Treatment for severe idiopathic upper thoracic scoliosis in adolescence.

STUDY DESIGN: To review the study of severe upper thoracic scoliosis (>90 degrees) in adolescence treated with pedicle screw constructs. OBJECTIVE: The purpose of the present study was to analyze the treatment for upper thoracic scoliosis in adolescence. SUMMARY OF BACKGROUND DATA: Upper thoracic scoliosis is an uncommon spinal deformity in young children. Upper thoracic scoliosis is special. METHODS: There were 21 patients (11 boys and 10 girls) with severe upper thoracic scoliosis and their mean age was 15 years (range, 13-18 y). The mean Cobb angle was 102.2 degrees (90-118 degrees) The clavicle angle ranged from 18 to 23 degrees, with an average of 21 degrees. Patients with the major curve of scoliosis located in the upper thoracic spine were treated with a posterior spinal fusion with a pedicle screw-only construct. There was a minimum 2-year follow-up. Follow-up information was obtained clinically and radiologically. RESULTS: All patients underwent a posterior spinal fusion with a pedicle screw-only construct. Their shoulders were nearly balanced. The preoperative major curve was 102.2±8.9 degrees with a flexibility of 25.8%±8.1% in a side-bending film. The deformity was corrected to 29.7±5.9 and 32.1±5.6 degrees at the most recent follow-up. There was a 3.9-degree correction loss during the postoperative follow-up. There were no neurological or vascular complications at 2 years of follow-up. There was no crankshaft phenomenon. CONCLUSIONS: The pedicle screw constructs can be safely used for severe upper thoracic scoliosis. Curve correction is powerful for these curves, which are stiff and difficult to manage. Screw accuracy was excellent in this review.

Posterior malleolar fracture: technique and clinical experience of the posterolateral approach.

OBJECTIVE: To introduce the postero- lateral surgical approach to the posterior malleolar fracture and report its clinical outcomes in 32 cases. METHODS: This study consisted of 32 cases, 22 males and 10 females with the mean age of 48 years (range, 21-63 years), suffering from posterior malleolar fracture. All cases were treated with the posterolateral surgical approach to the ankle. The average follow-up period was 28 months (range, 24-35 months). The clinical outcomes of these cases were evaluated on the basis of the Olerud-Molander Ankle (OMA) score and plain radiographs. RESULTS: All cases showed radiological evidence of bony union at follow-up. The average OMA score was 82 points; 21 cases had excellent scores (90-100 points), 9 good (61-90 points), and 2 fair (31-60 points). The excellent-to-good rate was 93.8%. Although most cases did not show any wound dehiscence or necrosis, one patient had a superficial infection which healed after using antibiotic dressing and one had sural cutaneous nerve injury that underwent spontaneous remission without any treatment after three months. In addition, one presented with mild symptoms of peroneal tendonitis that disappeared after plate removal. CONCLUSION: The posterolateral approach offers an effective technique for fracture reduction and fixation of large posterior malleolar fragments.

The clinical application of a novel method of internal fixation for femoral neck fractures-dynamic locking compression system.

BACKGROUND: Femoral neck fractures are the commonly encountered injury in orthopedic practice and result in significant morbidity and mortality. Currently, how to treat femoral neck fractures safely and effectively is still a challenge. The objective of this study is to evaluate the efficiency of dynamic compression locking system for femoral neck fractures. METHODS: This is a retrospective study conducted from May 2015 to October 2016. The study included 36 patients suffering from femoral neck fractures who underwent closed reduction and were fixed using dynamic compression locking system. All surgeries were performed by the same surgeon. The study was conducted by telephone and on-site follow-up. The Garden classification and anatomical site classification were categorized for all patients. We assessed radiographic outcomes of union, femoral neck shortening, screw back-out, and femoral head avascular necrosis. We also evaluated functional outcome using the Harris hip score. Other outcomes included the length of surgery, duration of hospital stay, injury to surgery time, intraoperative hemorrhage, time to clinical bone union, and other fracture complications. RESULTS: All patients were followed up 12 to 29 months with an average of 21.58 ± 5.41 months. All cases were caused by falls including 17 males and 19 females with an average age of 65.33 ± 9.30 years old ranging from 53 to 82 years old. Among them, injury to surgery time ranged between 1 and 4 days with an average of 2.58 ± 1.05 days. Duration of hospital stay was 8 to 21 days with an average of 15.33 ± 3.71 days. Intraoperative hemorrhage was 40 to 80 ml with an average of 61.67 ± 12.31 ml. Operation time was from 35 to 80 min with average of 50.25 ± 11.77 min. According to Garden classification, 9 cases (25%) were type II and 27 cases (75%) were type III. According to the anatomical site classification, 8 cases (22.2%) were subcapital femoral neck fractures, 19 cases (52.8%) trans-cervical, and 9 cases (25%) basi-cervical. At present, the follow-up has not found the fracture complications of femoral head avascular necrosis, fracture nonunion, and re-fracture. All patients achieved solid bone union. The mean time of clinical bone union was 3 to 4 months. Among all patients, there were only 3 cases of femoral neck shortening < 5 mm and 1 case of screw back-out = 4 mm. For Harris scoring, average Harris scale at the end of the follow-up was 93.42 ± 3.95 ranging from 85 to 98. There were 32 cases of excellent function scores on the Harris scale and 4 cases of good function scores on the Harris scale. Therefore, the excellent and good rate of Harris hip scores was 100%. CONCLUSIONS: Femoral neck dynamic compression locking system for femoral neck fractures in elderly patients can provide effective stability and reduce complications and revision rates.

[Treatment of the ununited lower limb fracture with reamed intramedullary interlocking nail].

OBJECTIVE: To investigate the clinical effect of the treatment of the ununited lower limb fracture with reamed intramedullary interlocking nail. METHODS: Fifty-two patients with ununited lower limb fracture were treated with intramedullary interlocking nail (femur 36, tibia 16). The main cause of nonunion was interternal fixation loosening or fracture (41 cases, 78.8%), other reasons included bone defection, bone infection or too much traction of fracture (11 cases, 21.2%). According to X-ray classification: 41 cases in type hypertrophy, 11 cases in type atrophy. All these patients need operation to remove the primary implant, clean the hard bone, ischemia bone and scar, manual ream and fix by intramedullary interlocking nail, then bone graft were done around the fracture site. With the knee joint stiffness, relax it by manipulate or operation. RESULTS: Beside 3 superficial infection (2 delayed healing and 1 healing after debridement), other 49 wounds healed on time. All cases were followed up for an average of 25.2 months, ranging from 12 months to 39 months. All the ununion healed from 5 to 11 months, mean union time were 6.1 months. Deep tissue infection, fat embolism, implant loosening, nail broken or nonunion were not found in this series. According to judet standard on the movement of knee, the excellent-good rate was 82.7%. CONCLUSIONS: Intramedullary interlocking nail is effective to treat nonunion of lower limb fracture.

Comparison of Anterior Cervical Discectomy and Fusion versus Posterior Cervical Foraminotomy in the Treatment of Cervical Radiculopathy: A Systematic Review.

Controversy remains over whether anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF) is superior for the treatment of cervical radiculopathy. We therefore performed a systematic review including three prospective randomized controlled trails (RCT) and seven retrospective comparative studies (RCoS) by searching PubMed and EMBASE. These studies were assessed on risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions, and the quality of evidence and level of recommendation were evaluated according to the GRADE approach. Clinical outcomes, complications, reoperation rates, radiological parameters, and cost/cost-utility were evaluated. The mean complication rate was 7% in the ACDF group and 4% in the PCF group, and the mean reoperation rate was 4% in the ACDF group and 6% in the PCF group within 2 years of the initial surgery. There was a strong level of recommendation that no difference existed in clinical outcome, complication rate and reoperation rate between the ACDF and the PCF group. There was conflicting evidence that the ACDF group had better clinical outcomes than the PCF group (one study with weak level of recommendation). PCF could preserve the range of motion (ROM) of the operated segment but did not increase the ROM of the adjacent segment (weak level of recommendation). Meanwhile, the average cost or cost-utility of the PCF group was significantly lower than that of the ACDF group (weak level of recommendation). In conclusion, the PCF was just as safe and effective as the ACDF in the treatment of cervical radiculopathy. Meanwhile, PCF might have lower medical cost than ACDF and decrease the incidence of adjacent segment disease. Based on the available evidence, PCF appears to be another good surgical approach in the treatment of cervical radiculopathy.

Emodin mitigates the oxidative stress induced by cisplatin in osteosarcoma MG63 cells.

Previously, the application of cisplatin in chemotherapy was limited due to the significant side effects on normal cell growth. In the present study, the concomitant application of emodin with cisplatin was demonstrated to ameliorate cisplatin-induced oxidative stress and markedly suppress tumor cell proliferation for the first time. Human osteosarcoma MG-63 cells were treated with cisplatin alone or in combination with emodin. The cell viability was determined by MTS assays and the augmentation of reactive oxygen species were determined by fluorogenic probes; in addition, a stable MG-63 subline bearing antioxidant response element (ARE)-driven luciferase expression was developed to monitor the activation of the nuclear factor erythroid 2-related factor 2 (Nrf2)-ARE signaling pathway. The results indicated that cisplatin or emodin may inhibit MG-63 cell proliferation in a time- or dose-dependent manner, respectively. Concomitant treatment with cisplatin and emodin demonstrated synergic anti-tumor effects. Cisplatin augmented reactive oxygen species in the MG-63 cells, followed by the translocation of Nrf2 from the cytoplasm into the nucleus, which triggered ARE-driven luciferase expression. The addition of emodin diminished the previously described phenomenon, resulting in decreased ROS augmentation, translocation of Nrf2 and ARE-driven luciferase activity. In conclusion, emodin could ameliorate cisplatin-induced oxidative stress and protect the cells from oxidative stress-induced damage. The findings of the present study provide a novel strategy for the treatment of osteosarcoma using emodin and cisplatin.

Establishment of a cell model for screening antibody drugs against rheumatoid arthritis with ADCC and CDC.

TNFα played a dominant role in the development and progression of rheumatoid arthritis (RA). Clinical trials proved the efficacies of anti-TNFα agents for curing RA. However, most researchers were concentrating on their abilities of neutralizing TNFα, the potencies of different anti-TNFα agents varied a lot due to the antibody-dependent cell-mediated cytotoxicity (ADCC) or complement dependent cytotoxicity (CDC). For better understanding and differentiating the potentiality of various candidate anti-TNF reagents at the stage of new drug research and development, present study established a cell model expressing the transmembrane TNFα for usage in in vitro ADCC or CDC assay, meanwhile, the assay protocol described here could provide guidelines for screening macromolecular antibody drugs. A stable cell subline bearing transmembrane TNFα was first established by conventional transfection method, the expression of transmembrane TNFα was approved by flow cytometer, and the performance of the stable subline in ADCC and CDC assay was evaluated, using human peripheral blood mononuclear cells as effector cells, and Adalimumab as the anti-TNFα reagent. The stable cell subline demonstrated high level of surface expression of transmembrane TNFα, and Adalimumab exerted both ADCC and CDC effects on this cell model. In conclusion, the stable cell line we established in present research could be used in ADCC or CDC assay for screening antibody drugs, which would provide in-depth understanding of the potencies of candidate antibody drugs in addition to the traditional TNFα neutralizing assay.

A free anterolateral thigh flap and iliotibial band for reconstruction of soft tissue defects at children's feet and ankles.

BACKGROUND AND PURPOSE: High-energy injury to children caused by a traffic accident is usually characterised by extensive soft tissue defects with exposure or loss of tendons and bone at the foot. Segmental loss of the Achilles tendon along with soft tissue defects is a great challenge for microsurgical reconstruction. Free anterolateral thigh (ALT) flap is indicated for reconstruction of such defects because limited local tissues are available. Additionally, iliotibial band in the donor area can be used to reconstruct the damaged tendon. MATERIALS AND METHODS: Here we described our successful management of 25 paediatric patients with such high-energy injury at feet and ankles in one-stage transplantation of a free ALT flap and an iliotibial band from January 2008 to January 2013. The tendon defect, ranging from 3 to 16cm in length, was reconstructed with an iliotibial band. The flaps ranged from 5 to 12cm in width and 8 to 18cm in length. RESULTS: All the flaps survived completely and no donor site complications were observed. In two flaps there was a small area of distal necrosis which was healed by dressing changes. The mean follow-up time was 14.2 months (from 6 to 24 months). Limb function was assessed using the Maryland Foot Score. The excellent and good rate was 92%. CONCLUSIONS: We believe a free ALT flap is ideal for reconstruction of massive soft tissue defects at the foot and ankle in children and an iliotibial band from the same donor site can be used for reconstruction of a damaged tendon.

Association between P-glycoprotein expression and response to chemotherapy in patients with osteosarcoma: a systematic and meta-analysis.

OBJECTIVE: The aim was to investigate the association between p-glycoprotein (Pgp) expression and response to chemotherapy in patients with osteosarcoma. MATERIALS AND METHODS: We searched and included the openly published articles evaluated the correlation between Pgp expression and response to chemotherapy. The odds ratio (OR) of response rate for Pgp positive group versus Pgp negative group was aggregated by random or fixed effect model. RESULTS: Twelve studies were included in our meta-analysis. The mean Pgp positive rate was 0.39 ± 0.10 with its range of (0.14-0.53). The summary response rate was 0.46 ± 0.16 in Pgp positive and 0.57 ± 0.27 in the Pgp negative group, with no statistical difference between two groups (P > 0.05). The pooled OR of response rate for Pgp positive group versus Pgp negative group was 0.75 with its 95% confidence interval of 0.47-1.22, indicating there was no association between Pgp expression and response to chemotherapy in patients with osteosarcoma. CONCLUSION: The present evidence indicated that there was no association between p-glycoprotein expression and chemotherapy response in patients with osteosarcoma.

A case report of a metastatic gastrointestinal stromal tumor occurring in femur.

Gastrointestinal stromal tumors (GISTs) are mesenchymal neoplasms that most commonly affect the stomach or small intestine, but can occur anywhere throughout the gastrointestinal tract. To the best of our knowledge, few cases have been reported in the literature about the femur metastasis of GIST. This paper describes a metastasis of a gastrointestinal stromal tumour (GIST) to the femur in a 62-year-old male, 2 years after treatment for a gastric primary. There were no signs of tumor recurrence at followup after 12 mo. This case suggests that the femur can be a potential metastatic site of GIST.

[Clinical investigation of the minimal invasive osteotomy for the treatment of hallux valgus combined with tailor's bunion].

OBJECTIVE: To investigate the clinical effects of the minimal invasive osteotomy treatment for hallux valgus combined with tailor's bunion deformity. METHODS: From May 2007 to May 2009, Forty-nine feet of 32 patients (a mean age of 57 years old) of hallux valgus combined with tailor's bunion deformity were reviewed retrospectively, including 2 males(2 feet) and 30 females (47 feet). All patients were treated by the minimal invasive osteotomy. The axial and lateral films of all feet with loading were taken before and after operation. The hallux abducto valgus angle(HAV),intermetatarsal angle(IM), fourth-fifth intermetatarsal angle (IM 4 to 5), modified fourth-fifth intermetatarsal angle (MIM 4 to 5), Metatarsophalangeal-fifth angle (MPA) and lateral deviation of the fifth matatarsal angle (LDA) were compared before and after operation. Therapeutic effects of all the patients were observed after operation, the item including AFAS score and WEN Jian-min's therapeutic effects standard. RESULTS: The average operating time was 40 minutes. All the patients were followed up,and the duration ranged from 6 to 24 months. The HAV angle, IM angle, IM 4 to 5 angle, MIM 4 to 5 angle,MPA angle and LDA angle significantly decreased after operation. The AFAS score significantly raised after operation. According to the criteria, 33 feet got an excellent result, 15 good and 1 fair. CONCLUSION: The minimal invasive osteotomy treatment for hallux valgus combined with tailor's bunion is effective and safe. This method is mini-trauma,less pain and it can make a very soon rehabilitation. This method has widely clinical value.

[Experiment study of alendronate in the prevention and treatment of aseptic loosening of prosthesis].

OBJECTIVE: To investigate the effect of alendronate on the prevention and treatment of aseptic loosening of prosthesis. METHODS: A rat model of particle-induced osteolysis was used. Thirty-xis SD rats were divided into three groups: negative control group, positive control group and experiment group. Alendronate was administered by ig in experiment group. Positive control group and experiment group received intro-articular injections of ultrahigh molecular weight polyethylene (UHMWPE) particles at 4, 6, 8, 10 weeks postoperatively. Negative control group was received injection with mixture solution of mouse serum and PBS only. All animals were sacrificed at 12 weeks after operation for histologic examination. In vitro human peripheral blood mononuclear (PBMC)were separated and cultured and divided into five groups as group A: PBMC group, group B: PBMC and particles,group C:PBMC and particles with 10(-4) mol/L alendronate, group D:PBMC and particles with 10(-5) mol/L alendronate, group E: PBMC and particles with 10(-6) mol/L alendronate. The production of IL-1beta, IL-6, TNF-alpha in each group were tested. RESULTS: Alendronate could prevent particle-induced osteolysis. The production of IL-1beta, IL-6, TNF-alpha was inhibited when alendronate was used. CONCLUSION: Alendronate can inhibit bone absorptive factors expression induced by wear particles and may be used in the prevention and treatment of aseptic loosening of prosthesis.

[Treatment of fracture of neck of femur in the aged with hollow compression screw].

OBJECTIVE: To summarize the clinical results of hollow compression screw in treatment of fracture of neck of femur in the aged. METHODS: From November 1993 to October, 1998, 52 aged patients with several types of fracture of neck of femur were treated; among them, there were 25 males and 27 females aged from 60 to 83 years (70 years on average). There were 48 cases of fresh fracture and 4 cases of old fracture. Forty-two cases were performed closed reduction internal fixation, 10 cases with open reduction internal fixation. RESULTS: All the patients could sit by themselves 4 to 6 days after operation, and could walk with a crutch 10 to 15 days after operation. The mobility of hip joint was nearly normal 4 weeks after operation. All the patients were followed 26 to 84 months, 48.5 months on average. Bone union was achieved in 50 cases, nonunion in 2 cases. The average healing time was 4.7 months. There were no other complications, such as ankylosis and muscular atrophy, but ischemic necrosis in 3 cases. CONCLUSION: This method has following advantages, convenient manipulation, less injury, stable fixation, and the short-term recovery, which avoid some common complications. It is a reliable method worthy of popularizing.