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Objective To assess the effectiveness of osteoperiosteal decortication and extracortical bone-bridging in the treatment of atrophic humeral nonunions.Methods Nineteen patients with atrophic humeral nonuninon were treated by osteoperiosteal decortication and extracortical bone-bridging between March 2008 and April 2016.They were 12 men and 7 women,aged from 23 to 68 years (mean,36.6 years).The fracture was located at the left side in 10 cases and at the right side in 9.Before admission to our hospital,8 had received surgery once,6 twice and 5 thrice.The time from fracture to hospitalization ranged from 12 to 106 months (average,26.3 months).Shoulder function was evaluated by Neer scoring and elbow function by Mayo elbow performance score (MEPS) at final follow-ups.Results All incisions healed by first intention.Two cases reported transient radial nerve symptoms of numbness.All the 19 patients were followed up for 28.9 months on average (range,from 13 to 78 months).Radiographic examinations showed signs of bone remodeling,disappearance of fracture lines and formation of extracortical bone bridge at 6 to 8 weeks after operation.All of them achieved radiographic union within 10 to 46 weeks (16.8 weeks on average).The Neer scores averaged 82.5 (range,from 70 to 98),giving 12 excellent cases,5 good ones and 2 fair ones.The MEPS averaged 84.4 (range,from 70 to 96),giving 11 excellent cases,5 good ones and 3 fair ones.Conclusion Osteoperiosteal decortication and extracortical bone-bridging in treatment of atrophic humeral nonunions can effectively induce osteogenesis and increase stability of broken ends,promoting bone healing.
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Objective To explore the effect of traumatic brain injury on the fracture healing and its related mechanism by observing the expression of platelet-derived growth factors (PDGF) in serum and bone callus in rats with bone fracture and cerebral trauma.Methods One hundred and forty-four SD rats were randomized into 4 equal groups (n =36) which were subjected respectively to:no treatment (group N),traumatic brain injury (group TBI),bone fracture (group F) and bone fracture and cerebral trauma (group TBI + F).The animals were sacrificed at 3 days,1,2,3 and 4 weeks after modeling.In all the 4 groups,ELISA was used to detect the expression of PDGF in serum.In groups F and TBI + F,the callus growth was observed at the right tibial fracture site by X-ray,the callus growth and morphology were also observed by HE staining,the expression of PDGF in the callus tissue was measured by immunohistochemieal analysis,and the expression of PDGF mRNA in the callus tissue was measured by RT-PCR.Results X-ray showed that fracture healing was accelerated in group TBI + F compared with group F.The serum expression of PDGF in group TBI + F was significantly higher and the peak time was significantly earlier than in the other 3 groups (P ＜ 0.05).H-E staining showed that osteoblastic activity at the fracture ends in group TBI + F was stronger than in group F.Inmunohistochemica[staining showed that the expression of PDGF in the local callus was significantly higher at 3 days and 1 week in group TBI + F and the peak time was significantly earlier than in group F (P ＜ 0.05).RT-PCR showed that the expression of PDGF mRNA in the local callus was significantly higher at 3 days and 1 week in group TBI + F than in group F (P ＜0.05).Conclusions Traumatic brain injury can promote fracture healing in rats,which is probably related to increased expression of PDGF after cerebral trauma.
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Objective To assess the effectiveness of pedicled iliac periosteal flap graft for treatment of old femoral neck fracture in adolescents.Methods Between June,2005 and December,2013,15 patients (15 hips) of old femoral neck fracture in adolescents treated with vascular pedicled iliac periosteal.There were 11 males and 4 females with an average age of 15.8(range 12 to 18) years.Based on the location of fracture,there was 5 cases of subcapital,8 cases of transcervical and 2 cases of basal.6 cases were treated with lower limb traction,3 cases with internal fixation and 6 just without any treatment.The average duration from injury to the second operation was 4.8 (range 1 to 19) months.There were 2 cases of femoral head necrosis after femoral neck fracture.Open reduction,pedicled iliac periosteal flap grafting and cannulate screw fixation were performed.Results All incisions healed by first intention.All patients were followed up 12 to 90 months (mean,46 months).The HHS was increased from (48.7 ± 8.3) pre-operation to (91.3 ± 6.1) at last followed-up,indicating a significant difference between before and after operation (P ＜ 0.01).One patient underwent total hip arthroplasty at 10 months after operation because of fracture nonunion and femoral head necrosis.Fracture healed successfully in 14 cases and the average time of fracture healing was 4 (range 3 to 6) months.Certain extent of remodelling and bulge of the head were observed in 2 cases of collapsed heads.Conclusion Pedicled iliac periosteal flap graft can provide good osteogenesis and vascular reconstruction for femoral head and promote fracture healing in treatment for old femoral neck fracture in adolescents.
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Objective To discuss the feasibility of positioning the acetabular center,fixing acetabular implant correctly and reconstructing hip rotation center according to Harris fossa and the remaining anatomical markers of acetabular notch in revision hip arthroplasty.Methods Twenty-eight patients underwent revision hip arthroplasty from April 2007 to June 2009.Based on Paprosky type,3 cases with type Ⅰ were treated with biological fixed acetabular component;8 cases with ⅡA and ⅡB were reconstructed with using of morselized bone grafting and large diameter cemented acetabular prosthesis;17 cases with type ⅡC,ⅢA and ⅢB were treated with using of morselized bone grafting and fixation of acetabular reinforcement ring.Among them,5 patients with massive bone loss in acetabular wall were reconstructed with the use of the structural and morselized bone grafting.The center of the original acetabulum was believed to be in the lunate cartilage surface which was closed to Harris fossa.During the operation,the center was located in the site which was 25-28 mm above in line with perpendicular bisector of acetabular notch connecting line.The acetabular center was the point of positioning acetabular prosthesis (Ⅰ type) or making new acetabulum by impaction bone grafting.Acetabular reinforcement ring (Ⅱ,Ⅲ type) was fixed in accordance with proper transverse angle and anteversion angle.The vertical distance from hip rotation center to teardrop connection and the horizontal distance from hip rotation center to teardrop were measured on preoperative and postoperative radiograph.And the outcomes of reconstruction of rotation center were evaluated.Results The vertical distance was changed from (14.22±3.39) mm preoperatively to (32.64±4.51) mm postoperatively.The difference was statistically significant (t=3.65,P＜ 0.05).The horizontal distance was changed from (25.13±3.46)mm preoperatively to (32.87±4.73) mm postoperatively.The difference was statistically significant (t=2.72,P＜0.05).Conclusion Using residual Harris fossa and acetabular notch as the anatomical markers in revision hip arthroplasty,the restoration of the anatomical hip center has shown to be favorable.
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Objective To explore an effective method for establishing femoral head necrosis models in young dog and to evaluate osteogenesis of vascular pedicled periosteum transplanted in the repairment offemoral head necrosis of young dogs.Methods Animal models of femoral head necrosis were established by liguting and destroying femoral neck artery circles as well as freezing femoral heads with liquid nitrogen in 29 dogs.At 4 weeks, the animal models of femoral head necrosis were evaluated through X-ray, MRI, ECT,and 2 dogs were randomly executed and detectd by histology examination, then 29 dogs were divided randomly into experimental group(n = 12), control group(n = 9 )and blank group(n = 8).Dogs in the experimental group were treated with the vascular pedicled periosteum from isolateral great trochanter, dogs in the control group were treated with the vascular pedicled bone from isolateral great trochanter, and the blank group were without any treatment.4,8, 12 weeks postoperation,these femoral heads were examined morphologically, radiologieally(X-ray, MRI, ECT) and histologically.All animals were executed and detectd by histology at 12 weeks to observe the repairs of necrotic femoral heads at different periods.Results Twelve weeks postoperation, dogs femoral head figurations in the experimental group were normal, MRI signals were odds in femoral head, ECT studies shows decreased radionuclide compared with contralateral femoral head;capillary vessel and osteoblast multiplication and new traboeulacs were matured in histology examination.Dogs femoral head figurations in the contral group were irregular, MRI revealed high-low signals intermix in femoral head, ECT revealed obviously decreased radionuclide, osteoblast actived, new trabeculac and lipocyte were observed in histology examination.In blank group, femoral head figurations were distorted and sunk, while MRI signals were low, ECT showed no radionuclide uptaking.Collapsed trabeculas and many vacant bone lacuna were observed in HE staining.Dogs femoral head figurations in the blank group taken on distortion andsunk, MRI signals were low, without radionuclide revealed uptake, trabeculac collapse, many bone lacuna were vacant.At the same time, radionuclide counts of vascular pedicled periosteums/vascular pedicled bones in ECT were significantly different between experimental group and control group(P < 0.01 ).Conclusion The vascular pedicled periosteum has higher osteogenesis capability compared with the vascular pedicled bone and can effectively repair the femoral head necrosis of young dogs by this means.
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Objective Exploration trophism of protein (relative molecular quantity 67?10 3) secreted by Schwann cell to motoneuron Methods Purfication of Schwann cell secretion neurotrophic protein (67?10 3) by method of Xiao Yuzhou Spinal cord ventral motoneuron (SCVMNs) of E 12～14 d (embryonic age 12～14 d) SD rats were harvested and cultured and identified SCVMNs were cultured in different concentration of protein (67?10 3) liquid Its neurobiological activity was assayed by MTT method Results The A values was not same in different concentration of protein (67?10 3) There was a dose effect relationship between biological effect intensity and protein dose, the optimum effect protein concentration of neurotrophic protein (67?10 3) was 20 ng/ml Conclusion The protein secreted by Schwann cell can maintain SCVMNs surval in culture
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0.05). Conclusion The nerve bridge compounded of bFGF heparin, acellular nerve basal lamina tube and Schwann cells can facilitate nerve regeneration. [Key words] Peripheral nerve; Tissue engineer; Acellular nerve basal lamina tube; Basic fibroblast growth factor(bFGF); Schwann cells