Rationale:To investigate the clinical efficacy of the axillary approach in the surgical treatment of Ideberg type I and II scapular glenoid fractures. Patient concerns and diagnosis:Retrospective analysis of 13 cases of scapular glenoid fracture treated in the affiliated Hospital of Jining Medical College, Jiaxiang County People hospital, Zoucheng City people Hospital, Yanzhou District People Hospital, and Juancheng County people Hospital from December 2020 to January 2022. Eight males (including 1 bilateral) and 5 females, with an average age of 57.5 years (range from 33 to 75 years). According to Ideberg classification, there were 10 cases of type I a, 1 case of type I a combined with type I b, and 2 cases of type II. All patients were treated with axillary approach surgery and 7 patients with combined anterior shoulder dislocation were treated by first-stage manipulation and second-stage reoperation. Seven patients were fixed with a wire anchor, 3 patients with type I a were fixed with a "T" plate, and 5 patients were complicated with rotator cuff tear and were repaired with a wire anchor. At the last follow-up, the Constant-Murley shoulder function score, visual analog score, DASH score, and Hawkins grade were used to evaluate shoulder function, pain, and stability after treatment. Intervention:The intervention was to treat patients with Ideberg type I and II scaphoid fractures using an axillary approach. Outcomes:All 13 patients in this group were followed up thoroughly, and the follow-up time was 12 to 25 months, with an average of 18.6 months. The operation time was 65 to 135 minutes, with an average of 85.6 minutes. Intraoperative blood loss ranged from 20 to 120 mL, averaging 55.6 mL. The duration of hospitalization ranged from 7 to 22 days, with an average of 9.6 days. The surgical incisions of all patients were grade-A healing. Bone healing of glenoid fractures was observed 3 months after the operation. Lessons:The axillary approach for Ideberg type I and II scapular glenoid fractures is a feasible surgical approach with complete access through the muscle gap, minimal surgical trauma, mild postoperative pain, and satisfactory clinical results.

OBJECTIVE:To formulate the classification criteria of femoral intertrochanteric fractures based on irreducibility or not in order to predict the difficulty of fracture recovery. METHODS:A clinical data of 244 patients with closed femoral intertrochanteric fractures admitted between January 2017 and March 2020 was retrospectively analyzed. There were 116 males and 128 females with an average age of 77.9 years (range, 45-100 years). The cause of injury included falling in 190 cases, traffic accident in 36 cases, smashing in 13 cases, and falling from height in 5 cases. The time from injury to operation was 1-14 days (mean, 3.6 days). According toAO/Orthopaedic Trauma Association (AO/OTA) classification, the fractures were classified as type 31-A1 in 38 cases, type 31-A2 in 160 cases, and type 31-A3 in 46 cases. According to whether the recovery difficulty occurred after intraoperative closed traction reset, the patients were divided into reducible-group and irreducible-group; combined with the literature and preoperative imaging data of two groups, the classification criteria of femoral intertrochanteric fractures was formulated based on the irreducibility or not. The 244 fractures were classified by the doctors who did not attend the operation according to the classification criteria, predicted the difficulty of fracture reduction, and compared with the actual intraoperative reduction situation. RESULTS:The 244 patients were divided into reducible-group ( n=164, 67.21%) and irreducible-group ( n=80, 32.79%) according to the intraoperative difficulty of reduction. Comparing the imaging data and characteristics of the two groups, and formulating the classification criteria of femoral intertrochanteric fractures based on irreducibility or not, the fractures were mainly divided into two categories of irreducibility and reducibility. The fractures of irreducibility category was divided into typesⅠ-Ⅴ, among which type Ⅲ was divided into subtypes 1-4; the fractures of reducibility category was divided into typesⅠand Ⅱ. Compared with the actual intraoperative evaluation results, the total accuracy rate of the doctors who did not attend the operation was 81.15% (198/244) based on the classification criteria of femoral intertrochanteric fractures. The accuracy rate of irreducibility category was 65.74% (71/108), and the reducibility category was 93.38% (127/136). All patients were followed up 13-25 months, with an average of 17.6 months. All fractures healed except 2 cases died of infection. CONCLUSION:The classification criteria of femoral intertrochanteric fractures based on irreducibility or not can accurately predict the reducible cases preoperatively, and most of the irreducible cases can be correctly predicted in a wider way. But the classification criteria still need to be further improved and supplemented.

目的 评价采用Ilizarov技术行骨搬运与骨短缩-延长治疗胫骨骨缺损合并软组织缺损的效果.方法 选择51例胫骨骨缺损合并软组织缺损的患者,根据治疗方式的不同分为试验组27例和对照组24例.对照组患者采用Ilizarov技术行骨搬运治疗,试验组患者采用Ilizarov技术行骨短缩-延长治疗.观察2组患者的术后疗效及并发症,骨折愈合时间、愈合疗效及患肢的膝关节功能恢复情况.结果 对照组患者的皮瓣移植均成活,创面达到Ⅱ期愈合;试验组患者创面达Ⅰ期愈合者7例,Ⅱ期愈合者15例,延期愈合者5例.2组患者术后均未发现合并永久性神经损伤及腓骨截骨处持续性疼痛等严重并发症.试验组患者术后并发症发生率为51.85％,对照组并发症发生率为62.50％,2组比较差异无统计学意义(x2=0.587 3,P=0.443 5).2组患者全部获得随访,随访时间至少1.5年,平均为(2.3±1.7)年.2组患者的骨折处骨延长端均自然愈合,其中试验组患者的愈合时间为(8.75±2.25)个月,对照组患者的愈合时间为(8.92±2.28)个月,2组患者的愈合时间比较差异无统计学意义(t=0.267 6,P=0.790 1).试验组患者骨缺损端愈合时间为(0.89±0.21)年,对照组患者的愈合时间为(1.12±0.18)年,2组比较差异有统计学意义(t=4.172 4,P=0.000 1);试验组骨缺损端自然愈合19例,二次清理后愈合5例,复植骨后愈合3例,对照组患者自然愈合17例,二次清理后愈合6例,复植骨后愈合1例,2组患者的自然愈合率比较差异无统计学意义(x2 =0.001 3,P=0.971 1).试验组患者的膝关节功能治疗后总有效率为88.89％,对照组为83.33％,2组比较差异无统计学意义(x2 =0.331 2,P=0.565 0).结论 采用Ilizarov技术行骨搬运与骨短缩-延长治疗胫骨骨缺损合并软组织缺损均可收到较好的临床效果,且采用骨短缩-延长治疗时患者的骨缺损端愈合时间较短.

BACKGROUND:Although there are many studies addressing osteoarthritis in China, population-based epidemiological studies of knee osteoarthritis have been rarely reported. OBJECTIVE:To explore and analyze the clinical efficacy of early ladder-like treatment in knee osteoarthritis patients from Zoucheng city in the southwest of Shandong province based on an epidemiological investigation. METHODS: A total of 3 427 people randomly enroled from Zoucheng city located in the southwest of Shandong province in 2008 were taken as research objects. A self-designed epidemiological survey on knee osteoarthritis was carried out to analyze the sex, age, urban and rural distribution, and incidence of knee osteoarthritis. According to Kelgren Lawrence Grading, 208 patients with levels 0, I, II of knee osteoarthritis were randomly selected and divided into two groups: surgical treatment group was given intraarticular injection, intraarticular rinsing, arthroscopic treatment and functional exercise; oral drug group was only given oral administration of non-steroidal anti-inflammatory drugs and blood circulation drugs. Ninety-eight patients in the surgical treatment group and 87 in the oral drug group were folowed-up for over 1 year. RESULTS AND CONCLUSION:The incidence of knee osteoarthritis showed an increasing trend with aging in Zoucheng city. There were 33.2% patients who did not receive treatment, 53.2% patients who received irregular treatment, and only 13.6 patients who could folow the doctor’s advice. The excelent rate and total effective rate were higher in the surgical treatment group (81% and 99%) than the control group (34% and 87%;P < 0.01). This epidemiological investigation exerts a certain protective role in the occurrence and development of knee osteoarthritis, and active early ladder-like treatment has achieved good outcomes in patients with knee osteoarthritis.

Objective:To investigate the effect of the humeral fracture with external fixator combined with absorbable screws.Methods:Sixty-eight cases of humeral fracture were treated with minimal incision and external fixator combined with 1~2 absorbable screws.Results: All cases in the group were followed up for 4~12 months.The average healing time was five months.Healing occurred uneventfully in all cases.The function of the shoulder joint and elbow joint was excellent.Conclusions: This operative method of external fixator combined with absorbable screws has the advantages of stable fixation,less operative time,less amount of operative bleeding,minimum tissue trauma and quicker bone union.It can also avoid the second surgical operation.

目的:探讨解剖钢板内固定治疗胫骨平台骨折的效果.方法:本组83例分别采用前外侧、前内侧或前内外侧联合切口,用单侧或双侧高尔夫钢板固定,骨缺损取自体髂骨植骨,术后早期行功能锻炼.结果:本组83例,78例得到随访膝关节功能按照雍氏评级标准:优58例、良15例、可3例、差2例,优良率为93.6%.结论:使用该固定方法较为牢固,骨折愈合快,病人可以进行早期的功能锻炼,能预防关节粘连僵硬,有利于膝关节内能恢复.