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BACKGROUND:Lumbar fusion surgery as an important and effective means of treating degenerative diseases is widely used in clinical application for almost a century. However, long-term clinical evidence showed that lumbar fusion also brought some problems, such as the loss of waist flexibility, complications of donor site, fusion segment motion loss and accelerating the adjacent segment degeneration. In recent years, the theory of spinal dynamic stabilization had spread widely, and a variety of non-fusion surgery is becoming more broadly used in treatment of lumbar degenerative disease. OBJECTIVE:To review the application of non-fusion surgery in the treatment of lumbar degenerative diseases and explain application perspectives and experiences. METHODS:Databases including PubMed and CNKI were retrieved to col ect clinical application and views about non-fusion internal fixation in the treatment of lumbar degenerative diseases from 2007 to 2016. The key words were“lumbar, non-fusion, bone fusion, dynamic stabilization, adjacent segment degeneration”. RESULTS AND CONCLUSION:Thirty papers were included in the final analysis after screening by two independent researchers. We summarized the lumbar non-fusion technology, including artificial nucleus replacement, total disc replacement and posterior lumbar dynamic stabilization device. The philosophy of these new technologies is to provide stability and physiological activity, reducing the abnormal stress that leads to adjacent segment degeneration. These methods can be applied to the step of treatment of lumbar degenerative diseases and to reduce the fusion of diseased segments. Simultaneously, it is needed to strictly grasp the indications for surgery, to identify the cause of the pain caused by low back pain and lumbar spine instability, and to select the most suitable non-fusion device for individual treatment.
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BACKGROUND:cells under mechanical stimulation can achieve their biological functions by converting mechanical signals into chemical signals through certain signal transduction mechanism. As the fibrous framework throughout a cell, cytoskeleton is one of the critical components in this process. OBJECTIVE:Through systemical y analyzing the role of the cytoskeleton in mechanical signal transduction, to provide a potential therapeutic target for the clinical treatment of cytoskeleton related diseases. METHODS:In order to search relevant articles about the mechanics mechanism of signal transduction of cytoskeleton from PubMed and CNKI databases (from 1990 to 2012), a computer-based search was performed, using the key words of“cytoskeleton, microtubules, microfilaments, intermediate filaments, mechanical stimulation, signal transduction”in English and Chinese, respectively. After eliminating literatures which were irrelevant to research purpose or containing a similar content, 48 articles were chosen for further analysis. RESULTS AND CONCLUSION:Mechanical stimulation plays an important role in cellproliferation, development and apoptosis. With the gradual understanding of the biological function of cytoskeleton, people have found that cytoskeleton is one of the critical components in the process of the mechanical signal transduction. After getting mechanical stimulation, cytoskeleton can be reorganized through Rho, protein kinase C, integrin and mitogen-activated protein kinase signaling pathways, then converting the mechanical stimulation to chemical signals and finishing its biological functions final y.
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BACKGROUND:Proteomics is a new field of research in the post-genomic era. The research subjects of proteomics include the structure and function of entire proteins in tissues or cells. It analyses the vital changes of pathological and physiological process of diseases by examining proteins. OBJECTIVE:To summarize the application of proteomics in orthopedic diseases and its prospect. METHODS:Articles about the application of proteomics in orthopedic diseases and its prospect were retrieved from the Digital Library Al iance of Zhujiang River Delta and PubMed with the key words of“proteomics, orthopedics, review, osteoblasts metabolism, osteoclasts metabolism, intervertebral disc degeneration, osteoporosis, osteoarthritis, serum related orthopedic diseases”in both Chinese and English from January 2001 to September 2013. Reproductive research and atypical reports were excluded. RESULTS AND CONCLUSION:Proteomics has been applied in the osteoblasts metabolism, osteoclasts metabolism, intervertebral disc degeneration, osteoporosis, osteoarthritis and serum related orthopedic diseases that are the most common il nesses in al types of people. These basic and clinical studies undoubtedly bring great benefit for human health, and proteomics technology wil get a bigger breakthrough in basic medicine and clinical medicine, and it shows us a broad prospect.
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Objective To evaluate biomechanical properties of self-designed polyaxial self-locking anatomical plate so as to offer scientific evidence for clinical application.Methods According to anatomic characteristics of distal tibiae of domestic people,a polyaxial self-locking anatomical plate for distal tibia was designed.Six paired ( left,right) fresh cadaver tibial specimens were used to make fracture fixation models and were divided into groups A and B,six specimens per group.Common anatomical locking plates were assembled in group A and polyaxial self-locking anatomical plates were assembled in group B.The biomechanical tests were performed by using 858 Mini Bionix testing machine.Non-destructive tests were performed in both groups,including axial loading,4-point bending and torsional loading and the stiffness of the two fixation instruments was compared.SPSS 13.0 software was used for statistical analysis.Results Polyaxial self-locking anatomical plate was fit for the morphology of distal tibiae.The self-designed pelyaxial plate could increase angular regulation amplitude for the locking screw up to 30°.Compression stiffness was (557.53 ± 20.72) N/mm in group A and (562.80 ± 28.26 ) N/mm in group B.Four-point bending stiffness was ( 268.02 ± 36.77) N/mm in group A and ( 265.76 ± 27.21 ) N/mm in group B.Torsional stiffness was (0.28 ±0.01) Nm/deg in group A and (0.29 ±0.02) Nm/deg in group B.The three tests in two groups showed no statistical significance ( P ＞ 0.05 ).Conclusions The self-designed polyaxial self-locking anatomical plate of distal tibia is fit for the tibial morphology of domestic people.Its biomechanical properties are equivalent to those of common anatomical locking plate,which can meet the needs for clinical application.
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ObjectiveTo establish rabbit knee joint cartilage injury models to evaluate effects of the type Ⅱ collagen sponge in repair of the articular cartilage.MethodsThe type Ⅱ collagen sponge was prepared according to previous method and the pore size of the sponges was measured based on the collagen autofluorescence characteristics.The type Ⅱ collagen sponge was transplanted into the injury lesions of the animal model for experimental study.The regeneration of the cartilage defects was observed by using MRI, histologic HE staining, Safranin O, sirius red polarized light staining, areas determination of the newly grown cartilage and immunohistochemistry of type Ⅱ collagen.ResultsAutofluorescent images of confocal microscope layer scanning showed that the pore size was (93.26 + 38.40) μm in diameter, suitable for chondrocyte growth.Comparison between MRI and H&E staining results showed quicker effusion absorption in the treatment groups than that in the control group, while the level of inflammatory response in the treatment group was lower than that in the control group.The sporadic cartilage signals first appeared at the 6th week.The newly formed cartilage with the expression of glycosaminoglycan and type Ⅱ collagen matrix was confirmed by Safranin O staining and immunohistochemical analysis.The sirius red polarized light staining showed that areas of the newly formed cartilage were significantly larger in the treatment group than that in the control group (P ＜ 0.01).Conclusion The type Ⅱ collagen sponge developed from purification can effectively repair the damaged cartilage tissues of the rabbit knee joints, as has been verified either by MRI or histology.
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BACKGROUND: Orthopedic academics are committed to the modification of calcium phosphate cement (CPC) by adding different additives, including the promotion of curing agents, plasticizers, anti-water blood solvent, porogen, enhancer, or biological activity substance or drug compound to the CPC in order to enhance its physical and chemical and biological properties which is a research hotspot in the field. OBJECTIVE: To investigate the physical and chemical characteristics of a biodegradable injectable CPC. DESIGN, TIME AND SETTING: Duplicated testing study was performed at the National Key Laboratory, College of Materials, South China University of Technology from December 2008 to May 2009. MATERIALS: Calcium phosphate with partial crystallization and strontium phosphate and calcium hydrogen phosphate dehydrate with partial crystallization were added with modified starch and type I collagen to prepare a new type of self-injectable CPC. METHODS: CPC phase was analyzed using X'Pert Pro X-ray diffractometer; CPC morphology was observed using HITA2 -CHIH-800 transmission/scanning electron microscope; setting-up time was tested using Vicat apparatus according to A S TM C190203 standard; compressive strength was measured using Instron 5567 omnipotent electron apparatus; syringeability was detected using syringe apparatus with 1.6 mm of inside diameter; collapsibility was tested using soaking-shaking quantitative materials. MAIN OUTCOME MEASURES: Phase component and microstructure of CPC products, setting-up time, syringeability, compressive strength, and collapsibility. RESULTS: The material coul be injected with an excellent performance, and the modified starch significantly improved the resistance of bone cement collapsibility. As the bone cement liquid-solid ratio increased, the compressive strength of cement decreased. When the bone cement liquid-solid ratio was 0.3, the compressive strength for cement was (48.0±2.3) MPa when the bone cement liquid-solid ratio was 0.6, the compressive strength of bone cement reduced to (21,0±2.5) MPa. Hydration productof cement-like bone hydroxyapatite crystallization also could be seen from the X-ray diffraction, due to the hydration of-cement was not complete, a baseline level of volatile explained fully hydrated conditions, suggesting that the bone cement could farther improve the compression strength. CONCLUSION: Developed an injectable strontium-contained collagen CPC is coincidence with the biomechanical strength of the human body and meets the requirements of the operation conditions.
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To detect the cellular immunity state of New Zealand white rabbit immunized by pig type II collagen. The New Zealand white rabbit was immunized by type II collagen for sixty days. The plasma was collected at a regular interval and the anti-type II collagen antibodies were examined. At the sixtieth day, the peripheral circular lymphocytes and the lymphocytes separated from spleen cells of rabbit and lymph nodes were collected and were stimulated by type II collagen in vivo again. The regulation of reactive cellular proliferation caused by the stimulation was detected. The experiment samples were divided into two groups. The first group was the positive control group by adding different concentrations of PHA and the non-specific immunity was assayed. The different concentrations of type II collagen were added to the second group and the specific immunity was assayed. The lymphocytes of normal rabbits showed proliferation by PHA stimulation but no proliferation by the first stimulation of type II collagen. Obvious proliferation due to the stimulation of both PHA and type II collagen in the immunized rabbit were observed. It shows that certain concentration of heterogeneous collagen may cause an increase of anti-type II collagen antibody in immunized rabbit and may cause a proliferation of lymphocytes in rabbit spleen and peripheral blood. The heterogeneous type II collagen causes cellular immunity in vivo.
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Animais , Feminino , Masculino , Coelhos , Divisão Celular , Colágeno Tipo II , Alergia e Imunologia , Citotoxicidade Imunológica , Antígenos de Histocompatibilidade , Linfócitos , Biologia Celular , Alergia e Imunologia , Baço , Biologia Celular , Suínos , Transplante HeterólogoRESUMO
The injectable calcium phosphate material is present to solve the clinical bone defects of bone tissue and the potential to undermine the ideal substitute. But the properties and biological evaluation are still to be improved. Therefore,the material of the academic community and the academic orthopedic bone cement was modified for a variety of studies,and the addition of strontium bone cement significantly improved the performance. The article indicated strontium-mixed calcium phosphate bone cement was characterizing by the compressive strength,the degradability,the hardening time,the solubility,the injection and the anti-water-solubility,suggesting the clinical practice of the strontium-mixed calcium phosphate bone cement. Prospectively,the strontium-mixed calcium phosphate bone cement may take in the bone tissue repair domain as a artificial bone substitution material.
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[Objective]To discuss a reasonable treatment for unstable intertrochanteric hip fractures in senile patients by comparing the effects of PFN fixation and hemiarthroplasty.[Method]Totally 82 intertrochanteric hip fractures in senile patients with complete clinical data were retrospectively analyzed,who were treated with hemiarthroplasty or PFN fixation from April 2005 to April 2007.Forty-six were treated with hemiarthroplasty,36 were treated with PFN fixation.All of them had multiple medical co-morbidities.According to modified Evens-Jensen classification,all of them belonged to unstable fracture.Comparison was made between the two treated groups in terms of the length of incision,operative time,the blood lost,blood transfusion during or after surgery,time for bed rest postoperatively,postoperative complications and St.Michael hip score one year after surgery.[Result]The average duration of follow-up for PFN fixation and hemiarthroplasty were 16 and 18 months respectively.Compared with the group of hemiarthroplasty,the group of PFN fixation experienced longer operation time,longer time for bed rest postoperatively,less blood lost,less blood transfusion during or after surgery,shorter incision length,and the differences between two groups had statistical significance (P0.05).[Conclusion]Both of the two methods are reasonable treatment for unstable intertrochanteric hip fractures in senile patients.
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[Objective]To discuss a reasonable treatment for unstable intertrochanteric hip fractures in senile patients by comparing the effects of hemiarthroplasty and DHS fixation.[Method]Totally 126 intertrochanteric hip fractures in senile patients with complete clinical data were retrospectively analyzed,who were treated with hemiarthroplasty or DHS fixation from June 2002 to October 2005.Of the 126 patients,53 were treated with hemiarthroplasty,73 were treated with DHS fixation.All of them had multiple medical co-morbidities and were combined with severe osteoporosis.According to modified Even-Jensen classification,all of them belonged to unstable fractures.Comparison was made between the two treated groups in terms of operative time,blood transfusion during or after surgery,time for bed rest postoperatively,postoperative complications and St.Michael hip score one year after surgery.[Result]The average duration of follow-up for hemiarthroplasty and DHS fixation was 16 and 18 months respectively.Compared with the group of DHS fixation,the group of hemiarthroplasty experienced shorter time for bed rest postoperatively,fewer postoperative complications and higher St.Michael score 1 year after surgery,and the differences between two groups had statistical significance(P0.05).[Conclusion]Cemented hemiarthroplasty has the advantages of allowing early full weight bearing after surgery,low complication rate and satisfactory functional recovery.It is a reasonable treatment for unstable intertrochanteric hip fractures in senile patients.
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BACKGROUND: Type Ⅱ collagen has been used as the carrier for chondrocyte transplantation in animal models, but whether type Ⅱ collagen may cause arthritis or mediate cytotoxicity remains unknown.OBJECTIVE: To detect the cellular immune functions of the New Zealand rabbits immunized by porcine type Ⅱ collagen.DESIGN: An exploratory comparative study based on the observations.SETTING: An institute of trauma surgery of a municipal hospital.MATERIALS: The study was conducted in the Institute of Trauma Surgery,Guangzhou Red Cross Hospital from August 1999 to February 2000. Six New Zealand rabbits, whose body mass ranged from 2.0 kg to 3.0 kg, were chosen of either gender.METHODS: The rabbits were immunized by porcine type Ⅱ collagen for 60days, during which the plasma was regularly taken for detection of type Ⅱ collagen antibody. On the 60th day, the peripheral blood as well as the spleens and lymph nodes were taken to separate the lymphocytes, which were subjected to secondary stimulation with type Ⅱ collagen in vitro to observe the reactive cell proliferation. The lymphocytes were randomly divided into two groups, and the first group was treated with phytohemagglutinin(PHA) of different concentrations to serve as the positive control, in which non-specific immunity was examined; The second group was treated with type Ⅱ collagen of different concentrations for examining specific immunity.peripheral blood lymphocytes of normal and immunized rabbits.RESULTS: On the 21st day, the titer of the antibody presented the first peak, and 40 days after the re-injection of the antigen the second peak appeared, which maintained for 20 days and then gradually descended. The lymphocytes of the normal rabbits proliferated in response to PHA stimulation but not to the first stimulation with the type Ⅱ collagen. The lymphocytes of the immunized rabbits exhibited significant proliferation upon stimulations with both PHA and type Ⅱ collagen. At the concentration of 25 mg/L, type Ⅱ collagen stimulation was sufficient to induce lymphocyte proliferation, the peak of which occurred when the collagen concentration reached 50 mg/L.CONCLUSION: Xenogenic type Ⅱ collagen at an adequate concentration may induce the increase of the type Ⅱ collagen antibody in immunized rabbits and proliferation of lymphocytes of the spleens and peripheral blood to cause cellular immune reaction and even immunological arthritis in relation to the transplantation.
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BACKGROUND: Intra-articular injection of hormone has been applied in the treatment of arthritis because it can alleviate arthralgia rapidly, which is accompanied commonly by progressive cartilage impairments. It is not clear if supplement of growth factor like insulin effect can play a protective role in articular chondrocytes.OBJECTIVE: To observe the effects of insulin or hydrocortisone alone and the combination on the proliferation of chondrocytes.DESIGN: Grouping comparative study, the effect of one medicine was analyzed by using one-factor analysis of variance, while the combined effect was analyzed with multi-factor analysis of variance.SETTING: Guangdong Institute of Trauma Sugery.MATERIALS: Articular cartilage from the knees of New Zealand white rabbits of 4 - 6 weeks old.METHODS: This study was carried out at Guangzhou Traumatic Research Institute from Feberary 2000 to May 2001. Chondrocytes were isolated from the knee joints of New Zealand white rabbits, digested with hyaluronidase,pancreatin and type Ⅱ collagenase and exposed to insulin, hydrocortisone or the combination of insulin and hydrocortisone of different dosage. They were divided into four groups:Control group ( without adding insulin and hydrocortisone), insulin group (0. 035,0. 35,3.5,35 mg/L subgroups), hydrocortisone group(1,5,10,50,100 mg/L subgroups) and insulin(0. 35 mg/L) combined with hydrocortisone(50 mg/L) group. Their influence on chondrocytes proliferation was observed with methyl thiazolyl tetrazolium(MTT) method.sulin.at the concentration of 0. 035 mg/L( P ＜ 0.01 ), reaching the maximum at could inhibit the proliferation of chondrocytes ( P ＜ 0.05 ), which became significant with increasing concentration and no viable chondrocytes could be exposed to 0 . 35 mg/L insulin combined with 50 mg/L hydrocortisone, the promoting effect of insulin was inhibited due to negative cooperation.CONCLUSION: Insulin at low concentration could enhance the proliferation of chondrocytes, but hydrocortisone displayed inhibiting effect on the growth of chondrocytes. The function of insulin was antagonized when combined with hydrocortisone.
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Objective To investigate the expression level of endogenetic nitric oxide(NO) in the reproduction process of human anterior cruciate ligament cells. Methods Anterior cruciate ligament cells were isolated and subcultured from the human anterior cruciate ligament. LPS was used to induce the anterior cruciate ligament cell to express the inducible nitric oxide synthase(iNOS ), and N-monomethyl -L-Arginine (L-NMMA) was used as the interdiction of nitric oxide. They were alone or together added in the culture medium of anterior cruciate ligament cells in different groups. The level of NO was indirectly measured in the medium of HACL. Results LPS promoted significantly anterior cruciate ligament cells to produce endogenetic nitric oxide, compared with the control group(P
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Objective To evaluate the effectiveness of locking compression plate (LCP) in treatment of comminuted fractures of distal end of radius. Methods A retrospective analysis of the clinical data was done for the 24 patients with comminuted fracture of distal end of radius who had been treated by locking compression plate fixation from August 2002 to August 2003. Results The follow up duration averaged 7.8 months. The satisfactory rate of functional outcome with LCP fixation was 91.6 percent. Conclusion Although LCP can provide the outstanding stability theoretically, it has not resulted in more exciting outcomes in treatment of comminuted fractures of distal end of radius than traditional methods.
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Objective To discuss our tentative application of the anatomic plate in the treatment of distal tibia fractures in order to develop a new effective fixation technique for this kind of fracture. Methods From November 2000 to September 2001, the authors applied Linkdistal tibia anatomical plates in the treatment of distal tibia fractures, which involved metaphysis in 12 cases, including 8 males and 4 females, aged from 18 years ～66 years, with 38 years on average. All the cases were of high energy injuries and complicated with ipsilateral fibular fracture. According to AO/ASIF classification: three were type A1, five were A2, three were A3, and one was B1; three of them were close fractures, five were type IO1 open fractures, and four were IO2. Results All the cases healed at one stage without infection or exposure of the implant. Bone callus could be found 2 3 weeks after operation. Bone union was achieved within 3～6 months, with 4 months on average. No delayed union or non union occurred. Functions of ankle joints recovered completely. Conclusion The anatomical plate for distal tibia is supperior to the traditional plates in both biomechanical and biological aspects. It is the best choice for the treatment of distal tibia fractures.
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Objective To assess the clinical value of the mi nimally invasive plate fixation technique in treatment of metaphyseal comminute d fractures of long tubular bones.Methods Sixty-eight patients with metaphyseal comminuted fractures o f femur or tibia were treated with min imally invasive percutaneous plati ng and early recovery movement from April 1999to October 2001.Results All the patients were followed up for a mean time of 10months.The postopera tive radiograph showed that reducti on and internal fixation were satisfactory in sixty-five patients.Lateral angular deformity of 8?occurred in one c ase,and 2cm shortage of the lower lim b in two cases.Sixty-eight patients obt ained bone union and satisfactory clinical function.There were no deep i nfec-tion,nonunion or other complicatio ns.Conclusion For metaphyseal comminuted fractur es of long bones of lower extremities,minimally invasive percutaneous plate fixation is o f significant value due to the advant ages of less iatrogenic trauma,rigid fixation and early movement.[
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Objective To discuss the surgical approaches t o treat the 3-and 4-part-fractures of the proximal humerus in young adults.Methods Open reduction,internal fixation with T-shaped steel plate or together with tension band wire,repair of rupture d rotator cuff and joint capsule were conducted.Early rehabilitation wa s performed after the operation.Results8cases were followed up for 1to 4years,with an average of 3years.The functional recovery of the injured shoulder joint had an excellent result of 87.5%.Conclusions Internal fixation with T-shaped steel plate or together with tension band wire to treat the 3-and4-part-fractures of the proximal hu merus in young adults can better the function al recovery of the shoulder joint,as long as used properly,because it is s table and eliminates the need of postoperativ e external fixation so that function al exercises can be done earlier.