Objective To discuss factors influencing the heterotopic ossifications (HO) after treatment of bi-column acetabular fractures. Methods One hundred and ninety-three cases of bi-column acetabular fractures were followed up, including 147 males and 46 females with an average age of 34. 4 years. Thirty-one cases were associated with craniocerebral trauma. The interval between injury and surgery was less than 1 week in 15 cases, 1 to 2 weeks in 121 cases, 2 to 3 weeks in 34 cases, and over 3 weeks in 23 cases. Factors that might have influenced HO, including surgical method, associated injury, and interval between injury and surgery, were analyzed retrospectively. Results All the cases were followed up for an average of 44. 2 (14 to 84) months. The mean operation time was 238 (150 to 330) minutes, and the average blood loss was 1453 (450 to 4400) mL. The incidence rate of HO was 39. 9% (77 in 193 cases), including 39 cases of degree one, 23 cases of degree two, and 15 cases of degree three. Of the 77 cases associated with HO, 14 had craniocerebral trauma and 63 did not (χ~2 = 0. 019, P = 0. 891) . HO was found in 2 cases that had been operated on in less than 1 week, 38 cases in 1 to 2 weeks, 21 cases in 2 to 3 weeks, and 16 cases in over 3 weeks. The Spearman correlation analysis between HO degree and clinical result showed no correlation ( R = 0. 041, P =0. 722). Only 15 cases (7. 8% ) were associated with HO after the debridement of the necrotic gluteus minimus. Conclusions HO after surgery for bi-column acetabular fractures may not be correlated with craniocerebral trauma, but highly correlated with the interval between injury and surgery. Debridement of necrotic gluteus minimus and other muscles can reduce the incidence of HO.

is lesion size and staging in pre-operative and etiologies are the risk factors associated with postoperative progression.

Objective To observe the MRI characteristics in subacute combined degeneration (SCD)of the spinal cord.Methods The data of 1 9 SCD patients were retrospectively analyzed by the clinical characteristics and MR images.Results Among the 1 9 pa-tients of SCD,1 6 cases showed abnormal findings.Most of intramedullary lesions located in posterior column of thoracic and cervical spinal cord,and only one case located in cerebellar cortex and medulla oblongata.Lesions were involved in muti-segmental spinal cord,and mainly located in the dorsal or lateral spinal cord,and only two cases located in the anterior spinal cord.Different segmental spinal cord lesions had a different morphological characteristics with no enhancement.After treatments with vitamin B1 2 ,the lesions diminished and even disappeared in 2 cases.Conclusion MRI has important value in the diagnosis and treatment monitor of the SCD.

Objective To develop an ELISA method for determination of heparin-induced thrombocytopenia (HIT)antibody. Methods The compound formed between human platelet factor 4 (PF4)and heparin was used as the coating antigen,incu-bating the patients plasma with the coating antigen in the well,after washing,the second antibody labeled HRP was added in the well to incubate and washing again,the chromogenic substrates was added in the well to incubate,when the stop reaction was finished,the absorbance A450/A630 was detected,and the test results were judged according to standard,this method was compared with IBL method and was optimized and evaluated the performance.Results An indirect ELISA method was de-velop with the purified human PF4,the optimal dilution of sample and second antibody were 1∶100 and 1∶1 500 which de-tected by the orthogonal test,the intra-and inter-assay average coefficients of variation were 7.66% and 7.76%(<10%) respectively that detected by repeated measurement the three positive standard plasma.Through measureing the 100 healthy human plasm with no history of using heparin,the positive and negative predictive reference values were 0.304 and 0.456. IBL and this method detected 100 hemodialysis patients samples at the same time,and the result of statistical analysis was that,the sensitivity,speciality and accuracy of this method were 90%,97.78% and 90%,respectively.The negative and posi-tive predictive value were 81.8% and 98.88% respectively,and the difference was statistically significant [K=0.84(0.81~1)and Pexac=0.012<0.05].The difference was statistically significant,consistency was optimal,95% confidence interval was 92.59%~92.59%.Conclusion Comparing with the IBL,the method reported by this article had the similar perform-ance and good consistency,and it could satisfy the clinical detection and diagnosis of HIT patients.

Objective To discuss the surgical technique of delayed acetabular fractures and its possible prognosis factors.Methods From April 2001 to November 2008,61 patients with delayed acetabular fractures were surgically treated.There were 47 males and 14 males,with an average age of 38 years.According to Letourael classification,16 simple fractures included 7 cases of posterior wall fractures,2 of posterior column fractures,1 of anterior column fractures and 6 of transverse fractures.Forty-five patients with mixed fractures included 3 cases with both fractures posterior column and wall,7 of transverse and posterior wall fractures,4 of T-shape fractures,6 of posteriorly semi-transverse fractures and 25 of both-columns fractures.Fifty-two patients suffered from traffic accident;6 patients were caused by falling from height and 3 suffered from crush injuries.Brain injuries occurred in 11 cases,thorax-abdominal injuries in 15,urinary tract injuries in 7,multiple fractures in 25.The injury of sciatic nerve was found in 3 patients preoperatively.The average interval form injury to surgery was 39 days.A single approach was employed in 13 cases,and combined antero-posterior approaches were employed in 48.The operation time was (248±45) min with a blood loss of (2160±100) ml averagely.Results The average follow-up was (61±8) months.The clinical result was evaluated by Matta reduction criteria,modified Merle d'Aubingne and Postel scoring system.Anatomical reduction was achieved in 45 cases;however,13 were unsatisfactory and 3 were poor.For clinical results,38 were graded as excellent,13 as good,6 as fair and 4 as poor.Osteonecrosis of the femoral head occurred in 3 cases (4.9%),and heterotopic ossification developed in 28 cases (45.9%).Additionally,4patients (6.6%) had a transient sciatic nerve paralysis.Conclusion Open reduction and internal fixation is a liable method for delayed acetabular fractures.Single approach is suitable for simple fractures;in principle and combined approaches are for compound delayed acetabular fractures.The reduction quality is closely related to surgeon's experience.

Objective To evaluate the osteogenesis of a novel borosilicate glass materials combined with platelet-rich plasma in repairing segmental bone defects. Methods 36 New Zealand white rabbits which bilateral radius were resected into l.5cm bone defect, were divided into 4 groups averagely depending on implanted materials: group A (one side: D-Alk- 1B, another side: D-Alk- 1B +PRP), group B (one side:D-Alk- 1B +PRP, another side: β-TCP); group C (one side: β-TCP, another side: experimental bone defect),and group D(one side:D-Alk-1 B,another side :experimental bone defect). The specimens were examined after 4, 8,12 weeks; the osteogenesis was evaluated through gross observation, X-ray radiograph,histological examination,scanning electron microscope and Micro-CT. Results There were similar results about gross observation,X-ray radiograph ,histological examination. After 4, 8, 12 weeks ,D-Alk-1B materials, β-TCP and D-Alk-1 B + PRP group had better osteogenesis ability than the experimental control group (P ＜0.05); D-Alk-lB + PRP had the best performance, better than D-Alk-1B and β-TCP (P＜0.05); D-Alk-1B were similar to β-TCP (P＞0.05). D-Alk-1 B materials degradated faster than β-TCP materials, and the porous structure of the materials disappeared after degradation. D-Alk-1B materials intergrated with host's bone was better than β-TCP materials. Conclusion D-Alk-1B material have good biological activity, histocompatibility and biodegradation and simiar presence of bone formation compared withβ-TCP in the aspect of repairing the segmental bone defect, the combination of PRP and D-Alk-1 B strengthened osteogenesis in vivo.

Objective To probe into the operative techniques and clinical outcomes of treating bi-columnar acetabular fractures. Methods From April 2001 to December 2006, 609 cases undergoing operation for aeetabular fractures were followed up. Of them, 193 eases, 147 males and 46 females with an average age of 34.4 years, were of bi-columnar type. Their complications involved the articular cartilage of the femoral head in 37, eranioeerebral trauma in 31, injury to bladder and/or urethra in 27, injury to thorax and/or abdomen in 68, injury to pelvis and/or sacroiliac joint in 59, and injury to sciatic nerve in 11. The interval between injury and surgery was within 1 week in 15 cases, within 2 weeks in 121, within 3 weeks in 34, and beyond 3 weeks in 23. A single ilioinguinal approach was adopted for 4 cases and combined ap-proaches for 189. Results The mean operating time was 238 (150 to 330) minutes, and the blood loss averaged 1453 (450 to 4400) mL. The mean follow-up period was 44.2 (14 to 84) months. All the eases were evaluated by Matta reduction criteria, X-ray manifestations and the modified Merle d'Aubingne and Postel clinical scoring. One hundred and sixty-eight patients got anatomical reduction, 17 unsatisfactory reduction, and 8 poor reduction. The X-ray manifestations were excellent in 162 patients, good in 16, fair in 8, and poor in 7. The clinic results were excellent in 152 patients, good in 27, fair in 9, and poor in 5. The Kendall coefficient correlation between reduction and clinical outcome and that between reduction and X-ray manifes-tation were 0.74 and 0.77, respectively. Ectopic ossification happened in 77 eases and transient post-operative sciatic nerve paralysis occurred in 3. Conclusions The combined approaches facilitate exposure and synergetie reduction of the bi-colunmar fractures of acetabulum. Reduction of the acetabular roof is essential to restoration of the normal contour of the acetabulum. Reduction bears a positive correlation to the clinical results as well as experience of surgeons.

Objective:To implement an intervention with community-dwelling middle-aged and elderly people through a new science promotion approach, and to evaluate changes in the level of bone health awareness.Methods:From April 2017 to June 2017, 200 community-dwelling middle-aged and elderly people aged 50 years and over were randomly included.They were divided into the intervention group receiving a new science promotion intervention(n=100, with 50 males and 50 females)and the control group(n=100, with 50 males and 50 females). Baseline and follow-up assessments of bone health awareness were performed before and after the one-year intervention.A questionnaire survey on preferences for different types of science promotion articles in WeChat accounts was conducted.Differences in scores for intervention effects before and after intervention were compared between the two groups.Potential influencing factors for the scale score were examined by a multi-factor analysis.Results:After one year of intervention, scores for intervention effects were higher in the intervention group than in the control group( P<0.001). In the intervention group, scores were higher after intervention than before intervention( P<0.001). In the control group, scores after follow-up were slightly higher than those at baseline(29.4±11.4 vs.27.9±10.1, P<0.001). The increase in scores before and after intervention was greater in the intervention group than in the control group( P<0.001). Baseline score, group designation, history of drinking and diabetes impacted the scores in middle-aged and elderly women, while other factors did not.Most middle-aged and older people preferred texts illustrated with pictures, and older people were more receptive to videos. Conclusions:The new science promotion method is beneficial to bone health management, can improve bone health awareness in middle-aged and elderly people.

Objective To evaluate the clinical and radiographic outcomes of locking plate plus endosteal fibular allograft augmentation for unstable proximal humeral fractures with comminuted medial column.Methods We retrospectively analyzed the 48 patients who had been treated by locking plate plus endosteal fibular allograft augmentation and fully followed up for unstable proximal humeral fractures with comminuted medial column between June 2014 and March 2016.They were 12 men and 36 women,with an average age of 64.3 years (from 33 to 87 years).By the Neer classification,7 cases were two-part fractures,21 three-part fractures and 20 four-part fractures.Postoperative assessments included Constant-Murley scores,shoulder scores of Quick Disabilities of the Arm,Shoulder and Hand (Quick DASH),Short Form Health Survey (SF12),humeral head height loss,change in humeral neck shaft angle,postoperative complications and revision rate.Results Their follow-ups averaged 16.7 months (from 12 to 30 months).Their final follow-ups showed a mean Constant score of 83.3 (from 67 to 98),a mean DASH shoulder score of 18.9 (from 6.6 to 49.9),and a mean SF12 of 82.8 (from 56 to 98).Postoperatively,the humeral head height loss averaged 1.2 mm (from 0.1 to 3.4 mm) and the neck-shaft angle 3.1° (from 0.1° to 9.1°).Complications happened in 5 cases (10.4％):loss of reduction in one and screw penetration out of the articular surface in 4.Conclusion Locking plate along with endosteal fibular strut allograft augmentation is a promising technique for the treatment of proximal humeral fractures with comminuted medial column because fibular strut allograft may enhance mechanical stability of the humeral head,maintain fracture reduction,reduce humeral head height loss and complications to ensure good clinical outcomes.

Objective To develop a simple and patient-reported scoring system for evaluating the efficacy of functional reconstruction of adult hip diseases.Methods A candidate indicators list to evaluate hip function was established through literatures review and panel discussion.Using two rounds of Delphi method,experts were invited to judge and score the importance of screening indicators including pain,daily living ability,activity level,labor ability and self-assessment score of the overall hip status,with explanation of the degree of similarity and the basis for determination.In the second round of consultation,the content of integrity and rationality of the scale were added for evaluation.The final indexes of the scale were determined according to the boundary value of the indexes (average value,full frequency,coefficient of variation).The positive coefficient,authoritative coefficient,and coordination coefficient of the two rounds were calculated,and then the weights of each index was identified to form the final rating scale.Results Two rounds of Delphi reclaimed 25 and 24 experts' responses,which from 28 and 25 questionnaires,and the positive coefficients of the two rounds experts were 89.3％ and 96％,respectively.The authoritative coefficient of the first and second level indicators were generally above 0.85;and both of the expert coordination coefficient with the index importance (so called as Kendall coefficient) were above 0.3,and the second round of the coefficient was higher than the first one,and it indicated the final one was better at the consistency.The candidate index of "by bus" in the mobility was rejected in accordance with the threshold of the boundary value on the importance.Finally,it was determined that the hip scoring system (Shanghai Sixth People's Hospital,SSPH) consisted of two parts:the first part had ten indicators out of four dimensions such as pain,daily living ability,activity level,and labor ability;and the weight scores of these four aspects were 45,25,21,9,respectively.The second part was the patient's self-evaluation score for the overall status of the hip (VAS,out of 100 points);the total score was the sum of the two parts,and the final weights accounted for 85％ and 15％ between the two parts respectively.Conclusion The SSPH hip score based on patient-reported outcomes formed by the Delphi is simple and feasible,and it can be used as a reference for evaluating the clinical efficacy of hip functional reconstruction.