BACKGROUND:Alendronate has a marked enhancing effect on bone mineral density. Ibandronate is the newest (the third generation) bisphosphonates. Evidence-based medicine data on the therapeutic effects ofboth twodrugs remain lacking because of different administration routes and time.
OBJECTIVE:To compare the therapeutic effects of ibandronate and alendronate on postmenopausal osteoporosis.
METHODS:A computer-based online search was conducted in CNKI, PubMed, CECDB, BMA, VIP, CQVIP, CBM, EMbase, ASP, The Cochrane Library, and EMCC databases from August 1999 toAugust 2015 to screen the relevant randomized controled trials. Meta-analysis was performed using Stata/SE version 12.0 software by extracting data from the relevant articles.
RESULTS AND CONCLUSION:A total of 10 randomized controlled trials involving 725 patients (ibandronate and alendronate for 379 and 346 patients, respectively) were included. The meta-analysis results showed that bone mineral density was significantly increased (P=0.174, I2=29.4%,WMD=0.03, 95%CI (0.01-0.04))at 6 months after treatment and incidence rate of fracture was significantly decreased(P=5.810,I2=0%,OR=0.32, 95%CI:(0.10-1.00))during 1-year treatment with ibandronate compared with alendronate treatment. However, no significant differences were found between two drug treatmentsin lumbar spine bone mineral density at 1 year after treatment and the incidence rate of fracture during 6-month treatment. Six-month treatment ofibandronate can improve bone mineral density and reduce the incidence rate of fracture of patients withpostmenopausal osteoporosis.

ObjectiveTo observe the curative effect of Gustilo typeⅢ fracture with soft tissue defect of leg in children.MethodsOf the 15 patients,the area of the soft tissue defect varied from 5 cm × 6 cm to 8 cm × 12 cm.With regard to the location of soft tissue defect,two were situated at the upper third of the leg,eight were middle part of the leg,four were lower portion of the leg and dorsum of foot,one was lower portion of the leg and heel.The fracture was fixed by external fixation device and raw surface was closed by negative pressure drainage in the first stage.The raw surface was eventually covered by the transposition of regional flap or cross leg flap in the second stage.Among them,three patients underwent transposition of saphenous neuro-veno-fasciocutaneous flap, three patients underwent sural neuro-veno-fasciocutaneous flap transposition,one case of medial head of gastrocnemius muscle flap and 7 cases of cross leg flap were performed,while only 1 patient underwent free lateral anterior thigh flap transposition.ResultsOne patient who underwent transposition of saphenous neuro-veno-fasciocutaneous flap present with necrosis of the distal end of the flap 5 days after operation,which was then cured by cross leg saphenous neuro-veno-fasciocutaneous flap.Dark crust in distal end of flap occurred in 1 patient who underwent sural neuro-veno-fasciocutaneous flap,which was cured by changing dressings.Bone fracture of 14 patients were all healed.One patient who was classified as Gustilo Ⅲ c underwent cross leg flap, but bone defect was produced 18 months later.Through 3 months to 2 years follow-up,the texture,colour and shape of flap is good. ConclusionWith regard to Gustilo type Ⅲ fracture combined with soft tissue defect of leg in children,external fixation coupled with flap transposition can cure effectively.

Objectives To explore the process and regularity of graft after vascularized bone allograft. Methods An adult rabbit model of massive femoral defect was established and reconstmcted with vascularized bone allograft based by laterial rotating femoral vessel.The experiments were carried out in two groups,the experimental group(vascularized bone allograft)and the control group(nonvascularized bone allograft).Then observation on periosteum,cortex and marrow was performed after operation containing in ink-infused specimen. Results The revascularization in the experimental grouD was observed synchronicly on periosteum,cortex and marrow after operation,while the phenomenon of vascularization took place from periosteum to marrow in the control group.The density of micro-vessel in experimental group were 10.0±1.8,15.8±1.5 and 13.8±1.5,13.8±1.5 respectivly after 2,4,8 and 16 weeks.and those were 2.8±0.8,6.0±0.9,5.5±1.0,6.0±1.1 in control group.The ink-infused experiment demonstrated a better revascularization in the experimental group. Conclusion The vaseularization can promote revascularization of graft during bone allograft.

Objective To provide anatomic basis for transposition of vascularized radial midforearm flap. Methods On 40 adult cadaveric upper limber specimens injected with red dye, the origin, course, branchs, diameters and anastomosis of intermuscular branch of radial artery and its cutaneous branch were observed. Results Originating from radial artery, intermuscular branch of radial artery descended along periosteum closely between pronator teres and supinator, the main stem was (4.8?1.0) cm in length and (1.2?0.2) mm in diameter. After its periosteal branches were sent off to distribute over middle and inferior shaft of radius, its eutaneous branch perforated from intermuscle and deep fascia and anastomosed with some other cutaneous branches in the forearm. Perforating point of the cutaneous branch was located(11.1?1.3) cm beneath laleral epicondyle of humerus, its diameter was about(0.6?0.1)mm. Conclusion Radial midforrarm flap pedicled with intermuscular branch of radial artery can be transferred to repair soft tissue defect of elbow, forearm or hand.

Objective To investigate the status of microchimerism in recipients and the relation between microchimerism and immunologic tolerance after vascularized allograft bone transplantation. Methods X-ray and histological examinations were performed on recipients after massive vascularized shaft of femur from female Japanese white rabbit donors was transplanted to male recipients. Microchimerism in different organs and tissues were checked postoperatively using a semi-quantitative polymerase chain reaction (PCR) with a Y-chromosome specific primer at different time. Results X-ray and histological examinations showed typical bone union in the experiment group but irregular new bone calluses surrounded the transplanted bones, with high density sequestrum in the control group.Semiquantitative PCR with a Y-chyomosome specific primer indicated that the incidence of microchimerism in organs and tissues in the experiment group was higher than that in the control group postoperatively and increased with time. Conclusions After vascularized allograft bone transplantation, organs and tissues show microchimerism that has a positive correlation with the histocompatibility of the transplanted bones.

Objective To investigate the special cases of distally based sural neurofasciocutaneous flap with muscle repairing the soft tissue defect of foot and ankle. Methods Since February 2004,distally based sural neurofasciocutaneous flap with muscle was applied for repairing the soft tissue defect of foot and ankle in 7 cases, the soft tissue defeat simultaneous chronic osteomylitis of tibia lower section 1 case, the soft tissue defeat simultaneous dead space of foot heel 3 cases, the soft tissue defeat of sole of foot simultaneous bone loss of calcaneus epicarp (5～8 mm) 3 cases, the scope of the flap was 16 cm?12 cm～10 cm?7 cm, the thickness of gastrocnemius flap was 1～4 cm, the muscle flap was smaller than the skin flap. Results Viewing 15 to 20 minutes during operation, muscle side of the muscle flap was errhysising actively, blood circulation fine, all flap were lively. All cases were followed up from 2 to 6 months, osteomyelitis cured, muscle flap outline satisfied, feels recoveried almost, and walk well. Conclusion Distally based sural neurofasciocutaneous flap with muscle can live, the operation is easy, and it is an good donner area in repairing the soft tissue defect of foot and ankle in special cases.

Objective To provide an anatomical basis for repairing the defect of cervical tracheal wall with vascularized pectoralis major tendon flaps.Methods Thirty-two lateral thoracic necrotomies were studied for the following aspects.Measurement of pectoralis major tendons' length,width and thickness.Anatomy of thoracoacromialartery,pectoral branches:origin,distribution.Measurement of length of pedicle,rotated radius of flaps and length from recipient site.An imitative operation was undergone on a specimen of corpse.One patient was undergone the operation of repairing the 3.0 cm × 1.5 cm defect of anterior cervical trachea wall,accompanying with incision infection,with pectoralis major tendon flap.Results Length of pectoralis major tendon:(22.9 ± 0.9)mm.Width of tendon:(51.0± 2.4)mm.Thickness of tendon:(5.81± 1.35)mm.Length of pedicle:(89.3 ± 5.3) mm.The radius of pedicle pectoralis major myotendinous flap:(121.7± 8.2)mm.The distance from pivot point of flap to central point of recipient:(96.5 ± 8.9)mm.Patient possessed normal pronunciation,good appearance and no emphysema at 5 months' follow-up.Tracheal lumen,measured 2.6 cm in the anteroposterior dimension and 1.8 cm in the lateral dimension,showed no recurrence of obvious stenosis in cervical computed tomography at 3 month postoperatively.Conclusion Pedicle pectoralis major tendon flaps,originated from thoracoacromial artery pectoral branches can repair cervical tracheal wall defects effectively.

This case report describes the use of a Functional Thenar Eminence myocutaneous flap for reconstruction of volar defect of distal right thumb of a 25-year-old male who sustained a twisting injury while working. Part of bone and tendon were exposed and the tip of the distal phalanx was crushed, with bony defect.
Adult ; Humans ; Male ; Myocutaneous Flap ; Thumb ; injuries ; surgery

BACKGROUND:To decrease operation amount of finite element analysis and increase its clinical practice,previous studies explored the material properties and 10 kinds of material attributes were assigned,which met the requirements of finite element analysis.Moreover,it can be used to calculate bone density.OBJECTIVE:To explore a method for measurement of bone density based on three-dimensional reconstruction and finite element analysis.METHODS:A total of 11 specimens of femoral superior segment were selected.The mass of control group was firstly measured.The experimental groups were treated with thin-slice high resolution CT scan and three-dimensional reconstruction in Mimics 10.0,volume meshing in Ansys,assigned with 10,100 and 400 kinds of material attributes Mimics,exported to Ansys to calculat the volumes of the block elements of every types of material attributes.The mass and the density of the specimens was harvested according to the empirical formula concerning the gray value and the bone density.All results were treated with one-way ANOVA.RESULTS AND CONCLUSION:One-way ANOVA showed that there were no significant differences between control group and experimental groups assigned with 10,100 and 400 kinds of material attributes (P＞0.28),and there were no significantly among the experimental groups (P＞0.8).Results show that the method was able to measure the mass and the density of bone quantitatively,as well as the proportion between compact bone and cancellous bone;to assign 10 kinds of material attributes to three-dimensional model of femur could match the needs for measurements.The results can be used as an initial preparation for the unification of bone density and finite element analysis for osteoporosis.

BACKGROUND:Based on previously theoretical derivation,it thought that assignment with 10 kinds of material attributes to three-dimensional model of bone can match the needs of finite element analysis,however,whether the results is consistent with actual needs to be validated by experimental results.OBJECTIVE:Twelve specimens of femoral superior segment were used for finite element analysis,which were verified with results of biomechanical testing,to explore a reasonable method for material assignment of bone.METHODS:All 12 specimens of femoral superior segment were treated with CT scan,three-dimensional reconstruction in Mimics 10.0 and volume meshing in Ansys.The finite element analysis group was divided into 2 kinds (compact bone and cancellated bone),10,50,100,200,400 kinds of material attributes groups based on the gray value.All models were assigned with material attributes and tested in Ansys for mechanics data of nodes on surface of femoral neck.In biomechanical testing group,12 specimens of femoral superior segment were treated with compressed testing to harvest mechanics data of measuring point same as that of finite element analysis group.RESULTS AND CONCLUSION:The one-way analysis of variance showed that the differences between the biomechanical testing group and finite element analysis group of 2 kinds of material attributes had no obvious significance (P=0.082).Compared to the 10,50,100,200,400 kinds of material attributes group,the difference had no significance (P > 0.39).However,the differences between the 2 kinds of material attributes and the 10,50,100,200,400 kinds of material attributes in the finite element analysis group were obviously difference (P< 0.05),which was no difference in the 10,50,100,200,400 kinds of material attributes (P>0.9).The results demonstrated that to assign 10 kinds of material attributes to three-dimensional model of bone can match the needs of finite element analysis.