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BACKGROUND:To improve local microenvironment and reduce local scars is conducive to peripheral nerve regeneration that promotes nerve function recovery.OBJECTIVE:To evaluate the effect of fresh amniotic membrane on the regeneration of tinjured peripheral nerve.METHODS:Sixty healthy Sprague-Dawley rats were randomly divided into three groups (n=20 per group) after constructing a model of sciatic nerve injury of the unilateral leg. In group A, the nerve was wrapped with fresh human amnion at the anastomosis end after the repair of nerve. In group B, the nerve was wrapped with biofilm at the anastomosis end after the repair of nerve. In group C, no treatment was conducted after the repair of nerve (blank control). The effects were evaluated by anatomical observation, light microscope observation, immunohistochemical detection (2, 4, 8, 12 weeks after surgery), transmission electron microscope observation, axon imaging analysis, action potential detection, and sciatic nerve function index (4, 8, 12 weeks after surgery).RESULTS AND CONCLUSION: (1) Gross observation. The amniotic membrane and biofilm were absorbed partialy at postoperative 2 weeks, mostly at postoperative 4 weeks and completely at postoperative 8 weeks. In the groups A and B, the nerve was adhered slightly and loosely to the surrounding tissues, with a fair range of motion. In the group C, the nerve was tightly adhered to the surrounding tissues, with a poor range of motion. (2) Observation under light microscope. The nerve regeneration was better in the groups A and B than group C at 2, 4, 8, 12 weeks postoperatively. (3) Observation under electron microscope. Regenerated nerve fibers were rarely seen and lamelar structures were unclear in the three groups at 4 weeks postoperatively. Then, increased regenerated nerve fibers, thickened myelin sheath, clear lamelar structure and enlarged axon diameter were found in the groups A and B compared with the group C at 8 and 12 weeks postoperatively. (4) Immunohistochemical detection. The expression and distribution of S-100 protein in the groups A and B were better than those in the group C. (5) Axon image analysis. Groups A and B were superior to the group C in the diameter of myelinated nerve fibers, thickness of myelin sheath and number of regenerated nerve fibers. There was a significant difference by statistical analysis (P < 0.05). (6) Electrophysiological examination. Shorter latency period, higher amplitude and faster nerve conduction velocities were observed in the groups A and B compared with the group C (P < 0.05). (7) The sciatic function index. The sciatic function index in group A or B was significantly higher than that in group C (P < 0.05). To conclude, the human amniotic membrane can reduce adhesion between the damaged nerve and surrounding tissues, and prevent scarring at the anastomosis end. In addition, it promotes the regeneration of nerve fibers, increase axon diameter and myelin sheath thickness, and ease inflammatory and immune responses at the neural incision.
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BACKGROUND:Experiments have demonstrated that biological membranes can be usedtorecon struct thetendon she athandin hibit exogenou shealing of thetendon.Therefore,the semembrane sprovide a good bed for tendon gliding and reduce tendon adhesion. OBJECTIVE:To compare the effectsof acelular amniotic membrane and medical membraneagainst tendon adhesion during the repair oftendon sheath defects. METHODS:ToesIIIfrom the bipeds of 66 leghorns were chosen to prepare tendon injury and tendon sheath defect models, which were randomly divided into three groups (n=22 per group). Amnion group were repaired with acelular amniotic membrane, medical membrane group with absorbable membrane, and control group had no treatment on tendon sheath defects. Gross, histological and biomechanical tests of each group were performed at 2, 4, 8, 12 weeks after surgery. RESULTS AND CONCLUSION:At 12 weeks after surgery, in the amniotic membrane and medical membrane groups, the tendon sheath formed completely, and the tendon healed well, with no adhesion, but in the control group, there was serious tendon adhesion. At 8 weeks after surgery, the number of synovial cells in the false sheath was highest in the amniotic membrane group sequentially followed by the medical membrane group and control group. In the amniotic membrane group, the rough endoplasmic reticulum expanded highly and secreted exuberantly in the matrix, while in the control group, the synovial cells presented with messy arrangement, and expanded vacuoles in the matrix were weaker than those in the other two groups. At 12 weeks after surgery, fibroblasts were arrayedtidily in layerwith dense structure in the medical membrane and amniotic membrane groups;but in the control group, fibroblasts were distributed disorderly with loose structure. Tendon sliding distance and total flexor toe angle in the amniotic membrane and medical filmgroups were significantly larger than those in the control group (P < 0.05),butthere was no significant difference between the medical membrane and amniotic membrane groups. Additionally, the maximum tensile fracture strength had no significant difference among three groups at 12 weeks after surgery. These results indicate that both amniotic membrane and medical membrane can markedlyprotect the tendon from exogenous healing and adhesion.
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Objective To measure the normal sagittal and coronal diameters of thumb and great toe distal phalanx bottom by ultrasonography. Methods One hundred and twenty volunteers' sagittal and coronal diameters of thumb and great toe distal phalanx bottom were measured by ultrasonography. The measurements was analysed by the statistical method. Results The thumb and great toe distal phalanx bottom showed hyperechoic zone,clear boundary with the adjacent fascia and tendon tissue showed low echo area at cross section by high frequency ultrasound. The sagittal diameters of thumb distal phalanx bottom was (8. 07 ± 0. 67)mm in men, while that of great toe distal phalanx bottom was (8. 34 ± 1. 02) mm( t = 1.73, P =0.86).The coronal diameters of thumb distal phalanx bottom was (11.61 ±0.89)mm in men, while that of great toe distal phalanx bottom was (14. 25 ± 0. 84)mm( t = 16. 77, P = 0. 00). The sagittal diameters of thumb distal phalanx bottom was (7. 52 ± 0. 62) mm in women, while that of great toe distal phalanx bottom was (7. 72 ± 0. 67) mm( t = 1. 72, P =0. 14). The coronal diameters of thumb distal phalanx bottom was (10.94 ± 0.97) mm in women, while that of great toe distal phalanx bottom was (13. 51 ±0. 75) mm( t =16.21, P = 0.00). Conclusions The normal sagittal and coronal diameters of thumb and great toe distal phalanx bottom measured by the ultrasonography can guide the operation of wrap-around flap of a great toe with phalanx ungual for thumb II degree defect reconstruction.
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Objective To investigate the biomechanicai characteristics of flexor profundus tendons repaired after decimeter wave therapy, and to observe the effect of decimeter wave therapy on early active mobilization. Methods A total of 56 Leghorn chickens were randomly divided into a therapy group and a control group with 28 chickens in each. The 3rd and 4th toes of their left feet were employed for the establishment of a tendon injury model. The flexor profundus tendons were cut and repaired. Gypsum support was applied and fixed with an adhesive plaster after the operation. The operated sites on toes Ⅲ and Ⅳ were exposed. The external fixation was removed 3 weeks later and the chickens were left free to move. Decimeter wave therapy ( frequency 915 MHz, power 8 Watts) was ap-plied for 10 minutes once daily on the left foot of each chicken in the therapy group from day 1 until 3 weeks after the operation. Sham decimeter wave therapy was applied to chickens in the control group. Four chickens from each group were randomly selected at the 1st, 7th, 10th, 14th, 18th, 21st and 28th days for biomechanical analysis. Biome-chanical parameters including tensile strength of rupture (Pmax), elongation ratio at rupture (δimax) and the tensile adhesion strength of the rupture zone (W0>) were observed at each time point. Results At the 7th, 10th, 14th, 18th, 21st and 28th day after the operation, the differences in Pmax, δmax and W0 between the therapy and control groups were statistically significant. The results of the therapy group were better than those of the control group. Conclusions Local decimeter wave therapy after flexor tendon repair can promote intrinsic healing and reduce ex-trinsic healing. The speed and quality of healing are improved. The elasticity and tenacity of the injured tendons are enhanced. Therefore decimeter wave therapy is helpful for early active mobilization training.
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Objective To observe the effects of decimeter wave irradiation on the rehabilitation of the acute peripheral nerve injury of rats. Methods Eighty Sprague-Dawley rats(200～250 g)were randomly divided into 2 groups:group A,the decimeter wave irradiation group and group B,the blank control group.The right sciatic nerves of all the rats were crushed with forceps to establish the experimental animal model of acute peripheral nerve injury.Then the rats of group A were exposed to decimeter wave irradiation for 10 minutes every day for 8 weeks.The rats of group B were also fixed on a table as those in group A but receive no decimeter irradiation.At different time points observation with light and electron microscopy,immunochemical staining,axon morphometric analysis,electrophysiological examination were carried out.Results Morphometric analysis showed that at different time points after operation the recovery of nerves in group A was better than that in group B.Axon morphometric analysis showed that the number,the diameter and the thickness of sheath of myelinated nerve fibers in group A were greater than those in group B. Electrophysiological assessment showed that the latency was shorter,the amplitude was higher,and the nerve conduction velocity was faster in group A than those in group B at the end of 8 weeks of decimeter wave treatment after operation.Conclusion Decimeter wave had significant effects on the rehabilitation of the acutely injured peripheral nerves.
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[Objective]To investigate the morbidity,classification and treatment of multiple fracture around the knee in adults,and to analyze the significance of AO classification in the treatment.[Method]Multiple fractures in 167 patients from 2003 to 2007 were retrospectively analyzed and grouped according to their ages,occurring years,mechanism of injury and treatment.AO/OTA classification was assessed from the preoperative X-ray result,and healing situation was evaluated according to postoperative X-ray.[Result]All 167 multiple fractures around the knee accounted 23.69% for all lower limb fractures,with 89.2% of male and 10.8 of female.For the patient's age analysis,30-40 years old age group accounted for the largest proportion (29.34%).For the injury mechanism,traffic accident accounted for the largest proportion (53.29%).Distal femur + proximal tibia fracture accounted for 44.3%.patella + distal femur fracture accounted for 31.1%.Proximal tibia + patella accounted for 19.8%.Distal femur + proximal tibia + patella accounted for 4.8%.According to AO classification,A3 fracture was the most common in distal femoral fracture group (25.4%).B1 fracture was the most common in proximal tibia fracture group (21.7).C3 fracture was the most common in patella fracture (31.2).Tthe final good-to-excellent rate was 85.63%.[Conclusion]Distal femoral fracture combined with proximal tibia fracture was the most common in multiple fractures around the knee.The common fracture type is supracondylar fracture in femur,transverse patella and tibia.Application of nail,plate,wire and tension band,et al.can achieve good fixation.