Objective: To explore the influence of the lower extremity abnormal alignment and the joint surface, and to explore the surgical skills. Methods: Twenty-two cases of tibial plateau Schatzker Ⅵ fracture internal fixation failure revision from January 2012 to January 2017 in Department of Orthopedics, Shanghai 10^th Hospital.One year follow-up after initial surgery to make sure of failure.Three-dimensional CT scan, radiography, infection index, gait analysis, knee joint ROM, femur tibia angle, tibial plateau tibial shaft angle and posterior slope if tibial plateau were observed. The medial approach and bi-planer osteotoma were used.Autogenous iliac bone graft, postoperative fast recovery channel were used.Follow-up point included preoperative and postoperative 7 days, 6 weeks, 3 months, and 6 months.Obvervational index included double lower limbs radiography, knee society score(KSS), complications such as infection, skin necrosis, joint main passive activity, double lower limbs alignment the last follow-up SF-36 scale.Rate was compared by χ² test, measurement data using paired sample t test.Correlation was analyzed by Pearson correlation regression testing. Results: Twenty-two patients received follow-up.KSS, more than 21 cases were benign, with good gait.One case was poor, with claudication gait.Not skin necrosis, no deep infection cases, 1 case get blisters 2 days postoperatively, and disappear after 5 days with detumescence and cold therapy.Whether restoring force line affect the KSS significantly(χ²=22.000, P=0.000). Knee joint ROM, SF-36 score, KSS and lower limb alignment were improved significantly. In different individual the articular surface and anatomical angle recovered greatly but the posterior slope angle was quite difference which has no correlation with KSS and SF-36 scale(P>0.01). Conclusions Revision of Schatzker type Ⅵ tibial plateau fracture failure should focus on the recovery of lower limb alignment.moderate overcorrect bone cutting and joint surface height can bring benefits to the postoperative knee function.Revision surgery patients have greater psychological pressure, more early psychological intervention is necessary.

Objective To investigate the effect of tumor-associated macrophage exosomes on glycolysis of pancreatic cancer cells and its mechanism.Methods The THP-1 cells were induced to differentiate into the M0 and M2 macrophages,and the exosomes(M0 exo and M2 exo)were extracted.The pancreatic cancer cells CAPAN-2 and ASPC-1 were divided into the PBS group,the M0 exo group,the M2 exo group and the M2 exo+siKRAS group,and co-incubated with equal volumes of PBS,10 μg/mL of M0 exo,10 μg/mL of M2 exo,and transfection of KRAS siRNA and 10 μg/mL of M2 exo,respectively.Transmission electron microscopy was used to observe the structure of exosomes;CCK-8 was used to detect the cell proliferation capacity;the kit was used to detect the glucose uptake rate and production level of lactic acid,and Western blot was used to detect the exosome markers expression,KRAS protein expression and ERK1/2 phosphorylation level.Results THP-1 was induced to differentiate into M2 macrophages expressing Arg-1 and IL-10 marker proteins.M0 exo and M2 exo had a bilayer membrane structure with a particle size of about 100 nm and expressed exosomal marker proteins of CD9,CD81,and TSG101.Compared with the PBS group,the cell proliferation,glucose uptake rate,production level of lactic acid of CAPAN-2 and ASPC-1 cells in the M2 exo group increased significantly(P<0.05),and the KRAS expression and ERK1/2 phosphorylation level were significantly increased(P<0.001).Compared with the M2 exo group,the proliferation,glucose uptake rate and production level of lactic acid of CAPAN-2 and ASPC-1 cells in the M2 exo+siKRAS group decreased significantly(P<0.05).Conclusion Tumor-associated macrophage exosomes can promote the glycolysis of pancreatic cancer cells via the activation of KRAS signaling pathway.