Objective:To comparatively the efficacy of the combined external fixator and the Ilizarov in the treatment of open tibia-fibula fractures and their influence on postoperative infection.Methods:A total of 215 patients with open tibio-fibula fractures diagnosed and treated at Tianjin Medical University General Hospital Airport Site from January 2021 to January 2024 were retrospectively selected as the research subjects. They were divided into the observation group (110 cases, using the combined external frame) and the control group (105 cases, using theIlizarov) according to the types of external fixators adopted. The clinical efficacy, bone healing condition, X-ray callus score, and serological indicators, including the bone morphogenetic protein (BMP-2), vascular endothelial growth factor (VEGF), osteocalcin (OC), C-reactive protein (CRP) in the two groups were compared. The America Orthopedic Foot & Ankle Society(AOFAS) score, Hospital for Special Surgery (HSS) score, and Health Survey Scale (SF-36) score were applied to evaluate the recovery of patients, and the postoperative infection conditions in the two groups were compared.Results:At 12 months after the operation, the excellent and good rate of clinical efficacy in the observation group was higher than that in the control group:90.00%(99/110) vs. 80.00%(84/105), there was statistical difference ( χ2 = 4.24, P<0.05). The complete weight-bearing time, swelling elimination time, bone healing time and postoperative hospital stay in the observation group were shorter than those in the control group:(144.73 ± 15.48) d vs. (152.12 ± 15.55) d, (11.25 ± 1.34) d vs. (13.18 ± 1.37) d, (123.01 ± 12.53) d vs. (136.38 ± 13.45) d, (30.15 ± 3.24) d vs. (31.47 ± 3.48) d, there were statistical differences ( P<0.01). The X-ray callus scores in the observation group at 1 week and 1, 3 and 6 months after the operation were higher than those in the control group: (1.37 ± 0.15) scores vs. (1.28 ± 0.14) scores, (7.65 ± 0.83) scores vs. (5.64 ± 0.75) scores,(12.34 ± 1.25) scores vs. (10.78 ± 1.16) scores,(14.52 ± 1.56) scores vs.(12.11 ± 1.35) scores, there were statistical differences ( P<0.01). Six months after the operation, the levels of BMP-2, VEGF and OC in the observation group were higher than those in the control group: (84.23 ± 8.51) ng/L vs. (76.79 ± 7.82) ng/L, (17.26 ± 1.83) ng/L vs. (15.34 ± 1.67) ng/L, (18.34 ± 1.92) μg/L vs. (6.48 ± 1.75) μg/L; while CRP was lower than that in the control group: (6.49 ± 0.76) mg/L vs. (7.13 ± 0.78) mg/L; there were statistical differences ( P<0.01). The scores of AOFAS, HSS and SF-36 in the observation group at 6 months after the operation were higher than those in the control group: (76.34 ± 7.85) scores vs. (70.11 ± 7.49) scores,(70.12 ± 7.63) scores vs. (67.77 ± 6.68) scores, (93.57 ± 10.34) scores vs. (85.73 ± 8.65) scores, there were statistical differences ( P<0.01 or <0.05). The patients were followed up for 12 months after the operation. There was no statistical difference in the incidence of complications between the two groups ( P>0.05). Conclusions:Compared with the Ilizarov, the combined external fixator has a better therapeutic effect in the treatment of open tibia-fibula fractures. It can promote the healing of bone wounds, improve joint function and quality of life, and has good safety.

Objective:To comparatively the efficacy of the combined external fixator and the Ilizarov in the treatment of open tibia-fibula fractures and their influence on postoperative infection.Methods:A total of 215 patients with open tibio-fibula fractures diagnosed and treated at Tianjin Medical University General Hospital Airport Site from January 2021 to January 2024 were retrospectively selected as the research subjects. They were divided into the observation group (110 cases, using the combined external frame) and the control group (105 cases, using theIlizarov) according to the types of external fixators adopted. The clinical efficacy, bone healing condition, X-ray callus score, and serological indicators, including the bone morphogenetic protein (BMP-2), vascular endothelial growth factor (VEGF), osteocalcin (OC), C-reactive protein (CRP) in the two groups were compared. The America Orthopedic Foot & Ankle Society(AOFAS) score, Hospital for Special Surgery (HSS) score, and Health Survey Scale (SF-36) score were applied to evaluate the recovery of patients, and the postoperative infection conditions in the two groups were compared.Results:At 12 months after the operation, the excellent and good rate of clinical efficacy in the observation group was higher than that in the control group:90.00%(99/110) vs. 80.00%(84/105), there was statistical difference ( χ2 = 4.24, P<0.05). The complete weight-bearing time, swelling elimination time, bone healing time and postoperative hospital stay in the observation group were shorter than those in the control group:(144.73 ± 15.48) d vs. (152.12 ± 15.55) d, (11.25 ± 1.34) d vs. (13.18 ± 1.37) d, (123.01 ± 12.53) d vs. (136.38 ± 13.45) d, (30.15 ± 3.24) d vs. (31.47 ± 3.48) d, there were statistical differences ( P<0.01). The X-ray callus scores in the observation group at 1 week and 1, 3 and 6 months after the operation were higher than those in the control group: (1.37 ± 0.15) scores vs. (1.28 ± 0.14) scores, (7.65 ± 0.83) scores vs. (5.64 ± 0.75) scores,(12.34 ± 1.25) scores vs. (10.78 ± 1.16) scores,(14.52 ± 1.56) scores vs.(12.11 ± 1.35) scores, there were statistical differences ( P<0.01). Six months after the operation, the levels of BMP-2, VEGF and OC in the observation group were higher than those in the control group: (84.23 ± 8.51) ng/L vs. (76.79 ± 7.82) ng/L, (17.26 ± 1.83) ng/L vs. (15.34 ± 1.67) ng/L, (18.34 ± 1.92) μg/L vs. (6.48 ± 1.75) μg/L; while CRP was lower than that in the control group: (6.49 ± 0.76) mg/L vs. (7.13 ± 0.78) mg/L; there were statistical differences ( P<0.01). The scores of AOFAS, HSS and SF-36 in the observation group at 6 months after the operation were higher than those in the control group: (76.34 ± 7.85) scores vs. (70.11 ± 7.49) scores,(70.12 ± 7.63) scores vs. (67.77 ± 6.68) scores, (93.57 ± 10.34) scores vs. (85.73 ± 8.65) scores, there were statistical differences ( P<0.01 or <0.05). The patients were followed up for 12 months after the operation. There was no statistical difference in the incidence of complications between the two groups ( P>0.05). Conclusions:Compared with the Ilizarov, the combined external fixator has a better therapeutic effect in the treatment of open tibia-fibula fractures. It can promote the healing of bone wounds, improve joint function and quality of life, and has good safety.

Objectives:To investigate the relationship between paraspinal muscle degeneration and isthmic spondylolisthesis in L5/S1.Methods:The clinical data of 108 patients with L5/S1 bilateral isthmic spondylolysis admitted and treated at the Department of Orthopedics,the First Affiliated Hospital of Zhengzhou University from January 1,2020 to December 31,2023 were retrospectively analyzed.There were 62 females and 46 males,aged 26-86(52.8±10.4)years.All the patients had complete imaging data,including lateral and dynamic lumbar X-ray,lumbar CT and lumbar MRI.According to the presence or absence of spondylolisthesis and Meyerding grading,the patients were divided into non-spondylolisthesis group(28 cases),grade Ⅰ spondylolisthesis group(46 cases)and grade n spondylolisthesis group(34 cases).Venebral body cross-sectional area(V CSA),erector spinae muscle cross-sectional area(ES CSA),multifidus muscle cross-sectional area(MF CSA),and facet joint angle(FJA)were measured at the inferior vertebral endplate of L5 vertebral body on the axial view of lumbar spine MRI.And the mean FJA(mFJA),relative MF CSA(MF rCSA),relative ES CSA(ES rCSA),fat infiltration rate of multifidus muscle(MF FIR)and fat infiltration rate of erector spinae muscle(ES FIR)were calculated.The differences in age,gender,body mass index(BMI),disease duration,V CSA,mFJA,MF CSA,ES CSA,MF rCSA,ES rCSA,MF FIR and ES FIR between the three groups were compared.Ordinal logistics regression was used to analyze the relationship between age,gender,disease duration,BMI,mFJA,MF rCSA,ES rCSA,MF FIR,ES FIR and the isthmic spondylolisthesis.Results:There were no statistical differences in age,body weight,BMI,V CSA,and mFJA between the three groups(P＞0.05).The proportion of female patients in the non-spondylolisthesis group(29％)was significantly lower than that in grade Ⅰ spondylolisthesis group(61％)and grade Ⅱ spondylolisthesis group(76％)(P＜0.05).The height of non-spondylolisthesis group(1.68±0.06m)was higher than that of grade Ⅰ spondylolisthesis group(1.64±0.75m)and grade Ⅱ spondylolisthesis group(1.63±0.54m)(P＜0.05),and the disease duration in the non-spondylolisthesis group was shorter than that of grade Ⅰ spondylolisthesis group and grade Ⅱspondylolisthesis group(P＜0.05).There was no significant difference in MF CSA,MF rCSA and ES FIR between the three groups(P＞0.05).ES CSA and ES rCSA in grade Ⅱ spondylolisthesis group(3183.2±1196.38mm2 and 2.14±1.11)were significantly greater than that in grade Ⅰ spondylolisthesis group(2579.28±896.56mm2 and 1.65±0.65)and non-spondylolisthesis group(2401.40±742.98mm2 and 1.56±0.58)(P＜0.05).The MF FIR of grade Ⅱ spondylolisthesis group(40.70±14.05)％was significantly higher than that of grade Ⅰspondylolisthesis group(30.39±12.98)％and non-spondylolisthesis group(26.69±9.96)％(P＜0.05).There were no significant differences in ES CSA,ES rCSA and MF FIR between grade Ⅰ spondylolisthesis group and non-spondylolisthesis group(P＞0.05).Ordinal logistics regression analysis showed that female(OR=2.81;95％CI:1.120-7.062;P=0.028)and increased MF FIR(OR=1.044;95％CI:1.003-1.088;P=0.034)were the independent risk factors for the progression of isthmic spondylolisthesis(P＜0.05).Conclusions:Patients with a higher degree of isthmic spondylolisthesis have more severe fat infiltration of multifidus muscle and hypertrophy of erector spinae muscle.Female and increased MF FIR are independent risk factors for the progression of isthmic spondylolisthesis.

Liver function can reflect the severity of cirrhosis,and has important clinical value for disease monitoring,efficacy evaluation and surgical risk prediction.At present,the methods commonly used in clinical evaluation of liver function include blood biochemical examination,drug excretion test,comprehensive scoring system and routine imaging examination.All these methods have their limitations.Gd-EOB-DTPA is a hepatocellular specific contrast agent,which is taken up and excreted by liver cells and can directly reflect liver function.Therefore,it is expected to achieve non-invasive segental quantitative evaluation of liver function through enhanced MRI of Gd-EOB-DTPA,which is the focus of current research.In this paper,the methods of Gd-EOB-DTPA enhanced MRI for liver function assessment were reviewed,and the feasibility of Gd-EOB-DTPA in liver function assessment was discussed.

Algorithms ; Crystallography, X-Ray ; Disulfides ; chemistry ; Models, Molecular ; Protein Conformation ; Proteins ; chemistry