BACKGROUND:Artificial hip replacement by the posterolateral approach is generally introduced as a treatment for femoral neck fracture in the elderly, but it is limited by the need for a large incision, cutting off the extortor, and postoperative hip dislocation. The supercapsular percutaneously-assisted total hip (SuperPATH) approach was developed based on the original lateral approach. The SuperPATH approach for hip replacement is characterized by the reduced chance of damaging blood vessels and nerves, reducing intraoperative blood loss, retaining all the joint capsules and supinator, and significantly reducing the incidence of postoperative hip dislocation. OBJECTIVE:We hypothesized that the SuperPATH approach for hip replacement can achieve better efficacy in the elderly with femoral neck fractures and promote the recovery of postoperative hip function compared with the posterolateral approach. METHODS/DESIGN:This is a prospective, single-center, open-label, randomized control ed clinical trial that will be completed at the Pudong Hospital of Fudan University, Shanghai, China. Forty patients with femoral neck fractures were randomly divided into two groups to undergo femoral head replacement by the SuperPATH approach in the experimental group, and by the conventional posterior approach in the control group. The follow-up period is 1 week and 6 months. The main outcome measures are Harris hip scores at baseline, and at 1 week and 6 months postoperatively to assess functional recovery of the hip. Secondary outcome measures to evaluate the advantages of the SuperPATH approach include the length of surgical incision, intraoperative blood loss, operative time, 24-hour postoperative drainage, and hospital stay. Other outcome measures include the incidence of adverse reactions at 1 week and 6 months after surgery. The study protocol was approved by the Ethics Committee of the Pudong Hospital of Fudan University, China, and performed in accordance with the guidelines of the Declaration of Helsinki, formulated by the World Medical Association. Written informed consent was obtained from all participants. DISCUSSION:The aim of this trial is to test our hypothesis that the SuperPATH approach is safer and more reliable for hip functional recovery compared with the posterolateral approach for the artificial hip replacement in femoral neck fractures of the elderly.

AIM: To analyze and screen humoral bioactive factors associated with accelerated fracture healing after traumatic brain injury. METHODS: A computer-based online search of Chinese Journal Full-text Database and Pubmed database was undertaken to identify related articles. After the first trial, only articles about the effect of humor changes after brain trauma or humoral factors on fracture healing were selected, and those published in recent five years and published in a authoritative journal were preferred. Repetitive research was excluded. RESULTS: Fracture healing can be accelerated, especially for people with traumatic brain injury. Brain injury, spinal cord injury, different parts of the spinal cord injury, and nerve injury have different influences on fracture healing. There are cell active factors in humour of patients after traumatic brain injury, which can induce karyogenetic division and proliferation of bone marrow-derived stroma cells. Bone morphogenetic protein (BMP) is a very important factor in fracture healing, but it seems not one of factors that are associated with accelerated healing mechanism. Transforming growth factor-? (TGF-?) is correlated with brain injury and bone healing. It is likely to be one of cell factors that can promote fracture healing. Basic fibroblast growth factor (bFGF) has an early expression in traumatic brain injury patients, which can promote osteoblast by stimulating vascular endothelial growth factor (VEGF) and TGF-? expressions. VEGF is only a member of various factors in the network in fracture healing. The action mechanism of single factor needs further exploration. Growth hormone has a high concentration in patients with traumatic brain injury, and can promote fracture healing through interaction with insulin-like growth factor. However, the mechanism is still uncertain. Nerve growth factor, prolactin and melantonin concentration significantly change after traumatic brain injury. They may be the humoral factors that influence bone healing, but the mechanism has not yet been identified. CONCLUSION: Accelerated fracture healing associated with traumatic brain injury is influenced by systemic and local bioactive factors. Currently, the researches about the association of some humoral factors such as BMP, TGF-? and bFGF with fracture healing have been conducted, but others need to further study.

Given the limited sources of autogenic tendon and the difficulties of the tissue engineering tendon to clinical application, the allograft tendon transplantation was a good way for tendon repairing defects. The domestic and foreign scholars have done a lot of studies on the acquisition, preservation, immunological characteristics, clinical application and prognosis of allograft tendon transplantation technology. The allograft tendon transplantation has been more and more used to repair the tendon tissue defects, but there still were some problems to be solved, such as the preservation, immunological characteristics, mechanical strength and postoperative adhesions.

Objective To assess the value of MRS in evaluating vertebral bone marrow. Methods A total of 152 female volunteers (mean age 58±14 years, ranged 30～80 years) were recruited in this study. All subjects underwent vertebral MRS examination after routine MRI examination (sagittal T_2WI, T_1WI and axial T_2WI). Single voxel (SV) was chosen for the 1H MRS acquisition at L_2～L_4 vertebral body with PRESS sequence. MRS parameters were measured by SAGE 7.0 software. Results The fat fraction (FF%) of vertebra ascend with aging;the water line width (LW) decrease with aging and there was not obvious tendency with lipid LW. Conclusion Vertebral MRS can be considered as a noninvasive examination added to routine spine MRI to demonstrate the changes of vertebral bone marrow.

BACKGROUND: Compared with the metal screws, absorbable screws have more obvious advantages, such as does not have to conduct internal fixation removal, non-metal ic components, no influence on the magnetic resonance imaging of patients after implantation, relatively simple operations, namely dril ing-tapping-screws fixation, more in line with the principles of minimal y invasive in orthopedics. OBJECTIVE: To investigate the biomechanical characteristics of absorbable screw fixation in repair of simple lateral mal eolus fractures by means of finite element technology. METHODS: The three-dimensional model of simple lateral mal eolus fractures and absorbable screw model were established, and then fixed according to standard orthopedic surgical techniques. The reference load when the load bearing of fibulotalar joint reaching the peak value in a normal adult gait cycle was loaded. The stress distribution and displacement of fibula and absorbable screws were analyzed. RESULTS AND CONCLUSION: There were total y 38 542 units, 8 790 nodes in the single screw fixation model. When the articular facet of lateral mal eolus loading 300 N, the maximum stress of screws was 89.35 MPa, the maximum displacement was 0.5 mm, the maximum displacement of the distal fracture was 0.5 mm. When the articular facet of lateral mal eolus loading 450 N, the maximum stress of screws was 152.58 MPa, the maximum displacement was 0.59 mm, the maximum displacement of the distal fracture was 0.77 mm. There were total y 43 115 units, 9 496 nodes in the double screws fixation model. When the articular facet of lateral mal eolus loading 300 N, the maximum stress of screws was 38 MPa, the maximum displacement was 0.44 mm, the maximum displacement of the distal fracture was 0.44 mm. When the articular facet of lateral mal eolus loading 450 N, the maximum stress of screws was 66.68 MPa, the maximum displacement was 0.48 mm, the maximum displacement of the distal fracture was 0.49 mm. The experiment verified the biomechanical feasibility of absorbable screw fixation in repair of simple lateral mal eolus fractures. For simple involving only the lower lateral fibular fracture, absorbable screw fixation is entirely feasible, and usual y requires at least two screws to maintain the stability of the articular surface of the reset.

BACKGROUND:For unstable intertrochanteric fracture repair, there are two views:extramedul ary fixation or intramedul ary fixation. Theoretical y, intramedul ary fixation is in line with the principles of minimal y invasive, more mechanical and biological advantages. However, evidence-based medicine and related studies have shown that compared with the extramedul ary fixation, intramedul ary fixation did not reflect the proper theoretical advantage. OBJECTIVE:To compare the biomechanical performance of two kinds of internal fixation systems:dynamic hip screw and Gamma nail which commonly used in repair of intertrochanteric fractures by finite element method, and to evaluate the advantages and disadvantages of dynamic hip screw and Gamma nail in treatment of unstable intertrochanteric fracture. METHODS:Three-dimensional finite element model of human femur unstable intertrochanteric fractures (31-A2;AO fracture classification), and the three-dimensional finite element models of dynamic hip screw and Gamma nail were established respectively, and were fixed according to the requirement of orthopedic surgery. The reference load which the joint bearing was at the peak time in adult step state period with the body mass of 700 N was stimulated. The stress distribution of bone, bone-internal fixation model, nail or screw, the strain and deformation of fracture location on the surface of the bone and bone-internal fixation model, the stress distribution along the femur and the loading transfer condition along the internal fixator and the like were analyzed. RESULTS AND CONCLUSION:Dynamic hip screw and Gamma nail have good sliding compression features which could make the continuous and dynamical y axial compression of the fractured section. Under the load conditions, the displacement value of dynamic hip screw was larger. In the treatment of unstable intertrochanteric fracture, Gamma nail was stronger than dynamic hip screw. Two kinds of internal fixations al make the bearing load of the proximal femur reduce. In the treatment of 31-A2 type unstable intertrochanteric fractures, we should choose dynamic hip screw for fixation if the femoral calcar was not seriously crushed, little defect or no defects and can immediately rebuild the stability of femoral calcar during operation, otherwise, stronger internal fixation, namely Gamma nail fixation should be chosen.

Objective To perform an anatomical study on anterior approach to fractures of the pelvis and acetabulum in an attempt to testify feasibility of the approach.Methods Position and variation of anatomical structure of the hypogastric abdominal wall and pelvic cavity were observed in 10 cadaveric adults (20 sides).Based on the anatomical study,anterior approach to pelvic fractures (n =20)and acetabular fractures (n =15) were performed and clinical results were observed.Results Anterior pelvic incision revealed no splitting or exposure of the spermatic cord/round ligament of uterus.Vertical incision through the muscle layer of abdominal wall located at lateral rectus abdominis and medial initial segment of hypogastric arteries/veins.In clinical practice,the approach revealed the mean incision length of 10 cm (range,9-12 cm) and mean blood loss of (225.5 ± 30.5) ml (range,170-350 ml).No injuries to femoral nerve and sciatic nerve occurred and there was no deep vein thrombosis.Surgical incision healed primarily.Bone union were recorded at the 18-month follow-up (11-35 months).Conclusions Anterior pelvic approach stretches the operative field from pubic symphysis to anterior-lateral cacroiliac joint and quadrilateral surface,allowing full exposure of the fracture site.The approach has benefits of high safety,minor trauma,large exposure,and satisfactory results and hence deserves wide application in clinical settings.

Talent training is the foundation for discipline construction and it is also the fundamental guarantee of hospital's sustainable development.The affiliated Zhongshan hospital of Fudan university launched investigations from the teaching management,teaching staff,resident and clinical skills to look for problems in clinical teaching and to propose improvement measures aiming at improving the clinical teaching and promoting hospital resident and specialists training.

BACKGROUND:Macropore morphology of a composite scaffold prepared by the three-dimensional printing technique is of great importance in determining the physicochemical and biological properties of tissue engineering scaffolds.OBJECTIVE:To fabricate strontium-containing mesoporous (Sr-MBG) bioactive glass (PCL) scaffolds by the three-dimensional printing technique, and to explore the effect of these scaffolds on MC3T3-E1 proliferation and osteogenic differentiation, thereby to find out the optimal macropore morphology.METHODS: Sr-MBG/PCL composite scaffolds were fabricated by the three-dimensional printing technique. The angles between fibrous latitudes and longitudes were set to 45°, 60° and 90°. Then the proliferation and alkaline phosphatase activity of MC3T3-E1 cells on the scaffolds were tested.RESULTS AND CONCLUSION: Cell counting kit-8 results showed that MC3T3-E1 cells could proliferate on all the three kinds of scaffolds. The proliferation rate of MC3T3-E1 cells on the 45° Sr-MBG/PCL scaffolds was just slightly higher than that on the 60° and 90° Sr-MBG/PCL scaffolds at days 1 and 4 (P > 0.05), but there was a significant increase at day 7 (P < 0.05). The 45° Sr-MBG/PCL scaffolds exhibited a significant increase in alkaline phosphatase activity of MC3T3-E1 cells compared to the 60° and 90° Sr-MBG/PCL scaffolds at day 14 (P < 0.05), while there was no significant difference among three groups at day 21 (P > 0.05). These results indicate that the 45° Sr-MBG/PCL scaffold is more suitable to promote the proliferation and osteogenic differentiation of the MC3T3 cells than the 60° and 90° Sr-MBG/PCL scaffolds.

Objective To investigate the correlation between vertebral diffusion weigllted imaging (DWI)and dual X-ray absorptiometry(DXA),quantitative computed tomography(QCT)for the evaluation of bone mineral density(BMD).Methods A total of 152 female volunteers[aged from 30 to 80 years,mean age(58.2±14.2)years 1 were recruited in this study.All subjects underwent lateral thoracicolumbar radiographs,dual X-ray absorptiometry(DXA)and quantitative computed tomography(QCT),as well as DWI examination.Lateral spine radiographs(T4-L4)were evaluated with Genant's semiquantitative assessment.BMD was obtained by both DXA and QCT at lumbar spine(L2-L4).Axial vertebral(L2-4)DWI was performed with single shot spin-echo echo-planar imaging(SS-SE-EPI)sequenee (b value=500 s/mm2)after routine MRI examination(saginal T2 WI,T1 WI and axial T2 WI).Apparent diffusion coefficient(ADC)was measured with GE-Functool DWI software.Pearson correlation analysis was used for the statistics.Results There was a decreasing tendency in ADC value with age.A positive correlation was found between ADC(0.241×10-3 mm2/s)and BMD results measured by both DXA (1.038 S/cm3)and QCT(104.2 mg/cm3)examinations(r=0.461,0.731,respectively,P＜0.01).Conclusion DWI is an useful tool for noninvasive evaluation of the pathophysiologic changes of bone marrow in volunteers with difierent bone mineral density.