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 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.
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 evaluate the advantage of single posterolateral approach for exposing the fragments of lateral malleolus and posterior malleolus in treating bimalleolar and trimalleolar fractures. MethodsBetween January 2013 and June 2015, 47 patients with ankle fractures were treated. Of 47 cases, 16 were male and 31 were female with an average age of 47.7 years (range, 25-65 years); the locations were the left side in 21 cases and the right side in 26 cases. According to types system of Lauge-Hansen, 11 cases were rated as pronation-external rotation and 36 cases as supination-external rotation. There were 9 cases of bimalleolar fractures and 38 cases trimalleolar fractures. CT examination showed that posterior malleolus fracture involved more than 35% of the joint surface in 11 cases, and 9 cases had comminuted posterior malleolus fracture. Of 47 cases, 44 had fresh fractures with a mean disease course of 4 days (range, 8 hours to 7 days), and 3 had old fracture with the disease course of 43, 58, and 62 days respectively. Posterior malleolus fractures were fixed with T-type plates in 12 cases, one-third tubular plates in 10 cases, and cannulated screws in 25 cases. ResultsThe operation time was 60-100 minutes (mean, 80 minutes); the bleeding volume was 50-100 mL (mean, 72 mL). Primary healing of incision was obtained in all patients, and no postoperative complications of infection, cutaneous necrosis, deep venous thrombosis, and sural nerve injury occurred. The CT examinations after operation showed anatomical reduction of fractures. All patients were followed up from 12 to 20 months (mean, 16 months). No fixation failure or reduction loss was found at last follow-up. All patients could walk normally. The active dorsiflexion of the affected ankles was within 5° less than normal side in 43 cases (91.5%) and 5-10° less than normal side in 4 cases (8.5%). The passive dorsiflexion of the affected ankles was within 5° less than normal side in 44 cases (93.6%) and 5-10° less than normal side in 3 cases (6.4%). According to the Olerud-Molander scoring system, the results were excellent in 40 cases, good in 5 cases, and fair in 2 cases; and the excellent and good rate was 95.7% at last follow-up. ConclusionThe single posterolateral approach could simultaneously expose the fragments of lateral malleolus and posterior malleolus, with less complication of the incision, short operation time, and clear exposure of posterior malleolus. The surgery could be performed under direct vision. It especially is suitable for bimalleolar and trimalleolar fractures with lateral malleolus and posterior malleolus.
ObjectiveTo evaluate the effectiveness of channel-assisted minimally invasive repair (CAMIR) for acute closed Achilles tendon ruptures. MethodsBetween January 2011 and June 2012, 30 patients (30 sides)with acute closed Achilles tendon ruptures were treated with CAMIR technique. Among 30 patients, 18 were male and 12 were female with an average age of 30.4 years (range, 22-50 years); the locations were left side in 10 cases and right side in 20 cases. All the causes were sports injury. B-ultrasound was used to confirm the diagnosis, with the average distance from the rupture site to the Achilles tendon insertion of 4.4 cm (range, 2-8 cm). The time from injury to operation was 3 hours to 9 days (median, 4 days). All injuries were repaired by CAMIR technique. ResultsThe average operation time was 17.0 minutes (range, 10-25 minutes), and the mean incision length was 2.0 cm (range, 1.5-2.5 cm). All the incisions healed by first intention. There was no complication of wound problem, deep vein thrombosis, re-rupture, or sural nerve injury. All cases were followed up 12-24 months with an average of 16 months. At last follow-up, the patients could walk normally with powerful raising heels and restored to normal activity level. MRI imaging suggested the continuity and healing of ruptured tendon. The circumference difference between affected leg and normal leg was less than 1 cm, and the ankle dorsi-extension was 20-30°, plantar flexion was 20-30°. Arner Lindholm score showed that the surgical results were excellent in 28 cases and good in 2 cases, with an excellent and good rate of 100%. ConclusionCAMIR is a safe and reliable method to repair acute closed Achilles tendon rupture, with many advantages of minimal injury, low re-rupture and infection. Sural nerve injury can be minimized using CAMIR by carefully placing the suture channel with a stab incision and special trocar based on a modified Bunnel suture technique.
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.