BACKGROUND: Tension band suture fixation is always used in treating patellar fracture, and its modified method of Kirschner wire plus tension band steel-wire is also widely applied. But because the traditional surgery always causes massive incision and scar formation, it affects the appearance and function of knee joint.OBJECTIVE: To investigate the clinical curative effect of percutaneous puncture plus tension zone steel-wire fixation for the treatment of patella closed transverse fracture.DESIGN: Retrospective analysis:SETTING: Second Hospital of Medical College, Xi'an Jiaotong University.PARTICIPANTS: Twenty-nine patients with closed patellar transverse fracture admitted by Department of Orthopedics,Medical College of Xi'an Jiaotong University were selected from an average age of 36 years old. Only people that were diagnosed by X-ray as closed patellar transverse fracture were enrolled, and the informed consent was obtained from them.jostled until resetting, and then the fractured pieces were clamped by a clavical clamp to fix. Two incisions were made at the upper and lower ends of patella, and two were penetrated from the incision until its tip out of the lower hole of the same Kirschner wire under skin. The soft steel wire was drawn tightly and bended along the tip of Kirschner wire. The three-grading method, and the recovery of patients in 4 years after operation was evaluated according to the composite evaluation means about the knee joint established by Xu et al (pain, movement range of knee joint and reset of the fracture in patellar face. Meanwhile, the postoperative complications were observed.MAIN OUTCOME MEASURES: Wound healing, postoperative functional recovery and complications of patients.cases scored in grade 1, accounted for 93%, 2 cases in grade 2, accounted for 7%, who were recovered after change of means about the knee joint established by Xu, 26 cases were excellent, and 3 were good; in the movement range of knee joint, 27 cases were excellent and 2 were good; in the resetting of fracture, 26 cases were excellent and 3 were infection, traumatic arthritis, or other complications were found in patients.CONCLUSION: Percutaneous internal fixation with Kirchner needles combined with tension band wires for treatment of closed patella transverse fractures is featured by minimal trauma, fast recovery and beautiful outlook in the operative area. Moreover, it permits early movement in the knee joints. This method has a satisfied clinical curative effect.

Digital orthopedic technologies are increasingly being applied to the clinical practice of joint surgery. These technologies include artificial intelligence, virtual/augmented/mixed reality, 3D printing, computer navigation, robotic-assisted joint replacement surgery, and other digital orthopedic technologies. Digital orthopedic technologies continue to empower joint surgeons, simplify complex operations, achieve precision in simple operations, and to make precise operations more individualized. Thus, they are becoming important development directions for joint surgery in the future. With the help of advances in computer-aided design and additive manufacturing technology, customized joint prostheses and bone tissue repair materials provide great convenience for reconstruction of complex bone defects during revision surgery. Various types of computer-assisted navigation technologies and robot-assisted surgery technologies can help doctors improve the accuracy of osteotomy and prosthesis implantation significantly. However, to fundamentally improve patients' satisfaction after joint replacements, we need to use digital orthopedics technologies to explore the ideal target value of arthroplasty. Further, we use personalized preoperative planning with objective and accurate assessment technology of soft tissue balance, precise intraoperative operations, and the use of customized prostheses to achieve individualized and precise joint arthroplasty. Various digital orthopedic technologies have their own advantages and disadvantages. Joint surgeons should have an in-depth understanding of these technologies and make full and reasonable use of these technologies to benefit the majority of patients.

OBJECTIVE: To investigate the effects of soybean isoflavones (SI) on expression levels of osteoprotegerin (OPG) and osteoprotegerin ligand (OPGL) mRNAs in bone tissues of ovariectomized rats, and to discuss the mechanism of soybean isoflavaones in preventing and treating postmenopausal osteoporosis (PMO). METHODS: Thirty adult SD rats were randomly divided into 3 groups: sham-operation group, untreated group and SI-treated group. The rats in the last two groups were bilaterally ovariectomized. The bone density of L(3) to L(6) vertebrae was detected after 12-week intervention. Total RNA was extracted from femur head and the expression levels of OPG and OPGL mRNAs were examined by real-time quantitative polymerase chain reaction. RESULTS: SI could increase the bone density of lumbar vertebrae in ovariectomized rats, up-regulate the expression level of OPG mRNA and down-regulate the ratio of OPGL mRNA/OPG mRNA, but exert no significant effect on the expression of OPGL mRNA. CONCLUSION: The therapeutic effects of SI on PMO may be related to regulating the expression levels of OPG and OPGL mRNAs, and the ratio of OPGL mRNA/OPG mRNA.

[Objective]To explore the result of total hip arthroplasty(THA) performed in patients with osteoarthritis secondary to developmental dysplasia of the hip(DDH) and the degree of hip dysplasia on the treatment result. [Method]Forty-seven cases(55 hips) with osteoarthritis secondary to DDH were treated with THA.According to the classification of Crowe,23 hips were in classⅠ,19 in classⅡand 13 in class Ⅲ/Ⅳ.Before operation,the morphological changes of acetabula and femurs were evaluated with helical CT.During the operation,the acetabula were reconstructed at the level of real acetabula,the femoral canal was carefully enlarged and the small and straight femoral protheses were employed.The Harris hip score was conducted in each patients preoperatively and postoperatively.[Result]The Harris hip score in class Ⅰ,Ⅱand Ⅲ/Ⅳ were from 50.7?7.6,44.9?6.2 and 41.1?8.2 preoperative to 90.6?3.7,87.3?4.5 and 82.7?7.3 postoperative,respectively.There was significant difference between them(P

[Objective]To observe the therapeutic effect of the combined external fixator and traditional Chinese medicine for senile femoral intertrochanteric fracture.[Method]There were sixty-eight cases for study .Thirty-five cases in treatment group were treated with external fixator in perculaneous transhepatic through Minimally Invasive Skill (MIK),together with oral medication of traditional Chinese medicine,while thirty-three cases in the control group only underwent external fixator.[Result]All of the cases had been followed up for an average period of three years and ten months,which arranged from one year and eight month to six years and nine months . The fracture healing time in the treated group was 12.4?2.5 weeks and that in the control group was 15.5?2.9 weeks,showing significant difference between them (P

OBJECTIVE: To observe the protective effects of ginkgo leaf extracts on spinal cord after ischemia-reperfusion (IR) injury in rabbits and to find out its possible mechanism. METHODS: Twenty-seven New Zealand white rabbits were randomly divided into three groups, which were sham-operation group, untreated group and ginkgo leaf extracts-treated group. The locomotor scores of hindlimbs in rabbits after 24 and 48 h of reperfusion were evaluated, and the activity of superoxide dismutase (SOD) and the content of malondialdehyde (MDA) in ischemia spinal cord were examined. The apoptotic index (AI) of neurons in spinal cord was detected by terminal deoxyribonucleotidyl transferase (TdT)-mediated dUTP-biotin nick end labeling (TUNEL) method. The expressions of Bcl-2 and Bax proteins were examined by streptavidin-biotin peroxidase method. RESULTS: The locomotor scores of hindlimbs in rabbits after 24 and 48 h of reperfusion in the ginkgo leaf extracts-treated group were obviously elevated as compared with those in the untreated group (P<0.05). The activity of SOD was higher and the level of MDA was lower in ischemia spinal cord in the ginkgo leaf extracts-treated group than those in the untreated group (P<0.01). The decreased neuron AI and the expressions of up-regulated Bcl-2 protein and down-regulated Bax protein were also observed in the ginkgo leaf extracts-treated group. CONCLUSION: The protective effects of the ginkgo leaf extracts against spinal cord injury induced by IR may be related to scavenging oxygen free radicals, reducing lipid peroxidation injury and inhibiting apoptosis.

BACKGROUND: Animal experiments show that hormone can induce femoral capillaries poor filling, decrease capillaries density in unit area, and reduce capillaries in cancellous bone inferior to cartilage. However, the involved mechanism remains unclear.OBJECTIVE: To explore the changes of vascular endothelial growth factor (VEGF) during the progress of glucocorticoid induced osteonecrosis.METHODS: The Chinese white rabbits were randomly divided into horse serum plus prednisone group and pradnisone alone group. Typical osteonecrosis model was established by Matsui Method. 10 mL/kg horse serum was injected into horse serum plusprednisone group through the ear margin veins, followed by additional injection after 2 weeks and intraparit0neal injection of prednisone, 45 mg/kg per day for 5 consecutive days. The control group was only subjected to prednisona, 45 mg/kg per day for 5 consecutive days. The VEGF expression was observed by means of reverse transcription polymerase chain react.ion (RT-PCR)before, 7, 14 days after administration, 1, 3, 7, 21, 35 and 49 days following the first application of hormone. The capillaries were quantified.RESULTS ANDCONCLUSION: The VEGF was significantly increased 7 days following horse serum, and gradually decreased to levels before treatment 1 days following hormone. The VEGF mRNA, expression decreased with increasing hormone treatment, in particular at 7 and 21 days (P ＜ 0.05), but cannot restore to normal level. Micrevascular count was decreased gradually, and at 21 days decreased to the minimum, positively correlated with VEGF expression. Results show that adrenal glucocorticoid inhibited VEGF expression in bone tissue and restrained angiogenesis, resulting in ischemia and hypoxia of the local environment in bone tissue. VEGF expression highly correlates with microvascular count and osteonecrosis degree.

Objective To investigate the effects of the platelet activation and the endothelial cell impairment on the osteonecrosis. Methods The contents of TXB2,6-keto-PGF1a, GMP-140 and TM in different periods of animal models of adrenoglucocortisone-induced osteonerosis were measured by the radio-immunity method. ResultsThe contents in group B increased dramatically from 24h after the injection of adrenoglucocortisone, and the contents of GMP-140 and TM from 3d after injection increased with significant difference from group A. Conclusion The results suggest that the early emergence of the platelet activation and endothelial cell impairment models induced by horse serum and adrenoglucocortisone plays a role in the formation of the osteonecrosis.

Objective To observe the expression of vascular endothelial growth factor (VEGF) in synovial tissue during treatment of rabbit arthritis model with corticosteroids and explore its mechanism.Methods The expression and alteration of VEGF in different periods of treatment process of rabbit arthritis model with corticosteroids (after 1 h ,24 h,3,7,14,21 and 28 d treatment with lipopolysaccharide),were investigated by reverse transcript polymerase chain reaction (RT PCR).Results There were different expressive degrees of VEGF in synovial tissue during each period of the process of rabbit arthritis model by corticosteroid treatment and the expressive degree of VEGF had been strongly inhibited by corticosteroids.Conclusion It is indicated that corticosteroids decrease inflammatory reaction of arthritis by inhibiting the expression of VEGF.

The authors adopted an auto control experimental research on 18 male adult dogs with 36 sides of femoral heads and necks which were divided into two groups. They were separately made models of old fracture of femoral neck and avascular necrosis of famoral head. Two wecks later, The free fibula with microvascular an astomosis was tranplanted. All experimental dogs were examined with X-ray, pathohitology, electron microscopy, 99~mTc-MDP scanning and tetracycling labeling after operation.The experiment showed that the free fibular graft with mierovascular anastomosis could provided a new system of vascula supply to the injured femoral head. The hard free fibula and the metallic internal fixation were inserted in femoral head and neck. After the Operation, in the fracture area the fibula formed a bone-bridge which not only diminished the stress force but also prevented rotation displacement of the bone fracture The periosteum of the transplanted fibula also took part in the repair course of avascular nerosis of femoral head.