Objective:To evaluate clinical outcomes and complications of minimal invasive surgery for the treatment of elderly patients with fragility fracture of pelvis.Methods:Elderly patients with fragile pelvic fractures undergoing minimally invasive surgery and being followed up were retrospectively analyzed from January 2015 to December 2019.Based on the classification of pelvic fragile fractures(FFP), open reduction and internal fixation with pelvic anterior ring instability internal fixator(INFIX)plus posterior ring sacroiliac screw, or open reduction and internal fixation with iliac fossa approach, were performed for elderly patients with fragile pelvic fractures.The general data of all patients(age, sex, mechanism of injury)were recorded.Time from injury to operation, VAS(visual analogue scale)before and after operation, blood loss during operation, complications during hospitalization, time to ambulation, mortality, and Koval walking index at 2 year follow-up were recorded to evaluate clinical outcomes and complications of minimal invasive surgery for the treatment of fragility fracture of pelvis.Results:Thirty-two patients were followed up, including 11 males and 21 females, aged 65-88 years(76.9±5.5)years.The mechanism of injury was fall on the ground as a percentage of 59.4%(19/32), fall in the sitting position as a percentage of 25.0%(8/32), and 15.63%(5/32)had unknown history of trauma.The time from injury to operation was 3-36 days(9.6±3.3)days.There were 50.0%(16/32)type Ⅱ, 31.3%(10/32)type Ⅲ and 18.8%(6/32)type Ⅳ cases according to FFP classification.The mean blood loss during operation was(65.9±35.2)ml(range, 20-200 ml). The preoperative VAS score was 5-9 scores, with an average of(6.41±1.07)scores.The postoperative VAS score was 1-4(1.71±0.63). Average time from injury to operation was(9.6±3.3)days(range, 3~36). The incidence of complications during operation was 9.4%(3/32), including 1 case of gastrointestinal bleeding, 1 case of lower extremity deep vein thrombosis, and 1 case of superficial wound infection.Ambulation was at 4 weeks post-operation in 56.3%(18/32)cases, at 6 weeks post-operation in 31.3%(10/32)cases and at 8 weeks post-operation in 12.5%(4/32)cases.6.25%(2/32)patients died within 2 year follow-up.Koval walking index of the rest 30 patients included grade 1 in 46.9%(15/32)cases, grade 2 in 18.8%(6/32)cases, grade 3 in 6.3%(2/32)cases, grade 4 in 18.8%(6/32)cases and grade 6 in 3.1%(1/32)case(1 year after surgery, hemiplegia after cerebral infarction).Conclusions:Minimal invasive surgery achieves significant pain relief and early mobilization in patients with fragility fracture of pelvis.

Objective:To evaluate the clinical outcomes of Acumed intramedullary nailing for AO type A3 forearm diaphyseal fracture in adults.Methods:A retrospective study was conducted of the 20 adult patients with AO type A3 forearm diaphyseal fracture who had been treated by Acumed intramedullary nailing from January 2016 to November 2018 at PLA General Hospital. They were 18 males and 2 females, aged from 18 to 56 years (average, 36.5 years). There were 6 radius diaphyseal fractures, 9 ulna diaphyseal fractures and 5 diaphyseal fractures of both forearm bones. The clinical outcomes of Acumed intramedullary nailing for AO type A3 forearm diaphyseal fractures were evaluated by recording the perioperative complications, fracture union time, forearm rotation range at 12-month follow-up, and Disability of the Arm, Shoulder and Hand Questionnaire (DASH) scores for the upper limb function.Results:The 20 patients were followed up for 12 to 18 months (mean, 15.8 months). Bony union was achieved in all the patients after 3 to 4 months (average, 3.3 months). Partial rupture of the extensor pollicis longus tendon happened during operation in one patient and at 3 months post-operation in another due to fixation irritation, and linear ossification of interosseous membranes was observed in one patient with diaphyseal fractures of both forearm bones. 12-month follow-ups showed that, in the 20 patients, forearm pronation ranged from 80° to 90° (average, 89°), supination from 60° to 90° (average, 86.3°) and DASH scores from 0 to 37 (average, 6.5).Conclusions:In the treatment of AO type A3 forearm diaphyseal fracture in adults, Acumed intramedullary nailing can lead to successful fracture union and excellent rotational activity at one year after operation. Therefore, adult AO type A3 forearm diaphyseal fracture can be listed as an indication for Acumed intramedullary nailing.

目的 ：调查研究集束化护理在骨科压疮预防中的应用效果。方法 ：选取我院收治的 70 例骨科压疮患者作为研究对象。70 位参与研究的入院患者入院时间均在 2019 年 1 月至 2020 年 12 月，依据入院时间分为研究组与对照组，每组分别占 35 例 ；对照组患者在入院期间采用常规护理模式 ；研究组患者则采用集束化护理干预措施，比较两组患者的临床治疗护理效果。结果 ：经不同方式护理后，研究组患者的压疮发生率显著低于对照组患者，患者的住院时间和知识掌握评分数据均显著优于对照组患者，研究组的满意度高达 97.14%，显著高于对照组的 45.71%，以上两组患者的数据做出对比，存在统计学意义（P ＜ 0.05）。结论 ：在骨科压疮预防中对患者采用集束化护理措施，具有显著的临床效果，增加患者对于疾病知识的了解程度，降低患者压疮的发生率，减少患者的住院时间，增加患者的护理满意度，值得借鉴和推广。

目的 了解终末期肾病(end stage renal disease,ESRD)在髋部骨折患者中的发病率,研究ESRD对髋部骨折患者预后的影响.方法 2012年1月至2016年12月我院共收治60岁以上、行手术治疗的髋部骨折患者1004例,其中合并ESRD患者41例(4.1％),其中男22例,女19例,年龄60～87岁,平均(77.39±7.04)岁,股骨转子间骨折25例,股骨颈骨折16例,分析ESRD对老年髋部骨折预后的影响.结果 合并ESRD老年髋部骨折患者术后30天、1年病死率分别为19.5％(8/41)、43.9％(18/41),19例(46.3％)患者发生27项并发症,人均并发症为(0.683±0.820)项,平均住院时间(15.53±14.51)天,8例(19.5％)术后需再手术,其中6例为股骨颈骨折未愈合,1例股骨粗隆间骨折内固定失效,1例因假体周围骨折行钢板固定,术后1年ADL评分平均为(55.00±7.23)分,存活患者中4例卧床,17例需辅助装置行走,2例可完全独立行走.结论 髋部骨折合并ESRD患者发病率较高,此类患者预后较差,住院时间长,再手术率高,术后1年病死率高,功能恢复差.

Pelvic fragility fractures are increasing with the aging population in China, characterized by high incidence, high mortality and high morbidity just as geriatric hip fractures. In diagnosis of a pelvic fragility fracture in the elderly, the patient＇s age, comorbidities, osteogenic factors, clinical manifestations and imaging examinations should be taken into consideration, as well as the special anatomical features and morphologies resulted from degenerative anatomy of the pelvis in the aged. Standard pelvic X-rays and CT scans may confirm the diagnosis in most cases, but MRI may prevent missing a fracture of malfunctioning pelvis or an insidious fracture line on the posterior ring. Fragility fractures of pelvis (FFP) classification, base on X-ray and CT checks, is a common guiding system in current clinic. Usually, conservative treatment is indicated for fractures of FFP types Ⅰ-Ⅱ while surgery for those of FFP types Ⅲ-Ⅳ. As far as possible, minimally invasive reduction and simultaneous fixation of the anterior and posterior rings are recommended. This article intends to review the characteristics, classification and development of minimally invasive techniques concerning pelvic fragility fractures in recent years, and to discuss the future trends in treatment of geriatric pelvic fractures.

目的 探讨基于电影情景的PBL教学法在培养医学生伤害控制学理念的长期随访效果.方法 回顾性研究2007-2010年在我院实习轮转的原第二军医大学2001-2004级临床医学专业本科生共90名.根据纳入排除标准2001-2002级学生共43名按传统教学方法大班形式教学(SBL组);2003-2004级共44名采用电影情景和经典病例模拟教学(PBL组).教学后即刻进行教研室统一命题考试和结构性问卷调查教学满意度;分别于毕业后1年和10年采用结构性问卷调查教学满意度和伤害控制学的理念与实践使用情况,并统计分析比较.结果 两组教学后即刻伤害控制学考试成绩,PB L组成绩优于SBL组,临床综合思维能力具有显著统计学差异.教学后即刻问卷调查显示,在团结合作和语言表达两组没有统计学差异;PBL组在文献收集、课堂氛围和实践指导优于SBL组,有统计学差异.毕业后1年、10年两组伤害控制学理念和实践应用PBL组虽然高于SBL组,但两组并没有统计学差异;课堂氛围和实践指导的满意度有明显的统计学差异.结论 基于电影情景模拟的PB L教学法指导伤害控制学理念长期满意度高,对活跃课堂气氛、提高医学生临床实践能力有所补益.

Objective:To investigate the characteristics of fragility fractures of pelvis(FFP) in the elderly and compare the clinical efficacy between conservative treatment and minimally invasive surgery.Methods:A retrospective study was conducted in the 56 elderly FFP patients who had been treated at Department of Orthopaedics, The General Hospital of Chinese People＇s Liberation Army from January 2017 to January 2019. They were 16 males and 40 females, with an age of 73.4 years (from 65 to 93 years). By the American Society of Anesthesiologists (ASA) classification, there were 12 cases of grade Ⅰ, 16 cases of grade Ⅱ, 20 cases of grade Ⅲ, and 8 cases of grade Ⅳ; by the FFP classification, there were 6 cases of type Ⅰ, 10 cases of type Ⅱ, 36 cases of type Ⅲ, and 4 cases of type Ⅳ. The morphological characteristics and injury mechanisms of FFP were analyzed. According to the treatment methods, the patients were divided into a conservative treatment group of 32 cases and a minimally invasive surgery group of 24 cases. The 2 groups were compared in terms of complication incidence, mortality and the Koval attenuation rate of walking ability after one-year follow-up.Results:There were mostly the fractures of pubic branches on both sides of the pubic symphysis and compression fractures of the sacral wing caused by lateral crush injury. The 2 groups were comparable due to no significant differences in the preoperative general data between them other than FFP classification ( P>0.05). By one year after treatment, the conservative treatment group had a complication incidence of 34.4% (11/32), a mortality of 9.4% (3/32) and a Koval attenuation rate of walking ability of 13.8% (4/29) while the minimally invasive surgery group had a complication incidence of 20.8% (5/24), a mortality of 4.2% (1/24) and a Koval attenuation rate of walking ability of 8.7%(2/23), showing no significant difference between the 2 groups ( P>0.05). Conclusions:The injury mechanism of geriatric FFP is mostly lateral compression injury. The fracture sites are mostly located on both sides of the pubic symphysis, pubic branches and the sacral wing of anterior and posterior rings simultaneously. Although there may be no significant difference in complication incidence, mortality or Koval attenuation rate of walking ability between conservative treatment and minimally invasive surgery after one year, the minimally invasive surgery deals with more unstable fracture types.

Objective：To explore the mechanism of posterior pilon fracture with different proportion of the medial malleolus involved and evaluate clinical outcomes of anterior-posterior screws fixation.Methods: Patients admitted to our hospital with diagnosis of tibial posterior Pilon fracture were identified from January 2014 to January 2018. Mechanism from medical history, proportion of the medial malleolus involved (not involved/partial involved /total involved) from axial CT sacn were recorded to figure out the mechanism . Burwell—Charnley radiographic criteria of reduction, American orthopaedic Foot＆Ankle society ankle-hindfoot scale at 12 month follow-up were recorded to evaluate the curative effect of anterior-posterior screws fixation.Result: Sixty-nine patients were identified in this retrospective study. 43 males and 26 females were included, with mean age 46.9 years old（range, 21-76 years）. Mechanism of the 8 cases with fracture line do not involve midial malleolus but accompanied with die-punch fragment included 4 ground level fall, 2 fall off stairs, 1 sport injury, 1 fall from bike. Mechanism of the 52 cases with midial malleolus partial involved included 14 motor vehicle accident, 14 fall off stairs, 5 sport injury, 3 fall from bike and 16 fall from height. Mechanism of the 9 cases with medial malleolus totally involved included 6 falling from height, 2 falling of stairs and 1 motor vehicle accident. Five patients were treated with the fixation of Anterior-Posterior screws, fracture line of four cases do not involve midial malleolus and the rest one partial involved. The Burwell—Charnley radiographic criteria of reduction were fair in 4 and poor in one on the post-operation X-ray. Three of them got implant failure. The AOFAS ankle-hindfoot scale 12-month post-operation for the rest two patients were 78 and 72.Conclusion: There is a high risk of implant failure using A-P screws for the treatment of posterior pilon fracture. The mechanism of posterior fracture involve medial malleolus is mainly vertical force .