Objective To compare the efficacy and safety of closed reduction and percutaneous Kirschner wire fixation and Kirschner wire fixation in the treatment of children with supracondylar fracture of humerus. Methods 88 children with supracondylar fracture of humerus in our hospital were randomly selected. And they were divided into closed group ( n =44 ) and open group ( n =44 ) by taking computer random sequence method. The closed group was treated with closed reduction and percutaneous Kirschner wire fixation,the open group was treated with Kirschner wire fixation. The treatment effect and safety of the two groups were compared. Results The operation time [(59.47 ±12.23)min],hospitalization time [(3.46 ±1.44) d],fracture healing time[(32.46 ±7.41)d] of the closed group were significantly shorter than those of the open group (t=5. 238,5. 395,7. 841,all P<0. 05). The amount of bleeding[(15.48 ±8.48)mL] of the closed group was significantly less than that of the open group (t=4. 867,P<0. 05). The effective rate of the closed group (90. 91%) was significantly better than the open group (χ2 =5. 096,P<0. 05). The incidence rate of complication between the two groups had no significant difference (6. 82%vs. 9. 09%,χ2 =0. 155,P>0. 05). Conclusion Compared with open reduction and Kirschner wire internal fixation, closed reduction and percutaneous Kirschner wire fixation in the treatment of children with supracondylar fracture of humerus has significant curative effect,it is safe and reliable,which is worthy of promotion in clinic.

Objective:To investigate the effects of atorvastatin combined with alendronate in the treatment of type 2 diabetes mellitus (T2DM) with osteoporosis (OP) on bone metabolism, tumor necrosis factor alpha (TNF-α) , interleukin 6 (IL-6) , and 25-hydroxyvitamin D[25- (OH) D] level.Methods:A total of 152 patients with T2DM and OP who were diagnosed and treated in our hospital from Jul. 2017 to Jul. 2020 were selected. According to the different treatment methods, they were divided into control group (73 cases with alendronate treatment) and study group (79 cases receiving atova Statins combined with alendronate sodium treatment) . The two groups were compared in terms of bone metabolism indexes, bone mineral density, changes in serum TNF-α, IL-6, 25- (OH) D levels, and adverse reactions before and after treatment.Results:After treatment, osteocalcin (BGP) , bone-specific alkaline phosphatase (BAP) , lumbar spine L1-4 bone mineral density, femoral neck bone mineral density, and 25- (OH) D of the two groups increased ( P< 0.001) , and the study group was significantly higher than the control group (BGP: 7.68±0.89 vs 6.88±0.93; BAP: 18.62±3.97 vs 16.82±3.24; lumbar spine L1-4: 0.95±0.08 vs 0.92±0.05; femoral neck: 0.79±0.07 vs 0.75±0.06; 25- (OH) D: 31.35±10.1 vs 26.54±7.14; all P<0.05) . After treatment, the serum type I collagen C-terminal peptide (s-CTX) , human tartrate acid phosphatase (TRAP-5b) , TNF-α, IL-6 were decreased for both groups ( P<0.001) , and they were significantly lower in the study group than those in the control group (s-CTX:0.37±0.12 vs 0.55±0.12; TRAP-5b: 2.43±0.66 vs 2.99±0.75; TNF-α: 9.93±1.91 vs 11.77±2.69; IL-6: 10.65±1.26 vs 12.91±1.21; all P<0.001) . The incidence of adverse reactions in the study group was significantly lower than that in the control group (16.46% vs 39.73%, P=0.001) . Conclusion:Atorvastatin combined with alendronate in the treatment of T2DM patients with OP can effectively increase 25- (OH) D levels, reduce inflammation, and promote bone metabolism and bone density.

Objective To explore the effects of knowledge-attitude-belief-practice ( KABP ) model in nursing interns regarding the education of hands hygiene .Methods A total of 108 nursing interns were randomly divided into control group and intervention group , 54 students respectively .Traditional teaching model was applied in patients of control group , and the model based on KABP teaching was applied in patients of intervention group .The knowledge of hands hygiene and the rate of performing hand hygiene were compared between control group and intervention group .Results The knowledge of hands hygiene in intervention group (14.80 ±0.15) was higher than (13.59 ±0.25) of control group (P<0.05).The rates of performing hand hygiene before handling patients , after exposure of body fluids , after handling patients , before sterile operation and after environmental exposure of patients in control group were 37.03%, 88.89%, 59.26%, 53.70%and 51.85% respectively, while those in intervention group were 59.26%, 100.00%, 88.89%, 74.07%, 77.78% correspondingly.The rate of performing hand hygiene was significantly higher in intervention group than that of control group (P <0.05).Conclusions The KABP teaching model significantly improves the knowledge of hand hygiene and the rate of performing hand hygiene among nursing interns .The KABP teaching model not only changes the behavior of performing hand hygiene but also cultures the learning habit , paving the way for further nursing career .

Objective To investigate the application effect of "teaching based on learning" diet and nutrition education in the perioperative nursing of diabetes patients in orthopaedics.Methods A total of 60 patients in the orthopedics department were selected as the research object,and were divided into the control group(30 cases)and the intervention group(30 cases)according to admission time. Patients in both groups received routine diabetes education,and patients in the intervention group received additional "teaching based on learning" diet and nutrition education on the basis of routine education. The level of knowledge on diabetes,fasting blood glucose and 2 h postprandial blood glucose were compared in the two groups before and after intervention.Results Before intervention,there was no statistical significance in the knowledge score of diabetes,the levels of fasting blood glucose and 2 h postprandial blood glucose between two groups(P>0.05). After intervention,the knowledge score of diabetes was(18.83±0.66)in the control group and was(21.66±0.40) in the intervention group. The knowledge score in the intervention group was higher than that in the control group after intervention(P<0.05). After intervention,the levels of fasting blood glucose and 2 h postprandial blood glucose were(7.28±0.29) mmol/L and(10.57±0.52) mmol/L in the control group,and they were(6.18±0.18) mmol/L and(8.76±0.38) mmol/L in the intervention group. Compared with the control group,the levels of fasting blood glucose and 2 h postprandial blood glucose in the intervention group were lower after intervention(P<0.05). Conclusions The application of "teaching based on learning" diet and nutrition education during perioperative period in patients with diabetes stimulates patients themselves to discover,research and explore the knowledge of diabetes,and improves educational compliance. Additionally,this education model can fully mobilize the enthusiasm of patients in dietary therapy,and achieve the aim of dietary therapy.

Objective:To explore the reasons of secondary fracture after percutaneous vertebroplasty (PVP) for osteo-porotic vertebral compression fractures (OVCFs) and discuss the measure of prevention and cure. Methods:From January 2011 to January 2013,the clinical data of 180 patients with primary OVCFs treated by PVP were retrospectively analyzed. There were 75 males and 105 females,aged from 68 to 95 years old with an average of (79.50±5.45) years. The involved ver-tebrae were identified according to the clinical symptoms and imaging data. PVP were performed in 362 vertebrae and the pa-tients were followed up with an average of 12 months. Subsequent vertebral fractures were found through the pain ’s reappearance and MRI or bone scan. The patients were divided into secondary fracture group and no secondary fracture group according to the subsequent fractures or no. Secondary fracture group was divided into two groups according to gender ,and the patients with sec-ondary fracture were also categorized into the original surgical vertebral fractures ,adjacent vertebral fracture and remote verte-bral fractures. The age,gender,the cement volume,the cement leakage,secondary fracture site,the incidence and type of sec-ondary fracture were observed and compared among different groups. Results:Among the 362 vertebrae of PVP,there were 109 vertebrae in male and 253 vertebrae in female. And 27 vertebrae (10 in male and 17 in female) of 22 cases (9 males and 13 fe-males) occurred secondary fracture. The second PVP were performed in 13 cases (16 vertebrae) and the third PVP in 2 cases (4 vertebrae);7 cases (7 vertebrae) were treated with conservative therapy. There was no statistically significant difference on age , gender,cement volume and leakage between secondary fracture group and no secondary fracture group (P>0.05). There was no statistically significant difference on the incidence and type of secondary fracture between male and female (P>0.05). No signifi-cant difference was found on the adjacent and remote vertebral fractures (P>0.05). Most of secondary fracture occurred in 6 months,and whether the single and double side injection,cement leakage had no obvious relation. Conclusion:There is no significant difference in the subsequent fracture after PVP for the OVCFs different gender and fractured site ,and also no signif-icant difference in the adjacent and remote vertebral fractures. The report didn't support the biomechanical viewpoint that verte-bral body stiffness increasing after PVP would lead to adjacent vertebral stress increasing and result easily in adjacent vertebral fracture. Secondary fracture occurs always in 6 months after operation ,which is the natural course of osteoporosis.

Objective To analyze the effect of the fracture healing by using selective sensory radicotomy before and after the ganglion.Methods From September,2014 to August,2015,120 rats were averagely divided into 3 groups,which was the sham operate group(SO),the anterior injury of ganglion rhizotomy group (AGR) and the posterior injury of ganglion rhizotomy group (PGR).Tibial transverse fracture was performed on right or left randomly and the fracture was fixed with intramedullary.In coordination with the fractured-side,the selective radicotomy from L4 to L6 was made.The mRNA level of collagen-Ⅰ and collagen-Ⅱ in bony callus was quantified at 3,7 days and 2 weeks after the operation by RT-PCR(n=5).The histological examination,X-ray,biomechanical testing were performed at 4 and 8 weeks.The quantitative data of iconography and biomechanics was acquired by using the relative ration which resulted from fractured-side data dividing the unfractured-side one for every pair tibia in same rat.Results At 3 days after surgery,the mRNA of collagen-Ⅰ were 81.3±11.1,37.5±8.2 and 24.7±9.2,the mRNA of collagen-Ⅱ were 2.4±0.5,2.1±1.0 and 2.9±1.2 in SO,AGR and PGR group respectively;At 7 days after surgery,the mRNA of collagen-Ⅰ were 17.9±5.8,7.2±1.8 and 6.7±2.4,the mRNA of collagen-Ⅱ were 12.5±3.4,2.8±1.3 and 1.2±0.4 in SO,AGR and PGR group respectively.The SO group had significantly upregulation of collagen-Ⅰ and collagen-Ⅱ mRNA compared with the AGR and PGR groups at 3 days and 7 days respectively after surgery(P＜0.05).There was a significant difference of the collagen-Ⅱ between AGR group (2.8±1.3) and PGR group (1.2±0.4) at 7 days after injury(P＜ 0.05).The fracture bony callus in PGR group was a significantly larger and less ossified than that in the AGR group.The mechanical load of fracture in SO group was larger than that of the other 2 groups (P＜0.05).Conclusion Sensory denervation negatively affects fracture-healing.The ganglion of sensory nerve plays an important role in bone fracture healing and normal innervation is essential for the fracture repair.

Objective To observe the expression of parathyroid hormone - related peptide (PTHrp) receptor in tibial growth plate and its effects on tibial extension in chronic renal insufficiency rats. Methods Two-week-old male Sprague-Dawley rats were randomly divided into sham group, model group and enalapril group, each with 20 rats. In model group and enalapril group rats had chronic renal insufficiency induced by left ureteral obstruction, and rats were respectively given saline and enalapril by gavage after the operation. In sham group, left ureter was only exposed without ligation, and rats were given saline. The urine was collected 4 weeks after the operation and the total protein content was measured. Then all rats were killed. The concentrations of PTHrp, creatinine and urea nitrogen in intracardiac blood were detected. HE staining and Masson staining were performed on the left kidney to observe pathological changes of glomeruli and renal tubules. The total length of bilateral tibia was measured. The number of columnar cells in the growth plate proliferative zone was measured by safranin O staining and the expression of PTHrp receptor in the growth plate was detected by immunohistochemistry. Results The 24 h urine total protein, creatinine and urea nitrogen in model group were higher than those in sham group (all P＜0.05), while these 3 renal functional parameters in enalapril group were lower than those in model group (all P＜0.05). In model group and enalapril group rats had higher blood concentrations of PTHrp than that in sham group (all P＜0.05), but blood PTHrp in enalapril group was lower than that in model group (P＜0.05). HE staining and Masson staining showed that in the model group rats had severe tubular dilation, inflammatory cell infiltration and the tissue fibrosis, while in enalapril group renal tubules slightly dilated and had a few inflammatory cell infiltration and tissue fibrosis. Compared with those in the sham group, in model group the tibia length, the chondrocyte number of column structure in the growth plate proliferative zone and the PTHrp receptor decreased (all P＜0.05). But in enalapril group those indexes increased than model group (all P＜0.05). Conclusions Chronic renal insufficiency rats had increased PTHrp concentration in the blood but decreased PTHrp receptors expression in tibial growth plate, which lead to their limited tibial extension.

Objective To investigate the effect of POSTN protein on the proliferation of chondrocytes of tibial plateau in old rats.Methods Cartilage cells collected from the tibial plateau of old rats were cultured in vitro to the third generation.Then the cells were divided into 3 groups:POSTN group,PBS group and POSTN antibody group.The proliferations of the three groups at 24 h,48 h and 72 h were determined by EDU method.The expression of Notch1 protein was detected by immunohistochemistry in all groups at the same time.Female 20-month-old Sprague-Dawley rats were randomly divided into 3 groups:POSTN protein injection group,Phosphate Buffered Saline (PBS) injection group and POSTN antibody injection group.Twelve weeks after the operation,related reagents were injected 3 times consecutively at day 1,day 3,day 5 and EDU was injected into joints at day 1.At 2 weeks after injection,the rats were killed and the knee tibial plateau was taken to observe the proliferation of the cartilage cells.Results At 24 h,there were differences between the three groups O(F=27.32,P=0.017).The proliferation rates of POSTN group [(23±8)％] and PBS group [(21±10)％] were higher than that of POSTN antibody group (16±5)(P=0.003,P=0.011).At 48 h,there were differences between the three groups (F=35.34,P＜0.01).The proliferation rate of POSTN group [(36±11)％] was higher than that of the other groups [(22±6)％],(18±6)％(P=0.021,P＜0.01).At 72h,there were differences between the three groups (F=52.62,P=0.000).The proliferation rate of POSTN group [(56±17)％] was the highest one,the proliferation rate of PBS group [(31±8)％] was the medium,and the POSTN antibody group [(26±7)％] was the lowest one (all P＜0.05).As for Notch1 protein expression in chondrocytes,there were differences between the three groups (F=26.72,P＜0.01).The Notch1 protein was the most frequently expressed in POSTN protein-injection group and the least in the anti-POSTN group.In rats,the proliferation rate of the chondrocytes in the medial tibia plateau of the knee of POSTN protein injection group [(36±14)％],which was the highest,and that of the POSTN antibody injection group [(10 ±4)％] was the lowest (all P＜0.05).Conclusion POSTN protein can promote the proliferation of chondrocytes knee OA rats.POSTN antibody injection has been shown to induce the proliferation of chondrocytes.The POSTN protein may promote the proliferation of chondrocytes by activating the Notch signaling pathway.

Objective To study the association between the expression of periostin and the occurrence and progression of knee osteoarthritis (OA) in synovial fluid.Methods The expression level of periostin in the synovial fluid of healthy people and patients with different stages of OA was tested.Furthermore,60 surgical-induced OA rat model were divided into two groups,the sham operation group had only implemented slit suture,and the OA model group had one side anterior cruciate ligament transected.The expression of periostin in intra-articular injection samples were analyzed at 1,2,4,8,12 week.Fluorescence molecular tomography (FMT) were performed after surgery at 4,8,12 week on the surgery knee.Gross morphologic lesions on the tibial plateau in rats were visualized by India ink staining,toluidine blue staining,cartilage permeation test.The synovium were visualized by HE staining and periostin were detected by immunohistoc hemistry.The measurement data were compared by one factor analysis of variance test.Results The expression of periostin in cartilage was lower in late-stage OA than the one from normal and early-stage OA (F=13.95,P＜0.01).The FMT showed that there was no obvious change in the extent of chronic inflammation in the sham operation group,and the chronic inflammatory degree of the OA model group gradually increased as time went on.Toluidine blue staining and cartilage permeation test showed that the cartilage degeneration in rat model of OA became more and more serious with time.There was no stastically significant difference of the periostin in control groutp at different time stage (F=0.67,P=0.53).The periostin in the intra-articular increased at first and then decreased with the development of OA (F=11.0,P＜0.05).HE staining of synovial tissue showed that the degree of synovial hyperplasia was consistent with the degree of degeneration of joints.With the extension of time,the expression of periostin in synovial tissue increased gradually.Conclusion The expression of periostin in human synovial fluid is low in normal knee joint,increases in early and middle stages,and decreases in late stage.The rat model indicates that the expression of periostin increases first and then decreases with the development of OA,but the expression in synovium increases gradually with the development of OA.The increased expression of periostin in synovial fluid may serve as an early diagnostic marker for OA and downregulation of the periostin may be a start marker for the late OA.

Objective To identify the risk factors for the fractures secondary to percutaneous vertebroplasty for osteoporotic vertebral compression fractures.Methods A comprehensive search was conducted for the studies from January 2006 to September 2016 on the risk factors for secondary fractures after percutaneous vertebroplasty in the Cochrane Library,PubMed Data,CNKI,Chinese Biomedical Database,Wanfang Data and manually as well.After retrieval of the eligible data,software Revman5.0 was used to perform the heterogeneity test and calculate the pooled odds ratio (OR),weighted mean difference(WMD) value and 95％ confidence interval (CI).Results Twenty studies involving 3,602 patients,627 of whom had fracture secondary to the surgery,were included in this meta-analysis.Meta-analyses showed the secondary fracture after percutaneous vertebroplasty for osteoporotic vertebral compression fracture was related to bone mineral density [WMD =-0.66,95％ CI (-0.97,-0.36),P ＜ 0.05] and kyphosis after primary operation [WMD =4.51,95％ CI (3.02,6.00),P ＜ 0.05],but not to gender [OR =0.98,95％ CI (0.77,1.25),P＞ 0.05],age [WMD=1.48,95％CI (-0.13,3.09),P＞ 0.05],body mass index [WMD=-0.76,95％ CI(-1.61,0.08),P＞ 0.05],cement volume [WMD=-0.15,95％CI (-0.60,0.30),P＞0.05],intradiscal cement [0R=1.11,95％CI (0.56,2.22),P＞0.05],number of vertebrae primarily treated [OR=0.74,95％ CI (0.09,6.45),P ＞ 0.05],thoracolumbar spine [OR =0.86,95％ CI (0.63,1.18),-P ＞ 0.05],or cement injection approach [OR =1.58,95％ CI (0.74,3.37),P ＞ 0.05].Conclusions Bone mineral density and kyphosis after primary operation may be the risk factors closely correlative to the secondary fracture after percutaneous vertebroplasty.There has not been enough evidence to support the associations between the secondary fracture and gender,age,body mass index,cement volume,intradiscal cement,number of vertebrae primarily treated,thoracolumbar spine,or cement injection approach.