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Objective:To investigate the efficacy of internal fixation maintenance after fracture-related infection (FRI).Methods:Retrospectively analyzed were the data of 81 patients with deep FRI after 6 weeks of internal fixation who had been treated with hardware maintenance at Department of Orthopedics, The Second Hospital Affiliated to School of Medicine, Zhejiang University between 2013 and 2021. They were 61 males and 20 females, aged from 11 to 73 years (average, 11 years). After admission, the patients received bacterial culture, thorough debridement, negative pressure suction, soft tissue repair, and local and intravenous antibiotics. If a joint was affected by FRI, its cavity was cleaned and drained. Infection control and fracture healing were regularly observed in all patients. A treatment was considered successful when the internal fixation was maintained until fracture union, and considered as unsuccessful when the internal fixation was removed before fracture union. Risk factors associated with treatment failure were identified from gender, age, smoking, diabetes, fracture type, methicillin-resistant Staphylococcus aureus (MRSA) infection, methicillin-susceptible staphylococcus (MSSA) infection, Pseudomonas aeruginosa infection, Escherichia coli infection, infection by two kinds of bacteria, negative bacterial culture, early infection (within 2 weeks) and local use of antibiotics.Results:All patients were followed up for an average of 30 months (from 6 to 84 months). Fracture union was achieved in 62 (76.5%) patients with infection control and internal fixation retained. Masquelet technique was used to treat bone defects in 2 patients; a muscle flap or skin flap was used to reconstruct soft tissue coverage in 11 cases; fracture union was achieved by antibiotics and dressing changes in 2 patients with sinus tract. Amputation was performed in one unsuccessful case due to uncontrollable infection, and internal fixation was changed to external fixation in the other 18 unsuccessful cases, of which 3 achieved final bone union after application of Masquelet technique, 7 achieved final bone union after application of bone transfer technique, and 3 achieved soft tissue coverage after reconstruction with flap technique. Pseudomonas aeruginosa infection, open fractures and FRI for more than 2 weeks were high risk factors for failure in internal fixation maintenance ( P<0.05). Conclusions:If internal fixation is still stable and effective, hardware maintenance should be tried first in the patients with FRI within 6 weeks after fracture internal fixation. Muscle flap or skin flap surgery should be performed as soon as possible to effectively control infection and promote fracture union in the patients with soft tissue defects after thorough and effective debridement. History of open fracture, Pseudomonas aeruginosa infection, and FRI for over 2 weeks may be risk factors for failure in internal fixation maintenance.
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Objective:To investigate the effect of liquiritin on the apoptosis of amygdala cell and the expression of apoptosis-related factors Bax and Bcl-2 protein in rats with post-stroke depression (PSD).Methods:Sixty rats were randomly divided into normal control group, stroke group, PSD group, citalopram group, liquiritin group, and normal saline control group ( n=10 in each group). The middle cerebral artery was occluded with a suture method to induce focal cerebral ischemia, and the PSD model was established by chronic and unpredictable mild stress stimulation and orphanism. At the same time every week after the model was made, the weight of rats in each group was measured and the depression behavior was evaluated, including sucrose water test and open field test. At 6 weeks after the model was made, TUNEL staining was used to detect the apoptosis of amygdala cell, immunofluorescence staining was used to detect the expression of Bax and Bcl-2 in the amygdala, and Western blot analysis was used to detect the protein expression of Bax and Bcl-2 in the amygdala. Results:Compared with the liquiritin group, citalopram group and normal control group, the body weight and sucrose solution preference of rats in the stroke group, PSD group and normal saline control group were decreased, and the horizontal and vertical movements in open field test were decreased; the differences were statistically significant (all P<0.01). TUNEL staining results showed that compared with the liquiritin group, citalopram group and normal control group, the number of apoptotic cells was significantly increased in the stroke group, PSD group, and normal saline control group; the difference was statistically significant (all P<0.01). The results of immunofluorescence staining showed that compared with the liquiritin group, citalopram group and normal control group, the number of bcl-2 immunoreactive cells in amygdala of the stroke group, PSD group and normal saline control group was significantly decreased, while the number of Bax immunoreactive cells was significantly increased; the difference was statistically significant (all P<0.01). Western blot analysis showed that compared with the liquiritin group and citalopram group, the expression of bcl 2 protein in amygdala of the stroke group, PSD group and normal saline control group was significantly decreased, while the expression of Bax protein was significantly increased; the difference was statistically significant (all P<0.01). Conclusion:Liquiritin can alleviate the symptoms of PSD, and its mechanism may be related to inhibiting the apoptosis of amygdala cells and regulating the expression of apoptosis-related factors.
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Objective:To explore the epidemiological characteristics, clinical characteristics, treatment strategies and clinical results of non-dislocated hyperextension tibial plateau fracture.Methods:A total of 25 cases of non-dislocated hyperextension tibial plateau fracture patients were collected, including 12 males and 13 females, aged 27-79 years with an average age of 51±15 years. Causes of injury: 18 cases of traffic accident, 2 cases of heavy injury, 5 cases of falling injury. Schatzker classification of tibial plateau fracture: 4 cases of type II, 5 cases of type IV, 13 cases of type V, 3 cases of type VI. Three columns theoretical classification: 4 cases of simple lateral column, 5 cases of simple medial column, 7 cases of medial column+lateral columns, 9 cases of three columns. Preoperative tibial plateau posterior slope angle was -10-0 degrees, average-5.2 degrees. Preoperative MRI showed 5 cases of medial collateral ligament (MCL) injury, 3 cases of posterolateral complex (PLC) complex injury, 2 cases of PLC+ posterior cruciate ligament (PCL) injury and 10 cases of menisci injury. The change of tibial plateau posterior slope angle was more than 10 degrees in patients with ligament injury, 5 patients had a tibial plateau posterior slope angle change more than 15 degrees, 5 patients had a tibial plateau posterior slope angle change more than 10 degrees, and the patients with a tibial plateau posterior slope angle change less than 10 degrees had no ligament injury; 6 patients with simple lateral column or medial column fracture had a ligament injury, 2 patients with medial column+lateral column fracture had a ligament injury, and 2 patients with three column fracture had a ligament injury.Results:All patients were followed up for 12-24 months, with an average of 16.4 months. The operation time was 124±33 min (65-180 min), and the bleeding volume was 106±48 ml (20-200 ml). All patients were treated by open reduction and internal fixation. According to the characteristics of fracture, targeted reduction of articular surface and restoration of lower limb force line were carried out. The plate was placed on the anterior part of tibial plateau to fix the fracture fragment. Evaluation of postoperative fracture reduction: 20 cases were anatomic reduction, 5 cases were good reduction (between 2-5 mm articular surface collapse), and the excellent rate of fracture reduction was 100%. Internal fixation: 4 cases were treated with simple lateral plate, 2 cases with simple medial plate, 15 cases with medial+ lateral plate, 1 case with medial plate+ lateral anchor suture, 1 case with medial plate+ posterior screw, 1 case with lateral plate+ fibular screw, 1 case with medial plate + lateral plate+ lateral anchor suture. The meniscus was repaired in 8 patients, including 5 medial and 3 laterals. The fracture healing time was 3-6 months (mean 3.3 months). The postoperative knee Rasmussen score was 24.9±3.5 (18-29), and the postoperative knee joint mobility was 118°±9° (90°-130°). Superficial infection occurred in 2 patients.Conclusion:The main imaging characteristic of "non-dislocated hyperextension tibial plateau fracture" is the change of tibial plateau posterior slope angle. The injury of single anteromedial column/anterolateral column fracture is easy to combine with the "diagonal" injury, and when the tibial plateau posterior slope angle changes more than 10 degrees, it is easy to be associated with peripheral ligament injury. By using open reduction and internal fixation, restoring the joint articular surface and lower limb force line, repairing the soft tissue structure and ligament, and reconstructing the stability of knee joint, we can achieve satisfactory results.
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Objective To investigate the effects of the jumbo cup in acetabular revision for patients with massive acetabular bone deficiency.Methods We retrospectively studies 48 patients (49 hips) who underwent jumbo cup revisions between 2006 and 2015 (19 men and 29 women;average age:62± 12 years).The acetabular bone defects were classified according to Paprosky classification (Paprosky Ⅱ 27 hips,Paprosky ⅢA 18 hips,Paprosky ⅢB 4 hips).Radiological assessments were conduced to evaluate the acetabular prosthesis loosening,dislocation and infection.The reasons for revisions were mechanical loosening in 41 cases,and infections in another 8 cases with cement spacer putted by last surgery.Results The operation duration and blood loss was 110 min (85-160 min) and 315 ml (270-455 ml) respectively.After an average follow-up of 6.8 years (1-11 years),Harris hip score was increased from 47.6±7.1 preoperatively to 82.4± 6.2 postoperatively.Osseointegration occurred in the acetabular components at 6 months postoperatively.Radiograph analysis showed satisfied position of acetabular cup without complications such as damages of vessels or nerves.The successful rate of jumbo cup revisions was 89.8％±4.4％.However,two in Paprosky ⅢA failures for periprosthetic infection occurred and two in Paprosky ⅢA,one in Paprosky ⅢA and the other in Paprosky ⅢB for acetabular component loosening.One patient in Paprosky ⅢB had weight-bearing pain and relieve slightly after conservative treatment.The radiologic study showed that there was no relationship between failure rate and acetabular abduction angle (r=0.06,P=0.53),rotation center migration in vertical direction (r=0.11,P=0.14) and horizontal direction (r=0.04,P=0.89).Conclusion The mid-term results show that using jumbo cup in revising acetabular failure with massive bone deficiency are optimal,which can be achieved by simplified operation procedures,reduction in the need of bone graft and promotion in acetabulum osseointegration.However,higher failure rate may occur in Paprosky ⅢB patients.
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Objective To investigate the effects of locally and systemically administered alendronate on wear-debris induced osteolysis in vivo. Methods Endotnxin-free titanium particles were injected into rabbit femurs prior to insertion of a non-weight-bearing polymethylmethacrylate plug into the distal femur canal. Then the particles were repeatedly injected into the knee 2, 4 and 6 weeks after the implantation. Alendronate was incorporated into bone cement for local delivery at three different concentrations [0.1, 0.5, and 1.0 weight%(wt%)]. For systemic delivery, alendronate was subcutaneously injected ( 1.0 mg· kg-1·week-1).Results Eight weeks after operation, there was significant evidence of osteolysis surrounding the plug in the control group, while markedly-blocked osteolysis was noted in the local delivery group (0.5 wt% and 1.0 wt%), and the systemic delivery group. It was found that alendronate had improved peri-prosthetic bone mineral density in a dose-effect model. Notably, no significant difference was found between local delivery of 0.5 wt% alendronate and systemic delivery in bone mineral density and implant fixation. Conclusion Alendronate-loaded bone cement (0.5 wt% ) may be as effective as the systemic delivery in inhibiting titanium particle-induced osteolysis.