High-energy fractures are known to result in a long healing proce ss and a high incidence of nonunion. In the traditional treatment of high-energ y fractures, bone grafting or bone substitute grafting is applied only after the delayed union or nonunion has already been confirmed. Secondary interventions t o treat nonunion are associated with a high morbidity of complications and a lon g time recovery. Charnley (1961) first recommended prophylactic bone grafting in treatment of high-energy fractures to reduce total time of fracture healing. H owever, autogenous bone graft has certain drawbacks, such as limited harvest ava ilable and serious complications at the donor site. In order to overcome these p roblems, various bone graft substitutes, such as growth factors, bioceramics and composite grafts, have been developed as early grafting materials.

Drug Therapy, Combination ; Echinocandins ; administration & dosage ; therapeutic use ; Humans ; Invasive Pulmonary Aspergillosis ; complications ; drug therapy ; Lipopeptides ; Liver Failure ; complications ; drug therapy ; microbiology ; Male ; Middle Aged ; Voriconazole ; administration & dosage ; therapeutic use

This study was aimed to analyze the dynamic accumulation of active ingredients of Echinacea purpurea. Contents of cichoric acid and total polyphenols in different parts through the whole growth process were determined by HPLC and colorimetry. The results showed that the content of total polyphenol changed little in annual plant. There were differences in content of cichoric acid of different parts in different periods. And the content reached the maximum at flowering stage. It was concluded that the harvest stage depended on the content of cichoric acid. The results provided theoretical basis for induced plant in Shandong province.

Objective To identify the relationship of the femoral morphology with the sex and age, analyze and compare the two methods of defining the morphology of marrow cavity.Methods AP and lateral radiography of the hip joint was made in 45 patiens who accepted total hip arthroplasty.The anatomic parameters of the proximal femur were measured on those radiography.The femoral morphology was analyzed using Dorr criteria and Noble class respectively.Results (1)The anatomic parameters of the proximal femur were not correlated with the age in male.(2)The inner diameter of canal 10 em distal to the lesser trochanter, isthmus width and canal to calar isthmus rate were positively correlated with age in female.(3)The medial cortical and lateral cortical thickness 10 cm distal to the lesser trochanter,cortical index and canal-flare index were negatively correlated with age in female.(4)According to Dorr criteria,13 femora were classified as type A,20 as type B,and 12 as type C.According to Noble class,4 femora were classified as champagne type,34 as normal type,and 7 as stove pipe type.Conclusions The femoral morphology don't change with age in male.The width of femoral canal increase with age in female.Type C of Dorr criteria contains all of stove pipe type and a portion of normal type.

BACKGROUND: Greatly higher elastic modulus of traditional metal prosthesis than bone elastic modulus is mechanical factor for aseptic loosening of artificial joint, resulting in stress shielding, bone resorption and bone atrophy.OBJECTIVE: To measure femoral stress after prosthetic replacement made of carbon fiber reinforced poly-ether-ether-ketone (CF/PEEK), and compare with domestic AML prosthesis, so as to explore the application prospect of compound material in total hip femoral head prosthesis. DESIGN, TIME AND SETTING: Comparative analysis was performed at Orthopedics Laboratory, First Hospital of Soochow University and Institute of Biomechanical Engineering of Shanghai University from September 2002 to March 2004.MATERIALS: CF/PEEK prosthesis was designed by the authors, composed of long CF/PEEK compound material as inner layer, 100 Gpa and short CF/PEEK compound material as outer layer, 20 Gpa; the layer intensity at stress center was strengthened, and the appearance and size of the CF/PEEK prosthesis simulated domestic AML cobalt alloy prosthesis (Beijing Huajiehao Company). Five pairs (10 femurs) of femurs were from fresh adult cadavers. METHODS: Five pairs of human cadaveric femora were divided equally into left and right groups: one group received a cobalt-chrome molybdenum alloy (CoCrMo) implant and the other received CF/PEEK implant. Strain-gauge rosettes were attached to external surface of each implant and proximal femora. The loading condition simulated single-limb stance. MAIN OUTCOME MEASURES: strains distribution on the normal femur and femoral surface after replacement with two kinds of prostheses; shearing strain at femur-prosthesis interface of two groups.RESULTS: Following prosthesis implantation, the strains exhibited a progressive proximal-to-distal increase, which was similar to that in the intact femur, and the strain was maximum near the distal prosthesis. The strains on the medial and lateral surface of the femur were reduced after implantation of both types of implants. The pattern and magnitude of the strains, however, were closer to those in the intact femur after insertion of CF/PEEK prosthesis than in the CoCrMo one. CONCLUSION: Mechanical performance of CF/PEEK compound prosthesis is similar to bone tissue, and can provide similar strain under loading condition. Therefore, it can provide immediate postoperative stability and proximal loading transfer.

[Objective]To develop a new femoral prosthesis that can integrate with femur compactly and increase proximal femoral stress transfer,and further improves the long-term curative effect of total hip arthroplasty.[Method]Five pairs of human cadaver femora were divided equally into two groups one of which received a cobalt-chrome molybdemum alloy(CoCrMo) implant and the other a carbon fiber reinforced polyetheretherketone composite(CF/PEEK) implant.Six strain-gauge rosettes were attached to the external surface of each implant and proximal femora.The loading conditions simulated single-limb stance and the strains were recorded first with the femora intact and then with the femoral components of two different designs implant inserted.[Result]After the insertion of a femoral component,the normal pattern of a progressive proximal-to-distal increase in strains was similar to that in the intact femur and the strain was maximum near the tip of the prosthesis.On the medial and lateral aspects of the proximal femur,thc strains were reduced after implantation of both types of implant.The pattern and magnitude of the strains,however,were closer to those in the intact femur after insertion of the CF/PEEK stem than that of CoCrMo stem.[Conclusion]Our findings suggest that the CF/PEEK stem can provide immediate postoperative stability,better proximal loading transfer in the metaphysis and further reduce stress shielding,bone resorption and osteanabrosis,thus prevent the implant from failuri.

Objective To explore the initial stability of a carbon fiber reinforced polyetheretherketone composite (CF/PEEK) stem in human femurs after total hip replacement. Methods 8 pairs of human cadaveric femurs were used to test the CF/PEEK prosthesis versus a conventional cementless stem of cobalt-chrome molybdemum alloy(CoCrMo). The bone-femoral prosthesis interface motion was measured in vitro using displacement transducers. Combined axial and torsional loads and simulated single-leg stance loading were applied. Subsidence, rotation and interface motion were measured with load cycles up to 1 000 N. Results The extent of the micro-motion in the proximal femoral region was larger than that in the distal femoral region. The CF/PEEK composite prosthesis showed less dynamic micro-motion in the proximal region compared with the CoCrMo alloy prosthesis stem, with the average difference being 42%. The extent of the distal micro-motion in the 2 groups was small but the difference was significant (P

[Objective]To discuss the effect of femoral head diameter on risk of dislocation after primary total hip arthroplasty,in order to choose the reasonable diameter of femoral head for preventing the postoperative dislocation. [Methods]From March 1990 to August 2008,primary total hip arthroplasties with various head sizes were performed in 706 patients(762 hips).There were 301 males and 405 females.The average age of the 706 patients in this series were 57 years(range 21～78 years).The preoperative diagnosis for each of the patients were osteonecrosis in 203,congenital dysplasia in 129(the Crowe IV in 15),femoral neck fracture in 190,osteoarthritis in 112,rheumatoid arthritis and ankylosing spondylitis in 58 and the other diagnosis in 14.The femoral head diameter was 22mm in 220 of the procedures,26mm in 83,and 28mm in 459.Among the 762 cases,a modified Harding approach was preferred in 95%,and a posterolateral approach was preferred in 5%.Patients routinely were followed at definite intervals and were specifically queried about dislocation.[Results]All the patients were followed up for at least six months.Of the 762 cases,there were 28 dislocations;the dislocation rate was 3.7%.In the subgroups,there were 7.3%(16/220) for 22mm heads,4.8%(4/83) for 26mm heads,and 1.7%(8/459) for 28mm heads,the difference were statistically significant(x2=13.193,P=0.001;R=0.131,P=0﹤0.01).[Conclusion]The femoral head diameter has a positive effect on risk of dislocation,using a larger femoral head could reduce the risk of dislocation after total hip arthroplasty.A larger femoral head could be selected for preventing the postoperative dislocation and 22mm femoral heads should be avoided.

[Objective]To investigate the possibility of using poly(hydroxybutyrate-co-hydroxyvalerate)(PHBV)as scaffolds for cartilage tissue engineering and to compare the engineered cartilage generated in vitro with those in nude mice modles.[Method]PHBV porous scaffolds were fabricated using a compression moulding,thermal processing and salt particulate leaching methods.Chondrocytes isolated from articular cartilage were seeded into porous PHBV scaffolds.After incubation for 2 weeks in vitro,chondrocytes-PHBV constructs were implanted subcutaneously in the dorsum of athymic nude mice.Control groups were established by subcutaneous implantation of PHBV alone.The implants harvested after in vivo incubation of 4 and 8 weeks and cell-scaffolds cultured in vitro for 6 and 10 weeks were respectively examined histologically.Chondrocytes cultured for 3,7 and 14 days on the scaffolds were examined by SEM.[Result]SEM showed that chondrocytes could aggregate and synthesize extracellular matrix on PHBV scaffolds.Both specimens harvested from nude mice and those cultured in vitro demonstrated new cartilage formation,while characteristics of the engineered cartilage generated in vivo were more typical.Those from control groups showed no cartilage formation.[Conclusion]PHBV can be used as scaffolds for cartilage tissue engineering and nude mice modle seems to facilitate chondrogenesis compared with that in vitro system.

[Objective]To compare clinical results of the mini midvastus approach with the traditional medial parapatellar approach for totall knee arthroplasty and to evaluate their advantages.[Methods]Sixty total knee arthroplasty(56 patients)have been freated during May 2002 to May 2006,28 patients(30 knee) were underwent TKA using either mini midvastus approach or traditional medial parapatellar approach.Two groups were compared according to skin incision length,postoperative pain score,total amount of drains,postoperative amount of decreasing Hb,active straight-leg raise time,postoperative length of stay,radiographic alignment of all the components,postoperative range of motion at 6 weeks and 12 weeks and 1 year,postoperative HSS score at 1 year.[Results]All the patients were followed from 1 to 1.5 year(mean,13.2 months).Position of all the components was normal in all patients except one case with abnormal position of tibial prosthesis in both groups.In the MIS group,the average skin incision length was 11.3 cm,average visual analog pain scale was 2.76 score,while the control group was 20.6 cm and 3.8 score.In the MIS group,the total amount of drains was 96.8 ml,postoperative amount of decreasing Hb was 22.5 g,while the control group was 276.3 ml and 32.5 g.In the MIS group,active straight-leg raise time was 3.8 days,postoperative length of stay was 8.6 days,while the control group was 5.8 days and 12.1 days.In the MIS group,the mean ROM at 6 weeks postoperatively was 107?and 117?at 12 weeks,while the control group was 98?and 108?.The differences between each factor group and operative results were significant(P0.05).[Conclusion]The mini midvastus approach wis associated with a more rapid functional recovery and a more satisfactory short-term result.