Epidemiological trends and mid-term to long-term outcomes of acetabular fractures in the elderly in China.

PURPOSE: To explore the epidemiological trends in acetabular fracture and report the mid-term to long-term clinical outcomes of the elderly treated with operation. METHODS: Retrospective study. Patients aged ≥ 14 years with operative treatment of the Acetabular fracture from Jan 2010 to Dec 2019 at a level-1 trauma centre were identified to analyze the epidemiological trends, and the difference in fracture patterns between young and elderly patients (≥ 60 years old) were compared. The elderly patients were followed up to evaluate their clinical outcomes and satisfaction degree (worst to best: 0 to10). The patients were divided into the 2010-2014 group and the 2015-2019 group according to the year of admission, and the clinical outcomes of the two groups were compared to verify the stability from mid-term to long-term after surgery for acetabular fracture. RESULTS: A total of 1024 patients (mean age 43.35 years, range 14-86 years) with acetabular fractures received operative treatment in this decade. The mean age of the acetabular fracture patients increased from 41.1 years to 47.7 years, and the proportion of elderly patients increased from 5.7% to 24.0%, with some volatility. The ratio of male to female decreased year by year, and the proportion of female patients increased with age. And the anterior fracture patterns were more common in the elderly patients compared to the young patients (P < 0.001). 118 elderly patients (82 males, 36 females; mean age 66.91 years, range 60-86 years) were followed-up (mean 77.4 months, range 35-152 months). The overall mortality rate of the elderly patients was 7.69% (9/118). The Harris hip score of those alive patients was 90.41 ± 12.91 points (excellent and good rate 84.4%). 87 patients completed the SF-12 with a normal HRQoL (PCS 50.49 ± 8.88 points; MCS 55.66 ± 8.86 points). 90.8% of the patients achieved a satisfaction score of 9 or higher. And there was no significant difference in clinical outcomes between the 2010-2014 group and the 2015-2019 group (P > 0.05). CONCLUSIONS: In conclusion, acetabular fractures presented an obvious ageing trend in China, and the fracture patterns of the elderly patients differed from those in the young patients. Operative treatment for elderly acetabular fractures yielded satisfactory and persistent clinical outcomes from mid-term to long-term clinical.

Customized 3D printed acetabular augment for repair of large acetabular bone defects in delayed total hip arthroplasty after failed treatment of acetabular fractures / 中华创伤骨科杂志

Objective:To investigate the early clinical effectiveness of using customized 3D printed acetabular augment to repair large acetabular bone defects in delayed total hip arthroplasty after failed treatment of acetabular fractures.Methods:A retrospective study was conducted to analyze the 6 patients who had undergone 3D printed acetabular augment to reconstruct acetabular bone defects in delayed total hip replacement from July 2021 to January 2023 after failed treatment of acetabular fractures. They were all males, with an age of (51.3±15.0) years. Paprosky classification: 2 cases of type ⅡB, 1 case of type ⅡC, and 3 cases of type ⅢA. Recorded were surgical time, intraoperative bleeding, hospitalization time, and visual analogue scale (VAS), and modified Merle d'Aubigné & Postel score, Harris hip score, and leg length discrepancy at the last follow-up.Results:For the 6 patients, the mean surgical time was (222.5±46.9) min, the mean intraoperative bleeding 1,100 (1,000, 2,625) mL, the mean hospitalization time (9.0±4.5) d, and the mean follow-up time (11.8±7.9) months. At the last follow-up, the VAS [(2.5±1.0) points] significantly decreased compared with the preoperative value [(6.2±0.8) points], the modified Merle d'Aubigné & Postel score [(13.2±2.1) points] and Harris hip score [(67.8±15.3) points] significantly increased compared with the preoperative values [(6.7±0.8) and (34.2±8.4) points], the vertical position of center of rotation [(22.5±5.2) mm] and the horizontal position of center of rotation [(40.7±2.6) mm] were significantly reduced compared with the preoperative values [(38.1±14.2) and (53.1±10.0) mm] ( P<0.05). At the last follow-up, the leg length discrepancy was (6.2±3.6) mm, showing no statistically significant difference from the preoperative value [(18.7±1.7) mm] ( P>0.05). At the last follow-up, no clear line at the cup-bone or augment-bone interface, or no possible prosthetic loosening or displacement was observed on the X-ray films. Conclusion:In delayed total hip arthroplasty after failed treatment of acetabular fractures, the customized 3D printed augment for repair of large bone defects in the acetabulum can reconstruct the normal rotation center of the hip joint, provide reliable stability for the cup prosthesis, and enable patients to obtain significant improvements in hip function.

Fixation with a 3D printed individualized custom-made plate for elderly patients with periprosthetic femoral fracture: an analysis of short-term efficacy / 中华创伤骨科杂志

Objective:To explore the short-term efficacy of fixation with a 3D printed individualized custom-made plate in the treatment of elderly patients with periprosthetic femoral fracture.Methods:Retrospectively analyzed were the 5 elderly patients with periprosthetic femoral fracture who had been treated by fixation with a 3D printed individualized custom-made plate from January 2022 to July 2022 at Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital. There were 3 males and 2 females, aged 81, 86, 77, 91 and 87 years, respectively. One left and 4 right limbs were affected. Vancouver classification: type B1 ( n=3), type B2 ( n=1), and type C ( n=1). The time from operation to injury was 5, 6, 10, 5 and 7 days, respectively. Preoperatively, the femur affected, prosthesis and individualized plate with a greater trochanteric hook, loop cable channel and bone-like trabecular microporous structure were custom-made by 3D printing according to 1:1 models. Virtual operations were simulated to formulate surgical protocols. The operation time, length of surgical incision, intraoperative blood loss and transfusion, hospital stay, hip function and complications at the last follow-up were recorded. Results:The 5 patients were followed up for 12, 7, 10, 3 and 6 months, respectively. There were no events of superficial incision or deep prosthesis infection. Respectively, the operation time was 1.8, 1.7, 2.3, 2.0 and 3.3 h; the length of surgical incision 31, 30, 38, 27 and 30 cm; the intraoperative bleeding volume 400, 300, 300, 500 and 600 mL; the length of hospital stay 8, 9, 15, 14 and 11 d. Four patients received intraoperative blood transfusion of 300, 900, 150 and 1, 050 mL, respectively. One patient died of a heart attack 3 months after discharge; another patient developed dyskinesia at the contralateral limb 3 months after discharge due to cerebral infarction and died of recurrent cerebral infarction 7 months after discharge. At the last follow-up, the Harris hip scores of 3 patients were 86, 77 and 69 points, respectively. None of the patients had complications like breakage or loosening of implants.Conclusion:In the treatment of elderly patients with periprosthetic femoral fracture, fixation with a 3D printed individualized custom-made plate may lead to fine limb function and good short-term curative efficacy.

Long-term imiquimod stimulation induces psoriasiform dermatitis and bone loss in mice / 中华皮肤科杂志

Objective@#To establish a mouse model of psoriasis complicated by bone loss by long-term topical application of imiquimod.@*Methods@#Twelve 10-week-old Kunming mice were randomly and equally divided into 2 groups: experimental group topically treated with 50 mg/d imiquimod cream every day on the shaved back, and control group topically treated with equivalent vaseline ointment every day on the shaved back. Skin manifestations were observed on the mouse back every day. The mice were sacrificed 10 weeks later. Before the sacrifice, the degree of erythema, scaling and skin thickening was evaluated, psoriasis area severity index (PASI) was calculated, mouse weight was measured, and eyeball blood was obtained. After the sacrifice, skin lesions on the back were resected and subjected to hematoxylin-eosin staining, so as to evaluate histological changes. Then, the left tibia was obtained from the mice, immunohistochemical staining was performed to observe the expression and distribution of osteoprotegerin (OPG) and receptor activator of nuclear factor kappa-β ligand (RANKL) in bone tissues, and micro-computerized tomography was conducted to determine the bone mass of spongy bone, and the bone volume-to-total volume ratio, number, thickness, spacing and connectivity density of the trabecular bone in the proximal tibia. The left femur was also obtained from the mice, and subjected to three-point bending test for evaluating its biomechanical properties. Enzyme-linked immunosorbent assay (ELISA) was performed to detect serum levels of tumor necrosis factor (TNF) -α and interleukin (IL) -17. RNA was extracted from the right tibia, and real-time PCR was conducted to determine the mRNA expression of OPG and RANKL. Two-independent-sample t test was used to compare the above indices between two groups.@*Results@#Ten-week topical stimulation with imiquimod could lead to psoriasiform dermatitis on the mouse back, presenting as erythema, scales and skin thickening. The PASI score was significantly higher in the experimental group (9.167 ± 1.722) than in the control group (0, t = 13.31, P < 0.001) . Hematoxylin-eosin staining showed thickened spinous layer, extended rete ridges, infiltration of inflammatory cells in the superficial dermis, spongiosis, vasodilatation and increased hair follicles in the experimental group. Immunohistochemical staining revealed that the expression of OPG and RANKL was significantly higher in the experimental group (16 021.33 ± 1 954.61, 35 433.33 ± 1 197.95 respectively) than in the control group (3 307.00 ± 1 158.72, 13 644.67 ± 4 764.61, respectively; t = 9.692, 7.682 respectively, both P < 0.01) . Micro-computerized tomography showed that the bone volume-to-total volume ratio and thickness of trabecular bone in the proximal tibia were significantly lower in the experimental group than in the control group, but the spacing of trabecular bone was significantly higher in the experimental group than in the control group (P < 0.01 or < 0.05) . There were no significant differences in the elastic modulus and fracture energy of the femur between the experimental group and control group (both P > 0.05) . Moreover, no significant differences in the serum levels of TNF-α and IL-17 were observed between the two groups (both P > 0.05) . Real-time PCR revealed that the mRNA expression of OPG and RNAKL was significantly higher in the experimental group than in the control group (P < 0.05, < 0.01 respectively) .@*Conclusions@#Long-term topical application of imiquimod can not only induce psoriasiform dermatitis in mice, but also lead to bone loss of spongy bone and micro-architectural deterioration in the proximal tibia. Thus, mouse models of psoriasis complicated by bone loss can be established by long-term imiquimod stimulation.

Long-term imiquimod stimulation induces psoriasiform dermatitis and bone loss in mice / 中华皮肤科杂志

Objective To establish a mouse model of psoriasis complicated by bone loss by long-term topical application of imiquimod. Methods Twelve 10-week-old Kunming mice were randomly and equally divided into 2 groups:experimental group topically treated with 50 mg/d imiquimod cream every day on the shaved back, and control group topically treated with equivalent vaseline ointment every day on the shaved back. Skin manifestations were observed on the mouse back every day. The mice were sacrificed 10 weeks later. Before the sacrifice, the degree of erythema, scaling and skin thickening was evaluated, psoriasis area severity index(PASI)was calculated, mouse weight was measured, and eyeball blood was obtained. After the sacrifice, skin lesions on the back were resected and subjected to hematoxylin-eosin staining, so as to evaluate histological changes. Then, the left tibia was obtained from the mice, immunohistochemical staining was performed to observe the expression and distribution of osteoprotegerin(OPG)and receptor activator of nuclear factor kappa-β ligand(RANKL)in bone tissues, and micro-computerized tomography was conducted to determine the bone mass of spongy bone, and the bone volume-to-total volume ratio, number, thickness, spacing and connectivity density of the trabecular bone in the proximal tibia. The left femur was also obtained from the mice, and subjected to three-point bending test for evaluating its biomechanical properties. Enzyme-linked immunosorbent assay(ELISA)was performed to detect serum levels of tumor necrosis factor(TNF)-αand interleukin(IL)-17. RNA was extracted from the right tibia, and real-time PCR was conducted to determine the mRNA expression of OPG and RANKL. Two-independent-sample t test was used to compare the above indices between two groups. Results Ten-week topical stimulation with imiquimod could lead to psoriasiform dermatitis on the mouse back, presenting as erythema, scales and skin thickening. The PASI score was significantly higher in the experimental group(9.167 ± 1.722)than in the control group(0, t=13.31, P<0.001). Hematoxylin-eosin staining showed thickened spinous layer, extended rete ridges, infiltration of inflammatory cells in the superficial dermis, spongiosis, vasodilatation and increased hair follicles in the experimental group. Immunohistochemical staining revealed that the expression of OPG and RANKL was significantly higher in the experimental group(16021.33 ± 1954.61, 35433.33 ± 1197.95 respectively)than in the control group(3307.00 ± 1158.72, 13644.67 ± 4764.61, respectively;t=9.692, 7.682 respectively, both P < 0.01). Micro-computerized tomography showed that the bone volume-to-total volume ratio and thickness of trabecular bone in the proximal tibia were significantly lower in the experimental group than in the control group, but the spacing of trabecular bone was significantly higher in the experimental group than in the control group(P<0.01 or<0.05). There were no significant differences in the elastic modulus and fracture energy of the femur between the experimental group and control group(both P>0.05). Moreover, no significant differences in the serum levels of TNF-αand IL-17 were observed between the two groups(both P>0.05). Real-time PCR revealed that the mRNA expression of OPG and RNAKL was significantly higher in the experimental group than in the control group(P<0.05,<0.01 respectively). Conclusions Long-term topical application of imiquimod can not only induce psoriasiform dermatitis in mice, but also lead to bone loss of spongy bone and micro-architectural deterioration in the proximal tibia. Thus, mouse models of psoriasis complicated by bone loss can be established by long-term imiquimod stimulation.

Silicosis decreases bone mineral density in rats.

Silicosis is the most common occupational lung disease in China, and is associated with a variety of complications, many of which are poorly understood. For example, recent data indicate that silicosis associates with the development of osteopenia, and in some cases this bone loss is severe, meeting criteria for osteoporosis. Although many factors are likely to contribute to this relationship, including a sedentary lifestyle in patients with advanced silicotic lung disease, we hypothesized that silica might directly reduce bone mineral density. In the present study, six Wistar rats were exposed to silica for 24 weeks in order to induce pulmonary silicosis and examine the relationship to bone mineral density. As expected, all rats exposed to silica developed severe pulmonary fibrosis, as manifested by the formation of innumerable silicotic nodules and the deposition of large amounts of interstitial collagen. Moreover, micro-CT results showed that bone mineral density (BMD) was also significantly reduced in rats exposed to silica when compared control animals and this associated with a modest reduction in serum calcium and 25-hydroxyvitamin D levels. In addition, we found that decreased BMD was also linked to increased osteoclast activity as well as fibrosis-like changes, and to the deposition of silica within bone marrow. In summary, our findings support the hypothesis that silicosis reduces bone mineral density and provide support for ongoing investigations into the mechanisms causing osteopenia in silicosis patients.

Morphology of the intervertebral disc in high fat combined with streptozotocin-induced type Ⅱ diabetic rats / 中国组织工程研究

BACKGROUND:Rat models of diabetes mellitus type 2 (T2DM) are usually induced by the combination of high-fat diet and low-dose streptozotocin, but their effects on the intervertebral disc have not yet been reported. Endplate sclerosis is an important factor contributing to intervertebral disc degeneration. OBJECTIVE:To evaluate whether the rat T2DM model induced by high-fat diet combined with low-dose streptozotocin is suitable for the study of T2DM related intervertebral disc degeneration. METHODS:Thirty-two 3-month-old female Sprague-Dawley rats were divided into four groups (n=8 per group), including sham, bilateral variectomy, DM, and bilateral variectomy plus DM groups, followed by subjected to bilateral ovariectomy and/or high-fat diet combined with low-dose streptozotocin, respectively. The blood glucose level, body mass and glucose tolerance were determined. The bone mineral density of the lumbar spine was measured after 8-week streptozotocin treatment. The L5-6 segments were removed and cut through midst sagittal plane after decalcification, and then underwent Von Gieson staining and histological degeneration scoring, and the disc height and endplate thickness were measured. RESULTS AND CONCLUSION:Fasting blood glucose and random blood glucose levels in the DM and bilateral variectomy plus DM groups were significantly higher than those in the other two groups, and the insulin sensitivity in the DM and bilateral variectomy plus DM groups were significantly lower than that in the other groups (P<0.05). L4-6 vertebral bone mineral density in the bilateral variectomy group was significantly lower than that in the sham group (P<0.05);L5-6 vertebral bone mineral density in the DM and bilateral variectomy plus DM groups was significantly lower than that in the sham group (P<0.05). L5-6 vertebral histological scores in the DM and bilateral variectomy plus DM groups were significantly higher than those in the other groups (P<0.05). Similar with the bilateral variectomy group, there were chondrometaplasia and mucoid degeneration of nucleus pulposus cells in the bilateral variectomy plus DM group, and the histological scores were significantly higher than those in the sham and DM groups (P<0.05). Compared with the sham group, the intervertebral disc height in the bilateral variectomy and bilateral variectomy plus DM groups was significantly decreased (P<0.05). While, there was no significant difference in the endplate thickness among groups. These results indicate the combination of high-fat diet and low-dose streptozotocin-induced rat T2DM models possess diabetic characteristics, but the rat intervertebral disc tissues show no significant differences from the normal ones;therefore, this model may be unsuitable for the study on T2DM-related intervertebral disc degeneration.