A Radiographic Evaluation of Short Monolithic Femoral Hip Stem (SMF) for Dysplastic Osteoarthritis: Does Stem Alignment Influence on the Stability?

Background: There have been a few reports of SMFTM stem for dysplastic hips. The aim of this study is to evaluate the influence of stem alignment in dysplastic femurs on the stability of the implants and on the bone reaction by means of consecutive radiographical analysis. Methods: The preoperative diagnosis is dysplastic osteoarthritis in all patients. Twenty-nine hips in 28 patients after MIS-THA were followed up for two or more years (3.5 years in average). The average age at the surgery was 60. Those who belonged to Crowe’s classification I were 19 and those of II were 10 hips. The shape of the femur was classified as Dorr’s Type A in 5, B in 21, and C in 3 hips. Results: The varus alignment of the stem was 21 hips and non-varus was 8 hips. Crowe’s Grade did not have influence on the stem alignment. The ratio of non-varus alignment was more with Dorr’s Type C than with others. Achieving rate of mediolateral fixation was significantly higher in the varus alignment than in non-varus. The significant subsidence occurred in 3 hips (10.3%) although all stems became stable within 6 months. No revision was necessary. Conclusion: The varus insertion of the stem seemed more secure also in dysplastic femurs, but even non-varus ones seemed acceptable as they brought about no severe problem. Comprehensively evaluating the result, careful selection of the patient is essential to take the advantage of and to overcome the disadvantage of this short stem for dysplastic hips.

Comparison of fatigue behaviour of eight different hip stems: a numerical and experimental study

In this study, finite element analysis was used to investigate the fatigue behavior of eight different hip stems. All of the prostheses investigated in the analysis are already being used in Turkish orthopaedic surgery. All stems were compared with each other in terms of fatigue, deformation and safety factors. Primary analysis was applied on three of the stems, which were tested experimentally. It was observed that the simulation and the experimental results are in good agreement with each other. After determining the reliability of the numerical method, the analysis was applied on all other stems. To obtain a more realistic simulation, boundary conditions were applied according to standards specified in the ISO 7206-4 standard. Three different types of materials were selected during analysis. These materials were Ti-6Al-4V, cobalt chrome alloy and 316L. Minimum fatigue cycles, critical fatigue areas, stresses and safety factor values have been identified. The results obtained from the finite element analysis showed that all stems were safe enough in terms of fatigue life. As a result of fatigue analysis, all stems have been found to be successful, but some of them were found to be better than the others in terms of safety factor. The current study has also demonstrated that analysing hip stems with the finite element method (FEM) can be applied with confidence to support standard fatigue testing and used as an alternative. Further studies can expand the simulations to the clinical relevance due to complex physical relevance.

Cemented Müller straight stem total hip replacement:18 year survival,clinical and radiological outcomes

AIM: To present the 18 year survival and the clinical and radiological outcomes of the Müller straight stem, cemented, total hip arthroplasty(THA).METHODS: Between 1989 and 2007, 176 primary total hip arthroplasties in 164 consecutive patients were performed in our institution by the senior author. All patients received a Müller cemented straight stem and a cemented polyethylene liner. The mean age of the patients was 62 years(45-78). The diagnosis was primary osteoarthritis in 151 hips, dysplasia of the hip in 12 and subcapital fracture of the femur in 13. Following discharge, serial follow-up consisted of clinical evaluation based on the Harris Hip Score and radiological assessment. The survival of the prosthesis using revision for any reason as an end-point was calculated by KaplanMeier analysis.RESULTS: Twenty-four(15%) patients died during the follow-up study, 6(4%) patients were lost, while the remaining 134 patients(141 hips) were followedup for a mean of 10 years(3-18 years). HSS score at the latest follow-up revealed that 84 hips(59.5%) had excellent results, 30(22.2%) good, 11(7.8%) fair and 9(6.3%) poor. There were 3 acetabular revisions due to aseptic loosening. Six(4.2%) stems were diagnosed as having radiographic definitive loosening; however, only 1 was revised. 30% of the surviving stems showed no radiological changes of radiolucency, while 70% showed some changes. Survival of the prosthesis for any reason was 96% at 10 years and 81% at 18 years. CONCLUSION: The 18 year survival of the Müller straight stem, cemented THA is comparable to those of other successful cemented systems.

Changes in Femoral Stem Geometry Reduce Intraoperative Femoral Fracture Rates in Total Hip Replacement

Intraoperative fracture rates in total hip arthroplasty (THA) have been associated with uncemented stems, anterolateral surgical approach, diagnoses other than osteoarthritis, and female gender. The purpose of this study was to investigate if changes in stem design would influence intraoperative fracture rates. 1497 THA with Bi-Metric stems were compared to 1277 THA with Echo Bi-Metric Full Proximal Profile stems and 366 THA with Echo Bi-Metric Reduced Proximal Profile stems. The intraoperative fractures rates were 5.48%, 1.41% and 1.37% for Bi-Metric and Echo Bi-Metric with standard and reduced proximal geometry stems, respectively. Stem survivorship with aseptic loosening as an endpoint was 100% in all cohorts at the final follow-up. We conclude that changes in femoral stem geometry in uncemented THA reduce intraoperative fracture rates while preserving fixation.

Bond strength analysis of the bone cement-stem interface of hip arthroplasties

Objective:To study and establish the preliminary linear and modified models for the interface shear mechanics performance between implant and bone cement and to explore its damage significantce.Method:The loosening research between artificial hip joint prosthesis stem and bone cement interface performance can be evaluated by the push-in test.Based on the debondittg perforntance test,the analytical expressions of the average load and displacement from the debottdiftg failure and splitting failure process were deduced and determined.The correlations of the expressions of the average load-displacement and statistical experimental data were analyzed.Results:It demonstrated that the interface debonding failure mechanical model could be characterisied as interface bond strength mechanical performance.Based on analysis of models and experimental data by the three statistical analysis methods,the results indicated the modified model could be better represented by the interfacial debonding strength properties.The bond stress(?)and relative sliding s distribution along the embedment regional were coupling affected by both pressure arch effect and shear lag effect in bone cement.Two stress peaks of implant have been found at the distance from 0.175L_0 loading tip to 0.325L_0 free tip,which also verified the early loosening clinical reports for the proximal and latter region.As the bone cement arch effect,the bond stress peak tend to move to the free tip when the debonding failure would be changed into the splitting failure,which presents a preliminary study on the mechanism of early delmnding failure for the stem-cement interface.Conclusions:Functional models of the stembone cement interfacial debonding failure are developed lo analyze the relevant mechanism.The different lotcational titanium alloy stress,and the interfacial bond stress and the relative slides are evaluated to acquire a guide of the different positions of interfacial damage.The coupling;effect which is original from the pressure arch and the interfacial shear hysteresis cumulative effect has influence on the interfacial debonding and damage process.

Intraoperative Fracture of the Femur in Revision Total Hip Arthroplasty with a Fully HA-Coated Stem

A retrospective review was made of intraoperative femoral fracture prevalence in seventy nine consecutive, cementless, fully HA-coated stems used for revision hip arthroplasty. Three patients were lost to follow up. Intraoperative fracture occurred in 15 (20%) femurs. Fractures occurred during cement removal (3/15) or insertion of the implant (12/15). All fractures were identified using intraoperative biplane X-ray, and were treated during the same operation. The clinical outcome of both groups (with or without fractures) was similar. The risk of intraoperative fracture was not statistically related to any demographic features or operative technique. Intraoperative radiographs are therefore mandatory in revision hip arthroplasty in order to diagnose and treat the common complication of femur fracture appropriately.

外侧入路和后外侧入路生物型长柄假体人工髋关节置换术治疗股骨转子间不稳定性骨折的效果对比

目的:探究不同入路生物型长柄假体人工髋关节置换术(THA)的疗效对比。方法:选择104例股骨转子间不稳定性骨折患者为研究对象,患者均行生物型长柄假体THA术治疗。根据患者手术入路的不同分为外侧组(n=48)与后外侧组(n=56)。比较两组患者围手术期指标、并发症发生情况、手术前、术后2 d及6个月Harris、Aubigné-Postel评分。结果:后外侧组围手术期指标均低于外侧组(P<0.05);两组手术并发症总发生率差异无统计学意义(P>0.05);术后2 d、6个月,两组髋关节评分均上升(P<0.05),且后外侧组术后各时间点Harris评分均高于外侧组(P<0.05);后外侧组优良率(85.71%)与外侧组(75.00%)比较,差异无统计学意义(P>0.05)。结论:外侧入路与后外侧入路生物型长柄假体THA术均能治疗股骨转子间不稳定性骨折,但后外侧组疗效更好,并发症更少,值得推广。

不同方法治疗老年股骨转子间不稳定骨折疗效对比

目的对比分析生物型加长柄关节置换与股骨近端防旋髓内钉内固定治疗老年股骨转子间不稳定骨折的临床效果。方法选取2019年6月至2021年6月安阳市第三人民医院收治的104例老年股骨转子间不稳定骨折患者作为研究对象,根据不同手术治疗方式将其分为置换组(52例)和固定组(52例),置换组患者采用生物型加长柄关节置换术治疗,固定组患者采用股骨近端防旋髓内钉内固定术治疗,对比观察两组患者围术期相关指标、髋关节恢复情况、生活质量及术后不良事件发生情况。结果置换组患者术中出血量明显多于固定组、手术时间明显长于固定组(t=5545、5150,P均<0001),而首次下床活动时间及住院时间与固定组无明显差异(t=1933、1619,P=0056、0109)。术后12个月,置换组患者髋关节恢复优良率为8077%,明显高于固定组患者的髋关节恢复优良率6154%(χ^(2)=4685,P=0030);置换组患者健康调查量表36(SF-36)中的躯体功能、躯体疼痛、总体健康、生理功能评分均明显高于固定组(t=3062、2868、3028、3440,P=0003、0005、0003、0001)。置换组患者术后不良事件发生率为577%,明显低于固定组患者的术后不良事件发生率2115%(χ^(2)=5283,P=0022)。结论与股骨近端防旋髓内钉内固定相比,生物型加长柄关节置换虽会增加老年股骨转子间不稳定骨折患者术中出血量,延长手术时间,但能够提高患者髋关节功能及生活质量,降低不良事件发生风险,临床效果更佳。

基于绝经后女性股骨样本的骨髓造血干细胞自噬与骨质疏松相关性研究

目的通过绝经后女性髋部骨折手术抽取分离获得骨髓造血干细胞,研究造血干细胞自噬与骨质疏松相关性。方法19例绝经后女性患者于髋部骨折手术中抽取骨髓,根据股骨颈、腰椎骨密度将患者分为骨质疏松组(n=13)和非骨质疏松组(n=6)。流式细胞术分选获得造血干细胞。成像流式细胞术检测两组造血干细胞自噬功能。反转录PCR(reverse transcription PCR,RT-PCR)检测两组骨髓造血干细胞自噬相关基因Atg7、LC3b、LAMP2a、P62、Atg5、Atg12表达。使用卵巢去势骨质疏松小鼠模型骨髓分选获得造血干细胞,RT-PCR检测造血干细胞自噬相关基因Atg7、LC3b、LAMP2a、P62、Atg5、Atg12表达。通过Western blot检测小鼠自噬相关蛋白表达。探究细胞自噬异常后血管内皮生长因子A(vascular endothelial growth factor A,VEGF-A)表达。结果骨质疏松患者骨髓造血干细胞自噬受抑制,自噬相关基因Atg7、LC3b、LAMP2a、P62、Atg5、Atg12表达下调(P<0.05)。小鼠骨质疏松组ATG7、BECLIN1、LC3-Ⅰ/LC3-Ⅱ蛋白表达受抑制。卵巢去势骨质疏松小鼠模型骨髓造血干细胞自噬相关基因Atg7、LC3b、LAMP2a、P62、Atg5、Atg12表达受抑制(P<0.05),细胞自噬被抑制后VEGF-A表达下降。结论骨髓造血干细胞自噬受抑制与骨质疏松有相关性。

骨小梁髋假体柄植入的应力分析

目的:分析髋关节置换中实心钛合金假体与骨小梁假体柄植入的应力。方法:基于Mimics软件逆向建立股骨模型,并使用Geomagic软件对股骨模型进行优化,再通过SolidWorks软件将模型实体化。将截骨后的股骨与金属股骨柄进行装配,并将装配好的模型导入ABAQUS中进行有限元计算。将股骨上部分为内侧近端点(小转子区)、外侧近端(大转子区)、股骨干近端点(茎突中段周围)、远端区域(茎突末端周围和远端)4个区域(处于不同整合状态),计算步态、爬楼梯载荷下植入实心钛合金假体和骨小梁假体前后的股骨应力以及区域未整合时的界面应力,并通过应力椭球分析骨界面的变形类型。结果:在小转子区,步态和爬楼梯载荷下骨小梁假体相比实心钛合金假体应力屏蔽率分别降低了20.5%和14.7%。实心钛合金假体存在不同整合状态时,步态与爬楼梯载荷下界面拉应力最大分别为10.842、12.900 MPa,剪应力最大分别为7.050、6.805 MPa;而骨小梁假体存在不同整合状态时,步态与爬楼梯载荷下界面拉应力最大分别为3.858、4.389 MPa,剪应力最大分别为4.156、3.854 MPa。2种不同载荷下,界面内侧剪应力椭球开口朝向两侧,骨界面发生拉伸变形;界面外侧剪应力椭球上下开口,发生压缩变形。结论:全髋关节置换术后,骨小梁假体的整体性能优于实心钛合金假体,且假体-骨界面未整合边缘易发生应力集中以及变形,引发进一步失效。

生物型加长柄半髋关节置换术对老年股骨粗隆间骨折患者HHS及并发症的影响

目的:探讨生物型加长柄半髋关节置换术对老年股骨粗隆间骨折患者Harris髋关节评分(HHS)及并发症的影响。方法:选取2022年1月—2023年1月景德镇市第一人民医院收治的老年股骨粗隆间骨折患者94例,采用随机数字表法分为两组,各47例。对照组实施骨水泥型加长柄半髋关节置换术治疗,观察组实施生物型加长柄半髋关节置换术治疗。比较两组围手术期指标(手术时间、总失血量、住院时间、术后次日扶患者下地负重站立时间、术后引流量)、HHS、骨密度、并发症发生情况。结果:观察组手术时间、骨折愈合时间均较对照组短,术后次日扶患者下地负重站立时间早于对照组,总失血量及术后引流量均较对照组多,差异均有统计学意义(P<0.05)。两组HHS的时点、组间、交互作用比较,差异均有统计学意义(P<0.05);两组术前HHS比较,差异无统计学意义(P>0.05);观察组术后各时点HHS均高于对照组(P<0.05);两组术后各时点均较术前升高,差异均有统计学意义(P<0.05),术后3个月均较术后6周升高,差异均有统计学意义(P<0.05),术后6个月均较术后3个月升高,差异均有统计学意义(P<0.05)。两组各部位骨密度时点、组间比较,差异均有统计学意义(P<0.05);两组术前比较,差异均无统计学意义(P>0.05),观察组术后各时点均高于对照组,差异均有统计学意义(P<0.05);两组术后各时点均较术前升高,差异均有统计学意义(P<0.05),术后3个月均较术后6周升高,差异均有统计学意义(P<0.05),术后6个月均较术后3个月升高,差异均有统计学意义(P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:生物型加长柄半髋关节置换术可缩短老年股骨粗隆间骨折患者手术时间,促进患者术后恢复,改善患者髋关节功能及骨密度,降低并发症发生风险,但该术式也存在失血量及术后引流量较多的问题。

股骨近端防旋髓内钉内固定术和加长柄人工髋关节置换术治疗老年股骨转子间骨折的效果分析

目的:分析股骨近端防旋髓内钉(PFNA)内固定术和加长柄人工髋关节置换术治疗老年股骨转子间骨折患者的临床效果。方法:选取2021年1月—2023年5月微山县人民医院骨科收治的老年股骨转子间骨折患者60例作为研究对象,按照随机数字表法分为对照组和研究组,各30例。对照组实施PFNA内固定术,研究组实施加长柄人工髋关节置换术。比较两组手术情况、术后恢复时间、不良事件发生情况、髋关节功能。结果:研究组手术时间长于对照组,术中出血量大于对照组,差异有统计学意义(P<0.001)。两组术后首次下床时间、骨折愈合时间及住院时间比较,差异无统计学意义(P>0.05)。两组术后不良事件发生率比较,差异无统计学意义(P>0.05)。术前,两组髋关节功能评分量表(Harris)评分比较,差异无统计学意义(P>0.05);术后3个月,两组Harris评分均高于术前,且研究组高于对照组,差异有统计学意义(P<0.001)。结论:PFNA内固定术和加长柄人工髋关节置换术治疗老年股骨转子间骨折的效果均较好,选择PFNA内固定术能够缩短手术时间、减少术中出血量,选择加长柄人工髋关节置换术能够促进患者髋关节功能恢复,建议临床根据患者需求选择手术治疗方式。

防旋型股骨近端髓内钉与加长柄生物型人工关节置换术治疗老年股骨粗隆间骨折的疗效对比

目的探讨防旋型股骨近端髓内钉(PFNA)与加长柄生物型人工关节置换术治疗老年股骨粗隆间骨折(IFF)的临床疗效及对骨愈合速度、髓鞘碱性蛋白(MBP)、髋关节功能(Harris)评分的影响。方法选取2018年1月至2022年5月九江一七一医院收治的82例老年IFF患者作为研究对象,按照随机数字表法分为对照组与观察组,每组42例。对照组行PFNA内固定术治疗,观察组行加长柄生物型人工关节置换术治疗,比较两组手术情况、临床疗效、MBP水平、Harris评分及手术安全性。结果观察组手术时间长于对照组,术中出血量多于对照组,住院时间、骨折愈合时间均短于对照组,差异有统计学意义(P<0.05)。观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。术后,两组疼痛、功能及活动范围评分均高于术前,且观察组高于对照组,差异有统计学意义(P<0.05)。术后,两组血清MBP水平均低于术前,且观察组低于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论PFNA与加长柄人工关节置换术治疗老年股骨粗隆间骨折各有优势,虽然加长柄生物型人工关节置换术治疗老年IFF患者的手术时间较长,但手术效果更佳,可更有效地促进患者骨愈合及功能恢复,抑制MBP释放,并减轻患者疼痛,手术安全性高,值得临床推广应用。

A Biomimetic Hip Joint Simulator and its Application in in vitro Study of the Integrity of Replacement Cemented Hip

A biomimetic hip joint simulator that can be used to evaluate the outcome of the cemented total hip replacement has been designed, manufactured and evaluated. The simulator produces motion in the extension/flexion plane, with a socket to rotate internal/externally. At the same time a dynamic loading cycle is applied. A validation test was performed on a cemented femoral stem within a novel composite femur. The hone quality has a strong effect on the stem migration and on the integrity of the interfaces. The migration of the stem is a combination of 3-D translation and rotation of the stem. Under the same loading conditions, weak bone allows more stem migration than strong bone. There is a great decrease in the strength of the stem-cement interface after the dynamic test, and the weak bone composite exhibited a greater reduction in interfacial strength than the strong bone composite. The decrease of the interfacial strength indicates that the primary bonding between the stem and the cement mantle had deteriorated and the integrity of stem-cement interface was damaged. The study demonstrates the value of using a hip joint simulator to investigate stem migration and interface integrity within the cemented hip replacement, suggesting that method can be used for in vitro evaluation of the biomaterials used in the cemented hip replacements.

自体骨髓间充质干细胞移植在老年股骨头坏死髓芯减压术中的应用价值

目的观察自体骨髓间充质干细胞(BMSCs)移植在老年股骨头坏死(ONFH)髓芯减压术中的应用效果。方法该研究为前瞻性研究,选择平顶山市第一人民医院2022年1月至2023年5月收治的113例ONFH老年患者为研究对象,以计算机随机分组法将其分为试验组(57例)和对照组(56例),对照组予以传统髓芯减压术治疗,试验组经自体BMSCs移植联合髓芯减压术治疗,比较两组治疗前后的BMSCs表面分子、骨代谢水平、骨密度、骨坏死面积、髋关节功能及疼痛症状改善情况。结果在不同治疗方案下,试验组的BMSCs表面分子CD34、CD105、CD166表达量分别为(2.48±0.76)%、(13.36±3.27)%、(37.49±5.28)%,均高于对照组[(1.92±0.36)%、(11.45±2.13)%、(34.23±5.16)%](P<0.05);试验组骨保护素(OPG)、骨钙素(BGP)、成纤维细胞生长因子(FGF-2)分别为(5.45±1.36)pg/mL、(6.27±1.45)μg/mL、(43.35±10.46)ng/L,均高于对照组[(4.41±1.36)pg/mL、(5.52±1.44)μg/mL、(37.25±10.41)ng/L](P<0.05);试验组术后1个月、术后3个月的骨密度分别为(0.32±0.11)g/cm^(2)、(0.49±0.23)g/cm^(2),均高于对照组[(0.25±0.11)g/cm^(2)、(0.35±0.16)g/cm^(2)](P<0.05);骨坏死面积分别为(26.44±5.17)%、(20.45±5.23)%,均低于对照组[(29.12±5.33)%、(23.32±5.18)%](P<0.05);试验组术后1个月、术后3个月的视觉模拟疼痛量表(VAS)评分分别为(4.25±1.27)分、(2.82±0.46)分,均低于对照组[(5.33±1.77)分、(3.21±0.52)分](P<0.05);试验组术后1个月、术后3个月的髋关节Harris量表评分分别为(70.33±10.32)分、(85.66±10.45)分,均高于对照组[(65.22±10.36)分、(80.33±10.71)分](P<0.05)。结论自体BMSCs能通过上调骨髓干细胞表面分子而改善老年ONFH患者的骨代谢水平,自体BMSCs移植联合髓芯减压术可有效提升患者骨密度水平,并减少骨坏死面积,对缓解患者髋关节疼痛、促进髋关节功能恢复均有积极意义。

Hip hemi-arthroplasty for neck of femur fracture:What is the current evidence?

This editorial reviews and summarises the current evidence(meta-analyses and Cochrane reviews) relating to the use of hip hemi-arthroplasty for neck of femur fractures. Regarding the optimal surgical approach,two recent meta-analyses have found that posterior approaches are associated with: higher rates of dislocation compared to lateral and anterior approaches; and higher rates of re-operation compared to lateral approaches. Posterior approaches should therefore be avoided when performing hip hemi-arthroplasty procedures. Assessing the optimal prosthesis head component,three recent meta-analyses and one Cochrane review have found that while unipolar hemiarthroplasty can be associated with increased rates of acetabular erosion at short-term follow-up(up to 1 year),there is no significant difference between the unipolar hemi-arthroplasty and bipolar hemi-arthroplasty for surgical outcome,complication profile,functional outcome and acetabular erosion rates at longer-term follow-up(2 to 4 years). With bipolar hemi-arthroplasty being the more expensive prosthesis,unipolar hemi-arthroplasty is the recommended option. With regards to the optimal femoral stem insertion technique,three recent metaanalyses and one Cochrane Review have found that,while cemented hip hemi-arthroplasties are associated with a longer operative time compared to uncemented Hip Hemi-arthroplasties,cemented prostheses have lower rates of implant-related complications(particularly peri-prosthetic femoral fracture) and improved postoperative outcome regarding residual thigh pain and mobility. With no significant difference found between the two techniques for medical complications and mortality,cemented hip hemi-arthroplasty would appear to be the superior technique. On the topic of wound closure,one recent meta-analysis has found that,while staples can result in a quicker closure time,there is no significant difference in post-operative infections rates or wound healing outcomes when comparing staples to sutures. Therefore,either suture or staple wound closure techniques appear equally appropriate for hip hemiarthroplasty procedures.

通过hiPS细胞诱导生成类肝细胞建立肝毒性检测模型及其初步评价

目的探讨通过人诱导多能干细胞(human induced pluripotent stem cells,hiPS cells)诱导生成类肝细胞,建立肝毒性检测模型并用于中药毒性体外评价的可行性。方法采用细胞因子4步诱导分化方法,通过加入激活素A(Activin A)、骨形态发生蛋白-4(BMP-4)、成纤维细胞生长因子-2(FGF-2)、肝细胞生长因子(HGF)、制瘤素M(Oncostatin M)等细胞因子,连续培养23 d,将hiPS细胞诱导分化成类肝细胞。采用细胞免疫荧光法检测hiPS细胞向类肝细胞分化过程不同阶段的特异性标记:叉头框转录因子A2(FOXA2)、性别决定区Y框蛋白17(SOX17)、甲胎蛋白(AFP)、白蛋白(ALB)、肝细胞色素P4503A4酶(CYP3A4)和α1-抗胰蛋白酶(AAT)等蛋白的表达;采用q PCR法检测类肝细胞特异性基因:甲胎蛋白(AFP)、白蛋白(ALB)、细胞角蛋白8(CK8)、细胞角蛋白18(CK18)和细胞角蛋白19(CK19)的基因表达;采用吲哚青绿(ICG)摄取实验检测类肝细胞排泌功能。采用雷公藤冻干粉(1,2,4,8 mg·m L^(-1))对类肝细胞进行肝毒性实验,作用24 h后检测谷草转氨酶(AST)、谷丙转氨酶(ALT)、丙二醛(MDA)、谷胱甘肽(GSH)、超氧化物歧化酶(SOD)的含量或活性。结果检测到FOXA2、SOX17蛋白在内胚层诱导阶段有表达,AFP、ALB在肝细胞分化与扩增阶段有表达,CYP3A4、AAT在肝细胞成熟阶段有表达;肝细胞特异性基因AFP、CK19、ALB、CK8、CK18在类肝细胞中均有表达,诱导前后比较差异有统计学意义(P<0.05);ICG摄取实验显示类肝细胞具有肝细胞的特异性ICG摄取功能。与对照组比较,雷公藤各剂量组的ALT及AST活性显著升高、MDA浓度显著升高、GSH及SOD活性显著降低,差异均有统计学意义(P<0.05,P<0.01)。结论通过hiPS细胞诱导生成类肝细胞的方法具有可行性,诱导得到的类肝细胞具有人正常肝细胞的功能,可以作为中药肝毒性筛选的模型细胞。

Factors Influence on the Broaching Hammering Sound during Cementless Total Hip Arthroplasty

Background: The aim of this study is to identify the factors influence on the broaching hammering sound character during cementless total hip arthroplasty. Methods: We analyzed frequency spectrum of the hammering sound for 49 cases of uncomplicated cementless THAs using two types of proximal-coated stem performed by experienced surgeons. Normalized sound pressure (NSP) of each 0.5 kHz frequency band in final stage of broach procedure was determined by the fast Fourier transform analysis. The relationships between those sound characteristics and femoral morphology such as canal calcar ratio (CCR), Canal flare index (CFI), morphological cortical index (MCI) and femoral shaft length (FSL) in different cementless stem were investigated. Results: In Accolade 2, CCR was positively related to NSP in several bands [Frequency band (kHz);r: 2.0 - 2.5;0.37, 4.5 - 5.0;0.37, 9.5 - 10.0;0.44], and negatively related to 7.5 - 8.0 kHz (r = -0.39). Negative correlations were observed among CFI and MCI in specific frequency bands (4.5 - 5.0, 5.0 - 5.5, and 7.5 - 8.0 kHz). In Taperloc Microplasty, strong correlations were found between FSL and the NSP of 7.5. - 8.0 kHz (r = 0.78) and CCR and the 7.5 - 8.0 kHz bands. There was significant difference of NSPs between high and low group divided by morphological parameters. Acoustic characteristics of NSPs between Accolade 2 and Microplasty were significantly different in 9 frequency bands. Conclusions: The hammering sound correlated with four parameters of the femoral morphology and differed in different types of proximal-coated stem. Those novel five factors are important to consider when to predict complications using acoustic analysis.

Investigation of Hammering Sound Frequency to Prevent Intraoperative Fracture during Total Hip Arthroplasty

Background: The 1st peak frequency of the hammering sound in total hip arthroplasty may serve as an evaluation index to prevent intraoperative fracture. Fixation of the stem and femur cannot be acquired unless the 1st peak frequency of hammering the stem into the femur stabilizes, and fixation can be judged as acquired when the 1st peak frequency becomes constant. To investigate whether the environmental sound in the operating room can be differentiated from the hammering sound of total hip arthroplasty, the 1st peak frequency of the hammering sound when impacting the stem into the femur with a hammer was identified. Method: The hammering sound of impacting the stem into a biomechanical test material through an impactor was analyzed using a fast Fourier transform analyzer. Environmental sound in the operating room was simulated and the 1st peak frequency of the sound on collision between the operator’s voice and the surgical instrument was measured. The 1st peak frequency of hammering sound was compared between patients indicated for total hip arthroplasty and healthy individuals to investigate whether there is a difference due to bone quality. Results: The natural frequency of the impactor was 3.41 ± 0.05 kHz, and the 1st peak frequency of the femur, stem, and impactor was 2.43 ± 1.45 kHz. The 1st peak frequency of hammering sound on simulated femur in patients indicated for total hip arthroplasty was 2.98 ± 0.73 kHz and that in healthy individuals was 2.15 ± 0.32 kHz. This suggested that the hammering sound in total hip arthroplasty-indicated patients overlaps with the frequency of the collision sound of surgical instruments. Conclusion: To develop a system to prevent intraoperative fracture, countermeasures, such as noise canceling, are necessary to prevent false detection of hammering sounds.

全髋关节置换术中生物型股骨柄沉降的应用研究

目的本研究观察生物型股骨柄应用于全髋关节置换术(total hip arthroplasty,THA)的临床效果,并探究影像学上生物型股骨柄的沉降情况。方法纳入2019年10月至2020年10月在西安交通大学附属红会医院关节中心行THA的124例患者(136髋),其中男性56髋,女性80髋;平均年龄(53.0±12.5)岁,收集纳入研究病例的术前及术后随访时的疼痛视觉模拟评分(visual analog scale,VAS)、Harris髋关节功能评分(Harris hip score,HHS)、生存质量评分(12-item short form health survey,SF-12)、伤口愈合情况、假体松动、感染及翻修等并发症的发生率;术后第1天、1个月、3个月、6个月、1年随访时分别拍摄骨盆正位X线片,并测量股骨柄沉降数据。结果术后1个月、3个月、6个月、1年随访时VAS、HSS及SF-12评分均较术前明显改善,且VAS评分在术后3个月以后无显著变化,HHS评分术后6个月以后无显著变化,SF-12在术后1年内呈逐渐提高趋势。术后1个月时有2例伤口浅表愈合不佳,给予清创缝合后均愈合,术后1年随访期间内,未发生假体松动、感染等并发症。术后3个月内生物型股骨柄有沉降发生,其中术后1个月平均沉降(0.46±2.63)mm,术后3个月沉降(1.15±2.77)mm,3个月后未再发生假体下沉。结论生物型股骨柄在THA术中应用可以获得良好的临床效果,生物型股骨柄在术后前3个月内确有沉降发生,但沉降量不会增加早期手术失败风险。