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Objective:To study the application of establishing WeChat group combined with PBL teaching mode in the practice of pediatric orthopaedics.Methods:The study was conducted among 36 postgraduates of "5+3" pediatrics and 22 postgraduates of orthopedic surgery of Batch 2012 who had practice in Department of Orthopaedics, Children's Hospital of Chongqing Medical University from September 2018 to August 2019, and they were randomized into control group and experimental group, with 29 students in each group. The control group was taught by traditional PBL mode, while the experimental group was taught by WeChat group combined with PBL mode. At the time of leaving the department, the two groups were assessed by theoretical knowledge, practical operation and questionnaire satisfaction, thus evaluating the teaching effects. The SPSS 23.0 was used to conduct t test and chi-square test. Results:The average scores of theoretical knowledge test (91.28±2.89) and practical operation test (87.44±2.94) in the experimental group were significantly higher than those in the control group (87.39±3.53) and (79.06±3.84), with statistically significant differences ( P<0.05). In the survey of teaching satisfaction, the experimental group[96.55%(27/29)] was significantly higher than the control group[61.90%(21/29)], with statistically significant differences ( P<0.05). Conclusion:The establishment of WeChat group and the combination of PBL teaching model can significantly improve the teaching effect and students' satisfaction in the practice of pediatric orthopaedics, which is worthy of further promotion and application.
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Objective To investigate the clinical efficacy of open reduction and internal fixation with K-wires for old Gartland Ⅲ supracondylar fracture in children.Methods A retrospective case series study was conducted on 49 children with old Gartland Ⅲ supracondylar humeral fracture admitted from June 2012 to January 2017.There were 35 boys and 14 girls,with average age of 6.1 years (range,3.4-11.5 years).The duration from initial trauma to operation ranged from 22 days to 60 days (mean,29.8 days).There were five cases of radial nerve injury,one case of median nerve injury,and one case of Volkmann ischemic contracture.All patients were surgically treated with open reduction and internal fixation with K-wires + plaster external fixation.Six patients with nerve injury underwent neurological exploration and release.Nerve partial fracture was seen in one patient during operation,and nerve repair was performed.The fracture healing and complications were observed.At the final follow up,Flynn's criteria was applied to evaluate the elbow joint function.The humerus length and transverse diameter of humeral condyle between the healthy limb and the suffered one were compared to evaluate the humerus growth.Results All patients were followed up for 6-24 months,with an average of 12.5 months.All fractures were healed,with no fracture redisplacement or bone nonunion occurred.The neurological symptoms of six patients with nerve injury disappeared after two months.One patient had superficial skin infection at the incision and recovered after treatment.Six patients (12％) developed cubitus varus deformity after operation.At the final follow-up,the clinical and radiographic outcomes were assessed via Flynn's criteria,and the results were excellent in 37 patients,good in five,fair in one,and poor in six patients,with an excellent and good rate of 86％.There were no significant differences in the humerus length [(189.3 ± 27.8) mm vs.(190.6 ± 28.8) mm] and transverse diameter of humeral condylar [(29.5 ± 3.5) mm vs.(29.7 ± 3.6) mm] (P ＞ 0.05) between the healthy limb and the suffered one,respectively.Conclusion For old Gartland type Ⅲ supracondylar humeral fracture in children,open reduction and internal fixation with K-wires + plaster external fixation can attain satisfactory function recovery of elbow joint and reduce the incidence of cubitus varus deformity,without negative influence on children's humerus growth or development.
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Objective To review the effect of exposed and buried Kirschner wire fixation of lateral humeral condyle fracture in children.Methods Randomized control trials (RCTs) about exposed versus buried Kirschner wire fixation of lateral humeral condyle fracture in children were identified through electronic search using the Cochrane Collaboration search strategies and manual search.Electronic database included Cochrane Library,Medline,PubMed,CBM,VIP,CNKI,Wanfang database and other Chinese and English database.Manual research included related journals and conference proceedings.Quality analysis of the included literatures was performed using the methodological index for non-randomized studies (MINORS).RevMan 5.3 software was used for Meta analysis.Results Four studies involving exposed Kirschner in 150 cases and buried Kirschner in 351 cases were included.The two techniques were similar with respect to postoperative infection (OR =1.10,95％ CI 0.52 ～ 2.33,P ＞ 0.05),superficial infection (OR =1.45,95 ％ CI 0.66 ～ 3.18,P ＞ 0.05),reoperation rate (OR =2.29,95％CI 0.51 ～ 10.25,P ＞0.05),delayed union rate (OR =1.57,95％ CI 0.76 ～ 3.21,P ＞0.05) and total complications (OR =1.57,95％ CI 0.76 ～ 3.21,P ＞ 0.05).However,Kirschner wire exposure shortened the time of pulling out Kirschner wire (MD =-13.28,95％ CI-16.42 ～-10.14,P ＜0.05).Conclusion Applied for lateral humeral condyle fracture in children,exposed versus buried Kirschner wire fixation results in short Kirschner wire stabilization time that avoids local anesthetic and cost while pulling out Kirschner wire in the late stage.
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Objective To compare the clinical effect of tensile band wire fixation and plate fixation for treating children with olecroanon fracture.Methods Sixty-three children with olecroanon fracture at Children's Hospital of Chongqing Medical University from January 2006 to January 2014 were selected.In those cases of fracture by means of open reduction,41 cases were treated with tensile band wire,and 22 cases were treated with internal fixation with anatomical plate.Operation time,bleeding during operation,recovery time postoperatively,postoperative complications and joint function recovery were analyzed by using independent sample t-test and chi-square test.Results In the group of tensile band wire,there was no case of Kirschner wire loosening and displacement fracture.In group of steel plate,there were 2 cases of myositis ossificans.In the 2 groups,there was no case of bone nonunion.The average operation time:plate fixation group was (65.3 ± 8.4) min and tension band wire group was (58.4 ± 12.6) min,and there was a significant difference between the both groups (t =7.419,P ＜ 0.05);blood loss:plate fixation group was (5.3 ±0.8) mL and tension band wire group was (4.7-± 1.2) mL,and there was a significant difference between the both groups (t =2.595,P ＜ 0.05);fracture healing time:plate fixation group was (74.1 ± 8.4) d and tension band wire group was (61.7 ±9.3) d,and there was a significant difference between the both groups (t =10.636,P ＜0.05).With Broberg-Morrey to evaluate two groups'quality rate of function recovery,there was no significant difference in statistics with 85.3％ (35/41 cases) in tensile band wire group and 81.8％ (17/22 cases) in steel plate group(x2 =0.651,P ＞ 0.05).Conclusions Olecranon fracture in children using tension band wire fixation may be a better way,more suitable for promotion and implementation at basic hospital.
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Objective To compare the effect of titanium elastic nailing (TEN) and plating in treatment of both radius and ulna fractures in children older than 10 years.Methods This retrospective analysis comprised 38 children (50 sides) of both radius and ulna fractures treated with TEN (30sides) or plate (20 sides) between 2009 and 2014.Parameters compared between the two fixation methods were operation time,ratio of open/close reduction,time to internal fixation removal,incidence of postoperative complications,and bone union time.Anderson score was used to evaluate the treatment results.Results Operation time [(94.3 ± 39.5) min vs (120.5 ± 45.4) min],time to internal fixation removal [(210.8 ± 84.1) d vs (264.4 ± 88.9) d],and ratio of open/close reduction (20/10 vs 20/0)varied significantly between TEN and plating groups (P ＜ 0.05 or 0.01).Whereas,no statistically significant differences were noted in regard to complication rate,bone union time,and effect evaluation.Conclusion For fracture of the radius and ulna in children older than 10 years,TEN should be used for closed type without obvious displacement,but plate fixation is associated with lower incidence of fracture malunion and better outcome in treatment of open type with obvious displacement.
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Objective To explore the application of case based learning(CBL)combined with multimedia teaching in the clinical pediatric surgery.Methods 144 five-year program students of Pediatrics in grade 2009 were randomly and evenly divided into the experimental group using CBL with multimedia teaching,and the control group using multimedia teaching mode.After the end of the course the students of the two groups took clinical teaching knowledge test.The evaluation scores were shown by mean ± standard deviation and comparison was made between the two groups with t test.At the same time,teaching satisfaction survey was conducted among the students of the experimental group.Results The usual results,the theoretical scores and total scores of the students in the experimental group were higher than those of the control group students in the operation skills,clinical thinking,and there was statistically significant difference in P＜0.01.(P=0.003,P=0.002,P=0.008,P=0.009,P=0.008).The questionnaire survey shows that compared with traditional multimedia teaching,CBL combined with multimedia teaching can preferably culture students' various abilities and is beneficial to learning.Condusion The use of CBL combined with multimedia teaching can affirmatively improve the clinical teaching effect in the clinical pediatric surgery,and it deserves to be generalized in the future teaching.
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BACKGROUND: Deproteinized bone has three diamensions frame profitting bone cells to adhere to, new capillaries and interstitial cells to enter, osteoblasts to differentiate and extracellular matrix to synthesize. Calcium phosphate cement (CPC) is a new in-ceramic bone cement that can degradate, which has plasticity, no heat production, invariably mechanics intension and porosity.OBJECTIVE: To explore the ability of CPC attaching with human vascular endothelial growth factor (rhVEGF) and recombinant human bone morphogenetic protein-2 (rhBMP-2) in promoting deproteinized osteoarticular allograft to repair osteoarticular defect.DESIGN: Randomly control observation.SETTING: Department of Orthopaedics, the First Affiliated Hospital, Chongqing Medical University.MATERIALS: A total of 42 adult hybridization dogs of both genders and weighing (10±0.5) kg were provided by Animal Center of Chongqing Medical University. RhVEGF was provided by Beijing Boaosen Biotechnology Co., Ltd.; rhBMP-2 by Guangzhou Dahui Biotechnology Co., Ltd.; CPC by Shanghai Ruibang Biotechnology Co., Ltd.METHODS: The experiment was carried out in the Laboratory of Orthopaedics (Municipal Laboratory), Clinical College,Chongqing Medical University from March to September 2006. A total of 36 adult dogs were randomly divided into three groups with 12 in each group, including group A: CPC/rhVEGF/rhBMP-2/deproteinized femoral inferior extremity (DPB)osteoarticular allograft; group B: rhVEGF/rhBMP-2/DPB osteoarticular allograft; group C: simple DPB osteoarticular allograft. The experimental dogs were cut off femur by wire saw from articular surface with 30 mm, then fixed the grafts to broken ends of fractured femur with cross Kirschner wires, drawn down the proximad periosteum and sutured it. At the 4th, 8th, 12th and 16th weeks after operation, the effects were partly assessed by X-ray film examination, histologic examination as well as immunohistochemistry analysis of VEGF and BMP-2, vas capillare analysis by vaso-filling with ink, radionuclide bone imaging examination (ECT) and vitodynamic tests.MAIN OUTCOME MEASURES: At the 4th, 8th, 12th and 16th weeks after operation, the effects were partly assessed by X-ray film examination, histologic examination as well as immunohistochemistry analysis of VEGF and BMP-2, vas capillare analysis by vaso-filling with ink, radionuclide bone imaging examination (ECT) and vitodynamic tests.RESULTS: All 36 rats were involved in the final results. ① From 4th to 16th week after operation, the callus formation in group A was better than that of group B and group C by x-ray film examination. ② Image analysis system displayed that the value of area integration of optical density in group A was obviously higher than that in group B and C about VEGF at the 8th, 12th and 16th weeks, and BMP-2 at the 4th, 8th, 12th and 16th weeks. The difference had statistical significance (P＜ 0.01). ③ The new vessels of grafts in group A were more than those in group B and C, part of those inclined to mature. The difference had statistical significance (P ＜ 0.01). ④ The blood flow of operation side was higher than that of uninjured side after operation, but that in group A was significantly higher than that in group B and C. The difference had statistical significance (P＜ 0.01). ⑤ At the 16th week, the result in group A was significantly higher than that in group B and C (P＜ 0.01).CONCLUSION: The recombinant deproteinized osteoarticular materials have fairly strong ability of new bone formation and vasculogenesis, and can early achieve bone healing, repairing osteoarticular defect and become autologous tissue at last.
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Objective:To explore the ability of osteo-articular allograft of variant deproteinized bone combining calcium phosphate cement with recombinant human vascular endothelial growth factor and bone morphogenetic protein-2 in repairing osteo-articular defect.Methods:36 adult mixtus dogs were constructed as semi-articular defect models through resecting 30mm right femur inferior extremity near articular facet,and they were randomly divided into 3 groups.In group A,material CPC/rh VEGF/rh BMP-2/DBP was transplanted into the semi-articular defect.In group B,material rhVEGF/rhBMP-2/DBP was transplanted there.In group C,simple material DPB was transplanted there.At 4,8,12 and 16 weeks after operation,the effects were as- sessed by macro-morphology observation,X-ray examination,histologic examination as well as collagen type I immunohistochem- istry analysis transmission electron microscope examination and vitodynamic tests in order to observe bone reparation matter. Results:The new bone formation observed by vitodynamic tests,macro-morphology observation,X-ray examination,histologic ex- amination and transmission electron microscope examination in group A was significantly superior to that in group B and C.The results of collagen type I immunohistochemistry analysis and vitodynamic tests were significantly superior to that in group B and C(P0.05).Conclusion:The mate- rials CPC/rh VEGF/rh BMP-2 can promote the new bone formation,achieve bone healing and make them become autologous tissue at last.
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Objective To explore the ability of revascularization of big section deproteinized bone (DPB) allograft combining calcium phosphate cement (CPC) with recombinant human vascular endothelial growth factor (rhVEGF) and bone morphogenetic protein-2 (rhBMP-2). Methods Totally 36 adult hybrid dogs were inflicted to demi-articular defect models by exsecting 30 mm right femur inferior extremity near articular surface,and then randomly divided into 3 groups, group A, receiving material CPC/rhVEGF/rhBMP-2/DPB transplantation into the demi-articular defect, group B, material rhVEGF/rhBMP-2/DPB transplantation, and group C with simple material DPB transplantation. At 4, 8, 12 and 16 weeks after operation, vasculogenesis and new bone formation were assessed by X-ray examination, histological examination, transmission electron microscopy, vas capillare analysis by vaso-filling with ink and radionuclide bone imaging examination (ECT). Results The bone formation and vascularization was significantly superior in group A to that in group B and C. The results of vaso-filling examination with ink and arterial perfusion of ECT examination were both significantly superior to that in group B and C (P