[Risk factors for infections after arthroscopic rotator cuff repair].

OBJECTIVE: To explore risk factors for infections after arthroscopic rotator cuff repair, and improve the under standing for reducing infection. METHODS: Clinical data of 2 591 patients who underwent arthroscopic rotator cuff repair from January 2019 to January 2022 were retrospectively analyzed, including 1 265 males and 1 326 females, aged from 25 to 82 years old with an average age of (51.5±15.6) years old. They were divided into infection group(n=18) and uninfected group(n=2 573) according to whether or not patients had postoperative infection. Gender, age, smoking, diabetes, body mass index, local closure within 1 month before operation, operation time, preventive use of antibiotics, and internal fixation implantation between two groups were recorded. Univariate Logistic regression analysis screened factors associated with infections after arthroscopic rotator cuff repair. Theresultswere entered into the multivariate logistic regression analysis, screening the high risk factors for infections after arthroscopic rotator cuff repair. RESULTS: In 2 591 patients, 18 patients were infected after operation, infection rate was 0.69%. Univariate Logistic regression analysis showed that gender, age, operation time, antibiotic prophylaxis, internal fixation implantation were risk factors for infections after arthroscopic rotator cuff repair. Multivariate Logistic regression analysis showed male(OR=14.227), age≥65 years(OR=34.313), operation time≥2 h (OR=15.616), without antibiotic prophylaxis(OR=4.891), and internal fixation implantation(OR=5.103) were major risk factors for infection after arthroscopic rotator cuff repair(P<0.05). CONCLUSION: Male, age≥65 years, operation time≥2 h, without antibiotic prophylaxis and internal fixation implantation were independent risk factors for infection after arthroscopic rotator cuff repair. Early diagnosis and timely treatment should be carried out to reduce the incidence of infection.

[Analysis of risk factors of healthy side fracture after hip fracture surgery in the elderly].

OBJECTIVE: To investigate the incidence and related risk factors of healthy side fracture after hip fracture surgery in the elderly, so as to provide basis for the prevention of re-fracture. METHODS: The data of 452 patients over 65 years old with femoral neck fracture or intertrochanteric fracture treated with hip arthroplasty or proximal femoral intramedullary nailing from June 2012 to June 2017 were analyzed, including 168 males and 284 females, the age ranged from 65 to 97(75.5±7.5) years. There were 191 cases of femoral neck fracture and 261 cases of femoral intertrochanteric fracture. According to whether there was a fracture in the healthy hip after operation, the patients were divided into fracture group and no fracture group. The gender, age, body mass index, fracture type, initial treatment method, bone mineral density, bed time, medical compliance, postoperative short-term delirium, whether there were medical diseases before injury and Harris score of hip joint in the final follow-up were recorded. Univariate Logistic regression analysis was used to screen out the risk factors of healthy side fracture after operation, and then statistically significant risk factors were included in multi factor Logistic regression analysis to screen out the independent risk factors of healthy side fracture after operation of hip fracture in the elderly. RESULTS: Among them, 42 of the 452 patients had hip fractures on the healthy side with an incidence of 9.3%. The average interval between the two fractures was (2.9±2.1) years. Univariate Logistic regression analysis showed that there were significant differences in age, bone mineral density, medical compliance, short-term postoperative deliriun, pre-injury complicated with medical diseases and Harris score of hip joint in the final follow-up (P<0.05). Multivariate Logistic analysis showed that age(OR=4.227), bone mineral density(OR=4.313), combined with medical diseases (OR=5.616) and low hip Harris score at the final follow-up (OR=3.891) were independent risk factors for healthy side fractures after hip fracture surgery in elderly(P<0.05). CONCLUSION: The age, bone mineral density, combined with medical diseases and low Harris score of hip joint in the final follow-up are the main risk factors of healthy side fracture after hip fracture in the elderly. It is necessary to strengthen the treatment of medical diseases, anti osteoporosis and improve hip joint function within 3 years after operation, so as to prevent the occurrence of healthy side hip fracture.

Mid-term results of bilateral synchronous total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis.

BACKGROUND: Total hip arthroplasty (THA) for bony ankylosis is technically challenging in patients with ankylosing spondylitis (AS). This study aimed to determine the mid-term results of bilateral synchronous THA for bony ankylosis in patients with AS. METHODS: Nineteen cases of bony ankylosis in patients with AS who received bilateral synchronous THA were included in this study (17 males and 2 females, mean age 49.2 years). Disease duration was 5-38 years (mean 18 years and 6 months). All patients received cementless THA. Intraoperative blood loss, visual analog scale (VAS) score, and complications were assessed. Harris hip scores evaluated the clinical effect. RESULTS: Patients were followed up for 62-98 months (mean 82.5 months). VAS score decreased from 7.42 ± 0.92 to 2.42 ± 0.83, Harris hip score improved from 21.8 ± 7.2 to 80.3 ± 6.5, and the flexion-extension range of the hip improved from 0 to 142.3 ± 6.2°. One patient with septum bronchiale had a fracture intraoperatively and was treated with wire strapping. One patient had a traction injury of the femoral nerve postoperatively and recovered 1 year after the operation. Loosening and subsidence were not observed in all patients. Heterotopic bone formation was noted in 3 patients. No complications such as joint dislocation, acute infection, and deep vein thrombosis were found. CONCLUSION: Bilateral synchronous THA was effective for bony ankylosis of the hip in patients with AS because it improved patients' quality of life and had satisfactory mid-term outcomes.

[Establishment of 3D finite element model of meniscus and its mechanical analysis].

OBJECTIVE: To establish a 3D finite element model of normal knee joint involved its meniscus, which can be used to simulate the anatomical morphology and characteristics of human knee joint, to verify the validity of the model by preliminary FEA mechanical analysis, and explain partially biomechanical mechanisms of meniscus. METHODS: CT and MRI data were harvested by scanning the knee joint of a healthy male volunteer, and then these data were imported into Mimics 10.01 software and Geomagic Studio software to constructed the 3D models of tissue structures of knee joint. These models were combined to constructed the 3D model of intact knee joint and meshed in ANSA software. Therefore the finite element model of intact knee joint was established. Finally, after the definitionof its material behavior, boundary conditions and loading. The finite element model of knee joint was analyzed and verified using ANSYS software. Meanwhile The biomechanical properties of meniscus were analyzed. RESULTS: The complete knee finite element model composed of bone, meniscus, articular cartilage, and major ligaments was established. It could effectively simulate the anatomical morphology and characteristics of knee joint and its meniscus. The contact area of medial meniscus was 771.05 mm2, while the contact area of lateral meniscus was 634.31 mm2, and the ratio was 1.216. The stress distribution was uniform, but the stress of the medial meniscus was higher than that of the lateral meniscus, and the peak stress located in the posterior horn of the medial meniscus and the anterior horn of the lateral meniscus, respectively, and the peak stress value was 4.11 MPa. The maximum displacement of the meniscus was located in body, and the displacement of the medial meniscus was more remarkable than that of the lateral meniscus, and the maximum displacement value is 0.33 mm. The obtained finite element analysis results corresponded to that reported in the literature, which mean the model's reliability. CONCLUSION: The established finite element model of knee joint are proved to be have validity, and is a useful model for finite element analysis of meniscus tear and menisectomy. The results of finite element analysis can explain partially biomechanical mechanisms of meniscus which can provide theoretical guidance for clinical treatment of meniscus injury.

[Progress in finite element analysis of meniscus].

The meniscus biomechanics is one of the hottest areas in medical research. Finite element analysis(FEA) provides a new method for biomechanical studies. Using the FEA, the stress force and strain distribution characteristics of the normal meniscus can be analysed by establishing the finite element model of the meniscus and utilizing finite element softwares. In addition, the finite simulation of the meniscus tears, meniscectomy, and knee tissue injury can assess the changes of meniscus biomechanical properties. These research results provide theoretical basis of biomechanics to prevent and treat knee joint injuries. However, the finite element analysis method has its limitations, future research will be aimed at establishing high quality finite element models, making the models offer more authentic simulations of the meniscus anatomy, and ensuring the FEA could be applied to research a variety of knee injuries.

[Comparison of long Gamma 3 nail and proximal femur locking plate for the treatment of femoral subtrochanteric fractures].

OBJECTIVE: To compare clinical efficacy of long Gamma 3 nail and proximal femur locking plate (PFLP) in treating femoral subtrochanteric fractures. METHODS: From January 2010 to January 2017, clinical data of 58 patients with subtrochanteric fractures followed more than 12 months were retrospective analyzed. Among them, 35 patients were treated with long Gamma 3 nail including 18 males and 17 females aged from 25 to 78 years old with an average of(66.5±23.5) years old;Causes of injury included fall on the ground in 18 cases, traffic accidents in 7 cases, and fall from height in 10 cases. The other 23 patients were treated with PFLP fixation including 8 males and 15 females aged from 31 to 81 years old with an average of (63.4±22.4) years old;Causes of injury included fall on the ground in 12 cases, traffic accidents in 6 cases, and fall from height in 5 cases. Operative time, blood loss (intraoperative and hidden blood loss), hospital stays, bone healing and complications were observed and compared. Harris hip score after 1-year following-up was used to evaluate postoperative clinical effect. RESULTS: Fifty-one patients were followed up from 14 to 36 months with an average of 24.8 months, including 31 patients were treated with long Gamma 3 and 20 patients were treated with PFLP. Blood loss(intraoperative and hidden blood loss) in PFLP group was less than that of long Gamma 3 nail group(P<0.05). There was no significant in operative time, hospital stays and complications between two groups(P>0.05). There was no significant differences in healing time of fractures between long Gamma 3 nail group (17.2±2.4) weeks and PFLP group (18.1±2.6) weeks(P<0.05). At 1-year following-up, there was no significant differences in Harris hip score between long Gamma 3 nail group(80.29±10.28) and PFLP group (76.49±12.28)(P<0.05). No complications such as pulmonary embolism and nonunion occurred. Two patients were treated with fitler whose occurred deep vein thrombosis. Postoperative pulmonary infection curred in 4 cases and was cured by anti-infection therapy. CONCLUSIONS: Both of long Gamma 3 nail and PFLP in treating patients with femoral subtrochanteric fractures can receive good clinical effects, long Gamma 3 nail is not suitable for the patients of the narrow medullary cavity and prominent anterior arch. PFLP is eccentric fixation, so early weight-bearing was not stress.

[Advanced progress on the treatment of anterior approach to the thoracolumbar vertebral fractures].

Thoracolumbar fractures are common and severe traumas. Anterior approaches can achieve adirect spinal cord decompression and reconstruct anterior column height what load bearing the major load distribution of the spine. Therefore, anterior approach is an important method in the treatment of thoracolumbar fractures. With the application of pedicle screw, most of the patients were treated with posterior approaches.Because of the unique advantages of anterior approach, the posterior approach can not be replaced it.The review summarizes the biomechanical characteristics? indications? fixation devices? bone grafting method and technique of the anterior approach and in order to provide better evidence for clinical treatment of thoracolumbar fractures.

Controlled study on Gamma nail and proximal femoral locking plate for unstable intertrochanteric femoral fractures with broken lateral wall.

The gamma nail and proximal femoral locking plate (PFLP) are both used for fractures. A controlled study was performed to determine the optimal implant. To assess and analyze the clinical effects of gamma nails and PFLPs for patients with unstable intertrochanteric femoral fractures, specifically with broken lateral walls. Thirty-six patients with unstable intertrochanteric femoral fractures and broken lateral walls were treated with gamma nails or PFLPs and retrospectively studied. The clinical data were compared. Duration of surgery and early full weight-bearing time were significantly longer in the PFLP group compared to the gamma nail group (P < 0.05). However, intraoperative fluoroscopy frequency and total blood loss in the PFLP group were significantly less than those in the gamma nail group (P < 0.05). No significant differences were found in hospitalized days, Parker Palmer mobility scores, Harris hip scores, and complications between the two groups. No difference in hip-functional recovery was found between the gamma nail group and the PFLP group, indicating that both the gamma nail and PFLP were effective for unstable intertrochanteric femoral fractures with a broken lateral wall. However, early weight bearing on the fractures was not encouraged in patients treated with PFLP.

Treatment of Neer IIb Distal Clavicle Fractures Using Anatomical Locked Plate Fixation With Coracoclavicular Ligament Augmentation.

PURPOSE: The purpose of this study was to evaluate the clinical and radiographic outcomes of Neer type IIb distal clavicle fractures treated with anatomical locking plate fixation combined with coracoclavicular ligament augmentation. METHODS: Twelve patients with Neer Type IIb distal clavicle fractures treated with anatomical locking plate fixation combined with suture anchor augmentation of the coracoclavicular ligament, were retrospectively studied. Clinical outcomes were assessed using the Constant score and the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Coracoclavicular distance was measured on plain radiographs. RESULTS: All patients were reexamined at a mean follow-up of 26.3 months (range, 25-30 months). Bony union occurred in all cases within 12 weeks and no major complications were encountered. At the final follow-up, the mean Constant score was 94 (range, 87-100) and the DASH score was 10.4 (range, 2-20). The mean postoperative coracoclavicular distance on the injured side was decreased by 40% compared with the preoperative status. CONCLUSIONS: Surgical fixation of Neer type IIb distal clavicle fractures using anatomical locking plate fixation combined with suture anchor augmentation of the coracoclavicular ligament was associated with a satisfactory functional outcome and low complication rate. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

[A medium term therapeutic effects of anatomic locking plate for femoral intertrochanteric with lateral femoral wall fractures].

OBJECTIVE: To retrospectively study medium term follow-up outcomes of the femoral intertrochanteric with lateral femoral wall fractures using anatomic locking plate fixation. METHODS: From June 2010 to January 2013, 18 cases of the unstable femoral intertrochanteric with lateral femoral wall fractures were treated with the anatomic locking plate, included 8 males and 10 females with an average age of 75.5 years ranging from 19 to 83 years old. There were 8 cases of traffic accident injuries, 6 cases of falls injuries, and 4 cases of falling from high place. The time from injury to operation was ranged from 1 to 14 days with an average of 4.5 days. The operation time, intraoperative blood loss and the length of hospitalization were recorded and analyzed. The fracture union was assessed by follow-up radiographs and hip functional recovery by PPMS and Harris hip scoring. RESULTS: All patients were followed up from 36 to 68 months with a mean of(44.8±8.8) months. The mean operative time was (61.02±38.28) min;the mean blood loss was (226.00±162.52) ml;the mean length of hospitalization was (10.8±9.2) days. During the follow-up period, no infection, deep veintllrombosis, screwed cut-out and implant failure occurred in all patients. Coxa vara with shortening deformity was noted in 2 cases. Bone union was found in all the cases. The bone healing time was ranged from 4 to 10 months with an average of 6.2 months. The mean PPMS score at the final follow-up was 7.22±2.36. The Harris score was 79.46±11.02, 5 cases were classified as excellent, 9 as good and 2 as fair. CONCLUSIONS: Proximal femoral anatomic locking plate can be used in treating intertrochanteric fractures with compromised lateral wall, which has a satisfied medium term follow-up outcomes, especially for complex fractures patterns in which intramedullary nailing may be difficult, and should not emphasis on premature loading.

[Inversive LISS plate in treating intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures].

OBJECTIVE: To study clinical effects of inversive LISS(less invasive stabilization system, LISS) plate for the treatment of intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures. METHODS: From January 2012 to January 2015, 24 patients with intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures were treated with inversive LISS plate, included 16 males and 8 females with an average age of 62.5 years old ranged from 35 to 81 years old. There were 8 cases of traffic accident injuries, 3 cases of falling from high place, and 13 cases of falls injuries. The time from injury to operation was ranged from 2 to 12 days with an average of 5.2 days. The operation time, intraoperative blood loss and the length of hospitalization were analyzed. The fracture union was assessed by follow-up radiographs and hip functional recovery by Harris hip scoring. RESULTS: All patients were followed up for 16.2 months (ranged, 18 to 36 months). The mean operative time was (68.22±48.36) min;the mean blood loss was (256.28±182.46) ml;the mean time of hospitalization was(14.8±5.2) days. There were no complications such as deep infection, deep vein thrombosis, pulmonary embolism and bone nonunion during the follow up period. The bone healing was ranged from 3 to 8 months with an average of 4.8 months. The mean Harris score was 76.49±12.28 at the final follow-up, 15 cases were classified as excellent, 6 as good and 3 as fair. CONCLUSIONS: Inversive LISS plate can be used in treating with intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures, and should not emphasis on premature loading.

Mechanisms underlying the antiapoptotic and anti-inflammatory effects of monotropein in hydrogen peroxide-treated osteoblasts.

Monotropein, the primary iridoid glycoside isolated from Morindacitrifolia, has been previously reported to possess potent antioxidant and antiosteoporotic properties. However, there is no direct evidence correlating the antiosteoporotic effect of monotropein with its observed antioxidant capacity, and the molecular mechanisms involved in mediating these processes remain unclear. Therefore, the aim of the present study was to investigate the protective effects of monotropein against oxidative stress in osteoblasts and the mechanisms involved in mediating this process. Osteoblast viability was evaluated using the MTT assay. The mitochondrial membrane potential and reactive oxygen species were detected by flow cytometry analyses. Western blotting and enzyme­linked immunosorbent assays were performed to detect protein expression levels. A significant reduction in osteoblast viability was observed at 24 h following exposure to various concentrations (100­1,000 µM) of H2O2 compared with untreated osteoblasts. The cytotoxic effect of H2O2 was notably reversed when osteoblasts were pretreated with 1­10 µg/ml monotropein. Pretreatment with 1-10 µg/ml monotropein increased the mitochondrial membrane potential and reduced the generation of reactive oxygen species in osteoblasts following exposure to H2O2. In addition, the H2O2­induced increase in apoptotic markers (caspase-3 and caspase-9) and H2O2-induced reduction in sirtuin 1 levels were significantly reversed following pretreatment of cells with monotropein. Furthermore, monotropein significantly reduced H2O2­induced stimulation of NF­κB expression, in addition to the expression of a number of proinflammatory mediators. These results indicate that monotropein suppresses apoptosis and the inflammatory response in H2O2­induced osteoblasts through the activation of the mitochondrial apoptotic signaling pathway and inhibition of the NF­κB signaling pathway.

[Comparison of anatomical locking plate and Gamma nail for the treatment of intertrochanteric fracture with external wall fractures].

OBJECTIVE: To compare clinical efficacy of anatomic locking plate and Gamma nail in treating unstable femoral intertrochanteric fractures with external wall fractures. METHODS: From June 2010 to June 2014,clinical data of 44 patients with intertroehanteric fractures associated with lateral wall fractures (type 31A2.2-3.3) followed more than 12 months,which treated with Gamma nail or anatomic locking plate,were retrospective analyzed. Sixteen patients were treated with anatomic locking plate, including 6 males and 10 females aged from 32 to 83 years old with an average of 56.5 years old. Twenty-eight patients were treated with Gamma nail including 17 males and 11 females aged from 26 to 87 years old with an average of 60.4 years old. Operative time, intraoperative fluoroscopy times, blood loss (intraoperative and hidden blood loss), hospital stays were observed and compared. PPMS and HHS scoring were used to evaluate postoperative clinical effect. RESULTS: All patients were followed up from 12 to 24 months with an average of 16.2 months. Operative time in Gamma nail was shorter than anatomic locking plate; while blood loss( intraoperative and hidden blood loss) and intraoperative fluoroscopy times in anatomic locking plate were less than that of in Gamma nail. There was no significant meaning in hospital stays between two groups. Postoperative full weight-bearing time in anatomic locking plate was prolonged than Gamma nail. At the final following-up, PPMS in Gamma nail was 7.50 ± 1.78 and 6.82 ± 1.38 in anatomic locking plate, and there was no obvious meaning between two groups (t = 2.341, P = 0.132); there was no significant differences in HHS score between Gamma nail (83.25 ± 11.18) and anatomic locking plate (86.14 ± 12.36) (t = 1.923, P = 0.243). The incidence of complications in Gamma nail was less than anatomic lock-ing plate (P = 0.005). CONCLUSION: Anatomic locking plate for intertrochanteric fractures with external wall fractures could avoid re-injury of external wall, especially for severe comminuted fractures, difficult for intramedullary nailing, and there was no significant meaning in hip joint function compared with Gamma nail, while postoperative incidence of complications was higher than Gamma nail, so early weight-bearing was not stress.

Curculigoside regulates proliferation, differentiation, and pro-inflammatory cytokines levels in dexamethasone-induced rat calvarial osteoblasts.

BACKGROUND: Curculigoside (CCG), one of the main bioactive phenolic compounds isolated from the rhizome of Curculigo orchioides Gaertn., is reported to prevent bone loss in ovariectomized rats. However, the underlying molecular mechanisms are largely unknown. Therefore, we investigated the effects of CCG on proliferation and differentiation of calvarial osteoblasts and discussed the related mechanisms. MATERIALS AND METHODS: Osteoblasts were incubated with dexamethasone (DEX) in the absence or presence of CCG concentrations for 24-72 h. Cell proliferation was evaluated by Cell Counting Kit-8 assay. Mitochondria membrane potential (MMP) and reactive oxygen species (ROS) were assessed by flow cytometry. We assessed the anti-inflammatory responses of CCG on DEX-induced osteoblasts by an enzyme-linked immunosorbent assay (ELISA). Relative protein expression of BMP-2, b-catenin, RANKL, OPG and RANK was measured using Western blotting. RESULTS: It was found that osteoblasts proliferation decreased significantly after treated with 1 µM of dexamethasone (DEX), compared with untreated osteoblasts and the cytotoxic effect of DEX was reversed remarkably when pretreatment with 25-100 µg/ml of CCG. Pretreatment with 25-100 µg/ml of CCG increased MMP level and decreased ROS production in osteoblasts induced by DEX. In addition, DEX-induced inhibition of differentiation markers such as alkaline phosphatase (ALP), OPG, BMP-2, ß-catenin, IGF-1 and M-CSF level, and promotion of differentiation markers such as RANKL and RANK was significantly reversed in the presence of CCG. CCG also reversed DEX-induced production of pro-inflammatory cytokines. CONCLUSIONS: These results provide new insights into the osteoblast-protective mechanisms of CCG through inducing proliferation and differentiation and reducing the inflammatory responses, indicating that CCG may be developed as an agent for the prevention and treatment of osteoporosis.