Interlocked intramedullary nailing is now established as the preferred method of managing femoral intertrochanteric fractures. Choosing the ideal entry point and inserting the guidewire accurately are key steps of the procedure. Several factors make the procedure more challenging, such as the supine position, obese patients, and the tip of the trochanter not aligning co-linear with the anatomic axis of the femoral medullary canal in the frontal plane. Our team has developed a new awl with a distal positioner that assists the guidewire insertion and entry portal of femurs. This comparative study analyzed 40 intertrochanteric fracture cases treated with locking intramedullary nailing, which were randomized to receive either the new awl incorporating a distal positioner (n = 20) or the conventional guide apparatus (n = 20). Operation time, blood loss, the success rate of the one-time insertion, radiation times, and bone healing time were recorded. The patients (21 males and 19 females) were treated with Gamma 3 and proximal femur nail antirotation (PFNA) with the help of the new awl with a distal positioner or conventional guide apparatus. There were no transoperative complications in the two groups. The surgical time in the new guide apparatus group was significantly shorter compared to the control group. The new awl group achieved a 100% success rate for one-time needle insertion, surpassing the control group's rate of 66.7%. The fluoroscopy time required for the new awl group was obviously shorter compared to that of the control group. However, no significant differences were observed in terms of intraoperative blood loss or bone healing time between the two groups. The newly designed guide awl with a distal positioner could reduce the difficulty in opening the femur for inserting the interlocked intramedullary nail. This tool is especially suitable for obese patients.

BackgroundOsteosarcoma (OS), the most prevalent primary malignant bone tumor in children and adolescents, arises from bone-forming mesenchymal cells. Despite advancements in surgical resection and neoadjuvant chemotherapy (cisplatin, doxorubicin, and methotrexate), chemotherapy resistance remains a significant challenge, leading to poor survival rates in patients with metastatic or recurrent OS.MethodsIn this study, we focused on the role of OTULIN, a key linear deubiquitinating enzyme, in OS chemoresistance. In addition, mechanistic investigations were carried out to identify potential downstream targets of OTULIN involved in cisplatin resistance.ResultsOur results demonstrated that OTULIN expression was significantly upregulated in OS tissues and cell lines following cisplatin treatment but not in response to doxorubicin or methotrexate. High OTULIN expression was associated with reduced survival in sarcoma patients. Furthermore, immunohistochemical analysis of prechemotherapy and postchemotherapy OS tissues revealed increased OTULIN expression in postchemotherapy samples. In vitro results demonstrated that OTULIN plays a critical role in mediating cisplatin resistance in OS. Mechanistically, GPX4 could be a downstream target of OTULIN, conferring cisplatin resistance to OS by blocking the mitochondrial apoptotic pathway but not ferroptosis. Specifically, OTULIN prevents the proteasomal degradation of GPX4 by reducing its ubiquitin level, thereby conferring resistance to cisplatin in OS cells.ConclusionThis study highlights the importance of OTULIN in OS chemoresistance and provides a promising approach for targeting the OTULIN-GPX4 axis to improve the prognosis of OS patients. Our findings offer new insights into the molecular mechanisms underlying OS chemoresistance and suggest potential therapeutic targets for future clinical interventions.

Transiliac-transsacral screw fixation is challenging in clinical practice as the screws need to break through six layers of cortical bone. Transiliac-transsacral screws provide a longer lever arm to withstand the perpendicular vertical shear forces. However, the screw channel is so long that a minor discrepancy can lead to iatrogenic neurovascular injuries. The development of medical robots has improved the precision of surgery. The present protocol describes how to use a new teleoperated robotic system to execute transiliac-transacral screw fixation. The Robot was operated remotely to position the entry point and adjust the orientation of the sleeve. The screw positions were evaluated using postoperative computed tomography (CT). All the screws were safely implanted, as confirmed using intraoperative fluoroscopy. Postoperative CT confirmed that all the screws were in the cancellous bone. This system combines the doctor's initiative with the Robot's stability. The remote control of this procedure is possible. Robot-assisted surgery has a higher position-retention capacity compared with conventional methods. In contrast to active robotic systems, surgeons have full control over the operation. The robot system is fully compatible with operating room systems and does not require additional equipment.

目的 探讨改良后路张力带钢板治疗因骶骨骨折导致的骨盆后环不稳定病人的临床疗效.方法 回顾性分析2015年6月至2018年6月我院采用改良后路张力带钢板治疗的7例因骶骨骨折导致骨盆后环不稳定病人的临床资料,其中男4例,女3例,年龄为23～63岁,Tile分型B11例,B21例,B31例,C13例,C21例.骶骨骨折Denis分区1区4例,2区3例.高处坠落伤3例,车祸伤4例.记录病人软组织激惹等并发症发生情况,采用Majeed评分标准评估骨盆功能.结果 病人手术时间平均为32 min,失血量平均为58 mL.所有病人均获得骨性愈合,愈合时间平均为19周.7例病人平均随访了16个月.根据Majeed评分,优6例,良1例,优良率100％.未出现软组织激惹、神经血管损伤、体表能触及钢板等并发症.结论 改良的后路张力带钢板能有效治疗因骶骨骨折导致的骨盆后环不稳定,安全有效,且软组织激惹较少.

目的 探讨双钢板联合自体骨移植治疗肱骨干无菌性骨折不愈合的疗效.方法 回顾性分析2017年4月至2021年6月期间于华中科技大学同济医学院附属同济医院行双钢板内固定联合自体骨移植治疗的10例肱骨干骨折不愈合病例.其中,男7例,女3例;年龄20～68岁,平均年龄45.1岁.初次内固定方式:7例3.5 mm LCP,2例3.5 mm双钢板,1例髓内钉.其中4例初次手术的内固定失效;骨折不愈合分型:有活性骨折不愈合4例,无活性骨折不愈合6例.二次术后行X线或CT检查评估骨折愈合情况.主要观察指标为术前、术后3个月和末次随访时间的MEPI肘关节和Constant-Murley评分.结果 平均随访时间为14个月(10～24个月).所有骨折不愈合均愈合,平均愈合时间4.7个月(3.5～7个月),未出现并发症.术后3个月时MEPI评分(82.50±10.61)分,Constant-Murley评分(79.60±6.11)分;末次随访,MEPI评分(88.50±5.30)分,Constant-Murley评分(86.90±4.12)分,较术前明显改善.结论 双钢板内固定联合自体骨移植治疗肱骨干骨折不愈合疗效满意.使用双钢板可以提高固定的稳定性,有利于早期功能锻炼,促进骨折愈合.

BACKGROUND:N6-methyladenosine (m6A) is the most common and abundant mRNA modification and it plays crucial roles in many biological processes. However, as a key RNA demethylase, alkylation repair homolog protein 5 (ALKBH5) has not been well studied in human osteosarcoma. The present study sought to explore ALKBH5-mediated m6A modification and the underlying mechanisms in human osteosarcoma.METHODS:The expression of ALKBH5 and its correlation with clinicopathological features were examined by bioinformatics analysis and tissue microarrays. Cellular proliferation was detected by CCK8 assays. Cell cycle and apoptosis were analyzed by TUNEL and Flow cytometry assay. Finally, investigation of the regulatory mechanism of ALKBH5 in human osteosarcoma was performed by MeRIP assay, RNA-sequencing, dual luciferase reporter assay, RNA pull-down and RNA stability assay. Tumor xenograft models were established for in vivo experiments.FINDINGS:Our data showed that low expression of ALKBH5 was associated with worse overall survival for osteosarcoma patients. Reducing m6A mRNA levels in human osteosarcoma cells through ALKBH5 up-regulation lead to cell proliferation inhibition, cell apoptosis and cycle arrest. We identified SOCS3, a negative regulator of STAT3, as a downstream target of ALKBH5-mediated m6A modification. And the m6A modified SOCS3 mRNA was recognized by YTHDF2, which promotes the decay of SOCS3. Mechanistically, our data revealed that ALKBH5 inactivated STAT3 pathway by increasing SOCS3 expression via an m6A-YTHDF2-dependent manner.INTERPRETATION:M6A methylation is rising as a pathway affecting tumorigenicity and tumor progression. Our findings illuminate the clinical significance of ALKBH5-mediated m6A modification in human osteosarcoma and the regulatory mechanisms underlying tumor proliferation and growth, suggesting that ALKBH5 is a potential biomarker for treatment in human osteosarcoma.FUNDING:This work was supported by and Science and Technology foundation of Hubei, China (Grant No.2017CFB762); the Tongji hospital foundation (Grant No.2201103013); and the National Natural Science Foudation of China (No.82002849).

Abstract Background The use of interlocked intramedullary nail has become the preferred method of treatment for intertrochanteric fracture of the femur. This study explored a new guide awl with a distal positioner assisting the guide wire insertion and opening canal, and verification the accuracy and security of our new guide awl.Methods 42 patients with intertrochanteric fracture treated by locking intramedullary nailing were retrospectively analyzed. Three patients with insufficient follow-up were excluded from analysis. 19 patients underwent the operation using the new guide awl, the other 20 patients in the control group were operated with the help of the conventional guide apparatus. Describe the new guide awl with a distal positioner usage in the operations. Operation time, the success rate of one-time insertion, fluoroscopy time, blood loss and bone healing time were recorded.Results 42 patients (25 males and 17 females) were treated with Gamma 3 and PFNA with the help of the new guide awl with a distal positioner or the conventional conventional guide apparatus. The surgical time in new guide awl group was significantly shorter compared to the control group. The success rate of one-time needle insertion in the new guide apparatus group was 89.5%, which was higher than the 65% of the control group. The fluoroscopy time in new guide apparatus group is obviously lower than in the control group. There was no significant difference in intraoperative blood loss and bone healing time.Conclusion The new guide awl with a distal positioner we designed could reduce the difficulty in opening the femur for inserting the interlocked intramedullary nail. It is especially suitable for obese patients.

目的 比较前环皮下内固定支架(INFIX)和微创经皮钢板内固定(MIPPO)治疗骨盆前环骨折的疗效.方法 回顾性分析2016年7月至2020年5月我院收治且符合标准的48例不稳定型骨盆骨折病人的临床资料,其中INFIX组22例,MIPPO组26例.INFIX组,男15例,女7例,年龄为(36.89±11.12)岁(21～58岁).MIPPO组,男17例,女9例,年龄为(43.70±17.66)岁(21～71岁).比较两组手术时间、术中出血量、骨折复位质量(Matta标准)、骨折愈合时间、骨折术后功能恢复情况(Majeed评分系统),并记录并发症.结果 两组均获得随访,随访时间为5～17个月,平均为13个月.INFIX组手术时间[(75.41±15.25)min]低于MIPPO组[(85.62±17.92)min],差异无统计学意义(t=-5.154,P=0.101);INFIX组术中出血量[(30.27±7.67)mL]明显低于MIPPO组[(111.15±24.30)mL],差异有统计学意义(t=-14.971,P=0.006);两组负重时间[(16.00±2.06)周vs.(15.94±2.32)周]、Majeed评分[(81.90±7.73)分vs.(83.44±3.54)分]、骨折复位优良率[81.8％vs.84.6％]比较,差异均无统计学意义(P均>0.05),但MIPPO组能够达到更好的解剖复位.INFIX组1例病人出现股外侧皮神经损伤,两组病人未出现内固定失败情况.结论 治疗骨盆前环骨折,INFIX具有出血少、手术创伤小等优点,钢板能够达到更好的解剖复位,两组具有相似的术后功能恢复情况.可根据术者经验和病人具体情况选择适宜的固定方式.

骨折复位内固定术是骨科的常规手术,内固定作为该手术的关键步骤之一,目的是维持骨折断端的复位.现阶段临床上使用的接骨板和螺钉系统大多数采用金属材料通过传统工艺制备而成,因其缺乏个性化外形且不具备降解性能,常常难以匹配特殊形态的骨折部位且需要二次手术取出.可降解材料结合增材制造技术有望解决以上问题,其可赋予接骨板个性化外形和降解性能,达到更好的治疗效果.但目前可降解个性化接骨板的制备和临床试验流程在国内外均缺乏统一认识和标准.因此,本共识专家组经过多轮讨论,以有机/无机复合材料接骨板为例,从可降解个性化接骨板的"增材制造流程"和"临床试验流程"两方面出发形成本共识,为国内外各中心可降解个性化接骨板的制备和临床试验提供参考.

Objective:To evaluate the significance of S1 posterior edge inlet view for placement of percutaneous sacroiliac screws.Methods:1. CT data of the pelvis were collected from 134 normal adults and introduced into Mimics Medical 21.0 system. Anatomical parameters of sacral vertebrae were measured and analyzed to observe the anatomical disparities between the anterior and posterior edges of S1 vertebral body. A mathematical model was established using the data acquired. 2. Manual placement of sacroiliac screws was performed using a conventional S1 posterior edge inlet view on the pelvic specimens from 5 adult cadavers in simulation of actual surgical situations. After placement, the inlet views from both the S1 anterior and posterior edges were taken to observe the imaging differences and to check if the screws had pierced the sacral canal. 3. A retrospective study was conducted of the 11 patients with posterior pelvic ring fracture who had been treated at Department of Orthopaedics, Tongji Hospital from January 2019 to October 2020. Their fractures were fixated by percutaneous sacroiliac screws under the guidance of a C-arm X-ray machine. The manual placement of the screws was guided intraoperatively by the inlet views from both the S1 anterior and posterior edges to secure a safe placement. Pelvic CT examinations were performed to check any screw dislocation.Results:1. CT measurements in the normal adults showed that the angle of S1 anterior edge inlet view (20.71°±11.89°) was smaller than that of S1 posterior edge inlet view (41.99°±11.67°) and the width of S1 upper end plate [(32.22±3.41) mm] greater than that of S1 lower end plate [(20.10±3.28) mm], showing significant disparities in anatomy between the anterior and posterior edges of S1 vertebral body ( P<0.05). 2. In 2 of the 5 cadaveric specimens, imaging differences were observed between the inlet views of the anterior and posterior edges of S1 and the screws pierced out of the sacral canal. 3. Satisfactory closed reduction was achieved in all the 11 patients. A total of 17 screws were placed, with 12 ones into S1 and 5 ones into S2. Operation time ranged from 84 to 141 min (average, 114.4 min), fluoroscopy frequency from 69 to 101 times (average, 89.6 times), and intraoperative blood loss from 110 to 463 mL(average, 296.6 mL). No screw dislocation was observed on postoperative CT. Conclusion:As there is a difference between the inlet views of the anterior and posterior edges of S1 vertebral body, the inlet view of the posterior edge of S1 can display the posterior edge of S1 more clearly so as to improve the safety of placement of percutaneous sacroiliac screws.

BACKGROUND:The transiliac-transsacral screw placement is a clinical challenge for surgeons. This study explored a point-to-point coaxial guide apparatus assisting the transiliac-transsacral screw insertion and aimed to investigate the feasibility and accuracy of the guide apparatus in the treatment of posterior ring unstable pelvic fracture compared with a free-hand technique.METHODS:A retrospective study was performed to evaluate patients treated with transiliac-transsacral screws assisted by the point-to-point coaxial guide apparatus or free-hand technique. The intraoperative data of operative time and radiation exposure times were recorded. Postoperative radiographs and CT scans were performed to scrutinize the accuracy of screws position. The quality of the postoperative fracture reduction was assessed according to Matta radiology criteria. The pelvic function was assessed according to the Majeed scoring criteria at 6 months postoperatively.RESULTS:From July 2017 to December 2019, a total of 38 patients were included in this study, 20 from the point-to-point guide apparatus group and 18 from the free-hand group. There were no significant differences between the two groups in gender, age, injury causes, pelvic fracture type, screws level, and follow-up time (P > 0.05). The average operative time of the guide apparatus group for each screw was significantly less than that in the free-hand group (25.8 ± 4.7 min vs 40.5 ± 5.1, P < 0.001). The radiation exposure times were significantly lower in the guide apparatus group than that in the free-hand group (24.4 ± 6.0 vs 51.6 ± 8.4, P < 0.001). The intraosseous and juxtacortical rate of screw placement (100%) higher than in the free-hand group (94.4%).CONCLUSION:The point-to-point coaxial guide apparatus is feasible for assisting the transiliac-transsacral screw in the treatment of posterior unstable pelvic fractures. It has the advantages of simple operation, reasonable design and no need for expensive equipment, and provides an additional surgical strategy for the insertion of the transiliac-transsacral screw.

随着人口老龄化的进展,老年人因行动不便容易跌倒,且常伴有骨量丢失[1] ,低暴力引起的老年骨盆脆性骨折发病率逐年上升[2]. 对于老年骨盆脆性骨折,保守治疗往往需要长期卧床,这就不可避免地增加了发生下肢深静脉血栓、坠积性肺炎、压疮等一系列严重并发症的风险[2-5]. 传统骨盆切开复位内固定手术治疗骨盆脆性骨折,需要对骨盆深层结构广泛暴露,对软组织损伤大、出血多、易损伤血管神经、手术时间长,体质较差或患有基础疾病的老年患者大多不能耐受此种手术方式[5]. 微创内固定治疗老年骨盆脆性骨折具有创伤小、手术时间短、术中出血少等优点. 笔者回顾了华中科技大学同济医学院附属同济医院骨科收治的采用微创内固定治疗的16例患者的临床资料,现将结果报告如下.

2020年初,新型冠状病毒感染的肺炎(简称新冠肺炎)在湖北省武汉市集中爆发,严重危害人民群众健康.截至2020年2月21日零时,全国共计确诊新冠肺炎病例75 000余例,死亡2 100人.国家已将该呼吸道疾病列为《中华人民共和国传染病防治法》规定的乙类传染病,并按甲类传染病管理.由于人群对该疾病普遍易感,且感染后存在长短不一的潜伏期,这些给骨科的诊疗带来了很大的挑战.不规范的诊疗流程对医务人员的健康构成了较大威胁,且增加了病人间的交叉感染.在此疫情之下,一线骨科医师应当充分掌握新冠肺炎的流行病学特点、临床表现、骨科接诊疾病的特征,对于就诊人员应当在积极排查的基础上科学有序地开展诊疗.

目的 探讨采用俯卧位踝关节镜下前后外联合入路治疗后足大范围病变的临床疗效.方法 回顾性分析2019年3月至2020年7月于我院骨科就诊的13例后足大范围病变病人(13足)的临床资料,按病种划分:踝关节滑膜炎合并距下关节炎5例,踝关节滑膜炎3例,距下关节炎合并跗骨窦综合征3例,踝关节感染2例.所有患足的病变范围均涉及后足的前方及后方,单纯前路或后路关节镜无法完全处理.所有病人术中采取俯卧位,先屈膝状态完成前路镜,如有必要,屈膝"4"字体位行跗骨窦清理,最后伸膝状态完成后路关节镜操作,必要时可行后路距下关节融合.观察并记录病人的手术时间、术中灌注水量、术后住院天数、术后并发症、手术前后的疼痛视觉模拟量表(visual analogue scale,VAS)评分.结果 病人手术时间为(46.8±12.6)min,灌注水量为(6807.7±3827.2)ml,术后住院天数为(3.8±0.8)d.所有切口均一期愈合,1例发生跗骨窦血肿,加压包扎后按时愈合拆线,并发症发生率为7.7％(1/13).VAS评分由术前(8.2±1.0)分降至术后(2.8±0.9)分,差异具有统计学意义(P<0.05).随访期间未见感染、骨不连、畸形愈合等并发症.结论 俯卧位关节镜可同时处理后足多个部位的病变,包括踝关节、距下关节及跗骨窦,微创化个性化治疗的同时,减少手术时间,缩短病人住院天数,节省病人治疗费用,是后足大范围病变可选择的治疗方式之一.

2020年初,新型冠状病毒肺炎(以下简称新冠肺炎)在湖北省武汉市暴发,截至2020年3月4日24时,全国累计报告确诊病例80409例,累计死亡病例3 012例.该疾病已被列为《中华人民共和国传染病防治法》规定的乙类传染病,并按甲类传染病管理.随着国家“科学防治、精准施策”政策的落实,疫情势头得到明显遏制,包括疫区在内的各地医疗单位逐步开放门诊和住院部.但由于人群对该疾病普遍易感,且感染后存在长短不一的潜伏期,这些都给骨科的诊疗带来了很大的挑战,不规范的诊疗流程对医务人员和患者的健康构成了较大威胁.

目的 观察低频振动对小鼠骨髓间充质干细胞(bone marrow mesenchymal stem cells,BMSCs)成骨分化的影响.方法 取3周龄C57BL/6小鼠,分离及培养其BMSCs.将细胞分为两组,对照组及低频振动组,两组均诱导BMSCs进行成骨分化,低频振动组在诱导过程中实施低频振动干预(15 Hz,垂直加速度0.3 g),对照组不进行干预,分别于第7天、第14天收获细胞,将第7天的细胞进行碱性磷酸酶(alkaline phosphatase,ALP)染色,将第14天的细胞进行茜素红染色;并利用Real-time PCR检测相关基因表达.结果 低频振动组细胞第7天的ALP活性明显高于对照组,且在14 d形成的钙结节多于对照组;所检测基因中,低频振动组细胞Ⅰ型胶原蛋白、骨桥蛋白、骨钙素、骨保护素基因的表达均高于对照组,而破骨细胞分化因子(receptor activator of NF-κB ligand,RANKL)较对照组低.结论 低频振动可以促进BMSCs的成骨分化,并调节成骨细胞分泌的细胞因子,影响破骨细胞的生成.

Skeletal muscle is among the three major muscle types, and skeletal muscle injury (SMI) can elevate the risk of dependency and falls. This study is designed to explore the key genes involved in SMI and skeletal muscle regeneration. Microarray data set GSE81096, which included 11 injured skeletal muscle stem cell samples and 12 noninjured skeletal muscle stem cell samples, was from Gene Expression Omnibus. The differentially expressed genes (DEGs) between injured and noninjured samples were screened by R package limma, and then were performed with enrichment analysis based on the Database for Annotation, Visualization, and Integrated Discovery. Followed by protein-protein interaction (PPI), transcriptional regulatory analyses were conducted using Cytoscape software. A total of 1018 DEGs were screened from the injured samples, among which four upregulated genes and nine downregulated genes were predicted as transcription factors. Besides, four modules were identified from the PPI network. In the transcriptional regulatory network, E2F1, E2F4, JUNB, FOS, and MEF2C had higher degrees. Moreover, E2F4 and FOS might function in SMI separately through targeting E2F1 and JUNB. E2F1, E2F4, JUNB, FOS, and MEF2C might be involved in SMI and skeletal muscle regeneration.

目的 研究股骨颈骨折(TF)患者氧化应激对其骨折愈合进度和凝血功能的影响.方法 选取2014年1月～2018年3月于湖北江汉油田总医院(以下简称“我院”)接受手术治疗的TF患者118例作为观察组.另选同期在我院接受健康体检的志愿者120名作为对照组.观察组术后随访4个月.检测并比较两组氧化应激指标、凝血功能及不同骨折愈合进度患者的氧化应激指标及凝血功能,分析指标间的相关性.结果 观察组的总抗氧化能力(TAC)、过氧化氢酶(CAT)和超氧化物歧化酶(SOD)水平均明显低于对照组,而其丙二醛(MDA)水平明显高于对照组(P＜0.05).两组凝血酶原时间、活化部分凝血活酶时间和凝血酶时间水平比较,差异无统计学意义(P＞0.05).观察组纤维蛋白原(FIB)水平明显高于对照组(P＜0.05).3个月愈合组的TAC、CAT和SOD水平均明显高于4个月愈合组及延迟愈合组,MDA和FIB水平均明显低于4个月愈合组及延迟愈合组(P＜0.05).4个月愈合组的TAC、CAT和SOD水平均明显高于延迟愈合组,MDA和FIB水平均明显低于延迟愈合组(P＜0.05).TF患者的TAC、CAT和SOD水平均分别与骨折愈合进度及FIB呈负相关,MDA均分别与骨折愈合进度及FIB呈正相关(P＜0.05).结论 TF患者氧化应激对其骨折愈合进度及凝血功能均会造成一定的影响,临床上可综合监测患者的氧化应激指标,从而可辅助判断其康复预后情况,值得关注.

The study aims to uncover mechanisms on repair process of two different types of skeletal muscle injuries, freezing injury (FI) and contraction-induced injury (CI). GSE5413 was utilized, including 11 eccentric CI, 11 FI, and 3 control samples at 4 time points (6 hours, 1 day, 3 days, and 7 days after injury). Differentially expressed genes (DEGs) separately were selected in FI and CI. Correlation analysis of samples at different time points was performed. Clustering analysis was conducted for DEGs in FI and CI, respectively. Moreover, enrichment analysis and protein/protein interaction network analysis were performed for the specific DEGs. There were 616 and 465 DEGs separately in FI and CI samples. For both FI and CI, samples between 6 hours and 1 day, and between 3 and 7 days, had a close distance. DEGs in FI and CI separately were enriched in leukocyte transendothelial migration (e.g., ICAM1 [intercellular adhesion molecule 1], ITGAM, MMP9) and protein processing in endoplasmic reticulum pathway (e.g., HSPH1, HSP90AA1). In addition, MMP9 (matrix metallopeptidase 9) and ITGAM, and MYC, HSPA1B, and HSPA1A were hub nodes in the networks in FI and CI, respectively. ICAM1, ITGAM, and MMP9 in FI, and MYC and HSP70 family members in CI were biomarkers for injury prevention.

目的 探讨新设计的具有远端导针定位器的导向开口器在髓内钉治疗股骨转子间骨折的疗效,并对导向开口器及远端定位器的准确性及安全性进行验证.方法 回顾性分析36例股骨转子间骨折的患者,根据当时术中使用开口器的类型分为对照组与实验组,其中实验组的18例患者采用新的具有远端导针定位器的导向开口器进行髓内钉治疗,对照组的18例患者采用常规开口器进行操作.详细介绍具有远端定位器的导向开口器的应用.统计并比较两组患者的手术操作时间、手术出血量、一次性穿针成功率和术中透视次数.结果 实验组患者手术时间(52.9±9.3) min小于对照组(68.4±15.1) min (P＜0.05);实验组一次性穿针成功率为100％,明显高于对照组66.7％;术中透视次数,实验组为(17.1±4.3)次,明显少于对照组(31.3±8.3)次(P＜0.05),术中出血量无明显差异,无统计学意义(P＞0.05).结论 新设计的具有远端导针定位器的导向开口器能够有效且快速进行股骨髓内钉的开口操作,精确插入导针及安全地进行扩髓操作,减少手术时间和透视次数.