中国修复重建外科杂志最新文献

Objective: To provide a comprehensive review of the surgical methods for repairing post-epicanthoplasty deformity, aiming to offer a reference for clinical decision-making in selecting appropriate techniques.

Methods: Relevant research literature concerning the repair of post-epicanthoplasty deformities was extensively reviewed. The background, clinical applications, and current challenges of these reconstructive procedures were summarized and analyzed.

Results: Post-epicanthoplasty deformities are not uncommon, and with evolving aesthetic standards, the demand for medial canthal reconstruction is increasing. The primary surgical techniques reported in the literature include the V-Y advancement flap, the reverse skin-redraping method, and the reverse Z-plasty. In recent years, the application of orbicularis oculi myocutaneous flaps has become more prevalent. While most of these procedures yield satisfactory outcomes, they still face certain limitations, particularly in addressing challenges related to scar management, individual patient variations, and the precise control of medial canthal morphology.

Conclusion: When clinically addressing post-epicanthoplasty deformities, surgeons must select the most suitable surgical method based on a comprehensive assessment of the patient's specific condition and various contributing factors. An individualized approach is crucial to achieving the optimal aesthetic and functional outcomes.

Objective: To analyze the trends in the disease burden of fall-related fractures among elderly Chinese from 1990 to 2023, and to examine the disparities by age, gender, and fracture site, in order to inform the development of targeted strategies for the prevention of such fractures.

Methods: Data on the incidence, prevalence, and years lived with disability (YLDs) of fall-related fractures among elderly Chinese from 1990 and 2023 was sourced from the 2023 Global Burden of Disease (GBD) study. The disease burden across age groups, genders, and fracture sites was assessed. Furthermore, temporal trends by these strata were analyzed using Joinpoint 5.4.0.0 software.

Results: From 1990 to 2023, the average annual percent changes in the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized years of life lost rate (ASYR) for fall-related fractures among elderly Chinese were 1.81%, 1.03%, and 0.83%, respectively. In China, the disease burden of fall-related fractures among the elderly increased with advancing age, and the rate of this increase accelerated in older age groups. Females had higher values than males in terms of ASIR, the rates of increase for all burden measures were greater in males. Fall-related fractures among the elderly Chinese can be classified into 12 sites, among which hip fracture had the highest ASIR, with values of 538.15 and 963.57 per 100 000 in 1990 and 2023, respectively. Fractures of the patella, tibia, fibula, or ankle had the highest ASPR and ASYR. Their ASPR were14 836.73 and 19 727.74 per 100 000 in 1990 and 2023, respectively, and ASYR were 740.84 and 989.54 per 100 000, respectively.

Conclusion: The increasing and heterogeneous burden of fall-related fractures among elderly Chinese calls for targeted management strategies, in addition to enhanced osteoporosis prevention, that address the distinct risks by gender, age, and fracture site.

Objective: To review the research progress and application prospects of Kartogenin (KGN) in cartilage repair and tissue engineering.

Methods: Through a literature review, the mechanisms of KGN in cartilage repair, biomaterial composite strategies, and the resulting repair effectivenes were sorted out.

Results: KGN regulates multiple signaling pathways to induce mesenchymal stem cells differentiation into chondrocytes, maintain chondrocyte phenotypes, inhibit chondrocyte senescence, and promote the secretion of extracellular matrix. KGN also forms high-efficiency scaffolds with various materials, suitable for tissue engineering scaffolds of different anatomical sites and defect types, and exhibits significant cartilage regenerative effectiveness in vitro and small animal models.

Conclusion: Overall, KGN shows great application potential in cartilage tissue engineering. However, clinical translation still faces many challenges, which represents a key direction for future research.

Objective: To review the role of chemokine networks in regulating synovial macrophage heterogeneity during osteoarthritis (OA) pathogenesis.

Methods: A review of recent literature on the developmental origins of OA synovial macrophages, single-cell transcriptomic characteristics, and chemokine signaling pathways was conducted to systematically summarize the functional phenotypes, immunometabolic mechanisms, and regulatory roles of synovial macrophages in OA.

Results: OA has been established as a low-grade, chronic inflammatory disease affecting the entire joint. Single-cell and spatial transcriptomic studies have confirmed that synovial macrophages are not a single population but rather a dynamic continuum of different functional states, including steady-state barrier-like, inflammatory amplification, fibrosis-related, and lipid-enriched phenotypes. Chemokine networks play a dual crucial role in this process: on one hand, chemokine gradients guide the migration of peripheral monocytes to the synovium and influence their differentiation; on the other hand, synovial macrophages in different states secrete chemokines, mediating transcellular communication between the synovium, subchondral bone, and peripheral nerves. This process reshapes the microenvironment and amplifies local inflammation and pain signals. Current therapeutic strategies targeting macrophage metabolic reprogramming and chemokine axis blockade show potential clinical applications.

Conclusion: Re-examining the interaction between synovial macrophages and microenvironment and constructing an integrated perspective of "lineage-state-chemokine network" will help to understand the pathological progression mechanism of OA. In the future, it is expected to provide a theoretical framework and intervention targets for the precise immune regulation of OA and the development of new targeted drugs by accurately analyzing the spatiotemporal evolution of macrophage subsets and their interaction with chemokines.

Objective: To analyze the changing trends and attributable risk factors of low back pain disease burden in Chinese population from 1990 to 2023, and to predict the related disease burden of low back pain in 2030.

Methods: Based on the 2023 Global Burden of Disease (GBD) study database, the incidence, prevalence, years lived with disability (YLDs), and characteristics and trends of risk factors among Chinese individuals with low back pain from 1990 to 2023 were analyzed, the age and gender differences in disease burden were assessed, and the disease burden in 2030 was jointly predicted by autoregressive integrated moving average model and age-period-cohort model.

Results: From 1990 to 2023, the number of incident cases, the number of prevalent cases, and YLDs in Chinese low back pain population showed an upward trend, from 29.989 1 million cases, 68.636 3 million cases, and 7.732 4 million person-years to 41.383 6 million cases, 95.324 0 million cases, and 10.635 9 million person-years, respectively. The incidence rate, prevalence rate, and YLDs rate increased from 2 543.31 per 100 000, 5 820.89 per 100 000, and 655.77 per 100 000 to 2 892.65 per 100 000, 6 663.01 per 100 000, and 743.43 per 100 000 respectively. However, the age-standardized incidence rate, age-standardized prevalence rate, and age-standardized YLDs rate showed a downward trend, from 2 859.73 per 100 000, 6 636.60 per 100 000, and 740.83 per 100 000 to 2 164.80 per 100 000, 4 929.78 per 100 000, and 551.92 per 100 000, respectively. The burden of low back pain in women was significantly higher than that in men and increased with age (peak at 50 to 59 years old). Attribution analysis showed that smoking, occupational factors, and high body mass index (BMI) were the main factors leading to the increase of YLDs, and there was a gender difference. The tow model showed that the age-standardized incidence rate, the age-standardized prevalence rate, and the age-standardized YLDs rate for low back pain would decrease year by year from 2023 to 2030.

Conclusion: The disease burden of low back pain in China shows that from 1990 to 2023, the burden of low back pain in the Chinese population has been increasing year by year. Smoking, occupational factors, and high BMI are the main risk factors. Interventions targeting these controllable risk factors are crucial for reducing the disease burden. It is expected that by 2030, the disease burden of low back pain is expected to decrease, although the absolute burden will remain high. Greater attention should be paid to the middle-aged and elderly population, especially the female population, who bear a heavier disease burden. Targeted interventions, such as weight control and smoking cessation management, should be actively implemented against these controllable risk factors.

Objective: To explore the effectiveness of arthroscopic-assisted closed reduction and internal fixation with absorbable screws in the treatment of Hawkins type Ⅱ talar neck fractures.

Methods: A retrospective analysis was conducted on the clinical data of 31 patients with closed Hawkins type Ⅱ talar neck fractures between October 2021 and July 2023, all of whom were treated with arthroscopic-assisted closed reduction and internal fixation with absorbable screws. There were 18 males and 13 females with an average age of 35.9 years (range, 17-61 years). Causes of injury included sports injuries in 26 cases and impact injuries in 5 cases. The time from fracture to operation was 3-5 days (mean, 3.7 days). During follow-up, ankle pain and function were assessed using the visual analogue scale (VAS) score and the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score (AOFAS-AHS), while radiological examinations were used to evaluate the quality of fracture reduction and healing.

Results: All operations were successfully completed, and all incisions healed by first intention. All patients were followed up 12-16 months (mean, 13.0 months). One patient experienced persistent pain, limping, and joint dysfunction postoperatively, which returned to normal after symptomatic treatment. At 3 months after operation and last follow-up, the VAS scores were 2.7±0.9 and 1.3±0.8, respectively; the AOFAS-AHS were 74.5±4.7 and 90.9±3.6, respectively. There were significant differences in VAS score and AOFAS-AHS between different time points ( P<0.05). At last follow-up, all fractures healed, and the internal fixation was secure. No complication such as talar necrosis, subtalar joint stiffness, wound infection, or screw irritation occurred during follow-up.

Conclusion: Arthroscopic-assisted closed reduction and internal fixation with absorbable screws for Hawkins type Ⅱ talar neck fractures has the advantages of minimal trauma, precise screw placement, few complications, and avoiding secondary screw removal, with satisfactory effectiveness.

Objective: To analyze the current status and trends in the burden of musculoskeletal diseases in China from 1990 to 2023, providing evidence-based support for formulating and optimizing prevention and control strategies for musculoskeletal diseases in China.

Methods: Based on the 2023 Global Burden of Disease (GBD) study database, the study integrated incidence, prevalence, disability-adjusted life years (DALYs), and age-standardized rates of musculoskeletal diseases in the Chinese population from 1990 to 2023, stratified by gender and age. The proportional contribution to all-cause prevalence was calculated, and regression models were constructed using Joinpoint software to assess temporal trends.

Results: In 2023, the five major musculoskeletal diseases collectively accounted for approximately 25.0% of all-cause prevalence in China. Among these, osteoarthritis contributed the most (11.68%), followed by low back pain (6.89%) and neck pain (3.52%). Gout (1.28%) and rheumatoid arthritis (0.36%) had relatively lower contributions. From 1990 to 2023, the overall burden of the five major musculoskeletal diseases remained substantial, with heterogeneous temporal patterns across diseases. Stratified by age and gender, the five diseases exhibited low levels during childhood and adolescence, increased significantly in middle and older adulthood, and peaked in the elderly. Except for gout, the burden of the other four diseases was higher in females than in males across most age groups. The scale of each disease varied considerably. Osteoarthritis showed the most significant increase in prevalence, with prevalent cases increasing from 53.7668 million to 161.7424 million, and the age-standardized DALYs rate rising by 16.19%. Gout showed the fastest growth in disease burden, with age-standardized DALYs rates rising from 19.88/100 000 to 25.14/100 000 (a 26.46% increase). Although low back pain showed a decline, it remained a major source of disability over the long term, with the age-standardized DALYs rate decreasing from 740.83/100 000 to 551.92/100 000 (a 25.49% decrease). Neck pain remained generally stable with a age-standardized DALYs rate increase of 1.18%. The age-standardized incidence rate of rheumatoid arthritis increased by 19.41%, and the age-standardized DALYs rate decreased by 8.38%.

Conclusion: Over the past 30 years, the burden of musculoskeletal diseases in China has shown a persistent upward trend with significant gender and age disparities. Future prevention and control strategies should place greater emphasis on early identification and proactive interventions, advocating for more targeted comprehensive measures for high-risk populations. Concurrently, efforts must be made to enhance standardized diagnosis and treatment capabilities at the primary care level, alongside strengthening continuous rehabilitation management.

Objective: To summarize the current research progress of finger flexion deformity caused by forearm flexor muscle lesions, providing a reference for clinical diagnosis and treatment.

Methods: The domestic and international literature about finger flexion deformity caused by forearm flexor muscle lesions was extensively reviewed. A summary analysis was conducted from the etiology and pathogenesis, diagnosis and differential diagnosis, and treatment methods.

Results: The three types of forearm flexor pathology leading to finger flexion deformity include Volkmann's contracture, pseudo-Volkmann's contracture, and congenital flexor muscle lesions with different pathogenesis. The diagnosis is mainly based on the patient's medical history, clinical features, and imaging examinations, with attention paid to differential diagnosis. Currently, conservative treatment for such deformities is not very effective, and surgical treatment is mainly adopted. According to the causes and severity, options such as resection of the contracture band, resection of contracture band, release of compressed muscle (tendon), and flexor origin muscle sliding surgery, could be performed to correct hand deformities and restore hand function, and thus resulting in favorable outcomes.

Conclusion: Volkmann's contracture, pseudo-Volkmann's contracture, and congenital flexor muscle lesions causing finger flexion deformity have different causes and pathogenesis, which can be distinguished by carefully inquiring about the medical history, the clinical characteristics of the three, and imaging examinations, thereby selecting appropriate treatment methods.