Objective To investigate the value of cranial CT cisternal grading combined with D-dimer(D-D)and Glasgow Coma Scale(GCS)score in predicting the short-term postoperative prog-nosis of patients with severe traumatic brain injury.Methods A total of 165 patients with severe trau-matic brain injury who were treated in the hospital from January 2019 to May 2024 were selected as study subjects,all underwent craniotomy surgery.Postoperative follow-up was conducted for 3 months to analyze the differences in clinical data and preoperative indicators such as cranial CT cisternal grad-ing,D-D levels,and GCS scores between patients with poor and good prognosis.The value of cranial CT cisternal grading,D-D levels,and GCS scores in predicting short-term postoperative poor prognosis in patients with severe traumatic brain injury was also analyzed.Results Compared with patients with good prognosis,patients with poor prognosis had higher proportion of age,cranial CT cisternal grading of Ⅰ to Ⅱ,D-D levels,and GCS scores＜6(P＜0.05).There were no statistically significant differences in C-reactive protein,prothrombin time,activated partial thromboplastin time,international normalized ratio,total cholesterol,triglycerides,high-density lipoprotein cholesterol,and low-density lipoprotein cholesterol levels between patients with poor and good prognosis(P＞0.05).Cranial CT cisternal grading,D-D levels,and GCS scores were influencing factors for short-term postoperative poor prognosis in patients with severe traumatic brain injury(P＜0.05).The area under the curve for poor prognosis by three indicators in combination was 0.941(95％CI,0.906 to 0.975),which was higher than the area under the curve for the individual predictions of cranial CT cisternal grad-ing,D-D levels,and GCS scores(P＜0.05).Conclusion The influencing factors for short-term postoperative prognosis in patients with severe traumatic brain injury include cranial CT cisternal grading,D-D levels,and GCS scores.The model based on these three indicators has certain appli-cation value in predicting patient prognosis.

Objective To investigate the relationships of serum microRNA-9-3p(miR-9-3p),microRNA-27b-3p(miR-27b-3p),with brain glioma(BG)grading and their impacts on prognosis.Methods A total of 172 BG patients admitted in Suqian Hospital of Jiangsu Provincial People's Hos-pital from May 2020 to May 2023 were enrolled and divided into high-grade group(grade Ⅲ to Ⅳ,n=101)and low-grade group(grade Ⅰ to Ⅱ,n=71)according to the World Health Organization(WHO)classification of central nervous system tumors.Additionally,85 healthy individuals of the same age range during the same period were selected as control group.General information,serum levels of miR-9-3p,and miR-27b-3p were compared among the three groups.The correlations of pre-treatment serum levels of miR-9-3p and miR-27b-3p with BG grading were analyzed.The prognosis of BG patients one year after treatment was recorded,and clinical data were compared between the poor prognosis group and the good prognosis group.Factors influencing poor prognosis in BG patients as well as the value of pretreatment serum miR-9-3p and miR-27b-3p in predicting poor prognosis were analyzed.Conventional factors influencing poor prognosis were used to establish a conventional prediction mod-el,and model combined with pretreatment serum miR-9-3p and miR-27b-3p levels was used as a new prediction model.The value of these two models in predicting poor prognosis in BG patients was compared.Results Before treatment,serum levels of miR-9-3p and miR-27b-3p were lower in the high-grade group than those in the low-grade and control groups,and lower in the low-grade group than those in the control group(P＜0.05).Correlation analysis showed that pretreatment serum levels of miR-9-3p and miR-27b-3p were negatively correlated with BG grading(r=-0.573,P＜0.001;r=-0.498,P＜0.001),and serum miR-9-3p level was positively correlated with miR-27b-3p level in BG patients(r=0.509,P＜0.05).Before treatment,the poor prognosis group had a higher proportion of patients with WHO grade Ⅲ to Ⅳ,low differentiation,Karnofsky Performance Scale(KPS)＜70,and higher serum interleukin-17(IL-17)levels compared to the good prognosis group,while serum levels of miR-9-3p and miR-27b-3p were lower(P＜0.05).Logistic regression analysis showed that pretreatment WHO grading,differentiation,KPS,serum IL-17,miR-9-3p,and miR-27b-3p levels were all influencing factors of poor prognosis in BG patients(P＜0.05).Receiver operating characteristic(ROC)curves showed that the areas under the curve(AUCs)for pretreatment serum miR-9-3p and miR-27b-3p alone in predicting poor prognosis in BG patients were 0.714 and 0.720,respectively,with no statistically significant difference(Z=0.086,P=0.413).The AUC of the conventional prediction model for predicting poor prognosis in BG patients was 0.829,and the AUC of the new prediction model was 0.926(P＜0.05).Conclusion Serum levels of miR-9-3p and miR-27b-3p are negatively correlated with BG grading and are factors influ-encing poor prognosis,demonstrating certain value in predicting poor prognosis.

Objective To examine the application effectiveness of dual 8F ultrafine pigtail drainage tubes versus a single 28F large-bore chest tube in single-port thoracoscopic lobectomy/segmentectomy. Methods Clinical data of patients who underwent single-port video-assisted thoracoscopic lobectomy/segmentectomy within our medical group from January 2020 to August 2023 were retrospectively analyzed. They were categorized into two groups based on postoperative drainage methods: a dual 8F ultrafine pigtail tubes group and a single 28F large-bore chest tube group. Comparative analysis was performed on perioperative data for the two groups of patients. Results The dual 8F ultrafine pigtail tubes group comprised of 68 patients, with 41 females and 27 males, and an average age of (54.72±13.34) years, while the single 28F large-bore chest tube group comprised of 80 patients, with 40 females and 40 males, and an average age of (57.60±11.04) years. There were statistical differences between the two groups in terms of postoperative drainage volume on day 1, day 2, and day 3, total postoperative drainage volume, postoperative tube placement time, postoperative pain score at 48 hours, maximum postoperative pain score, postoperative hospital stay, postoperative complications related to drainage tubes, and emergency use of pain-relieving medication after surgery (P＜0.05). Conclusion After single-port thoracoscopic lobectomy/segmentectomy, the application of dual ultrafine 8F pigtail drainage tubes can lead to a reduction in postoperative drainage volume and shorten the duration of postoperative drainage tube placement and hospital stay, thereby decreasing postoperative pain and the frequency of emergency pain-relieving medication. Moreover, it lowers the incidence of drainage tube-related complications. In alignment with current enhanced recovery after surgery principles, this approach is advantageous for postoperative recovery.

Objective:To compare the clinical efficacy between our first generation and second generation dynamic anterior plate-screw system for quadrilateral area (DAPSQ) in the treatment of T-shaped acetabular fractures.Methods:A retrospective study was conducted of the 28 patients with T-shaped acetabular fractures who had been treated at Department of Orthopaedics, General Hospital of Central Theater Command from January 2008 to December 2019. They were divided into 2 groups according to fixation methods. Group A [15 patients, 11 males and 4 females, an age of (43.5±9.1) years] were treated with the first generation DAPSQ while Group B [13 patients, 8 males and 5 females, an age of (42.5±7.0) years] with the second generation DAPSQ. Operation time, intraoperative bleeding, fracture reduction, function of the affected hip and postoperative complications were recorded and compared between the 2 groups.Results:The 2 groups were comparable because there was no significant difference between them in the preoperative general data ( P>0.05). The 28 patients were followed up for 12 to 60 months (average, 35.0 months). The operation time [(193.9±33.3) min] and intraoperative bleeding [(830.8±177.4) mL] for Group B were significantly less than those for Group A [(231.3±40.0) min and (1,043.3±190.7) mL] ( P<0.05). In Group A, according to the Matta scoring, the fracture reduction was rated as excellent in 8 cases, good in 5 and poor in 2; in Group B, the fracture reduction was rated as excellent in 8 cases, good in 4 and poor in one. According to the modified Merle d'Aubigné & Postel scoring at the final follow-up, the function of the affected hip was rated as excellent in 9 cases, as good in 3, as fair in 2 and as poor in one in Group A while as excellent in 9 cases, as good in 2 and as fair in 2 in Group B. There were no statistically significant differences between the 2 groups in reduction quality or in the function of the affected hip ( P>0.05). Follow-up observed hip traumatic arthritis in 2 cases in Group A and in one in Group B. Conclusion:In the treatment of T-shaped acetabular fractures, compared with the first generation DAPSQ, the second generation DAPSQ can shorten operation time and decrease intraoperative bleeding significantly, though both achieve comparable functional outcomes.

Objective:To compare the efficacy of 3D navigation versus C-arm fluoroscopy for placement of percutaneous double-segment long sacroiliac screws in the treatment of injury to the posterior pelvic ring.Methods:A retrospective study was conducted in the 48 patients with pelvic fracture who had been treated surgically from February 2015 to October 2020 at Department of Orthopaedics, General Hospital of Central Command of PLA. The patients were divided into a navigation group and a fluoroscopy group according to their different auxiliary ways to assist screw placement. In the navigation group of 27 patients, there were 19 males and 8 females, with an age of (45.5±7.4) years; in the fluoroscopy group of 21 patients, there were 14 males and 7 females, with an age of (44.1±10.1) years. The 2 groups were compared in terms of placement time for each screw, fluoroscopy time for each screw, adjustments of guide wire, accuracy of screw position, quality of fracture reduction, fracture union time, pelvic function, and postoperative complications.Results:The 2 groups were comparable because there was no significant difference between them in the preoperative general data ( P>0.05). The placement time for each screw [(12.7±2.2) min], fluoroscopy time for each screw [(40.7±9.3) s] and adjustments of guide wire [1 (0,1) time] in the navigation group were significantly less than those in the fluoroscopy group [(23.7±3.6) min, (71.4±14.1)s and 5 (4,6) times] (all P<0.05); the assessment of screw placement in the former (49 excellent, 4 good and one poor cases) was significantly better than that in the latter (29 excellent, 8 good and 5 poor cases) ( P<0.05). The 48 patients were followed up for 8 to 25 months (mean, 13.1 months). There were no significant differences between the 2 groups in fracture union time, quality of fracture reduction or Majeed scores for the pelvic function (all P>0.05).Symptoms of injury to the L5 nerve root were observed in one patient in the fluoroscopy group; none of the patients reported postoperative complications like wound infection, screw loosening or breaking. Conclusions:Compared with C-arm fluoroscopy, 3D navigation may better assist placement of percutaneous double-segment long sacroiliac screws in the treatment of injury to the posterior pelvic ring, because 3D navigation can significantly shorten the time for screw placement and the fluoroscopy time for screw placement, reduce adjustments of guide wire, and improve accuracy of screw placement.

Objective:To evaluate the clinical results of miniplates combined with reconstruction plate in treating comminuted posterior wall acetabular fractures.Methods:A retrospective case series study was conducted for 27 patients with comminuted posterior wall acetabular fractures treated in General Hospital of Central Theatre Command of PLA from October 2015 to June 2019. There were 18 males and 9 females, at age of 23-61 years［（45.9±10.9）years］. All patients were treated by using miniplates combined with the reconstruction plate. The operation time, intraoperative blood loss, intraoperative blood transfusion, length of hospital stay and time of fracture healing were recorded. The reduction quality was evaluated according to Matta radiographic standard at 2 days postoperatively. The modified Merle D'Aubigné-Postel score was adopted to evaluate the hip function at 3, 6 months postoperatively and the final follow-up. Postoperative complications were observed, and heterotopic ossification was assessed by Brooker grading standard.Results:All patients were followed up for 12-48 months［36（24, 36）months］. The operation time was 123-242 minutes［（165.4±29.8）minutes］; the intraoperative blood loss was 170-550 ml［（358.3±111.3）ml］; nine patients required intraoperative blood transfusion of 300-500 ml［（377.8±66.7）ml］. The length of hospital stay was 12-29 days［（21.4±4.7）days］. The fracture healing time was 12-24 weeks［（16.3±3.0）weeks］. According to Matta radiographic standard, the reduction quality was excellent in 21 patients, good in 3 and poor in 3 at 2 days postoperatively, with the excellent rate of 89%. The modified Merle D'Aubigné-Postel score was 9-16 points［（13.1±1.9）points］at 3 months postoperatively, was 10-18 points［（15.4±2.0）points］at 6 months postoperatively, and was 12-18 points［（16.9±1.8）points］at last follow-up（ P<0.01）. The modified Merle D'Aubigné-Postel score between 3 months and 6 months was significantly different（ P<0.01）, and the difference between 6 months and the follow-up was statistically significant（ P<0.01）. The modified Merle D'Aubigné-Postel score was graded as excellent in 0 patient, good in 7, fair in 11 and poor in 9 at 3 months postoperatively, with the excellent rate of 26%; graded as excellent in 3 patients, good in 19, fair in 2 and poor in 3 at 6 months postoperatively, with the excellent rate of 81%; graded as excellent in 18 patients, good in 5, fair in 3 and poor in 1 at the last follow-up, with the excellent rate of 85%（ P<0.01）. No iatrogenic sciatic nerve injury, deep vein thrombosis or wound infection occurred after operation. No hardware loosening or loss of reduction occurred during the follow-up. The post-traumatic arthritis was identified in 2 patients. The avascular necrosis of femoral head was observed in 1 patient and thereafter underwent total hip replacement. The heterotopic ossification occurred in 3 patients, among which 2 patients were graded as Brooker class I and 1 as class II, but there was no adverse effect on hip function. Conclusions:Miniplates combined with reconstruction plate in the treatment of comminuted posterior wall acetabular fractures have reliable fixation effect and attain good reduction, high fracture healing rate, less complications and satisfactory functional recovery.

Objective:To compare the effect of interlocking intramedullary nail and locking plate in the treatment of varus proximal humeral fractures in the elderly.Method:A retrospective case-control study was conducted to analyze the clinical data of 46 elderly patients with varus proximal humeral fractures treated in Central Theater General Hospital of PLA from June 2016 to January 2019, including 27 males and 19 females, at age of 60-84 years［（71.9±5.7）years］. All fractures were fresh. Overall 25 patients were treated with interlocking intramedullary nail（intramedullary nail group）, and 21 patients were treated with locking plate（bone plate group）. The incision length, operation time, intraoperative bleeding and fracture healing time were compared between the two groups. Visual analogue scale（VAS）was used to evaluate the degree of pain relief at 1 week and 1 month after operation, and Constant-Murley score was used to evaluate the recovery of shoulder function at 1 month, 3 months and 1 year after operation. The cervical trunk angle was recorded at 2 days and 1 year after operation to judge whether there was a loss of cervical trunk angle. Postoperative complications were observed.Results:All patients were followed up for 12-32 months［（19.7±6.6）months］. The incision length［（7.1±0.6）cm］, operation time［（60.8±5.2）minutes］, intraoperative bleeding［（64.4±8.4）ml］and fracture healing time［（10.0±1.0）weeks］in intramedullary nail group were significantly less than those in bone plate group［（13.6±0.9）cm,（80.2±8.1）minutes,（151.0±15.2）ml,（11.0±1.5）weeks］（ P<0.05）. In both groups, the VAS decreased significantly over time, and markedly increased Constant-Murley score was detected as well（ P<0.05）. The VAS in intramedullary nail group［（2.8±0.2）points,（1.1±0.2）points］was significantly lower than that in bone plate group［（4.0±0.2）points,（1.5±0.1）points］at 1 week and 1 month after operation（ P<0.05）. The Constant-Murley score in intramedullary nail group［（59.9±6.9）points,（79.1±6.8）points］was higher than that in bone plate group［（50.1±8.5）points,（73.6±8.4）points］at 1 month and 3 months after operation（ P<0.05）, but the score showed no significant difference between intramedullary nail group［（89.1±5.3）points］and bone plate group［（86.4±6.4）points］at 1 year after operation（ P>0.05）. According to Constant-Murley score, 10 patients were evaluated as excellent and 15 patients as good in intramedullary nail group at 1 year after operation, with the excellent and good rate of 100%, while 8 patients were evaluated as excellent, 11 patients as good and 2 patients as fair in bone plate group at 1 year after operation, with the excellent and good rate of 91%（ P>0.05）. The cervical trunk angle in intramedullary nail group［（140.2±2.9）°,（139.6±2.3）°］had significant difference from that in bone plate group［（139.6±3.2）°,（138.8±3.3）°］at 2 days and 1 year after operation（ P<0.05）. In both groups, the cervical trunk angle had slight lost at 1 year after operation compared with that at 2 days after operation, but the difference was not statistically significant（ P>0.05）. In intramedullary nail group, 1 patient had subacromial impact. In bone plate group, 1 patient had screw cutting, 2 patients subacromial impact, and 2 patients delayed fracture healing. The incidence of complications in intramedullary nail group was 4%（1/25）, lower than 24%（5/21）in bone plate group（ P<0.05）. Conclusion:Compared with locking nail plate, interlocking intramedullary nail in the treatment of senile varus proximal humeral fracture has the advantages of small trauma, early fracture healing, less pain, early function recovery and less complications.

Objective:To introduce the standard screw implantation methods and to analyze the biomechanical stability of the second-generation dynamic anterior plate-screw system for quadrilateral area (DAPSQ).Methods:Six adult formalin-preserved corpses were selected to make a complete pelvic specimen. Further, the left high double-column fracture models were made and randomly fixed with second-generation DAPSQ or anterior reconstruction titanium plate and 1/3 tube buttress-plate (ARTPB). The specimens of intact pelvis (IP) group, DAPSQ group and ARTPB group were fixed on a Zwick Z100 material machine and loaded vertically with 200 N, 300 N, 400 N, 500 N, 600 N, 700 N, and 800 N in a simulated sitting position, respectively. The axial displacement and strain changes in the anterior and posterior columns were tested in the three groups. The stiffness was calculated accordingly.Results:The axial compression displacement in the three groups showed an increase trend as well with the vertical load increased from 200 N to 800 N ( F=68.581, P<0.001; F=91.795, P<0.001; F=33.819, P=0.002). The axial displacement in ARTPB group was significantly larger than that in DAPSQ group and IP group ( P<0.05), while the difference between DAPSQ and IP groups was not significant ( P>0.05). Under the vertical load of 600 N, the pelvic axial stiffness of IP group, DAPSQ group, and ARTPB group were 220.72±70.33 N/mm, 185.68±48.49 N/mm and 135.83±60.58 N/mm, respectively. The axial stiffness of ARTPB group was significantly lower than that in DAPSQ group and IP group ( t=5.345, P=0.003; t=6.443, P=0.001), while the difference between DAPSQ and IP groups was not significant ( t=2.138, P=0.086). There were no significant differences of the strain values in anterior column among the three groups during the load increasing from 200 N to 800 N ( P>0.05). With the load increasing from 500 N to 800 N, the strain values of the posterior column in ARTPB group were significantly greater than those of IP and DAPSQ groups ( P<0.05). However, the differences between IP and DAPSQ groups were not statistically significant in strain values of the posterior column ( P>0.05). Conclusion:Compared with anterior reconstruction titanium plate and 1/3 tube buttress-plate, acetabular double-column fracture model fixed with the second-generation DAPSQ has less axial compression displacement but with greater axial stiffness. The stress change in the posterior columns of the acetabulum is like in IP. Therefore, the second-generation DAPSQ has reliable biomechanical stability.

Objective: To compare the clinical efficacy of posterior minimally invasive reconstruction plate and 3D-navigated percutaneous sacroiliac screw fixation of elderly patients with posterior pelvic ring fractures. Methods: A retrospective cases control study was performed to analyze the data of 75 elderly patients with posterior pelvic ring fractures admitted from January 2014 to June 2018 in Central Hospital of the PLA. There were 32 males and 43 females, with the age range of 60-83 years (mean, 67.7 years). Twenty-four patients in the plate group were treated by posterior minimally invasive reconstruction plate fixation, and 51 patients in the navigation group were treated by percutaneous sacroiliac screw internal fixation with 3D navigation. The operation time, intraoperative blood loss, X-ray exposure time, complication rate and postoperative visual analogue scale (VAS) were compared between the two groups. Postoperative Matta radiographic criteria was used to assess fracture reduction quality, and Majeed criteria was used to assess pelvic function at the last follow-up. Results: All 75 patients were followed up for 6-24 months (mean, 13.5 months). The operation time, intraoperative blood loss and X-ray exposure time in the plate group were (126.1±20.6)minutes, (251.6±50.8)ml, and (15.7±4.4)s, showing significant differences in comparison with the navigation groups [(49.7±17.5)minutes, (22.8±5.1)ml, and (112.8±8.8)s](P<0.05). The incidence of postoperative complications was not significantly different between the plate group (4%) and the navigation group (4%) (P>0.05). At day 3, one week, and one month postoperatively, the VAS in the navigation group was (3.3±0.7)points, (3.2±0.7)points, (2.4±0.6)points, better than that in the plate group [(7.2±0.7)points, (6.2±0.8)points and (4.5±0.7)points] (P<0.05). However, there was no significant difference between the two groups at 3 months and one year after operation (P>0.05). According to the Matta radiographic criteria, the excellent and good rate was 92% in plate group (excellent in 14 cases, good in 8, and fair in 2), and was 82% in the navigation group (excellent in 25 cases, good in 17 and fair in 9). There was no significant difference between the two groups (P>0.05). According to the Majeed criteria at the follow-up, the excellent and good rate was 96% in the plate group (excellent in 15 cases, good in 8 and fair in 1), and was 94% in the navigation group (excellent in 35 cases, good in 13 and fair in 3). The difference between the two groups was not statistically significant (P>0.05). Conclusion For elderly patients with osteoporotic posterior pelvic ring fractures, percutaneous sacroiliac screw fixation under 3D navigation has the advantages of shorter operation time, less bleeding, less radiation dose and less postoperative pain than minimally invasive reconstruction plate internal fixation, and hence deserves clinical application.

Objective:To investigate the effect of different screw and screw hole combination of locking compression plates (LCP) on axial micromotion of fracture ends.Methods:Eighteen mature male New Zealand white rabbits were enrollled and divided into Groups A, B and C according to the random number table method, with six rabbits in each group. After obtaining the whole fresh right tibial specimens, the tibia was cut off transversely at the middle part and fixed with LCP. All specimens were fixed with locking screws in locking holes at the distal side of the fracture end. In Group A, locking screws were fixed in locking holes at proximal end. In Group B, common screws were fixed in locking holes at proximal end. While in Group C, common screws were fixed in compression holes at proximal end. All specimens were subjected to a dynamic axial load of 0-50 N on a universal test machine. The distance of the micromotion of the fracture site was measured and axial compression stiffness corresponding to each fixing method was calculated through the instrument's own system.Results:All specimens generated corresponding axial displacement under the axial load. Under an axial load that approximated a body weight (25 N), the axial displacement value of the fracture end was (0.101±0.017)mm in Group A, (0.164±0.007)mm in Group B, and (0.305±0.041)mm in Group C. Under the axial load of approximately two body weights (50 N), the axial displacement value of the fracture end was (0.218±0.012)mm in Group A, (0.285±0.013)mm in Group B, and (0.513±0.051)mm in Group C. Under the same load, the average axial displacement value of fracture site was Group C>Group B>Group A ( P<0.01). The axial stiffness of LCP device was (234.36±13.28)N/mm in Group A, (203.78±16.46)N/mm in Group B, and (112.62±16.23)N/mm in Group C, namely Group A>Group B>Group C ( P<0.01). Conclusion:LCP fixed with common screws or via compression holes can significantly increase axial micromotion of the fracture end. While the combined application of the two methods has better effect and can reduce the stiffness of LCP device.