Objective To explore the method and effectiveness of lateral calcaneal U-shaped incision approach to treat calcaneal fractures involving the talocalcaneal and calcaneocuboid joints. Methods Between January 2009 and March 2011, 36 cases of calcaneal fractures involving the talocalcaneal and calcaneocuboid joints were treated by the lateral calcaneal U-shaped incision approach and calcaneal anatomical plate fixation. There were 27 males and 9 females with an average age of 38.7 years (range, 19-58 years). According to the Sanders classification criteria, there were 12 cases of type II, 20 cases of type III, and 4 cases of type IV. The Bouml;hler and Gissane angles were (6.21 ± 10.48)° and (89.85 ± 12.34)°, respectively. The average time from injury to surgery was 4.2 days (range, 2-14 days). Results Superficial skin flap necrosis and wound exudate occurred in 1 case respectively, which were cured after dressing change; primary healing was obtained in the other cases. All the cases were followed up 12-26 months (mean, 15.2 months). The X-ray films showed that all fractures healed with an average healing time of 10.6 weeks (range, 8-12 weeks). The reduction of articular surface was satisfactory, and the heel height returned to normal. No complication of breakage of internal fixation or traumatic arthritis occurred. The Bouml;hler and Gissane angles were (29.64 ± 5.33)° and (121.75 ± 6.65)°, respectively at 3 months after operation, showing significant differences when compared with the preoperative values (t=43.800, P=0.000; t=33.200, P=0.000). The average time of plate removal was 11.2 months (range, 9-20 months). According to Maryland foot score, the results were excellent in 17 cases, good in 15 cases, and fair in 4 cases; the excellent and good rate was 88.9%. Conclusion The lateral calcaneal U-shaped incision approach is an effective method to treat calcaneal fractures involving the talocalcaneal and calcaneocuboid joints, which can expose the fracture fully, restore the anatomy of the calcaneal bone, and do early exercise under the condition of rigid internal fixation.
Objective To review the research progress of hair follicle stem cell(FSC) in wound healing and correlative signals. Methods The advances in the FSC location, characters, relations with wound repair and correlative singals were introduced based on the recent related literature. Results FSC played an important role in hair follicle cycle and wound healing. The correlative signals maybe Wnt, bone morphogenetic protein/transforming growth factor β, Norch, Shh and fibroblast growth factor. Conclusion The multipotency and plasticity of FSC offer a new way in regeneration medicine and the signals in cell proliferation and differentiation will be the new focus in future research.
ObjectiveTo explore the application value of Furlow palatoplasty in reconstruction of velopharyngeal insufficiency (VPI) after cleft palate surgery.MethodsBetween August 2015 and January 2017, 48 patients with VPI after cleft palate surgery were treated with Furlow palatoplasty. There were 29 males and 19 females, aged from 4 to 17 years (mean, 6.1 years). There were 16 cases of incomplete cleft palate and 32 cases of complete cleft palate; and 16 cases of soft cleft palate and 32 cases of soft and hard cleft palate. The interval between first cleft palate surgery and Furlow palatoplasty was 3 to 13 years (mean, 5.9 years). The patients were accompanied by significant open rhinolalia and nasal leakage. The degree of velopharyngeal closure assessed by electronic nasopharyngeal fiberoptic endoscopy was grade Ⅲ. The operation time and intraoperative blood loss were recorded. The total length of palate, the length of soft palate, the depth of pharyngeal cavity, and the width of pharynx and palate arch were measured before operation and at immediate after operation, and the change of the above indexes before and after operation was calculated. According to the results of clinical assessment, the patients were allocated into three groups: velopharyngeal competence (VPC) group, marginal velopharyngeal inadequacy (MVPI) group, and VPI group. The relationship between the soft palate and the posterior pharyngeal wall was evaluated by lateral cephalometric radiographs at 3 months after operation, and the patients were allocated into complete contact group, point contact group, and non-contact group. The velopharyngeal closure was evaluated by electronic nasopharyngeal fiberoptic endoscopy (grade Ⅰ, Ⅱ, Ⅲ). Spearman analysis was used to analyze the correlation between the changes of the total length of palate, the length of soft palate, the depth of pharyngeal cavity, and the width of pharynx and palate arch before and after operation. The contact degree of soft palate and posterior pharyngeal wall and the closure degree of pharynx and palate were grouped separately, and the above indexes were analyzed statistically.ResultsThe operation time was 35-64 minutes (mean, 41 minutes); the intraoperative blood loss was 3-10 mL (mean, 6 mL). All patients were followed up 3 months. After 3 months of operation, the clinical evaluation results were 34 cases of VPC, 7 cases of MVPI, and 7 cases of VPI. Lateral cephalometric radiographs showed that 30 cases had complete contact with the posterior pharyngeal wall, 11 cases had point contact, and 7 cases had no contact. Electronic nasopharyngeal fiberoptic endoscopy showed that the pharyngeal closure function was improved to varying degrees, 29 cases of grade Ⅰ, 12 cases of grade Ⅱ, and 7 cases of grade Ⅲ. There were significant differences in the total length of palate, the length of soft palate, the depth of pharyngeal cavity, and the width of pharynx and palate arch between pre- and post-operation (P<0.05). Spearman correlation analysis showed a correlation between the change in the total length of palate before and after operation and the change in the length of soft palate (r=0.448, P=0.001). There were significant differences in the changes of total length of palate, the length soft palate, and the depth of pharyngeal cavity before and after operation between VPC, MVPI, and VPI groups (P<0.05); and there was no significant difference in the change of the width of pharynx and palate arch before and after operation between groups (P>0.05). There were significant differences in the changes of total length of palate and the length soft palate before and after operation between complete contact, point contact, and non-contact groups (P<0.05); and there was no significant difference in the change of the depth of pharyngeal cavity and the width of pharynx and palate arch before and after operation between groups (P>0.05).ConclusionFurlow palatoplasty can restore the VPI after cleft palate surgery, which can effectively prolong the soft palate and reduce the depth of the pharynx. It can cover the physiological and anatomical morphology of velopharyngeal closure significantly and improve the velopharyngeal function.
Objective To analyse and summarize the diagnosis, treatment, and cl inical effects of talus lateral process fracture. Methods Between February 2001 and March 2009, 21 male patients with an average age of 33.6 years (range, 18-46years) with talus lateral process fractures were treated. Fracture was caused by fall ing from height in 18 cases, by tumbl ing in 2 cases, and by sprain in 1 case. According to Hawkins classification, there were 4 cases of type I, 15 cases of type II, and 2 cases of type III, all being closed fractures. The disease course was from 2 hours to 26 days. In 17 patients whose fracture fragments were more than 1 cm × 1 cm × 1 cm or whose fracture fragments shifting was more than 1 mm, open reduction and internal fixation with AO hollow titanium nails were performed in 14 patients, open reduction and internal fixation with door-shape self-made nail in 1 patient, and open reduction and internal fixation with absorbable screws in 2 patients. In 4 patients whose fracture fragments were less than 0.6 cm × 0.5 cm × 0.5 cm or whose fracture fragments shifting was less than 1 mm, fragments removel was performed in 2 patients, Kirschner pins in 1 patient, and plaster conservative therapy in 1 patient. In patients with l igaments injury, the l igaments was reconstructed during the operation. Results All the incisions achieved primary heal ing. Twenty-one patients were followed up 9.5 months to 8 years. No ankle pain occurred and the range of joint motion was normal after operation. The X-ray films showed that all cases achieved fracture union. And the healing time was from 8 weeks to 14 weeks (10 weeks on average). According toAmerican Orthopeadic Foot amp; Ankle Society (AOFAS) for foot, the results were excellent in 17 cases, good in 3 cases, and moderate in 1 case; the excellent and good rate was 95.24%. Conclusion The size and displacement of fracture fragment should be considered first in the treatment of lateral process fracture of talus; in patients who are compl icated by lateral malleolus l igament injury, the l igament should be reconstructed to avoid the chronic non-stabil ity of lateral ankle.