Objective To investigate the effectiveness and technical points of posterior open approach combined with suture bridge technique for the treatment of tibial insertion avulsion fractures of posterior cruciate ligament (PCL). Methods A retrospective analysis was conducted on 21 patients with PCL tibial insertion avulsion fractures who underwent posterior open approach combined with suture bridge technique between July 2023 and July 2025. There were 14 males and 7 females, aged 11-68 years (mean, 48.3 years). Fracture displacement ranged from 3.9 to 13.7 mm, with an average of 7.9 mm. Preoperative Lysholm score was 46.1±3.9, International Knee Documentation Committee (IKDC) subjective score was 44.8±4.1, and posterior knee laxity was (4.1±0.5) mm. The time from injury to surgery ranged from 1 to 30 days, with an average of 9.4 days. The operation time and intraoperative blood loss were recorded. Knee function was assessed using Lysholm score and IKDC subjective score. Posterior knee laxity was measured bilaterally using a KT-2000 arthrometer, and the results were expressed as the side-to-side difference. Results All surgeries were successfully completed. The operation time ranged from 40 to 130 minutes (mean, 80.2 minutes), and intraoperative blood loss ranged from 7 to 20 mL (mean, 10.4 mL). All incisions healed by first intention without early complication such as surgery-related infection or neurovascular injury. All 21 patients were followed up 12-20 months, with a mean of 18.3 months. Radiographic examination showed anatomical reduction and bony union in all fractures, with healing time ranging from 8 to 14 weeks (mean, 11.5 weeks). During follow-up, no reduction loss, implant loosening or breakage was observed. At last follow-up, the Lysholm score was 90.3±3.1, IKDC subjective score was 91.0±3.1, and posterior knee laxity was (1.6±0.4) mm, all showing significant differences compared with preoperative values (P<0.05). ConclusionThe posterior open approach combined with suture bridge technique for PCL tibial insertion avulsion fractures offers the dual advantages of reliable reduction under direct vision and robust fixation with suture bridge, demonstrating safety and efficacy. It is particularly suitable for complex cases such as comminuted fractures, old fractures, or those complicated by posterior neurovascular injury.
ObjectiveTo explore the clinical feasibility and effect of minimally invasive treatment of accidentally sutured surgical drains after arthroplasty with orthopedic broken screw hollow saw, in order to provide a safe and convenient solution for clinical practice. Methods Between January 2016 and October 2023, the clinical data of 5 patients with accidentally sutured surgical drains after orthopedic joint replacement were retrospectively analyzed. There were 4 males and 1 female with an average age of 69.6 years ranging from 65 to 75 years. The hollow saw for broken screws in the orthopedic tool kit for broken screws was used to closely follow the drainage tube wall to the suture site for precise cutting operation without additional self-made tools or enlarged incision. By measuring the length of the extracted drainage tube and cross-checking it with the original record, while simultaneously examining the tube’s integrity to confirm the absence of any residue. Results The drainage tubes were successfully removed in 5 patients, and the removal process took 3-8 minutes, with an average of 5.4 minutes (excluding the time of instrument preparation and disinfection). After removal, all the drainage tubes were complete in shape, the measured length was completely consistent with the intraoperative depth record, and no fracture or residue was confirmed; no high-density foreign body shadow was found in the postoperative X-ray examination. There was no exudation or incision dehiscence after operation. All patients were followed up 24 months, and there was no sign of joint dysfunction, chronic pain or infection, and no complications related to delayed foreign body residues. ConclusionThe application of orthopedic broken screw hollow saw in the treatment of accidentally sutured surgical drains after orthopedic joint replacement has the advantages of simple operation, minimally invasive, short time-consuming, high success rate and no need for self-made tools.
Objective To investigate the improvement effects and mechanisms of composite chitosan (CS) hydrogel on traditional polypropylene (PP) mesh for repairing abdominal wall defects. Methods CS hydrogel was prepared via physical cross-linking and then combined with PP mesh to create a CS hydrogel/PP mesh composite. The internal structure and hydrophilicity of the composite were characterized using macroscopic observation, upright metallographic microscope, scanning electron microscopy, and water contact angle measurements. The performance of the composite (experimental group) in resisting cell adhesion and supporting cell infiltration was assessed through fibroblast (NIH-3T3) infiltration experiments and human umbilical vein endothelial cells (HUVECs) tube formation assays, and simple cells were used as control group. Finally, a bilateral abdominal wall defect model (1.5 cm×1.0 cm) was established in 18 Sprague Dawley rats aged 8-10 weeks, with the composite used on one side (experimental group) and PP mesh on the other side (control group). The effects on promoting wound healing, preventing adhesion, angiogenesis, and anti-inflammation were investigated through macroscopic observation, histological staining (HE and Masson staining), and immunohistochemical staining (CD31, CD68). Results The composite appeared as a pale yellow, transparent solid with a thickness of 2-3 mm, with the PP mesh securely encapsulated within the hydrogel. Scanning electron microscopy revealed that the hydrogel contained interconnected pores measuring 100-300 μm, forming a porous structure. Contact angle measurements indicated that CS hydrogel exhibited good hydrophilicity, while PP mesh was highly hydrophobic. In vitro cell culture experiments showed that DAPI staining indicated fewer positive cells in the experimental group after 1 day of culture, while the cells in control group covered the entire well plate. After 3 days of culture, the cells in experimental group were spherical and displayed uneven fluorescence, suggesting that the material could reduce cell adhesion while supporting cell infiltration. HUVECs tube formation experiments demonstrated an increase in cell numbers in experimental group with a trend towards tube formation, while cells in control group were sparsely distributed and showed no migration. In the rat abdominal wall defect repair experiment, results showed that after 1 week post-surgery, the experimental group had tissue and blood vessels infiltrating, and by 4 weeks, the integrity was well restored with significant regeneration of muscle and blood vessels, while the control group exhibited adhesions and incomplete healing. HE staining results indicated weaker cell infiltration in the experimental group, with cell density significantly higher than that of the control group at 2 and 4 weeks post-surgery (P<0.05). Masson staining revealed that collagen fibers in the experimental group were arranged neatly, with significantly increased collagen content at 2 weeks post-surgery (P<0.05), while collagen content was similar in both groups at 4 weeks (P>0.05). Immunohistochemical staining showed that CD31-positive cells were evenly distributed between muscle layers in the experimental group, whereas the control group exhibited notable defects. At 2 weeks after operation, the CD31-positive cell ratio was significantly higher than that in the control group (P<0.05); at 2 and 4 weeks after operation, the CD68-positive cell ratio in the experimental group was significantly lower than that in the control group (P<0.05). Conclusion CS hydrogel has a positive effect on preventing adhesions and promoting wound healing, exhibiting anti-inflammatory and pro-angiogenic properties during the healing process. This provides a promising strategy to address challenges related to abdominal adhesions and reconstruction.
Temporomandibular joint disorder (TMD) is a common oral and maxillofacial disease, which is difficult to detect due to its subtle early symptoms. In this study, a TMD intelligent diagnostic system implemented on edge computing devices was proposed, which can achieve rapid detection of TMD in clinical diagnosis and facilitate its early-stage clinical intervention. The proposed system first automatically segments the important components of the temporomandibular joint, followed by quantitative measurement of the joint gap area, and finally predicts the existence of TMD according to the measurements. In terms of segmentation, this study employs semi-supervised learning to achieve the accurate segmentation of temporomandibular joint, with an average Dice coefficient (DC) of 0.846. A 3D region extraction algorithm for the temporomandibular joint gap area is also developed, based on which an automatic TMD diagnosis model is proposed, with an accuracy of 83.87%. In summary, the intelligent TMD diagnosis system developed in this paper can be deployed at edge computing devices within a local area network, which is able to achieve rapid detecting and intelligent diagnosis of TMD with privacy guarantee.