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Objective To investigate the efficacy of arthroscopic rotator cuff repair plus Bankart repair for anterior shoulder dislocations combined with rotator cuff rupture in patients above 40 years old.Methods A retrospective case series study was conducted to analyze the clinical data of 23 patients above 40 years old with anterior dislocation of shoulder joint and rotator cuff tear in Honghui Hospital Affiliated to Medical College of Xi'an Jiaotong University from January 2010 to September 2015.There were 10 males and 13 females,aged 40-71 years [(58.1 ± 10.3) years].All patients underwent arthroscopic rotator cuff repair plus Bankart repair.The visual analogue scale (VAS) was used to evaluate pain,the Oxford shoulder instability score (OSIS) was used to evaluate shoulder stability,and ConstantMurley shoulder score was used to evaluate shoulder function.Meanwhile,the range of motion (ROM) of shoulder joint,complications and subjective efficacy feedbacks from the patients were recorded.Results All patients were followed up for 13-46 months [(24.2 ± 10.1) months].Before operation and at the last follow-up,there was significant decrease in the VAS score [(0.6 ± 0.2) points vs.(3.8 ± 1.2)points] and the mean OSIS score [(19.7 ± 5.5) points vs.(47.1 ± 14.1) points];significant increase was found in the Constant-Murley score [(79.1 ± 10.8) points vs.(36.6 ± 6.4) points],the ROM of ante-flexion [(149.1 ± 22.0) vs.(65.8 ± 14.7)],abduction [(119.4 ± 23.2) ° vs.(69.1 ± 16.7) °] and external rotation [(45.0 ± 11.4) ° vs.(8.9 ± 2.7) °] (all P ＜ 0.05).No significant difference was found in the ROM of internal rotation (P ＞ 0.05).There were no significant differences in the mean VAS score and OSIS score between the affected and unaffected shoulders (P ＞ 0.05),but the former had a significantly lower Constant-Murley score than the latter [(79.1 ± 10.8)points vs.(87.7 ± 9.3) points,P ＜ 0.05].In terms of the comparison of ROM,there was no significant difference in joint ante-flexion and internal rotation (P ＞ 0.05),but the affected shoulder had significantly lower ROM of external rotation and abduction [(45.0 ± 11.4) °and (119.4 ± 23.2) °] than the unaffected one [(55.9 ± 13.8) °and (153.1 ± 23.7)°] (P ＜ 0.05).The excellent-good rate of efficacy based on the subjective feedbacks from patients was 78％.Up to the last follow-up,none of the patients had wound infection or recurrent dislocation.Conclusions Arthroscopic rotator cuff repair plus Bankart repair can significantly relieve the pain,improve joint function and range of motion.Compared with the unaffected shoulder,the affected one had slight loss of function and decreased mobility in abduction and external rotation.
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BACKGROUND: Alginic acid has a relatively mild gel condition and good biocompatibility, and it has been widely used in bio-tissue engineering.OBJECTIVE: To construct bone tissue engineering scaffolds using alginate gel composite bone xenograft approach, and to observe the cell biological properties and in vivo osteogenic potential in scaffolds.METHODS: The bone marrow was harvested from two 2-week-old New Zealand rabbits, 1 ×10~(-8)mol/L recombinant human bone morphogenetic protein-2 was used to induce bone marrow mesenchymal stem cells. The induced bone marrow mesenchymal stem cells at the second generation were incubated into 1% sodium alginate gel, after cultured for 4 days, the cell morphology in gel was observed by hematoxylin-eosin staining. Bone marrow mesenchymal stem cells at the second generation were divided into simple DMEM gel group and DMEM containing 1% sodium alginate gel group, followed by a culture of 7 days. Then bone morphogenic protein-2 immunohistochemical staining was performed. A total of 24 nude mice were randomly divided into two groups, both sides of the thigh muscle pockets were implanted with bone marrow-derived mesenchymal stem cells/alginate gel/bovine cancellous bone complex as an experimental group, with bone marrow-derived mesenchymal stem cells/bovine cancellous bone as a control group. At 2 and 4 weeks post-operation, the osteogenesis in the composite was observed by histological examination, the percentage area of new bone or cartilage was determined using image analysis system.RESULTS AND CONCLUSION: The bone marrow-derived mesenchymal stern cells in the sodium alginate gel exhibited a well-stacked morphology, they suspended in a gel, showing cell division and mitosis phase. In the simple DMEM gel group and DMEM gel containing 1% sodium alginate group, the immunohistochemical results showed that, cell division and proliferation were normal, with prominence at a variety of forms, large nucleus, and clear nucleolus. The bone morphogenetic protein-2 expression had no significant difference between the simple DMEM gel group and DMEM gel containing 1% sodium alginate group (P>0.05).Scanning electron microscopy revealed that, the alginate gel evenly composited in bovine cancellous bone micropores, cell grew at different planes. Animal experiments showed that there were significant differences regarding the percentage of new bone or cartilage area between the experimental group and control group at 2 and 4 weeks postoperation (P< 0.05). It is indicated that constructing bone tissue engineering scaffolds by using alginate gel/bovine cancellous bone, complies with the ultra-structural principle of tissue engineering scaffolds, can maximize the cell loads, achieve good bio-performance, without adverse affects on the proliferation, osteogenic phenotype and related biological properties of bone marrow-derived mesenchymal stem calls, the in vivo osteogenic efficiency was high.
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BACKGROUND:The structure of tissue engineering carrier affects the bio-action of cells greatly.OBJECTIVE: To investigate the biological characteristics of bone marrow stem cells (MSCs) in different concentrations of alginate combined with de-antigen bone xenograft (DBX).DESIGN: Observational trial.SETTING: PLA Institute of Trauma and Orthopedics, the Fourth Military Medical University of Chinese PLA.MATERIALS: Alginate, calcium chloride, MSCs, bone xenograft.METHODS: Bovine cancellous bone was out into cubes, which were degreased, deproteinized and then lyophilized.Cubes in pore size within 300-500 μm were selected for use after ethylene oxide sterilization. The purified sodium alginate was dissolved in DMEM cell culture medium of concentrations as different as 0.5%, 2%, 8% and 16%; 1×1012 L-1 induced MSCs were blended with isopyknic alginate-DMEM and compounded with DBX at a status of 0.5 Mpa negative pressure for 5 minutes in order to make a cell suspension fully fill into the pores of the cancellous bone. Then alginate was crosslinked with 50 g/L calcium gluconic acid for 30 seconds. The complex was put into a CO2 incubator and cultured for 4 days. The gel compound and cell growth in the pores of the complex were grossly observed with an inverted microscope. Status of cell growth in the complex with different concentrations of alginate was observed with scanning electron microscopeMAIN OUTCOME MEASURES: Compound status of alginate and bone xenograft, cell growth status and matrix secretion in compound carries.RESULTS: When the concentration of alginate was 0.25% or 1%, alginate was equally combined in DBX, while that of 4% and 8% only combined on the surface of cancellous bone. After in vitro cultured for 4 days, alginate of 0.25% were broken off from DBX surface. But alginate of 1% was equally combined with DBX pores with cells secreting well in alginate. Development of cells in alginate of 4% was restricted and no cells were seen in alginate of 8%.CONCLUSION: Alginate of 1% is suitable for constructing the carrier of bone tissue engineering with bone xenograft.
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Objective To compare the clinical outcomes of posterior lumbar interbody fusion(PLIF) using simple cage alone fusion with pedicle screw fixation and autogenous bone grafting and cage fusion with pedicle screw fixation in adult spondylolisthesis. Methods From March 2003 to March 2004,Twenty-seven patients with lumbar spondylolisthesis were divided in two groups. In group A, 15 patients were treated by PLIF using simple cage alone fusion with pedicle screw fixation, including 4 males and 11 females, aging 53-68 years. Isthmic defects were located at L4 in 9 cases, at L5 in 6 cases. Four patients were smokers. The preoperative mean disc space height was 5.4±2.3 mm, the mean percentage of slip was 36.8%±7.2%. In group B, 12 patients were treated by PLIF using autogenous bone grafting and cage fusion with pedicle screw fixation, including 3 males and 9 females, aging 56 years. Isthmic defects were located at L4 in 8 cases, at L5 in 4 cases. Five patients were smokers. The preoperative mean disc space height was 5.7±2.5 mm, the mean percentage of slip was 37.8%±6.2%. Two groups were compared in the amount of blood loss, duration of hospitalization, back pain, radiating pain, fusion rate, the intervertebral disc space height, the postoperative degree of slip and the fusion rate. Results All patients were followed up for 24-38 months. The mean follow-up was 29(24-36) months in group A and 26(24-38) months in group B. There were no statistically significant differences in follow-up period, age,sex, the location of isthmic defects, smoking, the preoperative disc space height and the percentage of slip between two groups (P>0.05). There were no statistically significant differences in the amount of blood loss, the duration of hospitalization, the fusion time between two groups(P>0.05). But there were statistically significant differences in the back pain score, the radiating pain score and the fusion rate between two groups(P<0.05).The postoperative disc space height and the degree of slip of the last follow-up were 5.8±2.2 mm and 25.6%±7.2% in group A, 6.2±2.5 mm and 24.1%±7.4 % in group B, showing statistically significant difference (P<0.05). Conclusion The PLIF using autogenous bone grafting and cage fusion with pedicle screw fixations is more beneficial to improving the fusion rate and preventing long-term instabilities than simple cage alone fusion with pedicle screw fixation in adult spondylolisthesis.