Objective To simulate anterosuperior instabil ity of the shoulder by a combination of massive irreparable rotator cuff tears and coracoacromial arch disruption in cadaveric specimens, use proximally based conjoined tendon transfer forcoracoacromial l igament (CAL) reconstruction to restrain against superior humeral subluxation, and investigate its feasibility and biomechanics property. Methods Nine donated male-adult and fresh-frozen cadaveric glenohumeral joints were applied to mimic a massive irreparable rotator cuff tear in each shoulder. The integrity of the rotator cuff tendons and morphology of the CAL were visually inspected in the course of specimen preparation. Cal ipers were used to measure the length of the CAL’s length of the medial and the lateral bands, the width of coracoid process and the acromion attachment, and the thickness in the middle, as well as the length, width and thickness of the conjoined tendon and the lateral half of the removed conjoined tendon. The glenohumeral joints were positioned in a combination of 30° extension, 0° abduction and 30° external rotation. The value of anterosuperior humeral head translation was measured after the appl ication of a 50 N axial compressive load to the humeral shaft under 4 sequential scenarios: intact CAL, subperiosteal CAL release, CAL anatomic reattachment, entire CAL excision after lateral half of the proximally based conjoined tendon transfer for CAL reconstruction. Results All specimens had an intact rotator cuff on gross inspection. CAL morphology revealed 1 Y-shaped, 4 quadrangular, and 4 broad l igaments. The length of the medial and lateral bands of the CAL was (28.91 ± 5.56) mm and (31.90 ± 4.21) mm, respectively; the width of coracoid process and acromion attachment of the CAL was (26.80 ± 10.24) mm and (15.86 ± 2.28) mm, respectively; and the thickness of middle part of the CAL was (1.61 ± 0.36) mm. The length, width, and thickness of the proximal part of the proximally based conjoined tendon was (84.91 ± 9.42), (19.74 ± 1.77), and (2.09 ± 0.45) mm, respectively. The length and width of the removed lateral half of the proximally conjoined tendon was (42.67 ± 3.10) mm and (9.89 ± 0.93) mm, respectively. The anterosuperior humeral head translation was intact CAL (8.13 ± 1.99) mm, subperiosteal CAL release (9.68 ± 1.97) mm, CAL anatomic reattachment (8.57 ± 1.97) mm, and the lateral half of the proximally conjoined tendon transfer for CAL reconstruction (8.59 ± 2.06) mm. A significant increase in anterosuperior migration was found after subperiosteal CAL release was compared with intact CAL (P lt; 0.05). The translation after CAL anatomic reattachment and lateral half of the proximally conjoined tendon transfer for CAL reconstruction increased over intact CAL, though no significance was found (P gt; 0.05); when they were compared with subperiosteal CAL release, the migration decreased significantly (P lt; 0.05). The translation of lateral half of the proximally conjoined tendon transfer for CAL reconstruction increased over CAL anatomic reattachment, but no significance was evident (P gt; 0.05). Conclusion The CAL should be preserved or reconstructed as far as possible during subacromial decompression, rotator cuff tears repair, and hemiarthroplasty for patients with massive rotator cuff deficiency. If preservation or the insertion reattachment after subperiosteal release from acromion of the CAL of the CAL is impossible, or CAL is entirely resected becauseof previous operation, the use of the lateral half of the proximally based conjoined tendon transfer for CAL reconstruction isfeasible.
Objective To evaluate the clinical importance of doublecontrast CTdiagnosis of traumatic anterior shoulder instability. Methods Forty-eight patients underwent double contrast CT scan. With the guide of CT scan, anterior arthrocentesis of the shoulder was performed and 4 ml of 76% urografin was injected into the joint and then 10 ml of filtrated air was injected. The patients wereexamined by SOMATOM CR Systematic CT. The results of double contrast CT of the 48 patients were divided into Ⅰ, Ⅱ and Ⅲ degree according to the CT results related to their injury history, clinical symptoms, signs and operation findings. Results The patients had no complaint after the CT examination exceptfor 3 patients, who had slight pain within 2 days after CT examination. The results of double contrast CT were as follow:Ⅰ degree: 9 patients, Ⅱ degree: 22 patients, and Ⅲ degree: 17 patients. All patients with Ⅰ degree injuries were treated with rehabilitation program. The patients with Ⅱ degree injuries were mainly treated withrehabilitation program, but took much longer time. The patients with Ⅲ degreeinjuries were suggested to be treated with surgery. Conclusion To divide the results of double contrast CT into Ⅰ，Ⅱ and Ⅲ degree not only reflects the severity of traumatic anterior shoulder instability but provides information for the treatment of the instability.
Objective To evaluate the biomechanical stability of a newly-designed Y type pedicle screw (YPS) in osteoporotic synthetic bone. Methods The osteoporotic synthetic bone were randomly divided into 3 groups (n=20). A pilot hole, 3.0 mm in diameter and 30.0 mm in deep, was prepared in these bones with the same method. The YPS, expansive pedicle screw (EPS), and bone cement-injectable cannulated pedicle screw (CICPS) were inserted into these synthetic bone through the pilot hole prepared. X-ray film examination was performed after 12 hours; the biomechanical stability of YPS, EPS, and CICPS groups was tested by the universal testing machine (E10000). The test items included the maximum axial pullout force, the maximum running torque, and the maximum periodical anti-bending. Results X-ray examination showed that in YPS group, the main screw and the core pin were wrapped around the polyurethane material, the core pin was formed from the lower 1/3 of the main screw and formed an angle of 15° with the main screw, and the lowest point of the inserted middle core pin was positioned at the same level with the main screw; in EPS group, the tip of EPS expanded markedly and formed a claw-like structure; in CICPS group, the bone cement was mainly distributed in the front of the screw and was dispersed in the trabecular bone to form a stable screw-bone cement-trabecular complex. The maximum axial pullout force of YPS, EPS, and CICPS groups was (98.43±8.26), (77.41±11.41), and (186.43±23.23) N, respectively; the maximum running torque was (1.42±0.33), (0.96±0.37), and (2.27±0.39) N/m, respectively; and the maximum periodical anti-bending was (67.49±3.02), (66.03±2.88), and (143.48±4.73) N, respectively. The above indexes in CICPS group were significantly higher than those in YPS group and EPS group (P<0.05); the maximum axial pullout force and the maximum running torque in YPS group were significantly higher than those in EPS group (P<0.05), but there was no significant difference in the maximum periodical anti-bending between YPS group and EPS group (P>0.05). Conclusion Compared with EPS, YPS can effectively enhance the maximum axial pullout force and maximum rotation force in the module, which provides a new idea for the design of screws and the choice of different fixation methods under the condition of osteoporosis.
ObjectiveTo analyze the status of applying programmed death-1 (PD-1) / programmed death-ligand 1 (PD-L1) inhibitors combined with vascular endothelial growth factor (VEGF) / vascular endothelial growth factor receptor (VEGFR) inhibitors in advanced refractory colorectal cancer. MethodThe relevant literature on domestic and foreign research in recent years was summarized. ResultsThe discovery of immune checkpoint PD-1/PD-L1 and the clinical application of related drugs had changed the treatment pattern of advanced solid tumors, but PD-1/PD-L1 inhibitors had a poor efficacy in the mismatch repair prodicient tumors, and most advanced colorectal cancer belonged to this type. The combination of PD-1/PD-L1 inhibitors and VEGF/VEGFR inhibitors could enhance the therapeutic effect in the advanced refractory colorectal cancer, and their interaction mechanisms and clinical efficacy were continuously being proven. ConclusionsThe combination of PD-1/PD-L1 inhibitors and VEGF/VEGFR inhibitors is a promising treatment strategy for advanced refractory colorectal cancer. More studies need to be further clarified its efficacy.
ObjectiveTo compare the effectiveness of long and short proximal femoral nail anti-rotation (PFNA) in the treatment of type A2.3 intertrochanteric fracture of femur (IFF). Methods The clinical data of 54 patients with type A2.3 IFF admitted between January 2020 and December 2022 were retrospectively analyzed. According to the length of PFNA nail used in the operation, they were divided into long nail group (PFNA nail length>240 mm, 24 cases) and short nail group (PFNA nail length≤240 mm, 30 cases). There was no significant difference in baseline data such as gender, age, fracture side, body mass index, and time from fracture to operation between the two groups (P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, intraoperative reduction quality score, fracture healing, and complications of the two groups were recorded and compared. Harris score was used to evaluate the hip function of patients at 1 year after operation. According to the relationship between the fracture line of type A2.3 IFF and the lesser trochanter, the two groups of patients were divided into type Ⅰ(the fracture line extends to the level of the lesser trochanter), type Ⅱ(the fracture line extends to less than 2 cm below the lesser trochanter), and type Ⅲ (the fracture line extends to more than 2 cm below the lesser trochanter), and the postoperative stability and internal fixator loosening of each subtype were evaluated. Results The operation time, intraoperative blood loss, and intraoperative fluoroscopy frequency in short nail group were significantly less than those in long nail group (P<0.05). There was no significant difference in the intraoperative reduction quality score between the two groups (P>0.05). Patients in both groups were followed up 12-18 months, with an average of 13.5 months. The postoperative stability score of short nail group was significantly lower than that of long nail group (P<0.05). The Harris score in the long nail group was significantly higher than that in the short nail group at 1 year after operation (P<0.05), but there was no significant difference in Harris score grading between the two groups (P>0.05). Complications occurred in 3 cases of the long nail group (including 1 case of coxa varus caused by external nail entry point and 2 cases of loose internal fixator), and 7 cases of the short nail group (including 1 case of coxa varus caused by external nail entry point and 6 cases of loose internal fixator). Neither group had any anterior femoral arch damage, there was no significant difference in the incidence of complications between the two groups (P>0.05). The number of type Ⅲ patients was relatively small and not included in the statistics; there was no significant difference in the postoperative stability score and the incidence of internal fixator loosening between the long and short nail groups in type Ⅰ patients (P>0.05). In type Ⅱ patients, the postoperative stability score and the incidence of internal fixation loosening in the long nail group were significantly better than those in the short nail group (P<0.05).Conclusion Long PFNA fixation for type A2.3 IFF has longer operation time and more intraoperative blood loss, but the overall stability of fracture is better after operation. For type A2.3 IFF with fracture line extending to less than 2 cm below the lesser trochanter, long PFNA is used for fixation, although the surgical trauma is large, but the postoperative stability is better than that of short PFNA; for type A2.3 IFF with fracture line extending to the lesser trochanter, there is no significant difference in postoperative stability between long and short PFNAs.
Objective To analyze the main reasons of acetabular component initial instabil ity after primary total hip arthroplasty (THA) and to disscuss the prevention and management. Methods The cl inical data were retrospectively analyzed from 19 patients undergoing revision for acetabular component initial instabil ity after primary THA between January 2003 and June 2010. There were 11 males and 8 females, aged from 55 to 79 years (mean, 67.2 years). The locations were lefthip in 9 cases and right hip in 10 cases. The cementless hip prosthesis was used in 12 cases and cement hip rosthesis in 7 cases. The revisions were performed at 3 weeks to 6 months after primary THA. The reasons of early failure were analyzed. Both the coverage rate of acetabulum-bone and the Harris hip score were compared between pre- and post-revision. Results The main reason of acetabular component initial instabil ity after primary THA may be unsuitable treatment of acetabulum, improper selection of acetabular component, and incorrect place angle of acetabular component. Sciatic nerve palsy occurred in 1 case and recovered at 7 weeks after revision. Sl ight fracture of the acetabulum in 1 case and healed at 3 months after revision. All incisions healed by first intention. No infection, vessel injury, displacement of acetabular component, or deep vein thrombosis occurred. The patients were followed up 11-73 months (mean, 28 months). At last follow-up, no acetabular component instabil ity was observed. The coverage rate of acetabulum-bone was increased from 67.9% ± 5.5% before revision to 87.7% ± 5.2% after revision, showing significant difference (t=11.592，P=0.003). The Harris hip score at last follow-up (84.4 ± 4.6) was significantly higher than that at pre-revision (56.5 ± 9.3) (t=11.380，P=0.005). Conclusion Detailed surgical plan, proper choice of component, correct place angle and elaborative planning, and proficient surgical skill are necessary to achieve the initial stability of acetabular component in THA．
ObjectiveTo summarize the evolving concept and research progress on stability reconstruction in the surgical treatment of intertrochanteric fracture.MethodsRelated literature and author’s own experience concerning the surgical treatment of intertrochanteric fracture were reviewed and analyzed in terms of fracture pathoanatomy, stable and unstable pattern, adequate and in-adequate reduction, primary and secondary stability, postoperative stability evaluation, and early weight-bearing.ResultsIntertrochanteric fracture occur at the translational area of cervico-trochanteric junction, which has a nature tendency to varus instability. Fracture reduction quality is the paramount factor and is evaluated by two views, the anteroposterior and lateral Garden alignment and cortex apposition between the head-neck fragment and the femoral shaft. Rather than the posteromedial lesser trochanteric frag ment, the cortical support concept (positive, neutral, negative) emphasizes the reduction of anteromedial cortex to a nonanatomic positive apposition or an " anatomic” neutral apposition in intraoperative fluoroscopy. Postoperative radiographic stability score provides a quantitative assessment for early weight-bearing standing and walking. However, some fractures may lose cortical contact and buttress (negative) during the process of postoperative telescoping and secondary stability. Further studies are needed to elucidate the risk factors such as tilting, swing or rotation of the head-neck fragment, and propose new preventive methods.ConclusionStability reconstruction of intertrochanteric fracture requires adequate fracture reduction with Garden alignment and anteromedial cortical support apposition, and reliable sustainment by internal fixation implants. Early weight-bearing standing and walking is safe in patients with perfect postoperative stability score.
ObjectiveTo investigate the effect of glenohumeral ligament(GHL） in static stabilizing structure of shoulder joint. Methods Fifteen upper limbs specimen from fresh adult corpse were made shoulder jointbone ligament specimen and divided in 5 groups (n=3). The loadshift curve of the following specimen was measured respectively at the shoulder joint in abductive angles of 0°,45° and 90°,influenced by 50 N posterioranterior load to evaluate anterior stability of shoulder joint. According to different selectivecutting test, 5 groups were divided subgroups:group A (A1-A4), respectively normal group, superior GHL (SGHL) injury group；SGHL/middle GHL (MGHL) injury group and SGHL/MGHL/inferior GHL (IGHL） injury group； group B（B1-B3），respectively normal group，MGHL injury group，MGHL/IGHL injury group； group C（C1-C2），respectively normal group,IGHL-anterior band(IGHL-AB) injury group； group D（D1-D2），respectively normal group, IGHL-posterior band(IGHL-PB) injury group; and group E（E1-E2），respectively normal group, IGHL injury group. Results For complete shoulder joint(A1 group), there was verysmall average shift (15.00±4.99 mm), for A4 group, there was the worst stability of shoulder joint，the average shift was 22.34±5.70 mm. For B2 group，the stability of shoulder joint had no obvious decrease. For B3 group, the stability of shoulder joint was worst at abduction angleof 45° and 90°. For C2 group, the stability of shoulder joint at abduction angle of 45° (23.19±4.58 mm) and 90°(15.32±1.30 mm) was worse than that of A1 group （P＜0.05）; halfdislocation or dislocation could be seen. For D2 group(17.30±4.93 mm), there was less effect on anterior stability of shoulder joint than that of A1 group(P＜0.05).For E2 group(20.26±4.75 mm), the effect on anterior stability was similar toC2 group. Conclusion GHL is a key static stabilizing structure of shoulder joint. SGHL has no obvious effect on anterior stability of shoulder joint. MGHL and IGHL together holds anterior stability of shoulder joint, and IGHL plays the most important role.
The aim of this study is to construct an injectable gel with stable phototherapy and chemotherapy. Res-PTX@IR780 gel with phototherapy and chemotherapy property was prepared by introduction of photosensitizer IR780 and antioxidant resveratrol (Res) into the polyethylene glycol (PEG) solution of paclitaxel (PTX). The results showed that PTX, PTX@IR780 and Res-PTX@IR780 could form gels and the gels were injectable. ATR-FTIR results indicated not only components of the gels but also the formation of hydrogen bonding during the gelation. The results of UV showed instability of IR780 solution and stability improvement of Res-IR780 solution under infrared radiation (IR) irradiation. Photothermal tests showed that Res-PTX@IR780 displayed better photothermal conversion and photothermal stability under multiple irradiations than PTX@IR780. The results of in vivo exploration in mice showed that the skin site injected with Res-PTX@IR780 gel heated up from 35 ℃ to 64 ℃, and the temperature difference was up to 30 ℃. Res-PTX@IR780 gel is very promising as a combination agent of photothermal therapy and chemotherapy for the in situ treatment of tumors due to good photothermal conversion and photothermal stability under multiple irradiations.
In the evaluation of tear film stability based on corneal topography, a pretreatment algorithm for tear film video was proposed for eye movement, eyelash reflection and background interference. First, Sobel operator was used to detect the blur image. Next, the target image with highlighted ring pattern was obtained by the morphological open operation performed on the grayscale image. Then the ring pattern frequency of the target image was extracted through the Hough circle detection and fast Fourier transform, and a band-pass filter was applied to the target image according to the ring pattern frequency. Finally, binarization and morphological closed operation were used for the localization of the ring pattern. Ten tear film videos were randomly selected from the database and processed frame by frame through the above algorithm. The experimental results showed that the proposed algorithm was effective in removing the invalid images in the video sequence and positioning the ring pattern, which laid a foundation for the subsequent evaluation of tear film stability.