Revision total hip arthroplasty using a cementless prosthesis / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the operative technique and results with the usage of cementless prosthesis in hip revision.</p><p><b>METHODS</b>Retrospective study was done on revision of total hip arthroplasty with cementless prosthesis in 72 patients (41 males and 31 females) with an average age of 65.7 years (28-82 years) from January 2004 to December 2009. The reason for revision was 2 infection, 54 aseptic loosening, 4 periprosthetic fractures, 5 fracture of femoral stems and 7 cases of acetabular abrasion after hemi-arthroplasty. The operation time, bleeding loss, complications of infection, dislocation, periprosthetic fractures and loosening were evaluated. The Harris score were used for hip function evaluation.</p><p><b>RESULTS</b>The average operation time was (146±47) minutes (70-280 minutes) and bleeding loss during the operation was (970±540) ml (200-2500 ml). Bacterium cultivation during operation demonstrated infection in 2 patients. Bone windows at the lateral femoral were opened in 4 patients and extend trochanteric osteotomy was done in 7 patients. Fracture of the proximal femur occurred in 8 cases. Twenty-nine patients were treated with bone graft including 18 autografts and 11 allografts. Sixty-seven patients were followed up for an average time of 66 months (20-92 months). Additional revisions were performed in 3 cases including 2 dislocations and 1 infection. There were no death, no damage of major blood vessels and nerves. The bone graft healed during 3-5 months. The survival rates of the femoral prosthesis and the acetabulum prostheses were 95.5% and 98.4%. The mean Harris score was 86±8 (55-95 points). Osteolysis were seen in 13 hips but migration was seen in only 1 patient.</p><p><b>CONCLUSIONS</b>The cementless prosthesis is useful in revision total hip arthroplasty and the perfect clinical results are related to the reliable primary fixation.</p>

Association of estrogen receptor alpha gene polymorphisms with bone mineral density: a meta-analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>A number of studies have examined the association between estrogen receptor alpha (ESR-α) gene polymorphisms and bone mineral density (BMD), but previous studies of ESR-α gene XbaI (rs9340799) and PvuII (rs2234693) polymorphisms have been hampered by small sample size, regional restrictions and inconclusive results. Thus a meta-analysis is needed to assess their pooled effects.</p><p><b>METHODS</b>This study reviewed all published articles indexed in Pubmed using the keywords in the title or abstract. All data were extracted independently by two reviewers using a standard form, the studies were meta-analyzed and minor discrepancies were resolved by authors' discussion.</p><p><b>RESULTS</b>Twenty seven eligible studies involving 8467 women and 2032 men were identified. The XbaI and PvuII polymorphisms were significantly associated with BMD of the lumbar spine. XX and PP homozygotes had a protective effect in comparison with carriers of the x and p alleles, the effects were more significant in premenopausal women or Western women. At the femoral neck, the results were different. XX served as a protective factor in postmenopausal women, Western women, Western postmenopausal women, and men, while PP was likely to serve as a risk factor in Eastern women, Eastern postmenopausal women, and men.</p><p><b>CONCLUSIONS</b>The XbaI polymorphism is correlated to BMD at diverse skeletal sites. PP had a protective role for the lumbar spine but might be a risk factor for the femoral neck.</p>

Metaphase outcome of total hip arthroplasty with Zweymuller system in treating developmental dysplasia of the hip / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the metaphase outcome of total hip arthroplasty with Zweymuller system and deepening acetabulum technique in treating DDH.</p><p><b>METHODS</b>From Jan.1998 to Dec. 2004,56 patients (62 hips) with DDH (secondary osteoarthritis) were treated with total hip arthroplasty with Zweymuller system. There were 14 males (15 hips) and 42 females (47 hips) with an average age of 48.6 years,ranged from 30 to 67 years. All patients had pain of hip joint and functional disturbance before operation. Observation items included postoperative complications,imaging and function of hip joint. The function of hip joint was analyzed according to Harris scoring.</p><p><b>RESULTS</b>All patients were followed up from 5 to 11 years with an average of 6.5 years. X-rays showed that the acetabular cup was in the position of true acetabulum, which combined tightly with the peripheral bone, the abduction angle of the acetabular cup was from 35 degrees to 45 degrees, introversion and extroversion of the femoral prosthesis was within 3 degrees, operated legs were shorter with a mean of (0.5 +/- 0.2) cm. The complications were as following:deep vein thrombosis in 20 cases,which were improved after thrombolysis;hip dislocation in 1 case,which was treated with reduction and immobilization for 3 weeks; ectopic ossification in 4 patients,all were Brook II type; no found infection or nerve injury. The Harris scoring was 87.4 +/- 3.5 postoperative,which was significant higher than that preoperative (43.2 +/- 6.7).</p><p><b>CONCLUSION</b>The metaphase outcome of total hip arthroplasty with Zweymuller system and deepening acetabulum technique in treating DDH can obtain good result.</p>

Preliminary clinical outcome of domestic posterior-stabilized total knee arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>Total knee arthroplasty (TKA) has been widely used in China. More and more attentions are paid to the development of knee prosthesis that fit for the anatomy of Chinese knee. This study is to summarize the surgical techniques and clinical outcome of domestic posterior-stabilized total knee arthroplasty.</p><p><b>METHODS</b>Fifty-one patients including 19 males and 32 females underwent TKA by using TC-Dynamic from Jan. 2003 to Dec. 2004 were reviewed. The average age at the time of operation was (76.4 +/- 4.1) years (range, 71 to 84 years). Thirty-seven patients suffered from osteoarthritis and 14 patients were rheumatism arthritis. The courses of the disease ranged from 5 to 40 years and the symptoms were pain and limitation of motion. The knee rating score system (HSS) as well as X-rays of the lower extremity was used to evaluate the clinical results.</p><p><b>RESULTS</b>All patients were followed up at the 3rd month after TKA and the duration of follow-up of 32 patients ranged from 48 to 61 months. The HSS scores before TKA was (53.3 +/- 6.7) (40 to 59) points. At the 3rd month and 48th month of follow-up, the HSS scores were (86.1 +/- 7.7) (63 to 95) and (83.5 +/- 8.1) (60 to 95) points respectively. The stress X-rays showed preoperative varus deformities from 9 degrees to 30 degrees with the average of (21.0 +/- 5.8) degrees and normal alignment of the lower extremities postoperative. There were no complications related to TC-Dynamic prosthesis and other complications such as infection, prosthetic loosening and dislocation of patella.</p><p><b>CONCLUSION</b>There is a good mid-term clinical result of TC-Dynamic knee system, which is designed according to anatomical characteristic of Chinese knee joint. More attention should be paid to this knee system about the long term follow-up.</p>

Clinical analysis and prevention from coating shedding of uncemented hip prosthesis / 中国骨伤

<p><b>OBJECTIVE</b>The long-term biological effects of HA-coated prostheses remain uncertain. The purpose of the study is to analyze the reasons of coating shedding of uncemented hip prothesis, so as to provide evidences for the preventions and treatment.</p><p><b>METHODS</b>From 2002.10 to 2009.2, 5 patients with coating shedding of uncemented hip prosthesis were treated with kip revision operation. Among the patients, 3 patients were male and 2 patients were female, ranging in age from 55 to 68 years. The hip prosthesis were taken out in the operation and the cause of coating shedding was analyzed. Another ten normal prosthesis taken out from the revision operation were used as the control group. The histomorphology and microarchitecture of hip prosthesis were observed. The micrometer caliper and vickers hardness test were used to measure the thickness and hardness. The interface shearing force was measured by push-out test. The function of hip joint was evaluated by Harris score.</p><p><b>RESULTS</b>There were difference between control and experience groups in his tomorphology observation. In the 2 patients with HA-coated shedding, the thickness of coating were 112 microm and 138 microm respectively; Vickers hardness were 5,843 Hv and 4,524 Hv respectively; and the shear strength were 12.4 MPa and 11.6 MPa respectively. In the 3 patients with Ti-coated shedding, the Harris scores were 82, 88 and 87 respectively.</p><p><b>CONCLUSION</b>There are many reasons of coating shedding of uncemented hip prosthesis. But most reasons have relationship with the quality of hip prosthesis. Nowadays, there are many methods to enhance the binding strength between the coating and prosthesis, and to prevent the early coating shedding.</p>

Study on how much sterile saline should be used for efficient lavage during total knee arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the volume of pulse lavage sufficient for removal of intraoperative bone and polymethyl methacrylate (PMMA) particles.</p><p><b>METHODS</b>From 2007.11 to 2008.11, 18 patients with osteoarthritis underwent cemented TKA. Among the patients, 6 patients were male and 12 patients were female, ranging in age from 54 to 77 years, with an average of 61.5 years. The course of disease ranged from 3 to 9 years, mean 6.7 years. Pulse lavage with 1 L of sterile saline was performed for 8 times using a pulsatile irrigator after prothesis fixed. During pulse lavage, aspirated fluid was collected in a 1 L aliquot, and the weight of bone and PMMA particles in each fluid were measured.</p><p><b>RESULTS</b>The weight of particles peaked in the first 1 L lavage fluid and gradually decreased until the 8th lavage fluid. Significant differences were found between the first vs second, second vs third, and third vs fourth lavage. However, no significant differences were found beyond the fourth lavage.</p><p><b>CONCLUSION</b>The results of this study indicates that 4 L of pulse lavage is effective for removing the bone and PMMA particles during cemented TKA.</p>

The monitoring and analysis of arthroplasty related infection / 中国骨伤

<p><b>OBJECTIVE</b>To monitor and analyze the arthroplasty related infection situations of Drum Tower Hospital, so as to provide evidences for the prevention of infection after arthroplasty.</p><p><b>METHODS</b>Monitoring of infection situations of nine arthroplasty operations were carried out from July to August in 2008. Five sampling methods were used to monitor the air of the 30 m2 surgery for 4 times. Through the cotton swab sampling, hands of 14 surgeons and 76 samples of surgical instruments (forceps, surgical scissors, retractors) were collected and then for bacterial culture.</p><p><b>RESULTS</b>The average amount of the total number of free-floating bacteria in our surgery was 88.2 cfu/m3. For the germiculture, 8 samples of hand detections were positive; 11 samples of surgical instruments including those used and unused and exposed at different times were positive.</p><p><b>CONCLUSION</b>In the surgery of arthroplasty, all operation personnels should protect the air cleanliness degree, obey the surgical hand-washing rules and diminish the exposed time of aseptic table.</p>

Observation of the efficacy of local multimodal analgesic drugs injection in total hip arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To study the efficacy of periarticular multimodal analgesic drugs injection in total hip arthroplasty.</p><p><b>METHODS</b>Seventy-six patients undergoing total hip arthroplasty were randomly divided into two groups, 38 patients received periarticular intraoperative injection of multimodal analgesic drugs, and others not do. Pain of patients were evaluated with a visual analog scale postoperatively, and all patients received patient-controlled analgesia for 24 hours after surgery. The consumption of patient-controlled analgesia was recorded at different time-points.</p><p><b>RESULTS</b>Compared to the control group, visual analog scores for pain of the patients of injected group had significantly lower in the post-anesthetic-care unit and four hours after surgery. Patients of the injected group used significantly less patient-controlled analgesia at 6, 12 hours, and over the first 24 hours after surgery than the control group. No adverse effects resulted from the multimodal analgesic drugs were noted in the injected group.</p><p><b>CONCLUSION</b>Periarticular injection of multimodal analgesic drugs in total hip arthroplasty can significantly reduce the postoperative pain of patients and the consumption of patient-controlled analgesia.</p>

Extraction of sex hormone from antler velvet with supercritical CO2 / 中国中药杂志

<p><b>OBJECTIVE</b>To study the method of extraction of sex hormone from antler velvet with supercritical CO2.</p><p><b>METHOD</b>Supercritical fluid extraction (SFE) was used to extract sex hormone from antler velvet and radioimmunoassay (RIA) was used to analyze the extracts. The chemical compositions in extracts were identified by GC-MS, TLC and HPLC, respectively.</p><p><b>RESULT</b>The experimental results indicated that the extraction yield was 1.56% when 85% ethanol was used as co-solvent at temperature of 65 degrees C and extraction pressure of 30 MPa. Estradiol and progesterone in the extracts were 3.07, 776.18 ng x g(-1) respectively.</p><p><b>CONCLUSION</b>It is feasible to extract hormone from antler velvet with supercritical CO2.</p>

Homocysteine-induced apoptosis of endothelial cells and roles of caspase3 / 上海第二医科大学学报

Objective To investigate whether homocysteine(Hcy) induces apoptosis of endothelial cells via a pathway involving caspases3 and whether simvastatin antagonizes the proapoptotic effects of Hcy by regulating c-IAP. Methods Human umbilical vein endothelial cells(HUVEC) were treated with Hcy,with or without simvastatin,for 24 h.Cell apoptosis was evaluated by Annexin V staining and flow cytometery,as well as TUNEL.The mRNA and protein levels of caspase3,c-IAP-1 and c-IAP-2 were analyzed by RT-PCR and Western blot,respectively. Results Treatment with both low(0.5 mmol/L) and high(3.0 mmol/L) concentrations of Hcy-induced HUVEC apoptosis was accompanied by an increased level of caspase3 expression and activation,together with decreased c-IAP-1 and c-IAP-2 level.Simvastatin upregulated c-IAP-1 and c-IAP-2 expression while attenuated Hcy-induced apoptosis and caspase3 activation. Conclusion Hcy may induce HUVEC apoptosis via a pathway involving caspase3,which can be partially antagonized by simvastatin,possibly through upregulated c-IAP-1 and c-IAP-2 expression.

Effects of atorvastatin on liver cystathionine-?-synthase of apoE~(-/-) mice / 上海第二医科大学学报

Objective To explore the influence of homocysteine(Hcy)on liver cystathionine-?-synthase(CBS)and methylenetetrahydrofolate reductase(MTHFR)system in apoE-/- mice,and determine the effects of atorvastatin and/or folate/vitamin B12 on liver CBS and MTHFR system.Methods Eighty male 6-week-old apoE-/- mice were randomly divided into two groups:65 mice were fed with a chow diet containing 2%(wt/vol)L-methionine(homomethionine group)and 15 mice were fed with normal saline(control group).Two months later,the 60 mice survived in homomethionine group were subdivided into four groups:group Ⅰ(untreated),Ⅱ(3 mg/kg atorvastatin),Ⅲ(3 mg/kg atorvastatin+2 mg/kg folate+30 ?g/kg vitamin B12)and Ⅳ(2 mg/kg folate+30 ?g/kg vitamin B12).After one month,Western blotting was performed to detect the liver CBS and MTHFR system protein expression in each group.Results The relative expression of liver CBS and MTHFR was significantly lower in group Ⅰ than in control group(P