Research progress in strategy of lateral femoral offset reconstruction in total hip arthroplasty / 中国骨伤

As an important indicator of total hip arthroplasty (THA) the rate and degree of offset reconstruction play an important role in improving the prognosis and life quality of patients. The reconstruction of femoral offset is closely related to reserved length of calcar femorale, the head and neck length of prosthesis, angle degree of neck shaft and whether lower limb is isometric. Reconstruction strategy includes making a meticulous and standard measurement before the surgery, predicting the reserved length of calcar femorale, selecting a prosthesis with approximate anatomical neck-shaft angle and reconstructing offset by adjusting the head and neck length of the prosthetic during the operation. The aim of this article was to introduce the research progress and influence of offset on hip function, prosthetic wear and postoperative complications such as pain, limp and unequal leg length, and to discuss the reconstruction strategy.

Digital anatomy of the perforator flap in the thigh / 中华整形外科杂志

<p><b>OBJECTIVE</b>To provide algorithmic morphological data that enables safe elevation of the flow-through perforator flap, chimeric perforator flap in the thigh.</p><p><b>METHODS</b>15 fresh cadavers were injected with a modified lead oxide-gelatin mixture for three-dimensional reconstruction using a spiral computed tomography scanner and specialized volume-rendering software (MIMICS). All of specimens were then dissected by layers. Angiography and photography were used to document the precise course, size, location, and type of individual perforators in the thigh region. The surface areas of cutaneous territories and perforator zones were measured and calculate with Photoshop and Scion Image.</p><p><b>RESULTS</b>The main artery supplying the thigh is femoral artery. There are (41 +/- 4.0) perforators whose outer diameters > or = 0.5 mm. These perforators have a superficial pedicle length of (4.2 +/- 1.7) cm. The average outer diameter is (0.8 +/- 0.1) mm. Each perforator supplies an average area of (44 +/- 6.4) cm2. There are lots of truly anastomoses among perforaors to form a subcutaneous network in the thigh.</p><p><b>CONCLUSIONS</b>The volume rendering technique is very useful for showing the subcutaneous network and preoperative flap design. The thigh appears to have the greatest potential for harvesting new or modified perforator flaps, especially, flow-through perforator flap or chimeric perforator flap.</p>

Improved osteoblast proliferation, differentiation and mineralization on nanophase Ti6Al4V / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Previous studies have demonstrated increased functions of osteoblasts on nanophase materials compared to conventional ceramics or composites. Nanophase materials are unique materials that simulate dimensions of constituent components of bone as they possess particle or grain sizes less than 100 nm. However, to date, interactions of osteoblasts on nanophase materials compared to conventional metals remain to be elucidated. The objective of the present in vitro study was to synthesize nanophase metals (Ti6Al4V), characterize, and evaluate osteoblast functions on Ti6Al4V. Such metals in conventional form are widely used in orthopedic applications.</p><p><b>METHODS</b>In this work, nanophase Ti6Al4V surfaces were processed by the severe plastic deformation (SPD) principle and used to investigate osteoblast long-term functions. Primary cultured osteoblasts from neonatal rat calvaria were cultured on both nanophase and conventional Ti6Al4V substrates. Cell proliferation, total protein content, and alkaline phosphatase (ALP) activity were evaluated after 1, 3, 7, 10 and 14 days. Calcium deposition, gene expression of type I collagen (Col-I), osteocalcin (OC), osteopontin (OP) and the production of insulin-like growth factor-I (IGF-I) and transforming growth factor-beta 1 (TGF-β1) were also investigated after 14 days of culture.</p><p><b>RESULTS</b>Functions of osteoblasts including proliferation, synthesis of protein, and ALP activity were improved on the nanophase compared to the conventional Ti6Al4V. The expression of Col-I, OC and OP mRNA was also increased on nanophase Ti6Al4V after 14 days of culture. Calcium deposition was the same; the average number of the calcified nodules on the two Ti6Al4V surfaces was similar after 14 days of culture; however, highly significant size calcified nodules on the nanophase Ti6Al4V was observed. Of the growth factors examined, only TGF-β1 showed a difference in production on the nanophase surface.</p><p><b>CONCLUSION</b>Nanophase Ti6Al4V surfaces improve proliferation, differentiation and mineralization of osteoblast cells and should be further considered for orthopedic implant applications.</p>

Treatment of osteoporotic distal femur fractures with less invasive stabilizing system (LISS) and high strength injectable graft / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical results of less invasive stabilizing system (LISS) and high strength injectable graft in the treatment of osteoporotic distal femur fractures.</p><p><b>METHODS</b>From Feb. 2005 to Feb. 2008, 26 cases (15 males, 11 females) of osteoporotic distal femur fractures were treated with less invasive stabilizing system (LISS) and high strength injectable graft. The mean age of the patients was 68.5 years (ranging from 59 to 81 years). According to AO classification,there were 9 cases type A3, 6 cases type C1, 7 cases type C2, 4 cases type C3.</p><p><b>RESULTS</b>The mean operation time was (110 +/- 15) min (ranging from 90 to 135 min). The patients were followed-up for from 12 to 28 months (averaged 18 months). The mean healing time was 20.5 weeks(ranging from 16.5 to 28 weeks). No deep infection, fixation loosening, breakage or failure of implants were observed after the operations. According to Rasmussen radiological evaluation,the results showed 19 cases for "excellent", 7 cases for "good". One year postoperatively, the mean ROM of the knees was 2 degrees to 125 degrees, the HSS knee score was from 59 to 99 points with average of (86.5 +/- 8.2) points. According to HSS scoring system, the results showed 22 cases for "excellent", 2 cases for "good", 1 for "fair" and 1 for "poor".</p><p><b>CONCLUSION</b>The less invasive stabilizing system (LISS) and high strength injectable graft is an effective way for the treatment of osteoporotic distal femur fractures.</p>