Leyi Cai

Comparison of traditional surgery and surgery assisted by three dimensional printing technology in the treatment of tibial plateau fractures

PurposeThis study was conducted to compare traditional surgery and surgery assisted by 3D printing technology in the treatment of tibial plateau fractures. In addition, we also investigated the effect of 3D printing technology on the communication between doctors and patients.MethodsSeventy two patients with tibial plateau fractures were enrolled in the study from April 2014 to October 2015. They were divided into two groups: 34 cases of 3D model group, 38 cases of traditional surgery group. The individual models were used to simulate the surgical procedures and carry out the surgery according to plan. Operation time, blood loss, and number of intra-operative fluoroscopy were recorded. Through the follow-up, the recovery of patients were observed. Besides, we designed questionnaires to verify the satisfaction for both surgeons and patients.ResultsThe average operation time, average amount of blood loss, and number of intra-operative fluoroscopy for 3D model group was 85.2±0.9 minutes, 186.3± 5.5ml, 5.3± 0.2 times, and for traditional surgery group was 99.2±1.0 minutes, 216.2 ±6.9 ml,7.1 ± 0.2 times respectively. There was statistically significant difference between the traditional surgery group and 3D model group (P < 0.05). Via follow-up, we can see that the 3D printing group has a better clinical efficacy. The average score of the questionnaires to Patient and doctors were 7.3 ± 0.1 points and 8.5± 0.1 points respectively.ConclusionThis study suggested the clinical feasibility of 3D printing technology in treatment of tibial plateau fractures.

The protective effects of silibinin in the treatment of streptozotocin-induced diabetic osteoporosis in rats

Diabetic osteoporosis (DO) is a complication of diabetes mellitus. Our previous study showed that silibinin can attenuate high glucose mediated human bone marrow stem cells dysfunction through antioxidant effect. However, no study has yet investigated the effect of silibinin in diabetic rats. Therefore, we assessed the effects of silibinin on bone characteristics in streptozotocin-induced diabetic rats. The aim of our study was to determine whether providing silibinin in the different supplementation could prevent bone loss in diabetic rats or not. Rats were randomly divided into four groups: (1) control group (CG) (n=10); (2) diabetic group (DG) (n=10); (3) diabetic group with 50mgkg-1day-1 of silibinin orally (DG-50) (n=10); and (4) diabetic group with 100mgkg-1day-1 of silibinin orally (DG-100) (n=10). 12 weeks after streptozotocin (STZ) injection, the femora from all rats were assessed and oxidative stress was evaluated. Bone mineral density was significantly decreased in diabetic rats; these effects were prevented by treatment with silibinin (100mgkg-1day-1 orally). Similarly, in the DG and DG-50 groups, changes in microarchitecture of femoral metaphysis assessed by microcomputed tomography demonstrated simultaneous existence of diabetic osteoporosis; these impairments were prevented by silibinin (100mgkg-1day-1 orally). In conclusion, silibinin supplementation may have potential use as a possible therapy for maintaining skeletal health and these results can enhance the understanding of diabetic osteoporosis induced by diabetes.

Comparison of the Tight Rope Technique and Clavicular Hook Plate for the Treatment of Rockwood Type III Acromioclavicular Joint Dislocation

ABSTRACT Aim: Acromioclavicular joint dislocation is one of the most common shoulder problems and may lead to instability or degenerative changes. The aim of this study was to compare the clinical outcomes of the Tight Rope system and clavicular hook plate for Rockwood type III acromioclavicular joint dislocation in adults. Materials and Methods: This was a prospective, randomized study in a hospital setting. From January 2012 to December 2014, 69 patients with type III injury were reviewed. Patients were randomly divided into two groups: Group A was treated using the TightRope system and Group B with the clavicular hook plate. All participants were followed up for 12 months. Clinical outcomes, radiological results and postoperative complications were recorded. Results: The length of incision was significantly shorter in Goup A than that in Group B. The blood loss of surgery was significantly less in the Group A. Significant difference could be found between the two groups regarding the Visual Analogue Scale scores one day after surgery, at the 3 and 12 months follow-up. There were no differences according to the improvement of the Constant–Murley score and the coracoclavicular distance between the groups. Conclusions: The two groups have similar clinical and radiological outcomes. Both treatments could relieve the pain of dislocation, improve the function of Acromioclavicular joint and rectify the coracoclavicular distance measured in plain films. However, the TightRope system exhibited some advantages in terms of length of incision, blood loss of surgery, the pain postoperatively and no need for a second surgery.

Baicalin suppresses IL-1β-induced expression of inflammatory cytokines via blocking NF-κB in human osteoarthritis chondrocytes and shows protective effect in mice osteoarthritis models

ABSTRACT Osteoarthritis (OA) is a degenerative joint disease with an inflammatory component that drives the degradation of cartilage extracellular matrix. Baicalin, a predominant flavonoid isolated from the dry root of Scutellaria baicalensis Georgi, has been reported to have anti‐inflammatory effects. However, the anti‐inflammatory effects of baicalin on OA have not been reported. Our study aimed to investigate the effect of baicalin on OA both in vitro and in vivo. In vitro, human OA chondrocytes were pretreated with baicalin (10, 50, 100 &mgr;M) for 2 h and subsequently stimulated with IL‐1&bgr; for 24 h. Production of NO and PGE2 were evaluated by the Griess reaction and ELISAs. The mRNA expression of COX‐2, iNOS, MMP‐3, MMP‐13, ADAMTS‐5, aggrecan and collagen‐II were measured by real‐time PCR. The protein expression of COX‐2, iNOS, MMP‐3, MMP‐13, ADAMTS‐5, p65, p‐p65, I&kgr;B&agr; and p‐I&kgr;B&agr; was detected by Western blot. The protein expression of collagen‐II was evaluated by immunofluorescence. Luciferase activity assay was used to assess the relative activity of NF‐kB. In vivo, the severity of OA was determined by histological analysis. We found that baicalin significantly inhibited the IL‐1&bgr;‐induced production of NO and PGE2, expression of COX‐2, iNOS, MMP‐3, MMP‐13 and ADAMTS‐5 and degradation of aggrecan and collagen‐II. Furthermore, baicalin dramatically suppressed IL‐1&bgr;‐stimulated NF‐&kgr;B activation. In vivo, treatment of baicalin not only prevented the destruction of cartilage but also relieved synovitis in mice OA models. Taken together, these results suggest that baicalin may be a potential agent in the treatment of OA. HighlightsBaicalin inhibited IL‐1&bgr;‐induced NO, PGE2, iNOS, COX‐2 expression in human osteoarthritis chondrocytes.Baicalin inhibited IL‐1&bgr;‐induced MMP‐3, MMP‐13 and ADAMTS‐5 expression in human osteoarthritis chondrocytes.Baicalin inhibited IL‐1&bgr;‐induced aggrecan and collagen‐II degradation in human osteoarthritis chondrocytes.Baicalin inhibited the IL‐1&bgr;‐induced NF‐kB p65 activation in human osteoarthritis chondrocytes.Baicalin alleviated the progression of OA in mice OA models.

Closed Reduction and Percutaneous Fixation of Calcaneal Fractures in Children.

Open reduction and internal fixation has been widely used to treat displaced intra-articular calcaneus fractures in children. However, the complications of surgical trauma and the wound created through the extended lateral approach cannot be ignored. This study analyzed the outcomes of displaced intra-articular calcaneal fractures in children treated with closed reduction and percutaneous fixation. Medical records of pediatric patients who had displaced intra-articular calcaneus fractures and underwent closed reduction and percutaneous fixation at the study institution between January 2008 and January 2013 were reviewed. Preoperative radiographs and computed tomography scans were used to evaluate and classify the fractures. Clinical outcomes and radiographic findings were assessed at postoperative follow-up. The study included 14 displaced intra-articular calcaneal fractures in 11 patients (7 boys and 4 girls). Mean patient age was 11.18 years (range, 6-16 years), and average follow-up time was 42.8 months postoperatively (range, 12-72 months). There were 6 tongue-type fractures and 8 joint depression-type fractures, based on the Essex-Lopresti classification, and there were 11 type II and 3 type III fractures, based on the Sanders classification. Average Böhler angle was 8.00° (range, -5° to 18°) preoperatively and 30.79° (range, 26° to 40°) postoperatively (P<.001). Average subjective American Orthopaedic Foot and Ankle Society hindfoot score was 65.7 (range, 52-68). No patients had wound breakdown or infection. In the treatment of displaced intra-articular calcaneal fractures in pediatric patients, closed reduction and percutaneous fixation achieved good outcomes, with few complications. [Orthopedics. 2016; 39(4):e744-e748.].

Comparison of three surgical fixation methods for dual-bone forearm fractures in older children: A retrospective cohort study

BACKGROUND The aim of this study was to compare the outcomes of dual ESIN (D-ESIN) fixation, hybrid fixation, and open reduction and dual plate (d-plate) fixation in the treatment of dual-bone forearm fractures in children aged 10-16 years. MATERIALS AND METHODS 137 patients with dual-bone forearm fractures (48 patients in the D-ESIN group, 45 patients in the hybrid group, and 44 patients in the d-plate group) were reviewed. Duration of surgery, length of incision, intraoperative blood loss, intraoperative times of fluoroscopy, and duration of postoperative immobilisation were recorded. Radiographic outcomes, functional outcomes, and complication rate were also recorded. RESULTS Surgeries and incisions were significantly shorter, and less intraoperative blood loss occurred, in the hybrid group than the d-plate group (P < 0.001). The hybrid group was also characterised by less intraoperative fluoroscopy times and shorter duration of postoperative immobilisation compared with the D-ESIN group (P < 0.001). The union rate of the ulna at 3 months postoperatively was higher in the hybrid and d-plate groups than in the D-ESIN group (P = 0.003). The union rate of the radius was similar in all three groups (P = 0.403). No significant difference in the union rate of the radius or ulna was observed among groups at 6 months postoperatively (P = 0.052). The mean union time was notably later in the D-ESIN group than in the hybrid and d-plate groups. However, no significant difference in functional outcome or complication rate was observed among the three groups (P = 0.822 and P = 0.912). CONCLUSION Hybrid fixation was superior in terms of the duration of surgery, intraoperative use of fluoroscopy, intraoperative blood loss, duration of postoperative immobilisation, delayed union of the ulna, and bone union time. Therefore, hybrid fixation is a safe and effective treatment for dual-bone forearm fractures in children aged 10-16 years.

With versus without bone grafts for operative treatment of displaced intra-articular calcaneal fractures: A meta-analysis

PURPOSE This meta-analysis aimed to investigate the effectiveness of operative treatment of intra-articular calcaneal fractures with bone grafts versus without bone grafts. METHODS The electronic literature database of Pubmed, Embase, and Cochrane library were searched in April 2018. The data on Böhler angle, Gissane angle, calcaneal width, calcaneal height, AOFAS hindfoot scores and complications (including wound edge necrosis, wound infection, deep infection, hematoma and sural nerve injury) were extracted. The Stata 14.0 software was used for the meta-analysis. RESULTS Nine studies including 6 RCTs and 3 retrospective cohort studies met our inclusion criteria. This meta-analysis showed that there was no significant difference between the two groups regarding the Böhler angle (P = 0.44), Gissane angle (P = 0.06), calcaneal width (P = 0.09) and calcaneal height (P = 0.44) postoperatively and at the last follow-up. However, the bone graft group had significantly higher AOFAS scores than the non-bone graft group (P < 0.05). No significant difference was found between the two groups in complications (P = 0.63). CONCLUSION This meta-analysis suggested that operative treatment of intra-articular calcaneal fractures with bone grafts achieved better AOFAS scores than the non-bone graft group. The two groups had similar results in Böhler angle, Gissane angle, calcaneal width and calcaneal height. No increased risk of postoperative complications was identified. More RCTs are required for further research.

Three-dimensional printing assisted ORIF versus conventional ORIF for tibial plateau fractures: A systematic review and meta-analysis

PURPOSE The objective of this meta-analysis was to assess the influence of three dimensional printing technology on the open reduction and internal fixation (ORIF) of tibial plateau fractures from current randomized controlled trials and prospective comparative studies. METHODS The electronic literature database of Pubmed, Embase, and Cochrane library were searched in January 2018. The data operation time, intraoperative blood loss, follow-up knee function (Rasmussen score, HSS) and complications (including infection, screw loosening, knee stiffness, knee instability, posttraumatic osteoarthritis, VTE) were extracted. Stata 12.0 software was used for our meta-analysis. RESULTS 11 RCTs and 6 prospective comparative studies met our inclusion criteria with 358 tibial plateau fractures patients in the 3D group and 378 patients in the routine ORIF group. The meta-analysis showed that there were significant differences in operation time, intraoperative blood loss and bony union time between the 3D group and conventional group. As for the complications and follow-up function recovery evaluated by the excellent and good rate based on HSS and Rasmussen score, no significant differences were found. CONCLUSION The 3D group showed shorter operation time, less intraoperative blood loss and faster union time for patients with tibial plateau fractures. Therefore, compared with conventional ORIF, ORIF assisted by three-dimensional printing technology should be a more appropriate treatment of tibial plateau fractures. Further large-sample randomized controlled trials are needed in the future to confirm the superiority of three-dimensional printing assisted ORIF.

The Feasibility of 3D Printing Technology on the Treatment of Pilon Fracture and Its Effect on Doctor-Patient Communication

Purpose The aim of this study was to assess the feasibility and effectiveness of the three-dimensional (3D) printing technology in the treatment of Pilon fractures. Methods 100 patients with Pilon fractures from March 2013 to December 2016 were enrolled in our study. They were divided randomly into 3D printing group (n = 50) and conventional group (n = 50). The 3D models were used to simulate the surgery and carry out the surgery according to plan in 3D printing group. Operation time, blood loss, fluoroscopy times, fracture union time, and fracture reduction as well as functional outcomes including VAS and AOFAS score and complications were recorded. To examine the feasibility of this approach, we invited surgeons and patients to complete questionnaires. Results 3D printing group showed significantly shorter operation time, less blood loss volume and fluoroscopy times, higher rate of anatomic reduction and rate of excellent and good outcome than conventional group (P < 0.001, P < 0.001, P < 0.001, P = 0.040, and P = 0.029, resp.). However, no significant difference was observed in complications between the two groups (P = 0.510). Furthermore, the questionnaire suggested that both surgeons and patients got high scores of overall satisfaction with the use of 3D printing models. Conclusion Our study indicated that the use of 3D printing technology to treat Pilon fractures in clinical practice is feasible.

Application of 3D-printing technology in the treatment of humeral intercondylar fractures

PURPOSE OF THE STUDY This study was aimed to compare conventional surgery and surgery assisted by 3D-printing technology in the treatment of humeral intercondylar fractures. In addition, we also investigated the effect of 3D-printing technology on the communication between doctors and patients. MATERIAL AND METHODS A total of 91 patients with humeral intercondylar fracture were enrolled in the study from March 2013 to August 2015. They were divided into two groups: 43 cases of 3D-printing group, 48 cases of conventional group. The individual models were used to simulate the surgical procedures and carry out the surgery according to plan. Operation duration, blood loss volume, fluoroscopy times and time to fracture union were recorded. The final functional outcomes, including the motion of the elbow, MEPS and DASH were also evaluated. Besides, we made a simple questionnaire to verify the effectiveness of the 3D-printed model for both doctors and patients. RESULTS The operation duration, blood loss volume and fluoroscopy times for 3D-printing group was 76.6±7.9minutes, 231.1±18.1mL and 5.3±1.9 times, and for conventional group was 92.0±10.5minutes, 278.6±23.0mL and 8.7±2.7 times respectively. There was statistically significant difference between the conventional group and 3D-printing group (p<0.05). However, No significant difference was noted in the final functional outcomes between the two groups. Furthermore, the questionnaire showed that both doctors and patients exhibited high scores of overall satisfaction with the use of a 3D-printing model. DISCUSSIONS This study suggested the clinical feasibility of 3D-printing technology in treatment of humeral intercondylar fractures. LEVEL OF EVIDENCE Level II prospective randomized study.