The measurements of normal acetabular index and Sharp acetabular angle in Chinese hips / 中华骨科杂志

Objective To define the normal reference values of acetabular index and Sharp angle through 2333 standard anterior-posterior pelvic radiographs. Methods In our study, 2333 normal anteriorposterior pelvic radiograph images with standard exposure were selected. All the images were diagnozed normal by two radiologists and two pediatricians according to the criteria of T(o)nnis. All subjects were without any neuromuscular diseases and congenital defoemity. The acetabular index was measure in the subjects between age 0 to 10 years, and the groups were divided monthly within 1 year and yearly between 1 to 10years. The Sharp angle was measure in the subjects after 10 years, and the groups were divided yearly in adolescence and decadely in adults. Normal values of each age groups and the correlation charts were completed according to statistical analysis. Results The mean acetabular index was 28.39° in neonates followed by a steep decrease in the first three months after born. It decreased to 22.17°in the 1st year, 12.80°in the 10th years and then kept constant. Acetabular index of the female was generally 1°-2°larger than that of the male with statistical significance. The mean Sharp angle was 46.72°in the 10th years, which decreased to 39.10°in the 18th years and 35.69°in elderly people. Another declination was observed after age 40.Generally no gender difference was observed. Conclusion Acetabular index and Sharp angle vary with age.They reflect a dramatic morphological change in the acetabulum before adulthood and stay constant afterwards. Gender difference is obvious in many age groups but not all. Normal reference ranges of both gender at all age groups should be considered in clinical evaluation.

Treatment of spondylolisthesis in 7 children using Texas Scottish Rite Hospital posterior pedicle screw system / 中国组织工程研究

AIM:Spondylolisthesis is a common spinal disease for adults but rarely found in children.In this study,the treatment effect of spondylolisthesis in 7 children with posterior pedicle screw system after 1 year was explored.METHODS:①Eight children patients with spondylolisthesis treated in Shengjing Hospital of China Medical University between January 1996 and December 2006 were selected including 4 males and 4 females.The average age was 12.25 years(range,8-14 years).According to Meyerding classification,7 cases were of stage Ⅰand one of Ⅳ.②Texas Scottish Rite Hospital(TSRH) posterior pedicle screw system was provided by Wego Ortho Co.,Ltd.,GB1Z type,titanium,No.200511028009.Of the 8 cases,4 were treated by TSRH posterior pedicle screw system,3 were treated via a Wiltse paraspinal approach with autogenous bone graft placed between the transverse processes of L5 and sacral ala in situ fusion,and 1 was not treated by operation.The informed consent of treatment was obtained from the patients.③The changes in the spinal radioactive imaging before and after operation,and the material and host biocompatibility were observed.RESULTS:①Seven of 8 cases were followed up.The mean time of follow-up was 56.6 months with a range from 13 to 111 months.②Three of 4 cases treated by TSRH were vertebral completely reduction with the stability of instrumentation about 75%(3/4),and the other one was partly reduction(about 85%).One person developed the progress again in the X-ray films at three weeks after operation.Three cases treated by Wiltse paraspinal approach with autogenous bone graft placed between the transverse processes of L5 and sacral ala in situ fusion healed well without the recurrence of lumbosacral spondylolisthesis and nonunion.CONCLUSION:TSRH is an efficient and safety option for the treatment of spondylolisthesis in children.

Transmission disequilibrium between congenital dislocation of the hip and homeobox-containing genes* / 中国组织工程研究

BACKGROUND: Research shows that genetic factors are an important component of the congenital dislocation of the hip(CDH) . However, no susceptibility genes have been identified by now. The homebox-containing (HOX) genes that regulate the embryogenesis and vertebrate limb development may play a role in the pathogenesis of CDH.OBJECTIVE: To investigate whether a correlation exists between CDH and the Hox genes.DESIGN: Controlled study associated with family.SETTING: Department of aevelopmental pediatrics, genetic laboratory, department of pediatric orthopaedics in an affiliated hospital of a university.PARTICIPANTS: All the 101 CDH patients and their parents (altogether 303 members) were the in-patients from the Department of Pediatric Orthopaedics of the Second Clinical College of China Medical University; from December 1999 to January 2001. All the patients presented typical clinical manifestations and were diagnosed by X rays and operations for confirmation.METHODS: Four microsatellite markers D7S1808, D17S1820, D12S1686 and Hox4EP were selected in the chromosome regions of7p14 - 15, 17q21, 12q13and 2q31 where Hox A, Hox B, Hox C and Hox D genes which regulate the embryonic limb development reside respectively. Genotypes of 303 members in 101CDH families were analyzed by the techniques of polymerase chain reaction (PCR) and denaturing polyacrylamide gel electrophoresis. Then transmission disequilibrium test(TDT) was performed to analyze the data of genotypes.MAIN OUTCOME MEASURES: The genotypes of four microsatellite markers D7S1808, D17S1820, D12S1686 and Hox4EP in every CDH family including one child and parents; transmission disequilibrium test between transmission alleles and non-transmission alleles.RESULTS: Transmission disequilibrium was found between CDH and allele 7 of D7S1808(X2 = 6. 045, P = 0. 014) among a total of 10 alleles detected, between CDH and allele 4 of D17S1820(X2 =6. 025, P =0. 014) among a total of 12 alleles detected, between CDH and allele 4 of Hox4Ep (X2 = 6. 461, P =0.011) among a total of 16 alleles detected. But no transmission disequilibrium was found between CDH and D12S1686(X2 = 6. 171,P =0. 965) with 16 alleles detected.CONCLUSION: CDH may be related to Hox A, Hox B, Hox D genes, and Hox A, Hox B, Hox D genes may be susceptibility genes in CDH.

Evaluation of renal function in children with moderate or severe hydronephrosis after operation / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate postoperative renal function in children with congenital moderate or severe hydronephrosis.</p><p><b>METHODS</b>99mTc-labeled diethylenetriaminepenta-acetic acid scintigraphy was performed in 50 children with unilateral moderate or severe hydronephrosis to determine postoperative renal function. We also analyzed the factors influencing renal function recovery.</p><p><b>RESULTS</b>Average postoperative renal function in 50 cases was 40.62% +/- 10.09%. Among them, 32% of patients had nearly normal renal function and differentiated renal function reached up to 45%. Average preoperative and postoperative renal function in 25 cases was 23.89% +/- 11.65% and 39.33% +/- 8.59% respectively and the increase of renal function was about 15.44% +/- 11.18% (P = 0.0003). Renal parenchyma thickness was negatively correlated with postoperative renal function (r = -0.62, P = 0.0009). The follow-up period was positively correlated with postoperative renal function (r = 0.58, P = 0.0026). The patients' age had no correlation with renal function recovery (r = -0.05, P = 0.80). Recovery of renal function in hydronephrosis with extrarenal pelvis was greater than that in hydronephrosis with intrarenal pelvis (P = 0.016).</p><p><b>CONCLUSIONS</b>Postoperative renal function in children with moderate or severe hydronephrosis can recover to normal. Recovery of renal function was more obvious in hydronephrosis with thinner renal parenchyma, longer follow-up period and extrarenal pelvis.</p>

The long-term result of trochanteric arthroplasty for the treatment of absence of the femoral head in infancy / 中华骨科杂志

Objective To observe the long- term result of pathological dislocation of the hip with absence of the femoral head treated with trochanteric arthroplasty in infancy. Methods Eighteen cases with absence of the femoral head and pathological dislocation of the hip treated with trochanteric arthroplasty were followed- up for 5－ 16 years, with an average of 9.25 years. The timing of the surgery was average 18.2 months(ranged from 11 to 30 months). Based on Hunka pathological classification, one case was divided as typeⅠ lesion, 2 cases as typeⅡ lesion and 15 cases as typeⅤ lesion. Results There were 8 cases in the excellent group, the morphology and function of the reconstructed femoral heads were nearly normal and the limb shortening were in an average of 0.25 cm. There were 3 cases in good group, the femoral heads were nearly ball sized and the femoral necks were absent, however, the function was good and the limb shortening averaged 1.5 cm. There were 5 cases in fair group, the plastic femoral heads were abnormal and there were acetabular dysplasia and the limb shortening averaged 2.1 cm. There were 2 cases in poor group with redislocation. Conclusion The result demonstrate that surgical treatment of the absence of the femoral head in infancy could obtain a better reconstructed hip and fair function; the shortening of the limb can also be avoided.

Long- term evaluation of intracystic corticosteroid injection in the treatment of simple bone cysts / 中华骨科杂志

Objective To evaluate the long- term results of intracystic corticosteroid injection for the treatment of simple bone cysts. Methods Seventy- six children with simple bone cysts treated by intracystic injection of corticosteroid from 1985 to 1995 were followed- up for an average of 8.2 years（ 5－ 13 years） . Forty- one of the cysts were situated at the proximal end of the humerus, 20 at the proximal end of the femur and 15 at other sites. The mean injection times were 4.2(2－ 13 times). Results Forty- two(55.3％ ) cysts were healed up completely, 16(21.1％ ) basically healed up, 9(11.8％ ) healed up partially and 9(11.8％ ) failures. Satisfactory and effective rate was 76.4％ and 88.2％ respectively. Conclusion Intracystic corticosteroid injection appears to be the initial choice of treatment for simple bone cysts, because it is an effective, and non－ invasive method which can be carried out easily.

Expression of EGF mRNA in renal parenchyma of congenital hydronephrosis in children / 中华泌尿外科杂志

Objective To detect the expression of EGF mRNA in renal parenchyma in congenital hydronephrosis in children and to evaluate the role of EGF in causing chronic renal damage. Methods The expression of EGF mRNA in renal parenchyma, renal pelvis and PUJ tissues from congenital hydronephrosis in children was studied by means of RT PCR. Results The expression of EGF in the aff ected renal parenchyma and PUJ tissues decreased.It also decreased in the affected pelvis but the difference was not significant. The decrease of EGF expression was the most obvious in the affected renal parenchyma. Conclusions EGF expression decreased in renal parenchyma in congenital hydronephrosis and the decrease might be related to the chronic renal damage and renal atrophy caused by hydronephrosis.

The effect of triradiate cartilage injury on hip development / 中华骨科杂志

Objective To study the effect of premature physeal fusion of t ri radiate cartilage on hip development. Methods Ten rabbits aged 4 to 5 weeks were used by partial excision of triradiate physeal cartilage on the right hip of ea ch rabbit, and the opposite untreated hip served as control. Postoperative analy sis consisted of radiographic and histological studies. Radiographs of both hips were taken at 2 days and 3, 6, 9 and 12 weeks after surgery to evaluate the dev elopment and stability of hips. All rabbits were sacrificed at 12 weeks postoper atively. The gross and microscopic histological changes of the hip joints were s ubsequently assessed. The statistic analysis was performed by paired student’s t test worked out by SPSS software. Results On the operated hips, bone bridge fo rmed 3 weeks after operation at the site of triradiate cartilage. The medial ace tabular walls became thick, and the acetabula were shallow. At 6 and 9 weeks pos toperatively, the thickness of acetabular walls increased gradually, and irregul ar sclerosis appeared on the acetabular roof. The density of femoral head increa sed in 6 of 10 rabbits. At 12 weeks postoperatively, the acetabular cavity was m ore shallow, and the femoral head appeared flat. Subluxation of hip was observed in 5 rabbits. There was significant difference in approximate acetabular index (AAI), acetabular head index (AHI) and the thickness of acetabular wall between the operated and control hips. The mean value of AAI and AHI on the operated hip s at 12 weeks significantly decreased as compared to that at 2 days. Gross inspe ction confirmed that the acetabular cavity on the operated hips was characterist ically shallow with a marked increase thickness of medial wall. The femoral head became flattened, and the cartilage of both acetabulum and femoral head were th inned. Histological study showed thinning and partial loss of the joint cartilag e layer and irregularity of cartilage cells on the operated hip joints. There we re increased amounts of fibrovascular cells deep to the cartilaginous layer. In addition, the femoral head exhibited a zone of necrosis in its superior pole wit h thinning of the epiphyseal plate. On the control hips, structure of acetabulum and femoral head appeared normal congruity. Conclusion Acetabular triradiate ca rtilage injury might result in bony bar formation and premature fusion of physis . Its main pathologic changes are widening of the acetabular medial wall, shallo wness of the acetabular cavity, and subsequent hip dysplasia and dislocation.