Objective Compare the curative effect of simply bone grafting with bone grafting, sequentially or simultaneously instrumentation planting in surgical treatment of thoracolumbar spinal tuberculosis,to verify the possibility and curative effect of radical debridement,bone grafting, sequentially or simultaneously instrumentation planting.Methods Twenty-five cases were treated with radical debridement,bone grafting,21 patients with sequentially or simultaneously instrumentation planting.Evaluating the bony fusion rate,correction of deformity and the status of lesion contrastively.Results Forty-three patients were followed-up for an average of 21 monthes,all of them were cured and shown bony union. With instrumentation we got shorter bony union,better correction and no obviously correction lost.Conclusion Radical debridement,bone grafting, sequentially or simultaneously instrumentation planting can offer a complete removal of lesion as well as restruction of spinal stability which make the local immobilization possible.Through this procedure ,early rehabilitation will be possible and the cure rate fo spinal tuberculosis increased.

Objective To observe the effect of hyperbaric oxygen (HBO) therapy on lumbar intertransverse fusion in rabbits. Methods Twenty-eight healthy adult female rabbits underwent lum-bar intertransverse fusion at L5～6 with autogenous iliac bone graft. They were randomly assigned into an HBO group and a control group (n=14). Rabbits were killed 6 weeks after the operation for surgical inspection, X-ray, bone density measurement and histologic analysis. Results The fusion rate of the HBO group evaluated by surgical inspection, and radiologic examination in a blind fashion significantly increased compared with that of the control group (P<0.05). Qualitative histologic as-sessment showed increased bone formation and bone maturity in the HBO group compared with the control group. Conclusion Hyperbaric oxygen therapy could improve the fusion rate of lumbar inter-transverse fusion in rabbits.

[Objective] To analyze the cases performed by unicompartmental knee arthroplasty in order to assess the early outcome,and to discuss the indications and the key points of surgical technique.[Methods]Under the principle of "slight undercorrection",15 patients were performed by unicompartmental knee arthoplasty with the technique of limited medial release if necessary.The HSS score,the fomeral tibial angle and the maxima degree of flexion and extension measured preoperatively and in the latest follow-up were analyzed by SPSS 13.0 with the method of paired t test.Meanwhile the angle of the posterior slope of the tibial implants was measured.[Results]Postoperatively the HSS score,the fomeral tibial angle and the maxima degree of flexion and extension were improved significantly in the latest follow-up,and the average angle of the posterior slope of the tibial implants was 4.2 degrees.[Conclusion]Unicompartmental knee arthroplasty has a satisfing early outcome.And it is very important to carry out the indications strictly.With the surgical technique of limited medial release,the flexional contracture could also be improved significantly.

Objective To evaluate the effect of abducens orthosis combined with walker on de-velopmental dysplasia of the hip ( DDH ). Methods A total of 126 patients (224 hips ) with DDH aged 6～36 months in Xiangya Hospital was randomly divided into 2 groups: an orthosis combined with walker group and an improved hip frog cast fixation group. Seventy patients (130 hips) were treated by the orthosis combined with walker and 56 patients (94 hips) were treated by the improved hip frog cast fixation. We compared the effect and complications of the 2 groups. Results The fine-ness rates of the orthosis combined with walker group and the improved hip frog cast fixation group were 89.2% and 90.4% , respectively, with no significant difference (P>0.05). The rate of femoral head osteonecrosis in the orthosis combined with walker group was significantly lower than that in the improved hip frog cast fixation group (1.5 % vs. 5.3 % , P<0.05) , but the re-dislocation rate in the former was significantly higher than that in the latter (6.9 % vs. 1.1% , P<0.05). Conclusion Both methods are effective for DDH. Orthosis combined with walker has a lower propor-tion of femoral head osteonecrosis, but a higher proportion of re-dislocation.

AIM: To explore operation opportunity and method and curative effect of cementless total hip arthroplasty (THA) surgery for treatment of ankylosing spondylitis. METHODS: Twenty-seven (33 hips) ankylosing spondylitis patients were selected from Xiangya Hospital between 2000 and 2005. All patients underwent THA with cementless prosthesis through Gibson approach. Ribbed cementless artificial total hip was provided by Link. Merle D'Aubigne score and range of motion joint before and after surgery were compared.RESULTS: Twenty-seven patients (33 hips) were all followed up for 21 months (at least 5 months). The X-ray showed that the prosthesis was in good position with no dislocation. The Merle D'Aubigne score was 17.3 in average (range 16 to 18) postoperatively. CONCLUSION: For ankylosing spondylitis patients, cementless THA has no rigorous limitation to surgery age. According to different patient conditions, THA correct technique could restore hip joint function.

Objective To explore the operative method of open distal tibial pilon fractures, and to evaluate the outcome of ankle joint function postoperatively. Methods From March 2003 to March 2007, 24 patients with open Pilon fractures were treated with one-stage open reduction and internal fixation (18 males and 6 females) . The average age was 37. 6 years (14 ～ 53 years) . All 24 patients had open fracture, 12 of whom combined fibular fracture. According to AO comprehensive classification system, the fractures was classified as C1 in 4, C2 in 9, and C3 in 11. According to Gustilo-Anderson classification method, the fracture was classified as Type Ⅰ in 3, Type Ⅱ in 5, Type Ⅲ A in 4, Type Ⅲ B in 10, and Type Ⅲ C in 2. All tibial pilon fractures were treated by radical debridement, one - stage open reduction and internal fixation. Soft tissue defection was covered by a vascularized flap and continually washed by pipes under the flap. Results All patients were followed-up at an average of 2. 3 years(1～3.8 years) after the surgery. All the fractures healed at an average of 22. 3 weeks (16 ～54 wk) postoperatively. According to the scoring system of Con-roy, 17 were excellent (62. 5%), 4 good (25%), and 3 poor (12.5%), The excellence rate was 87.5% . According to the ankle score of Teeny and Wiss, there were 11 excellent (37. 5%), 7 good (37.5%), 3 fair (16.7%), and 3 poor (8.3%) and the excellence rate was 75% . Conclusion One-stage management for open Pilon fracture has the advantages of fewer complications, lower infectious rate, and better ankle joint function.

BACKGROUND: Proliferation and differentiation of mesenchymal stem cells (MSCs) is associated with platelet concentration in platelet-rich plasma (PRP). Low enrich multiple cannot reach proper effects, but high level had inhibitory effects on osteoanagenesis.OBJECTIVE: To observe the effect of different volume fraction of PRP on dog BMSC proliferation.DESIGN: A cytological in vitro study.MATERIALS: Healthy 12-month male Beagle dogs were supplied by the Experimental Animal Center, Xiangya Medical College,Central South University.METHODS: Dog BMSCs of 5 passage were adjusted to 3×10~8/L, and incubated in a 96-well plate at 200 μL per well. Following 24 hours of routine culture, primary medium and non-adherent cells were discarded. Prepared PRP gel was mixed with serum-free low-glucose DMEM containing penicillin and streptomycin, and then diluted into 5%, 6.25%, 7.5%, 8.75%, 10% volume fraction. 200 μL above-described liquid was added into the 96-well plate, which was subsequently placed in a incubator.We set up a blank control.MAIN OUTCOME MEASURES: MTT was used to investigate effect of different volume fraction of PRP on dog BMSC proliferation.RESULTS: Compared with the blank control group, various volume fraction of PLP could promote dog BMSC proliferation in early stage. With prolonged time, proliferation speed began to increase at day 6 in the 8.75% and 10% PRP groups, entering platform stage. BMSC number was increased rapidly in the 5% and 6.25% PRP groups, especially in the 6.25% PRP group.CONCLUSION: PRP gel could promote BMSC proliferation markedly and proliferation strength of BMSCs was correlated to the density of PRP. BMSC proliferation would be accelerated by the low density of PRP.

BACKGROUND: Platelet-rich plasma (PRP) contains abundant growth factors that were needed for osteanagenesis. Moreover,the proportion of each growth factor formed by an organism, with good synergism.OBJECTIVE: To explore the influence of PRP on osteogenetic activity of canine bone marrow mesenchymal stem cells (BMSCs) after induction in vitro.DESIGN, TIME AND SETTING: The in vitro cytological experiment was performed at the Central Laboratory of Xiangya Hospital of Central South University from June 2007 to February 2008.MATERIALS: Healthy 12-month male Beagle dogs were supplied by the Experimental Animal Center, Xiangya Medical College,Central South University.METHODS: The 3~(rd) generation BMSCs were collected and divided into 4 groups. BMSCs in the control group were incubated in standard medium. BMSCs in the osteogenetic induction medium group were incubated in high-glucose DMEM containing fetal calf serum, dexamethasone, beta-sodium glycerophosphate and vitamin C. BMSCs in the PRP group were incubated in low-glucose DMEM containing 6.25% PRP. BMSCs in the combination group were incubated in high-glucose DMEM containing 6.25% PRP, dexamethasone, beta-sodium glycerophosphate, and vitamin C.MAIN OUTCOME MEASURES: Alkaline phosphatase activities were measured. Expression of collagen type I was examined by immunocytochemical staining. Calcium tuberoses were labeled using modified Von Kossa staining. Expression of osteocalcin mRNA was examined by RT-PCR.RESULTS: Levels of alkaline phosphates of all groups became increased along with time. The alkaline phosphates level of combination group was strongest (P < 0.05). Following 7 and 14 days of induction, type I collagen expressed positively in the osteogenetic induction medium and combination groups, but negatively in the PRP and control groups. Following 14 days,formation of calcium nodules were found in the osteogenetic induction medium and combination groups. Following 7 and 14 days,expression of osteocalcin mRNA were similar between the control and PRP groups (P > 0.05), which was significantly lower than the osteogenetic induction medium and combination groups (P < 0.05). Expression of osteocalcin mRNA was significantly lower in the osteogenetic induction medium group compared with the combination group (P < 0.05).CONCLUSION: PRP gel can effectively promote osteoblastic effect of BMSCs after induction in vitro following induction in osteogenetic medium.

BACKGROUND:Hidden blood loss is an important risk for the intertrochanteric fracture patients, especial y the elderly patients, which can cause anemia in patients after internal fixation and can affect wound healing and patient recovery. OBJECTIVE:To compare the perioperative hidden blood loss and the risk factors of proximal femoral anti-rotation intramedul ary nail internal fixation and dynamic hip screw fixation for the treatment of femoral intertrochanteric fracture. METHODS:We selected 70 cases of femoral intertrochanteric fracture patients who treated with proximal femoral anti-rotation intramedul ary nail and dynamic hip screw fixation, including 21 patients with the age ≥ 80 years and 49 patients with the age<80 years;28 patients with the body mass index>30 kg/m2 and 42 patients with the body mass index ≤ 30 kg/m2;30 patients received anti-rotation intramedul ary nail internal fixation and 40 patients received dynamic hip screw fixation. The perioperative blood loss was calculated with Gross formula according to the changes of height, body mass index and the hematocrit before and after fixation. RESULTS AND CONCLUSION:The mean total blood loss was 936 mL, the mean dominant blood loss was 237 mL and the mean hidden blood loss was 699 mL. The hidden blood loss was accounted for 74.7%in total blood loss. The dominant blood loss in the dynamic hip screw fixation group was higher than that in the anti-rotation intramedul ary nail internal fixation group, and the hidden blood loss was lower than the anti-rotation intramedul ary nail internal fixation group. The total blood loss and the hidden blood loss of the elderly patients were higher than those of the non-elderly patients;there was no significant difference between male and female patients, obesity and normal patients. The results indicate that hidden blood loss is the major reason for total blood loss of femoral intertrochanteric fracture after internal fixation. The hidden blood loss of anti-rotation intramedul ary nail internal fixation is larger than that of dynamic hip screw fixation, and elder is the risk factor for hidden blood loss.

Objective To explore the clinical outcome of perforator flaps for reconstruction of limb soft tissue defects. Methods In this case series, from 2007 July to 2009 May, 108 cases of perforator flap to reconstruct the defects of the extremities were performed, of these, 98 were free perforator flaps, 10 were pedicled flaps. The perforator flaps included deep inferior epigastric artery perforator flap, anterolateral thigh perforator flap, thoracodorsal artery perforator flap, lateral thigh perforator flap, posterior interosseous artery perforator flap, collateral radial artery perforator flap, medial sural artery perforator flap, posterior tibial artery perforator flap, deep circumflex iliac artery perforator flap and peroneal artery perforator flap. The maximum size of the perforator flap was 44 cmx 9 cm, the minimum size of the perforator flap was 4 em x 2 cm.The donor defect was closed directly. Results Venous congestion occurred in 5 flaps, in 1 case venous congestion was overcomed after released the dressing, 4 flaps requiring reexploration for venous insufficiency,2 had a successful outcome, the other 2 flaps failed . The other 103 flaps were successful. The wounds healed without any infection complications. The follow-up ranges from 6-24 months( 10 months on average). The flaps were of good appearance and not bulky; there were only linear scars on the donor sites, the cosmesis and function of the donor sites were satisfying. Conclusion The muscle, deep fascia and motor nerve are not contained in the flap, the advantages of this type of flap is reducing morbidity of the donor site and its reliable blood supply and suitable thickness for resurfacing, no secondary debuiking is necessary. The perforator flaps can be chosen as the first option to deal with superficial extremity wounds.