Clinical diagnosis and treatment strategy for recurrent aneurysmal bone cysts of the extremities: a report of 29 cases / 中国肿瘤临床

Objective: To explore the clinical characteristics, imaging feature, surgical outcomes, and prognosis of recurrent aneurysmal bone cysts (RABC) of the extremities. Methods: Between January 2008 and January 2016, 29 patients histopathologically diagnosed with RABC were treated at our hospital. These patients included 15 males and 14 females. The mean age at the time of diagnosis was 17.4 years(range 4-42 years). The most common site of the RABC was the proximal tibia (12 cases), followed by the distal femur (11 cases), and 3 cases each with involvement of the proximal humerus and the proximal femur. Recurrence was most commonly ob-served within 24 months following the initial treatment. Intralesional re-curettage was performed in 24 patients and en bloc resection of the tumor and reconstruction in 5 patients. The medial tibial stress syndrome (MTSS) score was used to evaluate postoperative func-tion of the affected limb, and the comprehensive clinical efficacy was evaluated on the basis of the Mankin criteria. Results: The mean follow-up duration was 64 months (range 24-90 months). Re-recurrence occurred in 1 patient with a total re-recurrence rate of 3.4%. The postoperative MTSS score was 26-30 points (mean 29.1 points) in the intralesional re-curettage group and 21-27 points (mean 23.0 points) in the tumor resection group. Based on the Mankin criteria, excellent and good clinical outcomes were observed in 95.8% of patients in the intralesional and 60% of the patients in the tumor resection and reconstruction groups. Conclusions: Regular follow-up is essential for the early diagnosis of RABC. The re-recurrence rate following intralesional re-curettage was within an acceptable range, and postoperative limb function was satisfactory; therefore, intralesional re-curettage is the treatment of choice for RABC in-volving the extremities. Tumor resection can be performed in patients with severe articular surface destruction and repeated recur-rence, although long-term complications may occur.

Experimental study on rigidity effect of 3 kinds of different internal fixation at upper thoracic spine / 重庆医学

Objective To compare the rigidity at upper thoracic spine among the anterior transpedicular screw-plate system (ATPSPS),posterior transpedicle screw-rod system (PTPSRS) and anterior vertebral body screw-plate system (AVBSPS).Methods Twelve embalmed cadaver specimens were divided into three groups.The specimens in each group were randomly allocated to use the above 3 different internal fixation devices for conducting fixation.The stiffness of each specimen on the directions of axial compression,flexion and extension,and left and right lateral bending was detected under original status.All specimens conducted the simulated corpectomy of T2 (damage status).Then the rigidity on various directions was re-detected on the damage status.The corresponding internal fixation system was selected for conducting the install and fixation according to the grouping results.The intra-group and inter-group rigiditieson different directions were compared amongoriginal status,damage status and after internal fixation.Results The rigidities on different directions under original and damage statushad no statistical difference among various groups (P＜0.05).After conducting fixation in each group,the rigidity after fixation on different directions had statistically significant difference among groups(P＜0.05).The stiffness of anterior flexion in the ATPSPS group was greater than that in the other two groups (P＜0.05).The rigidity of axial compression and extension in the PTPSRS group was greater than that in the other two groups,the difference among groups was statistically significant (P＜0.05).The stiffness of lateral bending in the AVBSPS group was smaller than that in the other two groups,the difference was significant (P＜0.05),but the difference between the other two groups had no statistical significance (P＞0.05).Conclusion The rigidity of ATPSPS in all directions is higher than that of AVBSPS.The anterior flexion rigidity is greater than PTPSRS,and the axial compression and extension rigidity are less than PTPSRS,but the lateral bending rigidity is equivalent to PTPSRS.

Ischemic neurological injury during spinal deformity surgery: current status / 中华外科杂志

Ischemic neurological injury is the most feared complication of spinal deformity surgery.In recent years, more attention has been paid to ischemic neurological injury during spinal deformity surgery including causes, risk factors, and prevention. The direct and indirect causes of ischemic neurological injury contains ligature of the segmental arteries, perioperative bleeding and excessive stretching or shortening of the spinal cord.Those patients at greatest risk for paraplegia following diagnosis of thoracic kyphosis or kyphoscoliosis, unilateral vessel ligation, perioperative hypotension, and extensive anterior and posterior surgery. Keeping reasonable mean arterial pressure and multimodal intraoperative monitoring may effectively prevent ischemic neurologic injury during surgery for spinal deformity.

Computer navigation technique-assisted posterior spinal pedicle screw placement fixation:accuracy and safety / 中国组织工程研究

BACKGROUND:Posterior pedicle screw fixation is an important method to treat various diseases of the spine and to stabilize the spine. Computer navigation system can completely, intuitively and truly reveal the morphology of various tissues and their positions so that the performer can obtain three-dimensional images in time and avoid the risk area of the operation to the utmost, and can directly introduce accurate placement of the screw in the vertebral body. OBJECTIVE:To evaluate the accuracy and safety of computer navigation technique-assisted posterior spinal pedicle screw placement.METHODS:307 patients with spine diseases, who were treated in the First Affiliated Hospital of Guangxi Medical University from July 2008 to January 2014, were enrol ed in this study. They received computer navigation technique-assisted posterior spinal pedicle screw placement and laminectomy for decompression. C-arm fluoroscopy was applied to assess the precision of pedicle screw position during the operation. The mean implantation time per screw and the exposure time to radiation were recorded. 3-day postoperative radiographs and CT examination, which al owed measurements of screw position relative to pedicle position according to Andrew classification, were performed routinely. RESULTS AND CONCLUSION:Of the 1 820 screws inserted by computer-assisted navigation, 1 778 were grade I (accuracy 97.69%). A total of 92 screws were implanted in the cervical vertebrae, including 90 grade-I screws (accuracy 97.82%). 502 screws were implanted in the thoracic vertebrae, including 492 grade-I screws (accuracy 98%). 1 226 screws were implanted in the lumbar vertebrae, including 1 196 grade-I screws (accuracy 97.2%). The mean implantation time per screw was (7.0±1.5) minutes. 215 patients were fol owed up for (12±6) months. No complications such as fixator displacement or breakage or neurovascular injury occurred. Above findings suggested that computer navigation system-assisted spinal pedicle screw implantation provides real-time, multi-perspective, three-dimensional visualization of spinal anatomy, ensures the accuracy and safety of spinal pedicle screw implantation, and apparently reduces exposure time to radiation.

Surgical outcome for occipitocervical intradural extramedullary tumors / 中华骨科杂志

Objective To investigate the surgical strategy and outcome for occipitocervical extramedullary tumors.Methods 15 patients with occipitocervical extramedullary tumors from January 2007 to July 2010 were reviewed retrospectively.There were 7 males and 8 females with an mean age of 44.6 years (range,21-72 years).All cases were intradural tumors,including 7 cases in dorsolateral,5 cases in lateral side,and 3 cases in ventralis of spinal cord.Functional and neurological statuses were assessed using the Frankel grade and Japanese Orthopaedic Association (JOA) scale.According to Frankel grade system,there were 4 patients with Grade C,8 with Grade D,and 3 with Grade E.The mean preoperative JOA score was 10.5±3.6.Based on the tumor site,there were 5 cases in medulla oblongata-C1 and 10 cases in C1,2.Frankel grade and JOA score were used to evaluate neurological status and general health.The improvement of symptoms and characteristics of surgical strategies were analyzed.Results All cases were followed up for 2-4 years (mean 2.8 years).Complete resection of tumor and good fusion of bone graft were found in radiography postoperatively.The pathological diagnoses included 10 cases of schwannoma,3 cases of meningioma and 2 cases of neurofibroma.There was statistical difference between the preoperative and the final follow-up functional and neurological statuses including Frankel grade and JOA score.At the latest follow-up,2 cases improved from Frankel grade C to D,2from C to E,6 from D to E,but none in 2 cases with grade D.The mean JOA score at final follow-up was 15.6±1.6,and the average improvement rate was 80.7％± 17.4％.The mean preoperative C0-2 angle was 27.0°±4.1 °,and C2-7 angle was 16.8°± 12.7°.C0-2 angle was 27.6°±8.8°,and C2-7 angle was 10.2°±6.8° at the latest follow-up.However,these differences did not reach statistical significance.Conclusion Surgical treatment can effectively maintain or improve neurological function and improve quality of life.Extramedullary tumors can be resected completely by posterior approach,and spinal stabilization can be obtained satisfactorily through selecting appropriate surgical strategies.For medulla oblongata-C1 level,occipitocervical fusion is usually chosen after extirpation of tumor.For C 1,2 level,C1,2 fusion after tumor resection is useful in preventing atlantoaxial instability.

The feasibility of the anterior reverse transpedicular screw (ARTPS) fixation at upper thoracic spine / 中国脊柱脊髓杂志

Objectives: To verify the feasibility and safety of the anterior transpedicular screw(ATPS) fixation of the upper thoracic spine (T1-T4) through the radiological anatomy study on the cadaveric specimens. Methods: The upper thoracic spine thin-section CT data of 40 cases were collected from the radiology de-partment′s database(20 males and 20 females, aged from 18 to 68 years, the mean age was 39.7 years). The data of OPW(outer pedicle width), OPH(outer pedicle height), PAL(pedicle axis length), TPA(transverse section angle), SPA(sagittal section angle), DTIP(distance of transverse intersection point) and DSIP(distance of sagittal intersection point) of each pedicle were measured on the transverse and sagittal sections through the axis of each pedicle. The data were recorded and statistically analyzed. 10 upper thoracic spine(C7-T6) specimens of adults(5 males and 5 females, with unknown ages), with no damage to their appearance, the costovertebral joints and paravertebral soft tissue were completely retained. Then simulate surgical operations were done on the cadaveric specimens based on the obtained data. Screws were implanted anteriorly by free hand. After that, the specimens accepted X-ray fluoroscopy and CT scan. At last, the screws were removed, the speci-mens were sawed along the transaction and sagittal section of the screw channel. Then the success rate of the screw placement was evaluated according to Rao′s worn out classification standard of pedicle screws. Results: From T1 to T4, the OPW decreased from 8.14mm to 3.47mm; the OPH increased from 6.89mm to 10.29mm; the TPA decreased from 32.96° to 11.64°; the DTIP increased from 1.80mm to 5.50mm; the SPA increased from 104.95° to 115.74°; the DSIP increased from 5.95 to 8.76mm; the PAL changed irregularly, from 32.95 to 35.96mm. The pedicle diameters of T3 and T4 were too small to implant ATPS, but the ARTPS can be implanted successfully. The diameter of ATPS was about 4.0mm; the length of ATPS was about 35mm. The diameter of ARTPS was about 5.0mm; the length of ARTPS was about 35mm. 80 pedicle screws were implanted anteriorly, according to Rao′s worn out classification standard of pedicle screws, the fine rate was 90%. The internal walls of 7 pedicles were broken by screws of less than 2mm and no compression to the spinal cord. The internal walls of 5 pedicles were broken of 2 to 4mm, 1 at T1, 1 at T3 and 3 at T4, with varying degrees of spinal cord compression. The internal walls of 2 pedicles were broken of greater than 4mm, 1 at T2 and 1 at T4, with serious spinal cord compression. The external wall of 1 pedicle was broken at T2. Conclusions: The ATPS techniques at T1, T2 and the ARTPS techniques at T3, T4 are feasible, but the safety and clinical practice and further research is needed.

Study on the relationship between single nucleotide polymorphisms of PRKCG gene (rs2547362 and rs3745406) and susceptibility to osteosarcoma in a Chinese Han population / 中华骨科杂志

Objective To investigate the relationship between single nucleotide polymorphisms (SNPs) of PRKCG gene (rs2547362,rs3745406) and osteosarcoma susceptibility in the osteosarcoma patients and the normal population.Methods Sixtyone patients with osteosarcoma who had been admitted in our hospital from January 2011 to December 2012 and 63 healthy adults were enrolled in this study.A 2-ml peripheral blood sample was taken from each participant.The RT-qPCR method was used to detect the genotype and allele frequency distribution of PRKCG gene at rs2547362 and rs3745406 in osteosarcoma patients and normal population.Osteosarcoma patients were divided into several groups according to the clinical parameters such as age,gender,histology,tumor location,Enneking classification,tumor metastasis and therapy,and then we analyzed the relations between the genetic polymorphism and clinical parameters.Results 1) The genotype of PRKCG gene at rs3745406 included CC,CT and TT.The differences of genotypes (CC,CT,TF) and alleles (C,T) frequency distribution at rs3745406 were not statistically significant between osteosarcoma patients and the normal population (P=0.490,P=0.554).2) The genotype of PRKCG gene at rs2547362 included CC,CT and TT.The differences of genotypes (CC,CT,TT) and the alleles(C,T) frequency distribution at rs2547362 were statistically significant between the osteosarcoma patients and the normal population (P=0.006,P=0.007).3) The differences of genotypes (CC,CT,TT) and alleles (C,T) frequency distribution at rs3745406 were statistically significant between patients with metastasis and patients without metastasis (P=0.000,P=0.000).The CT and TT genotypes and the T allele carrier frequency at rs3745406 were higher in patients with metastasis than in patients without metastasis.SNPs at rs2547362 were not associated with clinical parameters.Conclusion The genetic polymorphism of PRKCG gene at rs2547362 is associated with osteosarcoma susceptibility.The TT genotype and T allele at rs3745406 are associated with metastasis of osteosarcoma,which may be a risk factor for metastasis in the osteosarcoma patients.

Custom-made Artificial Total Knee Prosthesis Replacement for Pathological Fracture of Distal Femur Caused by Giant Cell Tumor of Bone / 中国肿瘤临床

Objective: TO evaluate the effect of custom-made artificial total knee prosthesis replacement on pathological fracture of distal femur caused by giant cell tumor of bone. Methods." A total of 12 knees of 12 patients with pathological fracture of distal femur caused by giant cell tumor of bone were treated with cus-tom-made artificial total knee prosthesis replacement. There were 5 males and 7 females aged from 23 to 40 years (34.2 years on average). Results: All patients tolerated surgery very well. The surgical duration was 120～ 180 rain and the intraoperative bleeding was 500 ～ 900mL. The drainage tube was taken out in 5 days after surgery. The postoperative drainage volume was 300 ～ 700mL. There were no postoperative complica-tions. The postoperative X-ray examination showed that all of the prosthesises were in the right position. Lo-cal pain disappeared in all patients after surgery. The pathological examination identified all the patients with giant cell tumor of bone. All patients were followed up for 18 ～ 30 months (24 months on average). No recur-rence was observed after surgery. No infection or implant loosening occurred during the follow up. According to the Enneking assessment system of function after limb salvage surgery, the mean Enneking scale was 23.8 points (ranged from 15 to 28 points) at the last follow-up visit. Conclusion: Custom-made artificial total knee prosthesis replacement can achieve a high satisfactory rate in clearance of lesion and restoring function of the knee in patients with pathological fracture of distal femur caused by giant cell tumor of bone, improving patients' quality of life.

Cathepsin B antisense oligodeoxynucleotide suppresses invasive potential of MG-63 cells / 药物分析学报

Objective To study the biological effects of cathepsin B phosporotbioated antisense oligodeoxynucleotide on human osteosarcoma cell line MG-63 after transfection. Methods A 18-mer phosphorothioate antisense oligodeoxynucleotide (ASODN) targeted against the cathepsin B mRNA was transfected into the human osteosarcoma cell line MG-63 by lipofectamine 2000. The sense and nonsense oligodeoxynucleotides to cathepsin B and blank vector were used as controls. The expression of cathepsin B mRNA was examined by RT-PCR and the expression of cathepsin B was examined by Western blot. The invasive capability of MG-63 cells was evaluated by the boydern chamber assay. Results The expression of cathcpsin B was obviously inhibited in antlsense oligodeoxynucleotide treated cells compared with the control cells. The number of invading MG-63 cells was significantly lower in the ASODN-treated groups than that in the control groups. Conclusion The cathepsin B ASODN significantly inhibits the expression of cathepsin B and invasive ability of MG-63 cell in osteosarcoma.

Implantation techniques for dislocation of atlas-axis joint: Biocompatibility and biomechanics / 中国组织工程研究

BACKGROUND: Gallie, Brooks steel wire, and Halifax vertebral plate clamp are tools for internal fixation of atlas-axis joint. They can keep the flexion-extension stability of atlas-axis joint, but weaken the ability to against lateral bending and rotation. Magerl+Gallie implantation shows good biomechanics stability, but cannot well prevent axial dislocation. OBJECTIVE: To introduce the surgical technique from posterior approach for atlas, and explore the effect on biocompatibility and biomechanics of implants. RETRIEVAL STRATEGY: The articles related to atlas-axis joint dated between January 1970 and June 2007 were retrieved through Pubmed, PML, OVID and Wanfang database using of "atlas, axis, dislocation, fixation, posterior" and "atlas, dislocation, internal fixation, implant, posterior approach, biocompatibility, biomechanics" in Chinese. All collected articles were selected firstly and the articles related to implants, surgical skills, and biomechanics were selected. For articles in identical field, only those published in recently or in authoritative journals were selected. Repetitive articles and Meta analysis were excluded. 127 articles met the criteria and 30 of them were involved. LITERATURE EVALUATION: The articles involved were related to the surgical treatment of dislocation of atlas-axis joint. Of 30 articles, 3 were review articles, 3 were monographs, and the others were clinical or basic researches. DATA SYNTHESIS: ①Lateral mass and pedicle screw implantation techniques can achieve three-dimensional fixation. ②The screw entrance points of atlantoaxial pedicle screw implantation is higher than lateral mass technique, it is unnecessary to expose C1, posterior arch and other deep parts of anatomic structures. C2 nerve root and venous plexus are not separated completely, which reduce injury rate and blood loss. In addition, screw passage of pedicle screw is longer than Harms technique, so screw can completely contact with skeleton to enhance the fixation. CONCLUSION: Atlantoaxial fixation by posterior pedicle screw implantation shows good biomechanics and biocompatibility. It may become the optimal approach for atlantoaxial short segmental fixation.

Effect of different bone graft materials and methods on bone fusion for lumbar spondylolisthesis / 中国组织工程研究

BACKGROUND:The factors to affect spinal fusion are suitable bone graft location,good graft bed,enough bone grafts,strict fixation measure and enough fixation time. However,it is unclear which method should be used between intervertebral bone grafting and intertransverse bone grafting,as well as which material should be used between autogenous iliac bone and autogenous spinous process and vertebral lamina of resection. OBJECTIVE:To compare the fusion rate and improvement of clinical symptoms among different bone graft materials and methods which used in bone fusion for lumbar spondylolisthesis. DESIGN:A control observational experiment. PARTICIP ANTS:A total of 92 patients with lumbar spondylolisthesis who received bone fusion treatment. According to Meyerding classificantion,there were 50 cases of degree Ⅰ,40 cases of degree Ⅱ,1 case of degree Ⅲ,and 1 case of degree Ⅳ. There were 1 case in L3,58 cases in L4,and 33 cases in L5. METHODS:All patients received spinal canal decompression. After reduction and fixation was performed by spondylolisthesis reduction system(SRS) ,bone grafting fusion was performed in all patients. They were divided into four groups:autogenous spinous process and vertebral lamina graft placed between transverse processes group(n=21) ,autogenous spinous process and vertebral lamina graft placed between the vertebral bodies group(n=27) ,autogenous iliac bone graft placed between transverse processes group(n=21) ,autogenous iliac bone graft placed between the vertebral bodies group(n=23) . MAIN OUTCOME MEASURES:The fusion rate and the improvement of clinical symptoms were evaluated according to the X-ray pre and post operative,as well as the JOA score. RESULTS:At 6 months after operation,the fusion rate in the autogenous iliac bone graft placed between the vertebral bodies group were significantly higher than that in the other three groups(P 0.05) . According to the JOA score,at 6,9,and 12 months after operation,there were no differences in the score among the four groups. CONCLUSION:Posterior bone graft fusion of the vertebral body or transverse process using the vertebral lamina,spinous process,or iliac bone as autograft along with internal fixation for lumbar spondylolisthesis are effective. However the use of the iliac bone as autograft contributes to a higher fusion rate in the same method at 6 months. Further using the same material as autograft,the fusion rate of the autograft placed between vertebral bodies is better than that of the autograft placed between transverse processes at 6 months.

Biological characteristics of stemless hip arthroplasty and the recovery of hip joint function in young patients:A follow-up of medium- and short-term outcome / 中国组织工程研究

BACKGROUND: The standardized treatment for patients who require total hip replacement is the implantation of an intramedullary diaphyseal anchored hip prosthesis. A bone-sparing non-stemmed hip prosthesis (NSHP) can be used as an alternative device for young patients. The NSHP relies on proximal femoral metaphyseal and neck fixation. The theoretic advantage of leaving diaphyseal bone intact is easier conversion to a stemmed prosthesis. On the other hand,clinical investigations published reported THR had high loosening rate of the prosthesis, which greatly limits its long-term clinical results; the aim of NSHP is to give the femoral prothesis a kind of biological fixation to decrease the loosening rate of the prosthesis. This retrospective study evaluated the medium- and short-term results after total joint replacement using NSHP.OBJECTIVE: To evaluate the outcome of NSHP for the treatment of young patients with hip disorders.DESIGN: Case analysis.SETTING: Department of Orthopaedics, the First Affiliated Hospital of Guangxi Medical University.PARTICIPANTS: Fifteen patients (17 hips) with hip disorders, who were treated at the Department of Orthopaedics,First Affiliated Hospital of Guangxi Medical University between 2001 and 2005, were retrieved. The involved patients included 8 males and 7 females. They were aged (37.8±9.8) years ranging from 21 to 49 years when they underwent operation. Indications for implantation included avascular necrosis (7 hips), posttraumatic osteoarthritis(4 hips), primary osteoarthritis(3 hips), osteoarthritis secondary to dysplasia(3 hips). Informed consents were obtained from all the patients before operation. The neotype of non-stemmed hip prosthesis (NSHP) was made of Co-Cr-Mo casting alloy with good biocompatibility by Shanghai Fusheng Medical Equipment Co., Ltd (Guoyao guanxie (shi) No. 2002-3040397; Guoshi Yaojianxie(zhun) No. 2005-3460799).METHODS: Fifteen patients (17 hips) with hip diseases subjected to the replacement of total hip with NSHP. Patients were followed-up once every other 6 months in the postoperative first year, then once every year, 5 years in total. The follow-up visit included functional evaluation and X-ray evaluation. ① Functional evaluation: Evaluative criteria of Harris joint function scale were adopted: full marks (point) =100, ≥ 80 excellent, ≥ 60 good, 40 fair and ＜ 40 poor; The following clinical data were documented: relief of pain, ability to lie on the operated side, additional procedures, use of pain medication, postoperative hip dislocations and so on. Pain was evaluated by using visual analogue scale (VAS),which ranged from 0 (no pain) to 10 (worst possible pain). ② X-ray evaluation: A standardized radiographic assessment was performed using an anteroposterior view of the pelvis. The following radiological data were recorded: preoperative grade of osteoarthritis as classified according to the method from Busse et al, preoperative grade of femoral head necrosis as classified according to the method from Ficat et al, inclination angle of the operated and the untreated side,radiolucencies according to the method of Buergi et al, heterotopic ossifications, as classified according to the method of Brooker et al. Postoperative adverse events and complications were observed and revision operation was needed if necessary.MAIN OUTCOME MEASURES: Correlative conditions of patients who were followed up for 5 years: ① Inserting angle of prothesis and the collodiaphyseal angle in the opposite side. ②Radiolucency and heterotopic ossification classification.③preoperative osteoarthritis classification, preoperative avascular necrosis of femoral head classification. ④ Revision operation, adverse events and complications. ⑤ Postoperative functional evaluation: Relief of pain (Harris joint function score), ability to lie on the operated side, additional procedures, use of pain medication, postoperative hip dislocations and VAS results.RESULTS: Fifteen patients were involved. One patient was lost after 3-month treatment and the other patients were followed up for 5 years. ① Postoperative functional evaluation results of patients. In the postoperative 5-year follow-up visit, hip joints of 13 patients (15 hips) were still in situ, pain lessened or disappeared in 11 patients (84.6% ,11/13),12 patients(92.3%, 12/13) would undergo the procedure again, 10 patients (76.9%, 10/13) were able to lie on the operated side; The average of Harris hip score was (72±19.6). The average Harris hip score did not vary significantly between the different diagnosis groups (P ＞ 0.05). Postoperative VAS was 2.6±2.2 on average. There was no significant difference in the hip joint pain among different diagnosis groups (P ＞ 0.05); Nine patients required no pain medication (69.2%,9/13).Two patients (15.4% ,2/13) occasionally took nonsteroidal anti-inflammatory drugs and two patients (15.4% ,2/13) took nonsteroidal anti-inflammatory drugs on a regular basis. ② X-ray evaluation results of patients: Preoperative osteoarthristis classification: One hip had grade 1 joint degeneration, 3 hips had grade 2 joint degeneration and 6 hips had grade 3 degeneration. Preoperative avascular necrosis of femoral head classification: Out of 7 patients with avascularnecrosis of femoral head, 4 patients had stage 3 femoral head necrosis, and 3 patients had stage 4 femoral head necrosis. In the postoperative 5-year follow up, 1 patient had radiolucency. Because the range of radiolucency was very small, progression was not quick and clinical symptoms were not severe, so revision operation was not conducted;In the postoperative 6th month, the inclination angle averaged (135.2±6.8)° on the untreated side and (132.2±6.5)° on the treat side. One patient with congenital hip dysplasia and a previous varus derotational osteotomy had a postoperative inclination angle below 120°. Patients with postoperative inclination angles between 125° and 140° had significantly less hip pain than the rest of the series. Heterotopic ossifications classification: Three patients had postoperative heterotopic ossifications, one hip had grade 1 heterotopic ossification, 1 hip had grade 2 heterotopic ossification, and 1 hip had grade 3 heterotopic ossification.③ Revision operation: one patient (5.9%,1/17)required a revision total hip arthroplasty due to pain. Good bone stock of the proximal femur was found in the patient which allowed implantation of a conventional medullary anchored prosthesis. This revision surgery and postoperative rehabilitation were uncomplicated.④ Adverse events and complications: Hip dislocation occurred postoperatively in one patient (5.9%,1/17). Other complications included trochanter bursitis (n=1), fistula (n =1), and seroma (n =1).CONCLUSION: ① NSHP provides biological fixation for femoral prothesis by bone proliferation through the windows with connective tissues surrounding the prothesis and has the characteristics of low stress and deformation, high intensity and rigidity, and anti-loosening, thus, may prolong its live lime. ②Revision surgeries are facilitated by the good bone stock remaining in the proximal femur. ③ The short- and medium-term therapeutic effects of total hip arthroplasty are satisfying in young patients.

One-stage anterior debridement,allografts and internal fixation for leaping tuberculosis of lumbar vertebrae / 中国矫形外科杂志

[Objective]To assess the efficacy of one-stage allograft fusion and anterior spinal stabilization as an alternative treatment of lumbar leaping tuberculosis.[Methods]Eight patients with lumbar leaping tuberculosis underwent anterior route decompression and fusion.Combined chemotherapy was delivered to each patient at least three weeks before operation.There were 5 men and 3 women ranging in age from 21 to 62 years(average,37.2 years).The involved area included L1 and L3 in 2 patient,L1、2and L4 in 3 patient,L2、3and L5 in 1 patient,L2 and L5 in 2 patients.There were 1 patient with Frankel Grade B,2 with Grade C,1 with Grade D and 4 with Grade E.The kyphosis angle ranged from 5?～40?(average 21.5?).The patients were followed up for 12～24 months.[Results]The patients folerated operation well.The operation time were 120～180 min and the bleeding during operation were 400～900 ml.After surgery,pain reliefed in all patients.One patient in Grade B improved to Grade C,1 patient in Grade C improved to Grade D,1 patient in Grade C improved to Grade E,1 patients in Grade D improved to Grade E.The mean angle of kyphosis correction were 5?～20?(average angle:12.5?).There was no postoperative complication.During the follow-up period,all cases healed without any recurrence.There was no breakage of nails or fall of the internal fixation.Spinal fusion occurred after 4～7 months(average 5.3 months) after operation.[Conclusion]Lumbar leaping tuberculosis treated with this surgical technique can achieve a high satisfactory rate with advantages of restoring the spinal stability,providing early fusion,preventing and correcting progression of the kyphosis.

Anterior debridement and autograft with internal fixation for tuberculosis lesion of the lower cervical spine / 中国矫形外科杂志

[Objective]To assess the efficacy of autograft fusion and anterior spinal stabilization as an alternative treatment for tuberculosis lesion of the lower cervical spine. [Methods]Thirty patients with tuberculosis of the lower cervical spine underwent anterior decompression and fusion.There were 22 male and 8 female with the age from 24 to 58 years(mean age,37 years).The involved area included 2 vertebral bodies in 21 patients,3 vertebral bodies in 9 patients.Combined chemotherapy was delivered to each patient for at least three weeks preoperatively.There were 5 patients with Frankel Grade B,5 with Grade C,13 with Grade D and 7 with Grade E.The mean kyphosis angle were 12?.[Results]The patiets stood surgery well.The operation time was 70～100 min and the bleeding during operation was 50～150ml.There was no postoperative complication.All patients were followed up for 24～36 months.At the last follow-up visit,5 cases with Frankel Grade B improved to Grade D,3 cases with Grade C improved to Grade D,2 cases with Grade C improved to Grade E,13 cases with Grade D improved to Grade E.There was no breakage of nails or failure of the internal fixation during the follow up.Stable bone union was observed in all cases and the average time required for fusion were 6.5 months.[Conclusion]Anterior debridement and autograft with internal fixation is a safe and effective method for treatment of the lower cervical tuberculosis.

Biomechanical study on occipitocervical fusion fixed by metallic-rectangular frame / 中国矫形外科杂志

[Objective]To provide the mechanical evidence of self manufactured metallic-rectangular frame on the reconstruction of the stability of occipitocervical junction.[Method]Seven of the adult cervical spinal specimens which were entire wet-cadavers(from occipitale to C_6) were made to simulate the C_(0～2) fracture dislocation.These of specimens dislocated were fixed by metallic-rectangular frame and Occipito-cervical plate respectively.The three dimensional movements of C_(0～2) were recorded through photogrametry with a pure moment of 1.53 Nm.The range of motion(ROM) of each specimens in two fixation was caculated.[Result]Loaded by 1.53Nm,In metallic-rectangular frame fixation,the ROM in flexion,extension,lateral bending and axial rotation were 5.9?、7.7?、5.6?、11.2? respectively,decreased by 157.6%、68.8%、58.9%、131.3%,compared with occipitocervical plate fixation group.[Conclusion]Metallic-retangular frame fixation can reconstruct the stability of Occipitocervical junction immediatey,and is a relativity effective internal fixation for occipitocervical fusion.

On relationship between intraoperative findings during joint replacement and clinical manifestations in elderly patients with knee osteoarthritis / 中国微创外科杂志

Objective To study the relationship between intraoperative findings during knee joint replacement and clinical manifestations in elderly patients with knee osteoarthritis.Methods A total of 150 cases of senile knee osteoarthritis(182 knee joints) was selected for total knee replacement.Their X-ray examination results were gathered for recording the impairment of the articular surface,the joint space narrowing,and the location and amount of osteophytes.An MRI examination was performed in some of the cases for recording changes of fibrocartilage and locations of meniscus.Results Out of the 150 cases,there were 108 cases of genu varum(mean inversion angle,12.5?;range,0?~25?),21 cases of genu valgum(mean eversion angle,18.3?;range,15?~25?),and 21 cases of flexion contracture (mean angle,15.3?;range,0?~40?).The X-ray findings showed varying degrees of joint space narrowing in all the 150 cases,and osteophytes on the posterior border or at lateral part of the knee joint in 131 cases(152 joints).MRI examinations were performed in 11 cases(15 joints),in which discontinuous,cystoid,and worn-out fibrocartilages were seen.Radial displacement of the meniscus was found.Intraoperative findings proved that the fibrocartilage on the articular surface on the side with joint space narrowing was severely worn away,the collateral ligaments were contracted,the osteophytes were seen at the posterior part of the tibia and the femur,and abrasion or radial displacement of the meniscus on the side with joint space narrowing.Conclusions Joint space narrowing,varus or valgus deformity,osteophytes,and radial displacement of the meniscus are usually found in aged patients with knee osteoarthritis.

Application of prolem-based learning(PBL)in clinical practice of bone surgery / 中华医学教育探索杂志

Objective To discuss the teaching effects of PBL teaching mode applied in clinical practice of bone surgery.Methods Through clinical practice of bone surgery with the PBL teaching mode and the traditional one,a contrast between two teaching modes was made,and the teaching results were investigated base on the questionair.Results The PBL teaching mode is superior to the traditional one.Conclusion The PBL teaching mode has an obvious advantage in the teaching of clinical practice of bone surgery and can improve the teaching quality.

Repair of experimental defects of articular cartilage in rabbits with homografts of fibrin sealant and embryonic chondrocytes / 中国组织工程研究

BACKGROUND:Research about the repair of articular cartilage with heterograft chondrocytes is frequently reported, but the method may cause immune rejection. Since the embryonic cells possess lower antigenicity and stronger proliferation capability, it is hoped that they can be used as a novel carrier substitute in tissue engineering research.DESIGN: A randomized grouping observation and comparative experiment.SETTING: Histological Embryonic Laboratory in Guangxi Medical University.MATERIALS: A big white adult New Zealand rabbit pregnant for 4 weeks was adopted; and another 24 big white adult New Zealand rabbits were selected, with no limitationin whether they were female or male and with a body mass of 2 to 2.5 kg.METHODS: This experiment was carried out at the Histological Embryonic Laboratory in Guangxi Medical University between December 2000and June 2002. The models of defects in articular cartilage were made artificially in femur medial malleolus of the mature rabbits. In the experimental group, defects were repaired by the implantation of Fibrin Sealant and embryonic chondrocytes mixture, but for the control group, only Fibrin Sealant was implanted or nothing was done about the defect. The restoration of articular cartilage defect was then observed 4,8 and 12 weeks after the operation, and was scored according to modified Pineda's method. The standard consists of 5 items, I.e., cellular morphology, matrix staining, surfacing smoothness, cartilage thickness and host union. 0 refers to normal and the higher the score is, the more serious the pathological changes are.MAIN OUTCOME MEASURES: ①The general observation of rabbit knee joint; ② Histological observation of rabbit knee joints; ③ Histological semi-quantitative score of articular cartilage; ④ Appraisal of the curative effect of articular cartilage defects.RESULTS: Totally 24 rabbits were enrolled in this experiment and all entered the stage of result analysis. ① The general observation of rabbit knee joint: In embryonic chondrocytes plus fibrin sealant group, the color in defect area was basically the same as that of the normal cartilage, showing a strong quality and better elasticity with the boundaries from the surrounding cartilage approximately vanishing. In Fibrin sealant group and the control group, the defect did not heal completely, but the defect area became small and filled with white fibrous tissues. ② Histological observation of rabbit knee joints: In embryonic chondrocytes plus fibrin sealant group,tissues were predominated by hyaline cartilage, with bone tissues appearing in deeper position, and the surface was slightly raised or smooth, and the matrix showed normal staining, and were completely united with the surrounding cartilage and the division line was not clear. There was no lymphocyte infiltration in the tissues. In Fibrin sealant group and the control group, tissues were predominantly fibrous tissues, and part of them showed obvious residual hollow scar, connecting or partly connecting with the surrounding tissues. ③ Histological semi-quantitative score of articular cartilage: According to modified Pineda's method, the scores of embryonic chondrocytes plus fibrin sealant group after 12 weeks were obviously lower than those of the fibrin sealant group and the control group [(0.50±0.76) vs (7.88±1.13), (8.13±1.36), P ＜ 0.05]; moreover, the difference between pure fibrin sealant group and the control group was of statistical significance 4weeks after the operation (P ＜ 0.05), but there was no obvious difference 8and 12 weeks after the operation. ④Appraisal of the curative effect of articular cartilage defects: 12 weeks after the operation, in the embryonic chondrocytes plus fibrin sealant group, the defect of 8 cases healed completely. In fibrin sealant group 1 case healed but not completely, and 7cases did not get repaired for their defect. In the control group, 8 cases failed to get their defect repaired.CONCLUSION: The repaired tissues in embryonic chondrocytes trans plantation group were basically the same as normal cartilage, obviously superior to the fibrin sealant group and the control group, suggesting that such method is feasible in the repair of articular cartilage defects.

Surgical treatment of stale acetabular fracture through combined approaches / 中华创伤骨科杂志

Objective To summarize the surgical techniques to treat complex stale acetabular fractures through combined approaches. Methods From February 1993 to September 2005, 21 cases (12 males, 9 females, mean age of 33 years old) of complex stale acetabular fracture were treated with open reduction and internal fixation through combined approaches (K- L+ ilio- inguinal). Of the 21 fractures, 3 were transverse and posterior wall ones, 4 T- shaped ones, 11 both column ones, and 3 hemi- transverse and anterior column ones. Results 12 cases (57.1% ) got anatomic reduction, 5 cases satisfactory reduction (23.8% ), but 4 cases unsatisfactory reduction (19.1% ). The rates of anatomic reduction for the early 6 years and for the latest 6 years in this study were 44.4% and 66.7% respectively. 15 cases were followed up for 2 to 12 years. The excellent and good rate for clinical and roentgenographic results were 65.3% and 67.2% respectively. The clinical results for anatomic and non- anatomic reduction groups were 78.6% and 32.8% respectively (P

Clinal anatomy and significance of anterior surgical approach to upper thoracic spine / 中华骨科杂志

Objective To investigate the anatomic relationship between the upper thoracic vertebrae and adjacent structures in anterior approach of upper thoracic spine, an anatomy study was conducted and its clinical significance was evaluated. Methods Twenty upper thoracic spine specimens of adult human cadaver were exposed, measured and studied for their anatomic landmarks. The origin, course of the recurrent laryngeal nerve, thoracic duct and blood vessels and their relationship were measured and analyzed. The advantages and disadvantages of different surgical approaches exposing the upper thoracic vertebrae were also evaluated and compared. Results The right recurrent laryngeal nerve reaches the tracheo-esophageal groove at the level of C6-7 disc in 55% of the specimens and derives from vagus nerve at the level of T1,2. The thoracic duct empties into the systemic venous system from T1 to T1-2 disc space in 75% of the specimens and among them, more than 50% up to T1 level. The left brachiocephalic vein is at T3 in 55% of the specimens; and the aortic arch is at T3-4 disc in 80% of the specimens. The anterior aspect of T3 can be easily exposed through a modified anterior approach to the upper thoracic vertebrae in only 45% of the specimens(9), compared with outside space of the brachiocephalic trunk(between the right brachiocephalic vein and the brachiocephalic trunk and left brachiocephalic vein) in 95% of the specimens (19). Conclusion Surgical approach through outside space of the brachiocephalic trunk is simple and adequate to expose the T3,4 vertebra body and can get more exposed space of 0.5-1 of the vertebra body than through inner space of the brachiocephalic trunk and can be utilized selectively during anterior upper thoracic spine surgery. Attention should be paid to avoid injury of vagus nerve in the middle, right recurrent laryngeal nerve on the right and thoracic duct on the left, respectively.