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Progress of diagnosis and treatment of ankle fractures combined with acute deltoid ligament injury

Objective To review the diagnosis and treatment of ankle fractures combined with acute deltoid ligament injury. Methods Recent literature concerning the diagnosis and treatment of ankle fractures combined with acute deltoid ligament injury was reviewed. Results Misdiagnosis is common for ankle fractures combined with acute deltoid ligament injury. A diagnosis is given based on patients’ complaints, symptoms, and imaging examination, even surgical exploration is necessary. Whether to repair the deltoid ligament remains controversial. Conclusion Deltoid ligament is an important structure to stabilize the medial ankle joint. However, treatment of different kinds of ankle fractures combined with acute deltoid ligament injury should be standardized; whether or not repair deltoid ligament is determined by the intraoperative ankle stability.

锁骨骨折克氏针内固定术后并发症分析

Clinical Effect of Combination of Cytoreductive Surgery and Hyperthermic Intraperi-toneal Chemotherapy for Treating Hepatocellular Carcinoma with Peritoneal Metastasis

ObjectiveTo investigate the curative effects of cytoreductive surgery (CRS) combined with hyper-thermic intraperitoneal chemotherapy (HIPEC) for treating the hepatocellular carcinoma with peritoneal metastasis. MethodsThe clinical data of 80 cases of hepatocellular carcinoma with peritoneal metastasis who were treated in our hospital from January 2004 to January 2012 were collected, and were classified into observation group (n=40) and control group (n=40) according to the treatment. Case of observation group received CRS+HIPEC, and cases of control group received CRS+conventional intraperitoneal injection of chemotherapy. Then the comparison of clinical effect and prog-nosis was performed. ResultsIn observation group, the results of completeness of cytoreduction (CC) grade was:31 cases in grade 0, 6 cases in grade 1, and 3 cases in grade 2. In control group, the results of CC grade was:32 cases in grade 0, 6 cases in grade 1, and 2 cases in grade 3. There was no significant difference between 2 groups in the CC grade (P=0.213). In addition, there were no significant differences between observation group and control group in operation time (6.8 hours vs. 6.5 hours), hospital stay (17.3 days vs.18.7 days), and incidence of adverse reactions[70.0% (28/40) vs. 60.0% (24/40)], P>0.05. All of the cases of observation group and control group were followed up for 10-61 months (average of 42.5 months) and 6-49 months (average of 30.2 months) respectively. During the follow up period, in observation group, there were 18 cases died, 12 cases suffered from recurrence, 5 cases suffered from metastasis, and the rest of 5 cases survived; in the control group, there were 26 cases died, 9 cases suffered from recurrence, and 5 cases suffered from metastasis. However, the survival situation was better in observation group than that of control group (P<0.01). ConclusionCombining CRS and HIPEC for treating hepatocellular carcinoma with peritoneal metastasis was safe and effective, which would be widely applied.

T 型外支架结合有限内固定治疗邻近胫骨远端关节开放性骨折

目的 总结T 型外支架结合有限内固定治疗临近胫骨远端关节开放性骨折的疗效。 方法 2002 年8 月－ 2006 年10 月收治邻近胫骨远端关节开放性骨折15 例，男10 例，女5 例；年龄21 ～ 63 岁。骨折按AO 标准分型，A1 型5 例，A2 型6 例，A3 型4 例。伤口按Gustilo 分型，Ⅱ型10 例，Ⅲ型5 例。伤后4 ～ 8 h 手术，平均5.2 h。急诊清创，腓骨骨折采用解剖钢板或1/3 管型钢板固定，胫骨骨折复位后螺钉或克氏针固定骨折，再用T 型外支架固定。 结果 术后切口Ⅰ期愈合11 例，Ⅱ期愈合4 例。15 例均获随访，随访时间8 ～ 24 个月，平均12 个月。X 线片示术后4 ～ 8 个月，平均6.2 个月均达骨性愈合。采用Johner-Wruhs 评分标准，优10 例，良4 例，差1 例，差的1 例为小腿内翻约5°。3 例针眼周围皮肤发红、渗液；5 例皮肤缺损或皮肤坏死，经不同方法处理均愈合；2 例骨折远断端固定针骨折愈合后松动并失效。 结论 T 型外支架结合有限内固定治疗邻近胫骨远端关节的开放性骨折有利骨折愈合，并发症少，具有操作简便、医源性损伤小、固定可靠、便于软组织处理、利于肢体早期功能锻炼的优点。

带锁髓内钉治疗股骨干骨折