Accuracy of a Simple Digital Templating in Primary Uncemented Total Hip Arthroplasty

Objective To introduce a simple preoperative digital templating in uncemented total hip arthroplasty(THA) and to determine its accuracy for preoperative size selection of the prostheses.Methods A prospective study of digital planned THAs was performed on 90 hips with different types of prostheses from August 2013 to Angust 2014.The plastic templates of different types of prostheses were scanned for desired digital templating and the scanned images were then processed to the transparent,digital templates using Photoshop software.We calibrated the scales of the digital templates with the preoperative radiographs,and then selected the right size of the component.The preoperatively digital planned component sizes were compared to the actual sizes used in the operation,as well as the preoperatively traditional planned sizes.Results In either cup or stem templating,no difference was found among the groups with different types of prostheses,and the accuracy of digital templating was statistically higher than traditional templating.In cup templating,digital planned and implanted cup sizes were identical in 43.33% of the cases,78.89% of the cup sizes were predicted within 1 size(± 2mm) and 95.56% were predicted within 2 sizes(±4 mm),all significantly higher than the results of traditional planned sizes(30.00%,P=0.044;61.11%,P=0.007;82.22%,P=0.004).The exact femoral stem size was predicted in 40.00% of cases using the digital templating,84.44% of stem sizes were predicted within 1 size,and 93.33% within 2 sizes,better than using traditional templating(25.56%,P=0.028;53.33%,P<0.001;77.77%,P=0.003).Conclusion This simple digital preoperative templating is an accurate and reproducible process to preoperatively predict the implant size of uncemented THA.

Management of limb fractures in a teaching hospital： comparison between Wenchuan and Yushu earthquakes

Objective： To comparatively analyze the medical records of patients with limb fractures as well as rescue strategy in Wenchuan and Yushu earthquakes so as to provide references for post-earthquake rescue. Methods： We retrospectively investigated 944 patients sustaining limb fractures, including 891 in Wenchuan earthquake and 53 in Yushu earthquake, who were admitted to West China Hospital （WCH） of Sichuan University. Results： In Wenchuan earthquake, WCH met its three peaks of limb fracture patients influx, on post-earthquake day （PED） 2, 8 and 14 respectively. Between PED 3-14, 585 patients were transferred from WCH to other hospitals out- side the Sichuan Province. In Yushu earthquake, the maxi- mum influx of limb fracture patients happened on PED 3, and no one was shifted to other hospitals. Both in Wenchuan and Yushu earthquakes, most limb fractures were caused by blunt strike and crush/burying. In Wenchuan earthquake, there were 396 （396/942, 42.0%） open limb fractures, includ- ing 28 Gustilo I, 201 Gustilo II and 167 Gustilo III injuries. But in Yushu earthquake, the incidence of open limb fracture was much lower （6/61, 9.8%）. The percent of patients with acute complications in Wenchuan earthquake （167/891,18.7%） was much higher than that in Yushu earthquake （5/53, 3.8%）. In Wenchuan earthquake rescue, 1 018 surgeries were done, composed of debridement in 376, internal fixation in 283, external fixation in 119, and vacuum sealing drainage in 117, etc. While among the 64 surgeries in Yushu earthquake rescue, the internal fixation for limb fracture was mostly adopted. All patients received proper treatment and sur- vived except one who died due to multiple organs failure in Wenchuan earthquake. Conclusion： Provision of suitable and sufficient medi- cal care in a catastrophe can only be achieved by construc- tion of sophisticated national disaster medical system, pre- diction of the injury types and number of injuries, and con- flrmation of participating hospitals＇ exact role. Based on the valuable rescue experiences after Wenchuan earthquake, the rescue was faster, more orderly and effective in Yushu earthquake. Nevertheless, there is still a long way to go in the development of a stronger emergent response to the disasters.

Trigger finger at the wrist caused by an intramuscular lipoma within the carpal tunnel:A case report

BACKGROUND Trigger finger at the wrist,which occurs with finger movement,is an uncommon presentation.Few reports describing cases of trigger finger at the wrist have been published.Thus,we present a case of an intramuscular lipoma arising from an anomalous flexor digitorum muscle belly in a 48-year-old female patient causing painful finger triggering at the wrist and carpal tunnel syndrome(CTS).CASE SUMMARY A 48-year-old woman with complaints of a catching sensation during wrist motion and a progressive tingling sensation on the palmar aspect of the right hand for approximately 2 years was referred to our hospital.Triggering of the index to middle finger was evident with a palpable and audible clunk over the carpal tunnel during passive motion.Tinel’s sign was positive over the carpal tunnel of the right wrist with a positive Phalen’s test.Nerve conduction studies of the median nerve demonstrated a right CTS.Ultrasound examination revealed a 2.5 cm×2.0 cm subcutaneous hyperechoic mass with no obvious blood flow at the wrist of the right arm.Surgical excision of the tumor and muscle mass led to a resolution of the patient’s symptoms,and any triggering or discomfort disappeared.The patient has had no evidence of recurrence at more than 1 year of follow-up.CONCLUSION Triggering of the fingers at the wrist is rare. It must be noted that there are manypossible causes and types of triggering or clicking around the wrist. Accuratediagnosis is mandatory to avoid inaccurate treatment of patients with triggerwrist. During the diagnosis and treatment of CTS, attention should be paid to thevariation of tendon tissue in the carpal tunnel, to avoid only focusing on therelease of transverse carpal ligament and ignoring the removal of anomalousmuscle belly.

Design,characterisation,and clinical evaluation of a novel porous Ti-6Al-4V hemipelvic prosthesis based on Voronoi diagram

Three-dimensional printed Ti-6Al-4V hemipelvic prosthesis has become a current popular method for pelvic defect reconstruction.This paper presents a novel biomimetic hemipelvic prosthesis design that utilises patient-specific anatomical data in conjunction with the Voronoi diagram algorithm.Unlike traditional design methods that rely on fixed,homogeneous unit cell,the Voronoi diagram enables to create imitation of trabecular structure(ITS).The proposed approach was conducted for six patients.The entire contour of the customised prosthesis matched well with the residual bone.The porosity and pore size of the ITS were evaluated.The distribution of the pore size ranged from 500 to 1400μm.Porosity calculations indicated the average porosity was 63.13±0.30%.Cubic ITS samples were fabricated for micrograph and mechanical analysis.Scanning electron microscopy images of the ITS samples exhibited rough surface morphology without obvious defects.The Young’s modulus and compressive strength were 1.68±0.05 GPa and 174±8 MPa,respectively.Post-operative X-rays confirmed proper matching of the customised prostheses with the bone defect.Tomosynthesis-Shimadzu metal artifact reduction technology images indicated close contact between the implant and host bone,alongside favourable bone density and absence of resorption or osteolysis around the implant.At the last follow-up,the average Musculoskeletal Tumour Society score was 23.2(range,21-26).By leveraging additive manufacturing and Voronoi diagram algorithm,customised implants tailored to individual patient anatomy can be fabricated,offering wide distribution of the pore size,reasonable mechanical properties,favourable osseointegration,and satisfactory function.

Effect of dynamic hip system blade on the treatment of femoral neck fractures in elderly patients with osteoporosis

Objective：To discuss the curative effect of the dynamic hip system blade （DHS-blade） on the treatment of femoral neck fractures in elderly patients with osteoporosis.Methods：A retrospective study was conducted to analyse the clinical data of 60 elderly patients with osteoporosis who had been treated for femoral neck fractures with DHS-blade in our department between September 2012 and February 2014.There were 22 males and 38 females with a mean age of （66.8±3.2） years.According to the Singh Index Classification,all the patients＇ Singh index was below level 3.The Harris criterion and function recovery after operation were analysed.Results：All patients were followed up for 12-17 months （mean 14 months）.No femoral head necrosis,femoral neck shortening,internal fixation loosening or backing out of the nails occurred.Bone nonunion was found in one case and he had a good recovery after total hip arthroplasty.The time for fracture healing ranged from 3-6 months （average 3.5 months）.According to Harris criterion,35 cases were rated as excellent,22 good,2 fair and 1 poor.The Harris scale was significantly improved from 28.46±2.35 preoperatively to 91.98±3.26 at 6 months postoperatively （P＜0.05）.Conclusion：DHS-blade,being minimally invasive,allowing earlier postoperative exercise and avoiding the complications elicited by traditional internal fixation,is advisable for treatment of femoral neck fractured patients with osteoporosis.

Effect of dynamic hip screw on the treatment of femoral neck fracture in the elderly

[Abstract] Objective： To discuss the indications, surgical procedures, and curative effect of dynamic hip screw （DHS） in the treatment of femoral neck fracture in the elderly. Methods： A retrospective study was conducted to analyse the clinical data of 42 elderly patients who had been treated for femoral neck fracture with DHS in our department between June 2009 and November 2011. There were 21 males and 21 females with a mean age of 68.5 years （range 60-75 years）. According to the Garden Classification, there were 19 cases of type II, 21 cases of type III and 2 cases of type IV fractures. By the Singh In- dex Classification, there were 3 cases of level 2, 19 cases of level 3 and 20 cases of level 4 fractures. The Harris cri- terion, complications and function recovery after operation were analysed. Results： The average hospitalization time in 42 patients was 11.2 days （range 7-21 days）. All patients were followed up for 12-26 months （mean 18 months）. No lung infection, deep venous thrombosis or other complications occurred. Partial backing-out of the screws was found in 2 cases. The internal fixation device was with- drawn after fracture healing. Internal fixation cutting was found in 1 case, and he had a good recovery after total hip arthroplasty. The time for fracture healing ranged from 3-6 months （average 4.5 months）. According to Harris criteri- on, 15 cases were rated as excellent, 24 good, 2 fair and 1 poor. The Harris scale was significantly improved from 30.52＋2.71 preoperatively to 86.61＋2.53 at 6 months post- operatively （P〈0.05）. Conclusion： DHS, being minimal invasive, al- lowing early activity and weight-bearing, is advisable for treatment of elderly patients with femoral neck fracture. In addition, it can avoid complications seen in artificial joint replacement. It is especially suitable for patients with mild osteoporosis.

Middle-term follow-up results of Pipkin type Ⅳ femoral head fracture patients treated by reconstruction plate and bioabsorbable screws

Purpose： To investigate the mid-term curative effects of the treatment of Pipkin type Ⅳ femoral head fractures using a reconstruction plate and bioabsorbable screws and provide the evidence for clinical practice. Methods： From February 2010 to September 2014, 21 patients with Pipkin type IV femoral head fractures were treated surgically. There were 13 males and 8 females with an average age of 41.1 years （range, 20 -65 years）. The causes of the fractures included traffic accidents （13 cases）, falls from a height （four cases）, heavy lifting injuries （three cases）, and sport injury （one case）. All patients were followed up with radiography and three-dimensional reconstruction computed tomography and other checks and any complications were actively managed. Closed reduction of fracture-dislocation of the hip was attempted under general anesthesia using the Kocher-Langenbeck approach. Femoral head fractures were treated with internal fixation or excision based on the size of the fracture fragments, whereas acetabular fractures were fixed with a reconstruction plate and screws following anatomic reduction. Results： The incisions healed by primary intention in all patients after surgery, without any infection, deep venous thrombosis, or other complications. All 21 patients were followed up for 36-76 months, with an average follow-up duration of 49 months. Postoperative imaging data showed that all dislocations and fractures were anatomically reduced, and bony union of the fractures was achieved. Heterotopic ossification was found in four patients, post-traumatic osteoarthritis in three, and avascular necrosis of the femoral head in two. At the final follow-up, the assessment of hip joint function according to the Thompson-Epstein scoring scale was excellent in 10 cases, good in six cases, fair in three cases, and poor in two cases. The rate of excellent and good functional outcomes was 76.1%. Conclusion： The mid-term curative effects of a reconstruction plate and bioabsorbable screws in the treatment of Pipkin type IV femoral head fractures is significant, and such the treatment can significantly improve the patient＇s joint function and quality of life.

Multicenter follow-up study of ankle fracture surgery

Background Few data on ankle fractures in China from large multicenter epidemiological and clinical studies are available.The aim of this research was to evaluate the epidemiological features and surgical outcomes of ankle fractures by reviewing 235 patients who underwent ankle fracture surgery at five hospitals in China.Methods This study included patients who underwent ankle fracture surgery at five Chinese hospitals from January 2000 to July 2009.Age,gender,mechanism of injury,Arbeitsgemeinschaft für Osteosynthesefragen （AO） fracture type,fracture pattern,length of hospital stay and treatment outcome were recorded.Statistical analyses were conducted using SPSS software.The American Orthopedic Foot and Ankle Society （AOFAS） ankle-hindfoot scale,visual analogue scale （VAS）,and arthritis scale were used to evaluate outcome.Results Of 235 patients with ankle fractures,105 were male with an average age of 37.8 years and 130 were female with an average age of 47.3 years.The average follow-up period was 55.7 months.There were significant differences in the ratios of patients in different age groups between males and females,and in mechanisms of injury among different age groups.There were also significant differences in the length of hospital stay among different fracture types and mechanisms of injury.In healed fractures,the average AOFAS ankle-hindfoot score was 95.5,with an excellence rate of 99.6%,the average VAS score was 0.17,and the average arthritis score was 0.18.Movement of the injured ankle was significantly different to that of the uninjured ankle.There were no significant differences between AO fracture types,fracture patterns or follow-up periods and AOFAS score,but there were some significant differences between these parameters and ankle joint movements,pain VAS score and arthritis score.Conclusions Ankle fractures occur most commonly in middle-aged and young males aged 20-39 years and in elderly females aged 50-69 years.The most common mechanisms of injury are twisting injuries and falls from a standing height or less.The results of surgical treatment are satisfactory.

Meta-analysis comparing total hip arthroplasty with hemiarthroplasty in the treatment of displaced femoral neck fractures in patients over 70 years old

Objective： Total hip arthroplasty （THA） and hemiarthroplasty （HA） are effective methods currently used to treat femoral neck fracture in elderly patients, but the two options remain controversial in patients over 70 years old. The main purpose of our study was to determine whether THA or HA is a superior treatment of femoral fractures involving a displaced neck in patients who are over 70 years of age. Methods： A computer-based online search of Medline （1970-2011）, PubMed （1977-2011）, and the Cochrane Cen- tral Register of Controlled Trials （2002-201 l） was conducted. Six relevant randomized controlled trials with a total of 739 patients were included for the final analysis. The analysis was performed with software RevMan 5.0. Results： We found that compared with THA, HA needed shorter average time and lost less blood. While over the long-term follow-up, THA patients exhibited significantly less pain and better function and were less likely to require a revision hip surgery. Postoperative infection was equally common among HA and THA patients. Conclusions： The significant differences in outcomes suggest that THA is a valuable treatment option for active elderly hip fracture individuals. However, patients who are older, impaired or institutionalized benefit from HA.

Observation and establishment of an animal model of tractive spinal cord injury in rats

OBJECTIVE: To establish an animal model of tractive spinal cord injury in rats in order to investigate its pathophysiological changes and clinical significance. METHODS: T(12)-L(3) spines were tracted longitudinally with a special spinal retractor that was put on the proccessus transverses of T(12)-L(3) vertebrae of the rat after exposing T(13)-L(2) spinal cord via dual laminectomy. At the same tine, the spinal cord function was monitored by cortical somatosensory evoked potential (CSEP). Rats were randomly divided into four groups according to the amplitude of CSEP P(1)-N(1) wave, the amount of the decreasing P(1)-N(1) wave was 30% (the 30% group), 50% (the 50% group) and 70% (the 70% group), respectively. After traction, the changes of the neural behavioral function in rats were observed and the morphological structure of the spinal cord was analyzed quantitatively with image analysis system of computer. RESULTS: With traction of spine, compared with the control group, the 30% group had no marked difference in combined behavioral score (CBS), neuron count, section area of neuron and Nissl body density, but the 50% and 70% groups had marked difference (P

Relationship among bone mineral density,collagen composition,and biomechanical properties of callus in the healing of osteoporotic fracture

Objective： To study the change and relationship among bone mineral density （BMD）, collagen composition and biomechanical properties of the callus in the healing process of osteoporotic fracture. Methods： The osteoporotic rat model and fracture model were established through bilateral ovariectomy （OV＇X） and osteotomy of the middle shaft of the right hind tibiae, respectively. Ninety female SD rats were randomly divided into OVX group and sham group. With the samples of blood and callus, roentgenoraphic and histological observation were performed for the assessment of the healing progress of the fracture, and the serum concentration of TRAP-5b, proportion of type I collagen, BMD and biomechanical properties of the callus were measured. Results： The OVX group experienced a significant delay of fracture healing. The mean serum concentration of TRAP-5b of rats in the OVX group was much higher than that in the sham group after the operation （P 〈 0.05）, but the difference at the same time point after fracture was smaller than that before fracture （P 〈 0.05）. The BMD of the callus in both groups reached the peak value at the 6 th week after fracture while the proportion of the type I collagen and the biomechanical strength reached the peak at the 8th week. Conclusions. The deficiency of estrogen after the ovariectomy could induce the up-regulation of the osteoclasts activities, whereas the potency of further activation after fracture was depressed. Although the synthesis of collagen together with its mineralization determines the biomechanical properties of new bone, the accumulation of collagen could be assessed as an index in the prediction of biomechanical strength of bones independent of the bone mineral deposition.

Fabrication and biological evaluation of 3D-printed calcium phosphate ceramic scaffolds with distinct macroporous geometries through digital light processing technology

Digital light processing(DLP)-based 3D printing technique holds promise in fabricating scaffolds with high precision.Here raw calcium phosphate(CaP)powders were modified by 5.5%monoalcohol ethoxylate phosphate(MAEP)to ensure high solid loading and low viscosity.The rheological tests found that photocurable slurries composed of 50wt%modified CaP powders and 2wt%toners were suitable for DLP printing.Based on geometric models designed by computer-aided design(CAD)system,three printed CaP ceramics with distinct macroporous structures were prepared,including simple cube,octet-truss and inverse face-centered cube(fcc),which presented the similar phase composition and microstructure,but the different macropore geometries.Inverse fcc group showed the highest porosity and compressive strength.The in vitro and in vivo biological evaluations were performed to compare the bioactivity of three printed CaP ceramics,and the traditional foamed ceramic was used as control.It suggested that all CaP ceramics exhibited good biocompatibility,as evidence by an even bone-like apatite layer formation on the surface,and the good cell proliferation and spreading.A mouse intramuscular implantation model found that all of CaP ceramics could induce ectopic bone formation,and foam group had the strongest osteoinduction,followed by inverse fcc,while cube and octet-truss had the weakest one.It indicated that macropore geometry was of great importance to affect the osteoinductivity of scaffolds,and spherical,concave macropores facilitated osteogenesis.These findings provide a strategy to design and fabricate high-performance orthopedic grafts with proper pore geometry and desired biological performance via DLP-based 3D printing technique.

Perioperative treatment of femoral neck fracture with deep venous thrombosis： A case report

Deep venous thrombosis （DVT） is an important cause of disability and mortality after major orthopedic surgery. The roles of perioperative treatment and prevention of DVT in patients with femoral neck fractures who require major surgery have not yet been well explored in Chinese clinical practice. Here we report a case of calf muscular venous thrombosis in a 55-year-old woman with femoral neck fracture before surgery. Preventive and treatment measures including the administration of heparin sodium, application of venous foot pump and placement of inferior vena cava filter were taken. The condition of the patient was stable during the perioperative period and the surgery was successful. Besides, postoperative examination showed that the femur healed well and the functional recovery was satisfactory. Our results suggest that femoral neck fracture patients combined with DVT can receive surgery after accurate preoperative assessment and proper preoperative treatment.

A systematic assessment of hydroxyapatite nanoparticles used in the treatment of melanoma

Nano Research volume 13,pages2106–2117(2020)Cite this article 106 Accesses 1 Altmetric Metrics details Abstract Melanoma is a highly malignant skin tumor which is prone to recurrence and metastasis.Hydroxyapatite nanoparticles(nHAPs)were reported to possess a suppressive effect on proliferation of various tumor cells in vitro.This study aimed to assess in vitro and in vivo anti-tumor ability and biosafety of the nHAPs used in the treatment of melanoma.Three types of nHAPs with different morphology and crystallinity were synthesized.In vitro cell viability and proliferation studies demonstrated that all three types of nHAPs can inhibit viability and proliferation of A375 and SK-MEL-28 melanoma cells in a concentration-dependent manner.In addition,the rod-shape nHAPs with a crystallinity of 45.60%had the most prominent suppressive effect on the two melanoma cells tested.An important positive regulator of G1/S phase transition in cell cycle,Cyclin D1 protein,was reduced by nHAPs treatment in vivo.We further discovered that the migration ability of the nHAPs treated melanoma cells was greatly decreased.RNA sequencing result revealed that melanoma metastasis related genes were down-regulated by nHAPs,including MMP2,MMP14,ITGA9,ITGB3,ITGB4 and S100B.High concentration of nHAPs treatment in melanoma-bearing nude mice showed a strong inhibitory effect on tumor size and weight.Most importantly,hemolysis,electrolyte disturbance or inflammation response was not discovered in the experimental animals from nHAPs treated groups.We proved that the nHAPs synthesized in the current study has a selective effect to suppress melanoma tumor proliferation and was safe with regard to normal cells and tissue.

Efficacy and Safety of Zhuanggu Joint Capsules in Combination with Celecoxib in Knee Osteoarthritis： A Multi-center, Randomized, Double-blind, Double-dummy, and Parallel Controlled Trial

Background：Knee osteoarthritis （KOA） is a chronic joint disease that manifests as knee pain as well as different degrees of lower limb swelling,stiffness,and movement disorders.The therapeutic goal is to alleviate or eliminate pain,correct deformities,improve or restore joint functions,and improve the quality of life.This study aimed to evaluate the efficacy and safety of Zhuanggu joint capsules combined with celecoxib and the benefit of treatment with Zhuanggu alone for KOA.Methods：This multi-center,randomized,double-blind,double-dummy,parallel controlled trial,started from December 2011 to May 2014,was carried out in 6 cities,including Beijing,Shanghai,Chongqing,Changchun,Chengdu,and Nanjing.A total of 432 patients with KOA were divided into three groups （144 cases in each group）.The groups were treated,respectively,with Zhuanggu joint capsules combined with celecoxib capsule simulants,Zhuanggu joint capsules combined with celecoxib capsules,and celecoxib capsules combined with Zhuanggu joint capsule simulants for 4 weeks consecutively.The improvement of Western Ontario and McMaster Universities Osteoarthritis （WOMAC） index and the decreased rates in each dimension of WOMAC were evaluated before and after the treatment.Intergroup and intragroup comparisons of quantitative indices were performed.Statistically significant differences were evaluated with pairwise comparisons using Chi-square test （or Fisher＆#39;s exact test） and an inspection level ofα =0.0167.Results：Four weeks after treatment,the total efficacies of Zhuanggu group,combination group,and celecoxib group were 65%,80%,and 64%,respectively,with statistically significant differences among the three groups （P =0.005）.Intergroup pairwise comparisons showed that the total efficacy of the combination group was significantly higher than that of the Zhuanggu （P =0.005） and celecoxib （P =0.003）groups.The difference between the latter two groups was not statistically significant （P 〉 0.0167）.Four weeks after discontinuation,the efficacies of the three groups were 78%,95%,and 65%,respectively,with statistically significant differences （P 〈 0.0001）.Intergroup pairwise comparisons revealed that the efficacy of the combination group was significantly better than that of the Zhuanggu and the celecoxib groups （P 〈 0.0001）.The difference between the latter two groups was not statistically significant （P 〉 0.0167）.The incidences of adverse events in Zhuanggu group,combination group,and celecoxib group were 8.5%,8.5%,and 11.1%,respectively,with insignificant differences （P 〉 0.05）.Conclusions：Zhuanggu joint capsules alone or combined with celecoxib showed clinical efficacy in the treatment of KOA.The safety of Zhuanggu joint capsules alone or combined with celecoxib was acceptable.

Misdiagnosis and management of iatrogenic pseudoaneurysm of vertebral artery after Harms tech- nique of C1-C2 fixation

Harms technique of CI-C2 fixation for atlantoaxial complex becomes more popular due to good fusion rate and low vertebral artery injury （VAI） rate. But considering the unique and variable anatomy of atlanto- axial complex, iatrogenic VAI will result in catastrophic con- sequences and provides particular surgical challenges for surgeons. To our knowledge, comparing with iatrogenic VAI in the screw hole, iatrogenic VAI in the ＂open space＂ is much rarer during the Harms technique of C1-C2 fixation. In this article, we present a case of iatrogenic vertebral artery pseudoaneurysm after Harms technique of posterior C1-C2 fixation. This case of iatrogenic VAI effectively treated by endovascular coil occlusion and external local compressionwas initially misdiagnosed as VAI by pedicle screw perforation. It can be concluded that intraoperative or post- operative computed angiography is very helpful to diag- nose the exact site of VAI and the combination of endovascular coil occlusion as well as external local com- pression can further prevent bleeding and abnormal verte- bral artery flow in the pseudoaneurysm. However, patients treated require further follow-up to confirm that there is no recurrence of the Dseudoaneurysm.

Comparison of closed reduction and expert tibial nailing with open reduction and plate and screw fixation in the treatment of two segmental tibial fractures

Purpose： To compare the outcomes of closed reduction and expert tibial nailing （ETN） versus open reduction and plate and screw fixation in treating two segmental tibial fractures. Methods： This study included 53 cases of two segmental fractures of the tihial shaft. They were admitted to our department between March 2010 and June 2013 and treated respectively by closed reduction and ETN （ETN group, n = 31 ） or open reduction fixation with plate and screws （PS group, n = 22）. The general data of two groups including gender, age, injury cause, fracture type, etc showed no significant difference （p 〉 0.05）. To compare the therapeutic effects between two groups, the intraoperative condition, post- operative function and related complications were investigated. Results： All the patients were successfully followed up. The period was 19.2 months for ETN group and 20.5 months for PS group. All the fractures in ETN group had union without complications such as malunion, infection, or osteofascial compartment syndrome; whereas there were 3 cases of superficial infection cured by repeated dressing change and 2 cases of delayed union in PS group. The total incidence of complication in PS group was 22.7% （5/22）, much higher than that in ETN group （p 〈 0.05）. Moreover, ETN group showed a better result in terms of intraoperative blood loss, operation time, postoperative weight bearing time and fracture union time. In ETN group, at one-year follow-up, Johner-Wruhs＇ criteria was adopted to assess the postoperative function, which was reported as excellent in 18 cases, good in 10 cases and fair in 3 cases in ETN group （100% excellent-good rate）. While in PS group, the result was excellent in 10 cases, good in 7 cases, fair in 3 cases and poor in 2 cases （77.3% excellent-good rate）. The comparison was insignificant （p 〉 0.05）. Conclusion： Compared with plate and screw fixation, ETN fixation has the advantages of fewer complications, shorter operation time, being less invasive, earlier postoperative rehabilitation and weight bearing, quicker fracture union and better functional recovery, thus being an effective way to treat two segmental tibial fractures.

Over-correction of curvature causes the non-surgical curvature loss in one- and two-level anterior cervical discectomy and fusion

To the Editor:Cervical disc degenerative disease(CDDD)is a common clinical spinal disease,which has a great impact on the quality of life of middle-aged and elderly patients.[1,2]Although it is challenged by advanced surgical techniques,anterior cervical discectomy and fusion(ACDF)is still the best choice for most patients with CDDD.[3,4]In most cases,the focus of ACDF surgery is“decompression.”However,for patients with preoperatively poor curvature,in addition to the decompression of the nerve to relieve symptoms,it is also vital to improve the cervical curvature.

Critical care for severe coronavirus disease 2019:a population-based study from a province with low case-fatality rate in China

The coronavirus disease 2019(COVID-19)pandemic has affected over twenty million people worldwide since its outbreak,[1]in which approximately 19%are expected to progress to severe or critical disease,constituting the high-risk group for death.[2]The reported case-fatality rates among the severe COVID-19 varied a lot across different regions from zero to 61.5%[1,3]and the reason behind remained unclear.Very limited data concerning management of severe cases were reported from low case-fatality areas.In this study,we described the clinical features,multi-strategy management,and respiratory support resources usage for the severe COVID-19 in Sichuan province,where the 28-day case-fatality rate was 0.6%in all patients and 3.7%in severe cases,which was much lower compared with that reported in most of the studies worldwide.

Probable lumbar acute noncompressive nucleus pulposus extrusion: a case report of acute pain caused by a hydrated nucleus pulposus and review of the literature

Acute noncompressive nucleus pulposus(NP)extrusion has been widely described in veterinary medicine,especially in dogs and cats;however,caseshave rarely been reported in humans.We report a rare case of acute pain caused by a hydrated NP.Magnetic resonance imaging revealed an obvious hyperintense signal on T2-weighted images at the L5/S1 segments,while computed tomography imaging and radiography revealed amildly herniated discat the L4/5 level and slightlumbar spondylo listhesis at the L5/S1 segments.The operation was performed to confirm the presence of ared and swollen nerve root on the right side of the hydrated L5/S1 segment.The patient’s severe pain disappeared,and full recovery was achieved months after surgery.Thus,our case demonstrated a probable lumbar acute noncompressive NP extrusion in humans and reported associated symptoms and imaging characteristics.In such circumstances,surgical management is indicated and may be associated with a good outcome.