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Objective:To investigate the efficacy of Masquelet induced membrane technique combined with an external locking plate in the treatment of infectious bone defects of the tibia.Methods:A retrospective study was conducted to analyze the data of 32 patients with infectious bone defects of the tibia who had been treated by Masquelet induced membrane technique combined with an external locking plate at Department of Orthopaedic Surgery, The Fourth Hospital of Wuhan from January 2011 to January 2021. There were 22 males and 10 females, with an age of (43.2±13.1) years. The length of bone defects was (5.1±1.3) cm. By the Cierny-Mader classification, there were 12 cases of type Ⅲ and 20 cases of type Ⅳ. The defects were located at the proximal tibia in 11 cases, at the middle tibia in 12, and at the distal tibia in 9. At the last follow-up, the lower limb function was evaluated by the Paley scale, and the quality of life by the 36-Item Short Form Health Survey (SF-36).Results:All the 32 patients were followed up for (21.2±5.7) months. Normal healing was achieved in 30 cases but delayed healing occurred in 2 cases. The external plate and screws were removed at (23.1±4.6) weeks after operation. There was no infection in the original surgical incision or no injury to the nerve, blood vessel or tendon after operation, but nail tract infection occurred more or less in 3 cases. According to the Paley scale at the last follow-up, the lower limb function was evaluated as excellent in 22 cases, as good in 8, and as fair in 2, giving an excellent and good rate of 93.75% (30/32). The SF-36 quality of life score was (88.9±3.8) points.Conclusion:In the treatment of infectious bone defects of the tibia, Masquelet induced membrane technique combined with an external locking plate can achieve satisfactory clinical outcomes due to its effective control of infection, reduction in delayed healing, good stability and good patient tolerance.
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Unstable sacral fracture is usually caused by high-energy trauma. Unstable sacral fracture often results in damage to the mechano-conductive structures of the spine and pelvis and thereby affects walking dysfunction. Treatment of sacral fracture has been a challenge due to the complex local anatomy, unique biomechanics and poor bone quality of the sacrum. The screw-rod fixation system has always played an important role in the treatment of variant sacral fracture and more severe sacral fracture. With the introduction of new technology, the screw-rod fixation system has evolved into a variety of structural types. According to whether the fixation range extends to the spine, it can be divided into two categories including spine-pelvic stabilization techniques and pelvic stabilization techniques. The authors review the progress of the screw-rod fixation system in the treatment of sacral fracture from aspects of biomechanical properties and clinical efficacy, so as to provide a reference for the selection of clinical internal fixation.
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Objective:To explore the fixation with S 2 alar iliac screws (S 2AI) for unstable injury to the pelvic posterior ring. Methods:The clinical data of 18 patients were analyzed retrospectively who had been treated for unstable injury to the posterior pelvic ring by S 2AI screw fixation at Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University and at Department of Orthopaedics and Traumatology, The First Affiliated Hospital to University of South China from September 2017 to December 2020. They were 8 males and 10 females, with an average age of 40 years (from 20 to 64 years). According to Tile classification, there were 3 cases of type B2, 10 cases of type C1 and 5 cases of type C2. Sacral nerve injury was complicated in 3 patients (2 cases of Gibbons grade Ⅱ and one of Gibbons grade Ⅲ). Short-segment S 1-S 2AI fixation was used in 6 cases, contralateral S 1-S 2AI fixation in one case, lumbar-pelvic fixation in 5 cases, and sacroiliac triangle fixation in 6 cases. The accuracy of S 2AI placement was evaluated by CT after operation according to the Shillingford method; the reduction quality of pelvic fractures and complications were documented. Results:All the 18 patients were followed up for 19.8 months (from 12 to 36 months). Bony union was achieved in all fractures. A total of 21 S 2AI were implanted in the 18 patients without intraoperative neurovascular injury. Postoperative CT found penetration into the iliac cortex by S 2AI in 2 cases. According to the Matta criteria, the fracture reduction was excellent in 10 cases, good in 7 and fair in one. Of the 3 patients with preoperative sacral nerve injury, 2 with grade Ⅱ injury recovered to grade Ⅰ and one with grade Ⅲ injury recovered to grade Ⅱ after operation. Superficial infection occurred at the incision site in 2 patients after operation, and complications such as protrusion, rupture or loosening of implants were observed in none of the patients. Conclusion:S 2AI fixation can be flexibly applied to various types of posterior pelvic ring injury and can provide the pelvic ring and the lumbosacral junction with rigid fixation, leading to a low complication rate.
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Objective:Comparison of biomechanical stability of S 2-alar-iliac screw and S 1 pedicle screw fixation (S 2AI-S 1) with conventional sacroiliac screw in the treatment of Denis type II sacral fractures by finite element analysis. Methods:The lumbar spine and pelvis of a male volunteer with normal skeletal structure were scanned by CT, followed by three-dimensional reconstruction. The finite element model of right Denis type II sacral fracture and pubic symphysis injury was constructed using ANSYS 17.0 software. The anterior pelvic ring is fixed with a five-hole steel plate, and the posterior pelvic ring is fixed with four different internal fixation methods, namely, sacroiliac screw (S 1 segment half-thread hollow screw), S 2AI-S 1 and S 2AI screw and contralateral S 1 screw fixation (S 2AI-CS 1). By restraining the bilateral acetabular and applying 500 N vertical stress above the L 4 vertebral body, the maximum displacement, maximum von Mises stress and vertical stiffness of the three groups of internal fixation were compared. Results:In terms of the maximum displacement of the sacrum in the vertical and anteroposterior directions, the S 2AI-S 1 model was the smallest (1.40 mm, 1.40 mm, respectively), while the S 2AI-CS 1 model was the largest (1.60 mm, 1.56 mm, respectively); In terms of the maximum displacement of the sacrum in the horizontal direction, the S 2AI-S 1 model is the smallest (0.19 mm), while the SIS model is the largest (0.37 mm); In terms of the maximum von Mises stress of internal fixation, the stress of the sacroiliac screw model is the largest (216.02 MPa), while the stress of the S 2AI-S 1 model is the smallest (39.82 MPa); In terms of the maximum von Mises stress of the bone around the screw, the stress of the sacroiliac screw model (39.68 MPa) is the largest and that of the S 2AI-S 1 model is the smallest (31.56 MPa); In terms of the vertical displacement of the center point of the upper surface of the S 1 vertebral body, the sacroiliac screw, S 2AI-S 1 and S 2AI-CS 1 groups were 0.83 mm, 0.73 mm and 0.93 mm, respectively. Using the vertical displacement of the center point of the upper surface of the S 1 vertebral body to predict the vertical stiffness of the three groups of models, from large to small, are S 2AI-S 1, sacroiliac screw and S 2AI-CS 1. Conclusion:S 2AI-S 1 fixation has good biomechanical stability in three-dimensional finite element analysis. It can be used as a new type of internal fixation for the treatment of sacral fractures and is worthy of promotion.
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Objective:To screen for circle RNA (circRNA) differentially expressed in peripheral blood mononuclear cells (PBMCs) of patients with ankylosing spondylitis (AS), and to analyze its expression profile to explore the role of circRNAs in the pathogenesis of AS.Methods:CircRNA microarray chip technology was used to detect the expression of circRNAs in PBMCs of 3 patients with active AS, 3 patients with stable AS and 3 healthy controls (HC), and then screening for differentially expressed circRNAs by fold change (FC) and P value. Then differentially expressed circRNAs among the circRNAs with the highest differential expression were selected randomly to verify the chip results by real-time fluorescence quantitative polymerase chain reaction (qPCR); Differentially expressed circRNAs were subjected to Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, and microRNA (miRNA) target prediction software was used to predict the circRNA/miRNA interaction relationship. Finally, the data were statistically analyzed by t test and Mann-Whitney U test. Results:① Chip text results showed that there were 800 circRNAs with significantly different expression (FC>1.5, P<0.05) in active AS than HC, of which 466 were up-regulated and 334 were down-regulated; the stable AS had a total of 1 149 significantly differentially expressed when compared with the HC (FC>1.5, P<0.05) circRNAs, of which 589 were up-regulated and 560 were down-regulated. 233 circRNAs were significantly differentially expressed (FC>1.5, P<0.05) between active AS and stable AS, of which 145 were up-regulated and 88 were down-regulated. ②The RT-qPCR verification results suggested that the expression trends of the four differentially expressed circRNAs were consistent with the results of the chip. ③ GO analysis results suggested that these differentially expressed circRNAs were mainly involved in nonsense-mediated mRNA decay, Rho GTPase binding and other processes. The analysis showed that the KEGG pathway were enriched in Th17 cell differentiation and chemokine signaling pathways. The results of miRNA target prediction software analysis suggested that differentially expressed circRNAs might play a role by targeting miR-650, let-7b-5p and other miRNAs. Conclusion:Compared with HC group, there were differentially expressed circRNAs in Peripheral Blood Mononuclear Cells (PBMCs) of AS patients, The results of this study suggest that these circRNAs may be involved in the pathogenesis of AS.
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Objective:To analyze the expression of circular RNA (circRNA) in peripheral blood mononuclear cells (PBMCs) of patients with gout and to explore the possible mechanism of circRNA in the pathogenesis of gout.Methods:Peripheral blood samples of 24 patients with acute gout (AG), 24 patients with intermittent gout (IG) and 24 healthy control subjects (HC) were collected. Three cases of AG, IG, and HC were randomly selected, and the differentially expressed circRNA in PBMCs was screened by human circNA microarrays. The 6 circRNAs with large differences between the two comparison groups were selected, and the relative expression levels of 6 circRNAs in all the collected 72 PBMCs of the study subjects were detected by real-time fluorescent quantitative polymerase chain reaction (RT-qPCR). The significantly differentially ex-pressed circRNA (fold change>1.5, P<0.05) was analyzed by GO analysis, Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis, and its interaction with microRNA (miRNA) was predicted. The median (interquartile range) was used to describe the data, and the Mann-Whitney U test was used for comparison between groups. Results:(1) The microarray analysis results showed that compared with the HC group, the AG group and the IG group had 116 and 41 significantly differently expressed circRNAs, respectively; com-pared with the IG group, the AG group had 105 significantly differently expressed circRNAs. (2) Among the 6 circRNAs verified by PT-qPCR, the expression trends of 5 were consistent with the microarray results. The expression of hsa_circRNA_105034 in the AG group [5.17(4.60)] was statistically significantly different com-pared to the IG [1.68(2.39)] and HC [0.90(0.73)] groups (AG vs IG: Z=-4.413, P<0.01; AG vs HC Z=-5.052, P<0.01). (3) Bioinformatics analysis: ① GO analysis found that differential circRNA swere mainly involved in DNA transcriptional regulation, positive cell regulation and protein modification, etc. ② KEGG pathway analysis revealed that differential circRNA might be involved in the immune response mediated by the mitogen-activated protein kinase signaling pathway. ③ CircRNA might affect its inflammatory response by targeting molecules such as miRNA-146a, miRNA-302b and miRNA-23a. Conclusion:There are differentially expressed circRNAs in PBMCs of patients with gout, which may be closely related to the occurrence and development of gout.
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Objective:To investigate the clinical features, laboratory characteristics and risk factors of systemic sclerosis (SSc) patients with hematologic damages.Methods:The clinical data of 180 SSc patients were collected from January 2010 to April 2020, at the Affiliated Hospital of North Sichuan Medical College. The demographic information, laboratory tests, and clinical symptoms were analyzed retrospectively. Statistical Product and Service Solutions (SPSS) 19.0 was used for t-test, non-parametric Mann-Whitney U test, Chi-squared test, Logistics regression analysis. Results:① Among 180 SSc patients, 70(38.9%) cases were complicated with hematologic damages. Fifty-one (72.9%) cases had anemia, 24 cases (34.3%) had leukopenia, 24 cases (34.3%) had thrombocytopenia, and 22 cases had hematologic damages associated with more than two cell line involvement. ② Clinical symptoms: arthritis was significantly higher in the hematologic damage group than patients without( χ2=4.815, P=0.028), however, there was no significant difference in gender, age, disease course, respiratory symptoms, gastrointestinal symptoms, Raynaud's phenomenon, interstitial lung disease and pulmonary hypertension ( P>0.05). ③ Laboratory tests: erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) were increased in the hematologic damage group, while the albumin decreased ( Z=-2.448, P=0.014; Z=-2.450, P=0.014; Z=-4.773, P<0.01). The positive rates of anti-dsDNA antibody and anti-ribosomal P protein anti-body was higher in the hematologic damage group ( χ2=5.428, P=0.020; χ2=8.169, P=0.004). ④ Prognosis: during follow-up, leukopenia was more likely to recover, while the thrombocytopenia was more difficult to recover. ⑤ Logistics regression analysis showed that positive of anti-ribosomal P protein antibody might bea risk factor for SSc complicated with hematologic damages [ OR=3.930, 95% CI(1.130, 13.666, P=0.031)]. Conclusion:SSc complicated with hematologic damages is common, and patients with hematological damage have more serious clinical symptoms, some of whom have difficulty in recovery. Anti-ribosomal P protein anti-body may be a risk factor for SSc hematologic damages.
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Objective To explore the clinical technical points of the treatment of soft tissue defect of the foot and ankle with the supercharged peroneal artery perforator propeller flap,and to provide theoretical support by anatomical observation.Methods From January,2010 to February,2018,a total of 10 patients with soft tissue defect of foot and ankle were treated with supercharged peroneal artery perforator propeller flap.Cause of injury:trauma in 7 cases,wound ulcer in 1 case,and poor healing of the calcaneus incision in 2 cases.Defect site:5 cases of heel,2 cases of medial and lateral malleolus,and 3 cases of dorsum and sole.The size of flap ranged from 6.0 cm×3.0 cm to 16.0 cm×5.0 cm.All patients were followed-up at 1,3,6 months after operation,and the function recovery was judged by AOFAS Ankle Hindfood Scale at 3 months post-opertively.From November,2016 to May,2017,the anatomical basis and operative points of the supercharged peroneal artery perforator flap were summarized.Results All the 10 cases of supercharged peroneal artery perforator propeller flap survived.Two of them had local epidermal necrosis at the proximal end of the flap.After 1 to 2 weeks of dressing,they finally healed.The other 8 cases healed well.Anatomical studies showed that different planes of the supercharged peroneal artery perforator propeller flap can only reduce the compression of the double pedicles and reduce the distal necrosis rate of the flap by rotating in different rotation directions.Conclusion The supercharged peroneal artery perforator propeller flap can enhance the blood supply and venous return in the "big paddle" artery of the flap,preventing distal necrosis.
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With deepening understanding of surgical treatment of calcaneal fractures,clinical applications of external fixators have drawn more attention.At present,however,there has been no systematic review of such applications for intra-articular calcaneal fracture.This review collected all the recent reports available on such applications to analyze the use and clinical indications of different external fixators.Moreover,on the basis of our own clinical experience,we further proposed a novel treatment protocol for intraarticular calcaneal fractures which integrates internal and external fixation and minimally invasive techniques.
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Objective To clarify the function of LIM and SH3 domain protein-1 (LASP1) and ferritin in rhBMP2-induced osteogenic differentiation of beagle bone marrow mesenchymal stem cells (BMSCs).Methods After BMSCs from 3-18-month-old C57BL/6J mice were cultured adherently for 24 hours,they were subjected to osteogenic differentiation for 7,14 and 21 days in 3 groups.BMP2 (100 μg/L) and osteogenic differentiation medium was added in the experimental group,only osteogenic differentiation medium was added in the control group,and nothing was added in the blank group.Osteoblast differentiation was determined by examining marker genes (Runx2,OSX,OCN and OPN) using qRT-PCR.The protein expression of both LASP1 and ferritin was investigated using western blotting.After LASP1 and ferritin were silenced in the cells in the experimental group after transfection of shRNA to target LASP1(m),rhBMP2-induced osteogenesis was repeated to verify the roles of LASP1 and ferritin in osteoblast differentiation.Results The qRT-PCR showed successful osteoblast differentiation in the experimental group.Western blotting verified significant down-regulation of LASP1 and up-regulation of ferritin in the experimental group.After the LASP1 gene was silenced,the expression levels of osteoblast differentiation marker genes in the experimental group were higher than those in the control group.Conclusions rhBMP2 can induce mouse BMSCs to differentiate into osteoblasts in a significant manner.Combined with our preliminary research,the present study may confirm that LASP1 and ferritin,which play an important role in regulating cytoskeleton activity and iron metabolism,are critical in the osteogenic differentiation of mouse BMSCs induced by rhBMP2.
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As the descending genicular artery supplies multiple perforating branches around the knee joint,it can be used in corticocancellous,osteomusculocutaneous and other composite tissue flaps to repair composite tissue defects at one stage.Consequently it plays a very important role in the field of reconstruction surgery.At present,however,there has been no systematic review of its clinical applications.Having reviewed all the recent reports available on the free tissue perforator flaps with descending genicular artery,we classified them into five major forms.In this paper,we comment on their anatomical mechanisms,variations and clinical applications.Additionally,we predict that digital technology will be used in the future clinical application of the perforator tissue flaps with descending genicular artery.
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As the descending genicular artery supplies multiple perforating branches around the knee joint,it can be used in corticocancellous,osteomusculocutaneous and other composite tissue flaps to repair composite tissue defects at one stage.Consequently it plays a very important role in the field of reconstruction surgery.At present,however,there has been no systematic review of its clinical applications.Having reviewed all the recent reports available on the free tissue perforator flaps with descending genicular artery,we classified them into five major forms.In this paper,we comment on their anatomical mechanisms,variations and clinical applications.Additionally,we predict that digital technology will be used in the future clinical application of the perforator tissue flaps with descending genicular artery.
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Objective To investigate the safety , feasibility , and clinical application value of digital sub-traction angiography ( DSA) -guided insertion of totally implantable venous access port ( TIVAP) in patients with digestive system cancer .Methods We retrospectively analyzed the data of 15 digestive system cancer patients who were inserted with TIVAP under DSA guidance between April 2013 and January 2016, recorded the TIVAP-related complications and indwelling time, and investigated the patients’satisfaction about TIVAP.Paired rank sum test was used for the differences in patients’quality of life before and after the insertion of TIVAP.Results Of the 15 digestive system cancer patients , operation success rate of TIVAP insertion was 100%, with the success rate of venipuncture on first attempt being 100%.The incidence of complication was 6.67% ( 1/15 ) , which was manifested as pull feeling at the neck occurring in the eighth month after insertion .The indwelling time of TIVAP was from 2 to 28 months, with a median value of 9 months.Patients’satisfaction rate of TIVAP was 86.67%(13/15).The proportion of patients with a good quality of life was 100%(15/15), statically signifi-cantly higher than that before the insertion [46.67%(7/15), Z=-3.416, P=0.000).Conclusions TIVAP insertion under DSA guidance in digestive system cancer patients is safe and feasible , with few complications and fair patient satisfaction .It may improve the patient ’s quality of life , worthy of clinical application .