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OBJECTIVE： To systematically evaluate therapeutic efficacy of sodium hyaluronate combined with Compound betamethasone versus sodium hyaluronate in the treatment of knee osteoarthritis （KOA）， and to provide evidence-based reference for clinical drug use. METHODS： Randomized controlled clinical trials （RCTs） about sodium hyaluronate combined with Compound betamethasone （observation group） versus sodium hyaluronate （control group） in the treatment of KOA were collected from Cochrane Library， PubMed， Embase， Web of Science， CNKI， Wanfang database and Baidu academics database， etc. By literature screening， data extraction and quality evaluation of included literatures with Jadad scale， Meta-analysis was carried out by using Rev Man 5.3 software. RESULTS： Totally 24 RCTs were included， involving 2 929 patients. Meta-analysis showed that total response rate [OR＝5.33， 95％CI（3.85， 7.38）， P＜0.000 01]， knee joint score of American Special Surgical Hospital [SMD＝1.63， 95％CI（1.32， 1.93）， P＜0.000 01]， knee function score [SMD＝1.22， 95％CI（0.84， 1.59）， P＜0.000 01] of the observation group were significantly higher than those of the control group； visual analogue score was significantly lower than that of control group [SMD＝－1.44， 95％CI（－1.76，－1.11）， P＜0.000 01]. CONCLUSIONS： In the treatment of KOA， therapeutic efficacy of sodium hyaluronate combined with Compound betamethasone is significantly better than sodium hyaluronate， and it can significantly improve knee function.
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BACKGROUND: Metal implants have been extensively applied in joint arthoplasty, but the stress shielding effect caused by its high elastic modulus results in a series of complications, such as bone resorption, bone atrophy and prosthesis loosening. Carbon fiber-reinforced polyetheretherketone (CF-PEEK) composites are anisotropic and exhibit more advantages used for prosthesis due to its low elastic modulus and high intensity.OBJECTIVE: To investigate the blood compatibility of CF-PEEK composites, and compare the biomechanical properties after arthroplasty between CF-PEEK composites and Co-Cr-Mo used for femoral head prosthesis. METHODS: (1) The blood compatibility of CF-PEEK composites was evaluated through hemolysis test. (2) Femoral samples from eight fresh cadavers were collected and randomly divided into two groups, followed by subjected to CF-PEEK and Co-Cr-Mo prosthesis replacement, respectively. The displacement between the prosthesis and bone was measured under loading 200, 400, 600, 800 and 1000 N, and the torsional strength after arthroplasty was detected.RESULTS AND CONCLUSION: (1) The hemolysis rate of the CF-PEEK composites was 3.23% < 5%, which was in line with the national standards for biological evaluation of medical devices. (2) The micromovement in distal prosthesis was significantly less than that of proximal prosthesis under different loads in both two groups (P < 0.05). (3) The torsion angle under different loads in the CF-PEEK group was significantly less than that in the Co-Cr-Mo group (P < 0.05), and the torsion stiffness in the CF-PEEK group was significantly higher than that in the Co-Cr-Mo group (P < 0.05). (4) To conclude,the CF-PEEK composites possess good blood compatibility and stability, which can be used as a prosthesis material.
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AIM: To explore whether tumor necrosis factor-α (TNF-α) induces necroptosis in murine long bone osteocyte-like cell line MLO-Y4 and the possible mechanism.METHODS: The MLO-Y4 cells were divided into control group, TNF-α group, TNF-α+necrostatin-1 (Nec-1) group, TNF-α+Z-VAD group and TNF-α+receptor-interacting protein 3 (RIP3)-siRNA group.The death rate of MLO-Y4 cells was assessed by flow cytometry with Annexin V-FITC/PI staining.The morphological features of the cells were observed under transmission electron microscope (TEM).The protein levels of RIP1, RIP3 and cleaved caspase-3 were determined by Western blot.Finally, the numbers of total cells and RIP1-RIP3-positive cells were observed under laser scanning confocal microscope.The production of reactive oxygen species (ROS) in the cells was measured by DCFH-DA staining.RESULTS: Compared with control group, the apoptotic or necroptotic rate of the cells induced by TNF-α was increased significantly (P<0.01).The increased apoptotic or necroptotic rate was dramatically reduced by treating with Nec-1, Z-VAD or RIP3-siRNA transfection (P<0.01).In TNF-α group and TNF-α+Z-VAD group, a lot of MLO-Y4 cells with typical necroptotic morphological features were observed under TEM.However, obvious necroptotic cells were not found in Nec-1 or RIP3-siRNA treatment group.The protein level of RIP1 in the cells treated with Nec-1 was sharply lower than that in TNF-α group (P<0.01).However, Z-VAD did not reduce the elevated levels of RIP1 and RIP3.RIP3-siRNA effectively down-regulated the protein level of RIP3 compared with TNF-α group (P<0.01).Nec-1 effectively down-regulated the protein levels of RIP1 colocalized with RIP3 compared with TNF-α group (P<0.01).However, Z-VAD did not reduce the levels of RIP1 colocalized with RIP3.Nec-1, Z-VAD and RIP3 siRNA significantly decreased the ROS levels (P<0.01).CONCLUSION: TNF-α induces the necroptosis of MLO-Y4 cells.RIP3 play vital roles in the cell necroptotic signal pathway.ROS may be the executor of necroptosis of MLO-Y4 cells.
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BACKGROUND: Beta-tricalcium phosphate (β-TCP)/alpha-calcium sulfate hemihydrate (α-CSH) artificial composite bone has a porous morphology and good biocompatibility, and it is helpful to improve the fusion rate in a spinal fusion model, which however has not yet been confirmed.OBJECTIVE: To investigate the preparation methods, biocompatibility and application effect of β-TCP/α-CSH composite bone in the spinal fusion model.METHODS: (1) Calcium sulfate dihydrate under certain conditions and at a proper temperature can be dehydrated to prepare α-CSH. Healthy bovine cancellous bone was decellularized, degreased and sintered under the certain condition and at the certain temperature to prepare β-TCP particles. Then, the β-TCP particles were dissolved in anhydrous ethanol, suspended, dried, and then used to prepare the β-TCP/α-CSH composite bone. Osteoblasts from the rabbit periosteum were co-cultured with the composite bone, and then cell morphology, adhesion and proliferation were observed. (2) Twenty New Zealand white rabbits were selected to make bilaterally posterolateral spinal fusion models of the multiple thoracic vertebrae, in which β-TCP/α-CSH composite bone was implanted into the left side (experimental group) and autogenous bone implanted into the right side (control group). The spinal fusion rate was compared between the two groups.RESULTS AND CONCLUSION: (1) Under the phase contrast microscope, a relatively small amount of L929 cells adhered to the composite bone after 3 days of co-culture, while the number of adherent cells became relatively dense. Under the scanning electron microscope, there were many crystalline particles on the surface of the composite bone,indicating a higher number of adherent cells on the composite bone surface. (2) The spinal fusion rate was increased at 4 weeks after implantation of β-TCP/α-CSH composite bone, which was significantly higher than that after implantation of autogenous bone (P < 0.05). (3) At 4 weeks after autogenous bone implantation, the bone trabecular bone was scarce and clumped, and newborn bone tissues and the boneless autograft bone were dominant. After 8 weeks after spinal fusion, the newborn bone tissues around the autograft were further increased. At 4 weeks after β-TCP/α-CSH composite bone implantation, there was no degradation of debris, but existed a few new bone tissues; at 8 weeks after implantation,the composite bone was surrounded by newborn bone tissues, and thickened trabecular bone and degradation of the composite bone were found. To conclude, the prepared β-TCP/α-CSH composite bone can achieve a higher fusion rate in the spinal fusion model.
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BACKGROUND: There are many methods for the treatment of femoral head necrosis, such as core decompression, bone graft, arthroplasty and joint replacement, and each of which has its own shortcomings. So, percutaneous bal oon angioplasty combined with coral artificial bone provides a new attempt for the treatment of femoral head necrosis. OBJECTIVE: To observe the effect of percutaneous bal oon angioplasty combined with coral artificial bone on femoral head necrosis repair. METHODS: Twenty-four Duroc piglets were enrol ed to establish bilateral femoral head necrosis models by liquid nitrogen freezing method. Then, model piglets were randomly treated with percutaneous bal oon angioplasty combined with injectable coral artificial bone (experimental group) or bone cement (control group) on one affected side, and meanwhile, given no treatment on the contralateral side (blank control group). At 2, 4, 8 and 16 weeks after surgery, X-ray examination, biomechanical test and histological detection were conducted. RESULTS AND CONCLUSION: X-ray showed that at 16 weeks after surgery, numerous new bones could be found in the experimental group and there was a fuzzy boundary between the artificial bone and surrounding tissues; no new bone formed in the control group, and the boundary was clear; in the blank control group, the surface of the femoral head col apsed, and bone trabeculae arranged disorderly, which were seriously destroyed. And in the histological detection at 16 weeks after surgery, there were numerous bone trabecula and osteoblasts around the coral bone in the experimental group, and the coral artificial bone almost dissolved; in the control group, bone cement was in an irregular shape and no bone trabecula formed; in the blank control group, bone trabecula were damaged in the col apsed area, whose structure was in disorder. Additional y, biomechanical changes in the experimental group were significantly better than those in the other two groups at different time points after surgery (P < 0.05). In conclusion, percutaneous bal oon angioplasty combined with coral artificial bone can repair femoral head necrosis by promoting new bone formation.
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Objective To evaluate the indications,techniques and effects of high speed drill assisted cervical pedicle screw-rod system in treatment of cervical interlocking dislocation.Methods A retrospective review was made on data of 13 cases of cervical interlocking dislocation undergone pedicle screw-rod fixation and reduction with assistance of high speed drills from December 2006 to July 2011.Dislocation localized in C3/4 (n =3),C4/5 (n =5),C5/6 (n =4) and C6/7 (n =1) respectively.Causes for injury contained cervical hyperextension due to traffic accidents (n =7) and a fall from the height (n =6).Two remained neurological intact,seven were combined with syndrome of central canal damage,and four had paraplegia.All the 13 cases received posterior pedicle screw fixation and reduction within 7 days after injury.Pedicle screws were implanted on adjacent segment of cervical spine with unlocking the interlocked small joints by a distraction device.Results All 13 cases obtained good reduction,including eight with complete anatomic reduction and five with 1-2 mm of vertebral slight slippage.Fifty-two screws were inserted and 49 pedicle screws were put in place except for the excursion in three pedicle screws on the postoperative radiographic and CT scans.There was no injury of spinal cord,nerve root or vertebral artery during operation.The patients showed significant improvement in sensory and motor function of the upper extremities in the follow-up of 12-36 months.One case had screw breakage at postoperative three months with no nerve symptoms.Conclusion High speed drill assisted pedicle screw-rod system is suitable for treatment of cervical interlocking dislocation,for its reduction process accords with the biomechanics and allows decompression therapy.
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ObjectiveTo study the efficacy of different doses of tamsulosin hydrochloride sustained release tablets for treatment of premature ejaculation (PE). MethodsEighty PE patients from September 2010 to January 2011 were divided into two groups randomly,the 0.2 mg dose group and the 0.4 mg dose group.The therapeutic effect was assessed by the changes of the patients' CIPE-5 scores.ResultsThe intra-vaginal ejaculation latency time (IELT) of the two groups were (0.98 ± 0.47 ) and ( 0.89 ± 0.47 ) min respectively before treatment,and (4.40 ± 1.86 ) and (6.40 ± 5.10) min respectively after treatment.There were significant differences ( P ＜ 0.01 ).As for satisfaction degree of sexual life,lessening the patients' sexual anxiety and nervousness,and decreasing the difficulty in retarding ejaculation,the group of 0.4 mg had better effect than the other group.ConclusionLarge dose of tamsulosin hydrochloride sustained release tablets could prolong IELT and increase the sexual satisfaction.
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BACKGROUND: As a bone graft, coralline hydroxyapatite (CHA) has uniform and interacted pore structure, which is suitable for vascular regeneration, bone regeneration and bone deposition. It displays good biocompatibility and no immunogenicity. OBJECTIVE: To explore the clinical results of CHA in the treatment of benign osteolytic bone defects. DESIGN, TIME AND SETTING: A retrospective analysis was performed in the Department of Orthopaedics, Affiliated Hospital of Hainan Medical College from May 1996 to May 2007. PARTICIPANTS: A total of 32 cases of benign osteolytic bone defects were enrolled from Department of Orthopaedics, Affiliated Hospital of Hainan Medical College. Pathological diagnosis showed that the cause of bone defect included bone cyst for 8 cases, fibrous hyperplasia of bone for 9 cases, aneurysmal bone cyst for 4 cases, osteoenchondroma for 1 case; fracture complication for 5 cases consisting of femoral complete fracture for 2 cases and humeral complete fracture for 1 case, and humeral incomplete fracture for 2 cases. CHA was prepared by the Biomaterials Laboratory of Hainan Medical College. METHODS: According to routine approach of the operation, 32 cases of benign osteolytic bone defects were implant with CHA granules, chips or blocks after deleting tumor tissue and thinning cortical bone. Then the periosteum was sutured. Three cases with complete fracture received internal fixation, while other cases were untreated. None was fixed with plaster for external fixation. MAIN OUTCOME MEASURES: The X-ray films were observed to evaluate the bone healing at different time. RESULTS: All cases were followed up for average 6-24 months. No general abnormal reactions were found. The incisions were healed in two weeks. The lesion range of bone defect was from 3 cm?2 cm?2 cm to 12 cm?4 cm?4 cm before operation; At 1-3 months after operation, bone graft began to fuse with bone tissue around defects and fused completely at 3-6 months, which indicated the bone defect was almost repaired; At 6-24 months, bone graft was moulded and rebuilt, gradually substituted by newly formed born. CONCLUSION: The CHA is an idea bone graft substitute material for its good results in the treatment of benign osteolytic bone defects, shorter operating time and fewer complications.
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Diskoscope combined with screw-rod fixation was used in the treatment of lumbar spinal stenosis complicated by degree Ⅰ dislocation of 48 cases, with an average operation time 150 min, average amount of bleeding 160 mL, average admission for 14 days, and an average follow-up of 18 months. Four cases developed pain in lower limb caused by traction of nerve root, and the symptoms disappeared after symptomatic treatment. No loosening, nail breakage or rod breakage, no infection or inflammatory reaction was found after implantation. Clinical evaluation excellent rate was 95.8 % , indicating that diskoscope combined with screw-rod fixation after spinal fusion for the treatment of decompression has been effective, and the screw-rod system achieves an effective fixation, reduction of spondylolisthesis, and spinal stability.
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[Objective]To explore the clinic results of bi-posterolateral fusion combined with coralline hydroxyapatite interbody fusion,a three point stable spine fusion technique in the treatment of degenerative vertebra disc disorder.[Method]Bi-posterolateral fusion combined with posterior interbody fusion were performed to treat 41 cases of degenerative vertebra disc disorder from August 1998 to August 2006.The patients included 18 men and 23 women;their average age was 48 years.The slippage and grade of spondylolisthesis before and after spine fusion were investigated.The severity and slippage of radiographic measurements were also recorded,along with the average follow up of 19.1 month(range 12-48 months).The three point spine fusion applied autologous bone chips for bi-posterolateral fusion and one cubic block of coralline hydroxyapatite for anterior inter body fusion which achieved by PLIF technique.[Result]In the 41 patients who had underwent three point spine fusion surgery,only 1/41 patients experienced nerve root pain after surgery,and in most cases clinical symptoms were improved greatly.In 21/41 patients who had severe lower back pain completely disappeared after surgery,and in 9/41 cases these symptoms were minimal.The clinical evaluation according to the symptoms before the operation was excellent 2.4%(1/41),good 19.5%(8/41),fair 21.9%(9/41),bad 56.1%(23/41);after operation excellent 68.3%(28/41),good 29.2%(12/41),fair 2.4%(1/41),bad 0.0%(0/41).A radiographic measurements showed the anterior disc height was 8.05?2.35mm before operation and 11.44?3.38mm after operation(P