ObjectiveThis study aims to explore the correlation between Osteoporosis and stroke risk, and find potential common key genes and drugs for intervention through bioinformatics methods.MethodsThis study used clinical data to assess the relationship between Osteoporosis and stroke risk through univariate and multivariate logistic regression analyses. Additionally, blood sequencing data from patients with Osteoporosis and stroke were obtained from the GEO database, and common key genes were identified using differential analysis, LASSO regression, and ROC curve methods. Potential interventional drugs were predicted using the DSigDB database.ResultsIn the initial model, Osteoporosis was significantly associated with stroke risk (OR=1.78, 95% CI: 1.14-2.78, p < 0.01). This association was still significant after adjusting for factors such as age, gender, race, and BMI (OR=1.84, 95% CI: 1.18-2.89, p = 0.007). Bioinformatics analysis identified LILRA5, HNRNPL and AGBL3 as common key genes for Osteoporosis and stroke, and these genes were highly effective in diagnosing both diseases. The DSigDB database predicted that Cyclopenthiazide, Neostigmine bromide, and R-atenolol could potentially intervene with these three genes.ConclusionThere is a significant positive correlation between Osteoporosis and stroke risk. LILRA5, HNRNPL and AGBL3 could be key genes common to both diseases, and Cyclopenthiazide, Neostigmine bromide, and R-atenolol could be potential drugs for intervention.

ObjectiveRecent studies have shown that blood urea nitrogen to creatinine (BUN/Cr) ratio might be an effective marker for the prognosis of patients with respiratory diseases. Herein, we aimed to assess the association between BUN/Cr ratio and the risk of in-hospital mortality in patients with trauma-related acute respiratory distress syndrome (ARDS).DesignA retrospective cohort study.Setting and participants1034 patients were extracted from the Medical Information Mart for Intensive Care-III (MIMIC-III) database.Primary and secondary outcome measuresThe primary outcome of the study was in-hospital mortality, defined by the vital status at the time of hospital discharge (ie, survivors and non-survivors).ResultsOf the total patients, 191 (18.5%) died in hospital. The median follow-up duration was 16.0 (8.3–26.6) days. The results showed that high level of BUN/Cr ratio was significantly associated with an increased risk of in-hospital mortality (15.54–21.43: HR=2.00, 95% CI: (1.18 to 3.38); >21.43: HR=1.76, 95% CI: (1.04 to 2.99)) of patients with trauma-related ARDS. In patients with trauma-related ARDS that aged ≥65 years old, male and female, Onychomycosis Severity Index (OSI)>98, Revised Trauma Score (RTS)>11, Simplified Acute Physiology Score II (SAPS-II)>37 and sequential organ failure assessment (SOFA) scores≤7, BUN/Cr ratio was also related to the increased risk of in-hospital mortality (all p<0.05). The predictive performance of BUN/Cr ratio for in-hospital mortality was superior to BUN or Cr, respectively, with the area under the curve of receiver operator characteristic curve at 0.6, and that association was observed in age, gender, OSI, RTS, SAPS-II and SOFA score subgroups.ConclusionBUN/Cr ratio may be a potential biomarker for the risk of in-hospital mortality of trauma-related ARDS, which may help the clinicians to identify high-risk individuals and to implement clinical interventions.

目的 探讨柳州市老年骨质疏松性骨折(OPF)现状及其发生的危险因素.方法 回顾性分析2018年1月—2020年12月柳州市工人医院创伤中心收治的5 235例60周岁及以上老年OPF患者的临床资料,并从中随机抽取300例老年OPF患者临床资料作为研究组;选取同时期接诊的老年骨质疏松未骨折的300例患者临床资料作为对照组,通过医院病案管理系统,详细收集2组患者各项临床资料,分析柳州市老年OPF现状及危险因素.结果 5 235例老年OPF患者中,以胸腰椎压缩性骨折占比最高58.19%、其次为股骨颈骨折15.42%;60～74岁年龄段患者以胸腰椎压缩性骨折占比最高77.03%,75～89年龄段患者股骨颈骨折、粗隆间骨折占比均较高分别为43.36%、41.34%,≥90岁患者粗隆间骨折占比最高49.25%;男性、女性均以胸腰椎压缩性骨折占比较高,分别为46.34%、62.47%.经单因素/多因素分析显示,年龄、性别、体质量指数(BMI)、跌倒史、骨折史、骨密度(BMD)、糖尿病、不良生活习惯为老年OPF发生的独立危险因素(P＜0.05).结论 胸腰椎压缩性骨折是柳州市老年OP患者骨折的主要类型;老年OPF的发生与年龄、性别、BMI、跌倒史、骨折史、BMD、糖尿病、不良生活习惯等因素有关,应采取积极预防措施,降低OPF的发生风险.

Accurate classification of the acetabular injuries and appropriate treatment plan are great challenges for orthopedic surgeons because of the irregular anatomical structure of the acetabulum and aggregation of important vessels and nerves around it. Letournel-Judet classification system has been widely applied to classify acetabular fractures. However, there are several limitations, including incomplete inclusion of fracture types, difficulty in understanding and insufficient guidance for surgical treatment, etc. Serious complications such as traumatic arthritis are common due to wrong classification and diagnosis and improper selection of surgical strategy, which brings a heavy burden to the society and families. Three-column classification, based on anatomic characteristics, has advantages of containing more fracture types and being easy to understand, etc. To solve the problems existing in the diagnosis and treatment process based on Letournel-Judet classification, achieve accurate diagnosis and treatment of patients with acetabular fractures, and obtain satisfactory prognosis, the Orthopedic Trauma Emergency Center of Third Hospital of Hebei Medical University and the Trauma Orthopedic Branch of the Chinese Orthopedic Association organized experts from relevant fields to formulate the Expert consensus on the accurate diagnosis and treatment of acetabular fractures based on three-column classification ( version 2023) in terms of principles of evidence-based medicine. Based on the three-column classification, 15 recommendations were proposed, covering the diagnosis, treatment, complication prevention and management, etc, so as to provide reference for accurate diagnosis and treatment of acetabular fractures.

Objective:To analyze the clinical efficacy of three-dimensional (3D) navigation-assisted percutaneous sacroiliac screw fixation in the treatment of Tile C1 pelvic fractures.Methods:A total of 12 patients with Tile C1 pelvic fractures who underwent percutaneous sacroiliac screw fixation assisted by 3D navigation in Liuzhou People's Hospital Affiliated to Guangxi Medical University from September 2019 to March 2022 were retrospectively analyzed. There were 8 males and 4 females, aged 43.08±16.93 years (range, 21-72 years). 24 patients with Tile C1 pelvic fractures who underwent fluoroscopy-assisted percutaneous sacroiliac screw internal fixation during the same period were selected as controls by pairing them according to age and sex in a ratio of 1:2. There were 15 males and 9 females, aged 45.75±11.69 years (range, 32-75 years). The operation time, intraoperative blood loss, number of screws, intraoperative fluoroscopy times, guide pin drilling times and pelvic function scores were compared between the two groups. The quality of pelvic fracture reduction was evaluated based on the Matta scoring criteria, the screw cut-out rate was calculated according to the Lonstein evaluation criteria, and the degree of postoperative heterotopic ossification was evaluated according to the Brooker grading system.Results:All patients were followed up for 18.1±4.7 months (range, 12-30 months). In the 3D navigation group, the operation time was 110.67±44.85 min, the number of intraoperative fluoroscopies was 24.42±9.94, and the number of guided needle drilling was 7.33±4.70, which was lower than 145.00±48.51 min, 75.75±29.47, and 13.92±5.78 in the fluoroscopically-assisted group, and the differences were statistically significant ( P<0.05). At the last follow-up, the Majeed pelvic function score of 3D navigation group was 89.08±3.89, and the excellent and good rate was 100% (12/12). The score of fluoroscopy-assisted group was 74.00±10.71, and the excellent and good rate was 79% (19/24). The difference was statistically significant ( χ2=10.23, P<0.001). The excellent and good rate of Matta grading was 92% (11/12) in the 3D navigation group and 79% (19/24) in the fluoroscopic assisted group, showing no significant difference between the two groups ( χ2=2.93, P=0.403). The screw cut-out rate and heterotopic ossification rate in the 3D navigation group were 17% (2/12) and 8% (1/12), which were lower than 71% (17/24) and 13% (3/24) in the fluoroscopy-assisted group, and the differences were statistically significant ( χ2=9.76, P=0.021; χ2=31.71, P<0.001). Conclusion:3D navigation-assisted percutaneous sacroiliac screw fixation for Tile C1 pelvic fractures can reduce the operation time and radiation exposure, improve the postoperative pelvic function, and reduce the incidence of screw cut-out and heterotopic ossification.

背景:对于PauwelsⅢ型股骨颈骨折,内固定方式选择尚未达成共识.目的:采用三维有限元方法分析股骨颈系统治疗成人PauwelsⅢ型股骨颈骨折的生物力学特征,为其在临床实践中的应用提供理论依据.方法:利用志愿者CT影像资料建立PauwelsⅢ型股骨颈骨折模型,同时建立4种内固定模型:4枚空心拉力螺钉、双平面双支撑螺钉固定、经皮加压钢板、股骨颈系统.将内固定模型与股骨模型按照临床常用固定方法进行装配,最后使用Ansys软件进行加载、计算,分析各模型股骨与内固定的应力分布、应力峰值和最大位移.结果 与结论:①股骨近端骨折块应力主要分布在股骨颈下方靠近股骨距附近,4枚空心拉力螺钉组应力峰值最大,股骨颈系统组最小;②近端骨折块位移峰值4枚空心拉力螺钉组最大,股骨颈系统组最小;③股骨位移峰值经皮加压钢板组位移峰值最大,双平面双支撑螺钉固定组最小;④内固定应力主要分布在骨折面附近内固定装置表面,经皮加压钢板组应力峰值最大,4枚空心拉力螺钉组最小;⑤内固定位移峰值经皮加压钢板组位移峰值最大,双平面双支撑螺钉固定组最小;⑥结果表明,相较于其他3组,股骨颈系统显示出更小的近端骨折块应力及位移,内固定应力分布更均匀、分散,力的传导性更好.此外,双平面双支撑螺钉内固定位移峰值最小,但其内固定应力大于股骨颈系统,且应力相对集中,这可能会导致螺钉断裂.结果 说明,股骨颈系统生物力学稳定性更优,可以为骨折愈合创造更好的力学环境.

髋臼解剖位置深，周围重要的血管、神经集聚，该部位损伤多由高能量暴力导致 [1-2]。髋臼骨折的分型诊断困难，暴露、复位及固定技术要求高，是创伤骨科"皇冠上的明珠"，其精准诊疗对骨科医师也是巨大的挑战 [1-4]。1964年，Letournel与Judet教授将髋臼骨折分为5型简单、5型复杂骨折，自该分型提出以来，其已广泛应用于髋臼骨折的诊疗中 [2,5]。然而，不少学者发现Letournel-Judet分型存在囊括不全、难以理解、对手术治疗指导价值低等弊端，临床应用中易出现骨折类型误诊、手术决策不当等情况，导致患者下肢残疾等严重并发症，给社会和家庭带来沉重负担，严重制约习总书记"健康中国"战略的实施。

Protein delivery and release from synthetic scaffold materials are major challenges within the field of bone tissue engineering. In this study, 13-93B1.5 borosilicate bioactive glass (BSG) base paste was 3D printed to produce BSG-based scaffolds with high porosity (59.85 + 6.04%) and large pore sizes (350-400 um) for functionalization with a sodium alginate (SA)/calcitonin gene-related peptide (CGRP) hydrogel mixture. SA/CGRP hydrogel was uniformly filled into the interconnected pores of 3D printed BSG constructs to produce BSG-SA/CGRP scaffolds which were subject to bioactivity and biocompatibility analysis. BSG scaffolds filled with SA hydrogel underwent dissolution in simulated body fluid (SBF), resulting in the precipitation of hydroxyapatite (HA) on the borosilicate glass evidenced by scanning electron microscope (SEM), energy dispersive spectroscopy (EDS), X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR). Around 90% of CGRP was released from scaffolds after 7 days of immersion in SBF, reaching a final released concentration of 893.00 +/- 63.30 ng/mL. Cellular adhesion, proliferation, and differentiation of human bone marrow mesenchymal stem cells (HBMSCs) cultured with BSG-SA/CGRP scaffolds revealed improved biocompatibility and osteogenic capabilities compared with BSG-SA scaffolds in the absence of CGRP. When subcutaneously implanted in rat models, BSG-SA/CGRP scaffolds induced low localized inflammation without causing bodily harm in vivo. Findings revealed that bioactive glass scaffolds incorporating CGRP met the scaffold requirements for bone regeneration and that the addition of CGRP promoted osteogenic differentiation where it may potentially be utilized for future regenerative applications.

Objective:To explore the application value and effectiveness of pelvic unlocking closed reduction device for the treatment of unstable pelvic posterior ring disruption.Methods:A retrospective analysis of clinical data of 243 cases of unstable pelvic posterior ring disruption treated with pelvic unlocking closed reduction device in 13 orthopaedic trauma centers across the country between December 2018 and June 2020 was performed. There were 139 males and 104 females; the age ranged from 18 to 92 years, with an average age of 48.5 years. The cause of injury included 132 cases of traffic accident injuries, 102 cases of falling from height, and 9 cases of crushing injuries. According to AO/Orthopaedic Trauma Association (AO/OTA) classification, there were 5 cases of type 61-B1, 13 cases of type 61-B2, 32 cases of type 61-C1.1, 47 cases of type 61-C1.2, 89 cases of type 61-C1.3, 35 cases of type 61-C2, and 22 cases of type 61-C3. The time from injury to operation was 2-121 days, with a median of 10 days. Preoperative preparation time, installation time of unlocking closed reduction device, fracture reduction time, intraoperative fluoroscopy times, intraoperative blood loss, and surgical complications were recorded, and Matta scoring standard was used to evaluate the quality of fracture reduction. According to Matta evaluation results, the patients were divided into two subgroups: excellent-good group and fair-poor group. The differences in gender, age, time from injury to operation, AO/OTA classification, and perioperative clinical indicators were compared between the two groups, and the effects of baseline data and perioperative indicators on the quality of fracture reduction were studied.Results:Pelvic unlocking closed reduction device did not interfere with the display of the pelvic structure and fracture displacement direction during the intraoperative fluoroscopy, effectively correcting the displacement of the pelvic ring. The preoperative preparation time was 17-60 minutes, with an average of 30 minutes; installation time of unlocking closed reduction device was 10-32 minutes, with an average of 21 minutes; intraoperative fracture reduction time was 15-205 minutes, with an average of 49.2 minutes; intraoperative fluoroscopy times were 41-420 times, with an average of 132 times; intraoperative blood loss was 40-1 500 mL, with an average of 71.5 mL. The reduction quality of pelvic fracture was evaluated according to Matta score immediately after operation. The results were excellent in 153 cases, good in 61 cases, fair in 24 cases, and poor in 5 cases. The excellent and good rate was 88.1%. Further subgroup analysis showed that there was no significant difference in other indexes ( P>0.05) between the excellent-good group and the fair-poor group except for the time from injury to operation and AO/OTA classification ( P<0.05). Among them, the excellent-good reduction rate was 92.2% (119/129) in patients with injury-to-operation time less than 10 days, and the fair-poor reduction rate was 25.7% (9/35) and 40.9% (9/22) in patients with AO/OTA 61-C2 and 61-C3 types, respectively. There was no surgery-related complication due to the application of the pelvic unlocked reduction device, no secondary iliac fractures, vascular, or nerve injuries, and postoperative CT showed that all channel screws were located in the osseous channel.Conclusion:The pelvic unlocking reduction device can effectively help to reduce the unstable pelvic posterior ring and maintain reduction, meet the needs of different projection angles of pelvic fracture with intraoperative C-arm fluoroscopy. The system facilitate the operation of pelvic reduction and precise fixation.

Objective:By comparing the clinical effect of minimally invasive hollow screw internal fixation Assisted by orthopedic robot (TiRobot) and O-arm navigation in the treatment of pelvic fractures, and practicability and security of both treatments were evaluated.Methods:Retrospective analysis of data of 42 cases of Tile C type pelvic fractures was employed during June 2017 to June 2020. Among them, 32 cases, twenty-four men, eight women, aged 34±6.2 years (range 24-68 years), were treated with percutaneous screw fixation guided by O-arm X wire instrument. According to Tile classification, there were 3 cases of C1.1 type, 8 cases of C1.2 type and 21case of C1.3 type. According to the Denis classification of sacral fractures, 17 cases were in zone I, and 8 cases in zone II. Ten patients, eight males and two females, aged 36±5.2 years (range 19-62 years) were treated by percutaneous screw fixation assisted by orthopedic robot. According to Tile classification, there were 1 case of C1.1 type, 2 cases of C1.2 type and 7 cases of C1.3 type. According to the Denis classification of sacral fractures, there were 5cases in zone I, 2 cases in zone II. For those who got obviously displaced pelvic fractures, Starr frames were used and then internal fixation was used to fix pelvic anterior ring and posterior ring injury respectively. Based on the times of needle adjustments, intraoperative fluoroscopy time, good screw position and incidence of complications two groups were statistically analysed. Matta score was employed to evaluate the quality of fracture reduction, while the Majeed score was employed to evaluate the clinical efficacy. Through the two groups of cases guide needle adjustment times, intraoperative fluoroscopy time, screw position excellent and good rate and the incidence of complications, which were statistically analyzed.Results:All screw positions were confirmed by CT scan after operation. The average time required for each screw placement of the O-arm group was 7.36±2.63 s, of the robot group was 6.80±3.20 s, so difference was not statistically significant ( P<0.05). An average of screw adjustments per one screw was 1.56±0.02 times by O-arm, and by the robot group was 0.34±0.06 times, so differences between the two groups were statistically significant ( P>0.05). The average operating time of O-arm group was 53.86±15.06 min, while the robot group was 52.52±15.14 min, so differences between the two groups were not statistically significant ( P>0.05). Position distribution of screw placement in two groups, all screws in O-arm group of position evaluations were excellent, excellent rate was 100%, all screw position evaluations by robot were excellent, excellent rate was 100%, so difference in screw distribution between the two groups was not statistically significant ( P>0.05). All cases were followed up for 6-12 months. Fracture healing time: 34.6±8.6 weeks for O-arm group, 33.4±9.4 weeks for robot group. Comparison between the two groups was not statistically significant ( P>0.05). Majeed score of O-arm group was 55-87, including Excellence of 17 cases, goodness of 9, fairness of 6. The rate of excellence and goodness was 81.2%, while robot group was 76-95, and that were excellent 7 cases,1 good, and the excellent and good rate was 80%, there was no significant difference between Matta and Majeed score between the two groups ( P>0.05). The incidence of complications between the two groups were no statistically significant ( P>0.05). Conclusion:Orthopedic robot system and O-arm navigation system assisted by percutaneous hollow screw fixation treatment of pelvic anterior and posterior ring injury, which are accurate, safe, minimally invasive, can reduce radiation damage to patients and surgeons. The efficacy were satisfactory. Both treatments are ideal for minimally invasive treatment of pelvic fractures, and the orthopedic robot have advantages of being programmed, standardized, stable and it’s learning curve is shorter.

四肢节段性骨缺损,尤其是临界尺寸节段性骨缺损的修复仍然是骨科最具挑战性的难题之一.人工骨材料逐渐取代自体骨及同种异体骨成为骨缺损修复的研究热点.为评价人工骨材料作为骨缺损修复替代物的发展前景,有必要建立可重复且有效的节段性骨缺损动物模型,但目前尚无一种理想的大动物节段性骨缺损模型能完美模拟人类骨结构和力学特征.因此本文对大动物节段性骨缺损模型的临界尺寸骨缺损大小的取值、常用建模动物的优缺点、节段性骨缺损模型的建立、骨材料的不同固定方法等方面进行综述,以促进大动物节段性骨缺损模型的优化改进.

肩关节脱位是最常见的大关节脱位,双侧肩关节脱位临床较少见.癫或其他任何惊厥发作,极度创伤和电击伤,穿脱套头衣服或举重动作不当都可能造成双侧肩关节脱位,滑水、骑摩托车或骑马损伤等高速运动也可能造成双侧肩关节脱位.双侧肩关节同时脱位存在隐蔽性,临床上易漏诊,除了合并肱骨或肱骨近端骨折,还需关注肩关节脱位是否合并有大结节或喙突骨折以及腋窝神经损伤.老年病人在发生肩关节脱位时要关注急性肩袖撕裂导致肩前方不稳定,年轻病人还需要关注是否合并Hill?Sachs损伤.因此,临床医生需要重视此疾病的发生机制、诊断和治疗.

Objective:To investigate the feasibility and clinical efficacy of percutaneous screw fixation for acetabular anterior column fracture with laser-assisted axial fluoroscopy.Methods:Data of 20 patients (22 sided) with acetabular anterior column fracture treated by percutaneous screw fixation with laser-assisted axial fluoroscopy from January 2017 to December 2018 were retrospectively analyzed. There were 11 males and 9 females with an average of 42.1±3.2 years (range, 24-68 years). There were 7 cases of unilateral acetabular anterior column fracture, 2 cases of bilateral acetabular anterior column fracture (4 sides), 7 cases of anterior column with ipsilateral sacral fracture, and 4 cases of anterior column with sacroiliac joint injury. There were 3 hips of Area I, 6 Area II, 13 Area III of acetabular anterior column fractures according to Nakatani partition. The time from injury to surgery was 5 days (range, 3-11 days). All patients with acetabular anterior column fractures were fixed by percutaneous screw fixation with laser-assisted axial fluoroscopy, and patients with sacral fracture or sacroiliac joint injury were fixed by percutaneous sacroiliac screws with Starr frame-assisted reduction. The time of operation, the number of intraoperative fluoroscopy and the amount of intraoperative bleeding were recorded. Matta scoring criteria were used to assess fracture reduction quality, and hip function was assessed at the last follow-up according to the modified Merle D' Aubigné and Postel scoring system.Results:The average operative time was 22±10 min (range, 20-40 min) with an average times of intraoperative fluoroscopy of 30±8 times (range, 21-45 times), and the amount of intraoperative blood loss was 20±5 ml (range, 10-40 ml). 20 patients were followed up after operation for a period of 14±3.1 months (range, 12-18 months). The quality of postoperative fracture reduction was assessed according to the Matta acetabular fracture reduction criteria: anatomical reduction in 18 hips, satisfactory reduction in 2 hips, unsatisfactory reduction in 2 hips, with an excellent and good rate of 91% (20/22). The fracture healing time was 13±2.2 weeks (range, 11-16 weeks). At the lastest follow-up, hip function was assessed according to the modified Merle D' Aubigné and Postel scoring system: excellent 18, good 3, fair 1, and the satisfactory rate was 95%(21/22). No major neurological, vascular injury, wound infection and ectopic ossification were found during follow-up.Conclusion:Using laser-assisted axial fluoroscopy percutaneous screw to treat acetabular anterior column fracture, the operation is simple. And there is low risk to damage important blood vessels and nerves. This method can shorten the operation time of acetabular anterior column fracture, reduce the amount of blood loss during the operation, and the outcome is satisfactory.

BACKGROUND It is reported that trauma hemorrhagic shock (THS) could resulted in organ injury and is related to a high mortality rate. Maresin-1 (MaR1), a derived medium through biosynthesis, is involved in inflammatory responses. However, the mechanism of MaR1 against acute lung injury needs to be further understood. This report aimed to explore whether MaR1 had a protective effect on lung injury. MATERIAL AND METHODS We constructed a THS-induced acute lung damage rat model and then treated the rats with MaR1. We determined Evan's blue dye (EBD) lung permeability, lung permeability index, wet/dry (W/D) weight ratio, nitric oxide (NO) concentration and inducible nitric oxide synthase (iNOS) expression in lung tissue samples. The inflammation-related cytokines levels in the bronchoalveolar lavage fluid (BALF) and serum of rats were determined by enzyme-linked immunosorbent assay (ELISA). Finally, the TLR4/p38MAPK/NF-kappaB pathway was analyzed by quantitative real-time polymerase chain reaction and western blot assay. RESULTS The increased EBD ratio, lung permeability index and W/D weight ratio, NO concentration and iNOS levels were suppressed by MaR1 treatment. THS-induced over-production of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) in BALF and serum was suppressed by MaR1. Besides, the TLR4/p38MAPK/NF-kappaB pathway activation in THS-induced rats were inhibited by MaR1 treatment. CONCLUSIONS Our study showed that MaR1 could effectively alleviated THS-induced lung injury via inhibiting the excitation of the TLR4/p38MAPK/NF-kappaB pathway in THS-induced rats, suggesting that MaR1 might be a novel agent for lung damage treatment.

目的 比较关节镜下使用2枚Endobutton钢板与切开复位使用空心螺钉固定后交叉韧带(posterior cruci-ate ligament,PCL)胫骨止点撕脱骨折的临床疗效.方法 2015年3月至2018年6月我科收治急性PCL胫骨止点撕脱性骨折患者56例,其中男35例,女21例;年龄18～55岁,平均(29.51±15.02)岁.56例患者随机分为两组,26例采用关节镜下使用2枚Endobutton钢板结合高强线固定(关节镜组),30例采用改良的膝关节后内侧切口使用2枚空心螺钉固定(切开复位组).比较两组患者的手术时间、住院费用,术前、术后3d、术后1个月、术后1年膝关节疼痛评分,末次随访膝关节活动度、Lysholm评分、后抽屉试验阳性率及术后并发症等情况.结果 两组患者均获随访,随访时间12～19个月,平均(14.55±2.63)个月.末次随访所有患者骨折均愈合,无内固定失败、再次骨折发生.关节镜组较切开复位组手术时间长、住院费用高,两组比较差异有统计学意义(P<0.05).关节镜组术后3 d膝关节疼痛评分小于切开复位组,两组比较差异有统计学意义(P<0.05);两组患者术前、术后1个月、术后1年膝关节疼痛评分比较差异无统计学意义(P>0.05).两组患者末次随访膝关节活动度、ysholm评分、后抽屉试验阳性率比较,差异无统计学意义(P>0.05).结论 关节镜下使用2枚Endobutton袢钢板与改良膝关节后内侧入路使用空心螺钉治疗PCL止点撕脱骨折,均可获得良好的手术效果.关节镜组有微创、早期疼痛程度轻的优点,但手术时间较长、费用稍高.

[目的]介绍应用双螺杆骨折撑开器辅助切开复位锁定钢板内固定治疗跟骨SandersⅡ、Ⅲ型骨折的操作方法和初步疗效.[方法] 2016年2月～2017年5月,本院收治的14例(14足)粉碎性跟骨骨折患者,采用跟骨外侧“L”型切口,术中使用内外侧双螺杆骨折撑开器辅助复位,置入跟骨锁定钢板固定.[结果] 14例患者均顺利手术,无腓肠神经损伤.随访12～16个月.末次随访时AOFAS踝-后足评分为61～96分,其中优7例,良6例,可1例,优良率为92.86％ (13/14).影像方面,Bohle角由术前(14.14±5.58)°显著增加至术后(28.14±5.77)°(P＜0.05),Gissan角由术前(106.64±8.81)°显著增加至术后(124.36±5.70)°(P＜0.05).所有骨折末次随访时均已愈合,无内固定松动、退钉、断钉等发生.[结论]使用双螺杆撑开器辅助复位治疗跟骨SandersⅡ、Ⅲ型骨折,可以有效恢复跟骨高度,避免骨折复位再丢失,简化操作,减少手术并发症.

OBJECTIVE:To summarize the clinical application and research status of bioactive glass (BAG) in bone repair. METHODS:The recently published literature concerning BAG in bone repair at home and abroad was reviewed and summarized. RESULTS:BAG has been widely used in clinical bone repair with a favorable effectiveness. In the experimental aspect, to meet different clinical application needs, BAG has been prepared in different forms, such as particles, prosthetic coating, drug and biological factor delivery system, bone cement, and scaffold. And the significant progress has been made. CONCLUSION:BAG has been well studied in the field of bone repair due to its excellent bone repair performance, and it is expected to become a new generation of bone repair material.

[目的]比较应用交锁髓内钉与钢板内固定治疗胫骨多段骨折的临床疗效.[方法]回顾性分析2013年1月～2017年12月在本院行手术治疗的胫骨多段骨折共39例患者的临床资料.根据手术方式不同分为交锁髓内钉组(21例)和钢板组(18例).记录两组的手术时间,术中出血量及术后引流量,骨折愈合时间及并发症发生情况.末次随访时按照Johner-Wruhs胫骨干骨折疗效评估标准对患者功能进行评价.[结果]两组患者均顺利完成手术,术中均未出现肢体血管神经损伤.髓内钉组手术时间、切口总长度和术中失血量均显著优于钢板组,差异有统计学意义(P＜0.05).所有患者随访11～22个月,平均(13.67±4.76)个月.钢板组有2例术后因感染或骨不连行翻修术,而髓内钉组无翻修病例.髓内钉组开始负重行走时间和完全负重行走时间均显著早于钢板组(P＜0.05);末次随访时髓内钉组的膝伸屈、踝背伸和踝跖屈ROM均显著大于钢板组(P＜o.05);末次随访时按Johner-Wruhs标准评定临床效果,髓内钉组优14例,良6例,可1例,优良率95.23％;钢板组优10例,良5例,可1例,差2例,优良率83.33％.两组差异无统计学意义(P＞0.05).[结论]对于胫骨多段骨折,两种手术方式均能取得良好的临床疗效.但髓内钉可以更早负重,并发症发生率更低.

目的 观察肱骨近端锁定钢板内固定治疗老年骨质疏松性肱骨近端骨折的疗效.方法 138例老年骨质疏松性肱骨近端骨折患者随机分为观察组(73例)和对照组(65例),其中观察组采取肱骨近端锁定钢板内固定术治疗,对照组采取人工肱骨头置换术治疗;随访6个月,记录手术时间、切口长度、术中出血量、术后引流量、术后住院时间及并发症发生情况,在术前及术后1、3、6个月进行Constant-Murley肩关节功能评分(CMS),末次随访时采用Neer肩关节功能评分法评估疗效,比较两组疗效优良率.结果 两组手术时间、术中出血量、术后引流量比较,差异无统计学意义(P>0.05);观察组切口长度长于对照组,术后住院时间短于对照组,差异均有统计学意义(P<0.05);随访6个月,观察组并发症发生率明显低于对照组(P<0.05);观察组术后1、3个月CMS明显高于对照组(P<0.05);两组术前及术后6个月CMS差异无统计学意义(P>0.05);观察组末次随访时疗效优良率为85.25％,对照组为89.71％,组间差异无统计学意义(P>0.05).结论 肱骨近端锁定钢板内固定术可用于治疗老年骨质疏松性肱骨近端骨折,近期疗效满意,具有并发症发生少和术后肩关节功能恢复快的优势.

Objective:To evaluate the report quality and study characteristics of randomized controlled trials (RCT) published in the Chinese Journal of Health Management.Methods:All studies published in the Chinese Journal of Health Management from January 2007 to July 2019 were retrieved via Wanfang data. Two researchers screened the articles strictly according to the inclusion and exclusion criteria independently. Based on the Consolidated Standards of Reporting Trials (CONSORT) statement 2010, the report quality and characteristics of the articles (including the type of participants, recruiting site, interventions, outcome measure, etc.) were extracted and summarized. Then the report quality, study characteristics were analysed among three periods based on the publishing date (2008—2011 , 2012—2015 , 2016—2019). Results:Titles, abstracts, and full text manuscripts were screened against inclusion criteria by two independent reviewers and 57 studies were included. There were 13/25 items of the CONSORT statement were fulfilled completely, the other 8/25 items were partly fulfilled, and the else 4/25 items were not met the standards in these studies. There was statistically significant difference in the description ratio of ‘randomization sequence generation’ (16.7% vs. 47.6% vs. 66.7%), foundation (25.0% vs. 33.3% vs. 75.0%) and informed consent (50.0% vs. 76.2% vs. 100.0%) during the three periods (all P<0.05). There was no statistically significant difference in the proportion of chronic diseases (58.3% vs. 85.7% vs. 66.7%), the description ratio of participant flow (41.7% vs. 33.3% vs. 75.0%) and baseline data (83.3% vs. 95.2% vs. 100.0%) in the studies from different periods, however, the description situation of participant flow and baseline data has been improved along the time. Conclusion:According to the CONSORT statement, it is found that the quality of research in health management still needs to be improved, especially in the concealment of randomization and trial registration.