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Lateral ankle avulsion fracture is a common sports injury that can lead to chronic lateral ankle instability and substantial deterioration of the joint function. Currently, problems such as misdiagnosis, inappropriate treatment, disparate outcomes and lack of standardization are usually met in the diagnosis and treatment of lateral ankle avulsion fracture. The Foot and Ankle Committee of Chinese Association of Sports Medicine Physicians thus organized a working group of experts in the field of sports medicine and ankle surgery from China to develop "An evidence-based clinical guideline for the diagnosis and treatment of lateral ankle avulsion fractures (2022 version)" in accordance with the principle of evidence-based medicine and scientificity and practicability. The guideline covered the topics of imaging diagnosis, indications and methods of non-operative and operative treatment as well as postoperative rehabilitation, in order to provide guidance for the diagnosis and treatment of lateral ankle avulsion fracture.
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OBJECTIVE@#To investigate the effect and mechanism of mechanical stress on cartilage repair in inflammatory environment.@*METHODS@#The chondrogenic progenitor cells (CPCs) were isolated from the knee joint cartilage of patients with osteoarthritis (OA) undergoing total knee arthroplasty. The CPCs were cultured and expanded in a 3-D scaffold constructed with alginate. Intermittent hydrostatic pressure (IHP) was applied in a inflammatory environment induced by IL-1β, and Western blot was used to detect the expression of MAPK signaling pathway proteins. Cell proliferation was detected by CCK-8 method, and the expression of related genes like matrix metallo-proteinases 13 (MMP-13) and a disintegrins and metalloproteinase with thrombospondin motif 5 (ADAMTS-5) was detected by real-time RT-PCR. The anterior cruciate ligament of the rats was cut to construct the knee joint OA model, and the appropriate mechanical stress was constructed with external fixation to distract the knee joint in order to observe the repair of the cartilage and to explore its mechanism.@*RESULTS@#Adding 0.01 ng/ml IL-1β in cell culture inhibited the proliferation of CPCs. After IHP application, the expression of MAPK pathway protein was decreased, the mRNA expression of MMP-13 and ADAMTS-5 was reduced. The inhibition of IL-1β on CPCs was counteracted by IHP. Four weeks after the anterior cruciate ligament resected, the articular cartilage degeneration was observed in rats. The Mankin score in the OA treatment (joint distraction) group was lower, and the cartilage repair was better than that of the control group (<0.01). Animal experiments found that the suitable mechanical stress reduced the expression of P-p38, MMP-13 and COLL-X, inhibited cartilage cells apoptosis and promoted the repair of OA cartilage.@*CONCLUSIONS@#Mechanical stress can promote the proliferation of CPCs, reduce the expression of matrix degrading enzymes, and promote the repair of OA cartilage by inhibiting MAPK signaling pathway.
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Animals , Humans , Rats , Anterior Cruciate Ligament , Pathology , General Surgery , Cartilage, Articular , Pathology , Cells, Cultured , Chondrocytes , Cell Biology , Disease Models, Animal , Gene Expression Profiling , Mitogen-Activated Protein Kinases , Genetics , Osteoarthritis , Pathology , Polymerase Chain Reaction , Signal Transduction , Genetics , Stress, MechanicalABSTRACT
BACKGROUND:With the development of tissue engineering, autologous chondrocyte implantation is often used to repair cartilage defects. And poor integration is one of the common reasons that lead to failure repairing. Many models in vitro are used for related studies. OBJECTIVE:To develop an interface integrated model of tissue engineered cartilage repair in vitro and to evaluate the effect. METHODS:Cartilage integration model in vitro was established in pigs. Total y 21 cartilaginous rings were obtained and divided into agarose gel group (n=18) and control group (n=3). In agarose gel group, cartilage rings were covered with agarose gel. Chondrocytes were separated and implanted into the ring. The leakage of cells around the cartilage rings was observed. The sections were stained for histological observation at 1, 2, 4 weeks. The average area of neochondrocytes was measured and compared. RESULTS AND CONCLUSION:The results from the control group were not processed, because there was no chondrocyte aggregate formation in the center of the explant ring due to earlier chondrocyte leakage outside the explant. While no chondrocytes were found outside the explant ring in the agarose gel group. Tissue sections of the agarose gel group were stained by hematoxylin and eosin, alcian blue, Safranin-O and col agen type II immunohistochemistry at 1, 2, 4 weeks. Neochondrocytes proliferated within cartilage ring, and produced extracellular matrix. After 2 weeks of incubation, these inserted chondrocytes were significantly increased. There was no statistical y significant increment between 2 weeks and 4 weeks (P>0.05), although the area was further increased by 4 weeks. This model provides a convenient simulation of the cartilage integration process in vitro and has a potential application in studies of cartilage integration and cartilage tissue engineering.
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BACKGROUND:In joint surgery, the commonly used autologous chondrocyte transplantation often used to repair cartilage defects, and poor integration is one of the reasons that leading to failure repairing. Chondrocytes migration capability is proven to have correlation with integration and some pathways, such as Src-phosphorylated phospholipase Cγ1-extracellular regulated kinase 1/2 has been confirmed to have correlation with the migration ability of chondrocytes, but the correlation with the integration is stil unknown. OBJECTIVE:To determine the chondrocyte signaling pathways involved in autologous chondrocyte migration and their effects on cartilage integration in autologous chondrocyte implantation. METHODS:Articular chondrocytes were isolated from immature pig knee joints. The cells were divided into four groups:Src group, phosphorylated phospholipase Cγ1 group, extracellular regulated kinase 1/2 group and control group, then the Boyden chambers were used to quantify the chondrocyte migration. The chondrocytes/cartilage ring integration model was developed and cultured for 28 days, and then histology, biochemistry, biomechanics, western blot analysis and celltracking analysis were performed to observe the differences between the control group and the suppression groups. RESULTS AND CONCLUSION:The migration ability of chondrocytes was significantly decreased after pretreated with inhibitors. After the chondrocytes/cartilage ring co-cultured for 28 days, Western blot analysis showed that the pathway inhibitors has been presented in the entire culture cycle. The number and length of chondrocytes migrated into the integration area, col agen secretion level, matrix and mechanical strength in the control group were higher than those in three suppression groups. The results suggest that chondrocyte migration ability can affect the cartilage integration capability through Src-phosphorylated phospholipase Cγ1-extracellular regulating kinase 1/2 signal transduction pathway.
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Objective To investigate the result of arthroscopic surgery in the treatment of sinus tarsi syndrome. Methods The study involved 15 patients (6 males and 9 females) with sinus tarsi syndrome admitted to First Hospital of Nanjing from July 2006 to May 2008. The age of the patients ranged from 23 to 63 years ( average 46.3 years). All the patients had one side involvement, including 10 patients with left side involvement and five with right side involvement. All the operations were performed under the tourniquet control and the patients were placed at the lateral decubitus position. The lateral, anterolateral and posterolateral portals were applied intraoperatively and the medial portal was applied when necessary. Visual analogue scale (VAS) and American orthopedic foot and ankle scale (AOFAS) ankle-hindfoot scale were used for follow-up evaluation. Results More than two lesions were found under arthroscope in all patients. The lesions included scar tissue hypertrophy and inflammation in the sinus tarsal canal, soft tissue impingement in the subtalar joint, synovitis, partial tears of subtalar capsule, interosseous talocalcaneal ligament or cervical ligament, cartilage injury and subtalar degeneration. All patients were followed up for 19-35 months (mean 26. 1 months). At the final follow-up, the VAS score was improved from preoperative 7.6 points ( range 6-9 points) to postoperative 2.5 points (range 1-4 points) (P＜0.01 ), and the AOFAS score improved from preoperative 41. 9 points (range 20-67 points) to postoperative 83. 1 points ( range 70-100 points) ( P ＜ 0. 01 ). The excellence rate of the AOFAS score reached 73% at the final follow-up. Conclusion For patients with sinus tarsi syndrome after a failed conservative treatment, arthroscopic surgery should be performed as soon as possible and the clinical result is satisfactory.
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[Objective]Through a comparitive analysis between hemiarthroplaty and dynamic hip screws in femoral intertrochanteric fracture,to discuss the differences and similaries between two groups of patients.[Method]Using the methods of retrospective review,the author collected 63 cases of femoral intertrochanteric fracture,treated by hemiarthroplasty and dynamic hip screws respectively.Followed for a minimum period of 6 months,the author compared the postoperative complications,cumulative mortality rate and loss of ambulatory grades between two groups.[Result]There was no siganificant difference in operative time and introperative bleeding and no evident distinctions showed in posteroperative general conditions.But in local symptoms,DHS group appeared the cut-out from femoral head and coax vara resulting from the collapse of medial cortex,hemiarthroplaty group emerged the pain in hip without proof of loosening and infection of prosthesis.Hip scores decreased by 8.6% in DHS group and 9.2% in hemiarthroplaty group.In the opinion of the function convalescence,there was no definition to be worth recommending between two groups.[Conclusion]To eldly patients with unstable intertrochanteric fracture,fine function should be expected equal to preoperation after operation,but the chief motive is to provide the conditions which permit the patients earlier activity.So hemiarthroplaty is a reasonable alternative to a sliding screw device to treat intertrochanteric fractures.
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[Objective]To study the effect of semi-constrained total elbow arthroplasty in rheumatoid elbow arthritis.[Method]Eighteen semi-constrained total elbow replacements were performed on 22 rheumatoid patients with 28 elbows(Morrey Stage:6 of Ⅲ Stage,17 of Ⅳ Stage,5 of Ⅴ Stage).The elbows were reviewed retrospectively after a followup of mean 26 months(range12~44 months).Mayo Elbow Performance was used to evalue the function of preoperative and postoperative elbow.The curative effect and complications were observed.The statistically significant differences were analyzed.[Result]Elbow arthroplasty was successful in 22 rheumatoid patients with 28 elbows.After 6 weeks function exercise the Mayo Elbow Performance was improved from(31.6?29.2)to(82.1?24.3)with a statistically significant difference(P
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Objective To compare the efficacy of two-incision microinvasive and modified Harding approaches for total hip arthroplasty in aged patients.Methods From May 2003 to December 2006,21 old patients(aged 82 on average) received two-incision microinvasive total hip arthroplasty in our hospital.The outcomes of the surgery was compared with those of 39 cases(mean age,83),who underwent the operation through the modified Harding approach.Results No significant difference was observed in intraoperative blood loss between the two groups [(270?94) ml vs(280?107) ml,t=-0.360,P=0.720].On the 2nd day after the surgery,the patients in the two-incision group could raise their legs straight upward without needing help.At day 10,they could raise the legs straight up to a mean of(53?12)?,which was significantly higher than that in the Harding group [(32?16)?,t=5.262,P=0.000].However,the Harris scores were similar in both the groups in 6 months after the operation(80.6?12.6 vs 79.5?13.2,t=0.313,P=0.756).The incidence rates of orthopedics and systemic complications in the two-incision group was not significantly different from those in the Harding group [9.5%(2/21) vs 8.1%(3/37),?2=0.000,P=1.000;19.0%(4/21) vs 37.8%(14/37),?2=2.210,P=0.137].Conclusions The short-term outcomes of microinvasive two-incision total hip arthroplasty is better than that of modified Harding approach in aged patients.However,the long-term results of the two procedures are similar.
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Objective To study curative effects of infrared fluoroscopic navigation guided percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Methods A total of 28 cases of osteoporotic vetebral compression fractures(41 vertebrae) underwent infrared fluoroscopic navigation guided percutaneous vertebroplasty.The fracture was located at T_6～L_4 segment,including 16 thoracic vertebrae and 25 lumbar vertebrae.Fluoroscopic images of the spine were obtained,calibrated,and saved after the reference shelf was fixed on the spinous process of fractured vertebrae.The trajectory,a virtual tool corresponding to the tracked tool,was overlaid onto the saved fluoroscopic views in real time.Postoperative X-ray and CT examinations were performed to observe the vertebral body diaplasis as well as the distribution and leakage of bone cement.The vertebral body volume was measured with CT volumetry preoperatively and postoperatively.The visual analogue scale(VAS) scores were compared before and after operation. Results The bone cement was successfully injected in all the 41 vertebrae.Percutaneous vertebroplasty was performed in 13 vertebrae,while percutaneous kyphoplasty was conducted in 28 vertebrae(including balloon expansion in 12 vertebrae and "sky" expansion in 16 vertebrae).Vertebral body injection was performed via unilateral pedicle in 26 vertebrae and via bilateral pedicle in 15 vertebrae.Of the 28 cases,cement injection was carried out in one vertebral body in 17 cases,in two vertebral bodies in 9 cases,and in three bodies in 2 cases.No intraoperative deaths,nerve root or spinal cord injuries,or pulmonary embolism and cardiovascular or cerebrovascular emergencies occurred.The operative time for each vertebra was 7.7～20.7 min(14.2?3.3 min) in percutaneous vertebroplasty and 11.2～32.4 min(21.8?5.4 min) in percutaneous kyphoplasty.The X-ray exposure dose for each vertebra was 5.4～19.6 dGy(12.5?3.6 dGy).The amount of injected cement for each vertebra was 2.2 ～6.8 ml(4.6?1.2 ml).The vertebral volume was elevated from preoperative 21.4?4.6 cm3 to postoperative 25.8?5.4 cm3(t=5.623,P=0.000).The VAS scores decreased from preoperative 7.6?1.2 to postoperative 2.9?0.7(t=12.946,P=0.000).No serious complications or vertebral collapses were found during follow-up examinations for 3~14 months(mean,8 months) in the 28 cases. Conclusions Use of infrared fluoroscopic navigation for guiding percutaneous vertebroplasty is feasible.
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Objective: To analyze the effects of technetium99 conjugated with methylene diphosphonate(99Tc-MDP) on adjuvant arthritis in rats.Methods: Thirty SD rats were randomly and equally divided into a normal control group an adjuvant arthritis control group and a 99Tc-MDP treatment group.Intraperitoneal injection of 99Tc-MDP(2.5?10-3?g/kg) was given to the rats in the treatment group on the tenth day and repeated every other day after arthritis induction.The left-right diameter of the left hind ankle,arthritic index,serum TNF and IL-1? levels,articular radionuclide imaging and histopathological changes were observed.Results: Compared with the adjuvant arthritis group,the diameter of the left hind ankle,arthritic index,the serum TNF and IL-1? levels and the T/NT value were decreased in the treatment group,and histopathology showed less synovium hyperplasia and fewer infiltration of inflammatory cells in the group treated with 99Tc-MDP intraperitoneal injection than in the adjuvant arthritis control group.Conclusion: 99Tc-MDP intraperitoneal injection is effective for adjuvant arthritis in rats.
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Objective To analyse the differences between radiofrequency and mechanical debridement in treatment of knee osteoarthritis. Methods Randomized control and prospective case study were designed, with 24 cases in the radiofrequency treatment group and 36 cases in the mechanical debridement group (the control). All the cases were followed up for an average of 12.4 months (ranging 6 to 24months) according to Lysholm knee function evaluation score. Results The Lysholm scores for the treatment group were superior to those in the control group in cases of Outbridge grades Ⅱ and Ⅱ-Ⅲ chondromalacia (P0.05). Conclusion Radiofrequency is the first choice in treatment of chondromalacic lesions of no more than Outbridge grade Ⅲ.
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Objective:To investigate the perioperative issues on the elderly patients undergoing total knee arthroplasty.Methods:Seventy nine knees from 62 patients ≥75 years of age received total knee arthroplasty from September 2000 to January 2006,the operative result and perioperative complications were reported.Results:Sixty one cases were followed up for 28 months(ranging from 6 to 58 months),according to the hospital for special surgery(HSS) knee rating scale,the HSS scores were improved after the operation from 27.18?7.01 preoperatively to 76.24?6.08 postoperatively(P
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Objective To discuss the techniques and efficacy of arthroscopy-assisted treatment for popliteal cyst. Methods From June 2004 to January 2006, 14 patients with popliteal cyst were diagnosed and treated with arthroscopy. During the operation, the popliteal cyst was removed, and then the hernial opening was repaired by suturing the medial head of the gastrocnemius tendon. The outcomes of the operation were evaluated by using Rauschning and Lindgren Grading. Results Arthroscopic examinations showed evident pathological changes in the knee joints of the 14 patients, including 6 cases of posterior horn medial meniscus tear, 1 case of chondromalacia of patella, 2 patellofemoral malalignment, 4 osteoarthritis, and 1 discoid lateral meniscal tear. The patients were followed up for 5-18 months (mean 11 months). According to the Rauschning and Lindgren Grading, 8 patients were grade Ⅱ and 6 were grade Ⅲ before the operation. After the operation, 9 patients were grade 0, 4 were grade Ⅰ, and 1 was grade Ⅱ. There was a significant difference between the pre-and postoperative grading (Z=-4.498, P=0.000). No patient had recurrence during the follow-up. Conclusions Popliteal cyst is usually induced by knee joint disorders. It was difficult to eliminate the cyst by simple resection. Arthroscopy-assisted treatment can achieve good outcomes.
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15?， PASA≥ 11?； typeⅥ has metatarsal- phalangeal osteoarthritis. Each of them has its own particular pathogenesis and should be operated upon by different procedures respectively.
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Objective To evaluate the application of infrared fluoroscopic navigation guiding pedicle screwfixation of thoracic-lumbarspine.Methods The pedicle screw fixation of thoraic-lumbar spine was adopted in 32 patients,including 19 cases with thoracic-lumbarspine fractures,5 cases with protrusion of lumbar intervertebral disc or vertebral canal stenosis,8 cases with lumbar spine slippage.The timefor pedicle screwfixation and amount of bleeding were recorded.The pedicle screwposition was assessed with post-operative CTby using An-drewgrade.Results Totally148 screws were fixed in 32 cases successfully,including10 screws in T11,20 in T12,18 in L1,36 in L2,16 inL3,26 in L4,28 in L5,and 14 in S1.According to andrewgrade,165 screws were inⅠgrade(98%),2 inⅡgrade,and 1 inⅢ grade.Nonerve and spinal cord damage was observed after operation.The average time of per pedicle screwfixation was(10?2.4) min.The averageamount of bleeding was(400?52.3) ml in thoracic-Lumbar Spine fractures,(200?36.8) ml in protrusion of lumbar intervertebral disc orvertebral canal stenosis,and(300?44.6) ml in Lumbar Spine slippage.Conclusion Infrared fluoroscopic navigation can improve the pre-cision of pedicle screw fixation of thoraic-lumbar spine,reduce the amount of bleeding,and shorten the operative time.
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Objective To retrospective analyze the treatment of hallux valgus with the procedure of osteotomy of the base of the first metatarsal, combining with osteotomy of the base of the second and/or third metatarsal(s), and to study the indications and effects of this procedure. Methods 35 cases 56 hallux valgus feet were treated by operative procedure from January 1994 to December 2003. 26 cases 43 feet underwent the operative procedure of osteotomy of the base of the first metatarsal, 9 cases 13 feet with painful callus under the second and/or third metatarsal(s) head underwent osteotomy of the base of the first, second and/or third metatarsal(s). The axial and lateral films of all feet with loading were taken before and after operation. The change of anatomic indexes and AOFAS of the patient postoperatively were recorded and analyzed. Results In the group with osteotomy of the base of the first metatarsal, AOFAS score was 47.6?5.8 preoperatively, and 84.3?5.7 postoperatively. In the group with osteotomy of the base of the first, second and/or third metatarsal(s), AOFAS score was 44.7?5.7 preoperatively, and 85.7?4.5 postoperatively. There were significant differences between the preoperative and postoperative rontgenographic index and AOFAS in each group. Conclusion The operative procedure is effective. The operative procedure of osteotomy of the base of the first metatarsal can get good result in moderate and severe hallux valgus patients. Osteotomy of the second and/or third metatarsal(s) were recommended in cases with painful callus under the second and/or third metatarsal(s). Normal forefoot appearance and function can be restored by the procedure to reestablish the transverse arch.
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Objective The purpose of this study is to evaluate the safety and operation of a modified coaxial portals for posterior ankle arthroscopy. Methods 20 anticeptic-frozen ankle specimens were divided into 2 teams at random equally. In the first team, the original coaxial portals designed by Acevedo were established with K-wires first, then followed by modified coaxial portals. In the second team, modified coaxial portals were created at two levels, one at 1.5 cm proximal to the tip of lateral malleolus and the other at 2.5 cm to the tip. K-wires were left in place for distance measurement between them and the posterior important anatomic structures. Mimic ankle arthroscopy operation was performed on 5 fresh ankle amputations, using 2.7 mm, 30? arthroscopy with the modified coaxial portals technique. Results Results of the anatomic study show that the average distince was (22.07+2.82) mm to the small saphenous vein, (5.39+1.47) mm to flexor hallucis longus tendon, (6.27+1.84) mm to the tibial nerve in modified coaxial portals and (8.54+2.76) mm to the small saphenous, (3.62+1.37) mm to flexor hallucis longus, (4.40+1.40) mm to the tibial nerve in the original one. Only the difference of the average distance to the tibial nerve in the No.2 team has statistic significance. Flexor hallucis longus and flexor digitorum tendon were identified as the inner-safety landmarks. Neither penetration nor contact of nerve or vessel was observed. Conclusion Compared with original ankle posterior coaxial portals, the modified coaxial portals may be superior safety, easier-operated and reproducible.
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0.05） . Strains of cemented groups were usually less than that of non-cemented ones for all zones except the stem tip zone. Normal group and osteoporosis group had different stress shielding and concentration(P
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OBJECTIVE: To study the clinical influence of fe moral quality on cementless hip replacement and to evaluate cortical index (CI) for femoral quality in order to guide prosthesis choice and rehabilitation. METHODS: Forty-nine cases of cementless hip replacement were followed up for average 3.5 years, 42 of whom had X-ray films on preopera tion or operation day. RESULTS: Harris scores and patients' satisfaction were low bu t pain was significant and prolonged when cortical indices were low. CONCLUSIONS: CI is a reliable semi-quantity parameter for clin ical evaluation of femoral quality. Osteoporosis patients predispose to thigh pa in. Lag for full-weight loading and avoidance for torsion motion can contribute to less pain when CI<=2.2.
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Objective To study the method and clinical results of Infrared Fluoroscopic Navigation Guiding system guided percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures.Methods Twenty-two cases with 32 osteoporotic vertebral compression fractures underwent percutaneous vertebroplasty guided by Infrared Fluoroscopic Navigation Guiding system.The fracture segment was within T6-L 4(14 thoracical vertebrae,18 lumbarver vertebrae).The compression ratio was from 20% to 90% in which 5 vertebral bodies were 75%.12 vertebral bodies underwent PVP,and 20 vertebral bodies underwent PKP in which balloon expansion were used in 12 vertebral bodies and sky expansion were used in 8 vertebral bodies.Single vertebral body injection were in 14 cases,two vertebral body injection were in 6 cases,three vertebral body injection were in 2 cases including 18 vertebral bodies injection via unilateral pedicle of vertebral arch and 14 vertebral bodies injection via bilateral pedicle of vertebral arch.Restoration of vertebra height and cement leakage was observed by postoperative X-ray and CT scan.Changes of preoperative and postoperative vertebral body volume measured by CT volumetry was compared.Preoperative and postoperative Vasual analogue scale(VAS)score was compared.Results PVP was successful in 22 cases with 32 vertebral bodies.No nerve and spinal cord damage,lung embolism and heart and brain vessel acute reaction occurred.Operative time was(18.4?4.5)mins per vertebral body.X-ray dosage was(12.2?3.4)dGy per vertebrae.The amount of bone cement was(4.4?2.5)ml per vertebrae.The vertebral body volume was improved from preoperative(22.2?8.6)cm3 to postoperative(24.8?6.9)cm3 with a significant differences(P