Objective:To compare the therapeutic efficacy of the dual anteromedial and anterolateral approaches versus that of the anterior midline approach in the treatment of Wahlquist type C medial tibial plateau fractures accompanied by posterior column collapse.Methods:A retrospective study was conducted to analyze the 21 patients who had been treated for Wahlquist type C medial tibial plateau fractures plus posterior column collapse at The Fourth Orthopedic Ward, The 72nd Group Army Hospital of PLA between January 2019 and August 2023. The cohort included 13 males and 8 females, with an age of (43.3±6.7) years. The left side was involved in 14 fractures and the right side in 7 ones. The patients were divided into 2 groups based on their surgical approaches: a dual-approach group ( n=13) undergoing fixation via the dual anteromedial and anterolateral approaches, and a single-approach group ( n=8) undergoing fixation via the anterior midline approach. Comparative parameters included operative time, intraoperative blood loss, fracture healing time, quality of fracture reduction, medial proximal tibial angle (MPTA), incision complications, postoperative bone mass reduction quality (evaluated according to the Rasmussen anatomical criteria for tibial condyle fracture reduction), lateral tibial plateau instability, incidence of genu varum, and post-traumatic arthritis. Functional recovery of the lower limb joints was assessed at the final follow-up using the Merchant criteria. Results:No statistically significant differences were observed in the baseline characteristics between the 2 groups preoperatively, indicating comparability ( P>0.05). All patients were followed up for a mean duration of (38.1±11.3) months. The postoperative MPTA in the dual-approach group (86.8°±0.8°) was significantly larger than that in the single-approach group (85.5°±0.9°) ( P<0.05). Genu varum occurred in 1 patient in the dual-approach group and in 4 patients in the single-approach group, while lateral tibial plateau instability was observed in 1 patient in the dual-approach group and in 4 patients in the single-approach group, showing statistically significant differences between the 2 groups ( P<0.05). No statistically significant differences were found between the 2 groups regarding operative time, intraoperative blood loss, fracture healing time, quality of fracture reduction, incidence of incision complications, or incidence of post-traumatic arthritis ( P>0.05). At the final follow-up, no statistically significant difference was observed in the functional recovery of the lower limb joints assessed by the Merchant criteria between the 2 groups ( P>0.05). Conclusion:In the treatment of Wahlquist type C medial tibial plateau fractures accompanied by posterior column collapse, compared with the single anterior midline approach, the dual anteromedial and anterolateral approaches can restore more effectively the MPTA, and reduce the incidences of genu varum and lateral tibial plateau instability.

Objective:To compare the therapeutic efficacy of the dual anteromedial and anterolateral approaches versus that of the anterior midline approach in the treatment of Wahlquist type C medial tibial plateau fractures accompanied by posterior column collapse.Methods:A retrospective study was conducted to analyze the 21 patients who had been treated for Wahlquist type C medial tibial plateau fractures plus posterior column collapse at The Fourth Orthopedic Ward, The 72nd Group Army Hospital of PLA between January 2019 and August 2023. The cohort included 13 males and 8 females, with an age of (43.3±6.7) years. The left side was involved in 14 fractures and the right side in 7 ones. The patients were divided into 2 groups based on their surgical approaches: a dual-approach group ( n=13) undergoing fixation via the dual anteromedial and anterolateral approaches, and a single-approach group ( n=8) undergoing fixation via the anterior midline approach. Comparative parameters included operative time, intraoperative blood loss, fracture healing time, quality of fracture reduction, medial proximal tibial angle (MPTA), incision complications, postoperative bone mass reduction quality (evaluated according to the Rasmussen anatomical criteria for tibial condyle fracture reduction), lateral tibial plateau instability, incidence of genu varum, and post-traumatic arthritis. Functional recovery of the lower limb joints was assessed at the final follow-up using the Merchant criteria. Results:No statistically significant differences were observed in the baseline characteristics between the 2 groups preoperatively, indicating comparability ( P>0.05). All patients were followed up for a mean duration of (38.1±11.3) months. The postoperative MPTA in the dual-approach group (86.8°±0.8°) was significantly larger than that in the single-approach group (85.5°±0.9°) ( P<0.05). Genu varum occurred in 1 patient in the dual-approach group and in 4 patients in the single-approach group, while lateral tibial plateau instability was observed in 1 patient in the dual-approach group and in 4 patients in the single-approach group, showing statistically significant differences between the 2 groups ( P<0.05). No statistically significant differences were found between the 2 groups regarding operative time, intraoperative blood loss, fracture healing time, quality of fracture reduction, incidence of incision complications, or incidence of post-traumatic arthritis ( P>0.05). At the final follow-up, no statistically significant difference was observed in the functional recovery of the lower limb joints assessed by the Merchant criteria between the 2 groups ( P>0.05). Conclusion:In the treatment of Wahlquist type C medial tibial plateau fractures accompanied by posterior column collapse, compared with the single anterior midline approach, the dual anteromedial and anterolateral approaches can restore more effectively the MPTA, and reduce the incidences of genu varum and lateral tibial plateau instability.

Objective To analyse the effects of the lung recruitment manoeuvre(RM)mode implemented by ICU specialist nurses on remission of the patients with acute respiratory distress syndrome(ARDS),with the aim to explore the safety,feasibility and effectiveness of clinical implementation,and to further provide a new mode for patient management in nursing practice.Methods A total of 40 ARDS patients admitted into the ICU from January 2018 to August 2021 were randomly selected and divided into control group and trial group in equal number with a random number table.Patients in the control group was treated with a conventional RM mode implemented by doctors,and the RM mode implemented by the ICU specialist nurses was applied to the patients in trial group.The indexes of arterial blood gas analysis,mechanical ventilation time,length of ICU stay,number of RM,number of adjustments to a RM plan,and complication rate were compared between the two groups after the second RM implementation.Results There was no statistically significant difference in arterial partial pressure of oxygen,arterial partial pressure of carbon dioxide and oxygenation index between the groups at 1h and 24h after the second RM implementation(P>0.05).There was no statistically significant difference in the number of RM,mechanical ventilation and length of ICU stay between the groups(P>0.05).The number of modifications of the RM plan in the trial group was significantly more than that in the control group(P<0.05).There was no complication of RM in both groups.Conclusions The RM mode implemented by ICU specialist nurses could achieve good clinical effects in the treatment of patients with ARDS. The approach is safe and practicable.

Objective · To survey the willingness to enroll in nursing homes among the elders in Shanghai and explore its predictors. Methods · A field survey was performed to collect data from 641 elders aged 60 years old and above in six community health centers in Shanghai. Sociodemographic variables, willingness to use nursing home, perceived barriers and perceived benefits were measured. Results · The questionnaire is with good structural validity and good intrinsic reliability. KMO index, P value of Bartlett's test of sphericity, and the range of Cronbach's α coefficients were 0.862, 0.000,and 0.739-0.824, respectively. Among the respondents, 46% were willing to enroll in a nursing home in this survey. Age had significant influence on their willingness (P=0.045). After adjusting for age, the multivariate Logistic regression analysis showed that shame (OR=0.76, 95% CI=0.62-0.94), adaptability (OR=0.61, 95% CI=0.50-0.74) and perceived benefits (OR=1.63, 95% CI=1.32-2.03) were related to willingness (P<0.05).Conclusion · Elders in Shanghai have a relatively high level of willingness to enroll in nursing homes, especially the elders aged from 60 to 69. Shame and adaptability of elders, and the services provided by nursing homes were the predictors of the elders' willingness.