Long-term results of total hip arthroplasty with 4th ceramic-on-ceramic bearing for patients with history of hip injury / 中华骨科杂志

Objective:To evaluate the long-term clinical outcomes of total hip arthroplasty with the 4th ceramic-on-ceramic bearing in patients with history of hip injury.Methods:During December 2008 to December 2011, a total of 153 patients (157 hips) with history of hip injury were treated with 4th ceramic-on-ceramic bearing total hip arthroplasty. There were 25 cases (25 hips) were not followed up (16.3%). Ultimately, a total of 128 cases (132 hips) aged 49.26±14.18 (range 17-76) years including 87 males and 41 females were included in the study. In these patients, there were 15 cases (11.4%) with acetabular fracture, 90 cases (68.2%) with femoral fracture, 5 cases (3.8%) with hip dislocation and 22 cases (16.7%) with unknown history. Clinical outcomes, including operation duration, Harris score, range of motion, complications and noises, were evaluated. The survivorship was investigated by using Kaplan-Meier method.Results:The operation duration was 135.61±41.65 (range 64-320) min. The average follow-up duration was 9.62±0.82 (range 8.2-11.3) years. The Harris score increased from preoperative 44.07±19.71 to 94.03±4.10 at the last follow-up ( t=24.155, P<0.001). The range of hip motion increased from 75.90±28.05 degrees to 117.14±12.36 degrees ( t=13.176, P<0.001). There was no significant difference in Harris scores and ranges of motion among the groups with different history of fracture and dislocation. There were periprosthetic fracture in 1 case and hip dislocation in 2 cases. There was no periprosthetic hip infection or fracture of ceramic liner during the follow up. Thirteen cases (13 hips, 9.8%), including squeaking in 9 cases (6.8%) and clicking in 4 cases (3.0%), reported hip noise without pain and impairment on the quality of life. The survivorship was 100% at 10 years when regarded revision as an end point. However, the survivorship was 99.24% (95% CI: 97.8%, 100%) at 10 years when reoperation revision as an end point. Conclusion:Total hip arthroplasty with 4th ceramic-on-ceramic bearing could have excellent results for patients with a history of hip fracture or dislocation in the long-term follow-up. Although the prevalence of hip noise was about 10% in this cohort study, there was no impairment on the quality of life.

Study on artificial intelligence-based algorithm for acetabular cup in total hip arthroplasty / 中华骨科杂志

Objective:To develop a set of algorithms that could predict the precise size of acetabular cup preoperatively by the deep learning neural network technology.Methods:Retrospective analysis was performed on 30 patients with femoral head necrosis from April 2019 to April 2020, including 15 males and 15 females. At the age of (54.8±10.5) years (range 33-72 years). Thirteen hips on the left and seventeen hips on the right, who underwent primary unilateral THA. Based on the manually segmented hip joint CT database, a deep learning convolutional neural network was trained to realize automatic segmentation. A customized algorithm was created to fit the surface of the acetabulum. By the application of another deep learning convolutional neural network, the identification of anatomical points of the pelvis and correction of the pelvic position were realized. So that the placement of the acetabulum cup could be done. DOC (dice overlap coefficients) as well as the average error parameter were adopted to evaluate the accuracy of the above steps. The novel algorithm and Orthoview software were retrospectively used to template the acetabular cup separately. The results of both groups were compared with the actual size and the coincidence rate was calculated to evaluate the accuracy of the novel algorithm. To verify this algorithm, the conformance rate was calculated respectively.Results:Compared with other classical segmentation networks, the G-NET network can segment the pelvic with femoral head necrosis more accurately (DOC 92.51%± 6.70%). It also has better robustness. The average error of the point recognition network is 0.87 pixels. Among the 30 patients, the AI-based algorithm group had a complete coincidence rate of 96.7% and the Orthoview group had a complete coincidence rate of 73.3%. The difference was statistically significant ( χ2=6.405, P=0.011). Conclusion:The artificial intelligence-based algorithm can segment the CT image series and identify the feature points of the patient's hip accurately. Compared with the conventional 2D preoperative planning method, the AI-based algorithm is relatively more accurate. This artificial intelligence-based 3D preoperative software has promising prospect to makeaccurate surgical plan efficiently.

Research progress of regulatory T cells in preeclampsia / 中国医师杂志

Preeclampsia (PE) is characterized by hypertension and proteinuria. Despite extensive research, the etiology and pathogenesis of PE are not completely understood. Increasing evidence suggests that an exaggerated maternal systemic inflammatofrery response may play a central role in the pathogenesis of preeclampsia (PE). Regulatory T cells (Tregs) are a specialized subpopulation of T cells that act as potent suppressors of inflammation to prevent autoimmunity and graft rejection. A reduction in maternal Treg populations could prevent immunological tolerance of the fetus and has been associated with obstetrical complications, such as miscarriage, PE. The research of Treg in immunology is the focus of current research. In this paper, the relationship between the occurrence and development of regulatory Treg in preeclampsia is reviewed.

Clinical features of brucellosis periprosthetic joint infection / 中华骨科杂志

Objective:To explore the clinical manifestations, diagnostic characteristics, treatment strategies and outcomes of patients with brucellaperi prosthetic joint infection (PJI).Methods:The medical records of 6 patients with brucella PJI in the First Medical Center of Chinese PLA General Hospital and the Third Hospital of Hebei Medical University from January 2010 to December 2018 were retrospectively analyzed, including 5 males and 1 female, aged 61.5±11.5 years (range 45-79 years) with body mass index 23.0±2.8 kg/m 2 (range 18.4-26.1 kg/m 2). Five cases lived in the countryside, 1 in the city. Four cases were farmers, while two cases were herder and unemployed. One case had contact history in the epidemic area, and 1 case had been in the slaughter industry. Three cases were with knee PJI, of which 1 patient underwent total knee arthroplasty due to knee joint villous nodular synovitis and 2 patients due to knee osteoarthritis. Three patients had hip PJI of which 1 patient underwent total hip arthroplasty due to spondylitis and hip ankylosis and 2 cases due to femoral head necrosis. Three cases were with acute PJI, while other 3 cases were with chronic PJI. Three cases showed fever, while 5 cases had local wounds swelling. A total of 4 cases were complicated with sinus tracts. Five cases had laboratory examinations on the day of admission of which 3 cases had elevated blood C-reactive protein (CRP) and 5 cases with increased erythrocyte sedimentation rate (ESR). Five cases were with increased blood interleukin-6 (IL-6), 2 cases with increased blood alanine transaminase (alanine transaminase, ALT). All cases had varying degrees of restricted movement of the affected joints. The normal range of motion of the hip joint was from 10° to 130°. The average range of motion of 3 patients with hip joint involvement was from 0° to 75°. The normal range of motion of the knee joint was 10°-135°. Three patients with knee joint involvement had an average range from -8° to 67°. One case showed loosening of the right hip prosthesis with infection and 1 case showed local soft tissue swelling. Other cases showed no obvious abnormalities in X-rays. Two patients who underwent frozen pathological examination during the operation had positive pathological neutrophilcounts. Four cases had positive Brucella culture in joint tissues or synovial fluid (1 case with mixed infection) and 2 cases had blood Brucella antibody positive. Results:Among the 3 cases of acute PJI, two of them were treated with debridement, antibiotics, irrigation and retention. One case was treated with two-stage revision. Among the 3 cases of chronic PJI, one was treated with two-stage revision and 2 were treated with one-stage revision. Brucella-specific antibiotics such as rifampicin and doxycycline were used in the antibiotic treatment with the course of antibiotics 3 to 12 weeks. At the time of discharge, the CRP and ESR dropped to the normal range (CRP 0-0.8 mg/dl, ESR 0-20 mm/1 h) in all cases except for the second case. Interleukin 6 was not tested in the sixth case before discharge. In the remaining 5 patients, the blood interleukin 6 fell to the normal range (0-5.9 pg/ml) in 2 cases, and the blood ALT was in the normal range (0-40 U/L) in 4 cases. The body temperature of the second case was 37.3 ℃, while the other cases dropped below 37.3 ℃. In the second case, fever occurred intermittently after surgery. Thus, the incisionwas reddened and swollen and exuded 2 months after the operation. The patient recovered after intravenous infusion of levofloxacin. Until the last follow-up, all patients had no recurrence of infection. Imaging examination comfirmed that the prosthesis was in good position.Conclusion:For patients with Brucella PJI, Brucella culture positive and Brucella antibody positive have specific diagnostic significance. Different surgical strategies will be adopt based on the patient's symptoms and the duration of infection. Surgery combined with Brucella specific antibiotic treatment can usually achieve satisfied therapeutic outcomes.

Short-term clinical outcomes of robotic-assisted total hip arthroplasty in osteonecrosis of the femoral head patients / 中华骨科杂志

Objective:To explore the radiology and short-term clinical outcomes of MAKO robotic-assisted total hip arthroplasty (THA).Methods:The present study retrospectively reviewed the medical records of 23 patients (32 hips) who diagnosed as osteonecrosis of the femoral head and underwent MAKO THA from August 1st to December 31st, 2018 as MAKO THA group. A total of 23 patients (32 hips) with the same diagnosis underwent manual THA at the same time as conventional THA group. There was no statistical difference between the two groups in terms of gender, affected side, age, height, weight, Body Mass Index (BMI), stage of the Association Research Circulation Osseous (ARCO), preoperative Harris hip score, WOMAC Osteoarthritis Index and limb length discrepancy. The patients in both groups were operated by the same doctors. The MAKO THA group underwent the acetabular preparation and the acetabular shell impaction with the assistance of the robotic arm. The leg length and offset were adjusted under the feedback of the MAKO system. Other intraoperative procedures and postoperative interventions of MAKO THA group were similar as conventional THA group. The operation duration, incidence of complications, the radiograph parameters (version, leg length discrepancy and offset), consistency of acetabular prosthesis position in MAKO operation plan, position in postoperative X-ray, the consistency of acetabular prosthesis inclination, version in MAKO operation plan, angles in postoperative CT and functional scores (Harris hip score, WOMAC Osteoarthritis Index and forgotten joint score) at 6 months and 12 months after operation were compared between the two groups.Results:The operation duration of the MAKO THA group was longer than that of the conventional THA group (101.2±19.9 min, 65.5±5.6 min, t=7.659, P<0.001). In terms of radiograph parameters, the different of version (22.63°±5.58°, 15.98°±7.13°, t=4.156, P<0.001) and limb length discrepancy (0.35±0.30 cm, 0.87±0.43 cm, t=4.775, P<0.001) and offset (0.27±0.19 cm, 0.49±0.16 cm, t=4.155, P<0.001) between the two groups were statistically significant. The MAKO operative plan and postoperative radiographs were measured. The difference of inclination/version were 1.18°±2.52°/2.06°±2.79° ( r=0.846, P<0.001; r=0.810, P<0.001), respectively. The horizontal/vertical directions of the joint rotation center were 2.25±1.08 mm and 2.20±1.28 mm ( r=0.975, P<0.001; r=0.974, P<0.001), respectively. In terms of functional results at 6 months and 12 months after operation, Harris hip score in MAKO THA group and in conventional THA group was 90.2±5.40/89.9±5.23 ( t=0.188, P=0.851) and 93.9±2.31/94.0±2.61 ( t=0.254, P=0.801), respectively. The WOMAC index was 27.3±10.36/29.1±12.03 ( t=0.623, P=0.535) and 16.4±8.39/15.2±8.35 ( t=0.597, P=0.552). The forgotten joint score was 76.3±6.11/73.7±6.84 ( t=1.560, P=0.124) and 81.7±4.52/80.7±5.11 ( t=0.816, P=0.418), respectively. Transient bleeding in the anterior superior iliac spine pin holes were reported in 4 hips after discharge in MAKO THA group, which were healed after dressing change. No other intraoperative or postoperative complication was reported. Conclusion:Robotic-assisted THA were more accurate and stable than conventional THA. The version of robot-assisted THA was closer to the target of 20° with similar discrepancy in leg length and hip offset. The short-term functional outcomes were similar in the two groups. However, the operation duration of robot-assisted THA was prolonged.

Effects of high-fat diet exposure on glucolipid metabolism and ovarian function in offspring of female rats / 中国医师杂志

Objective To explore the effects of high-fat diet exposure on glucolipid metabolism and ovarian function in offspring of female Sprague Dawley rats.Methods Female and male rats were mated in cages at a ratio of 2∶ 1.Pregnant mice were collected and randomly divided into normal feed group (control group) and high-fat and high-glucose feed group (observation group).Female offspring were selected as the research object.After the offspring entering the stage of sexual maturity,the blood was taken from abdominal aorta artery.The contents of serum related factors were determined by automatic biochemical analyzer and enzyme linked immunosorbent assay (ELISA) kit.Hematoxylin-eosin staining (HE) was used to directly observe the distribution and quantity of liver tissue and the quantity and structure of ovarian follicles.Results Compared with the normal control group,the body weight,blood glucose,blood lipids and fat coefficient in high-fat diet rats were significantly increased (P ＜ 0.05).The secretions of estradiol (E2),follicle stimulating hormone (FSH) and luteinizing hormone (LH) in the ovary were significantly reduced (P ＜ 0.05).HE slices showed that compared with the normal control group,there were fat vacuoles in the cytoplasm of hepatocytes,the increase of hepatocyte arrangement gap,the number of adipocytes and the diameter of fat droplets in the observation group.The quantities of primordial follicles and primary follicles in the ovary showed increasing trend in high-fat diet group,and the diameter of follicles was decreased.Condusions High-fat and high glucose diet may cause abnormal glucolipid metabolism.It is speculated that high fat diet may cause ovary to be surrounded by fat through fat accumulation in the abdomen and buttocks of female offspring,which directly leads to dysfunction.

Microbiology analysis of periprothetic joint infection post total hip and knee arthroplasty of 9 centers in Beijing between 2014 and 2016 / 中华外科杂志

Objective@#To investigate the microbiological test, antibiotic sensitivity and surgical treatment of periprosthetic joint infection(PJI) cases in post total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients.@*Methods@#A retrospective cross-sectional survey was conducted on 318 patients who underwent THA or TKA in 9 clinical centers in Beijing from January 2014 to December 2016.The data of microbiology, antibiotic sensitivity and surgical treatment were collected.The average age of patients was (62.3±13.1) years old (range: 21-86 years old), including 145 males and 173 females.The body mass index was (25.6±3.8) kg/m 2 (range: 15.6-38.1 kg/m2).@*Results@#In total, 318 patients had microorganisms detected by periprosthetic tissue culture or synovial fluid culture, 209 cases (65.7%) had Gram-positive bacteria, 29 cases (9.1%) had Gram-negative bacteria, 10 cases (3.1%) had fungi, 3 cases (0.9%) had non-tuberculous mycobacteria, 72 cases (22.6%) were negative, 69 cases (21.7%) had methicillin-resistant bacteria. The antibiotic sensitivity results showed that the overall resistance rate of penicillin, cefuroxime, amoxicillin+clavulanic acid was 79.9%, 69.9%, and 68.1%, respectively; meropenem, vancomycin, and linezolid resistance rate was 0. For the treatment methods of hip and knee PJI, two-stage revision surgery acounted for 72.9% (108/148) and 64.1% (109/170), respectively. One-stage revision surgery accounted for 21.6% (32/148) and 7.6% (13/170), and open debridement surgery accounted for 4.7%(7/148) and 26.4% (45/170).@*Conclusions@#Gram-positive bacteria was still the main pathogen of PJI.The methicillin-resistant bacteria and rare bacteria should be payed attention to. The Majority of hip and knee PJI cases were treated by two-stage revision surgery.

Effects of high-fat diet exposure on glucolipid metabolism and ovarian function in offspring of female rats / 中国医师杂志

Objective@#To explore the effects of high-fat diet exposure on glucolipid metabolism and ovarian function in offspring of female Sprague Dawley rats.@*Methods@#Female and male rats were mated in cages at a ratio of 2∶1. Pregnant mice were collected and randomly divided into normal feed group (control group) and high-fat and high-glucose feed group (observation group). Female offspring were selected as the research object. After the offspring entering the stage of sexual maturity, the blood was taken from abdominal aorta artery. The contents of serum related factors were determined by automatic biochemical analyzer and enzyme linked immunosorbent assay (ELISA) kit. Hematoxylin-eosin staining (HE) was used to directly observe the distribution and quantity of liver tissue and the quantity and structure of ovarian follicles.@*Results@#Compared with the normal control group, the body weight, blood glucose, blood lipids and fat coefficient in high-fat diet rats were significantly increased (P<0.05). The secretions of estradiol (E2), follicle stimulating hormone (FSH) and luteinizing hormone (LH) in the ovary were significantly reduced (P<0.05). HE slices showed that compared with the normal control group, there were fat vacuoles in the cytoplasm of hepatocytes, the increase of hepatocyte arrangement gap, the number of adipocytes and the diameter of fat droplets in the observation group. The quantities of primordial follicles and primary follicles in the ovary showed increasing trend in high-fat diet group, and the diameter of follicles was decreased.@*Conclusions@#High-fat and high glucose diet may cause abnormal glucolipid metabolism. It is speculated that high fat diet may cause ovary to be surrounded by fat through fat accumulation in the abdomen and buttocks of female offspring, which directly leads to dysfunction.

Study on the mechanism of microRNA-210 regulating the immune pathogenesis of Treg cells in pre-eclampsia / 中国医师杂志

Objective The aim of this study was to evaluate the number of Treg cells in preeclamp-sia (PE) patients, to explore the expression levels of microRNA-210 (microRNA-210) and forkhead box p3 (Foxp3) genes in preeclampsia, and to reveal the regulatory mechanism of microRNA-210 and Foxp3 in preeclampsia. Methods Serum levels of cytokines [ interleukin ( IL)-6, IL-10, IL-17, and transforming growth factor-beta 1 (TGF-β1)] were detected with enzyme-linked immunosorbent assay (ELISA). 29 pa-tients with late-onset preeclampsia (≥36 weeks of gestation) , 27 pregnant women with normal uncomplicat-ed pregnancies (≥36 weeks of gestation) and 20 healthy non-pregnant women were enrolled in the study. Reverse-transcription polymerase chain reaction ( qRT-PCR) was performed to detect mRNA expression for maternal placenta retinoic acid-related orphan receptor C (RORc), Foxp3, and miR-210. Foxp3 protein expression was evaluated by Western blot. Results ⑴The serum levels of IL-6, IL-17 and TGF-beta 1 in preeclampsia patients were significantly higher than those in normal pregnant women, and the level of Treg cytokine IL-10 was lower than that in normal pregnant women ( P <0. 05 ) . ⑵ The percentage of CD4 +CD25 +CD127 - /CD4 +T cells in peripheral blood of preeclampsia patients was significantly lower than that of normal pregnancy group and healthy non-pregnant women ( P <0. 001 ) . ⑶ The mRNA expression of Foxp3 in placenta of preeclampsia patients was significantly lower than that of normal pregnant women, RORc in preeclampsia patients was significantly higher than that of normal pregnant women, and the expres-sion of microRNA210 in preeclampsia patients was enhanced ( P<0. 01 ) . ⑷ Consistent with mRNA ex-pression results, lower protein expression levels of Foxp3 was observed in patients with PE compared with normal pregnant subjects. Conclusions Treg cells decreased in preeclampsia patients and Treg/Th17 im-balance existed in preeclampsia patients, which regulate maternal immune tolerance to fetuses. The expres-sion of Foxp3 in placenta of preeclampsia patients was significantly decreased, which was correlated with the expression of microRNA-210.

Clinical application of augmented antibiotic-loaded cement spacer in two-stage infected total hip arthroplasty with acetabular bone defect / 中华骨科杂志

Objective To investigate the clinical outcomes and complications of augmented antibiotic-loaded cement spacer in two-stage infected total hip arthroplasty with acetabular bone defect.Methods The periprosthetic infection (PJI) patients with acetabular bone defect were retrospectively reviewed from January 2007 to June 2016 in our hospital.A total of 26 patients (11 males and 15 females) were eligibly included in the present study.The mean age was 46.7 years old.The two-stage revision arthroplasty included implants removel,meticulous debridement,implantation of antibiotic-loaded cement spacer in firststage.After systemic therapy of antibiotics,the prosthesis was implanted in the second-stage.The supra-acetabular antibiotic cement shelf with screws was used to improve hip stability with acetabular wall defect.The handmade acetabular spacer was able to prevent femoral spacer ifto pelvis in patients with acetabular internal wall defect.The clinical outcomes and complications (spacer dislocation,spacer fracture and acetabular wear) were measured.Results The positive rate of bacteria culture was 80.8％ (21/26)and 57.7％ (15/26) patients were cultured with staphylococcus.The others were 2 fungus,2 Gram-positive rod,1 brucella,1 pseudomonas aeruginosa,1 escherichia coli,1 enterococcus faecalis,1 defective probiotics,1 serratiamarcescens and 1 Kocuriaroseus.Moreover,19.2％ (5/26) patients were mixed infection.There was one patient with spacer dislocation and two with spacer fracture.No patients were recurrent infection.Infection was controlled,and two-stage revision was successfully performed in 24 patients.Twenty-two patients were followed averaging 4.1 years (1-8) and the Harris Hip Score was significantly improved from 40.9± 14.0to 81.2± 11.2 at the final follow-up (P＜0.05).Conclusion The application of augmented antibiotic-loaded cement spacer has satisfactory clinical outcomes in PJI patients with acetabular bone defect.It can provide joint mobility and increase additional joint stability with decreased iatrogenic bone defect caused by acetabular wear.

Effect of fluorofenidone on renal interstitial fibrosis in rats with unilateral ureteral obstruction / 中南大学学报(医学版)

Objective:To investigate the effect of fluorofenidone on renal interstitial fibrosis in rats with unilateral ureteral obstruction (UUO) and to observe the effect of fluorofenidone on the expressions of collagen type Ⅰ (Col Ⅰ),collagen type Ⅲ (Col Ⅲ),α-smooth muscle actin (α-SMA),connective tissue growth factor (CTGF),platelet derived growth factor (PDGF) in the renal tissues of UUO rats.Methods:Male Sprague-Dawley (SD) rats were randomly divided into a sham-operated group,a UUO group,and a flurofenidone group (n=5).UUO model was induced by ligating the left ureter in rats.The rats were treated with 125 mg/(kg.d) fluorofenidone by gastric gavage in the fluorofenidone group at 24 h before the operation,and the rats were treated with the identical dose of 0.5％ sodium carboxyl methyl cellulose (CMC-Na) in the other 2 groups.The rats were sacrificed at 14 days after UUO.Pathological changes of the renal tissue were observed by HE and Masson staining,the mRNA expressions of Col Ⅰ,Col Ⅲ,α-SMA,PDGF and CTGF were detected by real-time PCR,and the protein expressions of Col Ⅰ,Col Ⅲ,PDGF and CTGF were detected by immunohistochemical staining.Results:The renal interstitial damage index,relative collagen area and mRNA and protein expressions of Col Ⅰ and Col Ⅲ in the renal tissues of the rats in the UUO group significantly increased (P＜0.05),and fluorofenidone could reduce these indexes (P＜0.05).Compared with the sham-operated group,the protein expressions ofα-SMA,PDGF,CTGF and the mRNA expressions of PDGF and CTGF in the renal tissues of the rats in the UUO group were increased,but fluorofenidone could decrease the protein expressions of α-SMA,PDGF,CTGF and the mRNA expressions of PDGF and CTGF (P＜0.05).Conclusion:Fluorofenidone (125 mg/kg·d) could attenuate renal interstitial fibrosis through inhibition offibroblast proliferation,myofibroblastic activation,PDGF and CTGF expression.

Accolade Ⅱ short stem for Crowe type Ⅰ developmental dysplasia of the hip in adults / 中国组织工程研究

BACKGROUND:Compared with the cone stem,short stem holds good matching with femoral canal,and remarkably reduces the risk of prosthesis loosening.OBJECTIVE:To further investigate the clinical efficacy of Accolade Ⅱ stem for Crowe type Ⅰ developmental dysplasia of the hip.METHODS:Clinical data of 16 patients with Crowe type Ⅰ developmental dysplasia of the hip undergoing total hip arthroplasty using Accolade Ⅱ stem were collected,the length of both lower limbs before and after surgery was compared,and the Visual Analogue Scale,functional recovery of the hip and general conditions were observed at 12 weeks postoperatively.RESULTS AND CONCLUSION:(1) The change in length of both lower limbs before and after surgery had significant difference (P ＜ 0.05),and 10 patients (62％) with the same length of both lower limbs before surgery,and 15 cases (94％) after surgery.(2) The postoperative acetablar abducent angle was 41°-54° (average 46.9°).(3) The Visual Analogue Scale and Harris hip scores after surgery were significantly improved compared with baseline (P ＜ 0.05).(4) The intraoperative blood loss was 147 mL on average,the mean operation time was 72 minutes,and the hospitalization time was 7.2 days.(5) All patients recovered well and no complications occurred at 3 months postoperatively.(6) To conclude,Accolade Ⅱ stem is safe and reliable for Crowe type Ⅰ developmental dysplasia of the hip,and exhibits good functional recovery of the hip.

Recent developments in diagnosis of periprosthetic joint infection / 中华骨科杂志

Periprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty.Currently,PJI is the main cause for knee revision and the third reason for hip revision.Accurate diagnosis is of quite importance for patients with potential in revision surgery.However,there is no test alone can achieve both perfect sensitivity and specificity in diagnosis of PJI.The following diagnostic methods still have irreplaceable role,including erythrocyte sedimentation rate (ESR),C reactive protein (CRP) test,synovial white blood cell count and polymorphonuclear percentage,bacteria culture and histology analysis.Some novel diagnostic techniques,such as leucocytes esterase strip test,show advantages in diagnosing as fast,convenient and cost-saving.Synovial biomarkers,such as α-defensin,have promising prospect with both high sensitivity and specificity.Among various diagnostic methods,bacteria culture and drug sensitivity test can guide the therapy of PJI.Thus,it is crucial to improve the positive rate of bacteria culture.With the development of technology,sonication and polymerase chain reaction (PCR) will be the future research highlights.Although the imaging technologies,such as labeled leukocyte imaging and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET),have been progressed in the past years,most of them are still in controversy.Further researches are still needed in the future.

The Application of Ureteral Catheter in Complicated Gynecological Laparoscopic Surgery for the Prevention of Ureteral Injury / 中国微创外科杂志

Objective To investigate the application of ureteral catheter in complicated gynecological laparoscopic surgery for the prevention of ureteral injury . Methods A total of 182 cases of gynecological laparoscopic surgery performed from January 2009 to November 2011 were selected as study group .Bilateral ureteral catheters were inserted under cystoscopy , and then laparoscopic surgery was performed under the instruction of the catheter .The catheter was immediately removed after the surgery .A total of 200 cases of laparoscopic surgery were selected as control group and preoperative ureteral catheterization was not applied in this group .The incidence rate of ureteral injury was compared between the two groups . Results The success rate of bilateral ureteral catheterization in the study group was 98.9%(180/182)and no ureteral injury occurred .In the control group, ureteral injury was found in 2 cases, which were converted to open surgery for ureter repair and double J stent was retained .The 2 cases recovered 2 months after the surgery.Bladder injury was found in 2 cases during the surgery , which received immediate repair assisted by surgeons from the department of urinary surgery and recovered 2 months after postoperative catheterization . No statistical difference was found in complication rate between the two groups ( P=0.125 ) . Conclusion The application of ureteral catheterization in complicated gynecological laparoscopic surgery can reduce the risk of intraoperative ureteral injury .

Effect of enalapril on the expression of TGF-beta1, p-Smad2/3 and Smad7 in renal interstitial fibrosis in rats / 中南大学学报(医学版)

OBJECTIVE@#To explore the mechanism of enalapril for renal interstitial fibrosis by observing the effect of enalapril on the expression of transforming growth factor-beta1(TGF-beta1), p-Smad2/3 and Smad7 in renal tissuess of unilateral urethral obstruction (UUO) rat model.@*METHODS@#Thirty female Sprague-Dawley(SD) rats were randomly subdivided into a sham-operated group, a model group and an enalapril treated group. UUO model was induced by ligating the left ureter of rats. All rats were sacrificed 14 days after UUO. Pathological changes of the renal tissue were observed by HE and Masson staining, the protein expressions of Collagen I (ColI), TGF-beta1, p-Smad2/3 and Smad7 were detected by immunohistochemical staining,and the mRNA expressions of TGF-beta1 and Smad7 were detected by RT-PCR.@*RESULTS@#The renal interstitial damage index, the relative Collagen area and the expression of ColI in the model group significantly increased(P<0.01). Enalapril reduced these indexes. The protein and mRNA expressions of TGF-beta1 and the protein expressions of p-Smad2/3 were low in the sham-operated group, but were strongly positive in the model group, and enalapril could decrease the expressions of TGF-beta1 and p-Smad2/3(P<0.01). The protein and mRNA expressions of Smad7 in the model group were less than that in the sham-operated group(P<0.01),and enalapril could improve the expressions of Smad7(P<0.01).@*CONCLUSION@#Enalapril could inhibit the renal interstitial fibrosis by affecting TGF-beta1, p-Smad2/3 and Smad7 of TGF-beta/smads pathway in the renal tissues of UUO rats.

Clinical outcome of 1436 Ribbed anatomic cementless prosthesis / 中国矫形外科杂志

[Objective]To evaluate the clinical outcome of the Ribbed anatomic cementless prosthesis.[Method]A total of 1436 hips in 956 patients undergone THR with Ribbed anatomic cementless prosthesis were reviewed.Between March 1997 and September 2005,1 249 hips in 832 patients were available for clinical and radiological follow-up.The mean follow-up period was 6.7 years with a minimum of 2 and a maximum of 10.5 years.The patients were evaluated with Harris Hip Score and radiographic analysis.[Result]The mean Harris Hip Score increased from 34.7 preoperatively to 91.5 postoperatively.Excellent and good functional improvement was seen in 96.3% of the operated patients.There was neither periprosthetic osteolysis nor evidence of loosening on follow-up radiographs.[Conclusion]Ribbed anatomic cementless prosthesis is found to be performing well with good clinical and radiological result.

Safety evaluation of the patients with single stage multiple joint arthroplasty / 中国矫形外科杂志

[Objective]To evaluate the safety outcome of the 12 patients with simultaneous multiple joint replacement(≥3) in the recent three years.[Method]The complication rates,blood loss,transfusion volume,and hospital stay were analyzed in details.[Result]The mean operating time was 9 hours and 8 minutes(6 hours and 25 minutes to 12 hours).The mean overall volume of blood loss was 3140ml(1 000 ml-5 600 ml.Complications included reactive digestive ulcer in one case,acetabular component position error in one case,and deep infection in one hip of one case.[Conclusion]Simultaneous multiple joint replacement is an alternative protocol to the patients with multiple joint disorders.finished under a single aesthesia and in a single hospital stay.So the overall economical cost will be decreased,and rehabilitation being accelerated.Disadvantages include serious trauma,increased blood loss,and complications may be some how increased.

Arthroscopically assisted radiofrequency vaporization for the treatment of congenital muscular torticollis in teenagers / 中国微创外科杂志

Objective To discuss the curative effect of arthroscopiclly assisted radiofrequency tenotomy of the sternocleidomastoid muscle for the treatment of congenital muscular torticollis in teenagers. Methods A total of 12 patients (right, 4 patients; left, 8 patients) were enrolled in the study. A 3-mm skin incision was made at the site 5 cm below the sternoclavicular joint. A dissector was inserted through the incision to perform blunt dissection subcutaneously until the attachment points of the sternocleidomastoid muscle. After a subcutaneous operative space 3 cm ? 3 cm in size was created, a 30? wide-angle arthroscope was placed. Another incision was located at the site 5 cm below the mid-clavicle for placing the bipolar radiofrequency probes (Arthrocare 2000). Under the assistance of arthroscopy, the sternocleidomastoid muscle was severed from the attachment at the both sides. Results The operation time was 15~30 min (mean, 20 min). No intraoperative hemorrhage or vascular and nervous injuries were observed. Follow-up for 5~10 months (mean, 7 months) in the 12 patients found normal appearance and no recurrence or diplopia. Conclusions Arthroscopiclly assisted radiofrequncy therapy for congenital muscular torticollis is characterized by simplicity of manipulation, micro-invasion, and satisfactory curative effect.

The application of debridement with arthroscopy in acetabular dysplasia with osteoarthritis / 中华骨科杂志

Objective To study the application of debridement with arthroscopy in acetabular dysplasia with osteoarthritis. Methods Thirty-two cases in 48 hips acetabular dysplasia with osteoarthritis debrided under the arthroscopy. In this group, male 9 and female 23, the mean age was 38.1 years old (range, 28-52 years old), the left side for 9, right side for 7 and bilateralis for 16. In the 48 hips, X-ray showed that comparatively large acetabular draw with normal position of femoral head in 21 cases (28 hips), large acetabular draw with femoral head lateral shift slightly but did not exceed 1/3 of femoral head in 11 cases (20 hips).MRI demonstrated that intraarticular fluid in 28 hips, subcartilage anormal signal of acetabular and femoral head at weight loading region in 10 hips, signal interruption of glenoid lip of hip in 10 hips. The procdure which included to remove of osteophyma, loose body and hyperplasia synovial membrane, degenerated cartilage on the stress areas of the hip joint, wear and tear of glenoid lip. Results The perianal skin in 2 patients suffered dysesthesia because of the over traction during operation. They recovered 7 days postoperation. Dysesthesias twenty-eight patients (36 hips) were follow-up with an average of 23 months (range, 6 months-3.5 years). After debridement and lavage, the patients released from pain, restored function and the range of the motion. According to VAS evaluation system for pain, the preoperative score was 5-9, with an average of 6.8; the postoperative score was 4-6, with an average of 2. According to Harris hip joint score evaluation system, preoperative score was 58.8?6.15, postoperative score was 89.6?11.3. The excellent in 20, good in 4, fair in 3 and poor in 1. The excellent and good result was up to 85.7%. Conclusion Selectivity debridement and lavage were effective methods for osteoarthritis hip joint acetabular dysplasia. It can delay the developing of course of disease; improve clinical symptom and elevate quality of life.