ABSTRACT
BACKGROUND:The importance of autophagy for maintaining cellular homeostasis and stress response has long been recognized.As a way for cells to selectively clear their damaged organelles to achieve the recycling of cellular components,autophagy has a pivotal role in bone metabolism.OBJECTIVE:To review the role and possible mechanisms of autophagy in regulating bone-related cell activity and function among bone marrow mesenchymal stem cells,osteoblasts,osteocytes,and osteoclasts.METHODS:PubMed was searched for studies related to autophagy using the keywords of "autophagy;bone marrow mesenchymal stem cells;osteoblasts;osteocytes;osteoclasts."RESULTS AND CONCLUSION:We finally included 84 papers.Autophagy plays an important role in bone metabolism.Autophagy is involved in maintaining the balance between mineralization and absorption,and then maintaining bone homeostasis.An appropriate autophagy inducer may also benefit bone remodeling.Abnormal autophagy can lead to disorders of bone balance,leading to diseases such as osteoporosis.We may prevent or treat bone-related diseases by regulating the level of autophagy as its function in maintaining the balance of mineralization and resorption in bone homeostasis.
ABSTRACT
BACKGROUND: Osteonecrosis of the femoral head (ONFH) following internal fixation of femoral neck fractures is difficult to be cured in clinic.OBJECTIVE: To analyze the literatures concerning ONFH in patients with femoral neck fractures treated with screw internal fixation in recent 15 years, and to summarize the research progress in views of epidemiology, etiology, diagnosis,treatment and rehabilitation.METHODS: Databases of CNKI, WanFang, CqVip, PubMed, Medline, Web of Science were searched with the keywords of femoral neck fracture, osteonecrosis of femoral head, osteonecrosis, internal fixation, internal fixation with screw in English and Chinese, respectively. Afterwards, the reviews and case reports were excluded. RESULTS AND CONCLUSION: (1) A total of 54 eligible articles addressing the ONFH following internal fixation for femoral neck fractures were included, and the incidence of ONFH varied from 8.1% to 37.2%, which was found at an average of 17 months after injury. (2) ONFH was found to be related to age, preoperative fracture displacement, preoperative traction,reduction condition, time from injury to operation, elderly patients companied with other diseases, older patients undergoing removal of the screws, closed or open internal fixation, restored time postoperatively, high body mass index, hyperlipidemia, season, and depression. (3) Early prevention and remedial surgery were used to treat ONFH. (4) The patients without weight-bearing activities at 3-6 months postoperatively could be beneficial for functional recovery. (5) These results suggest that choosing appropriate surgical programs and rehabilitation plan can reduce the incidence of ONFH and achieve good treatment outcomes, such as reasonable preoperative planning, standardized operation skills, correct diagnosis and treatment, proper postoperative rehabilitation and good doctor-patient cooperation.
ABSTRACT
BACKGROUND:Intertrochanteric fracture is one of the most common fractures in older adults. The surgical treatment methods include artificial joint replacement (total hip and femoral head replacement) and internal fixation (proximal femoral nail anti-rotation and dynamic hip screw), but there is no clear evidence to evaluate the effect of them. OBJECTIVE: To compare the effect difference of arthroplasty and internal fixation in the treatment of intertrochanteric fracture in the elderly people. METHODS:We retrieved randomized controled studies on artificial joint replacement (total hip and femoral head replacement) and internal fixation (proximal femoral nail anti-rotation and dynamic hip screw) in the treatment of intertrochanteric fracture from 1990 to 2015. Meta-analysis was used to compare operation time, intraoperative bleeding volume, one-year postoperative Harris hip scores, and one-year postoperative complication between the arthroplasty and internal fixation. RESULTS AND CONCLUSION:(1) Twenty-one studies were included. (2) Intraoperative bleeding volume and one-year postoperative Harris hip scores were higher in the arthroplasty group than in the internal fixation group. (3) Operation time was similar between the arthroplasty and internal fixation groups. (4) Complication rate was lower in the arthroplasty group than in the internal fixation group. Incidence of complications was closed between the arthroplasty and internal fixation groups. (5) Results suggested that the effect of arthroplasty was better than internal fixation for treating intertrochanteric fracture in the elderly. However, prospective large-sample long-term randomized controled trials are needed for verification.