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Background@#Technical aspects of the correct placement of medial support locking screws in the locking plate for proximal humerus fractures remain incompletely understood. This study was to evaluate the clinical relationship between the number of medial support screws and the maintenance of fracture reduction after locked plating of proximal humerus fractures.@*Methods@#We retrospectively evaluated 181 patients who had been surgically treated for proximal humeral fractures (PHFs) with a locking plate between September 2007 and June 2013. All cases were then subdivided into one of four groups as follows: 75 patients in the medial cortical support (MCS) group, 26 patients in the medial multiscrew support (MMSS) group, 29 patients in the medial single screw support (MSSS) group, and 51 patients in the no medial support (NMS) group. Clinical and radiographic evaluations included the Constant-Murley score (CM), visual analogue scale (VAS), complications, and revision surgeries. The neck-shaft angle (NSA) was measured in a true anteroposterior radiograph immediately postoperation and at final follow-up. One-way analysis of variance or Kruskal-Wallis test was used for statistical analysis of measurement data, and Chi-square test or Fisher's exact test was used for categorical data.@*Results@#The mean postoperative NSAs were 133.46° ± 6.01°, 132.39° ± 7.77°, 135.17° ± 10.15°, and 132.41° ± 7.16° in the MCS, MMSS, MSSS, and NMS groups, respectively, and no significant differences were found (F = 1.02, P = 0.387). In the final follow-up, the NSAs were 132.79° ± 6.02°, 130.19° ± 9.25°, 131.28° ± 12.85°, and 127.35° ± 8.50° in the MCS, MMSS, MSSS, and NMS groups, respectively (F = 4.40, P = 0.008). There were marked differences in the NSA at the final follow-up between the MCS and NMS groups (P = 0.004). The median (interquartile range [IQR]) NSA losses were 0.0° (0.0-1.0)°, 1.3° (0.0-3.1)°, 1.5° (1.0-5.2)°, and 4.0° (1.2-7.1)° in the MCS, MMSS, MSSS, and NMS groups, respectively (H = 60.66, P < 0.001). There were marked differences in NSA loss between the MCS and the other three groups (MCS vs. MMSS, Z = 3.16, P = 0.002; MCS vs. MSSS, Z = 4.78, P < 0.001; and MCS vs. NMS, Z = 7.34, P < 0.001). There was also significantly less NSA loss observed in the MMSS group compared to the NMS group (Z = -3.16, P = 0.002). However, there were no significant differences between the MMSS and MSSS groups (Z = -1.65, P = 0.225) or the MSSS and NMS groups (Z = -1.21, P = 0.099). The average CM scores were 81.35 ± 9.79, 78.04 ± 8.97, 72.76 ± 10.98, and 67.33 ± 12.31 points in the MCS, MMSS, MSSS, and NMS groups, respectively (F = 18.68, P < 0.001). The rates of excellent and good CM scores were 86.67%, 80.77%, 65.52%, and 43.14% in the MCS, MMSS, MSSS, and NMS groups, respectively (χ = 29.25, P < 0.001). The median (IQR) VAS scores were 1 (0-2), 1 (0-2), 2 (1-3), and 3 (1-5) points in the MCS, MMSS, MSSS, and NMS groups, respectively (H = 27.80, P < 0.001). Functional recovery was markedly better and VAS values were lower in the MCS and MMSS groups (for CM scores: MCS vs. MSSS, P < 0.001; MCS vs. NMS, P < 0.001; MMSS vs. MSSS, P = 0.031; and MMSS vs. NMS, P < 0.001 and for VAS values: MCS vs. MSSS, Z = 3.31, P = 0.001; MCS vs. NMS, Z = 4.64, P < 0.001; MMSS vs. MSSS, Z = -2.09, P = 0.037; and MMSS vs. NMS, Z = -3.16, P = 0.003).@*Conclusions@#Medial support screws might help enhance mechanical stability and maintain fracture reduction when used to treat PHFs with medial metaphyseal comminution or malreduction.
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Aged , Female , Humans , Male , Middle Aged , Bone Plates , Bone Screws , Fracture Fixation, Internal , Methods , Humerus , Retrospective Studies , Shoulder Fractures , General Surgery , Treatment OutcomeABSTRACT
OBJECTIVE: To investigate the protective mechanism of red ginseng extract(RG) on aging mice induced by D-galactose and the correlation between tumor necrosis factor-α (TNF-α)glutathione peroxidase 1 (GPX1), glutathione peroxidase 2 (GPX2), interleukin-1β (IL-1β), interleukin-6 (IL-6) and interleukin-10 (IL-10). METHODS: Aging mice models were caused by D-galactose and randomly divided into control group, model group, RG low, medium and high dose (100, 200, 400 mg•kg-1) groups. The preparation of model and drug delivery, after 42 d, the mice were killed and determination of spleen index; the activity of superoxide dismutase (SOD) and malondialdehyde (MDA) in serum and brain tissue were measured. In serum, the levels of acetylcholinesterase (AChE), catalase (CAT), glutathione peroxidase (GSH-PX), inducible nitric oxide synthase (i-NOS) were measured. Enzyme-linked immunosorbent assay (ELISA) was used to test the levels of cyclooxygenase-2 (COX-2), TNF-α, IL-1β and IL-6 in brain tissue. Real time quantitative reverse transcription polymerase chain reaction (RT-PCR) was used to detect the correlation of TNF-α, GPX1, GPX2, IL-1β, IL-6 and IL-10 gene mRNA expression in brain tissue. RESULTS: The RG can enhance the spleen index, increase the activity of SOD in serum and brain tissue and AChE, CAT and GSH-PX in serum, decrease the content of MDA in serum and brain tissue, and decrease the content of iNOS in serum and the content of COX-2, TNF-α, IL-1β and IL-6 in brain tissue. At the same time, it significantly inhibited the mRNA expression of TNF-α, IL-1β and IL-6 in the brain tissue of mice, and increased the expression of GPX1, GPX2 and IL-10 mRNA in the brain tissue, and had statistical significance. CONCLUSION: Concentrated solution of red ginseng extract could significantly exhibit anti-aging effects, its mechanism may be related to the TNF-α, GPX1, GPX2, IL-1β, IL-6 and IL-10 expression in aging, enhancing immune function, and removing free radicals and inflammatory factor.
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Objective To design a novel double-leaf proximal humeral locking plate for fixing greater and lesser tuberosities in complex proximal humeral fractures,and evaluate its fixing stability by biomechanical tests.Methods Twelve fresh-frozen humerus specimens with intact rotator cuff were randomly divided into two groups (Group A and Group B) to establish the same greater and lesser tuberosities fracture models.Specimens in Group A were fixed with the double-leaf proximal humeral locking plate,while specimens in Group B were fixed with the proximal humeral internal locking system (PHILOS) and tension band suture,and a 3.5-mm cannulated screw was added to stabilize the lesser tuberosity.The tensile test on subscapularis,infraspinatus and teres,supraspi natus as well as the load-to-failure test on greater and lesser tuberosities were performed on specimens in two groups.Results For subscapularis tensile tests,displacements under 150 N tensile stretch and after fatigue test in Group A were both significantly smaller than those in Group B (P ＜ 0.05).For infraspinatus and teres tensile tests,there were no statistical differences between Group A and B in displacements under 150 N tensile stretch and after fatigue test (P ＞ 0.05).For supraspinatus tensile tests,there were no statistical differences between Group A and B in displacements under 90 N tensile stretch and after fatigue test (P ＞ 0.05).For load-to-failure tests on lesser tuberosity,the failure load in Group A was significantly greater than that in Group B (P ＜ 0.05),and the failure displacement in Group A was significantly smaller than that in Group B (P ＜ 0.05).For load-to-failure tests on greater tuberosity,there were no statistical differences between Group A and B in both the failure load and failure displacement (P ＞ 0.05).Conclusions Compared with the ordinary tension band suture plus cannulated screw for fixing lesser tuberosity,the novel double-leaf proximal humeral locking plate shows more obvious biomechanical stability,with the advantage of simultaneously fixing greater and lesser tuberosities.The research findings provide a new choice for the clinical treatment of complex proximal humeral fractures.
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Objective To design a novel double-leaf proximal humeral locking plate for fixing greater and lesser tuberosities in complex proximal humeral fractures, and evaluate its fixing stability by biomechanical tests. Methods Twelve fresh-frozen humerus specimens with intact rotator cuff were randomly divided into two groups (Group A and Group B) to establish the same greater and lesser tuberosities fracture models. Specimens in Group A were fixed with the double-leaf proximal humeral locking plate, while specimens in Group B were fixed with the proximal humeral internal locking system (PHILOS) and tension band suture, and a 3.5-mm cannulated screw was added to stabilize the lesser tuberosity. The tensile test on subscapularis, infraspinatus and teres, supraspinatus as well as the load-to-failure test on greater and lesser tuberosities were performed on specimens in two groups. Results For subscapularis tensile tests, displacements under 150 N tensile stretch and after fatigue test in Group A were both significantly smaller than those in Group B (P0.05). For supraspinatus tensile tests, there were no statistical differences between Group A and B in displacements under 90 N tensile stretch and after fatigue test (P>0.05). For load-to-failure tests on lesser tuberosity, the failure load in Group A was significantly greater than that in Group B (P0.05). Conclusions Compared with the ordinary tension band suture plus cannulated screw for fixing lesser tuberosity, the novel double-leaf proximal humeral locking plate shows more obvious biomechanical stability, with the advantage of simultaneously fixing greater and lesser tuberosities. The research findings provide a new choice for the clinical treatment of complex proximal humeral fractures.
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OBJECTIVE: To establish an HPLC method for determining four kinds of rare saponins, ie, 20(S)-Rg3, 20(R)-Rg3, Rk1, and Rg5 in black ginseng. METHODS: COSMOSIL C18-PAQ (4.6 mm×250 mm, 5 μm) column was used and temperature was maintained at 30℃. Gradient elution was conducted using mobile phase consisting of acetonitrile and water at a flow rate of 1.0 mL·min-1. The detection wavelength was set at 203 nm. The injected sample volume was 10 μL. RESULTS: Good resolution was achieved for the four rare saponins in the ranges of 0.051-0.256 (r=0.999 9), 0.009-0.280(r=0.999 7), 0.051-0.303(r=0.999 9) and 0.093-0.279 mg·mL-1(r=0.999 9) for 20(S)-Rg3, 20(R)-Rg3, Rk1, and Rg5, respectively. The corresponding average recovery rates were 103.9%, 99.2%, 97.0%, and 100.6%, and the standard deviations were 0.71%, 0.73%, 1.97%, and 0.57%, respectively. CONCLUSION: The method is accurate, simple, reliable and reproducible for the determination of saponins in black ginseng. The determination result can be used as a reference for the rational medication, quality control, and further study of black ginseng.
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OBJECTIVE: To study the anti-fatigue effect of dihydromyricetin on mice and its anti-fatigue mechanism. METHODS: Forty male mice were randomly divided into blank control group and dihydromyricetin dose groups (40, 20, 10 mg·kg-1), with continual intragastric administration for 28 d. Through the weight loading swimming experiment of mice, the swimming time of mice were recorded. On the twenty-nine day, mice swam 90 min without loading, and then the activities of BUN, BLA in the serum of mice and biochemical indicators of SOD, GSH-Px, MDA and hepatic glycogen etc were respectively determined. The expression of mRNA of PGC-1α and PPARα were detected by real-time PCR. RESULTS: Comparing with the blank control group, dihydromyricetin dose group can prolong the loaded-swimming time of mice, increase the reserve of liver glycogen in the body, reduce levels of BLA, BUN and MDA, and significantly increased the activities of SOD and GSH-Px. RT-PCR RESULTS showed that the expression levels of PGC-1α and PPARα mRNA in skeletal muscle of mice in the dihydromyricetin dose group were significantly increased, and all had statistical significance. CONCLUSION: Dihydromyricetin can accelerate clearance of free radical, enhance mice antioxidant capacity and improve exercise ability in fatigued mice thus play the anti-fatigue role, exercise-induced fatigue is correlated with PGC-1α.