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Osteoporosis is a common disease of old age that affects millions of people worldwide. Besides, it has been a chronic disease difficult to treat in the elderly, so it is of great significance to develop new drugs for the treatment of senile osteoporosis. The endocannabinoid system contains cannabinoid ligands, endocannabinoid receptors, and enzymes required for the synthesis and degradation of endocannabinoids, which play an important role in bone metabolism. Preclinical studies using endocannabinoid system-based therapies in animal models and in vitro have shown that endocannabinoid systems can prevent senile osteoporosis and highlight their therapeutic potential for senile osteoporosis. In this paper, PubMed, ScienceDirect, CNKY, and Wanfang databases were searched for articles related to the endocannabinoid system and osteoporosis. This paper analyzed the pathogenesis of senile osteoporosis (such as calcium, active vitamin D3 deficiency or insufficiency, sex hormone deficiency, cell function decline and secondary to chronic diseases, etc.), and reviewed the various components of the endocannabinoid system and their application in osteoporosis by regulating bone homeostasis in recent years, providing a new direction for the clinical treatment of senile osteoporosis.
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Polyetherketoneketone (PEKK) is a semi-crystalline linear thermoplastic polymer with two ketone bonds and one ether bond in the main chain structure. It has many advantages such as elastic modulus close to that of natural human bone, biocompatibility, good chemical stability, radiolucency, compatibility with MRI, etc, which make it a new biomaterial for the production of orthopedic implants. The development of PEKK composites with better bone bioactivity without compromising the original properties of PEKK through special material preparation processes has become a hotspot. PEKK composites are made by combining biological ceramics (hydroxyapatite, silicon nitride) and metals with good biocompatibility (aluminum, tantalum and titanium). These composites not only retain the elastic modulus similar to that of human bone, but also improve hardness, biocompatibility, antibacterial properties, and bone integration ability, and thus have great potential in the field of orthopedic implants. The application of PEKK and its composites in the orthopedic field was searched in PubMed, Embase, ScienceDirect, CNKI and Wanfang databases. The properties advantages and disadvantages of PEKK and its composite materials modified by various methods in the recnt years (e.g. modification doping mixture, modification of the surface by sulfonation, 3D printing and treatment by surface deposition) were analyzed to provide a reference for the preparation clinically usable orthopedic implants with different functions.
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Objective:To investigate the effect of arthroscopic superior capsular reconstruction (ASCR) of irreparable massive rotator cuff tears (RCTs) using the "Sandwich" patch graft (autologous fascia lata + LARS artificial ligament + autologous fascia lata).Methods:The patients with irreparable massive RCTs who underwent ASCR by using "Sandwich" patch graft were retrospectively evaluated between December 2016 and October 2018. All cases were followed up more than two years. The pain and function of the shoulder were evaluated by visual analogue scale (VAS), active forward elevation (aFE), American Shoulder & Elbow Surgeons score (ASES), University of California Los Angeles (UCLA) score, and Constant-Murley score. The acromiohumeral distance (AHD) and patch healing were assessed by shoulder X-ray and MRI scan.Results:Twenty-nine patients (12 males and 17 females) were enrolled for final analysis. The average age was 66.0±5.88 years (range 55-77 years). The average length of follow-up was 35.3±7.20 months (range 24-46 months). The tendon of the subscapularis muscle was intacted in 13 cases and repairable in 16 cases. All patients' teres minor muscles were intact and the function of deltoid muscles was all complete. Based on Hamada classification of massive RCTs, 11 cases with type 2, 14 cases with type 3, and 4 cases with type 4. At the last follow-up visit, the AFE of the surgical shoulder was 158.45°±23.87° (range 70°-180°), which was significantly higher than before the surgery 92.59°±45.99° (range 20°-160°, t=6.190, P<0.001). The ASES score was 92.92±9.08 (range 64-100), UCLA score was 31.62±3.93 (range 19-35), and Constant-Murley score was 85.8±8.44 (range 68-94), which were higher than those before the operation 30.69±12.99 (range 68-95), 10.93±3.43 (range 4-17), 39.62±12.68 (range 14-55). There were significant differences between them, respectively ( t=21.145, P<0.001; t=21.348, P<0.001; t=16.333, P<0.001). The VAS was 0.41±0.57 (range 0-2 points), which was significantly lower than that of 4.90±1.05 (range 3-7 points) before operation ( t=20.267, P<0.001). At the last follow-up visit, MRI showed that the AHD increased from 3.31±1.57 mm (range 1.1-6.6 mm) to 6.94±1.76 mm (range 3.0-10.8 mm) significantly ( t=12.195, P<0.001). Radiological outcomes were evaluated according to MRI, the total healing rate was 89.7% (26/29). There were two cases of complete tears, which including one case of infection and 1 partial tears. Conclusion:ASCR of irreparable massive RCTs using "Sandwich" patch graft showed the high healing rate in the short-term follow-up, which is possible to restore the shoulder functions early. It is an effective method for the treatment of irreparable massive RCTs.
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Objective To investigate the clinical outcomes of arthroscopic bridging reconstruction of irreparable massive rotator cuff tears using autogenous fascia lata.Methods From July 2015 to July 2017,a total of 10 cases (4 male and 6 female) who were treated with arthroscopic bridging reconstruction for irreparable massive rotator cuff tears using autogenous fascia lata were retrospectively analyzed.The age before surgery was 61.3±2.9 years (range 57-67 years).There were 7 patients with right shoulders and 3 with left shoulders.The dominate sides were involved in 7 cases.The trauma history was documented in 2 shoulders.The duration of preoperative symptoms was 14.0±13.5 months (1-48 months).The case with revision surgery was not included.The patients were examined with magnetic resonance imaging (MRI) to evaluate the healing of fascia lata patch bridging in the joint at one week,six months,one year and two years after operation.The motion range of shoulder and the clinical scores,including visual analogue scale (VAS),University of California Los Angeles (UCLA) score,Constant-Murley score and American Shoulder & Elbow Surgeons (ASES) score,were measured before surgery and at follow-up duration.Results All cases were reconstrncted the horizontal couple.No perioperative complication was occurred and all surgery were completed safely and successfully.At the end of two years,the score of ASES was 92.2±3.5 (range 88.3-98.3),UCLA 31.6±2.0 (range 28-34),Constant-Murley 85.2± 5.4 (range 78-93) with significant difference (t=11.254,P=0.000;t=12.111,P=0.000;t=8.948,P=-0.00) comparing with that bofore surgery.The VAS pain score was 0.6±0.5 (range 0-1) which was significantly lower than that preoperatively (t=1 1.326,P=0.000).At 2 years after operation,MRI shows that fascia lata patches healed well in 9 patients.However,one case was with re-tear and patch absorption.The range of motion of shoulder was significantly improved in all patients but with different degrees of weakness (3-4).Conclusion Arthroscopic bridging reconstruction using autogenous fascia lata could effectively improve shoulder function in patients with irreparable massive rotator cuff tears.The autogenous fascia lata patch can heal with the help of rotator cuff tissue through bridging reconstruction.
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Objective@#To investigate the clinical outcomes of arthroscopic bridging reconstruction of irreparable massive rotator cuff tears using autogenous fascia lata.@*Methods@#From July 2015 to July 2017, a total of 10 cases (4 male and 6 female) who were treated with arthroscopic bridging reconstruction for irreparable massive rotator cuff tears using autogenous fascia lata were retrospectively analyzed. The age before surgery was 61.3±2.9 years (range 57-67 years). There were 7 patients with right shoulders and 3 with left shoulders. The dominate sides were involved in 7 cases. The trauma history was documented in 2 shoulders. The duration of preoperative symptoms was 14.0±13.5 months (1-48 months). The case with revision surgery was not included. The patients were examined with magnetic resonance imaging (MRI) to evaluate the healing of fascia lata patch bridging in the joint at one week, six months, one year and two years after operation. The motion range of shoulder and the clinical scores, including visual analogue scale (VAS), University of California Los Angeles (UCLA) score, Constant-Murley score and American Shoulder & Elbow Surgeons (ASES) score, were measured before surgery and at follow-up duration.@*Results@#All cases were reconstructed the horizontal couple. No perioperative complication was occurred and all surgery were completed safely and successfully. At the end of two years, the score of ASES was 92.2±3.5 (range 88.3-98.3), UCLA 31.6±2.0 (range 28-34), Constant-Murley 85.2±5.4 (range 78-93) with significant difference (t=11.254, P=0.000; t=12.111, P=0.000; t=8.948, P=0.00) comparing with that before surgery. The VAS pain score was 0.6±0.5 (range 0-1) which was significantly lower than that preoperatively (t=11.326, P=0.000). At 2 years after operation, MRI shows that fascia lata patches healed well in 9 patients. However, one case was with re-tear and patch absorption. The range of motion of shoulder was significantly improved in all patients but with different degrees of weakness (3-4).@*Conclusion@#Arthroscopic bridging reconstruction using autogenous fascia lata could effectively improve shoulder function in patients with irreparable massive rotator cuff tears. The autogenous fascia lata patch can heal with the help of rotator cuff tissue through bridging reconstruction.
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Objective@#To investigate the clinical outcomes of arthroscopic bridging reconstruction of irreparable massive rotator cuff tears using autogenous fascia lata.@*Methods@#From July 2015 to July 2017, a total of 10 cases (4 male and 6 female) who were treated with arthroscopic bridging reconstruction for irreparable massive rotator cuff tears using autogenous fascia lata were retrospectively analyzed. The age before surgery was 61.3±2.9 years (range 57-67 years). There were 7 patients with right shoulders and 3 with left shoulders. The dominate sides were involved in 7 cases. The trauma history was documented in 2 shoulders. The duration of preoperative symptoms was 14.0±13.5 months (1-48 months). The case with revision surgery was not included. The patients were examined with magnetic resonance imaging (MRI) to evaluate the healing of fascia lata patch bridging in the joint at one week, six months, one year and two years after operation. The motion range of shoulder and the clinical scores, including visual analogue scale (VAS), University of California Los Angeles (UCLA) score, Constant-Murley score and American Shoulder & Elbow Surgeons (ASES) score, were measured before surgery and at follow-up duration.@*Results@#All cases were reconstructed the horizontal couple. No perioperative complication was occurred and all surgery were completed safely and successfully. At the end of two years, the score of ASES was 92.2±3.5 (range 88.3-98.3), UCLA 31.6±2.0 (range 28-34), Constant-Murley 85.2±5.4 (range 78-93) with significant difference (t=11.254, P=0.000; t=12.111, P=0.000; t=8.948, P=0.00) comparing with that before surgery. The VAS pain score was 0.6±0.5 (range 0-1) which was significantly lower than that preoperatively (t=11.326, P=0.000). At 2 years after operation, MRI shows that fascia lata patches healed well in 9 patients. However, one case was with re-tear and patch absorption. The range of motion of shoulder was significantly improved in all patients but with different degrees of weakness (3-4).@*Conclusion@#Arthroscopic bridging reconstruction using autogenous fascia lata could effectively improve shoulder function in patients with irreparable massive rotator cuff tears. The autogenous fascia lata patch can heal with the help of rotator cuff tissue through bridging reconstruction.
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Although the incidence of prosthesis joint infection(PJI) is low, it is one of more serious complications recognized by joint surgery because of the difficulty in diagnosis and treatment, so it is very important to diagnose PJI in time. Currently, clinical diagnostic techniques for PJI are immature, and each technique has certain limitations in terms of sensitivity or specificity of diagnosis. In general, the diagnosis of PJI relies mainly on clinical symptoms, laboratory tests and imaging examinations. The detection of pathogenic microorganisms is the basis of laboratory diagnosis and clinical treatment. The results of microbial susceptibility testing are also the main basis for the clinical application of sensitive antibiotics to treat PJI. However, the current positive rate of PJI pathogen culture is not high. In comparison, polymerase chain reaction(PCR) technology does not depend on the premise that unknown microorganisms can be cultured in vitro, and it is rapid and highly sensitive. Therefore, the use of genetic technology, especially PCR technology to diagnose PJI has become one of the current research hot spots. In order to understand the research and development of PCR diagnostic techniques for joint prosthesis infection in recent years, in this paper, the research progress of genetic technology is reviewed, especially PCR technology in the diagnosis of PJI.
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Although the incidence of prosthesis joint infection (PJI) is low,it is one of more serious complications recognized by joint surgery because of the difficulty in diagnosis and treatment,so it is very important to diagnose PJI in time.Currently,clinical diagnostic techniques for PJI are immature,and each technique has certain limitations in terms of sensitivity or specificity of diagnosis.In general,the diagnosis of PJI relies mainly on clinical symptoms,laboratory tests and imaging examinations.The detection of pathogenic microorganisms is the basis of laboratory diagnosis and clinical treatment.The results of microbial susceptibility testing are also the main basis for the clinical application of sensitive antibiotics to treat PJI.However,the current positive rate of PJI pathogen culture is not high.In comparison,polymerase chain reaction(PCR) technology does not depend on the premise that unknown microorganisms can be cultured in vitro,and it is rapid and highly sensitive.Therefore,the use of genetic technology,especially PCR technology to diagnose PJI has become one of the current research hot spots.In order to understand the research and development of PCR diagnostic techniques for joint prosthesis infection in recent years,in this paper,the research progress of genetic technology is reviewed,especially PCR technology in the diagnosis of PJI.
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Objective To evaluate the effect of perioperative intravenous (Ⅳ) iron sucrose therapy on reducing postsurgical blood transfusion rates in elderly patients with hip fractures.Methods From September 2011 to February 2014,200 patients aged≥65 years with hip fractures were enrolled.The iron sucrose group (n=100) received iron sucrose (600 mg,Ⅳ),while the control group (n=100) did not receive iron sucrose.Postsurgical blood transfusion rates,infection rates,mortality and length of hospital stay were evaluated.Results The difference in blood transfusion rates was significant (25.0％ vs.41.0％,P＜0.05),while differences in infection rates,mortality and length of hospital stay were not significant between the two groups.Conclusions Perioperative Ⅳ iron sucrose can reduce blood transfusion requirements in elderly patients with hip fractures.
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Objective To evaluate the curative effect of stereotactic radiotherapy in pancreatic cancer in the elderly. Methods Retrospectively analyzed 65 elderly patients with pancreatic cancer were treated with stereotactic radiotherapy. The ages of patients were 60 to 86, with mean age of 71 2. The numbers of treatment were 8 to 12 times according to the tumor size and patients condition Fractional dose were 3 to 6 Gy, total dose were 32 to 54 Gy. The curve of isodose was 50%～80% Results The patients average alive time was 9 3 months after stereotactic radiotherapy The clinical benefit response rate was 61 2%. The CR+PR was 38 4% Conclusions The stereotactic radiotherapy is safe and effective method for treating elderly pancreatic cancer