Long-term Follow-up Study on Perthes Disease

Objective: To analyze the efficacy of various therapies on Perthes diseaseand summarize a systematic treatment strategy. Methods: One hundred and sixty-five cases merelong-term followed. The advantages and disadvantages of various therapies were compared. Results:Each method had its advantage and disadvantage; the effects were correlated with the stages andtypes of the patients and the therapy they were given. Simple treatment is recommended for type Ⅰcases . For type Ⅱ , simple procedures can be used in stage Ⅰ of the patients and surgery wasusually contraindicated for stage Ⅲ cases . For type Ⅲ, vascularized fibula grafting may beconsidered for cases of stage Ⅰ , Ⅱ and Ⅲ. For type Ⅳ cases, combined therapies should beenconsidered. Conclusion: The therapy should be individualized to patient.

A Brief Note on Pathogenesis and Treatment of Perthes Disease

Measurement of intraosseous pressure in the proximal femur, stress test and venography performed on 49 hips with perthes disease and 38 hips of normal children revealed an increase in intrasoseous pressure in Perthes disease group with abnormal stress test and venography. It means that there is venous obstruction in the diseased proximal femur in accompany with raised intraosseous pressure. Core decompression performed on 31 hips with Perthes disease gaves good response in 84% of the hips, whereas Chiari pelvic osteotomy done in 18 hips with late stage disease, 77% of the hips improved fairly well. The anthore' opinion is that core decompression is effective for Perthes disease in early stage, and the Chiaripelvic osteotomy could be recommended in late stage cases.

BIOCHEMICAL STUDIES ON GLUCOAMINOGLYCANS CONTENT IN AFFECTED CARTILAGE HYALURONIC ACID LEVELS IN SERUM AND SYNOVIAL FLUID OF IDIOPATHIC FEMORAL HEAD NECROSIS

To investigate the role of cartilage alterations in the pathogenesis of the idiopathic femoral head necrosis, 3 components of glycosaminoglycans(GAG) in pathological and health cartilage, levels of hyaluronic acid(HA) in synovial fluid and serum were detected. The correlations among HA level in synovial fluid, serum and GAG content in cartilage were analyzed. The results showed that ①the three components of cartilage GAG in normal adults and children showed little difference; ②Compared with the normal autopsy specimens, steroid induced ANFH and Perthes disease specimens had significantly decreased GAG contents (P<0 025). In the former ones, sulfate radical content had no obvious reduction in Ficat Ⅱ (P>0 05), but it decreased significantly (P<0 05) in Ficat Ⅲ, while hexosamine decreased sharply in Ficat Ⅱ and had no marked alternation in Ficat Ⅲ. And hexuronic acid fell sharply during Ficat Ⅱ and Ficat Ⅲ (P<0 05). Serum level of HA did not have obvious changes until Ficat Ⅲ. HA level in synovial fluid decreased extremely in Ficat Ⅲ in contrast to Ficat Ⅱ and normal controls (P<0 05). Moreover, there was no correlation between levels of HA in serum and in synovial fluid (P>0 05); ③Children suffered from Perthes disease had a much higher level of HA in serum than the controls (P<0 01). HA level in serum led an inverse correlation with that in synovial fluid. (r=-0 663,P<0 05);④There was a positive correlation between HA level in synovial fluid and GAG content in both steroid induced ANFH and Perthes disease. GAG content was positive correlated with HA level in serum of Perthes disease, whereas, there was no correlation between them in steroid induced ANFH. The results suggest that:①GAG content in affected hip decreased significantly in the early stage. It provides clinical theory basis for auxiliary treatment to cartilage in early stage; ②Sulfate radical depletion is the most conspicuous one of GAG changes in middle and late stage. It suggests that the sulfate radical glycoaminoglycans should be replenished in these stages; ③Measurement of the serum HA level is of no value in early diagnosis of steroid induced ANFH. To some extent serum levels of HA reflect biochemical changes in cartilage in Perthes disease.

Investigation on the Physico－Chemical Properties of Lipiodol Anticancerous Chemo－Embolizing Agents

Measurement of intraosseous pressure in the proximal femur, stress test and venography performed on 49 hips with perthes disease and 38 hips of normal children revealed an increase in intrasoseous pressure in Perthes disease group with abnormal stress test and venography. It means that there is venous obstruction in the diseased proximal femur in accompany with raised intraosseous pressure. Core decompression performed on 31 hips with Perthes disease gaves good response in 84% of the hips, whereas Chiari pelvic osteotomy done in 18 hips with late stage disease, 77% of the hips improved fairly well. The anthore' opinion is that core decompression is effective for Perthes disease in early stage, and the Chiaripelvic osteotomy could be recommended in late stage cases.

Drilling Combined with Adipose-derived Stem Cells and Bone Morphogenetic Protein-2 to Treat Femoral Head Epiphyseal Necrosis in Juvenile Rabbits

This study was designed to evaluate the effects of drilling through the growth plate and using adipose-derived stem cells （ADSCs） and bone morphogenetic protein-2 （BMP-2） to treat femoral head epiphyseal ischemic necrosis, which can be done in juvenile rabbits. Passagefour bromodeoxyuridine （BrdU）-labeled ADSCs were cultured, assayed with MTT to determine their viability and stained with alizarin red dye to determine their osteogenic ability. Twomonth-old, healthy male rabbits （1.2 to 1.4 kg, n=45） underwent ischemic induction and were randomly divided into five groups （group A： animal model control; group B： drilling; group C： drilling ＆ ADSCs; group D： drilling ＆ BMP-2; and group E： drilling ＆ ADSCs ＆ BMP-2）. Magnetic resonance imaging （MRI）, X-ray imaging, hematoxylin and eosin staining and BrdU immunofluorescence detection were applied 4, 6 and 10 weeks after treatment. Approximately 90% of the ADSCs were labeled with BrdU and showed good viability and osteogenic ability. Similar results were observed in the rabbits in groups C and E at weeks 6 and 10. The animals of groups C and E demonstrated normal hip structure and improved femoral epiphyseal quotients and trabecular areas compared with those of the groups A and B （P〈0.01）. Group D demonstrated improved femoral epiphyseal quotients and trabecular areas compared with those of groups A and B （P〈0.05）. In summary, drilling through the growth plate combined with ADSC and BMP-2 treatments induced new bone formation and protected the femoral head epiphysis from collapsing in a juvenile rabbit model of femoral head epiphyseal ischemic necrosis.