Influence of dexamethasone on CBG levels and the incidence of osteonecrosis of femoral head in adult rats / 中国基层医药

Objective To investigate the effect of glucocorticoid (GC) to cortisol－binding globulin (CBG) expression in rats and the correlation between the changes of CBG levels and the osteonecrosis of the femoral head (ONFH) in rats after GC treatment.Methods A total of 72 healthy adult SD rats were randomly divided into low －dose group and high －dose group by computer random grouping.Thirty－six rats of low －dose group were injected dexamethasone at a dose of 1.5 mg· kg－1· d－1.Thirty－six rats of high－dose group were injected dexamethasone at a dose of 3.0 mg· kg－1· d－1.The blood samples were regularly collected ,CBG levels in blood samples were detected by Western －blotting.Rats were killed in batches , femoral head was collected and observed under light microscope after HE staining.The bone lacuna of each group was compared and the ratio of empty lacuna was calculated. Finally,the correlation between the change of CBG level and ONFH was evaluated.Results On the first day after administration,the CBG level of the two groups decreased ,and reached the lowest level on the seventh day of adminis－tration,and then gradually increased.The reduction of CBG level in the high dose group was greater.With the increase of time after treatment,the number and rate of bone lacuna void in the two groups increased gradually.28 days after treatment,the number of empty bone lacunae and the rate of empty bone lacunae in the low dose group were (6.75 ± 0.42) and (13.98 ±2.19)%,respectively,which were lower than those in the high dose group [(11.03 ±0.62) and (21.99 ±3.17)%,t＝4.864,3.926,all P＜0.05].Conclusion The risk of ONFH is increased with the increase of the dose of dexamethasone ,and there was no significant difference between the sexes.The decrease of serum CBG level after medication is correlated with the occurrence of ONFH.

Influence of dexamethasone on CBG levels and the incidence of osteonecrosis of femoral head in adult rats / 中国基层医药

Objective@#To investigate the effect of glucocorticoid (GC) to cortisol-binding globulin (CBG) expression in rats and the correlation between the changes of CBG levels and the osteonecrosis of the femoral head (ONFH) in rats after GC treatment.@*Methods@#A total of 72 healthy adult SD rats were randomly divided into low-dose group and high-dose group by computer random grouping.Thirty-six rats of low-dose group were injected dexamethasone at a dose of 1.5 mg·kg-1·d-1.Thirty-six rats of high-dose group were injected dexamethasone at a dose of 3.0 mg·kg-1·d-1.The blood samples were regularly collected, CBG levels in blood samples were detected by Western-blotting.Rats were killed in batches, femoral head was collected and observed under light microscope after HE staining.The bone lacuna of each group was compared and the ratio of empty lacuna was calculated.Finally, the correlation between the change of CBG level and ONFH was evaluated.@*Results@#On the first day after administration, the CBG level of the two groups decreased, and reached the lowest level on the seventh day of administration, and then gradually increased.The reduction of CBG level in the high dose group was greater.With the increase of time after treatment, the number and rate of bone lacuna void in the two groups increased gradually.28 days after treatment, the number of empty bone lacunae and the rate of empty bone lacunae in the low dose group were (6.75±0.42) and (13.98±2.19)%, respectively, which were lower than those in the high dose group[(11.03±0.62) and (21.99±3.17)%, t=4.864, 3.926, all P<0.05].@*Conclusion@#The risk of ONFH is increased with the increase of the dose of dexamethasone, and there was no significant difference between the sexes.The decrease of serum CBG level after medication is correlated with the occurrence of ONFH.

Risk factors and treatment of intraoperative periprosthetic acetabular fracture during total hip arthroplasty / 中华骨科杂志

Objective To analyze the risk factors of periprosthetic acetabular fracture in total hip arthroplasty (THA) and to discuss the prevention and management.Methods A total of 1 023 patients (1 168 hips) undergoing THA were retrospectively analyzed between January 2012 and June 2015.There were 421 males (507 hips) and 602 females (661 hips),aged from 23 to 96 years with mean age of 64.2± 15.0 years.Primary total hip arthroplasty was conducted in 1 053 hips,while revision surgery was conducted in 115 hips.The reasons of periprosthetic acetabular fracture were summarized.Age,gender,BMI,primary disease,left or right sides,surgical approach,osteoporosis,prosthetic type,the coverage rate of acetabulum-bone,and the amount of surgical operation annually were compared between non-fracture and fracture.Risk factors associated with the fracture were analyzed using chi square test followed by a multivariate logistic regression.Furthermore,revision surgery was compared with primary THA using chi square test.Results The incidence of intraoperative periprosthetic acetabular fractures was 2.8％ (33/1 168).The incidence of fracture was higher in revision surgery than that in primary THA (6.1％ vs.2.5％).Multivariate logistic regression showed that primary disease (developmental dysplasia of the hip and rheumatoid arthritis),osteoporosis,uncemented acetabular cup,the high-er coverage rate of acetabulum-bone,and the less amount of surgical operation annually were prone to appear periprosthetic acetabular fracture in primary THA.Among the 33 patients with acetabular fractures,13 cases (39.4％,13/33) were found intraoperatively and 20 cases (60.6％,20/33) postoperatively.Acetabular wall fractures were in 26 (78.8％,26/33),column fractures in 2 (6.1％,2/33),transverse fractures in 2 (6.1％,2/33) and quadrilateral surface fractures with prosthetic central dislocation in 3 (9.1％,3/33).Seven cases of 26 stable fractures and 6 cases of 7 unstable fractures were found intraoperatively.Acetabular wall fractures were fixed by additional augmentation screws or accepted no special treatment,and column fractures were fixed with plate.One quadrilateral surface fracture was accepted revision surgery using Jumbo cup,2 quadrilateral surface fractures and 2 transverse fractures with reconstruction cage.The patients were followed up for 42.3±13.7 months (range 29-60 months).The Harris hip score was 83.3±6.6 (range 72-94) at last follow-up.No complication,such as hip dislocation,osteolysis,and prosthetic loosening was reported.Conclusion Most of periprosthetic acetabular fiactures are wall fractures which could not endanger the periprosthetic stability.The detection rate of acetabular stable fracture is lower than that of unstable fracture in operation.Primary disease (developmental dysplasia of the hip and rheumatoid arthritis),osteoporosis,uncemented acetabular cup,the higher coverage rate of aeetabulum-bone,the less amount of surgical operation annually are the intraoperative risk factors which closely related to acetabular fractures of primary THA.The risk of intraoperative periprosthetic acetabular fractures in revision THA is higher than that in primary THA.

Using modular fluted tapered stem for management of periprosthetic femoral fracture in revision hip arthroplasty / 中华骨科杂志

Objective To evaluate the technique and clinical results of the modular fluted tapered stems for treating periprosthetic femoral fractures in revision hip arthroplasty.Methods From August 2007 to February 2014,fourteen patients (14hips) with periprosthetic femoral fractures underwent revision hip arthroplasty with modular fluted tapered stem.A retrospective analysis was performed involving all patients who were followed-up more than 2 years.The subjects consisted of 4 males and 10 females with mean age of 73.4±6.6 years (range,62-82 years) at the time of revision.All patients were unilateral with 8 left hips and 6 right hips.The status of primary arthroplasty was bipolar hemiarthroplasty in 3 patients and total hip arthroplasty in 11 patients.Nine cases were with cemented stems,5 cases with uncemented stems.The interval from primary hip arthroplasty to revision surgery ranged from 40 to 163 months,with an average of 120.9±31.9 months.Eight cases with Vancouver type B3 periprosthetic femoral fracture were found preoperatively,6 cases with aseptic loosening and bone deficiency occurred periprosthetic femoral fracture during the operation.Based on the Paprosky classification system for femoral bone deficiency:type ⅢA in 8 hips,type ⅢB in 5 hips,type Ⅳ in 1 hip.Both the femoral and the acetabular components were revised in 9 patients.All femoral fractures were treated with cable fixation,and the cortical allograft struts were used to augment femoral bone stock in 7 patients.The patients were followed up at 6 weeks,3 months,6 months,9 months,12 months and annually thereafter.Harris Hip Score System and radiographic examination was used to evaluate the clinical results,including fracture union,implant stability,bone stock,hip joint function and postoperative complications.Results The mean duration of follow-up was 62.1 ±22.2 months (range,30-96 months).The mean times of fracture union were 6.2±2.5 months (range,3-12 months).The Harris Hip Score improved from 29.6± 10.3 preoperatively to 86.3±4.2 postoperatively (t=-21.6,P=0.00).Thirteen cases (93％,13/14) had the stem subsidence of 4.9±2.5 mm (range,0-9 mm).Thirteen cases (93％,13/14) were presented with femoral bony restoration.Two cases showed incorporation of the allograft in 7 patients.One patient developed deep venous thrombosis of lower limbs,and one suffered from subcutaneous hematomas after surgery.There was no infection,aseptic loosening,dislocation or periprosthetic fracture complications at the followup.Conclusion The short-medium term results of the modular fluted tapered prosthesis applied in periprosthetic femoral fractures are encouraging in revision hip arthroplasty.The present technology can provide reliable primary stability and can tolerate minimal subsidence postoperatively.

Clinical application of 3D printing guild plate in total knee arthroplasty / 中华骨科杂志

Objective To evaluate the efficacy and safety of total knee arthroplasty (TKA) with 3D printing guild plate by comparing with conventional TKA. Methods From May 2014 to September 2014, 40 patients suffered primary unilateral TKA were received, in which there were 11 males and 29 females, aged from 57 to 82 years with an average age of 68.5±6.3 years. The subjects were divided into two groups randomly. One group was treated with TKA with 3D printing guild plate while the other group was treated with the conventional TKA. The blood loss, operation time, post?operative Hospital for Special Surgery (HSS) score, range of motion (ROM), lower limb mechanical alignment and incidence of complication were compared with insignificant differences. Results The operation time in the 3D printing TKA group (103.4±11.7 min) was lower than that in the conventional TKA group (124.5±21.6 min), which was statistically significant (t=3.838, P=0.000). The blood loss in the 3D printing TKA group (370.2±96.0 ml) was lower than that in the conventional TKA group (510.0±235.9 ml), which was statistically significant (t=2.454, P=0.019). The post?operative ROM of knee in the 3D printing TKA group was 104.3° ± 15.5° and that in the conventional TKA group was 103.5° ± 12.5° (t=0.169, P=0.867). HSS scores in the 3D printing TKA group and in the conventional TKA group were 88.5±5.7 and 89.4±4.8, which was statistically insignificant (t=-0.633,P=0.530). Mechanical alignment in the 3D printing TKA group was 2.9°±1.1° and that in the conventional TKA group was 3.0°±0.9°, which was not statistically significant (t=-0.317, P=0.753). No obvious complication occurred in two groups. Conclusion TKA with 3D printing guild plate has similar results to conventional TKA in HSS score, mechanical alignment and ROM of knee, but it shortens operation time and decreases the blood loss.

The classification of osteonecrosis of the femoral head based on the three pillars structure: China Japan Friendship Hospital (CJFH) classification / 中华骨科杂志

Objective To explore the regular progressive pattern of nontraumatic osteonecrosis of the femoral head (ONFH) in order to establish the reliable and convenient new classification of ONFH.Methods The coronal section of the femoral head was divided into three pillars (medial,central and lateral).The mid-coronal section of the femoral head on MRI was selected.The China-Japan Friendship Hospital (CJFH)classification of ONFH was established according to the site of necrotic focus in three pillars.A total of 153hips with ONFH were classified according to CJFH classification and Japanese Investigation Committee (JIC)classification,respectively.The collapse rate was observed and compared between both classifications of ONFH.Results The CJFH classification for ONFH consists of 3 types:type A,the medial pillar was involved; type B,the medial and central pillars were involved; type C,the lateral pillar was involved.According to site of necrosis focus in the lateral pillar,the type C was divided into 3 types:C1,there pillars were involved but there still was some normal tissue in lateral pillar;,C2,partial central pillar and all lateral pillar were involved; C3,the whole femoral head was involved.The natural history of the ONFH showed the collapse rate of type C2 and C3 in CJFH classification (95.3％) was higher than that (72.3％) of type C2 in JIC classification.Conclusion The CJFH classification of ONFH based on three pillars is more sensitive than JIC classification in predicting collapse of the femoral head.Moreover,the CJFH classification is convenient to use.

Prevention of dislocation after total hip replacement / 中国矫形外科杂志

To sum up the methods which can be used to prevent dislocation after total hip replacement.Recent original articles about the reasons of dislocation and methods which were used to treat or prevent dislocation were extensively reviewed,and retrospective and comprehensive analysis was performed.Dislocation after THA can be reduced by careful assessment of patients,selecting suitable prosthesis,improving the position of prosthesis and avoidance risk movements.Dislocation after THA can be reduced by careful pre-,intra-,and postoperative assessment.

Treatment of recurrent dislocation of total hip replacement / 中国矫形外科杂志

[Objective]To explore the causes and treatments of recurrent dislocation after total hip replacement.[Method]From July 1999 to January 2007,there were 47 cases of dislocation after total hip replacement.Thirteen cases were recurrent.CT and serial X-rays were taken to observe the position of prosthesis.The strength of their hip abductor was also tested.Stability test was used to value the stability of hip.Closed reduction,modular adjustments and revision were adopted according to patients,willingness,prosthesis and stability.[Result]All of the 13 patients had malposition.Eleven cases were tested with instability.Five cases were successfully treated by closed reduction.Despite dislocation reoccurred 1～2 times every year in 3 patients treated by closed reduction,patients felt satisfactory.In the 4 cases with modular revision procedure,2 cases changed the neck length,1 case used elevated liner and larger neck length,1 cases treated by using larger offset and adjusting abnormal liner.Another one treated by revision.[Conclusion]Malposition is the major causes of recurrent dislocation.The prosthesis test whowed instability.The treatments of recurrent dislocation after THA should use different ways according to the causes of dislocation,stability of prosthesis and the willingness of patients.

The causes and treatments of early dislocation after total hip replacement / 医学研究生学报

Objective:To analyze the causes of early dislocation after total hip replacement and explore its preventions and treatments. Methods:From July 1997 to October 2002, there were 12 cases of dislocation after total hip replacement. The strength of their hip abductor was tested and the X-ray films were measured. If closed reduction failed, capsular repairing was used. Results:There were 3 cases of malposition, 5 cases of abnormal soft-tissue tension, 3 cases of malposition and abnormal soft-tissue tension and 1 case of over motion. Close reduction was succeeded in 5 cases, 7 cases failed to close reduction, and were treated successfully by repairing the hip capsule and readjusted the prostheses when necessary. Conclusion:Abnormal soft-tissue tension has become the main causes of dislocation after total hip replacement. Those cases in which closed reduction has failed can be treated by repairing the hip capsule.

Using the percentage of necrotic surface area to predict collapse of avascular necrosis of the femoral head / 中华骨科杂志

Objective To explore the value of the percentage of necrotic surface area in predicting collapse of osteonecrosis. Methods 15 hips of avascular necrosis of the femoral head(ANFH) in 9 patients underwent MRI scan. On the MRI films, the percentage of necrotic surface area were calculated. While on the specimens of the 15 hips, the percentage of necrotic surface area were also measured. In 16 hips of 8 patients of ANFH with serials MRI at mean 18.9 months intervals (range, 6-41 months), the percentage of necrotic surface area were calculated and compared. In 38 hips of 27 patients without collapse, the percentage of necrotic surface area and the index of necrosis were calculated on MRI films. Follow-up was terminated when crescentic sign illustrated on X-ray film or CT demonstrated articular facet collapse. Those hips without collapse were followed up more than 24 months. The value of the percentag of necrotic surface area and the index of necrosis in predicting collapse of osteonecrosis was observed. Results The percentage of necrotic surface area were 63.23%?10.16% on specimens and 63.60%?7.78% on MRI films respectively. There were no significant differences between them. The percentage of necrotic surface area on specimens were coincidence with those on MRI. In the 16 hips with serials MRI; the percentage of necrotic surface area were 52.37%?19.91% on the first MRI films, 51.70%?21.29% on the second. There were no significant differences between them. This result revealed that the percentage of necrotic surface area did not vary with the extension of course of disease. In the 38 cases of early necrosis, 28(73.7%) hips collapsed and 10(26.3%) hips did not. The relative risk of the percentage of necrotic surface area was 1.043, and the relative risk of the index of necrosis was 1.020. No significant difference was found in ARCO staging for patients with or without femoral head collapse. It demonstrated that whether ischemic necrotic femoral head collapse or not had no relation with its ARCO stage. Conclusion The percentage of necrotic surface area can be used as more accurate predictor for future collapse.