Epidemiological comparison of adult talus fractures between East China and West China from 2010 to 2011 / 中华创伤骨科杂志

Objective To compare and analyze the epidemiological features of adult talus fractures between East China and West China from 2010 to 2011.Methods The data of adult talus fractures from January 2010 to December 2011 in 63 hospitals in East China and West China were collected through the PACS system and medical records systems.The data of 35 hospitals in East China were assigned into group A while the data of 28 hospitals in West China into group B.The analytic items included gender,age,and type of AO classification.Results A total of 1,014 cases were collected.In group A of 825 cases,there were 624 (75.64％) males and 201 (24.36％) females;in group B of 189 cases,there were 130 (68.78％)males and 59 (31.22％) females.There was no significant difference between groups A and B in male to female ratio (x2 =3.788,P=0.052).The mean age was 36 years old (26,47) in group A and 35 (24,48) years old in group B,showing no significant difference between the 2 groups (Z =-8.244,P ＜ 0.001).There was a significant difference between the 2 groups in the constituent ratio of age ranges (P ＜ 0.05).The peak age range was from 21 to 30 years old in group A (27.76％,229/825),and from 31 to 40 years old in group B (24.34％,46/189).The high-risk type of fracture was AO type 81-A in both groups.Conclusions There were more male talus fractures than female ones in both East China and West China.Most talus fractures happened in patients aged from 21 to 30 years in East China and in patients aged from 31 to 40 years in West China.AO Type 81-A was the most common in both West and East China.

Epidemiological characteristics of Monteggia fractures in the east and west areas in China from 2010 to 2011 / 中华创伤骨科杂志

Objective To analyze and compare the epidemiological features of Monteggia fractures between the east and west areas in China from 2010 to 2011.Methods The data of Monteggia fractures treated from January 2010 through December 2011 in 63 hospitals in the east and west China were collected through the PACS system and case reports checking system.The data from the 35 east hospitals were classified as group A while those from the 28 west hospitals as group B.The analytic items included general situation,gender,age,and Bado classification.Results A total of 593 Monteggia fractures were included,including 428 males and 165 females,with a male to female ratio of 2.59:1.The constituent ratios of Bado classification,from high to low,were type Ⅰ (42.50％),type Ⅲ (33.22％),type Ⅱ (14.00％) and type ⅣV (10.29％).There were 376 patients in group A including 263 (69.95％) males and 113 (30.05％)females while 217 patients in group B including 165 (76.04％) males and 52 (23.96％) females.The median age in group B was 31 yearn (from 2 to 75 years),significantly older than that in group A [18 years (from 1 to 83 years)] (Z =2.877,P =0.000).The differences in constituent ratios of age and Bado classification were statistically significant between the 2 groups (P ＜ 0.05).The Monteggia fractures predominated in the age range of 0 to 10 years in group A while in the age range of 31 to 40 years in group B.The high risk fracture type was Bado type Ⅰ in group A and Bado type Ⅲ in group B.The Monteggia fractures accounted for 1.15％ of the forearm fractures and 0.19％ of the systemic fractures.Conclusions More males suffered from Monteggia fracture than females.In the east China,the high risk age range was from 0 to 10 years and the high risk type Bado type Ⅰ;in the west China,the high risk age range was from 31 to 40 years and the high risk type Bado type Ⅲ.The proportion of Bado type Ⅳ in the west China was significantly higher than in the east China.

Epidemiological comparison of adult tibial plateau fractures from 2010 to 2011 between West China and East China / 中华创伤骨科杂志

Objective To compare and analyze the epidemiological features of adult tibial plateau fractures from 2010 to 2011 between West China and East China.Methods The data of adult patients with tibial plateau fracture treated from January 2010 to December 2011 in 63 hospitals from West China and East China were collected through the PACS system and case reports checking system.The data of 28 hospitals from West China were classified as West group while the data of 35 hospitals from East China as East group.The analytic items included gender,age,age distribution and type of Schaztker classification.Results A total of 4,603 adult tibial plateau fractures were collected.The largest age proportion was from 41 to 50 years,with 41 to 50 years in males and 51 to 60 years in females.The highest age proportion in group A was from 51 to 60 years,and that in group B was from 41 to 50 years,showing significant differences between the 2 groups in age distribution (P ＜ 0.05).There were 3,346 cases in group A,including 2,438 males and 998 females with a male to female ratio of 2.35:1;there were 1,257 cases in group A,including 821 males and 436 females with a male to female ratio of 1.88:1.There were significant differences between the 2 groups in gender distribution (P ＜ 0.05).The high-risk fracture type was Schaztker type Ⅵ in both groups,with 898 cases in group A and 411 ones in group B;the lowest fracture type was Schaztker type Ⅴ in both groups,with 214 cases in group A and 149 ones in group B.There were significant differences between the 2 groups in fracture type ratios (P ＜ 0.05).Conclusions Adult tibial plateau fractures predominated in males in both East and West China.The average age of the patients from East China was higher than that from West China.The high-risk type was Schaztker type Ⅵ in both areas.

Clinical features and proportion analysis of adult hip fractures at 11 hospitals in Southwest China from 2010 to 2011 / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical feature and constituent ratio of adult hip fractures in Southwest China.</p><p><b>METHODS</b>The data of adult inpatients and outpatients with hip fractures treated between January 2010 and December 2011 in 11 hospitals of the Southwest China were collected and analyzed. The data includes gender, age, age distribution and fracture pattern according to AO classification.</p><p><b>RESULTS</b>There were a total of 2,833 adult hip fractures, including 1,340 (47.30%) males and 1,493 (52.70%) females, with a male-to-female incidence ratio of 1: 1.11 and a mean age of (66±18) years. The highest frequency of hip fractures was seen in the 71 to 85 years age group (42.18%, 1,195/2,833). There were 844 fractures (29.79%) in the young and middle-aged group (16-<60 years) and 1 898 fractures (70.21%) in the geriatric group (≥60 years). Men had a higher rate than women (men: 577 fractures, 68.4%) in the young and middle-aged group, while women had a higher rate than men (women: 1,226 fractures, 61.64%) in the geriatric group, with a significant difference in the sex distribution between the two groups (χ2=214.001, P<0.01). The proportion of intertrochanteric fracture (type 31-A), femoral neck (type 31-B) and femoral head fracture (type 31-C) was 46.59%, 49.74% and 3.67% respectively. The highest frequency of the sub-type in each fracture type was type 31-A2, type 31-B2 and type 31-C2.</p><p><b>CONCLUSIONS</b>Women have a higher rate than men in Southwest China. Geriatric patients are more than the young and middle-aged patients. The femoral neck fractures, intertrochanteric fractures and femoral head fractures are in descending orders according to the proportion of the three different hip fractures.</p>

The research on CDK4 andβ-Catenin expression and clinic significance in glioma / 实用肿瘤学杂志

Objective To study the expression of CDK4 andβ-Catenin and their relevance in glioma. Methods We used immunohistochemistry to detect the expression of CDK4 andβ-Catenin in forty-five glio-ma tissues and eight normal tissues.According to the classification standard of WHO in 2000 classify and grade the tissues.Results There were significant differences of CDK4 andβ-Catenin expressions between normal tis-sues and glioma tissues(P<0.01).The expression of CDK4 and β-Catenin had positive correlation with the pathological grades of glioma and histological type and increased(P <0.05).Furthermore,the expression of CDK4 was positively correlated with the expression ofβ-Catenin in glioma(r=0.52,P<0.01).Conclusion The increased expression of CDK4 andβ-Catenin may have correlation with malignant change of glioma and oc-curance of glioblastoma,and their combination is expected to become an important indicator in assessing malignant glioma.

An experimental study of anti-apoptotic effect of Levodopa on steroid-induced osteonecrosis of the femoral head in rabbits / 中华骨科杂志

Objective To study the anti-apoptotic effects of Levodopa on osteonecrosis of the femoral head induced by methylprednisolone (MPS).Methods Forty-four rabbits were randomly divided in to 3 groups.The model group (n=15) was injected with lipopolysaccharide (LPS,10 μg/kg) and then MPS (20 mg/kg) was given 3 times with 24 h interval.The treatment group (n=1 5) was firstly treated by the same methods as the model group,then was administered Levodopa (0.4 g·kg~(-1)·d~(-1)) orally after the last injection of MPS.The control group (n=14) was injected with sodium chloride alone.On the 6th and 8th week after modeling,radiography and MR images were taken in 7 rabbits of each group,specimens taken from the femoral heads were observed by HE stain and TUNEL analysis was made.Blood samples were taken for detection of insulin-like growth factor-1 (IGF-1) on the 8th week.Results On the 6th and 8th week,the average percentage of empty osteocyte lacunae in the treatment group (13.33‰±3.06‰,25.97‰±6.29‰) was significantly lower than that of the model group (21.44‰±4.77‰,33.86‰±8.38‰,P<0.01),and the average apoptosis index in the treatment group (74.93‰±14.32‰,120.67‰±13.13‰) was significantly lower than that of the model group (102.56‰±18.96‰,202.02‰±18.99‰.,P<0.01).On the 8th week,the level of IGF-1 in the treatment group was (14.78±2.37)ng/ml,which was higher than that of the model group obviously (10.12±2.49)ng/ml(P<0.01).Conclusion The Levodopa can decrease apoptosis of osteocytes and effectively prevent the progress of steroid-induced osteonecrosis of the femoral head.

Preliminary observation of clinical results of treatment for early non-traumatic osteonecrosis of the femoral head with Madopar / 中华骨科杂志

Objective To observe the preliminary effects of the treatment for early non-traumatic osteonecrosis of the femoral head with Madopar. Methods Thirty-one patients with 48 hips of early stage (Ficat Ⅰ,Ⅱ) non-traumatic necrosis of the femoral head were treated with oral administration of Madopar since 2002. The disease was associated with consumption of alcohol in 16 cases with 27 hips; use of steroids in 10 cases with 13 hips; both consumption of alcohol and use of steroids in 2 cases with 4 hips; the remaining 3 cases, the condition was idiopathic. According to the criteria of Ficat et al., there were 4 hips in stage Ⅰ; 40 in stage Ⅱa and 4 in stage Ⅱb. Eighteen patients had received madopar for 10-28 months; 13 patients had been receiving the drug until now. Follow-up examinations were made by radiography, MRI and Charnley modified Merle d'Aubigne score. Results All patients were followed up for 12-84 months (average 27.8 months). The clinical symptoms improved in all cases. X-ray films showed that the bone density increased in nearly all the femoral heads, and 68.75%(33/48) of them maintained their shapes. The follow-up MRI showed their necrotic indices had decreased. The rate of clinical satisfaction was 91.67%(44/48), and the successful rate of treatment was 72.92%(35/48), and the collapse rate of early stage necrosis of the femoral head is 27.08%(13/48). Conclusion The preliminary results showed that madopar could prevent or delay collapse of the femoral head in early stage of osteonecrosis.

Biomechanical evaluation of transverse acetabular fracture fixation / 中华创伤骨科杂志

Objective To conduct a biomechanical evaluation of the four internal fixation methods to treat transverse acetabular fracture and find the b est one. Methods The transverse acetabular fracture models were created by osteo tomy in 12 pairs of embalmed cadaveric hip joints, and fixed with one of the fou r different methods: an anterior column plate (P/N), an anterior column plate w ith a posterior column screw (P+S), a posterior column plate with an anterior screw (S+P) and two posterior column plates (N/P?2). The biomechanical stabi lity was evaluated on longitudinal displacement, level displacement and stiffnes s measurements for fixed fracture fragments which were under 800 Newton vertical compression load. Results The longitudinal displacement in S+P was 3.99mm, in P+S 4.09mm, in N/P?2 5.07mm and in P/N 5.66mm; the level displacement in S+P was 0.015mm, in P+S 0.016mm, in N/P?2 0.022mm and in P/N 0.025mm; the average stiffness in S+P was 205.77N/mm, in P+S 207.52N/mm, in N/P?2 162.36N/mm and i n P/N 146.67N/mm. There were significant differences between the groups of S+P and P+S and the groups of N/P?2 and P/N (P

Surgical treatment of displaced com plex acetabular fractures / 中华骨科杂志

Objective To summarize the surgical techniques and results of displaced complex ac-etabular fractures.Methods Ninety-eight cases of complex type o f acetabular fracture with dislocation were treated with open reduction and inte rnal fixation from March 1990to Sept ember 1999.Of the 98cases,fractures of the posterior column an d wall was seen in 9cases,T -shaped in28cases,transverse and posterior wall in 22cases,anterior and hemi-transverse in 2cases,both column in 37cases.Kocher -Langenbeck approach was adopted in 28cases,ilio-inguinal approach in 21cases,extended iliofemoral approach in 16cases,and double approachs(K -L +ilio-inguinal)in 33cases.Results Sixty-two cases(63.3%)had anatomic reduction,32cases(32.7%)satisfactory reduction,4cases(4.1%)unsatisfactory reduction.The rates of anatomic reduction in the early 4.5years and the latest 4.5years of this study were 50.0%and72.4%respectively.Seventy-eight cases were followed up from 2to 10yea rs,excellent and good rate for clinical results in anatomic and non-anatomic reduction group were 83.9%and 36.4%respectively,the difference was very significant (P

Implantation of hydroxyapatite methylmethacylate cement in the treatment of osteonecrosis of femoral head: a medium-term evaluation of the results / 中华骨科杂志

Objective To introduce a method using hydroxyapatite methylmethacylate cement implanted in the femoral head for the treatment of patients suffering from avascular necrosis of the femoral head due to different causes and to review the medium term follow up results. Methods From January 1990 to December 1995, eight hips in seven patients(male 4, female 3) with femoral head necrosis at Ficat stage Ⅲ were treated with the hydroxyapatite methylmethacylate cement implantation in the involved femoral head. Four osteonecrosis were secondary to femoral neck fracture, two were due to corticosteroid intake and one had alcohol abuse history. All patients complained pain and limited joint activity. The operation consisted of the removal of necrotic bone under weight loading cartilage with curet and the implantation of the hydroxyapatite methylmethacylate cement. The function of hip joint were well evaluated and X ray films were taken pre and postoperatively. The average postoperative follow up was 7.9 years, ranging from 5.1 to 11 years. Results Merle d Aubign? method was used to assess and compare the pre and post operative function of hip joint. The average score for unilateral cases increased from 8.66 to 15.5 at final examination. On radiography, the improvement of the contours of the femoral head was seen in all patients and most of them could preserve their initial postoperative contours during the follow up. No sign of expansion of the bone necrosis appeared in most of the patients, although certain patients presented various joint degeneration such as narrowing of joint space,sclerosis and osteophyte. Subjective evaluation was satisfactory except two suffering from painless limited activity of hip joint. Conclusion This method is relatively simple with less invasion and rapid postoperative recovery. It may be a choice of surgery for the treatment of certain femoral head necrosis at Ficat stage Ⅲ, especially for young patients.

The study on hematological changes of nontraumatic osteonecrosis of the femoral head / 中华骨科杂志

Objective To study the hematological changes o f nontraumatic osteonecrosis of the femoral head,select the sensitive molecular symbols for early diagnosis and distinguish the high risk peopl e.Methods The studied subjects were divided in to three groups:1)NONFH early stage group(n=30);2)NONFH late stage group(n=30);3)the normal controlled group(n=30).Blood samples from cubital veins were collected.GMP -140,PC,D -Dime r were examined using ELISA.PAI was e xamined with chromogenic assay.Results1)The platelet GMP -140levels of early or late stage groups NONFH were signi ficantly higher than that of the normal contro lled group;the plasma PC levels of both groups were lower than that of the normal controlled group significan tly(P

Surgical treatment of both-column acetabular fractures through combined approaches / 中华骨科杂志

Objective To summarize the surgical techniques and results of b oth-column acetabular fracture through combination of ilioinguinal and Kocher-La ngenbeck approaches. Methods Between March 1990 and July 2001, 66 patients affec ted by both-column acetabular fractures were treated surgically through the comb ination of ilioinguinal and Kocher-Langenbeck approaches. There were 39 males an d 27 females with an average age of 37 years (range, 19 to 56 years). According to Letournel classification, all patients were diagnosed as the both-column frac tures of acetabulum. Of 66 patients, 14 were associated with dislocation or subd islocation of femoral head, 8 with dislocation of ipsilateral sacro-iliac joint, and 8 with intra-articular fragments. The interval from injury to operation was within 2 weeks in 24 and more than 2 weeks in 42. The surgical indications were as follows: 1) dislocation of both column fractures over 3 mm; 2) anterior colu mn fracture associated with severe posterior column comminuted fracture or poste rior wall fracture; 3)injury lasting more than 2 weeks; 4) injury associated wit h femoral head dislocation; 5) injury associated with intra-articular fracture f ragment. Postoperative reduction quality and long-term radiographic results were evaluated according to the Matta and the Epstein criterion separately; the d’A ubigne rating scale was used for the functional results. Results The average ope rative time was 4 hours, the average blood loss was 1 400 ml. Anatomic reduction were obtained in 57 cases (86%), satisfactory reduction in 6 (9%) and unsatisfa ctory in 3 (5%). The follow-up were from 2 to 13 years with an average of 6 year s. The clinical results were 89% excellent and good, 6% fair and 5% poor respect ively; the roentgenographic results were 82% excellent, 10% fair and 8% poor res pectively. 5 cases(8%) with Grade Ⅲ heterotopic ossification were found in Ko cher-Langenbeck approach, and no heterotopic ossification was in ilioinguinal ap proach. There was 1 deep infection (1.5%) in the ilioinguinal approach, and no i nfection in the Kocher-Langenbeck approach. Conclusion The results achieved thro ugh the combined approaches were significantly better than that of the both-colu mn acetabular fractures using the extended iliofemoral approach. The combined ap proach is an ideal method for the operation of the both-column acetabular fractu res with an excellent exposure, satisfactory reduction, shorter operating time, less blood loss, and lower operative complication rate.

Herbert screw treating displaced radial head fractures and a review of literatures / 中华创伤杂志

Objective To evaluate advantages of the Herbert screw in treating displaced radial head fractures. Methods The Herbert screw was used to treat 25 segmental fractures of the radial head from since 1991 and the results were compared with those of other treatment methods mentioned in the literature. Results A follow up averaging 6 years and 8 months showed that postoperative function was all excellent or good and that most cases recovered to normal absolutely, without complications. Conclusions The Herbert screw provides such rigid internal fixation for displaced radial head fractures that, after operation, a plaster cast is rarely required and most patients are able to return to work within a few weeks. This method of treatment appears to offer significant advantages over conventional techniques.