Objective To analyze the features of muscle ischemic injury in patients with crush syndrome due to be trapped under the rubble for a super long time in the Wenchuan earthquake.Methods Eight patients were identified with crush syndrome from 1070 hospitalized patients after Wenchuan earth quake in May 12,2008,including 4 males and 4 females,with the mean age of 35.4 years(range,25-45 years).The trapping time ranged from 9 to 152 hours,with an average of 52 hours.Six cages(eight limbs) were amputated due to acute renal failure caused by crush syndrome.Eight patients were treated with continuous renal replacement treatment(CRRT).Two cases died of cerebral hemorrhage and intestinal perforation.One was diagnosed gas gangrene.The mechanisms of the crush syndrome were also analyzed.The musculature necrosis differed after trap condition and time were notified and noted.Results The characteristics of muscla crush injury were described below.1)The ultra long trapping time leading to acute renal failure.2)The patients with crush injury might be easily ignored due to the mild skin damaged.3)Deep muscles revealed more severe injury than the superficial muscles.4)The muscle necrosis took place in multiple compartments and areas.5)It Was ditiicult to identify and resect the muscles of early necrosis mixed with the normal musculature.6)A secondary hemorrhage might occur after necrotic tissues falling from the wounds.Conclusion According to the features of the muscle crush injury in the Wenchuan earthquake,the crushed limbs should be operated for extended decompression and debridment after indicated swellings.The more subterranean necrosis might cause infection even weeks after the injury signaled by that the patient had an unexplainable fever.The decompressed area should be left open.MR examination Was helpful to identify early muscle necrosis.If a crush syndrome is suspected the CRRT application wag beneficial in life save and limb salvage except for the decompression surgery.

20 cases of cavus deformity of foot were corrected by tarsal wedge osteotomy. The procedure was adopted because this type of deformity had its peculiar anatomical features. 18 feet were followed up postoperatively. and the result was found to be satisfactory 7 months to 5 years alter the operation. The following 2 problems were particularly discussed:1.Cavus defomity is characterized by a marked increase in the longitudinal arch and flexion of the forefoot, with the dome of the arch situating just under naviculo-cuneiform joint. It is therefore deemed most reasonable to perform osteotomy at this point. We think that this procedure gives better result than that recommended by McElvenny and Caldwell or v-osteotomy designed by Japas.2.In cavus foot the result of the operation depends a great deal on an accurate measuremnt of the deformity on the x-ray film. It was suggested that the deformity may be classified as mild, moderate and severe types basing on the measurement of the lateral x-ray film of the affected feet.

Objective To investigate the bionomics of mesenchymal stem cells (MSCs) derived from Wharton's jelly of human umbilical cord. Methods Umbilical arteries, vein and umbilical cord tunica externa were removed, and the remaining tissue (Wharton's jelly) was harvested. To gather MSCs, the umbilical cord was cut into small fragments and digested with 0.075% type Ⅰ collagenase, or the small fragments were cultured with DMEM. The cells derived from Wharton's jelly of umbilical cord were serially subcultivated, the growth curve was drawn, and the identification of living cells was made for studying the cell growth kinetics. The surface antigens were detected with flow cytometry, the cartilage markers were detected by histochemistry and immunohistochemistry, and the expressions of Sox-9 and Col-2A1 mRNA were analyzed by RT-PCR. Results The confluence time of primary culture cells was 3-5d in cells harvested with enzyme digestion, and 10-15d in cells harvested with micro mass. The results of flow cytometry showed that the MSCs derived from umbilical cord expressed CD44 and CD105; the expression of HLA-ABC was positive, while HLA-DPDQDR was negative. There was no significant change on the immunophenotype of umbilical cord MSCs after cryopreservation and thawing. The findings of histochemistry and immunohistochemistry showed that the expression of chondrocyte markers in Wharton's jelly MSCs was weakly positive. The results of RT-PCR showed the chondrocyte markers Sox-9 and Col-2A1 were positively expressed in Wharton's jelly MSCs. Conclusion The MSCs derived from Wharton jelly of human umbilical cord do not differentiate into hematopoietic cells, may express the chondrocyte markers (they are suggested to have characteristics of pre-chondrocytes), and is expected to be a new type of stem cells of tissue engineering cartilage.

0.05).There were better effect of removal of myelin(P2

Objective To compare the expression of osteolysis and osteogenesis cytokines in the interface membrane around aseptically loosened prosthesis for the elucidation of the biological mechanism of osteolysis caused by wear particles at bone-implant interface. Methods Reverse transcription polymerase chain reaction(RT-PCR) and computerized image processing were adopted to determine the mRNA expression of PDGF-B and BMP-7 respectively in the interface membrane(IM) at osteolysis region(with wear particles) and non-osteolysis region. Normal synovial membrane(NSM), OA synovial membrane(OASM) and normal cancellous bone(NCB) were obtained as negative or positive control. Results Expression of PDGF-B mRNA from high to low was OASM, IM at osteolysis region, NCB, IM at non-osteolysis region and NSM(P

Objective To study the orientation of tissue differentiation at bone implant interface by comparing PDGF－? and BMP－ 7 receptor distribution on histiocytes of interface membranes around aseptic loosened prosthesis. Methods Interface membrane tissues of osteolysis and non- osteolysis regions around aseptic loosened prostheses of 10 cases were immunohistochemically stained by PDGFR－? and ActR－Ⅰ (ALK－ 2) multiclonal antibodies. The relative grey values of 100 positive cells of each factors from every case were determined by computerized image analysis system and were compared between different groups and cells. Results No specificity of PDGFR－? distribution on different kinds of cells of interface membrane. PDGFR－? expression on macrophages and fibroblasts of the membranes at osteolysis regions was significantly higher than that at non- osteolysis regions (P

Objective To report the experience of the revision procedure with morselized bone grafting and a special design of acetabular prosthesis with three wings for loosened acetabular component in our hospital. Methods Since December 1989 to Junanry 1999, 23 cases with loosened acetabular component and bone defect were revised by morselized bone auto/allografting. There were 12 males and 11 females, the average age of the patients was 54.2 years old (range from 38 to 71 years old). The prosthesis of primary THA was double cup in 4 cases, the conventional THA in 19 cases, cemented in 22 cases and cementless in 1 cases. The severity of acetabular component loosening was classified into four types according to Gustillo: Type II in 3 cases, type III in 9 cases and type IV in 11 cases. The morselized bone autografting and allografting with size 4－ 6 mm were used in 6 cases and in 17 cases respectively. Different acetabular components had been used, the thread metal acetabular cup in 2 cases, screw fixed conventional metal acetabular cup in 10 cases and special design acetabular prosthesis with three wings in 11 cases. The latter prosthesis consists of an conventional acetabular component with pearl porous surface and three wings with different length and sharp edge distributed centrally in the superior lateral quadrant on the surface, the liner is made of UHMPE. Results No infection of the wound occurred in this group. The mean time of follow- up was 3 years and 8 months. Except 3 cases, all of the bone grafts was healed well and X－ ray showed that the containing of acetabular component was good, no translucent line between donor bone bed and prosthesis, and the bone defect had been repaired. The average Harris score was 47 before revision, and 86 after revision. The successful rate of revision was 86.9％ . There were 3 loosening cases postoperatively, 2 cases were due to incorrect position of prostheses and insufficient bone graft, another case was due to the screw being too short to fix the acetabular component. However, all of the three cases have partial bone growth in the original loosening acetabular. Conclusion 1. Direct contact between the morselized bone auto/allograft and the surface of metal acetabular component and the firm fixation of the prosthesis have showed good result of bone defect reconstruction. 2. The special design of acetabular prosthesis with three wings could be selected as an alternative method for huge bone loss of acetabulum (ranged from 64 to 79 mm), because it was able to enlarge the volume of the acetabular component.

Periosteal autograft from different sources have been used to repair 1.5cm bone defects of radius in 10 rabbits.On the left side,sharp-dissected grafts were implanted and the animals were sacrificed 4,8,14,30 and 60 days after operation.Bone formation was studied with X-ray and histologic technique.The results showed that the way of sharp-dissecting can preserve the periosteum completely,and good bone formation was found in this group.It suggested that the sharp-dissecting of the periosteum is the important key for periosteal graft.

Objective The purpose of this study is to observe the property of guided bone regeneration by collagen membrane and investigate the mechanism of guided bone regeneration. Methods 10mm defect of radius was created bilaterally in adult New Zealand rabbits. The experimental group was transplanted by collagen membrane with surface decalcified bone allograft,and the control group was transplanted by surfaced decalcified bone allograft alone.Radiological and histological and immunohistochemical examinations were taken postoperatively. Results In the transplantation area of experimental group,distinctive periosteal reaction and new bone growth occurred remarkably,bone remodeling progressed successfully,and defects healed completely.But in the transplantation area of the control group,new bone growth and mature bone replacement were delay due to occupation of fibrous connective tissue. Conclusions Collagen membrance has an ability to block and guide.In addition,membrane tube can keep endogenic BMP with exogenic BMP greatly concentrating and effectively distributing. The distributive characteristic of BMP exerts an influence on cellular resources and pattern of bone healing.

Periosteal autograft from different sources have been used to repair 1 5cm bone defects of radius in 10 rabbits.On the left side,sharp dissected grafts were implanted and the animals were sacrificed 4,8,14,30 and 60 days after operation.Bone formation was studied with X ray and histologic technique.The results showed that the way of sharp dissecting can preserve the periosteum completely,and good bone formation was found in this group.It suggested that the sharp dissecting of the periosteum is the important key for periosteal graft.