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Objective@#To investigate the early clinical effects of tantalum augment assisted with 3D technology in treating acetabular bone defects of Paprosky type III in revision total hip arthroplasty (THA).@*Methods@#From May 2013 to July 2017, a total of 16 patients (18 hips) undergoing revision THA were retrospectively analyzed, including 11 males and 5 females aged 58.06±8.29 years (range 44-69 years). There were 3 cases with infective loosening and 15 cases with aseptic loosening, 13 cases with Paprosky IIIA type bone defects and 5 cases with IIIB type bone defects. 3D technology was used for precise planning before operation. The tantalum augment and cup were used to repair acetabular bone defects during operation. Cup anteversion, abduction angle, ratio of the lateral and contralateral vertical distance of the center of rotation, ratio of the lateral and contralateral horizontal distance of the center of rotation and femoral offset were measured preoperatively and postoperatively. The percentages of hips located in Lewinnek safe zone were calculated preoperatively and postoperatively. Postoperative radiographic evidence of loosening and Harris score were collected at the end of the follow-up.@*Results@#The percentage of the hips located in Lewinnek safe zone increased from 22% (4/18) preoperatively to 61% (11/18) postoperatively. The mean anteversion of the operative side was 11.99°±6.91° (range 1.71°-26.36°) postoperatively. The mean abduction angle of the operative side was 44.91°±5.93° (range 35.6°-56.0°). The mean ratio of the lateral and contralateral vertical distance of the center of rotation was 1.10±0.20 (range 0.87-1.62). The mean ratio of the lateral and contralateral horizontal distance of the center of rotation was 1.00±0.18 (range 0.69-1.46) and the mean ratio of the lateral and contralateral femoral offset was 1.01±0.66 (range 0.51-3.56). All the patients were followed-up for an average of 27.72±12.18 months (range 14-53 months). No complications, such as periprosthetic joint infection, dislocation or aseptic loosening, were observed in all patients. The mean Harris score was 77.28±4.80 (range 65-85) at 6 months postoperatively and 80.9±5.2 (range 69-89) at the end of the follow-up.@*Conclusion@#Using tantalum augmentassisted with 3D technology to re construct Paprosky type III severe bone defects of the hip can increase the accuracy of the acetabular cup positioning. The short-term outcomes are satisfying and no early prosthetic loosening was observed.
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Objective To investigate the early clinical effects of tantalum augment assisted with 3D technology in treating acetabular bone defects of Paprosky type Ⅲ in revision total hip arthroplasty (THA).Methods From May 2013 to July 2017,a total of 16 patients (18 hips) undergoing revision THA were retrospectively analyzed,including 11 males and 5 females aged 58.06±8.29 years (range 44-69 years).There were 3 cases with infective loosening and 15 cases with aseptic loosening,13 cases with Paprosky ⅢA type bone defects and 5 cases with ⅢB type bone defects.3D technology was used for precise planning before operation.The tantalum augment and cup were used to repair acetabular bone defects during operation.Cup anteversion,abduction angle,ratio of the lateral and contralateral vertical distance of the center of rotation,ratio of the lateral and contralateral horizontal distance of the center of rotation and femoral offset were measured preoperatively and postoperatively.The percentages of hips located in Lewinnek safe zone were calculated preoperatively and postoperatively.Postoperative radiographic evidence of loosening and Harris score were collected at the end of the follow-up.Results The percentage of the hips located in Lewinnek safe zone increased from 22％ (4/18) preoperatively to 61％ (11/18) postoperatively.The mean anteversion of the operative side was 11.99°± 6.91° (range 1.71°-26.36°) postoperatively.The mean abduction angle of the operative side was 44.91°±5.93° (range 35.6°-56.0°).The mean ratio of the lateral and contralateral vertical distance of the center of rotation was 1.10±0.20 (range 0.87-1.62).The mean ratio of the lateral and contralateral horizontal distance of the center of rotation was 1.00±0.18 (range 0.69-1.46) and the mean ratio of the lateral and contralateral femoral offset was 1.01±0.66 (range 0.51-3.56).All the patients were followed-up for an average of 27.72± 12.18 months (range 14-53 months).No complications,such as periprosthetic joint infection,dislocation or aseptic loosening,were observed in all patients.The mean Harris score was 77.28±4.80 (range 65-85) at 6 months postoperatively and 80.9±5.2 (range 69-89) at the end of the follow-up.Conclusion Using tantalum augmentassisted with 3D technology to reconstruct Paprosky type Ⅲ severe bone defects of the hip can increase the accuracy of the acetabular cup positioning.The shortterm outcomes are satisfying and no early prosthetic loosening was observed.
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Objective To delay the atrophy of denervated skeletal muscle by baby-sitting in reverse end-to-side fashion and explore the feasibility of this operation to improve the recovery of denervated muscle in rats.Methods From July,2015 to March,2016,32 female SD rats were divided into 4 groups randomly and the tibial nerve of each rats was transected.In immediate repair group,the transected tibial nerve was sutured in situ.In unprotected group,the tibial nerve stump was putting-aside.The sural nerve was transected in other 2 groups.The proximal sural nerve was connected to the distal tibial nerve stump directly in end-to-end (ETE) protected group and to the side of the distal tibial nerve stump in end-to-side (ETS) protected group.After 3 months,connected the two ends of tibial nerve except immediate repair group.After another 3 months,the tibial nerve functional index,electrophysiological testing,histology and morphology were examined.Results The gastrocnemius muscle was atrophy obviously in unprotected group,while in other groups the muscle structure was well protected.The tibial nerve functional index (-39.54±24.32),motor nerve conduction velocity[(30.25±12.65)m/s],and muscle contraction [(0.98 ± 0.38)N)] indicated that the gastrocnemius muscle function in ETS protected group was statistically better recovery than in unprotected group [-75.65±32.13,(24.93±8.69)m/s and (0.64±0.20)N,respectively] and ETE protected group [-62.34± 21.65,(16.90±7.92)m/s and (0.75-±0.15)N,respectively](P＜0.05).The contractility of muscle were poor recovery in ETE protected group,which was similar to unprotected group(P＞0.05).Conclusion Sensory nerve baby-sitting in reverse end-to-side fashion is a effective method to improve the recovery of denervated muscle in rats.
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Objective To evaluate the clinical effectiveness of 3?dimensional scaffold of typeⅠcollagen based autolo?gous chondrocyte implantation (ACI). Methods Nine patients of knee articular cartilage defect treated with 3?dimensional scaf?fold of type Ⅰcollagen based ACI from January 2013 to March 2014 was analyzed retrospectively, including 6 males and 3 fe?males with an average age of 30 years old. 4 defects located in femoral condyle, 4 in trochlea and 1 in patellae with a mean size of 4.9 ± 2.1cm2 (range, 2.5-10). ACI comprises 2?stage procedure:chondrocytes were first harvested from non?load bearing area of femoral condyle, then chondrocytes expand in vitro for 8-14 days to get enough cells. On second stage, cartilage defects were cov?ered by the grafts and fixed with fibrin albumen glue. All patients received strict rehabilitation protocol. International Knee Docu?mentation Committee (IKDC) scores and Lysh?lm scores were compared pre?operatively and 3, 6, 12 months post?operatively. MR and magnetic resonance observation of cartilage repair tissue (MOCART) scores were analyzed within 3 days, 3, 6, 12 months post?operatively. Results All the patients were followed up. IKDC score was 52.7 ± 6.9 pre?operatively and respectively 71.1 ± 6.6, 83.3±2.9 and 92.0±3.6 3, 6, 12 months post?operatively with significant differences. The Lysh?m score was 55.8±8.7 pre?oper?atively and respectively 74.8±7.0, 84.8±4.8 and 93.1±5.7 3, 6, 12 months post?operatively with significant differences. 8 patients had MRI. The mean MOCART score 3 days, 3, 6, 12 months post?operatively was respectively 43.6±6.0, 47.8±5.8, 57.8±5.8, 64.3± 4.8 and 72.1±4.9 with significant differences. T2 value of transplanted area was 48.7±3.2 12 months post?operatively with no sig?nificant differences compared to normal area. Conclusion Three?dimensional scaffold of typeⅠcollagen based ACI could re?pair knee articular cartilage defect. It may be a good choice for treating articular cartilage defect which shows satisfactory results.
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BACKGROUND:The preemptive analgesia is stil a controversial issue. Existing studies have not paid much attention to effects of preoperative factors on the hypersensitivity of peripheral and central mechanisms. Visual analog scale scores cannot subjectively and repeatedly reveal patient’s pain. OBJECTIVE:To investigate the validity of the preventive analgesia effect of Celebrex in patients with total knee arthroplasty. METHODS:Patients with osteoarthritis of the knee who received total knee arthroplasty were accessed by Pittsburgh sleep quality index, self-rating depression scale and self-rating anxiety scale. In al , thirty patients were enrol ed in the study. They were randomized into Celebrex group and vitamin C group, and each group had 15 patients. The patients in the Celebrex group and vitamin C group took 200 mg Celebrex and vitamin C, respectively, twice a day from day 2 to day 4. Both of their knees were evaluated by resting visual analogue scale and moving visual analogue scale in the evening of day 1 before treatment and day 3 after treatment. Meanwhile, the pain threshold and pain tolerance were accessed by a pain-threshold machine. RESULTS AND CONCLUSION:No statistical significance of the changes of resting and moving visual analogue scale scores was found in both knees in the Celebrex group (P>0.05). The pain threshold of both knees were significantly increased (P0.05). There were no significant changes in the pain tolerance in both knees (P>0.05). The changing values of resting or moving visual analogue scale were not significantly correlated with the pain threshold and pain tolerance (P>0.05). There were no significant changes in visual analogue scale scores, pain threshold and pain tolerance in both knees of the vitamin C group (P>0.05). Celebrex could increase the pain threshold of patients receiving total knee arthroplasty, especial y the severe knee, which indicates that the Celebrex is good for the preventive analgesia. Comparatively speaking, the pain threshold might be more sensitive than visual analogue scale in revealing the change of pain after analgesia. There is no significant correlation between visual analogue scale score and the hypersensitivity of pain.
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[Objective]To determine the prevalence of each type of adolescent idiopathic scoliosis in Lenke classification,and find out the relationship between Lenke classification and fusion level. [Method]Totally 154 cases of adolescent idiopathic scoliosis being treated with sugery between January 2002 and September 2007 were analyzed retrospectively in Guangdong General Hospital.All casess were classified with Lenke classification,prevalence of each type were counted.The fusion levels were compared with Lenke classification.[Result]All of 154 cases could be classified by Lenke classification,the 5 most common types were 1AN,5CN,1BN,2AN,1CN.95.5% of structural curve had been fused.[Conclusion]Lenke classification can provide effective guidance for pre-operative evaluation and choosing opertive method.The method of determining structural curve is useful.
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[Objective]To evaluate the clinical results of posterior hemivertebra resection and correction with transpedicular instrumentation for congenital scoliosis.[Method]From July 2002 to December 2006,thirty-nine consecutive cases,including 22 males and 17 females,underwent posterior hemivertebra resection and correction using transpedicular instrumentation.The average age at surgery was 8.3 years ranging from 3 to 15 years.There were 30 cases with fully segmented hemivertebra and 9 cases with partial segmented hemivertebra.Instrument included 16 cases of ISOLA,10 cases of CD-Horizon,10 cases of Moss-Miami and 3 cases of TSRH.The pre-and post-operative standing radiographic and at final follow-up were measured,and the Cobb's angles in the coronal and sagittal plane were analyzed,respectively.[Result]The average follow-up was 2.8 years ranging from 1 to 4.5 years.The Cobb's angle in coronal plane was corrected from 48? to 13?postoperatively and 13.2? at final follow-up,representing 70.2% correction rate.The kyphosis was corrected from 39? to 12.1? postoperatively and 12.7? at final follow-up,representing 68.7% correction rate.All cases had bony fusion,there was no neurological complication,no implant failure or infection.One case had crankshaft phenomenon.[Conclusion]Posterior hemiveterbra resection with instrumentation is a safe and effective treatment option for congenital scoliosis.Congenital scoliosis should be treated in early age.
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BACKGROUND:Olfactory ensheathing cells (OECs) have been shown to possess the potential of repairing injured spinal cord, but their biological characteristics after transplantation in vivo are not well understood.OBJECTIVE: To investigate the migration of OECs after transplantation into the injured spinal cord of adult rats.DESIGN: Randomized and controlled experiment.SETTING: Department of Orthopedics, Guangdong Provincial People's Hospital; Experimental Animal Center of the North Campus of Sun Yat-sen UniversityMATERIALS: Totally 38 2-month-old male SD rats with body mass of (350 ±20) g were used in this study.METHODS: This experiment was conducted in the Experimental Animal Center, North Campus of Sun Yat-sen University between February 2004and May 2004. Two SD rats were used to extract the OECs, which were stained with Hoechst 33342. Totally 36 SD rats were subsequently randomized into 3 groups, namely rostral transplantation group, caudal transplantation group and control group with 12 rats in each group. The rats in the rostral and caudal transplantation groups subjected to operations to establish thoracic spinal cord injury model and OEC suspension was injected; in the control group, the rats were spared of thoracic spinal cord injury with only OEC suspension injection.MAIN OUTCOME MEASURES: Distribution of OECs in the spinal cord was observed under fluorescence microscope 1, 2, 4 and 6 weeks after operation, respectively.RESULTS: Of the rats in the 3 groups, 1 died in the rostral group, and 2in each of the caudal transplantation and control groups, leaving 29 rats for result analysis. The OECs in the rostral and caudal transplantation groups migrated longitudinally along the long axis of the spinal cord to a farthest distance of 8 mm and penetrating the scar tissues, but very few cells could reach the contralateral side. The OECs in the control group diffused locally without migration.CONCLUSION: OECs mainly migrate along the axons in white matter of the injured spinal cord, and their rostral and caudal migration does not differ in speed or amount. Only a small amout of OECs can across the transected gap of the spinal cord.