ROS-scavenging hydrogel as protective carrier to regulate stem cells activity and promote osteointegration of 3D printed porous titanium prosthesis in osteoporosis.

Stem cell-based therapy has drawn attention as an alternative option for promoting prosthetic osteointegration in osteoporosis by virtue of its unique characteristics. However, estrogen deficiency is the main mechanism of postmenopausal osteoporosis. Estrogen, as an effective antioxidant, deficienncy also results in the accumulation of reactive oxygen species (ROS) in the body, affecting the osteogenic differentiation of stem cells and the bone formation i osteoporosis. In this study, we prepared a ROS-scavenging hydrogel by crosslinking of epigallocatechin-3-gallate (EGCG), 3-acrylamido phenylboronic acid (APBA) and acrylamide. The engineered hydrogel can scavenge ROS efficiently, enabling it to be a cell carrier of bone marrow-derived mesenchymal stem cells (BMSCs) to protect delivered cells from ROS-mediated death and osteogenesis inhibition, favorably enhancing the tissue repair potential of stem cells. Further in vivo investigations seriously demonstrated that this ROS-scavenging hydrogel encapsulated with BMSCs can prominently promote osteointegration of 3D printed microporous titanium alloy prosthesis in osteoporosis, including scavenging accumulated ROS, inducing macrophages to polarize toward M2 phenotype, suppressing inflammatory cytokines expression, and improving osteogenesis related markers (e.g., ALP, Runx-2, COL-1, BSP, OCN, and OPN). This work provides a novel strategy for conquering the challenge of transplanted stem cells cannot fully function in the impaired microenvironment, and enhancing prosthetic osteointegration in osteoporosis.

Investigation of the Underwater Absorption and Reflection Characteristics by Using a Double-Layer Composite Metamaterial.

It is well-known that the acoustic stealth of an underwater vehicle composed of a non-watertight structure has been facing severe challenges. The origins of this effect are associated with the fact that the coupling between the water and the mechanical structure is not negligible because both sides are in the water. Along these lines, the idea of forward absorption and backward reflection was proposed in this work to address this issue. More specifically, a composite underwater acoustic metamaterial (AM) was designed based on different layers, namely a sound absorption layer and a sound insulation layer from the outside to the inside. The sound absorption layer was made of a soft rubber matrix with embedded steel scatterers (ESs) to enrich the coupled resonance effects, while the sound insulation layer was composed of hard rubber with a built-in cavity to improve the impedance mismatching between the AM and the water. The impact of the number and thickness of the embedded ESs on the acoustic performance of the AM was also thoroughly investigated via a finite element method (FEM). A fast non-dominated genetic algorithm (NAGA-II) with elite strategy was used to optimize the position and the size of the ESs. The optimization results revealed the high absorption at the forward incidence and the high reflection at the backward incidence. Thus, our work provides a novel and effective approach for improving the acoustic stealth of underwater vehicles composed of non-watertight structures.

Intramedullary nails in combination with reconstruction plate in the treatment of unstable intertrochanteric femoral fractures with lateral wall damage.

BACKGROUND: The unstable intertrochanteric femur fracture remains a challenge for surgeons. However, few studies have compared the clinical effectiveness of intramedullary nail in combination with a reconstruction plate and intramedullary nail alone in the treatment of patients with unstable intertrochanteric femoral fractures with lateral wall damage. METHODS: This study retrospectively analyzed 16 patients with 31 A3 intertrochanteric fractures treated with the intramedullary nail in combination with reconstruction plate (the study group) and 19 patients with 31 A3 intertrochanteric fractures treated with intramedullary nail alone (the control group) between January 2012 and January 2018. The operation time, intra-operative blood loss, time of fracture healing, and complication rates of post-operative fixation failure were assessed between the two groups. At the follow-up of post-operative six and 12 months, Harris hip score (HHS) and the Parker-Palmer mobility score (PPMS) were used to evaluate the functional states and mobility levels. RESULTS: The distribution of all basic characteristics was similar between the two groups (P ˃ 0.05). The study group had longer operation time and more intra-operative blood loss in comparison with the control group (P < 0.001), while the study group had shorter fracture healing time (P = 0.03) and lower fixation failure rate as compared with the control group. Regarding the functional outcome, the study group had higher HHSs and PPMS than the control group (P = 0.003). CONCLUSIONS: Although intramedullary nails in combination with reconstruction plates had longer operation time and more intra-operative blood loss, it might be superior to intramedullary nail alone in terms of fracture healing time, fixation failure complication rate, and post-operative functional recovery.

Inhibition of long non-coding RNA-AWPPH decreases osteosarcoma cell proliferation, migration and invasion.

Long non-coding RNAs (lncRNAs) serve a crucial role in various types of cancer. The lncRNA AWPPH has been reported to promote hepatocellular carcinoma and bladder cancer progression. However, to the best of our knowledge, the biological roles of AWPPH in osteosarcoma (OS) remain unclear. In the present study, the levels of AWPPH in OS tissues and cell lines were determined by reverse transcription-quantitative polymerase chain reaction. An MTT assay was used to detect OS cell proliferation. The levels of proteins associated with the PI3K/Akt signaling pathway and apoptosis were determined by western blotting. Wound-healing and Transwell assays were conducted to determine cell migration and invasion, respectively. The results demonstrated that AWPPH was highly expressed in OS tissues and cells. Functional analyses revealed that AWPPH depletion significantly inhibited OS cell proliferation and migration, and promoted OS cell apoptosis. Furthermore, AWPPH downregulation significantly inhibited the PI3K/AKT pathway. The present study demonstrated that AWPPH was highly expressed in OS, and that AWPPH promoted OS cell proliferation and migration, and inhibited OS cell apoptosis, which may be mediated by PI3K/AKT pathway activation.

MicroRNA-410 participates in the pathological process of postmenopausal osteoporosis by downregulating bone morphogenetic protein-2.

The present study aimed to investigate bone morphogenetic protein (BMP)-2 and microRNA (miR)-410 expression and the mechanism of regulation in serum and CD14+ peripheral blood mononuclear cells (PBMCs) from postmenopausal osteoporosis patients and model mice. A total of 26 patients with postmenopausal osteoporosis were included in the experimental group and 29 age-matched healthy subjects were included in the control group. A total of 60 mice were divided into sham and ovariectomized (OVX) groups. Following surgery, 28 mice remained in the sham and 25 mice remained in OVX group. BMP-2 protein expression in serum and CD14+ PBMCs from patients and model mice was determined using ELISA and western blotting, respectively. Reverse transcription-quantitative polymerase chain reaction assays were performed to determine miR-410 and BMP-2 mRNA levels in serum and CD14+ PBMCs from patients and model mice. Dual luciferase reporter assays were used to identify direct interactions between miR-410 and BMP-2 mRNA. Compared with the control group, BMP-2 mRNA and protein expression in serum and CD14+ PBMCs from patients with postmenopausal osteoporosis and model mice were significantly decreased. miR-410 levels in serum and CD14+ PBMCs from patients with postmenopausal osteoporosis and model mice were significantly increased when compared with the control group. Dual luciferase reporter assays revealed that BMP-2 was a target gene of miR-410. The current study demonstrated that decreased BMP-2 expression in serum and CD14+ PBMCs from patients with postmenopausal osteoporosis was associated with the upregulation of miR-410. These results suggest that miR-410 may participate in the pathological process of postmenopausal osteoporosis by downregulating BMP-2.

MicroRNA-17 promotes osteosarcoma cells proliferation and migration and inhibits apoptosis by regulating SASH1 expression.

MicroRNAs (miRNAs) are abnormally expressed in numerous diseases, which are intimately associated with cell proliferation, migration and invasion. Recent study indicated that miR-17 may be involved in regulating osteosarcoma (OS) occurrence and development, but its function and mechanism have not been reported. In this study, quantitative real-time PCR (qRT-PCR) was used to measure the expression of miR-17, and Western blotting assay was performed to measure the expressions of SAM and SH3 domain containing 1 (SASH1), phosphoinoinositide-3 kinase (PI3K), protein kinase B (AKT), Caspase3, Bcl-2 gene family (Bcl-2, Bax) and matrix metalloprotein (MMP-2, MMP-9) in MG-63 cells. Luciferase reporter assay was conducted to confirm the target of SASH1 by miR-17. Cell proliferation, migration, invasion and apoptosis assay was performed to investigate the role of miR-17 in OS cells. We found that the expression of miR-17 was significantly up-regulated in OS cell lines. MiR-17 inhibitor inhibited the proliferation ability, and induced apoptosis of OS cells. Besides, miR-17 inhibitor prevented the migration and invasion of OS cells. Further, we identified that SASH1 was a target gene of miR-17. In addition, knockdown of miR-17 increased the protein expression of SASH1, and regulate related genes of cell proliferation, invasion and anti-apoptosis in the downstream of OS cells. These findings indicated that miR-17 was over-expressed and promoted cell proliferation, migration and inhibited cell apoptosis by targeting SASH1 in OS cells.

A new less invasive surgical technique in the management of acute Achilles tendon rupture through limited-open procedure combined with a single-anchor and "circuit" suture technique.

BACKGROUND: Traditional incision repair and minimally invasive repair for acute Achilles tendon repair have limitations. This study aimed to present our series of 23 patients with acute Achilles tendon rupture that was repaired using two small incisions to assist the anchor repair of the tear and a new "circuit" suture technique. METHODS: This was a retrospective study of 23 patients with acute Achilles tendon rupture treated with the new technique at Changhai Hospital between January 2015 and December 2016 and followed up for 14-33 months. Clinical outcome was assessed using the AOFAS, Leppilahti, and Arner-Lindholm scores. Complications, range of motion (ROM), and time to return to work and light sport activity were assessed. RESULTS: The AOFAS score was 85-96 at 3 months and 92-100 at 12 months. The 3-month ROM was 27°-37°, and the 12-month ROM was 36°-48°. The Leppilahti score was 85-95 at 3 months and 90-100 at 12 months. The recovery time of the patients was 10-18 weeks. The postoperative recovery time to exercise was 16-24 weeks. There was only one case of deep venous thrombosis. According to the Arner-Lindholm assessment criteria, patient outcomes were rated as excellent in 20 (87.0%) cases, good in three (13.0%) cases, and poor in 0 cases. The excellent-to-good rate was 100%. CONCLUSION: The limited-open procedure combined with a single-anchor and "circuit" suture technique could be used to repair torn Achilles sites, with a low occurrence of complications. This new and minimally invasive technique could be an alternative in the management of acute Achilles tendon rupture.

Increased circular RNA UBAP2 acts as a sponge of miR-143 to promote osteosarcoma progression.

Deregulated expression of circular RNA (circRNA) has been determined to be important in carcinogenesis and progression; however, in the most common type of primary malignant bone tumor osteosarcoma, the roles of circRNA in cancer development still remain to be elucidated. Here, we found that circRNA UBAP2 (circUBAP2) expression is significantly increased in human osteosarcoma tissues as compared to those in matched controls. Increased circUBAP2 expression was significantly correlated with human osteosarcoma progression and prognosis. Furthermore, increased circUBAP2 could promote osteosarcoma growth and inhibit apoptosis both in vitro and in vivo. Mechanistically, circUBAP2 was found to inhibit the expression of microRNA-143 (miR-143), thus enhancing the expression and function of anti-apoptotic Bcl-2, which is a direct target of miR-143. Together, our results suggest the roles of circUBAP2 in osteosarcoma development and implicate its potential in prognosis prediction and cancer therapy.

Surgical Versus Conservative Intervention for Acute Achilles Tendon Rupture: A PRISMA-Compliant Systematic Review of Overlapping Meta-Analyses.

Although many meta-analyses comparing surgical intervention with conservative treatment have been conducted for acute Achilles tendon rupture, discordant conclusions are shown. This study systematically reviewed the overlapping meta-analyses relating to surgical versus conservative intervention of acute Achilles tendon rupture to assist decision makers select among conflicting meta-analyses, and to offer intervention recommendations based on the currently best evidence.Multiple databases were comprehensively searched for meta-analyses comparing surgical with conservative treatment of acute Achilles tendon rupture. Meta-analyses only comprising randomized controlled trials (RCTs) were included. Two authors independently evaluated the meta-analysis quality and extracted data. The Jadad decision algorithm was applied to ascertain which meta-analysis offered the best evidence.A total of 9 meta-analyses were included. Only RCTs were determined as Level-II evidence. The scores of Assessment of Multiple Systematic Reviews (AMSTAR) ranged from 5 to 10 (median 7). A high-quality meta-analysis with more RCTs was selected according to the Jadad decision algorithm. This study found that when functional rehabilitation was used, conservative intervention was equal to surgical treatment regarding the incidence of rerupture, range of motion, calf circumference, and functional outcomes, while reducing the incidence of other complications. Where functional rehabilitation was not performed, conservative intervention could significantly increase rerupture rate.Conservative intervention may be preferred for acute Achilles tendon rupture at centers offering functional rehabilitation, because it shows a similar rerupture rate with a lower risk of other complications when compared with surgical treatment. However, surgical treatment should be considered at centers without functional rehabilitation as this can reduce the incidence of rerupture.

Screening of diagnostic markers for osteosarcoma.

Osteosarcoma, which is the most common type of highly malignant bone tumor in children and adolescents, has poor diagnosis and 2-year survival rates of 15-20% following surgery or radiotherapy, and has therefore generated marked attention. In order to investigate the potential biomarkers for diagnosing osteosarcoma, the expression profiling data from normal and disease tissues were compared, respectively, and the differentially­expressed genes were analyzed by three different statistical tests. Interacting proteins were determined and an interaction network was constructed by Search Tool for the Retrieval of Interacting Genes database. Subsequently, the protein interaction network was decomposed and Gene Otology annotation using Cytoscape, Mcode and Bingo, was conducted on the function modules. Finally, three differentially­expressed genes GJA1, COL1A2 and COL5A2 were identified, and an interaction network was successfully generated with COL1A2 and COL5A2 at the core. From the results, it was observed that COL1A2 and COL5A2 interact with a number of genes of the matrix metalloprotease (MMP) family, including MMP1, MMP2, MMP3 and MMP14, TGFß and RUNX2. Furthermore, these genes have been confirmed to be important in the tumorigenesis of osteosarcoma. It was hypothesized that the upregulation of the COL gene family may be considered as a diagnostic marker for osteosarcoma and collagen may be administered as a therapy.

Posterior trochanteric osteotomy in acetabular fractures for 32 cases.

The aim of this study is to explore the method and clinical outcome of posterior trochanteric osteotomy in acetabular fractures. From January 2000 to January 2008, 32 cases of acetabular fractures involving the dome of acetabulum underwent posterior trochanteric osteotomy for a better exposure and internal fixation with acetabular tridimensional memory fixation system. 28 cases (16 men and 12 women, mean age 39.9 years, range 16-73 years) were followed up with an average of 48.9 months (range of 19-95 months) and four were lost during follow up. Of 28 cases, 19 were fresh fractures and 9 were old fractures. The reduction was evaluated with Matta criteria. Clinical evaluation was based on modified Merle d'Aubigne and Postel scoring. Motor strength of the abductors was evaluated according to the Medical Research Council grading system. Ectopic ossification was classified according to Brooker criteria. Anatomical reduction was achieved in 17 cases and satisfied reduction in 10 patients. Poor reduction happened in an old fracture. All acetabular fractures got a direct bone union and no displacement and deep infection occurred. All osteotomies healed within 3.5 months without any nonunion, proximal migration of the greater trochanter, loosing or broken of instrumentation, and deep infection. Two superficial infections were healed with a regular dressing. Two patients underwent removal of implants from greater trochanter because of irritation. The strength of the abductors was of Grade 3/5 in two patients, Grade 4/5 in five patients, and normal in the rest. Clinical scoring was excellent to good in 84 %. Ectopic ossification occurred in five patients, grade 1 in two patients, grade 2 in two, and grade 3 in one. But function of hip joint was not seriously affected. Posterior trochanteric osteotomy can provide an adequate exposure of the dome of acetabulum without the associated complications like nonunion, proximal replacement, and weak of the abductors which often occur with standard oblique osteotomy.

Fuzzy clustering analysis of osteosarcoma related genes.

Osteosarcoma is the most common malignant bone-tumor with a peak manifestation during the second and third decade of life. In order to explore the influence of genetic factors on the mechanism of osteosarcoma by analyzing the inter relationship between osteosarcoma and its related genes, and then provide potential genetic references for the prevention, diagnosis and treatment of osteosarcoma, we collected osteosarcoma related gene sequences in Genebank of National Center for Biotechnology Information (NCBI) and local alignment analysis for a pair of sequences was carried out to identify the measurement association among related sequences. Then fuzzy clustering method was used for clustering analysis so as to contact the unknown genes through the consistent osteosarcoma related genes in one class. From the result of fuzzy clustering analysis, we could classify the osteosarcoma related genes into two groups and deduced that the genes clustered into one group had similar function. Based on this knowledge, we found more genes related to the pathogenesis of osteosarcoma and these genes could exert similar function as Runx2, a risk factor confirmed in osteosarcoma, this study may help better understand the genetic mechanism and provide new molecular markers and therapies for osteosarcoma.

Gene expression profile analysis of human intervertebral disc degeneration.

In this study, we used microarray analysis to investigate the biogenesis and progression of intervertebral disc degeneration. The gene expression profiles of 37 disc tissue samples obtained from patients with herniated discs and degenerative disc disease collected by the National Cancer Institute Cooperative Tissue Network were analyzed. Differentially expressed genes between more and less degenerated discs were identified by significant analysis of microarray. A total of 555 genes were significantly overexpressed in more degenerated discs with a false discovery rate of < 3%. Functional annotation showed that these genes were significantly associated with membrane-bound vesicles, calcium ion binding and extracellular matrix. Protein-protein interaction analysis showed that these genes, including previously reported genes such as fibronectin, COL2A1 and ß-catenin, may play key roles in disc degeneration. Unsupervised clustering indicated that the widely used morphology-based Thompson grading system was only marginally associated with the molecular classification of intervertebral disc degeneration. These findings indicate that detailed, systematic gene analysis may be a useful way of studying the biology of intervertebral disc degeneration.

Surgical results and prognostic factors for thoracic myelopathy caused by ossification of ligamentum flavum: posterior surgery by laminectomy.

BACKGROUND: Thoracic ossification of ligamentum flavum (TOLF) of the spine is characterized by a heterotopic bone formation in the thoracic ligamentum flavum, which causes slowly progressing spinal cord injury. Surgical decompression is the most common treatment of choice for patients with compressive myelopathy due to TOLF. However, the surgical outcome is not always satisfactory. METHODS: To identify the predictors of surgical outcome, we retrospectively studied the associations between various clinical and radiological parameters and postoperative recovery in 78 patients who underwent decompressive laminectomy for thoracic myelopathy due to TOLF between October 1998 and June 2011. Surgical outcomes were assessed using modified Japanese Orthopedic Association (mJOA) recovery rate (RR)/outcome scores. RESULTS: At a minimum of 1 year after surgery for TOLF treatment, the postoperative clinical scores showed statistically significant changes with improvement in the JOA scores. The results indicated that a longer duration of preoperative symptoms, fused-type TOLF, and the degree of compression of the anteroposterior diameter and ossified region (middle thoracic OLF) was related to poor prognosis. CONCLUSION: Early diagnosis and sufficient surgical decompression improved the functional outcomes of TOLF patients. The surgical risk is relatively higher due to the tenuous blood supply of the spinal cord and the limited spinal canal volume of the middle thoracic spine extending from T4 to T9.

Validation of the simplified chinese version of the functional rating index for patients with low back pain.

STUDY DESIGN: Cross-cultural translation and psychometric testing of the functional rating index (FRI). OBJECTIVE: To evaluate the reliability and validity of the adapted simplified Chinese FRI (SC-FRI) for patients with low back pain (LBP). SUMMARY OF BACKGROUND DATA: The FRI is a reliable and valid instrument to assess the perception of function and pain for patients with LBP. However, there is no culturally adapted, reliable, and validated FRI for use in mainland China. METHODS: The translation and cross-cultural adaptation were performed following international guidelines. The SC-FRI was administered to 115 patients with LBP along with the simplified Chinese version of the Oswestry disability index, 36-item short form health survey, and the visual analogue scale. Psychometric testing included internal consistency, test-test reliability, concurrent criterion validity, and construct validity. RESULTS: A high completion rate of 96% and no floor or ceiling effects were noted for the SC-FRI. The internal consistency was good (i.e., Cronbach α = 0.897 for the overall SC-FRI; range, 0.851-0.890, if an item was deleted). Test-retest reliability was excellent, with an intraclass correlation coefficient of 0.948 (95% confidence interval, 0.917-0.968). Concurrent criterion validity assessment demonstrated that the SC-FRI significantly correlated with the visual analogue scale (r = 0.852, P < 0.0001) and the simplified Chinese version of the Oswestry disability index (r = 0.958, P < 0.0001). Construct validity was confirmed by the significant Pearson correlation between the SC-FRI and physical functioning (r = -0.802, P < 0.0001), Bodily Pain (r = -0.698, P < 0.0001), social functioning (r = -0.573, P < 0.0001), role-physical (r = -0.503, P < 0.0001), and general health (r = -0.502, P < 0.0001) domains of the 36-Item Short Form Health Survey. CONCLUSION: The SC-FRI showed excellent reliability and validity in the evaluation of pain and the functional health status of Chinese-speaking patients with LBP. It is simple and easy to use and can be recommended in clinical and research practice in mainland China.

All-pedicle-screw versus hybrid hook-screw instrumentation for posterior spinal correction surgery in adolescent idiopathic scoliosis: a curve flexibility matched-pair study.

INTRODUCTION: Comparisons of all-pedicle-screw (PS) and hybrid hook-screw (HS) instrumentation for the treatment of adolescent idiopathic scoliosis (AIS) have produced conflicting results. The aim of this study was to compare all-pedicle-screw and hybrid hook-screw instrumentation for the treatment of AIS using a matched-pair study design in which preoperative flexibility was matched. METHODS: In this retrospective study conducted at one medical center, 21 all-pedicle-screw/hybrid hook-screw pairs of Lenke type I AIS patients matched for age, height, weight, body mass index, sex, and preoperative curve flexibility who had been treated at our institution from January 2000 to October 2006 were selected. Postoperative and 2-year postoperative coronal curve correction, postoperative kyphosis, blood transfusion needs, operation time, and hospital cost were measured and analyzed statistically. RESULTS: The PS group compared with the HS group had better postoperative correction (P = 0.0231) and 2-year coronal curve correction (P = 0.016). While statistically significant (P = 0.0073), the postoperative Cobb angle was only 3° less in the PS group, Maintenance of correction after 2 years was better in the PS group (P = 0.0016). The PS group had less blood loss (P < 0.0001) and shorter operation time (P < 0.0001), but the hospital cost for the PS group was higher (P < 0.0001). CONCLUSIONS: All-pedicle-screw and hybrid hook-screw instrumentations are comparable with regard to curve correction, but all-pedicle screw instrumentation reduces blood loss during surgery and shortens the operation time, which may help shorten healing time.

Treatment of bone nonunion and bone defects associated with unsuccessful humeral condylar fracture repair with autogenous iliac bone reconstruction.

BACKGROUND: Our preliminary study retrospectively assessed outcomes after the use of autogenous iliac bone grafts combined with internal fixation to repair refractory bone nonunions and bone defects associated with supracondylar or intracondylar humeral fractures, or both. MATERIALS AND METHODS: We identified 22 patients (14 men and 8 women) with a mean age of 33.8 years (range, 17-60 years) with bone nonunion and severe bone defects associated with supracondylar or intercondylar humerus fractures, or both. The humeral condyle in each patient was anatomically reconstructed using autologous iliac bone grafts and internal fixation. Active functional exercise was initiated 3 to 4 weeks after surgery. The following variables were assessed: preoperative and postoperative elbow range of motion, Mayo Elbow Performance Score (MEPS), and postoperative complications. RESULTS: Mean follow-up was 38.6 months. Mean duration until bone union was 5.6 months. Preoperatively, 16 patients had a fair or poor MEPS (<75). At final follow-up MEPS was excellent (>90) in 8, good (75-90) in 9, fair (60-74) in 4, and poor (<60) in 1 patient. Postoperative heterotopic ossification anterior to the elbow joint occurred in 2 patients. CONCLUSIONS: Our preliminary results suggest that anatomic reconstruction of the humeral condyle using autogenous iliac bone grafting with internal fixation can improve elbow joint function in patients with bone nonunion and bone defects associated with supracondylar or intracondylar humeral fractures, or both. Larger scale studies are warranted to confirm our findings and compare the efficacy of this vs other surgical approaches.

Development of the Simplified Chinese Version of the Spinal Appearance Questionnaire: cross-cultural adaptation and psychometric properties evaluation.

STUDY DESIGN: Cross-cultural adaptation and psychometric testing of the Spinal Appearance Questionnaire (SAQ). OBJECTIVE: To evaluate the reliability and validity of simplified Chinese version of the SAQ (SC-SAQ). SUMMARY OF BACKGROUND DATA: The SAQ is widely used to assess the perception of spinal appearance in patients with adolescent idiopathic scoliosis (AIS). However, there is no culturally adapted, reliable, and validated SAQ for mainland China. METHOD: The cross-cultural adaptation of the original SAQ was performed following international guidelines. The SC-SAQ was administered concurrently with the simplified Chinese version of the Scoliosis Research Society-22 (SC-SRS-22) questionnaire to 223 patients with AIS. A total of 92 patients were randomly selected to complete the questionnaires again 4 to 7 days after the first completion. Psychometric testing included reliability by internal consistency and test-test reliability, convergent validity by comparing the SC-SAQ with the SC-SRS-22 appearance domain, and discriminant validity by analyzing the relationship between SC-SAQ scores and patients' characteristics. RESULT: Internal consistency for the SC-SAQ was satisfactory, with intradomain correlations ranging from r = 0.526 to r = 0.808 (P, 0.0001). The test-retest reliability for the SC-SAQ was excellent with intraclass correlation coefficient of 0.933 (95% confidence interval = 0.903-0.956) and good Bland-Altman agreement. (No systematic bias was found in the Bland-Altman plot.) Convergent validity test demonstrated a moderate correlation between the overall SC-SAQ and SC-SRS-22 appearance domain, with ρ = -0.401 (P, 0.0001). Correlation between the overall SC-SAQ and the major curve magnitude was significant, with r = 0.827 (P, 0.0001). Discriminant validity was confirmed by significant differences of overall SC-SAQ and individual domain scores among the 6 subgroups categorized by the major curve magnitude (P, 0.0001) and among patients requiring exercise, bracing, or surgery (P, 0.0001). CONCLUSION: The SC-SAQ showed satisfactory reliability and validity in the evaluation of spinal deformity appearance for patients with AIS in mainland China.

Using side-bending radiographs to determine the distal fusion level in patients with single thoracic idiopathic scoliosis undergoing posterior correction with pedicle screws.

STUDY DESIGN: Prospective. OBJECTIVES: To evaluate a strategy to determine the distal fusion level in posterior pedicle screw correction of single thoracic idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: No standard method for selecting the lowest instrumented vertebra (LIV) for the correction of thoracic adolescent idiopathic scoliosis with posterior all-pedicle screw instrumentations exists. METHODS: Thirty-eight patients with single right thoracic (Lenke 1A) adolescent idiopathic scoliosis undergoing posterior pedicle screw fixation were studied. The LIV was determined using guidelines based on preoperative side-bending radiographs. In brief, (1) the whole thoracic Cobb curve should be included in the fusion mass, and the LIV should not be superior to the lower-end vertebra of the Cobb measurement. (2) On the right side-bending radiographs, the LIV should be derotated to neutral in skeletally immature (Risser 0 to 3) patients and the disc immediately below the LIV must open on the left side by at least 5 degrees. (3) On the left side-bending radiographs, the disc immediately below the LIV must be open on the right side by at least 0 degree. The first segment meeting the criteria when proceeding from the lower-end vertebra caudally is chosen as the LIV. Outcomes were based on the standing radiographs. RESULTS: Minimum follow-up was 2 years. The mean preoperative thoracic curve was 48.4±9.2 degrees and 12.6±6.1 degrees at final follow-up, resulting in a mean correction of 74.7%±8.5%. The mean preoperative compensatory lumbar curve of 23.7±7.5 degrees was 6.3±4.8 degrees at final follow-up. A change in lumbar lordosis from -41.2±11.9 degrees preoperatively to -38.2±9.9 degrees at final follow-up occurred. All patients achieved coronal balance and no decompensation or adding-on phenomenon was observed. Compared with the recommended fusion end by the Harrington stable zone method, 86.9% patients were saved 1 or more motion segment. CONCLUSIONS: The method described was effective in obtaining satisfactory curve correction, adequate trunk balance, and preservation of motion segments.

Treatment of lower extremity long bone nonunion with expandable intramedullary nailing and autologous bone grafting.

BACKGROUND: Nonunion of long bones in lower limbs is a common complication of orthopedic trauma that can be extremely debilitating. This retrospective study describes our experience using expandable intramedullary nails and autologous bone grafting in treating lower limb long bone nonunion with bone defects. METHODS: Nineteen patients (mean age 38.9 years, range 18-61) with lower limb long bone nonunion and defects caused by femoral or tibial fracture types were as follows: A2 (3 femoral, 1 tibial), A3 (1 femoral, 2 tibial), B2 (3 femoral, 4 tibial), and B3 (1 femoral, 4 tibial). Expandable intramedullary nailing and autologous bone (iliac and/or fibular) grafting were used for the treatment. Postoperative bone healing as determined by analysis of standard anteroposterior and lateral X-ray films every 4 weeks. Complications were noted. RESULTS: The average number of previous surgeries was 1.9 (range 1-4). The mean duration from original injury to treatment was 17.6 months (range 9-40 months). Femoral shaft nonunion healed on average of 26.5 weeks (range 16-60 weeks) after surgery, while tibial shaft nonunion healed on average of 23.6 weeks (range 12-40 weeks) after surgery. Class I healing occurred in all but two patients who experienced chronic postoperative osteomyelitis and delayed wound healing, respectively. Two patients complained of postoperative donor site pain. CONCLUSIONS: The use of expandable intramedullary nails and autologous bone grafts was an effective method for repair of nonunion of lower limb fractures combining with bone defects with minimal complications.