BACKGROUND: Theories concerning the pathogenesis of osteonecrosis of the femoral head (ONFH) are various, such as blood supply dysfunction, lipid metabolism disorder, increased intraosseous pressure, osteocyte apoptosis, gene polymorphism and immunity, but the underlying mechanisms remain unclear.OBJECTIVE: To review the pathogenesis of ONFH, thus providing clues for the study on ONFH.METHODS: Search strategy femoral head necrosis OR osteonecrosis of femoral head AND pathogenesis OR mechanism was used to search articles published between 1985 to 2017 in PubMed, Embase, and Medline databases.Meanwhile, CNKI, WanFang and VIP databases were searched with Chinese keywords of femoral head necrosis,pathogenesis from 1985 to 2017. Finally, 39 articles were included for retrospective analysis.RESULTS AND CONCLUSION: ONFH is a complex disease caused by a variety of factors, among which, biomechanics plays an important role in its occurrence and development. The internal mechanic strength of the femoral head is reduced or the imbalance between external stress and inner structures of femoral head caused by various risk factors leads to micro-fractures of the trabeculae, stress concentration and repeated destruction and repair. When the destruction rate exceeds the repair speed, the femoral heads eventually collapse. Most of ONFH cases are sporadic, but its familial aggregation has been reported; therefore, it may be related with genetic factor.

As the new development of scientometrics and informetrics, knowledge graph has infiltrated into the financial, industrial and medical fields, and become a hot issue in the real world research. In this article, the concept and features of knowledge graph, construction and the existing softwares, the application status and development prospect in the TCM field were reviewed, which may provide references for research on the knowledge graph in the TCM field.

Objective To investigate the clinical characteristics and outcomes of ipsilateral talar and calcaneal fractures.Methods From April 2003 to July 2011,22 patients with ipsilateral talar and calcaneal fractures were treated in our hospital.There were 20 males and 2 females with an average age of 30.2 years (range,17 to 51 years).The fractures occurred on the left side in 10 patients and on the right side in 12 patients.There were 8 cases of talar neck fracture,including 3 type Ⅰ,3 type Ⅱ and 2 type Ⅲ according to the Hawkins classification; there were 14 cases of talar body fracture,including 6 type Ⅱ,2 type Ⅲ and 6 type V according to the Sneppen classification.There were 13 cases of extra-articular calcaneal fracture and 9 cases of intra-articular fracture.Four patients had open fractures,including 1 type Ⅰ,2 type Ⅱ and 1 type llⅢA according to the GustiloAnderson classification.The average time from injury to surgery was 5.5 hours for patients with open fracture and 11 days for patients with close fracture.Seventeen patients underwent internal fixation and 5 patients underwent non-operative treatment.Results All patients were followed up for 25 to 89 months (average,41.5 months).Skin necrosis of the edges of the incision was found in 2 cases and wound infection in 1 case.No fracture nonunion and loss of reduction were observed in all patients.At final follow-up,the functional results were assessed according to the AOFAS score,and the average AOFAS score was 78.9 (range,53 to 95).The result was excellent in 5 patients,good in 10 and fair in 7,and the overall excellent or good rate was 68.2％.Traumatic arthritis was found in 12 patients who had undergone surgical treatment,including 5 cases in subtalar joint and 7 cases in ankle and subtalar joint.Diaz disease occurred in 1 patient who had undergone non-operative treatment.Conclusion Ipsilateral talar and calcaneal fracture is a complicated injury which has many fracture types.The fractures should be reduced anatomically,and traumatic arthritis is the most common complication.

The posterior malleolus plays an important role in the stability and function of the ankle joint. Approximately 7%to 44%of ankle joint fractures are accompanied by posterior malleolus fractures. The current published data suggest a poor outcome for ankle fractures involving the posterior malleolus. Inappropriate reduction of the posterior malleolus fragment may re?sult in symptomatic malunion requiring corrective osteotomy. The posterior malleolus fractures were categorized into three types by Haraguchi:the posterolateral?oblique fractures (Type I), the transverse medial?extension fractures (Type II) and the small?shell fractures (Type III). Mangnus divided posterior malleolus fractures into two basic types: posterolateral and posteromedial types. Bartonícek classified the posterior malleolus fractures into four types on the basis of CT scan and 3D reconstructions, and taking into account the location, shape, size of the fragment and the integrity of the fibular notch:extraincisural fragment with an intact fibular notch (Type I), posterolateral fragment extending into the fibular notch (Type II), posteromedial two?part fragment involving the medial malleolus (Type III) and large posterolateral triangular fragment (Type IV). The fracture lines associated with posterior malleolus fractures appear to be highly variable. So far, no generally accepted clinically relevant classification of posterior malleo?lus fractures exists, and the indications of the operative management of these fractures were often determined by the size of the fragment. The anteroposterior and lateral views were used to evaluate the fractures of the fibular and the medial malleolus, as well as the rupture of the ligament and the presence of subluxation or dislocation of the talus. The determination of proper surgical ap?proach and the internal fixation should take into account the size, shape and displacement of the posterior fragment by CT scans, through CT and 3D reconstructions. The aim of treatment for posterior malleolus fractures is to reduce the displaced fragments ana?tomically, and to restore the stability of the tibiotalar joint and the distal tibiofibular syndesmosis.

Objective To investigate the results and complications in the treatment of the mechanically unstable fractures of the distal femur when Less Invasive Stabilization System (LISS) is used.Methods From September 2011 to July 2014,81 patients with mechanically unstable fractures of the distal femur were treated with the LISS,according to the inclusion criteria and exclusion criteria,59 patients meet the condition including 31 male and 28 female.The mean age of the patients was 49.8 years (range 18-80 years).The fractures occurred on the left side in 40 cases and on the right side in 19 cases.According to AO classification,27 type 33A2,14 type 33A3,13 type 33C2,5 type 33C3.2 cases combined with ipsilateral fractures of the femoral shaft,according to AO classification,1 type 32A1,1 type 32C1.The mechanism of injury was a fall from the height in 8 cases,a traffic accident in 18 cases,a crush injury in 7 cases,a fall injury in 26 cases.55 fractures were closed,and 4 were open.According to the Gustilo-Anderson classification,there were 3 type Ⅰ,1 type Ⅱ.Results The 7-hole plate were used in 21 patients,9-hole plate in 26 patients and 13-hole plate in 12 cases.The 3.5 mm or 6.5 mm lag screw were placed around the LISS plate to stabilized the articular fracture fragment in 11 cases.The mean operation time was 105.2 min (85-145 min),the mean bleeding volume was 203 ml (130-315 ml).All patients were followed up 11-27 months (average 13.2 months).1 delayed union(13 months),the average time to union was 16 weeks (range 12-21 weeks).The average flexion of the knee was 116 degree,0 degree in extension.The functional outcome:32 had an excellent result,19 had a good result and 8 had a fair result,with 86.4％ excellent and good results.No deep infections occurred.No loss of reduction.3 cases had malalignment,2 failed fixation,4 patients with symptomatic hardware irritation.27 cases underwent implants removal after union,cold-welding occurred in 4 cases (9 screws) which resulted in difficult removal.Conclusion LISS is one of the reliable and effective methods in fixation of mechanically unstable fractures of the distal femur.However,its operation indications and operating instructions should be strictly followed.

Objectives To explore the clinical diagnosis and treatment of Dieulafoy disease in children. Method The clinical features, endoscopic features and treatment of Dieulafoy disease in a child were reviewed. Results The 2-year-5-month old girl was admitted due to hematemesis for 7 hours. She was diagnosed of Dieulafoy disease by the typical endoscopic appearance. Gastroscopy showed that the lesion was located in gastric angle which was the predilection position of Dieulafoy disease. The small red blood vessels in the central part of the erosion area was exposed on the mucosal surface. The high frequency electrocoagulation under gastroscope was performed and effect was definite. Conclusion Dieulafoy disease is rare in children and lacks obvious clinical features. Endoscopic treatment has definite effect with little trauma and is the first choice of treatment.

ObjectiveTo observe in vivo segmental lumbar motion in patients with lumbar disc herniation (LDH) during functional weight-bearing activities.MethodsFifteen patients with LDH at L4-5 were studied as experimental group.Ten healthy volunteers were recruited as control group.Three-dimension(3D) lumbar spine models of L3,L4 and L5 were reconstructed from thin section CT scans.Spine motions were then reproduced by matching lumbar spine models and images got from dual fluoroscopic imaging system (DFIS)under different motion state (standing,flexion-extension,left-right twisting and left-right bending).From local coordinate systems at the end plates,the motion of the cephalad vertebrae relative to the caudal vertebrae was calculated for vertebrae levels:L4-5 and L3-4.ResultsThe motion pattern at L4-5 was found to be altered.During flexion-extension,the migrations of the affected segments along the frontal axis,sagittal axis,vertical axis were similar with that of the control group,but the rotation angle along the frontal axis was significantly larger than that of the control group (P＜0.05).During left-right bending and left-right twisting,the migration and rotation angle along the frontal axis were significantly larger than those of control group.During flexionextension,the migrations of the neighboring segments (L3-4) along the three axes were larger than those of the control group,but there were no statistical significances.During left-right bending and left-right twisting,the migrations of the neighboring segments (L3-4) along the vertical axis were significantly larger than those of the control group (P＜0.05).ConclusionThe 3D lumbar motion pattern in LDH patient is different with that of normal people.For the affected segment,compared with the normal people,the range of flexion-extension motion and the translocation in left-right direction were significantly larger,but the rotation range along the vertical axis was smaller.

Objective To compare the biomechanical properties of Gamma3 and InterTan nails in the fixation of femoral intertrochanteric fractures. Methods Twelve synthetic femora of 4th generation were randomized into 4 equal groups ( n=3 ) for assessment of the 2 constructs of fracture fixation ( Gamma3 versus InterTan nails ) . Groups A and B were made into models of stable femoral intertrochanteric fracture (AO/OTA type 31-A1. 1) and groups C and D into unstable ones(AO/OTA type 31-A2. 3) . The biomechanical properties of Gamma3 and InterTan nails in the 4 models were tested and compared. Results For stable fracture models, the fracture gap movement increased with the increasing axial load and the torque increased with the increasing torsion angle. There were significant differences between groups A and B in fracture gap movement and torque ( P <0. 05 ) . There was no significant difference between groups A and B in failure load ( 5, 855. 5 ± 627. 8 N versus 5, 547. 1 ± 365. 4 N ) ( P > 0. 05 ) . For unstable fracture models, there were no significant differences between groups C and D in fracture gap movement when the axial loads were 500 N, 600 N or 700 N ( P > 0. 05 ) , but there was a significant difference between the 2 groups when the axial load was larger than 800 N ( P <0. 05 ) . With the increasing torsion angle, the torque increased in groups C and D. There was a significant difference between the 2 groups in the torque at the same torsion angle ( P <0. 05 ) . There were a significant difference between groups C and D in failure load ( 2, 781. 5 ± 600. 6 N versus 3, 150. 5 ± 633. 8 N ) ( P=0. 007 ) . Conclusions For stable femoral intertrochanteric fractures, InterTan and Gamma3 nails may exhibit similar biomechanical properties. For unstable femoral intertrochanteric fractures, InterTan nails may provide obviously better biomechanical stability than Gamma3 nails.

Objective To analyze the injury types and radiologic findings of the wounded in the major Wenchuan earthquake of May 12, 2008. Methods Radiologic results of 1013 victims admitted to MianYang Central Hospital from May 13, 2008 to May 19, 2008 were studied retrospectively, including X-ray of 854 cases (about 2900 local exam positions) and CT scan of 259 cases (about 300 local exam positions). Results 733 cases showed radiologic abnormalities, including 527 cases of single region injury (accounting for 52. 0%) and 206 cases of multi-region injury (accounting for 20. 3%), the overall positive rate was 72. 4%. The results were in the following order on the basis of the incidence, 288 cases of lower extremity injuries (28.4%), 151 cases of thoracic injuries(14. 9%), 136 cases of upper extremity injuries(13.4%), 133 cases of spine fracture(13.1%), 114 cases of pelvic fracture and dislocation(11.3%),88 cases of craniocerebral injuries (8. 7%), 25 cases of maxillofacial fracture (2. 5%) and 8 cases of abdominal tranma(0. 1%). Thoracic injuries included: rib fracture in 136 cases, pulmonary injury in 59 cases, and sternal fracture in 3 cases. Spinal fracture included: cervical vertebrae involved in 12 cases,thoracic vertebrae involved in 43 cases, lumbar vertebrae involved in 93 cases, and Sacrococcygeal vertebraeinvolved in 12 cases. Craniocerebral injuries included: skull fracture in 41 cases, endocranial abnormalities in 72 cases. Abdominal trauma included: intestinal obstruction in 4 cases, renal contusion in 3 cases and abdominal wall hematoma in 1 case. Conclusion Most parts of the body can be injured by earthquake.Bone fracture and dislocation of lower extremity are the most common manifestations.

Objective:To investigate the value of multi-stage dynamic contrast enhanced MRI (DCE-MRI) histogram in predicting survival of patients undergoing surgical treatment of colorectal cancer (CRC).Methods:The retrospective cohort study was conducted. The clinico-pathological data of 81 patients with CRC who were admitted to the Jiuquan City People′s Hospital from January 2018 to February 2019 were collected. There were 47 males and 34 females, aged (62±6)years. All patients underwent routine MRI and DCE-MRI examination to extract relevant imaging parameters. Observation indicators: (1) treatment, imaging examination and follow-up; (2) imaging factors influencing postoperative disease-free survival of patients with CRC. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Univariate and multivariate analyses were conducted using the COX proportional risk model. Pearson correlation test was used to analyze and exclude factors with correlation in univariate analysis, and the multi-variate analysis was conducted on the rest of factors. The Kaplan-Meier method was used to calculate survival rates, and Log-Rank test was used for survival analysis. Results:(1) Treatment, imaging examination and follow-up. All 81 patients underwent preoperative MRI plain scan, enhanced imaging, and diffusion weighted imaging. After complete examination, all patients underwent radical resection of CRC and received postoperative chemotherapy using the FOLFOX regimen. All 81 patients were followed up for 42(range, 11-61)months after surgery. The 1-, 3-, 5-year overall survival rate of 81 patients after surgery was 98.8%, 96.3%, 93.8%, respectively. During the follow-up period, 56 of the 81 patients survived from disease-free and 25 patients had disease progressed. (2) Imaging factors influencing postoperative disease-free survival of patients with CRC. Results of multivariate analysis showed that the kurtosis value and skewness value of positive enhancement integral (PEI) were independent imaging factors influencing postoperative disease-free survival of patients of CRC ( odds ratio=1.840, 1.243, 95% confidence interval as 1.403-2.412, 1.020-1.516, P<0.05). Taking the median values of kurtosis value and skewness value of PEI as 4.864 and 5.042 for further analysis. The postoperative 5-year disease-free survival rate of patients with kurtosis value of PEI <4.864 and ≥4.864 was 89.7% and 10.3%, showing a significant difference between them ( χ2=31.265, P<0.05). The postoperative 5-year disease-free survival rate of patients with skewness value of PEI<5.042 and ≥5.042 was 63.4% and 36.6%, showing a significant difference between them ( χ2=8.164, P<0.05). Conclusions:The kurtosis value and skewness value of PEI in DCE-MRI are independent imaging factors influencing postoperative disease-free survival of patients of CRC. The DCE-MRI histogram can effectively evaluate the postoperative prognosis of patients of CRC.