Objective This study aimed to investigate the correlation between the surface area ratio of medial tibial plateau(MTP)to lateral tibial plateau(LTP)and the mechanical tibiofemoral angle(mTFA).Methods Lower limb comput...Objective This study aimed to investigate the correlation between the surface area ratio of medial tibial plateau(MTP)to lateral tibial plateau(LTP)and the mechanical tibiofemoral angle(mTFA).Methods Lower limb computed tomography(CT)images were collected at our hospital.Then,the original CT data were analyzed and reconstructed using medical image processing software.The proximal and distal centres of the femur and tibia were marked.The surface areas of MTP and LTP were identified using image processing software.GraphPad Prism 8.0.2 was used to perform the statistical analysis.Results The surface area ratio of MTP to LTP was significantly correlated with the mTFA in all patients(P<0.0001),male group(P<0.0001),female group(P<0.0001),varus group(P<0.0001),and valgus group(P=0.002).Furthermore,the surface area of MTP and LTP was significantly greater in the male group than in the female group(P<0.0001).There was significant difference in the surface area of the MTP between the varus and valgus groups(P<0.0001).Significant difference was also observed in the surface area ratio of MTP to LTP between the varus and valgus groups(P<0.0001).Conclusion The surface area ratio of MTP to LTP was correlated with the mTFA.Within a certain range,the smaller the mTFA,the greater the surface area ratio of MTP to LTP.For patients undergoing total knee arthroplasty,of whom the surface area of the MTP was basically equal to that of the LTP,it is recommended that the osteotomy should be performed in accordance with mechanical alignment standards,and that a symmetrical tibial plateau prosthesis should be used.For patients whose surface area of MTP is significantly greater than that of the LTP,it is recommended that the osteotomy should be performed in accordance with kinematic alignment standards,and that an anatomical tibial plateau prosthesis should be used.展开更多
Complex tibial plateau fractures can seriously affect quality of life and physical and mental health of patients.The anatomical relationship between the proximal tibial bone and soft tissue is complex,resulting in dif...Complex tibial plateau fractures can seriously affect quality of life and physical and mental health of patients.The anatomical relationship between the proximal tibial bone and soft tissue is complex,resulting in different types of tibial plateau fractures.Violent trauma can lead to displaced fracture,serious soft tissue injury,and potentially,dislocation of the knee joint.Therefore,tibial plateau fractures are extremely unstable.AIM To assess the use of locking compression plate(LCP)+T-type steel plate for postoperative weight bearing and functional recovery of complex tibial plateau fractures.METHODS Ninety-seven patients with complex tibial plateau fractures who underwent surgery at our hospital were selected for retrospective study.Forty-nine patients had been treated with LCP+T-type steel plate limited internal fixation(study group),and 48 patients with bilateral ordinary steel plate support(control group).The operation process index,postoperative rehabilitation related index,Rasmussen score of the knee joint,tibial plateau varus angle(TPA),tibial plateau retroversion angle(PA),and surgical complications of the two groups were compared.RESULTS The operation time and intraoperative bone graft volume in the study group were lower than those in the control group(P<0.05).There were no significant differences in surgical bleeding,anterior external incision length,postoperative drainage,hospital stay duration,and fracture healing time between the groups(P>0.05).There was no significant difference in the TPA and PA angle between the groups immediately and 18 mo after surgery(P>0.05).At 12 mo after surgery,the Rasmussen scale score was higher in the study group than in the control group(P<0.05).There was no significant difference in the Rasmussen scale score at 18 mo after surgery,and the radiology score at 12 and 18 mo after surgery,between the two groups(P>0.05).The postoperative complication rate in the study group(3.77%)was lower than that in the control group(15.09%;P<0.05).CONCLUSION LCP+T-type steel plate internal fixation has advantages in terms of minimizing trauma and enabling early postoperative functional exercise,promoting functional recovery and lower limb weight-bearing,and reducing postoperative complications.展开更多
Objective:To explore a new artificial intelligence(AI)-aided method to assist the clinical diagnosis of tibial plateau fractures(TPFs)and further measure its validity and feasibility.Methods:A total of 542 X-rays of T...Objective:To explore a new artificial intelligence(AI)-aided method to assist the clinical diagnosis of tibial plateau fractures(TPFs)and further measure its validity and feasibility.Methods:A total of 542 X-rays of TPFs were collected as a reference database.An AI algorithm(RetinaNet)was trained to analyze and detect TPF on the X-rays.The ability of the AI algorithm was determined by indexes such as detection accuracy and time taken for analysis.The algorithm performance was also compared with orthopedic physicians.Results:The AI algorithm showed a detection accuracy of 0.91 for the identification of TPF,which was similar to the performance of orthopedic physicians(0.92±0.03).The average time spent for analysis of the AI was 0.56 s,which was 16 times faster than human performance(8.44±3.26 s).Conclusion:The AI algorithm is a valid and efficient method for the clinical diagnosis of TPF.It can be a useful assistant for orthopedic physicians,which largely promotes clinical workflow and further guarantees the health and security of patients.展开更多
Introduction: Tibial plateau fractures are solutions of continuity of the epiphyseal-metaphyseal block of the upper end of the tibia of which at least one line enters the joint. They threaten the stability and mobilit...Introduction: Tibial plateau fractures are solutions of continuity of the epiphyseal-metaphyseal block of the upper end of the tibia of which at least one line enters the joint. They threaten the stability and mobility of the knee and can compromise walking and standing. These fractures are on the increase, especially affecting young and active subjects. Orthopedic treatment is a rare indication apart from non-displaced or slightly displaced forms. Surgical treatment is required in displaced forms, particularly in depression fractures. The aim of this work was to report the lesional and therapeutic aspects of tibial plateau fractures in our department. Patients and Method: Patients and method: This was a retrospective study over 36 months from January 2019 to December 2021. Included in this study were patients treated for a tibial plateau fracture in our department and followed up for at least 10 months. The epidemiological and clinical data analyzed were age, sex, affected side, etiology, mechanism of injury, pathological anatomy and associated lesions. The fractures were classified according to the classification of Duparc and Ficat. The slightly or non-displaced forms were treated orthopedically while the displaced forms were treated surgically. The minimum follow-up was 10 months. The results were evaluated by the anatomical criteria according to Mazas and Duparc and functional according to Merle d’Aubigné. Results: The authors collected 71 cases of tibial plateau fractures. They accounted for 4.0% of all limb fractures, 5.8% of lower limb fractures and 33.8% of knee fractures in our service. The male sex was the most represented at 78.9% with a sex ratio of 3.7. The age group of [20 - 40] years was the most affected, i.e., 53.5%. The average age was 41 years with extremes of 17 and 82 years. The left side was affected (n = 47) and the right side (n = 24). Road traffic accident was the main cause. The mechanism of injury was mainly represented by lateral and sagittal compressions. Lateral unituberosity and bi-tuberosity fractures were the most frequent pathological types in our series, respectively 42.2% and 28.2%. The associated lesions were mainly represented by bone, ligament, skin and neurological lesions. The treatment was orthopedic in 52.1% and surgical in 47.9%. According to the functional criteria of PMA, our results were very good and good at 77.4%, Average at 14.1% and poor at 8.5%. Conclusion: It appears in this study that fractures of the tibial plateaus are frequent and serious because of their articular nature. Lateral and sagittal compressions are the most evoked injury mechanisms. Lateral unituberosity and bituberosity fractures are the most frequent pathological types. Functional and anatomical results are significantly better with surgical treatment.展开更多
The management of a combination of fracture and multiligament knee injury(MKI) in traumatic knee injury remains controversial, and there are evolving treatment recommendations. Currently, there are no studies focusing...The management of a combination of fracture and multiligament knee injury(MKI) in traumatic knee injury remains controversial, and there are evolving treatment recommendations. Currently, there are no studies focusing on older adult patients with MKI's in combination with tibia fractures. As a result, there is no well-established treatment algorithm for older adult patients with these complex injuries. We report two cases of MKI's with concomitant fractures in patients fifty years of age or older. Both patients were treated surgically for their associated tibial plateau fractures, but were managed with conservative treatment of the multiligamentous knee injuries. We also provide a review of the literature and guidelines for older adult patients with these types of complex traumatic injuries. Early to mid term acceptable outcomes were achieved for both patients through surgical fixation of the tibial plateau fracture and conservative treatment of the ligament injuries. We propose a comprehensive treatment algorithm for management of these complex injuries.展开更多
AIM To systemically review all studies reporting return to sport following tibial plateau fracture, in order to provide information on return rates and times to sport, and to assess variations in sporting outcome for ...AIM To systemically review all studies reporting return to sport following tibial plateau fracture, in order to provide information on return rates and times to sport, and to assess variations in sporting outcome for different treatment methods.METHODS A systematic search of CINAHAL, Cochrane, EMBASE, Google Scholar, MEDLINE, PEDro, Scopus, SPORTDiscus and Web of Science was performed in January 2017 using the keywords "tibial", "plateau", "fractures", "knee", "athletes", "sports", "non-operative", "conservative", "operative", "return to sport". All studies which recorded return rates and times to sport following tibial plateau fractures were included. RESULTS Twenty-seven studies were included: 1 was a randomised controlled trial, 7 were prospective cohort studies, 16 were retrospective cohort studies, 3 were case series. One study reported on the outcome of conservative management(n = 3); 27 reported on the outcome of surgical management(n = 917). Nine studies reported on Open Reduction Internal Fixation(ORIF)(n = 193), 11 on Arthroscopic-Assisted Reduction Internal Fixation(ARIF)(n = 253) and 7 on Frame-Assisted Fixation(FRAME)(n = 262). All studies recorded "return to sport"rates. Only one study recorded a "return to sport" time. The return rate to sport for the total cohort was 70%. For the conservatively-managed fractures, the return rate was 100%. For the surgically-managed fractures, the return rate was 70%. For fractures managed with ORIF, the return rate was 60%. For fractures managed with ARIF, the return rate was 83%. For fractures managed with FRAME was 52%. The return rate for ARIF was found to be significantly greater than that for ORIF(OR 3.22, 95%CI: 2.09-4.97, P < 0.001) and for FRAME(OR 4.33, 95%CI: 2.89-6.50, P < 0.001). No difference was found between the return rates for ORIF and FRAME(OR 1.35, 95%CI: 0.92-1.96, P = 0.122). The recorded return time was 6.9 mo(median), from a study reporting on ORIF.CONCLUSION Return rates to sport for tibial plateau fractures remain limited compared to other fractures. ARIF provides the best return rates. There is limited data regarding return times to sport. Further research is required to determine return times to sport, and to improve return rates to sport, through treatment and rehabilitation optimisation.展开更多
AIM To determine the location of medial tibial plateau stress fractures and its relationship with tibial plateau morphology using magnetic resonance imaging(MRI).METHODS A retrospective review of patients with a diagn...AIM To determine the location of medial tibial plateau stress fractures and its relationship with tibial plateau morphology using magnetic resonance imaging(MRI).METHODS A retrospective review of patients with a diagnosis of stress fracture of the medial tibial plateau was performed for a 5-year period. Fourteen patients [three female and 11 male, with an average age of 36.4 years(range, 15-50 years)], who underwent knee MRI, were included. The appearance of the tibial plateau stress fracture and the geometry of the tibial plateau were reviewed and measured on MRI.RESULTS Thirteen of 14 stress fractures were linear, and one of them stellated on MRI images. The location of fractures was classified into three types. Three fractures were located anteromedially(AM type), six posteromedially(PM type), and five posteriorly(P type) at the medial tibial plateau. In addition, tibial posterior slope at the medial tibial plateau tended to be larger when the fracture was located more posteriorly on MRI.CONCLUSION We found that MRI showed three different localizations of medial tibial plateau stress fractures, which were associated with tibial posterior slope at the medial tibial plateau.展开更多
Objective: To investigate the value of 3D printing techniques in the treatment of complex tibial plateau fractures. Methods: From September 2016 to September 2018, 28 patients with complex tibial plateau fractures wer...Objective: To investigate the value of 3D printing techniques in the treatment of complex tibial plateau fractures. Methods: From September 2016 to September 2018, 28 patients with complex tibial plateau fractures were treated in our hospital. According to the odevity of hospitalized order, the patients were divided into two groups. Group A used 3D reconstruction, virtually reduction, 3D printing and demonstration of individual fracture model before operation while group B only received conventional process by use X-rays or CT image. Comparison between the two groups was made in operation time, operative blood loss, radiation frequency, surgery instrument cost and knee function score. Results: The follow-up was 14.4 months on average (ranged 6 to 22 months). There was no statistical difference of the surgery instrument cost between the 2 groups (P > 0.05). The operation time of group A was significantly shorter than that of group B (P χ2 = 0.373, P = 0.54). Conclusion: 3D printing techniques can improve surgery effect in complex tibial plateau fractures.展开更多
The classic way of treatment of tibial plateau fractures with an extensive approach, opening of the knee and compressive internal fixation can lead to major complications such as infection, skin necrosis and knee stif...The classic way of treatment of tibial plateau fractures with an extensive approach, opening of the knee and compressive internal fixation can lead to major complications such as infection, skin necrosis and knee stiffness. Here we present a less invasive and thus safer surgical technique, and its indications and results. Twenty patients with various types of fractures according to Schatzker’s classification (mainly V and VI) were treated during a time period of seven years. Surgical treatment usually consisted of a combination of percutaneous canulated screws with a hybrid external fixator. In three cases canulated screws were combined with a laterally applied anatomic locking plate. Patients were followed up for six months to three years postoperatively. Indications as well as intra and postoperative parameters such as surgical time, stability of fixation, blood loss, wound healing, infection, fracture healing and final result were studied. No major complications were recorded either early or later. The use of external οr less invasive internal fixation in combination with percutaneous canulated screws appears to be an adequate method for the treatment of most types of these fractures.展开更多
The purpose of this study was to evaluate factors that affect initiation of early postoperative range of motion (ROM) rehabilitation and to investigate whether the postoperative ROM and clinical outcomes were affected...The purpose of this study was to evaluate factors that affect initiation of early postoperative range of motion (ROM) rehabilitation and to investigate whether the postoperative ROM and clinical outcomes were affected by initiation of early ROM, immobilization and other factors. We conducted a retrospective analysis of tibial plateau fractures treated using stable internal fixation between December 2003 and June 2007. The resulting degree of flexion and Rasmussen Clinical and Radiographic Scores were evaluated. Thirty-nine patients were included, and 23 patients underwent a lateral submeniscal arthrotomy for evaluation of joint surface reduction, with 6 lateral meniscus lesions identified via arthrotomy. Three lateral collateral ligament lesions, 3 medial collateral ligament lesions and 1 anterior cruciate ligament lesion were found. Meniscus and ligament lesions significantly and negatively affected the initiation of knee joint ROM. Early ROM was achieved in 26 cases and 13 patients underwent immobilization for 4 weeks. At the final evaluation, the early ROM group had 130.42° ± 5.50° of flexion, compared with 122.92° ± 5.28° in the immobilization group. Moreover, the final Rasmussen score was 25.69 ± 2.92 in the early motion group, compared with 22.61 ± 3.5 in the immobilization group. There was no difference between radiographic scores of the groups. Although the initiation of early ROM improved the clinical results, soft tissue lesions influenced initiation of early knee joint motion. Therefore, meniscus and ligament injuries should be considered as prognostic factors in similar cases.展开更多
Increased posterior tibial slope (PTS), medial tibial plateau slope (MTPS) and lateral tibial plateau slope (LTPS) have been proposed as potential risk factors for anterior cruciate ligament (ACL) tear. However, prior...Increased posterior tibial slope (PTS), medial tibial plateau slope (MTPS) and lateral tibial plateau slope (LTPS) have been proposed as potential risk factors for anterior cruciate ligament (ACL) tear. However, prior literature is inconclusive. The primary goal of the study was to investigate the relationship of MTPS, LTPS and PTS with ACL tears. The secondary goal was to determine whether injury mechanisms, age, gender, tobacco, obesity, extreme PTS (>12<span style="font-family:;" "=""><span style="font-family:Verdana;"><span style="color:#111111;font-family:Roboto, sans-serif;font-size:16px;white-space:normal;background-color:#FFFFFF;">°</span></span><span style="font-family:Verdana;">) or previous injuries are risk factors in ACL tears. Three groups were identified: a study group of patients with ACL injury;a second group diagnosed with meniscal injury;and a third group of non-injured patients. Demographic data was collected</span></span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;"> MTPS and LTPS were measured in MRI and PTS in lateral radiographs by two blinded observers. Data was analyzed using SPSS. 416 patients were included in the study. MTPS ranged from 0</span><span style="font-family:;" "=""><span style="font-family:Verdana;"><span style="color:#111111;font-family:Roboto, sans-serif;font-size:16px;white-space:normal;background-color:#FFFFFF;">°</span></span><span style="font-family:Verdana;"> to 14</span><span style="font-family:Verdana;"><span style="color:#111111;font-family:Roboto, sans-serif;font-size:16px;white-space:normal;background-color:#FFFFFF;">°</span></span><span style="font-family:Verdana;"> (average value 5.66 ± 2.98), LTSA 0</span><span style="font-family:Verdana;"><span style="color:#111111;font-family:Roboto, sans-serif;font-size:16px;white-space:normal;background-color:#FFFFFF;">°</span></span><span style="font-family:Verdana;"> to 16</span><span style="font-family:Verdana;"><span style="color:#111111;font-family:Roboto, sans-serif;font-size:16px;white-space:normal;background-color:#FFFFFF;">°</span></span><span style="font-family:Verdana;"> (5.69 ± 3.5) and PTS 0</span><span style="font-family:Verdana;"><span style="color:#111111;font-family:Roboto, sans-serif;font-size:16px;white-space:normal;background-color:#FFFFFF;">°</span></span><span style="font-family:Verdana;"> to 17</span><span style="font-family:Verdana;"><span style="color:#111111;font-family:Roboto, sans-serif;font-size:16px;white-space:normal;background-color:#FFFFFF;">°</span></span><span><span style="font-family:Verdana;"> (6.75 ± 3.18). Neither MTPS, LTPS nor PTS revealed increased risk of ACL tears related with higher slopes, although high MTPS showed a decreased </span><span style="font-family:Verdana;">risk. However, when comparing traumatic groups, extreme PTS w</span></span></span><span style="font-family:Verdana;">as</span><span style="font-family:Verdana;"> associated with LCA tear, but no differences were found when comparing non-traumatic</span><span style="font-family:Verdana;"> groups. This could mean that the importance of extreme angles in the LCA rupture may be restricted to traumatic mechanisms. Previous ACL tear was identified as a risk factor to ACL tear;increased age and a traumatic mechanism were associated with a lower risk.</span>展开更多
Mechanical traction and percutaneous reduction by leverage and fixation by a bilateral groove externalfixator were performed on 23 patients with complex tibial plateau fractures involving a depressed and splitfragment...Mechanical traction and percutaneous reduction by leverage and fixation by a bilateral groove externalfixator were performed on 23 patients with complex tibial plateau fractures involving a depressed and splitfragments. The fixator is composed of two long groove frames, three to five nuts, hooked bolts and Stein-manns pins.All fractures united in good position in three months with no incision (only pinpricks), llttle operativetrauma and no significant complications but pintract infection, and the flexion-extension range of kneemovement was excllent in all patients, so that this technique is particularly advisable for complex tibialplateau fractures.展开更多
Background:Internal tibial loading is influenced by modifiable factors with implications for the risk of stress injury.Runners encounter varied surface steepness(gradients)when running outdoors and may adapt their spe...Background:Internal tibial loading is influenced by modifiable factors with implications for the risk of stress injury.Runners encounter varied surface steepness(gradients)when running outdoors and may adapt their speed according to the gradient.This study aimed to quantify tibial bending moments and stress at the anterior and posterior peripheries when running at different speeds on surfaces of different gradients.Methods:Twenty recreational runners ran on a treadmill at 3 different speeds(2.5 m/s,3.0 m/s,and 3.5 m/s)and gradients(level:0%;uphill:+5%,+10%,and+15%;downhill:-5%,-10%,and-15%).Force and marker data were collected synchronously throughout.Bending moments were estimated at the distal third centroid of the tibia about the medial-lateral axis by ensuring static equilibrium at each 1%of stance.Stress was derived from bending moments at the anterior and posterior peripheries by modeling the tibia as a hollow ellipse.Two-way repeated-measures analysis of variance were conducted using both functional and discrete statistical analyses.Results:There were significant main effects for running speed and gradient on peak bending moments and peak anterior and posterior stress.Higher running speeds resulted in greater tibial loading.Running uphill at+10%and+15%resulted in greater tibial loading than level running.Running downhill at-10%and-15%resulted in reduced tibial loading compared to level running.There was no difference between+5%or-5%and level running.Conclusion:Running at faster speeds and uphill on gradients≥+10%increased internal tibial loading,whereas slower running and downhill running on gradients≥-10%reduced internal loading.Adapting running speed according to the gradient could be a protective mechanism,providing runners with a strategy to minimize the risk of tibial stress injuries.展开更多
The article presents the composition and current state of poisonous plants distributed on the Ustyurt plateau. Ustyurt is one of the largest deserts in Central Asia, differing from other deserts of the world in geogra...The article presents the composition and current state of poisonous plants distributed on the Ustyurt plateau. Ustyurt is one of the largest deserts in Central Asia, differing from other deserts of the world in geographical location, relief, flora and fauna and other features. The territory of Ustyurt occupies 21.3 million hectares, of which the Karakalpak part accounts for 7.2 million hectares. Poisonous alkaloid-bearing plants of the Karakalpak part of the Ustyurt plateau Anabasis aphylla, Atriplex flabellum, Kalidium capsicum, Salsola arbusculaeformis, Salsola foliosa, Aellenia subaphylla, Anabasis brachiata, Rheum tataricum, Capparis spinosa, Glycyrrhiza aspera. Alkaloid-bearing plants that are not eaten or poorly eaten by cattle Ephedra distachya, Delphinium songaricum, Anabasis salsa, alkaloid-bearing plants eaten by animals without harm Carex physodes, Eremopyrum orientale, Agrophyllum repens, Astragalus amodendron, Astragalus villosissimus, species of the genera Calligonum, Salsola. Poisonous plants of the Karakalpak part of the Ustyurt plateau. An analysis of the pasture flora of the Karakalpak part of the Ustyurt plateau shows that 62 species of wild poisonous plants belonging to 49 genera and 19 families grow here. Although these plants are considered poisonous, but in modern pharmaceutics and medicine, they are used as medicinal.展开更多
Existing studies contend that latent heating(LH)will replace sensible heating(SH)to become the dominant factor affecting the development of the Tibetan Plateau vortex(TPV)after it moves off the Tibetan Plateau(TP).How...Existing studies contend that latent heating(LH)will replace sensible heating(SH)to become the dominant factor affecting the development of the Tibetan Plateau vortex(TPV)after it moves off the Tibetan Plateau(TP).However,in the process of the TPV moving off the TP requires that the airmass traverse the eastern slope of the Tibetan Plateau(ESTP)where the topography and diabatic heating(DH)conditions rapidly change.How LH gradually replaces SH to become the dominant factor in the development of the TPV over the ESTP is still not very clear.In this paper,an analysis of a typical case of a TPV with a long life history over the ESTP is performed by using multi-sourced meteorological data and model simulations.The results show that SH from the TP surface can change the TPV-associated precipitation distribution by temperature advection after the TPV moves off the TP.The LH can then directly promote the development of the TPV and has a certain guiding effect on the track of the TPV.The SH can control the active area of LH by changing the falling area of the TPV-associated precipitation,so it still plays a key role in the development and tracking of the TPV even though it has moved out of the main body of the TP.展开更多
Tibial pilon fractures are rare injuries most often associated with soft tissue injuries, occurring during high-energy trauma. Surgical treatment represents the therapy of choice and must ensure anatomical reconstruct...Tibial pilon fractures are rare injuries most often associated with soft tissue injuries, occurring during high-energy trauma. Surgical treatment represents the therapy of choice and must ensure anatomical reconstruction of the joint surface while respecting the surrounding tissues. The evolution of our results showed a majority of good functional clinical radio results by the open treatment which showed its superiority compared to the closed treatment and the combined treatment.展开更多
The spring snow cover(SC)over the western Tibetan Plateau(TP)(TPSC)(W_TPSC)and eastern TPSC(E_TPSC)have displayed remarkable decreasing and increasing trends,respectively,during 1985–2020.The current work investigate...The spring snow cover(SC)over the western Tibetan Plateau(TP)(TPSC)(W_TPSC)and eastern TPSC(E_TPSC)have displayed remarkable decreasing and increasing trends,respectively,during 1985–2020.The current work investigates the possible mechanisms accounting for these distinct TPSC changes.Our results indicate that the decrease in W_TPSC is primarily attributed to rising temperatures,while the increase in E_TPSC is closely linked to enhanced precipitation.Local circulation analysis shows that the essential system responsible for the TPSC changes is a significant anticyclonic system centered over the northwestern TP.The anomalous descending motion and adiabatic heating linked to this anticyclone leads to warmer temperatures and consequent snowmelt over the western TP.Conversely,anomalous easterly winds along the southern flank of this anticyclone serve to transport additional moisture from the North Pacific,leading to an increase in snowfall over the eastern TP.Further analysis reveals that the anomalous anticyclone is associated with an atmospheric wave pattern that originates from upstream regions.Springtime warming of the subtropical North Atlantic(NA)sea surface temperature(SST)induces an atmospheric pattern resembling a wave train that travels eastward across the Eurasian continent before reaching the TP.Furthermore,the decline in winter sea ice(SIC)over the Barents Sea exerts a persistent warming influence on the atmosphere,inducing an anomalous atmospheric circulation that propagates southeastward and strengthens the northwest TP anticyclone in spring.Additionally,an enhancement of subtropical stationary waves has resulted in significant increases in easterly moisture fluxes over the coastal areas of East Asia,which further promotes more snowfall over eastern TP.展开更多
Introduction: Synovial cyst of the tibial tunnel in connection with anterior cruciate ligament (ACL) reconstruction is a rare but particularly troublesome complication. Medical treatment is often doomed to failure, an...Introduction: Synovial cyst of the tibial tunnel in connection with anterior cruciate ligament (ACL) reconstruction is a rare but particularly troublesome complication. Medical treatment is often doomed to failure, and surgical treatment usually consists of excising the cyst and filling the tunnel with bone. The aim of this study was to evaluate the results of filling the tunnel with acrylic cement. Hypothesis: Filling the tibial bone tunnel with acrylic cement should eliminate communication between the joint cavity and the pre-tibial surface and prevent cyst recurrence. Patients and Methods: This retrospective series is composed of 13 patients, 9 men and 4 women, mean age 48.5 years (31 to 64) operated on between 2011 and 2019 for an intra- and extraosseous synovial cyst consecutive to the tibial tunnel of an ACL graft. Between 1983 and 2016, 12 of the patients had had a bone graft without bone block fixation (DI-DT or Mac Intosh) and one patient, a bone-bone transplant (KJ). The cyst was of variable size, located on the anteromedial aspect of the proximal end of the tibia, and often painful, warranting consultation. At the time of the initial operation, 9 patients had undergone meniscectomies (6 medial, 2 lateral, 1 double). In 7 knees, there were 7 cartilage lesions in the femorotibial and/or patellofemoral compartments (one stage 1 lesion, 2 stage 2 lesions, 4 stage 3 lesions, and no stage 4 lesions). Only 2 knees had neither cartilage nor meniscus lesions. After curettage of the bone tunnel /− removal of the non-resorbed or PEEK interference screw, the tunnel was filled with acrylic cement /− reinforced with a ligament staple to prevent expulsion. All patients underwent regular follow-up consultations until recovery. Results: At a maximum follow-up of 8 years, only 1 cyst recurred, representing a 7.69% failure rate. It was reoperated with another technique, which involved filling the tibial bone tunnel with bone graft taken from a half-bank head. After recovery, the cyst healed definitively. All patients were able to return to their previous activity within 15 days of surgery. Conclusion: Filling the tibial tunnel with acrylic cement reinforced /− with a ligament staple is a reliable and rapid solution for the treatment of intra- and extra-articular synovial cysts in relation to the tibial tunnel of ACL grafts.展开更多
In recent years, lakes on the Qinghai-Tibet Plateau have become more responsive to climate change. In September 2011, Zonag Lake in Hoh Xil experienced sudden drainage, the water eventually flowed into Yanhu Lake, whi...In recent years, lakes on the Qinghai-Tibet Plateau have become more responsive to climate change. In September 2011, Zonag Lake in Hoh Xil experienced sudden drainage, the water eventually flowed into Yanhu Lake, which caused Yanhu Lake to continue to expand. The potential collapse of Yanhu Lake could directly threaten the operational safety of the adjacent Qinghai-Tibet Highway, Qinghai-Tibet Railway. To explore the implications of expanding lakes on the surrounding permafrost, we selected Hoh Xil Yanhu Lake on the Qinghai-Tibet Plateau to study the effect of lake expansion on permafrost degradation. The permafrost degradation in the Yanhu Lake basin from October 2017 to December 2022 was inverted using Sentinel-1 satellite image data and small baseline subset interferometry synthetic aperture radar(SBAS-In SAR) technology. Additionally, permafrost degradation from February 2007 and February 2010 was analyzed using advanced land observing satellite phased array-type L-band synthetic aperture radar(ALOS PALSAR) satellite images and differential interferometric synthetic aperture radar(D-In SAR) technique. The results showed that the permafrost around Yanhu Lake experienced accelerated degradation. Prior to the expansion of Yanhu Lake, the average annual deformation rate along the line of sight(LOS) direction was 6.7 mm/yr. After the expansion, the rate increased to 20.9 mm/yr. The integration of spatial-temporal distribution maps of surface subsidence, Wudaoliang borehole geothermal data, meteorological data, Yanhu Lake surface area changes, and water level changes supports the assertion that the intensified permafrost degradation could be attributed to lake expansion rather than the rising air temperature. Furthermore, permafrost degradation around Yanhu Lake could impact vital infrastructure such as the adjacent Qinghai-Tibet Highway and Qinghai-Tibet Railway.展开更多
To analyse the effectiveness of performing a transverse tibial bone graft in the treatment of patients with diabetic foot. We retrospectively analysed the clinical details of 51 diabetic foot patients in our hospital ...To analyse the effectiveness of performing a transverse tibial bone graft in the treatment of patients with diabetic foot. We retrospectively analysed the clinical details of 51 diabetic foot patients in our hospital from February 2023 to February 2024 and divided them into two groups according to the different treatment modalities, in which the control group received open debridement and the treatment group received transverse tibial bone transfer and compared the differences between the two groups. There were large differences in VAS score, Toronto Clinical Symptom Score, quality of life score, internal lumen diameter, blood flow velocity in the affected limb, perfusion volume, vascular endothelial growth factor, epidermal growth factor and CRP between the two groups after surgery (P < 0.05). Patients with diabetic foot should be treated with transverse tibial bone grafting, which is safer and more effective and can have a significant impact on improving the status of the affected limb, the inflammation and the patient’s quality of life.展开更多
基金the National Natural Science Foundation of China(No.81672155).
文摘Objective This study aimed to investigate the correlation between the surface area ratio of medial tibial plateau(MTP)to lateral tibial plateau(LTP)and the mechanical tibiofemoral angle(mTFA).Methods Lower limb computed tomography(CT)images were collected at our hospital.Then,the original CT data were analyzed and reconstructed using medical image processing software.The proximal and distal centres of the femur and tibia were marked.The surface areas of MTP and LTP were identified using image processing software.GraphPad Prism 8.0.2 was used to perform the statistical analysis.Results The surface area ratio of MTP to LTP was significantly correlated with the mTFA in all patients(P<0.0001),male group(P<0.0001),female group(P<0.0001),varus group(P<0.0001),and valgus group(P=0.002).Furthermore,the surface area of MTP and LTP was significantly greater in the male group than in the female group(P<0.0001).There was significant difference in the surface area of the MTP between the varus and valgus groups(P<0.0001).Significant difference was also observed in the surface area ratio of MTP to LTP between the varus and valgus groups(P<0.0001).Conclusion The surface area ratio of MTP to LTP was correlated with the mTFA.Within a certain range,the smaller the mTFA,the greater the surface area ratio of MTP to LTP.For patients undergoing total knee arthroplasty,of whom the surface area of the MTP was basically equal to that of the LTP,it is recommended that the osteotomy should be performed in accordance with mechanical alignment standards,and that a symmetrical tibial plateau prosthesis should be used.For patients whose surface area of MTP is significantly greater than that of the LTP,it is recommended that the osteotomy should be performed in accordance with kinematic alignment standards,and that an anatomical tibial plateau prosthesis should be used.
文摘Complex tibial plateau fractures can seriously affect quality of life and physical and mental health of patients.The anatomical relationship between the proximal tibial bone and soft tissue is complex,resulting in different types of tibial plateau fractures.Violent trauma can lead to displaced fracture,serious soft tissue injury,and potentially,dislocation of the knee joint.Therefore,tibial plateau fractures are extremely unstable.AIM To assess the use of locking compression plate(LCP)+T-type steel plate for postoperative weight bearing and functional recovery of complex tibial plateau fractures.METHODS Ninety-seven patients with complex tibial plateau fractures who underwent surgery at our hospital were selected for retrospective study.Forty-nine patients had been treated with LCP+T-type steel plate limited internal fixation(study group),and 48 patients with bilateral ordinary steel plate support(control group).The operation process index,postoperative rehabilitation related index,Rasmussen score of the knee joint,tibial plateau varus angle(TPA),tibial plateau retroversion angle(PA),and surgical complications of the two groups were compared.RESULTS The operation time and intraoperative bone graft volume in the study group were lower than those in the control group(P<0.05).There were no significant differences in surgical bleeding,anterior external incision length,postoperative drainage,hospital stay duration,and fracture healing time between the groups(P>0.05).There was no significant difference in the TPA and PA angle between the groups immediately and 18 mo after surgery(P>0.05).At 12 mo after surgery,the Rasmussen scale score was higher in the study group than in the control group(P<0.05).There was no significant difference in the Rasmussen scale score at 18 mo after surgery,and the radiology score at 12 and 18 mo after surgery,between the two groups(P>0.05).The postoperative complication rate in the study group(3.77%)was lower than that in the control group(15.09%;P<0.05).CONCLUSION LCP+T-type steel plate internal fixation has advantages in terms of minimizing trauma and enabling early postoperative functional exercise,promoting functional recovery and lower limb weight-bearing,and reducing postoperative complications.
基金supported by the National Natural Science Foundation of China(No.81974355 and No.82172525).
文摘Objective:To explore a new artificial intelligence(AI)-aided method to assist the clinical diagnosis of tibial plateau fractures(TPFs)and further measure its validity and feasibility.Methods:A total of 542 X-rays of TPFs were collected as a reference database.An AI algorithm(RetinaNet)was trained to analyze and detect TPF on the X-rays.The ability of the AI algorithm was determined by indexes such as detection accuracy and time taken for analysis.The algorithm performance was also compared with orthopedic physicians.Results:The AI algorithm showed a detection accuracy of 0.91 for the identification of TPF,which was similar to the performance of orthopedic physicians(0.92±0.03).The average time spent for analysis of the AI was 0.56 s,which was 16 times faster than human performance(8.44±3.26 s).Conclusion:The AI algorithm is a valid and efficient method for the clinical diagnosis of TPF.It can be a useful assistant for orthopedic physicians,which largely promotes clinical workflow and further guarantees the health and security of patients.
文摘Introduction: Tibial plateau fractures are solutions of continuity of the epiphyseal-metaphyseal block of the upper end of the tibia of which at least one line enters the joint. They threaten the stability and mobility of the knee and can compromise walking and standing. These fractures are on the increase, especially affecting young and active subjects. Orthopedic treatment is a rare indication apart from non-displaced or slightly displaced forms. Surgical treatment is required in displaced forms, particularly in depression fractures. The aim of this work was to report the lesional and therapeutic aspects of tibial plateau fractures in our department. Patients and Method: Patients and method: This was a retrospective study over 36 months from January 2019 to December 2021. Included in this study were patients treated for a tibial plateau fracture in our department and followed up for at least 10 months. The epidemiological and clinical data analyzed were age, sex, affected side, etiology, mechanism of injury, pathological anatomy and associated lesions. The fractures were classified according to the classification of Duparc and Ficat. The slightly or non-displaced forms were treated orthopedically while the displaced forms were treated surgically. The minimum follow-up was 10 months. The results were evaluated by the anatomical criteria according to Mazas and Duparc and functional according to Merle d’Aubigné. Results: The authors collected 71 cases of tibial plateau fractures. They accounted for 4.0% of all limb fractures, 5.8% of lower limb fractures and 33.8% of knee fractures in our service. The male sex was the most represented at 78.9% with a sex ratio of 3.7. The age group of [20 - 40] years was the most affected, i.e., 53.5%. The average age was 41 years with extremes of 17 and 82 years. The left side was affected (n = 47) and the right side (n = 24). Road traffic accident was the main cause. The mechanism of injury was mainly represented by lateral and sagittal compressions. Lateral unituberosity and bi-tuberosity fractures were the most frequent pathological types in our series, respectively 42.2% and 28.2%. The associated lesions were mainly represented by bone, ligament, skin and neurological lesions. The treatment was orthopedic in 52.1% and surgical in 47.9%. According to the functional criteria of PMA, our results were very good and good at 77.4%, Average at 14.1% and poor at 8.5%. Conclusion: It appears in this study that fractures of the tibial plateaus are frequent and serious because of their articular nature. Lateral and sagittal compressions are the most evoked injury mechanisms. Lateral unituberosity and bituberosity fractures are the most frequent pathological types. Functional and anatomical results are significantly better with surgical treatment.
文摘The management of a combination of fracture and multiligament knee injury(MKI) in traumatic knee injury remains controversial, and there are evolving treatment recommendations. Currently, there are no studies focusing on older adult patients with MKI's in combination with tibia fractures. As a result, there is no well-established treatment algorithm for older adult patients with these complex injuries. We report two cases of MKI's with concomitant fractures in patients fifty years of age or older. Both patients were treated surgically for their associated tibial plateau fractures, but were managed with conservative treatment of the multiligamentous knee injuries. We also provide a review of the literature and guidelines for older adult patients with these types of complex traumatic injuries. Early to mid term acceptable outcomes were achieved for both patients through surgical fixation of the tibial plateau fracture and conservative treatment of the ligament injuries. We propose a comprehensive treatment algorithm for management of these complex injuries.
文摘AIM To systemically review all studies reporting return to sport following tibial plateau fracture, in order to provide information on return rates and times to sport, and to assess variations in sporting outcome for different treatment methods.METHODS A systematic search of CINAHAL, Cochrane, EMBASE, Google Scholar, MEDLINE, PEDro, Scopus, SPORTDiscus and Web of Science was performed in January 2017 using the keywords "tibial", "plateau", "fractures", "knee", "athletes", "sports", "non-operative", "conservative", "operative", "return to sport". All studies which recorded return rates and times to sport following tibial plateau fractures were included. RESULTS Twenty-seven studies were included: 1 was a randomised controlled trial, 7 were prospective cohort studies, 16 were retrospective cohort studies, 3 were case series. One study reported on the outcome of conservative management(n = 3); 27 reported on the outcome of surgical management(n = 917). Nine studies reported on Open Reduction Internal Fixation(ORIF)(n = 193), 11 on Arthroscopic-Assisted Reduction Internal Fixation(ARIF)(n = 253) and 7 on Frame-Assisted Fixation(FRAME)(n = 262). All studies recorded "return to sport"rates. Only one study recorded a "return to sport" time. The return rate to sport for the total cohort was 70%. For the conservatively-managed fractures, the return rate was 100%. For the surgically-managed fractures, the return rate was 70%. For fractures managed with ORIF, the return rate was 60%. For fractures managed with ARIF, the return rate was 83%. For fractures managed with FRAME was 52%. The return rate for ARIF was found to be significantly greater than that for ORIF(OR 3.22, 95%CI: 2.09-4.97, P < 0.001) and for FRAME(OR 4.33, 95%CI: 2.89-6.50, P < 0.001). No difference was found between the return rates for ORIF and FRAME(OR 1.35, 95%CI: 0.92-1.96, P = 0.122). The recorded return time was 6.9 mo(median), from a study reporting on ORIF.CONCLUSION Return rates to sport for tibial plateau fractures remain limited compared to other fractures. ARIF provides the best return rates. There is limited data regarding return times to sport. Further research is required to determine return times to sport, and to improve return rates to sport, through treatment and rehabilitation optimisation.
文摘AIM To determine the location of medial tibial plateau stress fractures and its relationship with tibial plateau morphology using magnetic resonance imaging(MRI).METHODS A retrospective review of patients with a diagnosis of stress fracture of the medial tibial plateau was performed for a 5-year period. Fourteen patients [three female and 11 male, with an average age of 36.4 years(range, 15-50 years)], who underwent knee MRI, were included. The appearance of the tibial plateau stress fracture and the geometry of the tibial plateau were reviewed and measured on MRI.RESULTS Thirteen of 14 stress fractures were linear, and one of them stellated on MRI images. The location of fractures was classified into three types. Three fractures were located anteromedially(AM type), six posteromedially(PM type), and five posteriorly(P type) at the medial tibial plateau. In addition, tibial posterior slope at the medial tibial plateau tended to be larger when the fracture was located more posteriorly on MRI.CONCLUSION We found that MRI showed three different localizations of medial tibial plateau stress fractures, which were associated with tibial posterior slope at the medial tibial plateau.
文摘Objective: To investigate the value of 3D printing techniques in the treatment of complex tibial plateau fractures. Methods: From September 2016 to September 2018, 28 patients with complex tibial plateau fractures were treated in our hospital. According to the odevity of hospitalized order, the patients were divided into two groups. Group A used 3D reconstruction, virtually reduction, 3D printing and demonstration of individual fracture model before operation while group B only received conventional process by use X-rays or CT image. Comparison between the two groups was made in operation time, operative blood loss, radiation frequency, surgery instrument cost and knee function score. Results: The follow-up was 14.4 months on average (ranged 6 to 22 months). There was no statistical difference of the surgery instrument cost between the 2 groups (P > 0.05). The operation time of group A was significantly shorter than that of group B (P χ2 = 0.373, P = 0.54). Conclusion: 3D printing techniques can improve surgery effect in complex tibial plateau fractures.
文摘The classic way of treatment of tibial plateau fractures with an extensive approach, opening of the knee and compressive internal fixation can lead to major complications such as infection, skin necrosis and knee stiffness. Here we present a less invasive and thus safer surgical technique, and its indications and results. Twenty patients with various types of fractures according to Schatzker’s classification (mainly V and VI) were treated during a time period of seven years. Surgical treatment usually consisted of a combination of percutaneous canulated screws with a hybrid external fixator. In three cases canulated screws were combined with a laterally applied anatomic locking plate. Patients were followed up for six months to three years postoperatively. Indications as well as intra and postoperative parameters such as surgical time, stability of fixation, blood loss, wound healing, infection, fracture healing and final result were studied. No major complications were recorded either early or later. The use of external οr less invasive internal fixation in combination with percutaneous canulated screws appears to be an adequate method for the treatment of most types of these fractures.
文摘The purpose of this study was to evaluate factors that affect initiation of early postoperative range of motion (ROM) rehabilitation and to investigate whether the postoperative ROM and clinical outcomes were affected by initiation of early ROM, immobilization and other factors. We conducted a retrospective analysis of tibial plateau fractures treated using stable internal fixation between December 2003 and June 2007. The resulting degree of flexion and Rasmussen Clinical and Radiographic Scores were evaluated. Thirty-nine patients were included, and 23 patients underwent a lateral submeniscal arthrotomy for evaluation of joint surface reduction, with 6 lateral meniscus lesions identified via arthrotomy. Three lateral collateral ligament lesions, 3 medial collateral ligament lesions and 1 anterior cruciate ligament lesion were found. Meniscus and ligament lesions significantly and negatively affected the initiation of knee joint ROM. Early ROM was achieved in 26 cases and 13 patients underwent immobilization for 4 weeks. At the final evaluation, the early ROM group had 130.42° ± 5.50° of flexion, compared with 122.92° ± 5.28° in the immobilization group. Moreover, the final Rasmussen score was 25.69 ± 2.92 in the early motion group, compared with 22.61 ± 3.5 in the immobilization group. There was no difference between radiographic scores of the groups. Although the initiation of early ROM improved the clinical results, soft tissue lesions influenced initiation of early knee joint motion. Therefore, meniscus and ligament injuries should be considered as prognostic factors in similar cases.
文摘Increased posterior tibial slope (PTS), medial tibial plateau slope (MTPS) and lateral tibial plateau slope (LTPS) have been proposed as potential risk factors for anterior cruciate ligament (ACL) tear. However, prior literature is inconclusive. The primary goal of the study was to investigate the relationship of MTPS, LTPS and PTS with ACL tears. The secondary goal was to determine whether injury mechanisms, age, gender, tobacco, obesity, extreme PTS (>12<span style="font-family:;" "=""><span style="font-family:Verdana;"><span style="color:#111111;font-family:Roboto, sans-serif;font-size:16px;white-space:normal;background-color:#FFFFFF;">°</span></span><span style="font-family:Verdana;">) or previous injuries are risk factors in ACL tears. Three groups were identified: a study group of patients with ACL injury;a second group diagnosed with meniscal injury;and a third group of non-injured patients. Demographic data was collected</span></span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;"> MTPS and LTPS were measured in MRI and PTS in lateral radiographs by two blinded observers. Data was analyzed using SPSS. 416 patients were included in the study. MTPS ranged from 0</span><span style="font-family:;" "=""><span style="font-family:Verdana;"><span style="color:#111111;font-family:Roboto, sans-serif;font-size:16px;white-space:normal;background-color:#FFFFFF;">°</span></span><span style="font-family:Verdana;"> to 14</span><span style="font-family:Verdana;"><span style="color:#111111;font-family:Roboto, sans-serif;font-size:16px;white-space:normal;background-color:#FFFFFF;">°</span></span><span style="font-family:Verdana;"> (average value 5.66 ± 2.98), LTSA 0</span><span style="font-family:Verdana;"><span style="color:#111111;font-family:Roboto, sans-serif;font-size:16px;white-space:normal;background-color:#FFFFFF;">°</span></span><span style="font-family:Verdana;"> to 16</span><span style="font-family:Verdana;"><span style="color:#111111;font-family:Roboto, sans-serif;font-size:16px;white-space:normal;background-color:#FFFFFF;">°</span></span><span style="font-family:Verdana;"> (5.69 ± 3.5) and PTS 0</span><span style="font-family:Verdana;"><span style="color:#111111;font-family:Roboto, sans-serif;font-size:16px;white-space:normal;background-color:#FFFFFF;">°</span></span><span style="font-family:Verdana;"> to 17</span><span style="font-family:Verdana;"><span style="color:#111111;font-family:Roboto, sans-serif;font-size:16px;white-space:normal;background-color:#FFFFFF;">°</span></span><span><span style="font-family:Verdana;"> (6.75 ± 3.18). Neither MTPS, LTPS nor PTS revealed increased risk of ACL tears related with higher slopes, although high MTPS showed a decreased </span><span style="font-family:Verdana;">risk. However, when comparing traumatic groups, extreme PTS w</span></span></span><span style="font-family:Verdana;">as</span><span style="font-family:Verdana;"> associated with LCA tear, but no differences were found when comparing non-traumatic</span><span style="font-family:Verdana;"> groups. This could mean that the importance of extreme angles in the LCA rupture may be restricted to traumatic mechanisms. Previous ACL tear was identified as a risk factor to ACL tear;increased age and a traumatic mechanism were associated with a lower risk.</span>
文摘Mechanical traction and percutaneous reduction by leverage and fixation by a bilateral groove externalfixator were performed on 23 patients with complex tibial plateau fractures involving a depressed and splitfragments. The fixator is composed of two long groove frames, three to five nuts, hooked bolts and Stein-manns pins.All fractures united in good position in three months with no incision (only pinpricks), llttle operativetrauma and no significant complications but pintract infection, and the flexion-extension range of kneemovement was excllent in all patients, so that this technique is particularly advisable for complex tibialplateau fractures.
文摘Background:Internal tibial loading is influenced by modifiable factors with implications for the risk of stress injury.Runners encounter varied surface steepness(gradients)when running outdoors and may adapt their speed according to the gradient.This study aimed to quantify tibial bending moments and stress at the anterior and posterior peripheries when running at different speeds on surfaces of different gradients.Methods:Twenty recreational runners ran on a treadmill at 3 different speeds(2.5 m/s,3.0 m/s,and 3.5 m/s)and gradients(level:0%;uphill:+5%,+10%,and+15%;downhill:-5%,-10%,and-15%).Force and marker data were collected synchronously throughout.Bending moments were estimated at the distal third centroid of the tibia about the medial-lateral axis by ensuring static equilibrium at each 1%of stance.Stress was derived from bending moments at the anterior and posterior peripheries by modeling the tibia as a hollow ellipse.Two-way repeated-measures analysis of variance were conducted using both functional and discrete statistical analyses.Results:There were significant main effects for running speed and gradient on peak bending moments and peak anterior and posterior stress.Higher running speeds resulted in greater tibial loading.Running uphill at+10%and+15%resulted in greater tibial loading than level running.Running downhill at-10%and-15%resulted in reduced tibial loading compared to level running.There was no difference between+5%or-5%and level running.Conclusion:Running at faster speeds and uphill on gradients≥+10%increased internal tibial loading,whereas slower running and downhill running on gradients≥-10%reduced internal loading.Adapting running speed according to the gradient could be a protective mechanism,providing runners with a strategy to minimize the risk of tibial stress injuries.
文摘The article presents the composition and current state of poisonous plants distributed on the Ustyurt plateau. Ustyurt is one of the largest deserts in Central Asia, differing from other deserts of the world in geographical location, relief, flora and fauna and other features. The territory of Ustyurt occupies 21.3 million hectares, of which the Karakalpak part accounts for 7.2 million hectares. Poisonous alkaloid-bearing plants of the Karakalpak part of the Ustyurt plateau Anabasis aphylla, Atriplex flabellum, Kalidium capsicum, Salsola arbusculaeformis, Salsola foliosa, Aellenia subaphylla, Anabasis brachiata, Rheum tataricum, Capparis spinosa, Glycyrrhiza aspera. Alkaloid-bearing plants that are not eaten or poorly eaten by cattle Ephedra distachya, Delphinium songaricum, Anabasis salsa, alkaloid-bearing plants eaten by animals without harm Carex physodes, Eremopyrum orientale, Agrophyllum repens, Astragalus amodendron, Astragalus villosissimus, species of the genera Calligonum, Salsola. Poisonous plants of the Karakalpak part of the Ustyurt plateau. An analysis of the pasture flora of the Karakalpak part of the Ustyurt plateau shows that 62 species of wild poisonous plants belonging to 49 genera and 19 families grow here. Although these plants are considered poisonous, but in modern pharmaceutics and medicine, they are used as medicinal.
基金supported by the National Natural Science Foundation of China(Grant Nos.42175002,42030611,42075013)the Natural Science Foundation of Sichuan,China(Grant No.2023NSFSC0242)the Innovation Team Fund of Southwest Regional Meteorological Center,China Meteorological Administration(Grant No.XNQYCXTD-202202)。
文摘Existing studies contend that latent heating(LH)will replace sensible heating(SH)to become the dominant factor affecting the development of the Tibetan Plateau vortex(TPV)after it moves off the Tibetan Plateau(TP).However,in the process of the TPV moving off the TP requires that the airmass traverse the eastern slope of the Tibetan Plateau(ESTP)where the topography and diabatic heating(DH)conditions rapidly change.How LH gradually replaces SH to become the dominant factor in the development of the TPV over the ESTP is still not very clear.In this paper,an analysis of a typical case of a TPV with a long life history over the ESTP is performed by using multi-sourced meteorological data and model simulations.The results show that SH from the TP surface can change the TPV-associated precipitation distribution by temperature advection after the TPV moves off the TP.The LH can then directly promote the development of the TPV and has a certain guiding effect on the track of the TPV.The SH can control the active area of LH by changing the falling area of the TPV-associated precipitation,so it still plays a key role in the development and tracking of the TPV even though it has moved out of the main body of the TP.
文摘Tibial pilon fractures are rare injuries most often associated with soft tissue injuries, occurring during high-energy trauma. Surgical treatment represents the therapy of choice and must ensure anatomical reconstruction of the joint surface while respecting the surrounding tissues. The evolution of our results showed a majority of good functional clinical radio results by the open treatment which showed its superiority compared to the closed treatment and the combined treatment.
基金This research is funded by the National Natural Science Foundation of China(Grant No.42075050)Fundamental Research Funds for the Central Universities(Grant No.K20220232).
文摘The spring snow cover(SC)over the western Tibetan Plateau(TP)(TPSC)(W_TPSC)and eastern TPSC(E_TPSC)have displayed remarkable decreasing and increasing trends,respectively,during 1985–2020.The current work investigates the possible mechanisms accounting for these distinct TPSC changes.Our results indicate that the decrease in W_TPSC is primarily attributed to rising temperatures,while the increase in E_TPSC is closely linked to enhanced precipitation.Local circulation analysis shows that the essential system responsible for the TPSC changes is a significant anticyclonic system centered over the northwestern TP.The anomalous descending motion and adiabatic heating linked to this anticyclone leads to warmer temperatures and consequent snowmelt over the western TP.Conversely,anomalous easterly winds along the southern flank of this anticyclone serve to transport additional moisture from the North Pacific,leading to an increase in snowfall over the eastern TP.Further analysis reveals that the anomalous anticyclone is associated with an atmospheric wave pattern that originates from upstream regions.Springtime warming of the subtropical North Atlantic(NA)sea surface temperature(SST)induces an atmospheric pattern resembling a wave train that travels eastward across the Eurasian continent before reaching the TP.Furthermore,the decline in winter sea ice(SIC)over the Barents Sea exerts a persistent warming influence on the atmosphere,inducing an anomalous atmospheric circulation that propagates southeastward and strengthens the northwest TP anticyclone in spring.Additionally,an enhancement of subtropical stationary waves has resulted in significant increases in easterly moisture fluxes over the coastal areas of East Asia,which further promotes more snowfall over eastern TP.
文摘Introduction: Synovial cyst of the tibial tunnel in connection with anterior cruciate ligament (ACL) reconstruction is a rare but particularly troublesome complication. Medical treatment is often doomed to failure, and surgical treatment usually consists of excising the cyst and filling the tunnel with bone. The aim of this study was to evaluate the results of filling the tunnel with acrylic cement. Hypothesis: Filling the tibial bone tunnel with acrylic cement should eliminate communication between the joint cavity and the pre-tibial surface and prevent cyst recurrence. Patients and Methods: This retrospective series is composed of 13 patients, 9 men and 4 women, mean age 48.5 years (31 to 64) operated on between 2011 and 2019 for an intra- and extraosseous synovial cyst consecutive to the tibial tunnel of an ACL graft. Between 1983 and 2016, 12 of the patients had had a bone graft without bone block fixation (DI-DT or Mac Intosh) and one patient, a bone-bone transplant (KJ). The cyst was of variable size, located on the anteromedial aspect of the proximal end of the tibia, and often painful, warranting consultation. At the time of the initial operation, 9 patients had undergone meniscectomies (6 medial, 2 lateral, 1 double). In 7 knees, there were 7 cartilage lesions in the femorotibial and/or patellofemoral compartments (one stage 1 lesion, 2 stage 2 lesions, 4 stage 3 lesions, and no stage 4 lesions). Only 2 knees had neither cartilage nor meniscus lesions. After curettage of the bone tunnel /− removal of the non-resorbed or PEEK interference screw, the tunnel was filled with acrylic cement /− reinforced with a ligament staple to prevent expulsion. All patients underwent regular follow-up consultations until recovery. Results: At a maximum follow-up of 8 years, only 1 cyst recurred, representing a 7.69% failure rate. It was reoperated with another technique, which involved filling the tibial bone tunnel with bone graft taken from a half-bank head. After recovery, the cyst healed definitively. All patients were able to return to their previous activity within 15 days of surgery. Conclusion: Filling the tibial tunnel with acrylic cement reinforced /− with a ligament staple is a reliable and rapid solution for the treatment of intra- and extra-articular synovial cysts in relation to the tibial tunnel of ACL grafts.
基金supported by the Natural Science Foundation of Qinghai Province, China (No.2021-ZJ940Q)。
文摘In recent years, lakes on the Qinghai-Tibet Plateau have become more responsive to climate change. In September 2011, Zonag Lake in Hoh Xil experienced sudden drainage, the water eventually flowed into Yanhu Lake, which caused Yanhu Lake to continue to expand. The potential collapse of Yanhu Lake could directly threaten the operational safety of the adjacent Qinghai-Tibet Highway, Qinghai-Tibet Railway. To explore the implications of expanding lakes on the surrounding permafrost, we selected Hoh Xil Yanhu Lake on the Qinghai-Tibet Plateau to study the effect of lake expansion on permafrost degradation. The permafrost degradation in the Yanhu Lake basin from October 2017 to December 2022 was inverted using Sentinel-1 satellite image data and small baseline subset interferometry synthetic aperture radar(SBAS-In SAR) technology. Additionally, permafrost degradation from February 2007 and February 2010 was analyzed using advanced land observing satellite phased array-type L-band synthetic aperture radar(ALOS PALSAR) satellite images and differential interferometric synthetic aperture radar(D-In SAR) technique. The results showed that the permafrost around Yanhu Lake experienced accelerated degradation. Prior to the expansion of Yanhu Lake, the average annual deformation rate along the line of sight(LOS) direction was 6.7 mm/yr. After the expansion, the rate increased to 20.9 mm/yr. The integration of spatial-temporal distribution maps of surface subsidence, Wudaoliang borehole geothermal data, meteorological data, Yanhu Lake surface area changes, and water level changes supports the assertion that the intensified permafrost degradation could be attributed to lake expansion rather than the rising air temperature. Furthermore, permafrost degradation around Yanhu Lake could impact vital infrastructure such as the adjacent Qinghai-Tibet Highway and Qinghai-Tibet Railway.
文摘To analyse the effectiveness of performing a transverse tibial bone graft in the treatment of patients with diabetic foot. We retrospectively analysed the clinical details of 51 diabetic foot patients in our hospital from February 2023 to February 2024 and divided them into two groups according to the different treatment modalities, in which the control group received open debridement and the treatment group received transverse tibial bone transfer and compared the differences between the two groups. There were large differences in VAS score, Toronto Clinical Symptom Score, quality of life score, internal lumen diameter, blood flow velocity in the affected limb, perfusion volume, vascular endothelial growth factor, epidermal growth factor and CRP between the two groups after surgery (P < 0.05). Patients with diabetic foot should be treated with transverse tibial bone grafting, which is safer and more effective and can have a significant impact on improving the status of the affected limb, the inflammation and the patient’s quality of life.
