[Objective]To explore the efficacy and result of femoral component revision by using impaction bone grafting technique with anatomic cemented stem and freeze-dried allograft.[Method]Anatomic cemented stem combined with freeze-dried allograft were used in IBG for 49 cases of femoral revisions from Jan,2001 to Dec 2005.36 cases(73%)of which had severe bone loss(Paprosky grades ⅢB and Ⅳ).The mean follow-up time was 35.3 months(26~52 months).Harris Hip Score System and radiography were used to evaluate the clinical results.[Result]The mean Harris Hip Score was improved from 44.6 points preoperatively to 88.3 points at final evaluation.Good and excellent scores were about 89.8%.No major femoral stem subsidence was found in our patients.There were one case of dislocation(2%),one case of deep infection(2%)and 3 cases of femoral fractures during operations(6.1%),which were not related to the selection of femoral component and the type of allograft.[Conclusion]The impaction bone grafting technique by using freeze-dried allograft and the anatomic cemented femoral prosthesis for femoral revision was feasible and the short and mid-term result was good.Longer follow-up was needed to evaluate the long term result.

To discuss pathological factors which affection the prognosis of patients with esophageal cancer.We ex plored and compared the main pathological factors affecting the prognosis of esophageal cancer patients by analyzing their clinical data:the extent of tumor invasion,lymph nodes shift,distant organ metastasis,as well as stages of tumor.And the prognosis associated with the following independent factors:tumor histological type and degree of dif ferentiation tumor mierometastases,vascular tumor thrombus formation,and stromal tumor-infiltrating lymphocytes. The authors think the pathological stage of esophageal cancer patients need to be improved.

Retrospective analyses were performed for the clinical data of 67 patients with biliary calculi.Among them,laparocholedochoscopy plus holmium laser lithotripsy (n =31) and laparocholedochoscopy (n =36) were performed.As compared with laparocholedochoscopy,early postoperative serum inflammatory mediators of holmium laser lithotripsy were obviously lower,biliary pressure dropped faster and less volatile[(8.5±1.5)-(12.2±4.1) vs.(8.1 ±1.6)-(16.5±4.7) mmHg(1 mmHg=0.133 kPa)],operative duration [(93.5 ± 13.4) vs.(127.6 ± 34.5) min],conversion into laparotomy rate[3％ (1/31) vs.11％ (4/36)],postoperation SIRS rate[23％ (7/31) vs.42％ (15/36)],length of hospital stay [(8.5 ± 3.5) vs.(12.6 ± 3.9) days] and postoperative biliary residual stones rate [0％ (0/31) vs.8％ (3/36)]were also better than.

Objective To observe the effect of transformation of vascularized tissue-engineered bone with vascular bundle graft in vivo. Methods The bone marrow stem cells (BMSCs) obtained from rabbit os ilium were cultured, expanded and induced to form osteocytes, then they were combined with porous ?-tricalcium phosphate (?-TCP) to construct tissue-engineered bone. The tissue-engineered bone was implanted in a segmental defect with critical length of 15mm in rabbit femoral shaft. A bundle containing both artery and vein was inserted in the centre of the tissue-engineered bone with microvascular surgical technique. After an examination with DEXA bone scanner, the specimen was harvested for macroscopic and histological examination after 12 weeks of growth period. Results The site where the implanted vascular bundle inserted into the tissue engineered bone appeared like foramen nutriens, the blood vessels were patent. Abundant blood vessels, which emerged from the deep tissue of the engineered bone, were evident on the surface of specimen. Multicentric ossification area rich in blood vessels could be seen in the tissue-engineered bone histologically. The enchondral ossification in the center of tissue-engineered bone and membranous ossification in the periphery occurred simultaneously. Some materials in the centre of tissue-engineered bone had transformed into marrow cavity like construction. The results of the DEXA demonstrated that the vascularized tissue-engineered bone produced more boney tissue. Conclusions Implantation of blood vessel bundle into tissue-engineered bone may enhance neovascularization of the tissue-engineered bone and accelerate the process of reconstruction subsequently, and it is a promising method of vascularization of tissue-engineered bone.

Objective To investigate the effect of lamivudine for the prevention of hepatitis Bvirus reinfection in post-orthotopic liver transplantation (OLT) patients.Methods Clinical data of 41adult patients followed up for 2 years after liver transplantation,who received lamivudine prophylactic strategy for HBV reinfection,were analyzed retrospectively.Results Ten cases developed hepatitis B virus(HBV) reinfection,and 9 of them were caused by LAM-resistant HBV(YMDD).The one-and 2-year rate of HBV reinfection after transplantation was(9.8 %)(4/41) and(24.4 %)(10/41) respectively.The reinfection rate of group with negative preOLT serum HBV DNA was much lower than in the HBV DNA positive group.The reinfection rate of group receiving long-term(more than 6 months) lamivudine treatment and group not receiving anti-virus treatment pre-OLT was(66.7 %) and(23.1 %),respectively.Both of them were remarkably higher than in the group receiving short-term less than 6 months lamivudine treatment.Conclusions The short-term(less than 6 months) lamivudine treatment pre-OLT can suppress serum HBV DNA replication effectively,and long-term more than 6 months lamivudine treatment pre-OLT can decline the rate of HBV reinfection obviously.But the prophylaxis of long-term LAM monotherapy may induce LAM-resistant HBV variants(YMDD) reinfection.

Objective Experimental and clinical data suggest that fixed element knee designs a re not able to both supply adequate mobility and eliminate unnecessary constra int forces,as well as provide low contact stresses compatible with pr olonged life of UHMWPE bearing components.The present study investi-gated the preliminary clinical outc ome of TACK(Total Articulating Cementless Knee)system,a new design of mobile-bearing knee prosthesis.Methods Eighty-eight knees in 61patients underwent total knee replace-ment by using TACK were reviewed.Forty-five knees of 31patients were followed-up at least one year.The HSS knee rating score system as well a s X-ray films were used to evaluate th e clinical results with the mean follow-up period of 25.4months.Results At the latest follow-up examination,the rate of good to excellent clinical results was 96.4%.The range of motion was improved from 0-6.5-68.3degrees preoperatively to0-2-88.4degrees at the latest follo w-up.The complications such as oste olysis around the prosthesis,prosthetic loosening and dislocation of meniscus bearings were not found.Conclusion The TACK Knee is a third generation knee system design ed to introduce movable bearings between the metal tibial and femoral components that would reduce the sur face and subsurface stress states at the bearing surfaces and at the bone-implant interfaces by maximiz ing the conformity of the tibial and f emoral components and allowing mo-bility of the bearing surface.In an a verage of more than two years experie nce,it was observed that there was no aseptic loosening of the componen ts.A long term follow-up is obviously necessary to make more precise statement about this knee replaceme nt system.

Objective To compare the results of one-stage bilateral total hip arthroplasty (THA) and staged bilateral THA, and to determine the safety and efficacy of one-stage simultaneous bilateral THA. Methods The patients who were indicated for with bilateral THA were divided into 2 groups. Gourp A included 87 patients with one-stage simultaneous bilateral THA, and Group B included 31 patients with staged bilateral THA. The operating time, the amount of blood loss, the amount of blood transfusion necessary, post-operation functional scores, and perioperative complications were compared between group A and group B. Result There was no significant difference between group A and group B. Conclusion One-stage simultaneous bilateral total hip arthroplasty was a safe and efficacious procedure.

Objective To explore the intraoperative fluoroscopy in percutaneous sacroiliac screw fixation based on anatomic measurement and digital reconstructed CT data. Methods The CT data of the pelvis at prostration were collected for 3D reconstruction of the pelvic models from 30 patients with injury to the pelvis or acetabulum.Then the anatomical boundaries of thesafe zone of sacroiliac screw insertion were marked on the 3D models,including the upper,front and back cortex boundaries of S1 vertebra,the front and bottom cortex boundaries of sacral foramen area,and the sacral alar slope. The angles between these anatomical boundaries and the pelvic baseline were measured on the sagittal plane.The digital reconstructed radiology (DRR) was applied to form the inlet,outlet and lateral images of fluoroscopy.The standard protocol to acquire accurate intraoperative images was analyzed by characterization of important anatomic landmarks.Results The angles between the upper,front and back cortex boundaries of S1 vertebra and the baseline (αl,α2,α3) were respectively 37.7°± 8.6°(from 23.2°to 50.8°),22.9° ± 6.7° (from 13.1° to 32.0°),41.9°± 6.8° (from 33.0°to 54.8°).The angles between the front and bottom cortex boundaries of sacral foramen area and the baseline (α4,α5) were 37.0°± 12.0° (from 19.9° to 63.1°) and 38.8°± 8.0° (from 25.7°to 54.6°).The angle between the alar slope and the baseline (α6) was 82.4°± 13.0°(from 70.3°to117.3°).The characteristic manifestations of important anatomic landmarks were observed in the simulated fluoroscopy images. Conclusions It is recommended that the projecting angles in the inlet and outlet views should be decided according to the specific data of each patient.Because the alar slope can not be clearly identified in the outlet view due to its large inclination,the position of screw insertion should be verified in the lateral view to prevent the screw from penetrating the slope to hurt the L5 nerve and iliac vessels.

Objective To explore the evolution of HBV polymerase gene as a result of adefovir dipivoxil treatment in liver transplant patients with lamivudine resistance. Methods Eight patients with HBV reinfection which was lamivudine resistance received adefovir therapy (10mg/day). Sequential serum samples were obtained from 2 consecutive patients with adefovir failure, and the polymerase gene of HBV was amplified by PCR and TA cloned, and sequencing and analysis were performed in 10 random clones. Results Neither rtN236T nor A181V/T mutation, which were associated with adefovir (ADV) resistance, was found. The rtL180M mutation associated with lamivudine resistance presented before ADV treatment, and several previously unreported amino acid substitutions were observed in the reverse transcriptase domain. Conclusion Possibly, the rtL180M mutation in the B domain of HBV polymerase reduced the susceptibility to ADV. ADV resistance mutation may occur in other sites besides rtN236T and A181V/T amino acid substitutions or do not happen early after treatment.