Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

OBJECTIVE: To explore the effectiveness of free paraumbilical perforator flaps in repairing skin and soft tissue defects in children. METHODS: Between February 2018 and March 2024, 12 children with skin and soft tissue defects were treated with the free paraumbilical perforator flaps. There were 7 boys and 5 girls with an average age of 6.3 years (range, 2-12 years). The defects located on the upper limbs in 6 cases, lower limbs in 5 cases, and neck in 1 case. The causes of wounds included 7 cases of electrical burns, 1 case of thermal burn, 2 cases of scar release and excision due to scar contraction after burns, 1 case of scar ulcer at the amputation stump after severe burns, and 1 case of skin necrosis after a traffic accident injury. The size of defects after debridement ranged from 7.0 cm×4.0 cm to 18.0 cm×10.0 cm. According to the defect size, 11 cases were repaired with unilateral paraumbilical perforator flaps centered on the umbilicus, among which 3 cases with larger defects were designed as "L"-shaped flaps along the lateral and lower ends of the perforator; the donor sites were directly closed. One case with extensive defect after scar excision and release was repaired with bilateral expanded paraumbilical perforator flaps; the donor sites were repaired with autologous split-thickness skin grafts. The size of flaps ranged from 9.0 cm×4.0 cm to 20.0 cm×11.0 cm. Postoperatively, analgesia and sedation were provided, and the blood supply of the flaps was observed. RESULTS: All operations were successfully completed. The operation time was 4-7 hours, with an average of 5.0 hours. After postoperative analgesia and sedation, the visual analogue scale (VAS) score for pain in all children was less than or equal to 3, and there was no non-cooperation due to pain. All flaps and skin grafts survived completely, and the wounds healed by first intention. Ten children underwent 1-4 times of flap de-fatting, finger separation, and trimming. All children were followed up 6-48 months (mean, 26.6 months). No obvious swelling of the flaps occurred, and the texture was soft. At last follow-up, among the 6 children with upper limb defects, 2 had upper limb function grade Ⅳ and 4 had upper limb function grade Ⅴ according to the Carroll upper limb function assessment method. The 4 children with lower limb defects had no limitation of joint movement. The neck flexion and rotation in the 1 child with neck defect significantly improved when compared with that before operation. The 1 child with residual ulcer at the amputation stump could wear a prosthesis and move without limitation, and no new ulcer occurred. Linear scars were left at the donor sites, and no abdominal wall hernia was formed. CONCLUSION The free paraumbilical perforator flap has abundant blood supply and can be harvested in large size. It can be used to repair skin and soft tissue defects in children and has the advantages of short operation time, minimal injury, high safety, and minimal impact on the growth and development of children.
Humans ; Perforator Flap/transplantation* ; Child ; Male ; Female ; Soft Tissue Injuries/surgery* ; Child, Preschool ; Plastic Surgery Procedures/methods* ; Burns/surgery* ; Umbilicus/surgery* ; Skin Transplantation/methods* ; Skin/injuries* ; Cicatrix/surgery* ; Treatment Outcome

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective To evaluate the efficacy and accuracy of hammering reverse guide wire technique for safe placement of anterior column retrograde intramedullary screw in pelvic and acetabular surgery.Methods From September 2015 to March 2018,46 patients with pelvic or/and acetabular fracture involving the anterior column were treated with hammering reverse guide wire technique for safe placement of anterior column retrograde intramedullary screw at Department of Orthopaedics,Lishui Municipal Central Hospital.They were 28 men and 18 women,aged from 21 to 85 years (mean,55.6 years).There were 34 pelvic ring fractures,9 acetabular fractures and 3 combined pelvic ring and acetabular fractures.After the anterior lateral spine of pubic tuberosity was drilled by a guide pin and drill bit as the entry point,a reverse guide wire was knocked into the bone lightly by a hammer.For each retrograde intramedullary screwing into the acetabular anterior column,we recorded operation time,fluoroscopic frequency,and attempts to establish an acceptable screw pathway by the guide pin.The accuracy of screwing and the quality of fracture reduction were evaluated by imaging examination.For each patient,we recorded fracture union time and complications.Functional recovery of the pelvis and acetabulum was assessed by postoperative physical examination at the last follow-ups.Results The operation time of retrograde intramedullary screwing for the 46 patients averaged 28.9 minutes (from 16 to 55 minutes);the fluoroscopy frequency averaged 16.3 times (from 9 to 35 times);an acceptable screw pathway was established by the first attempt in 43 of the 46 patients (93.5％) and re-established after adjustment of the guide pin in the other 3.Forty patients were followed up for an average of 15.2 months(from 6 to 36 months).Postoperative CT scan and three-dimensional reconstruction showed that all the screws had been placed safely and accurately in the acetabular anterior column.Implant loosening and fracture displacement occurred in one case and lower limb thrombosis in another.No nail breakage,fracture nonunion,incision necrosis or infection,neurovascular injury or femoral head necrosis was observed.All fractures united after an average of 14.7 weeks (from 12 to 18 weeks).According to the Majeed scoring at the last follow-ups,the pelvic and acetabular function was evaluated as excellent in 29 cases,as good in 9,and as fair in 2,giving an excellent and good rate of 95.0％.Conclusion Hammering reverse guide wire technique is an effective method for safe placement of anterior column retrograde intramedullary screw in pelvic and acetabular surgery,because it can increase accuracy of screwing and reduce intraoperative radiation,operation time and incidence of complications though it is simple.

Objective: To investigate the primary clinical efficacy of Collinear clamp assisted reduction and proximal femoral nail antirotation(PFNA) in the treatment of medial-lateral irreducible intertrochanteric fractures. Methods: From January 2012 to December 2016, a total of 21 cases of medial-lateral irreducible intertrochanteric fractures of femur who were treated with Collinear clamp assisted reduction and PFNA in Lishui Hospital of Zhejiang University were selected.There were 12 males and 9 females, with a mean age of 76.7 years(ranged 51 to 91). According to Arbeitsge-meinschaft für Osteosynthesefragen/The Association for the Study of Internal Fixation(AO/ASIF) classification, there were 6 cases of type 31-A1 fractures, 11 cases of type 31-A2 fractures, 4 cases of type 31-A3 fractures.All patients were followed and the clinical results and functional rehabilitation were evaluated during perioperative period and after short term followed-up. Results: The mean operation time was 61.7min(ranged 40-110min). The mean intraoperative blood loss was 131.7mL(ranged 45-450mL). The average hospitalization days was 13.6d(ranged 7-29d). There were no severe complications and exacerbation of coexisting medical disease.All patients were followed up for 10 to 18 months (average 13.3 months) after treatment.The fracture union was obtained in all patients at the final follow-up.No poor healing, failure of internal fixation, cut-out of proximal screws, varus deformity, re-fractures occurred after operation.The clinical results were evaluated according to Harris hip score, 6 cases achieved excellent results, 13 cases were good, 2 cases were fair at last follow-up.The excellent and good rate of the hip joint function was 90.5%. Conclusion Surgical treatment of medial-lateral irreducible intertrochanteric fractures with Collinear clamp assisted reduction and PFNA can result in excellent reduction and function.This technique has less injury and faster recovery.However, the long-term effect needs to evaluate by follow-up.

Objective To explore the mechanism and inhibition of botulinum toxin type A (BTXA) on hypertrohic scar fibroblasts.Methods The cells were treated by 0 (control),0.2,0.4,0.8 U/ml BTXA for 48 h.Cell viability was detected by MTT assay.Cell apoptosis was detected by Hoechst staining.Cell cycle was detected by flow cytometry.The level of cell cycle related protein D1 (Cyclin D1),proliferation nuclear antigen (PCNA) and activation of phosphatidylinositol 3 kinase (PI3K) / protein kinase B (AKT) signaling pathway were assayed by western blot.Results Compared with control group(0.75±0.07),0.2,0.4,0.8 U/mL BTXA(0.59 ± 0.06,0.43 ± 0.04,0.34± 0.03) inhibited hypertrohic scar fibroblasts cell viability,increased cell apoptotic rate[control group(2.38±0.24)％;BTXA(15.79±1.54)％,(27.32±2.69)％,(38.46±3.90)％],down-regulated the expression of Cyclin D1(control group 1.57±0.18;BTXA 0.93±0.07,0.42±0.04,0.35±0.03) and PCNA(control group 1.46±0.16;BTXA 0.50±0.05,0.59±0.05,0.37±0.03),inhibited the expression of PI3K(control group 0.98±0.06;BTXA 0.49±0.04,0.50±0.04,0.39±0.03) and the phosphorylation of AKT(control group 1.38±0.08;BTXA 0.97±0.06,0.60±0.04,0.29± 0.02),made cell cycle arrested in G1 phase,The difference was statistically significant (P＜0.05).Conclusion These results suggested BTXA inhibit proliferation via blocking the activation of PI3K/AKT signal pathway and down-stream related cell cycle related protein.

Objective To study the efficacy of fixation with knee arthroscopy as adjuvant therapy for lateral tibial plateau fracture. Methods 72 cases with lateral tibial plateau fracture of our hospital from September 2011 to September 2014 were divided into experimental group (36 cases) and control group (36 cases), according to different operation method, the experimental group using arthroscopic, while the control group using traditional incision surgery. Then the incision length, operative time, hospital stay, wound healing, bone healing time were compared. Complications, knee function and reduction of the fracture were compared. Results The incision length of experimental group was significantly lower than the control group, the difference was statistically significant (P <0.05). Operative time, hospital stay, wound healing time, the bone healing time were significantly lower than the control group, the differences were statistically significant (P < 0.05). Delay healing, joint stiffness and traumatic arthritis were significantly lower than the control group, the differences were statistically significant (P < 0.05). RASMUSSEN function score and radiographic scores in the experimental group were significantly higher than the control group, the differences were statistically significant (P < 0.05). Conclusion Fixation with knee arthroscopy as adjuvant therapy for lateral tibial plateau fracture has advantages of smaller incision, shorter operative time and hospital stay and healing time, lower complication rate while better reduction of the fracture and function than conventional methods.

Objective This investigation was launched to characterize the relationship between some popular sports and the meniscus injury as well as the impairment extent due to practice duration.Methods The overall 819 women aged 20-49 years from clinic service,hospital,community and gymnasium were selected to join the investigation.The participants practice yoga or any other popular sports including badminton,jogging,climbing hills for at least one hour per day.The subjects were diagnosed with meniscus injury by means of physical examination and MR imaging.All of the subjects were therefore divided into the case(273)and the control(546)pools.The nested case-control model was applied to assess the relative risk of the meniscus.The 181 yoga subjects had been further divided into three sub-groups of 3-6 months,6-12 months and over 12 months,and they were accordingly analyzed with the variables of the age,body mass index(BMI)and Lysholm score.Results The study showed that yoga was associated with higher risk(OR=1.621,P=0.008)of meniscus injury,but the other sports showed no statistically significant risk (badminton 0R=1.028,jogging OR=1.116,climbing hills OR=1.259).The trainees appeared to be statistically different between the groups of 3-6 months and over 12 months on the items of the Lysholm score(P=0.006)and BMI(P=0.003).Conclusion Yoga plays a risky role on the issue of meniscus injury comparing some other popular sports among young women.The yoga players who exercise longer got lower Lysholm scores and lighter weight.

Objective To evaluate the effects of astragalus on liver injury and TGF-β1 mRNA expression in immature rats with obstructive jaundice(OJ).Methods Forty immature male Wistar rats were randomly divided into a control,a shamoperation,an OJ,and an OJ+A groups.Wistar rats in the OJ and OJ+A group were subjectedto common bile duct ligation(CBDL),while the sham group had the bile duct mobilized but not tied.The control,sham,and OJ groups were giyen 0.5ml of normal saline by intrapedtoneal injection daily.In the OJ+A group,250mg/100g body weight of astragalus injection was applied intraperitoneally daily from day 1 to 7 of the study.All animals were sacrificed on postoperative day 8.Liver tissue and peripheral blood were colleered.Serum Alanine aminotransferase(ALT),Aspartate aminotransferase(AST),and total cholic acid(TCA)level were detected.Hepatic morphological findings were observed by light microscopy.TGF-β1 mRNA were extracted from liver and measured by reverse transcription polymerase chain reaction(RT-PCR).Data were analyzed using chi-square test and student's test(-x±s),P＜0.05 was considered statistical significance.Results ①Serum AST,ALT,and TCA value in each OJ group were significantly higher than that of the control and sham operation groups.②In the control and sham operation group,normal structure of the liver remained,but in the OJ group,obvious degeneration of hepatocytes was detected,such as cholastasis,starch accumulation and fatty degeneration.Kupffer cells and dilated Disse'space were common in the OJ group.In the OJ group.histopathologic findings of the liver demonstrated intense degree of fibrosis,but in the OJ+A group.typical changes of large duct obstruction were significantly improved after astragalus injection treatment.③The TGF-β1 mRNA over-expression in the OJ group was seen compared with the control and the OJ+A groups.Conclusion ①In growing rat model of experimental obstructive jaundice,hepatic morphology and liver biochemical tests altered significantly.②The administration of astragaius can ameliorate liver damage and diminish expression of TGF-β1 mRNA of hepatic tissue,thus administration of astragalus may be effective in preventing hepatic injury in growing rats with obstructive jaundice.

OBJECTIVE: To establish an HPLC method for the determination of the contents of the related substances in metoclopramide.METHODS: The sample was separated on C18 column with the mobile phase consisted of acetonitrile-0.02 mol?L-1 phosphonic acid solution(19∶81) at a flow rate of 1.0 mL?min-1.The detection wavelength was set at 275 nm;the column temperature was kept under room temperature and the injected volume was 20 ?L.The contents of the related substances in metoclopramide were computed by self-control method of main constituent.RESULTS: Under the above described chromatographic conditions,metoclopramide was completely separated from its impurities.A good linearity between impurities' peak area and metoclopramide(contrast solution) concentration was achieved when the concentrations of impurities were over the range of 0.05%～4.0%.The lowest detectable limit of metoclopramide was 0.3 ng,and the contents of the related substances were all less than 0.26%.CONCLUSION: The method is convenient,accurate,sensitive and,specific,and it can be used for the determination of the related substances in metoclopramide.