Objective:To explore the safety and efficacy of the minimally invasive treatment of unstable pelvic fractures with the blunt head technique of Kirschner wire and 3D-printed external template technique.Methods:A retrospective study was conducted of the clinical data of 21 patients with unstable pelvic fracture who had undergone minimally invasive treatment at Department of Orthopaedics, Union Hospital from May 2016 to July 2018 using 3D-printed external templates and the blunt head technique of Kirschner wire. There were 7 males and 14 females with an age of 43.6 years (from 19 to 65 years). According to the Tile classification, there were 3 cases of B1, 7 ones of B2, 6 ones of C1 and 5 ones of C2. The intraoperative fluoroscopy, operation time, postoperative fracture reduction and functional recovery of the pelvis at the last follow-up were recorded.Results:The 21 patients were followed up for an average of 16.3 months (from 12 to 24 months). A total of 33 wires were inserted in the 21 patients, including 15 S 1 ones and 18 S 2 ones. The intraoperative fluoroscopy ranged from 13 to 27 times, averaging 21.8 times. The operation time ranged from 65 to 130 min, averaging 88.6 min. The anterior subcutaneous internal fixation was used to fix the anterior ring in 9 patients. No vascular injury occurred during the operation. By the Matta criteria, the postoperative fracture reduction was assessed as excellent in 14 cases, good in 5, and fair in 2, giving an excellent to good rate of 90.5% (19/21). By the Majeed scoring system, the pelvic function at the last follow-up was assessed as excellent in 10 cases, good in 8, and fair in 3, giving an excellent to good rate of 85.7% (18/21). Lateral femoral cutaneous nerve injury occurred in 2 patients but was recovered by the 3-month follow-up. No other complications were follwed up. Conclusion:The minimally invasive treatment of unstable pelvic fractures with the blunt head technique of Kirschner wire assissted by 3D-printed external templates is safe and effective, showing advatages of reduced fluoroscopic frequency and operation time.

Objective:To introduce a novel anatomical supra-pectineal quadrilateral surface buttress plate, and explore its advantages, disadvantages and clinical efficacy in the treatment of complex acetabular fractures.Methods:Data of eighteen cases of acetabular fractures treated in our department from March 2017 to March 2019were retrospectively analyzed. There were 15 males and 3 females with an average age of 49.6 years (range, 27-62 years). According to the Letournel-Judet’s classification, there were 3 cases of anterior column fractures (involving quadrilateral surface), 2 cases of "T" shaped, 8 of cases anterior column and posterior hemi-transverse (ACPHT) and 5 cases of double columns fractures. The time from injury to operation was 5-14 days (mean, 7 days). Before operation, all patients were taken pelvic anterior-posterior X-ray and CT scan. All patients were adopted supra-ilioinguinal approach and fixed by supra-pectineal quadrilateral surface buttress plate. Surgical time, intraoperative blood loss and postoperative complications were collected. After operations all patients were taken pelvic X-ray in anterior-posterior and Judet position, as well as CT scan. The radiographic quality of reduction was evaluated by Matta criteria and hip functions were evaluated by Matta Modified Merle d’Aubigné-Postel scoring system.Results:The average surgical time was 130 min (range, 100-200 min). The average blood loss was 560 ml (range, 400-900 ml). An additional shaping was unnecessary in 18 patients who were implanted with the anatomical supra-pectineal quadrilateral surface buttress plate and all patients were operated successfully. All patients were followed up for an average time of 9 months (range, 6-15 months). The quality of fracture reduction was evaluated according to Matta standard, of which there were 11 cases excellent, 4 cases good, and 3 cases poor, with an excellent rate of 83.3% (15/18). At the latest follow-up, the function of the hip joint was evaluated according to the Matta Modified Merle d’Aubigné-Postel scoring system for a mean of 15.8 scores (range, 12-18 scores), of which there were 10 cases excellent, 6 cases good, 2 cases fair, with an excellent rate of 88.9% (16/18). All patients recovered well, and there were 2 cases of lateral femoral cutaneous nerve injury postoperative who had recovered one month later. There was no other postoperative complications.Conclusion:The anterior and posterior column and quadrilateral surface could be stabilized simultaneously by the anatomical supra-pectineal quadrilateral surface buttress plate without intraoperative shaping. Moreover, it is more likely to obtain a satisfactory clinical outcome by using this special plate with lower complications and rigid fixation. Therefore, it is a kind of internal fixation method worthy of promotion in the treatment of complex acetabular fractures.

Objective To investigate the clinical efficacy of a novel acetabulum anatomic locking plate in the treatment of anterior wall and anterior column acetabular fracture.Methods A retrospective case series study was performed in five patients with anterior wall and anterior column acetabular fractures managed operatively using a novel acetabulum anatomic locking plate from March 2014 to January 2016.There were four males and one female,with an average age of 41.1 years (range,25-65 years).The mean time from injury to operation was 3.2 days (range,2-5 days).All patients were managed operatively using the superior ilioinguinal approach.Operation duration,intraoperative blood loss,blood transfusion,and bony union time were recorded.The image results by Matta standard were evaluated and the acetabular function after operation was assessed by modified Merle d'Aubigné-Postel.Postoperative complications were recorded.Results All patients were followed up for average 15.3 months (range,12-24 months).The average operation duration was 96 minutes (range,60-130 minutes) and average blood loss was 230 ml (range,100-800 ml).Autologous blood transfusion was selectively used except for one patient with allogeneic blood transfusion of 400 ml.The mean time of bony union was 2.9 months (range,2-5 months).According to the Matta criteria,four patients attained anatomical reduction,and unsatisfactory reduction was reported in one patient.Clinical outcomes (Merled'Aubigné-Postel) at 12 months were 100％ excellent with the average score of 17.1 (range,15-18).One patient had a lateral cutaneous nerve palsy,and symptom relief was seen after a follow up of 6 months.After operation,no complications such as surgical site infection,femoral head avascular necrosis,andtraumatic arthritis occurred in any patient.Conclusion The novel acetabulum anatomic locking platecan provide rigid and firm fixation for both anterior wall and anterior acetabular fractures using one singleplate,and the fracture reduction and function recovery are satisfactory.

Objective To explore the clinical effectiveness and reliability of combined acetabular quadrilateral surface plates for the treatment of both column fractures.Methods From June 2016 to August 2017,data of 15 cases with acetabular both column fractures who were treated in our department were retrospectively analyzed.Among them 9 cases were male and 6 were female.The mean age was 42.8 years (range,26-68 years).All cases were both column fractures according to the LetournelJudet's classification,including 4 cases combined with posterior wall fracture.Before operation,the pelvic CT thin layer scanning data of patients were collected in DICOM format,and then the data were imported to print the simulated model by 3D printing technology in order to understand the characteristics of fracture directly.The contralateral half pelvis was mirror printed in order to simulate the placement of combined quadrilateral surface plates and preshape all plates.During operation,infrapectineal main plate,pubo-ischiatic plate and ilio-ischiatic plate were placed consequently to fix the anterior column,"middle column" and posterior column respectively.The pubo-ischiatic and ilio-ischiatic plates were combined with the main plate.All cases were operated by supra-ilioinguinal approach.Results The average incision length was 11 cm (range,9-13 cm).The average operative time was 150 min (range,100-240 min).The average blood loss was 850 ml (range,600-1500 ml).Once reduction was obtained,plates could be placed easily and adhere to bone surface well.The quality of postoperative fracture reduction was evaluated according to Matta standard,of which there were 9 cases excellent,4 cases good,and 2 cases poor,with an excellent rate of 86.7％ (13/15).All patients were followed up for an average time of 10 months (range,6-12 months).At the latest follow-up,the average modified Merle d'Aubigne and Postel score was 16.4 (range,12-18),and there were 8 cases excellent,4 cases good,2 cases fair and 1 case poor,with an excellent rate of 80.0％ (12/15).Conclusion For the treatment of acetabular both column fractures,the combined quadrilateral surface plates could resist the medial displacement of quadrilateral area,and on the other hand the total floating posterior column and ischium could be fixed firmly.At the same time,this plate system is a multi-dimensional framework fixation,which is more effective and safer with lower complications rate,resulting in a satisfactory clinical outcomes.

Objective To investigate the effect of autologous platelet rich plasma along with bone transportation in tibia defect.Methods This was a randomized single-blind placebo controlled clinical trial.From Jan 2013 to Mar 2015,28 patients (28 cases) suffering from tibia defect because of trauma or osteomyelitis were randomly assigned to PRP group (PRP along with bone transportation,n=15) or bone transportation group (bone transportation only,n=13) through random number table and sealed envelop method.PRP group:male to female 12∶3,average age:40.9 years old,average bone defect:7.1 cm,6 caused by trauma,9 by osteomyelitis;while bone transportation group:male to female 10∶3,average age:37.7 years old,average bone defect:6.5 cm,3 caused by trauma and 10 by osteomyelitis.Bony results and tibia function were evaluated according to the Association of the Study and Application of the Method of Ilizarov (ASAMI) protocol.The external fixation index,complications and VAS pain score were also evaluated.Results The mean follow-up time was 21.8 m in PRP group and 23.2 m in bone transportation group and there were no loss to follow-up.There were no differences between two groups on postoperative VAS pain score:1st d postoperative (3.33±2.58 vs 4.46±2.73);7th d postoperative (2.67±2.09 vs 3.00±2.20);and 2 weeks postoperative (1.46± 1.77 vs 2.62±2.72).There was significant difference between two groups on external fixation index (37.9±7.7 d/cm vs 46.9± 13.7 d/cm).According to the ASAMI protocol,all patients achieve bone union,except 2 cases in control group which need revision surgery;excellent and good rate of bone defect union was 93％ in PRP group while 77％ in control group;while no difference was found on complication and lower extremity function.Conclusion Application of PRP along with bone transportation in the treatment of tibia defect resuits in shorter healing duration and external fixation duration.But no short-term postoperative analgesic effect,lower extremity function,and complication rates were found.

Objective To investigate the clinical outcomes in the treatment of complex acetabular fractures through a single supra-ilioinguinal approach after the application of preoperative 3D printing and rapid prototyping simulating the operative procedure.Methods From January 2013 to January 2016,24 cases of complex pelvic and acetabular fractures in our hospital were retrospectively analyzed.Among them 18 cases were male and 6 were female.The average age was 39.2+±13.8 years (range,24-68 years).According to Letoumel-Judet's classification,there were 6 cases of transverse,4 cases of T shaped,4 cases of combined anterior column and posterior hemi-transverse (ACPHT) and 10 cases of 2-column fractures.The time from injured to operation averaged 9 days (range,4-18 days).Before operation,pelvic AP view,three-dimensional CT as well as CTA of iliac blood vessels was taken routinely in all cases.The CT and CTA scan data were then imported into Mimics software for 3D reconstruction.Surgical simulation and optimal placement of internal fixations were performed on computer.After that,the individual simulated model of the pelvis was printed by the use of 3D printing and rapid prototyping technique.The order of reduction,selection and optimal position of the implants were determined.The plates were bent before operation and the length and direction of the screws were recorded.A uniform supra-ilioinguinal approach was used in all cases.Results The length of incision averaged 9 cm (range,8-13 cm).The operative time average 130 min (range,90-220 min).The blood loss averaged 600 ml (range,300-1 500 ml).Once a satisfactory reduction was obtained,single placement of the plates was achieved.In accordance with the preoperative plan,the plates were perfectly fitted to the bone surface.The 24 patients were followed for an average time of 18.3 months (range,15-30 months).The fractures healed in all cases.The average healing time was 4.2 months (range,3-6 months).According to Matta criteria,there were 16 cases of excellent,6 cases of good,2 cases of poor and the excellent rate was 91.7％ (22/24).The average modified Merle d'Aubigne score was 16.5 (range,13-18).The functional outcome was excellent in 13 cases,good in 6 cases and poor in 5 cases.The excellent rate of hip functions was 79.2％ (19/24).There were 2 cases of femoral lateral cutaneous nerve injury (recovered one month later) and another 1 case of fat liquefaction of the incision happened three days postoperatively (the wound healed completely after several dressing changes).No inguinal hernia or abdominal wall hemias was found.No other postoperative complications was found.Conclusion The application of 3D printing and rapid prototyping technique allows preoperatively simulating reduction in vitro,determining the optimal position of the implants,bending the plates and measuring the length of the screws in advance,which could largely reduce the operative time,intraoperative blood loss and occurrence of postoperative complications.Adopting supra-ilioinguinal approach for the treatment of complex acetabular fractures with a small incision and less trauma,a full exposure could be obtained,so the reduction and fixation of the anterior,posterior and middle column (also named pubo-ischiatic column) could be completed in a direct visualization,resulting in a satisfactory clinical outcomes.

Objective To explore the effects of systematic health courses training on quality of life in elderly patients with chronic diseases. Methods Totally 126 patients with chronic diseases who came from communities of Fuzhou city were trained with systematic health courses. Patients were evaluated by Shot Form 36 Health Survey Questionnaire (SF-36) before and after the intervention.Results After intervention, the quality of life of patients was higher than that before the intervention with a significant difference ( P<0. 05 ) . Conclusions The systematic health courses training can effectively improve the quality of life in community elderly patients with chronic diseases.

BACKGROUND:Stem cels can induce immune tolerance, prolong graft survival time and reduce rejection in organ transplantation, which have become a hot research. OBJECTIVE:To induce immune tolerance to alogenic kidney transplantation with amniotic fluid stem cels in recipient rats and to explore the mechanism underlying immune tolerance. METHODS: Amniotic fluid stem cels were isolated from Wistar rats. Two inbred male rat strains, Wistar rats and Sprague-Dawley rats, were selected as donors and recipients of kidney transplantation. The rat models of renal orthotopic transplantation were divided into the folowing four groups: a sham-operated group (n=10, Sprague-Dawley rats); an isograft group (n=10, Sprague-Dawley to Sprague-Dawley rats); a control group (n=10, Wistar to Sprague-Dawley rats, treated with 1 mL saline); and an experimental group (n=10, Wistar to Sprague-Dawley rats, treated with 1 mL of 3×106/L amniotic fluid stem cels). Serum levels of creatinine, urea nitrogen, interleukin-2, interferon-γ, parameters of oxidative stress were detected at 5 days after operation. Flow cytometry was employed to determine the percentage of CD4+ and CD8+ lymphocytes in the peripheral blood. Kidney transplants were observed pathologicaly. RESULTS AND CONCLUSION:Compared with the control group, the levels of creatinine, urea nitrogen, interleukin-2, interferon-γ, parameters of oxidative stress and proteinuria were lower in the experimental group (P < 0.05). Percentages of CD4+, CD8+ and CD4+/CD8+ ratio were also significantly lower in the experimental group than the control group. However, the rate of cretinemia clearance in the experimental group was significantly higher than that in the control group (P < 0.05). Furthermore, the degree of kidney injury in the experimental group was significantly lower than that in the control group. Our findings demonstrate that the amniotic fluid stem cel transplantation can induce immune tolerance, extenuate oxidative stress, attenuate pathological damage to the kidney transplant and preserve kidney function from acute rejection in rats undergoing kidney transplantation.

ObjectiveTo observe the healing effect of deep partial thickness burns by the injecting of breviscapine and discuss the possible mechanisms. Methods A rat model of deep partial thickness burns was designed,and was injected with breviscapine.The control group was injected with normal saline.The healing time of burn wound of the two groups was recorded,respectively.Seven days later,the tissues of bum wound of each group were extracted and the contents of hydroxyproline,collagenase-1,nitrogen monoxidum,erythrocuprein,and malonaldehyde that were contained in each extracts were measured.The results of each group were statistically analyzed.ResultsThe healing time of burn wound of the experimental group was [ ( 12 ± 1.428 ) days ],which was significantly shorter than the control group [ ( 14.75 ±1.291 )days] ( P ＜0.05).The contents of hydroxyproline[ (3.17 ± 1.136) mg/g],collagenase-1 [ ( 1.28± 0.651 ) mg/g ],nitrogen monoxidum [ ( 2.62 ± 0.30 ) μmol/gprot ],and erythrocuprein [ ( 221.25 ±25.94) U/mgprot ] in the experimental group were all higher than the control group [ (7.32 ± 2.173 )mg/g,(5.38 ±0.363) mg/g,(7.28 ± 0.40) μmol/gprot,(296.36 ± 29.29) U/mgprot ] ( P ＜ 0.05 or P ＜0.01 ).However,the content of malonaldehyde [ (6.36 ± 0.93 ) nmol/mgprot ] was lower than the control group [ ( 1.25 ± 0.59) nmoL/mgprot ] ( P ＜ 0.05 ).ConclusionsThe breviscapine injection can decurtate the healing time of deep partial thickness bums and it may be related to the extension of blood vessel,improvement of microcirculation,elimination of oxygen free radical,and degradation of lipid peroxidation.

In an effort to generate a desired expression construct for making heart-specific expression transgenic zebrafish, a Tol2 plasmid, which can drive EGFP reporter gene specifically expressed in the heart, was modified using subcloning technology. An IRES fragment bearing multiple cloning site (MCS) was amplified directly from pIRES2-EGFP plasmid and was inserted between the CMLC2 promoter and EGFP fragment of the pDestTol2CG vector. This recombinant expression plasmid pTol2-CMLC2-IRES-EGFP can drive any interested gene specifically expressed in the zebrafish heart along with EGFP reporter gene. To test the effectiveness of this new expression plasmid, we constructed pTol2-CMLC2-RED-IRES-EGFP plasmid by inserting another reporter gene DsRed-Monome into MCS downstream of the CMLC2 promoter and injected this transgenic recombinant plasmid into one-cell stage embryos of zebrafish. Under fluorescence microscope, both the red fluorescence and the green fluorescence produced by pTol2-CMLC2-RED-IRES-EGFP were detected specifically in the heart tissue in the same expression pattern. This novel expression construct pTol2-CMLC2-IRES-EGFP will become an important tool for our research on identifying heart development candidate genes' function using zebrafish as a model.
Animals ; Animals, Genetically Modified ; genetics ; growth & development ; DNA Transposable Elements ; genetics ; Genes, Reporter ; genetics ; Genetic Vectors ; biosynthesis ; genetics ; Green Fluorescent Proteins ; genetics ; Myocardium ; metabolism ; Plasmids ; genetics ; Transfection ; Transgenes ; Transposases ; genetics ; Zebrafish ; genetics ; Zebrafish Proteins ; genetics ; metabolism