The ankle biomechanics is easily changed due to the acute injury of the tissue around the ankle joint and the damage of the ankle joint structure, such as ankle instability and joint surface imbalance. When the mechanical load of the ankle changes, it can cause ankle regeneration and remodeling processes such as cartilage loss, bone remodeling, and degenerative changes. The aim of this study was to investigate the effect and mechanism of ginsenoside Rg1 against interleukin-1β (IL-1β)-induced apoptosis in human articular chondrocytes (HACs). The apoptosis model of HAC cells was established by IL-1β induction, and then the HAC cells were cultured with different concentrations of Rg1. The protective effect of Rg1 on HAC cell apoptosis was investigated by detecting the changes of apoptosis and activity of PI3K/Akt/mitochondrial signaling pathway. The results showed that a specific concentration of Rg1 could promote the proliferation of IL-1β-induced HAC cells and inhibit apoptosis. At the same time, Rg1 treatment with specific concentration can reduce the content of reactive oxygen species (ROS) and malondialdehyde (MDA) in HACs and improve the related expression of mitochondrial membrane potential (MMP). Furthermore, qRT-PCR and western blot results showed that Rg1 could improve the low expression of Bcl-2 and inhibit the high expression of Bax, caspase-3, caspase-8, caspase-9, FasL, AIF, and Cyto c in IL-1β-induced cells. In summary, Rg1 can inhibit IL-1β-induced apoptosis of HAC cells by decreasing the activity of PI3K/Akt/mitochondrial signaling pathway, and Rg1 has a protective effect on apoptosis of HAC cells.
Objective
To investigate the impacts of various displacement modes of lateral malleolus on the tibiotalar joint contact in ankle fractures.
Methods
The computed tomography scans of a normal adult volunteer were used for three-dimensional reconstruction of the whole ankle joint, including its cartilage and adjacent ligaments. Axial compressive loads during mid-stance and boundary conditions were set to sim-ulate the lateral displacement, shortening, internal rotation and external rotation of the fibula following ankle fracture. Magnitude and distribution of the peak contact stress on the tibiotalar joint were compared among various displacement modes of the lateral malleolus.
Results
The magnitude and distribution of the peak contact stress on the tibiotalar joint varied among the 4 fibular displacement modes. Compared to the reference model, the deviations of peak contact stress for the modes of shortening, lateral displacement, internal rotation and external rotation were 10.23%, 45.22%, 17.68%, and 17.68%, respectively. Regarding the distri-bution of contact stress on the tibiotalar joint, the fibular shortening significantly increased the contact area on the anterior facet and the lateral displacement of the fibula widened the ankle joint and pulled the talus out-wards. This made the articular contact migrate medially, resulting in a decreased contact area. When either internal or external rotation occurred to a certain extent, the contact area was transferred from the medial malleolus to the anterior tibiotalar facet.
Conclusions
In ankle fractures, various displacement modes of the lateral malleolus may affect the tibiotalar contact condition, especially the lateral displacement, internal rotation and external rotation of the lateral malleolus. This study may provide a theoretical basis for diagnosis and reconstruction of malreduction, maluion, secondary joint pain and arthritis following an ankle fracture.
Key words:
Ankle joint; Fractures, bone; Biomechanics; Finite element analysis
The purpose of this study was to investigate the correlation between single necleotide polymorphisms (SNPs) of human epidermal growth factor receptor-2 (HER2) gene with osteosarcoma susceptibility in Chinese Han population.90 patients with osteosarcoma and 100 healthy controls who were frequency-matched with the former by age and gender were enrolled for a case-control study. 5 SNPs of HER2, namely rs2952155, rs1810132, rs2952156, rs1136201 and rs1058808, were tested by Sequenom time of flight mass spectrometry technique. The linkage disequilibrium and haplotype were analyzed using haploview software. The risk intensity of osteosarcoma was expressed by odds ratio (OR) with 95% confidence interval (CI) which was calculated by chi-squared text. Hardy-Weinberg equilibrium (HWE) was also evaluated by chi-squared text.HER2 gene rs1136201 and rs1058808 polymorphisms were associated with the increased risk of osteosarcoma (P=0.04 and 0.02, respectively). Allele G in rs1136201 was 1.67 higher risk for osteosarcoma in cases than the control group (OR=1.67, 95% CI=1.11-2.51) and G allele of rs1058808 polymorphism also significantly increased osteosarcoma susceptibility (OR=2.06, 95% CI=1.27-3.22). The haplotype analysis showed that haplotype C-T-G-G might be a susceptible haplotype to osteosarcoma (OR=1.74, 95% CI=1.01-3.00). HWE test was eligible in controls (P>0.05).HER2 gene rs1136201 and rs1058808 polymorphisms and haplotype C-T-G-G may be related to osteosarcoma susceptibility in Chinese Han population, indicating that the interaction of gene polrmorphism plays an role in osteosarcoma risk.
Background: Midfoot arthrodesis is regarded as the main surgical approach for treating Müller-Weiss disease (MWD). This study aimed to investigate the incidence of postoperative pain during MWD treatment through midfoot reduction or malreduction during arthrodesis and to explore the factors influencing postoperative pain in patients with MWD. Methods: A total of 67 patients with MWD were recruited and divided into two groups according to whether midfoot alignment was reduced: reduction group ( n = 38) and malreduction group ( n = 29). Demographic characteristics before the operation and at the last follow-up, as well as clinical and radiographic parameters, were compared between the two groups. Clinical parameters included the American Orthopaedic Foot & Ankle Society score and visual analog scale score, whereas radiographic parameters included the calcaneal pitch angle, lateral Meary’s angle, talometatarsal-1 angle dorsoplantar (TMT1dp), talocalcaneal angle dorsoplantar (Kite angle), talonavicular coverage angle, and medial navicular pole extrusion. Postoperative complications and incidence of midfoot pain were evaluated at the last follow-up visit. Results: The reduction group exhibited better clinical and radiological parameters, including the TMT1dp and medial navicular pole extrusion, than the malreduction group at the last follow-up (all P < .05). However, the calcaneal pitch angle, lateral Meary’s angle, Kite angle, and talonavicular coverage angle did not significantly differ between the two groups (all P > .05). The overall incidence of midfoot pain was 26.4%. The reduction group showed a lower incidence of medial pain than the malreduction group (15.7% vs. 40.0%, P < .05). Regression analysis revealed that midfoot abduction, represented by the TMT1dp, was a critical factor for midfoot arthrodesis failure and that medial navicular pole extrusion was not correlated with postoperative midfoot pain. Conclusion: Midfoot reduction arthrodesis yields better clinical outcomes than malreduction arthrodesis. The TMT1dp, representing midfoot abduction, is a key factor for midfoot arthrodesis failure. The extruded medial navicular bone may not affect postoperative medial midfoot pain. Level of Evidence: Level III, retrospective comparative study.
Objective: To compare the clinical efficacy and the level of muscle and soft tissue damage between modified posteromedial approach via lateral side of flexor hallucis longus and modified posteromedial approach in the treatment of posterior Pilon fracture. Methods: Total of 43 patients (27 males and 16 females, aged from 19 to 71 years) diagnosed with posterior Pilon fracture from June 2016 to June 2018 in Foshan Hospital of Traditional Chinese Medicine were randomly divided into observation group (modified posteromedial approach via lateral side of flexor hallucis longus, 21 cases) and control group (modified posteromedial approach, 22 cases) according to the operation approach. The preoperative waiting time, intraoperative time, intraoperative blood loss, hospitalization time and the complications were recorded and compared between the two groups. The differences of blood creatine kinase (CK), myoglobin (Myo) and C-reactive protein (CRP) at different time points before and after operation were compared between the two groups to elevate the level of muscle and soft tissue damage. The fracture reduction qualities of the two groups were compared by Burwell-Charnley criteria. The differences of fracture healing time, range of motion of metatarsophalangeal joint of the great toe (MTP-ROM), ankle range of motion (Ankle-ROM), American Orthopaedic Foot & Ankle Society (AOFAS) score and visual analogue scale (VAS) score of pain were compared between the two groups at the last follow-up. Results: The observation group and the control group were followed-up for (19±6) months and (16±8) months, respectively; there was no significant difference between the two groups (P>0.05). There were no significant differences in preoperative waiting time, intraoperative blood loss, hospitalization time and fracture healing time between the two groups (all P>0.05). At the last follow-up, there was no significant difference in the MTP-ROM and Ankle-ROM between the two groups (both P>0.05); the AOFAS score of the observation group was 88.2±7.8 and it was 84.5±7.6 in the control group (P>0.05); the VAS score of the observation group was (0.9±1.0) and it was (1.3±0.8) in the control group(P>0.05). Anatomical reduction rate in observation group was higher than that in control group (90.5% vs 81.8%, P>0.05). The operation time in the observation group was (87±16) min and it was (98±11) min in the control group (P<0.05). CK, Myo and CRP were increased in both groups after surgery, but there was no statistical significance between groups at the same time point (all P>0.05). There was no nerve injury in the observation group, while 2 cases (9.0%) of nerve paralysis occurred in the control group. No incision infection and checkrein deformity of the Hallux was found in the two groups. Conclusion: The modified posteromedial approach via lateral side of flexor hallucis longus can obtain good operative field exposure, and does not increase muscle and soft tissue injury, with shorter operative time and fewer complications, without nerve injury and checkrein deformity, it is a safe approach for the treatment of posterior Pilon fracture.目的： 比较改良后内侧经踇长屈肌外侧入路与改良后内侧入路治疗后Pilon骨折的临床疗效以及对肌肉、软组织损伤的水平。 方法： 选取佛山市中医院2016年6月至2018年6月诊断为后Pilon骨折患者43例，男27例，女16例，年龄19~71岁，依手术方式将患者分为观察组（改良后内侧经踇长屈肌外侧入路）和对照组（改良后内侧入路），分别为21例和22例。比较两组术前等待时间、手术时间、术中出血量、住院时间，记录相关并发症。比较两组手术前后不同时间节点血肌酸激酶（CK）、肌红蛋白（Myo）、C反应蛋白（CRP）的差异，以评估肌肉、软组织损伤水平。采用Burwell-Charnley影像学评价标准比较两组骨折复位情况，比较两组骨折愈合时间、末次随访时踇趾跖趾关节活动度（MTP-ROM）、踝关节的活动度（Ankle-ROM）、美国矫形足踝协会（AOFAS）踝-后足评分、疼痛视觉模拟评分（VAS）的差异。 结果： 所有病例均获得随访，观察组随访（19±6）个月，对照组（16±8）个月，差异无统计学意义（P>0.05）。两组术前等待时间、术中出血量、住院时间和骨折愈合时间比较，差异均无统计学意义（均P>0.05）。末次随访时，两组MTP-ROM和Ankle-ROM差异均无统计学意义（均P>0.05）；观察组AOFAS评分为（88.2±7.8）分，对照组为（84.5±7.6）分，观察组VAS为（0.9±1.0）分，对照组为（1.3±0.8）分，差异均无统计学意义（均P>0.05）。观察组解剖复位率高于对照组，但差异无统计学意义（P>0.05）；观察组手术时间低于对照组，差异有统计学意义（P<0.05）。两组术后CK、Myo、CRP均较术前提高，但相同时间点组间差异均无统计学意义（均P>0.05）。观察组无神经损伤情况，对照组出现2例（9.0%）神经麻痹症状。两组无切口感染、踇趾挛缩等并发症。 结论： 改良后内侧经踇长屈肌外侧入路手术视野更好，时间更短，术后并发症更少，并不增加对肌肉、软组织的损伤水平，是治疗后Pilon骨折的一种安全入路。.
There is no gold standard for the operative treatment of patients with Müller-Weiss disease (MWD). This study reports the mid-term follow-up results for at least 5 years following talonavicular-cuneiform (TNC) arthrodesis for Müller-Weiss disease.A total of 15 patients undergoing TNC arthrodesis for MWD were retrospectively reviewed between January 2015 and August 2017. Two senior doctors assessed the radiographic results twice at each visit (preoperative, three months after the operation, and final follow-up). The clinical results and complications from preoperative and final follow-up were recorded.The mean follow up period was 74.0 (range 64 to 90) months. The calcaneal pitch angle, lateral Meary's angle, anteroposterior (AP) Meary's angle, AP talocalcaneal angle, and talonavicular coverage were significantly different before and three months after the operation (p < 0.05). There was no significant difference between the radiographic results of three months after the operation and the final follow-up (p > 0.05). The radiological measurements of the two senior doctors were calculated and found to be moderate to strong (ICC:0.899-0.995). The AOFAS, VAS, and SF-12 scores significantly improved at the last follow-up compared to those before the operation (p < 0.05). Two patients experienced early complications, four had late complications, and one underwent a second operation of midfoot fusion with calcaneal osteotomy.This research confirms that using TNC arthrodesis for the treatment of MWD can substantially improve the clinical and radiographic results. These results were maintained until mid-term follow-up.
Objective To evaluate the surgical techniques and clinical outcomes of tarsometatarsal arthrodesis with a bridging plate in the treatment of Lisfranc malunion.Methods From January 2008 to August 2010,26 patients with Lisfranc malunion (26 feet) were treated by tarsometatarsal arthrodesis with a bridging plate in our department.They were 18 males and 8 females with an average age of 34.6 years (from 18 to 65 years).The duration from injury to operation ranged from 6 to 13 months (average,8.9 months).Thorough radiographic examinations including weight-bearing X-ray and 3-D reconstruction CT scan were carried out before surgery so as to formulate an individualized surgical protocol.X-rays were taken during follow-ups to confirm the bone healing.Their American Orthopaedic Foot and Ankle Society (AOFAS) scores,visual analogue scale (VAS) and The Short Form-36 (SF-36) scores before operation and at the last follow-up were recorded and compared.Results Nineteen patients obtained a mean follow-up of 16.4 months (from 12 to 30 months).The other 7 were lost to the follow-up.All the wounds healed at the first stage without soft tissue complications.The postoperative X-ray showed that the fusion healed after an average of 12 months.At the last follow-up,their AOFAS score increased significantly from preoperative 49.6 ± 15.4 points to postoperative 76.8 ± 11.5 points,their VAS score decreased significantly from preoperative 5.7 ± 3.2 points to postoperative 1.4 ±0.8 points,and their SF-36 score increased significantly from preoperative 38.7 ± 7.4 points to postoperative 74.0 ± 6.4 points (P ＜ 0.05).Talonavicular arthritis occurred in 2 patients who had moderate to severe pain and limitation of walking which were cured by talonavicular arthrodesis.No implant failure,fusion failure or malunion occurred.Conclusion Anatomical reconstruction of the midfoot alignment followed by tarsometatarsal arthrodesis with a bridging plate is an effective and reliable treatment of Lisfranc malunion.
Key words:
Foot deformities, acquired; Arthrodesis; Fracture fixation, internal; Lisfranc malunion
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