A computer-based online search was conducted in PUMMED, English Medical Current Contents (EMCC), China Journal Full-text Database (CJFD), and Wanfang Database to summarize application and research progress of large-diameter femoral head hip prosthesis from January 1995 to January 2008. There were 62 literatures in total. Previous studies reported that when diameter of femoral head hip prosthesis was>32mm, joint worn out remarkably. During recent years, more and more basic and clinical researches demonstrate that diameter of femoral head is not correlated with wear rate; in particular, diameter of femoral head is not related to wear rate of artificial joint made by high cross linked polyethylene, metal, and ceramics. The superiority of large-diameter femoral head hip prosthesis has been paid more attention because of stability and activity. With the enlargement of diameter of femoral head, dislocated incidence decreases remarkably, and improvement of head-neck ratio increases the activity of prosthesis and reduces collision between two prostheses. Recently, large-diameter femoral head hip prosthesis has been widely applied for metal-on-mental hip joint, in particular, for hip resurfacing arthroplasty; in addition, large-diameter femoral head hip prosthesis plays a distinct role in joint replacement.

Because of their ability to inhibit osteoclast-mediated bone destruction,bisphosphonates are widely used in the treatment of malignant bone diseases.Recent preclinical evidence shows that bisphosphonates not only exert direct anti-tumor effects but also have anti-angiogenic properties.And furthermore,they may act synergistically with other chemotherapeutics or T cells on tumors.These new findings are ushering in the possible application of bisphosphonates as anti-tumor therapeutics in clinical practice.

[Objective]To discuss the surgical treatment of huge tumor invovled sacrum.[Method]A review of records in 18 patients with tumors invovled sacrum was made.Age at surgery averaged 43 years(range:31~65),eleven patients were male,seven patients were female.In this series,malignant tumor was in 14 cases,according to Enneking classification,these cases were classified toⅠA~ⅠB subtypies,which concluded chordoma(8 cases),giant cell tumor(5 cases)and osteochondroma(1 case).Benign tumor was in 4 cases with neurogenic tumor(3 cases)and aneurysmal bone cyst(1 cases).[Result]Over all,no patients were dead in the operation,no other major complications were occurred,the blood loss during surgery was 1 000 ml to 5 000 ml.All incisional wound were primary healing except 4 cases,two of them gained secondary closure after gluteus maximus pushing flap.Eighteen patients gained follow-up visiting,the average time of follow-up was 30 months,only 2 cases were tumor recurrence.[Conclusion]Huge tumors invovled sacrum present a great challenge,because of many organs surrounding sacrum invovled and complexity in anatomic region,sacrectomy of sacral tumor always complic generous blood loss,disorder of urination and defecation,disorder of sexual function et al.Abdominosacral approach can lead to a safer and relative radical local control of tumor,it is benefit to protect blood vessel and nerves.

[Objective]To investigate the operation indications and techniques of the ISOLA spinal system in reconstruction of the lumber-pelvis continuity after resection of high-level sacral tumors. [Method]A retrospective study was performed in 43 patients with high-level sacral tumor (HLST) between July 2001 to January 2007. Symptoms, signs, histological findings of the tumors and their outcomes were analyzed. All patients underwent resection of HLST and spinopelvic reconstruction with ISOLA spinal system,11 unilateral and 32 bilateral.[Result]Among the 43 patients, 33(77.1%)had chordoma, giant cell tumor of bone and neurogenic tumors. Thirty-four patients alive were followed-up for an average of 35 months(12~62 months), 5 patients had a recurrence of chordoma and 29 patients with HLST were under control. The pain originated from the lumbosacral joint and the spinal nerve root was obviously relieved.The patients could stand and ambulate normally. No loose screw or broken rod were found.X-rays showed no signs of the enlarged screw canal or lowered lumbar spine.The effect was 76.5%(26/34) excellent judged by the ISOLS system.[Conclusion]Spinopelvic reconstruction by ISOLA system after resection of HLST is characterized by easy manipulation, less complications and instant stable fixation. It may be widely used in the clinical practice.

[Objective] To explore the possible interest of therapeutic approaches including nitrogen-containing biphosphonate zoledronic acid using osteosarcoma cell lines MG63,and to investigate whether there is a synergism between zoledronic acid and methotrexate.[Method]Zoledronic acid alone or combined with methotrexate was used to treat human ostoesarcoma cells line MG63.The cell growth inhibition was assessed by MTT.[Result]There was a dose-dependent and time-dependent(1-100?mol/L)inhibition of cell proliferation by zoledronic acid.IC50 value of zoledronic acid for therapy of MG63 after 72h was 9.39 ?mol/L.The cell growth inhibition rates of MG63 at 72 h was 48.95% in zoledronic acid(10 ?mol/L)group,and 37.68%,45.93% and 52.42% in methotrexate groups MTX(1,10 and 100 mg/L).When combined treatment of zoledronic acid(10?mol/L)and methotrexate(1,10 and 100 mg/L)was used,the cell growth inhibition rates were 51.96%,66.77% and 69.23%,respectively.The combination of zoledronic acid and methotrexate demonstrated a synergistic effect.The differences were significant(P

[Objective]Extracellular signal-activated kinases(ERK),c-Jun N-terminal kinase(JNK) and P38 signal transduction pathway were three members of the MAPK family which mediated cellular proliferation,differentiation and apoptosis.The purpose of this study was to investigate the effects of ERK,JNK and P38 MAPK on pathogenesis and progression of human osteosarcoma.[Method]EnVisionTM immunohistochemical technique was used to detect the expressions of ERK,JNK and P38 protein among the 48 osteosarcoma and 25 osteoblastic benign tumor samples,and their differences were compared.[Result]The positive rates of ERK,JNK and P38 protein were 83.3%(40/48),72.9%(35/48) and 85.4%(41/48) respectively in 48 osteosarcoma,and 16.0%(4/25),12.0%(3/25) and 20.0%(5/25) in 14 osteoblastic benign tumor,the statistical analysis of the positive rates were performed using analysis of variance with P

Objective To evaluate the surgical procedures and clinical efficacy of endoprosthetic replacement as a salvage procedure for intertrochanteric fracture suffered failure of internal fixation.Methods The study involved 18 intertrochanteric fracture patients that suffered failed internal fixation from 2001 to 2009,including 16 patients with failed dynamic hip screw (DHS) fixation and two with failed proximal femoral nail anti-rotation (PFNA).The patients were at mean age of 76.5 years (range,58-92 years).The treatment methods included total hip arthroplasty in five patients and the bipolar hemiarthroplasty in 13.Harris score was used to evaluate the function outcome during the follow-up.Results The mean operation time lasted for 115 minutes,with intraoperative blood loss of 500 ml.Two patients presented with intraoperative complications.Of all the patients,three patients died within three months after operation and three patients were lost to follow-up.The remaining 12 patients received complete follow-up for a mean of 2.3 years ( range,1-7 years).One patient with hip joint dislocation was treated with closed reduction and distraction for three weeks.At the latest follow-up,the pain disappeared or was reduced in all the patients,including two patients with moderate pain and four with mild pain after some movements.The average Harris score was increased from preoperative 34 points to 83 points at one year after operation.Conclusions Endoprosthetic replacement is an effective salvage procedure for the failed treatment of the intertrochanteric fracture,as it can attain satisfactory pain relief and functional improvement.

Objective To compare the clinical effects of patellar resurfacing with patella reservation and patellaplasty in the total knee arthroplasty(TKA)for osteoarthritis so as to discuss appropriate management of patellas in TKA.Methods A retrospective study was conducted on 198 patients with osteoarthritis treated by TKA from January 2002 to December 2008.There were 62 patients managed by patellaplasty(patellaplasty group)and 136 patients by patellar resurfacing with patella reservation(patellar resurfacing group).The osteophytes of the patella were removed to make the articular surface of patellas similar to the primary one.Knee Society Score(KSS),Bristol patellar score,satisfaction survey and evaluation of joint range of motion(ROM)were performed during the regular follow-up.Incidence of postoperative anterior knee pain were analyzed and X-ray films were reviewed to understand the condition of the implants.Results A total of 125 patients were followed up,including 43 patients from the patellaplasty group and 82 from the patellar resurfacing group.The mean follow-up period was 51 months(range,36-80 months).Both groups showed significant improvement of each score postoperatively.No significant differences were found between the two groups regarding KSS score,patellar score and patient satisfaction in the follow-up one year later;but KSS function score in the patellar resurfacing group was superior to that in the patellaplasty group,with statistical difference.The incidence of anterior knee pain of the two groups had no statistical significance.Postoperative radiographs revealed no significant differences between the two groups concerning patellofemoral congruence,incidence of postoperative anterior knee pain or incidence of patellar related complications.Conclusion Patellar resurfacing with patella reservation for osteoarthritis in TKA can achieve satisfactory patellofemoral congruence and low incidence of intraoperative anterior knee pain,with comparable mid-term results with patellaplasty.

BACKGROUND: There are disputes concerning limb salvage and reconstruction in treating pelvis malignant tumor.OBJECTIVE: To study the surgical treatment following resection of tumor at acetabular region in order to restore pelvic stability with less damage or recurrence.METHODS: Thirty-three patients diagnosed with pelvic tumor at Department of Orthopaedics, First Affiliated Hospital of Second Military Medical University from April 2002 to June 2008 were selected. All patients were received tumor resection and computer-aided prosthetic replacement, 18 patients (8 cases with chondrosarcoma, 2 cases with Ewing sarcoma, 2 cases with osteosarcoma, and 6 cases with malignant fibrous histiocytoma) were combined with antitumor drug treatment. Functional assessment of therapeutic efficacy was divided into 4 levels: excellent, good, moderate, and inferior.RESULTS AND CONCLUSION: Two patients died at months 4 and 6 after prosthetic replacement; 31 cases were followed-up for 8-32 months, mean 12.5 months. Seven cases were recurred chondrosarcoma, the recovery of other patients were as follow: 18 cases were excellent, 4 cases were good, 2 cases were moderate and no case was inferior. Most of limb function and pelvic stability was preserved. The results suggested that malignant fibrous histiocytoma and Ewing sarcoma can receive a high rate of limb preservation if treated by effective chemotherapy with low recurrence; the recurrence of chondrosarcoma was high. Tumor resection combined with computer-aided prosthetic replacement can maximatily reserve limb function and raise life quality.

Objective To investigate the surgical indication,approach,resection methods and complications of total sacrectomy via posterior approach for primary malignant sacral tumors involving high level (S1,S2).Methods 5 cases of primary malignant sacral tumors treated by total sacrectomy via posterior approach and iliolumbar reconstruction from March 2010 to March 2011 were analyzed retrospectively.There were 3 males and 2 females.The mean age was 41,ranging from 32 to 55.The imageology examination showed osteolytic destruction,among which there were 4 cases of obvious soft tissue mass,1 case of obvious sacral foramina expansion with bone damage.MRI showed 1 case of the tumors in S1-S5,1 case of the tumors in S1 、S2,1 case of the tumors in S1-S3.The smallest tumor was 9.2 cm×7.6 cm×4.1 cm,while the largest was 22.0 cm× 19.0 cm× 16.0 cm.Preoperative TTNB were done on the 5 patients.Pathological diagnosis:2 cases of chordoma,1 case of malignant neurilemmoma,1 case of chondrosarcoma and 1 case of malignant hemangioendothelioma.5 patients had sacrococcygeal pain or lumbocrural pain before the surgery.Visual analogue scale (VAS):2 cases of 2,2 cases of 6 and 1 case of 8.Ilium stability reconstructions were all performed on 5 patients with spine pedicle screw-rod system.Results The mean operation time was 6.5 hours (range,4.5-11 hours),with the mean intraoperative blood loss of 3 700 ml (range,2 000-7 200 ml).There was no perioperative death.The mean follow-up time was 17 months (range,9-23 months).There were 2 cases of wound complications 2 weeks after surgery and healed by second intention with washing and drainage after debridement.There was no deep infection.1 case of rectal injury,which was performed with colostomy during the operation,and stoma returned 12 weeks after surgery.4 cases of sciatic nerve symptom of lower limbs and plantar flexion dyskinesia after bilateral S1 nerve roots resection.The patients walked with ankle brace fixed after the surgery.There was 1 case of implant breakage and no obvious spine down.5 patients had functional disability in sphincter after surgery.1 case of hemangioendothelioma recurred locally 9 months later.Local radiotherapy was performed since there was no reoperation indication.The patient is currently on the 13th month follow-up and survives with tumors.Compared with combined approach,the selection of posterior approach alone has relatively strict surgery indications.Conclusion Total sacrectomy via posterior approach is an effective way to treat the primary high-level malignant sacral tumors.The good surgical resection boundary is important to achieve the good oncology prognosis.The occurrence rate of postoperative complication is high,which has great influence on patients' postoperative neurological function.