<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> An open fracture is an injury in which the fracture site and/or hematom...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> An open fracture is an injury in which the fracture site and/or hematoma communicates with the external environment. It is associated with significant morbidity and disability and is a challenge to the surgical team. The lower extremities are the most often exposed to traumatic injuries compared to other anatomical parts of the body. Patterns of open fractures differ with different mechanisms of injury and the segment of the long bone affected. The correct and timely management of open fractures is beneficial to the patients and lead</span><span style="font-family:Verdana;">s</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> to a more favorable outcome. This study aimed at describing the pattern of open fractures of long bones of the lower limb treated in 3 major hospitals of the south west region, Cameroon. </span><b><span style="font-family:Verdana;">Methodology: </span></b><span style="font-family:Verdana;">This was a hospital-based retrospective review of files of patients with open fractures of long bones of the lower limb managed at the surgical units of three secondary health facilities in the South-West region of Cameroon from the 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> of January 2015 to the 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> of December 2019. The socio-demographic characteristics, clinical presentation, treatment modalities, and outcomes were recorded. The data was stored and analyzed using Epi info version 7.0 and SPSS version 23.0 respectively. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">A total of 195 files of patients aged 8 to 80 years were studied. The main age group affected was between 20</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">40 </span><span style="font-family:Verdana;">years. There were 147 (75.4%) males and 48 (24.6%) females giving a sex-ratio</span><span style="font-family:Verdana;"> of 3.1:1. The most common cause was road traffic crashes 142 (72.8%). In 98 cases (50.3%)</span></span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> the left side was more involved. The tibia was the most common long bone affected in 75 (38.5%) cases. Comminuted fracture was the most common fracture pattern encountered in 126 cases (64.6%). A total of 76 (39%) fractures were graded Gustilo-Anderson IIIA. External fixator was used in 112 cases (57.1%) and internal fixator in 86 cases (42.9%). We recorded 127 (65.1%) cases of wound infection and 143 (73.3%) cases of limb shortening as the most common complications. Other complications include</span><span style="font-family:Verdana;">: </span><span style="font-family:Verdana;">20 cases (17.1%) of mal-union, 27 cases (22.5%) of delayed union, 18 cases (15.1%) of non-union and 50 cases (38.5%) chronic osteomyelitis. We recorded a mortality of 2.1%. Gustilo IIIB and IIIC were associated to chronic osteomyelitis (P</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.02). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Open fractures of long bones of the lower limb affect the active age group of the population and road traffic crashes</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">are the most common causes. It tends to affect the left side and the tibia being the most fractured long bone. A reasonable proportion of these fractures subsequently get infected. Comminuted fracture is the common fracture pattern.</span>展开更多
OBJECTIVE: To investigate the combined effect of Traditional Chinese Medicine(TCM) decoction and low-molecular-weight heparin calcium on deep vein thrombosis(DVT) induced by surgery in patients with lower limb fractur...OBJECTIVE: To investigate the combined effect of Traditional Chinese Medicine(TCM) decoction and low-molecular-weight heparin calcium on deep vein thrombosis(DVT) induced by surgery in patients with lower limb fracture.METHODS: Totally 86 hospitalized patients with DVT after surgery of lower limb fracture between September 2012 and January 2015 were recruited and randomly divided into control group and observation group, 43 cases in each group. The patients in the control group were treated with subcutaneous injection of low-molecular-weight heparin calcium, and those in the observation group were additionally given Danshen Injection and TCM decoction. The differences between two groups in occurrence rate, medication time, therapeutic effects,recurrence rate of thrombosis, activated partial thromboplastin time(APTT), and prothrombin time(PT) were compared.RESULTS: The occurrence rate of DVT in observation group(4.65%, 2/43) was lower than that in control group(27.91%,12/43)(P<0.05). The medication time of observation group was(6.15±2.94) d, shorter than(9.76±3.12) d in the control group(P<0.05). In observation group, 2 cases of DVT were cured(2/2); in the control group, 9 cases presented therapeutic effects and the total effective rate was 75.00%(9/12). The improvement of APTT and PT in the observation group was better than that in the control group(P<0.05).CONCLUSION: Integrative TCM decoction plus low-molecularweight heparin calcium is superior to applicaton of low-molecularweight heparin calcium alone in reducing and treating DVT in the postoperative patients with lower limb fracture.展开更多
Objective:To investigate and analyze the long-term clinical effects of acupoint application combined with pneumatic compression therapy in the prevention of deep venous thrombosis after hip fracture surgery among the ...Objective:To investigate and analyze the long-term clinical effects of acupoint application combined with pneumatic compression therapy in the prevention of deep venous thrombosis after hip fracture surgery among the elderly.Methods:Sixty elderly patients who had undergone hip fracture surgery from February 2021 to February 2022 were selected as the research subjects.The patients were divided into two groups via drawing lots.Both the groups received nursing care,but the patients in the observation group were treated with TCM acupoint application combined with pneumatic compression therapy,whereas the control group received pneumatic compression therapy.The evaluation indicators included the patients’quality of life and complications.Results:The incidence of lower extremity deep vein thrombosis in the observation group was more than twice(0.3%),whereas the incidence of lower extremity complications in the control group was more than 6 times(20%).There was a significant difference between the two groups(p<0.05).Conclusion:Traditional Chinese medicine acupoint application combined with pneumatic compression therapy is beneficial for the prevention of postoperative lower extremity deep vein thrombosis among elderly patients.In addition,the patients’overall quality-of-life scores in both physiological and psychological aspects improved significantly,which carries significant clinical reference value.展开更多
Objective:To explore the anesthesia effect of ultrasound-guided nerve block in elderly patients with lower limb fractures.Methods:From November 2017 to November 2020,50 elderly patients with lower limb fractures in ou...Objective:To explore the anesthesia effect of ultrasound-guided nerve block in elderly patients with lower limb fractures.Methods:From November 2017 to November 2020,50 elderly patients with lower limb fractures in our hospital were divided into experimental group(25 cases,general anesthesia+femoral nerve and sciatic nerve block)and control group(25 cases,general body anesthesia).Compare the MAP,HR,anesthesia effect,and adverse reactions between the two groups at each time period.Results:Before induction,the difference in MAP and HR between the two groups of patients did not form,p>0.05;the MAP and HR of the experimental group were compared with the control group at the time of skin incision,1 hour during the operation,and removal of the laryngeal mask,P<0.05;the time of extubation in the experimental group(14.28±3.18)min,awake time(5.57±1.32)min,orientation recovery time(11.89±2.23)min,propofol dosage(191.36±22.48)mg,remifentanil dosage(0.23±0.04)mg,Compared with the control group,P<0.05;the adverse reaction rate of the experimental group(8%,2/25)was lower than that of the control group(32%,8/25),P<0.05.Conclusion:The use of ultrasound-guided femoral nerve and sciatic nerve block for elderly patients with lower limb fractures can enhance the effect of anesthesia,effectively reduce the use of anesthetics,and have fewer adverse reactions.It is worthy of promotion.展开更多
Stress fractures in sport are becoming increasing more common,comprising up to 10%of all of sporting injuries.Around 90%of such injuries are located in the lower limb.This articles aims to define the optimal managemen...Stress fractures in sport are becoming increasing more common,comprising up to 10%of all of sporting injuries.Around 90%of such injuries are located in the lower limb.This articles aims to define the optimal management of lower limb stress fractures in the athlete,with a view to maximise return rates and minimise return times to sport.Treatment planning of this condition is specific to the location of the injury.However,there remains a clear division of stress fractures by"high"and"low"risk."Low risk"stress fractures are those with a low probability of fracture propagation,delayed union,or non-union,and so can be managed reliably with rest and exercise limitation.These include stress fractures of the PosteroMedial Tibial Diaphysis,Metatarsal Shafts,Distal Fibula,Medial Femoral Neck,Femoral Shaft and Calcaneus."High risk"stress fractures,in contrast,have increased rates of fracture propagation,displacement,delayed and non-union,and so require immediate cessation of activity,with orthopaedic referral,to assess the need for surgical intervention.These include stress fractures of the Anterior Tibial Diaphysis,Fifth Metatarsal Base,Medial Malleolus,Lateral Femoral Neck,Tarsal Navicular and Great Toe Sesamoids.In order to establish the optimal methods for managing these injuries,we present and review the current evidence which guides the treatment of stress fractures in athletes.From this,we note an increased role for surgical management of certain high risk stress fractures to improve return times and rates to sport.Following this,key recommendations are provided for the management of the common stress fracture types seen in the athlete.Five case reports are also presented to illustrate the application of sportfocussed lower limb stress fracture treatment in the clinical setting.展开更多
Objective To observe the changes of thrombelastography (TEG) and color Doppler flow imaging (CDFI) in the perioperative period after closed lower limb fracture.Methods Fasting venous blood samples in the morning from ...Objective To observe the changes of thrombelastography (TEG) and color Doppler flow imaging (CDFI) in the perioperative period after closed lower limb fracture.Methods Fasting venous blood samples in the morning from 11 healthy adults were used展开更多
Lower limb injures are frequently observed in passenger car traffic accidents.Previous studies of the injuries focus on long bone fractures by using either cadaver component tests or simulations of the long bone kinem...Lower limb injures are frequently observed in passenger car traffic accidents.Previous studies of the injuries focus on long bone fractures by using either cadaver component tests or simulations of the long bone kinematics,which lack in-depth study on the fractures in stress analysis.This paper aims to investigate lower limb impact biomechanics in real-world car to pedestrian accidents and to predict fractures of long bones in term of stress parameter for femur,tibia,and fibula.For the above purposes,a 3D finite element(FE) model of human body lower limb(HBM-LL) is developed based on human anatomy.The model consists of the pelvis,femur,tibia,fibula,patella,foot bones,primary tendons,knee joint capsule,meniscus,and ligaments.The FE model is validated by comparing the results from a lateral impact between simulations and tests with cadaver lower limb specimens.Two real-world accidents are selected from an in-depth accident database with detailed information about the accident scene,car impact speed,damage to the car,and pedestrian injuries.Multi-body system(MBS) models are used to reconstruct the kinematics of the pedestrians in the two accidents and the impact conditions are calculated for initial impact velocity and orientations of the car and pedestrian during the collision.The FE model is used to perform injury reconstructions and predict the fractures by using physical parameters,such as von Mises stress of long bones.The calculated failure level of the long bones is correlated with the injury outcomes observed from the two accident cases.The reconstruction result shows that the HBM-LL FE model has acceptable biofidelity and can be applied to predict the risk of long bone fractures.This study provides an efficient methodology to investigate the long bone fracture suffered from vehicle traffic collisions.展开更多
AIM To determine if complete, split casts and backslabs [plaster of Paris(POP) and fiberglass] generate different intracast pressures and pain. METHODS Increased swelling within casts was modeled by a closed water sys...AIM To determine if complete, split casts and backslabs [plaster of Paris(POP) and fiberglass] generate different intracast pressures and pain. METHODS Increased swelling within casts was modeled by a closed water system attached to an expandable bag placed directly under different types of casts applied to a healthy lower limb. Complete fiberglass and POP casts, split casts and backslabs were applied. Twenty-five milliliter aliquots of saline were injected into the system and the generated intracast pressures were measured using a sphygmomanometer. The subject was blinded to the pressure scores to avoid bias. All casts were applied to the same right limb on the same subject to avoid the effects of variations in anatomy or physiology on intracast pressures. Pain levels were evaluated using the Visual Analogue Score after each sequential saline injection. Each type of cast was reapplied four times and the measurements were repeated on four separate occasions. Sample sizes were determined by a pre-study 90% power calculation to detect a 20% difference in intracast pressures between cast groups. RESULTS A significant difference between the various types of casts was noted when the saline volume was greater than 100 mL(P = 0.009). The greatest intracast pressure was generated by complete fiberglass casts, which were significantly higher than complete POP casts or backslabs(P = 0.018 and P = 0.008 respectively) at intracast saline volumes of 100 mL and higher. Backslabs produced a significantly lower intracast pressure compared to complete POP only once the saline volume within casts exceeded 225 mL(P = 0.009). Intracast pressures were significantly lower in split casts(P = 0.003). Split POP and fiberglass casts produced the lowest intracast pressures, even compared to backslabs(P = 0.009). Complete fiberglass casts generated the highest pain levels at manometer pressures of 75 mm Hg and greater(P = 0.001). Split fiberglass casts had significantly reduced pain levels(P = 0.001). In contrast, a split complete POP cast did not produce significantly reduced pain levels at pressures between 25-150 mmH g. There was no difference in pain generated by complete POP and backslabs at manometer pressures of 200 mm Hg and lower. CONCLUSION Fibreglass casts generate significantly higher intracast pressures and pain than POP casts. Split casts cause lower intracast pressures regardless of material, than complete casts and backslabs.展开更多
目的探讨筋骨疗伤膏联合补肾接骨汤对老年下肢骨折患者术后肿胀及典型Wnt/β-链蛋白(Canonical Wnt/β-catenin pathway,Wnt/β-catenin)信号通路的影响。方法收集2021年1月—2022年7月在医院骨外科进行诊治的下肢骨折患者92例,随机数...目的探讨筋骨疗伤膏联合补肾接骨汤对老年下肢骨折患者术后肿胀及典型Wnt/β-链蛋白(Canonical Wnt/β-catenin pathway,Wnt/β-catenin)信号通路的影响。方法收集2021年1月—2022年7月在医院骨外科进行诊治的下肢骨折患者92例,随机数字法分为试验组(46例)及对照组(46例)。所有受试者予以切开复位内固定术,对照组术后接受常规康复手段和热水泡脚,试验组在对照组的基础上予以筋骨疗伤膏联合补肾接骨汤。对比两组临床恢复情况、肿胀程度、疼痛评分、血液流变学指标、Wnt/β-catenin信号通路血清蛋白水平、骨痂生长情况及不良反应。数据结果应用统计学软件SPSS 19.0加以处理。结果与对照组相比,试验组完全负重锻炼、骨折愈合时间缩短,骨折延迟愈合率较低(P<0.05)。与治疗前相比,两组治疗后肿胀程度、疼痛评分均明显降低(P<0.05),与对照组相比,试验组患者肿胀程度、疼痛评分较低(P<0.05)。与治疗前相比,两组治疗后β-catenin升高,β-Ⅰ型胶原羧基端肽(βisomer of C-terminal telopeptide of type Ⅰ collagen,β-CTX)及总Ⅰ型胶原氨基端延长肽(total type Ⅰ collagen amino terminal extender peptide,T-PINP)水平均明显降低(P<0.05),与对照组相比,试验组β-catenin水平较高,β-CTX及T-PINP水平较低(P<0.05)。与治疗前相比,两组骨痂量评分、骨痂密度评分均明显升高(P<0.05),与对照组相比,试验组治疗后骨痂量评分、骨痂密度评分较高(P<0.05)。与对照组相比,试验组并发症发生率较低(P<0.05)。结论通过筋骨疗伤膏联合补肾接骨汤可减轻老年下肢骨折患者的肿胀及疼痛程度,改善血液微循环,其治疗机制可能与调节Wnt/β-catenin信号通路具有密切相关性。展开更多
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> An open fracture is an injury in which the fracture site and/or hematoma communicates with the external environment. It is associated with significant morbidity and disability and is a challenge to the surgical team. The lower extremities are the most often exposed to traumatic injuries compared to other anatomical parts of the body. Patterns of open fractures differ with different mechanisms of injury and the segment of the long bone affected. The correct and timely management of open fractures is beneficial to the patients and lead</span><span style="font-family:Verdana;">s</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> to a more favorable outcome. This study aimed at describing the pattern of open fractures of long bones of the lower limb treated in 3 major hospitals of the south west region, Cameroon. </span><b><span style="font-family:Verdana;">Methodology: </span></b><span style="font-family:Verdana;">This was a hospital-based retrospective review of files of patients with open fractures of long bones of the lower limb managed at the surgical units of three secondary health facilities in the South-West region of Cameroon from the 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> of January 2015 to the 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> of December 2019. The socio-demographic characteristics, clinical presentation, treatment modalities, and outcomes were recorded. The data was stored and analyzed using Epi info version 7.0 and SPSS version 23.0 respectively. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">A total of 195 files of patients aged 8 to 80 years were studied. The main age group affected was between 20</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">40 </span><span style="font-family:Verdana;">years. There were 147 (75.4%) males and 48 (24.6%) females giving a sex-ratio</span><span style="font-family:Verdana;"> of 3.1:1. The most common cause was road traffic crashes 142 (72.8%). In 98 cases (50.3%)</span></span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> the left side was more involved. The tibia was the most common long bone affected in 75 (38.5%) cases. Comminuted fracture was the most common fracture pattern encountered in 126 cases (64.6%). A total of 76 (39%) fractures were graded Gustilo-Anderson IIIA. External fixator was used in 112 cases (57.1%) and internal fixator in 86 cases (42.9%). We recorded 127 (65.1%) cases of wound infection and 143 (73.3%) cases of limb shortening as the most common complications. Other complications include</span><span style="font-family:Verdana;">: </span><span style="font-family:Verdana;">20 cases (17.1%) of mal-union, 27 cases (22.5%) of delayed union, 18 cases (15.1%) of non-union and 50 cases (38.5%) chronic osteomyelitis. We recorded a mortality of 2.1%. Gustilo IIIB and IIIC were associated to chronic osteomyelitis (P</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.02). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Open fractures of long bones of the lower limb affect the active age group of the population and road traffic crashes</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">are the most common causes. It tends to affect the left side and the tibia being the most fractured long bone. A reasonable proportion of these fractures subsequently get infected. Comminuted fracture is the common fracture pattern.</span>
基金2012 Science and Technology Program of Shenzhen(Grant No.:201203283)
文摘OBJECTIVE: To investigate the combined effect of Traditional Chinese Medicine(TCM) decoction and low-molecular-weight heparin calcium on deep vein thrombosis(DVT) induced by surgery in patients with lower limb fracture.METHODS: Totally 86 hospitalized patients with DVT after surgery of lower limb fracture between September 2012 and January 2015 were recruited and randomly divided into control group and observation group, 43 cases in each group. The patients in the control group were treated with subcutaneous injection of low-molecular-weight heparin calcium, and those in the observation group were additionally given Danshen Injection and TCM decoction. The differences between two groups in occurrence rate, medication time, therapeutic effects,recurrence rate of thrombosis, activated partial thromboplastin time(APTT), and prothrombin time(PT) were compared.RESULTS: The occurrence rate of DVT in observation group(4.65%, 2/43) was lower than that in control group(27.91%,12/43)(P<0.05). The medication time of observation group was(6.15±2.94) d, shorter than(9.76±3.12) d in the control group(P<0.05). In observation group, 2 cases of DVT were cured(2/2); in the control group, 9 cases presented therapeutic effects and the total effective rate was 75.00%(9/12). The improvement of APTT and PT in the observation group was better than that in the control group(P<0.05).CONCLUSION: Integrative TCM decoction plus low-molecularweight heparin calcium is superior to applicaton of low-molecularweight heparin calcium alone in reducing and treating DVT in the postoperative patients with lower limb fracture.
文摘Objective:To investigate and analyze the long-term clinical effects of acupoint application combined with pneumatic compression therapy in the prevention of deep venous thrombosis after hip fracture surgery among the elderly.Methods:Sixty elderly patients who had undergone hip fracture surgery from February 2021 to February 2022 were selected as the research subjects.The patients were divided into two groups via drawing lots.Both the groups received nursing care,but the patients in the observation group were treated with TCM acupoint application combined with pneumatic compression therapy,whereas the control group received pneumatic compression therapy.The evaluation indicators included the patients’quality of life and complications.Results:The incidence of lower extremity deep vein thrombosis in the observation group was more than twice(0.3%),whereas the incidence of lower extremity complications in the control group was more than 6 times(20%).There was a significant difference between the two groups(p<0.05).Conclusion:Traditional Chinese medicine acupoint application combined with pneumatic compression therapy is beneficial for the prevention of postoperative lower extremity deep vein thrombosis among elderly patients.In addition,the patients’overall quality-of-life scores in both physiological and psychological aspects improved significantly,which carries significant clinical reference value.
文摘Objective:To explore the anesthesia effect of ultrasound-guided nerve block in elderly patients with lower limb fractures.Methods:From November 2017 to November 2020,50 elderly patients with lower limb fractures in our hospital were divided into experimental group(25 cases,general anesthesia+femoral nerve and sciatic nerve block)and control group(25 cases,general body anesthesia).Compare the MAP,HR,anesthesia effect,and adverse reactions between the two groups at each time period.Results:Before induction,the difference in MAP and HR between the two groups of patients did not form,p>0.05;the MAP and HR of the experimental group were compared with the control group at the time of skin incision,1 hour during the operation,and removal of the laryngeal mask,P<0.05;the time of extubation in the experimental group(14.28±3.18)min,awake time(5.57±1.32)min,orientation recovery time(11.89±2.23)min,propofol dosage(191.36±22.48)mg,remifentanil dosage(0.23±0.04)mg,Compared with the control group,P<0.05;the adverse reaction rate of the experimental group(8%,2/25)was lower than that of the control group(32%,8/25),P<0.05.Conclusion:The use of ultrasound-guided femoral nerve and sciatic nerve block for elderly patients with lower limb fractures can enhance the effect of anesthesia,effectively reduce the use of anesthetics,and have fewer adverse reactions.It is worthy of promotion.
文摘Stress fractures in sport are becoming increasing more common,comprising up to 10%of all of sporting injuries.Around 90%of such injuries are located in the lower limb.This articles aims to define the optimal management of lower limb stress fractures in the athlete,with a view to maximise return rates and minimise return times to sport.Treatment planning of this condition is specific to the location of the injury.However,there remains a clear division of stress fractures by"high"and"low"risk."Low risk"stress fractures are those with a low probability of fracture propagation,delayed union,or non-union,and so can be managed reliably with rest and exercise limitation.These include stress fractures of the PosteroMedial Tibial Diaphysis,Metatarsal Shafts,Distal Fibula,Medial Femoral Neck,Femoral Shaft and Calcaneus."High risk"stress fractures,in contrast,have increased rates of fracture propagation,displacement,delayed and non-union,and so require immediate cessation of activity,with orthopaedic referral,to assess the need for surgical intervention.These include stress fractures of the Anterior Tibial Diaphysis,Fifth Metatarsal Base,Medial Malleolus,Lateral Femoral Neck,Tarsal Navicular and Great Toe Sesamoids.In order to establish the optimal methods for managing these injuries,we present and review the current evidence which guides the treatment of stress fractures in athletes.From this,we note an increased role for surgical management of certain high risk stress fractures to improve return times and rates to sport.Following this,key recommendations are provided for the management of the common stress fracture types seen in the athlete.Five case reports are also presented to illustrate the application of sportfocussed lower limb stress fracture treatment in the clinical setting.
文摘Objective To observe the changes of thrombelastography (TEG) and color Doppler flow imaging (CDFI) in the perioperative period after closed lower limb fracture.Methods Fasting venous blood samples in the morning from 11 healthy adults were used
基金supported by National Hi-tech Research and Development Program of China (863 Program,Grant No. 2006AA110101)"111 Program" of Ministry of Education and State Administration of Foreign Experts Affairs of China (Grant No. 111-2-11)+1 种基金General Motors Research and Development Center (Grant No. RD-209)Project of State Key Laboratory of Advanced Design and Manufacturing for Vehicle Body,Hunan University,China (Grant No. 60870004)
文摘Lower limb injures are frequently observed in passenger car traffic accidents.Previous studies of the injuries focus on long bone fractures by using either cadaver component tests or simulations of the long bone kinematics,which lack in-depth study on the fractures in stress analysis.This paper aims to investigate lower limb impact biomechanics in real-world car to pedestrian accidents and to predict fractures of long bones in term of stress parameter for femur,tibia,and fibula.For the above purposes,a 3D finite element(FE) model of human body lower limb(HBM-LL) is developed based on human anatomy.The model consists of the pelvis,femur,tibia,fibula,patella,foot bones,primary tendons,knee joint capsule,meniscus,and ligaments.The FE model is validated by comparing the results from a lateral impact between simulations and tests with cadaver lower limb specimens.Two real-world accidents are selected from an in-depth accident database with detailed information about the accident scene,car impact speed,damage to the car,and pedestrian injuries.Multi-body system(MBS) models are used to reconstruct the kinematics of the pedestrians in the two accidents and the impact conditions are calculated for initial impact velocity and orientations of the car and pedestrian during the collision.The FE model is used to perform injury reconstructions and predict the fractures by using physical parameters,such as von Mises stress of long bones.The calculated failure level of the long bones is correlated with the injury outcomes observed from the two accident cases.The reconstruction result shows that the HBM-LL FE model has acceptable biofidelity and can be applied to predict the risk of long bone fractures.This study provides an efficient methodology to investigate the long bone fracture suffered from vehicle traffic collisions.
文摘AIM To determine if complete, split casts and backslabs [plaster of Paris(POP) and fiberglass] generate different intracast pressures and pain. METHODS Increased swelling within casts was modeled by a closed water system attached to an expandable bag placed directly under different types of casts applied to a healthy lower limb. Complete fiberglass and POP casts, split casts and backslabs were applied. Twenty-five milliliter aliquots of saline were injected into the system and the generated intracast pressures were measured using a sphygmomanometer. The subject was blinded to the pressure scores to avoid bias. All casts were applied to the same right limb on the same subject to avoid the effects of variations in anatomy or physiology on intracast pressures. Pain levels were evaluated using the Visual Analogue Score after each sequential saline injection. Each type of cast was reapplied four times and the measurements were repeated on four separate occasions. Sample sizes were determined by a pre-study 90% power calculation to detect a 20% difference in intracast pressures between cast groups. RESULTS A significant difference between the various types of casts was noted when the saline volume was greater than 100 mL(P = 0.009). The greatest intracast pressure was generated by complete fiberglass casts, which were significantly higher than complete POP casts or backslabs(P = 0.018 and P = 0.008 respectively) at intracast saline volumes of 100 mL and higher. Backslabs produced a significantly lower intracast pressure compared to complete POP only once the saline volume within casts exceeded 225 mL(P = 0.009). Intracast pressures were significantly lower in split casts(P = 0.003). Split POP and fiberglass casts produced the lowest intracast pressures, even compared to backslabs(P = 0.009). Complete fiberglass casts generated the highest pain levels at manometer pressures of 75 mm Hg and greater(P = 0.001). Split fiberglass casts had significantly reduced pain levels(P = 0.001). In contrast, a split complete POP cast did not produce significantly reduced pain levels at pressures between 25-150 mmH g. There was no difference in pain generated by complete POP and backslabs at manometer pressures of 200 mm Hg and lower. CONCLUSION Fibreglass casts generate significantly higher intracast pressures and pain than POP casts. Split casts cause lower intracast pressures regardless of material, than complete casts and backslabs.
文摘目的探讨筋骨疗伤膏联合补肾接骨汤对老年下肢骨折患者术后肿胀及典型Wnt/β-链蛋白(Canonical Wnt/β-catenin pathway,Wnt/β-catenin)信号通路的影响。方法收集2021年1月—2022年7月在医院骨外科进行诊治的下肢骨折患者92例,随机数字法分为试验组(46例)及对照组(46例)。所有受试者予以切开复位内固定术,对照组术后接受常规康复手段和热水泡脚,试验组在对照组的基础上予以筋骨疗伤膏联合补肾接骨汤。对比两组临床恢复情况、肿胀程度、疼痛评分、血液流变学指标、Wnt/β-catenin信号通路血清蛋白水平、骨痂生长情况及不良反应。数据结果应用统计学软件SPSS 19.0加以处理。结果与对照组相比,试验组完全负重锻炼、骨折愈合时间缩短,骨折延迟愈合率较低(P<0.05)。与治疗前相比,两组治疗后肿胀程度、疼痛评分均明显降低(P<0.05),与对照组相比,试验组患者肿胀程度、疼痛评分较低(P<0.05)。与治疗前相比,两组治疗后β-catenin升高,β-Ⅰ型胶原羧基端肽(βisomer of C-terminal telopeptide of type Ⅰ collagen,β-CTX)及总Ⅰ型胶原氨基端延长肽(total type Ⅰ collagen amino terminal extender peptide,T-PINP)水平均明显降低(P<0.05),与对照组相比,试验组β-catenin水平较高,β-CTX及T-PINP水平较低(P<0.05)。与治疗前相比,两组骨痂量评分、骨痂密度评分均明显升高(P<0.05),与对照组相比,试验组治疗后骨痂量评分、骨痂密度评分较高(P<0.05)。与对照组相比,试验组并发症发生率较低(P<0.05)。结论通过筋骨疗伤膏联合补肾接骨汤可减轻老年下肢骨折患者的肿胀及疼痛程度,改善血液微循环,其治疗机制可能与调节Wnt/β-catenin信号通路具有密切相关性。