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.

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

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.

Objective To compare the efficacy of different analgesia regimens in elderly patients with femoral neck fracture undergoing posture changing during epidural anesthesia. Methods Ninety patients (35 males,55 females,aged 65-90 years,48-78 kg)with femoral neck fracture who would be treated with artificial femoral head replacement were randomly divided into 3 groups (n = 30 each):femoral nerve block group (group FNB),fascia iliaca compartment block group (group FIC)and intravenous group (group IV).Femoral nerve block or fascia iliaca compart-ment block was performed 30 min before epidural anesthesia (EA)in FNB group or FIC group re-spectively.Fentanyl 0.5 μg/kg was injected intravenously 3 min before EA.In the three groups,addi-tional 0.25 μg/kg fentanyl was administrated intravenously to keep the VAS scores <4 before posi-tioning.EA was performed between L1-2 in a position of troubled leg upper,and patients returned to supine position after epidural catheterization.The VAS scores at T0 (after entering the operation room),T1 (in supine posture before EA),T2 (before posture changing),T3 (while supine from lateral posture after EA),T4 (3 min after T3 ),the time for achieving EA,the fentanyl consumption, the cases of cardiovascular events and hypoxemia was recorded.Results Compared with group IV, VAS scores at T1 ,T2 ,the fentanyl consumption,time for achieving EA,and incidence of cardiovas-cular events and hypoxemia in group FNB and group FIC decreased significantly (P <0.05 or 0.01). There was no significant difference between group FNB and group FIC.Conclusion Preemptive anal-gesia regimens through both femoral nerve block and fascia iliaca compartment block during epidural anesthesia can reduce the fentanyl consumption,as well as decrease the incidence of cardiovascular e-vents and hypoxemia.

Objective To summarize the experience in the diagnosis and treatment of elastofibroma dorsi,focusing on the clinical features,the specific radiological characteristics,and the typical pathological alterations.Methods Clinical data of 10 cases of pathologically confirmed elastofibroma dorsi from January 1997 to April 2008 were retrospectively reviewed.Results Most patients were female(8/10)in this series.All the lesions were located within the muscles in the subscapular region.There were 13 lesions in 10 cases(3 cases with bilateral involvement).Seven patients complained of pain and feeling of foreign body,and three were asymptomatic.The size of the masses was between 4 centimeters to 12 centimeters,averaging at(7.46 ±2.70)centimeters.Except for the early 3 cases,accurate diagnosis was made in all the other 7 cases before the histological exams solely based on the physical examination and imaging findings.Marginal excision was done for all the cases under general anesthesia.Fluid accumulation,as the only kind of complication was found in 3 cases which was resolved by repeated paracentesis.No recurrence was found during the follow-up period(4 months to 125 months,median 11 months).Conclusion Elastofibroma dorsi is a rare,pseudotumoral lesion usually found in elderly women.It is a very special type of soft tissue tumors that its diagnosis can usually be made solely on the basis of unique imaging characteristics and physical examination before the histological exam.Surgical marginal excision is the choice of treatment with good short-term and long-term results.