[Application of 3D printing percutaneous guide plate in closed reduction and cannulated screw internal fixation of femoral neck fracture].

OBJECTIVE: To investigate the application of 3D printing percutaneous surgical guide plate in closed reduction and cannulated screw internal fixation of femoral neck fracture. METHODS: The clinical data of 12 patients with femoral neck fracture from March 2019 to March 2022 were retrospectively analyzed. Patients were divided into observation group and control group according to different operation plans, with 6 cases in each group. The observation group received percutaneous operation guide plate assisted closed reduction and hollow screw internal fixation, while the control group received closed reduction and hollow compression screw internal fixation. The operation time, intraoperative blood loss, fluoroscopy times, and Kirschner needle puncture times were compared between two groups. The location of screws were recordedon postoperative X-ray films, follow-up time, time of complete fracture healing, Harris score of hip joint and the incidence of complications were recorded on postoperative X-ray films. RESULTS: The operation time of observation group (32.17±6.18) min was shorter than that of control group (53.83±7.31) min (P<0.05). The amount of intraoperative bleeding in the observation group (18.33±2.94) ml was less than that in the control group (38.17±5.56) ml(P<0.05). The times of fluoroscopy in the observation group (7.50±1.05) were less than those in the control group (21.00±4.82) (P<0.05). The number of Kirschner needle punctures (8.00±0.63) in observation group was less than that in control group (32.67±3.08) (P<0.05). The follow-up time was(12.88±0.74) months in observation group and (12.83±0.72) months in control group, there was no significant difference between two groups (P>0.05). One year after operation, Harris score of hip joint in the observation group was(82.00±4.52) points, while that in the control group was(81.00±3.41) points, there was no significant difference between two groups(P>0.05). The time of complete fracture healing in the observation group was (7.50±1.05) months, while that in the control group was (7.67±1.21) months, there was no significant difference between two groups(P>0.05). The parallelism of the screws in the observation group was (0.50±0.11) ° and (0.76±0.15) °, which were lower than that in the control group (1.57±0.31) ° and (1.87±0.21) ° (P<0.05). The screw distribution area ratio (0.13±0.02) cm2 in the observation group was higher than that in the control group (0.08±0.01) cm2 (P<0.05). No complications such as necrosis of femoral head, nonunion of fracture, shortening of femoral neck and withdrawal of internal fixation occurred in both groups. CONCLUSION: The application of 3D printing percutaneous surgical guide plate improves the accuracy and safety of closed reduction and cannulated screw internal fixation for femoral neck fracture. It has the advantages of minimally invasive, reducing radiation exposure, fast and accurate, shortening the operation time and reducing intraoperative bleeding.

Comparison of Accuracy and Clinical Outcomes of Robot-Assisted Versus Fluoroscopy-Guided Pedicle Screw Placement in Posterior Cervical Surgery.

STUDY DESIGN: This was a prospective controlled study. OBJECTIVE: To compare the accuracy and clinical outcomes of robot-assisted (RA) and fluoroscopy-guided (FG) pedicle screw placement in posterior cervical surgery. METHODS: This study included 58 patients. The primary outcome measures were the 1-time success rate and the accuracy of pedicle screw placement according to the Gertzbein-Robbins scales. The secondary outcome measures, including the operative time, intraoperative blood loss, hospital stay, cumulative radiation time, radiation dose, intraoperative advent events, and postoperative complications, were recorded and analyzed. The Japanese Orthopedics Association (JOA) scores and Neck Disability Index (NDI) were used to assess the neurological function of patients before and at 3 and 6 months after surgery. RESULTS: The rate of grade A was significantly higher in the RA group than in the FG group (90.6% and 71.1%; P < .001). The clinically acceptable accuracy was 97.2% in the RA group and 90.7% in the FG group (P = .009). Moreover, the 1-time success rate was significantly higher in the RA group than in the FG group. The RA group had less radiation time (P < .001) and less radiation dose (P = .002) but longer operative time (P = .001). There were no significant differences in terms of intraoperative blood loss, hospital stay, intraoperative adverse events, postoperative complications, JOA scores, and NDI scores at each follow-up time point between the 2 groups. CONCLUSIONS: The RA technique achieved higher accuracy and 1-time success rate of pedicle screw placement in posterior cervical surgery while achieving comparable clinical outcomes.

Different Surgical Strategy for Patients with Cervical Angina: A Potential Role of Luschka's Joint Osteophyte.

OBJECTIVE: Cervical angina is an underrecognized type of noncardiac chest pain and its mechanism of pain remains obscure. The objective of the current study was to investigate the clinical outcomes of different surgical strategies for patients with cervical angina and to analyze the potential pathogenesis of Luschka's joint osteophyte. METHODS: From February 2013 to March 2018, a prospective study on cervical angina was performed in our hospital. All patients who were diagnosed with both noncardiac chest pain and cervical pathology were identified. During admission, they consulted with a cardiologist and underwent strict cardiac workups to exclude true angina pectoris. The included 41 patients were randomly divided into two groups according to different surgical strategies of whether or not to remove Luschka's joint osteophyte during anterior cervical decompression surgery: the osteophyte resection (OR group) and the nonresection (NR group). RESULTS: The OR group consisted of 21 patients (8 men and 13 women) with a mean age of 54.7 years (range, 41-65 years). The NR group was composed of 20 patients (9 men and 11 women) with an average age of 56.3 years (range, 43-68 years). Before surgery, the mean duration of symptoms was 6.1 months (range, 4-20 months). The Luschka's joint osteophytes were located at C6 -C7 (19 cases, 46.3%), C5 -C6 (17 cases, 41.5%), and C4 -C5 (4 cases, 12.2%). Their average area was 34.85 mm2 and the average length were 5.09 mm. No statistically significant differences in demographic characteristics were detected between the two groups (P > 0.05). After operation, there were significant improvements in the Japanese Orthopedic Association score and the Neck Disability Index score in both groups (P < 0.05). However, the visual analogue scale score for chest pain in the OR group was statistically lower than that in the NR group (1.4 ± 1.0 vs 2.1 ± 1.6, P < 0.05). In the OR group, the results of cervical spine surgery were excellent in 18 patients (85.7%), and fair in 3 patients (14.3%). In the NR group, there were 10 patients (50.0%) with excellent results, 9 patients with fair results (45.0%), and 1 patient with poor results (5.0%). Notably, there were statistically significant differences between the two groups (χ2 = 6.265, P = 0.044). The average follow-up was 31 months (24-52 months). CONCLUSION: Anterior cervical decompression surgery with resection of Luschka's joint osteophyte can effectively reduce cervical angina symptom and improve the patient's quality of life. In addition to nerve root compression, Luschka's joint osteophyte may be another pathogenic factor in cervical angina.

Paclitaxel Induce Apoptosis of Giant Cells Tumor of Bone via TP53INP1 Signaling.

OBJECTIVE: To evaluate the antitumor capability and to investigate the underlying molecular mechanism of paclitaxel. METHODS: First, cck-8 and apoptosis assays were used to determine survival and apoptotic effects of HS 737.T cells under treatment of paclitaxel. Next, RNA-seq and bioinformatics were used to determine the differentially expressed genes and to analyze the pathway involved. Quantitative real-time polymerase chain reaction was used to verify the accuracy of some differentially expressed genes (DEG). ClueGO was used to decode and visualize functionally grouped GO terms of differentially expressed genes, and to map the DEG protein-protein interactions (PPI) network. Western blotting was used to check the expression of target genes, the cleavage of Caspase-3 and PARP1, and the phosphorylation level of p53. Finally, transcriptomics, bioinformatics, and RNAi were used to estimate the antitumor capability and to identify the underlying mechanisms of paclitaxel in GCTB. RESULTS: Our data revealed that paclitaxel had significant time-dependent effects on the viability and induced apoptosis of HS 737.T cells. RNA-seq and bioinformatics analysis showed that apoptosis, death receptor signaling pathway, TNF signaling pathway, and TP53 regulated transcription of cell death genes pathway were closely associated with paclitaxel in the treatment of GCTB. Western bolt results revealed that paclitaxel induced cleavage of Caspase-3 and PARP1, and increased the phosphorylation level of p53 in HS 737.T cells. RNAi results showed that the expression level of TP53INP1 was significantly decreased in HS737.T cells (the decrease was more than 70%). In addition, we found that the inhibitory ratios of paclitaxel on HS737.T cells deficient in TP53INP1 were less than in HS737.T cells with empty vector (19.88 and 40.60%, respectively). Hence, our data revealed that TP53INP1 regulated paclitaxel-driven apoptosis in HS737.T cells. CONCLUSION: Paclitaxel can significantly repress cell proliferation and induce apoptosis of HS 737.T cells through activating Caspase-3, PARP1, p53, and TP53INP1. Paclitaxel may be an effective drug in the management of GCTB.

miR-149-5p inhibits cell growth by regulating TWEAK/Fn14/PI3K/AKT pathway and predicts favorable survival in human osteosarcoma.

MicroRNAs (miRNAs) as small non-coding RNAs act as either tumor suppressors or oncogenes in human cancers, of which miR-149-5p (miR-149) is involved in tumor growth and metastasis, but its role and molecular mechanisms underlying osteosarcoma growth are poorly understood. The correlation of miR-149 expression with clinicopathological characteristics and prognosis in patients with sarcoma was analyzed by The Cancer Genome Atlas (TCGA) RNA-sequencing data. Osteosarcoma cell growth affected by miR-149 was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and colony formation assays. As a result, we found that the expression level of miR-149 was markedly downregulated in human sarcoma samples and were negatively associated with tumor size, acting as an independent prognostic factor for overall survival of the sarcoma patients. Restoration of miR-149 expression suppressed osteosarcoma cell growth, while its knockdown reversed these effects. Furthermore, we identified TNFRSF12A (TNF receptor superfamily member 12A), also called fibroblast growth factor-inducible 14 (Fn14) as a direct target of miR-149, and TNFRSF12A and its ligand TNFSF12 (TNF superfamily member 12), also called tumor necrosis factor-related weak inducer of apoptosis (TWEAK), were both negatively correlated with miR-149 expression in sarcoma samples. Knockdown of TNFRSF12A suppressed cell growth, but its overexpression weakened the antiproliferative effects of miR-149 via the PI3K/AKT (AKT serine/threonine kinase) signaling pathway. Altogether, our findings show that miR-149 functions as a tumor suppressor in osteosarcoma via inhibition of the TWEAK-Fn14 axis and represents a potential therapeutic target in patients with osteosarcoma.

miR-146a promotes growth of osteosarcoma cells by targeting ZNRF3/GSK-3ß/ß-catenin signaling pathway.

MicroRNA-146a-5p (miR-146a) functions as a tumor suppressor or oncogene involved in multiple biological processes. But, the underlying molecular mechanisms by which miR-146a contributes to osteosarcoma (OS) remain unclear. The correlation of miR-146a expression with clinicopathologic characteristics and prognosis of OS patients was analyzed by Kaplan-Meier and Cox regression analysis. Cell growth in vitro and in vivo was assessed by MTT, cell colony formation and animal models. The target of miR-146a was identified by bioinformatics software and gene luciferase reporter. As a result, miR-146a expression was substantially elevated in OS tissues and was positively associated with the tumor size (P=0.001) and recurrence (P=0.027) of OS patients. Moreover, knockdown of miR-146a suppressed cell proliferation and colony formation in vitro and in vivo. In addition, zinc and ring finger 3 (ZNRF3) was identified as a direct target of miR-146a in OS cells, and was negatively correlated with miR-146a expression in OS tissues. Overexpression of ZNRF3 inhibited cell growth and rescued the tumor-promoting role of miR-146a via inhibition of GSK-3ß/ß-catenin signaling pathway. Taken together, miR-146a may function as an oncogene in OS cells by targeting ZNRF3/GSK-3ß/ß-catenin signaling pathway, and represent a promising biomarker for OS patients.

Effect of Asymmetric Tension on Biomechanics and Metabolism of Vertebral Epiphyseal Plate in a Rodent Model of Scoliosis.

OBJECTIVE: To investigate the effect of asymmetric tension on idiopathic scoliosis (IS) and to understand its pathogenic mechanism. METHODS: The rodent model of scoliosis was established using Sprague-Dawley rats with left rib-tethering from T6 to T12 , tail and shoulder amputation, and high-cage feeding. Vertebrae epiphyseal cartilage plates were harvested from the convex and concave sides. To analyze differences on the convex and concave sides, finite element analysis was carried out to determine the mechanical stress. Protein expression on epiphyseal cartilage was evaluated by western blot. Micro-CT was taken to evaluate the bone quality of vertebral on both sides. RESULTS: Scoliosis curves presented in X-ray radiographs of the rats. Finite element analysis was carried out on the axial and transverse tension of the spine. Stresses of the convex side were -170.14, -373.18, and -3832.32 MPa (X, Y, and Z axis, respectively), while the concave side showed stresses of 361.99, 605.55, and 3661.95 MPa. Collagen type II, collagen type X, Sox 9, RunX2, VEGF, and aggrecan were expressed significantly more on the convex side (P < 0.05). There was asymmetric expression of protein on the epiphyseal cartilage plate at molecular level. Compared with the convex side, the concave side had significantly lower value in the BV/TV and Tb.N, but higher value in the Tb.Sp (P < 0.05). There was asymmetry of bone quality in micro-architecture. CONCLUSIONS: In this study, asymmetric tension contributed to asymmetry in protein expression and bone quality on vertebral epiphyseal plates, ultimately resulting in asymmetry of anatomy. In addition, asymmetry of anatomy aggravated asymmetric tension. It is the first study to show that there is an asymmetrical vicious circle in IS.

Lever reduction using polyaxial screw and rod fixation system for the treatment of degenerative lumbar spondylolisthesis with spinal stenosis: technique and clinical outcome.

BACKGROUND: The management for degenerative lumbar spondylolisthesis with spinal stenosis remains controversial. Reduction of lumbar spondylolisthesis has been performed via numerous techniques. Most of them need extra reduction assembly. METHODS: In this retrospective analysis, 27 patients of degenerative lumbar spondylolisthesis with spinal stenosis underwent reduction using polyaxial screw and rod constructs and posterolateral fusion. The average age at the time of surgery was 53 ± 3.23 years. The outcome measures consisted of a radiographic assessment of deformity and fusion rate and a clinical assessment of perioperative improvement in low back pain and function. Preoperative and postoperative radiographic evaluation included the percent slip, slip angle, and the lumbar lordosis between L1 and the sacrum measured using the Cobb method. Before surgery and at the final follow-up, the Oswestry Disability Index (ODI) and the visual pain analog scale (VPAS) between 0 (no pain) and 10 (maximal pain) were quantified. RESULTS: The average follow-up period more than 5 years was available. The mean operative time was 90.19 ± 14.51 min, and the mean blood loss during surgery was 152.59 ± 45.71 ml. The mean length of incision was 4.83 ± 0.63 cm. The average percent slippage and the mean slip angle were, respectively, 19.8 ± 4.49% and 9.69 ± 3.79° before surgery, 5.09 ± 3.40% and 6.39 ± 3.16° after surgery, and 5.67 ± 3.92% and 7.21 ± 3.05° at the last follow-up. The average lumbar lordosis was 36.88 ± 2.64° before surgery, 41.96 ± 1.64° after surgery, and 40.27 ± 1.19° at the final follow-up. No neurologic deficit occurred. Solid fusion was achieved for all cases. Compared with the outcome preoperation, the data improved from 6.56 ± 1.40 to 2.48 ± 1.16 for VPAS pain scores and from 32.22 ± 3.57 to 10.93 ± 4.93 for the ODI at the final follow-up. CONCLUSIONS: Lever slip reduction maneuver techniques using polyaxial screw and rod fixation system was simple and practicable. The treatment outcomes showed satisfactory radiographic characteristics and clinical results. The length of the incision was relatively small with a low intraoperative blood loss and short operation time.

Kinetic magnetic resonance imaging analysis of spinal degeneration: a systematic review.

OBJECTIVE: To evaluate the clinical use of kinetic magnetic resonance imaging (kMRI) in spinal degenerative diseases. METHODS: A systematic search of PubMed, EMBASE and ISI databases for articles that had been published between January 1978 and February 2013 concerning patients who had undergone kMRI for spinal problems was performed. All selected patients had undergone kMRI in neutral, flexion, and extension weight-bearing positions. Evaluation of cervical and lumbar degeneration by kMRI was analyzed. kMRI showed significant reduction of mobility in cervical segments of patients with severe disc degeneration; in addition, it was more severely reduced in patients with severe cord compression than in those without it. In the cervical spine, it was found that although disc height, translational motion, and angular variation were significantly affected at the level of disc herniation, no significant changes were apparent in adjacent segments. kMRI also showed that lumbar degeneration is closely associated with disc degeneration, facet joint osteoarthritis and the pathological characteristics of the interspinous ligaments, ligamentum flavum and paraspinal muscles. RESULTS: Eleven articles (4162 patients) fulfilled the inclusion criteria and were reviewed. It was found that kMRI is more specific and sensitive than conventional MRI regarding relating patients' symptoms to objective findings on imaging that demonstrate pathology and biomechanics. In the kinetic position, kMRI improves detection of disc herniation by 5.78%-19.46% and thus provides a new means of studying the biomechanical mechanism(s) in degenerative spines. CONCLUSION: Kinetic MRI is effective for diagnosing, evaluating, and managing degenerative disease within the spine; however, it still has some limitations.

Comparative study of scientific publications in orthopedics journals originating from USA, Japan and China (2000-2012).

PURPOSE: To compare orthopedics publications from USA, Japan and China. METHODS: Scientific papers belong to ''Orthopedics'' category of Science Citation Index Expanded subject categories were retrieved from the "PubMed'' and ''Web of Knowledge'' online databases. RESULTS: In the field of orthopedics, the annual number increased significantly from 2000 to 2012 in the three countries (p<0.001). The share of articles increased significantly in China, but decreased significantly in Japan and USA (p<0.05). In 2012, USA contributed 35.3% of the total world output in orthopedics field and ranked 1st; Japan contributed 5.9% and ranked 4th; China contributed 5.2% and ranked 5th. Publications from USA had the highest accumulated IFs and the highest total citations of articles (USA > Japan > China, p<0.001). Average IF from USA was much higher than Japan and China (p<0.001). USA published the most articles in the top ten orthopedics journals (USA (14355) > Japan (1702) > China (487), p<0.01). CONCLUSION: Although China has undergone significant increase in annual number and percentage of scientific publication in orthopedics journals, it still lags far behind USA and Japan in the field of orthopedics in terms of quantity and quality.

Comparative study of scientific publications in orthopedics journals originating from USA, Japan and China (2000-2012)

PURPOSE: To compare orthopedics publications from USA, Japan and China. METHODS: Scientific papers belong to ''Orthopedics'' category of Science Citation Index Expanded subject categories were retrieved from the "PubMed'' and ''Web of Knowledge'' online databases. RESULTS: In the field of orthopedics, the annual number increased significantly from 2000 to 2012 in the three countries (p<0.001). The share of articles increased significantly in China, but decreased significantly in Japan and USA (p<0.05). In 2012, USA contributed 35.3% of the total world output in orthopedics field and ranked 1st; Japan contributed 5.9% and ranked 4th; China contributed 5.2% and ranked 5th. Publications from USA had the highest accumulated IFs and the highest total citations of articles (USA > Japan > China, p<0.001). Average IF from USA was much higher than Japan and China (p<0.001). USA published the most articles in the top ten orthopedics journals (USA (14355) > Japan (1702) > China (487), p<0.01). CONCLUSION: Although China has undergone significant increase in annual number and percentage of scientific publication in orthopedics journals, it still lags far behind USA and Japan in the field of orthopedics in terms of quantity and quality.

Whole-spine magnetic resonance imaging study in healthy Chinese adolescents.

OBJECTIVE: To establish a preliminary magnetic resonance imaging (MRI) database of whole spine of healthy Chinese adolescents. METHODS: MRI examination of whole spine and hindbrain was performed in 41 enrolled students aged 11-17 years (mean age 13.95; 18 males, 23 females) using a 1.5-T MR Scanner. Measurements of the ratio of anteroposterior (AP) and transverse (TS) diameters of the cord, cerebellar tonsillar level related to the basion-opsithion (BO) line, location of conus medullaris, total cord length, total vertebral length, cord/vertebral length ratio, thoracic cord area, thoracic vertebral area, thoracic cord/vertebral area ratio were obtained. RESULTS: Mean values of cervical AP and TS were 6.63 mm and 12.21 mm, respectively. The mean level of cerebellar tonsillar related to BO line was 3.97 mm. Mean level of conus medullaris located in L1 lower 1/3. Total cord length was 399.34 mm, total vertebral length was 529.49 mm, Cord/vertebral length ratio was 0.75 and thoracic cord/vertebral area ratio was 0.17 on average. Vertebral length was correlated with age (r = 0.352, P = 0.024) whereas cord length and their ratio were not (P > 0.05). Compared with female, male had significantly larger cervical AP and TS, longer cervical cord (P < 0.01), higher position of conus medullaris (P < 0.05). CONCLUSION: MRI is a useful tool for assessment of the whole spine. The longitudinal and cross-sectional morphology of spinal cord in healthy Chinese adolescents may benefit further study of spine cord in adolescent idiopathic scoliosis as well as in other spine diseases.

Uncoupled neuro-osseous growth in adolescent idiopathic scoliosis? A preliminary study of 90 adolescents with whole-spine three-dimensional magnetic resonance imaging.

Previous literatures revealed abnormal cross-sectional morphology of spinal cord in AIS, suggesting the presence of disproportional growth between the neural and skeletal system. No accurate measurement of whole spine by MRI multiplanar reconstruction and their correlation with Cobb angle were studied. In this study, MRI three-dimensional reconstruction of the whole spine was performed in 90 adolescents (49 AIS with thoracic/thoracolumbar curve, and 41 age-matched healthy controls). Measurements of the ratio of anteroposterior (AP) and transverse (TS) diameter of the cord, the concave and convex lateral cord space (LCS) were obtained at the apical level in AIS patients. Cerebellar tonsillar level related to the basion-opsithion line, location of conus medullaris, cord length, vertebral column length, cord/vertebral column length ratio were obtained. All of the same parameters were also measured in healthy controls at matched vertebral levels and their correlations with Cobb angle were made. We notice that AP, TS, AP/TS and LCS ratio were increased in AIS subjects with low-lying position of cerebellar tonsillar level and elevating position of conus medullary when compared with healthy controls (P < 0.01). AP, AP/TS and LCS ratio were correlated significantly with Cobb angle (P < 0.05). Cord length and vertebral column length were not significantly different between AIS and control group. However, cord/vertebral column length ratio was significantly smaller in AIS group (P < 0.01). Cord length, vertebral column length and cord/vertebral column length ratio were not related with age or Cobb angle (P > 0.05). These data suggest the presence of uncoupled neuro-osseous growth along the longitudinal axis of spinal cord with associated morphologic changes of cross-sectional configuration and relative position of the cord. Some changes are significantly relevant with Cobb angle, which may indicate pathogenesis of AIS.

[Computer-assisted versus traditional Cobb angle measurement on digital radiograph in scoliosis].

OBJECTIVE: To assess Mimics as a new measurement method in Cobb angle in a comparison with traditional measurement and try to explore the advantages and disadvantages of the new method. METHODS: Twenty X-ray plates of scoliosis were chosen randomly. Two experienced physicians measured the Cobb angles via Mimics and traditional methods twice with an interval of 1 week. And statistical analyses of Cobb angle and difference between two measurements were carried out. RESULTS: The overall correlation was 0.986 for Mimics and traditional measurements. ANOVA demonstrated no significant difference between these two methods. A significant difference existed between the first and second values of Cobb angle in Mimics and traditional measurements. However the absolute difference was small. CONCLUSION: Mimics can be a new method for measuring the digital radiographs. And its precision is superior to that of the traditional measurement.