Quality assessment of pharmacoeconomic evaluation literature in China from 2018 to 2022 / 中国药房

OBJECTIVE To analyze existing problems of pharmacoeconomic evaluation research in China and to improve the standardization and scientificity of research， so as to provide more high-quality evidence for government decision-making. METHODS Retrieved from CNKI， Wanfang database， VIP， PubMed， Web of Science from 2018 to 2022， the literature related to pharmacoeconomic evaluation in China was collected； Excel 2016 software was used to extract the key information of the included literature which met inclusion criteria. The Quality of Health Economic Studies （QHES） scale was used to evaluate the quality of the included literature. RESULTS A total of 113 pieces of literature were included in this study， involving 85 pieces of Chinese literature and 28 pieces of English literature. The overall score of QHES included literature was 65.7， of which the average score of Chinese literature was 62.0 and English literature was 76.9. The median quality scores for the literature in 2018， 2019， 2020， 2021 and 2022 were 62.0， 70.5， 59.3， 71.0， and 73.0， respectively. Of these， 65 pieces of literature reported the research perspective； 36 reported the discount rate indistinctly； 25 provided unclear definitions of thresholds； and 53 used two sensitivity analysis methods. Among different items of the QHES scale， item 2 （research perspective）， item 8 （time range and discount rate）， item 14 （potential bias） and item 16 （sources of funding） had low percentage of scores. CONCLUSIONS From 2018 to 2022， pharmacoeconomic evaluation literature published by Chinese academics has generally shown a fluctuating upward trend in terms of quality， but there is still some room for improvement. The main problems in current pharmacoeconomics research in China include unclear understanding of the research perspective， single measurement of cost and health outcomes， unreasonable design of time horizon， indistinct description of the threshold or discount rate， and lack of sensitivity analysis.

Clinical efficacy of anterior radius head fracture combined with lateral ligament complex injury / 中华骨科杂志

Objective:To investigate the operation efficacy of anterior radius head fracture combined with lateral ligament complex injury.Methods:The patients with radial head fracture admitted from September 2017 to August 2021 were retrospectively analyzed, 51 males and 54 females, average age of 38.84±13.63 years (range of 16-70 years). Based on the radial head fractures of Mason classification of type II, the cases involving the anterior radius head fracture were divided into three subtypes according to the number of fracture blocks and the type of displacement: type A (53 cases): one part of the anterior radius head collapse fracture; type B (50 cases): two or more parts of the anterior radial head collapse fracture; type C (2 cases): anterior radius head dissociated and displaced fracture. All fractures were treated with open reduction and internal fixation. Among them, the lateral ligament complex of type B were elongated due to the injury but the continuity existed. Therefore, the lateral ligament complex in 21 cases were not repaired in the early period (unrepaired group); in recent years, 29 cases repaired the lateral ligament complex (repair group). The postoperative efficacy was evaluated by elbow range of motion, table-top relocation test, Mayo score, and Broberg Morrey score. the patients were evaluated at final follow-up, except table-top relocation test was recorded according to the actual completion time.Results:All operations were successfully completed. The mean follow-up was 14.08±1.52 months (range of 12-18 months). Type A: the flexion and extension range was 115.70°±6.35°; the completion time of the table-top relocation test was 75.68±11.90 days; the Mayo score was 93.72±2.40 point, and the Broberg Morrey score was 92.89±2.28 point. Type B: lateral ligament repair group (repaired group) 29 cases and unrepaired lateral ligament group (unrepaired group) 21 cases. The flexion and extension range of elbow in repaired group was 112.1°±4.4°, which was better than that in unrepaired group 105.8°±3.7° ( t=5.31, P<0.001). The completion time of table-top relocation test was 77.72±6.51 days in repaired group and 104.29±18.45 days in unrepaired group ( t=6.32, P<0.001). The Mayo score of the repaired group was 90.21±5.88 points and that of the unrepaired group was 87.14±5.26 points ( t=1.90, P=0.063), and there was no significant difference between the two groups. Broberg Morrey score of 90.93±6.43 points in the repaired group was better than 86.95±6.37 points in the unrepaired group ( t=2.17, P=0.035). Type C for 2 patients, the flexion and extension range of elbow were 107°and 106°; the completion time of table-top relocation test were 82 days and 98 days; the Mayo scores were 91 point and 87 point; Broberg Morrey scores were 93 point and 85 point. There was a patient developed myositis ossificans in unrepair group of tybe B. Conclusion:The elbow joint is stable when one part of the anterior radius head collapse fracture; there is a degree of instability in the elbow when two or more parts of the anterior radial head collapse fractures suggest to repair the lateral ligament complex. The elbow joint is extremely unstable when anterior radius head dissociated and displaced fractures, the lateral ligament complex should be repaired in time.

Short-term clinical outcome of dual plate for proximal humerus fracture with calcar comminution / 中华骨科杂志

Objective:To investigate the efficacy of dual plate fixation in the treatment of proximal humeral fracture with comminuted calcar.Methods:From July 2018 to April 2020, 25 patients (7 males and 18 females) were treated operatively for proximal humeral fractures with calcar comminution using anterior plate and lateral Philos plate. The data of patients who were followed up for more than 12 months was retrospectively analyzed. The mean age was 58.3 years (range 33-79 years). There were 13 right sides (all principal sides) and 12 left sides (all non-principal sides). The causes of injuries included: falling on flat ground (12 cases), traffic accidents (11 cases) and falling from height (2 cases). According to Neer classification, there were 7 cases of two-part fractures, 16 cases of three-part fractures and 2 cases of four-part fractures. A number of parameters including patient demographics, mechanism of injury, operative time, time to union, the range of shoulder motion, visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley shoulder joint score, neck-shaft angle and the complications were recorded.Results:All of 25 patients were operated and followed up for 24.7 months (range 14 to 36 months). The operation time was 124.3 min (75-185 min), and the blood loss was 178.4 ml (100-350 ml). All patients had healed fractures at the last follow-up, and the neck-shaft angle was 132.88°±8.11° immediately after surgery, and 132.68°±8.36° at the last follow-up. All 25 patients healed completely in 4.7 months (range 3-5 months). Range of shoulder joint motion were forward flexion 161.20°±13.01° (range 140°-180°), external rotation 37.60°±7.65° (range 20°-45°), and internal rotation T 4-L 4 levels. VAS score was 0.36±0.81 points (range 0-3 points), while ASES score was 87.32±8.78 points (range 57.7-100 points) and Constant-Murley score was 89.40±8.37 points (range 60 to 100 points). Overall satisfaction score (Constant-Murley score) was excellent in 23 cases, and good in 2 cases. No obvious complications occurred. Conclusion:The combination of anterior plate and lateral Philos plate in the treatment of proximal humerus fractures with comminuted calcar can achieve stable fixation and satisfactory postoperative results.

Importance of distal radius teardrop angle in the treatment of distal radius middle column fracture / 中华骨科杂志

Objective:To investigate the importance of measuring and restoring distal radius tear drop angle in the treatment of distal radius middle column fracture with anterior collapse of lunate fossa joint.Methods:Thirty one cases of distal radius fractures in 29 patients was reported for 2 years from January 2018 to January 2020. Two patients with both distal radius fractures were included in this study. All cases in this group were treated by operation. Among the 29 patients, there were 20 males and 9 females. Their ages were 44.9±15.1 years (ranged from 20 to 78 years). Two patients with both distal radius fractures were included in this study, due to both teardrop angle (TDA) reduced. The time from injury to operation was 4-17 d, with an average of 6.9 d. Except for 2 cases of fracture with simple volar approach, the other cases were treated with combined volar and dorsal approach. All patients were treated with open reduction and internal fixation with plates and bone grafting. The teardrop angle was measured before and after operation, and the effect of surgical recovery of teardrop angle was compared. The wrist function was evaluated by Gartland-Werley scores.Results:The wounds of all patients healed in one stage without postoperative infection. The follow-up time of 29 patients were 15.1±5.2 months, ranged from 7 to 31 months. The healing time for all fractures was 10.3±2.9 weeks (from 8 to 16 weeks). No fracture nonunion or redisplacement. In 31 cases, the tear drop angle was 33.4°±5.83° (20°-45°) before operation, and 58.9°±9.89° (35°-70°) after operation. At the end of follow-up, Gartland-Werley scores was 4.7±4.6, ranged from 0 to 17. Among them, 10 cases were excellent, 16 were good, 5 cases were fair, and the excellent and good rate was 83.9%. The Gartland-Werley scores of the two subgroups with postoperative tear drop angle recovery ≥50° and <50° were compared, and the results were significantly different (the excellent and good rate for two subgroups were 96.2% and 20.0% respectively ( P=0.001). Conclusion:The distal radius fracture with significantly reduced tear drop angle should be actively treated. The measurement and recovery of tear drop angle is an important factor affecting the functional outcome of distal radius fracture with anterior edge collapse of lunate fossa joint, which should be highly concerned by clinical doctors. The recovery of teardrop angle mostly requires dorsal approach.

Single-cell transcriptome reveals features of immune environment and mechanisms of immune escape in giant cell tumor of bone / 中华骨科杂志

Objective:This study aims to reveal the special immune infiltrating environment and possible immune escape mechanism of giant cell tumor of bone through single-cell sequencing data.Methods:The fresh samples obtained from 4 patients with primary giant cell tumor of bone from January 2018 to December 2021 were collected, and single-cell transcriptome sequencing was performed on the 10X platform to explore the characteristics and immune environment of giant cell tumor of bone by using t-distributed stochastic neighbor embedding ( t-SNE). The main cell types and signal pathways of immune cell regulation and function in giant cell tumor of bone were observed by cell communication analysis. Results:Cell clustering, the definition of basic cell types, the classification of immune cells, and the mutual regulatory relationship between cell types were analyzed for 35 643 single-cell data from 4 giant cell tumor samples of bone. It was found that giant cell tumor of bone was composed of 9 basic cell types, in which the immune cells were mainly CD8 + T cells (51%) and the non-immune cells were mainly fibroblast like spindle stromal cells (74%). The immune infiltration of giant cell tumor of bone is dominated by cytotoxic CD8 + T cells and lacks exhausted CD8 + T cells. CD4 + T cells are characterized by high expression of immune checkpoint genes CTLA4 and TIGIT. In giant cell tumor of bone, immune cells mainly act on multinucleated osteoclast like giant cells through PARs and CCL signaling pathways, but not stromal cells. Conclusion:This study defined the main cell types of giant cell tumor of bone through single cell sequencing data, and further revealed the composition characteristics of its immune infiltration, and found that the target of its immune cells was mainly multinuclear osteoclast like giant cells, which provided effective information for further understanding the occurrence and development of giant cell tumor of bone.

Differential diagnosis and treatment of posterior Monteggia fracture and posterior dislocation of proximal ulna fracture / 中华骨科杂志

A classical Monteggia fracture is defined as an ulnar fracture with dislocation of the proximal radioulnar joints. If combined with posterior dislocation of the radial head (posterior dislocation of the radiocapitellar joints), it is called a posterior Monteggia fracture. And for those without dislocation of the proximal radioulnar joints, it should not be defined as the posterior Monteggia fracture, but as the posterior dislocation of the proximal ulna fracture. For dislocation of the proximal radioulnar joints, the Monteggia fractures, clinical are relatively rare. The coronoid process fracture is comminuted, the proximal radioulnar joints are destroyed, the membrane and the annular ligament is injured. After restoring osseous structure and repairing the lateral ligament complex, we must also pay attention to the stability of proximal radioulnar joints, and the prognostic efficacy not sure. However, posterior dislocation of proximal ulna fractures is relatively common in clinical practice, and the coronal process fracture is usually complete, with the annular ligament and interosseous membrane intact. In treatment, the bone structure is mainly restored, and the lateral ligament complex of elbow joint is treated at the same time, with good prognosis. Through anatomical basis, imaging characteristics, injury characteristics, treatment and prognosis, we can distinguish with the posterior Monteggia fracture and posterior dislocation of proximal ulna fracture.

Early efficacy evaluation of the treatment of complex proximal humeral fractures in the elderly with reverse shoulder arthroplasty / 中华骨科杂志

Objective@#To evaluate the short-term efficacy of one-stage reverse shoulder arthroplasty in the treatment of complex proximal humeral fractures in the elderly.@*Methods@#Data of 43 elderly patients with complex proximal humeral fractures who were treated by reverse shoulder arthroplasty from July 2017 to January 2019 were retrospectively analyzed. There were 12 males and 31 females with an average age of 72 years (range, 66-78 years). All fractures were fresh and close which caused by trauma. The average time from injury to operation was 8.0 days (range, 6-11 days). According to Neer classification, 21 cases (48.8%, 21/43) were three-part fractures, 22 cases (51.2%, 22/43) four-part fractures. Visual analogue scale (VAS), Neer shoulder replacement evaluation system and Constant-Murley score were used to evaluate the postoperative results.@*Results@#All operations were successfully completed. The average operation time was 141.3 minutes (range, 120-170 minutes. The mean blood loss was 407 ml (range, 250-700 ml) and intraoperative blood transfusion was 446.5 ml (range, 400-800 ml). All patients were followed up for 10.9 months (range, 6 to 16 months). All patients were discharged within 7 days after operation, and no wounds related complications occurred. The bigger and lesser tuberosities of all patients healed completely within 8 weeks. At the latest follow-up, no loosening or dislocation of prosthesis occurred, and the forward elevation was 133.0° (range, 100°-165°); external rotation was 29.5° (range, 20°-35°); internal rotation was 46.7° (range, 30°-60°). VAS score was 0.8 (range, 0-3). The Neer score was 87 (range, 73-98), with 20 cases (46.5%, 20/43) excellent, 16 cases (37.2%, 16/43) good, and 7 cases (16.3%, 7/43) fair. Constant-Murley score was 88.7 (range, 70-98). A 71-year-old patient had symptoms of axillary nerve injury after operation and recovered completely 6 weeks after the operation, which did not affect the functional rehabilitation exercise or the stability of the prosthesis. During the follow-up, no other complications such as infection, acromial stress fracture and scapular notching were found in all patients.@*Conclusion@#The short-term effect of one-stage reverse shoulder arthroplasty for the treatment of complex proximal humeral fractures in the elderly is satisfactory.

Differential diagnosis and treatment of posterior Monteggia fracture and posterior dislocation of proximal ulna fracture / 中华骨科杂志

A classical Monteggia fracture is defined as an ulnar fracture with dislocation of the proximal radioulnar joints.If combined with posterior dislocation of the radial head (posterior dislocation of the radiocapitellar joints),it is called a posterior Monteggia fracture.And for those without dislocation of the proximal radioulnar joints,it should not be defined as the posterior Monteggia fracture,but as the posterior dislocation of the proximal ulna fracture.For dislocation of the proximal radioulnar joints,the Monteggia fractures,clinical are relatively rare.The coronoid process fracture is comminuted,the proximal radioulnar joints are destroyed,the membrane and the annular ligament is injured.After restoring osseous structure and repairing the lateral ligament complex,we must also pay attention to the stability of proximal radioulnar joints,and the prognostic efficacy not sure.However,posterior dislocation of proximal ulna fractures is relatively common in clinical practice,and the coronal process fracture is usually complete,with the annular ligament and interosseous membrane intact.In treatment,the bone structure is mainly restored,and the lateral ligament complex of elbow joint is treated at the same time,with good prognosis.Through anatomical basis,imaging characteristics,injury characteristics,treatment and prognosis,we can distinguish with the posterior Monteggia fracture and posterior dislocation of proximal ulna fracture.

Early efficacy evaluation of the treatment of complex proximal humeral fractures in the elderly with reverse shoulder arthroplasty / 中华骨科杂志

Objective To evaluate the short-term efficacy of one-stage reverse shoulder arthroplasty in the treatment of complex proximal humeral fractures in the elderly.Methods Data of 43 elderly patients with complex proximal humeral fractures who were treated by reverse shoulder arthroplasty from July 2017 to January 2019 were retrospectively analyzed.There were 12 males and 31 females with an average age of 72 years (range,66-78 years).All fractures were fresh and close which caused by trauma.The average time from injury to operation was 8.0 days (range,6-11 days).According to Neer classification,21 cases (48.8％,21/43) were three-part fractures,22 cases (51.2％,22/43) four-part fractures.Visual analogue scale (VAS),Neer shoulder replacement evaluation system and Constant-Murley score were used to evaluate the postoperative results.Results All operations were successfully completed.The average operation time was 141.3 minutes (range,120-170 minutes.The mean blood loss was 407 ml (range,250-700 ml) and intraoperative blood transfusion was 446.5 ml (range,400-800 ml).All patients were followed up for 10.9 months (range,6 to 16 months).All patients were discharged within 7 days after operation,and no wounds related complications occurred.The bigger and lesser tuberosities of all patients healed completely within 8 weeks.At the latest followup,no loosening or dislocation of prosthesis occurred,and the forward elevation was 133.0° (range,100°-165°);external rotation was 29.5° (range,20°-35°);internal rotation was 46.7° (range,30°-60°).VAS score was 0.8 (range,0-3).The Neer score was 87 (range,73-98),with 20 cases (46.5％,20/43) excellent,16 cases (37.2％,16/43) good,and 7 cases (16.3％,7/43) fair.Constant-Murley score was 88.7 (range,70-98).A 71-year-old patient had symptoms of axillary nerve injury after operation and recovered completely 6 weeks after the operation,which did not affect the functional rehabilitation exercise or the stability of the prosthesis.During the follow-up,no other complications such as infection,acromial stress fracture and scapular notching were found in all patients.Conclusion The short-term effect of one-stage reverse shoulder arthroplasty for the treatment of complex proximal humeral fractures in the elderly is satisfactory.