Scanning electron microscopic study of subchondral bone tissues in osteoarthritic femoral head.

During total hip replacement for 12 cases of advanced osteoarthritis of the hip joint in aged women, three types of diseased or abnormal articular cartilage with different degrees of severity (white articular cartilage, white and hyperplastic articular cartilage, and yellowish articular cartilage) and ivory bone were obtained together with their subchondral bone tissues. These specimens were processed and studied under scanning electron microscope and were compared with sex- and age-matched non-osteoarthritic femoral head articular cartilage specimens. The following findings were observed: 1. In non-osteoarthritic femoral head, the subchondral bone plate was quite thin. The bone plate connected on its deep surface with the lattice-work of trabeculae of the epiphyseal region. The trabeculae were fine and smooth and some revealed round or spindle-shaped callus resulted from microfracture. 2. In osteoarthritic femoral heads, with increased the severity of the articular lesion, the articular cartilage gradually became thinned out and eventually lost. The subchondral bone plate was markedly thickened. The epiphyseal trabeculae were also thickened and turned rough so that the lattice-work pattern gradually disappeared. The thickened trabeculae finally fused into a large piece of dense bone tissue. No microfracture was detected. These changes were attributable to the increased stress imposed on the subchondral bone tissues as a result of defective articular cartilage. Consequently, the changes on the part of the subchondral bone tissues of the osteoarthritic femoral heads were the sequent, rather than the cause, of the articular lesions.

     

PRODUCTION AND TRANSFORMATION OF IVORY BONE IN OSTEOARTHRITIC FEMORAL HEAD

Twelve femoral heads were collected during total hip replacement forosteoarthritis of hip joint. The areas on the femoral head denuded of articular cartilageand the ivory bone were studied with scanning electron microscope. The following findingswere observed: 1. Over the area denuded of articular cartilage, the subchnodral bone platerevealed flake-like trabeculae whick were unequal in size and haphazard in array. Therewas a transformation of the flake-like trabeculae into lamellar bone tissues. 2. Over theivory bone, the lamellar bone tissues turned into Haversian systems and interstitiallamellae, thereby revealing characteristics of compact bone and became extremely hard. 3.Over the surface of the ivory bone could be seen fibrocartilaginous islands, representingreparative response from the marrow tissues.     

Dynamic gadoteridol-enhanced MR imaging in the end of growing long bone of piglets

Background It is of value to identify the non-invasive means that can accurately reflect the blood supply of epiphysis and is more sensitive in detection of early ischemia of epiphysis than the conventional gadoteridol （Gd）-enhanced SE TlWI. The aim of this study was to evaluate the blood supply of various anatomic regions at the end of normal growing long bone using dynamic Gd-enhanced MR imaging and compare the sensitivities between dynamic Gd-enhanced MR imaging and conventional Gd-enhanced SE TlWl in the detection of decreased blood perfusion of early epiphyseal ischemia. Methods Twenty-seven two-week-old piglets were used in this study. For the study of the end of normal growing long bone, unilateral MR imaging of the distal femur and proximal tibia was performed on eleven piglets. The comparison was made among various anatomic regions （physeal and epiphyseal cartilage, metaphyseal spongiosa, the secondary ossification center and metaphysis） using MRI in terms of the enhancement ratio and speed. Their relationships with the histological findings, including RBC/mm^2 and vessel distribution, were evaluated. To examine ischemic femoral head, 16 piglets were divided into two groups, with the control group having 8 piglets （involving 16 normal hips） and an ischemic group having 8 piglets （involving 16 hips with hyperabduction）. In the ischemic group, MR imaging was performed on the hips in the hyperabduction immobilized persistently for 30 minutes. After MRI, the piglets were allowed to ambulate freely for 1 day and the same MR scanning was then repeated in a neutral position. The difference in enhancement ratio and speed of the femoral head between the control and ischemic group were evaluated. Results With regard to the end of normal growing long bone, the enhancement ratio of the metaphyseal spongiosa was greatest among all the anatomic regions （P 〈0.001）. The enhancement ratio of physeal cartilage was greater than that of epiphyseal cartilage （P 〈0. 001）, which was the lowest in al     

Pelvis, acetabula

A comparative study of early postoperative effect of primary total hip arthroplasty with a mini-incision or a standard incision,The correlation between bone marrow edema,collapse and pain in osteonecrosis of the femoral head,Reconstruction of the acetabular in the Crowe Ⅲ dysplastic hip,Soft tissue balancing in the total hip arthroplasty for severe developmental dysplasia of the hip in adults     

Cartilage changes of femoral head osteonecrosis in stage Ⅱ and Ⅲ as detected by dGEMRIC

Objective To detect the cartilage changes of hip joint with osteonecrosis of femoral head (ONFH) in stages Ⅱ and Ⅲ and provide evidence for understanding cartilage changes of femoral head of osteonecrosis before collapse. Methods The cartilage changes of ONFH were determined by delayed gadolinium enhanced magnetic resonance imaging of cartilage (dGEMRIC). According to ARCO classification of ONFH, the samples were divided into three groups: Group A, 11 hips, stageⅡ; Group B,13 hips, stage Ⅲ; Group C, 10 hips, normal. All participates underwent the tests by dGEMRIC. And the data of T1Gd were collected and analyzed. Results The values of T1Gd were 420 ±60 (Group A) ,361 ±54(Group B) and 538 ±26 (Group C) respectively. There was a significant difference among three groups.The values of T1Gd in the ONFH patients were lower than their healthy counterparts. The values of T1Gd of Group B was 14% lower than those of Group A. And the difference was significant statistically. Conclusion Cartilage of the femoral head undergoes abnormal metabolic changes before collapse. There is a loss of GAG in the cartilage and it aggravates with the worsening of ONFH.     

Cartilage changes of femoral head osteonecrosis in stage Ⅱ and Ⅲ as detected by dGEMRIC

Objective To detect the cartilage changes of hip joint with osteonecrosis of femoral head (ONFH) in stages Ⅱ and Ⅲ and provide evidence for understanding cartilage changes of femoral head of osteonecrosis before collapse. Methods The cartilage changes of ONFH were determined by delayed gadolinium enhanced magnetic resonance imaging of cartilage (dGEMRIC). According to ARCO classification of ONFH, the samples were divided into three groups: Group A, 11 hips, stageⅡ; Group B,13 hips, stage Ⅲ; Group C, 10 hips, normal. All participates underwent the tests by dGEMRIC. And the data of T1Gd were collected and analyzed. Results The values of T1Gd were 420 ±60 (Group A) ,361 ±54(Group B) and 538 ±26 (Group C) respectively. There was a significant difference among three groups.The values of T1Gd in the ONFH patients were lower than their healthy counterparts. The values of T1Gd of Group B was 14% lower than those of Group A. And the difference was significant statistically. Conclusion Cartilage of the femoral head undergoes abnormal metabolic changes before collapse. There is a loss of GAG in the cartilage and it aggravates with the worsening of ONFH.     

Epiphyseal and Physeal Cartilage： Normal Gadolinium-enhanced MR Imaging

Jaramilloet al[1] revealed that abnormal perfu sion of the proximal femoral epiphyseal cartilage isdetectable using Gadolinium ( Gd) enhanced MRimaging. His study also indicated that cartilagi nous ischemia may be reversible if detected andcorrected early. We believe that the study of nor mal growth cartilage with Gd enhanced MR ima ging is necessary to further setting up diagnosticstandards for cartilaginous ischemia. In this study,vascular anatomy was d…     

PATHOLOGICAL AND MORPHOLOGICAL RESEARCH OF EXPERIMENTAL ACETABULAR DYSPLASIA

Objective To investigate the pathological mechanism of hip dysplasia. Methods The left knee joints of eighteen rabbits were fixed in extending position with plaster cylinder for four weeks, but their hip joints were flexed. The right side served as control. Roentgenogram was made in all animals. The changes of the xray films and the pathological findings between left and right hips were compared. Results Appearance of hip dysplasia was obvious at four weeks after plaster fixation. There were pathological changes, including shallow acetabulum and fiat femoral head, increased acetabular index and decreased acetabular head index on the x-ray films. Conclusion The hip dysplasia is the result of prolonged extending position of the knee joint. Abnormal knee posture seems to be one of the important factors of hip dysplasia. This kind of deformation may be worsened with time.     

A TETRACYCLINE LABELING STUDY OF SUBCHONDRAL BONE TISSUES IN OSTEOARTHRITIC HIP JOINT

Seven female patients (mean age of 56 years) with advanced hip joint osteoarthritis underwent total hip replacement. Four days before operation they were given oral tetracycline for two days. During operation specimens were taken from the white articular cartilage, the yellowish articular cartilage and the ivory bone together with their subchondral bone tissues. The undecalcified specimens were cut into 10 μm sections and observed under the fluorescence microscope. In all the specimens the following findings could be observed. 1. The osteoarthritic articular cartilage became thinner, with uneven surface and fissures. 2. The superficial and deep surfaces and the central part of the subchondral bone plate showed bright golden yellow fluorescence. It reflected extensive new bone formation. 3. The subchondral bone trabeculae also revealed bright golden yellow fluorescence on their peripheral borders, so trabeculae turned thicker obviously. 4. The marrow tissues between the bone trabeculae exhibited particulate or spherical bright golden yellow fluorescence, reflecting new bone formation in the marrow. The particulate and spherical bright golden yellow fluorescent materials might aggregate, enlarge and merge into large piece of new bone and they also fused with the neighbouring bone trabeculae. The aforementioned changes in the structure of the subchondral bone tissues increased greatly the mass in the osteoarthritic femoral head.     

MRI在Legg-Calve-Perthes disease中的应用

目的探讨LCP病的MRI表现和诊断价值。方法回顾性分析14例LCP病（15髋）临床和MRI资料,研究LCP病不同分期MRI影像学表现。结景缺血坏死期,2髋;血运重建期,6髋;修复期,7髋。MRI显示髋关节滑膜炎（15髋）,关节积液（15髋）,关节面滑膜侵蚀（5髋）,骨髓水肿（7髋）,髋臼和股骨头软骨增厚（6髋）,扁平髋（2髋）,股骨干骺端和股骨头骨骺间骨桥（3髋）。结论MRI是评价LCP病有效工具,可应用于诊断股骨头坏死,为疾病准确分期、各种并发症的发现及患者预后,提供重要信息;指导制定非手术和手术治疗方案具有重要意义。此外MRI还可以鉴别其它儿童髋关节疾病。     

股骨头骨骺滑脱的X线诊断

目的:探讨股骨头骨骺滑脱的X线表现,着重分析早期和轻度滑脱的X线征象及原因。方法:21例均照骨盆前后位平片,18例加照蛙式髋关节侧位片,15例作了CT、MRI检查。结果:中度以上滑脱者5例,早期轻度滑脱者16例。其X线表现:骺线增宽或明显增宽者10例。后倾角增大,部分骺线内窄外宽者7例。股骨颈弯曲伴内侧皮质增厚者4例。并发缺血坏死者4例。结论:骨盆前后位特别是蛙式位髋关节侧位片联合应用CT、MRI对早期轻度的股骨头滑脱有一定的诊断价值。     

低场强磁共振成像在股骨头坏死诊断中的应用

目的探讨股骨头坏死的低场强磁共振诊断。方法对18例共26个经磁共振诊断为股骨头缺血坏死的MRI图像进行观察和分析,并对其影像学改变进行分期。结果26个股骨头中,0期3个,Ⅰ期5个,Ⅱ期5个,Ⅲ～Ⅳ期13个,低场MRI能较特异地反映股骨头缺血坏死的各期表现,“双线征”是股骨头缺血坏死早期的特征表现。结论低场MRI不仅能发现股骨头缺血坏死的早期病变,而且能反映病变的确切范围和程度,对早期治疗和预后都有积极意义。     

股骨头缺血坏死的病理改变与影像学表现的对比分析

目的 探讨股骨头缺血坏死(ANFH)影像学表现对应的病理改变.方法 收集北京中日友好医院15位患者的20个坏死股骨头普通平片、CT、MRI表现与大体切片、组织病理做对照研究.结果 ANFH均累及股骨头前部的外上方,大体标本上坏死股骨头由软骨、坏死区、周围的增生反应区和病灶外正常区组成,增生反应区包绕坏死区.影像学改变:①坏死区在平片和CT上表现为等密度11个、低密度7个、稍高密度2个,MRI上股骨头坏死区3个呈脂肪样信号、1个呈血液样信号、2个为水样信号、9个呈纤维样信号、5个呈混杂信号.②增生反应区分隔坏死区和正常区,于平片和CT上呈高密度硬化带,其中CT、平片分别显示12个和7个股骨头于硬化带内侧见伴行的低密度透光带;MRI上增生反应区于T1WI和T2WI上均呈低信号,其中3个股骨头于T2WI上见双线征.结论 平片、CT、MRI能准确地显示ANFH大体标本上的坏死区、增生反应区和病灶外正常区,ANFH特征性影像学改变在病变的增生反应区.     

犬股骨头部分血管结扎早期股骨头坏死磁共振病理基础实验研究

目的：观察犬早期股骨头缺血坏死的ＭＲＩ图像特点，病理演变过程，探讨ＭＲＩ信号的病理基础。方法：手术结扎一侧股骨头部分滋养动脉，术后３、７、１４、３０及６０ｄ做磁共振及病理学检查。结果：术后７ｄＭＲＩ图像见有散在点状低信号改变，早期股骨头缺血坏死ＭＲ信号的病理基础是：１．骨髓细胞增大破裂的不定形细胞碎片。２．炎性细胞浸润。３．少量间充质组织形成的混合物。结论：磁共振是早期发现股骨头坏死最敏感的方法，早期股骨头缺血坏死ＭＲＩ信号在Ｔ１及Ｔ２加权图像上均呈低信号改变     

髋关节外科脱位入路在髋关节良性疾病的应用

目的  探讨髋关节外科脱位入路在髋关节良性疾病应用的早期临床疗效。方法  选取2013年1月-2014年12月中南大学湘雅二医院收治的27例髋关节良性疾病病例。所有病例均在术前收集详细的病历资料并行放射学检查,由同一高年资关节外科医生运用髋关节外科脱位入路进行手术。术后6、12及24个月均行X-Ray检查以明确是否出现股骨头缺血坏死、病变复发以及继发性骨关节炎。所有病例均获得至少1年的最终随访,并行Harris髋关节功能评分。结果  术后证实,26例（27髋）髋关节良性疾病包括：13例髋关节后脱位并股骨头骨折,8例髋股撞击综合征,3例滑膜软骨瘤病,1例股骨头骨骺滑脱（双侧）和1例化脓性关节炎。平均随访18个月,所有病例均未出现复发、大粗隆截骨不愈合以及股骨头缺血坏死等,术后Harris髋关节功能评分均为优良。结论  应用髋关节外科脱位入路治疗髋关节良性疾病能获得良好的显露,并能最大程度保护股骨头血运,早期临床疗效满意。

     

外周血干细胞移植治疗早期股骨头缺血性坏死疗效的初步研究

[目的]探讨外周血干细胞移植治疗早期股骨头缺血性坏死（avascalar necrosis of femoral head,ANFH）的疗效.[方法]确诊为早期股骨头缺血性坏死的患者30例（46髋）,术前4h行外周血干细胞分离提取后,DSA引导下经皮经股骨头供血动脉将外周血干细胞移植入患者自身股骨头内,分析治疗前后患者的临床及影像资料,观察患者髋关节疼痛、功能恢复情况及髋关节平片和MRI变化.[结果]患者经灌注治疗后4周内疼痛消失26髋,明显减轻10髋,减轻8髋,效果不明显2髋,总有效率95.65％（44/46）.患者治疗后髋关节功能恢复情况：0级者18髋（39.13％）,1级者23髋（50％）,2级者3髋（6.52％）,治疗后髋关节功能较治疗前明显改善.治疗后6个月x线平片所有患者股骨头未发现新的囊变、坏死,关节面未见塌陷.MRI扫描与治疗前相比,MR常规T1WI,T2WI无明显变化,1例患者脂肪抑制序列（STIR）示高信号区略有缩小.所有病例未见明显进展,部分病例周围软组织水肿减轻.[结论]外周血干细胞移植治疗早期股骨头缺血性坏死安全可靠,在缓解病人疼痛,改善髋关节功能方面有较好的疗效,远期效果尚需进一步研究.     

早期离床康复训练对老年股骨转子间骨折全髋关节置换术后康复效果的影响

目的:人工全髋关节置换术是老年股骨转子间骨折的一种常用的治疗方法,本文旨在探讨早期离床活动对老年股骨转子间骨折全髋关节置换术后康复效果的影响.方法:回顾性分析85例行全髋关节置换术的单侧股骨转子间骨折患者的临床资料,按照下床活动时间将其分为早期组(术后3天内下床活动者)和晚期组(7天后离床活动),采用股静脉流速、髋关节Harris评分和BADL指数评价2组的康复效果.结果:术后2组患者均未出现深部感染、压疮及深静脉血栓等并发症.术后10天时2组患者的股静脉血流峰速和平均速度差异有统计学意义(P峰速=0.040,P均速=0.019);术后3个月时2组患者髋关节Harris评分比较,差异无统计学意义(P=0.063);术后6个月时早期组的评分则显著高于晚期组,差异有统计学意义(P<0.001);术后6个月时2组患者的BADL指数评价显示,早期组能独立生活的患者人数多于晚期组,差异有统计学意义(P=0.027).结论:老年股骨转子间骨折全髋关节置换术后早期离床活动,可有效的促进髋关节功能恢复,缩短住院周期,提高患者日后的生活质量.     

早期股骨头缺血性坏死的实验研究

通过股骨头缺血性坏死（ａｖａｓｃｕｌａｓｎｅｃｒｏｓｉｓｏｆｆｅｍｏｒａｌｈｅａｄ，ＡＶＮ）的动物实验将磁共振成像（ＭＲＩ）与病理对照，探讨ＡＶＮ的早期病理改变并进行分期。１２条成年杂种狗单侧股骨头经冷冻制作ＡＶＮ模型，于术前、术后当天、１、３、５、７、１２、１９、３３ｄ进行ＭＲＩ，取下股骨头作病理检查。根据ＭＲＩ股骨头内信号表现，将其分为四个阶段，分别代表水肿、出血、液化和肉芽组织形成，以上改变与病理结果一致。ＭＲＩ为早期诊断股骨头缺血性坏死的首选影像学方法，ＭＲＩ可准确地描述坏死的程度和部位。