RÉSUMÉ
Objective:To identify the risk factors for premature proximal femur physeal closure (PPC) in children treated surgically for femoral neck fractures.Methods:Data of 106 children with an open triradiate cartilage who were treated surgically for a femoral neck fracture were retrospectively analyzed. Age, gender, laterality, mechanism of injury, the type of fracture, initial displacement, time to reduction, fixation method, whether the implant crossed the physeal plate, reduction method, reduction quality and development of femoral head avascular necrosis (AVN) were collected. PPC of the proximal femur was assessed through postoperative 6-12 months radiographs.Results:A total of 106 patients with an open triradiate cartilage were followed up, with an average duration of 20.4±13.3 months (range, 6-86 months). The overall rate of PPC following paediatric femoral neck fractures treated surgically was 36.8% (39/106). Among the 39 patients with PPC, 25 were males and 14 were females; the average age at the time of injury was 9.7±3.6 years (range, 3-15 years); 23 patients were involved in left hips and 16 were in right; the mechanisms of injury included motor vehicle accident in 5 fractures, falling injury in 21, sports-related injury in 12 and other causes in 1 fracture; two hips were Delbet type I, and 26 hips and 11 hips were Delbet type II and III, separately; type II and III of initial displacement were involved in 26 and 13 patients, separately; the mean duration from injury to surgery was 3.3±2.8 d (range, 1-14 d); 2 hips were treated with Kirschner wires, 35 hips with screw fixation, and the remaining 2 hips underwent screw and plate fixation; 2 hips had the hardware crossing the proximal femoral growth plate, and the remaining 37 hips didn’t; 15 hips were treated by closed reduction and internal fixation, and the other 24 hips underwent open reduction and internal fixation; anatomical reduction was achieved in 14 patients, acceptable reduction in 24 hips and unacceptable reduction in 1 hip; 24 hips developed AVN at the latest follow-up and the remaining 15 hips didn’t. Statistical analysis indicated that age ( t=3.875, P< 0.001), the severity of initial displacement ( Z=-2.118, P=0.034) and the rate of AVN ( χ2=42.280, P< 0.001) in patients with PPC were significantly higher than those in patients without; Logistic regression analysis confirmed age ( OR=1.288, P=0.011) and AVN ( OR=40.336, P< 0.001) as risk factors for PPC. ROC curve analysis indicated 10 years was the cut off age to significantly increase the rate of PPC. The rate of PPC in patients aged over 10 years (63.6%, 21/33) was significantly higher than that (24.7%, 18/73) in those aged less than 10 years ( χ2=14.848, P< 0.001). Conclusion:Age over 10 years and AVN are risk factors for PPC in children with femoral neck fractures treated surgically.
RÉSUMÉ
Objective To explore the expression of Ang -2 and CD105 in breast cancer and their po-tential associations with the cancerization and progression of breast cancer .Methods Thirty patients with breast cancer ( cancerous tissue ) ,15 intraductal papilloma cases ( precancer tissue ) and 15 normal breast tissue were col-lected for each group ,respectively .Immunohistochemistry ,western blot and RT-PCR techniques were used to ex-amine the expressions of Ang -2 and CD105 in cancerous breast tissue ,precancer breast tissue and normal breast tissue at both protein and mRNA levels .The possible correlations of Ang -2 and CD105 expression with clinico-pathological characteristics of the breast cancer were analyzed .Results The expressions of CD105 and Ang-2 in cancer and precancer tissues were higher than in normal tissues at both protein and mRNA levels ,and the trend of their expressions was increased from normal to precancer ,and cancer tissue .The expressions of CD 105 and Ang-2 protein and mRNA were positively correlated with tumor size ,invasion,lymph node metastasis,and negatively correlated with the differentiation of the cancer .Conclusion CD105 and Ang-2 are involved in the canceriza-tion and pregression of breast cancer .These two biomarkers can serve as two useful indicators in assisting diagno-sis and prognosis of breast cancer .
RÉSUMÉ
ObjectiveTo compare the clinical effect of posterior circumferential fusion with versus without intertransverse process fusion on lumbar instability in aged patients. MethodsThe elderly with lumbar instability were treated with the posterior instrumented circumferential fusion technique in 80 cases. Among 58 patients followed up for at least 2 years, 28 cases (group A)underwent posterior circumferential fusion with intertransverse process, while 30 cases (group B)without intertransverse process. X-ray examination was used before and 1, 3, 6, 12 and 24 months after operation to evaluate the fusion condition of the bone graft, and visul analogue scale (VAS) and Oswestry disability index (ODI) questionnaire were applied to assess the pain of center back and leg,and the conventional activity.ResultsThe operation time and blood loss were more in group A[(185.3±56.6) min and (376.3±92.9) m1] than in group B [(146.4±46.3) min and (234.3±64.5)ml (t=12.37, 37.49, P＜0.01)]. All the 58 cases were followed for at least 2 years. The 27 cases (96.4％) of group A and 28 cases (93.3％) of group B got bone fusion (x2 =0.004, P＞0.05).There were marked differences in the VAS of center back at 1 and 3 months after operation between the 2 groups (t=3.178, 2.158, both P＜0.05), while no difference at the other 3 time point. VAS about the leg pain and the ODI showed no differences between group A and B after operation (all P＞0.05). ConclusionsFor the lumbar instability in the elderly, the posterior circumferential fusion with or without intertransverse process fusion can achieve a similar high rate of fusion and satisfactory clinical results,andtheposteriorcircumferentialfusionwithoutintertranaverseprocess is recommended for less trauma.
RÉSUMÉ
ObjectiveTo establish a new biomechanical test for evaluating biomechanical properties of femoral metaphysis in ovariectomized rats.MethodsTwenty-five-month-old female Sprague-Dawley rats were randomly divided into ovariectomized (OVX) group and the sham-operated (Sham) group (n=10).Twelve weeks after operation,femur BMD and histomorphometry of distal femur were detected.Furthermore,femur biomechanical parameters were determined by diaphysis three-point bending test and a new designed metaphysis bending test.The relationships between the biomechanical parameters and BMD or bone histomorphometry were assessed with Pearson correlations.ResultsThe femur BMD,bone histomorphometrical indexes(％Th.Ar,Tb.N,Tb.Th),and biomechanical parameters(maximum load,yield load and stiffness) of OVX group significantly decreased compared with Sham group.In metaphysis bending test,the mean difference of the maximum load(Fmax),yield load(Fy) between group OVX and Sham were significant higher than that in diaphysis three-point bending test.Positive correlations between biomechanical parameters and femur BMD or bone histomorphometry indexes were observed in both the diaphysis bending and metaphysis bending test.The biomechanical parameters in the metaphysis bending test showed stronger correlations with BMD and bone.ConclusionFemur metaphysis bending test could be used to evaluate the biomechanical properties of osteoporosis.When compared with diaphysis bending test,femur metaphysis bending test is more sensitive in evaluating the change of biomechanical properties of femur in osteoporotic rats.