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[Objective] To measure the patella thickness and to investigate the techniques and safety of patella resurfacing during total knee arthroplasty in Chinese patients with rheumatoid arthritis.[Methods]From Jan.2005 to Jan.2006,the maximal and minimum thickness of the patella,the preserved thickness of bony patella after resurfacing and the total thickness of patella composite after patella replacement in 95 consecutive total knee arthroplasty for rheumatoid arthritis were measured.The patients were followed-up after operation,anterior knee pain and patella fracture were recorded.[Results]1)The mean maximal thickness before resurfacing was(22.01?1.64)mm(range,18~26 mm),the mean minimum thickness before resurfacing was(11.69?2.33)mm(range,6~16mm).2)The mean thickness of preserved bony patellar thickness was(13.23?0.96)mm,(range,11~16 mm),including 11 mm in 4 knees(4.2%),12 mm in 15 knees(12.7%),13 mm in 38 knees(40%),14 mm in 32 knees(33.7%),15 mm in 5 knees(5.3%)and 16 mm in 1 knee(1.1%).The mean thickness of the patella composite was 21.42 mm(range,20~25 mm),the thickness of resurfaced patella was equal to or thinner than the preoperative patellar thickness in 86 knees(90.5%).Anterior knee pain was found in 3 knees,but no patellar fracture or component loosening occurred.[Conclusion]1)The patellar thickness in rheumatoid arthritis is thinner than the thickness in normal patella.2)It is a safe option to retain bony patella thickness at 12~14 mm during patellar resurfacing in Chinese adults with rheumatoid arthritis.3)Patellar resurfacing in patients with rheumatoid arthritis has a good result in a short term.Careful attention to good surgical technique in component alignment and patellar resurfacing is crucial to obtain good results.
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[Objective]To investigate the method and efficiency of operative modified rotational acetabular osteotomy for treatment of adult acetabular dysplasia. [Methods]Twenty-seven patients with 30 hips with acetabular dysplasia were treated with modified rotational acetabular osteotomy. The study group consisted of three men with 3 hips and twenty-four women with 27 hips,the average age of the patients was 29.4 years(range,fifteen to forty-two years ).The anteroposterior plevis view,lateral and abduction view of bilateral hip were taken,CE angle(center-edge angle) and AC angle(acetabular roof obliquity) were measured,the changes of the rotational center of the hip ,Shenton's line and the degree of osteoarthritis were recorded ,the Harris score was obtained before and after operation.[Results]The femoral head coverage was improved in all patients. On average ,the CE angle was improved from 3.2 (-15?～15?)to 28.5?(20?～40?),the AC angle was declined from 26.6?(15?～38?)to 3.9?(0?～12?). The rotational center of the hip was medialized in 19 hips(63.3%),the discontinuity rate of Shenton's line was declined from 67% to 23%. On average 4.2 years follow-up ,1 case lost follow-up,the degree of osteoarthritis in 28 hips was not aggravated,pain was aggravated in 1 hip ,the Harris score was improved from 82.7(67～96) to 97.8(87～100).Two patients have had Fibre-union of pubic and one patient has had stress fracture of the inferior pubic ramus postoperatively,non-union of iliac and posterior column of the osteotomy or the greater trochanter was not found.[Conclusion]The method of modified rotational acetabular osteotomy for treatment of adult acetabular dysplasia is effective and safety.
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[Objective]To investigate the osteogenetic ability of calcium sulfate applied alone by comparing with that of autograft harvested from ilium crest and discuss the possible osteogenetic mechanism.[Method]A rabbit lumbar posterolateral spinal fusion model was established.The left zygapophyseal joint was implanted with calcium sulfate tablet,and the right with iliac crest bone graft.Radiographic analysis and decalcified histological evaluation were performed.[Result]At 3 weeks,residual calcium sulfate tablet could not be noted by X-ray and CT scan,while autograft can't be seen,histological assessment revealed the degeneration velocity of calcium sulfate was slower than that of autograft.Ingrowth of blood vessel tissue and osteo-blast could be seen in both sides.At 6 weeks,there were no difference between both sides,histological assessment revealed cartilage formation in both sides.At 12 weeks,there was no difference by radiographic and histological assessment between both sides,proliferative bone formation was similar with lumbar body.[Conclusion]Calcium sulfate plays the similar role to iliac crest bone graft when used alone in promoting spinal fusion in rabbit model.Calcium sulfate has good osteo-conductivity,perhaps has osteo-inductivity,so is a good bone graft substitute.
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[Objective]To evaluate the mid-term and long-term clinical outcome of total hip replacement in patients with congerital acetabular dysplasia.[Method]Twenty-five hips in 23 patients diagnosed as congemtal acetabular dysplasia were treated with total hip replacement.According to the classification ofPemer,17 hips belonged to type Ⅰ,5 type Ⅱ,2 type Ⅲ,and 1 type Ⅳ.The fixation of the prosthetic components was as follows: 5 cups and 7 stems with cement,20 cups and 18 stems with un-cement.[Result]The complications included femur trochanter fracture in 1 case,deep vein thrombosis in 1 case,limb discrepancy in 3 cases,All patients were followed.up with the duration of 8.2 years(3 to 11 years).The preoperative Harris hip score ranged from 25 to 59(average 44.5).After the operation,the pain was completely relieved and the Harris hip score ranged from.63 to 97(average 85.6).[Conclusion]Total hip replacement in congenital acetabular dysplasia could be somewhat difficult,because of the liability to complications.The technical difficulties encountered during surgery included the correction of the length of bilateral lower extremity,the balance of the abductor muscles,the release of the soft tissue,the dealing of the superior seganental defect of acetabulum and selection of the components.
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Objective:To explore the effect of progrmmed cell death 5(PDCD5)on apoptosis of rheumatoid arthritis fibroblast-like synoviocytes(RA FLS) induced by triptolide.Methods:Cultured synovial cells in vitro from RA patients were transfected with Ad-PDCD5.At protein level,expression of PDCD5 in RA FLS infected with Ad-PDCD5 was detected by Western blot.RA FLS infected with Ad-PDCD5 were cultured in presence or absence of triptolide and apoptosis of RA FLS was determined by flow cytometry.Results:Infection of RA FLS with increasing concentrations of Ad-PDCD5(50-300 MOI) resulted in a does-dependent increase in the production of PDCD5.Apoptotic cells percentage for noinfection group,Ad-null group and Ad-PDCD5 group were(22.41?3.87)%,(28.77?12.97)% and(48.87?12.69)%,respectively.Alternatively,infection without addition of triptolide stimuli had no effect.The data showed that gene transfection of PDCD5 alone without addition of triptolide was not sufficient to activate RA FLS apoptosis,PDCD5 acted as an enhancer rather than inductor of apoptosis.Conclusion:Overexpression of PDCD5 could enhance apoptosis of RA FLS induced by triptolide,PDCD5 may be a potential therapeutic target to RA.
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Objective: To investigate quantification of expression of LTB4 inducing IL-1? and TNF-? at mRNA level in synovial membrane cells of rheumatoid arthritis. Methods: Primary cultured synovial cells from RA patients were treated with exogenous LTB4,MK-886(inhibitor of 5-lipoxygenase activating protein) and Bestatin(inhibitor of leukotriene A4 hydrolase) in the presence of LIT respectively, expressions of TNF-? and IL-1? were detected at mRNA level by Real-time Quantitative PCR. Results: Expressions of basic TNF-?(TNF-?/GAPDH) and IL-?(IL-?/GAPDH) at mRNA level in primary cultured synovial cells were 0.02?0.00 and 0.16?0.01 respectively. LTB4(10~ -9 mol/L-10~ -8 mol/L) was shown to induce dose-dependent increase of mRNA expression of TNF-?.(7-15 times) and IL-1? (1 time) , endogenous product of LTB4 by LIT significantly increased mRNA expressions of TNF-? (145 times) and IL-1?(12 times) respectively. LIT-treated synoviocytes with addition of MK-886 (5-LOX exciting protein FLAP inhibitor) (1-10 ?mol/L) were inhibited to secrete LTB4 dose-dependently, following the markedly down-regulated expressions of TNF-? (15%-66%) and IL-1? (41%-71%) at mRNA level . Bestatin(100 mg/L) could also remarkably diminish LTB4-induced mRNA expressions of TNF-?(86%) and IL-1?(79%). Conclusion: LTB4 of synovial membrance cells in rheumatoid arthritis could induce expressions of TNF-? and IL-1? at mRNA level, and their expression at mRNA level had been quantified successfully. It is a beneficial help to quantify all kinds of cytokines in methodology.
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Objective A retrospective analysis was conducted on 1 202 cases of total knee replacements (TKR) during the periord of 14 years, in order to study the special clinical features of the patients and their knee deformities, with the final purpose of finding the appropriate methods for the management. Methods From April 1987 to Augest 2001, 1202 cases of total knee arthroplasty were performed for 833 patients. There were 464 unilateral TKRs in 464 patients, and 738 bilateral TKRs in 369 patients. The diagnosis of the clincal conditions were osteoarthritis (include synovial chondromatosis and kaschin beck disease), rheumatoid arthritis, ankylosing spondylitis, also included were some rare rheumatic diseases of the knee such as pigmented villonodular synovitis, tuberculous arthritis, Charcot arthritis, hemophilic arthritis and psoriatic arthritis. Patients in this series also had several kinds of severe deformities such as genu varus with dislocation or medial plateau defect, genu valgus, flexion contracture of the knee, flexion deformity with joint fusion, flexion joint fusion with subluxation, and deformity in the low extremities involving multiple joints in patients with JRA. Results Some severe deformities were considered as contraindication of surfacing total knee replacement, however the life quality of patients had significant improvement after operations. Through the improvement of surgical skill, the complications following TKR in severe knee flexion deformity are less in number than that happened in the early days. Conclusion 1) TKR in China at the moment is facing more challenges and difficulties than that in the developed countries. 2)The proper types of prosthesis should be selected beforehand in order to get the good result. 3) Physical therapy is very important in the rehabilitation following TKR, so that the establishment of full time rehabilitation team is mandatory. 4)The key point for promoting TKR treatment for patients with various knee disease is to develop homemade prosthesis in China. [
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Objective To explore the techniq ue and clinical result of total knee replacement in flex-ion ankylosed knee.Me thods From December1987to December2000,30TKRs in16patients were per formed by means of medial parapatellar approach,secondary osteotomy and soft tissue balance for knees with bony ankylosis in flexion position.At the same t ime,an appropriate technique was adopted to excise the patella-femoral joint while the femoral-tibial joint was ankylosed,so that the bone distribution an d the ori-entation of joint line were made appropriately to facilitate implan t prostheses.By measuring the range of mo-tion(ROM)and HSS score system ,the effects of this operative methods and the procedure of osteoto my were evaluated.In this group,there were12males and4females.The average age at s urgery was33.6years old(range,20to69years).All knees were fixed at a n average of 46.5?(range,15?to95?),with ROM of 0?.HSS scores w ere in average of 31.4points(16to47points).Of the16cases,14cases underwent bilat-eral TKRs,and2cases unilateral TKR.Results In the present series,the operative time lasted for 1.6hours(range,1.2to2.1h)ther e were3cases suffering from paralysis of unilateral common peroneal nerve for half a year,there was no other complication happened in this group.The mean f ollow-up was67.1months(range,1to14years),the average ROM of knee wa s72.5?(range,60?to100?),lack of full ex ten sion(ex-tension l ag)was7.8?(range,0?to15?).HSS of knee joint was average78.7p oints(range,71to89points),Comparing with the pre-operation,there was i mprovement of 47.3scores.Conclusion Al though it is more difficult to perf orm TKRS in bony ankylosed knee than in those without ankylosis,how ever,by using tech niques of medial parapatellar approach,secondary osteotomy,soft ti ssue balance and the appropriate way to ex cise patellar-femoral joint and fem ur-tibial joint which were naturally ankylosed,the ankylosed knee defor mi ti es could be corrected successfully,and TKR is also possible to improve the func tion of knee and life quali ty in these patients significantly.
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Objective To investiga te the relationship,diagnosis and thera peutic meth ods of degener-ative diseas es of lumbar and lower extremity joints in middle and aged patients.Methods Fr omNovember1997to May2002,50patients suffering from lum bar and hip or knee degenerative diseases concur rently were reviewed.In this group,there w ere14males and36females,ag ing from45to76years old(with an average of 60.5years).In lumbar degenerative disease,13cases were diagnosed as spi nal stenosis of lumbar,and12cases were diagnosed as spinal stenosis of lumb ar accompanied by degenerative spondylolisthesis,25cases spinal stenosis of lumbar accompanied by degenerative scoliosis.While in the degenerative diseases of joints,ostoarthritis was involved in58knee joints of 40cases,10hip joints of 6cases,and both6knee and5hip joints of 4cases.Results Allof the patients were operated upon;anterior lumbar decompression,bone grafting and Z-plate fixation to L1in5cases,posterior decompression and pedicle screws f ixation for insta-bility of spine in45cases.Of 50patients,11cases(1 4joints)underwent arthroscopy or joint replacement prior to lumbar operat ion,with an average interval period of 9.7months(1.5to29months);3ca ses(3knees)underwent joint replacements after lumbar operation,with an ave rage duration of 17.3months(4to36months);3cases(3hip joints)had hi p joint replacement simultaneously with lumbar operation in one setting.For the other33cases no articular operation was performed,and12cases had relief of the symptoms of osteoarthitis after lumbar opera tion;21cases were tre ated with conservative therapy for degenerative dis-eases of joint and allev iated the conditions satis factorily.The average follow-up period was14.2m onths(3to45months).Compared to pre-operation,the average HSS,Harris sco re of joint and JOA score of lumbar were improved by48.2,42.5and14 .3respectively.Conclusion In middle and aged patients with both lumbar and jo int degenerative dis eases,it is very important to make definite diagnosis an d distinguish symp-toms caused by lumbar or joint disease.The major diseas e portions should be treated firstly;if necessary,both joint and lumbar opera tion could be carried out in one surgical setting.