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Dr. Chen Zhongwei started the era of microsurgery with the world very first limb replantation in 1963. Over half a century, generations of Chinese surgical experts in microsurgery have innovatively made great contributions in the development of microsurgery in the world. The microsurgery in China has always been kept at the leading edge and advanced academic status in the world. The microsurgical experts in China have achieved and made great contributions in the fields of replantation surgery, reconstructive surgery, soft-tissue repair, and studies in repair of peripheral nerve. This article describes in details of the great achievements and contributions made to the world microsurgery by the Chinese surgeons. Look back into the past, the development of microsurgery in China embodies great efforts and wisdom of the earlier generations. Looking into the future, the younger generations should inherit the course of the older generations and continue to promote the popularisation and development of microsurgery in China.
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Objective To study the effect of using different tibial nerve proximal muscle branchs to repair deep peroneal nerve injury in animal experiment, and to screen out the most optimal donor nerve branch. Methods From June, 2016 to August, 2016, 64 adult female SD rats were randomly divided into 4 groups, which were LHG (using lateral head of gastrocnemius to repair peroneal nerve), MHG(using medial head of gastrocnemius to repair peroneal nerve), SNB (using soleus nerve branch to repair peroneal nerve), and blank. There were16 rats in each group. At 4 and 8 weeks after surgery, each group were tested on behavior, electrophysiology, muscle tension, muscle wet weight and histology, to evaluate function recovery of the muscles controlled by deep peroneal nerve in each group, and to compare recovery of the deep peroneal nerve repaired by different tibial nerve branches. Results Eight weeks after surgery,right foot of the rats in LHG,MHG and SNB group can be extended,toes can be completely opened. Rats in blank group showed limping gait, whose right foot can not be extended, right toe can not be opened, and muscle atrophied. At 4 and 8 weeks after the operation, the recovery rate of LHG, MHG, SNB group (at 4th weeks, 33.60 ±2.22)%, 33.07 ±2.38% and 35.91 ±2.02%; at 8th weeks, 67.16 ±5.74)%, 66.56 ±3.18% and 73.17 ± 5.33%, respectively)was higher than blank group(7.71±1.05% and 7.84±0.78%, respectively)on CMAP amplitude, tibialis anterior muscle contractility, tibialis anterior muscle cell area, muscle cell area. SNB group was superior to the LHG group and LHG group.And the difference was statistically significant(P<0.05). Conclusion All the proxi-mal tibial nerve muscle branchs can be used to repair the deep peroneal nerve injury, and the soleus nerve branch is the preferred donor nerve.
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Objective To investigate the results of defect reconstruction using anterolateral thigh free flap in medial and lateral approaches.Methods We reviewed the soft tissue defect reconstruction in 200 patients from February 2010 to June 2014 with anterolateral thigh flap in medial or lateral approach,to compare the operative time and donor site morbidity.Results The mean time of flap raising in medial group was (45 ± 4.5) minutes,while in lateral group was (65 ± 3.5) minutes.In medial group,fascial lata was closed directly in 39 cases (39％),while fascial lata was closed directly in all the cases (100％) in lateral group.All the 200 flaps survived uneventfully.All the donor sites healed smoothly.No infection occurred.An 8 to 32 months follow-up revealed a high satisfactory rate from the patients.No sensory deficit or functional impairment was noted in the donor sites.Conclusions Both in medial and lateral approach can achieve safely harvesting free anterolateral thigh flap.
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Objective To observe the change rules of insulin receptor from rat bladders after losing lower cen-tal innervations so as to explore the function of insulin receptor in denervated bladder. Methods From January, 2016 to June, 2017, 40 Sprague-Dawley rats were randomly divided into experimental group and control group,each group was 20. The conus medullaris of rats in experimental group were damaged, and rats in control group received sham opera-tion. The rats in 2 groups were sacrificed at different time after surgery (1 day, 1 week, 1 month, 3 months). Bladder specimens were harvested to perform wet weight measurement and immunohistochemical detection of insulin receptor. Results Corresponding to 1 day, 1 week, 1 month and 3 months after surgery, the bladder wet weight of control group were (0.089±0.022)g, (0.094±0.038)g, (0.106±0.112)g and(0.102±0.048)g, and of experimental group were (0.092± 0.026)g, (0.110 ±0.034)g, (0.538 ±0.098)g and (1.528 ±0.462)g. One month and 3 months after surgery, bladder wet weight of experiment group were significantly increased as compared with those of control group (P<0.05). One day, 1 week, 1 month and 3 months after the operation, the positive rate of insulin receptor expression was 60％, 100％, 100％and 80％. And strongly positive rate was 55％. In control group, the positive rate of insulin receptor expression was 20％, 40％, 40％, and 0％. The expression of insulin receptor in experimental group was significantly higher than that in con-trol group in every stage(P<0.05). Conclusion The expression of insulin receptor is significantly increased after den-ervation of bladder. The defections of insulin receptor might lead to apoptosis and muscle wasting after denervation. Re-store insulin receptor function might be key point to prevent bladder tissue from irreversible damage.
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BACKGROUND:Zinc-modified calcium silicate (CaSiO3) bioceramics coating on the titanium surface prepared in preliminary experiments has good chemical stability and antibacterial property. OBJECTIVE:To observe the effects of zinc-modified CaSiO3 bioceramics coating on osteointegration. METHODS:MC3T3-E1 cels were respectively cultured on the titanium with zinc-modified CaSiO3 bioceramics coating (experiment group), titanium with CaSiO3 bioceramics coating (control group) and pure titanium (blank control group). Then, cel adhesion, proliferation, calcification rate and the expression of type I colagen and osteocalcin were detected. The implant materials mentioned above were respectively inserted into the femurs of New Zealand white rabbits, and after 1.5 months, the osteoproliferation and osteointegration between the implants and the host were tested. RESULTS AND CONCLUSION:In vitro experiment: The number of adhesive cels at 12 hours after co-culture was significantly increased in the experimental group compared with the control group and blank control group (P < 0.05). At 14 days after co-culture, cel proliferation ability and ability of calcium nodule formation in the experiment group were significantly better than those in the other groups (P < 0.05). At 21 days after co-culture, there was no significant difference in the expression of type I colagen, but the expression of osteocalcin in the experiment group was higher than that in the control group and blank control group (P < 0.05).In vivo experiment: In the experiment group, a large amount of bone substances were detected, the coating materials directly contacted with the bone interface, new bone tissues and little fibrous tissues were observed at the interface. In contrast, there was a small amount of bone hyperplasia in the control group and almost no bone hyperplase in the blank control group. Moreover, a small part of the implant directly contacted with the bone interface and the most part was separated from bone trabeculae by fibrous tissues. These findings indicate that zinc-modified CaSiO3 bioceramics coating can enhance the ability of osteointegration between titanium implants and the host.
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BACKGROUND:The thermosensitive chitosan is a kind of chitosan, its hemostatic effect, tissue compatibility andin vivo absorption need further investigations. OBJECTIVE:To investigate the hemostasis,in vivo degradation and tissue compatibility of thermosensitive chitosan hemostatic film. METHODS: A total of 48 Sprague-Dawley rats were randomly divided into four groups, and carried out two experiments at the same time. (1) The incisions of the liver in three groups were covered with the thermosensitive chitosan hemostatic film, celulose hemostatic cotton and gelatin sponge, respectively. Blank control group received no treatment. The bleeding time and bleeding amount were recorded. (2) The incisions of the quadriceps femoris muscle of rats in the above three groups were embedded with the same hemostatic materials respectively. Blank control group was not embedded. At 1, 2, 3, 4, 6 weeks, the incision tissues of the liver and the quadriceps femoris muscle were harvested for observation. After 4 weeks, the incisions were observed with hematoxylin- eosin staining and transmission electron microscopy. RESULTS AND CONCLUSION: The bleeding time and bleeding amount of thermosensitive chitosan hemostatic film and celulose hemostatic cotton groups were significantly lower than those of gelatin sponge and blank control groups (P microscopy, the liver cels had integral structure, cellnucleus and organeles remained intact. The muscle fibers showed complete structure and little inflammatory cellinfiltration. Under transmission electron microscopy, the muscle fibers ranked tidily, with integral cellnucleus and organeles. The thermosensitive chitosan hemostatic film has good hemostasis effect and tissue compatibility.
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Objective To analyze the methods and effects for treating unstable posterior pelvic ring fracture combined with sacral nerve injury and further identify the relationships among the diagnostic methods,surgical approaches and clinical outcomes.Methods A total of 38 patients with posterior pelvic ring fracture combined with sacral plexus injury treated from January 2000 to January 2010 were enrolled in the study.There were 20 males and 18 females at an average age of 35 years (range,10 to 59 years).The causes of fractures included traffic injury in 20 patients,fall injury in 12,weighty object impingement injury in five,and stabbing injury in one.Classification of posterior pelvic ring fractures included fracture and dislocation of sacroiliac joints in eight patients,fracture of ilium wing in two and sacrum fracture in 28.According to the Denis typing of sacrum fractures,there was one patient with type Ⅰ fracture,14 with type Ⅱ fracture and 13 with type Ⅲ fracture.All 38 patients presented the decrease or loss of skin sensation around the lower extremities,perineal region and crissum.Simultaneously,30 patients suffered motor dysfunction of the lower extremities,while 20 patients had bladder and anus sphincter dysfunction or sexual disorder.Thirteen patients were suspected of sacral plexus avulsion and four of them were confirmed by myelography or MRI examination.All patients had at least one associated injury.The average ISS was 21.9 points ( range,9 to 47 points).Therapeutic methods were fracture reduction and fixation in the absence of nerve decompression for eight patients and nerve decompression for 30 patients including 26 patients being also managed by fracture reduction and fixation.Operation time ranged from 6 days to 6 months.The clinical outcomes were evaluated according to the British Medical Research Council (BMRC) evaluation criteria of sensation and movement function.Results Thirty-four patients were followed up for average 4.9 years ( range,1 to 10 years),during which their pelvis obtained stable recovery.The neurological outcome was excellent in two patients,good in four and unchanged in two in the nondecompression group and was excellent in 16 patients,good in nine and unchanged in one in the decompression group,with the decompression group superior to the non-decompression group ( P ＜ O.05 ).Conclusions For unstable posterior pelvic ring fracture combined with sacral nerve injury,nerve decompression and release combined with internal fixation can better improve the sacral nerve function and obtain good pelvic ring stability and is worth of clinical application.
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ObjectiveTo investigate the effects of chitosan/PVA nerve conduits which used for repairing sciatics nerve defect in rats.MethodsTwenty-seven rats were divided into 3 groups randomly,with 9 rats in each group. Firstly, the 15mm defects in the left sciatic nerves were made in the rats and were respectively repaired with chitosan/PVA conduits graft (group A), the silicon conduits graft (group B),and autografts (group C). At 12 weeks after the operations, the left sciatic nerves were taken out, and the comparative evaluation was made on the repairing effects by wet weight of gastrocnemius and soleus muscles, histological examination,computerized imaging analysis and True Blue retrograde tracing. ResultsThe wet weight of gastrocnemius and soleus muscles showed no significant difference between the chitosan/PVA graft and autograft groups (P ＞ 0.05). The wet weight of gastrocnemius and soleus muscles in significant difference between the chitosan/PVA graft and the silicon group at 12 weeks after the operation(P ＜ 0.05). The nerve fiber density showed no statistically significant differences between the chitosan/PVA and autograft groups(P＞ 0.05).The regenerative nerve fiber in group B had normal morphological and structural characters under transmission electron microscope.True Blue-labeled neuron cell bodies were found within both anterior horn of gray matter in the spinal cord and dorsal root ganglions (DRGs) ipsilateral to the operated side of the tested rats on illumination with ultra-violet light 1 week after the injection of True Blue.Conclusion Chitosan/PVA nerve conduit can effectively promote the nerve regeneration and myelinization of rat sciatic nerve, which is expected to substitute for autograft to repair nerve defects succesfully.
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Objective To establish an animal model of sacral nerve root avulsion in rats and e-valuate its efficiency. Methods A total of 20 adult SD rats (either sex) were chosen at random to es-tablish the sacral nerve root avulsion model by avulsing the fight L4-6 nerve roots out of intervertebral fo-ramina without laminectomy. The left side was set as control group. The models were evaluated in aspects of survival rate, Basso-Beattie-Bresnahan (BBB) scores, somatosensory evoked potential (SEP), horse radish peroxidase (HRP) tracing, bilateral weight and cross section area (CSA) of muscle biceps femo-ris, fiber of triceps surae and anterior tibial muscle. Results Of all, 19 rats were survived but one died, with survival rate of 95.0%. The BBB score was (10.78+3.15) points in experimental group and 21 points in control group. The success rate of establishing animal model was 89.5% ,for there detected no SEP in bilateral cerebral cortex of the wounded extremity of 17 rats. HRP showed positive reaction in the spinal segment of L4-6 in two rats but negative in 17, with success rate of 89.5%. There was statistical difference in aspects of weight and muscle fiber CSA of double biceps femoris, triceps surae and anterior fibial muscle between experimental group and control group. Electron microscope found denervation chan-ges including muscle fiber atrophy, nucleus shifting to (center and muscle satellite cell. Conclusion A-vulsion of L4-6 sacral nerve root out of vertebral canal is a feasible and ideal method to establish the avui-sion model of sacral nerve root injury in rats.
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AIM: To observe the curative effect of titanium wiring in treatment of the fractures of Neer Ⅱ type distal clavicle and dislocation of Tossy Ⅲ type acromioclavicular joint. METHODS: From March 2004 to December 2006, 37 cases with Neer Ⅱ type distal clavicle fractures or Tossy Ⅲ type acromioclavicular joint dislocation were treated with titanium wiring in Changzheng Hospital, Second Military Medical University of Chinese PLA. Titanium wiring (produced by Sofamor-Danek Company in USA) had good histocompatibility, intensity of tension and flexibility. The broken coracoclavicular ligament was repaired directly by titanium wiring in all cases. The outcomes were evaluated according to Herscovici's criteria. RESULTS: All the cases were followed up for 6 to 24 months. All the dislocated acromioclavicular joints returned to normal 2 weeks after operation. Excellent and good rate of shoulder function was 100% according to Herscovici standard. X-ray imaging showed all clavicle fractures united, acromioclavicular joint had no redislocation or titanium wiring breaking. The incisions of all cases had no obvious swelling and exudation. CONCLUSION: When Neer Ⅱ type distal clavicular fracture and Tossy Ⅲ type acromioclavicular joint dislocation are treated with titanium wiring, the acromioclavicular joint can exercise earlier and recover quickly.
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[Objective]To evaluate the diagnostic value of ultrasonography in patients with carpaltunnel syndrome (CTS) by measuring the thickness of transverse carpal ligament.[Method]Forty patients who had clinically and electrophysiologically confirmed as CTS underwent surgery and ultrasonographic examination by the same operator for the thickness of transverse carpal ligaments at the level of the hook of the hamate bone in transverse plane preoperatively.Twenty-four asymptomatic normal wrists served as control.Data of the ultrasonography and surgey from patients and the control groups were compared to determine the diagnostic parameters.[Result]The ultrasonographic thickness of transverse carpal ligaments in CTS patients was (0.42?0.08)cm at hamate hook leve and the data from surgey was (0.40?0.10).The data in control group was (0.29?0.07)cm.There was significant difference in the mean value of thickness of transverse carpal ligaments between the two groups at the same level.There was no significant difference between the data of CTS from surgey and ultrasonography.[Conclusion]Ultrasonography examination of the thickness of transverse carpal ligamentsis is a new and feasibile method in the diagnosis of carpal tunnel syndrome.
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BACKGROUND: The selective innervation of different sacral nerve roots on bladder in SD mice is still uncertain.OBJECTIVE: To study the selective innervation of sacral nerve roots to bladder in order to provide evidence for rebuilding bladder function after spinal cord injury and establishing experimental animal model of artificial bladder.DESIGN: Randomized and controlled study.SETTING: Department of orthopaedics in two universities and physiological department of a medical university.MATERIALS: The experiment was conducted in the Key Laboratory of Hand Function Reconstruction of Ministry of Public Health in Medical College of Fudan University from October 2000 to June 2002. Totally 10 male SD mice of clean class with body mass between 250 and 300 g were chosen.INTERVENTIONS: The mice were randomly divided into two groups of which one used left side as experimental side and the other used right side. Extradural electric stimulation was conducted to St -4 nerve roots of SD mice after spinal cord injury.MAIN OUTCOME MEASURES: To record the change of action potential of cystic nerve plexus and compound muscle action potential of bladder smooth muscle, and insert the pressure monitor into bladder to record internal pressure of bladder by pressure transducer.RESULTS: S1 -4 nerve all participate the innervation of bladder in SD mice,among them, the S2 nerve is the most important one, next with S1, S3 and S4is the minimum one.CONCLUSION: Different sacral nerve roots have different dominative effects to bladder smooth muscle. It is meaningful for patients of spinal cord injury to improve their urination function by performing artificially electric stimulation for emiction through the main nerve roots controlling of bladder or rebuilding artificial bladder reflex arc by neurorrhaphy
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As a kind of biomaterial, carboxymethyl chitosan (CMC) has excellent biodegradable and bioacceptable capabilities using. This study was aimed to probe into the feasibility of CMC to prepare the implantable sustained release Ciprofloxacin Hydrochloride (CPX) microspheres(MS), and to go further into the pharmaceutic technology, the morphology and the characteristics of in vitro release of the microspheres. First, we prepared the microspheres by emulsification and cross-linking technology. Then, scanning electron microscopy (SEM), infrared spectrum (IR) and differential thermal analysis (DTA) were used to detect the structure and morphology of the MS. The in vitro release of CPX/CMC-MS and the CPX content of the MS were detected through continuous-flow releasing system. We found that the structure and morphology of the MS were affected by the conditions of preparation such as emulsification and cross-linking temperature, ionic strength and stirring speed, that the releasing time of CPX was more than 7 days, and that the releasing behaviors of the microspheres conformed to the Higuchi model. So we drew the conclusions that CMC could be used as a kind of absorbable and implantable adjuvant for sustained release, the technology of emulsification and cross-linking was proved to be feasible, stable and simple.
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Humans , Absorbable Implants , Biocompatible Materials , Biodegradation, Environmental , Chitin , Pharmacokinetics , Chitosan , Ciprofloxacin , Pharmacokinetics , Cross-Linking Reagents , Delayed-Action Preparations , Drug Carriers , MicrospheresABSTRACT
<p><b>OBJECTIVE</b>To summarize surgical treatments and their corresponding curative effects on sciatic nerve injuries.</p><p><b>METHODS</b>Surgical treatments on sciatic nerve injury were performed in 28 patients from January 1990 to July 2000. The treatments included neurolysis, neurolysis plus partial nerve anastomosis, nerve anastomosis and nerve transplantation. The curative effect was evaluated according to Sunderland criteria.</p><p><b>RESULTS</b>Of 28 cases, 22 patients were followed up with a follow-up period of 13 months to 5 years (average 30 months). Of 22 nerves, 7 were excellent, 5 good, 7 fair and 3 poor, with an excellence rate of 54.5%.</p><p><b>CONCLUSIONS</b>The fair results of sciatic nerve injury are related to its structural character. Surgical exploration should be performed if nerve function does not recover 3 months after primary operation and if Tinel's sign and electromyogram show no signs of nerve regeneration. Electrophysiological monitoring in the operation is useful in electing surgical methods and predicting the results of nerve anastomosis.</p>
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Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Anastomosis, Surgical , Cohort Studies , Follow-Up Studies , Injury Severity Score , Nerve Regeneration , Physiology , Neurosurgical Procedures , Methods , Recovery of Function , Retrospective Studies , Sciatic Nerve , Wounds and Injuries , Sciatic Neuropathy , General Surgery , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To observe whether bladder controller can restore bladder function in paraplegic dogs.</p><p><b>METHODS</b>Four dogs were studied after their T(10) spinal cord was transected. Electrodes implanted around S(2) bilaterally were connected to subcutaneous recievers. Microsurgical techniques were employed in dorsal rhizotomy at S(1 - 3) intradural segment. After daily stimulation, the results of bladder controller were evaluated by micturition and vesicography.</p><p><b>RESULTS</b>Micturition was given under electrical stimulation with a urine volume of 80 - 140 ml per time. The mode of micturition was post-stimulus voiding. Vesicography showed that the bladder was filled and bladder neck was open in the micturition course of electric stimulation. Residual urine volume was 15 - 20 ml.</p><p><b>CONCLUSION</b>Bladder controller together with a sacral deafferentation procedure can restore bladder function of paraplegic dogs.</p>
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Animals , Dogs , Male , Disease Models, Animal , Electric Stimulation , Spinal Cord Injuries , General Surgery , Urinary Bladder , General Surgery , UrinationABSTRACT
Microsurgery has gone through three stages in china.At the initial stage from 1960s to 70s,impr ovement of microsurgical apparatuses and vascular anastomosis technique,an d replantation of cut-off limbs and f ingers were the main achievements.At the development stage from 1970s to 80s,efforts were made to increase the rate of successful vascular anastomosis,popularize digital replantation an d expand the application scope of mic ro-surgery.The maturity stage since 1980s has witnessed wider application of microsurgical techniques in more an d more surgical fields and establish ment of systematic theories so that microsu rgery has developed into an independent clinical specialty of orthopedics.All these achievements have resulte d from great efforts of Chinese orthopedic scholars. [
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Objective To explore the clinical application of reconstruct ion interlocking nail in treating ipsilateral fractures of femoral neck and shaf t. Methods Twelve cases of ipsilateral fractures of femoral neck and shaft trea ted with reconstruction interlocking nail by static locking were reviewed. The d iaplasis of the fracture was done in a close manner or in an open manner but wit h a little incision, and the two sides of the fracture were locked with nails by a three-dimensional aim implement. Two lag screws were inserted into the femor al neck at a 15 degree dip angle. Results Eleven cases were followed up (average 12.3 months). Their long term effects were evaluated according to MaYuanzhang e valuation criteria: 5 cases gained excellent clinical results, 4 good, 2 fair; t he excellent and good rates were 81.8% (9/11). The average period of femoral n eck fracture healing was 5.2 months and that of shaft fracture healing 6.7 month s .72.7 % of the patients(8/11) showed fracture healing at one stage. There were no necrosis of femoral head, no femoral neck nonunion or malunion, or no n ail rupture. Conclusions Reconstruction interlocking nail is a principal way in treating ipsilateral fractures of femoral neck and shaft because of its effecti ve fixation and excellent clinical effect. Anatomy reduction of femoral neck and non-open reduction should be emphasized in treatment of femoral neck fractures , while close nail insertion, limited reaming and static locking should be a rou tine way in treatment of femoral shaft fractures.
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To study the neural morphological basis of the "abdominal reflex spinal cord center bladder" artificial bladder reflex arc established by abdominal reflex. It is achieved by intradural microanastomosis of the right T 13 ventral root was anastomosed under microscope to S 2 ventral root by autogenous nerve grafting intraduraly, with the right T 13 dorsal root remaining intact and the right L 5 ～S 4 ventral roots severed. three to four months were allowed to achieve axonal regeneration, and new "abdominal reflex spinal cord center bladder" artificial bladder reflex pathway was established. Eight months after the operation, it was seen under light microscopy that regenerative nerve fibers of ventral root of T 12 had grown through the anastomotic site to distal nerve root. Under electron microscopy, nerve endings in the detrusor of the bladder were seen on the experimental side. The basic structure of the junction between parasympathetic nerve endings and bladder detrusor cells on the experimental side was similar to that on the control side. These features were not seen in the control group. The results suggested that the somatic motor axons above the lumbosacral paraplegia level could innervate bladder parasympathetic ganglion cells, and thereby transfersed somatic reflex activity to the bladder detrusor muscle, which was the morphological basis of the artificial bladder reflex arc leading to controllable micturition
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To explore the possibility of bladder reinnervation and artificial triggering voiding established by Achilles tendon reflex after spinal cord injuries above cone. Bilateral anterior roots of S 1 and main bladder innervating roots (S 2 or S 3) in 8 patients were severed intradurally and then anastomosed to establish artificial reflex arc of "Achilles tendon spinal cord bladder". After followed up for an average of 2 8 years, it was found that the patients were free from nocturnal incontinence, with micturition frequency of 5～6/d, and the urinary volume varied from 250 to 500 ml each time. The results suggested that artificial reflex arc of "Achilles tendon spinal cord bladder" could restore bladder function in patients with spinal cord injuries above cone