Science Citation Index分析不同材料螺钉在足踝外科的应用

背景：螺钉是骨科最常用及必不可少的材料,金属螺钉及可吸收螺钉在足踝外科已经普遍应用。目的：利用SCI数据库文献检索和深度分析功能,对于不同螺钉材料在足踝外科的应用的20年文献资料趋势进行多角度的探讨分析。设计：文献计量学分析。资料提取：由第一作者以英文＂ankle（踝骨折）;talus（距骨）;calcaneal（跟骨）;metatarsal（跖骨）;fracture（骨折）;bioabsorbable screw（可吸收螺钉）;stainless screw（不锈钢螺钉）;titanium screw（钛螺钉）＂为关键词检索SCI数据库1992-01/2011-12的相关文献,并将分析结果及资料导出,以文字和图表的形式进行统计和计量分析,描述其分布特征。入选标准：纳入标准：检索可吸收螺钉、不锈钢螺钉、钛金属螺钉等不同材质螺钉在足踝外科的应用相关的文献。文献类型包括研究原著、综述、会议记录及摘要、快报文章、编辑素材。排除标准：与文章目的无关的文献,大于20年较陈旧的文献,未发表的文章以及需电话追踪和手工检索逐一分析的文献。主要数据判定指标：以文献的类型、出版时间、发表文献的作者分布、学科类别、机构分布、国家地区分布、来源期刊、文献被引情况、以及不同材料螺钉在足踝外科的应用的文献对比进行相关分析。结果：SCI数据库1992/2011收录的文献中共检索到802篇不同材料螺钉在足踝外科的应用相关的文献,研究原著以740篇位居首位,其中有10篇可以确定为经典文献,在时间分布上,文献数量1992/2011总体呈上升趋势,Foot Ankle International《足与踝国际杂志》杂志发表文献量最多,121篇,占全部文献的15.09%。其次为Journal of Orthopaedic Trauma《骨创伤杂志》85篇。结论：通过文献计量学方法对来源于SCI数据库关于不同材料螺钉在足踝外科的应用的文献进行分析,可为了解该领域的概貌、现状和研究者进一步确定该领域研究的热点难点提供有价值的参考。     

Status of road traffic injury rescue and current work in China

STATUS OF TRAFFIC INJURY IN CHINA According to WHO statistics,every year there are more than 1.2 million people who die in traffic accident,around three thousand every day,and about 50 million people injured in traffic accident.Economic loss due to traffic accidents is as high as 518 billion US dollar.     

Concomitant vancomycin and piperacillin/tazobactam treatment is associated with an increased risk of acute kidney injury in Japanese patients

IntroductionRecent studies have corroborated that the co-administration of vancomycin (VCM) and piperacillin/tazobactam (PT) is correlated with an increased incidence of acute kidney injury (AKI). However, evidence directed at the Japanese population is scarce. Therefore, we conducted a retrospective study to compare the occurrence of AKI among Japanese patients who received VCM with PT (VP therapy) and VCM with another β-lactams (VA therapy).MethodsThe present study, performed at Tsuyama Chuo Hospital between June 2012 and December 2018, included adult patients who received VCM and β-lactam antibiotics for ≥48 h. We defined the primary outcome as the incidence of AKI based on the risk, injury, failure, loss, and end-stage kidney disease criteria. Patients' clinical characteristics and outcomes were reviewed and compared between the two groups with univariate and multivariate logistic regression analyses. Subgroup analysis was conducted by stratifying the patients’ baseline hospital admittance status, as intensive care unit or general wards.ResultsWe analyzed 272 patients (92 V P therapy and 180 VA therapy). Univariate analysis revealed a significant difference in AKI development between VP and VA therapy (25.0% vs 12.2%; p < 0.01). A multivariate analysis demonstrated that VP therapy and VCM initial trough levels ≥15 μg/mL were associated with an incidence of AKI. Patients at general wards, rather than those admitted at an intensive care unit, developed AKI with VP therapy (p = 0.02).ConclusionVP therapy was associated with an increased risk of AKI compared to that with VA therapy among the Japanese population.     

The first case of teeth discoloration induced by linezolid in children in China Mainland

Linezolid is an oxazolidinone antimicrobial agent often used to treat multidrug-resistant Gram-positive bacterial infections. The common adverse reactions of linezolid are diarrhea, nausea, headache and bone marrow suppression, and so on. Here, we report the first case of teeth discoloration induced by linezolid linked with extrinsic discoloration in China Mainland. This case report highlights a rare adverse reactions of a commonly used antibiotic.     

股骨外侧壁形态对股骨转子区骨折内固定失效的预测研究

目的：探讨外侧壁形态与股骨转子区骨折早期内固定失效的关系。方法：选取2015年1月至2020年1月行内固定治疗的295例股骨转子区骨折患者,根据术后是否出现早期内固定失败将患者分为两组,即失败组19例和正常组276例。对两组患者性别、患侧、年龄、AO分型、身体质量指数（body mass index,BMI）、术前血红蛋白、X线测量下外侧壁厚度、术前合并内科疾病、术中失血量、术后尖顶距（tip apex distance,TAD）、术后颈干角、手术时间等资料进行比较。比较两组外侧壁形态,对外侧壁形态与股骨转子区骨折早期内固失效进行相关性分析。结果：两组患者术后随访1年以上。两组患者在术中失血量、手术时间、术后TAD、术后颈干角等方面比较,差异无统计学意义（P>0.05）。末次随访失败组视觉模拟评分（visual anague scale,VAS）高于正常组（P<0.01）,失败组Harris评分小于正常组（P<0.05）。绘制外侧壁形态与股骨转子区骨折早期内固定失败之间的受试者工作特征（receiver operator characteristic,ROC）曲线,中...     

Masquelet技术与Ilizarov技术治疗成人胫骨慢性骨髓炎的早期临床疗效比较

目的 比较Masquelet技术与Ilizarov技术治疗成人胫骨慢性骨髓炎清创后大段骨缺损的早期临床疗效.方法 回顾性分析2011年1月至2015年5月我院收治的45例成人胫骨慢性骨髓炎病人资料,Masquelet技术治疗的27例纳入Masquelet组,男20例,女7例,骨缺损长度为(8.9±2.2)cm;Ilizarov技术治疗的18例纳入Ilizarov组,男12例,女6例,骨缺损长度为(8.3±2.1)cm.收集并比较两组病例的骨愈合时间、完全负重时间、术后并发症情况及末次随访时的Iowa膝关节评分、Iowa踝关节评分、SF-36量表得分.结果 45例病人的随访时间为12～38个月,平均(21.5±6.5)个月.Masquelet组与Ilizarov组的骨愈合时间分别为(20.85±4.31)周、(28.86±6.47)周,完全负重时间分别为(23.17±6.93)周、(32.87±6.79)周,两组间比较,差异均有统计学意义(t=4.944,P<0.0001;t=4.636,P<0.0001);两组末次随访时的Iowa膝、踝关节评分及SF-36量表总得分均较术前明显改善,但两组间比较,差异均无统计学意义(P均>0.05).结论 Masquelet技术与Ilizarov技术均可有效地解决成人胫骨慢性骨髓炎清创后大段骨缺损问题,但Masquelet技术能显著缩短治疗周期,完全负重时间早,是一种简单有效的手术方法.     

Return to duty following combat-related multi-ligamentous knee injury

IntroductionThis retrospective cohort study characterized injury patterns, treatment practices, and identified the return to duty (RTD) rate following combat-related multi-ligament knee injuries (MLKI).Patients and methodsWe evaluated injury characteristics and treatment methods of 46 military service members who had sustained a MLKI during combat activity. The primary clinical outcome measure was ability to return to active military duty. Secondary outcomes included subjective pain score, knee motion, knee instability, and use of ambulatory assistive device.ResultsThe RTD rate was 41% (19/46). High-energy mechanism, neurovascular injury, compartment syndrome, traumatic knee arthrotomy, and intra-articular femur fracture (Orthopedic Trauma Association Classification (OTA) 33-B/C) were all more prevalent in subjects who were unable to return to duty (p < 0.05). Acute external fixator application and poor knee range of motion (ROM) were also associated with military separation (p = 0.041 and p = 0.016, respectively). The most common ligament injury pattern (n = 9; 20%) was combined disruption of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), posterolateral corner (PLC), and medial collateral ligament (MCL). However, number of ligaments injured was not associated with RTD status.ConclusionMLKIs sustained in a combat setting have a high incidence of associated lower extremity injuries. Certain associated injuries, such as intra-articular femur fracture, knee arthrotomy, neurovascular injury, and compartment syndrome may be more important than the severity of the knee ligamentous injury in determining RTD outcome.     

Unstable trochanteric fractures: Issues and avoiding pitfalls

The incidence of trochanteric fractures is rising because of increasing number of senior citizens with osteoporosis. There are various modalities for reduction and internal fixation. However, the incidence of complications remains high. In the herein article we discuss issues that influence the fixation and outcomes of unstable trochanteric fractures. Moreover, the results of a prospective, randomised, cohort, time bound, hospital based, comparative study is presented.     

Virtual fracture clinic management of fifth metatarsal,including Jones’, fractures is safe and cost-effective

Virtual clinics have been shown to be safe and cost-effective in many specialties, yet barriers exist to their implementation in orthopaedics. The aims of this study were to look at whether the management of 5th metatarsal fractures using a virtual fracture clinic model is safe, cost effective and avoids adverse outcomes whilst being acceptable to patients using the service.All patients with a fifth metatarsal fracture between September 2013 and September 2015 had a standardised management plan initiated (blackboot, full weightbearing) in the emergency department (ED). 663 patients met inclusion criteria, 251 (37.5%) Type 1, 111 (17%) Type 2 (Jones’), 281 (42%) Type 3 or distal, 20 (3%) were misdiagnosed, and 4 (0.5%) patient’s images were unavailable.499 (75%) patients were discharged immediately, 47 (7%) had further imaging, 114 (17%) had either ESP or consultant clinic review, and 3 (<1%) transferred their care privately. The average number of clinic visits per patient was 0.17. At a conservative estimate of 1.3 visits per patient in a traditional pathway this saved 779 clinic visits with a cost saving of £60,000 on clinic visits alone. There were 8 (7%) asymptomatic non-unions in Type 2 (Jones’) fractures. One patient required surgical intervention.Fifth metatarsal fractures have excellent outcomes with conservative management yet traditionally have required clinic visits to confirm the diagnosis and explain the management and prognosis. Our study supports the use of a virtual fracture clinic model that is standardised, initiated in ED, that is both safe and cost-effective.