[Biomechanical study on femoroplasty-augmentation for prevention of osteoporotic hip fractures].

OBJECTIVE: To explore whether femoral plasty can improve the fracture resistance of osteoporotic femoral specimens and prevent hip fracture, and to compare the difference of mechanical strength changes between two different femoral plasty methods in osteoporotic femoral specimens, so as to determine the best strengthening area of the plasty. METHODS: Eighteen pairs of fresh osteoporotic femur specimens were collected and divided into two groups, A and B, 9 pairs in each group. Nine fresh osteoporotic femur specimens in each group were randomly selected for enhancement, and the corresponding contralateral specimens were used as control group. In group A1, the enhancement areas were femoral head, femoral neck, femoral trochanter and subtrochantericregion. And in group B1, the enhancement areas were femoral head, femoral neck and femoral trochanter region. The amount of cement injected into the femoral neck was recorded and the surface temperature of the femoral neck was measured. All specimens were biomechanically tested under simulated falls. Load-displacement curves, final loads were recorded. The final energy and stiffness of specimens were calculated. The biomechanical differences between the specimens of the enhancement group and those of the corresponding control group were compared, and the mechanical changes of the specimens by two different enhancement methods were compared. RESULTS: Compared with the control group, the ultimate load and energy of the specimens in the enhanced group increased significantly, but the stiffness did not change significantly. There was no significant difference in final load and energy between specimens strengthened by two different methods. CONCLUSION: Femoral plasty has the advantages of minimally invasive, simple operationand remarkable effect. It can be used as a new method to prevent osteoporotic hip fracture.

rhPDGF-BB combined with ADSCs in the treatment of Achilles tendinitis via miR-363/PI3 K/Akt pathway.

To investigate the mechanism of recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and human adipose-derived stem cells (hADSCs) in the treatment of Achilles tendinitis. Biomechanical indices of stiffness, stress, and maximum load-to-failure were detected by biomechanical test. mRNA and protein levels of miR-363, p-PI3K/AKT, tendon-related genes Collagen I, Scleraxis (Scx), and Tenascin C (TNC) were measured by qRT-PCR and western blot. The proliferation of hADSCs was accessed by MTT assay. Biomechanical indices of stiffness, stress, and maximum load-to-failure, and mRNA and protein levels of tendon-related genes could be improved by rhPDGF-BB or hADSCs alone, and could be further improved by rhPDGF-BB + hADSCs. rhPDGF-BB and hADSCs downregulated the expression of miR-363 and upregulated the levels of p-PI3K/Akt, and rhPDGF-BB + hADSCs further strengthened these effects. In addition, rhPDGF-BB promoted the proliferation of hADSCs in vitro and upregulated the expression of tendon-related genes. miR-363 mimic downregulated the levels of p-PI3K/Akt, miR-363 inhibitor upregulated the levels of p-PI3K/Akt, and miR-363 mimic and PI3K/Akt pathway inhibitor LY294002 reversed the positive effect of rhPDGF-BB on the proliferation of hADSCs, which suggested that rhPDGF-BB promoted the proliferation of hADSCs via miR-363/PI3K/Akt pathway. Biomechanical indices and tendon-related genes could be improved by rhPDGF-BB and hADSCs. Moreover, rhPDGF-BB promoted the proliferation of hADSCs via miR-363/PI3K/Akt pathway, indicating that rhPDGF-BB combined with ADSCs could treat Achilles tendinitis via miR-363/PI3K/Akt pathway.

[Treatment of tibiofibular diastasis without ankle fracture with endobutton device].

OBJECTIVE: To investigate the clinical effects of Endobutton device in the treatment of tibiofibular diastasis without ankle fracture. METHODS: From January 2009 to January 2011, a total of 8 patients with tibiofibular diastasis without ankle fracture were treated with Endobutton device. There were 6 males and 2 females with an average age of 34 years (ranged, 25 to 44 years). All the patients with ankle injured history and ankle pain, swelling, ecchy-mosis were diagnosed by radiology and then operated with Endobutton device. The clinical effects were evaluated according to Baird-Jackson scoring system and radiological evaluated parameters comprised of tibiofibular overlap,total clear space and medial clear space. RESULTS: All the patients were followed up, and the duration ranged from 6 to 24 months,with an average of 12 months. Radiographic results were detailed as follows: tibiofibular overlap averaged (3.83 +/- 0.37) mm in preoperative and (7.46 +/- 0.14) mm in postoperative; mean total clear space (7.90 +/- 0.22) mm in preoperative and (3.39 +/- 0.07) mm in postoperative; medial clear space averaged (5.08 +/- 0.34) mm in preoperative and (3.16 +/- 0.07) mm in postoperative. There was significant difference above data between preoperative and postoperative one. The lastest Baird-Jackson score results: 6 cases obtained an excellent result, 1 good and 1 fair. The main score was (94.63 +/- 3.66). CONCLUSION: Endobutton device for the treatment of tibiofibular diastasis without ankle fracture has advantages such as simple and minimally invasive, no need of second operation for implant removal, recover the ankle function better and less complications, which should be popularized and applied to clinical widely.

[Treatment strategy of double disruption of the superior shoulder suspensor complex (SSSC)].

OBJECTIVE: To discuss efficacy of the surgical treatment strategy of double disruption of the superior shoulder suspensor complex (SSSC). METHODS: The data of 15 patients with double disruption of the SSSC were retrospectively analyzed from January 2008 to December 2009. There were 11 males and 4 females, with an average age of 45.1 years (ranged, 19 to 60). Of them, 8 patients were treated with surgery and 7 patients with conservative treatment. The short-term effectiveness was evaluated according to Constant-Murley scoring system. RESULTS: All patients were followed up for 7 to 24 months with an average of 14.4 months. All fractures healed with a mean time of 12.3 weeks (ranged, 9 to 12). At final follow-up, the Constant-Murley scores with patients of surgical treatment was (92.37 +/- 1.99), and patients of conservative treatment was (55.52 +/- 1.29). CONCLUSION: Surgical treatment can restore the integrality of SSSC, in favour of stability between upper limb and trunk.

Phase I clinical trial of nasopharyngeal radiotherapy and concurrent celecoxib for patients with locoregionally advanced nasopharyngeal carcinoma.

We evaluated the incidence of acute toxicity of concurrent cyclooxygenase-2 inhibitor (celecoxib) plus radiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma (NPC). Thirty-four patients received an accumulated radiation dose of 72-76Gy in 36-38 fractions to the primary lesion and 60Gy in 30 fractions to cervical lymph-node lesions. Palpable residual nodes were boosted to 70Gy at the 90% isodose level with an electron field. Celecoxib was administered at escalating doses of 400, 600, and 800mg/day, starting 3days before the first fraction of radiotherapy and continuing throughout the course of radiotherapy. The majority of toxicities were grade 1, with mucositis and weight loss most frequently observed (28 of 34, 82.4%), followed by dermatitis (27 of 34, 79.4%) and otitis (14 of 34, 41.2%). The toxicities were not related to celecoxib dose (all P>0.05). Stomach pain was considered related to celecoxib, which developed in 2 patients at doses of 400mg and 800mg/day. No grade-3 or -4 toxicities or episodes of toxic death occurred. The tumors in 31 patients (31/34, 91.2%) showed a complete response, and 3 patients (3/34, 8.8%) had partial responses. The actuarial local progression-free survival was 96.6% at 1year, and the 2year overall survival rate was 84.6%. Celecoxib can be safely administered concurrently with nasopharyngeal radiotherapy at doses up to 800mg/day. The tumors responded well to treatment warranting further assessment in a phase II trial.

[Application of elastic intramedullary nail in treating bilateral femoral shaft fractures in children].

OBJECTIVE: To explore the curative effects and complications of elastic intramedullary nail in treating children's bilateral femoral shaft fractures. METHODS: Form February 2005 to March 2008, 7 patients with bilateral femoral shaft fractures were treated by closed reduction and internal fixation with elastic intramedullary nail. There were 5 males and 2 females. The age ranged from 3 to 13 years with the mean of 8.3 years. Six injuries caused by road accident and 1 injury caused by fall from high. Two cases associated with pulmonary contusion, 3 cases brain injuries, 1 case fracture of calcaneus and 1 case bladder injuries. All the cases were closed fractures without nerve and blood vessel injury. A cast external fixation had been used after operation for a month in two cases. RESULTS: All the patients were followed up for 21-37 months with an average of 30.3 months. No infecton of incisional wound, displacement fracture, internal fixation fail, delayedunion and malunion were found. All fracture obtained healing for 7-12 weeks with an average of 8.7 weeks. Inequality of lower limb was found in 1 case (length differences was 5 mm). According to Flynn scoring,all fractures were excellent. CONCLUSION: Treatment of femoral shaft fractures in children with elastic intramedullary nail according with biological principle. The method has little trauma, less complication, outstanding effect and it is a good way to treat bilateral femoral shaft fractures result from high-energy injuries.