Multivariate analysis of varus after Oxford unicompartmental knee arthroplasty / 北京大学学报(医学版)

OBJECTIVE@#To analyze the preoperative influencing factors of varus after Oxford unicompartmental knee arthroplasty.@*METHODS@#A total of 660 patients (767 knees) undergoing Oxford unicompartmental knee arthroplasty in adult joint reconstruction surgery department of Beijing Jishuitan Hospital from January 2018 to December 2019 were retrospectively analyzed. Inclusive criteria: diagnosis was osteoarthritis, single compartment lesions in the medial side of the knee; preoperative flexion deformity was less than 10°, active range of motion was greater than 90°; preoperative X-ray full-length images of both lower limbs showed less than 15° varus (Noyes method); anterior cruciate ligament was well functioned, The cartilage of lateral compartment of knee joint was intact.@*EXCLUSION CRITERIA@#combined with other inflammatory arthropathy; combined with extraarticular deformity; previous knee surgery history. The average age of the patients was (64.4±8.1) years, including 153 males and 497 females. The degree of post-operative varus was measured with Noyes method. The total patients were divided into varus group (Noyes≥3 °) and normal group (Noyes < 3 °). Gender, age, body mass index (BMI), range of motion (ROM), preoperative flexion deformity (FD), American Knee Society pain score (AKS) and American Knee Society function score (AKS function) were recorded. The standard anteroposterior and lateral X-ray films of knee joint and full-length lower extremity kinematic line films were taken by Sonialvision Safine Ⅱ (Shimadzu, Japan) multi-function digital tomography system. The image was measured by picture archiving and communication system (PACS). The following angles were measured preoperative Noyes angle, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA) and joint line converge angle (JLCA) were measured and analyzed.@*RESULTS@#Gender(P=0.346), operative side (P=0.619), age (P=0.746), BMI (P=0.142), preoperative ROM (P=0.102), preoperative knee pain score (P=0.131) and functional score (P=0.098) were not risk factors for postoperative varus. The influencing factors of postoperative varus were preoperative MPTA < 84 ° (P= 0.018, OR= 3.712, 95%CI: 1.250-11.027), preoperative Noyes > 5°(P=0.000, OR= 3.105, 95%CI: 1.835-5.254), preoperative FD > 5° (P= 0.001, OR=1.976, 95%CI: 1.326-3.234). Pre-operative LDFA (P=0.146) and preoperative JLCA (P= 0.709) had no significant effect on postoperative kinematic line.@*CONCLUSION@#Patients with severe preoperative varus, especially those with varus deformity mainly from the tibial side, and those with preoperative flexion deformity are more prone to get varus lower extremity kinematic line after Oxford unicompartmental knee arthroplasty.

Analysis on the response measures and outcomes of four epidemics of infectious diseases in Shanghai based on a time axis / 上海预防医学

Objective To compare the response measures and outcomes of SARS-CoV(2003), H1N1 influenza(2009), H7N9 influenza(2013)and COVID-19(2020)in Shanghai and provide scientific evidence for the emergency response of public health emergencies. Methods We compared the response measures and outcomes of the four epidemics in Shanghai in the aspects of government response, prevention and control system, scientific and technological support, social mobilization and prevention effects, using critical incident analysis based on the time axis of the epidemics from literature review. Results In response to the four epidemics of infectious diseases occurred in 2003-2020, Shanghai has generally made some significant effort and flexible measures in the first month of the epidemics, including"closure of live poultry markets"and"three closed-loops and four 100% coverage"and other specific prevention and control measures, which have enhanced the prevention and control system. However, we identified that the construction of prevention and control system for public health emergencies remained inefficient, compared to rapid economic development. The majority of the construction measures were principally post-epidemic. In addition, there were many challenges, such as passive response, temporary response teams and measures, and difficulties in the flexible bottom-up response for residents, families and industries without standard operating procedure and guidelines. Conclusion It may be an effective measure for the prevention and control of infectious diseases to build joint prevention and control measures with mass participation and regular drills, in the perspectives of strategic, tactical and operational levels of epidemic prevention and control.

Effect of warm joint needling plus rehabilitation on the balance function and quality of life of patients with spastic hemiplegia after ischemic cerebral stroke / 针灸推拿医学（英文版）

Objective:To observe the effect of warm joint needling plus rehabilitation techniques on the balance function and quality of life (QOL) of patients with spastic hemiplegia after ischemic cerebral stroke.Methods:Ninety patients with spastic hemiplegia after ischemic cerebral stroke were randomized into a rehabilitation group,a warm joint needling group and an observation group,with 30 cases in each group.The rehabilitation group was intervened by Bobath therapy,the warm joint needling group was treated with joint needling on the affected side plus warm needling,and the observation group was given the same rehabilitation treatment as the rehabilitation group together with the same warm joint needling as the warm joint needling group.The three groups were treated once another day,1 month as a treatment course for 6 months.Before the treatment,and respectively after 2-week,1-month,3-month,and 6-month treatment,the modified Ashworth scale (MAS) was used to measure the anti-spasm ability of the lower limb,the Berg balance scale (BBS) was adopted to evaluate the balance function,and the stroke-specific quality of life scale (SS-QOL)was employed to estimate the QOL.Results:After 3-month and 6-month treatment,the lower-limb MAS scores in the observation group were significantly better than those in the rehabilitation group and the warm joint needling group (all P＜0.05).After 1-month,3-month and 6-month treatment,the BBS scores in the observation group were significantly better than those in the rehabilitation group and the warm joint needling group (all P＜0.05).After 2-week,1-month,3-month and 6-month treatment,the SS-QOL scores in the observation group were markedly better than those in the rehabilitation group and the warm joint needling group (all P＜0.05).Conclusion:Warm joint needling plus rehabilitation can effectively improve the lower-limb spasticity state,balance function and QOL in patients with spastic hemiplegia after ischemic cerebral stroke.

Total Hip Arthroplasty Using Modular Trabecular Metal Acetabular Components for Failed Treatment of Acetabular Fractures: A Mid-term Follow-up Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Porous-coated cups have been widely used in acetabular reconstruction after failed treatment of acetabular fractures, and good results have been reported with the use of these cups; however, the durability and functionality of modular trabecular metal (TM) acetabular components in acetabular reconstruction after failed treatment of acetabular fractures remain unclear. This study aimed to examine the radiographic and clinical outcomes associated with the use of modular TM acetabular components for failed treatment of acetabular fractures to assess the durability and functionality of these components in acetabular reconstruction after failed treatment of acetabular fractures.</p><p><b>METHODS</b>A total of 41 patients (41 hips) underwent total hip arthroplasty (THA) using modular TM acetabular components for failed treatment of acetabular fractures at our hospital between January 2007 and December 2012. Among these patients, two were lost to follow-up. Therefore, 39 patients (39 hips) were finally included in this study. The Harris hip score before and after the surgery, satisfaction level of the patients, and radiographic results were assessed.</p><p><b>RESULTS</b>The mean Harris hip score increased from 34 (range, 8-52) before surgery to 91 (range, 22-100) at the latest follow-up examination (P < 0.001). The results were excellent for 28 hips, good for six, fair for three, and poor for two. Among the 39 patients, 25 (64%) and 10 (26%) were very satisfied and somewhat satisfied, respectively. All cups were found to be fully incorporated, and no evidence of cup migration or periacetabular osteolysis was noted.</p><p><b>CONCLUSIONS</b>Despite the technically demanding nature of the procedure, THA using modular TM acetabular components showed good durability and functionality and may be an effective reconstruction option for failed treatment of acetabular fractures.</p>

Two Different Total Hip Arthroplasties for Hartofilakidis Type C1 Developmental Dysplasia of Hip in Adults / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH) is more complex than the normal hip, with large replacement risks and many complications. Although nonosteotomy THA is convenient to perform, femoral osteotomy shortening can avoid blood vessel and nerve traction injuries. This study aimed to compare osteotomy THA with nonosteotomy to determine reasonable options for operative management of DDH.</p><p><b>METHODS</b>Data on 48 DDH patients who underwent THA were analyzed retrospectively. The patients were divided into two groups: Group A 29 cases (nonosteotomy), and group B 19 cases (osteotomy). Harris and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, limb length discrepancy (LLD), radiological data on the hip, and claudication were evaluated. Data were analyzed by using paired-sample Student's t-test, independent-sample Student's t-test, and Pearson's Chi-square test; the test level was α =0.05.</p><p><b>RESULTS</b>Postoperative Harris (90.7 ± 5.1) and WOMAC scores (88.0 ± 10.6) were significantly improved compared with preoperative Harris (44.8 ± 5.7) and WOMAC scores (42.0 ± 5.3) in group A (P < 0.05). Postoperative Harris (90.4 ± 2.8) and WOMAC scores (88.2 ± 5.9) were significantly improved compared with preoperative Harris (44.4 ± 4.2) and WOMAC scores (43.2 ± 4.3) in group B (P < 0.05). One case of dislocation occurred in group A; after closed reduction, dislocation did not recur. In group A, 2 patients developed cutaneous branch injury of the femoral nerve, which spontaneously recovered without treatment. Postoperative LLD >2 cm was seen in one case in group A and five cases in group B. Postoperative claudication showed no significant difference between the two groups (P > 0.05). No patients developed infection; postoperative X-rays showed that the location of the prosthesis was satisfactory, and the surrounding bone was not dissolved.</p><p><b>CONCLUSIONS</b>THA is effective and safe for DDH. For unilateral high dislocation DDH patients with limb lengthening ≤4 cm and good tissue conditions, THA without femoral osteotomy may be considered.</p>

Effect of Joint Line Elevation after Posterior-stabilized and Cruciate-retaining Total Knee Arthroplasty on Clinical Function and Kinematics / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Joint line (JL) is a very important factor for total knee arthroplasty (TKA) to restore. The objective of this study was to evaluate the early clinical and kinematic results of TKAs with posterior-stabilized (PS) or cruciate retaining (CR) implants in which the JL was elevated postoperatively.</p><p><b>METHODS</b>Data were collected from patients who underwent TKA in our department between April 2011 and April 2014. The patients were divided into two groups based on the prosthesis they received (PS or CR). At 1-year postoperatively, clinical outcomes were evaluated by the American Knee Society (AKS) knee score, AKS function score, and patella score. In vivo kinematic analysis after TKA was performed on all patients and a previously validated three-dimensional to two-dimensional image registration technique was used to obtain the kinematic data. Anteroposterior (AP) translation of the medial and lateral femoral condyles, and axial rotation relative to the tibial plateau, were analyzed. The data were assessed using the Mann-Whitney test.</p><p><b>RESULTS</b>At time of follow-up, there were differences in the AKS knee scores (P = 0.005), AKS function scores (P = 0.025), patella scores (P = 0.015), and postoperative range of motions (P = 0.004) between the PS group and the CR group. In the PS group, the magnitude of AP translation for the medial and lateral condyle was 4.9 ± 3.0 mm and 12.8 ± 3.3 mm, respectively. Axial rotation of the tibial component relative to the femoral component was 12.9 ± 4.5°. In the CR group, the magnitude of AP translation for the medial and lateral condyle was 4.3 ± 3.5 mm and 7.9 ± 4.2 mm, respectively. The axial rotation was 6.7 ± 5.9°. There were statistically different between PS group and CR group in kinematics postoperatively.</p><p><b>CONCLUSION</b>Our results demonstrate that postoperative JL elevation had more adverse effects on the clinical and kinematic outcomes of CR TKAs than PS TKAs.</p>

Lower-limb valgus deformity associated with developmental hip dysplasia / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Treating developmental dysplasia of the hip is often challenging. The difficulties include not only the hip surgery itself but also the treatment of the associated lower-limb valgus deformity. However, there have been very few studies on such deformity in patients with developmental hip dysplasia. In this study, we investigated the prevalence and severity of lower-limb valgus deformity, along with the relationship between the severity of valgus deformity and mechanical alterations of the hip or the ipsilateral knee.</p><p><b>METHODS</b>Two hundred and six affected lower limbs of 116 adult patients with untreated developmental dysplasia of the hip were included in the study, grouped according to the severity of hip dysplasia. Each study participant's radiographs were measured to quantitatively evaluate the mechanical axis deviation of the lower limb, and further to evaluate the prevalence and severity of the lower-limb valgus deformity. Some mechanical alterations of the hip and the ipsilateral knee were also measured on the radiographs.</p><p><b>RESULTS</b>Of the affected lower limbs, 14.1% had valgus deformities. Study participants with Crowe type III hip dysplasia had the most severe deformity and the highest prevalence of deformity. Severity of valgus deformity had a strong positive correlation with the lateral migration of the femoral head but not with the superior migration. A decreased lateral distal femoral angle contributed to the lower-limb valgus deformity, and the lateral distal femoral angle had a strong negative correlation with the severity of valgus deformity.</p><p><b>CONCLUSIONS</b>Hip dysplasia is commonly associated with lower-limb valgus deformity, and the severity of the lower-limb valgus deformity is mostly affected by lateral migration but not superior migration of the femoral head. The valgus deformity may originate mainly in the distal femur, in addition to the hip joint itself. These findings can be taken into account when planning to treat the patients with hip dysplasia.</p>

Surgical treatment of recurrent dislocation after total hip arthroplasty: the algorithmic approach and clinical outcome / 中华外科杂志

<p><b>OBJECTIVES</b>To study the surgical techniques and clinical outcomes of the revision surgery to treat recurrent dislocation after total hip arthroplasty.</p><p><b>METHODS</b>From March 1997 to November 2010, 12 patients (12 hips) with revision total hip arthroplasty for recurrent dislocation were reviewed. There were 5 male and 7 female, aged from 20 to 73 years (mean age 52.7 years), whose body mass index (BMI) were 14.8-30.0 kg/m2 (mean 23.6 kg/m2). The Harris score and WOMAC score were registered and analyzed before surgery and at the time of latest follow-up. Any episode of dislocation and other complications such as deep infection, deep vein thrombosis and pulmonary embolism (DVT-PE) events, periprosthetic fracture, or early aseptic loosening were recorded.</p><p><b>RESULTS</b>Twelve patients were successfully followed for 1.0-12.7 years (mean 4.0 years). No further dislocation episodes reported and all the hips were stable at the time of follow-up. No one complicated as deep infection, DVT-PE events, periprosthetic fracture, or early aseptic loosening. The Harris score was greatly improved from 38±21 before surgery to 81±9 at the time of last follow-up with statistic significance (t=-8.616, P<0.05) accompany with the WOMAC score elevation from 54±21 to 82±12 significantly (t=-6.200, P<0.05).</p><p><b>CONCLUSION</b>With a reasonable algorithmic approach, the recurrent dislocated total hip arthroplasty can be treated with a relatively high success rate.</p>

Treatment results and prognostic factors of patients undergoing postoperative radiotherapy for laryngeal squamous cell carcinoma / 癌症

Postoperative radiotherapy (PRT) is widely advocated for patients with squamous cell carcinomas of the head and neck that are considered to be at high risk of recurrence after surgical resection. The aims of this study were to evaluate the treatment outcomes of PRT for patients with laryngeal carcinoma and to identify the value of several prognostic factors. We reviewed the records of 256 patients treated for laryngeal squamous cell carcinoma between January 1993 and December 2005. Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Log-rank test was employed to identify significant prognostic factors for DFS and OS. The Cox proportional hazards model was applied to identify covariates significantly associated with the aforementioned endpoints. Our results showed the 3-, 5-, and 10-year DFS for all patients were 69.9%, 59.5%, and 34.9%, respectively. The 3-, 5-, and 10-year OS rates were 80.8%, 68.6%, and 38.8%, respectively. Significant prognostic factors for both DFS and OS on univariate analysis were grade, primary site, T stage, N stage, overall stage, lymph node metastasis, overall treatment times of radiation, the interval between surgery and radiotherapy, and radiotherapy equipment. Favorable prognostic factors for both DFS and OS on multivariate analysis were lower overall stage, no cervical lymph node metastasis, and using 60Co as radiotherapy equipment. In conclusion, our data suggest that lower overall stage, no cervical lymph node metastasis, and using 60Co as radiotherapy equipment are favorable prognostic factors for DFS and OS and that reducing the overall treatment times of radiation to 6 weeks or less and the interval between surgery and radiotherapy to less than 3 weeks are simple measures to remarkably improve treatment outcome.

Development of a force balance telemetry device for total knee arthroplasty / 医用生物力学

Objective A new type of tibial femoral force balancing telemetry device was developed for measuring force balance on the tibial femoral contact surface in knee joint. MethodThe force balance telemetry device was designed imitating the configuration of tibial part of total knee prosthesis, in which force sensors and telemetry circuit were embedded. During total knee arthroplasty(TKA), this device was implanted as a tibial prosthesis to measure tibial femoral force while the knee joint was being placed at different angles. The tension balance was adjusted by releasing soft tissue around knee joint. ResultsThe results indicat that this device has advantage of high accuracy for force measurement (r>0.98，RMS= 65　g), which is sufficient to meet clinical demand. ConclusionsThe measurement of force balance on the tibial femoral contact surface with telemetry device can provide new insight into the estimation of optimal knee prosthesis position and selection of appropriate polyethylene insert.

Eliminating impingement optimizes patellar biomechanics in high knee flexion / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>We investigated the impact of eliminating the impingement between extensor mechanism and tibial insert on patellar tracking and patellar ligament tension in high knee flexion.</p><p><b>METHODS</b>Six cadaveric specimens were tested on an Oxford-type testing rig. The Genesis II knee system was implanted into each specimen knee with the traditional tibial insert and high-flex insert successively. Compared to traditional insert, the high-flex insert was characterized with a chambered anterior post and a chambered anterior lip which eliminates patella-post and patellar ligament-anterior lip impingements. The patella was tracked with an NDI Optotrak Certus system. The patellar ligament tension was measured using a NKB S-type tension transducer.</p><p><b>RESULTS</b>There was a decrease of resultant patellar translation relative to the femur with statistically significant (P<0.05) at 90 degrees to 150 degrees of knee flexion and a decrease of patellar ligament tension with statistical significance (P<0.05) at 100 degrees, 120 degrees, 130 degrees, and 140 degrees of flexion using high-flex insert compared to traditional insert.</p><p><b>CONCLUSIONS</b>Eliminating the impingement between extensor mechanism and implant in high knee flexion altered patellar tracking and reduced patellar ligament tension, which would facilitate high knee flexion.</p>

Influence of the insert design on clinical results and kinematics of the knee after total knee arthroplasty / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the influence of the insert design of knee prosthesis on clinical results and kinematics of the knee after total knee arthroplasty (TKA).</p><p><b>METHODS</b>Forty-two knees in 28 patients with knee osteoarthritis undergoing TKA using the GENESIS II from July 2007 to June 2009 were included in this study, mean follow-up of 27.7 months. The cases were divided into 2 groups according to the type of insert, one was high flexion insert group (23 knees) and the other was standard insert group (19 knees). Two groups were compared by clinical ratings of knee function. The motion of flexion and extension of the two groups was observed by cyclic fluoroscopy and the data was analyzed by mapping software. The influence of the insert design of knee prosthesis on kinematics of the knee after TKA was investigated by comparing the parameters of the two groups during the movement of knee joint, including femoral roll back and extensor mechanism arm.</p><p><b>RESULTS</b>The range of motion of standard insert group and high flexion insert group was 120° and 123° respectively with no difference between them. There was no difference of knee society clinical rating system in both groups. Feller score of high flexion insert group was higher than the standard insert group, the difference was significant statistically (P = 0.012). In the imaging measurement, the two groups had no differences in femoral rollback and extensor mechanism arm during the 0 to 120° range of movement. The two groups appeared significant statistically (P = 0.034) in the extensor mechanism arm when flexion extended to 130°.</p><p><b>CONCLUSIONS</b>The high flexion improved design may play a certain role on reducing anterior knee pain and improving knee function after TKA. However, the improved design may be reduced the extensor mechanism arm when high flexion, so that affecting the work ability of quadriceps.</p>

Analysis of the failure mechanisms of the revision hip arthroplasties / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the failure mechanisms of revision hip arthroplasties and evaluate the effects of surgical technique, prosthesis design and patient-related risk factors on different failure mechanisms.</p><p><b>METHODS</b>A review of all revision hip arthroplasties from November 1995 to June 2008 identified 30 patients who underwent 30 revisions with 18 males and 12 females. The overall mean age for primary arthroplasties was 49 years (range 25-68 years) and 53 years (range 27-72 years) for index revision arthroplasties and the average interval between these two operations was 43.8 months (0-156 months). The failure mechanisms of index revision arthroplasties and primary arthroplasties were assessed and compared. Direct comparisons were made of data for the different age categories in terms of time to failures and reasons for failures.</p><p><b>RESULTS</b>Regarding revision or prosthesis removal as the end point of the study, the reasons for 30 revision arthroplasties were aseptic loosening in 22 hips (73.3%), infection in 4 hips (13.3%), periprosthetic fracture in 3 hips and instability in 1 hip (3.3%). The overall mean age for last arthroplasties or prosthesis removal was 58 years (range 38-77 years) with an average interval of 78.8 months (range 1-216 months) from previous revision arthroplasties. The mean time to failure for patients above 60 years of age was significantly shorter than patients below 60 years of age (P < 0.01).</p><p><b>CONCLUSION</b>The majority of failure mechanisms of revision hip arthroplasties are ineffective fixation of revisional implants and recurrence of local infection, which reveals the limitations to joint reconstruction philosophy and surgical technique.</p>

An investigation on failure mechanisms of primary 327 hip arthroplasties / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the detailed failure mechanisms of revision hip arthroplasties and related risk factors.</p><p><b>METHODS</b>From November 1988 to July 2008 revision of total hip arthroplasties was performed in 327 patients. The medical history, clinical and imaging material and operation records were investigated.</p><p><b>RESULTS</b>Regarding revision as the end point of the study, the reasons for 327 revision arthroplasties were aseptic loosening in 226 hips (69.1%), infection in 52 hips (15.9%), periprosthetic fracture in 22 hips (6.7%), instability in 17 hips (5.2%), stem fracture in 5 hips (1.5%) and liner dissociation in 5 hips (1.5%).</p><p><b>CONCLUSIONS</b>The main failure mechanisms of primary hip arthroplasties are aseptic loosening and infection of implants, which could be attributed to improper selection of operation indications and implants and limitations to surgical philosophy and technique.</p>

Radiographic appraisal between metal and bone interosculate backfill after total hip arthroplasty with trabecular metal cup / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the bone refilling in the interface between the trabecular metal (TM) acetabular shell and the bone surface according to consecutive X film measuring after surgery.</p><p><b>METHODS</b>From July 2006 to July 2007, 35 patients (40 hips) accepted total hip replacement using trabecular metal monoblock acetabular cup system (TM). The cup was made of a ellipse shaped press fit Tantalum shell and high cross-linked PE liner (Longevity) with 28 mm inner diameter. The patients demography was: 16 male (20 hips), 19 female (20 hips), 5 bilateral hip replacements, age from 41 - 71 (mean 53), including 18 avascular necrosis hips, 16 osteoarthritis hips (including those secondary to a dysplasia hip), 4 avascular necrosis hips after femoral neck fracture, 2 Ankylosis Spondylitis. All the 40 total hip replacements used posterior approach, using hemispherical acetabular reamer and 2 mm press fit of final metal shell without screw fixation. The consecutive X film was taken at the end time of surgery and 2, 6, 12, 24 weeks, and 12 months. The clinical results was evaluate according to Harris scoring system, and the standard pelvis AP X film was measured at the interface between metal shell and the acetabular bone surface, witch was divided into five regions (A, B, C, D, E).</p><p><b>RESULTS</b>Totally 32 patients (37 hips) were followed with average 8.7 months (7 - 12 months). The Harris before surgery was 50.5 (32 - 85), promoted to 91.0 (72 - 100), including 29 excellent, 6 good, 2 fair, and the total excellent and good rate was 94.6%. Complications include 4 patients leg length discrepancy from 1 - 2 cm, 3 patients moderate thigh pain and released after conservative therapy. No infection and dislocation was found. Twenty-one patients (23 hips) were found lucent line at the bone-metal interface from 1 - 5 mm, most common in B region and BC boundary than C, D, and CD boundary. All the patients followed was found the lucent line disappeared and refilled with bone at X film 24 weeks after surgery, however, no patients was found osteolysis and cup migration.</p><p><b>CONCLUSION</b>The trabecular metal has strong capacity of bone conductive and bone inducement.</p>

Clinical results and peri-operative complications of total knee arthroplasty for patients with different ages / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical results and complications of total knee arthroplasty (TKA) performed for patients with different ages.</p><p><b>METHODS</b>From January 2004 to March 2005,212 patients (300 knees) were followed up, all patients were divided into 6 groups according to the age. All the complications and knee society scores (KSS) were documented and retrieved for analysis.</p><p><b>RESULTS</b>KSS of all groups was significantly improved after TKA. The patients whose age was 70 years or older, and underwent bilateral TKA achieved the best improvement of knee function. The complication rate increased with the patients' age.</p><p><b>CONCLUSIONS</b>TKA predictably alleviates knee pain and restores knee function. Aging itself does not compromise clinical results of TKA. However perioperative complication rate is a little bit higher in aged patient group and simultaneously bilateral TKA patient group.</p>

Influence of the femoral head size on early postoperative gait restoration after total hip arthroplasty / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>We investigated the effects of using large-diameter femoral heads in total hip prostheses on early postoperative gait restoration in patients undergoing total hip arthroplasty (THA).</p><p><b>METHODS</b>We collected data for 19 primary THAs using 28-mm metal-on-polyethylene heads (conventional group) and for 12 THAs (BHR group) using metal-on-metal femoral heads with an average size of 45 mm (range, 40 - 49 mm). All patients had unilateral femoral head avascular necrosis. All patients underwent Harris Hip Scores evaluation and gait analysis with the IDEEA device at the same 3 time points which were before surgery and then at 1 month and again at 3 months after surgery, and the parameters measured were walking speed, stride length (SL), single limb support (SLS), cycle duration (CD), and swing power (SP). Harris Hip Scores and gait analysis parameters for both groups were compared.</p><p><b>RESULTS</b>Intraclass comparison indicated that Harris Hip Scores, speed scores, and gait parameter measures in both groups improved significantly with the passage of time; Interclass comparison showed no significance between Harris(1m postop) - Harris(preop) and Harris(3m postop) - Harris(preop) in both groups. The speed in the BHR group at 1 month and at 3 months after surgery was significantly higher than that of conventional group. At 1 month after surgery, each mean for SL(normal) - SL(affected), (SLS(normal) - SLS(affected))/CD, and SP(normal) - SP(affected) in the BHR group was significantly lower than that for the conventional group. At 3 months after surgery, the differences between means for both groups for SL(normal) - SL(affected), (SLS(normal) - SLS(affected))/CD, and SP(normal) - SP(affected) were not significant, but the mean of SP(normal) - SP(affected) in the BHR group was significantly lower than that in the conventional group.</p><p><b>CONCLUSIONS</b>Our data suggest that large-diameter femoral heads in THA provide better early gait restoration than conventional-size femoral heads.</p>

Deeply cooled far-infrared thermal imaging strategy for early tumor diagnostics / 中国医疗器械杂志

This paper is dedicated to evaluate the thermal behavior of skin surface embedded with tumor tissue through construction of three-dimensional heat transfer model of the human body. It was found that the far-infrared imaging equipment could not yet get the accurate results for diagnosis of tumors developed in early stage or located deeply in the human body, because of limited resolution and accuracy in the current system. Conceptual experiments with a thermal imaging system under various cooling levels were performed to confirm this issue. A dual cooling cavity was proposed to realize ultra-low-temperature so as to improve the cooling of the current infrared equipment and thereby to enhance its image precision and accuracy. This study is expected to be of significant reference value for realizing an early diagnosis of cancers through medical image.

Reconstruction of the acetabular in the Crowe III dysplastic hip / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the method and the outcome of the acetabular reconstruction in the Crowe III dysplastic hip.</p><p><b>METHODS</b>From January 2001 to June 2007, 43 cases (54 hips) were diagnosed osteoarthritis secondary to Crowe III dysplastic hip. Total hip arthroplasty was performed in all cases. The Harris score was 39 pre-operation. The method of the acetabular reconstruction included acetabular deepening (group A), medial-wall osteotomy (group B), femoral head bone grafting (group C). Radiography data and Harris score were taken to evaluate the clinical outcome.</p><p><b>RESULTS</b>The method of the acetabular reconstruction included acetabular deepening in 27 cases (34 hips), medial-wall osteotomy in 12 cases (15 hips), femoral head bone grafting in 4 cases (5 hips). Forty cases were followed up by the mean time of 29 months. The bone union time of the osteotomy and bone grafting were 4 - 5 months postoperation. In the three groups the obliquity angle of the cup were (41.0 +/- 7.5) degrees , (46.0 +/- 7.7) degrees , (39.0 +/- 11.0) degrees ; the anteversion angle of the cup were (10.0 +/- 2.8) degrees , (9.0 +/- 2.5) degrees , (4.0 +/- 1.9) degrees ; the rotation center of the hip was shift superiorly (8.4 +/- 3.6) mm, (7.3 +/- 2.6) mm, (1.2 +/- 0.5) mm; the rotation center of the hip were shift internally (7.0 +/- 1.5) mm, (9.9 +/- 1.7) mm, (-2.7 +/- 1.2) mm, and the Harris score were 89, 91, 86 at the follow up. The complication included deep venous thrombosis in 2 cases, pulmonary embolism in 2 cases, sciatic nerve palsy in 4 cases.</p><p><b>CONCLUSION</b>Acetabular deepening, medial-wall osteotomy, femoral head bone grafting can be used in reconstruction of the acetabular in the Crowe III dysplastic hip.</p>