目的 探讨一期单臂外固定架治疗儿童胫腓骨开放性骨折的临床疗效.方法 选择2013年1月至2016年9月遵义医学院附属医院小儿矫形外科收治的15例胫腓骨开放性骨折患儿作为研究对象,损伤程度为GustiloⅡ型或Ⅲ型,其中男13例,女2例,年龄4～12岁,平均6岁5个月,受伤时间2～9 h,平均5 h,均行急诊清创、骨折复位单臂外固定架固定术,术后随访6～12个月,平均10个月.结果 15例患儿均达到骨性愈合,骨性愈合时间为6～10周,平均8周,1例出现创区皮肤坏死,二期行皮瓣移植后治愈,按Flynn疗效评价标准,优13例,良2例,优良率100％,随访期间患儿未出现感染、骨不愈合、畸形愈合、跛行等并发症.结论 急诊清创、一期单臂外固定架治疗儿童胫腓骨开放性骨折疗效显著,可为临床首选.

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.

Avascular necrosis of the femoral head in children is also known as aseptic necrosis of the femoral head or Legg-Calve-Perthes disease.At present,generally acknowledged that it is a self-limited disease,its etiology is unclear,therapeutic methods are multiformity,and improper handling can lead to severe sequelae.The followings are the bases and clinics about avascular necrosis of the femoral head according to the recent reports and the author's research.

Objective To observe the expression and regulation of MEK,ERK and p-ERK in hemangioma derived endothelial cells (HemECs) and examine the effects of MEK/ERK signal pathway in different phases of infantile hemangioma.Methods HemECs were isolated from freshly resected hemangioma specimens.During logarithmic phase,culture medium was changed to serum-free and cell synchronization started within 48 hours.HemECs were treated with 50 μm/L propranolol,0.1 ng/L estradiol for treatment group and culture medium with serum for control group after 24 hours.Then the protein levels of MEK,ERK and p-ERK,cell cycle distribution and apoptosis were observed.Finally the relationship between apoptosis,cell cycle and protein levels of MEK,ERK and p-ERK was analyzed.Results After estradiol treatment for 24 hours,the protein levels of MEK (0.14 ± 0.01),ERK1/2 (1.36 ± 0.11/0.52 ± 0.10),p-ERK1/2 (0.12 ± 0.03/0.85 ± 0.10) were higher than those of control group MEK(0.08 ± 0.00),ERK1/2 (1.16 ± 0.06/0.29 ± 0.04) and p-ERK1/2 (0.06 ± 0.02/0.42 ± 0.08).And there were significant differences (t =10.01,2.86/3.45,3.57/5.95,P＜0.05).The total ratio of cells in G0/G1 phase (90.52 ± 1.28)％ was lower than that of control group (94.02 ± 0.85) ％.And there were significant differences (t =-3.98,P＜0.05).The total ratio of apoptosis cells (0.70 ± 0.10) ％ declined compared to control group (1.77 ± 0.21) ％.And the difference was statistically significant (t =-8.00,P＜0.05).After with a 24-hour treatment of propranolol,the protein levels of MEK (0.06 ± 0.01),ERK1/2(0.87 ± 0.05/0.14 ± 0.01) and p-ERK1/2 (0.02 ± 0.01/0.11 ± 0.05) were lower than those of control group.And there was significant difference(t =-2.88,-6.79/-6.20,-3.96/-5.74,P＜0.05).Cell cycle were arrested in G0/G1 phase.Compared to control group,propranolol group (96.42 ± 1.16)％ was higher than control group.And there was significant difference(t =-2.89,P＜0.05).The total ratio of apoptotic cells (2.87 ± 0.57)％ increased versus control group.And the difference was statistically significant (t =3.14,P＜0.05).Conclusions MEK/ERK pathway plays an important role in G0/G1 phase arrest and apoptosis of hemangioma vascular endothelial cells in vitro.Estradiol and propranolol may regulate the proliferation and apoptosis of HernECs through MEK/ERK signaling pathway.