BACKGROUND:Bone defects often occur after the reduction of periarticuar fractures, and bone grafting is required to fil bone defects, thereby to make the early support of articular surface and prevent the col apse and shift of the articular surface. Al ograft cancellous bone is the transplant material for the treatment of bone defects, but its osteogenesis ability is poor. Autologous red marrow has osteogenesis ability. Therapeutic efficiency of al ograft cancellous bone combined with autologous red marrow for periarticular fractures is stil yet to be
assessed.
OBJECTIVE:To study clinical effect of locking plate fixation and al ograft cancellous bone combined with autologous red marrow in the treatment of periarticular fractures.
METHODS:Forty-three cases of periarticular fractures were incorporated into the Orthopaedics Department of the Third Hospital of Hebei Medical University. After cutting the articular surface anatomical y, composite particles of the red marrow and al ograft cancellous bone were implanted into bone defects, and then, an anatomic locking plate was used. Medial lateral or bilateral locking plate was used for tibial plateau fractures. Dorsal or volar locking plate was used for distal radius fractures, and distal tibial medial or lateral locking plate was used for distal tibial fractures.
RESULTS AND CONCLUSION:Forty-three patients were fol owed up for 12 months to 6 years, an average of 4.3 years. X-ray films and CT scans review showed that 43 patients’ col apse fracture al reached bony union. Fresh fracture healing time was 2-6 months, an average of 4 months;the healing time for old fracture was 3-7 months, an average of 5.5 months. After bone grafting, 43 patients al had no significant immune rejection, two cases showed more wound exudates, and the wound was healed by dressing after 2 weeks. One case had wound infection, the wound was healed after 4 weeks of draining and dressing, and the infection had no recurrence fol owing up for 4 years and 1 month. Forty patients were satisfied with bone grafting, accounting for 93%, and three cases dissatisfied, accounting for 7%, based on Mankin and Komender’s standard assessment. The results confirmed that al ograft cancellous bone combined with autologous red marrow transplantation can play a supporting role in treating periarticular fractures to prevent the col apse of the articular surface and fracture displacement, and to provide reconstruction materials for periarticular defects. Its long-term goal is fracture healing.

Objective:To compare the accuracy and generalized robustness of three predictive models of knowledge-based treatment strategies for radiotherapy for optimized model selection.Methods:The clinical radiotherapy plans of 45 prostate cancer (PC) cases and 25 nasopharyngeal cancer (NPC) cases were collected, and analyzed using three models (Z, L and S model), proposed by Zhu et al, Appenzoller et al and Shiraishi et al, respectively, to predict the dose-volume histogram (DVH) of bladder and rectum on PC cases and that of left and right parotid on NPC cases. The prediction error was measured by the difference of area under the predicted DVH and the clinical DVH curves (|V (pre_DVH)-V (clin_DVH)|), where a smaller prediction error implies a greater prediction accuracy. The accuracies of these three models were compared on the single organ at risk (OAR), and the generalized robustness of models was evaluated and compared by calculating the standard deviation of the prediction accuracy on different OAR. Results:For bladder and rectum, the prediction error of L model (0.114 and 0.163, respectively) was significantly higher than those values of Z and S models (≤0.071, P<0.05); for left parotid gland, the predicted error of S model (0.033) did not present significant difference from those values of Z and L models (≤0.025, P>0.05); for right parotid gland, S model (0.033) demonstrated significantly higher prediction error than those of Z and L models (≤0.028, P<0.05). Regarding different OAR, S model showed a lower standard deviation of prediction accuracy when comparing to Z and L models (0.016, 0.018 and 0.060, respectively). Conclusions:In the prediction of DVH in bladder and rectum of PC, Z and S models were more accurate than L model. In contrast, Z and L models demonstrated higher accuracy than S model in the prediction of left and right parotid glands of NPC. In respect to different OAR, the generalized robustness of S model was superior than the other two models.