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Objective:To analyze the surgical method and clinical effect of modified anterolateral approach in the treatment of posterolateral tibial plateau fractures.Methods:From January 2014 to December 2017, 21 patients with posterolateral tibial plateau fractures were treated by the modified anterolateral approach in the second people's Hospital of Tangshan, Hebei Province were retrospectively analyzed.The outpatient department conducted regular reexaminations 1, 3, 6 and 12 months after the operation.Rasmussen radiology score, hospital for special surgery (HSS) score of knee function and Lysholm score were used to evaluate the postoperative knee function, and the score results were statistically analyzed.Results:The Rasmussen radiological score of 21 patients immediately after surgerywas (16.96±1.67), ranging from 15.00 to 18.00, with excellent in 15 cases, good in 6 cases, and the excellent and good rate was 100%.Rasmussen radiology score (16.57±1.51) in the last follow-up, ranging from 15.00 to 18.00, showed no significant difference between the last follow-up and the immediate postoperative ( t=0.935, P>0.05). At the last follow-up, the HSS score of knee joint function was (88.55±7.25), ranging from 80.00 to 9.00.At the last follow-up, Lysholm score (86.64±4.34), ranging from 82.00 to 90.00, was excellent in 15 cases, good in 6 cases, and excellent in 100%. Conclusion:The modified anterolateral approach for the treatment of posterolateral tibial plateau fractures is effective and simple, and can achieve good clinical results.
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Objective To investigate the recovery of knee joint function in patients with recurrent patellar dislocation treated by reconstruction of medial patellofemoral ligament with EndoButton double bundles.Methods A retrospective analysis was performed for 26 patients with recurrent patellar islocation who were treated in The Second Hospital of Tangshan from February 2014 to July 2016,with a total of 26 knees,aged 14-29 years.All patients underwent medial patellofemoral ligament reconstruction with autologous semitendinosus muscle.Double tunnel technique was used in medial patella and single tunnel technique was used in femoral side.Twenty-four patients were followed up for 12 to 24 months.The recovery of knee joint function was evaluated by Kujala score,Lysholm score,patellar fitness angle and patellar tilt angle before and after treatment.Results None of the follow-up patients had dislocation again,and the fear test was negative.The preoperative Kujala score and Lysholm score were (59.67 ± 5.28) and (61.75 ± 5.45) respectively.The corresponding scores at the last follow-up were (87.21±4.21) and (90.13±2.47).There were significant differences between the two scores (t =-19.98,-23.24,all P ＜0.01).The patellar fit angle changed from (23.17±3.63)degrees before operation to (14.17±2.01)degrees after operation.There was significant difference between the two scores.(t =10.62,P＜ 0.01);Patellar tilt angle changed from preoperative (18.33±3.92)degree to postoperative (2.45± 1.10)degree,the difference was significant (t =19.10,＜0.01).Conclusion EndoButton double-bundle reconstruction of medial patellofemoral ligament is effective in the treatment of patellar dislocation with satisfactory recovery of knee joint function.
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BACKGROUND:Bone morphogenetic protein 7 (BMP-7) can induce bone and cartilage formationin vivo, and induce chondrogenic and osteogenic differentiation of mesenchymal cels in muscles and around the vessels. OBJECTIVE:To observe the structure of domestic tantalum-muscle interface fibrous capsule, growth of muscle and smal blood vessels into the porous tantalum and the ability of ectopic osteogenesis after implantation of porous tantalum loaded with BMP-7 into the erector spinae of rabbits. METHODS: Porous tantalum slices loaded with BMP-7 (experimental group) and porous tantalum slices (control group) were implanted into the erector spinae muscle of New Zealand white rabbits. And the porous tantalum slices with surrounding muscle tissues about 0.5 cm thick were removed at 2, 4, 8 weeks after implantation, and observed under scanning electron microscope for hematoxylin eosin staining, Masson staining and hard tissue slice observation. RESULTS AND CONCLUSION:(1) Hematoxylin-eosin staining: Fibrous capsule formation was observed around the materials in the two groups, and with the extension of time, the fibrous capsules were slightly dense, and thinned. There was no obvious inflammatory reaction in the interface between the material and the muscle. There was no significant difference between the two groups in the fibrous capsules thickness. (2) Scanning electron microscope: 2 weeks after the surgery, a smal amount of colagen and muscle fibers were formed in the porous tantalum pores in the two groups, and some of colagen fibers attached to the pore wals. At 8 weeks after the surgery, al the pores of porous tantalum were ful of muscle fibers that were combined with the pore wal closely. There was no significant difference between the two groups. (3) Hard tissue slices: 2 weeks after the surgery, a smal amount of fibroblast cels and muscle fibers grew into the pores of porous tantalum in the two groups and new capilaries grew into the pores of porous tantalum in the experimental group. At 8 weeks after the surgery, the porous tantalum and al the pores were ful of muscle fibers that were combined with the pore wal closely, the number of smal blood vessels and cels decreased, and the tantalum and the muscle were fused closely. (4) Masson staining: 8 weeks after the surgery, a large number of mesenchymal cels, ossein and cartilage matrix formed in the muscle gaps and a few cartilage bone tissues were formed in the experimental group, but no cartilage was found in the control group. The study showed that porous tantalum carrying BMP-7 has good biocompatibility and osteogenic induction ability. Subject headings: Tantalum; Bone Morphogenetic Protein 7; Tissue Engineering.
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Objective To study the effects of intermittent low?dose administration of recombinant human parathyroid hor?mone (1-34) [rhPTH(1-34)] in the expression of Osterix (Osx) during early stage of fracture healing. Methods Forty?eight 2?month old male Sprague?Dawley rats were underwent close unilateral femoral fracture and intramedullary nail fixation. The sub?jects were divided into 2 equal groups randomly:treatment group undergoing subcutaneous injection of rhPTH(1-34) 10 mg/kg/d immediately after the operation and control group undergoing subcutaneous injection of normal saline of the same dose. Six rats in each group were sacrifice at 2, 7, 14, and 21 days after operation. X?ray photography study was conducted at 7, 14 and 21 days. Tissue RNA and protein were extracted from the bone tissues of bilateral femurs and the expression levels of Osx mRNA and pro?tein were evaluated via real time quantitative PCR and Western?blotting. Results Fracture healing was significant at 14 days af?ter operation, and the progress of fracture healing was better in the rhPTH(1-34) group than in the control group at 14 and 21 days. The relative expression of Osx mRNA and protein in the fractured femurs of the rhPTH(1-34) group (5.02±0.5 and 10.03±0.8 for Osx mRNA, 3164.03±131 and 3509.02±126 for protein) at 14 and 21 days after the operation were significantly higher than those of the control group (2.30±0.4 and 4.01±0.7 for Osx mRNA, 1053.04±121 and 2721.03±123 for protein). However, there was no significant difference at 2 and 7 days after operation between the rhPTH(1-34) and control group. Conclusion Intermittent low?dose administration of rhPTH(1-34) up?regulates the expression levels of osteogenesis?specific Osx mRNA and protein in rats. It will accelerate the early phase of fracture healing process.
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<p><b>OBJECTIVE</b>Unstable intertrochanteric fractures (ITFs) are mostly treated by proximal femoral nail antirotation (PFNA), Inter-Tan, Asian Hip, and other new internal fixation devices. But for complex unstable fractures, such as crushed lateral wall of the greater trochanter, the loss of fixation point on lateral wall slightly reduces the fixing effect. This study aimed to compare the biomechanical strengths between reversed less invasive stabilization system (LISS) and PFNA for treatment of unstable ITFs.</p><p><b>METHODS</b>Forty synthetic femurs were used to simulate unstable ITFs in vitro and were fixed using the reversed LISS or PFNA. These fractures were divided into two groups depending on whether the lateral wall of the greater trochanter is intact or not (AO classification: 31-A2.3 and 31-A3.3, respectively). The load-displacement of femur, stiffness, ultimate load, and cyclic fatigue resistance were detected using an incremental load test and a dynamic fatigue test through an MTS 858 test system.</p><p><b>RESULTS</b>For both 31-A2.3 and 31-A3.3, the vertical sinking displacement (VSD) of the femoral head under 500 N load was insignificantly smaller after treatment with reversed LISS than with PFNA, and when the displacement was 5 mm, the femoral head bore insignificantly greater load. The fixation with reversed LISS resulted in greater axial stiffness of the femur but smaller ultimate load. During the same cycle in the dynamic fatigue test, the VSD was insignificantly smaller with the fixation of reversed LISS.</p><p><b>CONCLUSION</b>Reversed LISS and PFNA have similar biomechanical strength for unstable ITFs. This conclusion should be supported by additional large-size research on basic biomechanics and clinical application. This is the first comparative biomechanical study comparing reversed LISS and PFNA for unstable ITFs.</p>
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Humans , Biomechanical Phenomena , Bone Nails , Femur , General Surgery , Fracture Fixation, Internal , Methods , Fracture Fixation, Intramedullary , Methods , Hip Fractures , General SurgeryABSTRACT
BACKGROUND: Effect of acellular surfactant and biological safety of bone graft materials highly correlated with selection of surfactant; therefore, a novel compound surfactant was used to prepare acellular bone graft materials in this study. OBJECTIVE: To evaluate acellular effect and biological safety of bio-derived bone tissue treated by a novel surfactant in order to obtain a safe and reliable bone graft material. METHODS: Surfactant was prepared with anionic surfactant sodium dodecyl benzene sulfonate (ABS), anionic surfactant sodium fatty alcohol ether sulfate (AES) and distilled water at the ratio of 13:7:80. Fresh bovine cancellous bone and surfactant which was used to remove cells and lipid by two-step flow were used to prepare a novel bio-derived bone graft material. The histological and microscopic observations of microstructure were made. Also acute body toxicity test, hematolysis experiment, cell toxicity test and biological safety were assessed on surfactant-treated bio-dedved bone graft material (STBB). A long-term animal experiment was conducted to observe the biocompatibility and biodegradability of STBB. The ultraviolet dispersion of light luminosity method was employed to measure the residual amount of surfactant in STBB. RESULTS AND CONCLUSION: STBB was a whitish porous cancellous bone. No cell was found in bone lacuna, bone canaliculus was empty, and the collagen fiber had an order arrangement. Acute body toxicity test was qualified according to GB/116886.11-1997 standard, hematolysis experiment was < 5%, and cell toxicity test was grade 0, confirming that STBB was safe. The remaining surfactant in STBB was lower than 0.1 g/L. The long-term animal experiment demonstrated that fiber was present at 4 weeks, bone lacuna had cellular growth and the fusion of STBB and host appeared. The STBB was partial absorbed by organism at 8 weeks and completely absorbed at 24 hours. The results indicated that STBB had an excellent biocompatibility and biodegradability. As a new bone implant material, STBB was safe and dependable for transplantation.
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BACKGROUND: Alginic acid has a relatively mild gel condition and good biocompatibility, and it has been widely used in bio-tissue engineering.OBJECTIVE: To construct bone tissue engineering scaffolds using alginate gel composite bone xenograft approach, and to observe the cell biological properties and in vivo osteogenic potential in scaffolds.METHODS: The bone marrow was harvested from two 2-week-old New Zealand rabbits, 1 ×10~(-8)mol/L recombinant human bone morphogenetic protein-2 was used to induce bone marrow mesenchymal stem cells. The induced bone marrow mesenchymal stem cells at the second generation were incubated into 1% sodium alginate gel, after cultured for 4 days, the cell morphology in gel was observed by hematoxylin-eosin staining. Bone marrow mesenchymal stem cells at the second generation were divided into simple DMEM gel group and DMEM containing 1% sodium alginate gel group, followed by a culture of 7 days. Then bone morphogenic protein-2 immunohistochemical staining was performed. A total of 24 nude mice were randomly divided into two groups, both sides of the thigh muscle pockets were implanted with bone marrow-derived mesenchymal stem cells/alginate gel/bovine cancellous bone complex as an experimental group, with bone marrow-derived mesenchymal stem cells/bovine cancellous bone as a control group. At 2 and 4 weeks post-operation, the osteogenesis in the composite was observed by histological examination, the percentage area of new bone or cartilage was determined using image analysis system.RESULTS AND CONCLUSION: The bone marrow-derived mesenchymal stern cells in the sodium alginate gel exhibited a well-stacked morphology, they suspended in a gel, showing cell division and mitosis phase. In the simple DMEM gel group and DMEM gel containing 1% sodium alginate group, the immunohistochemical results showed that, cell division and proliferation were normal, with prominence at a variety of forms, large nucleus, and clear nucleolus. The bone morphogenetic protein-2 expression had no significant difference between the simple DMEM gel group and DMEM gel containing 1% sodium alginate group (P>0.05).Scanning electron microscopy revealed that, the alginate gel evenly composited in bovine cancellous bone micropores, cell grew at different planes. Animal experiments showed that there were significant differences regarding the percentage of new bone or cartilage area between the experimental group and control group at 2 and 4 weeks postoperation (P< 0.05). It is indicated that constructing bone tissue engineering scaffolds by using alginate gel/bovine cancellous bone, complies with the ultra-structural principle of tissue engineering scaffolds, can maximize the cell loads, achieve good bio-performance, without adverse affects on the proliferation, osteogenic phenotype and related biological properties of bone marrow-derived mesenchymal stem calls, the in vivo osteogenic efficiency was high.
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BACKGROUND:Acellular dermal matrix possesses good flexibility and simple trimming.The intracutaneous or subcutaneous injection of acellular dermal matrix powder has fibroblast migration and collagen deposition.It has been widely used in plastic and reconstructive surgery.OBJECTIVE:To explore the feasibility of reconstructed acellular dermal matrix as a scaffold for chondrocyte implantation.DESIGN,TIME AND SETTING:Comparative observation.The study was performed at the Peking University Medical Department and Beijing Jishuitan Hospital between August 2003 and February 2007.MATERIALS:Neonatal calf dermis was provided by Beijing Yuanheng Shengma Biology Technology Research Institute.A total of 24 healthy adult SD rats,weighing 250 g,regardless of gender,and 36 New Zealand rabbits,aged 3 months,were selected.METHODS:①Calf full-thickness back skin was incubated with cell free buffer or ABS/AES for decellularization,followed by surface modification using growth factors.②Three rectangle skin flaps at two sides of the spinal cord of rats were made,and implanted with acellular dermal matrix.The implants were harvested at 2,6,and 12 weeks postoperatively.③The rabbits were divided into experimental and control groups.The cartilage was obtained from the left articular facet to isolate chondrocytes.The chondrocytes were seeded on the acellular dermal matrix.The cartilage defect was made on the right hind limb of experimentalrabbits,and implanted with acellular dermal matrix containing autoiogous chondrocytes.Biogel wass dropped on the surface of carrier.In the control group,the cartilage defect was made on the right hind limb of rabbits and the wound was sutured.Two rabbits from control group and 5 from experimental group were selected respectively at 4,12 and 24 weeks postoperatively.MAIN OUTCOME MEASURES:Cross-linking effect comparison;repair effect of rabbit bone defects.RESULTS:①The acellular dermal matrix cross-linked by glutaraldehyde demonstrated an obvious inflammatory reaction with tissue bleeding and necrosis.Conversely,ADM treated with water-soluble cross-linking agent caused displayed good histocompatibility.②The cartilage defects were repaired completely;the attached cells survived and proliferated and the acellular dermal matrix was degraded after 24 weeks of surgery.CONCLUSION:The acellular dermal matrix decellularized with cell free buffer,digested with digestive buffer,Cross-linked by water-soluble cross-linking agent,and further decorated with growth factor exhibited good histocompatibility,and was suitable forcell attachment and growth.The acellular dermal matrix scaffold almost degrades in the rabbits,with no rejection,and the bone defects were repaired after 24 weeks.
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BACKGROUND: Long-term follow-up of the patients undergoing anterior cervical discectomy and fusion (ACDF) shows some incidence of degeneration at the segments adjacent to the fusion level. Cervical total disc replacement may resolve this problem. OBJECTIVE: To compare the effects of cervical total disc replacement versus ACDF on the biomechanics of the segment adjacent to the operation level. DESIGN, TIME AND SETTING: The randomized controlled trial was performed at biomechanical laboratory in Beijng Trauma and Orthopaedic Institute from August 2007 to February 2008. MATERIALS: Eighteen samples of fresh goat cervical spine; Bryan artificial cervical disk (Medtronic); CSLP-VA cervical plate (Synthes); coral bone (Beijing Yihuajian Science And Trade Co., Ltd.). METHODS: The goat spines were divided into 3 groups: control group with no specific treatment; total disc replacement group, in which C5/6 segment underwent Bryan artificial cervical disk replacement and fusion; internal fixation group, in which the C5/6 segment underwent cervical discectomy, coral bone implantation and internal fixation with CSLP-VA cervical plate. MAIN OUTCOME MEASURES: The adjacent intervertebral disk pressure (IDP) was measured in flexion, extension, rotation and lateral bending under certain loading, and the pressure changes were compared among three groups. RESULTS: At level C4/5, the IDP between total disk replacement group and the control group had no statistical significances in flexion (P 0.05) but internal fixation group was significantly higher than control group (P=0.014). There were no significant differences among the three groups in IDP in extension, rotation and lateral bending. CONCLUSION: Compared with ACDF, the total disk replacement can reduce the adjacent segment IDP and may avoid the degeneration in adjacent cervical segment.