Objective:Managing 33-C3 femur fractures with medial wall bone defects poses a significant challenge for orthopedic surgeons.The gold standard treatment for arbeitsgemeinschaftfür osteosynthesefragen(AO)/orthopedic trauma association(OTA)33-C3 distal femur fractures with medial wall bone defects remains elusive.This study employs finite element analysis to compare the stability and mechanical behavior of 3 internal fixation patterns(single lateral distal locking plate,retrograde intramedullary nail,and dual plates)for 33-C3 femur fractures with medial wall bone defects.The aim is to provide a theoretical basis for the selection of internal fixation modalities in clinical practice. Methods:Enrollment included a 43-year-old male volunteer weighing 60 kg,without a history of femur fracture.Bilateral femur normality was verified through X-ray and CT scan assessments.A finite element simulation model of AO/OTA 33-C3 distal femur fracture with medial wall bone defect was established.Three fixation methods,named single lateral locking plate(single-plate group),retrograde intramedullary nail(retrograde intramedullary nail group),and dual plates(dual-plate group),were evaluated using finite element analysis under an axial load of 300 N.The assessment included an examination of von Mises stress distribution,shear stress,and displacement patterns at the internal fixation and femur fracture sites. Results:The finite element analysis revealed that dual-plate fixation effectively reduced the concentration of von Mises stress at the plate on the fracture site.Under full weight-bearing conditions,the maximum von Mises stress in the implants occurred at the distal femur defect level,with values of 149.30,59.281,and 58.03 MPa for single-plate fixation,retrograde intramedullary nail,and dual-plate fixation methods,respectively.Similarly,the maximum shear stress in the implants was 77.867,30.136,and 33.505 MPa for single-plate fixation,retrograde intramedullary nail,and dual-plate fixation methods,respectively,all presenting at the distal femur defect level.The maximum relative displacements of implants during compressive loading were 1.34,1.25,and 0.83 mm for the single-plate,retrograde intramedullary nail,and dual-plate groups,respectively.Consistently,the maximum loading-point displacements of fracture sites were 1.529,1.264,and 0.880 mm for the single-plate fixation group,retrograde intramedullary nail group,and dual-plate fixation group,respectively.Furthermore,at the distal femur defect level,the maximum von Mises stress was 72.682,112.430,and 40.716 MPa for the single-plate,retrograde intramedullary nail,and dual-plate fixation groups,respectively. Conclusion:Dual-plate fixation demonstrates superior biomechanical outcomes and exhibites the lowest maximum von Mises stress and shear stress,along with minimal relative movements between fracture fragments.This configuration offers optimal mechanical stability for managing AO/OTA 33-C3 distal femur fractures with medial wall bone defects.Consequently,dual-plate fixation emerges as a better treatment strategy for patients presenting with comminuted intra-articular distal femur fractures accompanied by medial wall bone defects.

OBJECTIVE: To provide transnasal endoscopic optic canal decompression with the anatomic reference. METHOD: 15 samples of the adult corpse wet specimen (30 sides for the optic canal) were examined under the endoscope to scrutinize the regional anatomy of the optic canal. RESULT: distance between the spina nasalis anterior and the midpoint of optic canal medial wall is (61.02 +/- 5.83) mm, and the angle between spina nasalis anterior and the midpoint of optic canal medial wall is (45.1 +/- 4.81) degrees. The medial wall of optic canal is longest, with an average length of (11.61 +/- 1.58) mm; the lateral wall of optic canal is thickest, and the medial wall thinnest. 10 traumatic blind patient underwent endoscopic optic canal decompression with satisfactory outcome. CONCLUSION The regional anatomy of the optic canal under endoscope is of importance to endoscopic optic canal decompression. Which is microinvasive with direct approach and clear view thus is widely used in clinical practice.
Adolescent ; Adult ; Blindness ; surgery ; Child ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Nose ; anatomy & histology ; surgery ; Optic Nerve ; anatomy & histology ; surgery ; Orbit ; anatomy & histology ; surgery ; Young Adult

The internal organs and meridians were associated with Yin and Yang, five elements, six qi, and time and space, based on the holistic view of heaven, earth and human, according to Huangdi Neijing. The syndrome differentiation system of six meridians and Zang Fu meridians were established by Shanghan Zabing Lun, on the basis of the three Yin, three Yang, six meridians, and five Zang system in Huangdi Neijing. We put forward the concept of the six meridians syndrome differentiation system of circular motion, considering that the six meridians syndrome differentiation system actually implies the theory of circular motion. The syndrome differentiation system was constructed with the circular model of one qi circulating around the road, rising left and falling right, corresponding up and down, and maintaining conservation in the middle as the core, integrating Yin and Yang, five elements, six qi, Zang Fu and meridians, qi, blood and body fluid, and the integration of heaven, earth and human, focusing on "disease location and disease nature", taking classical prescriptions as the main treatments, and cooperating with external treatments such as acupuncture and moxibustion. We organically combined the circular motion with the syndrome differentiation of the six meridians, systematically interpreted the physiological bases, pathological changes, progressive patterns, and the treatments, based on syndrome differentiation, by inheriting the classical thinking mode of Hetu, Luoshu,Zhouyi, Huangdi Neijing, ShennongHerbal Classic, and Shanghan Zabing Lun.

OBJECTIVETo observe the impacts of thermosensitive moxibustion (TSM) on the expressions of nitric oxide (NO), typeⅠdisintegrin and metalloproteinase with thrombospondin motifs-4 (ADAMTS-4), typeⅡcollagen and proteoglycan (PG) in the rabbit models of knee osteoarthritis (KOA) and explore the mechanism of TSM on KOA.

METHODSA total of 42 Japanese long-eared male rabbits were divided into a blank group (6 rabbits), a model group (6 rabbits), a moxibustion group (24 rabbits) and a sham-operation group (6 rabbits) according to the random number table. In the blank group, the rabbits were fed normally. In the model and moxibustion groups, the papain injection was given to establish KOA models. The rabbits in the sham-operation group were treated with the intracavity injection of 0.9% NaCl solution. The rabbits were forced to move for 30 min every day, continuously for 15 days during modeling. At the end of modeling, in the moxibustion group, moxibusiton was applied at "Dubi" (ST 35), once a day, 40 min each time, for 14 days totally. According to the temperature changes during moxibustion, the rabbits were divided into a TSM group and a non-TSM group. 6 rabbits were collected randomly from the two groups. The usual feeding was given in the blank group, the model group and the sham-operation group, without any intervention. The body mass and behavioristics changes were observed in each group. At the end of treatment, the nitrate reduction method was adopted to determine NO expression in the serum. The real-time PCR was adopted to determine the expressions of ADAMTS-4, typeⅡcollagen and PG in the cartilage.

RESULTS① After modeling, compared with the blank group, the body mass was all reduced and the Lequesne MG score was increased in the model group, TSM group, non-TSM group and sham-operation group (<0.05, <0.01). After intervention, compared with the blank group, the body mass was decreased and the Lequesne MG score was increased in the model and sham-operation groups (<0.05, <0.01). Compared with the model group, the body mass was increased and the lequesne MG score was decreased in the TSM, non-TSM, and sham-operation groups (<0.05, <0.01). Compared with the non-TSM group, the body mass in the TSM group was increased remarkably (<0.05), but the difference in Lequesne MG score was not statistically significant (>0.05). ② After intervention, compared with the blank group, the expressions of NO and ADAMTS-4 were all increased and the expressions of typeⅡcollagen and PG were decreased in the model group, TSM group, non-TSM group and sham-operation group (<0.05, <0.01). Compared with the model group, the expressions of NO and ADAMTS-4 were all remarkably lower and the expressions of typeⅡcollagen and PG were increased in the TSM group, non-TSM group and sham-operation group (<0.05, <0.01). Compared with the non-TSM group, the expressions of NO and ADAMTS-4 were all remarkably lower and the expressions of typeⅡcollagen and PG were increased in the TSM group after intervention (all <0.05).

CONCLUSIONThe thermosensitive moxibustion alleviates the inflammatory reactions and protects the joint cartilage through inhibiting the expressions of NO and ADAMTS-4 to achieve the effects in the treatment of KOA.

ADAMTS4 Protein ; metabolism ; Animals ; Cartilage ; metabolism ; Collagen Type III ; metabolism ; Male ; Moxibustion ; Nitric Oxide ; blood ; Osteoarthritis, Knee ; therapy ; Proteoglycans ; metabolism ; Rabbits ; Random Allocation