| Part 1 Radioimmunoimaging of bone cement pulmonary artery thrombi in rabbits with 99Tcm -SZ-51 and intervention studyBone cement (Polymethyl Methacrylate, PMMA) is a medical bonding, support materials, because of its simplicity, regularity and reliability, fastness. It is the preferred bonding material as prosthesis implantation for osteoporosis patients. It was widely used in artificial joint replacement. However, in the process of application, adverse reactions occurred in some patients, such as drop of blood pressure, dyspnea . Currently some people believed that the emboli getting into the blood circulation led to pulmonary embolism,when the femoral prosthesis was inserted into the bone marrow cavity.The exact composition of emboli was unclear, and it may include the blood clot, fat droplets, bone chip or bone cement particles, etc.Platelet activating monoclonal antibody SZ-51, can not combine with the unactivated platelets, but combined with the activated platelet. Activated platelets are the main component of thrombus. SZ-51 is from Suzhou Medical College Thrombosis and Hemostasis Institute, and mainly used in vivo thrombosis immunology dynamic radiation detection. It has been widely used in animal experiments. It has been proved to be an effective detection method in fresh thrombosis.99Tcm - SZ-51, a marker of thrombosis, was used in this study through Radioimmunoimaging technology. The change of radioactivity of 99Tcm - SZ-51was measured under different pretreatments and the preventive intervention for bone cement implantation syndrome was investigated in this study.Objective: To detect pulmonary artery thrombosis with 99Tcm SZ-51 after a rabbit cement perfusion, and to discuss the ways of preventing pulmonary artery thrombus.Methods: Sixteen rabbits (weight 2.5-3.0 kg)were randomly divided into 4 groups, the group A (no intervention group): bone cement perfusion into madullary cavity and compression, the group B(adrenalin hydrochloride group), pretreat the madullary cavity with adrenalin hydrochloride (1:10000), and then bone cement perfusion and compression, the group C (fibrin sealant group), pretreat the madullary cavity with fibrin sealant, and then bone cement perfusion and compression, the group D (blank control group), no bone cement perfusion. The femur head of each animal was removed and the femur was reamed. 99Tcm -SZ-51 was injected through ear marginal vein into each rabbit before bone cement perfusion. The radioactivity was measured at 60,120 and 180min. The radioactivity of lung was measured in vivo. The lung was harvested and it's radioactivity was measured in vitro. The pathological examination has been done.Results: The radioactivity of each group was measured at 60, 120 and 180 min The radioactivities are 11.48±2.35, 14.41±3.10, 18.25±5.01 ID/pixels in the group A, 8.21±3.21,10.19±2.40, 11.32±3.12 ID/pixels in the group B,4.06±1.04, 5.68±2.80, 7.40±1.12 ID/pixels in the group C. The difference among groups is statistically significant (P<0.05). Pulmonary artery thrombus had been found in group A, B and C, not ingroup D. Pretreatment with adrenalin hydrochloride and fibrin sealant, the radioactivity of lung was significantly decreased.Conclusion: 99Tcm-SZ-51 could be used in the observation of pulmonary artery thrombus formation after bone cement perfusion in rabbit. Pretreatment with adrenalin hydrochloride and fibrin sealant before bone cement perfusion can significantly lower the risk of pulmonary artery thrombus. Part2 The experimental study of different pretreatments to prevent bone cement implantation syndrome in hip arthroplasty.The incidence of fat embolism was 0.1% in bone cemnet hip arthroplasty . This complication was first reported in 1970 . In the 1950's, Charnley was the first man who used the bone cement in human arthroplasty. Later, in the bone cement hip arthroplasty, the researchers reported some progressively serious complications, including drop of blood pressure, cardiac arrest, deep vein thrombosis, pulmonary embolism, and they were collectively called as bone cement implantation syndrome. The serious fat embolism of lung was often observed in or after the bone cement hip arthroplasty. It was reported that the postoperative incidence of pulmonary embolism is about 0.1% in the hip replacement. The drop of blood pressure was more often observed in bone cement implantation syndrome. Smith, observing 3482 cases of bone cement total hip replacement for the statistics, found that the drop of blood pressure below 10mmHg accounted for 83%, 10-20mmHg for 11%, more than 20mmHg for 6.7%. In this experiment,we want to investigate possible methods to prevent the adverse effect of BCIS during hip arthroplasty by the rabbit model.Objective: To investigate possible methods to prevent the adverse effect of BCIS during hip arthroplasty by the rabbit model.Methods: 48 Belgium rabbits of either sex, 1.8-2.4 kg body weight, were anaesthetized with intravenous pentobarbitone sodium (10mg/kg body weight) and anaesthesia was maintained by additional doses of pentobarbitone sodium. The 48 Belgium rabbits(48 hips) were assigned to 8 groups randomly. The control group consisted of 6 rabbits, treated with conventional cementing technique; group 1-7 pretreated the medullary cavity with adrenaline(1:10000), drilling holes in femur,Fibrin Sealant or combined with these factors before having cement and femoral prosthesis inserted. Arterial blood pressure, central venous pressure and respiration rate were recorded at the carotid artery, the external jugular vein and the tracheal cannula by BL-420E+biological functional experimental system respectively. Data was collected and analyzed with SPSS. Specimens was taken from each lobe of the lung. The tissue sections were observed.Results: The blood pressure drop in group 3,4,7 are more significant than that in the control group, and the duration of blood pressure drop was shorter in group 1,3,5,6,7. Conclusions: Adrenaline saline, fibrin sealant and combined use of adrenaline and fibrin sealant, combined use of fibrin sealant and drilling holes, combined use of adrenaline and drilling holes can prevent blood pressure dropping during the HA;drilling holes have no effect,but can played a synergistic role with fibrin sealant.Part 3 Clinical Study Of Epinephrine Hydrochloride Prevents Bone Cement Implantation Syndrome In The Bone Cement Hip ReplacementBone cement belongs to Acrylic compounds. Its main chemical ingredients was Polymethyl methacrylate(PMMA). It is easy to shape, strong. It can be used to firmly fix prosthesis on the bone. However, it is not the real adhesives, only plays a role of filling fixed between the prosthesis and bone. in the bone cement hip arthroplasty, the researchers reported some progressively serious complications, including decreased blood pressure, cardiac arrest, deep vein thrombosis, pulmonary embolism, collectively called as bone cement implantation syndrome . Currently some people believe that the emboli get into the blood circulation leading to pulmonary embolism,when the femoral prosthesis was put into the bone marrow cavity.The exact composition of emboli can not be determined, may be the blood clot, fat droplets, bone chip or bone cement particles, etc. It was reported that the right ventricular hemodynamic changes can be observed by detecting right ventricular ejection fraction and something that passing through right ventricular be detected by dynamic transesophageal echocardiography during the hip replacement process, but no clinical manifestations in most patients, only a small number of patients died. The existence of a pulmonary embolism can be confirmed by the pulmonary perfusion scan and autopsy. Mortality in bone cement arthroplasty was reported differently. In foreign reports, the mortality rate of pulmonary embolism of bone cement was 0.05%, Internal report, 2.3% ~ 2.4%. About 914 cases in our hospital, the hip joint, knee joint bone cement replacement patients,4 cases of death, mortality rate was 0.44%.In this experiment,we want to investigate the bone cement influence on hemodynamics and the clinical application of Epinephrine hydrochloride to prevent bone cement implantation syndrome in the bone cement hip replacement.Objective: To investigate the bone cement influence on hemodynamics and the clinical application of Epinephrine hydrochloride to prevent bone cement implantation syndrome in the bone cement hip replacement.Method: In this study, we analysed retrospectively 48 hip replacement patients from July 2008 to April 2009. All the patients were divided into two groups; no intervention group, 24 patients--no preparation of bone marrow cavity with saline epinephrine hydrochloride before implantation of bone cement;intervention group, pretreatment bone marrow cavity with saline epinephrine hydrochloride before implantation of bone cement. Systolic blood pressure (SBP), diastolic blood pressure (DBP), the mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SPO2) were compared between two groups before and after bone cement implantation 1,2,3,4,5,6,7,8,9,10 min. The data were analyzed with variance and Q test.Results: Drop of blood pressure was observed for all patients in no-intervention group starting at 1min after bone cement implantation and the most significant blood pressure drop occurred at 2-6 min. the blood pressure was geting back at 7 min (SBP, p>0.05; DBP, p<0.05)and back to normal around 10min; oxygen saturation was decreased significantly (p<0.05). No statistical difference were found on heart rate,. In the intervention group, bone marrow cavity was pretreated with saline epinephrine hydrochloride before implantation of bone cement. Gauze baptisted with saline epinephrine hydrochloride (1:500000) were packed in the medullary cavity. No significant difference were found on the SBP, DBP, MAP, HR, SPO2 at different time points before and after bone cement implantation (p> 0.05).Conclusion: There was the most significant change of hemodynamics around 2-6 min in no-intervention group. In the intervention group, one patient was found with blood pressure drop and another one with the occasional premature ventricular contractions. Pretreatment of marrow cavity with saline epinephrine hydrochloride can effectively prevent bone cement implantation syndrome.Part 4 Effect of Early Postoperative Rehabilitation on pulmonary embolism and function recovery of aged Hip Arthroplasty PatientsThe biological materials was uesed to replace the and reconstruct the lesion hip joint to alleviate the symptoms in Hip Arthroplasty(HA). The purpose of a treatment is elimination of pain, improvement and restoration of hip joint function, improving the quality of life. It is suitable to hip osteoarthritis, rheumatoid arthritis of hip joint, avascular necrosis of femoral head III - IV or severe deformation of the femoral head, congenital acetabular dysplasia, congenital hip dislocation, of secondary bone arthritis, the age of the elderly over the age of 55 comminuted fractures of the femoral head or neck. In recent years, with improvement of people's quality of life, hip arthroplasty in elderly patients is increasing. Timely, safe and effective for functional recovery training, can reduce the incidence of postoperative pulmonary embolism and improve the quality of life of patients.Doing exercise after operation in the functional recovery and reduce complications play an important role, it can influence the effect of surgical treatment. If a longer time in bed after surgery, failed to carry out rehabilitation treatment as soon as possible, the degrees of muscle be reduced and the patient occur joint contracture, lower limb blood stasis, flow down easily to form deep vein thrombosis, resulting in pulmonary embolism, would seriously the impact to hip joint function and surgical efficacy, and even death. It is clinical workers and patients'common concern that how to prevent pulmonary embolism by early rehabilitation training after hip replacement surgery.The deep vein thrombosis is a life-threatening post-operative complication. The early diagnosis, timely prevention and treatment of deep vein thrombosis can reduce fatal pulmonary embolism. This study will show that how to prevent bone cement implantation syndrome and improve the joint function after hip replacement surgery for aged patients by early rehabilitation training.Objective: To evaluate the significantly lower the risk of pulmonary artery thrombus and effect of early rehabilitation program on aged people who underwent hip arthroplasty.Methods: 95 patients who received primary hip arthroplasty were evaluated immediately prior to surgery and 6 months postoperatively. Pain, function, and health related quality of life were evaluated with the WOMAC and the SF-36.each patient was given a guide-book describing the hospitalization period and the postoperative exercise program preoperatively.Results: None of the patients were found pulmonary embolism postoperatively. There were no age-related differences in joint pain, function, or quality-of-life measures preoperatively or 6 months postoperatively. Patients, regardless of age, showed significant improvement in pain, function, and stiffness. That was no significant difference between the 2 age groups regarding the preoperative and 6-month postoperative scores, except the older group reported less hip stiffness at 6 months. The magnitude of change as depicted by effect sizes typically showed greater gains in pain than function or stiffness for both age groups.Conclusions: Early postoperative rehabilitation program on hip arthroplasty for aged patient can significantly lower the risk of pulmonary artery thrombus.With increasing improvement of surgical technique and early rehabilitation program, age alone is not a factor that affects the outcome of hip joint arthroplasty and should not be a limiting factor when considering who should receive this surgery.
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