Systemic Lupus Erythematosus Complicated with Femoral Head Ischemic Necrosis Treated by Chinese Medicine Therapy for Activating Blood and Dredging Collaterals Method

Objective：To observe the effect and mechanism of Chinese medicine therapy for activating blood and dredging collaterals（ABDC） on treating systemic lupus erythematosus complicated with avascular necrosis of the femoral head（SLE-ANFH）.Methods：Thirty-four patients（51 joints） with SLE-ANFH were assigned by a random number table to two groups：22 patients（32 joints） in the treatment group and 12 patients （19 joints） in the control group.All received Western medical conventional treatment for anti-inflammation and immunosuppression,but an additional Chinese medicine decoction prescribed based on ABDC principle was administered to patients in the treatment group.The observation on the patients＇ condition and therapeutic effect lasted for 3 years.Results：The patients＇ conditions in the two groups,as assessed by Association for Research Circulation Osseous（ARCO） staging,were similar before treatment.After treatment,comparison between groups showed significant difference（P0.05）,and the raised Harris functional scores in the treatment group were higher than that in the control group（P0.01）.The post-treatment symptom improving rate in the treated group was 72.73%,which was higher than that in the control group（50.00%,P0.05）.Moreover,the former was superior in improving hematologic and hemorrheologic parameters in terms of prolonging activated partial thromboplastin time,lowering whole blood middle/low shear viscosity,and plasma viscosity（P0.05 or P0.01）. Two patients in the control group but none in the treatment group received hip joint replacement operation during the observation period.Conclusions：Chinese medicine ABDC therapy could effectively alleviate clinical symptoms and improve joint function of patients with SLE-ANFH.The mechanism may be related to its effects on improving high coagulation manner and trend for getting embolism.

TREATMENT OF ISCHEMIC NECROSIS OF FEMORAL HEAD BY THE FREE TRANSFERRING FIBULAR BONE GRAFT WITH VASCULAR PEDICLE IN ADULTS：A

cases (97 hips) with avascular necrosis of femoral head caused by variors factors treated by the free transferring fibular graft with vascular pedicle in the Second Teaching Hospital of Xi'an Medical University are reported. All patients have ben followed up for 2 to 11 years. Excellent and good rate of operative results was 86. 6%. A long observation indicated that this procedure was superior to the other operations for the osteonecrosis of femoral head. Successful interim and final operative results can warrant its continued use in management of this kind of patients.

Flaps for bulbar urethral ischemic necrosis in pelvic fracture urethral injury

Bulbar urethral ischemic necrosis(BUIN)is an iatrogenic entity resulting from repeated attempts at performing anastomotic urethroplasty for pelvic fracture urethral injuries.Etiologically speaking,BUIN is related to a compromised blood supply of the bulbar urethra,which normally relies on anterograde supply from bulbar arteries and retrograde supply from recurrent branches of dorsal penile arteries,through the glans.At each transection of the bulbar urethra,both the anterograde and retrograde supplies are compromised,increasing the risk of BUIN.Even though this term is widely used among reconstructive urologists,BUIN is orphan of an accepted scientific definition.We aim to report our personal perspective on BUIN,to identify factors associated with its occurrence,and to describe the management options in these patients.