The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

Objective:The aim of this study was to explore the application of maxillary osteotomy plate and positioning guide plate in maxillary Le Fort Ⅰ osteotomy to eliminate the postoperative error caused by condylar displacement.Methods:Patients suffered from skeletal malocclusion and needed Le Fort Ⅰ osteotomy between January 2018 and November 2020 were selected from the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College. All patients were scanned with 64 slice spiral CT. The DICOM format data were analyzed using the Simplant software to reconstruct the virtual three-dimensional model of the jaw before operation. Then, the measurement of indexes and the maxillary Le Fort Ⅰ osteotomy were carried out on the virtual three-dimensional model, respectively. 3D-printed osteotomy guide plate and positioning guide plate were used to determine the osteotomy line and the position of maxillary advancement. 3D-printed tooth supported occlusal plate was used to support the mandibular sagittal split and retraction. The differences of 10 indexes between the two groups (virtual operation and surgery) were analyzed by paired t test using SPSS 22.0. Results:A total of 8 patients (5 males and 3 females) needed maxillary Le Fort Ⅰ osteotomy aged from 18 to 39 years old were recorded. The deviation of age in these patients was 24.8. The 3D-printed guide plate and tooth supporting occlusal plate were positioned accurately in surgery. All the operations were successful with primary healing of the incision and stable occlusion, and without joint clicking. There was no significant difference on the 10 indexes between the groups of virtual operation and surgery ( P>0.05). Conclusions:The application of maxillary osteotomy plate and positioning guide plate can effectively and accurately control the three-dimensional movement of the maxilla and improve the precision of maxillary Le fort Ⅰ osteotomy in orthognathic surgery, making the surgical effect highly consistent with the preoperative design.

Objective:The aim of this study was to explore the application of maxillary osteotomy plate and positioning guide plate in maxillary Le Fort Ⅰ osteotomy to eliminate the postoperative error caused by condylar displacement.Methods:Patients suffered from skeletal malocclusion and needed Le Fort Ⅰ osteotomy between January 2018 and November 2020 were selected from the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College. All patients were scanned with 64 slice spiral CT. The DICOM format data were analyzed using the Simplant software to reconstruct the virtual three-dimensional model of the jaw before operation. Then, the measurement of indexes and the maxillary Le Fort Ⅰ osteotomy were carried out on the virtual three-dimensional model, respectively. 3D-printed osteotomy guide plate and positioning guide plate were used to determine the osteotomy line and the position of maxillary advancement. 3D-printed tooth supported occlusal plate was used to support the mandibular sagittal split and retraction. The differences of 10 indexes between the two groups (virtual operation and surgery) were analyzed by paired t test using SPSS 22.0. Results:A total of 8 patients (5 males and 3 females) needed maxillary Le Fort Ⅰ osteotomy aged from 18 to 39 years old were recorded. The deviation of age in these patients was 24.8. The 3D-printed guide plate and tooth supporting occlusal plate were positioned accurately in surgery. All the operations were successful with primary healing of the incision and stable occlusion, and without joint clicking. There was no significant difference on the 10 indexes between the groups of virtual operation and surgery ( P>0.05). Conclusions:The application of maxillary osteotomy plate and positioning guide plate can effectively and accurately control the three-dimensional movement of the maxilla and improve the precision of maxillary Le fort Ⅰ osteotomy in orthognathic surgery, making the surgical effect highly consistent with the preoperative design.

OBJECTIVE: To analyze the biomechanics of cystic lesions in the mandibular body in a three-dimensional (3D) finite element model. METHODS: A 3D finite element model of cystic lesion of the mandibular body was constructed based on the CT images of the mandible of a healthy adult female volunteer with normal occlusion. The size of the cyst and the residual bone wall were analyzed when the lesion area approached the stress peak under certain constraints and loading conditions. RESULTS: When the size of the cyst reached 37.63 mm×11.32 mm×21.45 mm, the maximal von Mises stress in the lesion area reached 77.295 MPa, close to the yield strength of the mandible with a risk of pathological fracture. At this point, the remaining bone thickness of the buccal and lingual sides and the lower margin of the mandible in the lesion area was 1.52 mm, 0.76 mm and 1.04 mm, respectively. CONCLUSIONS Residual bone mass is an important factor to affect the risk of pathological fracture after curettage of cystic lesions. A thickness as low as 1 mm of the residual bone cortex in the cystic lesion area of the mandibular body can be used as the threshold for a clinical decision on one-stage windowing decompression combined with two- stage curettage.
Adult ; Biomechanical Phenomena ; Female ; Finite Element Analysis ; Humans ; Imaging, Three-Dimensional ; Mandible ; Stress, Mechanical

Objective:To investigate the clinical effect of thin superficial inferior epigastric artery flaps in repairing soft tissue defects after buccal cancer surgery.Methods:From January 2018 to October 2019, 6 patients with buccal cancer who underwent surgery were constructed with thin superficial inferior epigastric artery flaps, including 2 males and 4 females, aged 43 to 68 years, with an average of 61.5 years. Doppler ultrasound was utilized of all patients to design flap preoperatively . According to the size of the affected area defect, according to the shape and direction of the blood vessels, a thin superficial inferior epigastric artery flap was elevated above the Scarpas fascia layer and transferred to repair soft tissue defects after buccal cancer surgery. The survival and functional recovery of the flap were observed.Results:All 6 flaps survived. The superficial inferior epigastric artery flaps ranged from 5.0 cm×7.0 cm to 7.0 cm×9.0 cm. The thickness of the flaps ranged from 0.5 cm to 1.3 cm, and the average thickness was 0.8 cm. The pedicle length is 6.0-9.0 cm.Four of them anastomosed to the superficial inferior epigastric veins and companion vein, 2 cases only anastomized superficial inferior epigastric veins . The follow-up period ranged from 3 to 12 months, with an average of 10 months. The cheek shape was good, the mouth opening was normal, there was no obvious bloating, and no secondary surgery was required. Linear scars were left on the donor site, with concealed location and no impairment of abdominal wall function.Conclusions:The donor site of the thin superficial inferior epigastric artery flap is small, the scar is concealed, the cheek is not bloated, and the opening degree of mouth is satisfactory. It is a good choice for reconstructing postoperative defect of cheek cancer.

Objective:To investigate the clinical effect of thin superficial inferior epigastric artery flaps in repairing soft tissue defects after buccal cancer surgery.Methods:From January 2018 to October 2019, 6 patients with buccal cancer who underwent surgery were constructed with thin superficial inferior epigastric artery flaps, including 2 males and 4 females, aged 43 to 68 years, with an average of 61.5 years. Doppler ultrasound was utilized of all patients to design flap preoperatively . According to the size of the affected area defect, according to the shape and direction of the blood vessels, a thin superficial inferior epigastric artery flap was elevated above the Scarpas fascia layer and transferred to repair soft tissue defects after buccal cancer surgery. The survival and functional recovery of the flap were observed.Results:All 6 flaps survived. The superficial inferior epigastric artery flaps ranged from 5.0 cm×7.0 cm to 7.0 cm×9.0 cm. The thickness of the flaps ranged from 0.5 cm to 1.3 cm, and the average thickness was 0.8 cm. The pedicle length is 6.0-9.0 cm.Four of them anastomosed to the superficial inferior epigastric veins and companion vein, 2 cases only anastomized superficial inferior epigastric veins . The follow-up period ranged from 3 to 12 months, with an average of 10 months. The cheek shape was good, the mouth opening was normal, there was no obvious bloating, and no secondary surgery was required. Linear scars were left on the donor site, with concealed location and no impairment of abdominal wall function.Conclusions:The donor site of the thin superficial inferior epigastric artery flap is small, the scar is concealed, the cheek is not bloated, and the opening degree of mouth is satisfactory. It is a good choice for reconstructing postoperative defect of cheek cancer.

Objective: To explore the clinical efficacy of combined plates through superior-ilioinguinal approach for acetabular fractures involving anterior wall and anterior column. Methods: Data of twelve patients with acetabular fractures involving anterior column and anterior wall who were treated by combined plates from June 2015 to August 2017 were retrospectively analyzed. Among them 9 cases were males and 3 cases were females, with an average age of 55.4 years old (range, 22-69 years old). Three cases were combined with posterior hemitransverse fractures. Six cases were combined with posterior column fractures. The mean time from injury to operation was 7.2 d (range, 5-12 d). Simultaneous management of anterior wall and anterior column fractures were achieved through single superior-ilioinguinal approach using the novel combined plates in all patients. The image results were evaluated by Matta’s standard and the functional outcome was evaluated by the Matta's improved Merle d'Aubigné-Postel scores system at the final follow-up. Results: All 12 patients were followed up for average 18.3 months (range, 12-24 months). Average blood loss was 560 ml (range, 200-1 200 ml) and average operative time was 102 min (range, 88-190 min). The mean time of bony union was 2.9 months (range, 2.5-4.5 months). The quality of postoperative fracture reduction was evaluated according to Matta’s standard, of which there were 7 cases anatomic, 3 cases satisfactory, and 2 cases unsatisfactory, with an anatomic or satisfactory rate of 83.3%(10/12). The average Matta’s improved Merle d’Aubigne-Postel score was 16.1 (range, 12-18), and there were 8 cases excellent, 2 cases good, 1 case fair and 1 case poor, with an excellent or good rate of 83.3%(10/12). Rupture of the peritoneum occurred in one patient during the surgery which was repaired immediately. One patient suffered obturator nerve palsy and was fully recovered in one year. No inguinal hernia, surgical site infection and femoral head avascular necrosis occurred. Conclusion The combined plates could provide simultaneous fixation for anterior column and anterior wall fractures firmly through single superior-ilioinguinal approach. Satisfactory reduction and functional outcomes could be achieved by the novel plates.

OBJECTIVE: To evaluate the efficacy of rapmycin for treatment of experimental autoimmune encephalomyelitis (EAE) in mice and explore the underlying mechanism. METHODS: An EAE model was established in C57BL/6 mice. After immunization, the mice were divided into model group and rapamycin groups treated daily with low-dose (0.3 mg/kg) or high-dose (1 mg/kg) rapamycin. The clinical scores of the mice were observed using Knoz score, the infiltration of IL-17 cells in the central nervous system (CNS) was determined using immunohistochemistry; the differentiation of peripheral Treg cells was analyzed using flow cytometry, and the changes in the levels of cytokines were detected with ELISA; the changes in the expressions of p-Smad2 and p- smad3 were investigated using Western blotting. RESULTS: High-dose rapamycin significantly improved the neurological deficits scores of EAE mice. In high-dose rapamycin group, the scores in the onset stage, peak stage and remission stage were 0.14±0.38, 0.43±1.13 and 0.14±0.37, respectively, as compared with 1.14±0.69, 2.14±1.06 and 2.2±0.75 in the model group. The infiltration of inflammatory IL-17 cells was significantly lower in high-dose rapamycin group than in the model group (43±1.83 153.5±7.02). High-dose rapamycin obviously inhibited the production of IL-12, IFN-γ, IL-17 and IL-23 and induced the anti-inflammatory cytokines IL-10 and TGF-β. The percentage of Treg in CD4+ T cells was significantly higher in high- dose rapamycin group than in the model group (10.17 ± 0.68 3.52 ± 0.32). In the experiment, combined treatments of the lymphocytes isolated from the mice with rapamycin and TGF-β induced a significant increase in the number of Treg cells (13.66±1.89) compared with the treatment with rapamycin (6.23±0.80) or TGF-β (4.87±0.85) alone. Rapamycin also obviously up-regulated the expression of p-Smad2 and p-Smad3 in the lymphocytes. CONCLUSIONS Rapamycin can promote the differentiation of Treg cells by up-regulating the expression of p-Smad2 and p-smad3 to improve neurological deficits in mice with EAE.
Animals ; Anti-Inflammatory Agents ; administration & dosage ; therapeutic use ; Cell Differentiation ; drug effects ; Encephalomyelitis, Autoimmune, Experimental ; drug therapy ; metabolism ; Interferon-gamma ; metabolism ; Interleukins ; metabolism ; Lymphocytes ; cytology ; Mice ; Mice, Inbred C57BL ; Sirolimus ; administration & dosage ; therapeutic use ; Smad Proteins ; metabolism ; T-Lymphocytes, Regulatory ; cytology ; drug effects ; Transforming Growth Factor beta ; metabolism ; Up-Regulation

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 design of a novel acetabulum anatomic locking plate and the clinical application for both column and quadrilateral surface fractures.Methods Clinical and follow-up data of 6 patients with both column fractures involving the quadrilateral plate managed operatively by a novel acetabulum anatomic locking plate from July 2014 to April 2015 were retrospectively analyzed.Among them 4 cases were male and 2 cases were female,with an average age of 35.1 years old (range,24-52 years old).The mean time from injury to operation was 7.2 d (range,2-12 d).According to the fracture classification of Letournel-Judet,there were all associated with two column fractures involving the quadrilateral plate..All patients managed operatively by the novel acetabulum anatomic locking plate,which can simultaneous manage both column and quadrilateral surface fractures through the single superior ilioinguinal approach.The image results by Matta standard were evaluated and the results of acetabular function after surgery were assessed by Merle d'Aubigne-Postel.Results The 6 patients were followed up for at least 14 months (range,12-22 months).Average blood loss was 860 ml,and average operative time was 286 min.The mean time of bony union was 4.3 months.According to the criteria described by Matta,66.7％ of the reductions were graded excellent,16.7％ were graded good,and 16.7％ were poor.Clinical outcomes (Merle d'Aubigne-Postel) at 12 months were 66.7％ excellent,16.7％ good,and 16.7％ poor.One patient (4.5％) had an iatrogenic injury of internal iliac artery during operation.Unilateral iliac artery embolization was performed.One patient had a fatty fluidization.No surgical site infection,femoral head avascular necrosis and traumatic arthritis occurred.Conclusion The novel acetabulum anatomic locking plates for both column and quadrilateral surface can provide strong and stable fixation for complex acetabular fractures through the single superior ilioinguinal approach.It can achieve satisfactory reduction and approving clinical functions.