter stabilizing plate and Gamma nail are effective methods for treatment of Evans type IIIB and type IV intertrochanteric fracture. To choose a suitable fixator, we should aggregately analyze fracture stability, healing state and the degree of osteoporosis.

BACKGROUND:With the increasing incidence of distal tibial fractures, locking plate fixation has become the preferred internal fixation method. OBJECTIVE:To analyze the biomechanical performance of distal tibial fractures, and to study the difference between medial and lateral locking plate methods for internal fixation of distal tibial fractures. METHODS:Articles concerning the biomechanics of the internal fixation of distal tibial fractures were col ected by literature search. The articles that met the criteria were analyzed in depth. In this paper, a biomechanical comparison between locking plate fixation and intramedul ary nail fixation was done as wel as the stress distribution and mechanism of the ankle joint. Meanwhile, 60 patients with distal tibial fractures who had received medial or lateral locking plate fixation at the Department of Orthopedics, Chongming Branch, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China from January 2009 to January 2012 were enrol ed for efficiency comparison. RESULTS AND CONCLUSION: For patients with distal tibial fractures, it is easy to cause posterior mal eolus fractures, Y-shaped fractures and anterior tibial compression, respectively, in the plantar flexion position, neutral position, and dorsiflexion position. Locking plate is better than the intramedul ary nail in the torsional force, and the intact fibula contributes to the improvement of fixed effects of these two internal fixation methods. When the fibula cannot be effectively fixed, the locking plate fixation has a better stability than the intramedul ary nail. Moreover, there is no difference in the fracture healing after fixation with medial and lateral locking plates. However, a lower incidence of complications and better function recovery of the ankle joint can be realized after lateral locking plate fixation.