BACKGROUND:The traditional repair methods for laryngeal cartilage defect are restricted by donor source, rejection, which are difficult to be popularized. OBJECTIVE:To investigate the effect of polylactic acid-glycolic acid copolymer/hydroxyapatite composite scaffold in repair of laryngeal cartilage defect. METHODS: A total of 20 Wistar rats were randomly divided into polylactic acid-glycolic acid copolymer/hydroxyapatite composite scaffold and polylactic acid-glycolic acid copolymer scaffold groups. Polylactic acid-glycolic acid copolymer/hydroxyapatite composite scaffold and polylactic acid-glycolic acid copolymer scaffold were respectively used for repair after the establishment of laryngeal cartilage defect models. RESULTS AND CONCLUSION: The laryngeal cartilage defect diameter of rats at 3, 5 and 7 days after modeling in the polylactic acid-glycolic acid copolymer/hydroxyapatite composite scaffold group was significantly smaler than that in the polylactic acid-glycolic acid copolymer scaffold group. The laryngeal cartilage defect of rats in the polylactic acid-glycolic acid copolymer/hydroxyapatite composite scaffold group was basicaly repaired and presented with a smooth surface, and there were no clear boundaries with surrounding tissues; however, the laryngeal cartilage defect of rats in the polylactic acid-glycolic acid copolymer scaffold group had indentations with a rough surface, and there were obvious boundaries with surrounding tissues. These results demonstrate that polylactic acid-glycolic acid copolymer/hydroxyapatite composite scaffold can promote the repair of laryngeal cartilage defect part, and its repair effect is more ideal.

[Objective]To explore the efficacy and result of femoral component revision by using impaction bone grafting technique with anatomic cemented stem and freeze-dried allograft.[Method]Anatomic cemented stem combined with freeze-dried allograft were used in IBG for 49 cases of femoral revisions from Jan,2001 to Dec 2005.36 cases(73%)of which had severe bone loss(Paprosky grades ⅢB and Ⅳ).The mean follow-up time was 35.3 months(26~52 months).Harris Hip Score System and radiography were used to evaluate the clinical results.[Result]The mean Harris Hip Score was improved from 44.6 points preoperatively to 88.3 points at final evaluation.Good and excellent scores were about 89.8%.No major femoral stem subsidence was found in our patients.There were one case of dislocation(2%),one case of deep infection(2%)and 3 cases of femoral fractures during operations(6.1%),which were not related to the selection of femoral component and the type of allograft.[Conclusion]The impaction bone grafting technique by using freeze-dried allograft and the anatomic cemented femoral prosthesis for femoral revision was feasible and the short and mid-term result was good.Longer follow-up was needed to evaluate the long term result.

BACKGROUND: Bone defects are widely seen in patients with development dysplasia of hip or revision, thus resulting in a difficulty in acetabular treatment. High placement technique has been suggested to ensure the appropriate bone-prosthesis contact and simplify the surgery. Because biomechanics is involved, it has aroused many concerns,even its curative efficacy.OBJECTIVE: To summarize the research and progress of high placement technique applied in total hip arthroplasty (THA).METHODS: A computer-based online research was conducted for articles published until December 2016 in PubMed and CNKI databases using the keywords of proximal placement, superior placement, high placement, high hip center,elevated hip center, total hip arthroplasty, revision total hip arthroplasty, dysplasia of developmental hip in English and Chinese, respectively. Totally 67 literatures were retrieved, and finally 45 eligible articles were enrolled in accordance with the inclusion criteria.RESULTS AND CONCLUSION: (1) High placement technique is feasible for acetabular bone defects in THA, especially can simplify THA with complicated conditions. (2) Seemingly it goes against the principle of restoring anatomic hip center,but THA with high placement can obtain initial stability based on enough bone contact through adjusting the reconstruction position properly, interface improvement, appropriate prosthesis, as well as developed operations and conception, meanwhile, exposes no effect on biomechanics of hip. (3) Notably, the definition and term of high placement are chaotic in Chinese and English literatures, which need to be standardized further.

Objective To assess the population pharmacokinetic parameters for propofol for Chinese surgical patients using a nonlinear mixed- effect model (NONMEN) program and qualitatively analyze the effects of gender, age and body weight.Methods Seventy-six ASA I - II patients(37 male,39 female) ,aged 17-77 years weighing 39-86 kg. Undergoing elective surgery were studied. The patients were premedicated with intramuscular sodium luminal 0.1 g and scopolamine 0.3 mg. Radial artery was cannulated for blood pressure monitoring and blood sampling. BIS, AEPindex, EGG, BP, PET CO2 and SpO2 were continuously monitored during operation. Anesthesia was induced and maintained with propofol and fentanyl. A loading dose of fentanyl 3 ?g? kg-1 was given iv followed by infusion at 2 ?g ? kg -1? h-1 until 30 min before the end of surgery. Propofol 1 -2.5 mg ?kg -1 was given iv over 0.5-4 min followed by infusion at 3-8 mg ? kg-1? h-1 until the end of surgery. When the patient was unconscious intubation was facilitated with vecuronium 0.1 mg? kg-1 . Blood samples were obtained before propofol and 2-120 min during propofol infusion and 2-600 min after discontinuation of propofol infusion for determination of blood propofol concentration. 1 439 blood samples were analyzed using NONMEM program. Interindividual and intraindividual variability was estimated for clearance and volume of distribution. The effects of age, body weight and gender were investigated. Results The pharmacokinetics of propofol in Chinese patients was best described by a three-compartment pharmacokinetic model . Body weight was found to be a significant factor affecting the two inter-compartmental clearances and the volume of the central compartment. The shallow and deep peripheral compartments remained constant for all individuals. For a 60 kg adult these parameters were estimated to be 1.56 L?min-1, 0.737 L?min-1 , 0.360L?min-1 ,12.1 L,43 L,213 L,respectively. For elderly patients, the clearances and volume of central compartment decreased with increasing age. Conclusions The pharmacokinetics of propofol in Chinese patients can be well described by a standard three-compartment pharmacokinetic model. Age and body weight can affect the parameters of the pharmacokinetic model. Pharmacokinetics adjusted to the individual patient should improve the precision of TCI system.

The effect of the selective debridement with the aid of the arthroscope performed under local anesthesia for osfeoarthritis of 296 knees in 260 patients was studied. The pathological changes of osteoarthritis under the arthroscopy include hyperplasia of synovial membrane, degeneration of cartilage or exposure of subchondral bone on the stress areas of the femur condyles and patella , wear and tear of meniscus, formation of osteophyte and loose body. The debridement included the removal of the loose body, hyperplasia of synovial membrane, degenerated cartilage, and the torn meniscus. Many factors,including age of the patients, selection of the indication, stress of the knee joint, and the degeneration of cartilage,may influence the curative effect. After selecfive debridement and lavage for osteoarthritis of the knee joint, the majority of patients were released from pain, with restoration of function and range of motion, and the development of pathological process was retarded. Good and excellent results constitute 74.7% of the patients.

[Objective]To explore the efficacy and results of tibial tubercle osteotomy used in exposure in complicated total knee arthroplasty.[Methods]During the period from Apr.2005 to Apr.2007,the tibial tubercle osteotomy were used in 16 cases of complicated total knee arthroplasty.The mean follow-up time were 20 months(6～26 months).Knee society score(KSS) and radiography were used to evaluate the clinical results.[Results]The mean KSS improved from 46 points preoperatively to 91 points postoperatively.The mean ROM improved to from 53?preoperatively 105?postoperatively.At 3 months after surgery the radiography examines showed all 16 cases had achieved satisfactory healing.The tubercle fragment slided toward proximal 0.7 cm occurred in one case,and finally healed at that position.[Conclusion]Exposure of the knee may be difficult in the total knee arthroplasty,but tibial tubercle osteotomy is a safe and reliable procedure which affords excellent exposure.

[Objective]To evaluate the safety outcome of the 12 patients with simultaneous multiple joint replacement(≥3) in the recent three years.[Method]The complication rates,blood loss,transfusion volume,and hospital stay were analyzed in details.[Result]The mean operating time was 9 hours and 8 minutes(6 hours and 25 minutes to 12 hours).The mean overall volume of blood loss was 3140ml(1 000 ml-5 600 ml.Complications included reactive digestive ulcer in one case,acetabular component position error in one case,and deep infection in one hip of one case.[Conclusion]Simultaneous multiple joint replacement is an alternative protocol to the patients with multiple joint disorders.finished under a single aesthesia and in a single hospital stay.So the overall economical cost will be decreased,and rehabilitation being accelerated.Disadvantages include serious trauma,increased blood loss,and complications may be some how increased.

Objective To compare the results of one-stage bilateral total hip arthroplasty (THA) and staged bilateral THA, and to determine the safety and efficacy of one-stage simultaneous bilateral THA. Methods The patients who were indicated for with bilateral THA were divided into 2 groups. Gourp A included 87 patients with one-stage simultaneous bilateral THA, and Group B included 31 patients with staged bilateral THA. The operating time, the amount of blood loss, the amount of blood transfusion necessary, post-operation functional scores, and perioperative complications were compared between group A and group B. Result There was no significant difference between group A and group B. Conclusion One-stage simultaneous bilateral total hip arthroplasty was a safe and efficacious procedure.

Objective Experimental and clinical data suggest that fixed element knee designs a re not able to both supply adequate mobility and eliminate unnecessary constra int forces,as well as provide low contact stresses compatible with pr olonged life of UHMWPE bearing components.The present study investi-gated the preliminary clinical outc ome of TACK(Total Articulating Cementless Knee)system,a new design of mobile-bearing knee prosthesis.Methods Eighty-eight knees in 61patients underwent total knee replace-ment by using TACK were reviewed.Forty-five knees of 31patients were followed-up at least one year.The HSS knee rating score system as well a s X-ray films were used to evaluate th e clinical results with the mean follow-up period of 25.4months.Results At the latest follow-up examination,the rate of good to excellent clinical results was 96.4%.The range of motion was improved from 0-6.5-68.3degrees preoperatively to0-2-88.4degrees at the latest follo w-up.The complications such as oste olysis around the prosthesis,prosthetic loosening and dislocation of meniscus bearings were not found.Conclusion The TACK Knee is a third generation knee system design ed to introduce movable bearings between the metal tibial and femoral components that would reduce the sur face and subsurface stress states at the bearing surfaces and at the bone-implant interfaces by maximiz ing the conformity of the tibial and f emoral components and allowing mo-bility of the bearing surface.In an a verage of more than two years experie nce,it was observed that there was no aseptic loosening of the componen ts.A long term follow-up is obviously necessary to make more precise statement about this knee replaceme nt system.

Objective To discuss the treatment of intraoperative periprosthetic fractures on the femoral side,and to evaluate the results of functional recovery after treatment.Methods Fifty-four cases of intraoperative periprosthetic fractures on the femoral side encountered from July 2002 to December 2006 were retrospectively studied.Fractures on the femoral side were classified by Mallory classification system.X-ray films were taken to evaluate the healing patterns of the fractures.Results Cerclage wires were adequate for stable type I and type Ⅱ fractures,while it could be treated expectantly when the fracture did not involve proximal femur in stable type Ⅱ.Unstable type Ⅱ fractures were taken care of with a long-stem uncementoid component.Type Ⅲ fractures were taken care of with a long-stem uncementoid component or LCP plate.Additional cortical strut allografts were used for the management of unstable fractures and the fractures with poor host bone stock.The average follow-up time was 23.5 months(5-52 months).All fractures were healed as shown by radiography except one case of type I fracture.There was no evidence of loosening or periprosthetic osteolysis on follow up radiograph.The mean postoperative Harris Hip Score was 94.5.Conclusion The treatment of intraoperative periprosthetic fracture around the femoral implant can successfully restore the function of the hip joint in most patients.Cerclage wires,long-stem uncementoid component and additional cortical strut allograft were effective treatment methods for different types of intraoperative periprosthetic fractures on the femoral side.Expectant treatment can achieve satisfactory result in stable type II fractures when the fracture did not destroy proximal femur.