Objective: To evaluate Kangli hollow screws with sliding compression locking plate system (KHS) in the treatment of femoral neck fractures. Methods: From February 2015 to October 2016, 47 femoral neck fractures were treated at Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan Puai Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology. They were 30 men and 17 women, aged from 26 to 68 years (average, 43.5 years). According to the Pauwels classification, there were 24 cases of type Ⅰ, 16 cases of type Ⅱ and 7 cases of type Ⅲ; according to the Garden classification, there were 23 cases of type Ⅱ, 19 cases of type Ⅲ and 5 cases of type Ⅳ. All the fractures were immobilized with KHS after closed reduction or open reduction (3 cases). The fracture union time, femoral head necrosis and femoral neck shortening were observed after operation. The Harris scores were used to evaluate therapeutic effects at the final follow-up. Results: All the patients were followed up for an average of 29.7 months (from 22 to 39 months). All the fractures obtained solid bony union after 9 to 15 weeks(average, 12.2 weeks). Femoral head necrosis occurred in one case (2.1%). Femoral neck shortening ≤ 5 mm was observed in 6 cases and femoral neck shortening >5 mm <10 mm in 2 cases, giving a total shortening rate of 17.0%. The Harris scores at the final follow-up ranged from 77 to 98 points, averaging 92.2 points. There were 42 excellent, 3 good and 2 moderate cases, giving an excellent and good rate of 95.7%. Conclusion KHS can lead to excellent therapeutic effects in the treatment of femoral neck fractures.

Inflammation plays an important role in the pathophysiological process of ischemic stroke.This article elaborates the inflammatory response process after ischemic stroke in order to improve the understanding of the pathophysiological mechanisms of ischemic stroke.

Objective To evaluate euthyphoria reduction combined with percutaneous iliosacral screw fixation in the treatment of irreducible sacroiliac dislocation.Methods From March 2012 to May 2015,29 patients with irreducible sacroiliac dislocation were treated using euthyphoria reduction followed by percutaneous iliosacral screw fixation.They were 18 men and 11 women,aged from 25 to 68 years (average,37.9 years).According to the Tile classification,there were 7 cases of type Cl,9 cases of type C2,and 13 cases of type C3.The intervals from injury to surgery ranged from 6 to 32 days (average,11.3 days).Results The operation time for this cohort ranged from 40 to 125 minutes (average,76.2 minutes).The intraoperative bleeding ranged from 50 to 360 mL (average,148.6 mL).Their follow-ups ranged from 24 to 41 months (average,28.9 months).According to the Matta criteria for reduction,20 cases were rated as excellent and 9 as good,yielding an excellent to good rate of 100％.Their Majeed scores at the final follow-up averaged 90.1 points (range,from 67 to 100 points),giving 20 excellent,7 good and 2 fair cases (with an excellent to good rate of 93.1％).No screw loosening or lameness of the affected limb was observed during follow-ups.Conclusions Euthyphoria reduction combined with percutaneous iliosacral screw fixation can lead to satisfactory outcomes in the treatment of irreducible sacroiliac dislocation.Additionally it may improve operative safety.

Objective To compare the biomechanical performance of Kangli hollow screws with sliding compression locking plate system (KHS) and conventional cannulated lag screws for fixation of type Pauwels Ⅲ femoral neck fracture.Methods 7 cadaveric femurs were selected,vertical fractures (Pauwels Ⅲ fracture,at 70° to the horizontal) were artificially conducted in these cadaveric proximal femurs by an orthopaedic surgeon and fixed by KHS screws with plate system or conventional cannulated lag screws.Samples were positioned at 75° of the femoral shaft to the horizontal,embedded in the mould and fixed in the experimental console.Optical sensors were set at the femoral neck around the osteotomy line.Then the loading were input in the vertical,horizontal lateral direction and rotating direction around the femoral neck axis,the maximal and minimal values between the fractured fragments and the corresponding values of the loading were recorded.The values of stiffness in three directions were calculated and compared.The CT data of the left femur of a 25 year-old healthy male volunteer was input into the co(m)esponding software and vertical femoral neck fracture model was generated.Two finite element analysis models were obtained after the fracture being fixed using these two different implants,and the Von Mises stress distribution on the femur,implants and the interface between the fractured fragments and the relative motion between the fractured fragments were compared.Results In the vertical,horizontal lateral direction and rotating direction around the femoral neck axis,the stiffness of the KHS were 3 904±1 148 N/mm,4 324±1 234 N/mm and 11.45±4.95 N · m/° respectively,higher than those of the CSs method with the values of 3 020±1 150 N/mm,3 020± 854 N/mm.and 6.53±4.83 N· m/° respectively.The differences between the two groups were statistically significant (t=2.7194,4.7694 and 2.9424;P=0.0347,0.0050 and 0.0423).In the finite element analysis test,the maximal Von Mises stress values distributing on the femur and the screws in the KHS group were 40.1 MPa and 126.4 MPa,and those in the CSs group were 98.1 MPa and 145.5 MPa respectively,and both values of the former were lower than the latter.But the Von Mises stress value on the interface between the fractured fragments in the KHS group was 14.37 MPa,which was much higher than that in the CSs groupwhich was 9.39 MPa.The gap at the fracture site of the CSs fixation model was dramatically larger than that of KHS fixation model.Conclusion The KHS screws and plate system could provide better immobilization effect for vertical femoral neck fracture compared to the cannulated lag screws.The risk of the screws failure was lower and the fracture union would be easier to obtained by the fixation of KHS screws with plate system.

Objective To investigate the differential effect of neutrophil to lymphocyte ratio (NLR) at admission on large artery atherosclerosis (LAA) and small vessel occlusion (SVO) in patients with minor stroke.Methods Patients with first-ever acute ischemic stroke registered in Nanjing Stroke Registration System were enrolled retrospectively.Minor stroke was defined as the National Institutes of Health Stroke Scale (NIHSS) score ≤3.Binary logistic regression was used to evaluate the independent relationship between NLR and LAA.Results A total of 417 patients with minor stroke were included,of which 242 were in a LAA group and 175 were in a SVO group.Univariate analysis showed that there were significant differences in leukocyte count,neutrophil count,lymphocyte count,NLR,glycosylated hemoglobin,highdensity lipoprotein cholesterol,onset to treatment time,and onset to NLR detection time between the patients of the LAA group and the SVO group (all P ＞0.05).Binary logistic regression analysis suggested that after adjusting for sex and high-density lipoprotein cholesterol,NLR (with the highest quartile as a reference,the first quartile:odds ratio [OR] 0.207,95％ confidence interval [CI]0.089-0.482;P ＞ 0.001;the second quartile:OR 0.277,95％ CI 0.122-0.625,P=0.002;the third quartile:OR 0.456,95％ CI 0.197-1.057;P =0.067),onset to NLR detection time (OR 1.216,95％ CI 1.038-1.424;P =0.015),and glycosylated hemoglobin (OR 1.414,95％ CI 1.142-0.751;P=0.002) were independently associated with LAA.The area under the ROC curve of NLR predicting the LAA was 0.611 in patients admitted within 7 d after onset,and was 0.673 in patients admitted within 24 h after onset.Conclusions The increased NLR was independently associated with the LAA in patients with minor stroke.Early NLR value may have higher predictive value for LAA.

Objective To investigate the capillary index score (CIS) and clinical outcome after endovascular treatment in patients with anterior circulation acute ischemic stroke (AIS). Methods From March 2014 to March 2017,patients with anterior circulation AIS received endovascular treatment in Jinling Hospital and Wuhu Yijishan Hospital were enrolled retrospectively. The data of intraoperative digital subtraction angiography were collected and CIS was calculated. They were divided into either a poor CIS group (score 0-1) or a good CIS group (scores 2-3). Univariate analysis was used to compare the baseline data, clinical data, and outcomes between the 2 groups. Multivariate logistic regression analysis was used to determine the correlation between CIS and symptomatic intracerebral hemorrhage (sICH), death, and functional outcome at 90 d after endovascular treatment(modified Rankin Scale score 0 to 2 was defined as good outcome). Results A total of 157 patients were enrolled, including 91 (58.0％) had poor CIS and 66 (42.0％) had good CIS.Age(P=0.020),baseline systolic pressure(P=0.014),baseline National Institutes of Health Stroke Scale score (P=0.011), early infarct size (P<0.001), as well as the proportions of internal carotid artery occlusion(P<0.001)and embolectomy >3 times(P=0.042)of the poor CIS group were significantly higher than those of the good CIS group.The vascular successful recanalization rate(P<0.001) and good outcome rate (P<0.001) at 90 d in the good CIS group were significantly higher than those in the poor CIS group, while the incidence of sICH (P=0.002) and mortality (P<0.001) were significantly lower than those of the poor CIS group. Multivariate logistic regression analysis showed that CIS were significantly correlated with the functional outcome at 90 d (odd ratio [OR] 0.581, 95％ confidence interval[CI]0.419-0.805;P=0.001)and the risk of sICH at 72 h(OR 0.611,95％ CI 0.407-0.919; P=0.018) after endovascular treatment in patients with anterior circulation AIS,but it did not have a significant correlation with the risk of death (OR 0.783, 95％ CI 0.492-1.246; P=0.301). Conclusions CIS was significantly correlated with the clinical outcome in patients with anterior circulation AIS after endovascular treatment. It can be used as a tool to select patients for endovascular treatment.

Objective Cerebral venous sinus thrombosis (CVST) is easily misdiagnosed for lack of specificity in its pathogenesis and clinical symptoms and characteristics.This study was to investigate the association of the clinical features of CVST with the time of diagnosis and the impact of diagnostic delay on the prognosis of the disease.Methods We retrospectively studied the clinical data about 94 cases of CVST treated in our hospital from March 2004 to August 2016.According to the interquartile-range time of diagnosis, we divided the patients into four groups, <5 d, 5-9 d, 10-16 d, and >16 d, and analyzed the correlation between the time of diagnostic delay with the clinical characteristics of the patients.The primary and secondary endpoints were the modified Rankin Scale score (mRS) ≤1 and ≤2 respectively at 3 months after discharge.Results Papilledema, isolated intracranial hypertension syndrome, and Glasgow Coma Score of 14-15 were associated with a longer diagnostic delay than seizure and hemorrhagic or infarction lesions (P<0.05).A significantly higher rate of earlier diagnosis was found in patients with lower levels of albumin and total protein, longer thrombin time, and a higher level of C-reaction protein (P<0.05).However, no significant correlation was observed between the time of diagnostic delay and the prognosis CVST.Conclusion The symptoms and laboratory indexes of the CVST patients at admission can be used as markers for the diagnosis of CVST, which may provide some new idea for its early diagnosis.

Objective To investigate the risk difference of early neurological deterioration (END) in minor stroke patients with large artery atherosclerosis (LAA) and small vessel occlusion (SVO). Methods From January 2012 to August 2016, consecutive patients with first-ever acute ischemic stroke registered in the Nanjing Stroke Registration System were enrolled. The patients with minor stroke whose National Institutes of Health Stroke Scale (NIHSS) ≤3 on admission were screened. Propensity score matching analysis and McNemar's test were used to analyze the risk difference of END in minor stroke patients with LAA and SVO. Results A total of 778 patients with minor stroke were included, including 249 with LAA, 183 with SAO, and 145 matched pairs with propensity score matching method. The proportion of patients with END in the LAA group was significantly higher than that in the SVO group (6.2% vs. 1.4%; P<0.001). Conclusion Minor stroke due to LAA is more prone to have END than that due to SVO.

Objective To investigate the clinical effect of the free fibula composite tissue flap transplantation to repair the first metatarsal bone with soft tissue defect on foot.Methods From August, 2008 to August, 2013, 6 patients with the first metatarsal bone and soft tissue defect on foot were treated with transplantation of free fibula composite tissue flap.The causes: 2 cases in traffic accident injury, 4 cases in machine injury;3 cases with traumatic defect, and septic defect in 3 patients.Of the 6 cases, the fibular length with transplantation was 6 cm to 12 cm, and the flap area was 8 cm × 5 cm-18 cm × 16 cm;All the cases were followed-up in 3, 6, 12 months postoperatively to observe the fracture healing, and to assess injured limb function in 1 year postoperatively.Results All cases were followed up 12-24 months, and average of 14 months;All the flaps survived, and the metatarsal bone and fibula healing was good visibly in half a year, The surgery function were assessed according to Maryland's scale, and the excellent were 2 and the good were 4.Conclusion The transplantation of free fibula composite tissue flap to repair the first metatarsal bone with soft tissue defect on foot is a safe and effective strategy, and it has the advantages such as covering the wound at foot approvingly, one-time rebuild repair foot weight bearing area and the surrounding soft tissue defect, shorten the treatment cycle, for small area damage in donor area, and the function postoperative is good, etc.

Objective To investigate the clinical effects of tibiotalocalcaneal arthrodesis (TTCA) using a retrograde intramedullary nail with a valgus curve.Methods At our department,22 patients underwent TTCA using a retrograde intramedullary nail with a valgus curve from June 2009 to January 2014 and were available for complete follow-up.They were 12 men and 10 women,aged from 46 to 79 years (average,62.2 years).There were 3 cases of primary ankle osteoarthritis,9 ones of traumatic arthritis,one of ankle arthritis secondary to severe talar avascular necrosis,3 ones of progressive subtalar arthritis following failed ankle replacement,5 ones of progressive subtalar arthritis following failed ankle arthrodesis,and one of arthritis secondary to equinovarus.The outcome measurements included the American Foot and Ankle Society (AOFAS) ankle-hindfoot scale,EQ-5DTM functional score,radiologic assessment and clinical examination.Results The mean follow-up was 21.3 months (range,from 14 to 38 months).A plantigrade foot and bony union were achieved in all the patients after a mean time of 3.9 months (range,from 2.4 to 6.2 months).Postoperative radiologic results showed a good hindfoot alignment in all the patients.Superficial infection occurred in one patient and loosening of the distal screw in another who asked for removal.The mean postoperative EQ-5DTM functional score and AOFAS ankle-hindfoot score were 69.3 (range,from 20 to 90) and 69.9 (range,from 45 to 85),respectively.Conclusion TTCA using a retrograde curved intramedullary nail may lead to solid fusion and good hindfoot alignment.