OBJECTIVE:To evaluate the safety and efficacy of early NovaBone grafting in accelerating healing of high-energy tibial shaft fractures.METHODS:In a prospective, randomized, controlled study 78 patients with open or closed tibial shaft fractures were treated with reamed interlocking nails, combined with NovaBone grafting. Forty patients were randomly assigned to the experimental group (with NovaBone grafting at fracture site), and 38 to the control group (without NovaBone grafting).RESULTS:All patients were followed up for an average of 8 months (range 6-18 months). The average fracture healing time was 12 weeks (range 8-16 weeks) in the experimental group, and 19 weeks (range 12-36 weeks) in the control group (P < 0.01). No delayed union or nonunion was found in the experimental group, but four cases (10.5%) in the control group were found to heal spontaneously between 7 and 8 months. When the data were analyzed at week 12 and week 26 according to the criteria of Johner and Wruhs, 88% and 100% of the cases in the experimental group were rated as excellent and good respectively, but in the control group, 50% and 89% were rated as excellent and good respectively, these being significant differences (P < 0.05).CONCLUSION:Internal fixation supplemented with early prophylactic NovaBone grafting of high-energy tibial shaft fractures is a safe and effective treatment which accelerates fracture healing.

Objective To summarize the surgical technique and the clinical result of subtrochanteric shortening with overlapping femoral resection in primary total hip arthroplasty(THA)for Crowe type Ⅳadult dislocated hip (ADH).Methods From January 2000 to December 2003,11 primary hip arthroplasties were Derformed in Crowe Ⅳadult hip dislocation using a subtrochanteric shortening with overlapping femoral resection.There were 3 men and 5 women with an average age of 48 years (range 40-57 years).Subtrochanteric shortening with overlapping femoral resection and"V"shaped derotational osteotomy were performed for all cases without soft tissue release.The proximal femoral shaft splitting was used in 6 hips.Resnits The mean follow-up was 5 years (range 3-7 years).No operation was complicated by dislocation,or deep infection.Length of the reseeted subtrochanteric femour averaged 4.5 cm(4-6 cm).No hip reduction was encountered difficultly,and no nerve palsies and lax dislocation of the hip occurred.X-ray showed all acetabular cups were placed at the anatomical position,all osteotomies healed by 3-6 months.The Harris hip score improved from 25-32 to 90-98.Limb-length discrepancy was restored to an average of 3 cm after surgerv.No acetabular and femoral components need revision.No aseptic loosening or osteolysis was identified around the femoral or acetabulum components.Conclusion Subtrochanteric shortening osteotomy is a safe and predictable method of restoring the anatomic hip center in Crowe Ⅳ adult hip dislocation.

Objective To explore the modulation of endochondral ossification in rat nasal chondrocyte cultures with 45S5 in vitro.Methods Chondrocytes were enzymatically isolated from the nasal septum of 21 day-old foetal SD rats and cultured up to 21 days in the presence of a melt-derived 45S5 and in the control group.The growth of the cultured chondrocyte were observed by phase contrast microscopy and MTT.Collagen matrix composed of densely packed fibers at the periphery of the chondrocyte cultures with 45S5 was observed by transmission electron microscopy.The specific activity of alkaline phosphatase was determined by atomic absorption spectrometry.Results On the 13th day in terms of morphological change in the cultures in contact with 45S5,granules became darker than that in the control group corresponding to the extend of matrix biomineralization.Transmission electron microscopy showed collagen matrix composed of densely packed fibres and mineralized foci formed needle-shaped crystals in contact with an electron-dense layer located at the periphery of the material.The specific activity of alkaline phosphatase was significant higher in 45S5 cultures on the 12th and 15th day than that in the control group.Conclusion This study shows 45S5 has the ability to modulate the growth of chondrocytes and endochondral ossification.

AIM: To search the factors influencing the concentration of cells cultured by the best way and find the characteristic of cell amplification of human osteoblast by culturing the osteoblast from human trabecubar bone. METHODS: The experiment was performed in the thrombus room of Hematonosis Research Institute of Jiangsu province (the Hematonosis Research Institute of the First affiliated Hospital of Suzhou University) from March to December 2005. ①Human osteoblasts were isolated from trabecular bone of femoral heads taken during total hip arthroplasty and condyles of femur taken during total joint replacement for isolating culture and identification. ②Osteoblasts were cultured according to the ratio of 1∶2,1∶3,1∶4 from the first generation,and osteoblast growth cycle was observed. ③The cell population was counted after culture and the effect of cell density on cell growth was observed.RESULTS: ①Growth and morphologic character of cells: After the primary osteoblasts were planted for 40 hours,a few osteoblasts were observed to adhere the bottle wall and stretch out the spurius. After 80 hours,there were more adherence cells of fusiform or polygon. After 7-12 days,the cells formed monolayer and the major displayed fusiform with abundant kytoplasm and high clarity; there were nuclear and visible plasmosome in the cells. The appearance of osteoblast was similar to fibroblast. After serial subcultivation,the major cells displayed fusiform or polygon,nucleus was big and there were more ecphymas,which were overlapping. The osteoblasts gradually linked to lamellar as time. ②Growth cycle of human osteoblast: It was about 4 days. ③Growth of human osteoblast cultured with different ratios: 1×106 cells serial subcultivation were taken according to the radio of 1∶2,1∶3 and 1∶4 respectively for 4 days,the number of total cells collected was (2.025±0.063)×106; (1.688±0.052)×106 and (1.352±0.059)×106. There were significant differences (P < 0.001). CONCLUSION: Cell number obtained is different if cells are cultured in different density under the same condition. Cell growth velocity is related to cell density. It is better to culture the human osteoblast in the ratio of 1∶2. It is convenient and shortcut to isolate and culture human osteoblast from trabecular bone. But cell density in serial subcultivation is very important to reach the best cell amplication velocity .

Objective To summarize the surgical technique and the clinical effects of late total hip arthroplasty (LTHA) after failed operative or nonoperative treatment of an acetabular fracture. Methods From January 1997 to January 2007,16 patients (16 hips) were treated with uncemented LTHA after operative or nonoperative treatment of an acetabular fracture. There were 9 men and 7 women with an average age of 45 years (range,26-71years). The causes of the fractures included traffic accidents in 14 cases and falls in 2 cases. 10 patients (10 hips) had previous open reduction and internal fixation (open-reduction group) and 6 patients (6 hips) had been treated nonoperatively (closed-treatment group). The pre-operation diagnoses were posttraumatic arthritis in 6 hips,avascular necrosis of the femoral head in 5 hips,and posttraumatic arthritis associated dislocation of the femoral head in 5 hips. The time from fracture to LTHA was 4 months to 20 years. Implant design: uncemented ceramic-ceramic coupling prostheses were used in 9 hips (ceramic group). Uncemented metal-polyethylene coupling prostheses were used in 7 hips (metal-polyethylene group). Results No complication was occurred such as deep infection,dislocation,or nerve and blood vessel injury. Compared the conservative treatment group to the open-reduction group at the time of LTHA,difficulties with exposure due to extensive scarring were 0%(0/6) to 60%(6/10) (P< 0.01); hardware needed to be removed were 0%(0/6) to 40%(4/10) (P< 0.01); the requirement of bone-grafting of acetabular defects were two of six patients(33%) to three of ten patients(33%) respectively(P >0.05). The coverage and stability of the acetabular cup should be hampered by the presence of residual acetabular deformity and nonunion,an reduction and internal fixation required in the closed-treatment group was 50%(3/6) while in the open-reduction group was 0%(0/10)(P< 0.01). Between these two groups,the mean operative time was 150 minutes (range,120-180 minutes) in the conservative group and 200minutes ( range,120-300minutes) in the open-reduction group (P< 0.01). The patients in the open-reduction group also had approximately double blood loss intraoperative and postoperative (1200 ml compared with 800 ml,P< 0.01) as the patients in the conservative group. Postoperative X-ray film showed that the coverage of the acetabular component and the initial fixation of the femoral components were excellent. The mean follow-up was 6 years (range,2 to 10 years).Twelve patients had excellent Harris hip scores,2 patients were good and 2 patients were fair (because the sciatic nerve injury didn't get recovery).Until now,no patient was revised,or needed to be revised. Latest X-ray film showed grade Ⅱ-Ⅲheterotopic bone formation in 2 cases,and no acetabular or femoral component was loose. Eight years after LTHA,linear wear of polyethylene insert was measured >2 mm/year in 2 cases,and their CT showed localized cavitary acetabualr osteolysis in zone 3. But no wear or osteolysis was found in the ceramic group. Conclusions 1.LTHA is an effective means of salvaging a hip after failed operative or nonoperative treatment of an acetabular fracture; 2.LTHA after previous operative treatment of an acetabular fracture is often more difficult than that after previous nonoperative treatment because of extensive scarring,heterotopic bone,and retained internal fixation devices; 3.The usage of uncemented LTHA and the improvement of bearing surface are the key points to make LTHA long survival.

目的评估生物型全髋置换术后早期负重对疗效的影响。方法从2002年2月~2003年2月共手术36例38髋,随机分为A、B两组。A组17例18髋,B组19例20髋;A组为早期负重,B组为晚期负重。两组病例均采用小切口全髋置换术。随访期最少为2年。A组开始完全负重行走的时间为术后17·5d,B组为42d。结果两组病例术后Harris评分无显著性差异,X线片均显示假体位置良好。结论生物型全髋置换术后的早期负重具有可行性。

Objective To summarize the effect of early prophylactic NovaBone grafting of high-(energy) tibial shaft fractures.Methods From May,2002 to February,2005,98 cases of high-energy tibial shaft fractures were treated with reamed interlocking nail.Patients were randomized into the experimental group of 50 cases(the fractured site were received early prophylactic NovaBone graft),and the control group of 48 cases(did not receive NovaBone).Results The averaging 8 months follow-up evaluation was made to all patients.The mean time to fracture healing was 12 weeks(range,8～16 weeks) in the experimental group,was 19 weeks(range,12～36weeks) in the control group(P<0.01).In the experimental group,no delayed union or nonunion,but in the control group,there were 5 fractures(10.4%) healed spontaneously in a period from 7 and 8 months.When the data were analyzed according to the criteria of Johner and Wruh,by week 12 and 26,there were excellent rate 86% and 100% in the experimental group,50% and 89% in the control group respectively,significant difference was found between the two groups(P<0.01).Conclusion We found early prophylactic NovaBone grafting is safe and well tolerated,and it reduces the necessity of secondary interventions to promote fracture-healing of high-energy tibial fractures.

Objective To summarize the mid-term result of total hip replacement with a proximally hydroxyapatite-coated femoral component. Methods From February 2000 to February 2001, 65 cases (70 hips) underwent uncement total hip replacement with a proximally hydroxyapatite-coated femoral component. There were twenty males and forty-five females with average of 63 years. The diagnosis included femoral neck fractures in 30 cases, osteoarthritis in 15 cases, avascular necrosis of the femoral head in 9 cases, loos-ening of artificial femoral head in 8 cases, rheumatoid arthritis in 2 cases, and arthrodesis in 1 case. Clinical and radiographic evaluations were performed postoperatively, at one week, three, six, twelve months, and yearly thereafter. Results Four patients died before the latest follow-up. Among the 61 cases (66 hips), the average follow-up was 7.5 years. At the latest follow-up, the mean Harris hip score was 96 points. 3 patients (4.5%) reported mild thigh pain, no ease need revision. By the measurement of the X-ray, 7 stems had less than 1.5 mm of subsidence within the 1 year follow-up. The remainer stems had no subsidence. Radiographic evaluation demonstrated all stems to get bone ingrowths fixation with evidence of spot welds, cancellous con-densation and cortical hypertrophy visible around Gruen zone 2 and zone 6 at 3 to 6 months postoperatively, including patients aged more than 70 years and of Dorr type C. Reactive lines covered the noncoated zone of the femoral stems for some eases. No hip had extensive proximal end osteolysis or distal intramedullary oste-olysis, and loosening. Conclusion Hydroxyapatite-coating on femoral implants is able to enhance the initial fixation of implants, to accelerate bone ingrowths and osseous fixation of the femoral component, to seal the interface between the implant and bone and to prevent ingress of polyethylene particles. So it is good to im-prove mid-term clinical results of the eementless total hip replacement.