BACKGROUND:The region around the hip is a bone tumor predilection site. It is difficult to conduct tumor resection due to the involvement of weight loading area. Tumor resection requires high surgical technique. The pelvis and hip are often needed to be rebuilt.
OBJECTIVE:To compare the effects of three reconstruction methods after tumor resection around the hip.
METHODS:From January 2007 to December 2012, 20 patients with bone tumors around the hip were treated by surgery in the Zhongshan Hospital, Wuhan University, including 7 benign tumors, 13 borderline and malignant tumors. Eight patients received al ograft. Eight patients received arthroplasty. Four patients received saddle prosthesis.
RESULTS AND CONCLUSION:A total of 20 patients were fol owed up for 5 to 60 months (averagely 40 months). According to Enneking evaluation criterion, the operative outcome was evaluated as excellent in 8 cases, good in 5 cases, average in 4 cases, and poor in 3 cases. Excellent and good rate was 65%. Results suggested that after excision of bone tumors, al ograft, arthroplasty or saddle prosthesis can significantly elevate patient’s survival rate, improve patient’s living quality and is an effective therapy for treating tumors around the hip.

Objective To probe the proper management of dural tear sustained during operation on the lumbar spine and cerebrospinal fluid leakage. Methods Sixty-eight patients sustained dural tears, which were repaired during the operation. According to the type of the dural tear, different ways was used to treat the cerebrospinal fluid leakage.Results Fifteen patients of the sixty-eight had cerebrospinal fluid leakage. None have any longterm deleterious effects. Conclusions Repair the dura during the operation was the best way to treat the dural tears, and closed subarachnoid drainage can successfully treat the cerebrospinal fluid leakage.

Objective To investigate therapeutic effects of muscle sliding operation treating Volkmann ischemic contracture of the forearm. Methods 32 cases Volkmann ischemic contracture were classified two types: the single type and the complex type. Three approaches were employed to treat different types which were single muscle sliding operation, muscle sliding plus skeletal operation, muscle sliding operation plus neurolysis.Results 29 cases were followed up, which excellent and good was 93.7 percent.Conclusions Muscle sliding operation was effective management for Volkmann ischemic contracture, and the skeletal operation or neurolysis could managed for the complex type in the meantime.

BACKGROUND: Biomechanics of bone in vivo is concerned by the scholars who work for orthopaedic and medical bioengineering all the time. The application of strainmeter in this measurement has been studied for many years, but the long-term and successive measuring problems have not been solved. A new installing method for analyzing biomechanics of bone in vivoshould be considered to be explored. OBJECTIVE: To investigate the biochemical change of external fixator at both external and internal medullary cavity of anxial compressing fracture end invivo when external fixator is used DESIGN: Randomized and controlled animal experiment SETTING: Laboratory of Orthopaedic Department, Renmin Hospital, Wuhan University MATERIALS: Totally 18 healthy white rabbits, of rather gender, with the body mass of 3.6 to 4.2 kg , were chosen. METHODS: This experiment was conducted at the laboratory of Or thopaedic Department, Renmin Hospital, Wuhan University in November 2004. The chosen 18 healthy white rabbits were randomly divided into 2groups. External measuring group (Group A): the strain guage was affixed to the tibia external cortex by 502 gauge. Internal measuring group (Group B): strain guage coated with bone cement was installed on the tibia internal cortex. Group A and Group B were divided into two subgroups A1, A2 and B1, B2, respectively according to the pressure 0.5 time body mass and 1 time body mass. Strain voltage change and attenuation coefficient after compressing were measured with scaler. Statistical comparison was performed among the groups. MAIN OUTCOME MEASURES: ① The data of scaler curve. ② Attenuation coefficient of different compressions.RESULTS: ① The scaler curves of Group A changed greatly during early stage. After reaching stable stage, trendline of internal and external cortex went consistent but the former value was higher than that of the latter . The time of compression reaching stable was shorter in the Group B than in the Group A, and the absolute value of strain was smaller in the Group B than in the Group A. ② Before reaching stable after compression, the attenuation coefficient was low in the Group A1 as compared with Group A2. There was the same result between Group B1 and Group B2 group. When comparison was conducted between Group A and Group B, the curve of Group A decreased firstly, then ascended, but there was no ascending tendency in the Group B. After reaching stable, there were descending tendency in the Group A1 group and Group A2. It descended fast in the Group A2, while it kept at normal level in the Group B1 group. Fluctuation appeared in the Group A2. CONCLUSION: Strain of external medullary cavity is significantly larger than that of internal medullary cavity. It is easier to reach stable in the inter nal medullary cavity than in the external medullary cavity. 0.5 time of body mass is suitable at the initial period in treating fracture with external fixator.

BACKGROUND:Currently, one of common methods is discectomy, nerve root decompression and fusion rigid fixation from the midline approach for disc herniation which is inefficient by conservative treatments. Thus, it is causing degeneration and limiting lumbar physiological activity of adjacent segments. The treatment of non-fusion lumbar disc herniation with the traditional posterior midline incision approach has some disadvantages such as big incision, wide peeling, and back muscle denervation.
OBJECTIVE:To observe therapeutic effects of dynamic stabilization system through Wiltse approach on lumbar disc herniation, and to compare the outcomes with traditional posterior approach.
METHODA total of 46 patients, who had undergone discectomy and internal fixation using dynamic stabilization systems for lumbar disc herniation at the Renmin Hospital of Wuhan University from January 2011 to January 2013, were enrol ed in this study. The operation was performed through the traditional posterior approach in 25 patients and Wiltse approach in 21 patients.
RESULTS AND CONCLUSION:Al 46 patients were fol owed up for 7 to 31 months (averagely, 13.8±2.4 months). The length of incision, intraoperative blood loss, and postoperative drainage amount were less in the Wiltse approach group than in the traditional posterior approach group (P<0.05). No significant difference in visual analog scale scores and operative time was detected between the two groups at 1 week and 6 months after fixation (P>0.05). Radiographs revealed that the position of implants was good in al patients, no loosing or breakage. These data verified that the early effect of dynamic stabilization system through Wiltse approach for lumbar disc herniation is similar to that of traditional posterior approach.

BACKGROUND:Though the effects of conservative or traditional open reduction and internal fixation in the treatment of thoracolumbar fractures are reliable and satisfactory for most cases, two methods also have shortages. Minimal-invasive percutaneous pedicle screw system provides a new available method. OBJECTIVE:To investigate the clinical effect of Sextant percutaneous pedicle screw system in the treatment of thoracolumbar fractures. METHODS:A total of 55 patients, who had undergone percutaneous pedicle screw fixation using Sextant system (25 patients) or traditional open internal fixation (30 patients) for single-level vertebral body compression fractures in Department of Orthopedics of Renmin Hospital of Wuhan University from February 2011 to January 2013, were enrol ed in this study. RESULTS AND CONCLUSION:Except two patients in traditional open internal fixation group were lost after discharge, al other patients were fol owed up for 8-14 months. Operative time, intraoperative blood loss, postoperative drainage amount and hospital day were better in percutaneous pedicle screw fixation group than in the traditional open internal fixation group (P<0.05). Compared with preoperation, the sagittal Cobb angle, visual analogue scale and Oswestry disability index after operation were significantly lower (P<0.05), while anterior vertebral body height ratio was significantly higher in each group (P<0.05). No significant difference was found in terms of correction loss and Oswestry disability index between two groups at 8 months after operation (P>0.05). The results show that percutaneous pedicle screw fixation using Sextant system has a satisfactory outcome in the treatment of thoracolumbar fractures. However, obeying indication strictly is very important for clinical application.

BACKGROUND: Vertebral reconstruction is stil a chal enge for spinal surgeons. Ideal reconstruction materials should have good osteogenesis ability, reliable support performance, low price and simple operating steps.
OBJECTIVE:To investigate the effect and feasibility of al ogenic cortical ring packed with autogenous cancellous bone in the reconstruction of rabbit cervical vertebra defect.
METHODS:Cervical vertebra defect models were established by resection of the fourth cervical vertebra in rabbits. Frozen-dried humeral cortical ring of rabbits was made to prepare the al ogenic cortical ring which was packed with autogenous cancellous bone. Then, al ogenic cortical ring packed with autogenous cancellous bone, single al ogenic cortical ring and autogenous iliac bone were used to repair rabbit cervical vertebra defects.
RESULTS AND CONCLUSION:The X-ray, histopathological examination, and scanning electron microscope examinations al showed that the bone union was most significant in group reconstructed with al ogenic cortical ring packed with autogenous cancellous bone. The alkaline phosphates activity in serum was higher in groups reconstructed with al ogenic cortical ring packed with autogenous cancellous bone and with autogenous iliac bone than in group reconstructed with only al ogenic cortical ring at 2 and 4 weeks after operation (P<0.01), but there was no difference between the former two groups. The biomechanical examination showed that the stability of al ogenic cortical ring packed with autogenous cancellous bone was higher than that of autogenous iliac bone at 1 month after operation (P<0.01). These findings indicate that the effect of al ogenic cortical ring packed with autogenous cancellous bone in the reconstruction of rabbit cervical vertebra defects is satisfactory, with a good biocompatibility, which is a promising method for the reconstruction of vertebral defects.

BACKGROUND:The effects of both conservative and traditional open reduction and internal fixation are dissatisfactory in the treatment of thoracolumbar fractures, however, minimal-invasive percutaneous pedicle screw-rod systems provide a new available method.
OBJECTIVE:To investigate the clinical effect of percutaneous pedicle screw fixation using Sextant minimal-invasive system in the treatment of thoracolumbar fractures.
METHODS:A total of 55 patients, who had undergone percutaneous pedicle screw fixation using Sextant system (25 patients) or open pedicle screw fixation (30 patients) for single-level vertebral body compression fractures in Department of Orthopedics, Renmin Hospital of Wuhan University from February 2011 to January 2013, were enrol ed in this study. They showed no neurological signs and symptoms. The operative time, intraoperablood loss, postoperative drainage amount, length of hospital stay, pre-and post-operative Cobb angle and anterior vertebral body height ratio were recorded and compared between two groups.
RESULTS AND CONCLUSION:Except two patients in open pedicle screw fixation group were lost after discharge, al other patients were fol owed up for 8-14 months. There were significant differences in operative time, intraoperative blood loss, postoperative drainage amount and length of hospital stay between two groups (P=0.000 0). The post-operative Cobb angle was significantly lower while anterior vertebral body height ratio was significantly higher at one week than those before fixation in two groups (P=0.000 0). No significant difference was found in correction loss between two groups at 8 months after operation. Experimental findings indicate that, percutaneous pedicle screw fixation using Sextant system has a satisfactory outcome in the treatment of thoracolumbar fractures. However, understanding the correct indications is very important for clinical application.

BACKGROUND: The clinical application of one-level osteotomy and multilevel osteotomy has been well documented, but currently few studies were reported to compare their biomechanical characteristics.OBJECTIVE: To investigate the biomechanical characteristics of one-level osteotomy with Dick screw fixation and multilevel osteotomy with Luque instrumentation in the treatment of kyphosis.DESIGN: Randomized comparative experiment.SETTING: Laboratory of the Department of Orthopedics, Renmin Hospital of Wuhan University.MATERIALS: Fresh specimens of thoracic and lumbar spinal segments obtained from 12 3 or 4-year-old calves.METHODS: The experiment was conducted in the laboratory of the Department of Orthopedics, Renmin Hospital of Wuhan University between September 2002 and September 2003. Fresh spinal segments T8-L5 from 12 calves were randomized into an intact group, Dick screw group with one-level osteotomy with Dick screw fixation and Luque group with multilevel osteotomy with Luque instrumentation, with 4 spesimens in each group. Lateral bending test of the specimens was performed to examine the physiological overload using an Instron 5 500 universal material testing machine at the constant speed of 10 mm/minute until fracture or dislocation was induced. Changes in the loading were recorded and the induced injuries observed to obtain the load-displacement curve of the injury test.MAIN OUTCOME MEASURES: The load-displacement curve of the destructive right bending test in each group.RESULTS:All the data of 12 canines were involved in the result analysis.The spinal segments of the intact group yielded to the force of 3 600 N with a flat and smooth load-displacement curve, and those of Dick screw group yielded to a load of 2 800 N with also a relatively flat curve, while in Luque group, the segments did not yield until a load of 7 160 N, followed by drastic decrease of the resistance to less than 4 000 N, generating a flat and smooth curve afterwards.CONCLUSION: Luque instrumentation is a little more preferable than Dick screw in terms of the maximum resistance, but this difference does not justify the clinical decision of their superiority. Both techniques benefit postoperative recovery of spinal function with strong stability.

Objective:To research the number and function of monocyte-macrophages in patients with chronic active hepatitis B. Methods:The 51 chronic viral hepatitis B( CHB) patients were selected randomly,which consisted of 20 cases of mild-moderate,31 cases of severe group and 13 cases of healthy controls. PBMCs were separated by percoll. Monocytes were tagged by CD14,the molecules CD80,CD86,HLA-DR and CD163 were detected by flow cytometry which expressed on the surface of PBMCs. Serum cytokine were detected for IL-10, IL-12 and IL-23 by ELISA. The distribution of CD68 was detected in the liver by immunohistochemical staining. Results:The expressions of CD80 for all chronic hepatitis B patients were lower than the controls respectively,no matter mild-moderate or even severe group. Similarly,the HBV patients expressed lower level of CD86 in the peripheral blood mononuclear cells when compared with the control group. Furthermore, there was statistically difference between the levels of CD86 in severe group compared with control group (P<0. 01). As the expression of CD80 and CD86,the levels of HLA-DR in the patents had also declined when compared with controls. While the HLA-DR levels in both the mild-moderate HBV hepatitis groups were statistically significant higher than the severe group (P<0. 01). Different from the above all,the expression of CD163 in all chronic HBV hepatitis was higher than the control group. The CD68 positive cells in chronic HBV patients were observed and infiltrated increasingly in portal area and hepatic lobules (P<0. 05). There were statistically significant differences of IL-10 levels between the mild-moderate group,severe group and the control group,respectively (P<0. 01). Conclusion:Macrophages have participated in the pathological lesions of liver in CHB patients,among peripheral blood mononuclear cells,the phenomena of imbalance between type M1/M2 and polarization to type M2 have been observed,which participated in the development of the chronicity of CHB.