Research progress in hip-preserving modalities for early osteonecrosis of the femoral head in young and middle-aged patients / 中华创伤杂志

Osteonecrosis of the femoral head (ONFH) is one of the common and difficult-to-treat orthopedic diseases caused by a variety of factors that lead to abnormal blood flow to the femoral head, which in turn leads to deformation and collapse of the femoral head and eventually results in severe hip joint dysfunction. The key to the treatment is early diagnosis and correct treatment according to the stage classification and active prevention of further aggravation of ONFH aiming to delay or avoid hip replacement surgery in young and middle-aged patients. At present, there are various non-surgical and surgical hip-preserving modalities for early ONFH, designed to slow down the progression of the disease, prevent the femoral head from collapsing and stop the mild collapse. In recent years, with the emergence and development of bone reconstruction biomaterials, artificial bone reconstruction after scraping of ONFH lesions has shown great potential in the treatment of early ONFH. The authors review the research progress in hip-preserving modalities for early ONFH in young and middle-aged patients from non-surgical and surgical perspectives, hoping to provide a reference for clinical treatment of early ONFH.

Effect of single locked-plate internal fixation combined with autogenous iliac bone graft in the treatment of Rorabeck type II periprosthetic distal femoral fracture after total knee arthroplasty / 中华创伤杂志

Objective:To investigate the efficacy of single locked-plate internal fixation combined with autologous iliac bone graft in the treatment of Rorabeck type II periprosthetic distal femural fracture (PDFF) after total knee arthroplasty (TKA).Methods:A retrospective case series study was made on 13 patients suffering from Rorabeck type II PDFF after primary TKA together with severe osteoporosis (T value≤ -2.5 SD) admitted to 940th Hospital of Joint Logistics Support Force of PLA from January 2016 to December 2020, including 4 males and 9 females, aged 65-85 years [(75.2±6.5)years]. All patients were treated with single locked-plate internal fixation combined with autologous iliac bone graft. Anti-osteoporosis and early standardized joint function rehabilitation were undertaken postoperatively. The operation time and intraoperative blood loss were recorded. The range of motion of knee joint was compared before operation, at postoperative 3, 6 and 12 months and at the last follow-up. The Hospital for Special Surgery (HSS) knee score was assessed at postoperative 3, 6 and 12 months and at the last follow-up to evaluate the recovery of knee joint function. The bone mineral density was reexamined at postoperative 6 months and 12 months to evaluate the therapeutic effect of anti-osteoporosis. Complications were detected as well.Results:All patients were followed up for 12-72 months [(43.2±19.9)months]. The operation time was 90-135 minutes [(103.8±12.6)minutes], with the intraoperative blood loss of 100-250 ml [(150.0±45.6)ml]. The range of motion of knee joint was (114.6±7.8)°, (90.4±8.0)°, (97.3±4.8)° and (98.1±6.3)° before operation and at postoperative 3, 6 and 12 months (all P<0.05). The HSS knee score was (80.2±2.2)points, (84.6±2.9)points and (87.3±3.3)points at postoperative 3, 6 and 12 months (all P<0.05). The knee joint function was excellent in 10 patients and good in 3 at postoperative12 months, and the excellent and good rate was 100%. The T value of bone mineral density was (-3.8±0.6)SD, (-3.4±0.6)SD and (-2.9±0.6)SD preoperatively and at postoperative 6 months and 12 months (all P<0.05). One patient experienced nonunion and was cured after secondary autologous iliac bone grafting combined with recombinant human bone morphogenetic protein-2 (rhBMP-2) bone grafting. Three patients developed venous thrombosis of lower limbs and were cured with oral administration of rivaroxaban. One patient had mild knee flexion and extension limitation and was improved after manual release under femoral nerve block anesthesia and subsequent functional rehabilitation. Conclusion:For patients with Rorabeck type II PDFF after TKA, single locked-plate internal fixation combined with autologous iliac bone graft has advantages of short operation time, few intraoperative bleeding, satisfactory knee range of motion and functional recovery as well as significant improvement of bone mineral density.

Clinical significance of peripheral blood circulating tumor cells detection in osteosarcoma patients / 中华骨科杂志

Objective To discuss the correlations amongst the count,molecular and clinicopathological characteristics of circulating tumor cells (CTCs),and the feasibility of using CTC as an aid to judge the metastasis of osteosarcoma,evaluate the therapeutic effect,and predict the prognosis of patients.Methods Retrospective analysis of 30 patients with newly diagnosed osteosarcoma diagnosed from January 2015 to June 2016,there were 17 males and 13 females.The average age was 13.77±4.31 years old (ranged from 7 to 21 years).There were 21 cases of Ennecking stage Ⅱ,including 2 cases of ⅡA,19 cases of ⅡB,and 9 cases of Ennecking Ⅲ.Peripheral blood of all patients was obtained and processed using CanPatrolTM System at baseline,pre-and post-operation.Multiplex RNA-in situ hybridization (RNA-ISH) assay was used to characterize the molecular markers.Combined with clinical data,the relationship between peripheral blood CTC counts,count changes,molecular characteristics,tumor metastasis,chemotherapy effects,and prognosis of patients with osteosarcoma was analyzed and compared.Results The CTC count in peripheral blood was 10.44±5.70 in Ennecking stage Ⅲ patients and 4.76±3.56 in stage Ⅱ patients.The increase or decrease in CTC counts was associated with good or poor neoadjuvant chemotherapy (P=0.002).In patients with good chemotherapy effect,the CTC count in peripheral blood was decreased after chemotherapy.The mean progression-free survival time was 11.85±4.93 months for patients with CTC number ≥7,and the average progression-free survival time was 15.53±4.09 months for patients with CTC number ＜ 7 (P=0.012).The proportion of interstitial CTC in Ennecking stage Ⅲ was 40.42％,which was higher than that of Ennecking ⅡB stage 23.00％.The difference was statistically significant (P=0.010).The positive rate of metastasis-associated gene 1 (MTA1) in interstitial CTC was 85.50％,and the positive rate of other types of CTC was 66.67％.The difference was statistically significant (P=0.000).Conclusion The counting and typing of peripheral blood CTC in osteosarcoma patients can be used as a complement to the commonly used imaging examinations,and they can play an auxiliary role in judging tumor metastasis,curative effect observation and prediction of poor prognosis.

Detection and clinical significance of circulating tumor cells in osteosarcoma using immunofluorescence combined with in situ hybridization / 中华肿瘤杂志

Objective@#To investigate the clinical significance of detection of circulating tumor cells (CTCs) in peripheral blood from patients with osteosarcoma (OS) using the iFISH (immunofluorescence and fluorescence in situ hybridization) method.@*Methods@#The live cells recovery rate of immune-magnetic beads was evaluated by live-cell fluorescent tracer technology. The expression of CD45 and CK18 on the cell surface of HOS and HepG2 cells was measured by flow cytometry. And the chromosome aneuploidy was detected by centromeric FISH probe CEP8. Subsequently, 23 OS patients were enrolled and divided into two groups, relapse or metastasis group and primary group. And the prognostic significance of CTCs numbers was analyzed.@*Results@#The live cells recovery rate of immune-magnetic beads was higher than 90%. The flow cytometry results showed that HOS cells were double negative for the surface biomarkers of CD45 and CK18. In addition, the FISH-CEP8 signal abnormality rate were 96.5% in HOS cells. Thus, CTC was identified using the criteria as follows: the cells with CEP8-positive signal >2 accounted for more than 96.5% of the total cells, of which the cells with >3 positive signal were more than 65.0%. Among the enrolled patients, 19 patients had detectable CTCs in the peripheral blood. The CTCs numbers in the relapse or metastasis group and primary group were 2.846±1.281 and 1.400±1.506, respectively. The results showed that the CTCs in patients with recurrence or metastasis were significantly higher than those in primary patients (P=0.021).@*Conclusions@#To our knowledge, this is the first evidence of existence of CTCs in OS patients. The CTCs numbers were positively associated with disease progression and poor prognosis. These results may provide a potential prognostic tool for monitoring metastasis and recurrence in OS patients.@*Trial registration@#Chinese Clinical Trial Registry, ChiCTR-OOC-15005925

Deposition of collagen Ⅰ in adipose tissue of obese mice was inhibited by toll like receptor 2 knockout / 中华内分泌代谢杂志

Objective To explore the effect of TLR2 on collagen Ⅰ(colⅠ) in adipose tissue of high-fat-diet induced obese mice.Methods Male C57bl/6J mice and TLR2 knockout mice were divided into groups according to high fat diet or normal chow.Total collagen, TLR2, colⅠ, MMP1, MMP2, TIMP1, colⅠα1 mRNA and colⅠα2 mRNA in adipose tissue were measured at the end of the experiments.Results Total collagen, TLR2, colⅠ, MMP2, TIMP1, colⅠα1 mRNA, and colⅠα2 mRNA in adipose tissue increased while MMP1 in adipose tissue decreased in mice with high fat diet.Decreased levels of total collagen, colⅠ, MMP2, TIMP1, colⅠα1 mRNA and colⅠα2 mRNA in adipose tissue were detected in TLR2 gene knockout mice with high fat diet.However, there was an increased level of MMP1 in TLR2 gene knockout mice with high fat diet.Conclusion In high-fat-diet induced obese mice, deposition of colⅠ in adipose tissue seems to be alleviated by TLR2 gene knockout via MMP1 and TIMP1.

Total hip arthroplasty in treating acetabular protrusion secondary to rheumatoid arthritis / 中华骨科杂志

Objective To investigate the clinical outcomes of total hip arthroplasty in treatment of severe acetabular protrusion secondary to rheumatoid arthritis.Methods From January 2011 to November 2014,eighteen patients (20 hips) with severe acetabular protrusion secondary to rheumatoid arthritis were treated with total hip arthroplasty (THA),including 6 males (6 hips) and 12 females (14 hips).The age ranged from 37 to 68 years (average,45.8±8.3 year).According to the classification of Sotelo-Garza and Charnley,there were 15 cases (17 hips) of type Ⅱ (acetabular protrusion 6-15 mm) and 3 cases (3 hips) of type Ⅲ (acetabular protrusion ＞ 15 mm).During the surgery,the femoral heads were moved out through retrograde method after the osteotomy of femoral neck by posterolateral approach.All patients underwent THA with autogenous bone graft by impacting technique for reconstruction of acetabula,and the cementless cups were planted with press-fit skills (Tantalum trabecular metal cup in 16 cases and Titanium porous coating cup in 4 cases).The hip function was evaluated by using Harris hip score.Radiographic measurement was performed with X-ray films to assess the restoration of the hip rotation center,graft incorporation and sign of prostheses loosening in follow-up duration.Results The mean operation duration and intraoperative blood loss were 89.5±8.1 min (range 55-131 min) and 295±10.9 ml (range 165-480 ml) respectively.The average amount of bone graft was 33.7±6.8 cm3 (range 32.5-61.2 cm3) in reconstruction of protrusion acetabulum.The mean follow up duration was 4.5± 1.7 years (range 2.5-6.0 years).The horizontal distance between the center of femoral head and the Kohler's line was increased from preoperative 8.87±3.9 mm (range-11.11-12.78 mm) to 23.55 ± 2.5 mm (range 21.23-25.57 mm) postoperatively,and the vertical distance between the center of femoral head and the line joining the bilateral ischial tuberosities was decreased from preoperative 87.45 ± 3.5 mm (range 74.75-96.97 mm) to postoperative 77.83±4.1 mm (range 68.22-90.40 mm) with statistically significant difference.The bone incorporation was achieved at 6 months postoperatively in radiological film.No loosening of acetabular components was found in final fellow-up.At last follow-up,Harris hip score was significantly improved from 55.3±9.5 points preoperatively to 92.2±12.7 postoperatively (t=51.569,P=0.000).The range of flexion of the hip significantly improved from 41.5°±6.7° preoperatively to 102.3°±14.5° at finial follow-up (t=64.865,P=0.000),and the range of extension of the hip improved from 8.2°±3.5° preoperatively to 29.8°±6.6° at finial follow-up (t=51.161,P=0.000).The discrepancy was significantly decreased from 23.7±0.82 mm preoperatively to 4.7±0.39 mm postoperatively (t=19.761,P=0.000).Mild thigh pain was reported in two hips,which typically occurred only with prolonged activity without disabling and not requiring medication.Conclusion Total hip arthroplasty with impaction bone grafting and cementless modular cup can recover the acetabular center of rotation and achieve satisfactory short-term outcomes in treating patients severe protrusion acetabula secondary to rheumatoid arthritis.

Cementless total hip replacement with femoral calcar reconstruction for unstable intertrochanteric fractures combined with femoral head necrosis / 中华创伤骨科杂志

Objective To explore the feasibility and therapeutic effects of total hip replacement (THR) for intertrochanteric fractures combined with late necrosis of the femoral head.Methods From June 2010 to October 2015,8 patients underwent THR for intertrochanteric fractures combined with necrosis of the femoral head.They were 6 males and 2 females,with an average age of 53.5 years(from 45 to 67 years).According to the Evans-Jensen classification,2 fractures were type ⅠB,5 type ⅡA and one type ⅡB.All the 8 fractures were complicated with late femoral head necrosis,5 cases of which were ischemic.According to the Ficat classification,the ischemic necrosis was type Ⅲ in one and type Ⅳ in 5 cases.In the other 3 cases,the necrosis secondary to the hip osteoarthrosis was type Ⅲ according to the Tonnis classification.The necrotic femoral head was removed after osteotomy of the femoral neck via the posterolateral approach;after reduction of the femoral calcar,the intertrochanteric fracture was reduced and fixated in a press-fit manner through antegrade implantation of a biological stem prosthesis.Functional assessment of the affected hip was carried out at the final follow-up using Harris scoring.Results The 8 patients were followed up for an average of 25.5 months (from 12 to 45 months).After operation,biological press-fit and initial stability of the femoral stem were achieved in all the patients.The X-ray films showed bone ingrowth fixation in all the 8 hips at 3 months postoperatively.The Harris hip scores at the final follow-up averaged 92.3(from 89 to 98).The patients showed fine subjective satisfaction.Follow-ups revealed no infection,prosthetic failure,osteolysis,dislocation or articular instability.Conclusion In treatment of intertrochanteric fractures combined with necrosis of the femoral head,THR can lead to fixation and reduction of the intertrochanteric fracture and replacement of the necrotic femoral head at one stage,promoting functional recovery of the affected hip.