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Objective:To investigate the safety, economic effect, and short-term clinical efficacy of ambulatory total hip arthroplasty (THA) in the treatment of hip osteopathy within.Methods:This study retrospectively reviewed patients who underwent 48-hour outpatient THA and conventional primary THA from July 2020 to July 2021. Gender, age, body mass index (BMI), clinical diagnosis, place of resident, length of hospital stay, duration of the surgery, hemoglobin, albumin, C-reactive protein (CRP) and D-dimer before and 1 day after surgery, the visual analogue scale (VAS) was obtained postoperative day 2, hip joint modified Harris score before and 1 month after surgery, readmission and reoperation within 1 month after operation as the data of evaluations were extracted and compared in this study.Results:A totally of 150 cases were involved in this study, which including 75 cases with 48-hour outpatient primary THA and 75 cases with conventional primary THA. There was no significant difference between the two groups in terms of age, sex, BMI, education level, preoperative diagnosis, and preoperative Harris score ( P>0.05), but a significant difference was found in term of residence (χ 2=6.29, P=0.043), that the patients in the outpatient group were all from Zhejiang Province and 48% (36/75) of them were from Hangzhou City. While, in the conventional group, 6 patients were from other provinces. The length of stay was 2.13±0.52 days and operation time was 59.73±18.91 minutes in the outpatient group, which were both shorter than those (6.71±1.44 days and 66.91±22.40 min) in the conventional group ( t=25.91, P<0.001 for the length of hospital stay; t=2.12, P=0.036 for operation time). Compared with the conventional group, outpatient group saved the average hospital cost (4.60±0.44 vs. 5.20±0.72 ten thousand yuan, t=6.16, P<0.001). The VAS on the second day after surgery 3.45±0.75 was higher in the outpatient group than in the conventional group (3.45±0.75 vs. 3.16±0.94 points, t=2.09, P=0.039). The modified Harris score was without statistical significance ( t=0.42, P=0.677) 1 month after surgery in both groups. 75 patients in the outpatient group, 7 patients delayed discharge (were not discharge within 48 hours), and the rate of delayed discharge was 9.3%. Reasons for delayed discharge included poor pain control in two cases, one case had postoperative nausea and vomiting, one case had failed to meet rehabilitation standards, hypotension in one case, the intraoperative infection in one case and postoperative fever within 48 hours in one case. Conclusion:Outpatient THA can reduce the length of hospital stay, operative time and total cost of hospitalization. It has similar safety and early clinical efficacy as conventional THA. However, a small proportion of patients would delay discharge.
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Objective@#To investigate the clinical effects of primary revision after artificial hip replacement and causes of revision surgery.@*Methods@#A total of 344 patients who underwent revision surgery after total hip arthroplasty (THA) and artificial femoral head replacement from January 2010 to December 2016 were retrospectively analyzed. There were 141 males and 203 fe-males, with a mean age 65.64±10.81 years (28-87 years). A total of 351 hip revisions were performed in 344 patients with 7 pa-tients in bilateral revisions. All patients were followed up for 60.38±22.75 months (24-105 months). All patients with periprosthet-ic infection underwent two-stage revision after prosthesis placement, and all others underwent one-stage revision. The clinical out-comes of revision surgery were assessed with the Harris hip score and the survival rate of the revision prosthesis. According to the duration from artificial hip replacement to revision surgery, all patients were divided into early revision (less than 5 years) and late revision (more than 5 years) groups. They were also divided into two groups according to the age of the patient in revision sur-gery: >55-year-old and ≤55-year-old groups. The causes of revision, hip reoperation and re-revision were recorded.@*Results@#In the 351 hip revisions, a total of 238 (67.8%) had aseptic loosening, 41 (11.7%) periprosthetic fractures, 30 (8.5%) periprosthetic infection, 23 (6.6%) recurrent dislocation and 19 (5.4%) the eccentric liner wear. The infection rate was significantly higher in the early revision group (21.1%) than that in the late revision group (4.2%) (χ2=24.443, P<0.001). The aseptic loosening rate was sig-nificantly higher in the late revision group (72.4%) than that in the early revision group (54.4%) (χ2=9.899, P=0.002). Sixteen pa-tients underwent hip surgery after revision, including 6 recurrent dislocations, 4 aseptic loosening, 3 periprosthetic fractures, and 3 periprosthetic infections. Eight of them underwent revision surgery, including 4 cases of aseptic loosening, 2 cases of periprosthet-ic fractures, and 2 cases of recurrent dislocation. The duration from the primary revision to the second revision was 22.1±10.0 months (1-75 months). The 5-year and 8-year survival rates of the revision prostheses were 99.3%[95%CI(98.3%, 100.3%)] and 92.6% [95%CI(87.1%, 98.1%)], respectively. The proportions of prosthetic infection and eccentric liner wear in the ≤55-year-old group were significantly higher than those in the >55-year-old group (χ2=3.981, P=0.046; χ2=5.226, P=0.022), while the propor-tion of aseptic loosening in the >55-year-old group was significantly higher than that in the ≤55-year-old group (χ2=5.254, P=0.022). The 8-year survival rates of the revision prostheses of ≤55-year-old group and >55-year-old group were 76.8% [95%CI(50.5%, 103.1%)] and 95.4% [95%CI(91.1%, 99.7%)], respectively.@*Conclusion@#Young patients have a higher risk of re-revi-sion after revision THA.
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Objective To investigate the clinical effects of primary revision after artificial hip replacement and causes of revision surgery. Methods A total of 344 patients who underwent revision surgery after total hip arthroplasty (THA) and artificial femoral head replacement from January 2010 to December 2016 were retrospectively analyzed. There were 141 males and 203 fe?males, with a mean age 65.64±10.81 years (28-87 years). A total of 351 hip revisions were performed in 344 patients with 7 pa?tients in bilateral revisions. All patients were followed up for 60.38±22.75 months (24-105 months). All patients with periprosthet?ic infection underwent two?stage revision after prosthesis placement, and all others underwent one?stage revision. The clinical out?comes of revision surgery were assessed with the Harris hip score and the survival rate of the revision prosthesis. According to the duration from artificial hip replacement to revision surgery, all patients were divided into early revision (less than 5 years) and late revision (more than 5 years) groups. They were also divided into two groups according to the age of the patient in revision sur?gery:＞55?year?old and≤55?year?old groups. The causes of revision, hip reoperation and re?revision were recorded. Results In the 351 hip revisions, a total of 238 (67.8%) had aseptic loosening, 41 (11.7%) periprosthetic fractures, 30 (8.5%) periprosthetic infection, 23 (6.6%) recurrent dislocation and 19 (5.4%) the eccentric liner wear. The infection rate was significantly higher in the early revision group (21.1%) than that in the late revision group (4.2%) (χ2=24.443, P＜0.001). The aseptic loosening rate was sig?nificantly higher in the late revision group (72.4%) than that in the early revision group (54.4%) (χ2=9.899, P=0.002). Sixteen pa?tients underwent hip surgery after revision, including 6 recurrent dislocations, 4 aseptic loosening, 3 periprosthetic fractures, and 3 periprosthetic infections. Eight of them underwent revision surgery, including 4 cases of aseptic loosening, 2 cases of periprosthet? ic fractures, and 2 cases of recurrent dislocation. The duration from the primary revision to the second revision was 22.1 ± 10.0 months (1-75 months). The 5?year and 8?year survival rates of the revision prostheses were 99.3%[95% CI(98.3%, 100.3%)] and 92.6% [95% CI(87.1%, 98.1%)], respectively. The proportions of prosthetic infection and eccentric liner wear in the≤55?year?old group were significantly higher than those in the＞55?year?old group (χ2=3.981, P=0.046; χ2=5.226, P=0.022), while the propor?tion of aseptic loosening in the＞55?year?old group was significantly higher than that in the ≤55?year?old group (χ2=5.254, P=0.022). The 8?year survival rates of the revision prostheses of ≤55?year?old group and＞55?year?old group were 76.8% [95% CI (50.5% , 103.1% )] and 95.4% [95% CI (91.1% , 99.7% )], respectively. Conclusion Young patients have a higher risk of re?revi?sion after revision THA.
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Objective To discuss the safety and the application of the self-designed multifunctional inflatable pelvis and hip-joint fixator (MIPHF) in damage control in pelvic fracture patients.Methods The MIPHF was subjected to pressure test and quality inspection.From September 2016 to June 2017,61 pelvic-fracture patients were treated with our self-designed MIPHF as pre-hospital first-aid care according to the concept of damage control orthopedics (DCO) (MIPHF group).The control group consisted of 69 pelvic-fracture patients who had not received pre-hospital first-aid care with the self-designed MIPHF from December 2015 to August 2016.There were no statistically significant differences between the two groups in gender,age,types of pelvic fracture,and preoperative injure severity score (ISS).The study compared the two groups for the case fatality rate,volume of blood transfused during surgeries,early complication rates,fracture reduction (Matta standards),and long-term efficacy (Cole scores).Results The pressure test showed that the MIPHF had a good fixation effect on the pelvis.And the quality inspection showed that the material used for the MIPHF was in line with national standards and the safety was guaranteed.The MIPHF group had 1 death (1.6％) and the control group had 8 deaths (11.6％),which was a significant difference (x2=4.979,P=0.026).All survival patients in both groups were followed up.The MIPHF group (61 cases) received 3.0 to 18.0 months follow-up,with an average of 9.0 months.And the control group (69 cases) had 18.0 to 30.0 months follow-up,with an average of 21.9 months.In the MIPHF group,23 cases were treated conservatively,and 37 cases were treated with surgery.Among them,3 cases were fixed with external fixator,20 cases with anterior open reduction and internal fixation,9 cases with posterior open reduction and internal fixation,and 5 cases with combined anterior and posterior fixation.The timing of surgery was 1 to 20 days after injury,with an average of 4.1 days.The volume of blood transfused in the MIPHF group during surgery was 200 to 1500 ml,with an average of 628.6 ml.In the control group,27 patients were treated conservatively,and 42 patients were treated with surgery.Among them,2 cases were fixed with external fixator,24 cases with anterior open reduction and internal fixation,10 cases with posterior open reduction and internal fixation,and 6 cases with combined anterior and posterior fixation.The timing of surgery was 1 to 15 days after injury,with an average of 3.l days.The volume of blood transfused in the control group during surgery was 200 to 4000 ml,with an average of 1 707.1 ml.There was a significant difference between the two groups in intraoperative blood transfusion(Z=-2.330,P=0.020).The MIPHF group had 10 (16.4％) cases of early serious complications and the control group had 22 (31.9％) cases,which had a significant difference (x2=4.187,P=0.041).According to the criteria proposed by Matta et al.,the good rate of results for treating fractures was 82.0％ in the MIPHF group and 60.9％ in the control group,which got a significant difference (x2=6.967,P=0.008).The MIPHF group and the control group also differed significantly in their mean long-term Cole scores (27.2±4.0 versus 25.1 ±5.6,t=2.457,P=0.015).Conclusion MIPHF,which reflects the DCO concept,may be recommended as pre-hospital first-aid care for patients with pelvic fracture because it can lessen bleeding and prevent secondary pelvic injury,thus reduce case fatality rate and the incidence of complications.It can also improve the success rate of treating pelvic fracture,which will positively affect long-term outcomes.
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Objective To investigate the diagnostic value of knee skin temperature and serum soluble intercellular adhesion molecule-1 (sICAM-1) level in peri-prosthetic infection after total knee arthroplasty (TKA).Methods Thirty patients (11 males and 19 females,aged 59.3±9.5 years old) underwent primary TKA during November 2012 and October 2015.Ten patients with peri-prosthetic infection (3 males and 7 females,aged 60.9±8.2 years old) underwent two-stage revision TKA from November 2012 to October 2015.The interleukin-6 (IL-6),C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),sICAM-1 in serum and the skin temperature in knee joint were recorded preoperatively (revision patients on diagnosis),at days 1,7 and at 1,3,6,12 months post-operatively.Results All of the 40 patients were followed up for 12 months.The serum CRP,IL-6 and ESR levels in the primary TKA group were normal preoperatively and increased after operation,reaching their peaks at 1-7 days postoperatively.These indexes then returned slowly to the normal levels within 3 months.The serum sICAM-1 level in the primary TKA group did not change significantly during the follow up.The serum levels of CRP,IL-6,ESR,and sICAM-1 in the revision group were significantly higher than that in the primary TKA group preoperatively (P＜0.05),IL-6,CRP,ESR returned slowly to the normal levels within 3 months after the second-stage revision,while the level of sICAM-1 returned to normal within 3 months after the first-stage revision.During whole follow-up after the second-stage revision,the level of sICAM-1 didn't change significantly.The preoperative mean differential temperature (MDT) in the primary TKA group was 0.73±0.62 ℃ preoperatively and elevated to 4.37±1.06 ℃ at 7 days postoperatively,which returned to the baseline within 6 months after primary TKA.The preoperative MDT in the revision group was 5.03±0.81 ℃,which was significantly higher than that in the primary TKA group (P＜0.05).The MDT returned to the normal level within 6 months after the second-stage revision TKA.Conclusion The change of MDT is in accordance with serum CRP,IL-6,and ESR,which together may predict the occurrence of infection.Serum sICAM-1 level may also be valuable in the diagnosis of peri-prosthetic infection.
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Objective To investigate the outcomes of the treatments for the patients with Vancouver type B 1 periprosthetic femur fractures.Methods Seventeen patients with periprosthetic femoral fractures (5 males and 12 females;average age,70.4 years,range from 37 to 86 years) who underwent revision arthroplasty or open reduction and internal fixation between December 2006 and June 2016 were retrospectively reviewed.Periprosthetic femoral fractures occurred at the mean time of 65.1 months after arthroplasty.Twelve patients underwent open reduction and internal fixation and five cases underwent total hip or stem revision with Solution from Depuy,Wagner from Zimmer,Echelon from Smith & Nephew or Secur-Fit Max from Stryker due to primary bone loss,acetabular component wear or long-time prosthesis use respectively.Data were collected at 1,3,6 and 12 months and then each year postoperatively.All patients were followed up,and the results of X-ray,postoperative Harris hip score,stability of prosthesis and complications were also evaluated.Results A total of 5 patients underwent revision arthroplasty,and 12 patients underwent open reduction and internal fixation.The mean follow-up duration was 56 months (range from 7 to 120 months).Total blood loss in the open reduction and internal fixation group and in revision group was 385± 129 ml and 531± 113 ml respectively.The operation duration in the open reduction and internal fixation group was 72±36 min while it was 126±48 min in the revision group.The postoperative Harris hip score in the open reduction and internal fixation group was significantly increased compared with preoperative Harris hip score (68.8±18.4 vs.46.2±9.6),as well as in the revision group (75.0±8.9 vs.57.4±13.0).For the incidence of complications,in the open reduction and internal fixation group,one patient suffer with delayed fracture union,one patient complained about persistent pain and one suffered a secondary fracture,while in the revision group one suffered from blood loss and one with long-term pain.Conclusion Open reduction and internal fixation is an optimal intervention for Vancouver B 1 fracture,and revision arthroplasty can be considered as a safe alternative in patients with primary bone loss,implant of short survival time,severe liner wear or long-term prosthesis use.
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Objective To investigate the effects of the jumbo cup in acetabular revision for patients with massive acetabular bone deficiency.Methods We retrospectively studies 48 patients (49 hips) who underwent jumbo cup revisions between 2006 and 2015 (19 men and 29 women;average age:62± 12 years).The acetabular bone defects were classified according to Paprosky classification (Paprosky Ⅱ 27 hips,Paprosky ⅢA 18 hips,Paprosky ⅢB 4 hips).Radiological assessments were conduced to evaluate the acetabular prosthesis loosening,dislocation and infection.The reasons for revisions were mechanical loosening in 41 cases,and infections in another 8 cases with cement spacer putted by last surgery.Results The operation duration and blood loss was 110 min (85-160 min) and 315 ml (270-455 ml) respectively.After an average follow-up of 6.8 years (1-11 years),Harris hip score was increased from 47.6±7.1 preoperatively to 82.4± 6.2 postoperatively.Osseointegration occurred in the acetabular components at 6 months postoperatively.Radiograph analysis showed satisfied position of acetabular cup without complications such as damages of vessels or nerves.The successful rate of jumbo cup revisions was 89.8％±4.4％.However,two in Paprosky ⅢA failures for periprosthetic infection occurred and two in Paprosky ⅢA,one in Paprosky ⅢA and the other in Paprosky ⅢB for acetabular component loosening.One patient in Paprosky ⅢB had weight-bearing pain and relieve slightly after conservative treatment.The radiologic study showed that there was no relationship between failure rate and acetabular abduction angle (r=0.06,P=0.53),rotation center migration in vertical direction (r=0.11,P=0.14) and horizontal direction (r=0.04,P=0.89).Conclusion The mid-term results show that using jumbo cup in revising acetabular failure with massive bone deficiency are optimal,which can be achieved by simplified operation procedures,reduction in the need of bone graft and promotion in acetabulum osseointegration.However,higher failure rate may occur in Paprosky ⅢB patients.
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Objective To explore the effect and factors of patellofemoral arthroplasty (PFA) for isolated patellofemoral osteoarthritis.Methods Data of 18 patients (3 males,15 females) with isolated patellofemoral osteoarthritis underwent PFA from March 2006 to December 2014 were retrospectively analyzed.There were 3 males and 15 females with a mean age of 54 years (range,46-74 years).It was strict to grasp the surgical indications according to the clinical symptoms,signs and imaging data preoperatively.11 patients were operated with AVON patellofemoral prosthesis (Stryker Inc.) and the other 7 patients were operated with the Gender Solutions patellofemoral prosthesis (Zimmer Inc.).Active and passive functional rehabilitation exercise was encouraged at the early stage after operation.Visual analogue scale (VAS) was 5.33±0.99 (range,4-7) and hospital for special surgery knee score (HSS) was 53.28±5.71 (range,44-63) before operation.Results The mean duration of follow-up was 63.98 months (range,6-104 months).VAS after operation for 1 and 3 months were 1.17±0.79 (range,0-3) and 0.72±0.67 (range,0-2),and the pain was almost relieved after 9 months.HSS after operation for 1,3,9 months were 70.06±6.33 (range,61-80),86.06±5.12 (range,77-95) and 91.39±4.83 (range,82-97).HSS score of the latest follow-up was 92.06±4.05 (range,84-97),which was improved obviously from the preoperative ones.The excellent and good rate was 100％ (excellent 15 cases,good 3 cases).The satisfactory rate was 94.4％ (17/18).Only one case got slightly knee pain when walking up and down the stairs after 2 years,and the pain was relieved after being administered with NSAIDs and rest.No incision infection,rupture,prosthesis supported bone fracture,prosthesis loosening and other complication was occurred during the follow-up period in the other patients.Conclusion The clinical outcomes of PFA are strictly related to surgical indications,implant design and appropriate surgical technique.Therefore,based on the appropriate PFA implants,strict surgical indications,appropriate patients,excellent operation skills and actively functional rehabilitation exercise,PFA could treat the isolated patellofemoral osteoarthritis effectively.
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Objective To investigate the risk factors related to the survival time of anti-protrusion cage in acetabular revision.Methods Data of 40 patients who had received acetabular revision using antiprotrusion cages between January 2002 and June 2010 were retrospectively analyzed.There were 16 males and 24 females,aged from 22 to 77 years (average,60.3 years).All patients were followed up for 12 to 82 months (average,39.2 months).According to the AAOS classification,there were 29 cases of type C and 11 cases of type D； while according to the Paprosky classification,there were 29 cases of type ⅢA and 11 cases of type Ⅲ B.The multiple regression analysis was utilized to investigate the relationships between different factors and anti-protrusion cage failure.The corresponding factors included gender,age,bone loss classification,superior or lateral migration of acetabular center of rotation,abduction angle,fixation manners (simple flange fixation or flange fixation plus transacetabular screw fixation),bone grafting techniques and cup type.Results At final follow-up,the average Harris score was 74.5±15.4.Two patients received rerevision due to prosthetic loosening.Obvious radiological loosening of prosthesis combined with pain was found in 2 cases.The statistical analysis indicated that superior migration of acetabular center of rotation,abduction angle and fixation manners were correlated with cup failure,especially when the superior migration was more than 8.5 mm or the abduction angle was larger than 53.5°.Flange fixation plus transacetabular screw fixation could reduce risk of cup failure.Conclusion There is a higher cup failure risk in acetabular revision using an anti-protrusion cage for patients with serious bone defect.However,implanting cup at the level of the true acetabulum as far as possible,decreasing abduction angle properly and using flange fixation plus transacetabular screw fixation can reduce cup failure risk.
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ObjectiveTo investigate the size effect of hydroxyapatite nanoparticles on proliferation and apoptosis of osteoblast-like cells.MethodsCetyltrimethylammnonium bromide (CTAB) was used to regulate the size of nano hydroxyapatite (nHAP) particles.All obtained particles were characterized by transmission electron microscopy (TEM),X-ray diffraction,dynamic light scattering and chemical analysis.HAP films were obtained by slowly coating cover glasses with 1％ HAP particle suspension.MG-63 cells on three different films(20HAP,40HAP and 80HAP) were cocultured for up to 5 days.Cell proliferation assay was obtained by methyl thiazolyl tetrazolium (MTT).Cell apoptosis was detected by flow cytometric detection.Cell ultrastructure morphology was observed by TEM observation.ResultsnHAP with diameter of 20 nm,40 nm and 80 nm were synthesized and and analyzed.The MG-63 cells were cultured on three different fihns.The optical density value of cells on 20HAP was 1.22±0.13 after 5 days incubation,and there was no different compared to the control group(F=6.843,P=0.124).Cell number and viability were significantly higher on 20HAP compared to large nHAP after 5 days incubation.The percentage of apoptotic cells increased with increasiug nHAP particle size.TEM images showed 20HAP was found in cytoplasm and cell morphology had no changes.ConclusionBoth cell proliferation and cell apoptosis are related to the size of the nHAP particles.20HAP was the most effective on promoting cell growth and inhibiting cell apoptosis.
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Objective To explore relationship between anterior knee pain after total knee arthroplasty and patella resurfacing and prosthesis design,and to evaluate which femoral prosthesis is more friendly with patella:Genesis Ⅱ or PFC knee prostheses.Methods Data of 145 patients (145 knees) who had undergone primary total knee arthroplasty for treating osteoarthritis were retrospectively analyzed.Posterior-cruciate-substituting total knee prostheses were used in all patients.Among 74 patients who had undergone patella resurfacing,Genesis Ⅱ knee prosthesis was used in 32 patients and PFC knee prosthesis in 42 patients.Among 71 patients who had not undergone patella resurfacing,Genesis Ⅱ knee prosthesis was used in 38 patients and PFC knee prosthesis in 33 patients.The Hospital for Special Surgery(HSS) score,patella score,patellar function score,range of motion of knee,anterior knee pain scale,and patient satisfaction were used to evaluate clinical outcomes.At the same time,the imaging results were evaluated by X-rays.Results 144 patients were successfully followed up for 21 to 43 months (average,33 months).There was no significant difference in incidence of anterior knee pain between the group with patella resurfacing and the group without patella resurfacing,while a significant difference was found between patients receiving Genesis Ⅱ knee prosthesis and those receiving PFC knee prosthesis.Four patients who had undergone total knee arthroplasty using PFC prosthesis underwent reoperation.There were no significant differences in postoperative HSS score,range of motion of knee and patient satisfaction between the Genesis Ⅱ group and the PFC group,while there were significant differences in patella score and patellar function score between them.Conclusion Postoperative anterior knee pain was related to the prosthesis design,rather than to the patella resurfacing.Genesis Ⅱ knee prosthesis was more friendly with patella than PFC knee prosthesis.
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Objective To investigate technique and clinical effect of total en bloc spondylectomy for thoracic and lumbar chondrosarcoma.Methods From January 2010 to March 2012,6 patients with thoracic or lumbar chondrosarcoma underwent total en bloc spondylectomy.There were 4 males and 2 females,aged from 25 to 54 years (average,38 years).The tumor ranged from T3 to L3; 1 located in T3 and T4,1 in T7,1in T11,1 in L1,1 in L2 and 1 in L3.According to Tomita surgical classification system,there was 1 case of type 2,1 case of type 4,3 cases of type 5 and 1 case of type 6.One patient underwent tumor resection through single posterior approach,while the other 5 patients underwent anterior dissection and posterior resection of tumor.All spines were reconstructed by posterior fixation with pedicle screws and anterior interbody fusion with titanium mesh cages or artificial vertebrae.Results The average amount of blood loss was 3200 ml (range,2100 to 6300 ml).The duration of operation ranged from 3.5 to 12 hours (average,5.5hours).Two patients obtained wide resection,3 obtained marginal resection,and 1 had intralesional margin.The complications included 2 cases of cerebrospinal leak,1 case of pleural effusion and 1 case of pulmonary infection.There was no wound infection and death during peroperative period.All patients were followed up for 6 to 32 months (average,19 months).The neurological function improved from preoperative Frankel C to postoperative Frankel E in 2 cases.All patients obtained bone union 6 to 12 months (average,8 months) after operation.At final follow-up,all patients could walk without aid,and there was no recurrence.Conclusion The total en bloc spondylectomy is an effective method for thoracolumbar chondrosarcoma,which could provide a satisfied tumor control and neurological function improvement.
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Objective To investigate the effects of locally and systemically administered alendronate on wear-debris induced osteolysis in vivo. Methods Endotnxin-free titanium particles were injected into rabbit femurs prior to insertion of a non-weight-bearing polymethylmethacrylate plug into the distal femur canal. Then the particles were repeatedly injected into the knee 2, 4 and 6 weeks after the implantation. Alendronate was incorporated into bone cement for local delivery at three different concentrations [0.1, 0.5, and 1.0 weight%(wt%)]. For systemic delivery, alendronate was subcutaneously injected ( 1.0 mg· kg-1·week-1).Results Eight weeks after operation, there was significant evidence of osteolysis surrounding the plug in the control group, while markedly-blocked osteolysis was noted in the local delivery group (0.5 wt% and 1.0 wt%), and the systemic delivery group. It was found that alendronate had improved peri-prosthetic bone mineral density in a dose-effect model. Notably, no significant difference was found between local delivery of 0.5 wt% alendronate and systemic delivery in bone mineral density and implant fixation. Conclusion Alendronate-loaded bone cement (0.5 wt% ) may be as effective as the systemic delivery in inhibiting titanium particle-induced osteolysis.
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Objective To discuss the diagnosis, differential diagnosis and therapeutics of the juxtaarticular bone cyst in the acetabulum. Methods Between August 1990 to April 2009, nineteen cases of clinical data of the juxta-articular bone cyst in the acetabulum data were collected from hospital records and analyzed retrospectively. There were 11 males and 8 females, with an average age of 42.3 years (range, 18-59). Seventeen patients felt an aching pain in the hip. The duration of symptoms was from 2 months to 20years with the median 15 months. All the radiographs showed a well-demarcated oval or circular radiolucent defect, close to subchondral bone, and outlined by a thin rim of sclerotic bone. Five cases accompanied with developmental dysplasia of the hip. After curettage of the bone cyst, 14 patients received iliac crest autogenous bone grafts, 3 patients received xenoma spongy bone-graft particles, and 2 patients received artificial bone grafts. Results Fourteen patients were precisely diagnosed as bone cyst by radiograph, and 4 patients were diagnosed by CT and MRI. The major axes of the focus were 2-4 cm in 16 patients, and 4-8 cm in 3patients. The sizes of the focus had no relationship with the symptoms and the course of the disease. Seventeen cases of the focus were located at the anterior superior of the bearing surface of the acetabulum. All patients were successfully followed up from 11 months to 13 years, averaged 6.2 years, and no relapses occurred during the follow-up period in every case. Fourteen patients felt asymptomatic, 3 patients felt uncomfortable in hip occasionally, and 2 patients with developmental dysplasia of the hip felt ameliorated in the initial stage of the therapy, followed by aggravation accompanying the hip joint space narrow. Conclusion Bone graft after thorough curettage of the capsular space was an effective therapy for the juxta-articular bone cyst in the acetabulum, and the anatomic distribution of radiological lesions indicated that the stress concentration maybe the etiological factor of the bone cyst.
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Objective To compare the clinical results of percutaneous compression plating (PCCP)and Trigen short reconstruction intramedullary nail for intertrochanteric hip fractures. Methods During 2005 and 2008, the patients suffered with AO/OTA Al and A2 intertrochanteric hip fractures were divided into two groups; 36 fractures were treated with PCCP and 48 fractures with Trigen short reconstruction nail.During an average of (16.3±3.2) months follow-up, clinical evaluation involved visual analogue scale(VAS)score for pain in the 1st week, the 1st month, the 3rd month, the 6th month and the 12th month, and a Harris hip score one year post operation. Radiographs were examined for fracture healing-time, displacement scale of the neck screws and fracture impaction scale. All the complication in both groups was recorded. Results There were no difference in blood loss and operation time in both groups. The postoperative pain was significantly lower in the PCCP group in the initial three months after the surgery. Larger scale of fracture impaction and screw telescoping were seen in PCCP group. Also shorter healing time, higher Harris score results were achieved in PCCP group than those of Trigen short reconstruction nail group. Four peri-implant fractures occurred in Trigen short reconstruction nail group, which included one in the greater trochanter and three in the femoral shaft, but only one case need revision for bone displacement. In PCCP group, it was found that the superior neck screw was slightly displaced for tendency to cut-out in one patient. Conclusion Both PCCP and Trigen short reconstruction intramedullary nail can be successfully used to treat Al and A2 intertrochanteric hip fractures with minimal invasive technique. And the PCCP showed more rapid pain relief and bone healing, easily bony reduction and fewer complications.
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[Objective]To observe the effect of bridging rabbit femoral bone defect by allograft of cortical plates.[Method]Allograft of cortical plates of frozen bone group,alcohol group and fresh group were transplated randomly into rabbit femoral bone defecs.The rabbit femoral bone defects were harvested in the 4~(th),8~(th) and 12~(th) week after the tansplantation and the biological process of allograft of cortical plates in the rabbit were analysed biomechanically,radiologically and histologically.[Result]The flexion stress and translation of the frozen group,alcohol group and fresh group were almost equal in the 4~(th) week after transplantation and there were big difference between the former two groups and fresh group.From the X-ray allograft of cortical plates were fused with host bone in the alcohol group and no fusion in the fresh group.In the 4~(th) week osteocytes were found in the frozen group and alcohol group and no in the fresh group.In the 8~(th) week the consecutive array of osteocytes were found in the frozen group and alcohol group and a little in the fresh group.In the 12~(th) week lots of consecutive array of osteocytes were found in the frozen group and alcohol group than that in the fresh group.[Conclusion]The frozen and alcohol treated and fresh allograft of cortical plates have initial biomechanical support.The allograft of cortical bone frozed group and alcohol group can fuse with host bone and that of fresh group have less ability to fuse with host bone due to immunological rejection.
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Changes in bone stress in the proximal femur following implantation can be estimated with the use of composite beam theory. The aim of this study was to construct the mathematical analytical models for predicting the degree of stress shielding and to test the validity of the predictions using finite element simulation. To define the periprosthetic bone stress values, the proximal femur was divided into eleven equidistant cross sections, then each section was divided into four quadrants corresponding to the anterior, posterior, medial and lateral aspects of the femur. Bone stress values were calculated by both mathematical analytical models and finite element analysis, then linear regression analyses produced slopes and R-values that show numerical and finite element results corresponding well to intact femur and both the types of fixation with/without cement. And the results also showed that femoral bone stress shielding by both the prostheses occurred in most periprosthetic zones. The most serious regions occurred in the proximal medial quadrant. This study has succeeded in creating the mathematical analytical models to predict the bone, cement and prostheses stress values, and thus can help us to evaluate the mechanical behavior of total hip replacement, to further understand the distinction between different fixation, and to make advances in implant design, surgical technique and long-term results.
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Humanos , Artroplastia de Reemplazo de Cadera , Fenómenos Biomecánicos , Fémur , Modelos Teóricos , Estrés Mecánico , Resistencia a la TracciónRESUMEN
Objective To evaluate the results of total knee replacement (TKR) in treating post traumatic degenerative arthritis. Methods A retrospective study was carried out on the results of TKR that performed in 11 patients with post traumatic degenerative arthritis due to a previous fracture around knee from 1997 to 2002. There were one female and 10 males with an average age of 59 years (31 76 years). The time from fracture to TKR averaged 8.7 years (2 27 years). Internal fixation was performed in seven cases, among which the removal of the hardware at one stage at the time of TKR was performed in four and TKR in three. Lateral retinacular release was done in four cases, extensor mechanism realignment in one and collateral ligament reconstruction in two at the time of TKR. Fracture malunion appeared in two cases during operation. Results All the cases were followed up for average 36 months (12 72 months). The mean pre operative Knee Society Scores for 37 scores (10 69 scores) for knee and 42 (0 60) for function were improved significantly to mean post operative 85 (10 100) and 75 (20 100), respectively. The mean knee arc of motion improved from pre operative 83?to post operative 93?. Post operative manipulation under anesthesia for poor motion was carried out in four knees. No knee had aseptic loosening that required subsequent revisions. One knee developed superficial infection treated with debridement and retention of components. Conclusions Significant improvement in function and relief in pain is seen in the patients with previous fractures following subsequent TKR. However, special efforts to restore limb alignment, ensure correct component position and manage soft tissue balance may improve outcome of TKA.
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Objective In order to probe the possible biomechanical mechanism of lumbar vertebral injuries, we studied the nonlinear stress distribution on lumbar vertebrae at 1500N axial compression force and 15Nm bending moments during hambar flexion, extension, lateral bending and axial torsion using an available nonlinear finite element (FE) model of functional spine unit. Methods Three-dimensional nonlinear FE model was created based on CT data of L3-L4 motion segment. The segment mechanical responses to different loadings were evaluated by the range of disc bulging, the stress level of fibrousrings, facet loadings and equivalent stress distribution of posterior structure. Results Compression and flexion induced disc bulging in anterior region, whereas extension and lateral bending induced disc bulging posteriorly and posterolaterally. Axial torsion caused not only higher unilateral facet stress but also the concentrated stress on posteroleteral fibrousrings stress. The loadings in extension and axial compression were lower than in torsion but higher than in lateral bending and anterior flexion. Higher equivalent stress was found when compression and extension loadings were applied to the pedicle of vertebral arch and interarticularis. Conclusion Intervertebral disc beared higher compressive than tensile. The posterolateral regions of lumbar vertebrae were prone to be deformity and at higher risk of fibrousring failure. Stress failure could be occured when facets were overloaded with axial torsion,extension and extension force due to the importance of facets during lumbar movement.
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Objective To investigate the pathogenesis, clinical manifestations, imaging features, and differential diagnosis of intraosseous ganglion. Methods Clinical and imaging features of 15 cases (5 men, 10 women; mean age 39.7 years) with intraosseous ganglia were retrospectively analyzed. There were 17 lesions, including 6 acetabula, 4 lunate, 3 proximal ends of tibia, 1 major tuberculum of humeral, 1 femoral head, 1 scaphoid, and 1 phalange. Results (1) Common radiological features included a unilocular or multilocular cyst surrounded by a full and thin rim of sclerotic bone in the subchondral epiphysis without any signs of degenerative joint disease. (2) Lesions were displayed as well defined round radiolucent defect or multi cystic changes with surrounding bony sclerosis or cystic and expansile change with irregular shape on CT scans. (3) CT showed an intraosseous ganglion communicating with adjacent joint in 1 patient. (4) CT values of the lesions were between 15- 80 HU. (5) Gas in the cyst could be seen in 3 cases. Conclusion Combined with patient′s age, lesion distribution, clinical manifestations, and imaging features, it is possible to make a correct diagnosis of intraosseous ganglion.