To further observe the concentration range of zoledronate on RAW264.7 cell toxic effect and confirm the optimum concentration in inhibition of RAW264.7 differentiation of osteoclast.

Mouse leukemia macro phage RAW264.7 was cultured as research object. RAW264.7 osteoclast toxic effect of zoledronate was detected by MTT method. Inhibition of osteoclast differentiation by different concentration of zoledronate were detected by tartrate-resistant acid phosphatase staining method.

After 24 h vitro culture, Enzyme-linked immunosorbent assay absorbance indicated that 10^-3 mol/L (0.511±0.920), 10^-4 mol/L (0.615±0.577) concentrations of zoledronate had significantly toxic effects on cells compared with the blank control group (0.789±0.061)(F=5.880, P<0.01). TRAP staining osteoclast count indicated that 10^-5 mol/L (8.333±0.817), 10^-6 mol/L (10.400±1.817), 10^-7 mol/L (11.250±2.750) and 10^-8 mol/L (11.143±1.864) concentrations of zoledronate all significantly inhibited RAW264.7 differentiation compared with the blank control group (F=27.972, P<0.05), showing concentration dependence, 10^-5 mol/L zoledronate had the highest inhabitation effect (P<0.01).

Zoledronate can effectively inhibit RAW264.7 differentiation, and the optimum concentration in vitro is 10^-5 mol/L.

To compare and analyze the epidemiological features of femoral intertrochanteric fractures in the elderly between Northern and Eastern areas of China from January 2010 to December 2011.

Data of human fractures treated between January 2010 to December 2011 in 39 hospitals in northern and eastern China were collected through the PACS system and case reports checking system. The data of 18 hospitals in northern China were classified as group A, while data of 21 hospitals in eastern China were classified as group B. Gender, age, side and fracture classification between two groups were compared.

A total of 5,413 femoral intertrochanteric fractures in the elderly were divided into group A (3,324 cases) and group B (2,089 cases). There were 2,116 males (39.09%) and 3,297 females (60.91%), with a male/female ratio of 1:1.56. The median age of all the patients was 79 years old (65-103 years old). Left side (2,791 cases, 51.56%) outnumbered the right side (2,622 cases, 48.44%). There were 1,431 males and 1,893 females in the group A (M/F=1:1.32), and 685 males and 1,404 females in group B (M/F=1:2.05, χ²=56.712, P<0.001). The median age of the two groups were 78 years and 81 years, respectively, difference was statistically significant (Z=-12.282, P<0.001). The predominant age group in group A was 75 to 79 years, accounting for 25.42% (845/3,324). The predominant age group in group B was from 80 to 84 years, accounting for 26.28% (549/2,089) . The high-risk type was type Ⅰ in group A, accounting for 28.34% (942/3,324). While in group B the high-risk type was type Ⅱ, accounting for 29.15% (609/20,894). There were no significant differences in type Ⅴ, while differences were statistically significant between the two groups in other types (P<0.05).

Femoral intertrochanteric fractures in elderly were most seen in females and the highest frequency fracture type was type Ⅰ and type Ⅱ in Northern and Eastern areas of China, respectively. Compared with northern China, the patients were older, the proportion of females was higher in eastern China. The proportion of type Ⅰ and typeⅢ was lower, while the proportion of type Ⅱ and type Ⅳwas higher.

To study the effect of levosimendan in the treatment of elderly heart failure patients underwent urgent hip fracture repairment.

A retrospective analysis was performed in the First Hospital of Handan from January 2013 to December 2016, including 64 (30 femoral neck fracture, 34 intertrochanteric fracture) elderly hip fractures conforming to inclusion criteria. Patients were divided into levosimendan group and control group according to the application of levosimendan, the levosimendan group had 32 cases same as the control group. The left ventricular ejection fraction (LVEF), b-type natriuretic peptide (BNP) and cardiac output (CO), cardiac index (CI) before application of levosimendanat 24 h and 7 d after surgery were compared to evaluate the curative effect of levosimendan.

LVEF, CO, CI at 24 h and 7 d after syrgery in Leosimendan group were significantly higher than control group (LVEF: t=2.428, t=3.150; CI: t=3.349, t=3.777; CO: t=2.615, t=2.620, P<0.05), BNP levels at 24 h and 7 d after surgery in leosimendan group was significantly lower than the control group, with statistical significance (t=2.989, t=2.693, P<0.05).

Levosimendan can be used to improve heart function and prognosis of elderly hip fracture with heart failure by regulating perioperative hemodynamic index.

To investigate the clinical value of bedside ultrasound in detection of deep vein thrombosis in elderly patients with femoral neck fracture.

A retrospective study was performed in patients with femoral neck fractures who underwent bilateral ultrasound in department of Sports Medicine and Adult Reconstructive Surgery of Drum Tower Hospital Affiliated to Medical School of Nanjing University from January 2016 to March 2017. The diameter of blood vessel, location, echo and blood flow were evaluated. Postoperative ultrasound were conducted routinely during hospitalization and after discharge.

A total of 135 patients were enrolled in this study. There were 45 males and 90 females. The average age was 76±8 years old and the average body mass index was 22±3 kg/m². Forty-five cases were diagnosed DVT. Seven cases were proximal DVT and thirty eight were distal. According to the anatomical location, one located in the iliac vein, four located in the femoral veins, four located in the popliteal veins, five cases located in the peroneal veins and three cases located in the posterior tibia veins, forty one cases located in the muscular vein. Surgeries were postponed in 13 DVT patients and all of them received thrombosis treatment and ultrasound screening every other day. Results showed that 10 cases were significantly improved, two cases had no improvement and one case aggravated, two cases received inferior vena cava filters. During postoperative screening, three preoperative DVTs were found to progress into other veins and all of them received treatment and the follow-up screening showed that no DVT failed off and no pulmonary embolism happened.

Bedside ultrasound can be used in the diagnosis, monitoring and follow up of DVT in patients with femoral neck fracture.

To investigate glenoid morphology and orientation in a Chinese population using 3D reconstruction and scanning image standardization.

Data of 98 cases of normal shoulder CT scan in China-Japan Union Hospital of Jilin University from January 2013 to June 2017 were collected. There were 36 males and 62 females, aged from 21 to 80 years, with an average of (51±14) years. The patient's CT data were imported into Mimics software for parallel three-dimensional CT reconstruction. The scapular plane was established to recalibrate the scanned image to avoid the influence of scanning angle and patient's posture. The 3-matic and Geomagic software were used to fit the joint glenoid surface into a 3D scatter model to determine the center of the glenoid and the plane of the glenoid fitting. Quantitatively analyze the normal human glenoid height, width, surface area, glenoid twist angle and tilt angle.

The average height of the glenoid was (35.2±2.9) mm, the width was (26.9±2.6) mm and the surface area was (824±143) mm². The torsion angle was posterior (1.01±4.07) ° and the tilt angle was upward (8.89±4.71)°. There was no statistical difference in the above parameters, but the height, width and surface area of glenoid in male were significantly higher than those of females (P<0.01). Correlation analysis showed that there was a significant positive correlation between height and glenoid size (r=0.815, P<0.01).

The three-dimensional reconstruction technique has high accuracy and repeatability for the analysis of glenoid morphological parameters, which is of reference value to optimize the design of glenoid prosthesis in Chinese. The predicted height of the Chinese subjects that corresponded to a glenoid width of standard 29 mm which designed based on Europeans and Americans was over 175 cm.

Biochemical markers of bone metabolism are some bone matrix components generated from osteoblasts and osteoclasts and released into the blood and urine. They are used to reflect the overall rate of bone turnover, and have an important significance in the diagnosis of osteoporosis and classification, prediction of bone loss, assessment of complete fracture risk and monitoring drug efficacy, etc. At present, the bone turnover markers such as BALP, TRACP, PINP, β-CTX etc. have been applied in the clinic extensively. But each bone turnover marker has its particularity and variability. A comprehensive analysis is needed for a better judge of the evolution and treatment of osteoporosis. This article mainly explored the clinical application and perspective of commonly used bone turnover markers.

To investigate the formation characteristics of deep venous thrombosis (DVT) in aged patients with femoral neck fracture who underwent total hip arthroplasty (THA) and treated with standard prophylatic anticoagulant therapy.

A retrospective study was performed in 363 aged patients 66±5 years cases underwent unilateral THA from January 2015 to June 2017. There were 114 male patients (31.4%) and 249 female patients (68.6%). Patients were divided into femoral neck fracture (n=187) and non-fracture (n=176) groups. Two groups were strictly complied "China's major orthopedic surgery venous thromboembolism prevention guidelines" for thromboprophylaxis. Retrospectively analyzed and compared patients with DVT occurred during the perioperative period.

There were 8 patients (2 patients occurred pulmonary embolism) with DVT in fracture group and 6 patients (1 patient occurred pulmonary embolism) with DVT in non-fracture group. Differences had no statistical significance (χ²=0.185, P>0.05). In fracture group, 5 patients occurred DVT before surgery and 3 after surgery. Meanwhile all 6 patients occurred DVT after surgery in the non-fracture group, differences of DVT distribution between two groups was statistically significant (P<0.05).

DVT was easy formed before and after surgery in elderly femoral neck fracture patients with THA. For these specific groups, prevention of DVT before operation is the priority.

To analyze risk factors of the perioperative heart failure following hip fracture surgery in the aged patients and put forward prevention countermeasures so as to reduce the mortality rate for clinical work.

The present study included 225 elderly patients who had received hip fracture surgeries from October 2010 to January 2017 in our hospital. Patients were divided into heart failure group (64 cases) and non-heart failure group (161 cases). Single factor analysis was performed in three aspects as preoperative basic situation, preoperative examination and surgical management, the dominant risk factors then rolled into logistic regression analysis to conclude the dependent risk factors of perioperative heart failure.

Age, systolic blood pressure, delay from admission to operation, ASA classification, numbers of systemic diseases (expect cardiovascular disease), cardiovascular disease, low hemoglobin volume, operative management, blood transfusion ≥400 ml, intraoperative fluid volume, daily liquid volume difference and infusion of human serum albumin were risk factors for perioperative heart failure in elderly hip fractures (χ²=19.861, χ²=7.075, χ²=8.732, χ²=25.504, χ²=29.226, χ²=45.825, χ²=14.362, χ²=6.662, χ²=8.190, χ²=7.216, χ²=30.086, χ²=10.122, χ²=12.079, P<0.05). The logistic regression analysis showed that combined with more than 4 underlying diseases, cardiovascular disease, anemia, electrolyte imbalance, perioperative fluid intake, ASA classification were independent risk factors for perioperative heart failure (OR: 5.769, 95% CI: 1.212-36.243; OR: 9.576, 95% CI: 2.118-45.387; OR: 3.686, 95% CI: 1.313-10.349; OR: 6.584, 95% CI: 1.217-26.744; OR: 14.114, 95% CI: 5.021-42.342; OR: 6.012, 95% CI: 3.245-11.329).

Perioperative heart failure in hip fracture is the result of combination of multiple factors, perioperative risk assessment, early treatment for complications, surgical trauma reduction and postoperative fluid rehydration are the key to reduce perioperative heart failure.

To explore whether the homeopathic traction reduction technique can provide better traction reduction for femoral shaft fractures with femoral intramedullary nailing, and improve the efficiency of surgery and reduce the surgical trauma.

Sixty cases of femoral shaft fractures treated by closed or limited open reduction and intramedullary nailing were prospectively collected from January 2016 to September 2017 in Shanghai Tenth People's Hospital. They were divided into homeopathic traction group and traction table group randomly using computer random number method, 30 cases in each. The homeopathic traction group used the homeopathic double reverse traction device, while traction table group used a standard orthopaedic traction table. Obvervational index including the preoperative and postoperative X-ray, VAS score, SF-36 score, operation time, Intraoperative blood loss, perioperative blood loss and incision length, femoral deformity degree.

All 60 cases received well follow-up and the rate was 100%. Homeopathic traction group all achieved closed or limited open reduction, 26 cases in traction table group receives closed or limited open reduction, 4 cases changed to open reduction, the incidence of difficult to reset in homeopathic traction group was lower than the traction table group, there was statistical significance (χ²=4.286, P=0.038). The operation time of the homeopathic traction group [(121±22)min] was shorter than that of the traction table group [(147±31)min, t=3.746, P<0.001]. The blood loss and perioperative blood loss in the homeopathic traction group [(320±50)ml, (423±115)ml] were less than the traction table group [(410±55)ml, (474±100)ml, t=6.632, t=1.833, P<0.001, P=0.073).

Double reverse traction technique can provide traction direction parallel to lower limb alignment. More convenient and accurate to adjustment such as Varus-valgus angle and rotating angle. It also could provide enough traction strength, which could significantly improve the efficiency and accuracy of reduction. Double reverse traction technique can reduce the intraoperative blood loss, shorten the operation time, it is an excellent technology worth promotion.

To compare the early clinical outcomes of vesselplasty and kyphoplasty in the treatment of osteoporotic vertebral compression fractures.

A retrospective analysis was performed in 114 patients with OVCFs underwent vesselplasty (59 cases, 68 vertebras) and kyphoplasty (55 cases, 66 vertebras) in Hangzhou Normal University affiliated Hospital between June 2015 to December 2016. Preoperative vertebral compression, vertebral height restoration, cement leakage, the shape of cement, the volume ratio of cement were compared between two groups. The Clinical effect were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI).

All 57 cases received an average of (3.7±0.9) months follow-up (3-6 months). Compared with preoperative data, VAS and ODI score were improved significantly at 1 day after operation in both groups (PKP: Z=-10.143, F=1768.418, P<0.05; vesselplasty: Z=-10.027, F=2192.838, P<0.05). And at the last follow-up, the VAS and ODI score were improved significantly compared to the postoperative 1 day after operation in both groups (PKP: Z=-5.708, F=204.339, P<0.05; vesselplasty: Z=-5.691, F=147.729, P<0.05). PKP group associated with a higher rate of cement leakage than the vesselplasty group (27.9% vs. 13.6%, χ²=4.146, P<0.05) and a lower rate of cement volume ratio [(22±5)% vs. (24±4)%, t=-2.659, P<0.05]. In the aspect of cement shape, the dominant one in PKP group were mixed type (60.3%) and trabecular type (39.7%), while the vesselplasty group were mixed type (78.8%) and mass type (15.1%), the difference had statistically significant (χ²=34.271, P<0.05). Four patients (1 case in PKP group and 3 cases in vesselplasty group) had vertebra fractures during the follow-up period, the inter-group comparison has no significant differences.

Vesselplasty can rapidly relieve pain, improve mobility, restore the height of vertebral in patients with OVCFs. It is suitable for complex vertebral fractures as reducing the incidence of cement leakage contrasting to PKP.

Knee osteoarthritis (KOA) was one of the most commonest orthopedic diseases, its clinical symptoms gradually progressed and accounting to 30%-50% developed knee varus deformity and impairsed knee joint function, thus need valgus high tibial osteotomy and total knee replacement. Professor Zhang yingze brought up with proximal fibula osteotomy, which was identified as an effective method for KOA, to further analysis this treatment, we propose five aspects including anatomiology, biomechanics, iconography, surgery treatments and theoretical basis to discuss this new treatment.