Comparative study of sacroiliac screw placement guided by three-dimensional printing template technology or X-ray fluoroscopy / 中华创伤杂志

Objective To compare the clinical effect of three-dimensional printing template technology with X-ray fluoroscopy in assisting surgery for sacroiliac screw placement. Methods A retrospective case-control study was conducted on 28 cases of sacroiliac complex injury from January 2015 to December 2016. The patients were divided into template group (13 cases) and fluoroscopy group (15 cases) according to whether the preoperative three-dimensional printing template was adopted. In template group, there were nine males and four females, with an average age of 46.7 years (range, 18-68 years). According to Tile typing, there were eight cases of type B (two type B1, three type B2, and three type B3) and five cases of type C (three type CI and two type C2). In fluoroscopy group, there were 11 males and four females, with an average age of 47.1 years (range, 18-65 years). According to Tile typing, there were 10 cases of type B (three type B1, four type B2, and three type B3) and five cases of type C (three type C 1 and two type C2). The screw numbers, time for single screw placement, and fluoroscopy frequency were recorded. The Matta criteria was used to evaluate fracture reduction quality, and Majeed score was used to evaluate pelvic fracture function at the last follow-up. Results All patients were followed up for 6-20 months [(10.4±0.6) months]. Fifteen screws were implanted in template group, and 17 in fluoroscopy group. The time for single screw placement was 25-38 minutes [(28 ±5.3) minutes] in template group and 45-70 minutes [(60.3 ±5.8) minutes] in fluoroscopy group (P ＜0.01). The fluoroscopy frequency was 2-5 times [(2.8 ±0.5) times] in template group and 11-23 times [(15.4 ±3.5) times] in fluoroscopy group. According to the Matta criteria, there were eight excellent cases, four good, one fair, with an excellent and good rate of 92％ in template group; there were seven excellent cases, six good, two fair, with an excellent and good rate of 87％ in fluoroscopy group (P＞0.05). According to Majeed score at the last follow up, there were eight excellent cases, three good, two fair, with an excellent and good rate of 85％ in template group; there were six excellent cases, six good, three fair, with an excellent and good rate of 80％ in fluoroscopy group (P＞0.05). Conclusions Compared with traditional surgery, three-dimensional printing template technology assisted surgery for sacroiliac screws placement presents advantages of less operation time and reduced fluoroscopy frequency. This technology improves the safety profile and should be further promoted in clinical applications.

Clinical effect of modified open-door laminoplasty with preservation of the unilateral paraspinal muscle ligament complex in treating ossification of posterior longitudinal ligament of the cervical spine / 中华骨科杂志

Objective To investigate the clinical efficacy of modified open-door laminoplasty with preservation ofthe unilateral paraspinal muscle ligament complex in treating ossification of posterior longitudinal ligament (OPLL) of the cervical spine.Methods From June 2015 to July 2017,thirty-two patients with OPLL of the cervical spine who underwent modified open-door laminoplasty with preservation of the unilateral paraspinal muscle ligament complex were retrospectively analyzed(modified group).There were 20 males and 12 females with the average age of 61.72±8.41 years (range 46-75 years).The decompression segment range included three cases of C2-C6,seven cases of C2-C7,eight cases of C3-C6,and fourteen cases of C3-C7.Moreover,twenty-three patients with OPLL of the cervical spine who underwent traditional unilateral open-door laminoplasty at the same time were included as controls (control group).The demographics,operation duration,and blood loss volume was recorded.The visual analogue scale (VAS),Japanese Orthopaedic Association scores (JOA),improvement rate of JOA score and neck disability index (NDI) were recorded and analyzed at preoperation,three months after operation,six months after operation and at the final follow-up.The cervical curvature,cervical curvature index (CCI),range of motion (ROM) were measured and statistically analyzed on the lateral X-ray film of the cervical spine.The union rate of the lamina hinge and that of spinous process-lamina was measured on the cross section of the CT scan.Bilateral cervical posterior muscle volume was recorded and analyzed at cross-section plane on MRI.Axial symptoms,C5 nerve root palsy and other complications were also recorded.Results All the patients were followed-up for 6 to 18 months (mean,13.04±4.67 months in control group,11.81±4.93 months in modified group).At the final follow-up,the JOA,VAS and NDI scores improved from preoperatively 6.09±0.79 to 13.43± 1.53,4.22±1.04 to 2.83±1.15 and 25.48％±3.20％ to 8.83％±5.41％ in the control group,versus 6.28±1.05 to 13.88±1.48,4.09± 1.00 to 1.16±0.57 and 25.06％±3.24％ to 5.66％±2.46％ in the modified group.The postoperative JOA score and recovery rate of the two groups was not significantly different,whereas the VAS and NDI scores were significantly reduced in the modified group compared to the control group.The maximum cervical flexion angle,cervical curvature,ROM and CCI of control group were 6.26°± 3.31°,30.17°±4.56°,11.39°±1.95° and 9.74％±4.05％ at the final follow-up,which were reduced significantly compared to pre-operation.The maximum cervical flexion angle,cervical curvature,ROM and CCI of modified group were 10.06°± 1.93°,35.03°± 5.01°,17.03°±2.86° and 14.22％±5.00％,and there were no significant differences compared to pre-operation.There were significant differences among two groups.At the final follow-up,the posterior muscle volume of the two groups at open side was decreased compared to preoperation,but there was no significant difference between the two groups.At the last follow-up,the posterior muscle volume at hinge side was not changed compared to preoperation in modified open-door laminoplasty group,while the volume of the posterior muscle at hinge side in the traditional control group decreased compared to preoperation.The difference was statistically significant.A total of eight patients with axial symptom were present after operation.There were two patients (6％,2/ 32) in the modified group and six patients (26％,6/23) in the control group.The difference of axial symptoms incidence was statistically significant between the two groups.Conclusion Modified open-door laminoplasty with preservation of the unilateral paraspinal muscle ligament complex is an effective technique in treating OPLL of the cervical spine.The technique not only guaranteed to have good recovery of neurological function and to maintain cervical curvature and range of motion,but also contributed to decrease the occurrence of postoperative axial symptoms.

Low bone mineral density in chronic hepatitis B virus infection: a case-control study

Objective: Osteoporosis is the well-known major complication in chronic hepatitis B virus [HBV] infection. Fewer reports are available of the relationship between bone loss and chronic HBV infection. We investigated the bone mineral density [BMD] and prevalence of osteoporosis in chronic HBV patients in comparison with healthy subjects

Methods: We assessed 148 chronic HBV patients and 148 age- and gender-matched healthy controls by dual energy X-ray absorptiometry [DEXA] for determination of BMD. T-score was used to define bone status according to the World Health Organization's classification

Results: The BMD values were significantly lower in HBV patients in all scan of specific regions compared with the controls [P < 0.05]. The prevalence of osteoporosis in either of LS, TH or the FN was significantly higher in the HBV patients group compared with the healthy controls. The rate of osteopenia and osteoporosis for HBV patients aged 45-54 years was significantly higher than that of the healthy controls

Conclusions: Chronic HBV infection was associated with low BMD and increased the risk of developing subsequent osteoporosis

A systematic review of hip fractures in elderly people / 中华骨科杂志

Objective To study the age peak of incidence,pathologic sites,therapeutic effect and complications of different treatment for hip fractures in the elderly.Methods Hip fractures,therapy,elderly were used as key words to search articles both in English and Chinese from 1979 to 2017.The articles were filtrated by title,abstract and full text and 32 of them were left.All the patients were objects of this study,but the repeated cases were excluded.The patients' data such as age of onset,gender,fracture type,operation method,follow-up time,and complications were collected and analyzed by systematic analysis.Results Data of 2 758 patients in 32 papers had been collected for analysis.There were 1791 femoral neck fractures and 967 intertrochanteric fractures,with a ratio of 1.85:1.The patients' age of onset was ranging from 54 to 92 years old,with an average of 76.7 years old,and the age peak of incidence was from 70 to 79 years old.The sex ratio was 1:1.66 (1 037 males:1721 females).All the patients had been followed up for 0.5 to 18 years,(average,7.8 years).Among 927 femoral neck fractures who were treated by 3 lag screws,there were 278 cases of non-union (29.9％),139 femoral head necrosis(15.1％) and 19 internal fixation loosening (2.0％);but for 183 femoral neck fractures who were treated by dynamic hip screws (DHS),there were 51 cases of non-union (28.1％),31 femoral head necrosis(17.0％),3 internal fixation losening(1.8％),and 27 cutting effect (15％).Then for 400 femoral neck fractures who were treated by hemiarthroplasty,there were 6 cases of dislocation(1.5％),14 shaft fracture (3.5％),8 deep infection (2.0％);while for 281 femoral neck fractures who were treated by total hip arthroplasty,there were 14 cases of dislocation (5.0％),11 shaft fracture (4.0％),and 10 deep infection (3.5％).On the other hand,for 354 intertrochanteric fractures who were treated by proximal femoral nail or proximal femoral nail antirotation internal fixation (PFN or PFNA),there were 18 cases of trochanter fracture (5.0％),28 hip varus (8.1％),32 displacement (9.0％);and for 210 intertrochanteric fractures who were treated by Gamma nail,there were 17 cases of trochanter fracture (7.9％),11 cutting effect (5.0％),6 displacement (3.0％);and for 135 intertrochanteric fractures who were treated by DHS,there were 8 cases of cutting effect (6.1％),7 displacement (5.2％);and for 101 intertrochanteric who were treated by proximal femoral locking plate,there were 5 cases of displacement (5.0％);Also for 89 intertrochanteric fractures who were treated by hemiarthroplasty,there were 2 cases of dislocation(1.8％),3 shaft fracture (3.0％),1 deep infection(1.5％);and for 78 intertrochanteric fractures who were treated by total hip arthroplasty,there were 4 cases of dislocation (4.8％),3 shaft fracture (4.0％),2 deep infection (2.5％).Conclusion The elderly hip fractures' age peak of incidence is from 70 to 79 years old,and femoral neck fracture takes up a majority of it.Female patients are more than male patients.The femoral neck fractures are mainly treated by 3 lag screws internal fixation;non-union and femoral head necrosis are the common complications postoperation.While the intertrochanteric fractures are mainly treated by proximal femoral nails;displacement,hip varus and trochanter fractures are the common complications postoperation.The artificial hip replacement is the effective remedy measure for secondary femoral head necrosis after hip fractures.

Multivariate correlation analysis of femoral head necrosis after operation of femoral neck fracture / 中华骨科杂志

Objective To analyze the related factors of femoral head necrosis after internal fixation operation of femoral neck fracture.Methods Clinical data of 524 patients with femoral neck fracture who underwent internal fixation surgery between January 2012 and January 2015 were retrospectively analyzed.Taking the femoral head necrosis as an observable indicator,the clinical data of postoperative femoral head necrosis and those other patients who were treated at the same period were compared.Whether the clinical factors (gender,age,surgical reduction type,fracture type,quality of reduction,post-injury operation time,loading time after operation,and whether to withdraw internal fixation) were in correlation with postoperative femoral head necrosis was analyzed by univariate analysis.Then the statistically significant indicators were integrated into logistic regression analysis to determine the related factors of femoral head necrosis.Results According to inclusion and exclusion criteria,the study group consisted of 212 cases,including 94 males and 118 females;the follow-up time was 2-5 years,and the average follow-up time was 3.6±1.6 years.There were 46 cases with femoral head necrosis and 166 cases without femoral head necrosis after operation.The rate of femoral head necrosis was 21.7％ (46/212).The femoral head necrosis group included 46 cases with 21 males and 25 females;20 cases below 60 years old and 26 cases above 60 years old;17 cases using open reduction and 29 cases using closed reduction;6 cases belong to type Ⅰ/Ⅱ and 40 cases belong to type Ⅲ/Ⅳ according to Garden classification;16 cases got satisfactory reduction while 30 cases with unsatisfactory reduction;30 cases below 48 h and 16 cases above 48 h on post-injury operation time;17 cases below 3 months and 29 cases above 3 months on post-operation loading time;22 cases with internal fixation removal and 24 cases without internal fixation removal.The femoral head without necrosis group included 166 cases with 73 males and 93 females;84 cases below 60 years old and 82 cases above 60 years old;69 cases using open reduction and 98 cases using closed reduction;120 cases belong to type Ⅰ/Ⅱ and 46 cases belong to type Ⅲ/Ⅳ according to Garden classification;160 cases got satisfactory reduction while 6 cases with unsatisfactory reduction;119 cases below 48 h and 47 cases above 48 h on post-injury operation time;70 cases below 3 months and 96 cases above 3 months on post-operation loading time;74 cases with internal fixation removal and 92 cases without internal fixation removal.Univariate x2 analysis suggested that fracture type and quality of reduction were associated with postoperative femoral head necrosis.Other clinical factors (gender,age,surgical reduction type,post-injury operation time,loading time after operation and whether to remove internal fixation or not) were not associated with postoperative femoral head necrosis.The multivariate Logistic regression analysis showed fracture type and quality of reduction were significantly related to postoperative femoral head necrosis.Conclusion Femoral head necrosis after internal fixation operation of femoral neck fracture is affected by many factors.The fracture type and quality of reduction are important factors affecting femoral head necrosis after internal fixation operation of femoral neck fracture.

Proximal femur locking plate fixation for the treatment of unstable femoral intertrochanteric fractures in elderly patients / 中华骨科杂志

Objective To explore the efficacy of proximal femur locking plate(PFLP) for the treatment of unstable femoral intertrochanteric fractures in elderly patients.Methods Data of 120 cases of patients with unstable femoral intertrochanteric fractures who were treated by PFLP were retrospectively analyzed.There were 56 males and 64 were females,aging from 62 to 78 year-old (average,69.4 year-old).85 cases were left hip,and 35 cases right hip.According to AO fracture classification,there were 12 cases of A2.2,23 A2.3,34 A3.1,29 A3.2,and 22 A3.3.According to Evans intertrochanteric fractures classification:there were 93 cases of type Ⅲ,19 type Ⅳ,and 8 type Ⅴ.Operation time,length of hospital stay,fracture healing time,postoperative complications and hip joint Harris scores were recorded.Results All patients were followed up for 8-14 months (average,12.4 months).Their operating time were 51-80 min (average,63.1 min);X-ray exposure were 8-15 times (average,11.6 times);intraoperative blood loss were 70-120 ml (average,92.7 ml);postoperative drainage volume were 50-100 ml (average,61.7 ml),and length of hospital stay were 7-14 d (average,10.2 days).The healing time ranged from 12 to 32 weeks (20.4 weeks average).14 cases had delayed union,and healing time was 8-10 months.In addition,4 cases had deep vein thrombosis (after thrombolysis therapy the vein was recanalized);2 had internal fixation broken,who were then treated with PFNA Ⅱ,and bone healed after 6 months;5 had hip varus,who were then treated via hip replacement,and no hip prosthesis fracture were found.No other complications occurred in the remaining patients.At the latest follow-up,according to Harris hip score:there were 38 cases with excellent results,71 good,9 fair,and 2 poor,and the rate of excellent and good was 90.8％ (109/120).Conclusion PFLP for the treatment of unstable femoral intertrochanteric fractures has advantages of less invasion,less complication,reliable fixation and high fracture healing rate,thus it is suitable for unstable intertrochanteric fractures in elderly patients.

The value of three dimensional printing technology assisted surgery in the treatment of complex tibial plateau fractures / 中华骨科杂志

Objective To investigate the advantage and application prospect of 3D printing technology in assisting surgery for complex tibial plateau fractures.Methods The complete clinical data of 41 patients (48 knees) were retrospectively analyzed.And these patients were divided into two groups as 3D printing assisted operation group and traditional operation group,according to whether 3D printing technology was applied.Study was carried out to compare the clinical efficacy of surgery assisted by 3D printing technology and traditional surgery in the treatment of complex tibial plateau fractures.The 3D printing assisted operation group included 18 patients (22 knees,12 males and 6 females),aging from 16 to 68 (mean age 45.5±7.2),and there were 12 cases of Schatzker Ⅴ and 10 Ⅵ.The traditional operation group included 23 patients (26 knees,15 males and 8 females),aging from 19 to 69 (mean age,46.2±6.8),and there were 14 cases of Schatzker Ⅴ and 12 Ⅵ.The operation time,intraoperative blood loss,the Rasmussen score and hospital for special surgery knee score (HSS) at 6 weeks post-operation were analyzed and the difference between the two groups was tested.Results All those patients were followed up for 7 to 20 months (mean 15 months).For 3D printing assisted operation group,the mean operation time was 81.4±6.3 min for Schatzker Ⅴ and 90.6± 15.4 min for Schatzker Ⅵ;the mean intraoperative blood loss was 200.4±72.3 ml for Schatzker Ⅴ and 280.6±101.6 ml for Schatzker Ⅵ;the result of 6-week Rasmussen score was 14 excellent,6 good and 2 fair (excellent and good rate 90.9％);the result of 6-week HSS score was 15 excellent,5 good and 2 fair (excellent and good rate 90.9％).Then for traditional operation group,the mean operation time was 100.4± 15.3 min for Schatzker Ⅴ and 111.5±20.2 min for Schatzker Ⅵ;the mean intraoperative blood loss was 450.4±173.3 ml for Schatzker Ⅴ and 500.5±247.2 ml for Schatzker Ⅵ;the result of 6-week Rasmussen score was 14 excellent,8 good,2 fair and 2 bad (excellent and good rate 84.6％);the result of 6-week HSS score was 13 excellent,8 good,2 fair and 3 bad (excellent and good rate 80.8％).The difference in operation time,intraoperative blood loss had statistical significance between the two groups;but the difference in 6-month post-operation Rasmussen score and HSS score had no statistical significance.Conclusion Compared with traditional surgery,3D printing technology assisted surgery for complex tibial plateau fracture possesses advantage such as shortened operation time,reduced intraoperative blood loss;but there's no evidence for improved knee function at 6 weeks post-operation.

Application of Integrative Medicines of TCM and WM Combined with Fast-track Surgery Concept in Perioperative Nursing in Colorectal Surgery / 昆明医科大学学报

Objective To study the clinical effect and significance of integrative medicines of TCM and WM combined with fast-track surgery concept on perioperative nursing in colorectal surgery.Methods One hundred and twenty patients with surgery were randomly divided into the observation group and the control group,60 cases in each group.The control group was treated with conventional nursing,while the observation group was treated with fast track surgery nursing of integrative medicines of TCM and WM.Results Bowel sound recovery time,anus exhaust time,defecation time,length of hospital stay and postoperative complications of observation group was significantly less than the control group (P＜0.05).Nursing total satisfaction of observation group was significantly higher than the control group (P＜0.05).Conclusion Integrative medicines of TCM and WM combined with fast-track surgery concept on perioperative nursing in colorectal surgery can reduce stress,speed up the recovery,reduce complications.So it is a safe and effective way of perioperative nursing,and worthy of clinical popularization and application.

Clinical Observation of Yunkang Granule Combined with Dydrogesterone in the Treatment of Early Threat-ened Abortion / 中国药房

OBJECTIVE:To explore the clinical efficacy and safety of Yunkang granule combined with dydrogesterone in the treatment of early threatened abortion. METHODS:128 patients with early threatened abortion were randomly divided into single drug group and combined medication group,64 cases in each group. Single drug group received Dydrogesterone tablet with first dose of 40 mg,then 10 mg,q 12 h until vaginal bleeding;combined medication group additionally received 8 g Yunkang granule, tid,until symptoms disappeared. Human chorionic gonadotropin (HCG),clinical symptoms remission time and disappearance time,pregnancy/childbirth complications,pregnancy outcome and neonatal adverse outcome,and the incidence of adverse reac-tions in 2 groups were compared. RESULTS:After treatment,HCG in 2 groups significantly increased,and combined medication group was higher than single drug group,the differences were statistically significant(P0.05). The incidence of adverse reactions in combined medication group was 10.9%, which was significantly lower than single drug group (40.6%),the difference was statistically significant (P<0.05). CONCLU-SIONS:Both dydrogesterone alone and Yunkang granule combined with dydrogesterone show good efficacy in the treatment of ear-ly threatened abortion,but the remission time and disappearance time of clinical symptoms and adverse reactions in combined medi-cation group are less than that in single drug group.

Clinical observation of artificial bone rod combined with decalcified bone matrix for the treatment of osteonecrosis of the femoral head / 中华显微外科杂志

Objective To evaluate the clinical outcome associated with the core decompression in combination with the nano-hydroxyapatite/collagen composite rod combined with decalcified bone matrix in a consecutive series of patients with osteonecrosis of femoral head,especially the prevention of collapse of femoral head and its predisposing factors.Methods From August,2012 to May,2013,46 pationts (50 hips) who had undergone core decompression in combination with nano-hydroxyapatite/collagen composite rod insertion in corporated with decalcified bone matrix in our hospital were involved in this study.Postoperative care consisted of prophylactic intravenous antibiotic and anticoagulation therapy.Patients were instructed to be non-weight-bearing for 3 weeks,to partial weight-bear for the next 3 weeks,and to weight bear as tolerated thereafter.All patients were evaluated both clinically and radiographically.The primary clinical outcome of this study was functional improvement assessed with the Harris hip score.Serial radiograms of the pelvis were taken at 1,3,6,12 months post-operatively to analyze the process of osteonecrosis.Results All patients followed up for 12 months,no one suffer complications.The mean Harris score pre-operation was 65.6 ± 10.6,post-operation score was 87.5 ± 15.3,with a mean improvement of 21.8 ± 13.2 (P ＜ 0.05).According to Harris hip score system,excellent for 30 hips,good for 14 hips,fair for 2 hip and poor for 4 hips.Refer to the Kaplan-Meier survivorship curve,the success rate at 12 months post-operatively was 92％.Radiological changes coincided with clinical changes.Conclusion Core decompressionin combination with nano-hydroxyapatite/ collagen composite rod insertion in corporated with decalcified bone matrix provided a minimally invasive surgical treatment option to treat early stage osteonecrotic hips(stage Ⅰ and Ⅱ) and to prevent femoral heads from collapsing,with clinical outcomes and success rates priorto other commonly used surgical procedures.

Intermediate and short-term clinical observation after treatment for bone diseases of ankle joint with Scandinavian total ankle replacement / 中华骨科杂志

Objective To evaluate results and demonstrate problems of Scandinavian total ankle replacement (STAR) in patients with ankle arthritis and clarify its role as a growing alternatives to ankle fusion.Methods Retrospectively analyzed 43 patients who had total ankle replacement from May 1999 to January 2013.All cases were evaluated with interview focusing on pain,daily activities and clinical and radiologic examinations.The average age of patients was 46 (range,35 to 56) years old.Among these cases,9 patients suffered from posttraumatic arthritis,25 osteoarthritis,5 rheumatoid arthritis and 4 avascular necrosis of the talar body.All patients complained about ankle joint pain and swelling as well as limited ROM of joint.Results Mean follow-up was 6.7 (1.5 to 12 years) years.37 cases had complete follow-up.The average preoperative ankle score was 27.0± 10.5,pain degree score was 16.5± 12.8,joint function score was 10.6±7.4,ROM score was 8.2±5.2.The average preoperative ankle score was 86.5±13.2,pain degree score was 49.5±4.5,joint function score was 19.7±9.5,ROM score was 19.2±3.2.The indicatiors compared with preoperative,postoperative differences have statistical significance.The score of postoperative Kofoed were divided into excellent 35 cases,good 1 case and poor 1 case,excellent and good rate was 97.3％.The American orthopaedic foot and ankle society (AOFAS) scoring system was improved from 40.5 preoperatively to 80.6 postoperatively.No postoperative loosening or migrating of the prosthesis was noted.Conclusion It was demonstrated that the standardized and normalized operative techniques as well as operative tools closely matched to the prosthesis could achieve favorable outcomes according to the clinical and radiographic outcomes and overall acceptable cornplication rates in the present study.STAR was a choice for the patients with advanced osteoarthritis,posttraumatic arthritis,rheumatic arthritis and avascular necrosis of the talar body.

MiR-17-5p modulates osteoblastic differentiation and cell proliferation by targeting SMAD7 in non-traumatic osteonecrosis

MicroRNAs (miRNAs) have recently been recognized to have a role in human orthopedic disorders. The objective of our study was to explore the expression profile and biological function of miRNA-17-5p (miR-17-5p), which is well known to be related to cancer cell proliferation and invasion, in osteoblastic differentiation and in cell proliferation. The expression levels of miR-17-5p in the femoral head mesenchymal stem cells of 20 patients with non-traumatic osteonecrosis (ON) and 10 patients with osteoarthritis (OA) were examined by quantitative reverse transcription-PCR (qRT-PCR). Furthermore, the interaction between miR-17-5p and SMAD7 was observed. We found that in non-traumatic ON samples the level of mature miR-17-5p was significantly lower than that of OA samples (P=0.0002). By targeting SMAD7, miR-17-5p promoted nuclear translocation of beta-catenin, enhanced expression of COL1A1 and finally facilitated the proliferation and differentiation of HMSC-bm cells. We also demonstrated that restoring expression of SMAD7 in HMSC-bm cells partially reversed the function of miR-17-5p. Together, our data suggested a theory that dysfunction of a network containing miR-17-5p, SMAD7 and beta-catenin could contribute to ON pathogenesis. The present study prompts the potential clinical value of miR-17-5p in non-traumatic ON.

MicroRNA-21 controls the development of osteoarthritis by targeting GDF-5 in chondrocytes

Osteoarthritis is a common cause of functional deterioration in older adults and is an immense burden on the aging population. Altered chondrogenesis is the most important pathophysiological process involved in the development of osteoarthritis. However, the molecular mechanism underlying the regulation of chondrogenesis in patients with osteoarthritis requires further elucidation, particularly with respect to the role of microRNAs. MiR-21 expression in cartilage specimens was examined in 10 patients with knee osteoarthritis and 10 traumatic amputees. The effect of miR-21 on chondrogenesis was also investigated in a chondrocyte cell line. The effect of miR-21 on the expression of growth differentiation factor 5 (GDF-5) was further assessed by luciferase reporter assay and western blot. We found that endogenous miR-21 is upregulated in osteoarthritis patients, and overexpression of miR-21 could attenuate the process of chondrogenesis. Furthermore, we identified GDF-5 as the direct target of miR-21 during the regulation of chondrogenesis. Our data suggest that miR-21 has an important role in the pathogenesis of osteoarthritis and is a potential therapeutic target.

Analysis of laboratory examination of recurrent vaginitis / 国际检验医学杂志

Objective To explore laboratory examination method of vaginal infection disease ,and to investigate the etiology of recurrent vaginitis .Methods 324 patients with recurrent vaginitis were selected to investigated the symptoms ,signs and vaginal discharge examination .Results (1)Among 324 patients ,293 cases (90 .4% ) of single infection and 31 cases (9 .6% ) mixed infec-tions were founded .There were 97 cases with VVC ,81 cases with CV ,17 cases with AV ,12 cases with BV ,and 14 cases with TV in the single infection cases .(2)In the 120 cases with VVC ,Candida albicans were accounted for 65 .0% ,non-Candida albicans strains were founded in 42 cases (35 .0% ) .(3)Among 28 cases of AV ,Escherichia coli ,Staphylococcus aureus ,Streptococcus aga-lactiae and Enterococcus f aecalis were main bacteria .Conclusion Recurrent vaginitis is common in clinical obstetrics and gynecolo-gy .Because of complex pathogeny ,clinicians should pay attention to laboratory results ,combined with the symptoms and signs , comprehensive evaluation ,improve disease diagnosis and treatment .

Seeding fresh bone marrow aspirate directly on scaffolds to construct tissue-engineered ligament / 中国组织工程研究

BACKGROUND:There are several reports about the application of fresh bone marrow aspirate being injected directly to repair partial ligament injury, but the application about fresh bone marrow aspirate directly being planted on scaffolds to build tissue-engineered ligament is rarely mentioned. OBJECTIVE:To evaluate the feasibility of applying fresh bone marrow aspirate planted directly on scaffolds to construct tissue-engineered ligament METHODS:We constructed fibroin fiber/smal intestinal submucosa composite scaffold, then planting fresh bone marrow directly to built bone marrow seeding group and planting seed cel s (bone marrow mesenchymal stem cel s) on the scaffold to built cel seeding group. The control group had no treatment. After that, we detected the density of cel adhesion, cel proliferation ability and extracel ular matrix secretion. Then, the composite in the bone marrow seeding group was implanted into the broken anterior cruciate ligament in rabbits, and material biocompatibility in vivo was evaluated after 12 weeks. RESULTS AND CONCLUSION:After 4 hours of incubation, bone marrow seeding group was significantly higher than the cel seeding group in cel adhesion density and proliferation rate (P<0.05). Bone marrow seeding group and cel seeding group showed higher type I, III col agen secretion compared with the control group (P<0.05), but the col agen secretion of bone marrow seeding group and cel seeding group showed no significant difference. Composite cel scaffold implantation in vivo did not cause fatal immune rejection and severe inflammatory reaction, and no significant ligament regeneration and vascularization occurred. These findings indicate that fresh bone marrow aspirate can be seeded directly on scaffolds to construct tissue-engineered ligament, and the short-term biocompatibility in vivo is good.

Mid- and long-term clinical effects of trochanteric flip osteotomy for treatment of Pipkin I and II femoral head fractures / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the mid- and long-term clinical results of trochanteric flip osteotomy for treating Pipkin type I and II femoral head fractures.</p><p><b>METHODS</b>We retrospectively reviewed twenty-three patients (aged 23-72 years with a mean of 44.1 years, including 15 male and 8 female patients) with femoral head fractures and posterior hip dislocation. The fracture was classified according to Pipkin classification based radiographic findings, and 9 patients were found to have type I and 14 had type II fractures. Trochanteric flip osteotomy was performed in all patients for surgical open reduction and internal fixation of the fractures. The clinical and radiographic outcomes of the patients were measured using Thompson-Epstein scoring scale and Merle d' Aubigne-Postel score.</p><p><b>RESULTS</b>One patient with follow-up period less than 12 months was excluded from analysis. Of the 22 patients (95.7%) followed up for more than 12 months (mean 23.5 months), the average Merle d' Aubigne Postel score was 13.77 at the final follow-up. According to the Thompson-Epstein criteria, 8 (36.4%) patients had excellent, 9 (40.9%) had good, 3 (13.6%) had fair, and two (9.1%) had poor outcomes; the total rate of excellent and good outcomes was 77.3% in these 22 patients. None of the patients developed habitual dislocation of the femoral head after the operation. Heterotopic ossification occurred in 2 patients. Partial neurapraxia of the sciatic nerve occurred in one patient and recovered completely within 6 months. Three patients developed post-traumatic arthritis, and one of them had avascular necrosis of the femoral head one year after surgery and received subsequently total hip arthroplasty.</p><p><b>CONCLUSION</b>The follow-up data demonstrate that trochanteric flip osteotomy is an effective and reliable option for treating Pipkin type I and type II femoral head fractures.</p>

Efficacy of bone grafts on posterior spinal fusion in elderly patients with lumbar spinal stenosis / 中华老年医学杂志

Objective To compare the fusion effect between lumbar posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) in elderly patients with lumbar spinal stenosis.Methods Data of 313 patients undergoing PLF or PLIF for treatment lumbar degenerative disease in Department of Orthopedics,Beijing Hospital of China Ministry of Health during January 1996 to December 2011 were retrospectively analyzed.Patients were divided into PLF group (n=116 cases) and PLIF group (n=197 cases).Data of fusion rate,operative time,operative blood-loss and complications were analyzed statistically.Results The fusion rate was 84.5％ in PLF group and 98％ in PLIF group.The average operative time was 247.8 min (120-480 min) and 240.6 min (90-600 min) in PLF and PLIF groups respectively.The blood-loss was 1142.9 ml (200 4500 ml) and 927.0 ml (200-2800 ml) in PLF and PLIF groups respectively.Postoperative complications were found in 38 cases in PLF group and in 36 cases in PLIF group.There were significant differences in fusion rate,operative time,operative blood loss,complications between the two groups (all P＜0.05).Conclusions PLIF has better effects on fusion rate and fusion grade than PLF.

Total hip arthroplasty with subtrochanteric femoral shortening osteotomy for Crowe Ⅳ developmental dysplasia of the hip / 中华骨科杂志

Objective To evaluate the clinical efficacy of total hip arthroplasty with subtrochanteric femoral shortening osteotomy for Crowe Ⅳ developmental dysplasia of the hip.Methods From September 2003 to September 2012,21 patients (24 hips) underwent total hip arthroplasty with subtrochanteric femoral shortening osteotomy for Crowe Ⅳ developmental dysplasia of the hip in our hospital.There were 3 males and 18 females,aged from 28 to 71 years (average,54±10 years).The ceramicpolyethylene articulation was used in 17 patients (20 hips),and metal-polyethylene articulation in 4 patients (4 hips).The osteotomy site was treated with autologous bone graft in 18 patients (21 hips) and allogeneic bone graft in 3 patients (3 hips).The Harris hip score was used to assess the clinical results.Results A total of 18 patients were followed up for 0.5 to 9 years (average,3.5 years).The Harris hip score was improved from preoperative 47.9±9.1 to 88.4±3.5 at 6 months postoperatively.For most patients,hip pain relieved significantly; range of motion of the hip was improved,and the gait returned to normal.Sciatic nerve palsy occurred in 1 patient.There was no wound infection.X-rays 6 months after operation showed that the position of prostheses was satisfactory,without loosening of prostheses and bone block resorption.Conclusion Total hip arthroplasty with subtrochanteric femoral shortening osteotomy can achieve good clinical effect in Crowe Ⅳ developmental dysplasia of the hip.Moreover,it can improve leg length discrepancy and decrease the risk of sciatic nerve injury.

The posterior approach combined with pedicle screw fixation for the treatment of lower cervical fractures and dislocation / 中华骨科杂志

Objective To evaluate the feasibility of using the posterior approach with cervical pedicle screw fixation technique for the treatment of lower cervical spine fractures and dislocations.Methods Thirty patients suffered lower cervical fractures and dislocations were retrospectively analyzed,and they were underwent cervical pedicle screw system fixation surgery from January 2010 to December 2012.There were 22 males and 8 females,with an average age of 41 years (range,24-61 years).Eight injuries were located at C4,5,12 at C5,6,and 10 at C6.7.According to the American Spinal Cord Injury Association (ASIA)impairment scale,8 cases were grade A,12 were grade B,5 were grade C,3 were grade D,and 2 were grade E.Results Reduction and fixation of the injured segments were performed via a posterior approach in all 30 patients.One hundred and forty pedicle screws were inserted successfully in all patients on the postoperative radiographic and CT scans.All the patients were followed up for 3-23 months,with the average of 11 months.According to the ASIA impairment scale,eight cases with grade A were still grade A,but the feeling and movement improved obviously.Ten grade B improved to grade C and the rest cases were complete recovery after operations.During the course of the follow up,solid bone union was achieved in all patients,and there were no hardware failures.All the patients' postoperative MRI showed disappearance of the spinal cord compression after reduction in all cases.Conclusion For the patients of lower cervical fractures and dislocation,the first choice of operation should be the posterior approach reduction and fixation with cervical pedicle screw.The correct lengthwise traction method could unblock the locked facet effectively,and prevent the retrusion of disc and the further injury of spinal cord.For the patients of disc disruption,the posterior approach could be used only.The cervical pedicle screw system could provide three-dimensional reduction of the injured cervical segments and the adequate mechanical strength.The posterior approach combined with pedicle screw fixation is feasible and effective for the treatment of lower cervical fractures and dislocation.

Treatment of Crowe type Ⅳ developmental dysplasia of the hip with total hip arthroplasty after limb-lengthing with external fixator / 中华骨科杂志

Objective To retrospectively analyze the methods and clinical outcome to treat Crowe type Ⅳ developmental dysplasia of the hip (DDH) in young adults with total hip arthroplasty (THA) after limb-lengthing with external fixator.Methods From October 2007 to January 2012,12 patients with unilateral Crowe type Ⅳ DDH were treated with two-staged surgical method in our department.There were 2 males and 10 females with an average age of 25.7 years (range,18-35 years).In the first stage,the patients underwent soft tissue relaxation and iliofemoral distraction with use of an external fixator for 10-17 days.There were 1-2 cm distraction at the first time and 3-5 mm daily distraction.When the femoral head was distracted to the level of anatomical position,the second stage-THA was performed.All patients underwent uncemented prosthesis with bulk femoral head autograft for acetabular reconstruction.The acetabular cup was placed in the anatomical position in every patient.Shortening femoral osteotomies were not required.Results The mean time of first operation was 35.2±3.6 min,and hospital stay was 13.3±1.6 days.The mean time of second operation was 77.3±12.4 min,and hospital stay was 9.2±2.5 days.The average follow-up was 13.6±3.2 months,limb-length discrepancy was 5.6±1.5 cm on average preoperatively and 0.5±0.2 cm on average postoperatively.The Harris hip score was increased from 45.7±2.6 preoperatively to 92.3±3.3 postoperatively.All of the cases had acquired good hip and knee function.No patient suffered pin-site infection,hip joint infection,prosthesis loosening or deep vein thrombosis in our research.Transient nerve palsy occurred during the leg limb lengthening in 3 cases; calf skin numbness after THA occurred in 5 cases.Conclusion For the Crowe type Ⅳ DDH in young adults,normal limb length can be restored nearly and avoid nerve injury via continuously limb-lengthing with external fixator before THA.This method can get precise results,improve limb function significantly and have fewer complications.