Objective:To investigate the efficacy and safety of nerve decompression surgery through the lateral-rectus approach for sacral plexus nerve injury after sacral fracture fixation.Methods:A retrospective study was conducted to analyze the 10 patients with combined sacral plexus nerve injury after sacral fracture fixation who had been admitted to Department of Orthopedics, Xiangya Hospital between May 2022 and May 2023. There were 2 males and 8 females with an age of 16.5 (15.0, 26.3) years. At the time of injury, the patients had been clearly diagnosed as sacral fracture combined with sacral plexus nerve injury. By the Denis classification of sacral fractures: 7 cases of type Ⅱ and 3 cases of type Ⅲ; sacral plexus nerve injury sites: 1 case of L 4, 8 cases of L 5, 7 cases of S 1, and 2 cases of S 2. All of them were treated with reduction and internal fixation via the posterior approach within 2 weeks after injury, but after surgery their manifestations of sacral plexus nerve injury still persisted which were confirmed by CT, magnetic resonance imaging and neuromuscular electromyography. Therefore, at (4.0±2.3) months after internal fixation, all patients were treated with nerve decompression surgery through the lateral-rectus approach. The operative time, intraoperative bleeding, length of hospitalization, Gibbons nerve damage score and neurological recovery at the last follow-up were recorded. Results:In the 10 patients, the operative time was (112.0±21.5) min, intraoperative bleeding (215.0±91.3) mL, and length of hospitalization 7.0 (6.0, 8.5) d. Intraoperatively, sacral plexus nerve compression was found in 9 cases (6 cases of nerve compression and pulling due to fracture displacement, 3 cases of nerve entrapment due to soft tissue scar adhesion), and 1 case of nerve root avulsion injury. No other intraoperative complications occurred. The 10 patients were followed up for (9.2±2.3) months after surgery. At the last follow-up, the Gibbons score for the 10 patients improved from preoperative 3.0 (3.0, 3.3) points to 1.0 (1.0, 2.0) point, and their British Medical Research Council (BMRC) nerve injury grading was improved from the preoperative grade 0.0 (0.0, 1.3) to grade 3.5 (2.8, 4.0) (1 case of M5, 4 cases of M4, 4 cases of M3, and 1 case of M2).Conclusion:The lateral-rectus approach is effective and safe for exploration and decompression of the sacral plexus nerve in patients combined with sacral plexus nerve injury despite sacral fracture fixation.

Objective:Type H blood vessels are a subtype of bone-specific microvessels(CD31hiEmcnhi)that play an important regulatory role in the coupling of angiogenesis and osteogenesis.Despite reports on the distinct roles of type H and L vessels under physiological and pathological bone conditions,their genetic differences remain to be elucidated.This study aims to construct a competitive endogenous RNA(ceRNA)network of key gene for differencial expression(DE)in type H and L vascular endothelial cells(ECs)through integrated bioinformatic methods. Methods:We downloaded relevant raw data from the ArrayExpress and the Gene Expression Omnibus(GEO)database and used the Limma R-Bioconductor package to screen for DE lncRNAs,DE miRNAs,and DE mRNAs between type H and L vascular ECs.A total ceRNA network was constructed based on their interactions,followed by refinement using protein-protein interaction(PPI)networks to select upregulated and downregulated key genes.Enrichment analysis was performed on these key genes.Random validation was conducted using flow cytometry and real-time RT-PCR. Results:A total of 1 761 DE mRNAs,187 DE lncRNAs,and 159 DE miRNAs were identified,and a comprehensive ceRNA network was constructed based on their interactions.Six upregulated(Itga5,Kdr,Tjp1,Pecam1,Cdh5,and Ptk2)and 2 downregulated(Csf1r and Il10)key genes were selected via PPI network to construct a subnetwork of ceRNAs related to these key genes.Upregulated key genes were mainly enriched in negative regulation of angiogenesis and vascular apoptosis.Results from flow cytometry and real-time RT-PCR were consistent with bioinformatics analysis. Conclusion:This study proposes a ceRNA network associated with upregulated and downregulated type H and L vascular ECs based on selected key genes,providing new insights into the regulatory mechanisms of type H and L vascular ECs in bone metabolism.

Accurate classification of the acetabular injuries and appropriate treatment plan are great challenges for orthopedic surgeons because of the irregular anatomical structure of the acetabulum and aggregation of important vessels and nerves around it. Letournel-Judet classification system has been widely applied to classify acetabular fractures. However, there are several limitations, including incomplete inclusion of fracture types, difficulty in understanding and insufficient guidance for surgical treatment, etc. Serious complications such as traumatic arthritis are common due to wrong classification and diagnosis and improper selection of surgical strategy, which brings a heavy burden to the society and families. Three-column classification, based on anatomic characteristics, has advantages of containing more fracture types and being easy to understand, etc. To solve the problems existing in the diagnosis and treatment process based on Letournel-Judet classification, achieve accurate diagnosis and treatment of patients with acetabular fractures, and obtain satisfactory prognosis, the Orthopedic Trauma Emergency Center of Third Hospital of Hebei Medical University and the Trauma Orthopedic Branch of the Chinese Orthopedic Association organized experts from relevant fields to formulate the Expert consensus on the accurate diagnosis and treatment of acetabular fractures based on three-column classification ( version 2023) in terms of principles of evidence-based medicine. Based on the three-column classification, 15 recommendations were proposed, covering the diagnosis, treatment, complication prevention and management, etc, so as to provide reference for accurate diagnosis and treatment of acetabular fractures.

Objective:To compare the clinical efficacy of robot-assisted versus fluoroscopy-assisted sacroiliac screw internal fixation for posterior pelvic ring fractures.Methods:China National Knowledge Infrastructure (CNKI), Wanfang Data, Chinese Medical Journal Full-text Database, PubMed, Web of Science and ScienceDirect were searched for literature on robot-assisted versus fluoroscopy-assisted sacroiliac screw internal fixation for posterior pelvic ring fractures. The search time was from the establishment of each database to March 2023. Meta-analysis was performed on the included literature. The random-effects model was used when the heterogeneity between groups was large, and the fixed-effects model was used when the heterogeneity between groups was small.Results:A total of 15 studies were included in the meta-analysis, including 465 patients in the robot-assisted group and 396 patients in the fluoroscopy-assisted group. Meta-analysis showed that the number of fluoroscopies [ SMD=-3.12, 95% CI (-4.34, -1.89), P<0.001], the number of guide pin adjustments [ SMD=-3.75, 95% CI (-6.77, -0.72), P=0.015], intraoperative blood loss [ SMD=-0.83, 95% CI (-1.18, -0.49), P<0.001], and operative time [ SMD=-2.59, 95% CI (-4.11, -1.08), P<0.001] were smaller than those in the fluoroscopy-assisted group. The rate of excellent screw implantation [ OR=10.13, 95% CI (3.67,27.98), P<0.001] of the robot-assisted was larger than the fluoroscopy-assisted group. There was no significant difference in Majeed functional score [ SMD=0.28, 95% CI (-0.0003, 0.55), P=0.050] and fracture healing time [ SMD=-0.14, 95% CI (-0.46, 0.17), P=0.367] between the two groups. Conclusion:Robot-assisted percutaneous sacroiliac screw fixation for posterior pelvic ring fractures has the advantages of less fluoroscopy, less guide pin adjustment, less intraoperative blood loss, shorter operation time, and higher rate of excellent screw position. However, there is no difference in Majeed score and fracture healing time between robot-assisted percutaneous sacroiliac screw fixation and fluoroscopy-assisted percutaneous sacroiliac screw fixation.

OBJECTIVES: To screen the risk factors for predicting venous thromboembolism (VTE) risk after hip fracture in the elderly, to establish a prediction model based on these factors, and to analyze its prediction efficacy. METHODS: A total of 52 hip fracture patients over 60 years old with VTE admitted to the Department of Orthopaedic Trauma, Xiangya Hospital, Central South University from March 2017 to April 2019 were selected as a thrombus group, and another 52 hip fracture patients over 60 years old without VTE were selected as a control group. The differences of hospitalization data and examination results between the 2 groups were compared. Logistic regression model was used to explore the influence of risk factors on VTE risk after hip fracture in the elderly and construct the prediction model based on these factors. The receiver operating characteristic curve was used to analyze the predictive effectiveness of model, Hosmer-lemeshow goodness of fit test was used to evaluate the fitting degree of prediction model. RESULTS: Univariate analysis showed that injury-admission interval, Caprini score, WBC count, platelet count, neutrophil count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammatory index (SII), and fibrinogen in the thrombus group were higher than those in the control group (all CONCLUSIONS SII, Caprini score, and injury-admission interval are independent predictors of VTE after hip fracture in the elderly. The prediction model based on these 3 factors has a good efficacy on the prediction of VTE risk, and could provide important reference for the prevention, management, and treatment of VTE after hip fracture in the elderly.
Aged ; Hip Fractures/surgery* ; Humans ; Middle Aged ; ROC Curve ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Venous Thromboembolism/etiology*

Objective To retrospectively analyze the effects of nerve block anesthesia versus general anesthesia on intertrochanteric fracture in the elderly. Methods The 104 elderly inpatients undergoing closed reduction and intramedullary nailing for the treatment of femoral intertrochanteric fractures were recruited into this study at Department of Orthopedics ,Xiangya Hospital ,Central South University from January 2015 to June 2017.Medical records were collected and analyzed by SPSS 16.0 or GraphPad Prism 6.0 software. Results A total of 104 patients were divided into general anesthesia group(n= 48 )and nerve block anesthesia group (n= 56 ). There was no statistical difference in the demographic characteristics between the two groups. The changes in heart rate ,maximum changes of systolic/diastolic blood pressures ,and infusion volume during surgery were lower in the nerve block anesthesia group than in the general anesthesia group [(12.7 ± 7.3)vs. (18.1 ± 7.8)beats/min ,(22.5 ± 8.8/12.2 ± 7.5)mmHg vs. (34.3 ± 7.9/21.6 ± 6.6)mmHg ,(792.9 ± 387.0)ml vs. (1 083.0 ± 445.5)ml ,respectively ,t=3.64 ,7.14 ,6.73 ,5.16 ,all P＜0.01]. There was no statistically significant difference between two groups in other perioperative data and the number of deaths at three months and one year after surgery. Conclusions As compared with the general anesthesia ,the nerve block anesthesia has less effects on the heart rate ,less maximum changes of systolic and diastolic blood pressures ,and less infusion volume during surgery ,and has no significant increase in postoperative mortality ,which is safe and worthy of further promotion.

Objective To understand the job burnout status of bank staff and analyse the relationship between job burnout and self-efficacy,job satisfaction.Methods The job burnout,self-efficacy and job satisfaction of 8 942 bank staff was surveyed by Maslach burnout inventory-general survey(MBI-GS),general self-efficacy scale (GSES) and job satisfaction scale (JSS) respectively.Results A total of 8 942 questionnaires were issued and 7 486 valid questionnaires were returned.The score of self-efficacy in male was significantly higher than that in the female(P ＜0.05).There was no significant difference in job satisfaction score between male and female(P ＞ 0.05).The score of emotional exhaustion (EE) in female was significantly higher than that in male,while the score of reduced personal accomplishment(RPA) was significantly lower than that in male (P ＜ 0.05);there was no significant difference in depersonalization (DP) score between male and female (P ＞ 0.05).The EE,DP and PAL scores of bank staff with post-graduate education were significantly lower than those with high school/secondary school and junior college/undergraduate (P ＜ 0.05);the DP and PAL scores of bank staff with junior college/undergraduate were significantly lower than those with high school/secondary school(P ＜ 0.05);there was no significant difference in EE score of bank staff between junior college/undergraduate and high school/secondary school(P ＞ 0.05).The EE score of age ＞ 50 years old bank staff was significantly lower than that of age ＜ 30 years old,30-40 years old and 41-50 years old (P ＜0.05);there was no significant difference in EE score among age ＜30 years old,30-40 years old and 41-50 years old bank staff (P ＞ 0.05).The DP score of 41-50 years old bank staff was significantly higher than that of age ＜ 30 years old (P ＜0.05);there was no significant difference in DP score among age ＜30 years old,30-40 years old and 41-50 years old bank staff (P ＞ 0.05).There was no significant difference in PAL score among all age groups (P ＞ 0.05).The three dimensions of job burnout had significant negative correlation with self-efficacy and job satisfaction (P ＜ 0.05).Conclusion Bank staff have a certain degree of job burnout.Age,sex,and education level maybe the influence factors of job burnout.Improvement of self-efficacy and job satisfaction may help to reduce the job burnout.

Objective To explore the value of comprehensive biochemical and serological test in Salmonella clinical test .Methods A total of 95 cases of suspected salmonella infection with enteric fever were selected as subjects in this study from April 2013 to A‐pril 2014 ,and 48 cases randomly divided in research group ,47 cases in control group .Regular inspection was conducted in the con‐trol group ,comprehensive biochemical and serological test were conducted in the control group .Compared the results in the two groups .Results The salmonella detection rate in the research group was 93 .75% ,which was significant higher than 68 .09% in the control group (P< 0 .05) .Conclusion Combined detection of comprehensive biochemical and serology test could detect Salmonella effectively ,it is worthy of application and popularization in clinic .

Objective To explore a variety of levels of serum marker test applications in the diagnosis of fatty liver .Methods Data were randomly selected from April 2013 to April 2014 for treatment of patients with fatty liver hospital 45 cases ,set the study group ,choose the same period in healthy volunteers to undergo a medical examination in our hospital 45 cases ,it was set to control group ,two groups of subjects were taking a variety of levels of serum markers tested .Comparison and analysis of two groups of subjects to detect a variety of levels of serum markers and positive case detection rate .Results The study group subjects ALT , AST ,TG ,TC index the average level of detection was higher than the control group ,statistically significant differences (P<0 .01);study group subjects ALT ,AST ,TG ,TC index the positive rates were 77 .78% ,93 .33% ,55 .56% ,46 .67% more than 8 .89% in the control group ,4 .44% ,15 .56% ,11 .11% higher ,statistically significant differences (P<0 .05);United biochemical indicator de‐tection of biochemical indicators of detection rate of fatty liver was obviously higher than that of single detection rate ,the difference was statistically significant (P<0 .05) .Conclusion Multiple levels of serum markers of fatty liver diagnostic test in higher detec‐tion rate .

BACKGROUND: With deepening of spinal biomechanics, artificial lumbar disc replacement is considered to be the optimal choice for treating degenerative lumbar disease. However, studies concerning biomechanics of artificial lumbar disc are insufficient. OBJECTIVE: To establish the three-dimensional (3-D) finite element model of artificial lumbar disc replacement and to explore the effects of artificial lumbar disc replacement on zygapophyseal joints using biomechanical analysis. METHODS: Based on normal 3-D finite element model of lumbar motion segment, L4-5 intervertebral disc, superior and inferior endplates were removed, and then, the model of SB-Charite Ⅲ disc prosthesis was added, which remained annular fibrosus and ligaments at L4-5 intervertebral space. Thus, 3-D finite element model of L4-5 segments artificial lumbar disc replacement was constructed. Biomechanical analysis of this model was processed under axial load, forward flexion, lateral bending or posterior extension moments. The stress data were contrasted with the normal 3-D finite element model of artificial disc replacement. RESULTS AND CONCLUSION: After artificial lumbar disc replacement, the data of biomechanical analysis indicated: ①There was no significant differences between the zygapophyseal joint and normal segment of stress under axial load (P > 0.01).②Compared with normal segment, the stress of anterior, posterior of upper and lower vertebral body and bilateral zygapophyseal joint had no obviously difference under forward flexion and posterior extension moments (P > 0.01). ③The stress differences between the both sides of upper and lower vertebral body and bilateral zygapophyseal joint were not significant under lateral bending moment (P > 0.01). Artificial lumbar disc replacement can keep the stress of motion segment at normal level, which can meet the needs of spinal functional reestablishment.