Clinical effects of robot-assisted total knee arthroplasty compared with traditional surgery: a Meta-analysis / 中国骨伤

OBJECTIVE@#To compare the difference between robotic-assisted TKA and traditional TKA by Meta-annlysis in order to determine whether robotic-assisted TKA can provide better lower limb force line and clinical prognosis.@*METHODS@#Computerized searches of Embase, Pubmed, Web of Science and CNKI, Wanfang and VIP databases were conducted until November 2018 to find out the difference between robotic assisted TKA and traditional TKA. After screening, quality evaluation and data extraction according to inclusion and exclusion criteria, Revman 5.3 software was used for meta-analysis of literature data.@*RESULTS@#Six clinical controlled studies were included, 253 in robot-assisted TKA group and 231 in traditional TKA group. Meta-analysis showed that the incidence of coronal force line angle[WMD=-1.00, 95%CI(-1.66, -0.35), =0.003], coronal force line inversion or valgus>3°[RR=0.04, 95% CI(0.01, 0.13), =0.000 01] in robot-assisted TKA group was significantly better than that in traditional TKA group, but there were no statistical differences between two groups in range of knee joint motion[WMD=0.06, 95%CI(-5.43, 5.55)], =0.98], anterior position tibial angle[WMD=-0.19, 95% CI(-0.81, 0.43), 95%, =0.55] and lateral tibial angle[WMD=-1.37, 95%CI(-3.73, 0.99), =0.25], anterior position femoral angle[WMD=0.30, 95%CI(-1.37, 1.96), =0.72] and lateral femoral angle[WMD=-0.93, 95%CI(-1.98, 0.013), =0.08], the incidence of complications[RR=0.84, 95%CI(0.45, 1.58), =0.60]. The operation time of robot-cassisted TKA group was longer than that of traditional TKA group[WMD=14.28, 95%CI(0.79, 27.77), =0.04].@*CONCLUSIONS@#The application of robotic assistant system in TKA surgery can significantly improve the accuracy of prosthesis fixation, better reconstruct the lower limb line of force, and has the potential advantages of reducing postoperative pain and promoting the recovery of knee joint function. Due to the limitation of the quantity and quality of the included literature, a high-quality randomized controlled study with long-term follow-up is still needed in the future to support the conclusions of this paper.

rhBMP in lumber fusion for lumbar spondylolisthesis: A systematic review and meta-analysis / 中华创伤杂志(英文版)

PURPOSE@#To compare the efficacy and safety of recombinant human bone morphogenetic protein (rhBMP) and iliac crest autograft in the fusion treatment of lumbar spondylolisthesis.@*METHODS@#The studies using randomized controlled trials to compare the rhBMP with iliac crest autograft in the treatment of lumbar spondylolisthesis were retrieved from Embase, Pubmed, ProQuest dissertations & theses (PQDT), China national knowledge infrastructure (CNKI), Chinese Biomedical Database, Wanfang Data, Cochrane Library (from March 1998 to March 2018). Postoperative fusion rate, clinical success rate, postoperative intervertebral height, complications, operation time, blood loss and duration of hospitalization were chosen as the outcome indicators. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software Revman 5.3 was used for data-analysis.@*RESULTS@#Eleven articles were included in the meta-analysis. The results showed that, comparing the efficacy of rhBMP with iliac crest autograft, statistical significance was found in the 24-month fusion rate post operation [95% CI (1.38, 24.70), p = 0.02] and operation time [95% CI (-14.22, -2.08), p = 0.008]. There is not sufficient evidence for statistical differences in the remaining indicators.@*CONCLUSION@#The current literature shows rhBMP is a safe and effective grafting material in the treatment of lumbar spondylolisthesis. Further evidence is dependent on the emergence of more randomized controlled trials with higher quality and larger sample sizes in the future.

Meta-analysis of clinical effects between non-metallic materials and metallic materials by internal fixation for patellar fracture / 中国骨伤

<p><b>OBJECTIVE</b>To systematically evaluate clinical effects of metal and non-metallic materials in internal fixation for patellar fracture.</p><p><b>METHODS</b>The reports concerning about controlled trial of metallic and non-metallic materials for patellar fracture from create database to June 2018 were searched from PubMed, EMBASE, Web of science, CNKI and Wanfang data. Information was screened and taken out according to inclusion and exclusion criteria by 2 researchers, and risk of bias in non-andomised studies of interventions (ROBINS-I) was used to evaluate literature quality. Rate of reoperation, excellent and good rate of clinical rehabilitation, incidence of postoperative complications were compared with Revman 5.3 software for Meta-analysis.</p><p><b>RESULTS</b>Totally 9 retrospective cohort studies including 493 patients were selected. There was no significant difference in reoperation rate of internal fixation failure between metallic implants and non-metallic implants[OR=0.52, 95% CI (0.25, 1.08) =0.08]. The excellent and good rate of postoperative clinical rehabilitation in patients receiving non-metallic implants were higher than those in receiving metallic implants[OR=3.34, 95% CI (1.67, 6.71), =0.000 7]; incidence of total complications was also lower than that of metallic implants[OR=0.21, 95% CI (0.07, 0.60), =0.003]. There was no significant difference in the incidence of non-metallic related complications after removing Kirschner wire needle and complications of skin irritation [OR=1.08, 95% CI(0.45, 2.56), =0.86].</p><p><b>CONCLUSIONS</b>Non-metallic plants could provide the same success rate of internal fixation as metal plants, could improve the excellent and good rate of postoperative rehabilitation by reducing incidence of complications associated with metallic plants. In further, more evidence-level research is needed to confirm in the future.</p>

Mechanisms and effects of biosynthesis and apoptosis in repair of full-thickness skin defect with collagen-chitosan dermal stent / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate biosynthetic and apoptotic mechanisms in repair of full thickness skin defect with collagen-chitosan porous scaffold transplantation, and to determinate differences between wound repair with the scaffold transplantation and scar healing without the scaffold transplantation.</p><p><b>METHODS</b>The full thickness skin defects were made on 10 Bama miniature pigs and the bilayer dermal equivalent (BDE) composed of collagen-chitosan porous scaffold and silicone membrane was transplanted on wounds. Surfaces of wounds were observed at 1, 2, and 3 weeks after the BDE transplantation, and so were done the wound repairs after epidermis had been grafted for 2 weeks on surface of the scaffold which had been transplanted on skin defect wounds for 2 weeks. At the same time, TGF-beta1 expressions, apoptosis and self collagen replacement of scaffolds in wounds were detected in situ by immunohistochemical staining, terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labeling (TUNEL) and picrosirius red polarized light. Wounds without scaffold transplantation were studied as control.</p><p><b>RESULTS</b>1) Wounds with the scaffold transplantation were different from granulation tissue. 2) The peak of TGF-beta1 expression in the scaffold wounds was from 1 to 2 weeks after BDE transplantation, and TGF-beta1 expressions decreased continuously from 3 to 4 weeks. TGF-beta1 expressions increased continuously in the control wounds from 1 to 3 weeks and decreased on 4 weeks. TGF-beta1 expressions in the scaffold wounds on 1st and 2nd week were significantly higher than those in the corresponding control wounds, whereas, TGF-beta1 expressions in the scaffold wounds on 3rd and 4th week were significantly lower than those in the corresponding control wounds. 3) Apoptosis increased continuously in the scaffold wounds from 2 to 4 weeks after BDE transplantation, and so did in the control wounds from 3 to 4 weeks. However, apoptosis signals in the scaffold wounds on 2nd, 3rd, and 4th week after BDE transplantation were significantly more than those in the corresponding control wounds, and there was no difference between apoptosis signals in the scaffold wounds on 1st week after BDE transplantation and those in the corresponding control wounds. 4) Observation by picrosirius red polarized light method: self collagen began to synthesize in the scaffold wounds on 1st week after BDE transplantation, and scaffolds had been replaced by self collagen from 2 to 3 weeks after BDE transplantation.</p><p><b>CONCLUSIONS</b>Collagen-chitosan porous scaffold plays a very important role in wound healing of full thickness skin defect. The mechanisms of wound repair by dermal scaffold are different from those by granulation and scar healing. It has a good future in repairing skin defect.</p>

Study on repair of full-thickness skin defect with collagen-chitosan dermal stent in pigs / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate angiogenesis of collagen-chitosan porous scaffold, and to study survive of skin grafts on the scaffold after bilayer dermal equivalent (BDE) was transplanted on wounds with full thickness skin defects.</p><p><b>METHODS</b>The full thickness skin defects were made on 10 Bama miniature pigs and the BDE composed of collagen-chitosan porous scaffold and silicone membrane was transplanted on wound. Angiogenesis in dermal equivalent, wound healing, and healing and survive of skin grafts on dermal equivalent were observed in 1, 2, and 3 weeks after the BDE transplantation. At the same time, CD34 positive signals (neo-forming micro-vessels) were detected by immunohistochemical staining.</p><p><b>RESULTS</b>Inflammatory cells and fibroblasts infiltrated into dermal equivalent and a few new micro-vessels had been formed in 1 week after the BDE transplantation; neo-forming micro-vessels perpendicular to wound bed had increased significantly in 2 weeks after the BDE transplantation; neo-forming micro-vessels could be observed in almost all dermal equivalents in 3 weeks after the BDE transplantation. CD34 positive signals (neo-forming micro-vessels) in 3 weeks after the BDE transplantation was much more than those in 2 weeks after the BDE transplantation, and CD34 positive signals in 2 weeks after the BDE transplantation was much more than those in 1 week after the BDE transplantation. Survival rate of intermediate split thickness skin graft were 10%, 70% and 100% respectively after the skin grafts had been grafted for 2 weeks on surface of the scaffold which had been transplanted for 1, 2 and 3 weeks. Epidermis which had been grafted on surface of the scaffold for 1 or 2 weeks could perfectly survive after BDE had been transplanted for 1 or 2 weeks.</p><p><b>CONCLUSIONS</b>Collagen-chitosan porous scaffold plays a very important role in wound healing of full thickness skin defect and can induce fibroblast infiltration and new micro-vessel formation. Epidermis grafted on surface of collagen-chitosan porous scaffold can perfectly repair wounds, and it has brilliant applied prospects in repairing skin defect.</p>