Background:A patellar avulsion fracture is a unique fracture type in children with an extremely low incidence rate in knee joint injuries, most of which are unilateral. Cases of simultaneous bilateral fracture are rare. Due to the physiological and anatomical characteristics of patellar sleeve fractures in children, obvious avulsed bony fragments are seldom seen with plain radiography after trauma; thus, this fracture type is often misdiagnosed or missed on first evaluation. Early diagnosis of patellar sleeve fracture is the key to successful treatment.Case report:This paper presents a case of bilateral patellar sleeve fracture in a 10-year-old girl that was missed in another hospital and treated successfully by open reduction and fixation of the osteochondral fragments after the patient was transferred to our hospital, yielding good clinical outcomes at the one-year follow-up.Conclusion:Overall, this case report described the clinical and imaging characteristics of inferior pole sleeve fractures in children and highlight clinicians' awareness of this injury to assist in early, accurate diagnosis and reduce the incidence of misdiagnosis and missed diagnosis due to unfamiliarity.

Objective:To analyze the clinical characteristic of patellar sleeve fracture in children, so as to improve the understanding of pediatric patellar sleeve fracture and reduce the misdiagnosis rate.Methods:Clinical data of 18 children with patellar sleeve fractures admitted and followed up in Department of Pediatric Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University from January 2013 to December 2019 were retrospectively analyzed, including 10 males and 8 females with the mean age of 11.4 years (8.0-14.0 years). There were 10 right patellar sleeve fracture cases, 7 left cases, and 1 case on both sides.Classified by the fracture cause, 10 cases were caused by falls, 3 cases of high jump, 2 cases of falling from height, 2 cases of car accidents, and 1 case of rope skipping, and all of cases were closed injuries.The mean post-injury visit to Affiliated Hospital of Zunyi Medical University was 3.5 days (4 hours -7 days). Twelve out of cases were transferred from other hospitals.All patients were treated with the open reduction and tension band wiring or patella tendon suturing through bone tunnel + patella circumferential wire banding and fixation.The curative effect of patella fracture was evaluated by the Bostman score.Results:Eighteen children with patellar sleeve fracture were diagnosed and treated promptly after admission, and regularly followed up after the operation for an average of 14 months (9-28 months). All cases achieved stage Ⅰ wound healing, and Kirschner wires and steel wires were removed according to the condition of fracture healing at 6 to 10 months postoperatively.According to the Bostman score for evaluating the patella fracture, 15 cases were excellent, 3 cases were good, and there were no missed or misdiagnosed cases.Conclusions:Patella sleeve avulsion fracture is a unique type of fracture in children.As cartilage is the main distal avulsion fracture lesion, it is difficult to be detected on X-ray scans, thus easily leading to missed diagnosis and misdiagnosis.Improving the understanding of this fracture type is the key to the early diagnosis and treatment.

Background: The epidemiological characteristics of the common pathogens underlying acute haematogenous osteoarticular infection (AHOI) and their resistance to drugs have temporal and regional differences. Aims: To determine the antimicrobial treatment most effective for culture-negative AHOI patients and those without bacterial cultures. Methods: Retrospective analysis of clinical data of children with AHOI who were culture positive from January 2007 to December 2021. And the distribution of the main pathogens and the drug resistance Staphylococcus aureus were analysed in different time periods, age groups and infection types. Results: A total of 188 cases met the inclusion criteria, including 97 cases of acute haematogenous osteomyelitis (AHO), 75 cases of septic arthritis (SA) and 16 cases of AHO concomitant with SA. The commonest causative pathogen in local children was S. aureus of Gram-positive cocci, followed by Streptococcus, and occasionally Gram-negative bacilli. The distribution of S. aureus had no significant correlation with age or infection type. Staphylococcus aureus accounted for 81.82%, 90.91% and 96.15% of all pathogens, and methicillin-resistant S. aureus (MRSA) accounted for 24.22%, 53.33% and 76.00% of S. aureus in 2007-11, 2012-16 and 2017-21, respectively. The frequency of MRSA infection showed an increasing trend over time. Conclusion: Staphylococcus aureus is still the main pathogen of AHOI in local children. The proportion of MRSA in S. aureus has also increased over time to 76% in the last 5 years, and the increased proportion of MRSA can affect the choice of initial empirical medication.

目的 探讨儿童狭窄性腱鞘炎经皮微创松解术治疗的临床效果.方法 47例(51指)狭窄性腱鞘炎患儿,按手术方式分为传统手术组25例(28指)和微创手术组22例(23指),分别行腱鞘炎松解术.术后随访3～6个月,采用Quinnell分级标准比较2组手术指功能和术后切口美观情况等.结果 术后2组患儿均痊愈,无不良反应;微创手术组单指手术时间[(9.42±1.00)min]短于传统手术组[(13.23±2.66)min](P＜0.05);微创手术组术后指功能优20指,良3指,优良率100％;传统手术组优24指,良4指,优良率100％,2组治疗后指功能疗效比较差异无统计学意义(P＞0.05);微创手术组术后指功能恢复时间[(1.29±0.39)d]短于传统手术组[(4.32±1.52)d](P＜0.05),术区瘢痕发生率(4.54％)低于传统手术组(36.00％)(P＜0.05).结论 经皮微创松解术治疗儿童狭窄性腱鞘炎手术时间短,指功能恢复好,切口美观.

目的 探讨脱细胞异体真皮联合头刃厚皮修复儿童瘢痕创面的临床效果.方法 52例外伤及烧伤后瘢痕,根据瘢痕切除后创面封闭术式分为复合植皮组和自体植皮组各26例,一次性切除瘢痕后,复合植皮组采用脱细胞异体真皮联合头刃厚皮移植修复创面,自体植皮组采用自体刃厚皮片或薄中厚皮片移植修复创面.比较2组植皮成活率和植皮后创面完全愈合时间,随访10个月,观察创面移植区域的色泽、质地、皮下丰满度、瘢痕增生情况及对关节功能的影响等.结果 复合植皮组创面植皮成活率(92.31％)、创面愈合时间(12.62±3.18)d]与自体植皮组[96.15％、(11.90二2.61)d]比较差异均无统计学意义(P＞0.05);复合植皮组植皮区丰满,瘢痕增生轻,色泽、质地优于自体植皮组(P＜0.05);复合植皮组关节功能受影响5例,自体植皮组关节功能受影响10例,差异有统计学意义(P＜0.05);复合植皮组头皮供皮区均无瘢痕增生,自体植皮组供皮区色素改变1 6例,瘢痕形成10例,其中2种情况均发生者8例,供皮区瘙痒16例,供皮区反复破溃3例,影响睡眠5例.结论 脱细胞异体真皮联合头刃厚皮修复儿童瘢痕丰满度高、瘢痕增生轻,功能恢复好,供皮区损伤小.

Objective To detect the relations of Wnt/β-catenin signal pathway and avascular necrosis femoral head of steroid-induced juvenile rabbits.Methods Thirty-five 8-week-old healthy New Zealand rabbits weighing 1.1-1.9 kg were randomly divided into steroid injection group (SIG,n =25) and control group (CG,n =10) according to a random number table.Prednisolone acetate of 7.5 mg/kg was injected into each SIG rabbit and an equal volume of saline for CG twice weekly for 8 weeks.Radiography and computed tomography (CT) were performed at Weeks 4,8 post-injection.All experimental animals were sacrificed at Week 8 and bilateral femoral heads harvested.According to imaging findings,SIG was further divided into disease group (DG) and non-disease group (NDG).Reverse transcription-polymerase chain reaction (RT-PCR) was employed for detecting the expressions of caspase-3,adipoq,β-catenin,LRP5 and BMP-2 mRNA in femoral heads of DG,NDG and CG.And the differences were compared among three groups.Results In SIG (n =25),only 22 rabbits survived and 6 experimental animals had positive avascular necrosis (DG) at an incidence of 27.3％ (6/22).The expression levels of β-catenin were 0.22 ± 0.01,0.35 ± 0.09 and 1.07 ± 0.41 in DG,NDG and CG respectively.Significant differences existed between CG and two other groups (t =4.94,10.60,P＜0.05).The expression levels of LRP5 were 0.22 ± 0.05,0.35 ± 0.12 and 1.12 ± 0.36 in DG,NDG and CG respectively.Significant differences existed between CG and two other groups (t =4.39,9.93,P＜0.05).The expression levels of Adipoq were 17.84 ± 5.51,3.33 ± 1.26 and 1.11 ± 0.27 in DG,NDG and CG respectively.Significant differences existed between CG and two other groups (t =5.88,12.01,P＜0.05).The expression levels of caspase-3 were 3.10 ± 0.90,1.29 ± 0.35 and 1.06 ± 0.24 in DG,NDG and CG respectively.Significant differences existed between CG and two other groups (t =7.15,7.75,P＜0.05).The expression levels of BMP-2 were 0.08 ± 0.05,0.31 ± 0.21 and 1.12 ± 0.32 in DG,NDG and CG respectively.Significant differences existed between CG and two other groups (t =2.93,8.08,P＜0.05).In DG,NDG and CG,the expression levels of β-catenin were positively correlated with LRP5 (r =0.779,0.914,0.885,P =0.008,0.020,0.019);the expression levels of caspase-3 negatively correlated with β-catenin,the expression levels of caspase-3 negatively correlated with LRP5,the expression levels of adipoq negatively correlated with β-catenin,the expression levels of adipoq negatively correlated with LRP5,the expression levels of BMP-2 positively correlated with β-catenin and the expression levels of BMP-2 positively correlated with LRP5.Conclusions Inhibitory effects of glucocorticoids on Wnt/β-catenin signal pathway may contribute to the apoptosis of osteoblasts and chondrocytes of femoral head,promote the formation of adipocytes and inhibit osteogenesis.

目的：对比观察增生期和退化期小儿毛细血管瘤组织中磷酸腺苷活化蛋白激酶（AMPK）、哺乳动物雷帕霉素靶蛋白（mTOR）表达，探讨AMPK／mTOR通路在小儿毛细血管瘤消退过程中的作用。方法收集50例小儿毛细血管瘤患者的瘤组织标本，按照Mulliken分类法24例患儿瘤组织处于增生期（增生期组），26例患儿瘤组织处于退化期（退化期组），采用免疫组织化学法检测其中 AMPK、mTOR的积分光密度。结果增生期组 AMPK、mTOR的积分光密度分别为33．94±12．78、182．43±47．10，退化期组分别为85．87±19．53、47．22±44．52。两组毛细血管瘤组织AMPK、mTOR积分光密度相比，P均＜0．01。50例小儿毛细血管瘤患者瘤组织AMPK、mTOR积分光密度值呈负相关（r＝－0．78，P＜0．01）。结论与增生期小儿毛细血管瘤组织相比，消退期小儿血管瘤组织中AMPK表达升高，mTOR表达降低。AMPK／mTOR信号通路参与小儿毛细血管瘤的消退过程。

Objective To systematically evaluate the association between protein C and Legg -Calve -Perthes disease.Methods A literature research was performed through PubMed,Embase,Cochrane library,Web of Science,Chinese Biomedical Literature Database(CBM),China National Knowledge Infrastructure(CNKI)and Wan-fang Database from inception to February 201 6 on the association between protein C and Legg -Calve -Perthes disease.According to the Newcastle -Ottawa Scale(NOS)criteria,the quality of studies was evaluated and data were extracted.Meta -analysis was performed with Stata 1 1 .0 software.Results A total of 1 4 articles were included.Twelve articles on protein C and Legg -Calve -Perthes disease in the study group and the control group were compared.The results of Meta -analysis showed that there was no significant difference in protein C levels between the study group and the control group[odds radio(OR)=1 .41 ,95% confidence interval(CI)(0.87,2.28),P =0.1 47];five articles on protein C and the white race of Legg -Calve -Perthes disease between the study group and the control group were com-pared,The results of Meta -analysis showed that there was no significant difference in protein C levels between the whiteskin patients′group and the control group[OR =0.61 2,95%CI(1 .83,7.29),P =0.61 2];three articles on pro-tein C and the yellow race of Legg -Calve -Perthes disease between the study group and the control group were com-pared,and the results of Meta -analysis showed that there was no significant difference in protein C levels between the yellow skin patients group and the control group[OR =0.59,95%CI(0.05,6.72),P =0.080].Conclusion There is no significant correlation between protein C and Legg -Calve -Perthes disease.