Osteoporosis is a disease that threatens human health seriously.Orthopedics plays a very important role in the prevention and treatment of osteoporosis.Teachers of orthopedic department should pay more attention to the teaching of osteoporosis and establish specialized courses to make medical students to learn more about osteoporosis in clinical teaching process

BACKGROUND: As the result of estrogen shortage due to ovariectomy,osteoporosis occursin the general and local bones, displaying bone loss and changes in bone microstructure and growth factor mRNA expression,which definitely has an important effect on fracture healing. OBJECTIVE: To probe into the effect of estrogen on bone microstructure and bone morphogenetic protein-4 mRNA expression and location during fracture healing. DESIGN: Randomized controlled study. SETTING:Laboratory of the Department of Molecular Biology of Yunnan University. MATERIALS: This study was conducted at the laboratory of Molecular Biology Department of Yunnan University between July 1999 and July 2002. We recruited 96 healthy female SD rats of 2 months old and with the mean body mass of 160 to 200 g. METHODS:①Of the 96 rats that received intraperitoneal anesthesia, 48rats were subjected to bilateral ovariectomy(osteoporotic group), and the other 48 rats received sham operation (control group). One month later, bilateral tibia fracture at the middle segment was artificially made on all rats under anesthesia, and no treatment was given so as to prepare fracture healing model. Then rats of both groups were put to death for collecting callus and the surrounding parenchyma at postoperative 1, 3, 5, 7, 14, 28,56 and 112 days, with 6 rats in each time point. ② The tibia bone microstructure was observed under electron microscope. ③ The mRNA expression of bone morphogenetic protein-4 at callus and the surrounding paranchyma was detected by RT-PCR method; no probe in hybrid fluid was used as negative controls. Six in situ hybridization slices with positive expression were selected from both groups at postoperative 1 and 3 days time points, and 3 visual fields were randomly selected from each slice for observing the positive granules under 25 times field lens. MAIN OUTCOME MEASURES: ①The tibia bone microstructure;② bone morphogenetic protein-4 mRNA expression at callus and the surrounding parenchyma. RESULTS: All the 96 rats entered the final results analysis. ① Observation of the tibia bone microstructure: at 28 days after tibia fracture, osseous callus and ostein fibers were found arranged densely in control group. Osteocytes, small with fewer cytoplasts, were observed in osseous lacuna, but osteoclasts were found surrounding small-sized bone trabecula. In osteoporotic group, fibrous callus and collagenous fibers in bone matrix were arranged loosely, lots of big osteoblasts could be observed with osteocytes easily seen. ② Bone morphogenetic protein-4 mRNA expression at callus and the surrounding parenchyma: it was less expressed in control group than in osteoporotic group at postoperative 1 to 3 days (23.714 3±5.056 8,21.714 3±5.023 8 vs 51.285 7±8.138 7,49.571 4±9.071 1, P ＜ 0.01) and the expression was mainly observed in parenchyma surrounding the fracture where callus was formed. CONCLUSION: Bone morphogenetic protein-4 mRNA expression is increased in osteoporotic group and is mainly observed in parenchyma surrounding the fracture, displaying a manner of regional expression. However,the formation and quality of callus matrix during fracture are obviously poorer than in control group.

[Objective]To investigate the feasibility and efficacy of percutaneous kyphoplasty in treating severe vertebral body compression fractures in patients with osteoporosis.[Method]Data from 15 patient who suffered from severe vertebral compression fractures was retrospectively reviewed.Seventeen percutaneous kyphoplasty were performed under C arm X-ray machine guidance.The clinical effects were evaluated by observing the charges of visual analog scale,locomotor activity scale,height of vertebral bodies and the Cobb's angle.[Result]All patients were successfully treated.Visual analog scale decreased from 7.9?1.3 preoperatively to 2.5?0.8 postoperatively(P

Objective To observe the clinical efficacy of percutaneous vertebroplasty (PVP) with percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fracture(OVCF) by systematic review. Methods From September 2005 to March 2009,46 cases of fresh OVCF were treated. Patients were divided into 2 groups (A, B), according to Jikei grade, Genant semiquantitative method, injury vertebra number. Twenty-five cases(group A)were treated by PVP,8 males and 17 females with the age of 52 - 78 years (average 69). Vertebra segment of fracture was within T6 - L5 (14 in case thoracical vertebrae and 11 lumbar vertebrae). Twenty-one cases(group B)were treated by PKP,There were 6 males and 15 females with the age of 54 - 82 years (average 71). Vertebra segment of fracture was within T6 - L4 (12 in case thoracical vertebrae and 9 lumbar vertebrae). The clinical efficacy, incidence rate of complication, the anterior height of vertebrae body,visual analogue pain scale(VAS) ,ease of pain were measured preoperatively and at 6 weeks, 3 and 6 months and 1 year postoperatively between the two groups. Results All the patients were followed up for 12 -45 months with an average of 23.5 months. The average recovery of anterior height of vertebrae body was respectively(85.95 ± 4.31) % in group A and (93.64 ± 3.35) % in group B,which statistically difference in vertebral height between two groups (P ＜ 0.05). No statistical significant difference was seen in VAS, analgesic durg (AID) and ease of pain complication between two groups (P ＞0. 05). Statistical significant difference was noted in pre-postoperatively between intra-two groups (P ＜0. 05). Conclusions PVP and PKP can quickly relieve pain and enhance vertebral stability in treating thoracolumbar OVCF according to evaluation parameter, and have the similar therapeutic efficacy in treatment of OVCF with minimal invasion. However, PKP is superior in the recovery of vertebral height.

Objective To investigate the interest,cognition degree,participation degree and current situation of the advanced undergraduate clinical students in our college,to discuss the reason for low level of students' scientific research quality,in order to provide the reference to making research training programs for them.Methods The advanced undergraduates of seven-year and five-year clinical program interned in orthopedics department from January to June in 2014 were selected with cluster sampling method,and investigated anonymously by questionnaires and interview.120 students were investigated by questionnaire,and 120 effective questionnaires were taken back.30 students were interviewed.Results The results showed that 90.0 percent (n=108) of students were interested in scientific activity,and 47.5 percent (n=57) of students had participated in scientific lectures.In interviews,students think factors hindering the research on the participation in scientific research are:1)too many courses and heavy school tasks;2) absence of relative knowledge;3) lack of support from college;4) tough condition for scientific training;5) immature management system.Conclusion The advanced undergraduate clinical students had great interest in scientific activity,but had few opportunities to take part in,leading to their low level of scientific research quality.A variety of measures should be taken to bolster their scientific training.

Objective To summarize the clinical experience of diagnosis and arthroscopic treatment of intratment of intra ular osteoid osteoma.Methods Seven patients(average 22.4 years old with range from 11～32 years)with intra-articular Osteoid osteoma who underwent arthroscopy treatment from March 2006 to June 2009 were studied respectively.Thin-section CT scanning was used to confirm diagnosis and determine surgery location.Results The time span between the appearance of clinical symptoms and confirmed diagnosis was 26.0 months on average(range from 18 to 36 months).At a mean 19-month follow-up,all patients showed significant improvements including VAS decrease,no recurrence,pain relief and normal range of motion.Conclusion The atypical clinical features and radiographic findings of osetoid osteoma might lead to the delayed diagnosis.Using arthroscopy to remove intro-articular osteoid ostema was a safe and effective way.

Objective To analyze characteristics and prophylaxis of pulmonary embolism (PE) after greater saphenous vein ligation and stripping.Methods We retrospectively analyzed the clinical characteristics and treatment of 11 inpatients with postoperative PE in Anhui Provincial Hospital and other hospitals from January 2008 to June 2013.Results In this group 6 patients died after failed cardiopulmonary resuscitation (CPR) and other treatments,the mortality was 54.5％.5 patients recovered after anticoagulation,thrombolysis and other treatments.During the process of thrombolysis,floating thrombus was found within the femoral vein in 2 patients and inferior vena cava filter was implanted.After 8-25 months follow-up,all 5 patients were free of difficulty of breathing,chest tightness,chest pain and other symptoms.Among many clinical manifestations,dyspnea (90.9％) was the most common,other clinical manifestations included chest pain (27.3％),syncope (18.2％),sudden death (18.2％).There was no typical triad of dyspnea,chest pain and hemoptysis in these patients.Conclusions Early diagnosis and early treatment of PE are most important to decrease mortality and to improve the prognosis of patients suffering from postoperative PE.

Objective To explore the clinical effect of percutaneous vertebroplasty (PVP) in the treatment of old unstable osteoporotic vertebral fracture.Methods Twenty cases of old unstable osteoporotic single vertebral body fracture were divided into the stable group and unstable group according to the imaging results,10 cases in each group.PVP was performed in all 20 cases.The VAS scores of waist bending activity at preoperative 30 min,postoperative 6 h,3,30 d were observed.The changes of anterior edge height of spinal body in the injured vertebral segment of erect position and horizontal position were compared before and after operation.Results The VAS score of waist bending at preoperative 30 min had statistical difference between the two groups (P＜0.05).Compared with at preoperative 30 min,the VAS scores at postoperative observation points in the two groups were significantly decreased with statistical difference (P＜0.05).The VAS scores at postoperative 6 h,3,30 d had no statistical difference between the two groups(P＞0.05).The changes of posterior edge height of spinal body in the stable groups had no statistical difference before and after operation (P＞0.05);the anterior edge height of spinal body after treatment in the unstable group were significantly changed compared with before operation,and the difference was statistically significant(P＜0.05).Conclusion Preoperative pain in the patients with unstable osteoporotic vertebral fracture is more obvious than that in the patients with stable osteoporotic vertebral fracture.But all have similar effect after PVP therapy;the postoperative height in unstable osteoporotic vertebral fracture can obtain a certain recovery after PVP.

BACKGROUND:Studies have shown that posterior orthopedic internal fixation and anterior orthopedic internal fixation al can get good clinical outcomes for treatment of adult idiopathic scoliosis, however, it has not been reported on what kind of methods could achieve a better clinical outcome for treatment of Lenke3 type adult idiopathic scoliosis, have less risk of pedicle screws breakage and more reliable long-term efficacy. OBJECTIVE:To establish the Lenke 3 type adult idiopathic scoliosis finite element model and thoracic screw guide target 3D model using finite element analysis software, so as to provide scientific basis for biomechanical analysis and scientific pedicle screw implantation. METHODS:The CT scan image from T 1 to sacrum of one 28 years old volunteer with Lenke 3 type adult idiopathic scoliosis was imported into Mimics 16.0 software by Dicom form. Integral idiopathic scoliosis three dimensional model was established by geometry clear technology. Nail guide target of thoracic vertebra was established on vertebral model by design module in Mimics 16.0 software. The point cloud form of three dimensional model was imported into Geomagic Studio 11.0 software. Series of image processing of model were conducted. At last, three dimensional model was imported into ANSYS 14.0 finite element analysis software in order to build finite element model with biological properties. RESULTS AND CONCLUSION:Complete Lenke 3 type adult idiopathic scoliosis three dimensional finite element model was established successful y. It concluded 440 975 tetrahedron units and 580 bar units, total y 441 555 units and 1 077 318 nodes. Total y 12 nail guide target models of thoracic vertebra were established, including 4 682 tetrahedron units and 7 390 nodes. Lenke 3 type adult idiopathic scoliosis three dimensional finite element model and nail guide target of thoracic vertebral model with a realistic appearance were established successful y in this experiment. These results confirm that Lenke 3 type adult idiopathic scoliosis three dimensional finite element model provides scientific basis for further biomechanical experiments. Meanwhile, the construction of nail guide target model of thoracic vertebra provide a new scientific method for thoracic pedicle screw placement.

Objective To evaluate the outcome of reoperation(after I stage anterior/posterior operation)for thoracolumbar fractures combined with kyphosis and spinal cord injury. Methods A retrospective study was done on the medical records of 12 patients who underwent two-stage decompression with kyphosis and neurologic deficit due to single-stage approach(anterior or posterior) operation of thoracolumbar fractures combined with spinal cord injury between January 2005 and April 2009.There were 9 males and 3 females,at mean age of 34.6 years(range,19-57 years).According to the Denis classification,there were five patients with burst fractures,five with compression fractures and two with fracture dislocation.All the patients had couns medullaris injury.Of all the patients,five underwent one stage anterior approach surgery and the others underwent posterior approach operation.All the patients had vailous degrees of neurological symptoms.The patients treated with one stage anterior surgery were treated with two stage posterior surgery and the patients treated with one stage posterior surgery were treated with the two stage anterior operation.The mean interval from one stage operation to two stage decompression was 13.4 months(range,12-18 months).The radiologic,neurologic and functional outcomes were assessed through observation of the Cobb angle,Frankel spinal cord injury grading and Japanese Orthopaedic Association Scores(JOA). Results AIl the patients were followed up for mean 25 months (12-48months),which showed primary healing of the incisions in all the patients.The average anterior and posterior heisht of the vertebrae wers corrected from preoperative 42.6%and 70.5%to postoperative 92.5%and 95.7%and to 87.3%and 92.2%at the final follow-up respectively.Neurologic status was improved at least one Frankel grade in the patients who had preoperative incomplete paraplegia.The Cobb angle was corrected from preoperative 36.3°to postoperative 5.8°and to 5.9°at the final follow-up(P<0.05).No patient had any notable loss of correction between discharge and final follow-up.According to JOA coring,the results were excellent in nine patients,good in two and fair in one,with excellence rate of 92%. Conclusions Two stage decompression for epiconus and cauda equina syndrome resulted from one stage approach(anterior or posterior)operation of thoracolumbar fractures combined with spinal cord injury call attain satisfactory correction of the kyphosis and nerve decompression as well as various degrees of nerve function recovery.