Saphenous vascular periosteal flap in prevention of bone bridge formation after epiphyseal plate injury: An experimental study / 中华显微外科杂志

Objective:To establish a model of epiphyseal plate injury in juvenile rabbits and explore the effect of periosteum flap with saphenous artery on preventing the formation of bone bridge after epiphyseal plate injury.Methods:From July 2017 to January 2018, 30 young New Zealand immature rabbit were randomly grouped into 3 groups (group A, B and C, with 10 rabbits per group). The blood vessels of knee joint were dissected and a periosteum flap with saphenous artery were designed. A model of distal femoral epiphyseal plate injury was established in immature rabbits with a 3.0 mm Kirschner wire on one side of the distal femoral epiphyseal plate as experimental side, and the other side of the distal femoral epiphyseal plate was assigned as control side. The injured epiphysis were prepared and described as follow: in experimental side of group A, a piece of periosteum with the same size as that in group C was resected and discarded. In experimental side of group B, a periosteal flap without vascular pedicle was filled in the injured area. And in experimental side of group C, a periosteum flap with saphenous artery was filled in the injured area. The length and varus angle of femur specimens of length and varus angle of femur specimens wihthin groups were measured at 24 weeks after surgery to evaluate the effect on bone growth in epiphyseal plate injury. The effect of the periosteum flap with saphenous artery on preventing a formation of bone bridge was assessed by section view of decalcified specimens, HE staining and toluidine blue staining. The measured data were expressed as Mean and standard deviation (Mean±SD), and data were compared within and between the groups using one-way analysis of variance (ANOVA). P<0.05 was considered as statistically significant. Results:The femur of experimental side of group A and B showed obvious short with valgus deformity compared with that of control side, and the difference of length and varus angle of femur specimens wihthin groups was statistically significant ( P<0.05). There were no significant differences in the length and valgus angle of the femur between experimental side and its control side in group C ( P>0.05). In experimental side of group A, there were bone bridges in the epiphyseal lesion area, with a clear boundary to the surrounding epiphyseal plate. In experimental side of group B, the periosteum flap in the injured area was absorbed, accompanied by the formation of a few pale white bone tissue, and with a clear boundary to the surrounding epiphyseal plate. In experimental side of group C, the lesion area was filled with milky white cartilage tissue with the same colour as the epiphyseal plate, and with an unclear boundary with the epiphyseal plate. HE stain and toluidine blue staining showed that the injured area of group A was filled with a large number of bone tissue, but no obvious cartilage tissue was observed. In group B, the area of lesion was filled mainly with fibrous tissue, with a small amount of bone tissue. In group C, a large number of hyaline cartilage tissues were formed along the tunnel of the injury area, and closely connected with the normal epiphyseal plate. Conclusion:Filling a periosteum flap with saphenous artery after epiphyseal plate injury can prevent the formation of bone bridge and prevent the affected limb form shortening and angulation.

Analysis of factors influencing X-ray images of spinal injury in patients with ankylosing spondylitis / 中华风湿病学杂志

Objective@#To investigate factors affecting X-ray structure of the spine in patients with ankylosing spondylitis (AS).@*Methods@#A total of 206 AS patients were recruited. Clinical and laboratory parameters in AS patients were recorded in detail. Disease activity index [Bath ankylosing spondylitis disease activity index (BASDAI), ankylosing spondylitis disease activity score (ASDAScrp)], X-ray structural damage index-modified stoke ankylosing spondylitis spine score (mSASSS) and grading results of radiographic examination of sacroiliac joint were calculated. Statistical analysis using Statistical Package form Soci-science(SPSS) 17.0 Chi-square test, rank test, Logistics regression analysis and other statistical methods were used. Differences of mSASSS levels, spine involvement (mSASSS>0) and rates of bone bridge formation were compared between different groups.@*Results@#Incidences of spine involvement (100%) and bone bridge formation(65.2%) in AS patients ≥40 years old were significantly higher than those in AS patients <40 years old (90.6%、31.9%)(χ2=4.651, P=0.031; χ2=16.647, P<0.01), and the level of mSASSS was also higher (Z=5.575, P<0.01). In AS patients with BMI ≥24 kg/m2, disease duration ≥5 years (49.2%, 50.4%), rates of bone bridge formation was significantly higher than those in AS with BMI <24 kg/m2, but the disease duration (34.5%, 19.7%)(χ2=4.014, P=0.045; χ2=18.173, P=0.03), and mSASSS values were significantly higher (Z=2.281, P=0.023, Z=4.828, P<0.01). Bone bridge formation rate in smoking patients (50.6%) was significantly higher than that in non-smoking patients (31.0%) (χ2=7.346, P=0.007) and mSASSS value was significantly higher (Z=2.045, P=0.041). Bone bridge formation rates in AS with high-ESR and high-CRP(48.6%, 49.0%) were significantly higher than those in patients with normal-ESR and normal-CRP(25.6%, 28.9%)(χ2=10.784, P=0.001; χ2=8.102, P=0.004) and mSASSS value was clearly higher(Z=2.379, P<0.01; Z=3.112, P<0.01). Bone bridge formation rate in AS with BASDAI≥4 or ASDAScrp≥2.1 groups (52.8%, 46.4%) were significantly higher than that in AS with BASDAI<4 or ASDAScrp<2.1 groups (34.2%, 30.7%) (χ2=5.681, P=0.017; χ2=4.646, P=0.031) and mSASSS values were significantly higher (Z=3.887, P<0.01; Z=3.895, P=0.004). Rates of bone bridge formation among different X-ray grading of sacroiliac joint (10.8%, 35.6%, 60.3%) and MRI findings (33.3%, 50.0%, 15.4%) differed with each other (χ2=25.714, P<0.01; χ2=6.855, P=0.032). Logistics regression analysis showed that BMI [OR(95%CI)=1.145(1.037, 1.265), P<0.01], disease duration [OR(95%CI)=1.144(1.055, 1.239), P<0.01], smoking [OR(95%CI)=2.832(1.343, 5.969), P<0.01] and sacroiliac joint X-ray staging [OR(95%CI)=2.584(1.337, 4.997), P<0.01] were risk factors for the bone bridge formation in spine of AS.@*Conclusion@#Spinal involvement in AS is related to disease activity. Bone bridge formation correlateswith disease duration, BMI and disease-status, especially with smoking.

Transplantation of a Scaffold-Free Cartilage Tissue Analogue for the Treatment of Physeal Cartilage Injury of the Proximal Tibia in Rabbits

PURPOSE: The purpose of this study was to investigate the effects of transplantation of an in vitro-generated, scaffold-free, tissue-engineered cartilage tissue analogue (CTA) using a suspension chondrocyte culture in a rabbit growth-arrest model. MATERIALS AND METHODS: We harvested cartilage cells from the articular cartilage of the joints of white rabbits and made a CTA using a suspension culture of 2x107 cells/mL. An animal growth plate defect model was made on the medial side of the proximal tibial growth plate of both tibias of 6-week-old New Zealand white rabbits (n=10). The allogenic CTA was then transplanted onto the right proximal tibial defect. As a control, no implantation was performed on the left-side defect. Plain radiographs and the medial proximal tibial angle were obtained at 1-week intervals for evaluation of bone bridge formation and the degree of angular deformity until postoperative week 6. We performed a histological evaluation using hematoxylin-eosin and Alcian blue staining at postoperative weeks 4 and 6. RESULTS: Radiologic study revealed a median medial proximal tibial angle of 59.0degrees in the control group and 80.0degrees in the CTA group at 6 weeks. In the control group, statistically significant angular deformities were seen 3 weeks after transplantation (p<0.05). On histological examination, the transplanted CTA was maintained in the CTA group at 4 and 6 weeks postoperative. Bone bridge formation was observed in the control group. CONCLUSION: In this study, CTA transplantation minimized deformity in the rabbit growth plate injury model, probably via the attenuation of bone bridge formation.

Lateral Sliding Calcaneal Osteotomy for Bilateral Talocalcaneal Coalition with Complete Bone Bridge (A Case Report) / 대한족부족관절학회지

Talocalcaneal coalition known as the most common tarsal coalition is a congenital failure of segmentation. Talocalcaneal coalition with complete bone bridge is very rare, and there are few references in the literature about the clinical results and the operative method for this type of tarsal coalition. We report a case of 15 years old female with complete talocalcaneal coalition, who showed good clinical results by lateral sliding calcaneal osteotomy.

Avaliação por imagem das lesões da placa de crescimento / Imaging of growth plate injuries

As estruturas responsáveis pelo crescimento do osso incluem a fise (também chamada placa de crescimento) e as epífises. Afecções que acometem pacientes com o esqueleto imaturo, ou seja, com a placa de crescimento ainda aberta, podem interferir no crescimento ósseo, resultando em complicações como parada do crescimento, encurtamento dos membros ou deformidades angulares. Condições traumáticas que resultam muitas vezes em fraturas epifisárias são a causa mais comum das lesões da placa de crescimento. A avaliação cuidadosa desses pacientes pelos métodos de diagnóstico por imagem atualmente disponíveis, sobretudo a radiografia, a tomografia computadorizada e a ressonância magnética, permite o reconhecimento precoce do comprometimento das estruturas relacionadas ao crescimento ósseo, além de tratamento adequado, diminuindo a possibilidade do desenvolvimento de tais complicações.

The structures responsible for the growth of bones include the physis (also called growth plate) and the epiphysis. Affections involving patients with immature skeletons, i.e., with a still open growth plate, may affect the bone growth, resulting in complications such as growth arrest, limb shortening and angular deformities. Traumatic conditions, many times resulting in epiphyseal fractures, are the most frequent cause of growth plate injuries. A careful evaluation of these patients by means of currently available imaging methods, especially radiography, computed tomography and magnetic resonance imaging, allows an early diagnosis of the involvement of structures related to the bone growth, besides an appropriate management, reducing the probability of secondary complications.

Congenital Distal Tibio-fibular Synostosis: Case Report / 대한정형외과학회잡지

Congenital distal tibio-fibular synostosis is a very rare disease with no reported cases in Korea. An 8 year old girl complained of ankle discomfort and deformity due to distal tibio-fibular synostosis. The patient was treated with an autogenous fat graft after a bone bridge resection and fibular osteotomy to restore the ankle mortise. Osteosynthesis with a plate was performed to treat the fibular nonunion during the follow-up. Fibular union was achieved, and there have not been any subjective symptoms or limitations of outdoor activity and ROM during a four and half year follow up.