BACKGROUND:Artificial femoral head replacement is an effective method for the treatment of elderly unstable intertrochanteric fractures.However,the effect of lesser trochanter reconstruction in femoral head replacement for Evans-Ⅲ femoral intertrochanteric fractures has not been reported. OBJECTIVE:To analyze the effect of lesser trochanter reconstruction on the outcome of artificial femoral head replacement with long stem in elderly patients with Evans-Ⅲ femoral intertrochanteric fracture. METHODS:A retrospective analysis was performed on medical records of 45 elderly patients who underwent bipolar long-stem artificial femoral head replacement due to Evans-Ⅲ femoral intertrochanteric fractures in the Department of Bone and Joint Surgery,Second Affiliated Hospital of Xi'an Jiaotong University from June 2017 to May 2021.According to whether the small trochanter was reconstructed during surgery(reduction and fixation),they were divided into the reconstruction group(n=25)and the non-reconstruction group(n=20).The operation time,bleeding volume,time of getting out of bed,hospital stay time,Harris scores at 3 and 6 months postoperatively,and the incidence of complications during follow-up were compared between the two groups. RESULTS AND CONCLUSION:(1)The operation time of the reconstruction group was longer(99.72±13.41 minutes)than that of the non-reconstruction group(88.90±16.53 minutes)(t=2.369,P=0.023),and there were no significant differences in bleeding volume,time of getting out of bed or hospital stay time between the two groups(P＞0.05).(2)The Harris score of the reconstruction group(69.06±5.64 points)was higher than that of the non-reconstruction group(63.35±5.93 points)at 3 months postoperatively(t=2.982,P=0.005).At 6 months postoperatively,the Harris score of the reconstruction group(86.67±4.49 points)was higher than that of the non-reconstruction group(82.34±5.68 points)(t=2.782,P=0.009).(3)In addition,no significant difference existed in the incidence of complications between the reconstruction and non-reconstruction groups(χ2=0.008,P=0.927).(4)It is concluded that in elderly patients with Evans-Ⅲ femoral intertrochanteric fractures,lesser trochanter reconstruction in the artificial femoral head replacement significantly improved postoperative hip function despite increased operative time,demonstrating the importance of the lesser trochanter reconstruction in the artificial femoral head replacement for Evans-Ⅲ intertrochanteric fractures in the elderly people.

Total hip arthroplasty(THA)is an effective treatment for elderly femoral neck fractures,mid-to late-stage femoral head necrosis,and end-stage hip osteoarthritis.However,serious complications such as aseptic loosening of the prosthesis,peripheral fractures,and dislocation of the prosthesis still exist following THA,which makes the selection of the appropriate hip prosthesis type and placement position before THA an important challenge for surgeons.Currently,the commonly used preoperative planning methods for THA mainly rely on static images from two-dimensional(2D)X-ray or three-dimensional(3D)computed tomography(CT),which fail to adequately consider the hip joint in weight-bearing as well as motion,lumbar-hip joint changes,and prosthetic impingement during motion.Recently,the dual fluoroscopic imaging system,as a new in-vivo,dynamic radiological imaging technology,provides comprehensive and accurate dynamic 3D data for THA preoperative planning.However,the technical process and expert consensus on preoperative 3D planning of THA using a dual fluoroscopic imaging system have not yet been established,which affects the promotion and application of this technology.In light of the above,national orthopaedic experts and related professional representatives discussed and proposed seven consensus issues,and the'expert recommendation rate'and'strong recommendation rate'were obtained through a questionnaire survey on the recommendations of the participating experts.This consensus aims to provide guidance and reference for the standardised application of preoperative 3D planning of THA using the dual fluoroscopic imaging system.

Total hip arthroplasty(THA)is an effective treatment for elderly femoral neck fractures,mid-to late-stage femoral head necrosis,and end-stage hip osteoarthritis.However,serious complications such as aseptic loosening of the prosthesis,peripheral fractures,and dislocation of the prosthesis still exist following THA,which makes the selection of the appropriate hip prosthesis type and placement position before THA an important challenge for surgeons.Currently,the commonly used preoperative planning methods for THA mainly rely on static images from two-dimensional(2D)X-ray or three-dimensional(3D)computed tomography(CT),which fail to adequately consider the hip joint in weight-bearing as well as motion,lumbar-hip joint changes,and prosthetic impingement during motion.Recently,the dual fluoroscopic imaging system,as a new in-vivo,dynamic radiological imaging technology,provides comprehensive and accurate dynamic 3D data for THA preoperative planning.However,the technical process and expert consensus on preoperative 3D planning of THA using a dual fluoroscopic imaging system have not yet been established,which affects the promotion and application of this technology.In light of the above,national orthopaedic experts and related professional representatives discussed and proposed seven consensus issues,and the'expert recommendation rate'and'strong recommendation rate'were obtained through a questionnaire survey on the recommendations of the participating experts.This consensus aims to provide guidance and reference for the standardised application of preoperative 3D planning of THA using the dual fluoroscopic imaging system.

Objective:To explore the clinical effect of robot-assisted core decompression combined with bone grafting in the treatment of early-stage osteonecrosis of femoral head.Methods:The data of 49 patients (84 hips) who attended the Department of Orthopedics and Joint Surgery of the Second Affiliated Hospital of Xi'an Jiaotong University from August 2019 to February 2021 were retrospectively analyzed. All the patients suffering Association Research Circulation Osseous (ARCO) II stage of osteonecrosis of femoral head underwent core decompression and bone grafting. Among the patients undergoing surgery, 30 patients (54 hips), including 19 males and 11 females, aged 44.3±5.4 years (range, 21 to 59 years) were treated with conventional surgical methods, and 19 patients (30 hips), including 12 males and 7 females, aged 41.4±7.2 years (range, 20 to 58 years), were assisted by the orthopedic robot navigation system. All operations were performed by the same operator. All patients were informed of the conventional and robotic surgical options by the surgeon at admission, and the patients made the decision. The baseline data of the two groups of patients, the time of unilateral operation, the number of unilateral X-ray fluoroscopy, the Harris hip score at the last follow-up after surgery, the visual analog score (VAS), and the collapse rate at the last follow-up were collected and compared.Results:A total of 41 patients (70 hips) were followed up, including 24 cases (42 hips) in the conventional surgery group and 17 cases in the robot-assisted group (28 hips). The average follow-up time of all cases was 14.6±4.8 months (range, 3 to 21 months). At the last follow-up, a total of 13 patients (13 hips) suffered femoral head surface collapse, including 11 patients in the conventional surgery group (11 hips) and 2 patients in the robot-assisted group (2 hips). The rate of femoral head collapse between the two groups had statistical difference ( P=0.045). The average operation time of unilateral hip in the conventional operation group was 21.3±5.4 min, and 16.8±3.3 min in the robot-assisted group, with significant difference ( t=3.94, P<0.001). The number of X-ray fluoroscopy of unilateral hip in the conventional operation group was 14.4±3.8 times, and 9.6±2.1 times in the robot-assisted group, with significant difference ( t=6.08, P<0.001). The Harris hip score before surgery in the conventional surgery group was 68.4±4.5 points, and 85.1±3.8 points at the last follow-up, while the preoperative Harris hip score of the robot-assisted surgery group was 67.2±3.9 points, and 86.5±4.4 points at the last follow-up. The Harris hip scores at the last follow-up of the two groups were significantly different from those before the operation, but there was no difference between the two groups after surgery ( t=1.09, P=0.283). The preoperative VAS of the conventional surgery group was 4.8±1.7 points, and 1.7±0.8 points at the last follow-up. The preoperative VAS of the robot-assisted surgery group was 5.1±1.5 points, and 0.9±0.3 points at the last follow-up. Τhere were significant differences between the two groups regarding the VAS in the last follow-up ( t=3.92, P<0.001). Conclusion:Core decompression combined with bone grafting have a definite effect in the treatment of osteonecrosis of ARCO II stage of osteonecrosis of femoral head. Compared with conventional surgery, robot-assisted surgery can achieve better short-term results and head preservation rate.

OBJECTIVE: To investigate the effects of melatonin (MT) on bone mass and serum inflammatory factors in rats received ovariectomy (OVX) and to investigate the effects of MT on the levels of inflammatory factors in culture medium and osteogenic ability of bone marrow mesenchymal stem cells (BMSCs) stimulated by lipopolysaccharide. METHODS: Fifteen 12-week-old Sprague Dawley (SD) rats were randomly divided into 3 groups. The rats in Sham group only received bilateral lateral abdominal incision and suture, the rats in OVX group received bilateral OVX, and the rats in OVX+MT group received 100 mg/(kg·d) MT oral intervention after bilateral OVX. After 8 weeks, the levels of serum inflammatory factors [interleukin-1β (IL-1β), IL-6, and tumor necrosis factor α (TNF-α)] were detected using ELISA assay. Besides, the distal femurs were detected by Micro-CT to observe changes in bone mass and microstructure, and quantitatively measured bone volume fraction, trabecular thickness, and trabecular number. The BMSCs were extracted from the femurs of three 3-week-old SD rats using whole bone marrow culture method and passaged. The 3rd-5th passage BMSCs were cultured with different concentrations of MT (0, 1, 10, 100, 1 000 µmol/L), and the cell viability was then detected using cell counting kit 8 (CCK-8) to select the optimal concentration of MT for subsequent experiments. Cells were devided into osteogenic induction group (group A) and osteogenic induction+1/5/10 μg/mL lipopolysaccharide group (group B-D). The levels of inflammatory factors (IL-1β, IL-6 and TNF-α) in cell culture medium were detected using ELISA assay after corresponding intervention. According to the results of CCK-8 method and ELISA detection, the cells were intervened with the most significant concentration of lipopolysaccharide for stimulating inflammation and the optimal concentration of MT with osteogenic induction, defining as group E, and the cell culture medium was collected to detect the levels of inflammatory factors by ELISA assay. After that, alkaline phosphatase (ALP) staining and alizarin red staining were performed respectively in groups A, D, and E, and the expression levels of osteogenic related genes [collagen type Ⅰ alpha 1 chain (Col1a1) and RUNX family transcription factor 2 (Runx2)] were also detected by real time fluorescence quantitative PCR (RT-qPCR). RESULTS: ELISA and Micro-CT assays showed that compared with Sham group, the bone mass of the rats in the OVX group significantly decreased, and the expression levels of serum inflammatory factors (IL-1β, IL-6, and TNF-α) in OVX group significantly increased (P<0.05). Significantly, the above indicators in OVX+MT group were all improved (P<0.05). Rat BMSCs were successfully extracted, and CCK-8 assay showed that 100 µmol/L was the maximum concentration of MT that did not cause a decrease in cell viability, and it was used in subsequent experiments. ELISA assays showed that compared with group A, the expression levels of inflammatory factors (IL-1β, IL-6, and TNF-α) in the cell culture medium of groups B-D were significantly increased after lipopolysaccharide stimulation (P<0.05), and in a concentration-dependent manner. Moreover, the expression levels of inflammatory factors in group D were significantly higher than those in groups B and C (P<0.05). After MT intervention, the expression levels of inflammatory factors in group E were significantly lower than those in group D (P<0.05). ALP staining, alizarin red staining, and RT-qPCR assays showed that compared with group A, the percentage of positive area of ALP and alizarin red and the relative mRNA expressions of Col1a1 and Runx2 in group D significantly decreased, while the above indicators in group E significantly improved after MT intervention (P<0.05). CONCLUSION MT may affect the bone mass of postmenopausal osteoporosis by reducing inflammation in rats; MT can reduce the inflammation of BMSCs stimulated by lipopolysaccharide and weaken its inhibition of osteogenic differentiation of BMSCs.
Female ; Rats ; Animals ; Tumor Necrosis Factor-alpha ; Osteogenesis ; Rats, Sprague-Dawley ; Core Binding Factor Alpha 1 Subunit ; Melatonin/pharmacology* ; Interleukin-6/genetics* ; Lipopolysaccharides/pharmacology* ; Coloring Agents ; Inflammation

Objective: To evaluate the progress and influence factors of asymptomatic osteonecrosis of the femoral head(ONFH). Methods: MRI was performed on the contralateral hips of 174 patients with unilateral symptomatic ONFH who admitted at Department of Orthopaedics, the Second Affiliated Hospital of Xi′an Jiaotong University from January 2012 to December 2018. Eighty-three of 174 patients with unilateral ONFH were found suffering from contralateral ONFH(47.7%), of which 77 patients were followed up.There were 28 males and 49 females with age of 48.6 years (range: 21-73 years). The pathogenesis, ARCO classfication, areas and position of osteonecrosis were collected.Independent sample t test, χ² test, Fisher exact test, multivariate Logistic regression were used to analyze the potential influence factors. Results: Patients were followed up for 36.7 months. During the following up period, ARCO classification of 28 patients (36.4%) progressed.The progress of asymptomatic ONFH was not related to the gender, age and original ARCO classification, but related to the pathogenesis, position and area of osteonecrosis (all P<0.05). Conclusion The progress of asymptomatic osteonecrosis is related to the pathogenesis, position and area of osteonecrosis,but most of asymptomatic ONFH will not progress.

OBJECTIVE: To investigate the relationship between necroptosis and apoptosis in MCET3-E1 cell death induced by glucocorticoids. METHODS: MC3T3-E1 cells were incubated with 10-6 mol/L dexamethasone followed by treatment with the apoptosis inhibitor z-VAD-fmk (40 μmol/L) or the necroptosis inhibitor necrostatin-1 (40 μmol/L) for 2 h. At 72 h after incubation with dexamethasone, the cells were harvested to determine the cell viability using WST-1 assay and the rate of necrotic cells using annexin V/PI double staining; the percentage of apoptotic cells was determined using Hoechst staining. The mitochondrial membrane potential and the level of ATP in the cells were also evaluated. Transmission electron microscopy was used to observe the microstructural changes of the cells. The expressions of RIP-1 and RIP-3 in the cells were detected by Western blotting. RESULTS: At a concentration of 10-6 mol/L, dexamethasone induced both apoptosis and necroptosis in MC3T3- E1 cells. Annexin V/PI double staining showed that inhibition of cell apoptosis caused an increase in cell necrosis manifested by such changes as mitochondrial swelling and plasma membrane disruption, as shown by electron microscopy; Hoechst staining showed that the percentage of apoptotic cells was significantly reduced. When necroptosis was inhibited by necrostatin-1, MC3T3-E1 cells showed significantly increased apoptosis as shown by both AV/PI and Hoechst staining, and such changes were accompanied by changes in mitochondrial membrane potential and ATP level in the cells. CONCLUSIONS In the process of dexamethasone-induced cell death, necroptosis and apoptosis can transform reciprocally accompanied by functional changes of the mitochondria.
3T3 Cells ; Adenosine Triphosphate ; Animals ; Apoptosis ; Cell Death ; drug effects ; Dexamethasone ; Membrane Potential, Mitochondrial ; Mice ; Microscopy, Electron ; Mitochondria ; ultrastructure ; Necrosis

Objective To evaluate the progress and influence factors of asymptomatic osteonecrosis of the femoral head(ONFH). Methods MRI was performed on the contralateral hips of 174 patients with unilateral symptomatic ONFH who admitted at Department of Orthopaedics, the Second Affiliated Hospital of Xi′an Jiaotong University from January 2012 to December 2018. Eighty?three of 174 patients with unilateral ONFH were found suffering from contralateral ONFH(47.7%), of which 77 patients were followed up.There were 28 males and 49 females with age of 48.6 years(range:21-73 years). The pathogenesis,ARCO classfication,areas and position of osteonecrosis were collected.Independent sample t test, χ2 test, Fisher exact test, multivariate Logistic regression were used to analyze the potential influence factors. Results Patients were followed up for 36.7 months. During the following up period, ARCO classification of 28 patients (36.4%) progressed.The progress of asymptomatic ONFH was not related to the gender, age and original ARCO classification, but related to the pathogenesis, position and area of osteonecrosis(all P<0.05). Conclusion The progress of asymptomatic osteonecrosis is related to the pathogenesis,position and area of osteonecrosis,but most of asymptomatic ONFH will not progress.

Objective To evaluate the progress and influence factors of asymptomatic osteonecrosis of the femoral head(ONFH). Methods MRI was performed on the contralateral hips of 174 patients with unilateral symptomatic ONFH who admitted at Department of Orthopaedics, the Second Affiliated Hospital of Xi′an Jiaotong University from January 2012 to December 2018. Eighty?three of 174 patients with unilateral ONFH were found suffering from contralateral ONFH(47.7%), of which 77 patients were followed up.There were 28 males and 49 females with age of 48.6 years(range:21-73 years). The pathogenesis,ARCO classfication,areas and position of osteonecrosis were collected.Independent sample t test, χ2 test, Fisher exact test, multivariate Logistic regression were used to analyze the potential influence factors. Results Patients were followed up for 36.7 months. During the following up period, ARCO classification of 28 patients (36.4%) progressed.The progress of asymptomatic ONFH was not related to the gender, age and original ARCO classification, but related to the pathogenesis, position and area of osteonecrosis(all P<0.05). Conclusion The progress of asymptomatic osteonecrosis is related to the pathogenesis,position and area of osteonecrosis,but most of asymptomatic ONFH will not progress.

The arrival of big data era has constantly changed the habits of social behavior,and also brought new opportunities for the medical and health industry.China's joint registration system has not yet been established.How to establish a national joint registration system in line with China's national conditions in the context of the big data era is a direction that every practitioner in relevant industries should pay attention to and work together.