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Osteonecrosis of the femoral head (ONFH) is one of the common and difficult-to-treat orthopedic diseases caused by a variety of factors that lead to abnormal blood flow to the femoral head, which in turn leads to deformation and collapse of the femoral head and eventually results in severe hip joint dysfunction. The key to the treatment is early diagnosis and correct treatment according to the stage classification and active prevention of further aggravation of ONFH aiming to delay or avoid hip replacement surgery in young and middle-aged patients. At present, there are various non-surgical and surgical hip-preserving modalities for early ONFH, designed to slow down the progression of the disease, prevent the femoral head from collapsing and stop the mild collapse. In recent years, with the emergence and development of bone reconstruction biomaterials, artificial bone reconstruction after scraping of ONFH lesions has shown great potential in the treatment of early ONFH. The authors review the research progress in hip-preserving modalities for early ONFH in young and middle-aged patients from non-surgical and surgical perspectives, hoping to provide a reference for clinical treatment of early ONFH.
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Objective:To investigate the efficacy of single locked-plate internal fixation combined with autologous iliac bone graft in the treatment of Rorabeck type II periprosthetic distal femural fracture (PDFF) after total knee arthroplasty (TKA).Methods:A retrospective case series study was made on 13 patients suffering from Rorabeck type II PDFF after primary TKA together with severe osteoporosis (T value≤ -2.5 SD) admitted to 940th Hospital of Joint Logistics Support Force of PLA from January 2016 to December 2020, including 4 males and 9 females, aged 65-85 years [(75.2±6.5)years]. All patients were treated with single locked-plate internal fixation combined with autologous iliac bone graft. Anti-osteoporosis and early standardized joint function rehabilitation were undertaken postoperatively. The operation time and intraoperative blood loss were recorded. The range of motion of knee joint was compared before operation, at postoperative 3, 6 and 12 months and at the last follow-up. The Hospital for Special Surgery (HSS) knee score was assessed at postoperative 3, 6 and 12 months and at the last follow-up to evaluate the recovery of knee joint function. The bone mineral density was reexamined at postoperative 6 months and 12 months to evaluate the therapeutic effect of anti-osteoporosis. Complications were detected as well.Results:All patients were followed up for 12-72 months [(43.2±19.9)months]. The operation time was 90-135 minutes [(103.8±12.6)minutes], with the intraoperative blood loss of 100-250 ml [(150.0±45.6)ml]. The range of motion of knee joint was (114.6±7.8)°, (90.4±8.0)°, (97.3±4.8)° and (98.1±6.3)° before operation and at postoperative 3, 6 and 12 months (all P<0.05). The HSS knee score was (80.2±2.2)points, (84.6±2.9)points and (87.3±3.3)points at postoperative 3, 6 and 12 months (all P<0.05). The knee joint function was excellent in 10 patients and good in 3 at postoperative12 months, and the excellent and good rate was 100%. The T value of bone mineral density was (-3.8±0.6)SD, (-3.4±0.6)SD and (-2.9±0.6)SD preoperatively and at postoperative 6 months and 12 months (all P<0.05). One patient experienced nonunion and was cured after secondary autologous iliac bone grafting combined with recombinant human bone morphogenetic protein-2 (rhBMP-2) bone grafting. Three patients developed venous thrombosis of lower limbs and were cured with oral administration of rivaroxaban. One patient had mild knee flexion and extension limitation and was improved after manual release under femoral nerve block anesthesia and subsequent functional rehabilitation. Conclusion:For patients with Rorabeck type II PDFF after TKA, single locked-plate internal fixation combined with autologous iliac bone graft has advantages of short operation time, few intraoperative bleeding, satisfactory knee range of motion and functional recovery as well as significant improvement of bone mineral density.
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The amino group PEGylation of rhIFNomega with monomethoxy polyethylene glycol succinimidyl succinate (mPEG-SS, 20 000) was investigated, and the modified mixture was separated and purified by ion exchange chromatography and gel filtration chromatography. Under the optimized purification conditions, the average content ofmono PEG-rhIFNomega in the collect liquid reached 182 microg x mL(-1). The average purified yield of mono PEG-rhIFNomega exceed to 22%, and the purity of mono PEG-rhIFNomega was greater than 98% by SDS-PAGE and RP-HPLC. Relative molecular mass of mono PEG-rhIFNomega was 43 790 detected by MALDI-TOF MS. The apparent molecular mass measured by SDS-PAGE was about 60 810. The purified PEG-rhIFNomega has the characteristics of typical PEGylated protein. Activity reservation rate of mono PEG-rhIFNomega was 15.0%, while the antigenicity decreased by at least 64 folds. In addition, the acid stability, thermal stability and stability in serum and trypsin solution of mono PEG-rhIFNomega were markedly better than those of the rhIFNomega. The pharmacological properties of mono PEG-rhIFNomega were significantly improved. The prepared PEG-rhIFNomega might be developed to a novel safe and long-acting interferon.
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Objective To investigate the effect of the decoction to help recover intestinal function on the intestinal mucosal barrier of rats with gut ischemia-reperfusion injury. Methods Forty-five SD rats were divided into three groups randomly: control group,gut ischemia-reperfusion injury group and decoction group.We detected the content of DAO and D-lactate in serum and lysozyme in perfusate of intestine in each group.We observed the bacteria translocation,the change of ileum mucous membrane in pathomorphology and intestinal villi. Results Compared with those in gut ischemia-reperfusion injury group,the contents of DAO and D-lactate and bacteria translocation ratio were all lower in decoction group(P
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Objective To investigate the effect of Intestinal Function-recovering Decoction on the bacteria and endotoxin translocation and the content of malondialdehyde(MDA)and superoxide dismutase(SOD)in serum of rats with multiple organ dysfunction syndrome(MODS).Methods Fifty-seven SD rats were divided into four groups randomly:control group,MODS group,decoction group and ampicillin group.We detected the content of endotoxin in the peripheral vein,portal vein and ileum.Bacterial translocation,change of ileum mucous membrane in pathomorphology and the contents of MDA,SOD,ALT,AST,Cr and BUN in serum in each group were also examined.Results The hepatic and renal function and ileum mucous membranes were significantly damaged in MODS group,decoction group and ampicillin group.Compared with those in MODS group,serum MDA,ALT,AST,Cr,BUN and endotoxin in the peripheral vein,portal vein and ileum in decoction group were significantly lower(P0.01).It exhibited a negative correlation between serum MDA and SOD in MODS group and ampicillin group(P
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Objective To investigate the possible protective effects of hydrogen sulfide (H2S) on rats with multiple organ dysfunction syndrome (MODS). Methods NaHS was taken as a donor of H2S. Forty Sprague-Dawley rats were divided into 5 groups with 8 rats in each group:sham group,MODS 12 h model group,MODS 24 h model group,NaHS protection 12 h and 24 h groups. The content of superoxidase dismutase (SOD),malondialdehyde (MDA),glutathione peroxidase (GSH-Px),alanime transaminse (ALT),creatine kinase (CK) and creatinine (Cr) in serum were measured,respectively. The histopathological changes in the heart,liver,lung,kidney and small intestine were observed. Results The serum content of SOD and GSH-Px was significantly higher in protected H2S groups (P