Objective To investigate the expression levels of osteoprotegerin (OPG) and receptor activator of nuclear factor kappa B l igand (RANKL) mRNAs in BMSCs in patients suffering glucocorticoid-induced necrosis of the femoral head (GNFH), and to discuss the relationshi p between OPG/RANKL system and GNFH. Methods The bone tissue and BMSCs of femoral head were collected from 35 patients suffering GNFH (experimental group) and from 21 patients suffering fracture of femoral neck (control group). The ratio of men to women was 4 ∶ 3 in two groups, aged 41 to 70 years (mean 55.34years in the experimental group and mean 55.33 years in the control group). The patients of experimental group received over 3 weeks’ glucocorticoid treatment or more than 1 week’s high-dose glucocorticoid therapy in recent 2 years, but patients of the control group did not receive more than 1 week’s hormone therapy. In 2 groups, the microstructure of bone tissue of femoral head was detected by HE staining. The BMSCs were isolated and cultured by adherent-wall method; the expression levels of OPG and RANKL mRNAs were examined by real-time quantitative polymerase chain reaction and the ratio of OPG mRNA to RANKL mRNA was caculated. Results Bone trabeculae and bone units were replaced by interrupted bone fragments, which were surrounded by inflammation and granulation tissue and few osteocytes were seen in bone lacunae in the experimental group. In control group, bone trabeculae and bone units were made by complete lamellar bone which surrounded blood vessels and osteocytes were seen in lacunae. The expression levels of OPG mRNA in the experimental group (0.37 ± 0.12) was significantly lower than that in the control group (0.47 ± 0.13), and the levels of RANKL mRNA in the experimental group (1.12 ± 0.39) was significantly higher than that in the control group (0.84 ± 0.24), showing statistically significant difference (P lt; 0.05). The ratio of OPG mRNA to RANKL mRNA in the experimental group (0.37 ± 0.17) was significantly lower than that in the control group (0.61 ± 0.26, P lt; 0.05). Conclusion The GNFH may be related to the expression levels of OPG mRNA and RANKL mRNA in BMSCs.
Objective To evaluate sex determining region of the Y (Sry) as a engrafting track of the transplanted BMSCs survival and new bone formation in the osteonecrosis of the femoral head (ONFH) of rabbit. Methods Fortynine 4-5-month-old New Zealand White rabbits were included, weighing 2.0-2.5 kg, 48 females and 1 male. BMSCs of the rabbits were isolated by density gradient separation method, the third passage cells were marked by 1, 1’-dioctadecyl-3, 3, 3’, 3’-tetramethyl indocarbocyanine perchlorate (DiI) and the concentration of cell suspension was 2.5 × 108/ mL. The animal model of ONFH were establ ished with 48 female rabbits by injecting l iquid nitrogen, and femoral head was not dislocated.The animal model were divided into 3 groups, 16 rabbits in each group. Group A only establ ished animal model as control. Autologous BMSCs (4 μL) marked by DiI was transplanted in the ONFH models of the group B. Allogenic BMSCs (4 μL) marked by DiI was transplanted in ONFH models of the group C. The femoral head were observed by X-ray, HE staining and Masson staining, and the regenerating trabecular volume percentages was determined at 2, 4, 6 and 8 weeks after operation respectively. The examples of the heart, lung, l iver, spleen and kidney were obtained. The transplanted BMSCs were traced by fluorescence microscope, the Sry gene expression was detected by PCR for cells survival. Results All rabbits survived till the end of experiment. The X-ray showed gradual necrosis in the femoral head of group A. HE and Masson staining results indicated that compared with the group A, the recovery condition of the necrotic femoral head in the groups B and C was better. At each time of groups B and C, the regenerating trabecular volume percentages were higher than that of the group A significantly (P lt; 0.01). There was no significant difference between groups B and C (P gt; 0.05). The cells marked by DiI were not founded in the tissues of the heart, lung, l iver, spleen and kidney in groups B and C at each time. PCR showed that the expression of Sry gene were not observed at the heart, lung, l iver, spleen and kidney of three groups at each time. The expression of Sry gene was clearly identified in the femoral head of all 16 rabbits in the group C at each time point. Conclusion Allografting of BMSCs transplanted into the femoral head can survive and induce new bone formation without redistribution.
Objective To investigate the treatment method of ischemic necrosis of the femoral head by the transplantation of pedicled bone flap with deep iliac circumflex vessel in adult and to assess its curative effect. Methods From February 1996 to September 2003, 46 adult patients with ischemic necrosis of thefemoral head (58 coxas) were treated by transplantation of pedicled bone flap with deep iliac circumflex vessel. The locations were the left side in 34 coxas and the right side in 24 coxas（stage Ⅱ in 16 coxas, stage Ⅲ in 39 coxas and stage Ⅳ in 3 coxas）.Results Thirty-seven patients (40 coxas) were followed up 6 months to 10 years after operation. According to the assess of FanQishen,the result was excellent in 19 cases (21 coxas), good in 11 cases (12 coxas), fair in 5 cases (5 coxas) and poor in 2 cases (2 coxas). The postoperative excellent and good rate was 81%. Conclusion Operative treatment of ischemic necrosis of the femoral head in adult by transplantation of bone flap pedicled with deep iliac circumflex vessel has the characteristics of restoration of blood supply ofthe femoral head, decompression of marrow cavity, elimination of necrotic bone and support of the femoral head. It is an effective and advanced method for treatment of ischemic necrosis of the femoral head in adult.
Objective To explore the program for calculating the necrotic articular surface area (NASA) and the ratio of NASA to whole articular surface area (WASA) of osteonecrosis of the femoral head (ONFH), to verify the accuracy of this calculation and to predict the collapse of the femoral head clinically using this program. Methods From June 2001 to June 2003, The specimens of the necrotic femoral head from eight patients (13 hips) were obtained by total hip arthroplasty. The magnetic resonance imaging (MRI) was taken in all patients before operation. According to a series of T1-weight pictures, the NASA and the ratio of NASA to WASA were calculated by designing program. The specimens of the necrotic femoral head were sawed into lays similar to MRI pictures using the coordinate paper stick on the auricular surface, the data processing were done by analytic instrument for pictures. The data of both were analyzed statistically by software SPSS 10.0 edition. The NASA and the ratio of NASA to WASA were calculated on MRI in ARCO Stage Ⅰ, Ⅱ 16 patients (25 hips) with non-operation. Follow-up was done to the patients with collapse of the femoral head and to the patients with no collapse for at least 24 months. The data were compared in collapse group and non-collapse group. Results There were no significant differences between MRI pictures calculation and specimens measurement (NASA: 0.412, ratio of NASA to WASA: 0.812, Pgt;0.05). Of the 25 hips followed up, collapse occurred in 17 hips. NASA was 31.06±8.10 cm2, (95% CI: 26.58 to 35.55)，the ratio of NASA to WASA was 58.91%±15.11%, (95% CI: 51.14to 66.68). No collapse appeared in 8 hips. NASA was 14.16±9.32 cm2(95% CI: 6.04 to 21.95), the ratio of NASA to WASA was 29.48%±19.76%(95% CI: 12.97to 45.99). The ratio in the patients with collapse was beyond 33%. Conclusion The NASA and the ratio of NASA to WASA in patients withONFH can be accurately calculated with the MRI pictures. The possibility of collapse can be predicted by this method. As it is complicated in operation, improvement should be made in order to put itinto clinical use.
OBJECTIVE In order to investigate the causes of necrosis of the retained flap after transplantation of the great nail flap, according to the principle of plastic surgery, the following operation was designed. METHODS A tongue-shaped great toe flap was made with its base on the tibial side of the great toe and the width of the base was 1 cm to 1.5 cm. The flap contained the supporting vessels and nerves and the periosteum was also preserved. RESULTS From June 1982 to November 1997, the flap was used to repair 267 case, 277 fingers defects. After operation, the retained flap on the tibial side developed necrosis in 13 sides, an incidence of 4.69%, and in 78 sides, there was necrosis on the grafted skin on the donor site, an incidence of 28.7%. Most of the wounds healed after changing dressing, while 37 wounds healed from another skin graft. Of these cases, 178 cases had been followed up for 5 months to 16 years. It was found that the retained tibial tongue-shaped flap showed hyperplasia which extended to the weightbearing area of metatarso-phalangeal of great toe. It showed that the taking off of great toe nail flap according to first dorsal metatarsal artery (FDMA) I, II or III type, the incidence of development of necrosis of retained flap on tibial side showed no significant difference (P gt; 0.05). CONCLUSION It was believed that the necrosis of the retained flap was not related to the FDMA classification but had relation with the design, operative technique and presence of infection.
Superficial cervical artery skin flap is widely used in clinical practice. In order to inprove the outcome of the flap in clinic, eleven cases of skin defect of scalp who were treated with the flap was discussed. After operation, the donor area healed but there was no hair growth on recipient area. Among them, six cases occurred partial necrosis of skin flaps. In order to avoid these problen, the relevant solution discussed as follows: 1. Handle well the pedicle of the skin flap to prevent the interference with venous returm. 2. Adhere strictly to indications. 3. Apply skin expander to obtain "extra" skin, then carryout the tranfer of skin flap and 4. Better use the skin flap with residual hair.
ObjectiveTo evaluate the value of 120 kV portal venous phase images combined with iodine maps created from dual-source dual-energy CT (DECT) for the diagnosis of pancreatic necrosis in the early stage of acute pancreatitis. MethodsThis prospective study enrolled 17 patients who underwent abdominal dual-source DECT within 72 hours from the onset of acute pancreatitis. All patients had received treatment in West China Hospital from May 2014 to August 2014. Comparison of the diagnostic value of 120 kV portal venous phase images alone and 120 kV portal venous phase images combined with iodine maps created from dual-source DECT was performed. ResultsSix of the 17 patients were found the presence of pancreatic necrosis (4 patients without obvious necrosis in the early stage developed to pancreatic necrosis, and 2 patients with the presence of necrosis in the early stage improved). The sensitivity, specificity, and accuracy of 120 kV portal venous phase images for the diagnosis of pancreatic necrosis were 50.0% (3/6), 100% (11/11), and 82.4% (14/17), respectively, and it had a good diagnostic value (AUC=0.856, P=0.018). The sensitivity, specificity, and accuracy of 120 kV portal venous phase images combined with iodine maps created from dual-source DECT for predicting pancreatic necrosis were 100% (6/6), 90.9% (10/11), and 94.1% (16/17), respectively, and this method had good value too (AUC=0.977, P=0.002), which higher than that of 120 kV portal venous phase images (P=0.002). ConclusionsThe 120 kV portal venous phase images combined with iodine maps created from dual-source DECT is helpful to improve subjective judgment in the diagnosis of pancreatic necrosis in the early stage of acute pancreatitis. It also contributes to the display of hypo-perfusion area of the pancreatic parenchyma, and has higher diagnostic value.