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At present, several measures are often used to deal with the wound, such as reducing the partial pressure, containing the wound infection, thorough debridement dressing, strengthening the local blood circulation, negative pressure closed aspiration and wet dressing methods, most of them can achieve good prognosis, but there are still some patients with non-healing wound, avascular necrosis of tissue and even gangrene, severe cases need amputation. In recent years, with the rapid development of stem cell research, the paracrine function of stem cell has received widespread attention in the treatment of chronic wounds, and stem cell-derived exosomes have become a new strategy for the treatment of non-healing wounds. Exosomes are double membrane sacs of lipid secreted by cells, with a diameter of 30-100 nm, which are paracrine products of stem cells. Studies have shown that stem cell exosomes participate in wound repair by means of many measures, including regulating inflammatory response, regulating the growth and expansion of extracellular matrix, promoting angiogenesis and inhibiting scar formation. However, exosomes from different stem cells have different regulatory mechanisms on wound healing. This paper reviews the role and related mechanism of exosomes derived from stem cells in wound treatment, and provides a theoretical basis for the application of exosomes in clinical treatment of non-healing wounds.
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Objective:To investigate the clinical efficacy of integrated steel plate system combined with Kirschner wire internal fixation in the treatment of Lisfranc injury.Methods:Data of 30 cases with Lisfranc injury who were admitted from January 2010 to December 2018, including 22 males and 8 females were retrospectively analyzed. The age ranged from 22 to 58 years, with an average age of 44.5 years. All of them were closed injuries, including 8 cases involving metatarsal tarsal base fracture, and 2 cases with compression fracture of dice. Classification of Lisfranc joint injury: 6 cases of injury of the inner column alone, 10 cases of injury of the inner column and the middle column, 4 cases of injury of the middle column and the outer column, 10 cases of injury of the three columns. Cause of injury: traffic injury in 12 cases, machine injury in 10 cases, fall injury in 8 cases. The time from injury to operation was 2-7 d, with an average of 5 d. After the improvement of soft tissue conditions, all patients were treated with open reduction and internal fixation using integrated plate system combined with Kirschner wire, followed up by regular post-operative imaging examination, and the therapeutic effect was evaluated by the American Association of Foot and Ankle Surgery (AOFAS) midfoot score.Results:Thirty patients were followed up for 12-30 months (mean 24 months), during which no soft tissue complications such as wound infection and skin necrosis were observed. Average postoperative healing was observed at 12 weeks (10-16 weeks) for them who combined with fracture. At the latest follow-up, the AOFAS midfoot score was 65-95 points (mean 85 points). The midfoot function scores of the 30 patients were: excellent in 15 cases, good in 10, fair in 3, poor in 2. The excellent and good rate was 83.3% (25/30). One patient showed low toxicity and red skin 8 months after the operation. The integrated steel plate system was removed and the skin healed smoothly after the operation. One year after surgery, 10 patients requested removal of the internal fixation. None of the patients had the complication of plate, screw and Kirschner wire fracture. Two patients with three-column injury developed traumatic arthritis and walking pain 12 and 18 months after surgery, respectively, and then underwent metatarsal tarsal joint fusion. The postoperative pain disappeared.Conclusion:The integrated steel plate system combined with Kirschner wire internal fixation for the treatment of Lisfranc injury is simple, can avoid joint redislocation and articular cartilage reinjury, is a safe and effective method for the treatment of Lisfranc injury.
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Objective:To investigate the medicinal retention of different concentrations of melatonin in the bone tissue of type 2 diabetic osteoporosis (T2DOP) rats and explore to efficacy of improvement of the bone microstructure of T2DOP rats.Methods:A total of 95 SD rats were selected, 60 of which had intraperitoneal in jection of high-fat diet combined with low-dose streptozotocin establishing a T2DOP rat model. Two months later, 45 rats' model was determined to be successful by detecting blood glucose and insulin sensitivity index. 30 successful modelling and 30 normal SD rats were randomly selected for melatonin distribution experiment, and were divided into four groups according to the injected melatonin concentration, including modeling rat high concentration group (50 mg/kg), modeling rat low concentration group (10 mg/kg), normal rat high concentration group (50 mg/kg) and normal rat low concentration (10 mg/kg), and there were15 rats in each group. Each group was divided into 5 sub-groups according to the time point of sampling (5, 15, 30, 60, 120 min), 3 animals per group. The bone tissue of each group was pretreated, and then the melatonin drug distribution in the bone tissue was detected by high performance liquid chromatography (HPLC). Another 15 rats were successfully modeled, and were divided into T2DOP group, high melatonin group (50 mg/kg) and low melatonin group (10 mg/kg), 5 rats in each group. 5 normal SD rats were taken as controls (control group), and Micro-CT was used to detect changes in bone microstructure after 8 weeks of treatment with melatonin.Results:The results of the drug distribution experiment showed that after melatonin was injected intraperitoneally, there were drugs remaining in the bone tissues of the rats in each group. The drug concentration reached the highest after 30 min of administration, and significantly decreased after 120 min. Compared with the normal rat low concentration group, there was no significant difference in the drug concentration between the two groups at 5 time points. However, the drug concentration at the four time points of 5, 15, 30, and 60 min in the modeling rat high concentration group were 7.613±2.568 ng/ml, 13.983±2.262 ng/ml, 18.816±1.291 ng/ml, 6.172±1.962 ng/ml, 1.112±0.566 ng/ml, which were significantly different compared with normal rat high group. Micro-CT results showed that after 8 weeks of melatonin treatment, the bone density of the high concentration group was (205.72±28.41 g/cm 3) significantly lower than that in the low concentration group (223.63±35.41 g/cm 3), but both groups were significantly higher than the normal rat group (158.31±31.86 g/cm 3). Conclusion:Exogenous melatonin is distributed in bone tissue, and the drug absorption rate of T2DOP rats is higher. Meanwhile, there is no difference in the distribution of melatonin in bone tissue with different concentrations, and these two concentrations of melatonincan canimprove the bone microstructure of T2DOP rats.
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Objective To investigate the therapeutic effect of anteromedial ankle approach for talus fracture.Methods From January 2012 to October 2018,the data of 28 cases of talus fracture treated by anteromedial ankle approach were retrospectively analyzed,including 26 males and 2 females,aged 24-61 years with an average of 38.6 years.All 25 cases of closed injuries and 3 cases of open injuries were fresh injuries.There were 16 cases of traffic injuries,8 falling injuries,2 heavy object injuries and 2 sprains.Among the 28 patients,17 were talus neck fractures,and according to Hawkins talus neck fracture classification,there were 1 case of type Ⅰ,12 type Ⅱ,and 4 type Ⅲ.There were 11 cases of talus fracture,which were classified according to Sneppen talus fracture types:2 cases of type Ⅰ,8 cases of type Ⅱ and 1 case of type Ⅴ.Among them,2 cases of talus neck fracture complicated with T12 vertebral body fractures and 2 cases complicated with calcaneal fractures.The time from injury to operation for 3 patients with open fracture was 3-6 hours.25 cases of closed fracture injuries took 2-10 hours to operate,with an average time of 5.6 hours.All patients were fixed with cannulated screws through the anteromedial ankle approach.The weight-bearing time and strength of lower limbs were determined according to fracture healing after surgery.The ankle function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) Score.Results All 28 patients were followed up for 23 to 82 months,with an average of 37.5 months.All fractures healed.The healing time of talus neck fracture was 3.5-8 months,with an average of 5 months.The healing time of talus fracture was 3-7 months,averaging 4.5 months.At the latest follow-up,AOFAS score ranged from 68 to 100,with an average of 82.5 points,including excellent in 15 cases,good in 8 cases,fair in 4 cases and poor in 1 case,with the excellent and good rate of 82.1％ (23/28).There were no signs of fracture displacement,malunion,loosening and prolapse of internal fixation,fracture and ischemic necrosis of talus after operation.Traumatic arthritis occurred in 9 patients,with an incidence rate of 32.1％ (9/28).Tibial joint was involved in 5 cases,talus joint in 3 cases,tibialis in 1 case and talus joint in 1 case.Among them,traumatic arthritis occurred in 2 cases of open injury.Nine patients (32.1％) suffered from traumatic arthritis 6-10 months after operation,with an average of 8 months.According to conservative treatments such as weight control,ankle immobilization,physiotherapy,anti-inflammatory and analgesic,nutrition of articular cartilage drugs,joint traction and plasty were given.The patients' conditions improved to different degrees and could tolerate walking and normal life and work.Conclusion The anteromedial ankle approach has the advantages of minimal vessel injuries,clear exposure for direct reduction,low rate of necrosis of talus and satisfactory curative effect.
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Objective To compare the curative effect of conservative treatment and full thread hollow screw in the treatment of Ekrol 2 fracture of the fifth metatarsal bone.Methods From April 2013 to May 2015,42 patients with avulsion fractures of the fifth metatarsal basement of type 2 fractures in Ekrol division were treated in our hospital.23 patients underwent full thread hollow screw surgery (surgical treatment group),and there were 12 males and 11 females,with an average age of 43.4±9.2 years,and the fracture displacement length was 2.3±0.2 mm.19 patients treated with plaster fixation (conservative group),including 10 males and 9 females,with an average age of 45.7±8.9 years and fracture displacement length was 2.1±0.2 mm.During follow-up,X -ray examination was performed to evaluate the time of fracture healing and forefoot score of American Orthopaedic Foot and Ankle Society (AOFAS),visual analogue score (VAS) and quality of life questionnaire (SF-36) were compared between the two groups.Results All 42 patients were followed up for 12 to 24 months with an average of 18 months.At the latest follow-up,the fracture healing time of the surgical group was 9.3±2.0 weeks,with AOFAS score of 84.1±3.9,VAS score of 0.1±0.2,and the SF-36 score of 95.1±2.9 points,and the shortening of length after treatment was 2.1±2.5 mm;the average healing time of the conservative treatment group was 12.2±2.1 weeks,with the average AOFAS score of 84.2±4.2 points,and the average VAS score of 0.2±0.2 points,the average SF-36 score of 94.1 ±5.2 points,and the shortening of length after treatment was 0.4±2.5 mm.The results of each short-term score and the shortening of the length of the fracture after treatment was statistically significant.The results of the mid-and long-term scores showed no significant difference between the two groups;the fractures of both groups reached bone healing.3 cases of sural nerve stimulation occurred in the operation group,while 1 case occurred in the conservative group.Abnormal healing occurred in 2 cases of conservative treatment,and the fractures of the surgical treatment group were anatomic reduced.Conclusion Usingfull thread hollow screwfor the treatment of Ekrol 2 fracture of the fifth metatarsal bone is better than the conservative treatment in the short term,but there is no significant difference in the long-term effect.
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Objective To compare the effect and prognosis outcome of open reduction internal fixation and primary arthrodesis in treatment of Lisfranc injuries combined with the first tarsal jointdislocation.Methods A retrospective case control study was conducted on the clinical data with complete follow up data of 126 patients with Lisfranc injuries combined with the first tarsal joint dislocation in nine ankle surgery centers of China from January 2009 to June 2015.There were 76 males (60.3％) and 50 females (39.7％) with an average age of 45.5 years (range,20-87 years).Among the 126 cases,simple dislocation occurred in 41 cases (32.5％),and fracture dislocation in 85 cases (67.5％).The duration from injury to surgery was 11.7 days (range,4-26 days).According to surgery method,the patients were divided into open reduction internal fixation group (n =92) and primary arthrodesis group (n =34).The outcomes were evaluated by American Orthopedic Foot and Ankle Society(AOFAS) score,36-items short form health survey (SF-36),and visual analogue score (VAS).Complications were also followed up.Results All patients were followed up for 18-80 months,with an average of 29.5 months.Primary union was seen in all the patients.At the last follow up,the mean AOFAS midfoot score was (79.4 ± 6.7) points in open reduction and internal fixation group and (85.1 ±8.3) points in primary arthrodesis group (P ＜ 0.05).The mean VAS was (3.1 ± 0.6) points in open reduction and internal fixation group and (2.2± 0.3)points in primary arthrodesis group(P ＜ 0.05).The physiological function of SF-36 was (80.3 ± 5.3) points in open reduction and internal fixation group and (83.5 ± 6.9) points in primary arthrodesis group(P ＞ 0.05).The body pain score of SF-36 was (76.1 ±4.6) points in open reduction and internal fixation group and (84.6 ± 8.7) points in primary arthrodesis group (P ＜ 0.05).In open reduction and internal fixation group,there were five cases (5％) with internal fixator loosening or fracture,16 cases (17％) with redislocation,36 cases (39％) with obvious pain of the middle foot during walking,and eight cases (6％) with tarsal joint traumatic arthritis which was given phase Ⅱ arthrodesis.In primary arthrodesis group,two patients (6％) reported pain due to internal fixation,and the pain was relieved after fixator removal.No re-dislocation,loosening of internal fixation,or traumatic arthritis were found (P ＜ 0.05).Conclusion For Lisfranc injuries combined with first tarsal joint dislocation,primary arthrodesis can stabilize the first tarsal joint and avoid complications or adverse consequences such as redislocation,pain,internal fixation failure,or reoperation.
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Objective To evaluate the midterm results of the revision total hip replacement with a fluted and tapered modular stem. Methods Nineteen patients (21 hips) underwent revision total hip arthroplasty from May 2000 to August 2005 were reviewed. There were 13 females and 6 males, with an average age of 67 years. Pre-revision diagnosis included aseptic loosening of the cups and stems associated with femoral defects (Paprosky classification) type Ⅱ 4 hips (19%), type Ⅲa 14 hips (67%), and type Ⅲb 3 hips (14%). The adopted acetabular component was SPH (Lima-Lto, Italy), and femoral component was a fluted and tapered modular stem (Lima-Lto, Italy). Clinical and radiographic evaluations were performed postoperatively. Results The mean follow-up was 7 years (range, 5-10). The Harris hip score improved from 46.2±15.2 preoperatively to 90.3±5.3 postoperatively, and maintain 92.2±3.5 at the latest follow-up. The X-ray films showed bone ingrowths fixation in 20 hips (95%) and fibrous stable fixation in 1 hip (5%). The average stem subsidence was 2.4 mm (range, 0-10 mm). There were no re-revisions of the femoral stem for any reason. Conclusion The midterm results of revision total hip replacement with a fluted and tapered modular stem in Paprosky type Ⅱ, Ⅲ a, Ⅲ b femoral defect associated aseptic loosening of the femoral stem was encouraging.
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ObjectiveTo summarize the clinical result of the proximal femoral shaft splitting at sagittal view in primary total hip arthroplasty (THA) in treatment of ultimate hip disease combined with femoral metaphyseal stenosis deformity.MethodsA retrospective study was done on 18 patients with proximal femoral deformity (22 hips including 14 patients with unilateral hips and 4 with bilateral hips)treated from January 2000 to December 2009.There were three males and 15 females, at age range of 41-75 years (average 54 years).According to Berry classification system, all patients were indentified as metaphyseal segment abnormality and deformity, including developmental type disease (congenital hip dysplasia) in 17 patients and old tuberculosis of the hip in one.The congenital hip dysplasia was diagnosed as type Ⅳ by using the Crowe classification system.All the patients were treated with the proximal femoral shaft splitting, subtrochanteric shortening with overlapping femoral resection and V-shaped derotational osteotomy.In the meantime, standard biological fixation of the femoral stem prosthesis was performed.ResultsThere found no dislocation, infection, lower extremity nerve stretch injury or uncontrolled proximal femur fractures.X-ray showed that all acetabular cups were placed at the anatomical position and that the initial femoral stem prosthesis fixation was rated as good.All osteotomy areas were healed within 3-6 months.Limb length discrepancy was restored to average 3 cm after surgery.The patients were followed up for 1-10 years (average six years), which showed that the average Harris hip score was improved from preoperative 30 to postoperative 93, with no aseptic loosening or osteolysis or radiolucent line around the femoral component, no prosthesis sinking or varus displacement, or no patients needing revision of the femoral component.ConclusionsThe proximal femoral shaft splitting at sagittal view and standard biological fixation of the femoral stem prosthesis can attain satisfactory result for patients with ultimate hip disease combined with femoral metaphyseal stenosis deformity.
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BACKGROUND:Lipopexia induced by glucocorticoid is fat precipitation in marrow due to abnormal lipomatabolism,or differentiation of cells resulting from hormone-affected bone marrow mesenchymal cells.The precise generating procedure remains unclear.OBJECTIVE:To Jnvastigate effects of vadous concentrations of dexamethasone on adipogenic differentiation of bone marrow mesenchymal cells.DESIGN,TIME AND SETTING:The observational study was performed at the Department of Biochemistry,China Medical University from January 2007 to January 2009.MATERIALS:A total of 80 Sprague-Dawley rats aged 3 or 4 weeks,weighing (110±10) g,of both genders,were used in this study.METHODS:Rat bone marrow mesenchymal cells were isolated and subcultured.Bone marrow masenchymal cells at the third passage were used as samples.MAIN OUTCOME MEASURES:Cellular morphologic changes after treatment of 10~(-7) mol/L dexamethasone were observed under an inverted microscope,as well as at 3,7,14 and 21 days under normal culture condition.Morphological changes of bone marrow mesenchymal cells were observed following alkaline phosphatase and Sudan Ⅲ staining.Alkaline phosphatase activity was measured using phenol reagent.Effects of dexamethasone on cell proliferation were measured using MTT assay.RESULTS:Following 24 hours of incubation,a few adherent cells were found in the bottom of the culture flask,showing spindle shape.With prolonged time,adherent cells became more,presenting radiated shape.Following passage,cells distributed uniformly,showing typical fibroblast-shape.Following dexamethasone stimulation,cells changed from spindle-shape into polygonal or irregular shape.In the late phase,with increased concentration and prolonged time,cell colonies disappeared;cells adhered,and died.In normal cultured cells,no or a few orange particles were found.In dexamethasone-cultured cells,with increased hormone concentration and prolonged time,Sundan Ⅲ stained particles increased.At 21 days,alkaline phosphatase activity under normal culture was separately 1.57-,4.49-and 5.0-fold of 10~(-8),10~(-7),10~(-6) mol/L dexamethasone group.At 7,14 and 21 days,alkaline phosphatase activity under normal culture was separately 2.93-,3.80-and 4.39-fold of 10~(-7) mol/L dexamethasone group (P ＜ 0.05).High concentration of dexamethasone had significant inhibitory effects on cell proliferation activity.Significant difference was detected as compared 10~(-7) mol/L and 10~(-6) mol/L to other groups (P ＜ 0.05).CONCLUSION:High-dose dexamethasone enhances adipogenic and suppresses osteoblastic differentiation of bone marrow mesenchymal cells.The effect will increase along with the increasing content and prolonged duration of demamethasone stimulation.
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Objective To study the effects of zinc on the expression of zinc transporter-7( ZnT-7) in the proliferation of the rat growth plate chondrocytes. Methods Growth plate chondrocytes were isolated from rih cartilage of Wistar rat. The cell3 were treated with zinc chelating agent N, N, N', N'-tetrakis (2-pyridylmethyl )ethylene-diamine (TPEN) of different concentration (0,5,10 and 20 μmol/L) for 12 horns. The expression of rat growth plate chondrocytes specificity collagen type Ⅱ was detected by immunohisloehemistiy. The localization of ZnT-7 was checked by immunofluorescent staining. Real-time RT-PCR and Western blot were used to measure the expression level of ZNT-7 in the cell. Results The result of the immunofluorescence showed that ZnT-7 located in the Golgi apparatus. The expression level of ZnT-7 was slightly higher in the cells treated with 5 μ-mol/L TPEN than the control group, while it was lower in the cells treated with 10 or 20 μmol/L TPEN than the control group. Conclusion ZnT-7 locates in Golgi apparatus and maintains the zinc ion stabilization in the condition of the zinc depletion.