Efficacy of transurethral endoscopic surgery in treating foreign body-induced lower urinary tract injury / 中华创伤杂志

Objective To investigate curative efficacy of transurethral endoscopic surgery for foreign body-induced lower urinary tract injury. Methods A retrospective case series study was conducted to analyze the clinical data of 31 patients with foreign body-induced lower urinary tract injury admitted to Henan Provincial People's Hospital from January 1998 to January 2018. There were 27 males and four females, aged 6-68 years [(27. 1 ± 16. 3)years]. Foreign bodies were located at the bladder in 12 patients, at urethra in 16, and at bladder and urethra in three. The foreign bodies were placed into the body by patients themselves in 23 patients, by other people in one, iatrogenic implantation in six, and by unknown approach in one. All patients underwent urethral surgeries, and individualized treatment plan was formulated according to the specific conditions such as the foreign body type, size, shape, location,activity and combined injury. The success rate, operation time and hospitalization time were recorded. The sexual function of the married males was evaluated by international index of erectile function-5 (IIEF-5) (IIEF-5 score≥22 points as normal) before and after the operation. The urination after the operation was evaluated by the maximum urinary flow rate ( Qmax) ( Qmax<15 ml/s as abnormal) and the complications were recorded. Results All the patients underwent successful surgeries and the foreign bodies were removed, including 26 patients who underwent transurethral endoscopic surgery alone with success rate of 84％ and five patients underwent open surgery due to failed transurethral endoscopic removal. All patients were followed up for 6-36 months [(27. 0 ± 7. 7)months]. The operation lasted for 20-72 minutes [(42. 0 ± 21. 7) minutes]. The hospitalization time was 2-7 days [(4. 0 ± 1. 7) days]. During the follow-up, 11 married males obtained normal sexual function after surgery [ postoperative IIEF-5:(23. 4 ± 1. 1) points vs. preoperative IIEF-5: (23. 8 ± 0. 9) points]. Twenty-nine patients had normal urination [Qmax=(21. 7 ± 5. 9)ml/s]. Two patients had narrow urinary tract (Qmax<15 ml/s), of whom one patient received regular urethral dilatation and another received resection and anastomosis of urethral stricture, both with satisfactory improvement of urination. Three patients had fever caused by urinary tract infection and recovered within 2 weeks after anti-infection treatment. There were no serious complications such as male sexual dysfunction, complex urethral stricture or septic shock. Conclusions Transurethral endoscopic surgery for foreign body-induced lower urinary tract injury has high success rate, minor impact on the sexual function of male patients and low incidence of complications, which is worthy of clinical practice.

Analysis on diagnosis and treatment of penile fractures in single clinical center in recent 25 years / 中华创伤杂志

Objective To summarize the epidemiological features,diagnosis and treatment of the penile fractures in single clinical center in recent 25 years so as to improve the treatment level.Methods A retrospective case series study was conducted on 23 patients with penile fractures from January 1993 to June 2017.The average age of patients was 37.78 years (range,21-66 years).Nineteen patients were married and four were not.Fourteen patients had penile fractures in summer,five in winter,three in spring and one in autumn.Three patients had Bachelor's degree or above,while 20 had less than university education.There were nine urban and 14 rural residents.Nineteen patients were caused by violent intercourse,two by violent masturbation,one by oral sex and one without willing explanation.All patients were unilateral rupture of albuginea penis,including five with urethral rupture.No misdiagnosis or missed diagnosis occurred.The time from injury to surgery was average 32 h (1993-2002),10.5 h (2003-2012),and 3.8 h (2013-2017),respectively.Emergency operations were performed using the degloved distal foreskin to repair the albuginea penis.The penile erectile function,urination and complications were recorded.Results All patients were followed up for 6-62 months (mean,26 months).In all patients,morning erection was restored at days 1 to 3 after operation,and normal urination was attained after the removal of urethral catheter.Normal sexual life was restored within 3 months after the operation.Penis elephantiasis combined with poor postoperative skin healing was seen in one patient,and mild penile erection pain was reported by one patient.No obvious erectile dysfunction,abnormal urination or other severe complications were reported.Conclusions The epidemiological features of penile fractures include low incidence,relatively concentrated region and age of onset,diversity of causes,and patients with insufficient education.Penile fractures can be diagnosed based on medical history and body examination.Emergency surgery is the first choice for penile fracture,with satisfactory outcomes and few postoperative complications.

Osteogenesis and expression of bone morphogenetic protein 2 after bone marrow mesenchymal stem cells combined with calf cortical bone with partial cancellous bone implanted into rabbits / 中国组织工程研究

BACKGROUND: Previous studies have confirmed that rabbit bone marrow mesenchymal stem cells (BMSCs) can differentiate into osteoblasts under osteogenic induction in vitro, stably express the specific phenotype of osteoblasts and have osteogenic ability. Calf cortical bone scaffold with partial cancellous bone has good biocompatibility and degradability, which can be used as a carrier material of bone marrow mesenchymal stem cells. OBJECTIVE: To combine rabbit BMSCs with calf bone composite according to the basic principles of bone tissue engineering and to observe the osteogenesis in the New Zealand white rabbits after implantation of BMSCs/calf bone composite into the ilium, thereby providing a direct evidence for preliminary clinical application of tissue-engineered bone products.METHODS: BMSCs/calf cortical bone scaffold with partial cancellous bone (tissue-engineered bone group), simple calf heterogeneous bone (heterogeneous bone group) or autologous iliac bone (autologous iliac bone group) was randomly implanted into the rabbit ilium. The changes of implant surface and tissue reactions around the implant were observed.X-ray examination was performed to observe osteogenic changes at 4, 8, 12, 24 weeks after implantation. Immunohistochemistry staining was used to observe the expression of bone morphogenetic protein 2.RESULTS AND CONCLUSION: After heterogeneous bone implantation, the wound healed well, and there were no systemic or local inflammation and toxicity reactions in all groups. The X-ray results showed that at postoperative 24 weeks, the implant was basically fused with the host bone in the tissue-engineered bone group, but the fusion was unsatisfactory in the heterogeneous bone group. The process of ossifications from cartilages was observed in all groups by hematoxylin-eosin staining, and bone morphogenetic protein 2 was positive for immunohistochemical staining. Findings from in vivo experiments indicate that rabbit BMSCs seeded onto the calf cortical bone scaffold with partial cancellous bone could construct tissue-engineered bone by osteoinductation in vitro in the rabbits.

Risk factor analysis of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage / 中国脑血管病杂志

Objective To investigate the clinical risk factors of delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH).Methods From January 2015 to April 2016,106 consecutive patients with aSAH treated with endovascular embolization at the Department of Neurosurgery,Nanjing General Hospital of Nanjing Military Command were enrolled retrospectively.The patients were divided into either a DCI group (n =34) or a non-DCI group (n =72) according to whether the occurrence of DCI.The general information of patients were collected,including sex,age,Hunt-Hess grade,modified Fisher grade,world federation of neurosurgical societies (WFNS) grade,acute cerebral edema,early (bleeding 1-3 d) hypoalbuminemia,and hypohemoglobinemia.Univariate and multivariate Logistic regression analyses were used to analyze the risk factors for occurrence of DCI.Results The incidence of DCI was 32.1％ (34/106).The Hunt-Hess grade ≥ Ⅲ,modified Fisher grade ≥ Ⅲ,WFNS grade ≥ Ⅳ,acute cerebral edema,the incidences of hypoalbuminemia and hypohemoglobinemia in the DCI group were higher than those in the non-DCI group.There were significant differences between the 2 groups (all P ＜ 0.05).There were no significant differences in the ratios of sex,age ≥ 55 years,hypertension,diabetes and hyponatremia between the 2 groups (all P ＞ 0.05).In univariate analysis,the Hunt-Hess grade ≥ Ⅲ grade,modified Fisher grade ≥ Ⅲ,WFNS grade ≥ Ⅳ on admission,and hypoalbuminemia were used as the independent variables for multivariate analysis,the results showed that WFNS grade ≥ Ⅳ (OR,8.02;95 ％ CI 2.41-26.70),modified Fisher grades ≥ Ⅲ (OR,4.44;95％ CI 1.38-14.32),and hypoalbuminemia at day 1-3 (OR,5.42;95％ CI 1.40-20.76) were the independent risk factors for occurring DCI in patients with aSAH (all P ＜ 0.05),and the Hunt-Hess grade ≥ Ⅲ was not the risk factor for occurring DCI in patients with aSAH (OR,1.86;95％ CI 0.39-8.88,P ＞ 0.05).Conclusion The patients with hypoalbuminemia,WFNS grade≥Ⅳ on adrnission,and modified Fisher grade ≥ Ⅲ may were the independent risk factors DCI after aSAH,and the clinical diagnosis and treatment should attach great importance to.

Therapeutic effect analysis for open resection in osteoid osteoma around lesser trochanter of femur / 中南大学学报(医学版)

To evaluate the radiological features of osteoid osteoma around lesser trochante of femur, and to analyze the outcomes of treatment with open surgery.
 Methods: From July 2013 to August 2015, 14 patients (9 males, 5 females) with osteoid osteoma around lesser trochanter were retrospectively reviewed. The ages of patients were 9-44 (average 20) years old. The duration of symptom was 3-36 (average 8) months. After the X-ray plain radiography, CT and MR, all patients underwent open resection. No intense exercise was allowed in the first three months after the operation.
 Results: There were 9 cases of cortical type, and 5 cases of subperiosteal type. The niduses were found by plain radiographs in 9 patients. By CT scan, the niduses were found in all 14 patients. The average pre-operative visual analogue scale (VAS) without NSAIDs was 6.5. One month after the operation, the average VAS was 0 for all patients. The follow up time for all patients was 9-34 (average 20) months. No recurrence, infection, neurovascular injury or fracture was found during the follow up.
 Conclusion: Open resection is a feasible method for osteoid osteoma around lesser trochanter of femur with satisfied outcome and low complication rate.

Efficacy of reconstruction with modular endoprosthesis after resection of periacetabular malignant tumors / 中南大学学报(医学版)

OBJECTIVE@#To explore the efficacy of the resection of periacetabular malignant tumors and the reconstruction with modular endoprosthesis.
@*METHODS@#From August 2006 to December 2012, 22 patients with periacetabular malignant tumors, who received the resection and reconstruction with modular prosthesis, were retrospectively reviewed. There were 11 males and 11 females, and the average age was 44 (16-65) years old. Pathological results showed there were 13 cases of chondrosarcoma, 5 cases of osteosarcoma, 2 cases of Ewing's sarcoma, 1 case of maligant fibrous histiocytoma, and 1 case of giant cell tumor. According to the classification system by Enneking, there were 11 cases of Type II+III resection, 5 cases of Type I+II+III resection, 3 cases of Type I+II resection, and 3 cases of Type II resection.
@*RESULTS@#All patients were followed up. The average time for follow-up was 49 (11-103) months. At the last time of follow-up, 13 patients (59%) were still alive, 9 patients (41%) died due to their primary disease. Metastasis occurred in 8 patients (36%), and local recurrence occurred in 5 patients (23%). The mean Musculoskeletal Tumor Society (MSTS) score for 13 cases of alive patients at the latest time of follow-up was (18.5±5.7) months. The mean score for 11 patients, whose limb salvage were successful, was 20.7±2.0.
@*CONCLUSION@#Reconstruction with modular prosthesis after wide resection for periacetabular malignant tumor can achieve satisfied outcome.

Endovascular embolization and prognosis of middle cerebral artery aneurysms / 中国脑血管病杂志

Objective To investigate the effectiveness and safety of endovascular embolization for the treatment of middle cerebral artery aneurysms. Methods From March 2007 to May 2015,the clinical data of 170 patients with 173 middle cerebral artery aneurysms treated with endovascular embolization at the Department of Neurosurgery,Nanjing Jinling Hospital were analyzed retrospectively,including 120 (69.4%)ruptured aneurysms and 53 (30. 6%)unruptured aneurysms. The incidence of complications and prognosis were compared between the 2 groups. Results (1)A total of 170 patients who could perform endovascular embolization after preoperative evaluation successfully completed the interventional procedure. None of the patients died. (2)18 patients (10. 6%)had intraoperative and postoperative complications,including 4 (7. 5%,4/53)in the unruptured aneurysm group and 14 (11. 7%,14/120)in the ruptured aneurysm group. There was no significant difference in the incidence of complications between the two groups. (3)101 patients were followed up for 3-48 months. No new nervous system symptoms and reruptured aneurysm were observed. One patient had recurrence in the unruptured aneurysm group and 4 had recurrence in the ruptured aneurysm group. Conclusion Endovascular treatment of middle cerebral artery aneurysms is a safe,effective,and feasible technique.

Thromboelastographic evaluation of the different dosage anti-platelet aggregation drugs on stent-assisted embolization of intracranial aneurysms / 中国脑血管病杂志

Objective To evaluate the effects of different dosage of aspirin and clopidogrel on the platelet inhibition rate by thromboelastography (TEG)before stent-assisted embolization of aneurysms. Methods The clinical data of 57 patients with unruptured aneurysms treated by stent-assisted coil embolization in General Hospital of Nanjing Military Command were analyzed retrospectively. The patients were divided into a low dose group (aspirin 100 mg + clopidogrel 75 mg,26 cases)and a high dose group (aspirin 300 mg +clopidogrel 75 mg,31 cases). All the patients were treated with aspirin and clopidogrel before surgery. The blood samples were collected on day 3 after oral administration with anti-platelet aggregation drugs. TEG was used to detect the arachidonic acid (AA )-induced inhibition rate of platelet aggregation and adenosine diphosphate (ADP)-induced inhibition rate of platelet aggregation. The platelet inhibition and drug resistance,as well as ischemic complications in the perioperative period between the two groups were compared. Results (1 )The platelet inhibition rates:there was no significant difference in the inhibition rates of platelet aggregation of AA and ADP between low dose group and high dose group at day 3 after oral antiplatelet drugs [AA inhibition rate:(76 ± 21)% vs. (80 ± 21)%;ADP inhibition rate:(72 ± 26)% vs. (73 ± 29 )%;all P >0. 05 ]. (2 )Drug resistance:in the low dose group,the patients of aspirin and clopidogrel resistant were 2 cases(7. 7%)and 1 case(3. 8%),and the patients in high dose group were 3 cases (9. 7%)and 4 cases(12. 9%). No statistical significant difference in the aspirin and clopidogrel resistant was detected in the two groups (all P>0. 05). (3)The ischemic complications in the perioperative period:there was 1 case (3. 8%)with ischemic complications in the low dose group,and 2 cases (6. 5%)in the high dose group. There was no significance difference in the incidence of ischemic complications between the two groups(P >0. 05). Conclusion For patients treated with stent-assisted embolization of aneurysms,no difference could be detected in the inhibitory effect of platelet aggregation between low and high dose groups of aspirin.

Applicative value of three-dimensional DSA and MRI or CT fusion technology in the treatment of intracranial arteriovenous malformations / 中国脑血管病杂志

Objective Toinvestigatetheapplicativevalueof3D-DSAandheadMRIorCTfusion technology for guiding the individualized treatment of intracranial arteriovenous malformation (AVM ). Methods Twenty-onepatientswithAVMdiagnosedwithDSAattheDepartmentofNeurosurgery,Nanjing General Hospital of Nanjing Military Command from January 2015 to May 2015 were analyzed retrospectively. All patients performed DSA,MRI,and CT scan respectively before procedure,and they also performed 3 D-DSA and MRI or CT fusion. Of the 21 patients,15 performed MRI and 3D-DSA fusion,6 performed CT and 3D-DSA fusion. According to the image fusion results of the patients,the individualized treatment regimens were further developed,including microsurgical resection,endovascular embolization,and stereotactic radiotherapy (alone or combined treatment). The patients were followed up and observed for 2 to 6 months after procedure.Results Fromthe3D-DSAwithheadMRIorCTfusionimagesofthepatientsbeforetheprocedure not only could observe the vascular architecture of AVM,the relationship between the niduses and the surrounding nerve structures,but also could precisely locate the positions of AVM with small aneurysms or tiny AVMs. According to the results of image fusion,17 patients with AVM were treated with microsurgical resection,2 were treated with interventional embolization and stereotactic radiotherapy,and 2 were treated with stereotactic radiotherapy only. Of the 17 patients with AVM underwent microsurgical resection, none experienced intracranial rebleeding during the follow-up period. The last Glasgow outcome scale (GOS)score was 5 in 13 cases,and 4 in 4 cases. One patient with AVM underwent combined stereotactic radiotherapy had intracranial rebleeding during the follow-up period,and their last GOS score was 4. The other remaining 3 patients did not have new neurological deficits or rebleeding during the follow-up period,and theirGOSscorewas5.Conclusions 3D-DSA,headMRI,andCTfusiontechnologyarenovel, the operative method is simple,and the fusion image is accurate. They can effectively develop the individualized treatment regimens for patients with AVM.

Assessed values of color-coded digital subtraction angiography for intracranial arteriovenous malformation / 中国脑血管病杂志

Objective To investigate the preoperative and intraoperative assessed values of the color-coded digital subtraction angiography (DSA ) for intracranial arteriovenous malformation (AVM). Methods Fifteen patients with AVM performed preoperative routine whole brain DSA were analyzed retrospectively,and the iFlow software was used to perform color-coded DSA of image post-processing. A comprehensive analysis such as the range of lesions,vascular architecture and hemodynamics of AVM was conducted on the two-dimensional DSA images and color-coded DSA. Results Of the 15 patients with AVM,9 were small-sized (including 4 nidi showed diffuse type),3 were medium-sized,and 3 were large-sized;8 patients had single feeding artery,and 7 had multiple feeding arteries;11 had single draining vein,and 4 had multiple draining veins. When showing the size of AVM nidus,particularly diffuse type nidus, the color-coded DSA was clearer than the two-dimensional image. The color-coded DSA could visually display the traveling of the superficial and deep draining veins,at the same time,the primary and secondary draining veins could be identified according to the size of the area under the curve and the full width at half maximum,and intuitively reflected the complete cycle of cerebral blood flow. Conclusion The color-coded DSA can quickly and accurately depict the range of AVM,angioarchitecture features and intraoperative hemodynamic changes.

Study on CD31 expression in the process of the calf cortical with partial cancellous bone xenograft / 中国医师杂志

Objective To investigate the expression and tissue distribution of CD31 in the process of the calf cortical with partial cancellous bone xenograft, to explore the healing mechanism and relationship between bone remodeling and revascularization, and to provide a basis for the further study of tissue engi-neered bone.Methods Thirty-six New Zealand rabbits were selected as our experimental animals.All ani-mals were implanted with the calf cortical with partial cancellous bone.Specimens were procured at 4, 8, 12 and 24 weeks after surgery, respectively.The expression and tissue distribution of CD31 were observed in the process healing with general condition, X-ray, histology and immunohistochemistry.The image analy-sis computer system was used for quantitative analysis.The extent of revascularization and remodeling was separately represented by revascularization indexes and new bone areas.The relationship was studied be-tween bone remodeling and revascularization.Results ⑴ The X-ray showed significant healing.⑵ The positive expression of CD31 was seen in the whole process of bone xenograft and was different at various stage and sites.By the 4 weeks and 8 weeks postoperative,the strong positive expression was seen in the pe-ripheral soft tissue of graft bone, the callus of joint and the periphery of cartilage nests.Much positive ex-pression was seen in the cancellous bone.There was seen some single, cord, and cluster vascular endotheli-al cells.The positive expression was seen in the enlarged haversian canals and periphery.By the 24 weeks postoperative,the positive expression was seen in the enlarged haversian canals and periphery with increasing newborn capillaries.⑶ The correlation analysis between new bone areas and revascularization showed a closely positive correlation ( r =0.984).Conclusions The positive expression of CD31 was seen in the whole process of bone xenograft and was different at various stage and sites.The positive expression of CD31 reflected the extent of revascularization and bone remodeling of bone grafts.The extent of revascularization of bone grafts and bone remodeling showed a closely positive correlation.

Expression of bone morphogenetic protein 2 in human nonunion tissue and the clinical significance / 中南大学学报(医学版)

OBJECTIVE@#To explore the difference of bone formation potential between hypertrophic nonunion tissue and atrophic nonunion tissue, which may be beneficial to nonunion therapy.@*METHODS@#From October 2010 to March 2014, 40 nonunion tissue samples were collected in Department of Orthopedics, Second Xiangya Hospital. The samples were divided into a hypertrophic nonunion group (n=20) and an atrophic nonunion group (n=20) according to nonunion character; or a 20 to 35 years old group (n=18), a 36 to 50 years old group (n=18), a more than 50 years old group (n=4) according to different ages; or a 9-12 months group (n=21), 13-24 months group (n=14) and a more than 24 months group (n=5) according to different nonunion time. Semi-quantification was performed by SP immunohistochemical method and IPP6.0 was used to analyze the expression of bone morphogenetic protein-2 (BMP-2) through measuring the mean optical density.@*RESULTS@#The mean optical density of BMP-2 was 0.1540±0.0408 in hypertrophic nonunion tissue, 0.1372±0.0372 in atrophic nonunion tissue, there was no significant difference between the 2 groups (P>0.05). The mean optical density of BMP-2 was 0.1477±0.0379 in the 20 to 35 years old group, 0.1419±0.0399 in the 35 to 50 years old group, 0.1456±0.0595 in the more than 50 years old group, there was no significant difference among the three groups (P>0.05). The mean optical density of BMP-2 was 0.1449±0.0366 in the 9-12 months group, 0.1472±0.0400 in the 13-24 months group, 0.1445±0.0541 in the more than 24 months group, there was no significant difference among the 3 groups (P>0.05).@*CONCLUSION@#The present results suggest that the hypertrophic nonunion tissue share similar osteogenic potential with the atrophic nonunion tissue.

Treatment of external fixator in young patients with valgus deformity of the knee companied with leg shortening / 中南大学学报(医学版)

OBJECTIVE@#To explore the efficacy and experience of callus distraction technique with the external fixator for valgus deformity of the knee companied with leg shortening in young patients and to provide evidence for selecting reasonable therapy.@*METHODS@#From January 2002 to January 2009, the clinical data of 28 young patients (17 males and 11 females, aged 8 to 14, mean age 11.9 years) treated with callus distraction, who had valgus deformity of the knee, companied with leg shortening, were analyzed retrospectively. Three had bilateral total valgus deformity of the knee, with a total of 31 knees. Before the operation, the abnormal limbs shortened from 3 to 7 cm (average 4.1 cm) companied with the normal one. The tibiofemoral angle ranged from 138° to 160° (mean angle 148°) and the Condyle interval from 5 to 33 cm (mean interval 15.2 cm).@*RESULTS@#The 28 patients were followed up for 35 to 84 ( mean 62 ) months. The extent length ranged from 4.5 to 10.1 cm (average 6.8 cm). The tibiofemoral angle ranged from 169° to 175° (mean 173°) after the union. The patients resumed the normal length of limbs, and the severe valgus deformity of the knee was corrected.@*CONCLUSION@#Callus distraction with external fixator is effective for serious valgus deformity of the knee companied with leg shortening.

Medial head gastrocnemius muscle flap in the limb-salvage operation for proximal tibial osteosarcoma / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the efficacy of transposition of the medial gastrocnemius muscle flap in the limb-salvage operation for proximal tibial osteosarcoma.@*METHODS@#From January 2000 to January 2010, 65 patients [37 males, 28 females; (17.0±6.5) years] suffering from the proximal tibial osteosarcoma had a limb-salvage operation. According to the Enneking staging system, 35 patients were in stage IIa, 30 in stage IIb. All of the patients underwent resection of the osteosarcomas and reconstruction of the bone defect by prothesis. Among them, there were 35 patients underwent the medial head of the gastrocnemius muscle flap transposition to reconstruct the soft tissues and the other 30 didn't.@*RESULTS@#All the patients were followed-up. In the group with the transposition of medial gastrocnemius muscle flap, the length of tumor bone resection was (13.5±4.2) cm, operation time was (150±45) min, intraoperative blood loss was (700±135) mL, and drainage volume was (500±200) mL. In the group without the transposition of medial gastrocnemius muscle flap, the length of tumor bone resection was (12.3±5.8) cm, operation time was (135±37) min, intraoperative blood loss was (600±105) mL, and drainage volume was (450±250) mL. There was significant difference in the operation time (P0.05). In the group with the transposition of medial gastrocnemius muscle flap, local skin necrosis occurred in 2 patients (5.7%), and prosthesis deep infection occurred in 1 (2.9%). In the group without the transposition of medial gastrocnemius muscle flap, subctaneous hematocele, and effusion occurred in 3 (10.0%), wound infection occurred in 4 (13.3%), 1 cured and the other 3 developed prosthesis deep infection.There was significant difference in the rate of local complications (P<0.05). According to the function assessment by the Enneking system, in the group with the transposition of medial gastrocnemius muscle flap, 13 patients had excellent results, 17 had good results, 3 had fair results and 2 had poor results, with a satisfaction rate of 85.7%. In the group without the transposition of medial gastrocnemius muscle flap, 10 patients had excellent results, 12 had good results, 5 had fair results and 3 had poor results, with a satisfaction rate of 73.3%. There was significant difference in function assessment between the 2 groups (P<0.05).@*CONCLUSION@#The flap transposition of the medial head of the gastrocnemiusmuscle can reconstruct the soft tissue defect, decrease the local complication rate and improve the clinical outcomes of the limb-salvage for the proximal tibia osteosarcoma.

Callus distraction in bone defect and leg shortening of femur after osteomyelitis / 中南大学学报(医学版)

OBJECTIVE@#To explore the efficacy of callus distraction performed by external fixtor in the reconstruction of bone defect and leg shortening of femur after osteomyelitis.@*METHODS@#Nineteen child patients with bone defect and leg shortening after ostemomyelitis were treated by callus distraction with external fixator. The mean length of the bone defect was 1.3 cm. The mean leg-length discrepancy was 4.8 cm.@*RESULTS@#All patients were followed up for 21-82 months. The bone lengthening area grew well, the length of callus distraction was 4.5-8.0 cm, and the mean radiographic consolidation index was 39.7 d/cm. According to the Paley's criteria, the healing effect of 14 cases was excellent, and that of the rest 5 cases was good. The functional recovery of 11 cases was excellent, and that of the rest 8 cases was good.@*CONCLUSION@#Callus distraction is a reliable method in the reconstruction of bone defect and leg shortening caused by ostemomyelitis.

Limping gait improvement by femoral lengthening in ankylotic hips and limb length discrepancy in young adults / 中南大学学报(医学版)

To investigate the clinical improvement of limping gait in patients with ankylotic hips and limb length discrepancy.Methods:From 1996 to 2005,12 patients with ankylotic hips and limb length discrepancy were treated by distraction osteogenesis with a mono-lateral external fixator and an intramedullary nail.The limb length discrepancy was 6.20-12.50 (median 8.45) cm.Limping gait was classified according to the recommendations of the American Academy of Orthopedic Surgeons/Hip Society and scored according to Harris:no limping scored 11 points,mild limping scored 8 points,moderate limping scored 5 points,while severe limping scored 0 points.Limping gait was severe in all patients pre-operatively and the total score was 0.Results:All patients were followed up for 30.00-46.00 (median 38.55) months,and all reported improvement in limping gait.The gain in length was 6.00-12.50 (median 8.20) cm,and the mean residual limb length discrepancy was 0-0.50 (median 0.20) cm.The total treatment time was 41.00-82.00 (median 61.50) weeks,the lengthening time was 14.00-38.00 (median 29.55) weeks.At the last follow-up,10patients had mild limping gait and 2 had moderate limping gait; the total score was 90.00.The median score was 7.50 (P25 was 8.00,P75 was 8.00).According to Wilcoxon signed rank test,the post-operative limping gait scores were significantly higher than pre-operative (P=0.001 ).Conclusion:Femoral lengthening can improve the limping gait significantly in ankylotic hips and limb length discrepancy.

Experimental study of rabbit bone mesenchymal stem cells seeding onto xenogenic calf cortical bone with partial trabecular bone / 中南大学学报(医学版)

OBJECTIVE@#To explore the possibility of xenogenic calf cortical bone with partial trabecular bone as cell carriers in tissue engineering, and to provide direct evidence for clinical application of matrix scaffold.@*METHODS@#Rabbit bone mesenchymal stem cells (BMSCs) were seperated and cultured on the surface of xenogenic calf cortical bone with partial trabecular bone. Relative growth rate was measured and cytotoxicity was graded. The growth, proliferation and matrix secretion of BMSCs in calf cortical strut were observed by scanning electron microscope. Sixty 3-month-old New Zealand rabbits were divided into 3 groups (20 in each group): a BMSCs/bone xenograft group, a simple bone xenograft group and an autogenous iliac bone group. Each group was implanted with the BMSCs induced osteogenic composite calf bone, simple bone xenograft and autogenous iliac bone into the ala of ilium. The expressions of bone morphogenetic protein-2 (BMP-2) mRNA were detected by reverse transcription polymerase chain reaction in 4, 8, 12, 24 weeks after the operation.@*RESULTS@#The toxicity gradation was 0 to 1. BMSCs adhered the surface of calf cortical strut and extended in the cancellous bone, and extracellular matrices were found. The BMP-2 mRNA expression in the simple bone xenograft group was lower than that in the BMSCs/bone xenograft group and the autogenous iliac bone group at all time points (P<0.05),which was lower in the BMSCs/bone xenograft group than that in the autogenous iliac bone group (P<0.05).@*CONCLUSION@#Rabbit BMSCs combined with calf cortical bonescaffold with partial cancellous bone have good osteogenic capacity in the New Zealand rabbits.

Study on the expression and significance of nucleolin in osteosarcoma / 中国医师杂志

ObjectiveTo investigate the expression of nucleolin in osteosarcoma and its clinicalsignificance.MethodsThe expression of nucleolin was evaluated by immunohistochemistry in paraffin-em bedded tissues from 35 cases of osteosarcoma and 15 cases of osteochondroma.ResultsAmong the osteo sarcoma cases, 8.6％ were negative for nucleolin, 20％ weakly positive, 34.3％ moderate positive, 37.1％ strong positive.The positive rate of nucleolin in osteochondroma was 40％, 46.7％, 13.3％, 0％, respectively.The nucleolin expression showed significant difference in the osteosarcoma and osteochondroma(P ＜0.01).Among the conventional ostcosarcoma cases, 6.9％ were negative for nucleolin, 13.8％ weakly positive, 34.5％ moderate positive, 44.8％ strong positive.The positive rate of nucleolin in paros teal osteochondroma was 16.7％, 50％, 33.3％, 0％, respectively.The nucleolin expression showed re markable correlation with pathological and genetical classification (P ＜ 0.05).The positive rate of nucleo 1in in osteoblastic osteochondroma was 5.9％, 5.9％, 29.4％, 58.8％, while in chondroblastic osteochon droma 0％, 33.3％, 33.3％, 33.3％ and 16.7％, 16.7％, 50％, 16.7％ in fibroblastic osteochondro ma, respectively.The positive expressions of nucleolin were almost the same in each subtype of osteosarco ma (P ＞ 0.05).ConclusionsThe nucleolin expression had correlation with property of tumors in bone, and the positive expressions of nucleolin had correlation with pathological and genetic classification of osteo

A clinical analysis on three methods for osteoarthritis of the knee / 中国微创外科杂志

Objective To compare the clinical effects of three methods in the treatment of osteoarthritis of the knee. Methods Three groups of patients received arthroscopic debridement, sodium hyaluronate injection and combined use of these two methods, respectively. Results All the patients were followed for more than 2 years. According to degrees of joint pain, joint swelling , range of motion and patients’ walking functions, comprehensive scores were obtained. In arthroscopic group, it gave good or excellent results in 86 7% of the patients 6 months ～ 1 year, in 78 8% of the patients 1 year ～ 2 years and 66 2% of the patients after 2 years. In sodium hyaluronate group, the good or excellent rates were 80 6% 6 months ～ 1 year, 72 8% 1 year ～ 2 years and 56 2 % after 2 years, respectively. In combination therapy group, the good or excellent rates were 96 8 % 6 months ～ 1 year, 87 2% 1 year ～ 2 years and 78 1% after 2 years, respectively. Conclusions All the three methods are effective: the combination treatment of arthroscopic debridement and sodium hyaluronate injection is markedly effective, the arthroscopic debridement takes the second place, and the sodium hyaluronate injection is less effective.

Experimental study of angiogenin factors secreted by bone marrow mononuclear cells cultured in vitro / 中国医师杂志

Objective To define the secretory capability of angiogenin factors by bone marrow mononuclear cells(BM-MNC) cultured in vitro.Methods Rat BM-MNCs were isolated by centrifugation through a Histopaque density gradient and cultured for four weeks in vitro.The levels of vascular endothelial cell growth factor(VEGF),basic fibroblast growth factor(bFGF) and interleukin-1?(IL-1?) were tested by enzyme-linked immunosorbent assay(ELISA).Results The levels of VEGF in the conditioned medium at 1,2,3 and 4 weeks were(24.40?7.99),(89.28?5.13),(115.24?10.08) and(157.00?15.64) pg/ml,respectively.The levels of bFGF at 1,2,3 and 4 weeks were(52.72?2.13),(48.10?6.41),(44.71?3.21) and(25.61?2.42) pg/ml respectively,and those of IL-1? were(31.28?5.44),(71.87?3.01),(55.77?11.94) and(41.75?9.14),respectively.Conclusion The BM-MNCs can persistently secrete potent angiogenic cytokines such as VEGF,bFGF and IL-1?.