Complex trimalleolar ankle fractures are a major orthopaedic challenge,with an incidence of 4.22 per 10000 person-years in the United States and an annual cost of 3.4 billion dollars.This review synthesizes current ev...Complex trimalleolar ankle fractures are a major orthopaedic challenge,with an incidence of 4.22 per 10000 person-years in the United States and an annual cost of 3.4 billion dollars.This review synthesizes current evidence on diagnostic protocols and management strategies,highlighting optimal approaches and emerging trends.Initial care emphasizes soft tissue assessment,often guided by the Tscherne classification,and fracture classification systems.External fixation may be required in open injuries,while early open reduction and internal fixation within six days is linked to improved outcomes.Minimally invasive techniques for the lateral malleolus,including intramedullary nailing and locking plates,are effective,while medial malleolus fractures are commonly managed with screw fixation or tension-band wiring.Posterior malleolus fragments involving more than 25%of the articular surface usually warrant fixation.Alternatives to syndesmotic screws,such as cortical buttons or high-strength sutures,reduce the need for secondary procedures.Arthroscopic-assisted open reduction and internal fixation benefits younger,active patients by enabling concurrent management of intra-articular and ligamentous injuries.Postoperative care prioritizes early weight-bearing and validated functional scores.Despite advances,complications remain common,and further research is needed to refine surgical strategies and improve outcomes.展开更多
The research presented in this paper aimed to analyze the evolution of fractures in strata in relation to the progress of longwall mining.To achieve this objective,an introscopic probe equipped with a highresolution c...The research presented in this paper aimed to analyze the evolution of fractures in strata in relation to the progress of longwall mining.To achieve this objective,an introscopic probe equipped with a highresolution camera was developed,along with additional equipment that enables continuous recording of the internal surfaces of drainage boreholes exceeding 100 m in depth.The probe was utilized to test two methane drainage boreholes in the Z-3b longwall,which operates within the 501/3 coal seam of the Jankowice mine in Poland.Automatic image analysis methods were applied to evaluate the recorded images,based on a newly developed classificationsystem for fractures categorized by size and number.The results were compared with an analysis of changes in the methane capture rate from the drainage boreholes,which correlated with longwall mining progress.A strong correlation was observed between the number of fractures and the lithology of the strata layers.The largest number of fractures and their evolution were recorded in the coal layers,followed by the shale layers,while the sandstone layers exhibited the least number of fractures.Based on parallel measurements of the methane capture rate from the drainage boreholes during the progress of longwall mining,the extent of the strata's fracture zone was determined to range from 6 m to 36 m.Within the fracture zone,the strata are highly fractured,which leads to an increase in methane emissions through seepage and diffusion processes.展开更多
Hydraulic fracturing serves as a critical technology for reservoir stimulation in deep coalbed methane(CBM)development,where the mechanical properties of gangue layers exert a significant control on fracture propagati...Hydraulic fracturing serves as a critical technology for reservoir stimulation in deep coalbed methane(CBM)development,where the mechanical properties of gangue layers exert a significant control on fracture propagation behavior.To address the unclear mechanisms governing fracture penetration across coal-gangue interfaces,this study employs the Continuum-Discontinuum Element Method(CDEM)to simulate and analyze the vertical propagation of hydraulic fractures initiating within coal seams,based on geomechanical parameters derived from the deep Benxi Formation coal seams in the southeastern Ordos Basin.The investigation systematically examines the influence of geological and operational parameters on cross-interfacial fracture growth.Results demonstrate that vertical stress difference,elastic modulus contrast between coal and gangue layers,interfacial stress differential,and interfacial cohesion at coal-gangue interfaces are critical factors governing hydraulic fracture penetration through these interfaces.High vertical stress differences(>3 MPa)inhibit interfacial dilation,promoting predominant crosslayer fracture propagation.Reduced interfacial stress contrasts and enhanced interfacial cohesion facilitate fracture penetration across interfaces.Furthermore,smaller elastic modulus contrasts between coal and gangue correlate with increased interfacial aperture.Finally,lower injection rates effectively suppress vertical fracture propagation in deep coal reservoirs.This study elucidates the characteristics and mechanisms governing cross-layer fracture propagation in coal–rock composites with interbedded partings,and delineates the dynamic evolution laws and dominant controlling factors involved.Thefindings provide critical theoretical insights for the optimization of fracture design and the efficient development of deep coalbed methane reservoirs.展开更多
Self-suspended proppants,which enable clear-water fracturing,represent a promising new class of materials for reservoir stimulation.Given the economic limitations associated with their exclusive use,this study investi...Self-suspended proppants,which enable clear-water fracturing,represent a promising new class of materials for reservoir stimulation.Given the economic limitations associated with their exclusive use,this study investigates proppant transport behavior in hybrid systems combining self-suspended proppants with conventional 40/70 mesh quartz sand at various mixing ratios.A dedicated experimental apparatus was developed to replicate field-relevant complex fracture networks,consisting of a main fracture and two branching fractures with different deflection angles.Using this system,sand bank formation and proppant distribution were examined for both conventional quartz sand fracturing and fracturing augmented with self-suspended proppants.The effects of slurry discharge volume,proppant mixing ratio,sand ratio,and injection location of the self-suspended proppant on transport and placement behavior were systematically analyzed.According to the results,the incorporation of self-suspended proppants markedly enhances the proppant-carrying capacity of the slurry and substantially modifies sand bank morphology.Increasing the discharge volume raises the inlet slope angle and promotes greater proppant penetration into branch fractures.The proportion of self-suspended proppant governs slurry viscoelasticity and,consequently,proppant settling behavior.As the fraction of self-suspended proppant decreases,the equilibrium height of the sand bank increases,while the proppant mass fraction within branch fractures exhibits a non-monotonic response,initially decreasing and then increasing.Variations in sand ratio alter both overall proppant concentration and the self-suspended proppant-to-water ratio,thereby modulating slurry rheology and influencing proppant placement.In addition,changes in injection location affect near-wellbore vortex structures,leading to distinct sand bank morphologies.展开更多
Background:Biological osteosynthesis preserves blood supply and promotes rapid healing by aligning fracture fragments without direct surgical exposure.Pedicle screws are primarily designed for internal fixation in spi...Background:Biological osteosynthesis preserves blood supply and promotes rapid healing by aligning fracture fragments without direct surgical exposure.Pedicle screws are primarily designed for internal fixation in spinal procedures.A key objec-tive of many orthopedic studies is to assess the biocompatibility of implants with bone and adjacent soft tissue.This study aims to evaluate the biocompatibility and effects of the Pedicle screw-Rod configuration as a novel external fixation method in canine tibial osteotomy.Methods:With ethics approval,eight healthy,intact male dogs,aged 10-12 months and weighing between 20 and 22 kg,underwent a minimally invasive medial tibial approach for surgical fixation of tibial osteotomy using a Pedicle screw-Rod configu-ration.Postoperative evaluations included ultrasound assessments at the osteotomy site and histological evaluations at the bone-screw interface.Results:B-mode ultrasound evaluation indicated healing progress at all osteotomy sites.The color Doppler examination revealed an initial increase in signals in the sur-rounding soft tissue during the first 4 weeks post-operation,followed by a decrease in signals within the adjacent soft tissue between the 5th and 8th weeks.During this latter period,the signals were primarily concentrated on the bone surface and the callus.The bone-screw interface at various screw sites exhibited similar histological changes,indicating effective integration of the newly formed woven bone into the screw threads.Conclusions:Fixation of non-articular tibial osteotomy with Pedicle screw-Rod con-figuration resulted in secondary bone healing,characterized by abundant callus for-mation and neovascularization.This implant demonstrated favorable biocompatibility with bone and surrounding soft tissue,without significant complications.展开更多
Objective:To analyze the clinical application value of autologous periosteum graft combined with platelet-rich plasma(PRP)in the treatment of long bone fractures in the extremities.Methods:A total of 40 patients with ...Objective:To analyze the clinical application value of autologous periosteum graft combined with platelet-rich plasma(PRP)in the treatment of long bone fractures in the extremities.Methods:A total of 40 patients with long bone fractures in the extremities admitted to Santai Hospital Affiliated to North Sichuan Medical College from January 2023 to January 2025 were included,including cases of upper extremity forearm fractures and lower extremity femoral and tibial fractures.The patients were evenly divided using a random number table,with the control group undergoing open reduction and internal fixation(ORIF)combined with autologous periosteum graft,and the observation group undergoing ORIF,autologous periosteum graft,and PRP injection.Surgical indicators,complication rates,excellent fracture healing rates,functional satisfaction,and joint range of motion were compared between the two groups.Results:The surgical indicators in the observation group were similar to those in the control group(p>0.05).The complication rate in the observation group was lower than that in the control group,while the excellent fracture healing rate and functional satisfaction were higher in the observation group(p<0.05).Conclusion:Autologous periosteum graft combined with PRP technology is safe and reliable for the treatment of long bone fractures in the extremities,with satisfactory clinical outcomes.展开更多
BACKGROUND Humeral shaft fractures are common and vary by age,with high-energy trauma observed in younger adults and low-impact injuries in older adults.Radial nerve palsy is a frequent complication.Treatment ranges f...BACKGROUND Humeral shaft fractures are common and vary by age,with high-energy trauma observed in younger adults and low-impact injuries in older adults.Radial nerve palsy is a frequent complication.Treatment ranges from nonoperative methods to surgical interventions such as intramedullary K-wires,which promote faster rehabilitation and improved elbow mobility.AIM To evaluate the outcomes of managing humeral shaft fractures using closed reduction and internal fixation with flexible intramedullary K-wires.METHODS This was a retrospective cohort study analyzing the medical records of patients with humeral shaft fractures managed with flexible intramedullary K-wires at King Abdulaziz Medical City,using non-random sampling and descriptive analysis for outcome evaluation.RESULTS This study assessed the clinical outcomes of 20 patients treated for humeral shaft fractures with intramedullary K-wires.Patients were predominantly male(n=16,80%),had an average age of 39.2 years,and a mean body mass index of 29.5 kg/m^(2).The fractures most frequently occurred in the middle third of the humerus(n=14,70%),with oblique fractures being the most common type(n=7,35%).All surgeries used general anesthesia and a posterior approach,with no intraoperative complications reported.Postoperatively,all patients achieved clinical and radiological union(n=20,100%),and the majority(n=13,65%)reached an elbow range of motion from 0 to 150 degrees.CONCLUSION These results suggest that intramedullary K-wire fixation may be an effective option for treating humeral shaft fractures,with favorable outcomes in range of motion recovery,fracture union,and a low rate of intraoperative complications.展开更多
Internal structural defects in engineering rock masses vary in size,exhibit complex shapes,and are unevenly distributed.Dominant fractures within a rock mass often play a critical to its mechanical behavior,directly a...Internal structural defects in engineering rock masses vary in size,exhibit complex shapes,and are unevenly distributed.Dominant fractures within a rock mass often play a critical to its mechanical behavior,directly affecting the macromechanical properties and failure modes.These fractures affect the instability and failure of the surrounding rock,significantlyimpacting the overall stability of engineering structures.Herein,sand-powder three-dimensional(3D)printing technology was used to prepare rock-like specimens with internal fracture networks.Triaxial compression testing,post-failure fracture mapping,and fractal dimension analysis of the fracture surfaces were conducted to investigate the effects of dominant fracture angles on the strength and deformation of rocks with internal fracture networks under triaxial stress.The results indicate that the dominant fracture angle has a pronounced effect on the mechanical behavior of rock.With increasing angle,both compressive strength and elastic modulus exhibit an initial decline followed by an increase.Moreover,higher confiningpressure significantlyimproves the compressive strength of fractured rock.This enhancement weakens as the confiningpressure further increases.Moreover,with increasing confiningpressure,the differences between the maximum and minimum values of elastic moduli and lateral strain ratios in fractured rock gradually decrease.Thus,the impact of the dominant fracture angle on rock mass deformation decreases with increasing confiningpressure.This research elucidates the effects of dominant fracture angles on the mechanical and failure properties of complex fractured rock masses and the influenceof the confiningpressure on these relationships.It provides valuable theoretical insights and practical guidance for stability analyses in engineering rock masses.展开更多
One of the key challenges for underground rock reservoirs is ensuring prevention of the unwanted fluid leakage through rock fracture networks during their service life.Microbial-induced calcium carbonate precipitation...One of the key challenges for underground rock reservoirs is ensuring prevention of the unwanted fluid leakage through rock fracture networks during their service life.Microbial-induced calcium carbonate precipitation(MICP)technology has emerged as a promising bio-healing method for rock fractures with small apertures.In this study,a new“three-stage”injection strategy-based MICP(TS-MICP)bio-healing method was proposed,aiming to achieve a“three-high”performance that includes high bridging rate,high mechanical strength,and high homogeneity.A series of meter-scale rock fracture models were prepared to conduct TS-MICP grouting tests.Compared with the traditional injection strategy-based biohealing methods,the TS-MICP method significantly improved the bridging rate(32.1%e89.5%),mechanical properties(0.138e1.023 MPa),and homogeneity of CaCO_(3)precipitation(334.4%).Additionally,it achieved a higher material utilization rate(1.72 times higher),reducing the consumption of cementation solution(CS)by 258.8%,thereby demonstrating greater potential for field applications.The underlying mechanism for achieving high bridging rate and high homogeneity in CaCO_(3)precipitation can be attributed to the synergistic effects of the coupling injection strategy,which optimizes the advantages at each stage.In stage I,under the influence of gravity,the rapid flocculation and hydrogen bonding interactions of organic matter lead to formation of the dense and high-strength CaCO_(3)precipitation at the bottom using a low-concentration bacterial suspension(BS).This process establishes bridging steps along the wall sides for subsequent uniform CaCO_(3)precipitation.In stage II,concentrated BS is utilized to produce looser CaCO_(3)flocculation,which precipitates uniformly on the pre-existing bridging steps.In stage III,a two-step injection strategy was employed to reinforce the loose CaCO_(3)crystals formed in stages I and II,and finally forms a strong bridging effect with“three-high”performance.展开更多
Objective:To observe and study the actual effects of percutaneous pedicle screw minimally invasive surgery in the treatment of spinal fractures and its impact on spinal function.Methods:This study included 48 patients...Objective:To observe and study the actual effects of percutaneous pedicle screw minimally invasive surgery in the treatment of spinal fractures and its impact on spinal function.Methods:This study included 48 patients with spinal fractures admitted between May 2023 and May 2024.The patients were divided into a control group and an experimental group based on treatment differences,with 24 patients in each group.The control group underwent open internal fixation surgery,while the experimental group received percutaneous pedicle screw minimally invasive surgery.Clinical index improvements,cervical dysfunction index,Japanese Orthopaedic Association scores,and pain level improvements were compared between the two groups.Results:The intraoperative blood loss,incision length,operation time,and hospitalization duration in the experimental group were(88.63±18.85),(6.32±1.05),(73.42±4.05),and(12.58±2.56),respectively,compared to(279.95±17.32),(12.89±1.36),(89.93±4.79),and(22.41±2.87)in the control group.Significant differences were observed between the groups,with the experimental group showing superior improvements across all metrics(P<0.05).Conclusion:Percutaneous pedicle screw minimally invasive surgery shows more significant effects in treating spinal fractures,particularly in improving cervical and lumbar spine function,enhancing treatment efficacy and safety,reducing pain levels,and shortening recovery time.Clinical application and promotion are recommended.展开更多
Objective:To evaluate the treatment effect of total hip arthroplasty(THA)for intertrochanteric femur fractures(IFF)in elderly patients.Methods:Thirty-two elderly patients with IFF admitted to the hospital from August ...Objective:To evaluate the treatment effect of total hip arthroplasty(THA)for intertrochanteric femur fractures(IFF)in elderly patients.Methods:Thirty-two elderly patients with IFF admitted to the hospital from August 2021 to August 2024 were selected and randomly divided into two groups using a random number table.The experimental group(16 patients)underwent THA surgery,while the control group(16 patients)underwent proximal femoral nail antirotation(PFNA)surgery.Hip joint function and quality of life indicators were compared between the two groups.Results:Before surgery,there was no significant difference in hip joint function and quality of life scores between the two groups(P>0.05).However,at six months postoperatively,the experimental group had higher hip joint function and quality of life scores compared to the control group(P<0.05).The total effective rate was higher in the experimental group than in the control group(P<0.05).The complication rate in the experimental group was similar to that in the control group(P>0.05).Conclusion:THA can improve the clinical efficacy of elderly patients with IFF,minimize postoperative complications,effectively restore hip joint function,and optimize postoperative quality of life.展开更多
The feasibility of three-dimensional (3D) printing technology cgmbined with minimally invasive surgery in the treatment of pubic rami fractures was explored.From August 2015 to October 2017,a series of 30 patients who...The feasibility of three-dimensional (3D) printing technology cgmbined with minimally invasive surgery in the treatment of pubic rami fractures was explored.From August 2015 to October 2017,a series of 30 patients who underwent surgical stabilization of their anterior pelvic ring (all utilizing the 3D printing technology)by one surgeon at a single hospital were studied.The minimally invasive incisions were made through anterior inferior cilia spine and pubic nodule.Data collected included the operative duration,the blood loss,the damage of the important tissue,the biographic union and therecovery of the function after the operation.Measurements on inlet and outlet pelvic cardiograph were made immediately post-operation and at all follow-up clinic visits.The scores of reduction and function were measured during follow-up.Results showed that the wounds of 30 patients were healed in the first stage,and there was no injury of important structures such as blood vessels and nerves.According to the Matta criteria,excellent effectiveness was obtained in 22 cases and good in 8 cases.According to the functional evaluation criteria of Majeed,excellent effectiveness was obtained in 21 cases and good in 9 cases.It was suggested that the 3D printing technology assisted by minimally invasive surgery can better evaluate the pelvic fracture before operation,which was helpful in plate modeling, and can shorten surgery duration and reduce intraoperative blood loss and complications. The positioning accuracy was improved,and better surgical result was finally achieved.展开更多
Prepulse combined hydraulic fracturing facilitates the development of fracture networks by integrating prepulse hydraulic loading with conventional hydraulic fracturing.The formation mechanisms of fracture networks be...Prepulse combined hydraulic fracturing facilitates the development of fracture networks by integrating prepulse hydraulic loading with conventional hydraulic fracturing.The formation mechanisms of fracture networks between hydraulic and pre-existing fractures under different prepulse loading parameters remain unclear.This research investigates the impact of prepulse loading parameters,including the prepulse loading number ratio(C),prepulse loading stress ratio(S),and prepulse loading frequency(f),on the formation of fracture networks between hydraulic and pre-existing fractures,using both experimental and numerical methods.The results suggest that low prepulse loading stress ratios and high prepulse loading number ratios are advantageous loading modes.Multiple hydraulic fractures are generated in the specimen under the advantageous loading modes,facilitating the development of a complex fracture network.Fatigue damage occurs in the specimen at the prepulse loading stage.The high water pressure at the secondary conventional hydraulic fracturing promotes the growth of hydraulic fractures along the damage zones.This allows the hydraulic fractures to propagate deeply and interact with pre-existing fractures.Under advantageous loading conditions,multiple hydraulic fractures can extend to pre-existing fractures,and these hydraulic fractures penetrate or propagate along pre-existing fractures.Especially when the approach angle is large,the damage range in the specimen during the prepulse loading stage increases,resulting in the formation of more hydraulic fractures.展开更多
BACKGROUND Few reports have described lumbar foraminal stenosis-induced radiculopathy after treatment by full-endoscopic spine surgery(FESS)combined with percutaneous vertebroplasty(PVP)in patients with vertebral comp...BACKGROUND Few reports have described lumbar foraminal stenosis-induced radiculopathy after treatment by full-endoscopic spine surgery(FESS)combined with percutaneous vertebroplasty(PVP)in patients with vertebral compression fractures.We herein report such a case,including the patient’s treatment process and doctor’s surgical experience.CASE SUMMARY A 79-year-old man presented with symptoms of radiculopathy after sustaining L4 vertebral compression fractures.Imaging and physical examination revealed L4 vertebral compression fractures combined with L3/4 Lumbar foraminal stenosis(LFS).The patient’s symptoms were low back pain with pain in the lateral left leg.Although many reports have described radiculopathy induced by osteoporotic vertebral compression fractures,the use of FESS combined with PVP has rarely been reported.This case report indicates that the combination of FESS and PVP is a safe and effective approach for the treatment of LFS-induced radiculopathy after vertebral compression fractures.This minimally invasive technique has great potential to replace traditional lumbar fixation and decompression surgery.Thus,we suggest the continued accumulation of similar cases to discuss the wider application of FESS.CONCLUSION For patients with osteoporotic vertebral compression fracture(OVCF)and LFS,PVP and FESS can be used to restore the vertebral height and reduce the pressure around the intervertebral foramen.Additionally,the combination of FESS and PVP can treat the pain or numbness of the low back and lower limbs and allow for recovery in a short time with excellent postoperative effects.In general,FESS is a good treatment for radiculopathy caused by foraminal stenosis after OVCF.展开更多
BACKGROUND Thoracolumbar fractures are generally combined with spinal cord injury to varying degrees,which may cause deterioration of the patients’condition and increase the difficulty of clinical treatment.At presen...BACKGROUND Thoracolumbar fractures are generally combined with spinal cord injury to varying degrees,which may cause deterioration of the patients’condition and increase the difficulty of clinical treatment.At present,anterior or combined anterior-posterior surgery is preferred for severe thoracolumbar fractures.AIM To investigate the effectiveness and postoperative rehabilitation of one-stage combined anterior-posterior surgery for severe thoracolumbar fractures with spinal cord injury.METHODS One-hundred-and-twenty patients who received surgery for severe thoracolumbar fractures with spinal cord injury at our hospital from February 2018 to February 2020 were randomly enrolled.They were randomly divided into group 1(one-stage combined anterior-posterior surgery,n=60)and group 2(onestage anterior-approach surgery,n=60).Treatment efficacy was compared between the two groups.RESULTS Blood loss was greater and the operation time was longer in group 1 than in group 2,and the differences were statistically significant(P<0.05).Incision length,intraoperative X-rays,and length of hospital stay were not significantly different between the two groups(P>0.05).Preoperative function of the affected vertebrae was not significantly different between the two groups(P>0.05).In each group,the patients showed significant improvement after surgery.The anterior vertebral height ratio and the posterior vertebral height ratio in group 1 after surgery were significantly higher than those in group 2.The Cobb angle after surgery was significantly lower in group 1 than in group 2(P<0.05).The canal-occupying ratio of the affected vertebrae was not significantly different between the two groups(P>0.05).Before surgery,there was no significant difference in the quality of life scores between the two groups(P>0.05).The above indicators were significantly improved after surgery compared with before surgery in each group.In addition,these indicators were markedly better in group 1 than in group 2 after surgery(P<0.05 for each).CONCLUSION One-stage combined anterior-posterior surgery effectively improves the function of the affected vertebrae and the life quality of patients with severe thoracolumbar fractures and spinal cord injury.This surgical approach is worthy of popularization in clinical use.展开更多
BACKGROUND In pediatric age group patients(<18 years old)treated operatively for distal radius/both bone fractures extending imaging beyond the initial postoperative period-particularly in uncomplicated cases-appea...BACKGROUND In pediatric age group patients(<18 years old)treated operatively for distal radius/both bone fractures extending imaging beyond the initial postoperative period-particularly in uncomplicated cases-appears to provide limited additional benefit.AIM To determine the necessary number of follow-up X-rays to use resources efficiently.METHODS Participants included in this study are pediatric age group patients who were treated operatively for distal radius/both bone fractures and were identified from a prospected collected data from the operating room database between the years 2009 and 2017.The data in the study included patients who had distal radius fractures and underwent fixation surgery(n=88).RESULTS When assessing the difference in the odds of conducting 1 or less X-ray compared to 2 or more X-rays in regard to the type of fixation,the only significant difference is the closed reduction fixation method.Patients who underwent closed reduction method procedure have significantly lower odds of having 2 more X-rays compared to those who didn’t have closed reduction method.Open reduction,internal fixation,and other fixation methods(close reduction and internal fixation,debridement,or epiphysiodesis)have higher odds of having two or more X-rays compared to patients who did not receive these methods;however,these odds are not statistically significant.CONCLUSION The findings of this study reveal notable absence of a statistically significant association between the frequency of postoperative X-rays and the outcome of children with distal radius fractures.展开更多
Understanding the relationship between normal stiffness and permeability in rock fractures under high and true-triaxial in situ stress conditions is critical to assess hydro-mechanical coupling in the Earth's crus...Understanding the relationship between normal stiffness and permeability in rock fractures under high and true-triaxial in situ stress conditions is critical to assess hydro-mechanical coupling in the Earth's crust.Previous data on stiffness–permeability relations are measured under uniaxial stress states as well as under normal stress.However,many projects involve faulted formations with complex three-dimensional(3D)stress states or significant changes to the original stress state.We rectified this by following the permeability evolution using a true-triaxial stress-permeability apparatus as well as independently applying a spectrum of triaxial stresses from low to high.The relationship between permeability and fracture normal stiffness was quantified using constraints based on the principle of virtual work.The impacts of fracture-lateral and fracture-normal stresses on permeability and normal stiffness evolution were measured.It was found that permeability decreases with increasing fracture-lateral and fracture-normal stresses as a result of Poisson confinement,independent of the orientation of the fracture relative to the stresses.The lateral stresses dominated the evolution of normal stiffness at lower normal stresses(σ_(3)=10 MPa)and played a supplementary role at higher normal stresses(σ_(3)>10 MPa).Moreover,correlations between the evolution of permeability and normal stiffness were extended beyond the low-stiffness,high-permeability region to the high-stiffness,low-permeability region under high fracture-lateral stresses(10–80 MPa)with fracture-normal stress(10–50 MPa)conditions.Again,high lateral stresses further confined the fracture and therefore reduced permeability and increased normal stiffness,which exceeded the previous reported stiffness under no lateral stress conditions.This process enabled us to identify a fundamental change in the flow regime from multi-channel to isolated channelized flow.These results provide important characterizations of fracture permeability in the deep crust,including recovery from deep shale-gas reservoirs.展开更多
BACKGROUND Postoperative delirium(POD)is a prevalent complication,particularly in elderly patients with hip fractures(HFs).It significantly affects recovery,length of hospital stay,healthcare costs,and long-term outco...BACKGROUND Postoperative delirium(POD)is a prevalent complication,particularly in elderly patients with hip fractures(HFs).It significantly affects recovery,length of hospital stay,healthcare costs,and long-term outcomes.Existing studies have investigated risk factors for POD,but most are limited by single-factor analyses or small sample sizes.This study systematically determines independent risk factors using large-scale data and machine learning techniques and develops a validated nomogram model to support early prediction and management of POD.AIM To investigate POD incidence in elderly patients with HF and the independent risk factors,according to which a nomogram prediction model was developed and validated.METHODS This retrospective study included elderly patients with HF who were surgically treated in Dongying People’sHospital from April 2018 to April 2022. The endpoint event includes POD. They were categorized into themodeling and validation cohorts in a 7:3 ratio by randomization. Both cohorts were further classified into thedelirium and normal (non-delirium) groups according to the presence or absence of the endpoint event. Theincidence of POD was calculated, and logistic multivariate analysis was conducted to determine the independentrisk factors. The calibration curve and the Hosmer-Lemeshow test as well as the net benefit threshold probabilityinterval by the decision curve were utilized to statistically validate the accuracy of the nomogram predictionmodel, developed according to each factor’s influence intensity.RESULTSThis study included 532 elderly patients with HF, with an overall POD incidence of 14.85%. The comparison ofbaseline data with perioperative indicators revealed statistical differences in age (P < 0.001), number of comorbidities(P = 0.042), American Society of Anesthesiologists grading (P = 0.004), preoperative red blood cell(RBC) count (P < 0.001), preoperative albumin (P < 0.001), preoperative hemoglobin (P < 0.001), preoperativeplatelet count (P < 0.001), intraoperative blood loss (P < 0.001), RBC transfusion of ≥ 2 units (P = 0.001), andpostoperative intensive care unit care (P < 0.001) between the delirium and non-delirium groups. The participantswere randomized to a training group (n = 372) and a validation group (n = 160). A score-risk nomogram predictionmodel was developed after screening key POD features using Lasso regression, support vector machine, and therandom forest method. The nomogram showed excellent discriminatory capacity with area under the curve of0.833 [95% confidence interval (CI) interval: 0.774-0.888] in the training group and 0.850 (95%CI: 0.718-0.982) in thevalidation group. Calibration curves demonstrated good agreement between predicted and actual probabilities,and decision curve analysis confirmed clinical net benefits within risk thresholds of 0%-30% and 0%-36%, respectively.The model has strong accuracy and clinical utility for predicting the risk of POD.CONCLUSIONThis study reveals cognitive impairment history, American Society of Anesthesiologists grade of > 2, RBCtransfusion of ≥ 2 units, postoperative intensive care unit care, and preoperative hemoglobin level as independentrisk factors for POD in elderly patients with HF. The developed nomogram model demonstrates excellent accuracyand stability in predicting the risk of POD, which is recommended to be applied in clinical practice to optimizepostoperative management and reduce delirium incidence.展开更多
Objective To identify risk factors contributing to prolonged postoperative length of stay(LOS)in very elderly patients following hip fracture surgery,with a focus on postoperative complications and the impact of diffe...Objective To identify risk factors contributing to prolonged postoperative length of stay(LOS)in very elderly patients following hip fracture surgery,with a focus on postoperative complications and the impact of different anesthesia approaches.Methods This retrospective single-center cohort study enrolled patients aged 90 years or older who underwent hip fracture surgery at Peking Union Medical College Hospital between January 31,2013 and December 31,2023.Relevant perioperative data were collected.The primary outcome was postoperative LOS,and the study cohort was divided into two groups:postoperative LOS≤7 days and LOS>7 days.Logistic regression was performed to identify factors related to prolonged postoperative LOS.Results A total of 155 patients were included.The average age was 92.7±2.6 years.There were 73(47%)patients with postoperative LOS>7 days.Postoperative pneumonia was the only factor associated with a prolonged postoperative LOS(OR=2.12,95%CI[1.09,4.16],P=0.028).Neither the type of anesthesia(regional vs.general anesthesia,OR=1.00,95%CI[0.53,1.90],P=0.993)nor the method of airway management(laryngeal mask ventilation vs.spontaneous breathing,OR=1.46,95%CI[0.58,3.76],P=0.424;endotracheal intubation vs.spontaneous breathing,OR=0.82,95%CI[0.39,1.69],P=0.592)showed a significant association with a prolonged postoperative LOS.Preoperative chronic obstructive pulmonary disease(OR=2.78,95%CI[1.05,7.65],P=0.040)and preoperative neutrophil count(OR=1.13,95%CI[1.01,1.26],P=0.029)were both significantly associated with the occurrence of postoperative pneumonia,while anesthesia type and airway management method were not.Conclusions Postoperative pneumonia was associated with prolonged postoperative LOS in very elderly patients undergoing hip fracture surgery,whereas anesthesia types and airway management methods show no association with prolonged postoperative LOS or postoperative pneumonia.Preoperative comorbidities,especially respiratory conditions and systemic inflammation,potentially play a substantial role in postoperative recovery.展开更多
BACKGROUND Traumatic injuries,such as falling,car accidents,and crushing mostly cause spinal fractures in young and middle-aged people,and>50%of them are thoracolumbar fractures.This kind of fracture is easily comb...BACKGROUND Traumatic injuries,such as falling,car accidents,and crushing mostly cause spinal fractures in young and middle-aged people,and>50%of them are thoracolumbar fractures.This kind of fracture is easily combined with serious injuries to peripheral nerves and soft tissues,which causes paralysis of the lower limbs if there is no timely rehabilitation treatment.Young patients with thoracolumbar fractures find it difficult to recover after the operation,and they are prone to depression,low self-esteem,and other negative emotions.AIM To investigate the association between anxiety,depression,and social stress in young patients with thoracolumbar spine fractures and the effect on rehabilitation outcomes.METHODS This study retrospectively analyzed 100 patients admitted to the orthopedic department of Honghui Hospital,Xi’an Jiaotong University who underwent thoracolumbar spine fracture surgery from January 2022 to June 2023.The general data of the patients were assessed with the Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD),life events scale,and social support rating scale(SSRS)to identify the correlation between anxiety,depression scores,and social stress and social support.The Japanese Orthopedic Association(JOA)was utilized to evaluate the rehabilitation outcomes of the patients and to analyze the effects of anxiety and depression scores on rehabilitation.RESULTS According to the scores of HAMD and HAMA in all patients,the prevalence of depression in patients was 39%(39/100),and the prevalence of anxiety was 49%(49/100).Patients were categorized into non-depression(n=61)and depression(n=39),non-anxiety(n=51),and anxiety(n=49)groups.Statistically significant differences in gender,occupation,Pittsburgh Sleep Quality Index(PSQI)score,and monthly family income were observed between the non-depression and depression groups(P<0.05).A significant difference in occupation and PSQI score was found between the non-anxiety and anxiety groups.Both depression(r=0.207,P=0.038)and anxiety scores(r=0.473,P<0.001)were significantly and positively correlated with negative life events.The difference in negative life event scores as well as SSRS total and item scores was statist-ically significant between patients in the non-depression and depression groups(P<0.05).The difference between the non-anxiety and anxiety groups was statistically significant(P<0.05)in the negative life event scores as well as the total SSRS scores.Additionally,JOA scores were significantly lower in both anxious and depressed patients.CONCLUSION Young patients with thoracolumbar fractures are prone to anxiety and depression.Patients’anxiety and depression are closely associated with social pressure,which reduces the life pressure of young patients with thoracolumbar fractures,enhances social support,and improves the psychology of anxiety and depression.,which affects patients’recovery.展开更多
文摘Complex trimalleolar ankle fractures are a major orthopaedic challenge,with an incidence of 4.22 per 10000 person-years in the United States and an annual cost of 3.4 billion dollars.This review synthesizes current evidence on diagnostic protocols and management strategies,highlighting optimal approaches and emerging trends.Initial care emphasizes soft tissue assessment,often guided by the Tscherne classification,and fracture classification systems.External fixation may be required in open injuries,while early open reduction and internal fixation within six days is linked to improved outcomes.Minimally invasive techniques for the lateral malleolus,including intramedullary nailing and locking plates,are effective,while medial malleolus fractures are commonly managed with screw fixation or tension-band wiring.Posterior malleolus fragments involving more than 25%of the articular surface usually warrant fixation.Alternatives to syndesmotic screws,such as cortical buttons or high-strength sutures,reduce the need for secondary procedures.Arthroscopic-assisted open reduction and internal fixation benefits younger,active patients by enabling concurrent management of intra-articular and ligamentous injuries.Postoperative care prioritizes early weight-bearing and validated functional scores.Despite advances,complications remain common,and further research is needed to refine surgical strategies and improve outcomes.
基金the PICTO project(RFCR-CT-2018-800711)funded by the European Research Fund for Coal and Steel(RFCS)and the Polish Ministry of Science and Higher Education(W93/FBWiS/2018).
文摘The research presented in this paper aimed to analyze the evolution of fractures in strata in relation to the progress of longwall mining.To achieve this objective,an introscopic probe equipped with a highresolution camera was developed,along with additional equipment that enables continuous recording of the internal surfaces of drainage boreholes exceeding 100 m in depth.The probe was utilized to test two methane drainage boreholes in the Z-3b longwall,which operates within the 501/3 coal seam of the Jankowice mine in Poland.Automatic image analysis methods were applied to evaluate the recorded images,based on a newly developed classificationsystem for fractures categorized by size and number.The results were compared with an analysis of changes in the methane capture rate from the drainage boreholes,which correlated with longwall mining progress.A strong correlation was observed between the number of fractures and the lithology of the strata layers.The largest number of fractures and their evolution were recorded in the coal layers,followed by the shale layers,while the sandstone layers exhibited the least number of fractures.Based on parallel measurements of the methane capture rate from the drainage boreholes during the progress of longwall mining,the extent of the strata's fracture zone was determined to range from 6 m to 36 m.Within the fracture zone,the strata are highly fractured,which leads to an increase in methane emissions through seepage and diffusion processes.
文摘Hydraulic fracturing serves as a critical technology for reservoir stimulation in deep coalbed methane(CBM)development,where the mechanical properties of gangue layers exert a significant control on fracture propagation behavior.To address the unclear mechanisms governing fracture penetration across coal-gangue interfaces,this study employs the Continuum-Discontinuum Element Method(CDEM)to simulate and analyze the vertical propagation of hydraulic fractures initiating within coal seams,based on geomechanical parameters derived from the deep Benxi Formation coal seams in the southeastern Ordos Basin.The investigation systematically examines the influence of geological and operational parameters on cross-interfacial fracture growth.Results demonstrate that vertical stress difference,elastic modulus contrast between coal and gangue layers,interfacial stress differential,and interfacial cohesion at coal-gangue interfaces are critical factors governing hydraulic fracture penetration through these interfaces.High vertical stress differences(>3 MPa)inhibit interfacial dilation,promoting predominant crosslayer fracture propagation.Reduced interfacial stress contrasts and enhanced interfacial cohesion facilitate fracture penetration across interfaces.Furthermore,smaller elastic modulus contrasts between coal and gangue correlate with increased interfacial aperture.Finally,lower injection rates effectively suppress vertical fracture propagation in deep coal reservoirs.This study elucidates the characteristics and mechanisms governing cross-layer fracture propagation in coal–rock composites with interbedded partings,and delineates the dynamic evolution laws and dominant controlling factors involved.Thefindings provide critical theoretical insights for the optimization of fracture design and the efficient development of deep coalbed methane reservoirs.
基金the China National Petroleum Corporation’s Forward-Looking Fundamental Technology Breakthrough Project(2021DJ2305).
文摘Self-suspended proppants,which enable clear-water fracturing,represent a promising new class of materials for reservoir stimulation.Given the economic limitations associated with their exclusive use,this study investigates proppant transport behavior in hybrid systems combining self-suspended proppants with conventional 40/70 mesh quartz sand at various mixing ratios.A dedicated experimental apparatus was developed to replicate field-relevant complex fracture networks,consisting of a main fracture and two branching fractures with different deflection angles.Using this system,sand bank formation and proppant distribution were examined for both conventional quartz sand fracturing and fracturing augmented with self-suspended proppants.The effects of slurry discharge volume,proppant mixing ratio,sand ratio,and injection location of the self-suspended proppant on transport and placement behavior were systematically analyzed.According to the results,the incorporation of self-suspended proppants markedly enhances the proppant-carrying capacity of the slurry and substantially modifies sand bank morphology.Increasing the discharge volume raises the inlet slope angle and promotes greater proppant penetration into branch fractures.The proportion of self-suspended proppant governs slurry viscoelasticity and,consequently,proppant settling behavior.As the fraction of self-suspended proppant decreases,the equilibrium height of the sand bank increases,while the proppant mass fraction within branch fractures exhibits a non-monotonic response,initially decreasing and then increasing.Variations in sand ratio alter both overall proppant concentration and the self-suspended proppant-to-water ratio,thereby modulating slurry rheology and influencing proppant placement.In addition,changes in injection location affect near-wellbore vortex structures,leading to distinct sand bank morphologies.
基金The Vice Chancellor of Research and Technology at Urmia University。
文摘Background:Biological osteosynthesis preserves blood supply and promotes rapid healing by aligning fracture fragments without direct surgical exposure.Pedicle screws are primarily designed for internal fixation in spinal procedures.A key objec-tive of many orthopedic studies is to assess the biocompatibility of implants with bone and adjacent soft tissue.This study aims to evaluate the biocompatibility and effects of the Pedicle screw-Rod configuration as a novel external fixation method in canine tibial osteotomy.Methods:With ethics approval,eight healthy,intact male dogs,aged 10-12 months and weighing between 20 and 22 kg,underwent a minimally invasive medial tibial approach for surgical fixation of tibial osteotomy using a Pedicle screw-Rod configu-ration.Postoperative evaluations included ultrasound assessments at the osteotomy site and histological evaluations at the bone-screw interface.Results:B-mode ultrasound evaluation indicated healing progress at all osteotomy sites.The color Doppler examination revealed an initial increase in signals in the sur-rounding soft tissue during the first 4 weeks post-operation,followed by a decrease in signals within the adjacent soft tissue between the 5th and 8th weeks.During this latter period,the signals were primarily concentrated on the bone surface and the callus.The bone-screw interface at various screw sites exhibited similar histological changes,indicating effective integration of the newly formed woven bone into the screw threads.Conclusions:Fixation of non-articular tibial osteotomy with Pedicle screw-Rod con-figuration resulted in secondary bone healing,characterized by abundant callus for-mation and neovascularization.This implant demonstrated favorable biocompatibility with bone and surrounding soft tissue,without significant complications.
文摘Objective:To analyze the clinical application value of autologous periosteum graft combined with platelet-rich plasma(PRP)in the treatment of long bone fractures in the extremities.Methods:A total of 40 patients with long bone fractures in the extremities admitted to Santai Hospital Affiliated to North Sichuan Medical College from January 2023 to January 2025 were included,including cases of upper extremity forearm fractures and lower extremity femoral and tibial fractures.The patients were evenly divided using a random number table,with the control group undergoing open reduction and internal fixation(ORIF)combined with autologous periosteum graft,and the observation group undergoing ORIF,autologous periosteum graft,and PRP injection.Surgical indicators,complication rates,excellent fracture healing rates,functional satisfaction,and joint range of motion were compared between the two groups.Results:The surgical indicators in the observation group were similar to those in the control group(p>0.05).The complication rate in the observation group was lower than that in the control group,while the excellent fracture healing rate and functional satisfaction were higher in the observation group(p<0.05).Conclusion:Autologous periosteum graft combined with PRP technology is safe and reliable for the treatment of long bone fractures in the extremities,with satisfactory clinical outcomes.
基金approved by King Abdullah International Medical Research Center Ethics Committee(approval No.0000074524).
文摘BACKGROUND Humeral shaft fractures are common and vary by age,with high-energy trauma observed in younger adults and low-impact injuries in older adults.Radial nerve palsy is a frequent complication.Treatment ranges from nonoperative methods to surgical interventions such as intramedullary K-wires,which promote faster rehabilitation and improved elbow mobility.AIM To evaluate the outcomes of managing humeral shaft fractures using closed reduction and internal fixation with flexible intramedullary K-wires.METHODS This was a retrospective cohort study analyzing the medical records of patients with humeral shaft fractures managed with flexible intramedullary K-wires at King Abdulaziz Medical City,using non-random sampling and descriptive analysis for outcome evaluation.RESULTS This study assessed the clinical outcomes of 20 patients treated for humeral shaft fractures with intramedullary K-wires.Patients were predominantly male(n=16,80%),had an average age of 39.2 years,and a mean body mass index of 29.5 kg/m^(2).The fractures most frequently occurred in the middle third of the humerus(n=14,70%),with oblique fractures being the most common type(n=7,35%).All surgeries used general anesthesia and a posterior approach,with no intraoperative complications reported.Postoperatively,all patients achieved clinical and radiological union(n=20,100%),and the majority(n=13,65%)reached an elbow range of motion from 0 to 150 degrees.CONCLUSION These results suggest that intramedullary K-wire fixation may be an effective option for treating humeral shaft fractures,with favorable outcomes in range of motion recovery,fracture union,and a low rate of intraoperative complications.
基金supported by the National Key Research and Development Program Young Scientist Project(Grant No.2024YFC2911000)the National Natural Science Foundation of China(Grant No.52474103)the Major Basic Research Project of the Natural Science Foundation of Shandong Province(Grant No.ZR2024ZD22).
文摘Internal structural defects in engineering rock masses vary in size,exhibit complex shapes,and are unevenly distributed.Dominant fractures within a rock mass often play a critical to its mechanical behavior,directly affecting the macromechanical properties and failure modes.These fractures affect the instability and failure of the surrounding rock,significantlyimpacting the overall stability of engineering structures.Herein,sand-powder three-dimensional(3D)printing technology was used to prepare rock-like specimens with internal fracture networks.Triaxial compression testing,post-failure fracture mapping,and fractal dimension analysis of the fracture surfaces were conducted to investigate the effects of dominant fracture angles on the strength and deformation of rocks with internal fracture networks under triaxial stress.The results indicate that the dominant fracture angle has a pronounced effect on the mechanical behavior of rock.With increasing angle,both compressive strength and elastic modulus exhibit an initial decline followed by an increase.Moreover,higher confiningpressure significantlyimproves the compressive strength of fractured rock.This enhancement weakens as the confiningpressure further increases.Moreover,with increasing confiningpressure,the differences between the maximum and minimum values of elastic moduli and lateral strain ratios in fractured rock gradually decrease.Thus,the impact of the dominant fracture angle on rock mass deformation decreases with increasing confiningpressure.This research elucidates the effects of dominant fracture angles on the mechanical and failure properties of complex fractured rock masses and the influenceof the confiningpressure on these relationships.It provides valuable theoretical insights and practical guidance for stability analyses in engineering rock masses.
基金supported by the National Key Research and Development Program of China(Grant No.2023YFC3007102)the National Natural Science Foundation of China(Grant Nos.42477188 and 41925012).
文摘One of the key challenges for underground rock reservoirs is ensuring prevention of the unwanted fluid leakage through rock fracture networks during their service life.Microbial-induced calcium carbonate precipitation(MICP)technology has emerged as a promising bio-healing method for rock fractures with small apertures.In this study,a new“three-stage”injection strategy-based MICP(TS-MICP)bio-healing method was proposed,aiming to achieve a“three-high”performance that includes high bridging rate,high mechanical strength,and high homogeneity.A series of meter-scale rock fracture models were prepared to conduct TS-MICP grouting tests.Compared with the traditional injection strategy-based biohealing methods,the TS-MICP method significantly improved the bridging rate(32.1%e89.5%),mechanical properties(0.138e1.023 MPa),and homogeneity of CaCO_(3)precipitation(334.4%).Additionally,it achieved a higher material utilization rate(1.72 times higher),reducing the consumption of cementation solution(CS)by 258.8%,thereby demonstrating greater potential for field applications.The underlying mechanism for achieving high bridging rate and high homogeneity in CaCO_(3)precipitation can be attributed to the synergistic effects of the coupling injection strategy,which optimizes the advantages at each stage.In stage I,under the influence of gravity,the rapid flocculation and hydrogen bonding interactions of organic matter lead to formation of the dense and high-strength CaCO_(3)precipitation at the bottom using a low-concentration bacterial suspension(BS).This process establishes bridging steps along the wall sides for subsequent uniform CaCO_(3)precipitation.In stage II,concentrated BS is utilized to produce looser CaCO_(3)flocculation,which precipitates uniformly on the pre-existing bridging steps.In stage III,a two-step injection strategy was employed to reinforce the loose CaCO_(3)crystals formed in stages I and II,and finally forms a strong bridging effect with“three-high”performance.
文摘Objective:To observe and study the actual effects of percutaneous pedicle screw minimally invasive surgery in the treatment of spinal fractures and its impact on spinal function.Methods:This study included 48 patients with spinal fractures admitted between May 2023 and May 2024.The patients were divided into a control group and an experimental group based on treatment differences,with 24 patients in each group.The control group underwent open internal fixation surgery,while the experimental group received percutaneous pedicle screw minimally invasive surgery.Clinical index improvements,cervical dysfunction index,Japanese Orthopaedic Association scores,and pain level improvements were compared between the two groups.Results:The intraoperative blood loss,incision length,operation time,and hospitalization duration in the experimental group were(88.63±18.85),(6.32±1.05),(73.42±4.05),and(12.58±2.56),respectively,compared to(279.95±17.32),(12.89±1.36),(89.93±4.79),and(22.41±2.87)in the control group.Significant differences were observed between the groups,with the experimental group showing superior improvements across all metrics(P<0.05).Conclusion:Percutaneous pedicle screw minimally invasive surgery shows more significant effects in treating spinal fractures,particularly in improving cervical and lumbar spine function,enhancing treatment efficacy and safety,reducing pain levels,and shortening recovery time.Clinical application and promotion are recommended.
文摘Objective:To evaluate the treatment effect of total hip arthroplasty(THA)for intertrochanteric femur fractures(IFF)in elderly patients.Methods:Thirty-two elderly patients with IFF admitted to the hospital from August 2021 to August 2024 were selected and randomly divided into two groups using a random number table.The experimental group(16 patients)underwent THA surgery,while the control group(16 patients)underwent proximal femoral nail antirotation(PFNA)surgery.Hip joint function and quality of life indicators were compared between the two groups.Results:Before surgery,there was no significant difference in hip joint function and quality of life scores between the two groups(P>0.05).However,at six months postoperatively,the experimental group had higher hip joint function and quality of life scores compared to the control group(P<0.05).The total effective rate was higher in the experimental group than in the control group(P<0.05).The complication rate in the experimental group was similar to that in the control group(P>0.05).Conclusion:THA can improve the clinical efficacy of elderly patients with IFF,minimize postoperative complications,effectively restore hip joint function,and optimize postoperative quality of life.
文摘The feasibility of three-dimensional (3D) printing technology cgmbined with minimally invasive surgery in the treatment of pubic rami fractures was explored.From August 2015 to October 2017,a series of 30 patients who underwent surgical stabilization of their anterior pelvic ring (all utilizing the 3D printing technology)by one surgeon at a single hospital were studied.The minimally invasive incisions were made through anterior inferior cilia spine and pubic nodule.Data collected included the operative duration,the blood loss,the damage of the important tissue,the biographic union and therecovery of the function after the operation.Measurements on inlet and outlet pelvic cardiograph were made immediately post-operation and at all follow-up clinic visits.The scores of reduction and function were measured during follow-up.Results showed that the wounds of 30 patients were healed in the first stage,and there was no injury of important structures such as blood vessels and nerves.According to the Matta criteria,excellent effectiveness was obtained in 22 cases and good in 8 cases.According to the functional evaluation criteria of Majeed,excellent effectiveness was obtained in 21 cases and good in 9 cases.It was suggested that the 3D printing technology assisted by minimally invasive surgery can better evaluate the pelvic fracture before operation,which was helpful in plate modeling, and can shorten surgery duration and reduce intraoperative blood loss and complications. The positioning accuracy was improved,and better surgical result was finally achieved.
基金financially supported by,the Fundamental Research Funds for the Central Universities(Grant No.2023QN1064)the China Postdoctoral Science Foundation(Grant No.2023M733772)Jiangsu Funding Program for Excellent Postdoctoral Talent(Grant No.2023ZB847)。
文摘Prepulse combined hydraulic fracturing facilitates the development of fracture networks by integrating prepulse hydraulic loading with conventional hydraulic fracturing.The formation mechanisms of fracture networks between hydraulic and pre-existing fractures under different prepulse loading parameters remain unclear.This research investigates the impact of prepulse loading parameters,including the prepulse loading number ratio(C),prepulse loading stress ratio(S),and prepulse loading frequency(f),on the formation of fracture networks between hydraulic and pre-existing fractures,using both experimental and numerical methods.The results suggest that low prepulse loading stress ratios and high prepulse loading number ratios are advantageous loading modes.Multiple hydraulic fractures are generated in the specimen under the advantageous loading modes,facilitating the development of a complex fracture network.Fatigue damage occurs in the specimen at the prepulse loading stage.The high water pressure at the secondary conventional hydraulic fracturing promotes the growth of hydraulic fractures along the damage zones.This allows the hydraulic fractures to propagate deeply and interact with pre-existing fractures.Under advantageous loading conditions,multiple hydraulic fractures can extend to pre-existing fractures,and these hydraulic fractures penetrate or propagate along pre-existing fractures.Especially when the approach angle is large,the damage range in the specimen during the prepulse loading stage increases,resulting in the formation of more hydraulic fractures.
基金Supported by National Natural Science Foundation of China,No.81972108.
文摘BACKGROUND Few reports have described lumbar foraminal stenosis-induced radiculopathy after treatment by full-endoscopic spine surgery(FESS)combined with percutaneous vertebroplasty(PVP)in patients with vertebral compression fractures.We herein report such a case,including the patient’s treatment process and doctor’s surgical experience.CASE SUMMARY A 79-year-old man presented with symptoms of radiculopathy after sustaining L4 vertebral compression fractures.Imaging and physical examination revealed L4 vertebral compression fractures combined with L3/4 Lumbar foraminal stenosis(LFS).The patient’s symptoms were low back pain with pain in the lateral left leg.Although many reports have described radiculopathy induced by osteoporotic vertebral compression fractures,the use of FESS combined with PVP has rarely been reported.This case report indicates that the combination of FESS and PVP is a safe and effective approach for the treatment of LFS-induced radiculopathy after vertebral compression fractures.This minimally invasive technique has great potential to replace traditional lumbar fixation and decompression surgery.Thus,we suggest the continued accumulation of similar cases to discuss the wider application of FESS.CONCLUSION For patients with osteoporotic vertebral compression fracture(OVCF)and LFS,PVP and FESS can be used to restore the vertebral height and reduce the pressure around the intervertebral foramen.Additionally,the combination of FESS and PVP can treat the pain or numbness of the low back and lower limbs and allow for recovery in a short time with excellent postoperative effects.In general,FESS is a good treatment for radiculopathy caused by foraminal stenosis after OVCF.
文摘BACKGROUND Thoracolumbar fractures are generally combined with spinal cord injury to varying degrees,which may cause deterioration of the patients’condition and increase the difficulty of clinical treatment.At present,anterior or combined anterior-posterior surgery is preferred for severe thoracolumbar fractures.AIM To investigate the effectiveness and postoperative rehabilitation of one-stage combined anterior-posterior surgery for severe thoracolumbar fractures with spinal cord injury.METHODS One-hundred-and-twenty patients who received surgery for severe thoracolumbar fractures with spinal cord injury at our hospital from February 2018 to February 2020 were randomly enrolled.They were randomly divided into group 1(one-stage combined anterior-posterior surgery,n=60)and group 2(onestage anterior-approach surgery,n=60).Treatment efficacy was compared between the two groups.RESULTS Blood loss was greater and the operation time was longer in group 1 than in group 2,and the differences were statistically significant(P<0.05).Incision length,intraoperative X-rays,and length of hospital stay were not significantly different between the two groups(P>0.05).Preoperative function of the affected vertebrae was not significantly different between the two groups(P>0.05).In each group,the patients showed significant improvement after surgery.The anterior vertebral height ratio and the posterior vertebral height ratio in group 1 after surgery were significantly higher than those in group 2.The Cobb angle after surgery was significantly lower in group 1 than in group 2(P<0.05).The canal-occupying ratio of the affected vertebrae was not significantly different between the two groups(P>0.05).Before surgery,there was no significant difference in the quality of life scores between the two groups(P>0.05).The above indicators were significantly improved after surgery compared with before surgery in each group.In addition,these indicators were markedly better in group 1 than in group 2 after surgery(P<0.05 for each).CONCLUSION One-stage combined anterior-posterior surgery effectively improves the function of the affected vertebrae and the life quality of patients with severe thoracolumbar fractures and spinal cord injury.This surgical approach is worthy of popularization in clinical use.
文摘BACKGROUND In pediatric age group patients(<18 years old)treated operatively for distal radius/both bone fractures extending imaging beyond the initial postoperative period-particularly in uncomplicated cases-appears to provide limited additional benefit.AIM To determine the necessary number of follow-up X-rays to use resources efficiently.METHODS Participants included in this study are pediatric age group patients who were treated operatively for distal radius/both bone fractures and were identified from a prospected collected data from the operating room database between the years 2009 and 2017.The data in the study included patients who had distal radius fractures and underwent fixation surgery(n=88).RESULTS When assessing the difference in the odds of conducting 1 or less X-ray compared to 2 or more X-rays in regard to the type of fixation,the only significant difference is the closed reduction fixation method.Patients who underwent closed reduction method procedure have significantly lower odds of having 2 more X-rays compared to those who didn’t have closed reduction method.Open reduction,internal fixation,and other fixation methods(close reduction and internal fixation,debridement,or epiphysiodesis)have higher odds of having two or more X-rays compared to patients who did not receive these methods;however,these odds are not statistically significant.CONCLUSION The findings of this study reveal notable absence of a statistically significant association between the frequency of postoperative X-rays and the outcome of children with distal radius fractures.
基金funded by the joint fund of the National Key Research and Development Program of China(Grant No.2021YFC2902101)National Natural Science Foundation of China(Grant No.52374084)+1 种基金the 111 Project(Grant No.B17009)DE acknowledges support from the G.Albert Shoemaker endowment.
文摘Understanding the relationship between normal stiffness and permeability in rock fractures under high and true-triaxial in situ stress conditions is critical to assess hydro-mechanical coupling in the Earth's crust.Previous data on stiffness–permeability relations are measured under uniaxial stress states as well as under normal stress.However,many projects involve faulted formations with complex three-dimensional(3D)stress states or significant changes to the original stress state.We rectified this by following the permeability evolution using a true-triaxial stress-permeability apparatus as well as independently applying a spectrum of triaxial stresses from low to high.The relationship between permeability and fracture normal stiffness was quantified using constraints based on the principle of virtual work.The impacts of fracture-lateral and fracture-normal stresses on permeability and normal stiffness evolution were measured.It was found that permeability decreases with increasing fracture-lateral and fracture-normal stresses as a result of Poisson confinement,independent of the orientation of the fracture relative to the stresses.The lateral stresses dominated the evolution of normal stiffness at lower normal stresses(σ_(3)=10 MPa)and played a supplementary role at higher normal stresses(σ_(3)>10 MPa).Moreover,correlations between the evolution of permeability and normal stiffness were extended beyond the low-stiffness,high-permeability region to the high-stiffness,low-permeability region under high fracture-lateral stresses(10–80 MPa)with fracture-normal stress(10–50 MPa)conditions.Again,high lateral stresses further confined the fracture and therefore reduced permeability and increased normal stiffness,which exceeded the previous reported stiffness under no lateral stress conditions.This process enabled us to identify a fundamental change in the flow regime from multi-channel to isolated channelized flow.These results provide important characterizations of fracture permeability in the deep crust,including recovery from deep shale-gas reservoirs.
基金Supported by Wang Zhengguo Foundation for Traumatic Medicine“Sequential Medical Research Special Foundation”,No 2024-XGM05.
文摘BACKGROUND Postoperative delirium(POD)is a prevalent complication,particularly in elderly patients with hip fractures(HFs).It significantly affects recovery,length of hospital stay,healthcare costs,and long-term outcomes.Existing studies have investigated risk factors for POD,but most are limited by single-factor analyses or small sample sizes.This study systematically determines independent risk factors using large-scale data and machine learning techniques and develops a validated nomogram model to support early prediction and management of POD.AIM To investigate POD incidence in elderly patients with HF and the independent risk factors,according to which a nomogram prediction model was developed and validated.METHODS This retrospective study included elderly patients with HF who were surgically treated in Dongying People’sHospital from April 2018 to April 2022. The endpoint event includes POD. They were categorized into themodeling and validation cohorts in a 7:3 ratio by randomization. Both cohorts were further classified into thedelirium and normal (non-delirium) groups according to the presence or absence of the endpoint event. Theincidence of POD was calculated, and logistic multivariate analysis was conducted to determine the independentrisk factors. The calibration curve and the Hosmer-Lemeshow test as well as the net benefit threshold probabilityinterval by the decision curve were utilized to statistically validate the accuracy of the nomogram predictionmodel, developed according to each factor’s influence intensity.RESULTSThis study included 532 elderly patients with HF, with an overall POD incidence of 14.85%. The comparison ofbaseline data with perioperative indicators revealed statistical differences in age (P < 0.001), number of comorbidities(P = 0.042), American Society of Anesthesiologists grading (P = 0.004), preoperative red blood cell(RBC) count (P < 0.001), preoperative albumin (P < 0.001), preoperative hemoglobin (P < 0.001), preoperativeplatelet count (P < 0.001), intraoperative blood loss (P < 0.001), RBC transfusion of ≥ 2 units (P = 0.001), andpostoperative intensive care unit care (P < 0.001) between the delirium and non-delirium groups. The participantswere randomized to a training group (n = 372) and a validation group (n = 160). A score-risk nomogram predictionmodel was developed after screening key POD features using Lasso regression, support vector machine, and therandom forest method. The nomogram showed excellent discriminatory capacity with area under the curve of0.833 [95% confidence interval (CI) interval: 0.774-0.888] in the training group and 0.850 (95%CI: 0.718-0.982) in thevalidation group. Calibration curves demonstrated good agreement between predicted and actual probabilities,and decision curve analysis confirmed clinical net benefits within risk thresholds of 0%-30% and 0%-36%, respectively.The model has strong accuracy and clinical utility for predicting the risk of POD.CONCLUSIONThis study reveals cognitive impairment history, American Society of Anesthesiologists grade of > 2, RBCtransfusion of ≥ 2 units, postoperative intensive care unit care, and preoperative hemoglobin level as independentrisk factors for POD in elderly patients with HF. The developed nomogram model demonstrates excellent accuracyand stability in predicting the risk of POD, which is recommended to be applied in clinical practice to optimizepostoperative management and reduce delirium incidence.
文摘Objective To identify risk factors contributing to prolonged postoperative length of stay(LOS)in very elderly patients following hip fracture surgery,with a focus on postoperative complications and the impact of different anesthesia approaches.Methods This retrospective single-center cohort study enrolled patients aged 90 years or older who underwent hip fracture surgery at Peking Union Medical College Hospital between January 31,2013 and December 31,2023.Relevant perioperative data were collected.The primary outcome was postoperative LOS,and the study cohort was divided into two groups:postoperative LOS≤7 days and LOS>7 days.Logistic regression was performed to identify factors related to prolonged postoperative LOS.Results A total of 155 patients were included.The average age was 92.7±2.6 years.There were 73(47%)patients with postoperative LOS>7 days.Postoperative pneumonia was the only factor associated with a prolonged postoperative LOS(OR=2.12,95%CI[1.09,4.16],P=0.028).Neither the type of anesthesia(regional vs.general anesthesia,OR=1.00,95%CI[0.53,1.90],P=0.993)nor the method of airway management(laryngeal mask ventilation vs.spontaneous breathing,OR=1.46,95%CI[0.58,3.76],P=0.424;endotracheal intubation vs.spontaneous breathing,OR=0.82,95%CI[0.39,1.69],P=0.592)showed a significant association with a prolonged postoperative LOS.Preoperative chronic obstructive pulmonary disease(OR=2.78,95%CI[1.05,7.65],P=0.040)and preoperative neutrophil count(OR=1.13,95%CI[1.01,1.26],P=0.029)were both significantly associated with the occurrence of postoperative pneumonia,while anesthesia type and airway management method were not.Conclusions Postoperative pneumonia was associated with prolonged postoperative LOS in very elderly patients undergoing hip fracture surgery,whereas anesthesia types and airway management methods show no association with prolonged postoperative LOS or postoperative pneumonia.Preoperative comorbidities,especially respiratory conditions and systemic inflammation,potentially play a substantial role in postoperative recovery.
文摘BACKGROUND Traumatic injuries,such as falling,car accidents,and crushing mostly cause spinal fractures in young and middle-aged people,and>50%of them are thoracolumbar fractures.This kind of fracture is easily combined with serious injuries to peripheral nerves and soft tissues,which causes paralysis of the lower limbs if there is no timely rehabilitation treatment.Young patients with thoracolumbar fractures find it difficult to recover after the operation,and they are prone to depression,low self-esteem,and other negative emotions.AIM To investigate the association between anxiety,depression,and social stress in young patients with thoracolumbar spine fractures and the effect on rehabilitation outcomes.METHODS This study retrospectively analyzed 100 patients admitted to the orthopedic department of Honghui Hospital,Xi’an Jiaotong University who underwent thoracolumbar spine fracture surgery from January 2022 to June 2023.The general data of the patients were assessed with the Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD),life events scale,and social support rating scale(SSRS)to identify the correlation between anxiety,depression scores,and social stress and social support.The Japanese Orthopedic Association(JOA)was utilized to evaluate the rehabilitation outcomes of the patients and to analyze the effects of anxiety and depression scores on rehabilitation.RESULTS According to the scores of HAMD and HAMA in all patients,the prevalence of depression in patients was 39%(39/100),and the prevalence of anxiety was 49%(49/100).Patients were categorized into non-depression(n=61)and depression(n=39),non-anxiety(n=51),and anxiety(n=49)groups.Statistically significant differences in gender,occupation,Pittsburgh Sleep Quality Index(PSQI)score,and monthly family income were observed between the non-depression and depression groups(P<0.05).A significant difference in occupation and PSQI score was found between the non-anxiety and anxiety groups.Both depression(r=0.207,P=0.038)and anxiety scores(r=0.473,P<0.001)were significantly and positively correlated with negative life events.The difference in negative life event scores as well as SSRS total and item scores was statist-ically significant between patients in the non-depression and depression groups(P<0.05).The difference between the non-anxiety and anxiety groups was statistically significant(P<0.05)in the negative life event scores as well as the total SSRS scores.Additionally,JOA scores were significantly lower in both anxious and depressed patients.CONCLUSION Young patients with thoracolumbar fractures are prone to anxiety and depression.Patients’anxiety and depression are closely associated with social pressure,which reduces the life pressure of young patients with thoracolumbar fractures,enhances social support,and improves the psychology of anxiety and depression.,which affects patients’recovery.
