Comparison of surgical effects between extension and flexion type of distal radius fracture / 中国骨伤

OBJECTIVE@#To compare therapeutic effects of internal fixation with volar locking plate in treating extension and flexion type of distal radius fracture (DRF).@*METHODS@#From January 2015 to June 2018, 103 patients with DRF were retrospectively analyzed. According to original fracture displacement direction, patients were divided into extension fracture(Colles) group and flexion fracture (Smith) group. In Colles fracture group, there were 24 males and 44 females aged from 20 to 79 years old with an average of (59.0±13.4) years old;according to AO classification, 9 patients of type A2, 13 patients of type A3, 16 patientsof type C1, 17 patients of type C2 and 13 patients of type C3;the time from injury to operation ranged from 2 to 9 days with an average of (3.9±0.8) days. In Smith fracture group, there were 15 males and 20 females, aged from 27 to 87 years old with an average of (60.1±15.3) years old;according to AO classification, 4 patienst of A2, 7 patients of A3, 14 patients of C1, 5 patients of C2 and 5 patients of C3;the time from injury to operation ranged from 2 to 6 days with an average of (4.1±0.9) days. Operation time, fracture healing time and postoperative complications were recorded between two groups. Disabilities of arm, shoulder and hand (DASH) score at 6 and 8 weeks, 6 and 8 months were used to evaluate functional recovery of affected limbs during each follow up. Volar tilt, radial inclination and radius height were measured at 8 months after operation. Mayo score was measured at 8 months after operation to evaluate recovery of limb function.@*RESULTS@#All patients were followed up for 8 to 30 months with an average of (14.8±4.3) months, and no difference in follow up between two groups (@*CONCLUSION@#Patients with Colles fracture and Smith fracture could receive good reduction and fixation through volar locking plate. The radiographic parameters of both groups recovered satisfactorily after operation. Recovery of volar tilt of Smith fracture group is better than that of Colles fracture group, and early recovery function of Colles fracture group is better than that of Smith group, but there is no significant difference in long-term wrist joint function and incidence of postoperative complications between two groups.

Mechanical strength of biological canulated cancellous screw / 医用生物力学

Objective To develop a biological canulated screw and evaluate its mechanical properties, so as to provide theoretical basis for the bio therapy of fracture with enrichment technique of bone marrow stem cells, which could be diffused through the canula, particularly for promoting bone union of femoral neck fracture and preventing avascular necrosis of femoral head. Methods TC4 titanium alloyed canulated cancellous screw (7.3 mm in diameter) commonly used for internal fixation of femoral neck fracture was improved by designing an end sealing plug and side holes in a 900 mm-long canulated screw. The side holes were arranged along the axis of screw, and the first side hole was 20 mm away from the screw tip. The distance between each side hole was 10 mm, and the number of side holes ranged from 0 to 6. The screws without holes were tested as control, and the rest were divided into two groups, i.e., group A: force direction parallel to the side hole, group B: force direction perpendicular to the side hole. Three point bending test on the screw was conducted by using Instron material testing machine, so as to study the relationship between the mechanical strength of the screw and the number of side holes, and the loading direction. Results (1) When the force direction was parallel to the side hole, which was confined within 0, 1 or 2, the bending deformation of the screw reached 3 mm, and no differences were found in the maximum loads and elastic modulus of the screw. However, when the number of side holes was increased to 3 or more, a significant reduction in the maximum load and elastic modulus of the screw was found (P＜0.05). (2) When the force direction was perpendicular to the side hole, which was confined within 0,1 or 2, and the bending deformation of the screw reached 3 mm, no significant differences were found in the maximum loads of the screw. While no significant difference was found in the elastic modulus of the screw when the side hole was 0, 1, 2 and 3. With an increase in the number of side holes, the maximum loads (≧ 3 side holes) and elastic modulus (≧ 4 side holes) were significantly reduced (P＜0.05). (3) When the force direction was perpendicular to the side hole and the number of side holes was 3 or more, the maximum loads and elastic modulus of the screw were all significantly higher than the screw with the same number of side hole under force direction parallel to the side hole. Conclusions (1) For achieving better mechanical properties of the screw, the number of side holes in titanium alloyed canulated cancellous screw (7.3 mm in diameter) should be within 2; (2) If the number of side holes was equal or over 3, screws under force direction perpendicular to the side hole could provide better mechanical properties than screws under force direction parallel to the side hole. This study may provide some theoretical evidence and support for future clinical development and practice of the biological canulated screw.

Study on correlation between reduction loss and fixator moment arm after treatment of acromioclavicular joint dislocation using endobutton technique / 医用生物力学

Objective To study the correlation between the amount of reduction loss and the length of fixator moment arm after treating acrmioclavicular（AC）joint dislocation with the endobutton technique as viewed from mechanics. Methods 24 patients with acute AC joint dislocation were treated with the endobutton technique and made the follow-up from Mar. 2009 to Dec. 2010 in Shanghai Ninth People’s Hospital. The loss of reduction was observed by evaluating the change of distance between the coracoid and clavicle three days and six months after the operation, respectively. Meanwhile, the length from the upper endnobutton midpoint to the proximal end of clavicle (L1) and the whole length of clavicle (L) were measured and the ratio of L1/L as the moment arm of the fixator was calculated to study the correlation between reduction loss and moment arm. Results All the 24 patients received good reduction after the operation, and the distance between the coracoid and clavicle returned to normal. The average distance between the coracoid and clavicle three days and six months after the operation was (28.2±3.9) and (29.5±4.1) mm, respectively. The amount of average reduction loss was (1.3±1.2) mm. The average moment arm was 0.79±0.03. There was a significant negative correlation between the reduction loss and moment arm with the correlation coefficient -0.498(P＜0.05). Conclusions For the treatment of AC joint dislocation using endobutton technique, the position of the endobutton is closely related with the loss of reduction postoperatively. The shorter the moment arm, the greater the loss of reduction would be. The proper moment arm should be around 0.80.

Test-retest reliability of Mandarin monosyllable lists: a multi-center study in Chinese dialectal regions / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To develop 22 Chinese Mandarin monosyllable lists with good psychometrical equivalence. This study was to evaluate the test-retest reliability of these lists when it was used in speech recognition test in normal hearing dialectal speakers.</p><p><b>METHODS</b>Seven cities including Dalian, Shanghai, Hangzhou, Wuhan, Guangzhou, Fuzhou and Xiamen were selected as testing centers which contain 6 typical Chinese dialectal regions including north of China, East of China, north of Fujian, south of Fujian, Guangdong and mid-south of China. At each center, 22 local normal hearing people were selected to join this study. Every participant was tested by each recognition test of all 22 lists twice in two sessions and same test order respectively. The second run of testing was carried out within 10 days-1 month since first run of testing.</p><p><b>RESULTS</b>There was a significant correlations between scores obtained at the two sessions (r = 0.682, P < 0.01). Paired student-t test had shown that a gross score of all dialectal participants was significantly higher than that of initial test to retest (P < 0.01). The mean increment of score was (2.7 +/- 10.1)%. A significant difference of test-retest score in 7 sites was 19.8% and it was equal to 5 test items. A one way ANOVA analysis had indicated that there were statistically significant difference between the score improvement of 7 test sites (P < 0.01). Another analysis had shown that there was no significant correlation between test-retest score improvement and intra-session intervals (P = 0.947).</p><p><b>CONCLUSIONS</b>Mandarin monosyllabic recognition test seems to be more stable, and the present study has indicated a systematic differences in Chinese Mandarin monosyllable recognition scores between test and retest. Monosyllable recognition test is not susceptible to memory effect. Pearson's correction analysis is not suitable to evaluation for test-retest reliability.</p>

Treatment of distal clavicle fracture with distal radius volar locking compression plate / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To observe the early clinical outcomes of the internal fixation with distal radius volar locking compression plate (LCP) in treatment of distal clavicle fracture.</p><p><b>METHODS</b>Six patients with unilateral distal clavicle fractures, identified as type II according to Neer classification system, including 4 males and 2 females, were treated with open reduction and internal fixation using a distal radius volar LCP. Bone union was evaluated by routine X-ray radiography, and shoulder joint function were assessed by Constant score system.</p><p><b>RESULTS</b>All fractures achieved bone union at 6 to 8 weeks postoperatively, and Constant scores ranged from 95 to 100 at the postoperative 10 to 12 weeks.</p><p><b>CONCLUSION</b>Fixation of distal clavicle fracture with distal radius volar LCP demonstrates excellent effects of bone union with rarely early complications, thus providing a new technique to treat distal clavicle fracture.</p>

Clinical study of lumbar fusion by hybrid construct of stem cells technique and biodegradable material / 中华外科杂志

<p><b>OBJECTIVE</b>To explorer the effectiveness of enriched bone marrow stem cells technique for lumbar fusion.</p><p><b>METHODS</b>With the randomization and control principles, 2 graft materials [Enrichment bone marrow mesenchymal stem cells hybridized with beta-tri calcium phosphate (composite graft group), autologous iliac crest bone graft (autograft group)] were compared in posterior lumbar fusion procedures. 56 patients with degenerative disc disease, lumbar instability or spinal stenosis, were included. The volume of cells suspension in pre- and post-enrichment and the number of nucleated cells (NCs) were identified. The number of osteoprogenitor cells was estimated by counting the colony-forming units which express alkaline phosphatase (CFUs/ALP+). Then the efficiency of the enrichment was evaluated. Clinical follow-up with roentgenogram and Oswestry scale scores was performed for outcome evaluation.</p><p><b>RESULTS</b>(249 +/- 31) ml bone marrow per patient from bilateral iliac crests was aspirated peri-operatively. About (43 +/- 11) ml enriched bone marrow was collected. The number of NCs was concentrated from (15.9 +/- 3.3) x 10(6)/ml to (44.1 +/- 10.8) x 10(6)/ml, CFUs/ALP+ was significantly increased from (118 +/- 86)/ml to(486 +/- 305)/ml. The follow-up was about (26.3 +/- 7.5) months. There was no significant differences in age, gender, disease and fusion segments between the two groups. The fusion rate was 93.3% and 96.2% for composite graft group and autograft group, respectively (chi2 = 0.2146, P = 0.6432). There was no difference in operation time between the two group (t = 0.5243, P = 0.6022), but blood loss in composite graft group was more than that in autograft group (t = 6.4664, P < 0.01). Cell salvage for auto-transfusion could transfuse back half of the blood loss during operation. No hematoma or chronic soreness in the bone marrow donor sites of composite graft group occurred, but a little exudation or moderate swelling in the wound happened in 4 cases which disappeared under medical treatment. Meanwhile, 15.4% patients had hematoma in the iliac bone donor site and 26.9% patients had chronic soreness, but no case had wound problem in autograft group. As for Oswestry scale scores, there was no significant difference between the two groups.</p><p><b>CONCLUSIONS</b>The enrichment technique of autologous bone marrow stem cells can greatly increase the concentration of MSCs. It is a rapid and safe method used peri-operatively. The composite material of enriched MSCs and porous beta-TCP is a good bone substitute in posterior spinal fusion.</p>

Total hip arthroplasty for Crowe type-IV development dysplasia of hip in adults / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the operation procedure of total hip arthroplasty (THA) for Crowe type-IV developmental dysplasia of hip and its relationship with nerve injury.</p><p><b>METHODS</b>A consecutive series of 39 THAs was performed for Crowe type-IV developmental dysplasia of hip in 35 patients (all female). The mean age of the patients at the time of surgery was 46 years (range 36 - 56 years). Thirty-five hips in 31 patients were followed up. The average follow-up period of the whole series was 4 years (range 1 - 8 years). All procedures were carried out through a lateral-posterior approach. In 33 of 35 hips, the cup was inserted in the "true" acetabulum. All the prostheses used were cementless, except for 5 cemented femoral stems in 5 patients. Each patient was evaluated clinically and by radiographs before the operation and during the follow-up period, according to the Harris hip score (HHS).</p><p><b>RESULTS</b>None of the cups and stems were revised for aseptic loosening, dislocation or infection during the follow-up period. The mean preoperative HHS was 43 compared with the postoperative HHS of 87. The mean amount of postoperative leg lengthening was 5 cm (range 4 - 6 cm).</p><p><b>CONCLUSIONS</b>The reconstruction of the hip at the level of the "true" acetabulum through a lateral-posterior approach is a safe and effective procedure of THA for Crowe type-IV developmental dysplasia of hip in adults. Acute leg lengthening of less than 6 cm could not cause nerve injury.</p>

Roles of OPG and OPGL in periprosthetic osteolysis / 中华创伤骨科杂志

Objective To investigate the histological and biochemical responses associated with periprosthetic osteolysis,including the changes of tumor necrosis factor-?(TNF-?),osteoprotegerin(OPG) and os- teoprotegeria ligand (OPEL) in the interface membrane in rat models so as to understand the mechanisms of these interactions.Methods Twenty-four male SD rats were used in this study.A titanium alloy plug was inserted into each distal femur through the knee joint.Polyethylene particles were injected into the left knee at 2,4,6,8 and 10 weeks after implantation of the plugs.Saline solution was injected into the right knee as the control.The animals were killed 12 weeks after implantation.The distal femur was taken from each knee to make histological sections. The samples were made decalcified and stained with hematoxylin and eosin.The histopathological changes were observed under a light microscope.The concentrations of TNF-?in the membrane were assayed by a ELISA kit and the mRNA expressions of OPG and OPEL extracted from the tissue around the plug were detected by RT-PCR. Results The interface membrane taken from the experimental side was found to contain extensive fibrous tissues which extended deeply into the surrounding hone.TNF-?concentrations in the membrane of the experimental side were higher than in the control membrane.There was a significant decrease of OPG mRNA and a significant increase of OPGL mRNA in the membrane around the plug at the experimental side compared with the control side.Con- clusions Polyethylene particles can induce inflammatory responses around the titanium alloy plug.The increase of OPGL expression and reduction of OPG expression in membrane at the experimental side may be induced by TNF-?. Such changes might contribute to the differentiation of osteoclasts and result in the periprosthetic osteolysis.

High-energy extracorporeal shock waves in treatment of nonunion and delayed union:preliminary results / 中华创伤骨科杂志

Objective To observe the effects of the Ossatron high-energy shock waves on bone nonunion and delayed union.Methods Between October 2004 and October 2005,18 patients with nonunion and four patients with delayed union were treated with high-energy extracorporeal shock wave therapy(Ossatron,HMT Co., Swiss).Facture lines were located with C-arm X-ray before treatment.Parameters of shock waves were decided according to fracture sites.Patients with unstable fixation received plaster or bracing for 6 to 8 weeks after treatment. After therapy,follow-up radiography was performed at 6 and 12 weeks and monthly afterwards until the fracture united. Results The mean follow-up was 6.7 months(range,3 to 12 months).There were no complications except local petechial hemorrhage and local swelling in 10 patients.Thirteen patients(59.1%)got bony union,including 12 patients(66.7% )with stable internal fixation,and the average healing time was 4.3 months(range,6 weeks to 6 months).Nine fractures(40.9%)still suffered nonunion.Conclusion High-energy shock waves are a good alternative therapy for nonunion and delayed union,with obvious advantages of being non-invasive and safe.