According to the latest data released by the National Bureau of Statistics, the total population of the mainland of China is 1.33 billion in 2010, including 177 million people aged 60 years or older, accounting for 13.25% of the total population, which increased to 15.53% in 2014. With the degree of growing aging population in our country, patients with musculoskeletal diseases increased greatly, which are the most common cause of severe chronic pain and physical disability among older people. Meanwhile, with the fast development of economy and industrialization in China, the number of patients of traffic injury and construction injury increases rapidly. Taken together, the expenses in orthopedics and traumatology will inevitably increase, challenging the existed medical and health system, presenting significant financial and emotional burden on the society. To address this challenge and improve the patient's care, the innovation of advanced concepts, surgical skills, and novel instruments for accurate diagnostic and treatment methods in orthopedics and traumatology has become more and more vital and imperative in our country. In the field of orthopedics and traumatology, innovation requires orthopedic surgeons to break the traditional rules and think out of the box using critical thinking. In our clinical practice, we emphasize discovering the new application of existed treatment methods. The pilot study using proximal fibulectomy to treat patients with medial compartment osteoarthritis (OA) of the knee joint is a good example. The fibula is the long and thin bone in the lower leg, located parallel to the tibia. In a long time, it is only regarded as an ideal bone source to be grafted onto other bones without affecting the bearing capacity of the leg. However, based upon our clinical experience in the past 20 years, a theory of "nonuniform settlement of tibial plateau playing a key role in the development of knee joint OA" was raised creatively. In this theory, fibula is tubular cortical bone with high bone density, when compared with the proximal tibia, which consists most of cancellous bone with a large weight-bearing area without bony barrier in the medial side. As a result, the rigid fibular support in the lateral side to the osteoporotic proximal tibia could contribute to the non-uniform settlement of tibial plateau, a shift in the mechanical axis, aggravating weight-bearing in the medial plateau, and resulting in articular cartilage degeneration and knee varus.[1] According to this theory, a 2 cm long section of fibula with its periosteum 6–10 cm below the fibular head was resected to treat medial compartment knee OA. The retrospective study following 110 patients with postoperation more than 2 years revealed that the fibular osteotomy could correct the alignment of lower extremity and widen the medial joint space, thus significantly improving both the radiographic appearance and function of the affected knee joint, and also achieving long-term pain relief. When compared to the common treatment methods for medial compartment OA of knee joint, such as the total knee arthroplasty and the high tibial osteotomy, proximal fibulectomy is a safe, simple, economic, and effective alternative. The research and development of minimally invasive surgery (MIS) techniques is an important and active area of innovation in orthopedics and traumatology. A lot of problems exist in the traditional orthopedic operation, with inaccurate fracture reduction and fixation, long exposure time of radioactive rays. At present, the concept of treatment for fractures has evolved from an emphasis on the anatomical reduction and rigid fixation to the indirect reduction and biological internal osteosynthesis with better local blood supply. MIS embodies the core concept of damage control orthopedics, which emphasizes the stabilization and control of the injury, avoiding the damage of "second hit" caused by orthopedic procedure and postponing the performance of fracture repair until an overall stable condition of the patient is maintained.[2] Based on the MIS theory, a series of minimally invasive percutaneous plate osteosynthesis instruments are developed and widely applied in the management of periarticular fractures, metaphyseal fractures, and diaphyseal fractures.[34] A new trend in the development of MIS technique is to improve the ability of restoring both the anatomical and biomechanical features of fractured bones in a more safe and easy fashion by inventing new instruments, which are expected to be more suitable for the size, anatomical characteristics and biomechanical features of bones of Chinese. The anatomy and biomechanics of posterior pelvic ring are complex and difficult to restore once fracture occurs. In this consideration, a minimally invasive adjustable plate, which conforms to the irregular shape of posterior pelvic ring and simulates the structure and biomechanics of sacroiliac complex, was developed to reduce and stabilize the posterior pelvic disruptions. It has been demonstrated to have obvious advantage as compared to traditional fixation techniques, with no need of prebending, short surgical procedure, less blood loss, better anatomical reduction, more stable fixation, and less complications.[5] Another trend is to improve the accuracy and feasibility of MIS techniques in the field of orthopedic trauma by incorporating with intraoperative two-dimensional or three-dimensional (3D) fluoroscopic navigation. Fluoroscopy-based navigation is a relatively new technique with numerous potential advantages, such as increasing the precision of screw placement, significantly reducing iatrogenic soft tissue injury, and decreasing radiation exposure for both patients and surgeons.[67] Bionic fixation will be a feasible treatment method for orthopedic patients. The bionic implants, including bionic flexible fixator, bionic prosthesis, and bionic cage, are designed to repair the injured bone ligament complex, replace the wearing joint or fix the adjacent vertebrae in a more natural way. Syndesmotic diastasis is a common injury, which can be treated with the use of syndesmotic bolt or tightrope. However, the syndesmotic bolt cannot permit a normal range of motion of the distal tibiofibular joint, and tightrope technique lacks the ability of reducing the syndesmotic diastasis. An assembled bolt-tightrope system (ABTS) was designed to combine the advantages of both syndesmotic bolt and tightrope techniques and simultaneously avoid their potential disadvantages. Clinical applications revealed that ABTS could reduce the syndesmotic diastasis and provide flexible fixation in a bionic fashion followed with satisfactory functional recovery of the lower extremities.[8] Orthopedic surgeons have also created many other novel bionic designs. However, some of these designs have been hindered from the clinical application due to the limited manufacturing capability of complex internal implants. The advent of 3D printing technique has greatly facilitated the transformation of novel and unique designs into fire new bionic and individualized implants in the field of orthopedics and traumatology. Currently, with this technology, a series of personalized prosthesis or implants with better performance and more bionic structure are produced. In 2014, researchers from Peking University Third Hospital have successfully completed the world's first application of the artificial customized vertebral body fabricated by 3D printing in the management of atlantoaxial tumors. 3D printing technique provides the Chinese orthopedic surgeons with a valuable chance to break through the limitations of traditional design and manufacture as well as operation methods and to realize their disruptive innovative ideas, staying current with the state of art technologies, and leading the new medical trend in the world. With ongoing basic research and clinical investigation, minimally invasive and personalized treatment strategies assisted by computer aided design and manufacturing technology and 3D printing technology is the developing direction of future orthopedics and traumatology. Through the efforts of more and more domestic colleagues with innovation spirit and extensive communication with experts internationally, it is believed that we could provide higher-quality, more convenient and accessible cost-effective care to our patients, and greatly improve the level of orthopedic and traumatic management in China, gaining the leadership in the world.
Objective:To evaluate the surgical treatment of ulnar olecranon avulsion fracture complicated with radial head fracture.Methods:A retrospective study was conducted to analyze the clinical data of 13 patients who had been treated at Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital for ulnar olecranon avulsion fracture complicated with radial head fracture from July 2016 to February 2022. There were 9 males and 4 females with an age of (38.1±11.7 years), and 6 cases on the dominant side and 7 cases on the non-dominant side. According to Mason classification of radial head fractures, there were 1 case of type Ⅰ, 1 cases of type Ⅱ and 11 cases of type Ⅲ. All patients were treated surgically and their radial head fractures were prioritized. For radial head fractures, 10 patients were treated with open reduction and internal fixation, and 3 patients with radial head replacement. For ulnar olecranon avulsion fractures, 11 patients were treated with repair of tendon insertions, and 2 patients with tendon repair only. At the last follow-up, the elbow mobility was recorded, and Mayo elbow performance score (MEPS), visual analogue scale (VAS) for pain, and Disabilities of the Arm, Shoulder and Hand (DASH) scoring were applied to assess the elbow function, pain, and subjective upper extremity function. Complications and secondary surgeries were also followed up.Results:The 13 patients were followed up for (37.6±18.5) months after operation. At the last follow-up, the flexion and extension was 102.3°±19.6° (from 70° to 130°), and the pronation-supination was 149.6°±20.0° (from 110° to 170°). Nonunion of the radial head fracture occurred in 1 patient, stiffness of the elbow in 3 patients, and ulnar nerve dysfunction in 1 patient. A total of 4 secondary surgeries were performed in 3 patients. At the last follow-up, in the 13 patients, the MEPS score was 100.0 (85.0, 100.0) points with a range from 75 to 100 points; the VAS score was 0.0(0.0, 2.0) point with a range from 0 to 3 points; the DASH score was 2.5 (1.3, 8.3) points with a range from 0 to 21 points.Conclusions:As ulnar olecranon avulsion fracture complicated with radial head fracture is not common, timely identification and clear diagnosis of such injury is very important. Surgical treatment may result in fine outcomes.
历史上，滑雪作为山区一种古老的交通方式，在狩猎、出行和军事行动等方面发挥着重要作用。目前关于滑雪最早的起源记载出现在我国阿勒泰地区。直至19世纪滑雪才成为一种流行的体育运动方式，近百年来，滑雪成为一项竞技体育运动 [1]。滑雪比赛于1936年加入冬季奥林匹克大家庭，而国际滑雪联合会第一届高山滑雪世界杯比赛于1967年举行。据估计，目前全球共有超2亿的活跃滑雪参与者。
Objective:To analyze the epidemiological characteristics of the patients who underwent knee arthroscopy in Nanfang Hospital, Southern Medical University between 2018 and 2022.Methods:A retrospective study was conducted to analyze the data of 2,184 patients who had undergone knee arthroscopy from January 2018 to December 2022 in Nanfang Hospital, Southern Medical University. The data of the patients' gender, age, disease diagnosis, place of residence, hospitalization time, and hospitalization costs were collected to analyze the epidemiological characteristics of the patients.Results:Of the 2,481 patients, 1,427 were males and 1,054 females with an age of 35.9 (26.0, 51.4) years. From the year 2018 to the year 2022, respectively, 344, 339, 344, 632, and 822 patients were admitted. No statistically significant differences were found in the comparison of the patients' gender or age between years ( P>0.05). The top 3 diseases diagnosed were dislocation, sprain and strain of the knee joint and ligaments (40.2%, 998/2,481), intra-articular disorder of the knee (30.7%, 761/2,481), and synovitis and tenosynovitis (5.5%, 136/2,481). The differences were statistically significant in disease diagnosis, place of residence, hospitalization time, and hospitalization costs between the years ( P<0.05). The main disease diagnosed was dislocation, sprain and strain of the knee joint and ligaments for males (47.3%, 675/1,427) and intra-articular disorder of the knee for females (32.2%, 339/1,054). The proportion of patients coming from Guangzhou gradually increased from 22.4% (77/344) in 2018 to 55.8% (459/822) in 2022. The hospitalization time for the patients in 2020, 2021, and 2022 was significantly shorter than that in 2018 and 2019, showing a significant decrease from 2020 to 2021 and from 2021 to 2022 ( P<0.05). The hospitalization costs for the patients showed an increasing trend from 2018 to 2021, with a significant increase in 2019, 2020, 2021, and 2022 in comparison with 2018, but the costs were significantly decreased in 2022 compared with 2021 (all P<0.05). Conclusions:From 2018 to 2022, the knee arthroscopy-related surgeries showed an increasing trend year by year. More males underwent knee arthroscopy than females. Knee injuries were mostly diagnosed in male patients. The patients coming from Guangzhou increased year by year. The hospitalization time showed a shortening trend, and the hospitalization costs decreased from 2022.
With rapid aging of populations, the incidence of intertrochanteric fractures in the elderly is increasing. Surgery is the preferred treatment for the fractures. The internal fixation methods commonly used for the fractures in clinical practice include dynamic hip screw (DHS), proximal femoral nail antirotation (PFNA), Gamma nail, InterTan intramedullary nail, and proximal femoral bionic nail (PFBN) which stemmed from the "lever reconstruction balance" theory. However, there has been no unified theoretical guidance on the early weight-bearing time for affected limbs after different internal fixation methods. This article reviews the current situation of early weight-bearing in elderly patients with femoral intertrochanteric fracture after treatment with different internal fixations, with a view to providing references for clinical healthcare professionals.
Postoperative delirium, one of the common complications in patients with hip fracture, has a high incidence and poor prognosis. As there have been no effective treatments for this complication, early prediction and intervention is the most effective method available to reduce its occurrence. This study reviews the types and characteristics of the patients who suffer from postoperative delirium after hip fracture, as well as the risk factors that have been currently found. The risk prediction models for postoperative delirium are also analyzed and compared in hip fracture patients from the perspectives of cohorts included, research design, model construction and validation methods, model performance, and clinical application. The limitations of existing models are analyzed to foresee the development trend of future delirium prediction models for hip fracture patients. This study aims to help clinical healthcare professionals to identify as soon as possible those who will face a high risk for postoperative delirium after hip fracture surgery and to work out algorithms for targeted prevention and management.
Objective:To investigate the biomechanical properties of a new pediatric femoral neck system in the fixation of pediatric femoral neck fractures with a free fracture fragment.Methods:Ten Sawbones model bones were randomly divided into 2 even groups ( n=5), all of which were made into Delbet Type Ⅱ femoral neck fractures with a Pauwels angle of 70°. A free bone block was removed from the bottom at the proximal end of the fracture to simulate a femoral neck fracture with a free fragment. Group A were fixed with traditional inverted triangle cannulated screws, and group B with a new pediatric femoral neck system. After the 2 groups of specimens were placed on a biomechanical testing machine, each specimen was subjected to a static axial compression test, an anti-torsion test and a cyclic load test in turn. The biomechanical results were compared between groups A and B in aspects of axial compression stiffness, torsional stiffness and maximum displacement difference. Results:The axial compression stiffness [(321.718±5.770) N/mm] and torsional rigidity [(1.448±0.079) N·m/°] in group B were significantly higher than those in group A [(266.722±4.788) N/mm and (1.282±0.023) N·m/°] ( P<0.05). The maximum displacement difference in the cyclic load test in group B [(0.063±0.038) mm] was also significantly smaller than that in group A [(0.117±0.056) mm] ( P<0.05). Conclusion:In fixation of pediatric femoral neck fractures with a free fracture fragment, the new pediatric femoral neck system can lead to better biomechanical stability than the traditional inverted triangle cannulated screws.
Objective:To characterize the injuries suffered by athletes in snow events other than alpine skiing in the Zhangjiakou Zone of the Olympic Winter Games Beijing 2022, in order to provide insights for prevention of sports injuries and preparation of large-scale winter sports events.Methods:The medical records were retrospectively collected of all athletes who had been treated at Beijing University Third Hospital Chongli within the closed loop of the Zhangjiakou Zone during the Winter Olympics and Paralympics (from November 21, 2021 to April 5, 2022). The incidence, severity and part of the injuries were analyzed, as well as the medical treatment process.Results:In the Zhangjiakou Zone, a total of 1,188 athletes participated in the Winter Olympic Games, with an injury incidence of 2.9% (34/1,188), while 420 ones participated in the Winter Paralympic Games, with an injury incidence of 1.7% (7/420). The average daily medical visits were the highest during the Winter Olympics phase (1.16 visits per day), and their emergency severity index (ESI) ranged from level 3 to level 4. The department of orthopedics was visited the most (92.7%, 38/41). Lower limb injuries accounted for the highest proportion (53.7%, 22/41), with the knee ones accounting for 36.6% (15/41) of all injuries. Most of the athletes with ESI level 3 received splint fixation (62.5%, 5/8), while those with ESI level 4 mostly received observation and follow-up (57.6%, 19/33). A total of 57 radiological examinations were performed in the 41 athletes. X-ray was used the most frequently on a single day (5.00 times) while magnetic resonance imaging was per day on average (0.16 times). The transfer time for the athletes injured was (27.4±8.8) min which was not influenced by the 4 weather conditions (cloudy, sunny, light snow, and cloudy) ( P=0.374). Conclusions:The incidence of injuries during the Beijing Winter Olympics in the Zhangjiakou Zone was lower than that in other areas of the Beijing Winter Olympics and in previous Winter Olympics. There were no serious life-threatening cases. The imaging examination resources and transfer speed in the Zhangjiakou Zone were able to meet the medical needs of athletes at all stages of the Beijing Winter Olympics and Paralympics. Athletes should pay attention to protection of their lower limbs during skiing competitions.
Objective:To investigate the spectrum, drug resistance and risk factors of multidrug resistant organism (MDRO) in chronic osteomyelitis.Methods:A retrospective study was conducted by cluster sampling to analyze the 414 patients with chronic osteomyelitis who had been admitted to Department of Orthopaedics, The Second Hospital Affiliated to Shanxi Medical University, Department of Orthopaedics, The People's Hospital of Shanxi Province, Department of Traumatology, Yuncheng City Hospital, and Department of Orthopaedics, Linfen City Hospital from January 2016 to December 2021. The patients were assigned into 2 groups according to whether MDRO had been detected or not. In the MDRO infection group of 150 cases, there were 118 males and 32 females with an age of (48.8±16.2) years; in the non-MDRO infection group of 264 cases, there were 194 males and 70 females with an age of (46.0±17.8) years. The characteristics of bacterial spectrum and drug resistance in MDRO infection were described and analyzed. The 2 groups were compared in terms of clinical data like gender, age, course of disease, body mass index, history of antibiotic use before admission, combined internal diseases, combined trauma, and length of hospital stay. The items with P<0.05 were included in a multivariate logistic regression model to explore the risk factors for MDRO infection. Results:Pathogenic bacteria (331 strains) were detected in 286 of the 414 patients with chronic osteomyelitis, and infection with 168 strains of MDRO was detected in 150 of the 286 patients, yielding a detection rate of 50.8% (168/331). Of the 168 strains of MDR, 129 (76.8%, 129/168) were Gram-positive and 39 (23.2%, 39/168) Gram-negative. Staphylococcus aureus was the most frequently detected species of Gram-positive bacteria (58.1%, 75/129) and the most frequently detected pathogen (44.6%, 75/168) in this study. The resistance of Gram-positive bacteria to peptides and oxazolidinones was low (less than 10%). Multivariate logistic regression analysis showed that age ≥45 years ( OR=6.991, 95% CI: 3.525 to 13.865, P<0.001), essential hypertension ( OR=4.191, 95% CI: 2.070 to 8.485, P<0.001), trauma ( OR=4.232, 95% CI: 2.409 to 7.435, P<0.001) and length of hospital stay ( OR=1.015, 95% CI: 1.001 to 1.029, P=0.030) were the risk factors for MDRO infection in patients with chronic osteomyelitis. Conclusions:The detection rate of MDRO is at a medium to high level. Gram positive bacteria are the main pathogens and resistant to most antibiotics. Antibiotic therapy guided by bacterial culture is of great significance for patients with chronic osteomyelitis. Age≥45 years, essential hypertension, trauma, and long hospital stay are risk factors for MDRO infection in patients with chronic osteomyelitis.
Objective:To explore the impact of weekend hospitalization on total hospitalization expenses for elderly patients with hip fracture under the geriatric orthopedic co-management.Methods:A retrospective analysis was conducted to analyze the clinical data of elderly patients with hip fracture who had been hospitalized for surgical treatment at Beijing Jishuitan Hospital from May 2015 to December 2020. They were divided into 2 groups based on their admission date. Group A was admitted from Monday to Thursday while Group B from Friday to Sunday. The general demographic data, diagnostic information, comorbidities, hospitalization expenses of the patients were collected. The differences in total hospitalization expenses, hospitalization time, rate of surgery within 48 hours and rate of hospital mortality between the 2 groups were analyzed by rank sum test, chi square test, correlation analysis, and multiple linear regression.Results:A total of 6,075 patients with hip fracture were included in this study, including 1,675 males and 4,400 females with a median age of 80 (74, 85) years. There were 3,935 ones in group A and 2,140 ones in group B. The total hospitalization expenses for group A was 58,160.52 (49,215.45, 72,748.94) yuan, insignificantly lower than those for Group B [58,412.90 (49,163.58, 72,712.61) yuan] ( P>0.05). The rate of surgery within 48 hours for group A was 75.8% (2,984/3,935), significantly higher than that for group B [49.3% (1,054/2,140)]. The hospitalization time for group A was 5 (4, 7) days, significantly less than that for group B [5 (4, 7) days] ( P<0.05). There was no significant difference in the rate of hospital mortality between the 2 groups ( P>0.05). Multiple linear regression analysis showed that total hospitalization expenses were significantly higher for patients admitted on weekends, hospitalization time was positively correlated with total hospitalization expenses, and total hospitalization expenses were significantly lower for the patients undergoing surgery within 48 hours ( P<0.05). Conclusion:Admission on weekends can increase total hospitalization expenses, prolong hospitalization time, and reduce rate of surgery within 48 hours for elderly patients with hip fracture.
Objective:To characterize the femoral dense insertion (FDI) of the anterior cruciate ligament (ACL) using 3D magnetic resonance imaging (MRI) so as to guide the femoral tunnel placement in ACL reconstruction.Methods:The 3D MRI data of the contralateral healthy knees were collected from 20 young and middle-aged patients who had been followed up for 2 years at the Department of Sports Medicine, Peking University Third Hospital from June to October 2019 after ACL reconstruction. There were 10 males and 10 females with an age of (34.5±7.8) years. The 3D models of FDI of ACL, as well as of the lateral femoral condyle and its cartilage were reconstructed using Mimics 15.01. The heights and front and rear positions of anteromedial (AM) bundle, center, and posterolateral (PL) bundle of FDI were measured with reference to the apex of deep cartilage (ADC), the deep cortical border of the lateral condyle, and the shallow and inferior cartilage margins.Results:In 3D MRI models, dense fibers of ACL femoral insertion were near the shallow and inferior cartilage margins to the shallow side, and extended obliquely deep and superior toward the over-the-top (OTP) in a band-like shape. The oblique angle was 12.5°. The AM bundle, FDI center, and PL bundle were all higher than ADC, being (4.5±0.7) mm, (3.5±0.8) mm and (2.2±0.6) mm away from ADC, respectively. The median distances to the deep cortical border of the lateral condyle and the shallow cartilage margin were (6.9±1.2) mm and (16.4±1.8) mm for the AM bundle, (11.0±1.4) and (12.1±1.6) mm for the FDI center, and (14.9±1.8) mm and (8.0±1.3) mm for the PL bundle.Conclusions:Dense fibers of ACL femoral insertion are near the shallow and inferior cartilage margin to the shallow side, and extend obliquely deep and superior toward the OTP in a band-like shape. As the height and depth measurements of the FDI in 3D MRI models supplement to the anatomy of ACL femoral insertion, they could be used to guide femoral tunnel placement in ACL reconstruction.
Objective:To characterize the severe sports injuries related to alpine skiing during the 2022 Beijing Winter Olympics and Paralympics so as to provide information for the prevention and treatment of sports injuries in the Yanqing National Alpine Skiing Center tracks.Methods:The medical data were collected of all the alpine skiing athletes and related staff who had sought medical treatment in Peking University Third Hospital Yanqing Hospital during January 20, 2022 to March 26, 2022. Descriptive statistical analyses were conducted for body part, type, occurrence place, and severity of the injuries.Results:There were 49 patients who had suffered severe injuries related to alpine skiing events during this Olympic Games, with 68 injuries by body parts and 72 injuries by types. The most common injury part was the knee (25.0%, 17/68), followed by the head (14.7%, 10/68), and the shoulder (8.8%, 6/68). The most common types of injury were contusion (including hematoma and abrasion, 30.6%, 22/72), followed by sprain (including dislocation, subluxation, and ligament injury, 22.2%, 16/72), and fracture (20.8%, 15/72). The most common occurrence place in the tracks for athletes was the "Haituo Bowl" area (41.7%, 10/24). In terms of severity, the injuries led to an absence from training or competition in 48 athletes [98.0% (48/49)], of whom 33 were severely injured [67.3% (33/49)].Conclusions:The most vulnerable part for severe sports injuries in the alpine skiing events of the 2022 Beijing Winter Olympics and Paralympics was the knee, mostly with ligament injuries, which is consistent with the findings of previous events. The high proportion of severe injuries indicated the difficulty of this track. The place where injuries mostly occurred was the "Haituo Bowl" area of the racing track, also the most challenging part of this track, indicating a necessity of more medical resources in this area.
Objective:To analyze the clinical characteristics and management strategies of the patients who were injured in winter snow sports in parts of Qingdao in order to provide useful information for "300 million people participating in ice and snow sports" .Methods:A retrospective study was conducted to analyze the data of 128 patients who had been admitted to Department of Orthopaedics, Qingdao Central Hospital for skiing injuries from November 2019 to March 2021. The gender, type, location and cause of injury, and treatment method of the patients were statistically analyzed.Results:Of the 128 patients, 72 were males and 56 females with an age of (32.0±12.1) years. Single injury accounted for 97.66% (125/128) while multiple injuries 2.34% (3/128). 46 injuries (35.11%, 46/131) due to single board skiing occurred in 44 patients (34.38%, 44/128); 85 injuries (64.89%, 85/131) due to double board skiing occurred in 84 cases (65.62%, 84/128). As for injury types, there were 44 cases (34.38%, 44/128) of soft tissue injury and 84 fractures (65.62%, 84/128). The top 3 injured locations were the lower leg (24.43%, 32/131), the peri-wrist part (18.32%, 24/131), and the peri-knee part (15.27%, 20/131). The most vulnerable location was, respectively, the wrist joint (26.09%, 12/46) in single board skiing and the calf (31.76%, 27/85) in double board skiing. The top three causes of injury were accidental fall (39.06%, 50/128), being struck by someone or emergency evacuation (14.84%, 19/128), and mismatched equipment models (12.50%, 16/128). The proportion of skiing beginners was as high as 76.56% (98/128). Surgical treatment was performed in 49 cases (38.28%, 49/128), and conservative treatment in 79 cases (61.72%, 79/128).Conclusions:The clinical characteristics of the patients who were injured in winter snow sports in parts of Qingdao are high proportions of skiing beginners, falls and fractures. Special attention needs to be paid to wrist protection in single board skiing and checking the ski disengagement device before double board skiing. Most patients may need only conservative treatment because although a number of patients required surgical treatment, severe multiple injuries were rare.
Objective:To compare the early clinical outcomes between domestic robot-assisted total knee arthroplasty (RA-TKA) and conventional manual total knee arthroplasty (CM-TKA) for patients with primary knee osteoarthritis.Methods:Embase, Pubmed, Web of Science, Zhi.com and Wanfang databases from January 2015 to April 2023 were searched for clinical controlled trials (RCTs) comparing the clinical outcomes between RA-TKA and CM-TKA. After literature screening, quality evaluation and data extraction according to the criteria required, Revman 5.3 software was applied to perform a Meta-analysis of the literature data. The operation time, intraoperative bleeding, hip-knee-ankle angle (HKA), HKA bias value, frontal femoral component (FFC), frontal tibia component (FTC), lateral femoral component (LFC), lateral tibia component (LTC), Knee Society Score (KSS), visual analogue scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), knee mobility, Hospital for Specialty Surgery (HSS) knee score, length of hospital stay, and rate of complications were compared between the RA-TKA and CM-TKA patients.Results:Eight RCTs and 449 patients were included, with 221 patients in the RA-TKA group and 228 ones in the CM-TKA group. The Meta-analysis showed that the RA-TKA group had significantly longer operation time ( MD=18.41, 95% CI: 11.28 to 25.23, P<0.001), significantly better HKA ( MD=0.41, 95% CI: 0.06 to 0.76, P=0.020), significantly better HKA bias value ( MD=-0.92, 95% CI: -1.25 to -0.60, P<0.001), significantly better FTC ( MD=0.38, 95% CI: 0.08 to 0.67, P=0.010), significantly better LTC ( MD=1.71, 95% CI: 0.94 to 2.48, P<0.001), and significantly better knee mobility ( MD=-2.23, 95% CI: -4.18~-0.27, P=0.030) than the CM-TKA group. However, the differences were not statistically significant between the 2 groups in the intraoperative bleeding, FFC, LFC, KSS, VAS, WOMAC, HSS, length of hospital stay, or rate of complications ( P>0.05). Conclusion:Use of a domestic robot to assist conventional manual TKA can significantly improve the accuracy of prosthesis fixation and reconstruct the alignment of lower limb better, showing potential advantages in promoting functional recovery of the knee for the patients.
Objective:To compare the clinical efficacy between modified open wedge high tibial osteotomy (MOWHTO) versus traditional open wedge high tibial osteotomy (TOWHTO) for varus knee osteoarthritis (KOA).Methods:A retrospective study was conducted to analyze the 50 patients (60 knees) with varus KOA who had received high tibial osteotomy at Department of Sports Medicine, The Affiliated Hospital of Qingdao University between September 2019 and December 2020. The patients were divided into 2 groups according to different ways of osteotomy: a traditional group and a modified group. In the traditional group subjected to TOWHTO, there were 25 cases (30 knees); in the modified group subjected to MOWHTO, there were 25 cases (30 knees). In MOWHTO, the bone block attached to the medial collateral ligament (MCL) of the knee was first chiseled at the MCL insertion before osteotomy to reduce excessive stripping of the MCL in the osteotomy area, and then the bone fragment attached to the MCL was filled into the osteotomy area to increase bone filling and bone coverage after the alignment of the lower limb was corrected. The hip-knee-ankle angle (HKAA), medioproximal tibial angle (MPTA), and joint line convergence angle (JLCA) were measured preoperatively and at 18 months postoperatively in both groups to evaluate correction of the alignment of the lower limb. Fracture healing time, bone loss in the osteotomy area, Hospital for Special Surgery (HSS) knee score and visual analogue scale (VAS) were recorded to evaluate the postoperative efficacy.Results:There was no statistically significant difference between the TOWHTO and MOWHTO groups in the general clinical data before operation, showing comparability ( P>0.05). At 18 months after operation, HKAA was (179.1° ± 1.1°) in the TOWHTO group and (179.3° ± 0.7°) in the MOWHTO group while MPTA was (91.9° ± 0.4°) in the TOWHTO group and (91.9° ± 0.4°) in the MOWHTO group, showing no statistically significant difference between the 2 groups ( P>0.05) but a significant difference between preoperation and postoperation in each group ( P<0.05). At 18 months after operation, JLCA was (1.8° ± 0.4°) in the TOWHTO group, significantly larger than that in the MOWHTO group (1.5° ± 0.4°), HSS score was 81.5 (79.5, 83.0) points in the TOWHTO group, significantly lower than that in the MOWHTO group [85.0 (82.5, 87.5) points], and VAS was 1.8 (1.6, 2.0) points in the TOWHTO group, significantly higher than that in the MOWHTO group [1.5 (1.5, 2.0) points] (all P<0.05). At 18 months after operation, the preoperative JLCA was significantly improved in both groups ( P<0.05). The time required for a fracture healing score higher than 4 points was (3.3 ± 0.6) months in the TOWHTO group and (4.5 ± 0.9) months in the MOWHTO group, and the rate of bone loss in the osteotomy area was 20% in the TOWHTO group (6/30) and 0 (0/30) in the MOWHTO group, both showing a significant difference between the 2 groups ( P<0.05). Conclusions:Both TOWHTO and MOWHTO can effectively treat varus KOA. MOWHTO is more effective in promoting bone healing in the osteotomy area, reducing bone defects in the osteotomy area and improving knee function.
Osteoporosis (OP) is a systemic bone metabolic disease when bone resorption becomes greater than bone formation, resulting in bone mass loss and poor bone structure. The disability or fatality caused by its complications has become a global public problem. As mitogen-activated protein kinases (MAPK) are important molecules that maintain and regulate cellular energy balance, they are closely related to bone metabolism. In clinical practice, traditional Chinese medicine has demonstrated obvious advantages in prevention and treatment of OP. However, there has not been enough comprehensive or systematic summary of the researches into the regulatory mechanisms of this signaling pathway in the treatment of OP by traditional Chinese medicine. Therefore, this paper expounds on the effects of single traditional Chinese herb and compound traditional Chinese herbs on the regulatory mechanisms of MAPK signaling pathway in bone metabolism so that a theoretical basis can be provided for future basic and clinical researches in the prevention and treatment of OP.
Objective:To investigate the clinical outcomes of Ortho-Bridge Combination System (OBCS) to achieve precise ulna-shortening osteotomy (USO) in the treatment of ulnar impaction syndrome.Methods:A retrospective study was conducted to analyze the 25 patients with ulnar impaction syndrome who had been treated at Institute of Orthopedic Trauma Research, The 920th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army between January 2020 to March 2022. The patients all underwent USO using OBCS. They were 14 females and 11 males with an age of (43.2 ± 10.1) years. Their CT scans were retrieved for preoperative planning and design of a personalized USO. Intraoperatively, OBCS was fixated to the ulna before USO. After the bone was resected according to preoperative planning, the gap between the osteotomy sites was closed with compression, and OBCS was finally fixated with locking screws. The time for bone union after resection, complications, range of motion and grip strength were recorded. The clinical outcomes were evaluated by visual analogue scale (VAS) and Mayo wrist score.Results:All patients completed their operations successfully using OBCS. Their follow-up time was (13.5 ± 1.2) months. The ulnar variation was corrected and osteotomy ends got united in all patients, without nonunion, angulation, or rotation. The wrist VAS significantly decreased from 6.0 (5.0, 6.5) points before operation to 2.0 (1.0, 2.0) points at the last follow-up ( P<0.05). At the last follow-up, the Mayo wrist score [(85.4 ± 8.9) points], grip strength [(39.4 ± 1.2) kg], wrist flexion-extension (111.9° ± 12.6°), wrist pronation-supination (133.2° ± 15.7°), and ulnar radial deviation (35.3° ± 2.8°) were significantly increased compared with the preoperative values [(69.2 ± 13.3) points, (31.3 ± 5.2) kg, 102.0° ± 16.0°, 128.0° ± 15.5°, and 32.2° ± 2.8°] ( P<0.05). Conclusion:In the treatment of ulnar impaction syndrome, OBCS can facilitate the process of USO, correct ulnar variance, and avoid complications like rotation and angulation to improve functions of the wrist.
前臂骨折脱位损伤种类繁多，受伤原因及损伤结构差异很大，治疗不当会造成前臂、肘、腕关节功能受限，影响日常生活。大家对一些少见类型的前臂骨折脱位损伤的诊疗不熟悉。我们选取创伤性单纯桡骨头脱位(isolated traumatic radial head dislocation，ITRHD)、分离性肘关节脱位（divergent dislocation of elbow, DDE)、汇聚性肘关节脱位（convergent dislocation of elbow，CDE）、前臂criss-cross损伤（交叉损伤）、Essex-Lopresti损伤（前臂纵向分离）及前臂双极骨折脱位结合文献介绍，并分享我们的治疗体会。
Objective:To investigate the clinical efficacy of arthroscopic limited incision of the articular capsule to repair the glenoid labrum in the treatment of borderline developmental dysplasia of the hip (BDDH) complicated with labral tear.Methods:A retrospective study was conducted to analyze the data of 18 patients with BDDH complicated with labral tear who had been admitted to Department of Orthopaedics, The Second Hospital Affiliated to Suzhou University from January 2016 to December 2019 (observation group). There were 12 males and 6 females with an age of (41.8 ± 8.5) years. Simultaneously, another 18 patients were selected as the control group whose hip development was normal but age and gender were matched with those in the observation group. There were 9 males and 9 females with an age of (43.5 ± 10.3) years. Both groups were treated by arthroscopic limited incision of the articular capsule to repair the glenoid labrum. The 2 groups were compared in terms of modified Harris hip score (MHHS), Hip Outcome Score Activities of Daily Living Subscale (HOS-ADL), and visual analogue scale (VAS).Results:There was no significant difference in the demographic data like age, gender ratio, body mass index, severity of labral tear or time from injury to operation between the 2 groups, indicating comparability between groups ( P>0.05). The observation and control groups were followed up for (38 ± 7) and (43 ± 6) months, respectively. For the observation and control groups, respectively, MHHS was (97.1 ± 3.3) points and (95.4 ± 4.2) points, HOS-ADL (92.6 ± 2.8) points and (91.4 ± 4.1) points, and VAS (0.6 ± 0.5) points and (1.0 ± 0.8) points, all showing no significant difference between groups ( P>0.05). Conclusion:In the treatment of BDDH patients complicated with labral tear, simple arthroscopic limited incision of the articular capsule to repair the glenoid labrum can lead to the same good medium-term efficacy as it can in those with normal hip development.
