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BACKGROUND:Osteoarthritis animal models induced by papain are commonly used for studying osteoarthritis. OBJECTIVE:To observe the morphology of articular cartilage surface during early osteoarthritis process in rats induced by papain and L-cysteine under scanning electron microscope. METHODS:The right knees of Sprague-Dawley rats were given 0.15 mL mixed solution of 2%papain and 0.03 mol/L L-cysteine in the ratio of 2:1. The left knees were given injections of 0.15 mL 0.9%NaCl, as the control group. Another two rats (four knees) maintained untreated, as the normal control group. Al the rats were observed with scanning electron microscope at 2, 4, 6 weeks after injection, to explore the surface morphology of medial condyle of femur. RESULTS AND CONCLUSION:The condyles of normal and control groups revealed numerous shal ow pits on the surface of articular cartilage. At 2 weeks after injection, the surfaces of condyles were unsmooth, presenting the shrinkage and distortion. The thinner articular cartilage and local tiny cracks were seen at 4 weeks. The deep and great cracks and cartilage defect were observed on the surface of cartilage at 6 weeks. The time of 4-6 weeks is a reference point for establishing early osteoarthritis model in rats through injections of 2%papain and 0.03 mol/L L-cysteine.
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Objective To evaluate and compare the clinical effects of proximal femoral nail antirotation blade (PFNA) with reverse less invasive stabilization system-distal femur (LISS) in the treatment of proximal femoral fractures associated with coxa vara. Methods From June 2007 to June 2010, A retrospective study with more than 10 months follow-up of 46 patients with proximal femoral fractures associated with coxa vara underwent PFNA or reverse LISS were carried out, including 24 with PFNA and 22 patients with reverse LISS. The physical status of patient was evaluated according to the American Society of Anesthesiologists (ASA) score. After the operation, the operation duration and volume of blood loss were assessed in the two groups, respectively. At the last follow-up, full weight bearing time, fracture healing time, and neck-shaft angle discrepancy related to contralateral side without fracture of the each group were assessed, respectively.Functional recovery was evaluated according to Parker and Palmer mobility score. Results The average follow-up period was 11.2 months (range, 10-12). All the fractures healed successfully and reached bony union.There were no significant differences between PFNA group and reverse LISS group for the average ASA score, the average operating time, the average volume of intraoperative bleeding and Parker and Palmer mobility score. The patients were allowed full weight-bearing from 9.33 weeks after surgery in PFNA group and from 16.95 weeks in reverse LISS group. The patients reached bony union after 17.21 weeks after surgery in PFNA group and from 30.73 weeks in reverse LISS group. Comparing with PFNA group, neck-shaft angle discrepancy decreased in reverse LISS group. Conclusion The results of PFNA and reverse LISS in the treatment of proximal femoral fracture were satisfactory. The fracture treated by PFNA allowed earlier weight bearing. Reverse LISS could provide better support for neck-shaft angle to avoid coxa vara more effectively.
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BACKGROUND:Prosthesis selection for total hip replacement is determined by geometrical matching with femoral medullary cavity of patients and the optimal biodynamics.It is of great significance for elevating outcomes of total hip replacement.OBJECTIVE:To evaluate the biomechanics of four groups of femoral stem prostheses matched with a femar and to get a stem whose mechanics distribution is similar to the normal femur.DESIGN:Controlled observation.SETTING:Department of Orthopaedics of Oriental Hospital Affiliated to Tongji University,Department of Orthopaedics of Changhai Hospital of Second Military Medical University of Chinese PLA,and Department of Mechanical and Power Engineering of Shanghai Jiao Tong University.MATERIALS:Experiments were performed at the Laboratory of Life Quality and Machinery Engineering of Department of Mechanical and Power Engineering of Shanghai Jiao Tong University from December 2004 to October 2005.A male volunteer aged 40 years with the normal proximal ferout(175 cm height and 78 kg weight),free from hip disease,were selected.X-ray image of the eutopic femar was shot and wrote into memory in the format of DICOM.The volunteer signed an infonned consent.The experiment was approved by Hospital Ethical Committee.No.Ⅰ prosthesis,Zimmer versys Fiber Metal Taperl 1#,No.Ⅱ prosthesis,Plus APL 2#,No.Ⅲ prosthesis,Welink Ribbed system cementless01#,and No.Ⅳprosthesis,Lima F2L 1# were used in this study.METHODS:The ezDICOM software was used to read files with DICOM format of femoral X-ray image,which was converted into files with bmp format.The image files with bmp format of the proximal femar X ray were introduced with Matlab software after regulation,and the two-dimensional contour data of femar were extracted.Prosthesis matched with the template was set in PhotoShop 7.0 software.The two-dimensional contour data of prosthetic femar were extracted in MATLAB software.The ANSYS software was used to establish the model of geometrical and two-dimensional nonlinearity finite element ncluding femur and femur-femoral stem.Stress distribution in the proximal femur was analyzed and compared by loading.MAIN OUTCOME MEASURES:Stress istribution of the proximal femur.RESULTS:Stress value and distribution of No.Ⅰ prosthesis and No.Ⅳ prosthesis in proximal femur were similar to the normal femar.Moreover,No.Ⅰ prosthesis was better than No.Ⅳ prosthesis.CONCLUSION:The biomechanics of femoral stem prostheses has been evaluated by analyzing and comparing the two-dimensional biomechanics of the femoral stem prostheses based on X-ray and template,which can offer support in optimal rosthesis selection.
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[Objective]To explore the treatment of intertrochanteric fracture with expandable proximal femoral nail and prevention and cure of some related complications.[Method]Fifty-eight cases of closed intertrochanteric fracture,including 28 male cases and 30 female,average 73.2 years old(range from 42 to 88)accepted treatment.The type of fracture according to Evans classification:5 cases were type Ⅰ,7 were type Ⅱ,28 were type Ⅲ,13 were type Ⅳ,and 5 were type Ⅴ.All cases were treated with expandable proximal femoral intramedullary nail after close reduction.[Result]Thirty-eight cases were followed up,from 12 to 36 months,average 18.5 months,all of the cases got clinical healing after 8-10 weeks postoperatively.Hip Harris score average was 91.8.Some complications occurred in 6 cases:1 case had secondary fracture nearby the greater trochanter needling insertion point,1 case femoral head peg was outside of the lock hole,and 1 case femoral head peg tip was broken during operation.And after operation,1 case had coxa vara deformation,1 case had femoral middle and superior segment fracture,and 1 case femoral head peg was exited.[Conclusion]Expandable proximal femoral intramedullary nail has some advantages as:minimal invasive,manipulation convenient,fixation reliability,remove easily,but surgeons must be familiar with the construction and fixation principle of the nail in the primary stage,and perform the operating instruction strictly,to reduce or avoid the complications occurrence because of mis-manipulation.
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[Objective]To investigate the restoration of the axial alignment of the lower extremity during operation for fracture of tibia plateau and to assess the curative effect.[Method]A retrospective analysis of 45 cases of fracture of tibial plateau were conducted from May 2000 to June 2005,25 male cases and 20 female,mean age were 45.3.The type of fracture:3 cases were Schatzker I,10 were type Ⅰ,19 were type Ⅲ,6 were type Ⅳ,5 were type Ⅴ,2 were type Ⅵ.All cases were treated with open reduction,bone graft and internal-fixation with plate and screw under arthroscopy-assisted,and the normal axial alignment of the lower extremity was restored.The restoration standard was in accordance with the uninjured side limb.The way of measurement:the axial line from anterior superior iliac to interdigit of the first and second toe was done,then,the perpendicular distance from the center of patella to this line was calculated,and compared the data with uninjured side limb's.[Result]Forty cases were followed up,from 6 months to 24 months,average 15 months,according to the Rasmussen knee score standard,24 were excellent,11 were good,3 were fair and 2 were poor.The satisfactory rate was 87.5%,the restoration of knee function were close correlated with whether the line normal or not,there were abnormal lines recurrence in some cases,the main causes were:(1)Meniscus to be cut excessive to the loading redistribution in joint;(2)The reduced articular surface collapsed,again due to the affected limb weight loading too early;(3)Fractures were too complicated to be compress fixed with common buttress plate,resulted in displace fracture.[Conclusion]It is very important that the axial alignment of the lower extremity to be corrected during operation to the injured knee function restoration after operation,and the causes result in the axial line abnormal above-mentioned should be considered thoroughly,at the same time,the corresponding measures should be taken.
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Objective To investigate the clinical application and therapeutic effect of reservation cortical expand resection and reconstruction for extremities bone tumor. Method Twelve cases with extremities invasion bone tumor were reviewed,including 6 male and 6 female.The average age was 37.1 years old.According to the MRI,TypeⅠtumor located in metaphysic and growth eccentricity,and was treated with outside tumor osteotomy with reservation of one side as integumentale,the cut line was shape of "匚".Type Ⅱ tumor was with invasion part articular surface,and was operated with part joint osteotomy with reservation of one side as integumentale,the cut line was shape of"L".Type Ⅲ was with invasion total joint surface and as integmentale,all tumor segment including joint could be cut,but the shape of cut close to the diaphysis was echelonment. Result The operation time was 1~3 h,the operative bleeding quantity were 150~400 ml,all incisions were obtained primary healing.Twelve cases were followed up from 6 months to 8 years.The average extremity functional score according to the system of ISOLS(International Society of Limb Salvage):upper extremity was 22.3 and the lower was 25.3 The average bone healing time of returned deactivation bone graft and bone allograft healing with the osteotomy plane was 3 months,original tumor recurrence in local was 1,the recurrence rate was 7.69%,no malignant change and metabasis was found. Conclusion The reservation cortical expand resection and reconstruction could increase the treatment effect of extremities bone tumor,it is key to decrease the recurrence with strict indication,non-neoplasma and aseptic technique.Tumor shell and osteotomy plane should be deactivated thoroughly.
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Objective To analyze the causes of postoperative step off of the tibial plateau fracture and to suggest strategies to cope with them. Methods 57 cases of tibial plateau fracture who had been treated operatively in our department from January 2001 to June 2003 with satisfactory reduction of the articular surface were reviewed. Their radiograms were analyzed. Results The follow ups lasted 6 to 30 months (average 15 months). Postoperative step off rate was 28.1%in all the cases according to radiological step off criteria. (A depression of the articular surface more than 3 millimeters or malalignment of the extremity more than 5 degrees is considered as step off.). Six causes of loss of reduction were: 1) more than sixty years of age, 2) severe osteoporosis, 3) preoperative displacement and fracture fragmentation, 4) poor anti shearing strength of screw and plate, 5) loose bonegraft, and 6) premature weight bearing. Conclusions The key points to enhance the outcome include precise judgment of the type of fracture, sufficient amount of bonegraft, rigid internal fixation after anatomic reduction and an appropriate plan for performing early, loadless, functional exercise. The traumatic osteoarthritis may be avoided or deferred if the above mentioned six causes can be taken into full consideration or preventive measures can be taken.
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Objective To explore the incidence of tibial plateau fracture with ligament injuries and the early diagnosis and management of the condition. Methods Fifty seven cases of tibial plateau fractures which had been treated operatively from Jan. 2001 to Jun.2003 and had satisfactory reduction of the articular surface were reviewed. The stability of their knee joints was analyzed. Results The follow up lasted 6 to 30 months with an average of 15 months. The incidence of knee unstability was low. The four potential reasons for the postoperative knee stability were found to be: 1) the low prevalence of ligament injury with displaced fractures of tibial plateau; 2) incomplete ligament disruption or mild ligament injury; 3) anatomic reduction and rigid internal fixation; 4) fine and detailed plan for immobilization and functional exercise. Conclusion The prevalence of complete ligament disruption is low, and nonoperative management can result in satisfactory outcomes for tibial plateau fracture with incomplete ligament injury.
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Objective:To obtain 29 anatomic parameters of normal Chinese proximal femur through CT 3D reconstruction so as to provide anatomical references for hip prosthesis selection and design. Methods:Bilateral proximal femurs of 82 normal Chinese were scanned by CT and visualized by CT 3D reconstruction. The parameters of proximal femur were measured by medical imaging analysis software and compared with the existing references. Results: The shape and size of proximal femoral medullary cavity had obvious individual diversities. All morphologic parameters of the proximal femur was close to a normal distribution with no marked difference between left and right side. Neck shaft angle was negatively correlated with offset; the femoral head diameter had a strong correlation with femoral neck diameter, femoral head height, distance between femoral head tip to great trochanter, and distance between apex of femur anterior arch to less trochanter section. The offset and neck-shaft angle were significantly different between Chinese and Caucasian(P