Efficacy and safety of VRD regimen of autologous hematopoietic stem cell transplantation in patients with newly diagnosed multiple myeloma / 中华内科杂志

Objective: To explore the stem cell collection rate and efficacy and safety of patients aged 70 and below with newly diagnosed multiple myeloma (MM) treated with the VRD (bortezomib, lenalidomide and dexamethasone) regimen followed by autologous stem cell transplantation (ASCT). Methods: Retrospective case series study. The clinical data of 123 patients with newly diagnosed MM from August 1, 2018, to June 30, 2020, at the First Affiliated Hospital of Soochow University and Suzhou Hopes Hematology Hospital, who were eligible for VRD regimen sequential ASCT, were collected. The clinical characteristics, efficacy after induction therapy, mobilization regimen of autologous stem cells, autologous stem cell collection rate, and side effects and efficacy of ASCT were retrospectively analyzed. Results: Of the 123 patients, 67 were males. The median patient age was 56 (range: 31-70) years. Patients with IgG, IgA, IgD, and light-chain types accounted for 47.2% (58/123), 23.6% (29/123), 3.2% (4/123), and 26.0% (32/123) of patients, respectively. In addition, 25.2% (31/123) of patients had renal insufficiency (creatinine clearance rate<40 ml/min). Patients with Revised-International Staging System (R-ISS) Ⅲ accounted for 18.2% (22/121) of patients. After induction therapy, the rates of partial response and above, very-good partial response (VGPR) and above, and complete response (CR)+stringent CR were 82.1% (101/123), 75.6% (93/123), and 45.5% (56/123), respectively. Overall, 90.3% (84/93) of patients were mobilized with cyclophosphamide+granulocyte colony-stimulating factor (G-CSF) and 8 patients with G-CSF or G-CSF+plerixafor due to creatinine clearance rate<30 ml/min and one of them was mobilized with DECP (cisplatin, etoposide, cyclophosphamide and dexamethasone)+G-CSF for progressive disease. The rate of autologous stem cell collection (CD34+cells≥2×106/kg) after four courses of VRD regimen was 89.1% (82/92), and the rate of collection (CD34+cells≥5×106/kg) was 56.5% (52/92). Seventy-seven patients treated with the VRD regimen sequential ASCT. All patients had grade 4 neutropenia and thrombocytopenia. Among the nonhematologic adverse events during ASCT, the highest incidence was observed for gastrointestinal reactions (76.6%, 59/77), followed by oral mucositis (46.8%, 36/77), elevated aminotransferases (44.2%, 34/77), fever (37.7%, 29/77), infection (16.9%, 13/77) and heart-related adverse events (11.7%, 9/77). Among the adverse events, grade 3 adverse events included nausea (6.5%, 5/77), oral mucositis (5.2%, 4/77), vomiting (3.9%, 3/77), infection (2.6%, 2/77), elevated blood pressure after infusion (2.6%, 2/77), elevated alanine transaminase (1.3%, 1/77), and perianal mucositis (1.3%, 1/77); there were no grade 4 or above nonhematologic adverse events. The proportion of patients who achieved VGPR and above after VRD sequential ASCT was 100% (75/75), and the proportion of patients who were minimal residual disease-negative (<10-4 level) was 82.7% (62/75). Conclusion: In patients aged 70 and below with newly diagnosed MM treated with VRD induction therapy, the collection rate of autologous stem cells was good, and good efficacy and tolerability were noted after follow-up ASCT.

A case-control study of two internal fixation methods in the treatment of comminuted fracture of inferior pole of patella / 中国骨伤

OBJECTIVE@#To compare the effects of tension band combined with patellar cerclage and memory alloy patellar concentrator fixation in the treatment of comminuted fracture of the lower pole of patella.@*METHODS@#From July 2015 to July 2019, 60 patients with distal patellar fracture were treated and were divided into two groups according to different operation methods. In group A, 30 patients were fixed with memory alloy patellar concentrator (NiTi PC), 17 males and 13 females, aged 20 to 71 (39.4±9.9) years, including 19 cases of falling injury, 9 cases of traffic injury and 2 cases of sports injury. The time from injury to operation was 10 to 75 (33.1±7.8) hours; 30 cases in group B were fixed with tension band andcerclage, 15 males and 15 females, aged 21 to 76 (38.6±10.2) years, including 17 cases of falling injury, 12 cases of traffic injury and 1 case of smashing injury. The time from injury to operation was 10 to 91 (34.5±9.1) hours. The curative effects of two groups were observed and compared.@*RESULTS@#All 60 patients were followed up for 9 to 30 months. There was no significant difference in intraoperative bleeding, operation time, follow-up time and fracture healing time between the two groups. Six months after operation, according to the Bostman function score of knee joint:30 cases in group A, the total score was 28.6±4.7, of which 26 cases were excellent and 4 cases were good. The total score of 30 cases in group B was 25.5±4.4, of which 20 cases were excellent, 8 cases were good and 2 cases were poor. There were significant differences in Bostman total score and curative effect evaluation between two groups (@*CONCLUSION@#Memory alloy patellar concentrator is strong and reliable in the treatment of inferior patellar fracture. It can take early rehabilitation exercise after operation, with good recovery of joint function and range of motion and less complications.

Busulfan Combined with Cyclophosphamide as the Conditioning Regimen in Patients with Multiple Myeloma Treated by Autolo-gous Hematopoietic Stem Cell Transplantation / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To retrospectively analyze the safety and efficacy of busulfan (BU) combined with cyclophosphamide (CY) as the conditioning regimen of autologous hematopoietic stem cell transplantation (auto-HSCT) in patients with multiple myeloma (MM).</p><p><b>METHODS</b>The safety and efficacy of the BUCY regimen were evaluated through observing the adverse reactions, recovery of hematopoietic reconstitution, response and survival in 20 patients after auto-HSCT.</p><p><b>RESULTS</b>In 20 MM patients with median age 52.5 (38-66), the neutrophil and platelet counts recovered at 10(8-18) d and 10 (8-17) d after auto-HSCT respectively, the treatment related mortality during 100 days after auto-HSCT was 0, the partial remission (PR) rate decreased from 31.58% to 0 (P < 0.05) after auto-HSCT, only 1 patient was in progression of disease, all patients were alived.</p><p><b>CONCLUSION</b>For patients with MM treated with Auto-HSCT, the BUCY regimen is ideal in safety and response, but the long-term effect still should be observed.</p>

Single center comparative analysis of hematopoietic cell transplantation from alternated donor in patients with hematologic malignancies / 中国实验血液学杂志

<p><b>OBJECTIVE</b>One of the truly revolutionary advances in hematopoietic cell transplantation (HCT) is the increasingly successful use of alternative donors, as only 1/4 of patients who require an allogeneic hematopoietic cell transplant will have a HLA-matched sibling donor. Thereby, three alternative graft sources: umbilical cord blood (UCB), haploidentical (hi) related donor and mismatched unrelated donor hematopoietic cell transplantation (MMUDT) are available. This study was purposed to compare the characteristics of umbilical cord blood transplantation(UCBT), haplaidentical (hi) related donor hematopoieetic cell transplantation(hi-HSCT) and MMUDT.</p><p><b>METHODS</b>The clinical date of 93 patients with hematologic malignancies who received UCBT (n = 22), hi-HSCT (n = 42) and MMUDT (n = 29), and the days of hematopoietic reconstration and engraftment, rate of acute graft-versus-host disease (GVHD), relapse rate, and overall survival (OS) were analysed.</p><p><b>RESULTS</b>The median days of hematopoietic reconstitution (WBC>1.0×10(9)) among UCBT recipients were significantly longer than those among hi-HSCT/MMUDT recipients, (19 in UCBT, 12 in hi-HSCT and 12 in MMUDT)(P < 0.001), whereas the median days of full engraftment (STR >95%) among hi-HSCT recipients were longer than those among UCBT/MMUDT recipients (26 in hi-HSCT, 15 in UCBT and 20 in MMUDT, P = 0.028), the implant failure rate of UCBT recipients was higher than others (26% in UCBT, 5% in hi-HSCT, 3% in MUUDT)(P < 0.05). Multivarite analysis demonstrated no apparent differences in the rate of aGVHD (50% in UCBT,57.1% in hi-HSCT and 72.4% in MMUDT) (P = 0.498), and the rate of III-VI aGVHD also was no significant defference (27.3% in UCBT, 28.6% in hi-HSCT and 17.2% in MMUDT)(P = 0.543), the rate of chronic GVHD of UCBT recipients was lowered (19.0% in UCBT, 45.5% in hi-HSCT, 58.3% in MMUDT, P = 0.026). Overall survival at 2 years was 79.9% in UCBT, 80.9% in hi-HSCT and 88.0% in MUUDT (P = 0.097), and the TRM in 100 days was 23.8% in UCBT, 20.0% in hi-HSCT and 11.1% in MMUDT (P = 0.245) respectively.</p><p><b>CONCLUSIONS</b>The UCBT is characterised by lowest rate of cGVHD, but its hematopoietic recostruction is slow; the hi-HSCT has more alternative donors for using in clinic and can achieve post-transplant adoptive cellular immunotherapy, but its TRM has been found to be higher; the first important problem for MMUDT is to decrease the higher incidence of aGVHD and cGVHD.</p>

CD20 Expression in Adult Patients with B-lineage Acute Lymphoblastic Leukemia and Its Prognostic Significance / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To explore the relationship between the expression of CD20 antigen and clinical characteristics in adult patients with B-acute lymphoblastic leukemia(B-ALL).</p><p><b>METHODS</b>The CD20 expression of 126 acute lympho-blastic leukemia patients in our hospital from July 2009 to July 2012 were determined by flow cytometry. The characteristics, examination results and outcome were analyzed retrospectively. The complete remission rate (CR rate), relape rate, 2-year survival rate and 2-year event-free survival (EFS) of patients with CD20 positive and negative after the first cycle of chemstherapy were compared.</p><p><b>RESULTS</b>Positive rate of CD20 antigen expression in 126 patients was 24.4% (31 cases), negative rate of CD20 antigen expression in 126 patients was 75.6% (95 cases). No significant relationship was found between CD20 antigen expression and sex, age, peripheral blood leucocytes count and chromosomal changes. The relapse rate, 2-year survival rate (OS) and 2-year event-free survival (EFS) of adult patients with B-ALL in CD20 positive and negative groups were 53.3% and 38.0%, 52.1% and 92.3%, 33.7% and 70.8% respectively.</p><p><b>CONCLUSION</b>Expression of CD20 in adult patients with B-ALL did not related with clinical features, but related with poor prognosis.</p>

Biomechanical study of posterior wall acetabular fracture fixation using acetabular tridimensional memory alloy-fixation system.

BACKGROUND: We developed the acetabular tridimensional memory alloy-fixation system (ATMFS), which is made of NiTi shape memory alloy, according to the specific mechanical properties of biological memory material, nitinol alloy and measured distribution of contact area and pressure between the acetabulum and the femoral head of cadaveric pelvis. METHODS: Six formalin-preserved cadaveric pelvis were used for this investigation. Pressure-sensitive film was used to measure contact area and pressure within the anterior, superior, and posterior regions of the acetabulum. The pelvis were loaded under the following four conditions: (1) intact; (2) following a creation posterior wall fracture defect; (3) following reduction and standard internal fixation with reconstruction plate; (4) following reduction and internal fixation with a new shape memory alloy device named ATMFS. A posterior wall fracture was created along an arc of 40-90 degrees about the acetabular rim. FINDINGS: Creation of a posterior wall defect resulted in increased load in the superior acetabulum (1422N) as compared to the intact condition (762N, P=0.007). Following reduction and internal fixation, the load distributed to the superior acetabulum (1486N) was not statistically different from the defect condition. Following the fixation with ATMFS, the load seen at the superior region of the actabulum (936N) was less than fixation with reconstruction plate and was not different from intact state (P=0.4). INTERPRETATION: These data indicate that the use of ATMFS as a fracture internal fixation device resulted a partial restoration of joint loading parameters toward the intact state. ATMFS fixation may result in a clinical benefit.

Anatomic measurements and quantitative analysis of posterior acetabular wall / 中国骨伤

<p><b>OBJECTIVE</b>To explore morphological character and clinical significance of superior-posterior acetabular wall by anatomically measuring and quantitatively analyzing thickness of posterior acetabular wall, then provide a theoretical reference for clinical treatment of acetabular fracture.</p><p><b>METHODS</b>Fifteen adult formalin-preserved cadaveric pelvises (8 males and 7 females) were used for this investigation. Excess soft tissue was removed and the whole acetabular posterior walls were marked with "angle" sector method and the thickness was measured with caliper in different levels of the different split points. The measurement results were validated and analyzed statistically.</p><p><b>RESULTS</b>At 5 mm away from acetabular rim, the average thickness of superior-posterior acetablar wall fluctuated between (6.47±0.61) mm and (7.43±0.71) mm; the average thickness of inferior-posterior acetabuluar wall fluctuated between (5.62±0.51) mm and (6.33±0.61) mm; the average thickness of acetabular roof fluctuated between (7.71±0.74) mm and (8.27±0.99) mm. There was no statistical difference between average thickness of superior-posterior wall of acetabulum and inferior-posterior wall of acetabulum (P>0.05), but the average thickness of acetabular roof was significantly larger than superior-posterior acetabular wall (P<0.05). At 10 mm away from the acetabular rim, the average thickness of superior-posterior acetabular wall fluctuated between (8.81±0.67) mm and (13.35±0.89)mm; the average thickness of inferior-posterior acetabular wall fluctuated between (7.02±0.63) mm and (7.66±0.69) mm; the average thickness of acetabular roof fluctuated between (14.46±0.97) mm and (17.05±1.35) mm. Comparatively, the average thickness of superior-posterior acetabular wall was significantly larger than inferior-posterior wall of acetabulum (P<0.05), and the average thickness of acetabular roof was significantly larger than superior-posterior acetabular wall (P<0.01). At 15 mm away from the acetabular rim, the average thickness of superior-posterior acetabular wall fluctuated between (12.08±0.78) mm and (19.84±1.03) mm; the average thickness of inferior-posterior acetabular wall fluctuated between (10.17±0.76) mm and (11.12± 0.77) mm; the average thickness of acetabular roof fluctuated between (23.23±1.12) mm and (26.01±1.53) mm. Comparatively, the average thickness of superior-posterior wall of acetabulum was significantly larger than inferior-posterior acetabular wall (P<0.01), and the average thickness of acetabular roof was significantly larger than superior-posterior acetabular wall (P< 0.01).</p><p><b>CONCLUSION</b>The thickness of entire acetabular posterior edge revealed an increasing tendency from inferior-posterior wall to the superior-posterior wall to acetabular roof. And this trend became more obvious with increasing distance away from acetabular rim. Therefore, the superior-posterior acetabular wall could not only maintain the stability of hip joint but also bear loading.</p>

Advanced bone graft combined with locking compression plate for the treatment of middle and distal tibia nonunion / 中国骨伤

<p><b>OBJECTIVE</b>To explore methods of treating middle and distal tibia nonunion with the treatment of advanced bone graft combined with locking compression plate.</p><p><b>METHODS</b>From January 2011 to December 2012, 12 patients with middle and distal tibia nonunion were treated with advanced bone graft combined with locking compression plate. Among patients, there were 8 males and 4 females aged from 20 to 69 with an average of 47 years old. The time from first injuries to bone nonunion was from 9 months to 5 years, avergaed 19 months. Four cases were treated with external fixation, 6 cases were treated with plate fixation, 2 cases of 12 patients occurred broken of plate and nail. Eleven patients were non-infective bone nonunion and 1 patient was infective bone nonunion. Preoperative X-ray and CT showed all patients had sequestration and formation of ossified bone with different degrees. Operative time, blood loss, wound healing were observed, fracture healing time was evaluated by postoperative X-ray. Johner-Wruhs scoring standards was used to evaluate ankle joint function after operation at 10 months.</p><p><b>RESULTS</b>Operative time ranged from 90 to 185 min with an average of (125.00±20.15) min; blood loss ranged from 225 to 750 ml with an average of (415.00±120.00) ml. All patients were followed up from 10 months to 2.5 years with an average of 1.5 years. Postoperative X-ray showed bone union was formed around fracture after operation at 4 months in all patients, 3 cases obtained bone healing within 6 months after operation, 9 cases obtained from 8 to 12 months. No infection, injury of nerve and vessles, and broken of plate and nail were ocurred. According to Johner-Wruhs scoring at 10 months after operation, 10 cases obtained excellent results, 1 good and 1 moderate.</p><p><b>CONCLUSION</b>Advanced bone graft combined with locking compression plate, which can build fracture multi-point supporting based on full compression of bone nonunion to get effective fixation, is an effective method in treating middle and distal tibia nonunion.</p>

Application of cannulated compression screws for the treatment of tibial tubercle avulsion fractures of Ogden type III in adolescents / 中国骨伤

<p><b>OBJECTIVE</b>To review the clinical outcome of the application of cannulated compression screws for the treatment of tibial tubercle avulsion fractures of Ogden type III in adolescents.</p><p><b>METHODS</b>From January 2003 to October 2010,11 adolescent patients with tibial tubercle avulsion fractures were treated with open reduction and internal fixation. There were 9 boys and 2 girls with an average age of 15.2 years old (ranged, 12.4 to 17 years old). According to Ogden classification, there were 9 patients with type IIIa and 2 patients with type IIIb. Postoperative functional exercise and regular follow-up were done and outcomes were evaluated by the Mosier clinical assessment system.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 7 to 69 months, with a mean of 25.5 months. All fractures healed at the first stage. According to the Mosier clinical assessment system, the final outcome was evaluated as excellent in all. One patient had infrapatellar hypoesthesia, and one patient had prominency of tibial tubercle without any symptoms.</p><p><b>CONCLUSION</b>The cannualted compression screws in the treatment of tibial tubercle avulsion fractures of Ogden type III in adolescents have an excellent outcome without deformity or functional loss.</p>

Application of Ni-Ti patellar concentrator combined with Herbert screw and wirerope for the treatment of comminuted patellar inferior pole fractures / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the surgical techniques and clinical effect of Ni-Ti patellar concentrator combined with Herbert screw and wirerope in treating comminuted patellar inferior pole fractures.</p><p><b>METHODS</b>From March 2008 to June 2010,34 patients with comminuted patellar inferior pole fracture were treated with Ni-Ti patellar concentrator combined with Herbert screw and wirerope. Of them, there were 19 males and 15 females with an average age of 38.6 years old(ranged from 22 to 75). Early functional exercise was guided postoperatively and the patients were regularly followed up and their outcomes were assessed.</p><p><b>RESULTS</b>All patients were followed up with an average of 13.5 months (ranged,7 to 20). All fractures healed. According to Böstman Clinical Rating System, the average score was 28.43 +/- 2.34,and excellent results in 21 cases,good in 13 cases and no poor case.</p><p><b>CONCLUSION</b>Ni Ti patellar concentrator combined with Herbert screw and wirerope for the treatment of comminuted patellar inferior pole fracture is an effective method and of great value to clinical application.</p>

Posterior partial trochanteric osteotomy for the treatment of the roof involved acetabular fractures / 中国骨伤

<p><b>OBJECTIVE</b>To introduce a new trochanteric osteotomy,and evaluate the outcome of the procedure combined a posterior lateral approach in treating acetabular fractures which involving the roof.</p><p><b>METHODS</b>Between March 2007 and Novmber 2010,30 patients with displaced acetabular fractures involving the dome need trochanteric osteotomy were retrospectively reviewed. There were 21 males and 9 females,ranging in age from 18 to 70 years with an average of 35.2 years at the time of injury. According to Letournel-Judet classification, there were 10 posterior wall fractures,7 posterior column fractures,5 transverse fractures, 2 T-shape fractures, 1 transverse associated with posterior wall fracture, 3 posterior column and wall fractures and 2 bicolumn fractures. The standards of Matta,the modified Merle d'Aubigne-Postel, Medical Research Council were respectively used to evaluate the reduction result, function of hip joint and the strength of hip abduction.</p><p><b>RESULTS</b>All patients were followed up with an average time of 25 months (18 to 40) and all osteotomy sites obtained bone union with an average time of 8.4 weeks (6 to 12). No bone non-union, bone block displaceing, internal fixation looseing and breaking,infection of deep part were found. Seventeen patients got anatomic reduction, 12 got satisfied reduction, and 1 got unsatisfied result according to the criteria of Matta. At final follow-up, function of hip joint obtained excellent results in 11 cases, good in 15, fair in 3 and poor in 1. The strength of the abductors of 3 patients were grade 4 and 27 patients were grade 5.</p><p><b>CONCLUSION</b>Posterior partial great trochanteric osteotomy can enhance the exposure and provide a more accurate reduction and degrade the difficulty of acetabular fracture fixation without increasing the risk of complications. The method provide a new way for the treatment of the roof involved acetabular fractures.</p>

Case-control study on two methods for the treatment of calcaneal fractures / 中国骨伤

<p><b>OBJECTIVE</b>To investigate clinical results of percutaneous reduction and hollow screw internal fixation for the treatment of calcaneal fractures, and to compare therapeutic effects between close reduction hollow screw internal fixation and open reduction plate internal fixation.</p><p><b>METHODS</b>From August 2007 to May 2010, 53 patients with calcaneal fractures were retrospectively analyzed. All the patients were divided into two groups, 25 patients in group A (PR group) treated with percutaneous reduction and hollow screw internal fixation, including 17 males and 8 females, with an average age of (39.4 +/- 9.9) years. While 28 patients in group B (OR group) treated with open reduction and plate internal fixation, including 18 males and 10 females, with an average age of (38.6 +/- 10.2) years. According to Sanders classification, there were 18 patients with type II fractures, 29 patients with type III and 6 type IV. In both groups, operative time, blood loss, postoperative complications and radiology were recorded. Functional recovery was evaluated by Maryland score.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from nine months to thirty-five months (averaged 20.4 months). There were no significant differences in sex, age, fracture type, fracture classification, initial Böhler angle, or late complications between the two groups. But significant difference can be seen between operative time, blood loss, and skin complications (in group A no nonunion and skin complications occurred, but subtalar posttraumatic arthritis occurred in 1 case; in group B, 3 patients had complications of skin necrosis, 1 patient suffered from a delayed union due to large defect filled with artificial bone, and 1 patient got subtalar posttraumatic arthritis). No difference were found in the latest X-ray film. According to Maryland score, in group A, 8 got an excellent result and 12 good. In group B, 10 got an excellent and 14 good. There were no significant differences between the two groups in Margland score.</p><p><b>CONCLUSION</b>The results of this study suggest that in comparison with open reduction, percutaneous reduction and hollow screw internal fixation minimizes complications and achieves good results. Further study of this technique is needed.</p>

Treatment of syndesmosis diastasis with shape memory staple fixation in ankle fractures / 中国骨伤

<p><b>OBJECTIVE</b>To explore operative method in the treatment of syndesmosis injury of ankle fractures.</p><p><b>METHODS</b>Twenty-four patients with ankle fractures and syndesmosis diastasis were treated with shape memory fracture staples, including 10 males and 14 females ranging in age from 19 to 71 years, with an average of 43 years. All patients were diagnosised with history, body examination and image data and were operated according to classification of Lauge-Hansen.</p><p><b>RESULTS</b>All patients were followed up from 6 to 28 months with an average of 16 months, and all fractures healed, with a mean time 9.2 (8 to 14) weeks. Only one case had radiological and clinical manifestations of traumatic arthritis, but no breakage of shape memory fracture staple in all cases. Sixteen patients got excellent results, good in 5, fair in 2, poor in 1.</p><p><b>CONCLUSION</b>Shape memory staple fixation for the treatment of syndesmosis diastasis in ankle fractures not only can perseve the physical motion of ankles, but also be remove earlier before weight bearing.</p>

Management of weight-bearing area fracture of acetabulum / 中国骨伤

Acetabulum, as the important factor for weight bearing of the upper body, has its unique anatomic features and complicated physiological function. The integrity and stability of the lunata articular surface in the dome region of acetabulum, is the important base to bear the physiological function of acetabulum. The fracture related to this part will cause relation change of contact area and stress between head of femur and acetabulum. Furthermore, the deep anatomical position of the dome region, the complicated surrounding anatomical relation, and the irregular bony structure will also increase the difficulty of surgical treatment. Especially for some complicated comminuted or compressed fracture, even with good explosions, it is hard to get satisfied anatomical reduction. Consequently,forward traumatic arthritis has greater probability of occurrence. Therefore, the clinical research on the fracture in the dome region of acetabulum was getting more and more attention worldly. This paper intended to review the relation of fracture classifications and anatomic features, physiological function,diagnostic criteria,and also its clinical treating countermeasure.

Closed reduction and percutaneous Kirschner pin fixation combined with plaster support for the treatment of supracondylar humerus fractures in children / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the therapeutic effects of closed reduction and percutaneous Kirschner pin fixation combined with plaster support for the treatment of supracondylar humerus fractures in children.</p><p><b>METHODS</b>From June 2007 to December 2008, 27 patients with Gartland III supracondylar fractures were treated with closed reduction and percutaneous Kirschner wire fixation combined with plaster support. Among the patients, 18 patients were male and 9 patients were female, ranging in age from 6 to 12 years,with an average of 8.1 years. Fifteen patients were extension type, 12 patients were buckling type; fourteen patients were ulnar deviation, 13 patients were radial deviation. The duration from injury to treatment ranged from 0.5 to 8 days, averaged 3.6 days.</p><p><b>RESULTS</b>Twenty-seven patients were followed up, and the duration ranged from 6 to 24 months, averaged 13.5 months. The healing time ranged from 4 to 6 weeks after surgery, with a mean of 4.5 weeks. Complications including implants loosening, fracture re-displacement, Volkmarm contraction, needle point or deep infection, ulnar nerve injury, myositis ossificans were found during follow-up. Two patients had postoperative elbow varus, but the varus angle was not more than 15 degree,which may be due to inappropriate functional exercise or early removal of external fixation. According to Flynn criteria, 19 patients got an excellent result, 5 good, 2 poor and 1 bad.</p><p><b>CONCLUSION</b>Closed reduction and percutaneous Kirschner wire fixation combined plaster support for the treatment of unstable supracondylar fractures in children has advantages including little trauma, reliable fixation, good elbow function and appearance.</p>

Design of ABC damage variable and positioning system for acetabular fractures and 1122 cases multi-center statistic analysis / 中国骨伤

<p><b>OBJECTIVE</b>To design ABC damage variable and positioning system for acetabular fracture and explore the feasibility and clinical practical value of the system through the multi-center analysis of 1122 acetabular fractures.</p><p><b>METHODS</b>According to acetabular three-column conception, and pelvic ring lesions damage direction caused by acetabular fracture domino effect and injury degree of proximal femur joint, it defined class A as any column acetabular fracture; class B as any two-column acetabular fracture; class C as front, dome and posterior mixture acetabular fracture. Lower case English letters a, m, p represented front, dome, posterior fracture, respectively. Acetabular damage variables: 1 was simple displaced fractures; 2 was comminuted fractures; 3 was compression fractures. Pelvic ring lesions damage variables: alpha was sacroiliac joints or sacroiliac fracture horizontal separation deflection; beta was sacroiliac joints or sacroiliac fracture vertical separation deflection; gamma was pubic symphysis separation/superior and inferior ramus of pubis fracture deflection; alpha beta gamma delta was compound floating damage. Proximal humerus joint damage variables: I was femoral head fracture; II was femoral neck fracture; II was intertrochanteric fractures of femur; IV was I to III compound fracture. The ABC damage variable positioning system for acetabular fracture was made up by the above-mentioned variables. The statistics from March 1997 to February 2010 showed 1122 cases acetabular fractures with 18 cases of double side acetabular fracture and 1140 cases of acetabular fractures. The pelvics anterior-posterior view, ilium and obturator oblique view, and 2/3D-CT materials were analyzed and researched.</p><p><b>RESULTS</b>Each damage variables distribution situation in 1140 cases of acetabular fracture involved A in 237 cases (20.8%), B in 605 cases (53.1%), C in 298 cases (26.1%);front column fracture in 808 cases(70.9%), dome fracture in 507 cases (44.5%), posterior fracture in 1026 cases (90%). Acetabular variables: variabe 1 in 203 cases of simple displaced fracture (17.8%); variabe 2 in 516 cases of comminuted fracture(45.3%); variabe 3 in 421 cases of compression fracture (36.9%); 249 cases of pelvic ring lesions damage (21.8%), 75 cases femoral head fracture (6.6%); 18 cases of double side acetabular fracture and relative pelvic ring and proximal humerus joint variables (1.58%). Key part and curative effect elements of 1140 cases acetabular fracture: 507 cases of dome or posterior acetabular fracture (44.5%); 421 cases of compression fracture (36.9%); 249 cases of pelvic ring variables (21.8%); 75 cases of proximal humerus joint variables (6.6%); 486 cases of simple Aa/pl/2,Bapl/2 acetabular fracture (42.6% ).</p><p><b>CONCLUSION</b>Compression fracture, especially defected compression fracture, takes important part in acetabular damage variables, and also presents that acetabular fracture with pelvic ring and proximal femoral damage variables are not rare at all. The relationship of the acetabular fracture damage variables, and its percentage shows the key points and elements in clinical treatment: weight-bearing to dome accounts for 44.5%; compression to defects account for 36.9%, pelvic ring to float accounts for 21.8%; dome fracture to double side fracture account for 6.6%. The system has significant guiding effects on clinic in terms of evaluation of injury severity, anatomic localization, difficulty index, alternative strategy, operative approach, effect of treatment,and prognosis. And the most important thing is that the system creates the comparison of damage variables in same type of fracture and the communication of homo-language and explores a new method.</p>

Treatment of Seinsheimer type V subtrochanteric femoral fractures with dynamic hip screw and shape memory alloy bow-teeth screw / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effect of Seinsheimer type V subtrochanteric femoral fractures with dynamic hip screw and shape memory alloy bow-teeth screw.</p><p><b>METHODS</b>Twelve patients with Seinsheimer type V subtrochanteric femoral fractures were retrospectively analyzed. There were 8 males and 4 females with an average age of 53 years (range 31 to 65 years). Seven cases were caused by traffic accident, 4 cases by falling from hight, 1 case by heavy object. According to the Seinsheimer classification, all the cases were type V fractures. All the cases accepted the surgical treatment with dynamic hip screw and shape memory alloy bow-teeth screw fixation.</p><p><b>RESULTS</b>The mean period of follow-up was 28 months (range 20 to 38 months). All the cases obtained bone union in average 3.3 months (from 3 to 4.5 months). There were no complications such as deep infection, deep vein thrombosis, pulmonary embolism and bone nonunion. The results of clinical evaluation according to Merle d'Aubigne scores were 16.75 +/- 1.14 and excellent in 4 cases, good in 8 cases.</p><p><b>CONCLUSION</b>Application of dynamic hip screw and shape memory alloy bow-teeth screw as a superior option can get satisfactory reduction with reliable fixation and will be one of a better choice for fixation of Seinsheimer type V subtrochanteric femoral fractures.</p>

Application of PHILOS plate with injectable artificial bone for the treatment of proximal humeral fractures in elderly patients / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effects of PHILOS plate with injectable artificial bone for the treatment of proximal humeral fractures in elderly patients.</p><p><b>METHODS</b>From March 2007 to March 2009,17 patients who suffered from proximal humeral fractures were retrospectively studied. There were 7 males, 10 females, with an average age of 71 years (ranged, 66 to 81 years). Nine patients were caused by falling, seven patients were caused by traffic accidents,and one patient was hit by heavy object. According to the Neer classification, 9 patients were type III and 8 patients were type IV. All the patients were treated with PHILOS plate internal fixation combined with injectable artificial bone. Assessment was based on the Constan-Murley shoulder score and percentage Constant-Murley score.</p><p><b>RESULTS</b>The mean period of follow-up was 16 months (ranged, 8 to 25 months). All the patients obtained bone union in an average of 3 months (2.5 to 3.5 months). There were no complications such as deep infection, nonunion or failure of fixation. The Constant-Murley score of the injured side was mean (86.50 +/- 10.50) (ranged, 75 to 95). The clinical outcomes were excellent in 9 cases, good in 6 cases, moderate in 2 cases.</p><p><b>CONCLUSION</b>The treatment of proximal humeral fractures in elderly patients with application of PHILOS plate combined with injectable artificial bone can get satisfactory clinical effect especially suitable for osteoporosis and comminuted proximal humeral fractures.</p>