Objective To discuss the socialized management model of medical transportation service in large-scale grade three hospital.Methods Selected a company through a competitive bidding,using dual management model of company and nursing department.The nursing department developed and implemented a unified regulatory system,introduce competition mechanism,participate incentives reform quality inspection programs,hold multi-sect oral coordination meetings regularly and also the hospital and company projeot management meetings.Results Socialization of medical transportation service not onlyreduced the problem of the hospital management cost to solve the hospital's birth control and labor,but also improved the satisfaction of patients and medical staff to the transportation members,it provided a strong support system to clinical service.Conclusions Implementation of social management in allied transportation service in hospital is feasible.The company management,nursing supervision model is a new path for transportation management.It is a guarantee of mechanism innovation,intensive training,strict management and supervision of a stable multi-party transport team to provide high-quality transportation service.

Objective:To evaluate arthrography-assisted reduction in minimally invasive treatment of tibial plateau fractures.Methods:From January to May 2019, 9 patients with tibial plateau fracture were treated by arthrography-assisted minimally invasive surgery at Department of Orthopaedics and Traumatology, Hong-Hui Hospital. They were 6 males and 3 females with an average age of 45.5 years (from 27 to 63 years). According to the Schatzker classification, there were 6 cases of type Ⅱ, one of type Ⅲ and 2 cases of type Ⅳ. Arthrography was used to determine the lowest filling point of contrast medium after intra-articular injection and to ensure satisfactory reduction of articular surface after fracture reduction and bone grafting, followed by minimally invasive percutaneous plate implantation. Comparisons were made between preoperation and 6 months postoperation in the range of knee motion and knee scores of The Hospital for Special Surgery (HSS). Knee X-ray films were evaluated by the Rasmussen imaging system at 6 months postoperation. Collapse of articular surface was recorded pre- and post-operation as well as postoperative complications.Results:All the 9 patients were followed up for 6 to 9 months (average, 7 months). All patients achieved bony union within 12 weeks postoperation. The preoperative knee flexion (60.7°±13.1°) and HSS (51.9±5.7) were significantly improved to 122.4°±10.8° and 84.9±5.3 at 6 months postoperation ( P<0.05), but there was no significant difference between preoperation and 6 months postoperation in knee extension (4.4°±2.5° versus 4.6°±2.9°) ( P>0.05). The collapse of articular surface was improved from preoperative 9.5 mm (from 5 to 15 mm) to postoperative 1.3 mm (from 0 to 3 mm). The Rasmussen imaging scores at 6 months postoperation showed 6 excellent and 3 good. No such postoperative complications occurred as incision infection, joint stiffness, loosening or breakage of implants. Conclusion:Arthrography helps minimally invasive treatment of tibial plateau fracture because it can better display fracture collapse during operation and accurately judge indirect reduction of articular surface.

Objective To explore the impact of modified vacuum sealing drainage (VSD) on prevention of tension blisters during treatment of opening fracture wounds.Methods From March 2015 to February 2016,53 patients with 60 open fracture wounds were treated after surgery by VSD at our department.They were 28 males (33 wounds) and 25 females (27 wounds),aged from 24 to 65 years (average,41.1 years).The patients were divided into 2 groups.Group A (33 wounds) were subjected to traditional VSD after surgery while group B (27 wounds) to modified VSD.The mean time from injury to surgery was 5.2 hours (from 2.0 to 8.3 hours).The VSD dressing was first removed to observe whether any tension blisters would appear surrounding the dressing 5 days after surgery.Results Tension blisters appeared around 9 wounds in group A (with an incidence of 27.3％) but around one wound in group B (with an incidence of 3.7％).The difference between the 2 groups was statistically significant (P =0.037).Conclusion In treatment of open fracture wounds,the modified VSD can effectively prevent formation of tension blisters surrounding the dressing while it is used to cover a wound.

Objective To investigate the total number, reasons, and distributing characteristics of vagrant psychosis patients in Xi'an. Methods The colony random sample in 4 objective research units from 2005 to 2010 in Xi'an, Shaanxi were included. Databank was set up according to the total number of vagrant psychosis patients based on basic information. Grading statistics was used. Results Total number of vagrant psychosis patients and salvation needs increased year by year in Xi'an. Home return and social assistance were the main approaches for distributing characteristics of medical assistance. Conclusion The total number of vagrant psychosis patients is relative large. Such number is increasing year by year in Xi'an. A better treatment and diagnostic system for vagrant psychosis patients should be set up governmentally as quickly as possible.

Objective To evaluate the clinical application of our self-designed ultradistal locking tool in the intramedullary nailing for tibial fractures.Methods From January 2014 to May 2016,175 patients with tibial fracture were treated at our department.They were 119 men and 56 women,from 19 to 73 years of age (average,46.3 years).They were divided into 2 groups according to the different targeting devices used in the intramedullary nailing.Conventional locking tools were used in the 83 patients from January 2014 to January 2015 and our self-designed new ultradistal locking tools in the 92 patients from February 2015 to May 2016.The 2 groups were compared in terms of operation time,frequency of intraoperative fluoroscopy,and successful rate of one-time locking.Results There were no significant differences between the 2 groups in general clinical data(P ＞ 0.05),showing similarities of the 2 groups.The operation time(59.8 ±4.3 min),frequency of intraoperative fluoroscopy(11.0 ± 2.1 times),and rate of one-time successful locking[94.4％ (238/252)] in the ultradistal locking group were significantly better than those in the conventional locking group [73.6 ± 5.3 min,23.0 ± 3.8 times and 85.7％ (180/210),respectively] (P ＜ 0.05).Conclusions Our new ultradistal locking tools are superior to the conventional ones in that they lead to shorter operation time,less intraoperative fluoroscopy and higher successful rate of one-time locking.Additionally,the new locking tools are easy to handle and incur no extra costs.

Objective To explore the predictive significance of platelet changes on deep venous thrombosis of the lower limbs after total knee replacement,and to guide the early clinical prediction and prevent the occurrence of thrombotic events.Methods A retrospective study was conducted of the 50 patients who had been treated by total knee arthroplasty for degenerative knee osteoarthropathy from January 2016 to June 2018 in the Department of Orthopedics and Traumaology,Xi'an Jiangtong University Medical College Red Cross Hospital.There were 10 males and 40 females,aged from 47 to 80 years (average age 65.1 years).According to the results of B ultrasound examination of the lower extremities,the patients were divided into the non embolic group (24 cases) and the embolic group (26 cases).The platelet counts and hemoglobin levels of the two groups were recorded before and after operation,and their respective differences were calculated.The difference of hemoglobin difference between the two groups was analyzed.At the same time,the difference of platelet count and total knee joint were examined.Whether the deep venous thrombosis of the lower extremity after replacement was statistically significant.If there was no statistical difference in the difference in hemoglobin between the two groups,and the difference in platelet count was statistically significant,the ROC curve was made to determine the optimal screening point.If obeying the normal distribution and the homogeneity of the variance,an independent sample t test was performed on the platelet count difference and the hemoglobin amount difference between the two groups,and the dose data in accordance with the normal distribution was expressed as (Mean ±SD).Results The difference of platelet count was (30.4 ± 14.8) ×109/L in thrombosis group and (53.5 ± 15.2) × 109/L in thrombosis group.The difference of platelet count between the two groups had statistical significance (P ＜ 0.001).The best screening point of platelet count difference was 34.0 × 109/L.The difference of hemoglobin count between thrombosis group and thrombosis group was (20.8 ± 9.3) g/L and (24.0 ± 10.7) g/L,there was no significant difference in hemoglobin between the two groups (P ＞ 0.05).Conclusions Preoperative and postoperative platelet count difference can effectively predict the incidence of lower extremity deep venous thrombosis after total knee arthroplasty.When the platelet count difference before surgery ≥34.0 × 109/L,early prevention of deep venous thrombosis should be avoided.The formation of the occurrence.

Objective    To evaluate the changes of left ventricular structure and function by echocardiography and its grading of left ventricular diastolic function in patients with mitral valve prolapse treated by minimally invasive mitral valve repair. Methods    By retrospective analysis, 37 patients including 25 males and 12 females aged 53.49±11.02 years with mitral valve prolapse who underwent minimally invasive mitral valve repair were as an operation group, and 34 healthy persons including 19 males and 15 females aged 54.26±8.33 years matched by age and sex were selected as a control group. Ultrasound parameters of every participant were routinely collected before operation, 1 month, 3 months, 6 months and 1 year after operation, and left ventricular diastolic function was graded. The ultrasound parameters between the two groups were compared. Results    The diameters of left ventricular end systolic and diastolic phase, left atrial diameter and left ventricular volume in the operation group were significantly smaller than those before operation. The diameters of left ventricle and left atrium after operation were significantly shorter than those before operation, but they were still larger than those of the control group. The ejection fraction value decreased significantly at one month after the operation and then returned to normal level. The incidence of left ventricular diastolic dysfunction at 6 months and 1 year after operation was significantly lower than that before operation (P<0.05). Conclusion    Minimally invasive repair for patients with mitral valve prolapse can significantly improve systolic and diastolic functions of left ventricle while reconstructing left atrial and left ventricular structures.

Objective: To explore the effect of bone transport external fixation combined with locking bone plate internal fixation technology in the treatment of segmental tibial defects. Methods: The clinical data of 12 patients with segmental tibial defects treated with annular external fixator and long locking plate in the Honghui Hospital, Xi′an Jiaotong University College of Medicine from January 2013 to March 2017 were analyzed retrospectively. There were 10 males and 2 females with an average age of 45 years (aged range from 20 to 65 years). External fixation time, external fixation index, healing time, mean healing index and complications were recorded. The follow-up time was 12-48 months, and the Paley bone and functional scores were used to evaluate the efficacy at the last follow-up. Results: All the patients achieved union at the distraction callus and docking site. The average external fixation time was 112.1 d, the average external fixation index was 16.5 d/cm, the average healing time was 299.5 d, and the average healing index was 44.9 d/cm. Seven cases had pain and 4 cases had pin-site infections as minor complications. The bony outcomes were excellent in all patients. The functional outcomes were excellent in eight cases and good in four. Conclusion Bone transport with external fixation combined with locking plate internal fixation in the treatment of segmental bone defects of tihia can shorten external fixation time and is beneficial to functional rehabilitation after operation.

Objective:To compare the clinical effects robot navigation assisted and conventional proximal femoral nail antirotation (PFNA) implantation and fixation in the treatment of elderly femoral trochanteric fractures.Methods:A total of 86 elderly patients with tuberosity fracture of the femur were admitted as research samples from January to March in 2022 in the Department of Trauma Orthopaedic, Xi′an Honghui Hospital Affiliated to Xi′an Jiaotong University, including 37 males and 49 females, who aged from 63 to 92 years, with an average age of (79.6 ± 6.9) years. All patients were treated with intramedullary nails (PFNA), 32 with dimensity robotic-assisted therapy (robot group) and 54 with traditional methods (conventional group). The length of incision, the number of intraoperative fluoroscopy, the amount of intraoperative blood loss, and the operation time were recorded. The occurrence of postoperative complications in the two groups was observed. The rate of excellent hip Harris score at 3 month after surgery was compared between the two groups. Measurement data with normal distribution were represented as mean ± standard deviation( ± s), and the comparison between groups was conducted using the t-test; the comparison of count data were represented as [ n(%)], and was conducted by Chi-square test or Fisher exact probability between groups. Results:All patients were followed up for 9 to 12 months, with an average of (10.6 ± 0.9) months. The incision length and tip apex distance (TAD) of the robot group were (3.40±0.82) cm and (21.85±1.44) mm, which were smaller than (4.82±0.75) cm and (26.83±1.75) mm in the conventional group ( P<0.05 for all). The number of intraoperative fluoroscopy and guide needle adjustment [(14.53±3.26) and 0 times] in the robot group were less than those in the conventional group [(20.67±4.84) and (2.83±1.42)] ( P<0.05). The intraoperative blood loss and drainage rate of the robot group were (87.03±9.41) and (46.40±8.91) mL, which were smaller than that of the conventional group [(110.00±12.52) and (69.62±10.22) mL] ( P<0.05). There was no significant difference in the number of days of hospitalization and operation time between the two groups ( P>0.05). The postoperative complication rate in the robot group was 9.4%, which was lower than that in conventional group (42.6%), and the difference was statistically significant ( χ2=11.88, P=0.036). The excellent rate of postoperative hip joint function in the robot group was 75.0%, and the conventional group was 66.7%, and there was no significant difference between the two groups ( χ2=0.66, P=0.416). Conclusion:Robot-assisted navigation downward PFNA surgery can have good clinical effect in the treatment of femoral tuberosity fracture in the elderly, which can reduce the number of surgical incisions and intraoperative fluoroscopy, and reduce the incidence of postoperative complications, which is helpful to achieve minimally invasive surgery and rapid recovery of elderly patients with femoral tuberosity fracture.

Bone nonunion,a common complication after fracture surgery,is one of the most challenging problems an orthopedist has to face.Although Ilizarov technique has been proved an effective treatment of infected nonunions or bone defects,it bears such shortcomings as long frame-wearing time and poor compliance.In order to tackle them,many scholars have suggested a combination of Ilizarov technique and internal implants for bone nonunion which greatly shortens the time a patient wears the frame and allows for early ambulation,leading to good outcomes.This article reviews the mechanisms of distraction osteogenesis for Ilizarov technique and advances in application of Ilizarov technique combined with internal implants for treatment of bone nonunions.