[Objective]To appraise the indications,essential technical points and selection of prostheses of hemi or total arthroplasty of the shoulder for severe damages of proximal part of humerus.[Method]Twelve cases had an arthroplasty of the shoulder;4 total-arthroplasties and 8 hemi-arthroplasties of the shoulder;6 cases of four parts fractures,2 cases of humeral head osteonecrosis,1 case of osteonecrosis of humeral head and glenoid cavity,2 cases of proliferative arthritis with the shoulder rigidity,1 case of bone humor.The function of the shoulder was evaluated postoperatively according to the methods of Amercian Society of Surgeons for Shoulder and Elbow Joints.All cases were followed up with a mean duration of 14 months.[Result]Twelve cases revealed obvious relief of pain with absence of pain in 8 and mild in 4.Twelve cases had no prosthetic stems loosening.The motion range of the shoulder was improved with a mean abduction of 100.Ten cases had the satisfactory results for treatment.[Conclusion]Hemi or total arthroplastyof shoulder is effective for complicated proximal humeral damages.The key of success is related with scientific operative method,appropriate selection of prostheses,effective rehabilitation plan.

BACKGROUND:Bone marrow mesenchymal stem cels play an osteogenic role under the assistance of scaffold materials. The scaffold cannot only deliver the cels to the bone defect area, but also act as a new bone growth framework. Colagen-chitosan composite is one of ideal scaffold materials in bone tissue engineering, which has osteoinductive ability and better osteogenic ability than conventional scaffolds. Bone transport technology has been widely used in the clinical repair of long bone defects, but it has some deficiencies, such as slow osteogenesis, long time for external fixation and nonunion. How to further accelerate bone formation and reduce complications has become the current problem to be solved. Here, it is hypothesized that bone marrow mesenchymal stem cels/ colagen/chitosan composite scaffold can increase the therapeutic effect of bone transport in the repair of tibial bone defects.
METHODS/DESIGN:This study is a randomized controled animal experiment, includingin vitro andin vivo tests.In vitro test: Bone marrow mesenchymal stem cels are isolated from the bone marrow of New Zealand rabbits aged 1-2 months, and passaged to the third generation. Then, cel suspension is added onto the colagen-chitosan scaffold to construct the bone marrow mesenchymal stem cels/colagen/chitosan composite scaffold.In vivo test: Twenty-four New Zealand rabbits at 3-4 months are selected and randomly assigned to receive bone transport, scaffold implantation, bone transport+scaffold implantation, respectively. The primary outcome measures are the growth of implant materials and bone defect interface, X-ray detection of bone defect repair, hematoxylin-eosin staining and scanning electron microscope observation of bone formation in the bone defect region, immunohistochemical detection of type I colage expression in the osteogenic region, scanning electron microscope observation of interface bonding between implant materials and host bone, ultrastructure and bone formation.
DISCUSSION:The results from this animal experiment wil help to determine the feasibility of bone marrow mesenchymal stem cels/colagen/chitosan composite scaffold to accelerate bone repair during bone defect repair using bone transport technology.

Objective:To retrospectivly study the complications of shoulder arthroscopy surgery in different postures. Methods:A total of 47 patients had taken shoulder arthroscopy surgery. Complications of shoulder arthroscopy surgery in lateral decubitus posture and beach chair posture were compared. Results:Both surgery postures could be taken to complete the shoulder arthroscopy surgery, but beach chair posture was better because of the lower complication rate. Conclusion:Beach chair posture is a better choice for shoulder arthroscopy surgery, which is easy to operate and is also recommended for patients who may be taken the open sugery.

Objective: To evaluate the clinical efficacy of proximal femoral nail antirotation (PFNA) in treatment of elderly incompleted inner wall type intertrochanteric fracture. Methods:The medical records of 33 patients with incompleted inner wall type intertrochanteric fractures were analyzed retrospectively. The incision length,blood loss,operative time,volume of drainage,start standing time,fracture healing time,abnormal rate of femur and complications were summarized,and the clinical effects were also evaluated according to Harris standard. Results:A total of 31 patients achieved complete follow-up data. The fracture healing time and clinical excellent rates were (12.5 ± 3.5) weeks and 90.3%. The abnormal rate of femur operative time, incision length, blood loss, operative time, volume of drainage, and start standing time were 12.9%,(4.3 ± 2.7) cm,(50.2 ± 35.0) ml,(40.3 ± 12.7) min,(30.5 ± 9.6) ml and (10.3 ± 5.7) d. Conclusion:PFNA fixation is an ideal method for treatment of elderly incompleted inner wall type intertrochanteric fractures, with small incision, shorter operative time, shorter fracture healing time, shorter bed rest time and less complications.

BACKGROUND:The use of 3D-printed patient-specific instruments in opening wedge high tibial osteotomy has advantages such as shorter operative time,fewer fluoroscopic exposures,and higher correction accuracy.However,previous studies have reported issues such as significant damage to surrounding soft tissues and improper fixation of the plates. OBJECTIVE:To investigate the clinical efficacy of using 3D-printed patient-specific instruments combined with customized locking plate in opening wedge high tibial osteotomy for the treatment of knee osteoarthritis. METHODS:A total of 20 patients diagnosed with knee osteoarthritis were divided into the 3D group(n=10)and the conventional group(n=10)according to surgical methods.The 3D group underwent opening wedge high tibial osteotomy using 3D-printed patient-specific instruments combined with customized locking plate,while the conventional group underwent opening wedge high tibial osteotomy using conventional methods.The operative time,fluoroscopic exposures,incision length,pre-and postoperative hip-knee-ankle angle,medial proximal tibial angle,posterior tibial slope,the difference between the planned and actual correction angle,preoperative and 1,3,6 months postoperative knee range of motion and Lysholm score,and incidence of complications were analyzed and compared between the two groups. RESULTS AND CONCLUSION:(1)The operative time and fluoroscopic exposures were significantly shorter in the 3D group compared to the conventional group,with a statistically significant difference(P<0.001).(2)Both groups showed a significant improvement in postoperative hip-knee-ankle angle and medial proximal tibial angle compared to preoperative values,with a statistically significant difference(P<0.001),while there was no significant change in posterior tibial slope.In the 3D group,the postoperative hip-knee-ankle angle,medial proximal tibial angle,and posterior tibial slope differed from their respective preoperative planned values by(-0.22±0.72)°,(-0.20±0.73)°,and(0.23±0.37)°,but the differences were not statistically significant.The difference between the planned and actual correction angle of 3D group was significantly smaller than that of conventional group(P<0.05).(3)Both groups showed a gradual increase in knee range of motion and Lysholm scores after surgery(P<0.001).Compared to the conventional group,the 3D group had superior knee range of motion at 1 and 3 months postoperatively,as well as a higher Lysholm score at 1 month postoperatively,with statistically significant differences(P<0.05).There were no statistically significant differences in Lysholm score at 3 months and knee range of motion and Lysholm score at 6 months between the two groups(P>0.05).(4)Complications occurred in neither groups.(5)The above results indicate that both 3D-printed patient-specific instruments combined with customized locking plate and conventional methods have good clinical efficacy.However,the former has a shorter operative time,fewer fluoroscopic exposures,and faster postoperative recovery of knee joint function.Additionally,3D-printed patient-specific instruments can achieve preoperative planning accurately.