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Osteoporotic proximal humeral fracture (OPHF) is one of the common osteoporotic fractures in the aged, with an incidence only lower than vertebral compression fracture, hip fracture, and distal radius fracture. OPHF, secondary to osteoporosis and characterized by poor bone quality, comminuted fracture pattern, slow healing, and severely impaired shoulder joint function, poses a big challenge to the current clinical diagnosis and treatment. In the field of diagnosis, treatment, and rehabilitation of OPHF, traditional Chinese and Western medicine have accumulated rich experience and evidence from evidence-based medicine and achieved favorable outcomes. However, there is still a lack of guidance from a relevant consensus as to how to integrate the advantages of the two medical systems and achieve the integrated diagnosis and treatment. To promote the diagnosis and treatment of OPHF with integrated traditional Chinese and Western medicine, relevant experts from Orthopedic Expert Committee of Geriatric Branch of Chinese Association of Gerontology and Geriatrics, Youth Osteoporosis Group of Orthopedic Branch of Chinese Medical Association, Osteoporosis Group of Orthopedic Surgeon Branch of Chinese Medical Doctor Association, and Osteoporosis Committee of Shanghai Association of Integrated Traditional Chinese and Western Medicine have been organized to formulate Expert consensus on the diagnosis and treatment of osteoporotic proximal humeral fracture with integrated traditional Chinese and Western medicine ( version 2024) by searching related literatures and based on the evidences from evidence-based medicine. This consensus consists of 13 recommendations about the diagnosis, treatment and rehabilitation of OPHF with integrated traditional Chinese medicine and Western medicine, aimed at standardizing, systematizing, and personalizing the diagnosis and treatment of OPHF with integrated traditional Chinse and Western medicine to improve the patients ′ function.
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Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.
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Wallis dynamic stabilization system is a surgical approach in the non-fusion technique of lumbar spine, consisting of interspinous blockers and dacron artificial ligaments that provide stability to the spine while maintaining a degree of motion in the affected segment. Recent studies have demonstrated the significant benefits of Wallis dynamic stabilization system in treating lumbar degenerative diseases. It not only improves clinical symptoms, but also effectively delays complications such as adjacent segmental degeneration. This paper aims to review the literature related to the Wallis dynamic stabilization system and degenerative diseases of the lumbar spine to describe the long-term prognostic effect of this system in the treatment of such diseases. This review provides a theoretical basis and reference for selecting surgical methods to treat degenerative diseases of the lumbar spine.
Sujets)
Humains , Arthrodèse vertébrale/méthodes , Vertèbres lombales/chirurgie , Région lombosacrale , Décompression chirurgicale/méthodes , Dégénérescence de disque intervertébral/chirurgie , Résultat thérapeutiqueRésumé
OBJECTIVE@#To preliminarily verify the effectiveness of self-designed artificial condyle-mandibular distraction (AC-MD) complex in the treatment of Pruzansky type ⅡB and Ⅲ hemifacial microsomia (HFM) through model test.@*METHODS@#Five children with Pruzansky type ⅡB and Ⅲ HFM who were treated with mandibular distraction osteogenesis (MDO) between December 2016 and December 2021 were selected as the subjects. There were 3 boys and 2 girls wih an average age of 8.4 years (range, 6-10 years). Virtual surgery and model test of AC-MD complex were performed according to preoperative skull CT of children. The model was obtained by three-dimensional (3D) printing according to the children's CT data at a ratio of 1∶1. The occlusal guide plate was designed and 3D printed according to the children's toothpaste model. The results of the model test and the virtual surgery were matched in three dimensions to calculate the error of the residual condyle on the affected side, and the model test was matched with the actual skull CT after MDO to measure and compare the inclination rotation of the mandible, the distance between the condylar of the healthy side and the residual condyle of the affected side, and the lengthening length of the mandible.@*RESULTS@#The error of residual condyle was (1.07±0.78) mm. The inclination rotation of the mandible, the distance between the condylar of the healthy side and the residual condyle of the affected side, and the lengthening length of the mandible after 3D printing model test were significantly larger than those after MDO ( P<0.05).@*CONCLUSION@#In the model test, the implantation of AC-MD complex can immediately rotate the mandible to the horizontal position and improve facial symmetry, and the residual condyle segment can be guided close to the articular fossa or the preset pseudoarticular position of the skull base after operation.
Sujets)
Mâle , Enfant , Femelle , Humains , Syndrome de Goldenhar/chirurgie , Mandibule/chirurgie , Ostéogenèse par distraction/méthodes , Impression tridimensionnelle , Asymétrie faciale/chirurgieRésumé
Objective:To investigate the clinical effect of gracilis musculocutaneous flap in repair of perineal soft defect with open pelvic fracture.Methods:From June 2009 to June 2019, 11 cases of open pelvic fracture associated with perineal injury were treated in the Department of Trauma and Orthopaedic of 521 Hospital of Norinco Group. There were 4 males and 7 females aged 16-56 (33 in average) years old. Cause of injuries: 6 cases by traffic accident, 4 by falling from height, and 1 by crushing. All the patients had open pelvic fractures. According to Tile classification, 1 case was rated as type A, 7 as type B and 3 as type C. All the patients were accompanied with perineal injury and soft tissue defect. The wound sizes ranged from 5 cm×5 cm to 8 cm×12 cm. The defects were repaired with gracilis musculocutaneous flap. The size of gracilis myocutaneous flaps was 6 cm×5 cm to 9 cm×13 cm. All donor areas of the flap were sutured directly. After surgery, 11 patients treated with strengthened nutritional support, keep supine position to avoid abduction, and appropriately raise the lower limbs. Follow-ups were conducted regularly after surgery.Results:All patients entered 6 to 30 (22 in average) months of follow-up. All of 11 myocutaneous flaps survived, besides 1 had a few necrosis at the distal surface of the myocutaneous flap, and healed after change of dressing. All the incisions at donor site had stage I healing. The colour, texture and flexibility of the gracilis myocutaneous flap were good. There was a scar at the donor sites without causing obvious dysfunction. Over the follow-up period, there was no failure of flap in either the recipient and donor sites. The patients were satisfied with the appearance and function.Conclusion:Gracilis musculocutaneous flap is one of the ideal methods in repair of perineal soft tissue defect with open pelvic fracture.
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Lower extremity deep vein thrombosis (DVT) is one of the main complications in patients with traumatic fractures, and for severe patients, the DVT can even affect arterial blood supply, resulting in insufficient limb blood supply. If the thrombus breaks off, pulmonary embolism may occur, with a high mortality. The treatment and rehabilitation strategies of thrombosis in patients with lower extremity fractures have its particularity. DVT in traumatic fractures patients has attracted extensive attention and been largely studied, and the measures for prevention and treatment of DVT are constantly developing. In recent years, a series of thrombosis prevention and treatment guidelines have been updated at home and abroad, but there are still many doubts about the prevention and treatment of DVT in patients with different traumatic fractures. Accordingly, on the basis of summarizing the latest evidence-based medical evidence at home and abroad and the clinical experience of the majority of experts, the authors summarize the clinical treatment and prevention protocols for DVT in patients with traumatic fractures, and make this consensus on the examination and assessment, treatment, prevention and preventive measures for DVT in patients with different fractures so as to provide a practicable approach suitable for China ′s national conditions and improve the prognosis and the life quality of patients.
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TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.
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Purpose To investigate the expression and the methylation status of miR-4687-5P and STIM1 gene in esophageal squamous cell cancer (ESCC) cell lines and ESCC tissue samples,in order to explore the correlation between miR-4687-5P and STIM1 expression,as well as whether they have a common expression regulation mechanism. Methods The qRTPCR and methylation specific PCR (MSP) methods were applied respectively to examine the expression and methylation of miR-4687-5P and STIM1 genes in ESCC cell lines (TE13, KYSE150,T. Tn) and ESCC samples,and further to analyze their correlation. Results The expression of miR-4687-5P and STIM1 genes in ESCC was significantly decreased,and consistent. The weak expression of miR-4687-5P and STIM1 genes was detected in three ESCC cell lines. After treated with 5-Aza-2'-deoxycytidine (5-Aza-Dc,a demethylation agent) ,the expression levels of these two genes were obviously increased. Meanwhile, the methylation bands were obviously weakened or disappeared. The promoter region of STIM1 gene was hypermethylated in ESCC tissues,and its methylation frequency was correlated with the expression of STIM1 and miR-4687-5P (P < 0. 01) . Conclusion miR-4687-5P and STIM1 genes are down-regulated in esophageal carcinoma,and the expression of miR-4687-5P may be regulated by the promoter of its host gene STIM1,and the hypermethylation may be one of the common mechanisms leading to down-regulatory expression of miR-4687-5P and STIM1 genes in ESCC.
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OBJECTIVE@#To explore clinical efficacy of bridge-link combined fixation system for adult mid-shaft clavicle fractures.@*METHODS@#From January 2016 to August 2016, 28 patients with mid-shaft clavicle fractures were treated by bridge-link combined fixation system, including 15 males and 13 females, aged from 27 to 82 years old with an average of(48.50±15.34) years old; the courses of disease was for 13 to 15 months with an average of (14.17±0.77) months. Fracture healing time and complication were observed, postoperative and postoperative Constant function score of shoulder joint at 1, 3 and 13 months and were compared.@*RESULTS@#All patients were followed up for 13 to 15 months with an average of (14.17±0.77) months. Twenty-eight patients achieved clinical fracture healing without infection, bone un-union, delayed union, breakage of internal fixation and re-fracture after removing of the internal fixation occurred. Fracture healing time ranged from 2.5 to 4 months with (3.05±0.44) months. Postoperative Constant score at 1, 3 and 13 months were 76.57±4.70, 90.75±3.62, 96.07±2.40 respectively, and had significant difference compared with before operation(58.36±4.98).@*CONCLUSIONS@#Bridge-link combined fixation system could be used as a new internal fixation for adult mid-shaft clavicle fractures, which has advantages of rapid recovery, less complications, and could reduce incidence of breakage of internal fixation, osteoporosis, re-fractures after removing the internal fixation.
Sujets)
Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Femelle , Humains , Mâle , Adulte d'âge moyen , Plaques orthopédiques , Clavicule , Ostéosynthèse interne , Consolidation de fracture , Fractures osseuses , Chirurgie générale , Résultat thérapeutiqueRésumé
Objective@#To discuss the efficacy of computer aided design (CAD) and computer aided manufacturing (CAM) in the treatment of microgenia by osseous genioplasty.@*Methods@#From July 2015 to January 2018, 17 cases (Male, n=5, Female, n=12), aged from 17 to 32 years, with the meanage of 24 years, were enrolled. All patients had microgenia, and underwent osseous genioplasty. Computed tomography (CT) was performed preoperatively and 7-10 days postoperatively for all cases. Based on preoperative CT data, CAD was applied to make individualized surgical plan, surgery simulation, todetermine the movement of mentum. CAM was used to prefabricate the individualized surgical templates and transfer the CAD into intraoperative guidance. The registration of CAD and postoperative CT were performed to evaluate the surgical accuracy.@*Results@#All patients were satisfied with the surgical outcomes. The deformity of microgenia was significantly corrected. The Pg error was (0.24±0.08) mm, and the Me error was (0.15±0.17) mm.@*Conclusions@#The application of CAD increases the accuracy of surgical planning, and CAM provides areliable guidance with individualized template. Anoptimal surgical outcome can be achieved.
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Intraoral facial contour surgery is one of the most popular craniofacial cosmetic surgeries in China, in spite of its challenging surgical technique and serious complication, such as fracture and bleeding. In addition, the key point, such as inadequate tissue exposure and high soft tissue tension cannot be simulated using traditional three-dimensional model. Consequently, craniomaxillofacial surgery requires a long learning curve for young surgeons. This article describes the establishment and application of a new model for intraoral facial contour surgery. Compared to young surgeons trained using traditional three-dimensional model, the authors confirmed this new surgical model is more reliable and effective. Therefore, it is worthy of being popularized.
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OBJECTIVE@#Graft rejection, with the possibility of a violent immune response, may be severe and life threatening. Our aim was to thoroughly investigate the biocompatibility and immunotoxicology of collagen-based dermal matrix (DM) before assessment in clinical trials.@*METHODS@#DM was subcutaneously implanted in BALB/c mice in two doses to induce a potential immune response. The spleen and lymph nodes were assessed for shape, cell number, cell phenotype via flow cytometry, cell activation via CCK8 kit, Annexin V kit, and Ki67 immunostaining. Serum samples were used to measure antibody concentration by enzyme-linked immunosorbent assay. Local inflammation was analyzed by histology and immunohistochemistry staining. Data analysis was performed by one-way ANOVA and non-parametric tests.@*RESULTS@#Our data illustrate that the spleen and lymph node sizes were similar between the negative control mice and mice implanted with DM. However, in the high-dose DM (DM-H) group, the total cell populations in the spleen and lymph nodes, T cells and B cells in the spleen had slight increases in prophase, and the low-dose DM (DM-L) group did not display gross abnormities. Moreover, DM-H initiated moderate cell activation and proliferation in the early phase post-immunization, whereas DM-L did not. Neither DM-H nor DM-L implantation noticeably increased IgM and IgG serum concentrations. Examination of the local cellular response revealed only benign cell infiltration and TNF-α expression in slides of DM in the early phase.@*CONCLUSION@#Overall, DM-H may have induced a benign temporary acute immune response post-implantation, whereas DM-L had quite low immunogenicity. Thus, this DM can be regarded as a safe product.
Sujets)
Animaux , Femelle , Souris , Matériaux biocompatibles , Collagène , Allergie et immunologie , Derme , Allergie et immunologie , Chirurgie générale , Cytométrie en flux , Immunité cellulaire , Noeuds lymphatiques , Allergie et immunologie , Souris de lignée BALB C , Prothèses et implants , Rate , Allergie et immunologieRésumé
Objective To establish a cranial bone defect model of goat and to study application in craniomaxillo-facial surgery.Methods Electron beam computed tomography (EBCT) scanner was used to scan goat'heads and faces in series and thin layers.Data of EBCT were input in workstation from digital inlet,and then to three-dimensional reconstruction with method of surface shadow.After final data were transformed to the files,the rapid prototyping machine was able to identify and establish the 3D model.Results The EBCT continuous thin-layer (1 mm) scanning data were passed to wave filter,falling coarse,distinguishing and collecting the outline,3D-reconstruction,curved surface reconstruction with CAD and the substance reconstruction.The final data were input into the laser rapid prototyping machine.Three-dimensional bionic cranium models were fabricated by machine in layer by layer manufacturing principle.Conclusions Establishment of the cranial bone defect model in the goat is very useful to the three-dimensional measurement,individualized reconstruction and basic and clinical research for the cranial bone defect.
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Objective@#To design a method of mandibular division for plastic surgery.@*Methods@#From January 2009 to June 2017, 118 patients who underwent mandibular plastic surgery were observed, measured and analyzed. Combined with clinical experience, a new method of mandibular division was designed. The mandible was divided into right and left sides and each side was subdivided into five subunits (A, B, C, D, E). Area A is mandibular ramus upper 1/2 and mandibular coracoid area; Area B is mandibular lower 1/2 area; Area C is mandibular body area; Area D is chin area; Area E is mandibular angle.@*Results@#The mandibles of 118 patients were divided according to the new method to obtain the characteristics of mandibular deformities and guide the design of the surgical plan.@*Conclusions@#The new method of mandibular division is concise and scientific, which is in favor of the diagnosis and surgical design of plastic surgery.
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Objective@#To discuss the establishment of three-dimensional mirror image plane ofhemifacial microsomia.@*Methods@#32 cases of hemifacial microsomia from Jan. 2006 to Jan. 2017 were collected in our hospital. CT scanning was performed for all patients. Then, the deformity characteristics were summarized through three steps: 3D reconstruction, mirror and discrepancy analysis.@*Results@#After statistical analysis, the stability of these three points was good. Clinical result showed that the patient′s appearance was greatly improved.@*Conclusions@#Using these three points to determine the mirror image plane is helpful to analyze the patient's facial features and facilitate the surgical design.
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Objective:To explore the differences of the relative expression levels of plasma long chain non encoding RNA(lncRNA)MALAT1,LincRNA-p21 and GAS5 in the patients with multiple myeloma(MM)and chronic lymphocytic leukemia(CLL),and to clarify their significances in the differential diagnosis of MM and CLL. Methods:A total of 60 cases of MM patients(MM group),60 cases of CLL patients(CLL roup)and 60 healthy persons after physical examinations(control group)were selected as the subjects.The plasma levels of lncRNA MALAT,LincRNA-p21 and GAS5 of the subjects in three groups were detected and compared.Results:The relative expression levels of lncRNA MALAT1 and GAS5 in plasma of the patients in MM group were significantly higher than those in the other two groups(P<0.05);the relative expression level of LincRNA-p21 in plasma of the patients in CLL group was significantly lower than those in the other two groups(P<0.05).The area under receiver operating characteristic curve(ROC)(AUC)of plasma LincRNA-p21 in the diagnosis of CLL was 0.850, its 95% confidence interval(CI)was 0.780-0.921. The AUC of plasma lncRNA MALAT1 and GAS5 in the diagnosis of MM were 0.898 and 0.815;their 95% CI were 0.836-0.959 and 0.740-0.890,respectively.The AUC of plasma lncRNA MALAT1,LincRNA-p21 and GAS5 in the differential diagnosis of CLL and MM were 0.878,0.778 and 0.805,and their 95% CI were 0.814 - 0.942,0.691 - 0.865 and 0.727 - 0.882, respectively.Conclusion:The incidence of MM is related with the high expressions of lncRNA MALAT1 and GAS5 in plasma and the incidence of CLL is related with the low expression of LincRNA-p21 in plasma. The relative expression levels of the above lncRNA can be used as the auxiliary indexes in the diagnosis of MM and CLL.
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Objective@#To design the aesthetic new gonion and osteotomy line for patients with prominent mandibular angle patients using computer-aided techniques, and to investigate the application of three-dimensional digital planning in gonioplasty.@*Methods@#From April 2016 to April 2017, 14 female patients with prominent mandibular angle underwent preoperative surgical design and surgical simulation using digital technology. Gonioplasty was performed under the guide of surgical templates, preoperative, surgical simulation and postoperative data were measured including bilateral mandibular angles, the height of ramus(Co-Go) and the length of mandibular body(Go-Me). Paired t test was used to compare the differences between surgical simulation and postoperative measurements.@*Results@#Gonioplasty was performed in 14 patients successfully, and all were satisfied with their facial outcomes. The mandibular angle was improved from 113.86°±4.11° to 124.52°±1.26° on the left side, and 114.30°±4.01° to 124.29°±1.24° on the right side respectively. The average ratio of Go-Me/Co-Go was 2.011 on both sides after operation, which was very close to surgical planning. No significant differences were found between surgical planning and postoperative measurements with respect to mandibular angle or the ratio of Go-Me/Co-Go on both sides(P>0.05). The deviations between them were 1.00°±0.68° and 0.058±0.038 on the left side, and 0.85°±0.63° and 0.072±0.053 on the right side respectively.@*Conclusions@#Computer-assisted gonioplasty could improve the efficiency and accuracy of surgery, reduce the risk of surgical complications, and attain higher patients′ satisfaction.
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<p><b>OBJECTIVE</b>To study the value of hsCRP and Alb in evaluating the prognosis of patients with systemic lupus erythematosus (SLE).</p><p><b>METHODS</b>126 SLE patients from January 2011 to January 2016 were enrolled in this study, and their clinical data were collected, including SLEDAI, hsCRP and Alb and complications. The correlation between hsCRP/Alb ratio and SLEDAI after treatment was analyzed. All patients were followed up after discharge, and the prognosis-related factors were analyzed.</p><p><b>RESULTS</b>After treatment, hsCRP/Alb ratio of patients with SLEDAI 10-14 score was significantly higher than that of 5-9 and 0-4 score(P<0.05). hsCRP/Alb ratio was positively correlated with infection (r=0.574), renal damage (r=0.499) and cardiac injury (r=0.516) (P<0.05), while it demonstrated no correlation with blood system damage, CNS damage and lung injury(P>0.05). after treatment SLEDAI ≥10 score, hsCRP/Alb≥0.05 mg/g and complications significantly correlated with prognosis of patients(P<0.05).</p><p><b>CONCLUSION</b>hsCRP/Alb correlates with the prognosis of patients with SLE at a certam level.</p>
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Objective To aesthetically evaluate the mandible,to position the gonion landmark of the aesthetic female with digital techniques and to establish three-dimensional mandibular measurements database of the aesthetic female.Methods 14 aesthetic volunteers were chosen by plastic surgeons and ordinary people based on the identical view of esthetic mandible.The heads were scanned by a spiral CT scanner,and the data were imported into Mimics 18.0 to generate the 3D skull images.Distance,angle and ratio measurements,which could represented the aesthetic characters of the mandible,were made on the images.All the data were transferred into the SPSS 22.0 software to perform statistical analysis.A two-tailed t test was used to compare the symmetry of bilateral mandibles.Dynamic database of aesthetic mandibles was established.The mean,standard deviation,standard error and 95% confidence interval of data were calculated by statistical software automatically.Results The results suggested that the mean of aesthetic mandibular angle was 123.91°,and the mean of mandibular plane angle was 27.03°.The ratio between the mandibular body and ramus approximated to 2 ∶ 1,and the ratio of the distance between gonion and mental foramen to ramus was close to 1.4.Conclusions The study of mandibular esthetics contributes to positioning the new gonion accurately for patients with prominent mandibular angle and gonion reconstruction,and it can assist surgeons in surgical designing,simulating and performing.
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Objective@#To explore the clinical value of bendopnea in chronic heart failure patients with reduced ejection fraction (HFrEF).@*Methods@#According to the existence of bendopnea or not, a total of 192 consecutive chronic heart failure patients with HFrEF admitted to our department from January 2014 to January 2016 were divided into the bendopnea group and non-bendopnea group. Subgroup analysis was performed in the subgroups with various bendopnea symptoms appearance time (0-10 s, 11-20 s and 21-30 s). The relationship between bendopnea and left ventricular ejection fraction (LVEF), 6-minute walking distance (6-MWD), NT-proBNP and NYHA classification were analyzed.@*Results@#Bendopnea was confirmed in 74 out of 192 (38.54%) cases with HFrEF, and the average time of symptoms appearance was (8.62±2.29) s. LVEF and 6-MWD values were significantly lower in the bendopnea group than those in the non-bendopnea group (both P<0.05). The NT-proBNP level and the prevalence of patients with NYHA grade Ⅳ were significantly higher in the bendopnea group than those in the non-bendopnea group (both P<0.05). There were significant difference on LVEF, 6-MWD, NT-proBNP and patients with NYHA grade Ⅳ in bendopnea patients with various bendopnea symptoms appearance time (all P<0.05) and shorter bendopnea symptoms appearance time was related to severe symptoms and signs of chronic heart failure.@*Conclusion@#The incidence rate of bendopnea is high in patients with HFrEF, and which is related closely to the cardiac function and shorter bendopnea symptoms appearance time is related to severe symptoms and signs of chronic heart failure in HFrEF patients.