Objective To study the mechanism of compound of calcium phosphate(TCP) and platelet-rich plasma(PRP) in the treatment of femoral head necrosis.Methods The left femoral heads of 48 New Zealand white rabbits were frozen by liquid nitrogen as to make themodel of femoral head necrosis.Twenty-four rabbits were randomly chosen as theexperimental group and their femoral heads were filled with TCP/PRP. The other 24 rabbits were used as the control group and their femoral heads were filled only with TCP. They were sacrificed at 2, 4,8,12 weeks after operation. The specimens were examined with X-ray and histological study.Results At 2 weeks after operation,there was no significant difference in femoral headdensity between the two groups. Four weeks after operation, femoral head density decreased in both groups, while it decreased more in the control group. At 8,12 weeks after operation, the density of the femoral heads in both groups increased, and it was higher in the experimental group. Histology examination showed thatthere was no difference between the two groups 2 weeks after operation. The head became flat at 4 weeks. Control group had more defects. At 4,8,12 weeks, more repairs were observed in the experimental group than that in the control group. The amount and maturity of osteogenesis in experimental group were much more greaterthan those in control group．Bone histomorphometry showed that the volum of thetrabecular was larger in the experimental group (36.65%±7.22%,38.29%±4.28%，39.24%±3.42%) than that of control group(P＜0.05). Conclusion TCP/PRP does not only provide osteoblasts scaffold, butalso promotes bone formation and the head repair. TCP/PRP is a good biomaterialfor the treatment of femur head necrosis.
Objective To investigate the treatment of extensive bone defect of distal femur caused by various diseases in adults. Methods From February 1998 to December 2002, 6 cases(aged from 19 to 37) of extensive bone defects of distal femur were treated with two free vascularized fibulae, whose defects were caused by resection ofbone tumor, osteomyelitis and trauma. After the resection of distal femur and articular surface of tibia, the fibulae were transplanted and fixed with screws. And the periosteum of the two fibulae was dissected and sutured with each other.Results The average follow-up time was 3.3 years. Twofree vascularized fibulae could give more support to the body and the bone union of the fibulae was possible when the periosteum was incised and sutured with each other. As time went on, both of the medullary canal reunioned to form a new canal as a whole, which would make the grafts ber. Conclusion Autograft with two free vascularized fibulae can increase the stability in treating extensive bone defect of distal femur, but the union of knee joint will make flexion and extension impossible.
ObjectiveTo design an auto-compressive and anti-circumrotate intramedullary nail( ACACIN) and to evaluate the preliminary clinical efficacy on fixing adult femur fracture. Methods From January 1998 to June 2001, 23 patientswith femur fracture were stabilized with auto-compressive and anti-circumrotateintramedullary nail. 2-4 elastic blocks were installed into the proximal and distal different distance of quincunx nail to defend circumrotate and axis compress. Results Fracture healing were obtained in all 23 patients treated with auto-compresseiveand anti-circumrotate intramedullary nail, the time of fracture healing was 6-13 weeks in 21 cases and 15-22 weeks in 2 cases of old fracture. There was no complication related to infection, nail break, abnormal union and joint ankylosis. The results were excellent in 19 cases, good in 3 cases, and moderate in 1 case according Kolmert’s criterion for function ; the effective rate was 95.7%. Conclusion Auto-compressive and anti-circumrotate intramedullary nail has a suitable radian for adult femur, can afford stable fixation, anti-circumrotate andaxis compress.
Forty cases of intertrochanteric fractures of femur were treated with percutaneous nonmetallic external fixator. The patients were followed up for 6 months to 3 years, and the fractures were all united without coxa vara or shirtening deformities. There was no mortality in this series. This method had the advantages ofbeing simple, save time and effort, less traumatic and early ambulation. The design of the apparatus tallied with the biomechanics of the neck and shaft of the femur.
Objective To analyse the factors of complications aftertreatment of intertrochanteric fractures with Gamma nail. Methods From January 1998 to May 2004, 50 patients were treated with Gamma nail, including 18 males and 32 females and ageing from 47 to 82 years. The locations were the left side in 16 cases andthe right in 34 cases. According to Evans classification, there were 4 cases oftype Ⅰ, 2 cases of type Ⅱ, 23 cases of type Ⅲ, 10 cases of type Ⅳ and 11 cases of type Ⅴ. Results Fifty patients were followed up 429 months. Accordingto the Harris criterion for evaluation, the results were excellent and good in 35 cases, showing sthenic weight loading walking and normal range of motion of the hip joint. The postoperative complications appeared in 15 cases: 5 cases of coxa vara or coxa valga, 3 cases of rotation deformity of lower limb, 2 cases oftension screwprotrusions and lower shorten, 1 case of failure of internal fixation, 1 case of femoral fracture, 2 cases of coxalgia and 1 case of pain in knee joint and stiff knee joint. Conclusion The reason of complications was various, mainly lies in insufficient comprehension and analysis of the types of fractures, unfamiliarity with the characteristics and usage of the instruments and neglected rehabi litation instruction, inappropriate functional training and too early weight loading after operation.
To evaluate the cl inical results of less invasive stabil ization system (LISS) for femur supercondylar and intercondylar fractures. Methods From March 2004 to November 2005, 47 patients with 49 intercondylar and supercondylar fractures were treated. Of all the patients, there were 34 males and 13 females with an average of 39.7 years (range 19-56 years). The locations were left side in 21 cases and right side in 28 cases. Fracture was caused by traffic accident in 31 cases, fall ing in 8 cases, violence in 6 cases and others in 2 cases. Forty-nine fractures included 14 intercondylar fractures, 21supercondylar fractures and 14 intercondylar and supercondylar fractures; 32 closed fractures and 17 open fractures. According to the AO typing, there were 6 type 33-A1, 8 type 33-A2 , 10 type 33-A3, 7 type 33-C1, 3 type 33-C2 and 15 type 33-C3. The disease course was 30 minutes to 6 days. Articular surface reduction was first performed, then the LISS plate was inserted via two incisions and locking screws were used later. Results The average operation time was 126 minutes (range 48-248 minutes). The blood loss was 180 mL(range 60-1 200 mL). The average follow-up time was 18.6 months (range 12-23 months). There were 4 patients with AP angular deformity and 5 patients with lateral angular deformity (range 2-5°). External rotation deformity was presented in 2 patients. There were no plate breakage, screw loosen and fixation failure. Average bone union time was 5.6 months (range 3-8 months) without infection case. Six cases were treated with il iac bone transplantation for delayed union. Conclusion LISS is one kind of effective treatment to femoral intercondylar and supercondylar fractures.
Objective To investigate the effect of treatment with proximal femoral nail (PFN) on femur intertrochanteric fractures in the old. Methods A retrospective study of 62 patients with femur intertrochantericfractures treated with PFN from October 2001 to September 2003 was carried out.The data of operative time, blood loss, intraoperative complications, wound drainage, postoperative complications, healing time, and hip function were recordedand compared with previous literature so as to evaluate the effect. Results All patients were followed up for 8-22 month(13.6 months on average). Intraoperative fracture occurred again in 2 cases. Two patients died of brain embolism and pulmonary infection respectively. Heterogeneous ossification occurred in 2 cases. Hip varus occurred in 1 case. Extra hip anteversion occurred in 1 case. The effect of other cases was satisfactory. The operative time was 76.5±29.1 min, the mean blood loss was 385.7±98.4 ml, the wound drainage was 45.5±21.7 ml, and the healing time was 13.2±3.8 weeks. According to the Sanders post-trauma hip function assessing system, the excellent and good rate was 89.6%. Conclusion The application of PFN is characterized by short operative time, less blood loss, stable fixation, so it is an effective way to treat femur intertrochanteric fracture in the old.
Objective To compare heterotopic ossification between femoral head reconstruction and total hip arthroplasty(THA) in patients with ischemic necrosis of femoral head(INFH). Methods Between June 1994 and December 2004, the femoral heads were repaired in 1 005 patients with INFH,the total hip was replaced in 485 patients with INFH. The rate of heterotopic ossification was observed in 74 (Ficat Ⅲ to Ⅳ stages) of 1 005 patients and 80 of 485 patients given THA to compared the results of the two methods. Results These patients were followed up 2 to 10 years(6.5 years on average). The rates of heterotopic ossification were 5.4%(4/74) and 22.5%(18/80), respectively. There was statistically significant difference between two operative methods (Plt;0.01). Conclusion The rate of heterotopic ossification of femoral head reconstruction is lower than that of THA, so femoral head reconstruction is a better operative method for young patients and THA is suitable for old patients.
Objective To investigate the impact of difference between the medial and lateral posterior condyle cartilage thickness on osteotomy in total knee arthroplasty (TKA) by measuring the thickness of the medial and lateral femur posterior condylar cartilage and the posterior condylar angle (PCA) in osteoarthritis (OA) patients. Methods Between May and December 2011, 53 OA patients (60 knees) scheduled for TKA met the inclusion criteria (OA group). There were 12 males (14 knees) and 41 females (46 knees), aged 57-82 years (mean, 71.9 years). The tibiofemoral angle was (183.2 ± 2.6) ° . Fifteen healthy volunteers (30 knees) were taken as controls (control group); there were 6 males and 9 females, aged 59-68 years (mean, 66.3 years). MRI scan data were imported into Mimics10.01 medical image control system to measure the thickness of femur posterior condylar cartilage and the PCA with and without femur posterior condylar cartilage. Results In the control group, the thickness of the medial and lateral femur posterior condylar cartilage was (1.85 ± 0.33) mm and (1.92 ± 0.27) mm respectively, the PCA with and without femur posterior condylar cartilage was (5.0 ± 0.9)° and (5.1 ± 0.8)° respectively, all showing no significant differences (P gt; 0.05). In OA group, the thickness of the medial and lateral femur posterior condylar medial cartilage was (0.45 ± 0.40) mm and (1.78 ± 0.51) mm respectively, the PCA with and without femur posterior condylar cartilage was (3.3 ± 1.7)° and (4.8 ± 1.8)° respectively, all showing significant differences (P lt; 0.05). In OA group, the difference between lateral and medial cartilage thickness was (1.33 ± 0.45) mm, and the difference between PCA with and without femur posterior condylar cartilage was (1.5 ± 1.3)°. There was a positive correlation between the difference of cartilage thickness and the difference of PCA (r=0.75, P=0.01). Conclusion There is significant difference between medial and lateral femur posterior condylar cartilage wear, which leads to difference of PCA. The difference will impact knee function and longevity of the prosthesis, so the difference should be considered during osteotomy.
ObjectiveTo design a new type of short femoral intertrochanteric nail (FITN) with anterior curvature (19.5 cm in length and 120 cm in radius) and observe the geometric match with medullary cavity of the femur. MethodsBetween November 2015 and June 2016, 25 geriatric patients with femoral intertrochanteric fractures were treated with the newly designed FITN. There were 7 males and 18 females with an average age of 82.3 years (range, 65-94 years). According to AO/OTA fracture classification, 3 cases were rated as A1.2, 2 cases as A1.3, 5 cases as A2.1, 8 cases as A2.2, and 7 cases as A2.3. The interval between injury and operation was 3.2 days (range, 2-7 days). Postoperatively, the nail entry point position (anterior, central, and posterior) on sagittal plane, the nail tip position (6-grade scale) and the nail tail level (3-grade scale) were measured using fluoroscopy and X-ray films to evaluate the geometric match of the nail with medullary cavity of the femur. ResultsOne patient with Parkinson disease died of asphyxia and pulmonary infection. The other 24 patients were followed up 1-8 months (mean, 4 months). Fracture union time was 6-10 weeks (mean, 8 weeks). The mean Parker-Palmer mobility score was 5.5 (range, 4-8). No patient had hip-thigh pain. The nail entry point was positioned anterior in 2 cases (8%), central in 18 cases (72%), and posterior in 5 cases (20%). The distal nail tip located at the central canal axis (grade 0) in 15 cases (60%), at anterior without contact with the anterior inner cortex (grade 1) in 8 cases (32%), at posterior (grade -1) in 1 case (4%), and at anterior with slight nail-tip impingement with the anterior cortex (grade 2) in 1 case (4%). The proximal nail tail level did not protrude out beyond the greater trochanter (grade 0) in 13 cases (52%), protruded out less than 5 mm (grade 1) in 9 cases (36%), and more than 5 mm (grade 2) in 3 cases (12%). ConclusionThe newly designed FITN has a good geometric match with the femur medullary canal in Chinese population, which may reduce the nail related complications.