Objective To compare percutaneous suturing with sponge forceps and open suturing for repair of acute closed Achilles ruptures.Methods From March 2011 to June 2014,40 patients with acute closed Achilles rupture were enrolled in this study and randomized into 2 equal groups (n =20) which were subjected to percutaneous suturing with sponge forceps or open suturing.The operative time,incisive length,blood loss,wound healing,hospitalization time and complications were compared between the 2 groups.Their ankle functions were evaluated at postoperative 3,6,and 12 months according to American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores.Results The operative time (median,60.0 min),hospitalization time (median,8.5 d) and incisive length (median,8.0 cm) in the open suturing group were significantly greater than those in the sponge forceps group (32.5 min,7.0 d and 1.5 cm) (P ＜ 0.05).The blood loss (15.1 ± 13.7 mL) in the sponge forceps group was significantly less than in the open suturing group (54.2 ± 33.9 mL) (P ＜ 0.05).The open suturing group received an average follow-up of 16.8 months (from 12 to 23 months),witnessed superficial skin infection in 3 cases,and obtained AOFAS scores of 91.2 ± 5.1,95.2 ± 2.8 and 97.8 ± 1.6 at 3,6,and 12 months postoperatively.The sponge forceps group received an average follow-up of 15.6 months (from 12 to 24 months),witnessed wound healing in all cases,and obtained AOFAS scores of 90.6 ±5.3,94.I ±2.6 and 97.0 ±2.6 at 3,6,and 12 months postoperatively.The sponge forceps group obtained insignificantly lower AOFAS scores than the open suturing group (P ＞ 0.05).No injury to the sural nerve or tendon rerupture happened in either group.Conclusions In treatment of acute closed Achilles ruptures,compared with open suturing,percutaneous suturing with sponge forceps may be relatively easier without using special equipment,and additionally,may lead to lower incidence of incision complications and better short-term efficacy.

Objective To observe the outcome of uncemented hip arthroplasty for failed internal fixation of intertrochanteric fracture.Methods Seventeen patients admitted from Februaty 2010 to January 2014 were reviewed retrospectively in this study.The patients aged 67.2 years (range, 41-80 years) composed 6 males and 11 females.There were 15 patients with intertrochanteric fracture and 2 intertrochanteric and subtrochanteric fracture.The primary internal fixation method was dynamic hip screw (DHS) fixation in 2 patients, proximal femoral nail anti-rotation(PFNA) fixation in 12 patients and intramedullary nailing in 3 patients.Arthroplasty with a prosthetic hip was performed for 15 patients and with a prosthetic femoral head was done for 2 patients 3-48 months after the internal fixation.Harris score was used for evaluation of the results of hip arthroplasty.Preoperative Harris score was (32.6 ± 6.8)points.Results All the patients were followed up for 6 to 48 months.One patient with intraoperative femoral fracture experienced early subsidence and dislocation of femoral stem following allogeneic bone plate and titanium cable fixation and had further revision surgery.One patient had secondary subsidence of the femoral stem without pain and limitation of motion.One patient had primary infection recurrence after arthroplasty, but the infection remained uncured even after a series of treatments like repeated debridements, sustained vacuum drainage, prosthesis removal, debridement and temporary spacer implantation.Sixteen patients showed postoperative pain relief and good hip function recovery characterized by the ability to care for themselves and no prosthetic loosening.Harris hip score signficantly improved to (79.2 ± 15.9) points at the final follow-up (P ＜ 0.01).Conclusions Uncemented hip arthroplasty is an effective method for the failed internal fixation of peritrochanteric fracture.The procedure achieves satisfactory function recovery, early weight-bearing exercise and early recovery of self-care ability,and avoids the complications of bone cement use.

Objective To investigate the clinical efficiency and safety of femoral head reduction osteotomy for young patients with coxa magna or coxa plana.Methods Between June 2012 and September 2015,the clinical characteristics of 12 patients (13 hips) with coxa magna or coxa plana who underwent femoral head reduction osteotomy were analyzed retrospectively.There were 6 males (7 hips) and 6 females (6 hips) with average age 18.1 years (range,10-25 years).The etiology of the femoral head deformity was multiple epiphyseal dysplasia in 6 hips and Legg-Calvé-Perthes sequela in 7 hips.The head reduction osteotomy was conducted through the surgical hip dislocation approach combined with extended retinacular soft-tissue flap extending technique.All patients underwent simultaneous periacetabular osteotomy and relative lengthening of the femoral neck,of which four also underwent proximal femur derotational osteotomy.All patients received the standardized rehabilitation procedures.The postoperative complications,gaits,the range of motion (ROM) of the hip,Harris hip scores,iHOT scores and VAS were analyzed postoperatively.In addition,the lateral center-edge (LCE) angle,sphericity index and coverage rate of femoral head were assessed as well.Results The average follow-up duration was 28.8 months (range,12-45 months).All patients achieved osteotomy healing of the femoral head and greater trochanter with average healing time 3.7 months (range,3-7 months).Nine of 12 patients had significant gaits improvement.The Harris hip scores (81.08± 12.36 vs.88.38 ± 8.96,t=2.41,P=0.033),iHOT score (51.90± 15.07 vs.67.69±8.70,t=3.63,P=0.003),LCE angle (-1.82°±16.57° vs.36.02°±7.72°,t=10.52,P=0.000),sphericity index of anteroposterior pelvic radiographs (71.08％± 10.32％ vs.81.22％±8.61％,t=7.17,P=0.000) and the coverage index (48.79％±11.85％ vs.87.46％± 10.44％,t=8.56,P=0.000) were all significantly improved when compared to those preoperatively.The VAS score (4.46± 2.37 vs.1.23±0.93,t=4.25,P=0.001) was significantly decreased when compared with that preoperatively.However,for the sphericity index of 65° false profile (78.96％± 10.39％ vs.80.36％±8.42％,t=0.411,P=0.688) and the average hip ROM (264.62°± 32.05° vs.255.00°±40.31°,t=0.89,P=0.391),they did not achieve statistical significant difference.One case of femoral head necrosis site was localized at the lateral-superior part of femoral head,and there was no progression after 3 years follow-up.Moreover,no revision or total hip arthroplasty were observed due to other complications (osteoarthritis,hip pain or non-union).Conclusion The femoral head reduction osteotomy can correct deformity,improve femoral head sphericity,relieve pain and improve gaits and hip function.This procedure leads to satisfied clinical outcomes for patients with coxa magna or coxa plana in early follow-up.

Objective To observe the effect of vancomycin-loaded calcium sulfate for one-stage treatment of chronic osteomyelitis.Methods A retrospective case series study was made on 26 patients with chronic osteomyelitis treated from January 2014 to April 2016.There were 23 males and 3 females,with a mean age of 35.8 years (range,16-90 years).After focus debridement of osteomyelitis,the cavities were filled with vancomycin-loaded calcium sulfate and systemic antibiotics were used.Meanwhile,gentamicin was added to patients showing unclear pathogens.Three patients underwent flap transfer surgery simultaneously due to the inadequate soft tissue coverage.Wound healing,local redness and swelling,sinus recurrence,recovery of osteomyelitis and repair of bone defect were detected after operation.Results All patients were followed up for 6-30 months (mean,19.5 months).Primary healing was achieved in all patients.One patient experienced wound exudate and was effectively managed by dressing change,one patient experienced inadequate local soft tissue coverage and was effectively managed by a second flap transfer surgery,and one patient remained wound unhealing after two surgeries and was cured by infected bone resection using the Masquelet induced membrane technique.Follow-up showed local bone defect was repaired in all patients without bone infection recurrence.Conclusions For patients with chronic osteomyelitis,one-stage surgery with vancomycin-loaded calcium sulfate can control infection with simultaneous repair of bone defect.Therefore,the procedure is a simple and effective method and worthy of clinical practice.

The clinical application of arthroscopic minimally invasive treatment of shoulder joint disease technology has become a routine,and it has been widely carried out around the world.Compared with the traditional open surgery,it only needs to establish a few channels in the shoulder and then the diagnosis and treatment of the structure under the acromion and glenoid joint internal lesions can be completed through the arthroscopic technique under direct vision,of course,including local collection of pathological specimens.Shoulder arthroscopic surgery has the advantages of simple operation technique,small economic burden of patients,small tissue trauma,quick recovery and high accuracy of disease diagnosis.At present,there are two main options for shoulder arthroscopy:the beach chair position (BCP) and the lateral decubitus position (LDP).The choice of surgical position for surgeons is closely related to the intraoperative operation,the risk of complications,the efficacy of surgery,and the cost of setting the posture.Shoulder arthroscopy of these two positions have their own advantages and disadvantages:in the BCP,the surgeon gets a better anatomical operation experience,if necessary,can be converted into open surgery at any time.Without continuous traction,upper limb nerve and vascular damage caused by traction can be avoid.But the incidence of cerebral ischemic events in patients may increase in the BCP.There is also possibility of the nerve damage of the pillow small nerve,great auricular nerve,lateral femoral cutaneous nerve and other nerves.In theory the risk of air embolism in the patients will increase in the BCP,and the cost of setting the position is also higher than the LDP.While in the LDP due to the patient's forearm continuous traction,the surgeon can get a more extensive operating space,and the occurrence of cerebral ischemic events is very rare.In the treatment of anterior shoulder instability after shoulder arthroscopic surgery,there is a lower recurrence rate in the LDP.The cost of setting the position is also significantly lower than the BCP.Of course,the disadvantages of the LDP is also obvious.In the LDP,the brachial plexus and other nerves or vascular injury may increase due to the continuous traction of the forearm.Meanwhile sustained traction in the LDP is also a risk factor for thrombosis,and so on.Therefore,there is still a debate about the optimal location of the shoulder arthroscopy.Many clinicians choose shoulder arthroscopic position based on their own experience and habits.

Objective:To investigate the effect of periacetabular osteotomy (PAO) assisted by preoperative 3D printing planning on the treatment of early developmental dislocation of the hip (DDH).Methods:A retrospective study was conducted of the 39 patients (44 hips) with CROWE type Ⅰ DDH who had been treated at Department of Orthopaedics, Guizhou Provincial People＇s Hospital from May 2015 to April 2019. In the observation group of 19 patients (22 hips) who were treated by PAO assisted by preoperative 3D printing planning, there were 4 males (4 hips) and 15 females (18 hips) with a mean age of 23(19, 39) years; in the control group of 20 patients (22 hips) who were treated by mere PAO, there were 2 males (2 hips) and 18 females (20 hips) with a mean age of 23(20, 29) years. The 2 groups were compared in terms of operation time, intraoperative bleeding, hospital stay, fluoroscopic frequency, Wiberg lateral center-edge angle (LCE), acetabular index (AC), acetabulum coverage rate, Harris hip scores (HHS) and complications at the final follow-up.Results:There were no significant differences between the 2 groups in their preoperative general data, showing compatibility of the 2 groups ( P>0.05). Both groups were successfully followed up for 6 to 12 months (mean, 9.6 months). The operation time [100 (90, 120) min], intraoperative bleeding [160 (150, 180) mL], hospital stay [6 (5, 7) d], and fluoroscopic frequency [24 (22, 25) times] in the observation group were all significantly better than those in the control group [140 (100, 157) min, 200 (180, 250) mL,9(7, 11) d and 28 (24, 32) times] in the control group ( P<0.05). However, there were no significant differences between the 2 groups in LCE, AC or acetabulum coverage rate immediately after operation, or in HHS or complications at the final follow-up( P>0.05). Conclusions:Although PAO has a definite therapeutic effect on early DDH, PAO assisted by preoperative 3D printing planning can effectively reduce operation time, intraoperative bleeding, hospital stay and intraoperative fluoroscopy. Thus, combination of the two can result in a better therapeutic effect than PAO alone.

Programmed death receptor 1 (PD?1) and its ligand PD?L1 have been shown to play an important role in evading the immune system. In recent years, PD?1／PD?L1 blockade has shown significant clinical effects in many malignancies, including malignant melanoma, renal cell carcinoma, classic Hodgkin lymphoma, non?small cell lung cancer and so on. PD?1／PD?L1 signaling pathway has become a new target of immunotherapy in patients with malignant tumors. However, there are few researches on immunotherapy in malignant bone tumors, and the progress of clinical research on PD?1／PD?L1 remains to be elucidated. This review started from the mechanism of PD?1／PD?L1 signaling in tumor immunity, and analyzed the application prospect of PD?1／PD?L1 antibodies in malignant bone tumors. We hope to provide a theoretical basis for the treatment of malignant bone tumors based on PD?1／PD?L1 signaling pathway in China.

Programmed death receptor 1 (PD?1) and its ligand PD?L1 have been shown to play an important role in evading the immune system. In recent years, PD?1／PD?L1 blockade has shown significant clinical effects in many malignancies, including malignant melanoma, renal cell carcinoma, classic Hodgkin lymphoma, non?small cell lung cancer and so on. PD?1／PD?L1 signaling pathway has become a new target of immunotherapy in patients with malignant tumors. However, there are few researches on immunotherapy in malignant bone tumors, and the progress of clinical research on PD?1／PD?L1 remains to be elucidated. This review started from the mechanism of PD?1／PD?L1 signaling in tumor immunity, and analyzed the application prospect of PD?1／PD?L1 antibodies in malignant bone tumors. We hope to provide a theoretical basis for the treatment of malignant bone tumors based on PD?1／PD?L1 signaling pathway in China.

Objective To explore a practical and feasible method for isolation,culture and identification of mouse bone marrow endothelial progenitor cells(EPCs).Methods Bone marrow-derived mononuclear cells isolated by density gradient centrifugation were cultured in endothelial cell growth medium-2 MV medium.Growth and morphological changes of the cells were observed under inverted microscopy.Cell proliferation was observed by cell counting kit-8 assay.Surface markers of the EPCs were detected by flow cytometry.Angiogenic tube formation was determined by Matrigel tube formation assay.Fluores cein isothiocyanat e-ulex europaeus agglutinin-1 (FITC-UEA-1) binding and Dil-Ac-LDL uptake capabilities were observed by fluorescent microscopy.Results In the early stage,the cells were round and spindle-shaped after induced culture for 4 days.After 7 days,the cells grew in colony arrangement and gradually increased in number.After 14 days,the cells were differently shaped,such as short shuttle and triangle.After 21 days,the typical "paving stone" appearance of the cells was observed.The cells were positive for endothelial markers in flow cytometry:CD34 + (84.3％),vascular endothelial growth factor receptor 2 + (74.1％),but CD45 + (4.04％).The cells were capable of forming capillary-like tubes,up-taking Dil-Ac-LDL and binding FITC-UEA-1 in Matrigels.Conclusions A reliable method for isolation,culture and identification of mouse bone marrow EPCs may be improved on the basis of previous experiences.Since the EPCs obtained by this method may be capable of good proliferation,large in number,and stable in biological characteristics,they can serve as ideal seed cells for related subsequent studies.

Objective:To investigate the efficacy and safety of modified Bikini approach periacetabular osteotomy in the treatment of developmental hip dysplasia under 50 years of age.Methods:The clinical data of 39 patients with developmental hip dysplasia who underwent periacetabular osteotomy in the Department of Orthopedics, Guizhou Provincial People′s Hospital from June 2016 to June 2021 were retrospectively analyzed.Among them, 20 patients (21 hips) underwent the improved Bikini approach (study group) and 19 patients (20 hips) underwent the improved Smith-Petersen approach (control group).In the study group, there were 3 males and 17 females, aged( M(IQR))27.5 (14.3) years (range:11 to 44 years).In the control group, there were 2 males and 17 females, aged 27.5 (19.3) years (range:17 to 47 years).Both groups were sutured in the same manner by the same physician.Incision length, operation time, intraoperative blood loss and complications were recorded.X-ray images, anterior central marginal angle (ACE), lateral central marginal Angle (LCE) and acetabulum tilt angle (Tonnis AI) were measured before and after the operation.The coverage rate of acetabulum to femoral head (AHI) was measured and calculated, and the healing time was observed.Harris Hip score, International Hip score (IHOT)-12 and visual analogue scale (VAS) were recorded before and after surgery.Vancouver Scar Scale (VSS) score and patient and observer scar assessment scale (POSAS) score were recorded 12 months after surgery.The independent sample t test,Wilcoxon rank sum test, χ2 test or Fisher exact test was used to compare the clinical efficacy between the two groups, respectively. Results:All patients successfully completed the operation.There was no significant difference in operation time and intraoperative blood loss between the two groups (all P>0.05).The incision length of the study group was smaller than that of the control group, and the difference was statistically significant (10.5(5.0)cm vs.15.0(3.0), W=309.000, P=0.007).Patients were followed up for (19.1±11.1) months (range:12 to 60 months).Femoral nerve stretching injury occurred in 2 cases and sciatic branch fracture occurred in 1 case in the study group, all of which recovered to normal at 3 months follow-up, while no corresponding injury occurred in the control group.Lateral femoral cutaneous nerve injury occurred in 3 cases in the study group and 2 cases in the control group.Delayed wound healing occurred in 1 case in each of the two groups, and both healed after re-operation debridement and suture.Pubic branch nonunion occurred in 4 patients in the study group and 5 patients in the control group.There were no serious complications such as sciatic nerve and femoral blood vessel injury between the 2 groups, and there was no statistical significance in the incidence of complications between the 2 groups (52.4%(11/21) vs.40.0%(8/20), χ2=0.631, P=0.427).The clinical healing time of the patient was (4.5±1.3) months after surgery (range:3.0 to 8.0 months).There were no significant differences in ACE, LCE, Tonnis AI and AHI between the 2 groups (all P>0.05).At the last follow-up, there were no significant differences in VAS,Harris hip score and IHOT-12 score between the two groups (all P>0.05).The incision scars in the study group were smaller than those in the control group, and the differences in VSS and POSAS were statistically significant (all P<0.05). Conclusion:Compared with the improved Smith-Petersen approach, the improved Bikini approach has the same early clinical efficacy in the treatment of patients with developmental hip dysplasia under the age of 50, and has the advantages of smaller postoperative incision scars, more hidden and beautiful incision, and no serious complications, which is worthy of further study and promotion.