Objective To propose measures to reconstruct the massive bone defect in acetabulum in revision hip arthroplasty on the basis of the experience in the cases treated by the authors. Methods Thirty- two hips of 33 hip revision cases with massive bone defect being operated on by the first author were summarized and analyzed. The patients included 17 males and 15 females, with the age of 40 to 90 years. 28 cases (29 hips) underwent revision for the first time, 2 cases (2 hips) for the second time,1 case (1 hip) for the third and the other 1 case (1 hip)for the fourth time. The primary surgery were artificial femoral head replacement in 8 cases (8 hips) and total hip replacement in 24 cases (25 hips). Except of 2 saddle protheses replacement, bone grafts, mainly cancellous bone grafts, were used in 31 hips, of which 22 hips were non- structural bone grafts and 9 hips were allografts of femoral head or autograft of ilium. After grafting, ready- made acetabular prostheses were implanted in 9 hips, while special prostheses were used in 24 hips, chiefly computer- aided custom- made acetabular prostheses, including winged prostheses, 2- layer metal mesh, acetabular reinforcing rings (ARR), bi- spherical prostheses, crested prostheses and saddle type prostheses. Results In the course of 0.5 to 11 years' follow- up, re- displacement or relapse of bone absorption was not found in any of the cases. The Harris hip function score rose to 54－ 89 from the pre- operative level of 17－ 48. The computer- aided custom- made acetabular prostheses could better meet the requirements of different conditions of disease, thereby reducing the difficulties of surgery. Conclusion Special prostheses have the advantages of better compatibility with the individual requirements, prevention of displacement or collapse of the bone graft and higher primary stability. The proper application of bone graft and choice of suitable prosthesis to achieve the reconstruction of acetabular fossa and the integrity of acetabular circumference will markedly improve the success rate of revision surgery.

Objective To summarize the experience in CAD / CAM custom-made hemipelvic prosthesis and its application in 8 patients. Methods The exact model of pelvis was generated with its CT data by Rapid Prototyping Technique (RPT). Simulated bone resection and prosthesis design were performed on the models. The prosthesis should be fixed simultaneously on the contralateral pubic ramus (or the remainder of pubis), the joint facet of sacrum (or the remainder of ilium) and on the remained ischium if part of it could be preserved. When prosthesis was put in place, the acetabular component should be symmetric with the contralateral acetabulum in terms of the height, lateral distance and abduction angle, after it's fixation on the remained pelvis with cancellous screws, bolts and hooks, conventional total hip implants with cemented acetabular and cementless femoral prothesis were implanted. 8 patients underwent this kind of procedure, of them 7 suffered from large pelvic tumor, including 2 chondrosarcoma, 3 giant cell tumors, 1 cartilaginous fibrodysplasia and 1 metastasis. One patient received this procedure for severe osteolysis after THA. Tumor artery embolization was done in 6 of them 24-48 h before operation. Results Blood transfusion was 4971 ml in average. The implantation of prosthesis was easily accessible. One suffered from remained sinus, and healed after myocutaneous flap transferring. All patients began non-weight bearing walk with double crutches 6 weeks after operation and gradually abandoned crutches in 3 months. One patient with chondrosarcoma died of lung metastasis 9 months after operation. No loosening was found during the 1 to 4 years (2.5 years in average) follow-up of the 7 cases. The position of bilateral hips was symmetric. They all recovered to self-care. Two of them returned to work 7 and 8 months after operation respectively. One local recurrence happened and was resected again. Conclusion The custom-made hemipelvic prosthesis generated with RPT and CAD/CAM can improve the prosthesis fixation, ensure the exact orientation of acetabular component and make the operation easy.

Objective To evaluate the clinical outcome of total hip arthroplasty (THA) for protrusio acetabuli. Methods Between 2003 to 2008, 31 patients(35 hips) with protrusio acetabuli were treated with THA, including 16 males (18 hips) and 15 females (17 hips). The age ranged from 36 to 71 years (average age 52.2 years). The femoral heads were moved out with retrograde method when necessary via posterior-lateral hip incision. The acetabular loops and bottoms were prepared respectively. Auto-bone grafting was used to repair acetabular defects and cementless prostheses were planted with press-fit skills. At follow-up visit,the hip functions were evaluated by Harris score. The loosening, re-protrusion and the union of graft bone was judged by X-ray. Results The mean follow-up was 46.5 months (19-152 months). One patient developed DVT on the second day post-operatively who recovered well after anticoagulation treatment. One patient complained of gentle thigh pain which disappeared at 6 months. No other complication was found. The mean Harris scores had improved from 48.9±6.5 pre-operatively to 91.2±5.7 post-operatively. All prostheses acquired bone stabilization with no sign of loosening and re-protrusion and the grafts bone were healed at a mean 6 months according to X-ray. Conclusion THA with acetabular bone grafting and cementless component for protrusio acetabuli have acquired excellent results and prevented loosening and re-protrusio effectively.

Objective To study the effect of IL-12 on Th1/Th2 cytokine expression level and the role of IL-12 in the shi ft ing of Th1/Th2 immune response against blood-stage Plasmodium b e ighei infection in mice. Methods [WT5”BZ ]BALB/c mice were infected with 5?105 parasitized RBC and received doses of 0.03 or 0.15 ?g/d of IL-12 on the day of infection and daily for 6 days post -in fection. The levels of IFN-? and IL-4 in sera or supernatants of splenic lymp hocyte cultured in vitro were detected by the EL ISA method. Results Compared with spleen cells fro m untreated mice, spleen cells from 0.03 ?g dose of IL-12-treated mice produ ced significantly higher level of Th1-associated cytokine IFN -?, but lower level of Th2-associated cytokine IL-4 in response to PHA or sA g stimulation on day 7 post-infection, whereas spleen cells from 0.15 ?g dose I L-1 2-treated mice produced significantly lower levels of IFN-? and IL-4. The le vel of IFN-? was apparent in the sera of mice treated with 0.03 or 0.15 ?g/d I L-12 on day 3 post-infection and peaked on the day 5 post-infection, but level of I FN-? even was significantly lower in mice treated with 0.15 ?g/d IL-12 comp ara ble to that in control mice on day 7 post-infection. The level of IFN-? was n ot detected in the sera of control mice through 7 days post-infection. [WT5” H Z] Conclusion Appropriate dose of IL-12 regulates the deve lop ment of resistance to P.berghei via a CD 4+ T h1 response, which involves the cytokines IFN-?. [HT5”SS] However, higher doses of IL-12 dramatically inhibite immune pro t ective ability, which may be detrimental to resistance against P .berghei infection. [

Objective: To observe the clinical effect of tuina in rehabilitation following total hip replacement. Methods: 60 cases were randomly allocated into a treatment group and control group, 30 cases in each group. Cases in the treatment were treated with combined mina and rehabilitation, while cases in the control group were treated with rehabilitation alone. All treatment retained for two weeks. The results were observed 7 d, 2 weeks and 6 weeks following the total hip replacement using Harris scale and Hamilton Anxiety Rating Scale (HAMA).Results: For Harris scale, there were significant intra-group differences in different time frames (P＜0.05); there were no statistical differences between the two groups 1 d, 7 d and 6 weeks following the total hip replacement (P＞0.05); and there were statistical differences between the two groups 2 weeks following the total hip replacement. For HAMA scale, there were significant intra-group differences in different time frames (P＜0.05); there were no significant differences between the two groups 1 d following the total hip replacement; and there were substantial differences between the two groups 7 d, 2 weeks and 6 weeks following the total hip replacement. Conclusion: In a given unit time, combined mina and rehabilitation is superior to rehabilitation alone in improving the patients' post-operative pain, articular range of motion and anxiety.

Objective To investigate the clinical value of proximal femoral nail antirotation ( PFNA) in treatment of intertrochanteric fractures.Methods From April 2007 to July 2009,112 patients with intertrochanteric fractures were treated by using PFNA.There were 34 males and 78 females,at mean age of 76 years.Of all,80 patients were with type 31-A2 fracture and 32 with type 31-A3 fractures according to AO classification.According to Singh index classification,there were 4 patients at grade Ⅰ,21 at grade Ⅱ,70 at grade Ⅲ and 15 at grade Ⅳ.The fracture was caused by low-energy injury in 97 patients and by high-energy injury in 15.The Salvati-Wilson score was used to evaluate the hip function postoperatively.Results Ninety patients received 12-24 months follow-up (average 18.6 months).The Salvati-Wilson score was (29.98 ± 5.18 ) points.The result was excellent in 41 patients,good in 40,fair in 6 and poor in 3,with excellenct rate of 90％.The introduction of the nail in operation was difficult in 22 patients,of which 3 patients suffered femoral cortex rupture.Displacement or separation of the fracture segments occurred in 34 patients and distal locking difficulty in nine during the screw blade tapping process.Local complications included hip pain in 21 patients,thigh pain in 4,apparent coxa vara in 2 and delayed healing in 7.There were no cutting-out or femoral shaft fractures no matter what type of Singh index was.The systemic complications included cardiovascular and cerebrovascular disease in one patient,pulmonary infection in four,deep vein embolism in one and perineum congestion or swelling in seventeen.Conclusion PFNA is effective in treating intertrochanteric fractures especially osteoporotic fractures,but delayed healing of the fractures and the mismatch between the intramedullary nail and the proximal femoral morphology remain to be addressed.

Humans ; Asthma/drug therapy* ; Biological Therapy