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.
ObjectiveTo evaluate the clinical outcome of stellated plate fixation of olecranal avulsion fracture. MethodsA retrospective analysis was made on the clinical data from 24 cases of olecranal avulsion fracture treated with stellated plate between April 2007 and April 2012. There were 13 males and 11 females, with an average age of 32 years (range, 18-65 years). The causes of injury included falling injury (14 cases), sports injury (7 cases), and machine injury (3 cases). The left elbow was involved in 4 cases and the right side in 20 cases. The average disease duration was 11 hours (range, 3 hours-2 days). According to Colton's classification criteria, all cases were classified as type Ⅱ A (avulsion fracture). One case had supracondylar humeral avulsion fracture, and 15 cases had triceps tendon tears. ResultsAll the cases obtained healing of incision by first intention, without infection and ulnar nerve injury. The average follow-up period was 24 months (range, 18-48 months). All fractures healed after 6-10 weeks (mean, 7 weeks). According to Morrey's elbow performance score, the results were excellent in 17 cases, good in 4 cases, and fair in 3 cases, with an excellent and good rate of 87.5%. There was no significant difference in the elbow range of motion (ROM) between the injured side (136.0±16.2)° and normal side (143.1±2.9)° (t=2.007, P=0.052). The ROM of normal elbow was significantly larger than that of the injured side in 3 patients who achieved fair results (t=2.820, P=0.048), but no significant difference was found in patients who achieved excellent and good results (P>0.05). ConclusionThe stellated plate has good clinical outcome in treatment of olecranal avulsion fracture, which has advantages of simple operation, firm fixation, and early functional exercise.
ObjectiveTo investigate the clinical features of ankle fractures involving Tillaux-Chaput in adults, and to observe the surgical effectiveness. MethodsBetween May 2009 and May 2013, 15 adult patients with ankle fractures involving Tillaux-Chaput were treated by open reduction and internal fixation. There were 12 males and 3 females, with an average age of 32 years (range, 19-45 years). The causes included sport injury (8 cases), traffic accident injury (5 cases), and falling injury from height (2 cases). The left ankle was involved in 5 cases and the right side in 10 cases. There were 2 open fractures (Gustilo type I) and 13 close fractures. Five patients had single Tillaux-Chaput fractures. The mean time between injury and surgery was 8.5 days (range, 3 hours to 15 days). According to the Lauge-Hansen classification, there were 9 cases of supination-external rotation, 5 cases of pronation-external rotation, and 1 case of pronation-abduction. ResultsPrimary healing of incisions was obtained in 13 patients without infection and neurovascular injury; 2 patients had superficial infection which was cured after oral antibiotics and dressing change. All cases were followed up for 23 months on average (range, 13-36 months). X-ray films showed complete fracture healing at 10-16 weeks postoperatively (mean, 13 weeks) in all cases. The mean American Orthopaedic Foot and Ankle Society (AOFAS) score was 87 (range, 78-99), with an excellent and good rate of 80% (excellent in 9 cases, good in 3 cases, and fair in 3 cases). ConclusionOpen reduction and internal fixation for ankle fractures involving Tillaux-Chaput in adults can achieve excellent effectiveness.
ObjectiveTo evaluate the effectiveness of Othofix pertrochanteric fixator for fixation of intertrochanteric fracture. MethodA retrospective analysis was made on the clinical data from 36 cases of intertrochanteric fracture treated with Othofix pertrochanteric fixator (OPF group) and 47 cases treated with Gamma nail (Gamma group) between October 2012 and March 2015. There was no significant difference in gender, age, cause of injury, side, AO fracture classification, combined medical disease, and injury to operation time between 2 groups (P>0.05) . The operation time, intraoperative blood loss, hospitalization time, fracture union time, and complication rate were recorded and compared between 2 groups. Hip function was evaluated with Sanders post-trauma criteria. ResultsThe operation time, intraoperative blood loss, and hospitalization time of the OPF group were significantly less than those of the Gamma group (P<0.05) . All the cases were followed up 6-12 months (mean, 8.8 months) in 2 groups. Healing of incision by first intention was obtained. Bone union was achieved in 2 groups, and the fracture union time of the OPF group was significantly shorter than that of the Gamma group (t=14.780, P=0.000) . There was no deep wound or pin track infection in 2 groups. Superficial skin reactions developed around the screw and the pins in 14 cases (38.9%) of the OPF group, but no incision infection in the Gamma group, showing significant difference (χ2=22.010, P=0.001) . Mild varus of the hip and pin cutting-out occurred in 3 cases (8.3%) and 2 cases (5.6%) of the OPF group, and in 4 cases (8.5%) and 3 cases (6.4%) of Gamma group, showing no significant difference (χ2=0.001, P=0.960; χ2=0.025, P=0.830) . According to Sanders post-trauma criteria, the results were excellent in 16 cases, good in 15 cases, fair in 3 cases, and poor in 2 cases, with an excellent and good rate of 86.1% in the OPF group; the results were excellent in 22 cases, good in 20 cases, fair in 4 cases, and poor in 1 case, with an excellent and good rate of 89.4% in the Gamma group; and there was no significant difference (χ2=0.200, P=0.610) . ConclusionsThe Othofix pertrochanteric fixator has good effectiveness in the treatment of intertrochanteric fracture, which has the advantages of simple operation, less operation time, little bleeding, and early functional recovery.