ObjectiveTo investigate the clinical results of modified subinguinal approach without iliac osteotomy for anterior surgical treatment of acetabular fractures which involve the anterior wall and medial wall or in combination with femoral neck fracture. MethodsThe subinguinal approach was modified after anatomical study on 12 adult cadavers. Between May 2010 and March 2012, 34 patients with acetabular fracture that involved the anterior wall and medial wall or in combination with femoral neck fracture were treated with open reduction and internal fixation through modified subinguinal approach in 15 cases and through modified subinguinal approach combined with Kocher-Langenbeck approach. There were 28 males and 6 females with an average age of 31.1 years (range, 20-64 years). According to the Letournel-Judet classification, there were 15 cases of anterior acetabular/column fractures, 8 cases of anterior acetabular/column fractures combined with trear half transverse fractures, 7 cases of double column fractures, and 4 cases of T shape fractures. The time between injury and operation was 5-16 days (mean, 7.4 days). ResultsAnatomy results: the inguinal ligament was reflection and continuity from the aponeurosis of obliquus externus abdominis with a length of (11.09±0.24) cm, which form part of abdominal muscle. The conjugate of inguinal ligament and iliopsoas muscle on the anterosuperior iliac spine was (0.69±0.08) cm. The vertical distance from the saphenous vein to the inguinal ligament was (3.58±0.49) cm. Clinical results: all the cases were followed up 4-24 months (mean, 14.6 months). No complication was observed, such as wound infection, internal fixation loosening, and iatrogenic injury to the sciatic or femoral nerve. The bone union time was 12-16 weeks (mean, 14 weeks). According to Matta reduction criteria for acetabular fractures, anatomic reduction were achieved in 21 cases, satisfactory reduction in 10 cases, and unsatisfactory reduction in 3 cases at 1 week after operation. According to D'Aubigne and Postel criteria for hip function, the results were excellent in 25 cases, good in 4 cases, fair in 3 cases, and poor in 2 cases at last follow-up. Heterotopic ossification (Brooker's grade I) occurred in 8 cases. ConclusionThe modified subinguinal approach can keep the inguinal ligament intact, provide broad visualization of anterior and medial wall of acetabulum and anterior hip capsule, which is a better modification and supplement for classic ilioinguinal approach.
Objective To explore the paracrine effect of bone marrow mesenchymal stem cells (BMSCs) on dexamethasone-induced inhibition of osteoblast function in vitro. Methods The serum free conditioned medium of mouse BMSCs cultured for 24 hours was prepared for spare use. The 3rd passage of MC3T3-E1 cells were divided into 4 groups: the control group (group A), dexamethasone group (group B), dexamethasone+BMSCs conditioned medium (1:1) group (group C), and BMSCs conditioned medium group (group D). After 24 hours of culture, the alkaline phosphatase (ALP) content was determined; the protein expressions of RUNX2 and Osteocalcin were detected by Western blot; and the gene expressions of collagen type I-α 1 (COL1A1), RUNX2, ALP, and Osteocalcin were detected by real-time fluorescence quantitative PCR (RT-qPCR); alizarin red staining was used to observe calcium nodules formation at 21 days. Results After cultured for 24 hours, ALP content was significantly lower in groups B, C, and D than group A, and in group B than groups C and D (P < 0.05), but no significant difference was found between groups C and D (P > 0.05). The relative protein expression of RUNX2 of group B was significantly lower than that of groups A, C, and D (P < 0.05), but difference was not significant between groups A, C, and D (P > 0.05). The relative protein expression of Osteocalcin was significantly lower in group B than groups A, C, and D, in groups A and C than group D (P < 0.05), but difference had no significance between groups A and C (P > 0.05). The relative gene expressions of RUNX2, Osteocalcin, COL1A1, and ALP of groups B, C, and D were significantly lower than those of group A (P < 0.05); the relative gene expressions of RUNX2, Osteocalcin, and ALP were significantly higher in group D than groups B and C, in group C than group B (P < 0.05). The gene expression of COL1A1 was significantly higher in group D than group B (P < 0.05), but difference was not significant between groups B and C, and between groups C and D (P > 0.05). The cells of group A all died at 6 days after culture; at 21 days, the calcium no dule staining was positive by alizarin red in groups B, C and D, and the degree of the staining gradually increased from groups B to D. Conclusion BMSCs conditioned medium can alleviate the inhibitory effect of dexamethasone on osteoblasts function.