We report a unique case of bilateral femoral stem fractures in a patient with Dorr A femoral morphology,underscoring the need for a critical reassessment of implant selection strategies.The initial failure involved a ...We report a unique case of bilateral femoral stem fractures in a patient with Dorr A femoral morphology,underscoring the need for a critical reassessment of implant selection strategies.The initial failure involved a cemented revision stem placed using the cement-within-cement technique combined with an extended trochanteric osteotomy(ETO).A second revision was subsequently performed using a cortical window osteotomy and a distally fixed uncemented stem,which resulted in successful recovery.A similar approach was used to treat a subsequent contralateral stem fracture,also with favorable outcomes.This case emphasizes three key considerations:First,that standard-length cemented stems may lead to oversizing and increased stress concentration in Dorr A femurs with narrow canals;second,that ETO may compromise femoral integrity and contribute to implant failure;and third,that cortical window osteotomy enables safer implant removal and reimplantation.Based on these findings,we advocate for an individualized approach to implant selection that may include cemented short stems,uncemented short stems,or modular solutions depending on femoral anatomy and patient-specific factors,and we encourage further investigation into optimal fixation strategies for patients with Dorr A femoral morphology.展开更多
Objectives: The purpose of this work was to measure the dimensions of the femoral veins, to describe the affluent and the variations of the femoral veins. Methodology: Twenty-four femoral veins of 12 fresh adult cadav...Objectives: The purpose of this work was to measure the dimensions of the femoral veins, to describe the affluent and the variations of the femoral veins. Methodology: Twenty-four femoral veins of 12 fresh adult cadavers were dissected and photographed. Results: The diameter of the superficial, deep and common femoral veins was respectively 8.75 mm;7.60 mm and 13.95 mm. The common femoral vein was 80.70 mm long. At the level of the superficial vein, the modal disposition was noted in 79.17%;as anatomical variations, it was split in 2 cases, the presence of a collateral canal in 1 case and in 2, and it received a quadricipital muscle vein. At the level of the deep femoral vein, the modal disposition was noted in 16.67%, and the anatomical variations were noted in 83.33% where it received no affluent in the femoral trine. The modal disposition was noted in 91.67% at the level of the mode of birth of the common femoral vein, in 16.67% at the level of its tributaries. The anatomical variations were noted in 8.33% in the mode of birth of the femoral vein, in 83.33% in which the common femoral vein received, in addition to the large saphenous vein, other tributaries, the most frequent of which were the quadricipital veins and the circumflex femoral veins. Conclusion: The diameter of the femoral veins is important. The main tributaries of the common femoral vein are GVS, VQ and circumflex femoral veins. The femoral variations are numerous and important to know to avoid a possible misdiagnosis in case of their thrombosis.展开更多
Exosomes have shown good potential in ischemic injury disease treatments.However,evidence about their effect and molecular mechanisms in osteonecrosis of femoral head(ONFH)treatment is still limited.Here,we revealed t...Exosomes have shown good potential in ischemic injury disease treatments.However,evidence about their effect and molecular mechanisms in osteonecrosis of femoral head(ONFH)treatment is still limited.Here,we revealed the cell biology characters of ONFH osteonecrosis area bone tissue in single cell scale and thus identified a novel ONFH treatment approach based on M2 macrophages-derived exosomes(M2-Exos).We further show that M2-Exos are highly effective in the treatment of ONFH by modulating the phenotypes communication between neutrophil and endothelium including neutrophil extracellular traps formation and endothelial phenotype transition.Additionally,we identified that M2-Exos’therapeutic effect is attributed to the high content of miR-93-5p and constructed miR-93-5p overexpression model in vitro and in vivo based on lentivirus and adenoassociated virus respectively.Then we found miR-93-5p can not only reduce neutrophil extracellular traps formation but also improve angiogenic ability of endothelial cells.These results provided a new theoretical basis for the clinical application of ONFH therapeutic exosomes.展开更多
The current artificial bone is unable to accurately replicate the inhomogeneity and anisotropy of human cancellous bone.To address this issue,we proposed a personalized approach based on clinical CT images to design m...The current artificial bone is unable to accurately replicate the inhomogeneity and anisotropy of human cancellous bone.To address this issue,we proposed a personalized approach based on clinical CT images to design mechanical equivalent porous structures for artificial femoral heads.Firstly,supported by Micro and clinical CT scans of 21 bone specimens,the anisotropic mechanical parameters of human cancellous bone in the femoral head were characterized using clinical CT values(Hounsfield unit).After that,the equivalent porous structure of cancellous bone was designed based on the gyroid surface,the influence of its degree of anisotropy and volume fraction on the macroscopic mechanical parameters was investigated by finite element analysis.Furthermore,a mapping relationship between CT values and the porous structure was established by jointly solving the mechanical parameters of the porous structure and human cancellous bone,allowing the design of personalized gradient porous structures based on clinical CT images.Finally,to verify the mechanical equivalence,implant press-in tests were conducted on 3D-printed artificial femoral heads and human femoral heads,the influence of the porous structure’s cell size in bone-implant interaction problems was also explored.Results showed that the minimum deviations of press-in stiffness(<15%)and peak load(<5%)both occurred when the cell size was 20%to 30%of the implant diameter.In conclusion,the designed porous structure can replicate the human cancellous bone-implant interaction at a high level,indicating its effectiveness in optimizing the mechanical performance of 3D-printed artificial femoral head.展开更多
Background:The efficacy of balloon angioplasty for treating peripheral artery disease is influenced by various factors,some of them not yet totally understood.This study aimed to evaluate the role of elastin content i...Background:The efficacy of balloon angioplasty for treating peripheral artery disease is influenced by various factors,some of them not yet totally understood.This study aimed to evaluate the role of elastin content in vascular responses 28 days postangioplasty using uncoated and paclitaxel-coated balloons with the same platform in femoral arteries of a healthy porcine model.Methods:Eight animals underwent balloon angioplasty on the external and internal branches of femoral arteries.Histopathologic evaluation was conducted at follow-up to assess the elastin content,vascular damage,morphological features,and neointimal formation.Results:The elastin content was significantly higher in the external than in the internal femoral artery(p=0.0014).After balloon angioplasty,it was inversely correlated with vascular injury score(ρ=−0.4510,p=0.0096),neointimal inflammation(ρ=−0.3352,p=0.0607),transmural(ρ=−0.4474,p=0.0103)and circumferential(ρ=−0.4591,p=0.0082)smooth muscle cell loss,presence of proteoglycans(ρ=−0.5172,p=0.0024),fibrin deposition(ρ=−0.3496,p=0.0499),and adventitial fibrosis(ρ=−0.6229,p=0.0002).Neointimal formation inhibition with paclitaxel was evident only in arteries with disruption of the internal elastic lamina,with a significant smaller neointimal area in arteries treated with paclitaxel-coated balloons compared to uncoated balloons(median[Q1–Q3]:10.25[7.49–15.64]vs.24.44[18.96–30.52],p=0.0434).Conclusions:Elastin content varies between branches of the femoral artery and significantly influences the integrity of the internal elastic lamina,the vessel's adaptive response,and paclitaxel efficacy after balloon angioplasty.展开更多
BACKGROUND With rising angiography costs and risks,we explored whether a 5-minute femoral ultrasound can predict patients that actually require angiography.AIM To detect associations between atherosclerosis of periphe...BACKGROUND With rising angiography costs and risks,we explored whether a 5-minute femoral ultrasound can predict patients that actually require angiography.AIM To detect associations between atherosclerosis of peripheral arteries and coronary stenosis in patients with coronary heart disease(CHD).METHODS The study included a total of 218 patients(63±10.9 years of age;54%male)with CHD subjected to coronary angiography and routine diagnostic assessment,including ultrasound imaging to assess the extent of peripheral atherosclerotic lesions.Receiver operating characteristic analysis and binomial logistic regression were used to detect the associations.RESULTS We demonstrated for the first time that the presence of atherosclerotic plaque with≥70%stenosis in femoral arteries was associated with significant coronary stenosis,with 93%sensitivity and 90%specificity,and thus can be used as an additional diagnostic marker for coronary stenosis.The data indicated associations between femoral artery atherosclerosis and atherosclerotic lesions of coronary arteries,with a high correlation coefficient r=0.8(P<0.05).The presence of an atherosclerotic plaque in the femoral arteries with≥30% or≥70%stenosis was associated with a 30-or 70-fold higher odds ratio of coronary stenosis,respectively.CONCLUSION For resource-limited clinics,our findings suggest skipping carotids-femoral ultrasound alone may suffice to rule out severe CHD.Ultrasound imaging femoral artery atherosclerosis provides a simplified approach for patient stratification.展开更多
BACKGROUND Osteonecrosis of the femoral head(ONFH)is an ischaemic disorder often leading to collapse of the femoral head and severe hip dysfunction.Mesenchymal stem cells(MSCs)have a key role in bone repair,through th...BACKGROUND Osteonecrosis of the femoral head(ONFH)is an ischaemic disorder often leading to collapse of the femoral head and severe hip dysfunction.Mesenchymal stem cells(MSCs)have a key role in bone repair,through their ability to differentiate into osteoblasts and their paracrine regulation of the bone microenvironment.While altered MSCs behaviour has been reported in some secondary forms of ONFH,the proliferative and differentiation programmes of MSCs in human idiopathic ONFH have not been previously characterized.AIM To compare the proliferative capacity,differentiation potential and nuclear factor kappa B(NF-κB)pathway activation of bone marrow MSCs(BM-MSCs)from idiopathic ONFH patients with those from osteoarthritis controls.METHODS Femoral heads were collected during total hip replacement surgeries.Idiopathic ONFH was defined by imaging and histological criteria.Secondary causes were excluded.BM-MSCs were isolated from trabecular bone cylinders and expanded to passage 2 prior characterizations.Proliferation was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay at various seeding densities.Osteogenic potential was assessed by alkaline phosphatase activity,osteogenic gene expression(RUNX2,ALPL,COL1A1 and BGLAP)and Alizarin Red staining.Adipogenesis was quantified by Oil Red O staining.Expression of NF-κB target genes(IL6,NFKBIA,CCL2)was analyzed by quantitative polymerase chain reaction.RESULTS Idiopathic ONFH MSCs exhibited significantly higher proliferation rates than osteoarthritis controls.However,they showed reduced alkaline phosphatase activity and osteogenic gene expression but paradoxically,increased mineralization,suggesting non-canonical mineral deposition mechanisms.These cells also display increased adipogenic differentiation.Importantly,ONFH-MSCs expressed higher,although non-significant levels of certain NF-κB target gene genes,consistent with an activated inflammatory state.CONCLUSION Human BM-MSCs from idiopathic ONFH display a paradoxical phenotype:Hyperproliferative yet osteogenically impaired with greater adipogenesis and activation of NF-κB signalling.This functional compromise and inflammatory bias may underline the failure of bone regeneration in ONFH,highlighting the need for therapies redirecting MSCs fate and modulating the bone marrow niche.展开更多
Objective:Sheep are commonly used as large animal pre-clinical models for inves-tigating cardiovascular therapies,interventions,anatomy and physiology.Further,novel small diameter vascular grafts are frequently tested...Objective:Sheep are commonly used as large animal pre-clinical models for inves-tigating cardiovascular therapies,interventions,anatomy and physiology.Further,novel small diameter vascular grafts are frequently tested via implantation into sheep carotid arteries(CAs).This is because,unlike humans,acute occlusion of one or both sheep CAs is not associated with morbidity or mortality and thus provides safer experimental testing,with reduced ethical constraints,animal numbers and costs.However,to date there has been no evidence regarding sheep tolerance of femoral artery(FA)occlusion.Methods:In this study,seven sheep underwent CA graft surgery,with digital subtrac-tion angiography(DSA)of the CAs performed every 2 months via femoral access,for a total of 8 months.Four months into the study,the left FA of two sheep became inac-cessible due to a suspected FA occlusion.Thus,femoral angiography was performed,followed by FA dissection,FA histology and retrospective analysis of both veterinar-ian animal monitoring and pain scores.Results:FA angiography and histology confirmed complete left FA occlusion in two sheep.Retrospective animal monitoring demonstrated sheep with occluded FAs did not display increased pain scores or deleterious effects on their gait or wellbeing.Conclusion:Our data shows that sheep tolerate FA occlusion with no symptoms,similar to their cerebral circulation,making them an appropriate model for assessing small diameter femoral graft interposition studies and testing other cardiovascular interventions.展开更多
BACKGROUND Certain implant combinations change leg length and offset in primary total hip arthroplasty(THA).Poor restoration of leg biomechanics is a frequently cited reason for patient dissatisfaction following prima...BACKGROUND Certain implant combinations change leg length and offset in primary total hip arthroplasty(THA).Poor restoration of leg biomechanics is a frequently cited reason for patient dissatisfaction following primary THA.A pure high-offset stem should provide direct lateralization without affecting femoral length when compared to a standard stem.However,clinical experience with preoperative planning software based on computed tomography-based three-dimensionalmodels reveals that using pure high-offset stems in THA may cause a difference between expected(no change in femoral length)and actual(small increase)in postoperative femoral length.AIM To elucidate the causes of these femoral length discrepancies using preoperative planning software.METHODS Preoperative templating for 43 robotic-assisted THAs,optimizing acetabular size and orientation,center of rotation,stem size and offset,and prosthetic head diameter were obtained.The preoperative planning software was used to calculate differences between preoperative and postoperative femoral length for standard and pure high-offset stems,unique to each patient.RESULTS Whilst the increase in femoral length between standard and high-offset stems was not significant(P=0.93),35 femurs(81.4%)experienced a 1-mm increase,and 3(7.0%)experienced a 2-mm increase in femoral length while using high-offset stem compared to the standard stem.The incidence of femoral length increase was lower for patients with shorter femurs(18/22;81.8%)compared to patients with longer femurs(20/21;95.2%).CONCLUSION When pure high-offset stems were used in preoperative planning software,we demonstrated an unexpected increase in leg length between 1-2-mm in 88.4%of patients.This unexpected increase in femoral length is due to a function of the preoperative planning software’s planned stem alignment with the anatomical axis,and not an inherent fault in the stem design.With expanding accessibility of robotic-assisted THA platforms,all potential sources of postoperative leg length discrepancy should be identified during preoperative templating and necessary alterations to the surgical plan should be made to accommodate this unexpected difference when using a pure high-offset stem.展开更多
BACKGROUND Femur fractures are one of the most serious injuries that occur in the older population and are associated with severe pain and increased mortality.The primary objective of this study was to find if there w...BACKGROUND Femur fractures are one of the most serious injuries that occur in the older population and are associated with severe pain and increased mortality.The primary objective of this study was to find if there was a significant difference in pain scores in patients treated with femoral nerve blocks(FNB)compared with patients treated with the standard analgesia protocol.The secondary objective was to find if there was a significant difference in morbidity between the two groups.AIM To evaluate the effectiveness of ultrasound(US)-guided FNB in managing preoperative pain and reducing morbidity in patients with neck femur fractures compared to the standard analgesia protocol.The study seeks to determine whether FNB offers superior outcomes in terms of pain control,rehospitalization rates,and mortality.METHODS This retrospective cohort study included 1577 patients suffering from neck femur fractures.387 patients were treated with a FNB for pain management upon arrival at the emergency department,the rest were treated with standard analgesia.Pain was assessed from electronic medical records using the visual analogue scale(VAS)pre surgery,12-and 24-hour post-surgery.To determine morbidity and mortality during hospitalizations and 6 months after,it was collected from electronic medical records.RESULTS In a cohort of 1577 patients,those receiving US-guided FNB had significantly lower preoperative VAS pain scores(1.46±2.49 vs 1.82±2.59,P=0.001),reduced rehospitalization rates(0.99±1.96 vs 1.46±2.34,P<0.001),and lower mortality(16%vs 32%,P<0.001)compared to standard analgesia.CONCLUSION US guided FNB is more effective for pain management compared with standard analgesia.This method was also found to significantly reduce the risk of morbidity in those patients.展开更多
BACKGROUND Postoperative anxiety,depression,irritability,and even fear in patients with intertrochanteric femoral fractures may hinder recovery,compromise treatment efficacy,and impede rehabilitation.AIM To investigat...BACKGROUND Postoperative anxiety,depression,irritability,and even fear in patients with intertrochanteric femoral fractures may hinder recovery,compromise treatment efficacy,and impede rehabilitation.AIM To investigate the correlations among anxiety,depression,sense of coherence(SOC),and post-traumatic growth(PTG)in patients who underwent intertrochanteric femoral fracture surgery to improve clinical management strategies and outcomes.METHODS This study carefully selected 211 patients who received surgical treatment for intertrochanteric femoral fractures and were admitted to Dongying People’s Hospital from March 2022 to March 2024.Anxiety and depression in these patients were assessed with the anxiety and depression subscales of the Hospital Anxiety and Depression Scale(HADS),respectively.SOC was evaluated using the 13-item SOC scale(SOC-13),which encompasses three key dimensions:Comprehensibility,manageability,and meaningfulness.PTG was assessed with the Chinese version of PTG Inventory(CPTGI),covering five distinct dimensions:Personal strength,appreciation of life,relating to others,new possibilities,and spiritual change.The Pearson correlation coefficient was used to meticulously analyze the associations among HADS-Anxiety,HADS-Depression,SOC-13,and CPTGI.Further,univariate and multivariate analyses were conducted to identify factors that affect PTG in patients who underwent intertrochanteric femoral fracture surgery.RESULTS The collected data demonstrated that 67.30%and 60.66%of the 211 patients experienced anxiety and depression,respectively,with overall anxiety levels ranging from mild to moderate and depression levels being mild.The mean SOC-13 score was 55.73±8.81 points,indicating a generally low SOC level.The average CPTGI score was 54.93±9.92 points,demonstrating a relatively low PTG level.Notably,both HADS-Anxiety and HADS-Depression scores were significantly negatively correlated with CPTGI,whereas SOC-13 scores were significantly positively correlated with CPTGI.Univariate and multivariate analyses identified the presence of comorbidities[odds ratio(OR)=2.747,P=0.003],monthly household income(OR=3.292,P<0.001),and exercise habits(OR=4.651,P<0.001)as independent predictors of PTG in patients.CONCLUSION The results of this study indicate a significant negative correlation of anxiety and depression with PTG in patients after intertrochanteric femoral fracture surgery,whereas a significant positive association exists between SOC and PTG.This study helps more comprehensively understand the psychological status and recovery processes of such patients,thereby potentially providing valuable information for clinical practice and psychological interventions.展开更多
Background:The risk of internal fixation failure remains relatively high in stable femoral neck fracture(FNF)(Garden I or II).Preoperative sagittal displacement of the femoral head has been proposed as a potential inf...Background:The risk of internal fixation failure remains relatively high in stable femoral neck fracture(FNF)(Garden I or II).Preoperative sagittal displacement of the femoral head has been proposed as a potential influencing factor.This study aimed to evaluate the impact of sagittal displacement on the outcomes of cannulated screw internal fixation(CSIF)in patients with stable FNF(Garden I or II)by reconstructing the axial sagittal oblique plane of the fracture using preoperative computed tomography(CT)imaging.Methods:This study included 167 patients with FNF who underwent CSIF.The sagittal tilt angle of the femoral head(STAFH)was evaluated using three-dimensional CT(3D-CT).The distribution of preoperative STAFH was analyzed,and its independent association with treatment failure was assessed.Treatment failure was defined as the need for revision surgery within 2 years postoperatively due to avascular necrosis,nonunion,or internal fixation failure.Results:Among the 167 patients,9(5.4%)exhibited anterior tilt(AT)of the femoral head,158(94.60%)presented with posterior tilt(PT).A total of 50 patients(29.9%)demonstrated excessive sagittal displacement(AT≥10°or PT≥20°).In the failure group,80.0%of patients had excessive sagittal displacement compared to 28.1%in the healed group.Excessive sagittal displacement was significantly associated with an increased risk of surgical failure(odds ratio:11.953,95%CI:3.656-39.083,p<0.05).Conclusions:In patients with Garden I or II FNF,greater preoperative sagittal displacement of the femoral head was correlated with a higher likelihood of CSIF failure.AT≥10°or PT≥20°were identified as independent predictors of CSIF failure in FNF patients.Nevertheless,these findings still require confirmation through prospective,multi-center clinical trials with large sample sizes.展开更多
Slipped capital femoral epiphysis(SCFE)is a hip disorder that predominantly affects adolescents.The primary pathological change involves the displacement of the femoral head epiphysis from its normal position at the g...Slipped capital femoral epiphysis(SCFE)is a hip disorder that predominantly affects adolescents.The primary pathological change involves the displacement of the femoral head epiphysis from its normal position at the growth plate toward the metaphysis of the femoral neck.This condition can result in hip pain,abnormal gait,and even avascular necrosis of the femoral head,significantly impacting the quality of life in adolescents.Currently,the exact etiology of SCFE remains unclear;however,evidence suggests that risk factors include endocrine disorders,metabolic conditions,and genetic diseases.Endocrine disorders encompass hypothyroidism,growth hormone abnormalities,hypogonadism,and obesity-related hormonal imbalances.Metabolic conditions involve obesity,vitamin D deficiency or rickets,and renal osteodystrophy.Genetic diseases include mutations in the COL2A1 gene,aromatase deficiency,and Prader-Willi syndrome.This review summarizes various medical conditions associated with SCFE and elucidates potential molecular mechanisms from abnormal chondrocyte function in the growth plate,hormonal imbalances and inflammatory/metabolic factors in SCFE based on relevant literature,aim to provide evidence for the prevention and treatment of SCFE.展开更多
BACKGROUND In intertrochanteric fractures,the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse.AIM To analyze the concept of medial cortical...BACKGROUND In intertrochanteric fractures,the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse.AIM To analyze the concept of medial cortical reduction(MCR)and its clinical and radiological association in geriatric intertrochanteric femur fractures.METHODS Geriatric patients who presented with AO/OTA 31A1 and 31A2 femur fractures and treated with proximal femoral nailing between July 2021 and June 2023 were include in this prospective cohort study.Based on the degree of MCR,they were divided into positive,neutral,or negative MCR groups.The demographic baseline characteristics,postoperative radiographic femoral neck-shaft angle and neck length were analyzed at 6,12 and 24 weeks post-surgery.Functional outcomes such as modified Harris Hip Score(HHS)and time to full-weight bearing were also analyzed.RESULTS 47 patients(Male:Famale 35:12)with mean age of 65.8±4.2 years were included in this study.Twenty-two cases had neutral support,nine had negative support,and sixteen had positive support in the medial cortex postoperatively.Baseline characteristics of the three groups were comparable.No significant differences were found in the femur neck length and femur neck-shaft angle changes post-surgery between the groups.The modified HHS was not found to be significant between the groups(P=0.883)as that of the time to full weight bearing(P=0.789).CONCLUSION The type of reduction achieved based on medial cortical alignment does not affect the femur neck length shortening or varus collapse.Future randomized controlled trials are needed to validate the findings noted in the study.展开更多
BACKGROUND Osteonecrosis of the femoral head(ONFH)is a prevalent clinical condition,and as the affected population becomes younger and more widespread,an increasing number of patients prefer to retain their own hip jo...BACKGROUND Osteonecrosis of the femoral head(ONFH)is a prevalent clinical condition,and as the affected population becomes younger and more widespread,an increasing number of patients prefer to retain their own hip joints.In comparison to joint replacement and hip-preserving surgeries,conservative hip preservation treatment is gaining more recognition from both clinicians and patients.AIM To observe the clinical efficacy and influencing factors of conservative hip preservation treatment for patients with ONFH.METHODS A total of 73 patients(119 hips)were included,and patients were grouped based on Association Research Circulation Osseous(ARCO)stage,Japanese Investigation Committee(JIC)classification,lesion size,and collapse degree.The clinical efficacy of conservative hip preservation treatment was evaluated from two aspects:Radiological progression and clinical functional scores[Harris Hip Score,Western Ontario and McMaster Universities Arthritis Index(WOMAC),international Hip Outcome Tool 12(iHOT-12),and visual analogue scale(VAS)].Analyzing the success rate of conservative hip preservation based on conversion to total hip arthroplasty or hip preservation surgery.RESULTS In this retrospective cohort study,we retrospectively analyzed 73 patients(119 hips)with an average follow-up time of 53.58±26.80(18-129)months.The overall success rate of hip preservation is 90.76%.The success rates of hip preservation in ARCO I-II,IIIa,and IIIb were 97.67%,91.53%,and 70.59%,respectively(P<0.05).The success rates of hip preservation for JIC A-B,C1,and C2 were 93.37%,92.59%,and 77.78%,respectively(P<0.05).The success rates of hip preservation with collapse degree≤2 mm and>2 mm were 94.12%and 70.59%,respectively(P<0.05).There was no significant difference in the success rate of hip preservation between different lesion sizes.In terms of clinical function,the Harris Hip Score,WOMAC,iHOT-12,and VAS scores at the last follow-up were significantly better than before treatment(P<0.05).The VAS scores of ARCO IIIa and IIIb were significantly worse than those of ARCO I and II(P<0.05).The iHOT-12,WOMAC,and VAS scores were significantly better with the lesion size<15%(P<0.05).In terms of radiological results,there was significant progress in ARCO staging and collapse degree after conservative hip preservation treatment,but there was no significant difference in JIC classification and lesion size.CONCLUSION Conservative hip preservation treatment can effectively treat ONFH,prevent the progression of the necrosis,and significantly improve the clinical function of patients.The radiological staging and lesion size at the initial visit may help determine the prognosis of conservative hip preservation treatment.展开更多
BACKGROUND Unstable intertrochanteric fractures in elderly patients require effective surgical management,with both cementless bipolar hemiarthroplasty(CBHA)and proximal femoral nail anti-rotation(PFNA)being valid tre...BACKGROUND Unstable intertrochanteric fractures in elderly patients require effective surgical management,with both cementless bipolar hemiarthroplasty(CBHA)and proximal femoral nail anti-rotation(PFNA)being valid treatment options to reduce morbidity and mortality.AIM To evaluate and compare the outcomes of CBHA and PFNA in treatment of unstable intertrochanteric fractures.METHODS A comprehensive search was conducted to identify relevant studies discussing the outcomes of using both CBH and PFNA in treatment of unstable intertrochanteric fractures.Studies published up to January 1,2025 were searched across multiple databases,including PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar.Full texts of the selected articles were retrieved,reviewed,and independently assessed by the investigators.Discrepancies were resolved by consensus,with any remaining disagreements being arbitrated by a third author.RESULTS This meta-analysis included three studies,all of which were retrospective,involving a total of 240 patients.The follow-up period for participants was at least 12 months.CBHA was associated with significantly higher blood loss compared to PFNA[mean differences(MD):129.14,95%CI(52.51,205.77),P=0.001],though heterogeneity was high(I²=97%).Operative time showed no significant difference initially[MD:6.10,95%CI(-13.34,25.54),P=0.54],but after excluding one study,BHA had longer operative times[MD:21.51,95%CI(18.60,24.41),P<0.00001].Hospital stay and Harris scores showed no significant differences between groups.CBHA facilitated faster progression to weight-bearing[MD:-11.92,95%CI(-22.46,-1.39),P=0.03]and a lower incidence of prosthetic loosening[risk ratio:0.21,95%CI(0.05,0.92),P=0.04].Refracture and thrombus formation rates were comparable between the two groups.CONCLUSION CBHA offers shorter weight-bearing duration and reduced prosthetic loosening but incurs greater blood loss and longer operative times compared to PFNA.Both techniques show comparable functional recovery,hospital stay,refracture,and thrombus risks.Clinical choice should prioritize early mobilization or surgical minimalism,guided by patient needs.Further prospective studies are warranted.展开更多
Background of the Study: Femoral shaft fracture is the most common pediatric injury requiring hospitalization. For children less than 5 years old, non-surgical approach is recommended. For pediatric patients 5 - 14 ye...Background of the Study: Femoral shaft fracture is the most common pediatric injury requiring hospitalization. For children less than 5 years old, non-surgical approach is recommended. For pediatric patients 5 - 14 years old, the most common mode of treatment is flexible intramedullary nailing with a known complication of pain at post-op site, inflammatory reaction/bursitis at the entry site, superficial and deep infection, knee synovitis, knee stiffness, leg length discrepancy, proximal nail migration, angulation or malunion, delayed and non-union, implant breakage. This study aims to present a rare complication of a femoral fracture fixed with flexible intramedullary nail. Methodology: We report the outcome of a 12-year-old male with peri implant fracture of the left femur. He underwent removal of plates and screws and subsequently fixed with flexible intramedullary nails. Patient was followed up at 1, 3, 7, and 10 months post-operatively. Varus-valgus, sagittal angulation, and limb shortening were measured pre- and post-operatively. Complications were recorded on each visit. Results: Pre-operative varus angulation was 10˚, pro-curvatum of 55˚ with limb shortening of 4 cm. Postoperatively, varus was maintained to 10˚ but pro-curvatum was corrected to 4˚ and limb shortening was reduced to 1 cm. However, after 1 month the varus angulation increased to 30˚ while maintaining sagittal pro-curvatum. Limb shortening also increased to 2 cm. New bone formation started to appear along the mechanical axis of the left femur which is apparent at 3 months post-op and pro-curvatum increased to 20˚. At 7 and 10 months post-op no signs of union was noted at the fracture site but the callus formation along the mechanical axis gradually matured and appeared as a new femoral shaft. Conclusion: Formation of new bone in response to unstable flexible intramedullary fixation in pediatric femoral shaft fracture is a very rare complication.展开更多
BACKGROUND Steroid-induced avascular necrosis of the femoral head(SANFH)involves bone metabolism imbalance and lacks effective therapies.Mesenchymal stem cells(MSCs),particularly human umbilical cord MSCs(hUCMSCs),off...BACKGROUND Steroid-induced avascular necrosis of the femoral head(SANFH)involves bone metabolism imbalance and lacks effective therapies.Mesenchymal stem cells(MSCs),particularly human umbilical cord MSCs(hUCMSCs),offer promise due to their osteogenic and immunomodulatory potential.Sclerostin(SOST)inhibits bone formation,so we developed a multi-target gene silencing strategy against SOST using RNA interference.We created hUCMSCs with SOST-silenced(sh-hUCMSCs)and compared their therapeutic efficacy with unmodified hUCMSCs in SANFH mice.This study explores a novel approach to enhance osteogenesis and mitigate SANFH progression.AIM To assess the effects of sh-hUCMSCs on bone metabolism in SANFH.METHODS hUCMSCs were isolated from placental tissue and transfected with SOST-targeting short hairpin RNA plasmids.A SANFH mouse model was established through intraperitoneal injection of lipopolysaccharide(20μg/kg)followed by intramuscular methylprednisolone administration(40 mg/kg).Mice were randomized into four experimental groups(n=10/group):Sham control,SANFH(untreated),hUCMSCs-treated,and sh-hUCMSCs-treated.Micro-computed tomography was used to measure bone volume(BV),bone surface area,bone surface/BV ratio,tra-becular number,trabecular thickness,and trabecular separation.Quantification of adipocyte area by hematoxylin and eosin staining.Collagen fiber volume was assessed by Masson’s trichrome staining.Serum levels of osteopro-tegerin(OPG),receptor activator of nuclear factor kappa B(RANK),RANK ligand(RANKL),tartrate-resistant acid phosphatase,and the OPG/RANKL ratio were measured by enzyme-linked immunosorbent assay.The expression levels of alkaline phosphatase,OPG,SOST,β-catenin,peroxisome proliferator-activated receptor gamma,and CCAAT/enhancer-binding protein in bone tissue were determined by western blot analysis.RESULTS hUCMSCs and sh-hUCMSCs exhibited typical fibroblast-like morphology and high expression of MSC surface markers(CD90,CD73,CD105>98%).These cells demonstrated tri-lineage differentiation potential,confirmed by positive Alizarin Red S,Oil Red O,and Alcian Blue staining,and upregulation of lineage-specific genes.After SOST-RNA interference modification,sh-hUCMSCs showed enhanced inhibition of adipogenesis and improved bone formation in a rat model of SANFH.Histological analysis revealed reduced lipid infiltration and empty lacunae in the femoral head of the sh-hUCMSC group.Western blot showed decreased CCAAT/enhancer-binding protein and peroxisome proliferator-activated receptor gamma expression(P<0.05).Masson staining and micro-computed tomography analysis confirmed significantly increased BV,trabecular number,trabecular thickness,and reduced trabecular separation in the sh-hUCMSC group compared to unmodified MSCs and SANFH groups(P<0.05).Serum enzyme-linked immunosorbent assay showed higher OPG and lower RANK,RANKL,and tartrate-resistant acid phosphatase levels in the sh-hUCMSCs group.Western blot further confirmed upregulated alkaline phosphatase,OPG,β-catenin,and downregulated SOST expression in sh-hUCMSCs compared to controls(P<0.05).These results suggest that SOST inhibition enhances the osteogenic potential and therapeutic efficacy of hUCMSCs in SANFH.CONCLUSION sh-hUCMSCs alleviate SANFH by activating the Wnt/β-catenin signaling pathway,thereby promoting osteogenic differentiation and suppressing adipogenesis to restore bone metabolic balance.展开更多
The study aimed to explore the efficacy and potential mechanisms of a naturally aromatic cyanogenic compound amygdalin(AMY)in treating glucocorticoid(GC)-associated necrosis of the femoral head(GANFH).We demonstrated ...The study aimed to explore the efficacy and potential mechanisms of a naturally aromatic cyanogenic compound amygdalin(AMY)in treating glucocorticoid(GC)-associated necrosis of the femoral head(GANFH).We demonstrated that GC exacerbates the oxidative stress(OS)microenvironment via promoting nicotinamide adenine dinucleotide phosphate oxidase 4(NOX4)expression in human,rat,and mesenchymal stem cells(MSCs)samples,thus generating excessive reactive oxygen species(ROS),leading to increased apoptosis and unbalanced osteolipogenic differentiation.Furthermore,computational docking results revealed that AMY could bind specifically to the predicted binding sites of NOX4.Additionally,AMY ameliorated the OS microenvironment of MSCs via decreasing NOX4 expression and inhibiting NOX4/ROS/p38MAPK signaling,thereby reversing the GC-induced apoptosis and imbalanced osteolipogenic differentiation,and ultimately alleviating GANFH.In summary,we demonstrated for the first time that AMY attenuated apoptosis and maintained osteolipogenic differentiation balance in MSCs via specifically targeting NOX4,inhibiting NOX4/ROS/p38MAPK signaling,thereby treating GANFH.展开更多
Purpose:To evaluate the effects of healthcare failure mode and effect analysis(FMEA)on the prevention of deep venous thrombosis(DVT)in elderly patients undergoing femoral fracture surgery.Methods:Eighty elderly patien...Purpose:To evaluate the effects of healthcare failure mode and effect analysis(FMEA)on the prevention of deep venous thrombosis(DVT)in elderly patients undergoing femoral fracture surgery.Methods:Eighty elderly patients undergoing femoral fracture surgery who did not apply FMEA in Suzhou BenQ Medical Center from June 1,2022 to May 31,2023 were selected as the control group.According to the equal group experiment method,80 elderly patients who were managed using FMEA from June 1,2023 to May 31,2024 were selected as the FMEA group.The control group received traditional nursing management,while the FMEA group applied FMEA to analyze failure causes,calculate Risk Priority Numbers(RPNs),identify failure modes with higher RPNs,analyze the influencing factors,develop improvement measures,and optimize processes.The RPN values and the incidence of DVT,as well as nursing satisfaction scores,were compared in the two groups.Results:Compared with the control group,the total RPN values of the FEMA group decreased significantly,with a reduction rate of 87.0%.Besides,the incidence of DVT was 1.3%in the FMEA group,lower than 10.0%in the control group(8/80).What’s more,the patients in the FMEA group were more satisfied with the nursing service compared with the patients in the control group.Conclusion:The application of the FMEA in elderly patients undergoing femoral fracture surgery has demonstrated its potential to prevent the incidence of DVT,lower RPN values,and improve nursing satisfaction.展开更多
文摘We report a unique case of bilateral femoral stem fractures in a patient with Dorr A femoral morphology,underscoring the need for a critical reassessment of implant selection strategies.The initial failure involved a cemented revision stem placed using the cement-within-cement technique combined with an extended trochanteric osteotomy(ETO).A second revision was subsequently performed using a cortical window osteotomy and a distally fixed uncemented stem,which resulted in successful recovery.A similar approach was used to treat a subsequent contralateral stem fracture,also with favorable outcomes.This case emphasizes three key considerations:First,that standard-length cemented stems may lead to oversizing and increased stress concentration in Dorr A femurs with narrow canals;second,that ETO may compromise femoral integrity and contribute to implant failure;and third,that cortical window osteotomy enables safer implant removal and reimplantation.Based on these findings,we advocate for an individualized approach to implant selection that may include cemented short stems,uncemented short stems,or modular solutions depending on femoral anatomy and patient-specific factors,and we encourage further investigation into optimal fixation strategies for patients with Dorr A femoral morphology.
基金Professor Seydou Doumbia for his financial support to the article
文摘Objectives: The purpose of this work was to measure the dimensions of the femoral veins, to describe the affluent and the variations of the femoral veins. Methodology: Twenty-four femoral veins of 12 fresh adult cadavers were dissected and photographed. Results: The diameter of the superficial, deep and common femoral veins was respectively 8.75 mm;7.60 mm and 13.95 mm. The common femoral vein was 80.70 mm long. At the level of the superficial vein, the modal disposition was noted in 79.17%;as anatomical variations, it was split in 2 cases, the presence of a collateral canal in 1 case and in 2, and it received a quadricipital muscle vein. At the level of the deep femoral vein, the modal disposition was noted in 16.67%, and the anatomical variations were noted in 83.33% where it received no affluent in the femoral trine. The modal disposition was noted in 91.67% at the level of the mode of birth of the common femoral vein, in 16.67% at the level of its tributaries. The anatomical variations were noted in 8.33% in the mode of birth of the femoral vein, in 83.33% in which the common femoral vein received, in addition to the large saphenous vein, other tributaries, the most frequent of which were the quadricipital veins and the circumflex femoral veins. Conclusion: The diameter of the femoral veins is important. The main tributaries of the common femoral vein are GVS, VQ and circumflex femoral veins. The femoral variations are numerous and important to know to avoid a possible misdiagnosis in case of their thrombosis.
基金the support of the National Natural Science Foundation of China (Grant No.82272503)Natural Science Foundation of Zhejiang Province (Grant No. LQN25H060006)
文摘Exosomes have shown good potential in ischemic injury disease treatments.However,evidence about their effect and molecular mechanisms in osteonecrosis of femoral head(ONFH)treatment is still limited.Here,we revealed the cell biology characters of ONFH osteonecrosis area bone tissue in single cell scale and thus identified a novel ONFH treatment approach based on M2 macrophages-derived exosomes(M2-Exos).We further show that M2-Exos are highly effective in the treatment of ONFH by modulating the phenotypes communication between neutrophil and endothelium including neutrophil extracellular traps formation and endothelial phenotype transition.Additionally,we identified that M2-Exos’therapeutic effect is attributed to the high content of miR-93-5p and constructed miR-93-5p overexpression model in vitro and in vivo based on lentivirus and adenoassociated virus respectively.Then we found miR-93-5p can not only reduce neutrophil extracellular traps formation but also improve angiogenic ability of endothelial cells.These results provided a new theoretical basis for the clinical application of ONFH therapeutic exosomes.
基金supported by the National Key R&D Program of China(Grant No.2021YFC2501700).
文摘The current artificial bone is unable to accurately replicate the inhomogeneity and anisotropy of human cancellous bone.To address this issue,we proposed a personalized approach based on clinical CT images to design mechanical equivalent porous structures for artificial femoral heads.Firstly,supported by Micro and clinical CT scans of 21 bone specimens,the anisotropic mechanical parameters of human cancellous bone in the femoral head were characterized using clinical CT values(Hounsfield unit).After that,the equivalent porous structure of cancellous bone was designed based on the gyroid surface,the influence of its degree of anisotropy and volume fraction on the macroscopic mechanical parameters was investigated by finite element analysis.Furthermore,a mapping relationship between CT values and the porous structure was established by jointly solving the mechanical parameters of the porous structure and human cancellous bone,allowing the design of personalized gradient porous structures based on clinical CT images.Finally,to verify the mechanical equivalence,implant press-in tests were conducted on 3D-printed artificial femoral heads and human femoral heads,the influence of the porous structure’s cell size in bone-implant interaction problems was also explored.Results showed that the minimum deviations of press-in stiffness(<15%)and peak load(<5%)both occurred when the cell size was 20%to 30%of the implant diameter.In conclusion,the designed porous structure can replicate the human cancellous bone-implant interaction at a high level,indicating its effectiveness in optimizing the mechanical performance of 3D-printed artificial femoral head.
基金iVascular,S.L.U.,Camíde Can Ubach,11–Nave 3,08620 Sant Vicençdels Horts,Barcelona,Spain。
文摘Background:The efficacy of balloon angioplasty for treating peripheral artery disease is influenced by various factors,some of them not yet totally understood.This study aimed to evaluate the role of elastin content in vascular responses 28 days postangioplasty using uncoated and paclitaxel-coated balloons with the same platform in femoral arteries of a healthy porcine model.Methods:Eight animals underwent balloon angioplasty on the external and internal branches of femoral arteries.Histopathologic evaluation was conducted at follow-up to assess the elastin content,vascular damage,morphological features,and neointimal formation.Results:The elastin content was significantly higher in the external than in the internal femoral artery(p=0.0014).After balloon angioplasty,it was inversely correlated with vascular injury score(ρ=−0.4510,p=0.0096),neointimal inflammation(ρ=−0.3352,p=0.0607),transmural(ρ=−0.4474,p=0.0103)and circumferential(ρ=−0.4591,p=0.0082)smooth muscle cell loss,presence of proteoglycans(ρ=−0.5172,p=0.0024),fibrin deposition(ρ=−0.3496,p=0.0499),and adventitial fibrosis(ρ=−0.6229,p=0.0002).Neointimal formation inhibition with paclitaxel was evident only in arteries with disruption of the internal elastic lamina,with a significant smaller neointimal area in arteries treated with paclitaxel-coated balloons compared to uncoated balloons(median[Q1–Q3]:10.25[7.49–15.64]vs.24.44[18.96–30.52],p=0.0434).Conclusions:Elastin content varies between branches of the femoral artery and significantly influences the integrity of the internal elastic lamina,the vessel's adaptive response,and paclitaxel efficacy after balloon angioplasty.
文摘BACKGROUND With rising angiography costs and risks,we explored whether a 5-minute femoral ultrasound can predict patients that actually require angiography.AIM To detect associations between atherosclerosis of peripheral arteries and coronary stenosis in patients with coronary heart disease(CHD).METHODS The study included a total of 218 patients(63±10.9 years of age;54%male)with CHD subjected to coronary angiography and routine diagnostic assessment,including ultrasound imaging to assess the extent of peripheral atherosclerotic lesions.Receiver operating characteristic analysis and binomial logistic regression were used to detect the associations.RESULTS We demonstrated for the first time that the presence of atherosclerotic plaque with≥70%stenosis in femoral arteries was associated with significant coronary stenosis,with 93%sensitivity and 90%specificity,and thus can be used as an additional diagnostic marker for coronary stenosis.The data indicated associations between femoral artery atherosclerosis and atherosclerotic lesions of coronary arteries,with a high correlation coefficient r=0.8(P<0.05).The presence of an atherosclerotic plaque in the femoral arteries with≥30% or≥70%stenosis was associated with a 30-or 70-fold higher odds ratio of coronary stenosis,respectively.CONCLUSION For resource-limited clinics,our findings suggest skipping carotids-femoral ultrasound alone may suffice to rule out severe CHD.Ultrasound imaging femoral artery atherosclerosis provides a simplified approach for patient stratification.
文摘BACKGROUND Osteonecrosis of the femoral head(ONFH)is an ischaemic disorder often leading to collapse of the femoral head and severe hip dysfunction.Mesenchymal stem cells(MSCs)have a key role in bone repair,through their ability to differentiate into osteoblasts and their paracrine regulation of the bone microenvironment.While altered MSCs behaviour has been reported in some secondary forms of ONFH,the proliferative and differentiation programmes of MSCs in human idiopathic ONFH have not been previously characterized.AIM To compare the proliferative capacity,differentiation potential and nuclear factor kappa B(NF-κB)pathway activation of bone marrow MSCs(BM-MSCs)from idiopathic ONFH patients with those from osteoarthritis controls.METHODS Femoral heads were collected during total hip replacement surgeries.Idiopathic ONFH was defined by imaging and histological criteria.Secondary causes were excluded.BM-MSCs were isolated from trabecular bone cylinders and expanded to passage 2 prior characterizations.Proliferation was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay at various seeding densities.Osteogenic potential was assessed by alkaline phosphatase activity,osteogenic gene expression(RUNX2,ALPL,COL1A1 and BGLAP)and Alizarin Red staining.Adipogenesis was quantified by Oil Red O staining.Expression of NF-κB target genes(IL6,NFKBIA,CCL2)was analyzed by quantitative polymerase chain reaction.RESULTS Idiopathic ONFH MSCs exhibited significantly higher proliferation rates than osteoarthritis controls.However,they showed reduced alkaline phosphatase activity and osteogenic gene expression but paradoxically,increased mineralization,suggesting non-canonical mineral deposition mechanisms.These cells also display increased adipogenic differentiation.Importantly,ONFH-MSCs expressed higher,although non-significant levels of certain NF-κB target gene genes,consistent with an activated inflammatory state.CONCLUSION Human BM-MSCs from idiopathic ONFH display a paradoxical phenotype:Hyperproliferative yet osteogenically impaired with greater adipogenesis and activation of NF-κB signalling.This functional compromise and inflammatory bias may underline the failure of bone regeneration in ONFH,highlighting the need for therapies redirecting MSCs fate and modulating the bone marrow niche.
基金funded by R.D.H.,P.B.,A.S.W. and Z.W,Heart Foundation Vanguard Grant#107321funded by contributions from The Baird Institute for applied Heart and Lung Research.
文摘Objective:Sheep are commonly used as large animal pre-clinical models for inves-tigating cardiovascular therapies,interventions,anatomy and physiology.Further,novel small diameter vascular grafts are frequently tested via implantation into sheep carotid arteries(CAs).This is because,unlike humans,acute occlusion of one or both sheep CAs is not associated with morbidity or mortality and thus provides safer experimental testing,with reduced ethical constraints,animal numbers and costs.However,to date there has been no evidence regarding sheep tolerance of femoral artery(FA)occlusion.Methods:In this study,seven sheep underwent CA graft surgery,with digital subtrac-tion angiography(DSA)of the CAs performed every 2 months via femoral access,for a total of 8 months.Four months into the study,the left FA of two sheep became inac-cessible due to a suspected FA occlusion.Thus,femoral angiography was performed,followed by FA dissection,FA histology and retrospective analysis of both veterinar-ian animal monitoring and pain scores.Results:FA angiography and histology confirmed complete left FA occlusion in two sheep.Retrospective animal monitoring demonstrated sheep with occluded FAs did not display increased pain scores or deleterious effects on their gait or wellbeing.Conclusion:Our data shows that sheep tolerate FA occlusion with no symptoms,similar to their cerebral circulation,making them an appropriate model for assessing small diameter femoral graft interposition studies and testing other cardiovascular interventions.
文摘BACKGROUND Certain implant combinations change leg length and offset in primary total hip arthroplasty(THA).Poor restoration of leg biomechanics is a frequently cited reason for patient dissatisfaction following primary THA.A pure high-offset stem should provide direct lateralization without affecting femoral length when compared to a standard stem.However,clinical experience with preoperative planning software based on computed tomography-based three-dimensionalmodels reveals that using pure high-offset stems in THA may cause a difference between expected(no change in femoral length)and actual(small increase)in postoperative femoral length.AIM To elucidate the causes of these femoral length discrepancies using preoperative planning software.METHODS Preoperative templating for 43 robotic-assisted THAs,optimizing acetabular size and orientation,center of rotation,stem size and offset,and prosthetic head diameter were obtained.The preoperative planning software was used to calculate differences between preoperative and postoperative femoral length for standard and pure high-offset stems,unique to each patient.RESULTS Whilst the increase in femoral length between standard and high-offset stems was not significant(P=0.93),35 femurs(81.4%)experienced a 1-mm increase,and 3(7.0%)experienced a 2-mm increase in femoral length while using high-offset stem compared to the standard stem.The incidence of femoral length increase was lower for patients with shorter femurs(18/22;81.8%)compared to patients with longer femurs(20/21;95.2%).CONCLUSION When pure high-offset stems were used in preoperative planning software,we demonstrated an unexpected increase in leg length between 1-2-mm in 88.4%of patients.This unexpected increase in femoral length is due to a function of the preoperative planning software’s planned stem alignment with the anatomical axis,and not an inherent fault in the stem design.With expanding accessibility of robotic-assisted THA platforms,all potential sources of postoperative leg length discrepancy should be identified during preoperative templating and necessary alterations to the surgical plan should be made to accommodate this unexpected difference when using a pure high-offset stem.
文摘BACKGROUND Femur fractures are one of the most serious injuries that occur in the older population and are associated with severe pain and increased mortality.The primary objective of this study was to find if there was a significant difference in pain scores in patients treated with femoral nerve blocks(FNB)compared with patients treated with the standard analgesia protocol.The secondary objective was to find if there was a significant difference in morbidity between the two groups.AIM To evaluate the effectiveness of ultrasound(US)-guided FNB in managing preoperative pain and reducing morbidity in patients with neck femur fractures compared to the standard analgesia protocol.The study seeks to determine whether FNB offers superior outcomes in terms of pain control,rehospitalization rates,and mortality.METHODS This retrospective cohort study included 1577 patients suffering from neck femur fractures.387 patients were treated with a FNB for pain management upon arrival at the emergency department,the rest were treated with standard analgesia.Pain was assessed from electronic medical records using the visual analogue scale(VAS)pre surgery,12-and 24-hour post-surgery.To determine morbidity and mortality during hospitalizations and 6 months after,it was collected from electronic medical records.RESULTS In a cohort of 1577 patients,those receiving US-guided FNB had significantly lower preoperative VAS pain scores(1.46±2.49 vs 1.82±2.59,P=0.001),reduced rehospitalization rates(0.99±1.96 vs 1.46±2.34,P<0.001),and lower mortality(16%vs 32%,P<0.001)compared to standard analgesia.CONCLUSION US guided FNB is more effective for pain management compared with standard analgesia.This method was also found to significantly reduce the risk of morbidity in those patients.
文摘BACKGROUND Postoperative anxiety,depression,irritability,and even fear in patients with intertrochanteric femoral fractures may hinder recovery,compromise treatment efficacy,and impede rehabilitation.AIM To investigate the correlations among anxiety,depression,sense of coherence(SOC),and post-traumatic growth(PTG)in patients who underwent intertrochanteric femoral fracture surgery to improve clinical management strategies and outcomes.METHODS This study carefully selected 211 patients who received surgical treatment for intertrochanteric femoral fractures and were admitted to Dongying People’s Hospital from March 2022 to March 2024.Anxiety and depression in these patients were assessed with the anxiety and depression subscales of the Hospital Anxiety and Depression Scale(HADS),respectively.SOC was evaluated using the 13-item SOC scale(SOC-13),which encompasses three key dimensions:Comprehensibility,manageability,and meaningfulness.PTG was assessed with the Chinese version of PTG Inventory(CPTGI),covering five distinct dimensions:Personal strength,appreciation of life,relating to others,new possibilities,and spiritual change.The Pearson correlation coefficient was used to meticulously analyze the associations among HADS-Anxiety,HADS-Depression,SOC-13,and CPTGI.Further,univariate and multivariate analyses were conducted to identify factors that affect PTG in patients who underwent intertrochanteric femoral fracture surgery.RESULTS The collected data demonstrated that 67.30%and 60.66%of the 211 patients experienced anxiety and depression,respectively,with overall anxiety levels ranging from mild to moderate and depression levels being mild.The mean SOC-13 score was 55.73±8.81 points,indicating a generally low SOC level.The average CPTGI score was 54.93±9.92 points,demonstrating a relatively low PTG level.Notably,both HADS-Anxiety and HADS-Depression scores were significantly negatively correlated with CPTGI,whereas SOC-13 scores were significantly positively correlated with CPTGI.Univariate and multivariate analyses identified the presence of comorbidities[odds ratio(OR)=2.747,P=0.003],monthly household income(OR=3.292,P<0.001),and exercise habits(OR=4.651,P<0.001)as independent predictors of PTG in patients.CONCLUSION The results of this study indicate a significant negative correlation of anxiety and depression with PTG in patients after intertrochanteric femoral fracture surgery,whereas a significant positive association exists between SOC and PTG.This study helps more comprehensively understand the psychological status and recovery processes of such patients,thereby potentially providing valuable information for clinical practice and psychological interventions.
基金supported by the National Natural Science Foundation of China(82422045).
文摘Background:The risk of internal fixation failure remains relatively high in stable femoral neck fracture(FNF)(Garden I or II).Preoperative sagittal displacement of the femoral head has been proposed as a potential influencing factor.This study aimed to evaluate the impact of sagittal displacement on the outcomes of cannulated screw internal fixation(CSIF)in patients with stable FNF(Garden I or II)by reconstructing the axial sagittal oblique plane of the fracture using preoperative computed tomography(CT)imaging.Methods:This study included 167 patients with FNF who underwent CSIF.The sagittal tilt angle of the femoral head(STAFH)was evaluated using three-dimensional CT(3D-CT).The distribution of preoperative STAFH was analyzed,and its independent association with treatment failure was assessed.Treatment failure was defined as the need for revision surgery within 2 years postoperatively due to avascular necrosis,nonunion,or internal fixation failure.Results:Among the 167 patients,9(5.4%)exhibited anterior tilt(AT)of the femoral head,158(94.60%)presented with posterior tilt(PT).A total of 50 patients(29.9%)demonstrated excessive sagittal displacement(AT≥10°or PT≥20°).In the failure group,80.0%of patients had excessive sagittal displacement compared to 28.1%in the healed group.Excessive sagittal displacement was significantly associated with an increased risk of surgical failure(odds ratio:11.953,95%CI:3.656-39.083,p<0.05).Conclusions:In patients with Garden I or II FNF,greater preoperative sagittal displacement of the femoral head was correlated with a higher likelihood of CSIF failure.AT≥10°or PT≥20°were identified as independent predictors of CSIF failure in FNF patients.Nevertheless,these findings still require confirmation through prospective,multi-center clinical trials with large sample sizes.
基金Supported by the Science Project of Hunan Provincial Healthy Commission,No.20230844.
文摘Slipped capital femoral epiphysis(SCFE)is a hip disorder that predominantly affects adolescents.The primary pathological change involves the displacement of the femoral head epiphysis from its normal position at the growth plate toward the metaphysis of the femoral neck.This condition can result in hip pain,abnormal gait,and even avascular necrosis of the femoral head,significantly impacting the quality of life in adolescents.Currently,the exact etiology of SCFE remains unclear;however,evidence suggests that risk factors include endocrine disorders,metabolic conditions,and genetic diseases.Endocrine disorders encompass hypothyroidism,growth hormone abnormalities,hypogonadism,and obesity-related hormonal imbalances.Metabolic conditions involve obesity,vitamin D deficiency or rickets,and renal osteodystrophy.Genetic diseases include mutations in the COL2A1 gene,aromatase deficiency,and Prader-Willi syndrome.This review summarizes various medical conditions associated with SCFE and elucidates potential molecular mechanisms from abnormal chondrocyte function in the growth plate,hormonal imbalances and inflammatory/metabolic factors in SCFE based on relevant literature,aim to provide evidence for the prevention and treatment of SCFE.
文摘BACKGROUND In intertrochanteric fractures,the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse.AIM To analyze the concept of medial cortical reduction(MCR)and its clinical and radiological association in geriatric intertrochanteric femur fractures.METHODS Geriatric patients who presented with AO/OTA 31A1 and 31A2 femur fractures and treated with proximal femoral nailing between July 2021 and June 2023 were include in this prospective cohort study.Based on the degree of MCR,they were divided into positive,neutral,or negative MCR groups.The demographic baseline characteristics,postoperative radiographic femoral neck-shaft angle and neck length were analyzed at 6,12 and 24 weeks post-surgery.Functional outcomes such as modified Harris Hip Score(HHS)and time to full-weight bearing were also analyzed.RESULTS 47 patients(Male:Famale 35:12)with mean age of 65.8±4.2 years were included in this study.Twenty-two cases had neutral support,nine had negative support,and sixteen had positive support in the medial cortex postoperatively.Baseline characteristics of the three groups were comparable.No significant differences were found in the femur neck length and femur neck-shaft angle changes post-surgery between the groups.The modified HHS was not found to be significant between the groups(P=0.883)as that of the time to full weight bearing(P=0.789).CONCLUSION The type of reduction achieved based on medial cortical alignment does not affect the femur neck length shortening or varus collapse.Future randomized controlled trials are needed to validate the findings noted in the study.
基金Supported by Zhejiang Medical and Health Science and Technology Project,No.2024KY133Zhejiang Provincial Plan for Traditional Chinese Medicine Science and Technology Project,No.2025ZR111 and No.2023ZL038.
文摘BACKGROUND Osteonecrosis of the femoral head(ONFH)is a prevalent clinical condition,and as the affected population becomes younger and more widespread,an increasing number of patients prefer to retain their own hip joints.In comparison to joint replacement and hip-preserving surgeries,conservative hip preservation treatment is gaining more recognition from both clinicians and patients.AIM To observe the clinical efficacy and influencing factors of conservative hip preservation treatment for patients with ONFH.METHODS A total of 73 patients(119 hips)were included,and patients were grouped based on Association Research Circulation Osseous(ARCO)stage,Japanese Investigation Committee(JIC)classification,lesion size,and collapse degree.The clinical efficacy of conservative hip preservation treatment was evaluated from two aspects:Radiological progression and clinical functional scores[Harris Hip Score,Western Ontario and McMaster Universities Arthritis Index(WOMAC),international Hip Outcome Tool 12(iHOT-12),and visual analogue scale(VAS)].Analyzing the success rate of conservative hip preservation based on conversion to total hip arthroplasty or hip preservation surgery.RESULTS In this retrospective cohort study,we retrospectively analyzed 73 patients(119 hips)with an average follow-up time of 53.58±26.80(18-129)months.The overall success rate of hip preservation is 90.76%.The success rates of hip preservation in ARCO I-II,IIIa,and IIIb were 97.67%,91.53%,and 70.59%,respectively(P<0.05).The success rates of hip preservation for JIC A-B,C1,and C2 were 93.37%,92.59%,and 77.78%,respectively(P<0.05).The success rates of hip preservation with collapse degree≤2 mm and>2 mm were 94.12%and 70.59%,respectively(P<0.05).There was no significant difference in the success rate of hip preservation between different lesion sizes.In terms of clinical function,the Harris Hip Score,WOMAC,iHOT-12,and VAS scores at the last follow-up were significantly better than before treatment(P<0.05).The VAS scores of ARCO IIIa and IIIb were significantly worse than those of ARCO I and II(P<0.05).The iHOT-12,WOMAC,and VAS scores were significantly better with the lesion size<15%(P<0.05).In terms of radiological results,there was significant progress in ARCO staging and collapse degree after conservative hip preservation treatment,but there was no significant difference in JIC classification and lesion size.CONCLUSION Conservative hip preservation treatment can effectively treat ONFH,prevent the progression of the necrosis,and significantly improve the clinical function of patients.The radiological staging and lesion size at the initial visit may help determine the prognosis of conservative hip preservation treatment.
文摘BACKGROUND Unstable intertrochanteric fractures in elderly patients require effective surgical management,with both cementless bipolar hemiarthroplasty(CBHA)and proximal femoral nail anti-rotation(PFNA)being valid treatment options to reduce morbidity and mortality.AIM To evaluate and compare the outcomes of CBHA and PFNA in treatment of unstable intertrochanteric fractures.METHODS A comprehensive search was conducted to identify relevant studies discussing the outcomes of using both CBH and PFNA in treatment of unstable intertrochanteric fractures.Studies published up to January 1,2025 were searched across multiple databases,including PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar.Full texts of the selected articles were retrieved,reviewed,and independently assessed by the investigators.Discrepancies were resolved by consensus,with any remaining disagreements being arbitrated by a third author.RESULTS This meta-analysis included three studies,all of which were retrospective,involving a total of 240 patients.The follow-up period for participants was at least 12 months.CBHA was associated with significantly higher blood loss compared to PFNA[mean differences(MD):129.14,95%CI(52.51,205.77),P=0.001],though heterogeneity was high(I²=97%).Operative time showed no significant difference initially[MD:6.10,95%CI(-13.34,25.54),P=0.54],but after excluding one study,BHA had longer operative times[MD:21.51,95%CI(18.60,24.41),P<0.00001].Hospital stay and Harris scores showed no significant differences between groups.CBHA facilitated faster progression to weight-bearing[MD:-11.92,95%CI(-22.46,-1.39),P=0.03]and a lower incidence of prosthetic loosening[risk ratio:0.21,95%CI(0.05,0.92),P=0.04].Refracture and thrombus formation rates were comparable between the two groups.CONCLUSION CBHA offers shorter weight-bearing duration and reduced prosthetic loosening but incurs greater blood loss and longer operative times compared to PFNA.Both techniques show comparable functional recovery,hospital stay,refracture,and thrombus risks.Clinical choice should prioritize early mobilization or surgical minimalism,guided by patient needs.Further prospective studies are warranted.
文摘Background of the Study: Femoral shaft fracture is the most common pediatric injury requiring hospitalization. For children less than 5 years old, non-surgical approach is recommended. For pediatric patients 5 - 14 years old, the most common mode of treatment is flexible intramedullary nailing with a known complication of pain at post-op site, inflammatory reaction/bursitis at the entry site, superficial and deep infection, knee synovitis, knee stiffness, leg length discrepancy, proximal nail migration, angulation or malunion, delayed and non-union, implant breakage. This study aims to present a rare complication of a femoral fracture fixed with flexible intramedullary nail. Methodology: We report the outcome of a 12-year-old male with peri implant fracture of the left femur. He underwent removal of plates and screws and subsequently fixed with flexible intramedullary nails. Patient was followed up at 1, 3, 7, and 10 months post-operatively. Varus-valgus, sagittal angulation, and limb shortening were measured pre- and post-operatively. Complications were recorded on each visit. Results: Pre-operative varus angulation was 10˚, pro-curvatum of 55˚ with limb shortening of 4 cm. Postoperatively, varus was maintained to 10˚ but pro-curvatum was corrected to 4˚ and limb shortening was reduced to 1 cm. However, after 1 month the varus angulation increased to 30˚ while maintaining sagittal pro-curvatum. Limb shortening also increased to 2 cm. New bone formation started to appear along the mechanical axis of the left femur which is apparent at 3 months post-op and pro-curvatum increased to 20˚. At 7 and 10 months post-op no signs of union was noted at the fracture site but the callus formation along the mechanical axis gradually matured and appeared as a new femoral shaft. Conclusion: Formation of new bone in response to unstable flexible intramedullary fixation in pediatric femoral shaft fracture is a very rare complication.
基金Supported by the National Natural Science Foundation of China,No.82260944the Key Research and Development Programs of Guangxi,No.2021AB09011。
文摘BACKGROUND Steroid-induced avascular necrosis of the femoral head(SANFH)involves bone metabolism imbalance and lacks effective therapies.Mesenchymal stem cells(MSCs),particularly human umbilical cord MSCs(hUCMSCs),offer promise due to their osteogenic and immunomodulatory potential.Sclerostin(SOST)inhibits bone formation,so we developed a multi-target gene silencing strategy against SOST using RNA interference.We created hUCMSCs with SOST-silenced(sh-hUCMSCs)and compared their therapeutic efficacy with unmodified hUCMSCs in SANFH mice.This study explores a novel approach to enhance osteogenesis and mitigate SANFH progression.AIM To assess the effects of sh-hUCMSCs on bone metabolism in SANFH.METHODS hUCMSCs were isolated from placental tissue and transfected with SOST-targeting short hairpin RNA plasmids.A SANFH mouse model was established through intraperitoneal injection of lipopolysaccharide(20μg/kg)followed by intramuscular methylprednisolone administration(40 mg/kg).Mice were randomized into four experimental groups(n=10/group):Sham control,SANFH(untreated),hUCMSCs-treated,and sh-hUCMSCs-treated.Micro-computed tomography was used to measure bone volume(BV),bone surface area,bone surface/BV ratio,tra-becular number,trabecular thickness,and trabecular separation.Quantification of adipocyte area by hematoxylin and eosin staining.Collagen fiber volume was assessed by Masson’s trichrome staining.Serum levels of osteopro-tegerin(OPG),receptor activator of nuclear factor kappa B(RANK),RANK ligand(RANKL),tartrate-resistant acid phosphatase,and the OPG/RANKL ratio were measured by enzyme-linked immunosorbent assay.The expression levels of alkaline phosphatase,OPG,SOST,β-catenin,peroxisome proliferator-activated receptor gamma,and CCAAT/enhancer-binding protein in bone tissue were determined by western blot analysis.RESULTS hUCMSCs and sh-hUCMSCs exhibited typical fibroblast-like morphology and high expression of MSC surface markers(CD90,CD73,CD105>98%).These cells demonstrated tri-lineage differentiation potential,confirmed by positive Alizarin Red S,Oil Red O,and Alcian Blue staining,and upregulation of lineage-specific genes.After SOST-RNA interference modification,sh-hUCMSCs showed enhanced inhibition of adipogenesis and improved bone formation in a rat model of SANFH.Histological analysis revealed reduced lipid infiltration and empty lacunae in the femoral head of the sh-hUCMSC group.Western blot showed decreased CCAAT/enhancer-binding protein and peroxisome proliferator-activated receptor gamma expression(P<0.05).Masson staining and micro-computed tomography analysis confirmed significantly increased BV,trabecular number,trabecular thickness,and reduced trabecular separation in the sh-hUCMSC group compared to unmodified MSCs and SANFH groups(P<0.05).Serum enzyme-linked immunosorbent assay showed higher OPG and lower RANK,RANKL,and tartrate-resistant acid phosphatase levels in the sh-hUCMSCs group.Western blot further confirmed upregulated alkaline phosphatase,OPG,β-catenin,and downregulated SOST expression in sh-hUCMSCs compared to controls(P<0.05).These results suggest that SOST inhibition enhances the osteogenic potential and therapeutic efficacy of hUCMSCs in SANFH.CONCLUSION sh-hUCMSCs alleviate SANFH by activating the Wnt/β-catenin signaling pathway,thereby promoting osteogenic differentiation and suppressing adipogenesis to restore bone metabolic balance.
基金supported by the Natural Science Foundation of China(81873325)the State Administration of Traditional Chinese Medicine of Zhejiang Province(2021ZZ014).
文摘The study aimed to explore the efficacy and potential mechanisms of a naturally aromatic cyanogenic compound amygdalin(AMY)in treating glucocorticoid(GC)-associated necrosis of the femoral head(GANFH).We demonstrated that GC exacerbates the oxidative stress(OS)microenvironment via promoting nicotinamide adenine dinucleotide phosphate oxidase 4(NOX4)expression in human,rat,and mesenchymal stem cells(MSCs)samples,thus generating excessive reactive oxygen species(ROS),leading to increased apoptosis and unbalanced osteolipogenic differentiation.Furthermore,computational docking results revealed that AMY could bind specifically to the predicted binding sites of NOX4.Additionally,AMY ameliorated the OS microenvironment of MSCs via decreasing NOX4 expression and inhibiting NOX4/ROS/p38MAPK signaling,thereby reversing the GC-induced apoptosis and imbalanced osteolipogenic differentiation,and ultimately alleviating GANFH.In summary,we demonstrated for the first time that AMY attenuated apoptosis and maintained osteolipogenic differentiation balance in MSCs via specifically targeting NOX4,inhibiting NOX4/ROS/p38MAPK signaling,thereby treating GANFH.
文摘Purpose:To evaluate the effects of healthcare failure mode and effect analysis(FMEA)on the prevention of deep venous thrombosis(DVT)in elderly patients undergoing femoral fracture surgery.Methods:Eighty elderly patients undergoing femoral fracture surgery who did not apply FMEA in Suzhou BenQ Medical Center from June 1,2022 to May 31,2023 were selected as the control group.According to the equal group experiment method,80 elderly patients who were managed using FMEA from June 1,2023 to May 31,2024 were selected as the FMEA group.The control group received traditional nursing management,while the FMEA group applied FMEA to analyze failure causes,calculate Risk Priority Numbers(RPNs),identify failure modes with higher RPNs,analyze the influencing factors,develop improvement measures,and optimize processes.The RPN values and the incidence of DVT,as well as nursing satisfaction scores,were compared in the two groups.Results:Compared with the control group,the total RPN values of the FEMA group decreased significantly,with a reduction rate of 87.0%.Besides,the incidence of DVT was 1.3%in the FMEA group,lower than 10.0%in the control group(8/80).What’s more,the patients in the FMEA group were more satisfied with the nursing service compared with the patients in the control group.Conclusion:The application of the FMEA in elderly patients undergoing femoral fracture surgery has demonstrated its potential to prevent the incidence of DVT,lower RPN values,and improve nursing satisfaction.
