[Objective] To study the application and clinical result of extended trochanteric osteotomy in hip joint revision.[Methods]Thirteen hips in 13 patients who were treated with extended trochanteric osteotomy in hip joint revision from 2003 to 2007 were followed-up for an average time of 32.3 months.The revision reasons,Harris score,osteotomed length,and the oeteotomed union time were analyzed.[Results]The average preoperative Harris score of all patients was 38(24~68),the average postoperative Harris score was 77(57-100),with the improvement of 39 points.The average osteotomed length from the tip of great trochanter to distal osteotomy site was 12.4 cm(9~15.1 cm).The osteotomy sites were healed in 11 patients at 3 months and 2 patients at 6 months after operation.[Conclusion]Extended trochanteric osteotomy is useful in hip joint revision.After osteotomy femoral prosthesis and cement could be taken out easily,and the osteotomy site could be healed easily.

BACKGROUND:Crowe IV developmental dysplasia of the hip is rarely seen clinical y. However, when treated with routine total hip arthroplasty, severe deformities in the bone and soft tissue can lead to high rate of operation failure and increased occurrence of complications. Total hip arthroplasty in combination with subtrochanteric osteotomy may be an option to resolve this problem.
OBJECTIVE:To retrospectively analyze the clinical outcome and safety of Crowe IV developmental dysplasia of the hip treated by the combination of total hip arthroplasty and subtrochanteric osteotomy in 17 cases.
METHODS:Twenty-one hips (17 cases) of Crowe IV developmental dysplasia of the hip treated by the combination of total hip arthroplasty and subtrochanteric osteotomy were retrospectively analyzed and fol owed for at least 2 years from January 2006 to June 2011. Complications, hip function, and radiological changes were evaluated.
RESULTS AND CONCLUSION:The mean fol ow-up period was (48.0±20.5) months. Harris’s score was increased postoperatively (P<0.05). The main complains were lower limb length discrepancy, difficulty in standing up from squatting, muscle weakness, and soft tissue tightness. One greater trochanter fracture occurred and was fixed by hook plate fixation. There were four femoral shaft splits treated by cerclage. One patient represented with femoral nerve palsy and got partial recovery until the latest fol ow-up. There was no deep infection, dislocation or prosthesis loosening. Crowe IV developmental dysplasia of the hip could be effectively treated by total hip arthroplasty in combination with subtrochanteric osteotomy, which requires high surgical techniques to control the complications. Further fol ow-up is required for long-term results.

Objective To investigate normal patellar morphology,then to explore its possible instructive significance in the design of patella prosthesis for Chinese people and in the process of resurfacing patella.Methods CT scan examinations were performed in 60 normal knees (left or right knee was selected randomly； scan region,from half proximal tibia to half distal femur) of 60 healthy Chinese adults (32 males,28 females； age range,18-54 years； mean age,33.7 years),then mimics software was used to reconstruct the 3-D morphology of each patella and new coronal and sagittal planes were created.Each patella's height,width,thickness,the position of the dome,the ratio of height/width,and the residual thickness after patella was resected at the level of the subchondral bone of the lateral facet during the stimulating process of patella resurfacing were measured or calculated.Results Patella of Chinese male:height 31.95±2.77 mm,width 45.02±2.70 mm,thickness 22.38 ±1.63 mm,the residual thickness after patella was resected 13.18±1.62 mm； Patella of Chinese female:height 28.72±2.17 mm,width 39.57±2.57 mm,thickness 19.88±1.36 mm,the residual thickness after patella was resected 11.20±1.20 mm.Significant differences existed between male and female for all the above four parameters.Patella of Chinese male:the ratio of width/height 1.42 ±0.11,the position of the dome (medial 42.9％)； Patella of Chinese female:the ratio of width/height 1.38±0.10,the position of the dome (medial 42.6％).No significant differences existed between male and female for the above two parameters.Conclusion The patella of Chinese people is small,thin and slim,especially in Chinese female.These findings should be considered in selecting or designing patella prosthesis to fit the Chinese people.For Chinese female,more attention should be paid to keep appropriate residual thickness after the patella was resected during the process of patella resurfacing.

Objective To evaluate the clinical outcome of Vancouver B2 and B3 periprosthetic femoral fractures treated with uncemented modular stems.Methods From September 2011 to April 2014,Twenty-four patients (12 males and 12 females,with the average age 63 years,ranging from 28 to 85 years) with periprosthetic femoral fractures (16 Vancouver B2 and 8 Vancouver B3) were treated with uncemented modular stems.Revision arthroplasty was conducted in all cases by using modular stems with 12 cerclage wirings and 11 great trochanter claw plates.One patient was treated with revision arthroplasty without additional fixations.Extended trochanter osteotomy was performed on 11 patients.Cortical strut allograft was used in 9 patients with severe femoral bone loss.Intraoperative complications including vascular or nerve injury and systemic complications including cardiovascular events,cerebrovascular events and deep vein thrombosis were recorded.Severe postoperative complications such as nonunion,re-fracture,periprosthetic joint infection and dislocation were recorded.The clinical outcome was evaluated by Harris score,Visual Analogue Score and Parker Mobility Score.The radiological outcome was taken to observe the healing status,stem subsidence and stability of the prosthesis.Results Two patients were lost to follow-up.Twenty-two patients were clinically followed-up.Radiological data was recorded in 16 patients.The average follow-up was 33 months (range,12-68 months).All fractures healed within 6 months.The average Harris score improved from 4.0± 1.1 preoperatively to 78.8± 16.2 postoperatively (t=-20.195,P=0.000).The mean Parker Mobility Score improved from 0.5±0.9 preoperatively to 7.0± 1.8 postoperatively (t=-14.835,P=0.000).The mean Visual Analogue Score decreased from 6.4± 1.2 preoperatively to 2.0± 1.5 postoperatively (t=10.879,P=0.000).No nonunion,infection or dislocation was found.One patient underwent re-operation because of re-fracture.Eight mm of prosthesis subsidence was observed in one case at 3 months postoperatively,and reached stable fixation at 6 months postoperatively without further subsidence.Conclusion Uncemented modular stems can achieve distal fixation and implant stability of periprosthetic femoral fractures while retaining optimal biomechanics of the hip.Assisted by femoral reconstruction techniques such as extended trochanter osteotomy,cortical strut allograft,great trochanter claw plates and cerclage wiring,revision arthroplasty using uncemented modular stems could realize optimal outcomes in treating Vancouver B2 and B3 periprosthetic femoral fractures.

Objective To observe the efficacy of total ankle replacement in treatment of osteoarthritis of ankle joint.Methods Between October 1999 and October 2006,42 patients with ankle osteoarthritis were admitted in Beijing Jishuitan Hospital.All the patients met surgical indications and were performed total ankle replacement with S.T.A.R.system ( Scandinavian Total Ankle Replacement) (Waldemar Link,Hamburg,Germany).The pain in patients,motion and function of joint were evaluated pre- and post-operatively according to Kofoed scoring system,and the efficacy was evaluated with the Mayo'evaluation criteria of total ankle replacement.Results According to Kofoed scoring system,the postoperative situation was obviously superior to the preoperative in pain,motion and function of joint(P ＜ 0.05 ),and the excellent and good rate was 90.32％.While,the excellent and good rate was 87.5％with the Mayo' evaluation criteria of total ankle replacement.Conclusion Total ankle replacement,which can relieve pain,restore ankle function and improve ankle activity,provides another effective method for the patients who need ankle arthrodesis.

Objective To discuss the characteristics and clinical results of rotating platform high flexion(RDHF)total knee replacement TKR. Methods A total of 61 patients(78 knees)including 13males(15 knees)and 48 females(63 knees)at age range of45-79 years(mean 64.3 years)were treated with Sigma(RP-HF)rotating platform high flexion total knee replacement.Osteoarthritis was found in 56patients and rheumatoid arthritis in 5.By medial parapatella approach,denervation and facet repair of the patella were done,without replacing them. Results All 78 knees were followed up for 3-16 months (mean 10.5 months).the X-ray film demonstrated no prosthesis loosening,patella dislocation or subluxation.According to the knee society scoring system,the preoperative score was 48 points(33-72 points)and the knee functional score was 41 points(28-63 points)on average.After surgery,the knee score was 97points(88-100 points),the functional score 96 points(84-99 points),and the range of motion(ROM)130.(110.-150.)on average.No spin-out or infection were detected. Conclusions The Sigma RP-HF knee system provides sufficient contact area.full range of patella locus and sufficient axial rotation,which helps reach a stable and durable high flexion performance.Our short-term clinical follow up result is good but the advantages of low wear and longevity of the Sigma RP-HF prosthesis still need further study.

Objective To investigate the effect of a novel lymphotoxin with selectively binding to p55 tumor necrosis factor receptor (p55TNFR) on myocardial ischemia-reperfusion injury in rats in order to explore the mechanism.Methods A total of 40 SD rats were randomly (random number) assigned into four groups (n =10 in each),namely sham operation group (group A),I/R group (group B),wild type rhLTα treatment group (group C),and p55TNFR selective rhLTα (rhLTα-Q107E) treatment group (group D).After I/R model rats were established,various therapeutic agents or saline were given by continuous intravenous infusion for 24 h via a micropump.After 24 hours of treatment,serum myocardial zymogram,such as aspartate aminotransferase (AST),lactate dehydrogenase (LDH) and creatine kinase (CK),as well as superoxide dismutase (SOD),malondialdehyde (MDA) and glutathione peroxidase (GSH-Px) activities were determined.Myocardial infarction size (MIS) was measured by nitro blue tetrazolium chloride (NBT) staining.Results Compared to sham operation group,MIS,AST,LDH,CK,MDA were increased,while the activities of SOD and GSH-Px were decreased.However,all the effects were significantly reversed by treatment with rhLTα-Q107E (P ＜ 0.05) but not rhLTα (P ＞ 0.05).Conclusions The rhLTα-Q107E plays a role in the protection against myocardial ischemia-reperfusion injury in rats by the mechanism of scavenging oxygen free radicals and increasing the activity of endogenous antioxidant system.

Objective: To study the effect of flavonoids from seed residues of Hippophae rhamnoides L.( FSH) and Hippophae rhamnoides L. oil(HRO)on serum lipid in female rats with obesity. Methods Female aged rats with obesity were given FSH and HRO by oral administration for 6 w. Serum triglyceride(TG) and cholesterol(TC) were determined every 2 w. The serum free fatty acid (FFA), high-density lipoprotein cholesterol (HDL-C),body weight and Lee’s index were measured after 6 w. Results: Serum TG and FFA level decreased significantly in rats given FSH. At the same time, FSH could inhibit the increase in body weight and Lee’s index. HRO could regulate the lipid metabolism and decrease serum TG level significantly in female aged rats with obesity. Conclusion: Both FSH and HRO can improve lipid metabolism in female aged rats with obesity.

ObjectiveTo observe the activity and safety of a novel combination therapy for patients with recurrent or refractory aggressive non-Hodgkin lymphoma (NHL).MethodsSix consecutive patients with recurrent or refractory aggressive NHL were treated with B-VIP regimen,boanmycin (5 mg/m2 on Days 1,4,8,12 and 15),vincristine (1.4 mg/m2 on Days 1,8 and 15),ifosfamide (1.2 g/m2 on Days 1,2,3 and 15,16,17) and prednisone (50 mg on Days 1 to 10),every 21 days.All the patients had received ≥5 cycles (average 8.3 cycles) of previous chemotherapy.ResultsSix patients (100 ％) were evaluable for response.The overall objective response rate was 66.7 ％ (4 patients),including 1 case complete (CR) and 3 cases partial responses.Myelosuppression was the most frequent serious complication of this regimen.ConclusionIn the current study,B-VIP was a highly active and safe combination therapy for patients with refractory disease with a poor prognosis or for patients with multiply recurrent aggressive NHL.

Objective To explore the in vitro culture methods for oriented differentiation of peritoneal cells and bone marrow cells into high-purity mast cells,and to identify the function of these mast cells.Methods Peritoneal cells and bone marrow cells were isolated from the peritoneal cavity lavages and femur of C57BL/6 mice,and cultured with both interleukin-3 (IL-3) and stem cell factor for 2 and 4 weeks respectively.Light microscopy was performed to observe the morphology of these cells,toluidine blue staining to identify the degree of maturity of these mast cells,and flow cytometry to measure the expression of cell surface markers C D 117 and FceR Ⅰ α.After the stimulation with compound 48/80 at different concentrations,the degranulation rate of mast cells was counted under the microscope,and β-hexosaminidase release rate was measured by spectrophotometry.Results After 2-or 4-week culture,the mouse peritoneal and bone marrow cells all manifested as refractive suspension cells of uniform size.Toluidine blue staining showed violaceous metachromatic granules in the cytoplasm of the two kinds of cells.The proportions of CD117 or FcεR Ⅰ α single-positive peritoneal and bone marrow-derived mast cells were all more than 95％,and the proportions of CD117/FcεR Ⅰ α double-positive peritoneal and bone marrow-derived mast cells were 97.68％ ± 0.80％ and 96.12％ ± 0.76％ respectively.The degranulation rates of mast cells in the 100-and 1 000-mg/L compound 48/80 groups significantly differed from those in the blank control group (all P ＜ 0.01).Compared with the blank control group,the β-hexosaminidase release rates significantly increased in bone marrow-derived mast cells in the 100-mg/L compound 48/80 group and peritoneal mast cells in the 10-and 100-mg/L compound 48/80 groups (P ＜ 0.01 or 0.05).Conclusion IL-3 and stem cell factor can co-induce the directed differentiation and proliferation of mouse bone marrow stem cells and peritoneal cells,so as to harvest highnuritv mature degranulated mast cells,and lay a foundation for subsequent cell biology research.