Exogenous directed electrical stimulation (ES) has a positive effect on accelerating wound closure. However, current ES relies on wires and bulky external power sources, limiting its application in daily treatments. Thermoelectric hydrogel, which can convert low-grade heat into electric energy, has great potential for self-power supply, facing the challenge that current generated by a small temperature difference cannot meet the demand for repairing endogenous electric field. In this study, a photo-thermoelectric supramolecular thermosensitive hydrogel (SPTP-Cu) is synthesized, which can achieve a centripetal current, controllable contraction, and effectuate antibacterial cooperation to accelerate wound closure and re-epithelization through a single NIR input on the hydrogel center. In addition, SPTP-Cu hydrogel demonstrates remarkable injectability, fast self-healing, a strong antioxidant, and rapid hemostatic without residual. In the rat infection wound repair experiment, SPTP-Cu + NIR treatment can effectively promote angiogenesis, collagen deposition, and re-epithelialization, achieving tissue remodeling in a short period (12 days). We deem photo-thermoelectric supramolecular thermosensitive hydrogel can be a promising candidate for multifunctional wound dressings for infectious wound treatment.

目的 探讨髓内钉置入内固定治疗对老年股骨干骨折患者临床疗效及膝关节功能的影响.方法 回顾分析2017年3月至2020年3月在本院拟行股骨干骨折治疗患者80例,分为观察组及对照组各40例.对照组采用解剖钢板内固定术,观察组则行髓内钉置入内固定术,对比两组患者手术指标、膝关节功能指标以及术后不良反应和并发症情况.结果 对照组患者术中出血量、手术时间、引流液量、骨折愈合时间均高于观察组(P<0.05):而对照组不良反应率高于观察组(P<0.05).结论 采用髓内钉置入内固定治疗股骨干骨折对患者手术影响较小、运动功能恢复较好,不良反应及并发症较少,利于患者术后康复.

目的 分析不同内固定方法 治疗胫骨远端骨折伴腓骨骨折的疗效及价值.方法选取2016年3月至2019年3月本院收治的胫骨远端骨折伴同侧腓骨骨折患者共80例,治疗医师根据数字表法将80例患者随机平分为两组.其中S组40例,行髓内钉治疗;G组40例,行MIPPO技术钢板固定治疗.结果 S组患者手术相关资料均显著优于G组患者(P<0.05);S组患者手术治疗后半年的临床疗效优于G组患者(P<0.05);S组患者手术治疗后末次随访时的并发症发生率明显低于G组患者(P<0.05).结论 虽然本研究两种手术方法均对胫腓骨远端骨折的治疗具有明显效果,但髓内钉内固定患者术后的骨折愈合时间更短,疗效更好,关节僵硬以及感染等并发症更少,适合临床医师选择应用.

目的 研究骨盆后环微创钉棒、 前环外固定支架治疗不稳定骨盆骨折患者的临床疗效.方法 选取本院于2016年2月至2019年1月收治的130例不稳定骨盆骨折患者进行研究,随机(随机数字表法)分为治疗组(n=65)和对照组(n=65).其中对照组给予常规手术方法治疗(包括前环切开复位钢板内固定术、后环切开复位钢板内固定术),治疗组则给予骨盆后环微创钉棒、前环外固定支架治疗.观察并比较两组患者临床治疗效果.结果 术后,治疗组优良率达92.31％,对照组仅为73.85％,两组比较差异有统计学意义(P<0.05).治疗组术中出血量较对照组明显更少,手术时间、下床活动时间、引流管拔除时间、骨痂出现时间、切口长度、肿胀消退时间、住院时间以及术后发热时间则较对照组显著更短,两组比较差异均有统计学意义(P<0.05).治疗组Maieed评分[(91.25±3.27)分]明显高于对照组评分[(84.57±4.38)分],两组比较差异有统计学意义(P<0.05).治疗组并发症发生率(3.08％)显著少于对照组(12.31％),两组比较差异有统计学意义(P<0.05).结论 骨盆后环微创钉棒、前环外固定支架治疗不稳定骨盆骨折患者临床疗效显著,术中创伤小且外固定取出方便,手术并发症少,术后早期可以活动,骨折愈合快,值得临床推广.

现代社会的创伤特点是高能量损伤,而高能量损伤的特点是伤情重、变化快,而且多涉及多个脏器的损伤和出血,病情复杂[1].如何能够在"黄金小时"给予多个出血部位及时止血就显得非常重要,是对创伤患者进行损害控制复苏的核心内容之一,也是从事创伤临床的一线医疗工作者面临的难题之一.近2年来浙江省余姚市人民医院创伤中心对25例涉及躯干多部位出血创伤患者综合采用同步多支动脉血管造影栓塞技术,取得一定成果,报告如下.

目的 探究四肢骨折和骨盆骨折合并胸部损伤患者的骨科创伤控制与并发症的情况.方法 选取在2012年6月至2015年6月期间在本院接收治疗的四肢骨折和骨盆骨折合并胸部损伤患者64例作为该研究的对象,对所有的患者进行随机的分组,分为观察组和对照组,观察组选择创伤控制进行干预治疗,对照组选择常规的确定性手术进行治疗,治疗结束后对患者的住院时间、手术时间、术中出血量、手术前后的相关指标以及患者的并发症情况进行比较和分析.结果 对照组患者的住院时间、手术出血量及手术时间明显多于观察组,两组患者各项数据比较具有统计学的意义;接受治疗之前组间各项指标比较无显著差异,治疗完成前后组内比较有先注差异,差异具有统计学的意义,治疗结束后组间的比较有显著差异,比较有统计学意义(P<0.05);对照组和观察组患者的并发症发生率分别是28.13%和6.25%,比较有显著差异,差异有统计学意义(P<0.05).结论 损伤控制能有效的降低患者的致残率和致死率,同时减少了患者的住院和手术时间以及术中出血量,是一种有效的方法,值得推广.

Objective To explore the timing of wound closure and the choice of methods in Gustilo Ⅲtype tibiofibula open fractures after emergency debridement.Methods 42 patients with Gustilo Ⅲ type tibiofibula open fractures from January 2014 to January 2015 were selected as the observation group.All patients were performed emergency fracture fixation after debridement and wound secretion culture immediately after debridement, if the training result was positive,the debridement,again until the training results for negative when square in 48 hours after closing a wound.Selected 38 patients with GustiloⅢtype tibiofibula open fractures,the prompt debridement 38 cases were fracture fixed routine treatment after closing the wound,they were set as the control group.Compared two groups of patients with wound infection and fracture healing.Results The fractures wound infection rate of the observation group was 4.76%,which was significantly lower than 15.79% of the control group,the difference was statistically significant(χ2 =10.739,P=0.000).The wound healing time and fracture healing time of the observation group were significantly better than those of the control group,there were statistically significant differences( t=9.684,7.324,all P<0.05).Conclusion GustiloⅢtype emergency open tibiofibula fracture after debridement of the wound closure time should according to the results of wound secretion culture,cultivate the results can be achieved when the negative for wound closure,according to the degree of injury of soft tissue,to choose the right means of wound closure.

Objective To explore the medium-and long-term effects of posterior short segment pedicle screw fixation and bone graft in the treatment of thoracolumbar burst fractures.Method From January 2009 to January 2011, 38 cases with thoracolumbar burst fractures were selected as subjects.All the subjects underwent posterior short segment pedicle screw fixation and bone graft treatment.Vertebral height, cobb angle, frankle classification and Christian grade were evaluated. Findings The patients were followed up 31 to 55 months after the operation, 46.8 months on the average; At the final follow-up, heights of anterior and posterior vertebral body were significantly superior to pre-operation;Cobb angles on final follow-up also significantly decreased(P <0.05); Frankle classification on final follow-up was superior to pre-operation (P <0.05); Christian grades: 3 points in 1 patients, 4 points in 1 patients, 5 points in 11 patients, 6 points in 16 patients and 7 points in 9 patients; Graft bone fusion were excellent and the internal fixations were firm.Conclusion Posterior short segment pedicle screw fixation and bone grafting have ideal medium-and long-term effects in treating thoracolumbar burst fractures.

目的：探讨内固定治疗Hoffa骨折的方法及疗效。方法对2005年10月至2012年9月,收治9例Hoffa骨折进行回顾性分析。Letenneur分型：I型6例，Ⅱ型1例，Ⅲ型2例。全部为闭合性骨折。根据骨折类型、受累髁部位选择手术入路，采用螺钉内固定。结果9例全部随访，时间11～36个月，平均18个月，4～7个月骨折均获骨性愈合，平均5.5个月。根据Letenneur术后功能评估系统评价：9例患者中优良5例，可3例，差1例。结论手术治疗Hoffa骨折是一种安全有效的方法，但要根据骨折类型及骨折的具体状况选择切口及固定的方式。

[Objective]To investigate effectiveness of using external fixation of the fractured bone combined with local injection of autologous bone marrow pluripotent stem cells for the treatment of comminuted distal radius fractures.[Method] The external fixation of the fracture combined with local injection of autologous bone marrow pluripotent stem cells in treating 18 cases.[Results] In follow-up over the next 6~15 m(average 8 m),results were excellent in 10 cases,good in 6 cases,fair in 2 cases and poor in 0 case.Excellent and good outcome rate was 88.9%.There were no cases of complications such as superficial infection.[Conclusion] The external fixation of the fracture combined with local injection of autologous bone marrow pluripotent stem cells for the treatment of comminuted distal radius fracture was a convenient and effective method,not only did the fractures heal well,but fracture healed reliably and the method aided in early recovery and rehabilitation.