Hailong Du

Erratum to: Autophagy Reduces Neuronal Damage and Promotes Locomotor Recovery via Inhibition of Apoptosis after Spinal Cord Injury in Rats

Autophagy is an intracellular catabolic mechanism that maintains the balance of proteins, lipids and aging organelles. 3-Methyladenine (3-MA) is a selective inhibitor of autophagy, whereas rapamycin, an antifungal agent, is a specific inducer of autophagy, inhibiting the protein mammalian target of rapamycin. In the present study, we examined the role of autophagy, inhibited by 3-MA and enhanced by rapamycin, in a model of acute spinal cord injury in rats. We found that rapamycin could significantly increase the expression of microtubule-associated protein 1 light chain 3 (LC3) and Beclin1 at the injury site. At the same time, the number of neurons and astrocytes with LC3 positive in the spinal cord was upregulated with time. In addition, administration of rapamycin produced an increase in the Basso, Beattie and Bresnahan scores of injured rats, indicating high recovery of locomotor function. Furthermore, expression of the proteins Bcl-2 and Bax was upregulated and downregulated, respectively. By contrast, the results for rats treated with 3-MA, which inhibits autophagy, were the opposite of those seen with the rapamycin-treated rats. These results show that induction of autophagy can produce neuroprotective effects in acute spinal cord injury in rats via inhibition of apoptosis.

Novel 3D hexapod computer-assisted orthopaedic surgery system for closed diaphyseal fracture reduction

Long‐bone fractures are very common in trauma centers. The conventional Arbeitsgemeindschaft fur Osteosynthesefragen (AO) technique contributes to most fracture healing problems, and external fixation technology also has several disadvantages, so new techniques are being explored.

Advancing computer-assisted orthopaedic surgery using a hexapod device for closed diaphyseal fracture reduction

Surgical complications such as healing problems, in fractures treated using the Arbeitsgemeinschaft für Osteosynthesefragen (AO) technique, present functional and economic challenges to patients and treatment dilemmas for surgeons. Computer‐assisted orthopaedic surgery using minimally invasive techniques focused on biological osteosynthesis is a novel direction for fracture treatment.

Intramedullary nailing versus plating for distal tibia fractures without articular involvement: a meta-analysis

BackgroundThe choice between intramedullary (IM) nailing or plating of distal tibia fractures without articular involvement remains controversial. A meta-analysis of randomized controlled trials (RCTs) and observational studies was performed to compare IM nailing with plating for distal tibia fractures without articular involvement and to determine the dominant strategy.Materials and methodsThe PubMed, Embase, Cochrane Library databases, Chinese Wan-Fang Database, and China National Knowledge Infrastructure were searched.ResultsTwenty-eight studies, which included 1863 fractures, met the eligible criteria. The meta-analysis did not identify a statistically significant difference between the two treatments in terms of the rate of deep infection, delayed union, removal of instrumentation, or secondary procedures either in the RCT or retrospective subgroups. IM nailing was associated with significantly more malunion events and a higher incidence of knee pain in the retrospective subgroup and across all the studies, but not significantly in the RCT subgroup, and a lower rate of delayed wound healing and superficial infection both in the RCT and retrospective subgroups relative to plating. A meta-analysis of the functional scores or questionnaires was not possible because of the considerable variation among the included studies, and no significant differences were observed.ConclusionsEvidence suggests that both IM nailing and plating are appropriate treatments as IM nailing shows lower rate of delayed wound healing and superficial infection and plating may avoid malunion and knee pain. These findings should be interpreted with caution, however, because of the heterogeneity of the study designs. Large, rigorous RCTs are required.

A Removable Hybrid Robot System for Long Bone Fracture Reduction

In traditional long bone fracture reduction surgery, there are some drawbacks such as low accuracy, high radiation for surgeons and a risk of infection. To overcome these disadvantages, a removable hybrid robot system is developed, which integrates a removable series-parallel mechanism with a motor-double cylinder (MDC) driven mode. This paper describes the mechanism in detail, analyses the principle and the method of the fracture reduction, presents the surgical procedure, and verifies the reduction accuracy by experiments with bone models. The results are shown as follows. The mean deviations of the axial displacement and lateral displacement are 1.60mm and 1.26 mm respectively. The standard deviations are 0.69 mm and 0.30 mm. The mean deviations of the side angle and turn inward are 2.06° and 2.22° respectively. The standard deviations are 0.50° and 0.99°. This minimally invasive robot features high accuracy and zero radiation for surgeons, and is able to conduct fracture reduction for long bones.

A visual servo-based teleoperation robot system for closed diaphyseal fracture reduction

Common fracture treatments include open reduction and intramedullary nailing technology. However, these methods have disadvantages such as intraoperative X-ray radiation, delayed union or nonunion and postoperative rotation. Robots provide a novel solution to the aforementioned problems while posing new challenges. Against this scientific background, we develop a visual servo-based teleoperation robot system. In this article, we present a robot system, analyze the visual servo-based control system in detail and develop path planning for fracture reduction, inverse kinematics, and output forces of the reduction mechanism. A series of experimental tests is conducted on a bone model and an animal bone. The experimental results demonstrate the feasibility of the robot system. The robot system uses preoperative computed tomography data to realize high precision and perform minimally invasive teleoperation for fracture reduction via the visual servo-based control system while protecting surgeons from radiation.

Preoperative trajectory planning for closed reduction of long-bone diaphyseal fracture using a computer-assisted reduction system

Balancing reduction accuracy with soft‐tissue preservation is a challenge in orthopaedics. Computer‐assisted orthopaedic surgery (CAOS) can improve accuracy and reduce radiation exposure. However, previous reports have not summarized the fracture patterns to which CAOS has been applied.

Accuracy Analysis of a Robot System for Closed Diaphyseal Fracture Reduction

We have developed a robot system for closed diaphyseal fracture reduction. Because accuracy is essential for the treatment effects of the robot system and for the safety of both the patients and surgeons, we analysed accuracy in a systematic way. Both the structure of the robot and the operation procedure are described. Using the transfer model of errors in series and the error differential solving method for parallel mechanisms, an error model was established, and the main influencing factors of errors were considered. The Monte Carlo method was used to perform the simulation based on the error model. Experiments of image registration, of the mechanism and of the whole robot system were tested in different aspects to verify that the results of the simulation are correct. The system accuracy was compared with clinical standards to show that the robot system fulfilled the requirements for closed diaphyseal fracture reduction. The accuracy analysis method also provides an efficient path for other medical robots.

A femur fracture reduction method based on anatomy of the contralateral side

Femoral fractures may result in loss of the original femur anatomy, without leaving a direct source of reference for femur reduction procedures. Femoral configuration renders it feasible to redesign the original femur based on the information obtained from the contralateral femur. In this report, we describe a method to rebuild the original femur based on the contralateral side as the reference after ascertaining the bilateral symmetry of the body. The method was tested on animals using the spine model and the experimental results are discussed briefly.

A computer aided measurement method for unstable pelvic fractures based on standardized radiographs

BackgroundTo set up a method for measuring radiographic displacement of unstable pelvic ring fractures based on standardized X-ray images and then test its reliability and validity using a software-based measurement technique.MethodsTwenty-five patients that were diagnosed as AO/OTA type B or C pelvic fractures with unilateral pelvis fractured and dislocated were eligible for inclusion by a review of medical records in our clinical centre. Based on the input pelvic preoperative CT data, the standardized X-ray images, including inlet, outlet, and anterior-posterior (AP) radiographs, were simulated using Armira software (Visage Imaging GmbH, Berlin, Germany). After representative anatomic landmarks were marked on the standardized X-ray images, the 2-dimensional (2D) coordinates of these points could be revealed in Digimizer software (Model: Mitutoyo Corp., Tokyo, Japan). Subsequently, we developed a formula that indicated the translational and rotational displacement patterns of the injured hemipelvis. Five separate observers calculated the displacement outcomes using the established formula and determined the rotational patterns using a 3D-CT model based on their overall impression. We performed 3D reconstruction of all the fractured pelvises using Mimics (Materialise, Haasrode, Belgium) and determined the translational and rotational displacement using 3-matic suite. The interobserver reliability of the new method was assessed by comparing the continuous measure and categorical outcomes using intraclass correlation coefficient (ICC) and kappa statistic, respectively.ResultThe interobserver reliability of the new method for translational and rotational measurement was high, with both ICCs above 0.9. Rotational outcome assessed by the new method was the same as that concluded by 3-matic software. The agreement for rotational outcome among orthopaedic surgeons based on overall impression was poor (kappa statistic, 0.250 to 0.426). Compared with the 3D reconstruction outcome, the interobserver reliability of the formula method for translational and rotational measures was perfect with both ICCs more than 0.9.ConclusionsThe new method for measuring displacement using a formula was reliable, and could minimise the measurement errors and maximise the precision of pelvic fracture description. Furthermore, this study was useful for standardising the operative plan and establishing a theoretical basis for robot-assisted pelvic fracture surgery based on 2-D radiographs.