Analysis of prophylactic effect of extended-duration anticoagulant drugs in elderly patients undergoing hip fracture / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the prophylactic effect of extended-duration anticoagulant drugs on venous thromboembolism, and to explore the time of drug prevention for venous thromboembolism after hip fracture.@*METHODS@#A retrospective analysis of 143 patients undergoing hip fractures from November 2017 to October 2018 in Peking University People's Hospital was conducted to investigate the relationship between the extended-duration anticoagulant drug and the morbidity of venous thromboembolism and bleeding during the treatment. All the drug prevention programs for the patients included in the study were implemented in accordance with the 2016 edition of the Guidelines for Prevention of Venous Thrombosis in Orthopaedic Surgery by Orthopaedic Society of Chinese Medical Association. The patients in the two groups were followed up for venous thromboembolism and bleeding during the medication within 5 weeks after the fracture. Venous thromboembolism included symptomatic and asymptomatic deep venous thrombosis of the lower extremities, pulmonary thromboembolism, and all the patients with deep venous thrombosis of the lower extremities required vascular ultrasound results to obtain clear evidence. The results of vascular ultrasound were the basis for determining deep venous thrombosis. Bleeding conditions were included, but not limited to gastrointestinal bleeding, wound bleeding, intracranial hemorrhage, intraspinal hematoma, and fundus hemorrhage.@*RESULTS@#There were no pulmonary thromboembolism in both groups after surgery. The morbidity of deep venous thrombosis was 22.09% and 8.77% in the 2-week and 4-week groups (P=0.037), the time to deep venous thrombosis in the two groups was (17.32±7.75) days and (29.20±0.17) days after surgery. One case of bleeding occurred during the use of anticoagulant drugs in both groups, the morbidity of bleeding during the treatment was 1.16% and 1.75% (P=0.769), respectively.@*CONCLUSION@#Extended-duration anticoagulant drugs to 4 weeks after surgery can significantly reduce the morbidity of postoperative venous thromboembolism, and does not increase the risk of bleeding. Patients with a risk of bleeding should carefully assess the risks and benefits of drug prevention and choose the best treatment.

Proximal femoral nails antirotation and dynamic hip screws for fixation of unstable intertrochanteric fractures of femur: A meta-analysis / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the efficacy and safety of proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS) for unstable intertrochanteric fractures using meta-analysis.@*METHODS@#The PubMed, Embase, Cocharane Central Register of Controlled Trials, Google Scholar, China Science and Technology Papers and Citation Database (CSTPCD) and China Journal Full-text Database (CNKI) were searched for published randomized controlled trials before January 1, 2019. Two researchers independently screened the literature in the light of the inclusion and exclusion criteria, evaluated the quality of the studies and extracted the data which were consisted of clinical efficacy indexes, such as incision length, operation time,intraoperative blood loss, weight-bearing time,fracture-healing time, Harris hip score and safety indicators like complications. Meta-analysis was performed with the Revman 5.3 software provided by Cochrane Community in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) standard.@*RESULTS@#Nine randomized controlled trials met the requirement with a total of 779 patients, of whom 383 were fixed with PFNA and 396 with DHS. Meta-analysis demonstrated that PFNA was associated with smaller surgical incision length [MD=-7.43, 95%CI (-9.31, -5.55), P<0.05], shorter operation time [MD=-22.76, 95%CI (-29.57, -11.95), P<0.05], less intraoperative blood loss [MD=-216.34, 95%CI (-275.18, - 157.49), P<0.05], earlier weight bearing after surgery [MD=-12.34, 95%CI (-17.71, -6.97), P<0.05], shorter fracture healing time [MD=-5.00, 95%CI (-7.73, -2.26), P<0.05], higher postoperative Harris hip score [MD=12.22, 95%CI (3.88, 20.55), P<0.05], higher rate of excellent Harris hip score [OR=3.56, 95%CI (1.44, 8.81), P<0.05] and lower incidence rate of postoperative complications [OR=0.48, 95%CI (0.33, 0.70), P<0.05], such as hip varus, wound infection, urinary tract infection, pulmonary infection, pressure sore, deep vein thrombosis, pulmonary embolism, heart failure and cerebral infraction when compared with DHS. No statistical difference was shown between the groups when it came to subgroup analysis by age. However, there was no significant difference (P>0.05) in the duration of hospitalization and the complications resulting in the occurrences of internal fixation loosening, such as femoral shaft fracture (during or post operation), internal fixation fracture, cut-out, displacement or retraction.@*CONCLUSION@#Current published evidence supports the superiority of PFNA to DHS for unstable intertrochanteric fractures in terms of clinical efficacy. The conclusion was limited because of the relatively low quality of evidence with low strength of confidence. Large scale and high-quality randomized controlled trials are required to validate the safety of PFNA and DHS for unstable intertrochanteric fractures.

Comparison of the effects of two cephalomedullary nails (zimmer natural nail and proximal femoral nail antirotation) in treatment of elderly intertrochan teric fractures / 北京大学学报(医学版)

OBJECTIVE@#To explore the effect of cephalomedullary nails for elderly intertrochanteric fractures: proximal femoral nail antirotation (PFNA) versus zimmer natural nail (ZNN) to provide the data support for clinical perioperative management.@*METHODS@#A retrospective study was used to analyze the clinical data of elderly intertrochanteric fractures cases which were treated with PFNA or ZNN fixation from May 2016 to May 2017. In the study, 59 cases were followed up completely, in which 28 cases accepted PFNA, and the other 31 cases accepted ZNN. The operation time, amount of bleeding, fracture healing time, postoperative complication, postoperative radiographic measurement (tip apex distance, TAD) and the last follow-up of hip function score were analyzed.@*RESULTS@#The patients were followed up for 6 to 19 months, with an average (10.8±4.0) months. In PFNA group, the operation time was (62.7±14.2) min, the amount of bleeding was (56.8±20.6) mL, the fracture healing time was (4.6±0.8) months, the postoperative complication was 3.6%, the TAD was (17.7±5.5) mm, and the last follow-up hip function score was 91.8±3.6. In ZNN group, the operation time was (73.6±18.3) min, the amount of bleeding was (68.7±31.6) mL, the fracture healing time was (4.5±0.7) months, the postoperative complication was 3.2%, the TAD was (16.5±4.7) mm, and the last follow-up hip function score was 92.2±3.8. The two groups of comparative experiments were carried out, the operation time of the PFNA group was less than that of the ZNN group (P<0.05). There was no significant difference in the amount of bleeding, fracture healing time, postoperative complication, TAD, postoperative hip score between the two groups (P>0.05).@*CONCLUSION@#Although group ZNN had significant longer operation time than group PFNA, both implants were useful tools in the treatment of elderly intertrochanteric fractures. The operation of PFNA was simpler,while the design of the anterior bow of ZNN might be more suitable for the patients with a large femoral anterior bow.

Correlation analysis between rotator cuff tear and the superior migration of humeral head / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the association between rotator cuff tear and the proximal migration of humeral head.@*METHODS@#In this research, we retrospectively selected 30 patients with unilateral rotator cuff tear in Peking University People's Hospital from September 2015 to May 2016, who received magnetic resonance imaging (MRI) and X-ray of the painful shoulder before enrollment in this study, the duration between the two examinations was no longer than 1 week, and also there was no past history of surgery in the selected shoulders. There was no other exclusion criteria. Upward migration index (UMI) was the ratio between the distance of humeral head center to the lower surface of acromion, and the radius of humeral head circle, which could help to minimize the effect of anatomy difference and imaging magnification, compared with the traditional acromiohumeral distance (AHD). Then we introduced this index to stratify the selected 30 patients into 3 groups, and each group contained 10 patients, UMI of group 1 was >1 and ≤1.2, UMI of group 2 was >1.2 and ≤1.4, UMI of group 3 was >1.4. As the supraspinatus was most commonly affected by pathological change among the four rotator cuff tendons, we took it as the research object. Then we used the Spearman correlation analysis to evaluate the relationship between UMI and fatty degeneration, rotator cuff tear size and the thickness of ruptured supraspinatus tendon from X-ray and MRI.@*RESULTS@#In the A-P view, the average UMI was 1.33 (1.02-1.51, SD: ±0.22). UMI and the tear size had a significant negative correlation (R=-0.584, P<0.01), and also there was a negative correlation between the fatty degeneration of the supraspinatus (R=-0.312, P=0.033). However, there was no correlation between UMI and the thickness of ruptured supraspinatus (R=0.127, P=0.071).@*CONCLUSION@#UMI is related with the fatty degeneration of supraspinatus and the tear size. The reduction of UMI is a predictable and reliable mark of rotator cuff tear and degeneration in clinic. Physicians can use physical examination and X-ray first when facing the patients with shoulder pain, which is convenient and helpful for evaluating rotator cuff tears.

Evaluation of the effects of standard rescue procedure on severe trauma treatment in china / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>This study aimed to evaluate the effects of standard rescue procedure (SRP) in improving severe trauma treatments in China.</p><p><b>METHODS</b>This study was conducted in 12 hospitals located in geographically and industrially different cities in China. A standard procedure on severe trauma rescue was established as a general rule for staff training and patient treatment. A regional network (system) efficiently integrating prehospital rescue, emergency room treatments, and hospital specialist treatments was built under the rule for information sharing and improving severe trauma treatments. Treatment outcomes were compared between before and 1 year after the implementation of the SRP.</p><p><b>RESULTS</b>The outcomes of a total of 74,615 and 12,051 trauma cases were collected from 12 hospitals before and after the implementation of the SRP. Implementation of the SRP led to efficient cooperation and information sharing of different treatment services. The emergency response time, prehospital transit time, emergency rescue time, consultation call time, and mortality rate of patients were 24.24 ± 4.32 min, 45.69 ± 3.89 min, 6.38 ± 1.05 min, 17.53 ± 0.72 min, and 33.82% ± 3.87% (n = 441), respectively, before the implementation of the standardization and significantly reduced to 10.11 ± 3.21 min, 22.39 ± 4.32 min, 3.26 ± 0.89 min, 3.45 ± 0.45 min, and 20.49% ± 3.11%, separately (n = 495, P < 0.05) after that.</p><p><b>CONCLUSIONS</b>Staff training and SRP can significantly improve the efficiency of severe trauma treatments in China.</p>

Case-control study on effects of fracture of processus styloideus ulnae on prognosis after plate fixation for the treatment of distal radial fractures / 中国骨伤

<p><b>OBJECTIVE</b>To analyze effects of fracture of processus styloideus ulnae on prognosis in the treatment of distal radial fracture of type C according to AO classification.</p><p><b>METHODS</b>This was a retrospective case-control study, and the information was got ten through case evaluation and follow-up, including sex, age, patient satisfaction, Gartland & Werley score and radiographic score. There were 76 patient treated with open reduction and plate fixation in People's Hospital Affiliated to Peking University from July 2006 to July 2011. All the patients were divided into two groups: no combination with fracture of processus styloideus ulnae (group A, 56 cases), combination with fracture of processus styloideus ulnae (group B, 20 cases). The patients in group A and B were treated with open reduction and internal fixation; however the fracture of processus styloideus ulnae was not fixed. The indexes such as clinical data, bone grafting, joint movement, Gartland & Werley score and radiographic score were compared between two groups.</p><p><b>RESULTS</b>The ulnaris pain of patients in group B was more obvious than that in group A. The local VAS, palmar and dorsal flexion degree of wrist joint, motion VAS, patients satisfaction score, radial and ulnar deviation degree, pronation and supination of forearm degree, Gartland & Werley score and radiographic score were separately 0.1 ± 0.1, (51.1 ± 1.9)°, (60.2 ± 1.9)°, 0.6 ± 0.1 (23.1 ± 0.9)°, (28.7 ± 1.3)° (81.5 ± 2.6)°, (68.2 ± 2.7)° 1.9 ± 0.3, 89.6 ± 12.3 in group A; and separately 0.3 ± 0.3, (51.4 ± 2.3)°, (66.6 ± 1.7)°, 0.5 ± 0.2, (24.5 ± 2.0)°, (26.9 ± 1.8)°, (80.3 ± 2.5)°, (70.3 ± 3.7)°, 1.2 ± 0.4, 92.5 ± 7.5 in group B; there were no statistical differences in above indexes between two groups.</p><p><b>CONCLUSION</b>Whether the distal radial fracture with a concomitant unrepaired ulnar styloid fracture or not exerts no influence on mainly outcomes including function, radiography and motion of the wrist.</p>

Prehospital road traffic injuries among the elderly in Beijing, China: data from the Beijing Emergency Medical Center, 2004-2010 / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Road traffic injuries (RTIs) are a worldwide issue associated with increasing development and motorization. However, statistical studies do not include any analyses of Beijing's geriatric population. Using data from the Beijing Emergency Medical Center, we present the main characteristics of traffic injuries involving the elderly in Beijing. We also provide objective information for those concerned with the safety of traffic systems and the prevention of traffic injuries.</p><p><b>METHODS</b>In a longitudinal, retrospective study, data were collected on 1706 victims aged 65 years and older who sustained traffic injuries in Beijing between 2004 and 2010. Personal information, time of injury event, emergency care response time, road user type, striking vehicle type, injury site, and severity of injury were analyzed using χ(2) tests and Logistic regression analysis.</p><p><b>RESULTS</b>The annual rate of traffic injuries was 21.80 per 100 000 elderly people in Beijing, and the morbidity rate decreased from 2004 to 2010 (P < 0.001). The mean age was (72.92 ± 5.67) years, and 911 (53.40%) of the victims were male. The majority of victims sustained head and lower limb injuries and were classified as being of medium severity. Traffic collisions occurred most frequently in the daytime excluding rush hours; these collisions included being hit by a car (85.64%) and pedestrian victim injuries (79.19%). Our statistical analysis found three factors for injury severity: abdominal injuries (P < 0.001), number of injury sites (P = 0.027), and head injuries (P = 0.034). The decline in traffic injuries is due to a decrease in victims aged 65-74 years and pedestrians; the severity of RTIs also decreased.</p><p><b>CONCLUSIONS</b>This study highlights the declining trend in traffic injuries among older adults in Beijing. However, traffic injuries remain a serious public health problem for the elderly and effective measures are required to reduce their incidence.</p>

Minimally invasive treatment of the KobyGard system for plantar fasciitis: a retrospective study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Calcodynia is a persistent condition that podiatric surgeons frequently see among their patients, and plantar fasciitis is the main reason for pain. When systematic conservative treatments fail to alleviate these conditions, it requires surgical intervention, mainly plantar fascia release surgery, which used to be an open heel release surgery. This study aimed to investigate whether minimally invasive treatment of the KobyGard system is more safe and effective for plantar fasciitis.</p><p><b>METHODS</b>From May 2009 to May 2012, a total of nine patients, three males and six females with plantar fasciitis, were treated in the Peking University People's Hospital with minimally invasive instruments, the KobyGard system, for the release of plantar fascia. Three patients, experiencing bilateral calcaneodynia, underwent bilateral surgery. One patient had bilateral calcaneodynia with enthesiopathy of Achilles tendon, and underwent Achilles tendon surgery. Preoperative and postoperative Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scores, Roles and Maudsley scores and SF-36 questionnaires were evaluated.</p><p><b>RESULTS</b>The nine patients were successfully followed up. The average postoperative follow-up time was 13.2 months and it varied from 2.0 months to 21.0 months. Pre- and postoperative average scores of VAS was 9.3 and 1.9 (P < 0.001), respectively. Pre- and postoperative average scores of AOFAS hind foot was 36.0 and 82.0 (P < 0.001), respectively. There was also a statistically significant amelioration in SF-36 scores and the Roles and Maudlesy scores. Eight patients were satisfied with the surgery outcome.</p><p><b>CONCLUSION</b>Minimally invasive surgery treatment of the KobyGard system for plantar fasciitis has the advantages of shorter operation time, ease of operation, and similar satisfaction rates with open surgery, but with smaller surgical incision.</p>

Positioning study of cervical vertebra pedicle axial line projective point by computed tomography image reconstruction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Safe placement of the screws is a critical aspect of trans-pedicle internal fixation, and little information on in vivo morphology of the cervical vertebrae pedicle measured with imaging methods is available. The aim of this study was to measure the dimensions of cervical vertebrae C3 to C7 and provide screw length, screw diameter and tilt angle for clinical cervical vertebra trans-pedicle internal fixation.</p><p><b>METHODS</b>Thirty Chinese men and women underwent high-speed spiral computed tomography measurements to obtain data for C3 to C7, and the morphology of the cervical vertebra pedicles was reconstructed.</p><p><b>RESULTS</b>Reconstructed computer tomography image data revealed that: (1) pedicle sponge width increased incrementally from C3 to C7, (2) pedicle depth was similar for C3 to C7, (3) pedicle angle decreased incrementally from 47.20° to 33.76° for C3 to C7, and (4) pedicle point to midline distance was similar for C3 to C7. There were no statistical differences in morphological data between the right and the left side. Men had statistically larger values than women for all morphological parameters.</p><p><b>CONCLUSIONS</b>Reconstructed computed tomography images can provide useful data for clinical cervical vertebra trans-pedicle internal fixation. The individual measurement of cervical vertebra pedicles is recommended for safe placement of trans-vertebra pedicle screws.</p>

Clinical effect of distal radius fracture treated with open reduction and internal plate fixation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>For some specific comminuted unstable intra-articular fracture, the plaster cast can not maintain the alignment of the articular surface effectively. The aim of this study was to evaluate the clinical effects of distal radius fracture treated with open reduction and internal plate fixation retrospectively.</p><p><b>METHODS</b>From January 2002 to March 2010, 539 cases of distal radius fracture were treated with open reduction and internal fixation, including 184 males and 355 females aging 21 - 72 years (mean 57 years). Fractures were caused by falling to the ground in 459 cases, by traffic accident in 62 cases and by athletic injuries in 18 cases. Of 539 cases, there were 523 cases of closed fracture and 16 cases of open fracture. According to Arbeitsgemeinschaft fur Osteosynthesefragen (AO) standards of classification, there were 14 cases of A2 type, 22 of A3 type, 18 of B1 type, 24 of B2 type, 62 of B3 type, 91 of C1 type, 162 of C2 type and 146 of C3 type. The time from injury to operation was 1 - 16 days (mean 5 days). All patitents received open reduction and internal plate screw fixation. Forty-seven patients with bone defect were given 6 - 15 g autologous ilium and 75 cases were given 5 ml calcium sulphate artificial aggregate after reduction.</p><p><b>RESULTS</b>All incisions healed by first intention after operation. Patients were followed up for 15 to 32 months postoperatively (mean 22 months). The fractures healed within 10 - 18 weeks after operation (mean 12 weeks). During the last follow-up, the mean palmar tilt was (7.0 ± 0.9)° and the mean ulnar variance was (21.0 ± 4.2)°, showing significant difference when compared with preoperation ((-5.0 ± 1.2)° and (8.0 ± 3.8)°). The radial heights were not abbreviated. According to Gartland and Werley assessment system, the results were excellent in 314 cases, good in 163 cases, fair in 46 cases, and poor in 16 cases 12 weeks after operation, the excellent and good rate was 88.5%.</p><p><b>CONCLUSIONS</b>The clinical effect of distal radius fracture treated with open reduction and internal plate fixation was relatively satisfactory. Meticulous operation procedure and individual rehabilitation strategy contribute to the wrist joint functional recovery.</p>

Three kind of scoring system for proximal humeral fractures in patients with postoperative functional review of evaluation: a multicenter study / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the ASES, Constant and HSS score systems and their significance on postoperative function of the shoulder.</p><p><b>METHODS</b>Totally 172 cases of proximal humeral fracture of five affiliated hospital from September 2004 to September 2008 were analyzed. All the functional outcome of the involved shoulder were evaluated by ASES, Constant, HSS score and patient self score. The correlations and agreement of three shoulder scales were analyzed with Pearson correlation test and Bland-Altman plot in different age groups and fracture types.</p><p><b>RESULTS</b>(1) The Constant score were lower than other two scores in the same age group and fracture type (F = 13.62 and 4.80, P < 0.05). (2) The correlations between three shoulder scales: ASES and Constant (r = 0.754, P = 0.0003), ASES and HSS (r = 0.755, P = 0.0001), Constant and HSS (r = 0.858, P = 0.0002). The correlations between three shoulder scales and patient self evaluation: ASES (r = 0.602, P = 0.0002), Constant (r = 0.705, P = 0.0001), HSS (r = 0.663, P = 0.0037). The Bland-Altman plot shows three shoulder scales have good agreement. (3)The correlation between Constant score and patient self evaluation decreased in the elder group and severe fracture type.</p><p><b>CONCLUSIONS</b>ASES, Constant, HSS shoulder score systems are all fit to evaluate the functional outcome of the shoulder, they have good correlation and agreement. Constant score in recommended for its high correlation coefficient with patient self evaluation score. However, its age bias must be paid attention in clinical practice. ASES shoulder score can be used in remote follow-up.</p>

Multicenter follow-up study of ankle fracture surgery / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Few data on ankle fractures in China from large multicenter epidemiological and clinical studies are available. The aim of this research was to evaluate the epidemiological features and surgical outcomes of ankle fractures by reviewing 235 patients who underwent ankle fracture surgery at five hospitals in China.</p><p><b>METHODS</b>This study included patients who underwent ankle fracture surgery at five Chinese hospitals from January 2000 to July 2009. Age, gender, mechanism of injury, Arbeitsgemeinschaft für Osteosynthesefragen (AO) fracture type, fracture pattern, length of hospital stay and treatment outcome were recorded. Statistical analyses were conducted using SPSS software. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, visual analogue scale (VAS), and arthritis scale were used to evaluate outcome.</p><p><b>RESULTS</b>Of 235 patients with ankle fractures, 105 were male with an average age of 37.8 years and 130 were female with an average age of 47.3 years. The average follow-up period was 55.7 months. There were significant differences in the ratios of patients in different age groups between males and females, and in mechanisms of injury among different age groups. There were also significant differences in the length of hospital stay among different fracture types and mechanisms of injury. In healed fractures, the average AOFAS ankle-hindfoot score was 95.5, with an excellence rate of 99.6%, the average VAS score was 0.17, and the average arthritis score was 0.18. Movement of the injured ankle was significantly different to that of the uninjured ankle. There were no significant differences between AO fracture types, fracture patterns or follow-up periods and AOFAS score, but there were some significant differences between these parameters and ankle joint movements, pain VAS score and arthritis score.</p><p><b>CONCLUSIONS</b>Ankle fractures occur most commonly in middle-aged and young males aged 20 - 39 years and in elderly females aged 50 - 69 years. The most common mechanisms of injury are twisting injuries and falls from a standing height or less. The results of surgical treatment are satisfactory.</p>

A new experimental model to study healing process of metaphyseal fracture / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There are few researches for the healing of metaphyseal fractures; moreover, the animal models to study the metaphyseal fractures are usually made by the oscillating saw osteotomy without reliable fixation, which is not in accordance with our current clinical practice. In this study, we established a new model to observe the healing process of metaphyseal fractures.</p><p><b>METHODS</b>Eighteen New Zealand rabbits were used in the study. The fracture model was created by splitting the medial tibial plateau in rabbits, then reset, and fixed with compression screws. At 1, 2, 3, 4, 6, and 8 weeks postoperatively, the tibial specimens were collected; firstly, a general observation and an X-ray examination of the specimens was done, and then they were embedded in methylmethacrylate and cut into sections with hard tissue slicer. The sections were stained with Giemsa reagent and examined under light microscopy.</p><p><b>RESULTS</b>There was no fracture displacement in the tibial specimens of all time points, except for one showing a collapse. No external callus formation could be observed by X-ray and general examination. After 1 week of the operation, the fracture gap was filled by mesenchymal tissue; 2 weeks postoperatively, a large number of woven bones were formed; from the third week onwards, the woven bone began to turn into lamellar bone, and new trabecular structure began to form. In all of the slices, no obvious chondrocytes formed in fracture areas; thus, there was no endochondral ossification.</p><p><b>CONCLUSIONS</b>This model was an ideal fracture animal model and suitable for the study of metaphyseal fracture healing. The X-ray and histological images demonstrated that metaphyseal fracture healing was a process of direct bone healing through intramembranous bone formation under the conditions of minor trauma, good reduction, and firm fixation.</p>

Clinical features analysis of femoral neck fractures in 219 patients / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the clinical features of femoral neck fractures and analyze related causes.</p><p><b>METHODS</b>The clinical data of patients with femoral neck fractures from June 2002 to August 2009 were retrospectively analyzed. The gender, age, fracture side, fracture type, basic social data, activities before injury, injury causes and treatment were analyzed.</p><p><b>RESULTS</b>A total of 219 patients (106 male and 113 female) was analyzed. All patients were divided into children group (age < 16 years), adult group (age ranged from 16 to 60 years) and older group (> 60 years). There were 5 patients (2.3%) in the children group, 81 patients (37.0%) in the adult group and 133 patients (60.7%) in the older group. There were 11 patients (5.0%) with Garden I fractures, 32 patients (14.6%) with Garden II fractures, 90 patients (41.1%) with Garden III fractures and 86 patients (39.3%) with Garden IV fractures. Fall damage and traffic injury were the main injury types. Home and public place were the main injury sites.</p><p><b>CONCLUSIONS</b>The incidence of femoral neck fracture shows the highest in the old persons. The male patients with femoral neck fractures are more than female patients in children and adult group, while the male patients with femoral neck fractures are less than female patients in older group. The dominant fractures type according to Garden classification is Garden III fractures in children and adult groups, but Garden IV fractures in older group. Fall damage and traffic injury are the main injury types. Home and public place are the main injury sites.</p>

Calcitonin gene-related peptide induces proliferation and monocyte chemoattractant protein-1 expression via extracellular signal-regulated kinase activation in rat osteoblasts / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Calcitonin gene-related peptide (CGRP), a sensory neuropeptide, affects osteoblast proliferation and bone formation. However, the mechanisms are not fully understood. Monocyte chemoattractant protein-1 (MCP-1) is a chemokine that stimulates the migration of monocytes and plays important roles in regulating bone remolding during fracture repair. In this study, we investigated the effects of CGRP on proliferation and MCP-1 expression in cultured rat osteoblasts.</p><p><b>METHODS</b>Primary rat osteoblasts were isolated from fetal rats calvariae. Cells were exposed to gradient concentrations (10(-9) to 10(-7) mol/L) of CGRP. Protein and mRNA levels of MCP-1 were quantified by Western blotting and semiquantitative reverse transcription-polymerase chain reaction, respectively. The protein level of MCP-1 was investigated and compared in cell culture media by enzyme linked immunosorbent assay (ELISA). Phospho-extracellular signal-regulated kinase (ERK) expression was detected by Western blotting. Cell proliferative activity was measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) and BrdU assay. The effects of MAPK/ERK kinase (MEK)-inhibitor U0126 on CGRP-induced MCP-1 expression in primary rat osteoblasts were examined.</p><p><b>RESULTS</b>CGRP effectively enhanced primary rat osteoblast proliferation and led to significant increases in the expression of MCP-1 mRNA and protein in time- and dose-dependent manners. CGRP activated the ERK pathway. Pretreatment of cultured rat osteoblasts with MEK inhibitor U0126 resulted in dose-dependent inhibitions of CGRP-induced MCP-1 mRNA and protein levels. Thus, CGRP promoted cell proliferation and stimulated MCP-1 expression in cultured rat osteoblasts.</p><p><b>CONCLUSION</b>These studies document novel links between CGRP and MCP-1 and illuminate the effects of CGRP in regulating bone remodeling.</p>

Clinical outcomes of total elbow replacement in the treatment of complex distal humeral fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the efficacy of total elbow replacement in the treatment of complex distal humeral fractures.</p><p><b>METHODS</b>From May 2005 to October 2008 12 patients were retrospectively studied who were diagnosed complex fractures of the distal humerus and treated by total elbow replacement (Coonrad-Marrey). The mean age was 60 years old, the mean follow-up time was 12 months. According to AO classification, there was 3 C2 and 9 C3. The study included: pain evaluation, range of motion, elbow stability, muscle strength, complications, Mayo elbow score, DASH score, radiological assessment of ectopic bone formation and loosening.</p><p><b>RESULTS</b>Two cases with mild pain. The mean flexion is 98.3 degrees, extension limit is 17.9 degrees, mean pronation is 82.9 degrees and supination is 70.8 degrees. All joints were stable postoperatively. All patients were satisfied with the outcome. There was 1 case of superficial soft tissue nonhealing and 2 cases of ulnar nerve symptoms. No ectopic bone formation or loosening was found. Mayo elbow score was 3 cases of excellent and 9 cases of good. The mean DASH score was 41.3.</p><p><b>CONCLUSION</b>Total elbow replacement can be used in such conditions as severe osteoporosis, severe comminution that internal plates can not get stable fixation, severe cartilage damage (because of fracture or inflammatory arthritis) that indicate traumatic or inflammatory arthritis.</p>

Overall anatomical features and clinical value of the sacral nerve in high resolution computed tomography reconstruction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sacral nerve injury is a common complication of pelvic or sacral fractures. As the sacral nerve courser within the sacrum and has a complex relationship with the surrounding tissues, different parts of the sacral plexus injury have similar clinical symptoms and signs. Since lack of specific imaging technique in the diagnosis of sacral nerve injury, especially on multi-segment, multi-site, how to determine the preoperative location and extent of the sacral nerve injury accurately becomes a concern of the general orthopaedic and images practitioners. This study was conducted to gain an insight into the overall anatomical features of the sacral nerve (SN) on the same slice in high resolution computed tomography (HRCT) reconstruction and to determine the value of this information for the clinical diagnosis of related diseases.</p><p><b>METHODS</b>Fifty healthy volunteers and 30 patients (40 sides) with SN lesions confirmed by surgery were scanned using a 16-slice helical CT scanner (Light Speed, GE, USA). Among the patients, 6 with intervertebral disk hernia (6 sides), 8 with spinal stenosis (12 sides), 11 with pelvic trauma (14 sides), 4 with pelvic malignancies (6 sides), and 1 with sacral vertebral tuberculosis (2 sides). The SN multiplanar reconstruction was performed using a UNIX-based SCD4.1 workstation where the image was set on the same slice. All images were stored in the Digital Imaging and Communications in Medicine format. The display of nerves in different sections was analyzed using a five-graded scale with coordinate curves of each individual score. The overall anatomic features visible on the slice were analyzed and the abnormalities of the lesions were studied.</p><p><b>RESULTS</b>The image of the same slice clearly revealed the shape, running direction, thickness, tension and adjacent anatomy of the S1-S4 nerves. The rank of display rates in different sections was: outward-rotated oblique sagittal > outward-rotated oblique coronal > oblique coronal plane > coronal > sagittal > transverse section. The S5 nerve was partially displayed from the starting point to the segment around the posterior sacral foramen. The overall anatomy of the triangular sacral plexus was only revealed in the oblique outward-rotated sagittal section, while 100% of its individual rami, as well as two or three of the adjacent rami, were displayed from their starting points to the anterior border of the piriformis. The abnormalities included 39 sides of morphological change (97.5%), 38 sides of compression (95.0%), 35 sides of adhesion (87.5%), 32 sides of displacement (80.0%), 34 sides of shrinkage (85.0%), 6 sides of thickening (15.0%), and 2 sides of abruption (5.0%).</p><p><b>CONCLUSIONS</b>The 16-slice CT multiplanar reconstruction was able to reveal the overall anatomic features of the SN on the same slice. The section of reconstruction was a crucial factor in determining the display capability of various sacral nerves. This technology was valuable in the diagnosis and management of related diseases.</p>

Neuronal differentiation of PC12 cells induced by sciatic nerve and optic nerve conditioned medium / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Previous work has shown that optic nerve and sciatic nerve conditional medium had neurotrophic activity on neurons. In order to find if the optic nerve conditioned media (CM) had a similar activity to make PC12 cells differentiate as sciatic nerve CM did, we explored the neurotrophic activity in optic nerve CM in the same in vitro system and compared the neurotrophin expression levels in optic and sciatic nerves under both conditions.</p><p><b>METHODS</b>PC12 cells were used to examine the effects of neurotrophins secreted by the sciatic nerve and optic nerve. RT-PCR and real-time QPCR showed that the sciatic nerve and optic nerve produced a range of neurotrophins including nerve growth factor (NGF), brain derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3).</p><p><b>RESULTS</b>The effects of sciatic nerve and optic nerve CM on neurite outgrowth were tested against a range of neurotrophins, and they had different neuritogenic activities. Only NGF and sciatic nerve CM had obvious neuritogenic activities, although the concentration of NGF in the sciatic nerve CM was very low.</p><p><b>CONCLUSIONS</b>Our experiment showed that sciatic nerve CM had a higher neurotrophic activity on PC12 cells than optic nerve CM. These results suggested that peripheral nervous system (PNS) and central nervous system (CNS) had different expression levels of neurotrophin, which may in part explain the lack of ability to regenerate the CNS.</p>

The prospective study project of 62 cases spinal cord injury / 中华外科杂志

<p><b>OBJECTIVE</b>To rudiment analyze the different intervention factors affecting the spinal cord injury functional recovery initially through prospective study project.</p><p><b>METHODS</b>Designed prospective study project without clinical treatment intervention and admitted 62 spinal cord injury cases into observation group from Dec 2006 to Dec 2007. The internalized standard included acute spinal cord injury within 1 week, aged from 18 to 65 years old without sexuality difference and diagnosed as type A injury: total spinal cord injury or type B injury: non-total spinal cord injury (without movement function below the injury plane) according to clinical physical examination and combined MRI or CT examination. All the 62 cases were followed up. The spinal cord function were estimated at the time of arriving hospital, 1, 3, 6 months after injury during the following up time according to the American Spine Injury Association standard (Revised at 2000) and functional independence measure (FIM) score. The intervention factors affecting the spinal cord injury functional recovery were analyzed.</p><p><b>RESULTS</b>Among the 62 cases, male 60 cases and female 2 cases, aged from 18 to 41 years old, mean age 24 years old, 29 cases can be classified into type A injury and 33 cases can be classified into type B injury. There was no significant difference (Index including sense ASIA, motor ASIA and FIM) between operation group and non-operation group, namely conservatively composite treatment at all observation point in all type A injury cases (P > 0.05). There was significant difference (Index including sense ASIA, motor ASIA and FIM) between operation group and non-operation group at all observation point in all type B injury cases (P < 0.05); And there was significant difference (Index including sense ASIA, motor ASIA and FIM) between operated in 8 hours (< or = 8 h) group and beyond 8 hours (> 8 h) group at all observation point in all type B operated cases (P < 0.05).</p><p><b>CONCLUSIONS</b>Operation and operation time were of no significant value for type A injury (total spinal cord injury), but considering the nursing convenience and the need for spinal stabilities, operation decompression and internal fixation can be chosen; Operation decompression should be performed as soon as quickly for type B injury (non-total spinal cord injury) in order to get better functional recovery.</p>

Traditional Chinese medicine and formulas of improving peripheral nerve regeneration / 中国中药杂志

Peripheral nerve impairment is a common complication in surgery, which repair relates directly to the recovery of motor function and sensory function. Clinical researchers always do nerve sutrure using microsurgical technique and adjuvant treatment to improve peripheral nerve regeneration. Western medicine used usually of adjuvant drugs, such as neurotrophic factors, are limited by their defects in clinical application. Traditional Chinese medicine classifies peripheral nerve impair as paralysis and arthromyodynia, considers that it is the result of defects of meridian and vessels, QI and blood, bones and muscles. So, drugs used usually are QI invigorating herbs, blood circulation promoting herbs for unblocking collaterals, and nourishing herbs, including astragali, hedysari, ginkgo leaf, angelica, danshen root, paeoniae radix, epimedium, chuanxiong, and common basic formulas, such as Buyang Huanwu decoction, Huangqi Guizhi Wuwu decoction, Huoxue Kangyuan decoction, compound radix hedysari, etc. To be ready for further study and development, we review the traditional Chinese medicine and formulas in this article.