Phase I total hip replacement for severe hip osteoarthritis with proximal femoral fractures / 中国骨伤

OBJECTIVE@#To investigate the effect and prognosis of stage I total hip replacement in the treatment of severe hip osteoarthritis with proximal femoral fracture.@*METHODS@#From July 2014 to October 2017, 8 patients with severe end-stage hip disease and proximal femoral fracture were treated with stage I total hip replacement including 6 males and 2 females, aged 59 to 72 years old with an average age of 65 years old, involving 4 femoral head necrosis with proximal femoral fracture in the right side, 3 femoral head necrosis with proximal femoral fracture in the left side, and 1 left acetabular dysplasia with proximal femoral fracture in the left side. The average time from injury to operation was 7 days. Eight patients were treated with biologically elongated hip prosthesis.@*RESULTS@#Eight patients with stage I total hip arthroplasty were followed up for 12 to 48 months with an average of 31 months. During the follow-up period, there was no loosening or subsidence of the prosthesis. Harris score increased from 33 points (22 to 42 points) preoperatively to 87 points(82 to 90 points) at the last follow-up. Among them, 3 cases were excellent and 5 cases were good. Abandoned abduction and walked 3 months after operation. X-ray films during 3-6 months after operation showed that fracture healing was good, hip pain and function were improved significantly, and the quality of life was greatly improved.@*CONCLUSIONS@#Phase I total hip arthroplasty for severe hip osteoarthritis patients with proximal femoral fracture has the advantages of shortening the treatment time, alleviating patients'pain, reducing hospitalization costs and good prognosis.

Long-term outcomes of Chiari osteotomy for Legg-Calvé-Perthes disease in children / 中国骨伤

OBJECTIVE@#To explore long-term outcomes of Chiari osteotomy for Legg-Calvé-Perthes disease in children with type Catterall III or IV, and to analyze clinical effect of osteotomy angle on clinical and radiographic results.@*METHODS@#From March 2005 to July 2013, 26 children with Legg-Calvé-Perthes disease with type Catterall III or IV were treated by Chiari osteotomy, including 17 males and 9 females, aged from 4 to 13 years old with an average of (8.9±2.6) years old. Children were divided into low osteotomy angle group and high osteotomy angle group. according to osteotomy angle. There were 10 children in low osteotomy angle group with an osteotomy angle of 10 degrees, including 8 boys and 2 girls, aged from 4 to 13 years old with an average of (9.2±3.3) years old; while there were 16 children in high osteotomy angle group with an osteotomy angle of 15 degress, including 9 boys and 7 girls, aged from 6 to 12 years old with an average of (8.8±2.1) years old. HHS score before operation and at the latest follow-up were recorded to observe clinical results. CE angle of hip joint, acetabular index, Sharp angle, Shenton's line continuity, femoral head coverage, acetabular depth ratio were recorded to compare radiographic results. Stulberg classification was analyzed to compare reshaping ability of femoral head.@*RESULTS@#Twenty-six children were followed up for 4.5 to 12.0 years with an average of (7.9±1.8) years. All incisions were healed at stage I for 10 to 14 days, with an average of(12.3±1.1) days. No inflammation, skin necrosis and injury of vessel and nerve occurred. All osteotomies achieved bone union for 8 to 13 weeks, with an average of(9.8±1.4) weeks. HHS score increased from 75.8±6.5 before operation to 93.5±2.5 at the latest follow-up in low osteotomy angle group(<0.05), and form 77.6±6.2 to 97.8±1.6 in high osteotomy angle group (<0.05). HHS score of high osteotomy angle group at the latest follow-up was higher than that of low osteotomy angle group (<0.05). The acetabular index decreased from (10.1±2.5)° before operation to (4.5±1.3)° at the latest follow-up in low osteotomy angle group (<0.05), and from (10.7±3.3)° before operation to (2.0±1.1)° in high osteotomy angle group (<0.05). The acetabular index of high osteotomy angle group at the latest followup was better than low osteotomy angle group(<0.05). There was no significant difference in CE angle, Sharp angle, Shenton's continuity, femoral head coverage, acetabular depth ratio between two groups. According to Stulberg classification, the femoral head reshaping ability in high osteotomy angle group was better than that of low osteotomy angle group(<0.05).@*CONCLUSIONS@#Chiari osteotomy with 15° for Legg-Calvé-Perthes disease in children with type Catterall III or IV could effectively decrease index of acetabulum, and helpful for femoral head reshaping ability, then in further improve clinical effects.

Repairing diabetic rats with bone defect by VEGF165 gene modified adipose-derived stem cells / 中国骨伤

<p><b>OBJECTIVE</b>To explore repairing results of VEGF165 gene modified adipose-derived stem cells for diabetic rats with bone defect.</p><p><b>METHODS</b>Seventy-eight male Wistar rats weighted 180 to 220 g were selected, 72 rats were established diabetic animal models by streptozotocin inducement method, blood glucose level was more than 16.7 mmol/L. Experimental animals were randomly divided into 5 groups, 6 rats in normal group and each 18 rats in other groups. VEGF165 gene modified adipose-derived stem cells were implanted into normal group with bone defect; single diabetic rats with bone defect were named as diabetic group;vascular endothelial growth factor implanted into single diabetic rats with bone defect named as growth factor group; adipose-derived stem cells implanted into diabetic rats with bone defect names as stem cell group; VEGF165 gene modified adipose-derived stem cells implanted diabetic rats with bone defect named as experimental group. After combination of VEGF165-ADSCs (5×106) cells combined with gel sponge, implanted into diabetic rats with bone defect. On the forth week, general form of defect repairing tissue were observed by optical microscopy;local density of micro-vessel were detected by immunohistochemistry method; content of Ca, P and ALP of repairing callus were detected by IRIS Intrepid XSP inductively coupled plasma emission spectrometer. Efficacy of the VEGF165-ADSCs repairing function was evaluated by SPSS statistic software.</p><p><b>RESULTS</b>Fluorescent staining results showed that expression of VEGF165 located on cytoplasm of ADSCs, expression percentage was more than 87%; general histology results showed that callus formation and quality was near to normal group, repairing results in diabetes group, growth factor group and stem cell group were poor. On the Forth week after implantation, content of Ca, P and ALP of repairing callus in experimental group were higher than those in growth group and stem cell group, and without significant differences compared with normal group; blood vessel density in experimental group was lower than normal group, but higher than other groups.</p><p><b>CONCLUSIONS</b>VEGF165 gene modified adipose-derived stem cells for repairing diabetic rats with bone defect has advantages of osteogenesis and angiogenesis, and should be one of the effective method for repairing diabetic rats with bone defect.</p>

Clinical and radiographic evaluation for total hip arthroplasty in treatment of bony ankylosis of hips / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical and radiographic effects of total hip arthroplasty (THA) in the treatment of bony ankylosis of hips.</p><p><b>METHODS</b>From January 2003 to August 2009, 20 patients (30 hips) with bony ankylosis of hips were treated with THA. There were 12 males and 8 females, with an average age of 36 years old. After operation, the follow-up results were evaluated with clinical and radiographic criteria. The clinical follow-up results were evaluated with Harris score, satisfaction of pain relief, limb length discrepancy, ROM of hip and the strength of hip abductor. The X-ray imaging follow-up results were evaluated with acetabula and periprosthetic osteolysis, prosthesis loosening, radiolucent and heterotopic ossification.</p><p><b>RESULTS</b>The average following-up was 4 years. The mean preoperative Harris score was (40.75 +/- 6.52) as opposed to postoperative Harris score of (86.40 +/- 5.42). Total pain relief was 65% and partial pain relief was 35% around the affected hips. The recovery of abductors strength was satisfactory in 13 cases, with limp symptoms was relieved obviously, and limb shortening decreased to less than 0.5 cm. The postoperative ROM of hip was significantly improved compared with the preoperative ROM. Radiographic analysis showed that heterotopic ossification in 2 cases, and radiolucent around prosthesis in one case. There were no dislocation and revision cases.</p><p><b>CONCLUSION</b>The THA can provide satisfactory clinical results in bony ankylosis of hips, which not only correct the deformity and recover the functions of hip, but also relieve the pain of hip to improve quality of life.</p>

Treatment of humeral supracondylar fracture in children with neurovascular complications / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the treatment methods of humeral supracondylar fracture in children with neurovascular complications.</p><p><b>METHODS</b>Ninety-six children (59 males, 37 females) with humeral supracondylar fractures were treated by surgery from February 2002 to November 2007, with the mean age of 6.4 years old (ranged from 4 to 16 years). Seventeen symptoms of nerve damage occurred in 16 cases, including radial nerve injury in 5 cases,median nerve injury in 7 cases,of which 1 cases with ulnar nerve injury, ulnar nerve injury in 5 cases; 13 patients had symptoms of vascular injury such as pulse weakness and hands coldness. The patients accompanied by nerve, blood vessel injury symptoms were all treated with open reduction and internal fixation.</p><p><b>RESULTS</b>Eighty-five patients were followed up with an average duration of 11 months(ranged from 6 to 18 months). Seventy-three patients had incision healing at the first stage and other 12 patients had incision healing at the second stage. All the 85 patients had no complications such as incision infection and functional disturbance of elbow joint. Among 5 patients with radial nerve injury, 3 patients had symptoms disappeared completely at 3 months after operation; one patient underwent exploration lysis at 3 months after operation and the symptoms disappeared at 5 months after operation; another 1 patient with iatrogenic injury of radial nerve had nerve function recovered at 3 months after releasing plaster compression. Among 7 patients with median nerve injury, 6 patients had nerve function recovered completely at 6 months after operation; another 1 patient combined with ulnar nerve injuries had nerve function recovered at 9 months after exploring of nerve at the second stage. Five patients with ulnar nerve injury had nerve function recovered completely at 6 months after operation. Preoperative symptoms of radial artery pulse weakness and cold hand in 13 patients disappeared after fracture reduction.</p><p><b>CONCLUSION</b>The ulnar nerve should be explored during the operation at the first stage of supracondylar fracture. Wether the median nerve, radial nerve and blood vessel be explored or not should be decided by preoperative examination results. The preoperative EMG and Doppler ultrasound examination is not a routine examination before surgery.</p>