Bouche decompression and implantation of acellular tissue engineered bone with titanium rods for treating early necrosis of the femoral head / 中国组织工程研究

BACKGROUND: For the Ficat Ⅱ of femoral head necrosis especially with osteoporosis, core decompression with or without acellular tissue engineered bone can result in a higher incidence of femoral head collapse. OBJECTIVE: To analyze the clinical effect of core decompression plus implantation of acellular tissue engineered bone with titanium rods in the treatment of early necrosis of the femoral head. METHODS: Thirty-five hospitalized patients with early necrosis of the femoral head (40 hips) were enrolled in the study and assigned into a observation group (15 cases with 20 hips, including 10 hips of Ficat I, 10 hips of Ficat Ⅱ) and a control group (20 cases with 20 hips, including 11 hips of Ficat Ⅰ, 9 hips of Ficat Ⅱ). Core decompression plus implantation of acellular tissue engineered bone with titanium rods were conducted in the observation group, while Bouche decompression with implantation of acellular tissue engineered bone was done in the control group. All the patients were followed up for 1 year. Visual analogue scale (VAS) score, Harris hip function score, and progression in necrosis of the femoral head were compared between two groups. RESULTS AND CONCLUSION: VAS scores and Harris scores at 1-year follow-up in both groups showed better outcomes (P ＜ 0.001). At the end of 1-year follow-up visit, the Harris score was significantly higher in the observation group than the control group (P＜0.05), while there was no difference in the mean VAS scores between the two groups (P ＞ 0.05). For Ficat II patients, the excellent/good rate in the observation group was higher than that in the control group at the last follow-up (80% vs. 40%, P＜0.05). According to the Ficat staging, the effective rate in the observation group was higher than that in the control group (90% vs. 80%, P＜0.05). During the postoperative 1-year follow-up visit, Ficat Ⅰ patients presented with better repair of lesions, no degeneration of the hip joint, and no subchondral bone collapse. Overall, it is an effective treatment for early necrosis of the femoral head by core decompression plus implantation of acellular tissue engineered bone with or without titanium rods; however, co-implantation with titanium robs can show better short-term outcomes.

Feasibility and clinical application of design about the hollowed titanium stick supporting the femoral head and preventing it from collapsing / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the feasibility and the clinical practicality of the design about the hollowed titanium stick supporting the femoral head and preventing it from collapsing.</p><p><b>METHODS</b>From Jan.2003 to Jun.2007, 36 patients (46 hips) diagnosed as cystis degeneration of the femoral head were treated by surgical operation, including 20 males and 16 females with an average age of 40 years ranging from 18 to 56 years old, and the course of the disease was from 10 to 24 months (16 months on average). According to ARCO staging,there were 24 patients (34 hips) in NFH II, of which 11 hips were II a stage, 13 hips were II b stage and 10 hips were II c stage; there were 6 patients diagnosed as osteofibrous,4 patients as simple bone cyst and 2 patients as chondromyxoid fibroma. Under X-ray the percutaneous narrow core decompression and focus infection elimination were performed and supported the sclerotin under the cartilage with titanium stick. The patients were followed-up at the first, third, sixth, twelfth, twenty-fourth and thirty-sixth month after the operation. The clinical evaluation was done by X-ray and the indexes included stable, unstable and abortive. The data was analyzed by Fisher exact probility and the suviaval rate was analyzed by Kaplan-Meier suviaval curve using statistical soft ware SPSS13.5.</p><p><b>RESULTS</b>There were no unstable or failure cases on each period from the 1st month to the 12th month after the operation, indicating that the supporting effect of the titanium stick was exact during 12 months after the operation. There were unstable and failure cases from the 12th month to the 24th month after the operation, which were mainly in stage NFH II c but the comparision of the stable rate in this period and 12 months after the operation had no obvious statistical differences (P>0.05) indicating that the supporting effect of the titanium stick was feasible during the stage. One of the unstable cases deteriorated and failed but there were no new unstable cases, both the stable rate and the unstable rate had no change and the failure rate rose on the 36th month after the operation. The compar- ision of the stable rate on each period after the operation had no obvious difference (P=0.197>0.05), which indicated that the supporting effect of the titanium stick was persistent. By the difference of the etiology the three-year survival rate of the relevant NFH II c pathological changes was the lowest-70% and the survival rate of the pathological changes induced by other etiological factors was 90.2%.</p><p><b>CONCLUSION</b>The design about the hollowed titanium stick supporting the collapsed femoral head is feasible. Using the hollowed titanium stick to support the femoral head and prevent it from collapsing is pragmatic in the clinical and the effect is positive, however, when it comes to the NFH II c pathological changes, the choice should be made discreetly.</p>

Investigation on the curative effect of brucellar spondyfitis / 中国地方病学杂志

Objective To investigate the curative effect of brucellar spondylitis,so as to provide scientific proof for improving the curative level of the disease.Methods Epidemiological information was collected from 113 patients diagnosed as brucellar spondylitis,who were divided into 5 groups according to different drugs and drug combinations of doxycycline,gentamicin,sulfamethoxazole and rifampicin.Then the curative effect was investigated.Twenty-one patients who had greater paoas muscle abscess or Para vertebral abscess,intraspinal abscess of spinal canal,necrotic intervertebral disk and major osteolasia received the minimal invasive surgery and the focus removal surgery.Results The occurrence of the disease in female was much higher than that in male.Grazing and breeding beasts was the principal route of infection.Lumbars was mostly involved.they usually was infected in the adjacent 2 piece.L4 was the most common and seriuous one.The curative effect of doxycycline group was better than that without doxycycline(72.60% vs 35.00%,X2=15.14,P＜0.05).Doxycyeline+gentamicin+sulfamethoxazole was reeommended as the first choice.However,the curative effect did not increase despi~course of the treatment prolonged.The heMing rate and effective rate after 1 course was 52.21%(59/113)and 92.04%(104/113).that after 2 courses 58.41%(66/113)and 95.58%(108/113),that after 3 courses 59.29%(67/113)and 95.58%(108/113).The healing rate in different course did not present differences(P＞0.05).21 patients undergoing surgery were followed-up,12 patients were after 2 years and 9 patients were between 1-2 years.The healing rate was 95.24%(20/21),1 case was healed basically,the effective rate was 100%.None reoccurred.Conclusions There are characterized features in clinical epidemiology of the brucell spondylitis.Long term,adequate in dosage,combination and multi-approach use of antibiotics is the most reliable way to treat and prevent it from recurring.But fof the patients soitable for surgery.the minimal invasive surgery or the focus removal could shorten the course of therapy,decrease the complications and increase the cure rate.