Abstract:Objective To analyze the advantages and disadvantages of using preformed rib fixation plates and shape memory embracing fixators during small incision surgery for multiple rib fractures.Methods A retro-spective analysis was conducted on 86 patients with multiple rib fractures who underwent internal fixation via small incisions in Cardiothoracic Surgery Department of the 72nd Group Army Hospital of the People's Liberation Army from Jan.2019 to Oct.2021.Among them,56 were male and 30 were female,with the age of 21-74 years,averaging 55.6 years.The injury causes included 40 cases of road traffic accidents,21 falls from heights,17 machine injuries,and 8 others.Based on the internal fixators used during surgery,patients were divided into the preformed group(by using preformed rib fixation plate,n=42)and the embracing fixator group(by using shape memory embracing bone plate,n=44).All the internal fixation was conducted via small incision,and the advantages and disadvantages of the two materials were compared.Results Compared with the preformed group,the embracing fixator group showed much higher incidence of intraoperative complications[2.4%(1/42)vs.25%(11/44)]and postoperative complica-tions[90.9%(40/44)vs.42.9%(18/42)],but much higher completion rate with a single incision[36.4%(16/44)vs.9.5%(4/42)]and much less hospitalization cost(CNY,17,800 vs.58,200),all revealing significant differences(P<0.05).Conclusion In the surgical management of multiple rib fractures via small incisions,the preformed rib fixation plate induced much less intra-and post-operative complications,but the shape memory embra-cing bone plate makes the internal fixation much easier via a single incision,together with much less cost.

Abstract:Objective To investigate the clinical efficacy of a modified cross-leg anterolateral thigh flap based on computed tomography angiography(CTA)in reconstructing soft tissue defects in the lower leg and ankle.Methods A retrospective analysis was carried out on 18 patients presenting with soft tissue defects in the lower leg and ankle.These patients were admitted to the 920th Hospital of the PLA Joint Logistics Support Force between Jun.2018 and Mar.2024,including 12 males and 6 females aged 19-53 years,mean 29.2 years.The causes of de-fects included heavy object impact in 8 cases,road traffic accidents in 7 cases,and machine crushing in 3 cases.All cases involved simultaneous injuries to any two of the anterior/posterior tibial/peroneal arteries.CTA from the ab-dominal aorta to the foot was conducted for all of them before operation,based on which Mimics 20.0 was used for 3D modeling of bones,blood vessels,and skin,and the optimal perforators of femoral arteries were selected according to the diameter and length to design the cross-leg flap.During the operation,flaps were harvested and anastomosed with the contralateral posterior tibial arteries and accompanying veins.After the operation,the survival of the flaps was recorded,and the Maryland scoring system was used to evaluate the patient's ankle function.Results All the free anterolateral thigh flaps were designed and harvested successfully.The location,diameter,and length of the per-forators were basically consistent with the preoperative modeling.The flap sizes ranged from 12 cm×8 cm to 20 cm×11 cm,which can completely cover the exposed bones and tendons.Partial necrosis occurred in 2 flaps:one under-went debridement and the other healed after pressing and dressing change.The other 16 flaps survived uneventfully.All donor sites healed satisfactorily.Patients were followed up for 7-24 months,and all flaps survived.At the final follow-up,according to the Maryland scoring system,the ankle function was excellent in 13 cases,good in 4,and fair in 1.Conclusion Preoperative CTA is helpful for a comprehensive assessment of the donor and recipient sites.The modified cross-leg anterolateral thigh flap based on CTA can precisely reconstruct soft tissue defects in the lower leg and ankle.

Abstract:Objective To investigate the efficacy of unilateral biportal endoscopy(UBE)combined with percutaneous pedicle screw fixation(PPF)in the treatment of thoracolumbar burst fractures.Methods A retro-spective analysis was conducted on 44 patients with single-segment thoracolumbar burst fractures combined with neu-rological injuries treated at our department from May 2021 to Jul.2023.This cohort included 26 males and 18 fe-males,aged 19-72(mean 46.3)years.Based on surgical approaches,patients were divided into two groups:19 cases were treated with UBE decompression combined with PPF(UBE group),and 25 cases were treated with open de-compression and PPF(open group).Comparisons were made between the two groups regarding operation time,intr-aoperative blood loss,and surgery-related complications.Preoperative,postoperative1-week,and final follow-up data were recorded,including visual analog scale(VAS)scores,American Spinal Injury Association(ASIA)grading,Oswestry disability index(ODI),radiographic and CT assessments of fracture healing,anterior vertebral height ratio,Cobb angle,and spinal canal occupancy rate.Results All the patients underwent surgery uneventfully,with no wound infections,worsened postoperative muscle weakness,or complications such as epidural hematoma.Primary wound healing was achieved in all patients.Operation time showed no statistically significant difference between the UBE and open groups(P>0.05).But the UBE group had significantly less intraoperative blood loss(mL,90.7±13.8 vs.128.8±11.3,P<0.05)and much lower VAS score(4.2±0.7 vs.4.9±1.2)and ODI(34.40%±7.40%vs.40.28%±7.17%)at 1 week postoperatively(both P<0.05),which were significantly improved at last follow-up for both UBE and open groups.The ASIA grades,anterior vertebral height ratio,Cobb angle,and spinal canal occu-pancy rate revealed no significant difference at all three time points between the two groups(all P>0.05).Conclu-sion UBE spinal canal decompression combined with PPF is safe and effective for managing thoracolumbar burst fractures.It can effectively relieve dural and nerve compression,restore spinal canal space,and maintain spinal align-ment and stability.Compared to open decompression,this method is less invasive and results in less intraoperative blood loss.

Abstract:Objective To explore the clinical effect of the application of ulnar artery-based supracarpal perforator flap in the repair of skin or soft tissue defects in the wrist and palm.Methods A total of 17 patients with skin or soft-tissue defects surrounding the wrist or palm admitted to our hospital from Nov.2014 to Oct.2024 were retrospectively analysed,for whom ulnar artery-based perforator flap transplantation was conducted.There were 13 males and 4 females aged 29-62(mean 38.3)years,with 9 cases on the left and 8 on the right.Among them,9 ca-ses were open injuries of the wrist and palm,5 were palm space infections and 3 were electrical injuries.The wound defect area ranged from 8.0 cm×2.0 cm to 12.0 cm×5.0 cm.After debridement and expansion of the wound,the ul-nar artery-sourced perforator flap,sized 10.0 cm×3.0 cm to 15.0 cm×6.0 cm,was prepared for grafting.The donor-sites of the dorsoulnar forearm were directly sutured in 13 cases at one stage,and grafted in the other 4 cases.Pa-tients were followed-up regularly in the outpatient clinic to observe the survival of the skin flap,functional recovery,and healing of the donor site.Results All patients were followed up for 3 months to 7 years,3.7 years on average.Among the 17 cases,16 flaps survived completely;1 case with palmar space infection showed distal 1/3 partial nec-rosis;1 cases had postoperative haematoma,for which re-operation was conducted to clear the haematoma and postop-erative flap survival was achieved;2 cases had revision surgery at the second stage for bloated flap pedicle.Func-tional evaluation assessed by the upper limb part functiontrial criteria proposed by the Hand Surgery Society of Chi-nese Medical Association revealed excellent results in 12 cases,good in 4,and poor in 1,with the good-to-excellent rate being 94.1%.Conclusion The ulnar artery-derived perforator flap transplantation was effective in the repair of wrist and palm wounds.Most of the donor sites can heal without skin grafting(linear scar).

Abstract:Objective To explore the research status and trends in the field of in-hospital treatment of ab-dominal traumas.Methods A bibliometric method was adopted.Relevant literature on in-hospital treatment of ab-dominal traumas published in the Web of Science from Jul.2014 to Jul.2024 was systematically retrieved and ana-lyzed.Bibliometric tools,namely CiteSpace and VOSviewer,were used to analyze the research status,themes,hotspots,and development trends in this field.Results A total of 1585 articles were included for bibliometric anal-ysis.Over the past decade,the research on in-hospital treatment of abdominal traumas has generally shown an up-ward trend.The United States was the country with the largest number of publications:612 articles."Inaba Kenji(21 articles)"and"Fu Chih-Yuan(11 articles)"ranked the maximum two contributing authors.Keyword analysis indicated the high-frequently discussed issues:treatment process,trauma types,and treatment methods.Among them,the keywords related to the treatment process were the most common.The temporal distribution of keywords revealed the minimally invasive and comprehensive trends in the diagnosis and treatment strategies of abdominal traumas.Conclusion Through a systematic summary of the research on in-hospital treatment of abdominal trauma in the past 10 years,the research hotspots and development trends in this field were revealed.Future research should focus on the combination of technological innovation and multidisciplinary collaboration,and continuously optimize the treatment process and management model to comprehensively improve the treatment effect and prognosis quality of patients with abdominal trauma.

Abstract:Objective To investigate the clinical application of flow-through anterolateral thigh flap(AL-TF)and its limb salvage value in the treatment of severe limb injuries.Methods From Jun.2022 to Dec.2024,12 patients with severe limb injuries(4 upper limb and 8 lower limb,9 male and 3 female)treated with flow-through ALTF were retrospectively analyzed.The age of the patients ranged from 6 to 57 years,with an average age of 29.3 years.The injury causes included blast in 1 case,rolling and cutting by agricultural machines in 3 cases,hit by heavy objects in 2 cases,and road traffic accidents in 6 cases.The length of the vascular defect was 5-10 cm,and the length of the bone defect was 2-9 cm,with the soft tissue defects being 10 cm×7 cm to 20 cm×6 cm.Ten cases were repaired in one stage and 2 cases in the second stage.The size of the flaps ranged from 11 cm×8 cm to 21 cm×7 cm.All patients were followed up at the outpatient clinic after operation,assessing the appearance and texture of the flap and limb,the fracture healing,and the function of the affected limb.Results Patients were followed up for 12-24 months(average 15.1 months).The flaps and limbs of all 12 patients survived,and the limb salvage was successful.Vascular crisis occurred in 2 cases at 1 d after operation,which was resolved following exploration and treatment.At two months after bone grafting and internal fixation,one patient experienced internal fixation breakage due to premature weight-bearing,which healed after re-surgery.The excellent and good rate of lower limb function was 87.5%by Johner-Wrush score,and 75.0%of upper limb function by Berton score.Conclusion The flow-through ALTF can simultaneously repair the soft tissue and vascular defects in patients with severe limb injuries.It has the advantages of reliable blood supply,high survival rate,and good functional recovery,and is an effective meth-od for limb salvage treatment.

Abstract:Trauma has become one of the major public health challenges globally,especially for severe trau-ma,which presents a high mortality and morbidity.A multidisciplinary trauma team can quickly assess and stabilize patient conditions,shorten rescue delay,and thus improve the survival rates.Therefore,enhancing the effectiveness of the trauma care through training has become one of the key concerns of trauma care systems in various countries.Our paper snapshots the international trauma care course design and effects and raises suggestions on domestic course model and evaluation system,aiming to promote the trauma care systemin China.

Abstract:The fingertip,as a key part of the hand to perceive the external world,is of great significance for appearance and functional integrity.Fingertip amputations caused by various trauma mechanisms are common in hand-surgery emergencies.Successful replantation is of great significance for restoring the hand function and appear-ance.The core of fingertip replantation is to accurately locate the arteries and veins and establish an effective blood circulation.Attention should be paid to the neural-function reconstruction,bone fixation,and nail-bed repair to a-chieve satisfactory results.Due to the slender blood vessels,thin vessel walls,and few number of blood vessels in the fingertip,it is difficult to establish a blood circulation,resulting in a high level of difficulty in replantation and fre-quent stump trimming.In recent years,with the progress of microsurgical techniques and equipment and constant improved skills of hand microsurgeons,remarkable progress has been made in finger-tip replantation.This article combines relevant domestic and foreign literature to analyze current and future strategies for fingertip replantation and share personal experience,aiming to provide reference and inspiration for professionals engaged in hand micro-surgery and to exchange experiences.

Abstract:Traumatic urethral injury is a common urinary system disease that can result in a series of serious complications such as urethral stricture and urinary tract infection.However,there exist controversies on its clinical treatment and surgical options.Therefore,this paper reviews related literature on its treatment,and analyzes surgical options and related complications in different periods,in order to provide reference for relevant surgeons.

Abstract:Non-combat musculoskeletal injuries(NBMSKIs)refer to physical damage sustained by military personnel during routine training and operational duties.These injuries,which include fractures,muscle strains,joint sprains and ligament tears,occur in non-combat environments and stem primarily from repetitive training exercises,physical conditioning,and mechanical tasks.Epidemiological studies reveal a striking pattern:service members suf-fer more musculoskeletal injuries during training than in combat,with basic physical conditioning proving particularly hazardous.As modern militaries intensify training regimens and raise performance standards,NBMSKIs continue to rise alarmingly.This paper provides a systematic review of the epidemiological patterns and injury characteristics of NBMSKIs in foreign military forces.It analyzes core causative factors such as biomechanical overload,overuse inju-ries,and abnormal training practices,and also evaluates cutting-edge prevention strategies,including pre-service screening,health behavior management,interdisciplinary interventions,and smart wearable monitoring technologies.These findings offer valuable insights to help our military develop a more scientific training-related injury prevention system.

Abstract:Blood transfusion is an indispensable treatment in major bleeding following severe trauma.In or-der to further improve the capabilities of blood supply and treatment efficiency for emergency rescue of severe trauma patients,and to reduce the risk of death due to transfusion delay,several associations combinedly organized the Chi-nese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients(version 2024).This paper aims to interpret this consensus from the application scenarios,universal blood type and infusion indications for pre-and in-hospital emergency care of severe trauma patients,as well as massive transfusion strategies,so as to facilitate the understanding and better guide the clinical practice.

Abstract:Objective To evaluate the efficacy of photoacoustic microscopy(PAM)in assessing cutaneous damage progression in rat models of incised wound or scald.Methods Twelve male SD rats aged 8-10 weeks were randomly assigned to two groups(n=6 per group):an incised wound model group and a scald wound model group.The incised wounds were created on the depilated dorsal skin using a biopsy punch,while the scalds were induced u-sing a standardized scald device.Wound progression was monitored at 1,3,7,and 28 d post-modeling by both con-ventional measurement and PAM.The former assessed the wound area and healing rate using a digital caliper and a small-animal imaging system,with subsequent analysis performed using ImageJ software.The PAM employed the In-sight-RSPAM2 system to acquire high-resolution images,and the accompanying Insight Analysis 2.3.3 software was used to further quantify wound area,lesion depth,vascular density,blood flow velocity,and oxygen saturation.Results The incised wounds exhibited faster healing,achieving 80.3%±6.8%closure by Day 28.In contrast,the scald wounds showed initial expansion followed by delayed healing,reaching only 69.1%±14.8%closure at the same endpoint.The wound areas of the incised rats measured by the two methods showed a mean difference of 0.06 cm2,with the 95%limits of agreement being 0.0001-0.1236 cm2.The PAM testing demonstrated that in the rat incised wound model,the lesion depth decreased significantly from(1509.70±249.44)μm to(426.41±49.23)μm during the 28-day healing period,with evident neoangiogenesis observed at Day 28.On Day 1 post-injury,the incised and scalded rats showed blood flow velocities of(4.31±0.10)mm/s and(3.38±0.12)mm/s,oxygen satu-rations of 71.20%±2.73%and 71.83%±8.29%,respectively,which were increased to(4.70±0.69)mm/s and(4.48±0.32)mm/s for blood flow velocity,and 75.25%±2.30%and 80.00%±2.25%for oxygen saturation by Day 3.From Day 7 to Day 28 post-injury,the skin wound blood oxygen saturation of the incised rats showed an in-creased trend(76.48%±2.22%to 82.58%±3.07%),while the blood flow velocity(mm/s,4.57±0.22 to 4.74±0.23)and blood oxygen saturation(81.48%±2.02%to 81.19%±2.20%)in scalded rats showed a plateaued trend.Conclusion PAM enables non-invasive longitudinal monitoring of cutaneous wounds in rats,providing quan-titative assessments of the wound area,lesion depth,and structural/functional parameters in both the injured tissue and surrounding vasculature.

Abstract:Objective To analyze the functional recovery and adverse reactions of saphenous nerve block vs.femoral triangle block under ultrasound guidance in patients undergoing arthroscopic knee surgeries.Methods From May 2023 to May 2024,80 patients with arthroscopic knee surgeries in Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University were enrolled,including 59 males and 21 females aged 23-58(mean 33.3)years.According to the random number table,patients were anesthetized via saphenous nerve block(SN group,n=40)or femoral triangle block(FT group,n=40).The number of cases with successful nerve block,intra-and post-operative application of adjuvant analgesia and the dosage of sufentanil and remifentanil were recor-ded and compared between the two groups.At 6,12 and 24 h after operation,the recovery of quadriceps femoris muscle strength,degree of pain and finish time of timed-up-and-go test were evaluated.The completion rate of func-tional exercise and incidence of postoperative adverse reactions like nausea and vomiting,drowsiness and dizziness were also recorded.Results The success rate of nerve block was 100%in both groups,with adjuvant analgesia ap-plied in 4 cases in SN group(10.0%)and 6 in FT group(15.0%).There was no significant difference regarding the dosage of sufentanil and remifentanil between the two groups(P>0.05).The total recovery rate of quadriceps femoris muscle strength was 72.5%at 12 h and 82.5%at 24 h after operation in the SN group,which was signifi-cantly higher than that in the FT group(47.5%and 55.0%respectively,both P<0.05).VAS score showed no sig-nificant differences at 6,12 and 24 h after operation,but the finished time of timed-up-and-go test was shorter in the SN group than in the FT group(s,15.3±4.2,10.7±3.4,8.6±3.5 vs.20.5±4.3,18.6±4.0,13.2±4.6,all P<0.05 compared at the same time point).While the completion rates of early knee functional exercise in the SN group were 62.5%,72.5%,75.0%and 80.0%on the operationday and 1,2 and 3 d after operation,respectively,which were significantly higher than those in the FT group(40.0%,47.5%,52.5%,and 57.5%,all P<0.05 com-pared at the same time point).The incidence of postoperative adverse reactions showed no significant differences between SN and FT group(5.0%vs.10.0%,P>0.05).Conclusion Ultrasound-guided saphenous nerve block can reduce the pain of patients with arthroscopic knee surgeries.The total recovery rate of quadriceps muscle strength is higher at 12 and 24 h after operation compared with the femoral triangle block,and patients can recover to the preoperative state more quickly.

Abstract:Objective To investigate the differences in perioperative blood loss and the influencing factors of hidden blood loss(HBL)between proximal femoral nail anti-rotation(PFNA)and cemented bipolar hemiarthro-plasty(CBH)for the treatment of elderly patients with unstable intertrochanteric femoral fractures.Methods A retrospective analysis was conducted on 56 elderly patients with unstable intertrochanteric femoral fractures admitted to our department from Jan.2023 to Jan.2024.There were 21 males and 35 females aged 73-96(mean 82.6)years.The injury causes included road traffic accidents(16 cases)and falls(40 cases).Patients were divided into PFNA group(n=24)and CBH group(n=32)based on surgical approaches.The intraoperative blood loss,postop-erative drainage volume,transfusion volume,hemoglobin(Hb)levels,hematocrit(Hct)levels,VAS,and Harris scores were compared between the two groups.The total blood loss(TBL)and HBL were calculated using the Gross,Bourke,and Camarasa formulas,and their differences were analyzed.Univariate t-test and multiple linear re-gression were used to analyze risk factors for HBL in such patients.Results Based on the Gross,Bourke,and Ca-marasa formulas,the PFNA group had significantly higher TBL[mL,1275.57(928.90,1588.58),1010.20(769.71,1232.76)and 1548.66(1261.01,1966.17)]and HBL[mL,985.57(648.95,1296.08),794.74(496.37,1311.59),1283.71(966.01,1731.17)),compared to the CBH group[TBL:mL,871.44(701.76,1 022.63),714.01(627.80,858.84),1013.38(823.00,1653.18);HBL:mL,500.53(334.31,621.33),351.27(201.47,453.07),620.28(489.05,1108.98)](allP＜0.05).However,the PFNA group showed much less overt blood loss than the CBH group(intraoperative blood loss:mL,120.00(110.00,150.00)vs.225.00(150.00,300.00);postoperative drainage volume:mL,135.83±24.30 vs.184.06±34.63,both P＜0.05).At 1 and 3 months postoperatively,the VAS scores were also much higher in the PFNA group[5(4,6)and 3(3,4)]than those in the CBH group[3(3,4)and 2(2,3)](both P＜0.05),while the Harris scores were much lower(45.9±6.9 and 61.8±5.7 vs.60.9±3.0 and 77.0±4.2)(both P＜0.05).But at 6 months postopera-tively,there were no significant differences in VAS and Harris scores between the two groups(both P＞0.05).Uni-variate and multiple linear regression analyses identified that age ≥ 80 years,surgical approach of PFNA,Evans typeⅣ classification,general anesthesia,comorbid hypertension or diabetes mellitus,pre-injury anticoagulant use,and time from injury to surgery ≥5 d were significant influencing factors for HBL(all P＜0.05).Conclusion Com-pared with CBH,PFNA for elderly patients with unstable intertrochanteric femoral fractures results in greater TBL and HBL,higher VAS scores and lower Harris scores within 3 months.Fracture classification,hypertension,diabetes mellitus,long-term preoperative anticoagulant use,anesthesia method,age,and delayed surgery after injury are signif-icant influencing factors for HBL.

Abstract:Modern naval combat injuries are characterized by high incidence,massive and serious injuries,and high incidence of combat stress reactions,which put forward higher requirements for the time-sensitive rescue of the injured.By reviewing the current situation of foreign military naval battle casualty rescue and combining with the current stage of Chinese army's strategic needs and the concept of defense and security,via the cutting-edge technol-ogy,this paper aims to explore efficient casualty rescue methods,enhance the care capacity of maritime war injuries,and improve the maritime war defense and security system,so as to increase time-sensitive rescue as well as battle-field casualty survival rate.

Abstract:Objective To explore the correlation between osteoporotic vertebral compression fractures(OVCF)and thoracolumbar fascia injury(TLFI),as well as the relationship between TLFI and postoperative resid-ual pain.Methods A retrospective analysis was conducted on 175 patients with OVCF admitted to our department from Jan.2021 to Dec.2023.Among them,there were 73 males and 102 females,with an age range of 65-86 years,mean 70.9 years.The injury causes were mild violence in 118 cases,lifting heavy objects in 38 cases,and violent cough in 19 cases.Preoperative MRI confirmed concomitant TLFI in 44 cases,who were divided into the fascia TLFI group,while the other 131 cases without TLFI were divided into the non-TLFI group.Patients' data were collected and a logistic regression model was adopted to analyze the interaction between OVCF and TLFI,as well as the resid-ual lower back pain,which was assessed by VAS scores before and 3 d,1 week,and 3 months after surgery.Results Compared with the non-TLFI group,the TLFI group showed much higher proportions of patients with＞2 adjacent vertebral fractures(86.7％vs.13.3％)or with vertebral fissure signs(74.5％vs.25.5％),and much lower rates of postoperative vertebral height recovery(38.9％±7.6％vs.45.7％±7.9％)and Cobb angle improvement(56.4°±7.5° vs.65.0°±8.8°)(all P＜0.05).Further Logistic multivariate analysis showed that the occurrence of TLFI in patients with OVCFs was related to the number of adjacent vertebral fractures(＞2),presence of vertebral fissure sign before surgery,and lower postoperative vertebral height recovery rate and Cobb angle improvement rate(all P＜0.05).Moreover,the TLFI group revealed much higher VAS scores at postoperative 3 d(5.8±0.8 vs.4.2±0.7)and 1 week(4.5±0.6 vs.2.5±0.4)(both P＜0.05).Conclusion Vertebral fissure signs and＞2 vertebral frac-tures are risk factors for OVCF patients with TLFI,who may have lower postoperative vertebral height recovery and Cobb angle improvement,as well as more postoperative residual pain.

Abstract:Objective To explore the efficacy of one-stage ilioinguinal approach combined with Kocher-Langenbeck(K-L)approach for reconstruction and internal fixation of complex double-column acetabular fractures.Methods A retrospective study was conducted on 8 cases of double-column acetabular fractures treated in our de-partment from Jun.2019 to Jun.2023,including 5 males and 3 females aged 45-60(mean 51.5)years.The injury course was 20-47(mean 27.6)d,with 4 road traffic injuries and 4 falls from height.All the 8 patients received one-stage reduction and plate internal fixation via the ilioinguinal approach combined with K-L approach.The char-acteristics of posterior acetabular fractures were summarized.And the reduction quality and hip joint functional re-covery were analyzed.Results Among the 8 cases,6 had posterior wall displacement fractures(1 proximal,1 distal and 2 middle posterior wall displacement,and 2 posterior wall comminution).Of the posterior column fractures,3 were of high level,1 of low level,and 4 of segmental type.The operation time was(4.9±1.2)h and intraoperative bleeding was(1375.0±296.4)mL.One case developed incision infection and achieved union after dressing change and anti-infection therapy.Postoperative lower limb venous ultrasound revealed deep vein thrombosis in another case in the proximal lower limb,for which anticoagulants were given.All patients were followed up for 9-46(mean 28.8)months.According to the Matta scoring criteria for postoperative fracture reduction,there were 4 cases of excellent and 3 of good,with an excellent and good rate of 87.5％.The fracture healing time was(15.1±2.8)weeks.There was 1 case of ectopic ossification and 2 cases of osteoarthritis changes after surgery.At last follow-up,the Merle d'Aubigne-Poster criteria for hip joint function rated 5 cases as excellent,2 as good,and 1 as fair,with an excellent and good rate of 87.5％.Conclusion For low or segmental posterior column fractures with displacement in double-col-umn acetabular fractures,the combined use of anterior and posterior approaches is helpful for the reduction and over-all fixation.Postoperative hip joint function recovery is good,the incidence of complications is low,and the therapeu-tic effect is satisfactory.

Abstract:Traumatic cardiac arrest(TCA)is the leading cause of early death among trauma patients and is generally regarded as having an extremely poor prognosis.This paper reviews the epidemiological features,common causes,and resuscitation and prevention strategies of TCA.It is hoped to help emergency physicians identify TCA at an early stage and improve the rescue success rate,and provide guidance for the construction of trauma and resusci-tation centers.

Abstract:Post-traumatic osteoarthritis(PTOA)is a degenerative joint disease caused by traumatic injuries such as fractures,dislocations,ligamentous injuries or repeated joint injuries.It is characterized by progressive de-struction of the articular cartilage,sclerosis of the subchondral bone,formation of bone redundancy,and synovial in-flammation,which ultimately leads to joint dysfunction and chronic pain.The pathogenesis of PTOA involves the in-teraction of mechanical injury,inflammatory immunity,subchondral bone remodeling,and oxidative stress.Although some progress has been made in the research of PTOA,its complex pathogenesis and irreversible joint destruction are challenging during its management.Therefore,this paper reviews the current progress on the pathogenesis of PTOA to provide reference for further research and potential treatment strategies.

Abstract:Objective To investigate the correlation between type Ⅱ respiratory failure(type Ⅱ RF)and refractory contralateral subdural effusion(CSDE)in patients with traumatic brain injuries(TBI)who developed CS-DE after decompressive craniectomy,in order to determine whether type Ⅱ RF contributes to the progression of CS-DE.Methods This was a single-center retrospective study that reviewed the clinical and imaging data of 108 TBI patients who developed CSDE following DC at our department between Jun.30,2013 and Dec.11,2022.The cohort comprised 79 males and 29 females aged 18 to 89(mean 49.1)years.The TBI causes included road traffic acci-dents(45 cases),falls from height(30 cases),assault(10 cases),sports injuries(8 cases),and others(15 ca-ses).The primary outcome was set as whether CSDE progressed to refractory CSDE and required surgical interven-tion within 3 weeks after DC.Univariate analysis was performed to identify factors associated with the development of refractory CSDE.A multivariate logistic regression model was subsequently constructed to evaluate the independ-ent association between type Ⅱ RF and refractory CSDE.Subgroup analysis was further conducted to assess the stratified and interactive effects of type Ⅱ RF on the progression of CSDE to refractory CSDE.Results Of the 108 TBI patients who developed CSDE after DC,34 progressed to refractory CSDE(31.5％),and 43 patients(39.8％)had type Ⅱ RF.Variables significantly associated with the development of refractory CSDE included peak body tem-perature during hospitalization(38.8℃±1.6℃),admission GCS score(8.9±2.7),preoperative GCS score(7.9±2.4),highest preoperative ICP(16.0 mmHg,range 0-18.0 mmHg),occurrence of type Ⅱ RF during hospi-talization(43 cases,39.8％),interval from TBI to DC(6.0 h,IQR 4.0-11.2 h),maximum width of CSDE within 3 d postoperatively(3.5 mm,IQR 2.5-5.1 mm),and midline shift(3.0 mm,IQR 0-6.0 mm).Multivariate logistic regression analysis showed that patients with type Ⅱ RF had a 3.639-fold increased risk of developing refractory CS-DE compared to those without type Ⅱ RF(95％CI:1.395-9.488).Furthermore,among patients with elevated pre-operative ICP(≥ 15 mmHg),the risk of developing refractory CSDE following type Ⅱ RF was 8.976 times higher than in those with lower ICP(＜15 mmHg)(95％CI:1.982-40.758).Conclusion In TBI patients who develop CSDE after DC,type Ⅱ RF is significantly associated with the progression of CSDE to refractory CSDE.This risk is particularly elevated in patients with elevated preoperative ICP.