Objective:To investigate the relationship between the CT images of a lateral condylar tibial plateau fractures and complete medial collateral ligament (MCL) injury.Methods:Data of 59 patients with lateral condylar fracture of tibial plateau complicated with MCL injury admitted to Tianjin Hospital from January 2020 to November 2021 were collected, including 32 males and 27 females, aged 42.4±12.3 years (range, 19-65 years), there were 26 cases of extension injury and 33 cases of flexion injury. The patients were separated into two groups: those with partial MCL injury and those with total rupture based on preoperative MR examination and intraoperative valgus stress test following fracture fixation. According to the ABC fracture classification of lateral condyle tibial plateau proposed by Sun et al., the fracture locations were determined on CT images, and the lateral plateau collapse depth (LPD) was measured. The relationship between LPD and MCL complete rupture was analyzed by receiver operating characteristic (ROC) curve.Results:Among 59 patients with lateral condylar tibial plateau fracture and MCL injury, 42 had partial injuries and 17 had complete ruptures. According to the ABC fracture classification, there were 26 cases of extension injury (involving area A), 21 cases of AB type, and 5 cases of ABC type; and 33 cases of flexion type injury, 19 cases of B type, 12 cases of BC type, and 2 cases of C type. All the 17 cases of MCL complete fracture occurred in extension injury, including type AB (14 cases) and type ABC (3 cases). The difference between the mean LPDs of the MCL full rupture group and the partial injury group was not statistically significant ( t=0.11, P=0.567), and the mean LPDs of both groups were 11.7±5.3 mm (range, 4.3-28.1 mm) and 11.5±4.8 mm (range, 3.8-23.6 mm), respectively. The area under the curve (AUC) of the ROC curve analysis was 0.504, and there was no statistical correlation between lateral platform collapse depth and MCL injury. Among the 26 patients with extensional injury area, MCL was completely ruptures in 17 cases and partially injury in 9 cases, LPD was 11.7±5.3 mm (range, 4.3-28.1 mm) and 6.6±1.8 mm (range, 3.8-9.4 mm), respectively, and the difference was statistically significant ( t=3.57, P=0.009). The best predictive cut-off value of LPD was 7.25 mm, the sensitivity was 88.2%, the specificity was 77.8%, and the AUC was 0.868. Conclusion:When the lateral condyle fracture of the tibial plateau is located in the extensional injury area (involving the A area in the ABC fracture classification) and the LPD measured on the CT image is greater than 7.25 mm, the complete rupture of the MCL should be considered. Clinical MCL repair is required after the fracture fixation surgery for improved surgical outcomes.

Objective:To analyze the risk factors of deep venous thrombosis (DVT) in patients with tibial plateau fracture during preoperative period.Methods:From July 2017 to October 2019, a total of 264 patients undergoing surgeries of tibial plateau fractures were enrolled. Duplex ultrasonography (DUS) during hospitalization was used to screen for DVT of the bilateral lower extremities. Patients were divided into DVT group and non-DVT group according to results of DUS. Data on demographics, comorbidities, injury-related data, fracture type, laboratory biomarkers were collected and compared between groups with and without DVT.Results:The incidence of preoperative DVT was 39.0% (103/264) among 264 patients with traumatic tibial plateau fractures, and distal thrombosis predominated in DVT group. There were 103 cases in DVT group. 55 were males and 48 were females. The average age was 54.00±11.12. According to the Schatzker classification of tibial plateau fractures, 7 cases belonged to type I, 37 to type II, 2 to type III, 11 to type IV, 29 to type V, and 17 to type VI. There were 161 cases in non-DVT group. 89 were males and 72 were females. The average age was 48.57±13.25. According to the Schatzker classification of tibial plateau fractures, 23 cases belonged to type I, 76 to type II, 2 to type III, 10 to type IV, 33 to type V, and 17 to type VI. Univariate analysis showed that age ( t=3.451, P=0.001), the type of tibial plateau fracture ( χ2=8.314, P=0.004), D-dimer ( χ2=18.552, P<0.001), APTT ( t=2.869, P=0.004), ALB ( t=2.292, P=0.023) and Hb ( t=1.983, P=0.048) were statistically different than those in non-DVT group. Multivariate analysis showed age ( OR=1.033, 95% CI: 1.009, 1.058; P=0.007), the type of tibial plateau fracture ( OR=1.829, 95% CI: 1.014, 3.299; P=0.045) and D-dimer ( OR=1.914, 95% CI: 1.057, 3.464; P=0.032) were independent risk factors. Conclusion:The incidence of DVT in patients with tibial plateau fractures during preoperative period is high, and distal thrombosis is the main part of venous thrombosis of lower extremity. The type of tibial plateau fracture, age and the level of D-dimer are independent risk factors of preoperative DVT in patients with tibial plateau fractures.

Objective: To investigate the clinical features of patients with hyperextension bicondylar tibial plateau fractures (HEBTPs), and assess surgical effectiveness of HEBTP and non-HEBTP fracture patients. Methods: From June 2014 to May 2017, 82 patients with bicondylar tibial plateau fracture were included in this study. There were 63 patients with 63 knees (76.8%) that had sustained non-HEBTPs, and 19 patients with 19 knees (23.2%) that had HEBTPs, including 49 males and 33 females with a mean age of 48.3 years (range, 22-76). Of the 19 HEBTPs patients, 4 cases were hyperextension valgus injury, 9 cases were hyperextension varus injury, and 6 cases were pure hyperextension injury. All patients were treated with open reduction internal fixation combined with bone grafting or non-bone grafting. All follow-up patients were evaluated clinically and radiographically, included the incidence of associated injuries, infection, posttraumatic osteoarthritis, range of motion (ROM) of knee, numeric rating scale (NRS) for assessment of pain, and Short Musculoskeletal Functional Assessment (SMFA) scores for assessment of knee function. The fracture healing and postoperative alignment were assessed with anteroposterior and lateral X-rays. Results: All patients were followed up for 12-22 months, the mean follow-up time was 15.4 months. Bone union was obtained in all patients, and the bone union time was 12.6 weeks (ranged: 12-16 weeks). At the last follow up, all patients had full range of motion. The incidence of significant associated injuries was 36.8% in the HEVBTP group compared with 15.8% in the non-HEBTP group. The incidence of popliteal artery injury, common peroneal nerve injury and ligament injury that needed repair in 19 HEBTPs patients was 21.1%, 26.3% and 31.6%, respectively, while the corresponding incidence of complications in 63 non-HEBTPs patients was 3.2%, 4.8%, and 9.5%, respectively. The NRS pain score of HEBTPs and non-HEBTPs at 12 months after surgery was 3.89±1.9 and 2.76±1.88, respectively. The value of HEBTPs patients was higher than that of non-HEBTPs patients, But the difference was not statistically significant. The SMFA scores of HEBTPs and non-HEBTPs patients at 12 months after surgery were 27.27±19.44 and 17.09±15.87, respectively. Patients with HEBTP had higher functional (SMFA) scores and a trend of higher pain scores than those with non-HEBTP, indicating associated soft-tissue damage and developed posttraumatic osteoarthritis. Conclusion The present showed that the HEBTP is a unique fracture. These injuries result in worse functional outcomes than non-HEBTP. Physicians must recognize the possible associated injuries (included ligaments, vessels and nerves), and the treatment effect of HEBTP is relatively poor.

Objective To investigate the relationship of ultrasonographic features and their pathologic basics in women of child-bearing period with abnormal uterine bleeding, and to explore the diagnostic ideas in detecting endometrial lesions. Methods A total of 149 women in childbearing age who had endometrial lesions with pathologically confirmed endometrial lesions, including 88 cases of endometrial hyperplasia, 41 cases of endometrial polyp, 20 cases of endometrial carcinoma, at Fuxing Hospital, Capital Medical University from October 2001 to September 2016 were selected. Ultrasound exams were performed on patients in early proliferative phase of menstrual cycle or within three days after vaginal bleeding stopped. We recorded patients′ age, measured sum diameters of length, width and thickness of uterine, mean thickness of endometrium and maximum diameter of polypoid lesions. We grouped the patients by pathologic results and compared ultrasound parameters between groups. The thickness of endometrium over 1.0 cm was considered as ″increased″. The pathologic exams also included ovarian structures. Results (1) There was no significant difference in the average age of patients with endometrial hyperplasia, endometrial polyps and endometrial cancer (P>0.05). (2) Ultrasonography: there was no statistically significant difference in the sum of the diameters of the uterus in the three groups (P>0.05); the thicker diameter of the uterine cavity in the intimal hyperplasia group was compared with the endometrial polyp group and the endometrial cancer group [(11.70±5.42)mm vs(10.59±3.83)mm vs(17.14±8.70)mm],the difference was statistically significant (F=9.779, P < 0.001), endometrial hyperplasia and endometrial cancer, endometrial polyps compared with the endometrial cancer group, the difference in uterine cavity echo thickness was statistically significant (both P<0.001); there was no significant difference in the uterine cavity echo thick diameter between the intimal hyperplasia group and the endometrial polyp group (P > 0.05). Of the 88 cases of hyperplasia of intimal hyperplasia, 53 were polypoid, and the mean diameter of the polypoid uplift was compared with the endometrial polyp group[(17.13±10.45)mm vs(12.14±4.67)mm],the difference was statistically significant (t=3.112, P=0.002). The proportions of point and strip blood flow signals in 41 cases of endometrial polyps and 53 cases of polypoid hyperplasia were 75.61% (31/41), 41.51% (22/ 53). Of the 163 patients in the three groups, 63 patients had a uterine cavity echo of <10 mm (42.3%). (3) Pathological examination: 20 cases of endometrial cancer were endometrioid carcinomas, 11 cases of hysterectomies, 7 cases of well-differentiated endometrioid carcinoma, 3 cases of moderate differentiation, 1 case of poorly differentiated; at the same time, 8 cases of ovariectomy. In 7 cases, there were multiple atresia follicles, and one case was pure cyst. Of the 88 patients with endometrial hyperplasia, 77 were hyperplasia and hyperplasia, 1 had dysplasia, 11 had complicated hyperplasia, and 3 had dysplasia. Of the 41 cases of endometrial polyps, 33 were non-functional polyps, 3 were functional polyps, and in 4 cases of adenoid fibroid polyps, there was 1 case of canceration. Conclusion In the early stage of endometrial proliferation or within 3 days after vaginal bleeding cases, the uterine cavity echo thickness diameter ≥ 10 mm suggests abnormal endometrium; uterine cavity echo thickness diameter <10 mm, endometrial abnormalities cannot be excluded; dynamic monitoring of ovulation by ultrasound may indicate the presence or absence of risk factors for abnormal growth of the endometrium.

Objective To assess the clinical value of cross raft screws technique in preventing postoperative collapse of tibial plateau fracture.Methods From September 2014 to November 2017,data of 14 patients with tibial plateau fracture who were treated by cross raft screws technique were retrospectively analyzed.There were 9 males and 5 females aged from 30-65 years old (average,44.4± 1.7 years).There were 8 patients that the thickness of subchondral cancellous bone measured preoperatively by CT data was less than 4 mm,and 6 patients that the thickness of subchondral cancellous bone measured intraoperatively was less than 4 mm.1/4 tubular plate was placed along the anterior rim of lateral tibial plateau,and the 3.5 mm cortical bone screws were fixed as bamboo raft from anterior to posterior through the plate.The collapse of tibial plateau after surgery were measured by CT scan after union of the fracture.The function of knee was evaluated by Rasmussen Anatomical and Functional Grading.Results The time of tubular plate procedure was 18 to 35 min (average,24.1±5.4 min).All 14 patients were successfully followed-up for 13.8±5.1 months.The height of collapse preoperatively by CT scan was 5-21 mm (average,8.00± 1.40 mm).3 days after the operation,the height between articular line and lateral articular surface was 0-2 mm (average,0.80±0.06 mm).Compared with CT data preoperatively,the collapse was corrected postoperatively that was proved by CT scan (P＜ 0.05).After the fracture was healed,according to CT data,the height between articular line and lateral articular surface was 0-2 mm (average,0.70±0.08 mm).Compared with CT data postoperatively,there was no postoperative collapse happened (P=0.466).The position and length of nails were placed appropriately.The average healing time of fracture was 3.6 months.There were no infection,nonunion and pain of tendon happened.The plate could be touched subcutaneously in 2 patients,who had no discomfort feelings.The patient's postoperative Rasmussen Anatomical Grading were 13-18 (average,16.7),including 8 cases excellent and 6 cases good.The postoperative Rasmussen Functional Grading was 18-28 (average,25.7),including 11 cases excellent and 3 cases good.Conclusion The cross raft screws technique is a good way to prevent the postoperative collapse of the lateral articular surface of tibial plateau.

Objective To study the correlation between multiple comet tail sign and the early abdominal visceral injury and explore the clinical application of the multiple comet tail sign in prompting the early abdominal visceral injury in an oleic acid animal model.Methods The experimental animals were divided into an experimental group and a control group.The sonograms of the lungs,livers and kidneys of control group were collected,and then the rabbits were executed.The animals of experimental group were made into multiple comet tail sign models.The thorax sonogram of successful model showed at least one lung area with varying degrees of multiple comet tail sign.Collect the sonograms of lungs,livers and kidneys were collected,and then the rabbits were executed.The two groups of rabbits were dissected,and the lungs,livers,kidneys,and spleens were removed to make the tissue sections.The gross pathologic findings and microscopic histological changes of the two groups were observed and noted.The ultrasound scores of chest sonograms were recorded:short comet tail sign for 1 point,isolated comet tail sign for 2 points,mild multiple comet tail sign for 3 points,moderate multiple comet tail sign for 4 points,and falls sign (severe multiple comet tail sign) for 5 points.The degree of organ injury was assessed by the percentage of pathologic injury area under microscope,and the correlation between the multiple comet tail sign and abdominal organ injary was analyzed.Results The successful rate of multiple comet tail sign model in experimental group was 100％.The sonograms of liver and kidney have no significant change after the experiment.The incidence of positive pathologic changes in experimental group was 100％ (11/11).The gross pathologic findings of lung were complete shape with dark red hemorrhagic area at surface;the microscopic pathologic findings were pulmonary edema (11/11,100％) and pulmonary hemorrhage (9/11,81.8％).The incidence of positive pathologic changes in the liver of experimental group was 45.5％ (5/11).The gross pathologic findings of liver were complete shape with reddish brown surface and flexible texture;the microscopic pathologic findings were cellular swelling of hepatocytes (5/11,45.5％).The incidence of positive pathologic changes in the kidneys of experimental group was 18.2％ (2/11).The gross pathology had no obvious changes,and the microscopic pathologic findings were cellular swelling of renal tubular epithelial cells (2/11,18.2％).Results showed that the lung ultrasound scores of rabbits with liver injury were obviously higher than those of rabbits with no liver injury,and there was significant differences (Z=-2.529,P=0.011).There was a statistically significant positive correlation between the lung ultrasound scores of rabbits with liver injury and the microscopic pathologic area of liver lesion (r=0.893,P=0.041),and the higher the lung ultrasound score,the more severity of the liver injury.Conclusions The appearance of multiple comet tail sign is earlier than the sonogram changes of liver and kidney.The most sensitive pathologic changes of abdominal organ appear in liver,followed by kidney.The scope and extent of the multiple comet tail sign can prompt the early injury in liver and kidney.

Objective To explore the clinical effect of periarticular knee fractures combined with anterolateral ligament (ALL) avulsion fracture.Methods From June 2014 to November 2015,13 patients with ALL avulsion fracture in periarticular knee fractures were fixed by the star plate,cannulated or screws suture anchor,including 9 male and 3 female with the mean age of 39.5 years (range from 28 to 51 years).6 patients were diagnosed distal femoral fracture,4 tibial plateau fracture,and 3 tibial intercondylar eminence avulsion fracture which all combined with ALL avulsion fracture.Postoperatively,all patients were treated with the adjustable knee brace for 3 months.Results All patients were followed up for 4-20 months,the mean follow-up time was 13.5 months.The average surgical time was 130 min (range from 90 to 210 min).In all 13 patients,ALL was found and identified.Bone union was obtained in all patients,and the bone union time was 11.4 weeks (10-12 weeks).7 cases were fixed with star plate,5 cases were fixed with hollow screw,and 1 case was fixed with anchor.All follow-up patients underwent anteroposterior and lateral X-rays.Pain,swelling and functional recovery of the knee joint were observed.Patients were assessed postoperatively with International Knee Documentation Committee (IKDC) score,Lysholm score,and Tegner activity scale to evaluate the clinical effect.At the last follow-up,all patients had full range of motion of the knee joint which from 0° to approximate 120°.The Lysholm,objective IKDC were 86.5 and 84.6 respectively.Among the 13 patients evaluated,9 patients were graded A,and 4 patients were graded B by subjective IKDC.The Tegner activity scale at the last follow-up was 6.7.Incision of poor healing in 1 case,and got healed after 32 d cleaning dressing.Conclusion This study confirmed the presence of the ALL.The fixation of ALL avulsion fracture in periarticular knee fractures can be an effective procedure at a minimum follow-up of 13.5 months.

Objective To investigate the pathogenic mutations of BRCA1 and BRCA2 in patients with early-onset breast cancer(≤35 years) and explore the relationships between BRCA1/2 mutations and clinical features.Methods Seventy-four patients with early-onset breast cancer were enrolled,who were treated in Hospital 307 between September 2014 and June 2016.High-throughput sequencing was used to test the 49 exon sequences and adjacent sequences of BRCA1 and BRCA2.χ2 test was used to analyze the distribution of BRCA1/2 pathogenic mutations in each group that was set up according to clinical features.Results Fifteen mutations(20.27%) were identified,including 5(6.76%) in BRCA1 and 10(13.51%) in BRCA2.Eleven new pathogenic mutations were discovered,and BRCA1:c.5470_5477delTGCCCAAT was found in one patient.The frequency of BRCA1/2 mutations in the group with a family history of breast cancer or ovarian cancer was higher than in the group without a family history (40.91% vs 11.54%) (χ2=6.534,P=0.011).Conclusion BRCA1/2 pathogenic mutation is significant for early-onset breast cancer,especially for those with a family history of breast or ovarian cancer.The new mutations may be specific to Chinese people.BRCA1:c.5470_5477delTGCCCAAT may be the ancestor mutation among the Chinese.

PurposeTo analyze the sonographic and the histological features of special types of breast malignant tumors in order to explore preoperative ultrasound diagnosis. Materials and Methods Seven cases of special types of breast malignant tumors confirmed by pathology were retrospectively investigated by ultrasound. The sonographic and histological features of the lesions were reviewed. The ultrasonogram manifestations of the breast anatomy and the lesions were observed and recorded.Results Among 7 cases, there were 2 cases of papillary carcinoma, 3 cases of mucinous carcinoma, and 2 cases of lymphoma. Microscopically, the papillary carcinoma had clear boundaries with infringing mesenchyme, and the tissues were papillary and dense. The mucinous carcinoma had cancer cells floated in mucus lake. The primary breast lymphoma was diffused large B-cell type with focal lesion. For sonography type of breast, there were 3 cases of fatty types, 1 case of fibroglandular-1 and 3 cases of fibroglandular-2. The papillary carcinoma was hypoechoic in 2 cases, one of them was expansive growth with large size. Two cases of mucinous carcinoma were hypoechoic without accompanying sound attenuation in 1 case and with accompanying acoustic shadow due to calcification in the other case. Lymphoma was apparent anechoic and cystoid.Conclusion Special types of breast malignancies have different sonographic features and histological features from the common invasive ductal carcinoma. It has high clinical significance to enhance the understanding of rare malignant breast tumors.

PurposeAcute lung injury/acute respiratory distress syndrome is a common severe disease, this paper aims to explore the pathological basis of diffuse comet-tail artifacts in rabbits with acute lung injury and evaluate the imaging value on pathological changes.Materials and Methods The bilateral anterior chest walls of the rabbits were divided into four zones, namely, left upper zone, right upper zone, left lower zone and right lower zone. The normal chest ultrasound images of the 6 rabbits were obtained. After oleic acid (0.1 ml/kg) was injected, the images of comet-tail artifact in the four lung zones were dynamically observed and stored for 1 hour. The chest ultrasound images were evaluated according to the ultrasound scores. The degree of pathological damage in each lung zone was assessed and analyzed in terms of the correlation with the ultrasound results.Results The animal model of acute lung injury with diffuse comet-tail artifacts was successfully made in all of the 6 rabbits. The main pathological changes of the animal model of oleic acid were diffuse pulmonary edema, congestion and congestive hemorrhage; necrosis was found in 4 rabbits. The area of pulmonary edema, congestion, and congestive hemorrhage increased gradually from top to bottom, and double diaphragm leaves were typical. A significant correlation was found between the ultrasound scores of comet-tail artifacts and the degrees of pathological damage (r=0.819,P<0.05).Conclusion The histological changes of chest diffuse comet-tail artifacts due to acute lung injury are pulmonary edema, congestion and congestive hemorrhage. The scope and density of diffuse comet-tail artifacts may indicate the degree of pulmonary parenchyma injury, which is important as reference to guide the treatment and prognosis.