异体颗粒松质骨移植治疗髋臼杯稳定的髋臼周围骨溶解

[目的]评价异体颗粒松质骨移植治疗THA术后髋臼杯稳定的髋臼周围骨溶解的效果。[方法]自1996年4月-2000年7月，对26例髋臼杯周围骨溶解而假体稳定者行保留髋臼杯，清除病灶、异体颗粒松质骨移植术，并更换聚乙烯内衬和股骨头假体。术后平均随访5．5a。对临床结果、骨溶解病变范围和骨移植愈合分别用Harris髋关节评分系统、放射线影像学和骨移植愈合分级系统进行评价。[结果]Harris评分由翻修术前的平均82分增加到术后平均88分；X线片示髋臼杯周围骨溶解范围正位由术前23．8mm×24．9mm减小到术后11．5mm×8．2mm，侧位由术前的11．1mm×11．6mm减少到术后5．3mmx4．5mm；异体骨愈合程度Ⅰ级12例（46％），Ⅱ级14例（54％）。[结论]保留髋臼杯、清除病灶后行异体颗粒松质骨移植术是非骨水泥髋臼杯稳定的髋臼周围骨溶解治疗的有效措施，可以保留更多的髋臼骨量。降低手术的复杂程度。

Capillaria hepatica in China

Capillaria hepatica(C.hepatica) is a parasitic nematode causing hepatic capillariasis in numerous mammals.Ecologic studies showed that the first hosts of C.hepatica were rodents,among which rats had relatively high infection rates,which explains why C.hepatica spreads globally.Anatomical studies showed that the liver was the principal site of colonization by these parasites and physical damage tended to occur.Although C.hepatica might lead to serious liver disorders,relevant clinical reports were rare,because of the non-specific nature of clinical symptoms,leading to misdiagnosis.This review mainly focuses on the biological characteristics and epidemiology of C.hepatica in China and histopathologic changes in the liver,with expectation of gaining a better understanding of the disease and seeking more effective treatment.

Diagnosis and treatment of spinal tuberculosis after liver transplantation

BACKGROUND: Spinal tuberculosis is a common disease in orthopedic clinical practice; however, it is seldom reported after organ transplantation. The aim of this study was to investigate the diagnosis and treatment of spinal tuberculosis after organ transplantation. METHOD: Two cases were diagnosed as spinal tuberculosis after liver transplantation and were treated with socarboxazide, rifampicin, streptomycin and ethambutol for more than one year. RESULTS: After treatment with anti-tuberculosis drugs for several months, the symptoms of both patients clearly improved. Back pain disappeared, and erythrocyte sedimentation and body temperature returned to normal. CONCLUSIONS: We should highly suspect spinal tuberculosis if notalgia and night sweats are present after organ transplantation. Anti-tuberculosis therapy is an effective treatment for spinal tuberculosis after organ transplantation.

Skeletal muscle cell apoptosis following motor nerve injury versus sensory nerve injury

Skeletal muscle atrophy inevitably occurs in denervated skeletal muscle, and cell apoptosis plays an important role in skeletal muscle atrophy and degeneration. The present study established rat models of simple nerve injury by transecting the ventral or dorsal spinal nerve root and observed rat skeletal muscle cell apoptosis following simple motor nerve injury versus simple sensory nerve injury. Following skeletal muscle denervation for 10 weeks, cell apoptosis was detected in skeletal muscle, which was accompanied by obvious changes in rat behavior and electrophysiological responses. In addition, changes in cross-sectional area and average gray-scale of motor endplates of the gastrocnemius muscle were analyzed following sciatic nerve injury and motor nerve injury. Cell nuclei in denervated skeletal muscle tissue were more densely arranged than in normal skeletal muscle tissue. Cell nuclei were most dense in the sciatic nerve injury group, followed by the motor nerve injury group and the sensory nerve injury group. Fas/FasL expression and the number of apoptotic cells increased in denervated skeletal muscle, and apoptosis-related changes were observed. These findings suggested that motor and sensory nerves provided trophic actions following skeletal muscle and motor nerve injury, resulting in a greater influence on skeletal muscle atrophy than sensory nerve injury. Therefore, reconstruction of motor nerves should be preferentially considered for treating denervation-induced skeletal muscle atrophy.

PFNA-Ⅱ combined with preoperative accurate measurement evaluation for the treatment of senile femoral fractures between rotor

Objective:Research PFNA-Ⅱcombined with preoperative accurate measurement of senile femoral fracture between the rotor of the clinical application value.Methods:Fiftytwo patients with intertrochanteric fractures admitted to our hospital from January 2017 to October 2019 were selected and divided into the traditional group and the measurement group according to the random number table method,with 26 patients in each group.The traditional group could not make accurate measurement before operation,but the measurement group could make accurate measurement before operation.Postoperative follow-up was conducted for at least 6 months to compare The Times of intraoperative X-ray fluoroscopy,operation time,intraoperative blood loss,and TAD,Harris score and improved BADL score of the hip joint between the two groups.Results:The number of intraoperative X-ray fluoroscopy in the measured group was less than that in the conventional group(15.08+/-2.10 vs 19.81±2.21 times,t=7.920,P=0.000).The operation time of the measured group was lower than that of the traditional group(78.46+/-3.68 vs 89.62+/-5.28 minutes,t=8.841,P=0.000).Intraoperative blood loss was less in the measured group than in the conventional group(146.15+/-24.18 vs 163.46+/-22.62 ml,t=2.666,P=0.010).There was no statistically significant difference in TAD values between the two groups(23.73+/-2.49 vs 24.04+/-2.63 mm,t=0.433,P=0.667).There is no interaction between intervention mode and time factor(F=0.362,P=0.698).There was statistical difference in Harris scores between different timepoints before and after the operation,in other words,there was time effect(F=378.110,P=0.000).There was no statistical difference in Harris scores between the 2 groups,in other words,there was no group effect(F=0.874,P=0.354).All the Harris scores of the two groups increased with time,and the increase trend was consistent(39.69+/-3.27,68.27+/-5.06,82.54+/-6.21 points,F=49.333,P=0.000;39.15+/-3.46,67.00+/-4.24,80.84+/-7.12 points,F=53.460,P=0.000).There was no significant difference in the improved BADL score between the two groups 6 months after surgery(t=0.587,P=0.560).Conclusion:PFNA-Ⅱcombined with preoperative accurate measurement in the application of the elderly femoral fracture between the rotor is safe and effective,not only can shorten the operation time,less intraoperative blood loss and the number of perspective,while reducing the risks of medical radiation.

Timing umbilical therapy in treatment of neurogenic bladder after spinal cord injury based on midnight-noon and ebb-flow doctrine:a randomized controlled trial

Objective To observe the clinical efficacy of timing umbilical therapy for neurogenic bladder after spinal cord injury based on the midnight-noon and ebb-flow doctrine.Methods Sixty patients with neurogenic bladder after spinal cord injury were randomly divided into a trial group and a control group,with 30 patients in each group.

通过取出物研究回顾采用28mm和32mm直径假体的全髋关节置换术

对翻修取出的直径为28 mm和32 mm的球头研究发现,髋臼和股骨颈部撞击可能经常发生。超高分子量聚乙烯、钴铬合金和氧化铝陶瓷界面可能都会因此受累。其中,钴铬合金界面和氧化铝陶瓷界面的坚硬内衬和金属被托设计使它们发生撞击的风险增加。造成不良影响的常见途径包括撞击、金属磨削转移和条状磨损。这些行为与采用陶瓷假体的全髋置换术后的异响有关。我们对老化的36 mm的氧化铝基复合陶瓷(AMC)球头(B IOLOX delta,CeramTec AG,Plochingen,Germany)进行模拟试验机磨损试验,在微分离模式下进行100万次的负载周期测试,发现条状磨损区的单斜相部分比主要磨损区和无磨损区的要高。这与我们之前对未老化陶瓷材料进行的模拟试验机试验结果一样,在那项研究中我们对纯氧化铝陶瓷(B IOLOX forte,同一生产商)和氧化铝基复合陶瓷都进行了对比研究,在经过500万次负载周期后我们发现,与对照组Forte球头-Forte内衬相比,Delta球头-Forte内衬和Delta球头-Delta内衬可以分别使磨损降低3倍和7倍。这表明Delta球头比Forte球头更能抵抗条状磨损的形成。因此,在髋关节假体的设计中使用大直径Delta陶瓷界面应该具有临床效益。

Association of sterol regulatory element binding protein 2 and insulin-like growth factor binding protein 3 genetic polymorphisms with avascular necrosis of the femoral head in the Chinese population

Background Sterol regulatory element binding protein （SREBP）-2 plays a key role in lipid homeostasis by stimulating gene expression of cholesterol biosynthetic pathways. The insulin-like growth factor binding protein （IGFBP） family regulates growth and metabolism, especially bone cell metabolism, and correlates with osteonecrosis. However, association of their gene polymorphisms with risk of avascular necrosis of the femoral head （ANFH） has rarely been reported. We determined whether SREBP-2 and IGFBP-3 gene polymorphisms were associated with increased ANFH risk in the Chinese population. Methods Two single nucleotide polymorphisms of SREBP2 gene, rs2267439 and rs2267443, and one of IGFBP-3 gene, rs2453839, were selected and genotyped in 49 ANFH patients and 42 control individuals by direct sequencing assay. Results The frequencies of rs2267439 TT and rs2267443 GA of SREBP2 and rs2453839 TT and CT of IGFBP-3 in the ANFH group showed increased and decreased tendencies （against normal control group）, respectively. Interaction analysis of genes revealed that the frequency of carrying rs2267439 TT and rs2267443 GA genotypes of SREBF-2 in ANFH patients was significantly higher than in the control group （P 〈0.05）. Association analysis between polymorphisms and clinical phenotype demonstrated that the disease course in ANFH patients with the rs2453839 TT genotype of IGFBP-3 was significantly shorter than that of CT＋CC carriers （P 〈0.01）. CT＋CC genotype frequency in patients with stage Ill/IV bilateral hip lesions was significantly higher than in those with stage Ill/IV unilateral lesions and stage II/111 bilateral lesions （P 〈0.05-0.02）. Conclusions Our results suggested that interaction of SREBP-2 gene polymorphisms and the relationship between the polymorphisms and clinical phenotype of IGFBP-3 were closely related to increased ANFH risk in the Chinese population. The most significant finding was that the CT＋CC genotype carriers of IGFBP-3 rs2453839 were highly associated with the development of ANFH.

Reversion effects of curcumin on multidrug resistance of MNNG/HOS human osteosarcoma cells in vitro and in vivo through regulation of P-glycoprotein

Background P-glycoprotein （P-gp） encoded by ATP-binding cassette sub-family B member 1 （ABCB1） gene is a kind of ATP-dependent drug transporter, which plays important roles in multidrug resistance （MDR） of human cancers, such as osteosarcoma. Curcumin is a natural phenolic coloring compound originating from the rhizomes of Curcuma Ionga, which is proved to possess antitumor biological activities including reversion of MDR. However, the effect and molecular mechanisms of curcumin to osteosarcoma MDR remain unclear.

Characteristics of bone tunnel changes after anterior cruciate ligament reconstruction using Ligament Advanced Reinforcement System artificial ligament

Background There are different materials used for anterior cruciate ligament （ACL） reconstruction. It has been reported that both autologous grafts and allografts used in ACL reconstruction can cause bone tunnel enlargement. This study aimed to observe the characteristics of bone tunnel changes and possible causative factors following ACL reconstruction using Ligament Advanced Reinforcement System （LARS） artificial ligament. Methods Forty-three patients underwent ACL reconstruction using LARS artificial ligament and were followed up for 3 years. X-ray and CT examinations were performed at 1,3, 6, 12, 24, and 36 months after surgery, to measure the width of tibial and femoral tunnels. Knee function was evaluated according to the Lysholm scoring system. The anterior and posterior stability of the knee was measured using the KT-1000 arthrometer. Results According to the Peyrache grading method, grade 1 femoral bone tunnel enlargement was observed in three cases six months after surgery. No grade 2 or grade 3 bone tunnel enlargement was found. The bone tunnel enlargement in the three cases was close to the articular surface with an average tunnel enlargement of （2.5＋0.3） mm. Forty cases were evaluated as grade 0. The average tibial and femoral tunnel enlargements at the last follow-up were （0.8＋0.3） and （1.1＋0.3） mm, respectively. There was no statistically significant difference in bone tunnel width changes at different time points （P 〉0.05）. X-ray and CT measurements were consistent. Conclusions There was no marked bone tunnel enlargement immediately following ACL reconstruction using LARS artificial ligament. Such enlargement may, however, result from varying grafting factors involving the LARS artificial ligament or from different fixation methods.

Biomechanical supporting effect of tantalum rods for the femoral head with various sized lesions： a finite-element analysis

Background Features of necrotic lesions and various interventions could affect the biomechanics of the femoral head. A three-dimensional finite-element analysis was designed to demonstrate necrotic femoral head stress changes with various sizes of necrotic lesions, and evaluate the effect of tantalum rods on preventing femoral head cracking. Methods Femoral computed tomography scans were used to build a normal three-dimensional finite-element femoral head model in a computer. Based on the normal model, necrotic models of different lesion diameters （15 mm, 20 mm and 30 mm） were created, as were the repaired models with tantalum rods for each diameter. After a series of meshing and force loading, the von Mises stress distributions, simulating single-legged stance, and stresses on specific points under loaded conditions were determined for each model. Results Deep exploration into the burdened area of the femoral head indicated that higher stresses to the femoral head were observed with a larger necrotic lesion; the largest stress concentration, 91.3 MPa, was found on the femoral head with a lesion diameter of 30 mm. By contrast, topical stress on the surface of the necrotic regions was lowered following implantation of a tantalum rod, and the changes in stress were significant in models with lesions of 15 mm and 30 mm in diameter, with the best biomechanical benefit from the tantalum rod found with a lesion diameter of 15 mm. Conclusions Femoral heads with larger necrotic lesions usually have a higher stress concentration and a higher risk of collapse. Various sized lesions on the femoral head can benefit from the mechanical support offered by the implantation of a tantalum rod; however, femoral heads with smaller sized lesions may benefit more. A thorough evaluation of the lesion size should be conducted prior to the use of tantalum rod implants in the treatment of femoral head necrosis.

Side effects and tolerability of post-exposure prophylaxis with zidovudine, lamivudine, and lopinavir/ritonavir： a comparative study with HIV/AIDS patients

Background In the era of highly active antiretroviral therapy （HAART）, the use of antiretrovirals as post-exposure prophylaxis （PEP） was the most important strategy for preventing occupational exposure to blood or fluids containing human immunodeficiency virus （HIV）. The objective of this study was to retrospectively evaluate the tolerability, safety, and side effects of a HAART regimen containing three antiretroviral drugs, consisting of zidovudine, lamivudine, and Iopinavir/ ritonavir, in healthcare personnel （HCP） who experienced occupational exposure to HIV. Methods The tolerability, safety, and side effects in 26 HCPs who experienced PEP and in 27 HIV/AIDS patients with HAART regimen, AZT＋3TC＋Lpv/r, were evaluated between January 2010 and December 2012. Results The most frequent clinical side effect was fatigue （in 23 cases, 88.5%）, and gastroenterological symptoms were the second most common side effects in HCP with PEP. Liver dysfunction was found in 10 cases （38.5%）, while drug rash was found in 18 cases （69.2%） after PEP. The prevalence of side effects in HCPs who experienced PEP was higher than that in HIV/AIDS patients P 〈0.05. One nurse （3.8%） experienced severe gastrointestinal symptoms, which led to withdrawal of PEP. No HIV infection was found during 6-month follow-up period. Conclusion HCPs who received occupational PEP with triple-drug regimen, AZT＋3TC＋Lpv/r, experienced different side effects, and the tolerability and safety of PEP regimen were good in this cohort. Chin Med J 2014;127 （14）： 2632-2636

Tumorigenesis and spontaneous metastasis by luciferase-labeled human xenograft osteosarcoma cells in nude mice

Background Osteosarcoma （OS） is the most common primary malignant tumor of bone. Mouse models of human OS can invariably provide greater insight into the complex mechanisms that underlie the development and pathogenesis of this aggressive tumor. Bioluminescence technology favored tracing cancer cells in vivo. In this study, an OS model was described and evaluated using human OS cell line, Saos2, labeled with luciferase （Saos2-1uc）. Methods Saos2 cells were infected by lentivirus loading a firefly luciferase gene. Luciferase expression of Saos2-1uc cells was characterized both in vitro and in vivo. Specific biologic and oncologic features of Saos2-1uc cells were analyzed. The OS was established as orthotopic xenografts in nude mice. Both orthotopic tumors and spontaneous lung metastasis were analyzed. Results Tumorigenesis and spontaneous lung metastasis in nude mice could be monitored in vivo through in vivo imaging system. The enhancement in proliferation, migration and invasion abilities and the attenuation in adhesion ability were observed in Saos2-1uc cells compared with Saos2 cells. Furthermore, there were the up-regulation of Osteocalcin, CCRIO, CXCR1 and ID1 and the down-regulation of ALP, collagen I, CCR1, CCR3, CXCR3, NID and N-cadherin in Saos2-1uc cells compare to Saos2 cells. The rate of spontaneous lung metastasis in Saos2-1uc cells was higher than that in Saos2 cells, although without significant difference. Conclusions Lentivirus transfection may cause alteration of gene expression profiles and further biological functions. This model can be used in the elucidation of molecular mechanisms of tumorigenesis and the screening of new therapeutic agents.

Effect of a combination of local flap and sequential compression- distraction osteogenesis in the reconstruction of post-traumatic tibial bone and soft tissue defects

Background Treatment of extensive post-traumatic composite bone and soft tissue defects remains a complicated therapeutic problem and a challenge for surgeons. We investigated the application of local flaps and Ilizarov osteogenesis in the reestablishment of severe combined defects of tibial bone and soft tissue. Methods Sixteen patients with bone and soft tissue defects were included. The mean age of the patients was 31.5 years. The average time from injury to initial surgery was 14.4 weeks. The average soft tissue and bone defect sizes were 92.9 cm2 and 8.7 cm, respectively. Local flaps were created to reconstruct the soft tissue defects. The Ilizarov external fixator or the Orthofix Limb Reconstruction System was used to reconstruct bony defects using delayed distraction osteogenesis. Results Two myocutaneous flaps and 14 reverse island flaps were applied. All transferred flaps survived. Fifteen patients healed with equal leg length, and one healed with a residual leg-length discrepancy of 1.5 cm. One patient with an Ilizarov external fixator developed ankle joint stiffening and a pin-track infection that was successfully treated with oral antibiotics. No patient developed pin loosening. All patients walked without assistance. Fifteen patients returned to their work, and one lost her job. The results were evaluated using the Paley bone and functional assessment scores. The bone assessment results were excellent in 14 and good in two patients. Functional assessment scores were excellent in 13, good in two, and fair in one patient. Conclusion The combination of local flaps and sequential distraction osteogenesis can be used for successful reconstruction of defects of incorporated bone and soft tissue.

Clinical results and intramedullary signal changes of posterior decompression with transforaminal interbody fusion for thoracic myelopathy caused by combined ossification of the posterior longitudinal ligament and ligamentum flavum

Background Surgical treatment of thoracic myelopathy caused by ossification of the posterior longitudinal ligament （OPLL） and ossification of the ligamentum flavum （OLF） is technically demanding, and the results tend to be unfavorable. Various operative approaches and treatment strategies have been attempted, and posterior decompression with transforaminal thoracic interbody fusion （PTTIF） may be the optimal method with which the anterior-posterior compression was removed in one step. It is comparatively less traumatic with fewer serious complications.

Comparing minimally invasive and open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease： a meta-analysis

Background Transforaminal lumbar interbody fusion （TLIF） through a minimally invasive approach （mTLIF） was introduced to reduce soft tissue injury and speed recovery. Studies with small numbers of patients have been carried out, comparing mTLIF with traditional open TLIF （oTLIF）, but inconsistent outcomes were reported.

Rotary self-locking intramedullary nail for long tubular bone fractures

Background Intramedullary nails had been widely used in the treatment of long-bone fractures because of less interference of fractures and center bearing biomechanical advantage. However, it had been also found many shortcomings such as broken nails, delayed healing and was modified in order to achieve better efficacy and reduce complications. The aim of the present study is to compare the efficacy of rotary self-locking intramedullary nails （RSIN） with that of interlocking intramedullary nails （IIN） in the treatment of long-bone fractures.

Reconstruction of segmental bone defects in the rabbit ulna using periosteum encapsulated mesenchymal stem cells-loaded poly（lactic-co-glycolic acid） scaffolds

Background Repair of large bone defects remains a challenge for clinicians. The present study investigated the ability of mesenchymal stem cells （MSCs） and/or periosteum-loaded poly（lactic-co-glycolic acid） （PLGA） to promote new bone formation within rabbit ulnar segmental bone defects. Methods Rabbit bone marrow-derived MSCs （passage 3） were seeded onto porous PLGA scaffolds. Forty segmental bone defects, each 15 mm in length, were created in the rabbit ulna, from which periosteum was obtained. Bone defects were treated with either PLGA alone （group A）, PLGA ＋ MSCs （group B）, periosteum-wrapped PLGA （group C） or periosteum-wrapped PLGA/MSCs （group D）. At 6 and 12 weeks post-surgery, samples were detected by gross observation, radiological examination （X-ray and micro-CT） and histological analyses. Results Group D, comprising both periosteum and MSCs, showed better bone quality, higher X-ray scores and a greater amount of bone volume compared with the other three groups at each time point （P 〈0.05）. No significant differences in radiological scores and amount of bone volume were found between groups B and C （P 〉0.05）, both of which were significantly higher than group A （P 〈0.05）. Conclusions Implanted MSCs combined with periosteum have a synergistic effect on segmental bone regeneration and that periosteum plays a critical role in the process. Fabrication of angiogenic and osteogenic cellular constructs or tissue-engineered periosteum will have broad applications in bone tissue engineering.

Effect of superior retinacular artery damage on osteonecrosis of the femoral head

Background Osteonecrosis of the femoral head （ONFH） is the result of dysfunctional blood supply, but associations between specific damaged arteries, imaging changes and clinical sign require more understanding. We investigated characteristics of ONFH that pertain to blood supply, imaging appearance, and clinical feature to judge the prognosis of ONFH.

Loss of p120 catenin aggravates alveolar edema of ventilation induced lung injury

Background p120 catenin （p120ctn） is an adheren junction protein that regulates barrier function, but its role has not been explored in alveolar edema induced by ventilation. We measured stretch-induced cell gap formation in MLE 12 cells due to the loss of p120. We hypothesized that alveolar permeability was increased by high tung inflation associated with alveolar epithelia cell tight junctions being destroyed, which resulted from the loss of p120. Methods Cultured MLE12 cells were subjected to being stretched or un-stretched （control） and some cells were pretreated with pp2 （c-src inhibitor）. After the end of stretching for 0, 1, 2, and 4 hours, the cells were lysed, and p120 expression and c-src activation was determined by Western blotting analysis. In vivo, SD rats were taken to different tidal volumes （Vt 7 ml/kg or 40 ml/kg, PEEP=0, respiratory rate 30-40 betas/min） for 0, 1, 2, and 4 hour and some were pretreated with pp2, and alveolar edema was calculated. Rerults It was found that p120 expression was reduced and c-src activation increased in a time-dependent and strain- dependent manner due to cyclic-stretch of the alveolar epithelial cells. These changes could be reversed by inhibition of c-src. We obtained similar changes in rats when they were subjected to large tidal volumes and the alveolar edema increased more than in rats in the low Vt group. Pretreated the rats with inhibition of c-src had less pulmonary edema induced by the high tidal volume ventilation. Conclusions Cyclic stretch MLE 12 cells induced the loss of p120 and may be the same reason by high tidal volume ventilation in rats can aggravate alveolar edema. Maintenance of p120 expression may be a novel therapeutic strategy for the prevention and treatment of ventilation induced lung injury （VILI）.