Internal fixation via only the modified Stoppa approach for central hip dislocation complicated with fracture of the posterior acetabular wall / 中华创伤骨科杂志

Objective:To evaluate internal fixation via only the modified Stoppa approach in the treatment of central hip dislocation complicated with fracture of the posterior acetabular wall.Methods:A retrospective study was conducted in the 13 patients with central hip dislocation and fracture of the posterior acetabular wall who had been treated at Department of Orthopedic Trauma, Nanfang Hospital between February 2015 and February 2018. They were 10 men and 3 women, aged from 31 to 65 years (average, 46.7 years). All patients were treated with internal fixation via only the modified Stoppa approach. The reduction of double-column and posterior wall fractures was evaluated according to the X-ray Matta scoring system, as well as to the Wiberg central-edge (CE) angles between the vertical line of the center point of the femoral head and the lateral edge of the acetabulum and acetabular tolerance on the normal and affected sides immediately after operation; the hip function was evaluated by the modified Merle d'Aubigne and Postel scoring system at 12 months after operation.Results:All patients were followed up for 16 to 52 months (average, 25.6 months). In all of them, reduction and fixation of central hip dislocation and acetabular fracture was completed successfully, and indirect reduction of posterior wall fracture and acetabular tolerance were satisfactory. Operation time ranged from 130 to 270 min, averaging 155.5 min; intraoperative blood loss from 600 to 5,600 mL, averaging 1,150.5 mL; intraoperative infusion of concentrated red blood cells from 2 to 12 U, averaging 6 U. By the X-ray Matta scoring system immediately after operation, anatomical reduction was achieved in 4 posterior wall fractures and satisfactory reduction in 9 ones. There was no significant difference between the normal and affected sides in the CE angle (43.53°±3.46° for the affected side versus 43.19°±3.28° for the normal side) or in the acetabular tolerance (76.56%±15.50% for the affected side versus 75.32%±16.24% for the normal side) ( P>0.05). The modified Merle d'Aubigne and Postel scores at 12 months after operation ranged from 12 to 18 points, averaging 16.5 points; the hip function was assessed as excellent in 9 cases, as good in 3 and as fair in one. By the last follow-up, none of the 13 patients lost fracture reduction, and their internal fixation was firm with no loosening or breakage. Conclusion:In the treatment of central hip dislocation complicated with fracture of the posterior acetabular wall, internal fixation via only the modified Stoppa approach can lead to satisfactory fracture reduction, firm fixation, good hip joint tolerance, and fine clinical efficacy.

Current study on classification of femoral neck fractures in adults / 中华创伤骨科杂志

Treatment of adult femoral neck fracture is still a great challenge faced by trauma orthopedists. As treatment effects can be infleunced by multiple factors, like age, gender and preoperative physical condition, they may vary with different treatment schemes. Classification of femoral neck fractures plays an important guiding role in choosing a proper treatment scheme and judging the prognosis. The current classic clinical classification systems for femoral neck fractures include Garden, AO/OTA and Pauwels classifications. Since the recent progress in science and technology has put more advanced technologies into clinic application, such as CT, MRI and Digital Subtraction Angiography (DSA), new ways of classification have appeared. However, each classification has its own shortcomings which need to be improved. This paper reviews the research progress in classification of adult femoral neck fractures and their treatment principles.

Characteristics and treatment of femoral neck fracture in children / 中华创伤骨科杂志

Femoral neck fracture in children is usually caused by high-energy trauma. This relatively rare injury characterized by skeletal immaturity is different from that in adult patients in proximal femoral anatomy and blood supply. Currently, a variety of fixation methods have been used for paediatric femoral neck fractures but their overall goal is anatomical reduction and stable fixation. Femoral neck fractures in children are usually associated with a high incidence of complications (e.g. femoral head necrosis, premature epiphyseal closure, coxa vara and nonunion) even after appropriate treatment. This review addresses the anatomic characteristics, treatment strategies and complications in the treatment of paediatric femoral neck fractures.

An exploratory study to perfect the Letournel classification of acetabular fractures / 中华骨科杂志

Objectives To put forward the modified Letournel classification of acetabular fractures,and evaluate the guiding role of the modified Letournel classification in clinical work.Methods A retrospective study of 170 patients (178 sides) with acetabular fractures treated at Nanfang Hospital between January 2006 and August 2018 was performed.Among them 129 cases were males and 41 were females.The average age was 40.2±14.2 years (range,14-82 years).According to the Letournel classification,unclassifiable/atypical acetabular fractures were found out with plain Ⅹ-ray and plain CT scan and three-dimensional CT,and then their unclassifiable reasons were analyzed.Based on anatomical landmarks,clear boundaries of acetabular walls were defined on the 3D printed pelvic model.The structure of each column is a trihedron.The wall's fracture and column's fracture were distinguished using a theory that the wall's fracture involved two surfaces of column with interruption of continuity and column's fracture involved three.When column's fracture associated with wall's fracture,lowercase a,p and q were used representing comminuted areas of corresponding anterior and posterior wall,quadrilateral plate respectively.When column's fracture didn't associates with wall's fracture,it is marked with number 0.Finally,all fractures were classified according to the modified Letournel classification.The relationship between fracture type and surgical approach was analyzed.Results There was 51.7％ (92 sides) of acetabular fractures that couldn't be classified by the Letournel classification.Incomplete fracture lines (49 sides,53.3％),comminuted fractures (28 sides,30.4％),both of them (15 sides,16.3％) were their unclassifiable reasons.There were 8 types in the modified Letournel classification,including posterior wall fracture,posterior column fracture,anterior wall fracture,anterior column fracture,transverse fracture,T-shaped fracture,anterior column+posterior hemitransverse fracture,and both columns fracture.Posterior column+posterior wall fracture,transverse+posterior wall fracture had respectively become a form of posterior column fracture and of transverse fracture.According to the modified Letournel classification,the reclassification rate of 178 side fractures was 100％,which was significantly higher than 48.3％ (86/178) of the traditional Letournel classification,and the difference was statistically significant (x2=124.06,P＜ 0.001).100％ of posterior wall fracture and 80.00％ of posterior column fracture were treated by posterior approach.100％ of anterior column fracture and 73.68％ of both columns fracture were treated by anterior approach.Conclusion All acetabular fractures can be classified by the modified Letournel classification.The orientation of the comminuted walls reflects in part severity of the injury,better helps orthopaedic surgeons understand the morphology of acetabular fractures and select appropriate surgical approach.

The optimal pathway for S1 sacroiliac screwing: 3D imaging study and clinical application / 中华创伤骨科杂志

Objective To determine the optimal pathway for S1 sacroiliac screwing based on the largest safe zone in Chinese population using 3D imaging models and observe its clinical application in patients with sacroiliac joint fracture or dislocation.Methods Pelvic CT scans of 54 Chinese adults were obtained to create reconstruction 3D models of the right hemi-pelvis.After the models were transparentized and rotated to the axial view of the S1 pedicle,the angle was slightly adjusted to maximize the translucent safe zone.Next,simulative insertion into the center of this zone was conducted with one virtual screw,as large as possible and tangent to the boundary.Measured were the diameter and length of the screw,the vertical distances from the entry point to the horizontal tangent line of the greater sciatic notch and to the vertical tangent line of the posterior superior iliac spine,and from the exit point to the S1 superior endplate and to the anterior cortex.The differences between males and females were analyzed.The above parameters of the optimal pathway for S1 sacroiliac screwing were used in insertion of 16 screws in the 12 patients with sacroiliac joint fracture or dislocation from January 2014 to January 2016 at Department of Orthopaedics and Traumatology,Nanfang Hospital.They were 8 males and 4 females,from 16 to 47 years of age (average,34 years).According to the Tile classification,6 cases belonged to Type Ⅱ and 6 ones to Type Ⅲ.The efficacy of S1 sacroiliac screwing was observed.Results In all the pelvic 3D imaging models,an oval translucent area for safe screw insertion could be easily identified from the S1 pedicle axial view.The maximum diameter and length of the optimal intraosseous pathway were 13.66 ±2.04 mm and 77.66 ±4.25 rmm;the vertical distances from the entry point to the horizontal tangent line of the greater sciatic notch and to the vertical tangent line of the posterior superior iliac spine were 32.77 ± 4.55 mm and 49.57 ± 5.24 mm;the vertical distances from the exit point to the S1 superior endplate and to the anterior cortex were 9.30 ± 1.54 mm and 15.85 ± 2.12 mm.The differences were of statistical significance between males and females regarding the maximum diameter,the distance from the entry point to the vertical axis,and the distance from the exit point to the anterior cortex (P ＜ 0.05).All the 16 screws were safely implanted in the 12 patients.Conclusion The optimal screw pathway can be easily identified and its parameters can be measured in pelvic 3D imagingmodels using computer virtual technology.The clinical application has proved that the parameters can serve as a theoretical basis for safe placement of S1 sacroiliac screws.

Regulatory effects of LASP1 and ferritin on rhBMP2-induced osteogenic differentiation of bone marrow mesenchymal stem cells / 中华创伤骨科杂志

Objective To clarify the function of LIM and SH3 domain protein-1 (LASP1) and ferritin in rhBMP2-induced osteogenic differentiation of beagle bone marrow mesenchymal stem cells (BMSCs).Methods After BMSCs from 3-18-month-old C57BL/6J mice were cultured adherently for 24 hours,they were subjected to osteogenic differentiation for 7,14 and 21 days in 3 groups.BMP2 (100 μg/L) and osteogenic differentiation medium was added in the experimental group,only osteogenic differentiation medium was added in the control group,and nothing was added in the blank group.Osteoblast differentiation was determined by examining marker genes (Runx2,OSX,OCN and OPN) using qRT-PCR.The protein expression of both LASP1 and ferritin was investigated using western blotting.After LASP1 and ferritin were silenced in the cells in the experimental group after transfection of shRNA to target LASP1(m),rhBMP2-induced osteogenesis was repeated to verify the roles of LASP1 and ferritin in osteoblast differentiation.Results The qRT-PCR showed successful osteoblast differentiation in the experimental group.Western blotting verified significant down-regulation of LASP1 and up-regulation of ferritin in the experimental group.After the LASP1 gene was silenced,the expression levels of osteoblast differentiation marker genes in the experimental group were higher than those in the control group.Conclusions rhBMP2 can induce mouse BMSCs to differentiate into osteoblasts in a significant manner.Combined with our preliminary research,the present study may confirm that LASP1 and ferritin,which play an important role in regulating cytoskeleton activity and iron metabolism,are critical in the osteogenic differentiation of mouse BMSCs induced by rhBMP2.

Medial iliosciatic plating via the Stoppa approach for complex acetabular fractures involving the posterior column / 中华骨科杂志

Objective To explore the clinical efficacy of medial iliosciatic plating via the Stoppa approach for complex acetabular fractures involving the posterior column.Methods Between February 2015 and February 2016,a total of 16 complex acetabular facture cases treated by the medial iliosciatic plate via the Stoppa approach were retrospectively analyzed in this study.This approach provided good exposure to a large region of the pelvis and acetabulum including pubis symphysis,pubic ramus,anterior and inner wall of acetabulum,quadrilateral surface,inner surface of posterior column,true pelvic margin,greater sciatic notch and sacroiliac articulation.The anterior and column was reduced and fixed by the anterior column plate and the medial ilioseiatie plate.The screw direction and angle were adjusted according to the intraoperative X-ray.Surgical time,amount of bleeding,and relevant complications were recorded.The reduction of the posterior column fracture was evaluated by Matta scoring system on the plain X-ray of the pelvic post-surgery,and functional outcomes of the hip joint affected were evaluated one year post-surgery by the Merle d'Aubigne-Postel scoring system.All the cases were followed for at least 12 months.Results The reduction and fixation of the posterior column was accomplished in all the 1 6 patients.The average surgical time was 165.5 min (range,130-270 min).The average blood loss was 1 245.6 ml (range,600-5 600 ml).Thc intraoperative infusionof concentrated red blood cells averaged 6 units.According to the Matta scoring system,anatomical reduction was achieved in 12 cases,satisfactory reduction in 3,and poor reduction in one.The patients were followed from 12 to 22 months.According to the Merle d'Aubigne-Postel scoring system,there were 11 cases of excellent and 3 cases of good,yielding a good or excellent rate of 87.5％.The average Merle d'Aubigne-Postel score was 15.8 (range,8-18).There were 1 case of external iiiac vein rupture and 1 case of bladder rupture.Both were repaired during surgery.Superior gluteal artery rupture was found in 1 case and surgical ligation of the artery was performed during surgery.Conclusion In the treatment of complicated acetabular fractures involving the posterior column,the medial iliosciatic plating via the Stoppa approach is safe and effective,because it can provide a safe and sufficient operative field for surgeons to reduce and fix the posterior column fractures,and it leads to satisfactory recovery of the patients with limited complications.

A short Chinese version of center for epidemiologic studies depression scale / 中华行为医学与脑科学杂志

Objective To develop a short Chinese version of the center for epidemiological studies depression scale(CES-D).Method A stratified random nationwide sample with 30801 normal people and a mentally ill sample with 415 patients were tested.Items in the short version were chosen according to both the result of independent t-test in current study and the result of reliance and validity.Cut-off scores were offered to check up depressions.Result The internal consistency reliability of the 9-item Chinese version CES-D ranged from 0.85 to 0.88.The test-retest reliability was 0.49(P＜0.001).All item-total correlations were higher than 0.5.The correlation between sumscores of the original scale and sunscores of the Chinese short version ranged from 0.94 to 0.96 (P＜ 0.001) in all the samples.The sum scores of initial diagnosis depression sample were significantly higher than that of treated depression sample and common sample.A two-dimension structure was testified.The cut-off scores of the short version were 10 and 17.Conclusion The 9-item Chinese version of CES-D can be used in various samples with reliable and valid effect.

Defense mechanisms and childhood abuse of patients with borderline personality disorder / 中华健康管理学杂志

Objective To understnad the defense mechanisms of patients with borderline personality disorder (BPD) and to explore its relationship with childhood abuses.Methods One hundred and forty-two outpatients with BPD (group A),63 outpatients with other personality disorders (group B) and 20 outpatients without any Axis Ⅱ diagnoses (group C) were enrolled and completed Chinese versions of the Childhood Experience of Care and Abuse Questionnaire (CECA.Q) and the Defensive Style of Questionnaire (DSQ).Multivariate analysis of variance and Pearson correlation analysis were used for data analysis.Results Compared to group B and C,the score of defense mechanisms reported by group A were significantly increased in all eight premature defense mechanisms,such as projection(F =26.5,P ＜ 0.05),passive aggression (F =18.1,P ＜ 0.05),acting out (F =28.3,P ＜ 0.05),complaint (F =16.7,P ＜0.05),fantasy(F =16.3,P ＜ 0.05),splitting (F =28.8,P ＜ 0.05),withdrawal (F =8.3,P ＜ 0.05),somatization(F=7.6,P ＜ 0.05),and part of the middle defense mechanisms,such as omnipotence-devaluation(F =9.2,P ＜ 0.05),isolation(F =4.7,P ＜ 0.05) and identification (F =10.0,P ＜ 0.05).At the same time,the BPD patients got lower scores in the mature defense mechanisms,such as sublimation (F =4.1,P ＜ 0.05) and repression(F =3.9,P ＜ 0.05).Those who experienced physical abuse use more complaint (F =6.9,P ＜ 0.05),denial mechanisms (F =5.2,P ＜ 0.05) and less anticipation one (F =4.6,P ＜ 0.05).Those who experienced sexual abuse use more somatization (F =4.4,P ＜ 0.05) and isolation mechanism (F =3.6,P ＜ 0.05).Conclusions BPD patients would like to use more immature and middle defense mechanisms and less mature ones.Emotional,physical and sexual abuse from parents and other adult care takers have a correlation with immature defense mechanisms,which indicates the importance of care about parental rearing patterns and mental health of children.

A Study of the Reliability and Validity of Millon Clinical Multiaxial Inventory Ⅲ (MCMI-Ⅲ) / 中国临床心理学杂志

Objective: To translate Millon Clinical Multiaxial Inventory Ⅲ (MCMI-Ⅲ) into Chinese, and then test its reliability and validity. Methods: MCMI-Ⅲ was administered to patients with mental disorders and normal people. Some subjects completed SAS, SDS, HAMA and HAMD simultaneously. 7-14 days later, some subjects completed the Chinese version of MCMI-Ⅲ again. Results: Cronbach’s alpha and the split-half reliability of MCMI-Ⅲ was 0.957 and 0.919, respectively. The mean Cronbach’s alpha, split -half and test -retest reliability of the subscales were 0.72, 0.70, 0.71 respectively. Most of the items correlated significantly (P