Exploring the intervention mechanism of Ginkgo biloba for steroid-induced necrosis of the femoral head based on network pharmacology / 中国临床药理学与治疗学

AIM: To explore the mechanism of Ginkgo biloba in the treatment of steroid-induced osteonecrosis of the femoral head based on network pharmacology. METHODS: The active ingredients and targets of Ginkgo biloba were predicted by the TCMSP, ADME, and PharmMapper databases. The disease targets related to steroid-induced osteonecrosis of the femoral head were searched by the GeneCards and OMIM databases. Cytoscape 3.6.1 was used to construct a protein-protein interaction network. The core target analysis, modular analysis, GO enrichment analysis, and KEGG pathway analysis of the targets of Ginkgo biloba in the intervention of steroid-induced osteonecrosis of the femoral head were performed by the STRING database. RESULTS: In this study, a total of 16 active ingredients of Ginkgo biloba and 547 targets were screened, of which 133 targets were related to steroid-induced femoral head necrosis. By PPI network topology analysis, TP53, AKT1, IL6, VEGFA, MAPK1, JUN, MAPK8, EGFR, EGF, and MYC were identified as the core targets. GO modularization analysis showed that these core targets were mainly related to apoptosis and angiogenesis. GO enrichment analysis was used to analyze the biological processes, cellular localization, and molecular functions of the core targets. KEGG enrichment analysis showed that the targets were mainly involved in molecular signaling pathways, among which the PI3K/AKT signaling pathway was the most relevant. CONCLUSION: Ginkgo biloba can inhibit steroid-induced osteonecrosis of the femoral head through multiple components, targets, and pathways, which provides the theoretical basis and reference for subsequent cell and animal experiments.

Research status and development of biodegradable zinc alloy as orthopedics implant / 生物医学工程学杂志

Znic (Zn) alloys with good cytocompatibility and suitable degradation rate have been a kind of biodegradable metal with great potential for clinical applications. This paper summarizes the biological role of degradable Zn alloy as bone implant materials, discusses the mechanical properties of different Zn alloys and their advantages and disadvantages as bone implant materials, and analyzes the influence of different processing strategies (such as alloying and additive manufacturing) on the mechanical properties of Zn alloys. This paper provides systematic design approaches for biodegradable Zn alloys as bone implant materials in terms of the material selection, product processing, structural topology optimization, and assesses their application prospects with a view to better serve the clinic.

Bone/cartilage immunomodulating hydrogels: construction strategies and applications / 中国修复重建外科杂志

OBJECTIVE@#To review the research progress in the construction strategy and application of bone/cartilage immunomodulating hydrogels.@*METHODS@#The literature related to bone/cartilage immunomodulating hydrogels at home and abroad in recent years was reviewed and summarized from the immune response mechanism of different immune cells, the construction strategy of immunomodulating hydrogels, and their practical applications.@*RESULTS@#According to the immune response mechanism of different immune cells, the biological materials with immunoregulatory effect is designed, which can regulate the immune response of the body and thus promote the regeneration of bone/cartilage tissue. Immunomodulating hydrogels have good biocompatibility, adjustability, and multifunctionality. By regulating the physical and chemical properties of hydrogel and loading factors or cells, the immune system of the body can be purposively regulated, thus forming an immune microenvironment conducive to osteochondral regeneration.@*CONCLUSION@#Immunomodulating hydrogels can promote osteochondral repair by affecting the immunomodulation process of host organs or cells. It has shown a wide application prospect in the repair of osteochondral defects. However, more data support from basic and clinical experiments is needed for this material to further advance its clinical translation process.

Degradable high purity magnesium screw in fixing the greater trochanter bone flap pedicled with transverse branch of lateral circumflex femoral artery: Treatment of avascular necrosis of femoral head in 12 young and middle-aged patients / 中华显微外科杂志

Objective:To investigate the effect of a degradable high-purity magnesium screw in fixing the greater trochanter bone flap of a lateral circumflex femoral artery transverse branch in the treatment of ischemic necrosis of femoral head in young and middle-aged adults.Methods:From February 2017 to February 2019, 12 cases (15 hips) of young and middle-aged patients with avascular necrosis of femoral head were treated in the Department of Orthopaedic of Affiliated Zhongshan Hospital of Dalian University. The age of patients was 30-53 years old. According to Association Research Circulation Osseous (ARCO), 2 hips were graded in stage II b, 4 in ARCO II c, 1 in ARCO III a, 5 in ARCO III b, 2 in ARCO III c and 1 in ARCO IV. The greater trochanter bone flap with a lateral circumferential vascular branch was used to fill the necrotic area, and fixed by a biodegradable high purity magnesium screw in the bone flap transfer. At 3, 6 and 12 months postoperation, the patient came to the hospital outpatient clinic for follow-up, and then were reviewed once a year. Imaging efficacy was evaluated by comparing preoperative and postoperative imaging. The Harris score and Visual Anoalogue Scale (VAS) score were tested at 12 and 24 months after surgery. The Harris score and VAS score before and after surgery were compared by Friedman test, and P<0.05 was considered statistically significant. Results:All 12 patients (15 hips) were entered in the 24-36 months of follow-up. At 12 and 24 months after surgery, Harris score was found at 87 (86, 92) and 90 (87, 92) respertively, which were both higher than that before surgery [59 (52, 74)] with a significant statistical difference ( Z=-3.743, Z=-4.473, P<0.05). However, there was no significant difference in Harris scores between 12 and 24 months after the surgery ( Z=-0.730, P>0.05). At the 12 and 24 months after surgery, VAS score was found at 3 (2, 3) and 2 (1, 3) respertively, which were both lower than that before surgery [6 (5, 6) ] with a significant statistical difference ( Z=-3.560, Z=-4.656, P<0.05). There was no statistical difference in VAS scores between 12 and 24 months after surgery ( Z=-1.095, P>0.05). X-ray and CT scan showed that the bone flaps healed well and the areas of osteonecrosis were repaired. Thirteen femoral heads were in good shape, and 2 femoral heads had further collapse of hips. No patients underwent joint replacement surgery at the time of last follow-up. Conclusion:Fixation of the greater trochanter flap of lateral circumflex femoral artery transverse branch with a degradable high-purity magnesium screw can ensure the healing of the flap at the implantation site and avoid the displacement and shedding of the flap. It is a new therapeutic option to treat the avascular necrosis of femoral head of young and middle-aged people.

Flap combined with 3D printed microporous tianium(tantalum)prosthesis in the treatment of lower extremity soft tissue defect with large bone defect / 中华显微外科杂志

Objective:To investigate the effect of flap combined with 3D printed microporous titanium(tantalum)prosthesis in the treatment of lower extremity soft tissue defect with large bone defect.Methods:From January 2019 to December 2020, 2 patients with large soft tissue defects on dorsal foot together with large metatarsal bone defect and 4 patients with soft tissue defects of calf with large tibial bone defect were treated. The areas of soft tissue defect were 5.0 cm×8.0 cm-15.0 cm×10.0 cm. The length of the bone defect were 3.8 cm to 7.0 cm, 5.75 cm in average. In the first stage, metatarsal bone defect or tibial bone defect was filled with vancomycin blended bone cement, meanwhile, soft tissue defect was repaired with anterolateral femoral flap(ALTF) with vascular anastomosis in 2 cases of feet, and local fascia flap was trans-positioned in 4 cases of lower extremity defects. The sizes of repairing flap were 6.0 cm×8.5 cm-16.0 cm×11.0 cm. Two to 7 months after the initial surgery, the customer designed microporous titanium prostheses were used(5 cases with microporous titanium and 1 with microporous tantalum) to repair the bone defects. The wound healing, the integration of metatarsal and tibial fractures with 3D printed microporous titanium(tantalum) prostheses, and the walking condition were observed after surgery. The follow-up lasted from 6 to 25 months, with an average of 12.7 months.Results:The wound healing in 5 patients was good. The patients stood on the foot in 2 months after surgery, started to walk with the assistance of crutch in 3 months after surgery, and took walk without assistance in 5-6 months after surgery. Good osseous integration were achieved. One diabetic patient had infection of foot wound 3 months after surgery. After removal of microporous titanium prosthesis and replacement of vancomycin blended interstitial substance of bone cement, the wound healed and the patient resumed walking.Conclusion:It is an effective method to encourage the patients to take early ambulation after the surgery for lower extremity soft tissue defect with large bone defect that was repaired by a flap and 3D printed microporous titanium(tantalum)prosthesis. Further observations are required to investigate the long-term efficacy, and the reduction of prosthesis infection rate requires further exploration.

ARCO Consensus on the Pathogenesis of Non-traumatic Osteonecrosis of the Femoral Head

Osteonecrosis of the femoral head (ONFH) is a devastating disease frequently leading to femoral head collapse and hip arthritis. Specifically, non-traumatic ONFH primarily affects young and middle-aged adults. Although compromised local circulation of the femoral head seems to be pathognomonic for the disease, the pathogenesis is perplexing and continues to be an area of scrutiny and research. Comprehension of the pathogenesis is of crucial importance for developing and guiding treatments for the disease. Therefore, we provide an up-to-date consensus on the pathogenesis of non-traumatic ONFH.

Osteonecrosis of the Femoral Head: an Updated Review of ARCO on Pathogenesis, Staging and Treatment

Non-traumatic osteonecrosis of the femoral head (ONFH) usually affects adults younger than 50 years and frequently leads to femoral head collapse and subsequent arthritis of the hip.It is becoming more prevalent along with increasing use of corticosteroids for the adjuvant therapy of leukemia and other myelogenous diseases as well as management of organ transplantation. This review updated knowledge on the pathogenesis, classification criteria, staging system, and treatment of ONFH.

Research progress on mechanism of osteoinduction of bone marrow mesenchymal stem cells / 中华骨科杂志

The treatment of large-segment bone defects is a severe trouble. The emergence of bone tissue engineering, a current research hotspot, has brought promising treatment strategies to this field. Bone marrow mesenchymal stem cells (BMSCs), as a kind of seeding cells for bone tissue engineering, have multipotentials, including easy isolation and culture, abundant sources and easy to expand. BMSCs can be differentiated into osteoblasts by a variety of methods to achieve the purpose of bone repairing. Currently, the components to induce osteogenic differentiation of BMSCs include cellular factors, hormones, biological materials, traditional Chinese medicine, physical stimulation and non-coding RNA. Osteogenic differentiation of BMSCs is a very complex process, which is controled by kinds of signaling pathways to maintain a balanced in bone metabolism, mainly including BMPs/Smad signaling pathway, transforming growth factor-β signaling pathway, Wnt signaling pathway, etc. The development of active factors and scaffold which can induce osteogenic differentiation of BMSCs is the basis for the development of bone tissue engineering. Further exploration of signaling pathways could reveal some specific molecular mechanisms and find new therapeutic targets in regeneration medicine. However, some issues, such as osteoblasts differentiation of BMSCs, mutual interference of signal pathways, clinical transformation and clinical application, are still needed to be resolved.

ARCO Consensus on the Pathogenesis of Non-traumatic Osteonecrosis of the Femoral Head

Osteonecrosis of the femoral head (ONFH) is a devastating disease frequently leading to femoral head collapse and hip arthritis. Specifically, non-traumatic ONFH primarily affects young and middle-aged adults. Although compromised local circulation of the femoral head seems to be pathognomonic for the disease, the pathogenesis is perplexing and continues to be an area of scrutiny and research. Comprehension of the pathogenesis is of crucial importance for developing and guiding treatments for the disease. Therefore, we provide an up-to-date consensus on the pathogenesis of non-traumatic ONFH.

Osteonecrosis of the Femoral Head: an Updated Review of ARCO on Pathogenesis, Staging and Treatment

Non-traumatic osteonecrosis of the femoral head (ONFH) usually affects adults younger than 50 years and frequently leads to femoral head collapse and subsequent arthritis of the hip.It is becoming more prevalent along with increasing use of corticosteroids for the adjuvant therapy of leukemia and other myelogenous diseases as well as management of organ transplantation. This review updated knowledge on the pathogenesis, classification criteria, staging system, and treatment of ONFH.

Calcaneus traction compression with orthopaedic reduction forceps combined with percutaneous minimally invasive treatment of intra-articular calcaneal fractures: An analysis of efficacy.

BACKGROUND: The treatment of displaced calcaneal fractures is controversial.Open reduction and internal fixation are widely described as the gold standard in the literature,but these technique shave many complications,including skin necrosis,internal fixation leakage and deep infection and wound healing problems.Percutaneous reduction and unilateral external fixation have received increasing attention because they can provide a good, stable reduction and reduce the soft tissue complications caused by open surgery(such as deep infection and delayed wound healing).The purpose of this retrospective study was to evaluate the reduction imaging and clinical results of calcaneus traction compressionwith orthopaedic compression reduction forceps combined with percutaneous minimally invasive external fixation for intra-articular calcaneal fractures. METHODS: This was a retrospective analysis. A total of 35 patients with unilateral calcaneal fractures were divided into two groups: 1) the open reduction, internal fixation group (19 feet)and 2) the percutaneous minimally invasive, closed reduction external fixation group (16 feet).Evaluation of the reduction include dimaging measurements of the calcaneus length,width,and height,and the Bohler angle and Gissane angle before and after surgery.Clinical outcomes included the time of surgery,length of hospital stay,operation time,wound-related complications,the American Orthopaedic Foot and Ankle Society hindfoot score,the visual analogue score for pain, and the SF-36 score. RESULTS: The average follow-up time was 25.52 ± 1.68 months.There was no significant difference in reduction between the open group and the closed group (P > 0.05).The operation time of the open group was significantly longer than that of the closed group(P = 0.0001).The length of hospitalization and waiting time for surgery in the open reduction group were significantly longer than those in the closed reduction group (P < 0.05).Incidence-related complications in the open group and closed group were 21.1 %(4/19) and 6.3 %(1/16),respectively (P = 0.0001).The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores in the open and closed groups were 81.35 ± 5.25 and 82.52 ± 4.78, respectively (P = 0.0875). The visual analogues cale (VAS) scores of the open group and the closed group were 1.81 ± 1.32 and 0.78 ± 0.91, respectively (P = 0.0412).The SF-36 scores were 80 ± 4.5 and 79 ± 4.2, respectively. CONCLUSION: Our research shows that for various types of intra-articular calcaneal fractures compared with open reduction,internal plate fixation,calcaneus traction compression with orthopaedic reduction forceps combined with percutaneous minimally invasive external fixation is a simple and effective method for treating calcaneal fractures; not only can the calcaneus be corrected, but it can also provide notable imaging and clinical results.

Pulmonary radiological change of COVID-19 patients with 99mTc-MDP treatment

BackgroundAs increasing cases of COVID-19 around world, urgent need for effective COVID-19-specific therapeutic drugs is necessary; therefore, we conducted a pilot randomized-controlled study to evaluate the efficacy of 99mTc-MDP for COVID-19 therapeutic treatment. MethodsA total of 21 mild patients with COVID-19 were enrolled in this pilot RCT from February 2020 through March 2020, and then were assigned, in a 1:1 ratio, into control (11 patients) and 99mTc-MDP group (10 patients). Patients in the control group received routine treatment and patients assigned to the 99mTc-MDP group received a combination of routine treatment and an administration of 99mTc-MDP injection of 5ml/day. Both of the patients in the control and 99mTc-MDP groups were treated for 7 days with the primary end point of CT-based radiological pulmonary changes during 7-day follow-up. FindingsFrom baseline to the day 7, 8 (80%) of 10 mild patients in the 99mTc-MDP group had a significant radiological improvement in lung and a decline in inflammatory infiltration, whereas only 1 (9.1%) of 11 patients in the control group had a radiological improvement in lung. None of the patients in the 99mTc-MDP group had disease progression from mild to severe, as well as an inflammatory cytokine storm, and 2 mild patients (18.2%) in the control group developed severe. During days 7 through 14, the number of patients with radiological improvement in the 99mTc-MDP group remained consistent, and only 1 additional case (22%) in the control group were reported. ConclusionIn this randomized pilot study, 99mTc-MDP had an effective inhibitory effect on the inflammatory disease progression for the therapy of COVID-19, and it can accelerate the absorption of pulmonary inflammation in a short period of time during the process of treatment.

Effect of tantalum coating on adhesion, proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells / 中华创伤骨科杂志

Objective:To investigate the effects of tantalum coating on adhesion, proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) in vitro. Methods:In this study, BMSCs were extracted from 6 6-week-old rats and cultured in vitro to the third generation. Tantalum coating was manufactured on Ti6Al4V by chemical vapor deposition. The cells were identified by flow cytometry before they were induced with different mediums for osteogenesis, chondrogenesis and adipogenesis. The adhesion, proliferation and osteogenic differentiation of BMSCs were detected with fluorescence staining, Cell Counting Kit-8 (CCK8) assay and Q-PCR, respectively. Recorded and compared were the adhesion rate, proliferation rate, and expression of osterix (OSX), Runt-related transcription factor 2 (RUNX2), osteonectin (OSN) and osteopontin (OPN) of BMSCs on the surface of titanium alloy round plates (the Ti6Al4V group) and of tantalum coating round plates (the Ta group). Results:The flow cytometry revealed CD44 (94.55%), CD90 (95.01%) and CD34 (0.06%). Alkaline phosphatase (ALP) staining was positive after osteogenic induction for 14 days; Alizarin red staining showed calcified nodules after osteogenic induction for 21 days; oil red O staining was positive after adipogenic induction for 21 days; alcian blue staining found chondrogenic ability after chondrogenic induction for 21 days. Laser confocal microscopy showed that the BMSCs grew in patches aggregated and closely linked on the surface of titanium alloy round plates (in the Ti6Al4V group) and of tantalum coating round plates (in the Ta group). More BMSCs adhered on the tantalum coating plates than on the titanium alloy plates and exhibited better ductility. The proliferation rates of BMSCs on tantalum coating were significantly faster than those on titanium alloy after 1, 3, 5 and 7 days of co-culture in vitro ( P<0.05).Q-PCR showed that tantalum coating promoted the expression of OSN and OPN after 7 days of culture significantly higher than titanium alloy did ( P<0.05).After 21 days of co-culture in vitro, tantalum coating enhanced the expression of OSX, RUNX2, OSN and OPN significantly higher than titanium alloy did ( P<0.05). Conclusion:Compared to titanium alloy which is used for conventional orthopedic implants, tantalum coating can observably promote adhesion, proliferation and osteogenic differentiation of BMSCs.

Preserving hip treatment of steroid-induced osteonecrosis of the femoral head / 中华骨科杂志

Objective@#To investigate the early diagnosis and treatment options for steroid-induced osteonecrosis of the femoral head (SONFH).@*Methods@#Retrospective analysis was conducted in 73 patients with unilateral SONFH from January 2010 to June 2017. There were 27 males and 46 females, aged 34.26±10.35 years (range, 20-45 years). The following type of cases were included, 21 cases of ARCO I, 24 cases of IIa, 8 cases of IIb, 18 cases of IIc and 2 cases of IIIa. Patients with ARCO I were limited in weight and were treated with low molecular weight heparin sodium and ginkgo dharma drugs after excluding bleeding risk. Core decompression was performed in patients with ARCO IIa and IIb vascularized greater trochanter bone transfer was conducted in patients with IIc and IIIa. During the follow-up duration, when the ARCO I progressed to ARCO IIa and IIb, the core decompression was performed. When the ARCO IIa and IIb progressed to the ARCO IIc or IIIa, the vascularized greater trochanter bone transfer was conducted. Vascularized greater trochanter bone combined with the tantalum rod was implanted in ARCO IIIb. The femoral head reconstruction with the larger trochanter bone flap or joint replacement was performed in ARCO IIIc and above. The Harris hip score was used to evaluate the clinical outcomes. The femoral head survival curve of SONFH was drawn with the end of joint replacement.@*Results@#All 73 patients were followed up for an average of 29 months (range, 18 to 48 months). After treatment of 21 patients with ARCO I, a total of 14 (67%) patients had no ARCO staging progress. After 6 months, three patients progressed to ARCO IIb and 4 patients progressed to ARCO IIc. All 32 patients with ARCO IIa and IIb were treated, of which 25 (78%) did not progress but 4 patients progressed to ARCO IIIa at 6 months. Only one patient progressed to ARCO IIIb at 6 months, and 2 patient progressed to ARCO IIIc at 12 months. There were 18 patients with ARCO IIc underwent treatment, of which 14 patients (78%) did not progress but 2 patients progressed to ARCO IIIa at 6 months and 2 patients progressed to ARCO IIIc at 24 months and to ARCO IV at 42 months, respectively. Two patients of ARCO IIIa, 1 patient did not progress and the other one progressed to ARCO IV at 36 months. The Harris hip score was 90.48±5.36 before treatment and 91.76±8.19 at the last follow-up. The difference was not statistically significant (t=1.231, P=0.402). The Harris hip score of patients with ARCO IIa and IIb in creased from 75.22±8.30 to 84.47±16.77 with statistically significant difference (t=5.624, P<0.001). The Harris hip score of patients with ARCO IIc and IIIa increased from 59.80±9.24 to 77.75±20.75 with statistically significant difference (t=12.033, P<0.001). Four patients eventually underwent arthroplasty. The femoral head survival rate was 98.6% at 2 years and 94.5% at 4 years.@*Conclusion@#The SONFH can be diagnosed early by screening, and is treated by different reserving hip methods according to severe stages. The short-term clinical effects are satisfied.

Prevention and early treatments of steroid-induced osteonecrosis of the femoral head / 中华骨科杂志

With the heavily application of steroid in the clinic, the incidence of steroid-induced osteonecrosis of the femoral head is also rapidly increasing. It is generally believed that steroid-induced osteonecrosis of the femoral head is the result of a various of pathological mechanisms. Clinical evidence suggests that the occurrence of osteonecrosis is highly correlated with the daily mean dose and cumulative dose of steroid. Patients don't always have osteonecrosis of the femoral head which may be related to the susceptibility of individual genes to steroid. Steroid-induced osteonecrosis of the femoral head is divided into three stages by pathomorphological, indicating the early, middle and late stage of blood supply changes. With the change of blood supply, the range of osteonecrosis is gradually increasing, and eventually leads to collapses. The earlier the osteonecrosis is found, the more selective the treatments regimen are. The prognosis will be often better with early diagnosis. Regulating the use of steroid can reduce the occurrence of osteonecrosis. Thus, we emphasize that the use of steroid in clinical settings should be cautious and regulated. Digital subtraction angiography can be used to assess early osteonecrosis of the femoral head. According to the assessment of progression of disease, the drug or the corresponding surgical procedure will be selected. Steroid-induced osteonecrosis of the femoral head can achieve good clinical results through early detection and early treatments.

Dynamic contrast-enhanced magnetic resonance imaging evaluation of blood supply in different zone of the normal femoral head in adults / 实用放射学杂志

Objective To investigate the difference of blood supply in different areas of the normal femoral head in adults.Methods A retrospective study analyzed the DCE-MRI parameters data of 2 5 normal adults (25 right hips)in our hospital.The femoral head was assumed to be a sphere.On T1 WI of DCE-MRI,the right femoral head was divided into three parts equally in coronal,sagittal, and transverse plane respectively.Time to peak(TTP),maximum of enhancement at first past(fEmax),maximum of enhancement (Emax)were measured in three parts and compared in coronal,sagittal and transverse plane respectively.Results (1 )In coronal plane,there were no significant differences between the three parts in TTP,fEmax and Emax.(2 )In transverse plane,fEmax and Emax were lower in the transverse superior zone than that in the transverse central zone significantly (P＝0.024 and P＝0.001)and the transverse inferior zone(P＝0.005 and P＝0.018).TTP was higher in the transverse superior zone than that in the transverse central zone and the transverse inferior zone(P＝0.005 and P＝0.018).(3)In sagittal plane,fEmax and Emax were lower in the sagittal lateral zone than that in the sagittal centralzone (P＝0.019 and P＝0.041)and sagittal medial zone (P＝0.047 and P＝0.01 1).TTP was higher in the sagittal lateral zone than that in the sagittal central zone and the sagittal medial zone(P＝0.014 and P＝0.010).There were no significant differences between other paired zones of the any values.Conclusion DCE-MRI can show the microcirculation in the normal adult femoral head in a non-invasive way.According to DCE-MRI parameters,there are poor perfusions on the transversesuperior and sagittallateral zones of the normal femoral head in adults.

The application of 3D printed customized porous tantalum acetabular patch for adult DDH hip reconstruction / 中华骨科杂志

Objective To explore the feasibility,safety and efficacy of customized porous tantalum acetabular patch made by three-dimensional (3D) printing technique in treating adult developmental dysplasia of the hip (DDH).Methods Eight adult patients with Crowe Ⅰ type DDH (2 men and 6 women,with a mean age of 43.75±7.81 years,range 33-58 years) who were treated with 3D printed customized porous tantalum acetabular patch hip reconstruction from January 2017 to September 2017 were included.The 3D printing technique was used for reconstructing and designing the optimal acetabular patch for the personalized hip joint of each patient.The acetabular patch was subjected to porous processing and finite element analysis until the biomechanical requirements were met.The 3D printing of porous tantalum acetabular patch and post-processing was subsequently performed.The acetabular patch was implanted through the anterior approach of the hip joint.The operative duration,intraoperative blood loss and complications were recorded.All the included patients were followed up at 1.5,3 and 6 months postoperatively.Pain was assessed using the visual analog scale (VAS),and the hip joint function was evaluated using the Harris score and gait analysis.The patients underwent anterior-posterior radiography and 3D computed tomography of the hip joint aiming to observe the position of the acetabular patch and osteoarthritis progression.Results The mean operative duration was 1.13±0.23 h,and the mean blood loss was 114.17±41.22 ml.All patients were followed up for 6 to 12 months,with an average of 8.2 months.The mean lateral central-edge angle and anterior central-edge angle ranged from 9.83°±5.34° preoperatively to 32.67°±2.53° postoperatively and from 3.83°± 2.79° preoperatively to 21.67°± 1.87° postoperatively,respectively.The rate of acetabular coverage increased from 57.33％±7.97％ preoperatively to 87.33％±4.56％ postoperatively.The VAS and Harris scores ranged from 2.92± 0.79 preoperatively to 0.83±0.72 postoperatively and from 69.67±4.62 preoperatively to 84.25±4.14 postoperatively with statistically significant difference,respectively.The results of gait analysis showed that the step speed,stride,the range of motion of hip and knee were better than that preoperatively.The images suggested a close contact between the tantalum acetabular patch and the iliac bone without loosening and progress of osteoarthritis in hip joint.Conclusion 3D printed customized porous tantalum acetabular patch could reconstruct the defect of acetabular,increase the coverage,and delay the progress of osteoarthritis of the hip joint.This method could reduce the difficulty of hip reconstruction,and the patients could obtain better joint function at the early stage.

Autologous bone marrow stromal stem cells combined with vascular pedicle iliac bone flap and tantalum rob implantation for osteonecrosis of the femoral head / 中国组织工程研究

BACKGROUND:There are a variety of treatments for femoral head necrosis,but their efficacy is not confirmed and unified.How to improve the differentiation ability of osteoblasts in the femoral head and improve the biomechanical support after the repair of the femoral head is an urgent problem to be solved.OBJECTIVE:To explore the clinical outcome of stem cells combined with vascularized iliac bone flap and tantalum rod implantation for the treatment of osteonecrosis of the femoral head (ONFH).METHODS:Totally 28 cases (36 hips) of non-traumatic ONFH admitted at the Zhongshan Hospital of Dalian University from January 2010 to January 2011 were enrolled.Bone marrow samples were extracted from each patient to isolate bone marrow stromal stem cells which were cultured in vitro for 2 weeks.Tantalum rod implantation with vascularized iliac bone graft was conducted to restore the femoral head shape,and then,prepared stem cell suspension were injected into the iliac bone flap and into the subchondral space of the femoral head.RESULTS AND CONCLUSION:All the 28 cases (36 hips) were followed up for 6-20 months (average 12 months),and their Harris hip scores and visual analogue scale scores at postoperative 6 and 12 months were significantly higher than the baseline (P ＜ 0.05).The Harris hip score at postoperative 12 months was significantly higher than that at postoperative 6 months (P ＜ 0.05),but there was no significant difference in the visual analogue scale scores at 6 and 12 months postoperatively (P ＞ 0.05).At the end of 12-month follow-up,clinical outcomes were excellent in 13 hips,good in 15 hips,fair in 4 hips,and poor in 4 hips,with an excellent and good rate of 90％.These findings indicate that autologous bone marrow stromal stem cell transplantation with vascularized iliac bone flap and tantalum rob implantation is an effective method with high clinical success rate for the treatment of ONFH.

Past decade on hip-preserving surgery for osteonecrosis of femoral head treatment in China / 中华骨科杂志

As a common disease in orthopedics,osteonecrosis of the femoral head (ONFH) frequently occurs among young and middle-aged people.Hip joint preserving surgery has attracted more and more attention due to the fact that artificial joint prosthesis has a certain useful life and the rate of hip joint revision is high and the higher risk of many complications.There are a large number of operative methods for preserving hip joint in clinical practice without definitive curative effects.Core decompression and impaction bone grafting with simple operative methods can relieve internal pressure of femoral head and pain symptoms,but they cannot remove necrotic bone completely.Hence,they are only used for ONFH in the early stage.Vascularized bone transplantation can fill defects of the former,as it can not only completely remove necrotic bone,but also provide bone graft with nourishing vessels for femoral head,being beneficial to reconstruct the bone structure of femoral head.Subsequently,the application of tantalum rod can provide mechanical support for femoral head to prevent the collapse of femoral head.The emergence of stem cell transplantation has created a new approach to preserve hip joint for ONFH,which promotes the regeneration of bone cells and assists femoral head in repair,often combined with other operative methods and using characteristics of superior proliferation and differentiation of stem cells.Hip joint preserving surgery,in recent years,has been performed increasingly,and has obtained improvement in clinical effects.The multiple combination of a variety of its operative methods provides more effective treatments for ONFH.It is an essential notion that hip joint preserving surgery,however with any operative method,should as far as possible select a surgical plan with little trauma,simple methods and little injury to bone structure of hip joint based on ensuring the efficacy.

Study on cytocompatibility and animal implantation test of domestic reticulated vitreous carbon / 中华显微外科杂志

Objective To investigate the possibility of the domestic reticulated vitreous carbon as a kind of scaffold material for bone tissue engineering,the biocompatibility of domestic reticulated vitreous carbon was first successfully tested with bone marrow stromal cells (BMSCs) in vitro and for bone tissue repair in vivo.Methods From June,2013 to August,2014,the morphology and proliferation of BMSCs co-cultured with scaffold material in vitro was measured.Differences of measurement were compared with single factor analysis of variance to detect the cytotoxicity of reticulated vitreous carbon.In vivo reticulated vitreous carbon were implanted into the bone defect site and the groin.After 12 weeks,the biocompatibility of reticulated vitreous carbon was observed.Results MTT results showed that after 7d co-culture,the survival and proliferation of BMSCs had not been significantly inhibited (P ＞ 0.05).Inverted fluorescence microscope and scanning electron microscope found that newly developed three-dimensional domestic reticulated vitreous carbon could promote adhesion,aggregation and proliferation of BMSCs in vitro.Studies in vivo demonstrate that implanted reticulated vitreous carbon with a high porosity and host bone may produce a stable connection and integration.Conclusion Non-cytotoxic domestic reticulated vitreous carbon can promote the adhesion and proliferation of bone marrow mesenchymal stem cells in vitro and has good bone induction properties in vivo.