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<p><b>OBJECTIVE</b>To investigate normal bony anatomy of the glenoid rim, to measure inner glenoid rim angle and outer glenoid rim angle, and the angles for successful anchor insertion for arthroscopic labral repairs.</p><p><b>METHODS</b>Twelve unpaired isolated human glenoids (6 right, 6 left) without any evidence of trauma were for studying. The glenoid specimens were scanned using 320-slice CT (Aquilion ONE), then reconstruction glenoid to a three dimensional model using materialise's interactive medical image control system (Mimics) and to obtain cross-sectional images in 6 different planes, mark the right glenoid rim with clockwise tag, the left with counterclockwise tag. Inner glenoid rim angle marked as angle α and outer glenoid rim angle marked as angle β were measured from the cross-sectional images of the glenoids at 8 positions: 2-, 3-, 4-, 5-, 6-, 7-, 8- and 9-o'clock positions. Glenoid morphology was noted for each position. Using 12 mm as radius, measured the minimum insertion angle of anchor, marked as angle γ. Normal distribution of the data was confirmed with Kolmogorov-Smirnov test. Paired t-test was performed to detect differences in the angles between two locations. Two independent samples t-test was performed to detect differences in the angles between same location of left and right. Analysis of variance (ANOVA) was performed to detect differences in the angles between right and left, and different locations of the glenoid rim.</p><p><b>RESULTS</b>The smallest α was at the 4-o'clock position (right 50° ± 6°, left 52° ± 9°), significant difference were seen when compared with the 6-o'clock position (t = 10.466, P = 0.000) or the 5-o'clock position (t = 3.754, P = 0.003), no significant difference exist between 4-o'clock position and 3-o'clock posion (t = 0.926, P = 0.374). The smallest β was at the 3-o'clock position (right 50° ± 6°, left 53° ± 10°), significant difference were seen when compared with the 6-o'clock position (t = 9.862, P = 0.000) or the 5-o'clock position (t = 3.634, P = 0.003), no significant difference exist between 4-o'clock position and 3-o'clock posion (t = 0.697, P = 0.501). Asymmetric morphology of the glenoid was noted with an almost straight line extending medially from the rim at the 3-o'clock position, whereas a concave morthology was noted at the 9-o'clock position. Similary at the 4- and 5-o'clock position, the scapular bony surface did not curve toward the base as markedly as it did at the corresponding posterior 8- and 7-o'clock position. Angle γ from the 3-o'clock to the 9-o'clock were 25° ± 4°, 54° ± 6°, 83° ± 4°, 119° ± 2° at right side, 23° ± 4°, 57° ± 4°, 89° ± 7°, 119° ± 4° at left side. No significant difference of any angle at the same position was noted between left and right (α:t = 0.283-1.785, P > 0.05;β:t = 0.369-2.067, P > 0.05;γ:t = 0.145-0.492, P > 0.05).</p><p><b>CONCLUSIONS</b>The available bone mass for the anchor insertion is found to vary depending on the position of the glenoid rim. The smallest inner and outer glenoid rim angle are at the 4- and 3-o'clock position. The minimum insertion angles of anchor differ at different position. Both rim angle and glenoid morthology for each position must be considered when selecting the ideal anchor insertion angle for Bankart repair. Meanwhile, minimum insertion angle of anchor should also be considered before anchor insertion.</p>
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Humans , Cross-Sectional Studies , Glenoid Cavity , Image Processing, Computer-Assisted , Plastic Surgery Procedures , Wound HealingABSTRACT
Objective To evaluate effect of bone grafting combining with titanium mesh and/or reinforcement cup in reconstruction of acetabular bone defect in total hip arthroplasty (THA).Methods From January 2008 to November 2011,32 patients,including 23 males and 9 females,aged from 51 to 76 years (average,66 years),underwent THA with acetabular defect reconstruction by using bone grafting combining with titanium mesh and/or reinforcement cup.There were 6 cases of primary THA and 26 cases of revision THA.Twelve cases (Paprosky Ⅱ B) and 7 cases (Paprosky Ⅱ C) underwent impaction bone grafting with titanium mesh; 6 cases (Paprosky Ⅱ C) underwent impaction bone grafting with reinforcement cup; 6 cases (Paprosky Ⅲ A) underwent impaction bone grafting and structural bone grafting with winged reinforcement cup; 1 case (Paprosky Ⅲ A) underwent double-layer impaction bone grafting with titanium mesh and reinforcement cup.Harris score and Gill classification were used to evaluate clinical and radiological results,respectively.Results All cases (32 hips) were followed up for an average of 22 months (range,12 to 25months).One year postoperatively,Harris score improved from preoperative 44.00±11.71 to postoperative 78.41 ±9.32.Twenty-four cases were excellent,4 good,4 fair,and the excellent and good rate was 87.5％.Three cases occurred mild displacement of acetabular rotation center; one case occurred dislocation.There was no loosing,subsidence,and bone resorption in other 28 cases at final follow-up.ConcLusion Bone grafting with titanium mesh and/or reinforcement cup is effective in reconstruction of acetabular bone defect in THA,which can improve the stability of acetabular cup.
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BACKGROUND: In tissue engineering, three-dimensional biodegradable scaffolds are generally used as a basic structure for cell anchorage, proliferation. Currently, no perfect scaffold is available. OBJECTIVE: To observe the growth of rabbit bone marrow stromal cells (BMSCs) cultured in different-intensity three-dimensional fibrin glue in vitro, and to discuss the feasibility of fibrin glue used as a scaffold material of bone tissue engineering. DESIGN, TIME AND SETTING: The single sample observational study was performed at the China-Japan Union Hospital of Jilin University and School of Mechanical Engineering of Tianjin University of Technology from September 2007 to January 2008. MATERIALS: Fibrinogen and thrombin were mixed at various proportions, and prepared into different intensity fibrin glue. A month-old male New Zealand white rabbits, weighing 0.25 kg was used in this study. METHODS: Rabbit BMSCs were cultured and serial subcultivation in a CO2 incubator. And then the amplified BMSCs were collected and continue to be cultured in different intensity fibrin glue for 4 weeks. MAIN OUTCOME MEASURES：Observation of growing BMSCs is performed using the phase contrast microscope. The activity of BMSCs in fibrin glue at different stages was observed using hematoxylin-eosin staining. The ultrastructural changes of BMSCs were observed which had been cultivated in fibrin glue for 4 weeks. RESULTS: After growing in fibrin glue for 4 weeks, BMSCs showed strongly active status in low intensity fibrin glue and growing slowly or dying in high intensity fibrin glue. Under the electron microscope, BMSCs following 4 weeks culture in fibrin glue (proportation of fibrinogen and thrombin was 4:1) were found, with visible cellular organs, and BMSCs had good activities. CONCLUSION: BMSCs can spread and proliferate quickly in low intensity fibrin glue. The optimal proportion of fibrinogen and thrombin is 4: 1.
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Objective To study the effects of vancomycin-impregnated polymethylmethacrylate (VCM-PMMA) on mechanics alteration and delayed release in order to guide clinical application.Methods The specimens of bone cement (each of 40 g) were divided into 7 groups depending on mixed different contents with vancomycin,containing 0,0.5,1.0,1.5,2.0,2.5 and 3.0 g vancomycin.The compressive strength,bending strength and bending elastic moduls were measured respectively.The elution examination of vancomycin from bone cement was performed by chromatography.Results There were no differences of compressive strength before elution of bone cement that were included from 0 to 3.0 g vancomycin.When the vancomycin in the content of the bone cement attained 3.0 g,the compressive strength after elution and bending elastic were lower than those in control group(P