Objective To explore the clinical efficacy of locking plate in the treatment of postoperative nonunion of limb long bone fracture.Methods We treated 53 patients whose limb long bone fracture failed to unite after operation with locking plate between April 2011 and November 2014.They were 38 men and 15 women,aged from 20 to 69 (average,39.7).There were 18 humeral fractures,5 radioulnar ones,9 femoral ones,and 21 tibial ones.On average,each patient had undergone 1.2 previous operations (from 1 to 2 times),including plating in 29 cases,intramedullary nailing in 15,and external fixation in 9.In the 15 patients whose intramedullary nails were reserved because of slightly loosening only under axial stress,lateral force and rotation,the nonunion was treated with bone autograft + unicortical or full-thickness locking plate.In the other 38 patients whose original implants were removed,the nonunion was treated by re-reaming of the medullary cavity + bone autograft + locking plate internal fixation.Regular radiological follow-ups were conducted for the patients.The functional recovery of upper limbs was evaluated by the Neer system while that of the lower limbs by the Johner-Wruhs system.Results One patient was lost to the follow-up.The rest 52 were followed up for 4 to 15 months (average,12.7 months).Nonunion was found in 2 patients whose internal fixation was broken and loosened.Bone healing was achieved in 50 cases after 4 to 6 months(average,5 months).Removal of implants was conducted in 36 patients at 12 to 24 months after operation (average,13.3 months).At the final follow-ups,the Neer score of upper limb was excellent in 15 cases,good in 5,fair in one and poor in one,giving an excellent to good rate of 90.9％;the Johner-Wruhs score of lower limb was excellent in 24 cases,good in 3,fair in 2 and poor in one,giving an excellent to good rate of 90.0％.Conclusion Locking plate can have good curative efficacy in the treatment of postoperative nonunion of long bone fracture.

BACKGROUND:As an oral anticoagulant drug, many experiments have proved that rivaroxaban can prevent the deep venous thromboembolism after the hip arthroplasty. The foreign literatures indicate that it can significantly reduce the incidence of deep venous thromboembolism after extending the treatment course to 35 days. But there is no significant conclusion at home, and the safety of drugs after extentding the course has not been confirmed. OBJECTIVE:To analyze the efficacy and safety of rivaroxaban versus low-molecular-weight heparin for the prevention of deep venous thrombosis after the hip arthroplasty. METHODS:106 patients with primary unilateral hip arthroplasty in the Second Clinical Medical College of Shanxi Medical University between March 2011 and September 2012 were selected. The patients were randomly divided into rivaroxaban group and low-molecular-weight heparin group. The patients in two groups were given drugs at 6 hours after replacement, the patients in the rivaroxaban group were given rivaroxaban 10 mg/d with the course of 5 weeks;the patients in the low-molecular-weight heparin group were given low-molecular-weight heparin 4 100 U/d with the course of 2 weeks. RESULTS AND CONCLUSION:The review and fol ow-up results showed there was no deep vein thrombosis or symptoms of deep vein thrombosis in patients of the rivaroxaban group after replacement, while seven cases (13%) of deep vein thrombosis were observed in the low-molecular-weight heparin group, and there was significant difference in the incidence rate of deep vein thrombosis between two groups (P<0.05). There were no significant differences in venous blood hemoglobin level, platelet level and coagulation function before and after replacement, as wel as the drainage volume and subcutaneous ecchymosis area after replacement of the patients received unilateral hip arthroplasty between two groups (P>0.05). The results indicate that ful course of rivaroxaban has clear effect and reliable security in the prevention of deep venous thrombosis after hip arthroplasty.

BACKGROUND:Nowadays, the internal fixation materials for the clinical treatment of unstable femoral intertrochanteric fractures are broadly divided into two categories:intramedul ary fixation system and
extramedul ary fixation system. However, the effects of the treatments usual y lack of macro evaluation.
OBJECTIVE:To compare the effect of intramedul ary fixation system and extramedul ary internal fixation system in the treatment of unstable femoral intertrochanteric fractures.
METHODS:217 patients with unstable femoral intertrochanteric fracture (Evans typing: Ⅲ type to Ⅴ type and R type) were treated by using intramedul ary fixation system and extramedul ary internal fixation system:18
cases were treated with dynamic condylar screw, 67 cases were treated with dynamic hip screw, 43 cases were treated with reconstruction nail, 72 cases were treated with proximal femoral anti-rotation blade nail, and 17 cases were treated with new generation of antegrade interlocking intramedul ary nail. The operative time, length of
incision, blood loss, time in bed, fracture healing time, complications and Harris hip score were analyzed and compared.
RESULTS AND CONCLUSION:In the aspects of operative time, blood loss, time in bed, complications and
Harris hip score, the intramedul ary fixation system was superior to extramedul ary internal fixation system. But there were significant differences in the aspects of length of incision and fracture healing time between two
methods. The results showed that the treatment of unstable femoral intertrochanteric fractures by using
intramedul ary fixation system was better than the extramedul ary internal fixation system, as the intramedul ary fixation system could effectively shorten the operative time and reduce blood loss. This stable and reliable fixation enables patients to take early postoperative functional exercise, and could significantly shorten the time in bed and reduce the incidence of complications and it is conducive to postoperative hip function recovery.
Therefore, intramedul ary fixation system is an ideal method for the treatment of unstable femoral intertrochanteric fractures.

Objective To compare the clinical outcomes of bone transport technique versus induced membrane technique for treatment of infected bone nonunion.Methods A retrospective study was made on 46 cases of infected bone nonunion admitted from April 2011 to December 2014.They were 33 males and 13 females,aged from 12 to 68 years (mean,45.3 years),involving 40 tibial and 6 femoral fractures.Bone transport technique was used in 37 cases while 9 cases were treated with induced membrane technique.Fracture union and complications were recorded.The function of the affected limb was evaluated at the final follow-up using Johner-Wruhs criteria.Results The 46 cases were followed up for 9 to 18 months (mean,14 months).In the bone transport group,bone union was achieved after a mean duration of 6.5 months (range,from 4 to 11 months) without complications like wound infection or neurovascular lesions.In the induced membrane group,bone union was achieved after a mean duration of 5.8 months (range,from 4 to 11 months) and there was one case of re-infection.According to the Johner-Wruhs score system,34 cases were rated as excellent,9 as good and 3 as fair,with a total excellent and good rate of 93.5％.Bone transport technique led to 28 excellent,4 good and one fair cases in the patients with tibial nonunion,and one excellent,2 good and one fair cases in the patients with femoral nonunion.Induced membrane technique led to 3 excellent,3 good and one fair cases in the patients with tibial nonunion,and 2 excellent cases in the patients with femoral nonunion.Conclusions Both bone transport technique and induced membrane technique are effective for infected bone nonunion.Bone transport technique may be preferred for tibial infected nonunion while induced membrane technique preferred for femoral infected nonunion.

BACKGROUND:The in vivo degradation process of chitosan/hydroxyapatite composite porous scaffolds is not very clear. Research on the effects of rat osteoblasts and degradation products is less.
OBJECTIVE:To analyze the biocompatiblity of rat osteoblasts with degradation products of chitosan/hydroxyapatite composite porous scaffolds.
METHODS:The second generation of cultured rat osteoblasts were respectively cultured in the extract of degradation products of chitosan/hydroxyapatite composite scaffolds (experimental group) and Dulbecco’s modified Eagle’s medium containing 10%fetal bovine serum (control group). At 2, 4, 6, 8, 10 days of culture, cel counting was measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Alkaline phosphatase activity was measured by the recommended method of determination of the Federation, and total protein was determined by BCA method.
RESULTS AND CONCLUSION:The proliferation speed, alkaline phosphatase activity, total cel ular protein synthesis and ratio of alkaline phosphatase to total protein in rat osteoblasts cultured in the experimental group were significantly higher than those in the control group (P<0.05). This experiment showed that the degradation products of chitosan/hydroxyapatite composite porous scaffolds cannot only promote rat osteoblast adhesion, growth and proliferation, but also enhance its ossification function, with good biocompatibility.

Objective To establish an enterovirus 71(EV71) infection model of tree shrew primary renal cells.Methods Tree shrew primary renal cells were obtained by trypsin digestion.After subculture and purification,EV71 virus was used to infect these primary cells.The culture supernatant of these EV71-infected cells was collected for virus titer detection at 1,2,4,6 and 8 days post-infection.The cells were collected for detection of EV71 VP1 protein by Western blot assay.Furthermore,the expression and location of VP1 protein in the infected cells were detected by indirect immunofluorescence assay.Vero cells were taken as positive control to evaluate the infectivity of EV71 virus to tree shrew primary renal cells.Results Morphologically,the cultured cells were proved to be majorly consisted of the primary renal cells after subculture and purification.The obtained primary cells were infected by EV71 virus.The virus titer was up to 1.3×106 TCID 50/mL during 48-96 h post-infection,proving that EV71 virus infected and proliferated in the tree shrew primary renal cells.Western blot showed that the viral VP1 protein was detected from infected primary cells at 2 to 8 d post infection.VP1 protein was also observed in the cytoplasm at 2 to 6 d post infection by indirect immunofluorescence.Compared with Vero cells,the infectivity of EV71 virus to tree shrew primary renal cells and its proliferation were confirmed.Conclusions Based on the successful establishment of cell culture of tree shrew primary renal cells,the infectivity to the obtained cells and proliferation of EV71 virus in the cells are confirmed.The model of EV71 virus-infected tree shrew primary renal cells is initially established.

ObjectiveTo evaluate the effects of double plates in the treatment of humeral intercondylar fractures.MethodsFrom January 2004 to March 2011,31 patients with humeral intercondylarfractures were reviewed.According to AO/Müller classification,there were three patients with type C1 fractures,16 with type C2 and 12 with type C3.Trans-olecranon osteotomy or trans-triceps-side approach and internal fixation by standard method of AO double plates were performed in all patients.ResultsAll 31patients were followed up for 12 -18 months,which showed fracture healing 6-12 months after surgery.According to the Cassebaum scoring system,the effects were evaluated as excellent in seven patients,good in 19,fair in four and poor in one,with excellence rate of 87％. ConclusionDouble plates is proved to be a good choice for humeral intercondylar fractures,since it can obtain satisfactory outcome with solid fixation,stable mechanical properties,few complications and facilitation for early rehabilitation.

Objective To evaluate the clinical and radiologic outcomes of minimally invasive plate percutaneous osteosynthesis (MIPPO) for distal clavicle fractures of Neer type Ⅱ. Methods From May 2015 to May 2016, 13 patients with distal clavicle fracture of Neer type Ⅱwere treated with MIPPO using an anatomic locking plate. Anteroposterior plain X-ray images of the clavicle were taken at intervals until union was observed. Fracture healing time and complications were recorded, and shoulder joint functions evaluated using Constant and University of California at Los Angeles (UCLA) scores. Results The average operating time was 60.9 minutes (range, from 48 to 83 minutes), average intraoperative blood loss 24.7 mL (range, from 18 to 30 mL), and average union time for the patients was 13.3 weeks (range, from 11 to 15 weeks). No delayed union or nonunion occurred. There were no major complications, like infection, plate breakage, or neurovascular injury. Only 2 patients felt local incision numbness. All the patients were satisfactory with their shoulder func-tions. At the final follow-ups, the mean Constant score was 93.2 points (from 87 to 95 points) and the mean UCLA score 30.6 points (from 28 to 34 points). Conclusion In the treatment of distal clavicle fractures of Neer type Ⅱ, minimally invasive plate percutaneous osteosynthesis can not only achieve good clinical and radi-ologic outcomes but also be advantageous over conventional open reduction in aspects of smaller invasion and better cosmetic effect.

Background: and Purpose Brainstem gliomas (BSGs) in adults are rare brain tumors with dismal outcomes. The aim of this study was to determine the clinical and genetic features in a series of BSGs and their association with the prognosis. Methods: Fifty patients who underwent a stereotactic biopsy between January 2016 and April 2018 at a single institution were collected. Data on clinicopathological characteristics were analyzed and factors associated with patient survival were identified using a Cox regression model. Results: The median age at diagnosis was 55.5 years, and 62% of the patients were male. Glioblastoma (44%) accounted for the largest proportion of BSGs, and oligodendroglioma (2 of 50) was rarely encountered. The IDH mutation (6 of 44) occurred infrequently in astrocytomas, and IDH-mutant tumors harbored both ATRX loss and MGMT promoter methylation at a relatively low level. Wild-type IDH astrocytomas were identified as having high rates of 1p/19q codeletion (5 of 38) and loss of heterozygosity 1p (8 of 38) or 19q (8 of 38) only. In diffuse midline glioma H3K27M mutant, MGMT promoter methylation occurred in three of four cases. Patients were offered radiotherapy and/or concurrent/adjuvant temozolomide chemotherapy, and their median survival time was 13 months. Multivariate analysis revealed that a low tumor grade, absence of tumor enhancement, duration of symptoms ≥3 months, Karnofsky performance status ≥70, and ATRX loss conferred a survival advantage. Conclusions Adult BSGs showed different molecular genetic characteristics, but also resembled supratentorial gliomas in their clinical features associated with oncological outcomes.

Background: and Purpose Brainstem gliomas (BSGs) in adults are rare brain tumors with dismal outcomes. The aim of this study was to determine the clinical and genetic features in a series of BSGs and their association with the prognosis. Methods: Fifty patients who underwent a stereotactic biopsy between January 2016 and April 2018 at a single institution were collected. Data on clinicopathological characteristics were analyzed and factors associated with patient survival were identified using a Cox regression model. Results: The median age at diagnosis was 55.5 years, and 62% of the patients were male. Glioblastoma (44%) accounted for the largest proportion of BSGs, and oligodendroglioma (2 of 50) was rarely encountered. The IDH mutation (6 of 44) occurred infrequently in astrocytomas, and IDH-mutant tumors harbored both ATRX loss and MGMT promoter methylation at a relatively low level. Wild-type IDH astrocytomas were identified as having high rates of 1p/19q codeletion (5 of 38) and loss of heterozygosity 1p (8 of 38) or 19q (8 of 38) only. In diffuse midline glioma H3K27M mutant, MGMT promoter methylation occurred in three of four cases. Patients were offered radiotherapy and/or concurrent/adjuvant temozolomide chemotherapy, and their median survival time was 13 months. Multivariate analysis revealed that a low tumor grade, absence of tumor enhancement, duration of symptoms ≥3 months, Karnofsky performance status ≥70, and ATRX loss conferred a survival advantage. Conclusions Adult BSGs showed different molecular genetic characteristics, but also resembled supratentorial gliomas in their clinical features associated with oncological outcomes.