ObjectiveTo explore the correlation among knee hyperextension angle, lower limb joints kinematics parameters and the activation of main muscles of lower limb in stroke hemiplegic patients with knee hyperextension during walking. MethodsFrom August, 2020 to September, 2021, 24 stroke hemiplegic patients with knee hyperextension and 24 healthy subjects matched with sex, age, height and body mass with knee hyperextension were analyzed with three-dimensional gait analysis system and the wireless surface electromyography acquisition system, to record the range of motion of pelvis, hip, knee and ankle joints in sagittal plane, and the activation of bilateral gluteus maximus, biceps femoris, vastus medialis and gastrocnemius medialis. ResultsAs the maximum of knee hyperextension, range of motion of the joints in sagittal plane and the activation of the muscles were different between the patients and the healthy subjects during the single-support phase of walking (|t| > 3.080, P < 0.01), and the maximum of knee hyperextension correlated with the activation of gluteus maximus in the patients (r = -0.532, P < 0.01), and the range of motion of ankle plantar flexion in both the patients and the healthy subjects (r > 0.686, P < 0.001). ConclusionThe correction for knee hyperextension gait in stroke hemiplegic patients may not only need to pay attention to knee joint control, but also need further treatment of ankle control and hip muscle function.

Objective To explore the effect of OASL expression on the proliferation and migration of pancreatic cancer cells. Methods The GEPIA database was used to analyze the differences in OASL expression in pancreatic cancer tissues and normal pancreatic tissues. The TIMER database was used to analyze the relationship between OASL expression and patient survival. The TCGA database was used to analyze the correlation of OASL expression with the clinicopathological parameters of pancreatic cancer. shRNA was used to knock down the expression of OASL gene in pancreatic cancer panc-1 cells. Lentiviruses were used to overexpress the OASL gene in pancreatic cancer cells. MTT assay was used to evaluate their proliferation ability, and scratch and Transwell experiments were used to evaluate their migration ability. Western blot experiments were used to detect changes in proteins related to tumor proliferation, migration, and invasion. Results OASL expression in the pancreatic cancer group was significantly higher than that in normal pancreatic tissue (P < 0.05), and patients with high OASL expression in pancreatic cancer patients had worse OS than patients with low expression (P < 0.05). After OASL gene knockdown, the proliferation and migration abilities of panc-1 cells were inhibited, whereas the overexpression of OASL gene promoted the proliferation and migration ability of panc-1 cells. Western blot experiments showed that after OASL knockdown, p-STAT3 protein expression increased, whereas STAT3 and BAK protein expressions decreased. After OASL overexpression, p-STAT3 protein expression decreased, and STAT3 and BAK protein expression increased. Conclusion OASL may affect the proliferation and migration of pancreatic cancer cells through the STAT3 signaling pathway while affecting BAK expression to induce cell death.

Objective:To compare Jefferson-fracture reduction plate (JeRP) and micro titanium plate in the transoral single-segment fixation of unstable atlas fractures.Methods:From January 2008 to December 2020, 45 patients with unstable atlas fracture were treated by single-segment fixation through an oral approach with a JeRP or a micro titanium plate at Department of Orthopedic Surgery, General Hospital of Southern Theatre Command. They were 24 males and 21 females, aged from 15 to 67 years. By the Gehweiler classification, 11 atlas fractures were type Ⅰ and 34 type Ⅲ; by the American Spinal Injury Association (ASIA) classification, the spinal cord injury was grade D in 7 cases and grade E in 38 cases; by the Dickman classification, the atlas transverse ligament injury was type Ⅰ in 4 cases and type Ⅱ in 11 cases. Of the patients, 26 were treated by transoral single-segment fixation with a JeRP and 19 by transoral single-segment fixation with a micro titanium plate. The 2 groups were compared in terms of baseline data, operation time, blood loss, hospital stay, visual analog scale (VAS) for neck pain and atlas lateral mass displacement (LMD) before operation and at the last follow-up, and intraoperative and postoperative complications.Results:The 2 groups were comparable because there was no significant difference between them in the preoperative general data ( P>0.05). All patients were followed up for 12 to 55 months (mean, 21.8 months). Wound dehiscence or infection was observed in none of the patients after operation. About 12 months after operation, all fractures achieved bony union, neck pain basically disappeared, and neck movement had no obvious limitation. The hospital stay was (13.9±2.2) d for the JeRP group and (14.2±2.9) d for the micro titanium plate group, showing no significant difference between the 2 groups ( P>0.05). The operation time was (203.5±173.4) min and the blood loss (167.3±138.6) mL in the JeRP group, significantly more than those in the micro titanium plate group [(121.5±50.5) min and (98.4±57.2) mL] ( P<0.05). In the JeRP group, the preoperative LMD was (6.7±1.7) mm and the preoperative VAS score (6.8±1.0) points, significantly higher than the last follow-up values [(0.7±0.6) mm and (0.7±0.6) points] ( P<0.05). In the micro titanium plate group, the preoperative LMD was (6.6±1.5) mm and the preoperative VAS score (6.7±0.9) points, significantly higher than the last follow-up values [(0.9±0.6) mm and (0.8±0.7) points] ( P<0.05). However, there was no significant difference in the preoperative or the last follow-up comparison between the 2 groups ( P>0.05). Implant loosening was observed in one patient in the JeRP group while foreign body sensation in the throat was reported in one patient after operation in the micro titanium plate group. Conclusions:Both JeRP and micro titanium plate in the transoral single-segment fixation can lead to effective treatment of unstable atlas fractures. Compared with JeRP, the micro titanium plate can effectively shorten operation time and reduce blood loss due to its smaller size and lower incision.

Temporomandibular joint (TMJ) is a unique synovial joint in mammals. There have been many reports on the structure and function of TMJ during embryonic development.Although studies on TMJ related signal molecules and transcription factors during embryonic development have been carried out since the last century, there are few reports on the molecular genetic regulation of TMJ compared with the abundant molecular regulation information of synovial joint. The studies on signal molecules and transcription factors of TMJ embryonic development were mainly conducted in rodents.There were few studies on the regulatory molecules and their regulatory mechanisms related to the development of TMJ conducted in large mammals and human embryos. This article reviews the research progress of key signal molecules and transcription factors of TMJ in embryonic development on the basis of modern molecular biology technology in order to find more core regulatory molecules and understand their regulation mechanism on TMJ development.

Objective: To compare the clinical efficacy of posterior minimally invasive reconstruction plate and 3D-navigated percutaneous sacroiliac screw fixation of elderly patients with posterior pelvic ring fractures. Methods: A retrospective cases control study was performed to analyze the data of 75 elderly patients with posterior pelvic ring fractures admitted from January 2014 to June 2018 in Central Hospital of the PLA. There were 32 males and 43 females, with the age range of 60-83 years (mean, 67.7 years). Twenty-four patients in the plate group were treated by posterior minimally invasive reconstruction plate fixation, and 51 patients in the navigation group were treated by percutaneous sacroiliac screw internal fixation with 3D navigation. The operation time, intraoperative blood loss, X-ray exposure time, complication rate and postoperative visual analogue scale (VAS) were compared between the two groups. Postoperative Matta radiographic criteria was used to assess fracture reduction quality, and Majeed criteria was used to assess pelvic function at the last follow-up. Results: All 75 patients were followed up for 6-24 months (mean, 13.5 months). The operation time, intraoperative blood loss and X-ray exposure time in the plate group were (126.1±20.6)minutes, (251.6±50.8)ml, and (15.7±4.4)s, showing significant differences in comparison with the navigation groups [(49.7±17.5)minutes, (22.8±5.1)ml, and (112.8±8.8)s](P<0.05). The incidence of postoperative complications was not significantly different between the plate group (4%) and the navigation group (4%) (P>0.05). At day 3, one week, and one month postoperatively, the VAS in the navigation group was (3.3±0.7)points, (3.2±0.7)points, (2.4±0.6)points, better than that in the plate group [(7.2±0.7)points, (6.2±0.8)points and (4.5±0.7)points] (P<0.05). However, there was no significant difference between the two groups at 3 months and one year after operation (P>0.05). According to the Matta radiographic criteria, the excellent and good rate was 92% in plate group (excellent in 14 cases, good in 8, and fair in 2), and was 82% in the navigation group (excellent in 25 cases, good in 17 and fair in 9). There was no significant difference between the two groups (P>0.05). According to the Majeed criteria at the follow-up, the excellent and good rate was 96% in the plate group (excellent in 15 cases, good in 8 and fair in 1), and was 94% in the navigation group (excellent in 35 cases, good in 13 and fair in 3). The difference between the two groups was not statistically significant (P>0.05). Conclusion For elderly patients with osteoporotic posterior pelvic ring fractures, percutaneous sacroiliac screw fixation under 3D navigation has the advantages of shorter operation time, less bleeding, less radiation dose and less postoperative pain than minimally invasive reconstruction plate internal fixation, and hence deserves clinical application.

Objective To explore the clinical efficacy of lateral osteotomy via the supra-fibular-head approach combined with lateral locking plating for simple posterolateral tibial plateau fractures.Methods From January 2014 to February 2017,11 patients with simple posterolateral tibial plateau fracture were treated at Department of Orthopaedics,General Hospital of Middle Military Command of PLA.They were 8 males and 3 females,aged from 21 to 55 years (average 41.8 years).In all of them the supra-fibular-head approach was used for lateral osteotomy according to the size and orientation of the fracture block.After the fracture was reset,a full bone graft was implanted under direct visualization,followed by fixation of the posterolateral bone mass with a lateral locking plate which was placed as far as possible above the fibular head.The patients were encouraged 6 weeks after surgery to do knee functional exercise within 90°.The therapeutic efficacy was evaluated at the final follow-up according to the Rasmussen's criteria for knee functions.Results The average operative time was 74 minutes (from 55 to 90 minutes);the average intraoperative blood loss was 70 mL (from 40 to 120 mL).All the patients were followed up for 12 to 35 months (average,17.5 months).No neurovascular injury or incision infection was observed.Bony union was achieved in all patients after 10 to 15 weeks (average,12.5 weeks).Follow-ups found no implant loosening/breakage,genu valgum,genu varum,fracture redisplacement,or knee instability.According to the Rasmussen's function evaluation of the knee joint,10 cases were rated as excellent and one as good.Conclusion Lateral osteotomy via the supra-fibular-head approach combined with lateral locking plating is a preferred treatment for simple posterolateral tibial plateau fractures.

Objective To design and develop intelligent rehabilitation equipment for administering continuous passive motion (CPM) of a rabbit's knee joint after tibial plateau fracture.Methods The equipment constructed had three main parts:the core machinery,electronic control and a control program designed based on bionics principles.Twenty six-month-old New Zealand White male rabbits were randomly divided into sedentary (SED) and CPM groups after their knees had been fractured.The rabbits in the CPM group were given 30 min of early joint rehabilitation once a day for 4 weeks using the CPM equipment,while those in the SED group were kept in their cages and allowed free activity without any special exercise program.The body weight,range of motion and swelling of the affected knee joint were measured before the fracture and on the 3rd,7th,14th,21st and 28th days after the fracture.On the 28th day after the fracture the pathological structure of the articular cartilage on the operative side was observed under a light microscope.Results The equipment ran safely and reliably,and drove the rabbits to move synchronously.It could accurately and conveniently adjust the knee flexion angle,movement speed and movement time.The intelligence of the equipment met the experimental requirements.On the 3rd day after the operation the average range of motion in the joints of both groups had changed significantly compared to that before the fracture.On the 28th day after the fracture the average degree of swelling and range of motion in the CPM group were significantly different from those of the SED group.On the 28th day,deformity and the smoothness of the fracture line in the CPM group were superior to those in the SED group.Moreover,the dominant tissues in the defect area of the CPM group were mainly hyaline cartilage while those in the SED group were mainly repair fibrocartilage.The defect area and its adjacent articular cartilages,chondrocyte regeneration and arrangement,layers of cells and subchondral tidal line recovery of the CPM group were better than in the SED group on average.Conclusion The equipment for knee joint manipulation is convenient to use,reliable and effective for the early rehabilitation of tibial plateau fracture,at least in rabbits.It promotes remodeling of the fracture and cartilage repair after tibial plateau fracture,and also improves range of motion in the knee and reduces swelling.

Objective To compare the clinical effect of digital orthopedic three-dimensional visualization technology combined with image-based computer navigation and simple image-based computer navigation in percutaneous screw fixation for the treatment of sacroiliac joint complex injury. Methods A retrospective case-control analysis was conducted on 49 cases of sacroiliac complex injury from January 2015 to May 2017. There were 27 males and 22 females, with an average of 39.3 years old (range, 21-66 years). According to AO typing, there were 10 cases of type B1, 19 type B2, and 20 type C1. The duration from injury to operation ranged from 5 to 11 days (mean, 6.5 days). Based on the application of three-dimensiona digital programming, the 49 cases were assigned to Group A (n =24) which used Mimics computer assisted surgery software to simulate screw placement on the healthy side of sacroilic joint before operation and Group B (n = 25) without the simulation programming. Screw placement time, intraoperative fluoroscopy frequency, and intraoperative bleeding were compared between two groups. Fracture reduction was evaluated by modified Matta standard score, and the function of hip joint by Majeed pelvic fracture function score at the last follow-up. Fracture healing and complications were observed. Results All patients were followed up for an average of 10.4 months (range, 6-24 months). The time of sacroiliac joint screw placement [(18.4 ±3.0)min] and the intraoperative fluoroscopy frequency [(12.9 ± 3.8) times] in Group A were significantly less than those [(26.4 ±3.8) min, (19.4 ±1.5) times] in Group B (P ＜ 0.05). There were no significant differences between Group A and Group B in intraoperative bleeding [(14.1 ± 3.0) ml vs. (15.1 ± 2.2) ml](P＞0.05). According to the modified Matta reduction standard, the good and excellent rate of Group A was 92％ (22/24), and that of Group B was 92％ (23/25). At the last follow up, the Majeed pelvic function score was 96％ (23/24) in Group A and 92％ (23/25) in Group B (P ＞0.05). Bone healing was seen in all patients 4 months after operation, and no complications such as wound infection, deep venous thrombosis, or screw loosening were observed. Conclusion The digital orthopedic three-dimensiona visualization technology in preoperative planning can reduce the time of sacroiliac screw placement and the intraoperative fluoroscopy frequency. It is an effective adjuvant technique for the percutaneous screw fixation under navigation in the treatment of sacroiliac joint.

Objective To evaluate the clinical outcomes of three-dimensional navigation assisted percutaneous sacroiliac screw combined with external fixator for the treatment of the Tile B and C pelvic fractures. Methods A retrospective case-control study was conducted on 43 patients with Tile B and C pelvic fractures from January 2014 to June 2017. There were 25 males and 18 females, with an average age of 44.6 years (range, 21-68 years). According to the AO typing, there were seven cases of type B1, 13 type B2, six type B3, 15 type C1, and two type C2. The duration from injury to operation ranged from 4 to 14 days (mean, 8.0 days). Based on the operation method, patients were divided into Group A (n=20) treated by three dimensional navigation assisted percutaneous sacroiliac screw combined with external fixator, and Group B (n = 23) treated by anterior open reduction and plate internal fixation. The two groups were compared in terms of operation time, blood loss, reduction quality by Matta score, Majeed pelvic fractures function score at the last follow up, and postoperative complications. Results All patients were followed up for 6-24 months (mean, 12.7 months). The operation time [(27.5 ± 1.6) minutes] and intraoperative bleeding [(26.3 ± 3.9) ml] in Group A were significantly less than those in Group B [(166.2±3.6)minutes and (128.0 ± 8.9) ml] (＜0.05). There were no significant differences between Group A and Group B in the good and excellent rate of reduction [85％ (17/20) vs.91％ (21/23)], and Majeed score [90％ (18/20) vs.91％ (21/23)](P＞0.05). The incidence of postoperative complication in Group A (10％) was significantly lower than that in Group B (39％) (P ＜0.05). Conclusion Compared with open reduction and plate internal fixation, three dimensional navigation assisted percutaneous sacroiliac screw combined with external fixator is preferable to unstable pelvic fractures due to the shorter operation time, less intraoperative bleeding, and fewer postoperative complications.

Objective To investigate the therapeutic effects of navigation-guided hollow screw fixation on the treatment of elderly patients with the sacroiliac complex injury.Methods Twentyone older patients with sacroiliac complex injury received the three-dimensional images-guided percutaneous hollow screw fixation from March 2015 to May 2016.There were 14 males and 7 females with age of 60-73 years[average(63.5 ± 3.7) years].Traffic accident injury was found in 15 cases,falling injury in 5 cases,others in one case.The pelvic fractures were classified by tile classification:type B2 in 2 cases,type B3 in 6 cases,type C1 in 5 cases,type C2 in 6 cases,type C3 in 2 cases.Intraoperative observation data,the injury of nerve and blood vessel during the screw insertion,postoperative fracture reposition and so on were recorded.The quality of fracture reposition was evaluated by Matta radiological criteria after surgery,and the pelvic function was assessed by Majeed scoring criteria at the last follow-up.Results A total of 30 hollow screws in 21 elderly patients were placed under three-dimensional images navigation,and each screw fixation time was 36-45 min,average (40.5±4.7)min with a small amount of bleeding (10-20)ml.Postoperative examinations showed that S1 vertebral cortical bone screw wear was found in one patient,and the end of the bolt washer was internalized into the outer table of the ilium without breaking the medial iliac plate in another patient.The above two patients had no postoperative complications.Other screws positions were good,without nerve or vascular injury and other complications.Postoperative reposition quality evaluated by the Matta radiological criteria showed that 14 cases had excellent quality,five with good quality,two with fair quality,and no case with poor quality.Therefore,the excellent and good rates were 90.5 ％.Moreover,19 elderly patients were followed up for 7-13 months average(10.3± 2.1)months,and only one patient showed the bilateral sacroiliac joint screws outside the lateral sacroiliac joint 5 mm.However,this patient had good function in the later follow-up without further prolapse.The remaining 18 patients assessed by the pelvic X-ray and CT at the end of the follow-up showed a good fracture healing,no screw breakage,loosening,and prolapse.Meanwhile,pelvic function findings evaluated by the Majeed standard demonstrated that nine cases were with excellent function,ten with good function,and the excellent and good rates were 90.5％.Conclusions Three-dimensional images-guided hollow screw fixation for the treatment of elderly patients with the sacroiliac complex injury is safe and effective with less trauma and high nailing accurateness.However,the placing process should be cautious in the elderly with osteoporosis.