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Objective To investigate the surgical strategy and outcome for occipitocervical extramedullary tumors.Methods 15 patients with occipitocervical extramedullary tumors from January 2007 to July 2010 were reviewed retrospectively.There were 7 males and 8 females with an mean age of 44.6 years (range,21-72 years).All cases were intradural tumors,including 7 cases in dorsolateral,5 cases in lateral side,and 3 cases in ventralis of spinal cord.Functional and neurological statuses were assessed using the Frankel grade and Japanese Orthopaedic Association (JOA) scale.According to Frankel grade system,there were 4 patients with Grade C,8 with Grade D,and 3 with Grade E.The mean preoperative JOA score was 10.5±3.6.Based on the tumor site,there were 5 cases in medulla oblongata-C1 and 10 cases in C1,2.Frankel grade and JOA score were used to evaluate neurological status and general health.The improvement of symptoms and characteristics of surgical strategies were analyzed.Results All cases were followed up for 2-4 years (mean 2.8 years).Complete resection of tumor and good fusion of bone graft were found in radiography postoperatively.The pathological diagnoses included 10 cases of schwannoma,3 cases of meningioma and 2 cases of neurofibroma.There was statistical difference between the preoperative and the final follow-up functional and neurological statuses including Frankel grade and JOA score.At the latest follow-up,2 cases improved from Frankel grade C to D,2from C to E,6 from D to E,but none in 2 cases with grade D.The mean JOA score at final follow-up was 15.6±1.6,and the average improvement rate was 80.7％± 17.4％.The mean preoperative C0-2 angle was 27.0°±4.1 °,and C2-7 angle was 16.8°± 12.7°.C0-2 angle was 27.6°±8.8°,and C2-7 angle was 10.2°±6.8° at the latest follow-up.However,these differences did not reach statistical significance.Conclusion Surgical treatment can effectively maintain or improve neurological function and improve quality of life.Extramedullary tumors can be resected completely by posterior approach,and spinal stabilization can be obtained satisfactorily through selecting appropriate surgical strategies.For medulla oblongata-C1 level,occipitocervical fusion is usually chosen after extirpation of tumor.For C 1,2 level,C1,2 fusion after tumor resection is useful in preventing atlantoaxial instability.
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Objective: TO evaluate the effect of custom-made artificial total knee prosthesis replacement on pathological fracture of distal femur caused by giant cell tumor of bone. Methods." A total of 12 knees of 12 patients with pathological fracture of distal femur caused by giant cell tumor of bone were treated with cus-tom-made artificial total knee prosthesis replacement. There were 5 males and 7 females aged from 23 to 40 years (34.2 years on average). Results: All patients tolerated surgery very well. The surgical duration was 120～ 180 rain and the intraoperative bleeding was 500 ～ 900mL. The drainage tube was taken out in 5 days after surgery. The postoperative drainage volume was 300 ～ 700mL. There were no postoperative complica-tions. The postoperative X-ray examination showed that all of the prosthesises were in the right position. Lo-cal pain disappeared in all patients after surgery. The pathological examination identified all the patients with giant cell tumor of bone. All patients were followed up for 18 ～ 30 months (24 months on average). No recur-rence was observed after surgery. No infection or implant loosening occurred during the follow up. According to the Enneking assessment system of function after limb salvage surgery, the mean Enneking scale was 23.8 points (ranged from 15 to 28 points) at the last follow-up visit. Conclusion: Custom-made artificial total knee prosthesis replacement can achieve a high satisfactory rate in clearance of lesion and restoring function of the knee in patients with pathological fracture of distal femur caused by giant cell tumor of bone, improving patients' quality of life.
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BACKGROUND: Autologous bone, bone substitute materials and guided bone regeneration (GBR) technique can repair jaw defects, but the absorption speed of bone substitute materials and GBR membrane are faster than the formation speed of new bone, therefore, it affects the volume and shape of new bone.OBJECTIVE: To investigate the role of personalized prefabricated titanium template, autologous bone and nano-hydroxyapatite on restoration of maxillary defect in rabbit.METHODS: A total of 18 rabbits were randomly divided into two groups, and maxillary alveolar defect with 10 mm length and 5 mm high was created. The template was implanted in both two groups, and fastened with titanium screws. Autologous and nano-hydroxyapatite were placed into the defect in experimental group; neither autologous bone nor bone substitute materials were implanted into the defect in control group. New bone formation, X-ray findings, and histological changes with HE stain were carded out 4, 8 and 12 weeks postoperatively.RESULTS AND CONCLUSION: The quality of new bone in experimental group was batter than that in control group 4 weeks postoperatively, but the quality of new bone was almost the same 8 and 12 weeks postoperatively. By paired t-test, there was significant difference in new bone density between the experimental group and the control group 4 .weeks after operation (P<0.01), but there was no significant difference in new bone density between the experimental group and the control group 8 and 12 weeks after operation (P > 0.05). Autologous bone and nano-hydroxyapatite can restore the defect of maxillary alveola.Personalized prefabricated titanium template can play an important role of screen membrane and external scaffold in new bone formation, and remain shape of new bone.
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BACKGROUND: With the development of n0eo-adjuvant chemotherapy, 5-year survival rate of bone tumors has significantly increased. Limb salvage has replaced amputation to become a major means of treating knee tumors and has achieved good results. OBJECTIVE: To investigate and compare the effect of knee joint reconstruction using hinge-knee system and rotating knee system. DESIGN, TIME AND SETTING: Comparative observation. The patients were selected from Department of Spine and Orthopedic Surgery, First Affiliated Hospital of Gaungxi Medical University between June 1999 and March 2006. PARTICIPANTS: A total of 72 patients with tumor round the knee were selected from the First Affiliated Hospital of Gaungxi Medical University, and 9 cases were lost in follow-up. Of the remaining 63 cases, there were 35 males and 28 females, aged 31 years (range, 15-58 years); 40 cases underwent knee joint reconstruction using hinge-knee system and 23 using rotating knee system. METHODS: The tumor excision of superior tibia was performed according to Ennecking principle. After joint reduction of hinge-knee prosthesis, the bolt was adjusted and locked; the high polymer polyethylene pad was placed in rotating knee system, and the joint rotation axis was assembled. The tumor excision of inferior tibia was performed from the medial thigh along medial vastus muscle posterior margin till medial patellar ligament of superior tibia. After joint reduction of hinge-knee prosthesis, the bolt was adjusted and locked; the high polymer polyethylene pad was placed in rotating knee system, and the joint rotation axis was assembled. MAIN OUTCOME MEASURES: The treatment effect was evaluated according to MSTS functional scores, ambulation scores, flexion-extension-angle, knee rotation and infection, relapse and operative time. RESULTS: The 63 patients were followed up for 9 months to 8 years. In hinge-knee system group, operative time was (2.663±0.336) hours; there were 5 cases of relapse, 3 cases of metastasis/death and 2 case of infection. In rotating knee system group, operative time was (2.572±0.288) hours; there were 3 cases of relapse, 2 cases of metastasis/death, and 2 case of infection. One case in rotating knee system group developed fracture and dislocation of the polyethylene bush of rotating axis and there was no syndrome after changing fittings. No prosthesis loosening was found in two groups. With exception of patients with relapse and metastasis/death, 50 cases were evaluated, and no significant difference was found in MSTS scores between two groups (P > 0.05); the total score and single item score of ambulation scores in rotating knee system group were significantly greater than hinge-knee system group (P < 0.05). The extension angle in two groups reached or was close to 0°, and the flexion-extension angle of hinge-knee system group (119.375±17.490)° was similar to rotating knee system group (125.000±15.340)° (P=0.260). CONCLUSION: The rotating knee system displays superior function than hinge-knee system in knee salvage after surgery. Ambulation scores revealed that the knee joint function of the rotating knee system is superior over hinge-knee system, while the MSTS scores did not. Therefore, ambulation scores is more sensitive and appropriate to evaluate the function after knee salvage. There were no significant differences in operative time and flexion-extension ability and syndrome between two methods.
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Objective To study the biological effects of cathepsin B phosporotbioated antisense oligodeoxynucleotide on human osteosarcoma cell line MG-63 after transfection. Methods A 18-mer phosphorothioate antisense oligodeoxynucleotide (ASODN) targeted against the cathepsin B mRNA was transfected into the human osteosarcoma cell line MG-63 by lipofectamine 2000. The sense and nonsense oligodeoxynucleotides to cathepsin B and blank vector were used as controls. The expression of cathepsin B mRNA was examined by RT-PCR and the expression of cathepsin B was examined by Western blot. The invasive capability of MG-63 cells was evaluated by the boydern chamber assay. Results The expression of cathcpsin B was obviously inhibited in antlsense oligodeoxynucleotide treated cells compared with the control cells. The number of invading MG-63 cells was significantly lower in the ASODN-treated groups than that in the control groups. Conclusion The cathepsin B ASODN significantly inhibits the expression of cathepsin B and invasive ability of MG-63 cell in osteosarcoma.
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BACKGROUND: The standardized treatment for patients who require total hip replacement is the implantation of an intramedullary diaphyseal anchored hip prosthesis. A bone-sparing non-stemmed hip prosthesis (NSHP) can be used as an alternative device for young patients. The NSHP relies on proximal femoral metaphyseal and neck fixation. The theoretic advantage of leaving diaphyseal bone intact is easier conversion to a stemmed prosthesis. On the other hand,clinical investigations published reported THR had high loosening rate of the prosthesis, which greatly limits its long-term clinical results; the aim of NSHP is to give the femoral prothesis a kind of biological fixation to decrease the loosening rate of the prosthesis. This retrospective study evaluated the medium- and short-term results after total joint replacement using NSHP.OBJECTIVE: To evaluate the outcome of NSHP for the treatment of young patients with hip disorders.DESIGN: Case analysis.SETTING: Department of Orthopaedics, the First Affiliated Hospital of Guangxi Medical University.PARTICIPANTS: Fifteen patients (17 hips) with hip disorders, who were treated at the Department of Orthopaedics,First Affiliated Hospital of Guangxi Medical University between 2001 and 2005, were retrieved. The involved patients included 8 males and 7 females. They were aged (37.8±9.8) years ranging from 21 to 49 years when they underwent operation. Indications for implantation included avascular necrosis (7 hips), posttraumatic osteoarthritis(4 hips), primary osteoarthritis(3 hips), osteoarthritis secondary to dysplasia(3 hips). Informed consents were obtained from all the patients before operation. The neotype of non-stemmed hip prosthesis (NSHP) was made of Co-Cr-Mo casting alloy with good biocompatibility by Shanghai Fusheng Medical Equipment Co., Ltd (Guoyao guanxie (shi) No. 2002-3040397; Guoshi Yaojianxie(zhun) No. 2005-3460799).METHODS: Fifteen patients (17 hips) with hip diseases subjected to the replacement of total hip with NSHP. Patients were followed-up once every other 6 months in the postoperative first year, then once every year, 5 years in total. The follow-up visit included functional evaluation and X-ray evaluation. ① Functional evaluation: Evaluative criteria of Harris joint function scale were adopted: full marks (point) =100, ≥ 80 excellent, ≥ 60 good, 40 fair and ＜ 40 poor; The following clinical data were documented: relief of pain, ability to lie on the operated side, additional procedures, use of pain medication, postoperative hip dislocations and so on. Pain was evaluated by using visual analogue scale (VAS),which ranged from 0 (no pain) to 10 (worst possible pain). ② X-ray evaluation: A standardized radiographic assessment was performed using an anteroposterior view of the pelvis. The following radiological data were recorded: preoperative grade of osteoarthritis as classified according to the method from Busse et al, preoperative grade of femoral head necrosis as classified according to the method from Ficat et al, inclination angle of the operated and the untreated side,radiolucencies according to the method of Buergi et al, heterotopic ossifications, as classified according to the method of Brooker et al. Postoperative adverse events and complications were observed and revision operation was needed if necessary.MAIN OUTCOME MEASURES: Correlative conditions of patients who were followed up for 5 years: ① Inserting angle of prothesis and the collodiaphyseal angle in the opposite side. ②Radiolucency and heterotopic ossification classification.③preoperative osteoarthritis classification, preoperative avascular necrosis of femoral head classification. ④ Revision operation, adverse events and complications. ⑤ Postoperative functional evaluation: Relief of pain (Harris joint function score), ability to lie on the operated side, additional procedures, use of pain medication, postoperative hip dislocations and VAS results.RESULTS: Fifteen patients were involved. One patient was lost after 3-month treatment and the other patients were followed up for 5 years. ① Postoperative functional evaluation results of patients. In the postoperative 5-year follow-up visit, hip joints of 13 patients (15 hips) were still in situ, pain lessened or disappeared in 11 patients (84.6% ,11/13),12 patients(92.3%, 12/13) would undergo the procedure again, 10 patients (76.9%, 10/13) were able to lie on the operated side; The average of Harris hip score was (72±19.6). The average Harris hip score did not vary significantly between the different diagnosis groups (P ＞ 0.05). Postoperative VAS was 2.6±2.2 on average. There was no significant difference in the hip joint pain among different diagnosis groups (P ＞ 0.05); Nine patients required no pain medication (69.2%,9/13).Two patients (15.4% ,2/13) occasionally took nonsteroidal anti-inflammatory drugs and two patients (15.4% ,2/13) took nonsteroidal anti-inflammatory drugs on a regular basis. ② X-ray evaluation results of patients: Preoperative osteoarthristis classification: One hip had grade 1 joint degeneration, 3 hips had grade 2 joint degeneration and 6 hips had grade 3 degeneration. Preoperative avascular necrosis of femoral head classification: Out of 7 patients with avascularnecrosis of femoral head, 4 patients had stage 3 femoral head necrosis, and 3 patients had stage 4 femoral head necrosis. In the postoperative 5-year follow up, 1 patient had radiolucency. Because the range of radiolucency was very small, progression was not quick and clinical symptoms were not severe, so revision operation was not conducted;In the postoperative 6th month, the inclination angle averaged (135.2±6.8)° on the untreated side and (132.2±6.5)° on the treat side. One patient with congenital hip dysplasia and a previous varus derotational osteotomy had a postoperative inclination angle below 120°. Patients with postoperative inclination angles between 125° and 140° had significantly less hip pain than the rest of the series. Heterotopic ossifications classification: Three patients had postoperative heterotopic ossifications, one hip had grade 1 heterotopic ossification, 1 hip had grade 2 heterotopic ossification, and 1 hip had grade 3 heterotopic ossification.③ Revision operation: one patient (5.9%,1/17)required a revision total hip arthroplasty due to pain. Good bone stock of the proximal femur was found in the patient which allowed implantation of a conventional medullary anchored prosthesis. This revision surgery and postoperative rehabilitation were uncomplicated.④ Adverse events and complications: Hip dislocation occurred postoperatively in one patient (5.9%,1/17). Other complications included trochanter bursitis (n=1), fistula (n =1), and seroma (n =1).CONCLUSION: ① NSHP provides biological fixation for femoral prothesis by bone proliferation through the windows with connective tissues surrounding the prothesis and has the characteristics of low stress and deformation, high intensity and rigidity, and anti-loosening, thus, may prolong its live lime. ②Revision surgeries are facilitated by the good bone stock remaining in the proximal femur. ③ The short- and medium-term therapeutic effects of total hip arthroplasty are satisfying in young patients.
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[Objective]To assess the efficacy of autograft fusion and anterior spinal stabilization as an alternative treatment for tuberculosis lesion of the lower cervical spine. [Methods]Thirty patients with tuberculosis of the lower cervical spine underwent anterior decompression and fusion.There were 22 male and 8 female with the age from 24 to 58 years(mean age,37 years).The involved area included 2 vertebral bodies in 21 patients,3 vertebral bodies in 9 patients.Combined chemotherapy was delivered to each patient for at least three weeks preoperatively.There were 5 patients with Frankel Grade B,5 with Grade C,13 with Grade D and 7 with Grade E.The mean kyphosis angle were 12?.[Results]The patiets stood surgery well.The operation time was 70～100 min and the bleeding during operation was 50～150ml.There was no postoperative complication.All patients were followed up for 24～36 months.At the last follow-up visit,5 cases with Frankel Grade B improved to Grade D,3 cases with Grade C improved to Grade D,2 cases with Grade C improved to Grade E,13 cases with Grade D improved to Grade E.There was no breakage of nails or failure of the internal fixation during the follow up.Stable bone union was observed in all cases and the average time required for fusion were 6.5 months.[Conclusion]Anterior debridement and autograft with internal fixation is a safe and effective method for treatment of the lower cervical tuberculosis.
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0.05).Ambulation scores revealed significant difference (P
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BACKGROUND:Research about the repair of articular cartilage with heterograft chondrocytes is frequently reported, but the method may cause immune rejection. Since the embryonic cells possess lower antigenicity and stronger proliferation capability, it is hoped that they can be used as a novel carrier substitute in tissue engineering research.DESIGN: A randomized grouping observation and comparative experiment.SETTING: Histological Embryonic Laboratory in Guangxi Medical University.MATERIALS: A big white adult New Zealand rabbit pregnant for 4 weeks was adopted; and another 24 big white adult New Zealand rabbits were selected, with no limitationin whether they were female or male and with a body mass of 2 to 2.5 kg.METHODS: This experiment was carried out at the Histological Embryonic Laboratory in Guangxi Medical University between December 2000and June 2002. The models of defects in articular cartilage were made artificially in femur medial malleolus of the mature rabbits. In the experimental group, defects were repaired by the implantation of Fibrin Sealant and embryonic chondrocytes mixture, but for the control group, only Fibrin Sealant was implanted or nothing was done about the defect. The restoration of articular cartilage defect was then observed 4,8 and 12 weeks after the operation, and was scored according to modified Pineda's method. The standard consists of 5 items, I.e., cellular morphology, matrix staining, surfacing smoothness, cartilage thickness and host union. 0 refers to normal and the higher the score is, the more serious the pathological changes are.MAIN OUTCOME MEASURES: ①The general observation of rabbit knee joint; ② Histological observation of rabbit knee joints; ③ Histological semi-quantitative score of articular cartilage; ④ Appraisal of the curative effect of articular cartilage defects.RESULTS: Totally 24 rabbits were enrolled in this experiment and all entered the stage of result analysis. ① The general observation of rabbit knee joint: In embryonic chondrocytes plus fibrin sealant group, the color in defect area was basically the same as that of the normal cartilage, showing a strong quality and better elasticity with the boundaries from the surrounding cartilage approximately vanishing. In Fibrin sealant group and the control group, the defect did not heal completely, but the defect area became small and filled with white fibrous tissues. ② Histological observation of rabbit knee joints: In embryonic chondrocytes plus fibrin sealant group,tissues were predominated by hyaline cartilage, with bone tissues appearing in deeper position, and the surface was slightly raised or smooth, and the matrix showed normal staining, and were completely united with the surrounding cartilage and the division line was not clear. There was no lymphocyte infiltration in the tissues. In Fibrin sealant group and the control group, tissues were predominantly fibrous tissues, and part of them showed obvious residual hollow scar, connecting or partly connecting with the surrounding tissues. ③ Histological semi-quantitative score of articular cartilage: According to modified Pineda's method, the scores of embryonic chondrocytes plus fibrin sealant group after 12 weeks were obviously lower than those of the fibrin sealant group and the control group [(0.50±0.76) vs (7.88±1.13), (8.13±1.36), P ＜ 0.05]; moreover, the difference between pure fibrin sealant group and the control group was of statistical significance 4weeks after the operation (P ＜ 0.05), but there was no obvious difference 8and 12 weeks after the operation. ④Appraisal of the curative effect of articular cartilage defects: 12 weeks after the operation, in the embryonic chondrocytes plus fibrin sealant group, the defect of 8 cases healed completely. In fibrin sealant group 1 case healed but not completely, and 7cases did not get repaired for their defect. In the control group, 8 cases failed to get their defect repaired.CONCLUSION: The repaired tissues in embryonic chondrocytes trans plantation group were basically the same as normal cartilage, obviously superior to the fibrin sealant group and the control group, suggesting that such method is feasible in the repair of articular cartilage defects.
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Objective To summarize the surgical techniques to treat complex stale acetabular fractures through combined approaches. Methods From February 1993 to September 2005, 21 cases (12 males, 9 females, mean age of 33 years old) of complex stale acetabular fracture were treated with open reduction and internal fixation through combined approaches (K- L+ ilio- inguinal). Of the 21 fractures, 3 were transverse and posterior wall ones, 4 T- shaped ones, 11 both column ones, and 3 hemi- transverse and anterior column ones. Results 12 cases (57.1% ) got anatomic reduction, 5 cases satisfactory reduction (23.8% ), but 4 cases unsatisfactory reduction (19.1% ). The rates of anatomic reduction for the early 6 years and for the latest 6 years in this study were 44.4% and 66.7% respectively. 15 cases were followed up for 2 to 12 years. The excellent and good rate for clinical and roentgenographic results were 65.3% and 67.2% respectively. The clinical results for anatomic and non- anatomic reduction groups were 78.6% and 32.8% respectively (P
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0.05). The stained neuronal cells were seen at spinal cord anterior horn under the reverse tracing by horse radish peroxidase (HRP). Conclusions There is no significant difference in repair of peripheral nerve defects between embryonic spinal cord transplantation and nerve allograft in the aspects of immunology, electrophysiology, muscular humidity and density, and histology.
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Objective To evaluate the short and middle-term outcome of metal surface hemiarthroplasty in treatment of femoral head osteonecrosis. Methods Forty-one patients (forty-eight hips) with average age of 40 years were performed hemi-arthroplasties and followed up for minimum 3 years. Thirty-five cases were at the stage of Ficat Ⅲand 13 at the stage Ⅳ and their acetabular were relatively normal. Measurements of the hip reconstruction were made on the anteroposterior pelvic radiograph assisted with computer. The outcome of metal surface hemi-arthroplasty and the correlation between the orientation of the femoral component and the migration of implant was evaluated. Results The mean duration of follow-up was 5.2 years. The average UCLA hip score was improved significantly (P