Effectiveness of arthroscopic autologous iliac bone grafting with double-row elastic fixation for recurrent anterior shoulder dislocation with massive glenoid bone defect / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of arthroscopic autologous iliac bone grafting with double-row elastic fixation in treatment of recurrent anterior shoulder dislocation combined with massive glenoid bone defects.@*METHODS@#Between January 2018 and December 2021, 16 male patients with recurrent anterior shoulder dislocation combined with massive glenoid bone defects were treated with arthroscopic autogenous iliac bone grafting and double-row elastic fixation. The patients were 14-29 years old at the time of the first dislocation, with an average age of 18.4 years. The causes of the first dislocation included falling injury in 5 cases and sports injury in 11 cases. The shoulders dislocated 4-15 times, with an average of 8.3 times. The patients were 17-37 years old at the time of admission, with an average age of 25.1 years. There were 5 left shoulders and 11 right shoulders. The preoperative instability severity index (ISIS) score of the shoulder joint was 5.8±2.1, and the Beighton score was 4.3±2.6. The University of California Los Angeles (UCLA) score, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and Rowe score were used to evaluate shoulder function, and the degree of the glenoid bone defect repair was observed based on CT after operation.@*RESULTS@#All incisions healed by first intention, and no complication such as incision infection or neurovascular injury occurred. The patients were followed up 12 months. At 12 months after operation, UCLA score, Constant score, ASES score, and Rowe score all significantly improved when compared with the scores before operation ( P<0.05). CT imaging showed the degree of glenoid bone defect was significantly smaller at immediate, 6 and 12 months after operation when compared with that before operation ( P<0.05), and the bone blocks healed with the scapula, and bone fusion had occurred at 12 months.@*CONCLUSION@#Arthroscopic autologous iliac bone grafting with double-row elastic fixation is a safe treatment for recurrent anterior shoulder dislocation combined with massive glenoid bone defects, with good short-term effectiveness.

Clinical expert consensus on platelet-rich plasma treatment for lateral epicondylitis (2022 version) / 中华创伤杂志

Lateral epicondylitis is a common clinical disease with characteristics of lateral elbow pain, insidious onset and easy recurrence, which can cause forearm pain and decreased wrist strength, seriously affecting patients′ daily life and work. Although there are various treatment methods for lateral epicondylitis with different effects, standard treatments are still lacking nowadays. Platelet-rich plasma (PRP) has good effects on bone and tendon repair, and is now widely used in the treatment of lateral epicondylitis. However, there is a lack of a unified understanding of the technology and specifications of PRP in the treatment of lateral epicondylitis. Therefore, the Sports Medicine Branch of the Chinese Medical Association and Physical Medicine and Rehabilitation Branch of the Chinese Medical Association organized experts in the fields of sports medicine and rehabilitation medicine in China to formulate the "clinical expert consensus on platelet-rich plasma treatment for lateral epicondylitis (2022 version)", and proposed suggestions based on evidence-based medicine mainly from the concept, epidemiology and pathophysiology of lateral epicondylitis, symptoms, signs and imaging manifestations of lateral epicondylitis, PRP concept and application component requirements, quality control of PRP preparation technology, indications and contraindications of PRP in the treatment of lateral epicondylitis, PRP injection in the treatment of lateral epicondylitis, application of PRP in the operation of lateral epicondylitis, related problems after PRP treatment of lateral epicondylitis, evaluation of the results after PRP treatment of lateral epicondylitis, and health and economic evaluation of PRP treatment of lateral epicondylitis, so as to provide guidance for clinical diagnosis and treatment.

Clinical evidence-based guideline for the diagnosis and treatment of anterior cruciate ligament injury (2022 version) / 中华创伤杂志

The anterior cruciate ligament (ACL) injury is a common sports injury that has a significant impact on knee function and patients′ mobility. With the popularity of national fitness campaign in China, the incidence of ACL injury is increasing year by year. Currently, there still lacks clinical standards or guidelines on how to choose appropriate treatment methods, surgical plans and rehabilitation protocols for ACL injury. In order to timely reflect the new treatment concept of ACL injury, standardize its diagnosis and treatment and improve the curative effect, the Sports Medicine Society of Chinese Research Hospital Association and the Editorial Board of Chinese Journal of Trauma organized domestic orthopedic and sports medicine experts to formulate the "clinical evidence-based guideline for the diagnosis and treatment of anterior cruciate ligament injury (2022 version)" based on the level of evidence-based medicine and in compliance with the principle of scientificity, practicability and advancement. The present guideline includes 12 recommendations for the diagnosis, treatment and rehabilitation of ACL injury in order to provide guidance and assistance for the clinical diagnosis and treatment of ACL injury in China.

Illness perception and influencing factors among patients with non-alcoholic fatty liver disease / 预防医学

Objective@#To investigate the perception about illness and identify its influencing factors among patients with non-alcoholic fatty liver disease ( NAFLD ) , so as to provide insights into the management of NAFLD patients. @*Methods@#NAFLD patients admitted to Hangzhou First People's Hospital Affiliated to Medical School of Zhejiang University from January to June, 2020, were selected as the study subjects, and subjects' demographic features were collected using questionnaires, including gender, age and education level. The perception about illness, coping models and social support were assessed using the Brief Illness Perception Questionnaire (BIPQ), Medical Coping Modes Questionnaire ( MCMQ ) and Social Support Rating Scale ( SSRS ), respectively, and factors affecting the perception about illness were identified using multivariable linear regression analysis among NAFLD patients.@*Results@#The 286 respondents included 151 males ( 52.80% ) and 135 females ( 47.20% ), and had a mean age of ( 55.27±10.39 ) years. The mean illness perception score was 38.55±9.21 among the respondents. The mean SSRS score was 42.90±8.64. The mean coping mode scores of confronce, avoidance and resignation were 23.51±4.30, 17.49±2.82, and 7.12±2.05, respectively. Multivariable linear regression analysis identified education level ( high school, β'=-0.216; diploma and above, β'=-0.355 ), household monthly income per capita ( β'=-0.372 ), regular exercise ( β'=-0.310 ), coping modes ( confronce, β'=-0.326; avoidance, β'=-0.191 ) and social support level ( β'=-0.259 ) as factors affecting the perception about illness among NAFLD patients.@*Conclusion@#Negative perceptions about illness are found among NAFLD patients, and household income, education level, regular exercise and coping modes are factors affecting the illness perception among NAFLD patients.

Animal models for study on rotator cuff injury / 中南大学学报(医学版)

Rotator cuff injuries are the most common cause of shoulder pain and dysfunction. Ideal animal shoulder models should have similar shoulder anatomy and function as human, and are able to replicate the microenvironment change after tendon injury. At present, a variety of animal models including rat, mouse, rabbit, sheep, canine, bovine, and primate have been used to study the mechanism of rotator cuff injury, effects of different repair techniques, and factors affecting tendon to bone healing. Although large animal models are more anatomically similar to humans, small animal models are more convenient in revealing the biological mechanism of rotator cuff injury and healing. Choosing appropriate animal models based on research objectives and establishing new small animal models play a critical role in revealing the mechanism of rotator cuff diseases and developing novel treating strategies.

Progress in diagnosis and treatment of post-traumatic osteomyelitis / 中南大学学报(医学版)

Post-traumatic osteomyelitis is one of the most common disorders of bone infection, which is secondary to open fracture caused by machinery injury, traffic accident, and it is also the main manifestation in the postoperative infection of open fracture. After trauma, bacteria invade bone tissue and reproduce rapidly in large quantities, which easily leads to osteomyelitis. Patients are often complaint of pain at the affected limb, loss of function, or even amputation due to deteriorated infection, resulting in loss of labor capability and poor quality of life. Because the diagnosis and treatment are not timely and standard, the treatment for post-traumatic osteomyelitis is often delayed, resulting in the difficulty of clinical cure. It also makes patients and their families bear a serious financial burden. However, the diagnosis and treatment for this disease is difficult for orthopedic physicians. In recent years, imaging methods (such as CT and MRI) combined with immune techniques have significantly improved the diagnostic accuracy and early diagnosis ability. The application of new diagnostic technologies (such as gene chip and second-generation sequencing) also makes the diagnosis more convenient and sensitive. The novel reconstruction and repair surgery (such as Ilizarov technology and Orthofix LRS technology) provides new treatment direction for orthopedic surgeons and patients.

Arthroscopic reconstruction of coracoclavicular ligament by suspensory fixation for management of acute acromioclavicular joint dislocation and MRI follow-up study / 中南大学学报(医学版)

OBJECTIVES@#To explore the safety and effectiveness of arthroscopic reconstruction of coracoclavicular ligament by suspensory fixation to manage the acute acromioclavicular joint dislocation.@*METHODS@#From January 2016 to December 2017, 18 cases of acute acromioclavicular joint dislocation were carried out with arthroscopic reconstruction of coracoclavicular ligament by double Endobutton plate suspensory fixation. Anteroposterior view X-ray plain radiographs were obtained on the second day, 6 months and 12 months after the surgery, MRI was performed in 1 year after operation. Meanwhile, subjective and objective scoring were obtained by Vsual Analogue Scale (VAS), Rating Scale of the American Shoulder and Elbow Surgeons (ASES) and University of California at Los Angeles Shoulder Rating Scale (UCLA).@*RESULTS@#All patients were followed up for 12 to 30 months (an average of 18 months). There was no patient with infection, neurovascular injury, loosening and breakage of internal fixation, re-dislocation of acromioclavicular joint, clavicular fracture, coracoid process fracture, etc. Postoperative X-ray showed that all acromioclavicular joints were completely relocated. The follow-up of MRI after 1 year showed no obvious dislocation of acromioclavicular joint and good recovery of acromioclavicular space. Postoperative shoulder joint function, VAS, ASES, UCLA and acromioclavicular distance were significantly improved compared with those before surgery, with statistically significant differences (all <0.05).@*CONCLUSIONS@#Arthroscopic reconstruction of coracoclavicular ligament by suspensory fixation to manage the acute acromioclavicular joint dislocation has the advantages of minimal invasive, rapid functional recovery and less complications and satisfactory early clinical results.

Effects of adenosine stress on left ventricular myocardial strain mechanics in healthy rabbits / 中华超声影像学杂志

Objective:To explore the changes of myocardial strain mechanics in healthy rabbits in the physiological condition by using speckle tracking echocardiography (STE) combined with adenosine stress.Methods:Twenty healthy rabbits underwent STE both at rest and during adenosine stress. The dynamic original images of 3 consecutive cardiac cycles of the standard views from the left ventricular (LV) short axis and apical long axis were acquired and analyzed by the Echo PAC workstation. The procedure was performed to obtain LV global longitudinal peak strain, global circumferential peak strain, and global radial peak strain both at rest and during adenosine stress.Results:There were no significant differences in heart rate and LV structural and functional parameters between baseline and adenosine stress ( P>0.05). After adenosine stress, LV global longitudinal peak strain and global circumferential peak strain increased significantly when compared with those at rest ( P<0.001), while LV global radial peak strain did not change significantly( P>0.05). Conclusions:Adenosine stress echocardiography combined with STE can be used to evaluate the characteristics of myocardial strain mechanics in rabbits in the physiological condition. This research provides reference value for the application of adenosine stress echocardiography in rabbit models with cardiovascular disease in future.

"Outside-in" Arthroscopic Cam Resection in the Treatment of Femoroacetabular Impingement Syndrome / 中国运动医学杂志

Objective To evaluate the efficacy and safety of "outside-in" arthroscopic cam resection in the treatment of femoroacetabular impingement (FAI)syndrome.Methods Nine patients were treated with "outside-in" hip arthroscopy for cam or mixed type FAI syndrome between July 2015 and July 2016.All the 9 patients(11 hips)underwent osseous correction of the femoral neck and labral debridement.Before the surgery and 12 months after it,all patients were evaluated using the Harris Score and their complications were observed.Results The average postoperative Harris Score(92.5,range from 64 to 100)was significantly better compared with the preoperative one(56.4,range from 22 to 70,P＜ 0.001).One patient with blister on dorsal foot and another with fluid leakage were cured.No neurovascular injuries or cartilage injuries were found among all the patients.Conclusion "Outside-in" arthroscopic treatment of FAI with osseous correction and labral debridement is safe and effective.

Application of pie-crusting the medial collateral ligament release in arthroscopic surgery for posterior horn of medial meniscus in knee joint / 中南大学学报(医学版)

Objective:To explore the effectiveness and safety of pie-crusting the medial collateral ligament release (MCL) in treating posterior horn of medial meniscus (PHMM) tear in tight medial tibiofemoral compartment of knee joint.Methods:Thirty-two consecutive patients with PHMM tear in tight medial tibiofemoral compartment of knee joint were admitted to our department from January,2013 to December,2014.All patients were performed pie-crusting the MCL release at its tibial insertion with 18-gauge intravenous needle.All patients were evaluated by valgus stress test and bilateral valgus stress radiograph at postoperative 1st day,4th week and 12th week.Visual Analogue Scales (VAS),Lysholm scores,Tegner scores and International Knee Documentation Committee (IKDC) scores were recorded at the 1st,3th,6th month follow-up,then follow-up every 6 months.Results:The mean follow-up was 28 (24-36) months.All cases were negative in valgus stress test.MCL rupture,femoral fracture,articular cartilage lesion and neurovascular injury were not found at the last follow-up.The median medial joint space width of affected side and unaffected side for valgus stress radiographs were 6.8 mm and 4.3 mm (P＜0.05) at the 1st day,5.5 mm and 4.2 mm (P＜0.05) in the 4th week and 4.8 mm and 4.3 mm (P＞0.05) at the 12th week,respectively.VAS scores was changed from 4.5±1.5 preoperatively to 1.7±1.0 at the final follow-up (t=16.561,P＜0.05).Lysholm scores was changed from 52.3±5.8 preoperatively to 93.2±6.3 at the final followup (t=-41.353,P＜0.05).Tegner scores was changed from 4.1±1.1 preoperatively to 5.5±0.6 at the final follow-up (t=-18.792,P＜0.05).IKDC scores was changed from 54.5±6.2 preoperative to 93.8±4.5 at the final follow-up (t=-38.253,P＜0.05).Conclusion:Pie-crusting the medial collateral ligament release is a safe,minimal invasive and effective surgical option for posterior horn of medial meniscus tear in tight medial tibiofemoral compartment of knee joint.

Treatment of patellofemoral instability in adolescent by anatomical double-bundle medial patellofemoral ligament reconstruction with double suture anchor technique / 中南大学学报(医学版)

Objective:To explore the clinical outcomes of anatomical double-bundle medial patellofemoral ligament (MPFL) reconstruction with double suture anchor technique in treating patellofemoral instability in adolescent.Methods:Twenty-five young people with patellofemoral instability (25 knees) in our department from January 2013 to December 2014 were enrolled for this study.All patients were performed anatomical double-bundle MPFL reconstruction with arthroscopic-assisted suture anchors technique in the patella,and fixed in the femoral socket with absorbable interference screw.All patients are evaluated by different methods,including patient's satisfaction,patellar apprehension test,recurrent subluxation/dislocation,CT assessment of bone tunnel and patellar tilt angle.Lysholm scores,Tegner scores and Kujala scores were recorded at the final follow-up.Results:The mean follow-up was 24 (range 20-40) months.All cases were observed in negative patellar apprehension test.Infection,recurrent subluxation/dislocation and patellar fracture were not found at the last follow-up.CT results demonstrated that the tunnel position were good.The patellar tilt angle was decreased from 21.6°±2.3° to 10.5°±1.6° (P＜0.05);the Lysholm scores was increased from 51.7±5.3 to 93.8±6.5 (P＜0.05).Tegner scores was increased from 4.1± 1.1 to 5.5±0.6 (P＜0.05).Kujala scores was increased from 53.5±6.4 to 94.6±4.3 (P＜0.05).Conclusion:Arthroscopic-assisted anatomical double-bundle MPFL reconstruction with the suture anchors technique is a safe,minimal invasive and effective surgical option for treating patellofemoral instability in adolescent.

Autogenous tendon transplantation for repair of grade III medial collateral ligament injury / 中国组织工程研究

BACKGROUND:Young patients with cruciate ligament injury and high activity levels are prone to grade III medial colateral ligament injury in knee joint. Conventional construction methods such as direct restoration of injured ligaments and muscle-tendon transposition may induce the loosening of medial colateral ligament complex. OBJECTIVE:To explore the clinical effect of autologous tendon transplantation for grade III medial colateral ligament injury of the knee joint. METHODS: Forty-seven patients with grade III medial colateral ligament rupture were treated by operative repair and reconstruction. After repairing the anatomical structure of medial colateral ligaments, we liberated organic semitendinous tendon, bone-patela tendon-bone, and hamstring tendon, to reconstruct superficial medial colateral ligament. RESULTS AND CONCLUSION:Thirty-seven patients were folowed up for 48 months. Preoperative Lysholm score, IKDC score, Tegner score at the final folow-up, and the widened medial joint space on valgus stress X-Ray films were significantly improved compared with before reconstruction (P < 0.05). According to clinical efficacy scores, 12 cases achieved excelent reconstruction, 18 cases achieved good reconstruction, 4 cases achieved moderate reconstruction, and 3 cases achieved poor reconstruction. The excelent and good rate was 82%. Medial colateral ligament reconstruction based on repairing the anatomical structure is effective and satisfactory. Autologous bone-patela tendon-bone or semitendinous tendon is a good choice for medial colateral ligament reconstruction.

Synovial lipoma in intra-patellar fat pad of the knee joint

Intra-articular synovial lipoma is an unusual tumorous pathologically benign condition and only a small number of case reports have been published to date. This manuscript describes the case of a 19-year-old adolescent who presented with right knee pain and loss of movement caused by an intra-articular synovial lipoma of the knee joint. A MRI scan revealed an intra-articular soft tissue neoplasm within the lateral compartment of the joint. Arthroscopy confirmed an encapsulated neoplasm that arose from the intra-patellar fat pad, and extended to the lateral compartment and trochlear groove. Additionally, histological analysis revealed synovial lipoma

Impact of fractionated local irradiation on lung metastasis in H22-bearing mice and exploration of its mechanism / 中华放射医学与防护杂志

Objective To study the impact of local fractionated irradiation on lung metastasis in H22-bearing mice, and to explore its mechanism involved. Methods Subcutaneous transplantation tumor model bearing with H22 was established. Mice were divided into three groups as healthy control, tumor control and irradiation groups. The size of subcutaneous tumors was measured and lung metastasis was observed. The expressions of PCNA, VEGF and MVD were detected immunohistochemically. The plasma levels of CD4 and CD8 were determined by using flow cytometry. Results The tumor size in irradiated group was smaller than that in tumor control group. The tumor inhibition rate in irradiated group was 30%.Lung metastasis in irradiated group was more severe than that in tumor control group (x2 = 8.31,4.48,9. 60, P＜ 0.05 ). The expressions of PCNA, VEGF and MVD in two groups were statistically different( t =23.78,-2.47, -6.43, P ＜ 0. 05). The levels of CD4 and CD8 in irradiated group were statistically different compared to healthy control group ( t = 4. 72 and 3.31, P＜ 0.05 ). Conclusions For the H22 model, radiation might inhibit the local transplantation tumor, but increase the risk of lung metastasis.

Energy expenditure of upper limb movements / 中国组织工程研究

BACKGROUND: Many methods involved in measuring energy expenditure of physical action, however, study regarding measurements of upper limber movement energy expenditure are few.OBJECTIVIE: To measure the energy expenditure of limber movement using indirect calorimetry, and to analyze the characteristics of upper limber movement energy expenditure and influencing factors such as age and gender.DESIGN, TIME AND SETTING: The comparison observation was performed at the Jiangsu Institute of Sports Science from January to March 2009.PARTICIPANTS: Totally 108 health adults, including 47 males and 61 females, participated in the study, 65 of them aged 20-39 years, and the remained 43 aged 40-59 years.METHODS: Energy expenditure of 4 upper limb movements were performed, including sitting posture arm swing (60 times/min),elbow flexion (40 times/min), shoulder flexion-extension (60 times/min), and lateral arm raise (30 times/min). At each interval,have a 3-minute rest.MAIN OUTCOME MEASURES: Oxygen expenditure of 4 kinds upper limb movements were measured by MetaMax 3B tester. RESULTS: Rest oxygen expenditure of males were greater than that of females (P < 0.05), greater in 20-39 years old than 40-59 years old (P < 0.05). The greatest oxygen consumption occurred in males with arm swing [(550.9±90.6) mL/min], which was (425.8±75.7) mL/min in females. The lowest oxygen expenditure was elbow bend [male: (440.4±82.7) mL/min, female: (367.0±60.1) mL/min]. Net oxygen expenditure of all 4 kinds of upper limb movements was lower than 250mL/min (1 metabolic equivalent).CONCLUSION: ① The energy expenditure of usual upper limber movements below 1 metabolic equivalent. ② Age and body mass has more effect on resting energy expenditure than the gender. ③ The efficiency of young adults upper limb movements is higher than old adults.