Affected by reservoir heterogeneity,developed natural fractures,and bedding fractures,the fracturing pressure curves in fracturing of shale gas horizontal wells present complex shapes.A large amount of information con...Affected by reservoir heterogeneity,developed natural fractures,and bedding fractures,the fracturing pressure curves in fracturing of shale gas horizontal wells present complex shapes.A large amount of information contained in the fracturing curves is still not fully excavated.Based on the theory of shale gas fracture network fracturing,the calculation model of bottom hole net pressure is established by integrating the real-time data such as casing pressure,pump rate,and proppant concentration.Net pressure slope and net pressure index are constructed as key parameters,and the net pressure curve is divided dynamically to describe the mechanical conditions corresponding to the fracture propagation behavior during the fracturing process.Six fracture propagation modes were identified,including fracture network propagation,fracture propagation blockage,normal fracture propagation,fracture propagation long bedding,fracture height growth,and rapidfluidfiltration,and then the operation pressure curve diagnosis and identification method were formed for shale gas fracture network fracturing in horizontal wells.The shortcomings of conventional operation curve diagnosis and identification methods are abandoned and the fracture network complexity index is presented.The higher index indicates more time of fracture network propagation and fracture propagation along bedding and the better reservoir stimulation effect.The model is applied to shale gas wells in the southeastern margin of Sichuan Basin,and the average fracture network complexity index of a single well is 0.3,which is in good agreement with the microseismic monitoring results.This proves the good reliability of the method developed.The method is helpful to improve the potential and level of fracturing stimulation of shale reservoirs and is of great significance for improving the post-fracturing evaluation technology of fracture network and guiding the real-time dynamic adjustment offield fracturing operations.展开更多
Using the methods of transmission electron microscopy, the carbide phase evolution in surface layers of the differentiallyquenched rails is studied after the passed tonnage of 691.8 million tons at the depth up to 10 ...Using the methods of transmission electron microscopy, the carbide phase evolution in surface layers of the differentiallyquenched rails is studied after the passed tonnage of 691.8 million tons at the depth up to 10 mm along the central axis andfillet of rail head. The action of two mutual supplement mechanisms of steel carbide phase transformation in surface layersat rail operation is established： （1） cutting mechanism of cementite particles with the following departure in the volume offerrite grains or plates （in pearlite structure）; （2） cutting mechanism and following dissolution of cementite particles,transfer of carbon atoms on dislocations （in Cottrell atmospheres and dislocation cores）, transfer of carbon atoms bymoving dislocations into ferrite grains volume （or plates） with the following repeated formation of nanosized cementiteparticles. The first mechanism is accompanied by the change in linear sizes and morphology of carbide particles. Cementiteelement composition change is not essential. Carbide structure change can take place during the second mechanism.展开更多
Operative management of humeral shaft fractures demonstrates superior early functional recovery(6-month Disabilities of the Arm,Shoulder,and Hand scores)and significantly lower nonunion rates(63.9%reduction)compared t...Operative management of humeral shaft fractures demonstrates superior early functional recovery(6-month Disabilities of the Arm,Shoulder,and Hand scores)and significantly lower nonunion rates(63.9%reduction)compared to functional bracing,particularly in complex cases,while conservative treatment remains viable for low-demand patients.Surgical techniques,including open reduction internal fixation,intramedullary nailing,and minimally invasive plate osteosynthesis,offer trade-offs between anatomic precision and complication risks(e.g.,radial nerve injury vs rotator cuff damage),with over 90%of radial nerve injuries resolving spontaneously.Ultrasound-guided diagnosis(89%sensitivity,95%specificity)optimizes decision-making for nerve entrapment.Individualized treatment selection,prioritizing fracture complexity and patient needs,is critical to balance accelerated rehabilitation with minimized complications.展开更多
The present letter to the editor is a commentary on the study titled“Rates of readmission and reoperation after operative management of midshaft clavicle fractures in adolescents”.There is a debate over whether surg...The present letter to the editor is a commentary on the study titled“Rates of readmission and reoperation after operative management of midshaft clavicle fractures in adolescents”.There is a debate over whether surgical treatment of clavicle shaft fractures improves clinical outcomes in adolescents.The readmission and reoperation rates following surgery should be identified.展开更多
Objective: To explore the operating room nursing mode of the elderly patients with intertrochanteric fracture surgery, in order to promote the patient rehabilitation. Methods: 120 elderly patients with intertrochanter...Objective: To explore the operating room nursing mode of the elderly patients with intertrochanteric fracture surgery, in order to promote the patient rehabilitation. Methods: 120 elderly patients with intertrochanteric femoral fractures were selected, and all of the study subjects were treated between January and June 2020. The medical staff divided the study subjects into two groups. 60 patients in the control group implemented the routine nursing intervention under the guidance of the medical staff, and 60 patients in the observation group implemented the comprehensive operating room nursing intervention under the guidance of the medical staff. After the study work, the medical staff compared the care effects of the two groups. Results: Compared with the patients in the control group, the odds of complications, cognition of surgical method, quality of preoperative preparation and quality score of intraoperative nursing coordination were all given significant advantages. In addition, the patients in the observation group had significant advantages in the satisfaction of the care mode, the negative emotion score, and the epinephrine condition, with P 0.05. Conclusion: The application of operating room nursing method in the treatment of elderly intertrochanteric fracture surgery patients can improve nursing satisfaction, improve anxiety and depression, establish correct surgical cognition, and improve nursing ability, which has a positive impact on the recovery of patients condition, and should be applied in clinical practice.展开更多
Objective: to analyze the effect of humanistic nursing intervention on elderly patients with lower limb fracture after operation. Methods: a comparative study was carried out in this paper with 100 cases. It is mainly...Objective: to analyze the effect of humanistic nursing intervention on elderly patients with lower limb fracture after operation. Methods: a comparative study was carried out in this paper with 100 cases. It is mainly the elderly patients with lower limb fractures collected in our hospital in recent years. They are randomly divided into 50 cases in each group. During the operation, the corresponding intervention conditions were set as the control group, and the differences between the two groups were analyzed. Results: it can be found that the psychological, life and nursing satisfaction of the two groups of patients are evaluated and scored respectively, and it can be found that the experimental group has obvious advantages, the result is less than zero, P<0.05 has statistical significance. Conclusion: for elderly patients with lower limb fractures, in the process of humanistic intervention and nursing, improving the patients' survival satisfaction is beneficial to the patients' early recovery and improving the patients' living standard.展开更多
AIM: To perform a systematic review and meta-analysis comparing operative vs non-operative treatment of displaced proximal humerus fractures in elderly patients.METHODS: A systematic literature search was performed us...AIM: To perform a systematic review and meta-analysis comparing operative vs non-operative treatment of displaced proximal humerus fractures in elderly patients.METHODS: A systematic literature search was performed using EMBASE and MEDLINE through the OVID interface,CINAHL,the Cochrane Central Register of Controlled Trials(CENTRAL),Proquest,Web of Science,SAE digital library,and Transportation Research Board's TRID database.Searches of conference proceedings were also conducted.All available randomized controlled trials comparing operative vs non-operative management of displaced three- and four-part proximal humerus fractures in elderly patients were included.The primary outcomes measures included physical function,pain,health related quality of life,mortality,and the re-operation rate.RESULTS: Six randomized controlled trials(n = 287) were included.There was no statistically significant difference in function(MD = 1.72,95%CI:-2.90-6.34,P = 0.47),as measured by the Constant score,between the operative and the non-operative treatment groups.There was no statistically significance difference insecondary outcomes of health related quality of life(standardized MD = 0.27,95%CI:-0.05-0.59,P = 0.09),and mortality(relative risk 1.29,95%CI: 0.50-3.35,P = 0.60).Operative treatment had a statistically significant higher re-operation rate(relative risk 4.09,95%CI: 1.50-11.15,P = 0.006),and statistically significant decreased pain(MD = 1.26,95%CI: 0.02-2.49,P = 0.05).CONCLUSION: There is moderate quality evidence to suggest that there is no difference in functional outcomes between the two treatments.Further high quality randomized controlled trials are required to determine if certain subgroup populations benefit from surgical management.展开更多
To evaluate the results of operative treatment of spinal fracture dislocation without neurologic deficits. Methods.Eighteen patients with spinal fracture dislocation were neurologically intact at the time of injury, a...To evaluate the results of operative treatment of spinal fracture dislocation without neurologic deficits. Methods.Eighteen patients with spinal fracture dislocation were neurologically intact at the time of injury, and all were treated operatively. The fracture sites were:8 cases in cervical spine, 3 cases in thoracic spine, and 7 cases in lumbar spine. Eight patients with cervical injuries had variant degrees of forward slide and kyphotic deformity. Of the 10 thoracic and lumbar fractures, one had lateral dislocation, 4 cases with kyphotic deformities, 5 cases with spinal canal compromise averaged 50% (ranging from 40% to 70%). Results.The average period of follow up was 4.4 years with a range of 11 months to 13 years. All the patients returned to full time work. No patient developed neurologic deterioration. Kyphotic deformity was corrected in the 4 cases, and no progressive kyphosis was noted. There was no operation related complication. The averaged post operative hospitalization time was 13 days. Conclusions. Despite the rare incidence of spinal fracture dislocation without neurologic deficits, we suggested that kind of fracture be considered unstable fracture because of its potential risk of delayed neurologic deterioration and kyphotic deformity, and be treated operatively to restore the sagittal alignment and the stability of the spine.展开更多
BACKGROUND Whether operation is superior to non-operation for humeral shaft fracture remains debatable.We hypothesized that operation could decrease the nonunion and reintervention rates and increase the functional ou...BACKGROUND Whether operation is superior to non-operation for humeral shaft fracture remains debatable.We hypothesized that operation could decrease the nonunion and reintervention rates and increase the functional outcomes.AIM To compare the clinical efficacy between operative and nonoperative approaches for humeral shaft fractures.METHODS We searched the PubMed,Web of Science,ScienceDirect,and Cochrane databases from 1990 to December 2023 for clinical trials and cohort studies comparing the effects of operative and conservative methods on humeral shaft fractures.Two investigators independently extracted data from the eligible studies,and the other two assessed the methodological quality of each study.The quality of the included studies was assessed using the Cochrane risk bias or Newcastle-Ottawa Scale.The nonunion,reintervention and the overall complications and functional scores were pooled and analyzed using Review Manager software(version 5.3).RESULTS A total of four randomized control trials and 13 cohort studies were included,with 1285 and 1346 patients in the operative and nonoperative groups,respectively.Patients in the operative group were treated with a plate or nail,whereas those in the conservative group were managed with splint or functional bracing.Four studies were assessed as having a high risk of bias,and the other 13 were of a low risk of bias according to the Newcastle-Ottawa Scale or Cochrane risk bias tool.The operative group had a significantly decreased rate of nonunion[odds ratio(OR)0.30;95%CI:0.23 to 0.40,reintervention(OR:0.33;95%CI:0.24 to 0.47),and overall complications(OR:0.62;95%CI:0.49 to 0.78)].The pooled effect of the Disabilities of Arm,Shoulder,and Hand score showed a significant difference at 3[mean difference(MD)-8.26;95%CI:-13.60 to-2.92],6(MD:-6.72;95%CI:-11.34 to-2.10),and 12 months(MD:-2.55;95%CI:-4.36 to-0.74).The pooled effect of Visual Analog Scale scores and the Constant-Murley score did not significantly differ between the two groups.CONCLUSION This systematic review and meta-analysis revealed a trend of rapid functional recovery and decreased rates of nonunion and reintervention after operation for humeral shaft fracture compared to conservative treatment.展开更多
This editorial explores the impact of non-steroidal anti-inflammatory drugs(NSAIDs)on postoperative recovery in hand fracture patients,amidst shifting pain management strategies away from opioids due to their adverse ...This editorial explores the impact of non-steroidal anti-inflammatory drugs(NSAIDs)on postoperative recovery in hand fracture patients,amidst shifting pain management strategies away from opioids due to their adverse effects.With hand fractures being significantly common and postoperative pain management crucial for recovery,the potential of NSAIDs offers a non-addictive pain control alternative.However,the controversy over NSAIDs'effects on bone healing—stemming from their Cyclooxygenase-2 inhibition and associated risks of fracture non-union or delayed union—necessitates further investigation.Despite a comprehensive literature search,the study finds a lack of specific research on NSAIDs in postoperative hand fracture management,highlighting an urgent need for future studies to balance their benefits against possible risks.展开更多
For figuring out the stress interference of multiphase fracture combinations and its effect on the fracture initiation pressure of subsequent hydraulic fracturing,a calculation model for the coupled stress field with ...For figuring out the stress interference of multiphase fracture combinations and its effect on the fracture initiation pressure of subsequent hydraulic fracturing,a calculation model for the coupled stress field with multiple induced fractures preexisted was established based on the calculation model for the stress field with single induced fracture preexisted,and the change laws of circumferential stress field around the wellbore under the effect of induced stress were analyzed.Then,the fracture initiation pressure of subsequent hydraulic fracturing was calculated according to the fracturing mechanics criterion.Finally,the effects of the length,phase,horizontal principal stress difference co-efficient and quantity of preexisting fractures on its initiation pressure were analyzed.And the following research results were obtained.First,the circumferential stress difference in the area near the fractures behind the preexisting fractures increase greatly and even the horizontal principal stress is reversed.Second,as the length of new preexisting fractures increases,the initiation pressure of initial preexisting fractures rises first and then drops.And when the length of new preexisting fractures is equal to that of the initial preexisting fractures,the initiation pressure of initial preexisting fractures drops quickly first and then slowly.Third,the initiation pressure of high phase fractures is lower than that of low phase fractures.Fourth,with the increase of fracture quantity,the initiation pressure of new preexisting fractures drops gradually,but the decline trend of initiation pressure difference is not obvious.Fifth,the stress interference of multiphase fractures influences the fracture initiation pressure,and high-phase long fractures and low-phase short fractures are both favorable for the simultaneous initiation of multiphase fractures.Sixth,syn-chronous propagation of multiple fractures can generate more complicated stress interference and excite the evolution of hydraulic fracture network,so as to realize uniform fracturing stimulation.In conclusion,the research results can provide a theoretical guidance for the design of fracturing operation,e.g.perforation phase of blasting induced fracturing,scale of induced fractures,and pump pressure of subsequent hydraulic fracturing.展开更多
Objective To study the effect of operative timing on clinical outcomes in elderly hip fracture.Methods Two hundred sixty-seven patients with hip fracture were treated from July 2006 to May 2008.The patients who had an...Objective To study the effect of operative timing on clinical outcomes in elderly hip fracture.Methods Two hundred sixty-seven patients with hip fracture were treated from July 2006 to May 2008.The patients who had an operation within展开更多
Metatarsal fractures are one of the most common injuries of the foot. There has been conflicting literatureon management of fifth metatarsal fractures due to inconsistency with respect to classification of these fract...Metatarsal fractures are one of the most common injuries of the foot. There has been conflicting literatureon management of fifth metatarsal fractures due to inconsistency with respect to classification of these fractures. This article provides a thorough review of fifth metatarsal fractures with examination of relevant literature to describe the management of fifth metatarsal fractures especially the proximal fracture. A description of nonoperative and operative management for fifth metatarsal fractures according to anatomical region is provided.展开更多
The precise diagnosis of distal tibiofibular syndesmotic ligament injury is challenging and a distinction should be made between syndesmotic ligament disruption and real syndesmotic instability.This article summarizes...The precise diagnosis of distal tibiofibular syndesmotic ligament injury is challenging and a distinction should be made between syndesmotic ligament disruption and real syndesmotic instability.This article summarizes the available evidence in the light of the author’s opinion.Pre-operative radiographic assessment,standard radiographs,computed tomography scanning and magnetic resonance imaging are of limited value in detecting syndesmotic instability in acute ankle fractures but can be helpful in planning.Intra-operative stress testing,in the sagittal,coronal or exorotation direction,is more reliable in the diagnosis of syndesmotic instability of rotational ankle fractures.The Hook or Cotton test is more reliable than the exorotation stress test.The lateral view is more reliable than the AP mortise view because of the larger displacement in this direction.When the Hook test is used the force should be applied in the sagittal direction.A force of 100 N applied to the fibula seems to be appropriate.In the case of an unstable joint requiring syndesmotic stabilisation,the tibiofibular clear space would exceed 5 mm on the lateral stress test.When the surgeon is able to perform an ankle arthroscopy this technique is useful to detect syndesmotic injury and can guide anatomic reduction of the syndesmosis.Many guidelines formulated in this article are based on biomechanical and cadaveric studies and clinical correlation has to be established.展开更多
This study explored the feasibility of employing computer-aided design(CAD)and 3 dimensional(3D)-printed personalized guide plate for the mini-invasive percutaneous internal screw fixation of fractured scaphoid.The st...This study explored the feasibility of employing computer-aided design(CAD)and 3 dimensional(3D)-printed personalized guide plate for the mini-invasive percutaneous internal screw fixation of fractured scaphoid.The study consisted of two parts:(1)experimentation on upper limbs from corpses and(2)preliminary clinical application.Corpse experiments involved upper limbs of 6 adult corpses.The specimens of upper limbs were subjected to plain CT scan.Then the CT data were input into computer to conduct 3D reconstruction of wrist region.The direction and depth of the guide wire and screw were designed on the basis of the principle that screw should lie at the center of scaphoid and the long axis of the screw should be aligned with that of the scaphoid.The carpal bone model and the guide plate were designed and 3D-printed.By using the guide plates,the guide wire was placed and the cannulated compression screw was inserted.The wrist region was examined by X-ray and CT to observe the location of the screw in the scaphoid.The scaphoid was longitudinally excised to grossly observe the location and evaluate the result of screw insertion.For clinical application,the guide plate was employed in 4 patients with fresh scaphoid fracture using the aforementioned operative technique.Our results showed that,in the 6 corpse limbs,the guide plate well fitted the skin surface and the guide wire and screw were accurately put in place in one session.X-ray examination and gross observation confirmed that the screw was satisfactorily positioned and the result met the requirements of the preoperative design.For 4 patients,the guide wire and screw were all precisely inserted into place in one session.The operation time and X-ray exposure times were apparently reduced.The imaging examination exhibited satisfactory results and the hand functioned well.It was concluded that the operative guide plate used for the miniinvasive percutaneous internal screw fixation of fractured scaphoid not only can assist in accurate placement of screw but also shorten operation time and reduce insertion and X-ray exposure times,thereby reducing the radiation injury and damage to the substance and the blood circulation of carpal bone.Its use can also improve the learning curve of surgeons.展开更多
BACKGROUND Based on the location and size of the fracture block,open reduction and internal fixation can be employed or assisted for shoulder arthroscopy in the treatment of glenoid fractures.However,the treatment of ...BACKGROUND Based on the location and size of the fracture block,open reduction and internal fixation can be employed or assisted for shoulder arthroscopy in the treatment of glenoid fractures.However,the treatment of lower part of glenoid fractures through a novel axillary approach has not been reported so far.CASE SUMMARY A 22-year-old right-handed man was transferred to our outpatient clinic because of right shoulder injury during a traffic accident.X-ray examination after admission suggested the fracture of the lower part of the right glenoid and an ipiselial proximal humeral fracture.Three-dimensional(3D)computed tomography(CT)further suggested that the size of the fracture block of the lower part of the right glenoid was 3.4 mm×16.2 mm.The patient was diagnosed as the fracture of the lower part of the glenoid,also known as bony Bankart lesion without shoulder dislocation.After general anesthesia,the patient was surgically treated with the open reduction internal fixation through a novel axillary approach.3D CT and shoulder joint function were reexamined at 12 mo of followup,showing acceptable recovery.CONCLUSION This case report describes a novel axillary approach adopted in an open reduction with cannulated screw and wire anchor internal fixation.After a follow-up for more than 12 mo,3D CT and shoulder joint function examinations display a good recovery.展开更多
基金National Natural Science Foundation of China Basic The ory of Efficient Development of Shale Oil and Gas(No.51490653)Theory and Method of Efficient Construction of Fracture Network in Deep and Ultra-Deep Shale Gas Horizontal Wells(No.U19A2043)Theory and Method of Long-term Propping for Deep Shale Gas Hydraulic Fractures based on DEM-LBM Hydro-Mechanical Coupling(No.52104039).
文摘Affected by reservoir heterogeneity,developed natural fractures,and bedding fractures,the fracturing pressure curves in fracturing of shale gas horizontal wells present complex shapes.A large amount of information contained in the fracturing curves is still not fully excavated.Based on the theory of shale gas fracture network fracturing,the calculation model of bottom hole net pressure is established by integrating the real-time data such as casing pressure,pump rate,and proppant concentration.Net pressure slope and net pressure index are constructed as key parameters,and the net pressure curve is divided dynamically to describe the mechanical conditions corresponding to the fracture propagation behavior during the fracturing process.Six fracture propagation modes were identified,including fracture network propagation,fracture propagation blockage,normal fracture propagation,fracture propagation long bedding,fracture height growth,and rapidfluidfiltration,and then the operation pressure curve diagnosis and identification method were formed for shale gas fracture network fracturing in horizontal wells.The shortcomings of conventional operation curve diagnosis and identification methods are abandoned and the fracture network complexity index is presented.The higher index indicates more time of fracture network propagation and fracture propagation along bedding and the better reservoir stimulation effect.The model is applied to shale gas wells in the southeastern margin of Sichuan Basin,and the average fracture network complexity index of a single well is 0.3,which is in good agreement with the microseismic monitoring results.This proves the good reliability of the method developed.The method is helpful to improve the potential and level of fracturing stimulation of shale reservoirs and is of great significance for improving the post-fracturing evaluation technology of fracture network and guiding the real-time dynamic adjustment offield fracturing operations.
基金supported by Russian Scientific Foundation(Project No.15-12-00010)
文摘Using the methods of transmission electron microscopy, the carbide phase evolution in surface layers of the differentiallyquenched rails is studied after the passed tonnage of 691.8 million tons at the depth up to 10 mm along the central axis andfillet of rail head. The action of two mutual supplement mechanisms of steel carbide phase transformation in surface layersat rail operation is established： （1） cutting mechanism of cementite particles with the following departure in the volume offerrite grains or plates （in pearlite structure）; （2） cutting mechanism and following dissolution of cementite particles,transfer of carbon atoms on dislocations （in Cottrell atmospheres and dislocation cores）, transfer of carbon atoms bymoving dislocations into ferrite grains volume （or plates） with the following repeated formation of nanosized cementiteparticles. The first mechanism is accompanied by the change in linear sizes and morphology of carbide particles. Cementiteelement composition change is not essential. Carbide structure change can take place during the second mechanism.
文摘Operative management of humeral shaft fractures demonstrates superior early functional recovery(6-month Disabilities of the Arm,Shoulder,and Hand scores)and significantly lower nonunion rates(63.9%reduction)compared to functional bracing,particularly in complex cases,while conservative treatment remains viable for low-demand patients.Surgical techniques,including open reduction internal fixation,intramedullary nailing,and minimally invasive plate osteosynthesis,offer trade-offs between anatomic precision and complication risks(e.g.,radial nerve injury vs rotator cuff damage),with over 90%of radial nerve injuries resolving spontaneously.Ultrasound-guided diagnosis(89%sensitivity,95%specificity)optimizes decision-making for nerve entrapment.Individualized treatment selection,prioritizing fracture complexity and patient needs,is critical to balance accelerated rehabilitation with minimized complications.
文摘The present letter to the editor is a commentary on the study titled“Rates of readmission and reoperation after operative management of midshaft clavicle fractures in adolescents”.There is a debate over whether surgical treatment of clavicle shaft fractures improves clinical outcomes in adolescents.The readmission and reoperation rates following surgery should be identified.
文摘Objective: To explore the operating room nursing mode of the elderly patients with intertrochanteric fracture surgery, in order to promote the patient rehabilitation. Methods: 120 elderly patients with intertrochanteric femoral fractures were selected, and all of the study subjects were treated between January and June 2020. The medical staff divided the study subjects into two groups. 60 patients in the control group implemented the routine nursing intervention under the guidance of the medical staff, and 60 patients in the observation group implemented the comprehensive operating room nursing intervention under the guidance of the medical staff. After the study work, the medical staff compared the care effects of the two groups. Results: Compared with the patients in the control group, the odds of complications, cognition of surgical method, quality of preoperative preparation and quality score of intraoperative nursing coordination were all given significant advantages. In addition, the patients in the observation group had significant advantages in the satisfaction of the care mode, the negative emotion score, and the epinephrine condition, with P 0.05. Conclusion: The application of operating room nursing method in the treatment of elderly intertrochanteric fracture surgery patients can improve nursing satisfaction, improve anxiety and depression, establish correct surgical cognition, and improve nursing ability, which has a positive impact on the recovery of patients condition, and should be applied in clinical practice.
文摘Objective: to analyze the effect of humanistic nursing intervention on elderly patients with lower limb fracture after operation. Methods: a comparative study was carried out in this paper with 100 cases. It is mainly the elderly patients with lower limb fractures collected in our hospital in recent years. They are randomly divided into 50 cases in each group. During the operation, the corresponding intervention conditions were set as the control group, and the differences between the two groups were analyzed. Results: it can be found that the psychological, life and nursing satisfaction of the two groups of patients are evaluated and scored respectively, and it can be found that the experimental group has obvious advantages, the result is less than zero, P<0.05 has statistical significance. Conclusion: for elderly patients with lower limb fractures, in the process of humanistic intervention and nursing, improving the patients' survival satisfaction is beneficial to the patients' early recovery and improving the patients' living standard.
基金Supported by In part by a Canada Research Chair to Dr.Bhandariin part by the Canadian Institutes of Health Research and Vancouver Coastal Health Research Institute to Dr.Slobogean
文摘AIM: To perform a systematic review and meta-analysis comparing operative vs non-operative treatment of displaced proximal humerus fractures in elderly patients.METHODS: A systematic literature search was performed using EMBASE and MEDLINE through the OVID interface,CINAHL,the Cochrane Central Register of Controlled Trials(CENTRAL),Proquest,Web of Science,SAE digital library,and Transportation Research Board's TRID database.Searches of conference proceedings were also conducted.All available randomized controlled trials comparing operative vs non-operative management of displaced three- and four-part proximal humerus fractures in elderly patients were included.The primary outcomes measures included physical function,pain,health related quality of life,mortality,and the re-operation rate.RESULTS: Six randomized controlled trials(n = 287) were included.There was no statistically significant difference in function(MD = 1.72,95%CI:-2.90-6.34,P = 0.47),as measured by the Constant score,between the operative and the non-operative treatment groups.There was no statistically significance difference insecondary outcomes of health related quality of life(standardized MD = 0.27,95%CI:-0.05-0.59,P = 0.09),and mortality(relative risk 1.29,95%CI: 0.50-3.35,P = 0.60).Operative treatment had a statistically significant higher re-operation rate(relative risk 4.09,95%CI: 1.50-11.15,P = 0.006),and statistically significant decreased pain(MD = 1.26,95%CI: 0.02-2.49,P = 0.05).CONCLUSION: There is moderate quality evidence to suggest that there is no difference in functional outcomes between the two treatments.Further high quality randomized controlled trials are required to determine if certain subgroup populations benefit from surgical management.
文摘To evaluate the results of operative treatment of spinal fracture dislocation without neurologic deficits. Methods.Eighteen patients with spinal fracture dislocation were neurologically intact at the time of injury, and all were treated operatively. The fracture sites were:8 cases in cervical spine, 3 cases in thoracic spine, and 7 cases in lumbar spine. Eight patients with cervical injuries had variant degrees of forward slide and kyphotic deformity. Of the 10 thoracic and lumbar fractures, one had lateral dislocation, 4 cases with kyphotic deformities, 5 cases with spinal canal compromise averaged 50% (ranging from 40% to 70%). Results.The average period of follow up was 4.4 years with a range of 11 months to 13 years. All the patients returned to full time work. No patient developed neurologic deterioration. Kyphotic deformity was corrected in the 4 cases, and no progressive kyphosis was noted. There was no operation related complication. The averaged post operative hospitalization time was 13 days. Conclusions. Despite the rare incidence of spinal fracture dislocation without neurologic deficits, we suggested that kind of fracture be considered unstable fracture because of its potential risk of delayed neurologic deterioration and kyphotic deformity, and be treated operatively to restore the sagittal alignment and the stability of the spine.
基金Supported by Natural Science Foundation of Chongqing,China,No.CSTB2023NSCQ-MSX1080.
文摘BACKGROUND Whether operation is superior to non-operation for humeral shaft fracture remains debatable.We hypothesized that operation could decrease the nonunion and reintervention rates and increase the functional outcomes.AIM To compare the clinical efficacy between operative and nonoperative approaches for humeral shaft fractures.METHODS We searched the PubMed,Web of Science,ScienceDirect,and Cochrane databases from 1990 to December 2023 for clinical trials and cohort studies comparing the effects of operative and conservative methods on humeral shaft fractures.Two investigators independently extracted data from the eligible studies,and the other two assessed the methodological quality of each study.The quality of the included studies was assessed using the Cochrane risk bias or Newcastle-Ottawa Scale.The nonunion,reintervention and the overall complications and functional scores were pooled and analyzed using Review Manager software(version 5.3).RESULTS A total of four randomized control trials and 13 cohort studies were included,with 1285 and 1346 patients in the operative and nonoperative groups,respectively.Patients in the operative group were treated with a plate or nail,whereas those in the conservative group were managed with splint or functional bracing.Four studies were assessed as having a high risk of bias,and the other 13 were of a low risk of bias according to the Newcastle-Ottawa Scale or Cochrane risk bias tool.The operative group had a significantly decreased rate of nonunion[odds ratio(OR)0.30;95%CI:0.23 to 0.40,reintervention(OR:0.33;95%CI:0.24 to 0.47),and overall complications(OR:0.62;95%CI:0.49 to 0.78)].The pooled effect of the Disabilities of Arm,Shoulder,and Hand score showed a significant difference at 3[mean difference(MD)-8.26;95%CI:-13.60 to-2.92],6(MD:-6.72;95%CI:-11.34 to-2.10),and 12 months(MD:-2.55;95%CI:-4.36 to-0.74).The pooled effect of Visual Analog Scale scores and the Constant-Murley score did not significantly differ between the two groups.CONCLUSION This systematic review and meta-analysis revealed a trend of rapid functional recovery and decreased rates of nonunion and reintervention after operation for humeral shaft fracture compared to conservative treatment.
文摘This editorial explores the impact of non-steroidal anti-inflammatory drugs(NSAIDs)on postoperative recovery in hand fracture patients,amidst shifting pain management strategies away from opioids due to their adverse effects.With hand fractures being significantly common and postoperative pain management crucial for recovery,the potential of NSAIDs offers a non-addictive pain control alternative.However,the controversy over NSAIDs'effects on bone healing—stemming from their Cyclooxygenase-2 inhibition and associated risks of fracture non-union or delayed union—necessitates further investigation.Despite a comprehensive literature search,the study finds a lack of specific research on NSAIDs in postoperative hand fracture management,highlighting an urgent need for future studies to balance their benefits against possible risks.
基金Project supported by the National Natural Science Foundation of China,“Microscopic Damage Mechanism of Saturated Brittle Rock during Blasting Induced Fracturing and Its Control Law on Macroscopic Damage”(No.51874339)the Natural Science Foundation of Shandong Province,“Study on the Coupled Response Mechanism of Crack Propagation and Rock Damage in the fracturing condition of multistage strong pulse”(No.ZR2016EEQ04)the Fundamental Research Funds for the Central Universities,China,“Study on the Mechanical Mechanism of Multistage Blasting Induced SRV in Deep-Seated Tight Reservoirs with High Horizontal Stress Difference”(No.17CX05004).
文摘For figuring out the stress interference of multiphase fracture combinations and its effect on the fracture initiation pressure of subsequent hydraulic fracturing,a calculation model for the coupled stress field with multiple induced fractures preexisted was established based on the calculation model for the stress field with single induced fracture preexisted,and the change laws of circumferential stress field around the wellbore under the effect of induced stress were analyzed.Then,the fracture initiation pressure of subsequent hydraulic fracturing was calculated according to the fracturing mechanics criterion.Finally,the effects of the length,phase,horizontal principal stress difference co-efficient and quantity of preexisting fractures on its initiation pressure were analyzed.And the following research results were obtained.First,the circumferential stress difference in the area near the fractures behind the preexisting fractures increase greatly and even the horizontal principal stress is reversed.Second,as the length of new preexisting fractures increases,the initiation pressure of initial preexisting fractures rises first and then drops.And when the length of new preexisting fractures is equal to that of the initial preexisting fractures,the initiation pressure of initial preexisting fractures drops quickly first and then slowly.Third,the initiation pressure of high phase fractures is lower than that of low phase fractures.Fourth,with the increase of fracture quantity,the initiation pressure of new preexisting fractures drops gradually,but the decline trend of initiation pressure difference is not obvious.Fifth,the stress interference of multiphase fractures influences the fracture initiation pressure,and high-phase long fractures and low-phase short fractures are both favorable for the simultaneous initiation of multiphase fractures.Sixth,syn-chronous propagation of multiple fractures can generate more complicated stress interference and excite the evolution of hydraulic fracture network,so as to realize uniform fracturing stimulation.In conclusion,the research results can provide a theoretical guidance for the design of fracturing operation,e.g.perforation phase of blasting induced fracturing,scale of induced fractures,and pump pressure of subsequent hydraulic fracturing.
文摘Objective To study the effect of operative timing on clinical outcomes in elderly hip fracture.Methods Two hundred sixty-seven patients with hip fracture were treated from July 2006 to May 2008.The patients who had an operation within
文摘Metatarsal fractures are one of the most common injuries of the foot. There has been conflicting literatureon management of fifth metatarsal fractures due to inconsistency with respect to classification of these fractures. This article provides a thorough review of fifth metatarsal fractures with examination of relevant literature to describe the management of fifth metatarsal fractures especially the proximal fracture. A description of nonoperative and operative management for fifth metatarsal fractures according to anatomical region is provided.
文摘The precise diagnosis of distal tibiofibular syndesmotic ligament injury is challenging and a distinction should be made between syndesmotic ligament disruption and real syndesmotic instability.This article summarizes the available evidence in the light of the author’s opinion.Pre-operative radiographic assessment,standard radiographs,computed tomography scanning and magnetic resonance imaging are of limited value in detecting syndesmotic instability in acute ankle fractures but can be helpful in planning.Intra-operative stress testing,in the sagittal,coronal or exorotation direction,is more reliable in the diagnosis of syndesmotic instability of rotational ankle fractures.The Hook or Cotton test is more reliable than the exorotation stress test.The lateral view is more reliable than the AP mortise view because of the larger displacement in this direction.When the Hook test is used the force should be applied in the sagittal direction.A force of 100 N applied to the fibula seems to be appropriate.In the case of an unstable joint requiring syndesmotic stabilisation,the tibiofibular clear space would exceed 5 mm on the lateral stress test.When the surgeon is able to perform an ankle arthroscopy this technique is useful to detect syndesmotic injury and can guide anatomic reduction of the syndesmosis.Many guidelines formulated in this article are based on biomechanical and cadaveric studies and clinical correlation has to be established.
文摘This study explored the feasibility of employing computer-aided design(CAD)and 3 dimensional(3D)-printed personalized guide plate for the mini-invasive percutaneous internal screw fixation of fractured scaphoid.The study consisted of two parts:(1)experimentation on upper limbs from corpses and(2)preliminary clinical application.Corpse experiments involved upper limbs of 6 adult corpses.The specimens of upper limbs were subjected to plain CT scan.Then the CT data were input into computer to conduct 3D reconstruction of wrist region.The direction and depth of the guide wire and screw were designed on the basis of the principle that screw should lie at the center of scaphoid and the long axis of the screw should be aligned with that of the scaphoid.The carpal bone model and the guide plate were designed and 3D-printed.By using the guide plates,the guide wire was placed and the cannulated compression screw was inserted.The wrist region was examined by X-ray and CT to observe the location of the screw in the scaphoid.The scaphoid was longitudinally excised to grossly observe the location and evaluate the result of screw insertion.For clinical application,the guide plate was employed in 4 patients with fresh scaphoid fracture using the aforementioned operative technique.Our results showed that,in the 6 corpse limbs,the guide plate well fitted the skin surface and the guide wire and screw were accurately put in place in one session.X-ray examination and gross observation confirmed that the screw was satisfactorily positioned and the result met the requirements of the preoperative design.For 4 patients,the guide wire and screw were all precisely inserted into place in one session.The operation time and X-ray exposure times were apparently reduced.The imaging examination exhibited satisfactory results and the hand functioned well.It was concluded that the operative guide plate used for the miniinvasive percutaneous internal screw fixation of fractured scaphoid not only can assist in accurate placement of screw but also shorten operation time and reduce insertion and X-ray exposure times,thereby reducing the radiation injury and damage to the substance and the blood circulation of carpal bone.Its use can also improve the learning curve of surgeons.
文摘BACKGROUND Based on the location and size of the fracture block,open reduction and internal fixation can be employed or assisted for shoulder arthroscopy in the treatment of glenoid fractures.However,the treatment of lower part of glenoid fractures through a novel axillary approach has not been reported so far.CASE SUMMARY A 22-year-old right-handed man was transferred to our outpatient clinic because of right shoulder injury during a traffic accident.X-ray examination after admission suggested the fracture of the lower part of the right glenoid and an ipiselial proximal humeral fracture.Three-dimensional(3D)computed tomography(CT)further suggested that the size of the fracture block of the lower part of the right glenoid was 3.4 mm×16.2 mm.The patient was diagnosed as the fracture of the lower part of the glenoid,also known as bony Bankart lesion without shoulder dislocation.After general anesthesia,the patient was surgically treated with the open reduction internal fixation through a novel axillary approach.3D CT and shoulder joint function were reexamined at 12 mo of followup,showing acceptable recovery.CONCLUSION This case report describes a novel axillary approach adopted in an open reduction with cannulated screw and wire anchor internal fixation.After a follow-up for more than 12 mo,3D CT and shoulder joint function examinations display a good recovery.
