ObjectiveTo investigate the changes of lymph flow by microwave heating whichhad achieved an excellent result in the management of lymphedema of extremities. Methods26 caseswith lymphedema of the extremities had been evaluated by means of lymphoscintigraphy using 99mTc －Dextran and SPECT to examine the lymph flow speed and half－ time(T1/2)clearance of the injection siteas well as lymphatic images of the affected limbs before and after treatment. Results The averagelymph flow speed in the affected limbs was significantly lower than that of the contralateral normal limbswith 7.82cm/min and 10.41cm/min respectively before treatment, and they increased significantly from7.82 to 9.36cm/min after two courses of treatment; in contrary, T1/2 was higher in the lymphedema-tous limbs with an average value of 154.21 min in comparison with 91.55 min contralaterally, and de-creased significantly to 115.38 min after treatment. In addition, lymphatic image disturbances improvedmarkedly in 22/26 cases(84.6% ) after treatment, especially in the patients with infectious lymphede-ma, and showed no changes in two cases. ConclusionThe results demonstrated that there was evi-dent lymph flow stasis in lymphedematous limbs, based on the preliminary calculation of lymph flow in-dexes; microwave heating could promote the lymph flow in lymphedema of extremities.

Objective The deformed nasal bone is commonly seen in clinical practice of plastic surgery, and up to now, there is still lack of systemic classification to direct clinical treatment. Attempt was made in this study to classify the deformed nasal bone and present their plastic surgery treatment. Methods According to the orientation of the nasal bone deviation, the nasal bone deformities were divided into seven types, including the depressed, deviated, combination of the depressed and deviated, convex, widened, shortened ones and others. Of the 78 cases with the deformed nasal bone, 52 cases were corrected by the bone osteotomy techniques, and 26 cases by augmentation rhinoplasty. Results The satisfactory repair outcomes were achieved in 48 nasal bone deformities of the 52 cases (92%), and then secondary procedures were performed in 4 cases for further improvements (8%). Augmentation rhinoplasty in 26 cases showed good results. Conclusions Those types of classification are relatively simple and comprehensive, which is conducive to clinical treatment. The nasal bone osteotomy is effective to repair the deformed nasal bone.

Objective To examine the effectiveness of a gene transfer of rat glial cell-line derived neurotrophic factor(GDNF)into Schwann cells Methods Rat GDNFcDNA was amplified from newly-born rat sciatic nerve by RT-PCR and ligated into the retroviral vector pLNCX-2 A fter being packaged by the amphotropic packaging cell line PT67,the viral supernatants from these anti-clonal producing lines were titred on fibroblast N IH3T3 The highest tire recombinant retrovirus was used to infect deviding populations of newly-born rat SCs The level of GDNF mRNA in GDNF-SCs and normal SCs was tested by RT-PCR The GDNF protein in genetically modified SCs and normal SCs was assayed by immunocytochemistry The amounts of GDNF in conditioned medium of GDNF-SCs in different phrase and normal SCs were detected by enzyme-linked immunoassay sensitive assay Biological activity of the secreted GDNF was tested using motoneuron bioassay by MTT method Results (1)The GDNF cDNA band of GDNF-SCs was more prominent than that of SCs (2)Cells in both groups were immunohistochemically positive for GDNF expression Staining for GDNF was more prominent in the Scs infected with pLNCX2-GDNF (3)The rate of GDNF secreted by GDNF-Scs was 5 1-fold compared with normal SCs (4)The bioassay comfirmed that the secreted GDNF from GDNF-Scs was biologically active,and more motoneurons survived than normal SCs group Conclusion With the help of retrovirus,GDNF gene can be transferred and stably expressed in SCs,and it′s may be a better way to graft SCs promoing regeneration of PNS injuries.

Objective To discuss the diagnosis, treatment and prognosis of stage Ⅲ osteosarcoma. Methods A retrospective analysis of 23 patients with stage Ⅲ osteosarcoma of extremities from December 1989 to December 2003 was studied. There were 9 females and 14 males, aging from 16 to 31 years with a mean of 22.4 years. 15 patients presented with lung metastases, 7 with bone metastases (including 5 of jumping metastases and 2 of osteosarcomas) and 1 with lung and bone metastases simultaneously. Patients received chemotherapy followed by resection of primary and metastatic lesions and additional chemotherapy. Results After preoperative chemotherapy, lung metastases disappeared in 1 patient, whereas in 1 with lung and bone metastases simultaneously, the lesion remained surgically unresectable because of new metastases after removal of the primary lesion. In 2 patients with osteosarcoma, primary lesion could only be removed, lung metastasis appeared in 2 of 5 patients with jumping metastases respectively after the removal of primary lesion and jumping metastases. 16 patients with lung metastases received thoracotomy and resection of the lung metastatic lesions, and 6 of them received a second thoracotomy because of a second lung metastasis inclunding 3 cases with extra-pulmonary metastases without any additional treatment. The tumor necrosis rate was not found obviously different between primary lesions and metastatic lesions. Of the 23 patients who achieved a mean 74.6 months follow-up (range, 5-168 months), 9 remained continuously free of disease, 4 relapsed with new metastases, and 10 died of tumors. The outcome of the Cox model proportional hazard regression showed the relation of the number of the metastases and the prognosis were significant(P

OBJECTIVETo investigate the value of application of recombinant human VEGF to accelerate flap viability in a rat model of non-ischemic prefabricated flap.

METHODSPrefabricated Flaps were created in 48 SD rats. An autologous tail artery loop was anastomosed to the femoral artery and vein, and implanted subcutaneously in the lower abdomen. Flaps were divided into four groups of 12 each. At the time of loop implantation, the control groups received 0.9% NaCl (Control 1) and 16% (V/W) polyvinyl alcohol (PVA) solution (Control 2). The treatment groups received VEGF in 0.9% NaCl (treatment 1) and VEGF in PVA (treatment 2). In each group, a 3 cm x 4 cm flap nurtured by the tail artery pedicle was elevated and resutured into place after 3, 4 and 5 weeks. The percentage of surviving skin of each flap was determined by planimetry 7 days after flap elevation.

RESULTSMean skin survival areas at 3, 4, and 5 weeks were 1%, 0%, 10% in control; 0%, 16%, 25% in control 2; 3.57%, 39.13%, 75.00% in treatment 1; 8.13%, 41.98%, 58.41% in treatment 2. VEGF significantly improved flap survival by 5 weeks (P < 0.05).

CONCLUSIONThese results suggest VEGF can accelerate maturation of prefabricated flaps.

Animals ; Endothelial Growth Factors ; pharmacology ; Female ; Lymphokines ; pharmacology ; Rats ; Rats, Sprague-Dawley ; Recombinant Proteins ; pharmacology ; Surgical Flaps ; physiology ; Vascular Endothelial Growth Factor A ; Vascular Endothelial Growth Factors

Objective To evaluate the bonding condition of hydroxyapatite (HA)/zirconia ( ZrO2 ) composite and bone interface and the ability of HA/ZrO2 in repair of bone defects.Methods Bone defect models were established in the lumbar vertebral body of 24 Beagle dogs and were implanted with HA/ZrO2 gradient composite (Group A ),HA/ZrO2 unilayer composite (Group B ),pure ZrO2 (Group C) and pure HA (Group D) successively.Dogs were sacrificed and lumbar vertebral specimens were harvested 6,12,16 weeks postoperatively and before the sacrifice at postoperative 6 and 12 weeks,the dogs were intramuscularly administered of quadracycline for fluorescence labeling.The interface bonding and repair of bone defects were observed through X-ray films,histomorphology and biomechanical test.Results The X-ray films displayed that the Group A achieved more formation of osteotylus and better repair of bone defects with the extension of the implantation period,followed by the Groups B and D and that the Group C had relatively worse results.Histomorphology study showed that the fluorescence labeling was enhanced gradually from 6 to 12 weeks in the Group A,with its growth from the edge of the implanted material to the inner part and its tight adhesion to the material,indicating active osteogenesis and massive bone formation.While the fluorescence labeling of the Groups B,C and D centered in the edge of implanted materials without presence in the material inner part.The mineralization rate of the four materials at 6 and 12 weeks had significant differences ( P ＜ 0.05).Synostosis rates at 6,12 and 16 weeks were the highest in the Group A,with the rate of up to (90.26 ±3.82) ％ at 16 weeks (P ＜0.05 ).Biomechanical test showed the maximum shear strengths at 6,12,16 weeks in the Group A were (2.64±0.16) MPa,(2.95 ±0.19) MPa and (3.45 ±0.23) MPa respectively (P＜0.05).Conclusion HA/ZrO2gradient biocomposite bonds well with the bone and possesses good repair ability for bone defects and hence is an ideal novel material for bone defect reconstruction.

Objective To explore the short?term functional outcomes of the reconstruction of the proximal humerus by re?verse shoulder arthroplasty after tumor rescetion. Methods 8 patients who underwent reverse shoulder arthroplasty after tumor resection between January 2013 and December 2014. 5 were female and 3 were male, mean aged was 38 years old (25-61). 2 chon?drosarcomas and 6 giant cell tumors. Enneking stageing of 2 cases with chondrosarcoma were stageⅠB and stageⅡB. 6 giant cell tumors were Campanacci stage 3, meanwhile 3 cases had pathological fractures. The deltoid and axillary nerve were intact in all patients by image analysis before the operation. The proximal humerus was resected according to Malawer typeⅠresection. Then reverse shoulder arthroplasty reconstruction and bone graft was performed. The follow?up was scheduled, and the patient received X?ray examination of the shoulder. The range of motion of the shoulder was measured, the Constant?Murley score and musculoskel?etal tumor society(MSTS) score was recorded. Results The mean duration of the operation was 2.7 h (2-3.5 h). The bleeding in the operation was 510 ml (300-850 ml). The mean length of humerus resection was 8 cm (6-10 cm). The allografts were used in 7 cases and reimplantation after tumor bone deactivation was used in one. The latissimus dorsi transfer were performed in 2 cases. The rotator cuff were resected 1-1.5 cm from the great and lesser tubercles. The follow?up was 13 months (3-26 months). No infec?tion, dislocation, or loosening of prosthesis was found by the last follow?up. The X?ray showed the case who received reimplanta?tion after tumor bone deactivation had achieved bone union 1 year postoperation,7 cases received allograft had still nonunion at the host?graft junction. Bone resorption were found in all cases in different extent but the prosthesis were stable. No local recur?rence of the tumor was found. At last follow?up, active abduction was 155° (100°-175° ) and active forward elevation was 150° (115°-170°) and Constant?Murley score was 76%(68%-87%). The MSTS score was 92%(87%-97%). Conclusion The func?tional outcomes of the reconstruction of the proximal humerus by reverse shoulder arthroplasty after tumor rescetion was satisfied in early period. The reverse shoulder arthroplasty can be used in younger patient, but long?term results need further study.

AIM: To evaluate the immunogenicity of a novel orthopedics materials (graded zirconia-hydroxyapatite composite) in vitro by using peripheral blood mononuclear cells (PBMCs) from healthy young people, and simple zirconia-hydroxyapatite composited material was used as control materials. METHODS: Proliferation of PBMCs cultured in different liquid after 5 days was measured by MTT methods. ELISA was used to detect TNF-? and IL-6 concentration in the supernatant of PBMCs cultured in the extracts after 24 hours. Flow cytometery was used to measure CD69 and CD25 in activated PBMCs cultured in the extracts of the two kinds of materials after 24 hours. RESULTS: The proliferation rate of the simple composite group was significantly lower than that in negative group (P

Objective To investigate the clinical effect of subtrochanteric osteotomy plus dynamic hip/condyle screw (DHS/DCS)fixation to treat the fibrous dysplasia of the proximal femur with coxa vara.Methods Twenty-six clinical cases of femoral fibrous dysplasia with coxa vara were retrospectively analysed from April 2001 to May 2010.There were 9 males and 17 females,with a median age of 19(10 to 53).Forteen patients presented with monostotic disease,and 12 with polyostotic disease.The length of the lesion for polyostotic disease was from 9 cm to 36 cm,while for monostotic disease was from 7 cm to 15 cm.Seventeen cases were merged with pathologic fracture.The neck shaft angles were from 65 to 110 degree preoperation.The shortage of limbs was from 1.5 cm to 4.5 cm.Twenty-one patients involved in femoral neck were fixed with DHS and the other 5 cases with DCS.Results The duration of operation was from 80 to 170 min.The amout of bleeding was from 280 to 1650 ml with the average of 960 ml.The average postoperative neck shaft angles were 127 degree(119 to 140).The shortened limbs were extended 2.3 cm for average (1.5 to 3.6 cm).The follow-up time was from 9 to 118 months with the average of 39 months.All patients with osteotomy were healed.The neck shaft angle of 1 case decreased from post-operative 126°to 115°56months post-operatively,no coxa adducta recurrented and all internal fixations were in position.Hip screw backed out through the barrel in one case with the shortage of femoral neck.One case had femoral fracture after an injury.According to Guille function standard,24 cases were regarded as satisfied and 2 cases as unsatisfied.Conclusion Subtroehanteric osteotomy plus DHS/DCS fixation can effectively correct the fibrous dysplasia of the proximal femur with coxa vara,and significantly improve the function.

Objective To investigate technique and clinical effect of total en bloc spondylectomy for thoracic and lumbar chondrosarcoma.Methods From January 2010 to March 2012,6 patients with thoracic or lumbar chondrosarcoma underwent total en bloc spondylectomy.There were 4 males and 2 females,aged from 25 to 54 years (average,38 years).The tumor ranged from T3 to L3; 1 located in T3 and T4,1 in T7,1in T11,1 in L1,1 in L2 and 1 in L3.According to Tomita surgical classification system,there was 1 case of type 2,1 case of type 4,3 cases of type 5 and 1 case of type 6.One patient underwent tumor resection through single posterior approach,while the other 5 patients underwent anterior dissection and posterior resection of tumor.All spines were reconstructed by posterior fixation with pedicle screws and anterior interbody fusion with titanium mesh cages or artificial vertebrae.Results The average amount of blood loss was 3200 ml (range,2100 to 6300 ml).The duration of operation ranged from 3.5 to 12 hours (average,5.5hours).Two patients obtained wide resection,3 obtained marginal resection,and 1 had intralesional margin.The complications included 2 cases of cerebrospinal leak,1 case of pleural effusion and 1 case of pulmonary infection.There was no wound infection and death during peroperative period.All patients were followed up for 6 to 32 months (average,19 months).The neurological function improved from preoperative Frankel C to postoperative Frankel E in 2 cases.All patients obtained bone union 6 to 12 months (average,8 months) after operation.At final follow-up,all patients could walk without aid,and there was no recurrence.Conclusion The total en bloc spondylectomy is an effective method for thoracolumbar chondrosarcoma,which could provide a satisfied tumor control and neurological function improvement.