OBJECTIVETo investigate the volume of pulse lavage sufficient for removal of intraoperative bone and polymethyl methacrylate (PMMA) particles.

METHODSFrom 2007.11 to 2008.11, 18 patients with osteoarthritis underwent cemented TKA. Among the patients, 6 patients were male and 12 patients were female, ranging in age from 54 to 77 years, with an average of 61.5 years. The course of disease ranged from 3 to 9 years, mean 6.7 years. Pulse lavage with 1 L of sterile saline was performed for 8 times using a pulsatile irrigator after prothesis fixed. During pulse lavage, aspirated fluid was collected in a 1 L aliquot, and the weight of bone and PMMA particles in each fluid were measured.

RESULTSThe weight of particles peaked in the first 1 L lavage fluid and gradually decreased until the 8th lavage fluid. Significant differences were found between the first vs second, second vs third, and third vs fourth lavage. However, no significant differences were found beyond the fourth lavage.

CONCLUSIONThe results of this study indicates that 4 L of pulse lavage is effective for removing the bone and PMMA particles during cemented TKA.

Aged ; Arthroplasty, Replacement, Knee ; methods ; Female ; Humans ; Male ; Middle Aged ; Polymethyl Methacrylate ; Sodium Chloride ; administration & dosage ; Therapeutic Irrigation

No abstract available.
*Bone Cements ; Extravasation of Diagnostic and Therapeutic Materials/*prevention & control ; Fluoroscopy ; Humans ; Injections ; Kyphoplasty/methods ; *Needles ; Polymethyl Methacrylate/*administration & dosage ; Time Factors ; Vertebroplasty/*methods

BACKGROUNDA number of methods have been used in the treatment of symptomatic and aggressive vertebral hemangioma, but none of them is optimal. Vertebral hemangioma treated with cement vertebroplasty or ethanol injection alone showed relatively good results despite their limitations.

METHODSBetween February 2002 and May 2004, twelve patients with vertebral hemangioma were subjected to combined cement vertebroplasty and ethanol injection, five of them were men and seven women, and aged from 26 to 54 years (mean, 41 years). The following levels of the spine were involved: T9: 1, T10: 3, T12: 2, L1: 1, L2: 2, L3: 2 and L4: 1. The clinical results and radiographic records of the patients were assessed after 2 years and 5 months of follow-up.

RESULTSThe average score of back pain significantly decreased from 6.5 before operation to 1.7 one month after operation. No severe complications occurred during and after operation. During the period of follow-up, symptoms were not deteriorated. At the end of follow-up, neither radiographic sign of aggressive destruction nor collapse of the involved vertebra was observed. Significant improvement in the 12 patients was demonstrated on 7 of 8 SF-36 Health Scale except for mental health.

CONCLUSIONSCement vertebroplasty combined with ethanol injection as a safe and effective technique is an alternative to the treatment of patients with vertebral hemangioma.

Adult ; Bone Cements ; therapeutic use ; Combined Modality Therapy ; Ethanol ; administration & dosage ; Female ; Hemangioma ; therapy ; Humans ; Injections ; Male ; Middle Aged ; Polymethyl Methacrylate ; Spinal Neoplasms ; therapy ; Spine ; surgery

AIMTo investigate the properties of cationic nanoparticles composed of poly (ethyleneimine)-g-poly (methyl methacrylate) (PEI-PMMA) as gene delivery carriers and explore the mechanism of PEI-PMMA nanoparticles mediated gene transfer.

METHODSPEI-PMMA nanoparticles were synthesized by free radical polymerization. The morphology of nanoparticles was observed by scanning electron microscopy. The particle size and zeta potential were measured by zeta sizer. The complex between pGL3 plasmid and nanoparticles was analyzed by gel electrophoresis; and PEI-PMMA nanoparticles mediated gene transfer into HeLa cells was observed by confocal laser scanning microscopy.

RESULTSPEI-PMMA nanoparticles are spherical shape and monodispersity. The particle size and zeta potential are 172 nm and +50.3 mV, respectively. When pGL3 plasmid complexed with nanoparticles at N/P ratio of 5: 1 and 20: 1, the particle size of pGL3/nanoparticle complex are 133 and 139 nm and zeta potential is + 21.4 and + 33.7 mV, respectively. pGL3 plasmid complexed with nanoparticles completely at N/P ratio of 5: 1. PEI-PMMA nanoparticles can deliver pGL3 plasmid into HeLa cells by endocytosis and release pGL3 into the cytosol.

CONCLUSIONPEI-PMMA nanoparticles effectively transferred DNA to target cells and it is a promising non-viral carrier for gene delivery.

DNA ; administration & dosage ; chemistry ; Drug Delivery Systems ; Endocytosis ; Gene Transfer Techniques ; Genetic Vectors ; HeLa Cells ; cytology ; Humans ; Imines ; administration & dosage ; chemistry ; Nanoparticles ; Particle Size ; Plasmids ; Polyethylenes ; administration & dosage ; chemistry ; Polymethyl Methacrylate ; administration & dosage ; chemistry ; Transfection

Effect of interleukin-6 receptor (IL-6R) antibody on polymethyl methacrylate (PMMA) bone cement-mediated expression of osteoprotegerin (OPG) and receptor activator of nuclear factor-kappaB ligand (RANKL) in synovial fibroblasts was investigated. Synovial tissue obtained from total knee arthroplasty was digested and cultured. Inverted microscope was employed to observe the synovial cells and immunocytochemistry (SABC method) staining was used to identify synovial fibroblasts. This experiment was divided into three groups according to different culture media: PMMA group (75 μg/mL PMMA bone cement particles), IL-6R antibody group (10 ng/mL IL-6R antibody+75 μg/mL PMMA bone cement particles), and control group (no IL-6R antibody or PMMA bone cement particles). Influence of IL-6R antibody and PMMA on proliferation of synovial fibroblasts was measured by cell counting kit-8 (CCK-8). ELISA method was used to measure OPG and RANKL levels in culture solution. Fluorescence quantitative real-time PCR (FQ-PCR) was used to detect the expression of OPG and RANKL mRNA. After three consecutive passages, more than 95% of the primary synovial cells became long spindle fibroblast-like cells. SABC staining results showed that the fibroblast-like cells were negative for anti-CD68 antibody and positive for anti-vimentin antibody, with brown madder stained. CCK-8 test demonstrated that the absorbance (A) value at 450 nm was significantly lower in IL-6R antibody group than in PMMA group and control group (P<0.01), but there was no statistically significant difference in A value at 450 nm between the control group and PMMA group (P>0.05). Results of ELISA indicated that the expression of OPG was significantly higher in IL-6R antibody group than in PMMA group and control group (P<0.01). The expression of RANKL was inhibited (P<0.05), and the ratio of OPG/RANKL was significantly increased in IL-6R antibody group as compared with PMMA group and control group. There was no significant difference in the expression of OPG between control group and PMMA group (P>0.05), but the expression of RANKL was higher in PMMA group than in control group (P<0.05), and there was a significant difference in the ratio of OPG/RANKL between them (P<0.05). Results of FQ-PCR revealed the expression of RANKL mRNA was significantly inhibited (P<0.01) and the expression of OPG mRNA was significantly increased (P<0.01) in IL-6R antibody group as compared with PMMA group and control group. The expression of RANKL mRNA was higher in PMMA group than in control group (P<0.05), but the expression of OPG mRNA had no significant difference between them (P>0.05). IL-6R antibody could significantly increase the expression of OPG, but inhibit the expression of RANKL, which might provide a theoretical basis of molecular biology for the prevention and treatment of aseptic loosening of prosthesis.
Antibodies ; administration & dosage ; immunology ; Bone Cements ; Fibroblasts ; immunology ; Gene Expression ; drug effects ; Humans ; Osteoprotegerin ; biosynthesis ; genetics ; Polymethyl Methacrylate ; administration & dosage ; Prostheses and Implants ; RANK Ligand ; biosynthesis ; genetics ; metabolism ; Receptors, Interleukin-6 ; immunology ; metabolism ; Synovial Fluid ; immunology ; metabolism

Percutaneous sacroplasty is a safe and effective procedure for sacral insufficient fractures under CT or fluoroscopic guidance; although, few reports exist about sacral metastatic tumors. We designed a pilot study to treat intractable pain caused by a sacral metastatic tumor with sacroplasty. A 62-year-old man and a 38-year-old woman with medically intractable pain due to metastatic tumors of S1 from lymphoma and lung cancer, respectively, underwent percutaneous sacroplasty. Over the course of the follow-up period, the two patients experienced substantial and immediate pain relief that persisted over a 3-month and beyond. The woman had deposition of PMMA (polymethyl methacrylate) in the needle track, but did not experience significant symptoms. No other peri-procedural complications were observed for either patient.
Adult ; Bone Cements/*therapeutic use ; Female ; *Fluoroscopy ; Humans ; Injections, Intralesional ; Male ; Middle Aged ; Pain, Intractable/etiology/*therapy ; Polymethyl Methacrylate/administration & dosage ; *Radiography, Interventional ; *Sacrum ; Spinal Neoplasms/complications/radiography/*secondary ; *Vertebroplasty/methods

OBJECTIVESTo evaluate the effect of percutaneous vertebroplasty on vertebral tumor metastasis using instruments and drugs made in China and to explore the technique of percutaneous vertebroplasty.

METHODSThirty-two patients with vertebral metastasis were treated with percutaneous vertebroplasty with instruments and drugs made in China. Anterolateral approach for cervical vertebrae and transpedicular approach for thoracic and lumbar vertebrae were used. The volume of disease focus and the amount of polymethy methacrylate (PMMA) injected were calculated with formula V = 4/3pi (D/2)(3) preoperatively. PMMA with contrast was mixed according to the ratio of powder/liquid/contrast of 3:2:1. The procedures were monitored under fluoroscopy. PMMA was injected in the polymerization time. CT scanning was performed before and after the operation.

RESULTSThe percentage of lesion PMMA fill was more than 50% as demonstrated by CT. Clinical data were obtained from the cases followed up for 7 - 12 months, and the rate of pain relief was 90.6% (29/32) at one week, 71.8% (23/32) at six months, and 58.6% (17/29) at 12 months after operation. There were no cases of PMMA leakage that affected clinical performance.

CONCLUSIONSPercutaneous vertebroplasty for vertebral tumor metastasis using instruments and drugs made in China was effective. It is important to prevent paravertebral leaks of PMMA and to ensure that PMMA is injected within the polymerization time.

Aged ; Aged, 80 and over ; China ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Polymethyl Methacrylate ; administration & dosage ; Reconstructive Surgical Procedures ; instrumentation ; methods ; Spinal Neoplasms ; secondary ; surgery ; Spine ; surgery ; Thoracic Vertebrae ; surgery

Few studies have been conducted to explain the pain patterns resulting from osteoporotic vertebral compression fractures (OVCF). We analyzed pain patterns to elucidate the pain mechanism and to provide initial guide for the management of OVCFs. Sixty-four patients underwent percutaneous vertebroplasty (N=55) or kyphoplasty (N=9). Three pain patterns were formulized to classify pains due to OVCFs: midline paravertebral (Type A), diffuse paravertebral (Type B), and remote lumbosacral pains (Type C). The degree of compression was measured using scale of deformity index, kyphosis rate, and kyphosis angle. Numerical rating scores were serially measured to determine the postoperative outcomes. As vertebral body height (VBH) decreased, paravertebral pain became more enlarged and extended anteriorly (p<0.05). Type A and B patterns significantly showed the reverse relationship with deformity index (p<0.05), yet Type C pattern was not affected by deformity index. Postoperative pain severity was significantly improved (p<0.05), and patients with a limited pain distribution showed a more favorable outcome (p<0.05). The improvement was closely related with the restoration of VBH, but not with kyphosis rate or angle. Thus, pain pattern study is useful not only as a guide in decision making for the management of patients with OVCF, but also in predicting the treatment outcome.
Aged ; Aged, 80 and over ; Female ; Fracture Fixation, Internal/methods ; Fractures, Compression/etiology/radiography/*surgery ; Humans ; Kyphosis/therapy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Osteoporosis/*complications/diagnosis ; Pain/etiology/*surgery ; Pain Measurement ; Pain, Postoperative/etiology ; Polymethyl Methacrylate/administration & dosage/therapeutic use ; Questionnaires ; Sickness Impact Profile ; Spinal Fractures/radiography/*surgery ; Tomography, X-Ray Computed ; Treatment Outcome