Effect of microfracture combined with biomimetic hydrogel scaffold on rotator cuff tendon-to-bone healing in rabbits / 中国修复重建外科杂志

Objective: To assess the effect of microfracture and biomimetic hydrogel scaffold on tendon-to-bone healing in a rabbit rotator cuff tear model. Methods: Gelatin and methacrylic anhydride were used to synthesize gelatin methacryloyl (GelMA). Then the GelMA were treated with ultraviolet rays and vacuum freeze-drying method to obtain a biomimetic hydrogel scaffold. The morphology of the scaffold was observed by gross observation and scanning electron microscope. Degradation of the scaffold was determined at different time points. Twenty-four adult New Zealand rabbits, weighting 2.8-3.5 kg and male or female, were surgically created the bilateral acute rotator cuff tear models. One shoulder was treated with microfractures on the footprint and transosseous suture (control group, n=24). The other shoulder was treated with the same way, except for putting the scaffold on the footprint before transosseous suture (experimental group, n=24). The general conditions of rabbits were observed postoperatively. Tendon-to-bone healing was evaluated by gross observation, Micro-CT, HE staining, and bio-mechanical testing at 4 and 8 weeks after operation. Results: The scaffold was white and has a porous structure with pore size of 31.7-89.9 μm, which degraded slowly in PBS solution. The degradation rate was about 95% at 18 days. All the rabbits survived to the completion of the experiment. Micro-CT showed that there was no obvious defect and re-tear at the tendon-to-bone interface in both groups. No difference was found in bone mineral density (BMD), tissue mineral density (TMD), and bone volume/total volume (BV/TV) between the two groups at 4 and 8 weeks postoperatively ( P>0.05). HE staining showed that the fibrous scar tissue was the main component at the tendon-to-bone interface in the control group at 4 and 8 weeks postoperatively; the disorderly arranged mineralized cartilage and fibrocartilage formation were observed at the tendon-to-bone interface in the experimental group at 4 weeks, and the orderly arranged cartilage formation was observed at 8 weeks. Besides, the tendon maturation scores of the experimental group were significantly higher than those of the control group at 4 and 8 weeks ( P0.05); the ultimate load to failure at 8 weeks was significantly higher in the experiment group than in the control group ( t=4.162, P=0.009), and no significant difference was found in stiffness between the two groups at 8 weeks ( t=2.286, P=0.071). Conclusion: Compared with microfracture alone, microfracture combined with biomimetic hydrogel scaffold can enhance tendon-to-bone healing and improve the ultimate load to failure in rabbits.

Clinical evaluation of arthroscopic rotator cuff repair using improved-press-ift double-row technique for patients of large rotator cuff tear / 中国内镜杂志

Objective To investigate the clinical outcomes of arthroscopic rotator cuff repair using improved-press-ift double-row technique for patients of large rotator cuff tear.Methods From December 2013 to November 2014, 52 patients (20 males, 32 females) with a full-thickness large rotator cuff tear underwent arthroscopic improved-press-ift double-row repair were retrospectively analyzed. The mean age of the patients was 65.6 years (range 51 to 76 years). The visual analog pain scale scores (VAS), the range of motion (ROM), University of California at Los Angeles (UCLA), and American Shoulder and Elbow Surgeons (ASES) were used for clinical and functional evaluations before surgery and at the time of 6 months after arthroscopy.Results The mean duration of follow-up was 10.9 months (range 6 to 17 months). At the time of 6 months after arthroscopy, the mean subjective pain score (VAS) was (1.6 ± 0.9), the mean active forward flexion was (145.6 ± 10.7)°, whereas the mean external rotation at the side was (30.8 ± 8.5)°. The mean UCLA score improved to (32.3 ± 3.5), the mean ASES score improved to (81.8 ± 8.7). There was significant difference postoperatively (P < 0.05). No re-tear occurred.Conclusion The improved-press-ift DR technique is effective in arthroscopic large rotator cuff repairing. Compared with suture-bridge technique, this technique can decrease operation time, costs, and is much easier to process.

FasT -Fix technology vertical mattress suture meniscal tear Ⅲ level of clinical patient outcomes / 中国基层医药

Objective To investigate the clinical results of arthroscopic FaxT -Fix technology vertical mat-tress suture for patients with meniscal tear Ⅲ level.Methods 50 cases with the level of meniscal Ⅲ orthopedic treatment of torn were divided into two groups using random number table,25 cases in each group.The control group received a simple meniscectomy,the observation group was given arthroscopic FaxT -Fix technology vertical mattress suture.Surgery and prognosis function were observed and compared in the two groups during recovery.Results The operation time (26.53 ±7.34)min,postoperative functional activity recovery time (25.01 ±9.55)d and hospital stay (5.68 ±2.01)d of the observation group were significantly shorter than the control group[(46.66 ±12.28)min, (39.53 ±11.28)d,(9.98 ±3.34)d],the differences were statistically significant (t =7.04,4.91,5.52,all P <0.05).3,6,12,18 months after operation,the improvements of Lysholm and IKDC scores of the observation group were significantly better than the control group (t =3.60,2.64,2.81,3.03,4.94,2.12,2.28,2.32,all P <0.05). During the postoperative follow -up period,the incidence rate of complications of the observation group (4.00%) was significantly lower than the control group (24.00%)(χ2 =4.15,P <0.05).Conclusion For patients with level of Ⅲ meniscus tear,arthroscopic FaxT -Fix technology vertical mattress suture can effectively reduce the surgery and hospitalization time,promote functional recovery of the patients 'knee,significantly improve the postoperative Lysholm knee score and IKDC,but also significantly reduce postoperative wound infection,hematoma,nerve damage vascular complication rate.

Evaluation the treatment effect of synovectomy under arthroscope on elbow rheumatoid arthritis / 中国基层医药

Objective To study the treatment effect of synovectomy under arthroscope on elbow rheumatoid arthritis.Methods 38 patients with elbow rheumatoid arthritis were selected as the research subjects,received arthroscopic synovial treatment,surgical procedures require more than one direction into the intra -articular,cleaning elbow joint synovial,complete removal of the foreign body cavity.Postoperative follow -up for 30 months,and com-pared the patients'Mayo elbow performance score and joint activity situation before and after surgery.Results After surgery,Elbow pain score[(30.12 ±8.11)points],activity level[(17.01 ±2.88)points],joint function[(20.67 ± 5.01)points]and total score[(73.04 ±12.01)points]were significantly higher than the pre -operative[(3.98 ± 3.89)points,(9.78 ±5.02)points,(13.77 ±3.69)points,(33.04 ±10.01)points](t =18.38,P <0.05;t =7.90, P <0.05;t =7.01,P <0.05;t =16.18,P <0.05 ).After surgery,elbow flexion activity score [(113.12 ± 15.11)points]was significantly higher than the preoperative flexion elbow activity score[(93.03 ±19.89)points] (t =5.09,P <0.05 ).Conclusion Treated elbow rheumatoid arthritis by synovectomy under arthroscope could effectively improve the disease status of patients,relieve pain,enhance mobility,allowing patients to gradually return to normal life,and it can be widely used in clinical practice.

Arthroscopic rotator cuff repair using suture bridge technique as treatment of traumatic shoulder dislocation combined with rotator cuff injury in older patients / 中国内镜杂志

Objective To compare the clinical results of arthroscopic rotator cuff repair using a suture bridge technique and conservative therapy as treatment of traumatic shoulder dislocation combined with rotator cuff injury in older patients. Methods From August 2010 to August 2013 a total of 63 patients were prospectively enrolled. In the case of documented tears of the rotator cuff in combination with symptoms persisting after conservative therapy, patients were free to decide between arthroscopic rotator cuff repair using a suture bridge technique and conservative treatment. Patients were monitored for changes in visual analogue scale (VAS) scores, range of motion, the Simple Shoulder Test (SST), the Constant score and recurrences over a minimum follow-up period of 1 year. Results 60 pa-tients (30 in surgical group and 30 in conservative treatment group) were follow-up for at least 1 year. There was no significant difference between the two groups at baseline. The surgical group resulted in better improvements in pre-operative to postoperative VAS scores, range of motion, SST scores and the Constant score. There were five recur-rences in the conservative treatment group, while no recurrences were documented in surgical group. Conclusion In this selected patient group, we believe arthroscopic repair using a suture bridge technique for the treatment of symp-tomatic rotator cuff tear can improve shoulder function and decrease recurrences in older patients suffered from trau-matic shoulder dislocation combined with rotator cuff injury. The long-term outcomes remain to be determined.

Efficacy of salmon calcitonin combined with zoledronic acid in treatment of senile primary osteoporosis / 中华全科医师杂志

One hundred and twenty patients with senile primary osteoporosis were enrolled in the study from January 2012 to April 2013,including 41 males and 79 females.Patients were randomly assigned to two groups:60 patients in study group were treated with salmon calcitonin combined with zoledronic acid (salmon calcitonin 50 IU i.m,q.d for 7 d,then 100 IU q.i.d for 7 d,followed by zoledronic acid 5 mg i.v gtt/y);60 cases in control group were treated with alendronate (70 mg p.o/wk).Both groups received the same doses of calcium.Visual analogue scale (VAS) scores were assessed before,and 1,6 and 12 months after treatment,12-Item Short-Form Health Survey (SF-12) and bone mineral density (BMD) were assessed before and 12 months after treatment.There were no significant differences in all baseline parameters between two groups (P ＞ 0.05).After 1 month of treatment,the VAS scores of study group was lower than that of the control group (2.1 ± 3.0 vs.4.2 ± 3.1,P ＜ 0.05),however,both groups had similar improvements in VAS scores in 6 and 12 months after the treatment (P ＞0.05).Compared to those before treatment,physical component summary and mental component summary of SF-12 scores after 1 year of treatment were improved significantly in both groups (P ＜ 0.05).Also,BMD was significantly improved after 1 year of treatment in both groups (P ＜ 0.05).The incidence of side effect in study group was lower than that in control group (16％ vs.20％,P ＜0.05).The results indicate that salmon calcitonin combined with zoledronic acid is an effective,safe,reliable and well tolerated therapy for senile primary osteoporosis.The long-term outcomes remain to be determined.

Clinical summary of 3 265 cases of cystic duct variation in laparoscopic cholecystectomy / 局解手术学杂志

Objective To make a clinical summary of the variation of cystic duct so as to collect 20 years of operative experience and to provide evidence for preventing injury of bile duct in laparoscopic cholecystectomy. Methods A retrospective analysis were made for 20 000 patients experienced laparoscopic cholecystectomy in the second affiliated hospital of Chongqing medical university and Chonggang General Hospital from April,1993 to December,2011. Results There were 3 265 cases of cystic duct variation which occupied 16. 33% of the 20 000 patients. And there were 3 200 cases of variation in the junction of cystic duct, 51 cases of short cystic duct;and 14 cases of gall-bladder surrounded by the liver. Most of the variation were found in the junction of cystic duct, including 371 cases (11. 36%) of cystic duct accompanied the common hepatic duct and then made a lower confluence;995 cases (30. 47%) of cystic duct traversed above the com-mon hepatic duct and then made a confluence, 643 cases (19. 69%) of cystic duct traversed below the common hepatic duct and then made a confluence;963 cases (29. 49%) of gallbladder neck attached to the common bile duct;and 228 cases (6. 98%) of higher confluence of cystic duct and common bile duct. Conclusion The rate of cystic duct variation accounted for a high rate, and most of the patients were found with a variation in the junction of cystic duct. Being familiar with the categories of cystic duct, discriminating the anatomic structure carefully, using choledochoscopic examination when necessary, and masterting reasonable time to make a transfer to laparocholecystotomy were reliable methods for coping with the injury of bile duct caused by variation of cystic duct.

Arthroscopic suture-bridge repair for moderate to massive full-thickness rotator cuff tear / 中华创伤杂志

Objective To evaluate the early clinical outcomes of arthroscopic suture-bridge repair of media to large full-thickness rotator cuff tear.Methods One hundred patients that underwent arthroscopic suture-bridge (suture-bridge group,n =50) or single-row repair (single-row suture group,n =50) for media to massive full-thickness rotator cuff tear from June 2010 to June 2014 were enrolled in this study.The patients (63 males and 37 females),aged 58.7 years (range,46 to 75 years),were all available to the follow-up.Thirty-one patients were injured in traffic crashes,30 in falls,27 in strains and 12 with no apparent reasons.Early passive activity was allowed in suture-bridge group,while shoulder abduction was maintained for 6 weeks postoperatively in control group.Clinical and functional outcomes were measured using the visual analogue scale (VAS),range of motion,University of California at Los Angeles (UCLA) score,and American Shoulder and Elbow Surgeons (ASES) score.Results Mean duration of follow-up was 16.7 months (range,8 to 24 months).Prior to the surgery,these measurements were similar between the two groups.After a follow-up of 3 months,the differences were significant in suture-bridge group compared to control group:VAS [(1.7 ± 1.5) points vs (3.9 ± 2.1) points],forward flexion [(168.3 ± 30.2)° vs (120.2 ± 51.6)°],external rotation [(47.0 ± 11.0)° vs (31.8 ± 13.8)°],UCLA score [(31.7±4.2) points vs (18.2±4.8) points],ASES score [(86.2±14.6) points vs (35.9 ±17.7) points] (P ＜0.05).No re-tear occurred after operation.Conclusion Arthroscopic suture-bridge repair of moderate to massive full-thickness rotator cuff tear results in significant improvement of function outcomes and clinical results,indicating a reliable and effective treatment technique.

Osteogenic differentiation of adipose-derived stem cells on a composite scaffold in the repair of osteoporotic bone defects / 中国组织工程研究

BACKGROUND:The traditional treatment methods for osteoporosis accompanied by bone defects, such as autogenous bone graft, al ograft, biomaterial implants, have significant limitations. The regenerative medicine approach using adipose-derived stem cells as seed cells offers a new way for the repair of bone defects fol owing osteoporosis. OBJECTIVE:To review the pathogenesis of osteoporosis and its impacts on the repair of bone defects, the signal pathway regulation of osteogenic differentiation of adipose-derived stem cells, and the feasibility of adipose-derived stem cells for repairing osteoporotic bone defects. METHODS:A computer-based online search of CNKI database and PubMed database was performed to retrieve the relevant articles published from January 1998 to September 2014 with the key words of“adipose-derived stem cells, osteoporosis, bone defect, osteogenic differentiation, bone regeneration”in Chinese and English, respectively. Final y 77 articles were included for review after deleting unrelated and repetitive ones. RESULTS AND CONCLUSION:In recent years, adipose-derived stem cells have been widely used in regenerative medicine research. With the development of relevant disciplines such as regenerative medicine, tissue engineering, molecular biology, and material science, in-depth studies on regulatory mechanisms of osteogenic differentiation of adipose-derived stem cells have been developed. Adipose-derived stem cells combined with biological scaffolds for construction of tissue-engineered bones provides a new way to repair osteoporotic bone defects.

The clinical effect of comprehensive rehabilitation therapy after arthroscopic rotator cuff repair using suture-bridge technique for full-thickness rotator cuff tears / 中华物理医学与康复杂志

Objective To evaluate and analyze the clinical effect of comprehensive rehabilitation therapy after arthroscopic rotator cuff repair using suture-bridge technique for full-thickness rotator cuff tears.Methods Forty-one patients (20 males,21 females; mean age 52.2 years) with full-thickness rotator cuff tears were treated with arthroscopic rotator cuff repair using suture-bridge technique between June 2010 and January 2012 in our hospital.After arthroscopic rotator cuff repair,the patients were randomly assigned to a treatment group (21 patients) or a control group (20 patients).The treatment group received systematic rehabilitation therapy including rehabilitation education,physical modalities treatment and rehabilitative training additionally,while the control group only accepted the routine rehabilitation therapy including stretching and muscle strength training.The outcome was evaluated at 6 months after surgery,by employing visual analogae scale (VAS),the range of motion (ROM) testing of shoulder joint flexion and rotation,the rating scale of University of California at Los Angeles (UCLA),and the shoulder index of American shoulder and elbow surgeons (ASES).Results The mean follow-up period was 15.6 months (8-24 months).Prior to intervention,there was no significant difference in any parameter between the two groups (P ＞ 0.05).Six months later,all scores of assessments changed:in treatment group VAS (1.7 ± 1.5),ROM [flexion (168.3±31.3)°,rotation (47.2±11.2)°],UCLA(30.7 ±4.13) and ASES (85.1 ±15.67); in control group VAS(3.8±2.2),ROM[flexion (121.2 ±53.6)°,rotation (32.9 ±14.9)°],UCLA(18.3 ±4.94) and ASES (36.4 ± 17.70).Significant changes occurred in both groups in all the parameters after treatment when compare to baseline (P ＜ 0.05).Conclusions Comprehensive rehabilitation therapy is an effective approach for improving motor ability of the shoulder in patients after arthroscopic rotator cuff repair with suture-bridge technique for their full-thickness rotator cuff tears.

Application of calcitonin for the treatment of unstable intertrochanteric fractures in elderly patients / 中华骨科杂志

Objective To compare the clinical outcomes between proximal femoral nail antirotation (PFNA) combined with salmon calcitonin and PFNA only for the treatment of unstable intertrochanteric fractures in elderly patients.Methods From January 2009 to December 2011,120 elderly patients with intertrochanteric fracture were randomly divided into two groups:calcitonin group and control group.Patients in calcitonin group were treated with PFNA combined with salmon calcitonin,while patients in control group were treated with PFNA only.According to Evans-Jensen classification,60 patients in calcitonin group (28 males and 32 females,with an average age of 75.1 years) were divided into 20 cases of type Ⅱ A,32 cases of type Ⅱ B and 8 type Ⅲ.Sixty patients in control group (27 males and 33 females,with an average age of 74.9 years) were divided into 22 cases of type Ⅱ A,32 cases of type Ⅱ B and 6 type Ⅲ.Bone healing was assessed with X-ray and bone mineral density (BMD) was measured by dual energy X-ray absorptiometry.Harris hip and SF-12 score,complications,adverse effect of salmon calcitonin and subsequent fragility fractures were evaluated postoperatively.Results One-hundred and thirteen patients were followed up for at least 2 years.In 6 months after surgery,there were 4 cases of delayed healing in control group.However,all fractures were healed in 12 months after surgery.No significant difference was found between the two groups in BMD preoperatively.The changes in BMD were significantly different between the two groups in 6 months,1 year and 2 years after surgery.No significant difference was found between the two groups in Harris hip and 1-year SF-12 score while the 2-year SF-12 score was significantly different between the two groups.There was 1 patient in calcitonin group who suffered from subsequent fragility fracture in 3 months after surgery,while there was 6 patients in control group during 13 to 23 months postoperatively.Conclusion PFNA combined with salmon calcitonin achieves good effect for the treatment of unstable intertrochanteric fractures in elderly patients.