Objective To compare efficacy and complications of endoscopic sphincterotomy(EST) and limited endoscopic sphincterotomy plus endoscopic papillary balloon dilation (ESBD) for choledocholithiasis.Methods A total of 120 choledocholithiasis patients (stone diameter ≤ 2 cm)underwent endoscopic treatment,including 60 cases of EST,60 ESBD.The stone-free rate,complication rate of postERCP pancreatitis,hemorrhage,perforation and recurrence rate of stones were compared between two groups.Results Success rates of one-time removal were 90.0％ (54 cases) and 93.3％ (56 cases) in group EST and ESBD (x2 =0.436,P =0.743).Eleven case (18.3％) and 4 case (6.7％) underwent mechanical lithotripsy(x2=3.733,P =0.053).There were 4 cases of hemorrhage,6 post-ERCP pancreatitis and 1 perforation in EST group,while in ESBD group,there was 1 case of hemorrhage,4 pancreatitis and no perforation.The total rates of early complications were 18.3％ (11/60) and 8.3％ (5/60) in two groups (x2 =3.322,P =1.422) and recurrence rate of stones were 21.7％ (13/60) and 6.7％ (4/60) respectively (x2=5.551,P =0.034).Conclusion There are no significant differences between EST group and ESBD group in treatment of choledocholithiasis,in success rate of one-time removal and the occurrence of early complications,but the recurrence rate of late complications in ESBD group is lower than that in EST group.ESBD shows high efficacy and safety for younger patient of choledocholithiasis.

Objective To observe and compare the short-time outcome in meniscal lesions with radiofrquency coblation technology or normally mechanical technology under the arthroscopy. Methods Thirty-eight patients with mentisci injury was selected, and divided into radiorfequency and normal group according to the standards. The patients in former group were treated with menisci reformation by radiofrequency, while in later group by menisci parthial excision. Some criteria were analysised and evaluated by comparison of operation-time, post-operation effusion of joint and improvement on the degrees of flexion and extension, clinical symptoms, functional restoration of knee joint of both groups. Results The average operation-time in radiofrequency group was less than that of normal group apparently. It was less possible for effusion of joint happened in the radiofrequency group after operation. The improvement on the degrees of flexion and extension and functional restoration of joint in the radiofrequency group exceeded in another group. Conclusion The radiofrequency under the arthroscopy is simper and less leading the surrounded tissue injury with more excellent functional restoration fo knee joint, also it has more advantage than the normal menisci partial excision mechanically.

AIM: To determine whether the viartrils could provide a beneficial effect on the prevention of early/middle stage osteoarthritis(OA) and affect the proliferation of chondrocytes. METHODS: An OA model was produced with severing the anterior, posterior cruciate ligaments of the knee in 24 adult New Zealand rabbits. The animals were then randomly divided into viartrils group and control group. After surgical operation, viartrils (mainly contains glucosamine sulphate) 2 pills per day were administered to the animals in viartrils group. The animals were sacrificed and specimens were taken from the weight-bearing portion of the femoral condylar seven weeks after operation. Each case was evaluated according to a modified histological-histochemical grading system(HHGS) using HE and safranin O/fast green staining slides, and immunohistochemical method was used to detect the proliferation of chondrocytes in articular cartilage. RESULTS: The method of severing the anerior, posterior cruciate ligaments of the knee could successfully induce the early/middle stage model of OA. The pathological remark in control group was significantly higher than that in the viartrils group (P

BACKGROUND: The skill to culture osteoblasts primarily has been well developed. However, trypsinase can affect membrane protein of osteoblasts if the time of digestion is long. Therefore, it is of great significance to select an ideal method to avoid the damage from trypsinase to cells as possible when culturing osteoblasts.OBJECTIVE: To explore a novel method to isolate and culture SD rat osteoblasts in vitro, and identify the functions of the cells.DESIGN: Observational study.SETTING: Department of Orthopaedics, First Affiliated Hospital of Jinan University.MATERIALS: This experiment was carried out in the Department of Orthopaedics, First Affiliated Hospital of Jinan University from March to May in 2007. Eight SPF 24-hour old SD rats were used in the experiment. The rats, irrespective of gender, were provided by the Experimental Animal Center of Nanfang Medical University. The experimental animals were disposed according to ethical criteria. The main reagents were detailed as follows: collagenase Ⅱ (Sigma Company);trypsin (Sigma Company); alkaline phosphatase (ALP) kit (Nanjing Jiancheng Biological Products Company); SABC-1021(Wuhan Boster Biotechnology Company).METHODS: 24-hour old SD rats were chosen for experiment. The newly born SD rats were sacrificed by anesthesia and the cranial bones of the rats were obtained cleanly, erased completely of the periosteum and cut to blocks of I mm3. The cranial bones were digested by 0.25 % trypsinase for 20 minutes, then by 0. 1% type Ⅱ collagenase for 60 minutes. The digestive time of trypsinase was controlled in the process of digestion to avoid to harm the cells. The liquid was gathered and centrifuged. The cells were cultured in culture flask and were purified by many times adhered.MAIN OUTCOME MEASURES: Morphology observations under the inverted phase contrast microscope, transmission electron microscope, and scanning electron microscope were performed. The phenotype, calcium tuberculation and the expression of alkaline phosphatase were studied with alizarin red staining and modified Gomori Ca-Co assays respectively.The cells were also evaluated with collage Ⅰ immunohistochemical staining.RESULTS: The cultured cells had active proliferation ability. Cells showed multi-angle or fusiform shape. Nucleus was immature and organell was plentiful. Therefore, they had typical morphological characters of osteoblasts. Moreover, they showed the osteoblastic phenotypes such as their synthesis of alkaline phosphatase, collage Ⅰ and formation of calcium tuberculations.CONCLUSION: The cells cultured by our modified enzymatic digestion method had typical morphological and biological characteristics of osteoblasts.

OBJECTIVETo detect the clinical value of the ECT bone scan in evaluating of the situation of infection control after hip knee arthroplasty.

METHODSThe clinical data were retrospectively analyzed in 62 patients, including 34 males and 28 females with an average age of 68.8 years old ranging from 65 to 74 years. The results of ECT bone scan, erythrocyte sedimentation rate, C-reactive protein were used to assess periprosthetic infection. The patients with positive ECT and ESR on CRP were considered to have periprosthetic infection; however, the patients with two or more negative, indexes were considered to have no infection.

RESULTSThe sensitivity, specificity, accurate rate of ECT were 75.0%, 88.9%, 87.1% respectively; ESR 50.0%, 72.2%, 69.4%; CRP 62.5%, 81.4%, 79.0%. The combination of the three methods were 87.5%, 96.3% and 95.2%,

CONCLUSIONCompared with ESR and CRP, ECT is a more effective way in the diagnosis of periprosthetic infection, which has great value and is worth popularizing.

Aged ; Arthroplasty, Replacement ; adverse effects ; Blood Sedimentation ; Bone and Bones ; diagnostic imaging ; C-Reactive Protein ; analysis ; Female ; Humans ; Male ; Prosthesis-Related Infections ; diagnostic imaging ; Retrospective Studies ; Tomography, Emission-Computed ; methods

Phagocytic capacities of both dendritic cells (DC) and macrophages(M?) in the DC-enriched fractions isolated from rat spleen were comparatively observed under electron microscope. Experiments were divided into two groups: in vitro and in vivo. In group 1, candida albicans(CA), cock red blood cells (CRBC) and CRBC opsonized with rat antiserum against CRBC (OCRBC) used as phagocytic markers were incubated with the DC-enriched fractions for 1h at 37℃ separately in vitro. In group 2, colloidal carbon (CC) (india ink) and heat killed Candida albicans (HKCA) were injected in vivo. The animals were sacrificed 18h later and DC-enriched fractions were isolated from the spleens. The results are as follow: generally, in the cytoplasm of DC, no phagocytic markers were identified except a few of DC ingested a small amount of CC in vivo and few CA occationally in vitro, while M? under the same conditions, ingested a lot of the substances mentioned above. It indicates that spleen M? phagocytose actively either to immunogenic or non-immunogenic, opsonized or non-opsonized particles (especially to opsonized particles), while DC in the same preparations are not.

OBJECTIVETo observe the clinical efficacy of Safflower Injection (Al) in treating and preventing the vascular crisis after free flap transplantation.

METHODSSixty patients undergoing free flap transplantation were randomly assigned to the treatment group and control group according to the visiting sequence, thirty in each. Free flap transplantation was performed on all patients, and medication was given 0. 5 h before flap vascular anastomosis, 1-7 days after surgery. Twenty mL Al was intravenously dripped to patients in the treatment group after adding in 250 mL 5% glucose injection, while Dextran-40 was intravenously dripped to patients in the control group. The medication was conducted once per day. The hemorheology and four indices of blood coagulation [prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen (FIB)] were compared between the two groups before operation (TO), during operation (T1), 24 h after operation (T2), three days after operation (T3), and seven days after operation (T4). Meanwhile, flaps were observed and adverse reaction recorded. The clinical efficacy and safety were compared.

RESULTSBetter result was obtained in the treatment group when compared their clinical efficacy (86. 67% vs 60. 00%, P<0.05). The whole blood high and low viscosity, plasma viscosity, red blood cell (RBC) volume, RBC aggregation index all decreased, and RBC deformed index increased in the two groups at T4, showing statistical difference when compared with those at T3 (P<0.05, P<0.01). There was no statistical significance in the four indices of blood coagulation when compared with any time point in the same group (P>0.05). There was no statistical significance in hemorheology and the four indices of blood coagulation between the two groups at the same time point (P>0.05). The adverse reaction rate in the treatment group was lower than that in the control group, showing statistical difference (13.33% vs 30.00%, P<0.05).

CONCLUSIONSAI could effectively prevent and treat the vascular crisis after free flap transplantation. It had less adverse reaction and good safety. It was better than Dextran-40. It was a safe and effective drug to prevent the vascular crisis.

Adult ; Carthamus tinctorius ; Female ; Free Tissue Flaps ; adverse effects ; Humans ; Injections ; Male ; Middle Aged ; Phytotherapy ; Skin Transplantation ; adverse effects ; Vascular Diseases ; etiology ; prevention & control ; Young Adult

Objective To investigate the clinical value and relating problems in treating atlantoaxial instability by using transpedicular instrumentation with fusion. Methods The study reviewed 18 patients (11 males and 7 females, at age range of 13-82 years, mean 46.5 years) with atlantoaxial instability undergone transpedicular screw internal fixation with bone grafts fusion. There were 15 patients with type Ⅱ odontoid fractures, two with traumatic disruption of transverse atlantal ligament and one with fracture of the anterior ring of C1, all of which were associated with atlantoaxial subluxation or obvious instability. Preoperative JOA score was 6-13 points (average 9.5 points). Results The operation lasted for mean 115 minutes (range 75-180 minutes), with intraoperative blood loss of mean 235 ml (range 130-450 ml). One patient presented intraoperative plexus venous bleeding during removal of lower edge of the posterior arch of atlas and was treated with hemostasis using compession of gelatin sponge. All the patients were followed up for a mean period of 13.5 months (6-38 months), which showed no complications including infection, loosening or breakage of internal fixators or neurovascular injury related to internal fixation. Postoperative JOA score was 12-17 points (average 14.5 points). Reduction and solid fusion of the bone graft were achieved satisfactorily in all patients. Conclusions Posterior transpedicular screw internal fixation with bone grafts fusion can achieve good reduction, reliable fixation, high fusion rate and is a reliable method to manage atlantoaxial instability. Correct selection of the indication, familiarity with local anatomy and mastery of the operation technique are key to a satisfactory curative effect.

BACKGROUND:Correlation between subchondral bone and articular cartilage in the process of osteoarthritis has not been fuly elucidated. Degeneration of cartilage is the focus of attention, and the subchondral bone also plays an important role in the process of osteoarthritis. OBJECTIVE: To observe the differences between experimental osteoarthritis models in rabbit knees established by two kinds of surgical methods and two kinds of proteases inducing methods, and to explore the correlation between subchondral bone mass and degeneration of cartilage. METHODS:Thirty-two New Zealand rabbits were randomly and averagely divided into four groups: Hulth group (group A), anterior cruciate ligament transaction group (group B), colagenase type II group (group C) and papain group (group D). The right knees of rabbits were established as osteoarthritis models, and the left knees served as controls. Bone mineral density of the knee joint was evaluated by dual-energy X-ray absorptiometry scanning at 0, 4 and 8 weeks after modeling. The rabbits were sacrificed at 8 weeks after MRI scanning, bilateral knee joints were harvested for general and histological observation. Quantitative analysis was done according to Mankin scores. RESULTS AND CONCLUSION: Bone mineral density of the right knees decreased at 0, 4 and 8 weeks after modeling, and the rank was as folows: group A > group B > group C > group D. MRI scanning showed that the articular cartilage thickness of the medial and lateral femoral condyle on the right knees became thinner compared with the left side, and the rank was as folows: group A < group B < group C < group D. Observation by specimens and pathological slices showed that the articular cartilage degeneration of the surgery groups worsened, group A was the most serious one, and group 1D was the lightest. Both surgery and proteases inducing methods can successfuly establish osteoarthritis models in rabbit knees. Surgery inducing models resemble the advanced or intermediate stage of osteoarthritis, while the proteases inducing models resemble the early stage of osteoarthritis. Degeneration of the articular cartilage and changes of subchondral bone are related in progressive development.

[Objective]To investigate the efficacy of total hip arthroplasty(THA)on the treatment of traumatic arthritis that caused by internal fixation failures of intertrochanteric fractures.[Methods]During January 2009 and March 2016,35 cases of trau?matic arthritis(male:18 cases;female17 cases;49 ~ 86 years old,with an average age of 68.5 years)caused by internal fixation failures or malunion of intertrochanteric fractures,were undergo THA. Among 35 cases,13 cases were performed with the proximal femoral fixation stems,10 cases were with distal fixation stems,and 12 cases were with extended stems.[Results]With 3~65 months follow-up,the hip joint HSS score was elevated from 44.1(31 ~ 65)preoperative to 82.5(58 ~ 94)postoperative without obvious loosening. No postoperative deep infectionwas found. The femoral stems in 2 cases were found to sink 5 mm and 10 mm,respectively. No obvious prosthesis loosening was found. Taken together ,the satisfaction rate of THA on the joint function of traumatic arthritis was 91.4%.[Conclusion]Total hip arthroplasty is recommended as an effective approach for treating traumatic arthritis caused by internal fixation failures of intertrochanteric fractures. Distal fixed prosthesis was recommended due to bone sclerosis or defects of proximal femur. Coupled with emphasis on reconstruction of the greater trochanter ,good therapeutic effects could be achieved.