中国修复重建外科杂志最新文献

In recent years, considerable progress has been made in the specific development and practice of enhanced recovery after surgery (ERAS) for geriatric hip fracture domestically and internationally. By synthesizing domestic and international research reports, this article analyzes the current status of key development areas of ERAS for geriatric hip fracture and puts forward future prospects. The main contents include the crises and opportunities of geriatric hip fracture against the backdrop of deep aging, the specific implementation of team and model construction in the application of ERAS concept to geriatric hip fracture management, the benefits and effect evaluation of recent studies, as well as the opportunities and innovative pathways brought by the development of big data and artificial intelligence for the future development of ERAS in this field.

Objective: To review the biomechanical rationale, surgical techniques, and clinical outcomes of meniscal centralization for degenerative medial meniscus extrusion.

Methods: A comprehensive literature search was conducted on recent domestic and international studies focusing on biomechanics, surgical methods, and clinical applications of meniscal centralization.

Results: Meniscus extrusion (radial displacement ≥3 mm beyond the tibial plateau) is commonly associated with degenerative knee conditions, leading to meniscal dysfunction and accelerated osteoarthritis progression. Meniscal centralization is a surgical technique that reduces extrusion by suturing the displaced meniscus back to the tibial plateau, thereby restoring its coverage and load-sharing function. Biomechanical studies have demonstrated its efficacy in reducing extrusion and improving joint contact mechanics. Surgical techniques primarily include the Pull-out method and anchor-based fixation, often supplemented by Pie-crusting release and meniscal mobilization to facilitate reduction. Clinical evidence suggests that centralization, either alone or combined with high tibial osteotomy and/or meniscal root repair, can improve short-term functional scores, reduce extrusion, and potentially delay joint degeneration.

Conclusion: Meniscal centralization represents a promising joint-preserving technique with favorable biomechanical and early clinical outcomes. However, its long-term efficacy warrants further investigation through high-quality studies.

Severe extremity injury results from high-energy trauma and causes extensive damage to multiple tissues. Such injuries directly threaten both limb viability and patient survival and remains a major challenge in trauma orthopaedics. The cornerstone of treatment is based on comprehensive assessment by a multidisciplinary team to guide evidence-based decisions on limb salvage. In repair and reconstruction strategies, the timing of soft-tissue coverage plays a critical role. Delayed primary flap coverage, performed 3-7 days after injury, has become the preferred approach. After repeated debridement to ensure a clean wound bed, this strategy improves flap survival and reduces infection risk. Fracture fixation requires dynamic decision-making. External fixators provide damage control and temporary stabilization and allow soft tissues to recover. Once conditions permit, conversion to internal fixation, such as intramedullary nails or plates to achieve stable fixation. Complex cases with severe contamination or infection require staged management. After thorough early debridement, local antibiotic delivery using antibiotic-loaded bone cement, such as vancomycin cement, can be applied. This is often combined with negative-pressure wound therapy, and external fixation may serve as definitive treatment. Large segmental bone defects can be managed using the induced membrane technique or bone transport. In addition, emerging strategies such as recombinant Staphylococcus aureus vaccines for infection prevention and three-dimensional-printed personalised implants for bone reconstruction show promising clinical potential.

Objective: To delineate the mechanistic role of platelet-rich plasma (PRP)-derived extracellular vesicles (EVs) in tissue repair and regeneration, and evaluate their clinical translation potential.

Methods: A systematic evidence synthesis was conducted through critical analysis of contemporary domestic and international literature, focusing on PRP-EVs' biophysical properties, signal transduction networks, and multi-tissue regenerative efficacy.

Results: PRP-EVs coordinate hemostasis, anti-inflammatory modulation, angiogenesis, and tissue plasticity through mediation of cellular proliferation, migration, and differentiation. Their low immunogenicity and biostability constitute a novel cell-free therapeutic paradigm.

Conclusion: PRP-EVs exhibit substantial translational merit in regenerative medicine, yet persistent impediments in standardized isolation protocols, longitudinal biosafety verification, and clinical translation frameworks necessitate resolution.

Reconstruction of missing thumbs or fingers remains one of the most demanding challenges in hand surgery. Over the past century, toe-to-hand transplantation has evolved from early experimental pedicled transfers into a highly refined microsurgical procedure, now widely regarded as the "gold standard" for restoring hand function. This article reviews the historical and technical development of toe transplantation-from Nicoladoni's pioneering concepts in the late 19th century, through Dr. YANG Dongyue's landmark second-toe transfer performed in 1966, to contemporary Chinese contributions such as the "total-shape reconstruction" paradigm. Modern surgical practice incorporates individualized strategies and advanced techniques, including Dr. GU Yudong's supplemental vascular-supply design and Dr. CHENG Guoliang's dual-pedicle bridging method, which collectively enhance functional recovery, aesthetic outcomes, and reliability. Emerging innovations such as three-dimensional-printed osseous scaffolds, artificial intelligence-assisted surgical planning, and tolerance-oriented transplant engineering are further driving the field toward greater precision, reduced morbidity, and improved long-term results.

Bone infection as one of the most challenging diseases in orthopedics, is characterized by a prolonged treatment and a high recurrence rate, imposing a significant disease burden on both patients and society. With the continuous emergence of drug-resistant bacteria and a deepening understanding of biofilm theory, traditional single-modality treatment have become inadequate in addressing these complex clinical challenges. This paper provides an in-depth analysis of the century-long dilemma in the treatment of bone infections. Through systematic theory, it shares the author's "Chongqing experiences" in bone infection management-a systematic strategy proposed based on extensive clinical practice and theoretical summarization. This approach emphasizes the importance of multi-disciplinary treatment, staged treatment, precise debridement, and a comprehensive grasp of the principles underlying bone infection therapy. The article also discusses humanistic considerations and future prospects in the treatment of bone infections, aiming to offer practical and valuable basis for clinical management.

Against the backdrop of increasing subspecialization in medicine, the Chinese Journal of Reparative and Reconstructive Surgery has established itself as a crucial academic platform for clinical and basic research involving multidisciplinary integration, focusing on the interdisciplinary field of reparative and reconstructive surgery. The year 2026 will mark the 40th anniversary of the journal's founding. This article reviews its developmental trajectory and discusses the definition of limb reconstruction, the evolution of relevant academic societies, advancements in prosthetic technology, and the concept of extreme reconstruction. In its narrow sense, limb reconstruction addresses defects, infections, and deformities, while broadly, it encompasses comprehensive treatment requiring multidisciplinary collaboration. The evolution of international academic societies from the Association for the Study and Application of Methods of Ilizarov (ASAMI) to International Limb Lengthening and Reconstruction Society (ILLRS) reflects both divergence and convergence in technical philosophies, with Chinese scholars playing a proactive role in this process. Advances in prosthetic technology, particularly in intelligent bionic prostheses and osseointegrated mechanoneural prostheses, have raised the standards for the precision of amputation surgeries and stump reconstruction, thereby fostering the development of the "maximum limb reconstruction" philosophy. This philosophy emphasizes a coherent three-stage approach (early, intermediate, and late) that integrates microsurgery, Ilizarov techniques, infection control, and soft tissue repair to achieve optimal restoration of structure, function, and morphology. By concentrating on multidisciplinary integration, the Chinese Journal of Reparative and Reconstructive Surgery has contributed significantly to the development of a limb reconstruction system with Chinese characteristics and is poised to continue leading progress in technological integration and academic innovation within this field.

The successful replantation of a severed limb by CHEN Zhongwei in 1963 marked the beginning of microsurgery in China. The complete survival of a completely severed finger replantation and the successful free transplantation of the second toe to reconstruct the thumb in 1966, as well as the successful transplantation of a free inguinal skin flap in 1973, were all landmark achievements. The Guangzhou Experience Exchange Conference on Limb Replantation in 1972 and the American Replantation Mission to China in 1973 promoted academic exchanges and technology dissemination both domestically and internationally in China's microsurgery field. China's limb (finger) replantation techniques and principles were recognized and promoted worldwide, and Chinese microsurgery developed in step with the world and created many world firsts. Since then, Chinese microsurgery has long been among the advanced academic ranks internationally.

The undulating characteristics of nerve fibers and the endoneurium are important factors in resisting traction force. The diagnostic accuracies of magnetic resonance neurography and ultrasonography for nerve injuries are 85.4% and 70.6%, respectively. Epineurial repair is the most commonly used nerve repair technique. Nerve grafts are generally required when the defect exceeds 2 cm. Nerve transfers are primarily indicated for brachial plexus root avulsions or intraforaminal lesions. Painful neuromas can be treated with target muscle reinnervation. Surgery yields reliable results for carpal-tunnel syndrome, cubital-tunnel syndrome, the common peroneal nerve entrapment, and the lateral femoral cutaneous nerve entrapment syndrome. Effective rehabilitation interventions related to the central nervous system include sensory reeducation, cross-modal sensory substitution, motor imagery, and action observation with simultaneous peripheral nerve stimulation.

Reduction is the first step in fracture treatment, and is the predominant factor for treatment outcomes. The positive anteromedial cortical support reduction theory was established by Professor Shi-Min Chang in 2014 for the fixation treatment of trochanteric femur fractures. It was referenced to the nonanatomic reduction theory proposed by Gotfried in 2013 for subcapital femoral neck fractures. Both are nonanatomic cortical support reductions to share medial compressive load, but were just the opposite with each other in the bearing and direction of the proximal head-neck fragment. For femoral neck fractures, positive cortical support means the proximal femoral head-neck fragment is intentionally positioned slightly lateral-superior to the distal neck (less than 1 cortical thickness) and is intramedullarily buttressed by the distal inferior cortex. For trochanteric femur fractures, positive cortical support means the proximal head-neck fragment is deliberately positioned slightly medial-superior to the distal shaft (less than 1 cortical thickness) and is extramedullarily buttressed by the anteromedial cortex of the femoral shaft. Currently positive reduction theory and its derivative Chang reduction quality criterion (CRQC) is widely accepted and practiced worldwide, and are appraised as one of the three keystone theories in the treatment of trochanteric femur fracture, which are tip-apex distance, lateral wall, and cortical support reduction. From the point of scientific methodology, this new theory establishment is related to several important factors, such as identify unusual events in clinical practice, seize the opportunity, abundant knowledge reserves, keep up with the latest progress, conduct analogical reasoning, and promptly summarize the results and publish academic papers.