1?g/ml)could inhibit osteoblasts to grow and proliferate, and showed cytotoxic activity. Conclusion aFGF possesses the effect of triggering osteoblasts to grow and proliferate, and its effective concentration is 10-100 ng/ml.

[Objective]To find an effective method of surgical treatment of fibrous dysplasia of bone involving the femur associated with severe varus deformity.[Method]Thirteen patients with fibrous dysplasia of bone involving 14 femurs with severe varus deformity were reviewed from Feb 2002 and Jul 2005.Medial displacement of valgus or valgus osteotomies,curettage and allograft,reconstructional nail have been adolted to treat fibrous dysplasia of bone involving the femur with severe varus deformity.[Result]All patients were followed up from 8 months to 41 months with an average of 21 months.Forteen femoral mechanical alignments(axis)had been corrected completely rdiologically;the preoperative average neck-shaft angle of 75?(range,55?~100?),corrected to the average 120?(range,95 ?~135?)of postoperative,the average shortening of the femur was 3.4 cm(range,2.0~4.5 cm)preoperatively,then enlongthened by 2.8 cm(range,1.8~3.6 cm)in postoperation.Ninteen location of osteotomies showed good union in 14 femur.All bone grafts were absorbed slightly beginning at 3 months and markedly at 10 to 14 months postoperatively.Preoperation,4 patients walked with bilateral crutches,2 used unilateral cane,5 can't walk due to pathological fracture,2 without support;after operation,11 patients walk without support,2 ambulated with the aid of unilateracane.Eleven patients were painless,2 moderate pain.All had no infections and recurrent fracture and progression of the deformity.[Conclusion](1)This method can correct varus deformity,improve function,as well as restore biomechanical axis of femur.(2)It is able to effectively eradicate lesions and prevent recurrence.(3)Impaction allograft is the key of prompting allograft incorporating fully and preventing pathological fracture.

Objective To analyze the effect of reconstruction for the proximal or distal femoral defect by a composite of massive frozen allograft and prosthesis replacement. Methods According to Enneking's classification, malignant bone tumors of the proximal or distal femur were widely resected in 28 cases. Reconstruction of the affected hip or knee joint after major joint removal was done by a composite of allograft and prosthesis. A conventional femoral component with a stem long enough to provide good fixation in the femoral shaft was threaded over a customized allograft. After the assembly had been reduced and checked for size and position, the allograft was cemented to the femoral component, and the composite was in turn cemented into the femoral shaft with PMMA. Results 26 patients were followed up from 6 to 78 months with an average of 41 months. 3 cases died within 18 months following operation; 4 case sustained recurrences within 8 months postoperatively, and underwent re-resection; and the others were alive without diseases. All patients had no dislocation, loosening or breakage of prosthesis. X-rays showed the time of bone healing between allograft and host femur was an average of 7.4 months (range, 5 to 11 months), and the rate of bone healing was 92% (24/26). Absorption was seen around allograft greater trochanter of femur in 9 cases and at femoral condyle in 6 cases. 13 cases with total hip composite replacement had good active extension-flexion degrees of an average of 85?( range, 71? to 124?), and 13 with total knee composite replacement had a rang of motion of 92?(range, 68? to 135?). The postoperative average ISOLS scale score of 26 cases by Enneking's system was 26.2 point (range, 22 to 28). Conclusion The clinical result demonstrated the composite of massive frozen allograft and prosthesis replacement has the advantages of both allograft and prosthesis. Its best indications are that the patients with a major femoral defect from benign or low grade malignant tumor have longer survival expectancy.

[Objective]To analyze the effect of renal replacement therapy on the wound of crush syndrome patients,and to provide better clinic evidence for scheduling the therapy strategy of crush syndrome.[Method]The clinic data of patients suffering from crush syndrome during Wenchuan earthquake were collected and classified into Group A treated by renal replacement therapy and Group B theraped by other treatments except renal replacement therapy.Wound infection rate,wound active artery bleeding occurrence,and the volume of oozes in fasciotomy wound between these two groups were compared.[Result]There was statistically significant difference in the rate of wound infection between Group A and Group B(P=0.006).The most common pathogens were acinetobacter spp,pseudomonas aeruginosa,and enterobacter spp in Group A,and these pathogens were all multi drug-resistant.There was statistically significant difference in the volume of oozes in incisive wound between these two groups(P=0.000).[Conclusion]Renal replacement therapy would increase the volume of oozes,raise the rate of wound infection,and be susceptiblely infected by multi drug-resistant pathogen.

Objective To assess the outcomes of the surgical treatment of supination external rotation trimalleolar fractures,comparing the techniques of lateral plating and antiglide plating as described previously.Methods This is a retrospective review.A total of 31 patients meeting our inclusion criteria,with supination external rotation trimalleolar fractures surgically treated between 2009 and 2011,were studied.17 patients were treated with antiglide plating,whereas the remaining 14 patients underwent traditional lateral plating.They were followed up by a period ranging from 14 to 38 months(average,26 months).The functional results were evaluated with olerud and molander scoring system described previously.All the data including time to surgery,operating room time,tourniquet time,hospital stay and ankle joint function scores,were respectively analyzed in accordance with the complete randomized design t-test.Results There was no statistically significant in time to surgery,operating room,tourniquet time,hospital stay and ankle joint functional scores.Conclusions The outcome of the surgical management of supination external rotation trimalleolar fracture is comparable with both techniques.Our data do not support one technique over the other.

Objective To determine the risk factors associated with surgical site infection in closed calcaneal fractures.Methods A retrospective analysis was made on the clinical data of 312 patients with closed calcaneal fracture who had been treated by open plate osteosynthesis at our trauma centre from January 2008 to November 2014.They were 182 males and 130 females,from 18 to 75 years of age (average,44.3 years).By Sanders classification,52 cases were type Ⅱ,146 type Ⅲ,and 114 type Ⅳ.The fractures were caused by fall from a height in 159 cases,traffic accident in 97 ones,and crushing in 56 ones.All the patients received open reduction and internal fixation via a typical L-shaped lateral incision.Gender,age,cause for injury,smoking history,diabetes,interval between injury and operation,operation time and bone grafting were analyzed as possible risk factors in the study.Multivariate logistic regression was conducted for significant risk factors derived from the univariate analysis.Results The patients were divided into an infection group (28 cases,9.0％) and a non-infection group (284 cases,91.0％).The univariate analysis showed that the rate of smoking was significantly higher,the operation time significantly longer,the interval between injury and operation significantly shorter in the infection group than in the non-infection group (P ＜ 0.05).However,the logistic regression analysis revealed that operation time was the only independent risk factor for surgical site infection (P =0.005,OR =43.870).Conclusion Since operation time may be an independent risk factor for surgical site infection in closed calcaneal fracture,it is important to speed up surgery as quick as possible in control of surgical site infection as long as the surgical quality is ensured.

Objective To evaluate and analyse the effectiveness of surgical treatment for fibrous dysplasia in proximal femur with severe varus deformity.Methods A retrospective study was performed in 21 patients (24 femora)of fibrous dysplasia who were treated in our hospital between August 2000 and May 2009.All patients had severe femoral varus deformity.The four-step procedures were performed orderlv as valgus osteotomy,lesion curettage,impacting of massive bone allograft,and fixation by femoral intramedullary nail.There were 6 patients with monostotic disease,15 with polyostotic diseases,including 12 males and 9 females with a mean age of 22.7 years(range,14-39 years).The average neck-shaft angle and femoral varus angle was 75°(range 55°-105°)and 30°(range,18°-45°),respectively.The average length of thigh shortened 3.4 cm(range,2.0-4.5 cm)compared with the contralateral thigh.Results All of the 21 patients were followed up from 21 months to 7 years with an average period of 3 years and 4 months.There were 30 osteotomy sites in 24 femurs,28 osteotomy sites showed bone union after 3-6 months from surgery.Two distal location of the double-level osteotomy showed nonunion,which received bone grafting again and got bone union after 3 months finally.The femoral mechanical alignments of the 21 patients had been recriticd.The average neck-shaft angle was 118°(range,95°-135°)postoperatively,the femoral varus angle disappeared.The average extremity lengthening was 2.8 cm(range,1.8-3.6 cm)postoperatively.There were no infection,recurrent fracture and progression of deformity.The visual analogue scales(VAS)score of 17 patients decreased to zero postoperatively from 7-10 preoperatively,and that of the other 4 patients decreased to 3-4 postoperatively from 8-10 preoperatively.The result of Harris hip functional score was excellent in 12 cases,good in 6,and fair in 3.Conclusion The valgus osteotomy can rectify varus deformity effectively.The reconstract nail of the fumer can support the stability of femur.Impacting of massive bone allograft can improve the capacity of the femur.

Objective To investigate and discuss the limb salvage strategies of malignant bone tumors in region S2 of shoulder girdle.Methods The data of 17 patients(13 males and 4 females)were retrospectivelv analyzed.All of them had malignant scapular tumor at least in region S2,and underwent limb salvage between January 2005 and January 2009.They aged from 14 to 55 years old(mean,32.6 years).The histologic types of them were chondrosarcoma in 6 patients,osteosarcoma in 4,fibrosareoma in 1,myeloma in 1,Ewing's sarcoma in 1,rhabdomyosarcoma in 1,non-Hodgkin lymphoma in 1,malignant giant cell tumor of bone in 1 and recurrent chondrosarcoma in 1.The tumors were staged according to Enneking surgical staging system:IB in 4 and IIB in 13.According to the MSTS classification system,the region S2 and lateral 1/3 of region S1 were effected in 11 cases,the region S2 and large part of region S1 were effected in 6 cases.The rotator cuff was involved to some extent in all patients,and the articular capsule were involved in 8 cases.Neo-adjuvant chemotherapy was given to 14 patients.The surgical strategies were depended on the range of tumor and preservation of articular capsule.The scapular prosthetic replacement was done in 8 cases with a relatively large range of tumor or resection of articular capsule,otherwise the scapular allograft replacement was done.Among the 11 cases with region S2 and lateral 1/3 of region S1 effected,the scapular allograft replacement was done in 9 cases with articular capsule preserved and the prosthetic replacement was done in 2 cases with articular capsule resected.And the prosthetic replacement was done in the other 6 cases.The articular capsule and partial rotator cuff were preserved and reconstructed preferentially.Results All patients were followed up 16-62 months (mean,35.1 months).Postoperative complications were noted in 9 patients, including mild allograft rejection and mild allograft resorption in 1 patient,allograft rejection in 1,prosthetic acromion exposure in 3,allograft resorption in 4.Local recurrence were noted in 1 patients.Three patients were dead because of extensive metastasis.The average function scores were 74.1%(range,53.3%-93.3%).Conclusion During the limb salvage surgery.it's very important to guarantee the en bloc resection of the tumor.In the meanwhile,the en bloc resection and functional reconstruction should be well balanced.

Sixteen goats with fractures of right femur received cortical bone plates allografts on both the sides of femurs. The right allograft strut endured the stimulation of physiological stress, and the left allograft strut did not. Groups of goats were sacrificed and specimens were procured at 3, 6, 12, and 24 week after surgery for histology observation and image analysis of the vessels after Chinese ink perfusion, the rate of bone porosity, the integrated optical density (IOD) of tetracycline fluorescence labeling and new bone formation were investigated in order to evaluate the incorporation of the allograft strut. The allograft strut revascularized at 6 weeks after surgery in the fracture group, but at 3 weeks in the control group. The rate of area of vessels after Chinese ink perfusion, the rate of bone porosity, the integrated optical density (IOD) of tetracycline fluorescence labeling and new bone formation in the fracture group were worse than control from 3 weeks to 6 weeks, but the observed and measured values were better in the fracture group than in the control group beyond 6 weeks after surgery (P < 0.05). The stimulation of stress would be harmful to the allograft strut if the strut endured the stress at an earlier period postoperation. Yet, it would be beneficial to the revascularization, new bone formation, substitution, and internal re-building on the strut provided that the extremity was immobilized for 6 weeks; and if the cortical graft endured the stimulation of physiological stress from 6 weeks postoperation till cancellous conjunction between the ends of fractures, the revascularization on the allograft strut and the bone conjunction between partially allograft strut and host would be faciliated.
Allografts ; Animals ; Biomechanical Phenomena ; Bone Plates ; Bone Transplantation ; Femoral Fractures ; Femur ; physiology ; Goats

Three-dimensional finite element models of the large defect of proximal femur were reconstructed with allograft prosthesis composite in clinical bone-healing phase; current model was under the given conditions of 138mm-intramedullary stem-length of host bone and 135mm defect-length of proximal femur. The femur was constructed with efilm software from CT data, then three-dimensional concrete models were created by using Proe-Wildfire software; the three-dimensional finite element models of allograft prosthesis composite were made in ANSYS11 software. Loads were simulated using the peaking values during stance walking. The stress on femur-cement-callus-prostheses and the influence of stress on the clinical bone-healing phase were analysed. The highest stress value of femur is on the medial side of the tip of the prostheses. The highest stress value of cement mantle is on the medical side of the cement mantle at the tip of the stem. The highest stress value of the prostheses is on the medial side near the upper 4cm of the stem tip. The highest stress value on the callus is at the medial side of the callus layer. The highest stress value on every part is under the corresponding fatigue strength. Clinical bone-healing phase model is well enough for stance walking.
Biomechanical Phenomena ; Female ; Femoral Neoplasms ; diagnostic imaging ; surgery ; Finite Element Analysis ; Hip Prosthesis ; Humans ; Imaging, Three-Dimensional ; Male ; Osteosarcoma ; diagnostic imaging ; surgery ; Tomography, Spiral Computed ; Weight-Bearing ; physiology ; Wound Healing