Objectives:To explore the incidence and risk factors of adjacent vertebral fractures(AVF)in pa-tients with osteoporotic vertebral compression fractures(OVCF)after percutaneous vertebroplasty(PVP)treatment.Methods:A retrospective analysis was conducted on 482 OVCF patients who underwent PVP at our hospital from June 2017 to January 2022.There were 146 males and 336 females,with an average age of 68.4±3.1 years(63-86 years).The average follow-up time was 42.9±10.2 months(24-70 months).Based on whether AVF occurred during the follow-up period,the patients were divided into an AVF group and a non-AVF group.The time of AVF occurrence was recorded,and the incidence rate of AVF was calculated using the Ka-plan-Meier method to obtain a survival curve.Intergroup comparisons were made in terms of clinical factors including gender,age,body mass index(BMI),adjacent vertebral CT value,and bone metabolism related index-es[total procollagen type Ⅰ N-terminal propeptide(tP Ⅰ NP),[3-cross-linked C-telopeptide of type Ⅰ collagen(β-CTX),and 25-hydroxyvitamin D(25-OHD)];Imaging factors such as whether the fracture was located in the thoracolumbar segment,whether it was accompanied by an upper endplate fracture,whether it was accom-panied by an intravertebral vacuum cleft(IVC),preoperative vertebral body height,wedge angle,and kyphosis angle;And surgical factors including bone cement injection volume,postoperative restoration of vertebral height,restoration of wedge angle,restoration of kyphosis angle and whether bone cement leakage occurred.Indicators that were significant in the univariate analysis were included in the multivariate logistic regression analysis.Results:AVF occurred in 47 cases(9.75％)in 17.9±14.7 months(1-55 months)after PVP.The Kaplan-Meier survival curve showed that the incidence of AVF in the group with upper endplate fractures was significantly higher than that in the group without upper endplate fractures(P＜0.001).There were no statistically significant differences between the AVF group and the non-AVF group in terms of gender,BMI,tP Ⅰ NP,[3-CTX,25-OHD,preoperative vertebral body height,wedge angle,kyphosis angle,bone cement injection volume,postoperative restoration of vertebral height,restoration of wedge angle and restoration of kyphosis angle(P＞0.05).Statistically significant differences were found in age,adjacent vertebral CT value,whether the fracture was located in the thoracolumbar segment,whether it was accompanied by an upper endplate fracture,whether it was accompanied by an IVC,and whether bone cement leakage occurred(P＜0.05).Further multivariate logistic regression analysis showed that advanced age(OR=1.187,95％CI=1.084-1.300,P＜0.001),low CT value of adjacent vertebra(OR=0.928,95％CI=0.892-0.964,P＜0.001),presence of upper endplate fracture(OR=3.514,95％CI=1.444-8.551,P=0.006),presence of IVC(OR=2.804,95％CI=1.238-6.349,P=0.013),and bone cement leakage(OR=2.415,95％CI=1.134-5.146,P=0.022)were the risk factors for AVF after PVP.Conclusions:Advanced age,low CT value of adjacent vertebra,upper endplate fracture,IVC,and bone cement leakage are the independent risk factors for postoperative AVF in OVCF patients undergoing PVP.

Objectives:To explore the incidence and risk factors of adjacent vertebral fractures(AVF)in pa-tients with osteoporotic vertebral compression fractures(OVCF)after percutaneous vertebroplasty(PVP)treatment.Methods:A retrospective analysis was conducted on 482 OVCF patients who underwent PVP at our hospital from June 2017 to January 2022.There were 146 males and 336 females,with an average age of 68.4±3.1 years(63-86 years).The average follow-up time was 42.9±10.2 months(24-70 months).Based on whether AVF occurred during the follow-up period,the patients were divided into an AVF group and a non-AVF group.The time of AVF occurrence was recorded,and the incidence rate of AVF was calculated using the Ka-plan-Meier method to obtain a survival curve.Intergroup comparisons were made in terms of clinical factors including gender,age,body mass index(BMI),adjacent vertebral CT value,and bone metabolism related index-es[total procollagen type Ⅰ N-terminal propeptide(tP Ⅰ NP),[3-cross-linked C-telopeptide of type Ⅰ collagen(β-CTX),and 25-hydroxyvitamin D(25-OHD)];Imaging factors such as whether the fracture was located in the thoracolumbar segment,whether it was accompanied by an upper endplate fracture,whether it was accom-panied by an intravertebral vacuum cleft(IVC),preoperative vertebral body height,wedge angle,and kyphosis angle;And surgical factors including bone cement injection volume,postoperative restoration of vertebral height,restoration of wedge angle,restoration of kyphosis angle and whether bone cement leakage occurred.Indicators that were significant in the univariate analysis were included in the multivariate logistic regression analysis.Results:AVF occurred in 47 cases(9.75％)in 17.9±14.7 months(1-55 months)after PVP.The Kaplan-Meier survival curve showed that the incidence of AVF in the group with upper endplate fractures was significantly higher than that in the group without upper endplate fractures(P＜0.001).There were no statistically significant differences between the AVF group and the non-AVF group in terms of gender,BMI,tP Ⅰ NP,[3-CTX,25-OHD,preoperative vertebral body height,wedge angle,kyphosis angle,bone cement injection volume,postoperative restoration of vertebral height,restoration of wedge angle and restoration of kyphosis angle(P＞0.05).Statistically significant differences were found in age,adjacent vertebral CT value,whether the fracture was located in the thoracolumbar segment,whether it was accompanied by an upper endplate fracture,whether it was accompanied by an IVC,and whether bone cement leakage occurred(P＜0.05).Further multivariate logistic regression analysis showed that advanced age(OR=1.187,95％CI=1.084-1.300,P＜0.001),low CT value of adjacent vertebra(OR=0.928,95％CI=0.892-0.964,P＜0.001),presence of upper endplate fracture(OR=3.514,95％CI=1.444-8.551,P=0.006),presence of IVC(OR=2.804,95％CI=1.238-6.349,P=0.013),and bone cement leakage(OR=2.415,95％CI=1.134-5.146,P=0.022)were the risk factors for AVF after PVP.Conclusions:Advanced age,low CT value of adjacent vertebra,upper endplate fracture,IVC,and bone cement leakage are the independent risk factors for postoperative AVF in OVCF patients undergoing PVP.

BACKGROUND:The clinical application of Mongolian Medicine Erdun-uril in the treatment of osteoarthritis is effective,but its therapeutic effect and related mechanism are still unclear. OBJECTIVE:To observe the repairing process of osteoarthritis in rats by Mongolian Medicine Erdun-uril and analyze its mechanism. METHODS:Thirty male Sprague-Dawley rats(8 weeks of age)were selected to establsih an osteoarthritis model using intraarticular injection of sodium iodoacetate solution into the unilateral knee joint.Two weeks after modeling,the model rats were randomly divided into three groups:control group(n=6)was given normal saline by gavage,and low and high dose groups(n=12 per group)were given Erdun-uril 1.4 and 2 g,respectively,3 times per day.After 2 and 4 weeks of continuous administration,blood samples,articular cartilage and periarticular bone tissue were taken from rats to detect changes in cartilage metabolic markers(cartilage oligomeric matrix protein,proteoglycan),bone metabolic markers(bone alkaline phosphatase,keratan sulfate),inflammatory markers(interleukin 6,tumor necrosis factor α),lipid metabolic markers(total cholesterol,triacylglycerol).Histopathological changes were also observed. RESULTS AND CONCLUSION:qRT-PCR results showed that after 2 and 4 weeks of administration,the mRNA expression of cartilage oligomeric matrix protein,proteoglycan and bone alkaline phosphatase and keratan sulfate in knee cartilage of rats were significantly reduced in the low and high dose groups compared with the control group(P<0.05,P<0.01,P<0.001),with the reduction being more significant in the high dose group.After 2 and 4 weeks of administration,compared with the control group,serum tumor necrosis factor α and interleukin 6 levels were decreased(P<0.01,P<0.001)and total cholesterol and triacylglycerol levels were increased(P<0.05,P<0.01,P<0.001)in the low and high dose groups,with the improvement being more significant in the high dose group.Hematoxylin-eosin staining results showed that in the control group,there were large defective areas on the surface of the knee cartilage with unknown structure and severe inflammatory cell infiltration;in the low dose group,the surface of the knee cartilage was rough with disordered cell arrangement and the cartilage structure did not improve significantly after 2 weeks of administration,while the number of inflammatory cells in the knee cartilage was reduced and the cartilage structure was restored to some extent after 4 weeks of administration;in the high dose group,the structure of the knee cartilage become clear after 2 weeks of administration and even clearer after 4 weeks of administration,and the inflammation was significantly reduced after 2 weeks of administration.To conclude,Mongolian Medicine Erdun-uril with better anti-inflammatory properties can improve cartilage metabolism and obviously alleviate osteoarthritis in rats.

Objective:To evaluate the clinical efficacy of arthroscopic side-to-side suture with remnants preserved in repair of transtendinous rotator cuff tears.Methods:A retrospective study was conducted to analyze the data of 17 patients who had been treated by arthroscopic side-to-side suture with remnants preserved for transtendinous rotator cuff tear caused by trauma at Sports Medicine Center, The Second Hospital Affiliated to Inner Mongolia Medical University from January 2017 to January 2020. There were 11 males and 6 females with an age of (47.9±8.3) years and a duration from injury to surgery of (50.4±21.3) d. Recorded were range of motion and muscle strength of the shoulder, University of California at Los Angeles (UCLA) shoulder function score, Constant-Murley shoulder function score, visual analogue scale (VAS) pain score, re-tears and complications before operation and at the last follow-up.Results:The 17 patients were followed up for (16.5±3.5) months after operation. Retear of the rotator cuff occurred in 2 patients after operation while MRI showed good healing of the rotator cuff in the other patients with no such postoperative complications as infection or wound dehiscence. At preoperation and the last follow-up, respectively, the range of shoulder flexion was 152.9°±8.5° and 172.4°±5.6°, the abductor muscle strength 3.5 (2.6, 4.1) kg and 6.9 (6.3, 8.3) kg, the external rotator muscle strength (3.8±1.0) kg and (5.9±1.6) kg, the internal rotator muscle strength 3.9 (3.4,4.7) kg and 5.2 (4.5,5.9) kg, the UCLA score (13.2±1.9) points and (30.9±2.4) points, the Constant score (40.1±2.8) points and (86.1±4.6) points, and the VAS score (6.7±0.8) points and (0.9±0.6) points, all showing a significant difference between preoperation and the last follow-up ( P<0.05). Conclusion:In repair of transtendinous rotator cuff tears, arthroscopic side-to-side suture with remnants preserved can lead to significantly improved clinical outcomes in range of motion, muscle strength, functional recovery and pain relief.

ObjectiveTo investigate the clinical effect of laparoscopic splenectomy and pericardial devascularization (LSPD) in patients with portal hypertension and the long-term effect of LSPD. MethodsA total of 40 portal hypertension patients with Child-Pugh A/B liver function who received LSPD in The First Hospital of Jilin University from August to December 2017 were enrolled as surgical group, and 44 portal hypertension patients with Child-Pugh A/B liver function who received conservative treatment during the same period of time was enrolled as internal medicine group. The patients were followed up to June 30, 2019, and liver function parameters, upper gastrointestinal bleeding, and portal vein thrombosis were recorded for all patients at each time point. The t-test was used for comparison of normally distributed continuous data between two groups; an analysis of variance was used for comparison between multiple groups, and the Bonferroni test was used for further comparison between two groups. The Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution; between multiple groups, and the Mann-Whitney U test was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. ResultsAt 6, 12, and 24 months after discharge, compared with the internal medicine group, the surgical group had a significantly higher level of cholinesterase (t=3.527, 3.849, and 5.555, all P＜0.05) and a significantly lower Child-Pugh score (t=2.498, 2.138, and 2.081, all P＜0.05). Compared with the internal medicine group at 12 and 24 months after discharge, the surgical group had a significantly higher level of albumin (t=3.120 and 2.587, both P＜0.05) and a significantly lower incidence rate of upper gastrointestinal bleeding (χ2=4.947 and 5.155, both P＜0.05). At 24 months after discharge, the surgical group had a significantly lower number of patients who had a significant increase in alpha-fetoprotein level than the internal medicine group (χ2=4.648, P=0.031). At 12 months after discharge, the surgical group had a significantly higher incidence rate of portal vein thrombosis than the internal medicine group (χ2=4.395, P=0.036). The surgical group had significant improvements in albumin (F=2.959, P=0.013), cholinesterase (F=11.022, P＜0001), prothrombin time (H=94.100, P＜0.001), and Child-Pugh score (F=3.742, P=0.003) from admission to 12 and 24 months after surgery. ConclusionIn portal hypertension patients with Child-Pugh A/B liver function, LSPD can improve liver function and reduce the incidence rate of upper gastrointestinal bleeding, and the high incidence rate of portal vein thrombosis can be effectively reduced by oral aspirin and rivaroxaban.

BACKGROUND:The treatment method of tibial avulsion fractures of anterior cruciate ligament is varied;each has its advantages. OBJECTIVE:To investigate the methods and clinical effects of the treatment of avulsion fractures of tibial insertion of anterior cruciate ligament by the means of making two decussate lines and four strands of non-absorbable Arthrex sutures passing through two bone tunnels combined with pushlock free knotting anchor under arthroscopy. METHODS:From December 2014 to November 2015, 23 cases of avulsion fractures of tibial insertion of anterior cruciate ligament were treated in the Second Hospital of Inner Mongolia Medical University. Under the arthroscopy, avulsed fracture was fixed in tibial intercondylar eminence by the means of making two decussate lines of Arthrex sutures passing through. At the same time, pushlock free knotting anchor beside tibial tubercle provided a tightening of tension for Arthrex sutures, which could strengthen the fixation of avulsion fracture blocks. Knee joint Lysholm and Tegner scores were fol owed up. Knee stability was evaluated by anterior drawer test and Lachman test. Postoperative reset and healing were evaluated with X-ray films. RESULTS AND CONCLUSION:(1) Al 23 patients were fol owed up for 6 months to 1 year. (2) Lysholm scale of the knee function was (47.31±6.16) preoperatively and (94.69±1.28) postoperatively (P<0.05). Tegner score was (3.14±1.58) preoperatively and (7.74±1.69) postoperatively (P<0.05). (3) Lachman test of al cases was negative. X-ray films demonstrated that fracture healing was good. There was no repeated swel ing or cross locking of the joint. The knee was not limited by flexion or extension. No infection or deep venous thrombosis of lower extremity occurred. (4) The method of Arthrex sutures passing through two bone tunnels combined with pushlock free knotting anchor under arthroscopy has the advantages of minimal y invasive, simple operation, reliable fixation, no metal implants and satisfactory result to treat the tibial intercondylar eminence fracture of anterior cruciate ligament.

BACKGROUND:Anterior cruciate ligament (ACL) has been reported to hold a self-recovery potential, which may be related to certain cytokines and biological factors, such as stem cells or progenitor cells.OBJECTIVE: To review the literatures about the relationship between mesenchymal stem cells and ACL injuries, and understand the potential of stem cells or progenitor cells differentiating into ACL, thus providing a basis for the clinical use of mesenchymal stem cells in the treatment of ACL injury. METHODS:A computer-based online research of PubMed databases was performed to collect articles including reviews, clinical trials and basic studies using the English keywords of ACL regeneration, stem/progenitor cells, mesenchymal stem cells. Forty-five eligible articles were included finally. RESULTS AND CONCLUSION:In recent years, there are a lot of studies addressing the treatment of ACL injuries and muscle/bone regeneration, but the use of stem cells is still far from the clinical requirements. The source of stem cells suitable for the ACL regeneration and their most suitable injection points are under discussion. Although the mesenchymal stem cells have been reported to successfully repair ACL injury in animal models, either trophic factors of stem cells or these cells themselves improving the regeneration remains unclear.

BACKGROUND:Until now, musculoskeletal bioengineering used in the orthopedic surgery and regenerative medicine are developing. OBJECTIVE:To summarize the construction strategies for tissue-engineered knee ligaments. METHODS:A computer-based online search was conducted in PubMed to screen the relevant literatures using the terms“knee ligament”AND“tissue engineering”OR“regenerative medicine”. The literature retrieval, data assessment and extraction were performed by both authors independently. The relevant literatures were included through reviewing preclinical and clinical studies to display the preclinical and clinical medicine progresses in the construction strategies for tissue-engineered ligaments. RESULTS AND CONCLUSION:Included 224 literatures focus on the construction strategies for tissue-engineered ligaments, including stem cel therapy, growth factors, biomaterials and scaffolds, and mechanical stimulation pattern. Construction techniques for tissue-engineered ligaments have some potential advantages, such as rapid function recovery, good tenacity, and reduced relapse. However, rigorous and high-level randomized control ed clinical trials are needed for the translation of preclinical results into successful clinical trials.

BACKGROUND:As meniscectomy may result in various adverse reactions, tissue-engineered meniscus is expected to be used for meniscus repair. Seed cel selection and optimal physicochemical stimuli are crucial for the construction of tissue-engineered meniscus.
OBJECTIVE:To overview the seed cel s for the tissue-engineered meniscus construction and the research progress of physicochemical factors.
METHODS:The first author retrieved the CNKI and Medline databases using the keywords of“meniscus, tissue engineering, seed cel s, physical and chemical factors”in English and Chinese, respectively, to retrieve articles related to the seed cel s and physicochemical factors of the tissue-engineered meniscus construction. Irrelative and repetitive articles were excluded, and 49 eligible articles were enrol ed for analysis.
RESULTS AND CONCLUSION:The seed cel s must maintain their phenotype and synthetic ability after physicochemical stimulation in combination with scaffolds, to achieve the reproducibility of tissue-engineered meniscus. Most of cytokines can be used for promoting the proliferation and differentiation of chondrocytes, but the underlying mechanisms were little known. Their application in the meniscus tissue engineering needs to be studied in depth. Currently it is urgent to improve physicochemical stimuli in order to construct the tissue-engineered meniscus. The shear force does harm to chondrocyte phenotype, and dynamic compression loading has been proved to enhance Ca+and glycosaminoglycan release. The fibrous cartilage stimulated by shear force and other factors may be helpful for constructing the tissue-engineered meniscus. An elaborated randomized control ed trial and the long-term quantitative analysis are of importance to assess the research results.

BACKGROUND:The meniscus injury is one of the most common sports injuries of knee joint. The treatment after injury is always a difficult problem in the clinic. Researchers have been trying to apply the method of using tissue-engineering to solve the problem of meniscus repair after injury.
OBJECTIVE:To summarize tissue-engineered meniscus-related basic research.
METHODS:The first author retrieved China National Knowledge Infrastructure and Medline for literatures on tissue-engineered meniscus. The key words were“meniscus, tissue engineering, basic research”. Articles with unrelated objective and repeated articles were excluded. Final y, 35 articles were included.
RESULTS AND CONCLUSION:There was some controversy about the classification of the cel of the meniscus. The outer tissue of the meniscus is mainly composed of the fibrous cartilage cel s and the extracel ular matrix. The inner tissue of the meniscus is mainly composed of a smal atypical class of cartilage cel s. The biomechanical properties of the meniscus can be properly adjusted when it is subjected to external pressure. The lateral meniscus is assumed to bear al the pressure of the outer part of the knee joint during knee flexion, but the medial meniscus is assumed to bear 50%of the medial part of the knee joint. The etiology and pathophysiology of meniscus injury are not the same, which is highly dependent on the age of onset of the patient. However, in each age group, right knee meniscus injury was the majority. The way of surgical repair of the meniscus tear can be divided into the technology from inside to outside, and that from outside to inside, total internal repair under arthroscopy and open repair technology.