Publications by authors named "Chong-Qi Tu"

47 Publications

Targeted and immuno-based therapies in sarcoma: mechanisms and advances in clinical trials.

Biochim Biophys Acta Rev Cancer 2021 Aug 8;1876(2):188606. Epub 2021 Aug 8.

Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China. Electronic address:

Sarcomas represent a distinct group of rare malignant tumors with high heterogeneity. Limited options with clinical efficacy for the metastatic or local advanced sarcoma existed despite standard therapy. Recently, targeted therapy according to the molecular and genetic phenotype of individual sarcoma is a promising option. Among these drugs, anti-angiogenesis therapy achieved favorable efficacy in sarcomas. Inhibitors targeting cyclin-dependent kinase 4/6, poly-ADP-ribose polymerase, insulin-like growth factor-1 receptor, mTOR, NTRK, metabolisms, and epigenetic drugs are under clinical evaluation for sarcomas bearing the corresponding signals. Immunotherapy represents a promising and favorable method in advanced solid tumors. However, most sarcomas are immune "cold" tumors, with only alveolar soft part sarcoma and undifferentiated pleomorphic sarcoma respond to immune checkpoint inhibitors. Cellular therapies with TCR-engineered T cells, chimeric antigen receptor T cells, tumor infiltrating lymphocytes, and nature killer cells transfer show therapeutic potential. Identifying tumor-specific antigens and exploring immune modulation factors arguing the efficacy of these immunotherapies are the current challenges. This review focuses on the mechanisms, advances, and potential strategies of targeted and immune-based therapies in sarcomas.
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http://dx.doi.org/10.1016/j.bbcan.2021.188606DOI Listing
August 2021

Three-dimensional-printed custom-made patellar endoprosthesis for recurrent giant cell tumor of the patella: A case report and review of the literature.

World J Clin Cases 2021 Apr;9(11):2524-2532

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.

Background: Giant cell tumor (GCT) is a benign lesion and rarely involves the patella. This disease is characterized by a relatively high recurrence rate after primary treatment. resection has been a predominant option for recurrent GCT. However, total patellectomy can lead to disruption of the knee. Therefore, exploration of functional reconstruction of the extensor mechanism is worthwhile.

Case Summary: A 54-year-old woman presented with right knee pain and swelling, and was diagnosed as having a GCT in the patella following curettage and autograft. Medical imaging revealed a lytic and expanded lesion involving the whole patella with focal cortical breaches and pathological fracture. Based on the combination of histological, radiological, and clinical features, a diagnosis of recurrent GCT in the patella was made (Campanacci grade III). After a multidisciplinary team discussion, three-dimensional (3D)-printed custom-made patellar endoprosthesis was performed following resection for reconstructing the extensor mechanism. The patient was followed for 35 mo postoperatively. No evidence of local recurrence, pulmonary metastasis, or osteoarthritis of the right knee was observed. The active flexion arc was 0°-120°, and no extension lag was detected. A favorable patellar tracking and height (Insall-Salvati ratio 0.93) were detected by radiography.

Conclusion: We depict a case of a GCT at the right patella, which was successfully treated by patellectomy and 3D-printed custom-made endoprosthetic replacement. The patella normal reconstruction, the precise-fit articular design, and gastrocnemius flap augmentation could lead to satisfactory knee function and a low rate of complications in the short-term follow-up.
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http://dx.doi.org/10.12998/wjcc.v9.i11.2524DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8040175PMC
April 2021

Patient-Derived Tumor Xenografts Plus Ex Vivo Models Enable Drug Validation for Tenosynovial Giant Cell Tumors.

Ann Surg Oncol 2021 Oct 21;28(11):6453-6463. Epub 2021 Mar 21.

Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.

Introduction: Tenosynovial giant cell tumor (TGCT) is a locally aggressive tumor with colony-stimulating factor 1 receptor (CSF1R) signal expression. However, there is a lack of better in vivo and ex vivo models for TGCT. This study aims to establish a favorable preclinical translational platform, which would enable the validation of efficient and personalized therapeutic candidates for TGCT.

Patients And Methods: Histological analyses were performed for the included patients. Fresh TGCT tumors were collected and sliced into 1.0-3.0 mm sections using a sterilized razor blade. The tumor grafts were surgically implanted into subrenal capsules of athymic mice to establish patient-derived tumor xenograft (PDTX) mouse models. Histological and response patterns to CSF1R inhibitors evaluations were analyzed. In addition, ex vivo cultures of patient-derived explants (PDEs) with endpoint analysis were used to validate TGCT graft response patterns to CSF1R inhibitors.

Results: The TGCT tumor grafts that were implanted into athymic mice subrenal capsules maintained their original morphological and histological features. The "take" rate of this model was 95% (19/20). Administration of CSF1R inhibitors (PLX3397, and a novel candidate, WXFL11420306) to TGCT-PDTX mice was shown to reduce tumor size while inducing intratumoral apoptosis. In addition, the CSF1R inhibitors suppressed circulating nonspecific monocyte levels and CD163-positive cells within tumors. These response patterns of engrafts to PDTX were validated by ex vivo PDE cultures.

Conclusions: Subrenal capsule supports the growth of TGCT tumor grafts, maintaining their original morphology and histology. This TGCT-PDTX model plus ex vivo explant cultures is a potential preclinical translational platform for locally aggressive tumors, such as TGCT.
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http://dx.doi.org/10.1245/s10434-021-09836-9DOI Listing
October 2021

Efficacy and safety of recombinant human epidermal growth factor for diabetic foot ulcers: A systematic review and meta-analysis of randomised controlled trials.

Int Wound J 2020 Aug 28;17(4):1062-1073. Epub 2020 Apr 28.

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, PR China.

To evaluate the efficacy and safety of recombinant human epidermal growth factor (rhEGF) in treating diabetic foot ulcers (DFUs), we conducted both database searches (PubMed, MEDLINE, EMBASE, CENTRAL, and Web of Science) and reference searches for randomised controlled trials from the inception of databases to 30 January 2020. Two reviewers independently scrutinised the trials, extracted data, and assessed the quality of trials. The primary outcome was the proportion of complete healing. The secondary outcomes were mean time to complete healing and adverse events. A subgroup analysis was performed by different administration routes. Statistical analyses were performed in RevMan 5.3. The time to complete healing Kaplan-Meier curves was pooled in the R software. Of the 156 citations, 9 trials (720 participants) met eligibility criteria and were included. The rhEGF achieved a higher complete healing rate than placebo (OR: 2.79, [95% CI: 1.99, 3.99]). The rhEGF also significantly shorten complete healing time (MD: -14.10 days, [95% CI: -18.03, -10.16]). Subgroup analysis showed that topical application was superior to intralesional injection, but that may be because of different ulcer severity they included. No significant difference was shown in adverse events. Results were coherent with sensitivity analyses. Therefore, rhEGF is an effective and safe treatment for DFUs.
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http://dx.doi.org/10.1111/iwj.13377DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7948637PMC
August 2020

[Therapeutic Effect of Uncemented Allograft-prosthetic Composite for the Reconstruction of Tumorous Bone Defect].

Sichuan Da Xue Xue Bao Yi Xue Ban 2018 Jan;49(1):129-132

Department of Orthopaedics,West China Hospital,Sichuan University,Chengdu 610041,China.

Objective: To investigate the surgical techniques and mid-term efficacy of reconstruction for proximal femur with allograft-prosthetic composite (APC) .

Methods: Fifteen patients who underwent uncemented APC reconstruction of proximal femur after bone tumor resection were retrospectively evaluated. Image and physical examinations were taken on the 1st,3rd,6th,9th and 12th month after surgery and every 6 months thereafter to assess union condition,greater trochanteric bone absorption and myodynamia of abductors. Musculoskeletal Tumor Society (MSTS) and Harris Hip Score (HHS) were utilized to evaluate the function of hip joint.

Results: Seven male and eight female patients were included with average age of 25.1 years(17-56 years) and average followup of 32.8 months(18-48 months). Four patients had giant cell tumor of the bone,3 patients had osteosarcoma,3 patients had chondrosarcoma,2 patients had malignant fibrous histiotoma,2 patients had osteoblastoma and 1 patient had Ewing sarcoma. Unions occurred in the allograft-host bone interfaces of all patients in the period of 5-9 months postoperatively. Bone absorption in the allograft-host bone interfaces,dislocation,hypersensitivity of the allograft and acetabulum abrasion were not observed,while there were no metastasis and tumor recurrence. Three patients had periprosthetic fractures intraoperatively and were well fixed with cerclage. Absorptions in the greater trochanteric happened to 6 patients. All patients had mean MSTS and HHS scores of 11.3 (7-15) and 47.3 (40.3-58.5) preoperatively and 26.1(24-29) and 80.1(66.2-92.7) postoperatively.

Conclusion: Uncemented APC reconstruction is proper for young patients with long life expectancy and high demand of function that suffered from tumors of proximal femur.
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January 2018

Prognostic value of the C-reactive protein to albumin ratio: a novel inflammation-based prognostic indicator in osteosarcoma.

Onco Targets Ther 2017 2;10:5255-5261. Epub 2017 Nov 2.

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China.

The prognostic role of the C-reactive protein to albumin ratio (CRP/Alb ratio) in patients with osteosarcoma has not been investigated. A total of 216 osteosarcoma patients were enrolled in the study. Univariate and multivariate survival analyses between the groups were performed and Kaplan-Meier analysis was conducted to plot the survival curves. Receiver operating characteristic curves were generated and areas under the curve (AUCs) were compared to assess the discriminatory ability of the inflammation-based indicators, including CRP/Alb ratio, Glasgow prognostic score (GPS), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR). The optimal cutoff value was 0.210 for CRP/Alb ratio with a Youden index of 0.319. Higher values of CRP/Alb ratio were significantly associated with poorer overall survival in univariate (HR =2.62, 95% CI =1.70-4.03; <0.001) and multivariate (HR =2.21, 95% CI =1.40-3.49; =0.001) analyses. In addition, the CRP/Alb ratio had significantly higher AUC values compared with GPS (=0.003), NLR (<0.001), and PLR (<0.001). The study demonstrated that the CRP/Alb ratio is an effective inflammation-based prognostic indicator in osteosarcoma, which potentially has a discriminatory ability superior to that of other inflammatory indicators including GPS, NLR, and PLR.
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http://dx.doi.org/10.2147/OTT.S140560DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5679688PMC
November 2017

[Design of Minimal Invasive Screw on Posterior Pelvis Ring and Pelvic Finite Element Analysis].

Sichuan Da Xue Xue Bao Yi Xue Ban 2017 Sep;48(5):673-680

Department of Orthopedics,West China Hospital,Sichuan University,Chengdu 610041,China.

Objective: To design minimal invasive screw on posterior pelvic ring and perform threedimensional finite element analysis based on a pelvis finite element model.

Methods: We measured the pelvic anatomical data of 20 healthy volunteers and identified potential designs for minimal invasive screw on posterior pelvic ring. A finite element model of pelvis was then established. Threedimensional finite element analyses were performed under static and dynamic mechanical loading,respectively.

Results: Three screw tracks on ilium (A,B and C) were identified based on a threedimensional reconstruction of pelvis. Nail track B and C had greater length and width,but shorter distance between nailing and soft tissue compared with nail track A. Static loading under an external rotation load of 500 N generated a maximum Mises Von stress of 582.05 Pa and sacral iliac complex of 107.38 Pa. The greatest strain was located at the articular cartilage on the side of the nail,followed by lateral sacral joint cartilage and symphysis pubis. The largest displacement was located at the ilium on the side of the nail,with a gradient decrease to the opposite side. The largest displacement of the anterior superior iliac spine was 0.35 cm on the side of the nail. The dynamic loading identified displacement of the anterior superior iliac spine with 1.5 mm in axis,1.8 mm in axis and -0.2 mm in axis; and displacement of the pubic bone with 0.8 mm in axis,1.0 mm in axis and 0.03 mm in axis. The maximum displacement appeared along the impact direction: axis. Relatively large equivalent stress was found in pubis and ischium,anterior superior iliac spine,sacrum,acetabular that are prone to fracture. With increased impact force,the stress of pelvis increased over time. The maximum impact force,stress and displacement of the pelvis occurred at 10 ms when peak force was reached. Under the impact of 4 000 N and 5 000 N,the bone was subject to a stress level of over 200 MPa,exceeding its average yield strength,which suggests a possibility of pelvic fracture.

Conclusion: Taking B/C as a main screw track and A as an auxiliary screw track is a reasonable choice. The pelvic finite element model lays a foundation for further studies into sacral fracture and design of screw tracks.
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September 2017

[Extensively Porous-coated Distal Fixation Long Stem Prosthesis for Unstable Proximal Femur Fracture with Complex Hip Disease].

Sichuan Da Xue Xue Bao Yi Xue Ban 2016 Jul;47(4):565-569

Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu 610041, China.

Objectives: To evaluate the clinical results of femoral proximal fracture with complex hip diseases using an uncemented extensively porous-coated long femoral stems.

Methods: 15 cases of femoral proximal fracture with complex hip diseases treated with the uncemented extensively porous-coated long femoral stem were retrospectively reviewed. All patients were followed up at 1, 3, 6, 12 months in the first year postoperatively and once a year from the second year on.Radiological evaluations were conducted using the related criteria, including anteropostierior radiograph of pelvis, anteropostierior and lateral radiograph of proximal femur, and flat tomography of lower limbs.The bone union of the femur fracture, the fixation of prosthesis, and periprosthetic bone loss were evaluated by above-mentioned radiography.The subsidence of femoral prosthesis was compared between 1 month postoperatively and the last follow-up. Complications during the follow-up period was recorded.Clinical outcomes were assessed with Harris Hip Score the last follow-up, including excellent (90-100), good (80-89), moderate (70-79) and bad (<70).

Results: The average follow-up period was (45.5±21.7) months. All fractures were united at mean 12.6 weeks. There were no femoral stem subsidence and evidence of loosening both radiologically and clinically. The reconstructive offset for femoral fracture was 35.8 mm, while the contralateral offset was 34.8 mm. The average Harris Hip Score was 89.5 at the last follow-up. Moreover, no loosening, dislocation or infection were observed.

Conclusions: Total hip arthroplasty with extensively porous-coated long femoral stem provides a good fracture stability that promotes fracture healing and offers a successful solution for femoral proximal fracture with complex hip diseases.
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July 2016

A multi-level comparative analysis of human femoral cortical bone quality in healthy cadavers and surgical safe margin of osteosarcoma patients.

J Mech Behav Biomed Mater 2017 02 12;66:111-118. Epub 2016 Nov 12.

National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, Sichuan, China.

Osteosarcoma is the most common primary malignancy of bone. However, the potential variation it brings to the adjacent undamaged bone tissue is seldom investigated. In this study, we conducted a multi-level comparison of human femoral cortical bone quality in healthy cadavers (aged 42±11 years) and in resected safe margin of osteosarcoma patients (aged 49±15 years). The objective of this study was to document the changes with exposure to osteosarcoma condition in bone mechanical strength, structural morphology and elementary composition, evaluated by static and dynamic mechanical analysis (DMA), scanning electron microscopy (SEM) imaging, X-ray diffraction (XRD) and Fourier-transform infrared spectroscopy (FTIR). The resected clinical samples from healthy and osteosarcoma conditioned bones were grouped into the Tumor and Healthy groups, and shaped into regular beam specimens or pulverized according to testing protocols. The results of mechanical tests confirmed osteolytic deteriorations in mineral phase of the Tumor group, in terms of significant reductions in storage modulus (-53.6%, at 1Hz), bending strength (-53.0%) and stiffness (-64.8%) as compared to the Healthy group. However, the energy dissipation/absorption ability of the collagen phase in the Tumor group did not differ from the Healthy group statistically. Although specimens showed no visible morphological difference, a decline in osteocyte lacunar density in bone specimens from the Tumor group was discovered (-54.4%, p<0.001). Higher magnification observation showed that the cell-free lacunae in the Tumor group were occluded by randomized overgrown collagen fibers. XRD and FTIR analysis further demonstrated a lower hydroxyapatite crystallinity and decreased mineral:matrix ratio in pulverized samples from the Tumor group, mainly due to the prominent Amide peaks. Taken together, these data revealed a previously unrecognized effect of osteosarcoma on the adjacent "normal" bone quality. The current study may provide insights on bone tumor pathology and an advanced understanding of surgical safe margin.
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http://dx.doi.org/10.1016/j.jmbbm.2016.11.008DOI Listing
February 2017

[Clinical Significance of Hip Rotation Center Location after Reconstruction with Modular Hemipelvic Prostheses for Pelvic Tumor].

Sichuan Da Xue Xue Bao Yi Xue Ban 2016 May;47(3):365-70, 381

Objective: To investigatethe clinical significance of hip rotation center location after reconstruction with modular hemipelvic prostheses for periacetabula tumors.

Methods: Forty-two patients who received periacetabular tumor resection and reconstruction with modular hemipelvic prosthesis between January 2004 and January 2014 in our institute were included. Postoperative complications, function (measured by MSTS score), survival rate and recurrence rate were analyzed. The position of prosthetic hip rotation center was measured. By its deviation angle from the ideal rotation center, the patients were divided into inward group, normal group and outward group in the horizontal level, and upward group, normal group and downward group in the vertical direction. And the relationship between positional difference of prosthetic hip rotation center and function at 1 month, 3 months, 6 months and 12 months after surgery was analyzed.

Results: Of forty-two cases in total, 25 patients were male and 17 patients were female. The age of the patients ranged from 12 and 69 years (median, 38 years). The minimal followup period was 12 months (mean,36 months; range,12-86 months). The complication rate was 31.0% and hip dislocation rate was 7.1%. The overall survival rate was 69.4% at 3 years and 43.7% at 5 years. After 1 month, 3 months, 6 months, the function of the reconstructed hip gradually improved, with MSTS score showing an increasing trend. The MSTS scores at these three time points were compared, the difference was statistically significant (P < 0.05). The improvement of function after 6 months and 12 months was not obvious, with the difference not being statistically significant (P > 0.05). The deviation of hip rotation center in the longitudinal direction and the horizontal direction did not affect the function of the hip (P > 0.05).

Conclusion: It is safe and effective for patients with pelvic tumor to receive modular hemipelvic prosthesis reconstruction once the prosthesis is fixed in the most firmly position, where soft tissue fully covered, the muscles could be rebuilt more easily and where the eccentricity of the femoral got a certain degree of recovery. The relationship between the deviation of hip rotation center and postoperative function needs to be confirmed.
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May 2016

[Current treatment situation and progress on bone defect of collapsed tibial plateau fractures].

Zhongguo Gu Shang 2016 Feb;29(2):187-91

Characteristics of collapsed tibial plateau fracture determines that the joint surface must remain anatomical reduction,line of force in tibial must exist and internal fixation must be strong. However, while renewing articular surface smoothness, surgeons have a lot of problems in dealing with bone defect under the joint surface. Current materials used for bone defect treatment include three categories: autologous bone, allograft bone and bone substitutes. Some scholars think that autologous bone grafts have a number of drawbacks, such as increasing trauma, prolonged operation time, the limited source, bone area bleeding,continuous pain, local infection and anesthesia,but most scholars believe that the autologous cancellous bone graft is still the golden standard. Allograft bone has the ability of bone conduction, but the existence of immune responses, the possibility of a virus infection, and the limited source of the allograft cannot meet the clinical demands. Likewise, bone substitutes have the problem that osteogenesis does not match with degradation in rates. Clinical doctors can meet the demand of the patient's bone graft according to patient's own situation and economic conditions.
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February 2016

Clinicopathological and prognostic significance of chemokine receptor CXCR4 in patients with bone and soft tissue sarcoma: a meta-analysis.

Clin Exp Med 2017 Feb 17;17(1):59-69. Epub 2015 Dec 17.

Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, People's Republic of China.

The prognostic significance of CXC chemokine receptor 4 (CXCR4) in patients with bone and soft tissue sarcomas remains controversial. To investigate the impact of its expression on survival and clinicopathological features, we performed a meta-analysis. Comprehensive literature searches were conducted in PubMed, Web of Science, Embase and Cochrane Library for relevant studies. In total, 12 studies with 997 sarcoma patients were included. CXCR4 expression was found to be significantly associated with poor overall survival (HR 2.37, 95 % CI 1.86-3.01; P < 0.001). Further, when the analysis was stratified by histological subtypes (bony sarcoma including osteosarcoma and Ewing sarcoma and soft tissue sarcoma including synovial sarcoma and rhabdomyosarcoma), statistical analysis method (multivariate analysis and univariate analysis) and CXCR4 measuring method (IHC or RT-PCR), the significant correlation to poor overall survival was also observed except for that in Ewing sarcoma and RT-PCR groups. As for clinicopathological features, CXCR4 expression was significantly associated with higher rate of metastasis (OR 6.97, 95 % CI 2.28-21.31; P = 0.001) and higher tumor stage (OR 7.55, 95 % CI 1.25-45.47; P = 0.027), but not associated with gender, age and tumor site. In conclusion, CXCR4 expression may be an effective predictive factor of poor prognosis and clinicopathological features for bone and soft tissue sarcomas. Further studies are needed to validate our findings.
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http://dx.doi.org/10.1007/s10238-015-0405-yDOI Listing
February 2017

Identification and functional study of osteosarcoma metastasis marker genes.

Oncol Lett 2015 Sep 1;10(3):1848-1852. Epub 2015 Jul 1.

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China.

To date, osteosarcoma metastasis genes, which are key for accurate initial diagnosis of the disease, have not been well identified. In the present study, osteosarcoma samples with and without metastasis were collected from 31 patients. Specific complementary DNA subtraction techniques were used to identify the osteosarcoma metastasis transcripts, which are responsible for the metastasis of osteosarcoma. The specific differentially expressed transcripts were identified by Basic Local Alignment Search Tool analysis and the results were validated by immunoblotting. Specifically, ezrin and β4 integrin were employed as markers to detect osteosarcoma metastasis in the initial stages. The results of the present study indicated that the two transcripts, ezrin and β4 integrin, were highly expressed in patients with osteosarcoma metastasis, and concluded that these were osteosarcoma metastasis genes. These results indicate that β4 integrin and/or ezrin may be used as a novel marker for the detection of osteosarcoma metastasis in the initial stages.
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http://dx.doi.org/10.3892/ol.2015.3444DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4533640PMC
September 2015

Cemented allograft-prosthesis composite reconstruction for the proximal femur tumor.

Onco Targets Ther 2015 25;8:2261-9. Epub 2015 Aug 25.

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.

Introduction: Cemented allograft-prosthesis composite (APC) reconstruction is one option following resection of the proximal femur tumor. However, rare studies have focused on the indications and complications. The goal of the present study was to (1) ascertain the indications for cemented APC arthroplasty in the proximal femur; (2) identify the detailed perioperative management; and (3) illustrate our experiences to avoid the complications of cemented APC.

Materials And Methods: A total 28 patients who underwent cemented APC reconstruction of the proximal femur after tumor resection were retrospectively evaluated at a median follow-up of 56 months. Clinical records and radiographs were reviewed to evaluate patients' outcome.

Results: In our series, excluding three cases of death that had a short follow-up period, union occurred in 22 (88.0%) patients (range 9-18 months). Nonunion of the greater trochanter was seen in six of the 12 patients (50.0%). Eight (32.0%) hips had resorption. There were two (8.0%) hips that were observed to have asymptomatic wear of the acetabulum. The average Musculoskeletal Tumor Society (MSTS) score was 26.5 points. The average Harris Hip Score (HHS) score was 80.6 points. There were no cases of recurrence, but metastasis was found in two hips.

Conclusions: Mastering indications, perioperative management, and complication prevention are all very important in the APC reconstruction after resection of the proximal femur.
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http://dx.doi.org/10.2147/OTT.S85788DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4556043PMC
September 2015

[Locking compression plate (LCP) combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) for the treatment of Pilon fracture].

Zhongguo Gu Shang 2014 Dec;27(12):1029-32

Objective: To summarize clinical outcomes of locking compression plate (LCP) combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) for the treatment of Pilon fracture.

Methods: From January 2009 to December 2012, Pilon fracture patients treated by LCP with MIPPO were retrospectively analyzed. All open fractures, pathologic fractures and those who had limb vascular disease or nerve injury were excluded. Thirty-eight patients were enrolled, including 29 males and 9 females aged from 21 to 78 years old with an average of 48 years old. According to AO classification, 20 cases were type B, 18 cases were type C. Operative time, blood loss, reduction quality, time of fracture healing complications and postoperative ankle joint function were applied for evaluating clinical outcomes, AOFAS scoring were used for assessing postoperative clinical effects.

Results: All patients were followed up from 13 to 24 months (averaged 18 months). All patients obtained bone union without any plate failures or loss of fixation/reduction. One patient occurred superficial wound infection, and resolved with antibiotics and local wound care. Postoperative average AOFAS score was 81 (ranged 65 to 97).

Conclusion: LCP with MIPPO for Pilon fratcure has advantages of less invasion, fewer complications and satisfactory ankle function.
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December 2014

[Analyzing risk factors for surgical site infection following Pilon fracture surgery].

Zhongguo Gu Shang 2014 Aug;27(8):650-3

Objective: To study the related risk factors for surgical site infection following Pilon fracture surgery. METH ODS: The data of 561 patients with Pilon fractures treated with open reduction plate osteosynthesis at our institution's trauma centre were collected from January 2006 to December 2012. All the patients were divided into two groups: infection group and non-infection group. In the infection group, there were 23 males and 10 females, ranging in age from 21 to 69 years old, with an average of (45.50±4.40) years old. In the non-infection group, there were 296 males and 232 females, ranging in age from 16 to 76 years old, with an average of (43.50±7.19) years old. The possible risk factors such as age, gender, smoking, diabetes, alcohol abuse, open fractures, compartment syndrome and operative time were studied. The multivariate Logistic regression model was used to analyze the risk, factors.

Results: The infection rate of surgical site after Pilon fracture surgery was 5.88%. There were significant statistical differences between infection group and non-infection group in operative time, open fractures and compartment syndrome. However, multivariate Logistic regression analysis revealed that only operative time was significantly associated with surgical site infection (P=0.005, OR=44.92).

Conclusion: Operation time is an independent predictor for post-operative surgical site infection of Pilon fracture treated with open reduction plate osteosynthesis. Though open fracture and compartment syndrome could increase the surgical site infection rate, they could not not be considered as independent predictors.
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August 2014

Comparison of Early and Delayed Open Reduction and Internal Fixation for Treating Closed Tibial Pilon Fractures.

Foot Ankle Int 2014 Jul 19;35(7):657-64. Epub 2014 May 19.

Orthopedic Department of West China Hospital, Sichuan University, Chengdu, PR China.

Background: The timing of surgery for osteosynthesis of type C pilon (AO/OTA) fractures remains controversial. The aim of this study was to determine the outcome of early and delayed open reduction and internal fixation (ORIF) for treating closed type C pilon fractures.

Methods: Forty-six patients with closed type C pilon fractures matched according to age, gender, soft tissue conditions, and fracture pattern were divided into group A (early group: underwent surgery within 36 hours of the injury) or group B (delayed group: underwent surgery 10 days to 3 weeks postinjury after the soft tissue swelling subsided). In the delayed group, 9 patients were treated first by temporary external fixation. All the closed fractures were managed by ORIF with locking plates. At follow-up, the clinical and radiographic results were retrospectively analyzed. The mean follow-up time was 25.8 months (range, 14 to 48 months) in group A and 26.0 months (range, 15 to 44 months) in group B.

Results: There was no significant difference (P > .05) between the 2 groups regarding the rate of soft tissue complication, the rate of fracture union, and the final functional score. The patients in group A had a significantly shorter mean time to fracture union (21.5 ± 4.0 weeks vs 23.3 ± 3.7 weeks, P < .05), operating time (84.3 ± 12.1 months vs 100.6 ± 13.7 months, P < .01), and hospital stay (7.6 ± 2.6 days vs 15.2 ± 4.2 days, P < .01).

Conclusion: If soft tissue conditions are acceptable, early ORIF for treating closed type C pilon fractures can be safe and effective, with similar rates of wound complication, fracture union, and final good functional recovery but shorter operative time, union time, and hospital stay. These results favorably compare with delayed ORIF treatment.

Level Of Evidence: Level III, retrospective comparative study.
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http://dx.doi.org/10.1177/1071100714534214DOI Listing
July 2014

[Anterior decompression and fusion with n-HA/PA66 cage for the treatment of lower cervical fracture and dislocation].

Zhongguo Gu Shang 2014 Feb;27(2):92-6

Objective: To explore the clinical effects of anterior decompression and fusion with a nano-hydroxyapatite/ polyamide 66 (n-HA/PA66) cage in treating lower cervical fracture and dislocation.

Methods: From January 2008 to December 2010, the clinical data of 42 patients with lower cervical fracture and dislocation were retrospectively analyzed. There were 29 males and 13 females aged from 20 to 65 years old. The mean age was 46.8 years. Five cases got injuried in C3, 14 cases in C4, 12 cases in C5, 7 cases in C6 and 4 cases in C7. According to Frankel grade, 4 cases were classified in grade A, 11 cases in grade B, 13 cases in grade C, 9 cases in grade D and 5 cases in grade F. Twenty-eight cases were treated with anterior corpectomy and fusion and 14 cases with anterior discectomy and fusion. Frankel grade was used to do neurologic assessment and visual analogue scale (VAS) was used to evaluate the improvement of clinical symptoms. Segmental height and sagittal lordosis were measured by radiographs and cage location. Cage appearance and fusion status were assessed by 3D-CT images.

Results: All patients were followed up for 3 to 5.2 years with an average of 4.1 years. Frankel grade had obviously improved than preoperative (Z = -4.845, P < 0.001). There were 2, 3, 11, 8, 11 cases classified in grade A, grade B, grade C, grade D and grade E respectively. At the third day after operation and latest follow-up,VAS was (2.6 +/- 1.8),(1.3 +/- 1.0) scores respectively. Both had improved than preoperative (P < 0.05). Up to the latest follow-up, there was only one patient (2.4%) with slight cage translocation (less than 2 mm), however, no cage prolapsed, or collapse, or breakage were found. Both segmental height and lordosis improved significantly after surgery (P < 0.001). And there was not significant difference in both parameters between each postoperative time points (P > 0.05). The mean distance of cage subsidence was 1.5 mm and the rate of cage subsidence (> 3 mm) was 4.8%.

Conclusion: The n-HA/PA66 cage can not only restore and maintain the fusion segmental height and radian, but also promote the osseous fusion and profit the radiographic assessment after operation. Thus, it was an ideal material for prop graft.
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February 2014

PDGF-regulated miRNA-138 inhibits the osteogenic differentiation of mesenchymal stem cells.

Biochem Biophys Res Commun 2014 Jun 2;448(3):241-7. Epub 2014 May 2.

Department of Orthopaedics, Chengdu Military General Hospital, Chengdu, Sichuan Province, China.

Differentiation-specific microRNAs may play a critical role in MSC differentiation, and they can be altered by PDGF signaling. We propose that PDGF modulates MSC differentiation by regulating microRNA expression. Therefore, we investigated whether PDGF treatment could alter the expression profile of miRNAs in MSCs. Furthermore, we assessed the osteoblast phenotype of MSCs after inducing osteogenic differentiation. We found that PDGF treatment significantly inhibits the osteogenic differentiation of MSCs and that miR-138 gene transcription is controlled by PDGF signaling. Our results confirm that miR-138 inhibits the osteogenic differentiation of MSCs and suppresses the phosphorylation of FAK, ERK1/2, and Runx2. Furthermore, our study clearly demonstrates that downregulation of Runx2 by miR-138 is critical for the PDGF-mediated inhibition of osteogenic differentiation of MSCs. These findings indicate that inhibition of miR-138 function in MSCs, either by treatment with anti-miR-138 or by overexpression of the miR-138 target sequence (miRNA sponge), could represent a potential therapeutic strategy for the treatment of bone homeostasis disorders caused by activation of the PDGF pathway.
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http://dx.doi.org/10.1016/j.bbrc.2014.04.091DOI Listing
June 2014

Internal fixation with headless compression screws and back buttress plate for treatment of old Hoffa fracture.

Chin J Traumatol 2014 Apr;17(2):79-83

Department of Orthopedics, West China Hospital, Chengdu 610041, China.

Objective: To analyze the early clinical and radiographic outcomes of Hoffa fractures treated by a standard protocol of open reduction and internal fixation using headless compression screws combined with back buttress plate in a consecutive series of 8 Chinese patients.

Methods: Open reduction and internal fixation was performed on all patients. The fractures were anatomically reduced and held temporarily by K-wire. If the ends of fractures were atrophic, autologous bone graft from the ipsilateral iliac crest was packed between the ends. Then the fracture fragments were fixed with AO 6.5 mm headless compression cannulated screws. At least two screws were used to provide rotational stability. One pre-contoured reconstruction plate was placed on the nonarticular surface posteromedially or posterolaterally as back buttress plate.

Results: All the patients were followed up for at least 12 months (range 12-25 months). All fractures achieved anatomical reduction and healed clinically and radiographically. At recent follow-up, the mean flexion degree was 120.6° (range 110°-135°) and the mean extension degree was 2.5° (range 0°-5°). The average visual analogue scale score was 1.6 points (range 0-3). Six patients were assessed as excellent and 2 as good according to the hospital for special surgery knee score system. There were no superficial or deep infections, or hardware breakages. No patient had giving way or locking of the knee, though some had intermittent pain and swelling after strenuous exercise. Injury mechanism had significant influence on the functional outcome (P=0.046).

Conclusion: Headless compression screws combined with back buttress plate and/or autologous bone grafting to treat old Hoffa fracture is one of effective measures. It would be conducive to not only fracture healing but also early exercise and functional recovery.
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April 2014

[Comparative analysis of the clinical characteristics of orthopedic inpatients in Lushan and Wenchuan earthquakes].

Beijing Da Xue Xue Bao Yi Xue Ban 2013 Oct;45(5):688-92

Department of Orthopaedics, West China Hospital of Sichuan University, Chengdu 610041, China.

Objective: To systematically analyze and compare the clinical characteristics of orthopedic inpatients in Lushan and Wenchuan earthquake, so as to provide useful references for future earthquakes injury rescue.

Methods: Based on the orthopedic inpatients in Lushan and Wenchuan earthquakes, the data of the age, gender, injury causes, body injured parts and speed of transport were classified and compared.

Results: The duration of patients admitted to hospital lasted long and the peak appeared late in Wenchuan earthquake, which is totally opposed to Lushan earthquake. There was no significant difference in the patient's age and gender between the two earthquakes. However, the occurrence rate of crush syndrome, amputation, gas gangrene, vascular injury and multiple organ dysfunction syndrome (MODS) in Wenchuan earthquake was much higher than that in Lushan earthquake. Blunt traumas or crush-related injuries (79.6%) are the major injury cause in Wenchuan earthquake, however, high falling injuries and falls (56.8%) are much higher than blunt trauma or crush-related injuries (39.2%) in Lushan earthquake. The incidence rate of foot fractures, spine fractures and multiple fractures in Lushan earthquake was higher than that in Wenchuan earthquake, but that of open fractures and lower limb fractures was lower than that in Wenchuan earthquake.

Conclusion: The rapid rescue scene is the cornerstone of successful treatment, early rescue and transport obviously reduce the incidence of the wound infection, crush syndrome, MODS and amputation. Popularization of correct knowledge of emergency shelters will help to reduce the damage caused by blindly jumping or escaping while earthquake happens.
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October 2013

[A biomechanical comparison of Acutrak headless compression screw and AO cannulated lag screw for the fixation of Hoffa fracture].

Sichuan Da Xue Xue Bao Yi Xue Ban 2013 Mar;44(2):226-30

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, China.

Objective: To compare the stability, strength of Letenneur type I Hoffa fractures fixed by Acutrak headless compression screws and AO cannulated lag screws.

Methods: 12 models of Letenneur type I Hoffa fractures were randomly divided into 4 groups, which were fixed with two AO cannulated lag screws or Acutrak headless compression screws anteroposteriorly or posteroanteriorly. The stress between two fragments of all specimens was tested. Axial compression test, the cycle load test and the limit load test were successively performed in every specimen.

Results: In axial compression test, displacement of Acutrak headless compression screw groups was lower than that of AO cannulated lag screw anteroposteriorly (P < 0.05). The load to failure for Acutrak headless compression screw groups was higher than that of AO cannulated lag screws (P < 0.05), no matter in anteroposterior or posteroanterior direction.

Conclusion: The strength and stability of Letenneur type I Hoffa fractures fixeded with Acutrak headless compression screw were superior to those provided by AO cannulated lag screw. The direction of screw affects the initial stability for AO cannulated lag screw, other than Acutrak headless compression screw.
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March 2013

[Comparison between allogeneic tendon fixation and screw fixation in ligamentous Lisfranc injury: a biomechanical analysis].

Sichuan Da Xue Xue Bao Yi Xue Ban 2013 Mar;44(2):222-5, 241

Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu 610041, China.

Objective: To compare the stability provided by a allogeneic tendon with a screw for the treatment of ligamentous Lisfranc injury.

Methods: Six fresh-frozen, paired cadaveric feet were loaded in the condition of Lisfranc ligament-intact, injury and fixation models. With axial or abduction stress, the distance between medial cuneiform and second metatarsal was recorded.

Results: With both two types of stress, there were statistically significant differences in motion detected between the intact and post-injury conditions (all P = 0.000), and the magnitudes were greater with abduction [(4.14 +/- 1.02) mm] than axial load [(1.60 +/- 0.64) mm]. In screw fixation group, the mean position changes under axial load and abduction load were (1.53 +/- 0.62) mm and (4.06 +/- 1.05) mm in post-injury model respectively, while the changes were (0.76 +/- 0.35) mm and (1.20 +/- 0.53) mm in the fixation model (all P = 0.000) which were not statistical different to that in the intact model. In allogeneic tendon fixation group, the mean position changes were (1.66 +/- 0.65) mm and (4.21 +/- 1.00) mm in the post-injury model, while were (0.90 +/- 0.41) mm and (1.33 +/- 0.61) mm in the fixation model (all P = 0.000) which also were not statistical different to that in the intact model.

Conclusion: Under abduction stress, a significantly greater difference was found between pre- and post-injury, which may be valuable for diagnosing and testing ligamentous Lisfranc injury. Allogeneic tendon fixation can provide similar stability as screw fixation in ligamentous Lisfranc injury.
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March 2013

Functional outcome of en bloc resection and osteoarticular allograft reconstruction with locking compression plate for giant cell tumor of the distal radius.

J Orthop Sci 2013 Jul 10;18(4):599-604. Epub 2013 May 10.

Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, People's Republic of China.

Background: Giant cell tumors of the distal radius at Campanacci grade III are particularly challenging to treat. We have treated 15 cases of giant cell tumor of the distal radius by en bloc excision and osteoarticular allograft reconstruction with locking compression plate (LCP). The purpose of this study was to assess the intermediate outcomes of all patients treated with this surgery.

Methods: From July 2002 to January 2009, we followed up 15 patients with giant cell tumors of the distal radius who were treated with en bloc excision and osteoarticular allograft reconstruction with LCPs that were long enough to approach the distal end of the allograft. All of the cases were evaluated based on clinical and radiologic examinations, the passive range of motion of the wrist joint, complications, Mayo wrist score, and short form (SF)-36.

Results: The clinical follow-up time after reconstruction averaged 5.2 years. The mean resected length of the radius was 8.1 cm. One patient had tumor recurrence in the soft tissues after 3 years (recurrence rate 6.67 %). No patient had allograft bone fracture, nonunion, or metastases. Subchondral bone alterations and joint narrowing were present in all cases, with 1 patient suffering from the pain, but the pain could be endured without the need for analgesics. The average range of motion of the wrist was 46.7° of dorsiflexion, 33.3° of volar flexion, 61.3° of supination, and 72.3° of pronation. The mean Mayo wrist score was 70 and the mean modified SF-36 score was 71.

Conclusions: En bloc excision and osteoarticular allograft reconstruction with an appropriate LCP for a Campanacci grade III giant cell tumor of the distal radius result in a reasonable functional outcome at intermediate follow-up evaluation. This method can excise the tumor integrally with a low rate of recurrence, good function, and a satisfactory range of motion.
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http://dx.doi.org/10.1007/s00776-013-0394-1DOI Listing
July 2013

Management of limb fractures in a teaching hospital: comparison between Wenchuan and Yushu earthquakes.

Chin J Traumatol 2013 ;16(1):16-21

Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu 610041, China.

Objective: To comparatively analyze the medical records of patients with limb fractures as well as rescue strategy in Wenchuan and Yushu earthquakes so as to provide references for post-earthquake rescue.

Methods: We retrospectively investigated 944 patients sustaining limb fractures, including 891 in Wenchuan earthquake and 53 in Yushu earthquake, who were admitted to West China Hospital (WCH) of Sichuan University.

Results: In Wenchuan earthquake, WCH met its three peaks of limb fracture patients influx, on post-earthquake day (PED) 2, 8 and 14 respectively. Between PED 3-14, 585 patients were transferred from WCH to other hospitals outside the Sichuan Province. In Yushu earthquake, the maximum influx of limb fracture patients happened on PED 3, and no one was shifted to other hospitals. Both in Wenchuan and Yushu earthquakes, most limb fractures were caused by blunt strike and crush/burying. In Wenchuan earthquake, there were 396 (396/942, 42.0%) open limb fractures, including 28 Gustilo I, 201 Gustilo II and 167 Gustilo III injuries. But in Yushu earthquake, the incidence of open limb fracture was much lower (6/61, 9.8%). The percent of patients with acute complications in Wenchuan earthquake (167/891, 18.7%) was much higher than that in Yushu earthquake (5/53, 3.8%). In Wenchuan earthquake rescue, 1 018 surgeries were done, composed of debridement in 376, internal fixation in 283, external fixation in 119, and vacuum sealing drainage in 117, etc. While among the 64 surgeries in Yushu earthquake rescue, the internal fixation for limb fracture was mostly adopted. All patients received proper treatment and survived except one who died due to multiple organs failure in Wenchuan earthquake.

Conclusion: Provision of suitable and sufficient medical care in a catastrophe can only be achieved by construction of sophisticated national disaster medical system, prediction of the injury types and number of injuries, and confirmation of participating hospitals?exact role. Based on the valuable rescue experiences after Wenchuan earthquake, the rescue was faster, more orderly and effective in Yushu earthquake. Nevertheless, there is still a long way to go in the development of a stronger emergent response to the disasters.
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July 2014

Infectious complications in patients with crush syndrome following the Wenchuan earthquake.

Chin J Traumatol 2013 ;16(1):10-5

Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu 610041, China.

Objective: To analyze the results of clinical and bacteriological examinations in patients with crush syndrome who suffered infectious complications after an earthquake in Sichuan, China.

Methods: A total of 313 bacteriological samples among 147 patients with crush syndrome were collected. Infectious complications, results of microbiological examinations, potential risk factors of infection and mortality were analyzed statistically.

Results: In the obtained database, 112 out of the 147 (75.7%) patients had infectious complications, in which, wound infection, pulmonary infection, and sepsis were most common. The time under the rubble and the time from injury to treatment were related to the occurrence of wound infection (P equal to 0.013, odds ratio 2.25; P equal to 0.017, odds ratio 2.31). Sepsis and wound infection were more common in patients who underwent fasciotomy or amputation than in those who did not (P equal to 0.001).

Conclusion: Quick rescue and injury treatment can decrease the infection risk in crush syndrome patients. It is better to obtain microorganic proofs before applying antibiotics, and bacteriological and drug sensitivity data should be taken into account, especially considering that most of these infections are hospital-acquired and drug resistance. Emphasizing the accuracy and efficiency of wound management in emergency situations, cautiously assessing the indications for fasciotomy to avoid open wounds from unnecessary osteofascial compartment decompression incisions may decrease the incidence of infection and ameliorate the prognosis.
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July 2014

[Appling the color Doppler in abdominal aortic balloon occlusion for pelvic and sacral surgery].

Sichuan Da Xue Xue Bao Yi Xue Ban 2012 Sep;43(5):715-9

Department of Anesthesiology, West China Second Hospital, Sichuan University, Chengdu 610041, China.

Objective: To apply the color Doppler in abdominal aortic balloon occlusion for pelvic or sacral surgery, and to evaluate its effectiveness in controlling blood loss.

Methods: A Philips 4500 color Doppler was used to place abdominal aortic balloons in 20 patients with pelvic or sacral tumors who underwent surgery. The temporary abdominal aortic balloons were used for controlling blood loss in the surgery. Transesophageal echocardiography was performed to detect the renal blood flow.

Results: Abdominal aortic balloons were successfully placed to the 20 patients, with a water injection rate of 10-18 (13.8 +/- 2.6) mL and a total of 45-180 min occlusion during the 70-450 (265 +/- 102) min surgery. The intraoperative blood loss ranged from 250 to 4000 (1357 +/- 997) mL. The water injection rate of abdominal aortic-balloons (Y) was correlated with the diameter of abdominal aorta (X): Y = 7.1602X + 2. 9968 (R2 = 0.7371, P < 0.05). Renal blood flow was not affected. The patients stayed in hospital for 7-13 (9.8 +/- 11.9) days after operation. One patient developed complications. The one year recurrence rate of tumors was 10%.

Conclusion: The color Doppler provides a simple and accurate instrument for abdominal aortic-balloon occlusion, with reliable blood loss control.
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September 2012

[Application of n-HA/PA66 composite artificial vertebral body in anterior reconstruction of lower cervical spine fracture and dislocation].

Zhonghua Wai Ke Za Zhi 2012 Apr;50(4):338-41

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, China.

Objective: To initially evaluate the application of artificial vertebra of n-HA/PA66 in anterior reconstruction of lower cervical spine fracture and dislocation.

Methods: In this study, 84 patients with lower cervical spine fracture and dislocation received anterior cervical discectomy, spinal canal decompression or subtotal corpectomy, spinal canal decompression and reconstruction by n-HA/PA66 composite artificial vertebral body combined with plate instrumentation. Neurological function was followed up by improvement rate of Frankel and situations of the supporting body was observed by X ray and 3D-CT in 3, 12, 24 months postoperatively. The intervertebral height, physical arc (reflected by Cobb angle) and the locations and fusion rate of the supporting body were assessed in order to evaluate the stability of the cervical spine and alignment improvements.

Results: All the patients underwent operation successfully and were followed up for 6 to 24 months with an average of 12 months. The preoperative symptoms were improved to varying degrees. Imaging studies showed that in all cases graft fusion were achieved, and cervical alignments, intervertebral height, cervical spine stability and the locations of the artificial vertebral body were well maintained. No displacement and subsidence of the artificial vertebral body occurred. Postoperative immediate intervertebral height (2.4 ± 0.2) cm, preoperative intervertebral height (1.9 ± 0.1) cm, comparisons of the two groups was statistically significant (q = 2.48, P < 0.001). The immediate, 3 month, 1 year, 2 year period follow-up group intervertebral height was not statistically significant (P > 0.05). Preoperative Cobb angle was 9.8° ± 1.2°, postoperative immediate Cobb angle was 16.6° ± 1.2°, comparisons of the two groups was statistically significant (q = 14.25, P < 0.001). The immediate, 3 month, 1 year, 2 year period follow-up group Cobb angle was not statistically significant (P > 0.05).

Conclusions: n-HA/PA66 artificial vertebral body can provide early cervical spine support and stability and effectively maintain the biological alignment and cervical intervertebral height. It has high rate of graft fusion and is convenient to observe by X-ray. Therefore, n-HA/PA66 can be taken as an ideal graft for anterior lower cervical spine fracture and dislocation operation, but further follow-up study is still required to evaluate the long-term effects.
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April 2012

[Finite element analysis and static biomechanics of pelvic after modular hemipelvic prosthesis reconstruction].

Sichuan Da Xue Xue Bao Yi Xue Ban 2012 Mar;43(2):206-9

Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu 610041, China.

Objective: To compare the stress distribution of normal pelvis with those of postoperative contralateral pelvic and modular hemipelvic prosthesis under different positions, with an aim to providing biomechanical evidence support for safe reconstruction of pelvic ring using modular hemipelvic prosthesis.

Methods: Three-dimensional finite element models of normal pelvis, postoperative pelvic and modular hemipelvic prosthesis were established using thin-layer CT scanning (TLCS). The stress distributions of normal pelvis, postoperative pelvic and prosthesis were measured under three static positions: standing on two feet, standing on one foot on the defective side and sitting.

Results: Little difference was found in contralateral pelvic stress between the normal pelvic and reconstructive pelvic models given the same load with different positions. The maximum stress level appeared at the upside of sacrum mesion, sacroiliac joints, superior greater sciatic notch and iscbial tuberosity, albeit a much lower level than fatigue strength. The maximum stress level of modular hemipelvic prosthesis appeared at the inner wall of connector bar between CS fixation and acetabular cup. Similarly, the stress level was also much lower than the fatigue strength of connector bar. The stress distribution of postoperative pelvic was similar to that of normal pelvic.

Conclusion: Reconstruction with modular hemipelvic prosthesis has little effect on contralateral pelvic. The maximum stress levels of contralateral pelvis and modular hemipelvic prosthesis are significantly lower than their fatigue strength, which indicates sound safety of contralateral pelvis and modular hemipelvic prosthesis. Pelvic reconstruction with modular hemipelvic prosthesis produces good biomechanical compatibility.
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March 2012

Timing of internal fixation and effect on Schatzker IV-VI tibial plateau fractures.

Chin J Traumatol 2012 ;15(2):81-5

Department of Orthopaedic Surgery, West China Hospital of Sichuan University, Chengdu 6l0041, China.

Objective: To study the effect of internal fixation performed at different times on therapeutic outcomes of Schatzker IV-VI tibial plateau fractures.

Methods: The clinical data of 42 cases of Schatzker IV-VI tibial plateau fractures treated in our department were analyzed retrospectively. Among these 42 patients, 21 received surgical treatment within 12 h after injury (Group I), the other 21 were first treated by traction or plaster fixation followed by a delayed internal fixation after soft tissue swelling subsided (Group II). The surgical time, complications, length of hospital stay, cost of hospitalization, and time for fracture union, as well as functional recovery were analyzed and compared between the two groups.

Results: After 10-28 months follow-up (mean 16.5 months), except 5 cases who lost to follow-up, no differences were found between the two groups regarding surgical time, preoperative and postoperative complications, healing time or the Hospital for Special Surgery (HSS) score at the end of follow-up, but significant differences were found in the length of hospital stay, cost of hospitalization and HSS score at 3 months after operation (P less than 0.05).

Conclusion: Under certain conditions, early internal fixation for Schatzker IV-VI tibial plateau fracture is feasible, which can shorten the length of hospital stay, decrease the cost of hospitalization and promote early functional rehabilitation.
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April 2016
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