双侧耳郭软骨骨化1例并文献复习

目的探讨耳郭软骨骨化的发病机制、临床表现、诊断依据、鉴别诊断、治疗方法。方法回顾性分析1例耳郭软骨骨化患者的临床资料并复习相关文献进行总结。结果耳郭软骨骨化的发病机制暂不明确,通常无明显不适症状,少数患者可伴有局部疼痛、听力下降等症状。颞骨CT可辅助诊断,最终确诊依赖于组织病理检查。症状不明显时可暂予观察,若症状严重影响了生活和工作,可予手术治疗。结论耳郭软骨骨化在临床上较为少见,目前尚无有效逆转耳郭骨化的办法。积极寻找病因,及早干预,有利于避免病情进一步发展。     

Acute total hip arthroplasty for older patients with acetabular fractures: A meta-analysis

ObjectiveMultiple treatment options for acetabular fractures in geriatric patients exist. However, no large-scale studies have reported the outcomes of acute total hip arthroplasty (THA) in this patient population. We systematically evaluated all available evidence to characterize clinical outcomes, complications, and revisions of acute THA for acetabular fractures in geriatric patients.MethodsMeta-analysis of 21 studies of 430 acetabular fractures with mean follow-up of 44 months (range, 17−97 months). Two independent researchers searched and evaluated the databases of Ovid, Embase, and United States National Library of Medicine using a Boolean search string up to December 2019. Population demographics and complications, including presence of heterotopic ossification (HO), dislocation, infection, revision rate, neurological deficits, and venous thromboembolic event (VTE), were recorded and analyzed.ResultsWeighted mean Harris Hip Score was 83.3 points, and 20% of the patients had reported complications. The most common complication was HO, with a rate of 19.5%. Brooker grade III and IV HO rates were lower at 6.8%. Hip dislocation occurred at a rate of 6.1%, 4.1% of patients developed VTE, deep infection occurred in 3.8%, and neurological complications occurred in 1.9%. Although the revision rate was described in most studies, we were unable to perform a survival analysis because the time to each revision was described in only a few studies. The revision rate was 4.3%.ConclusionsAcute THA is a viable option for treatment of acetabular fracture and can result in acceptable clinical outcomes and survivorship rates in older patients but with an associated complication rate of approximately 20%. Considering the limited treatment options, THA might be a viable alternative for appropriately selected patients.     

Could self-locking stand-alone cage reduce adjacent-level ossification development after aneterior cervical discectomy and fusion?

Numerous studies have shown that cervical arthrodesis is associated with the adjacent-segment pathology (ASP), such as adjacent-level ossification development (ALOD). However, it still remains largely unclear whether the self-locking stand-alone implant system can reduce the incidence of ALOD. In the present study, we prospectively recruited 120 patients with cervical degenerative disc disease (CDDD) who were treated by anterior cervical discectomy and fusion (ACDF). These patients were randomly and evenly divided into the ROI-C group and plate group. Clinical and radiologic follow-up was performed at 3, 6, 12, 24 and 36 months after surgery. Clinical evaluation included preoperative and postoperative assessments of Japanese Orthopaedic Association (JOA) score and Neck Disability Index (NDI) score. The presence and severity of ALOD, as well as the C2-7 Cobb angle, were assessed on the lateral cervical films during follow-up. There were no significant differences in JOA and NDI scores at each time point during the follow-up period between the two groups. ALOD occurred in 8.8% of 58 patients and 6.7% of 104 levels in the cage group. Moreover, ALOD occurred in 20.1% of 57 patients and 17.8% of 101 levels in the plate group. The ALOD was more serious in the plate group compared with the cage group. The C2-7 Cobb angle was significantly improved compared with that before the operation and could be maintained during the follow-up in both groups. The self-locking stand-alone cage was efficacious for ACDF, and it could reduce the incidence of ALOD compared with anterior plate and cage.     

强直性脊柱炎异位骨化机制研究进展

强直性脊柱炎是一种发病机制不明的慢性炎性脊柱关节病,主要侵犯骶髂关节、脊柱关节等,严重者可发生脊柱、关节的畸形和强直。临床表现为炎性腰背痛,夜间及休息后加重,活动后减轻。该病发病率男性高于女性,且男性主要表现为中轴关节改变,而女性大多首发于外周关节。目前生物制剂肿瘤坏死因子抑制剂通过控制炎症,从而改善病情发展,被认为是最前沿的药物,但其在阻断新骨形成方面尚未经循证医学证实有效。本文着眼于新骨形成角度,从基因及细胞因子层面探讨强直性脊柱炎的病因。目前相关研究发现LRP5、ANTXR2、PTGER4、ANKH等基因的异常表达激活骨形成信号通路,在多种细胞因子及相关蛋白(如Noggin蛋白、DKK、转化生长因子-β、骨形态发生蛋白、碳酸酐酶1等)直接或间接作用下将骨形成信号传至靶细胞表面,进而传入细胞核,改变靶细胞正常生理代谢过程,导致过度骨形成,造成异位骨化。近年的临床影像学病例分析也提示了骨赘形成的分布特点,进而推断机械应力是促进其形成的外部因素。本文对强直性脊柱炎异位骨化方面进行了文献综述,以期待能进一步加深对本病的认识,为临床治疗研究提供新的思路。     

Acute total hip arthroplasty for older patients with acetabular fractures: A meta-analysis

ObjectiveMultiple treatment options for acetabular fractures in geriatric patients exist. However, no large-scale studies have reported the outcomes of acute total hip arthroplasty (THA) in this patient population. We systematically evaluated all available evidence to characterize clinical outcomes, complications, and revisions of acute THA for acetabular fractures in geriatric patients.MethodsMeta-analysis of 21 studies of 430 acetabular fractures with mean follow-up of 44 months (range, 17−97 months). Two independent researchers searched and evaluated the databases of Ovid, Embase, and United States National Library of Medicine using a Boolean search string up to December 2019. Population demographics and complications, including presence of heterotopic ossification (HO), dislocation, infection, revision rate, neurological deficits, and venous thromboembolic event (VTE), were recorded and analyzed.ResultsWeighted mean Harris Hip Score was 83.3 points, and 20% of the patients had reported complications. The most common complication was HO, with a rate of 19.5%. Brooker grade III and IV HO rates were lower at 6.8%. Hip dislocation occurred at a rate of 6.1%, 4.1% of patients developed VTE, deep infection occurred in 3.8%, and neurological complications occurred in 1.9%. Although the revision rate was described in most studies, we were unable to perform a survival analysis because the time to each revision was described in only a few studies. The revision rate was 4.3%.ConclusionsAcute THA is a viable option for treatment of acetabular fracture and can result in acceptable clinical outcomes and survivorship rates in older patients but with an associated complication rate of approximately 20%. Considering the limited treatment options, THA might be a viable alternative for appropriately selected patients.     

Genetic interactions between Ror2 and Wnt9a,Ror1 and Wnt9a and Ror2 and Ror1: Phenotypic analysis of the limb skeleton and palate in compound mutants

Mutations in the human receptor tyrosine kinase ROR2 are associated with Robinow syndrome (RRS) and brachydactyly type B1. Amongst others, the shortened limb phenotype associated with RRS is recapitulated in Ror2^?/? mutant mice. In contrast, Ror1^?/? mutant mice are viable and show no limb phenotype. Ror1^?/?;Ror2^?/? double mutants are embryonic lethal, whereas double mutants containing a hypomorphic Ror1 allele (Ror1^hyp) survive up to birth and display a more severe shortened limb phenotype. Both orphan receptors have been shown to act as possible Wnt coreceptors and to mediate the Wnt5a signal. Here, we analyzed genetic interactions between the Wnt ligand, Wnt9a, and Ror2 or Ror1, as Wnt9a has also been implicated in skeletal development. Wnt9a^?/? single mutants display a mild shortening of the long bones, whereas these are severely shortened in Ror2^?/? mutants. Ror2^?/?;Wnt9a^?/? double mutants displayed even more severely shortened long bones, and intermediate phenotypes were observed in compound Ror2;Wnt9a mutants. Long bones were also shorter in Ror1^hyp/hyp;Wnt9a^?/? double mutants. In addition, Ror1^hyp/hyp;Wnt9a^?/? double mutants displayed a secondary palate cleft phenotype, which was not present in the respective single mutants. Interestingly, 50% of compound mutant pups heterozygous for Ror2 and homozygous mutant for Ror1 also developed a secondary palate cleft phenotype.