Objective To compare the effectiveness of open reduction and conservative treatment for pediatric mandibular condylar fractures and to provide the evidence for the selection of cl inical therapy. Methods The cl inical data were retrospectively analyzed from 25 patients with the mandibular condylar fractures between January 1988 and December 2006. Of them, 8 patients (11 fractures) were treated with surgical treatment (surgical group) and 17 patients (22 fractures) withnon-surgical treatment (non-surgical group). In surgical group, there were 6 males (9 fractures) and 2 females (2 fractures) with an age range of 8-13 years; fracture was caused by tumbl ing in 7 cases and by traffic accident in 1 with an interval of 1-6 days between injury and hospital ization; and 5 cases were identified as unilateral condylar fractures (3 compl icated by mental fractures) and 3 cases as bilateral condylar fractures compl icated by mental fractures. In non-surgical group, there were 12 males (15 fractures) and 5 females (7 fractures) with an age range of 3-12 years; fracture was caused by fall ing from height in 4 cases, by tumbl ing in 10, and by traffic accident in 3 with an interval of 1-25 days between injury and hospital ization; and 12 cases were identified as unilateral condylar fractures (3 compl icated by mental fractures) and 5 cases as bilateral condylar fractures (1 compl icated by mental fracture). Results Incision healed by first intention in surgical group, and 25 cases were followed up 1-6 years with an average of 3.5 years. At 12 months after treatment, no temporomandibular joint pain, eating disorder, or l imited mandibular movement occurred in 2 groups. No significant difference was observed in opening mouth extent, protrusive and lateral movements between 2 groups at 6 and 12 months (P gt; 0.05). During centric occlusion, mental point located at the midl ine with symmetric face figure. Two patients in surgical group and 3 in non-surgical group had sl ight snap when opening their mouths. Mandible deviation was observed in 3 patients of 2 groups, respectively when gaping. The X-ray films showed heal ing of fracture and condylar remodel ing at 3-6 months. Mandibular ramus were symmetric in cephalometry. Conclusion Good effectiveness can be obtained by surgical or non-surgical treatment in pediatric mandibular condylar fractures. Considering the pediatric mandibular condyle having powerful heal ing and reconstructing potency and avoiding secondary injury on the temporomandibular joint from surgery, non-surgical treatment should be first selected for the pediatric mandibular condylar fractrues in patients under 7 years.
ObjectiveTo research the change and significance of Ghrelin and Visfatin in plasma after Roux-en-Y gastric bypass surgery (RYGB) in type-2 diabetes (T2DM) rats. MethodsThirty healthy Sprague Dawley (SD) rats (8 weeks) were divided into T2DM group (n=22) and blank control group (CSO group, n=8). Then rats of T2DM group were fed with high calorie and high sugar diet for 6 weeks, following by one dose of streptozotocin via intraperitioneal injection. Finally, there were 18 T2DM rats were successfully established. Then those 18 T2DM rats were divided into two groups:RYGB group (n=10) and sham operation group (DSO group, n=8). Rats of RYGB underwent RYGB, rats of DSO group and CSO group underwent sham operation. Levels of fasting serum glucose (FBG), fasting serum insulin (FINS), Ghrelin, and Visfatin of rats in 3 groups were detected by enzyme-linked immunoassay (EIA) before and 4 weeks after operation, and calculating the lee index and insulin sensitivity index (ISI). ResultsIn RYGB group, compared with before operation, the body weight, lee index, levels of FBG, FINS, and Visfatin decreased after 4 weeks after operation (P < 0.050), but level of ISI and Ghrelin increased (P < 0.050), while there was no significant difference in body weight, body length, lee index, ISI, levels of FBG, FINS, Ghrelin, and Visfatin in DSO and CSO group before and 4 weeks after operation (P > 0.050). In addition, there was statistical difference among the 3 groups in difference before and after operation of Ghrelin and Visfatin, the difference before and after operation of Ghrelin and Visfatin was larger than those of DSO group and CSO group (P < 0.050), but the difference was not significant differed between DSO group and CSO group (P > 0.050). ConclusionsThe increase of plasma Ghrelin and the decrease of Visfatin play important role in the mechanism after RYGB in treatment of T2DM rats.
Objective To review the in vivo imaging research progress of two-photon microscopy (TPM) in spinal cord. Methods The recent literature concerning in vivo two-photon imaging of axon, microglia, and calcium in transgenic mice spinal cord was extensively consulted and reviewed. Results In vivo two-photon imaging of spinal cord provide dynamic information about axonal degeneration and regeneration, microglial accumulation, and calcium influx after spinal cord injury. Conclusion TPM in vivo imaging study on spinal cord will provide theoretical foundation for pathophysiologic process of spinal cord injury.
ObjectiveTo analyze the associated risk factors of hidden blood loss in the internal fixation of intertrochanteric fracture. MethodsA retrospective analysis was made on the clinical data of 317 cases of intertrochanteric fractures which were treated by internal fixation between January 1993 and December 2008. There were 154 males and 163 females with an average disease duration of 4.58 days (range, 7 hours to 33 days); the age was (69.86±15.42) years; the average height was 1.64 m (range, 1.50-1.84 m);and the average weight was 62.26 kg (range, 39-85 kg). Of them, intramedullary fixation was used in 203 patients and extramedullary fixation in 114 patients. The operation time was (61.99±18.25) minutes. The red blood cell transfusion was given to 84 patients, and the transfusion amount was 200-1 000 mL. The drainage volume was 0-750 mL (mean, 61.85 mL). Hidden blood loss was calculated through change of hematocrit level before and after operation. The multiple linear regression was performed to analyse the risk factors of hidden blood loss. ResultsThe total blood loss was (918.60±204.44) mL, the hidden blood loss was (797.77±192.58) mL, and intraoperative visible blood loss was (257.32±271.24) mL. Single factor analysis showed hidden blood loss was significantly higher in variables as follows:gender, age, injury cause, fracture type, American anesthesiologists grading, anesthesia mode, hypertension, diabetes, disease duration, operation time, intraoperative transfusion of red blood cells, and fixation type. Multiple linear regression showed age, fracture type, anesthesia mode, and fixation type were significant risk factors. ConclusionThe risk factors of hidden blood loss are advanced age (>60 years), unstable fracture, general anesthesia, and imtramedullary fixation. Especially in elder patients with unstable fracture treated by intramedullary fixation under general anesthesia, hidden blood loss is more significant.
ObjectiveTo compare the effectiveness and complications of proximal femoral nail antirotation (PFNA) and InterTAN nail in treatment of elderly intertrochanteric fractures. MethodsA total of 178 patients with intertrochanteric fractures between January 2011 and June 2013 were enrolled. PFNA was used in 100 cases (PFNA group) and InterTAN in 78 cases (InterTAN group). No significant difference was found in gender, age, side of fracture, cause of injury, fracture classification, and time between injury and operation between 2 groups (P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy time, postoperative complications, hospitalization time, fracture healing time, and Harris score were compared between 2 groups to evaluate the effectiveness. ResultsThe operation time, intraoperative blood loss, intraoperative fluoroscopy time in PFNA group were significantly less than those in InterTAN group (P<0.05). The hospitalization time had no significant difference between the 2 groups (t=1.270, P=0.206). Primary healing was obtained in the others except 2 cases having red and swollen in each group respectively. Ninety-two cases of PFNA group and 63 cases of InterTAN group were followed up 11 months on average (range, 8-16 months). In the patients who were lost, there were 4 deaths in PFNA group and 3 deaths in InterTAN group. The complication rate was 4.2% in PFNA group (2 cases of deep venous thrombosis and 2 cases of hip varus) and was 4.5% in InterTAN group (1 case of deep venous thrombosis and 2 cases of hip varus), showing no significant difference between 2 groups (χ2=0.077, P=0.782). X-ray showed that the fracture line disappeared; no complications of malunion, bone nonunion, infection, and loosening of internal fixation occurred. The patients could walk normally. The healing time and Harris hip scores at last follow-up showed no significant difference between 2 groups (t=1.324, P=0.188; t=1.594, P=0.113). ConclusionPFNA is suitable for elderly patients with osteoporosis in treatment of femoral intertrochanteric fracture; InterTAN can be a better choice for younger patients or patients with unstable fracture.
ObjectiveTo explore the impact of perioperative average blood-glucose level on the prognosis of patients with hip fracture and diabetes mellitus. MethodsA retrospective analysis was made on the clinical data of 244 patients with hip fracture and diabetes mellitus who accorded with the inclusion criteria between September 2009 and September 2012.Of 244 patients,125 patients with poorly controlled fasting blood-glucose (average fasting blood-glucose level >7.8 mmol/L) were assigned in group A,and 119 patients with well controlled fasting blood-glucose (average fasting blood-glucose level ≤7.8 mmol/L) were assigned in group B according to "China guideline for type 2 diabetes" criteria.There was no significant difference in gender,age,disease duration of diabetes mellitus,serum albumin,fracture type and disease duration,surgical procedure,anaesthesia,and complications between 2 groups (P>0.05).Group A had a higher hemoglobin level and fewer patients who can do some outdoor activities than group B (t=-2.353,P=0.020;χ2=4.333,P=0.037).The hospitalization time,days to await surgery,stitch removal time,the postoperative complication rate,the mortality at 1 month and 1 year after operation,and ambulatory ability at 1 year after operation were compared between the 2 groups. ResultsA total of 223 patients (114 in group A and 109 in group B) were followed up 12-15 months (mean,13.5 months).The days to await surgery of group A were significantly more than those of group B (t=-2.743,P=0.007),but no significant difference was found in hospitalization time and stitch removal time between 2 groups (P>0.05).The postoperative complication rate of group A (19.2%,24/125) was significantly higher than that of group B (8.4%,10/119)(χ2=5.926,P=0.015).Group A had a higher mortality at 1 month after operation than group B (6.1% vs.0)(χ2=5.038,P=0.025),but no significant difference was shown at 1 year after operation between groups A and B (8.8% vs.4.6%)(χ2=1.555,P=0.212).At 1 year after operation in patients who can do some outdoor activities,the proportions of patients who turned to do some indoor activities was 19.2%(15/78) in the group A and 13.5%(12/89) in group B,showing no significant difference (χ2=1.013,P=0.314). ConclusionPoorly controlled perioperative fasting blood-glucose may lead undesirable influence on the prognosis of patients with hip fracture and diabetes mellitus.In order to reduce the complication rate and other accidents,the fasting blood-glucose level should be controlled to 7.8mmol/L or less.
Objective To evaluate the effectiveness of the AO anatomical locking compression plate in treating type C distal humeral fracture. Methods Between July 2008 and April 2009, 13 cases of type C distal humeral fracture were treated with the AO anatomical locking compression plates. There were 5 males and 8 females with an average age of 52.1 years (range, 24-80 years). Fractures were caused by tumbl ing in 7 cases, by traffic accident in 4 cases, and by fall ing from height in2 cases. According to Association for Osteosynthesis/Orthopaedic Trauma Association (AO/OTA) classification, there were 3 cases of type C1, 6 cases of type C2, and 4 cases of type C3. Two cases compl icated by ulnar nerve injuries, 1 by radial nerve injury, 2 by fractures of ulnar olecranon, 3 by fractures of other parts of extremities, and 6 by osteoporosis. The time from injury to hospital ization ranged from 3 hours to 4 days (0.9 day on average). Results All the incisions achieved heal ing by first intention. Thirteen cases were followed up 12 to 21 months with an average of 15.9 months. According to the X-ray films, unions were achieved both at fracture site and the olecranon osteotomy site with a heal ing time of 8 to 13 weeks (10 weeks on average). The function of elbows recovered from 3 to 32 weeks (10 weeks on average). No fixation failure, myositis ossifican, delayed union, or malunion occurred during the follow-up. The Mayo Elbow Performance score ranged from 75 to 100 with an average score of 95.8; the results were excellent in 9 cases, good in 3 cases, and fair in 1 case with an excellent and good rate of 92.3%. Conclusion The AO anatomical locking compression plate has a good fixation in treating type C distal humeral fracture. Through the approach of olecranon osteotomy, it is easy to get anatomical reduction, stable fixation, and early exercise.
ObjectiveTo evaluate the effectiveness of locking compress plate (LCP) for the treatment of aseptic diaphyseal humeral nonunions. MethodsBetween January 2006 and January 2012, 23 patients with aseptic diaphyseal humeral nonuninons were treated with LCP and autologous iliac crest bone graft, and the clinical data were retrospectively analyzed. There were 15 males and 8 females with the average age of 42.5 years (range, 28-60 years). The fracture located at left side in 11 cases and right side in 12 cases. The mechanism of the injury was traffic accident in 15 patients, and falling from height in 8 patients. Fracture was treated by internal fixation in 20 cases and external fixation in 3 cases. And 6 patients had open fractures and other 17 had close fractures. Based on the Weber-Cech classification, 6 cases were rated as atrophic nonunions, and 17 cases as hypertrophic nonuninons. Shoulder function was evaluated by Constant-Murley score and elbow function was evaluated by Mayo score. ResultsAfter operation, 2 patients had transient radial nerve symptoms of numbness and 1 patient had superficial infection. Primary healing of incision was obtained in the other patients. All patients were followed up 22.22 months on average (range, 16-30 months). Normal range of motion of the shoulder was found in 11 cases; and limited movements of abduction, elevation, and posterior extension were observed in 12 cases. And osseous union was observed clinically and radiographically in all patients. The average union time was 16.95 weeks (range, 12-24 weeks). The average Constant-Murley score was 81.87 (range, 50-98); and shoulder function was excellent in 14 cases, good in 6, and fair in 3. And the average Mayo score was 87.78 (range, 70-96); and the result was excellent in 14 cases, good in 7, and fair in 2. ConclusionAseptic diaphyseal humeral nonunions can be successfully treated with LCP, coupled with the use of autologous iliac crest bone graft.
Objective To compare the effectiveness of internal fixation, hemiarthroplasty, and total hip arthroplasty in the treatment of displaced femoral neck fractures in elderly patients so as to provide the evidence for the selection of therapeutic methods. Methods Between May 2005 and April 2008, 108 elderly patients with displaced femoral neck fractures were treated by internal fixation with compression screw (IF group, n=31), hemiarthroplasty (HA group, n=37), and total hiparthroplasty (THA group, n=40). In IF group, there were 8 males and 23 females with an average age of 73 years (range, 65-80 years); fractures were caused by tumbl ing (25 cases) and traffic accident (6 cases), including 17 cases of Garden type III and 14 cases of Garden type IV; and the time from injury to operation ranged from 8 hours to 13 days with an average of 4.2 days. In HA group, there were 10 males and 27 females with an average age of 74 years (range, 65-80 years); fractures were caused by tumbl ing (29 cases) and traffic accident (8 cases), including 21 cases of Garden type III and 16 cases of Garden type IV; and the time from injury to operation ranged from 1 to 14 days with an average of 4.4 days. In THA group, there were 11 males and 29 females with an average age of 73 years (range, 66-80 years); fractures were caused by tumbl ing (32 cases) and traffic accident (8 cases), including 23 cases of Garden type III and 17 cases of Garden type IV; and the time from injury to operation ranged from 2 to 14 days with an average of 5.6 days. There was no significant difference in general data among 3 groups (P gt; 0.05). Results There were significant differences in operation time and blood loss among 3 groups (P lt; 0.05), and IF group was less than other 2 groups. All patients were followed up 1 year and 4 months to 2 years and 3 months with an average of 1 year and 8 months. In IF group, HA group, and THA group, the rates of early postoperative compl ications were 19.4% (6/31), 8.1% (3/37), and 7.5% (3/40), respectively; the rates of late postoperative compl ications were 29.0% (9/31), 13.5% (5/37), and 7.5% (3/40), respectively; and the reoperation rates were 29.0% (9/31), 10.8% (4/37), and 5.0% (2/40), respectively. The rates of the early postoperative compl ication, late postoperative compl ication, and reoperation rate were significantly higher in IF group than in HA group and THA group (P lt; 0.05), but there was no significant difference between HA group and THA group (P gt; 0.05). The mortal ity rates were 16.1% (5/31), 13.5% (5/37), and 15.0% (6/40) in IF group, HA group, and THA group, respectively; showing no significant difference (P gt; 0.05). According to Harris hip score, the excellent and good rates were 65.4% (17/26), 81.3% (26/32), and 85.3% (29/34) in IF group, HA group, and THA group, respectively; showing significant differences among 3 groups (P lt; 0.05). Conclusion According to patient’s age, l ife expectancy, and general conditions, THA is a reasonable choice for the patients aged 65-80 years with displaced femoral neck fracture.