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In growing children, growth plate cartilage has limited self-repair ability upon fracture injury always leading to limb growth arrest. Interestingly, one type of fracture injuries within the growth plate achieve amazing self-healing, however, the mechanism is unclear. Using this type of fracture mouse model, we discovered the activation of Hedgehog (Hh) signaling in the injured growth plate, which could activate chondrocytes in growth plate and promote cartilage repair. Primary cilia are the central transduction mediator of Hh signaling. Notably, ciliary Hh-Smo-Gli signaling pathways were enriched in the growth plate during development. Moreover, chondrocytes in resting and proliferating zone were dynamically ciliated during growth plate repair. Furthermore, conditional deletion of the ciliary core gene Ift140 in cartilage disrupted cilia-mediated Hh signaling in growth plate. More importantly, activating ciliary Hh signaling by Smoothened agonist (SAG) significantly accelerated growth plate repair after injury. In sum, primary cilia mediate Hh signaling induced the activation of stem/progenitor chondrocytes and growth plate repair after fracture injury.
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Mice , Animals , Hedgehog Proteins/genetics , Receptors, G-Protein-Coupled/metabolism , Cilia/metabolism , Cartilage/metabolism , RegenerationABSTRACT
Objective:To compare the clinical effect of Ilizarov frame and unilateral frame in the treatment of tibial segmental bone defect combined with soft tissue defect by open bone transport.Methods:A retrospective case-control study was conducted to analyze the clinical data of 32 patients with tibial segmental bone defect and soft tissue defect-up who underwent open bone transport technique in Tianjin Hospital from August 2008 to August 2016 and obtained complete followed-up. There were 22 males and 10 females, aged 22-64 years (mean, 36.8 years). Nineteen patients in the Ilizarov group showed the mean bone defect length of 7.9 cm and mean soft tissue defect area of 41.4 cm 2. Thirteen patients in the unilateral group showed the mean bone defect length of 7.8 cm and the mean soft tissue defect area of 39.2 cm 2. The results of fracture healing, wound healing time, radiological consolidation index, external fixation index, Association for the Study and Application of the Method of Ilizarov (ASAMI) bone and lower-limb function score and incidence of complications were compared between the groups. Results:All patients were followed up for 24 to 60 months [(32.6±1.3)months]. Bone healing was achieved in all patients. The wound healing time was (2.7±2.3)days in Ilizarov group and (2.4±1.8)days in unilateral group ( P>0.05). The consolidation index was (43.4±8.7)d/cm in Ilizarov group and (45.8±10.3)d/cm in unilateral group ( P>0.05). The external fixation index was (52.6±8.9)d/cm in Ilizarov group and (58.7±12.9)d/cm in unilateral group ( P<0.05). The results of ASAMI bone score was excellent in 10 patients, good in 6, fair in 2 and poor in 1 in Ilizarov group, with the excellent rate of 84%; and excellent in 6 patients, good in 4, fair in 2, and poor in 1 in unilateral group, with the excellent rate of 77%, with insignificant difference between two groups ( P>0.05). The results of ASAMI lower-limb function score was excellent in 8 patients, good in 7, fair in 3, poor in 1 in Ilizarov group, with the excellent rate of 79%; and excellent in 6, good in 3, fair in 3, poor in 1 in unilateral group, with the excellent rate of 69%, with insignificant difference between the two groups ( P>0.05). Incidence of axial deviation was zero in Ilizarov group versus 23% in unilateral group ( P<0.05). After operation, Ilizarov group had refracture in 1 patient and pin site infection in 5, and unilateral group had refracture in 1 patient and pin site infection in 1, showing no significant difference between the two groups ( P>0.05). Conclusions:Tibial segmental bone defect with soft tissue defect can be effectively treated by open bone transport with Ilizarov and unilateral frame. Ilizarov frame has better biomechanical properties and is more convenient for correction of poor postoperative axial alignment.
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Objective To evaluate the clinical effects of the Ilizarov method combined with two kinds of reversed neurocutaneous island flaps transfer for posttraumatic equinus with soft tissue defects on ankle and foot.Methods Data of 21 cases of posttraumatic equinus with soft tissue defects on ankle and foot who were treated with the Ilizarov external fixation combined with the two kinds of reversed neurocutaneous island flaps transfer from June 2006 to January 2018 were retrospectively analyzed.There were 17 males and 4 females,aged from 26 to 65 years,with an average age of 43.9 years.The soft tissue defect dimensions ranged from 6 cm×5 cm to 10 cm×9 cm,and the time from the initial trauma to the operation ranged from 2.5 to 240.0 months.The mean preoperative equinus contracture was-38.9° (range,-25° to-66°),and total ankle range of motion (ROM) was 7.1° (range,0°-18°).All cases were treated with the Ilizarov external fixation combined with the two kinds of reversed neurocutaneous island flaps transfer.Two weeks after the flap transfer,distraction of the Ilizarov fixator was initiated to gradually correct the equinus foot.The flap survival was observed in the postoperative period,and the International Club Foot Study Group (ICFSG) score was collected at the latest follow-up.The criteria were used to assess the morphological and functional outcome.Results A total of 21 resversed flaps were transferred,including 15 sural neurocutaneous flaps and 6 saphenous neurocutaneous flaps.The sizes of flaps were from 7 cm±6 cm to 11 cm± 10 cm.Among them,17 patients underwent primary flap transfer,and 4 patients underwent a delayed second-stage procedure 2 weeks after primary surgery.The 4 delayed flaps contain 3 sural neurocutaneous flaps and 1 saphenous neurocutaneous flap.All 21 patients were followed up and the average periodof follow-up was 20.3 months (range,8-96 months).Among the 21 flaps,19 survived completely.Although marginal necrosis was observed in 2 cases,these wounds healed after subsequent debridement and dressing change treatment.No major complication was seen,but superficial pin tract infection was present in 4 cases who then received dressing change and oral antibiotic.Deformities were corrected,and ankle motion had increased significantly.The mean ankle activity at the latest follow up was 22° (range,8°-38°),and postoperative ICFSG score at the latest follow-up was 5.67±3.09,which significantly reduced compared with preoperative one (30.81 ±3.63).The difference was statistically significant (t=32.815,P=0.035).The results were excellent in 13 feet,good in 7,and fair in 1,with the excellent and good rate of 95.24％ (20/21).The local infections were cured without recurrence at operative site.Equinus deformities were corrected,and the latest follow-up results showed that all patients walked normally without recurrence.Conclusion Ilizarov method combined with reversed sural and saphenous neurocutaneous island flap can improve the limb function and the flap can survival with good clinical effect.
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Objective To investigate the clinical outcomes of combined Ilizarov technique with tendon transfer for the treatment of rigid equinovarus foot deformity.Methods A retrospective analysis was performed on the clinical data of 11 patients (14 feet) with rigid equinovarus foot deformity who were treated by Ilizarov technique combined with tendon transfer without additional bony procedures from August 2015 to February 2018.The average age was 21.6 years old (range,12-36 years old) and 6 patients were males and 5 patients were females.According to Dimeglio classification,8 feet were grade Ⅱ and 6 feet were grade Ⅲ.Seven patients (10 feet) were treated with external fixator and tendon transfer simultaneously.Four patients (4 feet) underwent staging surgery,in which Achilles tendon lengthening,plantar fascia lysis and slow correction of deformity with external fixator were performed as the first stage operation,followed by the second stage tendon transfer.The average interval between the two operations was 26.5 days (range,20-32 days).The lateral tibiotalar angle on load-bearing ankle radiographs and tibiocalcaneal angle on Saltzman view radiographs were measured after operation,and compared with that before operation.Functional evaluation was performed by The American Orthopaedic Foot and Ankle Society (AOFAS) and Ankle Hind foot Scale.Quality of life assessment was assessed by the MOS 36-Item Short Form Health Survey (SF-36) Scale.The excellent and good rate of operation was evaluated by the International Clubfoot Study Group (ICFSG) scoring system.Results All patients were followed up for 6 months to 36 months with an average of 20 months.All cases achieved effective correction.There were no neurovascular complications in this group of patients.The preoperative ankle range of motion in dorsiflexion was-19.9°± 14.8°,and plantar flexion 38.5°± 12.8°.At the latest follow-up,the mean dorsiflexion increased to 2.7°± 1.6° and the plantar flexion decreased to 21.0°±9.2°.Preoperative Dimeglio classification included 8 feet in grade Ⅱ,6 feet in grade Ⅲ.At the latest follow-up,there were 13 feet in grade Ⅰ and 1 foot in grade Ⅱ.The tibiotalar angle was 122.2°± 16.6° before surgery and 100.8°±4.8° at the latest follow-up.The tibiocalcaneal angle of the Saltzman view was-25.2°±9.2° before surgery and-3.7°±2.8° at the latest follow-up.The mean preoperative AOFAS score increased from 63.9± 12.7 to 85.2±9.7,with statistically significant difference (t=14.87,P＜ 0.05).The average SF-36 score increased from 50.1±8.4 to 63.7±8.1,with statistically significant difference (t=4.10,P＜ 0.05).At the latest follow-up,the average ICFSG score was 6.6 (range,3-16).According to the classification of ICFSG score,there were 7 feet excellent,6 feet good,and Ⅰ foot fair,with an excellent and good rate of 92.9％ (13/14).Conclusion Ilizarov technique combined with tendon transfer could achieve successful correction of rigid equinovarus foot deformity with satisfactory short-term results.
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Objective To evaluate the clinical outcomes and correction accuracy of deformities around the knee joint using external fixator-assisted internal fixation (FAIF).Methods From January 2014 to March 2018,data of 15 patients (17 bone segments) with deformities around the knee joint who had been corrected with external fixator-assisted internal fixation were retrospectively analyzed.There were 6 males and 9 females,with an average age of 39 years (range,21-60 years).There were 9 patients with genu varus and 6 with genu valgus.All the 15 patients had shortening ranging from 5 to 22 mm,with an average of 12 mm.Unilateral external fixator was used to stabilize the osteotomy site intraoperatively until the satisfied mechanical axis was acquired.Then the plate or Intramedullary nail was inserted and fixed,the external fixator was removed after internal fixation.Results Femur osteotomy was done in 7 patients and tibia osteotomy was done in 6 patients,while 2 patients had osteotomy in both tibia and femur.Intramedullary nailing was used in 2 bone segments,and plate was used in 15 bone segments.The correction of angle ranged from 7° to 22°,with an average of 12.5°.The correction of the 9 cases of genua varus ranged from 10° to 22°,with an average of 17.6°.The correction of the 6 cases of genu valgum ranged from 7° to 13°,with an average of 10.4°.The mean time to achieve union of the osteotomy sites was 3.5 months (range,2.5-5.0 months).All the 15 patients were followed up for 8-48 months (average,23 months).The mechanical axis deviation (MAD) was 5.93 mm (range,0-15 mm) after operation which was 34.8 mm (range,8-55 mm) before operation.The mean post-operative mechanical lateral distal femoral angle (mLDFA) was 87.5° (range,84°-90°) which was 76.1° (range,66°-82°) before operation.The mean medial proximal tibia angle (MPTA) was 87.8° (range,86°-89°) which was 76.8° (range,68°-80°) before operation.There were no deep infection and neurovascular injury.Conclusion The FAIF not only has the advantage of minimal invasiveness and easy adjustment,but also can avoid uncomfortableness and complications of long-term of wearing the external fixator.It is an accurate and safe method to correct the deformities around the knee joint.
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Pneumonia is one of the most common medical complications after stroke.Stroke-associated pneumonia (SAP) can not only increase the length of hospital stay and medical cost of patients,but also an important risk factor for mortality and morbidity in patients with stroke.All these indicate that the importance of prediction and prevention of SAP.This article reviews the advances in research on the prediction and prevention of SAP.
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Objective To investigate the efficacy of the combination ofJiangtang decoction and insulin in the treatment of type 1 diabetes mellitus in children.Methods A total of 43 children with type 1 diabetes mellitus were enrolled and randomly allocated to either a insulin group (control group) and a insulin plusJiangtang decoction group (treatment group) using the table of random digits, with 23 patients in the control group and 20 in the treatment group. The patients in the control group were treated with insulin, and those in the treatment group were administrated withJiangtangdecoction on the basis of the treatment in the control group for 2 months. Body mass index (BMI), fasting plasma glucose (FPG), postprandial blood glucose (PBG) and hemoglobin A1c (HbA1c) were measured.Results The levels of FPG, PBG and HbA1c were significantly decreased in the treatment group (twere 3.376, 54.493, and 2.798, respectively; allP<0.01), and the PBG level was significantly decreased in the control group (t=29.714,P=0.000). The levels of FPG, PBG and HbA1c in the treatment group were significantly lower than those in the control group (twere 2.715, 2.191 and 5.627, respectively;P<0.05 orP<0.01). There was no difference in BMI between the treatment group and the control group (t=0.159,P=0.874). The proportion of patients with HbA1c <7.5% in the treatment group (60.0%, 12/20) was higher than that in the control group (26.1%, 6/23;χ2=5.055,P=0.025).Conclusion Combination ofJiangtang decoction and insulin can decrease the level of FPG, PBG and HbAlc, and its therapeutic effect is superior to insulin alone for type 1 diabetes in children.