Objective To determine the efficacy and safety of reamed versus nonreamed intramedullary nailing for femoral fractures in adults on the rates of nonunion, the rates of implant failure, the rates of pulmonary implications, infections, the time of union, et al. Methods According to Cochrane Systematic Review, Medline, Embase, Cochrane Library and CBM disc were searched for RCTs without limitation of language, and gray literatures had been also searched, furthermore, the bibliographies of retrieved papers and content experts were consulted for additional references. Methodology quality of literatures used simple evaluate method the Cochrane Collaboration recommended, which was graded to A, B, C. Data was extracted by two reviewers for inclusion using the designed extraction form. Revman 4.2.3 the Cochrane Collaboration provided were used for data management and analysis, and obtained evidences for the efficacy and safety of reamed versus nonreamed intramedullary nailing for femoral fractures in adults. Results Five RCTs were included by total retrieve and riddling. For methodology quality of literatures, one was A scale, two was B, and two was C. The combined results showed that reamed intramedullary nailing for femoral fractures in adults reduce the rates of nonunion RR=0.38, 95% CI(0.17, 0.88), P=0.02 , implant failure RR=0.45,95% CI (0.21,1.00), P=0.05 and the time to union WMD=-10.90,95% CI (-18.16,-3.64), P=0.003 . Conclusion To compare with nonreamed intramedullary nailing for femoral fractures in adults, reamed intramedullary nailing can reduce the rates of nonunion. However, the relation between reaming or not and implant failure, the time to union, pulmonary complications, infection etc needs further study.

Objective To observe the effects of bisphosphonate on the inhibit proliferation and the apoptosis effect in osteo‐sarcoma MG‐63 cells in vitro ,explore the phosphonic acid salt of bone sarcoma cells ,induce apoptosis and its possible mechanism . Methods Sixty three osteosarcoma MG‐63 cells were cultured in vitro .After treated with bisphosphonate 400 μg/mL ,without bi‐sphosphonate but normal saline ,they were incubated 72 h after the application of the two group cell immunofluorescence test ;then observe the expression of apoptosis factors Caspase 3 and Fas ;Flow cytometry detection line was used to detect the osteosarcoma cell line MG‐63 cells apoptosis rate of each group .Results 72 h after treatment with bisphosphonate ,the expression of apoptosis factor of Caspase‐3 and Fas in osteosarcoma MG‐63 cells were strongly expressed ,and it was observed by immunofluorescent assay , while in blank control group ,we could barely see the expression of apoptosis factors Caspase‐3 and Fas ;Flow cytometry test results showed that two phosphonic acid salt 400 μg/mL intervention group cell apoptosis rate was 54 .00% ,far more than normal saline blank control group ,of which the apoptosis rate was 3 .10% ,the difference was statistically significant (P<0 .05) ,there is an obvi‐ous phenomenon of induced apoptosis .Conclusion Bisphosphonate has a strong apoptotic effects of bisphosphonate in osteosarcoma MG‐63 cells in vitro .Bisphosphonate can inhibit osteolysis of osteosarcoma MG‐63 cells via regulating the expression of Caspase‐3 , Fas in osteosarcoma MG‐63 cells .Bisphosphonate may serve as a potential therapeutic agent for treatment of osteosarcoma .

BACKGROUND:Studies have shown that bisphosphonates can act on osteosarcoma cels, but the comparative analysis of bisphosphonates and cisplatin, a traditional first-line chemotherapy drug, is rarely reported. OBJECTIVE:To investigate the differences between bisphosphonates and cisplatin to inhibitin vitroproliferation of osteosarcoma cels and induce cel apoptosis. METHODS: Subcultured MG-63 cel lines were intervened with different concentrations of bisphosphonates and cisplatin, respectively, and cels with no treatment served as negative controls (blank group). Cel inhibition rate was detected using MTT method, and cel morphology was observed using fluorescent staining. RESULTS AND CONCLUSION:After intervention with different concentrations of bisphosphonates and cisplatin for different time, the growth inhibition rate of MG-63 cels was significantly higher as compared with the blank group (P < 0.05). But there was no difference in the growth inhibition rate between the bisphosphonates and cisplatin groups at 24, 48 and 72 hours (P > 0.05). These findings indicate that bisphosphonates has obvious inhibitory effect on the growth of osteosarcoma celsin vitro, and its inhibitory effect is similar to that of cisplatin.

BACKGROUND:There are controversies about preserving the remnant in the anterior cruciate ligament reconstruction procedure because of its uncertain therapeutic effects.
OBJECTIVE:Tocompare the efficacy and safety of preserving-remnant with removing-remnant for arthroscopic anterior cruciate ligament reconstruction using a meta-analysis.
METHODS:A computer-based online search was conducted in PubMed,Embase,the Cochrane Library, CDSR, CBM, and CNKI databases by using the English key wordsof “anterior cruciate ligamentAND remnant (OR stump)ANDrandomized controled trial (RCT)ORquasi-RCT” and the Chinese key words of“anterior cruciate ligament reconstruction, preserving-remnant, removing-remnant” to screen the relevant articles publishedfrom 1995 to July 2015. Meta-analysis was performed using Review Manager 5.3 software.
RESULTS AND CONCLUSION:A total of 13 randomized controled trials were included. The meta-analysis resultsshowed that there were no statisticaly significant differences in KT1000/2000 scores (OR=-0.28, 95%CI:-0.76-0.20,P=0.25), the good rate of synoveal coverage (OR=-0.30, 95%CI:-0.30-0.90,P=0.32), and the incidence of cyclops leions (OR=0.87,95%CI: 0.63-2.90,P=0.44). Postoperative Lysholm scores (OR=2.45, 95%CI: 0.52-4.39,P=0.01), proprioceptive function (OR=-1.72, 95%CI:-3.32 to 0.13,P=0.03), tunnel enlargement (OR=-0.66, 95%CI:-1.08 to-0.23,P=0.002) in preserving-remnant were superior to removing-remnant for arthroscopic anterior cruciate ligament reconstruction. These results suggest that both preserving-remnantandremoving-remnant for arthroscopic anterior cruciate ligament reconstructioncanobtain satisfactory antero-posterior stability of the knee. Preserving-remnant exhibits superiority in post-operative scores of the knee, proprioceptive function, tunnel enlargement.Furtherhigh-quality randomized controled trials are warranted because of some low-quality studies and the existing biases.

5 mm. Oblique coronal MR of secrum could show the full length of sacral never. There were some primiral espression of MR of sacral neurological dam-age -- the variation of sacral never canal, the fatty disappearance of peri-never, the route alteration of never. 14 patients were followed up from 6 to 12 months with an average of 7.1 months. According to the BMRC score system the excellent result was obtained in 9 cases, good in 1 case, no change in 1 case. Con-clusion Clinic history and neurological examination associated with X-ray, CT and MRI was the important of the diagnosis of sacral neurological damage, the new surgical approach may be a ideal approach to treat sacral neurological damage in the sacral nerve canal region.

BACKGROUND:Autologous peroneus brevis and alogeneic tendon are often used for reconstruction of lateral colateral ligament of the ankle joint, but these two kinds of materials have different histological and biomechanical properties. OBJECTIVE:To compare the clinical effects of autologous peroneus brevis and alogeneic tendon to reconstruct lateral colateral ligament of the ankle joint. METHODS: Sixty-six patients with chronic external ankle instability caused by old injury to lateral colateral ligament of the ankle joint were enroled, aged 15-63 years. The 34 of 66 patients underwent lateral ligament reconstruction using autologous peroneus brevis and the rest 32 patients received lateral ligament reconstruction using alogeneic tendon. After reconstruction, reaction time of the peroneous brevis, talar tilt angle and anterior talar translation, visual analog scale score and the American Orthopaedic Foot and Ankle Society (AOFAS) score were compared between the two groups. RESULTS AND CONCLUSION:At the last folow-up, the visual analog scale score, tilt angle and anterior talar translation were lowered in the two groups compared with the previous (P < 0.05), and the AOFAS scores were increased significantly in the two groups (P < 0.05); the reaction time of the peroneous brevis was increased inthe autologous peroneus brevis group (P < 0.05) and decreased in the alogeneic tendon group (P < 0.05); the above-mentioned indexes had no difference between the two groups. These findings indicate that autologous peroneus brevis and alogeneic tendon have similar effects on the lateral ligament reconstruction in terms of postoperative ankle function, stability and activity levels, but the alogeneic tendon shows advantages on less trauma and shorter operation time.

BACKGROUND:Mycobacterium tuberculosis heat shock protein 10 (r-Mt cpn10) is one of the main factors that cause bone tuberculosis dissolution and absorption as wel as inhibits the proliferation of osteoblasts. Receptor activator of nuclear factor kappa B ligand and osteoprotegerin are the important factors influencing bone metabolism.
OBJECTIVE:To observe the effect of r-Mt cpn10 on human osteoblast proliferation, alkaline phosphatase secretion, expression of receptor activator of nuclear factor-kappa B ligand mRNA and osteoprotegerin mRNA. METHODS:Human bone marrow stromal cel s were induced to differentiate into osteoblasts, and osteoblasts at passage 3 were cultured with various concentrations of r-Mt cpn10 (0.1, 1, 10 mg/L). Osteoblasts cultured without r-Mt CPN10 were assigned as controls.
RESULTS AND CONCLUSION:MTT assay results showed that, compared with control group, r-Mt cpn10 at different concentrations inhibited osteoblast proliferation and alkaline phosphatase secretion (P<0.05). RT-PCR analysis showed that, r-Mt cpn10 at different concentrations increased receptor activator of nuclear factor-kappa B ligand mRNA expression (P<0.01), and inhibited osteoprotegerin mRNA expression in a concentration-dependent manner (P<0.01). 10 mg/L r-Mt cpn10 exhibited the strongest effect (P<0.01). The r-Mt cpn10 can inhibit osteoblast proliferation and alkaline phosphatase activity, and it may influence bone metabolism by regulating the expression of receptor activator of nuclear factor-kappa B ligand mRNA and osteoprotegerin mRNA.

BACKGROUND:Reconstruction with remnant preservation can enhance tendon-bone healing. However, the study limits on the histological level, and there is a lack of research based on the modular biological level.
OBJECTIVE:To investigate whether anterior cruciate ligament reconstruction with remnant preservation can enhance tendon-bone healing.
METHODS:Seventy-two New Zealand rabbits were randomly al ocated to three groups (n=24 per group), fol owed by cruciate ligament reconstruction without remnant (group A), with remnant preservation (femoral tensioning and augmented suture) (group B) and with remnant preservation (graft passing remnant anterior cruciate ligament sheath) (group C), respectively.
RESULTS AND CONCLUSION:Hematoxylin-eosin staining showed that the tendon-bone healing in the groups B and C surpassed that in the group A, and group B was better than group C. Real-time PCR revealed that the expression level of osteoprotegrin mRNA and the osteoprotegrin/receptor activator of nuclear factor-κB ligand (RANKL) ratio were greater in the groups B and C than in the group A, and highest in the group C, while the expression levels of RANKL mRNA in the groups B and C were lower than that in the group A. In conclusion, these two kinds of anterior cruciate ligament reconstruction methods with remnant preservation can enhance tendon-bone healing, which have obtained most obvious achievements in the anterior cruciate ligament reconstruction in the graft passing anterior cruciate ligament remnant sheath that may be related to the up-regulation of osteoprotegrin mRNA and down-regulation of RANKL mRNA.

Objective To explore a safe dose range of spinal IMRT by comparing the cell damage in Beagles at different dose levels.Methods Thirty Beagles were randomly divided into 5 groups.The Beagle clinical model of tumor was established in the ninth and tenth thoracic spine.The Beagles were subjected to IMRT with the total doses of 0,40,50,60,70 Gy,respectively.The samples of spine were taken out from the same locum of the ninth and tenth thoracic spine at 3 month after radiation.All the samples were observed by the hematoxylin-eosin staining,and the VEGF expression in spine was evaluated by immunohistochemistry.Terminal deoxynucleatidyl transferase mediated dUTP nick and labeling (TUNEL) technique was used to examine the apoptotic cells in the spine.Results The osteocytes in the spine showed reversible injury in 40 Gy group,and cell apoptosis in 50,60,70 Gy groups.Compared with 40 Gy group,the rates of lacuna were increased in 50,60,70 Gy groups(F =2.57,P ＜0.05),as well as the cell apoptotic rates(F =3.52,P ＜ 0.05) and the expression of VEGF (F =3.64,P ＜ 0.05),but there were no significant differences among 50,60,70 Gy groups (P ＞ 0.05).Conclusions The late radiotherapy response of the spine was obviously observed at 3 month after radiation,especially at 50 Gy.

BACKGROUND: Most of studies focus on the biomechanical characteristics of thoracic spine neoplasm, but there is little report on the fracture risk in the patients with vertebral hemangioma through finite element analysis.OBJECTIVE: To establish a finite element model of vertebral hemangioma, and to analyze its biomechanical characteristics, and assess the risk of vertebral fracture.METHODS: Three-dimensional finite element models of T12-L2 vertebrae from normal individuals, the patients with vertebral hemangioma (hemangioma accounting for 20%, 40%, 60%, 80% of the vertebral cancellous bone) and bone cement filling were established, respectively, and then the mechanical characteristics were analyzed. The stress distribution and characters of each model were determined under a vertical static pressure of 600 N.RESULTS AND CONCLUSION: (1) Three-dimensional finite element models of T12-L2 vertebrae were established successfully. Under static pressure, the stress distribution of L1 cortical bone showed no significant difference among models, and the maximum stress all occurred at the base of pedicle, zygapophysial joint and isthmus. (2) The stress distribution did not differ significantly between vertebral hemangioma accounting for 20%-40% of vertebral cancellous bone with complete cortical bone and normal ones, but which differed significantly in hemangioma accounting for 60%-80%. (3) To conclude, the established thoracolumbar three-dimensional model is available. Additionally,biomechanical tests manifest that the completeness of cortical bone and destruction ratio of cancellous bone destruction are key factors for the fracture risk of vertebral hemangioma.