Gang Zhong

Sichuan University, Hua-yang, Sichuan, China

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Publications (20)5.4 Total impact

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    ABSTRACT: EDUCATIONAL OBJECTIVES As a result of reading this article, physicians should be able to: 1. Analyze the latest innovations in biomaterial scaffolds for the repair and regeneration of osteochondral defects. 2. Discuss the design and manufacture of biomaterial scaffolds. 3. Compare the advantages and disadvantages of stratified and nonstratified scaffolds. 4. Review the latest fixation methods of scaffolds in vivo. Due to their good biocompatibility and mechanical integrity, tissue engineering scaffolds have become a principal method of repair and regeneration of osteochondral defects. To improve their intrinsic properties, control their degenerative times, and enhance their cell adhesion and differentiation, numerous scaffold architectures and formation methods have been developed and tested, but the ideal scaffold design is still controversial. Moreover, scaffold fixation has a significant influence on repair and regeneration after implantation. The authors analyzed relative studies to address the latest scaffold designs, including biphasic scaffold, multilayered scaffold, and continuous nonstratified scaffold, and this article compares their advantages and disadvantages. In addition, the authors introduce a novel modified method for scaffold fixation known as magnetic fixation. Both stratified and nonstratified scaffolds can repair osteochondral defects, but continuous nonstratified scaffolds are more biomimetic compared with the native osteochondral structures, and they lead to a better regeneration of hyaline-like cartilage and structured bone tissue. Therefore, the authors suggest continuous nonstratified scaffolds are an effective option for treating osteochondral defects.
    Orthopedics 11/2013; 36(11):868-73. · 1.05 Impact Factor
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    ABSTRACT: To study the therapeutic effect of adjacent pedicle fascia flap filling and arthrodesis in the regional management of sinus tract in diabetic foot. From February 2007 to August 2010, 6 patients suffering diabetic foot with sinus tract were included. There were 4 male and 2 female patients, aged 47 to 68 (averaging 58.3 +/- 6.7). One case had the entrance of sinus tract in the heel, and its base located deep in the calcaneus. Three cases had the sinus tract in the vola or dorsum of the foot, in which 1 with a perforating tract connecting the vola and the dorsum. Another 2 cases were in the toes, both located around joints. Under the effective treatments of anti-infection, anti-coagulation and control of blood sugar, blood pressure as well as blood lipid level, the patients were subjected to surgical treatments of sinus tract, the sinuses in the heel, sole and dorsum of the feet were filled up with facial flap, and those in the toes were eliminated using arthrodesis. All the 6 patients received rational debridement. Four patients were treated with adjacent fascia flap filling, the other two were treated with arthrodesis. The sinus tracts healed 14-20 d after surgery in all patients. One patient developed skin necrosis at the edge of the incision in the dorsum of the foot and another whose sinus located in the toe suffered inflammation and exudation. Both patients recovered after dressing replacement, antiseptic therapy and blood sugar regulation for a period of time. Appropriately designed pedicle fascia flap can provide satisfactory healing for sinus in the heel, vola and dorsum, and arthrodesis is a safe and effective way for that in the toes. Rational debridement is the key prerequisite for healing of sinus tract in diabetic foot.
    Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition 09/2012; 43(5):766-9.
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    ABSTRACT: Subtrochanteric fractures of the femur complicated with segmental bone defects are uncommon injuries and challenging to manage. We evaluated the effect of reconstructing extensive bone defect in the subtrochanteric area (mean, 6.9 cm) with folded free vascularized fibular graft (FVFG). Between 2001 and 2007, 14 cases of subtrochanteric fractures complicated with huge bone defects treated by folded FVFG transfer in our hospital were retrospectively reviewed. The defect was reconstructed by folded FVFG transfer and locking plate stabilization in 10 patients with no sign of infection at admission (group 1). In the other four patients presented with infections (group 2), the defect was reconstructed by folded FVFG transfer and external fixator fixation. The average follow-up period was 67.4 months. Bone union was achieved in all of the cases at an average of 5.4 months (range, 4-6 months). Primarily, bone union was achieved in all of the cases in group 1, but one stress fracture occurred in group 2. The full weight bearing time was 5.4 months (range, 5-6 months) in group 1 and 8.5 months (range, 8-9 months) in group 2. Seven patients in group 1 had the locking plate removed in an average of 27 months (range, 18-38 months). In group 2, the external fixator removal time was 13 months (range, 10-18 months). There was no varus deformity at the final follow-up in group 1. The neck-shaft angle measured during the postoperative period and at final follow-up was 129.6 degrees and 129.4 degrees, respectively. In group 2, the neck-shaft angle at the final follow-up was significantly less than the angle measured at the postoperative period (115.5 vs. 129.5 degree, p = 0.021). The range of motion of the hip and knee joint (extend and flex) was 100 degrees or more in all patients at the final follow-up. The results of this study showed that huge subtrochanteric bone defects reconstructed by folded FVFG and locking plate were highly successful in achieving bone union, reducing risks of postoperative stress fracture and preventing malunion. When huge bone defects in the subtrochanteric area complicated with acute or chronic infections, the technique of external fixator offers an alternative to reconstruct the stability of the proximal femur after folded FVFG. However, because of the inadequate stabilization, the risks of varus malunion and postoperative stress fracture could be increased after external fixator fixation. V, therapeutic study.
    The journal of trauma and acute care surgery. 05/2012; 72(5):1404-10.
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    ABSTRACT: Compartment syndrome of the thigh is a rare emergency often treated operatively. The purpose of this study was to evaluate the effects of nonoperative treatment for compartment syndrome of the thigh associated with acute renal failure after the 2008 Wenchuan earthquake. Nonoperative treatment, which primarily involves continuous renal replacement therapy, was performed in 6 patients (3 men and 3 women) who presented with compartment syndrome of the thigh associated with acute renal failure. The mean mangled extremity severity score (MESS) and laboratory data regarding renal function were analyzed before and after treatment, and the clinical outcome was evaluated at 17-month follow-up. Laboratory data regarding renal function showed improvements. All 6 patients survived with the affected lower limbs intact after nonoperative treatment. Follow-up revealed active knee range of motion and increased muscle strength, as well as a recovery of sensation. A positive linear correlation was found between MESS and the time required to achieve a reduction in swelling, as well as the time required for the recovery of sensation and knee range of motion (r>0.8; P<.05). Satisfactory clinical outcomes were obtained in patients with compartment syndrome of the thigh associated with acute renal failure.Urine alkalization, electrolyte and water balance, and continuous renal replacement therapy have played an important role in saving lives and extremities. Nonoperative treatment should be considered in the treatment of compartment syndrome of the thigh associated with acute renal failure.
    Orthopedics 04/2012; 35(4):e486-90. · 1.05 Impact Factor
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    ABSTRACT: We evaluate the clinical results of reconstructing massive juxta-articular defects of the distal femur (mean, 16.4 cm) with series-connected double-strut free-vascularized fibular grafting (FVFG) and external fixator fixation. We retrospectively reviewed a consecutive series of 19 patients, who underwent FVFG transfer because of massive juxta-articular defects of distal femur. Sixteen cases had complete records and included in this study. Five patients underwent double-strut FVFGand 11 patients underwent series-connected double-strut FVFG. FVFG was performed from 2 months to 3 months after the clinica lsigns of the infection had subsided and erythrocyte sedimentation rates had returned to normal. Both fibulas (mean, 18.6 cm) were harvested to reconstruct the femoral defect, half-ring sulcated external fixator (Orthofix Srl, Italy), and K-wires were used to provide stabilization. Five fibular grafts (15.6%) had vascular complications on flap monitoring. Fifteen of the sixteen reconstructed femurs (93.8%)united primarily. Stress fracture occurred in one patient. The mean duration to achieve union was 7.1 month (range, 4–18 months).Full weight-bearing walking was allowed 3 months after the confirmation of bone union (mean, 10 months; range, 7–22 months).The external fixator was removed 12.2 months (range, 10–16 months) postoperatively. The K-wires were removed 26.4 months(range, 23–30 months) postoperatively. There was no statistically significant difference of hypertrophic change between series-connected grafts and conventional double-strut grafts (27.18 vs. 24.43%, p = 0.186) and also between the three levels of the grafted fibula. Within the series-connected group, the difference of hypertrophic change between anterograde fibular grafts and retrograde fibular grafts was also not significant (25.24 vs. 29.12%, p = 0.178). The overall rate of knee stiffness (90 degree)was as high as 68.75% (11 of 16 patients). Massive juxta-articular defects of the distal femur are difficult and uncommon injuries. The results of this study indicate that the huge femoral defect reconstructed by series-connected double-strut FVFG provide good results in achieving bone union, reducing stress fracture rate, and achieving leg length equality.
    The journal of trauma and acute care surgery. 02/2012; 72(2):E71-6.
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    ABSTRACT: To investigate the applications of fluoroscopy-based navigation in pelvic fractures and related surgical considerations. From May 2010 to December, 16 patients with pelvic fractures were treated with computerized navigation. There were 12 males and 4 females with an average age of 37 years (ranged from 20 to 54 years). Fractures were caused by traffic accident in 5 cases, crush injury in 5 cases and falling from height in 6 cases. Based on the Tile classification, there were 15 cases of Tile C type and 1 case of Tile B type. In these patients, 4 patients were treated with sacroiliac screw fixation; 2 patients were treated with sacroiliac screw fixation, screw fixation for pubic symphysis diastasis and pubic fractures; 8 patients were treated with sacroiliac screw fixation and screw fixation for pubic fractures; 2 patients were treated with screw fixation for pubic fractures. The index such as screw inserting time, accurance of inserting screws, intra-operative blood losing, injuries of nerve, vascular and other organs, reduction conditions were observed. A total of 36 screws were inserted. The average time was 20 min for each screw placement. The blood loss ranged from 10 to 20 ml. There were no wound infections, neurovascualr injuries and other organ injuries. The postoperative pelvic X-ray and three-dimensional CT showed that the fractures had good reduction and all the screws had good position. Percutaneous screw fixation of pelvic fractures with fluoroscopy-based navigation have advantages such as little trauma, less blood loss, little complication, reliable fixation and no blood transfusion, which can reconstruct the stability of the pelvic ring, but need adequate preoperative reperation and high requirements for the surgeon.
    Zhongguo gu shang = China journal of orthopaedics and traumatology 01/2012; 25(1):70-3.
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    ABSTRACT: To compare the biomechanical stability of Kirschner wire and tension band wiring, reconstruction plate combined with tension band wiring, and olecranon anatomical plate in fixing proximal ulna combined with olecranon fracture, so as to provide the theoretical evidence for clinical selection of internal fixation. Eight specimens of elbow joints and ligaments were taken from eight fresh male adult cadaveric elbows (aged 26-43 years, mean 34.8 years) donated voluntarily. The model of proximal ulna combined with olecranon fracture was made by an osteotomy in each specimen. Fracture end was fixed successively by Kirschner wire and tension band wiring (group A), reconstruction plate combined with tension band wiring (group B), and olecranon anatomical plate (group C), respectively. The biomechanical test was performed for monopodium compression experiments, and load-displacement curves were obtained. The stability of the fixation was evaluated according to the load value when the compression displacement of fracture segment was 2 mm. No Kirschner wire withdrawal, broken plate and screw, loosening and specimens destruction were observed. The load-displacement curves of 3 groups showed that the displacement increased gradually with increasing load, while the curve slope of groups B and C was significantly higher than that of group A. When the compression displacement was 2 mm, the load values of groups A, B, and C were (218.6 +/- 66.9), (560.3 +/- 116.1), and (577.2 +/- 137.6) N, respectively; the load values of groups B and C were significantly higher than that of group A (P < 0.05), but no significant difference was observed between groups B and C (t = 0.305, P = 0.763). The proximal ulna combined with olecranon fracture is unstable. Reconstruction plate combined with tension band wiring and olecranon anatomical plate can meet the requirement of fracture fixation, so they are favorable options for proximal ulna combined with olecranon fracture. Kirschner wire and tension band wiring is not a stable fixation, therefore, it should not be only used for proximal ulna combined with olecranon fracture.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 01/2012; 26(1):10-3.
  • Zhi Li, Yi He, Gang Zhong, Fuguo Huang
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    ABSTRACT: To review the research progress in the repair and reconstruction of isolated traumatic radial head dislocation with annular ligament injury in children. In recent years, the related literature concerning isolated traumatic radial head dislocation with annular ligament injury in children was reviewed. For isolated traumatic radial head dislocation with annular ligament injury in children, the surgery should be chosen as the main treatment, including open reduction and annular ligament reconstruction surgery. Triceps aponeurosis is usually used as reconstruction materials of annular ligament, mainly because the position of taking material of annular ligament is at the operative incision with less surgery trauma and short operative time; aponeurosis is tough and thick with rigid fixation and low risk of re-dislocation. Artificial materials are paid attention to increasingly because they are easy to get, have rigid fixation, and can avoid operative injury caused by taking material of annular ligament. Currently active annular ligament reconstruction surgery should be taken; triceps aponeurosis is widely adopted as reconstruction materials of annular ligament and artificial materials have come to be a new research trend.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 10/2011; 25(10):1266-8.
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    ABSTRACT: Clavicular fractures account for 2% to 2.6% of all fractures. Plating has been considered the gold standard for treating midshaft clavicular fracture. Intramedullary pinning and conservative treatments have also been commonly used. We hypothesized that intramedullary pinning and conservative treatments have the same treatment results compared with plating. To evaluate the effect of plating vs intramedullary pinning or conservative treatment for midshaft clavicular fracture, the Cochrane Central Register of Controlled Trials (CENTRAL; Wiley Online Library, October 2010), PubMed (1950 to October 2010), and EMBASE (1980 to October 2010) were searched. Randomized and quasi-randomized controlled clinical studies evaluating plating vs intramedullary pinning or plating vs conservative treatment for midshaft clavicular fracture in adults were collected. After independent study selection by 2 authors, data were collected and extracted independently. The methodologic quality of the studies was assessed. Pooling of data was undertaken. Four studies involving 305 clavicular fractures were included. There were no significant differences between plating and intramedullary pinning with regard to outcome for Oxford Shoulder Score, Constant Shoulder Score, nonunion, infection, fixation failure, and hardware removal. More symptomatic hardware events occurred with plating compared with intramedullary pinning. Reduced nonunion, malunion, and neurologic symptoms, as well as more satisfaction with ultimate appearance, were associated with plating than with conservative treatment. This meta-analysis supports the treatment effects reported previously with plating for midshaft clavicular fractures. The outcome of this meta-analysis contradicted the findings reported previously with conservative treatment for midshaft clavicular fractures. The available evidence suggests that there are no differences in treatment effects between plating and intramedullary pinning, but plating is associated with more side effects. Plating is associated with improved treatment effects when compared with conservative treatment.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 04/2011; 20(6):1008-15. · 1.93 Impact Factor
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    ABSTRACT: OBJECTIVE To review the efficacy of reconstruction plate combined with tension band wiring for treating proximal ulna and olecranon fractures. Between November 2004 and September 2009, 10 patients with proximal ulna and olecranon fractures were treated by reconstruction plate combined with tension band wiring. There were 6 males and 4 females with an average age of 45.3 years (range, 21-75 years). Five fractures were caused by traffic accident, 2 by falling from height, 2 by tumbling, and 1 by a machine strangulation. The locations were the left side and the right side in 5 cases respectively. One case was open fracture (Gustilo II) and the other 9 were closed fractures. Olecranon fractures included 4 cases of traverse fractures and 6 cases of comminuted fractures, and proximal ulna fractures included 6 cases of comminuted fractures and 4 cases of oblique fractures. The combined fractures included 6 radial head fractures, 4 coronoid process fractures, 2 proximal humerus fractures, and 3 scapula fractures; other injury included 1 elbow dislocation and 1 shoulder dislocation. Two patients had secondary operation; the other 8 patients received the primary operations and the time from injury to operation varied from 7 days to 20 days, with an average of 11 days. One case had infection at the incision 1 week after operation, and recovered after 2 months of antibiotics and debridement; incisions healed by first intention in other 9 patients. All patients were followed up 12-64 months (mean, 40.5 months). The X-ray films showed that fracture healing was achieved at 10-24 weeks (mean, 12 weeks). There was no ulnar nerve symptom in all cases. Heterotopic ossification occurred in 1 case at 2 months and stiffness of the elbow in 1 case at 3 months after operation; they were both cured after symptomatic treatment. Proximal migration of Kirschner wires was found in 1 case at 6 months after operation, whose implants were taken out at 9 months after the first operation because fracture had healed. At last follow-up, the flexion and extension are of the elbow averaged 92.8 degrees (range, 23-130 degrees), and the arc of forearm rotation averaged 124.4 degrees (range, 42-175 degrees). According to the American Hospital for Special Surgery (HSS) evaluation method, the results were classified as excellent in 6 cases, good in 2, fair in 1, and poor in 1. Treating proximal ulna and olecranon fractures by reconstruction plate combined with tension band wiring allows patients to do postoperative exercise early and could effectively avoid complications.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 01/2011; 25(1):17-20.
  • Zhi Li, Gang Zhong, Fuguo Huang
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    ABSTRACT: To review the basic research and clinical progress of elbow heterotopic ossification after injury. The recent literature concerning heterotopic ossification of the elbow was reviewed. Heterotopic ossification was caused by variety of stimuli and conditions. The current methods of prevention and treatment were to improve surgical techniques, to reduce trauma and bleeding, to rinse the area with bone fragments with plenty of salt water, and to use non-steroidal anti-inflammatory drugs. Once heterotopic ossification occurred, surgical treatment is unique treatment method, so emphasis is to prevent heterotopic ossification.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 10/2010; 24(10):1257-60.
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    ABSTRACT: To investigate the medium-term curative effects of locking proximal humerus plate for the treatment of comminuted fractures of proximal humerus, and provide evidences for the clinical practice. From August 2005 and April 2008, 23 patients with comminuted fractures of proximal humerus were treated with locking plates, including 12 males and 11 females, aged 27 to 76 years old (averaged 51.5 years old). There were 18 cases of traffic accident injuries, 4 cases of falls injuries, and 1 case injured after heavy pressure. According to Neer classification, 11 cases were three-part fractures, and 12 cases were four-part fractures. Outcomes were assessed with radiography and the Constant-Murley (C-M) shoulder evaluation. All the patients got primary healing of incisions. Twenty-three patients were followed up, and the duration ranged from 17 to 49 months, with an average of 35.25 months. Twenty patients had fracture healing during 4 to 7 months after operation. There was no significant differences among 3, 6 and 12 months after operation in C-M scoring. The average C-M score was (79.85 +/- 17.23) points (38 to 100 points) at the 12th month after operation, 8 cases got an excellent result, 8 good, 5 fair, and 2 poor. In the LPHP plus bone graft group 6 cases got an excellent result, 4 good, 3 fair, and 1 poor; in LPHP fixation group 2 excellent, 4 good, 2 fair,and 1 poor. The medium-term curative effect of the locking proximal humerus plate in the treatment of proximal humeral fractures is significant. For the comminuted fractures of proximal humerus combined with osteoporosis and bone defects, bone graft should be performed routinely.
    Zhongguo gu shang = China journal of orthopaedics and traumatology 09/2010; 23(9):661-4.
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    ABSTRACT: To explore related factors of cubital tunnel syndrome caused by cubitus valgus deformity so as to provide theoretical basis for the clinical treatment. Between June 2002 and September 2008, 40 patients with cubital tunnel syndrome caused by cubitus valgus deformity underwent anterior subcutaneous ulnar transposition. Related factors was analysed through logistic regression analysis using scoring standard recommended by Yokohama City University. All 40 patients were followed up 27.5 months on average (range, 12-75 months). The duration of cubitus valgus deformity, cubitus valgus deformity angle, and the duration of paraesthesia and muscular atrophy were identified as related factors for ulnar neuropathy and the odds ratios were 1.005 (P = 0.045), 9.374 (P = 0.000), and 4.358 (P = 0.010), respectively. The related prognosis factors were duration of paraesthesia and muscular atrophy, deformity angle, and age at surgery, with odds ratios of 8.489 (P = 0.000), 2.802 (P = 0.030), and 4.611 (P = 0.031), respectively. Related factors for ulnar neuropathy are durations of cubitus valgus deformity, cubitus valgus deformity angle, and duration of paraesthesia and muscular atrophy. Related factors for prognosis include age at surgery, cubitus valgus deformity angle, and duration of muscular atrophy. Early anterior subcutaneous ulnar transposition should be performed in patients with cubital tunnel syndrome caused by cubitus valgus deformity.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 08/2010; 24(8):967-71.
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    ABSTRACT: A 40-year-old woman had her right extremity avulsed at the proximal upper arm level and the wrist and hand of her left extremity irretrievably injured in a traffic accident. The right distal forearm was surgically amputated and replanted onto the stump of the left distal forearm. New strategy for nerve repair was applied and the function recovery of the cross-replanted hand was favorable. We thought that cross-extremity replantation was indicated when the patient suffered from bilateral total or subtotal amputation at different levels and orthotopic replantation was impossible.
    Archives of Orthopaedic and Trauma Surgery 05/2010; 131(2):157-61. · 1.36 Impact Factor
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    ABSTRACT: To investigate whether or not posterolateral rotatory instability of the elbow is due to type-I and type-II coronoid process fracture together with anterior bundle of medial collateral ligament (AMCL) injury so as to provide a theoretic basis for its clinical treatment. Ten fresh-frozen upper extremities were collected from cadavera which was donated voluntarily with no evidence of fracture, dislocation, osteoarthritis, mechanical injury of the surrounding ligament and joint capsule. They included 9 males and 1 female with an average age of 25.1 years (range, 19-40 years), including 3 cases at left sides and 7 cases at right sides. All specimens were transected at the upper midhumeral and carpal levels preserving the distal radioulnar joints to get the bone-ligament specimens. An axial load of 100 N compressing the elbow joint was applied along the shaft of the forearm in the sagittal plane through the biomechanical study system. The load-displacement plot was measured and analyzed at elbow flexion of 90, 60, and 45 degrees and under four conditions (intact elbow, type-I coronoid process fracture, type-I coronoid process fracture with AMCL deficient, and type-II coronoid process fractures with AMCL deficient). The posterior displacements were maximum at 90 degrees elbow flexion. Hence, the results at 90 degrees elbow flexion were analyzed: under condition of intact elbows, the posterior displacement was the smallest (2.17 +/- 0.42) mm and the posterolateral rotatory stability was the greatest; under condition of type-I coronoid process fracture, the posterior displacement was (2.20 +/- 0.41) mm, showing no significant difference compared with that of the intact elbow (P > 0.05); under condition of type-I coronoid process fracture with AMCL deficient, the posterior displacement was (2.31 +/- 0.34) mm, showing no significant difference compared with that of intact elbow (P > 0.05); and under condition of type-II coronoid process fracture with AMCL deficient, the posterior displacement was (2.65 +/- 0.38) mm, showing a significant difference compared with that of intact elbow (P < 0.05). There was no macroscopic ulnohumeral dislocation or radial head dislocation during the experiment. An simple type-I coronoid process fracture or with AMCL deficient would not cause posterolateral rotatory instability of elbow and may not need to be repaired. But type-II coronoid process fractures with AMCL deficient can cause posterolateral rotatory instability of elbow, so the coronoid process and the AMCL should be repaired or reconstructed to restore posterolateral rotatory stability as well as valgus stability.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 02/2010; 24(2):215-8.
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    ABSTRACT: To retrospectively analyze the medical treatment of 332 patients with lower leg fracture in Wenchuan earthquake admitted in West China Hospital. From May 12, 2008 to June 15, 2008, 332 patients with lower leg fracture injured in Wenchuan earthquake were treated in our hospital. The data on trauma condition and clinical treatment were collected and analyzed. Among the 332 cases of lower leg fracture, there were 179 cases of open fracture, accounting for 53.9%, in which 91% belonged to Gustilo II or III injury with serious pollution. Many patients had posttraumatic complications, vascular and nerve injury, wound infection or osteofascial compartment syndrome. After medical treatment, blood vessels were reconnected, wound surface was repaired and wound infection was under control. For the patients with lower leg fracture in earthquake, we followed the principle of "complete debridement - restoring the continuity of bone bracket-timely recovering blood supply of limbs and repairing nerve damage - repair the wound surface at stage I or II " so as to reduce the incidence of amputation and infection.
    Chinese Journal of Traumatology (English Edition) 02/2010; 13(1):10-4.
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    ABSTRACT: To determine the influence factors for limb salvage of bone fracture patients with hyperpotassemia caused by Wenchuan earthquake, to discuss the clinical symptom and to improve the clinical treatment. The clinical symptom, drug therapy, limb incision decompression, hemodialysis, and limb salvage of hyperpotassemia caused by earthquake were analyzed by logistic regression. All the 37 patients received drug therapy: 9 patients received incision and decompression singlely,8 received hemodialysis singlely,and the other 20 received decompression and hemodialysis simultaneously. The concentration of potassium decreased from (6.25 +/- 0.91) mmol/L to (4.47+/-0.65) mmol/L,with significant difference (P<0.05). Five patients with Gustilo III grade open injury received amputation at the concentration of potassium of (6.13+/-0.78) mmol/L, while the concentration of potassium for the other 32 patients was (6.25+/-0.31) mmol/L. There was no significant difference between them(P>0.05). Logistic regression analysis found the time of compression, the time before incision and decompression, and the time before hemodialysis were the main factors to affect limb salvage. The OR value of these factors was 4.394, 3.793 and 5.432;while the P value was 0.013, 0.047, and 0.015, respectively. Decreasing the time of compression, appropriate incision and decompression, and hemodialysis help improve the result of limb salvage in hyperpotassemia patients with bone fracture caused by earthquake.
    Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences 02/2010; 35(2):182-4.
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    ABSTRACT: To explore the preparing methods in vitro and test the clinical applicability of implantation in vivo of bone marrow stromal stem cells (BMSCs)-biphasic scaffold to repair defects of cartilage and subchondral bone and to compare the differences in repaired outcomes of composite, single biphasic scaffold and rabbits themselves. The upper chondral phase and the lower osseous phase of the plugs, using poly-lactic-co-glycolic acid (PLGA), hydroxyapatite (HA), and other biomaterials, were fused into carrier scaffold, on which collagen type I (Col I) was coated. The surface and inner structure of biphasic scaffold were observed under scanning electron microscope (SEM). BMSCs was isolated from the bone marrow of tibia and femurs of young New Zealand rabbits using centrifuging and washing, and their morphologies and adherences were observed everyday. Then BMSCs were inoculated on the surface of scaffold to form BMSCs-scaffold composites. Osteochondral defects were surgically created on articular surface of femoral intercondylar of 30 New Zealand rabbits, which were divided into groups A, B and C. In group A, a biphasic osteochondral composite were implanted into defect, BMSCs and biphasic cylindrical porous plug of PLGA-HA-Col I in group B, and group C was used as a control without implant. Specimens were harvested to make macroscopic and histological observations at the 1st, 3rd, 6th, and 9th months after operation respectively; meanwhile immunohistological and micro-computed tomography (micro CT) examinations were performed and graded at the 9th month after operation. SEM showed an excellent connection of holes in the biphasic scaffold infiltrated by Col I. Optical microscopy and SEM showed a good growth of BMSCs in scaffold without obvious cellular morphological changes and an accumulation in the holes. Macroscopic samples showed a resistant existence of defects of group C within 9 months; the scaffold completely degenerated and chondral-like tissue formed on articular surface with partly collapses and irregular defects in group A; and smoother surface without collapses and approach to normal with texture of new regeneration in group B. There were statistically significant differences in macroscopic results (P < 0.001), group B was superior to group A, and group C was the worst. The micro CT showed good repairs and reconstruction of subchondral bone, with a acceptable integration with newborn chondral-like tissue and host bone in group B. Quantificational analysis of relevant parameters showed no significant differences. Histological results showed inflammations located in defects at the 1st month, new tissue grew into scaffold at the 3rd month; new chondral-like tissue crept on the margin of defects and biphasic scaffold degenerated completely at the 6th month, and lots of collagen formed in subchondral bone with major fibrocartilage on chondral area at the 9th month after surgery in groups A and B. In groups A and B, immunohistological observations were weak positive for Col II and positive for Col I. Biphasic scaffold implanted in body can induce and accelerate repair of defects of articular cartilages which are mainly filled with fibrocartilage, especially for subchondral bone. Scaffold combined with BMSCs has the best repairing effects 9 months after implantation.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 01/2010; 24(1):87-93.
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    ABSTRACT: To simulate anterosuperior instability of the shoulder by a combination of massive irreparable rotator cuff tears and coracoacromial arch disruption in cadaveric specimens, use proximally based conjoined tendon transfer for coracoacromial ligament (CAL) reconstruction to restrain against superior humeral subluxation, and investigate its feasibility and biomechanics property. Nine donated male-adult and fresh-frozen cadaveric glenohumeral joints were applied to mimic a massive irreparable rotator cuff tear in each shoulder. The integrity of the rotator cuff tendons and morphology of the CAL were visually inspected in the course of specimen preparation. Calipers were used to measure the length of the CAL's length of the medial and the lateral bands, the width of coracoid process and the acromion attachment, and the thickness in the middle, as well as the length, width and thickness of the conjoined tendon and the lateral half of the removed conjoined tendon. The glenohumeral joints were positioned in a combination of 30 degrees extension, 0 degree abduction and 30 degrees external rotation. The value of anterosuperior humeral head translation was measured after the application of a 50 N axial compressive load to the humeral shaft under 4 sequential scenarios: intact CAL, subperiosteal CAL release, CAL anatomic reattachment, entire CAL excision after lateral half of the proximally based conjoined tendon transfer for CAL reconstruction. All specimens had an intact rotator cuff on gross inspection. CAL morphology revealed 1 Y-shaped, 4 quadrangular, and 4 broad ligaments. The length of the medial and lateral bands of the CAL was (28.91 +/- 5.56) mm and (31.90 +/- 4.21) mm, respectively; the width of coracoid process and acromion attachment of the CAL was (26.80 +/- 10.24) mm and (15.86 +/- 2.28) mm, respectively; and the thickness of middle part of the CAL was (1.61 +/- 0.36) mm. The length, width, and thickness of the proximal part of the proximally based conjoined tendon was (84.91 +/- 9.42), (19.74 +/- 1.77), and (2.09 +/- 0.45) mm, respectively. The length and width of the removed lateral half of the proximally conjoined tendon was (42.67 +/- 3.10) mm and (9.89 +/- 0.93) mm, respectively. The anterosuperior humeral head translation was intact CAL (8.13 +/- 1.99) mm, subperiosteal CAL release (9.68 +/- 1.97) mm, CAL anatomic reattachment (8.57 +/- 1.97) mm, and the lateral half of the proximally conjoined tendon transfer for CAL reconstruction (8.59 +/- 2.06) mm. A significant increase in anterosuperior migration was found after subperiosteal CAL release was compared with intact CAL (P < 0.05). The translation after CAL anatomic reattachment and lateral half of the proximally conjoined tendon transfer for CAL reconstruction increased over intact CAL, though no significance was found (P > 0.05); when they were compared with subperiosteal CAL release, the migration decreased significantly (P < 0.05). The translation of lateral half of the proximally conjoined tendon transfer for CAL reconstruction increased over CAL anatomic reattachment, but no significance was evident (P > 0.05). The CAL should be preserved or reconstructed as far as possible during subacromial decompression, rotator cuff tears repair, and hemiarthroplasty for patients with massive rotator cuff deficiency. If preservation or the insertion reattachment after subperiosteal release from acromion of the CAL of the CAL is impossible, or CAL is entirely resected because of previous operation, the use of the lateral half of the proximally based conjoined tendon transfer for CAL reconstruction is feasible.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 12/2009; 23(12):1469-73.
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    ABSTRACT: To evaluate the results of open arthrolysis by elevated the lateral and medial collateral ligament-musculature complex from the supracondylar ridge of the humerus in treatment of post-traumatic elbow stiffness. From March 2003 to December 2007, 33 patients with post-traumatic elbow stiffness were treated with open arthrolysis by elevated the lateral and medial collateral ligament-musculature complex from the supracondylar ridge of the humerus. There were 23 males and 10 females, aged 17-70 years old (mean 41.8 years old). According to Morrey, 15 cases were extremely serious (less than 30 degrees extension-flexion arc) and 18 cases were serious (30-60 degrees extension-flexion arc). The range of motion of the elbow stiffness was (32.5 +/- 28.9) degrees and the Mayo score was 51.9 +/-13.1 before operation. All initial fractures were healed according to clinical examination and X-rays films. All patients present with a post-traumatic elbow stiffness and the average period from initial trauma to elbow arthrolysis was 16.9 months (2-72 months). Wound infection occurred in 1 patient and cured after dressing change and anti-infectious treatment. The wounds healed by first intension in 32 cases. No patient showed sign of elbow instability and debilitating pain. All patients were followed up 6 months to 5 years (mean 3.3 years). At last follow up, the Mayo score was 82.3 +/- 14.4 and the range of motion of elbow stiffness was (108.8 +/- 36.0) degrees; showing significant differences when compared with preoperation (P < 0.05). According to Mayo evaluation, the results were excellent in 11 cases, good in 18 cases, fair in 2 cases, and poor in 2 cases, the excellent and good rate was 87.88%. Thirty-one patients achieve satisfactory results. Two patients were not satisfied with the result, but the satisfactory results were achieved by a second arthrolysis. Open elbow arthrolysis and postoperative rehabilitation for patients with elbow stiffness can improve joint function and ensure the stability of elbows.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 09/2009; 23(9):1087-91.