Objective To study the clinical effect of expert tibial nail (ETN) in the treatment of distal tibial fractures. Methods From October 2007 to June 2008,ETN was performed in 13 patients with distal tibial fractures. There were eight males and five females, at age range of 25-47 years (33.8 on average). According to AO/ASIF classification, there were three patients with 43-A1 fractures, four with 43-B1 fractures, four with 43-B2 fractures and two with 43-C1 fractures. All the patients were with close fractures except for three patients with Gustilo-Anderson type Ⅰ fractures. Their clinical data were analyzed for assessing the clinical effect of ETN. Results All patients were followed up for a mean time of 8.4 months (range 3-13 months), which showed that all the fractures obtained stable fixation and sound healing, with no complications like breakage of ETN, wound infection, fracture nonunion or limb shortening. According to Johner-Wruhs standard, the functional results were excellent in 10 patients and good in three. Conclusion ETN has advantages of minimal invasion, shorter operation time, stronger fixation,better soft tissue protection and better functional recovery for distal tibial fractures in comparison with traditional open reduction and buttress plate fixation.

ObjectiveTo elucidate the association between RANKL rs7984870 C ＞G polymorphism and the susceptibility to rheumatoid arthritis in a Chinese Han population.MethodsGenotypes were determined by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) method in 214 rheumatoid arthritis cases and 478 controls.ResultsThe RANKL rs7984870 C＞G genotype frequencies were 27.3% ( CC),51.2% ( CG),21.5% (GG) in the rheumatoid arthritis group and 25.3% (CC),49.1% (CG),25.7% (GG) in the control group respectively; Logistic regression analyses revealed that the risk associated with RANKL rs7984870 C＞G variant genotype was 0.78 (95% CI =0.49-1.24) for RANKL rs7984870 GG compared with its wild-type homozygote.ConclusionRANKL rs7984870 polymorphism may not serve as a risk factor of rheumatoid arthritis susceptibility.Further functional studies are warranted to verify our findings.

ObjectiveTo probe into the dependability of trochlear line (TL) as the reference axis for femoral component rotation in total knee arthroplasty.MethodsEighty-nine healthy adults had computed tomography (CT) scan for knees to position the surgical transepicondylar axis (STEA),posterior condylar line (PCL) and TL on the transverse sections.In the meantime,the angles including angle between TL and STEA (TSA),angle between TL and PCL (TPA) and angle between PCL and STEA (PCA) were measured and compare the dependability of TSA and PCA.ResultsThe TSA,TPA and PCA were (6.77 ± 3.12) °,(4.22 ± 2.64) ° and (2.95 ± 1.77) °,respectively.Three types of angles showed no statistical differences between males and females or between right knees and left knees (P ＞0.05).Rank sum test displayed significant differences in the overall distributions of three kinds of angles ( HC =66.837,P ＜0.01 ).The coefficient of variation of TSA was insignificant,but the standard variation was significant (3.12°).ConclusionTL can be considered only as the subsidiary femoral rotation osteotomy axis in total knee arthroplasty.

[Objective]To explore the clinic results of the locking compression plate fixation for the acetabular fractures.[Method]Twenty-three patients were treated in the author's department, 16 of them were male and 7 were female patients.The ages ranged from 21 to 61 years, and mean age was 43.3 years.Ninteen patients had been injured in an automobile accident,3 were fell from height and 1 was crushed by a heavy object. The patients were classified according to Letournel classification.There were 7 anterior column fractures,3 posterior wall fractures,5 anterior wall fractures,2 transverse fractures,1 anterior column and posterior column fracture,1 T shape fracture, 3 posterior wall and posterior column fractures,1 transverse and posterior wall fracture.[Result]All the incisions healed during the primary procedure and all the patients were available at follow-up ranging from 3 to 24 months(average 20.1 months).The average intraoperation time was 123 minutes(50～235 minutes),and the intraoperative blood loss was 100 to 1500 ml.The patinents underwent blood transfusion from 0 ml to 1 200 ml.According to Matt's criteria, the rate of excellent and good was 73.9%(17/23).[Conclusion]The locking compression plate fixation is one of the effective methods for treatment of acetabular fractures, with the advantages of being simple and minimally traumatic.

Objective To introduce a sort of method about thumb reconstruction to complex thumb defect. Methods From January 2003 to December 2006, 13 patients who incur sever thumb defect above5 grade adopt the upper limb lateral bone-skin flap combined with the second toe transplant primary thumb reconstruction, pestop follow-up visit 12 months to 3 years, according to hand surgery society of Chinese Medical Associaition thumb and finger reconstruction functional assessment probation standard to evaluatethe function of reconstituted thumb. Results All of the transplanted upper limb lateral bone-skin flaps and the second toes take, and function well. Conclusion The upper limb lateral bone-skin flap combined with the second toe transplant primary repair complex thumb defect had been tested one good method for thumb reconstruction to above 5 grade thumb defect.

Objective To study the predictive value of serum hyaluronic acid (HA) levels for morphological progression of osteoarthritis (OA).Methods Seventy New Zealand white rabbits were randomly and equally divided into the OA group and the normal control group.OA was induced by injecting 0.5 ml of 2％ papain into the left knee joints and the same volume of sterile saline solution was injected Into right knee joints in control group.The serum HA levels were detected at 1,2,4,6,8,10 and 12 weeks after injection.Then magnetic resonance imaging (MRI) and pathohistological changes were observed.T test was used for the analysis of measurment.Resuts Compared with the control group,degeneration changes were found in the OA group,such as thinner articular cartilage,fibrillation and destroyed cartilage matrix,and inflammation,proliferation and degeneration of the synovial tissue.All these changes were much worse with prolonged observation time.The serum HA levels were increased [12 week:(657±132) ng/ml,vs (166±8) ng/ml],which correlate with structural damage.Conclusion Serum HA levels had a predictive value for further development of OA.

BACKGROUND: Centrifugal force is a contributing factor inducing osteoblastic differentiation from bone marrow stroma cells.OBJECTIVE: To explore whether centrifugal force promote osteoblastic differentiation from rabbit marrow stroma cell seeded on polylactic-co-glycolic acid (PLGA) scaffolds. METHODS: Rabbit bone marrow stroma cells were isolated and cultured by whole bone marrow method, purified by attachment method, and digested by trypsin-EDTA at 80% confluency. The cell concentration was adjusted to 1×10~9/L. PLGA was cut into pieces, 5 mm×5 mm, soaked in serum-conditioned culture medium for 24 hours. The third passage of bone stroma cell suspension at a density of 300 μL was respectively seeded into the PLGA material. The scaffold/cell compound was placed in centrifuge tube, with cell at the upper layer and cultured in osteoblastic induced medium containing antiscorbic acid, β-sodium glycerophosphate, and dexamethasone respectively under centrifugal force every 12 hours (1 000 r/min for 30 minutes, relative centrifugal force 132 g) and static condition. Alkaline phosphatase activity, osteocalcin content and calcium content as well as observation by light microscopy were used to evaluate osteoblastic differentiation. RESULTS AND CONCLUSION: After 16 days of in vitro culture, the scaffolds of centrifugal force group were coated by multiplayer cells and mineralized matrix, but only a thin layer of cells were observed on the scaffold of control group. The centrifugal force system resulted in a significant decrease in alkaline phosphatase activity at day 2 (P < 0.05) but significant increase at day 4 compared with the static culture condition (P < 0.05). During the whole culture time, osteocalcin secretion remained low in control group. At days 12 and 16, a significant enhancement in osteocalcin secretion was observed for centrifugal force culture compared with static culture conditions (P < 0.05). Moreover, after 16 days of culture a significant increase in calcium deposition was observed in the scaffolds subjected to centrifugal force compared with static culture condition (P < 0.05). Centrifugal force can enhance osteoblastic differentiation and mineralized matrix production of bone marrow stroma cell seeded in PLGA.

ObjectiveTo discuss the clinical efficacy of hyperextension reduction with percutaneous kyphoplasty in treatment for osteoporotic vertebral compression fracture.MethodsTwenty-three patients with 23 vertebral compression fractures underwent hyperextension reduction with percutaneous kyphoplasty from September 2010 to October 2011.The vasual analogue scale(VAS) score and complications were recorded during followed up.Results All cases were successfully experienced the procedure using unilateral or bilateral percutaneous pedicle underwent hyperextension reduction.The operation time was (75 ± 45) minutes,the mean volume of cement injected into each vertebral body was(4.9 ± 1.9) ml.All patients had successful intervention without spinal cord injury,pulmonary embolism.Followed up(7.5 ± 6.5 ) months,the symptoms of the patients were improved,preoperative VAS score was (7.5 ± 0.7 ) scores,reduced to (3.4 ±0.4) scores at day 1 postoperatively,(2.7 ±0.5) scores at day 7 postoperatively and (2.3 ±0.5) scores at month 1 postoperatively,there was significant difference between preoperative and postoperative (P＜ 0.05).ConclusionsApplication of hyperextension reduction with percutaneous kyphoplasty can relieve pain and restore the vertebral body height,it may be an effective treatment method for patients with osteoporotic vertebral compression fracture.

Objective To evaluate preliminary effect of In-Space percataneous interspinous spacer in the treatment of lumbar instability.Methods Data of 18 patients who had undergone interspinous spacer implant for lumbar instability from May 2009 to June 2011 were retrospectively analyzed.There were 10 males and 8 female,aged from 39 to 58 years.All patients suffered from varying degrees of lower back pain induced by lumbar hyperextension,as well as radiating and segmental pain of unilateral lower limb.The visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate clinical outcomes.The pre-and postoperative interspinous distance,trailing edge height of intervertebral space,foraminal width,foraminal height,segmental lordotic angle and lumbar range of motion were tested and compared.Results All patients were followed up for 18 to 36 months.The VAS score improved from preoperative 7.9±2.1 to 3.1±1.3 at 6 months postoperatively and 1.5±0.8 at final follow-up.The ODI improved from preoperative 82.1％±13.1％ to 54.7％±14.8％ at 6 months postoperatively and 10.1％±2.5％ at final follow-up.The postoperative interspinous distance,trailing edge height of intervertebral space,foraminal height,foraminal width,segmental lordotic angle and lumbar range of motion were 9.29±1.43 mm,11.28±0.85 mm,21.27±1.01 mm,10.83±0.73 mm,7.62°±0.74° and 6.34°±0.81°,respectively.Wound healed smoothly in all patients,and there were no complications such as spinous process fracture,spinal cord injury,cerebrospinal fluid leakage,device displacement and device dislocation.Conclusion It is easy and safe to use In-Space percataneousinterspinous spacer in the treatment of lumbar instability,and the preliminary effect is satisfactory.

Objective To compare the clinic effect of the locking compression plate (LCP) fixation and the anatomical plate in treatment of high-energy distal tibial fractures. Methods The study involved 42 patients with high-energy distal tibial fractures treated between May 2003 and May 2009. The anatomical plate group included 24 patients ( 16 males and 8 females, at average age of 39 years), of whom there were 13 patients with type A fractures, five with type B and six with type C according to the AO/ASIF classification. The LCP group included 18 patients ( 15 males and 3 females, at average age of 40 years), of whom there were 11 patients with type A fractures, three with type B and four with type C according to the AO/ASIF classification. All the patients were followed up for 8-17 months. Their functional and radiographic outcomes were collected. The operation time, intra-operative blood loss, X-ray exposure, bone healing time, post-operative complications and therapeutic effects were compared between both groups. Mazur's criteria was used to evaluate the function of the ankle. Results The LCP group was followed up for average 11.6 months and the anatomical plate group for average 14.2 months, which showed fracture healing in all the patients. The bone graft in the anatomical plate group was used more frequently than the LCP group, while the X-ray exposure in the LCP group was much more than that in the anatomical plate group. The operation time, incision size, blood loss, postoperative complications and radiographic bone healing time in the LCP group were significantly less than those in the anatomical plate group. Conclusions Both the LCP and anatomical plate are effective methods for the high energy distal tibial fractures. LCP has advantages of less trauma, quick fracture healing and less complications, is consistent with the biomechanics of internal fixation and hence is an ideal method for the treatment of the high-energy tibial fractures.