BACKGROUND:Diagnosis of deep venous thrombosis has been reported in the literatures, but whether the combination with risk prediction scoring system and a variety of laboratory index increase the diagnosis rate of deep venous thrombosis remains unclear.
OBJECTIVE:To improve the diagnosis sensitivity of traumatic deep venous thrombosis of lower extremity using Wel s scoring system combined D-dimer and fibrin degradation product.
METHODA total of 82 patients with low limb fractures and spine fracture were included in this study, those patients with high risk factors of deep venous thrombosis or with the history of deep venous thrombosis were excluded. After admission, the fol owing indicators of deep venous thrombosis were determined, including
D-dimer, fibrin degradation product, fibrinogenase, prothrombin time, activated partial thrombokinase time, blood platelets count, C-reaction protein, and erythrocyte sedimentation rate. In addition, Doppler ultrasound detection of double lower limbs deep vein was performed, and the results were recorded. According to scoring system of deep venous thrombosis of lower extremity (Wel s scoring system), the patients were assigned into low-risk, middle-risk and high-risk cases.
RESULTS AND CONCLUSION:Doppler ultrasound detection showed that, there were 30 cases in deep venous thrombosis group, and 52 cases in non-deep venous thrombosis. The peak value of D-dimer and fibrin degradation product showed significant differences between the two groups (P<0.05). According to Wel s scoring system, there were 13 low-risk cases, 32 middle-risk cases, and 37 high-risk cases. The diagnosis rate of deep venous thrombosis using D-dimer and fibrin degradation product:positive prediction value for middle-risk deep venous thrombosis was 44.44%and for high-risk deep venous thrombosis was 70.97%. Logistic regression analysis showed that, in the middle-risk and high-risk deep venous thrombosis cases, the Wel s score has a positive correlation with laboratory test and Doppler ultrasound detection of deep venous thrombosis (P<0.05). The score of Wel s scoring system combined D-dimer and fibrin degradation product have clinical significances for the formation of deep venous thrombosis of lower extremity after trauma.

Objective To analyze the diagnosis and treatment of bone hydatid disease retrospectively. Methods From October 1957 to February 2004, thirty-seven consecutive cases, which were 16 males and 21 females, underwent debridement operation. The average age was 29 years ranging from 14 to 58 years. The history of bone hydatid disease was 3.1 years ranging from 0.5 to 12 years. The lesion was located at cervical vetebrae in 2, scapula in 1, thoracic vetebrae in 11, rib in 2, lumbar vetebrae in 5, ilium in 1, sacrum in 1, pelvic pubis in 1, hip joint in 2, femoral intertrochanter in 1, proximal humerus in 2, proximal tibia in 1, humeral head in 1, and proximal rudius in 1. The lesions of all cases were performed curettage thoroughly accepted and some of them received autogenetic or allogenetic bone graft, and artificial bone or bone cement was used to fill the defect in a few cases. Albendazole was used to prevent relapse for 3 months after operation, the dose of Albendazole tablets or powder was 20 mg/kg per day, or liposomal Albendazole 10 mg/kg per day. Results 24 cases were followed up; the period was 2 to 20 years with an average of 3.6 years. Of 37 cases, 31 were hydatid disease of trunk bone (83.78%), 24 were spinal hydatid disease. 25 of 37 cases were performed Casoni test, 21 cases were positive(84%). Four cases accepted the 8-tests immunodiagnosis for human hydatidosis, all were positive. MRI examination was taken in 21 of 37 cases, 18 cases were diagnosed as bone hydatid disease. In 24 cases which were followed up, 11 cases relapsed(45.83%). Conclusion Bone hydatid disease often occurs in the bone of trunk, especially in spine; the X-ray or CT images of bone hydatid disease are similar to tuberculosis, metastases, giant cell tumor, or cyst of bone, it should be identified with these diseases; MRI is valuable to diagnosis of spinal hydatid disease; serological examinations are the major method of identification diagnosis; spinal hydatid disease can not be eliminated easily by operation, and often relapses.

Objective Along with the development of science and technology , increase in the number of species gradually distal femoral fractures internal fixation materials , the choice of performer operation method is put forward to the test .To provide theo-retical basis for surgery of adult distal femoral fractures by systematically compare the distal femoral fractures in adults treated by intr -amedullary nail and plate . Methods We searched for articles comparing intramedullary nail and plate for distal femoral fractures in adults in Cochrane library, HighWire, CNKI, PubMed, super star MedaLink, Wanfang database.Manual retrieval related magazines, the retrieve date from June 2003 to June 2013.The RevMan5.1 provided for the extraction of available data after evaluate the quality of eligible literature . Results A total of 1200 patients were included ( 545 in the intramedullary nailing group and 655 in the plate group).Compared with the plate, intramedullary nail significantly reduced the risk of total complications (RR=0.48,95%CI[0.35, 0.67],P<0.01).Shorten the hospital stay (WMD =-3.55,95%CI[ -4.89, -2.24], P <0.01),full weight-bearing time (WMD=-0.80,95%CI[-1.49,-0.10],P=0.02), healing time(WMD=-3.32,95%CI[ -3.72,-2.92],P<0.01), all the above differences are statistically significant .In addition, this study found that intramedullary nail group is better in operation time and blood loss than steel group , but the conclusion by contrast in some literature . Conclusion Intramedullary nailing treatment of distal femoral fractures in adults can decrease the occurrence of postoperative complications .And in the operation time , hospitalization time, healing time, load time and blood loss, etc is superior to the steel group .Influenced by quality into literature , the above conclu-sion needs high quality case-control study further confirmed .

BACKGROUND:In closed fractures, the initial hematoma that is inclined to remove is seldom considered as the important reasons for bone healing. OBJECTIVE:To observe the mechanism and potential role of original fracture hematoma in fracture healing. METHODS:Ninety-six patients with closed fractures of the long bones undergoing open reduction and internal fixation were randomly divided into experimental group (n=48) and control group (n=48). In the experimental group, original fracture hematoma, 1.0-2.0 mL, was first taken out during the internal fixation and placed into a special sterile plastic bag; then, 3-4 pieces of hematomas were filed into the fracture site and sutured layer by layer. On the contrary, original fracture hematomas from the control group were discarded. Blood samples were extracted to detect the biochemical indicators at 1 month after internal fixation. X-ray examination was done at 1, 3, 6 months after internal fixation for observation of fracture healing. RESULTS AND CONCLUSION: X-ray films showed that the healing rate at 3 months after operation was 95% in the experimental group and 78% in the control group, and there was a significant difference between the two groups (P < 0.05). Levels of bone glaprotein, I-type precolagen carboxy terminus peptide and serum bone alkaline phosphatase were significantly higher in the experimental group than the control group (P < 0.01 orP < 0.05). These findings indicate that the original fracture hematoma can accelerate calus formation, promote bone induction, provide nutrition to the fracture site, and participate in revascularization. Therefore, the original fracture hematomas is one of the effectively therapeutic methods for union and nonunion of fractures.

Objective According to radiation therapy (6WV-X line) on experimental gerbils which were successfully infected by echinococcus granulosus,the outcomes of bone hydatid disease after radiation therapy were studied.Methods Totally 240 gerbil models that were infected bone hydatid disease,were randomly divided into three groups (each group was further divided into three-month and six-month groups,40 gerbils per group),one group as a control group,the 40 Gy/5 times and 50 Gy/5 times groups were given 6WV-X line radiation therapy.After 5 consecutive radiation therapies,stopped for two days and then repeated for five times.At the end of three and six months after radiotherapy,the rate of death and the ulceration or infection of the lesions was compared.Fifteen gerbils from each group were randomly selected to observe the deaths of scolex,protein and calcium concentration changes,the maximum diameter changes of the lesions,the changes of hydatid cyst wet weight and the rate of suppressing capsule,the bone destruction,and rebuilding situation of lesions under a microscope.Results At the end of three and six months after radiation therapy,with increasing dosage,the deaths decreased significantly (x2 =10.4,17.4,all P ＜ 0.05);the ulceration or infection of the lesions decreased significantly (x2 =6.0,10.1,all P ＜ 0.05);the mortality rate of scolex increased [3 month:(22.4 ± 3.1),(95.0 ± 5.2),(136.0 ± 5.4);6 month:(23.2 ± 2.2),(98.2 ± 4.6),(169.3 ± 7.0);F =2 252.5,3 220.3,all P ＜ 0.05];the concentration of protein and the calcium ion were changed significantly [3 month:(1.059 ± 0.056),(0.733 ± 0.051),(0.571 ± 0.043)g/L and (2.802 ± 0.157),(3.056 ± 0.060),(3.546 ± 0.135)mmol/L;6 month:(1.088 ± 0.043),(0.753 ± 0.034),(0.340 ± 0.032)g/L and (2.804 ± 0.019),(3.068 ± 0.052),(3.886 ± 0.046)mmol/L;F =366.0,138.9 and 1 550.5,2 727.3,all P ＜ 0.05];the maximum diameters of the lesions reduced significantly [3 month:(2.38 ± 0.14),(1.69 ± 0.05),(1.40 ± 0.09)cm;6 month:(2.65 ± 0.05),(1.69 ± 0.03),(1.03 ± 0.06)cm;F =372.5,3 846.1,all P ＜ 0.05];the hydatid cyst wet weight decreased significantly [3 month:(3.47 ± 0.11),(2.54 ± 0.12),(1.46 ± 0.07)g;6 month:(3.75 ± 0.31),(2.55 ± 0.08),(1.02 ± 0.20)g;F =1 475.6,608.0,all P ＜ 0.05].In the same group with time went on,in the control and 40 Gy/5 times group,the deaths gradually increased (x2 =4.3,4.6,all P ＜ 0.05),but in the 50 Gy/5 times group,the deaths was not significantly increased (x2 =1.1,P ＞ 0.05);in the control and 40 Gy/5 times group,the ulceration or infection of the lesions gradually increased (x2 =5.5,4.3,all P ＜ 0.05),but in the 50 Gy/5 times group,the ulceration or infection of the lesions did not change significantly (x2 =0.3,P ＞ 0.05);in the 50 Gy/5 times group,the mortality rate of scolex was significantly increased (F =212.6,P ＜ 0.05);in 50 Gy/5 times group,the protein (calcium) concentration decreased (increased) significantly (F =271.8,84.7,all P ＜ 0.05);the maximum diameters of the lesions increased gradually in the control group (F =47.1,P ＜ 0.05),in 50 Gy/5 times group,the maximum diameters of the lesions decreased gradually (F =188.3,P ＜ 0.05);in the control group,hydatid cyst wet weight increased significantly (F =10.7,P ＜ 0.05),in the 50 Gy/5 times group,hydatid cyst wet weight was significantly reduced (F =68.5,P ＜ 0.05);with increasing dosage,the damage of the bone matrix and the cells in lacunae of the lesions gradually increased,in the same group with time went on,in the control group,a few amount of bone cells in lacuna died,and in 40 Gy/5 times and 50 Gy/5 times groups,the bone matrix and bone cells were partially repaired.Conclusion The long-term effects of appropriate dosage (50 Gy/5 times) radiation on experiments hydatid diseased gerbils are affirmed,but it is still need a clinical validation.

Bone echinococcosis is usually caused by Echinococcus granulosus and E. multilocularis. People become infected when they eat food or water contaminated with the eggs. Treatment of bone echinococcosis usually includes surgery and medication, but the lengthy and costly treatment imposes a heavy burden on patients. MicroRNAs (miRNA) are known to be involved in a variety of biological processes and host-host interactions, including development, cell growth and death, lifespan-related target regulation, transcription, signal transduction, and cell motility, which will help us find new strategies and targets for the treatment and control of osteonechoconiosis. For further understanding of bone echinococcosis, it is important to understand the molecular basis of E. multilocularis development in both final and intermediate hosts. The miRNA found in E. granulosus and E. multilocularis have gene and developmental stage specificity in their respective host expression regulation. In this review paper, the progress of research on miRNA as a novel diagnostic marker for osteoblastic echinococcosis is reviewed.

Objective To study the treatment of femoral intertrochanteric fractures by reduction without a traction table in a special position and fixation with proximal femoral nail antirotation (PFNA).Methods From May 2016 to May 2017,34 patients with femoral intertrochanteric fracture were treated with PFNA.They were 20 men and 14 women,from 36 to 89 years of age (average,69.9 years).The left side was affected in 15 cases and the right side in 19.By AO classification,there were 10 cases of type AO 31-A1,13 ones of type 31-A2,and 11 ones of type 3 l-A3.Two cases were complicated with other fractures,and 5 with internal system disease,3 of whom had more than 2 concomitant diseases.Preoperative deep venous thrombosis was found in 2 cases.Surgery was performed for them between 2 and 8 days after injury (average,3.7 days).Reduction was performed in a special position without a traction table.The duration of anesthesia,operation time,intraoperative hemorrhage,postoperative complications and hip function by Harris scores were recorded.Results For the 34 patients,the anesthesia time ranged from 57 to 85 min (average,67.5 min),the operation time ranged from 28 to 65 min (average,40.9 min),and the intraoperative hemorrhage from 80 to 150 mL (average,110.6 mL).They received effective follow-up for 6 to 12 months (average,8.4 months).All the fractures healed after 6 to 12 months(average,7.2 months).No failure of internal fixation was observed during follow-ups.By the Harris scores at the final follow-up,the function of the affected hip was rated as excellent in 9 cases,as good in 21 and as fair in 4,giving an excellent to good rate of 88.2％.Conclusion In the treatment of femoral intertrochanteric fractures,reduction without a traction table in a special position and PFNA fixation may reduce anesthesia time,leading to satisfactory clinical outcomes.

Objective To investigate the risk factors of lower extremity deep venous thrombosis(DVT)after internal fixation in patients with type C pelvic fracture,and to establish a relevent nomogram model.Methods Atotal of 217 patients with type C pelvic fractures who were admitted to the Orthopedic Center of the hospital from January 2018 to January 2022 were included in the study.All patients underwent internal fixation.According to whether DVT of the lower extremities was formed after operation,they were divided into the DVT group and the non-DVT group(N-DVT).The general clinical data and preoperative in-flammatory factor expression levels of the two groups was compared.Multivariate analysis was used to obtain independent predictors of DVT formation after internal fixation in patients with type C pelvic fractures.The correlation between preoperative inflammatory factors and DVT formation after internal fixation in patients with type C pelvic fractures was analyzed.The relevant nomograph model was constructed,and the Bootstrap method and calibration curve were used to verify the nomograph model internally.The ROC curve and deci-sion curve for predicting DVT formation after internal fixation in patients with type C pelvic fracture were drawn,and the predictive efficiency and net rate of return of independent prediction and combined prediction were an-alyzed.Results Multivariate analysis showed that age,diabetes,preoperative tumor necrosis factor-α(TNF-α),traction and braking,and bed rest time were independent predictors of DVT formation after internal fixa-tion in patients with type C pelvic fractures(P＜0.05).A nomograph model was constructed based on inde-pendent predictors to predict the formation of DVT after internal fixation in patients with type C pelvic frac-ture,and the C index of the distinguishing evaluation index of the nomogram model was 0.834(95％CI:0.812-0.924),the results of goodness of fit(H-L)test showed that the predicted value of DVT formation probability after internal fixation in patients with type C pelvic fracture was in good agreement with the actual observed value(P＞0.05).ROC curve analysis and decision curve analysis showed that age,diabetes,TNF-α,traction and braking,bed rest time and combined prediction model had good predictive performance and net yield in predicting DVT formation after internal fixation in patients with type C pelvic fracture.Conclusion Age,diabetes,TNF-α,traction braking and bed rest time are independent predictors of DVT formation after internal fixation in pa-tients with type C pelvic fracture.The nomogram model based on the above independent predictors has a high value in predicting DVT formation after internal fixation in patients with type C pelvic fracture.

BACKGROUND:Toll-like receptors are an important class of pattern recognition receptors that have important functions in pathogen immunity and cytokine synthesis by recognizing specific molecular patterns.Previous studies have found that different types of bone tissue cells also express Toll-like receptors.Activation or inhibition of Toll-like receptors can have significant effects on osteoblast and osteoclast function through multiple pathways. OBJECTIVE:To summarize the expression and action pathways of Toll-like receptors in osteoblasts and osteoclasts,in order to further elucidate the biological mechanisms involved in the regulation of Toll-like receptors under physiological and pathological conditions. METHODS:Relevant literature was retrieved from databases such as PubMed and CNKI as of December 2022.The Chinese and English search terms included"Toll-like receptor,osteoblast,osteoclast,mesenchymal stem cells,macrophage,cytokine,signaling pathway".According to the research needs,the corresponding criteria were established to screen the final literature. RESULTS AND CONCLUSION:(1)Toll-like receptors could directly regulate osteoblast and osteoclast differentiation through the activation of related signaling pathways.(2)Toll-like receptor activation induces cytokine production and exerts regulatory effects.(3)Toll-like receptor activation can affect the survival and migration ability of osteoblasts and osteoclasts.(4)Toll-like receptors in osteoblasts and osteoclasts are activated in certain diseases and pathological settings and are involved in intercellular interactions.

BACKGROUND:Tumor necrosis factor-α is a broadly acting inflammatory cytokine that plays an important role in the immune inflammatory response of the body.The current study concluded that tumor necrosis factor-α has significant biological effects on a variety of bone tissue cells. OBJECTIVE:To summarize the expression and action pathways of tumor necrosis factor-α in osteoblastic and osteoclastic cells to further elucidate the regulatory role of tumor necrosis factor-α on bone tissue cells. METHODS:PubMed and CNKI were searched until March 2023,and the Chinese search terms included"tumor necrosis factor α,osteoblast,osteoclast,osteoclast,osteoprogenitor";the English search terms included"TNF-α,osteoblast,osteoclast,osteocyte,osteoprogenitor cell".The corresponding criteria were established according to the research needs,and the final literature was screened.Finally,77 articles were included for review. RESULTS AND CONCLUSION:(1)Tumor necrosis factor-α is participating in regulating the recruitment,appreciation,and differentiation of osteoprogenitor cells,but leads to osteoprogenitor cell stripping and death under specific environments.It also participates in bone resorption directly or indirectly through secreted enzymes.(2)Tumor necrosis factor-α can increase the level of inflammatory factors in the environment by activating relevant signaling pathways in osteoclast lineage cells or directly induce the generation of osteoclasts in specific environments.(3)Tumor necrosis factor-α can inhibit osteogenic differentiation by activating nuclear factor-κB signaling pathway,inhibiting the expression of transcription factors such as RUNX2 and Osterix,and inducing apoptosis and necrotizing apoptosis in osteoblasts.(4)Tumor necrosis factor-α inhibits osteogenesis and promotes osteoclastogenesis by activating the nuclear factor-κB signaling pathway in osteocytes and inducing cytokines such as RANKL,SOST,and DKK1,while enhancing apoptosis of the osteocytes,as well as bone resorption around the apoptotic bone tissue.(5)Taken together,the effect of tumor necrosis factor-α in bone tissue is mainly to inhibit osteogenesis and promote osteoclastosis.The biological effect of tumor necrosis factor-α in bone tissue cells is usually dependent on the activation of tumor necrosis factor receptor and nuclear factor-κB signaling pathways.(6)The interaction of tumor necrosis factor-α with other tissue cell types surrounding bone tissue and its role in bone immune regulation still deserve attention in future studies.