ABSTRACT
ObjectiveTo investigate and evaluate the result and the possibility of the clinical application of autologous chondrocyte implant (ACI).MethodsFrom November 2007 to June 2009,6 cases of knee articular cartilage defect were treated with ACI,including 2 males and 4 females with an average age of 39.5 years (range,19-55).All the defects were located on the condyles of femur with a mean size of 7.3 cm2 (range,3.8-11.6).ACI comprises a two-stage procedure:chondrocytes are first harvested from the non-load bearing area of the joint,expand in vitro to acquire enough cells,and then the chondrocytes are implanted.The defect of cartilage were covered with bone membrane and fixed with sutures and fibrin albumen glue.Lysholm score system,International Knee Documentation Committee (IKDC) grading system,and MRI were used to evaluate the effect of ACI,6 and 12 months post-operatively.ResultsAll the patients were followed up.The clinical outcomes of the 6 and 12 months follow-ups demonstrated increased of clinical scores.The MRI follow-up showed good filling of the defect with tissue having the imaging appearance of cartilage in all patients.Only one patient suffered adhesion,because she refused to finish rehabilitation exercises as our treatment advises.ConclusionAs the clinical effect of ACI for knee cartilage defect is satisfied,the ACI may be a good choice for treating knee cartilage defect in future.It is very important to control the indications strictly and guarantee to finish the post-operative rehabilitation exercises.
ABSTRACT
Objective To report the preliminary experiences in the treatment of old unstable thoracolumbar vertebral fractures by using anterior decompression, bone graft or titanium mesh and internal fixation with Z-plate system. Methods There were 23 cases (18 males and 5 females) with age range of 25-66 years (mean 41.7 years) as well as thoracolumbar vertebral fracture history for 1.2-28 years (mean 5.6 years). All cases complained of severe lower back pain, 17 of whom had slight neurological deficits (Frankel Grade D). Preoperative radiographic evaluation showed that all 23 cases had various degrees of kyphosis (25?-40?, averaged 34?), spinal cord compression and vertebral instability. Of 23 cases, 15 were treated with anterior decompression, full-thickness iliac crest autograft and internal fixation with Z-plate and the other 8 with titanium mesh instead of full-thickness iliac crest autograft. Results No severe complications happened during and after operation. The lower back pain and neurological deficits were improved or disappeared 2-3 months postoperatively. The average kyphotic correction degrees ranged from preoperative 34? to postoperative 12?. No patients' symptoms worsened during follow-up. In three cases with preoperative Frankel Grade D, the myodynamia recovered slightly but the Frankel Grade remained unchanged. The postoperative MRI examinations showed that vertebral canals were well decompressed. Conclusions Anterior decompression, autograft or titanium mesh and internal fixation with Z-plate are proved to be safe and effective techniques for clinical management of old thoracolumbar fractures, for they have advantages in effective decompression of neural structures, high healing rate of autograft and correction of kyphotic deformity.
ABSTRACT
Objective To explore the methods and clinical results of the arthroscopic acromioplasty for the treatment of impingement syndrome of shoulder. Methods 15 cases with impingement syndrome of shoulder were studied. There were 9 males and 6 females. 10 right shoulders and 5 left ones were involved. The average age of patients was 47 years ranging from 32 to 54 years. 3 injuries were classified as degree I, 4 as Ⅱ, and 8 as Ⅲ according to Neer classification. All the patients had a chronic injury and painful history around shoulder. The positive arch pain test was presented in 12 cases and impingement test in 13 cases. 13 patients had been received MR examinations, and 5 arthrographies of the shoulder. The AP and the supraspinatus outlet projection of the X-rays were obtained before surgery. The procedure of arthroscopic acromioplasty consisted of 5 following steps: the first was arthroscopic subacromial inspection with posterior portal; the second was subacromial bursectomy with electro-shaver or burr; the third was release or resection of the coracoacromial ligament with electrocautery; the fourth was subacromial decompression with full-radius resector or burr; and the last was debridement of the soft tissue around the acromio-clavicular joint and resection of the the spurs. 4 patients underwent reparation of the rotator cuff simultaneously. Results All cases were available for follow-up. The average time was 15 months. According to the UCLA scoring system, the average score was 18.5?8.2 and 31.7?6.5 pre- and post-operation respectively; the difference was of statistical significance(t=3.35, P