BACKGROUND:For evaluation of risks of periprosthetic fractures in elderly patients aged>75 years old after hemiarthroplasty, we should perform dynamic observation of postoperative physical health status, quality of life, hip function and bone mineral density. Presently, there is lack of general investigation.
OBJECTIVE:To provide references for clinical diagnosis and prediction of periprosthetic fractures after hemiarthroplasty in elderly patients.
METHODS:On the basis of arranging the exploration results of recent studies on risk factors for periprosthetic fractures of hip joint, we analyzed the monitoring method of scholars concerning fracture-associated risk factors. Simultaneously, in combination of the development of modern inspection sciences, the method was applied in the clinic. Thus, we summarized general evaluation methods with clinical significance for risk factors of prosthesis fracture in elderly patients after hemiarthroplasty.
RESULTS AND CONCLUSION:For elderly patients with femoral neck or intertrochanteric fracture combined with various medical il ness, hemiarthroplasty is an effective manner presently. Fractures surrounding the prosthesis in elderly patients postoperatively gradual y increased. Once fracture appeared, it would bring a great attack on patients’ spirit, economy and even life. Therefore, early evaluation on the risk factors for fractures surrounding the prosthesis is a necessary measure for preventing and saving this disastrous consequence by selecting general correct prevention and treatment strategies. This wil greatly improve patients’ prognosis and elevated patient’s quality of life and survival rate. Present short-term smal-sample prospective fol ow-up studies suggested that comprehensive dynamic evaluation possibly has a certain clinical significance for the evaluation of risks of fractures after hemiarthroplasty in elderly patients, and deserves further investigations.

Objective To evaluate the result of short-segment pedicle screw instrumentation plus pedicle screws inserted into the injury level for treatment of thoracolumbar burst fracture.Methods Fifty-six cases of thoracolumbar burst fracture treated from June 2008 to June 2011 were reviewed.There were 40 males and 16 females at mean age of 32.8 years (range,25-60 years).Twenty-four cases were injured from traffic accidents,19 cases from fall from the height,and 13 cases from fall of heavy objects.Fractured segments were T11 in 6 cases,T12 in 14 cases,L1 in 16 cases,L2 in 12 cases,L3in 5 cases,and L4 in 3 cases.Thirty cases underwent short-segment pedicle screw fixation through the level above the fracture to level below the fracture (Group A).Apart from this,26 cases were treated with additional transpedicular fixation at the fractured level (Group B).Anterior vertebral height ratio,sagittal Cobb' s angle,neurologic performance as evaluated by American Spinal Injury Association (ASIA) scale were assessed before operation,one week after operation,and one year after operation.Results Anterior vertebral height ratio and Cobb' s angle revealed no significant differences between the two groups before operation and one week after operation.At postoperative one year,anterior vertebral height ratio and sagittal Cobb' s angle were (87.2 ± 6.9)％ and (7.6 ± 3.2)°in Group A with significant differences from (93.3 5.7)％ and (5.7 ± 1.9) ° in Group B (P ＜ 0.05),but there was no statistical difference in ASIA scale of neurologic performance.Conclusion Short-segment pedicle screw instrumentation with stabilization at the level of fracture is an effective treatment for thoracolumbar burst fracture.

[Objective]Microsurgical lumbar discectomy(MSLD)and microendoscopic discoectomy(MED)were compared in methods and curative effect for providing the experience and therapy evidence of lumbar disc herniation(LDH).[Method]It was retrospectively analyzed that mono-segment lumbar disc herniation were treated in minimal invasion in our hospital.MSLD was 45 cases and MED was 32 cases.Operation time,operation information,complication,hospital time and curative effect were compared.[Result]The satisfactory rate of two groups were both beyond 90% and no significant deviation was found.The incision of MED was obviously shorter than MSLD and the operation time of MED was longer than latter.[Conclusion]The curative effects of two minimal invasion methods are satisfactory.But the indication of MED is limited obviously and the method has not obvious predominance by compared with MSLD.MSLD is an more ideal minimal invasion operation at present.

[Objective]To evaluate the effect of the tissue engineered nerve for bridging and repairing verve defect.[Method]Human bone marrow stromal cells(hBMSCs) were purified with centrifugate method,cultured in DMEM,induced with ATRA,BDGF and affected by heregulin,forsholin,bFGF(basic fibroblast growth factor),and PDGF(platelet-derived growth factor) of hBMSCs).The protein positive rate of S100 and GFAP of hBMSCs were determined by immunohistochmical staining.The tissue engineered nerves were constructed with hBMSCs mixed with extra-cellular matrix(ECM) and polylactic acid(PLA) tube.A 10mm defect of sciatic nerve was created in 24 Wistar mouse right limbs and ramdonly divided into three groups: group A(n=8),nerve defects bridged with polylactic acid(PLA) tube containing induced Schwann cells mixed with ECM,group B(n=8),with PLA tube containing ECM,group C(n=8) with autologous nerve graft.Functional recovery of nerve was examined by electrophysiological method and histological changes were examined with histological stainning of nerve and measurement quantity of new axon.[Result]The Schwann cells were presented at 12 wks after operation.The histologic and functional recovery of nerves of group A and group C were better than those of group B.the showed significant difference between group A or group C and group B and no significant difference between group A and group C.(PAB=0.021,PBC=0.001,PAC=0.065).Degradation of PLA tubes showed in group A and group B.[Conclusion]Schwann cells could be induced from hBMSCs,and the tissue engineered nerves,which were contructed by induced Schwann cells mixed with ECM and PLA tube,could be used to bridged and repair the peripheral nerve defect.

[Objective]To summarize and evaluate the curative effect of anterior decompression approach by using cervical retractor systems to treat cervical spondylosis.[Method]From April 2002 to October 2004,68 cases were performed anterior undermined far-reaching decompression and fusion with autograft and titanium plate internal fixation by using removing disc merely at the single-level or separately at the multilevels employing CCR self-retractor and Caspar cervical retractor systems via interspinal approach.The cases were followed up,and serial roantgcnographic evaluations being applied.Then the height of involved intcrspinal space was measured preoperatively and after 12 months postoperatively,and the spinal function was evaluated in accordance with the standard of Japanese Orthopeadic Association(JOA),and then all results were compared statistically.[Result]51 of all cases were followed up,of which 50 were better,1 was improved,no one worsened.After 12 months postoperatively,roentgenographic appearance showed that the allograft healing and interbody fusion of all patients were achieved,and the reserving height of involved interspinal space and JOA evaluation postoperatively were significantly superior to both preoperatively.No complications such as cervical spinal cord injury,internal fixation unfastening,and hematoma turned up.[Conclusion]Anterior decompression approach by using cervical retractor systems to treat cervical spondylosis could better reserve the height of involved interspinal space,and improve the spinal function significantly.

BACKGROUND:Fractures of the coronoid progress are common in patients with elbow dislocations, and often accompanied by elbow ligament and joint capsule laceration. The coronoid progress fracture often leads to elbow joint instability, if cannot get the correct therapy, wil result in repeatedly elbow instability, dislocation, and cause long-term irreversible damage to the elbow. OBJECTIVE:To review the literatures about coronoid fractures and relative anatomic and biomechanical studies. METHODS:An electronic search of the Web of Science database was conducted for clinical and experimental researches about coronoid fractures and relative anatomic and biomechanics published from January 1990 to March 2013, the key words were“coronoid process of the ulna, coronoid fracture, treatment method, research progress”. The articles published earlier and repetitive researches were excluded. RESULTS AND CONCLUSION:Coronoid process is an important primary stabilizer of elbow joint, The coronoid process combined with the soft tissues of ligaments, joint capsule and muscles that attached on the coronoid plays an important role in maintaining the elbow axial, varus, valgus and rotation stability. The selection of the treatment strategies for coronoid process fracture depends on the fracture type, degree of fracture fragments crush and injury of medial and lateral col ateral ligament and the anterior capsule. Uncomminuted large fractures can be treated with open reduction and internal fixation;comminuted fractures can be treated with reduction and internal fixation by the largest fracture fragments, autograft reconstruction or artificial coronoid process replacement;the repair of smal coronoid process fracture depends on the circumstances;if the elbow gets enough stability after repair of soft tissue injury, it cannot be addressed, if not, the elbow should be repaired with sutures or anchors. Earlier motion after operation is important to get better function, and the hinged external fixator can be used if necessary.

Objective To evalute the feasibility of a double hand allogroft to reconstuct the limbs'function. Methods A brain dead donor was chosen under the test of blood group in ABO and Rh,HLA match,PRA and the mixed leukocyte culture.The level of the transplantated hands was 5 cm proximal to the wrists The procedure of the allotransplantation was similar to that of the autologous replantation.The immunosuppressants were taken two days before the operation,in the operation and after the operation. The circulation,the vital signs and the rejection were under the supervision. Results The progress was satisfactory. No rejection was found postoperation.After 10 weeks the callus in both ends of radius and ulna was obvious.After 5 months sensation recovered.After 7 months the internal fixation(plates and screws) was removed and tenolysis was done. Now the recipient could use engrafted hands to wash face,make the bed,wear clothes,brush teeth,peel oranges,eat with a spoon,tie the shoelace slowly,pick up a telephoneor and use the conroller of Television. Conclusions With the immunosuppressive agents,the double hands allograft can survive.The growth rate of bone and nerve is faster than that of autologous replantation.

Objective To explore the application and clinical effect of bipolar hemiarthroplasty with bipolar prosthesis on unstable intertrochanteric fracture in the elderly patients.Methods The study involved 53 patients aged over 75 years with intertrochanteric fracture treated with bipolar hemiarthroplasty in our hospital from April 2003 to January 2010.According to Evans-Jensen classification,there were 24 patients with type Ⅲ fractures,eight with type Ⅳ and 11 with type Ⅴ.Osteoporosis degree was at Singh degree Ⅰ in 13 patients,degreeⅡ in 18,degree Ⅲ in 12 and degree Ⅳ in 10.Most patients underwent operation within three days after injury.Results The operation duration was(75 ±10)min,with intraoperative blood loss of(350 ± 68)ml.Three patients were lost to follow-up after discharge and one patient was died of respiratory failure caused by chronic bronchitis five months after operation.Forty-nine patients were followed up for 12-93 months(mean 38 months),which showed no joint dislocation,or loosening,subsidence or rupture of the prosthesis.According to the Harris score of hip joint,the result at final follow-up was excellent in 29 patients,good in 13 and fair in seven,with excellence rate of 86％.Conclusions Bipolar hemiarthroplasty is an effective treatment for osteoporotic and unstable intertrochanteric fractures in the elderly patients.However,as the complemented therapeutic method of proximal femoral nail antirotation(PFNA),bipolar hemiarthroplasty has severe secondary trauma and its indications must be strictly mastered.

Objective To explore the clinical application of lesser saphenous-sural nerve adipofascial flap accompanied with a full-thickness skin graft taken from the groin area for reconstruction of the distal one third of anterior tibia,.around the ankle. Methods A distally based lesser saphenous.sural nerve adipofag.cial flap accompanied with a full-thickness skin graft which was taken from the groin area was studied and used to treat 12 patients with soft tissue defects in the distal one third of anterior tibia,3 cases with soft tissue defects and tibia osteomyelitis,2 cases with soft tissue defects and tibia osteomyelitis.The size of the soft tissue defects ranged from 3 cm×5 cm to 9 cm×13 cm,and the biggest donor flap was 13 cm×18 cm.The donor sites at the posterior aspect of the leg and at the groin area were closed primarily. Results All 17 patients were followed up for 6-12 months(average 9 months).All 17 flaps had good perfusion and survived completely,which successfully treated all 17 patients with soft tissue defects or with both soft tissue defects and osteomyelitis.The donor and recipient sites of adipofascial flaps and the groin area healed primarily,and satisfactory appearance and function were achieved.Conclusion Distally based lesser saphenous-sural nerve adipofascial flap accompanied with a full-thickness skin graft which was taken from the groin area can reconstruct the distal one third of anterior tibia,around the ankle,and even treat osetomyelitis successfully,in the same time,which can preserve the function and appearance of the involved limb to the utmost.

BACKGROUND: In the process of limb allograft, apoptosis of target cell is one of the main mechanisms of dysfunction of allograft, which might lead to the failure of allotransplantation. It is assumed that immunosuppressant may relate with cell apoptosis. OBJECTIVE: To investigate effects of FK506 on Bcl-2 mRNA and Bax mRNA expressions and cell apoptosis in rat limb allograft. DESIGN, TIME AND SETTING: The randomized controlled animal trial was performed at the Animal Experimental Center of First Hospital of Harbin Medical University from June 2005 to November 2006. MATERIALS: Fifty-six clean-grade healthy male SD recipient rats and 56 Wistar donor rats were selected. FK506 was product of Fujisawa, Japan (No. 100143G). METHODS: Right hind limb was separated from the upper segment of thigh of SD rat (donor), and washed using heparin saline. The recipient rates underwent limb allotransplantation from allogenetic Wistar to establish injury model. The recipients were randomly divided into two groups (n=28): immunosuppressant group was injected with FK506 1 mg/kg per day, and the control group was not given any immunosuppressant. The right hind limb including skin, subcutaneous tissues, muscles and femoral arteriolar-venular tissue mass were harvested on postoperative days 1, 3, 5, and 7. MAIN OUTCOME MEASURES: Bcl-2 Mrna and Bax mRNA expression were detected using reverse transcription polymerase chain reaction (RT-PCR), and cell apoptosis was detected using in situ terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate nick end labeling technique. RESULTS: Fifty-six model rats were included in final analysis. On the 3, 5, and 7 days after FK506 injection, Bcl-2 mRNA expression in immunosuppressant group was significantly higher than the control group (t=7.18-21.20, P