Abstract:Objective In recent years,attention to non-invasive shock wave therapy which characteristic of fewer side effects and its application in the treatment has increased,this paper intends to explores the mechanisms of extracorporeal shock wave therapy for bone and joint and muscle pain;the function and transformation of Inflammatory during treatment.Methods Forty male Sprague-Dawley rats were randomly divided into normal control group,model control group,experimental group 1 and experimental group 2,10 rats in each group.By comparing the time of inflammation resolution and swelling extent,serum levels of inflammatory factors,inflammatory cells in tissue sections to study the mechanism of shock wave in anti-inflammatory and analgesia.Results The shock wave therapy could alleviate local inflammation,alleviate inflammatory exudation and infiltration of inflammatory cells,improve symptoms,relieve pain,and do no obvious damage to local tissue.It may be related to the increase of anti-inflammatory analgesic factor and the decrease of Inflammatory factor.Conclusion Extracorporeal shock wave therapy alleviate local inflammation and accelerate the dissipation of inflammation which improve symptoms,reduce pain.The mechanism may be related to promote β-endorphin production,inhibition of PGE2,5-HT and other pain factor release and Nitric oxide is also play an important regulatory role in therapy,but it''s mode of action is not clear.

Abstract:Objective To compare clinical efficacy and cost-effectiveness in treatment of femoral neck fracture with total hip arthroplasty(THA)and bipolar hemiarthroplasty(BHA)in elderly.Methods 169 patients over 70 years old with femoral neck fractures were treated with either THA or BHA.Comparison between THA and BHA groups were carried out on operation duration,incision size,blood loss,postoperative drainage,transfusion volume,average length of hospital stay,average cost,complication rate,hip function(Harris scores)and X-ray assessment.Results The patients were followed up for 2 years to 5 .7 years,with an average follow-up period of 5 .1 years.The operation duration,a-mounts of blood loss,postoperative drainage,blood transfusion,postoperative dislocation rate and average cost of THA group were greater than those of BHA group(P<0.05,respectively).Differences of average length of hospitalization, incision size,postoperative Harris scores,incidence of complications and infection rates between the two groups were not significant(P>0.05,respectively).In the patients over 75 years old,there were not significant differences on Harris scores 2 and 5 years post-operation and mortality between the two groups(P>0.05,respectively).The Harris scores at 0.5 years post-operation of BHA group was higher than that of THA group(P<0.05).Conclusion The clinical efficacy of BHA at mid-term was similar to that of THA in treatment of femoral neck fracture in elderly.However,BHA may be more suitable for patients who are frail and with complications because of it’s advantage in less surgical trauma and risks,quicker recovery and lower cost than THA.

Abstract:Objective To analyze the sex and age,characteristic of patients suffering ankle fracture as well as its lat-eral and seasonal distribution.Methods According to the database of Nanjing Drum Tower Hospital,the clinical data of 1080 ankle fracture cases from January 2005 to December 2016 were collected and analyzed.The sex and age character-istic,as well as lateral and seasonal distribution were analyzed statistically.Results There were 598 male patients(55. 4%,598/1 080) and 482 female patients(44.6%,482/1 080) in 1080 patients suffering ankle fracture totally.The inci-dence of ankle fracture in men under the age of 60(62.2%,460/740) was more than that in women(37.8%,280/740). Besides,women over 60 years old(59.4%,200/340)was more likely suffering from ankle fracture than men of the same age(40.6%,138/340).The incidence rate of left ankle fractures(45.4%,496/1 080) is lower than that of right ones(51.0%,551/1 080).When comparing with other age groups,men from 30 to 59 years old and women from 60 to 69 years old have a higher risk of ankle fracture.The incidences in 14~19 years old and over 70 years old groups in win-ter were relatively high,while 20~29,30~39,40~49,50~59 year-old groups were relatively uniform distribution in all seasons.Conclusion Ankle fractures,which is prone to be the right side,are more commom in men under 60 years old and women over 60 years old.Adolescents and the elderly are relatively easy to suffer,the remaining present a uni-form distribution in all seasons.

Abstract:Objective To explore correlation between the total blood loss and the hidden blood loss during different peri-ods after Surgery( PFNA)for elderly patients′intertrochanteric fractures. Methods A retrospective case series of 36 patients operated between January 2010 and January 2012 was reviewed. All the patients were initial illness,and 24 h infusion volume was not more than 2 000 mL. The patients of serious medical illness and autoimmune-diseases were excluded. According to Gross formula,we calculated the total blood loss with the patients′ height,weight,and Hct during peri-postoperative period, make statistical analyse by analysis variance design in different groups,and analyzed correlation between the total blood loss and the hidden blood loss during different periods. Results The mean total blood loss was(956. 82 ± 207. 61)mL. The mean observed blood loss was(88. 08 ± 16. 28)mL. The mean hidden blood loss was(820. 96 ± 164. 34)mL. About 90. 23% of the total blood loss volume was the hidden blood loss. There were no significant differences in the first day and the first 2~3 day, but were significant with first 4~5 day. Pearson rank correlation test showed that there were positive correlations between the totalblood loss( Y )and the hidden blood loss in the first day( A ),the first 2 ~3 day( B ),and the first 4 ~5 day( C )( P <0. 05). And we built the best regression equation,Y=0. 978*A+1. 029*B+0. 779*C+58. 327. Conclusion The hid-den blood loss was the major part of total blood loss in PFNA for elderly patients with intertrochanteric fractures,especially in the first 3 days. It is very important to supply the blood volume during peri-postoperative period to decrease the risk of compli-cations.

Abstract:Objective To compare percutaneous vertebroplasty (PVP) and balloon kyphoplasty (PKP),bone filling mesh container(BFMCs)in the treatment of thoracolumbar osteoporotic vertebral compression fractures (OVCFs),and clinical effect;To select the best surgical approach to improve the treatment of thoracolumbar osteoporotic vertebral compression fractures.Methods 114 cases of thoracolumbar osteoporotic vertebral compression fractures were treated with PVP,PKP and BFMCs in our hospital from May 2013 to April 2017,with a total of 114 cases,among them:T11 14,T12 35,L1 30,L2 15,L3 20,the three groups were recorded after surgery and surgery after January VAS,postoperative vertebral kyphotic angle、anterior vertebral height.Results Three kinds of surgical methods in the postoperative visual analogue scale VAS score lower than the preoperative.The PVP and PKP postoperative VAS score was lower than that of BFMCs,a significant difference between the three groups (P<0.05),after January the follow-up of VAS score no significant difference between the three groups (P>0.05);PKP and BFMCs in the postoperative vertebral kyphotic angle,vertebral height restoration of anterior vertebral is better than PVP,but PKP and BFMCs had no significant difference between the three groups (P>0.05);In the bone cement leakage:the incidence of BFMCs group was lower than that of group PVP and group PKP.Conclusion PVP,PKP,BFMCs in the treatment of thoracolumbar osteoporotic vertebral compression fractures were satisfied with the clinical effect;BFMCs did not cause bone cement leakage in the treatment of osteoporotic vertebral compression fractures,So BFMCs is a safe surgical procedure in the treatment of cortical bone defects.