Dianming Jiang

Meta-Analysis Comparing Arthroplasty with Internal Fixation for Displaced Femoral Neck Fracture in the Elderly

BACKGROUND The treatment of displaced femoral neck fracture includes internal fixation and arthroplasty. However, which is the best surgical treatment for the elderly patient with displaced femoral neck fractures has been controversial. Our objective was to compare the clinical effects of internal fixation with that of arthroplasty for displaced femoral neck fracture in the elderly (≥60 y of age). MATERIALS AND METHODS We searched for all randomized controlled trials of hip arthroplasty versus internal fixation for displaced femoral neck fractures in the elderly by electronically searching PUBMED (1966 to December, 2008), MEDILINE (1966 to December, 2008) and manually searching grey literatures. The quality of the trials was assessed and meta-analyses were conducted using the Cochrane Collaborations RevMan 4.2 software. RESULTS Nineteen published randomized controlled trials involving a total of 3505 patients were suitable for inclusion in the review. The combined results of meta-analyses showed no significant difference in mortality at 1 y postoperatively between the two methods. However, compared with internal fixation, arthroplasty could reduce the rate of reoperations and the major method-related complications. CONCLUSIONS Compared with internal fixation, arthroplasty can not only reduce the surgical revision, but also decrease the incidence of complications, and does not increase mortality. The present meta-analysis shows that there is an evidence base to support arthroplasty as a primary treatment for displaced femoral neck fractures in the elderly.

In vivo biocompatibility of new nano-calcium-deficient hydroxyapatite/poly-amino acid complex biomaterials.

Objective To evaluate the compatibility of novel nano-calcium-deficient hydroxyapatite/poly-amino acid (n-CDHA/PAA) complex biomaterials with muscle and bone tissue in an in vivo model. Methods Thirty-two New Zealand white rabbits were used in this study. Biomaterials were surgically implanted into each rabbit in the back erector spinae and in tibia with induced defect. Polyethylene was implanted into rabbits in the control group and n-CDHA/PAA into those of the experimental group. Animals were examined at four different points in time: 2 weeks, 4 weeks, 12 weeks, and 24 weeks after surgery. They were euthanized after embolization. Back erector spinae muscles with the surgical implants were examined after hematoxylin and eosin (HE) staining at these points in time. Tibia bones with the surgical implants were examined by X-ray and scanning electron microscopy (SEM) at these points in time to evaluate the interface of the bone with the implanted biomaterials. Bone tissues were sectioned and subjected to HE, Masson, and toluidine blue staining. Results HE staining of back erector spinae muscles at 4 weeks, 12 weeks, and 24 weeks after implantation of either n-CDHA/PAA or polyethylene showed disappearance of inflammation and normal arrangement in the peripheral tissue of implant biomaterials; no abnormal staining was observed. At 2 weeks after implantation, X-ray imaging of bone tissue samples in both experimental and control groups showed that the peripheral tissues of the implanted biomaterials were continuous and lacked bone osteolysis, absorption, necrosis, or osteomyelitis. The connection between implanted biomaterials and bone tissue was tight. The results of HE, Masson, toluidine blue staining and SEM confirmed that the implanted biomaterials were closely connected to the bone defect and that no rejection had taken place. The n-CDHA/PAA biomaterials induced differentiation of a large number of chondrocytes. New bone trabecula began to form at 4 weeks after implanting n-CDHA/PAA biomaterials, and lamellar bone gradually formed at 12 weeks and 24 weeks after implantation. Routine blood and kidney function tests showed no significant changes at 2 weeks and 24 weeks after implantation of both biomaterials. Conclusion n-CDHA/PAA composites showed good compatibility in in vivo model. In this study, n-CDHA/PAA were found to be safe, nontoxic, and biologically active in bone repair.

Comparison of osteotomy versus non-osteotomy approach for congenital scoliosis: a retrospective study of three surgical techniques

Currently, there are many reports about congenital scoliosis (CS) treatment, but there are still controversies existing with respect to selecting its surgical methods.