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Objective To study the clinical efficacy of external fixator and combined screwing at iliac crests and pubic symphysis for the treatment of unstable pelvic fractures.Methods From January 2013 to February 2014,12 cases of unstable pelvic fracture were treated at our department.They were 8 men and 4 women,from 32 to 57 years of age (average,42.5 years).Seven cases were caused by a traffic accident,and 5 by falling from a height.By Tile classification,8 cases were type B (including type B1 in 3 cases,type B2 in 3 and type B3 in 2),and 4 cases type C1.Associated injury included shock in 7 cases,bladder injury in one,limb long bone fracture in 6,joint injury in 3,and thoracic and lumbar injury in 4.The interval from injury to operation averaged 4 days,ranging from 12 hours to 7 days.The type B fractures were treated with an external fixator and combined screwing at iliac crests and pubic symphysis while the type C1 fractures with internal fixation with percutaneous S1 sacroiliac screws in addition to what was used for the type B fractures.Results The 12 patients were followed up for 5 to 12 months(average,9 months).No one died in this group.The fractures healed after 8 to 13 weeks (average,11.3 weeks).All the patients recovered normal walking.Superficial infection at the pin hole occurred in 7 cases,but there was no deep infection.Screw loosening was observed in only one case,and no reduction loss,injury to nerves or urinary canal was observed.According to the Majeed criteria,the efficacy was evaluated as excellent in 10 cases,good in one,and moderate in one.Conclusion External fixator and combined screwing at iliac crests and pubic symphysis can restore the stability of anterior pelvic ring,leading to good clinical outcomes.
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ObjectiveTo compare the clinical effect of percutaneous iliosacral screws osteosynthesis (PISO) and open reduction internal reconstruction plate fixation in treating unstable pelvic fractures combined with sacroiliac joint dislocation,and evaluate their safety and practicality.MethodsFrom March 2004 to October 2010,37 patients with vertical unstable pelvic fractures were admitted to our department.Twenty cases were treated with percutaneous sacroiliac screw fixation and 17 cases were performed opened reduction and internal reconstruction plate fixation under C-arm X-ray's guide.The perioperative parameters and postoperative imaging indexes were compared and analyzed.ResultsAll patients were followed up for 6 months to 26 months,with an average of 15 months.There were statistical significances between the PISO group and open reduction internal fixation group in operation time,blood loss,postoperative pain,mean fever time and hospital stay.The two groups showed no significant difference on postoperative X-evaluation of reduction effect.The average healing time was 3.2 months and the difference was not statistically significant between two groups.PISO group had no complications such as infection,bent nails or broken nails.ConclusionThrough compared and analyzed the two groups in treating unstable pelvic fractures,the percutaneous sacroiliac screw fixation has been proved for a kind of ideal minimally invasive surgery method because of locating exactly,less damage and blood loss,milder pain and quicker recovery.But it demands higher operation techniques.Adequate preoperative preparation and postoperative patients' cooperation can reduce complications incidence.The second group of anterior reconstruction plate or T-shape plate to fix vertically unstable pelvic fractures at same time shows a good result of stabilization.
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BACKGROUND: Although bone mineral density can diagnose osteoporosis, it cannot reflect the existing bone metabolism of the subjects; bone turnover markers cannot diagnose osteoporosis, but it can timely reflect the current bone turnover rate of the subjects. OBJECTIVE: To summarize osteoporotic fracture risk predicted by bone turnover markers and bone mineral density, and to theoretically analyze the feasibility of fracture healing after operation. METHODS: With bone turnover, biochemical marker, osteoporosis in English for the search terms, Pubmed database from January 1999 to January 2009 was retrieved; With bone turnover, bone metabolism, biochemical markers, bone mineral density, osteoporosis, fractures in Chinese for the search terms, CNKI database from January 1999 to January 2009 was searched. Literatures were limited to English and Chinese languages. Inclusive criteria: the article closely related to predict fracture risk with bone turnover markers and bone mineral density; Exclusive criteria: duplicated documents. RESULTS AND CONCLUSION: Totally 631 literatures were screened out by computer, according to inclusion and exclusion criteria, 31 documents of which were involved for analysis. Osteoporosis is one of the main causes of elderly disease and death. Early prediction of osteoporotic fracture risk has a great significance. This article describes the bone metabolism, the type of bone biochemical markers, bone mineral density measurement, multi-cell basic unit and the OPG-RANKL-RANK system in bone reconstruction after a long-term fixation; focuses on the use of bone turnover markers and bone mineral density to prognosticate the fracture risk in osteoporosis or after long-term fixation by domestic and foreign academician, and theoretically analyze the feasibility of predicting postoperative fracture healing.
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BACKGROUND: Osteoblasts derived from bone marrow stromal stem cells are the main force of the cells In bone marrow cavity.In the artificial joint replacement cases, their life situation is closely related to conductive pressure of prosthesis.OBJECTIVE: To observe the continuous pressure on the proliferation of rabbit's bone marrow stromal stem cells, and to reveal the biomechanism of continuous pressure causing loosening and sinking of prosthesis and its activity after replacement.DESIGN, TIME AND SE'I-I'ING: A randomized study based on cytology was performed at the Institute of Othorpaedics, the Fourth Military Medical University of Chinese PLA from February 2004 to October 2007.MATERIALS: One New Zealand rabbit aging 1 month and weighing 0.5 kg was used to extract the bone marrow stromal calls.METHODS: The third-passaged bone marrow stromal stem cells were inoculated in seven 24-well culture plates at the density of 1 × 104 cells/well. After 14 hours, cells were adherent completely and cultured in DMEM culture media containing 10% fetal bovine serum. Thereafter, the four culture plates were randomly divided into 4 experimental groups, including control group without any pressure, and continuous pressure (20, 60, and 100 kPa) groups. The continuous pressure was performed for 3 hours every day.MAIN OUTCOME MEASURES: Absorbance was detected at day 1, 3, 5, and 7 after culture using MTT assay.RESULTS: Absorbance of the three pressure groups after 3, 5 and 7 days was significantly lower than the control group (P < 0.01). There was no significant difference in absorbance between 20 kPa continuous pressure group and 60 kPa continuous pressure group on the third day (P >0.05); but the absorbance was significantly higher than 100 kPa continuous pressure group (P < 0.05). On the fifth day, there was significant difference in absorbance between paired continuous pressure groups (P < 0.05),i.e., the higher the continuous pressure was, the lower the absorbance was. On the seventh day, the absorbance of the 100 kPa continuous pressure group was significantly lower than 20 kPa continuous pressure group (P < 0.05).CONCLUSION: Patients with eady post-joint replacement had better not stand on the ground; otherwise, a continuous stress will be caused so as to induce the restrain of bone marrow stromal stem calls in the bone marrow cavity, which is not helpful for bone healing and easily causes subsidence and loosening of prosthesis.
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Many clinical bone nonunion or delayed union often appear in the early stage of bone healing,but they have been always found too lately.Before X-ray films of visual changes indicates salt content inbones reaching 25%,the very early changes ofclinical significance can not be observed.This paper introduces the theory of fracture healing and the definition of bone nonunionand the significance of the basic multicellular unit(BMU)and the OPG-RANKL-RANK system in bone reconstruction.Many technologies such as ultrasonic testing,vibration analysis,mechanical impedance analysis,the bone marrow cavity imaging technologiy,high-resolution CT etc.have been reported in study on the bone,as well as early diagnosis of fracture nonunion.However,the molecular level of early diagnosis is deficiency.
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Many clinical bone nonunion or delayed union often appear in the early stage of bone healing,but they have been always found too lately.Before X-ray films of visual changes indicates salt content inbones reaching 25%,the very early changes of clinical significance can not be observed.This paper introduces the theory of fracture healing and the definition of bone nonunion and the significance of the basic multicellular unit (BMU) and the OPG-RANKL-RANK system in bone reconstruction.Many technologies such as ultrasonic testing,vibration analysis,mechanical impedance analysis,the bone marrow cavity imaging technologiy,high-resolution CT etc,have been reported in study on the bone,as well as early diagnosis of fracture nonunion.However,the molecular level of early diagnosis is deficiency.
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[Objective]To prepare a new porous composite artificial bone substitute and evaluate its properties.[Method]Thermally induced phase separation was adopted to prepare the artificial bone made from oyster shell powder and PLLA which were proportionally mixed and its properties as porosity rate,pore size and mechanical strength were assessed.Meanwhile the related variation parameters were examined every 2 weeks in a course of 14 weeks after the slices of CAB and pure PLLA were immersed in NS of 37℃ in vitro,the results of which were compared in statistics.[Result]The average porosity rate of artifical bone with TIPS method was 85.1% and pore sizes ranged 100-300 ?m under the SEM,with better pore connectivity and regulation shape.The average compressive strength was 2.12 MPa.As the immersion prolonged,the regular variation was observed about the mass loss of CAB and the pH alteration of solution,there was statistically difference in the indexes between the two groups(P﹤0.05).[Conclusion]The porosity rate,pore size,mechanical strength and degradation performance in vitro of the artifical bone made by TIPS method can satisfy the requirement of bone substitute.
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[Objective]To investigate the chondrogenic ability and feasibility of bone mesenchymal stem cells(BMSCs) in three kinds of cellular carrier.[Method]BMSCs were separated and cultured into the third generation,which were cultivated in three knids of carriers by multi-point injection into and dropping on the surface of carriers(fibrin collagen sponge,group A;fibrin collagen sponge and FGF,group B and gelatin sponge,group C).All samples were analyzed after four weeks.[Result]There were a few chondrogenic cells in group A,much more chondrogenic cells in group B,and no cells in group C.According to analysis with SPSS 10.0 software,There were more cartilage cells(92.75?10.57) in group B than in group A(36.45?8.34).It was statistical different(P
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[Objective]To treat the low limb comminuted fracture with biological osteosynthesis as a guide in order to decrease damage of periosteal blood supply and increase the bone healing.[Method]For all types of long bone comminuted fracture in low limbs,the operation was taken for keeping connection of bone fragment with periost,indirect reduction through mechanical line,relative stable fixation and there is no need for anatomical reduction.Eighteen cases of intertrochanteric comminuted fractures and 16 cases of low femoral comminuted fractures were treated with DCS.Twenty-six cases of subtrochanteric comminuted fractures and 24 cases of low femoral fractures were fixed with anatomical steel plate in less screws.Twenty-seven cases of femoral shaft comminuted fractures and 31 cases of tibia and fibula comminuted fractures were fixed with compressive plate in less screws.Twenty-six cases of comminuted fractures of femoral shaft and 22 cases of tibia ones were fixed with LC-DCP in less screws.Twenty-five cases of comminuted fractures of femoral shaft and 18 cases of tibia ones were fixed with locking intermedullary nails.One hundred and three cases of comminuted fractures of tibia and fibula were fixed with extra-fixture.Fifty-six cases of comminuted fractures of tibia and fibula were fixed by unilateral multi-purpose external fixing.Twenty-one cases of comminuted fractures of tibia and fibula were fixed by unilateral multi-purpose external fixing with limited screws and plaster.[Result]A total of 413 cases had been treated and followed up within 6～18 months(average 10.5 months).Four hundred and eight cases had bone union and accounted for 98.46% in all cases.One case had nounion and two cases had malunion in femoral fracture.Two cases had delayed union and four cases had nounion in tibia fractures.[Conclusion]It is useful for the bone blood supplying and healing with biological osteosynthesis of reducing bone fracture indirectly and fixing one relatively,especially for comminuted fracture of long bone shaft.
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Objective To investigate clinical effects of arthroscopic synovectomy combined with radiofrequency vaporization for the treatment of rheumatoid synovitis of the knee joint.Methods In 36 cases of rheumatoid gonarthritis with chronic synovitis of the knee joint,with simultaneous administration of regular medication,we had applied arthroscopic synovectomy combined with radiofrequency vaporization to remove the hyperplastic synovium and pannus through standard anteromedial and anterolateral approaches, and superolateral and superomedial approaches.In 21 out of 36 cases,diseased synovium in the posterior compartment was resected via additional posteromedial and posterolateral approaches.A systematic rehabilitation program was practiced 3 days after operation. Results All the 36 cases were followed for 4~26 months(mean,16 months).Clinical effects evaluation showed "excellent" in 21 cases,"good" in 13 cases,and "fair" in 2,with a total excellent-or-good rate of 94.4%(34/36).The knee joint function scores were significantly elevated from 58.6?5.3 preoperatively to 91.6?5.8 postoperatively(t=2.723,P=0.003).The Lysholm scores were significantly elevated from 42.3?3.8 preoperatively to 90.2?4.4 postoperatively(t=2.437,P=0.001).Conclusions Combined use of arthroscopic synovectomy with radiofrequency vaporization for the treatment of rheumatoid gonarthritis has advantages of minimal trauma,little blood loss,and rapid recovery of joint function.The procedure can effectively control the progression of rheumatoid arthritis and restore the knee joint function to the greatest possible extent.
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Objective To investigate the therapeutic effect of vascular pedicle bone graft and compound bone matrical gelatin (Co BMG) in treatment of nonunion of femoral neck fracture . Methods 28 cases of femoral neck fracture who had been treated with operation and traction and observed for 6 to 9 months suffered from nonunion. The 28 cases of nonunion were treated by vascular pedicle bone graft and compound bone matrical gelatin. The progress of bone healing, complications such as necrosis of femoral head, and joint function were followed up after operation. Results All the 28 cases healed. The function of joint was evaluated according to Jacobs criteria. It was excellent in 19 cases, fine in 7 cases, and poor in 2 cases. Conclusion The vascular pedicle bone graft combined with BMG is the effective choice for treatment of nonunion of femoral neck fracture in adolescents and adults, because it has the double effects of bone grafting and bone induction.