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OBJECTIVE Trigeminal pain is mostly uni-lateral orofacial,but pain sensitization often spreads to contralateral orofacial or distal body regions.Widespread trigeminal pain has more severe intensity,longer dura-tion,and wider distribution,accompanied by more serious comorbid emotional syndrome.Unfortunately,the first-line analgesics for neuropathic pain has limited effect on widespread pain along with unavoidable side effects.In-depth understanding of the pathogenesis of wide-spread trigeminal pain is urgently needed.METHODS Trigeminal pain was induced by partial transection of the infraorbital nerve(p-IONX)and evaluated by measur-ing nociceptive thresholds to mechanical or heat stimula-tion.Neuronal activity was evaluated by single-unit and patch clamp recordings.HMGB1 expression was mea-sured by immunohistochemistry.Antagonism of HMGB1 was achieved by injecting anti-HMGB1 monoclonal anti-body(mAb)intracerebrally or intraperitoneally.RESULTS P-IONX model induced not only orofacial algesia but also somatic algesia in hind paw.Spontaneous firing frequency of glutamatergic neurons in the ventral posteromedial tha-lamic nucleus(VPMGlu)as well as the amplitude and fre-quency of sEPSCs significantly increased after p-IONX.Moreover,calcium signal recording showed that VPMGlu became to be activated by the noxious mechanical stimu-lation given on the hind paw,suggesting that VPMGlu recruited somatic afferents after p-IONX.We further explored the upstream brain regions of VPMGlu by virus retrograde tracing.We found the afferents from the grac-ile nucleus/cuneate nucleus(Gr/Cu),which are involved in the conduction of somatic sensation,markedly increased.And chemogenetical inhibiting Gr/Cu-VPM circuit alleviated the widespread neuropathic pain.In addition,the expression of HMGB1 in the VPM was sig-nificantly increased after p-IONX.Local administration of anti-HMGB1 mAb in the VPM relieved widespread neuro-pathic pain in mice receiving p-IONX.CONCLUSION These results demonstrate that the remodeling of affer-ent neurons in VPM underlie the spreading of wide-spread trigeminal neuropathic pain.Highly expressed HMGB1 in VPM plays an important role in these patho-logical changes after nerve injury and systemic adminis-tration of anti-HMGB1 mAb concurrently relieves wide-spread pain.
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Objective To investigate the effects of design parameters such as neck-shaft angle, femoral offset and anteversion angle of total hip arthroplasty ( THA) prosthesis on contact forces of the hip. Methods A musculoskeletal multi-body dynamic model of THA was established based on AnyBody software. The effects of single or multiple factors on hip contact force were studied when the neck-shaft angle, eccentricity and anteversion angle varied within ±10°, ±20 mm and ±10°, respectively. Results The maximum hip contact force increased by 26. 08% when femoral offset was reduced by 20 mm. The maximum hip contact force increased by 5. 99% when the neck-shaft angle increased by 10°. When the anteversion angle increased by 10°, the hip contact force decreased at 0% -24% of gait cycle, with the peak decreasing by 19. 16% . However, the hip contact force was significantly increased at 38% -70% of gait cycle, with the peak increasing by 67. 78% . Conclusions In extramedullary design of the femoral stem, based on reconstruction of the patient’s anatomical parameters, the offset of the femoral stem can be appropriately increased, and the neck-shaft angle and anteversion angle can bereduced to avoid increasing forces on the hip.
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Objective To analyze the influence of total hip arthroplasty (THA) on the process of proximal femoral bone remodeling by using the Wolff bone remodeling theory. Methods According to control equation of bone remodeling, the program of bone remodeling was written in Python language. Preoperative femur model and postoperative femur and prosthesis finite element models were established respectively in ABAQUS software. The process of bone reconstruction before and after THA operation was compared to analyze the effect of prosthesis implantation on mechanical properties of the femur in the middle and long term after THA operation. Results The stress in proximal femur continued to decrease after prosthesis implantation, and the stress site was transferred from the femoral head to the prosthesis, resulting in an obvious stress shielding phenomenon. Bone loss in the stress shielding area was serious. The femoral shaft cortical bone became thinner and the stress shielding was relieved. The medial side at the bottom of the prosthesis was compressed, and the stress was significantly higher than that of the lateral side, where the bone was unevenly distributed. Conclusions After THA operation, obvious stress shielding occured at proximal medial side of the femur, leading to bone loss and prosthesis loosening. The difference in stress levels on both sides at the bottom of the prosthesis resulted in an uneven bone distribution, causing the discordance between the prosthesis and the femur, as well as postoperative pain in the middle part of the thigh.
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Los pacientes candidatos a artroplastía total de cadera con protrusio acetabular asociada generan distintos desafíos en los equipos quirúrgicos. Múltiples estrategias han sido utilizadas a lo largo de los años para optimizar los resultados. Mediante una revisión de la evidencia actualizada disponible, proponemos diez tácticas a realizar en el manejo de estos pacientes que pueden mejorar y hacer predecible el tratamiento de un paciente con protrusio acetabular al que se le realiza una artroplastía total de cadera. Nivel de Evidencia V.
Patients with acetabular protrusio and osteoarthritis are a challenge for the surgical team. Many strategies have been developed to anticipate, plan and optimize the surgical results of these patients. Based on the current available clinical evidence, we propose ten tips to improve the surgical management of hip arthroplasty patients with protrusio acetabuli. Level of Evidence V.
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Humans , Male , Female , Arthroplasty, Replacement, Hip/methods , Acetabulum/surgery , Arthroplasty, Replacement, Hip/rehabilitation , Hip Injuries/diagnostic imaging , Hip Joint/diagnostic imagingABSTRACT
Objective To establish an HPLC method for simultaneous assay of macrocyclic polyphenols from Penthorum chinense Pursh, pinocembrin-7-O-[4'', 6''-(S)-hexahydroxydiphenoyl]-β-D-glucose (PHG), pinocembrin-7-O-[3''-O-galloyl-4'', 6''-(S)-hexahydroxydiphenoyl]-β-D-glucose (PGHG) and pinocembrin dihydrochalcone-7-O-[3''-O-galloyl-4'', 6''-(S)-hexahydroxydiphenoyl]-β-D-glucoside or thonningianin A (THA), and optimize the extraction process. Methods The total extraction rate of PHG, PGHG, THA was used as an investigated index to analyze the extracts from Penthorum chinense Pursh. Orthogonal design was applied to evaluate solvent amount, extraction time, solvent concentration and extraction times as the influencing factors for the optimal extraction process of macrocyclic polyphenols from Penthorum chinense Pursh. Results When this content assay method was adopted, there were good linear relationships for PHG, PGHG, THA in the linear range. The recoveries were between 100.90% to 102.04% with the RSDs below 1.5%. The optimal extraction process was involved in cutting Penthorum chinense Pursh into 3-5 cm, adding 10 times 80% ethanol aqueous solution by volume and refluxing 2 hours twice. The extraction rate of macrocyclic polyphenols was above 90% with this process. Conclusion This assay method is accurate, stable, and repeatable. The optimized extraction process is stable and feasible for further development and utilization.
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@#Introduction: Mortality following traumatic femoral neck fractures in the elderly (age >60 years) is influenced by many factors. Addressing some of them may reduce the mortality rate thus improving patient survival and quality of life. Materials and methods: This study was a retrospective research using data collected from Hospital Sultanah Bahiyah, Kedah between the years 2008-2018. We measured outcomes such as age, gender, hospital stay, default rate, ambulation post-surgery, American Society of Anaesthesiologists score (ASA) and surgical timing in correlation with mortality rate and 10-year survival of elderly patients treated with Total Hip Arthroplasty for femoral neck fractures in this centre. Results: A total of 291 traumatic femoral neck fractures aged above 60 years post total hip arthroplasty performed were included. There was higher number of female (n =233) compared to male (n=53) Estimated 10 years survival from Kaplan Meier was 42.88% (95% CI: 33.15, 52.54). One year mortality rate in our study was found to be 18.9%. The average time to event was 7.1 years (95% CI:33.15, 52.24) with a mean age group of 75. Discussion: Total hip arthroplasty patients not ambulating after surgery had a 4.2 times higher hazard ratio compared to ambulators. Those with pre-existing systemic disease (ASA III and IV) were found to have the highest hazard ratio, almost five times that of healthy patients, after adjusting for confounding factors. Delay of more than seven days to surgery was found to be a significant factor in 10-year survival with a hazard ratio of 3.8, compared to surgery performed earlier. Conclusion: Delay of more than 7 days to surgery in 10 years survival was significant with high hazard ratio. It is a predictor factor for survival in 10 years. A larger sample size with a prospective design is required to confirm our findings regarding “unacceptable surgical timing” for femoral neck fractures in patients above 60 years of age.
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Objective Based on the principle of uncemented stem design, the femoral anteversion in different CT planes before total hip arthroplasty (THA) and stem anteversion after THA was compared, so as to find out the preoperative measurement to estimate stem anteversion in patients with developmental dysplasia of the hip(DDH) after THA. Methods Twenty-one primary THA patients (28 hips) who were diagnosed with DDH between September 2007 and May 2013 in Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were selected. Preoperative and postoperative CT scans were performed on all patients. The femoral anteversion angle was defined as the angle between the midcortical line between the anterior and posterior cortical line in five CT slices and the posterior condylar axis. The slice levels for the 4 femoral sites were selected，including the area just distal to the femoral head, the center of the lesser trochanter，1 cm height above center of the lesser trochanter, 2 cm height above center of the lesser trochanter (marked as femoral anteversion 1-4). Femoral anteversion 5 was defined as the midcortical line of the anterior cortical line in the slice of 2 cm height above center of the lesser trochanter and the posterior cortical line in the slice of 50% of the distance from the top of greater trochanter to the center of the lesser trochanter above the center of the lesser trochanter. The stem anteversion angle was defined as the angle formed by the stem neck major axis and the posterior aspect of the femoral condylar line. The cup version and stem alignment were also calculated. The difference value and correlation coefficients of femoral anteversion 1-5 and stem anteversion were compared. Results Femoral anteversion 1-5 was 17.70°±10.54°, 35.59°±7.21°, 31.09°±7.98°, 24.71°±9.11°, 21.94°±10.10°, respectively。Stem anteversion was 20.52°±10.90°. The difference value between stem anteversion and femoral anteversion 1-5 was 2.82°±6.27°, -15.08°±7.99°, -13.80°±15.68°, -4.19°±5.69°, -1.42°±4.07°, respectively. Cup anteversion was 25.60°±11.65°, and combined antevertion was 46.11°±13.28°，sagittal stem tilt was 1.13°±1.53°. There were statistically significant differences between femoral anteversion 1-4 and stem anteversion (P＜0.05), and no statistical difference was found between femoral anteversion 5 and stem anteversion. The correlation coefficients of femoral anteversion 1-5 and stem anteversion were 0.829, 0.681, 0.689, 0.853, 0.928, respectively. Conclusions Femoral anteversion 5 had a highly positive correlation with stem anteversion, which was an effective a substitute of stem anteversion before THA.
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Objective To investigate the biomechanical effects of femoral offset (FO) on total hip arthroplasty (THA) patients with developmental dysplasia of the hip (DDH). Methods Based on the musculoskeletal dynamic software AnyBody and the related data from a female patient with Crowe Ⅳ DDH, the corresponding patient-specific lower extremity musculoskeletal multi-body dynamic model was constructed to analyze both hip joint forces and abductor forces within ±20 mm variation of FOs. The dynamic finite element (FE) model of S-ROM stem with varying offsets was also established. The dynamic load during a whole walking gait cycle calculated by the multi-body musculoskeletal model was applied to this FE models, and the Von Mises stress, contact stress, and stem-sleeve micromotion were then analyzed. Results A variation of ±20 mm offset had small influences on peak forces of hip joints. However, the decrease in FO could lead to an obvious increase in peak abductor force, while the increase in FO could lead to an obvious increase in the maximum Von Mises stress, contact stress, and micromotion of S-ROM prosthesis stem. Conclusions The change in FO had an obvious influence on the abductor forces, the maximum Von Mises stress, the contact pressure and the consequent fretting wear of THA patients with DDH, which should be carefully considered by surgeons.
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Objective Based on the principle of uncemented stem design, the femoral anteversion in different CT planes before total hip arthroplasty (THA) and stem anteversion after THA was compared, so as to find out the preoperative measurement to estimate stem anteversion in patients with developmental dysplasia of the hip(DDH) after THA. Methods Twenty-one primary THA patients (28 hips) who were diagnosed with DDH between September 2007 and May 2013 in Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were selected. Preoperative and postoperative CT scans were performed on all patients. The femoral anteversion angle was defined as the angle between the midcortical line between the anterior and posterior cortical line in five CT slices and the posterior condylar axis. The slice levels for the 4 femoral sites were selected，including the area just distal to the femoral head, the center of the lesser trochanter，1 cm height above center of the lesser trochanter, 2 cm height above center of the lesser trochanter (marked as femoral anteversion 1-4). Femoral anteversion 5 was defined as the midcortical line of the anterior cortical line in the slice of 2 cm height above center of the lesser trochanter and the posterior cortical line in the slice of 50% of the distance from the top of greater trochanter to the center of the lesser trochanter above the center of the lesser trochanter. The stem anteversion angle was defined as the angle formed by the stem neck major axis and the posterior aspect of the femoral condylar line. The cup version and stem alignment were also calculated. The difference value and correlation coefficients of femoral anteversion 1-5 and stem anteversion were compared. Results Femoral anteversion 1-5 was 17.70°±10.54°, 35.59°±7.21°, 31.09°±7.98°, 24.71°±9.11°, 21.94°±10.10°, respectively。Stem anteversion was 20.52°±10.90°. The difference value between stem anteversion and femoral anteversion 1-5 was 2.82°±6.27°, -15.08°±7.99°, -13.80°±15.68°, -4.19°±5.69°, -1.42°±4.07°, respectively. Cup anteversion was 25.60°±11.65°, and combined antevertion was 46.11°±13.28°，sagittal stem tilt was 1.13°±1.53°. There were statistically significant differences between femoral anteversion 1-4 and stem anteversion (P＜0.05), and no statistical difference was found between femoral anteversion 5 and stem anteversion. The correlation coefficients of femoral anteversion 1-5 and stem anteversion were 0.829, 0.681, 0.689, 0.853, 0.928, respectively. Conclusions Femoral anteversion 5 had a highly positive correlation with stem anteversion, which was an effective a substitute of stem anteversion before THA.
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Background: The Aim of the study was to analyze the functional outcome of limb length discrepancy after total hip replacement. . Methods: It is a Prospective study on 21 patients who underwent total hip replacement with different hip pathology between November 2015 and October 2017. Results: 13 males and 8 females patients with a mean age of 35.31±7.42 (21-50) were followed up for a time of 12months. Limb length discrepancy and hip function of 21 patients who underwent primary total hip arthroplasty were assessed before surgery and 1month, 3 month and 12 month after surgery. Limb length discrepancy was evaluated before and after surgery by clinical and radiological method, Functional outcome assessed by using the Oxford hip score (OHS) and Harris hip score(HHS). Preoperatively all patients had shorter limb length as compared to contra lateral side. Postoperatively in 42.9% (9/21) the limb operated on was longer, in 19 %( 4/21) of cases limb operated on was shorter and in 31 %( 8/21) postoperative limb length were equal. Postoperatively limb length discrepancy was present in 61.9 %( 13/21) & was perceived by 53.8 %( 7/13 of cases) when either shortening or lengthening exceeded 10mm. Oxford hip score (OHS) and Harris hip score (HHS) were significantly increased at subsequent follow up (at 1, 3 and 12 months). Functional scores (OHS and HHS) were excellent in patients with equal limb length as compared to those having shorter or longer limb length. Conclusion: Patient with limb length discrepancy had negative influence in relation to limping and pain. Patients should be counseled preoperatively about possible limb length differences and associated symptoms.
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Objective To learn the effects on improving mental anxiety and depression in empty-nest elderly with hip replacement by accompany care work, and the factors influencing psychological anxiety and depression after hip replacement in empty-nest eldly. Then to explore comprehensive nursing strategies for hip arthroplasty in empty-nest eldly. Methods We investigated empty-nest elderly with hip arthroplasty by using homemade questionnaire, SAS and SDS scale between november 2015 and october 2017. Different nursing methods were used to treat empty-nesters in different groups, and the influencing factors of anxiety and depression were analyzed.Results It is not statistically significant in demographic characteristics (χ2＜3.84, P＞0.05) and anxiety (t = 1.2037, P=0.2308) and depression (t =1.0094, P=0.3142) at the time of entering the hospital, etc. Patients anxiety is statistically significant at time of discharge (t =-5.0159, P≤0.001) and one month after discharge (t =-9.5160, P ＜ 0.001), Patients depression is statistically significant at time of discharge (t =-2.9271, P = 0.0039) and one month after discharge (t =-8.2383, P＜0.001).The factors causing anxiety is nursing mode, number of chronic diseases and postoperative complications. The factors causing depression are economic income, nursing mode, and number of chronic diseases.Conclusion Accompany care work can improve the problems of anxiety and depression in an empty-nest eldly man after hip replacement. It is related to anxiety in nursing patterns, chronic diseases, postoperative complications.Meanhiwle while depression is related to economic income, nursing patterns, and types of chronic diseases, etc.
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Objective:To compare the clinical effects of restrictive blood transfusion combined with hyperbaric oxygen preconditioning (HBOPC) and restrictive blood transfusion in the treatment of hip,knee arthroplasty (THA,THA).Methods:40 patients in the period of epidural anesthesia,femoral nerve hysteresis hip and knee arthroplasty were selected and randomly divided into two groups:restrictive transfusion group (maintain 80 g/L≤ Hb ＜100 g/L,n=20) and restrictive blood transfusion combined with HBOPC (HBOPC+maintain 80 g/L =Hb ＜100 g/L,n=20).The red blood cell transfusion,red blood cell transfusion rate,perioperative Hb,blood oxygen saturation (SO2),the incidence of hypotension during operation,hospitalization time and postoperative cerebral infarction,acute pulmonary embolism,pneumonia,myocardial infarction,wound infection rate and 90 days mortality rate were compared between two groups.Results:Compared with the restrictive transfusion group,the postoperative Hb,blood oxygen saturation (SO2) of restrictive blood transfusion combined with HBOPC group were significantly increased(P ＜ 0.05);the red blood cell transfusion,red blood cell transfusion rate,incidence of pneumonia,wound infection rate were significantly decreased (P＜0.05).Conclusion:Restrictive blood transfusion combined with hyperbaric oxygen preconditioning could improve the anoxic state of the hip,knee arthroplasty patients,which could effectively reduce red blood cell transfusion,reduce postoperative complications,has good clinical curative effect.
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OBJECTIVE:To investigate the effect of total saponins of Man medicine Thladiantha dubia root(TSTR)on the ex-pressions of CD3+,CD4+and CD8+ in spleen tissue of rats with type Ⅱ collagen-induced arthritis (CIA),and explore its mecha-nism in the treatment of rheumatoid arthritis(RA). METHODS:8 rats were taken as normal control group(NC group),the others 72 rats were injected mixture of bovine type Ⅱ collagen and Freund's complete adjuvant in tail and back to induce CIA model. The 50 modeled rats were randomly divided into model group(MC group),tripterygium polyglycoside(TG)group(12 mg/kg,posi-tive control),TSTR low-dose,medium-dose,high-dose groups (20,40,80 mg/kg),10 in each group. Rats in medicine groups were intragastrically administrated for 35 d,once a day;rats in NC group and MC group were intragastrically administrated equal volume of distilled water. Ankle swelling degree of rats was determined,arthritis indexes were calculated,HE staining was used to observe the lesions in synovial tissue,and immunohistochemistry was used to detect the expressions of CD3+,CD4+,CD8+ in spleen tissue of rats. RESULTS:After 35 d of administration,ankle swelling degree,arthritis indexes,CD4+ expression in spleen tissue,and CD4+/CD8+ ratio in MC group were significantly higher than NC group (P<0.05 or P<0.01),expressions of CD3+, CD8+were significantly lower than NC group(P<0.05);and there was congestion and massive inflammatory cell infiltration in sy-novial tissue. The ankle swelling degree,arthritis indexes,expression of CD4+ in spleen tissue,and CD4+/CD8+ ratio in administra-tion groups were significantly lower than MC group(P<0.05);the expressions of CD3+,CD8+ in spleen tissue in administration groups were significantly higher than MC group (P<0.05);TG group,TSTR medium-dose and high-dose groups showed mild congestion and a small amount of inflammatory cell infiltration in synovial tissue of rats,and TSTR low-dose group showed no ob-vious congestion or inflammatory cell infiltration. CONCLUSIONS:Up-regulating the expressions of CD3+,CD8+ and down-regu-lating the expression of CD4+ may be one of the mechanisms of TSTR in the treatment of RA;and with best efficacy when the TSTR dose of 20 mg/kg.
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Objective To get a controllable acetabulum component inclination angle during the total hip arthroplasty(THA) with the lateral position,a new method using a self-made instrument was introduced.Methods Totally 80 consecutive patients undergoing THA at the lateral position were enrolled.Forty acetabular components were assembled using a new method with a self-made instrument referring to the 42 degrees' angle drawn on the wall(group A),while another 40 acetabular cups were implanted free-handedly(group B).The postoperative inclination angle was evaluated on the anterior-posterior pelvic radiographs.Results The average inclination angle was 43.3° ± 3.7°(34.7°～49.1°) in group A and 40.3 ± 4.5o(32.8°～50.7°) in group B.Moreover,40/40 of group A and 38/40 of group B were in the Lewinnek's inclination safe zone(P＞0.05),without significant differences between the two groups.Conclusion It is practical and reliable to decide the acetabular component orientation using the lateral position instrument and reference angle on the wall.
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Objective To investigate biomechanical properties of the femur during slow walking and stair climbing before and after total hip replacement (THA), so as to provide theoretical basis for optimal design and manufacturing of the prosthetic hip. Methods The 3D finite element model of hip femur was established and validated first, and the stress distributions and stress shielding rates during slow walking and stair climbing before and after THA were calculated. Results During slow walking, the stress increased gradually from the proximal femur to the distal femur, reaching the maximum 90.6 MPa at the lower part of the femur before THA. A stress shielding phenomenon occurred on the femur after THA, but the stress amplitude decreased, with the maximum stress reaching 82.5 MPa. The maximum shielding rate appeared near the greater trochanter of the proximal femoral prosthesis and the total stress shielding rate reached 14.9%-99.0%. In addition, excessive stress concentration occurred at the prosthetic neck. Meanwhile, the stress distribution during stair climbing had a similar regular pattern as that appeared during slow waling, but with a more obvious stress shielding effect. Conclusions The greater stress shielding of the proximal femur and the excessive stress concentration on the prosthetic hip during stair climbing will both influence the THA surgery quality, so patients should minimize the movement involving large joint angle after THA.
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Objective To assess the surgical and rehabilitation effects of total hip arthroplasty (THA) through comparing changes of gait parameters in patients before and after THA.MethodsThe gaits of 7 THA patients during their natural walking before THA and in the 25th week after THA were tested by using a portable gait analyzer (IDEEA, MiniSun, USA). The gait parameters including single limb support (SLS) time, double-limb support (DLS) time, SLS/DLS, stride length, foot fall strength were collected for statistic analysis by SPSS 16.0 and Excel 2010. Results The SLS of the healthy leg after THA significantly decreased (P<0.05); for the majority of THA patients, the SLS of the diseased leg decreased, the DLS and SLS/DLS of the healthy leg also decreased obviously, while the foot fall strength of the diseased leg increased after THA. Conclusions The SLS of the healthy leg can be used as a sensitive parameter to evaluate the operation effect of THA. The portable gait analysis system can quantitatively reflect the subject’s gait, thus it is a non-invasive and convenient method of evaluating the operation effect in clinic.
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Objective To study the basic regular patterns of stress distributions inside and outside periacetabular districts during normal gait cycle of healthy adults, so as to provide clinical guidance for acetabular reconstruction of total hip arthroplasty (THA). Methods Based on CT scans of a male and a female healthy adult volunteer, The three-dimensional model including pelvis and proximal femur was reconstructed. By using an inhomogeneous material distribution scheme which was based on CT data to calculate elastic modulus and convergence analysis, each element was given a corresponding material attribute. The dynamic change of hip contact force during a normal gait cycle was used as the load condition to the model. Von Mises stress of the nodes inside and outside the model was considered as the criterion to assess the results. Results During normal gait, the stress on the hip surface of two volunteers was mainly transmitted from postersuperior part of acetabulum to auricular surface along posterolateral of iliac wing, and the maximum stress was at the district near greater sciatic. As for the superior, middle and inferior section of two volunteers' acetabulum, the stress was distributed both on cortical and cancellous bone of postersuperior part. However, in terms of acetabular anterior and posterior column, the stress distribution was mainly found on cortical bone. Conclusions According to the observed acetabular stress distribution pattern of health adults during normal gait cycle, choosing acetabular component with more suitable size and controlling the placement of acetabular component with more accuracy could obtain some acetabular reconstruction plan better in accordance with stress distributions during normal gait.
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Abstract： Objective To study the influence from different placement angles of acetabular component on inner and outer stress distributions of periacetabulum in acetabular reconstruction of total hip arthroplasty (THA), so as to explore proper orientation for improving stability of acetabular component after THA. Methods Based on model with inhomogeneous material property assignment, nine THA models with acetabular component at different anteversion angles(15°, 20°, 25°) and abduction angles(40°, 45°, 50°) as well as one normal hip model were constructed. The maximal hip contact force in phase of single leg stance during normal gait cycle was chosen as the loading condition. In addition, according to the qualitative and quantitative principle, inner and outer stress distributions on 9 THA models were analyzed and compared with the normal hip model as control. Results When abduction angle of acetabular component was the nearest to anatomic angle (19° anteversion, 46° abduction) of acetabulum, the phenomenon of stress shielding on periacetabulum was the most obvious. When abduction angle of acetabular component was placed at 45° and anteversion angle changed from 15° to 25°, no significant influence was exerted on the whole stress distributions of THA models. Meanwhile, when anteversion angle of acetabular component was 15°, the THA model had good stability in stress distributions, and the phenomenon of stress shielding on cortical and cancellous bone was obviously improved. Conclusions For patients who have normal anatomic acetabulum and need to be treated with THA, the abduction angle of acetabular component should be placed at 45°, as that of normal acetabulum; the anteversion angle should be 5° smaller than that of normal acetabulum and between 15° and 20°.
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[ ABSTRACT] AIM: To investigate the role of anterior thalamic nucleus in trigeminal nerve electrostimulation ( TNS)-induced effects on seizures and hippocampal damage.METHODS: The rats were intraperitoneally injected with pilocarpine to induce chronic epilepsy, and then received sham treatment, TNS treatment and TNS treatment after stereotac-tic lesion to the anterior thalamic nucleus.The TNS treatment lasted for 1 month in each group.Another injection of pilo-carpine was conducted to induce seizures, and the severity and duration of seizures were quantitatively evaluated.TUNEL, Fluoro-Jade B ( FJB) and Nissl staining were applied to determine in situ apoptosis, neuronal degeneration and neuron loss in the hippocampal CA1 area respectively.RESULTS:Compared with TNS group, TNS treatment after stereotactic lesion to the anterior thalamic nucleus significantly increased the severity and duration of seizures (P<0.05), and the numbers of TUNEL positive cells, FJB positive cells and lost neurons in the hippocampal CA1 area (P<0.01).CONCLUSION:Anterior thalamic nucleus plays a role in TNS-induced reduction of seizures and hippocampal damage.The mechanisms might be due to the chronically activation of the cortex through anterior thalamic nucleus pathway induced by TNS, resulting in the down-regulation of neuronal excitatory susceptibility.
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In Japan, hip joint degenerative diseases are based on acetabular dysplasia and the treatment strategy has been focused primarily on how to maintain the hip joint function and how to achieve pain relief. We employed total hip arthroplasty (THA) to treat end-stage OA of the hip joint. There are many possible complications in THA including infection, dislocation and nerve palsy. Especially in patients with Crowe IV dislocation, THA should be accompanied by simultaneous subtrochanteric shortening osteotomy to prevent sciatic nerve palsy. There is concern that the small metal head and posterior approach without re-attachment of posterior soft tissue commonly used in THA may be susceptible to postoperative dislocation. To avoid this scenario, we developed a modified less invasive total hip arthroplasty surgical approach that uses the anterolateral approach of the modified Watson-Jones approach. By using this approach, the risk of postoperative dislocation can be greatly reduced due to the intact posterior stabilizing soft tissue of the hip joint. Recently, a new concept in hip pathology describing femoroacetabular impingement (FAI) including retroversion of the acetabulum was proposed by Professor Ganz in 2003. Patients with acetabular dysplasia were also assumed to have acetabular retroversion. In patients with acetabular dysplasia to prevent further pathology of the hip joint, we developed a reorientation rotational acetabular osteotomy using a navigation system to obtain accurate direction and alignment in the reorientated hip joint. Orthopedic surgeons and rehabilitation doctors need to understand each other well in their respective fields of pathology and treatment strategy to ensure the optimal treatment of motor diseases.