[Objective]To analyze the failure mechanisms in patients undergoing revision surgery in different time after index total hip arthroplasty(THA).[Method]The clinical records and radiographs of 78 revision hip surgeries between June 1995 and June 2005 loere reviewed.Forty-two cases were total hip arthroplasty and 36 were hemiarthroplasty.Thirty-six patients had revision surgery within 5 years and 42 more than 5 years.[Result]The causes of early revision THA included infection(16 cases),aseptic loosening,acetabular erosion,and mechanical failure.In the late revision THA,aseptic loosening was the most common reason,and the next common reason were acetabular wear and osteolysis around a well-fixed implant.[Conclusion]Infection is a common reason for the early revision.Aseptic loosening is the major cause for the late revision total hip arthroplasty.

Objective To investigate the immunologic reactions around prosthesis and the relationship between immunologic reactions and aseptic loosening. Methods Nine specimens of bone- implant interface membranes obtained during revision of loosened total joint replacements were examined in order to investigate the evidence of hypersensitivity. T lymphocytes and it's subgroup (CD 3, CD 4, CD 8),macrophages (CD 68),IL－ 2 receptor (CD 25) and HLA－ DR antigens were demonstrated by immunohistochemistry on tissue sections. The relationship between the changes of T lymphocytes and inflammatory reactions was also evaluated. Results Histological examinations showed granuloma with a plenty of macrophages and foreign body giant cells in all sections of interface membranes. The number of T lymphocytes increased in five of nine cases, and three of them expressed IL－ 2 receptor. The distribution of T lymphocytes and subpopulations was similar in all cases. The increase of T lymphocytes and IL－ 2 receptor expression showed positive correlation with an increase of macrophages and inflammation reactions. Conclusion Hypersensitivity to the prosthetic materials can exist after total joint replacement. Hypersensitivity may be one of the reasons of prosthetic aseptic loosening.

Objective To study the causes and symptoms about locking knee of unclear causes and analyze the thrapeutic effects of arthroscopy. Methods Arthroscopy was performed for 47 cases who suffered from locking knee of unclear causes.The main focuses observed were synovial shelf(16 cases),synovial hyperplasia(15 cases),synovial cyst(3 cases),Hoffa disease(4 cases)and patellofemoral malalignment(9 cases).These synovial focuses were resected by arthroscopic shaving.For Hoffa disease,arthroscopic partial resection of the infrapatellar fat pad was done.For patellofemoral malalignment,the procedures consisted of a standard lateral retinacular release and distal realignment of the patella. Results All patients were followed up for 2 months to 3 years on (an average of 1 year).The locking of knee disappeared for all cases and painless of knee for 46 cases.The functional recoveries of Knee joint were mostly excellent. Conclusions The main causes consisted of synovial shelf?hyperplasia?cyst,Hoffa disease and patellofemoral malalignment for locking knee of unclear causes.Arthroscopy is not only an important diagnostic method,but also a significant procedure of treatment and the therapeutic effects are satisfactory.

[Objective] To investigate the radiographic changes of patella after total knee arthroplasty(TKA)with non-resurfaced patellar.[Methods]Fifty-one patients(64 knees)underwent TKA with patellar non-resurfaced.Average age was 68.5 years(range,57~78 years).Average follow-up was 4.8 years(range,2.5~8 years).The radiographic changes of patella,patellar tilt,and patellar lateral shift were evaluated.The functional results of patellofemoral joint were analyzed.[Results]The patellar tilt and lateral shift were improved obviously after surgery.Most patella tracking lied in the middle and there were no obvious degeneration with the time passing.Osteophytes formation and deterioration of patellar tracking were the most common abnormal radiographic changes.There were no obvious relationship between symptoms of patellofemoral joint and patellar degeneration.[Conclusion]Patellar tracking can be improved immediately after non-resurfaced total knee arthroplasty in osteoarthritis patients.There will not be obvious patellar degenerative changes with time passing.

Objective To elucidate the characteristics and treatment options of the primary joint arthroplasty in patients who had a previous history of the joint infection. Methods Eight total joint arthro-plasties in patients who had previous infection of the joint, were analyzed retrospectively from 1992 to 2001. The diagnosis of joint infection was pyogenic infection in six cases, and tuberculous infection in two cases. Total hip arthroplasty was performed in six cases, the average age of which was 38.1 years (24 to 51 years), and the average quiescent period of infection was 22 years ranging from 6 to 30 years. In these six cases, the average age of infection was 16 years (6 to 31 years); the quiescent period of all five pyogenic infections was more than 20 years, and the quiescent period of other one with tuberculous infection was six years. Total knee arthroplasty was performed in two cases. Results The count of WBC, ESR and CRP were examined routinely with normal values before surgery. While, there were no evidences of infection through intraopertive exploration, and bacterial culture of joint fluids and synovial tissue. The duration of follow-up was 2 to 11 years. The affected limbs had significant shortened deformity of 2 to 6 cm before surgery in hip infections. The hip joints had mal-development and flexion-contracture deformity. All of the patients had no active in-fection before arthroplasty. 5 patients with a quiescent period of pyogenic infection of more than 20 years had no recurrence of infection after total hip arthroplasty. One patient with a quiescent period of 6 months had recurrence of the infection after total knee arthroplasty. There were no recurrence of infection in 2 pa-tients who had tuberculous infection. The results were good except aseptic loosening in one total hip arthro-plasty. Conclusion The total joint replacement for patients with previous joint infection is more difficult in performing in one-stage and on younger patients. The good results can be achieved only on condition that the active infection healed completely, and the patients must keep a definite long period of quiescent time after infection.

OBJECTIVE:To establish and compare the HPLC characteristic Spectrum Erycibe obtusifolia from different habi-tats. METHODS:HPLC was performed on the column of Hypersil ODS C18 with the mobile phase of acetonitrile-0.1% phosphoric acid at flow rate of 1.0 ml/min,detection wavelength was 347 nm,the column temperature was 30℃and the sample size was 20μl. 12 different batches of samples were determined and the characteristic spectrums of those were established. TCM fingerprint evalu-ation software(2004 edition)was used to evaluate the similarity of 12 batches of samples. RESULTS:10 characteristic peaks were identified in the characteristic spectrum of E. obtusifolia. Peak 3 was scopolamine glycosides,peak 4 was chlorogenic acid and peak 6 was scopoletin. The similarities of 10 batches of samples were proved to be higher than 0.90 and 2 batches were proved to be less than 0.90. CONCLUSIONS:The method is simple,accurate and reproducible,and can provide scientific evidence for effectively controlling the internal quality standards.

Objective To report a retroperitoneal laparoscopic surgery for ureteropelvic junction obstruction (UPJO) by double renal veins.Methods A 28-year-old male patient with left low back pain for 6 months was diagnosed as left hydronephrosis and UPJO.A ureteral stent had been placed 3 months before and failed to improve hydronephrosis,so the ureteral stent was pulled out.CT scan showed that left UPJ went through the two renal veins,suggesting UPJO.Nephrogram showed that left GFR and right GFR were 35 ml/min and 34 ml/min,respectively.These results indicated mechanical obstruction of left upper urinary tract.The patient underwent retroperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty.Results The surgical procedure was successful.Two left renal veins were found,and the ventral one was in front of ureter,compressing the ureter.An aberrant renal artery went into left kidney with the ureter.0.5 cm stenosis of ureteropelvic junction was excised,and pyeloplasty was performed.A ureteral stent was placed into the ureter,then the pelvis and the ureter were sew up in front of the ventral renal vein.The surgical time was 240 min,and blood loss was 50 ml.Postoperative hospital stay time was 4 d.During 4 months' follow up,hydronephrosis was attenuated significantly.Conclusion Retroperitoneal laparoscopic surgery for UPJO with aberrant two renal vein might be a minimally-invasive and effective procedure.

Objective To investigate the role of hybrid bone grafting using autograft and freezedried allograft bone in restoration of acetabular bone defect,as well as to evaluate the clinical results of this grafting technique combined with acetabular scaffold in dealing with massive acetabular deficiency.Methods Between April 1999 to December 2007,18 patients (19 hips) underwent acetabular revision by using a mixture of autograft and allogenic freeze-dried cancellous bone particles plus acetabular scaffold.There were 8males and 10 females,aged from 33 to 76 years (average,64.7 years).The acetabular defects were caused by aseptic loosening of primary total hip arthroplasty in 17 patients and osteoarthritis secondary to osteotomy in 1 case of acetabular dysplasia.There were 5 cases of Paprosky Ⅱ B defect,2 Paprosky Ⅱ C defect,6 Paprosky ⅢA defect and 6 Paprosky ⅢB defect.Results All patients were followed up for 3.6 to 12.3 years (average,6.5 years).Harris hip score improved from preoperative 38.7±9.6 to 87.6±7.8 at final follow-up.According to X-rays,bone incorporation evidenced by trabecular bridging of the host-donor interface was found at 3to 6 months postoperatively,and effective bone incorporation was achieved in all cases one year postoperatively.Polyethylene wear occurred in one case.Acetabular component loosening was not found at final follow up.Conclusion Impacted bone grafting using a mixture of autograft and freeze-dried allograft bone can efficiently restore acetabular bone defect.Adding autograft bone to freeze-dried allograft bone is a highly effective way of achieving graft incorporation.Hybrid bone grafting technique with acetabulum scaffold is an attractive option for the treatment of extensive acetabular deficiency.

The effects of amino acid electuary on experimental liver fibrosis in rats with chronic liver injury induced by CCI4 were studied. The results showed that the electuary could prevent the decrease in body weight and food intake, reduce the levels of serum glutamic-pyruvic transaminase activities, elevate contents of total serum protein and serum albumin, normalize the serum ratio of BCAA to AAA and disordered amino acid pattern and suppress degeneration, necrosis and fibrosis of liver tissues in rats with chromc liver injury. These results indicate that the amino acid electuary has beneficial effects in prevention and treatment of liver fibrosis.

The effects of amino acid electuary (Ganan Elemental Granules) on experimental acute hepatic failure induced by D-galactosamine in rats were studied. The results showed that the electuary could significantly prevent the decrease in body weight and food intake, the prolongation in time of blood coagulation time and increase in the levels of serum glutamic-pyruvic transaminase activity, elevate contents of total serum protein and serum albumin, normalize the serum ratio of BCAA to AAA and disordered amino acid pattern, increase survival of animals and improve encephalopathy in rats with acute hepatic failure. These results suggest that the amino acid electuary has a better protective effects on acute hepatic failure.