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Objective:To compare the clinical and imaging outcomes of fascia lata autograft bridging repair reinforecd with an artificial ligament as the internal brace with the autograft bridging repair for the treatment of irreparable massive rotator cuff tears (IMRCTs).Methods:The data of 26 patients with IMRCT who underwent fascia lata autograft bridging repair augmented with artificial ligament as the internal brace (internal brace group) and of 24 patients with IMRCT who underwent bridging autograft repair alone (control group) were retrospectively evaluated preoperatively and at 2-year follow-up. Clinical outcomes were assessed using shoulder activity, the American Shoulder and Elbow Surgeons (ASES) Score, University of California Los Angeles (UCLA) Score, and visual analogue scale (VAS) for pain. Imaging outcomes were evaluated using acromiohumeral distance (AHD), Goutallier grade, and status of fascia lata grafts according to radiographs or magnetic resonance imaging results.Results:All 50 cases were followed up for 34.2±7.2 months (range 24-45 months). Compared to the control group, the internal brace group showed better ASES score (93.5±5.3 vs. 89.5±5.7, P<0.05), UCLA score (31.7±3.8 vs. 28.5±5.6, P<0.05), improvement in UCLA score (19.6±4.2 vs. 15.9±5.7, P<0.05), active elevation (167.3°±8.4° vs. 159.4°±13.6°, P<0.05), abduction strength (8.9±1.2 vs. 8.2±1.2, P<0.05), improvement in abduction strength (4.1±1.2 vs. 3.3± 1.0, P<0.05), AHD (7.0±1.4 mm vs. 5.9±1.0 mm, P<0.05), improvement in AHD (3.3±1.5 mm vs. 2.0±0.6 mm, P<0.05), and healing rate of fascia lata autografts (92% vs. 54%, P<0.05) at 2-year follow-up. Conclusion:Fascia lata autograft bridging repair reinforced with an artificial ligament as the internal brace improves healing rate of bridging graft and postoperatively short-term clinical outcomes of patients with IMRCT.
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OBJECTIVES@#To explore the physicochemical characteristics and biocompatibility of calcium peroxide (CPO)-loaded polycaprolactone (PCL) microparticle.@*METHODS@#The CPO/PCL particles were prepared. The morphology and elemental distribution of CPO, PCL and CPO/PCL particles were observed with scanning electron microscopy and energy dispersive spectroscopy, respectively. Rat adipose mesenchymal stem cells were isolated and treated with different concentrations (0.10%, 0.25%, 0.50%, 1.00%) of CPO or CPO/PCL particles. The mesenchymal stem cells were cultured in normal media or osteogenic differentiation media under the hypoxia/normoxia conditions, and the amount of released O2 and H2O2 after CPO/PCL treatment were detected. The gene expressions of alkaline phosphatase (ALP), Runt-associated transcription factor 2 (RUNX2), osteopontin (OPN) and osteocalcin (OCN) were detected by realtime RT-PCR. SD rats were subcutaneously injected with 1.00% CPO/PCL particles and the pathological changes and infiltration of immune cells were observed with HE staining and immunohistochemistry at day 7 and day 14 after injection.@*RESULTS@#Scanning electron microscope showed that CPO particles had a polygonal structure, PCL particles were in a small spherical plastic particle state, and CPO/PCL particles had a block-like crystal structure. Energy dispersive spectroscopy revealed that PCL particles showed no calcium mapping, while CPO/PCL particles showed obvious and uniform calcium mapping. The concentrations of O2 and H2O2 released by CPO/PCL particles were lower than those of CPO group, and the oxygen release time was longer. The expressions of Alp, Runx2, Ocn and Opn increased with the higher content of CPO/PCL particles under hypoxia in osteogenic differentiation culture and normal culture, and the induction was more obvious under osteogenic differentiation conditions (all P<0.05). HE staining results showed that the muscle tissue fibers around the injection site were scattered and disorderly distributed, with varying sizes and thicknesses at day 7 after particle injection. Significant vascular congestion, widened gaps, mild interstitial congestion, local edema, inflammatory cell infiltration, and large area vacuolization were observed in some tissues of rats. At day 14 after microparticle injection, the muscle tissue around the injection site and the tissue fibers at the microparticle implantation site were arranged neatly, and the gap size was not thickened, the vascular congestion, local inflammatory cell infiltration, and vacuolization were significantly improved compared with those at day 7. The immunohistochemical staining results showed that the expressions of CD3 and CD68 positive cells significantly increased in the surrounding muscle tissue, and were densely distributed in a large area at day 7 after particle injection. At day 14 of microparticle injection, the numbers of CD3 and CD68 positive cells in peripheral muscle tissue and tissue at the site of particle implantation were lower than those at day 7 (all P<0.01).@*CONCLUSIONS@#CPO/PCL particles have good oxygen release activity, low damage to tissue, and excellent biocompatibility.
Assuntos
Ratos , Animais , Osteogênese , Subunidade alfa 1 de Fator de Ligação ao Core , Ratos Sprague-Dawley , Peróxido de Hidrogênio/farmacologia , Diferenciação Celular , Oxigênio , Hipóxia , Células CultivadasRESUMO
@#Polydopamine (PDA) nanoparticles were prepared as a carrier, and bavachinin (BVA) was efficiently loaded by physical adsorption.The erythrocyte membrane was further utilized to modify and construct the erythrocyte membrane biomimetic nanoparticles (RBC-BP), the residence time in the body was extended and the in vivo analytical method was established to investigate their pharmacokinetics in mice.Polydopamine nanoparticles loaded with BVA (BP) were prepared by solvent replacement method, and the influencing factors of PDA loaded with BVA were investigated with the adsorption rate as the evaluation index.The erythrocyte membrane was extracted and separated, and RBC-BP was prepared by incubation coextrusion method. The effects of pH value on membrane coating and the extrusion times on the particle size and uniformity of RBC-BP were investigated.The particle size, potential, morphology, and cumulative release rate of RBC-BP were systematically characterized, and their pharmacokinetics in mice were preliminarily explored.The results showed that the adsorption rate of BP was as high as (92.08 ± 0.17) % and the drug loading rate was (42.05 ± 2.95) % at the PDA to BVA ratio of 1∶0.5, the solution pH value of 7, the incubation time of 6 h, and the incubation temperature of 20 °C, and that the erythrocyte membrane could be successfully oriented and coated on the surface of BP by the action of electric charge at the pH value of 4. The in vitro studies showed that RBC-BP has the apparent core-shell structure with the particle size of (308.63 ± 6.56) nm and good stability, and in vivo pharmacokinetic studies showed that RBC-BP can significantly extend the circulation time of nanoparticles in vivo.