High-energy fractures are known to result in a long healing proce ss and a high incidence of nonunion. In the traditional treatment of high-energ y fractures, bone grafting or bone substitute grafting is applied only after the delayed union or nonunion has already been confirmed. Secondary interventions t o treat nonunion are associated with a high morbidity of complications and a lon g time recovery. Charnley (1961) first recommended prophylactic bone grafting in treatment of high-energy fractures to reduce total time of fracture healing. H owever, autogenous bone graft has certain drawbacks, such as limited harvest ava ilable and serious complications at the donor site. In order to overcome these p roblems, various bone graft substitutes, such as growth factors, bioceramics and composite grafts, have been developed as early grafting materials.

Drug Therapy, Combination ; Echinocandins ; administration & dosage ; therapeutic use ; Humans ; Invasive Pulmonary Aspergillosis ; complications ; drug therapy ; Lipopeptides ; Liver Failure ; complications ; drug therapy ; microbiology ; Male ; Middle Aged ; Voriconazole ; administration & dosage ; therapeutic use

This study was aimed to analyze the dynamic accumulation of active ingredients of Echinacea purpurea. Contents of cichoric acid and total polyphenols in different parts through the whole growth process were determined by HPLC and colorimetry. The results showed that the content of total polyphenol changed little in annual plant. There were differences in content of cichoric acid of different parts in different periods. And the content reached the maximum at flowering stage. It was concluded that the harvest stage depended on the content of cichoric acid. The results provided theoretical basis for induced plant in Shandong province.

Objective To identify the relationship of the femoral morphology with the sex and age, analyze and compare the two methods of defining the morphology of marrow cavity.Methods AP and lateral radiography of the hip joint was made in 45 patiens who accepted total hip arthroplasty.The anatomic parameters of the proximal femur were measured on those radiography.The femoral morphology was analyzed using Dorr criteria and Noble class respectively.Results (1)The anatomic parameters of the proximal femur were not correlated with the age in male.(2)The inner diameter of canal 10 em distal to the lesser trochanter, isthmus width and canal to calar isthmus rate were positively correlated with age in female.(3)The medial cortical and lateral cortical thickness 10 cm distal to the lesser trochanter,cortical index and canal-flare index were negatively correlated with age in female.(4)According to Dorr criteria,13 femora were classified as type A,20 as type B,and 12 as type C.According to Noble class,4 femora were classified as champagne type,34 as normal type,and 7 as stove pipe type.Conclusions The femoral morphology don't change with age in male.The width of femoral canal increase with age in female.Type C of Dorr criteria contains all of stove pipe type and a portion of normal type.

[Objective]To develop a new femoral prosthesis that can integrate with femur compactly and increase proximal femoral stress transfer,and further improves the long-term curative effect of total hip arthroplasty.[Method]Five pairs of human cadaver femora were divided equally into two groups one of which received a cobalt-chrome molybdemum alloy(CoCrMo) implant and the other a carbon fiber reinforced polyetheretherketone composite(CF/PEEK) implant.Six strain-gauge rosettes were attached to the external surface of each implant and proximal femora.The loading conditions simulated single-limb stance and the strains were recorded first with the femora intact and then with the femoral components of two different designs implant inserted.[Result]After the insertion of a femoral component,the normal pattern of a progressive proximal-to-distal increase in strains was similar to that in the intact femur and the strain was maximum near the tip of the prosthesis.On the medial and lateral aspects of the proximal femur,thc strains were reduced after implantation of both types of implant.The pattern and magnitude of the strains,however,were closer to those in the intact femur after insertion of the CF/PEEK stem than that of CoCrMo stem.[Conclusion]Our findings suggest that the CF/PEEK stem can provide immediate postoperative stability,better proximal loading transfer in the metaphysis and further reduce stress shielding,bone resorption and osteanabrosis,thus prevent the implant from failuri.

BACKGROUND: Greatly higher elastic modulus of traditional metal prosthesis than bone elastic modulus is mechanical factor for aseptic loosening of artificial joint, resulting in stress shielding, bone resorption and bone atrophy.OBJECTIVE: To measure femoral stress after prosthetic replacement made of carbon fiber reinforced poly-ether-ether-ketone (CF/PEEK), and compare with domestic AML prosthesis, so as to explore the application prospect of compound material in total hip femoral head prosthesis. DESIGN, TIME AND SETTING: Comparative analysis was performed at Orthopedics Laboratory, First Hospital of Soochow University and Institute of Biomechanical Engineering of Shanghai University from September 2002 to March 2004.MATERIALS: CF/PEEK prosthesis was designed by the authors, composed of long CF/PEEK compound material as inner layer, 100 Gpa and short CF/PEEK compound material as outer layer, 20 Gpa; the layer intensity at stress center was strengthened, and the appearance and size of the CF/PEEK prosthesis simulated domestic AML cobalt alloy prosthesis (Beijing Huajiehao Company). Five pairs (10 femurs) of femurs were from fresh adult cadavers. METHODS: Five pairs of human cadaveric femora were divided equally into left and right groups: one group received a cobalt-chrome molybdenum alloy (CoCrMo) implant and the other received CF/PEEK implant. Strain-gauge rosettes were attached to external surface of each implant and proximal femora. The loading condition simulated single-limb stance. MAIN OUTCOME MEASURES: strains distribution on the normal femur and femoral surface after replacement with two kinds of prostheses; shearing strain at femur-prosthesis interface of two groups.RESULTS: Following prosthesis implantation, the strains exhibited a progressive proximal-to-distal increase, which was similar to that in the intact femur, and the strain was maximum near the distal prosthesis. The strains on the medial and lateral surface of the femur were reduced after implantation of both types of implants. The pattern and magnitude of the strains, however, were closer to those in the intact femur after insertion of CF/PEEK prosthesis than in the CoCrMo one. CONCLUSION: Mechanical performance of CF/PEEK compound prosthesis is similar to bone tissue, and can provide similar strain under loading condition. Therefore, it can provide immediate postoperative stability and proximal loading transfer.

Objective To explore the initial stability of a carbon fiber reinforced polyetheretherketone composite (CF/PEEK) stem in human femurs after total hip replacement. Methods 8 pairs of human cadaveric femurs were used to test the CF/PEEK prosthesis versus a conventional cementless stem of cobalt-chrome molybdemum alloy(CoCrMo). The bone-femoral prosthesis interface motion was measured in vitro using displacement transducers. Combined axial and torsional loads and simulated single-leg stance loading were applied. Subsidence, rotation and interface motion were measured with load cycles up to 1 000 N. Results The extent of the micro-motion in the proximal femoral region was larger than that in the distal femoral region. The CF/PEEK composite prosthesis showed less dynamic micro-motion in the proximal region compared with the CoCrMo alloy prosthesis stem, with the average difference being 42%. The extent of the distal micro-motion in the 2 groups was small but the difference was significant (P

Objective To describe the surgical technique for treatment of old traumatic posterior acetabular defects. Methods From March 1990 to March 1998, 6 patients were treated with a full thickness iliac crest autograft to reconstruct their posterior acetabular defects. There were 4 males and 2 females, the average age of the patients was 32 years. The acetabular defects were caused by traffic accident and delayed in treatment for 3 to 11 months. Results The duration of follow up was 2－ 10 years， the function of the hip joints were good in all of the patients, according to the criterion of d Aubigne six points. X－ ray film revealed that although the femoral head was not in exact congruence with reconstructed acetabulum, yet there was no dislocation. Slight degeneration was found in 3 cases. Conclusion Although this procedure did not exactly reproduce the anatomy of the hip joint, it restored the posterior stability, provided bone stock for the hip joints and prevented dislocation of the femoral head. So this procedure is useful for late total hip arthroplasty.

Objective To review the clinical results of cemented and uncemented revision total hip arthroplasty(RTHA). Methods The diagnoses included aseptic loosening of the femoral components in 23 cases, fractures around the tip of loosened femoral components in 3 cases. Of 26 cases, 10 cases(10 hips)underwent RTHA by the use of the second generation cementing techniques, 16 cases(16 hips)underwent uncemented RTHA with a long stem porous coated femoral component assisted with autografting. Results At an average of 6 years of follow- up for cemented RTHA, clinical results were evaluated as excellent or good in 5 hips(50％ ),fair in 3 hips(30％ ) and poor in 2 hips(20％ ), re- revision in 1 hip(10％ ). X－ ray film revealed definite loosening in 2 hips, probable loosening 1 hip, possible loosening 5 hips, and no loosening 2 hips. At an average of 5 years follow- up for uncemented RTHA,clinical results were evaluated as excellent in 9 cases(56％ ),good in 6 cases(38％ ), fair in 1 case (6％ ),no case need rerevision. X－ ray film revealed osseous fixation of the femoral components in 12 cases (75％ ), fibrous stability in 4 cases (25％ ). The apparent reconstitution of femoral bone structure present in the area of previous osteolysis or cortical thinning. Conclusion Clinical results of the uncemented RTHA are significantly superior to that of cemented RTHA. Reconstructing any structural bone loss with cancellous autograft and getting adequate mechanical fixation with a long stem porous- coated prosthesis may contribute to the good results of uncemented RTHA.

Objective To summarize the surgical techniques and results of displaced complex ac-etabular fractures.Methods Ninety-eight cases of complex type o f acetabular fracture with dislocation were treated with open reduction and inte rnal fixation from March 1990to Sept ember 1999.Of the 98cases,fractures of the posterior column an d wall was seen in 9cases,T -shaped in28cases,transverse and posterior wall in 22cases,anterior and hemi-transverse in 2cases,both column in 37cases.Kocher -Langenbeck approach was adopted in 28cases,ilio-inguinal approach in 21cases,extended iliofemoral approach in 16cases,and double approachs(K -L +ilio-inguinal)in 33cases.Results Sixty-two cases(63.3%)had anatomic reduction,32cases(32.7%)satisfactory reduction,4cases(4.1%)unsatisfactory reduction.The rates of anatomic reduction in the early 4.5years and the latest 4.5years of this study were 50.0%and72.4%respectively.Seventy-eight cases were followed up from 2to 10yea rs,excellent and good rate for clinical results in anatomic and non-anatomic reduction group were 83.9%and 36.4%respectively,the difference was very significant (P