Comparative study on curative effect of minimally invasive locking plate for the treatment of intra-articular calcaneal fractures via sinus tarsi approach / 中国骨伤

OBJECTIVE@#To compare clinical efficacy of minimally invasive locking plate and anatomic locking plate in treating intra-articular calcaneal fractures via sinus tarsi approach.@*METHODS@#A retrospective analysis was conducted of 48 patients with intra-articular calcaneal fractures treated with surgery via sinus tarsi approach from July 2016 to June 2017. According to differernt methods of internal fixation, the patients were divided into minimally invasive locking plate group and anatomic locking plate group. In minimally invasive locking plate group, there were 14 males and 10 females, aged from 27 to 46 years old with an average age of (38.70±5.58) years old, 18 patients were typeⅡand 6 patients were type Ⅲ according to Sanders classification. In anatomic locking plate group, there were 17 males and 7 females, aged from 26 to 46 years old with an average age of (37.10±6.44) years old, 16 patients were typeⅡ and 8 patients were type Ⅲ according to Sanders classification. Operative time, visual analogue scale (VAS), postoperative complications between two groups were compared, and Böhler angle, Gissane angal, calcaneal width and height were recorded and compared between two groups at 1 week after operation and final follow up. The functional effect was assessed according to Maryland foot function score at final follow up.@*RESULTS@#All patients were followed up for (14.10±1.94) months (ranged 12 to 18 months). All patients were obtained bone union from 8 to 16 weeks with an average of (10.60±2.25) weeks. Operation time, VAS score and complication rate in minimally invasive locking plate group were (69.50±7.51) min, (2.80±1.07) and 2 cases respectively, and (77.50±7.15) min, (3.80±1.09) and 8 cases in anatomic locking plate group respectively, there were statistical difference between two groups (@*CONCLUSION@#Compare with anatomic locking plate, minimally invasive locking plate via sinus tarsi approach for Sanders typeⅡ and Ⅲ intra-articular calcaneal fractures could obtain similar reliable fixation and functional recovery with more simple operation, shorter operative time, lighter postoperative pain and less complications.

Case-control study on minimally invasive surgery and conventional open plating for displaced midshaft clavicular fracture based on 3D-print / 中国骨伤

OBJECTIVE@#To compare clinical effect of minimally invasive surgery and conventional open plating for acute displaced midshaft clavicle fracture based on 3D-print.@*METHODS@#From July 2016 and December 2016, 40 patients with acute displaced midshaft clavicle fractures were retrospectively analyzed. The patients were divided into 3D minimally invasive surgery group (group A) and conventional open plating group (group B) according to different surgical incisions and whether to use 3D printing. In group A, including 11 males and 9 female, aged from 19 to 57 years old with an average of(37.2±9.3)years old; type 2A2 were 4 patients, type 2B1 were 9 patients and type 2B2 were 7 patients according to Robinson classification. In group B, including 13 males and 7 female, aged from 17 to 54 years old with an average of(35.1±9.5) years old; type 2A2 were 5 patients, type 2B1 were 8 patients and type 2B2 were 7 patients according to Robinson classification. Operative time, blood loss, length of incision, fracture healing time, complications were observed and compared between two groups, DASH score and Constant score of shoulder joint were evaluated at 12 months after operation.@*RESULTS@#Forty patients were followed up from 12 to 18 months with an average of(15.1±2.0) months. All fractures were healed, healing time in group A ranged from 12 to 18 months with an average of (14.3±1.7) months, in group B ranged from 11 to 18 months with an average of (14.4±1.9) months, while there was no statistical differences between two groups(>0.05). No differences in blood loss between two groups(>0.05). Operative time, length of incision in group A was less than that of group B (0.05). One patient in group A occurred complication, and 6 patients in group B occurred compilations, and has statistical differences between two groups(<0.05).@*CONCLUSIONS@#Minimally invasive technique based on 3D-print could resolve some difficulties of minimally invasive surgery effectively and achieve fracture healing and functional recovery similar to traditional open reduction with more beautiful incision, less complication, shorter operation time.

Biomechanical study of the lateral wall of the femur in the treatment of femoral intertrochanteric fracture with intramedullary or extramedullary fixation / 中国骨伤

<p><b>OBJECTIVE</b>To observe the biomechanical effects of the lateral wall of the femur in treating femoral intertrochanteric fractures with intramedullary or extramedullary fixation to guide the choice of clinical fixed methods.</p><p><b>METHODS</b>Twelve adults femur specimens of intertrochanteric fractures were belong to the type A1 of the AO fracture classification and randomly divided into the lateral wall complete PFNA group, the lateral wall complete PF-LCP group, the lateral wall breakage PFNA group, lateral wall breakage PF-LCP group, every group had 3 specimens. The four groups of specimens were subjected to compressive loading experiment with Universal Material Testing Machine. The maximum loading force was observed. The distance between fracture ends, the distance of fracture dislocation and the sliding distance of the fracture fragments along the intertrochanteric were measured with Calipers.</p><p><b>RESULTS</b>The maximum loading force of lateral wall complete PFNA group were larger than that of lateral wall complete PF-LCP group, and the maximum loading force of lateral wall breakage PFNA group were larger than that of lateral wall breakage PF-LCP group, there were significant differences (<0.05). The distance between fracture ends of the four groups before compression were not significant differences(>0.05). The distance between fracture ends, the distance of fracture dislocation and the sliding distance of the fracture fragments were not significant differences between lateral wall complete PFNA group and lateral wall complete PF-LCP group after compression (>0.05). But the distance between fracture ends, the distance of fracture dislocation and the sliding distance of the fracture fragments of lateral wall breakage PFNA group were less than that of lateral wall breakage PF-LCP group(<0.05).</p><p><b>CONCLUSIONS</b>Intramedullary fixation of intertrochanteric fractures have stronger loading force. Both intramedullary and extramedullary fixation of intertrochanteric fractures have strong stability when the lateral wall of the femur is complete, but intramedullary fixation of intertrochanteric fractures is stronger stability than extramedullary fixation when the lateral wall of the femur is broken. So the intramedullary fixation is the first choice for the treatment of intertrochanteric fracture.</p>

Comparison of swing shoulder and internal fixation for the treatment of proximal humeral fractures in elderly / 中国骨伤

<p><b>OBJECTIVE</b>To compare clinical outcomes of swing shoulder and internal fixation in treating proximal humeral fractures.</p><p><b>METHODS</b>From June 2007 to June 2012, totally 89 elderly patients with humeral proximal fractures were treated by swing of shoulder or internal fixation, and 81 patients were followed up. In swing shoulder group, there were 38 patients including 13 males and 25 females aged from 62 to 84 with an average of (67.11±6.18) years old; 27 cases were 2-part fractures and 11 cases were 3-part fractures according to Neer classfication. In internal fixation group, there were 43 patients including 16 males and 27 females aged from 60 to 80 with an average of (66.47±5.48) years old; and 29 cases were 2-part fractures and 14 cases were 3-part fractures according to Neer classfication. VAS score and complications were compared between two groups after treatment, and Constant-Murley functional scoring was used to evaluate shoulder function of patients.</p><p><b>RESULTS</b>Eighty-one patients were followed up from 13 to 26 months with an average of 18.3 months. There was no significant difference in preoperative VAS score between two groups. After treatment, VAS score in swing shoulder group was (3.11±0.95), and (3.88±1.14) in internal fixation group, and had significant difference between two groups (t=-3.313,P<0.05). There was no significant difference in Constant-Murley scores between swing shoulder group (79.53±3.73) and internal fixation group (77.98±4.11) (t=1.768,P>0.05). Postoperative complications in swing shoulder group was 18.4%(7/38), 39.5%(17/43) in internal fixation group, and had significant differences between two groups (χ2=4.313,P<0.05).</p><p><b>CONCLUSION</b>Swing shoulder for the treatment of proximal humeral fractures in elderly has advantages of low cost, less complications and good recovery of joint function; while internal fixation has a good therapeutic effect but increased complications.</p>

Analgesic and sedative effects of inhaling a mixture of nitrous oxide and oxygen on burn patient during and after dressing change / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the analgesic and sedative effects of inhaling a mixture of nitrous oxide and oxygen on burn patient during and after dressing change.</p><p><b>METHODS</b>A total of 240 burn patients hospitalized in the Institute of Burn Research of Changhai Hospital Affiliated to the Second Military Medical University, Department of Burns of the First People's Hospital in Zhengzhou, and Department of Burns and Plastic Surgery of General Hospital of Ningxia Medical University from October 2011 to September 2012 were enrolled in our study, and they were all in accordance with the inclusion criteria. The 240 patients were divided into control group (n = 60, treated with inhalation of oxygen during dressing change) and treatment group (n = 180, treated with inhalation of a mixture of 65% nitrous oxide and oxygen during dressing change) according to the computer-generated list of random number. The other treatments in control group and treatment group were the same. Before, during, and after dressing change, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), oxygen saturation (SO2), and adverse effects were observed. The degree of pain and anxiety felt by the patients were respectively evaluated with the visual analogue scale (VAS) and Chinese version of the burn specific pain anxiety scale (C-BSPAS) at the same time points as above. Data were processed with analysis of covariance, chi-square test, analysis of variance, and rank sum test.</p><p><b>RESULTS</b>There were no significant differences between control group and treatment group in the levels of HR, SBP, DBP, and SO2 before dressing change (with F values respectively 0.76, 0.06, 1.11, 0.70, P values all above 0.05). Compared with those of control group, the levels of HR, SBP, DBP, and SO2 in treatment group were significantly ameliorated during dressing change (with F values respectively 81.78, 146.36, 226.44, 205.62, P values all below 0.01). After dressing change, the levels of DBP in the two groups were close (F = 0.31, P > 0.05), but the levels of HR, SBP, and SO2 showed statistical differences (with F values respectively 7.02, 8.69, 12.23, P < 0.05 or P < 0.01). Before dressing change, the VAS scores were approximate between control group and treatment group (Z = 0.21, P > 0.05). Compared with those in control group (9.4 ± 0.7, 1.7 ± 2.5), the VAS scores were significantly lowered in treatment group during and after dressing change (1.6 ± 1.3, 0.7 ± 1.1, with Z values respectively 11.84, 3.35, P values all below 0.01). There was no significant difference in C-BSPAS score between control group and treatment group before dressing change (Z = 0.62, P > 0.05). Compared with those in control group (75 ± 13, 73 ± 12), the C-BSPAS scores in treatment group were decreased during and after dressing change (9 ± 15, 9 ± 14, with Z values respectively 11.91, 12.28, P values all below 0.01). There were no obvious adverse effects in two groups before, during, and after dressing change.</p><p><b>CONCLUSIONS</b>A mixture of nitrous oxide and oxygen seems to have obvious analgesic and sedative effects on burn patients during dressing change, and it can be widely used.</p>

Comparative study of intertrochanteric fractures treated with proximal femur locking compress plate in aged / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinic outcomes of dynamic hip screw (DHS), intramedullary fixation (IF) and proximal femur locking plate (PF-LCP) in the treatment of intertrochanteric fractures in the elderly patients.</p><p><b>METHODS</b>From July 2000 to August 2009, 165 old patients with intertrochanteric fractures were treated respectively by DHS, IF, PF-LCP. Fifty-eight patients were in DHS group including 30 males and 28 females with an average age of 71 years old; there were 30 cases of type II fracture of Jensen, 28 cases of type III fracture. Sixty-five patients were in IF group including 35 males and 30 females with an average age of 73 years old; there were 37 cases of type II fracture of Jensen, 28 cases of type III fracture. Forty-two patients were in PF-LCP group including 23 males and 19 females with an average age of 74 years old; there were 22 cases of type II fracture of Jensen,20 cases of type III fracture. The operative procedures,complications and therapeutic effects were compared among 3 groups.</p><p><b>RESULTS</b>All patients were followed up from 15 to 21 months (averaged 18.3 months). The incision length and the operation time of IF group were shorter than that of DHS and PF-LCP, but there were no significant difference between DHS group and PF-LCP group. The intraoperattive blood loss, rehabilitation and healing time of IF and PF-LCP were less or shorter than that of DHS group, but there were no significant difference between IF group and PF-LCP group. The functional recovery of IF group and PF-LCP were better than that of DHS group, there were significant difference among 3 groups. The complications of PF-LCP group was fewer than that of IF group and DHS group.</p><p><b>CONCLUSION</b>PF-LCP is the credible method for intertrochanteric fractures in the elderly patients, especially for severe comminuted fracture and osteoporosis, for it can reduce operation complications and benefit for fracture healing and hip functional recovery.</p>

Percutaneous kyphoplasty and conservative therapy for osteoporotic vertebral compression fractures: a clinical comparative study / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of percutaneous kyphoplasty (PKP) and conservative therapy in patients with osteoporotic vertebral compression fractures (OVCF).</p><p><b>METHODS</b>The data of 63 patients with OVCF from Sep. 2007 to Apr. 2009 were retrospectively analyzed. There were 14 males and 49 females,ranging in age from 63 to 92 years, with an average of 73.4 years. Among them, 30 cases(38 vertebrae), 33 cases (35 vertebrae) were respectively treated with PKP, conservative therapy. The VAS score, the height of vertebral body and the neighboring vertebral fracture were observed during follow-up.</p><p><b>RESULTS</b>All the patients were followed up from 10 to 15 months with an average of 13.3 months. Pain relieved in 27 cases with PKP, and VAS scores decreased from 8.32 before treatment to 2.63 at the 1st week after treatment; VAS scores still remained under 2 at the later follow-up. VAS scores had not changed at the 1st week after conservative therapy. VAS scores with conservative therapy were higher than with PKP after 1, 3 months (P < 0.05), but after 6 months, there was no significant difference between conservative therapy and PKP (P > 0.05). The average height of vertebral body on the X-rays increased in 4.1 mm at the 1st week after treatment with PKP (P < 0.01) and unchanged posteriorly. The height of vertebral body had some improvement at 3, 6 months after conservative therapy, but the height of vertebral body with PKP was significantly higher than with conservative therapy (P < 0.01). New fractures occurred in 4 cases (5 vertebrae) with PKP, in 2 cases (2 vertebrae) with conservative therapy.</p><p><b>CONCLUSION</b>PKP is an effective method in treating osteoporotic vertebral compression fractures, which can relieve pain quickly, increase stability immediately, recover height of vertebral body, but maybe can increase the risk of new fracture. Conservative therapy is not without any merit, as long as systemic treatment can still make good prognosis.</p>

Effects of Jiangu granule containing serum on the cyclins in rat's osteoblast at G1 phase / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To investigate the effects of Jiangu granule containing serum (JGG-serum) on the cyclins in rat's osteoblast at G1 phase.</p><p><b>METHODS</b>Osteoblasts isolated by enzymatic digestion from SD rats were cultured and intervened with JGG-serum or normal saline (as control) respectively. Cell generation cycle was detected by flow cytometry, and expressions of Cyclin D1, cyclin-dependent kinase 4 (CDK4), oncogene protein (P21) in the osteoblast were detected dynamically using immuno-cytochemical and RT-PCR technique.</p><p><b>RESULTS</b>As compared with the control, the cell generation cycle and cell proliferation were proceeding quicker in the JGG-serum (20%) intervention group; with higher protein and mRNA expressions of Cyclin D1 and CDK4, as well as much lowered expressions of P21 in nuclei of osteoblast detected at all time points (24 h, 48 h and 72 h after treatment, P < 0.05 or P < 0.01).</p><p><b>CONCLUSION</b>JGG-serum can adjust the G1 phase cyclins in osteoblast cultured in vitro, increase the mRNA and protein expressions of Cyclin D1 and CDK4, and inhibit P21 expression, so as to accelerate the proliferation of osteoblast.</p>

Experimental study of the effect of liposome-mediated vascular endothelial growth factor gene on the flap survival in rats / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of VEGF gene on the random flap survival after pedicle division at different time in rats.</p><p><b>METHODS</b>The random-pattern flaps were formed on the back of the 120 SD rats. PcDNAVEGF165 (gene) wrapped with liposome was injected into the flaps in experimental group (n = 40). The flaps in the two control groups were injected with PcDNA (n = 40) or saline (n = 40). 1, 3, 5, 7 days after injection, 10 rats in each group were randomly selected to performed pedicle division. 7 days after pedicle division, the rats were killed to measure the flap survival rate. The microvessels was studied by histologic examination. The expression of VEGF was assessed by immunohistochemical staining. The flaps were also examined under the electron ultrastructure microscopy.</p><p><b>RESULTS</b>1) Flap survival rate after pedicle division in experimental group at 1 day, 3 days, 5 days, 7 days after injection, were (45.45 +/- 12.24)%, (82.95 +/- 3.81)%, (85.00 +/- 3.38)%, (85.96 +/- 3.25)%, respectively. The flap survival rates were significant different between experimental group and the control groups at 3, 5, 7 days after injection (P < 0.05), but not at 1 days after injection (P > 0.05). 2) The average microvascular diameter and number in experimental group were significantly higher than those in control groups (P < 0.05). 3) The expression of VEGF in experimental group was significantly higher than that in the two control groups (P < 0.05). 4) Ultrastructure study showed more angiogenesis in experimental group.</p><p><b>CONCLUSIONS</b>Subcutaneous injection of liposome-mediated VEGF gene can increase the survival rate of flap with early pedicle division. It is a simple, efficient, economic, and the relatively safe gene therapy.</p>

Study on the correlations between the bone quality and level of u-DPD and serum 1,25-(OH)2D3 in the ovariectomized osteoporosis rats / 中国骨伤

<p><b>OBJECTIVE</b>To study the correlations between the bone quality and level of u-DPD and serum 1,25-dihydroxyvitamin D3 in the ovariectomized osteoporosis rats.</p><p><b>METHODS</b>Forty female rats were randomly divided into the ovariectomy group (the OVX group) and the sham-operation group (the Sham group), and draw materials in 12 and 24 weeks after operation. Bone mineral density (BMD) of the 1st lumbar, the femoral neck and femur was measured by dual-energy X-ray absorptionetry. The level of urine DPD was measured by ELISA. The concentration of 1,25-dihydroxyvitamin D3 in serum was measured by radioimmunoassay (RIA). The limit of compressive strength and elastic modulus of 1st lumbar and bending load of right femur were measured by photoelasticity meter. The osseous morphology of upper tibia was measured by the non-decalcifing section. The correlation of experimental data was analyzed by statistical method.</p><p><b>RESULTS</b>In ovariectomy group, except the level of urine DPD/Cr was increase, all data decreased significantly compared with the samp group,and descending continually with the lapse of time. The results showed that there was a negative correlation between the urine DPD/Cr and BMD of the 1st lumbar, femur, the limit of compressive strength of 1st lumbar, bending load of femur and trabecular bone area. But there was a positive correlation significantly between the concentration of 1,25-dihydroxyvitamin D3 in serum and BMD of the 1st lumbar, the femoral neck and femur, trabecular bone area, the limit of compressive strength of 1st lumbar, bend load of femur.</p><p><b>CONCLUSION</b>The correlation is remarkable between the bone quality and the level of urine DPD/Cr, 1,25-dihydroxyvitamin D3 in serum. We can predict the bone quality by measuring the level of urine DPD/Cr and 1,25-dihydroxyvitamin D3 in serum.</p>