Morphological measurements of the posterior surface of the normal proximal tibia in a healthy Chinese population

BackgroundTo measure and calculate the morphological parameters and determine the anatomical characteristics of the posterior surface of the proximal tibia in a healthy Chinese population.MethodsA total of 150 volunteers with normal knees were enrolled. The parameters in the multi-slice spiral computed tomography (MSCT) three-dimensional (3-D) reconstruction images were measured and calculated by two independent qualified observers. The differences and correlation were investigated. The intraclass correlation coefficient (ICC) was used to assess inter-observer reliability.ResultsThe posterior margin of the tibial plateau is presented as two superior arc-shapes. The central angles of these arcs were 118° ± 14° (medial) and 106° ± 20° (lateral). The radii of these arcs both showed a skewed distribution. The median radii of the arcs were 22 mm in the medial and 20 mm in the lateral. There were two significant angles present in the sagittal plane of the posterior cortex of the proximal tibia. The first angles were 39° ± 7° (medial) and 47° ± 7° (lateral). The second angles were 39° ± 4° (medial) and 41° ± 5° (lateral). Significant differences were observed in the central angles and the first angles but not in the second angles between the medial and lateral. There were no significant differences between different gender groups, and between left and right limbs. All of these parameters exhibited excellent to moderate ICC.ConclusionDue to the varying anatomic morphology between the postero-medial and postero-lateral surface of the proximal tibia, the internal fixation implants of these two parts should be designed differently.     

关节镜下自体韧带固定治疗后交叉韧带胫骨止点撕脱骨折 17例疗效分析

目的 分析关节镜下自体韧带"8"字固定法重建后交叉韧带胫骨止点撕脱骨折的临床疗效.方法 回顾性分析2013年1月至2017年6月广州市花都区人民医院收治纳入研究的后交叉韧带胫骨止点撕脱骨折病人17例,均行关节镜下后交叉韧带胫骨止点撕脱骨折自体半腱肌重建术,对比病人术前、术后VAS疼痛评分、IKDS膝关节评分、病人满意度.结果 病人随访31个月,时间范围为11～39个月,术后末次随访病人膝关节活动度较术前明显增加[(133.24±3.01)°比(36.29±2.82)°],视觉模拟(VAS)疼痛评分[(1.12±0.99)分比(6.06±1.34)分]、IKDS评分[(89.12±2.52)分比(37.94±2.11)分]均较术前明显改善,差异有统计学意义(P<0.05).其中有1例病人术后存留关节活动时疼痛,对手术效果不满意,16例病人表示满意,满意率94.1％.结论 关节镜下后交叉韧带胫骨止点撕脱骨折自体韧带重建效果良好,重建后对后交叉切割概率小,自体韧带无排异反应,功能恢复快.     

两种壳聚糖载rhBMP-2纳米微球对SD大鼠体内异位成骨的影响

目的　通过SD大鼠异位成骨实验来探究重组人骨形态发生蛋白-2/壳聚糖/硫酸葡聚糖(rhBMP-2/CS/DS) 复合微球和重组人骨形态发生蛋白-2/壳聚糖 (rhBMP-2/CS) 微球对SD大鼠体内异位成骨的影响。 方法　随机将36只SD大鼠平均分为三组（n=12）,分别为A组 (rhBMP-2), B组(rhBMP-2/CS), C组(rhBMP-2/CS/DS)。制备股四头肌肌袋模型后,分别将三种材料植入股四头肌肌袋肌间隙中。分别在4,8和12周时大体观察植入区组织硬度,每组处死4只大鼠后取出异位骨块,并切取异位骨化的组织行micro-CT扫描及 Mimics软件三维重建;检测各组织块骨体积分数（bone volume fraction,BVF）、骨小梁厚度（trabecular thichness,Tb.Th）、骨密度（bone mineral density,BMD）;并行组织学观察和ALP活性、钙含量检测。 结果 4周时,A、B、C三组植入区周围组织质地均稍硬,三者并无明显区别;8周和12周时,三组植入区硬度明显增加,且C组比A、B组质地更硬。4周时,HE染色可见三组有少量骨组织形成,但不明显;B、C两组BVF、Tb.Th、BMD,碱性磷酸酶（ALP）活性、钙含量均高于A组;B、C两组以上指标差异无统计学意义。8、12周时,HE染色可见到三组骨组织逐渐增多,并逐渐成熟,且B、C两组可见到比A组更成熟的骨组织,C组骨组织比B组更成熟;B、C两组BVF、Tb.Th、BMD,ALP活性、钙含量均高于A组,C组以上指标均高于B组。 结论　rhBMP-2/CS/DS纳米缓释微球的成骨效果明显强于rhBMP-2/CS纳米微球和单独rhBMP-2,其可能在骨组织工程领域有较好的运用前景。     

Assessing underlying bone quality in spine surgery patients: a narrative review of dual-energy X-ray absorptiometry (DXA) and alternatives

Poor bone quality and low bone mineral density (BMD) have been previously tied to higher rates of postoperative mechanical complications in patients undergoing spinal fusion. These include higher rates of proximal junctional kyphosis, screw pullout, pseudoarthrosis, and interbody subsidence. For these reasons, accurate preoperative assessment of a patient's underlying bone quality is paramount for all elective procedures. Dual-energy X-ray absorptiometry (DXA) is currently considered to be the gold standard for assessing BMD. However, a growing body of research has suggested that in vivo assessments of BMD using DXA are inaccurate and have, at best, moderate correlations to postoperative mechanical complications. Consequently, there have been investigations into using alternative methods for assessing in vivo bone quality, including using computed tomography (CT) and magnetic resonance imaging (MRI) volumes that are commonly obtained as part of surgical evaluation. Here we review the data regarding the accuracy of DXA for the evaluation of spine bone quality and describe the alternative imaging modalities currently under investigation.     

Serum osteopontin levels in relation to bone mineral density and bone turnover markers in postmenopausal women

Osteopontin (OPN) is an extracellular matrix protein that is expressed in bone cells such as osteoblast and osteocytes and associated with bone turnover and bone mineral density (BMD) in postmenopausal women. Here, we aimed to investigate the relationship between circulating OPN levels and BMD in postmenopausal women in Southern China. A total of 362 postmenopausal women were consecutively recruited into this study from 2011–2013. Serum levels of OPN, receptor activator of nuclear factor kappa B (NF-κB) ligand (RANKL), and bone turnover markers were analyzed. BMD was measured by dual energy X-ray absorptiometry. Osteoporosis and osteopenia were diagnosed according to the World Health Organization criteria. Serum OPN levels were remarkably higher in the osteoporotic group than those in the osteopenic and normal groups (all p?r?=??0.25, p?=?0.004; r?=??0.66, p?r?=??0.28, p?=?0.001; respectively) and positively associated with type I procollagen amino-terminal propeptide (PINP), carboxy-terminal cross-linking telopeptide of type I collagen (CTX), and RANKL (r?=?0.20, p?=?0.020; r?=?0.17, p?=?0.036; r?=?0.19, p?=?0.028, respectively) in the osteoporotic group. In multiple regression analyses, lumbar spine BMD, PTH and RANKL were the predictors for serum OPN levels. In conclusion, OPN serum levels are negatively related to BMD and positively correlated with bone turnover levels in this group of Chinese postmenopausal women.     

Serum serotonin concentration associated with bone mineral density in Chinese postmenopausal women

Recent studies have shown that circulating serotonin plays a potential role in bone metabolism. However, conflicting results have been reported for the relationship between serum serotonin concentrations and bone mineral density (BMD). We investigated whether the serum serotonin concentrations related to BMD in Chinese postmenopausal women. Serum serotonin and bone turnover concentrations of 117 premenopausal women and 262 asymptomatic postmenopausal women were analyzed by enzyme-linked immunosorbent assay. BMD at the lumbar spine and femoral neck was measured by dual energy X-ray absorptiometry. The relationship between serotonin and BMD was investigated. The postmenopausal women had lower mean serum serotonin concentrations compared to the premenopausal women. Serotonin concentrations were negatively associated with age, weight, BMI, fat mass, and β-CTX concentrations in postmenopausal women. No significant correlations were found between serotonin and these parameters in premenopausal women. In postmenopausal women, age- and BMI-adjusted serotonin concentrations were positively correlated with BMD of the lumbar spine and femoral neck. Multiple regression analyses showed serum serotonin and β-CTX were the predictors for lumbar spine BMD. Only serum serotonin was the determinant for femoral neck BMD. In conclusion, lower serum serotonin concentrations are linked to low lumbar spine and femoral neck BMD in postmenopausal women.     

几种指屈肌腱缝合方法的生物力学评价

目的：旨在通过比较四种肌腱缝合方法的抗拉强度，为临床应用及研究新的方法提供生物力学依据。方法：采用改良Ｋｅｓｓｌｅｒ法、Ｌｅｅ法、Ｂｅｃｋｅｒ法和Ｓａｖａｇｅ法，在体外缝合２８条人体指屈肌腱标本，对其抗拉强度进行生物力学评价。结果：四种方法其抗拉强度分别为３５．８Ｎ，３６．７Ｎ，７４．７Ｎ，９６．８Ｎ，结论：四种方法中Ｓａｖａｇｅ法在体外的抗拉强度最大，Ｂｅｃｋｅｒ法次之，改良Ｋｅｓｌｅｒ法和Ｌｅｅ法强度相同且最小。     

新型冠状病毒肺炎期间骨盆髋臼骨折诊疗专家共识

自2019年12月以来,新型冠状病毒(2019-nCoV)感染的肺炎(COVID-19)疫情暴发并向全国蔓延。相较于严重急性呼吸综合征(SARS)冠状病毒,2019-nCoV致死率更低,但却具有更高的传染性和致病力。截至2020年2月22日24时,累计报告确诊病例76936例(武汉36174例)[1];截至2月11日,全国医务人员感染3019例[2],远远超过了"非典"疫情感染人数。骨盆、髋臼骨折是创伤救治中最为复杂的病情之一,其发生率约占全身骨折的3%[3]。骨盆、髋臼骨折常发生于高能量损伤,容易合并大出血、重要脏器损伤等严重情况,病死率一直居高不下[4]。病毒流行为疫区骨盆、髋臼骨折院前急救、急诊诊疗、手术策略、麻醉和围手术期管理等医务工作带来了巨大挑战。在疫情流行期间,为了降低骨盆、髋臼骨折救治过程中患者之间、患者与医务人员之间、医务人员相互之间交叉感染的风险,提高骨折预后水平,需要通过多学科协作,统筹传染病和骨盆、髋臼骨折的诊疗方案,制定严密的诊疗计划,降低疾病的致残率和致死率。为响应党中央号召,科学战"疫",坚决打赢这场疫情防控的人民战争、总体战、阻击战,根据《新型冠状病毒感染的肺炎诊疗方案(试行第六版)》,结合肺炎防治和创伤救治相关诊疗指南[5,6,7,8,9,10],特制定此诊疗专家共识,以规范COVID-19疫情期间骨盆、髋臼骨折的诊疗,提高治愈率,降低交叉感染的风险。     

Morphological character of cervical spine for anterior transpedicular screw fixation

Background:

Anterior cervical interbody grafts/cages combined with a plate were frequently used in multilevel discectomies/corpectomies. In order to avoid additional posterior stabilization in patients who undergo anterior reconstructive surgery, an anterior cervical transpedicular screw fixation, which offers higher stability is desirable. We investigated in this study the anatomical (morphologic) characters for cervical anterior transpedicular screw fixation.

Materials and Methods:

Left pedicle parameters were measured on computed tomography (CT) images based on 36 cervical spine CT scans from healthy subjects. The parameters included outer pedicle width (Distance from lateral to medial pedicle surface in the coronal plane), outer pedicle height (OPH) (Distance from upper to lower pedicle surface in the sagittal plane), maximal pedicle axis length (MPAL), distance transverse insertion point (DIP), distance of the insertion point to the upper end plate (DIUP), pedicle sagittal transverse angle (PSTA) and pedicle transverse angle (PTA) at C3 to C7.

Results:

The values of outer pedicle width and MPAL in males were larger than in females from C3 to C7. The OPH in males was larger than in females at C3 to C6, but there was no difference at C7. The DIP and PTA were significantly greater in males than in females at C3, but there was no difference in the angle at C4-7. The PSTA was not statistically different between genders at C3, 4, 7, but this value in males was larger than females at C5, 6. The DIUP was significantly greater in males at C3, 4, 6, 7 but was non significant at C5.

Conclusions:

The placement of cervical anterior transpedicular screws should be individualized for each patient and based on a detailed preoperative planning.