Background To investigate the clinical effects of a unilateral external fixator combined with bone transport and tibio-talar fusion in the treatment of severe postoperative infection of peri-ankle fractures. Methods The clinical data of 32 patients (22 men and 10 women) with severe postoperative infection of peri-ankle fractures were retrospectively analyzed. Patients’ age ranged from 26 to 62 (mean, 42 ± 9.5) years old. The types of fractures were distal tibia fracture (25 cases), distal tibia and fibula fracture (5 cases), and talus fracture (2 cases). All patients underwent treatment with unilateral external fixation combined with bone transport and tibio-talar fusion. 6 patients with severe infection received two-stage treatment involving focal debridement and external fixation, osteotomy, and bone transport. The remaining 26 patients underwent debridement, external fixation, and osteotomy simultaneously. The length of bone transport, total fixation time of the external fixator, and postoperative complications were recorded for all patients. The efficacy of the treatment was assessed using the American Association of Foot and Ankle Society (AOFAS) ankle–hindfoot score. Results Patients were followed up for 16–36 months, with an average follow-up time of 24 months. The length of tibia bone transport ranged from 5 to 15 cm, with a mean length of 8.5 cm. The external fixator was applied for 12–24 months, with an average duration of 16 months. One patient suffered from refracture at tibio-talar fusion site, and one patient had external fixation pin-tract infection. No complications, such as recurrent infections (especially the MRSA infection), poor mineralization, refracture, iatrogenic nerve damage or fusion failure, were found in the remaining patients. The preoperative AOFAS ankle–hindfoot function score was 40.0 ± 3.8 (range, 30–52) points, and it increased to 75.0 ± 3.0 (range, 67–78) points at the last follow-up. Conclusion A unilateral external fixator combined with bone transport and tibio-talar fusion is an effective method for treating severe postoperative infection of peri-ankle fractures. This approach is capable of reconstructing large bone defects that remain after clearing the infected lesion. Additionally, it provides stability to the ankle, enhances ankle–hindfoot function, and improves the patient’s quality of life.

目的 探讨骨盆创伤中骨盆知名血管损伤时的紧急处理策略.方法 回顾性分析2005年1月至2021年10月山东省立医院收治的58例骨盆知名血管损伤病人的临床资料,其中男36例,女22例,年龄为(47.9±14.8)岁(24～75岁).其中"死亡冠"血管损伤15例(医源性损伤8例);臀上动静脉损伤17例(医源性损伤7例);臀下动静脉损伤6例(医源性损伤1例);阴部内动脉损伤13例;髂外动静脉(股动静脉)损伤7例(医源性损伤3例).所有病人根据不同的血管损伤机制,术中根据不同的情况分别选择直接血管结扎、纱布填塞、血管造影栓塞或联合腹主动脉阻断等方法急救止血.结果 58例骨盆知名血管损伤的病人,其中有55例病人得到成功的处理,术后存活.其中2例因"死亡冠"血管损伤所致的大出血死亡,1例因臀上动脉医源性损伤所致的大出血死亡.结论 临床医生在面对骨盆及臀部创伤时要充分了解并掌握骨盆知名血管损伤的预防和处理,同时也不能忽视骨盆知名血管的潜在损伤.了解骨盆骨折类型与血管损伤的潜在联系,对于"死亡冠"血管,可行预防性结扎避免损伤,一旦损伤在无法结扎的情况下应纱布填塞压迫止血结合介入栓塞;对于臀上和臀下血管,造影栓塞可作为第一选择,必要时可联合腹主动脉球囊阻断;对于阴部内动脉,纱布填塞及造影栓塞均有较好的效果;对于髂外血管的损伤,可在腹主动脉球囊阻断下行血管修补或置换.当骨盆知名血管损伤时,根据具体情况,掌握止血急救的措施,根据自已医院条件和自身的经验选择合适的方法,提高病人的预后和生存率.

Objective:To investigate the clinical effect of reaming and debridement combined with unilateral external fixator in the treatment of chronic infection after intramedullary nailing of long bone fractures.Methods:The data of 22 patients with chronic infection after treatment with intramedullary nails for long bone fractures of the lower extremity who were treated from January 2014 to January 2018 were retrospectively analyzed. There were 16 males and 6 females; age ranged from 21 to 62 years, with an average of (38.4±9.3) years old; 12 cases of femoral infection and 10 cases of tibial infection. Fifteen of the initial injuries were closed fractures; seven were open fractures. According to the Cierny-Mader classification of bone infection, there were 10 cases of type I (intramedullary type), 7 cases of type Ⅰ+ type Ⅲ (focal type), and 5 cases of type Ⅰ+ type Ⅱ (diffuse type). The intramedullary nails were removed from all 22 patients, and the pulp was reamed, meanwhile the pulp cavity was flushed. The infected and necrotic tissue inside and outside the pulp cavity was completely removed. For those with sinus tract and abscess at the same time, the infected soft tissue should be completely removed together; for those with focal infection, the infected and necrotic bone should be partially excised, and the local bone defect should be rebuilt after the infection was controlled in two stages. Bone transfer treatment were conducted in large bone defect. All patients received intravenous infusion of sensitive antibiotics for 2 weeks, and then changed to oral administration for 4 weeks, for a total of 6 weeks.Results:Twenty-two patients were followed up for 16-36 months, with an average of (24.5±4.1) months. There was no recurrence of infection or residual infection in 20 patients. One patient had skin and soft tissue infection, and the wound healed after dressing change. One patient had bone exposure and partial skin defect, and the wound improved after local skin flap was transferred to cover the wound. 12 patients with bone defect after infection and debridement, 10 patients underwent bone grafting after infection control to reconstruct bone defect, and 2 patients underwent bone transfer. All patients achieved fracture union.Conclusion:Reaming and debridement combined with external fixation is an effective method for chronic infection after intramedullary nailing of long bone fractures.

Background:In lumbo-iliac fixation, the iliac screw can be placed in several locations and directions. There is no uniform standard for the placement of a single iliac screw. Biomechanical tests and finite element analyses were used to compare the effect of bilateral single iliac screws with three channels on pelvic stability to determine the best channel.Methods:Five embalmed adult cadaver pelvic specimens were selected. An unstable Tile C1 pelvic injury model was established. Lumbo-iliac fixation for the treatment of left sacral Denis II fracture includes the following: three channels of bilateral, single iliac screws (channel A from posterior superior iliac spine (PSIS) to anterior inferior iliac spine (AIIS), channel B from 1 cm medial and 1 cm caudal of PSIS to AIIS, and channel C from 2 cm below PSIS to AIIS). Biomechanical testing was performed for stiffness evaluations. A finite element model was established to study the stress distribution of the model and the maximum von Mises stress of internal fixation.Results:Biomechanical tests revealed that under vertical compression loading. The compressive stiffness fixed by channel B (246.15 ± 27.85 N/mm) was better than that fixed by channel A and channel C. Under torsional load, the torsional stiffness fixed by channel B (2.234 ± 0.223 N·m/°) was stronger than that fixed by channel A and channel C. However, there was no significant difference in terms of compressive and torsional stiffness between channel B and channel A (P > 0.05). Finite element analyses conformed that the maximum von Mises stress of the internal fixator fixed in channel B under the conditions of vertical, forwards bending, backwards extension, left bending, left rotating, and right bending (213.98 MPa, 338.96 MPa, 100.63 MPa, 297.06 MPa, 200.95 MPa and 284.75 MPa, respectively) was significantly lower than those fixed in channel A and channel C.Conclusions:The construct stiffness of the channel from 1 cm medial and 1 cm caudal of PSIS to AIIS is better than that of the other two channels. This channel has the advantages of good biomechanical stability, small maximum von Mises stress of internal fixation.

Purpose To evaluate the effectiveness of pelvic packing (PP) in pelvic fracture patients with hemodynamic instability. Materials and methods Three databases—PubMed, Embase and the Cochrane Library—were systematically searched to identify studies presenting comparisons between a protocol including PP and a protocol without PP. Mortality, transfusion requirement and length of hospitalization were extracted and pooled for meta-analysis. Relative risk (RR) and standard mean difference (SMD), along with their confidence intervals (CIs), were used as the pooled statistical indices. Results Eight studies involving 480 patients were identified as being eligible for meta-analysis. PP usage was associated with significantly reduced overall mortality (RR = 0.61, 95% CI = 0.47–0.79, p < 0.01) as well as reduced mortality within 24 h after admission (RR = 0.42, 95% CI = 0.26–0.69, p < 0.01) and due to hemorrhage (RR = 0.26, 95% CI = 0.14–0.50, p < 0.01). The usage of PP also decreased the need for pre-operative transfusion (SMD = − 0.44, 95% CI = − 0.69 to − 0.18, p < 0.01), but had no influence on total transfusion during the first 24 h after admission (SMD = 0.05, 95% CI = − 0.43–0.54, p = 0.83) and length of hospitalization (ICU stay and total stay). Conclusions This meta-analysis indicates that a treatment protocol including PP could reduce mortality and transfusion requirement before intervention in pelvic fracture patients with hemodynamic instability vs. angiography and embolization. This latter technique could be used as a feasible and complementary technique afterwards. Level of evidence 3.

Background: Open Tile C pelvic fractures are particularly severe. However, reports on their management and outcomes are relatively rare. This study analyzed the demographic and clinical characteristics of patients with open Tile C pelvic fractures and describes our management and outcomes of these injuries.Methods: This retrospective review included all patients with open Tile C pelvic fractures treated in our department between January 2014 and June 2021. Data on patient demographics, characteristics of the injuries, surgical management, and outcomes were analyzed. Results: Thirty patients with a mean age of 34.0 years met the diagnostic criteria. The average Injury Severity Score was 40.3. According to the Tile fracture classification, 6 patients sustained type C1.1, 12 sustained type C1.2, 3 sustained type C1.3, 5 sustained C2 and 4 sustained type C3. Most patients had soft tissue injuries in multiple zones. All patients sustained associated injuries. Management consisted of bed rest in 8 cases, external fixation as the final strategy in 14, conversion from external fixation to internal fixation in 3, open reduction with internal fixation in 5, and amputation in 6. The average amount of packed red blood cells transfused was 33.3 units, the average intensive care unit stay was 11.3 days, the mean number of operations required was 6.2, and the mean length of hospital stay was 81.8 days. The main complications were early soft tissue infections and venous thrombosis. One patient died of sepsis and multi-organ failure. Soft tissue injuries in multiple zones increased utilization of hospital resources whereas anorectal injuries did not. Vascular damage accompanying truck crush injuries had a high amputation rate.Conclusion: Open Tile C pelvic fractures require multidisciplinary diagnosis and management and consume considerable hospital resources. More emphasis needs to be placed on this complex injury.

Background: This study aims to compare the diagnostic accuracy of magnetic resonance imaging (MRI) and MR arthrography (MRA) for the articular-sided partial-thickness rotator cuff tear (PTRCT). Methods: Three electronic databases, PubMed/Medline, Embase and Cochrane Library, were utilized to retrieve articles comparing the diagnostic value of MRA and MRI for detecting articular-sided PTRCTs. The pooled statistical indexes included sensitivity, specificity, positive/negative predictive value, diagnostic odds ratio (DOR) and the area under the receiver operating characteristic curve (AUC). Results: Eleven studies involving 1703 patients and 1704 shoulders were included. The pooled sensitivity, specificity, DOR and AUC and their 95% CIs of MRA to diagnose articular-sided PTRCTs were 0.81 (95% CI, 0.65–0.90), 0.96 (95% CI, 0.91–0.98), 68.14 (95% CI, 33.20–139.84) and 0.96 (95% CI, 0.94–0.97), respectively. The pooled sensitivity, specificity, DOR and AUC and their 95% CIs of MRI were 0.78 (95% CI, 0.65–0.87) and 0.97 (95% CI, 0.84–0.99), 47.82 (95% CI, 8.29–275.89) and 0.89 (95% CI, 0.86–0.92), respectively. Conclusions: This meta-analysis reveals that MRA has a better diagnostic value than that of MRI for the diagnosis of articular-sided partial-thickness rotator cuff tears because of an improvement of sensitivity.

BACKGROUND The management of vascular graft infections continues to be a significant challenge in a clinical situation. The aim of this report is to illustrate the novel vacuum sealing drainage (VSD) technique and rectus femoris muscle flap transposition for vascular graft infections, and to evaluate the prospective of future testing of this surgical procedure. CASE SUMMARY We report the case of a 32-year-old male patient, who presented a severe infected groin wound with biological vascular graft Acinetobacter baumannii infection resulting in extensive graft exposure. Using the VSD and muscle flap trans-position, the groin wound and vascular graft infection were finally treated successfully. CONCLUSION Our case report highlights that VSD technique and rectus femoris muscle flap transposition could be considered in patients presenting with a severe infected groin wound with biological vascular graft Acinetobacter baumannii infection resulting in extensive graft exposure, especially in consideration of treatable conditions.

目的 分析Pilon骨折术后感染的相关危险因素.方法 收集自2005年1月至2019年12月共621例Pi-lon骨折患者,全部采用切开复位钢板内固定术治疗.按照术后是否感染分为两组,其中感染组39例,男26例,女13例;年龄20～72岁,平均(43.4±13.5)岁.非感染组582例,男303例,女279例;年龄19～71岁,平均(42.1±12.0)岁.年龄、性别、身体质量指数(body mass index,BMI)、吸烟、糖尿病、高血压、饮酒、软组织损伤情况、手术时间、输血、引流时间等纳入可能的危险因素作为研究对象,统计学方法先采用单变量分析,有显著意义的危险因素再采用多变量的Logistic回归分析.结果 Pilon骨折手术部位感染率为6 28％,单变量分析发现感染组与非感染组之间的糖尿病患者、手术时间以及软组织损伤情况差异有统计学意义,而多变量的Logistic回归分析却发现仅手术时间与手术部位感染显著相关(P＜0.01,0R=0.121).结论 手术时间是Pilon骨折切开复位钢板内固定术后手术部位感染的独立预测指标,而严重软组织损伤虽能增加手术部位感染率,却不是Pilon骨折切开复位钢板接骨术后手术部位感染的独立预测指标.

Objective:To explore the clinical effect of open reduction in the treatment of Tile C pelvic fracture combined with acetabular fracture in a specific sequence.Methods:Retrospectively analyzed the clinical data of 53 patients with Tile C type pelvic fracture combined with acetabular fracture from January 2014 to January 2019, and were divided into specific sequence group and non-specific sequence group according to the sequence of intraoperative reduction. A total of 29 cases were observed in the specific sequence group, including 20 males and 9 females; aged 43.8±14.8 years old (18-71 years), and the fractures were reduced in the sequence of "inside and out, then up and down" during the operation. There were 24 cases in the non-specific sequence group, including 14 males and 10 females; aged 44.4±14.7 years old (18-69 years), and fracture reduction was not performed in this sequence during the operation. According to the type of pelvic and acetabular fracture injury, we choose the appropriate position and surgical approach. After open reduction, the fracture was fixed with internal plants. The intraoperative blood loss, operation time, visual analogue scale (VAS) score were compared between the two groups. The quality of fracture reduction was evaluated by Matta score, pelvic fracture function recovery was evaluated by Majeed score, and acetabular fracture was evaluated by hip joint modified Merle d'Aubigné-Postel score.Results:There was no statistically significant difference in general data between the two groups before operation ( P>0.05), which was comparable. The intraoperative blood loss of the specific sequence group and the non-specific sequence group were 1 031.1±513.7 and 1 406.3±738.1 ml, and the operation time was 3.5±1.0 and 4.8±1.4 h; The differences between the two groups were statistically significant ( P<0.05). 53 patients were followed up for 14.8±1.6 months (12-18 months) after operation. The average postoperative VAS scores of specific sequence group and non-specific sequence group were 1.3±1.1 and 1.5±1.3 respectively, and there was no statistically significant difference. The effectiveness of the pelvic fracture Matta score standard was evaluated in the specific sequence group: excellent in 22 cases, good in 5 cases, fair in 2 cases, excellent and good rate was 93.1%; non-specific sequence group excellent in 10 cases, good in 6 cases, fair in 5 cases, poor in 3 cases, excellent and good rate was 66.7%, the difference was statistically significant ( P<0.05). Matta score of acetabular fracture: 21 cases were excellent in specific sequence group, 5 cases were good, 3 cases were poor, excellent and good rate was 89.7%; 9 cases were excellent in non-specific sequence group, 8 cases were good, 7 cases were poor, excellent and good rate was 70.8 %, the difference is statistically significant ( P<0.05). The results of the last follow-up pelvic fractures were evaluated by Majeed score: 20 cases were excellent in the specific sequence group, 7 were good, 2 were fair, excellent and good rate was 93.1%; 10 were excellent in the non-specific sequence group, 5 were good, 5 were fair, and 4 were poor, excellent and good rate was 62.5%, the difference was statistically significant ( P<0.05). At the last follow-up, the modified Merle d'Aubigné-Postel score was used to evaluate the efficacy: 20 cases were excellent in the specific sequence group, 5 were good, 4 were fair, the excellent and good rate was 86.2%; In the non-specific sequence group, 9 cases were excellent, 7 cases were good, 4 cases were fair, and 4 cases were poor, excellent and good rate was 66.7%, the difference was statistically significant ( P<0.05). During the follow-up period, none of the patients in the two groups developed fracture nonunion, heterotopic ossification, iatrogenic neurovascular injury, and femoral head necrosis. Trauma arthritis occurred in 4 patients in the non-specific sequence group. Conclusion:"Inside and out, then up and down" sequential reduction of Tile C pelvis combined with acetabular fracture can significantly shorten the operation time and reduce the amount of intraoperative blood loss. The surgical procedure is reasonable, which helps to improve the quality of fracture reduction and promote the functional recovery of patients.

Background Numerous quantitatively biomechanical studies measuring the fixation stability of femoral stem using micromotions at the bone-implant interfaces in different directions and levels remain inconclusive. This network meta-analysis performed systematically aims to explore the rank probability of micromotions at the bone-implant interfaces based on biomechanical data from studies published. Methods Two electronic databases, PubMed/MEDLINE and Embase, were utilized to retrieve biomechanical studies providing the data of micromotions at the bone-stem interfaces. After screening and diluting out, the studies that met inclusion criteria will be utilized for statistical analysis. In order to contrast the stability of commonness and differences of the different parts of the femoral stem, the horizontal and vertical comparison of micromotions at the bone-implant interfaces were conducted using the pooled evaluation indexes including the mean difference (MD) and the surface under the cumulative ranking (SUCRA) curve, while inconsistency analysis, sensitivity analysis, subgroup analyses, and publication bias were performed for the stability evaluation of outcomes. Results Screening determined that 20 studies involving a total of 249 samples were deemed viable for inclusion in the network meta-analysis. Tip point registered the highest micromotions of 13 measurement points. In the horizontal level, the arrangements of 4 measurement points at the proximal (P1–P4), middle (P5–P8) and distal part of the stem (P9–P12) were P1 = P2 = P3 = P4, P7 > P8 > P6 = P5 and P10 ≥ P12 = P9 = P11, respectively. In the vertical level, the arrangements of 3 measurement points at the anterior, posterior, medial, and lateral directions was P9 > P5 = P1, P10 > P6 > P2, P11 > P7 > P3, and P12 > P8 > P4, respectively. Conclusion The network meta-analysis seems to reveal that the distal part of the femoral stem is easier to register higher micromotion, and tip point of femoral stem registers the highest micromotions.

目的 探讨股骨转子间截骨结合交锁髓内钉固定治疗股骨近端发育性畸形的疗效.方法 2017年5月山东大学附属省立医院创伤骨科收治股骨近端发育性畸形患者1例.患者女,32岁,因双膝关节外翻畸形、双髋关节活动时疼痛入院.通过术前精确测量双下肢髋、膝关节角度,确定畸形位于双股骨近端.股骨颈干角为右152°,左150°;双侧股骨近端外侧角均为60°;股骨前倾角为右36°,左28°.双髋关节Harris评分均为70分.采用双侧转子间截骨结合股骨近端交锁髓内钉固定矫正双侧股骨近端畸形.术后1、3、6、12个月复查X线,观察截骨面愈合以及髋关节疼痛和功能情况.结果 术后双侧股骨颈干角均为127°;股骨前方颈干角为右166°,左169°.术后12个月患者双髋关节痛感消失,步态恢复正常,双髋关节Harris评分均为100分.结论 采用转子间截骨结合股骨近端交锁髓内钉固定治疗股骨近端发育性畸形可取得良好的临床效果.

Objective To investigate the clinical efficacy and outcomes of the coracoid osteotomy with or without Bristow–Latarjet procedures in the treatment of chronic anterior shoulder dislocation (CASD). Methods Between January 2013 and January 2019, 20 shoulders of 18 patients who were diagnosed with chronic anterior dislocation and underwent open reduction in our trauma center were retrospectively studied. Open coracoid osteotomy with Bristow–Latarjet procedures were performed on 16 shoulders and open coracoid osteotomy without Bristow–Latarjet procedures were performed on four shoulders. Open coracoid osteotomy with or without Bristow–Latarjet procedures were chosen on the basis of the stability of the shoulder after reduction. Outcomes were assessed preoperatively and postoperatively with the visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, the University of California Los Angeles (UCLA) shoulder rating scale, and the range of motion (ROM) for shoulder activity. Results There were three males and 15 females with an average age of 60.94 ± 2.69 years. The time between dislocation and treatment ranged from 21 to 240 days with an average of 73.3 ± 14.4 days. All patients were available for a mean follow‐up of 15.2 ± 4.3 months. No procedure‐related death or incision‐related superficial or deep tissue infection was identified in all cases. No iatrogenic neurovascular injuries or fractures were found in this study. At the time of 12 months follow‐up, the range of motion and the shoulder functional evaluation (VAS [ P < 0.001], ASES [ P < 0.001], and UCLA score [ P < 0.001]) in patients who underwent Bristow–Latarjet procedures were significantly improved. Subluxation after surgical procedure was found and confirmed in one patient and this patient refused to undergo revision surgery. According to the Samilson and Prieto classification system, 16 shoulders were assessed as grade 0, three shoulders were grade 1, one shoulder was grade 2. Conclusions Coracoid osteotomy with or without Bristow–Latarjet procedure yielded an acceptable clinical result in this study. This method has the advantages of enlarging the exposure of surgical field, assisting reduction of shoulder, and convenient conversion to Bristow–Latarjet procedure. It is an efficient and reliable method for treatment of chronic anterior shoulder dislocation. A 69‐year‐old woman diagnosed with right chronic anterior shoulder dislocation with large Hill–Sachs lesion. The latarjet procedure with remplissage technique was applied for this patient.

目的 分析总结在COVID-19疫情期间收治创伤骨科患者的损伤特点及防治措施.方法 回顾性分析山东第一医科大学附属省立医院创伤骨科2019年12月30日—2020年3月8日COVID-19疫情期间收治的87例创伤患者的临床资料,男性37例,女性50例;年龄35～89岁,平均71.2岁;所有患者完成相应检查后,与家属均行胸部CT检查,排除疑似COVID-19患者,均行手术治疗.2018年12月30日—2019年3月8日非疫情时期曾收治172例创伤手术患者,男性90例,女性82例;年龄17～85岁,平均45.6岁.分析比较两个时期手术患者损伤情况、致伤因素、手术方式和治疗结果.结果 疫情期间女性患者骨折发生率(57.5％)高于男性患者(42.5％),差异有统计学意义(P<0.05);患者平均年龄(71.23±11.3)岁大于去年同期(45.57±18.29)岁,差异有统计学意义(P<0.05);疫情期间摔伤发生率(56.3％)高于去年同期(31.2％),差异有统计学意义(P<0.05),道路交通伤发生率(19.5％)低于去年同期(46.3％),差异有统计学意义(P<0.05),而坠落伤与砸压伤差异无统计学意义(P>0.05);疫情期间桡骨远端骨折发生率33.3％,髋部骨折发生率29.8％,高于去年同期桡骨远端骨折(21.5％)和髋部骨折(18.6％),差异有统计学意义(P<0.05),但踝关节骨折、骨盆骨折和开放性骨折发生率比较差异无统计学意义(P>0.05);陈旧性骨折(15.0％)高于去年同期(1.5％),差异有统计学意义(P<0.05).疫情期间外固定使用率(40.2％)高于去年同期(16.3％),差异有统计学意义(P<0.05).截至2020年3月8日,治愈出院64例,未发生COV-ID-19,无死亡病例,无医源性并发症发生.结论 在COVID-19疫情期间,骨折患者以老年女性居多,髋部骨折及桡骨远端等低暴力骨折常见,陈旧性骨折比例增高,外固定架使用比例增加;疫情期间创伤骨科患者的损伤因素及治疗方式明显不同于去年同期非疫情期间,这要求创伤骨科医师在做好疫情防控的前提下完成创伤手术治疗,减少并发症,获得更好的综合治疗.

Background Pelvic packing (PP) has been increasingly used for bleeding control in severe pelvic trauma. However, its effectiveness remains controversial. This meta-analysis was performed systematically to determine the efficiency of PP in pelvic fracture patients with hemodynamic instability. Methods Three databases, PubMed, Embase and Cochrane Library were systematically searched to identify studies presenting comparisons between protocol including PP and protocol without PP. Mortality, transfusion requirement and length of hospitalization were extracted and pooled for meta-analysis. Relative risk (RR) or standard mean difference (SMD) with their confidence interval (CI) was used for the pooled statistical indexes included mortality, transfusion requirement and length of hospitalization. Results Ten studies involving 560 patients were identified eligible for meta-analysis. A significantly reduced overall mortality (RR = 0.63, 95% CI = 0.50 to 0.79, p < 0.01) as well as reduced mortality within 24 h after admission (RR = 0.42, 95% CI = 0.27 to 0.63, p < 0.01) and due to hemorrhage (RR = 0.27, 95% CI = 0.15 to 0.49, p < 0.01) was shown by PP. The usage of PP also decreased the need for pre-operative transfusion (SMD = -0.44, 95% CI= -0.69 to -0.18, p = 0.001) but had no influence on transfusion during the first 24 h after admission (SMD = 0.04, 95% CI = -0.24 to 0.31, p = 0.215) and length of hospitalization (ICU and total stays). Conclusions This meta-analysis indicates that a treatment protocol including PP significantly reduce mortality and transfusion requirement before intervention in pelvic fracture patients with hemodynamic instability. An algorithm in which pelvic packing is performed as first-line treatment was recommended and complemented with angiography and embolization for patients with traumatic pelvic hemorrhage.

Background Minimally invasive repair is a better option for Achilles tendon rupture with low re-rupture and wound-related complications than conservative treatment or traditional open repair. The major problem is sural nerve injury. The purpose of this study was to evaluate the effect and advantage of the intraoperative ultrasonography assistance for minimally invasive repair of the acute Achilles tendon rupture. Methods A retrospective study was performed on 36 cases of acute Achilles tendon rupture treated with minimally invasive repair assisted with intraoperative ultrasonography from January 2015 to December 2017. The relationship of the sural nerve and small saphenous vein was confirmed on the preoperative MRI. The course of the small saphenous vein and the sural nerve was identified and marked by intraoperative ultrasonography. The ruptured Achilles tendon was repaired with minimally invasive Bunnell suture on the medial side of the small saphenous vein (SSV). Results All patients were followed up for at least 12 months. No sural nerve injury or other complications was found intraoperatively and postoperatively. All the patients returned to work and light sporting activities at a mean of 12.78 ± 1.40 weeks and 17.28 ± 2.34 weeks, respectively. The Mean American Orthopaedic Foot & Ankle Society (AOFAS) scores improved from 59.17 ± 5.31 preoperatively to 98.92 ± 1.63 at the time of 12 months follow-up. There was a statistically significant difference ( P < 0.001). No patient complained of a negative effect on their life. Conclusions The minimally invasive repair assisted with intraoperative ultrasonography can yield good clinical outcomes, less surgical time, and less complications, especially sural nerve injury. It is an efficient, reliable, and safe method for acute Achilles tendon (AT) rupture.

Background A coronal fracture of the distal femoral condyle, known as a Hoffa fracture, seldom occurs and is easy to misdiagnose. Surgery treatment, including open anatomic reduction and internal fixation, is the primary method of treatment. However, cases involving nonunion are extremely rare. Case Presentation We reported two cases in a 56‐year‐old female who visited our outpatient clinic with complaints of locking sensation, swelling, and pain, and a 64‐year‐old male patient who need additional care after having undergone surgery for a distal femur fracture. They presented with nonunion ofa Hoffa fracture (Letenneur type II), and these cases of nonunion were resolved surgically with debridement, two cannulated lag screws, a lateral extra‐articular buttress plate, and the liberal use of autologous bone grafts. After surgery, the two patients were allowed to bear partial weight and perform exercises. They were allowed to walk with full weight‐bearing after 3 months. No early complications, such as infection and loss of reduction, were noted after the revision surgery. At the one‐year follow‐up, both patients had excellent function and reported minimal pain, with a Lysholm score of 94. Conclusions Our case reports highlight the importance of the liberal use of autologous bone grafts, which allow stable reconstruction of the affected femoral condyle, thereby restoring joint congruence. A lateral extra‐articular buttress plate in combination with two cannulated lag screws is recommended for nonunion in Hoffa fracture patients, and they need to be closely followed up to detect complications promptly, especially those related to nonunion.

Background: This study aims to compare the diagnostic accuracy of magnetic resonance imaging (MRI) and MR arthrography (MRA) for the articular-sided partial-thickness rotator cuff tear (PTRCT). Methods: Three electronic databases, PubMed/Medline, Embase and Cochrane Library, were utilized to retrieve articles comparing the diagnostic value of MRA and MRI for detecting articular-sided PTRCTs. The pooled statistical indexes included sensitivity, specificity, positive/negative predictive value, diagnostic odds ratio (DOR) and the area under receiver operating characteristic curve (AUC). Results: Eleven studies involving 1703 patients and 1704 shoulders were included. The pooled sensitivity, specificity, DOR and AUC and their 95% CIs of MRA to diagnose articular-sided PTRCTs were 0.81 (95% CI, 0.65-0.90), 0.96 (95% CI, 0.91-0.98), 68.14 (95% CI, 33.20-139.84) and 0.96 (95% CI, 0.94-0.97), respectively. The pooled sensitivity, specificity, DOR and AUC and their 95% CIs of MRI were 0.78 (95% CI, 0.65-0.87) and 0.97 (95% CI, 0.84-0.99), 47.82 (95% CI, 8.29-275.89) and 0.89 (95% CI, 0.86-0.92), respectively. Conclusions: This meta-analysis reveals that MRA has a better diagnostic value than that of MRI for the diagnosis of articular-sided partial-thickness rotator cuff tears, but only small improvement of sensitivity. Considering the price and invasion of MRA, MRI is recommended as an initial examination to detect patients suspected with articular-side partial-thickness rotator cuff tears.

Bone marrow mesenchymal stem cells (BMSCs) play an important role in the process of bone repair. The present study investigated the effect of 5-azacytidine (AZA) and trichostatin A (TSA) on BMSC behaviors in vitro. The role of WNT family member 5A (WNT5A)/WNT family member 5A (WNT7A)/β-catenin signaling was also investigated. BMSCs were isolated from a steroid-induced avascular necrosis of the femoral head (SANFH) rabbit model. The third-generation of BMSCs was used after identification. The results revealed obvious degeneration and necrosis in the SANFH rabbit model. AZA, TSA and TSA + AZA increased BMSC proliferation in a time-dependent fashion. AZA, TSA and TSA + AZA induced the cell cycle release from the G0/G1 phase and inhibited apoptosis in BMSCs. AZA, TSA and TSA + AZA treatment significantly decreased caspase-3 and caspase-9 activities. The treatment obviously increased the activity and relative mRNA expression of alkaline phosphatase. The treatment also significantly up-regulated the proteins associated with osteogenic differentiation, including osteocalcin and runt-related transcription factor 2 (RUNX2), and Wnt/β-catenin signal transduction pathway-related proteins β-catenin, WNT5A and WNT7A. The relative levels of Dickkopf-related protein 1 (an inhibitor of the canonical Wnt pathway) decreased remarkably. Notably, TSA + AZA treatment exhibited a stronger adjustment ability than either single treatment. Collectively, the present studies suggest that AZA, TSA and TSA + AZA promote cell proliferation and osteogenic differentiation in BMSCs, and these effects are potentially achieved via up-regulation of WNT5A/WNT7A/β-catenin signaling.

Objective To explore the incidence and clinical significance of corona mortis vessels.Methods From December 2015 to December 2017,48 patients with pelvic acetabular fractures were treated with the Stoppa approach,including 36 males and 12 females,aged 30 to 67 years,with an average age of 47.2±8.2 years.There were 52 sides of hemipelvis in the all including 44 cases of unilateral pelvic acetabular fractures and 4 cases of bilateral pelvic acetabular fractures.In the 48 patients,there were 6 pelvic fractures,40 acetabular fractures and 2 pelvic combined with acetabular fractures.According to Judet-Letournel classification:there were 6 cases of anterior column fracture,4 cases of anterior column with anterior wall fracture,2 cases of anterior column with posterior transverse fracture,4 cases of transverse fracture,6 cases of "T" shape fracture and 20 cases of double column fracture.According to Tile classification,there were 2 cases of B1 type,2 cases of B3 type,2 cases of C1 type,and 2 cases of C2 type.The time from injury to surgery was 5 to 16 days,with an average of 8.3±2.8 days.All patients were treated with the Stoppa approach for reduction and fixation.The incidence,number and type of corona mortis vessels across the superior pubic branch,and the diameter and the distance between the vessels and the pubic symphysiswere detected and recorded.Results In the 52 hemi pelvis,there were 46 sides with an anastomotic blood vessel,and no anastomotic blood vessel was found in 6 sides,with the incidence of corona mortis vessels of 88.5％ (46/52).Among them,36 cases were venous type,with the incidence of 78.3％ (36/46);8 cases were arterial type,with the incidence of 17.4％ (8/46);2 cases were mixed type,with the incidence of 4.3％(2/46);corona mortis venous blood vessel diameter was 1.8-3.7 mm,with an average of 2.9±0.5 mm;arterial blood vessel diameter was 2.4-3.0 mm,with an average of 2.7±0.3 mm;the distance between the vessels and the pubic symphysis was 48-71 mm,with an average of 56.9±5.8 mm.Conclusion The corona mortis vessels are common,with the incidence through Stoppa approach about 88.5％.In the clinical treatment of pelvic acetabular fractures,we should pay attention to careful separation of pubic branches exposed by the Stoppa approach,especially when using ilioinguinal approach to avoid corona mortis vessels injury and haemorrhage.