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1.
Article in Chinese | WPRIM | ID: wpr-910062

ABSTRACT

Objective:To evaluate the application of ERAS concept in the treatment of tibial plateau fractures with minimally invasive double reverse tractions (MIDRT).Methods:A retrospective study was conducted of the 39 patients with tibial plateau fracture who had been treated at Department of Orthopedics, Union Hospital from February 2018 to June 2020. They were 20 males and 19 females, aged from 27 to 47 years. All cases were treated with the same MIDRT but with different perioperative management protocols. Of them, 20 received conventional perioperative management (control group) and 19 perioperative ERAS management (ERAS group). The 2 groups was compared in terms of visual analogue scale (VAS) at 24 hours postoperation, drainage volume, time for removal of drainage tube, hospital stay, patient’s satisfaction, incidence of complications, and American Special Surgery Hospital (HSS) scores at discharge and 1, 3, 6 and 9 months postoperation.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability between groups ( P>0.05). All cases obtained complete follow-up (mean, 10.9 months). No statistically significant difference was found between the 2 groups in drainage volume, time for removal of drainage tube or HSS scores at discharge or one month after discharge ( P>0.05). The VAS score at 24 hours after operation, hospital stay [(9.4±4.8) d], patient's satisfaction, HSS scores [(90.8±3.8), (93.5±4.3) and (95.6±3.7)] in the ERAS group were significantly better than those in the control group [(13.3±1.9) d, (87.5±5.1), (88.1±4.4) and (88.8±4.4)] ( P<0.05). None of the patients had such serious complications as wound infection, breakage or failure of internal fixation, or fracture nonunion. Conclusion:The perioperative management protocols designed according to the ERAS concept may enhance the clinical efficacy of MIDRT in the treatment of tibial plateau fractures and thus raise the patient’s satisfaction.

2.
Article in Chinese | WPRIM | ID: wpr-910013

ABSTRACT

Objective:To explore the epidemiological characteristics of inpatients with tibial pilon fracture in The Third Hospital of Hebei Medical University from 2016 to 2019.Methods:The data of all the patients who had been hospitalized for pilon fracture from January 2016 to December 2019 in The Third Hospital of Hebei Medical University were collected using the medical image computer archiving and transmission system and the medical record query system. The patients' age, gender, occupation, residence, season, cause of injury, Rüedi-Allg?wer classification, and AO classification were analyzed.Results:A total of 234 inpatients with tibial pilon fracture were collected, including 179 males and 55 females, with a ratio of male to female of 3.3∶ 1. The prevalence age ranged from 41 to 50 years in male patients (31.3%, 56/179) and from 51 to 60 years in female patients (25.5%, 14/55). In the 234 patients, farmers (101 cases, 43.2%), rural area (166 cases, 70.9%) and spring season (77 cases, 32.9%) accounted for a higher proportion. The proportions of high-altitude falling (41.0%, 96/234) and high-energy injury (61.5%, 144/234) were the highest. Of the 234 patients by the Rüedi-Allg?wer classification, 23 (9.8%) had type Ⅰ fracture, 90 (38.5%) type Ⅱ fracture, and 121 (51.7%) type Ⅲ fracture, with type Ⅲ fracture prevalent in males (58.1%, 104/179) and type Ⅱ fracture prevalent in females (16.4%, 9/55). Of the 234 patients by the AO classification, 131 (56.0%) had type 43B fracture and 103 (44.0%) type 43C fracture, with a higher proportion of type 43B fractures in women (67.3%, 37/55) than in men (52.5%, 94/179). In type 43B fractures, type 43B3 (43.5%, 57/131) and type 43B3.3 (75.4%, 43/57) were the most common; in type 43C fractures, type 43C3 (74.8%, 77/103) and type 43C3.3 (51.9%, 40/77) were the most common.Conclusions:In the recent 4 years in The Third Hospital of Hebei Medical University, pilon fractures increased year by year and occurred more frequently in spring. They were more common in farmers and in the rural areas. They prevailed in the patients aged from 41 to 50 years. The Rüedi-Allg?wer type Ⅲ fractures and the AO type 43B fractures were the most common.

3.
Article in Chinese | WPRIM | ID: wpr-909998

ABSTRACT

Objective:To compare the biomechanical properties between triangular supporting fixation and conventional dynamic hip screw (DHS) fixation in the treatment of femoral intertrochanteric fractures.Methods:Eight pairs of 16 femoral specimens with an average death age of 51.9 years were used in this study. After thawing, they were randomly divided into an experimental group ( n=8) and a control group ( n=8) according to the left or right laterality. They were made models of femoral intertrochanteric fracture of AO 31-A1 type with strain gauges pasted. The experimental group was subjected to fixation with double triangu-lar supporting and the control group conventional DHS fixation to achieve anatomical reduction. The specimens were then mounted onto a biomechanical testing machine and subjected to loading till 400 N at a rate of 10 N/s. The values of overall deformation of the specimens and strain at 16 selected sites were recorded and compared between the 2 model groups. Results:Under the load of 400 N, the overall deformation was (0.31±0.13) mm for the experimental group and (0.49±0.21) mm for the control group, showing a significant difference ( t=-2.456, P=0.023). The strain values in front of femoral neck, upon front fracture line, at inferior-lateral, inferior-median and inferior-interior sites of front fracture line, at the root of anterior fixation screw, below medial femoral neck fracture line, behind femoral neck, at superior-lateral, superior-median and superior-interior sites of posterior fracture line, below posterior fracture line, at superior and inferior roots of posterior fixation screw, at points parallel to the fixation screw in front of and behind femoral shaft were, respectively, -244.90, 13.16, -71.77, -124.38, -366.89,121.62, -10.94, -166.00, -54.93, -367.38, -608.93, -69.09, 326.50, 133.14, 52.97, and -185.82 in the experimental group and -24.62, -40.39, -36.99, -120.97, -486.38, 99.20, 35.36, -205.67, -74.30, -566.01, -1, 085.40, -77.41, 334.34, 114.08, 38.50, and -235.74 in the control group. Internal fixation failure occurred in one specimen in the control group after 1,759 cycles of loading but in none in the experimental group. Conclusion:For femoral intertrochanteric fractures, double triangular supporting fixation may result in less overall deformation and is more consistent with the normal biomechanical conduction of the femur than conventional DHS fixation.

4.
Chinese Journal of Trauma ; (12): 848-854, 2021.
Article in Chinese | WPRIM | ID: wpr-909948

ABSTRACT

The presence of tension blister often predicts severe soft tissue damage,which not only increases the risk of wound complications but also prolongs the surgical treatment time. However,the developed tension blister has been proposed as a potential decompressive approach for it may relieve the pressure of osteofascial compartment and improve the likelihood of relieving clinical symptoms,as well as avoid unnecessary surgery in cases of suspected osteofascial compartment syndrome. Recently,the osteofascial system has been increasingly recognized that associations were found between the tension blister and osteofascial self-release processing. Thus,the timing of blister occurrence and regression substantially influences physicians′ clinical decisions,making blister management as part of the treatment of fractures. In this review,the authors give an overview of the characteristics,mechanism,stress reduction effect,prevention,current treatment status and complications of the fracture-related tension blister,hoping to help orthopedic physicians understand and treat the tensile blister.

5.
Chinese Journal of Trauma ; (12): 653-661, 2021.
Article in Chinese | WPRIM | ID: wpr-909917

ABSTRACT

Objective:To investigate the effects and mechanism of exosomes secreted by human umbilical cord-derived mesenchymal stem cells (hUC-MSCs) in repair of tendon cell injury.Methods:The hUC-MSCs which were stably subcultured were isolated and purified by a tissue block adherent method,and the immunophenotype of hUC-MSCs was detected by flow cytometry. The induction media was employed to induce the differentiation of hUC-MSCs to osteoblasts,chondroblasts and adipocytes,and cell identification was performed subsequently. The secreted exosomes of MSCs (MSCs-exosomes) were extracted using an ultracentrifugation method. The exosomes were detected by Western blot and electron microscopy,and the fusion ability of the exosome membrane was detected by PKH67 staining fluorescence. Forty Wistar rats were divided into tendon injury group ( n = 20) and normal group ( n = 20) according to the random number table. In tendon injury group,the rats were sacrificed with 100 mg/kg pentobarbital sodium one week after Achilles tendon transection,and the injured tendon cells were obtained following digestion of the Achilles tendon. In normal group,the rats were sacrificed without any treatment and the normal tendon cells were obtained concurrently. After the exosomes were co-cultured with tendon cells in vitro for 12,24,48,72 hours,the proliferation of tendon cells was detected by CCK-8 assay. After the tendon cells were treated with hUC-MSCs exosomes for 24 hours,the effects of exosomes on transforming growth factor β (TGF-β),bone morphogenetic protein (BMP),vascular endothelial growth factor (VEGF),fibroblast growth factor (FGF),interleukin(IL)-1β and tumor necrosis factor-α (TNF-α) were detected by Western blot,qPCR and immunofluorescence. Results:The hUC-MSCs were identified and hUC-MSCs-exosomes were isolated successfully. The cultured MSCs were fusiform and positive for Alanine aminopeptidase (CD13),integrin β-1 (CD29),ECTO-5'-nucleotidase (CD73),thymocyte surface antigen (CD90) and endothelin (CD105),but negative for human leukocyte DR antigen (HLA-DR),hematopoietic progenitor cell antigen (CD34) and leukocyte common antigen (CD45). The exosomes isolated showed a round disc shape and a diameter of 30-100 nm with a depressed internal structure under the electron microscope which was verified via PKH67 staining and the motility-related protein-1 (CD9) and lysosomal associated membrane protein 3 (CD63) were highly expressed. The CCK-8 assay showed the cell viability in tendon injury group was markedly higher than that in normal group at 12 h,24 h,48 h,and 72 h following treatment of tendon cells ( P < 0.01). The results of qPCR revealed that the mRNA expressions of TGF-β (1.850 ± 0.127),BMP (2.133 ± 0.398),FGF (1.610 ± 0.223) and VEGF (2.207 ± 0.059) in tendon injury group were markedly higher than those in normal group(1.004 ± 0.105,1.007 ± 0.145,1.007 ± 0.140,1.001 ± 0.065,respectively) ( P < 0.05). However,the mRNA expressions of IL-1β (0.102 ± 0.009) and TNF-α (0.130 ± 0.013) in tendon injury group was markedly lower than those in normal group (1.004 ± 0.113,1.006 ± 0.134) ( P < 0.01). The results of Western blot were consistent with those of qPCR. Conclusions:The exosomes secreted by hUC-MSCs can promote the growth of tendon cells and repair of tendon cell injury by up-regulating the expression of growth factors TGF-β,BMP,VEGF and FGF,and inhibiting the expression of inflammatory factors IL-1β and TNF-α.

6.
Chinese Journal of Trauma ; (12): 577-579, 2021.
Article in Chinese | WPRIM | ID: wpr-909907

ABSTRACT

This year marks the 100th anniversary of the founding of the Communist Party of China (CPC)! Under the leadership of the CPC,Chinese orthopedics ushered in the 100th anniversary of its establishment! In the past 100 years,under the leadership of the CPC,Chinese orthopedics has developed from the initial group with only six members to a large clinical department with more than 300 thousands registered specialists. Standing on this important node of the centennial birthday of the CPC,it is more significant to recall the magnificent struggle course of orthopedics! According to the characteristics of orthopedic development,Chinese orthopedics was divided into three periods:hard pioneering period (1921-1949),preliminary development period (1949-1979) and rapid development period (1979 till now) to trace back the history of orthopedic people’s struggle and entrepreneurship in the past century!

7.
Chinese Journal of Trauma ; (12): 562-570, 2021.
Article in Chinese | WPRIM | ID: wpr-909905

ABSTRACT

Objective:To investigate the effect and mechanism of exosomes derived from human umbilical cord mesenchymal stem cells (hUC-MSC) in repair of tendon injury in rats.Methods:The hUC-MSC were cultured and the surface markers were identified by flow cytometry. The cells were induced to differentiate into osteoblasts, chondroblasts and adipocytes using a specific media. Meanwhile, the exosomes were isolated from the cell supernatant using exosome separation columns, and were identified by transmission electron microscopy, PKH67 staining and Western blot. A total of 40 Wistar rats were used to establish the Achilles tendon injury model by surgical resection. The rats were divided into hUC-MSC group (Group A) (with 100 μg exosome injected at the injured site) and control group (Group B) (with 250 μl normal saline injected at the injured site) according to the random number table, with 20 rats per group. The expressions of transforming growth factor β (TGF-β), bone morphogenetic protein (BMP-2), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF-2), interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in the tendon tissues of both groups were detected using q-PCR, Western blot and immunofluorescence assay at 4 weeks following injection. The expression of collagen III in the injured tissues of both groups was detected by immunohiestochemistry.Results:The isolated and cultured hUC-MSC presented fusiform under an inverted microscope. After osteogenic differentiation, the cells exhibited a cube nodular structure, and the Alizarin red staining was positive. After adipogenic differentiation, the fat was observed inside the cells, which was red by oil red O staining. After chondroblast differentiation, the cells secreted a large amount of glycosaminoglycans, and a strong positive was revealed by Alisin blue staining. The hUC-MSC-derived exosomes showed round disc shape with a depressed internal structure under a transmission electron microscope, which was verified via PKH67 staining. The Western blot analysis showed high expressions of motility-related protein-1 (CD9) and lysosomal associated membrane protein 3 (CD63). The q-PCR test revealed that the mRNA expressions of TGF-β (4.887±0.767), BMP-2 (3.079±0.150), VEGF (3.108±0.508) and FGF-2 (4.211±0.522) in Group A were markedly higher than those in Group B (1.000±0.062, 0.918±0.129, 1.004±0.103, 1.010±0.169, respectively) ( P<0.01), and that the mRNA expression of IL-1β (0.697±0.037) and TNF-α (0.793±0.021) in Group A was markedly lower than those in Group B (1.004±0.089 and 1.006±0.015, respectively) ( P<0.01). The Western blot analysis revealed that the protein expressions of TGF-β (1.434±0.041), BMP-2 (1.798±0.177), VEGF (1.552±0.113) and FGF-2 (1.357±0.039) in Group A were markedly higher than those in Group B (1.002±0.032, 0.992±0.068, 1.007±0.070, 0.994±0.051) ( P<0.01), and that the protein expressions of IL-1β (0.705±0.016) and TNF-α (0.840±0.045) in Group A was markedly lower than those in Group B (1.000±0.016, 1.003±0.040) ( P<0.01). The immunofluorescence revealed that the positive expression rates of TGF-β and VEGF in Group A were not significantly different from those in Group B ( P>0.05). However, the positive expression rates of BMP-2 (2.278±0.208) and FGF-2 (4.656±0.106) in Group A were markedly higher than those in Group B (0.315±0.101, 1.661±0.110) ( P<0.05 or 0.01), and the positive expression rates of IL-1β (1.677±0.947) and TNF-α (1.520±0.088) in Group A were greatly lower than those in Group B (4.296±0.291, 2.373±0.273, respectively) ( P<0.01). In Group A, the tendon collagen fibers were arranged regularly and tightly, with relatively significant expression of collagen III; while the tendon collagen fibers in Group B were distributed loosely, accompanying broken scarlike healing. Conclusion:The hUC-MSC-derived exosomes can prompt the repair of the injured tendon tissues, which may be associated with the function in up-regulating the expressions of growth factors including TGF-β, BMP-2, VEGF and FGF-2, enhancing the expression of collagen III and inhibiting the expression of the inflammatory cytokines including IL-1β and TNF-α.

8.
Chinese Journal of Trauma ; (12): 449-456, 2021.
Article in Chinese | WPRIM | ID: wpr-909890

ABSTRACT

Objective:To investigate the repair effect of electrospun gelatin polycaprolactone (GT/PCL) nanofiber aerogels (NFA) combined with cartilage extracellular matrix (ECM) for treatment of cartilage injuries in rabbits.Methods:Firstly, the GT/PCL electrospun membrane was prepared by electrospinning and was ground into the short fiber at high speed. ECM was extracted and separated from fresh bovine articular cartilage, which mixed with the short fiber solution (10 ∶1). Subsequently, it was used to prepared GT/PCL/ECM (NFA) three-dimensional scaffold. Finally, the physical characteristics of the three different scaffolds (GT/PCL, ECM and GT/PCL/ECM) were detected by scanning electron microscope and Fourier-transform infrared (FTIR) spectrometer, including the composition, microstructure, swelling rate, porosity, compressive strength and degradation rates. And the biocompatibility research was getting on by co-culturing the scaffold with chondrocytes. Fifteen male New Zealand white rabbits were divided into blank control group (Group A, n=5), ECM group (group B, n=5) and composite scaffold(GT/PCL/ECM)group (Group C, n=5) according to the random number table. An injury model was established and three types of bio-scaffold materials were implanted into different groups. At 3 weeks, the cartilage repair was evaluated among groups by semi quantitative global MRI scoring system (WORMS). After the animals were killed, the knee joints of each group were scored by the international society for cartilage repair histological score (ICRs); the ICRs histological score was performedby HE staining and safranine green staining. Results:Three scaffolds showed a porous three-dimensional structure under the scanning electron microscope. FIRT showed that GT and PCL were introduced into the scaffolds successfully. The GT/PCL NAF was loose and unable to be characterized by materials science. The swelling rate of GT/PCL/ECM scaffold [(1, 092.0±32.2)%] was higher than that of ECM scaffold [(933.6±16.3)%] ( P<0.01). The porosity of GT/PCL/ECM scaffold [(92.3±2.3)%] was higher than that of ECM scaffold [(85.9±2.2)%] ( P<0.05). The compressive strength of ECM scaffold [(2.7±0.1)kPa] and of GT/PCL/ECM scaffold [(2.4±0.1)kPa] showed no statistical difference ( P>0.05). The degradation rate of ECM scaffold was higher than that of GT/PCL/ECM scaffold, but the difference was not statistically significant ( P>0.05). The cytotoxicity rating of GT/PCL/ECM scaffold was grade I, indicating that its biocompatibility was better. At 3 weeks, the MRI WORMS score in Group C [(49.0±11.4)points] was significantly higher than that in Group B [(40.0±6.7)points] and that in Group A [(24.0±6.5) points] ( P<0.05 or 0.01); the general ICRS score of group C was [(7.4±1.1) points], which was significantly higher than that of group B [(4.6±1.1)points] and group A [(3.0±1.2)points] ( P<0.01); The ICRS histological scores of group C and group B were [(6.8±0.8)points] and [(4.2±0.8)points] respectively compared with group A [(2.8±0.8)points] were significantly higher ( P<0.05 or 0.01). Conclusion:GT/PCL/ECM (NFA) scaffold has similar tissue structure to natural cartilage and is superior to traditional ECM scaffold in physical properties and biocompatibility, which provides a stable environment for chondrocyte adhesion and growth, promotes collagen regeneration, and thus accelerates the repair of cartilage injury.

9.
Chinese Journal of Trauma ; (12): 284-288, 2021.
Article in Chinese | WPRIM | ID: wpr-909866

ABSTRACT

Tendon injuries often need surgical treatment, which enables to repair the structure and stability of the tendons to a certain extent, whereas it is difficult to restore to their normal strength. The primary reason is that the natural healing ability of tendons is limited and the functions of the repaired tendons cannot be restored completely. As further researches on tendon healing are conducted, biological technology provides a novel orientation for tendon repair. One of the research hotspots of tendon repair currently is to facilitate tendon healing using biological auxiliaries, including tendon stem /progenitor cells(TSPCs) and growth factors. The authors review the research progress in mechanism of TSPCs and growth factors accelerating tendon healing in order to provide a reference for the biological treatment of tendon injuries.

10.
Chinese Journal of Trauma ; (12): 176-181, 2021.
Article in Chinese | WPRIM | ID: wpr-909851

ABSTRACT

Trauma induces immune cells to infiltrate the fracture site, and regulates the removal of local dead bone and remodeling of new bone by secreting a variety of cytokines and inflammatory mediators. With the development of trauma immunology, the role of the immune system in the process of bone wound healing has been deeply studied in recent years. When fracture occurs, the non-specific and specific immune cells are successively attracted into the fracture site, participating in bone repair. If there was a disorder in the bone trauma microenvironment, the coordination between osteoblasts and osteoclasts will be disordered, leading to delayed or nonunion of fractures. Therefore, it is very important to systematically explore the communication between immune cells and immune cells or osteoblasts/osteoclasts in bone trauma microenvironment. The authors review the immune regulation mechanism in the process of bone clearance and repair after bone trauma, and provide a rationale for the future immunotherapy of bone trauma.

11.
Chinese Journal of Orthopaedics ; (12): 1803-1812, 2021.
Article in Chinese | WPRIM | ID: wpr-910775

ABSTRACT

Objective:To study the effect of microglia depletion combined with bone marrow mesenchymal stem cells (BMSC) transplantation for spinal cord injury (SCI) repair.Methods:GFP-BMSCs were cultured, identified and detected for expression levels of growth factors. The effects of BMSCs ondorsal root ganglion (DRG) axon outgrowth were observed by the co-culture of BMSCs with DRGs. Mice were depleted of microglia by administrating the colony stimulating factor 1 receptor (CSF1R) inhibitor PLX3397. The spinal cords of these microglia-depleted mice were subjected to crush injury. BMSCs were transplanted into SCI area after microglia depletion. Mice were randomly divided into control group (SCI+BMSCs) and experimental group (PLX3397+SCI+BMSCs). Mice were sacrificed at corresponding time points after transplantation for observing the survival of transplanted BMSCs and the repair of spinal cord. BMS score was used for evaluation of motor function recovery.Results:BMSCs secreted a large number of neurotrophic factors and promoted the growth of DRG axons when co-cultured with DRGs. Depletion of microglia significantly improved the survival of transplanted BMSCs. Compared with BMSCs transplantation alone, the combined treatments slightly but non-significantly reduced the area of the lesion ( t=2.141, P=0.065). Immunofluorescence staining showed that both BMSC transplantation alone and the combined treatments did not cause the corticospinalaxons across the lesion and into distal spinal cord. BMS scores were (1.20±0.45), (3.20±0.45), (3.80±0.45), (4.20±0.45), and (4.60±0.55) points in control group at 1, 7, 14, 21 and 28 d after injury. The experimental groups were(0.60±0.55), (3.00±0.71), (3.80±0.84), (4.20±0.84), and (4.40±0.89) points, respectively. Conclusion:Depletion of microglia improves the survival of transplanted cells, depletion of microglia combined with BMSC transplantation did not result in a significant reduction in lesion area. At the same time, the damaged CST axons were notregenerated. Thus, combining cell transplantation with axon-promoting strategy may be necessary for SCI repair.

12.
Chinese Journal of Orthopaedics ; (12): 1412-1418, 2021.
Article in Chinese | WPRIM | ID: wpr-910730

ABSTRACT

Objective:To investigate the effect of the placement of a drainage tube on the prognosis of patients with pelvic fractures treated by modified Stoppa approach.Methods:The medical records of patients with pelvic fractures treated with modified Stoppa approach from August 2012 to August 2017 were retrospectively analyzed. A total of 43 patients including 32 males and 11 females (mean age 47.6 years, range from16 to 69) were included in the study. According to Young-Burgess classification, there were 12 cases of Lateral Compression type LC-I type; 20 cases of Anterior and Posterior Compression type APC-I type and 11 cases of APC-II type. All patients were treated with modified Stoppa approach to reduce the fracture and fix with plate and screw. According to whether a drainage tube was placed during the operation, 22 cases were placed with a drainage tube (drainage group), and 21 cases were not placed with a drainage tube (non-drainage group). The main observation indicators were the intraoperative conditions, antibiotic application, incision suture removal time, postoperative body temperature change, hospital stay and clinical function (Harris score).Results:Wound infection was not observed in two groups. The duration of antibiotic use in the drainage group was 5.0 d (2.0, 8.0) d, and the non-drainage group was 4.0 d (2.0, 5.0) d, the difference was not statistically significant ( Z=1.161, P=0.924). The hospital stays of the two groups were 18.5 d (15.0, 24.3) d and 19.0 d (13.0, 26.0) d, respectively, and the difference was not statistically significant ( Z=0.542, P=0.591). The operation time was 150.2±52.4 min in the drainage group and 138.8±41.2 min in the non-drainage group, and the difference was not statistically significant ( t=0.791, P=0.433). The blood loss in the drainage group was 604.6±387.3 ml, and the non-drainage group was 581.0±275.0 ml. The difference was not statistically significant ( t=0.276, P=0.784). The postoperative body temperature changes of patients in the drainage group and non-drainage group were on day 1 (37.5±0.5 ℃ vs. 37.4±0.4 ℃, t=0.322, P>0.05), day 3 (37.1±0.4 ℃ vs. 37.0±0.4 ℃, t=0.286, P>0.05), day 5 (37.0± 0.3 ℃ vs. 36.8±0.2 ℃, t=2.127, P>0.05), on the 7th day (36.8±0.2 ℃ vs. 36.7±0.4 ℃, t=0.491, P>0.05), the difference was not statistically significant. The time for suture removal of surgical incision was 14.1±0.6 d in the drainage group and 13.9±0.6 d in the non-drainage group, and the difference was not statistically significant ( t=1.072, P=0.329). The Harris scores of the two groups were 96 (91, 100) points for the drainage group and 96 (93, 97) points for the non-drainage group, and the difference was not statistically significant ( Z=0.107, P=0.607). Conclusion:There is no significant influence of the application of drainage on recovery of wound or function for patients with pelvic surgery.

13.
Chinese Journal of Orthopaedics ; (12): 1373-1379, 2021.
Article in Chinese | WPRIM | ID: wpr-910725

ABSTRACT

Pelvic fractures usually are high-energy injuries, which often involve high incidence of nerve injury, including lumbosacral plexus injuries and cauda equina injuries. Duo to 50% of neurological improvement has been reported regardless of the type of operative or nonoperative management after pelvic fractures complicated with nerve injuries, it still remains controversial whether surgical exploration is effective in such cases at an early stage and there is also some disagreement between anterior exploration or posterior exploration. We should find out the mechanism of pelvic fractures and the nature of nerve injuries. What's more, we must have a clear understanding of the location and qualitative diagnosis of the nerve injuries. After admission of patients, a detailed physical examination, combined with pelvic X-ray, CT, magnetic resonance neurography (MRN) and other imaging findings, which are conducive to make accurate diagnosis of the nature of nerve injuries, are carried out to make a targeted treatment plan. Generally speaking, cauda equina injuries are more common injuries in U-shaped sacral fractures, which cause the compression and space-occupying lesions of the sacral canal, so the posterior approach is a major approach to achieve the reduction and fixation of the sacral fractures and the decompression of sacral canal. While the lumbosacral plexus injuries are caused by the anterior compression, it is better to perform anterior approach to achieve the desired effect.

14.
Chinese Journal of Orthopaedics ; (12): 1361-1366, 2021.
Article in Chinese | WPRIM | ID: wpr-910723

ABSTRACT

Objective:To compare the biomechanical properties of triangular supporting fixation and Gamma nail fixation for intertrochanteric fractures of the femur.Methods:The femoral CT imaging data provided by a healthy adult male volunteer aged 40 years, height 172 cm, and weight 75 kg were used to reconstruct the femur model using Mimics 21.0 software and Geomagics 2013 software. Evans type I intertrochanteric fracture models were established using UG12.0 software, and Gamma nail and triangular supporting intramedullary nail models were reconstructed to simulate intertrochanteric fracture internal fixation, respectively. In Abaqus software, two internal fixation models of Gamma nail and triangular supporting intramedullary nail in standing state are simulated, and the stress peaks of the main nail, fixation screw and bone substance were collected, also the stress peak of supporting screw of the triangular supporting intramedullary nail is obtained. Additionally, the maximum displacement of the fracture model fixed by Gamma nail and triangular supporting intramedullary nail is measured.Results:Under the load of 1 200 N, the peak stress of the two fracture internal fixation models was located in the main nail, in which the peak stress of the triangular supporting intramedullary nail was 233.73 MPa, which was 11.9% lower than that of the Gamma nail (265.21 MPa); the peak stress of the fixation screw was located in the contact area between the pressure screw and the main nail, which was 23.2% lower in triangular supporting intramedullary nail than that of the Gamma nail (138.86 MPa vs. 180.75 MPa); the peak stress of the bone model was located in the medial cortex of the femur, which was 61.67 MPa and 32.38 MPa, respectively, 47.5% lower in the triangular supporting intramedullary nail than that of the Gamma nail; the peak stress of the supporting screw in the triangular supporting intramedullary nail was 92.04 MPa. The maximum displacement of the fracture model fixed with triangular supporting intramedullary nail was 17.34 mm, which was 10.5% less than the maximum displacement of the fracture model fixed with Gamma nail (19.37 mm). Conclusion:Compared with Gamma nail, triangular supporting intramedullary nail fixation can significantly improve the stability of intertrochanteric fractures and stress distribution as well as reduce stress peak and stress concentration area, which is helpful to improve the efficacy of intertrochanteric fractures.

15.
Chinese Journal of Orthopaedics ; (12): 985-991, 2021.
Article in Chinese | WPRIM | ID: wpr-910681

ABSTRACT

Objective:To explore the correlation between fibular head height and varus knee osteoarthritis occurrence and severity.Methods:A retrospective analysis was performed on 618 participants (618 knees, 184 males and 434 females, mean age 61.12±10.98 years) who underwent standard weight-bearing full-leg radiographs and were diagnosed as non-knee osteoarthritis or varus knee osteoarthritis from January 2019 to June 2019. Knee osteoarthritis was diagnosed according to Kellgren-Lawrence grading: 0-I grades were diagnosed as non-osteoarthritis, II-IV grades were diagnosed as osteoarthritis. Joint line convergence angle (JLCA), medial proximal tibial angle (MPTA) and hip-knee-ankle angle were measured on X-rays to reflect varus deformity. The fibular head height was defined as the vertical distance from upper edge of fibular head to lateral tibial plateau. Patients were divided into 5 groups according to Kellgren-Lawrence grading. Differences of age, gender, height, weight, body mass index, varus deformity (JLCA, MPTA and hip-knee-ankle angle) between Kellgren-Lawrence 0-IV grades were compared. Ordinal logistic regression was performed to analyze the correlation between fibular head height and Kellgren-Lawrence grades. Pearson's correlation analysis was used for the correlation among fibular head height, JLCA, MPTA and hip-knee-ankle angle, and the main factor of JLCA, MPTA and hip-knee-ankle angle was extracted by factor analysis. Multiple linear regressions were used to analyze the correlation between fibular head height and varus deformity score.Results:There were 68, 66, 97, 98, 289 participants in Kellgren-Lawrence grades 0-IV respectively that was 134 participants were diagnosed as non-osteoarthritis and 484 participants were diagnosed as osteoarthritis. Fibular head height and MPTA showed a decreasing trend ( F=129.076, 24.875; P<0.001) while JLCA and hip-knee-ankle angle showed an increasing trend ( F=414.346, 105.996; P<0.001) with the increase in Kellgren-Lawrence grading. Age, body mass index and fibular head height are influencing factors of Kellgren-Lawrence grading with OR(95%CI) were 1.116(1.093, 1.141), 1.363(1.060, 1.754), 0.617(0.575, 0.662) . Fibular head height was negatively correlated with JLCA and hip-knee-ankle angle ( r=-0.641, -0.478; P<0.001) , respectively, and positively correlated with MPTA ( r=0.320, P<0.001). There were significant correlations between age, fibular head height and the varus deformity score ( β=0.274, -0.457; P<0.001). Conclusion:Fibular head height of patients with varus knee osteoarthritis is lower than that of non-osteoarthritis. In addition to age and body mass index, fibular head height is a risk factor for varus knee osteoarthritis occurrence. The smaller the fibular head height is, the more serious the osteoarthritis severity and varus deformity are.

16.
Chinese Journal of Orthopaedics ; (12): 644-653, 2021.
Article in Chinese | WPRIM | ID: wpr-884755

ABSTRACT

Objective:To investigate the repair effects and mechanism of mesenchymal stem cell osteogenesis-derived exosomes deliver miRNA-222-5p on tendon cell injury.Methods:Mesenchymal stem cell exosomes were collected, isolated and characterized. The mice achilles tendon was collected after cutting one week later. The tendon cells were isolated and cultured to obtain a tendon cell injury model (injury group). The subjects were divided into three groups. During the process of osteogenic differentiation, mesenchymal stem cells were co-cultured with tendon cells (co-culture group). Further, miRNA-222-5p mimics were transfected into mesenchymal stem cells, the co-cultured mesenchymal stem cells and tendon cells during the process of osteogenic differentiation (miRNA-222-5p group). Clone formation and Transwell were used to detect the ability of mesenchymal stem cells to secrete exosomes and exosomes transported miRNA-222-5p to repair damaged tendon cells. qPCR, Western-blot and fluorescence staining were used to detect the expression levels of cartilage-related proteins and bone-related proteins on mRNA and protein. Western-blot was used to detect the expression of signal pathway factors.Results:The shape of the exosomes was a typical cup - like structure. The exosome proteins marker was all expressed positively ( P<0.05). After counting the colony formation and Transwell test, the number of cell communities and cell invasion were significantly increased in the co-culture group compared with those in the injury group. The number of those in miRNA-222-5p group were significantly increased compared with those in co-culture group ( P<0.05). The qPCR, Western-blot and fluorescent staining test results showed that the mRNA and protein expression levels of SOX-9, COL2A1, ACAN, BMP2, Runx2, and OPN in the co-culture group were significantly increased compared with the injury group. The mRNA and protein expression levels of the above proteins in the miRNA-222-5p group were significantly increased compared with those in co-culture group ( P<0.05). We also detected the protein expression levels of signal pathway related factors. Western-blot results showed that the expression levels of NF-κB, Erk2, STAT3, STAT5 and Smad2 in the co-culture group were significantly increased compared with those in the injury group. The expression levels of the above factors in the miRNA-222-5p group were significant increased compared with the co-culture group ( P<0.05). Conclusion:The co-culture of mesenchymal stem cells and achilles tendon cells could promote the osteogenic differentiation of achilles tendon cells. Exosomes derived from mesenchymal stem cells could further promote the osteogenic differentiation of achilles tendon cells by transporting miRNA-222-5p. The mechanism may be related to the up-regulation of signal pathway factors in injured tendons, including NF-κB, Erk2, STAT3, STAT5 and Smad2.

17.
Chinese Journal of Orthopaedics ; (12): 195-200, 2021.
Article in Chinese | WPRIM | ID: wpr-884698

ABSTRACT

Traumatic fracture accounts for about 50% of the total of traffic accidents. The incidence of fracture in postmenopausal women is significantly higher than that in men. About 5%-10% of patients with bone fracture will suffer from complications such as delayed union or nonunion, which seriously affects the recovery of patients after operation and increases the economic burden of families and society, however, the specific regulatory mechanism has not been fully defined. Immune cells play an important regulatory role in fracture healing, and innate immune response is the first to initiate and participate in fracture healing. Macrophages are innate immune cells which widely exist in various tissues of the body. They play a complex and precise regulatory role in fracture healing by participating in inflammatory response, osteogenic and osteoclast differentiation, mineralization and angiogenesis. Nevertheless, macrophages can be polarized into different subsets and perform different or even opposite functions under different immune microenvironments. At present, it is believed that there are three main polarization states of macrophages: non-activated M0 macrophages, classically activated M1 macrophages and selectively activated M2 macrophage. It has been shown that each subset was positively involved in the regulation process of fracture healing at different stages. Herein, in this paper, the role of different subsets of macrophages in different stages of fracture healing and the related experimental studies are reviewed, helpfully to clarify the immunological mechanism of fracture in-depth and provide new strategies for the research on the immunological intervention of fractures targeting macrophages.

18.
Chinese Journal of Orthopaedics ; (12): 137-140, 2021.
Article in Chinese | WPRIM | ID: wpr-884697

ABSTRACT

Tibial plateau fracture is a common acute trauma of the knee joint. At present, there are many studies on its classification and treatment, and minimally invasive treatment has become a research hotspot and mainstream direction of tibial plateau fracture. We summarized the clinical results of minimally invasive treatment of more than 300 cases of tibial plateau fractures, and proposed the concept of core weight-bearing area on tibial plateau, that is, the core weight-bearing area of the tibial plateau of the knee joint under normal motion statuswhile walking and moderate-intensity running. We performed thinsection CT scanning of the knee joint in a male volunteer for three-dimension finite element modeling.The results showed that during the walking state (the load was twice that of gravity), the core weight-bearing area of the medial and lateral plateaus was 389 mm 2 and 363 mm 2, accounting for 33.2% and 42.9% of tibial plateau, respectively;during the moderate-intensity running state (the load was four times that of gravity), the core weight-bearing area of the medial and lateral plateaus was 418 mm 2 and 406 mm 2, accounting for 35.6% and 48.0%of tibial plateau, respectively. Accordingly, tibial plateau fractures are supposed to be divided into core weight-bearing fracture and non-core weight-bearing fracture, and there are significant differences in the treatment ofthese twokinds of fractures: reduction is more demanding for core weight-bearing fracture,and the fracture involves the core area closely, the anatomical reduction is sought; for non-core weight-bearing area, the reduction requirements can be appropriately low demanded, and even in some cases , for example simple avulsion fracture, marginal fracture, some tibial plateau Hoffa fractures,can be treated conservatively. In summary, during clinical diagnosis and treatmentpractice, orthopedic surgeons should take the core weight-bearing area fracture as the core of diagnosis and treatment, strictly evaluate the extent of fracture involvement, select targeted internal fixation materials, and target to promote more accurate, minimally invasive, and individualized treatment of tibial plateau fractures.

19.
Chinese Journal of Orthopaedics ; (12): 133-136, 2021.
Article in Chinese | WPRIM | ID: wpr-884696

ABSTRACT

Continual discoveries and inventions are the only way for the development of natural science. However, there has been controversy about either of which is more important than the other one. From the perspective of natural science, the present article compares the promoting effects of scientific discoveries versus technical inventions on natural science from four aspects: the definition and relationship of discoveries and inventions, the scientific discoveries and technical inventions view of Nobel Prize, the process from discoveries to inventions in theory, and the ownership of discovery right and invention right. This study focuses on the characteristics of subjects on 334 Nobel Prizes in the field of natural science from 1901 to 2019. Further, most awards are given for the scientific discoveries in Physiology or Medicine field, which account for 90.9%. This outcome indicates that scientific discovery as the source of science is more favored by the natural science community, which is in line with the general goal of the "Thirteenth Five-Year Plan" of the National Natural Science Foundation of China. We hope that the majority of natural science researchers, during the process of promoting the development of natural science in China, should not only pay attention to the original discoveries of the "source of water", but also discover some things with spirit of questioning. The researchers should have the courage to break the inherent thinking and have the courage and patience to to discover the fundamental theory.

20.
Article in Chinese | WPRIM | ID: wpr-884261

ABSTRACT

Objective:To analyze the epidemiological features of geriatric humeral surgical neck fractures from 2010 through 2019 in The Third Hospital of Hebei Medical University.Methods:A retrospective study was conducted of the data of the inpatients aged ≥60 years who had been treated for humeral surgical neck fractures in The Third Hospital of Hebei Medical University from 2010 through 2019. The patients were divided into 2 groups by the year of admission: the former five-year group (group A from January 1, 2010 to December 31, 2014) and latter five-year group (group B from January 1, 2015 to December 31, 2019). The data of the patients were compared between the 2 groups to find the epidemiological characteristics and trends of the humeral surgical neck fractures in the 10-year period.Results:A total of 312 geriatric humeral surgical neck fractures were included, accounting for 1.2%(312/25, 764) of the upper limb fractures and 0.4% (312/88, 886) of all the fractures in the same period. There were 64 males and 248 females, giving a male/female ratio of 0.26∶1. Their ages ranged from 60 to 93 years. The peak age of the fractures was from 60 to 69 years for both males and females. Falls and indoor activity injuries accounted for the largest proportion (71.2%, 222/312). The common fracture types were 11-A2 and 11-A3. The proportion of overweight and obese patients by the body mass index (BMI) was the largest (58.7%, 183/312). There were no statistically significant differences between groups A and B in male/female ratio (0.37:1 versus 0.22:1) or in proportion of peak age patients [42.7% (38/89) versus 55.2% (123/223)] ( P>0.05). There were statistically significant differences between the 2 groups in injury causes, fracture types and BMI distribution ( P<0.05). Conclusions:The geriatric humeral surgical neck fractures accounted for 1.2% of the upper limb fractures and 0.4% of all the fractures in the same period. There were more female patients than male ones. Falls and indoor activity injuries were the most common causes. The proportions of complex fractures and overweight and obese patients increased.

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