Objective To discuss methods treating complex distal radius fractures(types B and C fractures according to AO classification). Methods Seventy-eight patients(83 fracture parts)with complex distal tadius fractures were treated by surgical operation from June 2005 to June 2007.There were 51 males and 27 fenlalcs at an average age of 34.6 years.According to AO Classiiication.there were 12 typc B1 fractures,22 types B2 and B3,21 type C1,16 type C2 and 12 typc C3.The operation in-volved open reduction,external fixator,bone grafting for correcting the palm tilted angle and the ulna devi-ated angle. Results AIl patients were followed up for an average period of 10.5 months.After opera-tion the sinking or displacement of the articular surface was less than 2 mm.with average palm tilted an-gle of 10.6°and average ulna deviated angle of 20.3°.All fractures were healed.The ioint function was assessed by Gatrland and Werley score,which showed excellent result in 33 patients,good in 41.fair in 7 and poor in 2,with excellence rate of 89%. Conclusions Surgical operation is effective for treat-ment of complex distal radius fractures,for it can reduce the itaiured articular surface.correct the palm tilted angle and the ulna deviated angle and eliminate forearnl longitudinal shortening stress.

BACKGROUND:The reported time of bone marrow mesenchymal stem cel s induced to differentiate into chondrocytes is different. Few studies have observed and compared the cel s’ dynamic transformation during the induction process.
OBJECTIVE:To observe the dynamic differentiation and the mature time of rabbit bone marrow mesenchymal stem cel s which were directional y induced to chondroblasts for 8, 11, 14, 17, 20 days.
METHODS:Bone marrow was aspirated from the femur of New Zeal rabbits, and bone marrow mesenchymal stem cel s were isolated by gradient centrifugation. After cultivation and amplification, bone marrow mesenchymal stem cel s at passage 3 were directional y induced to chondrocytes by the serum-free medium containing transforming growth factor beta-1. The experiments were divided into five groups according to different induction time points:8 days, 11 days, 14 days, 17 days, 20 days. Then cel ular morphology, toluidine blue staining, typeⅡ col agen immunohistochemistry, aggrecan content in induction medium, and chondrogenic differentiation in each group were observed and compared.
RESULTS AND CONCLUSION:Bone marrow mesenchymal stem cel s had apparently transformed in morphology at 8 days of induction, and presented obvious chondrocytes’ morphology at 14 days. The aggrecan in induction medium could be detected at a low level at 4 days, significantly increased at 8 days, and maintained slow increasing at 20 days. At 14 days, the metachromatic particles could be found by toluidine blue staining, and the col agen type Ⅱimmunohistochemistry was significantly positive in cel climbing slice. Experimental findings indicate that, bone marrow mesenchymal stem cel s that are monolayer cultured in a high density can be induced into chondroblasts at the effect of transforming growth factor beta-1 and other factors. There are a few chondroblasts in the early induction process, then cel s begin to have chondrocytes morphology and function after induced for 8 days, and may differentiate to mature chondrocytes at 14 days. In addition, they can keep a high biological activity in the induction process.

Objective:To compare the therapeutic effects of debris spondylectomy,piecemeal spondylectomy,total en bloc spomdylectomy in treating lumbar metastatic tumors. Methods:The clinical data of 20 patients with lumbar metastatic tu-mors treated from January 2008 to October 2013 were retrospectively reviewed. There were 8 males and 12 females ,aged from 35 to 65 years old with an average of (49.50±9.97) years. All patients had single solitary metastases. Four cases were in L 1,5 cases in L2,4 cases in L3,4 cases in L4,and 3 cases in L5. According to the type of Tomita,typeⅡhad in 4 cases,typeⅢin 6 cases,typeⅣin 6 cases,type V in 4 cases. Tokuhashi score was 12.50±1.97. All patients complained with back or leg pain , VAS score was 8.13±0.85. Among patients,7 cases were treated with debris spondylectomy (group A),7 cases with piecemeal spondylectomy (group B),6 cases with total en bloc spondylectomy (group C). Statistical analysis was used to compare the three groups with respect to surgical trauma (including operative time,transoperative bleeding,and intraoperative blood trans-fusion),clinical symptoms (by VAS score at 1 week after operation),surgical procedures conditions (by AP and lateral X rays),and long term results (by recurrence and death information). Results:All patients were followed up from 6 to 36 months with an average of (16.50±7.88) months. Operative time for debris spondylectomy was (6.14±0.68) h,intraoperative bleeding was(3 457.14±399.40) ml,and intraoperative blood transfusion was(2 771.43±423.14)ml. Operative time for piece-meal spondylectomy was(4.93±0.61) h,intraoperative bleeding was(1 942.86±378.51) ml,and intraoperative blood transfu-sion was (1 500.00±336.65)ml. Operative time for total en bloc spondylectomy was(4.17±0.67) h,intraoperative bleeding was (1 341.67±361.13) ml,and intraoperative blood transfusion was (916.67±321.66) ml. There was significant differences in op-erative time,intraoperative blood loss,and intraoperative blood transfusion between three groups (P<0.05). In terms of these factors,total en bloc spondylectomy had the best outcome followed by piecemeal spondylectomy. All pains had released ,VAS score decreased obviously at 1 week after operation(P<0.05),and there was no significant differences between three groups(P>0.05). Surgical effects were well with these methods according to the evaluation of AP and lateral X rays . At final follow up, group A had 4 recurrences(2 with breast cancer,1 with prostate cancer,and 1 with thyroid cancer) and 3 deaths (2 with lung cancer and 1 with thyroid cancer);group B had 2 recurrences (1 with breast cancer and 1 with prostate cancer) and 3 deaths (1 with lung cancer,1 with breast cancer and 1 with kidney cancer);group C had no recurrences and 2 deaths for lung cancer. There was significant differences in recurrence and death between three groups(P<0.05). In terms of these factors,total en bloc spondylectomy had the best outcome in three methods. Conclusion:Three kinds of operation method can relieve pain ,improve nerve function,increase the spinal stability,control the local lesions,improve the patient's quality of life in treating lumbar metastatic tumors,but total en bloc spendylectomy,respect to operative time,transoperative bleeding,intraoperative blood transfusion,tumor recurrence and death is clearly superior to other two methods.

OBJECTIVE: To evaluate the effectiveness of robot-guided percutaneous fixation and decompression via small incision in treatment of advanced thoracolumbar metastases. METHODS: A clinical data of 57 patients with advanced thoracolumbar metastases admitted between June 2017 and January 2021 and met the selection criteria was retrospectively analyzed. Among them, 26 cases were treated with robot-guided percutaneous fixation and decompression via small incision (robot-guided group) and 31 cases with traditional open surgery (traditional group). There was no significant difference in gender, age, body mass index, lesion segment, primary tumor site, and preoperative Tokuhashi score, Tomita score, Spinal Instability Neoplastic Score (SINS), visual analogue scale (VAS) score, Oswestry disability index (ODI), Karnofsky score, and Frankel grading between groups ( P>0.05). The operation time, hospital stays, hospital expenses, intraoperative blood loss, postoperative drainage volume, duration of intensive care unit (ICU) stay, blood transfusion, complications, and survival time were compared. The pedicle screw placement accuracy was evaluated according to the Gertzbein-Robbins grading by CT within 4 days after operation. The pain, function, and quality of life were evaluated by VAS score, ODI, Karnofsky score, and Frankel grading. RESULTS: During operation, 257 and 316 screws were implanted in the robot-guided group and the traditional group, respectively; and there was no significant difference in pedicle screw placement accuracy between groups ( P>0.05). Compared with the traditional group, the operation time, hospital stays, duration of ICU stay were significantly shorter, and intraoperative blood loss and postoperative drainage volume were significantly lesser in the robot-guided group ( P<0.05). There was no significant difference in hospital expenses, blood transfusion rate, and complications between groups ( P>0.05). All patients were followed up 8-32 months (mean, 14 months). There was no significant difference in VAS scores between groups at 7 days after operation ( P>0.05), but the robot-guided group was superior to the traditional group at 1 and 3 months after operation ( P<0.05). The postoperative ODI change was significantly better in the robot-guided group than in the traditional group ( P<0.05), and there was no significant difference in the postoperative Karnofsky score change and Frankel grading change when compared to the traditional group ( P>0.05). Median overall survival time was 13 months [95% CI (10.858, 15.142) months] in the robot-guided group and 15 months [95% CI (13.349, 16.651) months] in the traditional group, with no significant difference between groups ( χ ²=0.561, P=0.454) . CONCLUSION Compared with traditional open surgery, the robot-guided percutaneous fixation and decompression via small incision can reduce operation time, hospital stays, intraoperative blood loss, blood transfusion, and complications in treatment of advanced thoracolumbar metastases.
Humans ; Blood Loss, Surgical ; Quality of Life ; Retrospective Studies ; Robotics ; Surgical Wound ; Decompression