RESUMO
BACKGROUND: Anterior and lateral columns of the femoral head integrity and stability have been reported to present a positive correlation with the prognosis of the osteonecrosis of the femoral head (ONFH) and efficacy of hip preserving. China-Japan Friendship Hospital Classification stressed that the retention of the anterior and lateral columns of the femoral head was of great importance to avoid the femoral head collapse, but there is little reported on its three-dimensional (3D) digital model.OBJECTIVE: To explore the method of establishing highly-simulated 3D model of China-Japan Friendship Hospital Classification for ONFH.METHODS: 3D reconstruction of normal and necrotic femoral head was established according to the CT and MRI of individuals with normal femoral head. A healthy adult male volunteer was selected and his CT image was collected; three adult male patients with types L1, L2 and L3 ONFH were selected, whose MRI images were obtained, respectively. 3D solid models were established based on CT and MRI data on Mimics 15.0, Geomagic Studio 13, Geomagic Design X, Solidworks2014 and Abauqus6.14 software. RESULTS AND CONCLUSION: A highly-simulated 3D model of L type ONFH was established, including the corticaland cancellous bones of ilium and proximal femur, articular cartilage, necrotic articular cartilage, muscles, joint capsuleand ligaments. It clearly showed the spatial structures of L type ONFH, by which different surgical programs could be compared in a virtual environment for selecting an appropriate treatment strategy to improve the success rate of hip preserving. The highly-simulated 3D model paves ways for surgical simulation and biomechanical analysis.
RESUMO
BACKGROUND: Fibular fixation and tantalum rod implantation are two commonly used methods for the treatment of early osteonecrosis of the femoral head (ONFH), both of which can effectively delay or even reverse the progress of ONFH. However, further comparative evaluation on their mechanical properties and therapeutic efficacy is required.OBJECTIVE: To compare the clinical efficacy of fibular fixation and tantalum rod implantation on ONFH at early stage.METHODS: Fifty-eight patients (81 hips) suffered from ONFH with ARCO stage 1 and stage 2, and underwent fibular fixation (30 cases, 41 hips) or tantalum rod implantation (28 cases, 40 hips). Postoperatively, both groups were followed up for over 2 years. The Harris scores of the hip were compared between two groups before and after treatment. With femoral head collapse and the collapse distance > 4 mm as observation points, the survival rate of the femoral head was compared between two groups.RESULTS AND CONCLUSION: The postoperative Harris scores of the two groups were significantly improved than before (P 4 mm collapse as the observation point, the Kaplan-Meier survival curve showed that overall survival rate of the hip was 95% in the fibular fixation group and 83% in the tantalum rod implantation group. After examined by log-rank (Mantel-Cox), there was a significant difference in the survival rate of the hip at Stage IIC between two groups (P=0.0418). To conclude, both fibular fixation and tantalum rods implantation applied to ONFH at early stage can effectively improve the hip function, and the survival rate of the hip at ARCO Stage IIC is better in patients undergoing fibular fixation than tantalum rod implantation.
RESUMO
BACKGROUND:Bone marrow mesenchymal stem cells have the potential of self-proliferation and multi-directional differentiation, while mesenchymal stem cells are few in adult bone marrow. In vitro purification, amplification and osteoinduction are very important for the research of bone tissue engineering. OBJECTIVE:To establish a simple and reliable in vitro cultivation and identification system of adult bone marrow mesenchymal stem cells, and to induce the mesenchymal stem cells to differentiate into osteoblasts. METHODS:Bone marrow were extracted from adult anterior superior iliac, the density gradient centrifugation and adhesion method were used to isolate, purify, culture and amplify the bone marrow mesenchymal stem cells. Osteogenic medium was prepared by mixing appropriate amount of dexamethasone,β-glycerophosphate and ascorbic acid C. The cells were divided into osteoinduction group and blank control group for observation. RESULTS AND CONCLUSION:Adult bone marrow mesenchymal stem cells were in typical long spindle-shape. The cells grew into rapid proliferation phase at 8-11 days and the growth curve was S-shape. CD44 and CD90 were in positive expression, while CD34 and CD45 were negative. The alkaline phosphatase activity was increased with culturing time prolonging, and reached the summit at the 12th day. The alkaline phosphatase activities of osteoinduction group were higher than those in the blank control group at different time points. These results suggested that in vitro cultivation, identification and osteoinduction system could obtain mesenchymal stem cells with high purity and good osteogenic differentiation capacity.