Influence of preoperative simulation on the reduction quality and clinical outcomes of open reduction and internal fixation for complex proximal humerus fractures.

PURPOSE: Proximal humerus fractures (PHFs) are common. With the development of locking plates, open reduction and internal fixation (ORIF) of the proximal humerus can provide excellent clinical outcomes. The quality of fracture reduction is crucial in the locking plate fixation of proximal humeral fractures. The purpose of this study was to determine the impact of 3-dimensional (3D) printing technology and computer virtual technology assisted preoperative simulation on the reduction quality and clinical outcomes of 3-part and 4-part proximal humeral fractures. METHOD: A retrospective comparative analysis of 3-part and 4-part PHFs undergoing open reduction internal fixation was performed. Patients were divided into 2 groups according to whether computer virtual technology and 3D printed technology were used for preoperative simulation: the simulation group and the conventional group. Operative time, intraoperative bleeding, hospital stay, quality of fracture reduction, Constant scores, American Society for Shoulder and Elbow Surgery (ASES) scores, shoulder range of motion, complications, and revision surgeries were assessed. RESULTS: This study included 67 patients (58.3%) in the conventional group and 48 patients (41.7%) in the simulation group. The patient demographics and fracture characteristics were comparable in these groups. Compared with the conventional group, the simulation group had shorter operation time and less intraoperative bleeding (P < 0.001, both). Immediate postoperative assessment of fracture reduction showed a higher incidence of greater tuberosity cranialization of < 5 mm, neck-shaft angle of 120° to 150°, and head shaft displacement of < 5 mm in the simulation group. The incidence of good reduction was 2.6 times higher in the simulation group than in the conventional group (95% CI, 1.2-5.8). At the final follow-up, the chance of forward flexion > 120° (OR 5.8, 95% CI 1.8-18.0) and mean constant score of > 65 (OR 3.4, 95% CI 1.5-7.4) was higher in the simulation group than the conventional group, as well as a lower incidence of complications in the simulation group was obtained (OR 0.2, 95% CI 0.1-0.6). CONCLUSIONS: This study identified that preoperative simulation assisted by computer virtual technology and 3D printed technology can improve reduction quality and clinical outcomes in treatment of 3-part and 4-part PHFs.

Circulating microRNA let­7e is decreased in knee osteoarthritis, accompanied by elevated apoptosis and reduced autophagy.

Knee osteoarthritis (KOA) is a major cause of leg disability in the elderly population. Recently, the expression levels of circulating microRNA (miRNA) let­7e have been reported to be significantly reduced in KOA. The aims of the present study were to assess the feasibility of let­7e as a serum marker for detecting KOA and to explore the underlying mechanisms of its involvement. Based on previous studies and bioinformatics analysis, let­7e may regulate apoptosis and autophagy of articular chondrocytes. A total of 10 patients with KOA and 10 patients with trauma without KOA were recruited to examine the levels of let­7e in peripheral blood. Subsequently, KOA rat models were established, and the levels of let­7e in the cartilage and serum were examined, the expression of apoptotic proteins and autophagy­related proteins in the cartilage were investigated, and apoptotic and autophagic activities of primary cultured chondrocytes were also detected. In patients with KOA, let­7e levels in the peripheral serum were significantly decreased compared with the control group, and this result was confirmed in the peripheral serum and cartilage of KOA rats. In addition, the expression levels of proteins involved in the apoptotic pathway were increased in the cartilage of KOA rats, and apoptotic activity was increased. The expression of autophagy­related proteins beclin 1 and microtubule associated protein 1 light chain 3 ß (LC3B) II/LC3BI in the articular cartilage of KOA rats was lower compared with the controls, and autophagy was decreased. Si­Miao­San (SMS) treatment restored the expression of let­7e and reversed the changes in apoptosis and autophagy. Therefore, the present study provided additional evidence that circulating let­7e may be a potential serum biomarker for the diagnosis and treatment of KOA. Elevated apoptosis levels and decreased autophagy levels of cartilage tissue are involved in KOA, and treatment with SMS may reverse these effects.

Gastric foregut cystic developmental malformation: case series and literature review.

Foregut cystic developmental malformation (FCDM) is a very rare lesion of the alimentary tract, especially in the stomach. We discuss the concepts of gastric duplication cyst, bronchogenic cysts, and FCDM. Nomenclature has been inconsistent and confusing, but, by some definitions, gastric duplication cysts involve gastric mucosa and submucosal glands, bronchogenic cysts involve respiratory mucosa with underlying cartilage and glands, and FCDM lacks gastric mucosa or underlying glands or cartilage but has pseudostratified ciliated columnar epithelium (PCCE). We searched our departmental case files from the past 15 years and identified 12 cases of FCDM in the alimentary tract. We summarize the features of these 12 cases including a report in detail on a 52-year-old man with a submucosal cyst lined with simple PCCE and irregular and stratified circular muscle layers that merged with gastric smooth muscle bundles near the lesser curvature of the gastric cardia. A literature review of cases with this histology yielded 25 cases. We propose the term gastric-FCDM for such cases. Our own series of 12 cases confirms that preoperative recognition of the entity is infrequent and problematic. The rarity of this developmental disorder, as well as a lack of understanding of its embryologic origins, may contribute to missing the diagnosis. Not appreciating the diagnosis preoperatively can lead to an inappropriate surgical approach. In contrast, presurgical recognition of the entity will contribute to a good outcome and reduced risk of complications.

Effect of the timing of surgery on the fracture healing process and the expression levels of vascular endothelial growth factor and bone morphogenetic protein-2.

The aim of the present study was to observe the effect of varying the timing of surgery on the fracture healing process and the expression levels of vascular endothelial growth factor (VEGF) and bone morphogenetic protein (BMP)-2 in rats. A total of 192 rats underwent closed femur fracture modelling. The rats underwent open reduction and internal fixation surgery 1, 3, 5, 7, 11 and 14 days subsequent to the fracture occurring. Immunohistochemical staining and analysis of the VEGF and BMP-2 expression levels were simultaneously conducted on bone from the fracture site of the rats on various days. The VEGF and BMP-2 expression levels at the fracture sites were higher and were maintained for a longer period of time in the 7- and 11-day surgery groups than in the other surgery groups and the rats that did not undergo surgery. The 5-day surgery group demonstrated a greater intensity in BMP-2 expression compared with the remaining surgery groups; however, no significant differences were identified between 1-day surgery and non surgery groups. In the 3-day surgery group, the expression levels VEGF and BMP-2 were low at each stage of the fracture-healing process and were lower compared with those observed in the non-surgery group. The timing of the surgical procedures affected the VEGF and BMP-2 expression levels at the fracture sites of the experimental rats and, the optimal time for performing surgery was identified to be within the first two weeks. However, surgery may not be conducive to fracture healing if it is performed within the first few days following fracture.

[Effective analysis of continous perfusion with Dandshen and heparin for treatment of femoral head necrosis].

OBJECTIVE: To investigate the effect of continous perfusion with Danshen and heparin for treatment of femoral head necrosis. METHODS: From April 2004 to June 2007,42 patients of femoral head necrosis were treated by contious perfusing with Dandshen and heparin, included 24 males and 18 females with an average age of 39.2 years ranging from 13 to 61 years. There were 18 patients on stage II, 13 patients on stage III, 11 patients on stage IV according to Ficat standard. The venous duct were inserted into femoral head then perfused Danshen and heparin into femoral head for 15 days. Every patient was carried out opacification before treatment and 1 month after operation. Every patient was evaluated according to Harris standard before treatment and 3, 6, 12 months after treatment. RESULTS: All patients were followed-up for 32 to 68 months (means 42.7 months). The average scores of 18 patients on stage II on 3, 6, 12 months after treatment were (88.43 +/- 3.41), (94.37 +/- 3.47), (92.84 +/-4.29), respectively, and the scores after treatment were higher than the score (78.23 +/- 3.47) after treatment. The average scores of 13 cases on stage III on 3, 6, 12 after treatment were (82.94 +/- 3.31), (88.60 +/- 2.31), (86.09 +/- 3.17) respectivly, and the scores after treatment were higher than the score (66.11 +/- 4.50) before treatment. The average scores of 11 cases on stage IV on 3, 6, 12 months after treatment were (61.31 +/- 4.06), (59.2 +/- 7.31), (54.62 +/- 8.20) respectivly,and the scores on 3, 6 months after treatment were higher than the score (50.16 +/- 2.35) before treatment,but there was no obvious difference between before treatment and 12 months after treatment. The rank of phlebography of 18 cases on stage II and 13 cases on stage IlI were improved obvi ously 1 month after treatment,but there was no obvious difference in 11 cases of stage IV. CONCLUSION: The method of contious perfusing with Danshen and heparin into femoral head has the advantage of little damage and good effect. It refers to patients in early stage (II and II ).

[Effect of static magnetic field on deep wound healing of SD rats].

OBJECTIVE: To investigate the effect of static magnetic field on deep wound healing of SD rats and VEGF during the wound healing and different strength static magnetic field on deep wound healing of SD rats. METHODS: Divided forty-eight SD rats into three groups: 0.16 T magnetic disk treatment (0.16 T group), 0.32 T magnetic disk treatment (0.32 T group), control group. General wounds healing situation was observated on the 3, 6, 9, 12 day. The area of every wound was calculated. The tissue of granulation was dyeing by immune tissue chemical decoration method, in which VEGF protein content with its range in tissue was measured. RESULTS: The healing index of 0.16 T magnetic group wounds were larger than that of control group on 6th and 9th day, there were statistical difference. The healing index of 0.32 T magnetic group wounds were larger than that of control group on 3rd, 6th, 9th and 12th day, there were statistical difference. The healing index of 0.32 T group wounds contrasted to that of 0.16 T group wounds had no statistical significance. Observation of VEGF at the course of wound healing:the expressing of VEGF in magnetic group wounds on 3rd and 6th was stronger than in control group wounds, there were statistical difference. While there were no obvious difference between them on 9th and 12th day (P>0.05). But the contrast between that in 0.32 T group and in 0.16 T group had no statistical difference. The expressing strength of VEGF in magnetic group reached the peak amplitude on the 6th day, and that in control group reached peak amplitude on 9th day. And the peak amplitude of magnetic group was stronger than that of control group. CONCLUSION: Static magnetic disc of 0.16T and 0.32 T can promote deep wound of SD rats heal. The mechanism of static magnetic field promoting wound heal may be relative to the expressing highly of VEGF during early and middle time.

[Treatment of fracture of the tubiform bone with domestic locking plate through minimal invasive incision and bridging reduction fixation].

OBJECTIVE: To study the therapeutic method and clinical effect of domestic locking plate for treating fracture of the tubiform bone through a minimal incision and bridging fixation. METHODS: Among 40 patients with fracture of the tubiform bone, 29 patients were male and 11 patients were female, aged from 29 to 69 years, with the average of 38.27 years. Among 34 patients with closed fracture, 7 cases were type A, 10 cases type B, 17 cases type C according to AO/ASIF classification. Among 6 patients with open fracture, 2 cases were type I, 4 cases were type II according to Gustilo classification. These patients were treated with a small incision after manipulative reduction. Locking plate and 3.5 mm diameter Kirschner wire were used to maintain the reduction and through the C-arm X-ray machine to check and adjust the position, screw were locked to bridging fixation at last. RESULTS: Forty cases were followed up in 6 months on average (ranging from 4 to 10 months). The average time of union of fracture was 4.6 months (ranging from 3 to 8 months). According to Ovadia typing, the results were excellent in 16 cases, good in 20 cases, fair in 3 cases,poor in 1 case. The excellent and good rate was 90%. CONCLUSIONS: The domestic locking plate is suitable for patients with osteoporosis and comminuted fracture because of the advantages of reliable fixation and low price. It could achieve the same effect of minimal invasive as LISS (less invasive stabilizing system) plate through the improvement of operative method.

[Surgical treatment for the intradural extramedullary tumor in the spinal canal].

OBJECTIVE: To study the clinical characteristics of the intradural extramedullary tumor in the spinal canal, as well as the application of internal fixation technique to restore the spinal stability in the surgical treatment of intradural extramedullary tumor in the spinal canal through posterior approach. METHODS: Among 24 patients receiving the tumor resection through posterior approach, 14 patients were male and 10 patients were female, ranging in age from 12 to 68 years, with an average of 40 years. Fourteen patients were treated with internal fixation and autogenous bone graft after tumor resection, and other 10 patients without internal fixation and autogenous bone graft. RESULTS: All the patients underwent one-stage resection of the tumor. During the follow-up period ranged from 6 months to 3 years (average 22 months), no recurrence of the tumor was found and the injury of spine cord did not aggravate, no vascular or nerve-root injury after the operation. The Frankle grades were improved by 1 to 3 degrees. Bone fusion formed at the corresponding bone grafted place. And there was no instrument broken or loosening. CONCLUSION: After the intradural extramedullary tumor is resected, internal fixation and autogenous bone graft can restore the stability of spine.