Objective To discuss three methods to treat intra-articular calcaneal fractures with malunion, and to investigate the indications and significances of the operative treatment. Methods From June 2002 to March 2004, 28 intra-articular calcaneal fractures with malunion patients (26 males and 2 females, 30 feet) suffered operations. The average age of these patients was 39.2 years old (range, 23-59 years). The malunion happened at left feet in 15 patients, right feet in 11, and bilateral feet in 2. The mean duration between injury and operation was 3.3 months (range, 2-5 months). All cases used improved "L" incisions at lateral of heels. 13 patients (14 cases) did open reduction and internal fixation; 9 patients (10 cases) operated calcaneal osteotomy to reserve subtalar joint and correct deformity with apophysis excision, then used internal fixations; 6 patients (6 cases) used correct deformity with apophysis excision, calcaneal cumulus reconstruction and subtalar arthrodesis. The calcaneal lateral and axial X-ray and CT films were got to measure the B?觟hler angle, Gissane angle, calcaneal width and axial length, and height of calcaneal body-thalamic portion before and after operation. There were siginificant differences at all index before and after operation(P

BACKGROUND:The human telomerase reverse transcriptase gene (hTERT) transfected into target cel s can play an important role in target cel proliferation and differentiation by increasing telomerase activity and maintaining telomere length. OBJECTIVE:To explore the effect of hTERT transfection on telomerase activity and biological characteristics of precartilage stem cel s culured in vitro. METHODS:Precartilage stem cel s cultured in vitro were subjected to hTERT gene transfection via a retrovirus vector pLXSN. Meanwhile, control and negative control groups were set up. After transfection, TRAP-ELISA assay was used to detect telomerase activity;RT-PCR and western blot employed to detect hTERT mRNA and protein expressions;cel counting kit-8 used to detect cel proliferaiton based on cel growth curve;and flow cytometry adopted to detect cel cycle and distribution. RESULTS AND CONCLUSION:The telomerase activity was significantly increased at 48 hours after hTERT gene was transfected into the precartilage stem cel s. After transfection of hTERT, hTERT mRNA and protein levels were significantly increased, the cel growth rate was significantly increased, the proportion of cel s at G 0/G 1 phase was decreased, and the number of S-phased cel s increased compared with the control group and negative control group. There were significant differences among the groups (P<0.05). In conclusion, hTERT transfection via retrovirus vector pLXSN can promote the proliferation of precartilage stem cel s in rats by increasing the telomerase activity.

Objective To explore the influential factors of treatment of the intra-articular calcaneal fractures treated with calcaneal titanic alloy plate.Methods The treatment of intra-articularcalcaneal fractures with calcaneal titanic alloy plate was reviewed.Thefalling height, weight, complication, Sanders evaluation method,mechanism of injured, the change degree of B(o)hler and Gissane angle were recorded and compared.One-way ANOVA, Chi-Square Tests and logistic test were applied to evaluate the relationship of these factors.Results According to AOFAS scale system, the average recovery score was 86.35, excellent rate was 91.6%.Binary logistic stepwise regression showed that the correlation between weight and resu1ts of treatment was statistically significant( P ＜0.01 ).The correlation between the period before operation and the recovery score was statistically significant( P ＜0.01).Sanders evaluation method was statistically significant ( P ＜0.05).The correlation between preoperative B(o)hler'sngle and Gissane's angle and the postoperative functional recovery score was statistically significant ( P ＜ 0.05) .Conclusions Calcaneal titanic alloy plate used in treatment of intra-articular calcaneal fracturcs was a good method.The weight, the period before operation, level of trauma and the B(o)hler's angle and Gissane's angle influenced the treatment effect.

BACKGROUND:Talus cartilage injury is a common motor system disease.This type of injury will affect the patient's daily life and work ability,and may worsen the condition if left untreated.Surgical treatment is commonly used,but the selection of surgical methods and the evaluation of medium-and long-term follow-up results have always been difficult clinical problems. OBJECTIVE:To explore the influence of T1ρ technique on the range of quantitative evaluation of talus osteochondral injury on the choice of surgical method and the results of medium-and long-term follow-up. METHODS:A total of 154 patients with osteochondral injury of talus admitted to The Second Hospital of Tangshan from January 2019 to August 2022 were retrospectively selected as the study subjects.The lesion site of talus was examined by MRI before operation,and the T1ρ and T2 values of different types were compared.Different surgical methods were selected according to the different T1ρ values.Group A(n=73)was treated with microfracture surgery with T1ρ<45 ms;group B(n=81)was treated with autogenous bone and cartilage transplantation with T1ρ≥45 ms.The general clinical characteristics and curative effects of patients under different surgical methods were compared;the important factors of postoperative recurrence were analyzed by multivariate Logistic regression,and the relationship between T1ρ value and postoperative recurrence was analyzed by restricted cubic spline graph,y=1-1/(1+e-z)regression equation to build a prediction model.The stability of the model was verified by cross-checking method. RESULTS AND CONCLUSION:(1)Classification of talus osteochondral injury in 154 patients(type Ⅰ:36 cases;type Ⅱ:37 cases;type Ⅲ:40 cases;type Ⅳ:41 cases),T1ρ and T2 values of the four groups were statistically significant(P<0.05);pairwise comparison was also statistically significant(all P<0.05).(2)After treatment of 154 patients,7 cases(4.6％)had local swelling,3 cases(2.0％)had pain aggravation,and 5 cases(3.3％)had wound infection.There were 2 cases(1.3％)with poor cartilage healing.(3)After treatment,there were statistically significant differences between groups A and B in terms of American Orthopaedic Foot&Ankle Society score,visual analog scale score,plantar flexor motion range,dorsoextension motion range,subchondral bone marrow edema volume,interleukin-6,interleukin-8,C-reactive protein,procalcitonin,platelet-derived growth factor,transforming growth factor-β1,and efficacy(P<0.05).The total effective rate of group B(90％)was higher than that of group A(85％)(P<0.05).(4)Age(OR=1.589,95％CI:0.305-1.252,P=0.036),interleukin-6(OR=1.737,95％CI:0.974-5.254,P=0.049),interleukin-8(OR=1.385,95％CI:1.066-4.355,P=0.034),C-reactive protein(OR=1.957,95％CI:1.323-2.178,P=0.035),transforming growth factor-β1(OR=1.459,95％CI:0.897-2.455,P=0.038),T1-ρ(OR=1.687,95％CI:0.854-3.321,P=0.026),T2(OR=1.843,95％CI:0.657-2.454,P=0.036),complications(OR=1.719,95％CI:0.654-3.464,P=0.019),and classification of osteochondral injury of talus(OR=3.789,95％CI:1.023-5.897,P=0.028)were independent risk factors for postoperative recurrence.Microfracture surgery(OR=0.751,95％CI:0.321-1.264,P=0.012)and autogenous bone and cartilage grafting(OR=0.649,95％CI:0.246-1.356,P=0.023)were independent protective factors for recurrence after medium-and long-term follow-up.(5)When T1ρ value≤35 ms,the risk of postoperative recurrence decreased rapidly,and when T1ρ value>35 ms,the risk of postoperative recurrence increased rapidly.(6)Further stepwise regression analysis showed that these nine risk factors were most closely associated with postoperative recurrence,and the formula for postoperative recurrence was obtained.The probability of postoperative recurrence was calculated using the regression equation.When P=0.75,the maximum value of Jorden index was 77.728,indicating that the model has a better prediction effect.(7)It is indicated that the quantitative evaluation of T1ρ before operation can effectively guide the selection of surgical methods,improve the success rate of surgery and the quality of life of patients.

Objective:To study the protective effect of alendronate combined with Lactobacillus rhamnosus on bone loss in ovariectomized mice.Methods:Fifty female C57BL/6 mice were divided into 5 equal groups ( n=10). Ovariotomy was performed in groups A, B, C and D while a sham operation was performed in group E. Group A was subjected to combined administration of alendronate and Lactobacillus rhamnosus, group B to administration of alendronate, group C to administration of Lactobacillus rhamnosus, and groups D and E to administration of physiological saline only. At 3 months after operation, all the mice were sacrificed to harvest their femurs. Micro CT scanning was performed to detect the bone mineral density (BMD), trabecular relative volume, bone surface area/bone volume, and trabecular thickness and number of trabecular bone. Three-point bending test was used to detect the maximum load, stiffness, ultimate load, Young＇s modulus, and fracture energy. Osteocalcin and alkaline phosphatase levels were measured using blood samples from the mice eyeballs. The 2 groups were compared in terms of all the above indexes. Results:The BMD [(669.87±67.87) mg/cm 3], maximum load [(14.35±0.75) N] and fracture energy [(1,497.43±38.29) J/m 2] in group A were significantly higher than those in group B [(520.07±9.01) mg/cm 3, (11.94±0.82) N and(1,277.61±35.12) J/m 2] and group C [(388.15±25.61) mg/cm 3, (11.10±0.93) N and (1,115.27±63.24) J/m 2] (all P<0.05). The osteocalcin level in group A [(22.25±1.78) ng/mL] was significantly higher than that in group B [(19.08±1.45) ng/mL] and group D [(19.33±1.66) ng/mL] (both P<0.05). The alkaline phosphatase level in group A [(83.21±9.69) ng/mL] was significantly lower than that in group C [(113.16±14.44) ng/mL] and group D [(137.96±14.01) g/mL] (both P<0.05). Conclusion:Alendronate combined with Lactobacillus rhamnosus may play a synergistic role in prevention of bone loss in ovariectomized mice, because combined administration of the two is more effective than administration of either of the two.