Mid-and long-term efficacy of modified Colonna arthroplasty in the treatment of unilateral dislocation type of juvenile developmental dysplasia of the hip / 中华骨科杂志

Objective:To investigate the mid-and long-term clinical efficacy of modified Colonna arthroplasty in the treatment of unilateral dislocation type developmental dysplasia of hip (DDH) in adolescents.Methods:A total of 28 adolescent DDH patients with unilateral dislocation who underwent modified Colonna capsular arthroplasty from January 2016 to January 2018 in the 920th Hospital of Joint Logistics Support Force of People's Liberation Army were retrospectively analyzed. There were 4 males and 24 females, aged 16.5±5.0 years (range, 10-25 years). The mean body mass index was 21.2±1.1 kg/m 2 (range, 18.7-24.1 kg/m 2). According to DDH classification, 10 cases were Tonnis type III and 18 cases were Tonnis type IV. The postoperative lateral center-edge angle, acetabular coverage, femoral anteversion angle and leg length discrepancy were measured. The operation time, intraoperative blood loss, visual analogue scale (VAS) of hip pain, Harris hip score (HHS) and congenital dislocation of the hip score were recorded. Results:All patients successfully completed the operation and were followed up for 72.1±5.2 months (range, 60-84 months). The operation time was 81.6±4.3 min (range, 70-90 min), the intraoperative blood loss was 177.5±12.6 ml (range, 160-200 ml), and the hospital stay was 6.8±0.7 days (range, 6-9 days). The VAS score of the hip joint was 1.8±0.6 before operation and 2.3±0.6 at the last follow-up, and the difference was not statistically significant ( t=2.845, P=0.224). The preoperative HHS score was 57.1±5.9, and it increased to 87.3±4.0 at the last follow-up, and the difference was statistically significant ( t=-22.141, P=0.001). At the last follow-up, the femoral anteversion angle was 17.0°±1.5°, which was lower than that before operation 41.6°±2.4°, with a statistically significant difference ( t=-44.868, P=0.008). The leg length discrepancy was 10.2±2.3 mm, which was lower than that before operation (26.4±6.1 mm), with a statistically significant difference ( t=-12.892, P<0.001). The lateral center-edge angle was 28° (26°, 30°), and the acetabular coverage rate was 78% (76%, 79%). The curative effect evaluation standard score of congenital dislocation of the hip was 24 (16.7, 25.7) points, including 7 excellent cases, 14 good cases, 4 fair cases, and 3 poor cases. The excellent and good rate was 75% (21/28). Conclusion:The modified Colonna arthroplasty for the treatment of unilateral dislocation DDH in adolescents has good mid-and long-term hip function recovery and radiographic improvement.

Composition of Ophiopogon Polysaccharide, Notoginseng Total Saponins and Rhizoma Coptidis Alkaloids Inhibits the Myocardial Apoptosis on Diabetic Atherosclerosis Rabbit / 中国结合医学杂志

OBJECTIVE@#To investigate the effects of Composition of Ophiopogon polysaccharide, Notoginseng total saponins and Rhizoma Coptidis alkaloids (CONR) on myocardial apoptosis of diabetic atherosclerosis (DA) rabbits METHODS: Sixty male New Zealand white rabbits were randomly divided into 6 groups [control group, model group, CONR high-dose group (450 mg/kg), CONR medium-dose group (150 mg/kg), CONR low-dose group (50 mg/kg), and simvastatin group] by using a completely random method, 10 in each group. DA model was established by intravenously injected alloxan combined with high-fat diet and abdominal aortic balloon injury. After mediation for 10 weeks, fasting blood glucose (FBG), glycosylated hemoglobin (GHB), glycosylated serum protein (GSP), fructoseamine (FRA), aldose reductase (AR), advanced glycation end products (AGEs) in serum were measured by enzyme linked immunosorbent assay (ELISA) method; the expression of receptor of AGEs (RAGE) in myocardial tissue were observed by immunohistochemical method; and p-Jun N-terminal kinase (p-JNK), caspase-3, B-cell lymphoma-2 (bcl-2) protein expression in myocardial tissue were measured by Western blotting. The myocardial apoptosis was detected by TdT-mediated dUTPnick-end labeling (TUNEL) method, and apoptosis index (AI) was calculated.@*RESULTS@#Compared with the control group, serum FBG, GHB, GSP, FRA, AR, AGEs and the expression of myocardium RAGE, p-JNK, caspase-3 proteins, as well as apoptosis index (AI) were significantly increased and bcl-2 protein was significantly decreased in the model group (P<0.01). Compared with the model group, the levels of serum FBG, GHB, GSP, FRA and AR showed a significant decline in CONR high- and medium-dose groups (P<0.01). FBG and GHB showed a significant decline in CONR low-dose group (P<0.01). Compared with the model group, the expression of serum AGEs and myocardium RAGE, p-JNK and caspase-3 protein as well as AI were significantly decreased and bcl-2 protein was significantly up-regulated in all treatment groups (P<0.01); high-dose CONR had the most significant effect on abovementioned indices compared with other treatment groups (P<0.01). Middle-dose CONR had better effect on serum AGEs compared with the low-dose group (P<0.01); middle-dose CONR and simvastatin groups had better effect on the expression of caspase-3, bcl-2 protein, myocardium apoptosis compared with the CONR low-dose group (P<0.01).@*CONCLUSION@#CONR may effectively inhibit myocardial apoptosis on DA rabbits by intervening AGEs-RAGE and JNK, caspase-3, and bcl-2 protein expressions.

A new method measuring the rotation center of hip joint and its significance for hip replacement surgery / 中国医师杂志

Objective To design and evaluate a new method for measuring the center of rotation of the hip joint,and to compare it with the traditional methods.Methods Data of healthy hips of 120 total hip arthroplasty (THA) patients (120 hips) and bilateral hips of 20 healthy volumteers (40 hips) were collected.A series of X-rays and magnetic resonance imaging (MRI) were taken from each patient with the hip joint abductted at differenct angles (0°,7.5°,15°,and 22.5°).The motion track of rotation center was obtained by comparing these X-ray and MRI images.The preoperative and postoperative data of 67 surgical patients who underwent two different measurement methods before surgery were compared.Results Compared with traditional measurement methods,the accuracy of our new method was significantly improved;the results of hip MRI verified the objectivity and accuracy of our new method;preoperative measurements and postoperative follow-up results showed that our new method had a better clinical effect than traditional measurements.Conclnsions The team's innovative new measurement method based on pelvic orthotopic X-ray photographs with different abduction angles of the hip shows more accurate data than traditional measurement methods and shows better clinical results.

A new method measuring the rotation center of hip joint and its significance for hip replacement surgery / 中国医师杂志

Objective@#To design and evaluate a new method for measuring the center of rotation of the hip joint, and to compare it with the traditional methods.@*Methods@#Data of healthy hips of 120 total hip arthroplasty (THA) patients (120 hips) and bilateral hips of 20 healthy volumteers (40 hips) were collected. A series of X-rays and magnetic resonance imaging (MRI) were taken from each patient with the hip joint abductted at differenct angles (0°, 7.5°, 15°, and 22.5°). The motion track of rotation center was obtained by comparing these X-ray and MRI images. The preoperative and postoperative data of 67 surgical patients who underwent two different measurement methods before surgery were compared.@*Results@#Compared with traditional measurement methods, the accuracy of our new method was significantly improved; the results of hip MRI verified the objectivity and accuracy of our new method; preoperative measurements and postoperative follow-up results showed that our new method had a better clinical effect than traditional measurements.@*Conclusions@#The team′s innovative new measurement method based on pelvic orthotopic X-ray photographs with different abduction angles of the hip shows more accurate data than traditional measurement methods and shows better clinical results.

Expression of transforming growth factor 1 and bone morphogenetic protein 9 in human nonunion tissues and its clinical significance / 中南大学学报(医学版)

Objective:To examine the expression of transforming growth factor I(TGF-β1) and bone morphogenetic protein-9 (BMP-9) in human nonunion tissues,and to evaluate the clinical significance.Methods:The number of hypertrophic nonunion tissue samples and atrophic nonunion tissue samples were collected from Department of Orthopedics,the Second Xiangya Hospital of Central South University and Suzhou Kowloon Hospital Affiliated to School of Medicine of Shanghai Jiao Tong University between 2010 and 2014.Semi-quantification of SP immunohistochemical method and pathological image analysis software IPP6.0 were used to analyze the expression of TGF-β1 and BMP-9.Nonunion type,patients' age and nonunion time were statistical analyzed.Results:The absorbance values of TGF-β1 and BMP-9 in the hypertrophic nonunion tissues were 0.3236±0.0390 and 0.1337±0.0400,respectively;while the absorbance values of TGF-β1 and BMP-9 in the atrophic nonunion tissues were 0.3191±0.0369 and 0.1373±0.0423,respectively,with no significant difference between the two types of tissues (both P＞0.05).There was also no significant difference in patients' age and bone nonunion time between them (all P＞0.05).Conclusion:There is no significant difference in osteogenic potential between the hypertrophic nonunion tissues and the atrophic nonunion tissues.

Total hip arthroplasty with soft tissue release for patients with severe development dysplasia of the hip / 中南大学学报(医学版)

Objective:To explore the clinical effect of total hip replacement with soft tissue release and true acetabulum reconstruction on treating osteoarthritis secondary to severe development dysplasia of the hip.Methods:From January 2005 to January 2011,23 hips in 21 patients with osteoarthritis secondary to Crowe Ⅲ development dysplasia of the hip underwent total hip arthroplasty with soft tissue release and true acetabulum reconstruction.There were 18 females and 3 males.The age was (45.1±13.2) years.Two patients underwent bilateral total hip arthroplasty (THA) and 19 cases underwent unilateral hip.The Harris hip score was 39.7±5.6.Results:The duration of follow up was (110±46) months.The symptoms of patients were relieved,and all the patients' femur head recovered to the true acetabulum after soft tissue released.Sciatic nerve paralysis occurred in one patient,who recovered after 3 months.All patients showed restoration of limb length,while the limb-length discrepancy was (11.0±3.5) mm.The postoperation Harris hip score was 87.2±5.9.Conclusion:Total hip arthroplasty with soft tissue release and true acetabulum reconstruction was an effective method in treating osteoarthritis secondary to Crowe Ⅲ development dysplasia of the hip and was a challenging work to the orthopedic surgeon.It was critical the surgeon to plan the operative intervention carefully.

Osteogenesis and expression of bone morphogenetic protein 2 after bone marrow mesenchymal stem cells combined with calf cortical bone with partial cancellous bone implanted into rabbits / 中国组织工程研究

BACKGROUND: Previous studies have confirmed that rabbit bone marrow mesenchymal stem cells (BMSCs) can differentiate into osteoblasts under osteogenic induction in vitro, stably express the specific phenotype of osteoblasts and have osteogenic ability. Calf cortical bone scaffold with partial cancellous bone has good biocompatibility and degradability, which can be used as a carrier material of bone marrow mesenchymal stem cells. OBJECTIVE: To combine rabbit BMSCs with calf bone composite according to the basic principles of bone tissue engineering and to observe the osteogenesis in the New Zealand white rabbits after implantation of BMSCs/calf bone composite into the ilium, thereby providing a direct evidence for preliminary clinical application of tissue-engineered bone products.METHODS: BMSCs/calf cortical bone scaffold with partial cancellous bone (tissue-engineered bone group), simple calf heterogeneous bone (heterogeneous bone group) or autologous iliac bone (autologous iliac bone group) was randomly implanted into the rabbit ilium. The changes of implant surface and tissue reactions around the implant were observed.X-ray examination was performed to observe osteogenic changes at 4, 8, 12, 24 weeks after implantation. Immunohistochemistry staining was used to observe the expression of bone morphogenetic protein 2.RESULTS AND CONCLUSION: After heterogeneous bone implantation, the wound healed well, and there were no systemic or local inflammation and toxicity reactions in all groups. The X-ray results showed that at postoperative 24 weeks, the implant was basically fused with the host bone in the tissue-engineered bone group, but the fusion was unsatisfactory in the heterogeneous bone group. The process of ossifications from cartilages was observed in all groups by hematoxylin-eosin staining, and bone morphogenetic protein 2 was positive for immunohistochemical staining. Findings from in vivo experiments indicate that rabbit BMSCs seeded onto the calf cortical bone scaffold with partial cancellous bone could construct tissue-engineered bone by osteoinductation in vitro in the rabbits.

Efficacy of reconstruction with modular endoprosthesis after resection of periacetabular malignant tumors / 中南大学学报(医学版)

OBJECTIVE@#To explore the efficacy of the resection of periacetabular malignant tumors and the reconstruction with modular endoprosthesis.
@*METHODS@#From August 2006 to December 2012, 22 patients with periacetabular malignant tumors, who received the resection and reconstruction with modular prosthesis, were retrospectively reviewed. There were 11 males and 11 females, and the average age was 44 (16-65) years old. Pathological results showed there were 13 cases of chondrosarcoma, 5 cases of osteosarcoma, 2 cases of Ewing's sarcoma, 1 case of maligant fibrous histiocytoma, and 1 case of giant cell tumor. According to the classification system by Enneking, there were 11 cases of Type II+III resection, 5 cases of Type I+II+III resection, 3 cases of Type I+II resection, and 3 cases of Type II resection.
@*RESULTS@#All patients were followed up. The average time for follow-up was 49 (11-103) months. At the last time of follow-up, 13 patients (59%) were still alive, 9 patients (41%) died due to their primary disease. Metastasis occurred in 8 patients (36%), and local recurrence occurred in 5 patients (23%). The mean Musculoskeletal Tumor Society (MSTS) score for 13 cases of alive patients at the latest time of follow-up was (18.5±5.7) months. The mean score for 11 patients, whose limb salvage were successful, was 20.7±2.0.
@*CONCLUSION@#Reconstruction with modular prosthesis after wide resection for periacetabular malignant tumor can achieve satisfied outcome.

Biomechanical responses of the femur-prosthesis-tibia complex after tumor-type total artificial knee replacement / 医用生物力学

Objective By studying biomechanical responses of the femur-prosthesis-tibia complex under normal standing condition after tumor-type hinged knee arthroplasty, to investigate the cause of femoral perforation in patients after knee arthroplasty, so as to provide a theoretical basis for optimal design and manufacturing of tumor-type hinged artificial knee prosthesis. Methods By coupling CT and 3D optical scanning, the finite element model of the subject-specific femur-prosthesis-tibia complex was established and was validated regarding its availability, so as to analyze stress distribution and stress shielding phenomenon of the complex in standing position. Results (1) Under the loading state of standing, the stress on the femur was significantly larger than that on the tibia, and presented an evident concentration phenomenon. The proximal 1/3 of femoral shaft presented a larger stress, with a stress shielding effect. (2) As the model was based on geometry and bone characteristics of the patient in clinic, the location of femur stress concentration was close to that of femur perforation in the patient, which indicated that femur injury behavior might occur when its own gravity was applied such as the patient condition. Conclusions After implantation of the tumor-type hinged artificial knee prosthesis, the prosthesis marrow needle goes deep into marrow cavities, which brings certain pressure to the marrow cavities even under normal standing condition. The produced stress shielding effect and the match of the prosthesis marrow needle to the marrow cavity are all likely to cause stress concentration on the femur, even make femur crack or perforation, and eventually affect the surgery quality. Thus, the prosthesis design should be carefully optimized before surgery in order to reduce or avoid such phenomenon that is related to the postoperative complication rate.

Study on CD31 expression in the process of the calf cortical with partial cancellous bone xenograft / 中国医师杂志

Objective To investigate the expression and tissue distribution of CD31 in the process of the calf cortical with partial cancellous bone xenograft, to explore the healing mechanism and relationship between bone remodeling and revascularization, and to provide a basis for the further study of tissue engi-neered bone.Methods Thirty-six New Zealand rabbits were selected as our experimental animals.All ani-mals were implanted with the calf cortical with partial cancellous bone.Specimens were procured at 4, 8, 12 and 24 weeks after surgery, respectively.The expression and tissue distribution of CD31 were observed in the process healing with general condition, X-ray, histology and immunohistochemistry.The image analy-sis computer system was used for quantitative analysis.The extent of revascularization and remodeling was separately represented by revascularization indexes and new bone areas.The relationship was studied be-tween bone remodeling and revascularization.Results ⑴ The X-ray showed significant healing.⑵ The positive expression of CD31 was seen in the whole process of bone xenograft and was different at various stage and sites.By the 4 weeks and 8 weeks postoperative,the strong positive expression was seen in the pe-ripheral soft tissue of graft bone, the callus of joint and the periphery of cartilage nests.Much positive ex-pression was seen in the cancellous bone.There was seen some single, cord, and cluster vascular endotheli-al cells.The positive expression was seen in the enlarged haversian canals and periphery.By the 24 weeks postoperative,the positive expression was seen in the enlarged haversian canals and periphery with increasing newborn capillaries.⑶ The correlation analysis between new bone areas and revascularization showed a closely positive correlation ( r =0.984).Conclusions The positive expression of CD31 was seen in the whole process of bone xenograft and was different at various stage and sites.The positive expression of CD31 reflected the extent of revascularization and bone remodeling of bone grafts.The extent of revascularization of bone grafts and bone remodeling showed a closely positive correlation.

Expression of bone morphogenetic protein 2 in human nonunion tissue and the clinical significance / 中南大学学报(医学版)

OBJECTIVE@#To explore the difference of bone formation potential between hypertrophic nonunion tissue and atrophic nonunion tissue, which may be beneficial to nonunion therapy.@*METHODS@#From October 2010 to March 2014, 40 nonunion tissue samples were collected in Department of Orthopedics, Second Xiangya Hospital. The samples were divided into a hypertrophic nonunion group (n=20) and an atrophic nonunion group (n=20) according to nonunion character; or a 20 to 35 years old group (n=18), a 36 to 50 years old group (n=18), a more than 50 years old group (n=4) according to different ages; or a 9-12 months group (n=21), 13-24 months group (n=14) and a more than 24 months group (n=5) according to different nonunion time. Semi-quantification was performed by SP immunohistochemical method and IPP6.0 was used to analyze the expression of bone morphogenetic protein-2 (BMP-2) through measuring the mean optical density.@*RESULTS@#The mean optical density of BMP-2 was 0.1540±0.0408 in hypertrophic nonunion tissue, 0.1372±0.0372 in atrophic nonunion tissue, there was no significant difference between the 2 groups (P>0.05). The mean optical density of BMP-2 was 0.1477±0.0379 in the 20 to 35 years old group, 0.1419±0.0399 in the 35 to 50 years old group, 0.1456±0.0595 in the more than 50 years old group, there was no significant difference among the three groups (P>0.05). The mean optical density of BMP-2 was 0.1449±0.0366 in the 9-12 months group, 0.1472±0.0400 in the 13-24 months group, 0.1445±0.0541 in the more than 24 months group, there was no significant difference among the 3 groups (P>0.05).@*CONCLUSION@#The present results suggest that the hypertrophic nonunion tissue share similar osteogenic potential with the atrophic nonunion tissue.

Artificial total hip arthroplasty for proximal femur tumors:clinical efficacy and security / 中国组织工程研究

BACKGROUND:With elevated medical levels, limb salvage surgery for limb malignant tumor is valuable day by day. At present, the limb salvage surgery has substituted amputation and becomes mainstream and development direction of present surgical treatment of limb tumors. However, so far, there are no unified surgical indications for proximal femur tumor, which are controversial. OBJECTIVE:To investigate the efficacy of artificial total hip arthroplasty combined with extended resection of tumor sections for proximal femoral bone tumors. METHODS:Patients with proximal femoral bone tumors in the Second Xiangya Hospital of Central South University were selected and divided into control group and observation group, with 30 patients in each group. According to the disease, lesion curettage, aneurysm wal inactivation, autologous and (or) al ogeneic bone, mixed bone graft and bone graft fixation were selected to treat the control group. The observation group patients received extended resection of tumor sections and total hip arthroplasty. The operative time, intraoperative blood loss, hospital stay and joint function of two groups were compared. 2 years later, patients were revisited. Metastasis and recurrence rate, death rate and quality of life of two groups were compared. RESULTS AND CONCLUSION:There was no significant difference in intraoperative blood loss and surgery time between the two groups (P>0.05). However, hospital stay of patients in the observation group was shorter than the control group. The excellent and good rate of recovery of joint function (83%) was higher in the observation group than in the control group (53%). The metastasis and recurrence rate within 2 years after surgery (7%) and death rate (3%) were lower in the observation group than in the control group (30%, 23%). Various indicators of quality of life of patients in the observation group were significantly better than the control group (P<0.05). These results confirmed that artificial total hip arthroplasty in the treatment of proximal femur tumors is safe and effective.

Application value of kissing stenting for the treatment of bilateral brachiocephalic-superior vena cava obstruction / 中华放射学杂志

Objective To evaluate the clinical value of the kissing stenting in bilateral brachiocephalic-superior vena cava obstruction syndrome.Methods Analysis the clinic effect in 17 patients who received interventional treatment retrospectively.All patients with bilateral brachiocephalic vein-superior vena cava obstruction were caused by malignant tumor.Each patient was implanted two stents by kissing stenting style.Among them,1 patient accompanied thrombosis in brachiocephalic vein was conducted with catheter-directed thrombolysis before stenting.The symptoms,pathological signs and complications were observed after the treatment,patients were underwent follow-up to see whether symptom recurred.Results All 17 patients received successful kissing stenting in bilateral brachiocephalic vein-superior vena cava.The symptoms and pathological signs eliminated after the operation.No serious complications occurred.Seventeen patients were underwent follow-up (1 to 16 months) with no obstructive symptom recurred including 5 patients died of the end-stage of malignant tumor.Conclusion Kissing stenting is a safe and effective methods for the treatment of bilateral brachiocephalic-superior vena cava obstruction.

Treatment of external fixator in young patients with valgus deformity of the knee companied with leg shortening / 中南大学学报(医学版)

OBJECTIVE@#To explore the efficacy and experience of callus distraction technique with the external fixator for valgus deformity of the knee companied with leg shortening in young patients and to provide evidence for selecting reasonable therapy.@*METHODS@#From January 2002 to January 2009, the clinical data of 28 young patients (17 males and 11 females, aged 8 to 14, mean age 11.9 years) treated with callus distraction, who had valgus deformity of the knee, companied with leg shortening, were analyzed retrospectively. Three had bilateral total valgus deformity of the knee, with a total of 31 knees. Before the operation, the abnormal limbs shortened from 3 to 7 cm (average 4.1 cm) companied with the normal one. The tibiofemoral angle ranged from 138° to 160° (mean angle 148°) and the Condyle interval from 5 to 33 cm (mean interval 15.2 cm).@*RESULTS@#The 28 patients were followed up for 35 to 84 ( mean 62 ) months. The extent length ranged from 4.5 to 10.1 cm (average 6.8 cm). The tibiofemoral angle ranged from 169° to 175° (mean 173°) after the union. The patients resumed the normal length of limbs, and the severe valgus deformity of the knee was corrected.@*CONCLUSION@#Callus distraction with external fixator is effective for serious valgus deformity of the knee companied with leg shortening.

Clinical application of Reading man flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of Reading man flap for the closure of round or elliptical-shaped defect.</p><p><b>METHODS</b>Based on the asymmetric Z flaps, F1 (triangular flap) and F2 (rectangular flap) flaps were designed to cover the round or elliptical-shaped defects. The flaps size ranged from 0.8 cm x 0.8 cm to 9.0 cm x 8.0 cm.</p><p><b>RESULTS</b>From 2008 to 2011, 32 cases were treated without infection or dog-ear deformity. Less than 5% of local necrosis happened in one flap, which healed spontaneously after dressing. Delayed healing happened in 5 cases. The scar after operation was inconspicuous.</p><p><b>CONCLUSIONS</b>Reading man flap can be designed flexibly. It is a good option for the closure of round or elliptical-shaped defects.</p>

Salvage therapy by hemicortical excision and reconstruction for low-grade malignant bone tumour / 中南大学学报(医学版)

Objective: To treat low-grade limb malignant tumors with hemicortical excision and reconstruction of the defect with recycled pasteurized autogratf. Methods:From January 2005 to January 2011, 10 patients [age (27.0±6.5) years] suffering from low-grade limb malignant tumors were treated with hemicortical excision and reconstruction of the defect with recycled pasteurized autogratf:7 were histopathologically diagnosed as parosteal osteosarcoma, and 3 as peripheral chondrosarcoma. According to the Enneking staging system, 8 were in Stage IA and 2 were in IB. Results:All the patients were followed-up for (50±23) months. All the patients had bony union at the last follow-up. The length of tumor bone resection was (9.5±2.7) cm, operation time was (150±45) min, intraoperative blood loss was (1000±350) mL, and drainage volume was (450±200) mL. hTe only fracture in the host bone during the operation was treated by internal ifxation. Local recurrence occurred in 1 patient was treated by a wide operative margin and reconstruction with a prosthesis. There was no distal metastasis. A ccording to the Enneking system, 9 patients had excellent results and 1 had good results. Conclusion:Hemicortical excision for low-grade limb malignant tumors is safe and effective.

En bloc excision and reconstruction of the defect with pasteurized autograft for femoral primary malignant bone tumor in childen / 中南大学学报(医学版)

Objective:To evaluate the efficacy of femoral primary malignant bone tumors treated by limb salvage, with wide en bloc excision and reconstruction of the defect with recycled pasteurized autogratf. Methods: From January 2008 to January 2011, 11 patients (7 males, 4 females), aged (11.0±2.5) years suffering from femoral primary malignant bone tumors were treated with en bloc excision and reconstruction of the defect with recycled pasteurized autograft. Ten patients were histopathologically diagnosed with high-grade osteosarcoma, and 1 with Ewing’s sarcoma.According to the Enneking staging system, all patients were in Stage IIb. Results:All patients were followed-up for 24-65(42±20) months and all showed bony union at the last follow-up. hTe length of tumor bone resection was (17.5±3.2) cm, the operation time was (180±35) min, the intraoperative blood loss was (1200±250) mL, and drainage volume was (650±125) mL. Local skin necrosis occurred in 1 patient (9.1%), which was resolved by debridement. Nonunion occurred in 3 patients (27.3%), who were treated by secondary iliac crest cancellous bone gratfing.Pulmonary metastasis occurred in 1 patient (9.1%) who died 35 months post-operatively. According to the function assessment by the Enneking system, 5 patients had excellent results, 4 had good results, 1 fair and 1 poor results, with a satisfaction rate of 81.2%. Conclusion:A pasteurized autograft can be an easily accessible and economical alternative for children’s malignant bone tumor of femurs.

Callus distraction in bone defect and leg shortening of femur after osteomyelitis / 中南大学学报(医学版)

OBJECTIVE@#To explore the efficacy of callus distraction performed by external fixtor in the reconstruction of bone defect and leg shortening of femur after osteomyelitis.@*METHODS@#Nineteen child patients with bone defect and leg shortening after ostemomyelitis were treated by callus distraction with external fixator. The mean length of the bone defect was 1.3 cm. The mean leg-length discrepancy was 4.8 cm.@*RESULTS@#All patients were followed up for 21-82 months. The bone lengthening area grew well, the length of callus distraction was 4.5-8.0 cm, and the mean radiographic consolidation index was 39.7 d/cm. According to the Paley's criteria, the healing effect of 14 cases was excellent, and that of the rest 5 cases was good. The functional recovery of 11 cases was excellent, and that of the rest 8 cases was good.@*CONCLUSION@#Callus distraction is a reliable method in the reconstruction of bone defect and leg shortening caused by ostemomyelitis.

Medial head gastrocnemius muscle flap in the limb-salvage operation for proximal tibial osteosarcoma / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the efficacy of transposition of the medial gastrocnemius muscle flap in the limb-salvage operation for proximal tibial osteosarcoma.@*METHODS@#From January 2000 to January 2010, 65 patients [37 males, 28 females; (17.0±6.5) years] suffering from the proximal tibial osteosarcoma had a limb-salvage operation. According to the Enneking staging system, 35 patients were in stage IIa, 30 in stage IIb. All of the patients underwent resection of the osteosarcomas and reconstruction of the bone defect by prothesis. Among them, there were 35 patients underwent the medial head of the gastrocnemius muscle flap transposition to reconstruct the soft tissues and the other 30 didn't.@*RESULTS@#All the patients were followed-up. In the group with the transposition of medial gastrocnemius muscle flap, the length of tumor bone resection was (13.5±4.2) cm, operation time was (150±45) min, intraoperative blood loss was (700±135) mL, and drainage volume was (500±200) mL. In the group without the transposition of medial gastrocnemius muscle flap, the length of tumor bone resection was (12.3±5.8) cm, operation time was (135±37) min, intraoperative blood loss was (600±105) mL, and drainage volume was (450±250) mL. There was significant difference in the operation time (P0.05). In the group with the transposition of medial gastrocnemius muscle flap, local skin necrosis occurred in 2 patients (5.7%), and prosthesis deep infection occurred in 1 (2.9%). In the group without the transposition of medial gastrocnemius muscle flap, subctaneous hematocele, and effusion occurred in 3 (10.0%), wound infection occurred in 4 (13.3%), 1 cured and the other 3 developed prosthesis deep infection.There was significant difference in the rate of local complications (P<0.05). According to the function assessment by the Enneking system, in the group with the transposition of medial gastrocnemius muscle flap, 13 patients had excellent results, 17 had good results, 3 had fair results and 2 had poor results, with a satisfaction rate of 85.7%. In the group without the transposition of medial gastrocnemius muscle flap, 10 patients had excellent results, 12 had good results, 5 had fair results and 3 had poor results, with a satisfaction rate of 73.3%. There was significant difference in function assessment between the 2 groups (P<0.05).@*CONCLUSION@#The flap transposition of the medial head of the gastrocnemiusmuscle can reconstruct the soft tissue defect, decrease the local complication rate and improve the clinical outcomes of the limb-salvage for the proximal tibia osteosarcoma.

Expression of CXCR3 and CCR5 chemokine receptor in spleens of patients with primary immune thrombocytopenia / 中华血液学杂志

<p><b>OBJECTIVE</b>To study CXCR3 and CCR5 chemokine receptor expression in spleens of patients with primary immune thrombocytopenia (ITP) and its clinical significance.</p><p><b>METHODS</b>The splenectomy specimens from 10 ITP patients (ITP group) and 8 patients with traumatic splenic rupture (normal control group) were studied. Immunohistochemistry (IHC) was used to study the positive rate of CXCR3 and CCR5. Western blot was performed to detect CXCR3 and CCR5 protein expression, while real-time polymerase chain reaction (RT-PCR) was conducted to analyze their mRNA expression.</p><p><b>RESULTS</b>The positive rate of CXCR3 and CCR5 were both higher in ITP group (90% and 100%, respectively) than those in control group (75% and 87.5%, respectively)(P < 0.05). The differences were statistically significant (P < 0.05). Protein and mRNA level of CXCR3 in ITP group were 3.0 and 3.5 times as high as those in control group, respectively. Those of CCR5 in ITP group were 1.2 and 1.7 times as high as those in control group, respectively.</p><p><b>CONCLUSION</b>High expression of CXCR3 and CCR5 may play a part in the splenic immune disorders in patients with ITP.</p>