Progress of parathyroid hormone regulating bone metabolism via different signaling pathways / 中国骨伤

Parathyroid hormone is one kind of osteoanabolic agents widely used in clinic for osteoporosis. However, parathyroid hormone needs to be further optimized in the treatment of osteoporosis due to its two way regulatory effect of bone formation with low-dose intermittent treatmentand bone resorption with high-dosecontinuous treatment. Hence, based on the molecular mechanism of parathyroid hormone regulating bone metabolism, we conclude that parathyroid hormone regulates bone metabolism mainly through the following signaling pathways: (1) Gs/cAMP/PKA signaling pathway, whichis the main mechanism of parathyroid hormone regulating bone metabolism to lead to bone formation or bone resorption. (2) G

Finite element optimization analysis of minimally invasive screw treatment for Sanders typeⅡcalcaneal fracture / 中国骨伤

OBJECTIVE@#To explore biomechanical characteristics of minimally invasive different screw fixations in treating Sanders typeⅡcalcaneal fractures.@*METHODS@#Dicom data of calcaneus by CT scan were input into Mimics 21.0 software and Ansys15.0 software to construct three-dimensional finite element digital model of calcaneus;this model was input into UG NX 10.0 software, and calcaneus was cut according to Sanders classification to establish Sanders typeⅡ calcaneus model with posterior articular surface collapse;then simulated minimally invasive screw internal fixation after calcaneal fracture:a screw from posterior articular surface was used to outside-in fix sustentaculum tali, other 4 screws were used to fix calcaneus by different methods through calcaneal tuberosity, and 4 different calcaneal models were obtained. Under the same conditions, 4 types of internal fixation models were loaded respectively, and nonlinear finite element analysis was performed to calculate the stress distribution of different internal fixation models.@*RESULTS@#Under the same condition of loading, the model 3 had smaller displacement value, maximum calcaneus displacement value and maximum equivalent stress value of the screw than other three internal fixation models, and the stress was more dispersed.@*CONCLUSION@#In minimally invasive screw internal fixation of calcaneus fracture, after 1 sustentaculum tali screw fixation, 2 screws crossed fix posterior articular surface from calcaneal tuberosity, 2 screws fix parallelly calcaneocuboid joint from calcaneal tuberosity are more suitable for biomechanical requirements, and could provide basic theory for clinical treatment.

Meta-analysis of direct anterior approach and other approaches for hemiarthroplasty in elderly patients with femoral neck fracture / 中国骨伤

OBJECTIVE@#To systematically evaluate the clinical efficacy of high-quality direct anterior approach (DAA) and other approaches for the treatment of elderly patients with femoral neck fracture.@*METHODS@#Literatures published in English or Chinese about the direct anterior approach and other approaches for hemiarthroplasty in femoral neck fracture were searched on Cochrane Library, PubMed, EMBASE, Web of science, Wanfang, CNKI databases from their establishment to May 2019. According to the inclusion and exclusion criteria, two researchers independently screened the literatures, and extracted the data. The quality of RCT were evaluated by Cochrane Risk of Bias Assessment Tool, and non-RCT were evaluated by the NOS scale. Meta-analysis was performed using the RevMan 5.3 software.@*RESULTS@#A total of 9 articles were included with 901 cases, in which 429 cases used DAA, and 472 used other approaches. DAA had a significantly lower dislocation rate compared to subgroup of posterior and posterolateral approach [=0.19, 95%CI (0.06, 0.61), =0.005]. No significant differences were found between DAA group and subgroup of direct lateral and anterolateral approach[=1.08, 95%CI(0.20, 5.76), =0.93]. Also there were no relevant differences between the DAA group and control in infection rate[=1.07, 95%CI(0.47, 2.43), =0.88], perioperative fracture rate[=0.95, 95%CI(0.36, 2.50), =0.92], re operation rate[=0.76, 95%CI(0.30, 1.89), =0.55], overall complication rate [=0.88, 95%CI (0.63, 1.22), =0.44], mortality [=1.33, 95%CI (0.84, 2.11), =0.23], operative time[MD=1.43, 95%CI(-5.85, 8.71), =0.70].@*CONCLUSION@#The current evidenceindicates that the DAA was associated with a significantly lower dislocation rate compared to posterior capsular approaches for hemiarthroplasty. There was no significant difference in dislocation rate with the lateral and anterolateral approach.

Preliminary development of guided template of middle and upper thoracic percutaneous vertebroplasty in thoracic pedicle approach due to three dimentional soft tissue print technique / 中国骨伤

OBJECTIVE@#To investigate the feasibility of a drill template for the placement of guided template of middle and upper thoracic percutaneous vertebroplasty in thoracic pedicle approach on digital design and 3D printing technology.@*METHODS@#The preoperative CT images of 20 patients with thoracic fracture were collected retrospectively. With the 3D soft tissue printing technology, the data was reconstructed by 3D imaging reconstruction software to produce 1∶1 three dimensional soft tissue model. The pedicle screw channel and the digital template were designed by the 3-matic module of Mimics15.0 software. After guide template was printed by 3D printer and three dimensional template was fixed on the model, 2.0 mm Kirschner was placed and the accuracy of a drill template was observed by CT scans, bone cement was injected through the puncture tube and verified with images. The time of nail guide design, guide template production and cost were recorded.@*RESULTS@#The effectiveness of three dimensional thoracic model and digital guided template of middle and upper thoracic percutaneous vertebroplasty of thoracic fractures in thoracic pedicle approach was confirmed. Kirschner was placed and the accuracy of screw placement was confirmed with CT scanning. Template and the corresponding anatomical landmark fitted well, bone cement had showed good filling. The average printing time of upper thoracic spine model with soft tissue, the mean time of nail guide design, guide template production and cost were (719.00±3.03) min, (12.30±1.01) min, (55.50±10.30) min and RMB 3 150 yuan on average respectively.@*CONCLUSION@#By means of individual design and 3D soft tissue printingtechnology, accurate placement of guided template of middle and upper thoracic percutaneous vertebroplasty could be realized.

Application of reverse dermal revascularization combined with vacuum sealing drainage in the large area of skin avulsion of the lower extremities / 中国骨伤

OBJECTIVE@#To summarize the clinical effect of emergency subcutaneous vascular network reverse skin replantation combined with vacuum sealing after drainage of large area skin avulsion injury.@*METHODS@#Clinical data of 30 patients with extensive skin avulsion of the lower limb treated between July 2010 and March 2018 were collected. There were 20 males and 10 females, ranging in age from 16 to 67 years old, with an average of(48±13) years old. Cause of injury: 19 cases of car accident injury, 11 cases of crush injury. The surgery time was 3 to 10 h, with an average of (5±1) h. All cases were completely debrided in stage I. The subdermal vascular network was reversed and skin grafted with multiple incision drainage combined with negative pressure closed drainage technique for 7 to 10 days. The wounds were removed by VSD observation:if the necrotic area is large, debridement is required. After the granulation growth of the wound is satisfactory, the skin grafting is performed again after electrification; the small area of necrotic skin strengthens the dressing and heals.@*RESULTS@#30 patients were followed up for 7 to 48 months, with an average of (20±11) months.No infection in 1 case appeared, 30 patients, living area more than 85% of the wound after treatment survival in the stage I; The skin necrosis ranged from about 12% in 5 patients in the stage II. The second stage was healed after redebriding free skin grafts. The other patients were healed after the dressing, capillary meshwork layer of skin color, good elasticity, feeling, wearable pressure, each joint activities is good, no obvious skin adhesion cause physical activity is limited.@*CONCLUSIONS@#Reverse skin grafting combined with VSD for the treatment of large skin avulsion of lower limb can greatly reduce wound infection rate, promote the application of skin and wound, conducive to drainage, improve the survival rate of reverse skin grafting and improve the function of lower limb joints.

Surgical treatment of capitellum and trochlea fractures in adult through Kaplan approach associated with anteromedial approach / 中国骨伤

OBJECTIVE@#To investigate the surgical treatment and outcome of capitellum and trochlea fractures in adult through Kaplan approach associated with anteromedial approach.@*METHODS@#From September 2012 to September 2016, 15 patients with capitellum and trochlea fractures were treated by Kaplan approach associated with anteromedial approach. Of the 15 cases, there were 6 males and 9 females, aged from 21 to 69 years old, with a mean of (42.0±10.5) years old. Eight patients had fractures on the left and 7 patients on the right. All the fractures were classified into type IIA(5 cases), type IIIA(4 cases) and type IIIB (6 cases) according to Dubberley classification. The results were evaluated by Mayo elbow function score for analysis.@*RESULTS@#All the patients were followed up, the mean follow-up duration was(13.0±4.7) months(ranged 8 to 26 months). The mean Mayo elbow function score was 85.6±5.3(ranged 76 to 94). Postoperative follow-up had 4 cases excellent, 7 cases good, and 4 cases fair. Average arc of motion in elbow was(129.2±12.1)° in flexion and(6.6±1.9)° in extension.@*CONCLUSIONS@#The surgical treatment of capitellum and trochlea fractures in adult through Kaplan approach associated with anteromedial approach can better expose the fractures to achieve the satisfactory exposure and finish the surgical procedure, and the short-term outcome is satisfactory.

Meta analysis of unilateral condylar replacement and high tibial osteotomy in the treatment of medial compartment osteoarthritis of the knee / 中国骨伤

OBJECTIVE@#Meta-analysis was used to compare the clinical efficacy of high tibial osteotomy(HTO) and unicondylar arthroplasty (UKA) in the treatment of medial compartment osteoarthritis (MIOA) and provide a better surgical choice for patients with MIOA.@*METHODS@#The Cochrane Library (Issue 6, 2017), PubMed, Ovid, ELSIVE, CNKI and Wanfang databases were searched by a computer. Literatures on HTO and UKA for MIOA from January 1, 1970 to June 30, 2017, including complications, knee joint score, knee mobility, revision rate and excellent and good rate, were searched and screened out according to the inclusion criteria, and strict quality evaluation was carried out. RevMan 5.0 software provided by Cochrane collaboration network was used to conduct the meta-analysis of the included research results and to test the heterogeneity of the data.@*RESULTS@#Total 13 articles met the inclusion criteria, and the total sample size was 1 043. Among them, 462 were HTO treatment group and 581 were UKA treatment group. By comparison between HTO treatment group and UKA treatment group, there were significant differences in the contralateral deterioration rate[WMD=3.21, 95%CI(1.13, 9.10)], pre-operative knee range of motion[WMD=6.55, 95%CI(1.44, 11.66)], Lysholm knee score[WMD=-3.15, 95%CI(-4.77, -1.53)], complications[WMD=2.78, 95%CI(1.52, 5.11], revision rate[WMD=1.81, 95%CI(1.17, 2.80)], the rate of excellent and good[WMD=0.49, 95%CI(0.30, 0.80)], and femorotibial angle changes[WMD=-2.37, 95%CI, (-3.63, -1.11)](0.05).@*CONCLUSIONS@#Based on the limited data, high tibial osteotomy is a better choice for the treatment of medial compartment osteoarthritis in the comparison of short and medium-term clinical outcomes, and long-term clinical outcomes may need further study.

Biomechanical study of the stability of subaxial cervical anterior transpedicular screw fixation for three-column injury / 中国骨伤

<p><b>OBJECTIVE</b>To compare the stability of subaxial cervical anterior transpedicular screw(ATPS) fixation and three traditional fixations for three-column injury.</p><p><b>METHODS</b>Six specimens of cervical spine were prepared. After measurememt of the range of motion(ROM) in intact state, the specimens were made into three-column injury models. The models were reconstructed with an anterior cervical cage, and stabilized by ATPS, anterior plate(AP), anterior plate + lateral mass screw(AP+LMS) and posterior transpedicular screw(PTPS). The ROM of the models in the four states were measured, and the results of data were compared after standardization.</p><p><b>RESULTS</b>The normalized ROM of ATPS state in flexion-extension, lateral bending, axial rotation were(77.17±4.75)%, (82.00±2.61)%, (83.17±2.23)%, which were significant small than those in intact state(<0.05). The normalized ROM of AP state in flexion-extension, lateral bending, axial rotation were(119.67±7.42)%, (116.33±7.53)%, (112.67±5.99)% , which were significant larger than those in intact state(<0.05). The normalized ROM of AP in all directions were significant larger than those of ATPS(<0.05). There was no significant difference between normalized ROM of PTPS state and those of ATPS state in flexion-extension and lateral bending(>0.05). The normalized ROM of PTPS state in axial rotation was(6.83±2.48)% and was significant larger than that of ATPS state(=0.009). The normalized ROM of AP+LMS state in flexion-extension was(68.50±2.43)%, which was significant smaller than that of ATPS state(=0.003). There was no significant difference between the normalized ROM of AP+LMS state and those of ATPS state in lateral bending and axial rotation(>0.05).</p><p><b>CONCLUSIONS</b>Subaxial cervical three-column injury model reconstruction by ATPS can provide the adequate primary stability, of which biomechanics property is superior compared to AP and PTPS, and is similar to that of AP+LMS. It can be applied to the patients with no need to decompression and reduction through posterior approach.</p>

Preliminary development of drill template-assisted placement of reverse intramedullary lag screw for superior ramus of pubis using three dimentional print technique / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the feasibility of a drill template for the placement of reverse intramedullary lag screws on the outside of the pubis based on digital design and 3D printing technology.</p><p><b>METHODS</b>The preoperative CT images of a 23-year-old male patient with pelvic fracture were collected retrospectively. According to the Young and Burgess classification, the type of pelvic fracture was LC IIwith the 3D printing technology. The data was reconstructed by 3D imaging reconstruction software to produce 1:1 three dimensional model. The screw channel and the individual drill template was designed by the softwares of Mimics 10.01 and Geomagic 12, the accuracy of a drill template was observed by X-rays and CT scans after the placement of 2.0 mm K-wires in the three dimensional template fixed on the model.</p><p><b>RESULTS</b>Three dimensional pelvic model and digital, individual drill template could meet the requirement of the placement of reverse interamodullary lay screw for the treatment of superior ramus of pubis fracture. K-wire was placed and the accuracy of screw placement was confirmed using the X-ray and CT scanning. Template and the corresponding anatomical landmark fitted well.</p><p><b>CONCLUSIONS</b>With the assistance of the individual design and 3D printing technology, the accurate placement of superior ramus of pubis fracture screws can be realized. This technology is helpful to reduce the operation time and X-ray exposure of the patients and doctors.</p>

Percutaneous endoscopic lumbar discectomy combined with epidural injection for prolapsed lumbar disc herniation / 中国骨伤

<p><b>OBJECTIVE</b>To assess the effect of percutaneous endoscopic lumbar discectomy (PELD) combined with epidural injection for prolapsed lumbar disc herniation(PLDH).</p><p><b>METHODS</b>In this prospective randomized controlled study, the clinical data of 126 patients who had undergone a PELD because of a single-level PLDH from March 2014 to June 2015 were analyzed. There were 67 males and 59 females, ranging in age from 17 to 75 years old with an average of(41.0±13.5) years old, 9 cases were L₃,₄, 76 cases were L₄,₅ and 41 cases were L₅S₁. According to the random number table, the patients were randomized into two groups, with 63 patients in each group. Patients in group 1 were injected normal saline after PLED, patients in group 2 were subjected to an epidural injection of Diprospan, Lidocaine and Mecobalamine after PLED. All the patients were followed up from 6 to 20 months with the mean of 12.4 months. Complications, the postoperative hospital stay, the period of return to work, visual analogue scale (VAS) and Japanese Orthopedic Association (JOA) score were compared between two groups, and clinical outcomes were evaluated according to modified MacNab criteria.</p><p><b>RESULTS</b>All the operations were successful, and no complications were found. The mean postoperative hospital stay and the period of return to work in group 1 were (4.61±1.25) days and (4.31±0.47) weeks, respectively, and in group 2 were (2.53±0.69) days and (3.14±0.52) weeks, there was significant differences between two groups(=0.000). Postoperative VAS and JOA scores in two groups were obviously improved (=0.000). At 1 day, 1 week, 1 month after operation, VAS, JOA scores in group 2 were better than that of group 1(=0.000), and after 6 months, there was no significant difference between two groups(>0.05). According to the modified MacNab criteria, 39 cases got excellent results, 21 good, 3 fair in group 1, and which in group 2 were 41, 20, 2, respectively, there was no significant difference between two groups(=0.087).</p><p><b>CONCLUSIONS</b>PELD is an mini-invasive technique for PLDH, it can fleetly reduce pain and improve function. And combination with epidural injection has the advantages of pain releasing and function improving in the short-term postoperative period, and it can decrease postoperative hospital stay and time of returning to work, and it is a safe and effective method.</p>

biomechanical study of the influence to the forefoot plantar pressure of the first tarsometatarsal joint fracture-dislocation fixed by three different implants

Objectives: To study the influence of forefoot plantar pressure of the first tarsometatarsal joint fracture-dislocation by three different implants to provide experimental reference in selecting implants

Methods: Eight fresh foot specimens were made into the models of the first tarsometatarsal joint fracture-dislocation, which were fixed with 3.5 mm cortical screw, 1/4 tubular plate and compressive staple in turn. After the loading of 600N, the changes of the plantar pressure in forefoot were measured by the method of the F-scan plantar pressure system

Results: After first tarsometatarsal joint fracture-dislocation, the peak pressure under the first metatarsal head would decrease, while the pressure under the second metatarsal head would increase [P<0.05]. When the first tarsometatarsal joint was fixed with screw or plate respectively; the peak pressure under the two metatarsal heads would tend to be normal. However, the staple fixation would show the statistical significant difference, although the peak pressure under the first and second metatarsal heads were recovered in some extent [P<0.05]

Conclusions: After the first tarsometatarsal joint fracture-dislocation, the plantar pressure might be compensated partly by the adjacent metatarsal heads. While the first tarsometatarsal joint fracture-dislocation was fixed by screw or plate, the plantar pressure of the forefoot would return to the normal state. However, if the joint was fixed by the staple, it would still be difficult to return the plantar pressure to be normal

Clinical results of femoral head fracture-dislocation treated according to the Pipkin classification

Objective: To summarize the clinical results of femoral head fracture-dislocation treated according to Pipkin classification

Methods: A total of 19 patients with femoral head fracture-dislocation were retrospectively analyzed from Mar. 2008 to Mar. 2015. According to the classification of Pipkin criteria, there were 4 cases in Type-I, 6 cases in Type-II, 6 cases in Type-III and 3 cases in Type-IV. Various procedures were taken according to the different types of the fracture, the time of the fracture, and the age of the patients. X-ray was examined during the follow-up period and functional evaluation was carried out by Harris Hip Score's criteria. The clinical therapeutic effects were analyzed

Results: All the patients got a mean follow-up of 18 months [9-36 months]. No patient suffered from infection, skin flap necrosis and X-ray showed no implants loosening or breakage. According to the Harris Hip Score's criteria, in Type-I, 4 cases were rated as excellent. In Type-II, 2 cases rated as excellent, 3 cases as good and 1 case as fair. In Type-III, 3 cases rated as good, 2 cases as fair and 1 case as poor. In Type-IV, 1 case rated as excellent, 1 case as good and 1 case as fair. The overall rate of excellent and good was 73.7%

Conclusions: Pipkin classification is helpful to make preoperative plan and judging the prognosis in cases of femoral head fracture-dislocation. However, multiple factors such as the time from injury to surgery, the ages of patients, the selection of implants should also be considered, which may affect the clinical results

linical application of personalized 3D printing-guided template of intramedullary lag screw insertion on lateral superior ramous of pubic / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the efficacy and advantages of personalized 3D printing-guided template of lateral superior ramous of pubic intramedullary lag screw.</p><p><b>METHODS</b>From July 2015 to December 2016, 20 patients with the superior and inferior ramous of pubis fracture were treated with lag screws placement. All the patients were divided into test group(with guided template) and control group(with general operation). There were 7 males and 3 females with an average age of (46.20±3.03) years old in test group and 6 males and 4 males with (48.50±2.25) years old in control group. There were 6 cases and 5 cases of superior and inferior branches fractures of pubic on the left side and 4 cases and 5 cases on the right side in two groups respectively. The operation time, perspective times and bleeding loss were compared between two groups.</p><p><b>RESULTS</b>The test group and the control group had no statistically significant relative to gender, age, fracture classification. The average time of surgery, average intraoperative fluoroscopy times, mean blood loss in test group were (31.0±5.3) min, (3.5±2.1) times, (75.6±10.5) ml respectively, and in control group were(55.0±6.8) min, (27.6±3.2) times, (85.5±12.5) ml respectively. There were significant Statistical differences between two groups(<0.05) in average operation time and average fluoroscopy times, however, mean blood loss had no significant differences between two groups(>0.05).</p><p><b>CONCLUSIONS</b>The personalized guide template based on 3D printing technology could realize precise placement of the lateral intramedullary lag screw fixation in the superior branch of pubic, also could save the operation time and reduce the times of radiation exposure of patients and surgeons.</p>

Comparison of fixation of sustentaculum tali of calcaneus aided by director for sustentaculum tali screwing and ordinary screwing guide / 中国骨伤

<p><b>OBJECTIVE</b>To explore clinical outcomes of director for sustentaculum tali screwing for fixing sustentaculum tali of calcaneus.</p><p><b>METHODS</b>From May 2012 to October 2013, totally 50 patients (60 feet) with calcaneal fractures were analyzed, and divided into director for sustentaculum calcaneous tali screwing treatment group (group A) and ordinary screwing group(group B). In group A, there were 25 patients, including 22 males and 3 females, aged from 17 to 75 years old with an average of (45.08±11.98) years; according to Sanders classification, 9 feet were type II, 16 feet were type III, and 7 feet were type IV. In group B, there were 25 patients, including 20 males and 5 females, aged from 19 to 78 years old with an average of (46.36±15.74) years; according to Sanders classification, 8 feet were type II, 13 feet were type III, and 7 feet were type IV. Radiological change, operative time, postoperative complications were observed and compared, Maryland scoring at 1 year after operation was applied to evaluate clinical outcomes.</p><p><b>RESULTS</b>Fifty patients were followed up, group A was followed up from 12 to 24 months with an average of (17.72±4.08) months;while group B was followed up from 12 to 24 months with an average of (18.68±3.40) months;there was no significant difference between two groups in following-up time(>0.05). There were significant difference in operative time, complications and fluoroscopy times between two groups(<0.05). There were significant difference in Böhler angle and Gissanes angle between two groups before and after operation(<0.05). Maryland score at 1 year after operation in group A was (84.94±12.75) and (76.96±15.32) in group B, had significant meaning between two groups (<0.05).</p><p><b>CONCLUSIONS</b>Fixation of sustentaculum tali of calcaneus aided by director for sustentaculum tali screwing, has advantages of less operative time, fluoroscopy times, incidence of complications and good recovery of function, which could provide a new aiding method for treating intra-articular calcaneal fractures.</p>

Meta-analysis on limb salvage and amputation for patients with local Enneking II osteosarcoma / 中国骨伤

<p><b>OBJECTIVE</b>To explore 5-year survival rate, local recurrence and metastasis rate of limb salvage and amputation for patients with local Enneking II osteosarcoma by Meta-analysis.</p><p><b>METHODS</b>From January 1, 1970 to December 1, 2015, Subject term and keywords about limb salvage and amputation for local Enneking II osteosarcoma with pathological fracture were searched from Cochrane, PubMed, Ovid, Spinger Link, Embase, CNKI and WanFang database foundation. Literature confirm with inclusion criteria were choose and quality evaluation were performed. RevMan 5.0 software from Cochrane collaboration was used to perform Meta-analysis. Local recurrence, 5-year survival rate and odds ratio of transfer risk were compared between limb salvage and amputation group.</p><p><b>RESULTS</b>Ten literatures confirm with inclusion criteria were included, and total sample size was 453. There were 315 patients in limb salvage group and 138 patients in amputation group. Five-year survival rate in amputation group was lower than that of limb salvage group [OR=2.88, 95%CI(1.40, 5.93)], however metastasis rate in limb salvage was less than that of amputation group [OR=0.43, 95%CI(0.20, 0.94)];there were no significant differences in local recurrence between two groups [OR=1.47, 95%CI (0.73, 2.97)]. Functional rehabilitation in limb salvage group was better than that of amputation group by MSTS systematic review.</p><p><b>CONCLUSIONS</b>Limb salvage as an alternative in treating local Enneking II osteosarcoma with pathological fracture does not greatly increase risk of local recurrence or 5-year overall survival rate compared with amputation group, and has a lower risk of metastatic occurrence.</p>

Intralesional curettage and wide excision for treatment of giant cell tumors (GCTs) of the distal radius: A Meta-analysis / 中国骨伤

<p><b>OBJECTIVE</b>To search all studies that had been published in the world with regarding to the effectiveness of the extent of intralesional curettage and wide excision for recurrence rate and complications and comparative functional outcomes in patients with giant cell tumours (GCT) of the distal radius and analyze them which were in high quality by means of Meta analysis, in order to give some evidences for the choice of method dealing with giant cell tumors GCT in surgery.</p><p><b>METHODS</b>Cochrane central register of controlled trials(Issue 8 2014), PubMed(1970-01-01/2013-01-01), Ovid (1970-01-01/2013- 01-01), Elsevier (1970-01-01/2013-01-01), CNKI (1970-01-01/2013-01-01) were searched. Including intralesional curettage and wide excision were performed to treat giant cell tumors (GCTs) of the distal radius in the literatures, selecting on meet eligibility in the standard literatures underwent strict quality assessment. The Meta-analysis was performed with software RevMan5.0 from the Cochrane collaboration. Additionally, the analysis checked the heterogeneity of data. The effectiveness of the extent of intralesional curettage and wide excision for recurrence rate and complication in patients with giant cell tumours of the distal radius were evaluated and Odds Ratio was calculated.</p><p><b>RESULTS</b>Seven relevant articles were identified involving total 163 cases. Among them, 92 cases were intralesional curettage (PMMA, n = 54; bone graft, n = 33; no PMMA or bone grafts, n = 5) and 71 cases were wide excision. The patients in the intralesional curettage group had a higher recurrence rate [OR = 3.87, 95% CI (1.42, 10.53)],especially for Campanacci grade 3 GCTs [OR = 10.12, 95% CI (1.57, 65.27)], yet fewer major complications [OR = 0.13, 95% CI (0.04, 0.40)] than the wide excision group. The use of PMMA versus bone graft did not affect the recur- rence rate [OR = 0.96, 95% CI (0.26, 3.56)]. By selecting the system evaluation of MSTS, the VAS and dynamometer, the result showed that the intralesional curettage group was equivalent or preferable to wide excision in terms of function rehabilitation.</p><p><b>CONCLUSION</b>Based on data obtained from the limited number of studies available, intralesional curettage appears to be moreappropriate for the treatment of local lesions (Grade 1 and 2) than Grade 3 GCTs of the distal radius. Moreover, PMMA was not additionally effective as an adjuvant, the intralesional curettage group was found to be equivalent or preferable to wide excision in terms of function rehabilitation.</p>

Short term clinical outcome of total hip arthroplasty for the treatment of Crowe IV congenital dysplasia of the hip in adults / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the short term clinical effects and surgery methods of the total hip arthroplasty (THA)for the treatment of Crowe type IV congenital dysplasia of hip (CDH) in adults.</p><p><b>METHODS</b>From March 2013 to March 2015, 20 patients (20 hips) with Crowe type IV CDH in adults were underwent THA, including 4 males and 16 females, with an average age of 52 years old ranged from 32 to 68 years old. All the cementless acetabular cups were placed at the original anatomic location. S-ROM prosthesis was adopted together with subtrochanteric transverse osteotomy in femoral side. All the patients were evaluated by using the Modified Harris Hip Score. Radiographic evaluations were made preoperatively and during follow up.</p><p><b>RESULTS</b>The incisions were healed by first intention. There was no hip dislocation events and venous thrombosis occurred. All patients were followed up for 8 to 60 months with an average of 38.1 months. Postoperative X ray films showed all acetabular prosthesis were in true acetabulum. No nonunion and loosening were found in all patients. Harris score at final follow up improved from preoperative 50.90±9.35 to postoperative 90.25±3.16. The difference was statistically significant (<0.05). There were 1 patient with femoral split fracture, 1 patient with nerve injury, 1 patient with heterotopic ossification of Brooker I. The hip function of all patients was good, the pain was disappeared.</p><p><b>CONCLUSIONS</b>THA with S-ROM prosthesis and subtrochanteric osteotomy is an effective method for the treatment of Crowe type IV CDH in adults. The recent clinical curative effect is satisfied.</p>

Sustentaculum tali screw fixation for the treatment of Sanders type II and III calcaneal fractures / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical outcomes of open reduction and internal fixation with calcaneal locking plates in treating Sanders type II and III calcaneal fractures.</p><p><b>METHODS</b>From January 2010 and October 2012, 38 calcaneal fractures with Sanders type II or III were treated with open reduction and internal fixation with calcaneal locking plate. According to the Sanders classification, 15 fractures were classified as type II, 23 fractures as type III. The patients were divided into two groups (group A and B) according to the different fixed methods. Sustentaculum tali was fixed with one screw in group A, including 13 males and 5 females, with a mean age of (38.56±8.03) years old (ranged, 25 to 55). And sustentaculum tali was not fixed in group B, including 16 males and 4 females, with a mean age of (42.35±8.29) years old (ranged, 29 to 53). Clinical effects were evaluated according to the changes of Böhler's angle and the Maryland Foot Score and VAS score.</p><p><b>RESULTS</b>All patients were followed up from 12 to 20 months with a mean of 14 months. Böhler's angles and subtalar joints obtained satisfactory reconstruction in all patients. One year after operation, the mean Maryland Foot Score was 88.61±7.59 in group A; and was 82.40±9.24 in group B; Maryland Foot Score of group A was higher and foot functional rehabilitation was better than group B. The mean VAS score was 13.39±11.47 in group A; and was 22.50±13.10 in group B; VAS score of group A was lower and foot pain was less than group B.</p><p><b>CONCLUSION</b>Sustentaculum tall screw fixation has advantages of strong fixed strength, high stability, less postoperative pain, rapid functional recovery in treating Sanders type II and III calcaneal fractures.</p>

Forefoot plantar pressure changes of the first tarsometatarsal joint fracture-dislocation fixation by different internal fixations / 中国骨伤

<p><b>OBJECTIVE</b>To measure the changes of plantar pressure of the first tarsometatarsal joint fracture and dislocation by three different implants to provide experimental reference in selecting implants.</p><p><b>METHODS</b>Eight fresh foot specimens were made into the models of the first tarsometatarsal joint fracture and dislocation, which were fixed with 3.5 mm cortical screw, 1/4 tubular plate and compressive staple in turn. After the loading of 600 N, the changes of the plantar pressure in forefoot were measured by the method of the F-scan plantar pressure system.</p><p><b>RESULTS</b>After first tarsometatarsal joint fracture and dislocation, the peak pressure under the first metatarsal head would decrease, while the pressure under the second metatarsal head would increased,whose differences were statistically significant (P<0.05). When the first tarsometatarsal joint was fixed with screw or plate respectively; the peak pressure under the two metatarsal heads would tend to be normal. However,the staple fixation showed the statistical significant difference compared with normal state, although the peak pressure under the first and second metatarsal heads were recovered in some extent(P<0.05).</p><p><b>CONCLUSION</b>After the first tarsometatarsal joint fracture-dislocation, the plantar pressure might be compensated partly by the adjacent metatarsal heads according to the regulation of the load transfer mechanism. While the first tarsometatarsal joint fracture-dislocation was fixated by screw or plate, the plantar pressure of the forefoot would return to the normal state. However,if the joint was fixated by the staple, it would still be difficult to return the plantar pressure to be normal.</p>

Effectiveness of manipulative reduction combined with minimally invasive surgery in the treatment of osteoporotic vertebral compression fracture: a meta-analysis / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of manipulative reduction combined with percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) in treating osteoporotic vertebral compression fracture (OVCF) using meta-analysis method, in order to provide a reference for clinical treatment.</p><p><b>METHODS</b>A systematic computer-based search (from January 1987 to April 2014) from CNKI, Wanfang database, Web of Science and PubMed were performed for the collection of controlled clinical researches on manipulative reduction combined with PVP or PKP in treating OVCF. The quality of selected researches was evaluated. Meta-analysis was adopted to evaluate visual analog scale, Cobb angle, anterior height ratio of the injured vertebra.</p><p><b>RESULTS</b>A total of 7 researches of 410 patients were included in the present analysis, there were 5 RCTs and 2 non-RCTs and all come from China. Manipulative reduction combined with PVP could got better improvement in Cobb angle (WMD=-7.35; 95%CI: -12.15, -2.54) and anterior height ratio of the injured vertebra (P<0.01) than simple PVP, but no significant difference was found in improvement of visual analog scale (WMD=-0.01; 95%CI: -0.45, 0.42). There were no significant differences in the improvement of visual analog scale, Cobb angle, anterior height ratio of the injured vertebra between manipulative reduction combined with PKP and simple PKP (P>0.05).</p><p><b>CONCLUSION</b>Compared with simple PVP, manipulative reduction combined with PVP may result in more clinical efficacy on the improvement of Cobb angle and anterior ratio of the injured vertebra. And compared with simple PKP, manipulative reduction combined with PKP has no obvious advantages on the improvement of visual analog scale, Cobb angle, anterior height ratio of the injured vertebra. However, the number and quality of the literatures, may resulted in the effect of mistrust, so more large sample and high-quality RCTs are needed in future.</p>