Curative effect of arthroscopic surgery on knee joint disease in children / 中华实用儿科临床杂志

Objective To analyze the clinical characteristics of children with knee joint diseases and discuss the curative effect of arthroscopy.Methods Eighty-nine children with knee joint diseases in Department of Orthopedics,the First Affiliated Hospital of Xinxiang Medical University from October 2012 to October 2015 were selected,and they were given knee arthroscopic surgery according to the disease types and characteristics,such as meniscal suture,suture plus angioplasty and synovectomy etc.All the symptoms,signs and the joint functions were recorded preoperatively and postoperatively.At the end of follow-up,surgical results were analyzed according to Lysholm score and International Knee Documentation Committee Knee evaluation form (IKDC) classification standard.Results The patients with discoid meniscus tear were the most,accounting for 55.55％ (55/99 knees).All patients were followed up for 6-30 months(the average time was 21 months) to find that all symptoms were relieved or disappeared within 1 year after operation.The outcome was evaluated according to the Tegner knee function:76 knees (76.76％) were markedly effective,16 knees (16.16％) were effective,6 knees (6.06％) were invalid and 1 knee (1.01％) was poor,and the excellent rate was 92.92％.The curative effect was evaluated according to Lysholm knee function score and IKDC score at the last follow-up.The Lysholm score in preoperation [(52.46 ± 4.79) scores] improved to (96.52 ± 3.97) scores in postoperation,and the difference was significant (t =-36.24,P ＜ 0.05);the IKDC score in preoperation [(46.52 ± 10.25) scores] improved to (90.67-± 5.89) scores in postoperation,and the difference was significant (t =-50.69,P ＜ 0.05).There was no joint infection,blood vessel or nerve damage and so on.Conclusions Meniscus tear is common in children with knee joint diseases,and most common is discoid lateral meniscus tear,and arthroscopy can have satisfactory outcome,with no obvious complications.Therefore,arthroscopic surgery is an ideal method for surgical treatment of children with knee joint disease.

Expressions of matrix metalloproteinases and their inhibitors in steroid-induced necrosis of rat femoral head / 西安交通大学学报(医学版)

Objective To study the protein expression levels of matrix metalloproteinases (MMPs)and their inhibitors in bone tissues of rat femoral head and to explore the relationship between necrosis of femoral head and glucocorticoid.Methods Twenty healthy adult SD rats were randomly divided into glucocorticoid group and control group,with 10 rats in each.Glucocorticoid group was treated with intramuscular injection of hydrocortisone twice a week.The control group received normal saline of the same volume.Four weeks later,bone tissues of left femoral head were collected from each group of rats for HE determination of femoral head necrosis.The expressions of matrix metalloproteinase-1 (MMP-1 ), matrix metalloproteinase-2 (MMP-2 ), tissue inhibitor of matrix metalloproteinase-1 (TIMP-1 ),and tissue inhibitor of matrix metalloproteinase-2 (TIMP-2 )at mRNA and protein levels were detected by RT-PCR and Western blot techniques,respectively.Results The expressions of MMP-1 and MMP-2 at mRNA and protein levels were higher in glucocorticoid group than those in the control group. However,TIMP-1 and TIMP-2 gene and protein expression levels were lower in glucocorticoid group (all P<0.05). Conclusion The expressions of MMPs in bone tissues of rat femoral head in early necrosis were increased,but their inhibitors had decreased expressions. We can draw the conclusion that glucocorticoid-induced necrosis of femoral head may be related to its regulation of the expression levels of MMPs and their related inhibitors.

Expressions of interleukin-1 beta and matrix metalloproteinase-13 in articular cartilage and synovial fluid of osteoarthritis model in rabbits / 西安交通大学学报(医学版)

Objective To investigate the feasibility of osteoarthritis (OA) model in rabbits by injuring medial meniscus so as to understand the role of interleukin-1 beta (IL-1β) and matrix metalloproteinase-13 (MMP-13) in pathological mechanism of articular cartilage and synovial fluid of OA model in rabbits.Methods We randomly divided 40 New Zealand white rabbits into experimental group (n =30) and control group (n =10).Pathological changes in articular cartilage of the femoral condyle were scored at weeks 2,6 and 12 after surgery.We detected the expressions of IL-1β and MMP-13 by immunohistochemistry.The cell fractions of IL-1β and MMP-13 were recorded by ELISA.Results The articular cartilage score and HE staining significantly differed at various time points of gross and pathological observation between control group and experimental group (P＜ 0.05).Immunohistochemistry showed that IL-1β was expressed in both groups and that the cell fraction differed significantly at weeks 6 and 12 (P＜0.05),but not at week 2 between the two groups.MMP-13 protein expression was not detected in articular condrocytes in control group,but was detected in experiment group with a significant difference (P＜0.05).IL-1β expression was consistent in articular cartilage and synovial fluid.Conclusion The reasonable rabbit animal OA model could be established by knee meniscus injury caused by surgical method.Expressions of IL-1β and MMP-13 change obviously in the pathomechanism of OA.Further clinical studies are needed to determine whether they can be used as markers in early diagnosis of OA.

Normal meniscus and discoid meniscus injuries:Classification and tissue repair under an arthroscopy / 中国组织工程研究

BACKGROUND:Meniscus plasty and prosthesis under an arthroscopy are widely used in treating discoid meniscus or normal meniscus injury.The normal shapes of meniscus are maintained by excising medial partial tears and suturing the lateral partial tearsOBJECTIVE:Injury classification and special features of discoid meniscus and normal meniscus were observed,and corresponding trearing methods were used,to discuss the therapeutic effect of repair.METHODS:Totally 260 cases of meniscus injury in knee ioint were selected from the First Aftiliated Hospital of Xinxiang Medical University from September 2003 to June 2008.They were divided into normal meniscus injury group(n=215),and discoid lateral meniscus injury(n=45).People with complete clinical data before operation and following data,confirmed by arthroscopy were selected.Meniscus injury in 260 cases was examined by arthroscopy,and plasty,or partial excision or incomplete resection or full resection was performed according to the injury types and surgical circumstance.RESULTS AND CONCLUSION:All subjects were followed for half a year to 2 years The knee function was evaluated by the Tenger criterion.Four tear types of Discoid meniscus were as follows:73.3% horizontal,15.5% complex,4.4% radial,and 2.2% longitudinal.Five tear types of normal meniscus were as follows:47.9% longitudinal,28.8%radial,1 1.6%horizontal,6 5% transverse and 5.1% complex.In 215 cases of normal meniscus,there were 165 knees with excellentfunction,35 with good,8 with fair and 7 with poor.The excellent and good rate was 93.0%.In 45 cases of discoid meniscus.there were 25 knees with excellent function,16 with good,3 with fair and 1 with poor.The excellent and good rate was 91.1%.Discoid meniscus is different from normal meniscus in anatomical feature and histological structure,therefore,the arthroscopic surgery for discoid meniscus is also different.The most function of meniscus should be remained and the degeneration of knee ioint should be delayed.Meniscus plasty should be performed in all discoid meniscuses except the patients with severe tear of meniscus.

Clinical application and biocompatibility of implants for internal fixation of spinal tuberculosis / 中国组织工程研究

OBJECTIVE:To investigate the development of implants for internal fixation of spinal tuberculosis,and to evaluate the clinical effect and biocompatibility. METHODS:Articles were retrieved from CNKI and Medline database from 1998 to 2008 with the of "spinal tuberculosis,thoracic spine,internal fixation,bone fusion,biocompatibility" in both Chinese and English. Among 50 retrieval articles,20 were included in the final evaluation according to inclusion and exclusion criteria. This study was designed to summarize therapy development of spinal tuberculosis and selection of implants for internal fixation,and to investigate clinical development of spinal tuberculosis therapy,types of implantation,biocompatibility of implants,and complications. RESULTS:Spinal tuberculosis treated by debridement bone graft and internal fixation characterized by reconstructing spinal stability,enhancing bone graft fusion ratio,reducing relapse rate,and preventing loss of corrected angle degree,thus it became a tendency for treatment of spinal tuberculosis. Implants which were implanted in focus of spinal tuberculosis were safe because they could not cause infection diffusion or formation of tuberculose focus in the local region. Otherwise,the implants had a good biocompatibility to host. Individualized program was chosen according to lesion degree and site in order to thoroughly clean focus,reconstruct spinal stability,and provide a stable environment for rehabilitation. Implantation of autologous ilium and titanium-net cancellated bone were widely used on clinic,and both of them had an excellent fusion ratio. Artificial bone did not have immunological rejection to organism,and it was gradually degraded and provided sufficient bone source. CONCLUSION:Spinal tuberculosis treated by debridement bone graft and internal fixation is an effective method to treat severe spinal tuberculosis. At present,autologous ilium and titanium-net cancellated bone are frequently used for clinical internal fixation,because both of them have good biocompatibility. Artificial bone characterizes by well clinical effect and biocompatibility,but the long-term effect and safety need to be further studied.

Grafting of vascularized fibula and ilium to repair bone defects of limbs / 中华创伤骨科杂志

Objective To study the clinical results of grafting of vascularized fibular and ilium to repair bone defects of limbs. Methods From January 1992 to January 2004, 49 cases of bone defects of limbs were treated with vascularized fibular grafting (33 cases) and vascularized iliac grafting (16 cases). Their limb functions were graded according to Ennekings system. The changes of the vascularized fibular and iliac grafts were evaluated radiographically according to the International Symposium on Limb Salvage. Results All the patients were followed up for 1 to 12 years. In the vascularized fibular group, the recovery rate for the operated limbs was 82.7%, the average healing time of the bone was 16.8 weeks and the healing rate of the bone was 87.9%. In the other group, the recovery rate of the operated limbs was 88%, the average healing time of the bone was 15.2 weeks and the healing rate of the bone was 93.8%. Conclusion The vascularized fibular graft can be adopted to repair long bone defects of lower limbs and distal radius, while the vascularized iliac graft can be adopted to repair the bone defects of upper limbs.