To analyze the postoperative functional recovery effect of posteromedial combined anterolateral dual portal technique in the treatment of complex tibial plateau fractures involving the posteromedial condyle, and explore the key factors affecting prognosis. A retrospective analysis of 85 patients with complex tibial plateau fractures involving the posterior medial condyle, all enrolled between January 2024 and January 2025, was conducted. Based on surgical approach, patients were categorised into a combined group (42 cases; combined posteromedial and anterolateral approach) and single-approach group (43 cases; anterolateral approach). The study compared postoperative 3-month joint function (HSS) scores, posterior tibial slope (PTS), medial proximal tibial angle (MPTA), knee and ankle range of motion (ROM) in flexion, complication rates, and key influencing factors identified through data mining between the two groups. At the three-month postoperative assessment, the combined approach group demonstrated significantly superior outcomes compared to the single-approach group. This was evidenced by higher scores across all domains of the HSS scale: joint stability (7.65 ± 1.54), flexion deformity (7.33 ± 1.19), muscle strength (7.58 ± 1.31), range of motion (13.32 ± 1.75), functional activity (16.44 ± 2.21), pain (21.13 ± 2.29), and total HSS score (73.36 ± 7.97) (all P < 0.05). Radiographic parameters, including MPTA (88.65 ± 3.62°), PTS (7.86 ± 1.22°), and knee flexion ROM (123.28 ± 14.39°), also showed significantly greater improvement in the combined group (P < 0.05). Furthermore, the postoperative complication rate was significantly lower in the combined group (2.38

Background. Bone defects caused by trauma, infection, tumors, and metabolic disorders remain difficult to treat due to hostile microenvironments and the limited functionality of conventional materials. With the rapid development of materials science, bone regeneration strategies have shifted from passive barrier membranes to multifunctional responsive systems capable of actively regulating the repair process. Among these, macrophage-mediated immunomodulation has emerged as a critical mechanism for coordinating inflammation, angiogenesis, and osteogenesis; however, a material-centered synthesis of this field remains lacking. Methods: This study systematically reviews macrophage-targeted responsive bone regeneration membranes, with a focus on material design strategies, microenvironment-responsive mechanisms, and immunoregulatory functions. Results: Advanced membrane systems integrate responsive elements (e.g., pH, ROS, and enzyme sensitivity), controlled drug delivery, and physicochemical surface functionalization to precisely modulate macrophage polarization, activate osteogenic signaling pathways, and enhance bone regeneration performance. Conclusions: Responsive membrane design represents a promising materials-driven strategy for precise bone repair. Nevertheless, challenges remain in structural optimization, multifunctional integration, scalable fabrication, and clinical translation, highlighting the need for further innovation toward high-performance and application-oriented biomaterials.

An increasing amount of clinical evidence indicates that one-stage exchange arthroplasty provides outcomes comparable to those of two-stage exchange arthroplasty in the management of chronic periprosthetic joint infection (PJI) following total knee arthroplasty (TKA). However, for cases complicated by a sinus tract, most specialists still advocate a two-stage exchange arthroplasty strategy. This study aims to evaluate the effectiveness of one-stage exchange arthroplasty in treating chronic PJI following TKA with sinus tract formation and to determine the feasibility of this approach in achieving infection control and restoring joint function. A retrospective analysis was conducted on 23 patients with PJI following TKA accompanied by a sinus tract, who were admitted between January 1, 2019 and December 31, 2023. All patients completed a minimum follow-up of 12 months. During this period, microbiological findings, individualized antimicrobial regimens, and incidences of infection recurrence were meticulously documented. To objectively evaluate infection control, serial measurements of serum inflammatory markers—including the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT)—were obtained preoperatively and on postoperative days 3, 7, 10, and 14, allowing for assessment of their dynamic changes. Furthermore, to assess functional recovery, the visual analog scale (VAS) score, knee range of motion (ROM), and Knee Society Score (KSS) were compared preoperatively and at postoperative day 14, 3 months, and the final follow-up. The mean follow-up duration was 14.0 ± 0.9 months. At the final follow-up, the infection-free survival rate was 95.65

Dexamethasone has shown promising efficacy in alleviating pain and enhancing outcomes undergoing TKA. However, an optimal route of administration, dosage, and treatment duration have not yet been established. This study is to assess the effects of intravenous dexamethasone administration on postoperative pain management and prognosis in patients undergoing TKA. Data were retrieved from PubMed, Embase, the Cochrane Library, and Web of Science to compare the effects of intravenous dexamethasone administration versus non-administration on outcomes following TKA. Primary endpoints included pain scores and morphine consumption. Secondary endpoints comprised walking distance, ROM, patients requiring rescue analgesics and antiemetics, LOS, levels of CRP and IL-6, QoR, and the incidence of adverse events. This meta-analysis included 15 RCTs involving 2,584 patients. The study indicated that intravenous dexamethasone can decrease VAS scores at rest (24 h, 95

High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are two common approaches for managing unicompartmental knee osteoarthritis. However, both procedures may eventually require revision to total knee arthroplasty (TKA). This study aims to compare the clinical outcomes and functional performance of revision TKA following HTO (HTO-TKA) versus revision TKA following UKA (UKA-TKA). The findings are intended to offer valuable insights for optimizing treatment strategies for patients with knee osteoarthritis in clinical practice. The postoperative clinical outcomes and functional results of HTO-TKA and UKA-TKA were assessed through a comprehensive review of relevant literature from PubMed, Embase, the Cochrane Library, and Web of Science up to October 2024. Primary endpoints included knee function scores, postoperative complications, and revision rates. Secondary endpoints encompassed operation time, range of motion (ROM), postoperative infections, and the types of revision implants used. This meta-analysis included 11 retrospective studies involving a total of 10,045 patients. The results demonstrated that the HTO-TKA group had significantly better knee function scores compared to the UKA-TKA group (MD = 3.35, 95

BACKGROUND:Tuberculosis is among the most devastating infectious diseases worldwide. Spinal tuberculosis is not easy to detect at an early stage, which without effective treatment often leads to spinal deformity and spinal cord damage which in turn cause complications such as paraplegia and quadriplegia. In this study, we established a model using three concentrations of bacteria and carried out a comprehensive evaluation of the model by imaging, general observations, and histopathological and bacteriological studies. AIM:To establish a rabbit model of spinal tuberculosis and examine the effect on the model's efficacy using different concentrations of Mycobacterium tuberculosis (M. tuberculosis) inoculum. METHODS:New Zealand rabbits were randomly divided into experimental, control and blank groups. The experimental and control animals were sensitized with complete Freund's adjuvant, a hole was drilled beneath the upper endplate of the L6 vertebral body and filled with gelfoam sponge. The experimental group was divided into three subgroups (experimental 1, experimental 2, experimental 3) and infused with M. tuberculosis suspension at various concentrations. The control group was inoculated with saline and the blank group received no treatment. The 12-week post-operative survival rates were 100%, 80% and 30% in the experimental groups inoculated with concentrations of 106, 107 and 108 CFU/mL bacteria, respectively. RESULTS:The survival rate of the control and blank groups was 100%. Vertebral body destruction at 8 weeks in the three experimental groups as determined by X-ray analysis was 33.3%, 62.5% and 66.7%, and by computed tomography (CT) and 3-dimensional CT 44.4%, 75% and 100%, respectively. At 12 weeks, the figures were 44.4%, 75% and 100% by X-ray analysis and 44.4%, 100% and 100% by CT and 3-dimensional CT, respectively. All surviving rabbits of the experimental groups had vertebral destruction. The positive bacterial culture rates were 22.2%, 75% and 66.7%, respectively, in the experimental groups. After being sensitized with complete Freund's adjuvant, large differences were observed in the extent of spinal tuberculosis after inoculation of the rabbits with different concentrations of H37RV standard M. tuberculosis. CONCLUSION:The experimental 1 had a low success rate at establishing an infection. The experimental 3 resulted in high mortality and complication rates. The experimental 2 was optimum for establishing a spinal tuberculosis model based on the high level of symptoms observed and the low rabbit mortality.

Dedifferentiated liposarcoma (DDLPS) is a subtype of LPS characterized by two distinct levels of differentiation and morphological structures, comprising areas of well-differentiated LPS and dedifferentiated, non-lipogenic, highly malignant components. DDLPS most frequently occurs in the retroperitoneum and the soft tissues of the pelvis and limbs, and is rare in the head and neck region, accounting for only 1% of head and neck sarcomas. The present study describes the case of a 72-year-old male with a 30-year history of left upper limb numbness and heaviness. During physical examination, a tumor measuring similar to 13x22 cm was discovered in the left posterior region of the head and neck. The mass was hard in texture and had limited mobility. A biopsy of the lesion revealed a mesenchymal tumor rich in adipose components with ossification, containing heterologous elements primarily indicative of osteosarcoma, highly suggestive of DDLPS. A radical excision of the tumor was subsequently performed. The surgical specimen exhibits cross-sections with a gray-white to gray-yellow solid consistency, featuring gray-white, semi-transparent areas resembling cartilage. Immunohistochemical staining was positive for murine double minute 2 (MDM2), cyclin-dependent kinase 4 (CDK4), P16, P53, Vimentin and Ki-67, and negative for cytokeratin pan, S-100, CD34 and smooth muscle actin. Fluorescence in situ hybridization results indicated amplification of the MDM2 and CDK4 genes. In the present study, a case of a large DDLPS in the neck with components of osteosarcoma and chondrosarcoma was reported. There was no recurrence during the follow-up period. The pathological characteristics, diagnosis and current treatment methods for DDLPS were also described. Although cases of DDLPS have been reported, the number of cases described at this site remains limited to date, and it is currently not possible to accurately predict the treatment efficacy and prognosis.

When orthopedic surgeons encounter periprosthetic femoral fractures after hip arthroplasty, the task they face becomes challenging. Controversy continues to surround the fixation of Vancouver type B2 fractures in particular. The most discussed and successful method is open reduction and internal fixation (ORIF) versus femoral stem revision arthroplasty (RA). Therefore, this article discusses both methods in order to compare the indications for both approaches. We systematically searched PubMed, Cochrane Library, Embase, and Web of Science (from January 1, 2006, to July 30, 2024) and included all studies comparing the outcomes of open reduction and internal fixation (ORIF) versus revison arthroplasty (RA) techniques. The primary outcome measures assessed were: injury to surgery time (ITST, days), union time (UT, months), length of hospital stay (LOS, days), surgical time (ST, minutes), and the Harris Hip Score (HHS). Complication metrics included: first-year mortality (FYM), blood transfusion rate (BT), as well as rates of revision, refracture, loosening, infection, dislocation, nonunion, subsidence, reoperation, total complications, and the proportion of patients with an American Society of Anesthesiologists (ASA) classification ≥ 3. Quality assessment (using the Newcastle-Ottawa Scale [NOS] for cohort studies) and data extraction were independently performed by two reviewers. This review included 34 studies comprising a total of 5137 patients.The injury to surgery time (days) was significantly shorter in the ORIF technique compared to the RA technique [Mean Difference (MD)=-0.66, [95

The purpose of this meta-analysis was to compare the effects of early anterior cruciate ligament reconstruction (ACLR) with delayed ACLR on meniscal tears. Two reviewers searched Pubmed, Embase, Web of Science, Cochrane Library, and some relevant gray literature sources without search date restrictions. All published literature on early versus delayed reconstruction for ACL rupture was found. Reviewers performed independent data extraction, risk of bias, and study quality assessments.After screening, 22 studies were included for analysis: 4 randomized controlled trials, 3 prospective cohort studies, and 15 retrospective cohort studies. We compared the incidence of meniscal tears at three time points (3, 6, and 12 months) following ACLR. ACLR performed within 3 months of injury was associated with a lower rate of medial meniscus (MM) tears compared with ACLR performed >3 months of injury (P = 0.01), but there was no statistically significant difference for lateral meniscus (LM) tears. ACLR performed within 6 months after injury was associated with a lower rate of MM tear compared with ACLR performed >6 months after injury (P = 0.0006). No statistical difference was observed between the two groups for LM tears. Similarly, ACLR performed >12 months after injury was associated with a higher rate of MM tear compared with ACLR performed within 12 months after injury (P = 0.0003) but not with a higher rate of lateral meniscal tears. The results of our study indicate that a delay exceeding 3 months in performing ACLR led to a significant increase in MM tears, while it had no significant impact on LM tears. The current available evidence suggests that for patients who require ACLR, it is recommended to undergo the procedure within 3 months of injury. Level of evidence: Level IV. Corresponding author.

Background Aseptic loosening commonly leads to surgical failure and revision arthroplasty after total hip arthroplasty (THA). C-X-C motif chemokine ligand 16 (CXCL16), a chemokine involved in various inflammatory and immune responses, has been implicated in bone metabolism. This single-institution study investigated the association between CXCL16 and aseptic loosening following THA.Methods We compared 100 patients who underwent revision THA due to aseptic loosening (experimental group) to 100 patients who underwent primary THA for femoral neck fracture or congenital hip dysplasia (control group). Immunohistochemistry and RT-PCR were used to assess CXCL16 expression at the protein and mRNA levels. Double immunofluorescence staining determined the RANKL/OPG ratio in periarticular synovial tissues. Statistical analysis included a chi-square test for CXCL16 protein expression differences and Pearson correlation for the relationship between CXCL16 mRNA expression and RANKL/OPG.Results Proteomics analysis revealed significantly higher CXCL16 expression in the experimental group compared to the control group (p < .01). Immunohistochemistry confirmed that 90% of samples in the experimental group showed positive CXCL16 staining compared to 7% in the control group (p < .01). RT-PCR demonstrated a 3.4-fold higher CXCL16 mRNA expression in the experimental group relative to controls (p < .01). TRAP staining identified that 72% of CXCL16+ multinucleated giant cells in the experimental group were macrophages. Immunohistochemical staining showed that 73% of CXCL16+ macrophages were M2 type, and 27% were M1 type. Dual-immunofluorescence staining indicated an increase in the RANKL/OPG ratio in the experimental group, with a positive linear correlation between CXCL16 mRNA expression and the RANKL/OPG ratio (r = .919, p < .01).Conclusion Our findings reveal a significant association between elevated CXCL16 expression and an increased RANKL/OPG ratio in periprosthetic synovial tissues, suggesting a role for CXCL16 in promoting osteoclast differentiation and activity. These findings offer preliminary insights into CXCL16 as a biomarker and a potential therapeutic target for managing bone resorption in aseptic loosening.

Postoperative infection following internal fixation of hip fractures is a rare but severe complication that can significantly impact patient outcomes. Conventional treatment typically involves a two-stage revision approach. This study investigates the efficacy of a one-stage revision procedure for managing infections after internal fixation of hip fractures, based on three clinical cases (one femoral neck fracture and two intertrochanteric fractures) treated at our institution. The patients underwent one-stage revision surgery, which included comprehensive debridement and a 2-week course of vancomycin administered both intravenously and via joint cavity injection. Discharge was permitted when inflammatory markers had normalized, bacterial cultures returned negative, and the patients' conditions were stabilized. Post-discharge, patients continued a 6-week course of oral rifampicin and ciprofloxacin. At the 1-year follow-up, none of the patients experienced pain or restricted range of motion, and all achieved Harris hip scores greater than 85. These results suggest that for infections following internal fixation of hip fractures, a one-stage revision, combined with thorough debridement and an adequate course of antibiotics (assuming a clear pathogen is identified), can effectively obviate the need for secondary surgeries, reduce healthcare costs, and minimize patient complications. This approach provides valuable insights and alternative strategies for managing postoperative hip fracture infections in clinical settings.

The task faced by surgeons becomes significantly more challenging when they encounter lower extremity bone defects due to a variety of causes requiring lengthening. The most discussed and successful approach is the Illizarov technique, or lengthening over a nail (LON):distraction osteogenesis is also widely performed with monoliteral external fixators and intramedullarylengthening nails have increasingly been used in the last decade. The data were collected from PubMed, Cochrane Library, Embase, and the Web of Science for all available studies comparing the outcomes of Ilizarov technique alone and LON technique (from January 1, 1997, to November 30, 2023). The outcomes of interest encompassed the external fixation index (EFI) (month/cm), mean duration of follow-up (MFT) (month), length gained (LG) (cm), consolidation index (CIx) (month/cm), and bone healing index (BHI) (month/cm).Complications include pin tract infection rate (PTI), axial deviation rate (AD), occurrence of intramedullary infection (II), delayed consolidation rate (DC), as well as data categorized into three levels of problems, obstacles, and sequelae based on the severity of complications.Two reviewers independently assessed each study for quality and extracted data. The case–control or respective cohort studies were evaluated using the Newcastle–Ottawa scale (NOS) to determine their techniqueological rigor.The Cochrane Collaboration’s risk assessment tool was employed to perform quality evaluations for randomized controlled trials. This review included thirteen studies comprising a total of 629 patients.The external fixation index (month/cm) was significantly smaller in the LON technique compared to the Ilizarov technique alone [Mean Difference(MD) = -29.59, 95

Purpose Combination of regional anaesthesia technique that is most effective in analgesia and postoperative functional outcome with the fewest complications needs investigation. Interspace between the popliteal artery and the capsule of the posterior knee block (IPACK) has been introduced clinically. We evaluated the efficacy of IPACK in combination with other nerve blocks after total knee arthroplasty. Methods Data were obtained from PubMed, Cochrane Library, Web of Science, and Sciencedirect. Studies that compared outcomes using IPACK combined with other regional nerve blocks after total knee arthroplasty with other analgesic modalities and those which used pain scores or opioid consumption as primary or secondary outcomes were included. Results Seventeen articles (20 trials, 1652 patients) were included. IPACK supplementation significantly reduced rest pain scores after total knee arthroplasty at postoperative hours 8–12(95%CI − 0.85 [− 1.36, − 0.34], I 2 = 94%, p = 0.001), postoperative day 1 (95% CI − 0.49 [− 0.85, − 0.14], I 2 = 87%, p = 0.006), and postoperative day 2 (95% CI − 0.28 [− 0.51, -0.05], I2 = 72%, p = 0.02); there was no significant difference at postoperative day 3 or discharge (95% CI − 0.14 [− 0.33, 0.05], I 2 = 0%, p = 0.14). Combination treatment resulted in reduced dynamic pain scores at postoperative hours 8–12 (95%CI − 0.52 [− 0.92, − 0.12], I 2 = 86%, p = 0.01) and postoperative day 1(95% CI − 0.49 [− 0.87, − 0.11], I 2 = 88%, p = 0.01). There was no difference between postoperative day 2(95% CI − 0.29 [− 0.63, 0.05], I 2 = 80%, p = 0.09), postoperative day 3 or discharge (95% CI − 0.45 [− 0.92, 0.02], I 2 = 83%, p = 0.06). In addition, it strongly reduced postoperative opioid consumption within 24 H (95% CI − 0.76 [− 1.13, − 0.39], I 2 = 85%, p < 0.00001), 24–48 H (95% CI − 0.43 [− 0.85, − 0.01], I 2 = 83%, p = 0.04), and total opioid use (95% CI − 0.64 [− 1.07, − 0.22], I 2 = 86%, p = 0.003). Although IPACK supplementation improved timed up and go test and walking distance at postoperative day 2, there was no statistically significant difference at other time periods or obvious improvement in knee range of motion and quadriceps strength. IPACK block supplementation could shorten the length of stay (LOS) (95% CI − 0.40 [− 0.64, − 0.15], I 2 = 70%, p = 0.001) and improve patient satisfaction (95% CI 0.43 [0.01, 0.84], I 2 = 87%, p = 0.04). Conclusion Based on these results, IPACK supplementation, in addition to standard postoperative analgesia, can be used effectively and safely to relieve early postoperative pain after total knee arthroplasty.

Aneurysmal bone cyst (ABC) is a benign, distending, osteolytic and locally aggressive bone tumor that is mostly associated with trauma. Approximately 1% of bone tumors are ABCs, which are most prevalent in adolescents and are usually detected in the spine and long tubular bones. The diagnosis of ABC mainly relies on histopathology, malignant transformation is rare, and the chance of malignancy increases if there are multiple recurrences. Due to the rarity of reports of malignant transformation of ABCs into osteosarcoma, there is still considerable debate on the appropriate treatment strategy. The current paper presents a case of aneurysmal bone cyst malignant to osteosarcoma and the therapeutic measures to provide expertise for the diagnosis and treatment of ABCs that are malignant to osteosarcoma.

Abstract Purpose Total knee arthroplasty (TKA) in patients with osteoarthritis (OA) are considered to be a successful procedure, but with little being known about outcomes in patients with rheumatoid arthritis (RA). The aim of this study was to compare the outcomes of TKA in patients with RA versus OA. Methods Data were obtained from PubMed, Cochrane Library, EBSCO and Scopus for all available studies comparing the outcomes of THA in RA and OA patients (From January 1, 2000 to October 15, 2022). Outcomes of interest included infection, revision, venous thromboembolism (VTE), mortality, periprosthetic fractures, prosthetic loosening, length of stay, and satisfaction. Two reviewers independently assessed each study for quality and extracted data. The quality of the studies was scored using the Newcastle-Ottawa scale (NOS). Results Twenty-four articles with a total 8,033,554 patients were included in this review. The results found strong evidence for increased risk of overall infection (OR = 1.61, 95% CI, 1.24–2.07; P = 0.0003), deep infection (OR = 2.06, 95% CI, 1.37–3.09; P = 0.0005), VTE (OR = 0.76, 95% CI, 0.61–0.93; P = 0.008), pulmonary embolism (PE) (OR = 0.84, 95% CI, 0.78–0.90; P<0.00001), periprosthetic fractures (OR = 1.87, 95% CI, 1.60–2.17; P<0.00001); and reasonable evidence for increased risk of deep venous thrombosis (DVT) (OR = 0.74, 95% CI, 0.54–0.99; P = 0.05), and length of stay (OR = 0.07, 95% CI, 0.01–0.14; P = 0.03) after TKA in patients with RA versus OA. There were no significant differences in superficial site infection (OR = 0.84,95% CI, 0.47–1.52; P = 0.57), revision (OR = 1.33,95% CI, 0.79–2.23; P = 0.28), mortality (OR = 1.16,95% CI, 0.87–1.55; P = 0.32), and prosthetic loosening (OR = 1.75, 95% CI, 0.56–5.48; P = 0.34) between the groups. Conclusion Our study demonstrated that patients with RA have a higher risk of postoperative infection, VTE, periprosthetic fracture, and lengths of stay, but did not increase revision rate, prosthetic loosening and mortality compared to patients with OA following TKA. In conclusion, despite RA increased incidence of postoperative complications, TKA should continue to be presented as an effective surgical procedure for patients whose conditions are intractable to conservative and medical management of RA.

Background To explore the surgical technique and clinical outcomes of cementless total hip arthroplasty (THA) combined with impacted bone grafting for the treatment of moderate and severe acetabular protrusion with rheumatoid arthritis (RA). Methods From January 2010 to October 2020, 45 patients (56 hips), including 17 men (22 hips) and 28 women (34 hips) with acetabular impingement secondary to RA, were treated with bioprosthetic THA combined with autologous bone grafting at our hospital. According to the Sotello-Garza and Charnley classification criteria, there were 40 cases (49 hips) of type II (protrusio acetabuli 6–15 mm) and 5 cases (7 hips) of type III (protrusio acetabuli > 15 mm). At the postoperative follow-up, the ROM of the hip joint, the VAS score, and the Harris score were evaluated. The healing of the bone graft, the restoration of the hip rotation center, and the prosthesis loosening were assessed by plain anteroposterior radiographs. Results The average operation time was 95.53 ± 22.45 min, and the mean blood loss was 156.16 ± 69.25 mL. There were no neurovascular complications during the operation. The mean follow-up duration was 5.20 ± 1.20 years. The horizontal distance of the hip rotation center increased from preoperative 10.40 ± 2.50 mm to postoperative 24.03 ± 1.77 mm, and the vertical distance increased from preoperative 72.36 ± 3.10 mm to postoperative 92.48 ± 5.31 mm. The range of flexion motion of the hip joint increased from 39.48 ± 8.36° preoperatively to 103.07 ± 7.64° postoperatively, and the range of abduction motion increased from 10.86 ± 4.34° preoperatively to 36.75 ± 3.99° postoperatively. At the last follow-up, the Harris score increased from 37.84 ± 4.74 to 89.55 ± 4.05. All patients were able to move independently without assistance. Conclusions Cementless THA combined with impacted grafting granule bone of the autogenous femoral head and biological acetabular cup can reconstruct the acetabulum, restore the rotation center of the hip joint, and achieve good medium-term outcomes in the treatment of moderate to severe acetabular herniation secondary to RA.

背景:直到现在骨髓炎仍然是临床骨科医生需要解决的难题,开发理想的骨髓炎模型对于新治疗方法的评价非常重要.目的:稳定有效地制备出适用于不同实验需求的兔胫骨骨髓炎模型.方法:将25只新西兰大白兔随机分成3组,小孔组10只、大孔组10只、假手术组5只.小孔组采用小孔法,用1 mm钻头在兔胫骨中上段钻孔,注入金黄色葡萄球菌(2×106 cfu)悬浮液100μL;大孔组采用大孔法,用5 mm钻头在兔胫骨中上段钻孔,其余操作同小孔组;假手术组切开后缝合,不进行钻孔及细菌注射.术后1个月内进行一般状态、体温、X射线片、CT、组织病理学观察及血清C-反应蛋白、降钙素原质量浓度测定.结果 与结论:①与假手术组相比,术后小孔组、大孔组兔体温和血清C-反应蛋白质量浓度均呈现不同程度升高;②钼靶X射线片及CT检查:小孔组影像学表现为全骨髓腔感染,大孔组表现为局部骨缺损感染;③提示在制备兔胫骨骨髓炎模型时,钻孔大小不同可导致不同的胫骨感染后果,使用5 mm钻孔的模型可能适用于局部抗感染材料效能的研究,使用1 mm钻孔的模型可能适用于全身抗生素药物治疗骨髓炎效果的评价.

[目的]介绍终末髋病伴陈旧性股骨粗隆下骨折加长生物柄全髋置换术的手术技术和临床效果.[方法]2021年本科收治1例终末期股骨头坏死合并陈旧性股骨粗隆下骨折患者,采用远端固定型加长生物柄行人工全髋关节置换术(total hip arthroplasty,THA)治疗.全麻后取后外侧入路,二次截骨法取出股骨头,先置换髋臼侧,再暴露股骨粗隆下骨折端,复位后采用钢板及钢丝临时固定骨折端,加长生物柄置入后取出钢板及远端钢丝,近端钢丝加压固定骨折.[结果]患者顺利接受手术,术后影像显示髋关节假体位置良好.术后1周即可扶助行器自行下地活动,左髋关节Harris评分77分,疗效满意.[结论]加长生物柄全髋关节置换术是治疗终末髋病伴陈旧性股骨粗隆下骨折的有效方法.

Abstract Objective: To evaluate the medium-term outcomes of uncemented total hip arthroplasty in patients ≤ 25 years. Methods: A retrospective research was performed on patients ≤ 25 who received uncemented total hip arthroplasty at the Department of Orthopedics of the 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army from January 2009 to December 2018. The clinical evaluation was measured with modified Harris Hip Score, Western Ontario & McMaster Universities Osteoarthritis Index, and Short-Form 36. Postoperative complications (such as infection, revision, dislocation, and incisional healing issues) were recorded. Using pelvic anteroposterior, hip anteroposterior and lateral X-rays, the radiographic outcome was evaluated, including the position of the implants, loosening, bearing-surface wear, osteolysis, and heterotopic ossification. Loosening of the acetabular or femoral component or revision for any reason was defined as failure. Results: At a follow-up of 8.3±2.4 years (range, 3.8 to 12 years), the preoperative modified Harris hip score was 43.5±12.9 (range, 18 to 62) and increased to 88.3 ± 8.8 (range, 72 to 97), and the preoperative postoperative Western Ontario & McMaster Universities Osteoarthritis Index score improved from 43.6±8.4 (range, 33.1 to 62.3) to 11.5 ± 6.8 (range, 2.5 to 25.8). The Physical Component score-SF-36 improved from 48.5 ± 8.6 (range, 36.4 to 61.3) to 81.2 ± 10.3 (range, 60.3 to 97.5), while the Mental Component score-SF-36 increased from 56.6±12.5 (range, 39.4 to 78.6) to 82.6 ± 12.9 (range, 54.7 to 97). The latest X-ray revealed that the position of the implants did not change substantially since the postoperative image. The abduction angle of acetabular cup was 41.8° ± 6.7° (range, 31° to 57°),the anteversion angle of acetabular cup was 18.2° ± 3.6° (range, 9.5° to 25.7°), and the filling ratio was 90.1% ± 3% (range, 85.2%-95.3%). The preoperative leg length discrepancy was 1.8 cm ± 0.8 cm (range, 1 cm to 5 cm) and reduced to 1.4 cm ± 0.5 cm (range, 0.5 cm to 2.5 cm). No considerable loosening, bearing-surface wear, osteolysis, or heterotopic ossification was observed. At the latest follow-up, the overall survival rate of the 49 hips was 98%. Conclusion: For patients with end-stage hip disease under 25 years old, uncemented THA exhibit excellent outcomes, with a high survival rate and fewer complications at medium-term follow-up.

Diabetes is one of the most common chronic diseases at present, and insulin pen injection therapy plays an important role in the treatment of diabetes. However, the majority of patients might reuse disposable insulin pen needles for various reasons, which leads to related complications. As far as we know, this article is the first to describe a patient whose needle remained in the right upper limb while reusing a disposable insulin injection needle for subcutaneous insulin injection with the non-dominant hand. The patient went to the doctor 1 week later. The needle moved from the lateral area of the proximal upper arm (the injection site) to the posterolateral area of the distal upper arm. The needle was then successfully removed by surgery. The reuse of disposable insulin pen needles might lead to serious complications. It is suggested to strengthen the education of people living with diabetes to help them use insulin pen needles safely.