Objective:To analyze the clinic effects of arthroscopic partial trapeziectomy and suture button suspensionplasty in the treatment of first carpometacarpal joint (CMCJ) Eaton stage II/III arthrosis.Methods:A retrospective study was conducted on a total of 15 cases (16 hands) of patients including 5 males (1 bilateral) and 10 females with CMCJ stage II/III arthrosis who underwent surgical treatment at the first affiliated hospital of Shenzhen university from January 2020 to June 2022, with mean age of 56.7±6.4 years (range, 46-75 years). The duration from pain to treatment was 7.8±3.2 months (range, 4-14 months). X-ray showed narrowing of CMCJ with osteophytes and distal radial subluxation. All the patients were treated with arthroscopic partial trapeziectomy and suture button suspensionplasty. The preoperative and last postoperative follow-up radiographs, visual analogue scale (VAS), thumb's Kapandji scores, disabilies of the arm, shoulder, and hand (DASH) scores, grip and pinch strength and time to return to work were compared.Results:All cases were followed up for 19.6±6.3 months (range, 11-36 months). The postoperative X-ray showed all the CMCJs were reduced with a normal height of first metacarpal. The mean time for patients to return to their daily activities was 18.69±3.70 d and the mean time to return to work was 24.63±4.91 d. The average VAS score decreased from 6.56±1.15 preoperatively to 1.00 (0.75, 1.25). The preoperative Kapandji's score was 8.00±0.82 and the postoperative Kapandji's score was 8.00 (7.25, 9.00). The average DASH values improved from 24.06±3.19 to 4.00 (3.00, 5.00). The were significant differences except for Kapandji score ( Z=-4.905, P<0.001; Z=-0.121, P=0.905; Z=-4.846, P<0.001). The mean grip and pinch strength showed improvement from an average of 16.4 (14.13, 18.68) kg and 1.70±0.35 kg to 26.14±3.27 kg and 3.58±0.91 kg with significant difference ( Z=-4.617, P<0.001; t=-7.669, P<0.001). Conclusion:Arthroscopic partial trapeziectomy and suture button suspensionplasty is a minimally invasive surgery for the treatment of first CMCJ Eaton stage II/III arthrosis. By this technique, the patients' existing instability and pain problems can be solved.

Osteosarcoma of the jaw (JOS), is a relatively rare type of osteosarcoma, with a unique pathogenesis and pathological manifestations. The clinical manifestation of JOS is not characteristic, and it often needs to be diagnosed by combining radiological and pathological examination. At present, the conventional treatment of JOS is a comprehensive treatment based on surgery and supplemented by radiotherapy and chemotherapy. Recently, the emergence of new therapies such as immunotherapy, gene therapy, phototherapy and traditional Chinese medicine has provided more choices for treatment and brought new hope to patients with JOS. Therefore, this article summarized the current understanding of diagnosis and the latest treatment development of JOS.

Objective:To investigate the clinical efficacy of wrist arthroscopic transosseous footprint repair technique for treating triangular fibrocartilage complex (TFCC) injury.Methods:A retrospective case series study was conducted to analyze the clinical data of 56 patients with TFCC injury admitted to Shenzhen Second People′s Hospital from July 2017 to September 2020, including 38 males and 18 females, aged 17-45 years [(33.5±3.6)years]. All patients had unilateral injury. Physical examination showed instability of the distal radioulnar joint, and MRI and arthroscopy confirmed deep ligament injury of TFCC. All patients underwent repair of deep insertion of the TFCC by using wrist arthroscopic transosseous footprint. The operation time, intraoperative blood loss, wound healing and postoperative complications were recorded. The flexion and extension range of motion of the wrist, radial and ulnal deviation of the wrist, rotation range of motion of the forearm, patient related wrist evaluation (PRWE) score, modified Mayo wrist score, visual analogue scale (VAS), and percentage of grip strength between the affected side and unaffected side were compared preoperatively, at 3 months postoperatively and at 1 year postoperatively.Results:All patients were followed up for 12-18 months [(13.4±5.2)months]. The operation time was (61.3±8.9)minutes, with the intraoperative blood loss of (2.4±1.2)ml. All wounds were healed by first intension. There was no wound infection or ulnar nerve irritation symptom after operation. Four patients experienced clicking on the ulnar side of the wrist in a short period of time post-operation, with spontaneous disappearance of the symptom. At 3 months postoperatively, the radial and ulnar deviation of the wrist was decreased from (52.5±5.9)° preoperatively to (42.6±5.9)°, and rotation range of motion of the forearm was decreased from (94.9±8.4)°preoperatively to (84.6±5.9)° (all P<0.01). The flexion and extension range of motion of the wrist was (93.1±17.4)° preoperatively, with insignificant difference compared with (89.4±5.8)° at 3 months postoperatively ( P>0.05). At 1 year postoperatively, the flexion and extension range of motion of the wrist, radial and ulnar deviation range of motion of the wrist, and rotation range of motion of the forearm were significantly increased to (101.3±13.6)°, (52.4±6.6)°, and (116.4±16.4)° when compared with those at 3 months postoperatively (all P<0.01). At 3 months postoperatively, the PRWE score was increased to (17.1±3.8)points from (10.6±3.2)points preoperatively ( P<0.01), modified Mayo wrist score was decreased to (70.3±6.7) points from (78.1±12.7)points preoperatively ( P<0.01), VAS was decreased to (4.4±1.7)points from (6.2±1.5)points preoperatively ( P>0.05), and percentage of grip strength between the affected side and unaffected side was decreased to (55.7±8.7)% from (74.4±15.2)% preoperatively ( P<0.01). At 1 year postoperatively, the PRWE score was increased to (2.0±0.9)points, modified Mayo wrist score was increased to (94.8±3.3)points, VAS was decreased to (2.1±1.1)points, and percentage of grip strength between the affected side and unaffected side was increased to (93.2±8.7)% when compared with those at 3 months postoperatively (all P<0.01). Conclusion:Wrist arthroscopic transosseous footprint repair technique can effectively treat deep ligament injury of TFCC, with advantages of significantly improving postoperative joint range of motion and functional score, relieving the pain on the ulnar side of the wrist and enhancing grip strength.

Objective:To evaluate the emergency iliosacral screw fixation assisted by TiRobot for unstable posterior pelvic ring fracture.Methods:The 26 patients with unstable pelvic fracture were analyzed retrospectively who had undergone emergency iliosacral screw fixation at Department of Orthopedics & Traumatology, Beijing Jishuitan Hospital from June 2018 to December 2020. They were divided into 2 groups depending on whether orthopaedic TiRobot was used to assist screw insertion. In the observation group of 14 cases subjected to TiRobot-assisted insertion of iliosacral screws, there were 10 males and 4 females with an age of (45.9 ± 10.1) years; in the control group of 12 cases subjected to conventional manual insertion of iliosacral screws, there were 9 males and 3 females with an age of (49.2 ± 11.3) years. All the surgeries were conducted within 24 hours after injury. The 2 groups were compared in terms of screw insertion time, pin insertion, intraoperative blood loss, fluoroscopy time, postoperative screw position, fracture reduction and Harris hip score at the final follow-up.Results:The 2 groups were comparable because there was no significant difference between them in their preoperative general clinical data or follow-up time ( P>0.05). The screw insertion time [(16.1 ± 3.4) min] and fluoroscopy time [(8.1 ± 3.3) s] in the observation group were significantly shorter than those in the control group [(26.4 ± 5.4) min and (25.2 ± 7.4) s], and the pin insertions [1 (1, 2) times] and intraoperative blood loss [(10.5 ± 6.4) mL] in the former were significantly less than those in the latter [6 (3, 8) times and (24.8 ± 6.7) mL] (all P<0.05). Postoperatively, the sacroiliac screw position was excellent in 18 cases and good in 2 in the observation group while excellent in 14 cases, good in 2 and poor in 2 in the control group; the fracture reduction was excellent in 12 cases, good in one and fair in one in the observation group while excellent in 10 cases, good in one and fair in one in the control group, showing insignificant differences in the above comparisons ( P>0.05). There was no significant difference either in the Harris hip score at the final follow-up between the 2 groups ( P>0.05). Conclusion:Compared with conventional manual insertion of iliosacral screws, emergency iliosacral screw fixation assisted by TiRobot can effectively decrease surgical time and reduce operative invasion due to a higher accuracy rate of screw insertion.

Objective:To investigate the impact of multidisciplinary diagnosis and treatment on postoperative 30-day mortality and complications in elderly patients with hip fracture.Methods:A retrospective analysis was conducted of the 260 elderly patients with hip fracture who had been treated by the mode of multidisciplinary diagnosis and treatment at Department of Orthopedics, Shenzhen Second People's Hospital from June 2018 to October 2019. The multidisciplinary group consisted of 66 males and 194 females with an age of 78.7 years ± 5.1 years, and 141 femoral neck fractures, 114 intertrochanteric fractures and 5 subtrochanteric fractures. They were compared with the 242 elderly patients with hip fracture (traditional group) who had been treated by the traditional mode from January 2017 to May 2018. The 2 groups were compared in terms of preoperative waiting time, 48-hour operation rate, 30-day mortality, and incidences of postoperative pneumonia and pressure ulcer.Results:There were no statistically significant differences in the preoperative general data or operative procedures between the 2 groups, showing comparability ( P>0.05). For the multidisciplinary group, preoperative waiting time was 41.9 h ± 36.5 h, significantly shorter than that for the traditional group (71.4 h ± 13.9 h), 48-hour operation rate 66.5% (173/260), significantly higher than that for the traditional group(8.7%, 21/242), incidence of postoperative pneumonia 3.1%(8/260), significantly lower than that for the traditional group(9.9%, 24/242), incidence of postoperative pressure ulcer (5.4%, 14/260), significantly lower than that for the traditional group(11.2%, 27/242), and 30-day mortality(2.3%, 6/260), significantly lower than that for the traditional group(5.8%, 14/242) (all P<0.05). Conclusions:Establishment of a mode of multidisciplinary diagnosis and treatment can significantly reduce the prolonged preoperative waiting time for elderly patients with hip fracture, thereby greatly reducing postoperative complications and postoperative 30-day mortality.

Objective To compare the functional outcomes between emergency operation and delayed selective operation for extra-articular fractures of distal radius complicated with dorsal displacement and comminuted metaphysis in elderly females.Methods Included for this study were 60 elderly female patients who had been treated at Department of Orthopedic Trauma,The Second People's Hospital of Shenzhen from March 2016 to March 2017 for extra-articular fractures of the dorsally displaced distal radius with a volar locking plate.They were all female,aged from 65 to 80 years (average,73.8 years).Of them,30 received surgical operation on the day or the next day after injury (emergency group) and the other 30 did 5 to 15 days after surgery (mean,8 days) (selective group).Follow-ups were conducted at 4,12 and 48 weeks after surgery to assess the ranges of motion (ROMs) of the wrist and forearm,grip strength (GS),the Disability of Arm,Shoulder and Hand (DASH) scores and complications.Results The 2 groups were comparable because there were no significant differences between them in their preoperative general data (P ＞ 0.05).A 4 weeks after operation,the ROMs,GS and DASH scores were all significantly improved in both groups,but the ROM of dorsal extension (49.6° ± 4.1°),ROM of volar flexion (58.6°± 3.5°),ROM of supination (78.1° ± 7.5°),ROM of pronation (81.4°± 7.0°),GS (58.5％ ± 11.2％) and DASH scores (17.3 ± 7.9) in the emergency group were all significantly better than those in the selective group (37.0° ± 6.3°,45.1 ° ± 3.6°,70.7 ° ± 9.6°,67.1 ° ± 10.3°,37.3％ ±9.1％ and 32.5 ± 9.6,respectively) (all P ＜ 0.05).At 12 weeks after operation,the ROM of dorsal extension (64.8° ± 7.9°),ROM of volar flexion (70.5°± 9.7°),GS (80.4％ ± 9.9％) and DASH scores (7.7 ± 4.9) in the emergency group were significantly better than those in the selective group (41.2°± 7.0°,61.6°±10.9°,66.9％ ±18.2％ and 14.2±7.3,respectively) (P ＜0.05),but there were no significant differences between the 2 groups in ROM of supnition or pronation (P ＞ 0.05).At 48 weeks after operation,there were no significant differences between the 2 groups in ROMs,GS or DASH scores (P ＞ 0.05).Postoperatively,superficial infection happened in one case and the extensor pollicis longus muscle tendon was ruptured in another in the emergency group.Conclusion In the elderly women with dorsally displaced extra-articular fracture of the distal radius,emergency surgery with a volar locking plate may lead to better functional recovery within 12 weeks post-surgery than the elective or delayed surgery.

Objective To evaluate white matter nerve fiber changes of children with binocular ametropic amblyopia by applying the technology of diffusion tensor imaging and the whole brain analysis method of deterministic tractography,and analyze its correlation with visual acuity.Methods Fourteen binocular ametropic amblyopia children was collected from the Second Xiangya Hospital of Central South University as study subject of experimental group,14 cases of normal sight children as the control group.All children were scanned by MRI system,conventional MRI examination,3DTlWI scan were made,then echo-planar sequence scanning was used to obtain diffusion tensor imaging.Quantitative analysis was made to all diffusion tensor imaging using deterministic tractography.Using the experimental group tracts with statistic changes of FA value,volume and tract count as the region of interest(ROI),the correlation analysis with vision for each ROI was performed.Results Isoametropic amblyopia children demonstrated low FA values in the right ventral and dorsal pathway,right optic radiation and corpus callosum compared to control group.There was low volume of fibers in the bilateral ventral and dorsal pathway,the left optic radiation and body of corpus callosum compared to control group.The tract count of right dorsal pathway had reduced compared to control group.Among FA value,tract count and volume,FA value had the maximum regression coefficient with visual acuity,the regression coefficient of tract count and volume was small.The relative correlation coefficient of FA value at right optic radiation,right ventral pathway and body of corpus callosum with vision acuity were 0.486,0.534 and 0.456,respectively,the right ventral pathway had the maximum correlation with visual acuity.Conclusion Isoametropic amblyopia patients shows abnormal structure on bilateral optic radiation,bilateral ventral and dorsal pathway and body of corpus cailosum,these may cause the capability loss of object recognition and spatial position recognition.The FA value of right ventral pathway has the maximum influence on visual acuity.

Objective To assess the mortality and risk factors for stroke among dialysis patients with different dialysis modality. Methods 590 patients who underwent hemodialysis (HD) or peritoneal dialysis (PD) from January 2008 to December 2012 were recruited in our study, and categorized according to dialysis modality. The prognostic risks of stroke were hazard ratio of risk was calculated by Cox regression analysis in HD and PD patients respectively. by the Kaplan?Meier curves or the Cox proportional hazards model. Results A total of 590 patients is under a median follow?up of 32.5 months. The stroke incidence rate of 49.2/1, 000 patient?years in total patients, and 74.1/1, 000 patient?years in HD patients, which was significantly higher compared with that of 31.8/1,000 patient?years in PD patients. On multivariate analysis, independent predictors of stroke occurrence were age(HR=1.05;95%CI:1.02~1.09;P=0.003)、diabete(HR=1.98;95%CI:1.31~3.46;P=0.001)、CVD(HR=2.06;95%CI:1.62-3.05;P < 0.001)、Total triglycerides(HR = 1.20; 95% CI:1.08-1.58; P = 0.034) and hemodialysis (HR = 2.03; 95% CI:1.46-3.89; P = 0.005). Conclusions Age, diabete, CVD, total triglycerides and hemodialysis are independently associated with increased stroke risks in dialysis patients, which suggest that these patients should pay attention to weight control and glucose control.

OBJECTIVETo establish a preoperative deep venous thrombosis predictor score for patients with fresh lower extremity fractures by statistical analysis.

METHODSFrom January 2011 to December 2012, 1 705 patients with fresh lower extremity fractures were admitted to department of orthopaedic trauma, Beijing Jishuitan Hospital. They were randomly divided into two groups, the group 1 (n = 879) was used to screen risk factors and derived a predictive models based on logistic regression, the group 2 (n = 826) validated the models.

RESULTSAmong the patients, there were 1 106 male and 599 female patients, with an average age of (50 ± 18) years.Variables related to preoperative deep venous thrombosis were age, length of time before surgery, cause of injury, low/high-energy injury, location of injury, history of cardiovascular and cerebrovascular diseases, and D-Dimer. The scores based on OR were: age ≤ 35 years: 1 point, > 35- < 65 years: 4 points, ≥ 65 years: 6 points; length of time before surgery, < 8 days:1 point, ≥ 8 days:2 points;low-energy injury:1 point, high energy injury:3 points;location of injury, foot and ankle:1 point, calf:3 points, around the knee: 5 points, femoral diaphysis and proximal femur:7 points, pelvis and acetabulum:4 points, ≥ 2 sites:6 point;history of cardiovascular and cerebrovascular diseases, yes:2 points, no:1 point. D-Dimer < 600 µg/L:1 point, ≥ 600 µg/L:3 points. Area under receiver operating characteristic curve was 0.79, critical point 15.5 points, sensitivity was 77.00%, specificity was 68.17%.

CONCLUSIONThe score can predict the preoperative deep venous thrombosis for patients with fresh lower extremity fractures, but limited.

Aged ; Female ; Fibrin Fibrinogen Degradation Products ; Fractures, Bone ; Humans ; Leg ; Leg Injuries ; Logistic Models ; Lower Extremity ; Male ; Middle Aged ; ROC Curve ; Risk Factors ; Sensitivity and Specificity ; Venous Thrombosis

OBJECTIVE: To compare the difference in intraocular pressure (IOP) readings as well as the tolerability between Icare rebound tonometer (Icare RBT) and Goldmann applanation tonometer (GAT), and to evaluate the application of Icare RBT in monitoring the intraocular pressure in children after congenital cataract surgery. METHODS: The IOP was measured with the Icare RBT and GAT respectively in 150 children (262 eyes) after congenital cataract surgery by two experienced ophthalmologists. Correlation and Bland-Altman analysis were used to assess the agreement in IOP readings between the two instruments. The influence of the central corneal thickness (CCT) adjusted for age on IOP readings was analyzed by linear regression analysis. The tolerance of the patients to Icare RBT and GAT measurement were surveyed. RESULTS: The mean age was (44.82 ± 11.56) months in 150 children, including 81 boys and 69 girls. The mean IOP readings by the Icare RBT and GAT were (16.08 ± 5.72) mmHg and (14.17 ± 5.05) mmHg, respectively. The mean difference between the Icare RBT and GAT was (1.91 ± 2.04) mmHg, which was significantly correlated with CCT (r=0.409, P<0.001). The IOP readings by Icare RBT was significantly correlated with that measured by GAT(r= 0.936, P<0.001). The 95% confidence interval of the difference between the two instruments was ?2.10 to 5.91 mmHg. The Icare RBT examination was well tolerated by the children compared to the GAT examination. CONCLUSION The Icare RBT is easy to use and well tolerated by the children after congenital cataract surgery. Compared to GAT, the value measured by the IOPs trends to be overestimated. The difference in readings between the 2 tonometers will magnify with the increase in CCT.
Cataract ; congenital ; Cataract Extraction ; Child, Preschool ; Female ; Humans ; Intraocular Pressure ; Male ; Tonometry, Ocular ; instrumentation