A comparative study of vancomycin loaded bone cement in the treatment of Wagner Ⅱ-Ⅳ diabetic foot / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of vancomycin bone cement in the treatment of diabetic foot ulcer (DFU) ruptured Wagner gradeⅡ-Ⅳ.@*METHODS@#From March 2019 to April 2021, 32 patients with Wagner gradeⅡ-Ⅳ diabetic foot were divided into vacuum sealing drainage (VSD) group and bone cement group according to different treatment methods. There were 16 cases in VSD group, 8 males and 8 females;the age ranged from 66 to 81 (70.50±7.20) years, and the course of disease ranged from 8 to 40 (27.56±8.55) months;Wagner gradeⅡin 2 cases, grade Ⅲin 7 cases and grade Ⅳin 7 cases;debridement and VSD were used. There were 16 cases in the bone cement group, 9 males and 7 females;the age ranged from 63 to 79 (69.56±7.29) years, and the course of disease ranged from 11 to 39(22.75±11.43) months;Wagner gradeⅡ in 2 cases, grade Ⅲin 5 cases and grade Ⅳ in 9 cases;vancomycin loaded bone cement was used for treatment. The types of bacteria, negative time of bacterial culture, skin healing time, hospital stay, operation times and complications were observed and compared between two groups.@*RESULTS@#All patients were followed up for 3 to 6 (4.00±1.07) months. The bacterial negative time, skin healing time and hospital stay in bone cement group were significantly lower than those in VSD group (@*CONCLUSION@#Vancomycin loaded bone cement is effective in the treatment of Wagner grade Ⅱ-Ⅳ diabetic foot ulceration wounds. It can reduce the length of hospital stay, shorten the healing time of skin and kill pathogens as soon as possible. It is one of the effective methods to treat Wagner gradeⅡ-Ⅳdiabetic foot ulceration.

Clinical effect of minimally invasive technique on the treatment of osteoporotic humeral shaft fractures in elderly patients with locking plates / 中国骨伤

OBJECTIVE@#To explore the clinical effect of minimally invasive technique combined with locking plates for the treatment of osteoporotic humeral shaft fractures in elderly patients.@*METHODS@#From July 2012 to December 2016, 26 patients were treated by minimally invasive technique combined with the locking plate for osteoporotic humeral shaft fractures, including 10 males and 16 females, ranging in age from 61 to 81 years old, with an average of 70.3 years old. The T-score of mean bone density was -2.74. All 26 patients had closed fractures, including 6 cases of type A, 7 cases of type B and 13 cases of type C. All patients were followed up for 12 months after surgery, and the Constant shoulder joint score and Mayo elbow score were calculated before surgery and 12 months after surgery.@*RESULTS@#All 26 patients were followed up, and the duration ranged from 12 to 16 months, with an average of 13.2 months. All fractures healed within 16 weeks, with an average healing time of 14.3 weeks. The average Constant shoulder joint score before surgery and 12 months after surgery was 54.61±2.09, 88.50±2.47. The average score of Mayo elbow joint before surgery and 12 months after surgery was 58.19±2.74, 90.30±2.16.@*CONCLUSIONS@#The shoulder and elbow joint function of elderly patients with osteoporotic humeral fractrues treated with minimally invasive technology combined with locking plate recovered well postoperatively. It is an effective method for the treatment of osteoporotic humeral shaft fractures in elderly patients.

Modified Metaizeau's technique for the treatment of radial neck fractures of Judet III or IV in children / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effect of modified Metaizeau's technique for radial neck fractures of Judet II or IV in children, summarizing the value of clinical application.</p><p><b>METHODS</b>From May 2014 to March 2017, 32 children of Judet III or IV radial neck fractures were treated with percutaneous Kirschner wire poking reduction and closed reduction with elastic intramedullary nailing fixation, including 21 boys and 11 girls, aged from 5.7 to 10.6 years old with a mean of 7.2 years old. The modified An-Morrey functional rating index were used to evaluate elbow range of motion, myodynamia, stability, and pain preoperatively and 1 year postoperatively in all the patients.</p><p><b>RESULTS</b>All patients were available for an average follow-up from 12 to 15 months. No complications such as incision infection, wire or nail tail irritation and avascular necrosis of radial head and epiphyses was occurred. The fracture achieved solid healing at 8 to 10 weeks after operation. The modified An and Morrey functional score improved from 58.69±5.80 before operation to 99.13±1.79 at 1 year after operation, there was obvious difference of scores between preoperative and postoperative at 1 year.</p><p><b>CONCLUSIONS</b>Modified Metaizeau's technique is a reliable and good treatment for Judet III or IV radial neck fractures in children, which has advantages of few complication, minimal invasion, quick fracture union and good recovery of elbow joint.</p>

Inhibition of vinorelbine on invasion and metastasis of breast cancer cell and its mechanism / 中草药

The MCF-7 and MDA-MB-435 cells were treated with 1 and 10 μmol/L VRB. The cell adhesion was tested by MTS, the invasion was detected by Transwell, secretion of TGF-β was detected using ELISA, the activities of MMP-2 and MMP-9 were detected by zymography, the expression of proteins, including E-cadherin (E-CAD), N-cadherin (N-CAD), MMP-2, and MMP-9, p-JNK and, p-Akt was evaluated by Western blotting, RT-PCR was used to detect E-CAD, N-CAD, MMP-2, and MMP-9 genes, and dual-luciferase reporter assay was used to validate the activities of AP-1 and NF-κB. Results After being treated with 1 and 10 μmol/L VRB, for MCF-7 and MDA-MB-435, the adhesion ability was decreased by 34.8% and 66.8%, 42.6% and 72.3%; The metastatic ability was decreased by 44.4% and 72.2%, 47.7% and 86.4%; The secretion of TGF-β was reduced by 28.2% and 52.1%, 39.0% and 55.1%, significantly; The mRNA expression levels of E-CAD were increased by 86.5% and 181.6%, 116.6% and 160.7%; while the levels of N-CAD were decreased by 33.7% and 74.1%, 57.6% and 76.9%; The gene expression of MMP-2 was decreased by 71.6% and 88.4%, 57.4% and 69.4%; The gene expression of MMP-9 was decreased by 15.0% and 84.0%, 22.1% and 73.0%, respectively. The protein expression of E-CAD was up-regulated while the protein expression of N-CAD, MMP-2, MMP-9, p-JNK, and p-Akt were down-regulated significantly; And dual-luciferase reporter assay validated VRB could inhibit the transcriptional activity of AP-1 and NF-κB by 27.7% and 68.2%, 34.8% and 71.4%, 18.4% and 44.8%, 24.4% and 51.9%, respectively. Conclusion VRB could inhibit the metastasis of breast cancer MCF-7 and MDA-MB-435 cells via down-regulation of inhibition and blocking of signaling pathway correlated with metastasis and epithelial-mesenchymal transition.

Unilateral external fixation assisted with closed reduction and interlocking intramedullary nail fixation for the treatment of comminuted fracture of femoral shaft / 中国骨伤

<p><b>OBJECTIVE</b>To introduce the use of single arm external fixation assisted reduction and closed complex intramedullary nail fixation for the treatment of femoral shaft fracture operation method and to study its effects.</p><p><b>METHODS</b>From June 2008 to October 2012, 24 patients with femoral shaft fractures were treated with unilateral external fixation assisted by closed reduction, interlocking intramedullary nail fixation. Among the patients, 19 patients were male and 5 patients were female, ranging in aged from 20 to 68 years,with an average of 45.6 years old. The fracture was caused by traffic accidents in 14 cases, by falling in 6 cases, by heavy bruising in 4 cases. Admission diagnosis was femoral shaft fracture. Operation was performed after traction from tibial tubercle for about 1 week.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 6 to 24 months, with a mean of 16.2 months. The X-ray showed fracture healing time ranging from 11 to 17 weeks, with an average of 13.8 weeks. All fractures healed without nails broken or close joint dysfunction. According to femoral shaft efficacy evaluation standards, 23 patients got an excellent result, 1 good.</p><p><b>CONCLUSION</b>Unilateral fixator assisted closed reduction and interlocking intramedullary nail fixation for the treatment of femoral shaft fracture has following advantages: less trauma, simple operation, effective reduction, high rate of fracture healing, and low complication rate.</p>

Clinical application of blocking screws and rooting technique in the treatment of distal tibial fracture with interlocking intramedullary nail / 中国骨伤

<p><b>OBJECTIVE</b>To introduce the clinical method of blocking screws and rooting technique in the treatment of distal tibial fracture with interlocking intramedullary nails.</p><p><b>METHODS</b>From June 2006 to March 2011, 26 patients with distal tibial fracture were treated with interlocking intramedullary nails using blocking screws and rooting technique, included 18 males and 8 females with an average age of 46.2 years old ranging from 24 to 64 years. According to AO classification: 10 cases of type A1, 4 cases of type A2, 8 cases of type B1, 4 cases of type B2. The average distance of the fractures end to the ankle joint was 85 mm ranging from 55 to 125 mm, the mean time between injured and operation was 4.5 days. The patients were evaluated with pain, range of motion, walking.</p><p><b>RESULTS</b>All cases were followed-up for 6 to 22 months (averaged 15 months). According to Iowa ankle joint grading system,the score was improved from preoperative (66.8 +/- 8.2) to postoperative (94.6 +/- 4.8). All fractures had united, and got satisfactory reduction and stable fixation with no complications had happen such as breakage of screw.</p><p><b>CONCLUSION</b>Fixation with interlocking intramedullary nail using blocking screws and rooting technique in treating distal tibial fracture, is a safe and effective technique for the improvement of stability.</p>