BACKGROUND:Alendronate has a marked enhancing effect on bone mineral density. Ibandronate is the newest (the third generation) bisphosphonates. Evidence-based medicine data on the therapeutic effects ofboth twodrugs remain lacking because of different administration routes and time.
OBJECTIVE:To compare the therapeutic effects of ibandronate and alendronate on postmenopausal osteoporosis.
METHODS:A computer-based online search was conducted in CNKI, PubMed, CECDB, BMA, VIP, CQVIP, CBM, EMbase, ASP, The Cochrane Library, and EMCC databases from August 1999 toAugust 2015 to screen the relevant randomized controled trials. Meta-analysis was performed using Stata/SE version 12.0 software by extracting data from the relevant articles.
RESULTS AND CONCLUSION:A total of 10 randomized controlled trials involving 725 patients (ibandronate and alendronate for 379 and 346 patients, respectively) were included. The meta-analysis results showed that bone mineral density was significantly increased (P=0.174, I2=29.4%,WMD=0.03, 95%CI (0.01-0.04))at 6 months after treatment and incidence rate of fracture was significantly decreased(P=5.810,I2=0%,OR=0.32, 95%CI:(0.10-1.00))during 1-year treatment with ibandronate compared with alendronate treatment. However, no significant differences were found between two drug treatmentsin lumbar spine bone mineral density at 1 year after treatment and the incidence rate of fracture during 6-month treatment. Six-month treatment ofibandronate can improve bone mineral density and reduce the incidence rate of fracture of patients withpostmenopausal osteoporosis.

Objectives To explore the process and regularity of graft after vascularized bone allograft. Methods An adult rabbit model of massive femoral defect was established and reconstmcted with vascularized bone allograft based by laterial rotating femoral vessel.The experiments were carried out in two groups,the experimental group(vascularized bone allograft)and the control group(nonvascularized bone allograft).Then observation on periosteum,cortex and marrow was performed after operation containing in ink-infused specimen. Results The revascularization in the experimental grouD was observed synchronicly on periosteum,cortex and marrow after operation,while the phenomenon of vascularization took place from periosteum to marrow in the control group.The density of micro-vessel in experimental group were 10.0±1.8,15.8±1.5 and 13.8±1.5,13.8±1.5 respectivly after 2,4,8 and 16 weeks.and those were 2.8±0.8,6.0±0.9,5.5±1.0,6.0±1.1 in control group.The ink-infused experiment demonstrated a better revascularization in the experimental group. Conclusion The vaseularization can promote revascularization of graft during bone allograft.

Objective To provide anatomic basis for transposition of vascularized radial midforearm flap. Methods On 40 adult cadaveric upper limber specimens injected with red dye, the origin, course, branchs, diameters and anastomosis of intermuscular branch of radial artery and its cutaneous branch were observed. Results Originating from radial artery, intermuscular branch of radial artery descended along periosteum closely between pronator teres and supinator, the main stem was (4.8?1.0) cm in length and (1.2?0.2) mm in diameter. After its periosteal branches were sent off to distribute over middle and inferior shaft of radius, its eutaneous branch perforated from intermuscle and deep fascia and anastomosed with some other cutaneous branches in the forearm. Perforating point of the cutaneous branch was located(11.1?1.3) cm beneath laleral epicondyle of humerus, its diameter was about(0.6?0.1)mm. Conclusion Radial midforrarm flap pedicled with intermuscular branch of radial artery can be transferred to repair soft tissue defect of elbow, forearm or hand.

Objective To investigate the status of microchimerism in recipients and the relation between microchimerism and immunologic tolerance after vascularized allograft bone transplantation. Methods X-ray and histological examinations were performed on recipients after massive vascularized shaft of femur from female Japanese white rabbit donors was transplanted to male recipients. Microchimerism in different organs and tissues were checked postoperatively using a semi-quantitative polymerase chain reaction (PCR) with a Y-chromosome specific primer at different time. Results X-ray and histological examinations showed typical bone union in the experiment group but irregular new bone calluses surrounded the transplanted bones, with high density sequestrum in the control group.Semiquantitative PCR with a Y-chyomosome specific primer indicated that the incidence of microchimerism in organs and tissues in the experiment group was higher than that in the control group postoperatively and increased with time. Conclusions After vascularized allograft bone transplantation, organs and tissues show microchimerism that has a positive correlation with the histocompatibility of the transplanted bones.

Objective To investigate the special cases of distally based sural neurofasciocutaneous flap with muscle repairing the soft tissue defect of foot and ankle. Methods Since February 2004,distally based sural neurofasciocutaneous flap with muscle was applied for repairing the soft tissue defect of foot and ankle in 7 cases, the soft tissue defeat simultaneous chronic osteomylitis of tibia lower section 1 case, the soft tissue defeat simultaneous dead space of foot heel 3 cases, the soft tissue defeat of sole of foot simultaneous bone loss of calcaneus epicarp (5～8 mm) 3 cases, the scope of the flap was 16 cm?12 cm～10 cm?7 cm, the thickness of gastrocnemius flap was 1～4 cm, the muscle flap was smaller than the skin flap. Results Viewing 15 to 20 minutes during operation, muscle side of the muscle flap was errhysising actively, blood circulation fine, all flap were lively. All cases were followed up from 2 to 6 months, osteomyelitis cured, muscle flap outline satisfied, feels recoveried almost, and walk well. Conclusion Distally based sural neurofasciocutaneous flap with muscle can live, the operation is easy, and it is an good donner area in repairing the soft tissue defect of foot and ankle in special cases.

Objective To provide an anatomical basis for repairing the defect of cervical tracheal wall with vascularized pectoralis major tendon flaps.Methods Thirty-two lateral thoracic necrotomies were studied for the following aspects.Measurement of pectoralis major tendons' length,width and thickness.Anatomy of thoracoacromialartery,pectoral branches:origin,distribution.Measurement of length of pedicle,rotated radius of flaps and length from recipient site.An imitative operation was undergone on a specimen of corpse.One patient was undergone the operation of repairing the 3.0 cm × 1.5 cm defect of anterior cervical trachea wall,accompanying with incision infection,with pectoralis major tendon flap.Results Length of pectoralis major tendon:(22.9 ± 0.9)mm.Width of tendon:(51.0± 2.4)mm.Thickness of tendon:(5.81± 1.35)mm.Length of pedicle:(89.3 ± 5.3) mm.The radius of pedicle pectoralis major myotendinous flap:(121.7± 8.2)mm.The distance from pivot point of flap to central point of recipient:(96.5 ± 8.9)mm.Patient possessed normal pronunciation,good appearance and no emphysema at 5 months' follow-up.Tracheal lumen,measured 2.6 cm in the anteroposterior dimension and 1.8 cm in the lateral dimension,showed no recurrence of obvious stenosis in cervical computed tomography at 3 month postoperatively.Conclusion Pedicle pectoralis major tendon flaps,originated from thoracoacromial artery pectoral branches can repair cervical tracheal wall defects effectively.

ObjectiveTo observe the curative effect of Gustilo typeⅢ fracture with soft tissue defect of leg in children.MethodsOf the 15 patients,the area of the soft tissue defect varied from 5 cm × 6 cm to 8 cm × 12 cm.With regard to the location of soft tissue defect,two were situated at the upper third of the leg,eight were middle part of the leg,four were lower portion of the leg and dorsum of foot,one was lower portion of the leg and heel.The fracture was fixed by external fixation device and raw surface was closed by negative pressure drainage in the first stage.The raw surface was eventually covered by the transposition of regional flap or cross leg flap in the second stage.Among them,three patients underwent transposition of saphenous neuro-veno-fasciocutaneous flap, three patients underwent sural neuro-veno-fasciocutaneous flap transposition,one case of medial head of gastrocnemius muscle flap and 7 cases of cross leg flap were performed,while only 1 patient underwent free lateral anterior thigh flap transposition.ResultsOne patient who underwent transposition of saphenous neuro-veno-fasciocutaneous flap present with necrosis of the distal end of the flap 5 days after operation,which was then cured by cross leg saphenous neuro-veno-fasciocutaneous flap.Dark crust in distal end of flap occurred in 1 patient who underwent sural neuro-veno-fasciocutaneous flap,which was cured by changing dressings.Bone fracture of 14 patients were all healed.One patient who was classified as Gustilo Ⅲ c underwent cross leg flap, but bone defect was produced 18 months later.Through 3 months to 2 years follow-up,the texture,colour and shape of flap is good. ConclusionWith regard to Gustilo type Ⅲ fracture combined with soft tissue defect of leg in children,external fixation coupled with flap transposition can cure effectively.

This case report describes the use of a Functional Thenar Eminence myocutaneous flap for reconstruction of volar defect of distal right thumb of a 25-year-old male who sustained a twisting injury while working. Part of bone and tendon were exposed and the tip of the distal phalanx was crushed, with bony defect.
Adult ; Humans ; Male ; Myocutaneous Flap ; Thumb ; injuries ; surgery

Objective To explore the effect of electroacupuncture at Quchi (LI11) and Zusanli (ST36) acupoints on motor behaviors, the axonal integrity and nerve bundle of motor cortex and striatum in rat model of ischemic stroke induced by middle cerebral artery occlusion (MCAO) using diffusion tensor imaging (DTI). Methods Thirty-six adult male Sprague-Dawley rats were randomly assigned to sham opera-tion group (sham group), ischemia control group (model group) and electroacupuncture treatment group (EA group) with twelve rats in each group. The later two groups were occluded their middle cerebral arteries for two hours. Twenty-four hours after modeling, EA group re-ceived electroacupuncture at Quchi (LI11) and Zusanli (ST36) acupoints on the paralyzed limb, once a day, for 14 days. They were assessed with modified Neurological Severity Scores (mNSS) and Rota-rod test, and scanned with small animal magnetic resonance imaging system for T2-weighted image (T2WI) and DTI, the infarct size, related fractional anisotropy (rFA) and related number of tracks of motor cortex and striatum were recorded. Results Compared with the sham group, the score of mNSS increased in the model group and EA group after model-ing, and was lower in EA group than in the model group seven days and 14 days after intervention (P<0.05). Rota-rod test showed that the retention time was significantly longer in EA group than in the model group (P<0.05). T2WI showed that the infarct size was smaller in EA group than in the model group (P<0.05). DTI showed that rFA in motor cortex and striatum was higher in EA group than in the model group (P<0.05), as well as the related number of tracks (P<0.05) in motor cortex. Conclusion Electroacupuncture at Quchi and Zusanli acupoints could improve the motor function in rats with ischemic stroke, which may be related to the recovery of nerve bundle of motor cortex and stri-atum in ischemic side.

Objective To investigate the choice of methods and time on the treatment of Gustilo type Ⅲ B and type ⅢC open tibia fractures by bone fixation and tissue flap repairing.Methods The clinic data of 136 cases of Gustilo Ⅲ B and Ⅲ C open tibia fractures were retrospectively studied.There were 102 males and 34 females,with average age of 34 years(range 14 to 68 years).Ninety-eight cases were classified as Gustilo type Ⅲ B and 38 cases were type Ⅲ C in degree.In all cases,one hundred and thirteen were treated with onestage external fixation,ninteen cases were treated with secondary bone fixation.Sixty-seven cases of all wounds were repaired by one-stage vascular pedicle skin flap.Seven wounds were repaired by one-stage free flaps with vascular anastomosis.Sixty-two cases were secondary repaired by different flaps after defect tissue under VSD (vacuum-sealing-drainage) treatment by 1 to several weeks,which contains 9 free skin graft,eleven muscle flaps based on posterior tibial artery perforator,thirteen flaps based on fibial artery perforator,fourteen gastrocnemius falps and 15 cross-leg flaps.Results Wound of all cases were healed wholly.Primary union occurred in 121 cases,twelve,cases healed after bone grafting for segmental bone defect.Three cases with delayed union healed after reoperation for infection that caused osteomyelitis and sinus tract.The period of bone healing was form 5 to 12 months.Conclusion The treatment of Gustilo Ⅲ B and Ⅲ C open tibia fractures by onestage or secondary bone fixation and tissue flap repairing get their advantages and disadvantages,but one-stage bone fixation and tissue flap repairing was better where appropriate.