Objective To evaluate clinical and radiographic outcomes associated with total hip arthroplasty (THA) using metal-on-metal prosthesis with large diameter femoral head.Methods From October 2007 to December 2007,41 patients (49 hips) underwent large diameter femoral head metal-on-metal THA in our hospital were involved in this study.Clinical outcomes measures were Harris score,hip range of motion and incidence of complications.Abduction angle and anteversion angle of cup were measured on radiological films.The radiolucent line and osteolysis around the prosthesis were also recorded.Results Thirty-nine patients (47 hips) were followed up at least 2 years.The average Harris hip score had improved from (43.8±13.1) points preoperatively to (92.0±5.4) points at final follow-up.All the patients had attained satisfactory results.No late complication happened.For the rang of motion at final follow-up:flexion of the hip had improved from 79.8° to 113.2°,abduction had improved from 20.9° to 40.2°,external rotation had improved from 12.0° to 30.8°.Radiological measurement showed the mean abduction angle of cup was 39.5°±4.9°,the mean anteversion angle of cup was 14.5°±2.1°.No radiolucent line and osteolysis were found after THA.Conclusion The short-term effects of THA using metal-on-metal prosthesis with large diameter femoral head is encouraging,especially for young patients.

Objective To investigate the middle-term results of anti-protrusio cage combining with allograft bone graft for revision arthroplasty of Paprosky type Ⅲ acetabular bone defect.Methods A retrospective analysis was done for 19 patients (20 hips) with Paprosky type Ⅲ acetabular bone defect who received acetabular revisions using anti-protrusio cage from January 2002 to December 2009.There were 11 males and 8 females,aged from 42 to 76 years (average,57.4 years).There were 7 hips (35％) of Paprosky type ⅢA acetabular bone defect,and 13 hips (65％) of type ⅢB.The follow-up time was (5.8±2.4) years.Hip function of patients was judged by Harris hip scores pre-and post-operation.The outcome of acetabular prostheses and bone grafts were assessed by radiologic evaluation.The five-year cage failure-free survival rate was assessed by Kaplan-Meier survivorship analysis.Results The Harris hip scores improved from preoperative 14.6±4.3 to 83.5±7.9 at the final follow-up.Lower limb discrepancy improved from preoperative (26.3±9.1) mm to postoperative (1.2±3.4) mm.The hip rotation center was reconstructed from preoperative(23.6±7.4) mm up-toward and (4.4±14.7) mm lateral-toward dislocation to inside Ranawat triangle.All the allograft bone was incorporated with host bone.None of cage displacement,screw fracture,progressive radiolucency and cement fracture was observed.Mild allograft bone resorption was observed in 3 hips (15％).There was no moderate or severe bone resorption found at the final follow-up.The five-year cage failure-free survival rate was 100％ (95％ CI,0.95-1.00).Conclusion The revision using anti-protrusio cage combined with allograft bone graft shows satisfying middle-term clinical and radiological results in the treatment of Paprosky type Ⅲ acetabular bone defect.

Objective To explore the anatomical morphology of femoral trochlear groove and the difference between normal males and females.Methods Eighty healthy volunteers were recruited,including 42 males and 38 females with an average age of 36.2 years (range,21-55 years).All the volunteers without knee unstabilization,pain and wound.CT scan of right femurs were performed and 3-D model were reconstructed.The anatomical parameters of right femoral trochlear groove were measured,which included transepicondylar axis,medial and lateral length of trochlear groove,medial and lateral condylar height,sulcus angle,depth of trochlear groove,transcondylar axis,anterior femoral condylar angle,trochlear groove position,and then compared the morphologic difference of trochlear groove between males and females.Results The average width of transepicondylar axis was 79.21±3.80 mm for males and 70.73±2.91 mm for females (t=-53.40,P=0.00).The minimum sulcus angle was acquired at 45° flexion for males and 42° flexion for females.It was 133.92°±4.76° for males and 132.71°±4.36° for females.The maximum length of transepicondylar axis was acquired at 87° flexion for males and 90° flexion for females.It was 42.36±3.48 mm for males and 39.03 ±3.36 mm for females.The anterior femoral condylar angle decreased with the increasing flexion angle of knee (P＞0.05).The position of the trochlear groove moved laterally with the increasing flexion angle of knee (P＞0.05).Conclusion There is no significant difference between male and female in the geometry of femoral trochlear groove,however there is a significant difference in sizes.Therefore,during design the knee prosthesis,close approximation of size is essential,while gender differences in morphology need not be considered a factor.

Objective To evaluate the efficacy and safety of local infiltration analgesia in the multimodal analgesia protocol.Methods Sixty patients who were scheduled to undergo TKA were randomly divided two groups:local infiltration analgesia (LIA) group (n=30) or the non-local infiltration analgesia (N-LIA) group (n=30).All patients were given Celecoxib 200 mg bid,3 days preoperative,and a single-injection femoral nerve block (SFNB) half an hour before the surgery (ropivacaine 3.3 g/L,30 ml).The LIA group was given local infiltration analgesia with ropivacaine (2.5 g/L,60 ml) and 0.1 mg epinephrine before suture the operative incision.The N-LIA group didn't do the LIA.Both of the two groups didn't use the patient controlled analgesia.The VAS scores,the knee joint range of motion,the muscle strength of quadriceps femoris and the side effects and complications were recorded.Results The VAS scores were lower in LIA group than in the N-LIA group,these scores at 2 h to 48 h after surgery at rest and after 24 h at motion had statistical significance.The range of motion and the muscular strength of quadriceps femoris in the LIA group were better than in the N-LIA group.In the LIA group the use of opioids was less and the side effects were lower.The average length of hospital stay after the operation was shorter in the LIA group than the N-LIA group.Conclusion This multimodal perioperative analgesia protocol that include SFNB and LIA offered improved pain control and minimal side effects to patients undergoing TKA.

Objective To determine medium-term curative effect of extensively coated non-modular femoral stems in twostage infection revision after joint replacement.Methods We retrospectively analyzed 33 patients (33 hips) who had a two-stage infection revision after total hip replacement arthroplasty from March 2005 to December 2006.Among of them,there were 20 men (20 hips) and 13 women (13 hips).Their mean age was 66.1±7.2 years with a range from 52 to 80.The two-stage revision protocol consisted of joint prosthesis taken out in the first stage,thorough debridement,hand-molded antibiotic bone cement spacer,and two-stage joint revision after anti-infective therapy.Anti-infective therapy included intravenous antimicrobial therapy for 4 weeks and oral antibiotics for 6 weeks.Harris hip score (HHS) was used to evaluate functions of hip joint.X-ray films were used to perform clinical and radiological evaluations of prosthesis stability,displacement and looseness.Reinfection criteria were the same as the criteria used to diagnose the joint infection.Results Follow-up visit was carried out for all patients for 5-9 years (6.1±1.7 years on the average).No infection or prosthesis looseness happened after two-stage revision.Microculture of samples taken during two-stage revision or pathological examination was negative.Harris hip joint score rose to 89.1 ±8.5 in the last follow-up visit from preoperative 42.3±6.5.30 patients achieved stable bone ingrowths and the remaining three had stable fibrous ingrowths.Impacted bone graft at acetabulum side for 11 patients and all impacted bone graft in marrow cavity were fused well with the host bones.Allogeneic cortical bone plate grafts were used in 10 hips on the femoral side.Nine of these cortical bone plates fused with the host bones after postoperative 1 year,whereas one fused after 2 years.Conclusion Using extensively coated non-modular femoral stems combined with intramedullary allograft in two-stage revision for treating infection can achieve satisfactory medium-term survival rate of prosthesis and infection clearance rate.

OBJECTIVETo investigate the early diagnosis and treatment for trauma around the knee with popliteal vascular injury.

METHODSA retrospective analysis was employed to analyze the clinical data from 15 patients (9 males and 6 females were with a mean age of 39.2 years old,ranging from 26 to 62 years old) with fracture or dislocation around the knee with popliteal vascular injury from January 2007 to January 2013. Combined with clinical symptoms and signs, oxygen saturation monitors, color ultrasound, DSA angiography and interventional surgery were used to determine the vascular injury. The knee fracture and dislocation were fixed with hybrid external fixation and plate-screw fixation, respectively. Then, the blood circulation was reconstructed by thrombectomy, repair and autologous vein graft for individual injured vascular. The average total operation time, average hospitalization days, predictive salvage index (PSI), average blood transfusion amount, average medical expenses and infection cases were recorded to determine the effect of early diagnosis and treatment.

RESULTSThere was one patient with death, 8 patients with amputation, and 6 patients with successful repair surgery for popliteal artery, anterior tibial and posterior tibial arteries. These six patients with surviving limbs were followed up for an average of 28.3 months (ranged, 12 to 60 months). Among the 6 successful patients, the joint function of 4 patients was good and excellent.

CONCLUSIONThe trauma around the knee with popliteal vascular injury is characterized by complex and serious injury, easy misdiagnosis and loss diagnosis, poor prognosis and high risk of amputation. The early diagnosis of trauma around the knee with popliteal vascular injury should depend on the mechanism of trauma, local anatomical characteristics of injury site, clinical presentations and appropriate auxiliary examinations. The appropriate indications for limb salvage and amputation should be used to achieve more effective clinical results.

Adult ; Early Diagnosis ; Female ; Humans ; Knee Injuries ; diagnosis ; surgery ; Male ; Middle Aged ; Popliteal Artery ; injuries ; surgery ; Retrospective Studies

A new approach based on online coupled liquid chromatography-gas chromatography-mass spectrometry ( LC-GC / MS ) was developed for the rapid determination of 4-( methylnitrosamino )-1-( 3-pyridyl)-1-butanone (NNK) in mainstream cigarette smoke, in which a switching valve was employed to online switching between two-dimensional chromatography. The online LC-GC / MS system used in this study was built by using online gel permeation chromatography-gas chromatography-mass spectrometry except that the micro gel column was replaced by micro alkaline alumina column which was prepared by ourselves before. The NNK in mainstream cigarette smoke was collected by a Cambridge filter pad, then the pad was extracted with dichloromethane, and the extract was quantitatively analyzed by online LC-GC / MS with D4-NNK as an internal standard. Online LC-GC / MS allowed online pretreatment purification, and the sample was subjected to online LC-GC / MS without any prior purification, which reduced human error in analysis process. The injection volume of the present online LC-GC / MS could reach 40 μL, which was 20 times of that of the conventional GC / MS (2. 0 μL of injection volume), and thus significantly improved the sensitivity. Under the optimum conditions, good linearity ( r = 0. 9998) was obtained over the range of 1. 2 - 120 ng / mL. The recoveries at three spiked levels ranged from 93. 9% to 96. 0% , and the limits of detection for qualitative and quantitative detection were 0. 25 ng / mL and 0. 9 ng / mL, respectively. All the results obtained by the present method are comparable to those of standard method recommend by China National Tobacco Company.

OBJECTIVETo investigate the expression of angiopoietin (Ang)-1 and Ang-2 in colorectal tumors and its relations to microvessel density (MVD) in tumor tissue.

METHODSAng-1, Ang-2 and factor VIII-related antigen were stained immunohistochemically in 91 cases of primary colorectal adenocarcinoma, 20 cases of colorectal adenoma and 24 cases of normal colorectal mucosal tissue, and MVD was also assayed in above tissue specimens.

RESULT(1) A significantly higher Ang-1 (7.07+/-2.00) was observed in normal tissue compared with 1.75 +/-1.98 in the adenoma and 1.40 +/- 1.22 in the adenocarcinoma (P<0.01). (2) Ang-2 protein positive rate in adenocarcinoma was significantly higher than that in normal tissue and adenoma (P<0.01). The expression of Ang-2 in adenocarcinoma was closely associated with poor differentiation and vessel invasion. (3) There were significant correlations between Ang-1 and Ang-2 (r=-0.338, P<0.01), Ang-1 and MVD (r=-0.388, P<0.01), Ang-2 and MVD (r=0.594, P<0.01) in the 135 cases.

CONCLUSIONThe overexpression of Ang-2 may play an important role in angiogenesis of colorectal adenocarcinoma. It can be regarded as an index for malignancy and prognosis in colorectal adenocarcinoma.

Adenocarcinoma ; blood supply ; metabolism ; Adult ; Aged ; Aged, 80 and over ; Angiopoietin-1 ; biosynthesis ; genetics ; Angiopoietin-2 ; biosynthesis ; genetics ; Biomarkers, Tumor ; Capillaries ; pathology ; Colorectal Neoplasms ; blood supply ; metabolism ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; von Willebrand Factor ; biosynthesis ; genetics

OBJECTIVETo explore optimal choice of surgical treatment and operative approach for closed complex tibial plateau fractures and its influencing factors.

METHODSFrom January 2003 to January 2011, 95 patients with closed complex tibial plateau fractures were estimated Schatzker V and Vl, and treated with three different surgical methods. The methods included single plate through anterolateral incision (Group A, 22 cases), double plates through inside and outside incisions (Group B, 36 cases), and double plates through antero-midline incisions (Group C, 37 cases). There were 56 males and 39 females, ranged the age from 19 to 57 years (averaged, 36.3 years), 50 cases in left, 45 cases in right. According to Schatzker classification, 51 cases were type V, 44 cases were VI. The data of operation time, intraoperative blood loss, complications (infectious of wound, necrosis, bad incision, collapse fracture, loosen of internal fixation, fracture failure)and recovery of function of lower limb joint were collected.

RESULTSThere were no significant difference among three groups in operation time (P > 0.05); blood loss in group A was obvious better than other groups (P < 0.05); collapse of joint surface and failure rate of internal fixation in group A was higher than other groups (P > 0.05); Merchant score after 1 year were higher in group B, C than group A. For lower limb function, 10 cases got excellent results, 5 good, 4 fair and 3 poor in group A; 21 cases got excellent results, 11 good, 3 fair and 1 poor in group B; 23 cases got excellent results, 11 good,2 fair and 1 poor in group C.

CONCLUSIONThe blood loss in group A was least, but fracture exposure and joint surface was not satisfactory, and stable fixation could not be achieved, the long-term result was not good. For fractures with double condyles and dislocated involved, double plates through inside and outside incisions or double plates through antero-midline incisions was suggested,which benefit good reduction of joint surface, stable fixation, and erlier exercise.

Adult ; Bone Plates ; Case-Control Studies ; Female ; Fracture Fixation ; adverse effects ; methods ; Fractures, Closed ; surgery ; Humans ; Male ; Middle Aged ; Tibial Fractures ; surgery

This study was aimed to create strontium-calcium sulfate compounds for making a new bioactive material with osteoconductive and osteoinduceable activity for bone repairing. Its mechanics and degradation features were assessed in vitro. Powders of alpha-calcium sulfate hemihydrate (alpha-CSH) and SrCl2 were mixed completely to make Sr-calcium sulfate compounds materials with 6 different concentrations (0%, 0.1%, 0.3%, 0.5%, 1% and 2%) of Sr. Scanning electron microscope was used to observe the configuration of the new materials. The compressive strength of each material was tested. The materials were soaked into simulated body fluid (SBF) to test the features of degradation, which included pH, weight loss, declination of compressive strength and the changes of strontium ion concentration. The crystal appearances were influenced by incorporating of strontium. The compressive strength of non-strontium incorporating calcium sulfate was 36.65 +/- 2.22 MPa. When the concentration of strontium was increasing, the compressive strength measurements of the materials tended to decline. The compressive strength declined to 20.56 +/- 2.64 MPa when the strontium concentration reached to 2%. The pH value of the SBF declined when the time of degradation increased, but both of them were very stable. All of the materials got weight loss after being soaked in SBF for several weeks. The weight loss was slight within 4 weeks and it became dramatic after 4 weeks. When the concentration of strontium was increasing, the weight loss became more rapid and significant (P<0.05). During 0-4 weeks' degradation in SBF, the materials' compressive strength decreased much slower when the strontium concentration was below 0.5%; however, when the decrement of strength became faster, the strontium concentration became higher. The concentration of strontium ion in SBF began to increase faster after 4 weeks' soaking in SBF. As the concentration of strontium was increasing, the strontium ion concentration in SBF became higher (P = 0.000). The new compound materials made by the mixing of alpha-calcium sulfate hemihydrate and SrCl2 can provide efficient compressive strength. The features of degradation of the materials are very stable. The new materials can release lots of bone inducible substance-strontium ions to repair bone defection after 4 weeks of degradation.
Bone Substitutes ; chemical synthesis ; chemistry ; Calcium Sulfate ; chemistry ; Compressive Strength ; Humans ; Osteogenesis ; Strontium ; chemistry