Objective To compare the cl inical outcomes of the core decompression combined with autologous bone marrow mesenchymal stem cells (BMSCs) transplantation with the isolated core decompression for the treatment of earlyavascular necrosis of the femoral head (ANFH). Methods From May 2006 to October 2008, 8 patients (16 hips) with earlyANFH were treated. There were 7 males and 1 female with an average age of 35.7 years (range, 19-43 years). According to the system of the Association Research Circulation Osseous (ARCO): 4 hips were classified as stage II a, 2 as stage II b, 1 as stage II c, and 1 as stage III a in group A; 2 hips were classified as stage II a, 2 as stage II b, 3 as stage II c, and 1 as stage III a in group B. The average disease course was 1.1 years (range, 4 months to 2 years). The patients were randomly divided into 2 groups according to left or right side: group A, only the core decompression was used; group B, both the core decompression and autologous BMSCs transplantation were used. The Harris score and visual analogue scale (VAS) score were determined, imaging evaluation was carried out by X-rays and MRI pre- and post-operatively. The erythrocyte sedimentation rate, C-reactive protein, l iver function, renal function, and immunoglobul in were detected for safety evaluation. Results All incisions healed by first intention. Eight patients were followed up 12-42 months (23.5 months on average). The cl inical symptoms of pain and claudication were gradually improved. The Harris scores and VAS scores of all patients were increased significantly at 3, 6, and 12 months after operation (P lt; 0.05). There was no significant difference between groups A and B 3 and 6 months after operation (P gt; 0.05), but there was significant difference between groups A and B 12 months after operation (P lt; 0.05). The necrosis area of femoral head in groups A and B were 18.13% ± 2.59% and 13.25% ± 2.12%, respectively, showing significant difference (P lt; 0.05). In group A, femoral head collapsed 12 months after operation in 1 case of stage III. No compl ication of fever, local infectionoccurred. Conclusion The core decompression and the core decompression combined with BMSCs transplantation are both effective for the treatment of early ANFH. The core decompression combined with BMSCs transplantation is better than core decompression in the rel ief of pain and postponing head collapse.
Objective To evaluate the early cl inical results of total knee arthroplasty (TKA) with JOURNEY prosthesis. Methods From September 2006 to May 2007, TKA with JOURNEY prosthesis was used to treat 32 patients in ATOS Cl inic, Germany. There were 21 males and 11 femals, aged 40-84 years old (average 65.6 years old). The locations were left knee in 13 cases and right knee in 19 cases, including 5 cases of traumatic arthritis, 19 cases of osteoarthritis and 8 cases of rheumatoid arthritis. All patients had pain and l imited range of motion (ROM) of knee. MRI scanning showed that cartilageand miniscus damaged in all cases. The disease course was 1 to 4 years (average 2.2 years). The CPM practice started 2 days after operation. Results The operative time was (75.0 ± 21.7) minutes. The blood loss was (280 ± 130) mL. All incision healed by first intention. Thirty-two patients were followed up 12 to 18 months (average 14.2 months). Hydrarthrosis occurred in 8 cases at 3-6 months postoperatively. Femur paraprosthesis fracture and implant dislocation occurred at 1 week and at 6 months in 2 cases, respectively. There were statistically significant differences in KSS score between preoperation and 3, 6, 12 months after operation (P lt; 0.05), between 3 months and 6, 12 months after operation (P lt; 0.05); there was no statistically significant difference in KSS score between 6 months and 12 months after operation (P gt; 0.05). There were statistically significant differences in pain score between preoperation and 3, 6, 12 months after operation (P lt; 0.05), and in ROM between 3 months and 6, 12 months after operation (P lt; 0.05). There was no statistically significant difference in ROM between preoperation and 3 months after operation (P gt; 0.05). Conclusion Ii is a simple way to TKA with JOURNEY prosthesis, which has a good results in early follow-up period.
ObjectiveTo evaluate mid-term effectiveness of manipulation under anesthesia combined with arthroscopic capsular release and subacromial debridement for primary frozen shoulder.MethodsBetween January 2013 and December 2017, 33 patients of primary frozen shoulder were treated with manipulation under anesthesia combined with 360° arthroscopic capsular release and subacromial debridement. There were 10 males and 23 females, aged from 37 to 65 years, with a mean age of 50.9 years. The affected shoulder on left side in 17 cases and on right side in 16 cases. The disease duration was 6-13 months (mean, 8.4 months). Before and after operation, the visual analogue scale (VAS) score was used to evaluate the shoulder joint pain, Constant score was used to evaluate the shoulder joint function, and the flexion, abduction, and external rotation of shoulder joint were recorded. The internal rotation function was assessed based on the vertebral plane that the thumb could reach after internal rotation of the affected shoulder joint (the rank of internal rotation vertebra). X-ray film was taken to measure the distance of the subacromial space.ResultsThere was no fracture or labrum tear in all patients, and all the incisions healed by first intention. All the 33 patients were followed up 20-31 months, with an average of 24.1 months. During the follow-up, there was no complication such as wound infection and nerve injury. At last follow-up, the range of motion of shoulder flexion, abduction, and external rotation, the rank of internal rotation vertebra, the VAS score, Constant score, and subacromial space were significantly improved when compared with preoperative ones (P<0.05).ConclusionManipulation under anesthesia combined with arthroscopic capsular release and subacromial debridement can achieve a good mid-term effectiveness without complication for primary frozen shoulder.