Objective To evaluate the characteristics, classification, treatment methods, and cl inical outcomes of the spoke heel injuries in children. Methods From June 2001 to June 2008, 289 children with bicycle or motorcycle spoke heel injuries were treated, including 179 males and 110 females aged 2-12 years old (average 3.9 years old). There were 179 cases of skin contusion and laceration (type I), 83 cases of skin and soft tissue defect with Achilles tendon exposure (type II), and 27 cases of wide skin and soft tissue defect with the Achilles tendon defect and rupture (type III). The defect size of the skin or the soft tissues ranged from 3 cm × 2 cm to 11 cm × 7 cm in type II and type III injury. The time between injury and hospital admission was 1-53 days (average 14.5 days). Child patients with type I injury were managed with dressing or suturing after debridement. For the child patients with type II injury, the wound was repaired with the regional fascia flap in 53 cases, the reverse sural neurocutaneous vascular flap in 19 cases, the reverse saphenous neurocutaneous vascular flap in 9 cases, and the lateral supramalleolar flap in 2 cases. For the child patients with type III injury, 6 cases underwent primary repair of the Achilles tendon followed by the transposition of the reverse sural neurocutaneous vascular flap, 3 cases received primary repair of the wound with the reverse sural neurocutaneous vascular flap and secondary reconstruction of the Achilles tendon with the upturned fascia strip or the ipsilateral il iotibial tract transplant, and 18 cases underwent primary repair of the wound and the Achilles tendon with the sl iding bi-pedicled gastrocnemius musculocutaneous flap. The flap size ranged from 4 cm × 2 cm to 30 cm × 12 cm. All the donor sites were closed bypartial suture and spl it-thickness skins graft. The lower l imbs were immobil ized with plaster spl ints after operation. Results All the flaps survived except for 1 case of type II suffering from distal flap venous crisis 3 days after operation and 6 cases of type III suffering from distal flap necrosis 3-5 days after operation. All those flaps survived after symptomatic treatment. All the skin grafts at the donor site survived uneventfully. All the wounds healed by first intention. All child patients were followed up for 15-820 days (average 42 days). Child patients with type I and type II injury had a full recovery of ankle functions. While 25 cases of type III injury had ankle dorsal extension degree loss (10-30°) and unilateral plantar flexion strength decrease 3 months after operationwithout influence on walking, and 2 cases recovered well. Conclusion Spoke heel injury in children has special mec hanisms of injury, and the choice of proper treatment method should be based on the types of injury.
ObjectiveTo compare and observe the visual acuity and ocular anatomical outcome of different subtypes in open-globe injury (OGI) Ⅲ. MethodsA retrospective study. A total of 187 eyes of 187 patients with OGI involving zone Ⅲ who were admitted to the Department of Ophthalmology of The First Affiliated Hospital of Army Medical University from January 2020 to December 2023 were included in the study. According to the 2022 International Globe and Adnexal Trauma Epidemiology Study groups consensus, zone Ⅲ was further divided into Ⅲa zone (5-8 mm posterior to the limbus) and Ⅲb zone (＞8 mm posterior to the limbus), with 58 eyes (31%, 58/187) in group Ⅲa and 129 eyes (69%, 129/187) in group Ⅲb. Best corrected visual acuity (BCVA) was examined using the international standard decimal visual acuity chart, converted into the logarithm of the minimum angle of resolution (logMAR) visual acuity when recorded. The injured zone, initial visual acuity, final visual acuity, retinal detachment (RD), uveal prolapse, and proliferative vitreoretinopathy (PVR) were collected. The follow-up time after surgery ≥ 6 months. The final visual acuity and anatomical prognosis of the two groups were observed. Silicone oil dependence, phthisis, and enucleation were defined as poor anatomical outcomes. Multiple linear regression analysis was performed to analyze the impact of zone Ⅲb of OGI on the final visual acuity. ResultsAt the 6-month follow-up, the logMAR BCVA of group Ⅲa and group Ⅲb was 1.49±1.0 and 2.51±0.85; there was a statistically significant difference in the logMAR BCVA between the two groups (t=?2.736, P＜0.05). Compared with group Ⅲa, the proportion with light perception in group Ⅲb was higher, and the proportions with visual acuity of hand movement, counting fingers, and ＞0.01 were lower, and the differences were all statistically significant (P＜0.05). Compared with group Ⅲa, RD and PVR were more likely to occur in group Ⅲb, and the differences were all statistically significant (χ2= 16.696, 8.697; P＜0.05). Among the affected eyes in group Ⅲa and group Ⅲb, there were 14 eyes (24.1%, 14/58) and 95 eyes (73.6%, 95/129) with poor final anatomical outcomes respectively; the incidence of poor final anatomical outcomes in group Ⅲb was higher, and the difference was statistically significant (χ2= 40.332, P＜0.01). The results of multiple linear regression analysis showed that initial visual acuity, RD, and uveal prolapse were independent risk factors affecting the final visual acuity (odds ratio=2.407, 4.162, 3.413; P＜0.05). ConclusionsPatients with OGI in zone Ⅲb have a worse visual prognosis and a higher incidence of poor anatomical outcomes. The subclassification of zone Ⅲ is helpful for better predicting the prognosis of OGI clinically.
ObjectiveTo investigate the correlation between the anterior talofibular ligament (ATFL) injury and the pathological changes of the anterior tibiotalar fat pad (ATFP) based on MRI. Methods The clinical and imaging data of 217 patients with ankle sprain who met the selection criteria between January 2019 and March 2024 were retrospectively analyzed. There were 113 males and 104 females with an average age of 38.2 years ranging from 18 to 60 years. Patients were divided into mild group (n=106), moderate group (n=63), and severe group (n=48) according to the degree of ATFL injury. There was no significant difference in gender, side, and body mass index among the 3 groups (P>0.05). The age of the mild group was significantly older than that of the moderate and severe groups (P<0.05). The imaging parameters including the longest and shortest sagittal axis, the largest thickness, the longest and shortest transverse axis, the ATFP area, the area of ATFP high-signal region, and the anterior distal tibial angle (ADTA) were measured according to the MRI and X-ray films of patients. According to the morphology of ATFP, the patients were divided into type Ⅰ (n=128), type Ⅱ (n=73), and type Ⅲ (n=16) based on the severity of the lesions. The distribution of ATFP types, ATFP area, area of ATFP high-signal region, and the ratio of area of ATFP high-signal region to ATFP area at the same level were statistically analyzed and compared among different ATFL injury groups. Additionally, radiographic parameters were compared across different ATFP types. Spearman rank correlation analysis was used to assess the relationships between ATFP area, area of ATFP high-signal region, and the ratio of area of ATFP high-signal region to ATFP area at the same level with patient baseline data. Through analysis of the area under curve (AUC) of ROC, optimal variables were selected for quantification to predict ATFL injury. Results There were significant differences in ATFP types among different ATFL injury groups (P<0.05). The mild group had a higher proportion of type Ⅰ, the moderate group had a higher proportion of type Ⅱ, and the severe group had higher proportions of both typeⅡ and type Ⅲ. No significant difference was found in ATFP area among the different ATFL injury groups (P>0.05). However, the area of ATFP high-signal region and the ratio of area of ATFP high-signal region to ATFP area at the same level were significantly lower in the mild group compared to the moderate and severe groups (P<0.05). Except for the longest sagittal axis, maximum thickness, and longest transverse axis, which were significantly smaller in ATFP types Ⅱ and Ⅲ compared to type Ⅰ (P<0.05), there was no significant difference in the remaining radiographic parameters among the different ATFP types (P>0.05). Spearman rank correlation analysis revealed that ATFP area was negatively correlated with patient gender (P<0.05), while area of ATFP high-signal region and the ratio of area of ATFP high-signal region to ATFP area at the same level were negatively correlated with patient age (P<0.05). Through analysis of the AUC for the response variable ATFP injury, the combined diagnostic AUC of ROC for the reciprocal of the maximum thickness and the reciprocal of the area of ATFP high-signal region was 0.839 (asymptotic P<0.001). The corresponding cutoff value when the Youden index reached its maximum was 0.570 3. ConclusionAs the severity of ATFL injury increases, the ATFP undergoes gradual morphological and functional changes. Classification based on ATFP types can assist in assessing the level of ATFL injury, thereby aiding in the prevention of post-traumatic osteoarthritis.
ObjectiveTo investigate the classification and clinical value of unilateral cervical lateral mass fracture (C3-7).MethodsFrom January 2008 to December 2017, 68 patients with unilateral cervical lateral mass fracture who had received treatment in Affiliated Hospital of Southwest Medical University, were included. According to the position of fracture, the fractures were classified into three types: articular process fractures (type A), isthmus fracture (type B), and comminution (type C). Two subtypes of articular process fractures were type A1 and type A2. Type A1 refered to articular process fracture with no or slight displacement. Type A2 refered to articular process fractures result in foraminal stenosis and nerve root compression. Single-level anterior cervical disectomy and fusion (ACDF) or anterior cervical corpectomy and fusion (ACCF) or conservative treatment was used in type A1. Posterior decompression, fixation and fusion or the method of posterior decompression associated with ACDF were suited to A2. Single-level ACDF was used in type B as well. Type C underwent two-level ACDF or ACCF or posterior procedure.ResultsThere were 35 cases of Type A1, of which 31 patients underwent single-level ACDF, 2 patients underwent ACCF, and 2 patients received conservative treatment, but one of the two underwent ACDF due to delayed cervical instability. Among the 7 cases of type A2, 4 underwent posterior foraminal decompression and posterior fusion with pedicure screw fixation, 2 underwent single-level ACDF and posterior decompression, and 1 underwent single section ACDF and posterior decompression combined with pedical screw fixation. Type C accounted for 21 cases of all targets. Fourteen performed two-level ACDF, 6 performed ACCF, and 1 performed posterior fixation with pedicure screw and expansive open-door laminoplasty. Six patients showed postoperative complications, including C5 root palsy in one case, incision hematoma in two and pulmonary infection in three. There were no case with incision infection or aggravating nervous injury. Sixty-two patients (91.2%) were followed up with a mean duration of 14 months. All the patients obtained bony fusion and no internal fixation failure or kyphosis was found.ConclusionsAccording to fracture position and CT, the unilateral cervical lateral mass fracture can be classified as type A1, type A2, type B, and type C. A satisfied clinical result can be obtained when choosing an appropriate treatment in accordance with different fracture types.
Objective To analyze the preoperative diagnosis and the operative methods for different types of Mirizzi syndrome (MS). Methods Eighty-six cases of MS confirmed by operation were enrolled from March 1990 to December 2008. Their laboratory examination results and X-ray appearances of endoscopic retrograde cholangiopancreatography (ERCP) were analyzed as well as B-ultrasonography (B-us), CT scan and magnetic resonance cholangiopancreatography (MRCP). According to the Csendes typing, different operative methods were adopted. Results The final diagnosis rate by ERCP for MS attained approximately 85.71% (48/56) in contrast with 17.44% (15/86) by B-us, with 9.52% (4/42) by CT scan and with 71.88%（23/32） by MRCP. Twenty cases were Csendes type Ⅰ, 43 cases were type Ⅱ, 17 cases were type Ⅲ, and 6 cases were type Ⅳ. According to the Csendes typing, the cases of type Ⅰ were treated by for the cholecystectomy or partial resection for reserving the neck of gallbladder, type Ⅱ by fistula reparation and laying up the T type drainage-tube under the fistula, and type Ⅲ and type Ⅳ by the hepaticocholangiojejunostomy and hepaticoduodenostomy. Conclusion The preoperative diagnosis for MS is very difficult, B-us may be acted as an accessory diagnostic method. ERCP and MRCP can improve the rate of preoperative diagnosis for MS strikingly. The best reasonable method of the operative therapy is selected according to the different pathologic type of MS.
Objective To summarize the advancement of breast cancer stem cells and genotyping and analyze the correlation between the two. Methods Relevant literatures about breast cancer stem cells and genotyping, which were published recently were collected and reviewed. Results Cancer stem cell origin theory was supported by researches of correlation between breast cancer stem cells and genotyping, which also explained the complexity of intrinsic subtypes and heterogeneity of breast cancer. Conclusions A new way can be detected to study the formation mechanism and biological characteristics of breast cancer at the cellular and molecular level by researches of correlation between breast cancer stem cells and genotyping, which are expected to provide new strategies and tools for diagnosis and treatment of breast cancer.