Periprosthetic fractures: the increasing challenges / 中华创伤骨科杂志

Surgery for periprosthetic fractures (PPF) is one of the most complex procedures in orthopedics. It is difficult, highly risky and extremely challenging, because the patients are usually advanced in age and suffering from essential organ dysfunction, numerous comorbidities, poor overall body condition, poor bone quality combined with osteolysis and even bone loss, and because the surgeons have to apply the concepts and techniques of Modern Orthopedic Trauma and artificial joint revision techniques in fracture fixation and prosthesis revision. This paper expounds on the clinical challenges due to the characteristics of PPF in order to call on clinical surgeons to update their concepts, deal with seriously and standardize their PPF treatment, and effectively improve their efficacy.

Combination pattern of internal fixation for periprosthesis fractures of the proximal femur after hip replacement / 中华骨科杂志

Objective:To investigate the combination of internal fixation for periprosthetic fractures of the proximal femur (PFFF) after hip arthroplasty.Methods:The data of 58 patients with periprosthetic fractures after hip arthroplasty from May 2008 to March 2022 were retrospectively analyzed, including 31 males and 27 females. The average age was 75.5±18.2 years (range, 35-95 years). There were 39 total hip arthroplasty and 19 hemiarthroplasty; 37 biological prosthesis and 21 cemented prosthesis. Intraoperative periprosthetic fractures occurred in 6 cases and 52 cases postoperatively. Unified classification system (UCS): UCS IV.3A1 type 2 cases, 3A2 type 1 case, 3B1.1 type 19 cases, 3B2.1 type 25 cases, 3B3 type 2 cases, 3C type 9 cases. Fracture site: 3 cases in zone A (greater trochanter), 46 cases in zone B (around the femoral stem), and 9 cases in zone C (distal to the tip of the femoral stem. Internal fixation is composed of primary and secondary fixation, the main fixation method was the cerclage of steel wire or titanium cable, locking compression plate, and locking attachment plate fixation. The secondary fixation method was the cerclage of titanium cable, which was required to cover three zones A, B and C to form an overall balanced fixation. The modified Harris hip scores (mHHS), plate length, working length and screw number of different internal fixation combinations were compared.Results:The follow-up time was 54.2±21.6 months (range, 11-86 months). All patients showed signs of fracture healing at 10.2±1.5 weeks (range, 7-13 weeks) after operation, and bony union was observed at 19.6±1.3 weeks (range, 17-22 weeks) after operation. No delayed union or nonunion was observed. After operation, one case had a stress fracture and was revised with double-plate internal fixation; one case had a failed internal fixation and was revised with double-plate internal fixation and a large allograft bone graft. The mHHS score of UCSIV.3B2.1 group (80.3±4.6) was the lowest at 6 months after operation, and the difference between the groups of different types was statistically significant ( F=256.72, P<0.001). The score of simple internal fixation group (91.6±4.2) was higher than that of revision combined with internal fixation group (81.9±4.1), and the difference was statistically significant ( t=8.32, P<0.001). The plate length and working length were 24.9±2.5 cm and 12.6±1.7 cm for UCS IV.3B1.1, 25.4±2.6 cm and 13.6±1.8 cm for 3B2.1 and 28.1±2.5 cm and 4.9±1.9 cm for 3C, respectively ( F=5.33, P=0.005; F=6.78, P<0.001). The number of screws in zone A was significant difference among different UCS types ( F=52.67, P<0.001); UCS IV.3B1.1 (6.5±2.3) and 3B2.1 (6.7±2.2) were more than 3B3 (3.5±1.5) and 3C (3.7±1.6). The number of screws in zone B was significant difference among different UCS types ( F=42.15, P<0.001); The number of UCS IV.3B1.1 (2.3±1.6) and 3B2.1 (2.8±1.9) were significantly more than that of 3B3 (1.0±0.5) and 3C (1.2±0.6). The number of screws in zone C was significant differences among different UCS types ( F=39.62, P<0.001); The number of UCS IV.3B1.1 (3.8±1.9) and 3B2.1 (3.9±1.7) were more than that of 3B3 (2.0±0.5), the difference was statistically significant ( P<0.05). Conclusion:The function of hip after simple internal fixation of proximal femoral periprosthetic fractures was better than that of those who underwent revision at the same time; the number of screws of UCSIV.B1 and B2 is more than that of B3.

The bone-hardness distributions of the human middle-upper thoracic vertebrae by micro-indentation / 中华骨科杂志

Objective:To measure and analyze the distribution characteristics of the micro-hardness of the middle-upper thoracic vertebrae (T 1-T 10) in the human body. Methods:T 1-T 10 vertebrae from three fresh cadavers were divided into vertebral body area and attachment area. 3 mm specimens were cut by a high-precision slow saw and 11 regions were selected and measured on each vertebrae by a Vickers microhardness tester (cortical bone: 1-9, cancellous bone: 10-11). The micro-hardness distribution of T 1-T 10 vertebrae was recorded and analyzed. Results:A total of 330 measurement areas from 30 vertebrae were measured, and 1 650 hardness values were collected. The average hardness values of the overall cortical bone of the middle-upper thoracic vertebrae of the 3 cadavers were 30.55±5.44 HV, 29.94±4.86 HV, and 29.55±4.36 HV, respectively. The difference among the groups was statistically significant ( F=4.680, P=0.009). The average hardness values of the overall cancellous bone were 27.93±5.61 HV, 28.21±4.96 HV, 27.98±3.94 HV, respectively. There was no significant difference among the groups ( F=0.091, P=0.913). There were statistically significant differences between the hardness values in the attachment area and vertebral body area of each cadaver ( t=7.467, 4.750, 6.621, P<0.001); the hardness of the cancellous bone in the attachment area of each cadaver was higher than that of the cancellous bone in the vertebral body ( t=1.785, 3.159, 3.103, P=0.077, 0.002, 0.003). The distribution of microhardness in 11 measurement areas of 3 cadavers were similar: the hardness of the cortical bone of pedicle, lamina and inferior endplate cortex (1, 2, 7) were higher; the hardness of the cortical bone of upper endplate and peripheral cortex (6, 8, 9) were lower. The distribution patterns of the microhardness in different vertebral segments of the 3 cadavers were similar: The hardness values gradually increased from T 1 to T 10. The vertebra with the largest hardness of the cortical bone was T 8; and the vertebra with the largest hardness of the cancellous bone were T 7, T 7 and T 6, respectively. Conclusion:The hardness of the upper endplate and peripheral cortex was low, which could disperse the load to protect the fragile cancellous bone. The hardness of the pedicle was the highest. The hardness of the cortical bone was higher than that of the cancellous bone, and the values of different segments gradually increased from top to bottom, which may be related to the physiological and anatomical morphology, and the gradual increase of the load of muscle force and body weight.

Current social support and social adaptation of HIV/AIDS patients in Henan province / 中华流行病学杂志

Objective@#To understand the status quo of social support for and social adaptation of HIV/AIDS patients in Henan province, analyze the relationship between social support and social adaptation, and provide reference for improving the quality of life of HIV/AIDS patients.@*Methods@#A multi-stage stratified random sampling method was adopted to select HIV/AIDS patients in high HIV prevalence areas (Shangcai, Shenqiu), middle epidemic areas (Queshan, Yongcheng), low prevalence areas (Jiyuan, Sanmenxia) in Henan province. A social support scale was used to investigate the three dimensions of objective support, subjective support and support utilization. A social adaptation scale was used to investigate the three dimensions of patient cognitive willingness, social interaction and role adaptation. Finally, the characteristics of the social support, social adaptation and their relationships were analyzed.@*Results@#The overall score of 506 HIV/AIDS patients’ social support was 36.30±9.34, the score of objective support was 7.48±3.01, the score of subjective support was 22.35±5.79, and the score of support utilization was 6.28±2.38, the overall score and the scores of three dimensions of social support of HIV/AIDS patients were lower than the national levels, and the differences were statistically significant (P<0.05). The overall score of patients’ social adaptation was39.10±7.10, the score of cognitive willingness was 9.96±3.23, the score of social interaction was 18.57±3.25, and the score of role adaptation was 10.57±2.52. The average score of social adaptation of patients was less than 2/3 of the overall score, and the average cognitive willingness score was less than 1/2 of the overall score. The differences in social support score and social adaptation score among patients with different gender, age, marital status, occupation, transmission route, number of symptoms were statistically significant (P<0.05). For the HIV/AIDS patients, there was a correlation between the social support and the social adaptation (r=0.14, P<0.05).@*Conclusion@#HIV/AIDS patients had a low level of social support and social adaptation, and social support might be a contributing factor to the social adaptation of HIV/AIDS patients.

Comprehensive analysis of the performance of national basic public health service plan in Zhengzhou from 2011 to 2016 / 中华健康管理学杂志

Objective To evaluate the implementation process of a basic public health service in Zhengzhou. Methods The primary data on the trends in the development of basic public health services were obtained from the annual report and the annual health statistics yearbooks from 2011 to 2016 published by the Zhengzhou City Health and Family Planning Commission. The techniques for order preference by similarity to an ideal solution (TOPSIS method) and rank sum ratio method were used to comprehensively study and analyze the implementation effects of 22 indicators in 13 items of a five-year basic public health project in Zhengzhou. Results Judging from the TOPSIS analysis results, the C values from 2011 to 2016 were 0.3757, 0.3228, 0.5212, 0.6292, 0.6494, and 0.6673 respectively. The year with the highest C value was 2016 and the year with the lowest C value was 2012. Using the rank sum ratio method, the RSR values from 2011 to 2016 were 0.4545, 0.4280, 0.5340, 0.6023, 0.7235, and 0.7576 respectively. From this, 2016 was found to be the best year for plan implementation. Further, the implementation of the five-year basic public health service plan can be divided into three levels. When the range of P (percentile) was P84.134-, and the corresponding year was 2016, the implementation level was higher. When the P (percentile) range was P50-, and it corresponded with 2013, 2014, and 2015, implementation was at a medium level. When the P (percentile) range was <P50, and it corresponded with 2011 and 2012, there was a low level of implementation. Conclusion The overall performance of basic public health services demonstrated positive trends in Zhengzhou from 2011 to 2016.

Protective effect of L-ascorbic acid against fibroblast cytotoxicity induced by cobalt nanoparticles and ions / 重庆医学

Objective To explore the effect of L-ascorbic acid(AA) for reducing the fibroblast cells induced by cobalt(co)cytotoxicity.Methods The experiment was divided into the blank control group,Co2+ group,Co2++AA group,cobalt nanoparticles(CoNPs) group,CoNPs+AA group and AA group.The AA pretreated for 1 h was performed in advance.The CCK8 assay was used to detect the CoNPs and Co2+ induced and AA-treated cytotoxicity.The fluorescence staining was used to measure the production of ROS in mitochondria.The real-time polymerase chain reaction(PCR) and Western blot were used to measure the expression of related protein and related molecular mRNA respectively.Moreover the cytochrome-C level in cytoplasml was detected.Results After treating the cells by CoNPs and Co2+,the cells appeared apoptosis.CoNPs could significantly induce ROS generation;the proapoptotic factors(caspases-3,and Bax) were significantly increased,while the anti-apoptotic factor Bcl-2 expression was decreased;cytochrome C and AIF expressions were up-regulated and released from mitochondria into the cytoplasm,after AA pretreatment,these changes caused by CoNPs were decreased.Conclusion AA can reduce the CoNPs caused cytotoxicity by reducing ROS generation and release,but can not weaken the Co2+ toxic effect.

Treatment of periprosthetic femoral fractures following hip arthroplasty utilizing locking compression plates / 中华骨科杂志

Objective To evaluate the clinical outcomes of periprosthetic femoral fractures (PFF) following hip arthroplasty utilizing locking compression plates (LCP) in regard to tips and tricks on the construction of LCP augmented with locking attachment plate (LAP) and titanium cables (TC).Methods A total of 41 cases of PFF follow hip arthroplasty (THA 3,Hemi-arthroplasty 2) between May 2008 to April 2016 have been retrospectively analyzed.There were 13 males and 28 females with an average age of 70.5±8.6 years,including 11 case of Unified Classification System (UCS) type Ⅳ.3B1.1,21 cases of B2.1 and 9 cases of type C.All were closed fractures caused by simple fall in terms of low-energy injury.Surgical options depended on individual configuration of the fractures with the combination of LCP and LAP or TC.In respect of reduction techniques,minimally invasive plate osteosynthesis (MIPO) was used in 5 cases for type B1.1 and 8 cases for type C,Mini-open in 6 cases for type B1.1 and 1 case for type C.Posterolateral approach with open reduction internal fixation were selected for type B2.1.The patients were followed up periodically.Harris score,Mukundan criteria and complications were recorded.Results Five cases died of the comorbidities (heart failure 3,pulmonary infection 1,multiple organs failure 1) within 1 year postoperatively.The follow-up rate was 78.0％ (32 out of 41 cases) and the average follow-up time was 41 months (ranging 11 to 71 months).No malunion,no reduction lost,no hardware failure,no hip dislocation and revision surgery following PFF care found.All cases showed the signs of fracture healing from 8 to 12 (average 10 weeks) postoperatively except 2 cases of delay union.The postoperative complications shown in 11 cases,including 2 cases of superficial infection of the wound,6 cases of deep vein thrombosis (popliteal vein 2,intramural gastrocnemius vein 4) and 3 cases of the prosthetic loosening.Harris score at the latest follow-up were 91.5±2.1 for group B1.1,77.5±4.2 for group B2.1 and 83.5±3.8 for group C.The LCP lengths were 248.9±24.3 mm,258.6±25.2 mm,280.4±24.0 mm for group B1.1,B2.1 and C respectively.The LCP length of group B1.1 was short than that of group C (P＜0.05).The screw numbers for the proximal fragments were 6.1±1.8,6.5±0.7 and 3.8±0.7 for group B1.1,B2.1 and C respectively.The number of screws used in B1.1 and B2.1 were more than that in C (P＜0.05).The screw numbers for the distal fragments were 3.5±0.5,3.9±0.5 and 5.1±0.8 for group B1.1,B2.1 and C respectively,indicating less screws used in B1.1 and B2.1 than that in C (P＜0.05).The cable numbers were 1.9±1.3,2.5±0.9 and 3.7±0.7 respectively for group B1.1,B2.1 and C (P＜0.05).The LAP used in 2,12 and 6 cases for type B 1.1,B2.1 and C respectively without significant difference statistically (P＞0.05).Conclusion Utilizing LCP for PFF following hip arthroplasty can achieve satisfactory short and mid-term clinical outcomes with the prerequisites of precise and individualized preoperative planning.LCP augmented by LAP and TC is a reliable option with low complication rate.However,type C PFF needs longer plate with more screws at distal fragment and more titanium cables.

The studies of cobalt nanoparticles on the toxicity and biological activity of osteoclast / 中华骨科杂志

Objective To explore the toxicity and biological activity of cobalt nanoparticles (CoNPs) on osteoclasts,and to analyze the relationship between cobalt nanoparticles and osteolysis.Methods From November 2014 to July 2015,RAW264.7 cell was induced to osteoclast-like cell by LPS.Different concentrations of cobalt nanoparticles and cobalt chloride were added,and the cell morphology was observed under a microscope.24 h after induction on RAW264.7,cells were grouped into cobalt nanoparticles group (10,20,50,100 μmol/L),cobalt chloride group (10,20,50,100 mol/L) and control group.MTT assessment and Q-PCR were performed at 2 h,4 h,8 h,24 h,48 h post-treatment.Results With the increase of concentration (10,20,50,100 μmol/L) and the action time (2 h,4 h,8 h,24 h,48 h),the inhibition rate of cobalt nanoparticles and cobalt chloride on osteoclast like cells was significantly increased,and the inhibition rate of cobalt nanoparticles was higher.With different concentrations (10,20,50,100 μmol/L) of CoNPs and cobalt chloride,the relative expression of CAⅡ,Cat K gene mRNA expression decreased compared with the control group,when the concentration of CoNPs was in the range of 10-50 μ mol/L,the relative expression of CAⅡ and Cat K was increased,which was reduced in cobalt chloride group.Conclusion Different concentrations of cobalt nanoparticles and cobalt chloride can inhibit the proliferation and differentiation of osteoclasts,and cobalt nanoparticles is more pronounced,when the concentration of cobalt nanoparticles was 10-50 μmol/L,the relative expression of osteoclasts CAⅡ,Cat K increaseed,which was suppressed at the same concentration of cobalt chloride.

Percutaneous locking compression plate in the treatment of posterior pelvic ring fracture / 中华骨科杂志

ObjectiveTo study the surgical indications of using locking compression plate (LCP) to fix the posterior pelvic ring fracture,and to explore its surgical techniques.MethodsFrom September 2005 to February 2010,30 patients with posterior pelvic ring fracture were treated with LCP.Among them 21 were males,9 were females,with the average age of 38.7 years(ranged from 21 to 68 years).The injuries were caused by traffic accident in 14 cases,fall-down from high place in 10 cases,smash of heavy object in 6cases.According to Tile classification,4 patients were type B2,8 patients were type B3,12 patients were type C1,5 patients were type C2,and 1 patient was type C3.Concurrent injures including:3 cases with lung contusion; 3 cases with abdominal parenchymatous organs rupture,2 cases with intestinal rupture,5 cases with urethral injury,5 cases with traumatic brain injury,and 8 cases with fractures of limbs,spine and acetabulum.ResultsAll the incisions of 30 patients were healed by first intention.No skin necrosis,fat liquefaction and infection.Thirty cases were followed up from 13 to 40 months,with the average time of 25.1months.According to Majeed functional score system,20 cases were excellent,7 cases were good and 3 cases were acceptable,the excellent and good rate was 90％.Twelve cases got bone healing 3 months after operation,10 cases got bone healing 4 months after operation,and 8 cases got bone healing 6 months after operation.All the cases had no reduction loss,no limb length discrepancy,no deep venous thrombosis,and had not accelerated the previous nerve symptom.ConclusionUsing LCP to fix posterior pelvic ring fracture has many advantages,including wide indication,strong strength of fixation,well biomechanical properties,easy-to-use,and very good follow-up results.

Effects of rising concentration of serum cobalt ions on the liver, kidney and heart in mice / 中华骨科杂志

Objective To investigate the effects of serum cobalt ion concentration on the liver, kidney and heart in mice. Methods Forty 4-week-old male ICR mice were randomly divided into four groups saline were given by intraperitoneal injection once per day for 3 weeks. The body weights of the mice were recorded every 3 days to ensure the correct doses of cobalt chloride. Blood samples for testing were taken at day 4, week 1, week 2 and week 3. Serum cobalt ion concentrations were measured in all samples whereas other serum biochemical variables, including aspartate aminotransferase (AST), alanine transaminase(ALT),blood urea nitrogen (BUN), creatinine (Cr), and creatine kinase (CK) were evaluated at week 1, 2 and 3. After killing the mice at week 3, the heart, liver and kidney were collected for pathological evaluation. Results Serum cobalt ion concentration was different between the groups. High-dose cobalt chloride significantly increased AST, ALT and CK concentrations, the concentrations increasing in parallel with treatment duration.Pathological evaluation showed that high-dose cobalt chloride had toxic effects on the heart and liver, however no significant effect was apparent in the kidney. Conclusion High-dose cobalt ion concentration in serum has toxic effects on the heart and liver, but no significant effect on the kidney in mice.

A Novel Multi-funtional Tool for Breaking off Ampoule Bottles / 医疗卫生装备

Objective To produce a novel tool for breaking off the ampoule bottles,which can protect the nurses from wounding their fingers by the glass fragment so as to guarantee the safety for the nurses. Methods We design a mould with the self curing plastic and leave some space in the end to insert the ampoule bottle,then fix the bistrique and spring to break off the bottles. Results This tool can break off several kinds of ampoule bottles with any bottles cracked and has achieved good clinical effect. Conclusion This mulfunctional tool is scientificly designed,easy to make,and it is very helpful for the medical staff in protection and enhancing working efficiency,so it is very valuable to be popularized in hospitals.

Clinical application of fast jointed implement for central oxygen supply / 医疗卫生装备

For many reasons,the size of jointed implement for central oxygen supply are different in some small and mediate hospitals,and some equipments can not used in other departments.In order to share mutual resource and make good use of all important equipments,we design a fast jointed implement for respirator joint.In the application of 24 cases,it shows convenient and effective for saving patients.

Introduction of a simple sickbed desk and a universal lamp holder / 医疗卫生装备

At first,this paper introduces a kind of sickbed desk,which can be manipulated easily,and patients could live more comfortable with it.Secondly,it introduces universal lamp holder.Different light sources are used in different medical equipments and the connection of their bulbs and lamp holders are different,too.These lamp holders are expensive and apt to be damaged.In order to prolong the using time of the chilly light,and reduce the spoilage and cost,this paper designs an economic and durable universal lamp holder.

Treatment of mandibular fractures with the tramsbical trochar instrumentation / 医疗卫生装备

Objective To observe the treatment effect of using screwed miniplates through an intraoral and transoral approach for patients with angle and ramus fractures. Methods 21 cases of mandibular angle and ramus fractures were treated by screwed miniplates placed through an intraoral incision with transbuccal mini-incision. Results The use of intraoral and transoral approach reduced the rate of facial paralysis and scar in the internal fixation operation. No postoperative infection occurred in all the cases. Conclusion The use of rigid internal fixation through an intraoral and transoral approach can be applied in the patients with angle and ramus fractures.

A simple bomu light treating instrument / 医疗卫生装备

In order to save the expense for hospitals,a simple bomu light treating instrument is developed by ourselves.It consists of bomu light,12V/24V transformer,5/50W variable potentiometer,silicon,capacitor,plugs and the worn ATX box.Although the structure is simpler and cost is lower,it can accomplish every treating function for gynecology.