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Objective To investigate the clinic efficacy of proximal humeral internal locking system(PHILOS) in the treatment of Neer Ⅱ and Ⅲ proximal humeral fractures.Methods From January 2013 to December 2015,a total of 47 patients with Neer Ⅱ and Ⅲ proximal humeral fractures was treated with PHILOS fixation in our hospital.The operative time,blood loss in operation,hospital stay,complications,Constant scores and radiography films were retrospectively analyzed.Results All 47 patients were followed up for an average of (19.2 ±9.6) month.The average operative time,the level of average intraoperative blood loss,the mean hospitalization time and the complication rate were(95.6 ±43.1) min,(108 ± 41.6) mL,(11.3 ±3.2) d and 14.7 ％ respectively.The Constant score was improved from(21.74 ± 8.24) preoperatively to(82.83 ± 7.21) at the last follow-up,and the difference was statistically significant(t=-36.57,P＜0.01).Conclusion Fixation with PHILOS is a safe and effective treatment for patients with Neer Ⅱ and Ⅲ proximal humeral fractures.
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Objective To analyze the periopemtive blood loss of elderly patients with intertrochanter fracture that fixed with proximal femoral nail-antirotation (PFNA),and to explore the risk factor influencing the perioperative blood loss following PFNA fixation.Methods The clinical data of 62 elderly patients with intemochanter fracture treated with PFNA were analyzed retrospectively to determine the perioperative obvious blood loss and hidden blood loss.The impact of gender,age and fracture type on blood loss was also analyzed.Results The obvious blood loss of 62 patients was (120.6 ±42.0) ml,which accounted for 15.5％ in total blood loss [(775.8 ± 129.6) ml].The hidden blood loss was (655.2 ± 109.1) ml,which accounted for 84.5％ in total blood loss.The hidden blood loss was much more than obvious blood loss (P＜ 0.01).The total blood loss,obvious blood loss,hidden blood loss was (773.3 ± 131.5),(122.5 ± 44.1),(650.8± 114.2) mlinmahgroup (20cases),(777.0± 124.7),(119.7±40.2),(657.3 ± 107.7) ml in female group (42 cases),and there was no significant difference between two groups (P ＞ 0.05).The total blood loss,obvious blood loss was (813.1 ± 107.5),(117.7 ±49.7) ml in advanced age group (35 cases),(727.4 ± 114.3),(124.4 ± 36.6) ml in non-advanced age group (27 cases),and there was no significant difference between two groups (P ＞0.05).The hidden blood loss was (695.4 ±74.1) ml in advanced age group,(603.0 ± 65.3) ml in non-advanced age group,and there was significant difference between two groups (P＜0.05).The total blood loss,obvious blood loss,hidden blood loss was (578.1 ±82.3),(68.5 ±23.1),(509.6 ±63.1) ml in stable group (14 cases),(833.5 ±84.1),(135.8 ±35.0),(697.7 ±79.3) ml in unstable group (48 cases),and there was significant difference between two groups (P ＜ 0.05).Conclusions Hidden blood loss is the major part of perioperative blood loss of elderly patients with intertrochanter fractures that fixed with PFNA.Advanced age and unstable fracture type are risk factors of hidden blood loss.
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BACKGROUND: Macrophage colony-stimulating factor (M-CSF)/receptor activator of nudeer kappa B ligand (RANKL), two types of cytokines co-induce myeloid stem cells to form osteoclasts, is a kind of new method to harvest ostaoclasts with high purity and quantity, but there is lack of uniform cultivation standard. OBJECTIVE: To construct an effective M-CSF/RANKL induced mice myeloid stem cells inducing osteoclast differentiation cultivation system. METHODS: Myeloid stem cells ware obtained from ICR mice and then cultured for 24 hours in a-minimum essential medium containing M-CSF, at cell density of 10~7/L, 10~8/L, 10~9/L. Then 10 μg/L M-CSF and 20, 50, 100 μg/L RANKL were added into culture medium. Tartaric-resistant acid phosphatase stained was performed to observe the transition process from stem cell to osteoclast, as well as cell morphology and stain situation after culture, and positive stained osteoclasts were counted. We compared the influence of different induction conditions to the quantity of osteoclast. RESULTS AND CONCLUSION: A small quantity of osteoclasts contained many red positive beads in the intracytoplasm were observed at 3 days. There were positive beads with hypochromatic dikeryon in cells. A large amount of positively stained osteoclests were seen after 6-day cultudng, which maintained dikaryon. After 9-day culturing, positively stained colossal multinudear cells occurred, became larger and maintained three nuclei. At certain cell density, 100 μg/L RANKL could induce to form more osteoclasts compared with other 2 concentrations (P < 0.05); at certain RANKL concentration, the osteoclasts formation at cells density of 10~8/L was dramatically greater than other 2 cell densities (P < 0.05); the number of osteoclasts was the most when the concentration of RANKL was 100 μg/L and cell density of 10~8/L (P < 0.05). When osteoclasts are induced by M-CSF/RANKL from mudne myeloid stem cells, the best concentration of RANKL is 100 μg/L and cells density is 10~8/L.