Abstract Purpose: To explore the clinical efficacy of minimally invasive percutaneous internal fixation "three point & two step" procedure for type II Galeazzi fracture without severing pronator quadratus. Methods: Patients admitted to the orthopedic department between December 2018 and February 2022 owing to type II Galeazzi fracture were eligible for analysis.All participants underwent "three point - two step", minimally invasive percutaneous, plate internal fixation, and were assessed for the surgical duration, intraoperative blood loss, postoperative fracture healing, and functional recovery of the affected limb. Results: The follow-up duration was 20.5 ± 10.7 months; the distal incision was 27.5 ± 2.5 mm and the proximal incision was 35 ± 3.78 mm; overall 38.21 ± 30.27 ml of intraoperative blood loss occurred among the analyzed patients; otherwise, all patients showed good alignment of the lower ulnar and radial joints, with no fracture nonunion. The patients received DASH and Mayo scores of 6.37 ± 1.24 and 88.21 ± 8.99, respectively, at 6 months post operation, and exhibited an excellent rate of 85.7%. Conclusions: The minimally invasive percutaneous internal "three point & two step" fixation for type II Galeazzi fracture has the advantages of minimal trauma, rapid recovery, and maximal regaining of wrist function. Thus, this procedure should be clinically promoted.

IntroductionImmunity is involved in a variety of bone metabolic processes, especially osteoporosis. The aim of this study is to explore new bone immune-related markers by bioinformatics method and evaluate their ability to predict osteoporosis. MethodsThe mRNA expression profiles were obtained from GSE7158 in Gene expression Omnibus (GEO), and immune-related genes were obtained from ImmPort database (https://www.immport.org/shared/). immune genes related to bone mineral density(BMD) were screened out for differential analysis. protein-protein interaction (PPIs) networks were used to analyze the interrelationships between different immune-related genes (DIRGs). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses of DIRGs function were performed. A least absolute shrinkage and selection operation (LASSO) regression model and multiple Support Vector Machine-Recursive Feature Elimination (mSVM-RFE) model were constructed to identify the candidate genes for osteoporosis prediction The receiver operator characteristic (ROC) curves were used to validate the performances of predictive models and candidate genes in GEO database (GSE7158,GSE13850).Through the RT - qPCR verify the key genes differentially expressed in peripheral blood mononuclear cells Finally, we constructed a nomogram model for predicting osteoporosis based on five immune-related genes. CIBERSORT algorithm was used to calculate the relative proportion of 22 immune cells. ResultsA total of 1158 DEGs and 66 DIRGs were identified between high-BMD and low-BMD women. These DIRGs were mainly enriched in cytokine-mediated signaling pathway, positive regulation of response to external stimulus and the cellular components of genes are mostly localized to external side of plasma membrane. And the KEGG enrichment analysis were mainly involved in Cytokine-cytokine receptor interaction, PI3K-Akt signaling pathway, Neuroactive ligand-receptor interaction,Natural killer cell mediated cytotoxicity. Then five key genes (CCR5, IAPP, IFNA4, IGHV3-73 and PTGER1) were identified and used as features to construct a predictive prognostic model for osteoporosis using the GSE7158 dataset. ConclusionImmunity plays an important role in the development of osteoporosis.CCR5, IAPP, IFNA4, IGHV3-73 and PTGER1were play an important role in the occurrences and diagnosis of OP.

目的:探讨BARTON骨折切开复位内固定的临床疗效.方法:收治Barton骨折患者40例.所有患者均予以切开复位内固定治疗.结果:治疗后,功能评估优良率95%,患者对治疗效果满意度(90.22±3.11)分;治疗后没有患者发生并发症的情况.结论:对不稳定性桡骨远端骨折患者予以切开复位内固定治疗,其临床效果显著,不会产生并发症,且患者较易接受.

Objective: In view of the poor prognosis and difficulties in the diagnosis of osteosarcoma, and the functionality of microRNA-Let7A in different types of human cancers, our study aimed to explore the diagnostic and prognostic values of microRNA-Let7A for osteosarcoma. Methods: A total of 39 patients with osteosarcoma and 19 normal healthy people were included in this study. All patients received surgical resection, and tumor tissues as well as pericarcinomatous tissues were collected during surgical operation. Venous blood (2 ml) was extracted from each participant. Expression of microRNA-Let7A in tumor tissues and pericarcinomatous tissues, and expression of E2F2 and microRNA-Let7A in blood of each participant was detected by qRT-PCR. ROC analysis was performed to evaluate the diagnostic values of blood E2F2 and microRNA-Let7A for osteosarcoma, and prognostic values of microRNA-Let7A for osteosarcoma was evaluated by survival curve comparisons. Results: Expression level of microRNA-Let7A was significantly lower in tumor tissues than that in pericarcinomatous tissues. MicroRNA-Let7A expression in blood was significantly downregulated in osteosarcoma patients compared with normal control. Expression of microRNA-Let7A was negatively correlated with the expression of E2F2 in blood of osteosarcoma patients. Compared with E2F2, blood microRNA-Let7A can more effectively predict osteosarcoma. Overall survival rate of osteosarcoma patient with low blood expression level of miRNAlet-7a was significantly lower than that of patients with high blood expression level of miRNA-let-7a. Conclusion: Blood microRNA-Let7A is a promising diagnostic and prognostic biomarker for osteosarcoma.

Objective To explore the association among bone iron content,serum ferritin(SF) and bone mineral density in patients with thoracolumbar fractures.Methods A retrospective analysis was conducted in 243 patients with thoracotumbar fracture who were undergone percutaneous kyphoplasty from January 2008 to December 2014.Mean age of the patients(91 males and 152 females)was 62.5 years(range:50-81 years).The patients were assigned to osteopenia group and osteoporosis group based on the preoperative bone mineral density(BMD).Blood samples were collected to determine iron metabolism and bone turnover biomarkers after overnight fasting.Bone specimens were obtained for detecting bone iron contents and performing iron stain respectively after percutaneous kyphoplasty.Results There was no significant statistical significance between osteopenia group and osteoporosis group in gender,age,height, and weight(P>0.05).Pearson correlation analysis showed that the age,bone iron content,SF,serum procollagen type 1 N-terminal propeptide, and β-carboxy terminal telopeptide of collagen type 1 were negatively correlated with BMD at femoral neck (r=-0.712,-0.348、-0.323,-0.236,-0.227;all P<0.05) and lumbar spine (r=-0.541,-0.206,-0.213,-0.184,-0.191;all P<0.05);the weight,body mass index,transferrin, and total iron binding capacity were positively correlated with BMD at femoral neck and lumbar spine (P<0.05).Bone iron content combined with SF could be put into the regression models of BMD at femoral neck and lumbar spine(femoral neck R2=0.388,L1-4 R2=0.374).Both bone iron content and SF were negatively correlated with BMD at lumbar spine (P<0.05).Conclusion The higher the values of bone iron and serum iron protein content in osteoporotic vertebral fracture patients,the higher the degree in osteoporosisis.Iron accumulation and osteoporosis is significantly correlated.

Objective To explore the surgical management and clinical efficacy for terrible triad of the elbow.Methods The clinical data of 28 patients with terrible triad of the elbow were retrospectively analyzed.Lateral approach or lateral combined with anteromedial approach was adopted during surgery.Fixation in coronoid process of ulna was conducted using suture anchor or Herbert hollow screw.Fixation in caput radii using Herbert hollow screw or artificial prosthetic replacement for caput radii was performed.Intraoperative exploration and sew-up were conducted in the patients with internal and external accessory ligament injury.Fixation using hinged external fixator was performed in the patients with elbow joint instability.Results Fracture healing was observed in all cases.The excellence-good rate of elbow joint function was 92.9%(26/28).The total incidence rate of complications was 10.7%(3/28).The range of flexion-extension of elbow joint was(120.1 ±5.7)°.The range of pronation/supination of forearm was(84.4 ±4.6)°/(65.2 ±3.5)°.Conclusion Open reduction and fixation combined with internal and external repair through lateral incision or lateral combined with anteromedial approach might achieve a satisfied clinical efficacy for terrible triad of the elbow.

目的 探讨老年骨科手术患者行改良式皮肤准备方法预防术后感染的效果.方法 老年骨科手术患者96例,随机分为两组,各48例.对照组行常规皮肤准备方法,观察组行改良式皮肤准备方法.观察并比较两组皮肤损伤情况、皮肤准备前后术区细菌数量和术后切口感染率.结果 观察组皮肤损伤率低于对照组(P<0.05),皮肤准备后术区细菌数量少于对照组(P<0.05),术后切口感染率低于对照组(P<0.05).结论改良式皮肤准备方法应用于老年骨科手术患者效果显著,可有效改善患者皮肤损伤情况,减少术区细菌数量,降低术后切口感染率.

目的:探究撬拔复位和切开复位内固定治疗SandersⅡ型跟骨骨折的疗效差异.方法:选取2012年1月～2013年2月骨科收治的68例SandersⅡ型跟骨骨折患者为研究对象,随机分为撬拔组和切开组,每组34例,分别采用撬拔复位内固定和切开复位内固定方法进行治疗,并成功随访1年.比较两组患者手术时间、住院时间、切口愈合时间及术中出血量,随访1年后采用Maryland足功能评分系统评价两组患者功能恢复情况并统计相关并发症发生情况.结果:撬拔组手术时间、住院时间、切开愈合时间及术中出血量明显少于切开组(P＜0.05);随访1年撬拔组和切开组足功能恢复优良率分别为79.41％和82.35％,两组比较差异无统计学意义(P＞0.05);撬拔组和切开组并发症发生率分别为2.94％和17.65％,两组比较差异有统计学意义(P＜0.05).结论:撬拔复位内固定术治疗SandersⅡ型跟骨骨折具有创伤小、术中出血量少等特点,利于切口愈合,能明显缩短手术和住院时间,减少并发症发生.

目的观察中西医结合疗法治疗桡骨下端骨折的临床疗效。方法选取在我院门诊和住院的60例患者。其中患有伸直型骨折35例,关节面骨折15例,屈曲型骨折10例,随机分成两组。观察组40例采用手法复位小夹板外固定治疗与中药外敷方法治疗桡骨下端骨折;对照组20例手术切开复位钢板内固定,分别比较观察组与对照组治愈、疼痛、肿胀情况。结果观察组治愈32例,好转8例;对照组治愈13例,好转7例。两组比较差异无显著性(P<0.05)。结论采用小夹板固定与中药外敷方法治疗桡骨下端骨折的患者恢复快,费用低,骨折恢复的速度快。

Objective To discuss the select of treatment,time of surgery and prevention of complications for type Ⅲ Pilon fractures.Methods Follow-up were done for 31 patients with Pilon fracture who had been treated in our department during April 2003 and July 2009.Their average age was 36.3 years(ranging from 21 to 64 years).6 cases were open fracture,and 25 cases were closed fracture.23 cases were accompanied with fibular fracture.23 cases of tibiae fracture fixed with plate,6 cases were treated with limited internal fixation with screw and Kirschner wire,2 cases were treated with the external fixators combined with limited internal fixation.Results With the 6～22 months follow-up after the operation(average 12 months).According to Mazur's criteria,the result was evaluated as excellent in 3 cases,good in 23 cases,fair in 3 cases and poor in 2 cases.The excellent and good recovery rate was 83.87%.Conclusion Many factors can affect the prognosis of complicated Pilon fracture,the key points for a successful operation are careful assessment of the injury,right treatment and timing of surgery,and practice after operation.

目的探讨应用急诊显微外科手术修复前臂切割伤的临床疗效。方法分析应用显微外科技术治疗2005年6月～2011年6月所收治35例前臂切割伤患者的临床资料。结果全部患者均得到随访,随访时间为术后半年～3年,肌腱损伤及正中神经、尺神经等神经损伤分别按TAM方法及BMRC提出的综合评价肢体神经运动和感觉功能来评定疗效,前者优良率达89.29%,后者优良率达88.89%。结论应用显微外科技术为伴有重要血管、神经损伤的前臂切割伤患者进行一期临床修复,损伤小、操作精细,有助于患者进行及早功能锻炼,具有良好的治疗效果,值得临床推广。

目的探讨四肢骨折脱位合并周围血管损伤的早期诊治。方法应用显微技术,及时修复血管,重建血运,保存肢体。结果本组37例患者无死亡,疗效较佳。患肢功能评定采用Johner-Wruhs评分法:优8例,良24例,可4例,差1例,优良率为86.49%。结论四肢骨折脱位合并血管损伤早期正确诊断及治疗意义重大。

目的探讨胫骨Pilon骨折临床治疗的手术时机、手术方法与治疗效果,为胫骨Pilon骨折的临床诊治提供参考依据。方法对苏州市第七人民医院2005年7月至2010年7月收治的48例胫骨Pilon骨折患者的临床诊治资料进行回顾性分析,对15例开放性骨折患者急诊行手术切开复位清创和锁定钢板内固定方法,对33例闭合性骨折行有限切开复位内固定辅以石膏托外固定患者13例,行切开复位支撑钢板内固定患者20例,对手术治疗效果进行评定。结果术后平均随访时间35个月,优26例,良16例,中4例,差2例,优良率达到87.50%。结论胫骨Pilon骨折后果严重且并发症多,解剖复位牢固固定可取得良好治疗效果,应预防创伤性关节炎和关节僵硬等并发症,以恢复患者踝关节功能。

目的分析肱骨干骨折伴桡神经损伤的原因及治疗方法。方法325例肱骨干骨折患者,行切开复位手术294例,保守治疗31例,出现桡神经损伤7例(2.15%)。其中4例给予单纯松解术,3例端端吻合。结果术后随访3～15个月,7例桡神经损伤者5例伸腕伸指完全恢复,2例不完全恢复。结论肱骨干骨折围手术期均可出现桡神经损伤,及时探查,功能恢复好,提倡早期手术探查

Objective and Method: The author reported their preliminary experience in the treatment of fractures with self-reinforced absorbable (SR . PGAl . PLLA) screws and rods. There were 27 cases of children's supracondylar fracture of humerus (All GarlandⅢ). Results: Functional recovery and the radigraphical appearance in the follow-up shows excellent results in 24 cases , good in 1 case and fair in 1 case. The fractures were all healed without displacement and infection. Conclusion:The authors believe the absorbable SR-PGA , PLLA screw and rod were excellent implant for fixation for children's supracondylar fracture of humerus.

腰椎间盘突出症治疗方法和技术的不断改进和完善,术后并发症逐渐减少.然而术后硬膜外纤维化与疤痕组织的形成,引起硬膜和神经根周围的粘连、硬膜囊受压、神经根滑动受限,以致酿成再发性根性坐骨神经痛或下腰部疼痛致手术失败,仍为临床上没有完全解决的问题.自1996年4月至2003年4月我们采用自体游离小珠状脂肪移植防治腰椎间盘手术后的硬膜及神经根粘连,获得较满意的疗效,现报告如下.

胫腓骨骨折是长管骨中最常发生骨折的部位,自1996年8月至2001年12月我院共收治胫腓骨骨折135例,经不同方法治疗疗效满意,现报告如下.