Reliability of tibial anterior crest as the anatomical reference of rotating alignment for tibial component in total knee arthroplasty / 中国骨伤

OBJECTIVE@#This study aimed to research whether anterior tibial crest is a reliable anatomical reference for rotational alignment of tibial component in TKA.@*METHODS@#The study included 122 patients who underwent computed tomography angiography (CTA) examination for unilateral lower extremity trauma with normal contralateral lower extremities, including 89 males and 33 females, with an average age of(51.4±16.4) years old(ranged 18 to 81 years old). Picture archiving and communication system (PACS) was used to mark 11 lines including the surgical epicondylar axis (SEA) connecting the most prominent points of the lateral epicondyle and the deepest point of the sulcus on the medial epicondyle of the femur, axis of medial border of patellar tendon (MEPT)connecting the middle of the posterior cruciate ligament (PCL) and medial border of the patellar tendon at the level of a standard tibial cut from 8 mm distal of the lateral tibial joint surface, transverse axis of tibia (TAT) at the level of a standard tibial cut from 8 mm distal of the lateral tibial joint surface, Akagi line connecting the projected middle of the PCL and medial border of the patellar tendon at the tibial attachment, the axis of the medial 1/3 of patellar tendon(M1/3) connecting the projected middle of PCL and the medial 1/3 of the patellar tendon at the patellar tendon attachment level, Insall line connecting the projected middle of the PCL and the medial 1/3 of tibial tubercle, the axis of medial border of tibial tubercle (MBTT) connecting the projected middle of the PCL and medial border of tibial tubercle, as well as the axis of the proximal anterior tibial crest (PATC), axis 1 of the middle anterior tibial crest (MATC1), axis 2 of the middle anterior tibial crest (MATC2) and the axis of the distal anterior tibial crest (DATC) which were marked by connecting the 4 equidistant points on the sharp anterior tibial crest and the projected middle of the PCL. The angles between TAT and SEA as well as the angles between other axes and the perpendicular to SEA were measured. Pairwise differences among the 10 tibial axes were examined using One-Way ANOVA and paired @*RESULTS@#The angles between the axes of MEPT, Akagi line, M1/3, Insall line, MBTT, PATC, MATC1, MATC2, DATC and the perpendicular to SEA were (-1.6 ±4.5)° , (1.4 ±5.0)° , (10.2±5.1)°, (11.9±5.4)°, (3.6±4.8)°, (12.0±6.9)°, (7.2±8.6)°, (7.1±10.4)°, (6.6±13.5)°, respectively. The angle between TAT and SEA was (4.1±5.3)°. MEPT was external rotation compared to SEA. M1/3, Insall line and PATC were significantly greater than Akagi line, MBTT, TAT (@*CONCLUSION@#The middle tibial anterior crest can be used as a reference for rotational alignment of tibial component in TKA, and its reliability is better than Insall line, but worse than Akagi line, TAT and MBTT.

Application of lower edge of teardrop on restoring anatomical hip center height in total hip arthroplasty / 中国组织工程研究

BACKGROUND: The position of acetabular prosthesis is very important in total hip arthroplasty; its ideal position is to restore its anatomical hip center of rotation. As the inferior edge of the teardrop is an important stable imaging marker, it is of great significance to evaluate the position of acetabular cup and guide the correct intraoperative placement of prosthesis. OBJECTIVE: To investigate the effect of the lower edge of the teardrop on restoring anatomical hip center height in total hip arthroplasty. METHODS: Medical records and anteroposterior images of 107 unilateral total hip arthroplasty with normal contralateral acetabulum and lower edge of cup at the same level as lower edge of the teardrop were reviewed. Center height and horizontal distance as well as cup inclination and anteversion were measured radiographically. The paired t test was used to compare data between left and right sides of hip center height. Scatterplots and Pearson's correlation coefficients were used to evaluate the association between the difference of the height of two hip centers, cup anteversion and inclination angle. RESULTS AND CONCLUSION: (1) The height of cup center was significantly higher than that of contralateral hip joint center (P < 0.001). Whereas 93.4% (100 cases) of absolute differences between them were in the range from 0 mm to 5 mm, only 6.6% (7 cases) were more than 5 mm. (2) However, when the lower edge of cup was 1.5-2.0 mm inferior to the lower edge of the teardrop, there was no statistical differences between them (P=0.345 and 0.331). (3) There was a weak correlation between the difference of the height of two hip centers with inclination and anteversion (r=0.376, 0.310, P < 0.001). (4) The position of cup with its inferior edge 1.5-2.0 mm below the inferior edge of the teardrop can exactly replicate the anatomic hip center.

Glucocorticoids Significantly Influence the Transcriptome of Bone Microvascular Endothelial Cells of Human Femoral Head / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Appropriate expression and regulation of the transcriptome, which mainly comprise of mRNAs and lncRNAs, are important for all biological and cellular processes including the physiological activities of bone microvascular endothelial cells (BMECs). Through an intricate intracellular signaling systems, the transcriptome regulates the pharmacological response of the cells. Although studies have elucidated the impact of glucocorticoids (GCs) cell-specific gene expression signatures, it remains necessary to comprehensively characterize the impact of lncRNAs to transcriptional changes.</p><p><b>METHODS</b>BMECs were divided into two groups. One was treated with GCs and the other left untreated as a paired control. Differential expression was analyzed with GeneSpring software V12.0 (Agilent, Santa Clara, CA, USA) and hierarchical clustering was conducted using Cluster 3.0 software. The Gene Ontology (GO) analysis was performed with Molecular Annotation System provided by CapitalBio Corporation.</p><p><b>RESULTS</b>Our results highlight the involvement of genes implicated in development, differentiation and apoptosis following GC stimulation. Elucidation of differential gene expression emphasizes the importance of regulatory gene networks induced by GCs. We identified 73 up-regulated and 166 down-regulated long noncoding RNAs, the expression of 107 of which significantly correlated with 172 mRNAs induced by hydrocortisone.</p><p><b>CONCLUSIONS</b>Transcriptome analysis of BMECs from human samples was performed to identify specific gene networks induced by GCs. Our results identified complex RNA crosstalk underlying the pathogenesis of steroid-induced necrosis of femoral head.</p>

A method for isolated culture of bone microvascular endothelial cells of human femoral head / 中国骨伤

<p><b>OBJCETIVE</b>To investigate the method of separation of culture of bone microvascular endothelial cells (BMECs) of human femoral head in vitro.</p><p><b>METHODS</b>From October 2013 to January 2014,15 femoral heads without pathologic change from patients resected during hip replacement were selected involving 2 males and 13 females with a mean age of 71.2 years old ranging from 38 to 92. Cancellous bone in femoral head was bited into broken bone grain and transfered into medium in aseptic contidion. Cells were isolated by the methods of enzymic digestion and density gradient centrifugation,purified by differiential attachment. The characteristics of cells was observed by inverted microscope. vWF and CD31 immunofluorescence analysis was applied for identification of cells.</p><p><b>RESULTS</b>The number of cells was positively correlated with patients' age after 24 hours in primary culture. The older patients had the less cells numbered. After 4 to 5 days' culture, primary cells appeared short spindle,polygon shaped and cobblestone-like morphology. After 7 to 10 days' culture, primary cells proliferated densely, became fusion, arranged in swirl, and contact inhibition appeared significantly. Immunofluorescence staining revealed the cells were 100% positive for vWF and CD31, and it showed that the cultured cells were BMECs.</p><p><b>CONCLUSION</b>It was a simple, steady, effective method with good reproducibility, by which highly purified human BMECs can be obtained.</p>

Total hip replacement with collum femoris preserving for the treatment of advanced stage of femoral head necrosis of young patients: a report of results of more than five years follow-up / 中华外科杂志

<p><b>OBJECTIVE</b>To observe the results of total hip replacement with collum femoris preserving for the treatment of advanced stage of femoral head necrosis of youth.</p><p><b>METHODS</b>From August 2002 to November 2009, 21 patients (28 hips) with advanced stage of femoral head necrosis were treated with total hip replacement with collum femoris preserving. Sixteen males (22 hips) and 5 females (6 hips) with an average age of 36 years (range from 26 to 51 years) were included. All patients were evaluated clinically using Harris score, the prosthesis components were assessed for position, loosening, bone resorption and other conditions with radiographs.</p><p><b>RESULTS</b>Nineteen patients (26 hip) were followed up for mean 5 years and 7 months (ranging 5 years and 3 months to 7 years and 1 month), 2 patients were missed. The average Harris score increased from the preoperative average 48.5 to 90.2. The leg-length discrepancy (the difference was less than 2 cm) occurred in 3 cases. No thigh pain and revision.</p><p><b>CONCLUSION</b>Total hip arthroplasty with collum femoris preserving is one of the best choices for the treatment of advanced stage of femoral head necrosis of young patients with good midterm outcome.</p>