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Objective To introduce a new method for preparation of bioactive β-tricalcium phosphate (β-TCP) by rapid stem cell screen-and-enrich-and-combine circulating system (SECCS) and evaluate its efficacy in the treatment of fresh fractures and bone defects.Methods Twenty-two patients with fresh fracture and bone defects were treated with SECCS from July 2013 to April 2016.They were 16 males and 6 females with an average age of 52.2 years (from 27 to 81 years).There were 15 tibial plateau fractures and 7 calcaneal fractures.The average size of bone defects was 12.5 mL.Bioactive β-TCP was prepared by SECCS intraoperatively and implanted back immediately into the bone defects.Radiographic examination,Lysholm knee scoring and Maryland foot scoring were used for assessment of curative efficacy.Results The 22 patients were followed up for an average of 25.7 months (from 12 to 46 months).By SECCS,the enrichment efficiency of bone marrow stromal cells (BMSCs) reached up to 82.4％ and the cell viability was not affected.The tibial plateau fractures were re-transplanted with 13,381.3 BMSCs on average and healed after an average of 8.9 weeks (from 6 to 15 weeks).The Lysholm knee scores at one year postoperatively averaged 93.6 points (from 84 to 100 points),yielding 10 excellent cases,4 good cases and one fair case.The calcaneal fractures were implanted back with 16,677.7 BMSCs on average and healed after an average of 9.4 weeks (from 8 to 13 weeks).The average Maryland foot score at one year after operation was 93.6 points (from 85 to 98 points),yielding 6 excellent cases and one good case.Conclusion Bioactive materials prepared by SECCS are good bone grafts for fresh fractures and bone defects.
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Objective To evaluate the validity and security of our self-designed bone marrow stem cell Screen-Enrich-Combine(-Biomaterials) Circulating System(SECCS) for bone non-union of limbs. Methods From May 2013 to December 2015, 24 patients with limb non-union were treated at our de-partment. They were aged from 20 to 65 years (mean, 42.8 years). Their non-union involved femur in 17 cases, tibia in 4, radius in one, humerus in one and fibula in one. In surgery, 80 mL bone marrow blood was aspirated from the anterior superior iliac spine for rapid preparation of bone substitute(β-TCP)composite with bone marrow stem cells by SECCS which was then implanted at the non-union locations. The bone marrow blood was collected before and after enrichment for stem cell counts. The bone union, clinical union time and related com-plications were evaluated by follow-up X-rays at 1, 3, 6 and 9 months after surgery. Results Each collection of bone marrow blood took 13.5 minutes on average. The enrichment rate of stem cells was 81.2%. 11,751 ± 1,011 stem cells were implanted per patient on average. All the patients were followed up for 9 to 48 months (mean, 19.2 months). Twenty-two patients acquired clinical union 9 months after operation and the other 2 suffered from malunion due to insufficient bone implant, yielding a union rate of 91.6% and an average union time of 6.5 months. No graft infection or internal fixation failure occurred and no severe complications hap-pened at the donor or implant sites.Conclusion The bioactive bone substitute manufactured by our self-designed SECCS can be used as a novel therapy for limb non-union, and this device is moreover charac-terized with convenience, limited invasion and satisfactory osteogenesis so that complications of autologous bone transplantation can be avoided.
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Objective To evaluate the efficiency of our self-designed enriched filtrator of stem cells in screening and collecting enriched human bone marrow stem cells (BMSCs) for rapid construction of bioactive materials.Methods Bone marrow blood from 32 patients was circulated in our self-designed enriched filtratorand filtered through beta-tricalcium phosphate(β-TCP).The numbers of BMSCs were counted pre-and post-filtration to assess the enrichment efficiency.The numbers of nucleated cells,red blood cells and platelets were compared pre-and post-filtration to assess the effects of the enriched filtrator of stem cells on blood cells.Bacteriological examinations were performed to test the safety of the device.Scanning electron microscopy was carried out to observe the adhesion of BMSCs on β-TCP.Results There was a significant difference between the pre-fihration colony number of BMSCs cultured (232.8 ± 128.6/mL) and the post-filtration one (37.8 ± 34.9/mL) (t =10.743,P ＜ 0.001).The efficiency of BMSCs enrichment of the device was 85.6％ ±8.4％ (from 63.8％ to 97.1％).There were no significant differences between pre-filtration and post-filtration in the numbers of nucleated cells [(16.8 ± 5.4) × 109/mL versus (16.3 ±5.0) ×l09/mL],red blood cells [(3.9±0.6) ×1012/mL versus (3.8±0.6) ×1012/mL] and platelets [(120.4 ± 54.6) × 109/mL versus (123.0 ± 51.8) × 109/mL] (P ＞ 0.05).All the bacteriological examinations of the bone marrow samples were negative.After in vitro osteogenic induction culture,formation of numerous BMSCs colonies was observed on the β-TCP by scanning electron microscopy.Conclusion Since our self-designed enriched filtrator can efficiently collect enriched BMSCs and combine them with β-TCP simultaneously,the device is capable of rapid and safe construction of bioactive materials.
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This review summarized some hot research fields in pharmacological effects of sinomenine such as anti-inflammatory, immunosuppressive, and anti-tumor effects. In addition to our exploration of its antinociceptive effect, we summarized above-mentioned pharmacological effects of sinomenine and its underly-ing mechanism, in order to provide an evidence for its clinical use.
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Objective To investigate the clinical value of proximal femoral nail antirotation ( PFNA) in treatment of intertrochanteric fractures.Methods From April 2007 to July 2009,112 patients with intertrochanteric fractures were treated by using PFNA.There were 34 males and 78 females,at mean age of 76 years.Of all,80 patients were with type 31-A2 fracture and 32 with type 31-A3 fractures according to AO classification.According to Singh index classification,there were 4 patients at grade Ⅰ,21 at grade Ⅱ,70 at grade Ⅲ and 15 at grade Ⅳ.The fracture was caused by low-energy injury in 97 patients and by high-energy injury in 15.The Salvati-Wilson score was used to evaluate the hip function postoperatively.Results Ninety patients received 12-24 months follow-up (average 18.6 months).The Salvati-Wilson score was (29.98 ± 5.18 ) points.The result was excellent in 41 patients,good in 40,fair in 6 and poor in 3,with excellenct rate of 90％.The introduction of the nail in operation was difficult in 22 patients,of which 3 patients suffered femoral cortex rupture.Displacement or separation of the fracture segments occurred in 34 patients and distal locking difficulty in nine during the screw blade tapping process.Local complications included hip pain in 21 patients,thigh pain in 4,apparent coxa vara in 2 and delayed healing in 7.There were no cutting-out or femoral shaft fractures no matter what type of Singh index was.The systemic complications included cardiovascular and cerebrovascular disease in one patient,pulmonary infection in four,deep vein embolism in one and perineum congestion or swelling in seventeen.Conclusion PFNA is effective in treating intertrochanteric fractures especially osteoporotic fractures,but delayed healing of the fractures and the mismatch between the intramedullary nail and the proximal femoral morphology remain to be addressed.
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Objective To evaluate the clinical outcome of total hip arthroplasty (THA) for protrusio acetabuli. Methods Between 2003 to 2008, 31 patients(35 hips) with protrusio acetabuli were treated with THA, including 16 males (18 hips) and 15 females (17 hips). The age ranged from 36 to 71 years (average age 52.2 years). The femoral heads were moved out with retrograde method when necessary via posterior-lateral hip incision. The acetabular loops and bottoms were prepared respectively. Auto-bone grafting was used to repair acetabular defects and cementless prostheses were planted with press-fit skills. At follow-up visit,the hip functions were evaluated by Harris score. The loosening, re-protrusion and the union of graft bone was judged by X-ray. Results The mean follow-up was 46.5 months (19-152 months). One patient developed DVT on the second day post-operatively who recovered well after anticoagulation treatment. One patient complained of gentle thigh pain which disappeared at 6 months. No other complication was found. The mean Harris scores had improved from 48.9±6.5 pre-operatively to 91.2±5.7 post-operatively. All prostheses acquired bone stabilization with no sign of loosening and re-protrusion and the grafts bone were healed at a mean 6 months according to X-ray. Conclusion THA with acetabular bone grafting and cementless component for protrusio acetabuli have acquired excellent results and prevented loosening and re-protrusio effectively.
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[Objective]To investigate the method of distal fractures of radius and ulna in children treated with minimal invasive technique.[Method] From 2003 to 2005,titanium elastic nail using descending technique was carried out on 15 children.The mean age was 7.4 years,all of them had been followed up from 4 month to 2 years.[Result]One case had cortex perforation,1 case had soft-tissue irritation at nail insertion.All patients were pain-free,without limitations in activities for daily life after treatment.[Conclusion] Using minimal invasive descending technique,tianium elastic nail is appropriate therapy for distal 1/3 fractures of radius and ulna in children.
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Nonunion is cessation of normal reparative sequence of fracture healing. With an incidence of about 5%to 10%, it is one of the difficult problems in orthopaedics. Definition, classification and location of nonunion are reviewed in this article. Causes of nonunion are analyzed. Traditional and modern treatment methods of nonunion are introduced systemically.
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Objective To summarize the experience in CAD / CAM custom-made hemipelvic prosthesis and its application in 8 patients. Methods The exact model of pelvis was generated with its CT data by Rapid Prototyping Technique (RPT). Simulated bone resection and prosthesis design were performed on the models. The prosthesis should be fixed simultaneously on the contralateral pubic ramus (or the remainder of pubis), the joint facet of sacrum (or the remainder of ilium) and on the remained ischium if part of it could be preserved. When prosthesis was put in place, the acetabular component should be symmetric with the contralateral acetabulum in terms of the height, lateral distance and abduction angle, after it's fixation on the remained pelvis with cancellous screws, bolts and hooks, conventional total hip implants with cemented acetabular and cementless femoral prothesis were implanted. 8 patients underwent this kind of procedure, of them 7 suffered from large pelvic tumor, including 2 chondrosarcoma, 3 giant cell tumors, 1 cartilaginous fibrodysplasia and 1 metastasis. One patient received this procedure for severe osteolysis after THA. Tumor artery embolization was done in 6 of them 24-48 h before operation. Results Blood transfusion was 4971 ml in average. The implantation of prosthesis was easily accessible. One suffered from remained sinus, and healed after myocutaneous flap transferring. All patients began non-weight bearing walk with double crutches 6 weeks after operation and gradually abandoned crutches in 3 months. One patient with chondrosarcoma died of lung metastasis 9 months after operation. No loosening was found during the 1 to 4 years (2.5 years in average) follow-up of the 7 cases. The position of bilateral hips was symmetric. They all recovered to self-care. Two of them returned to work 7 and 8 months after operation respectively. One local recurrence happened and was resected again. Conclusion The custom-made hemipelvic prosthesis generated with RPT and CAD/CAM can improve the prosthesis fixation, ensure the exact orientation of acetabular component and make the operation easy.
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Objective To propose measures to reconstruct the massive bone defect in acetabulum in revision hip arthroplasty on the basis of the experience in the cases treated by the authors. Methods Thirty- two hips of 33 hip revision cases with massive bone defect being operated on by the first author were summarized and analyzed. The patients included 17 males and 15 females, with the age of 40 to 90 years. 28 cases (29 hips) underwent revision for the first time, 2 cases (2 hips) for the second time,1 case (1 hip) for the third and the other 1 case (1 hip)for the fourth time. The primary surgery were artificial femoral head replacement in 8 cases (8 hips) and total hip replacement in 24 cases (25 hips). Except of 2 saddle protheses replacement, bone grafts, mainly cancellous bone grafts, were used in 31 hips, of which 22 hips were non- structural bone grafts and 9 hips were allografts of femoral head or autograft of ilium. After grafting, ready- made acetabular prostheses were implanted in 9 hips, while special prostheses were used in 24 hips, chiefly computer- aided custom- made acetabular prostheses, including winged prostheses, 2- layer metal mesh, acetabular reinforcing rings (ARR), bi- spherical prostheses, crested prostheses and saddle type prostheses. Results In the course of 0.5 to 11 years' follow- up, re- displacement or relapse of bone absorption was not found in any of the cases. The Harris hip function score rose to 54－ 89 from the pre- operative level of 17－ 48. The computer- aided custom- made acetabular prostheses could better meet the requirements of different conditions of disease, thereby reducing the difficulties of surgery. Conclusion Special prostheses have the advantages of better compatibility with the individual requirements, prevention of displacement or collapse of the bone graft and higher primary stability. The proper application of bone graft and choice of suitable prosthesis to achieve the reconstruction of acetabular fossa and the integrity of acetabular circumference will markedly improve the success rate of revision surgery.
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Objective To i nv estigate the clinical effect of shape-memory sawtooth-arm em bracing fixator in the management of periprosthetic femoral fracture.Methods Since1994, 21cases of periprosthet-ic femoral fractures had been treated in7hospitals with the shape-memory sawtooth-arm embracing fixator designed and developed b y the Ninth Peoples Hospital,Shanghai Second Medical University(SSMU ).Of the21cases,12were males and9were females,aging from42to83years old. Eighteen of the series ex peri-enced periprosthetic fracture at2weeks to10y ears after joint replacement the fractures were found as oblique,spi ral or comminuted with the fracture lines located between the lesser trochanter and a p oint 5cm distal to the end of prosthetic stem.The other three were revision c ases,in which2cases with osteoporosis had intraoperative spiral fracture and1 case had long segmental osteotomy for removal of the prostheses.One of the 21patients had Z-shaped femoral osteotomy,while the other20cases were clas sified into Jo hannson typeⅠfrac ture in4cases,typeⅡ9cases and typeⅢ7case s.All of them were complete fracture with dis-placement.In practice,the arm s of fixator were expanded firstly by immersing into the ice water to make the tempera ture of the device decrease to4~7℃.After reduction of the fracture ,the body of the fixator was placed on the tensile side of the femur,and th e temperature of the arms was raised with hot saline.With its shape memory ef fect,the sawtooth-arms began to close up and grasped the fracture fragments ti ghtly.Results Surgical process in all of the cases was smoothly done:the frac tures were stable after the fixation,and no ex-ternal fixation was required po stoperatively,except four cases underwent skin traction of the affected lim b for 2weeks.All the patients were able to walk with two crutches at2to4we eks after the operation.The post-operative follow-up lasted from1to7years, and no fracture re-displacement was found.The results of frac-ture healing were good while the functional recovery to the pre-operative level was achieved in the all se ries.Conclusion For periprosthetic femoral fracture,shape memo ry sawtooth-arm embracing fixator is a re liable device being implanted easily and offering stable fixation;it should be the treatment method of the first choice.