Objective To summarize the surgical techniques and results of displaced complex ac-etabular fractures.Methods Ninety-eight cases of complex type o f acetabular fracture with dislocation were treated with open reduction and inte rnal fixation from March 1990to Sept ember 1999.Of the 98cases,fractures of the posterior column an d wall was seen in 9cases,T -shaped in28cases,transverse and posterior wall in 22cases,anterior and hemi-transverse in 2cases,both column in 37cases.Kocher -Langenbeck approach was adopted in 28cases,ilio-inguinal approach in 21cases,extended iliofemoral approach in 16cases,and double approachs(K -L +ilio-inguinal)in 33cases.Results Sixty-two cases(63.3%)had anatomic reduction,32cases(32.7%)satisfactory reduction,4cases(4.1%)unsatisfactory reduction.The rates of anatomic reduction in the early 4.5years and the latest 4.5years of this study were 50.0%and72.4%respectively.Seventy-eight cases were followed up from 2to 10yea rs,excellent and good rate for clinical results in anatomic and non-anatomic reduction group were 83.9%and 36.4%respectively,the difference was very significant (P

Objective To study the hematological changes o f nontraumatic osteonecrosis of the femoral head,select the sensitive molecular symbols for early diagnosis and distinguish the high risk peopl e.Methods The studied subjects were divided in to three groups:1)NONFH early stage group(n=30);2)NONFH late stage group(n=30);3)the normal controlled group(n=30).Blood samples from cubital veins were collected.GMP -140,PC,D -Dime r were examined using ELISA.PAI was e xamined with chromogenic assay.Results1)The platelet GMP -140levels of early or late stage groups NONFH were signi ficantly higher than that of the normal contro lled group;the plasma PC levels of both groups were lower than that of the normal controlled group significan tly(P

Objective To study the anti-apoptotic effects of Levodopa on osteonecrosis of the femoral head induced by methylprednisolone (MPS).Methods Forty-four rabbits were randomly divided in to 3 groups.The model group (n=15) was injected with lipopolysaccharide (LPS,10 μg/kg) and then MPS (20 mg/kg) was given 3 times with 24 h interval.The treatment group (n=1 5) was firstly treated by the same methods as the model group,then was administered Levodopa (0.4 g·kg~(-1)·d~(-1)) orally after the last injection of MPS.The control group (n=14) was injected with sodium chloride alone.On the 6th and 8th week after modeling,radiography and MR images were taken in 7 rabbits of each group,specimens taken from the femoral heads were observed by HE stain and TUNEL analysis was made.Blood samples were taken for detection of insulin-like growth factor-1 (IGF-1) on the 8th week.Results On the 6th and 8th week,the average percentage of empty osteocyte lacunae in the treatment group (13.33‰±3.06‰,25.97‰±6.29‰) was significantly lower than that of the model group (21.44‰±4.77‰,33.86‰±8.38‰,P<0.01),and the average apoptosis index in the treatment group (74.93‰±14.32‰,120.67‰±13.13‰) was significantly lower than that of the model group (102.56‰±18.96‰,202.02‰±18.99‰.,P<0.01).On the 8th week,the level of IGF-1 in the treatment group was (14.78±2.37)ng/ml,which was higher than that of the model group obviously (10.12±2.49)ng/ml(P<0.01).Conclusion The Levodopa can decrease apoptosis of osteocytes and effectively prevent the progress of steroid-induced osteonecrosis of the femoral head.

Objective To summarize the surgical techniques and results of b oth-column acetabular fracture through combination of ilioinguinal and Kocher-La ngenbeck approaches. Methods Between March 1990 and July 2001, 66 patients affec ted by both-column acetabular fractures were treated surgically through the comb ination of ilioinguinal and Kocher-Langenbeck approaches. There were 39 males an d 27 females with an average age of 37 years (range, 19 to 56 years). According to Letournel classification, all patients were diagnosed as the both-column frac tures of acetabulum. Of 66 patients, 14 were associated with dislocation or subd islocation of femoral head, 8 with dislocation of ipsilateral sacro-iliac joint, and 8 with intra-articular fragments. The interval from injury to operation was within 2 weeks in 24 and more than 2 weeks in 42. The surgical indications were as follows: 1) dislocation of both column fractures over 3 mm; 2) anterior colu mn fracture associated with severe posterior column comminuted fracture or poste rior wall fracture; 3)injury lasting more than 2 weeks; 4) injury associated wit h femoral head dislocation; 5) injury associated with intra-articular fracture f ragment. Postoperative reduction quality and long-term radiographic results were evaluated according to the Matta and the Epstein criterion separately; the d’A ubigne rating scale was used for the functional results. Results The average ope rative time was 4 hours, the average blood loss was 1 400 ml. Anatomic reduction were obtained in 57 cases (86%), satisfactory reduction in 6 (9%) and unsatisfa ctory in 3 (5%). The follow-up were from 2 to 13 years with an average of 6 year s. The clinical results were 89% excellent and good, 6% fair and 5% poor respect ively; the roentgenographic results were 82% excellent, 10% fair and 8% poor res pectively. 5 cases(8%) with Grade Ⅲ heterotopic ossification were found in Ko cher-Langenbeck approach, and no heterotopic ossification was in ilioinguinal ap proach. There was 1 deep infection (1.5%) in the ilioinguinal approach, and no i nfection in the Kocher-Langenbeck approach. Conclusion The results achieved thro ugh the combined approaches were significantly better than that of the both-colu mn acetabular fractures using the extended iliofemoral approach. The combined ap proach is an ideal method for the operation of the both-column acetabular fractu res with an excellent exposure, satisfactory reduction, shorter operating time, less blood loss, and lower operative complication rate.

Objective To introduce a method using hydroxyapatite methylmethacylate cement implanted in the femoral head for the treatment of patients suffering from avascular necrosis of the femoral head due to different causes and to review the medium term follow up results. Methods From January 1990 to December 1995, eight hips in seven patients(male 4, female 3) with femoral head necrosis at Ficat stage Ⅲ were treated with the hydroxyapatite methylmethacylate cement implantation in the involved femoral head. Four osteonecrosis were secondary to femoral neck fracture, two were due to corticosteroid intake and one had alcohol abuse history. All patients complained pain and limited joint activity. The operation consisted of the removal of necrotic bone under weight loading cartilage with curet and the implantation of the hydroxyapatite methylmethacylate cement. The function of hip joint were well evaluated and X ray films were taken pre and postoperatively. The average postoperative follow up was 7.9 years, ranging from 5.1 to 11 years. Results Merle d Aubign? method was used to assess and compare the pre and post operative function of hip joint. The average score for unilateral cases increased from 8.66 to 15.5 at final examination. On radiography, the improvement of the contours of the femoral head was seen in all patients and most of them could preserve their initial postoperative contours during the follow up. No sign of expansion of the bone necrosis appeared in most of the patients, although certain patients presented various joint degeneration such as narrowing of joint space,sclerosis and osteophyte. Subjective evaluation was satisfactory except two suffering from painless limited activity of hip joint. Conclusion This method is relatively simple with less invasion and rapid postoperative recovery. It may be a choice of surgery for the treatment of certain femoral head necrosis at Ficat stage Ⅲ, especially for young patients.

Objective To study the effect of adenoviral-delivered short hairpin RNA (shRNA) target against permeability glycoprotein (Pgp) as a new drug in anti-epileptic drug resistance epilepsy treatment and to evaluate its efficiency. Methods MDR Sprague-Dawley (SD) rat estrocyte model was induced by Coriaria Lactone (CL), mainly over-expressing mdrlb. To reverse the drug resistance, astrecytes were treated with constructed replication deficient adencvirus AdS-EGFP-shRNAI-U6 delivering short hairpin (shRNA) target agianst mdrlb gene. Total RNA and protein were extracted from the infected cells, mdr1 b level was detected by Quantitative Real-time PCR whereas Pgp by Western blot, Rhodamine123 (Rho123) efflux ratio by Flow Cytometry. Results AdS-EGFP-shRNA1-U6 was succesfully constucted with high virus titer of 6×1010 pfu/ml. The interference efficency of AdS-EGFP-shRNA1-U6 agianst mdrlb in rat astrecyte model was about 94%. The Rho123 efllux ratio was about 15. 8%, significiently lower than control group which was 56. 2% (F = 127.5, P < 0. 05). Conclusions Pgp over-expression has been successfully suppressed and MDR has been reversed, which may provide a premising approach for refractory epilepsy remedy.

Objective To observe the preliminary effects of the treatment for early non-traumatic osteonecrosis of the femoral head with Madopar. Methods Thirty-one patients with 48 hips of early stage (Ficat Ⅰ,Ⅱ) non-traumatic necrosis of the femoral head were treated with oral administration of Madopar since 2002. The disease was associated with consumption of alcohol in 16 cases with 27 hips; use of steroids in 10 cases with 13 hips; both consumption of alcohol and use of steroids in 2 cases with 4 hips; the remaining 3 cases, the condition was idiopathic. According to the criteria of Ficat et al., there were 4 hips in stage Ⅰ; 40 in stage Ⅱa and 4 in stage Ⅱb. Eighteen patients had received madopar for 10-28 months; 13 patients had been receiving the drug until now. Follow-up examinations were made by radiography, MRI and Charnley modified Merle d'Aubigne score. Results All patients were followed up for 12-84 months (average 27.8 months). The clinical symptoms improved in all cases. X-ray films showed that the bone density increased in nearly all the femoral heads, and 68.75%(33/48) of them maintained their shapes. The follow-up MRI showed their necrotic indices had decreased. The rate of clinical satisfaction was 91.67%(44/48), and the successful rate of treatment was 72.92%(35/48), and the collapse rate of early stage necrosis of the femoral head is 27.08%(13/48). Conclusion The preliminary results showed that madopar could prevent or delay collapse of the femoral head in early stage of osteonecrosis.

Objective To evaluate advantages of the Herbert screw in treating displaced radial head fractures. Methods The Herbert screw was used to treat 25 segmental fractures of the radial head from since 1991 and the results were compared with those of other treatment methods mentioned in the literature. Results A follow up averaging 6 years and 8 months showed that postoperative function was all excellent or good and that most cases recovered to normal absolutely, without complications. Conclusions The Herbert screw provides such rigid internal fixation for displaced radial head fractures that, after operation, a plaster cast is rarely required and most patients are able to return to work within a few weeks. This method of treatment appears to offer significant advantages over conventional techniques.

Objective To conduct a biomechanical evaluation of the four internal fixation methods to treat transverse acetabular fracture and find the b est one. Methods The transverse acetabular fracture models were created by osteo tomy in 12 pairs of embalmed cadaveric hip joints, and fixed with one of the fou r different methods: an anterior column plate (P/N), an anterior column plate w ith a posterior column screw (P+S), a posterior column plate with an anterior screw (S+P) and two posterior column plates (N/P?2). The biomechanical stabi lity was evaluated on longitudinal displacement, level displacement and stiffnes s measurements for fixed fracture fragments which were under 800 Newton vertical compression load. Results The longitudinal displacement in S+P was 3.99mm, in P+S 4.09mm, in N/P?2 5.07mm and in P/N 5.66mm; the level displacement in S+P was 0.015mm, in P+S 0.016mm, in N/P?2 0.022mm and in P/N 0.025mm; the average stiffness in S+P was 205.77N/mm, in P+S 207.52N/mm, in N/P?2 162.36N/mm and i n P/N 146.67N/mm. There were significant differences between the groups of S+P and P+S and the groups of N/P?2 and P/N (P

BACKGROUND:Early clinical application of non-biological materials (bone cement) for treatment of hip joint is ineffective, due to the large fixed range, long fixation time, as wel as aging and rupture of bone cement interface causing complications such as prosthetic loosening. Thus, postoperative range of motion of the hip joint can be affected to some degree.
OBJECTIVE:To investigate the methods and progress of biological and non-biological materials for total hip replacement and to assess the features and clinical application of different hip prostheses.
METHODS:A computer-based search of PubMed and CNKI was performed by the first author to retrieve articles related to biological materials and tissue-engineered hip joint using the keywords of“carpal bone, fracture ununited”in the title and abstract. The keywords were limited to Chinese and English.
RESULTS AND CONCLUSION:Biological materials for internal fixation have good wear resistance, corrosion resistance and biocompatibility. Currently, the combination of metal joint head and polyethylene acetabulum with ultrahigh molecular weight is the most commonly used in hip replacement. However, the metal joint head exhibits an elastic modulus far from the human skeleton, resulting in stress shielding effects which are easy to cause prosthetic loosening and instability. Bio-inert ceramics has high in vivo stability and good mechanical strength;and bioactive ceramics has bone conduction characteristics and performance of the living bone integration. Composite prosthesis, because of adjustable elastic modulus and sufficient mechanical strength, shows the mechanical properties close to the human bone and has been gradual y noticed. However, there is a lack of ideal prostheses with good biocompatibility and biomechanics. Therefore, hip design and manufacturing processes should be improved to elevate wear resistance and mechanical properties, to enhance the binding between prosthesis and the host bone, and to reduce stress shielding in order to improve the biocompatibility of the implant with the host, and extend the prosthetic life.