ABSTRACT
Objective To evaluate the clinical outcomes of minimally invasive internal fixation for femoral intertrochanteric fracture in osteoporotic elderly patients. Methods A retrospective study was conducted in 112 patients using interan nail (IN) or trochanteric antegrade nail (TAN) for the management of intertrochanteric femoral fracture from January 2009 to September 2015 in our hospital. According to AO classification, there were 34 cases of type 31-A.1, and 61 cases of type 31-A.2, 17 cases of type 31-A.3. Clinical and radiological follow-up were available. Surgical and fluoroscopic time, length of hospital stay, blood loss, complications and hip functions were compared between two groups. Results A total of 78 patients meeting the criteria were evaluated at a mean follow-up of 15 months (range, 3-27 months). The IN was used in 41 patients and the TAN in 37 patients. Operative time, fluoroscopy time and blood loss showed significant difference between the IN group and TAN group (respectively, 58.9±6.9 vs. 75.6±5.9min; 2.70±0.47 vs. 4.40±0.47min; 107.6±6.7 vs. 127.8±6.8ml, P0.05). Conclusions For minimally invasive treatment of unstable femoral intertrochanteric fractures, use of either the IN or TAN is clinically effective. However, IN presents more advantages (e.g., easy operation, reliable fixation, less bleeding, better clinical outcomes, and less complications). The use of IN is a suitable option for the treatment of unstable intertrochanteric fractures in osteoporotic elderly patients.
ABSTRACT
Objective To evaluate the effect of TGF-β3 on rabbit nucleus pulposus( NP) cells cultured in three-dimensional polylactic-co-glycolic acid (PLGA)scaffold in vitro.Methods PLGA scaffolds were fabricated by particulate leaching method and soaked in rabbit NP cells suspension(1 × 106/scaffold).PLGA-seeded NP cells were devided into 4 groups: 100 ng/mL TGF-β3/PLGA,500 ng/mL TGF-β3/PLGA,1 μg/mL TGF-β3/PLGA, PLGA control group.Cell proliferation activity was measured using MTT assay.The glycosaminoglycan ( GAG ) analysis were performed by 1, 9-dimethylmethylene blue(DMMB) assay.mRNA expression was measured by quantitive PCR at each time point.Histological observation was performed to elucidate the morphological changes of NP cells in PLGA effected by TGF-β3.Results Higher cellular proliferation activity, GAG production,Collagen type II, Aggrean expression were observed in TGF-β3 /PLGA-seeded NP cells compared with PLGA control group on day-7,day-14,day-21(P<0.05). Higher dose of TGF-β3 exhibited intense cellular proliferation activity and peri-cellular matrix by increasing trend(P<0.05).Histological observation showed TGF-β3/PLGA developed more significant disc cells cluster than PLGA groups on day-21.Conclusion The 3D porous PLGA scaffold-seeded cells using TGF-β3 can promotes cell proliferation, and prompt extracellular matrix(ECM) production.It is a potential biotherapy for the treatment of disc degeneration.
ABSTRACT
Objective To explore the clinical application of PKP in treatment of VCF in elderly patients . Methods 77 elderly patients with VCF were divided randomly into PVP group unilateral PKP group and bilateral PKP group by method of random number table .Preoperative and postoperative VAS scores , vertebral height , Cobb′s angles,operative duration and incidence of bone cement leakage were observed and compared before and after opera -tions in different groups .Results VAS score after 6 days and 6 weeks after operation decreased significantly in all patients.In PVP group,VAS improved form (8.47 ±1.42) to (2.15 ±0.83) at 6 days after treatment ( t=5.24) and to (2.89 ±0.82) at 6 weeks after treatment(t=4.82);In unilateral PKP group,VAS improved form (8.52 ± 1.20) to (2.11 ±0.78) at 6 days after treatment(t=5.93) and to (2.04 ±0.75) at 6 weeks after treatment (t=2.05);In bilateral PKP group,VAS improved form (8.44 ±1.24) to (2.14 ±0.82) at 6 days after treatment (t=6.29) and to (2.02 ±0.71) at 6 weeks after treatment (t=3.14),(all P<0.05);VAS score after 6 weeks in PVP group was significantly higher than that in other two groups ( tunilateral PKP =5.19, tbilateral PKP =6.82, P <0.05);vertebral height and Cobb′s angle were improved significantly after operations in all patients ,In PVP group, vertebral leading edge height improved from (18.19 ±1.32)mm to (20.17 ±1.66)mm(t=7.53),vertebral back edge height improved from (23.62 ±0.71)mm to (24.07 ±0.60)mm (t=6.18),Cobb′s angle improved from (10.26 ±1.60) degrees to (5.40 ±0.92) degrees (t=4.92)(all P<0.05);In unilateral PKP group,vertebral leading edge height improved from (19.17 ±1.12)mm to (21.60 ±1.02)mm(t=5.51),vertebral back edge height improved from (22.31 ±0.92)mm to(24.98 ±0.30)mm(t=6.25),Cobb′s angle improved from (10.55 ±1.48) degrees to(5.28 ±0.43)degrees(t=5.44)(all P<0.05);In bilateral PKP group,vertebral leading edge height im-proved from (18.63 ±1.24)mm to (20.46 ±1.11)mm(t =4.28),vertebral back edge height improved from (24.61 ±0.40)mm to (25.09 ±0.43)mm(t =9.62),Cobb′s angle improved from (10.72 ±1.52)degrees to (55.32 ±0.48)degrees(t=8.36)(all P<0.05).Operative duration was significantly longer in bilateral PKP group which was (57.54 ±12.75)min than that in PVP group which was (40.39 ±11.40)min (t=7.10),or unilateral group which was (38.18 ±15.31)min (t=5.42,all P<0.05);incidence of bone cement leakage was significantly higher in PVP group(64.00%) than in bilateral(19.23%,χ2 =10.59)/unilateral groups(23.08%,χ2 =8.66)(all P<0.05).Conclusion Unilateral PKP is a proper method in treatment of VCF in elderly patients .