OBJECTIVE: To investigate the management strategies of external fixation combined with microsurgical techniques for repairing complex foot and ankle wounds in children. METHODS: The clinical data of 9 children with complex foot and ankle wounds who met the selection criteria between June 2017 and December 2021 was retrospectively analyzed. There were 6 boys and 3 girls, aged 3-13 years, with an average of 7.4 years. The causes of injury included crush injury in 5 cases and traffic accident injury in 4 cases. The wound size ranged from 6 cm×5 cm to 25 cm×18 cm. The time from injury to surgery ranged from 3 to 8 hours, with an average of 5 hours. All cases underwent staged surgical treatment. Among the 3 cases requiring deformity correction, 2 cases initially underwent free anterolateral thigh flap transplantation for wound coverage and limb salvage, followed by circular external fixation combined with osteotomy to address postoperative limb deformity, while 1 case received osteotomy for tibial fracture realignment prior to local pedicled flap reconstruction. All the 6 cases with non-deformity correction underwent initial external fixation followed by secondary flap reconstruction for wound management. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score was used to evaluate the foot and ankle function of children. RESULTS: All children successfully achieved limb salvage postoperatively. Among the 6 non-deformity correction cases, all flaps survived with satisfactory wound healing and no infection was observed; fractures healed within 2.5-4.5 months, after which external fixators were removed for functional rehabilitation with favorable recovery. One case treated with circular external fixation combined with osteotomy achieved bone union at 4 months postoperatively, followed by fixator removal. One case undergoing osteotomy for tibial fracture realignment showed bone healing at 2.5 months post-correction, with subsequent fixator removal. One patient receiving bone lengthening developed infection at 1 week postoperatively, which was managed with multiple debridements, ultimately achieving bone union at 16 months postoperatively and followed by fixator removal. At last follow-up, all patients demonstrated satisfactory ankle-hindfoot functional recovery, with AOFAS ankle-hindfoot scores ranging from 80 to 90 (mean, 84.2). CONCLUSION The combination of external fixation and microsurgical techniques demonstrates significant advantages in reconstructing complex foot and ankle wounds in children. The synergistic interaction provides both mechanical stability and biological repair, enabling early functional rehabilitation while reducing infection risks.
Humans ; Child ; Male ; Female ; Adolescent ; Child, Preschool ; Foot Injuries/surgery* ; Ankle Injuries/surgery* ; Retrospective Studies ; External Fixators ; Microsurgery/methods* ; Plastic Surgery Procedures/methods* ; Surgical Flaps ; Fracture Fixation/methods* ; Osteotomy/methods* ; Treatment Outcome

Osteotomy around the knee includes medial opening wedge high tibial osteotomy (HTO), lateral closing wedge HTO, lateral opening wedge distal femoral osteotomy (DFO), medial opening wedge DFO, and double-site osteotomy. Osteotomy redistributes the knee joint pressure by correcting the lower limb alignment, which can effectively delay the progression of knee osteoarthritis. Currently, three methods are used to determine the intraoperative osteotomy angle: the pre-drilling method, wedge block insertion method, and angle-guided linkage method. Coronal plane accuracy is evaluated using the hip-knee-ankle (HKA) angle, medial proximal tibial angle (MPTA), and ratio of lower limb weight-bearing line, while sagittal plane accuracy is assessed by measuring the posterior tibial slope (PTS). Individualized osteotomy guide plate can enhance osteotomy accuracy. The preparation process includes: (1) importing low-dose CT data of both lower limbs in DICOM format into reconstruction software to establish a 3D model of both lower limbs; (2) determining the osteotomy plane and distraction angle through threshold segmentation, importing the plate model, and establishing the length and position of each screw; (3) using fused deposition modeling to layer materials through a nozzle to create the 3D object. Individualized osteotomy guide plate in osteotomy around the knee can not only improve the accuracy of surgery, but also reduce the intraoperative fluoroscopy times and the incidence of complications. The operation efficiency and postoperative rehabilitation are better than those of traditional surgery. With the continuous upgrading of new materials and the improvement of design concepts, the accuracy and efficiency of individualized osteotomy guide will be further improved. Future research will focus on improving the degree of personalization of guide plate design and simplifying the manufacturing process.

Osteochondral defects caused by various factors are still difficult clinical problems. With the development of tissue engineering, the strategies and methods for repairing osteochondral defects in the past decade have made great progress, and some osteochondral tissue stratified stent products have gradually entered the clinical trial stage.. The related articles on tissue engineering for the treatment of osteochondral defects were retrieved by searching databases with key words osteochondral defects, cartilage repair and hierarchical scaffolds. This paper discussed the research status of hierarchical scaffolds in osteochondral tissue engineering during recent five years. In this work, the classification of hierarchical scaffold including monophasic scaffolds, bilayered scaffolds, multilayered scaffolds and gradient scaffolds, are summarized by comparing different experiment researches. Furthermore, the advantages and disadvantages of different types of hierarchical scaffolds were introduced through analyzing relevant studies. Monophasic scaffolds can support the adhesion and proliferation of osteoblasts and chondrocytes, but lack the inherent stratified structure features required for osteochondral regeneration.. Bilayered scaffolds consist of a chondral layer and subchondral layer which base on the biocompatibility of monophasic scaffolds. Biphasic scaffolds are significantly better than monophasic scaffolds in simulating natural cartilage, but the interface between chondral and subchondral layer is poor binding. Compared with bilayered scaffold, trilayered scaffolds are added with an intermediate layer which simulates the calcification of normal cartilage between the two layers, so as to obtain better connection of the bone and cartilage layer. Unlike hierarchical scaffolds, gradient scaffolds provide a gradient connection between the layers, which is more similar to the native osteochondral tissue. In the past five years, the development of osteochondral layered scaffolds mainly depended on the novel structure and fabrication methods of scaffolds. However, correlational clinical studies are quite few. Further high quality and large clinical studies are still required.

Objective To investigate the clinical value of tumor marker combined with cytokeratin 18 and 19 in the diagnosis of malignant tumors .Methods 264 patients with malignant tumor were selected as the observation group.During the same period,136 patients with benign tumor were selected as the control group .The tumor markers, cytokeratin 18 (CK18) and cytokeratin 19 (CK19) levels were compared between the two groups ,and the positive detection rate of tumor markers combined with CK 18 and CK19 were analyzed .Results The serum CK18 and CK19 levels of the observation group were (25.48 ±75.14) U/L,(18.67 ±64.85)U/L,respectively,which were signifi-cantly higher than those of the control group [(0.56 ±1.52)U/L,(0.76 ±0.43)U/L],the differences were statisti-cally significant (t=17.38,15.75,all P<0.05).The serum levels of CEA,CA125,CA50,CA19-9 and TSGF of the observation group were (21.24 ±30.16) μg/L,(69.85 ±112.75) mU/L,(47.32 ±121.81) mU/L,(41.87 ± 20.65) mU/L,(91.64 ±43.84) mU/L,respectively,which were significantly higher than those of the control group [(1.27 ±0.85) ng/mL,(15.82 ±3.87) mU/L,(12.85 ±31.65) mU/L,(6.89 ±4.85) mU/L,(38.35 ± 8.01) mU/L],the differences were statistically significant (t=15.73,16.89,14.86,17.79,16.73,all P<0.05).The positive detection rates of CK18 and CK19 for gastric cancer (66.67％) and lung cancer (77.14％) were signif-icantly higher than tumor markers ,and the differences were statistically significant (χ2 =5.67,6.78,all P<0.05). The positive detection rate of tumor markers combined with CK 18 and CK19 for malignant tumors ( 75.00％) was significantly higher than CK18 and CK19 joint detection (65.91％),tumor markers (46.97％),the differences were statistically significant (χ2 =6.78,7.12,all P<0.05).Conclusion Tumor markers combined with CK18 and CK19 detection is helpful to improve the detection rate of malignant tumors and provide effective basis for following treatment.

Objective To explore the angiogenesis&neovascularization effects of naringin treatment in ovariectomized rats’fracture healing. Methods Upper 1/3 transverse tibial fracture model 4 weeks later after ovariectomized were estimated and randomly divided into the naringin group and control group. Microfil perfusion technique was used to analysis the angiogene?sis situation at two weeks after bone fracture. HE staining was used to evaluate the level of angiogenesis&neovascularization of tis?sue from histological point of view. The relative expression of VEGF in the callus was identified by real?time polymerase chain re?action. Immunohistochemical technique was used to observe the vessel endothelial growth factor?2 in the callus of the two groups. Maximum fracture load was tested by three?point bend test. Results The vascular volume and vascular density were more in nar?ingin group than control group. The HE staining of the 2 week group slices shows that the VA, VN2 of the unit of high magnifica?tion vision of the naringin group was significantly larger compared to the control group. Real?time PCR revealed that the compara?tive expression of VEGF is more in naringin group than in control group; the positive number of VEGFR?2 is more in naringin group than in control group. Naringin can promote the maximum load of the callus. Conclusion Naringin can promote ovariecto?mized rats’angiogenesis&neovascularization in the early process of fracture healing. It may be act on the signaling pathway of VEGF/VEGFR?2.

Estrogen is involved in the process of postmenopausal osteoporosis, and the main functional cells are osteoclasts. However, the mechanism of estrogen on the osteoclasts is not yet fully understood. Here we demonstrate the effects of estrogen on osteoclasts in three aspects: morphology and structure, apoptosis of osteoclasts and differentiation of preosteoclasts, which give an overall explanation for effects of estrogen on osteoclasts.

Objective To investigate the clinical efficacy of radiofrequency surgical therapy combined with ozone for patients with discogenic low back pain. Methods The clinical data were collected in 120 patients treated with radiofrequen?cy and ozone for lumbar disc herniation at Tianjin Hospital from October 2013 to October 2015. Pain visual analogue scale (VAS) was used to patients at preoperative and postoperative 1 week, 1, 3, 6 and 12 months. Health survey (SF-36) score was used at preoperative and postoperative six months. The efficacy was evaluated by MacNab curative effect evaluation. Re?sults The preoperative VAS score was (7.02±0.64) points. The postoperative VAS scores were (3.13±0.32) points, (2.11± 0.67) points,(2.62±0.89) points,(2.37±0.34) points and (2.31±0.50) points at one week, one month, three months, six months and twelve months, respectively. The VAS scores were significantly decreased after surgery (P<0.05). Preoperative SF-36 score was (48.32 ± 7.46) points, which reached to the (82.03 ± 5.89) points six months after surgery (P < 0.05). After six months, the fineness rate reached to 89.17%evaluated by MacNab curative effect evaluation. Conclusion Radiofrequency combined with ozone treatment is an effective and reliable method for discogenic low back pain.