Legg-Calvé-Perthes disease (LCPD) involves femoral head osteonecrosis caused by disrupted blood supply, leading to joint deformity and early osteoarthritis. This study investigates the role of miRNA-223-5p in regulating hypoxia-induced apoptosis and enhancing osteogenesis in bone marrow mesenchymal stem cells (BMSCs). Utilizing a juvenile New Zealand white rabbit model of LCPD established through femoral neck ligation, we transfected BMSCs with miR-223-5p mimics, inhibitors, and controls, followed by hypoxic exposure. The impact of miR-223-5p on BMSC apoptosis was assessed using qPCR, Western blotting, and dual-luciferase reporter assays, focusing on the Wnt/β-catenin signaling pathway. In vivo, we evaluated the effects of transplanting miR-223-5p-overexpressing BMSCs into the LCPD model. Our results indicate that miR-223-5p is downregulated under hypoxic conditions. Overexpression of miR-223-5p in BMSCs inhibited hypoxia-induced apoptosis and activated the Wnt/β-catenin pathway by directly targeting CHAC2. In vivo, miR-223-5p-overexpressing BMSCs enhanced femoral head osteogenesis and reduced necrosis in the LCPD model. These findings suggest that miR-223-5p inhibits hypoxia-induced apoptosis in BMSCs by targeting CHAC2 and activating the Wnt/β-catenin pathway, proposing miR-223-5p as a promising target for improving bone repair in ischemic conditions.

Abstract Objective There were few reports in the literature regarding hidden blood loss following surgery for developmental dysplasia of the hip in children. This study aimed to evaluate the volume of hidden blood loss and its risk factors among children undergoing hip reconstruction for developmental dysplasia of the hip. Methods A retrospective analysis of clinical data from 42 patients (58 hips), who underwent Pemberton and femoral osteotomies between March 2020 and March 2023, was conducted. Serial complete blood count assays were conducted on the day of admission and four days post-surgery. Preoperative and postoperative hematocrit levels were documented to calculate hidden blood loss utilizing the Gross formula. Pearson and Spearman correlation analyses, along with multivariable linear regression, were employed to ascertain associations between patient characteristics and hidden blood loss. Results The mean hidden blood loss was recorded as 283.06 ± 271.05 mL, constituting 70.22% of the total blood loss. Multiple linear regression analysis identified weight and surgical duration as independent risk factors contributing to hidden blood loss. Conclusions A relevant amount of postoperative hidden blood loss occurs after Pemberton osteotomy and femoral osteotomy for developmental dysplasia of the hip. Surgeons should be aware that patients who require blood transfusions and have longer surgical durations are at a higher risk of developing more hidden blood loss. Therefore, attention should be given to hidden blood loss to ensure patient safety during the perioperative period for those undergoing Pemberton and femoral osteotomies. Level of evidence IV.

Introduction: Legg-Calvé-Perthes disease or Perthes disease is a condition that occurs in children aged 2 to 15 years, and is characterized by osteonecrosis of the femoral head, which results in physical limitations. Despite ongoing research, the pathogenesis and molecular mechanisms underlying the development of Perthes disease remain unclear. In order to obtain further insights, the expression patterns of long non-coding RNAs (lncRNAs), miRNAs, and mRNAs in a rabbit model of Perthes disease were analyzed in this study by transcriptome sequencing. Methods and results: The results of RNA-seq analyses revealed that 77 lncRNAs, 239 miRNAs, and 1027 mRNAs were differentially expressed in the rabbit model. This finding suggested that multiple genetic pathways are involved in the development of Perthes disease. A weighted gene co-expression network analysis (WGCNA) network was subsequently constructed using the differentially expressed mRNAs (DEmRNAs), and network analysis revealed that the genes associated with angiogenesis and platelet activation were downregulated, which was consistent with the findings of Perthes disease. A competing endogenous RNA (ceRNA) network was additionally constructed using 29 differentially expressed lncRNAs (including HIF3A and LOC103350994), 28 differentially expressed miRNAs (including ocu-miR-574-5p and ocu-miR-324-3p), and 76 DEmRNAs (including ALOX12 and PTGER2). Disscusion: The results obtained herein provide novel perspectives regarding the pathogenesis and molecular mechanisms underlying the development of Perthes disease. The findings of this study can pave the way for the development of effective therapeutic strategies for Perthes disease in future.

The pathogenesis and the mechanism of orally administered propranolol in the treatment of hemangioma are unclear. In this study, we evaluated the changes of xenograft hemangioma in nude mice after intervention with estradiol and propranolol. Raf-1 and p-ERK expression in xenograft hemangiomas was assessed to evaluate their role in hemangioma proliferation and regression after treatment. A hemangioma xenograft model in nude mice was established. The successful xenograft specimens were selected and then randomized into control group, estradiol group and propranolol group. At the date of injection, and on day 7 and 21 after injection, the morphological changes of xenograft hemangiomas were visually characterized and imaged by light microscopy. The distribution and expression Raf-1 and p-ERK protein was determined by immunohistochemical detection. In control group, the xenografts increased gradually in volume, had a soft texture and their colors gradually turned red with observation of proliferation of endothelial cells and a capillary lumen that contained monolayer endothelial cells. In Estradiol group, the xenografts grew fast and increased significantly in volume, had a soft texture and their colors were dark red with a hyperplasia of endothelial cells, irregular volume, and deranged and compact endothelial cells. More capillary lumens and sinuses were also seen. Raf-1 and p-ERK expression in estradiol group was significantly increased (P < 0.05). In Propranolol group, the xenografts volume decreased, had a soft texture, and their colors turned gradually white with decreased number of proliferative endothelial cells. The vascular lumens, composed of endothelial cells, were larger, and some of them disappeared and were replaced by fibrous connective tissue and vascular adipose tissue. Raf-1 and p-ERK expression in propranolol group was lower than estradiol and control group (P < 0.05). In conclusion, Raf-1/ERK signaling pathway may be involved in hemangioma. Estrogen and propranolol may regulate the proliferation or regression of hemangioma through Raf-1/ERK signaling pathway.

目的 探讨小切口手术松解治疗小儿Quinnell分级Ⅲ～Ⅳ级先天性拇指狭窄性腱鞘炎的效果及对手指捏力的影响.方法 回顾性分析2016年1月至2020年3月遵义医科大学附属医院收治的272例先天性拇指狭窄性腱鞘炎患儿的临床诊治资料,将2016年1月至2018年2月接受传统外科手术治疗的130例患儿纳入传统组,2018年3月至2020年3月接受小切口手术松解治疗的142例患儿纳入小切口组,比较两组患儿围术期指标.随访3个月,比较两组患儿患指关节总主动活动度(TAM)、腱鞘厚度、手指捏力、临床疗效及并发症发生情况.结果 小切口组患儿的手术时间、住院时间和患指功能恢复时间分别为(32.28±4.41)min、(4.15±1.07)d、(21.06±3.44)d,明显短(快)于传统组的(45.18±6.37)min、(7.28±2.10)d、(30.17±4.62)d,而术中失血量为(1.47±0.34)mL,明显少于传统组的(2.62±0.31)mL,差异均具有统计学意义(P<0.05).术后3个月,两组患儿的腱鞘厚度均变薄,且小切口组为(0.45±0.10)mm,明显薄于传统组的(0.60±0.08)mm,差异具有统计学意义(P<0.05);术后3个月,两组患儿的手指捏力均增大,且小切口组为(7.15±1.28)磅,明显大于传统组的(6.64±1.13)磅,差异具有统计学意义(P<0.05);术后3个月,小切口组患儿的TAM优良率、临床有效率分别为83.10％、91.55％,明显高于传统组68.46％、80.00％,并发症发生率为5.64％,明显低于传统组的17.70％,差异均具有统计学意义(P<0.05).结论 小切口手术松解治疗小儿Quinnell分级Ⅲ～Ⅳ级先天性拇指狭窄性腱鞘炎具有操作简便、术后恢复快等优势,可有效提高患儿手指捏力,改善指关节活动度,临床疗效确切.

畸胎瘤是一种生殖细胞肿瘤,通常由三个胚层分化的细胞组成,根据其组织学特征可分为成熟、未成熟和恶性肿瘤,最常见的部位是骶尾区、卵巢和纵隔.原发于椎管内的畸胎瘤罕见,临床表现无明显特征,容易造成误诊.我院收治一例左髋关节不明原因疼痛并伴有左下肢跛行病例,脊柱磁共振成像(MRI)显示L1和L2椎体节段椎管内囊性病变,术中完全切除椎管内病变,病理检查显示为成熟畸胎瘤,无未成熟和恶性成分.术后患者临床症状明显改善,随访1年效果良好.现对该病例的诊治经过进行回顾性分析,并结合有关文献讨论了椎管内畸胎瘤的病因、影像学特点及手术治疗.

BACKGROUND:The pathogenesis of Legg-Calve-Perthes disease (LCPD), a juvenile form of avascular necrosis of the femoral head (ANFH), is not fully understood.OBJECTIVES:The purpose of this work was to study the regulatory effect of R-spondin 1 (Rspo1) on osteoblastic apoptosis and evaluate the pre-clinical efficacy of recombinant human protein Rspo1 (rhRspo1) in treatment of LCPD.MATERIAL AND METHODS:This is an experimental study. In vivo rabbit ANFH model was established. Human osteoblast cell line hFOB1.19 (hFOB) was used to overexpress and silence Rspo1 in vitro. Additionally, hFOB cells were induced with glucocorticoid (GC) and methylprednisolone (MP), and treated with rhRspo1. The expressions of Rspo1, β-catenin, Dkk-1, Bcl-2, and caspase-3, and the apoptosis rate of hFOB cells were examined.RESULTS:The expressions of Rspo1 and β-catenin were lower in ANFH rabbits. The expression of Rspo1 was decreased in GC-induced hFOB cells. Compared to the control group, after 1 μM MP induction for 72 h, the expressions of β-catenin and Bcl-2 were higher, while Dkk-1, caspase-3 and cleaved caspase-3 expressions were lower in Rspo1 overexpression and rhRspo1-treated groups. The apoptosis rate of GC-induced hFOB cells was decreased in Rspo1 overexpression and rhRspo1-treated groups compared to the control group.CONCLUSIONS:R-spondin 1 inhibited GC-induced osteoblast apoptosis via Wnt/β-catenin pathway, which might be associated with the development of ANFH. Moreover, rhRspo1 had a potential pre-clinical therapeutic effect on LCPD.

目的:比较瘤体内注射与外用博来霉素治疗浅表型婴幼儿血管瘤的疗效.方法:选取2018年12月至2019年12月我院小儿矫形外科住院浅表型血管瘤患儿,随机分成两组,分别予以博来霉素瘤体内注射治疗与瘤体表面外涂治疗.结果:共收集40例浅表型婴幼儿血管瘤,注射组与外用组各20例.外用组显效12例,有效8例,注射组显效14例,有效6例,两组疗效差异无统计学意义(P>0.05).注射组治疗后瘤体质地硬,而外用组治疗后瘤体质地软;注射组主要不良反应为瘤体局部坏死或感染(P<0.05),外用组未见明显不良反应.结论:外用博来霉素治疗浅表型婴幼儿血管瘤疗效确切,治疗后不良反应少.

Objective:To explore the relationship between the transforming growth factor-β (TGF-β) signaling pathway and steroid-induced osteonecrosis of the femoral head in young rabbits.Methods:Sixty 8-week-old rabbits weighing 1.5-2.0 kg were randomly divided into steroid injection group (48 cases) and control group (12 cases). Rabbits in the former group were injected with Prednisolone Acetate 7.5 mg/kg into bilateral gluteal muscles twice a week for 8 weeks, and those with successful modeling were included in the disease group; otherwise, they were included in the non-disease group.Rabbits in control group were similarly injected with the same volume of 9 g/L saline.Penicillin sodium 50 000 U/rabbit was injected once a week for preventing infection.After 8 weeks of injection, CT was performed in all the experimental animals.They were then sacrificed for collecting bilateral femoral heads.Expression levels of TGF-β1, TGF-β2, Smad2 and Smad3 in the femoral head were detected by enzyme linked immunosorbent assay (ELISA), and the mRNA level of Runx2 in the femoral head was detected by quantitative real-time PCR (qPCR), the expression differences of related factors in each group were compared.Results:In steroid injection group (48 cases), 6 rabbits were sacrificed, and 32 survived, involving 6/32 cases (18.75%) experimental animals with positive avascular necrosis (disease group), and 26 negative ones (non-disease group). ELISA data showed that expression levels of TGF-β1 in control group, non-disease group and disease group were (77.12±14.62) ng/L, (90.17±11.90) ng/L and (126.14±25.66) ng/L, respectively ( t=3.35, 4.24, all P<0.05). The expression levels of TGF-β2 in control group, non-disease group and disease group were (74.54±7.63) ng/L, (89.24±9.51) ng/L and (109.74±16.45) ng/L, respectively ( t=4.12, 5.65, all P<0.01). The expression levels of Smad2 in control group, non-disease group and disease group were (17.74±2.72) μg/L, (23.82±3.58) μg/L and (31.28±3.88) μg/L, respectively ( t= 4.54, 7.99, all P<0.01). The expression levels of Smad3 in control group, non-disease group and disease group were (1.76±0.52) μg/L, (2.39±0.45) μg/L and (3.53±0.47) μg/L, respectively ( t=5.60, 6.71, all P<0.01). qPCR data showed that the mRNA levels of Runx2 in control group, non-disease group and disease group were 1.02±0.17, 1.27±0.14, and 1.72±0.11, respectively ( t=7.60, 8.91, all P<0.01). Conclusions:TGF-β is up-regulated in the model of steroid-induced osteonecrosis of the femoral head in young rabbits, which stimulates the proliferation and differentiation of osteoblasts and osteoclasts, and triggers the process of bone remodeling.The TGF-β signaling pathway involved in the repair of necrotic bone.

目的 总结儿童髋关节一过性滑膜炎(TSH)的临床特点,进一步提高对该病的诊治水平.方法 回顾性分析2010年1月至2019年12月于遵义医科大学附属医院小儿矫形外科治疗的1054例入院诊断为髋关节性滑膜炎患儿的临床资料并分析其特点.结果 1054例中最终确诊967例,其中男性702例,女性265例,男女发病数量比较差异具有统计学意义(P<0.05);患儿年龄0.5～14岁,平均年龄(5.6±3.1)岁;170例有呼吸道感染病史,39例有外伤史,18例有剧烈活动病史,1例有腮腺炎病史;秋季多见,4月、9月为发病高峰;实验室检查多数患儿表现为淋巴细胞及单核细胞计数的增加,超声及MRI检查多提示髋关节积液、滑膜增厚及软组织肿胀;单髋发病917例,双髋发病50例.患儿主要表现为髋关节疼痛伴跛行(555例),部分可仅表现为跛行(150例)或伴大腿或膝关节的疼痛(108例),少数可仅表现为髋关节疼痛(73例)或伴下肢拒绝承重(67例),极少数仅表现为大腿或膝关节疼痛(14例),所有患者均出现不同程度的髋关节活动受限.结论 儿童TSH好发学龄前期,男性多见,单侧发病较多,主要表现为不同程度的髋关节疼痛、活动受限、患肢乏力及跛行,治疗上主要以卧床休息及患肢牵引制动为主.

目的 分析外涂博来霉素软膏治疗浅表型婴幼儿血管瘤的临床疗效.方法 选取我院于2019年6月—2020年6月诊治的浅表型婴幼儿血管瘤患儿78例为研究对象,征求家属意愿后分为治疗组(外涂博来霉素软膏)66例及观察组12例(定期观察患儿瘤体大小、颜色及质地变化情况),统计患儿年龄、性别、瘤体部位、大小、颜色及质地情况,治疗3个月后根据瘤体变化按三级疗效评定法评价疗效,并记录患儿的不良反应.结果 两组患儿年龄、性别比较差异无统计学意义(P>0.05);疗效评定:治疗组:Ⅲ级41例,其中完全消退5例,Ⅱ级20例,Ⅰ级5例,观察组:Ⅲ级1例,Ⅱ级2例,Ⅰ级9例,两组有效率比较,治疗组(92.42％)明显高于观察组(25.00％),差异具有统计学意义(P<0.05),两组消退率比较,治疗组(62.12％)明显高于观察组(8.33％),差异具有统计学意义(P<0.05),78例患儿在治疗及观察中均未发现明显不良反应.结论 外涂博来霉素治疗浅表型婴幼儿血管瘤疗效确切,无明显不良反应,家属更易接受,可作为治疗浅表型婴幼儿血管瘤的方法之一.

Objective:To analyze the clinical characteristics of bone tumors in children, so as to improve the understanding and diagnosis of bone tumors in children.Methods:The clinical data of bone tumors in children hospitalized in the Affiliated Hospital of Zunyi Medical University from January 2009 to December 2018 were collected, with the age ≤ 14 years old.All children′s gender, age, tumor type, location, number of lesions and first symptoms were counted, and the clinical characteristics of bone tumors in children in this area were analyzed.Results:Totally 548 children with bone tumor were collected, with 344 males and 204 females, and the ratio of males to females was 1.69∶1.00, with 462 single cases and 86 multiple cases.Among the multiple cases (86 cases), 82 cases (95.35%) were benign bone tumors.The total number of cases increased with age.The age of different tumors has its own characteristics.Tibia was the most common tumor location (223 in total), followed by femur (177 in total) and humerus (82 in total). According to the classification of tumor nature, there were 478 cases (87.22%) of benign bone tumors, 43 cases (7.85%) of intermediate bone tumors and 27 cases (4.93%) of malignant bone tumors.The incidence of benign bone tumors was significantly higher than that of intermediate and malignant bone tumors, with statistically significant differences ( χ2=72.604, P<0.05). Among the benign bone tumors (478 cases), osteochondroma was the most common (265 cases), accounting for 55.44%; among the intermediate bone tumors (43 cases), aneurysmal bone cyst was the most common (20 cases), occupying 46.51%; among the malignant bone tumors(27 cases), osteosarcoma was the most common (16 cases), accounting for 59.26%.Among the initial symptoms, 268 cases were local masses, and 166 cases were pain, which were significantly higher than that of 79 without symptoms, with 28 lameness, 4 deformity and 3 dysfunction, and the differences were statistically significant( χ2=71.422, P<0.05). Conclusions:The majority of bone tumors patients in children were male, and the incidence increased with age.Benign and solitary are common, and the multiple cases were mainly benign.The most common locations are tibia and femur.The initial symptoms were mainly local mass and pain.Most importantly, the clinical characteristics of different tumors are slightly different.

目的 探讨儿童狭窄性腱鞘炎经皮微创松解术治疗的临床效果.方法 47例(51指)狭窄性腱鞘炎患儿,按手术方式分为传统手术组25例(28指)和微创手术组22例(23指),分别行腱鞘炎松解术.术后随访3～6个月,采用Quinnell分级标准比较2组手术指功能和术后切口美观情况等.结果 术后2组患儿均痊愈,无不良反应;微创手术组单指手术时间[(9.42±1.00)min]短于传统手术组[(13.23±2.66)min](P＜0.05);微创手术组术后指功能优20指,良3指,优良率100％;传统手术组优24指,良4指,优良率100％,2组治疗后指功能疗效比较差异无统计学意义(P＞0.05);微创手术组术后指功能恢复时间[(1.29±0.39)d]短于传统手术组[(4.32±1.52)d](P＜0.05),术区瘢痕发生率(4.54％)低于传统手术组(36.00％)(P＜0.05).结论 经皮微创松解术治疗儿童狭窄性腱鞘炎手术时间短,指功能恢复好,切口美观.

目的 探讨先天性绞扼轮综合征的手术治疗方法 .方法2013年7月—2018年11月手术治疗先天性绞扼轮综合征患儿9例,均采用一期手术切除束带,Z形松解成形的方法进行治疗,其中2例小腿束带合并马蹄内翻足患儿先予束带切除、成形手术,术后1年行在Ponseti石膏疗法基础上行马蹄内翻足软组织广泛松解、肌腱转移手术.结果 9例全部手术切口愈合良好,未出现皮瓣坏死,环状缩窄带得到充分松解.2例小腿束带合并马蹄内翻足术后畸形矫正满意,未出现复发.结论 1期手术切除束带并松解成形,不会导致皮瓣的坏死,而且可获得较满意的外观,Ponseti石膏疗法基础上行马蹄内翻足软组织广泛松解、肌腱转移手术是治疗束带合并马蹄内翻足优良的手术方法.

目的 评价尺桡骨中上段旋转截骨治疗先天性尺桡骨融合(CRS)畸形的临床疗效.方法 回顾性分析16例CRS畸形患者的临床资料,其中单侧13例,双侧3例,采取尺桡骨中上段截骨旋转、内固定的手术方式,Ⅰ期旋转至功能位,术后随访18～36月,平均24个月,评价患肢功能疗效.结果 16例患儿均矫正至功能位,基本能完成日常生活,生活质量明显改善,无骨筋膜室综合征、骨不连及骨髓炎等并发症发生.结论 尺桡骨中上段旋转截骨是治疗CRS畸形较理想的方法之一.

目的 探讨白细胞介素-1β(IL-1β)和胰岛素样生长因子-1(IGF-1)在发育性髋脱位(DDH)髋臼软骨细胞增殖和凋亡中的作用及意义.方法 选取4周龄实验幼兔32只,采用左侧后肢伸膝屈髋位管型石膏固定方法制作DDH动物模型,右侧后肢不做特殊处理作为对照侧,将幼兔平均分为4组(A、B、C、D组),分别在石膏固定8、12、16、20周后处死,采用免疫组织化学法和Western blot法检测双侧髋臼外缘软骨块及细胞中IL-1β和IGF-1的表达情况和蛋白水平,结果进行统计学分析.结果 IL-1β和IGF-1在双侧髋臼软骨细胞中均有不同程度的阳性表达;D组实验侧髋臼软骨中IL-1β的阳性率和蛋白水平最高,B、C、D组实验侧和对照侧比较,差异有统计学意义(P＜0.05).C组实验侧髋臼软骨中IGF-1的阳性率最高,B组实验侧髋臼软骨中IGF-1的蛋白水平最高,B、C组实验侧和对照侧比较,差异有统计学意义(P＜0.05).结论 IL-1β与IGF-1在DDH髋臼软骨细胞中的表达异常,导致软骨细胞增殖和凋亡之间失衡,可能是DDH发生髋关节退行性变的原因之一.

Castleman病(Castleman disease,CD)是一种罕见、病因未明的淋巴结异常增生性疾病.由于该病起病隐匿,临床表现复杂多样,临床特点及影像学特征无特异性,术前误诊率较高,多为术后病理证实,不同分型其治疗及预后都有所不同,给临床诊治带来困难.现报道我院一例颈部Castleman病并复习相关文献,以加深对该病的认识,减少误诊.

目的 总结先天性垂直距骨的临床诊疗特点.方法 回顾性分析我院收治的1例先天性垂直距骨患者的临床资料并结合16篇中英文文献分析本病的病因、分型、诊断及临床治疗.结果 本例属于畸形综合征型先天性垂直距骨,术前行连续反Ponseti法石膏矫形固定治疗5次,手术为微创切开内固定术,术后随访至6个月,患足外观恢复正常.结论 石膏矫形联合微创手术治疗畸形综合征型先天性垂直距骨取得了较满意的疗效,为先天性垂直距骨的治疗提供了更加简单,创伤更小的治疗方法.