OBJECTIVE: To explore the effect of collaborative nursing based on Roy Adaptive Mode (RAM) on postoperative functional reconstruction, soft tissue pain and quality of life in patients with femoral intertrochanteric fracture.
METHODS: A retrospective matched control method was used in this study. A total of 96 patients with femoral intertrochanteric fracture admitted to our hospital from July 2018 to September 2021 were selected. According to different nursing methods, the patients were divided into a collaborative group and a routine group, with 48 cases in each group. Patients in both groups were treated with intramedullary nail surgery. The routine group was given routine perioperative nursing intervention, and the collaborative group was given collaborative nursing intervention on this basis. The hip function recovery and quality of life before and after the intervention were compared between the two groups. The preoperative and postoperative pain degree, and the perioperative complications of the two groups were recorded. Logistic multivariate regression analysis was used to analyze the risk factors affecting the recovery of hip joint function in patients with femoral intertrochanteric fracture after operation, thereby constructing a risk prediction model. ROC curve was used to analyze the clinical value of influencing factors in predicting postoperative hip function recovery in patients with femoral intertrochanteric fracture.
RESULTS: Harris score each dimension after intervention in the collaborative group was obviously higher than that of before intervention and the conventional group (P < 0.05). After intervention, the excellent and good rate of hip joint function the collaborative group was 83.33%, which was significantly higher than 60.42% in the routine group (P < 0.05). Postoperative VAS scores each time point in the collaborative group was obviously lower than that in the routine group (P < 0.05). After intervention, the scores of physiological function, physiological role, body pain and general health in the collaborative group were significantly higher than those in the routine group (P < 0.05). The incidence of complications in the collaborative group was 6.25%, which was significantly lower than 22.92% in the routine group (P < 0.05). There were statistically significant differences in age, preoperative ASA grade, internal fixation method, osteoporosis grade and perioperative nursing methods between the excellent hip recovery group and the poor hip recovery group (P < 0.05). Logistic multivariate regression analysis showed that age, preoperative ASA grade, internal fixation method and osteoporosis grade were the risk factors affecting the recovery of hip joint function after operation, and perioperative nursing method was the protective factor (P < 0.05). Among the influencing factors, the internal fixation method and the grade of osteoporosis had certain clinical value in predicting the recovery of hip joint function in patients with femoral intertrochanteric fracture after operation.
CONCLUSIONS: The RAM model-based collaborative nursing method may effectively restore the hip joint function of patients with femoral intertrochanteric fracture after operation, and may reduce the perioperative pain degree of patients, improve the quality of life of patients and reduce the incidence of complications, which can be popularized and applied in clinical practice. In addition, there are many factors influencing the recovery of hip joint function in patients with femoral intertrochanteric fracture after operation, and targeted measures should be taken according to the influencing factors to improve the effect of intramedullary nail treatment.

UNASSIGNED: Chondromyxoid fibroma (CMF) is a rare cartilaginous tumor, accounting for < 1% of benign bone tumors. We report a case of temporomandibular joint (TMJ)-CMF, involving the pterygopalatine space and skull base and discuss its epidemiology, clinical characteristics, and management.
UNASSIGNED: A 56-year-old woman presented with facial asymmetry and progressive mouth opening restriction due to a mass expanding upwardly to the auriculotemporal region. Using digital techniques to determine the lesion\'s boundary and reconstruct the normal glenoid fossa, the temporalis myofascial flap was transplanted between the titanium mesh and condyle to reconstruct the disc after tumor resection.
UNASSIGNED: This case highlights the importance of identifying patients with TMJ-CMF.

BACKGROUND: The surgical management of patients diagnosed with papillary thyroid carcinoma (PTC) and tracheal invasion has been a subject of ongoing discussion, particularly regarding the approach to tracheal functional reconstruction. The objective of this study was to examine the surgical technique and prognosis of PTC patients with tracheal invasion.
METHODS: This study employed both univariate and multivariate Cox proportional hazard models to determine predictive factors that affect the progression-free survival (PFS) of PTC patients with tracheal invasion. Cox regression analysis was conducted by using R software version 4.3.1.
RESULTS: In our study, we included 247 patients with T4a PTC. Among them, 146 patients (59.1 %) were classified as Shin I, 57 patients (23.1 %) as Shin II-III, and 44 patients (17.8 %) as Shin IV. Patients in the Shin I group underwent shaving of the tumours in the airway. The preferred surgical methods in the Shin II, III and IV groups were window resection (66.7 %), sleeve resection (34.8 %) and partial tracheal resection and skin fistula (61.8 %), respectively. Multivariate analysis demonstrated that neither tracheal surgery nor reconstruction procedures had an impact on PFS in T4a PTC patients with tracheal invasion. The 5-year DSS rate for patients receiving radioiodine (RAI) therapy was 87.3 % (p = 0.033).
CONCLUSIONS: This study confirmed that tracheal surgery and reconstruction methods had no impact on PFS in T4a PTC patients with tracheal invasion in different Shin groups. Furthermore, RAI therapy has the potential to increase the survival rate of patients with preoperative distant metastasis of T4a PTC.

OBJECTIVE: Microvascular bone flap jaw reconstruction has achieved satisfactory clinical outcomes. However, little is known about the long-term stability of the reconstructed jaw. This prospective longitudinal study aimed to investigate the long-term stability of jaw reconstruction and factors that were associated with it.
METHODS: Patients with successful computer-assisted osseous free-flap jaw reconstruction in the Department of Oral and Maxillofacial Surgery, Queen Mary Hospital, Hong Kong were recruited for this prospective longitudinal study. The three-dimensional jaw models at the pre-operative plan, post-operative 1-month, and 2 years were aligned and compared.
RESULTS: A total of 69 patients were recruited, among which 48 patients were available for the long-term analysis. Compared to 1-month after surgery, further deviation from the pre-operative plan was observed at post-operative 2 years. Lack of accuracy in surgery, segmental mandible resection especially with the involvement of mandible angles, and post-operative radiation therapy were identified as the significant factors affecting the positional stability of the reconstructed jaw (p < 0.05). Stable reconstruction was observed in the subgroup analysis of patients without post-operative radiation therapy.
CONCLUSIONS: Up to the best of our knowledge, this is the first prospective longitudinal study reporting the long-term stability of jaw reconstruction and its affecting factors. Our data demonstrated that the reconstructed jaw position lacked stability over the postoperative period. How to improve long-term stability of reconstructed jaw thus optimize the functional outcomes warrants further studies.

Meniscus injury is one of the most common sports injuries within the knee joint, which is also a crucial pathogenic factor for osteoarthritis (OA). The current meniscus substitution products are far from able to restore meniscal biofunctions due to the inability to reconstruct the gradient heterogeneity of natural meniscus from biological and biomechanical perspectives. Here, inspired by the topology self-induced effect and native meniscus microstructure, we present an innovative tissue-engineered meniscus (TEM) with a unique gradient-sized diamond-pored microstructure (GSDP-TEM) through dual-stage temperature control 3D-printing system based on the mechanical/biocompatibility compatible high Mw poly(ε-caprolactone) (PCL). Biologically, the unique gradient microtopology allows the seeded mesenchymal stem cells with spatially heterogeneous differentiation, triggering gradient transition of the extracellular matrix (ECM) from the inside out. Biomechanically, GSDP-TEM presents excellent circumferential tensile modulus and load transmission ability similar to the natural meniscus. After implantation in rabbit knee, GSDP-TEM induces the regeneration of biomimetic heterogeneous neomeniscus and efficiently alleviates joint degeneration. This study provides an innovative strategy for functional meniscus reconstruction. Topological self-induced cell differentiation and biomechanical property also provides a simple and effective solution for other complex heterogeneous structure reconstructions in the human body and possesses high clinical translational potential.

There is no unified approach for restoring the suprapatellar quadriceps tendon and covering tissue defects simultaneously. In this case report, we present the pedicled myocutaneous rectus femoris flap as one effective approach in two cases with extensive loss or impairment of the suprapatellar muscle-tendon structures after trauma-related suprapatellar quadriceps tendon rupture and multiple reconstruction attempts. Additionally, we provide a literature review of the reconstructive use of the functional pedicled myocutaneous rectus femoris flap.
METHODS: Two male patients, 48 and 74 years old, with extensive loss or impairment of the suprapatellar muscle-tendon structures due to multiple reconstruction attempts, underwent restoration of the knee extension with a pedicled myocutaneous rectus femoris flap.
RESULTS: Three months after reconstruction, both patients were able to walk freely, unaided. After a six-month follow-up, the free passive mobility of the knee joint was restored, and the active extension of the knee joint was possible in both patients.
CONCLUSIONS: The authors conclude that the pedicled rectus femoris flap is a reliable method for the restoration of knee extension, with excellent functional results in cases of suprapatellar tendon lesions. Further to the functional restoration, this technique has the additional advantage of simultaneously achieving coverage of soft-tissue defects, while a direct closure of the donor site is possible. Elderly patients and patients with relevant comorbidities or multiple revisions may especially benefit from this technique.

暂无摘要。

Free functional muscle transfer is a reconstructive strategy for the reconstruction of lost muscle units in the lower extremity after oncologic resection, trauma, compartment syndrome, or severe nerve injuries. Under appropriate circumstances, free functional muscle transfer may be the only suitable reconstructive option. This article reviews the underlying principles of free functional muscle transfer, its application to lower extremity reconstruction, appropriate patient selection, and surgical techniques.
The underlying principles of free functional muscle transfer, its application to lower extremity reconstruction, appropriate patient selection, and surgical techniques are presented. Commonly used donor muscles appropriate for each type of functional defect are discussed. A review of recent publications on free functional muscle transfer in the lower extremity was also performed.
Good functional recovery with a Medical Research Council grade of up to 4/5 and full range of motion can be attained with free functional muscle transfer. Clinical outcomes and specific parameters for published case series in lower extremity free functional muscle transfer are presented and an illustrative case.
Free functional muscle transfer is a suitable treatment for the appropriate patient to restore essential functions and potentially regain ambulation. However, additional published clinical outcomes are needed and represent a major area for further investigation.

BACKGROUND: The functional deficits that develop after a peripheral nerve injury mean a considerable reduction in the quality of life for the affected patients. However, interventions on the injured nerve are not always possible or effective. In this case, secondary procedures, e.g. tendon transfers, are a feasible option for functional reconstruction.
OBJECTIVE: An overview of the most common secondary surgical procedures for functional reconstruction after peripheral nerve injuries.
METHODS: Presentation and discussion of the most common secondary surgical procedures with emphasis on tendon transfers. Illustration of the primary functions that need to be reconstructed depending on the respective nerve lesion.
RESULTS: The basic principle of secondary surgical procedures after nerve injuries is the transposition of a healthy tendomuscular unit to replace a lost function following a loss of muscle or tendon or if an intervention on the nerve is not promising. For example, by transferring flexor forearm muscles, wrist, finger and thumb extension can be reconstructed after radial nerve injury. By transposing the tibialis posterior muscle, dorsiflexion in the talocrural joint can be restored to enable the affected patient to walk safely without an orthosis.
CONCLUSIONS: Secondary surgical procedures are a valuable option for functional reconstruction after nerve injury.
UNASSIGNED: HINTERGRUND: Die nach einer peripheren Nervenverletzungen entstehenden funktionellen Defizite bedeuten für die betroffenen Patienten eine erhebliche Einschränkung der Lebensqualität. Jedoch sind Eingriffe am verletzten Nerv nicht immer möglich oder zielführend. Motorische Ersatzoperationen stellen in diesem Fall eine sinnvolle Option zur funktionellen Rekonstruktion dar.
UNASSIGNED: Übersicht über die gängigsten sekundären operativen Verfahren zur funktionellen Rekonstruktion nach Verletzungen peripherer Nerven.
METHODS: Darstellung und Diskussion der gängigsten sekundären operativen Verfahren mit Schwerpunkt auf Sehnentransfers. Veranschaulichung der primär zu rekonstruierenden Funktionen abhängig von der jeweiligen Nervenläsion.
UNASSIGNED: Das Grundprinzip sekundärer operativer Verfahren nach Nervenverletzungen ist die Transposition einer gesunden tendomuskulären Einheit zum Ersatz einer verlorenen Funktion, wenn es zum Verlust von Muskeln oder Sehnen gekommen oder ein Eingriff am Nerv nicht erfolgversprechend ist. Durch einen Transfer beugeseitiger Unterarmmuskeln können beispielsweise die Handgelenks‑, Finger- und Daumenextension nach einer Verletzung des N. radialis rekonstruiert werden. Durch die Transposition des M. tibialis posterior kann die Dorsalextension im oberen Sprunggelenk wiederhergestellt werden, um den betroffenen Patienten einen sicheren Gang ohne Orthese zu ermöglichen.
UNASSIGNED: Motorische Ersatzoperationen stellen eine wertvolle Option zur funktionellen Rekonstruktion nach Nervenverletzungen dar.

BACKGROUND: Soft-tissue functional reconstruction is important for restoring hip function in proximal femoral replacement for tumor resection. This study evaluated the functional outcome and postoperative complications of a specific synthetic ligament for soft-tissue functional reconstruction in proximal femoral replacement for tumor resection.
METHODS: This cohort included 80 patients (40 men and 40 women, mean age, 40 years (range, 10 to 79)) who had benign invasive tumors (n = 13), primary malignant bone tumors (n = 40), or bone metastases (n = 27). Patients\' medical records, imaging files, surgical details, and postoperative pathological diagnoses were collected. Tumor staging was performed with the Enneking staging criteria. Lower limb and hip functions were assessed using the Musculoskeletal Tumor Society scoring system and Harris Hip score, respectively.
RESULTS: Mean postoperative Musculoskeletal Tumor Society and Harris Hip scores were 27 (range, 24 to 30) and 90 (range, 76 to 97), respectively, indicating satisfactory range of motion and stability. Trendelenburg gait was observed in 3 osteosarcoma patients (3.8%), and 6 patients showed unequal lower-limb lengths. Reoperations occurred in 5 cases, including 3 cases of deep vein thromboses and 1 case each of giant cell granuloma and periprosthetic infection. There were 27 patients who had bone metastases who did not require reoperation.
CONCLUSIONS: The synthetic ligament reconstruction of the hip with proximal femoral replacement for tumor resection was associated with improved outcomes. Its implementation exhibits the potential to reduce postoperative incidences of hip dislocation and periprostheses infection, thereby warranting its prospective clinical application.