Otimization of auxiliary lines for proximal femoral intramedullary nail in the treatment of simple femoral intertrochanteric fractures / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical outcomes of C-arm X-ray fluoroscopy before incision to make assistant lines and insert the guide wire of PFNA and PFNA blade.</p><p><b>METHODS</b>From January 1st 2012 to January 1st 2015, 132 intertrochanteric fracture patients of type 31A1 and 31A2 according to AO-classification, were retrospectively analyzed. Among them, 62 patients(14 males and 48 females) aged from 52 to 95 years with a mean age of(69.58±8.55) years in traditional group were operated by traditional procedure, while 70 patients in the skin marking group included 15 males and 55 females aged from 61 to 88 years with a mean age of(71.94±7.64) years, on the basis of the traditional operation method, the assistant line of the body surface and the C-arm X-ray was increased, and the guide pin positioning of the proximal femoral nail and the spiral blade was guided by the auxiliary line in the operation. Operative time, frequency of C-arm fluoroscopy, Harris hip score of the third months after surgery and the complications in both groups were queried for statistical analysis.</p><p><b>RESULTS</b>In addition to skin making group 1 patients had superficial wound infection complications, all patients were stage I wound healing. All patients were followed up for 3 to 18 months with an average of (6.81±3.07) months. The operative time was significantly reduced in skin marking group (56.16±6.36) minutes compared to traditional group (59.06±9.19) minutes (>=0.035). And the frequency of C-arm fluoroscopy of skin marking group was(25.89±5.81) times which was also significantly reduced compared to traditional group(31.32±9.81) times (<0.001). There was no statistical difference in Harris hip score at 3 months after operation and the complication rate between the two groups(>0.05).</p><p><b>CONCLUSIONS</b>In this study, a simple and easy method of assistant line marking can shorten the operation time and reduce the number of times of operation.</p>

Case-control study on modified femoral prosthesis in reducing the incidence of patellar clunk syndrome after the initial posterior stabilized total knee arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To explore therapeutic effects of modified femoral prosthesis applied in the initial posterior stabilized total knee arthroplasty.</p><p><b>METHODS</b>From April 1, 2012 to January 1, 2013, 156 patients with knee osteoarthritis underwent posterior stabilized total knee arthroplasty by the same director of orthopedic surgeon. Sixty-one patients were treated with modified femoral prosthesis, including 7 males and 54 females, with an average age of (68.34 +/- 5.41) years old; and 95 patients were treated with conventional designed femoral prosthesis, including 14 males and 81 females, with an average age of (69.92 +/- 5.11) years old. Indexes including age, body mass index, Insall-Salvati index, type of prosthesis, occurrence rate of patella click syndrome, postoperative line of force of lower extremity and postoperative function of the knee joint were observed and recorded. And American Knee Society (AKS) score was used to evaluate the clinical results.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 36 to 56 weeks, with a mean of 45.31 weeks. Among patients in the conventional designed femoral prosthesis group, 7 patients had patella click syndrome, but there was no patient having patellar click syndrome in the modified femoral prosthesis group. Postoperative knee activity of patients in the modified femoral prosthesis group was (110.98 +/- 10.32) degrees, which was better than (107.05 +/- 8.61) degrees in the conventional designed femoral prosthesis group. The AKS score in the modified femoral prosthesis group was 129.79 +/- 9.63 during 21 to 28 days after operation, which was higher than 126.85 +/- 7.79 in the conventional designed femoral prosthesis group.</p><p><b>CONCLUSION</b>New designed femoral components are effective to reduce the occurrence rate of postoperative patellar click syndrome and obtain better early functional recovery from knee surgery.</p>

Analysis of clinical effects of uncovertebral joints resection and decompression for the treatment of cervical spondylotic radiculopathy through anterior approach / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the clinical and radiologic outcomes of bilateral uncovertebral joints resection and decompression in treating cervical spondylotic radiculopathy through anterior approach.</p><p><b>METHODS</b>From January 2007 to December 2009, the clinical data of 56 patients with cervical spondylotic radiculopathy undergoing sugical treatment were retrospectively analyzed. There were 33 males and 23 females with an average age of (58.83 +/- 8.01) years (ranged 41 to 72). The course was from 5 to 48 months with an average of (14.09 +/- 8.54) months. All patients underwent bilateral uncovertebral joints resection, vertebral canal decompression and fusion through anterior approach. Perioperative, radiologic,nerve functional parameters were analyzed before and after operation. Perioperative parameters included hospital stay days and blood loss volume and operative time; radiologic parameters included vertebral height and lordosis angle and fusion rate; and according to JOA score to evaluate the nerve function.</p><p><b>RESULTS</b>All patients were followed up from 12 to 30 months with an average of 18.2 months. Hospital stay days, blood loss volume and operative time were (4.42 +/- 0.25) d, (195.51 +/- 23.67) ml and (145.52 +/- 28.29) min, respectively. Preoperative vertebral height was (5.19 +/- 0.03) cm, and postoperative 1 year arrived to (5.37 +/- 0.29) cm, there was no significant difference between preoperative and postoperative (P > 0.05). Lordosis angle increased from preoperative (1.53 +/- 0.03) degrees to (7.78 +/- 0.66) degrees at the 1 year after operation (P<0.01). Fusion rate was 96.5% at the 1 year after operation. JOA score increased from preoperative 8.69 +/- 2.13 to 15.58 +/- 2.45 at the 1 year after operation (P < 0.001). According to standard of JOA scoring, 20 cases were excellent, 28 good, 7 fair and 1 poor.</p><p><b>CONCLUSION</b>Uncovertebral joints resection and decompression through anterior cervical approach in treating cervical spondylotic radiculopathy is safe and reliable, which can get satisfactory clinical outcomes. This surgical procedure is suitabl oe for the patients of cervical spondylosis, especially combined canal stenosis and osteophytosis of the uncovertebral joint.</p>

Influence of self-designed three-dimensional woven scaffolds on in vitro growth of Schwann cells and its in vivo degradation / 第二军医大学学报

Objective: To prepare a self-designed three-dimensional woven scaffold using poly lactide-co-glycolide acid (PLGA), and to observe the influence of the prepared scaffold on the growth of Schwann cells in vitro and its in vivo degradation. Methods: The 3D scaffolds were prepared by means of melt spinning, extension, weaving, and other procedures. The alignment of micro-tubules was observed under the scanning electronic microscope (SEM). The size of the micropores was also measured. Primary cultured Schwann cells were seeded on the 3D scaffolds, and the growth, adherence, proliferation, and apoptosis of Schwann cells were observed under inverted phase contrast microscopy and SEM; the results were compared between Schwann cells cultured in collagen sponge and culture dish. The scaffold carrying Schwann cells was implanted into the paraspinal muscle in rats, and H-E staining was used to observe the in vivo degradation and the inflammation responses. Results: The external diameters of the scaffold and micro-tubules were 3 mm and 100 μm, respectively, and the micro-tubules were arranged in an even and parallel manner. The adherence rates and proliferation rates of Schwann cells were similar between scaffold group and collagen sponge group, but both groups were significantly lower than the culture dish group (P<0.05). The 3D scaffold degraded completely within 12 weeks, with no visible inflammatory cells around. Conclusion: The self-designed 3D scaffold has no harmful effect on the growth of Schwann cells, and it can degrade in vivo, showing a satisfactory biocompatibility.

Novel three-dimensional nerve tissue engineering scaffolds and its biocompatibility with Schwann cells / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To develop a novel scaffolding method for the copolymers poly lactide-co-glycolide acid (PLGA) to construct a three-dimensional (3-D) scaffold and explore its biocompatibility through culturing Schwann cells (SCs) on it.</p><p><b>METHODS</b>The 3-D scaffolds were made by means of melt spinning, extension and weaving. The queueing discipline of the micro-channels were observed under a scanning electronic microscope (SEM).The sizes of the micropores and the factors of porosity were also measured. Sciatic nerves were harvested from 3-day-old Sprague Dawley (SD) rats for culture of SCs. SCs were separated, purified, and then implanted on PLGA scaffolds, gelatin sponge and poly-L-lysine (PLL)-coated tissue culture polystyrene (TCPS) were used as biomaterial and cell-supportive controls, respectively. The effect of PLGA on the adherence, proliferation and apoptosis of SCs were examined in vitro in comparison with gelatin sponge and TCPS.</p><p><b>RESULTS</b>The micro-channels arrayed in parallel manners, and the pore sizes of the channels were uniform. No significant difference was found in the activity of Schwann cells cultured on PLGA and those on TCPS (P larger than 0.05), and the DNA of PLGA scaffolds was not damaged.</p><p><b>CONCLUSION</b>The 3-D scaffolds developed in this study have excellent structure and biocompatibility, which may be taken as a novel scaffold candidate for nerve-tissue engineering.</p>