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.

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 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 To develop a method to prepare human articular cartilage derived microcarrier for both rapid propagating chondrocytes and being used as scaffold to support chondrogenesis. Methods Human articular cartilage was crushed into small pieces by muller after lyophilization, and sorted through two different meshes to collect only those specimens measuring 150-200 microns. Then, in turn, the specimens were subjected to 0.25% trypsin at 37 ℃ for 24 hours and 1% Triton X-100 for 72 hours, respectively. The specimens were observed by inverted phase contrast microscopy, and assessed by staining with haematoxylin-eosin, safranin-O (for GAG), as well as by the immunohistochemistry of aggrecan, collagen type Ⅱ. The microcarriers were seeded with human chondrocytes after being irradiated by 60Co. Results Using inverted phasecontrast microscope, the freezing-dry cartilage particles were observed as yellow, different shapes, and their surfaces were uneven, and with many pits. After treating with trypsin and Triton X-100, the microcarriers showed light yellow, without cartilage morphology. The microcarriers became flocculous or like a hairbrush, and the area of contacting surface significant increased. After culture with cartilage cell for 2 hours, lots of spherical chondrocytes adhered to the microcarriers. HE stain of section confirmed that the celluar constituents of the specimens were removed, the specimens stained weakly positive for GAG, negatively for aggrecan, and positively for collagen type Ⅱ, respectively. Conclusion The detergent and trypsin can remove the cellular constituents and knock out the aggrecan from human articular cartilage while maintaining collagen type Ⅱ and GAG, and made the cartilage pieces flocculous or hairbrush-like. The chondrocytes can be well maintained in human articular cartilage derived microcarriers. Human articular cartilage derived microcarriers were prepared successfullly.

[Objective]To investigate the influence of Nitinol modified on its surfaces by the coating of titanium or titanium-niobium alloy on separat ion of Ni~(2+).[Method]The specimens from 1 to 7 days after the experiments were collected and the concentration of Ni~(2+) were cletermined by physiologic saline immersing test,low temperature ashing furnace,Mg(NO_3)_2 as matrix modifier and graphite furnace atomic absorption spectrometry(GFAAS).[Result]Specimens of Nitinol were devided into 3 groups:alloy coated with Ti(Ti group);alloy with Titanium-Niobium(TiNi group);only Nitanol without coating group.Obvious separation of Ni~(2+) was detected in the groups of Nitinol that were not modified and were put in baking oven(37℃),the separating procedure was mainly within 4 days,the separation rate(10~(-7)??g? cm~(-2)?s~(-1)) from the first to the forth days was 18.2,3.45,1.75 and 0.45 respectively,the Ni~(2+)was no more separated from the fifth day.Whereas,Ni~(2+) was not separated in the groups of Nitinol that were modified by the coating of metallic Ti and TiNb alloy.The recovery rate of the experiments was between 94.6%～108.6%.[Conclusion]The coating of Ti or TiNb on the surfaces of Nitinol stopped Nitinol from separating Ni~(2+).

[Objective]To analyze factors related with surviving rate and to evaluate effectiveness of the adjuvant chemotherapy in the treatment of osteosareoma.[Method]Eighty-four patients aging from 9 to 47 years(averaged,21 years)were analysed respectively:52 of them were male and 32 were female.The tumors were located at the femur in 42,the tibia in 29,the humerus in 13.There were 22 patients classified as stage ⅡA and 62 patients as ⅡB.The pathological study,of subtype of osteosarcoma revealed that 47 were osteoblastic,11 chondroblastic,19 fibroblastic and 7 other subtypes.There were 46 patients who received the chemotherapy;38 patients without chemotherapy,49 of the 84 patients treated surgically had limb salvage procedures,35 had amputations.Multivariate analsis was done by using the proportional hazards model of Cox,categoric data were analyzed by using the chi-square statistic.[Result]All cases were followed up from 6 to 74 months(with an average of 25.5 months).Cox model analysis showed that age,sex,site,and subtype were not significant prognostic variables in this group of patients;the significant affecting prognosis in patients was Enncking staging and chemotherapy.Chi-square showed significant difference in the higher metastasis rates of lung in the group without chemotherapy than in those with chemotherapy group(P