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 observe effect of lidocaine pretreatment to malondialdehyde(MDA) and endothelin(ET) of patient ac-cepeted brain tumor removing and discuss the optimized pretreatment time .Methods 60 brain tumor patients in the hospital from March 2009 to September 2011 .according to the different pretreatment time ,the patients were randomly divided into five groups :group A(preoperative 48 h) ,group B(preoperative 24 h) ,group C(preoperative 12 h) ,group D(0 h or anesthesia induced) ,group E (control group) and group F(blank control group) ,10 cases in each group .Group A ,B ,C ,D with 1% lidocaine 1 .5 mg/kg intrave-nous pretreatment on schedule ,then induced conventional anesthesia ;group E were supplemented with 1% lidocaine 2 .5 mg · kg -1 · h-1 intravenous injection after anesthesia induction ;group F was performed routine program without lidocaine .The spontaneous breathing time ,awake time and tracheal extubation time was recorded ,while NIHSS score for evaluation of neural function defect was applied ,and peripheral serum level of MDA and ET was detected by colorimetric technique and radio-immunity .Results In group C ,the spontaneous breathing time ,awake time and tracheal extubation time were shorter than other groups ,but the difference had no statistically significant(P>0 .05) .There was no significant difference among each group in the aspect of NIHSS score 1 day before surgery(P>0 .05) ,after 14 days of operation ,NIHSS of group C was statistically lower than that of group E and group F (P<0 .05) .Before anesthesia induction ,there was no significant difference among groups (P> 0 .05) .MDA and ET content in group C was significantly lower than those in other groups after surgery (P<0 .05) .Conclusion Lidocaine given 12 h before cere-bral ischemia has varying degree protection against cerebral ischemia-reperfusion injury .The protection has relation with the de-crease of MDA and ET content .

Osteoarthritis (OA) is a common degenerative disease. Its most significant pathological change is destruction of articular cartilage and the main clinical symptoms are pain and dysfunction of joints. Recent studies have shown that the expression of non-coding RNA (ncRNA) in chondrocytes can abnormally up-regulate or down-regulate and alter the activities of chondrocytes like their proliferation, migration and apoptosis, thus leading to the occurrence and development of osteoarthritis. Exosomes are extracellular vesicles with a diameter of 40-100 nm, which are secreted in intercellular fluid, act as medium of intercellular communication. They protect ncRNA, protein, lipid and other bioactive materials from enzymatic degradation by encapsulating them and transferring to sibling chondrocytes, due to their good tissue permeability. They can also improve communication between cells and regulate the activities of chondrocytes. Thus, exosomes behave like gene carriers. The ncRNA carried by exosomes can supplement or adsorb the abnormal ncRNA in chondrocytes, so as to regulate the activity of chondrocytes, and is therefore considered as a possible candidate with capabilities to repair cartilages. In this study we reviewed existing literatures related to the roles and effects of exosome miRNA, lncRNA and circRNA on osteoarthritis. We also reviewed the pathogenesis of exosome ncRNA in osteoarthritis.

Perthes disease is a hip lesion caused by vascular disorders in the femoral head of children.Although the disease is a self-limited disease,but often residualvary degrees of femoral head deformity,leading to early osteoarthritis.It is currently believed that the lesions of Perthes disease are mainly located in the femoral head.However,some studies demonstrated that patients with Perthes disease also appearvary degrees of acetabular morphological changes.In recent years,the acetabular retroversions were found in 31-60％ of patients with Perthes disease.The acetabular retroversion is a pathological anatomical variation of the acetabulum in the horizontal plan.It is related to the occurrence of the femoracetabular impingement and osteoarthritis.Many studies showed that the patients with poor prognosis (Stulberg Ⅲ,Ⅳ or Ⅴ) are associated with a higher prevalence of acetabular retroversion.The grading and the age of onset of Perthes disease are important factors affectingprognosis.Although existing studies illustrate that the lateral column grading,gender and age are not associated with the acetabular retroversion of Perthes disease significantly,the cases of the studies are limited and further researches are expected.Surgery containment therapy is an important wayto treat Perthes disease.The pelvic osteotomy can directly change the shape of the acetabulum and cause the acetabular retroversion,which result inthe femoracetabular impingement.The acetabular retroversion should be avoided as much as possible intraoperatively.Further research should be focused on whether the surgical interventions and the subsequent biomechanical changes could induce the acetabular retroversion.The cause of the acetabular retroversion in patients with Perthes disease is unclear.In order to elucidate the occurrence and development of acetabular retroversionin Perthes disease,some scholars found thataccompanying femoral head deformity,acetabular anteversion angleand inclinationdecreased significantly,and thecoverage angle in the superior,posterior,and inferior quadrants alsogradually reduced in animal studies.This is similar to clinical observations.This article reviews the progress of acetabular retroversion in Perthes disease by summarizing the relevant literatures.We hope to givenew insights for the etiology and pathology of Perthes disease,and provide new ideas for the treatment and prevention of the femoracetabular impingement and early osteoarthritis.

Objective To study the distribution and the characteristic of elbow fractures in children according to the age,sex,year,season and anatomical location.Methods The data of pediatric elbow fractures which were treated either in outpatient department or hospitalized in the First Affiliated Hospital of Guangxi Medical University between January 2011 and December 2016 were collected.The distribution and characteristics of the fractures were analyzed by using SPSS 18.0 software and Excel 2010.Results A total of 613 patients with elbow fractures (628 different anatomical sites) were registered.The incidence seemed to increase by each year.Among them,414 cases were male and 199 cases were female (male/female ratio 2.08 ∶ 1.00).There were 3 distinct peaks which were respectively at the ages of 1,3 and 5.The fractures happened frequently from April to October.The most common type was supracondylar fracture of humerus(71.29％,437/613 cases),followed by lateral condylar fracture of humerus(14.68％,90/613 cases),olecranon fracture(3.26％,20/613 cases) and radial neck fracture (2.28％,14/613 cases).The most common cause of injury was falling on the same level (67.54％,414/613 cases),followed by dropping from heights (16.64％,102/613 cases),then sports injury (7.83％,48/613 cases),traffic accidents (5.55％,34/613 cases) as well as some intentional injuries (0.65％,4/613 cases).Conclusions The highest incidence of elbow fracture was found in children around 1 year,and 3-6 years.Boys are more affected than girls,probably attributed to their active nature.Fractures are more frequent in summer in which supracondylar fracture of humerus is the most common type.Most fractures occur after falling on the same level,indicating how easy it is to get injured in children.So careful examination is necessary to all the pediatric cases who came with a history of fall.Attention should be paid to intentional injuries especially so as to rule out if the cases belong to brutal abuse.

Malignant bone tumors, one of the most common bone tumors includes osteosarcoma, Ewing's sarcoma, multiple myeloma, and metastatic bone tumors etc. These tumors are often accompanied by distant metastatic lesions at time of diagnosis, leading to low 5-year survival rates. At present, the use of biomarkers for early detection in order to facilitate early treatment are very limited. Therefore, most medical researchers are exploring the roles of exosomes in detecting malignant bone tumors. Exosomes are extracellular microvesicles secreted by different types of cells, which exist in a variety of body fluids. They are new intercellular information carriers that play important physiological roles. Current literature have reported that the RNA contained in exosomes (such as mRNA, miRNAs, lncRNAs and circRNAs) play important roles in the incidence as well as development of malignant bone tumors. However, the previous studies mostly focused on the roles of exosomal RNA in malignant bone tumor diseases, in tumor cell proliferation or apoptosis, transfers, evasion of immune surveillance and chemotherapy drug resistance etc. However, exosomal RNAs may function in the whole process of the disease progression via regulation networks. Our review of existing literature revealed that exosomal RNAs affacted the proliferation, metastasis, immune evasion and drug resistance of five common malignant bone tumors; Osteosarcoma, Ewing sarcoma, Chondrosarcoma, multiple myeloma, and metastatic bone tumors. Therefore, by elucidating on the mechanism of exosomal RNAs in the occurrence and development of malignant bone tumors, this study, could provide new ideas for early diagnosis, concomitant diagnosis, efficacy estimation (chemotherapy, radiotherapy and immunotherapy, etc.) as well as assessing the prognosis of malignant bone tumors.

Hereditary multiple exostoses (HME) are benign bone tumors characterized by autosomal dominant inheritance, which can cause skeletal malformation in adolescents, seriously affecting the body's aesthetic and motor functions. Currently, there are no guidelines for diagnosing and treating HME, and the main treatment is surgical treatment to remove the tumor and correct the deformity. However, osteochondroma is multiple and difficult to be completely resected. Therefore, more and more scholars are exploring the method of conservative treatment. However, the current understanding of the pathogenesis of HME is limited, and there are no safe and effective drugs in the clinic. Most hypotheses regarding the pathogenesis of HME are based on genetic mutations. Patients with HME may have EXT tumor suppressor gene mutations and function loss caused by secondary mutations such as loss of gene heterozygosity, which ultimately induce abnormal proliferation and differentiation of cartilage in growth plates. Abnormal EXT gene expression causes a decrease in the level of heparan sulphate (HS), leading to abnormalities in multiple molecular pathways that regulate the development and differentiation of growth plate chondrocytes, which together participate in the entire process of HME development and progression. This paper reviews the relevant studies on the pathogenesis of HME in recent years, in order to better understand the pathological process of HME, provide a theoretical basis for the diagnosis and treatment of HME, and also provide ideas for the development of drugs targeting HME.

Osteosarcoma needs to continuously induce angiogenesis to satisfy its own nutritional supply in the process of development. Therefore, the inhibition of osteosarcoma cell-induced angiogenesis as a target has become a research hot in recent years. Currently, vascular inhibitors targeting mRNA-encoded protein have been applied in clinic, but the efficacy is poor. Non-coding RNA (ncRNA) is a type of RNA molecules that do not participate in protein coding. ncRNA can regulate the angiogenesis of osteosarcoma by regulating the secretion of vascular factors such as vascular endothelial growth factor, angiogenin-2 and hypoxia-inducible factor 1 or the interaction between ncRNAs. This article reviews the role of ncRNA in the angiogenesis of osteosarcoma to provide references for clinical targeted therapy strategies for osteosarcoma.

Some primary bone tumors are prone to hematogenous metastasis and after that, the therapeutic effect is not that good and prognosis is poor. Circulating tumor cells (CTC) shed from the tumor cells of primary or metastatic focus and then enter into blood circulation. CTC may appear in the early stage of the tumor, which can implant in distant organs to form metastatic sites and self-implant in the primary sites leading to the tumor recurrence; CTC are closely related with the prognosis of patients with tumors. In most primary bone tumors, CTC are heterogeneous compared with primary tumor cells. Studying CTC from various aspects can provide a basis for the early diagnosis and treatment of primary bone tumors. This review summarizes the current researches of CTC in common primary bone tumors, and expects the future of research direction and application practice in clinic.

Developmental dysplasia of the hip (DDH) is a developmental disease with abnormal position and morphology of the acetabulum and femoral head. DDH ranges from mild dysplasia to complete dislocation, including simple acetabular dysplasia, subluxation, and total dislocation. DDH is one of the most common hip diseases in children, and its onset begins in infancy. The anatomical structure of the hip joint is complex, and there are some practical problems in the large -scale clinical diagnosis and screening work, such as heavy workload, high misdiagnosis rate and missed diagnosis rate, and a long learning period of surgery. Artificial intelligence (AI) is an emerging technology science used to research and develop theories, methods, technologies and application systems that can simulate human intelligence. The main goal is to enable machines to complete complex tasks that require human intelligence. At present, artificial intelligence is mainly used in the diagnosis and treatment of DDH. Artificial intelligence combined with X-ray or ultrasound is used to diagnose and screen DDH, which avoids subjectivity to a certain extent and improves the accuracy of diagnosis and screening. In the preoperative planning of periacetabular osteotomy and total hip arthroplasty, it can more accurately track the position of the bone block and design the size of the prosthesis, which makes the surgical planning more accurate to a certain extent. Artificial intelligence technologies such as 3D navigation system, surgical robot and robotic arm are helpful to improve the accuracy and safety of surgery. Artificial intelligence has the characteristics of simplicity, speed, high repeatability and deep learning ability, which to a certain extent saves manpower, material resources and time costs for DDH diagnosis and treatment, facilitates medical workers to share DDH diagnosis and treatment experience and reduces the burden of patients, families, society and the country. The application of artificial intelligence in DDH diagnosis and treatment is becoming more and more extensive, but at present, artificial intelligence in DDH screening is still in its preliminary stage. There are few reports on artificial intelligence technology in DDH hip preservation treatment and other surgical methods, and there is insufficient research on artificial intelligence in DDH conservative treatment, postoperative complications and prognosis prediction. It is worth exploring new ideas by researchers. At present, the application of artificial intelligence in DDH still has certain limitations, including problems such as difficult to control the quality of image data, difficult to develop and promote technology, and lack of laws and regulations. Based on the literature database and relevant data sharing network, this paper reviews the application of artificial intelligence in the diagnosis and treatment of DDH at home and abroad in recent years, summarizes the current application status of artificial intelligence in the diagnosis and treatment of DDH, and provides new ideas for the future application of artificial intelligence in the diagnosis and treatment of DDH.