Estudio retrospectivo de 544 timpanoplastias con cartílago y pericondrio: resultados anatómicos y funcionales / A retrospective study of 544 tympanoplasty with cartilage and perichondrium: anatomical and functional results

Introducción: el cierre de las perforaciones timpánicas se realiza con diferentes materiales, entre ellos el cartílago y el pericondrio. En este estudio se compararon los resultados anatómicos y funcionales obtenidos con ambos materiales, y se evaluaron posibles factores asociados con los buenos resultados. Material y métodos: estudio retrospectivo en pacientes intervenidos de timpanoplastia sin mastoidectomía entre el 1 de enero de 2001 y el 31 de diciembre de 2018. Resultados: se incluyeron 544 timpanoplastias. En la mayoría se utilizó cartílago (78,5 %) y en el resto pericondrio. El cartílago se utilizó con mayor frecuencia en los menores de 18 años (p=0,001), perforaciones totales y subtotales (p=0,000) y timpanoplastias secundarias y terciarias (p=0,008). No hubo diferencias en el tiempo de seguimiento (15,68 ± 22,18 meses frente al 12,86 ± 14,9 meses, p=0,169). La tasa de éxito anatómico fue mayor en el grupo de cartílago, sin diferencias en los resultados auditivos (82 % con cartílago y 78,3 % con pericondrio). El éxito anatómico se relacionó con la técnica utilizada para la reconstrucción con cartílago, mientras que los resultados auditivos se asociaron significativamente con el estado de la mucosa del oído medio y la cadena de huesecillos en el momento de la cirugía y el éxito anatómico posquirúrgico. Conclusiones: con el cartílago se consiguieron mejores resultados anatómicos que con el pericondrio, sin diferencias a nivel funcional. Sin embargo, los resultados funcionales empeoraron si había patología a nivel del oído medio y en ausencia de restauración anatómica.

Introduction: Different materials are used to close tympanic perforations. This stu-dy aimed to compare anatomical results obtained with cartilage and perichondrium and evaluate factors associated with successful results. Material and method: Re-trospective study of patients who underwent tympanoplasty without mastoidectomy between January 1, 2001, and December 31, 2018. Demographic data, ear pathology, surgical intervention, and anatomical and functional results were collected. Results:544 tympanoplasty were included. Cartilage was the most used (78.5%). Cartilage was used more frequently in children under 18 years (p = 0.001), to reconstruct total and subtotal perforations (p = 0.000) and in secondary and tertiary tympanoplasty (p = 0.008). Follow-up time did not differ between the two groups (15.68 ± 22.18 months vs. 12.86 ± 14.9 months, p = 0.169). The anatomical success rate was higher in the cartilage group, with no significant differences in hearing outcomes (82% with cartilage and 78.3% with perichondrium). Anatomical success was related to the technique used for cartilage reconstruction (monoblock or palisade). Hearing re-sults were significantly associated with the state of middle ear mucosa at the time of surgery, the state and mobility of the ossicle chain, and post-surgical anatomical suc-cess. Conclusions: Cartilage achieved better anatomical results than perichondrium. Both materials were comparable on a functional level. However, the functional re-sults worsen if there is pathology of the middle ear (mucosa or chain of ossicles) and anatomical restoration is not achieved.

Effectiveness of comprehensive rhinoplasty on secondary nasal deformity with saddle nasal deformity after cleft lip surgery / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of comprehensive rhinoplasty with autogenous costal cartilage grafting and prosthesis augmentation rhinoplasty in the treatment of secondary nasal deformity with saddle nasal deformity after cleft lip surgery.@*METHODS@#The clinical data of 96 patients with secondary nasal deformity with saddle nasal deformity after cleft lip surgery between September 2008 and January 2019 were retrospectively analyzed. There were 17 males and 79 females with an average age of 25.6 years (range, 17-38 years). Autogenous costal cartilage grafts were used to construct stable nasal tip framework and enhance the strength of alar cartilage. Nasal dorsum prostheses (39 cases of bulge, 45 cases of silicone prosthesis) or autogenous costal cartilage (12 cases) were used for comprehensive rhinoplasty. Visual analogue scale (VAS) score was used to evaluate the postoperative satisfaction subjectively, and nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle were calculated to evaluate objectively before and after operation.@*RESULTS@#All patients were followed up 6 months to 8 years, with an average of 13.4 months. Nasal septal hematoma occurred in 3 patients after operation, which was improved after local aspiration and nasal pressure packing. Two cases had mild deformation of the rib cartilage graft of the nasal dorsum, one of which had no obvious deviation of the nasal dorsum and was not given special treatment, and one case underwent the cartilage graft of the nasal dorsum removed and replaced with silicone prosthesis. The incisions of the other patients healed by first intention, and there was no complication such as postoperative infection and prosthesis displacement. The nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle significantly improved after operation when compared with preoperative ones ( P<0.05). Postoperative subjective satisfaction evaluation reached the level of basic satisfaction or above, and most of them were very satisfied.@*CONCLUSION@#Comprehensive rhinoplasty using autologous rib cartilage grafting to construct a stable nasal tip support, combined with dorsal nasal prosthesis or autologous cartilage implantation, can achieve good effectiveness on secondary nasal deformity with saddle nasal deformity after cleft lip surgery.

Reconstrução nasal com uso de costela em paciente com síndrome de Binder: Um relato de caso e revisão de literatura / Nasal reconstruction using ribs in a patient with Binder syndrome: A case report and literature review

Introdução: A síndrome de Binder também pode ser conhecida como displasia maxilonasal e é uma malformação congênita caracterizada por hipoplasia nasomaxilar devido a um subdesenvolvimento do esqueleto facial médio. A atual incidência ou prevalência ainda é desconhecida, mas afeta aproximadamente um recém-nascido vivo em cada 10.000 nascimentos. O diagnóstico pode ser clínico ou associado a ultrassonografia pré-natal, caracterizada por nariz achatado e convexidade anormal da maxila. O tratamento é cirúrgico para correção das anormalidades estéticas e funcionais. Relato de Caso: Paciente que recebeu diagnóstico de síndrome de Binder aos 14 anos, sem outras malformações associadas, com queixa estética e funcional nasal. A correção cirúrgica foi iniciada pela extração de um bloco da sexta cartilagem costal à esquerda, com abertura nasal na margem columelar, no padrão de uma rinoplastia aberta, e dissecados os tecidos no plano subSMAS. Após preparo da área receptora nasal, foram esculpidos bloco de cartilagem para reconstrução do dorso nasal, enxertos alares e enxerto de cartilagem septal. Houve melhora de projeção da ponta nasal e alongamento nasal. Conclusão: A rinoplastia pode ser uma cirurgia desafiadora nesses pacientes, sendo a reconstrução autóloga com o uso de cartilagem costal indicada pela literatura como a melhor opção. É necessário individualizar cada caso para programação de enxertos e reestruturação nasal, sendo fundamental também a melhora funcional desses casos.

Introduction: Binder's syndrome can also be known as maxillonasal dysplasia and it is a congenital malformation characterized by nasomaxillary hypoplasia resulting from an underdevelopment of the middle facial skeleton. The current incidence or prevalence is still unknown, but it affects approximately one child in every 10,000 births. The diagnosis can be clinical or associated with prenatal ultrasonography, characterized by a flattened nose and abnormal maxillary convexity. The treatment is surgical to correct aesthetic and functional abnormalities. Case Report: Patient diagnosed with Binder's syndrome at the age of 14, without other associated malformations, with aesthetic and functional nasal complaints. Surgical correction began with the extraction of a block of the sixth costal cartilage on the left, with a nasal opening on the columellar margin, in the pattern of an open rhinoplasty, and tissue dissection in the sub-SMAS plane. After preparing the nasal receptor area, a block of cartilage was sculpted for reconstruction of the nasal dorsum, alar grafts and septal cartilage grafts. There was an improvement in the projection of the nasal tip and nasal dorsum. Conclusion: Rhinoplasty can be a challenging surgery in these patients, and the literature indicates that the best option is autologous reconstruction with costal cartilage. It is necessary to individualize each case to schedule nasal grafts and restructuring, and functional improvement in these cases is also essential

Treatment of Chondral Lesions in the Knee / Tratamento das lesões condrais no joelho

Abstract Articular cartilage injuries are common and lead to early joint deterioration and osteoarthritis. Articular cartilage repair techniques aim at forming a cartilaginous neo-tissue to support the articular load and prevent progressive degeneration. Several techniques are available for this purpose, such as microfracture and chondrocyte transplantation. However, the procedural outcome is often fibrocartilage, which does not have the same mechanical resistance as cartilaginous tissue. Procedures with autologous osteochondral graft have a morbidity risk, and tissue availability limits their use. As such, larger lesions undergo osteochondral transplantation using fresh or frozen grafts. New techniques using minced or particulate cartilage fragments or mesenchymal stem cells are promising. This paper aims to update the procedures for treating chondral lesions of the knee.

Resumo As lesões da cartilagem articular são comuns e levam à deterioração precoce da articulação e ao desenvolvimento da osteoartrite. As técnicas de reparo da cartilagem articular visam a formação de um neo-tecido cartilaginoso capaz de suportar carga articular e evitar a progressão da degeneração. Há várias técnicas disponíveis para esse fim, como a microfratura e o transplante de condrócitos. Entretanto muitas vezes o desfecho do procedimento é a formação de fibrocartilagem, que não possui a mesma resistência mecânica do tecido cartilaginoso. Em outros procedimentos, nos quais é realizado enxerto osteocondral autólogo, há risco de morbidade associada ao procedimento, além da disponibilidade limitada de tecido. Por esse motivo, o transplante osteocondral, utilizando enxertos a fresco ou congelados tem sido utilizado para lesões de maior volume. Por fim, novas técnicas utilizando fragmentos de cartilagem picada ou particulada, assim como o uso de células tronco mesenquimais se apresentam como promissores. O objetivo desse artigo é realizar uma atualização dos procedimentos para tratamento das lesões condrais do joelho.

Refixation of the Excised Acetabular Labrum can Affect the Structural Changes of Cartilage Surface in the Hip Joint / La Refijación del Labrum Acetabular Extirpado Puede Afectar los Cambios Estructurales de la Superficie del Cartílago en la Articulación Coxal

SUMMARY: Refixation of the damaged acetabular labrum is a method of surgical treatment of the hip joint that can promote the repair of joint function after injury and prevent premature osteoarthritis. We sought to determine the condition of the hip joint in rabbits 4 months after excision of the acetabular labrum and the condition of the joint after labral refixation. The articular cartilage of the femoral head and acetabulum was examined by histological methods, multipoint measurement of cartilage thickness, and the ratio between cartilage matrix and chondrocytes lacunae, and the condition of cartilage according to the OARSI grading scale was carried out. On this model, a correlation analysis was performed between the results of the OARSI grading scale and the data of linear morphometry. All these parameters made it possible to better assess changes in articular cartilage. The ratio between matrix and chondrocyte lacunae turned out to be a method that allows establishing early cartilage damage when erosion, fibrosis or deformation did not occur. We found significant differences between the condition of the cartilage after exicion of acetabular labrum and after labral refixation, which give hope to confirm that this surgical technique can delay or prevent progressive changes in the cartilage of the damaged hip joint.

La refijación del labrum acetabular dañado es un método de tratamiento quirúrgico de la articulación coxal, que puede promover la reparación de la función articular después de una lesión y prevenir la osteoartritis prematura. Intentamos determinar el estado de la articulación coxal en conejos de 4 meses después de la escisión del labrum acetabular y observar el estado de la articulación después de la refijación del labrum. El cartílago articular de la cabeza femoral y el acetábulo se examinó por métodos histológicos, se midió a través de multipunto el grosor del cartílago y se realizó la relación entre la matriz del cartílago y las lagunas de condrocitos, y se llevó a cabo la condición del cartílago según la escala de clasificación OARSI. Sobre este modelo se realizó un análisis de correlación entre los resultados de la escala de calificación OARSI y los datos de la morfometría lineal. Todos estos parámetros permitieron evaluar mejor los cambios en el cartílago articular. La relación entre la matriz y las lagunas de condrocitos resultó ser un método que permite establecer temprano el daño del cartílago cuando no se presentó erosión, fibrosis o deformación. Encontramos diferencias significativas entre la condición del cartílago después de la extirpación del labrum acetabular y después de la refijación del labrum, lo que da la esperanza de confirmar que esta técnica quirúrgica puede retrasar o prevenir cambios progresivos en el cartílago de la articulación coxal dañada.

Child Fractures: Are We Getting More Surgical? / Fraturas na criança: Estamos ficando mais cirúrgicos?

Abstract Historically, surgeries on the immature skeleton were reserved for open or articular fractures. In recent years, the improvement in the quality and safety of anesthesia, new imaging equipment, implants designed especially for pediatric fractures, associated with the possibility of shorter hospitalization time and rapid return to social life has demonstrated a new tendency to evaluate and treat fractures in children. The purpose of this update article is to answer the following questions: (1) Are we really turning more surgical in addressing fractures in children? (2) If this is true, is this surgical conduct based on scientific evidence? In fact, in recent decades, the medical literature demonstrates articles that support better evolution of fractures in children with surgical treatment. In the upper limbs, this is very evident in the systematization of the reduction and percutaneous fixation of supracondylar fractures of the humerus and fractures of the forearm bones. In the lower limbs, the same occurs with diaphyseal fractures of the femur and tibia. However, there are gaps in the literature. The available published studies show low scientific evidence. Thus, it can be inferred that, even though the surgical approach is more present, the treatment of pediatric fractures should always be individualized and conducted according to the knowledge and experience of the professional physician, taking into account the presence of technological resources available for the care of the small patient. All possibilities, non-surgical and/or surgical, should be included, always instituting actions based on science and in agreement with the family's wishes.

Resumo Historicamente, as cirurgias no esqueleto imaturo eram reservadas às fraturas expostas ou articulares. Nos últimos anos, a melhora na qualidade e segurança das anestesias, novos equipamentos de imagem, implantes desenhados especialmente para fraturas pediátricas, associados à possibilidade de menor tempo de hospitalização e rápido retorno ao convívio social vêm demonstrando uma nova tendência de avaliar e tratar fraturas na criança. O objetivo deste artigo de atualização é responder às seguintes questões: (1) estamos realmente ficando mais cirúrgicos na abordagem das fraturas em crianças? (2) Caso isto seja verdadeiro, esta conduta cirúrgica está baseada em evidências científicas? De fato, nas últimas décadas, a literatura médica demonstra artigos que suportam melhor evolução das fraturas na criança com o tratamento cirúrgico. Nos membros superiores, isto fica muito evidente na sistematização da redução e fixação percutânea das fraturas supracondilianas do úmero e das fraturas de ossos do antebraço. Nos membros inferiores, o mesmo ocorre com fraturas diafisárias do fêmur e tíbia. No entanto, há lacunas na literatura. Os estudos publicados são geralmente com baixa evidência científica. Assim, pode-se deduzir que, mesmo sendo a abordagem cirúrgica mais presente, o tratamento de fraturas pediátricas deve ser sempre individualizado e conduzido de acordo com o conhecimento e experiência do médico profissional, levando em conta a presença de recursos tecnológicos disponíveis para o atendimento do pequeno paciente. Deve-se incluir todas as possibilidades, não cirúrgicas e/ou cirúrgicas, sempre instituindo ações baseadas na ciência e em concordância com os anseios da família.

Study of developing tracheal cartilage under light microscope

Background: Airway formation is one of the earliest events in development of respiratory system. However, maturation of airway continues well in post-natal life. The trachea has framework of incomplete ring of hyaline cartilage united by fibrous tissue and smooth muscle through which air conduction takes place. The trachea-bronchial mucosa is target for host of airborne toxic agents; bacterial and viral agents, allergens, reactive gases, aerosols, and irritant particles. This fascinates many workers for detailed study of epithelium or lining air passage. Aims and Objectives: The present study was undertaken to document normal developmental microscopic structure of tracheal cartilage in fetuses of different age group (gestational ages between 12th and 40th weeks) and to compare the difference between different age groups. Materials and Methods: Tissues from trachea of various age group fetuses were collected, processed, and stained with H and E and Masson’s trichrome. Results: Development of tracheal cartilage was observed into three trimesters. The 2nd and 3rd trimesters were further divided in the early 2nd (13th–16th weeks), mid-2nd (17th–20th weeks), late 2nd (21st–24th weeks), early 3rd (25th–28th weeks), mid-3rd (29th–32nd weeks), and late 3rd (33rd–40th weeks) phases. Conclusion: Perichondrium of cartilage had shown well-marked outer fibrous layer with increased vascularity by late 2nd to early 3rd trimester. Well-marked inner cellular layer of perichondrium was noticed by 3rd trimester, while cartilage had shown active chondrocytes by late 2nd to early 3rd trimester. At the late 3rd trimester, typical hyaline cartilage had shown chondrocytes in cell nest surrounded by territorial matrix.

Effects of different moxibustion time on knee cartilage morphology and the expression of TNF-α and IL-10 in rats with knee osteoarthritis / 针灸推拿医学（英文版）

Objective:To observe the effects of different moxibustion time on cartilage morphology,tumor necrosis factor(TNF)-α and interleukin(IL)-10 of the knee joint in rats with knee osteoarthritis(KOA),and to explore the best treatment time of moxibustion for KOA.Methods:Healthy male Wistar rats were randomly divided into a blank group,a model group,a 15-minute-moxibustion group,a 30-minute-moxibustion group,and a 60-minute-moxibustion group,with 10 rats in each group.Except for the blank group,the KOA model was established in all groups by injecting sodium iodoacetate solution into the knee joint cavity of rats.Rats in the 15-minute-moxibustion group,the 30-minute-moxibustion group,and the 60-minute-moxibustion group were all treated with mild moxibustion intervention for 15 min,30 min,and 60 min,respectively at Neixiyan(EX-LE4)and Dubi(ST35)points near the patella,3 times a week for 4 weeks,12 times in total.Rats in the blank group and the model group were fixed for 30 min without moxibustion intervention.Macroscopic observation for the smoothness of knee cartilage surface was performed after the intervention.Hematoxylin-eosin staining,toluidine blue staining,and Mankin score were used to evaluate the pathological changes in the cartilage.The expression levels of TNF-α and IL-10 in the serum were detected by enzyme-linked immunosorbent assay.Results:Compared with the blank group,the articular cartilage surface in the model group was rough,the chondrocyte arrangement was irregular,the Mankin score and the serum TNF-α expression were significantly increased(P＜0.05),while the expression of serum IL-10 was significantly decreased(P＜0.05).Compared with the model group,the articular cartilage surface was smoother,the chondrocytes were arranged neatly,the Mankin score and serum TNF-α expression level were significantly lower in the three moxibustion intervention groups(P＜0.05);the serum IL-10 level in the 30-minute-moxibustion group and the 60-minute-moxibustion group was increased significantly(P＜0.05).Compared with the 15-minute-moxibustion group,the articular cartilage surface in the 30-minute-moxibustion group and the 60-minute-moxibustion group was smoother,the chondrocyte arrangement was more regular,the Mankin score and the serum TNF-α level were decreased significantly(P＜0.05),and the serum IL-10 level was increased(P＜0.05).There was no significant difference in the serum TNF-α or IL-10 level between the 30-minute-moxibustion group and the 60-minute-moxibustion group(P＞0.05).Conclusion:Moxibustion can obviously improve the morphology and structure of KOA articular cartilage,protect articular cartilage,inhibit cartilage inflammation,and delay KOA cartilage degeneration.Moxibustion's effect is closely related to moxibustion time;the therapeutic effect of the 30-minute-moxibustion and the 60-minute-moxibustion is better than that of the 15-minute-moxibustion.

Application of expanded polytetrafluoroethylene support combined with ear cartilage in rhinoplasty / 中华医学美学美容杂志

Objective:To explore the application of expanded polytetrafluoroethylene (ePTFE) as the main support combined with a small amount of ear cartilage in rhinoplasty.Methods:Through a nasal opening approach, the ePTFE was used as a support implant for the nasal dorsum and columella, and unilateral concha cartilage was used as a nasal tip modification graft.Results:This method was applied in 56 cases of rhinoplasty (36 cases of initial nose, 20 cases of silicone augmentation rhinoplasty). The wounds of 55 patients healed at one stage without complications, with satisfactory results (average follow-up of 6 months). In one case, nasal mucosa was damaged early after surgery, and the ePTFE was partially exposed, which healed after debridement and suture.Conclusions:For most primary rhinoplasty and simple repair of the nose, using ePTFE as the main support combined with a small amount of ear cartilage, has the advantages of fewer materials, rapid surgery, mild trauma, and stable postoperative results.

Effects of costal cartilage cortex on nasal tip contour improvement / 中华医学美学美容杂志

Objective:To investigate the effect of autologous costal cartilage cortex as nasal tip support and modified graft for nasal tip contour improvement.Methods:From June 2020 to June 2021, 116 patients (male 26, female 90, aged 20-45 years) who received rhinoplasty in the cosmetic surgery department of Myoung Beaucare Clinic of Beijing, were examined the costal cartilage by CT, and the costal cartilage was cut. The costal cartilage cortex was made into " strip" and " cap" grafts to shape the nasal tip, and the nasal dorsum was raised by polytetrafluoroethylene or silicone prosthesis for comprehensive rhinoplasty.Results:A total of 116 patients were followed up for an average of 11.7 months. After the operation, there was no space occupying in the nasal cavity, no graft protrusion, no obvious foreign body feeling in the nasal valve, and the nasal tip could swing left and right. At the same time, the nasal tip showed obvious signs, the lower lobule was full, and there were no complications such as cartilage appearance, exposure, infection, etc. Due to the untreated deviation of nasal septum, 3 cases had deviation of nasal columella and asymmetric nostrils. The shape of nasal tip was stable in the remaining 113 cases, and satisfactory results were obtained.Conclusions:By using autologous costal cartilage cortex as nasal tip support and modification graft for nasal tip contour improvement, the shaped nasal tip is soft and movable, and does not affect the airway. It is a good surgical technique in nasal tip plastic surgery, which is worthy of clinical application.

Application of nasal aesthetic polygon theory in reconstruction of new domes by costal cartilage on nasal tip / 中华医学美学美容杂志

Objective:To explore the application of nasal aesthetic polygon theory in the reconstruction of new domes on nasal tip with autogenous costal cartilage.Methods:From June 2019 to June 2021, 116 patients (26 males and 90 females) received rhinoplasty, CT-assisted examination of the costal cartilage, nasal bone and nasal cartilage was performed, and the autogenous costal cartilaginous cortex was used to make dome reconstruction grafts that were transplanted to the original alar cartilage and partially fixed to the original nasal septum cartilage to form a satisfactory and natural nasal shape.Results:All the patients were followed up for 6-24 months. No cartilaginous, overrotated or underrotated appearance was found in nasal tip. The shape of nasal tip was clear and good, with an obvious performance point and full lower lobule. The nose was tall and straight, and looked natural and beautiful in three dimensions.Conclusions:The nasal aesthetic polygon theory is used to guide the reconstruction of new domes with autogenous costal cartilage in nasal tip surgery. Compared to the cap and shield grafts, the nasal tip is more close to the normal anatomical structure, the shape and texture are more similiar to the natural state and the nasal tip is softer by using autogenous costal cartilage, and so it is an ideal surgical procedure for nasal tip reconstruction.

Paranasal augmentation using autologous costal cartilage as an adjunct to rhinoplasty / 中华医学美学美容杂志

Objective:To investigate the postoperative effect of paranasal concavity augment by block united with diced autologous costal cartilage.Methods:The data of 76 patients who were underwent costal cartilage rhinoplasty together with paranasal augmentation from January 2016 to December 2019 were analyzed retrospectively. The surgical technique was described in detail. Medical charts and operative records were reviewed to summary the complications. Patients′subjective satisfaction of the postoperative nasal appearance was self-evaluated with grading (1 worse, 2 no change, 3 improved, and 4 much improved). Cosmetic effects were evaluated by the measurements of the nasolabial angle and the distance between ACJ and intertragic notch preoperatively and postoperatively.Results:The postoperative follow-up duration was 6 to 34 months. Overall, functional and aesthetic outcome was satisfactory in most patients, and the mean score by the patients′self-evaluation was 3.4±0.5. Graft exposure, mobility, or significant resorption, pneumothorax or significant donor-site pain were not observed. The average nasolabial angle was changed from (78.2±13.2)° preoperatively to (89.8±10.2)° 6 months postoperative at the last follow-up ( t=152.00, P<0.01). And the distance from the alar-cheek junction to the left tragus was increased by 3.8±2.1 (2.2-6.1) mm. Conclusions:Costal cartilage rhinoplasty combined with augmentation of parasal area can improve parasal depression, with stable postoperative effect and fewer postoperative complications, and has a good effect for patients with normal occlusal relationship or mild abnormality.

Exosomes secreted by hypoxia-preconditioned BMSCs promote cartilage regeneration / 中华骨科杂志

Objective:Observing the effect of exosomes derived from hypoxic Bone marrow mesenchymal stem cells (BMSCs) on the function of chondrocytes, and exploring the role and mechanism of exosomal miR-196b-5p. Evaluating the application prospects of hypoxic BMSCs exosomes and miR-196b-5p for cartilage regeneration.Methods:Chondrocytes were cultured in the supernatant of BMSCs cultured under normoxia or hypoxia, respectively. The proliferation of chondrocytes was detected by CCK-8 assay and the expressions of Collagen type 2 (Col2), Col1, Aggrecan and SOX9 were detected by qPCR to evaluate the effect of hypoxic BMSCs paracrine on chondrocyte functions. Obtaining normoxic and hypoxic exosomes through ultracentrifugation, and testing their effects on the proliferation and anabolic-related genes of chondrocytes through CCK-8 assay and qPCR. Verifying the expression of miR-196b-5p in hypoxic exosomes based on exosomal miRNA array. Knocking out miR-196b-5p in hypoxic BMSCs, and detecting the effect of hypoxic exosomal miR-196b-5p on the functions of chondrocytes by loss-of-function assay. Predicting the downstream of miR-196b-5p through bioinformatics tools, and exploring the mechanism of hypoxic exosomal miR-196b-5p by gain-of-function assays. Hypoxic exosomes and miR-196b-5p-knockout hypoxic exosomes were loaded on silk fibroin hydrogel and subcutaneously into nude mice. After 4 weeks of culture, histological staining of saffron O, Masson and biochemical content of sGAG and collagen were performed to assess the application prospect of hypoxic exosomes and hypoxic exosomal miR-196b-5p on cartilage regeneration. Results:The results of CCK-8 assay and qPCR indicated that the supernatant of hypoxic BMSCs significantly promoted the proliferation of chondrocytes 1.20±0.07 and the expression of cartilage-related markers (Col2 2.95±0.17, Aggrecan 2.45±0.27, SOX9 2.92±0.29) compared to normoxic BMSCs (0.94±0.04, 1.89±0.09, 1.67±0.21, 1.76±0.16), the differences were statistically significant ( P<0.05). The result of CCK-8 assay showed that hypoxic exosomes (1.28±0.04) promoted the proliferation of chondrocytes compared to normoxic exosomes 1.05±0.06, the differences were statistically significant ( P<0.05). CCK-8 assay revealed that the down-regulation of miR-196b-5p in hypoxic exosomes 0.99±0.06 attenuated the proliferation of chondrocytes compared to control group 1.20±0.07, the differences were statistically significant ( P<0.05); the expression of Col2 0.56±0.04, Aggrecan 0.74±0.09, and SOX9 0.45±0.05 in chondrocytes was reduced in the miR-196b-5p knockdown group compared to the control group (1.00±0.09, 1.00±0.12, 1.00±0.07), the differences were statistically significant ( P<0.05). Co-transfection of pmirGLO-BACH1-WT reporter vector with miR-196b-5p mimics decreased the luciferase activity 0.73±0.06, the differences were statistically significant ( P<0.05). Co-transfection of pmirGLO-BACH1-MUT reporter vector with miR-196b-5p mimics showed no change in luciferase activity. BACH1 is the target of miR-196b-5p. Subcutaneous culture in nude mice showed that hypoxic exosomes significantly promoted the deposition of sGAG 383.2±21.54 and collagen 67.40±3.45, while reducing the expression of miR-196b-5p in hypoxic exosomes weakened the deposition of sGAG 258.4±19.50 and collagen 57.15±4.95, the differences were statistically significant ( P<0.05). Conclusion:Hypoxic exosomes promoted the functions of chondrocytes by inhibiting the expression of BACH1 through miR-196b-5p. Hypoxic exosomes can be applied in cartilage regeneration.

Evaluation of knee cartilage based on MRI artificial intelligence reconstruction model of knee joint / 中华骨科杂志

Objective:To explore the feasibility of the AI intelligent reconstruction model based on knee joint magnetic resonance data developed by Nuctech Company Limited for evaluating knee cartilage injury.Methods:Thirty-three patients (a total of forty-one knees) who were hospitalized with severe knee osteoarthritis in Beijing Tsinghua Changgung Hospital from May 2021 to April 2022 were selected. All of them were planned to be performed total knee arthroplasty (TKA) for the treatment of knee osteoarthritis. Fifteen males with an average age of 71±5 years old and twenty six females with an average age of 71±9 years old were included in this study. There were 19 cases of left knee and 22 cases of right knee. Thin layer MRI examination on the patients' knee joints was performed before the surgery, and artificial intelligence model based on the thin layer MRI data of the knee joint was reconstructed. The cartilage part of the model was selected and corrected by Principal Component Analysis (PCA) in order to realize model straightening. The tibial plateau cartilage of knee joint which intercepted during operation was classified according to the International Cartilage Repair Society (ICRS). Finally the results were compared with the ICRS classification results of knee artificial intelligence reconstruction model and artificial recognition of knee joint MRI images.Results:Compared with the grade of cartilage injury intercepted during our operation which was according to the ICRS classification, the sensitivity of artificial intelligence reconstruction model for the diagnosis of cartilage injury with ICRS classification grade four was 93.1%. The specificity of artificial intelligence reconstruction model was 91.4%. The positive predictive value (PPV) of artificial intelligence reconstruction model was 92.2%. And the negative predictive value (NPV) of artificial intelligence reconstruction model was 80.3%. The area under ROC curve (AUC) was 0.92. The ICRS classification consistency between artificial intelligence model and physical inspection results was good with kappa value 0.81 ( P<0.001) . In the aspect of artificial recognition of cartilage injury grading in MRI images, the sensitivity of artificial recognition was 92.10% compared with the manual identification of cartilage injury classification in MRI images. The specificity of artificial recognition was 91.60%. The positive predictive value (PPV) of artificial recognition was 97.20% and the negative predictive value (NPV) of artificial recognition was 78.8%. The kappa value of the cartilage injury classification in MRI images consistency between artificial recognition and manual identification was 0.79 ( P<0.001). Conclusion:Based on the evaluation of cartilage injury by AI reconstruction model of knee joint, the sensitivity and specificity of the diagnosis of ICRS grade IV cartilage injury can be acceptable, but still needs to be improved.

Recent advances of acellular cartilage matrix in cartilage regeneration / 中华骨科杂志

Osteoarthritis is a common degenerative joint disease, and cartilage damage is often considered an early factor in irreversible joint degeneration. Repairing damaged cartilage remains a medical challenge due to its limited ability to self-repair and regenerate. In recent years, the application of tissue engineering strategies to treat cartilage defects has been recognized as an emerging therapeutic avenue. Acellular cartilage matrix (ACM) is an ideal material for cartilage repair and regeneration as it retains the extracellular matrix structure and bioactive components of natural cartilage, mimicking the extracellular environment of natural cartilage to the greatest extent. Type II collagen is the main type of hyaline cartilage and plays an important role in regulating the mechanical properties of cartilage tissue. It has been shown that type II collagen, growth factors and the hypoxic microenvironment play important roles in promoting cartilage regeneration. Type II collagen induces cell aggregation and chondrogenic differentiation in a specific way; Various growth factors contained in the ACM induce Sox9 expression and promote chondrogenic differentiation of stem cells; The hypoxic microenvironment upregulates the expression of type II collagen (COL2A1), Sox9 and maintains chondrocyte phenotype. In addition, ACM has been widely used in cartilage regeneration studies, either as a decellularized scaffold, hydrogel or 3D bioprinting technique for the repair of defective cartilage. Although the ACM-derived biomaterials discussed in this paper have many advantages, there are still some difficulties in their practical applications, such as loss of ACM components and reduced scaffold performance, which are still worth exploring in depth.

Orthotopic osteochondral transplantation for the treatment of femoral head compression fracture: a case report and literature review / 中华骨科杂志

Femoral head fracture is commonly seen in high-energy injury. However, compression fracture of femoral head is more rare. In most classifications of femoral head fracture, the compression is unusually involved. A case about acute traumatic dislocation of hip joint with compression fracture of femoral head is reported, involving a patient who hurt himself by riding electric bike and hitting the flower bed. He came to our hospital complaining of pain and limited motion of his right leg. The diagnosis of right hip anterior dislocation with the compression fracture of femoral head was confirmed by medical history, physical examination and imaging. Closed reduction of hip dislocation was performed in an emergency. Then we transplanted the bone cartilage from the non-weight-bearing area under the femoral head to the collapsed weight-bearing area, fixing it with countersunk hollow screws, and then the non-weight-bearing donor area was reconstructed with autogenous iliac bone, using surgical hip dislocation. The anatomical structure of the femoral head was therefore restored successfully during the operation. Three months after surgery, the X-ray showed that the femoral head was smooth and the cartilage graft was well fixed. Eight months after surgery, the patient gradually increased the bearing weight from partial to full according to his own condition, and there was no obvious pain in hip. After 24-month follow-up, we found the X-rays showed good reduction and fixation of the femoral head fracture. The CT scan showed no necrosis or cystic degeneration. He got well-active and passive movement in hip joint, and got no pain when walking with burden. For the patient with hip dislocation and compression fracture of femoral head, early joint reduction and non-weight-bearing osteocartilage transplantation can restore the anatomical structure of the weight-bearing area of the femoral head, to avoid traumatic osteoarthritis, and to improve the long-term quality of life of patients.

Expert consensus on platelet-rich plasma treatment for osteochondral lesion of talus (version 2023) / 中华创伤杂志

Osteochondral lesion of talus (OLT) is a foot and ankle disease characterized by ankle pain, which may impact the joint function and life quality. If managed improperly, it may lead to a further ankle arthritis, severely compromising the prognosis. The therapeutic effect of conservative treatment for OLT is still uncertain. Surgery is still the main treatment modality for OLT with various techniques. However, the optimized surgical technique is still inconclusive, furthermore, regeneration and repair of cartilage after debridement is also a great challenge for the treatment of OLT. Platelet-rich plasma (PRP) with good repair effect on cartilage injury is gradually applied in the treatment of OLT. However, there still lacks the unified understanding of the technique and specification of PRP for the treatment of OLT. Therefore, National Orthopedics Center of Shanghai Sixth People′s Hospital allied Foot Ankle Basic Research & Orthopedics Group, Chinese Association of Orthopedic Surgeons; Foot and Ankle Committee of Chinese Association of Sports Medicine Physicians; and Foot and Ankle Group of Orthopedic Specialized Branch of Shanghai Medical Association to organize related experts to formulate the Expert consensus on platelet- rich plasma treatment for osteochondral lesion of talus ( version2023). Fifteen recommendations were put forward upon PRP preparation, indications, contraindications and treatment methods of PRP for OLT, so as to standardize the PRP treatment for OLT.

Clinical analysis of otoendoscopic myringoplasty with tragus perichondrium in 20 cases / 中国基层医药

Objective:To analyze the clinical application effect of otoendoscopic myringoplasty with tragus perichondrium.Methods:The clinical data of 20 patients with tympanic membrane perforation who received treatment in Suixian Traditional Chinese Medicine Hospital from March 2019 to March 2020 were retrospectively analyzed. Among the 20 patients, 6 patients had traumatic tympanic membrane perforation, and 14 patients had tympanic membrane perforation caused by chronic suppurative otitis media (stationary phase). All patients underwent otoendoscopic myringoplasty with tragus perichondrium. After surgery, the healing of tympanic membrane perforation and the improvement of hearing were evaluated.Results:After surgery, all patients were followed up for 12 months. Traumatic tympanic membrane perforation healed in six patients. The tympanic membrane grafts survived in 12 patients with tympanic membrane perforation caused by chronic suppurative otitis media (stationary phase). One patient had poor postoperative healing and the remaining small perforation healed after secondary treatment under local anesthesia. Healing from tympanic membrane perforation was not achieved in one patient because of perforation caused by otitis media. The healing rate of tympanic membrane perforation caused by chronic suppurative otitis media was 95%. Before surgery, the air conduction pure tone hearing threshold was (42 ± 11) dBHL, and it was (25 ± 10) dBHL 12 months after surgery. There was a significant difference in air conduction pure tone hearing threshold between before and after surgery ( t = 4.00, P < 0.05). No complications such as tragus cartilage infection, skin flap necrosis of external auditory meatus, peripheral facial paralysis, hearing loss, or tinnitus occurred in 20 patients with tympanic membrane perforation. Conclusion:Otoendoscopic myringoplasty with tragus perichondrium leads to a high perforation healing rate, improves healing greatly, has no serious complications, produces minimal trauma, and contributes to a rapid recovery from tympanic membrane perforation.

Efficacy of osteochondral fragment fixation using bioabsorbable pins for Hepple Ⅱ osteochondral lesions of the talus in adolescents / 国际外科学杂志

Objective:To investigate the efficacy of osteochondral fragment fixation using bioabsorbable pins for Hepple Ⅱ osteochondral lesions of the talus (OLT) in adolescents.Methods:Retrospective case analysis was used. The clinical data and follow-up results of 13 adolescent patients (13 feet) with Hepple Ⅱ OLT were all treated with osteochondral fragment fixation using bioabsorbable pins admitted to Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2017 to December 2021 were retrospectively analyzed. There were 7 males and 6 females, with 13 right feet. The age was (14.85±2.23) years old, ranged from 12 to 18 years old. According to the American orthopedic foot and ankle society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS) and SF-36 score before operation and at the last follow-up were used to evaluate the efficacy and function of the patients. Measurement data with normal distribution were represented as mean ± standard deviation( ± s), and the comparison between groups was conducted using the t-test; The mearsurement data with skewness distribution were expressed by M( Q1, Q3), and rank-sum test was used for inter-group comparison. Results:Thirteen adolescent patients (13 feet) with Hepple Ⅱ OLT underwent surgery successfully and were followed up for (25.54±9.95) months. All wounds healed by first intention, and no complications such as wound infection and delayed healing occurred. Preoperative AOFAS ankle-posterior foot score, VAS and SF-36 score were 58.62±3.55, 7.00 (6.50, 8.00) and 68.38±4.81, respectively. At the last follow-up, the scores were 97.38±2.73, 1.00 (0.00, 1.00), 91.15±4.28, respectively, and the results were significantly improved at the last follow-up, with the difference between the two groups statistically significant( P<0.05). Conclusion:Osteochondral fragment fixation using bioabsorbable pins which can promote cartilage repair, significantly improve symptoms, and achieve better clinical satisfaction with fewer complications, is a safe and effective surgical treatment option for Hepple Ⅱ OLT in adolescents with satisfactory short-term clinical outcomes.

Stress Relaxation Behavior of Collagen Type II- Silk Fibroin Composite Cartilage Scaffold under Different Degradation Cycles / 医用生物力学

Objective To study stress relaxation behaviors of cartilage scaffolds under different degradation cycles by using finite element analysis combined with theoretical models. Methods Based on the established degradation theoretical model, the elastic modulus of the scaffold was calculated under different degradation cycles. The finite element model of cartilage scaffolds was established and stress relaxation simulation was performed to analyze the variation of scaffold relaxation stress with time. The stress relaxation constitutive model was established to predict mechanical properties of the scaffold. Results The elastic modulus of cartilage scaffolds at 14 th, 28th, 42nd, 56th day after degradation was 32. 35, 31. 12, 29. 91, 28. 74 kPa, respectively. The upper layer for cartilage scaffolds was the largest. The overall relaxation stress of the scaffold decreased rapidly with time and then tended to be stable. At 8th week after degradation, the stress which the scaffold couldwithstand was still within the physiological load range of the cartilage. The predicted results of the stress relaxation constitutive model were in good agreement with the finite element simulation results. Conclusions The elastic modulus of the scaffold gradually decreases with the increase of degradation time. The longer the degradation period is, the less stress the scaffold can withstand. At the same degradation period, the larger the applied compressive strain, the larger the stress on the scaffold. Both the finite element simulation and stress relaxation constitutive model can effectively predict stress variations of cartilage scaffolds under degradation