Purpose To evaluate whether the 24-weeks postoperative fracture union rate for the investigational TFNA intramedullary nail was non-inferior compared to the control product PFNA-II. Methods The study was a prospective, randomized, single-blind, noninferiority dual-arm study drawing from 9 trauma centers across China, between November 2018 and September 2020, with follow-up measurements at 24 weeks after internal fixation. The full analysis data set (FAS [Intent-to-Treat]) was analyzed and is summarized here. The primary outcome was fracture union rate, a composite score combining clinical and radiographic assessment. Secondary endpoints comprised (a) clinical outcomes including (1) SF-12, (2) Harris Hip, and (3) EQ-5D Scores, (b) radiographic incidence of complications such as loosening or cut-out requiring revision, (c) revision rates, (d) reoperation rates, and (e) adverse events, including 24-weeks revision and reoperation rates. Results Both TFNA and PFNA-II group fracture healing rates were 100% at 24 weeks; TFNA was therefore shown to be non-inferior to PFNA-II. With baseline data matched in all parameters except age in both the TFNA and PFNA-II groups, comparisons of union rates, SF-12, Harris Hip, and EQ-5D Scores yielded p values > 0.05 indicating no significant difference between the two groups, further supporting the noninferiority of TFNA. In both groups, revision and re-operation rates were 0, and the incidences of serious adverse events were 19.4% and 17.4%, respectively. Conclusion In terms of fracture union rate at 24 weeks, the DePuy Synthes Trochanteric Fixation Nail Advanced (TFNA) was not inferior to the marketed Proximal Femoral Nail Antirotation (PFNA-II) device produced by the same manufacturer. Secondary and safety outcomes showed no significant differences between the two groups. Registration Registration was completed at ClinicalTrials.gov NCT03635320.

目的 分析ICU感染性休克在救治过程中应用连续肾脏替代疗法血液净化的临床效果.方法 抽取2019年11月—2021年11月牡丹江医学院附属红旗医院ICU收治的感染性休克患者102例作为研究对象,并对其临床资料进行回顾性分析,以入院先后顺序将其平均分成两组,接受常规治疗的51例患者为对照组,在此基础上增加连续肾脏替代疗法血液净化治疗的51例患者为研究组,对比两组患者PCT水平、肿瘤坏死子因-ɑ(TNF-ɑ)水平、白细胞介素-6(IL-6)水平、急性生理和慢性健康状况评分系统(APACHE Ⅱ)评分、序贯器官

中药药浴是一种传统的中医外治疗法,药物由皮肤吸收直通经络进行治疗,不经胃肠道给药因而不会对其产生明显的刺激作用.目前治疗类风湿性关节炎常用的是西医的药物疗法,但西医药物治疗副作用明显.近年来,由于药浴疗法的独特优势,关于药浴治疗类风湿性关节炎的报道越来越多.本文结合20年来中药药浴治疗类风湿性关节炎的临床应用,对其特色优势、临床应用、使用方法、用药组成和现代作用机制等进行综述,以供中药及民族药药浴的临床合理应用以及药物综合开发提供参考和借鉴.

To evaluate surgical treatment of symptomatic non-union of lateral condylar elbow fractures in adults.

Objective To compare the effect of coronoid fixation combined with lateral collateral ligament repair versus hinged external fixator in treatment of elbow varus posteromedial rotational instability.Methods This retrospective cohort research included 34 patients with elbow varus posteromedial rotational instability operated between January 2011 and June 2015.All patients had coronoid process fractures of O'Driscoll type Ⅱ[(six with subtype 1,24 with subtype 2 and four with subtype 3).Fifteen of the 34 patients were operated by coronoid fixation combined with lateral collateral ligament repair (Group A) and other 19 patients were operated by coronoid fixation combined with placing hinged external fixator (Group B).Interval between injury and operation,operation time and blood loss were recorded.At final follow-up,elbow range of motion,Mayo elbow performance score (MEPS) and Hastings and Graham heterotopic ossification classification were measured.Results There were no significant differences in the interval between injury and operation,operation time and blood loss between the two groups (P ＞0.05).Median period of follow-up was 30 months in Group A and 40 months in Group B.Last follow-up showed flexion of the affected elbow in Group B [145° (135°-150°)] was better than that in Group A [140° (130°-145°)] (P ＜ 0.05),while between-group differences were insignificant in elbow extension,elbow extension-flexion,forearm pronation-supination and heterotopic ossification classification (P ＞ 0.05).MEPS in Group A scored 100 in 10 patients,90 in three,85 in one and 70 in one;MEPS in Group B scored 100 in 13 patients,90 in one,85 in four and 80 in one.There was no significant difference in MEPS between the two groups (P ＞ 0.05).Conclusion For treating elbow varus posteromedial rotational instability,either lateral collateral ligament repair or hinged external fixation after anatomic reduction and coronoid fixation can achieve good results.

OBJECTIVE:To evaluate the efficacy of total elbow arthroplasty in treatment of distal humeral fracture in the elderly.METHODS:A total of 24 elderly patients who were diagnosed of distal humeral fracture and received Coorad-Morry prosthesis arthroplasty were retrospectively selected and analyzed from Beijing Jishuitan Hospital from 2003 to 2009. X ray examination of elbow joint and clinical evaluation were conducted in the follow-up; Mayo Elbow Performance Score (MEPS) was used in the last follow-up to evaluate patients' elbow function.RESULTS:A total of 20 patients with intact follow-up information were included in the final analysis, with mean follow-up length 92 months (65 - 136), mean VAS score 0.8 (0 - 2), extension degree of elbow 25 (0 - 60)degrees, flexion degree 112 (80 - 135)degrees; Mean MEPS was 88.5, with 7 excellent, 8 good, and 1 fair. Two patients had severe heterotopic ossification, 3 patients had ulnar neuropathy, 2 of which were temporary. One patient had superficial infection, and 1 had aseptic loosening in the humeral part, but did not receive revision surgery.CONCLUSION:Total elbow arthroplasty can successfully treat distal humeral fracture in the elderly and achieve satisfactory result which can last for a long time.

Objective To retrospectively compare the clinical effect of anatomically designed perpendicular and parallel double plates in fixation of intercondylar humerus fractures.Methods A complete follow-up was made on 45 patients treated with anatonic locking plates for intercondylar humerus fractures.Among them,26 underwent perpendicular double plate fixation (perpendicular group) and 19 parallel double plate fixation (parallel group).Mayo elbow performance score (MEPS)was performed at the last follow-up.All postoperative complications were documented as well.Results All fractures were healed without joint pain in the elbow.Arc of elbow flexion and extension,arc of forearm rotation,MEPS and rate of excellent/good outcomes between parallel and perpendicular groups were (100 ± 21) °vs (99 ±34)°,(164± 12)° vs (171 ± 16)°,(91 ± 6) points vs (91 ± 10) points,100％ vs 92％,respectively (P ＞ 0.05).Conclusions Both fixation methods are effective in treatment of intercondylar humerus fractures.Additionally,the surgeons can make a choice about fixation methods based on fracture pattern and individual condition of the patients.

Objective To analyze functional recovery and complications in patients undergoing arthrolysis for post-traumatic elbow stiffness. Methods From April 2007 to April 2011,306 cases of stiff elbow were treated by the same treating team.Of them,258,166 men and 92 women,were fully followed up.Their average age was 36.7 years old.The stiff elbow was on the left in 142 cases,on the right in 116 cases,on the dominant side in 119 cases and on the nondominant side in 139 cases.They were treated with sole arthrolysis or arthrolysis combined with hinged external fixators according to specific conditions.Based on the original approaches used and specific causes of elbow stiffness we adopted the medial,lateral,posterior or medial combined with lateral approaches. Results The average follow-up time was 12.0 months (from 6 to 48 months).Arthrolysis combined with hinged external fixators was performed in 213 cases,with a mean time of external fixation of 7.7 weeks (from 5 to 11 weeks).Sole arthrolysis was performed in the other 45 cases.The mean range of motion (ROM) in extension and flexion was improved by 53.9° ± 36.0° (0° to140°),from preoperative 42.4° ± 31.1 ° (0° to 90°) to peostoperative 96.2° ± 18.2° (60° to 140°) ; the mean pronation and supination was improved by 24.4° ± 33.4° (0° to 110°),from preoperative 136.8 ± 49.1 ° ( 10° to 180°) to postoperative 161.2°± 22.2° (120° to 180°).The mean Mayo Elbow Performance Score (MEPS) was improved by 20.0 ± 17.1 points (0 to 40 points),from preoperative 71.5 ± 15.3 points (60 to 100 points) to postoperative 91.6 ± 7.3 points (85 to 100 points). There were significant differences between preoperation and postoperation in all the indexes above ( P ＜ 0.05).Hematoma at the posterior elbow,wound dehiscence,pin hole infection,external fixator breakage and nerve lesions were observed in 95 patients postoperatively. Conclusions As long as preoperative appraisal of the condition is precise and operative indications are strictly followed,arthrolysis can achieve satisfactory outcomes in management of post-traumatic elbow stiffness.Meticulous operative protocols can reduce postoperative complications.

Objective To introduce a type of anatomical locking plate (Synthes(R) LISS DF) in the less invasive stabilization system (LISS) which can have an effect of indirect reduction and fixation on comminuted fractures of the femur.Methods From December 2002 through December 2006,13 male patients with complicated fresh fracture of the distal femur were treated with Synthes LISS DF.Their ages ranged from 18 through 58 years,with an average of 37.1 years.First,a specially shaped LISS DF was placedat the femoral external condyle to fixate the distal femur.The distal locking screws at the holes D and F of the LISS DF plate were paralleled to the knee joint surface in the anteriorposterior view and the line between the screw holes D and F was kept as long as the axis of the femoral lateral condyle in the lateral view.Next the proximal end of the LISS DF was placed at the lateral femur to fixate the femur shaft after traction to restore the length of the femur.After the fixation like this,the femoral fractures were reduced automatically in a functional reduction.The femoral axis orientation and the Blumensaat line were used for evaluation of the reduc-tion.Results All the patients were followed up for an average of 18 months (from 13 to 36 months).The fracture united in 61.5％ (8/13) of the patients at 3 months postoperation and in all at 12 months postoperation.The average distal femoral axis orientation was 81.7°±3.5° and the average angle between the Blumensaat line and the long axis of the femoral shaft was 38.7° + 6.0°.The last follow-up found no secondarydisplacement of the fracture or no implant failure.By the evaluation system of The Hospital for Special Surgery (HSS),the patients scored 76 on average (from 42 to 96).Three cases were rated as excellent,6 as fine,3 as fair and one as poor,with a good to excellent rate of 69.2％.Conclusions LISS DF can be used as a template to fix and reduce simultaneously the comminuted fractures of the distal femur,especially in cases who have lost the reduction marks on X-ray.In this way,the surgical procedures can be simplified to achieve a functional reduction of the femur in a minimally invasive plate osteosynthesis.

Objective To analyze the results of modular prosthesis replacement for treatment of comminuted and unreconstructable radial head fractures associated with other elbow fractures and sof-tissue injuries. Methods From November 2009 to March 2011,22 patients with comminuted radial head fracture of Mason type Ⅲ were treated with Acumed modular prosthesis replacement. Repair of collateral ligaments and associated elbow fractures was carried out simultaneously.They were 16 men and 6 women,with an average age of 41.5 years (from 21 to 62 years).The left side was involved in 9 cases and the right in 13.One patient was associated with posterior olecranon fracture-dislocation of Monteggia type Ⅱ,13 with elbow terrible triad,one with elbow dislocation but without coronoid process fracture,3 with Essex-Lopresti injury and 4 with medial collateral ligament injury.The coronoid process fracture was fixated with Kirschner wire and the proximal ulnar fracture with plate and screw.Hinged external fixators were used in 2 cases of elbow terrible triad.Patients were evaluated by the Mayo Elbow Performance Score (MEPS). Results The follow-ups averaged 12.95 months ( range,6 to 22 months ).One patient had disturbed elbow flexion of less than 90° due to prosthesis overstuffing,one patient had elbow instability in spite of full range of motion gained due to prosthesis understuffing,and one patient had elbow ankylosis at elbow flexion of 70° with a heterotopic ossification bridge.The results in the other 19 patients were good to excellent. Their average flexion was 131.5°±4.4° (from 130° to 140°),average extension 5.4°±6.3° (from 0 to 20°),average range of extension-flexion motion 126.1 ° ± 7.7° ( from 120° to 140°),average pronation 81.6° ± 6.4° ( from 70°to 90°),average supination 85.6° ± 3.1° (from 80° to 90°),and average range of rotation 167.2° ± 8.2°(from 150° to 180°).Their mean postoperative MEPS score was 94.2 ± 5.1 points (from 85 to 100points). Conclusions The Acumed modular radial head prosthesis offers 200 standard combinations (10left and 10 right stem options with 5 diameters and 4 collar height options) to accommodate different sizes and provide proper restoration of the overall length of the radius,replicates natural radial head geometry,provides improved articulation with the capitellum,prevents loosening and maintains the proper relationship between the radial neck and the plane of the head.Consequently,it is a fine treatment option for radial head fractures of Mason type Ⅲ complicated with additional elbow fractures and soft-tissue injuries,but it can also lead to complications.

BACKGROUND:The correlation between the plasma D-dimer level and deep vein thrombosis has not been conclusive in various studies. The aim of this research was to study the relationship between plasma D-dimer levels and the severity of orthopedic trauma by retrospective examination of orthopedic trauma cases.METHODS:Clinically acute trauma and non-acute trauma patients were selected and their plasma D-dimer levels were measured. Plasma D-dimer levels in patients of these two groups were compared. The relationship between the plasma D-dimer level and the severity of the trauma was also studied.RESULTS:There were 548 cases in the acute trauma group and 501 cases in the non-acute trauma group. The levels of plasma D-dimer were significantly higher in the acute trauma group than in the non-acute trauma group (P < 0.01). In the acute trauma group, the correlation between the D-dimer level and the number of fractures was a positive linear correlation (r = 0.9532).CONCLUSIONS:Elevated plasma D-dimer is common in trauma patients. The D-dimer level and the number of fractures in the trauma patients are closely correlated. D-dimer is not only an indicator for the diagnosis of deep vein thrombosis and pulmonary embolus, but also an indicator of the severity of trauma in acute trauma patients.

目的 调研健康人群双手握力差别,为患者伤后握力恢复程度提供参考值.方法 应用北京中考体育训练专用握力计测量双手握力,比较双手握力差别.结果 健康人力大侧握力的平均值男性为65 kg,女性为30 kg.两手握力差95%分位数男性为40%,女性为59%.结论 男性握力明显大于女性.男性患者患侧手握力恢复达到健侧的60%、女性达到健侧的41%可认为恢复接近正常.

目的探讨应用制动结合早期功能锻炼地方法治疗桡骨头边缘骨折患者的护理方法。方法选取北京积水潭医院39例桡骨头边缘骨折患者为研究对象,对其治疗中的护理方法进行总结分析,探讨护理要点,总结经验。结果制动结合早期肘关节功能锻炼的方法能够有效地治疗桡骨头边缘骨折。结论对患者实施积极有效的护理是确保桡骨头边缘骨折患者顺利进行治疗的关键。

Objective To analyze factors influencing the incidence of deep venous thrombosis (DVT) and discuss the prevention and treatment of DVT in hip fracture patients. Methods The present study enrolled 531 patients who received surgery between June, 2008 to June, 2010 for hip fractures. They were 242 men with a mean age of 56. 2 years and 289 women with a mean age of 65.2 years. There were 336 femoral neck fractures, 183 femoral intertrochanteric fractures, and 12 femoral subtrochanteric fractures. The associations between DVT incidence and fracture type, plasma D-Dimer, sex, age and preoperative duration of immobilization were statistically analyzed. Inferior yens cava filters were used for patients who suffered DVT while surgery was performed. Results The total incidence of DVT was 10. 4% in this series. DVT occurred in 21 cases of femoral neck fracture, 34 cases of femoral intertrochanteric fracture and 0 case of femoral subtrochanteric fracture. All DVT events happened before surgery. DVT incidence had no significant associations with age or sex (P =0. 347 and 0. 376, respectively), but did with plasma D-Dimer, fracture type and preoperative duration of immobilization (P = 0. 002, 0. 017 and 0. 037, respectively). All the 55 DVT patients underwent a successful surgery. Conclusions The DVT incidence in hip fracture patients may have no significant associations with age or sex, but may do with plasma D-Dimer, fracture type and preoperative duration of immobilization. Inferior vena cava filters can ensure a successful internal fixation of the fracture and an uneventful postoperative rehabilitation.

Objective To discuss clinical results of Stryker dynamic joint distractor (DJD Ⅱ) hinged external fixators in elbow arthrolysis for patients with elbow stiffness. Methods From January to December in 2009, 43 cases of stiff elbow were treated by the same operative team. Forty-one patients, 23 males and 18 females, obtained full follow-up. Their average age was (37.3 ± 11.3) years old. There were 22 left and 19 right sides, and 20 dominant and 22 non-dominant sides. In group A, 13 cases were treated only with arthrolysis;in group B, 26 cases were treated with arthrolysis and hinged external fixators;in group C, 2 cases were treated with inter-positional arthroplasty and hinged external fixators. Results The average follow-up lasted 8.0 months (4 to 15 months) . The mean time for external fixation was 6.4 weeks (5 to 8 weeks) . The mean ROM of extension and flexion in Group A was improved by (63.85 ± 45. 01 )°, from (38.46 ± 31.05) ° before operation to ( 1 02. 31 ± 29. 20) ° after operation. In Group B, it was improved by (90.77 ± 21.53) °, from (29. 23 ± 22. 61 ) ° before operation to ( 120. 00 ± 17.89) ° after operation. There was a significant difference ( P ＜ 0. 05 ) in the improvement between the 2 groups. Of the patients treated with external fixators, 3 had mild infection in the pin holes, one had rotation limitation because of the insufficient incision, one experienced breakage of the external fixator, one suffered early skin abrasion due to the swollen elbow. There was no report of neural complication or pin loosening. Conclusions Application of the Stryker DJD Ⅱ hinged external fixator after arthrolysis for treatment of the stiff elbow can achieve good outcomes, especially in improvement of the ROM of extension and flexion. However, improper manipulation may give rise to limitation of ROM.

Objective To study the clinical results of functional therapy for partial radial head fractures with early motion of the elbow. Methods From June 2006 to December 2009, we managed 39 cases of partial radial head fractures through functional rehabilitation. Of them, 16 cases were of Mason type Ⅰ and 23 of type Ⅱ. Early motion of the elbow was conducted as soon as possible under the instruction and supervision of the surgeon while the elbow was immobilized except for the time of early motion. Full range of motion was performed one to 2 times per day in the first 2 weeks and increased later on. Immobilization with brace or sling continued for 4 to 6 weeks. Results The patients were followed up for 8 to 24 weeks (mean, 12 weeks). No limitation of the extension and rotation of the elbow was observed in 12 cases. In all the cases, limitation of extension of the elbow was less than 30°, pronation was larger than 60° and supination larger than 80°. The average Broberg-Morrey elbow score was 95 (from 85 to 100). The excellent to good rate was 100% for this series. ConcLusion Immobilization plus early motion of the elbow can achieve nearly full functional recovery for patients with partial radial head fractures.

目的 总结创面负压治疗技术(NPWT)在供皮区的临床应用价值.方法 采用NPWT治疗24例取皮区创面,观察其愈合时间和更换敷料时的疼痛程度.结果 NPWT治疗后创面愈合时间(14.0±3.3)d,更换敷料时的VAS疼痛评分小于3分,创面美观性好.结论 NPWT用于供皮区创面是一种安全、有效、引起较少疼痛的治疗方法.

Objective To compare minimally invasive plate osteosynthesis(MIPO)and open reduction and internal fixation(ORIF)for distal tibia fracture. Methods We retrospectively analyzed 58 patients with distal tibia fracture who had received MIPO or ORIF treatment randomly.We finallv selected 30 (15 pairs of ORIF and MIPO)of them for a pair comparison based on the accordance of sex.age and AO fracture pattern.The average age was respectively 41.1 yrs and 39.8 yrs respectively and the average time interval from initial injury to surgery wag 7.1±4.9 days and 6.5±3.6 days in the either groups.Parameters such as duration of surgery,postoperative drainage volume,healing time,time for return to work,irritative symptoms by internal implants,delayed union,nonunion and infections were recorded.The JohnnerWruhs grading scale was used to evaluate the limb function. Resuits There was no malunion which resulted in angnlation deformity greater than 5°.Only one patient developed osteomyelitis.In ORIF group 10 cases were evaluated as excellent,3 us good,one as fair and one as poor.In MIPO group.10 cages were evaluated as excellent and 5 as good.In the parameters of duration of surgery,postoperative drainage volume and hospital stay,paired ttests found no significant differences between the 2 groups (P values:0.073.0.096 and 0.896).There were no significant difierences in healing time and time for return to work either(P values:0.737 and 0.379). Conclusion The MIPO does not manifest distinctively presult than ORIF in treating distal tibia fractures.

Objective To study the therapeutic effect of the early surgical treatment of acute traumatic patellar dislocation treatment,for the clinical treatment guidance.Methods 86 patients in our hospital from January 2008 to December 2010 for treatment of acute traumatic patella in were divided into two groups,according to the wishes of the families,of the experimental group of 48 cases to receive early surgical treatment,control group of 38 cases to receive manual reduction + cast immobilization + traditional Chinese medicine.Patients were assessed after treatment of patellar stability and knee function,complications were investigated.Results Functional recovery rateand complications of the experimental group were both better than the control group,the function evaluation levels of the two groups were with statistically significant difference(P0.05).Conclusion The early surgical treatment is featured with good therapeutic effect,patellar stability,knee function recovery,and no serious adverse complications,which is worth wide clinical application.

Objective To observe MRI presentations of fracture healing process in the early stage.Methods Six New Zealand rabbits were used in the experiment. A union model of long oblique fracture of 1 mm in bone defect and 10 mm in vertical length was created on the right radius. A model of 10 mm bone defect was created on the left radius. X-ray and MRI examinations were performed in 1 w, 2 w, 4 w, 6 w, 8 w, 12 wafter the surgery and CT examination was performed in 4 w, 12 w after the surgery. The imaging presentations at the fracture sites were observed on T1, T2, FS-T2, PD, FS-PD sequences. Results The soft tissue around the fracture site presented high signals on T2, FS-T2, PD, FS-PD sequences in the early stage of fracture healing. The signals decreased as time went on, but turned intermediate at 6 w after surgery. The signals of bone marrow turned from high to intermediate on T1, T2 and PD sequences early after the surgery,but turned high again with the healing of medullary cavity. On FS-T2 and FS-PD sequences, bone marrow presented intermediate signals mixed with high signals, but the high signals subsided as time went by. Early changes of callus formation could be observed by MRI. Callus formation at the site of fracture showed intermediate signals in FS-T2 and FS-PD images obtained at 2 w after the surgery in the fracture union model. The changes above could not be observed in the bone defect model. Conclusions Callus formation may be predicted earlier by MRI than by X ray, especially on FS-T2 and FS-PD sequences. The MRI presentations of early fracture healing are to be confirmed by pathological examinations.