Objective To investigate the feasibility of repairing the radius defect with inductive bone regeneration membrane combined with freezed allogenic bone. Methods Preparation PLGA/bBMP+IGF-Ⅱ+ bFGF complosite was prepared as artificial periosteum. Twenty seven rabbits with 1.0 cm long right radius segmental osteoperiosteum defect were werved as the animal model, and randomly assigned to 3 groups with 9 in eath group; Group A: the defects were connected with the PLGA/bBMP+IGF-Ⅱ+bFGF membrane and allogenic bone; Group B: the defects were treated with the PLGA/bBMP+IGF-Ⅱ+bFGF membrane; Group C: the defects were implanted only woth allogenic bone grafts. Animals were killed at 2, 4, 8 weeks postoperation respectively. The healing was study with radiological, histological and immunological methods. Results The osteogenic ability in PLGA/bBMP+IGF-Ⅱ+bFGF group was superior to that in the other groups. The defects of group A ware fully repaired at week 8; bony bridging under remodeling was observed in group B; and the putrescence of allogenic bone which was packaged by mass of connective tissue was observed with group C; Group A caused lower titer of antibody than group C and inhibited lymphocytes reproduction in vitro; There was significant difference between group A and group C. Conclusion PLGA/bBMP+IGF-Ⅱ+bFGF artificial periosteum had provided a excellent osteoinduction condition. Artificial periosteum combined with freezed allogenic bone can effectively promote the rapair of radius defects of rabbit.

[Objective]To study the efficacy and related problems of lumbar microdiscectomy and small-incision discectomy in the treatment of lumbar disc herniation.[Method]A total of 82 cases were treated with lumbar microdiscectomy,70 cases were treated with small-incision discectomy.The results of two groups were compared.[Result]Compared with the small incision group,the operative time and the complication rates were significently reduced.The effective rate between the two groups had no significent difference.[Conclusion]Small-insion discectomy is as an effective operation as microdiscectomy,while lumbar microdiscectomy had the advantages of minimal invasive,more indications,less bleeding.Strict selection of indications,sufficient preoperative preparations and practiced surgical techniques are the key points of the two minimally invasive techniques to award good outcomes.

[Objective]To oberserve the method and efficacy of anterior microsurgical decompression and fusion via cervical disc space in the treatment of cervical spondylotic myelopathy.[Method]Forty-three patients were treated with microsurgical decompression via cervical disc space and fusion with PEEK(Polyetheretherketone)cages.Preoperative,immediate postoperative and follow-up X-ray films were utilized to oberserve the fusion rate of the segments,and to evaluate the restoration of lordosis(Cobb's angle)and intervertebral height.[Result]All patients were followed up with an average of 15.4 months.The fusion rate was 100% and the satisfactory rate was 88.4% according to the 40 score method.Immediate postoperative X-ray films showed 6.0?improvement in lordosis(P

BACKGROUND:Many patients underwent aspirin anticoagulation in preventing cardiovascular disease before hip and knee replacement. No report addressed the effect of aspirin on blood loss during perioperative stage in patients receiving hip and knee replacement. OBJECTIVE:To observe the effect of perioperative continuous low-dose aspirin anticoagulation application on total hip arthroplasty or total knee arthroplasty. METHODS: A total of 40 patients with primary total hip arthroplasty or total knee arthroplasty were enroled in the Department of Orthopedics, Tianjin First Center Hospital from December 2012 to August 2013. According to anticoagulation scheme, they were divided into two groups (n=20). In the observation group, 100 mg/d aspirin anticoagulation was continuously used before replacement for a long period, and the medicine was not withdrawn except the day of replacement. In the control group, aspirin anticoagulation was not used, and their ages were similar to the observation group. The operation was conducted by the same physician in the observation and control groups. 10 patients received total hip arthroplasty and 10 patients received total knee arthroplasty in both groups. Bleeding was stopped actively during replacement. After replacement, pressurized ice compress was used to reduce bleeding. At 48 hours after replacement, wound drainage, perioperative hemoglobin and the incidence of complications were recorded. Joint function recovery was observed at 3 months of folow-up. RESULTS AND CONCLUSION:Hemoglobin levels before and after operation, postoperative blood drainage at 48 hours, perioperative hemoglobin changes, the incidence of complication, and joint function score at 3-month folow-up did not show significant difference between both groups. These findings indicate that it is safe to use some measures for reducing blood loss and continue low-dose aspirin in the perioperative period. The use of aspirin did not impact blood loss.

BACKGROUND:Clinical fol ow-up studies have shown that alendronate is effective to prevent femoral head col apse fol owing traumatic osteonecrosis of the femoral head, but its mechanism remains poorly understood. OBJECTIVE:To analyze the effects and mechanisms of alendronate on prevention of col apse in traumatic osteonecrosis of the femoral head. METHODS:Total y 45 Sprague-Dawley rats were randomly divided into three groups, with 15 rats in each group. Placebo group received physiological saline after establishing models of avascular necrosis of the femoral head. Alendronate group received treatment of alendronate after model induction. Sham surgery group received an equal volume of physiological saline. At 5 weeks after model establishment, the rats were sacrificed. Femoral samples at the modeling side were col ected for general observation, X-ray irradiation, Micro-CT and histological detection. RESULTS AND CONCLUSION:General observation revealed that the femoral head was obviously deformed in the placebo group, but mild deformity was visible in the alendronate group. The ratio of height to width of the femoral head ranked as fol ows:sham surgery group>alendronate group>placebo group, showing significant differences. Micro-CT scanning results demonstrated that the mean number of bone trabecula was more in the alendronate group than in the placebo group, but less than sham surgery group, showing significant differences. The mean thickness of bone trabecula was less in the alendronate group than in the placebo group, but no significant difference was detectable as compared with the sham surgery group. The mean spacing of bone trabecula was less in the alendronate group than in the placebo group, but larger than in the sham surgery group, showing significant differences. Bone volume, bone surface area and bone mineral density were larger in the alendronate group than in the placebo group, but less than sham surgery group, showing significant differences. Histological detection results demonstrated that apparent sequestrum existed and osteoclasts were obviously inhibited in the alendronate group. The number of osteoclasts was noticeably less in the alendronate group than in the placebo group. Osteoblasts and new vessels were suppressed to some degrees. Results suggested that alendronate can inhibit curing reaction through inhibiting osteoclast and osteoblast activity and vessel formation, which can final y slow down the absorption of necrotic bone and preserve femoral head mass and shape. Thus, alendronate can be used as a preventive against femoral head col apse in rats with traumatic osteonecrosis of the femoral head.

Objective To observe if endothelial progenitor cells (EPCs) and bone marrow mesenchymal stem cells (BMSCs) could home to the injured region and study the effect of BMSCs-derived EPCs on traumatic brain injury (TBI) in rats.Methods BMSCs were isolated from 3-month-old SD male rats weighing 150 g,and induced to EPCs.EPCs were identified by surface markers CD133,CD34 and FLK-1.A total of 120 female adult SD rats were divided into 3 groups (n =40 each) according to the random probability table method:EPCs group,BMSCs group and 3T3 cells group.The model of moderate to severe TBI was induced by the fluid percussion device.All the cells (i.e.EPCs,BMSCs and 3T3 cells) were injected with BrdU before transplantation to the tail vein of rats.On days 2,7,14 and 28 after transplantation,rat neurological function was evaluated using the modified neurological severity score (mNSS),and injured brain tissue was harvested to detect CD34 and brain-derived neurotrophic factor (BDNF) positive cell density using the immunohistochemistry method.Sry-positive cells were evaluated using the fluorescence in situ hybridization (FISH).Results The positive rate of CD133,CD34 and Flk-1 was 52％,33％ and 38％,indicating BMSCs differentiation towards an EPCs phenotype.On days 7,14 and 28 after transplantation,the mNSS in EPCs group [(10.2 ± 1.5),(8.7 ± 1.0) and (4.9 ± 1.0) points] and in BMSCs group [(10.8 ± 1.7),(10.1 ± 1.7),and (7.2 ± 1.3) points] were lower than that in 3T3 cells group [(12.4 ± 1.5),(1 1.7 ± 1.8),(10.3 ± 1.5) points] (P ＜ 0.05).On 14 and 28 days after transplantation,BrdU-positive CD34 and BDNF in EPCs group were significantly more than those in BMSCs group (P ＜ 0.05).Instead,there were no positive cells in 3T3 cells group.The method of Sry probe to trace the transplanted cells could detect more positive cells compared to the BrdU labeling method.Conclusion Both BMSCs and EPCs can home to the injured region,but EPCs have much better therapeutic effect.

One option with minimally invasive surgery for treatment of painful osteoporotic vertebral compression fracture is percutaneous vertebroplasty or percutaneous kyphoplasty via an inflatable balloon tamp followed by stabilization with polymethylmethacrylate cement.The vertebral height is restored and the decreased loading ability of the fractured vertebral body is re-strengthened with pain relief.The effect of the method is widely demonstrated in those conditions.At the same time, the relative problems, such as the complications are being lucubrated and discussed.The reports on the re-fracture or height loss of the operated vertebrae with cemented augmentation are becoming more.By now, there are some unclear aspects on the problem: the definition of the re-fracture of the augmented vertebra is still unclear and not ascertained and the clinical manifestations are various.The mechanisms and correlative factors are still not clear-cut either.The rate of subsequent re-fractures after cemented augmentation from literature is fargoing, with a rate of 0％ to 63％.The correlative factors on the re-fracture of the operated vertebrae chiefly include: osteoporosis, bone necrosis caused by the heat injury from cement solidification,failure to achieve endplate-to-endplate cement augmentation, intravertebral cleft or avascular bone necrosis, premature mobilization or excessive movement, overfull reduction of the vertebral height, the biological character of the spine column, and so on.Great controversy still exists on the correlation between those possible factors and the re-fractures.More attention should be paid to this problem to explore the true risk factors and mechanism, decrease the re-fracutre rate, and elevate the clinical outcome in osteoporotic compression fractures.

Objective To explore the reasonable nursing interventions of advanced schistosomiasis patients. Methods The medical records of 52 advanced schistosomiasis patients hospitalized from 2008 to 2013 were collected,and the nursing interven-tions were summarized. Results The 52 cases of advanced schistosomiasis included 38 men and 14 women,with a mean age of 65.8 years(57-75 years). Totally 53.8%of the subjects were schistosome positive by IHA test,67.3%positive by ELISA,and 21.2%positive of HBsAg. There were 13 cases of ascites type,34 cases of megalosplenia type,and 5 cases of dwarfism type of ad-vanced schistosomiasis. Following the therapy together with nursing interventions,73.1%achieved clinical cure,23.1%achieved stable,and 3.8%achieved improvement. The major nursing interventions involved basic nursing,diet nursing,treatment nursing, physiological nursing and surgical nursing. Conclusion The scientific and reasonable nursing interventions can improve the ther-apeutic efficacy and prognosis in advanced schistosomiasis patients,as well as improve their quality of life.

Objective To evaluate the efficacy of plasma radiofrequency ablation at low temperature in disc combined with collagenase injection out of disc in patients with cervical intervertebral disc herniation.Methods Fifty-six patients suffering from cervical intervertebral disc herniation with headache,dizziness,and pain in the neck and in the shoulder were randomly divided into 2 groups ( n =28 each):collagenase injection out of disc group (group C) and plasma radiofrequency ablation at low temperature in disc combined with collagenase injection out of disc group (group R).All operations were carried out under CT guidance.Results At the sixth month of follow up after treatment,the remission rates of headache,dizziness and pain in the neck and in the shoulder were 86％,79％,and 93％ in group C and 96％,93％,and 100％ in group R,.respectively,with significant difference between the two groups ( P ＜ 0.05 ) Conclusion The efficacy of plasma radiofrequency ablation at low temperature in disc combined with collagenase injection out of disc is much better than collagenase single in patients with cervical intervertebral disc herniation.

Objective To evaluate the method and clinical effect of subtalar joint distractor assisted open reduction and internal fixation of comminuted intra-articular calcaneal fracture.Methods Twenty-two patients with fresh closed calcaneal fracture treated with open reduction and internal fixation from May 2011 to July 2013 were included in the study.According to the modes of operation,the patients were randomly divided into two groups (n =11 in each):in group A patients underwent fracture reduction assisted by subtalar joint distractor and in group B patients underwent Steinmann pin traction and poking reduction.All were fixed using the lateral calcaneal plate.Operation time,B(o)hler angle,Gissanes angle,calcaneus height,incision healing time and complications of the two groups were investigated for evaluating the effect of operation.Clinical effect was evaluated using the American Orthopedic Foot & Ankle Society (AOFAS) score before the removal of internal fixation.Results Period of follow-up was (14.3±0.8)months (range,12 to 18 months).Two patients in group B had delayed wound healing,and were treated with regular wound care.At the final follow-up,no infection,nonunion,malunion and internal fixation failure were observed.B(o)hler angle,operation time and calcaneus height observed in group A were superior to those in group B (P ＜0.01).There was no significant difference in Gissanes angle between the two groups (P ＞ 0.05).Compared to the preoperative data,B(o)hler angle,Gissanes angle and calcaneus height were significantly improved in both groups (P ＜0.01).AOFAS score was (83.6 ± 1.4) points in group A and (81.7 ± 1.5) points in group B.Conclusion Subtalar joint distractor assisted open reduction and internal fixation is effective to shorten operation time,improve fracture reduction,reduce wound complications and increase the operative effect for comminuted intraarticular calcaneal fracture.