[Objective]To investigate the hallux valgus angle and pathogenesis of hallux valgus in general population.[Method]A total of 1 233 adult population in Shijiazhuang were selected for this study by random cluster sampling method,then a questionnaire survey was participated including gender,age,nation,culture degree,inhabitate time,symptome occurrence time,original symptome,aggravate factors,relieve factors,family medical history,living habit,life style,et al.Hallux valgus angle was measured by protracter.The angle exceed 15? was confirmed the hallux valgus.The data was analysised with logistic multiple regression analysis.[Result]The average hallux valgus angle was(8.31?4.93)? of male and(9.72?7.12)? of female.There were 98 hallux valgus patients in this study,and the morbidity rate was 7.95%.The morbidity rate was 1.29% of male and 11.00% of female.Ratio of male to female was 1∶8.53.The average age was 22 years old.The concentrated symptome occurrence time was 20 to 45 years old;the average age was 25 years old.78 hallux valgus patients had a family medical history(79.6%).The dangerous factors of hallux valgus were inheritance,gender,flatfoot.The effective factors in female related to inheritance,the age that start wearing high-heel shoes but not to the height of the heel and the full time who were high-heel shoes.The aggravate factors were as follow:wearing high-heel shoes,long time standing,long time walking.The relieving factors were as follow:wearing flat and low-hell shoes,a warm water bath for foot,massage.[Conclusion]Female has a high risk to have hallux valgus.The hallux valgus has a close relationship with inheritance,and the age who start wearing high-heel shoes influences the incidence in female.

Objective To evaluate the effect of internal iliac artery or abdominal aorta blockade on the pressure of internal iliac artery net in order to provide theoretical basis for reasonable option of arterial blockade in management of arterial bleeding of pelvic fractures.Methods Five goats were included in the study.The measurement of the pressure of internal iliac artery net was made in the following steps:( 1 ) measurement of the pressure of normal internal iliac artery,(2) measurenent of the pressure following blockade of unilateral internal iliac artery,(3) measurement of the pressure following blockade of bilateral internal iliac arteries,(4) measurement of the pressure following blockade of abdominal aorta and bilateral internal iliac arteries simultaneously,(5) measurement of the pressure following blockade of abdominal aorta only.Results The normal internal iliac artery pressure was ( 57.84 ± 13.46 ) mm Hg.The pressures following the blockade of unilateral internal iliac artery,bilateral internal iliac arteries,abdominal aorta and bilateral internal iliac arteries sinultaneously,and abdominal aorta only were (38.40±17.39) mm Hg,(29.70 ± 12.16) mmHg,(32.80 ± 17.02) mm Hg and (29.20 ± 18.52) mm Hg,respectively.All the blocking designs had obvious effect on the pressure of normal internal iliac artery ( P ＜ 0.05 ),while the various blockade modes themselves showed no statistical differences (P ＞ 0.05). Conclusion The upper described four modes of blockade are similar in decreasing the pressure of the internal iliac artery net.Thereby,only one of them is enough in management of artery hemorrhage following pelvic fractures.

Background and purpose:B7-H3 is a newly identiifed member of the B7-family of co-stimulatory molecule, and however, its exact role in human osteosarcoma is still unclear. The purpose of this study was to examine the expression of B7-H3 in osteosarcoma tissues and to investigate its correlations with clinicopathological factors and overall survival in patients with osteosarcoma.Methods:The expression of B7-H3 and the intensity of tumor-inifltrating T lymphocytes (TILs) in pathologic specimens of osteosarcoma, osteochondroma and bone ifbrous dysplasia tissues were evaluated by immunohistochemical assay.Results:The expression rate of B7-H3 was 91.8% (56/61) in osteosarcoma lesions, while B7-H3 was barely expressed in adjacent normal tissues and bone ifbrous dysplasia tissues. The intensity of B7-H3 expression in osteochondroma was 56.8%, which was signiifcantly decreased compared with osteosarcoma tissues. Tumor B7-H3 expression was associated with Ennecking stage and pulmonary metastasis, while inversely correlated with the number of tumor-inifltrating CD8+ T cells (P<0.05). Moreover, patients with high tumor B7-H3 levels had a signiifcantly shorter survival time and recurrence time than patients with low tumor B7-H3 levels (P<0.05).Conclusion:B7-H3 is overexpressed in human osteosarcoma tissues, and B7-H3 expression is highly correlated with tumor development and overall patients’ prognosis. Moreover, overexpression of B7-H3 in tissues can relfect CD8+T cell inifltration and may help tumor cells avoid immune surveillance.

Objective To investigate the effect of transforming growth factor β1 (TGF-β1) on the early reconstruction of Wistar rats rotator cuff tears through the tendon-bone healing biomechanical testing . Methods A total of 45 healthy Wistar rats were randomly divided into three groups: the high-dose, the low-dose, and the control group, with 15 animals in each group. The rats underwent full thickness leisure and reconstructive surgery by suture-bridge and TGF-β1 injection at the tendon bone interface. The parameters of tendon-bone interface biomechanics, including tensile strength, cross-section area, stiffness, percentage of loading, were measured at 1-, 2-, 3-weeks post surgery. Results No significant differences werey observed at the fracture point within the tendon suture among the three groups The maximum tensile strength , maximum load percentage, stiffness and tendon bone repair interface in the high-dose group were higher than those in the low-dose group and those in the control group(P < 0.05, respectively). The maximum axial loading, tensile strength and stiffness of the tendon-bone interface in the low-dose group were significantly higher than those in the control group (P < 0.05). The high-dose group renovated the tendon-bone interface healing and increase stiffness with the extension of the rehabilitation. Conclusion TGF-β1 can enhance the maximum tensile strength of the tendon-bone and promote the healing of rotator cuff injury.

Objective To investigate the biomechanicai characteristics of flexor profundus tendons repaired after decimeter wave therapy, and to observe the effect of decimeter wave therapy on early active mobilization. Methods A total of 56 Leghorn chickens were randomly divided into a therapy group and a control group with 28 chickens in each. The 3rd and 4th toes of their left feet were employed for the establishment of a tendon injury model. The flexor profundus tendons were cut and repaired. Gypsum support was applied and fixed with an adhesive plaster after the operation. The operated sites on toes Ⅲ and Ⅳ were exposed. The external fixation was removed 3 weeks later and the chickens were left free to move. Decimeter wave therapy ( frequency 915 MHz, power 8 Watts) was ap-plied for 10 minutes once daily on the left foot of each chicken in the therapy group from day 1 until 3 weeks after the operation. Sham decimeter wave therapy was applied to chickens in the control group. Four chickens from each group were randomly selected at the 1st, 7th, 10th, 14th, 18th, 21st and 28th days for biomechanical analysis. Biome-chanical parameters including tensile strength of rupture (Pmax), elongation ratio at rupture (δimax) and the tensile adhesion strength of the rupture zone (W0>) were observed at each time point. Results At the 7th, 10th, 14th, 18th, 21st and 28th day after the operation, the differences in Pmax, δmax and W0 between the therapy and control groups were statistically significant. The results of the therapy group were better than those of the control group. Conclusions Local decimeter wave therapy after flexor tendon repair can promote intrinsic healing and reduce ex-trinsic healing. The speed and quality of healing are improved. The elasticity and tenacity of the injured tendons are enhanced. Therefore decimeter wave therapy is helpful for early active mobilization training.

Objective To retrospectively study postoperative nonunion of femoral neck fractures so as to identify high risk factors for their nonunion.Methods A total of 965 patients with complete clinical data out of the 1 323 patients with femoral neck fractures treated by internal fixation with cannulated compression screws from January 2003 to January 2011 were included in the study.Logistic muhiple regression method was used to analyze five factors including patients' age,gender,injury mechanism (whether high energy injury or not),fracture type (with or without displacement) and medical comorbidities [American Society of Anesthesiologists Physical Score (ASAS) grade] and their correlation with fracture healing to investigate the high risk factors for the nonunion of femoral neck fractures.Results Quantitative assay of the factors affecting healing of femoral neck fractures was ranged as follows:medical comorbidities (ASAS grade),injury mechanism (whether high energy injury or not),fracturc type (with or without displacement),gender and age.Conclusion Age ＞ 50 years,females,displacement fracture,high energy injury,and ASAS grade above Ⅲ are high risk factors for nonunion of femoral neck fractures.

OBJECTIVE: To evaluate the curative effect and clinical significance of bone cement on coagulation functions during percutaneous vertebroplasty in patients with osteoporotic spinal compression fractures.METHODS: A total of 24 patients, comprising 18 females and 6 males, aged 69 years averagely (range 48-83 years), with 44 osteoporotic vertebral compression fractures underwent percutaneous vertebroplasty in Department of Spinal Surgery, Third Hospital of Hebei Medical University between December 2006 and December 2007. The fracture segment was within T_5-L_3 (20 thoracic vertebrae and 24 lumbar vertebrae). Under the guidance of C-arm fluoroscopy, bone marrow biopsy needle was inserted percutaneously via transpedicular way into the fractured vertebrae. Polymethylmethacrylate (PMMA, bone cement) was injected into the fractured vertebrae. The relative parameters were observed in all patients 10 minutes before, 10 minutes, 30 minutes, 1 hour, 2 hours and 3 hours after bone cement implantation, including prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), plasma protamine paracoagulation test (3P test), and D-dipolymer (D-D). RESULTS: PT was decreased, and FIB, 3P test, D-D were increased 10 minutes after bone cement implantation in percutaneous vertebroplasty peaked at 1 hour and gradually decreased afterward; moreover, there were significant difference between bone cement preimplantation and 10 minutes, 30 minutes, 1 hour, 2 hours and 3 hours after bone cement implantation (P < 0.05), but no difference was observed in APTT and TT (P > 0.05). The influence of bone cement on the parameters was vanished in 3 hours after bone cement implantation, and all indexes were similar to pre-implantation (P > 0.05).CONCLUSION: Bone cement implantation causes temporal hypercoagulabale state in percutaneous vertebroplasty. It is important to monitor blood clotting state in 3 hours after bone cement implantation in order to avoid thrombus disease.

Objective To detect the osteopontin (OPN) autocrine function of the osteoclasts in neurofibromatosis type 1 heterozygote (Nfl+/-) and wild type (Nfl+/+) mice.Test the osteoclasts function of neurofibromatosis type 1 heterozygote (Nfl+/-) and wild type (Nil+/+) mice with exogenous neutralizing OPN antibody,analysis the role of autocrine OPN in the hyperfunction of osteoclast in neurofibromatosis type 1.Methods Culture the low density bone marrow cells from Nfl heterozygote (Nfl+/-) and wild type (Nfl+/+) mice (4-6 weeks old) with macrophage colony-stimulating factor (M-CSF) and receptor activator of NF-κB ligand(RANKL),Measure.the OPN concentration in osteoclast culture superenant with ELISA.Culture the low density bone marrow cells from Nf1+/-and Nf1+/+ mice with or without exogenous neutralizing antibody for OPN.The function of osteoclasts and osteoclast progenitors in formation,migration,adhesion,and bone absorption were tested.Results A significantly higher concentration of OPN was detected in the Nf1+/-osteoclast culture media as compared to that of wild type.In control,Osteoclast functions,including migration,adhesion,and bone resorption of Nf1 +/-were higher than that of wild type.Addition OPN neutralizing antibody to the Nf1+/-OCL significantly reduced OCL formation.Neutralizing OPN antibody diminished both wild type and Nf1+/-OCL adhensiontion,Anti-OPN minimized OCL migration in both wild type and Nf1 +/-OCL cultures as measured by the transwell assays.Neutralizing OPN antibody diminished both wild type and Nf1+/-OCL pit formation,P＞0.05 for comparing Nfl+/-vs.wild type OCLs with anti-OPN antibody.Conclusion The hyperfunction of osteoclast in Nf1 heterozygote is related with autocrine osteopontin,inhibition of OPN may be an effective treatment for bone destruction of neurofibromatosis type 1.

Objective To investigate the effect of multidisciplinary physician/nurse collaboration care mode in diagnosis and treatment of elderly patients with intertrochanteric fracture.Methods Clinical data of 433 elderly patients with intertrochanteric fracture treated from August 2011 to September 2013 were studied retrospectively.Among them,136 were diagnosed and treated using conventional methods (control group) and 297 using the multidisciplinary physician/nurse collaboration approach (collaboration group).Hospital stay,surgery rate,time from hospitalization and operation,and complications were compared between the two groups.Results Length of hospital stay [(14.8 ± 5.9) d] in collaboration group was not statistically different from that in control group [(16.0 ± 4.7) d,t =0.433,P ＞ 0.05],but surgery rate was improved (72.8％ vs 83.9％,x2 =7.212,P ＜ 0.05),time from hospitalization and operation shortened [(5.6 ± 2.9) d vs (6.9 ± 3.4) d,t =3.096,P ＜ 0.05],and perioperative complication rate reduced in collaboration group compared to control group (all P ＜ 0.05).Conclusion Multidisciplinary physician/nurse collaboration mode is a novel method for diagnosis and treatment of intertrochanteric fracture in the elderly and is associated with improved surgery rate,reduced perioperative complications and early functional recovery.

Objective To evaluate the possibility of deep vein thrombosis defluvium of lower limb using ultrasonography to provide important reference for the implantation and retrieve of retrievable inferior vena cave (IVC ) filters.Methods Sixty-four patients who were diagnosed as lower limb deep vein thrombosis using ultrasonography were enrolled.Fourteen patients with critical values were allocated to high risk group,50 patients without critical value to low risk group.All the patients underwent inferior vena cava filter operation.Of all these patients,ultrosonography were performed once again before IVC filters were retrieved.Seventeen patients with broken thrombosis were allocated to unstable group,47 patients with stable thrombosis to stable group.Relationships between conditions of thrombosis and ultrasonography results were analysed.The conditions of thrombosis were recorded.The rates of thrombosis defluvium were compared.Results In high risk group,10 patients (71 .43%)had thrombosis.In low risk group,8 patients (16%)had thrombosis.There were significant differences in the rates of thrombosis defluvium beteen the high risk group and low risk group(P <0.05).In unstable group,12 patients (70.59%)had thrombosis.In stable group,6 patients (12.77%) had thrombosis,there were significant differences in the rates of thrombosis defluvium between the unstable group and stable group (P < 0.05 ).Conclusions Ultrasonography can be used to evaluate the possibility of lower extremity deep vein thrombosis defluvium which will guide the pratice of the retrievable inferior vena cava filter.