Abstract:Neck trauma carries a high mortality risk due to the inherent complexity of its anatomical struc-tures.Airway injuries,among the most critical complications of neck trauma,constitute a major risk factor for early mortality.Consequently,prompt and effective airway management is paramount for successful rescue.Multidiscipli-nary team cooperation enhances the success rate of managing difficult airways in neck trauma patients and reduces associated complications.Within this collaborative framework,the medical staff of Otorhinolaryngology-Head and Neck Surgery plays a key role in managing the airway and reconstructing laryngeal function.Accordingly,this manu-script reviews the mechanisms of airway injuries in neck trauma,airway management techniques,and perioperative airway management strategies,aiming to offer practical insights for clinicians.

Abstract:Objective To investigate the clinical efficacy of arthroscopically-assisted K-wire internal fixa-tion in the treatment of fifth metacarpal neck fractures.Methods A retrospective analysis was conducted on 17 pa-tients with fifth metacarpal neck fractures treated in our department using arthroscopically-assisted K-wire internal fixation between Mar.2022 and Mar.2024.This cohort included 13 males and 4 females,aged 22-59 years(mean 38.2 years).Injury mechanisms included clenched-fist trauma(12 cases),road traffic injuries(2 cases),machine crush injuries at work(2 cases),and ground-level falls(1 case).All patients underwent surgery within one week post-injury.Intraoperatively,continuous traction reduction was applied using an arthroscopic tower,and percutaneous pinning was performed under fifth metacarpophalangeal joint arthroscopic guidance for accurate positioning and di-rection.After satisfactory fluoroscopic confirmation,the K-wire ends were bent and left exposed externally.The op-eration time,fluoroscopy frequency,and K-wire insertion attempts were recorded.At 4 weeks postoperatively,radio-graphic union was assessed,and internal fixation was removed as appropriate.Pain was evaluated using the visual analog scale/score(VAS),while joint and hand function were assessed using the total active movement(TAM)and the Michigan hand outcomes questionnaire(MHQ).Results The 17 patients were followed up for 6-24 months(mean 13.5 months).Mean operation time was(30.7±5.8)min,with intraoperative fluoroscopy of(4.3±1.7)times and K-wire insertion attempts of(3.2±1.3)times.No postoperative complications such as fixation failure or wound infection occurred.K-wires were removed at 4-5 weeks postoperatively(mean 4.4 weeks).At the 6-month follow-up,TAM was excellent in 15 cases and good in 2 cases,yielding an excellent-good rate of 100%.The mean MHQ score was(94.2±2.7)points.Conclusion The arthroscopically-assisted K-wire internal fixation for fifth metacarpal neck fractures offers advantages of minimal invasion,rapid and safe operation,quick postoperative func-tional recovery,and few complications.This technique is worthy of further clinical promotion.

Abstract:Blast-induced auditory organ injury refers to the complex damage to the external/middle ear,cochlea,and central auditory pathways from intense explosion shockwaves or high-intensity impulse noise.This multi-system trauma manifests clinically as conductive,sensorineural,or mixed hearing loss,frequently accompanied by tin-nitus and vertigo.Conductive hearing loss could often be improved through surgical intervention.Sensorineural hear-ing loss caused by blast should be treated as early as possible,and drugs that improve microcirculation in the inner ear and promote cell metabolism can be given to improve hearing.This manuscript delineates recent mechanistic in-sights and evaluates evolving interventions,synthesizing preclinical models,clinical studies,and preventive strategies to advance evidence-based management of blast-related auditory organ injuries for otologists and hearing specialists.

Abstract:Objective To analyze the degree of temporal bone pneumatization among various injury charac-teristics in patients with facial paralysis following temporal bone fractures,and to explore the potential influence of pneumatization on these injury characteristics.Methods A retrospective analysis was conducted on 42 patients(36 males,6 females;mean age 36.2 years,ranging 16-64 years)with facial paralysis caused by temporal bone fractures who were treated at the Second Affiliated Hospital of Air Force Medical University between Jun.2015 and Jun.2024.The degree of temporal bone pneumatization was assessed using high-resolution temporal bone CT.Differences in pneumatization were compared across four injury characteristics:ossicular chain dislocation(n=27),elevated bone-conduction thresholds(n=12),facial nerve injury segments(geniculate ganglion:n=23;horizontal segment:n=16;vertical segment:n=3),and bony fragment compression of the facial nerve(n=11).Results Patients with ossicular chain dislocation had a lower rate of patients with≥grade Ⅲ pneumatization in the pericarotid air cells(25.9％,7/27),compared with those without dislocation(60.0％,9/15,P=0.036).Infralabyrinthine pneumatiza-tion≥grade Ⅲ was absent in the dislocation group(0),but present in 33.3％of the non-dislocation group(5/15,P=0.023).Among patients with elevated bone-conduction thresholds,the proportion of patients with≥grade Ⅲpericarotid pneumatization(16.7％,2/12)was much lower than that among those without threshold elevation(46.7％,14/30,P=0.016).Similarly,infralabyrinthine pneumatization≥grade Ⅲ was absent in the threshold ele-vation group(0)but present in 16.7％of the non-elevated group(5/30,P=0.025).No significant pneumatization differences were observed between patients with or without geniculate ganglion injury across the retrosigmoid,petrous apex,infralabyrinthine,or perigeniculate regions(all P>0.05).However,perigeniculate pneumatization≥grade ⅢI was significantly more frequent in patients with facial nerve compression by bony fragments(81.8％,9/11),com-pared with those without compression(32.3％,10/31,P=0.013).Conclusion Higher pneumatization of the peri-carotid and infralabyrinthine air cells may protect against ossicular chain dislocation and hearing threshold elevation,whereas increased perigeniculate pneumatization may predispose to fracture fragment compression of the facial nerve.

Abstract:Rapid and massive fluid resuscitation and blood transfusion are required in the rescue of patients with traumatic hemorrhagic shock(THS).The warming and pressurization equipment is an important positive factor affecting the treatment effects,which improves the rescue success rate of THS patients.This manuscript reviews the research progress of rapid fluid resuscitation equipment from the aspects of pressurization technical equipment,fluid rewarming methods and effects,etc.,meanwhile,to analyze the recent deficiencies.With the development of artifi-cial intelligence technology,intelligent,automated and compact-sized rapid warming transfusion devices are the future direction,which would play a greater role in improving the success rate of THS management.

Abstract:Objective To summarize the clinical characteristics,diagnostic and therapeutic approaches,and associated risk factors of migratory cervical foreign bodies secondary to esophageal perforation.Methods A retro-spective analysis was conducted on 74 patients with ingested foreign bodies admitted to our department between Jan.2018 and Jan.2025.Among them,31 cases(13 males,18 females;mean age 60.9 years,ranging 29-91 years)ex-hibited esophageal perforation with migratory cervical foreign bodies into the periesophageal tissues,as confirmed by preoperative cervical CT.A control group of 43 patients(18 males,25 females;mean age 58.7 years,ranging 24-90 years)with esophageal foreign bodies admitted during the same period,as indicated by CT,was included.Surgical strategies were tailored based on the location of the foreign body.Basic data,surgical details,postoperative complica-tions,and clinical outcomes were collected.The two groups were compared regarding the types of ingested foreign bodies,mean initial medical consultation time,duration of nasogastric tube retention,and hospitalization length.Risk factors for foreign body migration were analyzed.Results Clinical manifestations of the 31 patients with migratory cervical foreign bodies included odynophagia in 20 cases(64.5%),foreign body sensation in 17 cases(54.8%),neck pain in 13 cases(41.9%),fever in 6 cases(19.4%),and dyspnea in 3 cases(9.7%).The types of foreign bodies were fish bones in 25 cases(80.6%),metal wires in 3 cases(9.7%),and chicken bones in 3 cases(9.7%).Complications arising from migratory cervical foreign bodies included neck abscess in 11 cases(35.5%),mediastinal abscess in 5 cases(16.1%),and retropharyngeal abscess in 1 case(3.2%).All the 31 pa-tients underwent lateral neck incision for foreign body removal,with concurrent abscess incision and drainage per-formed when neck or mediastinal abscesses were present.Postoperative complications mainly included hoarseness in 1 case(3.2%)and choking during eating in 3 cases(9.7%).In contrast,patients with esophageal foreign bodies primarily presented with pharyngeal pain,odynophagia,foreign body sensation,and localized neck pain.The types of foreign bodies in this group included fish bones in 29 cases(67.4%),chicken bones in 5 cases(11.6%),duck bones in 4 cases(9.3%),pork bones in 2 cases(4.7%),jujube pits in 2 cases(4.7%),and dentures in 1 case(2.3%).No significant preoperative complication was observed in this group,and esophagoscopic foreign body re-moval was performed without notable postoperative complications.Compared to patients with esophageal foreign bodies(n=43),those with migratory cervical foreign bodies(n=31)showed that fish bone ingestion[25(80.6%)vs.29(67.4%),OR=2.01]and initial medical consultation time>24 h[27(87.1%)vs.9(20.9%),OR=25.50]were significant risk factors for foreign body migration outside the esophagus(all P<0.001).Conclusion Esophageal impaction of ingested foreign bodies predominantly involves sharp objects.Sharp foreign bodies and an initial medical consultation time>24 h are risk factors for esophageal perforation and foreign body migration.Migratory cervical foreign bodies require open surgical intervention,with favorable surgical out-comes.Esophageal foreign bodies should be managed promptly to prevent migration and severe complications.

Abstract:Objective To observe the short-and long-term efficacy of surgical treatment for ear-related complications of temporal bone fractures(TBF).Methods This study retrospectively analyzed clinical data of 26 TBF patients with ear complications who received surgical treatment at our department from Apr.2018 to Apr.2025.There were 17 males and 9 females,with the age ranging from 14 to 61 years(average age:35.4 years).The injury causes included 14 cases of falls,9 road traffic accidents,2 falls from heights,and 1 blast injury.Ear-related complications included hearing loss in 26 cases,facial nerve palsy in 8 cases,tinnitus in 12 cases,cerebrospinal fluid otorrhea in 1 case,and vestibular dysfunction in 2 cases.The TBF types,complication distributions,treatment plans,and short-and long-term prognostic outcomes were collected and analyzed.Results Among the 26 patients,there were 13 cases of longitudinal fractures,4 transverse fractures,4 mixed fractures,and 5 unclassifiable.Regarding the otic capsule involvement,23 cases were otic capsule sparing and 3 were otic capsule violating.All the included pa-tients were treated surgically,i.e.,tympanotomy with ossicular chain reconstruction was performed in 19 cases,with outcomes categorized as marked effectiveness in 11 cases,effectiveness in 4 cases,and ineffectiveness in 4 cases;concurrent facial nerve decompression was performed in 2 cases,both of which achieved postoperative recovery to House-Brackmann grade Ⅱ;and cochlear implantation was successfully performed in 7 cases.All the patients were discharged uneventfully.Conclusion The predominant types of TBF among the enrolled patients were longitudinal fractures and otic capsule sparing.Early identification and comprehensive assessment of TBF types and ear-related complications are crucial for clinical diagnosis and treatment.For different types of TBF complications,correct and reasonable surgical strategies are key to improving the prognosis and efficacy.

Abstract:The abnormal gait formation in patients with chronic ankle instability(CAI)is primarily related to the weakened strength and control ability of the muscles surrounding the ankle joint.Surface electromyography(sEMG)can objectively and quantitatively reflect the activity status of muscles and has significant application value in gait analysis for CAI patients.This manuscript explores the application of sEMG in gait analysis for CAI patients,from the aspects of sEMG characteristics of relevant muscles,abnormal gait manifestations,and gait analysis based on sEMG.In particular,the authors focus on the research progress of sEMG in analyzing abnormal gait in CAI patients,emphasizing the application of sEMG in studying the activity characteristics of muscles related to abnormal gaits and abnormal gait patterns.

Abstract:Objective To investigate the relationship between prognostic nutritional index(PNI)and clin-ical outcomes and prognosis in geriatric trauma patients.Methods A total of 1,025 trauma patients aged≥65 years hospitalized in Tongji Hospital from May 2018 to May 2022 were included.PNI was calculated based on initial serum albumin concentration and lymphocyte count after admission.Patients were divided into survival group(n=965)or death group(n=60)based on the in-hospital outcomes.Univariate analysis and multivariable logistic re-gression analysis were utilized to find independent risk factors for in-hospital death of geriatric trauma patients;re-ceiver operating characteristic(ROC)curve analysis was performed to calculate the optimal cut-off value of PNI;relative risk(RR)was calculated to assess the risk of PNI with in-hospital clinical outcomes and complications;and survival curve was drawn to investigate the prediction of PNI for in-hospital death risk.Results Among the 1,025 geriatric trauma patients,60 died during hospitalization,with a mortality of 5.9%.The PNI in patients in the death group was 35.90(range 30.05-41.44),much lower than that in the survival group(42.30,range 38.05-45.68,P<0.05).Logistic regression analysis showed that independent risk factors for in-hospital mortality of geriatric trauma patients were age(OR=1.110,95%CI:1.055-1.167),ISS(OR=1.084,95%CI:1.055-1.114),WBC(OR=1.107,95%CI:1.049-1.169),serum Na+(OR=1.134,95%CI:1.049-1.226)and PNI(OR=0.945,95%CI:0.902-0.989).The optimal cut-off value of PNI was 37.5.Patients were then divided into low-PNI and high-PNI groups based on the optimal cut-off value.Compared with the high-PNI group,the low-PNI patients showed much higher risks of in-hospital death(RR=5.788,95%CI:3.472-9.647),in-hospital pneumonia(RR=3.201,95%CI:2.571-3.984),sepsis(RR=5.843,95%CI:2.507-13.618),deep vein thrombosis(RR=2.649,95%CI:1.876-3.740),hospitalization duration≥30 d(RR=2.519,95%CI:2.009-3.159)and ICU stay≥7 d(RR=3.010,95%CI:2.509-3.611).Conclusion PNI serves as an independent risk factor for in-hospital mortality in geriatric trauma patients.A decreased PNI value is significantly associated with increased risks of death and various complications,as well as prolonged hospital stay.Therefore,incorporating PNI into the admission assessment for ear-ly evaluation of nutritional status and prognostic risk stratification of geriatric trauma patients can help identify high-risk patients and guide clinical interventions,demonstrating important predictive value for improving patient out-comes.

Abstract:Chronic ankle instability(CAI)is a common ankle injury,which is manifested by ankle pain,swelling,weakness,instability and frequent sprain.At present,there are still many difficulties and controversies in the treatment of CAI,without any standardized treatment protocol.Simultaneously with the continuous development of arthroscopic skills in the field of joint surgery,arthroscopy has been increasingly applied in CAI management,show-ing a trend to replace open surgeries.In this paper,the latest progress,indications and curative effects of CAI by open surgeriesor arthroscopy were introduced in detail,in order to provide help and reference for clinical choices.

Abstract:Currently,nearly 3000 trauma centers in China are confronted with the issues of lagging entity construction,insufficient standardization,and lack of standardized operating mechanisms.To address these challen-ges,this paper proposes the"trauma+X"model,which,based on trauma rescue,extends the medical service scope of trauma centers to other related diseases like surgical critical illness,acute general surgery,etc.(named as"X"),to ensure them a stable patient resource and technological continuity.Operated under this mode,a trauma center can carry out in-depth clinical practice and research focusing on skilled fields,which brings specialized effects.In the near future,with the further development of pre-hospital triage and inter-hospital referral systems,more trauma cen-ters may implement the"trauma+X"mode to promote sustainable development of trauma medicine in China.

Abstract:Objective To develop and validate a risk prediction model for venous thromboembolism(VTE)in trauma patients based on clinical risk factors,thus providing reference for precise intervention of high-risk VTE trauma patients.Methods A total of 996 hospitalized trauma patients admitted to West China Hospital of Si-chuan University from Jun.to Dec.2021 were retrospectively analyzed.Patient information and possible risk factors were collected through the hospital information system.Factors with statistically significant differences between VTE and non-VTE patients were selected for further multivariable logistic regression analysis using the Boruta method,to obtain the final model and draw a nomogram to visualize the risk.Internal validation was performed using the boot-strap method,and the discrimination,calibration,and clinical capability of the nomogram prediction model were eval-uated using the area under the curve(AUC),calibration curve,and decision curve analysis.Results Among the 996 patients,252 cases had VTE,with the incidence being 25.30%(95%CI:0.227-0.281).The final prediction model included 10 risk factors:age,body mass index,injury severity score,upper limb injury,lower limb injury,pel-vic injury,central venous catheter,blood transfusion,length of surgery,and admission to ICU.Internal validation showed that the AUC of the model was 0.796(95%CI:0.767-0.825),with a sensitivity of 0.790,and a specificity of 0.653.The Hosmer-Lemeshow test revealed that χ2=5.559 and P=0.697.The model's Brier score was0.146,and the decision curve analysis showed that the model had positive net benefit within the threshold probability range of 0.01-0.96.Conclusion This study constructs a10-factor VTE risk prediction model for trauma patients and visu-alizes it using a nomogram.The model has good discriminative ability and calibration,and a good clinical capability range,which can be clinically applied in combination with interventions in the future.

Abstract:Objective To investigate the effects of complete thoracoscopic internal fixation on surgical trau-ma and other related indicators of patients with rib fractures.Methods A retrospective analysis was conducted on 125 patients with rib fractures who required surgical treatment at our department from Jun.2022 to Jun.2024.There were 78 males and 47 females,aged31-70 years,with an average of 47.8 years.The fracture locations were divided into 7 types:anterior rib in 8 cases,lateral rib in 5,posterior rib in 19,anterior+lateral ribs in 5,anterior+posterior ribs in 60,lateral+posterior ribs in 12,and anterior+lateral+posterior ribs in 16 cases.The causes of in-juries were 54 cases of road accident injuries,33 falls from height,24 ground-level falls,and 14 crush injuries.A-mong them,98 were combined with traumatic hemopneumothorax,and 27 with flail chest.Primary diseases included 58 cases of hypertension,53 diabetes,and 14 coronary heart disease.The injury severity score(ISS)was 9-16,with an average of 13.8.According to the surgical method,patients were divided into endoscopic group(minimally invasive complete thoracoscopic rib fracture internal fixation,n=64)and open surgery group(traditional rib fracture internal fixation,n=61).Incision trauma index,surgical trauma index,operation time,intraoperative bleeding,post-operative drainage volume and drainage tube removal time of different rib fracture locations were observed.Results Comparison between the endoscopic and open surgery groups revealed significantly less trauma in the former when the rib fracture was located at posterior,anterior+posterior,lateral+posterior,and anterior+lateral+posterior(the incision trauma index:3.6±2.4 vs.7.6±4.5,4.2±2.8 vs.9.5±4.2,3.1±1.7 vs.8.3±2.6,and 5.3±1.8 vs.11.3±3.9,all P<0.001;the surgical trauma index:19.5±10.9 vs.32.3±16.4,21.6±14.7 vs.33.1±16.4,20.7±18.6 vs.34.9±20.6,22.6±17.6 vs.37.9±19.4,all P<0.001).Moreover,other surgery relevant indicators were much minimal in the endoscopic group than in the open surgery group for the abovementined four types of rib fracture locations,i.e.,posterior,anterior+posterior,lateral+posterior,and anterior+lateral+posterior(operation time,min,109.8±13.6 vs.152.6±15.3,129.4±11.5 vs.154.2±13.4,127.5±14.6 vs.155.3±16.6,and 140.6±16.3 vs.167.6±17.4,all P<0.001;perioperative bleeding,mL,70.5±21.3 vs.95.3±22.1,72.9±22.5 vs.92.4±25.2,80.2±21.9 vs.96.7±24.1,and 122.4±26.6 vs.167.8±24.4,all P<0.001;postoperative drainage volume,mL,787.8±23.6 vs.830.4±24.6,821.6±24.2 vs.887.8±27.9,820.7±28.7 vs.874.9±26.6,and 842.9±32.8 vs.933.5±33.4,all P<0.001;drainage tube removal time,d,2.9±1.9 vs.3.3±1.4,2.6±1.7 vs.3.4±1.4,2.7±1.6 vs.3.9±0.6,2.6±1.6 vs.3.9±1.4,all P<0.001).However,the incision or surgical trauma indexes,operation time,perioperative bleeding,postoperative drainage volume,and drainage tube removal time revealed no significant differences between the endoscopic and open surgery groups when the rib fracture locations were anterior,lateral,and anterior+lateral(all P>0.05).Conclusion Compared with traditional open rib fracture internal fixation,thoracoscopic internal fixations induce less trauma in patients with sim-ple posterior rib fractures or combined with posterior rib fractures.

Abstract:Objective To explore the application effect of arterial embolization intervention combined with pelvic stabilization technique in the early treatment of hemodynamically unstable pelvic fractures and to assess the influence on the incidence of complications.Methods Clinical data of 103 patients with hemodynamically unstable pelvic fractures who were admitted to the Emergency Department,Changsha Traditional Chinese Medicine Hospital-from Mar.2021 to Mar.2024 were retrospectively selected.In the combined group,there were 51 cases that under-went arterial embolization intervention combined with pelvic stabilization;while in the control group,there were 52 cases that received pelvic stabilization alone.The HR,MAP,central venous pressure(CVP),shock index,recovery time of coagulation function,lactate clearance time,shock correction time,ICU treatment time,total length of hospital stay,operation time,success rate of hemostasis within 24 h after operation,dosage of norepinephrine,infusion volume of crystal fluid,blood transfusion volume(plasma infusion volume and concentrated red blood cell infusion volume),and complications were compared after treatment.Results After treatment in both groups,HR and shock index de-creased significantly,while MAP and CVP increased significantly(all P<0.05 compared with those before treat-ment).Moreover,the HR(beats/min)and shock index of the combined group were 105.9±7.2 and 0.76±0.25 respectively,whichweremuchlower than those of the control group(110.4±9.5 and 1.05±0.45);while the MAP(mmHg)and CVP(cmH2 O)were 79.6±10.0 and 5.3±1.5 respectively,which were much higher than those of the control group(71.1±9.3 and(4.4±1.3),all revealing significant differences between the two groups(P<0.05).Besides,the combined group showed much quicker recovery of coagulation function,lactic acid clear-ance,shock correction,as well as ICU and total hospital discharge,together with a much higher success rate of hemo-stasis within 24 h after surgery,but significantly longer operation time(all P<0.05).The dosage of norepinephrine and the input volume of crystal fluid,plasma and concentrated red blood cells in the combined group were all signifi-cantly less than those in the control group(all P<0.05).The incidence of disseminated intravascular coagulation,multiple organ failure and persistent hemorrhagic shock presented no statistically significant difference between the two groups(all P>0.05).The mortality rate,infection rate,acidosis rate,and anemia incidence rate of the com-bined group were 1.9%,3.9%,1.9%and5.8%respectively,which were all significantly lower than those of the control group(13.4%,17.3%,15.3%,23.0%,all P<0.05).Conclusion Compared with the simple perform-ance of pelvic stabilization,arterial embolization intervention combined with pelvic stabilization is more conducive to controlling bleeding,rapidly restoring hemodynamic stability and reducing mortality and complication rates.

Abstract:Objective To investigate the effects of mechanical stimulation with different intensities on the early healing of the Achilles tendon-calcaneus interface in rats,via using a rat model of Achilles tendon insertion re-pair surgery under varying treadmill training intensities.Methods After 1 week of adaptive treadmill training,60 rats were randomly divided into three groups after establishing the calcaneal suture model(1)control group:cage fed,free to move;(2)low-intensity exercise group:treadmill training at 10 m/min for 20 min/day;and(3)high-intensity exercise group:treadmill training at 17 m/min for 20 min/day.On postoperative days 7 and 10,three rats from each group were randomly euthanized,and the right Achilles tendon-calcaneus interface was harvested as the in-flammatory-phase specimen for gross observation.The day-10 rat samples were further processed for histological as-sessment of the inflammatory phase.At 4 weeks post-surgery,an open-field test was performed on the remaining rats in each group,after which the right Achilles tendon-calcaneus interface was harvested for gross inspection,histologi-cal evaluation,and biomechanical testing.Results At 7 and 10 days post-surgery,all groups exhibited the formation of abundant loose paratenon connective tissue.The low-intensity group showed significantly less paratenon connective tissue compared to the control and high-intensity groups,with the tissue being denser and more organized.Histologi-cally,at 10 days post-surgery,all groups displayed substantial inflammatory tissue filling the space between tendon and bone tissues.The low-intensity group exhibited more regular tendon-bone contact and relatively less inflammatory tissue compared to the control and high-intensity groups.At 4 weeks post-surgery,the low-intensity group demonstra-ted significantly longer movement distance(cm)in the open field test(1097.8±216.1),compared to the control(610.3±107.1)and high-intensity(286.6±56.5 cm)groups(both P<0.001).The low-intensity group also showed the least scar formation and tissue swelling at the tendon-bone interface among all groups.Histologically,the low-intensity group exhibited a denser tendon-bone interface tissue structure compared to the other two groups.The interface contained a more uniform distribution of fibrocartilage-like tissue,with a higher content than the other two groups.Biomechanically,the low-intensity group showed significantly greater maximum load(N,43.5±9.4)and e-lastic modulus(N/mm,17.1±6.7),compared to the control(N,33.4±4.2,P<0.01;N/mm,11.0±4.2,P<0.05)and high-intensity(N,30.1±2.5,P<0.001;N/mm,9.2±3.5,P<0.01)groups.Conclusion Low-in-tensity mechanical stimulation,compared to no stimulation or high-intensity stimulation,promotes early healing of the tendon-bone interface following Achilles tendon-calcaneus repair in rats.

Abstract:Objective To investigate the effect of a portable thermal insulation device,equipped with self-heating individual meal packs as the heating source,on the rewarming of severely burned domestic rabbits in the ear-ly stage under extremely cold conditions.Methods Altogether 18 healthy domestic adult rabbits weighing(3.50±0.20)kg were numbered randomly as 1-18 and then divided into two groups,namely group A(odd numbers,the study group)and group B(even numbers,the control group).Each group contained 9 rabbits.Then,the animal model of 30%total body surface area(TBSA)with 3rd-degree skin burns was performed.For each group,the ani-mals were placed in a 2.5 kg military sleeping bag separately after modeling,and then each of the bag were put into an ultra-low temperature freezer set at-30 ℃.Meanwhile,each rabbit was supplied with oxygen and treated with the same anti-shock rehydration.For group A,the sleeping bag was equipped with two 20-patten self-heating individual meal packs as the heat source,which were replaced every 15 min.The pulse indicator continuous cardiac output technology was adopted to monitor the changes in body temperature and cardiac output at 2,4,6 and 8 h after injury.Results At 2,4,6,and 8 h post-injury,the mean body temperatures(℃)of rabbits in both groups were decreasing continuously,but the decreasing trend was milder in group A,and comparison between the two groups revealed signif-icant differences at all time points(38.97±0.60 vs.38.08±0.35,38.56±0.42 vs.36.60±0.21,38.31±0.33 vs.35.07±0.37,38.23±0.39 vs.33.41±0.47,all P<0.05).At4,6,and8 h post-injury,the mean cardiac output(L/min)in both groups decreased too,but significantly milder in group A(0.84±0.05 vs.0.71±0.06,0.75±0.04 vs.0.52±0.03,0.72±0.02 vs.0.43±0.03,all P<0.01).Conclusion Under extremely low tem-perature,rabbits with severe burns,though with warming interventions,show decreased body temperature and cardiac output,but the insulation devices utilizing self-heating individual meal packs as a heat source can significantly miti-gate the decreasing trend at an early stage after severe burns,effectively maintaining the core temperature,and markedly reducing the impact of anextremelylow-temperature environment.

Abstract:Objective To establish a model of uncontrolled hemorrhagic shock(UHS)caused by com-bined thoracoabdominal injuries in beagle dogs,to stimulate unexpected rescue emergencies during sanitary train e-vacuation,and to promote rescue skills.Methods This animal experiment was conducted on 18 beagle dogs of ap-proximately 2 years old and 9-15 kg weight,11.8 kg on average.The dogs were randomly divided into three groups u-sing the random number table:group A(control group,trauma dogs without shock modeling or resuscitation treat-ment),group B(autologous blood transfusion group,shock dogs receiving autologous blood transfusion),and group C(limited resuscitation group,shock dogs undergoing resuscitation with lactated Ringer's solution).Anesthesia in-duction was carried out at a field training site.A combined thoracoabdominal injury model was constructed on all the animals,i.e.,hemopneumothorax by modified Wigger's method and abdominal wall puncture by using a sharp knife.After modeling(recorded as 0 min),the dogs were handled according to 4 experimental periods:(1)0-60 min:animals were transferred to the sanitary train,and those in groups B and C underwent bloodletting to simulate hemorrhagic shock;(2)60-120 min:resuscitation treatment with autologous blood transfusion(group B)or lactated Ringer's solution(group C);(3)120-180 min:preoperative preparation;(4)180-300 min:surgical treatment,including thoracic drainage and exploratory laparotomy for abdominal hemostasis.The parameters of mean arterial pressure(MAP),central venous pressure(CVP),arterial blood lactic acid(Lac),arterial blood base excess(BE),alanine aminotransferase(ALT),creatinine(Cr),hemoglobin content(Hb),hematocrit(HCT),red blood cell count(RBC),prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT),and fibrinogen(FIB)were recorded at the five time points of 0,60,120,180,and 300 min.Results All the 18 experi-mental dogs were successfully modeled and survived after 72 h.Compared with group A,groups B and C showed sig-nificantly lower MAP,CVP,RBC,and BE at 60 min after bloodletting(all P<0.05),along with significantly higher Lac,ALT,and Cr(all P<0.05).At120 min after resuscitation,MAP in group B increased rapidly but didnot ex-ceed that in group A(mmHg,73.8±4.5 vs.84.3±5.5,P<0.05),while MAP in group C remained at a low level compared with group A(mmHg,50.3±3.5 vs.84.3±5.5,P<0.001);CVP showed a similar trend to MAP.Af-ter the treatment surgeries(300 min),group B showed much better results than group C in terms of Hb(g/L,113.2±4.2 vs.93.2±8.3),RBC(×1012/L,5.12±0.3vs.4.02±0.4),BE(mmol/L,-4.60±0.23 vs.-7.61±0.24),Lac(mmol/L,6.42±0.46 vs.9.32±0.43),ALT(U/L,53.5±1.4 vs.73.2±2.3),Cr(μmol/L,51.6±1.9 vs.66.6±1.4),FIB(g/L,6.64±0.62 vs.8.73±0.41)(all P<0.01),but PT,APTT,and TT revealed no statistically significant differences between the two groups(all P>0.05).Conclusion This study successfully es-tablished a UHS model of combined thoracoabdominal injuries in beagle dogs.Both autologous blood transfusion and limited resuscitation were effective.Our animal model is helpful formedical training of UHS rescue in field rescue and during sanitary train evacuation.

Abstract:Acute compartment syndrome(ACS)refers to a series of early syndromes caused by acute ische-mia of muscles and nerves within the osteofascial compartment,which is formed by bones,interosseous membranes,muscle septa,and deep fascia.It is most commonly seen in the volar aspect of the forearm and the lower leg.Delayed diagnosis and treatment of ACS often lead to limb dysfunction,contracture deformities,or even amputation in severe cases,seriously impairing the patient's quality of life.At present,the treatment of ACS is mainly based on the prin-ciple of thorough decompression.With the in-depth research on the mechanism of ACS,it has been found that inflam-mation is closely associated with ACS and runs through the entire process of its occurrence and development.There-fore,treating ACS from the perspective of"anti-inflammation"may be effective.Thus,starting from the inflammatory mechanism,this review collects domestic and international experimental findings on the relationship between ACS and the inflammatory mechanism,aiming to provide a new direction for its treatment.

Abstract:Objective To explore the application of Pie-crusting technique in posterior horn injury of the medial meniscus and its impact on gait characteristics.Methods A total of 112 patients with posterior horn injury of the medial meniscus and admitted to the First Affiliated Hospital of Kunming Medical University from Jan.2022 to Dec.2023 were prospectively selected and randomly divided into observation and control groups according to the ran-dom number table method,with 56 cases in each group.Both groups underwent arthroscopic surgery,with the obser-vation group adopting the Pie-crusting technique for release and the control group conventional release.The operation and postoperative conditions,imaging evaluation results and complications of the two groups were statistically ana-lyzed,and the gait characteristics,as well as the knee joint functions by Lysholm score,Tegner score,etc.,before and 3 and 6 months after surgeries were compared.Results Compared with the controls,the observation group showed much shorter operation time(min,35.6±4.5 vs.39.7±4.5)and release operation time(min,1.1±0.2 vs.3.3±0.4)(both P<0.05);at postoperative 3 and 6 months,both groups showed significantly improved walking speed,step frequency and single leg support time than those before operation,but inter group comparisons revealed no significant difference(P>0.05),and the Lysholm and Tegner scores showed consistent results.At6 months af-ter surgery,there were no significant differences between the two groups(P>0.05)in terms of meniscus healing or Outbridge cartilage degeneration.However,the total incidence of complications was much lower in the observation group than in the control group(5.4%vs.19.6%,P<0.05).Conclusion Pie-crusting technique for the treat-ment of posterior horn injury of the medial meniscus can shorten the release operation time and the whole operation time,and reduce the incidence of complications,but shows comparable treatment efficiency with the conventional re-lease method.

Abstract:Objective Based on preoperative knee CT scans,measure and analyze the relevant anatomy in-volved in the tibial intramedullary nail entry point,determine the optimal intraoperative fluoroscopic angle,and per-form preliminary clinical validation.Methods A retrospective analysis of 86 knee CT scans from June 2018 to June 2022 at the First Affiliated Hospital of Nanjing Medical University.There were 49 males and 37 females;ages ranged from 18 to 65 years,with a mean of 53.4 years.Compare the angle α1 between the line L1,connecting the midpoint O of the tibial spine and the tibial tubercle A,and the line L2,the posterior line of the tibial plateau(inner and outer sides of the posterior condyle)and the line L4(the fluoroscopic line perpendicular to the fibular head).Also compare the ratio La/Lb/Lc,where La is the length of the segment of L2 passing through the maximal plane of the fibular head,and Lb/Lc is the ratio of the horizontal distance from the fluoroscopic line to the fibular head on both sides,measured by the line through the outermost edge of the tibial plateau and parallel to the tibial spine line(the inner-to-outer length ratio).In the CT axial plane,determine the angle α3 between the fluoroscopic line L4 shown by the tibular bisector line method and the direction of the line from the midpoint O of the tibial spine to the tibial tubercle A(the fluoroscopic angle difference).Results α1<α2(P<0.001).There were no obvious differ-ences between sexes in the intramedullary nail entry-point related measurements(La,Lb/Lc)(P>0.05).On the maximal plane of the fibular head,the angle α3 between the L1 fluoroscopic line and the L4 fluoroscopic line was 7.38±2.67 in males and6.34±2.15 in females,with a statistically significant difference(P<0.001).The line be-tween the midpoint O of the tibial spine and the tibial tubercle A forms a perpendicular relationship with the posteri-or condylar line on the maximal plane of the tibial plateau.In standard anteroposterior knee radiographs,the distance ratio from the lateral tibial edge to the fibular head on both sides can be considered 2:1.Conclusion During tibial intramedullary nail surgery,fluoroscopy using the standard lateral view corresponding to the overlap of the medial and lateral femoral condyles,rotated 90 to one side,yields the optimal frontal fluoroscopic orientation,significantly reduc-ing the number of intraoperative fluoroscopic exposures and preventing positioning differences from affecting needle-entry point localization.