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1.
BMC Musculoskelet Disord ; 22(1): 535, 2021 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-34118907

RESUMO

BACKGROUND: To determine whether multiple drilling is effective in postponing the need for total hip arthroplasty (THA) in early-stage nontraumatic osteonecrosis of the femoral head (ONFH). METHODS: We identified 514 patients who were diagnosed with early-stage ONFH between January 2008 and December 2018. One hundred ninety-six patients underwent multiple drilling, and 318 patients had a natural course of progression. One hundred fifty-nine patients were selected for each group after case-control matching for preoperative demographics and modified Ficat and Arlet stage. The rates of THA conversion were compared. We also performed Cox regression to identify risk factors associated with THA conversion in patients who underwent multiple drilling. RESULTS: Kaplan-Meier survivorship with an endpoint of THA for nontraumatic reasons were not significantly different between the multiple drilling group (75.6, 95% confidence interval 67.8-83.4%) and the natural course group (72.2, 95% confidence interval 64.8-79.6%) at 5 years (log-rank, P = .191). In the Cox regression model, a larger extent of necrotic lesion, bone marrow edema (BME), and higher postoperative work intensity significantly increased the risk of THA conversion (P < .05). Among patients treated with autogenous bone grafting, there was a lower risk of failure in patients with necrotic lesion less than 15% (P < .05). CONCLUSIONS: Multiple drilling is not effective in reducing the rate of THA conversion in early-stage nontraumatic ONFH. The risk of conversion to THA after multiple drilling is increased by a larger extent of necrotic lesion, presence of BME, and higher postoperative work intensity in patients with early-stage ONFH. TRIAL REGISTRATION: The trial was registered in the Chinese Clinical Trial Registry ( ChiCTR2000035180 ) dated 2 August 2020.


Assuntos
Artroplastia de Quadril , Necrose da Cabeça do Fêmur , Artroplastia de Quadril/efeitos adversos , Transplante Ósseo , Estudos de Casos e Controles , Cabeça do Fêmur/cirurgia , Necrose da Cabeça do Fêmur/epidemiologia , Necrose da Cabeça do Fêmur/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
2.
Medicine (Baltimore) ; 100(22): e26210, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087895

RESUMO

BACKGROUND: Osteonecrosis of the femeral head (ONFH) occurs predominantly in young- and middle-aged people, and the disability rate is high in the late stage of the disease and most patients have to undergo total hip replacement. Clinically, increasing attention is paid to intervening early and middle-stage ONFH so as to delay its progress. Acupuncture and moxibustion (AM) is a unique method for treating ONFH in China. This study aims to summarize the advantages of AM for the treatment of ONFH. METHODS: A comprehensive literature search was conducted on the database with languages of English and Chinese. The medical subject titles used are "Osteonecrosis of the femoral head" and "acupuncture and moxibustion." Related words in the title or abstract including but were not limited to "necrosis of the femoral head," "avascular necrosis of the femoral head," "ischemic necrosis of the femoral head," "caput femoris necrosis," "bone paralysis," "bone erosion," and "bone atrophy." RESULTS: Nine randomized controlled trials were identified in this meta-analysis that included 630 subjects. Meta-analysis showed that the trial group that treated with conventional therapy combined with AM had a higher effective rate (Z = 2.27 P = 0.02) and excellent and good rate (Z = 4.85 P < 0.00001) and Harris hip function score (HHS) (Z = 2.31 P = 0.02) and lower incidence of related adverse reactions during treatment (Z = 2.82 P = 0.005) compared with the control group that treated with conventional therapy alone. CONCLUSIONS: AM for early and middle-stage ONFH is an effective and relatively safe intervention, which can improve the effective rate and excellent and good rate and HHS, and reduce the adverse reaction rate. Clinically, early and middle-stage ONFH can be intervened by combining with AM while taking conventional therapy to improve the efficacy.


Assuntos
Terapia por Acupuntura/métodos , Necrose da Cabeça do Fêmur/terapia , Cabeça do Fêmur/patologia , Moxibustão/métodos , Terapia por Acupuntura/efeitos adversos , Adulto , Idoso , Estudos de Casos e Controles , China/epidemiologia , Terapia Combinada/métodos , Feminino , Cabeça do Fêmur/irrigação sanguínea , Necrose da Cabeça do Fêmur/classificação , Articulação do Quadril/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Moxibustão/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
3.
Bone Joint J ; 103-B(5): 999-1004, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33934650

RESUMO

AIMS: The most important complication of treatment of developmental dysplasia of the hip (DDH) is avascular necrosis (AVN) of the femoral head, which can result in proximal femoral growth disturbances leading to pain, dysfunction, and eventually to early onset osteoarthritis. In this study, we aimed to identify morphological variants in hip joint development that are predictive of a poor outcome. METHODS: We retrospectively reviewed all patients who developed AVN after DDH treatment, either by closed and/or open reduction, at a single institution between 1984 and 2007 with a minimal follow-up of eight years. Standard pelvis radiographs obtained at ages one, two, three, five, and eight years, and at latest follow-up were retrieved. The Bucholz-Ogden classification was used to determine the type of AVN on all radiographs. Poor outcome was defined by Severin classification grade 3 or above on the latest follow-up radiographs and/or the need for secondary surgery. With statistical shape modelling, we identified the different shape variants of the hip at each age. Logistic regression analysis was used to associate the different modes or shape variants with poor outcome. RESULTS: In all, 135 patients with AVN were identified, with a minimum of eight years of follow-up. Mean age at time of surgery was 7.0 months (SD 0.45), and mean follow-up was 13.3 years (SD 3.7). Overall, 46% had AVN type 1 while 54% type 2 or higher. More than half of the patients (52.6%) had a poor outcome. We found 11 shape variants that were significantly associated with a poor outcome. These shape variants were predominantly linked to AVN type 2 or higher. CONCLUSION: Specific morphological characteristics on pelvis radiographs of AVN hips were predictive for poor outcome, at a very young age. There was an overall stronger association to Bucholz-Ogden types 2-3-4 with the exception of two modes at age two and five years, linked to AVN type 1. Cite this article: Bone Joint J 2021;103-B(5):999-1004.


Assuntos
/terapia , Necrose da Cabeça do Fêmur/etiologia , Cabeça do Fêmur/anormalidades , Criança , Pré-Escolar , Feminino , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Humanos , Lactente , Masculino , Estudos Retrospectivos
4.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 52(3): 452-457, 2021 05.
Artigo em Chinês | MEDLINE | ID: mdl-34018364

RESUMO

Objective: To investigate the difference in the expression of Ras-associated protein 1 (Rap1) in necrotic and healthy areas of non-traumatic osteonecrosis of femoral head (NONFH) patients. Methods: Femoral head tissue samples from 30 cases of NONFH and 30 cases of traumatic osteonecrosis of the femoral head (TONFH) were collected after hip replacement surgery, respectively. No significant difference of Association Research Circulation Osseous (ARCO) staging was found between the NONFH and the TONFH groups ( Z=-0.769, P=0.442). In the NONFH group, 8 patients were ARCO stage IIIb, 10 were stage IV, and 12 were stage V, while in the TONFH ground, 11 patients were ARCO stage IIIb, 9 were stage IV, and 10 were stage V. There were 19 males and 11 females in the NONFH group, with an average age of 49.6 yr. (26-69 yr.), and 16 males and 14 females in the TONFH group, with an average age of 54.2 yr. (37-68 yr.). There was no significant difference in gender or age between the two groups ( P>0.05). Specimens were collected from different bone areas, including those from the necrotic areas (area A) and the healthy areas (area B) of the NONFH group, and those from the healthy areas (area B') of the TONFH group, i.e., the control group. Western blot and quantitative real-time reverse transcription PCR (qRT-PCR) were used to analyze the different expression of Rap1, vascular endothelial growth factor (VEGF) protein, phosphoinositide 3-kinase (PI3K), and Akt protein and their corresponding mRNA in the three areas of bone tissue. HE staining and immunohistochemisty staining were done in order to observe the morphological changes of each area. Results: Western blot results indicated that there was no statistical difference in the relative expression of Rap1, VEGF, PI3K, and Akt proteins ( P>0.05). The relative expressions of Rap1, VEGF, PI3K, and Akt proteins in the area A were lower than those in the area B and the difference was statistically significant ( P<0.05). qRT-PCR results showed that the relative expressions of Rap1, VEGF, PI3 K and Akt mRNA in area A were lower than those of area B, and a statistical difference was found ( P<0.05). The relative expression of the mRNA of Rap1, VEGF , PI3 K and Akt in area B and area B' were not significantly different ( P>0.05). HE staining and immunohistochemisty staining showed that chondrocytes decreased in the necrotic area (area A) of NONFH, chondrocytes nucleus disappeared, subchondral bone trabeculae were broken, bone trabeculae thickened, and empty bone lacunae appeared. Granulation tissues composed of new capillaries and fibrous cells have proliferated and crawled around the necrotic area. Positive expressions of the Rap1, VEGF, PI3K and Akt proteins in area A were weaker than those of the normal area. In addition, there were positive expressions of Rap1, PI3K and Akt on the trabecular bone of both area A and area B at similar intensity of expression. There were strong positive expressions of Rap1, VEGF, PI3K and Akt on the intima of arterioles and venules, and on the peripheral stromal cell membrane, but the positive expression in area A was significantly lower than that in area B. However, the positive expression positions and intensity of all indicators were similar in area B and area B'. Conclusion: The necrosis in NONFH may be related to vascular endothelial damages caused by the inhibition of the Rap1-PI3K/Akt signaling pathways and the subsequent decline in the protein expression.


Assuntos
Necrose da Cabeça do Fêmur , Cabeça do Fêmur , Endotélio Vascular , Feminino , Necrose da Cabeça do Fêmur/genética , Humanos , Masculino , Pessoa de Meia-Idade , Fosfatidilinositol 3-Quinases , Fator A de Crescimento do Endotélio Vascular/genética
5.
Medicine (Baltimore) ; 100(20): e25926, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011064

RESUMO

BACKGROUND: Several studies have reported that medical robot-assisted method (RA) might be superior to conventional freehand method (FH) in orthopedic surgery. Yet the results are still controversial, especially in terms of femoral neck fractures surgery. Here, 2 methods were assessed based on current evidence. METHODS: Electronic databases including Cochrane Library, PubMed, Web of Science. and EMBASE were selected to retrieved to identify eligible studies between freehand and RAs in femoral neck fractures, with 2 reviewers independently reviewing included studies as well as collecting data. RESULTS: A total of 5 studies with 331 patients were included. Results indicated that 2 surgical methods were equivalent in terms of surgical duration, Harris score, fracture healing time, fracture healing proportion and complications, while RA showed clinical benefits in radiation exposure, intraoperative bleeding, total drilling times, and screw parallelism. CONCLUSIONS: Current literature revealed significantly difference between 2 techniques and suggested that RA might be beneficial for patients than freehand method.


Assuntos
Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/lesões , Cabeça do Fêmur/cirurgia , Fluoroscopia/efeitos adversos , Fluoroscopia/estatística & dados numéricos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Humanos , Duração da Cirurgia , Parafusos Pediculares , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Robóticos/instrumentação , Fatores de Tempo , Resultado do Tratamento
6.
Biomed Res Int ; 2021: 6655225, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33928159

RESUMO

Recent studies have suggested that exosomes exert similar therapeutic effects to those of mesenchymal stem cells (MSCs) in regenerative medicine and MSCs-derived exosomes exhibit therapeutic effects on steroid-induced osteonecrosis of the femoral head (ONFH). Furthermore, reparative functions of exosomes from MSCs are enhanced by hypoxia treatment of the cells. However, there are no related reports about whether exosomes derived from hypoxia-preconditioned MSCs could show better therapeutic effects on steroid-induced ONFH. In vitro, we investigated the effects of hypoxia precondition on exosomes derived from bone marrow mesenchymal stem cells (BMMSCs) from rats and the proangiogenic ability of exosomes derived from hypoxia-preconditioned BMMSCs. In vivo, we investigated the role of exosomes from hypoxia-preconditioned BMMSCs on angiogenesis and protecting osteonecrosis in a rat ONFH model. We found that the potential of the proangiogenic ability of exosomes derived from hypoxia-preconditioned BMMSCs was higher than exosomes derived from BMMSCs cultured under normoxia. Exosomes derived from hypoxia-preconditioned BMMSCs significantly promoted proliferation, migration, vascular endothelial growth factor (VEGF) expression, and tube formation of human umbilical vein endothelial cells (HUVECs) compared with exosomes derived from BMMSCs cultured under normoxia. Administration of exosomes derived from hypoxia-preconditioned BMMSCs significantly prevented bone loss and increased vessel volume in the femoral head compared with exosomes derived from BMMSCs cultured under normoxia. Taken together, our data suggest that exosomes derived from hypoxia-preconditioned BMMSCs exert better therapeutic effects on steroid-induced ONFH by promoting angiogenesis and preventing bone loss.


Assuntos
Exossomos/metabolismo , Necrose da Cabeça do Fêmur/prevenção & controle , Necrose da Cabeça do Fêmur/terapia , Cabeça do Fêmur/irrigação sanguínea , Células-Tronco Mesenquimais/metabolismo , Neovascularização Fisiológica , Esteroides/efeitos adversos , Animais , Osso e Ossos/patologia , Hipóxia Celular , Movimento Celular , Proliferação de Células , Modelos Animais de Doenças , Exossomos/ultraestrutura , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/patologia , Necrose da Cabeça do Fêmur/induzido quimicamente , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Células Endoteliais da Veia Umbilical Humana/metabolismo , Humanos , Ratos Sprague-Dawley , Microtomografia por Raio-X
7.
Eur J Radiol ; 139: 109681, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33819804

RESUMO

PURPOSE: To determine the diagnostic performance of virtual noncalcium (VNCa) dual-energy computed tomography (DECT) in the detection of bone marrow edema (BME) in participants with osteonecrosis of the femoral head (ONFH). METHODS: In this prospective study, 24 consecutive participants (15 men, 9 women; mean age, 44 years, range, 21-72 years) diagnosed with ONFH who underwent DECT and magnetic resonance imaging (MRI) between September 2019 and January 2020 were involved. Two independent readers visually evaluated color-coded VNCa images using a binary classification (0 = normal bone marrow, 1 = BME). MRI served as the reference standard for the presence of BME. Interobserver agreement for the visual evaluation of VNCa DECT images was calculated with κ statistics. We determined computed tomography (CT) numbers on VNCa images and weighted-average CT sets using region-of-interest-based quantitative analysis. The t-test was used to compare the differences of CT values between BME areas and normal bone marrow areas. Receiver operating characteristic (ROC) curve was used to select an optimal CT values of VNCa images for detecting BME. A p value of <0.05 was considered as statistically significant. RESULTS: The sensitivity, specificity, and accuracy of Reader 1 and Reader 2, respectively, in the identification of BME at DECT were 95 % and 89 % (18 and 17 of 19), 96 % and 96 % (25 and 25 of 26), and 93 % (43 and 42 of 45). Interobserver agreement was excellent (κ = 0.86). The VNCa CT numbers of the BME area and the normal bone marrow area were -28.6 (-17.9--39.4) HU and -97.9 (-91.3--104.4) HU, respectively, with statistical significance (t = -10.6, p < 0.001). The weighted-average CT numbers of the BME area and the normal bone marrow area were 152.4(122.2-182.7) HU and 121.1(103.6-183.6) HU, respectively, with no statistical significance (t = -2.0, p > 0.05). The area under the receiver operating characteristic curve was 0.99 in differentiation of the BME from normal bone marrow. A cut-off value of -57.2 HU yielded overall sensitivity, specificity, and accuracy, respectively, of 95 % (18 of 19), 100 % (26 of 26), and 98 % (44 of 45) detection of BME in participants with ONFH. CONCLUSION: Visual and quantitative analyses of VNCa images shows excellent diagnostic performance for assessing BME in participants with ONFH.


Assuntos
Medula Óssea , Osteonecrose , Adulto , Idoso , Medula Óssea/diagnóstico por imagem , Edema/diagnóstico por imagem , Feminino , Cabeça do Fêmur , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Adulto Jovem
8.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(3): 356-365, 2021 Mar 15.
Artigo em Chinês | MEDLINE | ID: mdl-33719246

RESUMO

Objective: To investigate whether exosomes derived from miR-27a-overexpressing human umbilical vein endothelial cells (HUVECs)-exo (miR-27a) can promote bone regeneration and improve glucocorticoids (GC) induced osteonecrosis of femoral head (ONFH) (GC-ONFH). Methods: The exo (miR-27a) were intended to be constructed and identified by transmission electron microscopy, nanoparticle tracking analysis, Western blot, and real-time fluorescent quantitative PCR (qRT-PCR). qRT-PCR was used to evaluate the effect of exo (miR-27a) in delivering miR-27a to osteoblasts (MC3T3-E1 cells). Alkaline phosphatase staining, alizarin red staining, and qRT-PCR were used to evaluate its effect on MC3T3-E1 cells osteogenesis. Dual-luciferase reporter (DLRTM) assay was used to verify whether miR-27a targeting Dickkopf WNT signaling pathway inhibitor 2 (DKK2) was a potential mechanism, and the mechanism was further verified by qRT-PCR, Western blot, and alizarin red staining in MC3T3-E1 cells. Finally, the protective effect of exo (miR-27a) on ONFH was verified by the GC-ONFH model in Sprague Dawley (SD) rats. Results: Transmission electron microscopy, nanoparticle tracking analysis, Western blot, and qRT-PCR detection showed that exo (miR-27a) was successfully constructed. exo (miR-27a) could effectively deliver miR-27a to MC3T3-E1 cells and enhance their osteogenic capacity. The detection of DLRTM showed that miR-27a promoted bone formation by directly targeting DDK2. Micro-CT and HE staining results of animal experiments showed that tail vein injection of exo (miR-27a) improved the osteonecrosis of SD rat GC-ONFH model. Conclusion: exo (miR-27a) can promote bone regeneration and protect against GC-ONFH to some extent.


Assuntos
Exossomos , Células-Tronco Mesenquimais , MicroRNAs , Animais , Cabeça do Fêmur , MicroRNAs/genética , Osteogênese , Ratos , Ratos Sprague-Dawley
9.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(3): 381-386, 2021 Mar 15.
Artigo em Chinês | MEDLINE | ID: mdl-33719249

RESUMO

Objective: To summarize the current progress of vascularized bone grafting in the treatment of osteonecrosis of the femoral head (ONFH), and to provide reference for treatment of ONFH. Methods: The literature at home and abroad on the treatment of ONFH with vascularized bone grafting was reviewed, and the mechanism, operating methods and effectiveness, indications, and complications were summarized. Results: Vascularized bone grafting is a commonly used clinical hip-preserving operation. By replacing necrotic bone tissue with vascularized bone, it can rebuild the blood circulation system, promote the healing of the necrotic area, and provide biomechanical support for the necrotic area of the femoral head, prevent the joint surface collapse. The main operations include the vascularized iliac bone flap grafting, the vascularized greater trochanter bone flap grafting, and the vascularized fibular grafting. The clinical application has achieved certain effectiveness, and the different procedures are suitable for different types of patients. The procedures need to be selected based on the patient's overall condition, the cause of ONFH, the necrosis stage, and the degree of the evaluation. Conclusion: Vascularized bone grafting has a definite effectiveness in the treatment of ONFH in the young and middle-aged. It can significantly improve hip joint function, control the further development of the disease to a great extent, effectively delay or even avoid hip arthroplasty. It is a reliable hip-preserving operation worthy of promotion.


Assuntos
Necrose da Cabeça do Fêmur , Cabeça do Fêmur , Transplante Ósseo , Cabeça do Fêmur/cirurgia , Necrose da Cabeça do Fêmur/cirurgia , Fíbula , Humanos , Ílio , Pessoa de Meia-Idade , Resultado do Tratamento
10.
Am J Sports Med ; 49(5): 1209-1219, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33661717

RESUMO

BACKGROUND: Gaining a better understanding of the underlying pattern of acetabular dysplasia 3-dimensionally can help better guide treatment and optimize clinical outcomes after periacetabular osteotomy (PAO). PURPOSE: (1) To examine the relationship between femoral head coverage before and after PAO for dysplasia and patient-reported outcome measure (PROM) scores and (2) to assess if the direction/orientation of correction of the acetabulum can be predicted based on the Ottawa classification. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A retrospective analysis of a prospectively collected database from a single-center institutional registry of PAO was conducted, and PROM scores at a minimum of 2 years were analyzed. A total of 79 hips (67 patients [56 female]; mean age at surgery, 27.5 years [range, 15.8-53.7 years]) were available for inclusion. According to the Ottawa classification, 54 hips (68.4%) had global deficiency, 15 hips (18.9%) had posterior deficiency, and 10 hips (12.7%) had anterior deficiency. Hip2Norm software was used to analyze the 3-dimensional coverage of the femoral head. Statistical analysis was conducted to look at significant predictors of improvements in PROMs using the minimal clinically important difference (MCID) for the Hip disability and Osteoarthritis Outcome Score (HOOS) Activities of Daily Living subscale. RESULTS: At a mean follow-up of 3.1 years (range, 2.0-7.4 years), all functional outcome scores improved significantly. A postoperative total femoral coverage <75.7%, posterior coverage (PC) <45.2%, and femoral head extrusion index >15.5% were all associated with not reaching the MCID for the HOOS Activities of Daily Living subscale. Multivariate analysis showed that PC was the single most important significant modifier influencing functional outcomes after PAO for the treatment of acetabular dysplasia, with an odds ratio of 6.0 (95% CI, 1.8-20.4; P = .004). One-way analysis of variance showed a significant difference comparing the mean change in radiographic measurements, that is, anterior coverage, PC, and total femoral coverage, per the Ottawa classification (P < .001). CONCLUSION: Our study demonstrated that postoperative femoral head coverage and acetabular orientation were significant predictors of PROM scores. Classifying acetabular dysplasia into 3 groups based on the plane of instability could optimize the planning of PAO by giving a better understanding of the 3-dimensional deformity.


Assuntos
Acetábulo , Luxação do Quadril , Acetábulo/cirurgia , Atividades Cotidianas , Estudos de Coortes , Feminino , Cabeça do Fêmur/cirurgia , Luxação do Quadril/cirurgia , Humanos , Osteotomia , Medidas de Resultados Relatados pelo Paciente , Estudos Retrospectivos , Resultado do Tratamento
11.
Mol Med Rep ; 23(5)2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33760114

RESUMO

Steroid­induced avascular necrosis of the femoral head (SANFH) is a common orthopaedic disease that is difficult to treat. The present study investigated the effects of total flavonoids of Rhizoma drynariae (TFRD) on SANFH and explored its underlying mechanisms. The SANFH rat model was induced by intramuscular injection of lipopolysaccharides and methylprednisolone. Osteoblasts were isolated from the calvariae of neonatal rats and then cultured with dexamethasone (Dex). TFRD was used in vitro and in vivo, respectively. Haematoxylin and eosin staining was used to assess the pathological changes in the femoral head. Terminal deoxynucleotidyl transferase­mediated deoxyuridine triphosphate nick end labelling assay and flow cytometry were conducted to detect apoptosis of osteoblasts. The 2',7'­dichlorofluorescein­diacetate staining method was used to detect reactive oxygen species (ROS) levels in osteoblasts and the 3­(4,5­dimethylthiazol­2­yl)­2,5­diphenyltetrazolium bromide assay was used to detect osteoblast proliferation. The expression of caspase­3, Bax, Bcl­2, VEGF, runt­related transcription factor 2 (RUNX2), osteoprotegerin (OPG), osteocalcin (OCN), receptor activator of nuclear factor κB ligand (RANKL) and phosphoinositide 3­kinase (PI3K)/AKT pathway related­proteins were detected via western blotting. It was found that TFRD reduced the pathological changes, inhibited apoptosis, increased the expression of VEGF, RUNX2, OPG and OCN, decreased RANKL expression and activated the PI3K/AKT pathway in SANFH rats. TFRD promoted proliferation, inhibited apoptosis and reduced ROS levels by activating the PI3K/AKT pathway in osteoblasts. In conclusion, TFRD protected against SANFH in a rat model. In addition, TFRD protected osteoblasts from Dex­induced damage through the PI3K/AKT pathway. The findings of the present study may contribute to find an effective treatment for the management of SANFH.


Assuntos
Flavonoides/farmacologia , Osteonecrose/tratamento farmacológico , Extratos Vegetais/farmacologia , Polypodiaceae/química , Animais , Proliferação de Células/efeitos dos fármacos , Subunidade alfa 1 de Fator de Ligação ao Core/genética , Modelos Animais de Doenças , Cabeça do Fêmur/patologia , Flavonoides/química , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Masculino , Osteoblastos/efeitos dos fármacos , Osteogênese por Distração/métodos , Osteonecrose/induzido quimicamente , Osteonecrose/patologia , Osteoprotegerina/genética , Fosfatidilinositol 3-Quinases/genética , Extratos Vegetais/química , Proteínas Proto-Oncogênicas c-akt/genética , Ligante RANK/genética , Ratos , Espécies Reativas de Oxigênio/metabolismo , Transdução de Sinais/efeitos dos fármacos , Esteroides/efeitos adversos
12.
Cochrane Database Syst Rev ; 3: CD013409, 2021 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-33687067

RESUMO

BACKGROUND: Hip fractures are a major healthcare problem, presenting a huge challenge and burden to patients, healthcare systems and society. The increased proportion of older adults in the world population means that the absolute number of hip fractures is rising rapidly across the globe. The majority of hip fractures are treated surgically. This review evaluates evidence for types of internal fixation implants used in joint-preserving surgery for intracapsular hip fractures. OBJECTIVES: To determine the relative effects (benefits and harms) of different implants for the internal fixation of intracapsular hip fractures in older adults. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, Web of Science, Cochrane Database of Systematic Reviews, Epistemonikos, Proquest Dissertations and Theses, and National Technical Information Service in July 2020. We also searched clinical trials databases, conference proceedings, reference lists of retrieved articles and conducted backward-citation searches. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs comparing implants used for internal fixation of fragility intracapsular proximal femoral fractures in older adults. Types of implants were smooth pins (these include pins with fold-out hooks), screws, or fixed angle plates. We excluded studies in which all or most fractures were caused by specific pathologies other than osteoporosis or were the result of a high energy trauma. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion. One review author extracted data and assessed risk of bias which was checked by a second review author. We collected data for seven outcomes: activities of daily living (ADL), delirium, functional status, health-related quality of life (HRQoL), mobility, mortality (reported within four months of surgery as early mortality, and at 12 months since surgery), and unplanned return to theatre for treating a complication resulting directly or indirectly from the primary procedure (such as deep infection or non-union). We assessed the certainty of the evidence for these outcomes using GRADE. MAIN RESULTS: We included 38 studies (32 RCTs, six quasi-RCTs) with 8585 participants with 8590 intracapsular fractures. The mean ages of participants in the studies ranged from 60 to 84 years; 73% were women, and 38% of fractures were undisplaced. We report here the findings of the four main comparisons, which were between different categories of implants. We downgraded the certainty of the outcomes for imprecision (when data were available from insufficient numbers of participants or the confidence interval (CI) was wide), study limitations (e.g. high or unclear risks of bias), and inconsistency (when we noted substantial levels of statistical heterogeneity). Smooth pins versus fixed angle plate (four studies, 1313 participants) We found very low-certainty evidence of little or no difference between the two implant types in independent mobility with no more than one walking stick (1 study, 112 participants), early mortality (1 study, 383 participants), mortality at 12 months (2 studies, 661 participants), and unplanned return to theatre (3 studies, 736 participants). No studies reported on ADL, delirium, functional status, or HRQoL. Screws versus fixed angle plates (11 studies, 2471 participants) We found low-certainty evidence of no clinically important differences between the two implant types in functional status using WOMAC (MD -3.18, 95% CI -6.35 to -0.01; 2 studies, 498 participants; range of scores from 0 to 96, lower values indicate better function), and HRQoL using EQ-5D (MD 0.03, 95% CI 0.00 to 0.06; 2 studies, 521 participants; range -0.654 (worst), 0 (dead), 1 (best)). We also found low-certainty evidence showing little or no difference between the two implant types in mortality at 12 months (RR 1.04, 95% CI 0.83 to 1.31; 7 studies, 1690 participants), and unplanned return to theatre (RR 1.10, 95% CI 0.95 to 1.26; 11 studies, 2321 participants). We found very low-certainty evidence of little or no difference between the two implant types in independent mobility (1 study, 70 participants), and early mortality (3 studies, 467 participants). No studies reported on ADL or delirium. Screws versus smooth pins (seven studies, 1119 participants) We found low-certainty evidence of no or little difference between the two implant types in mortality at 12 months (RR 1.07, 95% CI 0.85 to 1.35; 6 studies, 1005 participants; low-certainty evidence). We found very low-certainty evidence of little or no difference between the two implant types in early mortality (3 studies, 584 participants) and unplanned return to theatre (5 studies, 862 participants). No studies reported on ADL, delirium, functional status, HRQoL, or mobility. Screws or smooth pins versus fixed angle plates (15 studies, 3784 participants) In this comparison, we combined data from the first two comparison groups. We found low-certainty evidence of no or little difference between the two groups of implants in mortality at 12 months (RR 1.04, 95% CI.083 to 1.31; 7 studies, 1690 participants) and unplanned return to theatre (RR 1.02, 95% CI 0.88 to 1.18; 14 studies, 3057 participants). We found very low-certainty evidence of little or no difference between the two groups of implants in independent mobility (2 studies, 182 participants), and early mortality (4 studies, 850 participants). We found no additional evidence to support the findings for functional status or HRQoL as reported in 'Screws versus fixed angle plates'. No studies reported ADL or delirium. AUTHORS' CONCLUSIONS: There is low-certainty evidence that there may be little or no difference between screws and fixed angle plates in functional status, HRQoL, mortality at 12 months, or unplanned return to theatre; and between screws and pins in mortality at 12 months. The limited and very low-certainty evidence for the outcomes for which data were available for the smooth pins versus fixed angle plates comparison, as well as the other outcomes for which data were available for the screws and fixed angle plates, and screws and pins comparisons means we have very little confidence in the estimates of effect for these outcomes. Additional RCTs would increase the certainty of the evidence. We encourage such studies to report outcomes consistent with the core outcome set for hip fracture, including long-term quality of life indicators such as ADL and mobility.


Assuntos
Pinos Ortopédicos , Placas Ósseas , Parafusos Ósseos , Cabeça do Fêmur/lesões , Fixação Interna de Fraturas/instrumentação , Fraturas do Quadril/cirurgia , Idoso , Idoso de 80 Anos ou mais , Viés , Intervalos de Confiança , Feminino , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/mortalidade , Fraturas do Quadril/mortalidade , Articulação do Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/métodos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
13.
BMC Musculoskelet Disord ; 22(1): 268, 2021 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-33706727

RESUMO

BACKGROUND: Preoperative templating in total hip arthroplasty (THA) is mandatory to achieve appropriate offset and leg length equality. However, templating methods using the contralateral hip might be susceptible to errors resulting from side-differences in the femoral morphology. The distance of the lesser trochanter to the femoral head center (LTFHD) is a frequently used reference parameter for preoperative planning and intraoperative validation during THA. However, currently no three-dimensional (3D) analysis of side differences of the LTFHD exists. METHODS: Using Computer tomography (CT)-based surface models from 100 paired femora (50 cadavers), side-to-side asymmetry of the LTFHD, femoral length, femoral head diameter (FHD) and femoral antetorsion were analyzed. Univariate linear regression models were established to evaluate potential associations between sides regarding LTFHD and FHD as well as a correlation of these parameters with each other. RESULTS: Statistically significant side-differences were found for the LTFHD (p = 0.02) and FHD (p = 0.03) with a mean absolute side-difference of 1.6 ± 1.4mm (range 0.1-5.5mm) and 0.4mm ± 0.6mm (range 0-3mm), respectively. The ratio between the LTFHD and FHD was consistent with an average value of 1.16 ± 0.08 and reliable between sides with a correlation coefficient (r) of 0.72 (p < 0.01). CONCLUSIONS: The LTFHD is a reliable reference parameter for preoperative templating and intraoperative validation during THA with a high correlation between sides (r = 0.93, p < 0.01). However, 8 % of the investigated specimens revealed a LTFHD of more than 4mm, which should be anticipated during THA to avoid unsatisfiable results.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/cirurgia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Tomografia Computadorizada por Raios X
14.
BMJ Case Rep ; 14(3)2021 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-33731396

RESUMO

A 72-year-old male patient presented to the hospital because of sudden inability to bear weight and without a history of trauma. A fracture of the head of the femur was identified on CT scan of the pelvis. In his history, the patient had a hospital admission 3 months earlier, during which he had a urinary catheter, and a urine specimen was analysed. The same pathogen was found in the patient urine and in the head of the femur specimen. This is a report of blood-borne spread of Serratia marcescens infection from the urothelium to the hip joint, responsible for spontaneous fracture of the femoral head without history of trauma.


Assuntos
Fraturas Ósseas , Infecções por Serratia , Idoso , Cabeça do Fêmur , Articulação do Quadril , Humanos , Masculino , Infecções por Serratia/diagnóstico , Serratia marcescens
15.
Biomater Sci ; 9(8): 3005-3018, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33651043

RESUMO

The osteonecrosis of femoral head (ONFH), a common refractory disease, is still not fully understood today. Hypoxia caused by ischemia is not only an important pathogenic factor but also a critical challenge for the survival of seed cells in the tissue engineering therapy of ONFH. To explore an efficient strategy to treat ONFH by targeting hypoxia, newly designed CaO2/gelatin microspheres were composited with 3D printed polycaprolactone/nano-hydroxyapatite (PCL/nHA) porous scaffold, sodium alginate/gelatin hydrogel, and bone marrow mesenchymal stem cells (BMSCs) to develop a novel tissue engineering scaffold and then transplanted into the core depression area of the ONFH rabbit model. The current data demonstrated that CaO2/gelatin microspheres can constantly release oxygen for 19 days. In vitro assays with BMSCs illustrated that scaffolds have high biocompatibility and are favorable for cell proliferation in extreme hypoxia (1% O2). The in vivo study demonstrated that the transplanted scaffold with oxygen-generating microspheres significantly enhanced the osteogenic and angiogenic effects compared to the scaffold without microspheres. Further assessments revealed that microspheres in the scaffold can reduce the local cell apoptosis and enhance the survival of grafted cells in the host. Collectively, the present study developed a novel oxygen slow-releasing composite scaffold, which can facilitate tissue engineering efficiency for treating the osteonecrosis of the femoral head by enhancing the angiogenesis and survival of grafted stem cells.


Assuntos
Células-Tronco Mesenquimais , Engenharia Tecidual , Animais , Cabeça do Fêmur , Gelatina , Microesferas , Osteogênese , Oxigênio , Coelhos , Tecidos Suporte
16.
Zhongguo Gu Shang ; 34(3): 215-9, 2021 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-33787163

RESUMO

OBJECTIVE: To study the relationship between osteonecrosis of femoral head after internal fixation of femoral neck fracture and serum bone metabolism, vascular active factors, and analyze the risk factors. METHODS: Total 150 patients with femoral neck fracture who underwent reduction and internal fixation from April 2016 to April 2019 were selected, including 83 males and 67 females. According to whether there was necrosis of femoral head after operation, they were divided into necrosis group(32 cases) and non necrosis group (118 cases). Before operation and 1, 3, 5 days after operation, the serum levels of beta-C terminal cross-linked telopeptides of typeⅠ collagen(ß-CTX), N-telopeptide of typeⅠ procollagen(PINP), nitric oxide (NO), Endothelin-1 (ET-1) were measured. The clinical characteristics of the two groups were compared. The risk factors of postoperative femoral head necrosis were analyzed by logistic regression model. The value of serum indexes in predicting postoperative femoral head necrosis was analyzed by ROC curve. RESULTS: There was no significant difference in the levels of serum PINP and ß-CTX between necrotic group and non necrotic group before operation and 1, 3 and 5 days after operation(P>0.05). There was no significant difference in the levels of serum NO and ET-1 before operation and 5 days after operation(P>0.05). There were significant differences in the levels of serum NO and ET-1(P<0.05), fracture type, preoperative traction ratio and reduction quality (P<0.05). Logistic regression analysis showed that the decrease of serum NO content and the increase of ET-1 content at 1 day after operation, Ⅲ-Ⅳ fracture and Ⅲ-Ⅳ reduction were the risk factors of femoral head necrosis;ROC curve analysis showed that serum NO and ET-1 content at 1 day after operation had predictive value for femoral head necrosis, and the best cut-off points were 26.55 µmol / L and 7.785 µg / L, respectively. CONCLUSION: The content of serum NO and ET-1 on the first day after operation can predict the necrosis of femoral head.


Assuntos
Fraturas do Colo Femoral , Necrose da Cabeça do Fêmur , Osteonecrose , Feminino , Fraturas do Colo Femoral/cirurgia , Cabeça do Fêmur , Necrose da Cabeça do Fêmur/etiologia , Fixação Interna de Fraturas/efeitos adversos , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco
17.
J Biomech ; 119: 110208, 2021 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-33662748

RESUMO

Measuring the location of necrotic lesions is necessary to diagnosis of osteonecrosis. Different region segmentation methods of the femoral head were proposed to quantitatively measure necrotic lesions including Japanese Investigation Committee for Avascular Necrosis (JIC) classification and China-Japan Friendship Hospital (CJFH) classification. Biomechanical methods could bring important information to evaluate the reasonability of these classifications. In this study, microstructural and mechanical properties of trabecular bone were quantitatively analyzed according to the region segmentation methods described in these classifications. Microstructural parameters of trabecular bone were analyzed based on micro-CT scanning. Mechanical properties were measured through Nanoindentation and micro-finite element analysis. It was found that microstructural and mechanical properties of trabecular bone in the middle region was more adaptive to load bearing than the medial and lateral regions according to the CJFH classification; lesions in the middle region could bring more changes to microstructure and stress distribution. According to JIC classification, differences of microstructural and mechanical properties among the three regions were not significant. Biomechanical characteristics of trabecular bones could be better distinguished with CJFH classification.


Assuntos
Osteonecrose , Cabeça do Fêmur , Análise de Elementos Finitos , Humanos , Osteonecrose/diagnóstico por imagem , Estresse Mecânico , Suporte de Carga , Microtomografia por Raio-X
18.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33542017

RESUMO

A 74-year-old patient presented to the emergency department with acute atraumatic hip pain 9 years after her primary left total hip arthroplasty (THA). Plain radiographic imaging demonstrated lateralisation of the femoral head within the acetabular shell-indicating an issue with the polyethylene liner. The patient required revision of the acetabular component and the femoral head, as well as a new polyethylene liner. A detailed analysis of the components removed was performed by DePuy Synthes Engineering. Between 2009 and 2020, 8 publications have documented 52 cases of liner dissociation with the Pinnacle acetabular component and Marathon polyethylene liner. Various theories have been proposed in the literature as all of these components appear to fail in the same way, with shearing of the locking tabs in the polyethylene liner. In spite of a manufacturer analysis of the components, no root cause was identified as to why the polyethylene liner failed.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/efeitos adversos , Cabeça do Fêmur/cirurgia , Prótese de Quadril/efeitos adversos , Polietileno/efeitos adversos , Falha de Prótese , Idoso , Feminino , Humanos , Radiografia , Reoperação
19.
Am J Sports Med ; 49(4): 1023-1030, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33592149

RESUMO

BACKGROUND: Three-dimensional computed tomography (3D-CT) is commonly used for the evaluation of cam deformity; however, it does not display the cam border directly. PURPOSE: To compare the efficacy of the best-fit sphere (BFS) method and the alpha angle marking (AAM) method in 3D-CT evaluation for the cam border. STUDY DESIGN: Cohort study (Diagnosis); Level of evidence, 3. METHODS: Twenty-six cases of cam deformity, confirmed during hip arthroscopy, were included in this study. All patients underwent a CT scan before surgery. Using multiplanar reconstruction, we obtained reformatted CT images of oblique axial, oblique coronal, and radial views. The alpha angle and femoral head-neck offset ratio (hnoR) were measured on the reformatted CT images. The cam area on 3D-CT was displayed in 4 different ways: by importing the markers from the reformatted CT images of the oblique axial view (cam-oa), the oblique coronal view (cam-oc), or the radial view (cam-r) using the AAM method, or by using the BFS method (cam-bfs). The sizes and locations of the displayed cams were compared. RESULTS: All hips in this study had an alpha angle greater than 60° and an hnoR smaller than 0.17. The radial view measured a larger alpha angle and smaller hnoR than the oblique axial and coronal views (P < .05). The areas of cam-oa, cam-oc, cam-r, and cam-bfs were 161.47 ± 27.96, 89.78 ± 19.23, 241.73 ± 34.55, and 329.75 ± 42.73 mm2, respectively, and their medial-to-lateral ranges along the acetabulum (clockface referents) were 12:30 to 03:00, 11:30 to 01:30, 11:30 to 03:00, and 11:00 to 03:30, respectively. Among the 4 displays, cam-bfs had the largest area and medial-to-lateral range (P < .05), and cam-r had the second largest area and range (P < .05). No significant difference in the mean distances from the acetabular rim to the superior border was detected among the 4 displays (P > .05). CONCLUSION: The cam area displayed by the BFS method on 3D-CT was larger than those evaluated by the AAM method. In the reformatted CT, the sizes and locations of cam deformity differed among the oblique axial, oblique coronal, and radial views, with the radial view showing the greatest area.


Assuntos
Impacto Femoroacetabular , Estudos de Coortes , Impacto Femoroacetabular/diagnóstico por imagem , Cabeça do Fêmur , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Tomografia Computadorizada por Raios X
20.
AJR Am J Roentgenol ; 216(4): 1014-1021, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33534621

RESUMO

OBJECTIVE. The purpose of this study was to assess the utility of radiography in diagnosing osteonecrosis of the femoral head with pathologic examination as the reference standard. MATERIALS AND METHODS. Radiography and pathology reports of 253 consecutive femoral head resections were reviewed. A subset of 128 cases in which the diagnosis of osteonecrosis was made or suggested radiographically or pathologically were reviewed to evaluate for factors that might influence correlation. A total of 23 patients in this subset had also undergone MRI, and those reports and images were reviewed. RESULTS. There was 93.9% agreement between radiography and pathologic examination overall (κ = 0.67). When grade 3 osteoarthritis was present, 95.0% agreement was found, but because of the large number of patients with severe osteoarthritis, the kappa value decreased to 0.51. In the subset of cases in which osteonecrosis was diagnosed or suspected, radiologic-pathologic correlation decreased as osteoarthritis grade increased, and the diagnostic uncertainty for both evaluation methods increased. One patient without osteoarthritis had osteonecrosis diagnosed in both hips at radiography and MRI, but osteonecrosis was absent at pathologic examination. CONCLUSION. Radiography depicts osteonecrosis in most patients who have osteonecrosis and subsequently undergo femoral head resection. False-positive and false-negative radiographic findings occur, however. Diagnosis is most difficult in patients with advanced osteoarthritis or subchondral fractures. The number of patients who underwent MRI was not sufficient for evaluation of the accuracy of MRI.


Assuntos
Necrose da Cabeça do Fêmur/diagnóstico , Idoso , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/patologia , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Necrose da Cabeça do Fêmur/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia
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