BACKGROUND:Circular RNA (circRNA) has been shown to affect the pathological process of osteoarthritis (OA) and is expected to become a potential marker for disease diagnosis. This study aimed to investigate the association between circRNA derived from the gene of runt-related transcription factor 2 (RUNX2) and OA risk.METHODS:The expression profile of RUNX2-derived circRNAs in serum of OA patients was detected. Then, the cytological localization of screened differential circRNAs was studied. Luciferase (LUC) reporter assay was used to identify the microRNA (miRNA) sponge capacity of the circRNAs. Bioinformatics analysis was used to construct the functional pathway of this circRNA-miRNAs network. And then, the diagnostic value of RUNX2-derived circRNAs in OA was evaluated.RESULTS:RUNX2-derived hsa_circ_0005526 (circ_RUNX2) is significantly highly expressed in OA serum and mainly located in the cytoplasm within the cartilage cell by sponging multiple miRNAs (miR-498, miR-924, miR-361-3p, and miR-665). Bioinformatics analysis showed ECM-receptor interaction pathway ranked the most significant pathway of circ_RUNX2-miRNAs regulatory network in KEGG database. The ROC curve showed that there may be good diagnostic value of serum circ_RUNX2 in OA.CONCLUSION:RUNX2-derived circ_RUNX2 may be involved in OA development via ECM-receptor interaction pathways and may be used as potential clinical indicator of OA.

目的:观察A型肉毒毒素联合物理治疗对难治性先天性肌性斜颈(CMT)的近期疗效及其安全性.方法:选取2018年9月至2019年8月厦门大学附属第一医院收治的23例难治性CMT患儿,随机分为对照组(n=12)和联合治疗组(n=11).对照组应用单纯物理治疗,联合治疗组应用局部注射A型肉毒毒素联合物理治疗,记录治疗前后头颈倾斜度和颈部旋转范围等相关参数.结果:治疗后,联合治疗组患儿头部倾斜度显著小于对照组,颈部旋转范围明显大于对照组,差异具有统计学意义(P＜ 0.05).联合治疗组头部倾斜的改善程度和颈部旋转改善程度均显著高于对照组,差异具有统计学意义(P＜0.05).两组患儿不良反应发生率比较,差异无统计学意义(P＞0.05).结论:A型肉毒毒素联合物理治疗对难治性CMT有效,并发症较少,安全性较好.

Purpose The ideal web reconstruction for syndactyly requires both satisfactory function and aesthetic appearance. In this study, we report a dorsal hexagon local flap with adequate size and that leaves most of the scars in the interdigital space. Methods Between June 2015 and June 2017, 16 patients (10 males and 6 females) with 22 syndactylies underwent surgical reconstruction using the dorsal hexagon local flap technique. All patients had simple syndactyly. The postoperative evaluation included the quality of scarring, the extent of flexion and extension deformity, web creep, lateral flexion deformity, and rotational deformity of the digit. Results All flaps survived and there were no postoperative complications. All patients achieved satisfactory interdigital commissure depth. During 12 to 34 months of follow-up, no case of flexion contracture or web creep after reconstruction was noted. Conclusions The dorsal hexagon local flap is an alternative method for syndactyly reconstruction. Copyright (C) 2020 by the American Society for Surgery of the Hand. All rights reserved.

目的 观察针对儿童股骨干骨折应用弹性髓内钉治疗的临床效果.方法 选取2017年7月至2018年1月收治的的32例进行弹性髓内钉内固定的患者,收集患者的相关资料进行回顾性分析.结果 在患者出院后,进行时间为5～14个月的随访调查,平均时间为10个月;术后8～20周骨折均愈合,平均时长为15周;下肢髋、膝关节的活动能力均恢复正常,均无跛行现象;术后有6例患者出现下肢不等长症状,双下肢长度相差1～3cm(平均1. 3cm);有6例患者出现皮肤激惹状况,在内固定取出后症状均消失;均未出现髓内钉断裂或弯曲的情况;无再骨折或骨髓炎症状发生.结论 弹性髓内钉对于儿童股骨干骨折的治疗具有显著的临床效果,具有手术时间较短、手术创面小、恢复速度较快等方面的优势.

目的:儿童急性起病的单关节炎症,多数为细菌感染导致的化脓性关节炎.但部分风湿性关节炎急性起病的临床表现与化脓性关节炎难以鉴别.通过分析血清学炎性标志物的差异,以帮助在急诊中增强对两类疾病的诊断与认识.方法:选取2014年3月-2018年3月笔者所在医院骨科急诊首诊以急性化脓性关节炎收治的患儿42例,其中确诊为风湿性关节炎10例,化脓性关节炎32例.按最终诊断将患儿分为化脓组与风湿组.对比两组患儿基本资料及血清学炎性标志物检查结果.结果:两组患儿性别比例、入院体温、WBC、CRP及ESR比较差异无统计学意义(P>0.05).化脓组患儿年龄及ASO低于风湿组,化脓组的PCT及IL-6高于风湿组,差异均有统计学意义(P<0.05).结论:结合血清学炎性标志物检查,可提高早期对急性化脓性关节炎与风湿性关节炎的鉴别诊断.

目的:对比分析小儿股骨干骨折采取闭合复位弹性髓内钉固定术和切开复位接骨板内固定术治疗的临床效果.方法:选取2015年6月-2017年6月于笔者所在医院择期行手术治疗的股骨干骨折患儿134例,运用随机数字表法分为观察组和对照组,每组67例.其中观察组行闭合复位弹性髓内钉固定术,对照组行切开复位接骨板内固定术.比较两组手术时间、术中出血量、住院时间、骨折愈合时间、下地负重时间及术后并发症发生情况.结果:观察组手术时间[(68.92±7.19)min]、术中出血量[(61.28±6.27)ml]、住院时间[(6.77±0.44)d]、骨折愈合时间[(62.73±6.35)d]和下地负重时间[(82.17±8.26)d]均显著少于对照组,差异有统计学意义(P<0.01).观察组术后并发症总发生率为2.99％(2/67),显著低于对照组[23.88％(16/67)],差异有统计学意义(P<0.01).结论:与切开复位接骨板内固定术相比,小儿股骨干骨折应用闭合复位弹性髓内钉固定术治疗患儿创伤小,术后恢复快,安全性高.

BACKGROUND:Tricho-rhino-phalangeal syndrome (TRPS) is a rare autosomal dominant genetic disorder characterized by distinctive craniofacial and skeletal abnormalities, while non-ossifying fibroma (NOF) is a common benign bone tumour in children and adolescents. To date, no case of TRPS coexisting with NOF has been reported. This report presents a 12-year-old girl who had the characteristic features of tricho-rhino-phalangeal syndrome and non-ossifying fibroma with a fibula fracture. CASE PRESENTATION:A 12-year-old girl was admitted to the Department of Endocrinology and Diabetes for evaluation of brachydactyly and a right fibula fracture. Clinical examination revealed sparse scalp hair, a characteristic bulbous pear-shaped nose, and brachydactyly with significant shortening of the fourth metatarsal. Neither intellectual disability nor multiple exostoses were observed. Radiography of both hands showed brachydactyly and cone-shaped epiphyses of the middle phalanges of the digits of both hands with deviation of the phalangeal axis. Genetic analysis of TRPS1 identified a heterozygous germline sequence variant (p.Ala932Thr) in exon 6 in the girl and her father. Approximately 1 month before being admitted to our department, the girl experienced a minor fall and suffered a fracture of the proximal fibula in the right lower limb. The pathological cytological diagnosis of the osteolytic lesion was NOF. Ten months following the surgery, the lesion on the proximal fibula of the girl disappeared. CONCLUSIONS:In conclusion, the present study is the first to report a rare case of NOF with a pathologic fracture in the fibula of a girl with TRPS. The identification of a missense mutation, (p.Ala932Thr), in exon 6 of TRPS1 in this kindred further suggested that the patient had type I TRPS and indicated that mutations in this exon may be correlated with more pronounced features of the syndrome. Radiological techniques and genetic analysis played key roles in the definitive diagnosis.

目的:研究闭合复位弹性髓内钉治疗在小儿股骨骨折中的临床有效性.方法:选取笔者所在医院收治的90例股骨骨折患儿,以随机法将其分为两组,对照组采用接骨板内固定术治疗,观察组采用闭合复位弹性髓内钉治疗.对两组患儿临床治疗效果进行对比.结果:两组患儿临床治疗有效率比较差异无统计学意义(P>0.05);但观察组患儿手术时长、手术出血量、手术创口长度及手术后愈合时间均优于对照组,差异均有统计学意义(P<0.05).结论:通过闭合复位弹性髓内钉治疗股骨骨折患儿,不仅能够确保临床疗效,同时亦能够减少手术创伤,提升患儿骨折愈合速度.

目的:探讨膝关节单髁置换术(Unicondylar knee arthroplasty,UKA)治疗膝关节病的早期临床疗效及技术特点.方法:对15例1 7个膝关节行UKA,其中:男6例(7膝)、女9例(11膝);年龄42～90岁,平均65岁;术前诊断:骨性关节炎9例(11膝)、股骨内侧髁坏死3例(3膝)、创伤性关节炎3例(3膝).结果:15例患者均获得随访,时间3～26个月,平均15.3个月.患者术后在疼痛、功能、活动度方面改善明显,膝关节本体感觉良好,HSS评分由术前(38.5±3.5)分提高到术后(89.4±4.1)分,差异有统计学意义(P＜0.05),手术优良率90.5％.术后定期摄膝关节正侧X线片均显示膝关节假体位置、力线良好,股骨、胫骨假体周围无X线透亮线,假体无任何松动迹象,髌骨轨迹良好.结论:UKA对于治疗局限单间室的膝关节病,早期临床疗效满意,它具有切除骨质少,植入异物少,手术时间短便于翻修等特点.

BACKGROUND:Pelvic osteotomy in the treatment of children with developmental dysplasia of the hip(DDH) has been widely used,but for younger children there are some limitations in the traditional treatment methods,which requires the implantation of autologous iliac in the osteotomy gap.OBJECTIVE:To discuss the efficacy of allogenic bone transplantation in the treatment of pediatric DDH.METHODS:A retrospective study was carried out in 36 DDH patients aged 1.5-3.0 years undergoing allogenic bone transplantation.The treatment of hip dislocation was evaluated by imaging.RESULTS AND CONCLUSION:The follow-up of 1.0-2.5 years after treatment showed that there was no incision drainage;none of patients had slight pain in the hip,no rejection,no allograft bone displacement and absorption.Imaging evaluation for the efficacy of hip dislocation showed that 38 hips were excellent and good(90%),three hips were fair(7%) and one hip was poor(3%) after treatment.The follow-up result of allogenic bone transplantation for pediatric DDH was satisfied.

Objective To discuss the application value of arthroscopy for the treatment of transient synovitis of hip joint in children.Methods From June 2009 to June 2012,11 patients(13 hips) were treated by hip arthroscopy in the First Affliated Hospital of Xiamen University.Pathological manifestations of hip joint were observed under arthroscope,the thickened synovium was cleaned and the articular cavity was washed,the improvement of symptom and the complications were evaluated after the surgery.Results Under the scope,there were extensive proliferation of synovium which showed dark red in 11 patients(13 hips),round ligament enclosed by proliferative synovial membranes in 5 patients(5 hips),with fibrous cord-like tissue in bilateral acetabulum.Postoperative pathological examination showed hyperemia and edema in synovial membranes,without obvious inflammatory cells infiltration.All patients were followed up from 5-10 months,with the average of 7.5 months.Range of motion of hip joint was recovered at 3 weeks after surgery,symptom of pain disappeared after 6 weeks,symptoms of limp and disability of bearing weight also disappeared after 3 months.There were no complications of vascular,nerve injuries or skin necrosis,and no recurrent cases had happened during the follow-up.Conclusions For the treatment of hip transient synovitis in children,hip arthroscopy is a comparable choice with the advantages of accurate diagnosis and good efficacy,due to arthroscopic observation of pathological manifestation,and thorough cleaning of hip joint lesion and proliferative synovium.

Objective To investagate the effect of surgery on less common pediatric Gartland I Ⅳ-type supracondylar humerus fractures.Methods 8 cases of children with severe humerus supracondylar fractures(Gartland Ⅳ type),admitted from March 2008 to August 2010 in Department in Pediatric Orthopaedics of the First Hospital of Xiamen,were investigated and evaluate the efficacy of surgical treatment.Results 8 patients with Gartland Ⅳ supracondylar humerus fractures underwent both open reduction and Kirschner wire fixation,and received functional exercise of the elbow in the early stages.The effect of surgery was good for all patients,as showed no case of nonunion,cubitus varus and nerve damage in one to three years follow-up time.Conclusion Open reduction is still the main means for children with Gartland Ⅳ supracondylar humerus fractures.In addition,early functional exercise is to improve the efficacy of the types of fractures and prevent cubitus varus deformity.

Objective To observe the clinical effect and safety of nano2 hydroxyapatitepolyam ide 66(n2HAPA66)composite in the ilium due to Developmental Dysplasia of Hip(DDH).Methods From January 2007 to May 2009,10 patients(2 males,10 females;age,1.5～3.5 years,averaged 2.5 years) with Developmental Dysplasia of Hip(DDH).were treated with the n2HAPA66 pieces.1 of the patients had bilateral DDH.The osteotomy sites were filled up w ith the n2HAPA66 grains.The incision healing,local inflammatory reaction,rejection,toxic reaction,osteotomy site healing,and function recovery of the limbs were all observed after operation.Results All the patients were followed up for 5～28 months,and all the incisions healed by the first intention.There were no inflammatory reactions,and no rejection or general toxic reaction.At 1.5～2 months(mean 1.75 months)after operation,osteogenesis was found in the space filled with the n2HAPA66 grains.3 months after operation,the patients′ lower limbs could bear weight.Conclusion The n2HAPA66 grains have great biological safety,good biocompatibility,and good bone conduction,which are good materials for the bone repair and reconstruction,and can be safely,and effectively used during in the ilium due to Developmental Dysplasia of Hip(DDH).

<正>先天性肌性斜颈是小儿骨科常见病,早期治疗效果好,面部畸型可以完全纠正。我院自1998年至今,收治68例,均经手术治疗,疗效满意。现报道如下:1资料与方法1.1一般资料本组68例患孩,男38例,女30例;年龄1~8岁,1~2.5岁43例,2.5~8岁25例;左侧44例,右侧24例;臀位产史23例,剖腹产史16例。常规拍颈椎X片,排除骨性畸形。

我科自1995年至今,收治小儿肱骨髁上骨折近80例,其中住院手术66例.我科分别采用闭合复位+克氏针内固定、上支悬吊牵引、开放复位+克氏针内固定等不同方法治疗.现总结如下:

随着骨质疏松的高龄患者逐渐增加,特别是髋部,轻微的外伤就可造成髋部粉碎性骨折.我科自2001～2003年采用人工股骨头置换术治疗高龄老年股骨粗隆间不稳定型粉碎性骨折10例,取得满意的效果,报告如下.

股骨粗隆间骨折是比较常见的下肢骨折,目前提倡闭合或切开复位髁钢板、DHS或PFN等内固定治疗,治疗效果令人满意.有关骨折愈合取出内固定物后股骨颈螺钉孔的愈合情况及是否并发股骨颈骨折的报告甚少.我院自1996～2001年收治股骨粗隆间骨折169例,年龄22～97岁.无论骨折类型(Ⅰ-Ⅳ型)都行DHS内固定[1].已取出DHS111例,其中2例取DHS后因轻微外伤导致股骨颈头下型骨折[1].现介绍如下.

目的报道腰椎间盘突出症伴腰椎不稳疾病中应用椎间后路融合器植入融合椎体的临床结果,并对该手术的优点、并发症防治进行讨论.方法回顾分析26例应用椎间融合器植入融合椎体的临床资料.结果术后经24～36月随访,疗效优良率为89.5%,椎间融合率为89.5%,融合器术后脱落1例.结论腰椎间盘突出症伴腰椎不稳以椎间融合器后路植入,椎体融合率高,可防止术后腰椎不稳,从而保证临床效果.但要严格掌握手术适应症,对其并发症要有足够认识,并提出预防方法.

我院自1995年至今,用CT平扫诊断及指导波及距下关节面的跟骨骨折的治疗取得一些体会,介绍如下.