目的 分析儿童下肢截肢及其康复的流行病学特点与临床特征,阐述儿童截肢的原因及截肢后并发症的情况.方法 选择2016年1月至2021年3月北京博爱医院收治的下肢截肢儿童51例,分析截肢原因与截肢后并发症的相关性.结果 创伤性截肢占58.82％,主要原因为交通事故(70％);疾病性截肢占41.18％,主要原因为先天性肢体畸形(80.95％).创伤性截肢后发生残端并发症的可能性较预期更高(P<0.05);疾病性截肢后发生残端并发症的可能性较预期更低(P<0.05).结论 交通事故是儿童创伤性截肢的主要原因,其临床特征是不良残端发生率高,主要原因是软组织异常,大部分病例需要通过残端修整术改善不良残端而达到装配假肢恢复行走的目的.先天性胫骨假关节是儿童疾病性截肢的主要原因,往往经历长期的保肢治疗后仍不能避免截肢的结局.

Background: Traumatic knee injury is common and highly debilitating. Its signs and symptoms usually persist long enough to produce muscle atrophy and, sometimes, even permanent contractile dysfunction. Aim: Our goal was to evaluate the effect of combined rehabilitative exercise and celecoxib treatment on the inflammatory reaction in spastic rat quadriceps after traumatic knee injury. Methods: Rats were randomly assigned to one of /bur subgroups: a control group, exercise group, celecoxib treatment group, and combined rehabilitative exercise and celecoxib treatment. From each group, quadriceps muscles were collected four, eight, 12, 16, and 20 weeks after traumatic knee injury. In addition to range of motion in each rat, expression of IL-1, IL-2, TNF-a, COX-1, and COX-2 was evaluated at each time point using real-time polymerase chain reaction and immunohistochemistry. Results: Our results showed that, consistent with an apparent decrease in range of motion after knee injury, expression of the cytokines IL-1, IL-2, COX-1, and COX-2 significantly increased in the spastic rat quadriceps, which was at least partially reversed using combined rehabilitative exercise and celecoxib treatment, resulting in reduced expression of those molecules and improved behavioral outcomes. Conclusion: This study clearly shows that combined rehabilitative exercise and celecoxib treatment relieves acute and chronic inflammation in spastic rat quadriceps after traumatic knee injury.

目的 培养康复治疗学本科生的临床思维和操作能力.方法 将五年制康复治疗学专业分为实验组和对照组,每组15名实习学生.对照组采用常规教学方法.实验组采用案例学习法(CBL)和以问题为基础的学习法(PBL),在实习中使用CBL,通过典型疾病的诊治流程,使学生掌握相关疾病的诊治技能;通过PBL帮助学生回顾相关基础知识,将基础知识融于临床实践中.实习结束后,对两组学生的考核成绩进行比较.结果 实验组考核成绩显著优于对照组(t>6.235,P<0.001).结论 CBL和PBL相结合适用于康复治疗学骨科实习教学,对巩固学生的基础知识、临床思维能力有较大的帮助.

Objective To investigate the perioperative characteristics of hip fractures and the effects of early rehabilitation in elderly patients. Methods Clinical data of 123 elderly patients admitted to our department from January 2012 to January 2014 were retrospectively analyzed. Patients were divided into a rehabilitation group and a control group ,based on whether rehabilitation therapy was offered.Comparison was made between the two groups on postoperative mortality and postoperative complications. Results Of 123 patients ,there were 51 males and 72 females ,with a mean age of (83.5 ± 4.8)years(aged 67~96 years).Femoral fractures were seen in 32 patients and femoral intertrochanteric fractures in 91 patients.Before operation ,112 (91.1% ) patients had concomitant diseases. There were significant differences in postoperative complications and one-year mortality after operation between patients receiving early rehabilitation and controls (5/60 or 8.3% vs.14/63 or 22.2% ,4/60 or 6.7% vs.13/63 or 20.6% ,χ2=4.539 and 5.034 ,P=0.033 and 0.025 , respectively ). Conclusions Elderly hip fracture patients have many concomitant diseases before operation.With appropriate perioperative management ,well-chosen methods of anesthesia and surgery ,and early postoperative rehabilitation measures ,the incidence of perioperative complications and one-year mortality can be decreased ,and desirable surgical outcomes can be attained.

[Objective] To investigate the outcome of rehabilitation treatment on the range of motion and pathological changes in the quadrieeps in a rat modle with post-traumatic knee stiffness.[Methods] Thirty-two 9-week-old male SD rats were randomly divided into control group and rehabilitation group after establishment of the model of knee joint stiffness.Therange of motion of knee joint was measured at different time points.Pathological changes in the quadriceps were evaluated.[Results] After 12 weeks,the range of motion of knee joint was significantly improved in the rehabilitation group than in the control group (P ＜0.05).According to the pathological examination of the quadriceps,compared with the control group,the rehabilitation group had substantially recovering muscle cells.[Conclusion] Knee trauma results in stiffness.Rehabilitation treatment helps to restore the normal range of motion and muscle tissue.

Objective To investigate the effects of structural changes of scaffolds on the proliferation of nerve cells.Methods The primary cultured and purified Schwann cells(SCs)were included from the sciatic and brachial plexus nerve of 1-3 days oldfetal SD rats.The purified SCs were inoculated on the scaffolds with different pore sizes by the drip method to determine the proliferation of SCs. Morphology and molecular biology were used for the examination.Results The cell proliferation in the large aperture group was significantly better than that in the small aperture group.The CCK-8 cell proliferation curve showed thatthe cell proliferation at 96 h in the large aperture group(0.43±0.01)was significantly higher than that in the small aperture group(0.38±0.01)(P<0.05).The findings of ELISA showed that the expression of nerve growth factor in the large aperture group was significantly higher than that in the small aperture group(P<0.05).Conclusion Although the small aperture scaffoldmaterial stimulates the proliferation of cells at the early stage,the biological behavior of SCs was inhibited. Although the early cell base of the large aperture scaffoldmaterial is insufficient,the three-dimensionalspatial structure of the scaffold material is enough to accommodate cells,so that the number of cells gradually increases. Thus,the different three-dimensional spatial structure of the scaffold material may directly affect the proliferation of nerve cells on the scaffold material.

The present study aimed to explore the potential diagnostic role of diffusion tensor magnetic resonance imaging (DTI) in the early stage of modified corticosteroid-induced osteonecrosis of the femoral head (ONFH). A total of 20 beagles were randomly classified (1:1) into either an experimental group (LM), which were intramuscularly injected with lipopolysaccharide (LPS) and methylprednisolone (MPS) on three consecutive days, or control (CON) group, which were injected with saline. Magnetic resonance imaging (MRI) and DTI were performed at pre-induction and 8 and 12 weeks post-induction. Apparent diffusion coefficient (ADC) values in the range of interest in the femoral head were quantified using DTI. Proximal femora were examined for ONFH at 8 and 12 weeks. The results demonstrated that ONFH developed in four beagles at 8 weeks and in six beagles at 12 weeks, whereas no ONFH was detected in the CON group. No abnormalities were detected by MRI and DTI, and no mortality occurred. In beagles with ONFH in the LM group, the ADC values were 4.7±0.2×10-4 and 4.8±0.3×10-4 mm2/sec at 8 and 12 weeks, respectively, which were significantly increased compared with the CON group (2.5±0.3×10-4 and 2.4±0.3×10-4 mm2, respectively) and the LM group without ONFH (2.6±0.4×10-4 and 2.4±0.3×10-4 mm2, respectively) (P<0.05). The results of the present study indicated that intramuscular injection of LPS and MPS may lead to early-stage ONFH in beagles. As such, the detection of locally elevated ADC values in the femoral head may aid in the early diagnosis of ONFH.

Orthopaedic rehabilitation is an important part of rehabilitation resident standardization training, that is complex and unique. Introduction of the discipline, as well as optimizing teaching methods, clinical practice and test are very important for a satisfactory out-come, such as combination of theory and practice, and systematical rehabilitation procedures, principles and operation.

[目的]评价创伤性肘关节异位骨化(traumatic heterotopic ossification of elbow,THOE)和神经源性肘关节异位骨化(neurologic heterotopic ossification of elbow,NHOE)的手术效果,探讨影响肘关节异位骨化手术疗效的相关因素.[方法]回顾性分析2006年7月～ 2011年9月间行肘关节异位骨化切除术的58例(66肘)患者资料.38肘为THOE组,20肘为NHOE组,8肘为混合组.测量患者术前、术后的肘关节活动角度,并进行Mayo评分.以术后2年肘关节僵硬情况和DASH上肢评分功能作为评定手术疗效的指标,分析可能对疗效产生影响的因素.[结果]屈伸活动度、旋转活动度和MEPS评分,THOE组、NHOE组、混合组各组术后与术前比较差异均有统计学意义(P＜0.01).THOE组有1例出现异位骨化复发,而NHOE组有3例出现异位骨化复发.经多因素Logistic回归分析发现骨折数量(OR=16.158,P=0.005)、受伤距松解手术时间(OR=20.408,P=0.004)、术前旋转活动度(OR=12.824,P=0.005)是肘关节异位骨化切除术后2年关节僵硬的独立危险因素;而病因(OR=48.914,P＝0.006)、运动控制(OR=72.019,P=0.000)是肘关节异位骨化切除术后2年上肢功能差的独立危险因素.[结论]手术治疗NHOE和THOE的疗效均满意,但NHOE术后可能更易复发.多处骨折、合并前臂旋转受限、伤后＞12个月手术影响肘关节异位骨化手术效果.运动控制异常的NHOE不利于术后上肢功能恢复.

Objective To analyze related factors and effect of arthrolysis for forearm rotational limitation caused by post-traumatic elbow stiffness.Methods This is a retrospective case series including 44 patients (46 elbows,with a 36-month follow-up) who received arthrolysis treatment for elbow stiffness in both sagittal and rotational motion plane.Pre-and post-operation motion range of flexion and rotation,as well as the Disabilities of the Arm,Shoulder and Hand (DASH) scores were measured and analyzed orderly.Regression analysis was employed to investigate the relation between rotation motion and related factors.Results Rotational range of motion was related with upper limb function.Improvement in rotational arc of motion is negatively correlated with delay of arthrolysis for patients with more than 12 months delay after injuries and the implantation of external fixator.Synostosis,heterotopic ossification and implant block were major inhibitors of rotation recovery.Elbow arthrolysis was effective in increasing rotational range of motion.More importantly,this gain in range translated to a statistically significant improvement in upper limb function.Conclusion Rotational range of motion would directly affect upper limb function.Surgical treatment should be considered within 12 months since primary injuries.Resecting heterotopic ossification,removing implant involved in proximal radial ulnar joints,and performing postoperative special rotational rehabilitation with pain control would avoid stiffness and improve elbow function.

ObjectiveTo evaluate therapeutic results of surgical treatment of posttraumatic elbow stiffness with heterotopic ossification.MethodsA retrospective review of analysis was performed 16 case of patients who underwent open surgical treatment for posttraumatic elbow stiffness by the senior author from July 2008 to December 2010. The study group included 12 males and 4 females, with an average age 38.1 years (range 14 to 59 years). The time from injury to surgery averaged 8.9 (rang 6 to 19) months. We performed elbow open release with excision of the heterotopic ossification. The patients were given indomethacin for 6 weeks after operation. We examined elbow range of motion and used Mayo Elbow Performance Score (MEPS) for evaluations before and after operation.ResultsThe range of flexion to extension of the elbow improved 32°±17.4° to 108°±16.7°. The range of pronation to supination improved from 45°±8.8° to 80.0°±11.0°. The MEPS improved from 52.0±11.2 to 82.0±8.1 (t=8.722, P<0.001) and there were significant differences before and after surgery. Recurrence of heterotopic ossification occurred in one of sixteen cases. Two cases fracture at ulna pinhole with hinged external fixation.ConclusionOpen elbow release with excision of heterotopic ossification is a valuable procedure for post-traumatic stiffness.

Background: Hip fractures in elderly patients prone to a variety of perioperative complications. Perioperative delirium (POD) has been paid more attention in recent years. <br> Objective:To investigate the incidence, risk factors and protective factors of POD in the elderly with hip fracture. <br> Methods:A retrospective analysis was performed in 384 elderly patients with hip fracture treated by surgery from January 2001 to January 2013. There were 206 females and 178 males with a mean age of 78.3 years (range, 65 to 95 years). Gen-der, age, operative time, surgical approach, anesthesia, blood transfusion, medications and complications were taken as inde-pendent variables, and the incidence of POD was taken as dependent variable for Logistic regression analysis. <br> Results:The mean hospital stay of the 384 patients was 15.8 days (range, 7 to 35 days). POD occurred in 79 patients, and the incidence of POD was 20.6%. The age, operation time, anesthesia, complications, blood transfusion and medication were enrolled into Logistic regression equation (P<0.05). Advanced age, extremely-long operative time, general anesthesia, complications (cerebrovascular disease, especially) were risk factors for POD, while medications and blood transfusion were protective factors. Gender and surgical approach were not significantly related to POD (P>0.05). <br> Conclusions:Elderly hip fractures are often complicated by POD. Orthopaedic surgeons should carefully evaluate periopera-tive factors related to POD, avoid general anesthesia, decrease surgical time, and actively manage complications. It is essen-tial to take transfusion and drug prophylaxis for high-risk patients.

Osteoarthritis (OA) is associated with the presence of inflammation. Sialic acid (SA), an acetylated derivative of neuraminic acid, is reported to be a useful biomarker of inflammation. The aim of the present study was to investigate the correlation between SA levels in the serum and synovial fluid (SF) and radiographic severity in patients with knee OA. A total of 234 patients with knee OA were recruited for the study, as well as 20 patients that had suffered a knee injury or fracture (without knee OA) and 160 healthy controls. Radiological grading of OA in the knee was conducted according to the Kellgren-Lawrence (KL) grading system. SA levels in the serum and SF were measured using Warren's thiobarbituric acid assay. The results demonstrated that knee OA patients exhibited significantly elevated levels of serum SA when compared with the healthy controls, and also significantly elevated levels of SF SA when compared with the knee fracture patients. Higher SA levels in the SF were identified in knee OA patients with KL grade 4 as compared with patients with KL grade 2 or 3. In addition, OA patients of KL grade 3 had significantly higher SA levels in the SF as compared with patients with KL grade 2 (P<0.01). The SA levels in the SF of the knee OA patients positively correlated with the KL grades (r=0.353; P<0.01). However, there was no significant correlation identified between serum SA levels and KL grade. Therefore, SA levels in the SF positively correlated with the radiographic severity of OA, thus, SA levels in the SF may serve as a biomarker for the progression of OA.

Objective Explore discipline of expression of inflammatory cytokines in quadriceps for post-traumatic knee stiffness and rehabilitation process.Methods Sclect thirty-six,9-week-old,male SD rats.Establish knee joint stiffness model.Choose quadriceps to detect immunohistochemistry and Reverse transcriotion-polymerase chain reaction (RT-PCR) of Interleukin (IL)-1,IL-2,Tumor necrosis factor-α (TNF-α),cyclooxygenase (COX)-1 and COX-2.Results Comparation of rehabilitation and observation groups:(1) After 12 weeks,IL-1 rehabilitation group IA (Integrated optical density) value:158 976.8 ± 27 475.8,the observation group IA value:338 956.1 ± 32 126.7,IL-2 rehabilitation group IA value:274 188.1 ± 20 514.8,the observation group IA value:410 647.7 ± 24 070.6,there are significant differences between two groups (P ＜ 0.05).(2) After 8 weeks,COX-1 rehabilitation group IA value:413 716.7 ± 40 176.8,the observation group IA value:500 528.2 ± 28 400.5,COX-2 rehabilitation group IA value:294 577.5 ±28 712.6,the observation group IA value:420 301.2 ±30 663.4,there are significant differences between two groups (P ＜ 0.05).(3) mRNA levels of RT-PCR measurement results are consistent with the above between two groups.Conclusion Knee trauma caused by the stiffness.In the rehabilitation process,IL-1,IL-2,COX-1 and COX-2 inflammatory cytokine expression of quadriceps increased firstly and then decreased.

BACKGROUND:Static compressure effect between the fracture fragments was generated by fixation itself (tension band wire and screw), but dynamic compression effects were generated during flexion. Mechanical strength and stability of patel ar fracture fixation have obvious advantages. However, there are lacks of quantitative comparative studies on static and dynamic compression effects of these fixation methods. <br> OBJECTIVE:To observe strength changes and clinical significance of static and dynamic compression using four fixation techniques. <br> METHODS:Standardized transverse patel ar fracture models were created with fresh cow patel as. The patel as were randomly divided into four groups:fixation was accomplished with modified tension band wiring (wire group);modified tension band with braided cable (cable group);interfragmentary screws (screw group);cannulated screw tension band with wire (cannulated screw group). Before fracture fixation, Fuji pressure-sensitive film was laid among fracture fragments to measure the pressure among fracture fragments after fixation, i.e., static and dynamic compression. Model of each group was measured as fol ows:(1) after fixation, the fixation was removed, and the Fuji pressure-sensitive film was taken out;(2) after fixation, material testing machine was used. Samples underwent a three-point bending test with a 5 000 N load, simulating dynamic compression during knee flexion. Subsequently, Fuji pressure-sensitive film was taken out. Each Fuji pressure-sensitive film was tested using prescale FPD-8010E software. Thus, average pressure among broken bone ends was obtained, and statistical analysis was performed. Static and dynamic compression among broken bone ends was compared in each group. <br> RESULTS AND CONCLUSION:Average static compression was significantly lower in the wire group than in the cable group, screw group and cannulated screw group (P<0.05). Under 5 000 N load of dynamic compression, similar compression among broken bone ends was visible among wire group and cable group, screw group and cannulated screw group (P>0.05). Dynamic compression was higher than static compression in the wire group (P<0.05). Results verified that compared with modified tension band wire fixation technique, cable or screw could evidently increase static compression among broken bone ends, but simultaneously weaken dynamic compression among broken bone ends.

Objective To explore the method to establish animal model of early osteonecrosis of the femoral head (ONFH) induced by steroid. Methods 20 healthy male Beagles were randomly divided into control group and experimental group with 10 dogs in each group. The experimental group was injected lipopolysaccharide 10μg/kg and methylprednisolone 20 mg/kg for 3 days consecutively. The control group was injected normal saline. 2 months and 4 months after administration, both groups were performed magnetic resonance imaging (MRI). 5 animals were sacrificed respectively at 2 months and 4 months after administration in each group, and bilateral femoral head speci-mens were obtained to perform histological examination. Plasma prothrombin time (PT), activated partial thromboplastin time (APTT), anti-thrombin III (AT-III) were tested before and 24 h after administration. Results In the experimental group, the pathological results showed that there were 4 ONFH 2 months and 6 ONFH 4 months after administration and MRI did not show any abnormality. Compared with the control group, the PT, APTT, AT-III in the experiment group shortened significantly after administration (P<0.001). Conclusion Modified steroid-induced method can establish the animal model of early ONFH. Hypercoagulation and low fibrinolysis may be the reason of ste-roid-induced osteonecrosis.

Objective To compare the efficacy and complications among three surgical treatments of femoral intertrochanteric fractures in elderly patients.Methods Totally 209 elderly patients with femoral intertrochanteric fracture were divided into 3 groups:DHS group[n =115,patients treated with dynamic hip screws (DHS)],PFNA group [n=57,patients treated with proximal femoral nails anti-rotation (PFNA)] and SEFT group [n=37,patients treated with singlearm external fixator technique (SEFT)].The length of hospitalization,operative time,bleeding volume,hip function scores and complications were compared among the three groups.Results All patients were followed up for 5-12 months (10.6 months in average).The length of hospitalization,operative time,bleeding volume,weight-bearing time and Harris hip score in postoperative 3 months were (14.3±2.7) d,(102.4±22.7) min,(240.8±38.4) ml,(50.2±7.7) d,(88.7±12.8) min in DHS group,(11.2±3.4) d,(50.3±15.6) min,(80.5±18.7) ml,(22.6±4.8) d,(92.6±15.4)min in PFNA group,(15.1±3.3) d,(35.8±10.9) min,(52.6±12.9) ml,(55.4±10.1) d,(87.3 ± 12.6) min in SEFT group,respectively.There were significant differences in the length of hospitalization,operative time,bleeding volume,weight-bearing time and Harris hip score in postoperative 3 months among the three groups (all P ＜ 0.05),while there was no significant difference in healing time among the three groups (all P＞0.05).The incidence of complications was highest in DHS group,higher in SEFT group,and lowest in PFNA group (all P＜0.05).Conclusions DHS is more suitable for patients with good physical condition and stable fractures.SEFT is suitable for patients with poor condition,who can not tolerate trauma,anesthesia and bleeding.PFNA has more advantages including stable fixation,less invasive,less complications and wide indications,which is more suitable for femoral intertrochanteric fractures than the other two treatments.

目的 探讨正规系统康复治疗对创伤后膝关节僵直的临床疗效.方法 回顾性分析2004年2月至2010年11月接受康复治疗的63例创伤后膝关节僵直患者的临床资料,并对治疗前后膝关节活动度和膝关节功能评分(HSS)进行统计学分析.结果 随访3-72个月,平均为18.5个月,膝关节的活动度平均增加55..治疗前后活动度[(54.0±25.0).vs(99.0±21.8).]和HSS评分[(75.0±10.0)分vs.(90.0±6.6)分]的比较均有统计学差异(P均<0.05).结论 正规系统康复治疗对创伤后膝关节功能障碍有显著疗效,其适应证的选择是前提条件.

OBJECTIVES:To investigate the therapeutic effect of rehabilitation, arthroscopy and "hybrid technique" for posttraumatic knee stiffness (PTKS), and to make the best choice for the treatment.METHODS:From February 2004 to November 2009, 66 patients suffered from PTKS were treated, and the clinical data were studied retrospectively, 36 male and 30 female patients with an average age of 41 years were analyzed, knee stiffness time averaged 15 months (0.5 - 108.0 months), 21 cases of patients were treated with rehabilitation (rehabilitation group), 22 cases of patients with arthroscopy + rehabilitation (arthroscopy group) and 23 cases of patients with mini-invasive "hybrid technique" + rehabilitation (hybrid technique group). For each case, the difference of range of motion (ROM) and hospital for special surgery (HSS) score of the knee before and after the treatment were analyzed statistically. The characters of PTKS including the course of the disease, the degree of extensor mechanism involving, physical examination and other ancillary data were also analyzed. The management methods for PTKS were summarized.RESULTS:Total 66 cases were followed up ranging from 24.0-72.5 months and the mean time was 34.2 months. The average ROM was improved obviously: rehabilitation group increased from 45° ± 22° to 95° ± 24° (t = -11.2, P < 0.05), arthroscopy group from 47° ± 26° to 118° ± 11° (t = -11.0, P < 0.05) and hybrid technique group from 36° ± 22° to 110° ± 14° (t = -13.4, P < 0.05). Both ROM and HSS score of the knee before and after the treatment for each group showed significant difference statistically (t = -9.1, -6.0, -5.2, P < 0.05). Wound necrosis, tearing, re-fracture and extension lag were not found. According to Judet standard at final follow-up, 15 cases were excellent, 3 cases good and 3 cases normal in rehabilitation group; 15 cases were excellent, 5 cases good and 2 cases normal in arthroscopy group; 14 cases were excellent, 8 cases good and 1 case bad.CONCLUSIONS:Pathology of PTKS is complex, satisfactory result could be obtained through individualized treatment program, which were established depend on the course of the disease, the degree of extensor mechanism involving, physical examination and ancillary data. The timely and effective surgical interference followed by a comprehensive rehabilitation program is the key point for satisfied outcome.

[Objective]To evaluate the outcome of the surgical-treated ankle fractures.[Method]We reviewed the outcomes of 109 cases of ankle fracture which had completed follow-up data from January 2005 to January 2009,the outcomes were assessed by AOFAS scoring scale.[Result]Follow-up ranged 12-24 months.All cases had fracture healed.AOFAS outcomes:the excellent to good results rate was 89%.The outcomes were satisfying.[Conclusion]Surgical treatment for ankle fractures can have a good clinical result duing to nantomic reduction of ankle joint and effected internal fixation permitting early rehabilitation and proper treatment of tibiofibular syndesmosis ligament injury.