Objective To explore surgical techniques and clinical effects of arthroscopic absorbable interference screw fixation and four-stranded hamstring tendon autograft for the reconstruction of anterior cruciate ligament (ACL). Methods Forty-two patients with rupture of the ACL were operated on by arthroscopic four-stranded hamstring tendons autograft reconstruction using SR-PLLA absorbable screw fixation. Results Follow-up for 3～22 months (mean, 11 4 months) in all 42 patients showed normal motion range of knee joint. Postoperative Lachman test revealed ≤1+ in 37 patients, 2+ in 4 patients and 3+ in 1 patient. All patients showed an absent pivot shift. Postoperative Lysholm score was 89 7?9 6 points, which had increased significantly as compared with the preoperative score (49 4?9 1 points; t =2 12, P =0 038). Postoperative Tegner activity grading scale was 5 3?1 1 points, which was significantly higher than the preoperative one (2 3?0 7 points; t =4 13, P =0 008). MRI examination at first postoperative year showed that absorbable interference screws were partly absorbed in 29 patients,and reconstructed ligaments were in good position and normal in shape in 27 patients.The tendon grafts were anchored on the femur a little too more to the front side in 2 patients, and on the tibia a little too more to the front side in 3 patients, with slight impingement phenomena. Conclusions In ACL reconstruction, four-stranded hamstring tendon is an ideal graft material and absorbable interference screw is optimal for internal fixation.

Objective To investigate the clinical effects of subemergency treatment of femoral intertrochanteric fractures in elderly patients.Methods From June 2013 through February 2014,47 patients older than 65 years were treated for femoral intertrochanteric fracture at our department and completed full follow-ups.Of them,20 received subemergency operation.They were 9 men and 11 women,with an average age of 72.2 ± 4.8 years.By the Evans-Jensen classification,there were 2 cases of type Ⅰ,5 of type Ⅱ,5 of type Ⅲ,5 of type Ⅳ,and 3 of type Ⅴ.The time from injury to surgery ranged from 0.5 to 1.7 days (average,0.8 days).The other 27 patients underwent selective operation.They were 11 men and 16 women,with an average age of 74.9 ± 5.7 years.By the Evans-Jensen classification,there were 3 cases of type Ⅰ,6 of type Ⅱ,6 of type Ⅲ,7 of type Ⅳ,and 5 of type Ⅴ.The time from injury to surgery ranged from 2 to 5 days (average,3.4 days).We compared the 2 groups in terms of in-hospital complications,fracture healing time,length of hospital stay,and hip scores at the last follow-up.Results All the patients were followed up for 12 to 15 months (mean,13.4 months).The rate of in-hospital complications in the subemergency operation group (35.0％,7/20) was significantly lower than that in the selective operation group (51.9％,14/27),and the length of hospital stay in the former (12.1 ± 1.6 days) was significantly shorter than in the latter (16.1 ± 1.8 days) (P ＜ 0.05).There was no significant difference between the 2 groups in fracture healing time (13.1 ± 1.8 weeks versus 13.6 ± 1.2 weeks) (P ＞ 0.05).According to the hip scores at the last follow-up,the subemergency operation group had 16 excellent,2 good,one fair and one poor cases (with an excellent to good rate of 90.0％) while the selective operation group had 21 excellent,2 good,2 fair and 2 poor cases (with an excellent to good rate of 85.2％),showing no significant difference between groups (P ＞ 0.05).Conclusion Subemergency operation can reduce not only in-hospital complications but also length of hospital stay for old patients with femoral intertrochanteric fracture.

Objective To summarize the value of early mechanical ventilation plus continuous vacuum suction in treatment of serious pulmonary contusion.Methods Forty-eight cases of severe pulmonary contusion were assigned to mechanical ventilation plus continuous vacuum suction (observation group,n =20) and mechanical ventilation plus discontinuous vacuum suction (control group,n =28)according to the random number table.Modes of mechanical ventilation were synchronized intermittent mandatory ventilation (SIMV),pressure support ventilation (PSV),and positive and expiratory pressure (PEEP).Changes in blood gas analysis,mechanical ventilation time,and associated complications were compared between groups.Results At ventilation time of 6 and 24 hours,PaO2 in observation group was (100.36 ± 5.90) mmHg and (105.34 ± 7.40) mmHg respectively,with significant differences from (75.36 ± 8.95) mmHg and (76.36 ± 8.35) mmHg in control group (P ＜ 0.01).At ventilation time of 24 hours,PaO2/FiO2 was (283.50 ± 15.20) mmHg in observation group and (201.50 ± 10.20) mmHg in control group (P ＜0.01).Mechanical ventilation time and PEEP at ventilation time of 48 hours in observation group was (3.2 ± 1.1) days and (4.5 ± 2.3) cmH2 O,with significant differences from (6.5 ± 2.8) days and (8.5 ± 2.5) cmH2O in control group (P ＜ 0.01).Associated complications of the two groups revealed no significant difference (P ＞ 0.05).Conclusion Early mechanical ventilation with sustained vacuum suction is effective to keep airway clear,improve oxygenation index,decrease PEEP level,and control the duration of mechanical ventilation,but may not lower the risks of ventilator-associated pneumonia and pulmonary atelectasis.

Objective To evaluate the clinical efficacy of percutaneous kyphoplasty (PKP) in surgical treatment of osteoporotic thoracolumbar vertebral compression fracture in the elderly.Methods From March 2007 to February 2013,210 cases (100 males and 110 females;55-91 years of age,mean 72.5 years) of osteoporotic vertebral compression fracture were treated with PKP.Single-segment fracture was observed in 180 cases,two-segment fracture in 20 cases and three-segment fracture in 10 cases.Lesion involved in 250 vertebrae located in the T6-L5 segment.Bone cement injected into each vertebra was 3-5 ml (mean,4 ml).Treatment effects were assessed with vertebral height,Cobb angle and visual analogue score (VAS).Results At the follow-up of 6-15 months (mean 11 months),thoracic back pain significantly alleviated or disappeared.After operation,improvements were observed in VAS [(8.7 ± 1.2) points vs (2.6 ±0.7) points],anterior vertebral height loss [(11.0 ±3.2) mm vs(5.5 ± 0.8) mm],central vertebral height loss [(8.6 ± 1.1)mm vs (3.3 ± 1.0) mm],and Cobb angle [(29.8 ± 4.5) ° vs (16.7 ± 3.4) °] (P ＜ 0.01).Four patients appeared no pain or numbness in lower limbs although cement leak into disc.Whereas two patients had lower extremity nerve irritation because of cement leak into the spinal canal and recovered after symptomatic treatment.Conclusion PKP is an effective method for treatment of osteoporotic vertebral compression fracture in the elderly,for it can rebuild vertebral height,increase vertebral rigidity as well as stability and relieve thoracic back pain.

Objective To assess the clinical efficacy of percutaneous iliosacral screwing versus reconstruction plating in the treatment of pelvic posterior ring fractures of Tile C.Methods The authors retrieved the randomized controlled trials (RCTs) and clinical controlled trials (CCTs) comparing percutaneous iliosacral screwing versus reconstruction plating for Tile C pelvic posterior ring fractures from the Cochrane library,Medline,Embase,CNKI,Wanfang Data and Chinese Biomedical Database by computer and from major Chinese orthopedic journals by hand.Qualified data were extracted by statistical software Revman 5.2 for meta-analysis.Results 334 cases were included in this Meta-analysis from one RCT and 3 CCTs.Of them,162 underwent percutaneous iliosacral screwing and 172 reconstruction plating (including 66 cases of percutaneous reconstruction plating and 106 ones of anterior reconstruction plating).There was no significant difference between percutaneous iliosacral screwing and reconstruction plating in operation time (P =0.16).Percutaneous reconstruction plating consumed significantly less operation time than anterior reconstruction plating (P ＜ 0.001).Percutaneous iliosacral screwing decreased significantly incision length and intraoperative blood loss than both methods of reconstruction plating (P ＜ 0.001),but significantly increased times of X-ray exposure than percutaneous reconstruction plating (P ＜ 0.001).There were no significantly differences in the good to excellence rates by Matta scores and Majeed scores between percutaneous iliosacral screwing and percutaneous reconstruction plating (P ＞ 0.05),but percutaneous iliosacral screwing performed significantly better than anterior reconstruction plating (P ＜ 0.001).Percutaneous reconstruction plating led to significantly fewer postoperative complications than anterior reconstruction plating (P ＜ 0.001) but similar incidence of postoperative pain at the sacroiliac joint compared with percutaneous reconstruction plating (P =0.30).Conclusion Compared with anterior reconstruction plating,pereutaneous iliosacral screwing and percutaneous reconstruction plating may lead to better clinical efficacy and fewer complications.Percutaneous iliosacral screwing may be superior in incision length and intraoperative blood loss,but it requires more intraoperative X-ray exposure and more demanding technical skills.

OBJECTIVETo observe the clinical effects of free musculo-cutaneous flap bridging with contralateral posterior tibial vessel on repair of lower extremity soft tissue defect.

METHODSFrom February 2006 to June 2013, 10 patients with soft tissue defect on lower shank and foot were included. The posterior tibial vessel on healthy lower extremity was chosen as recipient vessel and anastomosed with free latissimus dorsi musculo-cutaneous flap, or free latissimus dorsi musculo-cutaneous flap combined with thoracic-umbilical skin flap or anterolateral femoral musculo-cutaneous flap. The retrograde bridged flap was transposed to repair defect on contralateral lower shank and foot. The wound area ranged from 40 cm x 21 cm to 22 cm x 15 cm, with flap size from 48 cm x 26 cm to 25 cm x 18 cm. Meanwhile the defects on donor sites were covered with skin graft and both lower extremities were fixed with kirschner wires at middle tibia and calcaneus. The kirschner wires were removed at 4 weeks and pedicles were cut off 5-8 weeks postoperatively. Six patients received posterior tibial vessel reanastomosis at the same time of pedicle cutting.

RESULTSAll the 10 flaps survived and 3 patients received thinning of flaps due to excessive thickness. During the follow-up period of 3 months to 2 years follow up, the ambulatory function of injured legs recovered gradually with satisfactory appearance. The reanastomosed posterior tibial vessel on the healthy side was recovered.

CONCLUSIONSAppropriate bridged musculo-cutaneous flaps is suitable for extensive soft tissue defect of lower shank and foot. It is a safe and effective method for limb salvage.

Objective To evaluate the clinical application of a three-dimensional (3D) printing personalized guide for medial open wedge high tibial osteotomy(MOWHTO) in the treatment of knee varus osteoarthritis.Methods A retrospective study was conducted of the 16 patients with knee varus osteoarthritis who had been treated at Department of Orthopaedics,Zhengzhou Central Hospital of Zhengzhou University from January 2016 to January 2017.They were 6 men and 10 women,aged from 49 to 65 years (mean,55.8 years).Bilateral knees were involved in 2 cases and a unilateral knee was involved in 14 cases.Their disease duration ranged from one to 12 years (mean,5.3 years).A personalized guide for MOWHTO was designed and manufactured by 3D printing for every patient preoperatively.All the patients underwent knee arthroscopy before osteotomy which was assisted by the personalized guide.The femorotibial angle (FTA),medial proximal tibial angle (MPTA),weight bearing line (WBL),posterior tibial slope (PTSA) and the patellofemoral height Insall-Salvati index (IS index) were measured on their X-ray radiographs preoperatively and 6 months postoperatively.The Hospital for Special Surgery (HSS) score and visual analogue scale (VAS) were used to evaluate the outcomes at the final follow-ups.Results All surgeries were successful.The 16 patients were followed up for 6 to 12 months (mean,9.1 months).The FTA,MPTA,WBL and IS index at postoperative 6 months were significantly improved than the preoperative values (P ＜ 0.05).There was no significant difference between postoperative PTSA and preoperative PTSA (P =0.990).The mean VAS scores for the 16 patients at the final follow-ups were 0.8 ± 0.7 peints,significantly better than the preoperative ones (4.2 ± 0.9 points) (P ＜ 0.05);their mean postoperative HSS scores (89.3 ± 6.7 points) were also significantly improved than the preoperative ones (61.9 ± 10.5 points) (P ＜ 0.05).According to the HSS scores at the final follow-ups,the surgical outcomes were excellent in 14 knees,good in 3 and fair in one.Conclusion A 3D printed osteotomy guide can be used to perform precise osteotomy in MOWHTO for knee varus osteoarthritis,leading to effective correction of the alignment of the lower limb and good short-term surgical outcomes.

Objective To provide a scientific benchmark for the era of population aging and improve the medical care environment for the elderly in terms of hospital facility accessibility.Methods A random sampling method was used to select 375 individuals from 10 healthcare institutions in a specified city as survey participants from December 2022 to February 2023.A total of 375 questionnaires titled"Comprehensive Rating Scale for Patient Experience in Medical Facilities(Accessibility Category)"were distributed among the participants,with 356 valid responses received and subjected to reliability and validity assessments.The questionnaire included 6 accessibility indicators,each rated from 1 to 10,to evaluate the accessibility level of healthcare fa-cilities.The acquired data was analyzed using the Rank Sum Ratio method and the Four Quadrants model.Results The average score for building accessibility in the city's medical institutions was 35.86,with several indicators at a moderate level,indicating a need for an improvement of the facility accessibility.Meanwhile,the economic operational status of various medical institutions appeared to influence the implementation of accessibility features,which also correlated with local government construction plan-ning,staff awareness of accessible infrastructure,and other factors.Conclusion Medical facilities in cities could implement bar-rier-free modifications in parking,toilets,and other areas,improve the use of accessible AI technology,and develop intelligent medical scenarios in order to meet the challenges of an aging society,improve the medical care quality for the elderly,and reduce social security cost.The governments should accelerate the improvement of supportive policies and regulations and bolster support for the accessibility enhancements.Higher education and research institutions can collaborate with healthcare providers for innova-tive integration of industry academia,research,and application,fostering the conversion of research into practical solutions.

Objective:To investigate the intervention effect of decision aid on the fear of falling in elderly patients after total hip arthroplasty.Methods:This study was a quasi experimental research. From June 2021 to November 2021, 84 patients after total hip arthroplasty who were admitted to the Department of Orthopedics of Zhengzhou Central Hospital Affiliated to Zhengzhou University were selected as the research objects. According to the order of admission, they were divided into the control group (42 cases, 2 cases fell off ) and the observation group (42 cases). The control group was given routine nursing care and guidance for fear of falling, while the observation group was given a decision-making aid intervention program on the basis of the control group. The time to first getting out of bed, the scores of Modified Falls Efficacy Scale (MFES), Generalized Anxiety Disorder (GAD-7) and Harris Hip Score (HHS) were compared between two groups.Results:The time to get out of bed for the first time in the observation group was (42.71 ± 6.41) h, lower than that in the control group (49.95 ± 5.73) h, and the difference was statistically significant ( t=5.38, P<0.05). Twelve weeks after discharge, the GAD-7 score in the observation group was (4.64 ± 1.43), which was lower than that of the control group (6.85 ± 1.83), and the difference was statistically significant ( t=6.10, P<0.05). The score of the MFES in the observation group was [8.50(8.00,10.00)], which was higher than that in the control group [7.50(7.00,8.00)], and the difference was statistically significant ( Z=-6.26, P<0.05). The hip joint function score of the observation group was (81.74 ± 4.24), which was higher than that of the control group (74.30 ± 4.51), and the difference was statistically significant ( t=7.69, P<0.05). Conclusions:Decision support can advance the time of downward movement of elderly patients after total hip arthroplasty, reduce their anxiety and fear of falling, and improve hip function.

Objective:To evaluate the hemostatic effects of our self-designed pelvic band with inflatable balloon in a swine model of hemodynamically unstable pelvic fracture.Methods:"Open-book like" fractures were created with the external iliac blood vessels exposed in 24 12-month-old female Bama miniature pigs which were randomly divided into 4 groups ( n=6). Group C (the control group) was subjected to no treatment other than exposure of the external iliac blood vessels, group D to no treatment following destruction of the external iliac blood vessels, group T1 to fixation with simple pelvic band after destruction of the external iliac blood vessels, and group T2 to fixation with our self-designed pelvic band with inflatable balloon after destruction of the external iliac blood vessels. The 4 groups were compared in terms of 40-min survival rate, bladder pressure, peak lactate value, total blood loss, bleeding rate, infusion rate, and angiographic images. Results:There was no significant difference in the baseline indexes among the 4 groups before experiment, showing comparability ( P>0.05). The 40-min survival rate in group T2 was 83.3% (5/6), significantly higher than that in groups D and T1 [0% (0/6) and 0% (0/6)] ( P<0.05). There were no significant differences among groups C, D, T1 and T2 in bladder pressure [(6.67±1.03) mmHg, (5.83±1.94) mmHg, (6.00±1.55) mmHg, and (6.00±1.10) mmHg] or in total blood loss among groups D, T1 and T2[(1,198.0±182.9) mL, (1,252.0±148.4) mL, and (1,150.0±125.7) mL] (all P>0.05). The peak lactate value in group T2 [(2.26±0.24) mmol/L] was significantly lower than that in group D [(5.00±0.60) mmol/L] and group T1 [(3.86±0.57) mmol/L], and the bleeding rate and infusion rate in group T2 [(25.83±5.49) mL/min and (26.00±4.69) mL/min] were also significantly lower than those in group D [(83.50±19.85) mL/min and (71.50±29.11) mL/min] and group T1 [(54.17±15.59) mL/min and (54.17±8.98) mL/min] (all P<0.05). Angiography showed contrast agent extravasation in group T2, especially from the artery, but the extravasation speed in group T2 was significantly slower than that in group D. Conclusion:In a swine model of hemodynamically unstable pelvic fracture, our self-designed pelvic band with inflatable balloon has a definite hemostatic effect on vascular injury which is better than that of a simple pelvic band.