Orthopaedic Trauma

People’s Hospital Department of Traumatology and Orthopaedics is a comprehensive discipline integrating wards, emergency services, outpatient services and a research laboratory. It is currently a doctoral program at Peking University, a national key discipline under the Ministry of Education’s 211 Project, a national key specialty (orthopaedics) of the Ministry of Health, a national standardized severe-trauma treatment training base, and a Ministry of Education innovation team. It is the former chairperson unit of the Traumatology Branch of the Chinese Medical Association, the deputy-chairperson unit of the Orthopaedics Branch of the Chinese Medical Association, and the chairperson unit of the Orthopaedics Branch of the Beijing Medical Association. The discipline has a well-structured personnel hierarchy, including 8 senior-professional-title staff, 5 associate-senior-title staff, 7 intermediate-title staff, and 42 junior-title medical and nursing staff and postgraduate students. Its main clinical services include diagnosis and treatment of fractures of the limbs and around joints (shoulder and elbow, and foot and ankle surgery), repair of peripheral nerve injuries, and spinal cord injuries. In clinical diagnosis and treatment, internationally advanced AO principles and internal-fixation techniques have been used to treat large numbers of patients with spinal, pelvic and limb fractures, with satisfactory outcomes. Joint replacement has been used for severe comminuted intra-articular fractures of the shoulder and elbow; the number of cases completed and treatment outcomes rank among the leading levels in China. Treatment of spinal and limb fractures, especially periarticular fractures, has reached the internationally advanced level of the same period. In peripheral nerve injury, based on extensive experimental research, the possibility of repairing peripheral nerve injuries with a biological conduit small-gap coaptation technique was proposed and subsequently verified in lower and higher animals. A nationwide multicenter clinical trial has now been successfully completed, and the nerve-regeneration conduit is under application review by the National Medical Products Administration. Related research has received 1 Second Prize of the National Science and Technology Progress Award, 1 GUSI Peace Prize, 1 First Prize of the Ministry of Education Technology Invention Award, 1 First Prize of the Ministry of Education Science and Technology Progress Award, 1 Chinese Medical Science and Technology Progress Award, and 2 Beijing Science and Technology Progress Awards. The discipline has received the title “National Youth Civilized Unit” 2 times.

Key Laboratory of Trauma Treatment and Nerve Regeneration, Ministry of Education (Peking University)

Laboratory Introduction

The “Key Laboratory of Trauma Treatment and Nerve Regeneration, Ministry of Education,” submitted by the Department of Traumatology and Orthopaedics and the Trauma Treatment Center, was approved for establishment in 2018. The laboratory is committed to improving the clinical treatment outcomes of trauma patients and patients with peripheral nerve injuries in China, producing numerous original research achievements and independently owned intellectual property rights, and enhancing international academic influence in trauma treatment and nerve-regeneration research.

The Key Laboratory of Trauma Treatment and Nerve Regeneration, Ministry of Education, at Peking University People’s Hospital follows national strategies and policies for scientific and technological development, addresses international scientific and technological frontiers and China’s modernization needs, and focuses on social health needs and major scientific and technological problems in trauma treatment and nerve regeneration. Its main research directions are “trauma systems and technology,” “mechanisms of severe trauma,” “bone and joint injuries,” “sports and geriatric trauma,” “peripheral nerve injury and regeneration,” “muscle and neuronal diseases,” and “cranial nerve diseases.” It conducts in-depth clinical and basic research in trauma treatment and nerve regeneration.

The discipline currently has 11 senior-professional-title staff, 8 associate-senior-title staff, and more than 50 intermediate- and junior-level medical and nursing staff and postgraduate students. Its main clinical and research directions include severe-trauma treatment, peripheral nerve injury, and periarticular fractures.

The discipline undertakes multiple projects, including the national “973” Program, the Public Welfare Industry Research Special Fund of the Ministry of Health, and the National Natural Science Foundation of China. More than 520 academic papers have been published, including more than 120 SCI papers in The Lancet, Spine and other journals; 22 monographs have been edited or translated as chief editor or translator; 24 patents have been granted; and 20 transfers have been successfully completed. Research achievements have received 1 Second Prize of the National Science and Technology Progress Award, 1 First Prize of the Ministry of Education Technology Invention Award, 1 First Prize of the Ministry of Education Science and Technology Progress Award, and 1 First Prize of the Chinese Medical Science and Technology Award.

Professor Jiang Baoguo, the academic leader, is currently chairperson of the China Trauma Rescue Alliance and chairperson of the International Trauma Rescue Alliance. He has received the International Gu’s Peace Prize, the Wu Jieping–Paul Janssen Medical and Pharmaceutical Award, and the Ho Leung Ho Lee Prize for Scientific and Technological Progress.

Research Directions

I. Trauma Treatment:

(1) Trauma Systems and Technology Research

A Chinese trauma treatment system has been established. The core concept of establishing a “closed-loop regional trauma treatment system centered on general hospitals” was proposed pioneeringly at the international level, and a new trauma-treatment model based on establishing trauma-treatment teams in general hospitals was proposed first. The establishment and dissemination of standardized severe-trauma treatment protocols have been systematically carried out.

Frontier concepts and key technologies for trauma treatment have been established, with intelligent assessment, early warning and linkage systems enabling rapid diagnosis and precise diagnosis and treatment of severe trauma.

(2) Mechanism Research on Severe Trauma

Taking advantage of multidisciplinary integration among traumatology, pathophysiology, epigenetics and molecular biology, the key pathogenic mechanisms, targets and time points of severe trauma are studied, and targeted interventions are explored, in order to identify more effective organ-protection and treatment strategies and comprehensively improve the treatment capacity for severe trauma.

(3) Bone and Joint Injury Research

Through precise assessment of pulmonary function and changes in hip-joint structure and function in iatrogenic SARS patients, important reference value was provided for prognostic assessment of pulmonary lesions in novel coronavirus pneumonia and for glucocorticoid use.

Based on the “lever–balance–reconstruction” theory, a new proximal femoral intramedullary nail was developed. A bionic proximal femoral intramedullary nail was developed using bionic topology optimization, opening an entirely new direction for fixation treatment of intertrochanteric fractures.

(4) Sports and Geriatric Trauma Research

A complete set of clinical treatment protocols was summarized for elderly patients with hip fractures accompanied by multiple medical diseases (hypertension, diabetes, Parkinson’s disease, respiratory failure, hepatic or renal failure, cerebral hemorrhage, stroke, hemophilia, systemic lupus erythematosus, rheumatoid arthritis, leukemia, and after bone-marrow transplantation or cardiovascular and cerebrovascular stent placement).

Retrospective and prospective studies of preoperative scoring systems were initiated for elderly patients with osteoporotic fractures accompanied by more than 2 medical comorbidities. Surgical risk was greatly reduced and quality of life was maximized in elderly patients with hip fractures, complex conditions and more than 2 medical diseases.

Research on occult blood loss in elderly hip-fracture surgery was initiated first for overt and occult blood-loss rates associated with internal fixation or joint-replacement surgery, greatly improving perioperative safety.

II. Nerve Regeneration

(1) Peripheral Nerve Structural Association Omics Research

Based on transcriptomic research, key mRNA molecules for improving repair after nerve injury are sought, providing reference data for gene therapy research on peripheral nerve injury and repair. It was discovered that donor nerves from different anterior-horn motor neurons can effectively repair target organs innervated by the median nerve, laying a theoretical foundation for nerve-transfer repair.

(2) Systemic Remodeling Mechanisms During Peripheral Nerve Injury Repair

The research group proposed that “regeneration after peripheral nerve injury repair is a systemic remodeling process involving interaction between nerves and terminal effectors.” Different functional requirements of peripheral effectors determine the proportions of central functional-remodeling regions and constitute an intrinsic driver of spinal-cord functional differentiation. This study provided evidence, at the spinal-cord structural level, that effectors induce central functional remodeling, supplying a theoretical basis for innovative repair strategies for severe nerve injuries.

(3) Key Targets and Mechanisms of Peripheral Nerve Injury Repair

Second-generation RNA sequencing is used after peripheral nerve injury to explore key targets of denervation muscle atrophy, study important factors regulating muscle atrophy, and investigate positive regulatory effects on treatment of peripheral nerve injury.

(4) New Materials and Methods for Peripheral Nerve Injury Repair

A biodegradable chitin biological conduit independently developed by the laboratory passed review by the National Medical Products Administration (National Medical Device Standard 20213130298). Nanofiber scaffolds, conductive materials, injectable hydrogels and chemical modification are key research directions for developing new materials that can replace or promote peripheral nerve injury repair and improve repair outcomes.

Small-gap coaptation and amplification-regeneration techniques are used to address the lack of proximal donors after peripheral nerve injury. Coaptation-suture nerve transection repair and coaptation-suture nerve cross-amplification repair were proposed, improving surgical repair protocols for different clinical situations involving peripheral nerve injury.

(5) Peripheral Nerve Signal-Conduction Mechanisms, Analysis and Simulation

Effective analysis of nerve electrophysiological signals is achieved on the basis of structural information. An adaptive feedback model is established to simulate the motor components of peripheral nerves, and functional rehabilitation is achieved with a mechanical exoskeleton. A topology-type exoskeleton rehabilitation system based on electromyographic signals is constructed and further expanded into a human–machine-interaction-interface exoskeleton rehabilitation system based on nerve electrical signals.