[Summary] With the increasing global aging population, osteoporosis vertebral compression fracture ( OVCF) is getting more attention as a big challenge for orthopedic surgeons.Current therapeutic options include conservative treatment, traditional open reduction and internal fixation, percutaneous vertebroplasty (PVP), and percutaneous kyphoplasty (PKP).Due to excellent clinical results on pain relief and function improvement, PVP and PKP, as minimally invasive surgical techniques, now increasingly become more popular for painful OVCF.The review focused on a brief introduction of the current status of the two procedures and a discussion of the future trends of the two techniques.

Objective: By comparing different repairing effects of different methods on articular cartilage defects in rabbit model, the ability of a new bioactive glass scaffold to repair cartilage defect was studied. Methods: We prepared the PSC/CS bone cement by mixing the bioactive glass (BG) powder composed of 10.8%P₂O₅-54.2%SiO₂-35%CaO (PSC), chitosan solution (CS) and calcium sulfate hemihydrate (CSH), then the bone cement was sized by a mold to form cylindrical scaffold. In vivo experiment, 18 male rabbits were divided into three groups randomly, including blank group, BG group and TGF-β1 group, which was added TGF-β1 into BG scaffold. Both knees of each rabbit were made cartilage defect for the same group, and no intervention was applied in B group, then implanted scaffolds into defects in both experimental groups. At 6 and 12 weeks after surgery, observed the macroscopic growth, histologic staining and collagen II immunohistochemistry (IHC), and the International Cartilage Repair Society (ICRS) and Wakitani score were used to analyze the experimental results quantitatively. Results: At 6 weeks after surgery, there was no obvious difference between blank group and BG groups, but the macroscopic result of TGF-β1 group was better than the other two groups and its ICRS score 4.67±0.52 points was statistically higher than BG group 2.83±0.75 points (t=-2.817, P=0.015). As to the comparison of histologic staining and Wakitani socre among three groups, no statistical difference was observed (blank group=13.67±0.52, BG group=13.83±0.41, TGF-β1 group=13.33±1.03). At 12 weeks after surgery, there was still no obvious difference between blank and BG groups, while the results of macroscopic observation and ICRS score in TGF-β1 group were significantly higher than them 9.01±0.63 points (blank group vs TGF-β1 group: t=-2.289, P=0.022; BG group vs TGF-β1 group: t=-2.326, P=0.020). More importantly, much deeper positive staining were observed in TGF-β1 group, and the Wakitani score was higher than the other two groups (blank group=9.83±1.33, BG group=9.51±1.05, TGF-β1 group=6.50±1.38, blank group vs TGF-β1 group: t=-2.771, P=0.007; BG group vs TGF-β1 group: t=-2.756, P=0.006). By comparing the degree of histologic staining and Col II expression with normal cartilage, the regenerated tissue in TGF-β1 group was similar. Conclusion Single PSC/CS scaffold doesn’t possess excellent ability to repair cartilage defect. When TGF-β1 was added into PSC/CS bioactive glass, the scaffold was able to promote cartilage defect repair, and the regenerated tissue was similar to normal cartilage.

Objective To analyze the iatrogenic fractures following treatment of type 12-A humeral shaft fractures with antegrade intramedullary nails. Methods We reviewed the patients who had been treated with antegrade intramedullary nails for type 12-A humeral shaft fracture from October 2006 to March 2017. They were 13 males and 13 females with an age range from 22 to 76 years and an average age of 44. 5 years. Six of them were complicated with other fractures or radial nerve injury. We divided the patients into an iatrogenic fracture ( IF ) group and a non-iatrogenic fracture ( NIF ) group and compared gender, age, fracture type, reaming and nonunion between the 2 groups. Results The follow-up time for the 26 patients ranged from 13 to 182 weeks ( 63. 8 weeks on average ) . Of them, 7 suffered iatrogenic fracture and 4 nonunion. The union time for the other 22 patients ranged from 9 to 29 weeks ( 14. 6 weeks on average ) . All the 7 patients in the iatrogenic fracture group were treated with reaming while only 9 of the 19 patients in the non-iatrogenic fracture group were treated with reaming. Nonunion occurred in 3 patients in the iatrogenic fracture group but in only one patient in the non-iatrogenic fracture group. All the above comparisons were statistically significant between the 2 groups ( P < 0. 05 ) but there were no significant differences in comparisons between the 2 groups regarding gender, age, nail diameter, fracture type, way of locking proximal and distal screws or rate of secondary surgery ( P > 0. 05 ) . Conclusions Antegrade intramedullary nailing may cause an iatro-genic fracture in the treatment of type12-A humeral shaft fractures. The iatrogenic fracture may affect fracture union. Intraoperative reaming may be the risk factor for the iatrogenic fracture.

Objective To improve the quality of clinical biochemistry laboratory by quality indicators of pre-analytical,analytical,post-analytical phase and the whole process.Methods Analytical Phase:The Sigma values of items were calculated,applying the equation Sigma =(TEa％-Bias％)/CV％.Total allowable error (TEa) is from analyticalal specification defined in WS/T403-2012 of China,Bias％ is from the evaluation results of National Center for Clinical Laboratory (NCCL) trueness verification PT series and CV％ is from internal quality control data during the last 6 months in our lab.Normalized Sigma metrics plot was made to evaluate the analysis performance and the quality control strategies were designed accordingly.The quality goal indexes (QGI) were also calculated to propose improvement measures for items below 6 Sigma.Quality indicators of pre-,post-analytical and whole analytical phase,such as quality of specimen,critical value notification,critical value notification in time,TAT of hs-cTnT,TAT of emergency biochemical items,rewrite of laboratory reports and unacceptable performance in EQA-PT were measured in Sigma metrics too.The Sigma metrics changes before and after taking improvement measures were compared to conform the effectiveness.Results The average Sigma value of 17 biochemical tests was 5.29,of which 8 items (UA,K,ALP,CK,AMY,AST,TG,Na) achieved excellent to world class level (≥ 5 Sigma),6 items (LDH,Cre,TC,ALT,Mg,Glu) achieved marginal to good level (5 ＞ Sigma ≥ 3),BUN performed poorly (3 ＞ Sigma ≥ 2),Ca,TP performed unacceptably (Sigma ＜ 2) with serious quality defects.The Sigma values of unacceptable specimen,critical value notification,critical value notification in time,unacceptable turn around time (TAT) of hs-cTnT,unacceptable turn around time (TAT) of emergency biochemical items,rewrite of laboratory reports,unacceptable performance in EQA-PT were 4.17,3.60,2.75,1.72,3.27,4.52,3.33 respectively,rising to 4.30,4.30,2.90,2.45,3.75,4.80,3.60 accordingly after improvement.Conclusions Sigma metrics is potentially an ideal approach for clinical biochemistry laboratories management,which is helpful to find out problems,put forward improvement measures,and confirm the effectiveness,so as to achieve the purpose of continuous quality improvement.