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Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.
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Objective:To investigate the clinical efficacy of fixed-bearing unicompartmental knee arthroplasty (UKA) in the treatment of anteromedial knee osteoarthritis or spontaneous osteonecrosis of the femoral condyle.Methods:Between June 2017 and June 2018, 62 consecutive patients were treated at Department of Joint Surgery, Fuzhou Second Hospital Affiliated to Xiamen University for anteromedial knee osteoarthritis or spontaneous osteonecrosis of the femoral condyle using a fixed-bearing UKA system. They were 27 men and 35 women, aged from 58 to 85 years (average, 69.8 years). There were 58 cases of anteromedial knee osteoarthritis and 4 cases of spontaneous osteonecrosis of the femoral condyle. The courses of disease ranged from 2 to 10 years (average, 5.1 years). Medial unicompartmental knee arthroplasty was performed for all the patients on the fixation platform SLED. Recorded were the hip-knee-ankle angle (HKA) of the patients 2 days after operation, Oxford knee score (OKS) and American Knee Society score (KSS) at the final follow-up and post-operative complications.Results:The 62 patients were followed up for 9 to 21 months (average, 15.6 months). Tibial plateau fracture occurred in one case who eventually obtained bony union after open reduction and internal fixation. Another case had a wound healing problem which responded to drainage and debridement with prosthesis preservation. Another case presented prepatellar pain which was improved after physical therapy. In the 62 patients, the HKA 2 days after operation (172.27°±1.61°) was significantly improved compared to the preoperative value (177.79°±1.32°), the OKS at the final follow-up (19.8±2.7) significantly lower than the preoperative value (50.2±3.1), and the KSS at the final follow-up (89.7±2.6) significantly higher than the preoperative value (49.6±5.2) (all P<0.05). Follow-ups revealed no cases of joint infection or prosthetic loosening. Conclusion:Fixed-bearing unicompartmental knee arthroplasty can lead to fine short-term outcomes for anteromedial knee osteoarthritis or spontaneous osteonecrosis of the femoral condyle.
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BACKGROUND:Direct anterior approach has been reported to be associated with a risk of reaming the anterior column of the acetabulum,but there is little evidence supporting this opinion.OBJECTIVE:To reveal differences in the bone stock of the anterior and posterior columns between the direct anterior approach and the posterolateral approach in total hip arthroplasty by CT measurement.METHODS:Sixty cases of primary total hip arthroplasty through direct anterior approach (n=30) or posterolateral approach (n=30) at Fuzhou Second Hospital of Xiamen University from October 2015 to December 2017 were enrolled.The cross-sectional area of the anterior and posterior column of the acetabulum,the height of the anterior and posterior column,acetabular diameter,and anteversion were measured by CT.All researchers had 5-10 years of clinical experience,and the surgeons were associate chief physicians or above.The trial has been approved by the Ethics Committee of Fuzhou Second Hospital of Xiamen University on June 1,2017.All patients signed the written informed consents.RESULTS AND CONCLUSION:(1) The postoperative cross-sectional area of the anterior and posterior column of the acetabulum,and the height of the anterior and posterior column in the two groups were less than those at baseline (P ＜ 0.05),the acetabular diameter was larger than that at baseline (P ＜ 0.01),and the anteversion showed no significant difference (P ＞ 0.05).The area of the anterior column in the direct anterior approach group was higher than that in the posterolateral approach group (P ＜ 0.05),and other parameters were insignificantly different between two groups (P ＞ 0.05).(2) in summary,compared with posterolateral approach in total hip arthroplasty,direct anterior approach leads to increased area of the anterior column,and made no effect on other parameters.Thereafter,direct anterior approach is not a risk factor for eccentric reaming the anterior column of acetabulum,and the conclusion needs to be confirmed by multicenter,prospective randomized controlled trials.
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BACKGROUND:Previous studies have shown that apoptosis, a central feature of articular chondrocytes, plays a dominant role in cartilage damage, which is one of the pathological factors of articular cartilage degeneration. OBJECTIVE:To observe the effects of meditcated serum containingDuhuojisheng Decoction on the expression of cytochrome C, proCaspase-9 and proCaspase-3 in rat degenerative chondrocytes in vitro and to investigate the possible molecular biological mechanism ofDuhuojisheng Decoction in the treatment of knee osteoarthritis. METHODS:A cultivation system of degenerative chondrocytes in vitro was established. After treatment with meditcated serum containingDuhuojisheng Decoction or blank serum for 24 and 48 hours, the protein expression of cytochrome C, proCaspase-9 and proCaspase-3 was measured by western blot assay. RESULTS AND CONCLUSION: In the cytoplasm, the release of cytochrome C was reduced gradualy in both groups in a time-dependent manner, and the release amount of cytochrome C was significantly lower in the medicated serum group than the blank serum group (P < 0.05). In mitochondria, cytochrome C leakage was gradualy decreased in both groups, and it was decreased significantly in the medicated serum group compared with the blank serum group (P < 0.05). The protein expression of proCaspase-9 and proCaspase-3 was gradualy increased in both groups, especialy in the medicated serum group; the medicated serum containingDuhuojisheng Decoction could promote the protein expression of proCaspase-9 and proCaspase-3 in a time-dependent manner, and there was a significant difference at 24 and 48 hours (P< 0.01). These findings indicate that the medicated serum containingDuhuojisheng Decoction can inhibit the apoptosis of osteoarthritis chondrocytes through inhibiting the release of cytochrome C and the activation of Caspase-9 and Caspase-3.
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BACKGROUND:Due to variation of spinal anatomic structure, vertebral body rotation, absence of vertebral body, and spinal canal deformation in patients with scoliosis, the deviation of pedicle screw placement can induce catastrophic results. Recently, with the wide application of pedicle screw and the continuous development of computer navigation, scoliosis surgery becomes more accurate and safe. OBJECTIVE:To review the existing problems and advantages of Iso-C arm three-dimensional (3D) navigation system for guiding internal fixation of pedicle screw implantation in the treatment of scoliosis. METHODS: The first author searched PubMed (http://www.ncbi.nlm.nih.gov/PubMed) and CNKI (http://www.cnki.net/) for articles published until December 2012. The key words were “computer navigation, scoliosis, pedicle screw”. The literatures with abstracts containing above key words were retrieved. Totaly more than 50 articles were found, and 13 articles were accorded with the inclusion criteria. RESULTS AND CONCLUSION: Iso-C arm 3D navigation system for guiding internal fixation of pedicle screw implantation in the treatment of scoliosis had obvious advantages. It fuly combined the advantages of CT 3D navigation and intraoperative X-ray navigation, and can quickly and accurately capture the image data. Real time display of images could ensure the safety of repair operation. Automatic registration function of Iso-C arm 3D navigation undoubtedly improves the efficiency and accuracy of the repair, and helps physicians with more accurate and safe ways to carry out a variety of complex scoliosis surgery.
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[Objective] To study the effect of celecoxib on osteoblast apoptosis induced by titanium particle in neonatal rats. [Methods]The best in vitro celecoxib serum concentration for promoting proliferation of osteoblast in neonatal rats was obtained through MTT.One group of rat osteoblast in vitro was cultured with serum containing saline and titanium particle and the other was cultured with serum containing celecoxib and titanium particles.Concentrations of TNF-? and PGE-2 in cells collected after 24 hours were analyzed by ELLSIA,COX-2 mRNA and protein were indicated by FO-PCR and Westren blot.[Results]Some cellar factors such as COX-2,TNF-? and PGE-2 could be induced by titanium particle in in vitro,but celecoxib could inhibit expression of these factors by COX-2 pathway.[Conclusion]Celecoxib coule be a promising drug for treatment of aseptic loosening.
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Background and Purpose:Cyclooxygenase-2(COX-2) plays an important part in tumor genesis,growth,and angiogenesis.Many inhibitors of COX-2 could inhibit proliferation and induce apoptosis of cancer cells. This study investigated the impact of NS398 on anti-proliferation and the induction of apoptosis in human osteosarcoma cell line MG-63.Methods:Cell proliferation is measured by MTT method.Characteristic changes of apoptosis in morphology are observed by fluorescence microscopy、transmission electron microscopy(TEM) and quantitatively by TDT-mediated dUTP-biotin nick end-labeling(TUNEL) assay.The apoptotic rates are calculated by flow cytometry(FCM).Results:The growth inhibition rates of MG-63 cells treated with 1,10,50,100 and 200 ?mol/L NS398 are 14.7%,23.5%,33.6%,52.5% and 81.4%,respectively(P
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Objective To investigate the relationship between ovary excision and serum levels of TNF ?, TGF ? 1. Methods Serum levels of TNF ? and TGF ? 1 in ovariectomized rats were measured by ELISA. Results The serum levels of TNF ? were increased〔(53 88?16 35)ng/L〕, but the TGF ? 1 were decreased 〔(6 78?0 75)?g/L〕 in ovariectomized rats when E 2 decreased compared with those of the Sham group( P