Objective:To evaluate the safety and efficacy of digital technology-assisted debridement and bone and soft tissue reconstruction in the treatment of chronic osteomyelitis of the tibia.Methods:This retrospective study analyzed clinical data from 38 patients (26 males, 12 females; mean age 45.61±18.36 years, range 16-83 years) with chronic post-traumatic osteomyelitis complicated by soft tissue defects in the tibia, treated at the Department of Orthopaedics, Fourth Medical Center of PLA General Hospital between June 2021 and June 2023. There were 18 cases of traffic accidents, 6 cases of high-altitude falls, 6 cases of heavy objects and 6 cases of low-energy falls. Lesion sites: 12 cases in the upper segment of the tibia, 12 cases in the middle segment, and 14 cases in the lower segment. According to the Cierny-Mader classification, there were 24 cases of type III and 14 cases of type IV. Before the operation, the "3D point cloud technology" was used to plan the debridement range of bone and soft tissue. During the operation, the optical navigation system was used to monitor the debridement range in real time. The flap was designed by combining "Reading Tablet Treasure" with CT angiography, and the amount of bone graft was predicted by AI algorithm. The surgical method adopted is the Masquelet technique, namely thorough debridement, bone cement occupation and soft tissue repair in the first stage, and bone reconstruction in the second stage. Comparing the calculated bone defect amount and soft tissue defect area before the operation with the actual measured values after debridement. The cure rate of infection was evaluated by using the McKee bone infection treatment criteria after the operation. The visual analogue scale (VAS) for pain, lower extremity functional scale (LEFS), and self-rating anxiety scale (SAS) were used to evaluate the improvement of the quality of life of postoperative patients.Results:38 patients were followed up with a mean follow-up of 13.53±2.37 months. 37 patients' infections were effectively controlled, and 1 patient had a recurrence of infection, with an effectiveness rate of 97% for the treatment of McKee's infections. The preoperative calculated bone defect amount and soft tissue defect area were 51.05±26.31 cm 3 and 68.42±43.45 cm 2 respectively, and the actual measured values after debridement during the operation were 51.66±26.35 cm 3 and 68.82±43.76 cm 2 respectively. There was no statistically significant difference before and after the operation ( P>0.05). The interval between the first and second stage surgeries was 10.36±1.61 weeks, and all flaps survived after the first stage surgery. Two months after the operation, one case had recurrent osteomyelitis. After palliative treatment, sinus tracts were formed at the infection site. At the 12-month regular dressing change follow-up, there were still purulent secretions in the sinus tracts. There was no recurrence of infection after primary debridement in 37 cases, and the bone grafts healed. The bone healing time was 3.58±0.97 months. The postoperative VAS, LEFS, and SAS scores were 1.00±0.91, 66.68±7.91, and 34.30±4.29, respectively, which were significantly improved compared with the preoperative scores of 7.54±1.52, 21.22±4.29, and 52.70±6.74, respectively, and the difference was statistically significant ( P<0.05). Conclusions:The application of digital technology to precisely design the debridement range of bone and soft tissue, and the real-time holographic visualization monitoring of the debridement range during the operation can achieve precise debridement of bone and soft tissue and personalized and precise repair of soft tissue defects. It is a safe and effective technique for the treatment of chronic osteomyelitis of the tibia.

Objective:To evaluate the efficacy and safety of the Masquelet technique on the basis of characterization of hematogenous and traumatic chronic osteomyelitis of the tibia.Methods:A retrospective analysis was conducted with chronic tibial osteomyelitis who had been treated by the Masquelet technique at Department of Orthopedic Surgery, The Fourth Medical Center, PLA General Hospital from February 2021 to June 2023. The patients were classified into 2 groups based on the underlying etiology of their conditions: a hematogenous group and a traumatic group. Treatment efficacy was evaluated in terms of infection control rate, bone graft healing time, visual analog scale (VAS) pain score, anxiety measured by the self-rating anxiety scale (SAS), and lower limb function assessed by the lower extremity functional scale (LEFS).Results:A total of 66 patients with chronic tibial osteomyelitis were included in the study. There were 17 cases in the hematogenous group. They were 11 males and 6 females with a median age of 31.0 (15.0, 45.0) years and a median disease duration of 3.0 (1.5, 8.0) months. The median interval between the first and second-stage surgeries was 11.5 (8.0, 13.0) weeks, the median volume of bone defect 25.0 (15.0, 40.0) cm 3, and the median bone graft healing time 4.0 (3.0, 4.0) months. No bacteria were detected in secretion culture in 6 cases and Staphylococcus aureus was found in 6 cases. At 12 months postoperatively, the median VAS score was 1.0 (0.0, 2.0) point, the median SAS score 27.0 (20.0, 32.0) points, and the median LEFS score 78.0 (75.0, 80.0) points. There were 49 cases in the traumatic group. They were 36 males and 13 females with a median age of 52.0 (42.0, 63.0) years and a median disease duration of 6.0 (3.0, 36.0) months. The median interval between the first and second-stage surgeries was 10.0 (8.0, 17.0) weeks, the median volume of bone defect 30.0 (22.0, 53.0) cm 3, and the median bone graft healing time 3.5 (3.0, 4.5) months. No bacteria were detected in secretion culture in 10 cases and Staphylococcus aureus was found in 19 cases. At 12 months postoperatively, the median VAS score was 2.0 (1.0, 3.0) points, the median SAS score 35.0 (28.0, 42.0) points, and the median LEFS score 54.0 (42.0, 60.0) points. According to the McKee criteria for infection treatment, 14 cases achieved complete recovery, 2 ones showed improvement, and 1 case experienced recurrence in the hematogenous group, while 44 cases achieved complete recovery, 4 ones showed improvement, and 1 case experienced recurrence in the traumatic group. Conclusions:Although hematogenous and traumatic cases of chronic osteomyelitis of the tibia differ in terms of age of onset, disease duration, and lesion extent, Staphylococcus aureus is the predominant pathogen in both conditions. Application of the Masquelet technique has proven to be an effective treatment for both conditions with comparable bone graft healing time.

Objective:To evaluate the safety and efficacy of digital technology-assisted debridement and bone and soft tissue reconstruction in the treatment of chronic osteomyelitis of the tibia.Methods:This retrospective study analyzed clinical data from 38 patients (26 males, 12 females; mean age 45.61±18.36 years, range 16-83 years) with chronic post-traumatic osteomyelitis complicated by soft tissue defects in the tibia, treated at the Department of Orthopaedics, Fourth Medical Center of PLA General Hospital between June 2021 and June 2023. There were 18 cases of traffic accidents, 6 cases of high-altitude falls, 6 cases of heavy objects and 6 cases of low-energy falls. Lesion sites: 12 cases in the upper segment of the tibia, 12 cases in the middle segment, and 14 cases in the lower segment. According to the Cierny-Mader classification, there were 24 cases of type III and 14 cases of type IV. Before the operation, the "3D point cloud technology" was used to plan the debridement range of bone and soft tissue. During the operation, the optical navigation system was used to monitor the debridement range in real time. The flap was designed by combining "Reading Tablet Treasure" with CT angiography, and the amount of bone graft was predicted by AI algorithm. The surgical method adopted is the Masquelet technique, namely thorough debridement, bone cement occupation and soft tissue repair in the first stage, and bone reconstruction in the second stage. Comparing the calculated bone defect amount and soft tissue defect area before the operation with the actual measured values after debridement. The cure rate of infection was evaluated by using the McKee bone infection treatment criteria after the operation. The visual analogue scale (VAS) for pain, lower extremity functional scale (LEFS), and self-rating anxiety scale (SAS) were used to evaluate the improvement of the quality of life of postoperative patients.Results:38 patients were followed up with a mean follow-up of 13.53±2.37 months. 37 patients' infections were effectively controlled, and 1 patient had a recurrence of infection, with an effectiveness rate of 97% for the treatment of McKee's infections. The preoperative calculated bone defect amount and soft tissue defect area were 51.05±26.31 cm 3 and 68.42±43.45 cm 2 respectively, and the actual measured values after debridement during the operation were 51.66±26.35 cm 3 and 68.82±43.76 cm 2 respectively. There was no statistically significant difference before and after the operation ( P>0.05). The interval between the first and second stage surgeries was 10.36±1.61 weeks, and all flaps survived after the first stage surgery. Two months after the operation, one case had recurrent osteomyelitis. After palliative treatment, sinus tracts were formed at the infection site. At the 12-month regular dressing change follow-up, there were still purulent secretions in the sinus tracts. There was no recurrence of infection after primary debridement in 37 cases, and the bone grafts healed. The bone healing time was 3.58±0.97 months. The postoperative VAS, LEFS, and SAS scores were 1.00±0.91, 66.68±7.91, and 34.30±4.29, respectively, which were significantly improved compared with the preoperative scores of 7.54±1.52, 21.22±4.29, and 52.70±6.74, respectively, and the difference was statistically significant ( P<0.05). Conclusions:The application of digital technology to precisely design the debridement range of bone and soft tissue, and the real-time holographic visualization monitoring of the debridement range during the operation can achieve precise debridement of bone and soft tissue and personalized and precise repair of soft tissue defects. It is a safe and effective technique for the treatment of chronic osteomyelitis of the tibia.

Objective:To evaluate the efficacy and safety of the Masquelet technique on the basis of characterization of hematogenous and traumatic chronic osteomyelitis of the tibia.Methods:A retrospective analysis was conducted with chronic tibial osteomyelitis who had been treated by the Masquelet technique at Department of Orthopedic Surgery, The Fourth Medical Center, PLA General Hospital from February 2021 to June 2023. The patients were classified into 2 groups based on the underlying etiology of their conditions: a hematogenous group and a traumatic group. Treatment efficacy was evaluated in terms of infection control rate, bone graft healing time, visual analog scale (VAS) pain score, anxiety measured by the self-rating anxiety scale (SAS), and lower limb function assessed by the lower extremity functional scale (LEFS).Results:A total of 66 patients with chronic tibial osteomyelitis were included in the study. There were 17 cases in the hematogenous group. They were 11 males and 6 females with a median age of 31.0 (15.0, 45.0) years and a median disease duration of 3.0 (1.5, 8.0) months. The median interval between the first and second-stage surgeries was 11.5 (8.0, 13.0) weeks, the median volume of bone defect 25.0 (15.0, 40.0) cm 3, and the median bone graft healing time 4.0 (3.0, 4.0) months. No bacteria were detected in secretion culture in 6 cases and Staphylococcus aureus was found in 6 cases. At 12 months postoperatively, the median VAS score was 1.0 (0.0, 2.0) point, the median SAS score 27.0 (20.0, 32.0) points, and the median LEFS score 78.0 (75.0, 80.0) points. There were 49 cases in the traumatic group. They were 36 males and 13 females with a median age of 52.0 (42.0, 63.0) years and a median disease duration of 6.0 (3.0, 36.0) months. The median interval between the first and second-stage surgeries was 10.0 (8.0, 17.0) weeks, the median volume of bone defect 30.0 (22.0, 53.0) cm 3, and the median bone graft healing time 3.5 (3.0, 4.5) months. No bacteria were detected in secretion culture in 10 cases and Staphylococcus aureus was found in 19 cases. At 12 months postoperatively, the median VAS score was 2.0 (1.0, 3.0) points, the median SAS score 35.0 (28.0, 42.0) points, and the median LEFS score 54.0 (42.0, 60.0) points. According to the McKee criteria for infection treatment, 14 cases achieved complete recovery, 2 ones showed improvement, and 1 case experienced recurrence in the hematogenous group, while 44 cases achieved complete recovery, 4 ones showed improvement, and 1 case experienced recurrence in the traumatic group. Conclusions:Although hematogenous and traumatic cases of chronic osteomyelitis of the tibia differ in terms of age of onset, disease duration, and lesion extent, Staphylococcus aureus is the predominant pathogen in both conditions. Application of the Masquelet technique has proven to be an effective treatment for both conditions with comparable bone graft healing time.

Bone Transplantation/adverse effects* ; Transplantation, Autologous/adverse effects*

Masquelet technique has become a safe and effective treatment for chronic osteomyelitis of the long limb shaft. The vast majority of osteomyelitis can be ultimately controlled, segmental bone defects repaired and limb functions restored. Accumulation of clinical applications and development of imaging technology have led to rapid progress in determining the infection scope of chronic limb osteomyelitis, precise preoperative design for repair of soft tissue defects, evaluation of bone structure stability, and use of bone grafting materials. This article reviews the progress of Masquelet technique in the treatment of chronic limb osteomyelitis from the aspects of its theoretical foundation, key operations, and selection of fixation methods, hoping to deepen the understanding of current Masquelet technique.

Skin avulsion injuries of the lower leg are common in clinical practice, which can easily lead to skin necrosis and infection of the lower leg, and have a significant impact on the appearance and function of the lower limb. Among them, the open avulsion injury has the highest incidence and is often accompanied by multiple tissue injuries. Therefore, improper diagnosis and treatment may cause skin and soft tissue defects of the lower leg combined with bone exposure or even bone defects, seriously impairing patients′ life and health. In order to have a better understanding of the open skin avulsion injury of the lower leg, achieve precise diagnosis and treatment and improve prognosis, the Chinese Society of Traumatology of Chinese Medical Association and the Chinese Association of Microsurgeons of Chinese Medical Doctor Association organized experts in the related fields to formulate Clinical guideline for the diagnosis and treatment of open skin avulsion injuries of the lower leg ( version 2024) based on evidence-based medicine principles. A total of 16 recommendations were proposed on the diagnosis, treatment, postoperative rehabilitation of open lower leg skin avulsion injury, so as to provide a reference for its diagnosis and treatment.

Skin avulsion injuries of the lower leg are common in clinical practice, which can easily lead to skin necrosis and infection of the lower leg, and have a significant impact on the appearance and function of the lower limb. Among them, the open avulsion injury has the highest incidence and is often accompanied by multiple tissue injuries. Therefore, improper diagnosis and treatment may cause skin and soft tissue defects of the lower leg combined with bone exposure or even bone defects, seriously impairing patients′ life and health. In order to have a better understanding of the open skin avulsion injury of the lower leg, achieve precise diagnosis and treatment and improve prognosis, the Chinese Society of Traumatology of Chinese Medical Association and the Chinese Association of Microsurgeons of Chinese Medical Doctor Association organized experts in the related fields to formulate Clinical guideline for the diagnosis and treatment of open skin avulsion injuries of the lower leg ( version 2024) based on evidence-based medicine principles. A total of 16 recommendations were proposed on the diagnosis, treatment, postoperative rehabilitation of open lower leg skin avulsion injury, so as to provide a reference for its diagnosis and treatment.

ObjectiveTo investigate the protective effect of Guiqi Baizhu prescription combined with oxaliplatin on the intestinal barrier of tumor-bearing mice with gastric cancer by regulating downstream aquaporin 3 （AQP3） and aquaporin 4 （AQP4） through the vasoactive intestinal peptide （VIP）/cyclic adenosine monophosphate （cAMP）/protein kinase A （PKA） signaling pathway. MethodThe gastric cancer cell lines MFC with a density of 1×10⁷/mL were prepared into cell suspension. The tumor-bearing mouse model of gastric cancer was established by inoculating 0.2 mL cell suspension under the right axilla of mice. After successful modeling， mice were randomly divided into 5 groups， namely， model group， oxaliplatin group （10 mg·kg^-1）， and high， medium， and low-dose oxaliplatin + Guiqi Baizhu prescription groups （17.68， 8.84， 4.42 g·kg^-1）， with 10 mice in each group， and the remaining 10 mice were set as a blank group. Mice in each group were treated with Chinese medicine， oxaliplatin， or normal saline by gavage or intraperitoneal injection for 14 d. The next day after the last dose， blood was taken from the eyeball to separate serum and take colonic samples. Hematoxylin-eosin （HE） staining was used to observe the changes in tissue morphology. The content of D-lactate acid （D-LA） and diamine oxidase （DAO） in the serum was determined by enzyme-linked immunosorbent assay （ELISA）. The mRNA and protein expressions of VIP， cAMP， PKA， AQP3， and AQP4 were detected by Real-time quantitative polymerase chain reaction （Real-time PCR） and Western blot， respectively. ResultCompared with the blank group， the model group showed edema in the colonic submucosa， disordered arrangement of intestinal glands in the mucosal layer， loss of goblet cells， infiltration of inflammatory cells， and villus shedding. However， there were different degrees of improvement in each administration group. As compared with the blank group， the serum levels of DAO and D-LA in the model group were significantly increased （P<0.01）. As compared with the model group， the levels of DAO and D-LA in the high-dose oxaliplatin + Guiqi Baizhu prescription group and the level of D-LA in the medium-dose oxaliplatin + Guiqi Baizhu prescription group were decreased （P<0.05， P<0.01）. As compared with the oxaliplatin group， the levels of D-LA in the high and medium-dose oxaliplatin + Guiqi Baizhu prescription groups were decreased （P<0.05）， and the levels of DAO and D-LA in other administration groups were decreased as well， but the difference had no statistical significance. As compared with the blank group， the mRNA and protein expression levels of VIP， cAMP， PKA， AQP3， and AQP4 in the model group were significantly decreased （P<0.05， P<0.01）. As compared with the model group， the mRNA and protein expression levels of VIP， cAMP， PKA， AQP3， and AQP4 in each administration group were increased， and those in the high-dose oxaliplatin + Guiqi Baizhu prescription group were significantly increased （P<0.05， P<0.01）， while the protein expression level of cAMP in the medium-dose oxaliplatin + Guiqi Baizhu prescription group were increased （P<0.05）. As compared with the oxaliplatin group， the protein expression levels of cAMP in the high-dose oxaliplatin + Guiqi Baizhu prescription group were increased （P<0.05）， and the mRNA and protein expressions of these indexes in the other groups were also increased but the differences were not statistically significant. ConclusionGuiqi Baizhu prescription combined with oxaliplatin can regulate AQP3 and AQP4 through the VIP/cAMP/PKA signaling pathway to protect the intestinal barrier of tumor-bearing mice with gastric cancer.

Hypoxia is one of the factors restricting the survival of people at high altitudes, which can cause various symptoms such as vomiting, diarrhea, palpitations, shortness of breath and acute coma. About 80% of patients with acute mountain sickness have at least one symptom of a gastrointestinal distress (e. g., anorexia, nausea, diarrhea, vomiting, etc.). The pathological characteristics, pathogenesis and drug treatment of intestinal injury caused by high-altitude hypoxia were studied, which is conducive to the diagnosis and treatment of plateau gastrointestinal diseases. Therefore, by summarized relevant literature and systematically expounds the related researches on intestinal damage caused by high altitude hypoxia. We summarized the changes of intestinal morphology, intestinal cells, intestinal flora and other intestinal homeostasis caused by high altitude hypoxia, the mechanism of intestinal inflammation and oxidative damage, and the treatment of traditional Chinese medicine, which provide reference and information for reference for scientific research workers and clinicians.