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BACKGROUND: The medial column fracture of the proximal humeral fracture is a type of fracture with high postoperative complications after internal fixation. Proximal humeral internal locking system is widely used in the proximal humeral fracture. The biomechanical stability of two different internal fixation models for the treatment of the poor medial column support proximal humeral fractures with proximal humeral internal locking system and proximal humeral internal locking system with fibular allograft augmentation is still unclear. OBJECTIVE: To investigate the biomechanical stability of the proximal humeral intemallocking system and proximal humeral internal locking system with fibular allograft augmentation in the poor medial column support proximal humeral fracture with finite element analysis, and to compare the difference in fixation modes in humeral calcar supporting screws under different fixing methods. METHODS: The proximal CT data of osteoporosis were obtained. According to the 5-mm osteotomy of the humerus, the posterior medial column of the humerus was established and divided into two groups. Group A was the proximal humeral internal locking system plate group, in which the A 1 group was placed in the proximal end of the plate, the A2 group was the E screw missing, the A3 group was the D screw missing; the 8 group received the proximal humeral intemallocking system plate combined with fibular allograft augmentation, and all screws was placed in the proximal end of the plate in the 81 group. In the 82 group, E screw was missing; in the 83 group, D screw was missing. The three-dimensional finite element method was used to analyze the biomechanical stability of different groups of models under indirect violence. RESULTS AND CONCLUSION: (1) In terms of structural stability, 8 group was significantly better than A group. The structural stability of A 1 group and A3 group of A group was comparable and better than that in A2 group. In 8 group, the structural stability of 81 group and 82 group was comparable and superior to 83 group. (2) For the poor medial column support proximal humeral fracture, the mechanical stability of the proximal humeral internal locking system plate combined with fibular allograft augmentation was better than that of the proximal humeral intemallocking system plate alone. When the fibular support was combined, the screw placement in the proximal end of the plate is optimal, and D screw has an important stabilizing effect on the support of the poor medial column support proximal humeral fracture. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of low-intensity pulsed ultrasound (LIPUS) on hematopoietic function in rats after combined chemotherapy with doxorubicin and cyclophosphamide., Methods: Eighty rats were randomized into control group and LIPUS group ( n =40) for treatment with intraperitoneal injection of doxorubicin (2 mg/kg)+cyclophosphamide (20 mg/kg) for 4 consecutive days and continuous irradiation with LIPUS for 7 days following the injections, respectively. The white blood cells, red blood cells and platelets counts in each group were measured at 0, 4, 7, 9, 11, 14 and 18 days after the start of drug administration. The pathological sections of the bone marrow were examined at 0, 4 and 11 days, and the flow cytometry was performed for detecting the cell apoptosis; qPCR was performed for detecting the expressions of SCF, ICAM-1, and VCAM-1 mRNAs, and ELISA was used to detect the expressions of IL-3 and GM-CSF., Results: The white blood cell count was significantly higher in LIPUS group than in the control group ( P < 0.05). Histopathological examination of the bone marrow revealed significantly increased hematopoietic tissue in LIPUS group ( P < 0.05). Flow cytometry demonstrated an obviously lower cell apoptosis rate in the bone marrow in LIPUS group than in the control group ( P < 0.05). Compared with those in the control group, the mRNA expression levels of ICAM-1 and VCAM-1 as well as the protein levels of IL-3 and GM-CSF were significantly increased in LIPUS group ( P < 0.05)., Conclusions: LIPUS can alleviate the hematopoietic damage after combined chemotherapy with doxorubicin with cyclophosphamide probably by increasing the expressions of ICAM- 1, VCAM-1, IL- 3, and GM-CSF.

Objective: To investigate the effectiveness of a percutaneous release with L shaped hollow needle knife in treating trigger finger., Methods: Between September 2007 and September 2009, 160 patients with trigger fingers (202 fingers) were treated by percutaneous release with L shaped hollow needle knife. There were 47 males and 113 females with a mean age of 55 years (range, 12-68 years). The disease duration was 2 weeks to 1 year. Affected fingers included 58 thumbs, 20 index fingers, 46 middle fingers, 60 ring fingers, and 18 little fingers. According to Quinnell grading, 63 fingers were classified as grade III, 126 fingers as grade IV, and 13 fingers as grade V. A1 pulley was released during operation and steroid was injected after release procedure using the same needle., Results: The mean operation time was 8.2 minutes (range, 5-19 minutes), and no complication occurred. All the patients were followed up 1 year to 3 years and 6 months (mean, 1.6 years). The patients still felt pain in 36 fingers at 1 week after operation, which were relieved after oral administration of non-steroidal anti-inflammatory drug. Twenty-five fingers had snapping or locking in flexion-extension motion; 5 fingers recovered at 1 month after operation and 20 fingers had no obvious improvement; of 20 fingers, symptom was alleviated in 10 fingers, and was not alleviated in 10 fingers after re-release with L shaped hollow needle knife. According to Quinnell grading for efficacy evaluation at 6 months after operation, the results were excellent in 165 fingers, good in 27 fingers, poor in 10 fingers with an excellent and good rate of 95.0%., Conclusion: The percutaneous release with L shaped hollow needle knife is a safe and effective procedure in treating trigger finger with low complications.

This study sought to find out whether the femoral artery of rabbit could be occluded after microbubbles mediated intermitten ultrasound exposure. One hundred and eight rabbits were randomly divided into 3 groups subjected to 3 different factors, namely ultrasound, HIFU combined with Microbubble (the intermitten mode and the continuous mode). After exposure, HE staining was used for visual inspection of the histopathologic change of femoral artery. Electron microscope was used for observation of the ultramicrostructural change; digital subtraction radiography (DSA) was used for inspections of the change in blood flow. There were thrombi formed in the femoral artery and the blood flow was occluded; the endarterium of the femoral artery of rabbits was damaged, and there was cavitation observed in the intermitten exposure group. In the other two groups, there was no change in the the femoral artery of rabbits. Thrombus could be formed in the femoral artery, and blood flow was occluded after exposure to microbubbles-mediated intermitten HIFU.

Objective: To assess the outcomes of pedicle subtraction osteotomy and short-segment pedicle screw internal fixation in kyphosis deformity., Methods: From June 2001 to November 2003, 16 cases of kyphosis deformity were treated with pedicle subtraction osteotomy and short-segment pedicle screw internal fixation, including 11 males and 5 females and aging 24-51 years. The kyphosis deformity was caused by ankylosing spondylitis in 12 cases, old lumbothoracic fracture-dislocation in 2 cases, and vertebral dysplasia in 2 cases. The disease course was 7-25 years with an average of 12.8 years. The whole spine radiographs were taken pre- and postoperatively. The sagittal balance was assessed by measuring thoracic kyphosis angle, lumbar lordosis angle, sacrohorizontal angle and distance between posterosuperior point of S1 and the vertical line. The clinical outcomes were assessed by Bridwell-Dewald scale for spinal disorders., Results: The mean follow-up period was 25. 6 months. The mean bleeding was 1100 ml. Satisfactory bone graft healing was achieved at final follow-up. Complications were paralytic intestinal obstruction in 1 case, dura laceration in 1 case, and temporary lower limb paralysis in 2 cases. Final follow-up radiograph showed an increase in lumbar lordosis angle from 9.6+/-16.4 degrees to 42.6 14.3 degrees (P<0.05), whereas thoracic kyphosis angle remained relative stable. The distance between posterosuperior point of S1 and the vertical line was decreased from 97.5+/-45.6 mm to 10.7+/-9.6 mm (P < 0.05). Satisfactory clinical outcome was achieved by evaluating the changes of pain, social and working status., Conclusion: Pedicle subtraction osteotomy and short-segment pedicle screw internal fixation is effective for correction of kyphosis deformity.

Objective: To develop a new noninvasive limb-salvaging method in the treatment of primary malignant bone tumor in the extremities., Methods: Forty-four patients with primary malignant bone tumor were treated by extracorporal high intensity focused ultrasound (HIFU) with or without chemotherapy, with a mean follow-up of 17.6 months., Results: The overall survival and complication rates were 84.1% and 18.2%. In 34 patients with stage II b disease, 30 were disease-free, with 2 died of tumor metastasis to brain and lung and 3 developed local recurrence. In 10 patients with stage III b disease, 5 survived with tumor, with 1 developed local recurrence and 5 died of lung metastasis. Thirty-six of 44 patients were > or = 15 points by Enneking system., Conclusion: High intensity focused ultrasound combined with chemotherapy for primary malignant bone tumor in the extremity is proved to be effective and safe, preserving good function in the limbs. HIFU may possibly become a new limb-salvaging treatment for this tumor.

Objective: To investigate the efficacy and side-effects of high intensity focused ultrasound (HIFU) in the treatment of malignant solid tumors., Methods: Thirty such patients who refused surgery and or refractory to chemotherapy, were treated by HIFU alone, with the efficacy and side effects monitored in terms of vital organ signs observation, functional assay of important organs, imaging examinations: digital subtraction angiography (DSA), CT, MRI, single photoemission computed tomography (SPECT), large core needle biopsy, complications or metastasis., Results: After HIFU therapy, the vital signs remained stable and the function of heart, lung, kidney and liver was also normal. DSA images showed that small or larger arteries were not damaged. After a follow-up of 10 - 38 months (23.1 months), 26 patients (87%) have been alive. The volume of the tumor underwent complete regression in 10 patients. Shrinkage of tumor volume >/= 50% was observed in 13. Eight of 13 patients were examined by large core needle biopsy, all showing necrosis and/or fibrosis though 3 patients (10%) had local recurrence. Two of these were retreated again by HIFU and the locally recurrent tumor became well controlled. New metastases developed in 5 patients after HIFU therapy. Two patients suffered from peripheral nerve injuries, most of which have recovered during the follow-up. However, one patient developed skin injury., Conclusion: High intensity focused ultrasound alone is effective and safe in the treatment of malignant solid tumors.