Objective To evaluate mid-term clinical and radiographic outcomes associated with cementless total hip arthroplasty(THA) in a consecutive series of patients with osteonecrosis of the femoral head. Methods This study examined the mid-term (equal to or more than 5 years) results of THA. From January 1998 to March 2001, a series of 71 patients (80 hips) who had undergone THA with cementless components in our hospital were involved in this study. All patients were evaluated both clinically and radiographically. Clinical outcomes were evaluated according to Harris evaluation score. Components migration, bone changes around the implant, the polyethylene wear rate and direction of the acetabular polyethylene wear were measured radiologically. Kaplan-Meier analysis was performed to evaluate the survival of the femoral and acetabulum components. End point was radiographical loosening or revision of the acetabular component, and revision of the femoral component for any reason. Results 62 hips in 54 patients were followed up at least 5 years. The mean Harris hip score improved from preoperation (44.0?8.4) points to (92.4?5.7) points at the time of final follow-up. No component was seen to be loose radiographically or had been revised because of any reason at the time of final follow-up. Only one focal area of pelvic osteolysis in one patient and twelve small focal areas of femoral osteolysis in another patient were identified. The mean linear wear rate was (0.125?0.074) mm/year. When loosening was used as the end point for failure, the survival rate of the acetabular and femoral components was 1.0 (95% confidence interval, 0.98 to 1.00) in both groups. Conclusion Cementless THA in patients with osteonecrosis of the hip had a satisfactory clinical and radiographic outcome at a minimum of five years follow-up. Because polyethylene wear and osteolysis can not avoided, radiographical follow-up for cementless components is very important.

Objective To discuss a new method of BMSCs culture which can reduce the lead-in of extraneous antigenic substances in the process of cell culture, and can thus better meet the demand on the quantity and biological characteristics of BMSCs in the clinical use of tissue engineering bone. Methods BMSCs from a human adult in vitro were induced by using autologous platelet-rich plasma instead of animal serum in high-carbohydrate DMEM (Dulbecco's minimum essential medium). After the cultured BMSCs were amplified rapidly by Rotary Cell Culture System, their growth status was observed and their biological characteristics were detected. Results The cells were in good growth status and presented fine biological characteristics. Their growth speed in Rotary Cell Culture System was observed to be evidently faster than that by conventional methods. Conclusions Rotary Cell Culture System by autologous platelet-rich plasma instead of animal serum is a good culture method to induce human BMSCs in vitro. The quantity and biological characteristics of BMSCs cultured in this way can meet the demand in clinical use.

Objective To evaluate the computed tomography (CT) characteristics of cardiovascular involvement in Beheet syndrome. Methods Eleven patients with clinically diagnosed Behcet syndrome were studied retrospectively from July 1995 to December 2007. Electron beam CT or 64-slice helical CT scanner was used and CT characteristics were reviewed. Results Eleven patients were diagnosed according to the criteria reported by the international study group for Behcet syndrome. Of them, 4 patients presented with aortic valve prolapse (2 patients with mitral valve prolapse), false aneurysm of right coronary artery was demonstrated in 2 patients, false aneurysm of left subclavian artery, aortic aneurysm and penetrating ulcers, aortic arch false aneurysm, aortic dissection, pulmonary embolism and interatrial scptum aneurysm in 1 case, respectively. Conclusion CT is a very useful method for the diagnosis and foUow-up of Behcet syndrome.

Objective To investigate the effects of alcohol on hippocampal apoptosis-inducing factor (AIF) and caspase-3 expression in cercbral ischemia/reperfusion in rats.Methods Sixty-eight healthy adult male Wistar rats were randomly divided into a sham operation group (n =4) and a saline control group as well as low-dose (1.0 g/kg),medium-dose (1.5 g/kg) and high-dose (2.0 g/kg) ethanol groups.The saline control group and each dose alcohol group were redivided into ischemia/reperfusion 0,1,2 and 3 h subgroups according to the intervention time points (n =4 in each group).A model of middle cerebral artery ischemia/reperfusion in rats was induced by the suture method.The corresponding doses of ethanol or an equal volume of saline were injected intraperitoneally at ischemia for 2 h and reperfusion for 0,1,2 and 3 h in the alcohol groups and the saline control group.At ischemia for 2 hand reperfusion for 24 h,the neurological deficit in rats was evaluated by using behavioral score.Immunohistochemistry assay was used to detect the expressions of AIF and caspase3 in the hippocampus of ischemic sides at ischemia for 2 hand reperfusion for 24 h.Results The behavior evaluation showed that the neurological deficit score was 0 in the sham operation group.The neurological deficit scores in the different dose ethanol groups were significantly lower than those in the saline control group at the same intervention time points (all P=0.000),and there were significant differences between the same intervention time points in the different dose ethanol groups (all P =0.000).The high-dose ethanol group was the lowest.There were no significant differences between the different intervention time points in the same dose ethanol groups (all P＞0.05).Immunohistochemistry revealed that the numbers of positive cells of AIF and caspase-3 in the sham operation group were 17.21 ±2.86 and 20.60 ±4.39,respectively,and they were significantly less than those in the saline control group and the each dose ethanol group at ischemia/reperfusion 0 h (all P =0.000); the number of positive cells of hippocampal AIF and caspase-3 in the different dose ethanol groups were all significantly less than those in the saline control group at the same intervention time points (all P =0.000).There were significant differences between the same intervention time points in the different dose ethanol groups (all P =0.000),and the high-does ethanol group was the lowest.There were no significant differences between the different intervention time points in the same dose ethanol groups (all P =0.000).Conclusions Alcohol has protective effect on the cerebral tissue in ischemia/reperfusion injury in rats.Its mechanism may be associated with the inhibition of AIF and caspase-3 expression.

Objective To investigate the effects of previous open nephrolithotomy on the technical features, outcomes and morbidities of subsequent percutaneous nephrolithotomy (PCNL). Methods Ninety-eight patients who underwent PCNL from January 2006 to January 2011 were selected in this study. The 34 patients of them who had previous open nephrolithotomy on the same kidney were assigned as group A, and the other 64 patients who had no previous open surgery as group B. The data of operation time, blood transfusion quantity, residual stones rate, hospitalization time and time of tube evulsion were collected and compared between the two groups. Results There were no significant differences between the group A and B with respect to the mean operative time [(84.0±24.6) min vs. (94.0±22.7) min, t=1.372, P=0.177], hospitalization time [(6.5±1.1)days vs. (6.3±1.8)days, t=0.49, P=0.261], blood transfusion quantity [(82.9±10.6) ml vs. (85.0±11.8) ml, t=0.415, P=0.682], kidney and colostomy channels [single channel(70.6% vs. 75.0%), double channel (29.4% vs. 25.0%), χ2 =0.22, P=0.638] and residual stones rate (5% vs. 3%,χ2=0.42, P=0.282). Conclusions When PCNL is performed after previous open nephrolithotomy, there is no difference in success rate and morbidities.

Objective To explore the efficacy and safety of greenlight photoselective vaporization of prostate (PVP) in high-risk elder patients with benign prostatic hyperplasia (BPH). Methods A total of 120 high-risk elder patients with BPH underwent PVP procedure. The operating time, blood 1oss, indwelling catheterization and operation-related complications were monitored. The variables such as international prostate symptom score (IPSS), Quality of life (QOL) score, maximum urinary flow rate (Qmax) and residual urine volume (RUV) were recorded and compared pre- and post-operatively. Results All the 120 patients had a good peri-operative condition. The mean operating time was (52. 6 ± 5.8 )min, intraoperative blood loss was (20.4 ±9.5) ml. Among the 120 cases,26 did not received postoperative catheterization. In the other 94 cases received postoperative catheterization, the mean catheterization time was (24. 5 ± 15.9) hour. IPSS and QOL scores decreased from (28.5 ± 3.8) and (5.0 ± 0.8) preoperatively to (7.2 ± 1.8) and (1.5 ± 0.6)postoperatively. Qmax increased from ( 5.2 ± 3.1 ) ml/s to ( 15.2 ± 4.3 ) ml/s, and RUV decreased from ( 118.6 ± 15.2) ml to ( 16. 5 ± 4. 6) ml. There was significant difference for these parameters before and after the operation (Ps ＜ 0. 05 ). Conclusion The PVP is considered to be a safe, effective and minimally invasive procedure to treat BPHin high-risk elder patients. It is easy to manipulate, with advantages of shorter operating time,less blood loss, better tolerance and rapid recovery, especially for high-risk elder patients with BPH.

Objective To evaluate and analyse the effectiveness of surgical treatment for fibrous dysplasia in proximal femur with severe varus deformity.Methods A retrospective study was performed in 21 patients (24 femora)of fibrous dysplasia who were treated in our hospital between August 2000 and May 2009.All patients had severe femoral varus deformity.The four-step procedures were performed orderlv as valgus osteotomy,lesion curettage,impacting of massive bone allograft,and fixation by femoral intramedullary nail.There were 6 patients with monostotic disease,15 with polyostotic diseases,including 12 males and 9 females with a mean age of 22.7 years(range,14-39 years).The average neck-shaft angle and femoral varus angle was 75°(range 55°-105°)and 30°(range,18°-45°),respectively.The average length of thigh shortened 3.4 cm(range,2.0-4.5 cm)compared with the contralateral thigh.Results All of the 21 patients were followed up from 21 months to 7 years with an average period of 3 years and 4 months.There were 30 osteotomy sites in 24 femurs,28 osteotomy sites showed bone union after 3-6 months from surgery.Two distal location of the double-level osteotomy showed nonunion,which received bone grafting again and got bone union after 3 months finally.The femoral mechanical alignments of the 21 patients had been recriticd.The average neck-shaft angle was 118°(range,95°-135°)postoperatively,the femoral varus angle disappeared.The average extremity lengthening was 2.8 cm(range,1.8-3.6 cm)postoperatively.There were no infection,recurrent fracture and progression of deformity.The visual analogue scales(VAS)score of 17 patients decreased to zero postoperatively from 7-10 preoperatively,and that of the other 4 patients decreased to 3-4 postoperatively from 8-10 preoperatively.The result of Harris hip functional score was excellent in 12 cases,good in 6,and fair in 3.Conclusion The valgus osteotomy can rectify varus deformity effectively.The reconstract nail of the fumer can support the stability of femur.Impacting of massive bone allograft can improve the capacity of the femur.

OBJECTIVETo explore the effects of nano-hydroxyapatite/polyamide 66 (n-HA/PA66) cage on recovering and maintaining lumbar curvature, lumbar heights and fusion rate when used in the transforaminal lumbar interbody fusion.

METHODSFrom February to July 2012, 50 patients with degenerative lumbar disease(lumbar disc herniation in 32 cases and lumbar spondylolisthesis in 18 cases) were treated with transforaminal lumbar interbody fusion using the n-HA/PA66 cage, and their preoperative and postoperative clinical outcomes were analyzed. The patients were followed up for 2, 4, 6 and 8 months after operation, during which the CR and CT film of lumbar vertebra were checked to get relative height of vertebral space, Taillard index,index of lumbar spinal curvature,angle of segmental and full lumbar lordosis. The data were analyzed respectively with pair t-test, analysis of variance or LSD-t-test.

RESULTSAll the patients were followed up, and the duraion ranged from 8 to 13 months, with a mean of 11.32 months. There were significant differences in relative height of vertebral space, Taillard index, index of lumbar spinal curvature, angle of segmental and full lumbar lordosis after surgery, but there were no significant differences in different periods after operation. The fusion time of lumbar ranged from 4 to 8 months.

CONCLUSIONThe n-HA/PA66 cage can recover and maintain lumbar normal stability with higher rate of fusion and less complications.

Adult ; Durapatite ; administration & dosage ; Female ; Humans ; Intervertebral Disc Displacement ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Nylons ; Spinal Fusion ; adverse effects ; instrumentation ; methods ; Spondylolisthesis ; surgery ; Tomography, X-Ray Computed

OBJECTIVETo analyze the reasons why anterior decompression and titanium mesh fusion for cervical spondylosis always show poor therapeutic effects, and to investigate the clinical effects of anterior revision surgery in these patients.

METHODSFrom January 2004 to December 2011, 16 patients underwent anterior decompression and titanium mesh fusion for cervical myelopathy were treated with anterior revision surgery. There were 7 males and 9 females with an average age of 61 years old (ranged from 46 to 75 years), including 11 cases with cervical spondylotic myelopathy, 2 cases with nerve root cervical spondylosis and 3 cases with mixed type cervical spondylosis. Average duration from the first operation to reoperation was 7 years(ranged from 4 to 12 years). In the first operation, titanium mesh segment located in C3-C5 (2 cases), C4-C6 (8 cases), C4-C7 (2 cases), C5-C7 (4 cases), and one of them, titanium mesh implantation in C4 and C5,6 intervertebral disk removal and cage fusion. After the first operation, symptom of 13 patients recurred after improvement or disappearance, 2 patients did not show obvious improvement, and 1 patient aggravated. Cervical spine radiography, CT scan and MRI were performed in all patients before re-operation. There were 12 patients with compression of the spinal cord or nerve root caused by degenerative changes in adjacent segments of fusion segments, 4 cases in upper segments, and 8 cases in lower segments; 3 patients with compression of the spinal cord or nerve root caused by vertebral posterior osteophyte of decompressed segments; 1 patient with compression of the spinal cord caused by incomplete anterior decompression. JOA, NDI and Odom classification were used to assess the clinical effects.

RESULTSAll anterior revision surgery were successful with a mean time of 110 min (80 to 150 min) and mean bleeding of 160 ml (30 to 200 ml). There was 30 ml clear drainage fluid in 1 patient suspected of cerebrospinal fluid leakage. But the 2nd day after operation, the tube was removed and the drainage opening was sutured, and the suture incision healed in grade A after 10 days. Other patients had no complications such as dysdipsia, hoarseness, and laryngeal edema, etc. All patients were followed up for 12 to 28 months with an average of 16 months. Two months after operation and at last follow-up, JOA scores and ODI index had obviously improved than preoperation (P < 0.01), and there was significant difference between postoperative 2 months and last follow-up (P < 0.01). At the final follow-up, improvement rate of JOA was (72.9 +/- 0.2)%. According to the standard of Odom, 12 cases got excellent results, 3 good, 1 fair.

CONCLUSIONAfter surgery of cervical decompression and bone graft fusion with titanium mesh, the patients need re-operation because of incomplete decompression, degenerative changes in adjacent segments or newly formed compression factors, and complications caused by implants. Anterior revision surgery can obtain good clinical effects.

Aged ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; methods ; Female ; Humans ; Male ; Middle Aged ; Reoperation ; Spinal Fusion ; methods ; Spondylosis ; surgery ; Surgical Mesh ; Titanium

A finite element model of cervical spine was three-dimensionally reconstructed through computed tomography (CT) scan, recording the edges of image using Snigraphics V18.0 software, and calibrating in sequence of point, line, area, and solid. The stress distribution of cervical C_(3-4) was analyzed using compute aided design to validate the availability of reconstructed models. Results showed that the three-dimensional finite element cervical C_(3-4) was feasible in simulation analysis. These indicate that the established three-dimensional finite element models can simulate biomechanical experiments, providing foundations for analyzing biomechanical performance of local structure of this finite element model under various pressure conditions.