[Clinical application of special fluoroscopy method in the treatment of distal radius fractures with volar locking plate].

OBJECTIVE: The relationship between the distal screws and the wrist articular surface was assessed by the additional lateral oblique fluoroscopic view during the operation, and the dorsal tangential view of the wrist was used to observe whether the distal screw penetrated the dorsal cortex, so as to evaluate the clinical efficacy of the volar locking plate in the treatment of distal radius fractures. METHODS: From January 2020 to June 2021, 45 cases of fresh distal radius fractures were treated using the volar Henry's approach, including 20 males and 25 females, aged from 32 to 75 years old with an average of (52.4±8.1) years old. During the operation, they were divided into 2 groups according to the different intraoperative fluoroscopic views:the control group of 20 cases, treated with standard anteroposterior and lateral fluoroscopic view;25 cases in the observation group, additional lateral oblique fluoroscopic view and dorsal tangential view of the wrist were taken. The wrist joint function score and postoperative complications were evaluated at 6 weeks, 3 and 6 months after operation between two groups. RESULTS: All 45 patients were followed up and the duration ranged from 6 to 14 months, with an average of (10.8±1.7) months, all patients achieved bone union and the incision healed well. The incidence of postoperative complications in the observation group was lower than that in the control group, and the difference was statistically significant (P<0.05). In terms of Gartland-Werley score of wrist joint function, the score of wrist function in the observation group was (4.58±1.31) at 6 weeks, (2.98±0.63) at 3 months and (1.95±0.65) at 6 months post-operatively, which were better than those in the control group (6.32±1.96) at 6 weeks, (3.63±0.76) at 3 months and (2.43±0.73) at 6 months. The difference was statistically significant (P<0.05). In the observation group, 7/25 cases(28%) were found to have screw penetration during the operation by additional lateral oblique and dorsal tangential radiograph fluoroscopic views of wrist. CONCLUSION: The addition of lateral oblique and dorsal tangential during the operation could improve the accuracy of distal screw placement, reduce postoperative complications, and achieve early functional exercise.

[Comparison of curative effect between F-shaped hollow screw and traditional three parallel screws in the treatment of Pauwels type â ¢ femoral neck fracture].

OBJECTIVE: To analyze and compare the clinical efficacy of F-shaped hollow screw and traditional inverted triangle three parallel screws in the treatment of young and middle-aged Pauwels type Ⅲ femoral neck fracture. METHODS: From January 2017 to January 2020, 38 patients with Pauwels type Ⅲ femoral neck fracture were treated. They were divided into two groups according to different screw placement methods. Among them, 18 patients in group A were fixed with F-shaped hollow screw, including 12 males and 6 females, aged 37 to 55 years, the time from injury to operation was 1 to 3 days. Other 20 cases in group B were fixed with 3 parallel screws in traditional inverted triangle, including 12 males and 8 females, aged 35 to 55 years. The time from injury to operation was 1 to 3 days. The fracture nonunion, femoral head necrosis, femoral neck shortening, hollow screw withdrawal, hip function Harris score and visual analogue scale(VAS) of pain were compared between the two groups. RESULTS: All patients were followed up for 15 to 31 months. There was no significant difference in fracture nonunion, femoral neck shortening and femoral head necrosis between two groups(P>0.05). There was significant difference in screw withdrawal between two groups(P<0.05). There was no significant difference in hip Harris score and VAS between the two groups at 12 months after operation(P>0.05). CONCLUSION: The short-term and medium-term effects of F-shaped and traditional inverted triangle three parallel screws in the treatment of young and middle-aged Pauwels Ⅲ femoral neck fractures are similar, but the nail withdrawal rate of F-shaped hollow screw is low.

[Imageology study of correlation loss and its related factors after short-segment pedicle screw reduction and fixation for lumbar fractures].

OBJECTIVE: To analyze the correction loss after posterior segmental fixation for lumbar spine fractures and explore the related image factors. METHODS: Posterior short-segment fixation was received in 48 patients with L2-L4 fractures. There were 32 males and 16 females, with ages of 23 to 60 (45.98±8.20) yeaes. The anterior vertebrae height (AVH), vertebral wedge angle (VWA) of the injured vertebra and local kyphosis angle (LKA) were measured before operation, 1 week after operation and the final follow-up. The loss of segmental discal angle (LoSDA), LKA(LoLKA), AVH(LoAVH) were calculated between 1 week postoperative and the last follow up. Preoperative load-sharing scores(LSS), TLICS scores, and adjacent intervertebral disc injuries (IDIs) were assessed. Then the correlation between the age, follow up time, LSS, TLICS, IDIs and the correction loss was analyzed. RESULTS: The average follow-up was 12 to 18 (16.13±5.39) months. LKA, AVH and VWA at 1 week postoperative and those at the final follow up, were significantly improved compared with those preoperative (P<0.05). In the final follow up, the average LKA(5.70±3.17)° and AVH(4.31±5.95)% correction loss were observed compared with those 1 week postoperative(P<0.05). Otherwise the lose of VWA was not obvious(P>0.05). Univariate analysis showed that the SDA (r=0.706, 0.579, 0.449) and LKA(r=0.715, 0.566, 0.502) correction loss were aggravated with the increase of LSS, TLICS and IDIs, and AVH (r=-0.325, -0.219) correction loss was aggravated with the increase of LSS and TLICS(P<0.05). Multivariate analysis showed that increased LSS scores were all risk factors for segmental disc angle (SDA) loss, LKA correction loss, and AVH correction loss (P<0.05). CONCLUSION: The angle of adjacent intervertebral discs and anterior height of injured vertebrae were lost statistically after posterior short-segment pedicle screw treatment for lumbar fractures, and multivariate analysis showed that all of them were correlated with load-sharing score.

[Analysis of the clinical effects of different pedicle screw fixation methods for the treatment of thoracolumbar fractures].

OBJECTIVE: To discuss the clinical effects of the different pedicle screw fixation methods for the treatment of thoracolumbar fractures. METHODS: The clinical data of 55 patients with single thoracolumbar fractures treated between January 2013 and December 2016 were retrospectively analyzed. There were 32 males and 23 females, aged from 20 to 55 years with an average of 35.6 years old. All the fractures were located on a single segment, 8 cases of T11, 18 cases of T12, 19 cases of L1, 10 cases of L2. According to the classification of AO, 10 cases were type A1, 17 cases were type A2, 18 cases were type A3, 7 cases were type B2, 2 cases were type B3, 1 case was type C1. The patients were divided into three groups according to the different fixation methods, among them, 20 cases treated by traditional short-segment 4 pedicle screws fixation were control group, 22 cases treated by intermediate bilateral pedicle screws fixation (6 pedicle screws fixation) were bilateral group, 13 cases treated by intermediate unilateral pedicle screw fixation (5 pedicle screws fixation) were unilateral group. The three groups were compared by operation time, intraoperative blood loss, hospitalization cost, VAS and ODI scores, the correction of the fractured vertebrae height and kyphosis angle postoperatively and the losing rate of the fractured vertebrae height and kyphosis angle at the final follow-up and so on. RESULTS: All the patients were followed up from 12 to 20 months with an average of 15.2 months. No complications such as loosening of internal fixation and breakage were found after operation. There was no significant difference in operation time and intraoperative blood loss among three groups(P>0.05). In terms of hospitalization cost, the control group[(20 932.4±298.3)yuan] was significantly lower than the unilateral group[(22 428.2±321.5)yuan] and the bilateral group [(23 630.5±310.5)yuan] (P<0.05), and the unilateral group was lower than the bilateral group (P<0.05). There was no significant difference in VAS and ODI scores at preoperative, postoperative 1 week and final follow-up among the groups(P>0.05). And there was no significant difference in the correction of the injuried vertebrae height and kyphosis angle immediately after operation among three groups(P>0.05). However, for the losing rate of the injuried vertebrae height at the final follow-up, the unilateral group[(6.3±2.1)%] and bilateral group [(5.6±2.8)%] were significantly better than the control group[(9.2±1.8)%] (P<0.05), there was no significant difference between unilateral group and bilateral group; for the losing rate of kyphosis angle at the final follow-up, the unilateral group[(15.2±6.5)%] and bilateral group[(13.9±7.2)%] were significantly better than the control group[(23.6±7.5)%] (P<0.05), but there was no statistical difference between the unilateral and bilateral group(P>0.05). CONCLUSIONS: All the three different pedicle screw fixation methods are suitable for the treatment of thoracolumbar fractures and the short-term clinical effects are consistent. Compared with traditional short-segment 4 pedicle screws fixation, intermediate bilateral or unilateral pedicle screw fixation were more effective in maintaining the height of the injuried vertebrae and preventing the occurrence of kyphosis. The intermediate unilateral pedicle screw fixation was comparable to that of bilateral fixation at clinical outcomes, but the unilateral fixed hospitalization cost was lower, which was worthy of clinical promotion.

Single-dose local administration of parathyroid hormone (1-34, PTH) with ß-tricalcium phosphate/collagen (ß-TCP/COL) enhances bone defect healing in ovariectomized rats.

Parathyroid hormone (1-34, PTH) combined ß-tricalcium phosphate (ß-TCP) achieves stable bone regeneration without cell transplantation in previous studies. Recently, with the development of tissue engineering slow release technology, PTH used locally to promote bone defect healing become possible. This study by virtue of collagen with a combination of drugs and has a slow release properties, and investigated bone regeneration by ß-TCP/collagen (ß-TCP/COL) with the single local administration of PTH. After the creation of a rodent critical-sized femoral metaphyseal bone defect, ß-TCP/COL was prepared by mixing sieved granules of ß-TCP and atelocollagen for medical use, then ß-TCP/COL with dripped PTH solution (1.0 µg) was implanted into the defect of OVX rats until death at 4 and 8 weeks. The defected area in distal femurs of rats was harvested for evaluation by histology, micro-CT, and biomechanics. The results of our study show that single-dose local administration of PTH combined local usage of ß-TCP/COL can increase the healing of defects in OVX rats. Furthermore, treatments with single-dose local administration of PTH and ß-TCP/COL showed a stronger effect on accelerating the local bone formation than ß-TCP/COL used alone. The results from our study demonstrate that combination of single-dose local administration of PTH and ß-TCP/COL had an additive effect on local bone formation in osteoporosis rats.

Prevention of ovariectomy-induced osteoporosis in rats : Comparative study of zoledronic acid, parathyroid hormone (1-34) and strontium ranelate.

Recently, the use of the pharmacological agents strontium ranelate (SR), parathyroid hormone (1-34, PTH) and zoledronic acid (ZA) has come to prominence for the treatment of osteoporosis due to their ability to prevent bone loss in osteoporotic patients. Although much emphasis has been placed on using pharmacological agents for the prevention of disease, much less attention has been placed on which one is more effective. There is still no direct comparative study on these three drugs. The aim of the present study was to investigate the effect of SR, PTH, ZA on preventing ovariectomy-induced osteoporosis in rats. After bilateral ovariectomy the rats randomly received vehicle, SR (500 mg/kg body weight/day, orally), PTH (20 µg/kg/day, subcutaneously) or a single injection of ZA (0.1 mg/kg, i.v.) until death at 12 weeks. The distal femurs were harvested for evaluation of bone metabolism. The rats treated with ZA demonstrated the highest levels of new bone formation as assessed by microcomputed tomography (CT), biomechanical strength, histological analysis and bone metabolism. Furthermore, PTH and SR showed a stronger effect on improving trabecular bone mass at 12 weeks. The results from the present study demonstrate that systemic administration of PTH, SR and ZA could prevent bone loss, while a single dose of ZA has a better effect on preventing ovariectomy-induced osteoporosis than either PTH or SR.

Inhibition of inflammatory cytokines after early decompression may mediate recovery of neurological function in rats with spinal cord injury.

A variety of inflammatory cytokines are involved in spinal cord injury and influence the recovery of neuronal function. In the present study, we established a rat model of acute spinal cord injury by cerclage. The cerclage suture was released 8 or 72 hours later, to simulate decompression surgery. Neurological function was evaluated behaviorally for 3 weeks after surgery, and tumor necrosis factor α immunoreactivity and apoptosis were quantified in the region of injury. Rats that underwent decompression surgery had significantly weaker immunoreactivity of tumor necrosis factor α and significantly fewer apoptotic cells, and showed faster improvement of locomotor function than animals in which decompression surgery was not performed. Decompression at 8 hours resulted in significantly faster recovery than that at 72 hours. These data indicate that early decompression may improve neurological function after spinal cord injury by inhibiting the expression of tumor necrosis factor α.

[Posterior short-segment fixation with undermining decompress for upper lumbar burst fractures].

OBJECTIVE: To observe clinical effects of posterior short-segment fixation with undermining decompress by posterior ligament complex for the treatment of upper lumbar burst fractures. METHODS: From October 2010 to March 2013,23 patients with upper lumbar burst fractures (Denis B type) were treated by posterior short-segment fixation with undermining decompress by posterior ligament complex. There were 18 males and 5 females aged from 26 to 64 years old with an average of 45.7 years old. Twelve patients were caused by falling down, 5 cases were caused by traffic accident, 4 cases were the bruise injury caused by heavy object and 2 cases were caused by other injury. Fourteen patients were L1 fracture and 9 patients were L2 fracture. Thirteen patients were combined with nerve injuries (degree D according to ASIA classification). Internal fixation were removed from 12 to 20 months with an average of 14.3 months. JOA scores and imaging changes were recorded and compared at different time points. RESULTS: All patients were followed up from 18 to 24 months with an average of 20.4 months. Thirteen patients with nerve injuries were completely recovered at 3 to 6 months after operation. JOA score at 1 year after operation was 20.63 ± 0.92, and 20.38 ± 1.06 at 3 months after removal of internal fixation,which were improved obviously than 9.90 ± 2.73 at 3 months after operation. (P > 0.05) Anterior height of injured vertebrae, vertebral body angle and local Cobb angle was (95.0 ± 0.53)%, (2.78 ± 1.36) and (2.43 ± 1.52) °respectively, and improved obviously than that of before operation (P < 0.05). There was no statistical significance in JOA scores at 3 months after removal of internal fixation and 1 year after operation (P > 0.05). CONCLUSION: posterior short-segment fixation with undermining decompress by posterior ligament complex for the treatment of upper lumbar burst fractures has advantages of minimally invasive, could effective recover vertebrae height, maintain stability of spine, decrease low back pain. It is a safe and effective operative method.

Anthelmintic activity of the crude extracts, fractions, and osthole from Radix angelicae pubescentis against Dactylogyrus intermedius in goldfish (Carassius auratus) in vivo.

A bioassay-guided fractionation was performed to evaluate the anthelmintic activity of the crude extract fractions and osthole from Radix angelicae pubescentis against Dactylogyrus intermedius in goldfish (Carassius auratus) in vivo. Among four extracts (petroleum ether, ethyl acetate, acetone, and ethanol), only ethanol extract exhibited the best anthelmintic efficacy with 100% mortality of Dactylogyrus and no death of fish at the optimal anthelminthic concentration of 120 mg/L. Therefore, ethanol extract was subjected to column chromatography to obtain sixteen fractions. The activity was found in fraction F with 100% mortality of Dactylogyrus and no toxicity to fish at dose of 2.0 mg/L. A white crystal was isolated from fraction F and identified as osthole which exhibited the optimal activity with 100% mortality of Dactylogyrus at 1.6 mg/L had and no toxicity to fish at dose up to 6.2 mg/L. This is the first report on the isolation and identification of anthelmintic active compound from R. angelicae pubescentis against D. intermedius in goldfish (C. auratus) in vivo.