Influence of Medial Support Screws on the Maintenance of Fracture Reduction after Locked Plating of Proximal Humerus Fractures / 中华医学杂志(英文版)

Background@#Technical aspects of the correct placement of medial support locking screws in the locking plate for proximal humerus fractures remain incompletely understood. This study was to evaluate the clinical relationship between the number of medial support screws and the maintenance of fracture reduction after locked plating of proximal humerus fractures.@*Methods@#We retrospectively evaluated 181 patients who had been surgically treated for proximal humeral fractures (PHFs) with a locking plate between September 2007 and June 2013. All cases were then subdivided into one of four groups as follows: 75 patients in the medial cortical support (MCS) group, 26 patients in the medial multiscrew support (MMSS) group, 29 patients in the medial single screw support (MSSS) group, and 51 patients in the no medial support (NMS) group. Clinical and radiographic evaluations included the Constant-Murley score (CM), visual analogue scale (VAS), complications, and revision surgeries. The neck-shaft angle (NSA) was measured in a true anteroposterior radiograph immediately postoperation and at final follow-up. One-way analysis of variance or Kruskal-Wallis test was used for statistical analysis of measurement data, and Chi-square test or Fisher's exact test was used for categorical data.@*Results@#The mean postoperative NSAs were 133.46° ± 6.01°, 132.39° ± 7.77°, 135.17° ± 10.15°, and 132.41° ± 7.16° in the MCS, MMSS, MSSS, and NMS groups, respectively, and no significant differences were found (F = 1.02, P = 0.387). In the final follow-up, the NSAs were 132.79° ± 6.02°, 130.19° ± 9.25°, 131.28° ± 12.85°, and 127.35° ± 8.50° in the MCS, MMSS, MSSS, and NMS groups, respectively (F = 4.40, P = 0.008). There were marked differences in the NSA at the final follow-up between the MCS and NMS groups (P = 0.004). The median (interquartile range [IQR]) NSA losses were 0.0° (0.0-1.0)°, 1.3° (0.0-3.1)°, 1.5° (1.0-5.2)°, and 4.0° (1.2-7.1)° in the MCS, MMSS, MSSS, and NMS groups, respectively (H = 60.66, P < 0.001). There were marked differences in NSA loss between the MCS and the other three groups (MCS vs. MMSS, Z = 3.16, P = 0.002; MCS vs. MSSS, Z = 4.78, P < 0.001; and MCS vs. NMS, Z = 7.34, P < 0.001). There was also significantly less NSA loss observed in the MMSS group compared to the NMS group (Z = -3.16, P = 0.002). However, there were no significant differences between the MMSS and MSSS groups (Z = -1.65, P = 0.225) or the MSSS and NMS groups (Z = -1.21, P = 0.099). The average CM scores were 81.35 ± 9.79, 78.04 ± 8.97, 72.76 ± 10.98, and 67.33 ± 12.31 points in the MCS, MMSS, MSSS, and NMS groups, respectively (F = 18.68, P < 0.001). The rates of excellent and good CM scores were 86.67%, 80.77%, 65.52%, and 43.14% in the MCS, MMSS, MSSS, and NMS groups, respectively (χ = 29.25, P < 0.001). The median (IQR) VAS scores were 1 (0-2), 1 (0-2), 2 (1-3), and 3 (1-5) points in the MCS, MMSS, MSSS, and NMS groups, respectively (H = 27.80, P < 0.001). Functional recovery was markedly better and VAS values were lower in the MCS and MMSS groups (for CM scores: MCS vs. MSSS, P < 0.001; MCS vs. NMS, P < 0.001; MMSS vs. MSSS, P = 0.031; and MMSS vs. NMS, P < 0.001 and for VAS values: MCS vs. MSSS, Z = 3.31, P = 0.001; MCS vs. NMS, Z = 4.64, P < 0.001; MMSS vs. MSSS, Z = -2.09, P = 0.037; and MMSS vs. NMS, Z = -3.16, P = 0.003).@*Conclusions@#Medial support screws might help enhance mechanical stability and maintain fracture reduction when used to treat PHFs with medial metaphyseal comminution or malreduction.

Expression of leukemia inhibitory factor in osteoarthritic tissues in rabbits and human:an experimental and clinical study / 中华创伤骨科杂志

Objective To investigate the regulation expression of leukemia inhibitory factor(LIF)in hu- man and animal osteoarthritic(OA)tissues and its clinical relevance.Methods 1)Thirty-five Japanese rabbits, aged eight months,were used to make models of experimental osteoarthritis.Operations were performed at the right knee and the sham ones at the left knee in each rabbit.Rabbits were sacrificed on the 3,7,14,28,42,56 and 84 days after operation respectively.Cartilage and synovium of the knee were collected to observe histological changes of osteoarthritis at different times;immunohistochemistry analysis was conducted to observe the LIF expression and distribution in the cartilage and synovium of the animals.2)From April 2003 to October 2003,32 samples of human articular tissues(cartilage,subchondral bone and synovium)were obtained in the operational procedures and a good quantity of RNA was isolated using Magnetic Beads.The patients who underwent articular operations donated the samples.In the reverse transcription-polymerase chain reaction(RT-PCR),the mRNA expression of LIF was mea- sured by semi-quantity analysis and the location of LIF protein was determined by enzyme-linked immunosorbent assay (ELISA).Results A slight expression of LIF was seen in normal cartilage but less in synovium.However,the expression of LIF was remarkable in synovial lining cells,superficial and middle layers of cartilage in animal os- teoarthritis.There was a significant difference in expression between the animal osteoarthritis and the control group (P＜0.05 ).In human tissue study,LIF mRNA was expressed to a very low level in normal articular tissues and there was no significant difference(P＞0.05)between different anatomical locations.In moderate degrading sub- chondral bone,LIF mRNA was expressed to its highest level.LIF was expressed to the highest level in seriously degrading cartilage tissues.The results were similar to ELISA testing results.LIF extents varied in different articular tissue sections.Conclusions LIF is an important mediator that can contribute to tbe pathogenesis of OA.The different temporal and spatial distributions of LIF in normal and OA tissues imply that LIF may play some important roles in pathogenesis of OA.