[Comparison of effectiveness of anterior subcutaneous internal fixator and plate internal fixation for unstable anterior pelvic ring fractures].

OBJECTIVE: To compare the effectiveness of anterior subcutaneous pelvic internal fixator (INFIX) and plate internal fixation in treatment of unstable anterior pelvic ring fractures. METHODS: The clinical data of 48 patients with unstable anterior pelvic ring fractures who met the selection criteria between June 2014 and December 2019 were retrospectively analyzed. Among them, 21 cases were treated with INFIX (INFIX group), and 27 cases were treated with plate (plate group). There was no significant difference in gender, age, body mass index, cause of injury, time from injury to operation, Injury Severity Score (ISS), and fracture type between the two groups ( P>0.05). The operation time, intraoperative blood loss, fracture healing time, partial weight-bearing time, and complete weight-bearing time were recorded and compared between the two groups. Matta standard was used to evaluate the quality of fracture reduction, and Majeed score system was used to evaluate the functional recovery of pelvic fracture after operation. RESULTS: The patients in both groups were followed up for an average of 12.5 months (range, 6-16 months). The operation time and intraoperative blood loss in INFIX group were significantly lower than those in plate group ( t=-11.965, P=0.000; t=-20.105, P=0.000). There was no significant difference in the quality of fracture reduction, fracture healing time, partial weight-bearing time, and complete weight-bearing time between the two groups ( P>0.05). At 14 weeks after operation, there was no significant difference in the scores of pain, working, standing and walking, and total scores between INFIX group and plate group ( P>0.05), but there were significant differences in sitting and sexual intercourse scores ( t=-4.250, P=0.003; t=-6.135, P=0.006). The incidences of lateral femoral cutaneous nerve injury, femoral nerve injury, and heterotopic ossification were significantly higher in INFIX group than in plate group ( P<0.05), while the incidence of incision infection was lower in INFIX group than in plate group ( P<0.05). CONCLUSION: Compared with the plate internal fixation, the INFIX internal fixation can obtain the similar effectiveness for the unstable anterior pelvic ring fracture and has the advantages of shorter operation time, less blood loss, and lower risk of infection.

[Theranostics of osteosarcoma and lung metastasis with new integrin α vß 3 receptor targeted radiotracers].

Objective: To investigate the value of integrin α vß 3 targeted microPET/CT imaging with 68Ga-NODAGA-RGD 2 as radiotracer for the detection of osteosarcoma and theranostics of osteosarcoma lung metastasis. Methods: The 68Ga-NODAGA-RGD 2 and 177Lu-NODAGA-RGD 2 were prepared via one-step method and their stability and integrin α vß 3 binding specificity were investigated in vitro. Forty-one nude mice were injected with human MG63 osteosarcoma to established the animal model bearing subcutaneous osteosarcoma ( n=21), osteosarcoma in tibia ( n=5), and osteosarcoma pulmonary metastatic ( n=15). The microPET-CT imaging was carried out in 3 animal models at 1 hour after tail vein injection of 68Ga-NODAGA-RGD 2. Biodistribution study of 68Ga-NODAGA-RGD 2 was performed in animal model bearing subcutaneous osteosarcoma at 10, 60, and 120 minutes. The animal model bearing pulmonary metastatic osteosarcoma was injected with 177Lu-NODAGA-RGD 2 at 7 weeks after model establishment to observe the therapeutic effect of pulmonary metastatic osteosarcoma. Histological and immunohistochemistry examinations were also done to confirm the establishment of animal model and integrin ß 3 expression in animal models bearing subcutaneous osteosarcoma and bearing pulmonary metastatic osteosarcoma. Results: 68Ga-NODAGA-RGD 2 and 177Lu-NODAGA-RGD 2 had good stability in vitro with the 50% inhibitory concentration value of (5.0±1.1) and (6.5±0.8) nmol/L, respectively. The radiochemical purity of 68Ga-NODAGA-RGD 2 at 1, 4, and 8 hours was 98.5%±0.3%, 98.3%±0.5%, and 97.9%±0.4%; while the radiochemical purity of 177Lu-NODAGA-RGD 2 at 1, 7, and 14 days was 99.3%±0.7%, 98.7%±1.2%, and 96.0%±2.8%. 68Ga-NODAGA-RGD 2 microPET-CT showed that the accumulation of 68Ga-NODAGA-RGD 2 in animal models bearing subcutaneous osteosarcoma and osteosarcoma in tibia and in lung metastasis as small as 1-2 mm in diameter of animal model bearing pulmonary metastatic osteosarcoma. Biodistribution study of 68Ga-NODAGA-RGD 2 in animal model bearing subcutaneous osteosarcoma revealed rapid clearance from blood with tumor peak uptake of (3.85±0.84) %ID/g at 120 minutes. The distribution of 177Lu-NODAGA-RGD 2 in lung metastasis was similar with 68Ga-NODAGA-RGD 2. The number and size of osteosarcoma metastasis decreased at 2 weeks after 177Lu-NODAGA-RGD 2 administration and integrin targeting specificity was confirmed by pathology examination. Conclusion: 68Ga-NODAGA-RGD 2 was potential for positive imaging and early detection of osteosarcoma and metastasis. Targeted radiotherapy with 177Lu-NODAGA-RGD 2 was one potential alternative for osteosarcoma lung metastasis.

Comparison of Percutaneous Kyphoplasty Versus Modified Percutaneous Kyphoplasty for Treatment of Osteoporotic Vertebral Compression Fractures.

BACKGROUND: Although percutaneous kyphoplasty (PKP) is performed to restore the vertebral body height and kyphosis in osteoporotic vertebral compression fractures (OVCFs), the regained height may be lost on balloon deflation. This study compares PKP with modified percutaneous kyphoplasty (MPKP) in terms of the clinical outcomes in treating OVCFs. METHODS: Between May 2014 and March 2016, 76 patients with OVCFs were randomly assigned to 2 groups according to the procedure chosen: the PKP group (n = 36) and MPKP group (n = 40). Perioperative parameters, radiologic data, and other clinical parameters were compared between the groups. RESULTS: Of the 76 patients, 68 were followed-up for an average of 16 months. Both groups showed similar degrees of postoperative improvement on the visual analog scale, without any significant intergroup difference. However, the MPKP group showed greater improvement in vertebral body height and recovery of the Cobb angle compared with the PKP group. Additionally, the volume of bone cement and operative time were significantly higher in the MPKP group than in the PKP group, whereas the Oswestry Disability Index at the last follow-up was significantly lower in the MPKP group than in the PKP group. The cement leakage ratio and incidence of recurrent vertebral fractures did not differ significantly between the groups. CONCLUSIONS: MPKP prevents the loss of vertebral height observed with PKP during balloon deflation in addition to providing greater height, Cobb angle recovery, and quality of life compared with PKP in cases of OVCF.

Clinical application of the pedicle in vitro restorer in percutaneous kyphoplasty.

BACKGROUND: Percutaneous kyphoplasty (PKP) is widely applied for the treatment of osteoporotic vertebral compression fractures (OVCFs) and has achieved satisfactory clinical results. With the accumulation of clinical cases and prolonged follow-up times, the inability to reconstruct vertebral height defects has attracted more and more attention. A comparison of clinical effects was retrospectively reviewed in 72 patients who underwent simple PKP or pedicle in vitro restorer (PIVR) combined with PKP to discuss the clinical application of self-developed PIVR used in PKP. METHODS: From August 2013 to August 2016, 72 patients with OVCFs were treated surgically, with 30 patients undergoing PKP (group A) and 42 undergoing PIVR combined with PKP (group B). Operation-related situations, radiological data, and related scores were compared between the two groups by corresponding statistical methods. RESULTS: Bone cement was successfully injected into 72 vertebral bodies. Sixty-three cases were followed up for an average of 14 months. There were significant differences between the two groups in the improvement of the height of the vertebral body, sagittal Cobb angle, and visual analogue scale (VAS) 1 week after the operation (P < 0.05), and the improvements of group B were better than those in group A. The cement leakage ratio was significantly different between the two groups (P < 0.05). The Oswestry Disability Index (ODI) at last follow-up was significantly different between the two groups (P < 0.05). There was no significant difference in the incidence of recurrent vertebral fractures between the two groups at the last follow-up (P > 0.05). CONCLUSION: PIVR combined with PKP can overcome the limitations of PKP alone, that is, hardly restoring vertebral height and height being easily lost again with balloon removal. The combined method can also restore the vertebral fractures to a satisfactory height and effectively maintain the stability of the spine, which improves the long-term quality of life of patients. Thus, PIVR combined with PKP is a better choice for patients with OVCFs.