Research progress in molecular coupling mechanism of osteogenic differentiation and angiogenesis in traumatic bone defects / 中华创伤杂志

Management of bone defects caused by fractures，bone tumors or infections is clinically difficult as well as a hot topic in current studies. With further researches over bone defects，the construction of tissue-engineered bone has played a great role in the treatment of bone defects. Blood vessels not only provide the necessary nutritional mineral salts，growth factors，hormones for bone formation，also are able to mediate the interaction among osteoblasts and osteoclasts，osteocytes，bone autonomic nerve and endothelial cells，since bone formation exist spatially and temporally connection with angiogenesis. Therefore，the authors make a systematic literature review on the research progress of the coupling mechanism of angiogenesis and osteogenic differentiation，blood vessels and related signal pathways on osteogenic differentiation and angiogenesis-related molecules in osteogenic differentiation during the process of traumatic bone defects，so as to provide new ideas for the treatment of bone defects.

Arthroscopic Treatment for Femoroacetabular Impingement Syndrome in Patients over 50 Years Old / 中国运动医学杂志

Objective To evaluate the clinical effect of arthroscopic treatment of femoroacetabular impingement syndrome(FAI) for patients over 50 years old,and explore the occurrence regularity and treating rules for such a disease.Methods The clinical data of 71 patients(78 hips with FAI) over 50 years old who underwent arthroscopic treatment for FAI in our department between May 2012 and May 2017 were studied retrospectively.Physical examination,X-ray and CT 3D scans were made preoperatively for explicit diagnosis.The follow-up period ranged from 6 to 66 months,with an average of 31.78 ± 18.07 months.Every patient had a joint space greater than 2 mm,and a grade Ⅰ or Ⅱ hip osteoarthrosis according to the Trnnis scale.Under the hip arthroscopy the synovial hyperplasia was cleaned,the damaged labrum and cartilage were repaired,and the femoroacetabular hyperplasia and the impingement factors were removed to restore the normal shape of femoroacetabular.The joint clearance,changes ofthe alpha angle when at Dunn position and centre edge(CE) angle at normotopia on the X-ray,the intraoperative injuries of cartilages and glenoid labrum and surgical satisfaction and complications were measured and recorded.The modified Harris hip score(mHHS) and visual analogue scale(VAS) were used to evaluate the hip function recovery and pain relief of patients.Results The average age of the patients was 55.15 ± 5.02 years old,ranging from 50 to 69.Among the 23 males and 48 females,there were 33 left hips with FAI and 45 right hips with FAI.The average preoperative joint clearance was 4.81 ± 0.87 mm,and all incisions were healed by first intention after the treatment.The average α angle of the patients decreased from 50.11 ± 4.75 to 42.72 ± 4.7 degrees after the treatment,with the α angle of 7 patients(8.97％) bigger than 55 degree,and that of 40 patients(51.28％) smaller than 50 degree.The average CE angle decreased from 36.54 ± 9.14 degrees to 35.19 ± 8.55 degrees after the treatment,with that of 27 patients(34.62％) bigger than 40 degrees.Before the treatment,the main clinical manifestations were hip pain and swelling,including 36 cases(46.15％) with hip joint lock,70 (89.74％) with groin tenderness.Moreover,75 cases(96.15％) were positive in hip adduction internal rotation test(FADIR) and 64 cases(83.33％) were positive in the hip abduction and external rotation impingement test.However,the pain was relieved or disappeared after the treatment.The average VAS score decreased significantly from preoperative 4.42 ± 1.42 points to 1.31 ± 1.28 at the last follow-up,while the average mHHS score increased significantly from preoperative(52.4 ± 19.38) points to(81.72 ± 10.82) during the last follow-up,and the difference was statistically significant (P＜0.01).Significant improvement was observed in the mHHs and VAS scores of 89％ patients(P＜0.01).1 patient(1.28％) underwent hip replacement during the follow-up period.No serious complications occurred.Conclusion In most cases,arthroscopic treatment of FAI in old patients(over 50 years old),who were with osteoarthrosis and hip labrum injury,can significantly improve the joint function and relieve pain.It is a treatment with safety.

Clinical research of anterior cruciate ligament anatomic reconstruction using three-tunnel double-bundle methods with Femoral-Intrafix system / 中华骨科杂志

Objective To investigate the results of arthroscopic anterior cruciate ligament anatomic reconstruction using three-tunnel double-bundle methods with Femoral-Intrafix system.Methods From October 2010 to October 2013,data of 30 cases of arthroscopic anterior cruciate ligament (ACL) reconstruction who were randomly used with Femoral-Intrafix system were retrospectively analyzed.Hamstring tendons autograft were used for all patients.The Femoral-Intrafix system fixation was used for the femoral tunnel and the Milagro interference screw was used for tibial tunnels.KT-1000 arthrometer measurements,Lachman and Pivot-shift tests,and knee function with the Intemational Knee Documentation Committee (IKDC),Lysholm scores were used for clinical evaluation.Results All the patients were followed up for an average time of 24.71 ± 1.60 months (range,18-36 months).No patients had ligament re-rupture,deep vein thrombosis,exfliation of interference screw,joint pain and limited mobility during follow-up period.At the latest follow-up,the Lachman sign was Ⅰ degrees positive in 1 patient,and all patients had normal range of motion.The Lysholm scores increased from preoperative 67.51 ±4.92 to 96.41 ±6.31 at the latest follow up.The IKDC scores increased from preoperative 62.31 ±5.45 to 95.61±6.32 at the latest follow up.There was 93.3％ excellent and good rate,including excellent in 23 cases,good in 5 cases,and fair in 2 cases according to the IKDC.All knee function scores were improved.The results of KT-1000 were improved significantly (7.62± 1.25 mm vs.1.53± 1.02 mm at 30° of flexion,5.43± 1.21 mm vs 1.07± 1.02 mm at 90° of flexion) at the tensile fore of 134 N.Conclusion Arthroscopic ACL reconstruction using three-tunnel double-bundle methods with the Femoral-Intrafix system fixation is a reliable technique,which is easy to operate and has satisfactory short clinical outcome for knee function recovery.

Protective effect of Shenfu soup on myocardial ischemia in rats and expression of apelin / 中国药理学通报

Aim To study the effects of Shenfu soup onthe ISO -induced myocardial ischemia injury model ofrats and the influence of apelin level changes on myocardial ischemia.Methods The myocardial ischemiainjury model of rats was established by the subcutaneous injection of ISO.For 1 5 days,rats in Shenfugroups were given by gavage 3,6 and 1 2 g · kg -1Shenfu soup and rats in SF injection group were given6.67 g·kg -1 Shenfu injection,rats in sham group andmodel group were given the same volume of distilledwater.Rats were subcutaneously multipoint injectedISO for 5 days on the eleventh administrating day.Theeffects of Shenfu soup on myocardial morphology,serum myocardial enzyme levels,apelin mRNA level inserum and apelin protein level in myocardial tissue,and relationship between myocardial enzyme and apelinexpression were evaluated. Results Shenfu soupcould reduce the degree of myocardial tissue necrosisand compared with model group,CK values and LDHvalues of rats in middleand highdose groups were significantly lower (P <0.05 or P <0.01 ).However,the apelin mRNA level in myocardial tissue and apelinprotein level in serum of the rats in middleand highdose groups compared with model group had increased(P <0.05,P <0.01 ).Meanwhile,serum levels ofapelin and the expression of myocardial enzyme CK andLDH were negatively correlated.Conclusion Shenfusoup has a protective effect on myocardial ischemia injury in rats induced by ISO and the mechanism is involved with the promotion of apelin mRNA and proteinexpression,the inhibition of myocardial enzyme production and the improvement of myocardial ischemia.

Establishment of Anterior Instability of Gienohumeral Joint on Rabbits / 中国运动医学杂志

Objective To establish the animal model(rabbit) of shoulder instability for providing the experimental basis of related studies.Methods shoulder joints of 6 skeletally matured New Zealand white rabbits were measured with the anatomical characteristics and joint motion range in order to determine the operative approach,the similarities of skeletal structure,surrounding muscles,joint capsule and ligaments between rabbit and human were compared.Eighteen rabbits,weighing between 2.5 and 3kg were randomized into 2 groups(experimental group 12 and control 6).In experimental group,instability model was established by means of the operation procedure as follows:the glenohumeral joint of right shoulder was exposed by cutting the subscapularis tendon,then the anteroinferior labrum and surrounding capsular ligament were excised.For control group,sham operation was performed by only curing the skin and superficial tissue,the subscapularis tendon and glenoid structures was kept intact.The specimens of 6 rabbits were harvested 6 weeks after operation.The remaining rabbits of both experimental and control groups were killed 12 weeks post the operation for specimens processing.The motion range and instability were measured in all specimens.Results The gross anatomy of shoulder ioint in rabbit is similar to human.In experimental group,the stability is showed less than control,grade 2 anterior instability was found.The motion range was restricted in all directions,such as external and internal rotation,extension and abduction compared to control group.Conclusion Rabbit is suitable to establish animal model for shoulder instability and related iniuries,the animal model which was designed by this study could provide valuable information for the research of anterior shoulder instability.

Arthroscopically Assisted Mini-Open Rotator Cuff Repair for Rotator Cuff Tears / 中国微创外科杂志

Objective To study clinical results of arthroscopically assisted mini-open rotator cuff repair.Methods Twenty-two patients with rotator cuff tears were treated with arthroscopically assisted mini-open rotator cuff repair from March 1999 to March 2004.Thirteen patients underwent arthroscopic inspection,mini-open subacromial decompression,and rotator cuff repair.Nine patients underwent arthroscopic subacromial decompression and mini-open repair.The UCLA scoring system was used for outcome assessment.Results The 22 patients were followed for 12-72 months(mean,47 months).The UCLA scores were increased from 14.8?3.8 preoperatively to 32.0?4.7 postoperatively(t=15.086,P=0.000).The results were classified as excellent in 7 patients,good in 13 patients,fair in 1 patient,and poor in 1.Twenty patients were satisfied with the operative outcomes.Conclusions Arthroscopically assisted mini-open rotator cuff repair is an effective procedure for rotator cuff tears,with simplicity of performance and little invasion.

Investigation of surgically repaired menisci in 168 cases / 中华创伤骨科杂志

Objective To investigate the clinical effects and postoperative complications of arthrotomy and arthroscopy in repair of 170 menisci in 168 cases.Methods One hundred and sixty-eight patients with meniscus injury were repaired by arthrotomy or arthroscopy.They were 121 males and 47 females.There were 77 left knees and 91 right knees;117 medial menisci and 53 lateral ones.Their average age was 25.5?8.4 years old.Arthro- scopic repair methods included puncture and grinding,bio-absorbable meniscus arrow fixation,Outside-In suturing, Inside-Out suturing,Elite scuff instrument repairing,T-Fix fixation and FasT-Fix fixation techniques.The clinical results were assessed on the basis of symptoms,physical signs,Tegner scores and Lysholm scores of the cases. Postoperative complications were also investigated.Re-arthroscopic exploration was done for patients with obvious symptoms and physical signs.Results The average folluw-up time was 49.3?28.8 months.Their mean pre- operative Tegner score was 3.3?2.3,and their postoperative one 6.8?2.1 (P＜0.05).Their preoperative Lysholm score was 30.1?18.2,and their postoperative one 87.5?22.5 (P＜0.01).There were significant differences in Tegner and Lysholm scores before operation and after operation.Ninety-eight repaired menisci were rated as excellent(57.7%),57 as good (33.5%),10 as fair (5.9%),and five as poor (2.9%).The total ex- cellent and good result was 91.2%.Of the 19 patients with obvious symptoms and physical signs,re-arthroscopic exploration found no healing in five and partial healing in six.Postoperative complications included pain at the Outside-In suture nodes in three cases,referred pain at posterior articular capsule resulted from failed Outside-In meniscus anterior horn suturing in one case,and twinge at the meniscus arrow site in the posterior capsule in five cases.No serious lesion occurred at blood vessels or nerves.The postoperative complication incidence was 5.3%. Conclusion The eight methods of arthrotomy and arthroscopy to repair injured menisci investigated in our study can have a high successful rate and low perioperative and postoperative risk.

Arthroscopic treatment of osteoarthrosis of the elbow in nonathlete patients / 中国微创外科杂志

Objective To assess the effectiveness of arthroscopic debridement techniques for osteoarthrosis of the elbow in nonathlete patients. Methods Twenty-six nonathlete patients with elbow osteoarthrosis were treated with arthroscopic debridement from January 1999 to January 2006.Of the 26 patients,23 were followed for 4～86 months (mean,23 months).All of the 23 patients had complained of pain and loss of elbow motion and 4 patients had symptoms of ulnar neuritis. The Mayo Elbow Performance Score was used as evaluation criteria of the efficacy. Results Twenty-three patients were followed for 4～86 months (mean, 23 months). Twenty elbows (87%) were not painful or were only mildly painful, and three (13%) were moderately painful. The mean arc of flexion-extension was improved from 99.6? (range, 65?～135?) preoperatively to 122.1? (range, 80?～150?) at the time of follow-up. According to the Mayo Elbow Performance Score, the result was excellent in 16 elbows, good in 4, and fair in 3, with a rate of excellent or good results of 87%. Symptoms of ulnar neuritis disappeared in the 3 patients and continued without aggravation in the remaining 1 patient. Fourteen patients were greatly satisfied with the results, 6 satisfied, and 3 unsatisfied, the satisfactory rate being 87%. One patient reported a delayed ulnar nerve symptoms after operation. Conclusions Arthroscopic debridement techniques for elbow osteoarthrosis in nonathlete patients can yield satisfactory pain relief, significant increase in the range of motion, and quick recovery.

Diagnosis and treatment of partial-thickness rotator cuff tears / 中国微创外科杂志

Objective To discuss the diagnosis and treatment of partial-thickness rotator cuff tears.Methods A total of 14 cases of partial-thickness rotator cuff tears from April 1999 to January 2004 were surgically treated in this hospital.Before operation,X-ray examinations at anteroposterior view and at scapular outlet view were conducted in all cases,B-ultrasonography was conducted in 11 cases,and magnetic resonance imaging(MRI) or magnetic resonance arthrography(MRA),in 14 cases.Subacromial decompression and tear debridement was performed in 5 cases,while subacromial decompression and rotator cuff repair was performed in 9 cases.The University of California Los Angeles(UCLA) shoulder scoring system was used to evaluate the outcomes.Results The partial tears were identified at bursal-side in 7 cases and at articular-side in 7 cases.The 14 cases were followed for 1~6 years(mean,38 months).The UCLA scores were elevated from 15.9?3.9 preoperatively to 30.9?5.2 postoperatively(t=15.000,P=0.000).The curative results were classified as "good" in 13 cases and "poor" in 1 case.Conclusions Arthroscopy is a reliable method for the diagnosis of partial-thickness rotator cuff tears,which can be effectively treated with rotator cuff repairs.Arthroscopic repair gives little invasion and quick recovery.

Arthroscopic-assisted anterior cruciate ligament reconstruction / 中国微创外科杂志

In oder to make the bone tunnel in optimal position, effective and firm fixation, early functional recov- ery and minimally operative injury we reported a new technique in reconstructive anterior cruciate ligament(ACL)using patellar tendon autograft fixed with interference screw. With the assistance of arthroscopy 74 patients with ACL rupture were treated between October 1997 and April 1999. The clinical results showed that the operative injury was minimal, fixed bone grafts were accurate and the reconstructed ACL was isometricity. The reconstructed ligament could be fixed biologically and firmly because of used patellor tendon autograft with bone grafts at two end. Clinical experience of ar- throscopic - assisted ACL reconstruction was summarized.

A new method of arthroscopic total meniscectomy (a report of 169 cases) / 中国微创外科杂志

Objective To research for a new method of arthroscopic total meniscectomy with simple instru- ments. Methods One hundred and sixty nine cases were followed up for short period that had been operated on with a forward knife, a back cutting knife, a punch and a 30?scope from Nov. 1992. to Aug. 1998. Results The av- erage time of operation was 78 minutes. The operations had no injury to cartilage and ligament. It is necessary for only 7 .9 percent of patients to take analgesic intramuscularly after operation. Eight patients had a transient tourniquet paral- ysis. All of them could begin to work and exercise after postoperative 2 weeks. Conclusion As compared with the method introduced by David Sisk ,this method has the advantages of simple instruments, fewer ports and complications and minimal trauma Either lateral meniscus or medial meniscus can be cut off by the same method. This method is a safety and a better way to arthroscopic meniscectomy.

Clinical pathology of recurrent anterior dislocation of shoulder joint / 中华骨科杂志

Objective To comprehensively know clinical pathological change of recurrent anterior dislocation of shoulder joint by arthroscopy. Methods 52 patients with recurrent anterior shoulder dislocation were inspected by arthroscopy in our institute, 38 cases were male, 14 cases were female; the mean age were 24.7, from 16 to 49 years old. 2 epilepsy patients were excluded, the other 50 cases were divided into two groups, the first group included 32 shoulder dislocated patients accompanied with shoulder hyper-laxity. The other group included 18 purely traumatic shoulder dislocated patients. All patients were explored by arthroscopy and all pathological changes were recorded and the difference of pathological change between the two groups were contrasted. Results 51 cases showed anterior-inferior labrum injury, 50 cases showed Hill-Sachs injury, 32 cases showed biceps-tendon inflammation or injury, 30 cases showed bone or cartilage injury of anterior-inferior glenoid, 29 cases showed SLAP injury, 7 cases showed rotator cuff injury. Anterior-inferior labrum injury: labrum abraded disappear was more occurred in pure traumatic group(P=0.055) and ALPSA injury was more in hyper-laxity group (59.4% to 38.9%, P=0.164). Bone or cartilage injury of anterior-inferior glenoid were more occurred in purely traumatic group(P=0.083, P=0.052). Hill-Sachs injury was more superficial or only cartilage injury in hyper-laxity group but wider and deeper in purely traumatic group. Conclusion The general pathological changes of recurrent anterior shoulder dislocation sucessively are: anterior-inferior labrum injury, Hill-Sachs injury, biceps-tendon inflammation or injury, bone or cartilage injury of anterior-inferior glenoid, SLAP injury and rotator cuff injury. The pathological changes of the hyper-laxity group were lighter than purely traumatic group.

Arthroscopic subacromial decompression for subacromial impingement syndrome / 中华创伤杂志

Objective To explore the clinical results of arthroscopic subacromial decompression (ASD) for treatment of subacromial impingement syndrome. Methods Twelve cases with subacromial impingement syndrome from October 1998 to November 2003 were retrospectively studied. There was one case at degree Ⅰ, five at degree Ⅱ and six at degree Ⅲ according to Neer classification. Preoperative X-ray of obverse shoulder joint and outlet supraspinatus muscle was made. Seven cases was examined with ultrasonography and 10 with MRI or MRA. All cases were treated with arthroscopic subacromial decompression and arthroscopic acromioplasty and six cases underwent simultaneously arthroscopic suture of the rotator cuff. Results The follow up for 1-6 years (average 26 months) showed significant statistical difference upon preoperative UCLA score and postoperative UCLA score that were 16.9?4.0 and 32.5?1.4, respectively (t=-14.027,P﹤0.01). The results were excellent in two cases and good in ten. All cases were satisfied with the operation. Conclusions ASD is shown to be an effective procedure for subacromial impingement syndrome and has the advantages of minimal trauma and rapid postoperative recovery.