This study was designed to identify risk factors for wound complications including surgical site infection (SSI) and wound healing issues following open reduction and internal fixation (ORIF) of ankle fractures. A retrospective analysis of individuals with ankle fractures treated with ORIF was undertaken. Study subjects were divided into a wound complications (WC) group and a no wound complication (NWC) group. The WC group was further divided into an SSI group and wound healing issues group. Twenty-one potential risk factors associated with wound complications after ORIF were tracked. Uni- and multivariate binary logistical regression analyses were used to identify risk factors associated with wound complications, ISS and wound healing issues. In total, 613 individuals, who had undergone surgery for ankle fractures formed the study cohort. The incidence of postoperative wound complications was 10.3% (63 cases), including 5.2% of SSI (32 cases) and 5.1% of wound healing issues (31 cases). The independent risk factors for wound complications were age 65 years or older, preoperative serum albumin level below 35 g/L, peripheral neuropathy, open fracture, fewer than seven cases per year in surgical volume, and attending surgeon level. The independent risk factors for SSI were age 65 years or older, preoperative serum albumin level below 35 g/L, open fracture and fewer than seven cases per year in surgical volume. The independent risk factors for wound healing issues were preoperative serum albumin level below 35 g/L, peripheral neuropathy, open fracture and attending surgeon level. Herein we found both factors inherent to the injury and individual and those pertaining to the surgical team affected the frequency of wound complications after ORIF of ankle fractures. Specifically, advanced age and low surgical volume were associated with a greater risk of SSI. Peripheral neuropathy and the low expertise level on the part of the surgeon were associated with a greater risk of wound healing issues. Hypoproteinaemia and open fracture were both associated with a greater risk of both SSI and wound healing issues.

高黄芩素是从灯盏细辛、木蝴蝶、野菊花等中草药提取出的天然黄酮类单体成分,具有抗氧化、抗炎的生物学作用,已用于哮喘、风湿病、糖尿病、神经性疾病等临床疾病的治疗.近年来,高黄芩素在抗肿瘤方面的作用被逐渐的认识,研究发现,高黄芩素在胃癌、肝癌、结肠癌、肺癌、多发性骨髓瘤等恶性肿瘤中表现出显著的抑瘤作用,其抑瘤机制主要包括促进肿瘤细胞凋亡、抑制肿瘤细胞增殖、阻碍肿瘤细胞的周期进程、抑制肿瘤细胞迁移与侵袭、遏制肿瘤血管新生等.另外,高黄芩素具有生物利用度高、可靶向选择肿瘤细胞等特点,表明高黄芩素是潜在的重要肿瘤化疗药物.目前,尚缺乏高黄芩素抗肿瘤作用及机制的研究进展荟萃,本文就近年来国内外有关高黄芩素的抗肿瘤作用及分子机制进行综述,以期为高黄芩素的实验室研究与临床应用提供科学参考与思路.

目的 探讨18F-FDG PET/CT显像在腹膜增厚病因诊断中的价值及显像特点.资料与方法 回顾性分析2017年1月—2021年6月于济宁医学院附属医院行18F-FDG PET/CT显像的108例腹膜增厚患者,检查前临床均未明确病因且未进行治疗.观察腹膜增厚形式、病变范围、器官病变、腹膜及器官最大标准化摄取值(SUVmax)、CT值、有无腹水等.通过视觉分析及半定量分析法,结合临床及显像资料,对病因及原发灶做出诊断,比较PET/CT、PET、CT显像的诊断效能及恶性腹膜增厚与结核性腹膜增厚之间的区别.结果 108例患者中,恶性肿瘤性病变90例,良性病变18例.PET/CT、PET、CT分别诊断出69、58、51例恶性腹膜病变原发灶,未准确诊断21、32、39例.PET/CT、PET、CT在腹膜增厚病因诊断中的敏感度分别为76.7％、64.4％、56.7％,特异度分别为72.2％、66.7％、83.3％,准确度分别为75.9％、64.8％、61.1％,阳性预测值分别为93.2％、90.6％、94.4％,阴性预测值分别为38.2％、27.3％、27.8％.90例恶性腹膜增厚的SUVmax(7.4±4.9)高于7例非结核性良性腹膜增厚(1.9±1.1;t=5.372,P=0.000),但与11例结核性腹膜增厚(6.1±3.5)差异无统计学意义(t=0.431,P=0.795).恶性腹膜增厚与结核性腹膜增厚患者年龄(t=5.218,P=0.001)、腹膜增厚形式(χ2=7.182,P=0.007)、有无其他器官病变(χ2=9.395,P=0.002)、有无腹水(χ2=3.947,P=0.047)、是否伴发热(χ2=41.749,P=0.000)差异有统计学意义,腹膜及器官SUVmax、CT值、腹膜病变范围差异无统计学意义(P均>0.05).结论 18F-FDG PET/CT显像对腹膜增厚病因诊断具有较高的价值,恶性腹膜增厚的SUVmax高于非结核性良性腹膜增厚,但与结核性腹膜增厚其他显像及临床特点存在差异.

Bone healing is a complex and orchestrated process, involving in inflammation, angiogenesis, mesenchymal stem cells differentiation, vascular endothelial cells and skeletal cells proliferation and cell autophagy. The individualized differences of patients including risk factors, combined with the perspective of phenotype can provide a novel view for the treatment of bone unhealing. Bone morphogenetic protein-2 (BMP-2), fibroblast growth factor-2 (FGF-2), runt-related transcription factor 2 (RUNX2) and vascular endothelial growth factor (VEGF) take part in multiple phenotypes of bone healing, thus these candidates are the main treatment targets of bone unhealing. Taking advantage of these phenotypes and molecular mechanisms is beneficial for the understanding of mechanisms of fracture healing and helpful for the transformation from laboratory research to the clinical application. Here we characterized the main phenotypes and mechanisms in the treatment of bone unhealing.

背景:目前世界上尚无老年股骨转子间骨折手术平衡止血和抗凝的共识及指南.将氨甲环酸与利伐沙班联合应用于老年股骨转子间骨折患者围术期止血与抗凝管理的相关文献较少.目的:观察氨甲环酸联合利伐沙班对老年股骨转子间骨折患者围术期出血、输血及术后静脉血栓形成的影响.方法:纳入老年股骨转子间骨折患者60例,计划行股骨防旋髓内钉手术治疗,所有入组的患者给予利伐沙班10 mg/d抗凝,直至手术前24 h.患者分2组,试验组30例术中静脉滴入1.0 g氨甲环酸,对照组例静脉滴入相同体积的葡萄糖溶液.收集两组手术失血量、输血及出院前静脉血栓形成情况进行比较.结果与结论:①试验组的失血量明显低于对照组(P<0.05).两组出院前静脉血栓形成无显著差异;②试验组中3例患者接受了输血,对照组7例患者接受了输血;③结果证实,氨甲环酸联合利伐沙班不仅可以减少老年股骨转子间骨折患者的围术期失血,而且不增加静脉血栓形成的风险.

目的 探讨切开复位内固定治疗髋臼骨折的手术技巧及疗效分析.方法 回顾性分析2016年1月至2018年1月济宁医学院附属医院共收治62例髋臼骨折患者的临床资料和随访结果,其中男性36例,女性26例,年龄18～83岁,平均45岁.根据Judet-Letournel分型,简单骨折39例,复杂骨折23例.62例患者根据骨折类型采用髂腹股沟入路(前路)、Kocher-Langenbenk入路(后路)或前后联合入路,均一期行切开复位重建钢板螺钉内固定术.结果 62例患者术后均获得12～40个月的随访(平均18.5个月),采用Matta标准评定骨折复位效果,62例患者获得解剖复位40例,满意复位22例.采用Matta改良的D'Aubigne和Postal评分标准评定临床效果,62例患者均达到优/良水平,优54例,良8例,其中1例患者术后出现浅表皮肤软组织感染,给予切口清创、换药后切口愈合良好;1例患者出现股骨头坏死,但髋关节功能良好,建议其远期可行人工股骨头置换术;2例患者术后出现下肢肌间静脉血栓,给予抗凝治疗后血栓消失.所有患者随访过程中X线片示内固定位置良好,经康复锻炼后髋关节功能恢复可.根据损伤程度,15例患者髋部出现不同程度异位骨化,下肢出现不同程度的感觉减退或异常.结论 切开复位内固定治疗髋臼骨折,恢复髋关节正常头臼关系,骨折端坚强内固定,恢复正常解剖位置,术后早期功能锻炼,使患者术后能够达到满意疗效.

目的 比较带锁髓内钉与钢板螺钉治疗闭合性股骨干骨折的疗效.方法 回顾性分析2012年1月至2018年1月63例闭合性股骨干骨折内固定治疗的患者资料,根据股骨干手术方式不同分为观察组即采用带锁髓内钉内固定患者28例和对照组即采用钢板螺钉内固定患者35例,比较两组术中固定股骨干时的出血量、手术时间、骨折愈合时间、股骨干骨折愈合率、Karlstrom和Olerud股骨骨折疗效评价情况及术后并发症发生率等.结果 所有患者术后获3～24个月随访.观察组出血量(215.36±27.10)ml较对照组(400.00±43.68)ml少,差异有统计学意义(P<0.05).股骨干骨折手术时间[(2.38±0.16)h vs(2.72±0.17)h]、骨折愈合时间[(14.07±0.68)周vs(15.91±1.25)周]、骨折愈合率(96.4％vs 97.1％),比较差异均无统计学意义(P>0.05).两组患者术后刀口均未出现感染,所有患者均达到Karlstrom和Olerud股骨骨折疗效评价标准的优良水平.结论 与钢板螺钉内固定比较,带锁髓内钉治疗闭合性股骨干骨折具有出血量少的优势,但两者在骨折愈合率、骨折愈合时间、手术时间、术后并发症上并无明显差别,二者在治疗闭合性股骨干骨折上均可获得满意疗效.

[目的]评估不同麻醉方式对髋部骨折患者围手术期失血、住院时间和相关费用的影响,为髋部骨折围手术期治疗提供一定的参考.[方法]回顾性分析2012年4月～2014年4月502例连续就诊于本院创伤骨科的股骨转子间骨折患者,其中资料完整409例.按照麻醉方式的不同,分为全麻组(83例)和椎管内麻醉组(326例).收集信息包括一般资料、手术时间、入院及术后第1d时血常规检查、围手术期输血量、基础疾病、住院时间、麻醉方式和住院期间并发症.采用Gross方程计算围手术期总失血量和隐性失血量.[结果]409例患者纳入统计分析.椎管内麻醉组术中失血量为(141.7±110.7) ml明显低于全麻组(242.0±235.1) ml (P=0.001) (P＜0.05).同时椎管内麻醉组隐性失血量(P =0.001)和总失血量(P=0.001)明显低于全麻组(P＜0.05).椎管内麻醉组血红蛋白和红细胞压积变化分别为(23.8±16.5) g/L和(6.9±4.8)％.全麻组血红蛋白和红细胞压积变化分别为(35.1±14.8)g/L和(10.5±4.1)％,明显高于椎管内麻醉组(P =0.001) (P ＜0.05).椎管内麻醉组输血费用明显低于全麻组(P=0.042) (P＜0.05),但两组之间麻醉费用(P =0.639)、手术费用(P =0.163)和总费用(P=0.067)无明显差异(P＞0.05).两组之间住院期间并发症发生率无显著差异(P＞0.05).[结论]同全麻相比,椎管内麻醉可以减少围手术期失血量、输血量和输血相关费用;麻醉方式的选择同住院时间、住院期间并发症和住院费用无关.

BACKGROUND:After internal fixation, limb fracture nonunion is the most common complication. Many factors affect fracture healing, but in recent years researchers have found that serum leptin may be involved in the process of fracture healing to regulate a variety of metabolisms. OBJECTIVE:To analyze the relationship between the changes of serum leptin and fracture healing in patients with long tubular fracture of the limbs after internal fixation. METHODS:Sixty patients with long tubular bone fracture who underwent internal fixation treatment were selected, and divided into two groups, union group (n=30) and nonunion group (n=30), according to the degree of fracture healing at 8 months after operation. Another 30 healthy volunteers served as normal control group. Peripheral blood samples were extracted before and after internal fixation to detect the changes in serum leptin levels using ELISA. RESULTS AND CONCLUSION:Preoperative serum leptin level was higher in the union group and nonunion group than the normal control group as wel as higher in the union group than the nonunion group (P < 0.05). There was no difference in the serum leptin levels in the union group before and after operation, but the nonunion group had a higher preoperative serum leptin level than the postoperative level. These findings indicate that the serum leptin may have an influence on fracture healing.

Objective To analyze the perioperative blood loss in the different surgical treatments of senile hip fractures (femoral neck and intertrochanteric fractures).Methods Enrolled in the study were 128 aged patients who had been treated in our department for hip fractures between December 2013 and May 2014.They were 53 men and 75 women,with a mean age of 80.5 years.They were divided into 2 groups according to fracture type,with 57 cases in group A (femoral intertrochanteric fracture) and 71 cases in group B (femoral neck fracture).Their perioperative blood loss was calculated according to the Gross equation.The preoperative hidden blood loss was compared between the 2 groups.The dominant blood loss,postoperative hidden blood loss,total perioperative hidden blood loss and total blood loss were compared between cannulated screw fixation,hemi-hip arthroplasty and total hip arthroplasty for the femoral neck fractures and intramedullary nailing for the intertrochanteric fractures.Results The preoperative hidden blood loss in group A (213.0 ±65.3 mL) was significantly greater than in group B (138.4 ±51.4 mL) (P ＜ 0.05).In comparison of dominant blood loss,total hip arthroplasty ＞ hemi-hip arthroplasty ＞ intramedullary nailing ＞ cannulated screw fixation.In comparisons of postoperative hidden blood loss,total perioperative hidden blood loss and total blood loss,total hip arthroplasty ＞ intramedullary nailing ＞ hemi-hip arthroplasty ＞ cannulated screw fixation.All the above differences were statistically significant (P ＜ 0.05) except the one regarding total perioperative hidden blood loss between total hip arthroplasty and intramedullary nailing (P ＞ 0.05).Conclusions The surgeons should have a comprehensive knowledge of the perioperative blood loss in the treatment of senile hip fractures.Enough attention should be paid to the preoperative and postoperative hidden blood loss.

BACKGROUND:Pelvic and acetabular fractures in elderly are frequently observed in the clinic, and the incidence gradual y increased. Moreover, it is difficult to conduct reduction and fixation due to their physical status and osteoporosis to different degrees. Locking plate is ideal fixation material in surgical treatment of acetabular fractures in elderly due to the special functions and good molding of screw and locking plate. <br> OBJECTIVE:To analyze the advantages and disadvantages of locking reconstruction plate used in the acetabular fracture for the aged patients and to improve the clinical effect of acetabular fractures in elderly. <br> METHODS:From January 2010 to February 2013, 21 aged patients with acetabular fracture were treated by open reduction and internal fixation with locking reconstruction plates made of titanium and 00Cr 18 Ni 14 Mo 3 stainless steel in the Department of Orthopedics Affiliated Hospital of Jining Medical University. <br> RESULTS AND CONCLUSION:Of 21 patients, 20 cases were fol owed up for 12-18 months (mean 14 months), but one dropped out. Al the fractures were healed within 4-6 months and no failure cases. According to Matta evaluation criteria, the satisfactory rate was 90%. According to the D’Aubigne scoring system, the excellent and good rate was 95%. These data indicated that locking reconstruction titanium plate is reliable, has low failure rate and satisfactory clinical effects for acetabular fracture in aged patients, and is ideal fixation material in treatment of acetabular fractures in elderly.

[目的]回顾性对比研究切开复位内固定术治疗陈旧性与新鲜性髋臼骨折的临床效果.[方法]回顾总结2009年9月～2013年3月应用切开复位内固定的方法分别治疗陈旧性和新鲜性髋臼骨折共90余例,其中陈旧性35例,男23例,女12例;年龄23 ～67岁,平均40岁,手术时间为伤后22 ～65 d,平均36 d;新鲜性髋臼骨折55例,男39例,女16例,年龄17～86岁,平均56岁,手术时间3～20d,平均8.1d,手术根据骨折类型采用髂腹股沟入路、Kocher-Langenbenk入路或联合入路,采用Matta标准评定骨折复位效果,采用Matta改良的D'Aubigne和Postal评分标准评定临床效果.[结果]全部病例均得到随访,随访时间12 ～24个月,平均18个月,骨折复位质量采用Matta标准,陈旧性骨折组:解剖复位15例,满意复位17例,不满意复位3例.新鲜骨折组:解剖复位35例,满意复位19例,不满意复位1例.两组满意复位率比较,差异无统计学意义;临床效果根据Matta改良的D'Aubigne和Postal评分,陈旧骨折组:优16例,良15例,一般2例,差2例,新鲜骨折组:优35例,良18例,一般1例,差1例,两组优良率比较,差异无统计学意义.[结论]切开复位内固定治疗陈旧性髋臼骨折与新鲜髋臼骨折相比,满意复位率及临床效果优良率差异均无统计学意义,是治疗陈旧性髋臼骨折有效、可行的方法.

Objective To know the surgical sites infection and pathogens distribution.Methods By retrospective survey and etiology detection,the surgical incision infections and the distribution of pathogens for patients who underwent surgery were investigated.Results 198 infected among the 62 723 surgical cases during the year 2008 ～ 2010,the hospital infection rate was 0.32%.A total of 215 strains of pathogens were isolated from infection specimens,including Gram-negative bacilli(76.3%),Gram-positive cocci(23.7%) and part of fungus.Conclusion The surgical incision infection rate was in general control range,pathogens form infection specimens were mostly Gram-negative bacilli in the hospital.

目的 探讨应用附加锁定板衍生的Poller钉技术治疗股骨干骨折髓内钉固定术后不愈合的疗效.方法 回顾性分析2009年1月至2012年4月收治的6例股骨干骨折髓内钉固定术后不愈合患者资料,男4例,女2例;年龄23 ～61岁,平均36.9岁.骨折不愈合部位:近1/3段3例,中1/3段1例,远1/3段2例.骨折不愈合类型:萎缩型5例,增生型1例.骨折不愈合时间8～14个月,平均10.7个月.保留原髓内钉,应用8～12孔锁定钢板或钛板固定,断端两侧各用2～3枚双皮质骨螺钉固定,保证髓内钉矢状面稳定;再用1～2枚锁定钉单皮质抵紧髓内钉固定,确保髓内钉冠状面稳定.所有患者断端行自体髂骨植骨. 结果 本组患者平均手术时间为131 min,平均术中出血量为383 mL.2例患者出现供骨区疼痛,均于1个月内缓解.6例患者术后获10～ 17个月(平均13.8个月)随访.所有患者均于3个月内完全负重行走.骨愈合时间为4～6个月(平均4.8个月).末次随访时3例膝关节屈曲功能明显受限患者中2例屈曲至90°以上,1例恢复至80°～90°;其余3例膝关节屈伸活动度均＞ 100°.本组患者均无感染、内固定物松动及断裂等并发症发生. 结论 附加锁定板衍生的Poller钉技术可以有效改善骨折不愈合断端局部的旋转不稳定,是治疗股骨干骨折髓内钉固定术后不愈合的有效且简单方法.