Objective To investigate associations between femoral head necrosis (FHN) and injury to the retinaculum of Weitbrecht in patients with femoral neck fractures who had undergone initial trials of either closed reduction or direct open reduction. Methods This prospective observational study included 110 patients with displaced femoral neck fractures admitted to the Sixth People's Hospital Affiliated to Shanghai Jiaotong University and Shanghai Tongji Hospital between January 2008 and May 2017. Among these, 25 patients underwent initial closed reductions, and 85 patients underwent an open reduction directly. Watson‐Jones anterolateral approach was used during the surgery for injury to the retinaculum of Weitbrecht, and FHN was assessed as a surgical outcome. The severity of injury to the retinaculum of Weitbrecht was evaluated using a scoring system developed by our surgical team. Follow‐up was at least 24 months. Results The initial closed reduction treatment group had significantly higher total scores of injury to the retinaculum of Weitbrecht (6.24 ± 2.20 vs 4.62 ± 2.12, p = 0.009) compared to the open reduction group. High total scores were significantly associated with initial trials of closed reduction treatment, especially for the broken and released injury to the superior and anterior retinacula (both p = 0.01). Twenty‐six patients experienced FHN postoperatively, with mean onset time of 19.42 ± 3.87 months. FHN was significantly associated with the severity of injury to the retinaculum of Weitbrecht ( p < 0.001) at the superior, anterior, and inferior retinacula. FHN was significantly associated with injury to the retinaculum of Weitbrecht in females. Conclusions Femoral neck displacement in patients treated initially with closed reduction is associated with subsequent injury to the retinaculum of Weibrecht, which may lead to FHN. Severity of injury to the retinaculum of Weibrecht may be used as a biomarker to evaluate bone necrosis in patients with femoral neck fractures.

[Objective] To explore the impact of syndesmotic injury on the stability of ankle joint.[Methods] Six fresh frozen cadaveric specimens were used to make a biomechanical testing.The specimens were amputated above the knee joint.Ligaments of the syndesmosis,interosseous membrane,and deltoid ligament were sequentially sectioned.The specimens were loaded under a combination of 600 N axial loading and 5 Nm external rotation loading.Motion of the syndesmosis and the external rotation angle of the ankle joint were measured.[Results] Sequential resection of the syndesmotic ligaments and deltoid ligament led to increase of the medial-lateral displacement,anterior-posterior displacement,and rotation angle (around its axis) of the distal fibula,as well as the external rotation angle of the ankle joint.[Conclusions] The syndesmosis takes an important part in maintaining the biomechanical stability of the ankle joint.The posterior tibiofibular ligament seems to be the most important syndesmosis ligament for the rotational stability of the ankle joint.Dissection of the deltoid ligament would make the ankle joint much more unstable following the syndesmosis resection.

Objective To evaluate the application of locking plate in treatment of comminuted distal radius fractures.Methods The clinical data of 98 patients with comminuted distal radius fractures admitted from Jan 2007 to Jan 2010 were retrospectively analyzed.The fractures were classified as type C2 or C3 according to the AO classification.Thirty cases were treated with open reduction and locking plate internal fixation;while 68 cases were treated with closed reduction plaster immobilization. Results The functional rehabilitation was evaluated by Gartland-Werley scoring system.The results showed that the rate of excellent and good in plaster immobilization group was 82.4%(56/68);while that in locking plate fixation group was 93.3%(28/30).Conclusion Locking plate has advantages of stable fixation and early functional rehabilitation in treatment of distal radius fractures and should be widely used,especially for the senile osteoporotic patients.

Objective To evaluate the therapeutic effect of retrograde locking plate of femoral condyle in treatment of subtrochanteric femoral fractures and to analyze the feasibility of the clinical application of the retrograde locking plate of femoral condyle in the treatment of the subtrochanteric femoral fractures.Methods Twenty patients with subtrochanteric femoral fractures were treated with retrograde locking plate of femoral condyle from Mar.2007 to Dec.2009.According to the Seinsheimer classification system,1 case was in typeⅡB,3 cases in typeⅡC,typeⅢA and typeⅢB respectively,6 cases in typeⅣand 4 cases in typeⅤ.Results All incisions were healed by first intention and all cases did early rehabilitation exercises in hip joint,with the guidance of physical therapist.No complications occurred during hospitalization,including infections,decubital ulcer,deep vein thrombus,internal fixation loosening or breakage.Patients were followed-up for 10 to 24 months, mean(16.2±6.6)months.According to the Harris scoring system,the outcome of patients was excellent in 9 cases,good in 7 cases,fair in 4 cases with the excellent and good rate of 80%and no cases was classified as poor.Conclusions The retrograde locking plate of femoral condyle can provide rigid fixation in subtrochanteric femoral fractures,which enables early rehabilitation with less complication.It is an ideal method in treating subtrochanteric femoral fractures.

Objective:To investigate the inhibitory effects of conventional chemotherapy combined with metronomic chemotherapy on the growth of xenografted osteosarcoma in SD rats and compare the efficacy between different therapeutic regimens.Methods:One hundred and ten SD rats bearing osteosarcoma were divided into 4 groups randomly.Three groups were given conventional,metronomic,and combined chemotherapies while the forth group was as a control group.The tumor volumes were measured every week during the treatment period.At the end of 8-week treatment,the rats were sacrificed and the isolated tumors were weighed.Expression of vascular endothelial growth factor A(VEGFA) protein in tumors was determined by Western blot assays.Results:The three therapeutic regimens had inhibitory effects on the growth of osteosarcoma in SD rats.Conventional and metronomic chemotherapies had similar effects on tumor growth but both of them lost their inhibitory effect in the late period.However the combination therapy maintained the effectiveness till the end of the treatment.The tumor volumes and weights in the three treatment groups had statistically significant difference with control group at the 8th week after chemotherapy(P0.01).There was significant difference in tumor volume and weight between combination treatment group and conventional chemotherapy group and between combination treatment group and metronomic chemotherapy group(P0.01).Combination therapy achieved most powerful inhibitory effects on the growth of osteosarcoma(P0.001).Western blot indicated that the expression of VEGFA decreased significantly in all the treatment groups(P0.01) and the combination therapy group had the lowest VEGFA expression.Conclusion:Conventional chemotherapy combined with metronomic chemotherapy has more powerful anti-angiogenesis and anti-tumor effects.It will become an effective therapeutic regimen for osteosarcoma.

Objective To observe the morphologic characteristics of blood vessel of osteosarcoma cast and to study its pathological meaning.Methods Six osteosarcoma specimens were eroded by using blendable hypochlorous reagent to obtain a blood vessel cast of osteosacoma and observe the morphological characteristics of the vessel cast.Results From all the 6 specimen casts of osteosarcoma,an extraordinary developed system of tumour blood vessel configuration of osteosarcoma with excessive blood vessels,much wider and thicker,or narrower and thiner could both be seen in one area.Other morphologic characteristics of tumour blood vessel such as blood vessel lake,artery displacement,embranchment by a right angle,absence of center blood vessel, and center blood vessel with bottom vanishing,etc.could be found in all 6 osteosarcoma casts.Conclusion The capability of invasion,growth,and metastasis of osteosarcoma is seemly related to the tumour blood vessels.

Objective To study the related factors on which can improve therapeutic effects on fractures of tibial plateau(Schatzker Ⅳ～Ⅵ type).Methods The study covered 36 patients with a fracture of tibial plateau(SchatzkerⅣ～Ⅵ type) from January 2004 to December 2004.All patients were checked by ultra-thin sectional anatomy and computerized three-dimensional reconstruction technology.Incisions,reductions,bone transplantations and internal fixation by anatomical plates were selected according to CT 3D reconstruction after five to fourteen days' injury.Rehabilitation training were emphasized after operation.Results Ⅰ/first incision healing was found in 34 fractures.30 of 36 patients had been followed up for at least 12 months.The effective rate was 86.7%.Conclusion CT 3D reconstruction,suitable operation time and incisions,anatomical reduction,bone transplantation,rigid internal fixation and right rehabilitation training are all key factors which improve the therapeutic effects on tibial plateau(SchatzkerⅣ～Ⅵ type) fracture.

Objective To report the clinical results of application of locking proximal humerus plate in treatment of proximal humerus fractures in old patients.Methods 27 cases of old patients with proximal humerus fracture were treated with locking proximal humerus plates.According to Neer's classification,11 cases were two-part fractures,11 three-part fractures and 5 cases four-part fractures.Results The mean time for union tested by X-ray was 7.1(6 to 12) weeks.Nonunion was not found in all the cases.By Constant's scoring system,there were 17 excellent cases,8 good and 2 fair cases.The excellent and good rate together was 92.6%.Conclusion Locking proximal humerus plate is a minimally invasive device which has fewer complications and high bone union rate,and especially good as the aged patients with osteoporosis are concerned.

目的研究交锁髓内钉治疗下肢长骨骨折并发症原因,提出防治措施.方法我院1996年1月～2002年1月对239例下肢长骨骨折行交锁髓内钉治疗,发生骨延迟愈合、骨不连、锁钉断裂、深部感染、小腿外旋畸形、肢体不等长、会阴神经损伤等并发症共21例.6例骨延迟愈合及时改静力交锁为动力交锁;4例骨不连行拔钉、扩髓、换钉、植骨等治疗;5例深部感染予引流、抗生素治疗,骨折部分愈合后拔钉闭式引流、冲洗;小腿外旋畸形1例再次手术矫正;单纯锁钉断裂2例、不等长畸形2例、会阴神经损伤1例未特殊处理.结果骨延迟愈合6例和骨不连4例均骨愈合;深部感染5例感染控制和骨折愈合;单纯锁钉断裂2例、小腿外旋和不等长畸形3例骨折均骨愈合;会阴神经损伤1例3个月后神经功能恢复.结论交锁髓内钉是治疗下肢长骨骨折的有效手段,严格掌握手术指征、适当选材、适时掌握静力与动力固定、彻底清创是减少并发症的有效措施.

骨肉瘤是青少年中常见的恶性肿瘤.目前我院骨肉瘤外科治疗根据手术指征选择骨肉瘤切除灭活再植术辅以全身化疗者占多数,但骨肉瘤组织类型、分化程度及个体差异常影响化疗疗效[1],为此本研究试图建立适应临床检测特点的体外骨肉瘤化疗预测系统,以指导临床用药.

屈指肌腱断裂,是手部常见的损伤之一,多因外伤所致.处理不当往往造成肌腱的粘连,导致手功能的严重障碍.本组选取本院近几年来外伤所致屈指肌腱断裂病例20例,采用一期缝合,同时尽可能修复腱外膜、腱鞘及腱周组织,并结合早期活动的方法,治疗手部屈指肌腱断裂.经随访获得较为满意的效果,现将治疗体会报告如下: