OBJECTIVE: To evaluate the safety and effectiveness of reducing posterior malleolar fractures via the modified Rammelt transfibular approach. METHODS: A retrospective analysis was conducted on 26 patients with ankle fractures who met the selection criteria and were admitted between September 2023 and May 2024. There were 13 males and 13 females, aged from 14 to 59 years (median, 43.5 years). Causes of injury included traffic accident (1 case), falls (7 cases), and sprains (18 cases). Time from injury to operation ranged from 1 to 13 days (mean, 3.9 days). According to the Lauge-Hansen classification, there were 5 supination-external rotation type Ⅲ fractures and 21 supination-external rotation type Ⅳ fractures. According to the Bartoníček classification for posterior malleolar fractures, there were 12 type Ⅱ fractures, 10 type Ⅲ fractures, and 4 type Ⅳ fractures. During operation, the fracture was exposed via the modified Rammelt transfibular approach; then, the fracture reduction was achieved under direct vision using techniques such as towel clip traction, posterolateral compression, and lifting with a posterior transverse periosteal elevator; finally, the fracture was fixed using anteroposterior cannulated screws or Kirschner wires. The incision healing was observed after operation. At 4 months after operation, X-ray film and CT were reviewed to evaluate the quality of fracture reduction. The medial clear space, tibiofibular clear space, and the anterior/posterior tibiofibular syndesmotic distances were measured. At last follow-up, the ankle function was assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) score and the range of motion. RESULTS: The marginal necrosis occurred in 2 lateral malleolar incisions, and superficial infection occurred in 1 lateral malleolar incision; the remaining incisions healed by first intention. All 26 patients were followed up 13-21 months (mean, 15.6 months). X-ray films showed that fractures in 25 patients achieved clinical union within 3-8 months (mean, 5.4 months); 1 case had delayed union of the lateral malleolus. At 4 months after operation, no significant difference was found between the injured and healthy sides in the medial clear space, tibiofibular clear space, or the anterior/posterior tibiofibular syndesmotic distances ( P>0.05). No malreduction of the posterior malleolus or the tibiofibular syndesmosis occurred. At last follow-up, the AOFAS score ranged from 80 to 100 (mean, 91.9). The range of motion ranged from 17° to 22° (mean, 21.0°) in active ankle dorsiflexion and from 40° to 49° (mean, 44.6°) in plantar flexion. Internal fixator was removed in 12 patients at 1 year after operation, with no ankle instability occurring. Ankle joint degeneration was observed in 1 patient at last follow-up. CONCLUSION The modified Rammelt transfibular approach is a safe and reliable technique. It enables precise reduction under direct vision, improves the quality of reduction for the distal tibial articular surface and the tibiofibular syndesmosis, and provides satisfactory ankle functional recovery in short-term follow-up.
Humans ; Male ; Female ; Adult ; Ankle Fractures/diagnostic imaging* ; Middle Aged ; Retrospective Studies ; Fracture Fixation, Internal/instrumentation* ; Adolescent ; Treatment Outcome ; Young Adult ; Bone Screws ; Ankle Joint/surgery* ; Fibula/surgery* ; Range of Motion, Articular

BACKGROUND:Hip arthroplasty and internal fixation are presently effective therapeutic methods in treatment of femoral neck fracture in the elderly. However, which method can reduce the incidence of postoperative complications remains controversial.
OBJECTIVE:To systematical y review the reoperation, postoperative complications and 1-year and 2-year mortality after hip arthroplasty and internal fixation in the elderly with femoral neck fracture.
METHODS:Pubmed/Medline, EMBASE, and Cochrane CENTRAL databases were retrieved by computer for articles published before May 2013. Systematic review on randomized control ed trials of hip arthroplasty versus internal fixation for femoral neck fractures in the elderly was conducted using the Cochrane Col aboration’s RevMan 5.2 software. Outcome measures included reoperation, main complications related to the surgery and mortality.
RESULTS AND CONCLUSION:Six published randomized control ed trials of nine literatures containing 1 496 cases were involved in this review. Meta-analysis results indicated that reoperation rate was greater in the internal fixation group within and more than 2 years after the surgery compared with the hip arthroplasty group (P<0.000 01). Compared with hip arthroplasty group, internal fixation significantly increased the main complications related to the surgery [OR=8.79, 95%CI(6.50-11.88), P<0.000 01]. No significant difference in 1-year and 2-year mortality after surgery was detected between the internal fixation and hip arthroplasty groups [OR=0.85, 95%CI(0.66-1.11), P=0.23;OR=0.88, 95%CI(0.70-1.10), P=0.27]. These data suggested that the long-term reoperation rate and incidence of main complications were obviously higher in internal fixation compared with hip arthroplasty for femoral neck fracture in the elderly, and no significant difference in 1-year and 2-year mortality after the surgery was detectable between the two methods. Clinical recommended hip arthroplasty in the repair of femoral neck fracture in the elderly.

Objective To explore the effects of kurorinone on the serum level of TNF-? and IL-6 in the patients with chronic hepatitis B (CHB). Methods 87 patients with CHB were randomly divided into groups A and B. Patients in group A (n=45) and group B (n=42) received kurorinone and diammonium glycyrrhizin treatment, respectively, for 3 months. The liver histopathological changes were observed, and liver function and the serum level of TNF-? and IL-6 in the patients with CHB were detected after treatment. Results Compared with group B, liver injury and liver function of the patients in group A were obviously ameliorated, and the serum level of TNF-? and IL-6 significantly decreased (P

Objective To evaluate the effects of kurorinone combined with thymosin on the treatment of chronic hepatitis B. Methods 178 patients with chronic hepatitis B were randomly divided into group A, B and C. 64 patients in group A received kurorinone combined with thymosin for 3 months. 58 patients in group B received kurorinone only, and 56 patients in group C received thymosin only. Results At the end of treatment, HBeAg and HBV DNA negative-transformed rates were respectively 51.8% and 53.6% in group A, but 32.7% and 34.6% in group B, 21.6% and 21.6% in group C, the differences were statistically significant (P

AIM:To study the electrophysiological effects of amiodarone on the pacemaker cells in guinea-pig left ventricular outflow tract under the conditions of hypoxia,acidosis and treatment with epinephrine.METHODS:The action potentials of the pacemaker cells in guinea-pig left ventricular outflow tract were recorded by conventional intracellular microelectrode technique.The effects of amiodarone on the spontaneous slow response potentials were investigated under the conditions of hypoxia,acidosis and treatment with epinephrine.RESULTS:(1) Amiodarone at concentration of 0.1 ?mol/L markedly decreased the rate of pacemaker firing (RPF) and maximal diastolic potential (MDP),lengthened 80% of the duration of action potential (APD80).Amiodarone at concentration of 1 ?mol/L significantly decreased the velocity of diastolic depolarization (VDD) and RPF,the maximal rate of depolarization (Vmax),MDP and amplitude of action potential (APA),lengthened 50% of the duration of action potential (APD50) and APD80.Amiodarone at concentration of 10 ?mol/L led to a significant decrease in VDD and RPF,Vmax,MDP and APA,a notable lengthening in APD50 and APD80 was also observed.(2) Under the condition of hypoxia and perfusion with deprived glucose content for 15 min,VDD,RPF,MDP,Vmax and APA decreased significantly,APD50 was shortened notably.Under the condition of hypoxia,amiodarone at concentration of 1 ?mol/L significantly decreased VDD,RPF and Vmax,increased MDP,lengthened APD50 and APD80 as compared to the cells treated with hypoxia only.(3) Perfusion with pH 6.8 solution for 10 min,VDD and RPF significantly decreased,Vmax and APA notably reduced,APD80 was markedly shortened.Under the condition of acidosis for 10 min,amiodarone significantly decreased VDD,RPF,MDP and APA,lengthened APD50 and APD80 as compared to the cells under the condition of acidosis only.(4) Perfusion of epinephrine at concentration of 10 ?mol/L for 10 min resulted in a significant increase in VDD,RPF,Vmax,MDP and APA,a notable shorting in APD50 and APD80 was also observed.Compared to 10 ?mol/L epinephrine group,1 ?mol/L amiodarone+ 10 ?mol/L epinephrine significantly reduced VDD,RPF,Vmax,MDP and APA,lengthened APD50 and APD80.CONCLUSION:Amiodarone markedly decreases the autorhythmicity of the pacemaker cells in guinea-pig left ventricular outflow tract.This electrophysiological effects were significantly influenced by hypoxia,acidosis and epinephrine.

Objective To study the efficacy of interferon ? 2b (IFN? 2b) combined with kurorinone in the treatment of chronic hepatitis B. Methods 146 patients with chronic hepatitis B were randomly divided into four groups(A,B,C,D). Based on the similar general treatment(group D),37 patients in group A was treated with IFN ? 2b and kurorinone. However, 37 patients in group B and 36 patients in group C received IFN ? 2b and kurorinone,respectively.Dynamic changes and relationships among liver histopathology,expression of TGF ? in liver tissue and serum levels of TGF ?,HBeAg,HBV DNA were studied using immunohistochemistry,radioimmunoassay and ELISA before and after treatment of IFN ? 2b and kurorinone. Results The score of histological hepatitic fibrosis,expression of TGF ? in liver tissue and serum levels of TGF ?,HBeAg, HBV DNA in group A showed significant lower than in group B and group C ( P

Objective To evaluate the therapeutic effect and safety of Lianhua Qingwen Capsules (LHQC) in the treatment of influenza. Methods A multi- center, randomized, double- blind, positive- controlled, parallel group trial was designed. A total of 240 cases, which were diagnosed with influenza and classified as the syndrome of toxic heat invading lung, aged from 18 to 50 years old, with body temperature over 38.0 ℃ and disease course with 48 hours, was recruited. The intent- to- treat infected (ITTI) population was 152 cases , among which 76 were treated with LHQC (4 capsules thrice daily for 3 days) and other 76 with Lingyang Ganmao Capsules (2 capsules thrice daily for 3 days). Results In the ITTI population, the effective rate for subsiding fever was 71.1 % and 53.9 % (P=0.029), and that for relieving TCM symptoms was 73.7 % and 55.3 % (P=0.018) in LHQC group and Lingyang Ganmao Capsules group, respectively. A safety analysis was conducted in 233 cases. No adverse action was found in LHQC group while two adverse events (allergic dermatitis and diarrhea) in Lingyang Ganmao Capsules group. Conclusion Early application of LHQC is effective and safe in treating infuenza.