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Objective:To evaluate the clinical results of reduction and fixation via fibular osteotomy for treatment of old ankle fractures involving the posterior malleolus in middle-aged and elderly patients.Methods:A retrospective case series study was made for 13 middle-aged and elderly patients with old ankle fractures involving the posterior malleolus treated from July 2013 to March 2018 in Sixth People's Hospital Affiliated to Shanghai Jiao Tong University. There were 2 males and 11 females, with age of 48-63 years (mean, 54.8 years). The mean surgical period was 8-18 weeks from injury (mean, 9.6 weeks). According to Haraguchi classification, all posterior malleolar fractures were type I. According to Lauge-Hansen classification, there were 2 patients with pronation-external rotation type and 11 with supination-external rotation type. All patients underwent open reduction and fixation via fibular osteotomy. Bone healing time and postoperative complications were recorded. Clinical results were assessed by visual analogue scale (VAS) score and American orthopedic foot and ankle society (AOFAS) ankle-hind score.Results:All patients were followed up for average 20.3 months (range, 9-36 months). All patients had bone union, with the mean healing period of 12-15 weeks (average 14.8 weeks). No infection, implant loosening or breakage occurred after operation. X-ray film of one patient suggested mild traumatic arthritis. At the latest follow-up, VAS was improved to (1.0±0.2)points compared to pre-operative (5.3±0.6)points ( P<0.05), and the AOFAS ankle-hind score was improved to (85.2±7.4)points compared to pre-operative (42.4±6.7)points ( P<0.05). According to the AOFAS ankle-hind score, the results were excellent in 4 patients, good in 8, moderate in 1, with the excellent and good rate of 92%. Conclusion:For old ankle fractures involving the posterior malleolus in the middle-aged and elderly patients, reduction and fixation via fibular can reduce postoperative complications, facilitate bone healing, relieve ankle pain and improve function recovery.
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Objective To evaluate the surgical techniques and clinical outcomes of ankle distraction arthroplasty with platelet-rich plasma(PRP) injection for post-traumatic ankle arthritis.Methods From May 2012 to May 2017,32 patients with post-traumatic ankle arthritis were treated at Department of Orthopaedic Surgery,Shanghai Sixth Peopled Hospital.They were 22 males and 10 females,with an age of 32.6±5.8 years(from 18 to 40 years).Their course of disease was 14.0±2.8 months(from 6 to 24 months).After failure of the conservative management for at least 6 months,they received ankle distraction arthroplasty with PRP injection.American Orthopaedic Foot&Ankle Society(AOFAS) ankle-hindfoot score and visual analogue scale(VAS) were used to evaluate the final overall outcomes.Range of motion(ROM) of the ankle joint and complications were also recorded postoperatively.Results Pin tract infection occurred in 12 patients but responded to alcohol care.All the patients were followed up for an average of 36 months(from 18 to 60 months).The VAS score decreased significantly from preoperative 6.8±1.2 to postoperative 8±1.4;the AOFAS ankle-hindfoot score increased significantly from preoperative 38.5±6.2 to 80.3±8.1 at the final follow-up;dorsal expansion and plantar flexion of the ankle increased significantly from preoperative 8.3°±7.0° and 24.7°±6.4° to 12.8°±6.5° and 31.4°±5.3° at the final follow-up,respectively(all P<0.05).Two patients had to receive salvage arthrodesis after conservative management failed to relieve their symptoms or delay the progression of their post-traumatic arthritis.Conclusion Ankle distraction arthroplasty with PRP injection is an effective ankle preserving surgery which can relieve symptoms,improve functions and delay progression of post-traumatic ankle arthritis.
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Objective@#To compare instrumentation with 3D-printed patient-specific guides versus conventional techniques in supramalleolar osteotomy for varus ankle osteoarthritis.@*Methods@#A retrospective analysis was done of the 21 patients with varus ankle osteoarthritis who had been treated at Department of Orthopaedics, Shanghai JiaoTong University Affiliated Sixth People's Hospital from January 2017 to December 2018. They were divided into 2 groups by their treatment methods. In the 9 patients treated by instrumentation with 3D-printed patient-specific guides, there were 6 males and 3 females with an age of 54.6±8.6 years, 4 left and 5 right sides involved, and one case of Takakura stage 1, 3 cases of Takakura stage 2 and 5 cases of Takakura stage 3a. In the 12 patients treated by conventional techniques, there were 7 males and 5 females with an age of 53.0±6.5 years, 7 left and 5 right sides involved, and one case of Takakura stage 1, 5 cases of Takakura stage 2 and 6 cases of Takakura stage 3a. The 3D printed guide group and the conventional group were compared in terms of operation time, intraoperative blood loss and frequency of intraoperative fluoroscopy, tibial anterior surface angle (TAS), talar tilt angle (TT), and tibial lateral surface angle (TLS). The differences in TAS, TT and TLS between pre- and post-operation in the 3D printed guide group were also evaluated.@*Results@#There were no significant differences in the preoperative general data between the 2 groups (P>0.05), indicating they were comparable. All the patients were available for follow-up for an average of 7.8 months (from 3 to 15 months). The 3D printed guide group incurred significantly shorter operation time (106.2±10.6 min), less intraoperative blood loss (207.2±16.0 mL) and lower fluoroscopy frequency (2±0) than the conventional osteotomy group (all P<0.01). The post-operative TAS (94.3°±3.2°) and TT (3.8°±0.8°) angles in the 3D guide group were significantly different from their preoperative values (84.6°±3.5° and 7.6°±1.6°) (P<0.01). The 3D printed guide group was not significantly different from the conventional group in postoperative TAS (94.3°±3.2° versus 92.4°±5.9°), TT (3.8°±0.8° versus 4.2°±1.1°) or TLS (83.7°±3.4° versus 84.2°±2.2°) angles (P>0.05).@*Conclusions@#Compared with conventional techniques, instrumentation with 3D-printed patient-specific guides can shorten operation time and reduce intraoperative blood loss and fluoroscopy frequency. The 3D printed patient-specific guides in osteotomy can facilitate accurate correction of varus deformity, leading to similar efficacy compared with conventional osteotomy.
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Objective To compare instrumentation with 3D-printed patient-specific guides versus conventional techniques in supramalleolar osteotomy for varus ankle osteoarthritis.Methods A retrospective analysis was done of the 21 patients with varus ankle osteoarthritis who had been treated at Department of Orthopaedics,Shanghai JiaoTong University Affiliated Sixth People's Hospital from January 2017 to December 2018.They were divided into 2 groups by their treatment methods.In the 9 patients treated by instrumentation with 3D-printed patient-specific guides,there were 6 males and 3 females with an age of 54.6 ±8.6 years,4 left and 5 right sides involved,and one case of Takakura stage 1,3 cases of Takakura stage 2 and 5 cases of Takakura stage 3a.In the 12 patients treated by conventional techniques,there were 7 males and 5 females with an age of 53.0 ± 6.5 years,7 left and 5 right sides involved,and one case of Takakura stage 1,5 cases of Takakura stage 2 and 6 cases of Takakura stage 3a.The 3D printed guide group and the conventional group were compared in terms of operation time,intraoperative blood loss and frequency of intraoperative fluoroscopy,tibial anterior surface angle (TAS),talar tilt angle (TT),and tibial lateral surface angle (TLS).The differences in TAS,TT and TLS between pre-and post-operation in the 3D printed guide group were also evaluated.Results There were no significant differences in the preoperative general data between the 2 groups (P ＞ 0.05),indicating they were comparable.All the patients were available for follow-up for an average of 7.8 months (from 3 to 15 months).The 3D printed guide group incurred significantly shorter operation time (106.2 ± 10.6 min),less intraoperative blood loss (207.2 ± 16.0 mL) and lower fluoroscopy frequency (2 ± 0) than the conventional osteotomy group (all P ＜ 0.01).The post-operative TAS (94.3° ± 3.2°) and TT (3.8° ± 0.8°) angles in the 3D guide group were significantly different from their preoperative values (84.6°±3.5° and 7.6°± 1.6°) (P ＜ 0.01).The 3D printed guide group was not significantly different from the conventional group in postoperative TAS (94.3°± 3.2° versus 92.4°±5.9°),TT (3.8° ± 0.8° versus 4.2° ± 1.1°) or TLS (83.7° ± 3.4° versus 84.2° ± 2.2°) angles (P ＞0.05).Conclusions Compared with conventional techniques,instrumentation with 3D-printed patient-specific guides can shorten operation time and reduce intraoperative blood loss and fluoroscopy frequency.The 3D printed patient-specific guides in osteotomy can facilitate accurate correction of varus deformity,leading to similar efficacy compared with conventional osteotomy.
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Objective To investigate clinical effect of minimally invasive knotless bridge-suture technique for acute achilles tendon rupture.Methods The clinial data of 23 patients with acute achilles tendon rupture treated in Department of Orthopaedics,Shanghai Jiao Tong University Affiliated Sixth People's Hospital from August 2017 to February 2018 were analyzed retrospectively.There were 21 males and 2 females,aged (37.1 ± 5.6) years,with an age range of 29-51 years.Minimally invasive knotless bridge-suture technique was performed in all cases until the soft tissue condition of the patients improved.Patients were followed up by outpatient review at 3 weeks,6 weeks,3rd,and 6th months postoperatively,followed by every 3 months,followed up 12 to 18 months,and the deadline was April 2019.Ratio of perimeter of the affected lower extremity to that of the uninjuried,number of repetitions for one leg calf rise in one minute,American Orthopaedic Foot and Ankle Society (AOFAS) anklehind foot score,the achilles tendon total rupture score(ATRS) and time to return to work were investigated at last follow-up,as well as complications during the follow-up period.Results Twenty-three cases were followed up.At last follow-up,ratio of perimeter of the affected lower extremity to that of the uninjuried was (92.7 ± 1.8) ％,number of repetitions for one leg calf rise in one minute was (25 ± 2) times,AOFAS ankle-hind foot score was (91.5 ±2.2) scores,ATRS was (92.6 ±2.4) scores,time to return to work ranged from 6 to 9 weeks.All patients underwent first-stage healing.No skin necrosis,superficial infection and sural nerve injury occurred.No achilles tendon re-rupture was seen during the follow-up period.Conclusion Minimally invasive knotless bridgesuture technique for acute achilles tendon rupture is applied easily and less invasive,enabling patients to return to work earlier and proved to be a secure and effective treatment.
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Cartilage injury is very common in clinical,which can be caused by multiple factors,such as trauma,degenerative change and chronic strain.The clinical application of cartilage injury treatment includs conservative treatment,surgical treatment,and chondrocytes implant with cell scaffold,but all these methods are still unable to achieve a very satisfactory effect.Therefore,new explorations have been made in the field of cartilage repair,and the metal and other inorganic substances with better human compatibility have made great progress.Tantalum,a kind of transitional element,which has excellent chemical and physical properties and biocompatibility,is becoming more and more concerned in cartilage repair.This paper will review the research progress of tantalumin the repair of cartilage in recent years.
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Objective To investigate the effect of amiloride on the invasion capacity of esophageal carcinoma EC9706 cell line in vitro and to elucidate its possible mechanism.Methods The invasion capacities of EC9706 cells pretreated with amiloride were measured by transwell chamber assay. The urokinase-type plasminogen activator (uPA) transcription were determined by RT-PCR.The protein expression of uPA were assessed by Western blot.Results After the EC9706 cells were pretreated with amiloride at different concentrations,the number of invaded cells was obviously less than those of control group with obvious dosage dependent pattern (96±7,78±6,57±6,33±4,15±3,F =43.46,P ＜ 0.01).The transcription levels of uPA mRNA and the protein expression levels of uPA in EC9706 cells decreased significantly compared with the control (mRNA:0.623±0.065,0.526±0.054,0.389±0.041,0.312±0.038,0.247±0.025,F =6.71,P ＜0.01; protein:0.732±0.064,0.644±0.057,0.533±0.058,0.391±0.036,0.267±0.043,F =6.71,P ＜0.01).Conclusion Amiloride inhibits the invasion capacity of esophageal carcinoma EC9706 cells.The mechanism might be associated with down-regulation of the expression of uPA.
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Objective To investigate the expression and influence to tumor angiogenesis of urokinase-type plasminogen activator (uPA) and vascular endothelial growth factor (VEGF) in esophageal carcinoma. Methods The expression of uPA and VEGF in the tissue of normal (18 cases) and esophageal carcinoma (68 cases) were evaluated by SP immunohistochemistry, CD34 was detected as marking tumor microvessel density (MVD). uPA and VEGF expression were assessed as to the pathologically biological features of esophageal cancer and to the influence to tumor angiogenesis. Results The positive rates of uPA were 27.8 % (5/18) and 70.6 % (48/68) in the tissue of normal and esophageal carcinoma, respectively, there was significant difference in two tissues (x2 =11.63, P 0.05), but associated with clinical stage, histologic grading and lymph node metastasis (P <0.05). Conclusion Rising expression levels of uPA and VEGF are common in esophageal carcinoma. Altered expression of uPA and VEGF may contribute to tumor angiogenesis of esophageal carcinoma, whose overexpression indicate worse prognosis.
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Objective To study the proliferation and apoptosis of endothelia cells in cavernous hemangioma of liver(CHL),and to find their relation with the occurrence and development of CHL.Methods Twenty two CHL speciments of resection or biopsy in our hospital were collected.Another 10 speciments of small blood vessel in portal area of normal liver tissues and 10 speciments of strawberry hemangioma were collected as contrasts .The expression of proliferating cell nuclear antigen(PCNA) was assessed with monoclonal antibody of PCNA by immunohistochemical ABC method.The apoptosis of cells was assessed by end labeling method(TUNEL).Results Proliferation index(PI) of endothelia cells in CHL was 13.27?5.79.There wasn't significant difference from PI of endothelia cells of small blood vessels in portal aera of normal liver(10.85?4.79),while significant difference did exist compared with PI of tumor cells in strawberry hemangioma ( 29.31 ?8.55). Apoptosis index(AI) of endothelia cells in CHL was (3.49?1.36).There wasn't significant difference from AI of endothelia cells of small blood vessels in portal aera of normal liver(2.65?1.06),while significant difference did exist compared with AI of tumor cells in strawberry hemangioma ( 11.38 ?2.66,t=11.18,P