Low-intensity pulsed ultrasound promotes bone and cartilage regeneration / 中国组织工程研究

BACKGROUND: Low-intensity pulsed ultrasound (LIPUS) is a non-thermal and non-invasive mechanical stimulation, which has achieved certain curative efficacy on bone and cartilage defects. OBJECTIVE: To retrospectively analyze the effects and mechanisms of LIPUS in bone and cartilage regeneration process, and to review the related cellular signals and tissue regeneration mechanism involved in the current achievement of basic research and clinical application, thus providing theoretical basis for clinics. METHODS: The first author retrieved Cochrane Library, PubMed, CBM, CNKI and WanFang databases using compute for the articles addressing LIPUS promoting bone and cartilage regeneration published from January 1990 to February 2017. The keywords were "LIPUS, calcium, integrin, nitric, oxide, prostaglandin, BMP" in English and Chinese, respectively. The articles published in authoritative magazines or recently published were preferred, and finally 80 articles were selected for result analysis. RESULTS AND CONCLUSION: The basic research concerning LIPUS involves cellular mechanics and tissue engineering. Especially with the support of molecular biology, there has been a major breakthrough in promoting bone and cartilage regeneration. LIPUS can stimulate cells and tissues to produce mechanical signals by mechanical wave, lead to changes in cytokines in the signaling pathways, further accelerate blood supply and metabolism, and finally promote the regeneration of bone and cartilage. Therefore, LIPUS is an effective treatment method.

Effect of acetabular defect on hip stress in adults: three-dimensional finite element analysis / 中国组织工程研究

BACKGROUND: Acetabular defect is one of the typical characteristics of adult developmental dysplasia of the hip. The acetabular defect caused an insufficient coverage to the femoral head, which means the contact area between them decreased and the pressure increased. Stress concentration could quicken hip wear and lead to arthritis or dislocation of the hip. Till now, there is no accepted objective criterion about what degree defect could lead to biomechanics changes in the hip. OBJECTIVE: To analyze the influence of different degrees of acetabular defect on the stress distribution of hip joint by using three-dimensional finite element method, and provide theoretical guidance for clinical treatment of hip dysplasia. METHODS: CT thin layer scanning data of normal adult hip were selected. Hip dysplasia models with varying degrees of bone defect were built by using Mimics15.0 and Hypermesh software. Von Mises stress distribution on the subchondral bone of the hip was analyzed by using Ansys10.0 software in the case of single foot touchdown. RESULTS AND CONCLUSION: Each model result was consistent with the actual situation. The maximum Von Mises stress value appeared at the top of the acetabulum dome and medial posterior femoral neck. When simulating one leg standing, the smaller the CE angle, the greater the maximum Von Mises stress on femoral head was; and acetabulum increased from 2.768 MPa and 3.029 MPa with 30° CE angle to 11.075 MPa and 15.322 MPa with 5° CE angle. This change was more obvious when CE angle was less than 15°. These findings confirmed that acetabular defect increases the peak stress of the hip joint, and the greater the defect, the greater the stress was. It is suggested that clinical intervention should be done as early as possible in patients with acetabular defect.

Prevalence of Developmental Dysplasia of the Hip in Chinese Adults: A Cross-sectional Survey / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The prevalence of developmental dysplasia of the hip (DDH) is unknown in China. We aimed to determine the prevalence of DDH in Chinese adults.</p><p><b>METHODS</b>In this study, we performed a cross-sectional survey of a nationally representative sample of Chinese adults. All participants underwent questionnaire investigation, physical examination, and X-ray examination. Factors associated with DDH were analyzed with logistic regression.</p><p><b>RESULTS</b>We invited 29,180 individuals aged 18 years and over to participate, randomly selected from 18 primary sampling units (street districts in urban areas and townships in rural areas). The survey and examination were completed in 25,767 people (10,296 men and 15,471 women). DDH was diagnosed in 391 people, yielding an overall DDH prevalence of 1.52%. Based on this information, we estimate the number of individuals with DDH in China to be approximately 16.05 million. DDH prevalence increased with age (odds ratio = 1.53 [1.03-2.27], P = 0.036), was significantly higher among women than men (2.07% vs. 0.75%, P< 0.001), and was higher among rural residents than urban residents (1.75% vs. 1.29%, P< 0.001). Economic development was independently associated with the presence of DDH. There was no evidence of an association between body mass index alone, education, or current smoking or drinking and risk of DDH (P > 0.05).</p><p><b>CONCLUSIONS</b>DDH has become an important public health problem. Special attention should be paid to residents with DDH. Screening for DDH should be performed in China.</p>

Uncontacted tire explosion causing trauma to bilateral lower extremities: A case report / 中华创伤杂志(英文版)

It is uncommon for tire explosion related injuries on the lower extremity. The bilateral lower extremities were injured by tire explosion when the patient was seated in a bus. She sustained an open fracture with partial bone loss in the right calcaneus (a comminuted fracture in the right ankle joint) and a closed comminuted fracture in the left tibia and fibula. This damage was caused by uncontacted tire explosion, thanks to a thick floor between the exploded tire and the patient's feet. This type of injury on lower extremity caused by uncontacted tire explosion was uncommon.

Prevalence of Nontraumatic Osteonecrosis of the Femoral Head and its Associated Risk Factors in the Chinese Population: Results from a Nationally Representative Survey / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Nontraumatic osteonecrosis of the femoral head (NONFH) is a debilitating disease that represents a significant financial burden for both individuals and healthcare systems. Despite its significance, however, its prevalence in the Chinese general population remains unknown. This study aimed to investigate the prevalence of NONFH and its associated risk factors in the Chinese population.</p><p><b>METHODS</b>A nationally representative survey of 30,030 respondents was undertaken from June 2012 to August 2013. All participants underwent a questionnaire investigation, physical examination of hip, and bilateral hip joint X-ray and/or magnetic resonance imaging examination. Blood samples were taken after overnight fasting to test serum total cholesterol, triglyceride, and high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels. We then used multivariate logistic regression analysis to investigate the associations between various metabolic, demographic, and lifestyle-related variables and NONFH.</p><p><b>RESULTS</b>NONFH was diagnosed in 218 subjects (0.725%) and the estimated NONFH cases were 8.12 million among Chinese people aged 15 years and over. The prevalence of NONFH was significantly higher in males than in females (1.02% vs. 0.51%, χ2 = 24.997, P < 0.001). Among NONFH patients, North residents were subjected to higher prevalence of NONFH than that of South residents (0.85% vs. 0.61%, χ 2 = 5.847, P = 0.016). Our multivariate regression analysis showed that high blood levels of triglycerides, total cholesterol, LDL-cholesterol, and non-HDL-cholesterol, male, urban residence, family history of osteonecrosis of the femoral head, heavy smoking, alcohol abuse and glucocorticoid intake, overweight, and obesity were all significantly associated with an increased risk of NONFH.</p><p><b>CONCLUSIONS</b>Our findings highlight that NONFH is a significant public health challenge in China and underscore the need for policy measures on the national level. Furthermore, NONFH shares a number of risk factors with atherosclerosis.</p>

Effect of superior retinacular artery damage on osteonecrosis of the femoral head / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Osteonecrosis of the femoral head (ONFH) is the result of dysfunctional blood supply, but associations between specific damaged arteries, imaging changes and clinical sign require more understanding. We investigated characteristics of ONFH that pertain to blood supply, imaging appearance, and clinical feature to judge the prognosis of ONFH.</p><p><b>METHODS</b>Clinical data were collected for 92 patients (118 hips) with ONFH, including gender, age, duration of pain (from initial clinical presentation to arthroplasty), cause, stage, and classification. Magmatic resonance imaging and X-rays were obtained of all patients to diagnose ONFH. The sizes of lesions were classified by necrotic index. The location of necrosis was classified as Type A, B, or C using the grading system by magmatic resonance imaging and X-rays. All hips were imaged with digital subtraction angiography to visualize their blood-supply characteristics. Hips were divided into groups based on the source artery for femoral head damage: superior retinacular artery (S), inferior retinacular artery (I), and combined superior and inferior retinacular arteries (S+I). Via digital subtraction angiography, imaging appearances and clinical data in three groups were compared.</p><p><b>RESULTS</b>ONFH was caused by damage in either the superior or inferior retinacular artery, or both, in all of 118 hips. The group with only inferior retinacular artery damage reported longer hip pain duration than the other groups. The probability of the lesion extending laterally to the acetabular edge in group S was much more than it in group I. Necrosis indices of the patients in S and S+I were higher than those in group I.</p><p><b>CONCLUSIONS</b>ONFH associated with interruption of the superior and inferior retinacular arteries in this study. When the former alone was damaged, the necrosis of the volume was larger, the risk of femoral head collapse was higher and the time from initial clinical presentation to arthroplasty was shorter.</p>

CT and MRI in diagnosis of avascular necrosis of the vertebral body / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the value of CT and MRI in the diagnosis of avascular necrosis of the vertebral body (ANV).</p><p><b>METHODS</b>Twelve ANV patients were retrospectively analysed by their medical history, clinic manifestation, CT and MRI. Twelve AVN patients were treated with percutaneous vertebroplasty (PVP). The pain level of each patient was assessed, both before and after the procedure, using a visual analogue scale (VAS).</p><p><b>RESULTS</b>All the patients had ANV in the thoracolumbar spine. The intravertebral vaccum phenomenon (VP), with gas or fluid-like collection, was seen on computed tomographic (CT) images and magnetic resonance images (MRI). In the early stages, the VP zone was characterized by fluid-like collection, and was low intensity on T1, high intensity on T2. In the latter stages, the margin of VP zone had sclerotic change on CT scan. VAS score decreased from preoperative (9.08 +/- 0.76) to (2.33 +/- 1.43) at 3 days after PVP.</p><p><b>CONCLUSION</b>ANV must be considered as a possible diagnosis of VP secondary to osteoporotic vertebral fractures. Both CT and MRI could provide reliable diagnostic proof for ANV. PVP is proved to be an effective and safe procedure for the treatment of ANV, and could provid quick pain relief.</p>

Biomechanical comparison of double-row versus transtendon single-row suture anchor technique for repair of the grade III partial articular-sided rotator cuff tears / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>For partial-thickness tears of the rotator cuff, double-row fixation and transtendon single-row fixation restore insertion site anatomy, with excellent results. We compared the biomechanical properties of double-row and transtendon single-row suture anchor techniques for repair of grade III partial articular-sided rotator cuff tears.</p><p><b>METHODS</b>In 10 matched pairs of fresh-frozen sheep shoulders, the infraspinatus tendon from 1 shoulder was repaired with a double-row suture anchor technique. This comprised placement of 2 medial anchors with horizontal mattress sutures at an angle of ≤ 45° into the medial margin of the infraspinatus footprint, just lateral to the articular surface, and 2 lateral anchors with horizontal mattress sutures. Standardized, 50% partial, articular-sided infraspinatus lesions were created in the contralateral shoulder. The infraspinatus tendon from the contralateral shoulder was repaired using two anchors with transtendon single-row mattress sutures. Each specimen underwent cyclic loading from 10 to 100 N for 50 cycles, followed by tensile testing to failure. Gap formation and strain over the footprint area were measured using a motion capture system; stiffness and failure load were determined from testing data.</p><p><b>RESULTS</b>Gap formation for the transtendon single-row repair was significantly smaller (P < 0.05) when compared with the double-row repair for the first cycle ((1.74 ± 0.38) mm vs. (2.86 ± 0.46) mm, respectively) and the last cycle ((3.77 ± 0.45) mm vs. (5.89 ± 0.61) mm, respectively). The strain over the footprint area for the transtendon single-row repair was significantly smaller (P < 0.05) when compared with the double-row repair. Also, it had a higher mean ultimate tensile load and stiffness.</p><p><b>CONCLUSIONS</b>For grade III partial articular-sided rotator cuff tears, transtendon single-row fixation exhibited superior biomechanical properties when compared with double-row fixation.</p>

Three-D gait patterns before and after total hip arthroplasty / 中华外科杂志

<p><b>OBJECTIVE</b>To determine how selected gait parameters may change as a result of total hip arthroplasty (THA).</p><p><b>METHODS</b>From February 2006 to February 2007 the study was performed on 53 osteonecrosis of femoral head subjects prior to and 6 weeks, 3, 6 and 12 months after total hip arthroplasty surgery. Gait analysis was performed using the three-dimensional Infrared-based system (Dalian Dong Fang Xin Rui Company, China). Kinematic data were recorded for the lower limb. The results obtained from the osteonecrosis of femoral head subjects were compared with those of 40 individuals without osteonecrosis. Using a three-dimensional motion analyzer, the following were measured: (1) gait speed, stride length, cadence; (2) step length, stride width; (3) standing phase time, walking phase time; (4) gait cycle time, Joint movement angular.</p><p><b>RESULTS</b>Compared with persons before total hip arthroplasty, THA patients showed significantly increased gait speed, gait frequency, step length and affected limb stand phase (P < 0.01). Angle timetable: preoperative hip-maximum flexion was 15 degrees, post-extension was 8 degrees, knee-maximum flexion was 70 degrees, ankle-maximum flexion was 15 degrees. Postop hip-maximum flexion was 27, post-extension was 17 degrees, knee-maximum flexion was 50 degrees, ankle-maximum flexion was 14 degrees; parameters of hip, knee between preoperative and postoperative was significance (P < 0.01).</p><p><b>CONCLUSION</b>These results suggest that 3-D gait analysis before and after total hip arthroplasty can evaluate precisely hip vitodynamics variation.</p>

Free iliac crest grafts with periosteum for treatment of old acetabular defects / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To inquire into the therapeutic effectiveness of free iliac crest grafts with periosteum on old acetabular defects.</p><p><b>METHODS</b>From February 1996 to June 2005, 9 patients were treated with free iliac crest grafts with periosteum to reconstruct old acetabular defects. There were 7 males and 2 females and the average age was 41.3 years. The acetabular defects were caused by traffic accidents in 6 cases and fall injury in 3 cases. The time from injury to treatment was 4-13 months and averaged 8 months. Intraoperatively we firstly removed the acetabular fracture fragments of the posterior wall. The femoral head was then reduced. Bone graft was harvested from the iliac crest with periosteum, which was sculpted with a rongeur to conform to the defect. The concave (iliac fossa) side of the graft was placed toward the femoral head. The graft was securely fixed by two to three leg screws.</p><p><b>RESULTS</b>Postoperative syndrome was not found in any of the cases. Harris' score system showed that the score raised from 32.3 points preoperatively to 81 points postoperatively. The hip function was evaluated as excellent in 3 cases, good in 4 cases and fair in 2 cases.</p><p><b>CONCLUSIONS</b>Although this procedure could not exactly reproduce the anatomy of the hip joint, it enables to restore the posterior stability, provide bone-stock for the hip joints and prevent dislocation of the femoral head.</p>

Conservative methods for osteonecrosis of the femoral head: the review of 1005 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To research on the conservative methods used to preserve the femoral head of patients with osteonecrosis of the femoral head.</p><p><b>METHODS</b>In these series surgical procedures the osteonecrotic lesion was removed and various vascularized bone blocks or periosteal flaps with its nutrient vessels were transferred to regain sphericity of the femoral head and reinforce the sequestrum. The current study assessed 1005 patients (1226 hips) operated on from 1989 to 2002 with an average follow-up of 5.1 years (range, 1.5-15 years). The mean age of the patients was 37.4 years (range, 17-65 years).</p><p><b>RESULTS</b>Sixty-one hips (57 patients) had conversion surgery to a total hip arthroplasty because of progressive collapse or severe pain, or both. In the patients without failure, postoperative Harris hip score improved significantly. Of the 1174 reconstructions that were in situ, 1041 (89.4%) were clinically successful, and 878 (75.4%) were radiologically successful. In relation to the stage of necrosis according to the classification system of Ficat and Alert, good results were achieved in 95.3% of the patients with stages II disease, 87.9% with stages III and 60.8% with stages IV.</p><p><b>CONCLUSIONS</b>Conservative methods of vascularized bone block or periosteal flap transfer should be considered in active symptomatic patients to preserve the femoral head. In addition, the earlier the stages of the disease the better outcome could be obtained.</p>

Arthrowand technique under arthroscope in diagnosis and treatment of knee disease / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the clinical experience in diagnosis and treatment of knee disease by arthrowand technique under arthroscope.</p><p><b>METHOD</b>Seventy-two patients were divided randomly into control and test groups (each 36 patients). The patients suffered from meniscectomy, synovitis and arthritis. The control group confirmed and treated by knee arthroscope, was subjected to debridement, cleansing and hole drilling for reduction of pressure. The test group was treated by arthrowand under arthroscope. All patients received rehabilitation therapy.</p><p><b>RESULTS</b>The patients developed no infection or complication. Better therapeutic results were obtained after follow up of 6 to 24 months.</p><p><b>CONCLUSION</b>Arthrowand technique under arthroscope for the diagnosis and treatment of knee diseases has the advantages of less injury, bleeding, and complication but quick recovery.</p>

Treatment of osteonecrosis of the femoral head by using greater trochanteric bone flap pedicled with double blood vessels / 中华显微外科杂志

Objective To evaluated the clinical results of treatment of osteonecrosis of the femoral head(ONFH)by using bone flap pedicled with gluteal muscle branch of ascending branch of the lateral femo- ral circumflex artery and transversal branch of the lateral femoral cireumflex artery.Methods Bone flap pedicled with double blood vessels was applied in 32 hips with stageⅡandⅢONFH according to the Fieat staging system.Fifteen hips were in stageⅡand 17 were in stageⅢ.All patients were followed up for a mean of 25 months(range,15-38 months)and were assessed clinically and radiologically according to Harris sco- ring.Selective digital subtraction angiography was performed in 9 cases to confirm the blood reconstruction of femoral head.Results Two cases underwent total hip replacement postoperatively.Preoperative and postop- erative Harris score were 55 and 88.6.Clinical success rate was 90.6% and radiological success rate was 87.5%.DSA demonstrated blood supply was found reconstruction in the necrotic femoral head.Conclusion Transplantation of bone flap pedicled with gluteal muscle branch of ascending branch of the lateral femoral circumflex artery and transversal branch of the lateral femoral circumflex artery appears to be a effective treat- ment for osteonecrosis of the femoral head,blood supply of bone flap and blood reconstruction of femoral head was confirmed.Early clinical results were satisfied.