Cement-Augmented Screw Fixation with PHILOS Plating for Osteoporotic Proximal Humeral Fractures: An Observation of Mid- and Long-Term Curative Efficacy.

OBJECTIVES: The mid- and long-term clinical outcomes of cement-augmented screws in the treatment of osteoporotic proximal humeral fractures have rarely been reported. The aim of this study was to observe the mid- and long-term efficacy of combined cement-augmented screw fixation and PHILOS plating in the treatment of osteoporotic fractures of the proximal humerus. METHODS: This study retrospectively analyzed data from 19 patients with osteoporotic fractures of the proximal humerus who had undergone internal fixation at the Guizhou Provincial People's Hospital from February 2017 to May 2021. The cohort was comprised of six males and 13 females, aged 75-87 (mean age: 82.52 ± 1.24) years. According to the Neer classification, three, 12, and four patients had two-part, three-part, and four-part fractures, respectively. All patients were treated with open reduction internal fixation with cement-augmented screws and PHILOS plating. Time until fracture healing was recorded postoperatively. Patients were observed for postoperative complications, including humeral head necrosis, loosening or breaking of the augmented screws, screw perforation of the humeral head, and varus fracture displacement. Visual analog scale and Constant scores of the shoulder joint were compared 1, 3, 6, and 12 months after surgery. Scores at the most recent follow-up were used to evaluate shoulder joint function. Measured data conforming to a normal distribution were expressed as mean ± SD. Analysis of variance or rank sum tests were used for intergroup comparisons. A value of p < 0.05 was considered significant. RESULTS: All 19 patients followed up for 1-4 (average: 2.13 ± 0.61) years. Fractures united in all cases, with a healing time of 8-14 (average: 10.25 ± 1.72) weeks. There were no cases of humeral head necrosis, screw loosening, fractures, or perforation of the humeral head. One patient had mild varus fracture displacement with a reduced neck-shaft angle. There were significant differences in visual analog scale and Constant scores 1, 3, and 6 months after surgery (p < 0.05). The visual analog scale score was 0 at final follow-up in all cases. The Constant score of the shoulder joint was excellent, good, fair, and poor in two, 12, four, and one case, respectively, yielding an excellent and good rate of 73.68%. CONCLUSIONS: Cement-augmented screw fixation combined with PHILOS plating of osteoporotic proximal humeral fractures had good mid- and long-term clinical efficacy. It should be considered a new option for fracture treatment in such patients.

99mTc-methylene diphosphonate SPECT/CT imaging of gout spondylitis: a case report.

Single-photon emission computed tomography (SPECT)/computed tomography (CT) imaging of the gouty spine is rare. We describe a 66-year-old man who presented with pain and numbness in the right lower leg; he reported a 2-month history of intermittent low back pain. Imaging revealed neoplastic lesions of the spine, which were initially regarded as tumors. Thus, the patient underwent surgical removal of the lumbar lesion. However, the postoperative pathological diagnosis was gout spondylitis. In this report, we show multimodal images of advanced gout spondylitis. The metabolic information provided by SPECT/CT, combined with the microscopic changes in bone structure revealed by dual-source thin-layer CT and the anatomical localization information provided by magnetic resonance imaging, can help clinicians to more fully understand the pathophysiological mechanisms and imaging manifestations of gout from multiple perspectives, thereby reducing the rate of misdiagnosis.

miR-23a-3p regulated by LncRNA SNHG5 suppresses the chondrogenic differentiation of human adipose-derived stem cells via targeting SOX6/SOX5.

Cartilage generation and degradation are controlled by miRNAs. Our previous study showed miR-23a-3p was downregulated during chondrogenic differentiation in chondrogenic human adipose-derived mesenchymal stem cells (hADSCs). In the present study, we explored the function of miR-23a-3p in chondrogenesis differentiation. The role of miR-23a-3p in chondrogenic differentiation potential of hADSCs was assessed by Alcian blue staining, quantitative real-time polymerase chain reaction (qRT-PCR), and Western blot. We show that miR-23a-3p suppressed the chondrogenic differentiation of hADSCs. LncRNA SNHG5 interacted with miR-23a-3p, and suppression or overexpression of SNHG5 correlates with inhibition and promotion of hADSC chondrogenic differentiation, respectively. We have determined that SNHG5 can sponge miR-23a-3p to regulate the expression of SOX6/SOX5, transcription factors that play essential roles in chondrocyte differentiation. Furthermore, the overexpression of SNHG5 activates the JNK/MAPK/ERK pathway. In conclusion, miR-23a-3p regulated by lncRNA SNHG5 suppresses the chondrogenic differentiation of human adipose-derived stem cells via targeting SOX6/SOX5.

An Individualized Intra-Articular Stabilization Device Designed Based on 3D Printing Technology for Traumatic Instability of the Ulnohumeral Joint.

We aimed to design an individualized intra-articular stabilization device based on 3D printing technology and investigate the clinical effects of this device for treating traumatic instability of the ulnohumeral joint. This study enrolled nine patients with traumatic instability of the ulnohumeral joint (age: 47.2 ± 1.80 years) who received treatment between March 2018 and March 2019 in our hospital. All patients underwent a thin-layer computed tomography (CT) scan of the elbow before surgery. The original injury and repair models of the elbow were printed using 3D printing technology based on CT data. An individualized intra-articular stabilization device was designed with a 2.0 mm Kirschner wire based on the repair model. Nine patients agreed to receive surgical treatment for elbow disease and placement of the intra-articular stabilization device. The nine patients underwent open reduction through a posterior median approach, and the intra-articular stabilization device was placed in the elbow. Operation time, intraoperative blood loss, and postoperative complications were recorded and followed up. The device was removed at two postoperative months, and the Mayo score was used to evaluate elbow function. Four months after removing the intra-articular stabilization device, elbow joint function was evaluated again using the Mayo score. The mean operation time was 100.1 ± 8.2 min, and the mean intraoperative blood loss was 35.5 ± 7.1 ml. No complications occurred after operation. Two months after surgery, eight patients received an excellent Mayo score, and one patient received a good Mayo score. Four months after removal of the intra-articular stabilization device, eight patients received an excellent Mayo score, and one patient received a good Mayo score. The individualized intra-articular stabilization device can increase ulnohumeral stability and achieve rapid functional recovery of the elbow.

Osteochondral repair using scaffolds with gradient pore sizes constructed with silk fibroin, chitosan, and nano-hydroxyapatite.

BACKGROUND: One of the main problems associated with the development of osteochondral reparative materials is that the accurate imitation of the structure of the natural osteochondral tissue and fabrication of a suitable scaffold material for osteochondral repair are difficult. The long-term outcomes of single- or bilayered scaffolds are often unsatisfactory because of the absence of a progressive osteochondral structure. Therefore, only scaffolds with gradient pore sizes are suitable for osteochondral repair to achieve better proliferation and differentiation of the stem cells into osteochondral tissues to complete the repair of defects. METHODS: A silk fibroin (SF) solution, chitosan (CS) solution, and nano-hydroxyapatite (nHA) suspension were mixed at the same weight fraction to obtain osteochondral scaffolds with gradient pore diameters by centrifugation, freeze-drying, and chemical cross-linking. RESULTS: The scaffolds prepared in this study are confirmed to have a progressive structure starting from the cartilage layer to bone layer, similar to that of the normal osteochondral tissues. The prepared scaffolds are cylindrical in shape and have high internal porosity. The structure consists of regular and highly interconnected pores with a progressively increasing pore distribution as well as a progressively changing pore diameter. The scaffold strongly absorbs water, and has a suitable degradation rate, sufficient space for cell growth and proliferation, and good resistance to compression. Thus, the scaffold can provide sufficient nutrients and space for cell growth, proliferation, and migration. Further, bone marrow mesenchymal stem cells seeded onto the scaffold closely attach to the scaffold and stably grow and proliferate, indicating that the scaffold has good biocompatibility with no cytotoxicity. CONCLUSION: In brief, the physical properties and biocompatibility of our scaffolds fully comply with the requirements of scaffold materials required for osteochondral tissue engineering, and they are expected to become a new type of scaffolds with gradient pore sizes for osteochondral repair.

Application of silk fibroin/chitosan/nano-hydroxyapatite composite scaffold in the repair of rabbit radial bone defect.

Silk fibroin (SF), chitosan (CS) and nano-hydroxyapatite (nHA) possess excellent biocompatibility, thus, these were used to construct a SF/CS/nHA composite scaffold. Previously published results identified that this material exhibited satisfactory physical and chemical properties, and therefore qualified as a repair material in bone tissue engineering. The aim of the present study was to investigate the capacity and mechanism of this composite scaffold in repairing bone defects. In total, 45 New Zealand white rabbits were used to model defect in the right radial bone. A radial bone defect was induced, and rabbits were divided into the following treatment groups (n=15 in each): Group A, in which the SF/CS/nHA scaffold was implanted; group B, in which the SF/CS scaffold was implanted; and group C, in which rabbits did not receive subsequent treatment. X-ray scanning, specimen observation and histopathological examination were implemented at 1, 2, 3 and 4 months after modeling, in order to evaluate the osteogenic capacity and mechanism. At 1 month after modeling, the bone density shadow in the X-ray scan was darker in group A as compared with that in group B. Observation of the pathological specimens indicated that normal bone tissues partially replaced the scaffold. At 2 months, the bone density shadow of group A was similar to normal bone tissues, and normal tissue began to replace the scaffold. At 3-4 months after modeling, the X-ray scan and histopathological observation indicated that the normal bone tissues completely replaced the scaffold in group A, with an unobstructed marrow cavity. However, the bone mass of group B was lower in comparison with that of group A. The bone defect induced in group C was filled with fibrous connective tissues. Therefore, it was concluded that the SF/CS/nHA composite scaffold may be a promising material for bone tissue engineering.

A silk fibroin/chitosan scaffold in combination with bone marrow-derived mesenchymal stem cells to repair cartilage defects in the rabbit knee.

Bone marrow-derived mesenchymal stem cells (BMSCs) were seeded in a three-dimensional scaffold of silk fibroin (SF) and chitosan (CS) to repair cartilage defects in the rabbit knee. Totally 54 rabbits were randomly assigned to BMSCs + SF/CS scaffold, SF/CS scaffold and control groups. A cylindrical defect was created at the patellofemoral facet of the right knee of each rabbit and repaired by scaffold respectively. Samples were prepared at 4, 8 and 12 weeks post-surgery for gross observation, hematoxylin-eosin and toluidine blue staining, type II collagen immunohistochemistry, Wakitani histology. The results showed that differentiated BMSCs proliferated well in the scaffold. In the BMSCs + SF/CS scaffold group, the bone defect was nearly repaired, the scaffold was absorbed and immunohistochemistry was positive. In the SF/CS scaffold alone group, fiber-like tissues were observed, the scaffold was nearly degraded and immunohistochemistry was weakly positive. In the control group, the defect was not well repaired and positive immunoreactions were not detected. Modified Wakitani scores were superior in the BMSCs + SF/CS scaffold group compared with those in other groups at 4, 8 and 12 weeks (P < 0.05). A SF/CS scaffold can serve as carrier for stem cells to repair cartilage defects and may be used for cartilage tissue engineering.