Objective:To evaluate the effectiveness of surgical combination with traditional Chinese medicine dialectical therapy in three phases for the treatment of intertrochanteric fracture of the femur(IFF).Methods:84 patien...Objective:To evaluate the effectiveness of surgical combination with traditional Chinese medicine dialectical therapy in three phases for the treatment of intertrochanteric fracture of the femur(IFF).Methods:84 patients with IFF admitted to the hospital from December 2022 to December 2024 were selected and randomly divided into two groups using a random number table.The combined group received surgery and traditional Chinese medicine dialectical therapy in three phases,while the control group received surgery alone.The total effective rate,fracture healing time,hip function score,and lower extremity function score were compared between the two groups.Results:The total effective rate was higher in the combined group than in the control group(P<0.05).After treatment,the fracture healing time was shorter in the combined group than in the control group,and the hip function and lower extremity function scores were higher in the combined group than in the control group(P<0.05).Conclusion:Surgical combination with traditional Chinese medicine dialectical therapy in three phases can shorten the fracture healing time of IFF patients and restore their hip and lower extremity function,demonstrating significant efficacy.展开更多
Objective:To explore the correlation between fetal foot length measured by ultrasound and gestational age.Methods:This study employed ultrasound to measure the fetal foot length,femoral length,and foot length/femoral ...Objective:To explore the correlation between fetal foot length measured by ultrasound and gestational age.Methods:This study employed ultrasound to measure the fetal foot length,femoral length,and foot length/femoral length ratio in 214 pregnant women from 12 to 40 weeks of gestation,all of whom had no pregnancy complications or obstetric complications,and whose fetuses were normal.Results:A significant positive correlation was found between fetal foot length and gestational age(r=0.967,p<0.001);a similarly significant positive correlation was observed between fetal femoral length and gestational age(r=0.972,p<0.001);and a non-significant positive correlation was noted between the foot length/femoral length ratio and gestational age(r=0.943,p<0.001).Conclusion:Ultrasound can accurately measure fetal foot length and femoral length,both of which exhibit a significant positive correlation with gestational age,making them important reference indicators for assessing fetal growth and development.展开更多
BACKGROUND Total hip arthroplasty(THA)has increased along with an increasing demand for improved quality of life.Combined with prolonged life expectancy,the number of revision surgeries is expected to increase.Stress ...BACKGROUND Total hip arthroplasty(THA)has increased along with an increasing demand for improved quality of life.Combined with prolonged life expectancy,the number of revision surgeries is expected to increase.Stress shielding is a significant issue with traditional femoral stems used in THA,making revision surgeries particularly challenging in younger patients.This has sparked renewed interest in studying safety and functional outcomes of short metaphyseal femoral stems,which have the potential to alleviate these challenges and simplify revision surgeries.AIM To evaluate the long-term outcomes of short-stem THA.METHODS A total of 124 hips that underwent THA using the short femoral stem(TRILOCK®Depuy)between May 2006 and November 2008 were included in this study.Patients were followed for a period of 15 years.Outcomes were assessed in terms of pain relief,hip joint range of motion,improvement in mobility,and functional outcomes using the modified Harris Hip Score,Oxford hip score,and Western Ontario and McMaster Universities Osteoarthritis index score.RESULTS A total of 124 hips in 98 patients were evaluated.Significant improvements in functional outcomes were observed over the 15-year follow-up period,with no cases of subsidence,implant loosening,or complications necessitating revision surgery.The only complication reported was heterotopic ossification in 1 patient.CONCLUSION Short metaphyseal stems provide better functional outcomes with early mobilization,and its long-term follow-up without subsidence,implant loosening,or proximal femoral bone loss simplifies revision surgery in younger patients.展开更多
BACKGROUND Femur fractures are one of the most serious injuries that occur in the older population and are associated with severe pain and increased mortality.The primary objective of this study was to find if there w...BACKGROUND Femur fractures are one of the most serious injuries that occur in the older population and are associated with severe pain and increased mortality.The primary objective of this study was to find if there was a significant difference in pain scores in patients treated with femoral nerve blocks(FNB)compared with patients treated with the standard analgesia protocol.The secondary objective was to find if there was a significant difference in morbidity between the two groups.AIM To evaluate the effectiveness of ultrasound(US)-guided FNB in managing preoperative pain and reducing morbidity in patients with neck femur fractures compared to the standard analgesia protocol.The study seeks to determine whether FNB offers superior outcomes in terms of pain control,rehospitalization rates,and mortality.METHODS This retrospective cohort study included 1577 patients suffering from neck femur fractures.387 patients were treated with a FNB for pain management upon arrival at the emergency department,the rest were treated with standard analgesia.Pain was assessed from electronic medical records using the visual analogue scale(VAS)pre surgery,12-and 24-hour post-surgery.To determine morbidity and mortality during hospitalizations and 6 months after,it was collected from electronic medical records.RESULTS In a cohort of 1577 patients,those receiving US-guided FNB had significantly lower preoperative VAS pain scores(1.46±2.49 vs 1.82±2.59,P=0.001),reduced rehospitalization rates(0.99±1.96 vs 1.46±2.34,P<0.001),and lower mortality(16%vs 32%,P<0.001)compared to standard analgesia.CONCLUSION US guided FNB is more effective for pain management compared with standard analgesia.This method was also found to significantly reduce the risk of morbidity in those patients.展开更多
Prophylactic fixation(ProFix)of the proximal femur in elderly patients with osteoporosis presents a forward-thinking approach to preventing debilitating fractures and their associated complications.By addressing fract...Prophylactic fixation(ProFix)of the proximal femur in elderly patients with osteoporosis presents a forward-thinking approach to preventing debilitating fractures and their associated complications.By addressing fracture risk before an injury occurs,ProFix has the potential to enhance patient outcomes,promote long-term mobility,and reduce healthcare costs.Early intervention in individuals at high risk can significantly lower hospital admissions,shorten recovery periods,and preserve independence,mitigating challenges such as chronic pain and reduced life expectancy.Given the high prevalence of undiagnosed osteoporosis,prioritising early risk assessment and targeted prevention is essential.Advancements in minimally invasive surgical techniques and safer anaesthesia methods further support ProFix as a feasible and effective strategy to decrease fracturerelated morbidity,improve overall patient well-being,and optimise the use of healthcare resources.This opinion review details the evidence supporting this concept,its efficacy,the challenges in its implementation,and a strategic plan for future implementation.展开更多
Objective:To evaluate the treatment effect of total hip arthroplasty(THA)for intertrochanteric femur fractures(IFF)in elderly patients.Methods:Thirty-two elderly patients with IFF admitted to the hospital from August ...Objective:To evaluate the treatment effect of total hip arthroplasty(THA)for intertrochanteric femur fractures(IFF)in elderly patients.Methods:Thirty-two elderly patients with IFF admitted to the hospital from August 2021 to August 2024 were selected and randomly divided into two groups using a random number table.The experimental group(16 patients)underwent THA surgery,while the control group(16 patients)underwent proximal femoral nail antirotation(PFNA)surgery.Hip joint function and quality of life indicators were compared between the two groups.Results:Before surgery,there was no significant difference in hip joint function and quality of life scores between the two groups(P>0.05).However,at six months postoperatively,the experimental group had higher hip joint function and quality of life scores compared to the control group(P<0.05).The total effective rate was higher in the experimental group than in the control group(P<0.05).The complication rate in the experimental group was similar to that in the control group(P>0.05).Conclusion:THA can improve the clinical efficacy of elderly patients with IFF,minimize postoperative complications,effectively restore hip joint function,and optimize postoperative quality of life.展开更多
BACKGROUND Clinical studies using Trabecular Titanium™acetabular cups have shown promising short and medium-term results.This material,due to its macro and micro surface roughness,provides a substrate for osseointegra...BACKGROUND Clinical studies using Trabecular Titanium™acetabular cups have shown promising short and medium-term results.This material,due to its macro and micro surface roughness,provides a substrate for osseointegration and enhances implant stability.However,there is a lack of evidence in the literature on the use of this material in patients with femoral neck fracture.AIM To evaluate the short-term clinical-functional and radiographic outcomes in patients with femoral neck fractures undergoing total hip arthroplasty(THA)with Trabecular Titanium™acetabular cup implants.METHODS The study included 104 patients with medial femoral neck fractures who underwent THA between January 2020 and December 2020 with the Delta TT acetabular cup(Lima Corporate,Villanova di San Daniele del Friuli,Italy).The mean age of the patients was 69.57±10.16 years(range:36-85 years).The followup period ranged from a minimum of 3 to a maximum of 4 years.Three questionnaires(Harris Hip Score,Oxford Hip Score,and EQ5D)were administered along with radiographic evaluations.Statistical methods included the Student's t-test and one-way analysis of variance for comparisons(with significance set at 0.05),and the Kaplan-Meier curve for prosthetic implant survival.RESULTS The mean follow-up was 41.5 months.The Harris Hip Score(HHS)showed a mean increase of 2.74 points(mean HHS 88.52 at 6 months postoperatively and mean HHS 91.26 at the last follow-up)with statistical significance.Similarly,the Oxford Hip Score demonstrated a statistically significant difference between follow-up groups.However,the EQ5D did not show statistically significant differences among the three groups(preoperative,6-month follow-up,and last follow-up).Revision surgery was required in 6 patients.According to Moore's criteria,96%of the acetabular components were radiographically stable and well-integrated at the last follow-up.The Kaplan-Meier curve showed a 96%survival rate.CONCLUSION The clinical and radiographic results obtained in the short to medium term confirm the excellent performance of the Delta TT acetabular cup in terms of osseointegration,providing an optimal solution both for young patients with high functional recovery demands and for fragile patients requiring optimal stability of the acetabular component to reduce the risk of implant failure.展开更多
BACKGROUND In intertrochanteric fractures,the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse.AIM To analyze the concept of medial cortical...BACKGROUND In intertrochanteric fractures,the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse.AIM To analyze the concept of medial cortical reduction(MCR)and its clinical and radiological association in geriatric intertrochanteric femur fractures.METHODS Geriatric patients who presented with AO/OTA 31A1 and 31A2 femur fractures and treated with proximal femoral nailing between July 2021 and June 2023 were include in this prospective cohort study.Based on the degree of MCR,they were divided into positive,neutral,or negative MCR groups.The demographic baseline characteristics,postoperative radiographic femoral neck-shaft angle and neck length were analyzed at 6,12 and 24 weeks post-surgery.Functional outcomes such as modified Harris Hip Score(HHS)and time to full-weight bearing were also analyzed.RESULTS 47 patients(Male:Famale 35:12)with mean age of 65.8±4.2 years were included in this study.Twenty-two cases had neutral support,nine had negative support,and sixteen had positive support in the medial cortex postoperatively.Baseline characteristics of the three groups were comparable.No significant differences were found in the femur neck length and femur neck-shaft angle changes post-surgery between the groups.The modified HHS was not found to be significant between the groups(P=0.883)as that of the time to full weight bearing(P=0.789).CONCLUSION The type of reduction achieved based on medial cortical alignment does not affect the femur neck length shortening or varus collapse.Future randomized controlled trials are needed to validate the findings noted in the study.展开更多
Reconstruction of a traumatic distal femur defect remains a therapeutic challenge.Bone defect implants have been proposed to substitute the bone defect,and their biomechanical performances can be analyzed via a numeri...Reconstruction of a traumatic distal femur defect remains a therapeutic challenge.Bone defect implants have been proposed to substitute the bone defect,and their biomechanical performances can be analyzed via a numerical approach.However,the material assumptions for past computational human femur simulations were mainly homogeneous.Thus,this study aimed to design and analyze scaffolds for reconstructing the distal femur defect using a patient-specific finite element modeling technique.A three-dimensional finite element model of the human femur with accurate geometry and material distribution was developed using the finite element method and material mapping technique.An intact femur and a distal femur defect model treated with nine microstructure scaffolds and two solid scaffolds were investigated and compared under a single-leg stance loading.The results showed that the metal solid scaffold design could provide the most stable fixation for reconstructing the distal femur defect.However,the fixation stability was affected by various microstructure designs and pillar diameters.A microstructure scaffold can be designed to satisfy all the biomechanical indexes,opening up future possibilities for more stable reconstructions.A three-dimensional finite element model of the femur with real bone geometry and bone material distribution can be developed,and this patient-specific femur model can be used for studying other femoral fractures or injuries,paving the way for more comprehensive research in the field.Besides,this patient-specific finite element modeling technique can also be applied to developing other human or animal bone models,expanding the scope of biomechanical research.展开更多
Background of the Study: Femoral shaft fracture is the most common pediatric injury requiring hospitalization. For children less than 5 years old, non-surgical approach is recommended. For pediatric patients 5 - 14 ye...Background of the Study: Femoral shaft fracture is the most common pediatric injury requiring hospitalization. For children less than 5 years old, non-surgical approach is recommended. For pediatric patients 5 - 14 years old, the most common mode of treatment is flexible intramedullary nailing with a known complication of pain at post-op site, inflammatory reaction/bursitis at the entry site, superficial and deep infection, knee synovitis, knee stiffness, leg length discrepancy, proximal nail migration, angulation or malunion, delayed and non-union, implant breakage. This study aims to present a rare complication of a femoral fracture fixed with flexible intramedullary nail. Methodology: We report the outcome of a 12-year-old male with peri implant fracture of the left femur. He underwent removal of plates and screws and subsequently fixed with flexible intramedullary nails. Patient was followed up at 1, 3, 7, and 10 months post-operatively. Varus-valgus, sagittal angulation, and limb shortening were measured pre- and post-operatively. Complications were recorded on each visit. Results: Pre-operative varus angulation was 10˚, pro-curvatum of 55˚ with limb shortening of 4 cm. Postoperatively, varus was maintained to 10˚ but pro-curvatum was corrected to 4˚ and limb shortening was reduced to 1 cm. However, after 1 month the varus angulation increased to 30˚ while maintaining sagittal pro-curvatum. Limb shortening also increased to 2 cm. New bone formation started to appear along the mechanical axis of the left femur which is apparent at 3 months post-op and pro-curvatum increased to 20˚. At 7 and 10 months post-op no signs of union was noted at the fracture site but the callus formation along the mechanical axis gradually matured and appeared as a new femoral shaft. Conclusion: Formation of new bone in response to unstable flexible intramedullary fixation in pediatric femoral shaft fracture is a very rare complication.展开更多
Periprosthetic fracture of femur is a common and complex complication after joint replacement. With the increase of operation volume, its incidence is increasing year by year. The treatment of this fracture is affecte...Periprosthetic fracture of femur is a common and complex complication after joint replacement. With the increase of operation volume, its incidence is increasing year by year. The treatment of this fracture is affected by many factors, including fracture type, prosthesis stability, patient age and comorbidities, and individualized treatment strategy is needed. In recent years, the internal fixation technology and prosthetic revision technology have made significant progress in surgical treatment, such as locking steel plate, titanium cable and bridge combined internal fixation system and other new technologies have effectively improved the treatment effect. In addition, the application of new materials and 3D printing technology, as well as the optimization of multidisciplinary cooperation mode, also provide new ideas for the treatment of complex fractures. However, there are still some problems such as inaccurate diagnosis, difficult choice of treatment options and high incidence of postoperative complications. In the future, technological innovation, the introduction of artificial intelligence and big data, and the further development of personalized treatment will bring more possibilities to improve the prognosis and quality of life of patients. This study summarizes the relevant research results and prospects the future development direction, providing references for clinical practice and subsequent research.展开更多
AIM To report the clinical and radiographic results of titanium elastic nail(TEN) in diaphyseal femoral fractures of children below age of six years.METHODS A retrospective analysis of 27 diaphyseal femoral fractures ...AIM To report the clinical and radiographic results of titanium elastic nail(TEN) in diaphyseal femoral fractures of children below age of six years.METHODS A retrospective analysis of 27 diaphyseal femoral fractures in children younger than six years treated with TEN between 2005 and 2015 was conducted. Patients were immobilized in a cast for 5 wk and the nails were removed from 6 to 12 wk after surgery. Twenty-four cases were clinically and radiographically re-evaluated using the Flynn's scoring criteria, focusing on: Limb length discrepancy, rotational deformity, angulation, hip and knee range of motion(ROM), functional status, complications, and parent's satisfaction.RESULTS Sixteen males and eight females with a mean age of 3.2 years at the time of treatment were re-evaluated at an average follow-up of 58.9 mo. No cases of delayed union were observed. The mean limb lengthening was 0.3 cm. Four cases experienced limb lengthening greater than 1 cm and always minor than 2 cm. Twelve point five percent of the cases showed an angulation < 10°. Complete functional recovery(hip and knee ROM, ability to run and jump on the operated limb) occurred in 95.7% of cases. Complications included two cases of superficial infection of the TEN entry point, one case of refracture following a new trauma, and one TEN mobilization. According to the Flynn's scoring criteria, excellent results were obtained in 79.2% of patients and satisfactory results in the remaining 20.8%, with an average parent's satisfaction level of 9.1/10.CONCLUSION TEN is as a safe, mini-invasive and surgeon-friendly technique and, considering specific inclusion criteria, it represents a useful and efficacy option for the treatment of diaphyseal femoral fractures even in patients younger than six years of age.展开更多
Adult patients with developmental dysplasia of the hip develop secondary osteoarthritis and eventually end up with total hip arthroplasty(THA) at younger age. Because of altered anatomy of dysplastic hips, THA in thes...Adult patients with developmental dysplasia of the hip develop secondary osteoarthritis and eventually end up with total hip arthroplasty(THA) at younger age. Because of altered anatomy of dysplastic hips, THA in these patients represents technically demanding procedure. Distorted anatomy of the acetabulum and proximal femur together with conjoined leg length discrepancy present major challenges during performing THA in patients with developmental dysplasia of the hip. In addition, most patients are at younger age, therefore, soft tissue balance is of great importance(especially the need to preserve the continuity of abductors) to maximise postoperative functional result. In this paper we present a variety of surgical techniques availablefor THA in dysplastic hips, their advantages and disadvantages. For acetabular reconstruction following techniques are described: Standard metal augments(prefabricated), Custom made acetabular augments(3D printing), Roof reconstruction with vascularized fibula, Roof reconstruction with pedicled iliac graft, Roof reconstruction with autologous bone graft, Roof reconstruction with homologous bone graft, Roof reconstruction with auto/homologous spongious bone, Reinforcement ring with the hook in combination with autologous graft augmentation, Cranial positioning of the acetabulum, Medial protrusion technique(cotyloplasty) with chisel, Medial protrusion technique(cotyloplasty) with reaming, Cotyloplasty without spongioplasty. For femoral reconstruction following techniques were described: Distraction with external fixator, Femoral shortening through a modified lateral approach, Transtrochanteric osteotomies, Paavilainen osteotomy, Lesser trochanter osteotomy, Double-chevron osteotomy, Subtrochanteric osteotomies, Diaphyseal osteotomies, Distal femoral osteotomies. At the end we present author's treatment method of choice: for acetabulum we perform cotyloplasty leaving only paper-thin medial wall, which we break during acetabular cup impacting. For femoral side first we peel of all rotators and posterior part of gluteus medius and vastus lateralis from greater trochanter on the very thin flake of bone. This method allows us to adequately shorten proximal femoral stump, with possibility of additional resection of proximal femur. Furthermore, several advantages and disadvantages of this procedure are also discussed.展开更多
OBJECTIVE： To investigate the effects of Huogu I formula on regulation of lipid metabolism in ste- roid-induced osteonecrosis of the femoral head （SONFH） rats and verify our hypothesis that Huogu I formula regulat...OBJECTIVE： To investigate the effects of Huogu I formula on regulation of lipid metabolism in ste- roid-induced osteonecrosis of the femoral head （SONFH） rats and verify our hypothesis that Huogu I formula regulates lipid metabolism by down-regulating peroxisome proliferator-activated receptor gamma （PPARy） expression and activating Wnt signaling pathways. METHODS： Eighty-five rats were divided into four groups： control, model, Huogu 15 g/kg and Huogu 30 g/kg. Six weeks later, animals were anaesthe- tized, femora were dissected for histopathologicalexamination of the osteonecrotic changes and re- pair processes, micro computed tomography （Mi- cro-CT）-based micro-angiography was performed to assess vascularization. Serum lipid levels were detected by haematological examination. The ex- pressions of PPARy, Wnt3a, low density lipoprotein receptor-related protein 5 （LRP5） and 13-catenin were evaluated by immunohistochemistry, Western blot and quantitative real-time polymerase chain reaction analyses. RESULTS： The incidence of osteonecrosis, ratio of empty lacuna, adipose tissue area and adipocyte perimeter in the bone marrow were dramatically lower in the Huogu ~ formula treatment groups. By micro-CT quantification, Huogu ~ formula treat- ment dose-dependently increased vessel volume, vessel surface, percentage of vessel volume and vessel thickness of the femoral heads of SONFH rats. Levels of serum lipid in Huogu 15 g/kg and Huogu 30 g/kg groups reduced significantly. HuoguⅠformula treatment could suppress the ex- pression of PPARy and increase the expressions of Wnt3a, LRP5 and 13-catenin at both protein and mRNA levels. CONCLUSION： The results of our present study highlight the lipid-lowering potential of Huogu Ⅰ formula, and provide further evidence of the in- volvement of the PPARy inhibition and Wnt/LRPS/ 13-catenin signaling activation in the effects of Huogu Ⅰ formula.展开更多
OBJECTIVE: To investigate the efficacy and safety of intravenous cervus and cucumis polypeptides for treating avascular necrosis of the femoral head(ANFH) in regard to pain and hip function in a randomized clinical tr...OBJECTIVE: To investigate the efficacy and safety of intravenous cervus and cucumis polypeptides for treating avascular necrosis of the femoral head(ANFH) in regard to pain and hip function in a randomized clinical trial.METHODS: A total of 96 subjects with ANFH who were recruited at the Orthopaedic Hospital Affiliated with Hebei United University and Qian Hai Femoral Head Hospital of Beijing were assigned by lottery to an intervention group(n = 48) or a control group(n = 48). All subjects underwent physical therapy and rehabilitation exercises. In addition,subjects in the intervention group were given intravenous infusions of cervus and cucumis polypeptides. Visual analogue scale(VAS), Harris hip score,and radiography or magnetic resonance imaging were applied to assess all subjects at the beginning of treatment and 3, 6, and 9 months afterward. All the subjects were followed up for 2 years.RESULTS: At the beginning of treatment, there were no statistically significant differences between the two groups in terms of the general condition of patients or the VAS and Harris hip scores(all P > 0.05). At 3, 6, and 9 months after treatment,however, the VAS score decreased and the Harris hip score increased in all patients, with the improvement of intervention group significantly greater than that of the control group(P < 0.05).The total effectiveness rates for the intervention and control groups were 89.58% and 70.83%, respectively, with the difference being statistically significant(P < 0.05). There was no statistically significant difference between the two groups in terms of the safety of the injections(P > 0.05).CONCLUSION: Intravenous infusion of cervus and cucumis polypeptides relieved pain and improved hip function of subjects with ANFH.Thus, the intravenous infusion of cervus and cucumis polypeptides was a safe, effective treatment for ANFH.展开更多
OBJECTIVE: To investigate the effect of acupuncture therapy on fracture healing in rats with femur fractures.METHODS: A total of 10 groups were formed;control group, groups sacrificed on 7 th, 14 th, and 21 st days of...OBJECTIVE: To investigate the effect of acupuncture therapy on fracture healing in rats with femur fractures.METHODS: A total of 10 groups were formed;control group, groups sacrificed on 7 th, 14 th, and 21 st days of fracture formation, groups to which acupuncture was applied for 7, 14, and 21 d, groups to which fracture and acupuncture were applied for 7,14, and 21 d. A transverse fracture line was formed in femurs of rats by using a Gigli saw. The Kirschner wire was driven retrograde down from the fracture line to proximal part of the bone and then, the fracture was fixed towards distal part. Acupuncture was applied to the rats for 7, 14, and 21 d as 4 sessions per week after formation of the fracture.RESULTS: Malondialdehyde(MDA), reduced glutathione(GSH) levels, catalase(CAT), glutathione-Stransferase(GST), superoxide dismutase(SOD), and glucose-6-phosphate dehydrogenase(G6 PD) activities were measured. Despite the increased MDA levels, G6 PD and SOD activities reduced during the fracture healing. There was a statistically significant increase in MDA, GSH levels, and G6 PD activity in fracture groups compared to control group, but CAT, GST, and SOD activities decreased. The use of acupuncture enhanced callus development and bone mineralization during bone healing.CONCLUSION: The acupuncture therapy can affect suppression of the effects of free oxygen radicals and regulation of the antioxidant enzyme activity in fracture healing. Thus, it is suggested that acupuncture treatment would be beneficial for fracture healing in order to eliminate the negative effects induced by oxygen free radicals.展开更多
To study the effect of titanium alloy cage on the treatment of the ischemic necrosis of femoral head in dog, the model of the ischemic necrosis of femoral head was made with the liquid nitrogen in 15 hybrid adult dogs...To study the effect of titanium alloy cage on the treatment of the ischemic necrosis of femoral head in dog, the model of the ischemic necrosis of femoral head was made with the liquid nitrogen in 15 hybrid adult dogs. The titanium alloy cage made of a hollow cylinder was driven into the subchondral bone of necrotic femoral head via central channel. The dogs were divided into 3 groups, each group was sacrificed 3, 6, 12 weeks after the operation respectively. No collapse of femoral head was observed after the operation. The position of the cages was good on radiograph. Microscopically, the cancellous bone of necrotic femoral head rebuilt gradually and grew into cage. After 12 weeks of creeping substitution, the cancellous bone filled up the hollow cavity and holes of the cages. It is concluded that the titanium alloy cage can provide structural support for the subchondral bone and prevent collapse and can be used for the treatment of the ischemic necrosis of femoral head.展开更多
AIM To review and report functional outcomes, complications,and survivorship associated with total knee arthroplasty(TKA) in the treatment of post-traumatic arthritis(PTA).METHODS We conducted a systematic review acco...AIM To review and report functional outcomes, complications,and survivorship associated with total knee arthroplasty(TKA) in the treatment of post-traumatic arthritis(PTA).METHODS We conducted a systematic review according to the PRISMA guidelines. We searched PubMed, Cochrane Library, and SCOPUS in December 2015 for Englishlanguage clinical research studies, both prospective and retrospective, examining the use of TKA for the treatment of PTA. All relevant articles were accessed in full. The manual search included references of retrieved articles.We extracted data on patients' demographics and clinical outcomes, including preoperative diagnosis and pre- and post-operative functional scores. We summarized the data and reported the results in tables and text.RESULTS Sixteen studies, four prospective and ten retrospective,examined patients who underwent TKA for PTA due to fractures of the proximal tibia, patella, and/or distal femur. Eleven studies utilized the Knee Society Scores criteria to assess functional outcomes. All studies utilizing these criteria reported an improvement in functional and knee scores of patients following TKA. Further, studies reported an increased range of motion(ROM) and reduction of pain following surgery. The most commonly reported complications with TKA included infection, stiffness, wound complications, intraoperative rupture of tendons, and osteolysis/polyethylene wear. The overwhelming majority of these complications occurred within the first two years following surgery. Six studies examined the survivorship of TKA with subsequent revision for any reason as an endpoint. Compared to patients with osteoarthritis, patients with PTA required more revisions, the majority for polyethylene wear.CONCLUSION Although associated with higher complication rates,TKA is an effective treatment for PTA, as it improves ROM, pain and functional outcomes.展开更多
Total femoral replacement(TFR) is a salvage arthroplasty procedure used as an alternative to lower limb amputation. Since its initial description in the mid-20^(th) century, this procedure has been used in a variety o...Total femoral replacement(TFR) is a salvage arthroplasty procedure used as an alternative to lower limb amputation. Since its initial description in the mid-20^(th) century, this procedure has been used in a variety of oncologic and non-oncologic indications. The most compelling advantage of TFR is the achievement of immediate fixation which permits early mobilization. It is anticipated that TFR will be increasingly performed as the rate of revision arthroplasty rises worldwide. The existing literature is mainly composed of a rather heterogeneous mix of retrospective case series and a wide assortment of case reports. Numerous TFR prostheses are currently available and the surgeon must understand the unique implications of each implant design. Long-term functional outcomes are dependent on adherence to proper technique and an appropriate physical therapy program for postoperative rehabilitation. Revision TFR is mainly performed for periprosthetic infection and the severe femoral bone loss associated with aseptic revisions. Depending on the likelihood of attaining infection clearance, it may sometimes be advisable to proceed directly to hip disarticulation without attempting salvage of the TFR. Other reported complications of TFR include hip joint instability, limb length discrepancy, device failure, component loosening, patellar maltracking and delayed wound healing. Further research is needed to better characterize the long-term functional outcomes and complications associated with this complex procedure.展开更多
Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics.The ...Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics.The various treatment options that have been described can be broadly divided according to the aim of improving either biology or biomechanics. Surgeries aimed at improving the biology, such as vascularized fibula grafting, have good success rates but require high levels of expertise and substantial resources. A popular surgical treatment aimed at improving the biomechanics-valgus intertrochanteric osteotomyoptimizes conditions for fracture healing by converting shear forces across the fracture site into compressive forces. Numerous variations of this surgical procedure have been developed and successfully applied in clinical practice. As a result, the proximal femoral orientation for obtaining a good functional outcome has evolved over the years, and the present concept of altering the proximal femoral anatomy as little as possible has arisen. This technical objective supports attaining union as well as a good functional outcome, since excessive valgus can lead to increased joint reaction forces. This review summarizes the historical and current literature on valgus intertrochanteric osteotomy treatment of nonunion neck of femur, with a focus on factors predictive of good functional outcome and potential pitfalls to be avoided as well as controversies surrounding this procedure.展开更多
文摘Objective:To evaluate the effectiveness of surgical combination with traditional Chinese medicine dialectical therapy in three phases for the treatment of intertrochanteric fracture of the femur(IFF).Methods:84 patients with IFF admitted to the hospital from December 2022 to December 2024 were selected and randomly divided into two groups using a random number table.The combined group received surgery and traditional Chinese medicine dialectical therapy in three phases,while the control group received surgery alone.The total effective rate,fracture healing time,hip function score,and lower extremity function score were compared between the two groups.Results:The total effective rate was higher in the combined group than in the control group(P<0.05).After treatment,the fracture healing time was shorter in the combined group than in the control group,and the hip function and lower extremity function scores were higher in the combined group than in the control group(P<0.05).Conclusion:Surgical combination with traditional Chinese medicine dialectical therapy in three phases can shorten the fracture healing time of IFF patients and restore their hip and lower extremity function,demonstrating significant efficacy.
文摘Objective:To explore the correlation between fetal foot length measured by ultrasound and gestational age.Methods:This study employed ultrasound to measure the fetal foot length,femoral length,and foot length/femoral length ratio in 214 pregnant women from 12 to 40 weeks of gestation,all of whom had no pregnancy complications or obstetric complications,and whose fetuses were normal.Results:A significant positive correlation was found between fetal foot length and gestational age(r=0.967,p<0.001);a similarly significant positive correlation was observed between fetal femoral length and gestational age(r=0.972,p<0.001);and a non-significant positive correlation was noted between the foot length/femoral length ratio and gestational age(r=0.943,p<0.001).Conclusion:Ultrasound can accurately measure fetal foot length and femoral length,both of which exhibit a significant positive correlation with gestational age,making them important reference indicators for assessing fetal growth and development.
文摘BACKGROUND Total hip arthroplasty(THA)has increased along with an increasing demand for improved quality of life.Combined with prolonged life expectancy,the number of revision surgeries is expected to increase.Stress shielding is a significant issue with traditional femoral stems used in THA,making revision surgeries particularly challenging in younger patients.This has sparked renewed interest in studying safety and functional outcomes of short metaphyseal femoral stems,which have the potential to alleviate these challenges and simplify revision surgeries.AIM To evaluate the long-term outcomes of short-stem THA.METHODS A total of 124 hips that underwent THA using the short femoral stem(TRILOCK®Depuy)between May 2006 and November 2008 were included in this study.Patients were followed for a period of 15 years.Outcomes were assessed in terms of pain relief,hip joint range of motion,improvement in mobility,and functional outcomes using the modified Harris Hip Score,Oxford hip score,and Western Ontario and McMaster Universities Osteoarthritis index score.RESULTS A total of 124 hips in 98 patients were evaluated.Significant improvements in functional outcomes were observed over the 15-year follow-up period,with no cases of subsidence,implant loosening,or complications necessitating revision surgery.The only complication reported was heterotopic ossification in 1 patient.CONCLUSION Short metaphyseal stems provide better functional outcomes with early mobilization,and its long-term follow-up without subsidence,implant loosening,or proximal femoral bone loss simplifies revision surgery in younger patients.
文摘BACKGROUND Femur fractures are one of the most serious injuries that occur in the older population and are associated with severe pain and increased mortality.The primary objective of this study was to find if there was a significant difference in pain scores in patients treated with femoral nerve blocks(FNB)compared with patients treated with the standard analgesia protocol.The secondary objective was to find if there was a significant difference in morbidity between the two groups.AIM To evaluate the effectiveness of ultrasound(US)-guided FNB in managing preoperative pain and reducing morbidity in patients with neck femur fractures compared to the standard analgesia protocol.The study seeks to determine whether FNB offers superior outcomes in terms of pain control,rehospitalization rates,and mortality.METHODS This retrospective cohort study included 1577 patients suffering from neck femur fractures.387 patients were treated with a FNB for pain management upon arrival at the emergency department,the rest were treated with standard analgesia.Pain was assessed from electronic medical records using the visual analogue scale(VAS)pre surgery,12-and 24-hour post-surgery.To determine morbidity and mortality during hospitalizations and 6 months after,it was collected from electronic medical records.RESULTS In a cohort of 1577 patients,those receiving US-guided FNB had significantly lower preoperative VAS pain scores(1.46±2.49 vs 1.82±2.59,P=0.001),reduced rehospitalization rates(0.99±1.96 vs 1.46±2.34,P<0.001),and lower mortality(16%vs 32%,P<0.001)compared to standard analgesia.CONCLUSION US guided FNB is more effective for pain management compared with standard analgesia.This method was also found to significantly reduce the risk of morbidity in those patients.
文摘Prophylactic fixation(ProFix)of the proximal femur in elderly patients with osteoporosis presents a forward-thinking approach to preventing debilitating fractures and their associated complications.By addressing fracture risk before an injury occurs,ProFix has the potential to enhance patient outcomes,promote long-term mobility,and reduce healthcare costs.Early intervention in individuals at high risk can significantly lower hospital admissions,shorten recovery periods,and preserve independence,mitigating challenges such as chronic pain and reduced life expectancy.Given the high prevalence of undiagnosed osteoporosis,prioritising early risk assessment and targeted prevention is essential.Advancements in minimally invasive surgical techniques and safer anaesthesia methods further support ProFix as a feasible and effective strategy to decrease fracturerelated morbidity,improve overall patient well-being,and optimise the use of healthcare resources.This opinion review details the evidence supporting this concept,its efficacy,the challenges in its implementation,and a strategic plan for future implementation.
文摘Objective:To evaluate the treatment effect of total hip arthroplasty(THA)for intertrochanteric femur fractures(IFF)in elderly patients.Methods:Thirty-two elderly patients with IFF admitted to the hospital from August 2021 to August 2024 were selected and randomly divided into two groups using a random number table.The experimental group(16 patients)underwent THA surgery,while the control group(16 patients)underwent proximal femoral nail antirotation(PFNA)surgery.Hip joint function and quality of life indicators were compared between the two groups.Results:Before surgery,there was no significant difference in hip joint function and quality of life scores between the two groups(P>0.05).However,at six months postoperatively,the experimental group had higher hip joint function and quality of life scores compared to the control group(P<0.05).The total effective rate was higher in the experimental group than in the control group(P<0.05).The complication rate in the experimental group was similar to that in the control group(P>0.05).Conclusion:THA can improve the clinical efficacy of elderly patients with IFF,minimize postoperative complications,effectively restore hip joint function,and optimize postoperative quality of life.
文摘BACKGROUND Clinical studies using Trabecular Titanium™acetabular cups have shown promising short and medium-term results.This material,due to its macro and micro surface roughness,provides a substrate for osseointegration and enhances implant stability.However,there is a lack of evidence in the literature on the use of this material in patients with femoral neck fracture.AIM To evaluate the short-term clinical-functional and radiographic outcomes in patients with femoral neck fractures undergoing total hip arthroplasty(THA)with Trabecular Titanium™acetabular cup implants.METHODS The study included 104 patients with medial femoral neck fractures who underwent THA between January 2020 and December 2020 with the Delta TT acetabular cup(Lima Corporate,Villanova di San Daniele del Friuli,Italy).The mean age of the patients was 69.57±10.16 years(range:36-85 years).The followup period ranged from a minimum of 3 to a maximum of 4 years.Three questionnaires(Harris Hip Score,Oxford Hip Score,and EQ5D)were administered along with radiographic evaluations.Statistical methods included the Student's t-test and one-way analysis of variance for comparisons(with significance set at 0.05),and the Kaplan-Meier curve for prosthetic implant survival.RESULTS The mean follow-up was 41.5 months.The Harris Hip Score(HHS)showed a mean increase of 2.74 points(mean HHS 88.52 at 6 months postoperatively and mean HHS 91.26 at the last follow-up)with statistical significance.Similarly,the Oxford Hip Score demonstrated a statistically significant difference between follow-up groups.However,the EQ5D did not show statistically significant differences among the three groups(preoperative,6-month follow-up,and last follow-up).Revision surgery was required in 6 patients.According to Moore's criteria,96%of the acetabular components were radiographically stable and well-integrated at the last follow-up.The Kaplan-Meier curve showed a 96%survival rate.CONCLUSION The clinical and radiographic results obtained in the short to medium term confirm the excellent performance of the Delta TT acetabular cup in terms of osseointegration,providing an optimal solution both for young patients with high functional recovery demands and for fragile patients requiring optimal stability of the acetabular component to reduce the risk of implant failure.
文摘BACKGROUND In intertrochanteric fractures,the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse.AIM To analyze the concept of medial cortical reduction(MCR)and its clinical and radiological association in geriatric intertrochanteric femur fractures.METHODS Geriatric patients who presented with AO/OTA 31A1 and 31A2 femur fractures and treated with proximal femoral nailing between July 2021 and June 2023 were include in this prospective cohort study.Based on the degree of MCR,they were divided into positive,neutral,or negative MCR groups.The demographic baseline characteristics,postoperative radiographic femoral neck-shaft angle and neck length were analyzed at 6,12 and 24 weeks post-surgery.Functional outcomes such as modified Harris Hip Score(HHS)and time to full-weight bearing were also analyzed.RESULTS 47 patients(Male:Famale 35:12)with mean age of 65.8±4.2 years were included in this study.Twenty-two cases had neutral support,nine had negative support,and sixteen had positive support in the medial cortex postoperatively.Baseline characteristics of the three groups were comparable.No significant differences were found in the femur neck length and femur neck-shaft angle changes post-surgery between the groups.The modified HHS was not found to be significant between the groups(P=0.883)as that of the time to full weight bearing(P=0.789).CONCLUSION The type of reduction achieved based on medial cortical alignment does not affect the femur neck length shortening or varus collapse.Future randomized controlled trials are needed to validate the findings noted in the study.
基金funded by the TaipeiMedical University-National Taiwan University of Science and Technology joint research program under Grant No.TMU-NTUST-109-09.
文摘Reconstruction of a traumatic distal femur defect remains a therapeutic challenge.Bone defect implants have been proposed to substitute the bone defect,and their biomechanical performances can be analyzed via a numerical approach.However,the material assumptions for past computational human femur simulations were mainly homogeneous.Thus,this study aimed to design and analyze scaffolds for reconstructing the distal femur defect using a patient-specific finite element modeling technique.A three-dimensional finite element model of the human femur with accurate geometry and material distribution was developed using the finite element method and material mapping technique.An intact femur and a distal femur defect model treated with nine microstructure scaffolds and two solid scaffolds were investigated and compared under a single-leg stance loading.The results showed that the metal solid scaffold design could provide the most stable fixation for reconstructing the distal femur defect.However,the fixation stability was affected by various microstructure designs and pillar diameters.A microstructure scaffold can be designed to satisfy all the biomechanical indexes,opening up future possibilities for more stable reconstructions.A three-dimensional finite element model of the femur with real bone geometry and bone material distribution can be developed,and this patient-specific femur model can be used for studying other femoral fractures or injuries,paving the way for more comprehensive research in the field.Besides,this patient-specific finite element modeling technique can also be applied to developing other human or animal bone models,expanding the scope of biomechanical research.
文摘Background of the Study: Femoral shaft fracture is the most common pediatric injury requiring hospitalization. For children less than 5 years old, non-surgical approach is recommended. For pediatric patients 5 - 14 years old, the most common mode of treatment is flexible intramedullary nailing with a known complication of pain at post-op site, inflammatory reaction/bursitis at the entry site, superficial and deep infection, knee synovitis, knee stiffness, leg length discrepancy, proximal nail migration, angulation or malunion, delayed and non-union, implant breakage. This study aims to present a rare complication of a femoral fracture fixed with flexible intramedullary nail. Methodology: We report the outcome of a 12-year-old male with peri implant fracture of the left femur. He underwent removal of plates and screws and subsequently fixed with flexible intramedullary nails. Patient was followed up at 1, 3, 7, and 10 months post-operatively. Varus-valgus, sagittal angulation, and limb shortening were measured pre- and post-operatively. Complications were recorded on each visit. Results: Pre-operative varus angulation was 10˚, pro-curvatum of 55˚ with limb shortening of 4 cm. Postoperatively, varus was maintained to 10˚ but pro-curvatum was corrected to 4˚ and limb shortening was reduced to 1 cm. However, after 1 month the varus angulation increased to 30˚ while maintaining sagittal pro-curvatum. Limb shortening also increased to 2 cm. New bone formation started to appear along the mechanical axis of the left femur which is apparent at 3 months post-op and pro-curvatum increased to 20˚. At 7 and 10 months post-op no signs of union was noted at the fracture site but the callus formation along the mechanical axis gradually matured and appeared as a new femoral shaft. Conclusion: Formation of new bone in response to unstable flexible intramedullary fixation in pediatric femoral shaft fracture is a very rare complication.
文摘Periprosthetic fracture of femur is a common and complex complication after joint replacement. With the increase of operation volume, its incidence is increasing year by year. The treatment of this fracture is affected by many factors, including fracture type, prosthesis stability, patient age and comorbidities, and individualized treatment strategy is needed. In recent years, the internal fixation technology and prosthetic revision technology have made significant progress in surgical treatment, such as locking steel plate, titanium cable and bridge combined internal fixation system and other new technologies have effectively improved the treatment effect. In addition, the application of new materials and 3D printing technology, as well as the optimization of multidisciplinary cooperation mode, also provide new ideas for the treatment of complex fractures. However, there are still some problems such as inaccurate diagnosis, difficult choice of treatment options and high incidence of postoperative complications. In the future, technological innovation, the introduction of artificial intelligence and big data, and the further development of personalized treatment will bring more possibilities to improve the prognosis and quality of life of patients. This study summarizes the relevant research results and prospects the future development direction, providing references for clinical practice and subsequent research.
文摘AIM To report the clinical and radiographic results of titanium elastic nail(TEN) in diaphyseal femoral fractures of children below age of six years.METHODS A retrospective analysis of 27 diaphyseal femoral fractures in children younger than six years treated with TEN between 2005 and 2015 was conducted. Patients were immobilized in a cast for 5 wk and the nails were removed from 6 to 12 wk after surgery. Twenty-four cases were clinically and radiographically re-evaluated using the Flynn's scoring criteria, focusing on: Limb length discrepancy, rotational deformity, angulation, hip and knee range of motion(ROM), functional status, complications, and parent's satisfaction.RESULTS Sixteen males and eight females with a mean age of 3.2 years at the time of treatment were re-evaluated at an average follow-up of 58.9 mo. No cases of delayed union were observed. The mean limb lengthening was 0.3 cm. Four cases experienced limb lengthening greater than 1 cm and always minor than 2 cm. Twelve point five percent of the cases showed an angulation < 10°. Complete functional recovery(hip and knee ROM, ability to run and jump on the operated limb) occurred in 95.7% of cases. Complications included two cases of superficial infection of the TEN entry point, one case of refracture following a new trauma, and one TEN mobilization. According to the Flynn's scoring criteria, excellent results were obtained in 79.2% of patients and satisfactory results in the remaining 20.8%, with an average parent's satisfaction level of 9.1/10.CONCLUSION TEN is as a safe, mini-invasive and surgeon-friendly technique and, considering specific inclusion criteria, it represents a useful and efficacy option for the treatment of diaphyseal femoral fractures even in patients younger than six years of age.
文摘Adult patients with developmental dysplasia of the hip develop secondary osteoarthritis and eventually end up with total hip arthroplasty(THA) at younger age. Because of altered anatomy of dysplastic hips, THA in these patients represents technically demanding procedure. Distorted anatomy of the acetabulum and proximal femur together with conjoined leg length discrepancy present major challenges during performing THA in patients with developmental dysplasia of the hip. In addition, most patients are at younger age, therefore, soft tissue balance is of great importance(especially the need to preserve the continuity of abductors) to maximise postoperative functional result. In this paper we present a variety of surgical techniques availablefor THA in dysplastic hips, their advantages and disadvantages. For acetabular reconstruction following techniques are described: Standard metal augments(prefabricated), Custom made acetabular augments(3D printing), Roof reconstruction with vascularized fibula, Roof reconstruction with pedicled iliac graft, Roof reconstruction with autologous bone graft, Roof reconstruction with homologous bone graft, Roof reconstruction with auto/homologous spongious bone, Reinforcement ring with the hook in combination with autologous graft augmentation, Cranial positioning of the acetabulum, Medial protrusion technique(cotyloplasty) with chisel, Medial protrusion technique(cotyloplasty) with reaming, Cotyloplasty without spongioplasty. For femoral reconstruction following techniques were described: Distraction with external fixator, Femoral shortening through a modified lateral approach, Transtrochanteric osteotomies, Paavilainen osteotomy, Lesser trochanter osteotomy, Double-chevron osteotomy, Subtrochanteric osteotomies, Diaphyseal osteotomies, Distal femoral osteotomies. At the end we present author's treatment method of choice: for acetabulum we perform cotyloplasty leaving only paper-thin medial wall, which we break during acetabular cup impacting. For femoral side first we peel of all rotators and posterior part of gluteus medius and vastus lateralis from greater trochanter on the very thin flake of bone. This method allows us to adequately shorten proximal femoral stump, with possibility of additional resection of proximal femur. Furthermore, several advantages and disadvantages of this procedure are also discussed.
基金Supported by the National Natural Science Foundation ofChina(No.81173417No.30901982No.81373656)
文摘OBJECTIVE： To investigate the effects of Huogu I formula on regulation of lipid metabolism in ste- roid-induced osteonecrosis of the femoral head （SONFH） rats and verify our hypothesis that Huogu I formula regulates lipid metabolism by down-regulating peroxisome proliferator-activated receptor gamma （PPARy） expression and activating Wnt signaling pathways. METHODS： Eighty-five rats were divided into four groups： control, model, Huogu 15 g/kg and Huogu 30 g/kg. Six weeks later, animals were anaesthe- tized, femora were dissected for histopathologicalexamination of the osteonecrotic changes and re- pair processes, micro computed tomography （Mi- cro-CT）-based micro-angiography was performed to assess vascularization. Serum lipid levels were detected by haematological examination. The ex- pressions of PPARy, Wnt3a, low density lipoprotein receptor-related protein 5 （LRP5） and 13-catenin were evaluated by immunohistochemistry, Western blot and quantitative real-time polymerase chain reaction analyses. RESULTS： The incidence of osteonecrosis, ratio of empty lacuna, adipose tissue area and adipocyte perimeter in the bone marrow were dramatically lower in the Huogu ~ formula treatment groups. By micro-CT quantification, Huogu ~ formula treat- ment dose-dependently increased vessel volume, vessel surface, percentage of vessel volume and vessel thickness of the femoral heads of SONFH rats. Levels of serum lipid in Huogu 15 g/kg and Huogu 30 g/kg groups reduced significantly. HuoguⅠformula treatment could suppress the ex- pression of PPARy and increase the expressions of Wnt3a, LRP5 and 13-catenin at both protein and mRNA levels. CONCLUSION： The results of our present study highlight the lipid-lowering potential of Huogu Ⅰ formula, and provide further evidence of the in- volvement of the PPARy inhibition and Wnt/LRPS/ 13-catenin signaling activation in the effects of Huogu Ⅰ formula.
基金Supported by Tangshan Science and Technology Research Project(No.13130242b)
文摘OBJECTIVE: To investigate the efficacy and safety of intravenous cervus and cucumis polypeptides for treating avascular necrosis of the femoral head(ANFH) in regard to pain and hip function in a randomized clinical trial.METHODS: A total of 96 subjects with ANFH who were recruited at the Orthopaedic Hospital Affiliated with Hebei United University and Qian Hai Femoral Head Hospital of Beijing were assigned by lottery to an intervention group(n = 48) or a control group(n = 48). All subjects underwent physical therapy and rehabilitation exercises. In addition,subjects in the intervention group were given intravenous infusions of cervus and cucumis polypeptides. Visual analogue scale(VAS), Harris hip score,and radiography or magnetic resonance imaging were applied to assess all subjects at the beginning of treatment and 3, 6, and 9 months afterward. All the subjects were followed up for 2 years.RESULTS: At the beginning of treatment, there were no statistically significant differences between the two groups in terms of the general condition of patients or the VAS and Harris hip scores(all P > 0.05). At 3, 6, and 9 months after treatment,however, the VAS score decreased and the Harris hip score increased in all patients, with the improvement of intervention group significantly greater than that of the control group(P < 0.05).The total effectiveness rates for the intervention and control groups were 89.58% and 70.83%, respectively, with the difference being statistically significant(P < 0.05). There was no statistically significant difference between the two groups in terms of the safety of the injections(P > 0.05).CONCLUSION: Intravenous infusion of cervus and cucumis polypeptides relieved pain and improved hip function of subjects with ANFH.Thus, the intravenous infusion of cervus and cucumis polypeptides was a safe, effective treatment for ANFH.
基金Supported by a Grant from the Firat University Scientific Research Projects Coordination Unit Subject(No.VF.12.12)。
文摘OBJECTIVE: To investigate the effect of acupuncture therapy on fracture healing in rats with femur fractures.METHODS: A total of 10 groups were formed;control group, groups sacrificed on 7 th, 14 th, and 21 st days of fracture formation, groups to which acupuncture was applied for 7, 14, and 21 d, groups to which fracture and acupuncture were applied for 7,14, and 21 d. A transverse fracture line was formed in femurs of rats by using a Gigli saw. The Kirschner wire was driven retrograde down from the fracture line to proximal part of the bone and then, the fracture was fixed towards distal part. Acupuncture was applied to the rats for 7, 14, and 21 d as 4 sessions per week after formation of the fracture.RESULTS: Malondialdehyde(MDA), reduced glutathione(GSH) levels, catalase(CAT), glutathione-Stransferase(GST), superoxide dismutase(SOD), and glucose-6-phosphate dehydrogenase(G6 PD) activities were measured. Despite the increased MDA levels, G6 PD and SOD activities reduced during the fracture healing. There was a statistically significant increase in MDA, GSH levels, and G6 PD activity in fracture groups compared to control group, but CAT, GST, and SOD activities decreased. The use of acupuncture enhanced callus development and bone mineralization during bone healing.CONCLUSION: The acupuncture therapy can affect suppression of the effects of free oxygen radicals and regulation of the antioxidant enzyme activity in fracture healing. Thus, it is suggested that acupuncture treatment would be beneficial for fracture healing in order to eliminate the negative effects induced by oxygen free radicals.
基金a grant from the National Natural Sciences Foundation of China (No. 30170945)
文摘To study the effect of titanium alloy cage on the treatment of the ischemic necrosis of femoral head in dog, the model of the ischemic necrosis of femoral head was made with the liquid nitrogen in 15 hybrid adult dogs. The titanium alloy cage made of a hollow cylinder was driven into the subchondral bone of necrotic femoral head via central channel. The dogs were divided into 3 groups, each group was sacrificed 3, 6, 12 weeks after the operation respectively. No collapse of femoral head was observed after the operation. The position of the cages was good on radiograph. Microscopically, the cancellous bone of necrotic femoral head rebuilt gradually and grew into cage. After 12 weeks of creeping substitution, the cancellous bone filled up the hollow cavity and holes of the cages. It is concluded that the titanium alloy cage can provide structural support for the subchondral bone and prevent collapse and can be used for the treatment of the ischemic necrosis of femoral head.
文摘AIM To review and report functional outcomes, complications,and survivorship associated with total knee arthroplasty(TKA) in the treatment of post-traumatic arthritis(PTA).METHODS We conducted a systematic review according to the PRISMA guidelines. We searched PubMed, Cochrane Library, and SCOPUS in December 2015 for Englishlanguage clinical research studies, both prospective and retrospective, examining the use of TKA for the treatment of PTA. All relevant articles were accessed in full. The manual search included references of retrieved articles.We extracted data on patients' demographics and clinical outcomes, including preoperative diagnosis and pre- and post-operative functional scores. We summarized the data and reported the results in tables and text.RESULTS Sixteen studies, four prospective and ten retrospective,examined patients who underwent TKA for PTA due to fractures of the proximal tibia, patella, and/or distal femur. Eleven studies utilized the Knee Society Scores criteria to assess functional outcomes. All studies utilizing these criteria reported an improvement in functional and knee scores of patients following TKA. Further, studies reported an increased range of motion(ROM) and reduction of pain following surgery. The most commonly reported complications with TKA included infection, stiffness, wound complications, intraoperative rupture of tendons, and osteolysis/polyethylene wear. The overwhelming majority of these complications occurred within the first two years following surgery. Six studies examined the survivorship of TKA with subsequent revision for any reason as an endpoint. Compared to patients with osteoarthritis, patients with PTA required more revisions, the majority for polyethylene wear.CONCLUSION Although associated with higher complication rates,TKA is an effective treatment for PTA, as it improves ROM, pain and functional outcomes.
文摘Total femoral replacement(TFR) is a salvage arthroplasty procedure used as an alternative to lower limb amputation. Since its initial description in the mid-20^(th) century, this procedure has been used in a variety of oncologic and non-oncologic indications. The most compelling advantage of TFR is the achievement of immediate fixation which permits early mobilization. It is anticipated that TFR will be increasingly performed as the rate of revision arthroplasty rises worldwide. The existing literature is mainly composed of a rather heterogeneous mix of retrospective case series and a wide assortment of case reports. Numerous TFR prostheses are currently available and the surgeon must understand the unique implications of each implant design. Long-term functional outcomes are dependent on adherence to proper technique and an appropriate physical therapy program for postoperative rehabilitation. Revision TFR is mainly performed for periprosthetic infection and the severe femoral bone loss associated with aseptic revisions. Depending on the likelihood of attaining infection clearance, it may sometimes be advisable to proceed directly to hip disarticulation without attempting salvage of the TFR. Other reported complications of TFR include hip joint instability, limb length discrepancy, device failure, component loosening, patellar maltracking and delayed wound healing. Further research is needed to better characterize the long-term functional outcomes and complications associated with this complex procedure.
文摘Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics.The various treatment options that have been described can be broadly divided according to the aim of improving either biology or biomechanics. Surgeries aimed at improving the biology, such as vascularized fibula grafting, have good success rates but require high levels of expertise and substantial resources. A popular surgical treatment aimed at improving the biomechanics-valgus intertrochanteric osteotomyoptimizes conditions for fracture healing by converting shear forces across the fracture site into compressive forces. Numerous variations of this surgical procedure have been developed and successfully applied in clinical practice. As a result, the proximal femoral orientation for obtaining a good functional outcome has evolved over the years, and the present concept of altering the proximal femoral anatomy as little as possible has arisen. This technical objective supports attaining union as well as a good functional outcome, since excessive valgus can lead to increased joint reaction forces. This review summarizes the historical and current literature on valgus intertrochanteric osteotomy treatment of nonunion neck of femur, with a focus on factors predictive of good functional outcome and potential pitfalls to be avoided as well as controversies surrounding this procedure.
