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Objective:To investigate the effect of mechano-growth factor（MGF）on osteoclast activity and its mechanism.Methods:The RAW264.7 precursor osteoclast cell line was cultured with 25 ng/ml macrophage-colony stimulating factor（M-CSF）and 30 ng/ml receptor activator of NF-κB ligand（RANKL），and identified by tartrate resistant acid phosphatase（TRAP）staining after 7 days of culture. Western blot anslysis was used to determine the effect of 45 ng/ml MGF on the phosphoinositide-3-kinase/protein kinase B（PI3K/AKT）signaling pathway in separated osteoclasts，including levels of AKT，phosphorylation（p）-AKT，lactation mammalian target of rapamycin（mTOR），p-mTOR and TRAP at 0，4，8 and 12 hours. Real-time fluorescence quantitative PCR was used to expressions of TRAP in osteoclasts at 0，4，8 and 12 hours. The PI3K/Akt phosphorylation inhibitor LY294002（20 μmol/L）combined with MGF（45 ng/ml）was used to act on osteoclasts，and expression levels of Akt，p-Akt，mTOR，p-mTOR and TRAP were detected by Western blot at 0，4，8 and 12 hours.Results:After culturing RAW264.7 cells with M-CSF and RANKL for 7 days，a large number of osteoclasts with positive TRAP staining can be obtained. Western blot analysis showed expression levels of Akt and mTOR did not change significantly over time（ P>0.05），expression levels of p-Akt and p-mTOR increased continuously from（2.18±0.34）pg/ml and（0.83±0.10）pg/ml at 0 hour to（3.86±0.36）pg/ml and（1.56±0.19）pg/ml at 12 hours（ P<0.05），and expression level of TRAP decreased significantly over time，from（5.66±0.47）pg/ml at 0 hour to（3.76±0.38）pg/ml at 12 hours（ P<0.05）. Real-time fluorescence quantitative PCR analysis of expression of TRAP in osteoclasts showed that MGF inhibited the expression of TRAP in osteoclasts，which decreased from 1.02±0.06 at 0 hour to 0.53±0.11 at 12 hours（ P<0.05）. After acting LY294002 combined with MGF on osteoclasts，Western blot analysis showed expression levels of Akt and mTOR did not change significantly over time（ P>0.05），expression levels of p-AKT and p-mTOR decreased significantly from（3.28±0.18）pg/ml and（3.29±0.22）pg/ml at 0 hour to（2.06±0.34）pg/ml and（2.04±0.20）pg/ml at 12 hours（ P<0.05），and expression level of TRAP had no significant difference over time（ P>0.05）. Conclusions:MGF inhibits osteoclast activity by inhibiting the expression of TRAP in osteoclasts through PI3K/Akt signaling pathway. LY294002 inhibits the expression of PI3K/Akt signaling pathway in osteoclasts，further verifying the mechanism of MGF inhibiting osteoclast activity，and this finding puts forward new ideas for clinical prevention and treatment of osteoporosis.
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Objective@#To evaluate the treatment of complex acetabular fractures involving the posterior column by anterograde lag screws via the ilioinguinal approach.@*Methods@#A retrospective study was conducted of the 8 patients with complex acetabular fracture involving the posterior column who had been treated at Department of Orthopaedics, The Second Affiliated Hospital to Inner Mongolia Medical University from January 2017 to June 2018. They were 5 males and 3 females, aged from 35 to 62 years (average, 43.5 years). According to the Letournel-Judet classification, 3 cases were T-shaped fractures, 4 anterior column plus posterior hemitransverse fractures and one both column fracture. The interval from injury to operation averaged 8 days (from 7 to 17 days). The anterior acetabulum was fixated by a reconstruction plate and the posterior column by antegrade lag screws, all through the ilioinguinal approach. The quality of fracture reduction, fracture union time, function of the affected hip and complications were recorded.@*Results@#By the Matta imaging criteria, the quality of fracture reduction was rated as excellent in 7 cases and as fine in one. Intraoperative major hemorrhage or injury to sciatic nerve occurred in none of the patients. This cohort obtained an average follow-up of 8 months (from 6 to 18 months). All fractures united well after an average of 10 weeks (from 8 to 12 weeks). The function of affected hip evaluated by the improved Merle d’Aubigne & Postel criteria at the last follow-up was excellent in 7 cases and fine in one. Follow-ups revealed no incidence of deep vein thrombosis or heterotopic ossification.@*Conclusions@#For patients with complex acetabular fracture involving the posterior column, internal fixation of the anterior acetabulum with a reconstruction plate through the ilioinguinal approach and fixation of the posterior column with antegrade lag screws also through the ilioinguinal approach can result in fine therapeutic effects, because complications like ectopic ossification and sciatic nerve injury related to the Kocher-Langenbeck approach can be prevented. This treatment is particularly suitable for the patients whose condition of the soft tissues at the posterior pelvis is poor.
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Objective To evaluate ilioischial plating via the modified Stoppa approach for acetabular fractures involving the posterior column.Methods A retrospective analysis was conducted of the 12 patients who had been treated for acetabular fractures involving the posterior column from January 2017 to June 2018 by ilioischial plating via the modified Stoppa approach at Department of Orthopaedics,The Second Affiliated Hospital to Mongolia Medical University.They were 7 males and 5 females,aged from 35 to 62 years (average,43.3 years).According to the Letournel-Judet classification,there were 5 transverse fractures,4 anterior column plus posterior hemitransverse fractures and 3 both column fractures.Ilioischial plating was conducted for all the patients via the modified Stoppa approach.The Matta criteria were used to evaluate the fracture reduction.The operative time,intraoperative bleeding volume,postoperative fracture reduction and complications like traumatic arthritis and deep venous thrombosis were recorded.Merle d'Aubigné and Postel scoring was used to evaluate hip function during follow-up.Results The operative time for this group averaged 130 min (from 90 to 170 min) and the intraoperative blood loss 550 mL (from 400 to 700 mL).No major intraoperative bleeding occurred.All the 12 patients were followed up for 6 to 16 months (average,8 months).The Matta evaluation for reduction quality yielded 10 excellent and 2 good cases.Their fractures healed after 8 to 10 weeks (average,8.7 weeks).At the last follow-up,the affected hips scored 12 to 18 points (average,16 points),giving 6 excellent,4 good and 2 fair cases.Follow-ups revealed no fracture re-displacement,nerve injury,deep vein thrombosis,ectopic ossification or other complications.Conclusion In the operative treatment of complex acetabular fractures involving the posterior column,ilioischial plating via the modified Stoppa approach displays advantages of easy reduction,easy maintenance of the reduction,limited complications and fine therapeutic effects.
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Objective To evaluate the treatment of complex acetabular fractures involving the posterior column by anterograde lag screws via the ilioinguinal approach.Methods A retrospective study was conducted of the 8 patients with complex acetabular fracture involving the posterior column who had been treated at Department of Orthopaedics,The Second Affiliated Hospital to Inner Mongolia Medical University from January 2017 to June 2018.They were 5 males and 3 females,aged from 35 to 62 years (average,43.5 years).According to the Letournel-Judet classification,3 cases were T-shaped fractures,4 anterior column plus posterior hemitransverse fractures and one both column fracture.The interval from injury to operation averaged 8 days (from 7 to 17 days).The anterior acetabulum was fixated by a reconstruction plate and the posterior column by antegrade lag screws,all through the ilioinguinal approach.The quality of fracture reduction,fracture union time,function of the affected hip and complications were recorded.Results By the Matta imaging criteria,the quality of fracture reduction was rated as excellent in 7 cases and as fine in one.Intraoperative major hemorrhage or injury to sciatic nerve occurred in none of the patients.This cohort obtained an average follow-up of 8 months (from 6 to 18 months).All fractures united well after an average of 10 weeks (from 8 to 12 weeks).The function of affected hip evaluated by the improved Merle d'Aubigne & Postel criteria at the last follow-up was excellent in 7 cases and fine in one.Follow-ups revealed no incidence of deep vein thrombosis or heterotopic ossification.Conclusions For patients with complex acetabular fracture involving the posterior column,internal fixation of the anterior acetabulum with a reconstruction plate through the ilioinguinal approach and fixation of the posterior column with antegrade lag screws also through the ilioinguinal approach can result in fine therapeutic effects,because complications like ectopic ossification and sciatic nerve injury related to the Kocher-Langenbeck approach can be prevented.This treatment is particularly suitable for the patients whose condition of the soft tissues at the posterior pelvis is poor.