BACKGROUND:Diabetic osteoporosis is characterized by disrupted bone remodeling involving impaired osteogenesis and excessive osteoclastic activity. Although glucagon-like peptide-1 receptor agonists (GLP-1RAs) have hypoglycemic benefits, their effects on bone metabolism remain unclear. This study investigates the osteoprotective potential of polyethylene glycol loxenatide (PEG-Loxe), a GLP-1RA hypoglycemic drug. METHODS:In vitro studies involved MC3T3-E1 osteoblasts and RANKL-stimulated RAW264.7 osteoclasts, both treated with 100 nM PEG-Loxe. Osteogenic markers (ALP, Col-1, and Runx2) and osteoclast differentiation were assessed, and HMGB-1 overexpression was used to validate pathway involvement. For in vivo studies, type 2 diabetic ApoE-/- mice were treated with PEG-Loxe. We examined serum markers (CTX, HMGB-1, TNF-α, and IL-1β) and performed micro-CT and histomorphometric analyses. In clinical research, serum markers and BMD were analysed. RESULTS:PEG-Loxe has dual regulatory effects. PEG-Loxe can significantly enhance osteoblast differentiation (increased ALP, Col-1 and Runx2 activities, p < 0.001) and suppressing osteoclastogenesis by inhibiting HMGB-1/RAGE/TLR4/NF-κB pathway (p < 0.001). In ApoE-/- mice, PEG-Loxe increased osteoblasts and reduced osteoclasts. RAGE, HMGB-1, TNF-α, and IL-1β were reduced to varying degrees (p < 0.05; p < 0.01; p < 0.01; p < 0.01). Micro CT scanning of 3D images of mouse femurs showed that PEG-Loxe can increase femoral tissue and reduce porosity. In clinical research,CTX, HMGB-1, TNF-α, and IL-1β were significantly reduced in the PEG-Loxe group compared to the Non-PEG-Loxe group (p < 0.05). There was no significant difference in BMD between the two groups. CONCLUSIONS:PEG-Loxe exerts comprehensive osteoprotective effects in type 2 diabetes by simultaneously promoting osteogenesis and suppressing osteoclastogenesis, through modulation of HMGB-1 signaling. PEG-Loxe can significantly improve bone turnover status and reduce bone resorption levels, with potential osteoprotective effects.

Osteoarthritis (OA) closely associates with pathological changes of bone and cartilage under abnormal stress, however, the mechanism of it is still unclear. In order to study the mechanism, many animal models such as spontaneity, gene modification, invasive models (surgical and chemical inductions) are commonly used. All of the models are important tools for OA research, but they have mixed effects and unable to comprehensively reflect the role of abnormal stress in the whole pathological process. With the development in research and improvement of technologies, non-invasive compression-loading model has been gradually employed to study the development of OA. With a direct compression-loading, it can create variety types of injuries to simulate the occurrence and development of OA induced by abnormal stress or various injuries in clinic. A non-invasive loading model can not only simulate externally loaded stress, but also quantify the load and then make more objective studies on the injury caused by abnormal stress in the whole process of disease. This paper summarised the application and research progress of non-invasive compression-loading models. It may provide a meaningful way for the future study of abnormal stress load and post-traumatic knee OA, to explore the mechanism of OA lesions and relevant prevention and treatment, with a potential research method and theoretical basis.

Objective To introduce the clinical features of and surgical techniques for a rare type of irreducible pertrochanteric femur fracture pattern with bisection of the lesser trochanter. Methods From January 2017 to December 2019, 357 patients with per/intertrochanteric femur fractures underwent surgery by closed reduction and internal fixation, of whom 12 patients were identified with rare preoperative imaging features, the lesser trochanter was almost equally bisected. The main fracture pathoanatomy of these cases included: The anterior fracture line passed along the intertrochanteric line to the medial lesser trochanter and bisected it into 2 equal parts from mid-level of the lesser trochanteric protrusion. The proximal part of the lesser trochanter connected to the head-neck fragment and attached by the psoas major tendon, while the distal part of the lesser trochanter connected to the femoral shaft and attached by the tendon of the iliac muscle. These fractures were irreducible by a closed maneuver and were reduced with limited assistance by some devices, and short intramedullary nails were used for fixation of these fractures. Results All patients were followed up for an average of 14.2 ± 2.1 months. Clinical fracture union occurred at an average of 10.8 ± 1.5 weeks, while radiographic union occurred at an average of 12.7 ± 1.2 weeks. No cut out of the helical blade was visible on radiographs. The average Parker-Palmer score was 6.9 ± 1.3 (range, 5-9) at the last follow up, including 8 cases rated as excellent, 2 as good and 2 as fair. Conclusion Two-part pertrochanteric femur fractures with bisection of the lesser trochanter have an irreducible fracture pattern with cortical locking and soft tissue incarceration. Soft tissue release and short cephalomedullary nail fixation for this fracture pattern provide stable fixation and allow early exercise. This treatment appears to have excellent outcomes in the short and medium terms.

背景 骨关节炎致残、致畸率高，可合并多种身心疾病，但早期症状不明显。当前社区骨关节炎的管理存在管治不协调、方法不健全、制度不完善等问题。目的 构建并评价基于信息化的社区骨关节炎多学科管理模式，以促进对社区骨关节炎患者的管理，改善患者疾病预后。方法 首先构建社区骨关节炎患者的多学科管理模式，包含基于危险因素分层的患者分级管理流程、多学科管理团队及其诊治分工，然后构建基于信息化的多学科管理流程，并完成信息软件开发。选取2019年7月至2020年7月在上海市定海、大桥社区卫生服务中心全科门诊，以及杨浦区中心医院骨科门诊就诊的膝骨关节炎患者80例为研究对象，采用随机数表法将其分为普通组和多学科组，各40例。普通组采用常规治疗模式，多学科组在此基础上进行基于信息化的多学科管理。分别于治疗前和治疗12周后评估两组患者的视觉模拟评分法（VAS）评分、西安大略麦克马斯特大学（WOMAC）骨关节炎指数、关节炎生活质量测量量表（AIMS2）评分、健康素养管理量表（HeLMS）评分、体质指数（BMI）。结果 治疗前，多学科组和普通组膝骨关节炎患者的VAS评分、WOMAC骨关节炎指数、AIMS2评分、HeLMS评分、BMI比较，差异均无统计学意义（P＞0.05）；治疗12周后，多学科组和普通组膝骨关节炎患者的VAS评分、WOMAC骨关节炎指数低于治疗前，AIMS2总分、HeLMS总分高于治疗前，差异有统计学意义（P＜0.05）；治疗12周后，多学科组患者AIMS2总分、HeLMS总分高于普通组，VAS评分、WOMAC骨关节炎指数、BMI均低于普通组，差异有统计学意义（P＜0.05）。结论 对膝骨关节炎患者实施基于信息化的社区骨关节炎患者多学科管理模式，可有效减轻患者的关节疼痛和体质量，提高患者的日常生活能力和健康素养，改善患者的生活质量，延缓患者的病情进展。

We demonstrated previously that there is a correlation between glucagon-like peptide-1 (GLP-1) single-nucleotide polymorphism (SNP) and bone mineral density in postmenopausal women. Both GLP-1 and glucose-dependent insulinotropic peptide are incretins. The glucose-dependent insulinotropic peptide receptor (GIPR) SNP rs10423928 has been extensively studied. However, it is not clear whether GIPR gene mutations affect bone metabolism. The aim of this study was to investigate the association between rs10423928 and bone mineral density in postmenopausal women in Shanghai. rs10423928 was detected in 884 postmenopausal women in Shanghai, and the correlation between the GIPR SNP and bone mineral density was assessed. The dominant T/T genotype of rs10423928 was found to be related to the bone mineral density of the femoral neck (P = 0.035). Overall, our findings indicate that the dominant T/T genotype of rs10423928 in postmenopausal women is significantly associated with a higher bone mineral density and that the T/T genotype exerts a bone-protective effect.

Background Osteoarthritis is a chronic disease commonly seen in community settings, and the management of which is associated with numerous inter-related factors. Due to lack of appropriate healthcare-seeking perceptions and behaviors in osteoarthritis patients, it is difficult to diagnose, treat and manage osteoarthritis. Objective To understand healthcare-seeking perceptions and behaviors in community-living osteoarthritis patients, providing evidence for improving the diagnosis and treatment of such patients in the community. Methods This was a mixed-methods study. From May to June 2019, interviews for understanding osteoarthritis patients' healthcare-seeking perceptions and behavior-related factors, as well as management were conducted with a purposive sample of five orthopedic physicians and five general practitioners (GPs) from a general hospital in a regional healthcare consortium in Shanghai's Yangpu District, and a convenience sample of 12 GPs and 12 osteoarthritis patients from six community health centers (CHCs) in the same consortium. Then from June 2019 to December 2020, 425 patients with osteoarthritis were chosen from three randomly selected CHCs of the above-mentioned six ones to attend a survey using a quantitative questionnaire developed based on the themes derived from the above-mentioned interviews (excluding some highly subjective and less quantifiable indicators) for understanding their socio-demographic information, disease status, healthcare-seeking perceptions and behaviors, self-management and utilization of the APP for chronic disease management. Binary Logistic regression was used to analyze the influencing factors of healthcare-seeking behaviors in patients with osteoarthritis. Results The following themes were extracted from the interviews: patients' insufficient awareness of osteoarthritis, lack of management of osteoarthritis and influencing factors of patients' healthcare-seeking behavior. Three hundred and ninety-seven of the 425 cases (93.4%) who effectively completed the questionnaire were included for quantitative analysis. One hundred and fifty-two (38.3%) respondents understood osteoarthritis, and 79 (52.0%) of them acquired relevant knowledge from the media, and other 50 (32.9%) from ward-mates. Two hundred (50.4%) respondents knew the treatments for osteoarthritis, including 91 (45.5%) knowing exercise and physical therapies, and 105 (52.5%) knowing treatment with painkillers. The healthcare-seeking behaviors in osteoarthritis patients varied significantly by sex, BMI, pain level, impact of pain on sleep quality, and previous healthcare-seeking experience (P<0.05) . The results of regression analysis demonstrated that sex, BMI, pain level, previous treatment experience and impact of pain on sleep quality were associated with healthcare-seeking behavior (P<0.05) . Conclusion Community-living patients with osteoarthritis had insufficient awareness of healthcare-seeking and weak self-management awareness, and their healthcare-seeking behaviors were affected by multiple factors. To improve these patients' healthcare-seeking perceptions and behaviors, priority should be given to take actions to enhance patients' healthcare-seeking perceptions, train patients' self-management ability, better GPs' diagnostic and therapeutic skills, improve doctors and patients' negative attitude toward osteoarthritis treatment, and promote patients seeking healthcare actively.

骨关节炎(osteoarthritis,OA)是最常见的关节疾病,其发病率逐年增加,目前尚无有效的治愈方法,是导致老年人功能残疾的常见原因之一.对膝OA的认识不足、预防及治疗延迟是导致其发病率逐年升高的重要原因.疼痛是OA的早期警示信号,也是OA的主要症状,还是临床最重要的诊断依据.由于目前对早期疼痛重视不足,对患者疼痛的原因和机制认识不足,常会导致OA疼痛的治疗效果不佳,患者对治疗效果不满意,病变持续进展,甚至导致患者关节残疾,最终需要进行关节置换.因此,很有必要了解疼痛产生的原因,疼痛的特点,疼痛的传导与感知,疼痛与骨关节炎病变发生、发展之间的关系,以及疼痛的病理生理学机制.研究显示,OA疼痛具有复杂的病理生理学机制,它不仅是异常应力和生物学作用下关节的伤害性疼痛,还和局部炎症、外周和中枢神经病变紧密相关,也受多种因素调节(如患者的精神、遗传因素和气候影响等).而且,临床研究强调OA疼痛并不是单一的和固定不变的.疼痛的发生是可以独立于结构改变而存在的,而且在不同患者和不同的特定时间发生程度也不同.本文对OA疼痛机制的研究进展进行综述,以期有利于辅助医师在临床工作中探寻治疗效果不佳的原因,改善治疗效果,对疼痛进行从基础到临床科学地转化研究,有利于将来对OA疼痛患者进行最佳管理.

OBJECTIVE Hip pain arising from implant instability is generally caused by repetitive stress injury, which subsequently leads to induction or exacerbation of abnormal metabolism of bone around the implant. single photon emission tomography/computed tomography (SPECT-CT) has advantages in localizing areas of increased tracer uptake that reflects such abnormal bone metabolism. Therefore, we investigated whether the application of SPECT/CT with stress analysis can be an effective practice in evaluating the instability of stem in noncemented hip arthroplasty or not. METHOD In total 16 patients were collected for unexplained painful hip arthroplasties. When physical examination and blood tests were unremarkable, radiographs were inconclusive and bone scan indicated increased scintigraphic uptake at the proximal part and at the tip of the stem; SPECT/CT was performed. Stem stability was assessed by measuring whether there was consistency between the increased scintigraphic uptake and the direction of the stress around the implant along with the location of the prosthesis. RESULT Among the 16 symptomatic hips, 9 hips showed the stability of the stem, 3 hips showed the stem instability and 4 hips showed the acetabular loosening with the stem stability. With the application of SPECT/CT with stress analysis, 15 out of 16 (93.7%) cases were found to have the change in the diagnoses, and managements were implemented in 11 out of 16 (68.7%) cases. When comparing before and after SPECT/CT, there was no significant association in clinical diagnosis and management (Pearson chi- square test = 4.61 and 1.33, P = 0.33 and 0.25). CONCLUSION SPECT/CT combined with stress analysis can be a useful tool in early diagnosis of stem instability and can assist surgeons in subsequent management and decision implementation when other radiographic imagings are inconclusive.

[目的]介绍关节镜下边缘增强缝线桥全层修复肩袖分层撕裂的手术技术与初步临床疗效.[方法]2017年8月～2019年04月对21例肩袖分层撕裂患者进行镜下修复.镜下探明肩袖撕裂的部位,并进行清创,磨钻打磨肱骨大结节,直至磨平、松质骨渗血为止.复位分层肩袖,应用单排固定或内排打结固定加强缝合固定肩袖撕裂两端的止点,全层修复分层撕裂,于足印区缝线桥压紧固定整体肩袖.[结果]所有患者均顺利手术,无感染等并发症.随访时间至少12个月,UCLA评分由术前的(13.86±1.77)分提高到最终随访时的(32.62±1.53)分,Constant-Murley评分由术前(35.05±4.25)分提高到(92.67±3.86)分(P＜0.001).[结论]镜下边缘增强缝线桥全层修复能很好地恢复分层肩袖的整体性和完整性,防治肩袖进一步撕裂,增强肩袖整体的初始强度,改善患者关节功能.

BACKGROUNDGlucagon-like peptide-1 receptor (GLP-1R) agonists are able to inhibit bone resorption to a certain extent and improve bone formation. GLP-1R single nucleotide polymorphism (SNP) is related to its activity, but the relationship between GLP-1R SNP and osteoporosis in postmenopausal women was still unclear. This study was to investigate the association between GLP-1R SNP and bone mineral density (BMD) in postmenopausal women in Shanghai.METHODSEight SNPs of GLP-1R were detected (rs3765467, rs1042044, rs2268657, rs6923761, rs2268641, rs2295006, rs4714210 and rs10305420) in 884 postmenopausal women in Shanghai. The correlation between GLP-1R SNP and BMD was further assessed.RESULTSThe A/A genotype of rs2295006 was negatively related to lumbar vertebrae 1-4 BMD (P<0.05). Allele A was negatively related to hip BMD (P<0.05). There was a negative correlation between haplotype CGAGCCA and lumbar BMD, and a positive correlation between haplotype CGGGCTA and lumbar BMD. The remaining seven GLP-1R SNPs had no relationship with BMD.CONCLUSIONSThe rs2295006 of GLP-1R is related to the BMD of postmenopausal women in Shanghai, China.

目的 探讨围手术期预防性应用渗透性泻剂及益生菌对老年髋部骨折患者围手术期便秘的预防效果.方法 选取上海市杨浦区中心医院2017年6月 ～2018年9月收治的老年髋部骨折患者133例,实验组84例,对照组49例.实验组与对照组均按照围手术期常规方式进行诊疗,同时,实验组围手术期预防性应用渗透性泻剂及益生菌,对照组不给予针对便秘任何形式的预防措施.观察两组围手术期便秘的发生情况.结果 实验组术后7 d与入院时在Wexner便秘量表评分、Bristol大便分类、排便周期方面比较差异均无统计学意义(P>0.05);对照组术后7 d与入院时在Wexner便秘量表评分、Bristol大便分类、排便周期方面比较,差异均有统计学意义(P<0.05);实验组口服渗透性泻剂及益生菌预防髋部骨折围手术期便秘总有效率显著高于对照组(P<0.05).结论 髋部骨折围手术期预防性应用渗透性泻剂及益生菌可改善肠功能,有效预防髋部骨折围手术期便秘症状的发生,应用价值较大.

Background: GIP (glucose-dependent insulinotropic peptide) has been found to affect bone metabolism. GIPR single nucleotide polymorphism (SNP) is related to its activity, but the relationship between GIPR SNP and osteoporosis in postmenopausal women is still unclear. The Aim of this study was to investigate the association between GIPR SNP and bone mineral density (BMD) in postmenopausal women in Shanghai. Methods: GIP SNP rs10423928 was detected in 884 postmenopausal women in Shanghai. The correlation between GIPR SNP and BMD was further assessed. Results: There was a statistical difference between the dominant model of this site rs10423928 and the bone mineral density of the femoral neck (P = 0.035) and the Wards triangle area (P = 0.033). Conclusions: The rs10423928 of GIPR is related to the BMD of postmenopausal women in Shanghai, China.

It has become a research hotspot in the field of trauma orthopedics how to fix intertrochanteric fractures effectively,especially the head-neck fragment,so that the osteoporotic fracture ends can be stabilized.In order to reduce fixation failure,application of bio-reinforced materials is another promising mothod in addition to improving the design of internal fixation.This paper reviews the research history,characteristics,current research into the biomechanics and clinical application of bone reinforced cement materials,intending to help surgeons understand the principles,surgical techniques and application scope of bone bio-reinforced materials for internal fixation.

随着生活质量的提高,医疗技术的革新,以及部分国家人口生育率的大幅下降,世界范围内的人口老龄化正在不断加剧.超过60岁的成人中,10％～20％存在与骨性关节炎(Osteoarthritis,OA)有关的问题,OA 影响了超过5.25 千万的人口,占总人口的22.7％.Deshpande等的研究显示,有膝OA症状的患者中,有一半以上小于65岁,并且预计在长达30年的生存期内,将忍受疼痛和功能障碍.

Background: It has been reported that glucagon-like peptide-1 (GLP-1) can alleviate diabetic osteoporosis (DOP). This study was to investigate the effects of GLP-1RA liraglutide and dipeptidyl peptdase-4 (DPP-4) inhibitor vildagliptin on the advanced glycation end products (AGEs)-induced bone injury in ApoE(-/-) mice with euglycemia. Methods: The bone markers OC, PINP, PTH, TRACP and CTX, the mRNA and protein expressions of RAGE in the femur, and the femoral morphology index were determined to evaluate whether the osteoporosis was improved by liraglutide or vildagliptin. Results: AGEs adversely affected the bone metabolism, characterized by reduced OC and increased CTX. However, vildagliptin reduced AGEs and increased OC, and liraglutide significantly decreased AGEs and PTH. Both vildagliptin and liraglutide had no effects on the bone metrology and RAGE expression in the femurs of ApoE(-/-) mice. Conclusions: The elevated AGEs may exacerbate osteogenesis and increase bone resorption, and vildagliptin/liraglutide may improve bone metabolism.

Objective To compare the biomechanical stabilities among different combinations of anterior and medial cortical supports after intramedullary nailing for unstable intertrochanteric fractures.Methods Twenty-seven synthesized femur specimens were used to create models of unstable intertrochanteric fracture of type 31A2.1 according to AO/ASIF classification.They were divided into 9 groups (n =3) according to 9 combinations of anterior and medial cortical supports on the anteroposterior and lateral X-ray films:positive-positive,positive-neutral,positive-negative,neutral-positive,neutral-neutral,neutral-negative,negative-positive,negative-neutral,negative-negative groups.After all the fractures were fixated with the newly adapted femoral intertrochanteric nails (FITN),static loadings were applied for tests of fatigue and destruction to investigate the relative displacements and yield loads of the head-neck fragments.Results For the positive-positive,positive-neutral,positive-negative,neutral-positive,neutral-neutral,neutral-negative,negative-positive,negative-neutral,negative-negative groups,the vertical displacements of the head-neck fragments under fatigue loading were respectively 5.33 ±0.58 mm,7.83 ±0.29mm,7.73 ±0.15 mm,8.17 ± 0.29 mm,8.33±1.15 mm,8.83±0.29 mm,9.33±0.58 mm,9.67±1.15 mm and 12.0±1.0 mm,showing significant differences (P ＜ 0.05).The smallest displacement was observed in the positive-positive group,significantly smaller than that in any other groups (P ＜ 0.05).For the above 9 groups,the yield loads were respectively 4,967 ± 153 N,4,467 ± 58 N,3,717 ± 76 N,2,767 ± 58 N,2,533 ± 58 N,2,267 ± 58 N,1,833 ± 58 N,1,667 ± 58 N and 1,333 ± 58 N,showing significant differences between any 2 groups (P ＜ 0.05).In the destruction test,bone interface loosening in the femoral head happened in 2 cases,bone interface loosening in the intertrochanteric zone in 15 cases,split fracture at the zone of distal locking nail in 2 cases,and loosening and breakage of the internal fixator in the distal femur in 8 cases.Conclusions The medial cortical support plays a major role and the anterior cortical support plays a secondary role in the stability of unstable intertrochanteric fracture.In the surgical procedure,surgeons should avoid the medial cortical negative support as much as possible.

骨关节炎(OA)是整个关节的退变性疾病,不仅有关节软骨退变,还有软骨下骨和关节周围组织的病变.研究显示,转化生长因子β(TGF-β)参与了早期关节的形成,对骨、软骨的发育和关节重塑起着重要作用,是维持关节稳态的关键因子之一.近年的研究还显示,TGF-β参与了软骨、软骨下骨的退变和滑膜的炎症,是关节破坏的重要因素.本文对TGF-β信号在OA发生和发展中的作用进行综述,以期为OA的研究和治疗探寻新方法和思路.

[目的]介绍经腓骨头上入路水平箍钢板排筏螺钉固定治疗胫骨平台后外侧象限骨折的手术技术.[方法]回顾性分析2014年1月～2016年12月收治的9例单纯胫骨平台后外侧象限骨折患者,男6例,女3例;年龄33～67岁.根据术前X线片和CT检查,确认胫骨平台骨折均为孤立的后外侧象限骨折.术中采用侧卧位,经改良前外侧腓骨头上入路,对骨折撬拨复位,以桡骨远端钢板折弯后成水平带状并以排筏螺钉固定.[结果]手术时间52～73 min.切口均一期愈合,无切口感染发生.其中,8例随访12个月以上,无膝关节不稳、骨折再塌陷者,所有患者骨折均获愈合,愈合时间12～18周.术后12个月,HSS评分87～98分,SMFA评分14～31分,膝关节活动幅度100°～135°.患者对治疗效果非常满意者5例,满意者3例,总体满意率100％.[结论]对于孤立的胫骨平台后外侧象限骨折,经改良前外侧腓骨头上入路可以充分显露骨折端,手术操作方便;箍钢板固定骨折块稳定可靠.

Objective To investigate microstructure changes of cartilage and subchondral bone in the nonsclerotic and sclerotic zones of the tibial plateau in patients with knee osteoarthritis (OA),and explore the pathological features of different parts and stages of knee OA.Methods Tibial plateau tissues abandoned after total knee arthroplasty were collected in OA patients.After gross observation,the cartilage and subchondral bone were divided into nonsclerotic and sclerotic zones.The pathologic changes of tissue and cell microstructure characteristics were observed by scanning and transmission electron microscopies,and the microstructure of subchondral bone was evaluated by Micro-CT scanning system.Results As compared with the nonscleroic zone,scanning electron microscopy showed that the cartilage morphology of the scleroic zone was chaotic and thinner,and surface collagen fibers were disarranged.The cracks to the subchondral bone were observed.The subchondral bone plate and trabecular bone were thickened,and gap narrowed.The transmission electron microscopy showed that the nucleus of the chondrocytes in the scleroic zone was irregular,and the rough endoplasmic reticulum was dilated,the Golgi apparatus was underdeveloped,and mitochondria displayed edema.Bone matrix collagen arranged sparsely.Secondary lysosomes increased and bright microfilament reduced in osteoclasts.The osteoblast envelope was wrinkled with no small protuberances on the surface.The microvascular formation was seen in the scleroic zones.The micro-computed tomography showed bone mineral density (BMD,98.040 ± 20.600),BV/TV (40.060 ±7.110),Tb.N (1.540 ±0.181) and Tb.Th (0.250 ±0.039) were increased,and Tb.Sp (0.43 ±0.047) and SMI (0.83 ±0.124) decreased in the scleroic zone as compared with the non-sclerotic zone (t=7.931,11.959,6.212,8.070,8.566,10.803,P＜0.05).Conclusion The microstructure of cartilage and subchondral bone in OA sclerotic area is different from that in nonsclerotic area.The microstructure of cartilage and subchondral bone in the sclerotic area should be further studied.

Objective To measure the rotation angle of the head-neck fragment of intertrochanteric fracture after cephalomedullary nail fixation by three-dimensional CT imaging, and to explore its clinical significance. Methods The clinical data of 68 patients with unstable intertrochanteric fracture of AO/Orthopaedic Trauma Association (AO-OTA) type 31-A2 treated with cephalomedullary nail fixation and with complete intraoperative fluoroscopy and postoperative three-dimensional CT imaging data between July 2016 and October 2018 were retrospectively analyzed. Among them, there were 21 males and 47 females, aged 68-93 years, with an average age of 81.8 years. There were 31 cases of AO/OTA type 31-A2.2 and 37 cases of 31-A2.3. Fracture reduction quality was evaluated according to Baumgaertner et al. and Chang et al. criteria. The anteromedial cortical contact or not of each patient was observed by three-dimensional CT imaging on T3DView software after operation. The rotation of head-neck fragments were divided into three types: non-rotation, flexion rotation, and hyperextension rotation. The rotation angles of each type were measured and the relationship between the rotation type of the head-neck fragments and the contact of the anteromedial cortex was analyzed. Results The reduction and fixation of the small trochanter were not performed in 68 patients. According to Baumgaertner et al. criteria, the quality of fracture reduction was excellent in 15 cases (22.1%), acceptable in 50 cases (73.5%), and poor in 3 cases (4.4%). According to Chang et al. criteria, 31 cases were excellent (45.6%), 33 cases were acceptable (48.5%), and 4 cases were poor (5.9%). Thirty-nine cases (57.4%) received anteromedial cortical support and 29 cases (42.6%) did not receive cortical support. Three-dimensional CT imaging showed non-rotation in 12 cases (17.6%), flexion rotation in 39 cases (57.4%), and hyperextension rotation in 17 cases (25.0%). There were 7 cases (58.3%), 30 cases (76.9%), and 2 cases (11.8%) of cortical support in non-rotation group, flexion rotation group, and hyperextension rotation group, respectively. The rotation angles were (1.05±0.61), (13.96±6.17), (8.21±3.88)°, respectively. There were significant differences between groups ( P<0.05). Conclusion In the unstable intertrochanteric fracture after cephalomedullary nail fixation, the rotation of head-neck fragment exists in most patients, and the types of flexion rotation and non-rotation can easily obtain cortical support reduction.