[Objective]To evaluated the clinical results of treatment of osteoneerosis of the femoral head(ONFH)with repair and reconstruction through long-term follow-up.[Methods]A total of 313 patients(382 hips)operated on from November 1986-March 1997 who had a mean age of 36.4 years(range,18～65 years)were reviewed retrospectively.The hips were 151 Ficat and Arlet stage Ⅱ,142 stage Ⅲ,89 stage Ⅳ.All patients were followed up for a mean of 12.1yrs(range,10～20 yrs) and were assessed clinically and radiologically according to Harris scoring and variation of Ficat stage respectively.The patients were analyzed by the Kaplan-Meier method with replacement for any reason as the end-point.[Results]Ninteen hips underwent total hip replacement postoperatively.Preoperative and postoperative Harris score were 56.2 and 85.8.Clinical success rate was 85.6%and radiological success rate was 75.4%.Kaplan-Meier survivorship curves showed there was a lower long-term survival on stage-IV、abuse of hormone alcolutic indulger and above 55 years old patients.[Conclusion]The long-term efficacy is satisfactory to be confirmed by repair and reconstruction in treatment of osteonecrosis of the femoral head.This procedure will improve the curative effect of preserving head treatment of ONFH and early-middle clinical results being satisfied.

Objective To probe into the microsurgical method of using arthroscope in treating ischemic necrosis of femoral head(INFH) Method Twenty six cases (33 hips) with early stage of INFH were operated by vascularized greater trochanter bone flap graft through the lateral acetabulum approach under the surveillance of arthroscope Result The follow up ranged from 1 to 3 years Function evaluation was made according to pain,function,joint activity and radiographic criteria The clinical results were satisfactory Conclusion With this method, can accurately clean the sequestra and reconstruct the blood supplying system of femoral head At the same time, the injury of the peripheral muscle of hip joint and ligament can be further reduced and the function of hip joint can be recovered maximally So the method of applying arthroscope and microsurgical technique to treat early stage INFH is a simple, convenient and effective method

Objective To explore the biomechanical influences of cystic degeneration in different locations on femoral head and guide the appropriated surgical treatment to preserve the femoral head. Methods First scanning a upper femur specimen with spinal CT, dealing the two-dimensional image with Efilm software, identifying the outline of the femoral head by range estimation, inputting coordinate value of the femur into the computer to build up three-dimensional finite element model of the upper femur by Ansys-5.7 software, then simulating necrosis and cystic degeneration of 1 cm diameter by analogue computer, at last putting three kinds of pressure on the femoral head respectively to analyse the stress distribution and the stress/strength ratio and predict the collapse of the femoral head. Results The tension concentration was obvious when the necrosis and cystic degeneration was beneath the loading area or medial or lateral to the loading area in the femoral head, the stress/strength ratio of the cancellous bone beneath the articular surface was high which tends to cause collapse of the femoral head. When the necrosis and cystic degeneration located in the inferior parts of the femoral head, the strain concentration was not obvious and the stress/strength ratio of the cancellous bone beneath the articular surface was normal and the femoral head had little danger of collapse. When the focus located in the anterior or posterior part of the femoral head, its upper edge displayed tension concentration but not obvious and the stress/strength ratio of the cancellous bone beneath the articular surface was lower than normal and the danger of collapse was little. Conclusion When the necrosis and cystic degeneration is beneath the loading area or medial or lateral to the loading area in the femoral head, the focus should be cleared thoroughly and the vascularised bone flap should be implanted ideally with abutment against the subchondral plate to prevent the collapse of the femoral head. If the necrotic range is large involved the loading area and its medial or lateral sides, the vascularised bone flap should be implanted beneath the loading area.

Objective To provide an effective and convenient microsurgical method for ischemic necrosis of femoral head in children (Perthes disease) Method Basing on anatomic study, two periosteal flap pedicled with anterior superior iliac and anterior inferior iliac branches of lateral femoral circumflex vessel transposition was designed for the treatement of Perthes disease Result Eleven patients were performed with this method, and the average period of follow up was 2 1 years (range 1～3 5 years) The good and excellent rate was 82 percent Conclusion The operative method can not only provide with plenty of blood supply,but also increase osteogenic ability of the femoral head So, it is an effective method for the treatment of Perthes disease

BACKGROUND:There are a variety of treatments for femoral head necrosis,but their efficacy is not confirmed and unified.How to improve the differentiation ability of osteoblasts in the femoral head and improve the biomechanical support after the repair of the femoral head is an urgent problem to be solved.OBJECTIVE:To explore the clinical outcome of stem cells combined with vascularized iliac bone flap and tantalum rod implantation for the treatment of osteonecrosis of the femoral head (ONFH).METHODS:Totally 28 cases (36 hips) of non-traumatic ONFH admitted at the Zhongshan Hospital of Dalian University from January 2010 to January 2011 were enrolled.Bone marrow samples were extracted from each patient to isolate bone marrow stromal stem cells which were cultured in vitro for 2 weeks.Tantalum rod implantation with vascularized iliac bone graft was conducted to restore the femoral head shape,and then,prepared stem cell suspension were injected into the iliac bone flap and into the subchondral space of the femoral head.RESULTS AND CONCLUSION:All the 28 cases (36 hips) were followed up for 6-20 months (average 12 months),and their Harris hip scores and visual analogue scale scores at postoperative 6 and 12 months were significantly higher than the baseline (P ＜ 0.05).The Harris hip score at postoperative 12 months was significantly higher than that at postoperative 6 months (P ＜ 0.05),but there was no significant difference in the visual analogue scale scores at 6 and 12 months postoperatively (P ＞ 0.05).At the end of 12-month follow-up,clinical outcomes were excellent in 13 hips,good in 15 hips,fair in 4 hips,and poor in 4 hips,with an excellent and good rate of 90％.These findings indicate that autologous bone marrow stromal stem cell transplantation with vascularized iliac bone flap and tantalum rob implantation is an effective method with high clinical success rate for the treatment of ONFH.

Objective:To detect the changes of tumor necrosis factor-α(TNF-α) in nasopharyngeal secretion of patients with nasopharyngeal carcinoma(NPC).Method: The content of TNF-α in nasopharyngeal secretion was determined by radioimmunoassay (RIA) in 20 controls,52 patients with NPC.Result:The average concentrations of TNF-α were (12.95±4.62)pmol/L in control group,(33.68±15.13) pmol/L in NPC group and (64.00±11.57)pmol/L in NPC with necrosis group. The content of TNF-α in nasopharyngeal secretion in control group was lower significantly than that of patients with NPC (P<0.01).Conclusion:The level of TNF-α in nasopharyngeal secretion of NPC patients was higher than that of normal subjects. To detect the content of TNF-α in nasopharyngeal secretion is a useful test for the study and diagnosis of NPC.

BACKGROUND:Seed cells and scaffold are two key factors for cartilage defects after osteonecrosis of femoral head using tissue-engineered method. OBJECTIVE:To explore the feasibility of Bio-gide col agen membrane combined with dog bone marrow mesenchymal stem cells into chondrocytes. METHODS:Bone marrow mesenchymal stem cells were isolated from beagle dogs by whole bone marrow blood centrifugation method and adherence screening method in vitro and cultured. Morphological changes in cells were observed, and identification was done using cellsurface antigens. Bone marrow mesenchymal stem cells of passage 3 were induced by chondrocyte induction medium to differentiate into chondrocytes (experimental group). cells cultured in normal medium were considered as control group. 3-(4, 5-Dimethylthiazol-2-yl) 2, 5-diphenyl tetrazolium bromide assay was used to measure growth curve of chondrocytes. cells underwent typeⅡcol agen immunohistochemistry and toluidine blue staining. The coculture of bone marrow mesenchymal stem cells at passage 3 and Bio-gide col agen membrane were observed under an inverted phase contrast microscope and scanning electron microscope. RESULTS AND CONCLUSION: Bone marrow mesenchymal stem cells with high purity and high viability were obtained by whole bone marrow blood centrifugation method and adherence screening method. cells grew wel and had strong amplified ability, and successful y differentiated into chondrocytes. Numerous bone marrow mesenchymal stem cells adhered on the Bio-gide col agen membrane, showing a tendency of multi-layer growth. cells and Bio-gide col agen membrane seem to blend into an integrant part. Cel processes appeared and connected each other and gradual y wrapped the Bio-gide col agen membrane, with the presence of obvious cel matrix secretion. These results suggested that bone marrow mesenchymal stem cells can grow and differentiate into chondrocytes on the Bio-gide col agen membrane.

Objective To explore the clinical outcome of vascularized iliac bone flap combined with tantalum rod implantation for the treatment of osteonecrosis of the femoral head (ONFH).Methods Totally 28 cases (36 hips) of non traumatic avascular necrosis of the femoral head patients from January 2010 to January 2011,which were 15 males and 13 females; a mean age of 40 years (ranged,18-53years),according to ARCO stages:eight hips of stage Ⅱ a,ten hips of stage Ⅱ b,nine hips of stage Ⅲ a,nine hips of stage Ⅲ b,adopt to vascularized iliac grafting combined with tantalum rod Implantation for osteonecrosis of the femoral head.The Harris hip score and VAS score of pre-and post-operation was recorded to evaluate the clinical outcome,and to compare observe and analyze the change of postoperative of patients by used three-dimensional gait.Results All 28 cases (36 hips) were followed up 6 ～20 months,averaged 12 months.The results of Harris hip score and VAS score of the 6 months postoperatively and last follow-up were significantly higher than preoperative ones (P ＜0.05).And the Harris hip score of the last follow-up was also significantly higher than the one of 6 months postoperatively (P ＜ 0.05).However,there was no significant different in that of VAS score (P ＞0.05).There were 13 cases in excellent,fourteen in good and 4 in fair with an excellent and good rate of 89.8％,which shows that the extension of time and changes in patients gait tends to normal by three-dimensional gait analysis.Conclusion Vascularized iliac bone flap transplantation combined with tantalum screw was an effective method with high clinical success rate for treatment of younger patients with early-mid stage ONFH.It provided good blood supply and enough mechanical support to reduce the progress of femoral head collapse.

OBJECTIVE: To study the relationship between the radiotherapy resistance and autophagy. To provide a theoretiacal basis for drugs that regulate autophagy to improve radiotherapy sensitivity. METHOD: Flow cytometry (FCM) was performed to analyze the distribution of the cell cycle of CNE2 and CNE2/DDP cells under the action of X radiation. The expression of autopagy-specific gene Beclin1 and microtubule-associated protein light chain 3β (MAPLC3β) in CNE2 and CNE2/DDP cells was determined by real time PCR and Immumofluorescence staining. RESULT: CNE2/DDP and their parental CNE2 cells produced the G2-M phase arrest under the action of X radiation. With the radiation dose increasing,The cells which in the G2-M phase were more and more (P<0. 05). The G2-M phase arrest in CNE2/DDP cells was more obvious than in CNE2 cells (P<0. 05). The expression of Beclin1 and MAPLC3β in CNE2 and CNE2/DDP cells increased under the action of X radiation. What's more, the raise was more and more obvious with the increase of the irradiation dose(P<0. 05). The expression levels of Beclin1 and MAPLC3β in CNE2/DDP was lower than that in CNE2 cells (P<0. 05). CONCLUSION Autophagic cell death may be the one manner of death in nasopharyngeal carcinoma CNE2 and CNE2/DDP cells under the action of X radiation. The radiation resistance of CNE2/DDP cells may be related to the low expression of autophagy-related genes.
Apoptosis Regulatory Proteins ; genetics ; Autophagy ; Beclin-1 ; Carcinoma ; Cell Cycle ; Cell Line, Tumor ; radiation effects ; Dose-Response Relationship, Radiation ; Humans ; Membrane Proteins ; genetics ; Microtubule-Associated Proteins ; genetics ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; genetics ; Radiation Tolerance ; X-Rays

Objective To evaluate the safety and accuracy in treating the avascular necrosis of femoral head (ANFH) with computer navigated core decompression and bone marrow stream cell transportation and to guide the clinical treatment. Method Within the prospective study, 36 patients suffered ANFH (ARCO Ⅰ - Ⅱ ) and treated with computer navigated core decompression and bone marrow stream cell transportation were studied. The operating time, blood loss, x ray exposure, preoperative and 6 week postoperative Harris score and imaging evaluation were recorded and compared with conventional core decompression and bone marrow stream cell transportation. Results There were no obvious difference between the two groups in imaging evaluation, operating time and blood loss ( P ＞ 0. 05 ). There were statistical difference between the two groups in x ray exposure and 6 week postoperative Harris score [ (4. 1 ± 1.8 ) s,(13.6±3.2)s,P ＜0. 01,and89.4±10. 1,83.1±10. 5, P ＜0.01]. Conclusion Computer navigated core decompression and bone marrow stream cell transportation have good security and precision in treating early stage ANFH.