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Objective To evaluate the curative effect of arthroscopic surgery for the treatment of first-time shoulder dislocation combined with Bankart lesions.Methods Retrospectively analyzed the clinical data of 35 cases who were admitted into our hospital from June 2015 to October 2016 and underwent arthroscopic surgery for the treatment of first-time shoulder dislocation.All the 35 cases were combined with Bankart lesions,and the lacerated glenoid labrum were repaired with suture anchorsy.The postoperative ASES scroe and Rowe score were adopted for the final evaluation.Results All the 35 cases were followed up for 1 to 6 months,3 months averagely.All the patients had satisfactory shoulder function,with no shoulder dislocation occured again.The ASES score and Rowe score after surgery was better than that before surgery with statistically significant difference(P<0.05).Conclusion Arthroscopic surgery for the treatment of first-time shoulder dislocation combined with Bankart lesions has many advantages such as mini-invasion,rapid recovery and satisfactory outcome in function and motion.
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Objective To evaluate the clinical results of arthroscopic arthrolysis for the treatment of elbow stiffness.Methods Totally 34 cases with elbow stiffness caused by trauma who needed to undergo arthroscopic arthrolysis were selected from General Hospital of Shenyang Military Area Command from October 2014 to February 2016.Among them,3 cases were lost to follow-up,and the other 31 cases were included in the study.All the patients were performed arthroscopic arthrolysis.Removed the hyperplasia of osteophyte and girdle,cleaned the articular cavity,restored the smooth of articular surface,and released the joint capsular and ligament around the elbow joint during the operation.Manipulation release was used coordinate with analgesia and rehabilitation therapy after operation.Mayo scores of elbow were used for function evaluation and range of motion(ROM) was collected.Results Patients were followed-up from 9 months to 12 months,(10.4±1.5) months on average.Before the operation,the mean maximal flexion angle of the elbow was (87.6±5.9)°,the extension angle was (35.5±6.4)°,the pronation angle was (75.9±9.6)°,the rotational angle was (67.2±7.4)°,and it was (125.9±6.5)°,(5.0±1.9)°,(82.0±9.1)°,(81.0±7.0)°respectively after operation,and the differences before and after opreation were statistically significant (P<0.05).The Mayo scores was (61.9±7.6) preoperatively and (88.8±4.7) postoperatively,and the difference was statistically significant(P<0.05).Conclusion Arthroscopic arthrolysis has the advantages of clear operative field,minimal invasion and rapid recovery.It can effectively improve the elbow joint activity and arthroscopic arthrolysis is an effective surgical treatment for elbow stiffness.
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Objective To discuss the clinical effects of arthroscopy combined with Brostrom repair in the treatment for chronic ankle instability talofibular ligament injury.Methods From January 2012 to June 2015,42 cases of chronic ankle instability in our hospital were performed modified Brostrom repair.All the cases were evaluated by AOFAS scoring system.Results All the patients were followed up for 9 to 17 months,an average of (12.7±3.5)months.At the last follow-up,all cases could participate in normal daily running training mission.Activity levels of 2 cases with cartilage injury had a decline than before.The others were able to attend the confrontational training.Postoperative AOFAS score(88.4±4.9) increased compared with preoperative score (43.3±7.8),the difference was significant(P<0.05).ConclusionThe curative effect of arthroscopy combined with Brostrom repair in treatment of chronic ankle instability talofibular ligament injury is satifactory.It can be helpful to the wounded rapid rehabilitation and good for the popularization and application in basic-level hospitals.
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BACKGROUND: The study of tissue-engineered cartilage with predetermined shaping and regeneration has provided novel ideas and techniques for repair of laryngeal cartilage erosion; however, due to the special natures of the morphology, location and function of laryngeal cartilage, tissue engineering research has not, to date, exhibited its ful advantages in the reconstruction of laryngeal cartilage. OBJECTIVE:To explore the feasibility of building tissue-engineered larynx-shaped cartilage using poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) (PHBHH) as a scaffold filed and encapsulated with pedicled myofascial flaps. METHODS:Porous PHBHH was prepared and formed into a holow like larynx-shape, and the cel PHBHH composites were cultured for 1 weekin vitro prior to implantationin vivo. The cel-PHBHH composite was filed and encapsulated with myofascial flaps with the pedicle forin situ implantation in nine rabbits as experimental group. PHBHH scaffold with no chondrocytes was implanted alone in three rabbits as control group. Cartilage regeneration was assessed at 6, 12 and 18 weeks after surgery through morphological observation, histological and immunohistochemical detection. RESULTS AND CONCLUSION: In the experimental group, the shape and porosity (> 90%) of the material were ideal, the cels exhibited good adhesion with the material and the blood supply within the myofascial flap with pedicle was rich for effective filing and encapsulation of the cel PHBHH composite. Tissue-engineered laryngeal cartilage with the holow, semi-trumpet shape was idealy formed at 6 weeks after the surgery. Further maturation of the cartilage was observed at 12 and 18 weeks after the surgery. However, there was no cartilage tissue in the control group. This study shows that PHBHH is a suitable material for the formation of a holow, semi-trumpet shape with good celular compatibility. Myofascial flap filing and encapsulating can be used to build tissue-engineered laryngeal cartilage with a holow, semi-trumpet shape.
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BACKGROUND:A great development has been achieved in essential research on tissue engineered cartilage. However, its real application in otolaryngology has been rarely reported. It is faced with the topic to explore the simple and convenient method of repairing laryngeal cartilage by tissue engineering technique. OBJECTIVE:To compare the effect of porous spongy poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) seeded with chondrocytes or using senior tissue engineered cartilage in repairing al ogenic thyroid cartilage defects.METHODS:Chondrocytes at passage 3 were harvested from infant rabbits within 3 days. Porous spongy poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) seeded with chondrocytes composites were made by tissue engineering technique. The chondrocyte-poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) composites were co-cultured in vitro to form junior tissue engineered cartilage. And then respectively used for repairing the thyroid cartilage defects and directly transplanted with junior tissue engineered cartilage (experimental group A, n=5), or firstly the junior tissue engineered cartilage to be implanted subcutaneously for a period of time to further maturity for relative senior tissue engineered cartilage and secondly to be transplanted (experimental group B, n=5) into adult New Zealand white rabbits. Simple poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) sponge scaffold (control group A, n=4) and chondrocyte suspensions(control group B, n=4) were used as reparative materials in defect areas as control groups. Final y, the reparative effect was respectively studied grossly and histological y at 4 weeks (experimental group B) and 8 weeks (experimental group A, control group A and control group B) after transplantation. RESULTS AND CONCLUSION:The cartilage defects were wel repaired in the experimental groups. It was smooth between the reparative area and original cartilage without dents and defects. Both were similar grossly. But few chondrocytes at interfacial region between the reparative area and original cartilage and poor matrices were observed in the experimental group A. A Few chondrocytes and more matrices were observed in the experimental group B. Inflammatory cellinfiltration was not obvious in two experimental groups. Control groups showed soft tissue of dark-red color accompanied with local concave in gross specimens. Histological examination and special staining showed there were no cartilage-like structure and secretion of matrix components. The results showed that it is possible to repair thyroid cartilage defect using junior tissue engineered cartilage directly or junior tissue engineered cartilage after in vitro implantation in al ograft rabbits with immunity, and the immunoreaction is not obvious;in the same period, the repairing effect of mature tissue engineered cartilage is better than that of junior tissue engineered cartilage. However, application of junior tissue engineered cartilage directly can save time, costs, workload and operational link, and avoid the pain from secondary skin surgery, which is one of the more practical approaches.
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ObjectiveTo investigate the injury mechanism,clinical characteristics and surgical treatments of Segond fracture combined with anterior cruciate ligament (ACL) injury.MethodsNine patients suffering from Segond fracture combined with ACL injury were treated between January 2008 and December 2010.All the patients revealed ACL and medial collateral ligament (MCL) breakage under arthroscopy.Furthermore,one patient was associated with lateral collateral ligament (LCL) breakage and medial meniscus injury,four with medial meniscus tear and two with lateral meniscus tear.All the patients underwent arthroscopic tendon allotransplantation,ACL reconstruction and MCL repair.Besides,synchronous LCL reconstruction was performed in one patient,meniscus suture in three and meniscus plasty in four.Six patients with large Segond fracture fragments were fixed with two hollow lag crews and three with relatively small fracture fragments fixed with one hollow lag crew.ResultsThe mean followup period was 12 months,which showed average postoperative Lysholm score of 59 points and satisfactory clinical outcome.ConclusionsSegond fracture is often combined with ACL injury and is predictive for ACL injury.In ACL reconstruction,large Segond fracture blocks should be reduced and fixed and the combined injuries also should be treated in the same period.
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BACKGROUND:Studies have demonstrated that the success rate of isolation of umbilical cord blood mesenchymal stem cells (UCB-MSCs)is low,which also lacks of unified identification method.OBJECTIVE:To modify the traditional in vitro isolation and culture method of UC8-MSCs to obtain a higher success rate and to observe its biological characteristics.DESIGN,TIME AND SETTING:In vitro observation of cytology.The study was performed at the Ninth People's Hospital of Shanghai Jiao Tong University Medical College between April 2006 and January 2007.MATERIALS:A totaI of 28 UCB samples were obtained from full-term normal delivery.Department of Matemity,Shanghai Red House Hospital.The written informed consent was obtained from the puerpera and their families.METHODS:NeonataI umbilical cord blood was collected under sterile condition.Mononuclear cells (MNCs) were separated from using lymphocyte isolation medium by centrifugation and suspended in α-minimum essential medium(α-MEM)containing 10% fetal bovine serum.The medium was half exchanged after 5-7 days of primary culture and then was totally exchanged every 3-4 days.The confluent cells were divided into 2 groups.In group 1.when the round megakaryocytes were confluent and fusiform fibroblast-like cells were fell off.the cell suspension was transferred to new culture dish;in group 2.when the round megakaryocytes dominated the majodty,the culture medium was replaced by α-MEM containing 15% calf serum,followed by culture in α-MEM containing 10% fetal bovine serum when the round megakaryocytes fell off.The fifth passage of UCB-MSCs was harvested for subsequent osteoinduction in vitro.MAIN OUTCOME MEASURES:The cell morphology was observed by microscopy;Flow cytometry was used to examine the surface antigen phenotype;alkaline phosphatase and oil red staining was performed to detect cell differentiation capacity.RESULTS:Of 28 samples of UCB,attaching cells were obtained from 20 samples(6/10 in group 1,14/18 in group 2),fibroblast-like cells that could passage steadily(4 samples in group 1,9 in group 2)were cultured from 13 0f 20 samples with success rate of 46.4%,among which MSCs were passaged steadily up to P22.UCB-MSCs were all positive for MSC-related antigens such as CD29 and CD105,but negative for CD34,CD45 and CD106.Incubation of UCB-MSCs under special condition resulted in a differentiation of osteoblast and adipocyte.CONCLUSIONMSCs exist in UCB,which have multi-differentiation capacity,and passage steadily.The modified in vitro culture method improves culture success rale of UCB-MSCs.
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[Objective]To explore the value of magnetic resonance imaging (MRI) for articular cartilage lesions after bone bruise of distal femur under arthroscopy.[Method]Articular cartilage lesions of 29 cases of distal femur bruises diagnosed by MRI were examined under arthroscopy,12 cases of them combined with medial and lateral meniscus injury,17 combined with anterior cruiciate ligament rupture.[Result]The distal femur articular cartilage lesions examined under arthroscopy were corresponding to MRI findings.The lesions showed by arthroscopy were in direct proportion to MRI.These lesions were classified into Ⅰ-Ⅳ degrees.[Conclusion]Arthroscopic examination showed correspondent result to MRI findings for articular cartilage lesions.Sometimes MRI couldn't deliver the severity of cartilage lesions because of instrument factors.Arthroscopy is considered as the golden standard of evaluation for articular cartilage lesions after bone bruises.
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[Objective]To discuss the postoperative effect of the posteromedial structure injury (medial collateral ligament,MCL,posterior oblique ligament,POL) of the knee.[Method]Fourteen cases of complex posteromedial structure injury were treated from January 2002 to October 2007,twelve of which combined with ACL injury and two combined with PCL injury.Classification of posteromedial structure injury:typeⅠ,8 cases,ruptured from the femur with small bone fragment;type Ⅱ,2 cases,ruptured from the femur without bone fragment;typeⅢ,2 cases,the structure were torn from the body area,and type Ⅳ,2 cases,ruptured from the tibia.The injury were repaired by different techniques according to the classification.Eight cases applied star-shaped steel plate,four with GⅡ anchor screws(2 attached to the femur and 2 to the tibia adhesion respectively),and 2 cases with end-to-end suture.The ruptured ACL and PCL were reconstructed by arthroscopy.Autologous semitendinosus and gracilis were used for 8 ACL reconstruction and B-T-B technique for the other two ACL reconstruction.Two ruptured PCL were reconstructed with allograft of Achilles tendon.[Result]All cases were followed up for twelve months at average(6-18 months) except two cases only for four months.The functional score of the knees were improved from 56.7(50-60) preoperatively to 81.2(74-94) postoperatively in average valued by Lysholm system.Ten cases received normal knee flexion and extension range after repair of the posteromedial structure while 2 cases with restricted 5 degree extension.Nine cases received excellent result in lateral stress test while 2 cases with "+" and 1 case with "++" at zero angle.[Conclusion]Early repaire for the posteromedial structure injury will deliver excellent knee stability.
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Objective To observe histomorphology of neo-cartilage obtained with tissue-engineering by combining calcium alginate gel and in vitro cultrue of chondrocytes. Methods Articular chondrocytes from the knee joints of 2-week-old New Zealand white rabbits were harvested, expanded in cell culture, and following the second generation of the culture, the chondrocyte suspension was mixed with calcium alginate gel resulting in a cell density of 5? 10 6/ml. Finally the mixture, which contained 1％ sodium alginate, 40 mmol/L calcium gluconate, 0.135 mol/L NaCl, 0.1 mol/L K 2HPO 4 and 5? 10 6 chondrocytes per milliliter, were injected into the dorsal subcutaneous tissue in rabbits of experimental groups (A and B). Animals of the control groups (C and D) were injected with calcium alginate without chondrocytes or chondrocytes without calcium alginate. Specimens were harvested at the 2nd and 4th week after injection, and stained with HE and toluidine blue. Results In the HE stained specimens in the experimental groups, proliferation of chondrocytes was demonstrated at the 2nd week and the formation of neo-cartilage at the 4th week after injection of calcium alginate chondrocyte-composite. Toluidine blue stained specimens showed positive staining of chondrocytes and cartilage matrix of neo-cartilage. In some animals injected with chondrocytes without calcium alginate, relative small amount of neo-cartilage was also formed and no neo-cartilage was observed in animals injected with calcium alginate without chondrocytes. Conclusion Injectable calcium alginate-chondrocyte-composite can induce tissue engineered neo-cartilage in allogenic animal.