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Objective:To investigate the mid-term clinical outcomes of selective column arthrodesis based on the three-column theory in the treatment of malunion of Lisfranc injury.Methods:The 28 patients with malunion of Lisfranc injury were analyzed retrospectively who had been treated by selective column arthrodesis at Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine from January 2011 to January 2020.They were 18 males and 10 females, with an average age of 37.2 years(from 18 to 65 years). Twelve left and 16 right sides were affected. According to Myerson's three-column classification, one case was medial column injury (type A), 4 ones middle column injury (type B), 7 ones medial plus middle columns injury and 16 ones three-column injury. Medial column arthrodesis was conducted in 7, middle column arthrodesis in 4 and medial plus middle columns arthrodesis in 17. The American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and visual analogue scale (VAS) were compared between preoperation and the last follow-up to evaluate the improvements in foot function and pain. The operation-related complications were recorded.Results:All patients were followed up for an average of 35.6 months (from 18 to 60 months). The AOFAS midfoot score increased from 43.1±4.1 at pre-operation to 84.1± 7.4 at the last follow-up and the VAS score decreased from 5.7±1.3 at pre-operation to 2.0±0.9 at the last follow-up (both P<0.001). The wounds healed in 28 patients, 3 of whom had postoperative wound exudation but responded to dressing change. There were no such complications as injury to the deep peroneal nerve or deep venous thrombosis. The internal fixation was removed in 5 patients at about one year after arthrodesis. Conclusion:Selective column arthrodesis based on the three-column theory can result in satisfactory med-term clinical outcomes in the treatment of malunion of Lisfranc injury.
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Objective:To investigate the curative effect of suture anchor in the treatment of ankle joint fracture complicated with distal tibiofibular syndesmosis injury.Methods:From January 2017 to August 2019, data of 65 patients with Weber C type ankle fracture combined with posterior malleolus fracture in our hospital who underwent surgical treatment were retrospectively analyzed and were divided into two groups according to the treatment method of injury: suture-anchor repair group (suture-anchor was used to repair the anterior inferior tibiofibular ligament) and screw fixation group (cortical bone screw was used to fix the tibiofibular syndesmosis). Among them, 17 cases were treated with suture-anchors to repair the anterior inferior tibiafibular ligament, including 7 males, 10 females, 11 left and 6 right. In the Lauge-Hanson subgroup, there were 10 cases of pronation external rotation (PER), and 7 cases of pronation abduction (PA). The mean age was 43.76±15.83 years old. Forty-eight patients were treated with cortical screw fixation, including 33 males, 15 females, 34 left and 14 right. In the Lauge-Hanson subgroup, there were 30 cases of PER, and 18 cases of PA. The mean age was 39.90±13.57 years old. The differences in operation time, number of fluoroscopy, quality of reduction and postoperative complications were compared between the two groups. The ankle joint function was compared at 16 weeks postoperatively and at the last follow-up. The ankle joint function score was based on the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score.Results:All the 65 patients were followed up and the average follow-up time of 65 cases was 16.88±4.46 months. All the fractures were clinically healed 12-16 weeks after operation. The operative time of screw fixation group was 123.71±41.36 min, and the number of fluoroscopy was 25.17±16.29 times, while the operative time of suture-anchor repair group was 99.94±24.16 min and the number of fluoroscopy was 16.26±10.58 times. The difference between the two groups was statistically significant ( t=2.048, 2.175; P=0.045, 0.033). In the screw fixation group, the mean anterior and posterior distance of the tibiofibular syndesmosis was 3.15±1.35 mm, and 6.48±1.43 mm, respectively. In the suture-anchor repair group, the mean anterior distance of the syndesmosis was 2.06±1.47 mm, and the mean posterior distance of the syndesmosis was 6.76±1.78 mm. There was statistically significant difference in the distance of anterior distance of the syndesmosis ( t=3.328, P=0.002), while there was no statistically significant difference in the posterior distance of the syndesmosis ( t=0.701, P=0.486). The incidence of postoperative complications was 16.67% (8/48) in the screw fixation group and 5.88% (1/17) in the suture-anchor repair group, which was no statistically different ( χ2=1.282, P=0.258). The excellent and good rates of AOFAS ankle-hindfoot scores were 91.67% (44/48) in the screw fixation group and 88.24% (15/17) in the suture-anchor repair group at 16 weeks; 95.83% (46/48) in the screw fixation group and 94.12% (16/17) in the suture-anchor repair group at the last follow-up. There was no significant difference ( P >0.05). Conclusion:Compare with screw fixation in the treatment of acute distal tibiofibular syndesmosis injury, suture-anchor repair of anterior inferior tibiofibular ligament is a safe and effective method. It can increase the anatomical reduction rate of anterior distance of the syndesmosis, and reduce the operation time without increasing the incidence of complications.
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Objective To compare the effect and prognosis outcome of open reduction internal fixation and primary arthrodesis in treatment of Lisfranc injuries combined with the first tarsal jointdislocation.Methods A retrospective case control study was conducted on the clinical data with complete follow up data of 126 patients with Lisfranc injuries combined with the first tarsal joint dislocation in nine ankle surgery centers of China from January 2009 to June 2015.There were 76 males (60.3％) and 50 females (39.7％) with an average age of 45.5 years (range,20-87 years).Among the 126 cases,simple dislocation occurred in 41 cases (32.5％),and fracture dislocation in 85 cases (67.5％).The duration from injury to surgery was 11.7 days (range,4-26 days).According to surgery method,the patients were divided into open reduction internal fixation group (n =92) and primary arthrodesis group (n =34).The outcomes were evaluated by American Orthopedic Foot and Ankle Society(AOFAS) score,36-items short form health survey (SF-36),and visual analogue score (VAS).Complications were also followed up.Results All patients were followed up for 18-80 months,with an average of 29.5 months.Primary union was seen in all the patients.At the last follow up,the mean AOFAS midfoot score was (79.4 ± 6.7) points in open reduction and internal fixation group and (85.1 ±8.3) points in primary arthrodesis group (P ＜ 0.05).The mean VAS was (3.1 ± 0.6) points in open reduction and internal fixation group and (2.2± 0.3)points in primary arthrodesis group(P ＜ 0.05).The physiological function of SF-36 was (80.3 ± 5.3) points in open reduction and internal fixation group and (83.5 ± 6.9) points in primary arthrodesis group(P ＞ 0.05).The body pain score of SF-36 was (76.1 ±4.6) points in open reduction and internal fixation group and (84.6 ± 8.7) points in primary arthrodesis group (P ＜ 0.05).In open reduction and internal fixation group,there were five cases (5％) with internal fixator loosening or fracture,16 cases (17％) with redislocation,36 cases (39％) with obvious pain of the middle foot during walking,and eight cases (6％) with tarsal joint traumatic arthritis which was given phase Ⅱ arthrodesis.In primary arthrodesis group,two patients (6％) reported pain due to internal fixation,and the pain was relieved after fixator removal.No re-dislocation,loosening of internal fixation,or traumatic arthritis were found (P ＜ 0.05).Conclusion For Lisfranc injuries combined with first tarsal joint dislocation,primary arthrodesis can stabilize the first tarsal joint and avoid complications or adverse consequences such as redislocation,pain,internal fixation failure,or reoperation.
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Objective To report the clinical outcomes of the patients with open comminuted intra-articular calcaneal fracture who were treated with our self-designed bilateral triangle external fixators which are extensible and gimbaled.Methods Between January 2011 and June 2014,12 patients with open comminuted intra-articular calcaneal fracture were treated and followed up.They were 8 men and 4 women,aged from 23 to 58 years (average,36.8 years).According to the Sanders classification,the fractures were type Ⅱ in 4 cases,type Ⅲ in 7,and type Ⅳ in one.According to the Gustilo classification,the soft tissue injury was type Ⅱ in 2 cases,type ⅢA in 7,and type Ⅲ B in 3.All the patients were treated with immediate debridement and preventive intravenous antibiotics.First stage wound closure or temporary coverage with vacuum sealed drainage was chosen according to the condition of soft tissue injury.Our self-designed bilateral triangle external fixators were applied together with cannulated screws or Kirschner wire in all the patients after Kirschner wire poking.Of them,7 received emergency treatment and 5 were treated 3 to 5 days after injury.After no wound infection was observed for sure,6 cases received selective open reduction and internal fixation via a lateral incision while 6 continued external fixation with Kirschner wire for 8 to 10 weeks (average,9.1 weeks).Results The 12 patients were followed up for 6 to 36 months (average,18.5 months).Their AOFAS scores averaged 84.6 points (range,from 74 to 94 points).One case required tissue transfer for wound coverage.Wound shallow infection developed in 3 cases.No deep infection or amputation happened.No wound infection or necrosis occurred in the 6 cases that had undergone open reduction and internal fixation at the second stage.Conclusion Application of our self-designed extensible gimbaled bilateral triangle external fixators in the treatment of open comminuted intra-articular calcaneal fractures may help effectively reduce the deep infection or incidence of osteomyelitis after operation as long as early debridement is thorough,internal fixation is timely applied,and indications for internal fixation are properly followed.
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Objective To explore clinical effect of reconstruction for chronic Achilles tendon rupture of Kuwada IV type with flexor hallucis longus (FHL) harvested using a minimally invasive technique.Methods The data of 35 patients with chronic Achilles tendon rupture of Kuwada IV type was retrospectively analyzed who were treated by FHL which was harvested using a minimally invasive technique from July 2006 to June 2011.There were 21 males and 14 females,with the age from 23 to 71 years (average,42.1 years).All patients were unilateral injury.MRI showed Achilles tendon rupture fissures 6.0-9.2 cm.The local appearance and function recovery on postoperation was observed,and all patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Leppilahti Achilles tendon repair score.Results Thirty-two patients were followed up for 18 to 72 months,with an average of 33.2 months.Except for 1 patient whose wound healed after six weeks through resuture immediately for the wound dehiscence occurred in the ten days,other patients' wound healed smoothly.The average of AOFAS ankle-hindfoot score had increased from 51.92±7.08 preoperatively to 92.56±6.71 postoperatively.Leppilahti Achilles tendon repair score had increased from 72.56±7.43 preoperatively to 92.58±5.1 postoperatively.Twenty-seven cases were excellent,good in 3,and fair in 2,with the total excellent and good rate 93.8％ (30/32).No case of the sural nerve and tibial nerve injury,plantar painful scar,plantar outside nerve injury.MRI of Achilles tendon showed even signal without signal of tear and cystic degeneration.Conclusion Reconstruction for chronic Achilles tendon rupture of Kuwada IV type with FHL harvested using a minimally invasive technique offers a desirable outcome in rapid postoperative recovery,high strength in tenodesis,fewer complications.
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Graded Zirconia-hydroxyapatite composite bioceramic and simplex Zirconia-hydroxyapatite composite bioceramic were produced, and the extractes of these two of materials were made to evaluate their immunocompatibility. Scanning electron microscope (SEM) was used to detect the character of the surface of the graded composite bioceramic. Holding and without holding phytohemagglutinin (PHA), proliferation and activation of peripheralblood monocytes(PBMCs) cultured in the two extracts were studied. Cultured in PHA after 72 hours, the proliforation rate of the graded composite group was significantly higher than the simplex composite group (P < 0.01). There was no difference of apoptosis of PBMCs of the two groups (P > 0.05). Cultured in PHA after 24 hours, the ratio of CD3/CD69 positive PBMCs of the simple composite group was significantly higher than that of the graded composite material group (P < 0.01). The numbers of PBMCs activated by the graded composite material group were less than that of the simply composite material group and the technique of graded composite will be helpful to improve its immunocompatibility.
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Adult , Humans , Cells, Cultured , Dental Porcelain , Chemistry , Pharmacology , Durapatite , Chemistry , Pharmacology , Materials Testing , Monocytes , Allergy and Immunology , Zirconium , Chemistry , PharmacologyABSTRACT
BACKGROUND: Osteosarcoma is the most common type of bone tumor and generally occurs between the age of 10 to 25; moreover, in clinical practice osteosarcoma is found to occur more often in minority nationalities in Xinjiang Autonomous Region. Do its incidence and prognosis vary between nationalities at gene levelOBJECTIVE: To observe the different expressions of p53, bcl-2 and proliferative cell nucleus antigen (PCNA) gene during the development of osteosarcoma between various Xinjiang nationalities.DESIGN: Non-randomized comparative experiment taking clinical pathological specimens as subjects.SETTING: Immunohistochemical Laboratory, the Pathological Center of Xinjiang Medical University.PARTICIPANTS: Totally 52 pieces of specimen were obtained from excised osteosarcoma tissues in the Pathological Department, the First Affiliated Hospital of Xinjiang Medical University, and the Pathological Department, the First Affiliated Hospital of Shihezi University, between January 1,1984 and December 31, 2001. The 52 cases of osteosarcoma included 29cases derived from male patients and 23 from female patients; among them there were 12 cases of Kazak minority, 17 cases of Uygur minority and 23cases of Han nationality. Other 32 specimens were obtained from 32 patients with tumor-like lesions (such as osteofibrous dysplasia or fibrous dysplasia), including 7 cases of Kazak minority, 11 cases of Uygur minority,and 14 cases of Han nationality. The informed consent was obtained from the patients.METHODS: This experiment was carried out at the Immunohistochemical Laboratory, the Pathological Center of Xinjiang Medical University. LSAB method was used to detect p53, bcl-2 and PCNA expression in the two groups. The first antibody was re placed by PBS as blank control, and the available positive expression was taken as positive control. P53 protein and PCNA were observed to express in cell nucleus, appearing obvious redbrown granules with positive expression, whereas Bcl-2 protein was expressed in cytoplasm.lationship between the expression of Bcl-2, p53 and PCNA in osteosarcoma.of different nationalities: The expression of p53, bcl-2 and PCNA in Kazak minority, Uygur minority and Han nationality was not remarkable p53, bcl-2 and PCNA in osteosarcoma and bone tumor-like lesions: The expression of P53, Bcl-2 protein and PCNA in osteosarcoma was remarkably higher than that in tumor-like lesions (42.31% vs. 3.13 %, 59.62%sion of bcl-2, p53 and PCNA in osteosarcoma: There was a close correlation between bcl-2 and p53, as well as between bcl-2 and PCNA in osteosarcoma tissues (X2 =5.818 2, 4.900 0, P＜0.05).CONCLUSION: The results indicate that there was no statistical difference between various nationalities in the expression of p53, bcl-2 and PCNA, as well as osteosarcoma differentiation. Suggesting that these genes may share the common regulation during the development of osteosarcoma,which is less associated with their nationality-related hereditary background.
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AIM: To study whether caspase-3,8 is activated during azurin-induced apoptosis in U2OS cells. METHODS: AnnexinV /PI method was used to detect apoptosis. The changes of procaspase-3 were analyzed by Western blot, the changes of caspase-3 mRNA were detected by semi-quantitative RT-PCR, and caspase-3 relative activity was determined by colorimetric assay. RESULTS: After U2OS cells were treated with 0, 25, 50, 100, 200, 500 mg/L azurin for 24 h, respectively, the level of procaspase-3 protein decreased and the level of caspase-3 mRNA increased as azurin concentration increased. When the cells were treated with 100 mg/L azurin for 6, 12, 24, 48 h , respectively, the caspase-3 activity began to rise from 6 h,reached the peak at 24 h,and was still higher than the control group at 48 h ( P
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AIM: To determine the role of Fas antigen and caspase-8 in modulating apoptosis of osteosarcoma cells induced by bacterial redox protein azurin. METHODS: The human osteosarcoma cell line U2OS was treated with bacterial redox protein azurin (150 mg/L) for 6, 12, 24 and 48 h, respectively. Cell immunohistochemistry and quantitative image pattern analysis were applied for detecting the expression of Fas antigen. Caspase-8 activity was detected using caspase-8 fluorescent assay kit. The apoptotic rate was measured by FCM. RESULTS: Compared with the control group, the expression of Fas antigen and activity of caspase-8 significantly increased in U2OS cells treated with 150 mg/L azurin (P
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AIM: To evaluate the immunogenicity of a novel orthopedics materials (graded zirconia-hydroxyapatite composite) in vitro by using peripheral blood mononuclear cells (PBMCs) from healthy young people, and simple zirconia-hydroxyapatite composited material was used as control materials. METHODS: Proliferation of PBMCs cultured in different liquid after 5 days was measured by MTT methods. ELISA was used to detect TNF-? and IL-6 concentration in the supernatant of PBMCs cultured in the extracts after 24 hours. Flow cytometery was used to measure CD69 and CD25 in activated PBMCs cultured in the extracts of the two kinds of materials after 24 hours. RESULTS: The proliferation rate of the simple composite group was significantly lower than that in negative group (P