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Yi X.-H.,Wenzhou Medical College | Chen H.-W.,Central Hospital of Yiwu City | Pan J.,Wenzhou Medical College
Yiyong Shengwu Lixue/Journal of Medical Biomechanics | Year: 2013

Objective: To investigate the biomechanical stability of DHS (dynamic hip screw) and PFN (proximal femoral nail) for treating unstable intertrochanteric fractures. Methods: A standard 4-part osteotomy was performed in 8 pairs of fresh frozen human cadaver femurs, which were then randomly assigned to two groups: PFN group and DHS group for biomechanical testing. These specimens were applied to a cyclic load up to 0.2, 0.4, 0.6, 0.8, 1, 1.2, 1.4 kN, respectively. Fracture displacement was measured during the loading to determine biomechanical stability of the implant. Each specimen was repeatedly loaded for 5 times to calculate the average displacement and draw the load-displacement curve. For failure testing, the initial load and loading rate was set at 1.4 kN and 10 N/s, respectively. The applied compressive load was increased by 600 N each time for five cycles. The pressure was gradually increased to its peak force, and sustained for 10 second before it was gradually decreased to 0 N. The highest force value sustained before failure was defined as the maximum strength of the implant. Results: The biomechanical testing on all specimens was completed successfully. There was no damage to the internal fixation. The average displacement and stiffness in DHS group were (3.92±2.21) mm and (215.28±58) N/mm, while those in PFN group were (4.22±1.80) mm and (197.06±34.20) N/mm, so no significant difference was found between the DHS and the PFN group (P> 0.05). New fracture occurred at the distal end of nail in PFN group. The DHS was fractured at the distal cortical screw, but no nail was cut out of the femoral head. The average load required for failure was (4312±560) N in PFN group and (3954±520) N in DHS group, and no significant difference was found between the two groups (P>0.05). Conclusions: The test shows that the PFN does not appear to offer any distinct biomechanical advantage over the DHS in the treatment of unstable intertrochanteric fractures. The implant chosen for treating intertrochanteric fractures must depend on patient's fracture geometry, and anatomic reduction should be conducted in clinical treatment. If the anatomic reduction is difficult, try to recover continuity of the posterior cortical bone would be necessary. Source

Liu G.-D.,Chongqing Medical University | Zhang Q.-G.,Tongji University | Ou S.,General Hospital of Guangzhou Military Command | Zhou L.-S.,General Hospital of Guangzhou Military Command | And 4 more authors.
International Journal of Surgery | Year: 2013

Objective: The purpose of this study is to compare the outcomes of intramedullary nailing and plate fixation in the treatment of humeral shaft fractures using meta-analysis. Methods: PubMed, MEDLINE, EMBASE, the Cochrane Controlled Clinical Trials Register (CCTR) databases were searched for studies that investigated the efficacy of intramedullary nailing and plate fixation in the management of humeral shaft fractures. Delayed healing rate, nonunion, postoperative infection and radial nerve paralysis were key outcomes of interest. Data were searched within the time period of July 1990 through September 2012. The statistical software RevMan 5.0 was used to analyze the statistical significance of the results. Results: Total 459 cases of patients in 10 literature, including 231 cases of plate group and 228 cases of the intramedullary nailing groups were collected. The results of meta-analysis showed that delayed healing rate of humeral shaft fractures was lower in plate fixation compared with intramedullary nailing (RR=2.64, 95% CI (1.08, 6.49), P<0.05). No statistically significant difference in nonunion, postoperative infections, radial nerve paralysis and other complications was identified between nailing and plate fixation groups (P>0.05). Conclusions: In general, the effect size of intramedullary nailing may be comparable to that of plate fixation in the terms of nonunion, postoperative infections, radial nerve paralysis. The only slightly difference was identified in the event of delayed healing rate. © 2013 Surgical Associates Ltd. Source

Chen H.-W.,Central Hospital of Yiwu City | Liu G.-D.,Chongqing Medical University | Ou S.,General Hospital of Guangzhou Military Command | Fei J.,Chongqing Medical University | And 3 more authors.
PLoS ONE | Year: 2015

The aim of the study was to explore the clinical outcome of posterolateral and anteromedial approaches in treatment of terrible triad of the elbow. The study involved 12 patients with closed terrible triad of the elbow treated by posterolateral and anteromedial approaches between January 2010 and June 2012. The mechanism of injury included fall from height in 9 patients and traffic accident in 3. According to O'Driscoll classification for fractures of the ulnar coronoid, there were 11 patients with type I and 1 with type II fractures. According to Mason classification for fractures of the radial head, there were 3 patients with type I, 7 with type II and 2 with type III fractures. All patients were followed up for 12-27 months (average 15.5 months), which showed no pain or severe pain in all patients except for 2 patients with mild pain. At the last follow-up, the mean flexion was for 125° (range, 90°-140°), the mean extension loss for 20° (range, 0° -70°), the mean pronation for 66° (range, 20°-85°) and the mean supination for 60° (range, 30° -85°). The bony union time was 8-14 weeks (average 11 weeks) and the elbows were stable in flexion-extension and varus-valgus in all patients. The elbows maintained a concentric reduction of both the ulnotrochlear and the radiocapitellar articulation. Mild heterotopic ossification of the elbow occurred in 3 patients at 6 months after operation and mild degenerative change in 1 patient at 18 months after operation. The Broberg and Morrey elbow performance score was 82 points (range, 58-98 points). The results were excellent in 6 patients, good in 4, fair in 1 and poor in 1, with excellence rate of 83.3%. The results showed that the combined posterolateral and anteromedial approaches can facilitate the reduction and fixation of terrible triad of the elbow. Repair of radial head, coronoid, medial and lateral collateral ligaments can sufficiently restore the elbow stability, allow early postoperative motion and enhance the functional recovery. © 2015 Chen et al. Source

Chen H.-W.,Central Hospital of Yiwu City | Ou S.,General Hospital of Guangzhou Military Command | Liu G.-D.,Chongqing Medical University | Fei J.,Chongqing Medical University | And 3 more authors.
Clinical Neurology and Neurosurgery | Year: 2014

Objectives The aim of this study was to evaluate the clinical efficacy of simple decompression (SD) versus anterior transposition (AT) of the ulnar nerve for the treatment of cubital tunnel syndrome.Methods Seven public databases (PubMed, MEDLINE and EMBASE, Springer, Elsevier Science Direct, Cochrane Library and Google scholar) were searched from 1971 to December 2013. The overall odds ratios (OR) and their 95% confidence intervals (CI) were pooled to compare the clinical outcomes. Subgroup analysis was performed based on the region, study type, Jadad score, type of AT, and follow-up duration. Meta-analysis was conducted by using Rev. Man 5.1 and Stata 11.0 software.Results Finally, we included 13 studies involved 1009 (500 patients receiving SD and 509 patients receiving AT) patients with cubital tunnel syndrome. The overall estimate (OR = 0.91, 95% CI = 0.67-1.23, P = 0.536) indicated that there was no significantly statistical difference between the clinical outcomes of patients treated with SD and AT. Meanwhile, subgroup analyses by region, study type, Jadad score, type of AT and follow-up duration showed the consistent results with the overall estimate. In addition, we found that the incidence of complications in patients treated by SD was significantly lower than that in patients treated by AT (OR = 0.32, 95% CI = 0.17-0.60, P = 0.05).Conclusions In conclusion, although SD had equivalent clinical outcomes with AT for the treatment of cubital tunnel syndrome, SD should be preferred due to having lower incidence of complications. © 2014 Elsevier B.V. All rights reserved. Source

Zong Y.,Zhejiang University | Chen J.,Central Hospital of Yiwu City | Guo J.-Z.,Kunming Medical University | Zhang X.-J.,Kunming Medical University | And 2 more authors.
Acta Anatomica Sinica | Year: 2015

Objective To investigate the inhibiting effects of resveratrol (Res) on the expression of potentially inflammatory cytokines by cultured osteoclast precursor Raw 264. 7 cells stimulated with lipopolysaccharide ( LPS ). Methods Inflammatory cell model was established by LPS-stimulated Raw 264. 7 cells. The Raw 264. 7 cell identification test was measured by tartrate resistant acid phosphatase (TRAP) staining. The cells were treated with Res ( 1 μmol/L and 5 μmol/L ) prior to LPS ( 5 mg/L ) exposure. The effects on the mRNA and protein levels of inflammatory enzymes, inducible nitric oxide synthase ( iNOS ) and cyclooxygenase-2 ( COX-2 ), and inflammatory cytokines, tumor necrosis factor-a ( TNF-α ), and interleukin-1 β ( IL-1 β ), inflammatory signaling proteins nuclear factor-κB ( NF-κB ) were analysed by reverse transcription-polymerase chain reaction (RT-PCR) and double-immunofluorescence labeling assay. The effects of Res on cytotoxicity determination of Raw 264. 7 cells were measured by MTT assay. Results LPS-induced iNOS, COX-2 and NF-κB protein and mRNA expression levels were significantly decreased by Res. Res had an effect on the expression of TNF-α, IL-1 β through transcriptional and translational inhibition. Conclusion The inhibitory effects of Res on LPS-induced inflammatory mediators in osteoclast precursor cells exert functions on its anti-osteoporosis through NF-κB. Source

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