Objective To explore the shortcomings of the traditional clinical probation teaching mode, propose and implement the interactive teaching mode, so as to stimulate the students’ interest in knowledge and achieve better teaching effects. Methods The students of Grade 2017 who had clinical probation in the Orthopaedic Trauma Center of West China Hospital of Sichuan University from September 2020 to December 2021 were selected. Students were randomly divided into traditional clinical probation teaching mode group and interactive teaching mode group according to random number table method. Wechat mini program anonymous questionnaire survey was used to evaluate students’ satisfaction with the interactive teaching model of orthopaedic trauma and the teaching effect. Results A total of 110 students were enrolled, 55 in the traditional clinical probation teaching mode group and 55 in the interactive teaching mode group. There was no significant difference in gender or age between the two groups (P>0.05). The students in the interactive teaching mode group were better than those in the traditional clinical probation teaching mode group in orthopedic theory test (90.13±3.65 vs. 88.39±3.74; t=2.469, P=0.015) in the orthopedic theory test, teacher evaluation (89.15±2.94 vs. 87.56±3.12; t=2.751, P=0.007) and student self-evaluation (89.07±3.18 vs. 87.41±2.89; t=2.865, P=0.005). The teaching satisfaction of the interactive teaching group was higher than that of the traditional teaching group (96.36% vs. 87.27%; Z=?2.159, P=0.031). Conclusion Interactive teaching mode can effectively stimulate students’ interest in knowledge seeking, improve the enthusiasm and interaction of clinical probation, and effectively improve the satisfaction of undergraduate orthopaedic trauma clinical probation teaching.
Objective To evaluate the surgical treatment and its results of complex tibial plateau fractures.Methods From May 2003 to November 2004, 24 cases of complex tibial plateau fractures were treated by two-incision approaches. There were 16 males(including 1 case of bilateral), and8 females, with mean age of 40.6 years(21-65 years), eleven fractures occurred in left extremity and 14 in the right. No patients suffered open fractures. Fracture was caused by fall from height in 10 cases, by traffic accident in 12 cases and by another causes in 2 cases. According to Schatzkerclassification, type Ⅴ fracture was found in 14 extremities，type Ⅵ in 11 extremities. All cases were operated with twoincision approaches and double-plates fixation. The operation was performed 6-15 days after injury with mean 10.4 days. Results All cases were followed up from 12 to 23 months (mean 15.6 months). Time of the bone healing was 69 months, with mean 7.4 months. No reduction of anatomy was achieved because of comminuted fractures of articular surfaces in 2 limbs. The line of the lower extremity did not recover because of metaphysis comminution in 1 limb, which led to knee varus. Epidermal necrolysis was observed in 3 limbs, and the wound healedafter change dressing. The function of the knee wasevaluated according to Rasmussen’s criteria, the results were excellent in 10limbs, good in 8 limbs, fair in 3 limbs, and poor in 4 limbs. Conclusion The twoincision approaches reduced the complication of softtissueinjury, which is conductive to reduction of articular surface. Double-plates provide a sufficient internal fixation. It can permit early motion of knee joint. Therefore, two-incision approach are an effective surgical approach of treatment of complex tibial plateau fractures.
Objective To review the research progress of graphene and its derivatives in repair of peripheral nerve defect. Methods The related literature of graphene and its derivatives in repair of peripheral nerve defect in recent years was extensively reviewed. Results It is confirmed by in vitro and in vivo experiments that graphene and its derivatives can promote cell adhesion, proliferation, differentiation and neurite growth effectively. They have good electrical conductivity, excellent mechanical properties, larger specific surface area, and other advantages when compared with traditional materials. The three-dimensional scaffold can improve the effect of nerve repair. Conclusion The metabolic pathways and long-term reaction of graphene and its derivatives in the body are unclear. How to regulate their biodegradation and explain the electric coupling reaction mechanism between cells and materials also need to be further explored.
ObjectivesTo systematically review the efficacy and safety of tranexamic acid (TXA) in reducing blood transfusion and total blood loss in patients undergoing orthopaedic trauma surgery.MethodsA systematic literature search was performed using PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases. A search for grey literature was also performed in American Academy of Orthopaedic Surgeons (AAOS) and Orthopaedic Trauma Association (OTA). The search time was up to June 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias, then meta-analysis was performed by using RevMan 5.3 and Stata 14.0 softwares.ResultsA total of 10 studies were included, including 936 patients. The pooled results indicated that TXA group was superior to the control group in blood transfusion (RR=0.75, 95%CI 0.63 to 0.89, P=0.001), the total blood loss (MD=–157.61, 95%CI –250.09 to –65.13, P=0.000 8) and the wound complications (RR=0.24, 95%CI 0.10 to 0.58, P=0.002). There was no significant difference in risk of thromboembolic events (RR=1.25, 95%CI 0.78 to 2.00, P=0.36) and the mortality (RR=0.81, 95%CI 0.40 to 1.66, P=0.57) between TXA and control group.ConclusionsTXA can effectively reduce blood transfusion, total blood loss and wound complications in patients undergoing orthopedic trauma surgery. Furthermore, TXA does not significantly increase the incidence of thromboembolic events and mortality. Due to the limited quality of included studies, more high quality studies are required to verify the above conclusions.
目的 探討鎖骨鉤鋼板并改良Weaver-Dunn技術治療Tossy Ⅲ型陳舊性肩鎖關節脫位的療效。 方法 2007年１月－2011年１月，對12例Tossy Ⅲ型陳舊性肩鎖關節脫位采用鎖骨鉤鋼板并改良Weaver-Dunn技術治療。其中3例為肩鎖關節脫位手術后再次發生脫位，2例合并鎖骨遠端骨折采用保守治療無效，余7例單純性陳舊性肩鎖關節脫位未經任何檢查治療。 結果 術后患者切口均Ⅰ期愈合，無神經血管損傷、無切口感染等并發癥。12例均獲隨訪，隨訪時間12～30個月。X線片示鎖骨復位情況良好，去除內固定后未見肩鎖關節脫位復發。肩鎖關節功能好，局部畸形消失，無肩周肌肉萎縮及肩周炎出現，鎖骨位置良好。手術療效評價：獲優10例，良2例，優良率100%。 結論 鎖骨鉤鋼板并改良Weaver-Dunn技術治療Tossy Ⅲ型陳舊性肩鎖關節脫位，復位固定滿意，韌帶重建易成功，肩關節功能恢復好，是一種治療陳舊性肩鎖關節脫位較理想的方法。
Objective To study the outcomes of nerve defect repair with the tissue engineered nerve, which is composed of the complex of SCs, 30% ECM gel, bFGF-PLGA sustained release microspheres, PLGA microfilaments and permeable poly (D, L-lacitic acid) (PDLLA) catheters. Methods SCs were cultured and purified from the sciatic nerves of 1-day-old neonatal SD rats. The 1st passage cells were compounded with bFGF-PLGA sustained release microspheres andECM gel, and then were injected into permeable PDLLA catheters with PLGA microfilaments inside. In this way, the tissueengineered nerve was constructed. Sixty SD rats were included. The model of 15-mm sciatic nerve defects was made, and then the rats were randomly divided into 5 groups, with 12 rats in each. In group A, autograft was adopted. In group B, the blank PDLLA catheters with PBS inside were used. In group C, PDLLA catheters, with PLGA microfilaments and 30% ECM gel inside, were used. In group D, PDLLA catheters, with PLGA microfilaments, SCs and 30% ECM gel inside, were used. In group E, the tissue engineered nerve was appl ied. After the operation, observation was made for general conditions of the rats. The sciatic function index (SFI) analysis was performed at 12, 16, 20 and 24 weeks after the operation, respectively. Eelectrophysiological detection and histological observation were performed at 12 and 24 weeks after the operation, respectively. Results All rats survived to the end of the experiment. At 12 and 16 weeks after the operation, group E was significantly different from group B in SFI (P lt; 0.05). At 20 and 24 weeks after the operation, group E was significantly different from groups B and C in SFI (P lt; 0.05). At 12 weeks after the operation, electrophysiological detection showed nerve conduct velocity (NCV) of group E was bigger than that of groups B and C (P lt; 0.05), and compound ampl itude (AMP) as well as action potential area (AREA） of group E were bigger than those of groups B, C and D (P lt; 0.05). At 24 weeks after the operation, NCV, AMP and AREA of group E were bigger than those of groups B and C (Plt; 0.05). At 12 weeks after the operation, histological observation showed the area of regenerated nerves and the number of myel inated fibers in group E were significantly differents from those in groups A, B and C (Plt; 0.05). The density and diameter of myel inated fibers in group E were smaller than those in group A (Plt; 0.05), but bigger than those in groups B, C and D (P lt; 0.05). At 24 weeks after the operation, the area of regenerative nerves in group E is bigger than those in group B (P lt; 0.05); the number of myel inated fibers in group E was significantly different from those in groups A, B, C (P lt; 0.05); and the density and diameter of myel inated fibers in group E were bigger than those in groups B and C (Plt; 0.05). Conclusion The tissue engineered nerve with the complex of SCs, ECM gel, bFGF-PLGA sustained release microspheres, PLGA microfilaments and permeables PDLLA catheters promote nerve regeneration and has similar effect to autograft in repair of nerve defects.
ObjectiveTo systematically review the efficacy and safety of operative treatment versus nonoperative treatment in patients with adult spinal deformity (ASD).MethodsPubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, WanFang Data, and CQVIP databases were searched for controlled studies about operative treatment versus nonoperative treatment for ASD published up till June 2019. ClinicalTrials.gov was searched for grey literatures informally published up till June 2019. Two reviewers independently screened literatures, extracted data, and assessed risk of bias. Meta-analysis was performed by using RevMan 5.3 and Stata 14.0 softwares.ResultsA total of 10 non-randomized controlled studies were included, including 1 601 patients. The pooled results indicated that the operative group was superior to the nonoperative group in ability improvement [the increment of Scoliosis Research Society-22 score: weighted mean difference (WMD)=0.70, 95% confidence interval (CI) (0.69, 0.70), P<0.000 01; the decrement of Oswestry Disability Index score: WMD=11.12, 95%CI (10.74, 11.50), P<0.000 01], pain relief [the decrement of Numeric Rating Scale score: WMD=3.25, 95%CI (3.16, 3.35), P<0.000 01], and Cobb correction [WMD=14.06°, 95%CI (13.60, 14.53)°, P<0.000 01]. The incidence of complications was higher in the operative group than that in the nonoperative group [relative risk=5.38, 95%CI (3.67, 7.88), P<0.000 01].ConclusionsSurgery shows superior efficacy on ability improvement, pain relief, and Cobb correction compared with nonoperative treatment in ASD patients, though its incidence of complications is high. Nonoperative treatment is also an effective treatment for patients with poor physical condition and intolerance to surgery. Due to the limited quantity and quality of included studies, more high-quality studies are required to verify the above conclusions.
Objective To evaluate the clinical and radiographic outcomes of headless compression screws for Lisfranc joint injuries. Methods A retrospective analysis was made on clinical data of 34 patients (36 feet) with Lisfranc joint injuries who underwent open reduction and internal fixation with headless compression screws between January 2006 and January 2012. There were 22 males (24 feet) and 12 females (12 feet), aged 21-73 years (mean, 38.9 years). The causes of injury included traffic accident in 16 cases (17 feet), falling from height in 11 cases (12 feet), crushing in 5 cases (5 feet), and sports in 2 cases (2 feet). Of them, there were 19 cases (20 feet) of closed injury and 15 cases (16 feet) of open injury; there were 7 cases (8 feet) of pure dislocations of tarsometatarsal joints and ligamentous Lisfranc injuries (LD), 22 cases (23 feet) of Lisfranc joint fracture dislocations (LFD), 5 cases (5 feet) of combined Chopart-LFD (CLFD). According to Myerson classification, 5 cases (5 feet) were rated as type A, 7 cases (8 feet) as type B1, 14 cases (15 feet) as type B2, 5 cases (5 feet) as type C1, and 3 cases (3 feet) as type C2. Associated fractures included 12 cases (13 feet) of metatarsal shaft fracture, 4 cases (4 feet) of cuboid fracture, 4 cases (4 feet) of navicular bone fracture, 6 cases (7 feet) of coneiform bone fracture/dislocation, 8 cases (10 feet) of ipsilateral lower limb multiple fracture, and 4 cases (4 feet) of contralateral lower limb multiple fracture. The clinical outcomes were evaluated according to American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score. Postoperative X-ray films were taken to assess the reduction, internal fixation, and the foot arch height. Results All patients were followed up 1 year to 5 years and 2 months (mean, 3.5 years). X-ray films showed anatomical reduction in 31 cases (33 feet, 91.7%). At last follow-up, AOFAS score and VAS score averaged 80.6 (range, 60-100) and 2.3 (range, 0-6), respectively; the AOFAS score was significantly higher in patients having anatomical reduction than the patients having no anatomical reduction, in patients with LD and LFD than in patients with CLFD, and in patients without cuneiform bone fracture/dislocation than in patients with cuneiform bone fracture/dislocation (P lt; 0.05). There was no significant difference in the talus-first metatarsal angle, the distance between the lateral edge of the base of the first metatarsal bone and the medial edge of the base of the second metatarsal bone, and the arch height between the injured foot and normal foot (P gt; 0.05). Reduction loss was observed in 1 case (1 foot) because of early weight bearing; post-traumatic arthritis developed in 9 patients (10 feet). The incidence of post-traumatic osteoarthritis was higher in the patients with non-anatomic reduction, coneiform bone fracture/dislocation, comminuted intra-articular fractures of Lisfranc joints, the injury types (P lt; 0.05). Conclusion Headless compression screws for fixation of Lisfranc joint injuries can provide satisfactory short- and mid-term clinical and radiographic outcomes. During surgery, the precise anatomic reduction and stable fixation should be paid attention to, especially in patients with CLFD, coneiform bone fracture/dislocation, and comminuted intra-articular fractures of Lisfranc joints so as to control the incidence of the post-traumatic osteoarthritis.
Objective To evaluate the results of operative treatment of complex acetabular fractures and to investigate its influence factors. Methods From June 2000 to August 2006, 54 patients with complex acetabular fractures were treated, including 44 males and 10 females aged 20-75 years old (average 39.1 years old). Fractures were due to traffic accidentin 40 cases, fall ing from high places in 8 cases and crush by heavy objects in 6 cases. All cases were fresh and close fractures and the time from injury to operation was 5-72 days. There were 5 cases of posterior column and posterior wall fracture, 25 of transverse and posterior wall fracture, 2 of T-type fracture, and 22 of double column fracture. During operation, Kocker- Lagenbach approach was used in 23 cases, anterior il ioinguinal approach was appl ied for 3 cases and the combination of anterior and posterior approaches was performed on 28 cases. AO reconstructive plate and screw internal fixation were used in all the cases. Results Fifty-two cases were followed up for 12-74 months (average 31.3 months). Anatomical reduction was achieved in 23 cases, satisfactory reduction in 19 cases, poor reduction in 10 cases, and the excellent and good rate reached 80.77%. During operation, 1 case suffered from a tear in the external il iac vein and healed after vein repair; 2 cases had sciatic nerve injury and took mecobalamin as oral administration, one of them fully recovered, and the other had incomplete recovery at 18-month follow-up. At the final follow-up, there were 6 cases of severe heterotopic ossification, one of them received heterotopic bone resection and the rest 5 patients received conservative treatment; there were 9 cases of traumatic osteoarthritis, one of them received total hip replacement and the rest 8 patients received conservative treatment; there were 5 cases of avascular necrosis of the femoral head, two of them received total hip replacement, 1 received no further treatment because the femoral head didn’ t collapse, and the rest 2 patients gave up total hip replacement; 75.00% patients were graded as excellent and good according to the modified Merled’Aubigné-Postel hip score system. Patients’ qual ity of l ife was compared with local population normsmatched for age and sex by using SF-36 scales, their overall score were below the local population norms, and their general health, vital ity, role l imitation due to emotional problems and mental health were comparable to the local population norms. Logistic regression analysis revealed the time to reduce hip dislocation, qual ity of fracture reduction nd traumatic arthritis were independent risk factors affecting postoperative functional outcomes. Conclusion Applying open reduction and internal fixation in the treatment of displaced complex acetabular fractures has a satisfying therapeutic effect. Time to reduce hip dislocation, qual ity of fracture reduction as well as traumatic arthritis are independent risk factors affecting postoperative functional outcomes.
Objective To evaluate the effect of minimally invasive dynamic hip screws (MIDHS) in treating aged intertrochanteric fractures. Methods From April 2006 to March 2008, 49 aged patients with intertrochanteric fractures were treated with MIDHS. There were 22 males and 27 females, aged 65-78 years (average 70.2 years). Frature was caused by trafficaccident in 7 cases, by fall ing from height in 3 cases, and by injury from fall in 39 cases. The time from injury to operation was 2-12 days (average 5.5 days). According to Evans classification, there were 28 cases of types I, II (stable fracture) and 21 cases of types III, IV (unstable fracture). If the Singh index≤3 was defined as osteoporosis, the osteoporotic rate was 71.4% (35/49). All patients were on a radiolucent fracture traction table and their fractures had satisfactory closed reduction. After the guide wire was inserted and reamed under fluoroscopy, the lag screw and side plate were introduced through the small incision. In all unstable fractures, an additional, antirotational and large cancellous bone screw was used cranial to the DHS. Results The average operation time was 65.2 minutes. The average blood loss was 189.3 mL. All patients had satisfactory reduction and 79.6% (39/49) had adequate lag screw positions. The average postoperative hospital ization days was 5.8 days (3-12 days). All incision healed at stage I. There was no postoperative complications. Forty-nine patients were followed up 12 to 30 months (average 19.8 months). Fractures healed within 16 weeks in 47 patients and the average healing time was 13.1 weeks (12-16 weeks). The average Harris scoring was 90.8 (75-95). Implant failure and nonunion occurred in 2 cases, no serious compl ication occurred in other patients. Conclusion The MIDHS is a simple, safe and effective method for treatment of aged intertrochanteric fractures.