目的 探讨AU结合因子1(AUF1)调控p21对骨肉瘤细胞增殖和凋亡的影响及机制.方法 采用qRT-PCR和Western blot分别检测AUF1在骨肉瘤组织mRNA和蛋白表达水平.在骨肉瘤U2OS和HOS细胞中分别转染sh-NC和sh-AUF1后,CCK8检测细胞增殖情况;qRT-PCR检测增殖相关分子PCNA的表达水平;流式细胞术检测细胞凋亡情况;Western blot检测凋亡相关分子Cleaved-caspase-3的表达水平.RNA结合蛋白免疫沉淀实验和RNA半衰期实验检测AUF1调控p21的机制.结果 AUF1 mRNA和蛋白的表达水平在骨肉瘤组织中明显高于癌旁正常组织(P<0.05),AUF1 mRNA的表达水平在骨肉瘤伴转移的患者中明显高于骨肉瘤不伴转移的患者(P<0.05).在U2OS和HOS细胞中分别转染sh-NC和sh-AUF1,AUF1 mRNA和蛋白的表达水平在转染sh-AUF1组较sh-NC组明显下降(P<0.05).低表达AUF1能够明显抑制U2OS和HOS细胞的增殖和增殖相关分子PCNA的表达(P<0.05),促进细胞凋亡和凋亡相关分子Cleaved-caspase-3的表达(P<0.05).低表达AUF1能够明显促进U2OS和HOS细胞中p21 mRNA和蛋白的表达水平(P<0.05).AUF1蛋白能够与p21 mRNA结合,同时低表达AUF1能够明显抑制p21 mRNA的降解速度(P<005).结论 AUF1在骨肉瘤组织和细胞中明显高表达,低表达AUF1能够抑制p21 mRNA降解,增加p21蛋白的表达,进而抑制骨肉瘤细胞增殖和促进细胞凋亡.

目的:探讨circ_0001461对骨肉瘤细胞增殖和凋亡的影响及调控机制.方法:采用实时荧光定量聚合酶反应(qRT-PCR)检测检测circ_0001461在骨肉瘤组织和细胞中的表达水平.在U2OS和HOS细胞中转染sh-NC和sh-circ_0001461后,采用CCK8检测细胞增殖情况,流式细胞术检测细胞凋亡情况,qRT-PCR检测增殖相关分子Ki-67 mRNA的表达水平,Western Blot检测凋亡相关分子Cleaved-caspase-3蛋白的表达水平.采用双荧光素酶报告基因检测circ_0001461和miR-30a-5p的结合情况.结果:circ_0001461在骨肉瘤组织中的表达水平明显高于癌旁正常组织(P＜0.05),circ_0001461在骨肉瘤细胞U2OS和HOS中的表达水平均明显高于成骨细胞NHOst(P＜0.05).低表达circ_0001461能够抑制骨肉瘤细胞U2OS和HOS的增殖和增殖相关分子Ki-67的表达(P＜0.05);促进骨肉瘤细胞U2OS和HOS的凋亡和凋亡相关分子Cleaved-caspase-3蛋白的表达(P＜0.05).双荧光素酶结果显示circ_0001461能够靶向结合miR-30a-5p.低表达circ_0001461能够促进miR-30a-5p的表达(P＜0.05),circ_0001461和miR-30a-5p在骨肉瘤组织中的表达呈负相关(P＜0.05).在U2OS细胞中共转染sh-circ_0001461和miR-30a-5pmimics后能够进一步加强单独转染sh-circ_0001461对U2OS细胞增殖和凋亡的影响(P＜0.05);在HOS细胞中共转染sh-circ_0001461和miR-30a-5p inhibitors后能够逆转单独转染sh-circ_0001461对U2OS细胞增殖和凋亡的影响(P＞0.05).结论:circ_0001461在骨肉瘤组织和细胞中明显高表达,低表达circ_0001461能够靶向促进miR-30a-5p的表达进而抑制骨肉瘤细胞增殖和促进细胞凋亡.

To investigate the clinical effect of fibula transverse transport technique in the treatment of diabetic foot ulcer. Nine patients (7 males and 2 females) with diabetic foot ulcer were treated with fibula transverse transport technique from September 2017 to September 2020. The mean age was (55±9) years (ranged from 43 to 66 years). In terms of Wagner classification, 2 cases were in grade 2, 5 cases were in grade 3, and the other 2 cases were in grade 4. All of the cases involved ischemic ulcers or ischemic-nerve ulcers. The transcutaneous oxygen pressure (TcPO 2) of the dorsal foot of the affected limb was measured, with the ulcer healing and TcPO 2 changes recorded at follow-up. All the 9 patients were followed up for (23±12) months (3 to 38 months). It was found that all patients with foot ulcers were cured within (4.2±1.9) months (2 to 8 months), and all the patients obtained limb salvage. Besides, there was no serious complications occurred, such as skin necrosis and needle tract infection. Before the operation, the TcPO 2 of the affected foot was (28.6±3.8) mmHg(1 mmHg=0.133 kPa), while it was (35.0±5.6) mmHg three months after operation ( P<0.05). The technique of fibula transverse transport can effectively improve the microcirculation function of diabetic foot, and it can promote the healing of the ulcer with few complications.

Objective: To explore the feasibility and clinical effects of using free thinned deep inferior epigastric artery perforator flap to repair extensive soft tissue defects in extremities. Methods: From April 2010 to January 2014, 12 patients with extensive soft tissue defect in extremities after trauma, including 10 males and 2 females, aged 21 to 48 years, 6 patients with defect in the back of wrist and 6 patients with defect in ankle were admitted to the Department of Bone Microsurgery of Xi'an Honghui hospital. After debridement, the size of soft tissue defect ranged from 15.0 cm×4.5 cm to 28.0 cm×11.0 cm. The free thinned deep inferior epigastric artery perforator flap was designed, cut and transferred for reconstruction, with size of 15.0 cm×5.0 cm to 29.0 cm×12.0 cm. The flap thickness ranged from 4.0 to 6.5 cm before defatting, and was 0.6 to 0.9 cm after defatting. All the donor sites of flaps were closed directly by suturing. The flap survival and the appearance and function of flap and donor site were observed during follow-up. Results: All the flaps survived smoothly after surgery. During follow-up of 10 to 42 months, the flaps showed no bloat in appearance, no further flap revision or defatting procedures were required, the distance of static 2-point discrimination was 11 to 17 mm (14.5 mm on average). The abdominal function of patients was not affected, and no postoperative abdomen hernia or ulceration was noted. Conclusions: The free thinned deep inferior epigastric artery perforator flap is thin and suitable for repairing extensive soft tissue defects in extremities with very good outcomes.

目的:探讨解剖型桡骨远端掌侧锁定接骨板内固定治疗老年性桡骨远端骨折的手术复位固定技巧并评价其疗效.方法:2016年3月至2018年9月,采用解剖型桡骨远端掌侧锁定接骨板治疗30例桡骨远端骨折.其中男11例,女19例;年龄54～82岁,平均65岁.致伤原因:摔伤22例,交通事故伤8例.均为闭合性骨折,按AO分型:A3型9例,B2型6例,B3型5例,C1型6例,C2型4例.其中19例因骨折不稳定先行手法复位石膏固定,之后复位丢失行手术治疗;11例术前未接受任何治疗.病程1～23d,平均8.9d.术前掌倾角(-16.0±3.3)°,尺偏角(10.8±6.0)°,桡骨短缩(1 1.2±2.9) mm,腕关节屈曲活动度(41.0±6.5)°,腕关节背伸活动度(42.0±5.8)°,握力为健侧的33.0％±3.3％.结果:术后患者切口均Ⅰ期愈合,无术后早期并发症发生.30例患者均获随访,随访时间1～1.5年,平均1.3年.X线片复查示所有患者骨折均顺利愈合,愈合时间为8～16w,平均9.6w;关节面移位均＜1mm.末次随访时桡骨远端掌倾角为(13.1±3.2)°,尺偏角为(21.9±4.6)°,桡骨短缩(2.0±1.1) mm,腕关节屈曲活动度为(52.0±11.7)°,腕关节背伸活动度为(65.0±4.8)°,握力为健侧的84.0％±4.2％,均较术前显著改善(P＜0.05).末次随访时采用Gartland和Werley评分评价疗效,优21例,良5例,可2例,差2例,优良率86.7％.结论:利用解剖型桡骨远端掌侧锁定接骨板设计上的优势,辅以适当的手术技巧,能较好地复位固定老年性桡骨远端骨折,取得满意疗效.

Oxidative-stress-induced osteoblast dysfunction plays an important role in the development and progression of osteoporosis. BTB and CNC homology 1 (Bach1) has been suggested as a critical regulator of oxidative stress; however, whether Bach1 plays a role in regulating oxidative-stress-induced osteoblast dysfunction remains unknown. Thus, we investigated the potential role and mechanism of Bach1 in regulating oxidative-stress-induced osteoblast dysfunction. Osteoblasts were treated with hydrogen peroxide (H2O2) to mimic a pathological environment for osteoporosis in vitro. H2O2 exposure induced Bach1 expression in osteoblasts. Functional experiments demonstrated that Bach1 silencing improved cell viability and reduced cell apoptosis and reactive oxygen species (ROS) production in H2O2-treated cells, while Bach1 overexpression produced the opposite effects. Notably, Bach1 inhibition upregulated alkaline phosphatase activity and osteoblast mineralization. Mechanism research revealed that Bach1 inhibition increased the activation of nuclear factor erythroid 2-related factor 2 (Nrf2)/antioxidant response element (ARE) signaling and upregulated heme oxygenase 1 and NAD(P)H:quinone oxidoreductase 1 mRNA expression. The Bach1 inhibition-mediated protective effect was partially reversed by silencing Nrf2 in H2O2-exposed osteoblasts. Taken together, these results demonstrate that Bach1 inhibition alleviates oxidative-stress-induced osteoblast apoptosis and dysfunction by enhancing Nrf2/ARE signaling activation, findings that suggest a critical role for the Bach1/Nrf2/ARE regulation axis in osteoporosis progression. Our study suggests that Bach1 may serve as a potential therapeutic target for treating osteoporosis.

病例介绍:患者,男,75岁.左拇指包块复发4年余.于2012年06月19日门诊入院.2008年,患者因“左拇甲下渗出伴溃烂”于外地某医院行“左拇指末端部分切除术”,术后病理诊断:恶性肿瘤,无色素性黑色素瘤.术后恢复良好,如期出院.2009年,无明显诱因出现左拇渗出伴溃烂,伤口一直不愈合,分泌白色脓液和血色脓液.患者未给予系统重视及系统治疗.2012年3月,左拇指末端桡侧出现包块伴溃烂,呈逐渐增大趋势,伴随表面发黑及渗出,分泌物为白色和黑色脓性及恶臭;2012年4月,左拇尺侧也出现包块,类似于桡侧包块呈双头状.

[目的]分析和总结胭血管损伤患者中不同损伤平面的临床特点,提高该损伤的临床认识和诊疗水平.[方法]回顾2014年1月～2016年12月本院收治的54例腘血管损伤患者,男43例,女11例,年龄6.5～75岁,平均(42.08±15.04)岁.分析患者的伤因、血管损伤平面、肢体缺血时间、手术方法、手术次数和随访时肢体功能等临床指标.[结果]据血管影像资料,损伤平面位于胭动脉发出腓肠动脉分支以上者(高位组)12例,位于胭动脉发出腓肠动脉分支以下者(低位组)42例.高位组12例,血管修复9例(术后溶栓2例),保肢成功9例,截肢3例,平均手术3.92次/例,保肢患者肢体功能优良率22.22％;损伤平面在腓肠动脉以下的患者(低位组)42例,血管修复36例(术后溶栓3例),单纯溶栓治疗5例,保肢成功39例,一期截肢1例,二期截肢2例,平均手术2.91次/例,保肢患者肢体功能优良率66.67％.高位组患者在保肢率、保肢后肢体功能优良率等指标上显著差于低位组,两组差异有统计学意义(P≮0.05).[结论]损伤平面在腓肠动脉分支平面以下者,保肢率及肢体功能明显优于损伤平面在腓肠动脉以上的患者.腓肠动脉的侧支代偿作用是胭血管不同损伤平面临床差异的主要原因.

目的:探讨3D打印技术在大段骨缺损、设计游离腓骨瓣中临床应用的效果.方法:收集2014年1月至2016年1月在西安市红会医院骨显微修复外科应用3D打印技术设计腓骨瓣治疗大段骨缺损的患者,所有患者均根据3D打印骨缺损的长度、宽度及形状进行腓骨瓣的截骨设计.共收集到4例患者,其中2例患者为股骨骨缺损,将腓骨瓣双折并截骨后游离移植;1例为内踝缺损,切取游离腓骨头,并进行截骨,重建内踝;1例为胫骨骨缺损,将游离腓骨瓣双折并截骨后游离移植.随访12～18个月,平均15个月,随访患者术后1月、3月、6月、12月、18月X线片,观察骨愈合情况,并与对侧骨质比较,测量相对应骨节段的宽度,测量相关关节的活动度,评价关节功能.结果:术后1月时骨质未见明显愈合;术后3月时可见骨质部分愈合,可见植骨连接处有骨痂形成;术后6月时骨质均愈合,植骨连接处可见愈合良好;术后12个月时,骨质完全愈合,并可见腓骨皮质较前增粗,病人可负重行走.术后1个月时受区相邻关节活动度约为对侧的50％,术后3个月时受区相邻关节活动度约为对侧的70％,术后6月时受区相邻关节活动度约为对侧的80％,术后12个月时受区相邻关节活动度约为对侧的90％.结论:3D打印技术可以在术前指导腓骨瓣设计,使腓骨瓣的形状与骨缺损形状更为接近,更利于骨缺损的愈合及功能的恢复.

目的:分析和总结腘血管不同损伤平面的临床特点,提高该疾患的诊疗水平.方法:收集2014年1月至2016年12月收治54例腘血管损伤患者影像和临床资料,男43例,女11例,年龄6～75岁,平均41.70岁,分析患者伤因、血管损伤平面、肢体缺血时间、手术方法、手术次数、术后坏死感染和愈后肢体功能等临床指标.结果:损伤平面在腓肠动脉以上患者(A组)12例,平均手术3.17次/例,术后坏死50％,术后感染25％,截肢25％,保肢后膝关节功能优良率16.67％;损伤平面在腓肠动脉以下患者(B组)42例,平均手术3.95次/例,术后坏死38.10％,术后感染23.81％,截肢7.14％,保肢后膝关节功能优良率45.24％.B组患者在截肢、术后坏死和保肢后膝关节功能优良率等指标上显著优于A组(P＜0.05).结论:①腘血管不同损伤平面具有重要的临床意义.损伤平面在腓肠动脉以下者,保肢及愈后功能明显优于腓肠动脉以上平面患者.②腓肠动脉的代偿作用是腘血管不同损伤平面临床差异的主要原因.

目的:探讨应用自制抗生素骨水泥珠链植入治疗慢性骨髓炎的临床疗效.方法:本组50例患者,先取出内固定物,清创后植入抗生素骨水泥珠链,Ⅰ期闭合伤口行外固定架固定;Ⅱ期取出抗生素骨水泥珠链,取髂骨植骨.结果:随访11～40个月(21.51±4.52月).46例伤口Ⅰ期愈合,植骨患者32例植骨全部愈合.结论:彻底清创、抗生素骨水泥珠链植入结合外固定架固定及Ⅱ期植骨是治疗感染性骨折不愈合简单而有效的方法.

目的:研究在MRI技术支持下使用3D打印技术对臂丛神经损伤进行术前评估预演.方法:应用3.0T超导性核磁共振扫描仪,添加颈部矩阵线圈、替补矩阵线圈、脊柱矩阵线圈[14].扫描后使用常规序列,3D-STIR序列平扫、3D-STIR序列增强扫描图像,对比图像评价.使用SLS技术打印接受扫描者3D模型,由我院磁共振室高年资医师和我院骨显微修复外科高年资显微外科医师结合磁共振结果分析.结果:此项研究,可以针对臂丛神经损伤进行术前个性化诊断,术前预演,术中定位、定向.可以有效缩短手术时间,减少术中创伤及盲目性,减少术中出血和麻醉药物使用,提高手术的安全性.结论:①通过3D打印模型可以较真实地反映臂丛神经根性撕脱损伤情况,尤其是脑脊液外漏;②把平面的影像诊断学资料变成真实的三维立体模型,利于理解.对于临床教学及与患者术前沟通更加便利.

目的:探讨腓肠神经营养血管皮瓣治疗足踝部软组缺损的疗效.方法:2007年6月至2018年3月收治的53例足踝部软组缺损,缺损原因:外伤40例,术后感染、坏死10例,肿瘤切除术后缺损3例;术中先行彻底清创一期或二期行腓肠神经营养血管皮瓣修复创面,术后观察疗效.结果:53例患者均获得随访6～12个月,平均10个月.3例出现皮瓣部分坏死,考虑为术后下肢外旋后的蒂部所致,经过换药结痂愈合;1例皮瓣完全坏死,考虑为蒂部缝合过紧所致,后期行游离皮瓣再次修复成功.2例患者出现感染,经过局部换药、敏感抗生素治疗后愈合.踝关节功能按美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝与后足功能评分标准:优42例,良10例,可1例,优良率98.11％.皮瓣全部成活,创面愈合,皮瓣质地柔软、弹性好,色泽及足部功能满意,皮肤无破损,感觉部分恢复.结论:各种原因所致的足跟、踝关节周围软组织缺损,采用腓肠神经营养血管皮瓣修复创面,安全可靠,效果良好.

目的:利用心电监护仪氧饱和度指套来检测手指/足趾末梢血氧饱和度(以下简称SpO2),快速筛查四肢血管损伤,降低误诊漏诊.方法:收集2016年11月至2018年12月183例我院急诊科接诊的可疑四肢血管损伤患者,以心电监护仪氧饱和度指套分别检测双侧手指/足趾末梢SpO2,进行四肢血管损伤早起筛查.记录双侧手指/足趾末梢SpO2数值,以SpO2＜90％或双侧相差≥10％为阳性,以双侧SpO2相差＜10％并波形波幅改变为可疑,以SpO2≥90％或双侧相差＜10％为阴性.结果:183例患者共检测阳性37例,可疑3例,阴性143例.最终证实血管损伤患者29例,无血管损伤154例.将监测结果可疑归为阳性结果进行统计分析.手指/足趾SpO2发现腘血管损伤的敏感度100％,特异度93.33％,阳性预测值72.5％,阴性预测值100％,准确度94.33％.结论:监测手指/足趾末梢SpO2可作为四肢血管损伤患者的早期筛查手段,拥有心电监护仪的医疗机构均可采用,值得推广.

[Objective] To evaluate and compare the clinical outcomes of great saphenous autografting by suture,by stapling device versus synthetic vascular graft for repair of limb vascular injury.[Methods] From January 2014 to December 2015,89 patients (146 vessels) with limb vascular injuries were surgically treated.Of them,30 patients had injured vessels repaired by autogenous great saphenous vein grafting anastomosed with microscopic suture (the suture group),33 patients received saphenous vein autografting anastomosed with a stapling device (the stapling group),while the remaining 26 patients underwent synthetic vascular grafting (the synthetic group).The perioperative parameters and clinical outcomes at 3 months were evaluated and compared among the 3 groups.[Results] The total operation time lasted (353.13±6.49) min in the suture group,(217.27±8.30) min in the stapling group and (288.64±4.53) min in the synthetic group,where were statistically different among the 3 groups (F=596.91,P＜0.001).Additionally,the total transfusion volume was recorded as (2435.2± 153.08) ml,(1271.07±87.47) ml and (522.60±103.0) ml in the 3 groups respectively,there also was a statistical difference among them (F=141.909,P＜0.001).The Stapling group had the shortest operation time and least blood transfusion compared with the other 2 groups (P＜0.001).In term of complication,the suture group was parallel to the stapling group,both of them had less complications than the synthetic group.However,the vascular patency and vascular crisis revealed no statistically significant difference among 3 groups (P＞0.05).[Conclusion] For selection of surgical procedures for limb vascular injuries,the surgeon must consider the overall conditions of the patient,the local structure involved,vascular donor situation,as well as the vascular caliber.Vascular grafting anastomosed by the stapling devices consume the shortest operation time.Considering no significant differences among these 3 surgical procedures in postoperative complication,the synthetic vascular graft is still practicable in clinical setting.

Objective To explore the curative effect of fibular flap with limbs composite soft-tissue.Methods From February,2013 to February,2016,13 cases with body severe trauma patients were treated,which including 5 cases of upper limbs and 8 cases of lower limbs,and all existed bone defect,soft tissue defect and trunk vessel defect.Three cases with limbs distal non blood supply were emergency treated with debridment and flow-through fibular flap transplantation renovation,peroneal artery repairing defective blood vesscls to rcstorc limbs distal blood supply,fibular flap repairing bone defect,skin flap repairing soft tissue defect.The limb blood supply for other 10 cases were in good condition,but one case with main artery defect did the second phase of fibular flap transplantation and repaired defective blood vessels,bone and skin soft tissue synchronously according to wound condition.According to the postoperative observation for flap survival and appearance,X-ray films to observe fracture healing after 6 weeks,three months and 6 months of operation as well as evaluating limb function recovery,then analyzed the results.Results Flaps survived successfully for 11 cases,and flaps for the other 2 cases were partial necrosis.One Case was edge flap necrosis,heal scabby after dressing,and the other case was necrosis for 1/3 of the area,but the deep fascia survival,and the skin graft healing after dressing.One case with forearm rolling was in vascular crisis after operation,but tbe crisis was relieved after detection,and fingers blood supply was recovered.All the patients were followed up for 6 to 36 months(mean,14 months).All flaps were survived,fractures healed well and limbs distal blood supply was good.Bone healing time was 8 to 24 weeks,and patients with lower limbs injury could bear load after 3 to 8 months.Lower limbs restored walking function.Upper limbs and hands restored rotation function.Transplant flapshad good elasticity and satisfactory appearance.Conclusion Using fibular flap to repair defective blood vessels,bone and soft tissue synchronously,not only can rescue the limbs on the verge of amputation,but also can repair defective composite tissue and get a good prognosis.It is an effective method for open injuries severely treatment in clinic.

Objective To compare curative effect of open reduction Kirschner tension band internal fixation and closed reduction percutaneous pressing hollow screw internal fixation for patellar fractures.Methods Sixty-five patients with patellar transverse fractures from January 2013 to January 2016 were treated:30 cases were treated by closed reduction percutaneous pressing hollow screw(hollow screw group) while 35 cases were treated by open reduction Kirschner tension band (tension band group).The VAS scores and knee-joint function scores of the two groups 0.5,3 and 6 months after operation were compared.Results The 65 cases were followed up for 6-12 months and the average was 8 months.Two cases in tension band group had Kirschner pins losing out with skin irritation,and were relieved after taking out internal fixation.There was no wound infection,loosening or breakage of internal fixation and skin irritation in hollow screw group.The VAS scores in postoperative 0.5,3 and 6 months for hollow screw group were lower than tension band group.The Lysholm scores of postoperative 0.5,3,and 6 months for hollow screw group were higher than tension band group.The difference was statistically significant (P ＜0.05).Conclusion Close reduction percutaneous pressing hollow screw internal fixation for patellar fractures can get good clinical results,and patients can get good knee-joint function,small postoperative pain and less complications.

The activity of Schwann cells (SWCs) is very important in trauma-induced nerve repair, and tumour necrosis factor-α (TNF-α) produced during tissue injury inhibits the viability of SWCs, which delays the repair of peripheral nerves. Loganin is an iridoid glycoside that has been shown to alleviate a variety of cytotoxic effects. In the current study, we evaluated the potential efficacy and the mechanism of action of loganin in TNF-α-induced cytotoxicity in SW10 cells. The experimental results indicated that loganin blocked TNF-α-mediated Smad2 activation, downregulated the expression of the G1 phase cell cycle inhibitor p15IN4KB, and upregulated the expression of the G1 phase cell cycle activator cyclin D1-CDK4/6, which upregulated E2F-1-dependent survivin expression and relieved TNF-α-induced apoptosis in SW10 cells. The protective effect of loganin on SWCs has potential medicinal value in the promotion of peripheral nerve repair and is significant for studies in the field of tissue regeneration.

MicroRNAs have emerged as important regulators of osteoclast differentiation in recent years. Of these, miR-34c has been reported to play an important role in bone development. However, its role and the underlying mechanism in osteoclast differentiation remains poorly understood. In this study, we aimed to investigate the precise role and molecular mechanism of miR-34c in osteoclast differentiation. We found an obvious increase in miR-34c expression during osteoclast differentiation in osteoclast precursors induced by receptor activator of nuclear factor κB (NF-κB) ligand and macrophage colony-stimulating factor in vitro. Further experiments showed that overexpression of miR-34c significantly promoted osteoclast differentiation while suppression of miR-34c showed the opposite effect. Interestingly, bioinformatics analysis and dual-luciferase reporter assays showed that miR-34c targets the 3'-untranslated region of leucine-rich repeat-containing G-protein-coupled receptor 4 (LGR4). The expression of LGR4 was regulated by miR-34c in osteoclasts. Moreover, miR-34c regulated NF-κB and glycogen synthase kinase 3-β signaling during osteoclast differentiation. Overexpression of LGR4 partially reversed the promoting effect of miR-34c overexpression on osteoclast differentiation. Taken together, our study suggests that miR-34c contributes to osteoclast differentiation by targeting LGR4, providing novel insights into understanding the molecular mechanism underlying osteoclast differentiation.

目的:探讨在开放性胫腓骨骨折中,使用交锁髓内钉与传统外固定架固定相比,评价局部伤口及全身感染率、骨折愈合情况及远期功能恢复的区别.方法:将本院68例胫骨干开放性骨折患者随机分为2组,A组(对照组)34例,采用常规治疗+外固定;B组(实验组)34例,采用常规治疗+交锁髓内钉固定.结果:在局部及全身感染率上,两组没有明显差异(P＜0.05);A组一期愈合率为73％,延迟愈合16％,畸形愈合11％,远期优良功能恢复75％;B组一期愈合率为89％,延迟愈合9％,畸形愈合2％,远期优良功能恢复86％.结论:与传统外固定架固定相比,交锁髓内钉治疗胫腓骨开放性骨折具有提高骨折一期愈合率、改善远期骨关节功能的明显优势.