Background It’s difficult to treat segmental tibial fractures (STFs), which are intricate injuries associated with significant soft tissue damage. The aim of this study was to compare the clinical effect of hexaxial external fixator (HEF) and intramedullary nail (IMN) in treatment of STFs. Methods A total of 42 patients with STFs were finally recruited between January 2018 and June 2022. There were 25 males and 17 females with age range of 20 to 60 years. All fractures were classified as type 42C2 using the Arbeitsgemeinschaftfür Osteosythese/Orthopaedic Trauma Association (AO/OTA) classification. 22 patients were treated with HEF and 20 patients were treated with IMN. The condition of vascular and neural injuries, time of full weight bearing, bone union time and infection rate were documented and analyzed between the two groups. The mechanical medial proximal tibial angle (mMPTA), mechanical posterior proximal tibial angle (mPPTA), mechanical lateral distal tibial angle (mLDTA), mechanical anterior distal tibial angle (mADTA), hospital for special surgery (HSS) knee joint score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle joint score, range of motion (ROM) of flexion of keen joint and ROM of plantar flexion and dorsal flexion of ankle joint were compared between the two groups at the last clinical visit. Results There were no vascular and neural injuries or other severe complications in both groups. All 22 patients in HEF group underwent closed reduction but 3 patients in IMN group were treated by open reduction. The time of full weight bearing was (11.3 ± 3.2) days in HEF group and (67.8 ± 5.8) days in IMN group( P < 0.05), with bone union time for (6.9 ± 0.8) months and (7.7 ± 1.4) months, respectively( P < 0.05). There was no deep infection in both groups. In the HEF group and IMN group, mMPTA was (86.9 ± 1.5)° and (89.7 ± 1.8)°( P < 0.05), mPPTA was (80.8 ± 1.9)° and (78.6 ± 2.0)°( P < 0.05), mLDTA was (88.5 ± 1.7)° and (90.3 ± 1.7)°( P < 0.05), while mADTA was (80.8 ± 1.5)° and (78.4 ± 1.3)°( P < 0.05). No significant differences were found between the two groups at the last clinical visit concerning HSS knee joint score and AOFAS ankle joint score, ROM of flexion of keen joint and ROM of plantar flexion of ankle joint ( P > 0.05). The ROM of dorsal flexion of ankle joint in IMN group was (30.4 ± 3.5)°, better than (21.6 ± 2.8)° in HEF group ( P < 0.05). Conclusion In terms of final clinical outcomes, the use of either HEF or IMN for STFs can achieve good therapeutic effects. While HEF is superior to IMN in terms of completely closed reduction, early full weight bearing, early bone union and alignment. Nevertheless, HEF has a greater impact on the ROM of dorsal flexion of the ankle joint, and much more care and adjustment are needed for the patients than IMN.

Objective:To investigate the effects of R-spondin 2 (Rspo2) on the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) and bone mineral content in ovariectomized mice. Methods:BMSCs were extracted from the bone marrow of the long bones of 7 4-week-old female C57BL/6 mice using whole bone marrow culture and passaged. After the cell phenotype was identified by flow cytometry, the 3rd generation cells were co-cultured with 10, 20, 40, 80, and 100 nmol/L Rspo2. Then, the cell activity and proliferative capacity were determined by cell counting kit 8 (CCK-8), and the intervention concentration of Rspo2 was screened for the subsequent experiments. The osteogenic differentiation ability of BMSCs was detected by alkaline phosphatase (ALP) staining, and the mRNA levels of osteogenesis-related genes [RUNX family transcription factor 2 (Runx2), collagen type Ⅰ alpha 1 (Col1), osteocalcin (OCN)] were detected by real-time fluorescence quantitative PCR (RT-qPCR). In addition, 18 10-week-old female C57BL/6 mice were randomly divided into sham operation group (sham group), ovariectomy group (OVX group), and OVX+Rspo2-intervention group (OVX+Rspo2 group), with 6 mice in each group. The sham group only underwent bilateral back incision and suturing, while the other two groups established osteoporosis mouse models by bilateral ovarian castration. Then, the mice were given a weekly intraperitoneal Rspo2 (1 mg/kg) treatment in OVX+Rspo2 group and saline at the same dosage in sham group and OVX group. After 12 weeks of treatment, the body mass and uterus mass of the mice were weighed in the 3 groups to assess whether the OVX model was successfully prepared; the tibia bones were stained with HE and immunohistochemistry staining to observe the changes in tibial bone mass and the expression level of Runx2 protein in the bone tissues. Blood was collected to detect the expressions of bone metabolism markers [ALP, OCN, type Ⅰ procollagen amino-terminal peptide (PINP)] and bone resorption marker [β-collagen degradation product (β-CTX)] by ELISA assay. Micro-CT was used to detect the bone microstructure changes in the tibia, and three-dimensional histomorphometric analyses were performed to analyze the trabeculae thickness (Tb.Th), trabeculae number (Tb.N), trabeculae separation (Tb.Sp), and bone volume fraction (BV/TV). Results:CCK-8 assay showed that Rspo2 concentrations below 80 nmol/L were not cytotoxic ( P>0.05), and the cell viability of 20 nmol/L Rspo2 group was significantly higher than that of the control group ( P<0.05). Based on the above results, 10, 20, and 40 nmol/L Rspo2 were selected for subsequent experiments. ALP staining showed that the positive cell area of each concentration of Rspo2 group was significantly larger than that of the control group ( P<0.05), with the highest showed in the 20 nmol/L Rspo2 group. The expression levels of the osteogenesis-related genes (Runx2, Col1, OCN) significantly increased, and the differences were significant between Rspo2 groups and control group ( P<0.05) except for Runx2 in the 40 nmol/L Rspo2 group. In animal experiments, all groups of mice survived until the completion of the experiment, and the results of the body mass and uterus mass after 12 weeks of treatment showed that the OVX model was successfully prepared. Histological and immunohistochemical staining showed that the sparseness and connectivity of bone trabecula and the expression of Runx2 in the OVX group were lower than those in the sham group, whereas they were reversed in the OVX+Rspo2 group after treatment with Rspo2, and the differences were significant ( P<0.05). ELISA assay showed that compared with the sham group, the serum bone metabolism markers in OVX group had an increase in ALP and a decrease in PINP ( P<0.05). After Rspo2 intervention, PINP expression significantly reversed and increased, with significant differences compared to the sham group and OVX group ( P<0.05). The bone resorption marker (β-CTX) was significantly higher in the OVX group than in the sham group ( P<0.05), and it was significantly decreased in the OVX+Rspo2 group when compared with the OVX group ( P<0.05). Compared with the sham group, Tb.Th, Tb.N, and BV/TV significantly decreased in the OVX group, while Tb.Sp significantly increased ( P<0.05); after Rspo2 intervention, all of the above indexes significantly improved in the OVX+Rspo2 group ( P<0.05) except Tb.Th. Conclusion:Rspo2 promotes differentiation of BMSCs to osteoblasts, ameliorates osteoporosis due to estrogen deficiency, and promotes bone formation in mice.

3D printed Titanium alloy is widely used as a material of artificial joints and its mechanical properties is a key factor for improving operation results. Because the elastic modulus of the 3 D printed titanium alloy specimen was related to the size of the metal blank. It is very difficult to identify mechanical parameters by traditional mechanics experiments. In this paper, according to the inverse analysis principle of the parameter estimation, a response surface methodology (RSM) was proposed to identify the mechanical parameters, based on finite element inverse analysis. The finite element models of femoral prosthesis stem were established in line with compression experiments. The material parameters were combined by central composite design (CCD), and the response surface (RS) models were constructed using a quadratic polynomial with cross terms and optimized using a genetic algorithm (GA). Finally, the best mechanical parameter combination of the femoral prosthesis was calculated. The calculated elastic modulus and Poisson's ratio of a 3 D printed titanium alloy femoral prosthesis stem were 109.07 GPa and 0.29, respectively, with the elastic modulus error being very small. The proposed method is effective and can be extended for the identification of mechanical parameters in other 3 D printed models.

The early diagnosis and treatment of spinal fractures and paraplegia by CT scan is investigated in depth and its clinical value is discussed in this paper. In this paper, a novel circulatory generation adversarial network, Spine-GAN, is proposed for the diagnosis of various spinal diseases. The algorithmic model can fully automate the segmentation and classification of multiple spinal structures, such as intervertebral discs, vertebrae, and neuroforamina, simultaneously to intelligently generate a complete clinical diagnosis. The innovation of this method is that Spine-GAN not only overcomes the high variability and complexity of spinal structures in MRI images but also preserves the subtle differences between normal and abnormal spinal structures and dynamically learns obscure but important spatial pathological relationships between adjacent structures of the spine, thus overcoming the limitations of small datasets. Spine-GAN enables accurate segmentation, radiological classification, and pathological correlation representation of the three spinal diseases. Specifically, Spine-GAN achieves a pixel accuracy of 96.2% with a specificity and sensitivity distribution of 89.1% and 86%, respectively. The DMML-Net and Spine-GAN algorithm models have important applications and research values in the clinical diagnosis of spinal diseases and MRI image processing, as well as in the intelligent generation of medical image diagnostic reports, which are of great importance for the study of fine-grained image classification of pathological images. It also has a positive impact on the development of the software.

Objective:To compare the clinical effect of circular external fixator and intramedullary nail in treatment of tibial segmental fractures.Methods:A retrospective case control study was performed on clinical data of 43 patients with segmental tibial fractures treated from January 2006 to December 2012 in Tianjin Hospital. There were 31 males and 12 females with age range of 20-60 years［（35.9±9.6）years］. All fractures were classified as type 42C2 using the AO/OTA classification. A total of 21 patients treated with circular external fixator（circular fixator group）and 22 patients were treated with intramedullary nail（intramedullary nail group）. The condition of vascular and neural injuries，methods of fracture reduction，time of full weight bearing，bone healing time and infection rate were compared between the two groups. The proximal tibial medial angle，proximal tibial posterior angle，IOWA knee and ankle joint score，range of motion of flexion of keen joint and range of motion of plantar flexion and dorsal flexion of ankle joint were compared between the two groups at the last follow-up.Results:All patients were followed up for 12- 48 months［（19.6±2.1）months］. There were no vascular and neural injuries or other severe complications in both groups. All 21 patients in circular fixator group underwent closed reduction but 3 patients in intramellary nail group were treated by open reduction. The time of full weight bearing was（12.9±2.8）days and in circular fixator group and（75.1±8.0）days in intramedullary nail group（ P<0.05），with bone healing time for（7.0±1.0）months and（8.2±1.4）months，respectively（ P<0.05）. There was no deep infection in both groups. In circular fixator group and intramedullary nail group，the proximal tibial medial angle was（86.7±1.5）° and（93.5±1.7）°（ P<0.05），while the proximal tibial posterior angle was（82.1±1.8）°and（75.1±2.7）°（ P<0.05）. No significant differences were found between the two groups at the last follow-up concerning IOWA knee and joint score，range of motion of flexion of keen joint and range of motion of plantar flexion of ankle joint（ P>0.05）. The range of motion of dorsal flexion of ankle joint in intramedullary nail group was（30.9±3.0）°，better than（21.2±2.2）° in circular fixator group（ P<0.05）. Conclusion:For segmental tibial fractures，cirlular external fixation is superior to intromedullary nail in aspects of completely close reduction，early full weight bearing and early bone healing and alignment.

The aim of the present study was to characterize the morphological parameters of giant cell tumor of bone (GCTB) in the knee. The imaging data of 250 patients with GCTB in the knee were retrospectively reviewed, and the morphological parameters were analyzed. The study included 137 cases with GCTB in the distal femur and 113 cases with GCTB in the proximal tibia. The maximal longitudinal diameter of the tumor was 6.616±2.322 cm in the femur group and 5.738±2.278 cm in the tibia group (P=0.003). The maximal transverse diameter in the two groups was 4.865±1.525 and 4.313±1.309 cm, respectively (P=0.003). The shortest distance from the articular surface (SDAS) in the two groups was 0.381±0.404 and 0.280±0.328 cm, respectively (P=0.035), whereas the longest distance from the articular surface in the two groups was 6.924±2.135 and 5.878±1.825 cm, respectively (P=0.001). There were statistically significant differences between the two groups in terms of the range of SDAS (P=0.043). Additionally, the incidence of pathological fractures in the femur was higher compared with that in the tibia (P=0.001), and the incidence of pathological fractures in the two groups gradually increased with the increase in lesion diameter. GCTB in the distal femur was larger compared with that in the proximal tibia, whereas GCTB in the tibia was closer to the articular surface compared with that in the femur. Furthermore, the incidence of pathological fractures in the femur was higher compared with that in the tibia.

Objective To explore the effectiveness of Taylor spatial frame (TSF) in the treatment of tibiofibular fractures and computer-assisted closed reduction. Methods The clinical data of 30 cases of tibiofibular fractures with soft tissue injury treated with TSF between January 2015 and September 2017 was retrospectively analyzed. According to different reduction methods, the patients were divided into control group (15 cases, open reduction in TSF external fixation) and trial group (15 cases, closed reduction in 1-3 days after TSF external fixation). There was no significant difference in the general data such as gender, age, affected side, cause of injury, AO classification of fracture, time from injury to operation between the two groups ( P>0.05). The operation time, intraoperative blood loss, fracture healing time, and removal time of external fixator were recorded and compared between the two groups. At 3 months after removal of external fixator, the limb function was evaluated according to Johner-Wruhs criteria for evaluating the final effect of tibial shaft fracture treatment. Results Both groups were followed up 9-16 months, with an average of 14 months. The operation time, intraoperative blood loss, fracture healing time, and removal time of external fixator in the trial group were significantly shorter than those in the control group ( P<0.05). There were 2 cases of superficial infection of the external fixation (1 case in each group), 1 case of incision infection (control group), 1 case of delayed fracture healing (control group), 2 cases of traumatic arthritis (1 case in each group); no significant difference was found in the incidence of complications between the two groups ( χ 2=0.370, P=0.543). The wounds of soft tissue defect healed by the first intension in both groups. At 3 months after removal of the external fixator, the limb function results in the trial group were excellent in 3 cases, good in 9 cases, fair in 2 cases, and poor in 1 case, and the excellent and good rate was 80.0%; in the control group, the results were excellent in 3 cases, good in 8 cases, fair in 3 cases, and poor in 1 case, and the excellent and good rate was 73.3%. There was no significant difference in incidence of complication between the two groups ( χ 2=0.917, P=0.821). Conclusion Compared with intraoperative open reduction, postoperative computer-aided closed reduction can shorten the operation time, reduce the intraoperative blood loss, reduce the risk of long-term operation, avoid to destroy the blood supply of fracture end, shorten the healing time of fracture and the wearing time of stent, and alleviate the pain of patients after TSF treatment of tibiofibular fracture.

BACKGROUND Bone neoplasms are common in humans and have high lethality. Recently, great progress has been made in understanding the pathophysiological mechanisms, but little is known about the molecular and genetic networks involved. MATERIAL AND METHODS qRT-PCR assays were conducted to detect the expression levels of lncRNA HULC in various cell lines. MTT assay, Transwell assay, and wound-healing assay were performed to investigate the proliferation speed, invasion ability, and migration ability of each cell line, respectively. Western blot analysis was also done to assess the expression level of EMT-related factors. Statistical analysis was performed using the t test, Kaplan-Meier method, and log-rank test. RESULTS Compared to the human normal bone cell line, we found lncRNA HULC was over-expressed in all 6 bone neoplasm cell lines, and we finally chose HT1080 and Saos-2 cell lines, which possessed the highest lncRNA HULC expression level, for the subsequent studies. We then observed that the expression level of lncRNA HULC was negatively correlated with overall survival rate of bone neoplasm patients, which means that lncRNA HULC has prognostic value in patients with bone neoplasms. Thus, we assessed the influence of lncRNA HULC down-regulation on proliferation, invasion, and migration abilities of bone neoplasm cells, and found a significant decrease in these abilities. Finally, we found that down-regulating lncRNA HULC led to decreased expression of EMT-related factors in bone neoplasm cells. CONCLUSIONS LncRNA HULC can promote the tumorigenesis of bone neoplasms through increasing the proliferation, invasion, and migration abilities and the expression level of EMT-related factors.

Objective To compare the clinical effect of the treatment of calcaneal fractures with external fixator,cannulated screw and anatomical titanium plate,and to investigate the indications of three kinds of internal fixation.Methods Data of 61 patients with closed calcaneal fractures from January 2014 to January 2016 and 31 patients from Tianjin Hospital were respectively analyzed,31 cases were fixed with anatomical titanium plate,30 cases were fixed with cannulated screw,and 31 cases were fixed with external fixator.Results There were no significant differences in the affected calcaneal length,height,width,Bohle angle,Gissane angle and axial angle before operation among the three groups (P ＞0.05).There were statistical differences in Bohle angle,Gissane angle and calcaneal length parameters after operation between the stent group and plate group (P ＜0.05).There were statistical differences in Bohle angle,calcaneal length parameters after operation between the screw group and external fixator group (P ＜0.05).There were statistical differences in Bohle angle,calcaneal length and calcaneal length parameters after operation between the screw group and plate group(P ＜0.05).For the time from injury to the operation,bleeding volume,and fracture healing time,the screw group was superior to plate group,and the external fixator group was superior to plate group,there were significant differences (P ＜0.05).There were no significant differences in the postoperative AOFAS score among the three groups(P ＞0.05).Conclusion External fixator and cannulated screw are suitable for Sanders Ⅰ,Ⅱ and most of the Sanders type Ⅲ of calcaneal fractures,but for part of the Sanders type Ⅲ calcaneal fractures and Sanders type Ⅳ calcaneal fractures,anatomical titanium plate is needed in order to achieve good effect.