Objective:To explore the efficacy of closed reduction using "three-men method" and percutaneous pinning for type Ⅳ pediatric supracondylar humeral fractures.Methods:Clinical data were retrospectively reviewed for 145 children with type Ⅲ/Ⅳ supracondylar humeral fractures undergoing operations from January 2016 to November 2019. They were divided into two groups according to the fracture classification. Twenty-six children with type Ⅳ supracondylar humeral fractures were selected as group A, including 19 boys and 7 girls with an average age of 5.5 years. Involved side was left (n=12) and right (n=14). And 119 children with type Ⅲ supracondylar humeral fractures were assigned into group B, including 84 boys and 35 girls with a mean age of 5.4 years. Involved side was left (n=73) and right (n=46). Age, gender, fracture time, operative duration and Kirschner wire fixation method were recorded along with postoperative needle-path infection, fracture healing, nerve injury recovery, postoperative Bowman angle, loss of carrying angle and elbow range of motion. Postoperative functional recovery was assessed by the Flynn scoring criteria of elbow joint function.Results:None had any postoperative onset of cubitus varus, nonunion, myositis ossificans or Volkmann ischemic contracture. The excellent/good rate of postoperative carrying angle and elbow range of motion according to Flynn score was 96%. There were no significant inter-group differences in age, gender, sideness of injury or fracture time. Operative duration in group A was longer than that in group B [ (36.3±13.8 ) vs. (31.3±13.8) min] and the difference had statistical significance ( P=0.032 ) . The probability of using the third/fourth Kirschner wire was higher in group A than that in group B [46.2% (12/26) vs. 27.7% (33/119) ] and the difference had statistical significance ( P=0.01 ) . The average fracture healing time was 4.6 weeks in group A and 4.4 weeks in group B. No significant inter-group difference existed in fracture healing time ( P=0.105) . There were no significant inter-group differences in pin tract infection rate, elbow range of motion, Bowman angle, loss of carrying angle or whether or not extension line of anterior humeral line passing through capitellum ( P>0.05) . Conclusions:For type Ⅳ supracondylar humeral fractures in children, closed reduction and percutaneous Kirschner wire fixation may achieve similarly satisfactory outcomes to the same method for type Ⅲ supracondylar humeral fractures.

摘要：目的 通过以问题为基础的临床带教（Problem - Based Learning, PBL）方法与传统带教的比较，探究新冠肺炎疫情下改良的PBL教学模式在儿童骨科住院医师规范化培训中的应用。方法 抽取在我科轮转的规范化培训医生52人，设立具有可比性的PBL教学实验组26人和传统教学对照组26人，采用理论考试、操作考核及问卷调查方式分析两组带教效果。结果 PBL教学实验组理论考试成绩与传统教学对照组比较差异无统计学意义(P=0.306)；PBL教学实验组操作考核成绩明显高于对照组(P=0.000)；PBL教学实验组医生对教学法抱有肯定态度的人数多于传统教学对照组，差异有统计学意义(P=0.000)。结论 在儿童骨科规范化培训医生临床带教中，改良的线下和线上PBL教学法可提高疫情期间规范化培训医生临床操作能力、自我学习能力和学习兴趣。

Genu valgus is one of the most common limb deformities in hereditary multiple exostoses (HME). However, it is easily concealed and may account for subsequent osteoarthritis of the knee. The knees of 56 patients (33 men and 23 women) with HME were investigated bilaterally. Knee valgus was described by the mechanical axis deviation (MAD), mechanical lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA). We investigated sex, age, BMI, total number of palpable osteochondromas, number of radiographic osteochondromas around the knee, forearm deformities, morphology and distribution of lesions, and correlations between these factors and genu valgus. The measurement of LDFA and MPTA was performed to identify the sources of genu valgus deformity. Based on the measurement of the mechanical axis, limbs were classified as genu valgus (n = 22) or normal mechanical axis groups (n = 90). The different severities of the genu valgus patients were classified by MAD. By bivariate logistic regression, genu valgus was significantly associated with more sessile and flared metaphyseal lesions. However, only the number of flared metaphyseal lesions had a significant influence on the severity of genu valgus. By analyzing the LDFA and MPTA, it was found that abnormalities of both proximal tibia and distal femur play important roles in genu valgus. Early detection of sessile and flared metaphyseal knee lesions in patients with HME can contribute to early intervention of genu valgus. Level of relevance: Level 2.

目的 通过新冠疫情期间对我院实习学生进行前瞻性随机对照队列研究,探讨孟氏骨折教学中不同侧重点对教学效果的影响,获得一种更倾向于减少孟氏骨折漏诊率的教学方法.方法 新冠疫情期间,实习学生被要求居家隔离,无法进入教学医院进行有效学习,故使用线上教学方式对其进行教学,我科选取"儿童孟氏骨折"作为知识重点进行实习教学探索,对新冠期间不能来教学医院实习的学生进行分组教学并测试教学成效.选取具有一定医学知识但无专科经验的实习生、规陪轮转学员作为研究对象,随机分成A、B两组.A组教学中强调孟氏骨折定义,B组教学中强调桡骨头脱位的阅片方法,对比两种方法教学后提高孟氏骨折诊断正确率的差别.教学提高率=(教学后正确频数-教学前正确频数)/(受试题数-教学前正确频数)x100％.结果 强调孟氏骨折的阅片关键点的教学方法(B组)的教学提高率比强调孟氏骨折定义(A组)更高,χ2=4.4,P=0.04(<0.05),差异有统计学意义.结论 两种教学方法均能提高实习学生对儿童孟氏骨折知识点的掌握程度,同时,强调孟氏骨折阅片比强调孟氏骨折定义的教学方法更有效.单次教学后,儿童孟氏骨折的漏诊误诊率仍较高,需加强孟氏骨折的教学.

Objective:To compare the presentation and postoperative results of children treated for open and Gartland type Ⅲ supracondylar fractures of the humerus.Methods:From June 2011 to June 2019, 19 patients with open and 38 patients with Gartland type Ⅲ supracondylar fractures of the humerus were evaluated. Intravenous antibiotics were used for open supracondylar fracture patients as early as possible. Patients with Gustilo types Ⅲ and Ⅱ open supracondylar fracture of the humerus were treated by emergency operation. Gustilo type Ⅰ open supracondylar fracture patients were treated by disinfection, bandage, reduction, temporary plaster fixation, emergency or sub emergency operation. Gartland type Ⅲ supracondylar fracture patients were treated by reduction, temporary plaster fixation, and operation within the time limit. The wound characteristics, combined injuries, operation timing, operation time, clinical efficacy, and complications were analyzed.Results:The two groups were similar with respect to age and sex. All the patients were followed for 6-27 months, with an average of 19 months. The mean operative time of Gustilo type Ⅰ patients was (35.18±4.67) min, and that of Gartland type Ⅲ patients was (40.77±2.68) min; the difference between them was not statistically significant (P=0.273). The mean operative time of Gustilo type Ⅱ patients was (41.25±5.15) min, which was longer than that of Gartland type Ⅲ patients, but with no statistically significant difference (P=0.063). The mean operative time of Gustilo type Ⅲ patients was (200.00±61.64) min, which was longer than that of Gartland type Ⅲ patients (P=0.037). The incidence of postoperative infection was 5.3% in open fracture patients and 2.6% in Gartland type Ⅲ patients, and the difference between them was not statistically significant (χ2=0.259, P=0.611). The incidence of nerve injury was 28.9% in Gartland type Ⅲ patients and 42.1% in open fracture patients, and there was no significant difference between them (χ2=0.987, P=0.321). At the last follow-up, 36 cases (94.7%) achieved excellent results and 2 cases (5.3%) achieved good results in Gartland type Ⅲ patients and the corresponding figures in open fracture patients were 16 (84.2%) and 3 (15.8%), respectively, there was no significant difference between them (χ2=1.754, P=0.185).Conclusion:Open supracondylar fracture of the humerus in children can be cured with antibiotics, timely debridement, and effective fixation. The treatment effect of open supracondylar fractures of the humerus in children is similar to that of Gartland type Ⅲ supracondylar fractures. The therapeutic effect is excellent.

作者团队按照小儿骨科教学特点和要求,对迷你临床演练(Mini-Clinical Evaluation Exercise,Mini-CEX)进行了改良,增加了对小儿骨科门诊操作和手术操作的考察,并将其应用于对小儿骨科住院医师进行住院医师规范化培训的轮转培训及教学效果的评估.作者团队通过门诊基本知识、医疗面谈技能、体格检查技能、骨科基本操作技能、围手术期准备和处理、对患者的人文关怀、临床判断、沟通技能、组织效能9项评估项目,在接诊新患者、术前、手术、术后4个阶段进行考察.结果发现,近3年来小儿骨科住培的113名住院医师合格率为100％,优良率为92.1％,住院医师的临床能力得到了有效提升,改良Mini-CEX的应用在临床教学中取得了满意的效果.

目的:探讨非特发性早发性脊柱侧凸(EOS)的Mehta石膏矫形治疗效果.方法:回顾性分析2014年10月-2019年10月在本中心就诊并进行石膏治疗的有完整影像资料11例非特发性EOS患儿.全部患儿均于治疗开始前拍摄站立位全脊柱X线片,并在石膏矫形治疗1个月后再次拍摄站立位全脊柱X线片,测量EOS冠状面(Cobb角)和水平面(RVAD).采用配对样本t检验比较治疗前后的影像学资料及治疗效果.结果:得到随访的11例患儿,麻醉下Mehta石膏治疗5例,共7次,先天性2例,神经肌肉型1例,神经纤维瘤病1例,脊髓疾病1例;非麻醉下Mehta石膏治疗6例,共7次,先天性2例,神经纤维瘤病3例,神经肌肉型1例.麻醉下Mehta石膏组有1例拆除石膏后发现背部皮肤压疮,换药后愈合,非麻醉下Mehta石膏组未见有石膏压疮.患儿经过1个月Metha石膏矫形后平均Cobb角较术前明显降低,差异有统计学意义(P<0.01).与术前相比较,术后RVAD较术前有明显下降,差异有统计学意义(P<0.01).结论:初步结果显示Mehta石膏可有效控制非特发性EOS冠状面和水平面畸形.

Precartilaginous stem cells (PCSCs) are adult stem cells that can initiate chondrocytes and bone development. In the present study, we explored whether miR-132/212 was involved in the proliferation of PCSCs via Hedgehog signaling pathway. PCSCs were isolated and purified with the fibroblast growth factor receptor-3 (FGFR-3) antibody. Cell viability, DNA synthesis and apoptosis were measured using MTT, BrdU and flow cytometric analysis. The mRNA and protein expression were detected by real-time PCR and Western blot, respectively. The target gene for miR-132/212 was validated by luciferase reporter assay. Results showed that transfection with miR-132/212 mimic significantly increased cell viability and DNA synthesis, and inhibited apoptosis of PCSCs. By contrast, miR-132/212 inhibitor could suppress growth and promote apoptosis of PCSCs. Luciferase reporter assays indicated that transfection of miR-132/212 led to a marked reduction of luciferase activity, but had no effect on PTCH1 3'-UTR mutated fragment, suggesting that Patched1 (PTCH1) is a target of miR-132/212. Furthermore, treatment with miR-132/212 mimics obviously increased the protein expression of Indian hedgehog (Ihh) and parathyroid hormone related protein (PTHrP), which was decreased after treatment with Hedgehog signaling inhibitor, cyclopamine. We also found that inhibition of Ihh/PTHrP signaling by cyclopamine significantly suppressed growth and DNA synthesis, and induced apoptosis in PCSCs. These findings demonstrate that miR-132/212 promotes growth and inhibits apoptosis in PCSCs by regulating PTCH1-mediated Ihh/PTHrP pathway, suggesting that miR-132/212 cluster might serve as a novel target for bone diseases.

肘关节脱位在儿童并不多见,总发病率约 3 ％,多数为后脱位,前脱位极为罕见,且多并发骨折[1].普通平片可明显观察到关节脱位,CT则有助于发现骨折,尤其是碎骨块嵌顿于关节内影响肘关节复位时.近期本院成功治疗一例肘关节前脱位患儿,报道如下.

留学生不仅在文化背景、生活学习习惯、教育经历等方面与国内学生存在差异,还存在不同程度的语言交流障碍.本文总结留学生实习带教经验,找出留学生在儿童骨科临床实习期间存在的问题,听取留学生反馈意见,通过合理组建带教队伍,改革教学方式等手段,完善儿童骨科实习带教方案,提高留学生带教质量.

Prolonged or overdose glucocorticoids (GCs) usage is the common cause of osteoporosis. In the present study, we studied the cellular mechanism of dexamethasone (Dex)‐induce osteoblast cell death by focusing on the role of mitochondrial permeability transition pore (mPTP). In cultured osteoblastic MC3T3‐E1 cells, Dex‐induced mPTP opening, which was demonstrated by mitochondrial membrane potential (MPP) decrease, cyclophilin‐D (CyPD)–adenine nucleotide translocator 1 (ANT‐1) mitochondrial complexation and cytochrome C (cyto‐C) release. The mPTP inhibitor sanglifehrin A (SfA) dramatically inhibited Dex‐induced MPP loss, cyto‐C release and MC3T3‐E1 cell death. Dex‐induced cell death requires mPTP composing protein CyPD, as CyPD inhibitor cyclosporin A (CsA) and CyPD siRNA knockdown inhibited Dex‐induced MC3T3‐E1 cell death, while CyPD overexpression aggravated Dex's cytotoxic effect. We found that Dex induced P53 phosphorylation and translocation to mitochondria, where it formed a complex with CyPD. Glucocorticoid receptor (GR) siRNA knockdown, or P53 inhibition (by its inhibitor pifithrin‐α or shRNA silencing) suppressed Dex‐induced CyPD‐P53 mitochondrial association and subsequent MC3T3‐E1 cell death. Finally, in primary cultured osteoblasts, Dex‐induced cell death was inhibited by CsA, SfA or pifithrin‐α. Together, our data suggest that Dex‐induced osteoblast cell death is associated with GR‐P53‐regulated mPTP opening. J. Cell. Physiol. 229: 1475–1483, 2014. © 2014 Wiley Periodicals, Inc.

Objective To explore the availability and feasibility of the bioabsorbable fixation to treat tibiofibula fractures in children.Methods Twenty patients with tibiofibula fractures underwent internal absorbable fixation in this institute from January 2011 to January 2012.The distal tibiofibula fractures were fixed with bioabsorbable screws,while the midpiece fractures of tibiofibula were fixed with bioabsorbable screws combined with elastic intramedullary nail.Distal tibial epiphyseal fractures were fixed using bioabsorbable spiral and pin.Fracture healing and functional recovery were followed up after surgery.Results Follow-up period was 6 to 12 months.All fractures were healed.One patient's tibia comminuted fracture was fixed with absorbable elastic intramedullary nail,and postoperative X-radiogram suggested bony callus formed slower than average during follow-up.However,continuous weight-bearing exercises accelerated bony callus formation and a mass of bony callus was found on the X-radiogram 6 months after surgery.Conclusions The bioabsorbable internal fixation is safe and effective for the treatment of tibiofibula fractures in children.

目的:研究儿童孟氏骨折微创手术的治疗效果.方法:回顾分析2005 ～2010年我院治疗的儿童新鲜孟氏骨折23例,行骨折复位尺骨闭合穿针治疗,石膏外固定4～6周,骨折愈合后解除石膏行功能训练,6～8周后拆除克氏针.23例均得到随访,随访时间为9个月～5年.结果:本组优18例,良4,中1例,无差,优良率95％.1例骨间背侧神经麻痹者于术后1个月恢复,其余病例均于术后3个月内恢复.结论:尺骨闭合穿针治疗儿童孟氏骨折稳定性高,再脱位可能性小,可早期功能训练,尽早恢复肘关节的功能.如术中闭合复位困难、桡骨小头位置欠佳,建议行切开复位.

目的儿童骨折后的再塑形能力较强,儿童骨盆骨折的治疗应与成人应有所差异,现探讨苏州大学附属儿童医院儿童骨盆骨折的治疗方法和效果。方法对2005年8月至2010年1月收治的41例儿童骨盆骨折的临床资料进行分析,本组中男24例,女17例,年龄16月~14岁,平均5.3岁。按Torode-Z ieg分类法对41例病例分型:Ⅰ型,3例;Ⅱ型,8例;Ⅲ型,18例;Ⅳ型,12例。患者入院后早期明确诊断,及时抗休克,处理合并伤,生命体征稳定后对骨盆骨折及时复位和固定,其中1例髂骨撕脱性骨折,分离移位明显,予以切开复位内固定治疗,其余病例予以早期髋人位石膏固定处理。结果 41例患者中,1例死亡于开放性骨盆骨折及腹内脏器损伤所致的出血,40例经6个月至4年的随访,平均26.3月,其中2例患侧髋关节功能轻度受限,有跛行,余治疗效果满意。结论儿童骨盆骨折应早期明确诊断,及时治疗合并伤,骨折早期复位固定,预后较好,大多数儿童的骨盆骨折有较少的临床意义且不需其他的特殊治疗。尽管儿童骨盆骨折开始病情严重,但因软骨的重塑过程可使骨盆有不断恢复正常的形态解剖功能,可获得满意的效果。