Objective:To explore the risk factors for different severities of epiphyseal injury caused by distal tibial fractures in adolescents.Methods:A retrospective analysis was conducted on 195 children with distal tibial fractures accompanied by epiphyseal injuries who were admitted to the Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2018 to December 2023. Among them, there were 132 males and 63 females; the age was 11.7±2.1 years (range, 5-15 years). Among them, 91 cases were on the left side and 104 cases were on the right side. Salter-Harris classification of epiphyseal injuries: there were 42 cases of type I, 90 cases of type II, 34 cases of type III, 26 cases of type IV, and 3 cases of type V. Causes of injury: 37 cases were sports injuries, 29 cases were traffic accident injuries, 120 cases were fall injuries, and 9 cases were fall from height injuries. Dias-Tachdjian classification of injury mechanisms: there were 65 cases of supination-adduction type, 59 cases of supination-plantar flexion type, 35 cases of supination-external rotation type, and 36 cases of pronation-abduction-external rotation type. Among them, 72 cases were complicated with fibular fractures, and 56 cases were accompanied by periosteum incarceration. The age, gender, side of injury, body mass index, cause of injury, presence or absence of fibular fracture, and injury mechanism of children with each type of Salter-Harris injury were compared. The indicators with statistically significant differences were included in the multiple logistic regression analysis to determine the independent risk factors for each type of Salter-Harris injury.Results:The ages of patients with type I-IV were 10.70±2.77, 12.18±1.70, 11.32±2.08, 12.35±1.19, and 11.67±2.08 years old respectively, and the difference was statistically significant ( F=4.794, P=0.001). The body mass indexes were 11.90±3.84, 21.30±4.48, 21.41±4.08, 22.42±3.74, and 24.32±4.82 kg/m 2 respectively, and the difference was statistically significant ( F=1.914, P=0.009). The numbers of cases of sports injuries/traffic accident injuries/fall injuries/fall-from-height injuries were 6/7/23/6, 17/12/59/2, 6/5/22/1, 7/4/15/0, and 1/1/1/0 respectively, and the difference was statistically significant ( P=0.032). The numbers of cases of supination-adduction/pronation-abduction-external rotation/supination-plantar flexion/supination-external rotation were 21/6/9/6, 21/16/37/16, 19/6/8/1, 4/7/4/11, and 0/1/1/1 respectively, and the difference was statistically significant ( P=0.001). The numbers of cases of periosteum incarceration (none/yes) were 32/10, 54/36, 27/7, 25/1, and 1/2 respectively, and the difference was statistically significant (χ 2=17.156, P=0.002). There was no statistically significant difference in gender, side of injury, and presence or absence of fibular fracture among patients with each type of epiphyseal injury ( P>0.05). Age, body mass index, cause of injury, injury mechanism, and periosteum incarceration were included in the multiple logistic regression analysis. The results showed that age [ OR=1.337, 95% CI (1.097, 1.628), P=0.004], the supination varus type of the injury mechanism [ OR=0.257, 95% CI (0.075, 1.013), P=0.015] in the Salter-Harris type II, and the supination plantar flexion type of the injury mechanism [ OR=0.154, 95% CI (0.027, 0.872), P=0.034] in the Salter-Harris type IV were independent risk factors for the severity of epiphyseal injury caused by distal tibial fractures in adolescents. Conclusion:The severity of distal tibial fractures accompanied by epiphyseal injuries in adolescents is related to multiple factors such as age, body mass index, cause of injury, injury mechanism, and periosteum incarceration. For every one-year increase in age, the risk of epiphyseal injury in children with Salter-Harris type II is 1.337 times higher than that in those with type I. The type I epiphyseal injury caused by supination varus injury is 3.891 times that of type II injury, and the type I epiphyseal injury caused by supination plantar flexion injury is 6.493 times that of type IV injury.

Objective:To explore the risk factors for different severities of epiphyseal injury caused by distal tibial fractures in adolescents.Methods:A retrospective analysis was conducted on 195 children with distal tibial fractures accompanied by epiphyseal injuries who were admitted to the Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2018 to December 2023. Among them, there were 132 males and 63 females; the age was 11.7±2.1 years (range, 5-15 years). Among them, 91 cases were on the left side and 104 cases were on the right side. Salter-Harris classification of epiphyseal injuries: there were 42 cases of type I, 90 cases of type II, 34 cases of type III, 26 cases of type IV, and 3 cases of type V. Causes of injury: 37 cases were sports injuries, 29 cases were traffic accident injuries, 120 cases were fall injuries, and 9 cases were fall from height injuries. Dias-Tachdjian classification of injury mechanisms: there were 65 cases of supination-adduction type, 59 cases of supination-plantar flexion type, 35 cases of supination-external rotation type, and 36 cases of pronation-abduction-external rotation type. Among them, 72 cases were complicated with fibular fractures, and 56 cases were accompanied by periosteum incarceration. The age, gender, side of injury, body mass index, cause of injury, presence or absence of fibular fracture, and injury mechanism of children with each type of Salter-Harris injury were compared. The indicators with statistically significant differences were included in the multiple logistic regression analysis to determine the independent risk factors for each type of Salter-Harris injury.Results:The ages of patients with type I-IV were 10.70±2.77, 12.18±1.70, 11.32±2.08, 12.35±1.19, and 11.67±2.08 years old respectively, and the difference was statistically significant ( F=4.794, P=0.001). The body mass indexes were 11.90±3.84, 21.30±4.48, 21.41±4.08, 22.42±3.74, and 24.32±4.82 kg/m 2 respectively, and the difference was statistically significant ( F=1.914, P=0.009). The numbers of cases of sports injuries/traffic accident injuries/fall injuries/fall-from-height injuries were 6/7/23/6, 17/12/59/2, 6/5/22/1, 7/4/15/0, and 1/1/1/0 respectively, and the difference was statistically significant ( P=0.032). The numbers of cases of supination-adduction/pronation-abduction-external rotation/supination-plantar flexion/supination-external rotation were 21/6/9/6, 21/16/37/16, 19/6/8/1, 4/7/4/11, and 0/1/1/1 respectively, and the difference was statistically significant ( P=0.001). The numbers of cases of periosteum incarceration (none/yes) were 32/10, 54/36, 27/7, 25/1, and 1/2 respectively, and the difference was statistically significant (χ 2=17.156, P=0.002). There was no statistically significant difference in gender, side of injury, and presence or absence of fibular fracture among patients with each type of epiphyseal injury ( P>0.05). Age, body mass index, cause of injury, injury mechanism, and periosteum incarceration were included in the multiple logistic regression analysis. The results showed that age [ OR=1.337, 95% CI (1.097, 1.628), P=0.004], the supination varus type of the injury mechanism [ OR=0.257, 95% CI (0.075, 1.013), P=0.015] in the Salter-Harris type II, and the supination plantar flexion type of the injury mechanism [ OR=0.154, 95% CI (0.027, 0.872), P=0.034] in the Salter-Harris type IV were independent risk factors for the severity of epiphyseal injury caused by distal tibial fractures in adolescents. Conclusion:The severity of distal tibial fractures accompanied by epiphyseal injuries in adolescents is related to multiple factors such as age, body mass index, cause of injury, injury mechanism, and periosteum incarceration. For every one-year increase in age, the risk of epiphyseal injury in children with Salter-Harris type II is 1.337 times higher than that in those with type I. The type I epiphyseal injury caused by supination varus injury is 3.891 times that of type II injury, and the type I epiphyseal injury caused by supination plantar flexion injury is 6.493 times that of type IV injury.

OBJECTIVE：To comp are cytotoxicity and anti-inflammatory effects of raw Aconitium kusnezoffii and A. kusnezoffii processed with Terminalia chebula . METHODS ：Using H 9c2 cardiomyocytes isolated from rat as subjects ，CCK-8 assay was used to detect the effects of 0.5，1，2，4，6，8，10 mg/mL raw A. kusnezoffii and A. kusnezoffii processed with T. chebula on cell inhibition rate after cultured for 4，8，12，24 h. Hoechst 33258 staining was used to observe the effects on cell morphology characteristics after treated with 2，4，6 mg/mL raw A. kusnezoffii and A. kusnezoffii processed with T. chebula . Using macrophages RAW264.7 cells as subjects ，CCK-8 assay was used to detect the effects of 0.05，0.1，0.25，0.5，0.75，1，1.5，2 mg/mL raw A. kusnezoffii and A. kusnezoffii processed with T. chebula on cell survival rate after cultured for 24 h. ELISA assay was used to detect the effects of 0.05，0.1，0.25，0.5 mg/mL raw A. kusnezoffii and A. kusnezoffii processed with T. chebula on the release of NO ， TNF-α and IL-6 in RAW 264.7 inflammation cells induced by LPS. RESULTS ：When the mass concentration was 0.5，1 mg/mL， neither raw A. kusnezoffii and A. kusnezoffii processed with T. chebula had no inhibitory effect on H 9c2 cells. When the mass concentration was 2 mg/mL，the inhibitory effects of A. kusnezoffii processed with T. chebula on H 9c2 cells was higher than that of raw A. kusnezoffii （P＜0.05 or P＜0.01）；fluorescence intensity of cells treated for 24 h was stronger than that of raw A. kusnezoffii，but its nucleus was intact. When the mass concentration was 4-10 mg/mL，the inhibitory rate of A. kusnezoffii processed with T. chebula on H 9c2 cells at different time points （except for 24 h culture of 8，10 mg/mL）was significantly lower than raw A. kusnezoffii （P＜0.05 or P＜0.01）. The characteristics of cell morphology also showed that the fluorescence intensity of raw A. kusnezoffii group at 4，6 mg/mL was stronger than that of A. kusnezoffii processed with T. chebula group，and the cell nucleus fragmentation was more serious in the raw A. kusnezoffii group. 0.05-0.5 mg/mL raw A. kusnezoffii and A. kusnezoffii processed with T. chebula had no toxicity to RAW264.7 cells. 0.25，0.5 mg/mL raw A. kusnezoffii and 0.1，0.25，0.5 mg/mL A. kusnezoffii processed with T. chebula showed significant inhibitory effect on the release of NO ，0.05，0.1，0.25，0.5 mg/mL raw A. kusnezoffii and A. kusnezoffii processed with T. chebula showed significant inhibitory effect on the release of TNF-α and IL-6 in RAW 264.7 cell（P＜0.05 or P＜ 0.01）. The inhibitory effects of A. kusnezoffii processed with T. chebula at the same concentration on the release of NO was better than that of raw A. kusnezoffii ，but poorer than raw A. kusnezoffii in the inhibitory effects on the release of TNF-α and IL-6. CONCLUSIONS：The toxicity of A. kusnezoffii can be reduced after processed with T. chebula ，especially the toxicity of it in medium or high concentration and short-term use is lower than that of raw A. kusnezoffii . At the same time ，the anti-inflammatory effect of A. kusnezoffii processed with T. chebula is comparable to that of raw A. kusnezoffii at the same concentration.