Efficacy and influencing factors of primary total hip arthroplasty in elderly patients with femoral neck fracture / 局解手术学杂志

Objective To evaluate the efficacy of primary total hip arthroplasty(THA) in elderly patients with femoral neck fracture and explore its influencing factors.Methods The clinical data of 84 elderly patients with femoral neck fracture from January 2013 to January 2016 in Second Affiliated Hospital of Hainan Medical College hospital who received the primary THA was retrospectively analyzed.The age,gender,body mass index (BMI),fracture type,bone mineral density,preoperative complication,methods of anesthesia,surgical approach,operation time,the amount of intraoperative bleeding,drainage condition,recessive blooding,limb length changes,postoperative rehabilitation exercise time,pain management and psychological intervention were collected,and the Harris score was recorded in 1 year follow-up to evaluate the joint function.Firstly,univariate analysis was used to find out the influencing factors of the hip joint function from the above information,then Harris score as dependent variable by logistic regression analysis was used to determine the independent influencing factors.Results The Harris score at postoperative 1 year showed that:24 cases were excellent,42 cases were good,13 cases were fair,5 cases were poor,the excellent and good rate was 78.6％.The univariate analysis results showed that BMI,bone mineral density,method of anesthesia,surgical approach,recessive bleeding,limb length changes,postoperative rehabilitation exercise time and postoperative pain management had significance difference in hip joint function of different patients(P ＜ 0.05).Multivariate logistic regression analysis showed that BMI,bone mineral density,method of anesthesia,surgical approach,recessive bleeding,limb length changes,postoperative rehabilitation exercise time,postoperative pain management were independent factors of hip function after primary THA for femoral neck fracture in the elderly(P ＜ 0.05).Conclusion The efficacy of primary THA for the femoral neck fractures in elderly patients is significant.BMI,bone mineral density,method of anesthesia,surgical approach,recessive bleeding,limb length changes,postoperative rehabilitation exercise time,postoperative pain management are independent factors affecting the efficacy,which should be given enough attention.

Treatment of large circular soft tissue defect in lower extremities with a combination of bridge flaps and free skin graft covered by vacuum sealing drainage / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the surgical technique and clinical value of treatment for posttraumatic large circular soft tissue defect in the lower extremities using a combination of posterior tibial vascular bridge flap in the unaffected leg and skin graft covered by vacuum sealing drainage (VSD).</p><p><b>METHODS</b>From January 2008 to June 2010, 11 cases with posttraumatic large circular soft tissue defects with deep tissue exposed or partial necrosis in the lower extremities were treated by bridge flaps and combined with free skin graft covered by VSD. There are 7 males and 4 females, with an average age of 32.5 years (range from 15 to 52 years). The size of wound varied from 24 cm × 13 cm to 45 cm × 24 cm. After the wound were completely debrided, the external fixation or internal fixation was conducted for the patients with unstable fracture. Then VSD were used to covered the wound for 1-2 times with a period of 5 to 7 days according to the wound condition. After granulation tissue grew, bridge flap transplantation was performed to repair tissue defect and cover the exposed bone, which combined with skin graft covered by VSD was used to cover the residual wound. Survival rate and quality healing of the flaps were followed up postoperatively.</p><p><b>RESULTS</b>The granulation growth of 11 cases with large circular soft tissue defect in the lower extremities associated tissue exposure was good after the application of VSD. All the cases were covered by free flap transplantation and skin grafting except for 6 cases due to large defect. The wound was covered by skin re-grafting in 4 cases and frequently dressing change in 2 cases. All the flaps were successful with good infection control and no sinus. The average period of follow-up was 10.6 months (5 - 24 months). All the patients were satisfied with the good outline and good function of the affected limb.</p><p><b>CONCLUSION</b>Patients with posttraumatic large circular soft tissue defect in the lower extremities can be effectively treated with a combination of bridge flaps and free skin graft covered by VSD, which can shorten the course of treatment, and restore the function of affected extremities as much as possible.</p>

Three-dimensional reconstruction technique in gastrocnemius flap surgery: initial clinical application / 南方医科大学学报

<p><b>OBJECTIVE</b>To discuss the experience with three-dimensional reconstruction technique in initial clinical application in gastrocnemius muscle flap surgery.</p><p><b>METHOD</b>From 2007 to 2008, 7 patients received gastrocnemius muscle flap surgeries to repair the wounds. Preoperative CT angiography or magnetic resonance imaging (MRI) was performed after injection of the contrast media for individualized three-dimensional gastrocnemius muscle flap reconstruction using Amira4.1 software. According to the size of the defect in the wound, individualized three-dimensional gastrocnemius muscle flap was designed and harvested from the posterior leg.</p><p><b>RESULTS</b>Individualized three-dimensional reconstruction of the gastrocnemius flap was performed in 7 cases, and the reconstructed flaps clearly displayed the blood vessels, skin and the adjacent three-dimensional structures. In 6 cases the main perforating branched and trunk of the blood vessels in the designed flap were consistent with the surgical findings; in 1 case, the perforating branches failed to be clearly displayed in the designed flap, and surgical examination identified perforating branches with an average diameter of 0.5 mm (minimally 0.3 mm). The flaps survived in all the 7 cases.</p><p><b>CONCLUSIONS</b>Three-dimensional reconstruction of the gastrocnemius flap based on the lower limb CT angiography or MRI allows three-dimensional observation of the anatomy of the flap and accurate marking of the extent of the flap to be harvested, therefore avoiding intraoperative injuries to the blood vessels to better survival of the flaps.</p>

Green fluorescent protein as a tracer of bone marrow stromal cells in bone tissue engineering in rhesus / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the role of green fluorescent protein (GFP) in tracing rhesus bone marrow stromal cells (rBMSCs) during tissue-engineered bone formation in vivo.</p><p><b>METHODS</b>Ad5.CMV-GFP was amplified by infecting QBI-293A cells, and the bone marrow was harvested from the ilium of adult male rhesus to obtain rBMSCs, which were cultured and passaged in vitro. GFP was transfected into the third-passage rBMSCs via adenovirus vector and the labeled cells were inoculated into absorbable HA scaffold and cultured for 3 days, with untransfected rBMSCs as control, before the cell-matrix compounds were implanted into the latissimus dorsi muscles of rhesus. Samples were harvested at 6 week and embedded in paraform, and ground sections of the bone tissue were prepared to observe green fluorescence under laser scanning confocal microscope. Propidium iodide staining of the sections was also performed for observation.</p><p><b>RESULTS</b>The rBMSCs grew well after GFP transfection, and green fluorescence could be seen 24 h after the transfection and became stronger till 48 h, with a positive transfection rate beyond 80%. Six weeks after cell implantation, the rBMSCs labeled by GFP-emitted green fluorescence were detected in the bone tissue under laser scanning confocal microscope.</p><p><b>CONCLUSION</b>GFP can effectively trace BMSCs during bone tissue engineering, and the transplanted BMSCs constitute the main source of bone-forming cells in bone tissue engineering.</p>

Study of osteoblasts transfected with gfp in vitro and traced in vivo / 中华整形外科杂志

<p><b>OBJECTIVE</b>To observe the osteoblasts transfected with green fluorescent protein (GFP)by adenovirus vector expressed in vitro and traced it in vivo in order to research the feasibility of GFP as a tracer of seeding cells for tissue engineering.</p><p><b>METHODS</b>CFP were transfected into the osteoblasts which derived from adult human bone marrow stromal cell (hBMSc) by adenovirus vector after being packed in 293A cells. The nontransfected hBMSc was used as the control group. The osteoblasts in each group were observed under an inverted phase contrast microscope and fluorescence microscope. The expressive efficiency of GFP was examined by flow cytometry,and alkaline phosphatase (ALP) activities and osteocalcin (OCN) synthesis. After eight days of the transfection,the osteoblasts were implanted into the muscle of nude mouse thigh while the non-transfected osteoblasts were also implanted as a control. Four and eight weeks after the operation, the nude rats were killed and the continuous tissue sections were examined using fluorescence microscopy after adjacent sections were performed by immunohistochemistry or routine HE staining.</p><p><b>RESULTS</b>The green fluorescence was shown the transfected osteoblasts which derived from bone marrow. The rate of positive expression was over 75%. After eight days of the transfection, the marker proteins of the surface of the osteoblasts showed extremely efficient expression of CD29 and CD44, but the CD34 expressed negative. Either ALP or OCN of the osteoblasts was no significant difference between the two groups (P > 0.05) four and eight days after the transfection. The GFP were obviously expressed in nude mouse both at four and eight weeks, meanwhile it did not harm on the morphology and function of the transfected osteoblasts whose immunohistochemistry examination showed positive reaction.</p><p><b>CONCLUSIONS</b>GFP could be transfected osteoblasts effectively in vitro and traced in vivo in nude mouse. It may be an optimal tracer for living cells on tissue engineering research.</p>

The method of accelerating osteanagenesis and revascularization of tissue engineered bone in big animal in vivo / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study whether tissue engineered bone can repair the large segment bone defect of large animal or not. To observe what character the fascia flap played during the osteanagenesis and revascularization process of tissue engineered bone.</p><p><b>METHODS</b>9 Chinese goats were made 2 cm left tibia diaphyseal defect. The repairing effect of the defects was evaluated by ECT, X-ray and histology. 27 goats were divided into three groups: group of CHAP, the defect was filled with coral hydroxyapatite (CHAP); group of tissue engineered bone, the defect was filled with CHAP + bone marrow stroma cells (BMSc); group of fascia flap, the defect was filled with CHAP + BMSc + fascia flap. After finished culturing and inducing the BMSc, CHAP of group of tissue engineered bone and of fascia flap was combined with it. Making fascia flap, different materials as described above were then implanted separately into the defects. Radionuclide bone imaging was used to monitor the revascularization of the implants at 2, 4, 8 weeks after operation. X-ray examination, optical density index of X-ray film, V-G staining of tissue slice of the implants were used at 4, 8, 12 weeks after operation, and the biomechanical character of the specimens were tested at 12 weeks post operation.</p><p><b>RESULTS</b>In the first study, the defect showed no bone regeneration phenomenon. 2 cm tibia defect was an ideal animal model. In the second study, group of CHAP manifested a little trace of bone regeneration, as to group of tissue engineered bone, the defect was almost repaired totally. In group of fascia flap, with the assistance of fascia flap which gave more chance to making implants to get more nutrient, the repair was quite complete.</p><p><b>CONCLUSIONS</b>The model of 2 cm caprine tibia diaphyseal defect cannot be repaired by goat itself and can satisfy the tissue engineering's demands. Tissue engineered bone had good ability to repair large segment tibia defect of goat. Fascia flap can accelerate the revascularization process of tissue engineered bone. And by this way, it augment the ability of tissue engineered bone to repair the large bone defect of goat.</p>