Meta-analysis of the efficacy of volar plate internal fixation versus closed reduction and external fixation in the treatment of adult distal radius fractures

Objective:To compare the efficacy of open reduction and volar locking plate internal fixation with closed reduction and external fixation in the treatment of distal radius fractures by using meta analysis.Methods:The databases of CNKI,Wanfang,Weipu,Chinese biomedical literature,Pubmed,Embase,and Cochrane Library were retrieved,and the randomized controlled studies that directly compared the efficacy of plate internal fixation and closed reduction external fixation in the treatment of distal radius fractures published publicly from the establishment of the database to April 2023 were collected.The two researchers independently screened the retrieved literature according to the inclusion and exclusion criteria,extracted data,used Cochrane risk bias assessment tool for quality assessment,and used RevMan 5.4 software for meta analysis.Results:A total of 10 randomized controlled trials were included,all of which were in English.There were 1042 patients in total,and 9 of them were rated as low risk.Meta analysis results showed that one year after the treatment of distal radius fracture with volar locking plate internal fixation,DASH score[MD=-5.64,95%CI(-7.21,-4.06),P<0.00001];One year later,PRWE score[MD=-5.90,95%CI(-8.88,-2.92),P=0.001];Palm flexion[MD=5.92,95%CI(1.29,10.55),P=0.01];Pronation[MD=2.48,95%CI(0.59,4.36),P=0.01];Postrotation[MD=4.73,95%CI(2.15,7.31),P=0.0003];Grip strength[MD=0.61,95%CI(0.12,1.10),P=0.02];palmar tilt angle[MD=9.84,95%CI(5.66,14.02),P<0.00001];Radial inclination[MD=4.33,95%CI(2.97,5.69),P<0.00001]was superior to closed reduction plaster or splint external fixation.One year later,the European Five dimensional Health Scale(EQ-5D-5L)score[MD=0.02,95%CI(-0.01,0.05),P=0.27];Back extension[MD=2.22,95%CI(-4.15,8.59),P=0.49];Ulnar deviation[MD=3.49,95%CI(-0.80,7.78),P=0.11];Radial deviation[MD=2.05,95%CI(-2.39,6.50),P=0.37];Ulnar variance[MD=-1.14,95%CI(-3.16,0.88),P=0.27];There was no significant difference in complications[MD=0.77,95%CI(0.54,1.10),P=0.16](P>0.05).Conclusion:Based on the current clinical data,internal fixation with volar locking plate is more conducive to mid-term DASH score and grip strength recovery than closed reduction plaster or splint external fixation,but there is no significant difference in the quality of life and complications of patients.For adult distal radius fractures,surgical indications should be carefully grasped,and non operative treatment should be given priority.

Application of lesser trochanteric reduction fixator in the treatment of unstable intertrochanteric fractures

BACKGROUND Closed reduction and internal fixation with intramedullary nails has been widely accepted for treating intertrochanteric fractures.AIM To focus on how to avoid displacement of the lesser trochanter in unstable intertrochanteric fractures.METHODS We developed a lesser trochanteric reduction fixator for treating intertrochanteric fractures through fixing the lesser trochanter by combining the loop plate through the fixator after reduction by the reducer.Five patients with intertrochanteric fractures treated with the newly developed lesser trochanteric reduction fixator and loop plate combined with intramedullary nails,and 20 patients with intertrochanteric fractures treated with simple intramedullary nails were selected from December 2020 to March 2021.RESULTS The postoperative Harris hip score was significantly higher in patients treated with the lesser trochanteric reduction fixator than in patients treated without the lesser trochanteric reduction fixator,which indicated that this lesser trochanteric reduction fixator had a positive impact on rehabilitation of the hip joint after surgery and could significantly improve the quality of life of patients.CONCLUSION We fully realize the significance of trochanteric reduction and fixation,namely,reconstruction of structures under pressure,in the treatment of intertrochanteric fractures.As long as the general condition of patients is favorable and they are willing to undergo surgery,fixation of the main fracture end should be performed and the lesser trochanter should be reduced and fixed at the same time.

Open reduction and internal fixation for radial head fractures: A prospective observational study

Objective: To evaluate the effect of open reduction and internal fixation on radial head fracture and assess the post-operative function. Methods: This prospective observational study was conducted from June 2016 to July 2017 at Liaquat National Hospital and Medical College, Karachi. Altogether, 28 patients with radial head and neck fractures were enrolled in our study. These patients were admitted to the hospital and their fractures were fixed with open reduction and internal fixation. Baseline information of the patients was collected, and patient-rated elbow evaluation scores were calculated. Results: Out of the 28 patients, 21 were male and 7 were female. Besides, 16 fractures were on the right side and 12 were on the left side and 17 involving the dominant hands. In addition, 8 patients had Mason type Ⅱ fracture and 20 had Mason type Ⅲ fracture. The mean age of patients was (31.0 ± 8.0) years, and the mean follow-up is (1.2 ± 0.5) years. The mean average patient-rated elbow evaluation scores were (27.64 ± 1.60) at 1-year follow-up. Conclusions:The majority of the patients who had radial head fractures and treated by open reduction and internal fixation have attained an excellent range of motion postoperatively.

Functional Outcomes of Traumatic Complex Acetabulum Fractures with Open Reduction and Internal Fixation: 200 Cases

Objective: Acetabular fractures are common injuries in Iran. We assess the functional outcome of open reduction and internal fixation management of displaced Complex acetabular fractures. Materials and Methods: We analyzed a case series of patients with open reduction and internal fixation (ORIF) for complex acetabular fractures. Two hundred patients (132 men, 68 women) in four age groups including with a mean age of 43.39 ± 6.18 years (range 20 - 59 years) and a mean follow-up of 82.34 ± 12.48 months (range 18 - 109 months) met the inclusion criteria. Functional outcome at final follow-up was graded assessed according to Harris score. Factors affecting were defined. Results: Anatomic reduction was achieved in 192 hips, imperfect in 8 and poor in none. Radiological outcome revealed excellent results in 128 (64%) hips, good in eight, fair in five and none in poor. Harris score were excellent in 139 (69.5%) hips, good in 43 (21.5%) and fair in 18 (9%) and poor in none. The anatomical reduction results had a favorable final functional outcome. (0.003) However, BMI (P Conclusion: Optimal functional and radiological outcomes have been achieved with anatomic postoperative reduction. Also experience of specialist, on time surgery and good recovery lead to receiving excellent functional outcome with at least complications.

Recent advances and perspectives in cobalt‐based heterogeneous catalysts for photocatalytic water splitting,CO_(2) reduction,and N_(2) fixation

Solar‐driven conversion of carbon dioxide,water and nitrogen into high value‐added fuels(e.g.H_(2),CO,CH_(4),CH_(3)OH,NH_(3) and so on)is regarded as an environmental‐friendly and ideal route for relieving the greenhouse gas effect and countering energy crisis,which is an attractive and challenging topic.Hence,various types of photocatalysts have been developed successively to meet the requirements of these photocatalysis.Among them,cobalt‐based heterogeneous catalysts emerge as one of the most promising photocatalysts that open up alluring vistas in the field of solar‐to‐fuels conversion,which can effectively enhance photocatalytic efficiency by extending light absorption range,promoting charge separation,providing active sites,and lowering reaction barrier.In this review,we first present the working principles of cobalt‐based heterogeneous catalysts for photocatalytic water splitting,CO_(2) reduction,and N_(2) fixation.Second,five efficient strategies including surface modification,morphology modulation,crystallinity controlling,crystal engineering and doping,are discussed for improving the photocatalytic performance with different types cobalt‐based catalysts(cobalt nanoparticles and single atom,oxides,sulfides,phosphides,MOFs,COFs,LDHs,carbide,and nitrides).Third,we outline the applications for the state‐of‐the‐art photocatalytic CO_(2) reduction and water splitting,and nitrogen fixation over cobalt‐based heterogeneous catalysts.Finally,the central challenges and possible improvements of cobalt‐based photocatalysis in the future are presented.The purpose of this review is to summarize the past experience and lessons,and provide reference for the further development of cobalt‐based photocatalysis technology.

Synergy of staggered stacking confinement and microporous defect fixation for high‐density atomic Fe^(Ⅱ)‐N_(4)oxygen reduction active sites

The development of high‐performance nonprecious metal catalysts(NPMCs)to supersede Pt‐based catalysts for the oxygen reduction reaction(ORR)in polymer electrolyte membrane fuel cells is highly desirable but remains challenging.In this paper,we present a pyrolysis strategy for spatial confinement and active‐site fixation using iron phthalocyanine(FePc),phthalocyanine(Pc)and Zn salts as precursors.In the obtained carbon‐based NPMC with a hierarchically porous nanostructure of thin‐layered carbon nanosheets,nearly 100%of the total Fe species are Fe^(Ⅱ)‐N_(4) active sites.In contrast,pyrolyzing FePc alone forms Fe‐based nanoparticles embedded in amorphous carbon with only 5.9%Fe^(Ⅱ)‐N_(4) active sites.Both experimental characterization and density functional theory calculations reveal that spatial confinement through the staggeredπ–πstacking of Pc macrocycles effectively prevents the demetallation of Fe atoms and the formation of Fe‐based nanoparticles via aggregation.Furthermore,Zn‐induced microporous defects allow the fixation of Fe^(Ⅱ)‐N_(4) active sites.The synergistic effect of staggered stacking confinement and microporous defect fixation results in a high density of atomic Fe^(Ⅱ)‐N_(4) active sites that can enhance the ORR.The optimal Fe^(Ⅱ)‐N_(4)‐C electro‐catalyst outperforms a commercial Pt/C catalyst in terms of half‐wave potential,methanol toler‐ance,and long‐term stability in alkaline media.This modulation strategy can greatly advance efforts to develop high‐performance NPMCs.

Modified Closed Reduction and Percutaneous Kirschner Wires Internal Fixation for Treatment of Supracondylar Humerus Fractures in Children

Objective Supracondylar humerus fractures are the most frequent fractures of the paediatric elbow.The present study introduced a modified surgical procedure for treatment of supracondylar humerus fractures in children.Methods From February 2015 to August 2019,73 patients with Gartland’s type II and III supracondylar fractures were treated with this modified method.Totally,68 of all patients were followed up for 3–12 months(mean 8.25 months).The evaluation results included fracture nonunion,ulnar nerve injury,pin track infection,carrying angle and elbow joint Flynn score.Results The results showed that bone union was observed in all children,one case had an iatrogenic ulnar nerve injury,and the symptoms were completely relieved in 4 months after removing of the medial-side pin.All children had no cubitus varus deformity and no pin track infection,and the rate of satisfactory results according to Flynn’s criteria score was 100%.Conclusion The modified closed reduction and Kirschner wires internal fixation could effectively reduce the rate of open reduction,the risk of iatrogenic ulnar nerve injury,and the incidence of cubitus varus deformity in treatment of supracondylar humerus fractures in children.

Metatarsal Fracture Reduction and Fixation by Kirschner Wires: Technical Tip

The incidence of metatarsal fractures is not precisely known. Malposition might cause future metatarsalgia, mid-foot pain and discomfort, which may dictate an on-going need for in-shoe orthosis, shoe modification and, occasionally, operative correction. To minimize and prevent these problems, we describe a simple technique for reduction and fixation of metatarsal fractures by Kirschner wires. We have found this technique to be a simple and efficient way of reducing and fixing metatarsal fractures. It is applied easily by the closed and open technique.

THE DISTRACTION REDUCTION FIXATION SYSTEM AND ITS APPLICATION IN SPONDYLOLISTHESIS

Objective． An internal fixation apparatus—— distraction reduction fixation system(DRFS) was designed to satisfy the clinical needs for spondylolisthesis. Methods. Since 1996, 53 patients were treated with DRFS. Among them, 35 had spondylolisthesis, 12 had lumbar canal stenosis accompanied with instability, 2 had vertebral tumors and 4 suffered from spinal fracture. The average age was 53.6 years old (ranged 24～ 72yrs). The mean time for follow- up was 30.6 months (16～ 44 months). Results． The slip rate was 0.15± 0.10 before operation, and decreased to 0.09± 0.07 after operation. Entire slip reposition was achieved in 19 cases (54.3％ ). The change in height of the intervertebral space within the fixation segments was 0.7± 0.17. Conclusion． DRFS achieved better results for spondylolisthesis less II degree and no other adverse effects were found. Compared with other foreign and domestic techniques, it had advantages in less implants, less operation gears required and ease to utilize in operation. It was proved to be an ideal internal fixation apparatus.

Clinical Analysis of Minimally Invasive Single-segment Reduction and Internal Fixation in Patients with Thoracolumbar Fractures

Objective:To study the clinical effect of minimally invasive single-segment reduction and internal fixation in patients with thoracolumbar fractures.Methods:From June 2013 to June 2014,100 patients with thoracolumbar fractures were selected as the subjects and they were randomly divided into observation group(50 cases)and control group(50 cases).The patients in the observation group were treated with minimally invasive singlesegment reduction and internal fixation.The patients in the control group were treated with short segmental fixation.The clinical effects of the two groups were compared.Results:There was no significant difference in the compression rate and Cobb angle between the two groups before and after operation(P>0.05).For all patients who were followed up for the last time,the Cobb angle was significantly lower in the observation group than in the control group(P<0.05).The social function,affective function and physical pain score of the observation group were significantly better than the control group(P<0.05).The amount of bleeding in the observation group was(250.4±41.0)ml,which was significantly lower than that in the control group(267.5±32.8)ml.The time required for the operation was(90.2±35.4)min,which was significantly lower than that of the control group(104.5±22.6)min(P<0.05).After treatment,the prognosis was 70.00%and the excellent and good rate was 98.00%,which was significantly higher than that of the control group(46.00%)and 78.00%(P<0.05).Conclusion:Thoracolumbar fractures in patients with dilated channel minimally invasive single-segment reduction and internal fixation treatment can effectively repair the patient's vertebral height and Cobb angle and the degree of correction after surgery was significantly better,safer and worthy of clinical recommended use.

Breaking the linear correlations for enhanced electrochemical nitrogen reduction by carbon-encapsulated mixed-valence Fe_(7)(PO_(4))_(6)

Electrochemical nitrogen reduction(NRR)is deemed as a consummate answer for the traditional Haber–Bosch technology.Breaking the linear correlations between adsorption and transition-state energies of intermediates is vital to improve the kinetics of ammonia synthesis and obtain a less energy-intensive process.Herein,carbon-encapsulated mixed-valence Fe_(7)(PO_(4))_(6) was prepared and applied as an electrocatalyst for high-efficiency NRR.A dramatic faradaic efficiency(FE)of 36.93%and an NH_(3) production rate of 13.1μg h^(-1) mg_(cat)^(-1) were obtained at-0.3 V versus RHE,superior to nearly all Fe-based catalysts.Experiments and DFT calculations revealed that the superior performance was ascribed to the synergistic effect of mixed-valence iron pair,which braked the linear correlations to improve the kinetics of ammonia from collaborative hydrogenation and*NH_(3) separation.This work proves the feasibility of mixedvalence catalysts for nitrogen reduction and thus opening a new avenue towards artificial nitrogenfixation catalysts.

Percutaneous reduction combined with bone graft in treatment of displaced intra-articular calcaneal fractures

Objective： To introduce the experience and key points of percutaneous reduction combined with bone graft to treat calcaneal fractures. Methods： Percutaneous reduction and internal fixation combined with bone graft was performed from April 2004 to April 2006 on 15 cases （16 sides） with intra-articular calcaneal fractures including 13 males （14 feet） and 2 females （2 feet） ,with average age of 36. 6 years （24-61 years）. All patients underwent radiography including lateral and axial views for calcaneus, oblique view for foot and three-dimensional CT imaging reconstruction. According to Sanders classification, there were 12 feet of type Ⅱ （3 type Ⅱa, 3 type Ⅱb and 8 type Ⅱc） and 2 feet of type Illac. The length of calcaneus was recovered through traction by Steinmann pin which passed through calcaneal tubercle perpendicularly and the posterior facet was elevated until reduction by a curve scissors through an 0.5 cm incision along the primary fracture line of lateral calcaneus. The calcaneus was fixed with different cannulated cancellous screws according to the type of fractures. Then bone graft was injected to fill the defect of calcaneus through lateral incision. Results： All patients were followed up for an average of 18.4 months （ranged, 12 to 34 months）. No complication such as wound infection, screw breakage and calcaneum varus was found postoperatively. The average time for bone healing was 10 weeks. The results were excellent in 12 cases, good in 4 cases according to the American Orthopaedic Foot and Ankle Society （AOFAS） hindfoot score. The rate of excellent and good clinical results was 100%. The mean AOFAS hindfoot score in tongue type group （86.5±4.4） was better than in joint depression type group （81.2±1.7, P〈0.05）. Radiography showed basic restoration of Bohler＇s angle, Gissane＇s angle and calcaneal shape. Conclusion： The combination of percutaneous reduction and injectable bone graft is suitable for surgical treatment of Sanders Ⅱ and Ⅲ type calcaneal fractures, with advantages of simple operation, fewer complications and good clinical results.

Nitrogen fixation driven by mesoscale eddies and the Kuroshio Current in the northern South China Sea and the East China Sea

N2 fixation rates(NFR,in terms of N)in the northern South China Sea(nSCS)and the East China Sea(ECS)were measured using the acetylene reduction assay in summer and winter,2009.NFR of the surface water ranged from 1.14 nmol/(L·d)to 10.40 nmol/(L·d)(average at(4.89±3.46)nmol/(L·d),n=11)in summer and 0.74 nmol/(L·d)to 29.45 nmol/(L·d)(average at(7.81±8.50)nmol/(L·d),n=15)in winter.Significant spatio-temporal heterogeneity emerged in our study:the anticyclonic eddies(AE)(P<0.01)and the Kuroshio Current(KC)(P<0.05)performed significantly higher NFR than that in the cyclonic eddies or no-eddy area(CEONE),indicating NFR was profoundly influenced by the physical process of the Kuroshio and mesoscale eddies.The depth-integrated N2 fixation rates(INF,in terms of N)ranged from 52.4μmol/(m2·d)to 905.2μmol/(m2·d)(average at(428.9±305.5)μmol/(m2·d),n=15)in the winter.The contribution of surface NFR to primary production(PP)ranged from 1.7%to 18.5%in the summer,and the mean contribution of INF to new primary production(NPP)in the nSCS and ECS were estimated to be 11.0%and 36.7%in the winter.The contribution of INF to NPP(3.0%–93.9%)also decreased from oligotrophic sea toward the eutrophic waters affected by runoffs or the CEONE.Furthermore,we observed higher contributions compared to previous studies,revealing the vital roles of nitrogen fixation in sustaining the carbon pump of the nSCS and ECS.

Percutaneous fixation of neonatal humeral physeal fracture: A case report and review of the literature

BACKGROUND Neonatal distal humeral physeal fractures are rare and difficult to diagnose.Thus,missed diagnoses and delayed healing are possible.Few studies have reported surgical treatment,because a callus may develop at the fracture site 5 d after the fracture,resulting in difficult reduction,and reduction of the limb may cause further physeal injury.Other surgical challenges include the provision of adequate anesthesia and complexity of the operation.However,without appropriate reduction and fixation,a varus elbow deformity may develop.Manual reduction and percutaneous pin fixation are ideal treatment options.CASE SUMMARY A 4-day-old neonate with left elbow pain accompanied by limited movement for 4 d was admitted,and diagnosed with delayed physeal fracture of the distal humerus based on physical examination,ultrasonography,and magnetic resonance imaging.The patient was treated by manual reduction combined with percutaneous pin fixation under arthrography.Postoperatively,the reduction was successful.The upper limbs could have been lifted and the fingers could have been moved freely on the second day after the operation.CONCLUSION The techniques of manual reduction and percutaneous pin fixation,to treat neonatal distal humeral physeal fractures,are safe and reliable.

Internal fixation and unicompartmental knee arthroplasty for an elderly patient with patellar fracture and anteromedial osteoarthritis:A case report

BACKGROUND Open reduction and internal fixation(ORIF)is the traditional surgical treatment for patellar fractures,and unicompartmental knee arthroplasty(UKA),especially Oxford UKA,has been increasingly used in patients with medial knee osteoarthritis(OA).However,the process of choosing treatment for patients with both patellar fractures and anteromedial knee OA remains unclear.We present the case of a patient with a patellar fracture and anteromedial OA.CASE SUMMARY We present the case of a 72-year-old woman with a history of bilateral medial compartment OA of the knees and a right Oxford UKA.She also experienced a recent left patellar fracture.ORIF and Oxford UKA were performed in a single stage.The patient showed excellent postoperative clinical results.CONCLUSION ORIF and Oxford UKA can be performed simultaneously for patients with patellar fracture and anteromedial OA on the same knee.

Percutaneous Pedicle Screw Fixation in Injury Vertebrate and Curving Rob Indirect Decompression for Type A3 Thoracolumbar Burst Fracture with Neurological Deficits

Objective:To explore the effectiveness of percutaneous pedicle screw fixation in injury vertebrate and curving rob indirect decompression for type A3 thoracolumbar burst fracture with neurological deficits.Method:A retrospective study was made in 26 patients with type A3 thoracolumbar burst fracture with neurological deficits from August 2014 to July 2018 treated within 3 days after injury,which were treated with percutaneous pedicle screw fixation in injury vertebrate and curving rob indirect decompression.The radiological indexs、clinical effectiveness indexs、perioperative index and complication incidence were recorded and compared to observe the clinical result.Result:All patients were followed up from 6 to 23 months.There were no nerve injury and other severe complications,which 1.1 grade of neurological recovery was observed at the final follow-up.The average operation time was(102.31±16.87)minutes,with a mean intraoperative blood loss of(87.88±13.05)ml and hospital stays were(15.53±13.00)d.Local anesthesia was 5 patients and general anesthesia were 21 patients.Before the operation,the anterior height of fracture vertebral body(98.31±13.07)%、kyphotic angle(2.76±3.70)°、the Sagittal Cobb angle(1.35±6.78)were improved to(50.19±12.32)%、(21.98±5.58)°、(16.30±8.69)°respectively after the operation(P<0.05).The anterior height of fractured vertebral body and kyphotic angle in final follow-up were worse than the post-operative,but no significant difference was found between two stages(P>0.05).The Sagittal Cobb angle in final follow-up was better than those in post-operative(P<0.05).The VAS scores had statistical improvement(P<0.05).Conclusion Posterior percutaneous pedicle screw fixation in injury vertebrate and curving rob indirect decompression in treating the type A3 thoracolumbar burst fracture with neurological deficits was a minimally invasive,safe and effective surgical procedure to intraspinal interference and direct decompression.

In-situ construction of novel sulfur-vacancy-rich Bi/Bi_(2)S_(3)/SnS_(2)Z-scheme heterostructure photocatalysts for efficient Cr(Ⅵ)reduction and nitrogen fixation

Highly competent and economical photocatalysts are one of the most charming targets in environmental restoration and clean production.Herein,a novel sulfur-vacancy-rich Bi/Bi_(2)S_(3)/SnS_(2)Z-scheme heterostruc-ture was constructed in situ and applied for the photoreduction Cr(VI)and nitrogen fixation.The fab-ricated Bi/Bi_(2)S_(3)/SnS_(2)-2 exhibits the optimum photoreduction Cr(VI)performance with the efficiency of 94.5%within 15 min visible light irradiation.The remarkably enhanced catalytic efficiency derived from the synergistic effect of the construction of intimate contacted interface,abundant sulfur vacancy and surface plasmon resonance(SPR)effect of metal Bi.Meanwhile,the excellent photocatalytic nitrogen fix-ation property(96.4μmol g^(-1)h^(-1))was achieved by Bi/Bi_(2)S_(3)/SnS_(2)-2 under full solar illumination because sulfur vacancy could provide sufficient catalytic sites to accelerate the adsorption and nitrogen activation.The Z-scheme heterostructure was proposed to expound the photocatalytic mechanism.This work offers a new perspective on hierarchical heterostructure with plentiful vacancies for environmental remediation and energy development.

骨科机器人联合Starr骨盆复位架治疗Tile C型骨盆环骨折

目的:探讨骨科机器人联合Starr骨盆复位架治疗Tile C型骨盆环骨折的临床疗效。方法:2019年10月至2021年5月采用机器人联合Starr骨盆复位架治疗14例Tile C型骨盆环骨折患者,男9例,女5例;年龄33~69岁。14例患者均为新鲜闭合骨折且不合并股骨、胫腓骨骨折等损伤。入院后4~7 d完成手术,术中在可透视碳素床,通过Starr骨盆复位架牵引复位骨盆环,联合骨科机器人治疗C型骨盆环骨折。观察手术时间、出血量、单枚螺钉置入透视次数、骨折复位质量、患肢功能及并发症等。采用Matta评分标准进行放射学复位评价,末次随访采用Majeed骨盆功能评分系统进行临床疗效评价。结果:14例患者均顺利完成手术,手术时间84~141 min,手术出血量20~50 ml,单枚螺钉置入透视次数4~9次。14例患者均获得随访,随访时间12~24个月。术后所有骨折获得骨性愈合,愈合时间3~7个月,未发现内固定断裂、螺钉松动、感染、神经损伤等并发症。依据Matta影像学复位评估标准:优9例,良4例,可1例。末次随访采用Majeed骨盆功能评分系统:优10例,良4例。结论:机器人联合Starr骨盆复位架治疗C型骨盆环新鲜骨折操作简单、缩短了手术和麻醉时间、并发症少,降低了手术风险,实现了骨盆骨折的微创治疗。但对于陈旧性骨折,因骨折复位困难,该技术并不适用。对于螺钉进钉点区域粉碎的骨折,通道螺钉置入困难,建议采用其他方式固定。对于伴有骨盆外伤史或骨盆发育异常者,术前需仔细评估有无经皮螺钉通道,避免损伤神经、血管。

两种切口钢板内固定治疗胫骨平台骨折的疗效比较

目的比较两种切口钢板内固定治疗胫骨平台骨折的疗效。方法将108例胫骨平台骨折患者按照切口不同分为观察组(采用微创切口钢板内固定治疗,54例)和对照组(采用传统切开复位钢板内固定治疗,54例)。记录两组切口长度、住院时间、骨痂形成时间、骨折愈合时间、开始部分负重行走时间、并发症发生情况、膝关节活动度、膝关节功能优良率。结果患者均获得随访,时间12~18个月。切口长度、住院时间、骨痂形成时间、骨折愈合时间、开始部分负重行走时间观察组均短(早)于对照组(P<0.05)。术后6个月,膝关节功能优良率观察组高于对照组(P<0.01),膝关节屈曲、伸直活动度观察组均优于对照组(P<0.05)。术后并发症发生率观察组低于对照组(P<0.05)。结论与传统切开复位钢板内固定相比,微创切口钢板内固定治疗胫骨平台骨折具有创伤小、住院时间短、并发症发生率低的优点,更利于骨折愈合、患者早期功能锻炼及膝关节功能的恢复。

川西冷杉林下地表苔藓固氮速率及林窗的影响

苔藓与蓝细菌的共生固氮作用为许多生态系统贡献了高达50%氮输入,是“新增”氮素的重要来源。然而,苔藓与蓝细菌共生固氮速率如何受林窗等生态系统动态影响仍然未知。本文研究了四川西部典型藓类冷杉林地表苔藓与蓝细菌的固氮速率在生长季内的动态变化,及其在林窗和林冠覆盖两种生境下的差异,并评估了苔藓含水量、气温和光照条件等因素对固氮速率的驱动作用。研究结果发现,锦丝藓(Actinothuidium hookeri)和塔藓(Hylocomium splendens)生长季平均固氮速率分别为77.49和129.69 nmol·(g·d)^(−1)。地表苔藓固氮速率在生长季不同月份的变化极大,固氮速率高峰出现在生长季早期的5月、7月、8月,基本与植物生长高峰期相符;6月苔藓含水量较低,导致苔藓几乎没有固氮活性;生长季末期的10月苔藓固氮速率较低,不及7月的1/7。相比于林冠覆盖生境,林窗提高了地表气温、光照和苔藓含水量,但从整个生长季来看,林窗对苔藓固氮速率仅表现出微弱的促进作用。综上,苔藓与蓝细菌共生体固氮速率和林窗的影响效应可以为深入认识生态系统氮循环提供依据。