Objective To evaluate the technique and clinical effect of arthroscopic treatment of anterior cruciate ligament tibial eminence avulsion fracture with suture bridge fixation technique. Methods From May 2013 to July 2015, 18 patients with anterior cruciate ligament tibial eminence avulsion fracture were treated with arthroscopic re﹣duction and fixation by suture bridge technique. There were 12 males and 6 females with an average age of 29.8 years old (range, 9~45 years). The right knees were involved in 10 cases and left knees in 8 cases. The injury caus﹣es included traffic accident injury in 10 cases, sports injury in 5 cases and other reasons in 3 cases. 2 patients had old fracture, the others had fresh fracture. The results of Lachman and anterior drawer test were both positive. The International Knee Documentation Committee (IKDC) subject score was (53.8 ± 4.2). Based on Meyers-Mckeaver classification, there were 5 cases in typeⅡ, 10 cases in type Ⅲ and 3 cases in type Ⅳ. Results The operation time was 50~80 minutes (mean, 60.5 minutes), X-ray showed satisfactory fracture reduction after surgery. Primary healing of incision were obtained with no infection, all 18 patients were followed up for 6 ~ 31 months (mean, 18.6 months). The results of Lachman and anterior drawer test were both negative in 17 cases, the result was negative for anterior drawer test and was weakly positive for Lachamn test in 1 case. The IKDC subject score were significantly improved to (95.2 ± 3.8) at last follow-up (P< 0.05). Conclusion It could achieve early restoration of knee joint function to treat the anterior cruciate ligament tibial eminence avulsion fracture with suture bridge fixation technique because of satisfactory reduction, reliable fixation, minor trauma, and quick recovery.

Objective To investigate the prevalence of nutritional risk and undernutrition of geriatric patients with hip fracture in the department of orthopaedics and analyze the relationship between nutritional risk scores and clinical outcomes.Methods In this prospective cohort study,the baseline demographic data of 235 elderly patients with hip fracture in the department of orthopaedics of Ningbo First Hospital were consecutively recorded from November 2013 to December 2015.The prevalence of nutritional risk and undernutrition,infectious complications,and length of hospital stay were also recorded.The infectious complications and length of hospital stay in patients in different age groups(60-69 years,70-79 years,and ≥80 years)and those with different nutritional risks(<3 points,3-4 points,and ≥5 points)were analyzed.Results All patients without PN EN support during hospitalized durations.The incidence of nutritional risk was 62.98％in 235 elderly patients with hip fracture,twenty patients were undernutritioned by multi-item standard based on Nutritional Risk Screening 2002 nutrition disorder score,and 15 patients were undernutritioned by one-item standard with body mass index.Hip arthroplasty patients had significantly higher nutritional risk than those who had undergone internal fixation(74.04％vs.54.20％,P=0.002).Patients with comorbidities had significantly higher nutritional risk than patients without comorbidities(71.56％vs.55.56％,P=0.011).There were significant differences in infectious complications(2.30％vs.3.91％vs.50.00％)and length of hospital stay[(6.35±0.87)d vs.(8.12±1.13)d vs.(10.85±1.52)d,(8.66±2.06)d vs.(10.45±2.43)d vs.(13.25 ±3.65)d] among patients with different nutritional risks(<3 points,3-4 points,and ≥5 points)(P=0.000).Conclusions Elderly patients with hip fracture has relatatively high nutritional risk.These patients tend to have more complications and longer hospital stay.

Objective To investigate the status quo of nutritional risks and malnutrition of orthopedic inpatients and to provide an objective basis for standardizing nutritional support for orthopedic inpatients. Methods Patients who were hospitalized in the Department of Orthopedics, Ningbo First Hospital between November 2013 and December 2015 were continuously selected as respondents by convenience sampling. Their general data were recorded in an electronic data collection system (EDC). Then the patients were assessed for nutritional risks with nutritional risk screening 2002 (NRS 2002), and their status quo of malnutrition was identified according to recommendatory standards of guidelines.Results Totally 451 out of the 3083 patients suffered from nutritional risks, and the incidence of nutritional risks was 14.63%. 59 of them were diagnosed with malnutrition. Patients with hip fracture showed the highest incidence of malnutrition, followed by those with pelvic fracture and thoracolumbar fracture, and their incidences of nutritional risks were 56.55%, 51.61% and 27.93%, respectively. There were statistically significant differences between patients of different ages (P<0.05). The incidences of hip fracture and thoracolumbar fracture patients aged above 70 were 79.10% (140/177) and 74.19% (92/124), respectively, higher than those of patients under 70 years old (P<0.05). Conclusions Orthopedic inpatients and elderly patients, especially those with hip fracture, pelvic fracture and thoracolumbar fracture, show high incidence of nutritional risks. Therefore, the nutritional support for orthopedic inpatients should be further standardized.

Objective? To explore the effects of enhanced recovery after surgery based on nutritional support in perioperative nursing of elderly patients with hip fracture and joint replacement. Methods? From January 2015 to June 2017, we selected 278 elderly hip fracture patients with nutritional risk (NRS 2002≥3) by convenience sampling. All of the patients were divided into observation group (n=132) and control group (n=146) with the method of envelope. Observation group accepted nutritional support and brought it into enhanced recovery nursing process. Control group applied routine perioperative nursing without standardized nutritional support. We compared the albumin and loss of hemoglobin at the second day after surgery, the score of activity of daily living (ADL), time of getting out from bed for the first time, hospital stay as well as complications of patients between two groups. Results? The albumin at the second day after surgery and score of ADL of patients in observation group were (29.16±1.33) g/dl and (63.90±5.47) respectively higher than those in control group;the loss of hemoglobin after surgery, time of getting out from bed for the first time, hospital stay in observation group were (1.34±0.30) g/dl, (1.56±0.20)d, (7.08±2.23)d respectively lower than those in control group;the differences were all statistical (t=-3.089, -14.881, -13.640, -15.279, -8.480;P＜0.05). The incidence of complications of observation group was 9.09% lower than that of control group (19.18%) with statistical difference (χ2=3.877, P＜0.05). Conclusions? Enhanced recovery nursing based on nutritional support can shorten the hospital stay in elderly patients with hip fracture, promote postoperative rehabilitation after hip joint replacement and improve clinical outcomes of patients.

Objective To investigate the mutation characteristics in exon 7 of the PAH gene in phenylketonuria(PKU) patients in Xinjiang.Methods The mutations in exon 7 of PAH gene were detected by PCR/SSCP in 37 PKU patients.Results Five missense mutations including R243Q,L255S,E280G, E280K and P281L were identified in 74 chromosomes from 37 PKU patients,with relative frequencies of 18.9%,4.1%,1.4%,1.4% and 1.4% respectively.The frequency of mutant alleles in exon 7 was 27%. Among the five mutations,it was the second time the E280G mutation was reported in the world.In China,it was the second time the L255S,E280K and P281 L mutations were found.P281L and R243Q mutations were first found in 2 of Chinese Uygur.Considering the previous reports and the present study,R243Q was the most prevalent form in Asian PKU populations.P281L and E280K were two common mutations in PKU patients from European countries.However,E280G and L255S were two characteristic forms in Chinese. Condusions Characteristics of PAH gene mutations are shown in Chinese PKU population from Xinjiang, which is a special distribution belt that located between China and Europe.The results give a clue that Xinjiang could probably be an ideal genetic resource repertoire for studying diversity of gene mutations, heterogeneity of PAH gene,human genesis and migration.

Objective To investigate the current status of perioperative nutritional risk and nutritional intake in aged patients with hip fracture, so as to provide references for standard nutritional support. Methods A prospective cohort study was designed. 235 patients with hip fracture admitted in the Orthopedics Department of Ningbo First Hospital from November 2013 to December 2015 were selected and investigated by nutritional risk screening 2002 ( NRS-2002 ) , to assess the nutritional risk of patients with hip fracture and collect their nutritional intake situation. Results The nutritional risk of 235 patients with hip fracture was 63. 40%, which was higher than that of patients without hip fracture (χ2=37.445,P<0.05), and it was also higher than that of patients with other kinds of fracture ( P<0. 05 ) . Single factor analysis showed that, the perioperative nutritional risk of aged patients with hip fracture was influenced by surgical procedures (χ2 =9. 093,P<0.05) . 235 aged patients with hip fracture were given daily foods in the perioperative period, and the intake of protein and calories were lower than the standard recommended in guideline. Conclusions The nutritional risk in aged patients with hip fracture is high, and the nutritional support was not enough, which should be paid attention by clinical medical workers.

ObjectiveTo evaluate the clinical effectiveness of doctor-nursing integration mode on the prevention of venous thromboembolism(VTE) in geriatric patients with hip fracture. MethodsFrom January to June of 2018, a total of 120 elderly patients with hip fracture admitted to the orthopaedic department of Ningbo First Hospital were selected in this study. According to the time of admission, they were divided into the control group (n=58)and the observation group (n=62). The conventional nursing mode was adopted in the control group and doctor-nursing integration nursing mode was adopted in the observation group. The two groups were compared in terms of the scores of VTE related knowledge, swelling degree of the affected limbs, the plasma D-Dimer level and the incidence of DVT on the lower limbs as well as the pulmonary thrombus. ResultsOne week after surgery, the patients in the observation group achieved higher score in the VTE related knowledge than the control group with statistical significance (P＜ 0.05); one day and one week after surgery, the observation group was lower than the control group in the swelling degree of the 10cm above the hip of the affected limb; one week and two weeks after surgery, the observation group was lower than the control group in the plasma D-Dimer level, both with statistical significance (P＜0.05); the control group's incidence of perioperative DVT on the lower limbs was 11.4% , lower than the 25.8% in the observation group with statistical significance (P＜ 0.05). ConclusionsDoctor-nursing integration nursing model can help to improve the compliance with the thrombosis prevention of the elderly patients with hip fracture, relieve the symptoms related to perioperative VTE and reduce the incidence of DVT on the lower limbs.

Objective? To establish, implement and evaluate the pain control quality system for patients with total knee arthroplasty(TKA). Methods? Through literature search and interviews with medical staff and retrospective reviews of TKA cases in orthopedic wards, the problems in pain control of TKA patients during perioperative period were analyzed. According to the evidence-based practice guideline and the existing problems in pain nursing practice, the pain control quality system was constructed. From January to November 2018, 75 TKA patients in Orthopedic Department, Ningbo First Hospital were selected as the research objects and randomly divided into the control group (n=35) and the intervention group (n=40). The control group received the routine pain nursing mode, and the intervention group was managed by the pain control quality system. The static and dynamic VAS scores on the 1st, 3rd and 7th day after TKA, the incidence of analgesia-related complications and the quality of pain nursing were compared between the two groups. Results? There were significant statistical differences in static and dynamic VAS scores of knee joint between the two groups on the 1st, 3rd and 7th day after operation (P＜0.05). There was no statistical difference in the incidence of analgesia-related complications between the two groups (P＞ 0.05). The total score of TKA perioperative pain nursing quality in the intervention group was 84 (80, 85), while that of the control group was 56 (53, 58). The difference between the two groups was statistically significant (P＜0.01). Conclusions? The construction of pain control quality system can effectively improve the level of perioperative pain management of TKA, the quality of pain nursing care, and improve the perioperative pain of TKA patients.