Objective To explore diagnosis of nonunion following intramedullary nailing of femoral and tibial fractures and the treatment of nonunion of femoral and tibial fractures with Less Invasive Stabilization System (LISS) or locking compression plate (LCP). Methods From February 2003 to December 2004, 7 cases of nonunion after intramedullary nailing of femoral and tibial fractures were diagnosed by X-ray or CT scanning or CT-3D. LISS or LCP fixation and bone grafting were employed to treat the 7 cases of nonunion in the femur and tibia. Their case histories ranged from 10 to 49 (mean 23.3) months. Results All the 7 patients were followed up for a mean of 9.1 (4 to 16) months. The bone union time for all the fractures averaged 4.7 months (ranging from 4 to 6 months). No loosening or breakage of the implants occurred in this series. Conclusions The operation should be done for the patients who feel pain in the lower extremities or the fracture line still exists at the fracture ends long time after intramedullary nailing. In order to improve the healing of bone fractures, micromovement and bone defects at the fracture site should be eliminated. Because of its merits in design, the LISS can be used to effectively treat nonunion at the distal femur or the proximal tibia.

Objective To study the feasibility of repairing long bone defects with transplantation of vascular pedicled fibala with periosteum. Methods 72 healthy rabbits were divided randomly into three groups. Group A consisted of transplanation of single fibula, group Bwith transplantation of two fibulae without periosteum, and group C with transplanation of two fibulae with periosteum, to repair of a tibial defect of 10mm in length. Seram levels of ALP and BGP were determined, bone and mineral density were assessed by X-ray, and biomechanic index was assayed 2, 4, 8, 12, 16 weeks after the transplantation. At the same time the condition of the bone healing and contour were observed. The 34 patients, operative procedure same as in of group C was performed. Results X-ray showed that the area of external callus was larger in C group compared with groups A,B, and the bone trabeculae appeared orderly. The transplanted fibula showed significant bone hypertrophy. Serum ALP and BGP and mineral density level were higher in group C than those in groups A, B. The difference showed statistical significance (P

Objective To study the effect of operation on transplanted fibula healing,which repaired long and thick and burnden bone defects by two fibula compound transplanation under periosteum with vascular loop. Methods Seventy-two healthy rabbits were divided randomly into three groups.Group A is the mono-fibular transplanation group;group B,the double fibular transplanation extra-periosteum and group C,the double fibular transplanation under-periosteum.Each group consisted of 24 rabbits.Animal models of 10mm tibial defects were established and three operation patterns were performed.the serum were obtained to determine the level of ALP and BGP bone and mineral density and biomechanic index at 2,4,8,12,16 weeks.4 rabbits of each group were examined roentgenographically and histologically.the condition of the bone healing and contour were observed.The different effects of each operation were compared with such observation index. Results The X-ray showed that the area of the external callus were larger in C groups than that in A,B and eht bone trabecula were in order,the fibula showed significant bone hypertrophy.the serum ALP,BGP and mineral density level were higher in C group than that in A,B.the difference has statistical significance (P

Objective To report the preliminary results of treatment of fracture nonunion at the distal femur and the proximal tibia with Less Invasive Stabilization System (LISS). Methods From February 2003 to August 2004, LISS fixation and bone grafting were employed to treat 5 cases of fracture nonunion at the distal femur and 4 cases of fracture nonunion at the proximal tibia. The nonunion had resulted from failure of internal fixation in 7 cases, failure of external fixation in 1 and infection in 1. The history of nonunion lasted from 10 to 111 months (mean 29m). Results All the 9 patients were followed up for an average of 8 (6 to 16) months only to reveal solid bone union in all the fractures, with a mean healing time of 4.7 months (ranging from 4 to 6 months). No loosening or breakage of the implants occurred in this series. Conclusion Due to its advanced design, LISS can be used to treat effectively fracture nonunion at the distal femur and the proximal tibia.

Objective To investigate the effects of Notch1 siRNA on VEGF and angiogenesis of myeloma cell line RPMI-8226 in vitro and in vivo.Methods In vitro,Notch siRNA was transfected into RPMI-8226 cells,and then cell supernatant VEGF secretion was detected using ELISA method.Expression levels of Notch1 and VEGF proteins were assayed by Western blotting.RPMI-8226 cells were subcutaneously transplanted in NOD/SCID mice,and then the tumor mice were divided into three groups randomly:NS group (Notch1 siRNA-transfected group),CS group (Control siRNA-transfected group) and UN group (Untransfected group),and the changes of tumor volume were observed.Immunohistochemical staining was used to detect the changes in expression levels of Notch1,VEGF and CD34.Results Notch1 and VEGF proteins expressions of RPMI-8226 cells were significantly decreased by Notch1 siRNA.At 48 h and 72 h,VEGF secretion level in NS group was significantly different with CS group [(120 ± 25) ng/L ∶ (175 ± 15) ng/L,t =3.27,P ＜ 0.05;(145 ± 24)ng/L ∶ (295 ± 17)ng/L,t =8.83,P＜0.01].At 13 d,17 d and 21 d,tumor volume in NS group was significantly reduced,that was significantly different with CS group [(1 548 ± 218) mm3 ∶ (1 820 ± 64) mm3,t =2.68,P ＜0.05;(1 200 ±75)mm3 ∶ (2 180 ±84)mm3,t =19.46,P＜0.01;(1 150 ±88)mm3 ∶ (2 250 ± 145)mm3,t =14.50,P ＜0.01].The expression levels of Notch1 and VEGF protein were decreased by Notch1 siRNA.The expression levels of Notchl and VEGF in NS group were different with CS group [(16.33 ±2.52)％∶ (75.33 ±2.52)％,t=28.71,P＜0.01;(5.00±1.00)％∶29.67±2.08 ％,t=18.50,P ＜ 0.01].Notch1 siRNA reduced the number of transplanted tumor neovascularization in NS group.Microvascular density in NS group was significantly less than that in CS group [(14.67 ± 2.52) ∶ (30.00 ± 5.00),t =4.74,P ＜ 0.01].Conclusion In vitro,Notch siRNA reduces human myeloma cell RPMI-8226 cell supernatant VEGF secretion.In vivo,Notch siRNA can reduce tumor volume and the number of new blood vessels in transplanted-multiple myeloma mice.Thus,Notchl is an effective molecular target for anti-angiogenesis in myeloma.

Objective: To compare instrumentation with 3D-printed patient-specific guides versus conventional techniques in supramalleolar osteotomy for varus ankle osteoarthritis. Methods: A retrospective analysis was done of the 21 patients with varus ankle osteoarthritis who had been treated at Department of Orthopaedics, Shanghai JiaoTong University Affiliated Sixth People's Hospital from January 2017 to December 2018. They were divided into 2 groups by their treatment methods. In the 9 patients treated by instrumentation with 3D-printed patient-specific guides, there were 6 males and 3 females with an age of 54.6±8.6 years, 4 left and 5 right sides involved, and one case of Takakura stage 1, 3 cases of Takakura stage 2 and 5 cases of Takakura stage 3a. In the 12 patients treated by conventional techniques, there were 7 males and 5 females with an age of 53.0±6.5 years, 7 left and 5 right sides involved, and one case of Takakura stage 1, 5 cases of Takakura stage 2 and 6 cases of Takakura stage 3a. The 3D printed guide group and the conventional group were compared in terms of operation time, intraoperative blood loss and frequency of intraoperative fluoroscopy, tibial anterior surface angle (TAS), talar tilt angle (TT), and tibial lateral surface angle (TLS). The differences in TAS, TT and TLS between pre- and post-operation in the 3D printed guide group were also evaluated. Results: There were no significant differences in the preoperative general data between the 2 groups (P>0.05), indicating they were comparable. All the patients were available for follow-up for an average of 7.8 months (from 3 to 15 months). The 3D printed guide group incurred significantly shorter operation time (106.2±10.6 min), less intraoperative blood loss (207.2±16.0 mL) and lower fluoroscopy frequency (2±0) than the conventional osteotomy group (all P<0.01). The post-operative TAS (94.3°±3.2°) and TT (3.8°±0.8°) angles in the 3D guide group were significantly different from their preoperative values (84.6°±3.5° and 7.6°±1.6°) (P<0.01). The 3D printed guide group was not significantly different from the conventional group in postoperative TAS (94.3°±3.2° versus 92.4°±5.9°), TT (3.8°±0.8° versus 4.2°±1.1°) or TLS (83.7°±3.4° versus 84.2°±2.2°) angles (P>0.05). Conclusions Compared with conventional techniques, instrumentation with 3D-printed patient-specific guides can shorten operation time and reduce intraoperative blood loss and fluoroscopy frequency. The 3D printed patient-specific guides in osteotomy can facilitate accurate correction of varus deformity, leading to similar efficacy compared with conventional osteotomy.