Objective To systematically evaluate the association between protein C and Legg -Calve -Perthes disease.Methods A literature research was performed through PubMed,Embase,Cochrane library,Web of Science,Chinese Biomedical Literature Database(CBM),China National Knowledge Infrastructure(CNKI)and Wan-fang Database from inception to February 201 6 on the association between protein C and Legg -Calve -Perthes disease.According to the Newcastle -Ottawa Scale(NOS)criteria,the quality of studies was evaluated and data were extracted.Meta -analysis was performed with Stata 1 1 .0 software.Results A total of 1 4 articles were included.Twelve articles on protein C and Legg -Calve -Perthes disease in the study group and the control group were compared.The results of Meta -analysis showed that there was no significant difference in protein C levels between the study group and the control group[odds radio(OR)=1 .41 ,95% confidence interval(CI)(0.87,2.28),P =0.1 47];five articles on protein C and the white race of Legg -Calve -Perthes disease between the study group and the control group were com-pared,The results of Meta -analysis showed that there was no significant difference in protein C levels between the whiteskin patients′group and the control group[OR =0.61 2,95%CI(1 .83,7.29),P =0.61 2];three articles on pro-tein C and the yellow race of Legg -Calve -Perthes disease between the study group and the control group were com-pared,and the results of Meta -analysis showed that there was no significant difference in protein C levels between the yellow skin patients group and the control group[OR =0.59,95%CI(0.05,6.72),P =0.080].Conclusion There is no significant correlation between protein C and Legg -Calve -Perthes disease.

Objective:To analyze the clinical characteristic of patellar sleeve fracture in children, so as to improve the understanding of pediatric patellar sleeve fracture and reduce the misdiagnosis rate.Methods:Clinical data of 18 children with patellar sleeve fractures admitted and followed up in Department of Pediatric Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University from January 2013 to December 2019 were retrospectively analyzed, including 10 males and 8 females with the mean age of 11.4 years (8.0-14.0 years). There were 10 right patellar sleeve fracture cases, 7 left cases, and 1 case on both sides.Classified by the fracture cause, 10 cases were caused by falls, 3 cases of high jump, 2 cases of falling from height, 2 cases of car accidents, and 1 case of rope skipping, and all of cases were closed injuries.The mean post-injury visit to Affiliated Hospital of Zunyi Medical University was 3.5 days (4 hours -7 days). Twelve out of cases were transferred from other hospitals.All patients were treated with the open reduction and tension band wiring or patella tendon suturing through bone tunnel + patella circumferential wire banding and fixation.The curative effect of patella fracture was evaluated by the Bostman score.Results:Eighteen children with patellar sleeve fracture were diagnosed and treated promptly after admission, and regularly followed up after the operation for an average of 14 months (9-28 months). All cases achieved stage Ⅰ wound healing, and Kirschner wires and steel wires were removed according to the condition of fracture healing at 6 to 10 months postoperatively.According to the Bostman score for evaluating the patella fracture, 15 cases were excellent, 3 cases were good, and there were no missed or misdiagnosed cases.Conclusions:Patella sleeve avulsion fracture is a unique type of fracture in children.As cartilage is the main distal avulsion fracture lesion, it is difficult to be detected on X-ray scans, thus easily leading to missed diagnosis and misdiagnosis.Improving the understanding of this fracture type is the key to the early diagnosis and treatment.

Objective:To investigate the clinical value of thromboelastogram in early diagnosis of deep vein thrombosis (DVT) in patients undergoing free flap surgery of lower extremity.Methods:A retrospective study was conducted to analyze the 192 patients undergoing surgical repair of soft tissue defects at lower extremity with free anterolateral femoral flap at Department of Orthopaedics, Tongji Hospital from January 2018 to June 2022. There were 117 males and 75 females, with an age of (45.6±12.7) years and an area of skin defects ranging from 5 cm × 3 cm to 18 cm × 9 cm. The patients were divided into 2 groups according to whether DVT occurred on the first day after surgery. In the DVT group of 22 patients, there were 14 males and 8 females, with an age of (47.7±14.3) years; in the DVT-free group of 170 patients, there were 103 males and 67 females, with an age of (45.3±12.5) years. The 2 groups were compared in terms of reaction time, coagulation time, maximum amplitude and coagulation angle in the thromboelastogram. Diagram of receiver operating characteristic (ROC) curves was used to evaluate the predictive value of thromboelastography in assessing the risk of DVT after surgery.Results:The 2 groups were comparable because there was no significant difference in the baseline information or operation time between them ( P>0.05). The reaction time [(5.21±0.85) min] and coagulation time [(1.12±0.30) min] in the DVT group were significantly shorter than those in the DVT-free group [(6.48±0.06) min and (1.60±0.03) min], and the maximum amplitude [(71.45±1.17) mm] and coagulation angle [69.54° (64.59°, 76.64°) ] in the DVT group were significantly larger than those in the DVT-free group [(66.63±0.40) mm and 64.92°(54.11°, 74.21°)] (all P<0.05). The optimal cut-off points in the ROC diagram were 5.46 min at reaction time, 1.52 min at coagulation time, 72.31 mm at maximum amplitude and 59.89° at coagulation angle. The sensitivity and specificity of detecting DVT on the first day after surgery were 80.7% and 71.6%, respectively, according to the combination of the best cut-off points in the ROC diagram and all the indexes in the thromboelastogram. Conclusion:Thromboelastogram is of a great value for the diagnosis of lower extremity DVT, and of a positive significance for the prevention of serious complications after surgery in patients undergoing free flap surgery of lower extremity.