Objective To explore the clinical effect of bone allograft plus interlock plate internal fixation in the treatment of tibial plateau fractures.Methods 43 patients with tibial plateau fractures were treated by open reduction,bone allograft,locking plate fixation and early knee joint function training.Results All patients were followed up for 8 ～ 14 months with an average of 10 months.All patients achieved bone union and the duration of union was averaged 6.9 months.Knee joint function was rated based on HSS score system as excellent in 30 cases,good in 9 cases,fair in 3 cases and poor in 1 case.The excellent and good rate was 90％.Conclusion Reliable effect can be achieved for fracture of tibial plateau treatment with bone allograft plus interlock plate internal fixation.It provides satisfactory function of the knee.It has many advantages,such as stable and durable fixation and avoidance of secondary compression of tibial plateau.

Objective To explore the method and effect of treating thoracolumbar fracture with posterior bone grafts on first stage and transpedicular internal fixation .Methods The clinical data of 22 cases with thoraco-lumbar fracture ,treated with posterior bone grafts on first stage and transpedicular internal fixation at the same time , were analyzed and assessed .Results In this group,the vertebral height and physiological curve were recovered satis-factorily,no loss of which was found in the long-term follow-up.There were no loosening of internal fixation ,infection and iatrogenic nerve injury .All patients had achieved bone fusion in one year after the operation of posterior bone grafts,and their nerve functions were recovered .Conclusion The operation of transpedicular internal fixation is safe and reliable ,and is proved to be an effective method of treatment for patients with thoracolumbar fracture .

Objective To explore the method and effect of prosthetic replacement for the management of intertrochanteric fracture in the elderly.Methods 24 elderly patients with intertrochanteric fracture were treated with prosthetic replacement.According to the Evans classification,there were 4 cases of Evans Ⅱ,16 Evans Ⅲ and 4 Evans Ⅳ.Results The mean time to ambulation following the surgery was (6.0 ± 2.2) days.No prosthetic loosening or infection were observed in the follow-up of 6 to 27 months(average 12 months).According to the Harris hip score,the excellent and good rate was 83.3％.Conclusion Prosthetic replacement is safe and effective for intertrochanteric fractures in elderly patients,which allows early ambulation and have a relatively low rate of complications.

Objective To explore the surgical method and effect of arthroscopy assisted minimally invasive therapy in the treatment of tibial plateau fractures .Methods Under arthroscopy surveillance ,32 patients with tibial plateau fracture ( Schatzker Ⅰ-Ⅳ) were taken reduction and fixation .Results All cases were followed up for 4-39 months .All fractures were unitied 3-6 months after operation ,and no joint infection compartment syndrome or ankylo-sis occurred.The results were excellent in 25 patients,good in 7 cases according to the HSS evaluating system 9 months after operation .Conclusion For tibial plateau fractures under arthroscopy assisted reduction and minimally invasive plate osteosynthesis has little injury ,exact reset fixation ,early recovery of the knee joint function ,the curative effect is satisfied .

Objective To investigate the clinical value of gallbladder function in predicting postoperative complications after endoscopic treatment of calculus of common bile duct.Methods 118 patients with complete gallbladder who underwent endoscopic clearance for calculus of common bile duct were selected from January 2018 to December 2022.After the liver function recovered to normal,the patients underwent lipid meal ultrasound examination to evaluate fasting volume,residual volume,and gallbladder ejection fraction(GBEF).The relationship between clinical features,gallbladder function and recurrent biliary complications was analyzed in patients with calculus of common bile duct.Results Among the 118 patients with calculus of common bile duct,86 had concomitant cholecystolithiasis,while 32 did not.During the follow-up period,23 patients developed biliary complications.Among the 86 patients with concomitant cholecystolithiasis,15 had spontaneous clearance of cholecystolithiasis,14 underwent cholecystectomy due to acute cholecystitis or recurrent abdominal pain,and 6 died of non-biliary causes.The GBEF of the patients with cholecystolithiasis was significantly lower.Cholecystolithiasis,alcohol consumption,and more than one endoscopic treatment were the risk factors for recurrent biliary complications after endoscopic treatment of calculus of common bile duct.Conclusion Patients with calculus of common bile duct combined with cholecystolithiasis have poor GBEF.Cholecystolithiasis,alcohol consumption,and more than one endoscopic treatment are the risk factors for recurrent biliary complications after endoscopic treatment of calculus of common bile duct.Since cholecystolithiasis may spontaneously resolve,conservative monitoring of the gallbladder after endoscopic treatment for calculus of common bile duct is appropriate,but regular follow-up is necessary for high-risk patients.

Objective To observe the effect of oxycodone hydrochloride combined with parecoxib sodium preemptive analgesia on postoperative pain in patients undergoing gynecologic laparoscopic surgery.Methods The clinical data of patients who underwent gynecological laparoscopic surgery at the General Hospital of Huainan Oriental Hospital Group from July 2021 to February 2023 were retrospectively analyzed and the patients were divided into a control group(parecoxib sodium)and a combined group(oxycodone hydrochloride combined with parecoxib sodium)according to the different preemptive analgesic regimens.The observational indexes of this study included opioid consumption within 24 h postoperatively,visual analog scale(VAS)scores at 0,2,6,12 and 24 h postoperatively,the number of effective presses of the patient controlled analgesiac(PCA),the time of the first press of the PCA,the number of remedial analgesia,the satisfaction of analgesia,and the occurrence of postoperative adverse reactions.Results A total of 80 patients were included in the study,with 39 in the control group and 41 in the combined group.The time of the first press of the analgesic pump was significantly longer in the combined group than in the control group(P＜0.05),while the number of effective presses and sufentanil consumption were significantly lower in the combined group than in the control group(P＜0.05).The difference in the number of remedial analgesia between the two groups was not statistically significant(P＞0.05).The VAS scores at 0 h,2 h and 6 h postoperatively in the combined group were significantly lower than those in the control group(P＜0.05),and the differences between the VAS scores at 12 h and 24 h postoperatively were not statistically significant(P＞0.05).The analgesic satisfaction score of patients in the combined group was significantly higher than that of the control group(P＜0.05),and the difference in the incidence of adverse reactions was not statistically significant(P＞0.05).Conclusion The preemptive analgesia regimen of oxycodone hydrochloride combined with parecoxib sodium significantly reduced the consumption of opioid drugs in patients after gynecological laparoscopic surgery,alleviated postoperative pain,and improved patient satisfaction.

Background::Programmed death 1 (PD-1) blockade plus chemotherapy has become the new first-line standard of care for patients with advanced non-small-cell lung cancer (NSCLC). Yet not all NSCLC patients benefit from this regimen. This study aimed to investigate the predictors of PD-1 blockade plus chemotherapy in untreated advanced NSCLC.Methods::We integrated clinical, genomic, and survival data from 287 patients with untreated advanced NSCLC who were enrolled in one of five registered phase 3 trials and received PD-1 blockade plus chemotherapy or chemotherapy alone. We randomly assigned these patients into a discovery cohort ( n = 125), a validation cohort ( n = 82), and a control cohort ( n = 80). The candidate genes that could predict the response to PD-1 blockade plus chemotherapy were identified using data from the discovery cohort and their predictive values were then evaluated in the three cohorts. Immune deconvolution was conducted using transcriptome data of 1014 NSCLC patients from The Cancer Genome Atlas dataset. Results::A genomic variation signature, in which one or more of the 15 candidate genes were altered, was correlated with significantly inferior response rates and survival outcomes in patients treated with first-line PD-1 blockade plus chemotherapy in both discovery and validation cohorts. Its predictive value held in multivariate analyses when adjusted for baseline parameters, programmed cell death ligand 1 (PD-L1) expression level, and tumor mutation burden. Moreover, applying both the 15-gene panel and PD-L1 expression level produced better performance than either alone in predicting benefit from this treatment combination. Immune landscape analyses revealed that tumors with one or more variation in the 15-gene panel were associated with few immune infiltrates, indicating an immune-desert tumor microenvironment.Conclusion::These findings indicate that a 15-gene panel can serve as a negative prediction biomarker for first-line PD-1 blockade plus chemotherapy in patients with advanced NSCLC.