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BACKGROUND: Ipsilateral femoral shaft and neck fracture is a rare clinical injury, and its treatment has attracted more and more attention from scholars. At present, there are many internal fixation methods. OBJECTIVE: To retrospectively analyze efficacy of three internal fixation methods in the treatment of ipsilateral femoral shaft and neck fracture, and its indications. METHODS: Thirty-three cases of ipsilateral femoral neck and shaft fracture treated by three different internal fixation implants between January 2015 and September 2018 were retrospectively studied. Patients were divided into three groups according to different internal fixation: intramedullary nail only group (group A; n=11), retrograde nail with cannulated screw group (group B; n=10) and plate with cannulated screw group (group C; n=12). The general clinical data, the intraoperative situations, the postoperative follow-up conditions and complications were compared among the three groups. RESULTS AND CONCLUSION: (1) There was no significant difference between the three groups with regard to age, gender, cause of injury, AO fracture classification, Garden classification and average time from injury to surgery (P > 0.05). (2) There were statistically significant differences among the three groups in incision length (P 0.05); the incision length was smaller in groups A and B than in group C (P 0.05). (3) There were no significant differences among the three groups in time to bony union in both femoral shaft and neck, complication rate, and excellent and good rate of Harris hip score (P > 0.05). (4) Femoral neck fracture delayed healing occurred in one case of the group A; re-fracture occurred in one case of the group B; and the fracture end was located under the femoral tuberosity; screw loosening occurred in one case of the group C. (5) It is indicated that all three internal fixation methods can achieve good therapeutic effects. The operator can choose the skilled internal fixation method according to the specific conditions of the patient.
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Objective To observe biomechanical characteristics and advantages of the self-developed anatomical locking plate of sternoclavicular joint by comparison with the radial distal oblique T-shaped locking plate and sternoclavicular hook plate. Methods Nine embalming and moistening adult corpses were selected, including 6 males and 3 females. Model of complete dislocation of the sternoclavicular joint caused by complete removal of the sternoclavicular joint specimen. The bilateral sternoclavicular joints of 9 specimen models were randomly numbered, matched and divided into Group A(experimental group, sternoclavicular joint anatomical locking plate), Group B(control group 1, the radial distal oblique T-shaped locking plate) and Group C(control group 2, sternoclavicular hook plate), with 6 sternoclavicular joints in each group. All specimens were placed with steel plates on both sides and fixed on the universal mechanical test machine. Three biomechanical experiments were carried out, including loading of distal clavicle, torsion of distal clavicle and anti-pull out of sternum handle screw. Results Distal clavicle loading test: the load-displacement of specimens in three groups showed a linear relationship. The compressive deformation resistance in experimental group was stronger than that in two control groups. Distal clavicle torsion test: the relationship between torque and torsion angle was linear. The torsional deformation resistance in experimental group was stronger than that in two control groups. Anti-pullout test of sternum handle screw: there was a significant difference in the maximum anti-pullout force of sternum handle screw among the three groups (P＜0.05). The anti-pullout performance of the sternum handle screw in the experimental group was better than that in the two control groups. Conclusions The self-developed sternoclavicular joint anatomical locking plate is superior to the oblique T-shaped locking plate of distal radius and the plate of sternoclavicular hook in terms of anti-compression, anti-torsion and anti-pullout of sternoclavicular screw, so as to provide an ideal internal fixation device for the treatment of fracture and dislocation of sternoclavicular joint.
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BACKGROUND:Acellular nerve scaffolds have the three-dimensional structure of natural nerves and low immunogenicity,but their effect on long nerve defects is still not ideal.Therefore,it is necessary to construct tissueengineered nerve using acellular nerve and seed cells in order to improve the therapeutic effect.OBJECTIVE:To systemically review the efficacy of combination of acellular nerve grafts (ANGs) and mesenchymal stem cells (MSCs) or Schwann cells (SCs) transplantation in the treatment of sciatic nerve defects in a rat model.METHODS:Randomized controlled trials (RCTs) about the effects of combination of ANGs and MSCs or SCs transplantation for sciatic nerve defects in rats were searched in PubMed,The Cochrane Library,EMbase,CNKI,WanFang and VIP from inception to July 2016.Three reviewers independently screened literature according to the inclusion and exclusion criteria,extracted data,and assessed the risk of bias of included studies.Then,a Meta-analysis was performed using Review Manger5.3 software.RESULTS AND CONCLUSION:A total of 10 RCTs involving 252 rats were included.The results of meta-analysis showed that:compared with the control group (simple acellular nerve scaffold group),the sciatic functional index (SFI) of the combined group (combination of ANGs and MSCs or SCs transplantation) were superior at 2 weeks [SMD=2.73,95％ CI (1.92,3.45),P ＜ 0.000 01],4 weeks [SMD=4.57,95％ CI (3.43,5.70),P ＜ 0.000 01],6 weeks [SMD=1.62,95％CI (0.18,3.06),P=-0.03],8 weeks [SMD=4.90,95％ CI (2.96,6.84),P ＜ 0.000 01] after surgery.The nerve conduction velocity [SMD=1.39,95％ CI (0.99,1.78),P ＜ 0.000 01),latency period (MD=-0.98,95％ CI (-1.19,-0.76),P ＜ 0.000 01],and amplitude [SMD=1.23,95％ CI (0.62,1.85),P ＜ 0.000 1] were superior at 12 weeks after surgery.The myelin sheath thickness was superior at 8 weeks [MD=0.14,95％ CI (0.07,0.21),P ＜ 0.000 1],12 weeks [SMD=1.85,95％ CI (1.63,2.08),P ＜ 0.000 01] and the number of myelinated nerve fibers were superior at 12 weeks [SMD=3.59,95％CI (2.63,4.55),P ＜ 0.000 01] after surgery.The gastrocnemius wet weight was superior at 8 weeks after surgery [SMD=4.22,95％ CI (2.40,6.03),P ＜ 0.000 01].Current evidence indicates that the combination of ANGs and MSCs or SCs can promote the regeneration and functional recovery of the peripheral nerve.Due to the limited quality of the included studies,the above conclusion should be verified by conducting high-quality and large-scale RCTs.
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Objective To evaluate the effect of tissue-engineered nerve graft combined with tetramethylpyrazine in the repair of ischiadic nerve defect in rats.Methods Fifty-five adult SD rats were allocated into groups A (n =15),B (n =15),C (n =15) and D (n =10),according to the random number table.All experimental sciatic nerves were at the right hind side.After the rats were anesthetized with 10 g/L pentobarbital through abdominal injection,a 1.5 cm nerve sciatic nerve was excised at the point 0.5 cm away from the lower margin of the piriformis.Four grafts were used to bridge the nerve defect,including tissue-engineered nerve transplanted neural stem cells (NSCs) that were cultured in medium containing tetramethylpyrazine for 1 week (group A),tissue-engineered nerve transplanted NSCs that were cultured in tetramethylpyrazine-free medium for 1 week (group B),acellular nerve allograft (group C),and nerve autograft (group D).After operation,group A was administered tetramethylpyrazine for 12 weeks in the operative site.For other groups,the same volume of normal saline was used instead of tetramethylpyrazine.Repair results were detected with the sciatic function index (SFI),nerve electrophysiological evaluation,fluorescent microscopy,horseradish peroxidas (HRP) retrograde tracer and nerve fiber regeneration study.Results At postoperative 2 weeks,no differences were found in SFI and electrophysiological evaluation among the groups,there was an intensive fluorescence in groups A and B and no fluorescence in group C,and large nestin-positive cells were observed in groups A and B.At postoperative 12 weeks,SFI was-17.52 ± 2.41 in group A,-25.74 ± 2.85 in group B,-36.12 ± 3.41 in group C and-15.87 ± 2.26 in group D;electrophysiological evaluation showed nerve conduction velocity of (9.43 ± 0.40) m/s in group A,(7.76 ± 0.31) m/s in group B,(5.87 ± 0.67) m/s in group C and (10.16 ± 0.39) m/s in group D;fluorescence microscope and histological staining showed NSCs could survive in vivo,migrate and differentiate into neurons and gliocytes;HRP-positive neurons were 885.40 ± 19.91 in group A,684.57 ± 38.37 in group B,390.33 ± 43.41 in group C and 941.67 ± 32.54 in group D;regenerated nerve fibers,often myelinated were large in group A.All the measures in group A were better compared to groups B and C (P ＜ 0.05),but didn't differ from those in group D (P ＞0.05).Conclusion Tissue-engineered nerve transplanted NSCs cultured in medium including tetramethylpyrazine can effectively repair rat sciatic nerve defect,and promote peripheral nerve regeneration and lower limb motor function recovery.