Objective:To study the effects of absorbable materials in non-weight-bearing bone fractures of extremities.Methods:After 66 patients with nonweight-bearing bone fractures of extremities were selected,absorbable materi...Objective:To study the effects of absorbable materials in non-weight-bearing bone fractures of extremities.Methods:After 66 patients with nonweight-bearing bone fractures of extremities were selected,absorbable materials were used in the observation group and metal materials were used in the control group.Results:After treatment,the bone healing in the observation group was significantly improved(P<0.05).Conclusion:the application of absorbable materials in non-weight-bearing bone fractures of extremities is effective.展开更多
Background Intramedullary nails had been widely used in the treatment of long-bone fractures because of less interference of fractures and center bearing biomechanical advantage. However, it had been also found many s...Background Intramedullary nails had been widely used in the treatment of long-bone fractures because of less interference of fractures and center bearing biomechanical advantage. However, it had been also found many shortcomings such as broken nails, delayed healing and was modified in order to achieve better efficacy and reduce complications. The aim of the present study is to compare the efficacy of rotary self-locking intramedullary nails (RSIN) with that of interlocking intramedullary nails (IIN) in the treatment of long-bone fractures.展开更多
Bone is a unique tissue that is capable of repairing itself after damage.However,there are certain instances of fractures and defects that require clinical intervention for proper alignment and healing.As with any imp...Bone is a unique tissue that is capable of repairing itself after damage.However,there are certain instances of fractures and defects that require clinical intervention for proper alignment and healing.As with any implant,careful consideration of the material used to create the implants to treat these problems is needed.If the incorrect material is chosen,the implants themselves can lead to bone fractures or defects,or bone healing may not take place at all.All three classes of biomaterials-metals,ceramics,and polymers-have been used in the treatment of both bone fractures and bone defects,and each has its own unique benefits and limitations for its applications.Furthermore,composites of these different materials have also been created to try to take advantage of all the different benefits offered by each different material.This review highlights different materials that have been used for the development of internal fixators and bone graft substitutes to treat fracture and bone defects as well as their limitations and needed future research.展开更多
The clinical application of magnesium(Mg)and its alloys for bone fractures has been well supported by in vitro and in vivo trials.However,there were studies indicating negative effects of high dose Mg intake and susta...The clinical application of magnesium(Mg)and its alloys for bone fractures has been well supported by in vitro and in vivo trials.However,there were studies indicating negative effects of high dose Mg intake and sustained local release of Mg ions on bone metabolism or repair,which should not be ignored when developing Mg-based implants.Thus,it remains necessary to assess the biological effects of Mg implants in animal models relevant to clinical treatment modalities.The primary purpose of this study was to validate the beneficial effects of intramedullary Mg implants on the healing outcome of femoral fractures in a modified rat model.In addition,the mineralization parameters at multiple anatomical sites were evaluated,to investigate their association with healing outcome and potential clinical applications.Compared to the control group without Mg implantation,postoperative imaging at week 12 demonstrated better healing outcomes in the Mg group,with more stable unions in 3D analysis and high-mineralized bridging in 2D evaluation.The bone tissue mineral density(TMD)was higher in the Mg group at the non-operated femur and lumbar vertebra,while no differences between groups were identified regarding the bone tissue volume(TV),TMD and bone mineral content(BMC)in humerus.In the surgical femur,the Mg group presented higher TMD,but lower TV and BMC in the distal metaphyseal region,as well as reduced BMC at the osteotomy site.Principal component analysis(PCA)-based machine learning revealed that by selecting clinically relevant parameters,radiological markers could be constructed for differentiation of healing outcomes,with better performance than 2D scoring.The study provides insights and preclinical evidence for the rational investigation of bioactive materials,the identification of potential adverse effects,and the promotion of diagnostic capabilities for fracture healing.展开更多
Objective: To better characterize nonunion endochondral bone healing and evaluate novel therapeutic approaches for critical size defect healing in clinically challenging bone repair, a segmental defect model of bone i...Objective: To better characterize nonunion endochondral bone healing and evaluate novel therapeutic approaches for critical size defect healing in clinically challenging bone repair, a segmental defect model of bone injury was adapted from the threepoint bending closed fracture technique in the murine femur.Methods: The mouse femur was surgically stabilized with an intramedullary threaded rod with plastic spacers and the defect adjusted to different sizes. Healing of the different defects was analyzed by radiology and histology to 8 weeks postsurgery. To determine whether this model was effective for evaluating the benefits of molecular therapy, BMP-2 was applied to the defect and healing then examined.Results: Intramedullary spacers were effective in maintaining the defect. Callus bone formation was initiated but was arrested at defect sizes of 2.5 mm and above, with no more progress in callus bone development evident to 8 weeks healing. Cartilage development in a critical size defect attenuated very early in healing without bone development, in contrast to the closed femur fracture healing, where callus cartilage was replaced by bone. BMP-2 therapy promoted osteogenesis of the resident cells of the defect, but there was no further callus development to indicate that healing to pre-surgery bone structure was successful.Conclusions: This segmental defect adaptation of the closed femur fracture model of murine bone repair severely impairs callus development and bone healing, reflecting a challenging bone injury. It is adjustable and can be compared to the closed fracture model to ascertain healing deficiencies and the efficacy of therapeutic approaches.展开更多
Lower limb injures are frequently observed in passenger car traffic accidents.Previous studies of the injuries focus on long bone fractures by using either cadaver component tests or simulations of the long bone kinem...Lower limb injures are frequently observed in passenger car traffic accidents.Previous studies of the injuries focus on long bone fractures by using either cadaver component tests or simulations of the long bone kinematics,which lack in-depth study on the fractures in stress analysis.This paper aims to investigate lower limb impact biomechanics in real-world car to pedestrian accidents and to predict fractures of long bones in term of stress parameter for femur,tibia,and fibula.For the above purposes,a 3D finite element(FE) model of human body lower limb(HBM-LL) is developed based on human anatomy.The model consists of the pelvis,femur,tibia,fibula,patella,foot bones,primary tendons,knee joint capsule,meniscus,and ligaments.The FE model is validated by comparing the results from a lateral impact between simulations and tests with cadaver lower limb specimens.Two real-world accidents are selected from an in-depth accident database with detailed information about the accident scene,car impact speed,damage to the car,and pedestrian injuries.Multi-body system(MBS) models are used to reconstruct the kinematics of the pedestrians in the two accidents and the impact conditions are calculated for initial impact velocity and orientations of the car and pedestrian during the collision.The FE model is used to perform injury reconstructions and predict the fractures by using physical parameters,such as von Mises stress of long bones.The calculated failure level of the long bones is correlated with the injury outcomes observed from the two accident cases.The reconstruction result shows that the HBM-LL FE model has acceptable biofidelity and can be applied to predict the risk of long bone fractures.This study provides an efficient methodology to investigate the long bone fracture suffered from vehicle traffic collisions.展开更多
Bones are organs of the skeletal system, providing shape, mechanical support, and protection to the body and facilitating the movement. In addition, bones contribute to the mineral homeostasis of the body and have rec...Bones are organs of the skeletal system, providing shape, mechanical support, and protection to the body and facilitating the movement. In addition, bones contribute to the mineral homeostasis of the body and have recently been found to participate in endocrine regulation of energy metabolism. The well-known limitations associated with clinical use of autografts and allografts continue to drive efforts to develop bone graft substitutes, using the principles of biomaterials and tissue engineering. Under some stressful and continuous compressive conditions, the ability of the bone tissue to tolerate strength decreases. Whenever these forces overcome the toleration of the bone tissue, bone fracture occurs. years展开更多
BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pa...BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pain control after operation for femoral bone fracture and decreases the complications induced by systemic analgesic drugs. The severity of postoperative pain is affected by genetics, cultural and social factors across the world. In this study we assessed the efficacy of fascia iliaca compartment nerve block when it is used as part of multimodal analgesia after surgery for femoral bone fracture.METHODS: An institution-based case control study was conducted from September, 2013 to May, 2014. All patients who had been operated on under spinal anesthesia for femoral bone fracture were included. The patients divided into a FICNB group(n=20) and a control group(n=20). The FICNB group was given 30 mL of 0.25% bupivacaine at the end of the operation. Postoperative pain was assessed within the f irst 24 hours, i.e. at 15 minutes, 2 hours, 6 hours, 12 hours and 24 hours using 100 mm visual analogue scale(VAS), total analgesic consumption, and the time for the f irst analgesic request.RESULTS: VAS pain scores were reduced within the f irst 24 hours after operation in the FICNB group compared wtih the control group. VAS scores at 2 hours were taken as median values(IQR) 0.00(0.00) vs.18.00(30.00), P=0.001; at 6 hours 0.00(0.00) vs. 34.00(20.75), P=0.000; at 24 hours 12.50(10.00) vs. 31.50(20.75), P=0.004; and at 12 hours(17.80±12.45) vs.(29.95±12.40), P=0.004, respectively. The total analgesic consumption of diclofenac at 12 and 24 hours was reduced in the FICNB group, and the time for the fi rst analgesic request was signifi cantly prolonged(417.50 vs. 139.25 minutes, P=0.000).CONCLUSIONS: A single injection for FICNB could lead to postoperative pain relief, reduction of total analgesic consumption and prolonged time for the fi rst analgesic request in the FICNB group after surgery for femoral bone fracture. We recommend FICNB for analgesia after surgery for femoral bone fracture and for patients with femoral bone fracture at the emergency department.展开更多
Objective To investigate the clinical outcomes of facial never decompression via a combined subtemporal-su- pralabyrinthine approach to geniculate ganglion for management of facial paralysis in temporal bone fracture....Objective To investigate the clinical outcomes of facial never decompression via a combined subtemporal-su- pralabyrinthine approach to geniculate ganglion for management of facial paralysis in temporal bone fracture. Methods Eighteen patients with unilateral facial paresis due to temporal bone fracture were treated between March 2003 and March 2011. Facial function was House-Braekmann(HB) grade m in 6 patients, HB grade V in 9 patients and HB grade VI in 3 patients. The preoperative mean air conduction threshold was 52 dB HL for the 15 cases with longitudinal temporal bone fracture and showed severe sensorineural heating loss in the 3 cases with transverse temporal bone fracture. Fracture lines were detected in 15 cases on temporal bone axial CT scans and ossicular disruption was determined in 11 cases by virtual CT endoscopy. The geniculate ganglion or the tympanic mastoid segment of the facial nerve showed an irregular morphology on curved planar reformation images of the facial nerve canal. After an intact canal wall mastoi- do-epitympanectomy, the ossicular chain recess was opened by drilling through the was disrupted, the incus was removed to damage was evaluated. If the ossicular chain was intact, the supralabyrinthine cells between the tegmen tympani and ossicular chain. If the ossicular chain access the supralabyrinthine recess. The geniculate ganglion and the distal labyrinthine segment of the facial nerve were exposed. After completing facial nerve decompression, the dislocated incus was replaced, or a fractured incus was reshaped to bridge the space between the malleus and the stapes. Results Pronounced ganglion geniculatum swelling was found in 15 cases of longitudinal temporal bone fracture, with greater petrosus nerves damage in 3 cases and bleeding in 5 cases. Disrupted ossicular chains were seen in 11 cases, including dislocated incus resulting in crushing of the horizontal portion of the facial nerve in 3 cases and fracture of the incus long process in 1 case. In 3 cases of transverse fractures, dehiscence on the promontory, semicircular canal or oval window was found. All cases had primary healing with no complication. At follow-ups ranging from 0.5 to 3 years (average 1.2 years), facial nerve function recovered to HB grade I in 11 cases, 11 in 5 cases and m in 2 cases. Overall hearing recovery was 33 dB. Conclusion The clinical outcomes concerning facial nerve function and hearing recovery are satisfactory via a combined subtemporal-supralabyrinthine approach to the geniculate ganglion for facial nerve decompression in temporal bone fracture patients with facial paralysis.展开更多
Objective To explore the value of computed tomography virtual endoscopy(VE) in assessing ossicular chain disruption in temporal bone fracture and ear trauma with intact tympanum. Methods High resolution spiral compute...Objective To explore the value of computed tomography virtual endoscopy(VE) in assessing ossicular chain disruption in temporal bone fracture and ear trauma with intact tympanum. Methods High resolution spiral computerized tomography(CT) was completed in 35 cases of temporal bone fracture and 5 cases of tympanum trauma, all with intact or healed tympanum. Three-dimensional reconstruction was completed using a virtual endoscopy software. Audiological tests were conducted in all patients and evaluation of facial nerve injury in patients with facial paralysis. Patients with mild conductive deafness, ossicular chain subluxation on VE, and no facial paralysis were treated conservatively for 4-12 weeks with repeated hearing evaluation; those with facial paralysis underwent surgery if no recovery after 4- 8 weeks of conservative treatment. Patients with moderate to severe conductive hearing loss or mixed hearing loss, incus long process fracture or dislocation on VE and facial paralysis, underwent ossicular chain reconstruction and facial nerve decompression after conservative treatment for 4-8 weeks, or exploratory tympanotomy only if no facial paralysis. VE, audiological tests and facial nerve function tests were repeated in 3-6 months after surgery. Results Of the 6 cases with mild conductive hearing loss, ossicular chain subluxation and no facial paralysis, 3recovered to normal hearing spontaneously and 3 showed no significant improvement, after 4-12 weeks of conservative treatment. After conservative treatment for 4-8 weeks, 3 of the 12 cases with mild conductive deafness, ossicular chain dislocation on VE and facial paralysis recovered to normal hearing and HouseBrackmann(HB) grade I facial function from HB grade II,4 showed facial function recovery to HB grade I(n=2) or II(n=2) from HB grade III but no hearing recovery, and 5 gained no recovery and went on to receive exploratory tympanotomy and facial nerve decompression. The 11 cases with moderate to severe conductive deafness, incus long process fracture or dislocation on VE and facial paralysis all received ossicular chain reconstruction and facial nerve decompression after 4-8 weeks of conservative treatment. The 7 cases with moderate to severe conductive deafness, dislocated or fallen incus on VE but no facial paralysis received ossicular chain reconstruction after conservative treatment. The 4 cases with mixed hearing loss, dislocated or fallen incus on VE and no facial paralysis received ossicular chain repair via the intact canal wall epitympanum approach after conservative treatment. Pharmacological therapies continued postoperatively in these patients to treat sensorineural deafness. Although temporal bone CT scans displayed the fracture line and malleus/incus abnormalities, VE provided additional detailed information on dislocation of incudomalleal and incudostapedial joints, incus dislocation or fracture, separation between crus longum incudis and stapes, and incus shifting. These were all confirmed during surgery. VE results and surgery findings were 100% consistent in patients with ossicular chain disruption. Conclusion VE can provide reliable visual evidence for accurate assessment of traumatic ossicular chain disruption, timing of surgery and individualizing surgical strategies and postoperative follow-up.展开更多
BACKGROUND Flexible intramedullary nailing(FIMN)is relatively contraindicated for pediatric length unstable femoral fractures.AIM To evaluate FIMN treatment outcomes for pediatric diaphyseal length unstable femoral fr...BACKGROUND Flexible intramedullary nailing(FIMN)is relatively contraindicated for pediatric length unstable femoral fractures.AIM To evaluate FIMN treatment outcomes for pediatric diaphyseal length unstable femoral fractures in patients aged 5 to 13 years.METHODS This retrospective study includes pediatric patients(age range 5-13 years)who received operative treatment for a diaphyseal femoral fracture at a single institution between 2013 and 2019.Length unstable femur fractures treated with FIMN were compared to treatment with other fixation methods[locked intramedullary nailing(IMN),submuscular plating(SMP),and external fixation]and to length stable fractures treated with FIMN.Exclusion criteria included patients who had an underlying predisposition for fractures(e.g.,pathologic fractures or osteogenesis imperfecta),polytrauma necessitating intensive care unit care and/or extensive management of other injuries,incomplete records,or no follow-up visits.Patients who had a length stable femoral fracture treated with modalities other than FIMN were excluded as well.RESULTS Ninety-five fractures from ninety-two patients were included in the study and consists of three groups.These three groups are length unstable fractures treated with FIMN(n=21),length stable fractures treated with FIMN(n=45),and length unstable fractures treated with either locked IMN,SMP,or external fixator(n=29).P values<0.05 were considered statistically significant.Patient characteristic differences that were statistically significant between the groups,length unstable with FIMN and length unstable with locked IMN,SMP,or external fixator,were average age(7.4 years vs 9.3 years,respectively),estimated blood loss(29.2 mL vs 98 mL,respectively)and body mass(27.8 kg vs 35.1 kg,respectively).All other patient characteristic differences were statistically insignificant.Regarding complications,length unstable with FIMN had 9 total complications while length unstable with locked IMN,SMP,or external fixator had 10.Grouping these complications into minor or major,length unstable with locked IMN,SMP,or external fixator had 6 major complication while length unstable with FIMN had 0 major complications.This difference in major complications was statistically significant.Lastly,when comparing patient characteristics between the groups,length unstable with FIMN and length stable with FIMN,all characteristics were statistically similar except time to weight bearing(39 d vs 29 d respectively).When analyzing complication differences between these two groups(9 total complications,0 major vs 20 total complications,4 major),the complication rates were considered statistically similar.CONCLUSION FIMN is effective for length unstable fractures,having a low rate of complications.FIMN is a suitable option for length stable and length unstable femur fractures alike.展开更多
Background: Bone fracture frequencies and survival rates are essential parameters in skeleton evolution, but information on the functional consequences of naturally healed fractures is scarce. No leg bone fracture hea...Background: Bone fracture frequencies and survival rates are essential parameters in skeleton evolution, but information on the functional consequences of naturally healed fractures is scarce. No leg bone fracture healing in the wild has been reported so far from long-legged Charadriiformes(waders), which depend on bipedal locomotion for feeding.Methods: We documented a healed but malaligned tarsometatarsus fracture in a wild Willet(Tringa [Catoptrophorus]semipalmata), and a malaligned tibiotarsus fracture in a Curlew(Numenius arquata) skeleton from a museum collection. Functional consequences of the malalignments were evaluated by kinematic analyses of videos(Willet) and in silico 3D modeling(Curlew).Results: The Willet's left tarsometatarsus exhibited an angular malalignment of 70°, resulting in a limping gait that was less pronounced at high than at low walking speed. The bird seemed unable to club the toes of the left foot together, apparently a secondary effect of the deformity. The Curlew's tibiotarsus showed an angular and an axial malalignment, causing the foot to rotate outwards when the intertarsal joint was flexed. Despite the severe effects of their injuries, the birds had survived at least long enough for the fractures to heal completely.Conclusions: Somewhat unexpectedly, leg fractures are not necessarily fatal in long-legged waders, even if deformities occur in the healing process. Bipedal locomotion on vegetated grounds must have been impeded due to the bone malalignments in both analyzed cases. The birds probably alleviated the impact of their handicaps by shifting a larger proportion of their activities to vegetation-free habitats.展开更多
To assess the effect of using buttress plate associated with antografting of fibula and iliac bone for the treatment of distal femoral C3 type fracture.Methods Seventeen cases of distal femoral C3 type fracture usin...To assess the effect of using buttress plate associated with antografting of fibula and iliac bone for the treatment of distal femoral C3 type fracture.Methods Seventeen cases of distal femoral C3 type fracture using buttress plate associated with antografting of fibula and iliac bone were analyzed retrospectively.Results All cases were followed up for an average of 24 months(8~55 months).The average time of octets bridge forming were 4 months(3~5 months) while the average time for bone union were 8 months (6~14 months).According to Shelbourne rating system,result of all 18 cases were excellent and no malunion,infection were found.Conclusion Buttress plate associated with antografting of fibula and iliac bone is an effective alternative for the treatment of distal femoral C3 type fracture.It can provide more stable fixation to the bone and earlier functional exercises can be achieved.5 refs,3 figs,1 tab.展开更多
Fractures of the lateral process of the talus(FLPT)are uncommon fractures that represent a clinical challenge.Traditional radiological classification systems rely predominantly on radiographic findings.However,due to ...Fractures of the lateral process of the talus(FLPT)are uncommon fractures that represent a clinical challenge.Traditional radiological classification systems rely predominantly on radiographic findings.However,due to the high rate of FLPT misdiagnosis and the limited accuracy in evaluating concomitant talar injuries through plain radiographs,novel imaging classification systems have been developed that aim to enhance the diagnosis of concomitant talar injuries,thereby optimizing patient management and reducing the incidence of long-term complications.展开更多
Objective:To evaluate the effect of encircled fixer of shape memory alloy on bone fracture. Methods:A total of twenty patients with eighteen males and two females was studied. There were three patients with fractares ...Objective:To evaluate the effect of encircled fixer of shape memory alloy on bone fracture. Methods:A total of twenty patients with eighteen males and two females was studied. There were three patients with fractares in the upper one third of thighbone, five with fractures in the middle part of thighbone, six with humeral fractures, three with collarbone fractures,one with ulna fracture and two with thighbone fractures as complication of artificial hipbone arthroplasty. After exposure and fixation of fracture ends, prepared encircled fixer was inserted into 0~4℃ normal reline(NS) to lower its temperature, then pulled out with a clamp. Encircled fixer was put on the tersile side of the fractured bone(center pointed to fracture line), restored and stabilized after raising temperature in 40℃ NS. Results: Encircled fixers of shape memory alloy were used to treat twenty patients with bone fracture.Clinical concrescence was obtained in 1.5 to 3 months after operation,and the joint gained its normal function without complication. Conclusion:Encircled fixer of shape memory alloy has features as exerting vertical pressure continoulsy, little stress shield effect and convenient manipulation, especially adapt to stem fracture after artificial arthroplasty.展开更多
Starling with the L- and D,L-lactide copolymer (L:DL = 9:1) [P(L-DL)LA] of M-W = 32.1 x 10(4), rods were obtained through a two stage process: (1) melt-extrusion at 155 degreesC, and (2) hot-drawing at 90 degreesC to ...Starling with the L- and D,L-lactide copolymer (L:DL = 9:1) [P(L-DL)LA] of M-W = 32.1 x 10(4), rods were obtained through a two stage process: (1) melt-extrusion at 155 degreesC, and (2) hot-drawing at 90 degreesC to various drawing ratios. The molecular weight of P(L-DL)LA fell to 9.3 x 10(4) as a consequence of the production process. The crystallization and molecular orientation of P(L-DL)LA developed as a result of the hot-drawing. The mechanical strengths of the rods increase with the drawing ratio; The maximum for tensile strength, bending strength, bending modulus, and shear strength are 329 MPa, 237 MPa, 8.8 GPa, and 157 MPa, respectively.展开更多
This study explored the feasibility of employing computer-aided design(CAD)and 3 dimensional(3D)-printed personalized guide plate for the mini-invasive percutaneous internal screw fixation of fractured scaphoid.The st...This study explored the feasibility of employing computer-aided design(CAD)and 3 dimensional(3D)-printed personalized guide plate for the mini-invasive percutaneous internal screw fixation of fractured scaphoid.The study consisted of two parts:(1)experimentation on upper limbs from corpses and(2)preliminary clinical application.Corpse experiments involved upper limbs of 6 adult corpses.The specimens of upper limbs were subjected to plain CT scan.Then the CT data were input into computer to conduct 3D reconstruction of wrist region.The direction and depth of the guide wire and screw were designed on the basis of the principle that screw should lie at the center of scaphoid and the long axis of the screw should be aligned with that of the scaphoid.The carpal bone model and the guide plate were designed and 3D-printed.By using the guide plates,the guide wire was placed and the cannulated compression screw was inserted.The wrist region was examined by X-ray and CT to observe the location of the screw in the scaphoid.The scaphoid was longitudinally excised to grossly observe the location and evaluate the result of screw insertion.For clinical application,the guide plate was employed in 4 patients with fresh scaphoid fracture using the aforementioned operative technique.Our results showed that,in the 6 corpse limbs,the guide plate well fitted the skin surface and the guide wire and screw were accurately put in place in one session.X-ray examination and gross observation confirmed that the screw was satisfactorily positioned and the result met the requirements of the preoperative design.For 4 patients,the guide wire and screw were all precisely inserted into place in one session.The operation time and X-ray exposure times were apparently reduced.The imaging examination exhibited satisfactory results and the hand functioned well.It was concluded that the operative guide plate used for the miniinvasive percutaneous internal screw fixation of fractured scaphoid not only can assist in accurate placement of screw but also shorten operation time and reduce insertion and X-ray exposure times,thereby reducing the radiation injury and damage to the substance and the blood circulation of carpal bone.Its use can also improve the learning curve of surgeons.展开更多
Therapy based on androgenic deprivation is one of the standard treatments that many prostate cancer patients receive. Moreover, its use is increasing owing to a clear expansion of the indications for this therapy in p...Therapy based on androgenic deprivation is one of the standard treatments that many prostate cancer patients receive. Moreover, its use is increasing owing to a clear expansion of the indications for this therapy in patients with localized prostate cancer. Despite classically being considered to be well tolerated, androgenic deprivation has adverse effects. Of these, the loss of mineral bone mass is particularly notable and can lead to osteoporosis, as well as an increased risk of bone fracture. Some fractures, such as hip fractures, may have serious consequences. Useful procedures such as bone densitometry can aid in the diagnosis of these conditions. Once diagnosed, decreases in mineral bone mass can be managed by dietary recommendations, general changes in lifestyle or medication. We review the most important randomized controlled trials evaluating different drugs (bisphosphonates, denosumab and toremifene) in the prevention of bone loss and in the reduction in fracture risk in prostate cancer patients treated with androgen-deprivation therapy. Following the applicable recommendations, urologists must carefully monitor the bone health of prostate cancer patients subjected to androgenic deprivation to obtain an early diagnosis and apply the appropriate general and/or therapeutic measures if necessary.展开更多
Objective To evaluate efficacy of surgical treatment in traumatic facial paralysis.Methods:Thirty-three cases were reviewed,including temporal bone fracture and iatrogenic facial nerve injury.All the patients were tre...Objective To evaluate efficacy of surgical treatment in traumatic facial paralysis.Methods:Thirty-three cases were reviewed,including temporal bone fracture and iatrogenic facial nerve injury.All the patients were treated with various surgical methods according to their pathogeny.Results The mean percentage facial function improvement (House-Brackmann GradeⅠ-Ⅱ) was 86% in temporal bone fracture and function was improved after proper operation to iatrogenic facial nerve injury.Conclusions Patients with traumatic facial paralysis receive proved outcomes itreaed with proper surgical methods according to their particular condition of nerve injury.展开更多
文摘Objective:To study the effects of absorbable materials in non-weight-bearing bone fractures of extremities.Methods:After 66 patients with nonweight-bearing bone fractures of extremities were selected,absorbable materials were used in the observation group and metal materials were used in the control group.Results:After treatment,the bone healing in the observation group was significantly improved(P<0.05).Conclusion:the application of absorbable materials in non-weight-bearing bone fractures of extremities is effective.
文摘Background Intramedullary nails had been widely used in the treatment of long-bone fractures because of less interference of fractures and center bearing biomechanical advantage. However, it had been also found many shortcomings such as broken nails, delayed healing and was modified in order to achieve better efficacy and reduce complications. The aim of the present study is to compare the efficacy of rotary self-locking intramedullary nails (RSIN) with that of interlocking intramedullary nails (IIN) in the treatment of long-bone fractures.
文摘Bone is a unique tissue that is capable of repairing itself after damage.However,there are certain instances of fractures and defects that require clinical intervention for proper alignment and healing.As with any implant,careful consideration of the material used to create the implants to treat these problems is needed.If the incorrect material is chosen,the implants themselves can lead to bone fractures or defects,or bone healing may not take place at all.All three classes of biomaterials-metals,ceramics,and polymers-have been used in the treatment of both bone fractures and bone defects,and each has its own unique benefits and limitations for its applications.Furthermore,composites of these different materials have also been created to try to take advantage of all the different benefits offered by each different material.This review highlights different materials that have been used for the development of internal fixators and bone graft substitutes to treat fracture and bone defects as well as their limitations and needed future research.
文摘The clinical application of magnesium(Mg)and its alloys for bone fractures has been well supported by in vitro and in vivo trials.However,there were studies indicating negative effects of high dose Mg intake and sustained local release of Mg ions on bone metabolism or repair,which should not be ignored when developing Mg-based implants.Thus,it remains necessary to assess the biological effects of Mg implants in animal models relevant to clinical treatment modalities.The primary purpose of this study was to validate the beneficial effects of intramedullary Mg implants on the healing outcome of femoral fractures in a modified rat model.In addition,the mineralization parameters at multiple anatomical sites were evaluated,to investigate their association with healing outcome and potential clinical applications.Compared to the control group without Mg implantation,postoperative imaging at week 12 demonstrated better healing outcomes in the Mg group,with more stable unions in 3D analysis and high-mineralized bridging in 2D evaluation.The bone tissue mineral density(TMD)was higher in the Mg group at the non-operated femur and lumbar vertebra,while no differences between groups were identified regarding the bone tissue volume(TV),TMD and bone mineral content(BMC)in humerus.In the surgical femur,the Mg group presented higher TMD,but lower TV and BMC in the distal metaphyseal region,as well as reduced BMC at the osteotomy site.Principal component analysis(PCA)-based machine learning revealed that by selecting clinically relevant parameters,radiological markers could be constructed for differentiation of healing outcomes,with better performance than 2D scoring.The study provides insights and preclinical evidence for the rational investigation of bioactive materials,the identification of potential adverse effects,and the promotion of diagnostic capabilities for fracture healing.
基金Loma Linda Veterans Association for Research and EducationGrant/Award Number Seed Grant(to CR)+2 种基金US Department of Veterans AffairsGrant/Award Number Merit Review Award#5 I01 BX002519-04(to CR)Senior Research Career Scientist Award(to SM)。
文摘Objective: To better characterize nonunion endochondral bone healing and evaluate novel therapeutic approaches for critical size defect healing in clinically challenging bone repair, a segmental defect model of bone injury was adapted from the threepoint bending closed fracture technique in the murine femur.Methods: The mouse femur was surgically stabilized with an intramedullary threaded rod with plastic spacers and the defect adjusted to different sizes. Healing of the different defects was analyzed by radiology and histology to 8 weeks postsurgery. To determine whether this model was effective for evaluating the benefits of molecular therapy, BMP-2 was applied to the defect and healing then examined.Results: Intramedullary spacers were effective in maintaining the defect. Callus bone formation was initiated but was arrested at defect sizes of 2.5 mm and above, with no more progress in callus bone development evident to 8 weeks healing. Cartilage development in a critical size defect attenuated very early in healing without bone development, in contrast to the closed femur fracture healing, where callus cartilage was replaced by bone. BMP-2 therapy promoted osteogenesis of the resident cells of the defect, but there was no further callus development to indicate that healing to pre-surgery bone structure was successful.Conclusions: This segmental defect adaptation of the closed femur fracture model of murine bone repair severely impairs callus development and bone healing, reflecting a challenging bone injury. It is adjustable and can be compared to the closed fracture model to ascertain healing deficiencies and the efficacy of therapeutic approaches.
基金supported by National Hi-tech Research and Development Program of China (863 Program,Grant No. 2006AA110101)"111 Program" of Ministry of Education and State Administration of Foreign Experts Affairs of China (Grant No. 111-2-11)+1 种基金General Motors Research and Development Center (Grant No. RD-209)Project of State Key Laboratory of Advanced Design and Manufacturing for Vehicle Body,Hunan University,China (Grant No. 60870004)
文摘Lower limb injures are frequently observed in passenger car traffic accidents.Previous studies of the injuries focus on long bone fractures by using either cadaver component tests or simulations of the long bone kinematics,which lack in-depth study on the fractures in stress analysis.This paper aims to investigate lower limb impact biomechanics in real-world car to pedestrian accidents and to predict fractures of long bones in term of stress parameter for femur,tibia,and fibula.For the above purposes,a 3D finite element(FE) model of human body lower limb(HBM-LL) is developed based on human anatomy.The model consists of the pelvis,femur,tibia,fibula,patella,foot bones,primary tendons,knee joint capsule,meniscus,and ligaments.The FE model is validated by comparing the results from a lateral impact between simulations and tests with cadaver lower limb specimens.Two real-world accidents are selected from an in-depth accident database with detailed information about the accident scene,car impact speed,damage to the car,and pedestrian injuries.Multi-body system(MBS) models are used to reconstruct the kinematics of the pedestrians in the two accidents and the impact conditions are calculated for initial impact velocity and orientations of the car and pedestrian during the collision.The FE model is used to perform injury reconstructions and predict the fractures by using physical parameters,such as von Mises stress of long bones.The calculated failure level of the long bones is correlated with the injury outcomes observed from the two accident cases.The reconstruction result shows that the HBM-LL FE model has acceptable biofidelity and can be applied to predict the risk of long bone fractures.This study provides an efficient methodology to investigate the long bone fracture suffered from vehicle traffic collisions.
文摘Bones are organs of the skeletal system, providing shape, mechanical support, and protection to the body and facilitating the movement. In addition, bones contribute to the mineral homeostasis of the body and have recently been found to participate in endocrine regulation of energy metabolism. The well-known limitations associated with clinical use of autografts and allografts continue to drive efforts to develop bone graft substitutes, using the principles of biomaterials and tissue engineering. Under some stressful and continuous compressive conditions, the ability of the bone tissue to tolerate strength decreases. Whenever these forces overcome the toleration of the bone tissue, bone fracture occurs. years
文摘BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pain control after operation for femoral bone fracture and decreases the complications induced by systemic analgesic drugs. The severity of postoperative pain is affected by genetics, cultural and social factors across the world. In this study we assessed the efficacy of fascia iliaca compartment nerve block when it is used as part of multimodal analgesia after surgery for femoral bone fracture.METHODS: An institution-based case control study was conducted from September, 2013 to May, 2014. All patients who had been operated on under spinal anesthesia for femoral bone fracture were included. The patients divided into a FICNB group(n=20) and a control group(n=20). The FICNB group was given 30 mL of 0.25% bupivacaine at the end of the operation. Postoperative pain was assessed within the f irst 24 hours, i.e. at 15 minutes, 2 hours, 6 hours, 12 hours and 24 hours using 100 mm visual analogue scale(VAS), total analgesic consumption, and the time for the f irst analgesic request.RESULTS: VAS pain scores were reduced within the f irst 24 hours after operation in the FICNB group compared wtih the control group. VAS scores at 2 hours were taken as median values(IQR) 0.00(0.00) vs.18.00(30.00), P=0.001; at 6 hours 0.00(0.00) vs. 34.00(20.75), P=0.000; at 24 hours 12.50(10.00) vs. 31.50(20.75), P=0.004; and at 12 hours(17.80±12.45) vs.(29.95±12.40), P=0.004, respectively. The total analgesic consumption of diclofenac at 12 and 24 hours was reduced in the FICNB group, and the time for the fi rst analgesic request was signifi cantly prolonged(417.50 vs. 139.25 minutes, P=0.000).CONCLUSIONS: A single injection for FICNB could lead to postoperative pain relief, reduction of total analgesic consumption and prolonged time for the fi rst analgesic request in the FICNB group after surgery for femoral bone fracture. We recommend FICNB for analgesia after surgery for femoral bone fracture and for patients with femoral bone fracture at the emergency department.
文摘Objective To investigate the clinical outcomes of facial never decompression via a combined subtemporal-su- pralabyrinthine approach to geniculate ganglion for management of facial paralysis in temporal bone fracture. Methods Eighteen patients with unilateral facial paresis due to temporal bone fracture were treated between March 2003 and March 2011. Facial function was House-Braekmann(HB) grade m in 6 patients, HB grade V in 9 patients and HB grade VI in 3 patients. The preoperative mean air conduction threshold was 52 dB HL for the 15 cases with longitudinal temporal bone fracture and showed severe sensorineural heating loss in the 3 cases with transverse temporal bone fracture. Fracture lines were detected in 15 cases on temporal bone axial CT scans and ossicular disruption was determined in 11 cases by virtual CT endoscopy. The geniculate ganglion or the tympanic mastoid segment of the facial nerve showed an irregular morphology on curved planar reformation images of the facial nerve canal. After an intact canal wall mastoi- do-epitympanectomy, the ossicular chain recess was opened by drilling through the was disrupted, the incus was removed to damage was evaluated. If the ossicular chain was intact, the supralabyrinthine cells between the tegmen tympani and ossicular chain. If the ossicular chain access the supralabyrinthine recess. The geniculate ganglion and the distal labyrinthine segment of the facial nerve were exposed. After completing facial nerve decompression, the dislocated incus was replaced, or a fractured incus was reshaped to bridge the space between the malleus and the stapes. Results Pronounced ganglion geniculatum swelling was found in 15 cases of longitudinal temporal bone fracture, with greater petrosus nerves damage in 3 cases and bleeding in 5 cases. Disrupted ossicular chains were seen in 11 cases, including dislocated incus resulting in crushing of the horizontal portion of the facial nerve in 3 cases and fracture of the incus long process in 1 case. In 3 cases of transverse fractures, dehiscence on the promontory, semicircular canal or oval window was found. All cases had primary healing with no complication. At follow-ups ranging from 0.5 to 3 years (average 1.2 years), facial nerve function recovered to HB grade I in 11 cases, 11 in 5 cases and m in 2 cases. Overall hearing recovery was 33 dB. Conclusion The clinical outcomes concerning facial nerve function and hearing recovery are satisfactory via a combined subtemporal-supralabyrinthine approach to the geniculate ganglion for facial nerve decompression in temporal bone fracture patients with facial paralysis.
基金This study was supported by Medical Research Fund Projects of Guangdong Province,Jinan University Scientific Research Opening Stock Project
文摘Objective To explore the value of computed tomography virtual endoscopy(VE) in assessing ossicular chain disruption in temporal bone fracture and ear trauma with intact tympanum. Methods High resolution spiral computerized tomography(CT) was completed in 35 cases of temporal bone fracture and 5 cases of tympanum trauma, all with intact or healed tympanum. Three-dimensional reconstruction was completed using a virtual endoscopy software. Audiological tests were conducted in all patients and evaluation of facial nerve injury in patients with facial paralysis. Patients with mild conductive deafness, ossicular chain subluxation on VE, and no facial paralysis were treated conservatively for 4-12 weeks with repeated hearing evaluation; those with facial paralysis underwent surgery if no recovery after 4- 8 weeks of conservative treatment. Patients with moderate to severe conductive hearing loss or mixed hearing loss, incus long process fracture or dislocation on VE and facial paralysis, underwent ossicular chain reconstruction and facial nerve decompression after conservative treatment for 4-8 weeks, or exploratory tympanotomy only if no facial paralysis. VE, audiological tests and facial nerve function tests were repeated in 3-6 months after surgery. Results Of the 6 cases with mild conductive hearing loss, ossicular chain subluxation and no facial paralysis, 3recovered to normal hearing spontaneously and 3 showed no significant improvement, after 4-12 weeks of conservative treatment. After conservative treatment for 4-8 weeks, 3 of the 12 cases with mild conductive deafness, ossicular chain dislocation on VE and facial paralysis recovered to normal hearing and HouseBrackmann(HB) grade I facial function from HB grade II,4 showed facial function recovery to HB grade I(n=2) or II(n=2) from HB grade III but no hearing recovery, and 5 gained no recovery and went on to receive exploratory tympanotomy and facial nerve decompression. The 11 cases with moderate to severe conductive deafness, incus long process fracture or dislocation on VE and facial paralysis all received ossicular chain reconstruction and facial nerve decompression after 4-8 weeks of conservative treatment. The 7 cases with moderate to severe conductive deafness, dislocated or fallen incus on VE but no facial paralysis received ossicular chain reconstruction after conservative treatment. The 4 cases with mixed hearing loss, dislocated or fallen incus on VE and no facial paralysis received ossicular chain repair via the intact canal wall epitympanum approach after conservative treatment. Pharmacological therapies continued postoperatively in these patients to treat sensorineural deafness. Although temporal bone CT scans displayed the fracture line and malleus/incus abnormalities, VE provided additional detailed information on dislocation of incudomalleal and incudostapedial joints, incus dislocation or fracture, separation between crus longum incudis and stapes, and incus shifting. These were all confirmed during surgery. VE results and surgery findings were 100% consistent in patients with ossicular chain disruption. Conclusion VE can provide reliable visual evidence for accurate assessment of traumatic ossicular chain disruption, timing of surgery and individualizing surgical strategies and postoperative follow-up.
文摘BACKGROUND Flexible intramedullary nailing(FIMN)is relatively contraindicated for pediatric length unstable femoral fractures.AIM To evaluate FIMN treatment outcomes for pediatric diaphyseal length unstable femoral fractures in patients aged 5 to 13 years.METHODS This retrospective study includes pediatric patients(age range 5-13 years)who received operative treatment for a diaphyseal femoral fracture at a single institution between 2013 and 2019.Length unstable femur fractures treated with FIMN were compared to treatment with other fixation methods[locked intramedullary nailing(IMN),submuscular plating(SMP),and external fixation]and to length stable fractures treated with FIMN.Exclusion criteria included patients who had an underlying predisposition for fractures(e.g.,pathologic fractures or osteogenesis imperfecta),polytrauma necessitating intensive care unit care and/or extensive management of other injuries,incomplete records,or no follow-up visits.Patients who had a length stable femoral fracture treated with modalities other than FIMN were excluded as well.RESULTS Ninety-five fractures from ninety-two patients were included in the study and consists of three groups.These three groups are length unstable fractures treated with FIMN(n=21),length stable fractures treated with FIMN(n=45),and length unstable fractures treated with either locked IMN,SMP,or external fixator(n=29).P values<0.05 were considered statistically significant.Patient characteristic differences that were statistically significant between the groups,length unstable with FIMN and length unstable with locked IMN,SMP,or external fixator,were average age(7.4 years vs 9.3 years,respectively),estimated blood loss(29.2 mL vs 98 mL,respectively)and body mass(27.8 kg vs 35.1 kg,respectively).All other patient characteristic differences were statistically insignificant.Regarding complications,length unstable with FIMN had 9 total complications while length unstable with locked IMN,SMP,or external fixator had 10.Grouping these complications into minor or major,length unstable with locked IMN,SMP,or external fixator had 6 major complication while length unstable with FIMN had 0 major complications.This difference in major complications was statistically significant.Lastly,when comparing patient characteristics between the groups,length unstable with FIMN and length stable with FIMN,all characteristics were statistically similar except time to weight bearing(39 d vs 29 d respectively).When analyzing complication differences between these two groups(9 total complications,0 major vs 20 total complications,4 major),the complication rates were considered statistically similar.CONCLUSION FIMN is effective for length unstable fractures,having a low rate of complications.FIMN is a suitable option for length stable and length unstable femur fractures alike.
文摘Background: Bone fracture frequencies and survival rates are essential parameters in skeleton evolution, but information on the functional consequences of naturally healed fractures is scarce. No leg bone fracture healing in the wild has been reported so far from long-legged Charadriiformes(waders), which depend on bipedal locomotion for feeding.Methods: We documented a healed but malaligned tarsometatarsus fracture in a wild Willet(Tringa [Catoptrophorus]semipalmata), and a malaligned tibiotarsus fracture in a Curlew(Numenius arquata) skeleton from a museum collection. Functional consequences of the malalignments were evaluated by kinematic analyses of videos(Willet) and in silico 3D modeling(Curlew).Results: The Willet's left tarsometatarsus exhibited an angular malalignment of 70°, resulting in a limping gait that was less pronounced at high than at low walking speed. The bird seemed unable to club the toes of the left foot together, apparently a secondary effect of the deformity. The Curlew's tibiotarsus showed an angular and an axial malalignment, causing the foot to rotate outwards when the intertarsal joint was flexed. Despite the severe effects of their injuries, the birds had survived at least long enough for the fractures to heal completely.Conclusions: Somewhat unexpectedly, leg fractures are not necessarily fatal in long-legged waders, even if deformities occur in the healing process. Bipedal locomotion on vegetated grounds must have been impeded due to the bone malalignments in both analyzed cases. The birds probably alleviated the impact of their handicaps by shifting a larger proportion of their activities to vegetation-free habitats.
文摘To assess the effect of using buttress plate associated with antografting of fibula and iliac bone for the treatment of distal femoral C3 type fracture.Methods Seventeen cases of distal femoral C3 type fracture using buttress plate associated with antografting of fibula and iliac bone were analyzed retrospectively.Results All cases were followed up for an average of 24 months(8~55 months).The average time of octets bridge forming were 4 months(3~5 months) while the average time for bone union were 8 months (6~14 months).According to Shelbourne rating system,result of all 18 cases were excellent and no malunion,infection were found.Conclusion Buttress plate associated with antografting of fibula and iliac bone is an effective alternative for the treatment of distal femoral C3 type fracture.It can provide more stable fixation to the bone and earlier functional exercises can be achieved.5 refs,3 figs,1 tab.
文摘Fractures of the lateral process of the talus(FLPT)are uncommon fractures that represent a clinical challenge.Traditional radiological classification systems rely predominantly on radiographic findings.However,due to the high rate of FLPT misdiagnosis and the limited accuracy in evaluating concomitant talar injuries through plain radiographs,novel imaging classification systems have been developed that aim to enhance the diagnosis of concomitant talar injuries,thereby optimizing patient management and reducing the incidence of long-term complications.
文摘Objective:To evaluate the effect of encircled fixer of shape memory alloy on bone fracture. Methods:A total of twenty patients with eighteen males and two females was studied. There were three patients with fractares in the upper one third of thighbone, five with fractures in the middle part of thighbone, six with humeral fractures, three with collarbone fractures,one with ulna fracture and two with thighbone fractures as complication of artificial hipbone arthroplasty. After exposure and fixation of fracture ends, prepared encircled fixer was inserted into 0~4℃ normal reline(NS) to lower its temperature, then pulled out with a clamp. Encircled fixer was put on the tersile side of the fractured bone(center pointed to fracture line), restored and stabilized after raising temperature in 40℃ NS. Results: Encircled fixers of shape memory alloy were used to treat twenty patients with bone fracture.Clinical concrescence was obtained in 1.5 to 3 months after operation,and the joint gained its normal function without complication. Conclusion:Encircled fixer of shape memory alloy has features as exerting vertical pressure continoulsy, little stress shield effect and convenient manipulation, especially adapt to stem fracture after artificial arthroplasty.
文摘Starling with the L- and D,L-lactide copolymer (L:DL = 9:1) [P(L-DL)LA] of M-W = 32.1 x 10(4), rods were obtained through a two stage process: (1) melt-extrusion at 155 degreesC, and (2) hot-drawing at 90 degreesC to various drawing ratios. The molecular weight of P(L-DL)LA fell to 9.3 x 10(4) as a consequence of the production process. The crystallization and molecular orientation of P(L-DL)LA developed as a result of the hot-drawing. The mechanical strengths of the rods increase with the drawing ratio; The maximum for tensile strength, bending strength, bending modulus, and shear strength are 329 MPa, 237 MPa, 8.8 GPa, and 157 MPa, respectively.
文摘This study explored the feasibility of employing computer-aided design(CAD)and 3 dimensional(3D)-printed personalized guide plate for the mini-invasive percutaneous internal screw fixation of fractured scaphoid.The study consisted of two parts:(1)experimentation on upper limbs from corpses and(2)preliminary clinical application.Corpse experiments involved upper limbs of 6 adult corpses.The specimens of upper limbs were subjected to plain CT scan.Then the CT data were input into computer to conduct 3D reconstruction of wrist region.The direction and depth of the guide wire and screw were designed on the basis of the principle that screw should lie at the center of scaphoid and the long axis of the screw should be aligned with that of the scaphoid.The carpal bone model and the guide plate were designed and 3D-printed.By using the guide plates,the guide wire was placed and the cannulated compression screw was inserted.The wrist region was examined by X-ray and CT to observe the location of the screw in the scaphoid.The scaphoid was longitudinally excised to grossly observe the location and evaluate the result of screw insertion.For clinical application,the guide plate was employed in 4 patients with fresh scaphoid fracture using the aforementioned operative technique.Our results showed that,in the 6 corpse limbs,the guide plate well fitted the skin surface and the guide wire and screw were accurately put in place in one session.X-ray examination and gross observation confirmed that the screw was satisfactorily positioned and the result met the requirements of the preoperative design.For 4 patients,the guide wire and screw were all precisely inserted into place in one session.The operation time and X-ray exposure times were apparently reduced.The imaging examination exhibited satisfactory results and the hand functioned well.It was concluded that the operative guide plate used for the miniinvasive percutaneous internal screw fixation of fractured scaphoid not only can assist in accurate placement of screw but also shorten operation time and reduce insertion and X-ray exposure times,thereby reducing the radiation injury and damage to the substance and the blood circulation of carpal bone.Its use can also improve the learning curve of surgeons.
文摘Therapy based on androgenic deprivation is one of the standard treatments that many prostate cancer patients receive. Moreover, its use is increasing owing to a clear expansion of the indications for this therapy in patients with localized prostate cancer. Despite classically being considered to be well tolerated, androgenic deprivation has adverse effects. Of these, the loss of mineral bone mass is particularly notable and can lead to osteoporosis, as well as an increased risk of bone fracture. Some fractures, such as hip fractures, may have serious consequences. Useful procedures such as bone densitometry can aid in the diagnosis of these conditions. Once diagnosed, decreases in mineral bone mass can be managed by dietary recommendations, general changes in lifestyle or medication. We review the most important randomized controlled trials evaluating different drugs (bisphosphonates, denosumab and toremifene) in the prevention of bone loss and in the reduction in fracture risk in prostate cancer patients treated with androgen-deprivation therapy. Following the applicable recommendations, urologists must carefully monitor the bone health of prostate cancer patients subjected to androgenic deprivation to obtain an early diagnosis and apply the appropriate general and/or therapeutic measures if necessary.
文摘Objective To evaluate efficacy of surgical treatment in traumatic facial paralysis.Methods:Thirty-three cases were reviewed,including temporal bone fracture and iatrogenic facial nerve injury.All the patients were treated with various surgical methods according to their pathogeny.Results The mean percentage facial function improvement (House-Brackmann GradeⅠ-Ⅱ) was 86% in temporal bone fracture and function was improved after proper operation to iatrogenic facial nerve injury.Conclusions Patients with traumatic facial paralysis receive proved outcomes itreaed with proper surgical methods according to their particular condition of nerve injury.