ABSTRACT
<p><b>BACKGROUND</b>Avascular necrosis of femoral head (AVNFH) typically presents in the young adults and progresses quickly without proper treatments. However, the optimum treatments for early stage of AVNFH are still controversial. This study was conducted to evaluate the therapeutic effects of multiple small-diameter drilling decompression combined with hip arthroscopy for early AVNFH compared to drilling alone.</p><p><b>METHODS</b>This is a nonrandomized retrospective case series study. Between April 2006 and November 2010, 60 patients (98 hips) with early stage AVNFH participated in this study. The patients underwent multiple small-diameter drilling decompression combined with hip arthroscopy in 26 cases/43 hips (Group A) or drilling decompression alone in 34 cases/55 hips (Group B). Patients were followed up at 6, 12, and 24 weeks, and every 6 months thereafter. Radiographs were taken at every follow-up, Harris scores were recorded at the last follow-up, the paired t-test was used to compare the postoperative Harris scores. Surgery effective rate of the two groups was compared using the Chi-square test.</p><p><b>RESULTS</b>All patients were followed up for an average of 57.6 months (range: 17-108 months). Pain relief and improvement of hip function were assessed in all patients at 6 months after the surgery. At the last follow-up, Group A had better outcome with mean Harris' scores improved from 68.23 ± 11.37 to 82.07 ± 2.92 (t = -7.21, P = 0.001) than Group B with mean Harris' scores improved from 69.46 ± 9.71 to 75.79 ± 4.13 (t = -9.47, P = 0.037) (significantly different: t = -2.54, P = 0.017). The total surgery effective rate was also significantly different between Groups A and B (86.0% vs. 74.5%; χ2 = 3.69, P = 0.02).</p><p><b>CONCLUSION</b>For early stage of AVNFH, multiple small-diameter drilling decompression combined with hip arthroscopy is more effective than drilling decompression alone.</p>
ABSTRACT
<p><b>OBJECTIVE</b>To explore the effects of the shock wave on the capacity of mesenchymal stem cells(MSCs) to proliferate and differentiate into osteoblasts.</p><p><b>METHODS</b>MSCs were isolated from the bone marrow of healthy donors. The human bone marrow MSCs(BM-MSCs) were divided into 3 groups including blank control group,osteoinduced group and shock wave group. The MSCs in blank control group were cultured with common mediam; the MSCs in osteoinduced group were treated with osteogenic agents and cultured; the MSCs in shock wave group were cultured with common medium and stimulated by shock wave. The morphology of MSCs in each groups were observed by micoscopy; the CCK-8 was used to detect the proliferation ability of MSCs; the alkaline phosphatase staining and von Kossa staining were used to evaluale the differentiation potential of MSCs in each groups.</p><p><b>RESULTS</b>The results of CCK-8 revealed the shock wave could promote cell proliferation as compared with blank control group. The results of alkaline phosphatase and Von Kossa staining showed that the shock wave displayed a stronger ability to promote the human BMMSC differentiation into osteoblasts cells in comparison with the osteoinduced group. The blank control group was weakly positively stainined.</p><p><b>CONCLUSION</b>The shock wave treatment can promote proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells.</p>
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the clinical effects of popliteal cyst excision combined with debridement of the knee under arthroscopy with local anesthesia.</p><p><b>METHODS</b>From February 2009 to August 2014, 52 patients with popliteal cysts were treated in our hospital, including 34 males and 18 females with an average age of 43.6 years old ranging from 14 to 62 years old; 29 cases were on the right knee and 23 on the left knee. Preoperative diagnosis was performed according to MRI findings and to determine whether other knee disorders were associated with the disease, 52 patients were diagnosed as popliteal cyst before operation; 23 cases of simple meniscus injury or cartilage injury, 18 cases of osteoarthritis, 7 cases of cruciate ligament injury, 2 cases of gouty arthritis, 1 case of rheumatoid arthritis, 1 case of pigmented villonodular arthritis. The preoperative clinical manifestations involved knee swelling in 21 cases, knee joint pain in 16 cases, joint lock in 8 cases, leg weakness in 4 cases, and knee joint snapping in 4 cases. Cyst size was 4.0 cm× 3.3 cm to 6.2 cm× 5.3 cm. According to the Rauschning and Lindgren standards, 1 case was grade I, 9 cases were grade II, 42 cases were class III. The rehabilitation plan should be made according to the patient's specific injuries and intraoperative management. During the postoperative follow-up, the postoperative curative effect was evaluated by the standard grading of Rauschning and Lindgren of popliteal cyst.</p><p><b>RESULTS</b>All the incisions healed by first intention, and no complications occurred. All the cases were followed up from 25 to 64 months (averaged 39.6 months). For the Rauschning and Lindgren grading, 43 cases were grade 0, 8 cases were grade I, 1 case were grade II.</p><p><b>CONCLUSIONS</b>Local anesthesia under arthroscopy and popliteal cyst removal knee joint cavity debridement is effective, less trauma, quick recovery, short term effect is good. The recurrence rate is also low because of the primary disease of the knee joint is also treated. After the operation, the rehabilitation plan should be made according to the intraoperative treatment and actively trained so as to recover at an early date.</p>