Inhibition connexin 43 by mimetic peptide Gap27 mediates protective effects on 6-hydroxydopamine induced Parkinson's disease mouse model / 北京大学学报(医学版)

OBJECTIVE@#To explore whether the using of mimetic peptide Gap27, a selective inhibitor of connexin 43 (Cx43), could block the death of dopamine neurons and influence the expression of Cx43 in 6-hydroxydopamine (6-OHDA)-induced Parkinson's disease mouse models.@*METHODS@#Eighteen C57BL/6 mice were randomly divided into control group, 6-OHDA group and 6-OHDA+Gap27 group, with 6 mice in each group. Bilateral substantia nigra stereotactic injection was performed. The control group was injected with ascorbate solution, 6-OHDA group was injected with 6-OHDA solution, and 6-OHDA+Gap27 group was injected with 6-OHDA and Gap27 mixed solution. Immuno-histochemical staining was used to detect the number of dopamine neurons, quantitative real-time polymerase chain reaction (qRT-PCR) was used to detect the expression of Cx43 messenger ribonucleic acid (mRNA), immuno-fluorescence staining was used to detect the distribution of Cx43 protein, the contents of Cx43 protein and Cx43 phosphorylation at serine 368 (Cx43-ps368) in mouse midbrain were detected by Western blot.@*RESULTS@#After injection of 6-OHDA, numerous dopamine neurons in substantia nigra died as Cx43 content increased, Cx43-ps368 content decreased. Mixing Gap27 while injecting 6-OHDA could reduce the number of death dopamine neurons and weaken the changes of Cx43 and Cx43-ps368 content caused by 6-OHDA. The number of tyrosine hydroxylase (TH) immunoreactive positive neurons in 6-OHDA group decreased to 27.7% ± 0.02% of the control group (P < 0.01); The number of TH immunoreactive positive neurons in 6-OHDA+Gap27 group was (1.64±0.16) times higher than that in 6-OHDA group (P < 0.05); The content of total Cx43 protein in 6-OHDA group was (1.44±0.07) times higher than that in 6-OHDA+Gap27 group (P < 0.05) while (1.68±0.07) times higher than that in control group (P < 0.01). In 6-OHDA group, the content of Cx43-ps368 protein and its proportion in total Cx43 protein were significantly lower than that in 6-OHDA+Gap27 group (P < 0.05).@*CONCLUSION@#In 6-OHDA mouse models, mimetic peptide Gap27 played a protective role in reducing the damage to substantia nigra dopamine neurons, which was induced by 6-OHDA. The overexpression of Cx43 protein might have neurotoxicity to dopamine neuron. Meanwhile, decreasing Cx43 protein level and keeping Cx43-ps368 protein level may be the protective mechanisms of Gap27.

Current advances in research of semaphorin 3A:a potential target for the treatment of nospecific low back pain / 中国骨伤

Nonspecific low back pain is closely associated with afferent nerve ingrowth into degenerated IVDs and increasing the inflammatory response. Members of the class 3 semaphorins signal their response through two prominent receptors; the NRP (Neuropilin-1) and the Plexin A. Sema3A (Semaphorin3A) is primarily known for their role in modulating neuronal survival as well as neurite outgrowth and guidance via regulation of Sema3A-NRP-1-plexinA signal pathway. Also, sema3A is shown to be conductive to innervate the inner painful degenerated IVDs (Intervertebral discs). Furthermore, sema3A is thought to act as a barrier to endothelial cells survival and migration on vascular endothelial growth factor (VEGF) and inhibition of KLF5-induced (Krüppel-like factor 5) inflammatory mediators within degenerated IVDs. Therefore, Sema3A produce a new perspective of dual-action therapeutic agent for attenuating the regulator of innervation and angiogenesis into degenerated IVDs and inhibition of KLF5-induced inflammation.

Effect of fluoride varnish on primary teeth in children aged 3-6 years in Huangpu District of Shanghai / 上海预防医学

Objective To evaluate the implementation process, and cost-effectiveness of fluoride varnish in preventing primary caries project for children aged 3-6 years in Huangpu District.This would provide the basis for the popularization of fluoride varnish project in preschool children as a basic measure of caries prevention in community health service. Methods From 2016 to 2017, children aged 3-6 years old from 12 kindergartens in Huangpu District were varnished by fluoride twice a year.Three-years-old children in 12 kindergartens were divided into intervention group and control group according to the baseline survey results.The intervention group was implemented according to the established norms, while the control group was implemented according to the routine requirements.Follow-up examinations were conducted after 4 interventions to monitor primary caries increment among these children. Results Caries rate, average caries index and SiC in children aged 3, 4, 5 and 6 years were all dropped after fluorination in year of 2018.The caries rate of 5-year-old deciduous teeth decreased from 58.8% in 2015 to 45.0% in 2018.The dental caries rate in the intervention group was lower than that in the control group, and the frequency of fluoride application per capita was higher than that in the control group, showing a statistically significant difference (P < 0.05), but there was no significant difference in the rate of fluoride application and average caries index between the two groups (P > 0.05).The direct input-output ratio of the project is 1 : 5.16. Conclusion Fluorinated caries prevention project using fluoride varnish for preschool children can effectively reduce the incidence of dental caries in deciduous teeth and has good economic benefits.The application of standard fluorine coating on preschool children′s deciduous teeth can affect caries prevention.

Effect of benzo(a)pyrene on dopaminergic neurons and α-synuclein in brain and its mechanism involved / 北京大学学报(医学版)

OBJECTIVE@#To analyze the effect of benzopyrene on the decrease of dopaminergic neurons, and the increase and aggregation of α-synuclein, which are the pathological features of Parkinson's disease, and to explore its possible mechanisms.@*METHODS@#Eight-month-old transgenic mice with human SNCA gene were randomly divided into a BaP-exposed group and a control group. BaP and solvent corn oil were injected intraperitoneally to BaP-exposed group and control group respectively, once a day for 60 days. The motor dysfunction of mice was tested by rotarod test. The effects of BaP on the decrease of dopaminergic neurons and increase and aggregation of α-synuclein were observed by immunohistochemistry and Western blot experiments respectively, and the expression of related mRNA was detected by quantitative real-time PCR (qRT-PCR). Twenty genes were tested in the study, mainly related to neurotransmitter transporter (2 genes), neurotransmitter receptor function (10 genes), cellular autophagy (5 genes), and α-synuclein aggregation and degradation (3 genes).@*RESULTS@#After BaP exposure, the movement time of the mice in the rotarod test was significantly reduced (P<0.05). The substantia nigra dopami-nergic neurons in the mice were significantly reduced, which was 62% of the control group (P<0.05), and the expression of α-synuclein in the midbrain increased, which was 1.36 times that of the control group (P<0.05). After BaP exposure, mRNA expressions of 14 genes in the midbrain of the mice were significantly down-regulated (P<0.05). Alpha-synuclein degradation and cell autophagy (5 genes), neuron transporters (2 genes), and neurotransmitter receptor functions (5 genes) were involved. The expression of one gene, Synphilin-1, was significantly up-regulated (P<0.01), which was related to α-synuclein aggregation.@*CONCLUSION@#BaP exposure not only inhibited function of neurotransmitter receptor and dopamine transporter, but also interfered cell autophagy, thereby hindering the degradation of α-synuclein, which could lead to decrease of dopaminergic neurons in substantia nigra and increase and aggregation of α-synuclein in midbrain, as the significant pathology of Parkinson's disease. Therefore, BaP exposure may increase the risk of Parkinson's disease.

Comparison of clinical effects between anterior cervical discectomy combined with corpectomy and cervical posterior single open-door laminoplasty in treating three-segment cervical spondylotic myelopathy / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical effects between anterior cervical discectomy and fusion(ACDF) combined with anterior cervical corpectomy and fusion(ACCF) and cervical posterior single open-door laminoplasty with mini-titanium plate fixation in treating three-segment cervical spondylotic myelopathy.</p><p><b>METHODS</b>The clinical data of 63 patients (39 males and 24 females) with three-segment cervical spondylotic myelopathy underwent surgical treatment from March 2014 to March 2016 were retrospectively analyzed. Among them, 43 cases were treated by ACDF combined with ACCF(anterior group), and 20 cases were treated by cervical posterior single open-door laminoplasty with mini-titanium plate fixation(posterior group). Operative time, intraoperative blood loss, postoperative complications were compared between two groups. And according to JOA score to evaluate the clinical effect.</p><p><b>RESULTS</b>All the patients were follow-up from 16 to 40 months with an average of 25.8 months. Operative time of anterior group and posterior group were (123.70±6.21) min and(118.70±5.41) min, respectively, there was no significant difference between two groups(>0.05). Intraoperative blood loss of anterior group and posterior group were (85.23±7.51) ml and (107.18±9.41) ml, respectively, there was significant difference between two groups(<0.05). In anterior group, axial symptoms occurred in 6 cases, dysphagia in 1 case, and no C₅ nerve root palsy, hoarseness and choking cough were found, the incidence rate of complication was 16.3%(7/43); and in posterior group, axial symptoms occurred in 5 cases, C5 nerve root palsy in 1 case, and no dysphagia, hoarseness and choking cough were found, the incidence rate of complication was 30.0%(6/20); there was significant defference in incidence rate of complication between two group(<0.05). At 1 week after operation and final follow-up, the JOA scores of anterior group were obviously better than that of posterior group(<0.05).</p><p><b>CONCLUSIONS</b>Above-mintioned two surgical treatment for cervical spondylotic myelopathy can provide instantly stability, the method of ACDF combined with ACCF was obviously better that of the method of cervical posterior single open-door laminoplasty in intraoperative blood loss, the incidence rate of complications, clinical effect.Thus, for the treatment of three-segment cervical spondylotic myelopathy, the method of ACDF combined with ACCF would be firstly chosen.</p>

Analysis of correlative factors of spinal cord posterior displacement after single door laminoplasty / 中国骨伤

OBJECTIVE@#To observe the open angle (OA), cervical curvature angle (CA), preoperative spinal cord compression rate(PSCR), postoperative spinal cord shift (PSCS) in patients with chronic compressive cervical myelopathy undergoing C3-7 single open laminoplasty, and to explore the possible mechanism and influencing factors of postoperative average spinal cord drift, so as to provide objective basis for predicting PSCS.@*METHODS@#From May 2012 to July 2016, 32 patients with multi-segmental chronic compressive cervical myelopathy who underwent single-door laminoplasty in our department were analyzed retrospectively, including 14 cases of cervical spondylotic myelopathy, 8 cases of developmental cervical spinal stenosis with cervical myelopathy, and 10 cases of ossification of posterior longitudinal ligament. The OA of cervical spine was measured on CT, the CA was measured on X-ray, the PSCR and PSCS were measured on MRI. The patients were divided into two groups according to PSCS(group A>=2.5 mm, group B0.1), and the partial regression coefficients of OA and PSCR were 0.113 and 0.059 respectively.@*CONCLUSIONS@#PSCS is the result of OA, CA and PSCR, among which PSCR has the most important influence, OA is the second, CA is the least. PSCS can be predicted by 0.059×OA+0.113×PSCR-2.266 equation, which provides a theoretical basis for preoperative evaluation of spinal cord decompression after surgery.

Roles of signaling lymphocytic activation molecule expression on CD4 +T cells surface in the pathogenesis of allergic conjunctivitis / 眼科新进展

Objective To discuss the function of signaling lymphocytic activation molecule (SLAM) expression on CD4 + T cells surface in the pathogenesis of allergic conjunctivitis.Methods Totally 10 patients with allergic conjunctivitis were selected as the observation group,and 10 individuals with no history of allergies receiving physical examination were selected as the control group,followed by the collection of venous blood.The expression of total IgE in the serum was tested by ELISA,and the expression of SLAM on CD4 + T cell surface was assessed by using flow cytometry.Then the correlation between SLAM expression on CD4 +T cell surface and serum total IgE level were analyzed.Next,20 Balb/c mice (2-month old) were equally divided into two groups (control group and model group) at random,with 10 mice in each group.Model group was firstly sensitized with the mixture of ragweed and complete Freund's adjuvant by footpad and root of tail injection on day 1.On day 7 and 14,intraperitoneal injection was enhanced,while rats in the control group were intraperitoneally injected with equal amounts of Freund's adjuvant.On day 15,mice were excited by ragweed pollen crude infusion drops,and,after 1 h,the eyes were taken for histopathology testing.Then,peripheral blood was collected,and the whole blood was used for the detection of SLAM expression,while the serum was used for the detection of specific IgE for ragweed pollen.Finally,the difference between the two groups and the correlation between SLAM expression and specific IgE level were analyzed.Results The expression of SLAM on CD4 +T cell surface in the observation group was significantly decreased when compared with the healthy controls (P =0.016),but the total IgE level was significantly increased in allergic conjunctivitis patients (P =0.002);and there was a negative correlation between SLAM expression and total IgE level (r =-0.453 4,P ＜ 0.05).About mice,the expression of SLAM on CD4 + T cell surface of the model group was significantly lower than that of the control group (P =0.000).The expression level of specific IgE of the model group was significantly higher than that of the control group (P =0.000).And there was a negative correlation between SLAM expression and specific IgE level in the model group (r =-0.527 4,P ＜ 0.05).Conclusion In allergic conjunctivitis,the expression of SLAM on CD4 + T cell surface in peripheral blood is significantly decreased,which is correlated with the production of IgE,and this may reflect the disease severity to some extent.

Up-regulation of miR-101 inhibits proliferation and invasion of retinoblastoma cells / 眼科新进展

Objective To investigate the effects of miR-101 expression on retinoblastoma cell proliferation and invasion.Methods A total of 31 cases of retinoblastoma tissues and 7 cases of normal retinal tissues were collected.Human normal retinal vascular endothehal cell line ACBRI-181 and retinoblastoma cell line HXO-Rb44 were cultured.HXO-Rb44 cells were transfected with Lipofectamine 2000 and grouped as follows:negative control (NC) group 1,in which cells were transfected with miRNA-101 negative controls,miR-101 expression group,cells transfected with miRNA-101 mimics;NC group 2,in which cells were transfected with histone-lysine N-methyltransferase (EZH2) negative controls,siRNA-EZH2 group,cells transfected with EZH2 siRNA,siRNA-EZH2 + mimics group,cells transfected with EZH2 siRNA and miRNA-101 mimics,and EZH2 + mimics group,cells transfected with EZH2 expression vector and miRNA-101 mimics.Normal HXO-Rb44 cells were served as blank group,miR-101 and EZH2 mRNA expression were detected by qRT-PCR,and EZH2 protein expression was measured by Western blot.Cell proliferation and invasion ability were determined by MTT and Transwell assays,respectively.Luciferase reporter assay was used to assess the targeting relationship between miR-101 and EZH2.Xenograft in nude mice was performed to detect cell proliferation ability in vivo.Results Compared with normal retinal tissues and ACBRI-181 cells,the relative expression of miR-101 in retinoblastoma tissues and HXO-Rb44 cells was significantly down-regulated (both P ＜ 0.05).The relative expression of EZH2 mRNA and protein in the miR-101 expression group was significantly lower than that in the blank group and NC group 1 (all P ＜ 0.05).At 72-96 h,the A values of the miR-101 expression group was significantly lower than those of the blank group and NC group 1 (both P ＜0.01).The number of invasive cells in the miR-101-expressing group (51 ± 6) was significantly lower than that of the blank group (97 ± 11)and NC group 1 (92 ± 8) (both P ＜ 0.01).EZH2 was the target gene of miR-101.At 48-96 h,the A values of the siRNA-EZH2 group and siRNA-EZH2 + mimics group were significantly lower than those of the blank group and NC group 2 (all P ＜0.01).At 72-96 h,the A values of the siRNA-EZH2 + mimics group were obviously lower than those of the siRNA-EZH2 group (both P ＜ 0.05).At 24-96 h,the A values of EZH2 + mimics group were not statistically different from the blank group or NC group 2 (all P ＞ 0.05).The number of invasive cells in the siRNA-EZH2 group (48 ± 4) and siRNA-EZH2 +mimics group (38 ±3) was significantly lower than that in the blank group (95 ± 10) and NC group 2 (90 ±6) (all P ＜0.01),and siRNA-EZH2 + mimics group was significantly lower than siRNA-EZH2 group (P ＜0.05).The number of invading cells of the EZH2 +mimics group (101 ± 11) was not statistically different from the blank group and NC group 2 (both P ＞ 0.05).At 5-7 weeks,the tumor volumes of siRNA-EZH2 group and siRNA-EZH2 + mimics group were significantly lower than those of the blank group and NC group 2 (all P ＜ 0.01),and siRNA-EZH2 + mimics group was significantly lower than the siRNA-EZH2 group (P ＜ 0.05).There was no significant difference in the tumor volume between the EZH2 + mimics group and the blank group or the NC group 2 (all P ＞ 0.05).Conclusion Up-regulation of miR-101 expression can inhibit the proliferation and invasion of HXO-Rb44 cells,which might be achieved by inhibiting the expression of EZH2.

Correlation of serum homocysteine, vitamin B12 and folic acid with oxidative stress in patients with diabetic retinopathy / 眼科新进展

Objective To analyze changes in serum homocysteine (Hcy),vitamin B12 (VitB12) and folic acid as well as the association with oxidative stress in patients with diabetic retinopathy (DR).Methods Totally 140 patients with type 2 diabetes (T2DM) in our hospital were selected,and underwent fundoscopy,fundus fluorescein angiography,and photograph examination.And according to the diagnosis from Chinese Medical Association Fundus Disease Group,the subjects were divided into 75 patients with non-diabetic retinopathy (NDR group),37 patients with nonproliferative diabetic retinopathy (NPDR group),and 28 patients with proliferative diabetic retinopathy (PDR group).Additional 70 patients,no blood sugar and abnormal hemoglobin,who received physical examination in our hospital were collected as normal control group.Then the levels of serum homocysteine (Hcy),vitamin B 12 (VitB 12),folic acid,superoxide dismutase (SOD),malondialdehyde (MDA),and reduced glutathione (GSH)were detected in each group.Then,the patients in the NPDR group was randomly divided into group A (18 patients) and group B (19 patients),and the former group was given orally with pancreatic kininogenase,and group B received VitB12 plus folic acid plus pancreatic kininogenase.After one month of treatment,the serum levels of Hcy,VitB12,fohc acid,SOD,MDA,and GSH were measured in the two groups.Results There were significant differences in the serum Hcy and MDA levels between the four groups (all P =0.000).The levels of both Hcy and MDA in the NDR group,NPDR group,and PDR group increased in turn and were significantly higher than those in the normal control group (all P ＜0.05).There were statistically significant differences in the serum VitB12,folic acid,SOD,and GSH levels among the four groups (all P =0.000).The levels of VitB12,folic acid,SOD,and GSH in the NDR group,NPDR group,PDR group decreased in turn and were significantly lower than those in the normal control group (all P ＜ 0.05).After one month of treatment,the levels of serum Hcy,MDA,VitB12,folic acid,SOD,and GSH in group A did not significantly changed when compared with before treatment (all P ＞=0.05);the serum Hcy and MDA levels in group B were significantly lower than before treatment (all P ＜ 0.05),serum VitB12,folic acid,SOD,GSH levels were significantly higher than before treatment (all P ＜ 0.05),and serum levels of Hcy and MDA in group B after treatment were significantly lower than those in group A (all P ＜ 0.05),VitB12,folic acid,SOD,and GSH levels were significantly higher than those in group A (all P ＜ 0.05).There was a positive correlation between serum Hcy and MDA level (r =0.79,P ＜ 0.05) and negative correlation with VitB12,folic acid,SOD,and GSH levels (r =-0.61,-0.54,-0.43,-0.57,all P ＜ 0.05).Conclusion Serum VitB12 and folic acid levels decreased,accompanied by increased Hcy level,and enhanced oxidative stress.Combination therapy with VitB12 and folic acid can decrease serum Hcy levels and alleviate oxidative stress responses in patients with DR.

Current advances on surgical treatment for knee articular cartilage injuries / 中国骨伤

Chondral injuries are short of self-healing ability and need to surgical repair after articular cartilage injury. Conventional treatment includes debridement and drainage under arthroscope, micro-fracture, osteochondral autograft transplantation (OATS), mosaiplasty and osteochondral allografts (OCA), autologous chondrocyte implantation (ACI). Debridement and drainage could remove pain factor, and has advantages of simple operation, wide clinical application and early clinical effect. Micro-fracture and osteochondral autograft transplantation is suitable for small area of cartilage repair, while the further effect showed that fibrous cartilage permeated by drill could decrease postoperative clinical effect. Osteochondral autograft transplantation has better advantages for reconstruction complete of wear-bearing joint. Autologous chondrocyte implantation and allogeneic cartilage transplantation are suitable for large area of cartilage defect, postoperative survival of allogeneic cartilage transplantation is effected by local rejection reaction and decrease further clinical effect. Cartilage tissue engineering technology could improve repair quality of autologous chondrocyte implantation, and make repair tissue close to transparent cartilage, but has limit to combined subchondral bone plate, reactive bone edema, bone loss and bad axis of lower limb. New technology is applied to cartilage injury, and has advantages of less trauma, simple operation, rapid recover, good clinical effect and less cost;and could be main method for treat cartilage injury with surgical repair technology. How to improve repair quality with compression resistance and abrasive resistance are expected to be solved.

Analysis of influencing factors the postoperative axial symptoms of cervical single open-door laminoplasty / 中国骨伤

OBJECTIVE@#To explore the influencing factors and possible mechanism of axial symptoms(AS) after C₃-C₇ single open-door laminoplasty in patients with chronic compression cervical myelopathy.@*METHODS@#The clinical data of 32 patients with multi-segment chronic compression cervical cord disease treated by C₃-C₇ single open-door laminectomy from May 2012 to July 2016 were retrospectively analyzed. Including cervical spondylotic myelopathy of 14 cases, developmental cervical stenosis complicated with cervical myelopathy of 8 cases, ossification of posterior longitudinal ligament(OPLL) of 10 cases. There were 17 males and 15 females, aged from 47 to 82 years old with an average of 57.46 year, the course of disease was 5 to 35 months with an average of 22.4 months. The opening angle(OA), cervical curvature angle(CA), preoperative spinal cord compression rate(PSCR) and postoperative spinal cord shift (PSCS) were recorded. After 2 weeks of surgery, determining whether occurred an AS condition according to the AS assessment criteria, the patients were divided into a axial symptom group and a non-axial symptom group, the general data and imaging parameters of the two groups were compared and the factors that may be postoperative AS were analyzed by binary Logistic regression analysis.@*RESULTS@#At 2 weeks after operation, 13 patients occurred AS. There was no significant difference in gender, age and course of disease between axial symptom group and a non-axial symptom group (>0.05). In axial symptom group, OA was(36.76±9.35)°, CA was(11.53±4.36)°, PSCR was(27.83±1.72)%, PSCS was (3.17±0.81) mm, while in non-axial symptom group, above items were (33.03±10.52)°, (7.71±4.73)°, (25.16±3.59)%, (2.43±0.95) mm, respectively, there was significant difference in CA, PSCR, PSCS between two groups(0.05). The results of the binary Logistic regression analysis of 3 parameters(OA, PSCR, PSCS) and AS showed OA and PSCR were eliminated in dependent variables, and the partial regression coefficient of PSCR was 0.311, and =0.031.@*CONCLUSIONS@#CA, PSCR, and PSCS are related influencing factors of AS, and PSCS is a high risk factor for AS. C₄,₅ nerve traction caused by posterior spinal movement, postoperative dural self-expansion causes greater traction of the spinal cord, excessive deformation of the cervical spinal cord causes autonomic nerve damage or necrosis that dominates blood vessels may be the pathogenesis of AS, but this is only a theoretical inference, and further improved experiment is necessary to verify it in the future.

Treatment of posterior cruciate ligament avulsion fracture with rivet-assisted hollow nail:a case-control study / 中国骨伤

<p><b>OBJECTIVE</b>To retrospectively investigate the clinical effect of the rivet-assisted hollow screw in the treatment of posterior cruciate ligament avulsion fracture.</p><p><b>METHODS</b>Total 49 patients with knee cruciate ligament avulsion fracture in the ending point of the ligament from January 2010 to December 2014 were divided into the treatment group and the control group. Thirty-one patients in treatment group were treated with rivet-assisted double cannulate nail, including 13 males and 18 females, ranging in age from 38 to 51 years old, with a mean of (40.6±5.1) years old; according to Meyers classification, 23 cases of type 2, 8 cases of type 3; 5 patients were caused by the low energy injury and 26 patients were caused by the high energy injury. Eighteen patients in control group were treated with double gold hollow screw fixation, including 5 males and 13 females, ranging in age from 36 to 52 years old, with an average age of (4.16±4.7) years old; according to Meyers classification, 14 cases of type 2 and 4 cases of type 3;2 patients were caused by the low energy injury and 16 patients were caused by the high energy injury. The operation time, postoperative complications, fracture healing time and the last AKS scoring system were compared between the two groups.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 12 to 24 months, with an average of 14.2 months. The patients in treatment group had no displacement of fracture fragments and internal fixation failure. The results of AKS score:pain was 48.1±1.5, activity was 21.3±2.7, stability was 20.9±2.5, walking ability was 47.3±1.9, under the stairs ability was 43.4±2.1, the total score was 190.7±2.9. There were 2 cases in control group had fracture fragment displacement and 1 patient had nail withdraw. The results of AKS score:pain was 40.1±2.2, activity was 20.1±0.2, stability was 18.1±3.2, walking ability was 46.3±1.7, under the stairs ability was 40.2 ±1.3, the total score was 180.2±1.4. Therefore, the comparison of the above indicators, the results of the treatment group were better than those of the control group.</p><p><b>CONCLUSIONS</b>Rivet-assisted hollow screw fixation in the treatment of cruciate ligament avulsion fracture in the ending, has some advantages such as follows:accurate reduction, less postoperative complications and better postoperative knee function recovery, therefore it is an effective way to treat posterior cruciate ligament avulsion fracture.</p>

Case-control study on InterTan intramedullary nail in treating coronal femoral intertrochanteric fracture in elderly / 中国骨伤

<p><b>OBJECTIVE</b>To compare clinical effect of closed reduction and limited open reduction and internal fixation with InterTan intramedullary nail in treating elderly patients with coronal femoral intertrochanteric fracture.</p><p><b>METHODS</b>From January 2013 to December 2015, 23 elderly patients with coronal femoral intertrochanteric fracture were divided into two groups according to different ways of reduction to be retrospectively analyzed. There were 12 cases with closed reduction and internal fixation with InterTan intramedullary nail group (closed reduction group), including 7 males and 5 females with an average age of(63.6±12.1) years old; while 11 cases with limited open reduction and internal fixation with InterTan intramedullary nail group(limited reduction group), including 6 males and 5 females with an average of (60.8±12.5) years old. Intraoperative blood loss, fluoroscopy, operative time, postoperative complications, hospital stays and bone healing time were observed and compared. Harris score of hip joint at 1 year after operation was compared between two groups.</p><p><b>RESULTS</b>The incisions between two groups were healed well at stage I, and no complications occurred. One case was died during following-up, and 22 cases were obtained following-up from 12 to 23 months with an average of 13.6 months. There were significant difference in operative time, intraoperative blood loss and fluoroscopy(<0.05); while no difference in hospital stays, postoperative complications(>0.05). Harris score at 1 year after operation in open reduction group was(83.9±8.9), and(83.4±9.1) in closed reduction group without significant difference between two groups(>0.05).</p><p><b>CONCLUSIONS</b>Closed reduction and limited open reduction with InterTan intramedullary nail internal fixation for the treatment of intertrochanteric femoral coronal fractures could achieve good clinical effects, the former to receive more radiation dose, with less trauma;while the latter has disadvantages of long blood bleeding and operative time, but could obtain high quality of reduction.</p>

Delayed lower extremity deep venous thrombosis after operation for osteofibrous dysplasia of the left femur: report of one case / 浙江大学学报·医学版

Lower extremity deep venous thrombosis (LDVT) is one of the most common complications in orthopedic surgery, and it often occurs in the first 24 h after operation. We report a case of delayed LDVT, which occurred on d 16 after operation for osteofibrous dysplasia on the left femur. Upon the diagnosis confirmed, thrombolysis and anticoagulation therapy was conducted. The symptoms disappeared 3 weeks later and lower limb vascular ultrasound examination showed no remnant thrombosis.

Case-control study on needle-knife to cut off the medial branch of the lumbar posterior ramus under C-arm guiding for the treatment of low back pain caused by lumbar facet osteoarthritis / 中国骨伤

<p><b>OBJECTIVE</b>To study the clinical efficacy of needle-knife to cut off the medial branch of the lumbar posterior ramus under C-arm guiding to treat low back pain caused by lumbar facet osteoarthritis.</p><p><b>METHODS</b>From July 2009 to June 2011, 60 patients with low back pain caused by lumbar facet osteoarthritis were reviewed,including 34 males and 26 females, ranging in age from 39 to 73 years old,averaged 61.9 years old; the duration of the disease ranged from 6 to 120 months, with a mean of 18.9 months. All the patients were divided into two groups, 30 patients (18 males and 12 females, ranging in age from 39 to 71 years old, needle-knife group) were treated with needle-knife to cut off medial branch of the lumbar posterior ramus under C -arm guiding and the other 30 patients(16 males and 14 females, ranging in age from 41 to 73 years old, hormone injection group) were treated with hormone injection in lumbar facet joint under C-arm guiding. The preoperative JOA scores and the scores at the 1st, 12th and 26th weeks after treatment were analyzed.</p><p><b>RESULTS</b>Before treatment,the JOA scores between the two groups had no significant difference (P= 0.479); after 1 week of treatment, the JOA scores between the two groups had significant difference (P= 0.040), the improvement rate of hormone injection group was superior than that of the needle-knife group,which were (58.73+/-18.20)% in needle-knife group and (71.10+/-22.19)% in hormone injection group; after 12 weeks of treatment, the JOA scores between the two groups had no significant difference(P=0.569), and the improvement rate between the two groups had no significant difference,which were (50.09+/-19.33)% in the needle-knife group and (48.70+/-18.36)%) in the hormone injection group; after 26 weeks of treatment,the JOA scores between the two groups had significant difference (P=0.000), the improvement rate of hormone injection group was superior than that of the needle-knife group,which were (48.56+/-28.24)% in needle-knife group and (15.62+/-11.23 )% in hormone injection group.</p><p><b>CONCLUSION</b>Using needle-knife to cut off the medial branch of the lumbar posterior ramus could get longer efficacy than hormone injection in the treatment of lumbar facet osteoarthritis.</p>

Efficacy and safety of using denervation to treat the low back pain due to lumbar joint origin / 中国骨伤

<p><b>OBJECTIVE</b>To explore efficacy and safety of using denervation of dorsal medial branch to treat the low back pain due to lumbar joint origin.</p><p><b>METHODS</b>From March 2009 to October 2010,10 patients with the low back pain due to lumbar joint origin were enrolled in this study including 6 males and 4 females with an average age of 56.4 years old (41 to 68). The average disease duration was 1.2 years (0.5 to 3). All patients were operated by blocking the dorsal medial branch. Single branch (dorsal medial branch of the involved level), dual branches (dorsal medial branches of the involved and the upper or lower level, 5 with the upper level, 5 with the lower level), three branches (dorsal medial branches of the involved and the upper and lower levels), four branches (dorsal medial branches of the involved and the upper two and lower levels) were blocked by 0.5% lidocaine 15 ml compounded with betamethasone injection 1 ml (10 mg/ml) and a cobalt ammonium injection 500 microg at the junction of the superior articular process and the transverse process. Low back pain VAS, average EMG of multifidus of the involved level and low back muscle strength were assessed and statistically compared. Low back muscle strength was measured by the back power meter.</p><p><b>RESULTS</b>The mean low back pain VAS of the 10 patients in the preoperation was 6.85 +/- 1.55, in single branch blocked group was 5.80 +/- 1.05, in dual branches blocked group was 3.65 +/- 1.20, in three branches blocked group was 2.80 +/- 1.10 and in four branches blocked group was 2.75 +/- 1.15. Average EMG of multifidus was 69.25 +/- 2.13 in the preoperation,in single branch blocked group was 62.15 +/- 1.85, in dual branches blocked group was 51.25 +/- 1.28, in three branches blocked group was 47.30 +/- 1.85 and in four branches blocked group was 45.96 +/- 1.98. The mean low back muscle strength was 60 kg in the preoperation, in single branch blocked group was 55 kg,in dual branches blocked group was 48 kg, in three branches blocked group was 44 kg and in four branches blocked group was 43 kg. Among the dual branches blocked group,low back pain VAS and low back muscle strength in the dorsal medial branches of the involved and the upper level blocked showed great decline compared with those in the dorsal medial branches of the involved and the lower level blocked.</p><p><b>CONCLUSION</b>It is effective by denervation of dorsal medial branch to treat the low back pain due to lumbar joint origin. There are significant difference in low back pain VAS between every two among the preoperation,single branch blocked group,dual branches blocked group and three branches blocked group. There is no significant difference between four branches blocked group and three branches blocked group. In low back muscle strength and average EMG of multifidus, compared with the preoperation group,there is no significant decline in single branch blocked and dual branches blocked group,and there is significant decline in three branches blocked and four branches blocked group. Therefore, single or dual dorsal medial branch blocked is safety. Among the dual branches blocked group, dorsal medial branches of the involved and the upper level blocked should be given priority to. There is a certain risk in three or four dorsal medial branches blocked which should be used with caution.</p>

Surgical treatment of degenerative lumbar scoliosis with spinal stenosis / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effects of limited decomression, fixation, and fusion in treating degenerative scoliosis with spinal stennosis.</p><p><b>METHODS</b>From June 2002 to January 2009, 26 patients of degenerative scoliosis with spinal stenosis were treated with limited decomression, fixation, and fusion. There were 6 males and 20 females with an average age of 61.3 years (ranged, 51 to 72 years). Course of disease of spinal stenosis was from 11 months to 6 years with an average of 36 months. X-ray, CT, MRI examination were performed preoperatively for all the cases and myelography was performed for 6 cases. Preoperative Cobb's angle,focal lordosis angle,the distance between C7 plumb line (C7PL) and upper edge of S1 vertebral body (SVA), and the distance between C7PL and center sacral vertical line (CSVL) were (22.0 +/- 10.1) degrees, (21.6 +/- 10.2) degrees, (7.6 +/- 6.4) cm, (6.8 +/- 5.6) cm respectively. Measured Cobb's angle, focal lordosis angle, SVA, CSVL after operation and final follow-up were compared with preoperative data. JOA score system were used to evaluate clinical effects.</p><p><b>RESULTS</b>The operative time All the patients were followed up from 1.3 to 5 years with an average of 2.5 years. Postoperative and final follow-up, Cobb's angle was (10.5 +/- 8.2) degrees, (8.8 +/- 5.2) degrees, respectively; focal lordosis angle was (25.4 +/- 14.2) degrees, (31.6 +/- 13.2) degrees, respectively; SVA was (0.6 +/- 3.3) cm, (-1.2 +/- 2.5) cm,respectively; CSVL was (2.8 +/- 1.3) cm, (1.6 +/- 1.2) cm, respectively. There was significant difference in data before and after operation. Preoperative, instantly postoperative, final follow-up, JOA score was 11.0 +/- 1.7, 22.4 +/- 2.4, 24.0 +/- 2.1, respectively; 13 cases obtained excellent results, 8 good, 3 fair, 2 poor. Loss of correction occurred in one case. No collapse of intervertebral space, nerve injury, breakage of fixation system were found.</p><p><b>CONCLUSION</b>Surgical treatment with limited decompression, pedicle screw fixation and fusion is effective method for degenerative scoliosis with spinal stenosis, individualized surgery design should be made according to clinical symptoms, signs and imaging features.</p>

Clinical study on surgical treatment for thoracolumbar burst fractures / 中国骨伤

<p><b>OBJECTIVE</b>To explore the choice of operative approach for thoracolumbar burst fractures and evaluate its clinical effects.</p><p><b>METHODS</b>From September 2005 to March 2009, the clinical data of 94 patients with thoracolumbar burst fractures were analyzed retrospectively. Including 59 males and 35 femals with an average age of 36.8 years (ranged from 20 to 63). The fractures were classified according to Denis classification: 17 cases of type A, 32 cases of type B, 6 cases of type C, 24 cases of type D, 15 cases of type E. Neurological injuries were classified according to ASIA classification: 3 cases of grade A, 4 cases of type B, 23 cases of grade C, 38 cases of grade D, 26 cases of grade E. Among the patients, 42 cases were treated with reduction, decompression, internal fixation with pedicle-screw through posterior approach, meanwhile, of them, 18 cases with posterior-lateral bone graft fusion; 36 cases were treated with decompression, bone graft, through anterior approach, of them, 16 cases with TSRH system fixation and 20 cases with Zeplate system fixation; 16 cases (because of bone block intruded into vertebral canal leading to spinal cord compression ) were treated with anterior and posterior approach, internal fixation with pedicle-screw through posterior approach and subtotal vertebrectomy, decompression, titanium mesh cages bone graft fusion through anterior approach, meanwhile, of them, 8 cases with screw-rod and titanium steel plate system fixation.</p><p><b>RESULTS</b>All patients obtained good results and were followed up from 9 to 52 months with an average of 22.8 months. Cobb angle were corrected from preoperatively (25.00 +/- 5.50) degrees to postoperatively (4.20 +/- 1.80) degrees. Height of anterior and posterior border of vertebral body improved from preoperatively (50.80 +/- 2.82)%, (79.30 +/- 3.08)% to postoperatively (94.85 +/- 1.80)%, (98.20 +/- 1.40)%, respectively. The ratio of protruded bones to the spinal canal anteroposterior diameter decreased from preoperatively (33.10 +/- 1.40)% to postoperatively (6.70 +/- 1.50)%. Sagittal abnormity were corrected; posterior convex angle and height were no markedly lost during follow-up; no internal fixation loosening and titanium mesh displacement were found. In the aspect of never function, except for 1 case of grade A there is no recovered others obtained different improvement, among them, from grade A to B was in 2 cases; B to C, D was in 2,2, respectively; C to D, E was 16,7, respectively; D to E was in 38 cases.</p><p><b>CONCLUSION</b>The two factors decide surgical methods:the integrity of posterior ligamentous complex and nervous system function. Anterior approach refers to patients with incomplete spinal cord injury and anterior vertebral canal compression; posterior approach refers to patients with injury of posterior ligamentous complex; combination with anterior and posterior approach refers to patients with two injury factors.</p>

Surgical treatment of the old with degenerative lumbar spinal stenosis / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the perioperative characteristics and surgical methods in treating the old with degenerative lumbar spinal stenosis.</p><p><b>METHODS</b>From January 2000 to October 2007, 36 patients with degenerative lumbar spinal stenosis with the age more than 60 years,including 16 males and 20 females, the age from 60 to 81 years with an average of 67.5 years. Of all patients, 6 cases were treated by simple surgical decompression, 16 cases by decompressive laminectomy, 20 cases by decompressive laminectomy combined with internal fixation and fusion.</p><p><b>RESULTS</b>No death cases occurred during perioperation and complication occurred in 14 cases, including cerebrospinal fluid leakage in 3 cases, incision late healed in 1 case, heart abnormal symptom in 1 case, respiratory infection in 1 case, gastrointestinal symptom in 4 cases, urinary system infection in 1 case, spirital symptom in 1 case. After symptomatic treatment, all complications improved. All the cases were followed up from 6 months to 5 years with an average of 2.5 years. Oswestry scoring improved from preoperative 45.66 +/- 7.12 to postoperative 16.80 +/- 5.75, there was significant difference between before and after operation (P < 0.05).</p><p><b>CONCLUSION</b>The age and heath condition are not operative absolute contraindication in treating old with degenerative lumbar spinal stenosis,with the proper operation modus after controlling concomitant diseases, the surgical treatment could guarantee the satisfactory therapeutic effect.</p>

Small needle-knife for the treatment of heel pain according to its classification / 中国骨伤

<p><b>OBJECTIVE</b>To treat heel pain with small needle-knife according to its classification,so as to improve the therapeutic effects.</p><p><b>METHODS</b>From August 2005 to December 2008, 200 patients with 266 heel pain were treated according to the author's classification standards. There were 83 males and 117 females, ranging in age from 26 to 72 years, with a mean age of 46 years; the course of the disease ranged from 3 to 36 months, averaged 6.8 months. According to the classification:67 heels with plantar fasciitis type, 61 heels with calcaneal bursitis type, 36 heels with plantar fat pad inflammation-based type, 6 heels with calcaneus high pressure-type, 21 heels with nerve compression type, 75 heels with mixed type. All the patients were treated with small needle-knife by using different methods according to its classification.</p><p><b>RESULTS</b>After 1 month treatment, among the patients with plantar fasciitis-type, 31 heels got an excellent result,36 good;among the patients with calcaneal bursitis type, 32 heels got an excellent result, 29 good; among the patients with plantar fat pad inflammation-based type, 9 heels got an excellent result, 20 good, 4 poor and 3 bad; among the patients with calcaneus high pressure-type, 1 patient got an excellent result, 3 good and 2 poor; among the patients with nerve compression type, 11 heels got an excellent result, 8 good, 1 poor and 1 bad; among the patients with mixed type, 16 heels got an excellent result, 46 good, 5 poor and 8 bad. At the 6th month after treatment, among the patients with plantar fasciitis-type, 21 heels got an excellent result, 40 good,5 poor and 1 bad; among the patients with calcaneal bursitis type, 30 heels got an excellent result, 28 good and 3 poor; among the patients with plantar fat pad inflammation-based type, 15 heels got an excellent result, 18 good, 2 poor and 1 bad; among the patients with calcaneus high pressure-type, 0 patient got an excellent result, 3 good and 3 poor;among the patients with nerve compression type,7 heels got an excellent result, 11 good, 1 poor and 2 bad; among the patients with mixed type, 10 heels got an excellent result, 45 good, 11 poor and 9 bad.</p><p><b>CONCLUSION</b>The causes of heel pain can't be explained by using single pathogenesy,and also can't be treated with one method. The patients with calcaneal pain should be treated with different methods according to classification of heel pain, and thus the therapeutic effects can be improved.</p>