OBJECTIVE: To investigate the factors affecting shoulder joint functions following artificial humeral head replacement. METHODS: A total of 22 patients with complex fracture of proximal humerus, managed by humeral head replacement in Changhai Hospital of The Second Military Medical University from June 2006 to December 2008 were collected, including 12 males and 10 females, with average age of 67 years (52-86 years). During the procedure, soft tissue damage was minimized, the bone of the tuberosity was reserved as much as possible, appropriate matching size of humerus head prosthesis was selected, and early staging functional rehabilitation was performed. Neer's scoring system was used to evaluate the treatment results after replacement. RESULTS: The 22 patients were followed up for 10-30 months, mean 22.6 months. The shoulder joint functions of 14 cases were recovered more quickly through early post-operative staging rehabilitation, No shoulder joint unstable and stiff occurred. The shoulder joint functions of 8 cases were recovered slowly as they complained pain and did not perform early physical therapy after surgery, shoulder joint of 2 cases presented little unstable and 1 case presented stiff. Only 4 cases of all complained occasionally slight shoulder pain, but could continue daily work. The mean movement ranges of shoulder were as follow: mean flexion for 96°(80°-103°), mean extension for 38° (32°-45°), mean abduction for 86°(80°-110°), mean adduction for 31°(30°-35°), mean external rotation for 32°(30°-37°) and internal rotation for 42° (10°-75°). No vasculardamage, nerve damage, lessening prosthesis or prosthesis dislocation was found in all cases. Based on Neer's scoring system, 5 cases were rated as excellent, 11 as good and 4 as fair, with excellent rate of 82% and case satisfaction rate of 87%. CONCLUSION: In order to recover maximally the shoulder joint functions for post-artificial humeral head replacement, we must try our best to avoid soft tissue damage, reserve the bone of the tuberosity, select appropriate humerus head prosthesis, perform early post-operative staging rehabilitation, as well as maintain a normal retroversion of the prosthesis.

BACKGROUND:In elderly patients with unstable intertrochanteric fracture, because of poor general condition and poor bone condition, on one hand, the internal fixation of fracture may lead to nonunion. On the other hand, patients stil need longer time in bed and hip joint fixation, and may result in complications of long-term bed rest. Artificial femoral head replacement is a safe operation mode, can solve the problem of early ambulation of patients. OBJECTIVE:To observe the repair effect of bipolar artificial femoral head replacement on unstable femoral intertrochanteric fracture in elderly patients. METHODS: A total of 39 elderly patients with unstable femoral intertrochanteric fractures, who were treated in the Department of Orthopedics, 101 Hospital of Chinese PLA from 2005 to 2014, were enroled in this study. There were 21 males and 18 females, at the age of 80-96 years old, averagely 85 years old. They al received bipolar artificial femoral head replacement. Harris score was measured to assess hip joint function at 1 year after replacement. The incidence of complications was recorded. RESULTS AND CONCLUSION:A total of 39 cases were folowed up for 1-5 years. The wound of al patients was healed in the primary stage. No cardiovascular or cerebrovascular accident appeared. Al patients passed safely through the perioperative period. No severe complications occurred. Hip joint function was assessed according to Harris score at 1 year after replacement: excelent in 13 cases, good in 20 cases, average in 4 cases, poor in 2 cases, with an excelent and good rate of 85%. No dislocation appeared. The results suggest that bipolar artificial femoral head replacement can be used to treat femoral intertrochanteric fracture in elderly patients. The postoperative recovery time was short; bleeding was less; complications were few. Hip joint function recovered wel. For elderly patients with femoral intertrochanteric fracture, bipolar artificial femoral head replacement is an ideal safe effective repair method.

BACKGROUND:Posterior hip dislocation combined with femoral head fractures easily induced femoral head necrosis, ectopic ossification, osteoarthritis and deep vein thrombosis. Different therapeutic methods should be utilized according to the type of fracture.
OBJECTIVE:To investigate the factors affecting the therapeutic effects and complications fol owing surgery of posterior hip dislocation combined with femoral head fractures.
METHODS:Twenty-eight patients, who had been diagnosed as posterior hip dislocation combined with femoral head fractures in the 101 Hospital of Chinese PLA from September 2004 to May 2010, were enrol ed in this study. According to Pipkin typing, operative approach and the time from injury to surgery, therapeutic effects were evaluated using radiographs and the recovery conditions of hip function (Epstein method), and the occurrence of complications was recorded.
RESULTS AND CONCLUSION:A total of 28 patients were fol owed up from 1 to 5 years, averagely 2.8 years. Using the Epstein method, there were excellent in 6 cases, good in 12 cases, average in 7 cases, and poor in 3 cases, with an excellent and good rate of 64%. The therapeutic effects in patients with Pipkin I and II were good, with excellent and good rates of 100%and 78%, respectively. Moreover, the complications were less, with a rate of 17%and 22%, respectively. The therapeutic effects of patients with Pipkin III and IV were poor, especial y, Pipkin IV patients, whose excellent and good rate was only 20%and the incidence of complications was 80%. No significant difference in the incidence of complications was detected in patients undergoing Smith-Peterson anterior approach and K-L posterior approach (P>0.05). No significant difference in the incidence of complications was detectable among patients from three groups (the time from fracture to operation<12 hours, 12-48 hours, and>48 hours) (P>0.05). Results indicated that the choice of treatment method should be determined by the type of fracture. The prognosis depends on the patient’s age, time of treatment, types of fracture and dislocation, methods of treatment and related measures of prevention of complications.

Objective To explore the effect of evodiamine(EV)on macrophage polarization in knee osteoarthritis(OA)rats by regulating the nuclear transcription factor-κB(NF-κB)pathway.Methods SD rats were used to establish a knee osteoarthritis model by intra-articular injection of sodium iodoacetate(MIA).They were randomly separated into model group,low-dose(6.9 mg/kg)EV group,high-dose(13.8 mg/kg)EV group,high-dose(13.8 mg/kg)EV+phorbol 12-myristate 13-acetate(PMA)(2μg/kg)group,with 10 rats in each group.Ten rats were selected as the control group,and an equal amount of normal saline was injected into the joint cavity of each rat.After EV and PMA treatment,the joint tenderness threshold,joint swelling rate,joint range of motion,and gait score of rats were measured in each group.The pathological morphology of cartilage and synovial tis-sues of rats in each group was detected by safranin O-fixed green and HE staining.Macrophage polarization in synovial tissue of rats in each group was detected by flow cytometry.The levels of pro-inflammatory factors[interleukin-6(IL-6),IL-1,and IL-1β]in the serum and synovial fluid of rats in each group were detected by ELISA.The expression levels of NF-κB pathway related proteins in rat articular cartilage and synovial tissue were detected by Western blotting.Results Compared with the control group,pathological damage of the cartilage and synovial tissue morphology in rats in the model group was more obvious,the threshold for joint tenderness and joint range of motion were reduced significantly(all P＜0.05).The joint swelling rate,synovi-al thickness,gait score,cartilage pathology score,synovial pathology score,proportion of M1 macrophages and M1/M2 ratio in synovial tissue,the levels of IL-6,IL-1,IL-1β in serum and synovial fluid,p-inhibitor of NF-κBa(p-IκB-a)/IκB-a,p-NF-κB p65/NF-κB p65 in cartilage and synovial tissue were increased significantly(all P＜0.05).Compared with the model group,the mor-phological and pathological damage to the cartilage and synovial tissues of rats in the low-dose and high-dose EV groups was re-duced,the joint range of motion and the proportion of M2 macrophages in synovial tissue were increased(all P＜0.05).The joint swelling rate,synovial thickness,gait score,cartilage pathology score,synovial pathology score,proportion of M1 macro-phages and M1/M2 ratio in synovial tissue,the levels of IL-6,IL-1,IL-1β in serum and synovial fluid,p-IκB-α/IκB-α,p-NF-κB p65/NF-κB p65 in cartilage and synovial tissue were reduced(all P＜0.05).Effect of EV increased with increasing concentra-tion.Effects of EV was inhibited in terms of the above indicators in OA rats after PMA treatment.Conclusion EV can promote polarization of M2 macrophages and inhibit polarization of M1 macrophages by blocking NF-κB signaling pathway activation,thereby reducing inflammation in knee osteoarthritis rats and improving symptoms such as joint pain,swelling,and limited mob-ility.