Objective To study and compare boneforming mechanismafter compound of autologous periosteum-wrapped tendon with spongiosa homogenate and other implants in articular cavity, and to explore the possibility of the compound as a substitute for the lunate in Kienbock’s disease.Methods Forty-five New Zealand white rabbits were randomly divided into three groups: periosteum group(group A, n=15), composite group(group B, n=15), and control group(group C, n=15). The three sorts of implants were placed into articular cavity of the knee respectively. The changes of bone formation and bone morphogenetic protein (BMP) distribution of the implants were examined under optical microscope with HE and immunohistochemical staining and measured by CT 3, 6 and 9 weeks after operation.Results The result of BMP staining was negative after 3 weeks and positive in new cartilage cells after 9 weeks in group A. The positive BMP staining was observed in group B after 3 weeks and 9 weeks, which mainly distributed in new bone cells and cartilage cells. And negative BMP staining was observed every stage in groupC. The quantitative CT bone mineral density (BMD) values of 3 implants were analyzed, the difference was significant between the groups (Plt;0.01), except that between groups A and C in the 3rd week (Pgt;0.05). Conclusion The above results demonstrated that the compound of autologous periosteum-wrapped tendon and spongiosa homogenate can produce bone and cartilage massively under the induction of periosteum and bone-forming factors such as BMP in spongiosa homogenate and the compound can be used as a substitute for the lunate.
In order to evaluate the long-term effect of total hip replacement (THR) in patients with steroid-induced femoral head necrosis, 40 cases of 50 hips received THR patients were followed up for an average of 8.5 years after operation. Evaluation was carried act according to Harris score system. In these cases, average score was seventy-five points. Revision rate among them was 2% after four years and 18% after five to eight and a half years, with as overall rate of 20%. It was found that the main reason for revision was looseness of the prosthesis. In this follow-up, it showed that besides foreigen body reaction, abnormal osseous remodelling was the main factor in long-term failure of this arthroplasty. It was also proved that it was a good selection to perform cemented total hip replacement in younger patients, which could improve living quality.
ObjectiveTo study the clinical efficacy of core decompression and allogeneic nonvascularized fibular grafting on patients with different femoral head necrotic area. MethodsBetween January 2010 and December 2011, 59 hips in 59 patients with Ficat stage Ⅱ osteonecrosis of femoral head were treated with core decompression and allogeneic nonvascularized fibular grafting. Fifty-four patients (54 hips) were followed up. According to the necrotic area of femoral head, patients were divided into three groups: 6 hips in type A, 37 hips in type B and 11 hips in type C. We analyzed the outcomes by changes in radiographic images, Harris hip scores, hip activity and visual analogue scale (VAS) pain scores. The mean follow-up time was 40.1 months. ResultsThe postoperative X-ray images were good with no fibula prolapse, fracture or infection. Six femoral heads collapsed in patients of type C group. No head collapsed in patients grouped into type A or type B. The three groups' Harris hip scores were better than those before surgery (P<0.05). But the Harris hip score of patients with femoral head collapse was as bad as that before surgery (P>0.05). The Harris score of group C was significantly lower than group A and B (P<0.01). The joint movements of type A and type B patients were similar with those before surgery, and the VAS pain score was lower. But patients of type C suffered worse joint movement and the pain was not relieved. ConclusionThe clinical efficacy of femoral head necrotic patients treated with core decompression and allogeneic nonvascularized fibular grafting is generally good. But the risk of femoral head collapse in type C patients is high, and the clinic outcome is worse than patients of type A and B. Therefore this type of surgery is more suitable for patients with type A and B femoral head necrotic area.
OBJECTIVE To investigate the therapeutical effect of treatment of ischemic necrosis of femoral head by the transfer of vascular pedicled iliac periosteum. METHODS From June 1983 to August 1997, 106 cases with ischemic necrosis of femoral head (II stage in 64 cases, III stage in 39 cases, IV stage in 3 cases) were treated by the transfer of vascular pedicled iliac periosteum with ascending branch of lateral femoral circumflex vessel or deep circumflex iliac vessel pedicle. RESULTS Followed up 2 years and 4 months to 16 years, there were excellent in 54 cases, better in 38 cases, moderate in 9 cases, poor in 5 cases, and 86.8% in excellent rate according to the criterion of the therapeutical effect on the repair and reconstruction of adult ischemic necrosis of femoral head. CONCLUSION Treating ischemic necrosis of femoral head by the transfer of vascular pedicled iliac periosteum has the advantage of constant pedicle, easily drawing materials and reliable therapeutical effect.
Eight cases(10 hips) of avascular necrosis of femoral head in adults were treated with transplantation of sartorius musculo-skeletal graft through the greater trochanter since August 1990. The patients were followed up for 12 to 20 months,with disappearance of pain in 7 cases. The degree of hip motion was markedly increased. The good results rated 87.5 percent.
Thirty-nine cases of fracturc of the femoral neck were treated by transplantation of iliac bone graft pedicled with the deep circumflex iliac vessel. The average period of the follow up was 89.4 months. The results showed that Harris Hip Functional Evaluation was 88.2±15.6. The rate of necrosis of the femoral head was 48.7 percent before being operated and 23.1 percent after being operated. The non-union rate of the fracture was 56.4 in contrast to 17.9 percent. The authors believed that the indications wer...
Since 1985, on the basis of anatomical observation of 50 fresh adult specimens, we designed the transposition oF vascularized capitate bone carrying the dorsal branche of the anteriot interosses artery to replace the damaged lunate bone from avascular necrosis. The operation had been done in 6 patients and the follow-up observation (from 6 months to 4 years) showed that the operation was satisfactory. The anatomic basis, the advantages and disadvantages, and the surgical indications were discussed.
From March. 1987 to March. 1989,we have treated 8cases of children with avascular necrosis of the femoral headby synovectomy of the hip and lateral circumflex femoralartery pedicled iliac bone graft to the femoral neck. Satisfac- tory therapeutic results were achived. The advantages of thisoperation are : 1. the microcirculation of the femoral headwas improved-by intraarticular decompression. 2. the venouspressure decreased by osteotomy at femoral head and neck.3. iliac bone graft can prevent femoral head coiiapsc.4.the blood supply of the femoral head was recstablished by vascularized iliac bone gredt.
Objective Dexamethasone (DXM) can regulate the balance of neutrophil and cytokine and enhance the ischemia-reperfusion tolerance of the skin flap; amlodipine besylate (AB) can selectively expand the peripheral blood vesselsand rel ieve the vascular smooth muscle spasm. To investigate the percutaneous penetration abil ity of DXM/AB compound gel and evaluate its effect on survival of ischemic skin flap. Methods Sodium carboxymethylcellulose was used to make blank gel, which was mixed in DXM, AB, azone (AZ), and progylene glycol (PG) respectively to make the compound gel containing 0.3%DXM/0.5%AB only (group D), the compound gel containing 3%AZ/2%PG, 3%AZ, and 2%PG (groups A, B, and C), the 0.3%DXM gel containing 3%AZ/2%PG (group E), the 0.5%AB gel containing 3%AZ/2%PG (group F). The accumulative penetration of DXM and AB in compound gel, 0.3%DXM gel, 0.5%AB gel through excised rat skin and its penetration within flap tissue were investigated by ultraviolet spectrophotometry. Fifty SD rats were selected to make 100 mm × 10 mm random flap at the back, and were randomly divided into 5 groups according to different gels which were used to treat flaps (n=10): compound gel group (group A1), 0.3%DXM gel group (group B1), 0.5%AB gel group (group C1), blank gel group (group D1), and peritoneal injection of DXM (5 mg/kg) and AB (2 mg/kg) (group E1). The survival area of ischemic random skin flap was measured on the 7th day by planimetry. Twenty-four SD rats were selected to make 100 mm × 10 mm random flap at the back, and were randomly divided into 2 groups (n=12). The accumulative penetration of DXM and AB within skin flap were also detected at 2 and 6 hours after appl ication of 2 g of compound gel containing 3%AZ/2%PG (group A2) and peritoneal injection AB (2 mg/kg) / DXM (5 mg/kg) (group B2). Results The accumulative penetration of DXM and AB in compound gel were increased in time-dependent manner (P lt; 0.05), and it was the highest in group A, and was significantly higher than that in group B and group C (P lt; 0.01), but there was no significant difference when compared with group E or group F (P gt; 0.05). The accumulative penetration of DXM and AB in groups A, B, and C were significant higher than that in group D (P lt; 0.05). After 7 days, the survival area of flaps in groups A1, B1, C1, D1, and E1 were (695.0 ± 4.6), (439.3 ± 7.1), (477.5 ± 14.5), (215.2 ± 3.8), and (569.4 ± 9.7) mm2, respectively; group A1 was significantly higher than other groups (P lt; 0.05). After 2 and 6 hours, the quantities of DXM and AB in skin flap of group A2 were significantly higher than that of group B2 (P lt; 0.05). Conclusion In 0.3%DXM/0.5%AB compound gel, DXM and AB might penetrate into skin tissue, which could significantly increase the survivalarea of ischemic skin flap.