OBJECTIVE: To establish the animal models of mandibular distraction osteogenesis in rabbits and study its osteogenetic mechanism. METHODS: The right mandibles just anterior to the first molars of 12 rabbits were performed osteotomies, and the mandibles were positioned with distractors. The left mandibles were control group without operation. After 1 week, the distractors were stretched 0.9 mm every day for 10 days progressively. One day, 2, 4, 8 weeks after distraction, the mandibles were studied with gross measurement, X-ray, and histological examination. RESULTS: The right mandible were lengthened 8.3 mm on average without bone nonunion and deformity healing. It was observed that the gaps between the distracted bone edges were first occupied by fibrous tissue. Two weeks after distraction, it was found that the gaps were bridged by callus in X-ray, the new bone and the normal bone could not be differentiated clearly after 8 weeks. In histological sections, there were collagen bundles in early distraction, then those collagen bundles were calcificated and become trabeculaes. No Cartilage was found during distraction. CONCLUSION: It suggests that the rabbit mandible can be lengthened by distraction osteogenesis, and the new bone is formed by intramembranous ossification.
Objective To investigate the morphological changes of the proximalfemur and their implication to the total hip arthroplasty in patients with Crowe Ⅱ/Ⅲ developmental dysplasia of the hip (DDH). Methods The experimental gr oup was composed of 15 hips in 14 patients (Crowe Ⅱ, 9 hips; Crowe Ⅲ, 6 hips ) with osteoarthritis secondary to Crowe Ⅱ/Ⅲ DDH (2 males, 12 females; age, 35-61 years). None of the patients had accepted any osteotomy treatment. The control group was composed of 15 normal hips in 15 patients with unilateral DDH (3 males, 12 females; age, 35-57 years). Twelve hips came from the experimental group and the other 3 came from the patients with unilateral Crowe Ⅰ DDH. The femurswere examined with the CT scanning. The following parameters were measured: theheight of the center of the femoral head (HCFH), the isthmus position (IP), theneckshaft angle(NS), the anteversion angle, the canal flare index, and the canal width. Then, the analysis of the data was conducted. Results HCFH and IP in theexperimental group and the control group were 50.1±6.7 mm, 50.1±7.4 mm, and 107.4±21.5 mm, 108.7±18.1 mm，respectively, which had no significant differencebetween the two groups（Pgt;0.05）. In the experimental group and the control group, the NS were 138.3±10.0° and 126.7±5.7°，the anteversion angles were 36.5±15.9° and 18.8±5.4°, and the canal flare indexes were 4.47±0.40and 5.01±0.43. There was a significant difference between the two groups in the above 3 parameters （Plt;0.05）. As for the canal width of the femur, therewasa significant difference in the interior/exterior widths and the anterior/posterior widths at the level of 2 cm above the lesser trochanter and 4 cm belowthe lesser trochanter between the two groups （Plt;0.05）; however, there was nosignificant difference in the canal width of the femur at the isthmus between the two groups（P＞0.05）. Conclusion It is necessary to evaluate the morphology of the proximal femur before the total hip arthroplasty performed in patients with Crowe Ⅱ/Ⅲ DDH. The straight and smaller femoral prosthesis should be chosen and implanted in the proper anteversion position duringoperation.
The femoral veins were excised from 28 dogs and distended with pressure of 40, 80 and 120 kPa, respectively before grafted to femoral arteries. The veins were harvested at different times and Pollak sections were prepared which revealed different stains of elastin, collagen and smooth muscle in each section. The sections were led to image analysis system to computerize the relative contents of theabove components. The results were as follows: Elastin decreased significantly at 4 weeks (P lt;0.01), and was constant between 4 and 16 weeks. No statistical difference was found in 40, 80 kPa and the control group (P gt;0.05), but the elastin of 120 kPa group by the 16th week was still decreasing. Collagen of each group had no difference, but C/E increased significantly with time. Smooth muscle contents were correlated positively with time, and negatively with the pressure at 1 week, then positively with the pressure at 16th week. The changes of the above trends were the same as development of intimal hyperplasia. The contentions were the value of C/E was determined by the arterial pressure but that of 120 kPa pressure was more higher. The preimplant pressure distension was a possible significantfactor leading to excessive intimal hyperplasia of early and middle stage of autogenous vein grafts.
Objective To study the effect of Shengguzaizaosan on experimental fracture healing. Methods Thirty six-month-old Chinchilla rabbits were made the models with 3 mm bone defect in the middle of two-side radius and were divided randomly into 3 groups: Shengguzaizaosan group(group A, n=10), Xianlinggubao group(groupB, n=10) and control group(group C, n=10). Five rabbits were sacrificed 14 days and31 days after operation respectively. The double marks with tetracyslin hydrochloride were given on the 4th day and the 5th day for the first mark and on the 11th day and the 12th day for the second mark in the rabbits sacrificed 14 days later,and on the 20th day and the 21st day for the first mark and on the 28th day andthe 29th day for the second mark in the rabbits sacrificed 31 days later. The samples were taken to make the bone histomorphometry study. Results When compared group A with group C, there were significant differences(P＜0.01) in osteoid area density, osteoid mean width, active osteoblastic surface, mineralization surface and dynamic parameters after 14 days,and in mean width of mineralization callus, active osteoblastic surface and mean depth of lacunae after31 days. There was a approximate effect between group B and group C. when compared group B with group A, there were significant differences(P＜0.05) in osteoclastic index,mineralization surface,bone formation rate after 14 days, and in osteoid surface,mean depth of lacunae and bone formation rate after 31 days. Conclusion Shengguzaizaosan can increase osteoid,accelerate mineralization rate and bone formation rate, and reduce mineralization lag time at early period of fracture. It can increase mineralization calluswidth and resorption of osteoclast at later period of fracture. To some extent, shengguzaizaosan can accelerate the experimental fracture healing.
OBJECTIVE To compare the osteogenesis of recombination artificial bones, which are bovine deproteined bone (bDPB) and bovine bone morphogenetic protein (bBMP), combined with tumor necrosis factor alpha (TNF alpha), basic fibroblast growth factor (bFGF), epidermal growth factor (EGF) respectively. METHODS One hundred trephined skull bone defects in fifty rabbits were divided into four groups, which implanted with bDPB/bBMP/TNF alpha, bDPB/bBMP/bFGF, bDPB/bBMP/EGF, and bDPB/bBMP respectively. X-ray and histological changes were observed in the 1st, 2nd, 4th, 6th, 8th weeks after implantation. The content of 35S and 45Ca and ash weight were measured at 10 and 42 days after operation. RESULTS The osteogenesis of bDPB/bBMP/TNF alpha group was ber than that of bDPB/bBMP/bFGF group(P lt; 0.01), while bDPB/bBMP/bFGF group was ber than that of bDPB/bBMP/EGF(P lt; 0.01). No significant statistical difference were found between bDPB/bBMP/EGF and bDPB/bBMP(P gt; 0.05). CONCLUSION TNF alpha combined with bBMP and carrier can stimulate bone formation and increase the volume of new bone in vivo. It suggests that bDPB/bBMP/TNF alpha is a valuable biomaterial of bone graft.
ObjectiveTo investigate the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging (Gd-EOB-DTPA-MRI) in gross morphological classification of hepatocellular carcinoma (HCC). MethodsThe clinicopathologic data of patients with HCC who received surgical treatment in the Affiliated Huai’an Hospital of Xuzhou Medical University from January 2017 to December 2022 were retrospectively gathered. The Gd-EOB-DTPA-MRI was performed before operation. Two radiologists independently assessed the gross morphological classification of HCC according to the imaging performance. The tumors were cut into sections in a coronal plane and were taken pictures for recording pathological features after operation. The tumors were assigned into 4 types according to the references and clinical experiences: single nodular type (SN), single nodular with extranodular growth type (SN-EG), confluent multi-nodular type (CMN), and infiltration type (IF). Matching degree of morphological classification was analyzed between by the Gd-EOB-DTPA-MRI and resected specimen. The pathological features of 4 types of HCC were also analyzed. ResultsA total of 87 patients with HCC were included. The gross morphological classification by the Gd-EOB-DTPA-MRI was 28 (32.2%) patients with SN, 28 (32.2%) patients with SN-EG, 21 (24.1%) patients with CMN, 10 (11.5%) patients with IF, which by the resected specimen was 33 (37.9%) patients with SN, 24 (27.6%) patients with SN-EG, 21 (24.1%) patients with CMN, and 9 (10.4%) patients with IF in the 87 patients with HCC. The Kappa’s coefficient of agreement between the results of Gd-EOB-DTPA-MRI and postoperative resection specimens was 0.776 (P=0.199). There were statistical differences in the tumor diameter and microvascular invasion (MVI) among the 4 types of gross morphology classification (F=2.937, P=0.038; χ2=16.852, P=0.001), the MVI rate was highest and tumor diameter was biggest in the patients with IF among the 4 types of gross morphology classification (P<0.05). ConclusionsFrom the results of this study, the gross morphological classification of HCC is closely related to the tumor diameter and MVI. Results of Gd-EOB-DTPA-MRI and postoperative resection specimens in assessing the gross morphological classification are good agreement. Therefore, an accurate preoperative planning and better therapy strategy for the patients with HCC can be provided according to gross morphological classification by preoperative Gd-EOB-DTPA-MRI.
ObjectiveTo assess outcomes of transcatheter aortic valve replacement (TAVR) for pure native aortic valve regurgitation.MethodsA total of 129 patients underwent transfemoral TAVR in Fuwai Hospital from May 2019 to October 2020 were retrospectively analyzed. There were 83 males and 46 females with an average age of 72.26±8.97 years. The patients were divided into a pure native aortic valve regurgitation group (17 patients) and an aortic valve stenosis group (112 patients).ResultsThe incidence of valve in valve was higher in the pure native aortic valve regurgitation group (47.0% vs. 16.1%, P<0.01). There was no statistical difference between the two groups in conversion to surgery, intraoperative use of extracorporeal circulation, intraoperative left ventricular rupture, postoperative use of extracorporeal membrane oxygenation (ECMO), peripheral vascular complications, disabled stroke, death, or pacemaker implantation. There was no statistical difference in the diameter of annulus (25.75±2.21 mm vs. 24.70±2.90 mm, P=0.068) or diameter of outflow tract (25.82±3.75 mm vs. 25.37±3.92 mm, P=0.514) between the pure native aortic valve regurgitation group and the aortic valve stenosis group.ConclusionTransfemoral TAVR is a feasible method for patients with pure native aortic valve regurgitation. The diameter of annulus plane, the diameter of outflow tract and the shape of outflow tract should be evaluated.
Objective To explore the related factors of femoral stem anteversion (FSA) after total hip arthroplasty (THA), so as to provide reference for clinical design of FSA before operation and reduce the risk of hip dislocation after arthroplasty. Methods Ninty-three patients (103 hips) who underwent THA between October 2021 and September 2022 and met the selection criteria were selected as the study subjects. Among them, there were 48 males and 45 females with an average age of 58.5 years (range, 25-88 years). Body mass index was 18.00-37.84 kg/m2, with an average of 24.92 kg/m2. There were 51 cases (57 hips) of osteonecrosis of femoral head, 35 cases (39 hips) of hip osteoarthritis, and 7 cases (7 hips) of congenital hip dysplasia. Based on CT images, the following indicators were measured: preoperative femoral neck anteversion (FNA), preoperative femoral rotation angle (FRA), preoperative acetabular anteversion (AA), and preoperative combined anteversion (CA; the sum of preoperative FNA and AA); postoperative FSA and the change in femoral anteversion angle (the difference between postoperative FSA and preoperative FNA). Based on preoperative X-ray films, the following indicators were measured: femoral cortical thickness index (CTI) and canal flare index (CFI), the proximal femoral medullary cavity was classified according to Noble classification (champagne cup type, normal type, chimney type), neck-shaft angle (NSA), and femoral offset (FO). Pearson correlation analysis, one-way ANOVA, and Point-biserial correlation analysis were used to investigate the correlation between postoperative FSA, postoperative change in femoral anteversion angle, and patient diagnosis, proximal femoral medullary cavity anatomy type, gender, age, as well as preoperative FNA, FRA, AA, CA, NSA, FO, CTI, and CFI. FSA was used as the dependent variable and the independent variables that may be related to it were included for multiple linear regression analysis. Results Based on CT image measurement, preoperative FNA was (15.96±10.01)°, FRA (3.36±10.87)°, AA (12.94±8.83)°, CA (28.9±12.6)°, postoperative FSA (16.18±11.01)°, and postoperative change in femoral anteversion angle was (0.22±9.98)°. Based on preoperative X-ray films measurements, the CTI was 0.586±0.081; the CFI was 4.135±1.125, with 23 hips classified as champagne cup type, 68 hips as normal type, and 12 hips as chimney type in the proximal femoral medullary cavity anatomy; NSA was (132.87±7.83)°; FO was (40.53±10.11) mm. There was no significant difference between preoperative FNA and postoperative FSA (t=−0.227, P=0.821). Pearson correlation analysis showed that postoperative FSA was positively correlated with preoperative FNA, preoperative CA, postoperative change in femoral anteversion angle, and age (P<0.05), while negatively correlated with preoperative FRA (P<0.05). The postoperative change in femoral anteversion angle were positively correlated with preoperative FRA and postoperative FSA (P<0.05), and negatively correlated with preoperative CA and FNA (P<0.05). One-way ANOVA analysis showed that the above two indicators were not correlated with diagnosis and the proximal femoral medullary cavity anatomy type (P>0.05). Multiple linear regression analysis showed a linear correlation between FSA and FNA, CA, age, and FRA (F=10.998, P<0.001), and the best fit model was FSA=0.48×FNA–2.551. Conclusion The factors related to FSA after THA include patient’s age, preoperative FNA, CA, FRA and postoperative femoral anteversion, of which preoperative FNA is the most closely related. When designing a surgical plan before surgery, attention should be paid to the patient’s preoperative FNA, and if necessary, CT around the hip joint should be scanned to gain a detailed understanding of the proximal femoral anatomical structure.
ObjectiveTo investigate the impact of the Salter innominate osteotomy on the acetabular morphology and direction and the relationship between them in children with developmental dislocation of the hip (DDH) by three-dimensional CT. MethodsBetween January 2013 and January 2015, 51 patients with unilateral DDH were treated. All patients were females with an average age of 2 years and 5 months (range, one year and 6 months to 5 years). All the patients underwent open reduction of the hip, Salter innominate osteotomy, proximal femoral osteotomy, and hip cast immobilization for treatment. The data of three-dimensional CT before surgery and at 1 week after surgery were measured and collected as follows:the anterior acetabular index (AAI), posterior acetabular index (PAI), axial acetabular index (AxAI), acetabular anteversion angle (AAA) of the acetabulum, and the distances of the forward, outward, and lateral rotation of the distal osteotomy fragments. The differences of AAI, PAI, AxAI, AAA between before and after surgeries were compared and the difference values of the data with significant difference results were calculated. The relationship between the difference values and the distances of three different rotation directions before and after surgeries were tested by Spearman correlation analysis. ResultsThere were significant differences in the AAI, PAI, and AAA between before and after surgery (P<0.05), but no significant difference was found in the AxAI between before and after surgery (t=0.878, P=0.384). The difference values of AAI, PAI, and AAA were (4.518±4.601), (4.219±6.660), and (3.919±4.389)° respectively. The distances of the outward, lateral, and forward rotation of the distal osteotomy fragments after surgery were (0.420±0.339), (2.440±0.230), and (0.421±0.311) cm. There was a significant correlation between the three different rotation directions and AAI difference (P<0.05), especialy the outward rotation (r=0.981). There was a correlation between the outward, forward rotation and PAI, AAI differences (P<0.05), and no significant correlation between the lateral rotation and PAI, AAA was found (P>0.05). There was a significant correlation between the forward rotation and AAA difference (r=0.841). ConclusionSalter innominate osteotomy can increase the curvature of the anterior wall of the acetabulum in DDH, but reduce the curvature of the rear wall. At the same time, it can also change the direction of the acetabulum, significantly decrease the acetabular anteversion, but it can not change the depth of the acetabulum. The main factors of the curvature change after Salter innominate osteotomy of DDH is attributable to outward rotation, followed by forward rotation, and the main factor of the acetabular direction change is attributable to forward rotation.