The direct anterior approach is an ideal minimally invasive surgical procedure, which exposes the hip joint through an intermuscular and internervous interval. Compared with other approaches, the direct anterior approach for total hip arthroplasty has several advantages, including less postoperative pain, faster functional recovery and higher patient satisfaction. However, the direct anterior approach could be associated with longer learning curve and higher rate of perioperative complications. We converted the operative position from the classic supine to the lateral decubitus position, aiming to inherit the advantages of the direct anterior approach and to overcome the difficulty of exposing the femoral side in the supine position. The degree of extension, external rotation and adduction of the hip joint was significantly increased in the lateral decubitus position compared to those in the supine position, which provided safe reaming of the femoral medullary cavity and precise implantation of the femoral stem. Therefore, the surgeons do not need to change the operating habits of the acetabular side. The reason is that the exposure of acetabulum in the lateral decubitus position is the same as that in familiar posterior approach. Familiarity with the surgical anatomy and understanding the limitations of the anterior hip approach are the key factors for successful execution.

Objective To investigate the expression level of Ezrin and its clinical significance in nontraumatic os-teonecrosis of femoral head. Methods Expression level of Ezrin in 38 patients with nontraumatic osteonecrosis of femoral head ( experimental group) and 16 patients with femoral neck fractures ( control group) were detected by immunohistochemistry and RT-PCR analysis. Results The expression level of Ezrin was significantly lower in ex-perimental group than that in control group (P<0. 05). It was correlated with the Ficat Stage, and had no rela-tionship with gender, age, BMI, profession and etiological factor. Conclusion Ezrin may involve in the develop-ment of nontraumatic osteonecrosis of femoral head, and play an important role in regulation.

60%(lot number 20040828, Jiahui, Shanghai, China).METHODS:Rabbit autologous BMSCs were isolated and cultured in vitro.At the third passage, BMSCs at 2?1010/L were combined on 3 cm?2 cm gelatin sponge.Each gelatin sponge contained 60 ?L cell suspension, placed in a cell incubator for 4 hours for further use.In each group, rabbit models of steroid-associated femoral head necrosis were established by liquid nitrogen frozen method.After natural rewarming, a hole was drilled.Rabbits in the model control group were left intact.Rabbits in the decompression group were implanted with gelatin sponge.Rabbits of the BMSC transplantation and theaflavin + BMSC transplantation groups were implanted with gelatin sponge with rabbit autologous BMSCs, and perfused with 250 mg theaflavin three time every day till death.MAIN OUTCOME MEASURES:The following parameters were measured:general conditions of animals;signal changes in the femoral head necrosis region were observed in the hip by magnetic resonance imaging scanning.Histology of femoral head samples was observed.Results of scanning electron microscope observation.RESULTS:After 8 weeks, rabbits became more active than before treatment, and walking way became normal gradually in the BMSC transplantation, theaflavin + BMSC transplantation groups.Four weeks after model induction, magnetic resonance imaging signal region of all groups had no obvious changes, but 8 weeks later, the necrosis signal region of the model control group magnified while it reduced obviously in the decompression group.Low signal region range became slightly small in the cell transplantation group.The low signal region range became significantly small in the theaflavin + BMSC transplantation group, and bone density signal was nearly normal.Compared with other three groups, positive number of empty lacunae significantly reduced in the theaflavin + BMSC transplantation group at 4 and 8 weeks following model induction(P

AIM: Theaflavins are the major constituent of black tea, and have a lot of pharmacological activities, for example, regulating blood fat, anti-oxygen, anti-tumor, resisting cerebrovascular disease, and so on. Previously, theaflavins' effect on human fat metabolism mostly belongs to macro-analysis, but this experiment try to find out the effect of theaflavins on the differentiation of rabbit mesenchymal stem cells (MSCs) into adipocytes in terms of cells. METHODS: The experiment was completed in the center laboratory of Anhui Provincial Hospital Affiliated to Anhui Medical University from May to September in 2007.①Ten rabbits of cleaning grade and 4-8 weeks old were provided by the animal experiment center of Anhui Medical University. The disposal of animals in process of experiment referred to the ethical standard of animals.②The heparinized rabbits were sacrificed in drugged state, then bilateral femur, tibia and humerus were obtained and their soft tissues were removed, cutting epiphysis of two sides including epiphyseal plate. The MSCs were isolated and cultured with whole bone marrow culture method, inoculated at a density of 2?108 L-1. When the cells grew to the fusion of 80%-90%, digesting and passage culture were performed. Cells of the third generation were collected and inoculated at a density of 1?105/cm2 to be cultured for 2 weeks with DMEM adipocyte-induced liquid, which contained recombinant human insulin 10 mg/L, dexamethasone 10-6 mol/L, and IBMX 0.5 mmol/L. Three groups were set up: adipocytes control group in 1 mL adipocyte-induced liquid; theaflavins group with the 500 ?g/L theaflavins in 1 mL adipocyte-induced liquid; blank group in equal amount of ordinary DMEM culture medium.③The cultured cells of the second generation were selected to draw growth curve; oil O staining was used to identify the induced adipocytes and calculate the differentiation efficiency of adipocytes. RESULTS: ①Cell growth curve: MSCs had vigorous reproductive activity, 1 day of the culture was the cell adaptive phase, 3 days was the increased logarithmic phase, and 8 days was the platform phase. After 8 days, cell proliferation quickly stepped down and cells reduced.②Identification of adipocytes by oil O stain: Lipid droplets in adipocytes were stained into salmon pink, and the nucleus was stained into blue. Most of MSCs in adipocyte control group were induced into adipocytes, the differentiation efficiency was (64.8?4.8)%, while that in theaflavins group was only (32.0?3.4)%. No adipocytes obviously formed in blank control group. CONCLUSION: Theaflavins can obviously inhibit differentiation from rabbit MSCs to adipocytes.

[Objective]To analyze the causes for postoperative incisal effuscin following posterior lumbar spinal surgery, to study a protocl for classification of effusion and afford according treatments.[Method]1186 cases of posterior lumbar spinal surgery were completed in the hospital from june 2001 to june 2005,877 operations with instrumentation, Il09 oprations with non-instrumentation, to compare the rate of incisal effusion between the two groups. The patients of incisal effusion were divided into three types:Type Ⅰ:the causes are ascertained, 28 cases: Type Ⅱ: infection, 11 cases; Type Ⅲ:the causes are uncertain, 14 cases o Patients of type Ⅰ were received puncturation, etiological treatment, nutrient therapy. Patients oftype II were received invisal drainaga,debridement, surgical irrigation and culture-directed antibiotic. Patients of type Ⅲ were received puncturation, and prophylactic antibiotics. [Result]The occurrences of incisal effuson were higher in instrumental group (4.33%)thannon-instrumental group(1.35%),P

[Objective]To explore the diagnosis and surgical procedure of soft tissue tumors!in the wrist.[Method]A retrospective study was conducted to evaluate surgical excision of 132 cases of wrist soft tissue tumors in our hospital from jan 2003 to jun 2004.The preoperative diagnosis was compared with pathologic diagnosis and surgical complications was analyzed.[Result]Totally 132 cases included 110 ganglion and 22 non-ganglion were related to 11 disease.The correct rate of preoperative diagnosis was 86.4%(ganglion 95.5%,non-ganglion 40.9%).All cases were recieved surgical excision and were followed up 2 years except 5 cases,123 cases were cured,3 cases were recurrence and 1 died.Complications were seen in 2 dorsal cases and 6 volar cases.[Conclusion]Soft tissue tumors in the wrist are related to much broader spectrum of diseases.On cureing ganglion it is important to master surgical indications and crucial points of operation procedure for different sites.Because histological features of non-ganglion is difficult to determine,surgical treatment should be adviced for initial choise.

[Objective]To analyze the clinical effect of the unstable pertrochanteric femoral fracture treated with anatomical plate.[Method]To prospectively compare anatomical plate with dynamic hip screw(DHS) in terms of treatment of the unstable pertrochanteric femoral fracture in elderly.Fifty-eight elderly patients with unstable pertrochanteric femoral fracture who were treated from June 2003 to May 2007 and followed up for 9-24 months were randomized into two treatment groups,ie,anatomical plate internal fixation(group I) and dynamic hip screw internal fixation(group II).Of all,32 patients were treated with anatomical plate internal fixation and 26 with DHS internal fixation.The treatment groups were comparable with regard to all demographic and injury variables.[Result]Patients treated with anatomical plate internal fixation had shorter operative times,fewer blood loss and blood transfusion,and higher Harris scores,there were significant differences in the two groups.The incidence rate of early postoperative complication was 9.38% in group I and 11.54% in group Ⅱ.The incidence rate of late postoperative complication was 9.38% in group Ⅰ and 30.78% in group Ⅱ.There were significant differences in late postoperative complication and no significant differences in early postoperative complication between the two groups.[Conclusion]The unstable pertrochanteric femoral fracture treated with anatomical plate could achieve excellent clinical results.

BACKGROUND:Systemic lupus erythematosus is a kind of heterogeneous disease, and the difference of clinical features may also be the risk factors of osteonecrosis besides of treatment with glucocorticoids according to the literature. However, it remains controversial on the risk factors of osteonecrosis in systemic lupus erythematosus patients.
OBJECTIVE:To systematical y review the major risk factors of osteonecrosis in the Chinese patients with systemic lupus erythematosus.
METHODS:The CNKI database, CBMdisc database and Wanfang database were retrieved for the published case-control study literatures on the risk factors of osteonecrosis in the Chinese patients with systemic lupus erythematosus. The literatures met the inclusion and exclusion criteria were included, and a Meta-analysis was conducted by RevMan 5.0 and Stata software. Then, the pooled odd ratio and 95%confidence interval of each risk factor were calculated.
RESULTS AND CONCLUSION:Ten case-control study literatures were included involving 332 cases in the case group and 986 cases in the control group. The pooled odd ratio and 95%confidence interval of each risk factor of osteonecrosis in the Chinese patients with systemic lupus erythematosus were as fol ows:Raynaud’s
phenomenon 3.28(1.69-6.38), dental ulcer 2.95(2.13-4.09), renal involvement 1.21(0.83-1.74), vasculitis 5.64(2.84-11.21), hyperlipidemia 5.11(3.10-8.42), anti-phospholipid antibody 2.32(1.49-3.61) and joints involvement
2.02(1.33-3.07). It has been clear that the glucocorticoids is an independent risk factor of osteonecrosis in the patients with systemic lupus erythematosus. However, it is not the one and only risk factor. The fol owing risk factors of
vasculitis, hyperlipidemia, Raynaud’s phenomenon, dental ulcer, positive anti-phospholipid antibody and joints involvement are the risk factors of osteonecrosis in the patients with systemic lupus erythematosus.

To evaluate the treatment effect of the late avascular necrosis of femoral head with concentrated autologous bone marrow and impaction autologous bone graft. The clinical data of 35 patients with late avascular necrosis of femoral head treated with the above methods was analyzed retrospectively with the University of Pennsylvania staging system, and evaluated with Harris hip score system. Among the 35 patients, there were 8 at stage Ⅲ, 23 at stage Ⅳ and 4 at stage Ⅴ. The preoperative Harris hip scores ranged from 43-72 with the average scores of 49. The patients were followed up for at least one year with the mean time of 2 years and 3 months. Two patients (preoperative at stage Ⅴ) had received total hip replacement duo to severe pain and ostarthritis. The imageology in 5 patients showed that the femoral head appearance collapsed little compared with that before operation, but their subjective feelings were well. All the femoral heads of left patients remained the shape after operation, complains of pain disappeared or lessened. The overall successful rate was 94% (33/35). In Harris scale, there was 1 patient with 92 scores, 17 with 80-89 scores, 3 with 70-79 scores and 2 patients

Objective To compare the efficacy of fixed bearing(FB) and rotating bearing(RB) in total knee arthroplasty (TKA) for knee valgus. Methods Data of 203 cases with valgus knee deformity who had undergone TKA procedure from January 2007 to December 2013 were retrospectively analyzed. 181 cases were primary joint replacement. They were divided into FB group and RB group. 168 patients (168 knees) were followed?up for more than 2 years. 83 cases (83 knees) were in FB group, and 85 cases (85knees) were in RB group. There were 57 males and 111 females, aged from 40 to 79 years, with an average age of 59.3 ± 7.2 years. Among them, 153 cases were osteoarthritis and 15 cases were rheumatoid arthritis. Activities of the knee , tibio?femoral angle on X?ray, Hospital for Special Surgery (Hospital for Special Surgery, HSS) knee score and the SF?36 scale scores were recorded before surgery and at the final follow?up. Results All patients were followed up for 24 to 84 months (average, 37.4 months). The average knee activities of the fixed bearing and rotating mobile bearing were from 72.8°±13.1°and 71.2°±12.8° be?fore surgery to 106.5°±9.8°and 115.4°±7.9° at final follow?up. The average tibiofemoral angle on X?ray decreased from 16.8°±5.3° and 15.2° ± 4.7° preoperatively to 5.6° ± 2.3 and 5.2° ± 2.1° at the final follow?up. The HSS knee score improved from 47.5 ± 7.1 points and 49.6±8.9 points to 89.1±4.6 points and 90.2±5.3 points at final follow?up. The SF?36 scale scores improved from 52.3± 15.4 points and 50.1±17.9 points to 81.6±12.3 points and 82.2±14.5 points at the final follow?up. At the latest follow?up, except the Range of motion, there were no statistically significant in any other indicator between two groups. Two cases appeared postoper?ative deep venous thrombosis symptoms. One case had joint stiffness early, and the symptoms improved after strengthen functional exercise. No infections, delayed knee instability, implant loosening or subsidence was found during the follow?up. Conclusion For patients with mild to moderate knee valgus, both fixed and rotating bearing with same soft tissue balance technique can improve the knee function and correct the valgus deformity, and the recent results are satisfactory.