ABSTRACT
Objective:To investigate the prevalence of deep vein thrombosis (DVT) in patients after selective ankle or mid-hindfoot surgery.Methods:A retrospective analysis was conducted of the 109 patients with ankle or mid-hindfoot disease who had been treated from January 2018 to December 2019 at Department of Orthopaedics, Wuhan Fourth Hospital. They were 65 males and 44 females, aged from 32 to 74 years (average, 49.0 years). Ultrasonography was performed at preoperative 1 day, postoperative 2 and 6 weeks to determine the occurrence, location and clinical symptoms of DVT. The patients were divided into an early DVT group, a late DVT group and a DVT-free group according to the occurrence and onset time of DVT. The 3 groups were compared in terms of gender, age, body mass index and tourniquet duration.Results:The incidence of postoperative lower limb DVT was 22.9% (25/109). All the thromboses were observed beyond the distal plane of the popliteal vein. 72.0% of the DVT patients were clinically asymptomatic. There was no significant difference in gender, age or body mass index between early DVT group ( n=17), late DVT group ( n=8) and DVT-free group ( n=84) ( P>0.05). The incidence was 68.0% (17/25) for early DVT and 32.0% (8/25) for late DVT. The intraoperative tourniquet duration for the early DVT group [(77.7±12.3) min] was significantly longer than that for the late DVT group [(66.8±11.2) min] and for the DVT-free group [(65.9±10.5) min] ( P<0.05). Conclusions:The majority of postoperative DVTs may be clinically asymptomatic in patients after selective ankle or mid-hindfoot surgery. Although DVT tends to occur within postoperative 2 weeks, its risk may continue after 2 weeks. Increased tourniquet duration may be associated with incidence of early DVT.
ABSTRACT
Objective:To report our experience in the emergent foot and ankle surgery in the epidemic of COVID-19.Methods:The data of 18 patients with acute foot and ankle injury were reviewed who had been admitted to the Department of Foot and Ankle Surgery, Wuhan Fourth Hospital from 20th January, 2020 to 26th February, 2020. They were 11 men and 7 women, aged from 18 to 70 years (average, 42.5 years). There were 5 cases of acute open injury and 13 ones of acute closed injury. COVID-19 infection was diagnosed or suspected in 5 cases but not in the other 13 cases. Emergency operation was carried out for 2 patients with open injury plus COVID-19 infection and one with complicated pilon fracture plus COVID-19 infection, one of whom received secondary operation. One patient with closed fracture of the left calcaneus plus COVID-19 infection was hospitalized from emergency department for secondary surgery, and another with closed fracture of the right lateral malleolus was referred to the isolation ward after emergency plaster fixation. Of the 10 patients with closed injury but without COVID-19 infection, 3 received conventional secondary surgery after admission and the others conservative treatment at the outpatient department. Recorded were COVID-19 infections in the patients after admission and in the medical staff. The measures taken and experience in control and prevention of COVID-19 infection after outbreak of the epidemic were reviewed.Results:Of the 11 patients who had been hospitalized for foot and ankle injury in emergency, 5 were definitely diagnosed of or suspected of COVID-19 infection and 6 free of COVID-19 infection. During hospitalization, COVID-19 infection was confirmed in the 5 cases and no COVID-19 infection occurred in the other 6 patients. No COVID-19 infection occurred in the medical staff; no cross infection was observed between the patients and the medical staff.Conclusions:Reasonable strategies are advised to balance the foot and ankle surgery and epidemic prevention. A simplified management is not advised for all the cases. The operative procedures in emergent foot and ankle surgery should be optimized in line with the epidemic control and prevention principles to facilitate functional rehabilitation for the patients.
ABSTRACT
Objective To explore the methods and clinical effect of the sinus tarsus mini incision approach with percutaneous fixation technique in the treatment of Sanders Ⅱ,Ⅲ calcaneus fractures.Methods From January 2015 to May 2016,the clinical data of 64 cases with Sanders Ⅱ,Ⅲ calcaneus fractures who were treated by sinus tarsus mini incision approach with percutaneous reduction and fixation were analyzed retrospectively.The average age was 46.64±10.51 years (range,25-68) and 49 patients were males and 15 patients were females.According to Sander's classification,39 patients were Sanders Ⅱ and 25 were Sanders Ⅲ fracture.Calcaneal varus was corrected and the length,width and height of bone were reduced by sinus tarsus mini incision approach with percutaneous fixation technique.Calcaneal fracture was treated by calcaneal bone plate combined with percutaneous screw fixation.Complications and operation procedure were recorded post-operation.Anteroposterior,lateral and axial views of preoperative and postoperative X-ray and CT scan were taken to assess the classification,restoration and intertion status of fracture.Radiological assessment was performed using B(o)hler's angle and Gissane's angle.Functional outcome was assessed using the Maryland foot score (MFS).Results All of the sixty-four patients were followed up for 12-18 months (average,14.80± 2.03).After surgery,only 4 cases of superficial necrosis of the incision were found,and the incisions were all healed and no infection occurred after surgery.No tendon tenosynovitis was seen after surgery.There were no fracture displacement,internal fixation failure,and fracture deformity healing cases.The mean time of bone union was 9.44±1.38 weeks (8-12 weeks) without fracture deformity healing case.The mean time of bone union was 9.17±1.16 weeks for the 23 cases with bone graft.For the 41 cases without bone graft,the bone healing average time was 9.91 ± 1.62 weeks,and there is no statistically difference between cases with and without bone graft (t=1.936,P=0.061).B(o)hler's angle was 6.625°±4.904° (range,-5°-15°) preoperative,and improved to 31.031°± 4.660° (range,24°-40°),which had statistically significant difference (t=-28.863,P=0.000).Gissane's angle was from preoperative 76.094°±12.981° (range,55°-105°) to 127.328°±6.486° (range,115°-140°) at the time of the latest follow-up,and the difference had statistically significant (t=-28.246,P=0.000).Maryland Score:excellent 30 cases (22 cases of type Ⅱ,8 cases of type Ⅲ),good 27 cases (15 of type Ⅱ,12 of type Ⅲ),fair 7 cases (2 of type Ⅱ,5 of type Ⅲ).The overall good rate was 89.06％ (57/64).Conclusion The tarsal sinus minimally invasive small incision reduction and internal fixation combined with percutaneous reduction and fixation technique in the treatment of ealcaneal fractures,exerts the advantages of small trauma,clear surgical exposure for reduction,reliable fixation,and low incision complications,which is applicable to treat the Sanders Ⅱ,Ⅲ calcaneal fractures.
ABSTRACT
Objective To compare the curative effects of retrograde intramedullary nailing versus locking plating for tibiotalocalcaneal arthrodesis. Methods A retrospective study was performed of the 47 patients who had undergone tibiotalocalcaneal arthrodesis from January 2012 through January 2017 at De-partment of Orthopaedics, Pu'Ai Hospital. Of them, 28 were treated by retrograde intramedullary nailing and 19 by locking plating. The 2 ways of fixation were compared in terms of bony union rate, bony union time, revision rate, complications, American Orthopaedic Foot and Ankle Society ( AOFAS ) Ankle-Hindfoot Scale and Short Form 36 ( SF-36 ) scores. Results The overall bony union rate was 80.9% ( 38/47 ) for the 47 patients; the bony union rate for the intramedullary nailing group ( 71.4%) was significantly lower than that for the locking plating group ( 94.7%) ( P ＜0.05 ). There were no significant differences between the 2 groups in revision rate due to nonunion [ 17.8% ( 5/28 ) versus 5.2% ( 1/19 ) ] , bony union time ( 5.0 ± 0.9 months versus 5.5 ± 1.1 months ) , AOFAS Ankle-Hindfoot Scale ( 80.6 ± 8.4 points versus 79.5 ± 5.7 points) or SF-36 scores ( 78.9 ± 7.1 points versus 88.9 ± 7.7 points ) ( P ＞ 0.05 ) . The locking plating group had a significantly higher incidence of wound complications ( 47.4%) than the intramedullary nailing group (17.9%) ( P ＜0.05), but there were no significant differences between the 2 groups in symptomatic hardware or nerve irritations. Conclusions Both retrograde intramedullary nailing and locking plating can lead to fine curative effects in tibiotalocalcaneal arthrodesis. Although locking plating may result in a higher union rate than retrograde intramedullary nailing, it may cause a higher rate of wound complications.
ABSTRACT
Objective To study the relationship between plasma homocysteine and acute cerebral infarction and the effect of folic acid and VITB12.Methods74 cases of cerebral infarction patients in Jiande Hospital of Integrated Chinese and Western Medicine from December 2015 to December 2016 were selected as the observation group, 42healthy patients who received physical examination at the same stage were selected as the control group.All the researchers are using fluorescence polarization immunoassay to measure the plasma levels of homocysteine.47 patients with hyperhomocysteinemia in patients with acute cerebral infarction, then according to the classification method of randomly divided into the treatment group(n=23) and non treatment group(n=24).The treatment group was treated with folic acid and vitamin B12, while those in the non treatment group were not treated with these drugs, the effect of the intervention was compared.ResultsThe level of plasma homocysteine in the observation group was significantly higher than that in the control group, the difference was statistically significant (P<0.05).The levels of plasma HCY in the treatment group were significantly decreased after treatment with folic acid and vitamin B12,compared with non treatment group, the difference was statistically significant (P<0.05).ConclusionIn patients with acute cerebral infarction and the plasma homocysteine level was significantly higher than normal, so it needs to be controlled in a reasonable range, folic acid and vitamin B12 can reduce plasma HCY of the patient's body, and keep it in a more reasonable range, for the prevention of acute cerebral infarction is significant, it is worthy of clinical application.
ABSTRACT
Objective To analyze the feasibility of Ilizarov apparatus for ankle joint distraction to treat post-traumatic ankle osteoarthritis(OA).Methods From March 2012 to May 2014,15 patients with moderate post-traumatic ankle OA treated with foot and ankle deformities,and combined with ankle distraction surgery simultaneously by Ilizarov apparatus.The average age of patients was (35.6±6.5) years (10 Males and 5 females).Selected cases were involved in unilateral ankle disease,including 9 cases with ankle fractures medical history and 6 cases with ankle sprain medical history.Distraction was carried out for 3 months during which full weight bearing was allowed.Results Joint mobility and radiographic joint space were preserved in all 15 cases.No patients had undergone either ankle arthrodesis or total ankle arthroplasty.Ankle osteoarthritis scale (AOS) score was (33.8 ± 7.95) points before operation,(55.4 ± 5.46) points in the first year follow-up,and increased to (71.4 ± 10.19) points in the second year after operation,medical outcomes study 36-item short-form health survey (SF-36) score was (37.2 ± 4.32) points before operation,and increased to (52.8 ± 3.42) and (59.2 ± 2.95) points at 1 year and 2 years after operation,respectively,the difference between the two groups was statistically significant.The results of ankle range of motion (ROM) indicated function improved which was similar at both 1 year and 2 year's follow-up.Radiology joint space width (JSW) assessment indicated that ankle gap was improved significantly in 11 patients (73.3％,11/15) in the first year and maintain successfully in the second year.For the rest 4 patients (26.7％,4/15),ankle joint gap did not improved significantly,AOS and SF-36 showed clinical symptoms improved.Conclusion Ilizarov apparatus for ankle joint distraction is a promising treatment for moderate post-traumatic ankle OA at early stage of treatment,at least delaying the need for a joint fusion or total ankle arthroplasty.
ABSTRACT
Objective To compare the therapeutic effects of locking compression plate distal ulna hook plate (LCP-DUHP) and cannulated screws in the internal fixation for fractures of the fifth metatarsal base at zones Ⅰ and Ⅱ.Methods This retrospective study included 67 patients who had been treated for fractures of the fifth metatarsal base at zones Ⅰ and Ⅱ from July 2013 through December 2015.Of them,29 were treated by internal fixation with cannulated screws,including 17 men and 12 women with an average age of 46.6 years.There were 13 zone Ⅰ fractures and 16 zone Ⅱ fractures according to the Lawrence-Botte partition.The other 38 patients were treated by internal fixation with LCP-DUHP,including 20 men and 18 women with an average age of 33.7 years.There were 20 zone Ⅰ fractures and 18 zone Ⅱ fractures according to the Lawrence-Botte partition.The therapeutic effects were evaluated at the final follow-ups using visual analogue scale (VAS) for the affected feet,American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scoring system,and incidence of postoperative complications.Results All this series were followed up for 51 to 87 weeks (average,57weeks).There were no significant differences between the cannulated screws group and the LCP-DUHP group in terms of fracture healing time (13.9 ± 1.6 weeks versus 14.2 ± 1.8 weeks),VAS scores (4.9 ± 1.3 versus 4.8 ± 1.O) or AOFAS midfoot scores (87.9 ± 3.4 versus 88.6 ± 2.5) (P ＞ 0.05).Bony union was achieved in all.No implant failure was observed in this series.Conclusion Both LCP-DUHP and cannulated screws can lead to satisfactory therapeutic effects in the treatment of fractures of the fifth metatarsal base at zones Ⅰ and Ⅱ.
ABSTRACT
Objective To investigate the effect of fluvastatin on ventricular remodeling and serum tumor necrosis factor alpha(TNF-α)level in elderly patients with acute myocardial infarction.Methods 87 elderly patients with acute myocardial infarction were chosen in Jiande Hospital of Integrated Traditional Chinese and Western Medicine from October 2014 to October 2016,were randomly divided into control group(42 cases)and observation group(45 cases),the control group received aspirin,PI Gray chlorine and other conventional treatment,the observation group were given fluvastatinon the basis of the control group treatment.The changes of cardiac function and serum inflammatory factor TNF-α levels were observed before and after treatment.Results After the treatment,left ventricular weight index such asleft ventricular systolic volume index,left ventricular diastolic membrane membrane volume index,left ventricular ejection fraction in the two groups were improved in different degree,but the observation group improved significantly(P<0.05).In the control group,there was no significant improvement; and after treatment,the indexes of the observation group were significantly better than those of the control group(P<0.05).The effective rate in the observation groupwas 93.33％,was significantly higher than the control group(P<0.05).After treatment,the levels of serum TNF-α were significantly improved in the observation group,and the level of serum was significantly decreased compared with before treatment(P<0.05),and the observation group after the treatment was obviously lower than the control group(P<0.05).Conclusion For elderly patients with acute myocardial infarction with fluvastatin can better improve the patient's heart function,improve the body's inflammatory level,effectively improve the treatment effect,inhibit ventricular remodeling.
ABSTRACT
Objective To investigate the clinical effects of tibiotalocalcaneal arthrodesis (TTCA) using a retrograde intramedullary nail with a valgus curve.Methods At our department,22 patients underwent TTCA using a retrograde intramedullary nail with a valgus curve from June 2009 to January 2014 and were available for complete follow-up.They were 12 men and 10 women,aged from 46 to 79 years (average,62.2 years).There were 3 cases of primary ankle osteoarthritis,9 ones of traumatic arthritis,one of ankle arthritis secondary to severe talar avascular necrosis,3 ones of progressive subtalar arthritis following failed ankle replacement,5 ones of progressive subtalar arthritis following failed ankle arthrodesis,and one of arthritis secondary to equinovarus.The outcome measurements included the American Foot and Ankle Society (AOFAS) ankle-hindfoot scale,EQ-5DTM functional score,radiologic assessment and clinical examination.Results The mean follow-up was 21.3 months (range,from 14 to 38 months).A plantigrade foot and bony union were achieved in all the patients after a mean time of 3.9 months (range,from 2.4 to 6.2 months).Postoperative radiologic results showed a good hindfoot alignment in all the patients.Superficial infection occurred in one patient and loosening of the distal screw in another who asked for removal.The mean postoperative EQ-5DTM functional score and AOFAS ankle-hindfoot score were 69.3 (range,from 20 to 90) and 69.9 (range,from 45 to 85),respectively.Conclusion TTCA using a retrograde curved intramedullary nail may lead to solid fusion and good hindfoot alignment.
ABSTRACT
Objective To explore therapeutic mechanism of angiotensin-converting enzyme inhibitor (Captopril) in renal ischemia reperfusion (I/R) injury.Methods Wistar rats were randomly divided into sham operation group (Sham group),ischemia-reperfusion group (I/R group),captopril-treated group (CAP group),I/R model was made through ligating one side renal vessel.Renal function indexes including SCr and BUN were detected through biochemical analysis.Changes of renal tissue were observed by pathological section.ELISA detection was used to determine inflammatory cytokines such as IL-6,IL-8 and TNF-α.Activation of MAPK signaling pathway were analyzed by Western blot.Results After captopril treatment,SCr,BUN levels of the I/R group and the CAP group were higher than those of Sham group(P ＜ 0.05),Scr,BUN concentrations of CAP group were lower than those of I/R group(P ＜ 0.05).After captopril treatment,IL-6,IL-8,TNF-α concentrations of I/R group were higher than those of the Sham group(P ＜0.05);IL-6,IL-8,TNF-α concentrations of CAP group were lower than those of I/R group(P ＜ 0.05).Renal tissue c-jun N-terminal kinase,extracellular signal-regulated protein kinases,P38 in I/R group and CAP group were phosphorylated,and there were no significant differences between the two groups.Conclusion Captopril couldimprove renal function to some degree,and reduce expression of inflammatory cytokines rather than MAPK inflammatory signaling pathway.
ABSTRACT
We investigated the development of an injectable, biodegradable hydrogel composite of poly(trimethylene carbonate)-F127-poly(trimethylene carbonate)(PTMC11-F127-PTMC11 )loaded with bone morphogenetic protein-2 (BMP-2) derived peptide P24 for ectopic bone formation in vivo and evaluated its release kinetics in vitro. Then we evaluated P24 peptide release kinetics from different concentration of PTMC11-F127-PTMC11 hydrogel in vitro using bicinchoninic acid (BCA)assay. P24/ PTMC11-F127-PTMC11 hydrogel was implanted into each rat's erector muscle of spine and ectopic bone formation of the implanted gel in vivo was detected by hematoxylin and eosin stain (HE). PTMC11-F127-PTMC11 hydrogel with concentration more than 20 percent showed sustained slow release for one month after the initial burst release. Bone trabeculae surround the P24/ PTMC11-F127-PTMC11 hydrogel was shown at the end of six weeks by hematoxylin and eosin stain. These results indicated that encapsulated bone morphogenetic protein (BMP-2) derived peptide P24 remained viable in vivo, thus suggesting the potential of PTMC11-F127-PT- MC11 composite hydrogels as part of a novel strategy for localized delivery of bioactive molecules.
Subject(s)
Animals , Rats , Biocompatible Materials , Chemistry , Bone Morphogenetic Proteins , Pharmacology , Bone and Bones , Dioxanes , Chemistry , Drug Delivery Systems , Hydrogels , Chemistry , Osteogenesis , Peptides , Prostheses and ImplantsABSTRACT
Objective To investigate the cause of metastatic metatarsalgia after hallux valgus surgery and the clinical outcomes of Weil osteotomy for metastatic metatarsalgia after hallux valgus surgery. Methods From July 2009 to Janurary 2012, data of 27 patients (27 feet) with metastatic metatarsalgia of 2nd to 4th head of metatarsal bone after hallux valgus surgery who had been treated by Weil osteotomy were retrospectively analyzed. There were 1 male and 26 females with an average age of 51 years (range, 28-73 years). Metatarsalgia occurred 6-24 months after operation for hallux valgus. 13 feet underwent mini-invasive cervi-cal wedge osteotomy of the first metatarsal, 7 with Chevron procedure, 5 with Akin procedure, and 2 with Lapidus procedure. No shortening in first metatarsal was found in 5 feet with Akin osteotomy, while there were varying degrees of shortening in first meta-tarsal in the remaining 22 feet. The clinical results were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores. The preoperative and postoperative plantar pressure changes were tested by plantar pressure tester. Results 25 Patients were followed up for 12-42 months (average, 24 months). Among these 25 cases, the metatarsalgia of 23 cases were completely disappeared. The metatarsal plantar lateral metastatic pain occurred in the remaining 2 cases (2 feet) and 1 was relieved by the foot pad, 1 was cured by re-Weil osteotomy. AOFAS score was 46.82 ± 6.13 before surgery and 90.63 ± 1.65 after surgery. The VAS score was 7.5 (6, 7) before surgery and 0.5 (0, 1.0) after surgery. The last follow-up, according to the score of AOFAS toe metatarsophalangeal-interphalangeal joint, of which 23 cases were excellent, 1 good, 1 poor;the excellent and good rate was 96%(24/25). Preoperative pressure under 2nd to 5th metatarsal head were 3.12±1.62 Pa, 5.81±1.92 Pa, 4.63± 2.10 Pa, 3.37±1.57 Pa, 1.67±1.20 Pa and postoperative were 3.33±1.35 Pa, 3.89±1.08 Pa, 3.65±1.96 Pa, 2.25±1.23, (1.48±1.11) Pa. Postoperative pressure under 2nd to 5th metatarsal head were significantly decreased. Conclusion Weil osteotomy can effec-tively adjust the length of the metatarsal and the height of metatarsal head, thus effectively improve the pressure under the metatar-sal head, so it could reach a good effect in the treatment of metastatic metatarsalgia after hallux valgus surgery.
ABSTRACT
Objective To prepare P24/PTMC11-F127-PTMC11 hydrogel,to study the in vitro release profile and to observe ectopic bone formation in p24 peptide incorporated PTMC11-F127-PTMC11 hydrogel.Methods Corresponding weight powder of p24 peptide was infunded into tubes of PTMC11-F127-PTMC11 solution with concentrations of 16％,20％ and 25％.Release profiles of P24 peptide in different concentration PTMC11-F127-PTMC11 hydrogel were measured in vitro by BCA assay.P24/PTMC11-F127-PTMC11 hydrogel was implanted into each rat's erector muscle of spine,and the implanted gel was detected by hematoxylin and eosin stain (HE).Results PTMC11-F127-PTMC11 hydrogel showed sustained slow release for the whole process after the initial burst release.With the increase of concentration in PTMC11-F127-PTMC.hydrogel,the initial burst release was reduced significantly.Ectopic bone formation was observed by computed tomography in p24 peptide incorporated PTMC11-F127-PTMC11 hydrogel after four weeks.Bone trabeculae surround the P24/PTMC11-F127-PTMC11 hydrogel was observed at forth week by hematoxylin and eosin stain.The bone trabeculae became thicker from sixth week.Conclusion Delayed release of peptide from the hydrogel was mainly controlled by disintegration of hydrogel and a satisfactory release profile was observed.These results suggest that the p24-loaded PTMC11-F127-PTMC11 hydrogel remmns active of p24 at the implanted site,continuously induce differentiation of osteoblast precursor cells into osteoblasts,and activate osteoblasts to promote ectopic calcification.
ABSTRACT
Objective To evaluate the clinical outcome of lateral malleolar's anatomical hook-plate in treating ankle fracture including distal fibular fracture. Methods Nineteen patients of ankle fracture including distal fibular fracture were treated from January 2006 to January 2009. There were 12 males and 7 females with an average age of 36 years (range, 18-72 years). The fractures were classified by Danis-Weber system. There were A type in 8 cases, B type in 11 cases. The average time of duration between injury and operation was 6 days (ranged from 6 hours to 16 days). The distal fibular fracture were treated with lateral malleolar's anatomical hook-plate. The medial malleolus was fixed with cancellous bone screw. The posterior malleolus was fixed with screw or plate according to the pattern of fracture. Results The mean follow-up period was 18.8 months with a range from 6 to 32 months. No obvious fracture line could be seen on the radiographs 4-6 weeks after operation. Bone healing was achieved in 10 cases 12 weeks after operation and in 9 cases 20 weeks after operation. All surgical incisions healed adequately. There were no instances of infection, instability of ankle and other complications. According to Mazur ankle joint scoring scale system, the fiual result was scored from 67 to 92 (average 86.3). There were excellent in 12 cases, good in 4, fair in 2,and poor in 1 case. The excellent and good rate was 84.2%. Conclusion The lateral malleolar's anatomical hook-plate represents a definite biomechanical superiority in treating fracture of the external malleolus, with advantage of restoring anatomic structure, joint activity effectively and firm fixation.
ABSTRACT
Objective To investigate the therapeutic effect of lengthening and rotational osteotomy of the fibula for lateral malleolar malunion. Methods Twenty-three patients who had suffering from the traumatic arthritis of ankle were due to lateral malleolar malunion treated with lengthening and rotational osteotomy from October 2005 to July 2008. Special radiographs were use to fully detect the extent of shortening and rotation of the fibula. The Lengthening and rotational osteotomy could be conducted with a special compression/distraction device and bone graft. The function of the ankles was evaluated by the American Orthopedic Foot Ankle Society (AOFAS) scoring system. Serial radiographs of the ankle were made to assess the bone healing and changes of posttraumatic osteoarthritis. Results Seventeen of 23 patients were followed up, with a mean 29.1 months (12-45 months). All the fractures were healed. The mean bone healing time was 13.3 weeks (11-16 weeks) and the mean time of total weight-bearing was 12.1 weeks (11-15 weeks). The ankle function score had improved from 29 (21-47) preoperatively to 81 (56-91)12 months after the operation. There was 5 in excellent, 8 in good, 3 in mild, 1 in poor, and the rate of good outcomes was 76.5%. After the operation, 1 patient had a skin necrosis around the wound which healed by conservative treatment. A slightly aggravated degeneration of the ankle joint was seen in 2 patients who responded to conservative managements. No failure of the internal fixation was noted in this group. Conclusion The outcomes demonstrate that reconstructive lengthening osteotomy is well worthwhile when there is absent or minimal osteoarthritic change, regardless the time from the original injury. Lengthening of the fibula is an important step in the treatment of the painful ankle when the fibula become shorter after injury, even when degenerative changes of the joint are already present. The lengthening of the fibula could lead to a good outcome in ankle with lateral malleolar malunion.
ABSTRACT
BACKGROUND: The proliferation and differentiation of mesenchymal stem cells (MSCs) lack of regulatory functions. Following combining with suitable vectors, MSCs cannot highly effectively proliferate and differentiate, which are keys to prevent MSCs entering the clinic. It is of great importance to effectively regulate the differentiation of stem cells into osteoblasts using pulse electromagnetic field.OBJECTIVE: To investigate the differentiation of mouse MSCs into osteoblasts in vitro following stimulation of pulse electromagnetic field.DESIGN, TIME AND SETTING: The cytological in vitro controlled study was conducted at the Laboratory of Department of Orthopaedics, Puai Hospital of Tongji Medical College, Huazhong University of Science and Technology from May 2004 to October 2007.MATEIRALS: Totally 20 BALB/C mice were supplied by the Experimental Animal Center of Tongji Medical College. Pulse electromagnetic field deviser was designed and made by the Department of Electric Machine, Naval University of Engineering.METHODS: Mouse bilateral femur was sterilely isolated. BMSCs were harvested by the Percoll density gradient centrifugation,and purified and proliferated by the adherent method. Cells at the third passage (2×10~7/L) were incubated in a 6-well plate, and then divided into 4 groups. Cells in the blank control group were incubated in the complete medium. Cells in the pulse electromagnetic field underwent pulse electromagnetic field radiation of 50 Hz, sinusoidal wave, and 1 mT, twice a day, once 30 minutes, with an interval of 12 hours, totally 10 days. Cells in the osteogenic induction group were incubated in the complete medium, supplemented with dexamethasone, sodium glycerophosphate and VitC. Cells in the pulse electromagnetic field + osteogenic induction group were subjected to the same pulse electromagnetic field radiation and then incubated in the complete medium.MAIN OUTCOME MEASURES: The differentiation of BMSCs was measured.RESULTS: Results of alkaline phosphatase staining showed that cells were negative in the blank control group, but weakly positive in the pulse electromagnetic field group, positive in the osteogenic induction group, and strongly positive in the pulse electromagnetic field + osteogenic induction group 10 days following intervention. Compared with the blank control group,absorbance value of type I collagen immunohistochemistry was significantly greater in the osteogenic induction group, pulse electromagnetic field + osteogenic induction group (P < 0.05, P < 0.01).CONCLUSION: Pulsed electromagnetism fields of 50 Hz, waves of sine, with the intensity of 1 mT could promote alkaline phosphatase and type I collagen expression and enhance the differentiation of mouse BMSCs into osteoblasts in vitro.
ABSTRACT
BACKGROUND:Studies confirm that electromagnetic field (EMF) can promote the synthesis and secretion of many bone growth factors,and some growth factors can induce the osteoblastic directional differentiation of bone marrow mesenchymal stem cells (MSCs).OBJECTIVE: To investigate the effect of power-frequency EMF on mRNA expressions of bone morphogenetic protein-2 (BMP-2) and transforming growth factor-beta 1 (TGF-β1) in mouse bone marrow MSCs cultured in vitro.DESTGN: Single sample, block design, observation and controlled animal trial.SETTING: Department of Traumatic Surgery, Tongji Hospital Affiliated to Tongji Medical .College, Huazhong University of Science and Technology.MATERIALS: This trial was carried out in the laboratory of Department of Traumatic Surgery, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology during February to December 2005. ①Twenty Kunming mice of clean grade were selected for harvest of bone marrow MSCs. ②Magnetic field generator,which could generate EMF with 0 to 100 mT field strength and successive adjustable 50 Hz sinusoidal wave, was developed by Wuhan Naval University of Engineering. ③ Primer was all synthesized by Saibaisheng Bioengineering Co.,Ltd., Beijing.NETHODS: ① The involved mice were sacrificed by cervical dislocation. Bilateral femora and tibia were harvested. Bone marrow MSCs were isolated and cultured in vitro, and the second generation of cells were used for the trial. ②Different intensities of EMF stimulation tests: Negative control group, positive control group, EMF 0.4, 0.8 and 1.6 mT stimulation groups were set. Five bottles of cells of the second generation were chosen from each group for test. The cells in the negative control group and positive control group were not exposed to EMF. But medium containing osteogenic inductor(10-8 mol/L dexamethasone, 10 mmol/L β-sodium glycerophosphate and 50 mg/L Vitamin C included) was added in the positive control group at passage. After adhering to the wall, the cells in the EMF 0.4,0.8 and 1.6 mT stimulation groups were exposed to EMF of 0.4,0.8 and 1.6 mT field strength, respectively, one hour per day, five days later, they were detected.③ EMF stimulation tests in the same field strength and different time: Negative control group, EMF 1.6 mT stimulation 15,30 and 60 minutes groups were set.Five bottles of cells of the second generation were chosen from each group for test. The cells in the negative control group were exposed to EMF. The cells in the EMF 1.6 mT stimulation 15,30 and 60 minutes groups were respectively given 15,30 and 60 minutes of EMF stimulation at 1.6 mT successively.Five days later, they were detected.④ The mRNA expressions of BMP-2 and TGF-β1 were detected in each group by reverse-transcriptase polymerase chain reaction (RT-PCR) technique.MAIN OUTCOME MEASURES: ① The effect of different field strength of exposure of 50 Hz EMF on mRNA expressions of BMP-2 and TGF-β1. ② The effect of the same field strength and different time of exposure of 50 Hz EMF on mRNA expressions of BMP-2 and TGF-β1.RESULTS: ①Five days after EMF stimulation, the mRNA expressions of BMP-2 and TGF-β1 in the positive control group and EMF 0.4,0.8 and 1.6 mT stimulation groups were significantly enhanced as compared with negative control group (all P ＜ 0.01), and the mRNA expression of BMP-2 in the EMF 1.6 mT stimulation group reached the peak [(57.74±0.23)％]and mRNA expression of TGF-β1 in the EMF 0.4 mT stimulation group also reached the peak [(126.20±0.21 )％].② Five days after EMF stimulation, the mRNA expressions of BMP-2 and TGF-β1 in the EMF 1.6 mT stimulation 15,30 and 60minutes groups were significantly enhanced (all P ＜ 0.01) as compared with negative control group, and the mRNA expressions of two factors in the EMF 1.6 mT stimulation 60 minutes group reached peak separately [(28.06±0.11 )％ and (75.20±0.16)％].CONCLUSION:Proper intensity and action time of exposure of power-frequency EMF can obviously promote the mRNA expressions of BMP-2 and TGF-β1 in mouse bone marrow MSCs cultured in vitro.
ABSTRACT
BACKGROUND: As a non-invasive therapy, pulsed electromagnetism fields (PEMFs) have been confirmed to have definite clinical efficacy on bone nonunion and other orthopaedic diseases. However, the action of bone marrow mesenchymal stem cells (MSCs) in the treatment of fracture by PEMFs is always neglected due to the restriction of previous knowledge.OBJECTIVE: To observe the proliferation and changes of cell cycle of MSCs in mice under PEMFs of 50 Hz, sine waves, at different intensity and different time, so as to find out the optimal window for intervention.DESIGN: A single-sample, grouped design, comparative observation of cell culture in vitro.SETTING: Department of Orthopaedics, Puai Hospital of Tongji Medical College, Huazhong University of Science and Technology.MATERIALS: Twenty BALB/C mice of 4-5 weeks old, weighing 18-22 g, either male or female, clean degree, were provided by the experimental animal center of Tongji Medical College [No. SYXK(E)2004-0028]. The animal experiment met the requirements of animal ethics. Pulse magnetic field generator was designed and manufactured by the Department of Electrical Engineering, Naval University of Engineering.METHODS : The experiments were carried out in the orthopaedic laboratory of Puai Hospital of Tongji Medical College, Huazhong University of Science and Technology from January to June in 2004. Mice MSCs were isolated using the density gradient centrifugation, then screened by means of adhesion, and the mice MSCs of the 3rd passage that grew well were treated with 50 Hz sine-wave PEMFs of 4, 3, 2 and 1 mT respectively, twice a day, 30 minutes for each time, with an interval of 12 hours. The stem cells untreated with PEMFs were taken as the control group.MAIN OUTCOME MEASURES: At 24, 48 and 72 hours after irradiation, the level of MSCs proliferation was detected with methyl-thiazol-tetrazolium (MTT) assay, cell cycle was analyzed with flow cytometer, and the influence of PEMFs on the proliferation of mice MSCs was expressed as proliferation index (PI).RESULTS: Effect of PEMFs on the proliferation of mice MSCs: There were no significant differences after irradiation for 24 and 48 hours between the PEMFs intervention groups and control group (P＞0.05). The proliferated MSCs after irradiation for 72 hours in the PEMFs intervention groups were significantly more than those in the control group (P＜0.05-0.01), and which was the most obvious by PEMFs of 1 mT (P＜0.01). Effect of PEMFs on the cell cycle of mice MSCs: No cell with abnormal DNA ploidy (diploid: 100%) was observed in all the samples. The PI values after PEMFs intervention of 1, 2, 3 and 4 mT for 72 hours were significantly higher than that in the control group (P ＜0.05-0.01), which was the most obvious by PEMFs of 1 mT (P＜0.01).CONCLUSION: Pulsed electromagnetism fields of 50 Hz, sine waves and intensity of 1 mT for 72 hours could obviously promote the proliferation of mice MSCs in vitro, this being the optimal window for intervention.
ABSTRACT
A preliminary experimental research on the proliferation and differentiation of rat bone marrow mesenchymal stem cells with exposure to 50 Hz magnetic fields is done. The experimental results can be well repeated, showing that 50 Hz magnetic fields can evidently affect the proliferation and differentiation of rat bone marrow mesenchymal stem cells (MSCs), besides, the results are not linear with the amplitude of magnetic fields, but existing therein a 'window' phenomenon. At the end of this paper, the domestic and overseas development of the research is discussed on with the emphasis how to cure the bone fracture with the help of magnetic fields, and our investigative thoughts are also presented.