Objective:To explore the clinical benefits of digital simulation surgery in the limited open reduction and intramedullary nail fixation for treatment of proximal humeral fractures.Methods:A retrospective study was conducted to analyze the clinical data of 40 patients who had been treated by limited open reduction and intramedullary nail fixation at Department of Trauma and Orthopedics, The People's Hospital of Weifang from June 2020 to September 2022 for 3-part proximal humeral fractures by Neer classification. The patients were assigned into 2 groups according to different preoperative strategies. In the observation group of 17 patients [4 males and 13 females with an age of (66.9±8.6) years], the angle of intramedullary nail placement into the humeral head and the sequence of reduction and fixation were simulated in the preoperative digital simulation surgery. In the control group of 23 patients [7 males and 16 females with an age of (63.0±8.6) years], routine reduction and fixation were performed based on the preoperative shoulder joint CT images and intraoperative fluoroscopy without preoperative digital simulation surgery. The 2 groups were compared in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, incidence of postoperative complications, fracture healing time, active range of motion of the shoulder joint at the last follow-up, as well as the intramedullary nail heights, humeral neck-shaft angles, Constant shoulder function scores, and visual analogue scale (VAS) pain scores at 3 days, 12 weeks, and 24 weeks postoperatively.Results:The 2 groups were comparable because there were no statistically significant differences in the preoperative general data between them ( P>0.05). The operation time in the observation group [(57.5±6.2) min] was significantly shorter than that in the control group [(71.3±10.2) min], and the intraoperative fluoroscopy frequency in the former [(28.5±4.4) times] significantly lower than that in the latter [(45.4±2.6) times] ( P<0.05).The 2 groups were followed up for (15.0±1.6) months. For the observation and the control groups, respectively, the fracture healing time was (10.5±2.4) weeks and (10.0±2.0) weeks, showing no statistically significant differences between groups ( P>0.05). There were no statistically significant differences between the 2 groups in the intraoperative blood loss, or in the intramedullary nail heights, humeral neck-shaft angles, Constant shoulder function scores, or VAS pain scores at 3 days, 12 weeks, or 24 weeks postoperatively, or in the active range of motion of the shoulder joint at the last follow-up ( P>0.05). Complications such as infection, humeral head necrosis, and screw removal occurred in none of the patients. Conclusion:In the treatment of proximal humeral fractures, before the routine limited open reduction and intramedullary nail fixation, digital simulation surgery can be performed to reduce the operation time and fluoroscopy frequency without sacrifice of the therapeutic efficacy.

Objective:To explore the clinical benefits of digital simulation surgery in the limited open reduction and intramedullary nail fixation for treatment of proximal humeral fractures.Methods:A retrospective study was conducted to analyze the clinical data of 40 patients who had been treated by limited open reduction and intramedullary nail fixation at Department of Trauma and Orthopedics, The People's Hospital of Weifang from June 2020 to September 2022 for 3-part proximal humeral fractures by Neer classification. The patients were assigned into 2 groups according to different preoperative strategies. In the observation group of 17 patients [4 males and 13 females with an age of (66.9±8.6) years], the angle of intramedullary nail placement into the humeral head and the sequence of reduction and fixation were simulated in the preoperative digital simulation surgery. In the control group of 23 patients [7 males and 16 females with an age of (63.0±8.6) years], routine reduction and fixation were performed based on the preoperative shoulder joint CT images and intraoperative fluoroscopy without preoperative digital simulation surgery. The 2 groups were compared in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, incidence of postoperative complications, fracture healing time, active range of motion of the shoulder joint at the last follow-up, as well as the intramedullary nail heights, humeral neck-shaft angles, Constant shoulder function scores, and visual analogue scale (VAS) pain scores at 3 days, 12 weeks, and 24 weeks postoperatively.Results:The 2 groups were comparable because there were no statistically significant differences in the preoperative general data between them ( P>0.05). The operation time in the observation group [(57.5±6.2) min] was significantly shorter than that in the control group [(71.3±10.2) min], and the intraoperative fluoroscopy frequency in the former [(28.5±4.4) times] significantly lower than that in the latter [(45.4±2.6) times] ( P<0.05).The 2 groups were followed up for (15.0±1.6) months. For the observation and the control groups, respectively, the fracture healing time was (10.5±2.4) weeks and (10.0±2.0) weeks, showing no statistically significant differences between groups ( P>0.05). There were no statistically significant differences between the 2 groups in the intraoperative blood loss, or in the intramedullary nail heights, humeral neck-shaft angles, Constant shoulder function scores, or VAS pain scores at 3 days, 12 weeks, or 24 weeks postoperatively, or in the active range of motion of the shoulder joint at the last follow-up ( P>0.05). Complications such as infection, humeral head necrosis, and screw removal occurred in none of the patients. Conclusion:In the treatment of proximal humeral fractures, before the routine limited open reduction and intramedullary nail fixation, digital simulation surgery can be performed to reduce the operation time and fluoroscopy frequency without sacrifice of the therapeutic efficacy.

Objective:To establish the mouse model with radiation-induced pulmonary fibrosis, and to identify and analyze it from the aspects of function, imaging and pathology.Methods:Thirty C57BL/6 mice were randomly divided into the control group, 16 Gy irradiation group and 20Gy irradiation group. The mice in the irradiation groups received a single 16 Gy or 20 Gy chest X-ray irradiation, and underwent functional examination, imaging examination and pathological examination at 3 and 6 months after irradiation.Results:At 6 months after irradiation, hair on the chest and back of the mice turned white and fell off, and the airway resistance was increased significantly. CT images showed extensive patch shadows and consolidation in the lung. Three dimensional reconstruction suggested that the lung of mice was distorted and deformed, and the volume was decreased significantly. Pathological examination confirmed that there was extensive pulmonary fibrosis.Conclusions:Significant pulmonary fibrosis occurs after 6 months of chest irradiation in mice. The animal model of radiation-induced pulmonary fibrosis in C57BL/6 mice was successfully established.

For non-small cell lung cancer (NSCLC) patients with positive surgical margins, the survival rates can be dramatically decreased. However, high-level evidence is lacking in the standard adjuvant treatment for NSCLC patients with positive surgical margins. In this article, consensus and disputes on the adjuvant therapy for NSCLC patients with positive surgical margins were reviewed.

BACKGROUNDPelvic fractures are uncommon in elderly patients and so are infrequently addressed in the literature. The purpose of this study was to investigate the management and outcome of pelvic fractures in elderly patients.

METHODSWe retrospectively reviewed the records of pelvic fractures in elderly patients (age ≥55 years) who were treated in our department from September 1997 to May 2010.

RESULTSA total of 40 elderly patients with pelvic fractures were identified. Their mean age was 65.8 years (range 55-87 years). About 68% (n = 27) were men. The average Injury Severity Score (ISS) was 17.8 (range 6-45). Twelve (30%) patients required blood transfusion (mean 10 units) during the first 24 hours. The fractures were most frequently due to falling from a standing position (48%). Almost half (48%) were grade I breaks. Associated injuries were present in 70% (n = 28) of patients, and 65% (n = 26) had medical co-morbidities. Altogether, 29 patients (73%) underwent non-surgical management of their pelvic fracture. The average hospital stay was 25 days. There were five in-hospital deaths and one death 10 months after discharge. High ISSs (>25) were associated with increased in-hospital mortality (P = 0.018). At the final assessment (mean follow-up 15 months), 52% of the surviving patients had experienced decreased self-sufficiency.

CONCLUSIONSPelvic fractures in elderly patients result in high morbidity and mortality rates. A high ISS (>25) can be used to identify a patient at high risk. We recommend aggressive resuscitation and intensive care for that patient. For patients with an unstable pelvic or displaced acetabular fracture (≥2 mm) who can endure surgery, open reduction and internal fixation can provide adequate fixation for early weight-bearing and restoration of the bone stock.

Aged ; Aged, 80 and over ; Blood Transfusion ; Female ; Fracture Fixation, Internal ; Fractures, Bone ; etiology ; surgery ; therapy ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Pelvic Bones ; injuries ; Retrospective Studies

Objective To investigate the early diagnosis and treatment of pelvic fracture with vaginal injury.Methods From January 2000 to July 2010,13 patients suffered from pelvic fracture with vaginal injury were treated in our hospital,whose average age was 31.7 years.According to the Tile classification,there were 4 cases of type B1,1 case of type B2,4 cases of type B3,3 cases of type C1,and 1 case of type C2.Emergency repair of vagina together with open reduction and internal fixation of pelvic fracture was performed in 3 patients.After the patients' condition became stable,5 patients with shock were treated with emergency repair of vagina together with primary external fixation of pelvic fracture.Prompt repair of vagina together with open reduction and internal fixation or primary external fixation of pelvic fracture was performed in 2 patients who underwent delayed diagnosis.Two cases of extensive pelvic abscess due to missed diagnosis of vaginal laceration were treated with debridement and external fixation of pelvic fracture,and reconstructions of vagina were performed after infection control.Results Twelve patients survived,and 1 patient died 6 h after admission.Eleven patients were followed up for 8 to 36 months (average,17 months).Among 9 patients who underwent one-stage repair of vagina,5 married patients had normal sexual life,1 suffered from pain during sexual intercourse,and 3 unmarried patients had normal menses.Two patients who underwent second-stage reconstruction of vagina suffered from pain during sexual intercourse.At final follow-up,the mean Majeed score was 82.2 (range,56 to 96),and the results were excellent in 6 cases,good in 3 cases,fair in 2 cases.Conclusion Vaginal injury should be highly suspected in females with anterior pelvic ring fracture.Early diagnosis and repair of vaginal injury is crucial to good clinical outcomes.Delayed diagnosis and treatment may lead to severe complications.

ObjectiveTo investigate fecal diversion in the management of pelvic fractures associated with perineal injuries.MethodsThis retrospective study involved 27 patients of pelvic fractures associated with perineal injuries during April 2005 to April 2011.There were 23 males and 4 females,and the mean age was 32.9 years old (range,16-62 years old).Fractures type according to Tile classification:4 cases were type A,10 cases were type B,and 13 cases were type C.The pelvic external fixator and fecal diversion were selectively used.Results Of the 27 patients of pelvic fractures associated with perineal injuries,24survived.The overall mortality of pelvic fractures associated with perineal injuries in the present study was 11％.The survived 24 patients were totally reviewed clinically.The mean follow-up time of these patients was 10.9 months (range,4-42 months).Of those patients who underwent early fecal diversion (＜ 48 h),none experienced infectious completions.However,of those underwent non-early (＞48 h) fecal diversion (including those who did not undergo fecal diversion),four patients experienced infectious completions.Fisher's exact test was used to compare the infection rate of these two groups.And the result of Fisher's exact test demonstrated that those patients who underwent early (＜ 48 h) fecal diversion and non-early (＞48 h) fecal diversion (including those who did not undergo fecal diversion).ConclusionStabilization of hemodynamic; selective fecal diversion; early stabilization of pelvic fracture are necessary for the emergency management of pelvic fractures associated with perineal injuries.Rectal injury and severe perineal injury without involvement of rectum should undergo fecal diversion.Early fecal diversion (＜ 48 h) could reduce the infection rate of pelvic fractures associated with perineal injuries.