Application of mobile medical intelligence software combined with OBE-CBCL dual-track teaching method in standardized training of orthopaedic residents / 沈阳医学院学报

Objective:To explore the effect of mobile medical intelligent software combined with OBE-CBCL dual-track teaching method in standardized training of orthopaedic residents.Methods:The orthopedic residents who received resident standardized training in our hospital from Jan 2022 to Sep 2022 were selected as the study subjects.The orthopedic residents who received regular teaching method from Jan 2022 to Mar 2022 were group A,orthopedic residents who received mobile medical intelligent software + regular teaching method from Apr 2022 to Jun 2022 were group B,and the orthopedic residents who received mobile medical intelligent software + OBE-CBCL dual-track teaching method from Jul 2022 to Sep 2022 were group C.All three groups participated in the relevant professional theoretical knowledge assessment,Mini-CEX,and satisfaction survey at the time of discharge.Results:The scores of professional theoretical knowledge assessment in groups B and C were higher than that in groups A,and it was higher in group C than that in group B(P＜0.05).The scores of each item of Mini-CEX in groups B and C were higher than those in group A(P＜0.05).Except for clinical judgment ability,the scores of the other items of Mini-CEX in group C was higher than those in group B(P＜0.05).In the satisfaction survey,the scores of deepening knowledge mastery in groups B and C were higher than that in group A,and that in group C was higher than that in group B(P＜0.05).The scores of improving clinical thinking and stimulating learning interest in groups B and C were higher than those in group A(P＜0.05),and the scores of improving team assistance and overall satisfaction in group C were higher than those in groups A and B(P＜0.05).Conclusion:Mobile medical intelligent software combined with OBE-CBCL dual-track teaching can significantly improve teaching effect of orthopaedic resident standardized training.

Expert consensus on the accurate diagnosis and treatment of acetabular fractures based on three-column classification (version 2023) / 中华创伤杂志

Accurate classification of the acetabular injuries and appropriate treatment plan are great challenges for orthopedic surgeons because of the irregular anatomical structure of the acetabulum and aggregation of important vessels and nerves around it. Letournel-Judet classification system has been widely applied to classify acetabular fractures. However, there are several limitations, including incomplete inclusion of fracture types, difficulty in understanding and insufficient guidance for surgical treatment, etc. Serious complications such as traumatic arthritis are common due to wrong classification and diagnosis and improper selection of surgical strategy, which brings a heavy burden to the society and families. Three-column classification, based on anatomic characteristics, has advantages of containing more fracture types and being easy to understand, etc. To solve the problems existing in the diagnosis and treatment process based on Letournel-Judet classification, achieve accurate diagnosis and treatment of patients with acetabular fractures, and obtain satisfactory prognosis, the Orthopedic Trauma Emergency Center of Third Hospital of Hebei Medical University and the Trauma Orthopedic Branch of the Chinese Orthopedic Association organized experts from relevant fields to formulate the Expert consensus on the accurate diagnosis and treatment of acetabular fractures based on three-column classification ( version 2023) in terms of principles of evidence-based medicine. Based on the three-column classification, 15 recommendations were proposed, covering the diagnosis, treatment, complication prevention and management, etc, so as to provide reference for accurate diagnosis and treatment of acetabular fractures.

An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique (version 2023) / 中华创伤杂志

Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.

Clinical application of adjustable traction skin stretchers in repair of wounds at the lower leg, foot and ankle / 中华创伤骨科杂志

Objective:To evaluate the clinical effects of adjustable traction skin stretchers used in repair of wounds at the lower leg, foot and ankle.Methods:A retrospective study was performed to analyze the clinical data of 56 patients who had been treated for skin defects at the lower leg, foot and ankle from August 2016 to September 2022 at The First Affiliated Hospital of Zhengzhou University, Honghui Hospital, Affiliated to Xi'an Jiaotong University Medical College, The First Affiliated Hospital of Henan Polytechnic University, and Yunnan Zhongde Orthopedic Hospital. There were 35 males and 21 females, aged (39.9±18.7) years. There were 43 traumatic wounds, 3 burns, 6 inflammatory wounds, 3 relief incisions due to osteofascial compartment syndrome, and 1 scar. The areas of skin defect ranged from 2.5 cm × 2.0 cm to 20.0 cm × 10.0 cm. The duration of wounds was (8.6±7.8) d. All the wounds were repaired with adjustable traction skin stretchers. The row-hook type of skin stretchers was used in 28 cases, the single-rod type in 20 cases, the single-rod type combined with an external fixator in 5 cases, and a combination of the row-hook type and the single-rod type in 3 cases.The time for wound traction closure, color of wound skin margin, skin swelling around the wound, functional recovery of affected limb and complications were recorded.Results:The time from skin stretching to wound closure was (7.8±3.8) d in the 56 patients. The color of wound skin edge after stretching was normal in 16 cases, dark red in 38 cases, and dark in 2 cases; the skin swelling around the wound was degree 1 in 21 cases, degree 2 in 33 cases, and degree 3 in 2 cases. The 56 patients were followed up for (8.9±4.1) months. Primary wound closure was achieved in 48 patients, and secondary wound closure in 8 patients after repair with an autologous skin graft. Partial skin necrosis occurred due to tension blisters after skin stretching in 2 patients, one of whom was repaired with an autologous skin graft and the other of whom by dressing change. Deep bone infection recurred in 2 patients whose wounds healed after their bone defects were repaired using Ilizarov technique of bone transfer. In the 56 patients, the muscle strength of the lower extremity beyond the wound was recovered to normal, and the range of motion of the joints adjacent to the wound also recovered to normal.Conclusion:In repair of wounds at the lower leg, foot and ankle, adjustable traction skin stretchers can lead to fine clinical effects and limited complications, because the stretchers can control the tension of skin digitally and precisely.

Study on application of ultrasonic bone curette in anterior cervical spine surgery / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effect of ultrasonic bone curette in anterior cervical spine surgery.@*METHODS@#A clinical data of 63 patients with cervical spondylosis who were admitted between September 2019 and June 2021 and met the selection criteria was retrospectively analyzed. Among them, 32 cases were operated with conventional instruments (group A) and 31 cases with ultrasonic bone curette (group B). There was no significant difference between the two groups (P>0.05) in gender, age, surgical procedure, surgical segment and number of occupied cervical space, disease type and duration, comorbidities, and preoperative Japanese Orthopaedic Association (JOA) score, cervical dysfunction index (NDI), and pain visual analogue scale (VAS) score. The operation time, intraoperative bleeding, postoperative drainage, postoperative hospital stay, and the occurrence of postoperative complications were recorded in both groups. Before operation and at 1, 3, and 6 months after operation, the JOA score and NDI were used to evaluate the function and the postoperative JOA improvement rate was calculated, and VAS score was used to evaluate the pain improvement. The anteroposterior and lateral cervical X-ray films were taken at 1, 3, and 6 months after operation to observe whether there was any significant loosening and displacement of internal fixators.@*RESULTS@#Compared with group A, group B had shorter operation time and postoperative hospital stay, less intraoperative bleeding and postoperative drainage, and the differences were significant (P<0.05). All incisions healed by first intention in the two groups, and postoperative complications occurred in 5 cases (15.6%) in group A and 2 cases (6.5%) in group B, showing no significant difference (P>0.05). All patients were followed up 6-12 months (mean, 7.9 months). The JOA score and improvement rate gradually increased in groups A and B after operation, while the VAS score and NDI gradually decreased. There was no significant difference in VAS score between 3 months and 1 month in group B (P>0.05), and there were significant differences between the other time points of each indicator in the two groups (P<0.05). At 1, 3, and 6 months after operation, the JOA score and improvement rate in group B were better than those in group A (P<0.05). X-ray films examination showed that there was no screw loosening or titanium plate displacement in the two groups after operation, and the intervertebral cage or titanium mesh significantly sank.@*CONCLUSION@#Compared with traditional instruments, the use of ultrasonic bone curette assisted osteotomy in anterior cervical spine surgery has the advantages of shorter operation time, less intraoperative bleeding, less postoperative drainage, and shorter hospital stay.

Application and research progress of artificial intelligence technology in trauma treatment / 中国修复重建外科杂志

OBJECTIVE@#To review the application and research progress of artificial intelligence (AI) technology in trauma treatment.@*METHODS@#The recent research literature on the application of AI and related technologies in trauma treatment was reviewed and summarized in terms of prehospital assistance, in-hospital emergency care, and post-traumatic stress disorder risk regression prediction, meanwhile, the development trend of AI technology in trauma treatment were outlooked.@*RESULTS@#The AI technology can rapidly analyze and manage large amount of clinical data to help doctors identify patients' situation of trauma and predict the risk of possible complications more accurately. The application of AI technology in surgical assistance and robotic operations can achieve precise surgical plan and treatment, reduce surgical risks, and shorten the operation time, so as to improve the efficiency and long-term effectiveness of the trauma treatment.@*CONCLUSION@#There is a promising future for the application of AI technology in the trauma treatment. However, it is still in the stage of exploration and development, and there are many difficulties of historical data bias, application condition limitations, as well as ethical and moral issues need to be solved.

Early effectiveness of Ti-Robot assisted femoral neck system for minimally invasive treatment of elderly Garden type Ⅱ and Ⅲ femoral neck fractures / 中国修复重建外科杂志

OBJECTIVE@#To investigate the early effectiveness of the Ti-Robot assisted femoral neck system (FNS) in the treatment of elderly Garden type Ⅱ and Ⅲ femoral neck fractures.@*METHODS@#A retrospective analysis was conducted on the clinical data of 41 elderly patients with Garden type Ⅱ and Ⅲ femoral neck fractures who were admitted between December 2019 and August 2022 and met the selection criteria. Among them, 21 cases were treated with Ti-Robot assisted FNS internal fixation (study group), and 20 cases were treated solely with FNS internal fixation (control group). There was no significant difference in baseline data, including gender, age, side, cause of injury, time from injury to surgery, fracture Garden classification, and fracture line classification, between the two groups ( P>0.05). Surgical effectiveness was evaluated based on parameters such as operation time (including incision time and total operation time), reduction level, number of dominant pin insertions, intraoperative fluoroscopy frequency, incision length, whether to extend the incision, need for assisted reduction, postoperative hospital stay, fracture healing time, incidence of osteonecrosis of the femoral head, postoperative visual analogue scale (VAS) score at 1 day, and Harris hip score at last follow-up.@*RESULTS@#The study group showed significantly shorter incision time, fewer dominant pin insertions, fewer instances of extended incisions, fewer intraoperative fluoroscopy frequency, and smaller incisions than the control group ( P<0.05). There was no significant difference in total operation time, reduction level, and assisted reduction frequency between the two groups ( P>0.05). Both groups achieved primary wound healing postoperatively, with no complications such as incision leakage or skin infection. All patients were followed up 12-24 months with an average of 14.6 months. Fractures healed in both groups, with no significant difference in healing time ( P>0.05). There was no significant difference in postoperative hospital stay between the two groups ( P>0.05). The study group showed significantly better VAS score at 1 day after operation and Harris hip score at last follow-up when compared to the control group ( P<0.05). No complication such as internal fixation failure, fracture displacement, or hip joint varus occurred in both groups during the follow-up. Osteonecrosis of the femoral head occurred in 1 patient of the control group, while no was observed in the study group, and the difference in the incidence of osteonecrosis of the femoral head between the two groups was not significant ( P=0.488).@*CONCLUSION@#Compared to sole FNS internal fixation treatment, Ti-Robot assisted FNS internal fixation for elderly Garden typeⅡ and Ⅲ femoral neck fractures can reduce incision time, achieve minimally invasive and accurate nail implantation, and decrease intraoperative fluoroscopy frequency, leading to improved postoperative hip joint function recovery.

Endovascular treatment of acute ischemic stroke with large vessel occlusion in anterior circulation: cardioembolism versus large artery atherosclerosis / 国际脑血管病杂志

Objective:To investigate the clinical characteristics of acute ischemic stroke with anterior circulation large vessel occlusion caused by cardioembolism (CE) and large artery atherosclerosis (LAA) and the efficacy of endovascular treatment.Methods:Patients with acute ischemic stroke caused by large vessel occlusion in anterior circulation and received endovascular treatment in the Stroke Center of the 971 st Hospital of the PLA Navy from April 2014 to April 2021 were retrospectively enrolled. The etiological classification of stroke was CE or LAA. According to the modified Rankin Scale score at 90 d after onset, the patients were divided into good outcome group (0-2) and poor outcome group (>2). The demographic and clinical data between the groups were compared. Multivariate logistic regression analysis was used to determine the independent influencing factors of clinical outcome. Results:A total of 106 patients were enrollded. Their age was 61.39±13.73 years and 70 (66.0%) were males. Seventy-four patients (69.8%) were in the CE group and 32 (30.2%) were in the LAA group. Sixty-six patients (62.3%) had good outcomes. Univariate analysis showed that there were significant differences in gender, age, smoking, systolic blood pressure, diastolic blood pressure, baseline National Institutes of Health Stroke Scale (NIHSS) score, time from onset to femoral artery puncture, time from puncture to vascular recanalization, and the number of retrieval attempts between the CE group and the LAA group (all P<0.05), and there were no significant differences in the incidences of poor outcome, hemorrhagic transformation, and symptomatic intracranial hemorrhage. There were significant differences in systolic blood pressure, diastolic blood pressure, baseline NIHSS score, time from onset to femoral artery puncture, and blood perfusion grade after treatment between the good outcome group and the poor outcome group (all P<0.05). Multivariable logistic regression analysis showed that higher systolic blood pressure (odds ratio [ OR] 1.046, 95% confidence interval [ CI] 1.014-1.078; P=0.004), higher baseline NIHSS score ( OR 1.117, 95% CI 1.037-1.203; P=0.003), longer time from onset to femoral artery puncture ( OR 1.008, 95% CI 1.001-1.015; P=0.019) and poor blood perfusion after treatment ( OR 8.042, 95% CI 1.532-42.215; P=0.014) were significantly and independently associated with the poor outcomes. Conclusions:Compared with LAA, CE do not increase the risks of hemorrhagic transformation and symptomatic intracranial hemorrhage. The safety and efficacy of the two are similar.

Reconstruction of defects of distal-and-middle segments of finger pulps with striated wrist transverse flap carrying superficial palmar branch of radial artery with sensory nerve / 中华显微外科杂志

Objective:To evaluate the clinical effect of striated free wrist transverse flap pedicled with superficial palmar branch of radial artery carrying sensory nerve in repairing pulp defect of middle-and-distal segments of fingers.Methods:From February 2019 to March 2021, the data of 20 patients with defects of middle-and-distal finger segment were collected. The defects were repaired with striated free wrist transverse flaps pedicled with superficial palmar branch of radial artery. The defects sized were 2.0 cm×1.5 cm-4.0 cm×1.5 cm, and the flaps sized were 2.5 cm×2.0 cm-4.5 cm×2.0 cm. The flap carried metacarpal cutaneous branch of median nerve for the reconstruction of the sensation of finger pulps. The donor sites were directly sutured. After operation, the patients were evaluated according to the shape, sensation and functional recovery of the repaired fingers through outpatient visits and reviews via WeChat.Results:All 20 flaps survived and the wounds healed well. All patients entered regular follow-up for 6-12(average, 8) months. The colour of the flaps was close to the finger skin, without bloating flaps. The flaps were soft in good shapes and function. TPD were 6-11 mm, at 8 mm in average. The scars at the donor sites were hidden and the wrist function was not affected. According to the Trial Evaluation Standard of Upper Limb Function of Hand Surgery Society of Chinese Medical Association, 16 patients were classified as excellent and 4 as good.Conclusion:The striated transverse wrist flap with radial artery palmar superficial branch and sensory nerve offers many advantages, such as a good texture, hidden donor site, convenient flap harvesting, good recovery of sensation, etc. More clinical studies and the promotion of the technique are expected.

Mechanical Stimulation and Diameter of Fiber Scaffolds Affect the Differentiation of Rabbit Annulus Fibrous Stem Cells

BACKGROUND@#Degeneration of the annulus fibrosus (AF), an important structure of the intervertebral disc, is one of the main causes of degenerative disc disease. Fabrication of scaffolds replicating the stratified microstructure of the AF is critical for the successful regeneration of AF. @*METHODS@#In this study, we cultured rabbit AF-derived stem cells (AFSCs) using fabricated electrospun fibrous poly-Llactic acid scaffolds with different diameters. We applied cyclic tensile strain (CTS) on the scaffolds to regulate the differentiation of AFSCs into specific cell types that resided at the inner, middle, and outer zones of the AF. @*RESULTS@#We found that the morphologies of AFSCs on the smaller-fiber-diameter scaffolds were nearly round, whereas spindle-like cells morphologies were observed on large-diameter scaffolds. CTS enhanced these phenomena and made the cells slender. The expression levels of collagen-I in cells increased as a function of the fiber diameter, whereas collagen-II and aggrecan exhibited opposite trends. Moreover, the application of CTS upregulated the gene expressions of collagen-I, collagen-II, and aggrecan. @*CONCLUSION@#Overlaying the scaffolds with different CTS-stimulated cells could eventually lead to engineered AF tissues with hierarchical structures that approximated the native AF tissue. Thus, the proposed methodologies could be potentially applied for AF regeneration.

Application of arterial end-to-end and end-to-side anastomosis in superficial branch of the superficial circumflex iliac artery perforator flap transfer / 中华显微外科杂志

Objective:To explore a comparative study of arterial end-to-end and end-to-side anastomosis in superficial branch of the superficial circumflex iliac artery(SCIA) perforator flap transfer.Methods:Between November, 2019 and December, 2020, 21 patients with the soft tissue defects in the limbs were repaired with superficial branch of the SCIA perforator flaps. The size of flaps ranged from 3.5 cm×7.0 cm to 9.0 cm×18.0 cm. According to the upper or anterior wall of the main artery in the recipient area having branches that matched the flap artery, 2 groups were established. End-to-end group: 10 cases were anastomosed end-to-end between the flap artery and branch of the main artery in the recipient area; End-to-side group: 11 cases were anastomosed end-to-side between the flap artery and side mouth of the main artery in the recipient area. The vein of flap was anastomosed end-to-end with the accompanying vein to the main artery in the recipient area. All of the donor sites were sutured directly. All patients were followed-up for 6-12 months and the survival of the perforator flap, the appearance and function of the perforator flap and the donor site were observed. All data of the 2 groups were conducted statistical analyzed. P<0.05 was statistically significant. Results:All 10 flaps in end-to-end group survived successfully. In end-to-side group, 2 cases had venous crisis in 11 cases of flaps,the exploration revealed venous thrombosis, and the arterial end-to-side anastomosis had smooth blood flow had embolism. One flap survived after re-anastomosis of the vein, and 1 flap was changed to a pedicled abdominal flap during the re-venous crisis. The postoperative follow-up was 6 months to 1 year. The appearance and function of the flap and donor site were satisfactory, without difference between the 2 groups. The SCIA superficial branch artery caliber, recipient artery branch or lateral caliber was not statistically different between the 2 groups( P>0.05). The time of anastomosis for end-to-end group was[(16.70±1.34) min]. It was lower than that of anastomosed end-to-side group[(23.73±1.68) min]. The difference was statistically significant( P<0.01). Conclusion:In superficial branch of the SCIA perforator flap transfer, if the upper or anterior wall of the main artery in the recipient area has a branch that matches the flap artery, the flap artery should first be anastomosed with its end. Because it dose not required to make a side port, and makes the operation more convenient with a short anastomosis time; Otherwise, perform end-to-side anastomosis with the main artery of the recipient site.

Mechanical Stimulation and Diameter of Fiber Scaffolds Affect the Differentiation of Rabbit Annulus Fibrous Stem Cells

BACKGROUND@#Degeneration of the annulus fibrosus (AF), an important structure of the intervertebral disc, is one of the main causes of degenerative disc disease. Fabrication of scaffolds replicating the stratified microstructure of the AF is critical for the successful regeneration of AF. @*METHODS@#In this study, we cultured rabbit AF-derived stem cells (AFSCs) using fabricated electrospun fibrous poly-Llactic acid scaffolds with different diameters. We applied cyclic tensile strain (CTS) on the scaffolds to regulate the differentiation of AFSCs into specific cell types that resided at the inner, middle, and outer zones of the AF. @*RESULTS@#We found that the morphologies of AFSCs on the smaller-fiber-diameter scaffolds were nearly round, whereas spindle-like cells morphologies were observed on large-diameter scaffolds. CTS enhanced these phenomena and made the cells slender. The expression levels of collagen-I in cells increased as a function of the fiber diameter, whereas collagen-II and aggrecan exhibited opposite trends. Moreover, the application of CTS upregulated the gene expressions of collagen-I, collagen-II, and aggrecan. @*CONCLUSION@#Overlaying the scaffolds with different CTS-stimulated cells could eventually lead to engineered AF tissues with hierarchical structures that approximated the native AF tissue. Thus, the proposed methodologies could be potentially applied for AF regeneration.

Osteoperiosteal decortication and extracortical bone-bridging for treatment of atrophic humeral nonunions / 中华创伤骨科杂志

Objective To assess the effectiveness of osteoperiosteal decortication and extracortical bone-bridging in the treatment of atrophic humeral nonunions.Methods Nineteen patients with atrophic humeral nonuninon were treated by osteoperiosteal decortication and extracortical bone-bridging between March 2008 and April 2016.They were 12 men and 7 women,aged from 23 to 68 years (mean,36.6 years).The fracture was located at the left side in 10 cases and at the right side in 9.Before admission to our hospital,8 had received surgery once,6 twice and 5 thrice.The time from fracture to hospitalization ranged from 12 to 106 months (average,26.3 months).Shoulder function was evaluated by Neer scoring and elbow function by Mayo elbow performance score (MEPS) at final follow-ups.Results All incisions healed by first intention.Two cases reported transient radial nerve symptoms of numbness.All the 19 patients were followed up for 28.9 months on average (range,from 13 to 78 months).Radiographic examinations showed signs of bone remodeling,disappearance of fracture lines and formation of extracortical bone bridge at 6 to 8 weeks after operation.All of them achieved radiographic union within 10 to 46 weeks (16.8 weeks on average).The Neer scores averaged 82.5 (range,from 70 to 98),giving 12 excellent cases,5 good ones and 2 fair ones.The MEPS averaged 84.4 (range,from 70 to 96),giving 11 excellent cases,5 good ones and 3 fair ones.Conclusion Osteoperiosteal decortication and extracortical bone-bridging in treatment of atrophic humeral nonunions can effectively induce osteogenesis and increase stability of broken ends,promoting bone healing.

Effect of traumatic brain injury on expression of platelet derived growth factors and fracture healing in rats / 中华创伤骨科杂志

Objective To explore the effect of traumatic brain injury on the fracture healing and its related mechanism by observing the expression of platelet-derived growth factors (PDGF) in serum and bone callus in rats with bone fracture and cerebral trauma.Methods One hundred and forty-four SD rats were randomized into 4 equal groups (n =36) which were subjected respectively to:no treatment (group N),traumatic brain injury (group TBI),bone fracture (group F) and bone fracture and cerebral trauma (group TBI + F).The animals were sacrificed at 3 days,1,2,3 and 4 weeks after modeling.In all the 4 groups,ELISA was used to detect the expression of PDGF in serum.In groups F and TBI + F,the callus growth was observed at the right tibial fracture site by X-ray,the callus growth and morphology were also observed by HE staining,the expression of PDGF in the callus tissue was measured by immunohistochemieal analysis,and the expression of PDGF mRNA in the callus tissue was measured by RT-PCR.Results X-ray showed that fracture healing was accelerated in group TBI + F compared with group F.The serum expression of PDGF in group TBI + F was significantly higher and the peak time was significantly earlier than in the other 3 groups (P ＜ 0.05).H-E staining showed that osteoblastic activity at the fracture ends in group TBI + F was stronger than in group F.Inmunohistochemica[staining showed that the expression of PDGF in the local callus was significantly higher at 3 days and 1 week in group TBI + F and the peak time was significantly earlier than in group F (P ＜ 0.05).RT-PCR showed that the expression of PDGF mRNA in the local callus was significantly higher at 3 days and 1 week in group TBI + F than in group F (P ＜0.05).Conclusions Traumatic brain injury can promote fracture healing in rats,which is probably related to increased expression of PDGF after cerebral trauma.

Pedicled iliac periosteal flap graft to treat old femoral neck fracture in adolescents / 中华显微外科杂志

Objective To assess the effectiveness of pedicled iliac periosteal flap graft for treatment of old femoral neck fracture in adolescents.Methods Between June,2005 and December,2013,15 patients (15 hips) of old femoral neck fracture in adolescents treated with vascular pedicled iliac periosteal.There were 11 males and 4 females with an average age of 15.8(range 12 to 18) years.Based on the location of fracture,there was 5 cases of subcapital,8 cases of transcervical and 2 cases of basal.6 cases were treated with lower limb traction,3 cases with internal fixation and 6 just without any treatment.The average duration from injury to the second operation was 4.8 (range 1 to 19) months.There were 2 cases of femoral head necrosis after femoral neck fracture.Open reduction,pedicled iliac periosteal flap grafting and cannulate screw fixation were performed.Results All incisions healed by first intention.All patients were followed up 12 to 90 months (mean,46 months).The HHS was increased from (48.7 ± 8.3) pre-operation to (91.3 ± 6.1) at last followed-up,indicating a significant difference between before and after operation (P ＜ 0.01).One patient underwent total hip arthroplasty at 10 months after operation because of fracture nonunion and femoral head necrosis.Fracture healed successfully in 14 cases and the average time of fracture healing was 4 (range 3 to 6) months.Certain extent of remodelling and bulge of the head were observed in 2 cases of collapsed heads.Conclusion Pedicled iliac periosteal flap graft can provide good osteogenesis and vascular reconstruction for femoral head and promote fracture healing in treatment for old femoral neck fracture in adolescents.

Reconstruction of rotation center in revision hip arthroplasty / 中华骨科杂志

Objective To discuss the feasibility of positioning the acetabular center,fixing acetabular implant correctly and reconstructing hip rotation center according to Harris fossa and the remaining anatomical markers of acetabular notch in revision hip arthroplasty.Methods Twenty-eight patients underwent revision hip arthroplasty from April 2007 to June 2009.Based on Paprosky type,3 cases with type Ⅰ were treated with biological fixed acetabular component;8 cases with ⅡA and ⅡB were reconstructed with using of morselized bone grafting and large diameter cemented acetabular prosthesis;17 cases with type ⅡC,ⅢA and ⅢB were treated with using of morselized bone grafting and fixation of acetabular reinforcement ring.Among them,5 patients with massive bone loss in acetabular wall were reconstructed with the use of the structural and morselized bone grafting.The center of the original acetabulum was believed to be in the lunate cartilage surface which was closed to Harris fossa.During the operation,the center was located in the site which was 25-28 mm above in line with perpendicular bisector of acetabular notch connecting line.The acetabular center was the point of positioning acetabular prosthesis (Ⅰ type) or making new acetabulum by impaction bone grafting.Acetabular reinforcement ring (Ⅱ,Ⅲ type) was fixed in accordance with proper transverse angle and anteversion angle.The vertical distance from hip rotation center to teardrop connection and the horizontal distance from hip rotation center to teardrop were measured on preoperative and postoperative radiograph.And the outcomes of reconstruction of rotation center were evaluated.Results The vertical distance was changed from (14.22±3.39) mm preoperatively to (32.64±4.51) mm postoperatively.The difference was statistically significant (t=3.65,P＜ 0.05).The horizontal distance was changed from (25.13±3.46)mm preoperatively to (32.87±4.73) mm postoperatively.The difference was statistically significant (t=2.72,P＜0.05).Conclusion Using residual Harris fossa and acetabular notch as the anatomical markers in revision hip arthroplasty,the restoration of the anatomical hip center has shown to be favorable.

An experiment study of the vascular pedicled periosteum transfer for the treatment of femoral head necrosis in young dogs / 中华显微外科杂志

Objective To explore an effective method for establishing femoral head necrosis models in young dog and to evaluate osteogenesis of vascular pedicled periosteum transplanted in the repairment offemoral head necrosis of young dogs.Methods Animal models of femoral head necrosis were established by liguting and destroying femoral neck artery circles as well as freezing femoral heads with liquid nitrogen in 29 dogs.At 4 weeks, the animal models of femoral head necrosis were evaluated through X-ray, MRI, ECT,and 2 dogs were randomly executed and detectd by histology examination, then 29 dogs were divided randomly into experimental group(n = 12), control group(n = 9 )and blank group(n = 8).Dogs in the experimental group were treated with the vascular pedicled periosteum from isolateral great trochanter, dogs in the control group were treated with the vascular pedicled bone from isolateral great trochanter, and the blank group were without any treatment.4,8, 12 weeks postoperation,these femoral heads were examined morphologically, radiologieally(X-ray, MRI, ECT) and histologically.All animals were executed and detectd by histology at 12 weeks to observe the repairs of necrotic femoral heads at different periods.Results Twelve weeks postoperation, dogs femoral head figurations in the experimental group were normal, MRI signals were odds in femoral head, ECT studies shows decreased radionuclide compared with contralateral femoral head;capillary vessel and osteoblast multiplication and new traboeulacs were matured in histology examination.Dogs femoral head figurations in the contral group were irregular, MRI revealed high-low signals intermix in femoral head, ECT revealed obviously decreased radionuclide, osteoblast actived, new trabeculac and lipocyte were observed in histology examination.In blank group, femoral head figurations were distorted and sunk, while MRI signals were low, ECT showed no radionuclide uptaking.Collapsed trabeculas and many vacant bone lacuna were observed in HE staining.Dogs femoral head figurations in the blank group taken on distortion andsunk, MRI signals were low, without radionuclide revealed uptake, trabeculac collapse, many bone lacuna were vacant.At the same time, radionuclide counts of vascular pedicled periosteums/vascular pedicled bones in ECT were significantly different between experimental group and control group(P < 0.01 ).Conclusion The vascular pedicled periosteum has higher osteogenesis capability compared with the vascular pedicled bone and can effectively repair the femoral head necrosis of young dogs by this means.

Development of Molecular Image Segmentation / 医疗卫生装备

The application value of molecular image segmentation in molecular image technology is introduced especially in results analysis, motion analysis, 3D visualization, and other follow-up operation, and image guided surgery, oncology radiation therapy, therapeutic assessment. It gives an overview on molecular image segmentation of the main methods (Artificial Neural Networks, Snake, etc.), development trends, topics, the assessment of such issues and discussion.

Development of Thermochemotherapy Equipment of Peritoneal Perfusion / 医疗卫生装备

Objective To develop a whole-automatic intellectual thermochemotherapy equipment of peritoneal perfusion by which hyperthemic chemotherapeutics were post in peritoneal cavity with constant flow pump.Methods MSP430 one chip whole-automatic machine was adopted to monitor and keep chemotherapeutic temperature.Results Being treated with peritoneal perfusion thermochemotherapy after radical excision,one-year and three years survival rates of the patients with advanced gastric carcinoma were increased 8.12% and 20%,meso-life span extends 18 months.Conclusion The thermochemotherapy equipment of peritoneal perfusion can eliminate dissociating malignant cell in peritoneal cavity and minimum cancer focus on peritoneal membrane,and prevent peritoneal recurrence effectually.