Due to the patella’s thin overlying skin, metal implants frequently cause local discomfort that necessitates removal. This study aimed to evaluate the intraoperative and early postoperative outcomes of treating comminuted patellar fractures using non-absorbable sutures as the sole internal fixation method via the Nice knot technique. This retrospective study reviewed 25 patients with unilateral closed comminuted patellar fractures who underwent open reduction and internal fixation using either non-absorbable sutures tied with a Nice knot (NK group, n = 12) or the traditional tension band technique (TB group, n = 13). Intraoperative surgical time and blood loss were recorded. Postoperative clinical outcomes were evaluated using the Visual Analogue Scale (VAS) for pain, knee range of motion (ROM), and the Böstman scoring system. Radiographic assessments were conducted to evaluate fracture healing. Complications, including infection, implant loosening, and discomfort or irritation, were also documented. Although the intraoperative surgical time was slightly longer in the NK group compared to the TB group, the difference was not statistically significant. The difference in blood loss between the NK and TB groups was also not statistically significant. No cases of bone non-union, implant loosening, or internal fixation failure were observed in either group during the follow-up period. One patient in the TB group developed a wound infection one week postoperatively. At the final follow-up, there were no significant differences between the two groups in terms of VAS scores, knee range of motion (ROM), or Böstman scores. However, in the TB group, five patients reported notable discomfort or irritation caused by the internal fixation. Compared with traditional tension band fixation, the Nice knot technique reduces soft tissue irritation, avoids implant removal surgery, potentially lowers postoperative infection rates, and achieves comparable fracture healing time and knee function. However, broader validation through multi-center studies is required.

Diabetic conditions impair bone regeneration due to dysregulated macrophage polarization and inflammatory imbalance. Current therapies often fail to address systemic immune homeostasis. Herein, a bone-targeted nanoplatform (abbreviated as AgSr-MSNs) is engineered to scavenge excess nitric oxide (NO) and respond to the acidic diabetic microenvironment based on upregulated inducible nitric oxide synthase (iNOS) expression in M1 macrophages residing within both the diabetic bone marrow and localized osteolytic regions in our study. The system integrates silver sulfide quantum dots (Ag2S QDs) and Sr2+ into mesoporous silica nanoparticles (MSNs), encapsulated with rhodamine/β-cyclodextrin and surface-modified with alendronate for bone-specific targeting. Under near-infrared (NIR) irradiation, the nanoparticles induce macrophage repolarization toward M2 phenotypes through JAK/STAT signaling pathway, followed by upregulating anti-inflammatory mediators (TGF-β, PD-L1) and tissue-regenerative factors (BMP-2/4, VEGF-B), while suppressing pro-inflammatory cytokines (CCR2, S100A4). This dual NO/pH-responsive platform synergistically mitigates inflammatory dysregulation, enhances osteogenesis, and promotes angiogenesis. In diabetic models, systemic administration with NIR-mediated mild hyperthermia reduces CD86+ macrophages and TNF-α levels while elevating CD206+ macrophages locally and systemically. Concurrently, it boosts CD31, Runx2, and osteocalcin (OCN) expression levels at defect sites, indicating restored vascularization and osteogenesis. This strategy addresses the pathological triad of diabetic osteopathy-chronic inflammation, vascular insufficiency, and osteogenic impairment-providing a translatable nanotherapeutic paradigm for metabolic bone disorders.

Severe tissue defects present formidable challenges to human health, persisting as major contributors to mortality rates. The complex pathological microenvironment, particularly the disrupted immune landscape within these defects, poses substantial hurdles to existing tissue regeneration strategies. However, the emergence of nanobiotechnology has opened a new direction in immunomodulatory nanomedicine, providing encouraging prospects for tissue regeneration and restoration. This review aims to gather recent advances in immunomodulatory nanomedicine to foster tissue regeneration. We begin by elucidating the distinctive features of the local immune microenvironment within defective tissues and its crucial role in tissue regeneration. Subsequently, we explore the design and functional properties of immunomodulatory nanosystems. Finally, we address the challenges and prospects of clinical translation in nanomedicine development, aiming to propose a potent approach to enhance tissue regeneration through synergistic immune modulation and nanomedicine integration.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

目的 探讨鞣花酸对口腔鳞癌HSC3细胞增殖、迁移和侵袭的影响及可能机制.方法 体外培养HSC3细胞,用不同剂量(2、4、8μg/ml)鞣花酸干预24 h后,CCK-8法和克隆形成实验检测细胞增殖、划痕实验和Transwell分别检测细胞迁移和侵袭,蛋白质印迹法检测细胞中E-cadherin和N-cadherin蛋白表达,qRT-PCR法检测细胞中miR-1254表达.收集39例口腔鳞癌患者癌组织和癌旁组织,RT-PCR法检测组织中miR-1254表达.转染miR-1254模拟物至HSC3细胞,或转染miR-1254抑制剂至HSC3细胞后再用8μg/ml鞣花酸干预24 h,然后采用上述相同方法检测细胞增殖、迁移和侵袭.结果 与对照组比较,不同剂量鞣花酸提高了HSC3细胞增殖抑制率和E-cadherin蛋白表达(P<0.05),降低了细胞克隆形成数、划痕愈合率、侵袭数及N-cadherin蛋白表达(P<0.05).同时,与对照组比较,不同剂量鞣花酸促进了HSC3细胞中miR-1254表达(P<0.05).口腔鳞癌组织中miR-1254表达低于癌旁组织(P<0.05).过表达miR-1254后,HSC3细胞增殖抑制率和E-cadherin蛋白表达升高(P<0.05),细胞克隆形成数、划痕愈合率、侵袭数及N-cadherin蛋白表达降低(P<0.05).过表达miR-1254逆转了鞣花酸对HSC3细胞增殖、迁移和侵袭的影响.结论 鞣花酸可能通过上调miR-1254抑制口腔鳞癌HSC3细胞增殖、迁移和侵袭.

近年来,心脏移植手术操作、围手术期管理和免疫抑制剂应用等方面都取得了巨大进步,但心脏移植术后并发症仍然是影响受者生存的重要危险因素.其中急性肾损伤是一种心脏移植术后早期常见的并发症,可导致心脏移植术后继发慢性肾病,并进展到终末期肾病,严重影响受者生存质量和长期存活.因此,识别心脏移植术后肾损伤的危险因素,并及时给予干预,对改善心脏移植预后具有重要意义.本文旨在对心脏移植术后肾损伤相关并发症的发生情况、危险因素、防治策略等方面的研究进展进行综述,以期为临床心脏移植术后肾损伤相关并发症的预防、诊断及治疗提供参考,改善心脏移植受者预后.

The aim of this study was to evaluate the clinical application of double-reverse traction for minimally invasive reduction of complex tibial plateau fractures. A retrospective analysis was performed to identify all patients admitted to the Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, from March 2017 to December 2019 with Schatzker type VI tibial plateau fractures. 12 patients were identified (7 men and 5 women) with an average age of 46.15 ± 13 (39-58) years old. All patients were treated with double-reverse traction and closed reduction. After the fracture was reduced, the bone plate was fixed by percutaneous minimally invasive implantation. Outcomes assessed in this study include operation time and intraoperative blood loss. Imaging was performed during the postoperative follow-up, and functional recovery was evaluated at the final follow-up according to the Hospital for Special Surgery (HSS) score and the International Knee Joint Literature Committee (IKDC) functional score. Patients were followed up for 12.54 ± 1.5 (8-15) months. The average operation time was 63.63 ± 21 (35-120) minutes, and the average intraoperative blood loss was 105.45 ± 21 (60-200) mL. The Rasmussen imaging score was either excellent or good in all cases. The knee joint HSS score was 86.15 ± 6 (79-90) points, and the IKDC score was 80.01 ± 11 (75-90) points. No complications, such as wound infection, incision disunion, loosening of internal fixation, and internal fixation failure, occurred. In the treatment of Schatzker VI type complex tibial plateau fracture, the dual-reverse traction minimally invasive technique has the advantages of safety and effectiveness, less soft tissue injury, and allowing early joint movement, which is worthy of clinical promotion.

Background We aimed to compare the intraoperative and early postoperative clinical outcomes of using an acromioclavicular joint hook plate (AJHP) versus a locking plate (LP) in the treatment of anterior sternoclavicular joint dislocation. Methods Seventeen patients with anterior sternoclavicular joint dislocation were retrospectively analyzed from May 2014 to September 2019. Six patients were surgically treated with an AJHP, and 11 were surgically treated with an LP. Five male and one female patients composed the AJHP group, and nine male and two female patients composed the LP group. The mean age of all patients was 49.5 years. Results Reduction and fixation were performed with AJHP or LP in all 17 patients. The mean operative blood loss, operative time, and length of incision in the AJHP group were significantly better than those in the LP group. Shoulder girdle movement of the AJHP group was significantly better than that of the LP group. Conclusions This study revealed that AJHP facilitated glenohumeral joint motion, reduced the risk of rupture of mediastinal structures, required a shorter incision, and had lesser blood loss and a shorter duration of operation compared with LP. However, some deficiencies require further improvement.

Background: We aimed to compare the efficacy and functional outcomes of using an acromioclavicular joint hook plate (AJHP) versus a locking plate (LP) in the treatment of anterior sternoclavicular joint dislocation. Methods: Seventeen patients with anterior sternoclavicular joint dislocation were retrospectively analyzed from May 2014 to September 2019. Six patients were surgically treated with an AJHP, and 11 were surgically treated with an LP. Five male and one female patients comprised the AJHP group, and nine male and two female patients comprised the LP group. The mean age of all patients was 49.5 years. Results: Reduction and fixation were performed with AJHP or LP in all 17 patients. All patients were followed up for a mean duration of 14.4 months. There were no reported complications, wound infections, or instances of plate or screw breakage. The mean operative blood loss, operative time, and length of incision in the AJHP group were significantly better than those in the LP group. Shoulder girdle movement of the AJHP group was significantly better than that of the LP group. Conclusions: This study revealed that AJHP facilitated glenohumeral joint motion, reduced the risk of rupture of mediastinal structures, required a shorter incision, and had less blood loss and a shorter duration of operation compared with LP. However, some deficiencies require further improvement. Trial registration:

PURPOSE:To evaluate intraoperative and early postoperative clinical outcomes using the Nice knot as an auxiliary reduction technique in displaced comminuted patellar fractures.METHODS:Thirty-nine patients with unilateral closed displaced comminuted patellar fractures received open reduction and internal fixation (ORIF), utilizing either Nice knot (the NK group, 24 patients) or traditional reduction (the TR group, 23 patients) techniques, were retrospectively reviewed in this study. Intra-operative surgical time and peri-operative hemoglobin were recorded. Post-operative clinical outcomes were measured using visual analgesic score, range of motion of the knee joint and the Böstman scales, and radiographic outcomes were used to evaluate fracture healing. Complications including infection, bone non-union, implant loosening, fragment displacement and painful hardware were also assessed.RESULTS:In-hospital records indicated significantly shorter surgical duration (32.6 min) in the NK group than in the TR group (63.9 min). Intraoperative blood loss was also significantly decreased in the NK group (64.7 ml) compared to the TR group (189.1 ml). Patients in the NK and TR groups were followed for mean of 12.9 months and 12.5 months respectively. The union rate was 100% (24/24) in the NK group and 91.3% (21/23) in the TR group. In the TR group, there were two non-unions, including one infected non-union. There was no difference in the visual analgesic score, the range of motion of the knee joint or the Böstman scale at last follow-up between the two groups.CONCLUSION:The sliding, self-stabilizing Nice knot was associated with reduced surgical time, decreased intraoperative blood loss, and satisfactory postoperative outcomes in the treatment of displaced patellar fractures. Future studies are needed to ensure the generalizability of these findings to additional patient populations at other institutions.

目的 观察养阴清肺汤治疗急性放射性口腔炎的临床疗效及其对患者免疫功能和炎症细胞因子的影响.方法 患者100例,按照随机数字表法分为治疗组与对照组各50例,两组均采用西医常规治疗,治疗组在对照组治疗基础上加用养阴清肺汤,两组疗程均持续到放疗结束后2～4周.观察两组临床疗效,治疗前后两组唾液中y-干扰素(IFN-γ)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及白细胞介素-8(IL-8)水平及两组治疗前后免疫功能指标(CD3+、CD4+、CD8+、CD4+/CD8+)的变化情况.结果 治疗组总有效率为92.00％,显著高于对照组的76.00％ (P＜ 0.05).治疗组症状体征、唾液炎症细胞因子、相关免疫功能指标恢复程度均优于对照组(P＜0.05).结论 养阴清肺汤可有效缓解急性放射性口腔炎的疼痛和黏膜损伤程度,加速患者伤口愈合,有效抑制急性放射性口腔炎的相关炎症细胞因子.

背景:异烟肼作为抗结核的一线药物,对细胞内外结核菌都具有极强的杀菌效果,但目前还没有研究报道异烟肼对成骨细胞的毒性作用.目的:探讨不同质量浓度异烟肼对新生SD大鼠成骨细胞增殖、分化的影响.方法:将不同质量浓度(0,10,20,30,40,50,60,100 mg/L)异烟肼分别加入新生SD大鼠第3代成骨细胞中,采用CCK-8法、碱性磷酸酶活性试剂盒和免疫荧光染色法检测异烟肼对成骨细胞增殖、分化的影响.结果与结论:与对照组比较,异烟肼质量浓度在30 mg/L时,成骨细胞增殖开始受到抑制;随着异烟肼质量浓度增高,碱性磷酸酶活性、Ⅰ型胶原表达明显降低.结果表明,异烟肼质量浓度过高对成骨细胞增殖和分化具有抑制作用.

Objective To explore the clinical effect of bone grafting in the injured vertebrae combined with pedicle screw-rod system assisted with drugs in treating lumbar vertebral compression fracture in the elderly.Methods A retrospective case-control study was carried out to analyze the clinical data of 48 cases of lumbar vertebral compression fracture in the elderly admitted to the Union Hospital between October 2015 and October 2018.There were 34 males and 14 females,aged 60-78 years [(62.8 ± 2.5) years].Segment of injury was L1 in 37 cases,L2 in 7,L3 in 2,and L4 in 4.There were 20 cases in bone grafting group involving 15 males and five females,aged from 60 to 78 years [(63.7 ± 2.1)years].There were 28 cases in non-bone grafting group involving 19 males and nine females,aged from 60 to 75 years [(62.4 ± 2.9) years].The Frankel scale in bone grafting group was grade D in 15 cases and grade E in 5,and in non-bone grafting group was grade D in 18 cases and grade E in 10.All the cases were treated by pedicle screw fixation combined with antiosteoporosis drugs,and the bone grafting group were treated by bone grafting via the injured vertebrae,but the other group were not.The intraoperative blood loss and operation time for each segmental vertebrae were recorded.The visual analogue scale (VAS) before operation and one year after operation,the bone healing at three months and one year postoperatively were recorded.The compression rate of the injured vertebrae at operation,at one day and one-year postoperatively as well as the height loss of the injured vertebrae at postoperative one year were measured.Spinal cord injury was also evaluated by Frankel scale.Wound healing,lower limb thrombosis,lung infection and ulcer were observed.Results All the cases were followed up,with duration for 12-25 months [(16.2 ±3.4) months] in bone grafting group and 15-24 months [(17.5 ± 5.4) months] in non-bone grafting group (P ＞ 0.05).The blood loss was (240 ± 70) ml in bone grafting group and (210 ± 65) ml in non-bone grafting group (P ＞ 0.05).Screw implantation time for each segment was (38.5 ±9.6)minutes in bone grafting group and (30.5 ±5.4)minutes in non-bone grafting group (P ＜ 0.05).The VAS was (7.5 ± 1.8)points preoperatively and (1.5 ± 0.7)points at one year postoperatively in bone grafting group,while (7.8 ± 1.4) points and (2.9 ± 1.2) points in non-bone grafting group,with significant difference between the two groups at one year postoperatively (P ＜ 0.05).The fracture healing rate was 85％ (17/20) and 95％ (19/20) at three months and one year postoperatively in bone grafting group,while 64％ (18/28) and 86％ (24/28) in non-bone grafting group,with no statistical difference between the two groups (P ＞ 0.05).No significant difference was found in compression rate of the injured vertebral height between the two groups before and after operation (P ＞ 0.05).The height loss rate of the injured vertebrae was 3％ (2％,4％) at one year postoperatively in bone grafting group and 6％ (5％,8％) in non-bone grafting group (P ＜0.05).The Frankel scale was all Grade E postoperatively.During the follow-up,no lower limb thrombosis,lung infection or ulcer occurred.One case had bone non-union in bone grafting group and four in non-bone grafting group (P ＞ 0.05).Conclusion For lumbar vertebral compression fracture in the elderly,bone grafting in the injured vertebrae combined with pedicle screw-rod system assisted with drugs is significantly better in recovering and maintaining the injured vertebrae height,relieving the pain and promoting the bone healing,although the screw implantation time is prolonged.

To compare the clinical effect of 3D-printed template technology with X-ray fluoroscopy in assisting surgery for sacroiliac screws placement. Institutional review board-approved retrospective analysis. The clinical data of 31 cases of sacroiliac complex injury between January 2015 and December 2016 were analyzed. There were 16 patients, males 11 and females 5, who underwent surgery assisted by 3D-printed template in template group, and that of contemporaneous 15 patients, males 11 and females 4, who underwent traditional surgery were gathered as fluoroscopy group. All those patients were followed up for more than 6 months. The operation time and X-ray fluoroscopy times for each screw placement, and the Matta and Majeed score were analyzed and the difference between the two group was tested. All cases were followed up for 6–20 months, average 11.4 ± 0.6 months. In template group, 19 screws were implanted. Each screw spent 25–38 min, average 27.2 ± 5.3 min, and need 2–5 times fluoroscopy, average 2.7 ± 0.5. The fracture reduction quality was evaluated by Matta score scale: excellent 10, well 4, fair 2, good rate 87.5%; and pelvic function were evaluated by Majeed score scale: excellent 11, well 3, fair 2, and good rate 87.5%. In fluoroscopy group, 17 screws were implanted. Each screw spent 45–70 min, average 60.3 ± 5.8 min, and needs 11–23 times fluoroscopy, average 15.4 ± 3.5. The fracture reduction quality was evaluated by Matta score scale: excellent 7, well 6, fair 2, and good rate 86.7%; and pelvic function was evaluated by Majeed score scale: excellent 6, well 6, fair 3, and good rate 80.0%. The difference in operation time, X-ray fluoroscopy times between template group and fluoroscopy group had statistical significance. But the Matta and Majeed score had no difference between two groups. Compared with traditional surgery, 3D-printed template technology-assisted surgery for sacroiliac screws placement in sacroiliac complex injury patients possesses advantage such as shortened operation time and reduced X-ray exposure times. This technology improves the safety profile of this operation and should be further studied in future clinical applications.

With the outbreak of novel coronavirus pneumonia (NCP) induced by 2019 novel coronavirus (2019-nCoV) in Wuhan, Hubei Province in December 2019, more and more suspected or confirmed cases have been found in various regions of China. Although China has adopted unprecedented strict quarantine and closed management measures to prevent the spreading of the disease, Department of Traumatic Orthopedics may still have to manage NCP patients with open fractures or severe trauma that require emergency surgery. Therefore, the identification and management of 2019-nCoV infection as soon as possible as well as the protection of all medical staff involved in the emergency treatment of patients are the severe challenges faced by orthopedic traumatologists during the prevention and control of NCP. Based on the characteristics of such patients and related diagnosis and treatment experiences during the epidemic of NCP, the authors formulate the surgical management strategies for orthopedic trauma patients.

Since December 2019, novel coronavirus pneumonia (NCP) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of NCP. Based on the needs of orthopedic trauma patients for emergency surgery and review of the latest NCP diagnosis and treatment strategy and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of NCP and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.

目的 观察止血带对微创掌侧桡侧腕屈肌入路手术治疗闭合性桡骨远端骨折的影响.方法 回顾性分析自2018-09-2019-12采用微创掌侧桡侧腕屈肌入路手术治疗的86例闭合型桡骨远端骨折,其中新鲜骨折45例,陈旧骨折41例.新鲜骨折中20例手术全程使用止血带(A组),25例不使用止血带(B组);陈旧性骨折中24例手术全程使用止血带(C组),17例不使用止血带(D组).比较4组手术时间、术中出血量、切口长度、术后2d切口引流量、切口红肿数、白细胞水平升高数以及术后2d疼痛VAS评分.结果 86例均顺利完成手术并获得随访,随访时间6～12个月,平均8.7个月.A组与B组手术时间、术中出血量、切口长度比较差异无统计学意义(P＞0.05),C组与D组术中出血量、切口长度比较差异无统计学意义(P＞0.05),C组手术时间较D组短,差异有统计学意义(P＜0.05).4组切口引流量、切口红肿数、白细胞水平升高数比较差异无统计学意义(P＞0.05),B组疼痛VAS评分较其他3组低,差异有统计学意义(P＜0.05).结论 微创掌侧桡侧腕屈肌入路手术治疗新鲜桡骨远端骨折时,并不必需使用止血带;但治疗陈旧性骨折桡骨远端骨折时使用止血带可以缩短手术时间.

ABSTRACT Hepatitis B, caused by hepatitis B virus (HBV) infection, is one of the epidemic and infectious hepatitis diseases. The sigle-nucleotide polymorphisms were identified to associate with HBV infection in East Asian population by genome-wide association study (GWAS), but no study in Yunnan HBV population was reported. We recruited 493 HBV patients and 460 general controls to genotype 7 GWAS SNPs, and then, the association study was performed between these SNPs and biochemical features of HBV patients. The results showed that genotype and allele frequencies of SNPs in the HLA-DP (rs3077, 9277535, and 3128917) and HLA-DQ (rs2856718 and 7453920) genes were associated with HBV infection. Significantly different genotyping frequencies were investigated among three HBV subgroups. Genotype AA of rs3130542 (HLA-C) showed significantly higher frequency in subgroup #1 patients than the other two subgroups (#1 vs. #2, p = .02; #1 vs. #3, p = .03). Meanwhile, genotype frequencies of rs3077, rs9277535, and 3128917 (HLA-DP) were significantly different between patients in subgroup #2 and #3. The indirect bilirubin level was significantly lower in patients with genotype CT of rs3077 than patients with genotype CC (p = .009) or TT (p = .016), and it also showed lower level in patients with genotype GT of rs3128917 than patients with genotype GG (p = .015). The direct bilirubin level was higher in patients with genotype TT of rs4821116 (UBE2L3) than patients with genotype CT (p = .010). In summary, we identified the association between GWAS SNPs and HBV infection or biochemical features in Yunnan HBV population.