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Tendon injuries often need surgical treatment, which enables to repair the structure and stability of the tendons to a certain extent, whereas it is difficult to restore to their normal strength. The primary reason is that the natural healing ability of tendons is limited and the functions of the repaired tendons cannot be restored completely. As further researches on tendon healing are conducted, biological technology provides a novel orientation for tendon repair. One of the research hotspots of tendon repair currently is to facilitate tendon healing using biological auxiliaries, including tendon stem /progenitor cells(TSPCs) and growth factors. The authors review the research progress in mechanism of TSPCs and growth factors accelerating tendon healing in order to provide a reference for the biological treatment of tendon injuries.
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Objective:To understand and verify the biomechanical mechanism of tibial plateau Hoffa (coronal) fracture by simulating high-altitude falls and traffic injuries using knee joint specimens.Methods:Ten specimens of lower limb knee joint were used. They were from 6 males and 4 females, with an average age of 57.4 years (from 42 to 65 years). They were divided into 2 equal groups: one subjected to simulation of high-altitude falls (fall group) and the other to simulation of traffic injury (traffic injury group). After injury simulation, standard orthographic and lateral X-ray examinations and CT scans were performed of the knee joints in the extended position to observe whether there was a fracture, where the fracture occurred, and how the fracture line went.Results:A tibial plateau coronal fracture was successfully simulated in 6 cases, but not in the other 4 cases. The failure was attributed to femoral fractures and other types of tibial plateau fracture. In the 3 successful fractures simulated by high-altitude fall, the fracture line was located all on the posterior medial side, involving the posterior 1/3, 2/5, and 1/2 of the tibial plateau, respectively. The fracture line and the coronal plane formed angles of 21°, 19° and 12°, respectively. The fracture was not shown on X-ray film in one case which was a posterior medial fracture on CT. In the other 3 successful fractures simulated by traffic injury, the fracture line involved 1/6, 1/4 and 1/3 of the posterior tibial plateau, respectively. The angles between the fracture line and the coronal plane were 47°, 56° and 63°, respectively. One case showed no obvious fracture signs on the X-ray but a coronal fracture on CT.Conclusions:This study has confirmed for the first time that both high-altitude falls and traffic injuries can cause coronal fractures of the tibial plateau which vary significantly in the extent of involvement and morphology. X-rays are not sufficient to fully diagnose this type of fractures, suggesting that patients with a clear history of knee flexion or axial violence injury should be routinely scanned by CT to reduce risks of missed diagnosis and insufficient treatment.
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Hoffa fracture of tibial plateau is a special type of coronal fracture of tibial plateau, among which occult fracture accounts for a large proportion, resulting in missing diagnosis and delayed treatment. The current studies are all case reports, and the incidence, diagnostic protocol, injury characteristics and injury mechanism of Hoffa fracture have not been systematically studied. The commonly used classifications such as AO type, Schatzker type, three-column classification and comprehensive classification of tibial plateau cannot cover this type. In this study, a retrospective case series study was performed for the clinical data of 3 086 patients with tibial plateau fractures. There were 13 patients with Hoffa fracture of tibial plateau, and 23% of them were occult ones. The injury mechanism of this fracture was as follows: under the state of knee joint flexion, axial violence through femur concentrated on the posterior half of tibial plateau, with the knee joint in transient varus and pronation position, leading to the posteromedial coronal splitting fracture. According to the position and degree of fracture displacement involving the joint, the fracture was divided into three type: type I involving the articular surface of tibial plateau fracture less than 1/4, type II involving the articular surface of tibial plateau equal to or more than 1/4 and less than 1/2, type III involving the joint face equal to or more than 1/2. Each fracture type was divided into three subtypes, of which subtype A was non-displaced fracture, subtype B had articular surface displacement<2 mm, and subtype C had articular surface displacement≥2 mm. According to the classification characteristics, the treatment principles were proposed. The authors systematically summarized the Hoffa fracture of tibial plateau for the first time in aspects of the incidence, injury characteristics, injury mechanism, fracture classification and treatment principles, which is helpful to avoid missed diagnosis and improve treatment efficacy.
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ObjectiveTo investigate the clinical features and treatment of ascending paralysis after thoracolumbar fracture.MethodsThree male patients with 2 fracture levels at T12 and one at L1 were retrospectively studied.Their mean age was 41.3 years(range,39-42 years).All 3 cases were undertaken open decompression,reduction and internal fixation.Paralysis level began to ascend at 2-5 days after injury,with 2 cases up to C2,3 and 1 case up to T7.Two patients suffered irritating pain over the paralysis level before onset of ascending.Postoperative MRI images demonstrated well reduction and no compression of spinal cord.In the early phase after ascending,MRI obviously showed swelling in spinal cord and long T1 and long T2 signals shaped patchy and stripy distribution in the central area.One patient's MRI displayed that the spinal cord shrinked 16 days after trauma with abnormal high signal in the central area.ResultsTwo cases died of respiratory muscle paralysis and 1 case suffered paraplegia with no recovery 5 years after surgery.ConclusionAscending paralysis after thoracolumbar fracture is a rare complication with very poor prognosis.MRI is available for evaluating operational effects and affected level.The exact mechanism and effective treatment are still unclear and need further investigated.
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Objective To investigate the risk factors and preventive measures for acute epidural hematoma after posterior thoracic spine surgery.Methods A retrospective study of 14 patients who developed acute epidural hematoma after thoracic spine surgery from May 2002 to May 2012 was conducted.There were 6 males and 8 females,aged from 41 to 69 years (average,61.2 years).There were 10 cases of thoracic spinal canal stenosis,3 cases of thoracic spinal meningioma,and 1 case of thoracic metastasis.About 3-14 h (average,6.6 h) after posterior thoracic spine surgery,the neurological deterioration was found,and according to the American Spinal Injury Association (ASIA) classification,there were 5 cases of grade A and 9 cases of grade B.The neurological function before evacuation of hematoma was compared with that after evacuation of hematoma and that at final follow-up.The correlations between hematoma compression time,neurological improvement rate and neurological function before evacuation of hematoma were statistically analyzed.Results After evacuation of hematoma,the ASIA classification of 14 patients was as follows:grade B in 1 case,grade C in 2 cases,grade D in 4 cases,and grade E in 7 cases.The hematoma compression time of 3 patients with grade B or C was more than 10 hours.Obvious difference of neurological function was found before and after evacuation of hematoma.The neurological improvement rate was 63.7％±23.3％ after evacuation of hematoma,which was negatively correlated with hematoma compression time and positively correlated with preoperative neurological function.The neurological function before evacuation of hematoma was significantly different from that at final follow-up.The neurological improvement rate was 86.97％±17.58％ at final follow-up,which was negatively correlated with hematoma compression time and positively correlated with preoperative neurological function.Conclusion The acute epidural hematoma after thoracic spine surgery could cause severe neurological deterioration.The neurological improvement was negatively correlated with hematoma compression time.Evacuation of hematoma must be done as soon as possible once progressive neurological deterioration is found.