Objective To explore an ideal operative treatment to preserve the hi p joint for the old femoral neck fracture in young and middle-aged patients. Methods Between January 2002 and June 2006, 28 cases of old femoral neck fracture, 23 males and 5 females, aged 19-55 years old (37.6 on average), were reconstructed with free il iac grafts and fixed by dynamic hi p screws (DHS) and/or canulated screws. Multi ple vascular bundles derived from lateral circumflex femoral vascular were implanted in 19 cases. All the 28 cases were close fractures, with 17 of left hip and 11 of right hip. In terms of the fracture site, 4 cases were infer-head, 17 were per-neck and 7 were fundamental-form. The Harris score was 25-72 (49.6 onaverage) before operation. No callus formation was found on X-ray films in all cases; sclerosis and cyst were found in 4 cases and osteonecrosis of femoral head (ONFH) was confirmed by MRI. The duration between initial injury and surgery was 1-21 months (8.6 months on average). Results No deep infection was observed in all 28 cases, and paralysis of the lateral cutaneous nerve of the thigh was observed in 5 cases, and was better 6 months after operation with no special treatment. All 28 cases were followed up for 20-72 months (35.8 months on average). A total of 25 fractures healed within 4-8 months, with the heal ing rate of 89.3%; 3 fractures had nonunion and received artificial hip replacement. During the follow-up, 7 cases (25%) developed ONFH confirmed by MRI within 18 months, and 5 cases (17.9%) developed femoral head collapse. The Harris score was 27-100 (82.7 on average). Leg length discrepancy was not observed and the gait was fairly normal. Conclusion The femoral neck reconstruction procedure can restore the normal anatomy of femoral head and neck and the blood supply, so as to promote fracture heal ing as well as delay or avoid the artificial joint replacement. Therefore, it is an important treatment to preserve the hip joint for the old femoral neck fracture in young and middle-aged patients.
ObjectiveTo detect the expressions of signal peptide-CUB-EGF-like domain containing protein 3 (SCUBE3) and specificity protein 1 (SP1) in breast cancer tissues, and explore relations between their protein expressions and clinicopathologic features or prognosis.MethodsFrom February 2013 to October 2015, the breast cancer tissues and the corresponding adjacent normal breast tissues of 80 women patients with breast cancer in the Mianyang Central Hospital were selected, and the expressions of SCUBE3 and SP1 proteins in the tissues were detected by immunohistochemistry. The relations between the expressions of SCUBE3 and SP1 and clinicopathologic parameters of breast cancer were analyzed, the correlation between the SCUBE3 and SP1 was analyzed by Spearman rank correlation analysis. Kaplan-Meier method was used to analyze the survival of patients with breast cancer; and Cox proportional hazards regression model was used to analyze the risk factors of overall survival of patients with breast cancer.ResultsThe positive rates of SCUBE3 and SP1 proteins expressions in the breast cancer tissues were higher than those in the corresponding adjacent normal breast tissues (P<0.05). The positive rates of SCUBE3 and SP1 protein expressions were higher in the breast cancer tissues with lymph node metastasis and molecular subtypes of Luminal A or B (P<0.05), and the positive rates of SCUBE3 protein expression were higher in the breast cancer tissues with TNM stage Ⅱ–Ⅳ and high Ki67 (P<0.05). The retsult of Spearman rank correlation analysis showed that the positive rates of SCUBE3 and SP1 proteins expressions in the breast cancer tissues was positive correlation (χ2=7.979, rs=0.316, P=0.005). Kaplan-Meier curve showed that the overall survival of the patients with positive expression of SCUBE3 or SP1 protein was worse than that of the patients with negative expression (χ2=4.042, P=0.044; χ2=10.676, P=0.001). The Cox proportional hazards regression model multivariate analysis showed that the positive SCUBE3 (HR=6.020, P=0.016), positive SP1 (HR=4.077, P=0.018), lymph node metastasis (HR=3.518, P=0.017), and higher Ki67 expression (HR=7.989, P<0.001) were the independent risk factors of overall survival for the patients with breast cancer.ConclusionPositive rates of SCUBE3 and SP1 proteins expressions in breast cancer tissues are higher and there is a positive correlation between them, which are closely related to clinicopathologic parameters such as lymph node metastasis and molecular subtypes and prognosis of patients with breast cancer.
Objective To summarize surgical procedures of hip-preservation based on peri-collapse stage of osteonecrosis of the femoral head (ONFH). Methods The basic points of peri-collapse stage theory was expounded. The related literature on surgical procedures was summarized and analyzed based on the theory. Results Surgical procedures of hip-preservation tend to emphasize on mechanical repair, giving consideration to biological repair. It is consistent with the essence of peri-collapse stage theory, which attaches great importance to biomechanical stability. Conclusion Peri-collapse stage theory has a guiding significance to the choice of surgical timing and approach, and it is one of the important theoretical basis for hip-preservation treatment.
ObjectiveTo observe the retinal microcirculation changes in chinchilla rabbit with branch retinal vein occlusion (BRVO), and to evaluate the feasibility of laser speckle imaging (LSI) technology as monitoring tool for retinal microcirculation. MethodsTen 4-month-old chinchilla rabbits were used for the experiment, selecting the right eye as the experimental eye. The main retinal vein, adjacent 0.5-1.0 mm to the optic of rabbit retina, was selected to the target vessel under surgical microscope. The software of LSI instrument was used to measure the diameter of target vein and blood flow of 0.2 mm2 area of target vein. The BRVO rabbit model was induced by photodynamic therapy, then measure the diameter and blood flow in the same region using the method as before and after 10 minutes modeled. ResultsThe retinal color pictures, infrared laser and the distribution of blood flow pseudo-color were synchronous displayed by LSI technology. Before and after modeling, the target vessel diameter were (0.104±0.009), (0.128±0.008) mm, and the 0.2 mm2 area blood flow of target vessel were (563.500±28.788), (256.000±53.319) PU. The diameter of target blood vessel after modeling was significantly thicker than before, with the significant difference (t=12.14,P=0.008). The blood flow in 0.2 mm2 area of target vessel was significantly lower than before, also with the significant difference (t=183.00,P=0.009). ConclusionsThe diameter of target vessel of the BRVO rabbit model is enlarged, and the target vessel area of 0.2 mm2 blood flow is reduced significantly. LSI system can monitor the retinal microcirculation real-time and quantitatively.
ObjectiveTo explore the different imaging manifestations of osteonecrosis of the femoral head (ONFH) and their correlation with the occurrence of pain during the peri-collapse period.MethodsThe 372 patients (624 hips) with ONFH in the peri-collapse stage who were admitted between December 2016 and October 2019 and met the selection criteria were selected as the research objects. Among them, there were 270 males and 102 females, with an average age of 35.3 years (mean, 15-65 years). There were 120 cases of unilateral hip and 252 cases of bilateral hips. There were 39 cases (39 hips) of traumatic ONFH, 196 cases (346 hips) of hormonal ONFH, 102 cases (178 hips) of alcoholic ONFH, and 35 cases (61 hips) of idiopathic ONFH. Among them, there were 482 hips with pain symptoms and 142 hips without pain. The pain duration was less than 3 months in 212 hips, 3-6 months in 124 hips, 6-12 months in 117 hips, and more than 12 months in 29 hips. According to the Association Research Circulation Osseous (ARCO) staging, the ONFH was rated as stage Ⅱ in 325 hips and stage Ⅲ in 299 hips. The patients were grouped according to ONFH etiology and ARCO staging, and hip joint pain and X-ray film (crescent sign and cystic changes), CT (subchondral bone fractures and cystic changes), and MRI (bone marrow edema, joint effusion, and subchondral hypointensity zone) were compared. Spearman rank correlation was used to determine the correlation between ONFH pain duration and X-ray film, CT, and MRI imaging manifestations.ResultsThere were significant differences (P<0.05) between ONFH patients with different etiologies in crescent sign on X-ray film, subchondral bone fracture on CT, and joint effusion on MRI. And there were significant differences (P<0.05) between ONFH patients with different ARCO stages in hip pain duration and all imaging manifestations. Correlation analysis showed that the pain duration of ONFH patients was correlated with all imaging manifestations (P<0.05). The cystic change on CT was correlated with the subchondral hypointensity zone and joint effusion grade on MRI, and subchondral hypointensity zone and joint effusion grade on MRI were also correlated (P<0.05).ConclusionThe cystic changes, subchondral hypointensity zone, and joint effusion are closely related to the collapse of the femoral head and hip pain in patients with ONFH in the peri-collapse stage. The above-mentioned signals in stage Ⅱ ONFH indicate the instability of the femoral head, which is to predict the development of ONFH and the rational choice of hip-preserving treatment methods provides a basis.
ObjectiveTo investigate the effect of dexmedetomidine on systemic vascular resistance in patients undergoing cardiopulmonary bypass. MethodsThirty-one patients undergoing cardiac surgery with cardiopulmonary bypass from January to April, 2012 were randomized into experimental group (n=16) and control group (n=15). The flow rate was kept at 2.4 L/(min·m2) and moderate hypothermia was maintained. Equivalent dexmedetomidine and 0.9% sodium chloride solution were pumped for the experimental group and control group, respectively. The mean artery pressure (MAP), systemic vascular resistance (SVR), Cortisol, epinephrine and norepinephrine were determined before (T0) and at 10 and 20 minutes (T1,T2) after dexmedetomidine administration. ResultsCompared with T0, there were significant decreases in MAP and SVR at T1 and T2 (P<0.05). MAP and SVR were significantly lower in the experimental group than in the control group at T1 and T2, respectively (P<0.05); cortisol, epinephrine and norepinephrine were significantly lower in the experimental group than in the control group at T1 and T2, respectively (P<0.05). ConclusionDexmedetomidine reduces SVR and causes decrease in MAP. It can effectively inhibit the stress reaction in patients undergoing cardiopulmonary bypass.
ObjectiveTo investigate the pathological and microstructural features of the osteonecrosis samples from subjects with steroid-induced or alcohol-induced osteonecrosis of the femoral head (ONFH).MethodsThirty femoral head bone samples were collected from ONFH patients who underwent total hip arthroplasty between August 2015 and April 2016. There were 22 males and 8 females. The etiology of ONFH was alcohol-induced in 15 patients and steroid-induced in 15 patients. No significant difference of Association Research Circulation Osseous (ARCO) stage was found between alcohol-induced and steroid-induced ONFH (Z=2.143, P=0.143). The femoral head bone samples in different areas (necrosis, sclerosis, and normal) from involved subjects was taken, and gross observation, HE staining were carried out (the rate of empty lacunaes was calculated). The intact femoral head was scanned by Micro-CT and the parameters of bone microstructure were analyzed quantitatively. The parameters included bone volume to total volume (BV/TV), bone surface area to bone volume ratio (BS/BV), bone mineral density (BMD), bone mineral content (BMC), structural model index (SMI), trabecular plate number (Tb. N), trabecular plate thickness (Tb. Th), and trabecular spacing (Tb. Sp).ResultsAs observed in hard tissue slicing of both groups, the integrity of trabecular bone was destructed and cystic lesions left by the bone resorption was replaced by granulation tissues. Significant revascularization was found in granulation tissues of steroid-induced ONFH, but not in the alcohol-induced one. HE staining showed that the bone marrow structure was disordered in both group, as well as bone marrow necrosis and empty bone lacunaes noticed. The structure and integrity of trabecular bone of steroid-induced ONFH was far more severe whereas that of alcohol-induced one were thicker and better. The rate of empty bone lacunae in necrosis area of steroid-induced group was significantly higher than that of alcohol-induced one (P<0.05), but no significant difference was found in sclerotic and normal areas between 2 groups (P>0.05). Micro-CT showed that necrotic and sclerotic areas of both groups were low bone density. Bone structure in the former area was mostly heterogeneous. Further blood-rich granulation tissues formation was observed in the same places of hard tissue slicing, while the sclerotic one wasn’t. The results of quantitative bone structure analysis showed that BV/TV, BMD, BMC, Tb.N, and Tb.Th of the necrotic and sclerotic areas of steroid-induced ONFH were significantly lower than those of alcohol-induced one (P<0.01), BS/BV, SMI, and Tb.Sp of steroid-induced ONFH were significantly higher than those of alcohol-induced one (P<0.01). No significant difference among the indexes above was found in the normal areas of both groups (P>0.05).ConclusionThe integrity of trabecular bone was destroyed in necrotic area of steroid-induced or alcohol-induced ONFH. However, they performed different features of osteonecrosis and contrasted with each other. The steroid-induced ONFH was characterized by multiple " osteolytic bone destruction”, while the alcohol-induced one was manifested by some kinds of " coagulative destruction”.
Objective To analyze the femoral head collapse and the operation of osteonecrosis of the femoral head (ONFH) in different Japanese Investigation Commitee (JIC) types, in order to summarize the prognostic rules of each type of ONFH, and explore the clinical significance of CT lateral subtypes based on reconstruction of necrotic area of C1 type and verify their clinical effect. Methods A total of 119 patients (155 hips) with ONFH between May 2004 and December 2016 were enrolled in the study. The total hips consisted of 34 hips in type A, 33 in type B, 57 in type C1, and 31 in type C2, respectively. There was no significant difference in age, gender, affected side, or type of ONFH of the patients with differenct JIC types (P>0.05). The 1-, 2-, and 5-year femoral head collapse and operation of different JIC types were analyzed, as well as the survival rate (with femoral head collapse as the end point) of hip joint between different JIC types, hormonal/non-hormonal ONFH, asymptomatic and symptomatic (pain duration >6 months or ≤6 months), and combined preserved angle (CPA) ≥118.725° and CPA<118.725°. JIC types with significant differences in subgroup surgery and collapse and with research value were selected. According to the location of the necrotic area on the surface of the femoral head, the JIC classification was divided into 5 subtypes in the lateral CT reconstruction, and the contour line of the necrotic area was extracted and matched to the standard femoral head model, and the necrosis of the five subtypes was presented by thermography. The 1-, 2-, and 5-year outcomes of femoral head collapse and operation in different lateral subtypes were analyzed, and the survival rates (with collapse of the femoral head as the end point) between CPA≥118.725° and CPA<118.725° hip in patients with this subtype were compared, as well as the survival rates of different lateral subtypes (with collapse and surgery as the end points, respectively). ResultsThe femoral head collapse rate and operation rate in the 1-, 2-, and 5-year were significantly higher in patients with JIC C2 type than in patients with other hip types (P<0.05), while in patients with JIC C1 type than in patients with JIC types A and B (P<0.05). The survival rate of patients with different JIC types was significantly different (P<0.05), and the survival rate of patients with JIC types A, B, C1, and C2 decreased gradually. The survival rate of asymptomatic hip was significantly higher than that of symptomatic hip, and the survival rate of CPA≥118.725° was significantly higher than that of CPA<118.725° (P<0.05). The lateral CT reconstruction of type C1 hip necrosis area was selected for further classification, including type 1 in 12 hips, type 2 in 20 hips, type 3 in 9 hips, type 4 in 9 hips, and type 5 in 7 hips. There were significant differences in the femoral head collapse rate and the operation rate among the subtypes after 5 years of follow-up (P<0.05). The collapse rate and operation rate of types 4 and 5 were 0; the collapse rate and operation rate of type 3 were the highest; the collapse rate of type 2 was high, but the operation rate was lower than that of type 3; the collapse rate of type 1 was high, but the operation rate was 0. In JIC type C1 patients, the survival rate of the hip joint with CPA≥118.725° was significantly higher than that with CPA<118.725° (P<0.05). In the follow-up with femoral head collapse as the end point, the survival rates of types 4 and 5 were all 100%, while the survival rates of types 1, 2, and 3 were all 0, and the difference was significant (P<0.05). The survival rate of types 1, 4, and 5 was 100%, of type 3 was 0, and of type 2 was 60%, showing significant difference (P<0.05). Conclusion JIC types A and B can be treated by non-surgical treatment, while type C2 can be treated by surgical treatment with hip preservation. Type C1 was classified into 5 subtypes by CT lateral classification, type 3 has the highest risk of femoral head collapse, types 4 and 5 have low risk of femoral head collapse and operation, type 1 has high femoral head collapse rate but low risk of operation; type 2 has high collapse rate, but the operation rate is close to the average of JIC type C1, which still needs to be further studied.