Comprehensive clinical assessment on imaging diagnosis of low back pain / 中国矫形外科杂志

Objective To pursue the appropriate selection of radiographic examinations of low back pain and to reduce the expenses. Method In this study,61 cases of imaging tests were studied,including 38 cases of lumbar disc herniation,10 cases of lumbar spondylolisthesis,4 lumbar stenosis,4 lumbar infection and 5 lumbar neoplasm. Result Correct diagnosis was based on the clinical signs and symptoms.Imaging findings had its value only when basing on them.Conventional roentgenogram offered a cheap evaluation and high spatial resolution of bony structures.And it could give a clue to take further imaging studies.Low back disorders could be inferred from the contrast column defect of dura sac and nerve root sheath in the myelography.In the diagnosis of disc herniation,its limitations existed at far lacteral and L5S1 disc herniation.Computed tomography,a cross-sectional imaging modality,allows direct visualization of the bony structure of the spine.But routine imaging could only cover a limited number of levers.Another limitation was the difficulty in distinguishing the soft tissue changes in the spinal canal with the similar CT values.CT-myelography was performed to delineate more clearly the bony and soft tissue anatomy,and could determine whether lesions were medullary,intradual or extradual in location.MR imaging provided the larger anatomic region in multiple planes with high spatial resolution of soft tissue.One limitation of MR imaging was relatively low spatial resolution of bony structure. Conclusion Of all imaging studies conventional roentgenogram is the most important and the most fundamental.It could not be substituted by myelography,CT,CT-myelography,and MR imaging,which have their designated own roles respectively in the clinical decision-making process and in general were more complementary than competitive.

Experimental study of calcium alginate compound in the construction of tissue engineered bone and cartilage / 中国组织工程研究

BACKGROUND: Seed cells and supporting materials are two key problems for cartilaginous tissue engineering. Enough functional cells in supporting materials is the foundation in the formation of bone and cartilaginous tissue in vivo.OBJECTIVE:To perform a morphological study on the tissue engineered bone and cartilage constructed with calcium alginate, in vitro cultured bone marrow stem cells(BMSCs) and growth factors.DESIGN:Morphological comparative study with the results observed for 12 weeksSETTING:Orthopaedic Institute of Zhengzhou University and Orthopedic Laboratory of the Second Affiliated Hospital of Shanghai Medical University.MATERIALS:This experiment was completed from September 2001 to June 2002 in the Orthopedic Laboratory of the Second Affiliated Hospital of Shanghai Medical University. Nine New Zealand male rabbits at the age of 3 months were selected, their mean body mass was 3.2 kg.METHODS: Rabbits received dorsal subcutaneous injection of five kinds of the following combinations at two points for each combination and in the Ⅰ+TGF-β. Totally ten points were marked. Three rabbits were put to death at the 4th, 8th, 12th weeks after injection respectively and dorsal subcutaneous hyperplasia tissues were collected for observation by using hematoxylin and eosin (HE), toluidine blue, Masson, tomato red-O staining techniques.MAIN OUTCOME MEASURES: Histological observation of dorsal subcutaneous hyperplasia tissues.RESULTS: At the fourth week, cartilaginous like tissues island could be observed in calcium alginate+ BMSCs + IGF-Ⅰ group, calcium alginate+BMSCs +TGF-β group and calcium alginate + BMSCs + IGF-Ⅰ +TGF-βgroup, with chondrocblasts surrounded by alkaline matrix; A great deal of cartilaginous-like tissue appeared at the eighth week with part of it transforming into bone, and cells secrete much matrix, part of the chondroblast clustered. At the 12th week, approximately all of the cartilaginous tissues turned into bone in calcium alginate+ BMSCs + IGF- Ⅰ +TGF-β group, and began to absorb.CONCLUSION: The compound composed of calcium alginate, BMSCs and growth factor might form bone and cartilaginous tissue. Calcium alginate is suitable for the growth of BMSCs and is believed to be an optimal bone and cartilaginous engineering carrier.

In vitro culture of bone marrow stromal cells immobilized in calcium alginate beads / 中国组织工程研究

BACKGROUND:Carrier material provides an essential part of microenvironment for seed cell culture. There are some investigations analyzing the long-term in vitro culture of cartilaginous cell in calcium alginate gel matrix.OBJECTIVE: This study was designed to investigate the activity, morphology and microstructure of cultured in vitro bone marrow stromal cells (BMSCs) immobilized in calcium alginate beads.DESIGN: Single sample studySETTING: It was conducted at the Orthopaedic Institute of Zhengzhou University and Orthopaedic Laboratory of Shanghai Second Medical University.MATERIALS: The experiment was conducted at the Orthopaedic Laboratory of Shanghai Second Medical University from September 2001 to March 2002. Eight New Zealand white rabbits, with an age ranging from 4 to 6weeks, were used for collecting BMSCs.METHODS: Eight rabbit were anaesthetized and 1.0-2.0 mL bone marrow was aspirated from the humerus of femur using a 16-gange biopsy needle pretreated with heparin for primary and passage culture of BMSCs.Sodium alginate solution was prepared. The sodium alginate-BMSCs composite formed calcium alginate beads, with a cell density of 1×109 L-1 and tology characteristics of BMSCs were examined using toluidine blue staintron microscope (TEM).scope, many aggregate cells with round shape, in all sizes, occasionally characteristics of BMSCs: Cells and matrix materials were well-mixed, with no materials stained. The cells were equably stained, in all sizes, with large nuclei and little plasma, and occasionally having two or more nuclei and cell division. These cells had an intact structure, well-defined border, and tures of BMSCs: The cells had normal structures, with no mitochondrion swelled and no degranulation in ribosomes. They had a continuous nuclear membrane, with babyhood morphology, round shapes,oval shapes or irregular shapes, and occasionally having two nuclei.CONCLUSION: BMSCs-calcium alginate beads exhibit advantages including a good hydrophilicity, easiness for nutritive matter to penetrate and proliferating actively. It is feasible to amplify BMSCs through in vitro cullage repair by tissue engineering (TE) method.

Minimally-invasive management of injuries of knee joint / 中华创伤骨科杂志

The arthroscopic technique was first used for minimally invasive treatment and diagnosis of injuries inside the knee joint. It can make the diagnosis of acute cartilage injury more accurate. Since it can also correctly detect the location, type and scope of the meniscus injury, surgeons can reasonably decided whether the injured meniscus should be sutured or partially resected so as to maintain as most part of meniscus as possible. It can also be applied to repair or reconstruct the anterior and posterior cruciate ligaments. The combination of arthroscopic technique and minimally invasive internal fixation has often been used to treat fractures of tibial plateau, patella, and femoral condyles, as well as to assist the treatment of fractures of distal femur with retrograde interlocking nails. The internal fixation by percutaneous minimally invasive anatomical plates, e.g. Liss Invasive Stabilization System(LISS), has proved to be effective in the clinical treatment of fractures near tibial and femoral metaphyses.

Progress in treatment of intra-articular injury and arthroscopic techniques in China / 中华创伤骨科杂志

Intra-articular injury refers to acute and chronic trauma o f such joint structures as bone, cartilage and intra-articular soft tissues: li gament,cartilage disc and synovium. The limitations of traditional diagnosis and treatment usually result in joint instability and traumatic arthritis. Arthrosc opic surgery is a typical method of minimally invasive technique, and has been a pplied in our country since 1980s. With rapid progress and popularization of t he arthroscopic technology as well as great improvement in arthroscopic instrume nts and equipment (lens systems, fiberoptic systems and accessory operative inst ruments), the advanced arthroscopic operative method can be widely applied in di agnosis and treatment of acute joint traumas, intra-articular bone and cartilag e fractures, intra-articular ligament injuries, meniscus injuries and shoulder joint ailments. The article reviews the progress made in the past decade in the clinical application of arthroscopic technology.

Prospect of the basic fibroblast growth factor (bFGF) application in orthopaedics / 中华创伤骨科杂志

Basic fibroblast growth factor is one of the most important grow th factors with broad distribution and powerful bioactivities. Since it has positi vely inductive or stimulative effects on tissues, such as bone, cartilage, muscl e, vessel, and nerve, it will have extensive applications in orthopaedics in the future. The current review introduces new advances in the applications of bFGF in orthopaedics.

Seed cells and its culture methods in cartilage tissue engineering / 中华创伤骨科杂志

Acute cartilage injury is one of the most common disorders in orthopaedic clinics.Articular cartilage is known to have a limited capacity to repair or regenerate itself. The disorder is difficult to be dealt with, usually affects the function of joint and may induce the onset of osteoarthrosis.This will result in great economic burdens on the patients and their family and greatly degrade the patient s quality of life. The recent progress in researches on seed cells, culture methods, biological material has provided a new method to repair the acute injury of articular cartilage and thus may solve many problems. The article introduces new advances in seed cells and their culture methods in cartilage tissue engineering.

True scapular roentgenographic diagnosis of subacromial impingement syndrome / 中华骨科杂志

Objective To evaluate the acromion morphology of scapular roentgenography in the diagnosis of subacromial impingement syndrome. Methods Sixty four patients 75 shoulders with chief complaint of shoulder pain were examined roentgenographically by true scapular A-P and lateral views. The Neer impingement sign of all these patients were positive. Results In this series, there were 10 shoulders of type Ⅰ acromion, 13.3%; typeⅡ 17 shoulders, 22.7%; type Ⅲ 48 shoulders, 64.0%. Fifty nine cases 69 shoulders accepted Lidocaine test. The positive rate was: type Ⅰ, 4 shoulders, 44.4%; type Ⅱ, 8 shoulders, 53.3%; type Ⅲ, 38 shoulders, 84.4%. Among these three groups, the result of Chi test for Lidocaine tests: P0.05 (typeⅠ to type Ⅱ). Conclusion True scapular X ray film is a useful and effective diagnostic method for subacromial impingement syndrome. The incidence of subacromial impingement syndrome of the patients with type Ⅲ acromion is significantly higher than the other two types.

Arthroscopic synovectomy for rheumatoid arthritis in early and middle stages / 中国微创外科杂志

Objective To compare the efficacy of arthroscopic synovectomy between early and middle stage rheumatoid arthritis. Methods A total of 34 cases of rheumatoid arthritis (42 knee joints) either in early stage (22 cases, 24 joints) or in meddle stage (12 cases, 18 joints) underwent arthroscopic synovectomy. The bipolar radiofrequency was used for the synovial debridement and hemostasis in 32 knee joints. Postoperatively, routine anti-rheumatoid drugs were administrated. Follow-up observations in the two groups included the evaluation of knee function, the erythrocyte sedimentation rate (ESR), the C-reaction protein (CRP), and the rheumatoid factor (RF). Results The rate of excellent or good results was 91.7% in early stage (22/24) and 66.7% in middle stage (12/18), without statistical significance between the two groups ( ? 2=2.705, P =0.100). Conclusions Arthroscopic synovectomy is effective for the treatment of rheumatoid arthritis in both early and middle stage. Bipolar radiofrequency is helpful for the complete elimination of the synovium, the prevention of joint hematoma, and the rehabilitation of joint function.

The effect of bipolar radiofrequency technique in the treatment of patellofemoral malalignment / 中华骨科杂志

Objective To study the early effect of arthroscopic bipolar radiofrequency technique in the treatment of patellofemoral malalignment. Methods 42 patients(47 knees) who were confirmed to be patellofemoral malalignment by radiographic methods, underwent arthroscopic bipolar radiofrequency chondroplasty and lateral retinacular release. The cartilage abnormality were classified according to the Outerbridge grade. 34 cases(37 knees) were followed up and mean period was 18.3 months. Patients were assessed before and after surgery using the Kujala patellofemoral score. Patellofemoral alignment were evaluated through MRI in 23 of 37 knees. The change of Cac (congruence angle of cartilage), Tac(tilt angle of cartilage), LPDc (lateral patellofemoral distance of cartilage) and LPFac(lateral patellofemoral angle of cartilage) were measured. Results The patellofemoral joint score was improved significantly in OuterbridgeⅠ,Ⅱand Ⅲ grade patients(6 knees ofⅠgrade: 60.83?3.54 preoperatively and 82.50?9.22 postoperatively, P0.05). The score of all these 37 knees was improved from 55.86?9.39 preoperatively to 69.41?14.89 postoperatively(P

Effect of recombinant human bone morphogenetic protein-4 on cultured bone marrow stem cells / 中华骨科杂志

Objective To produce bioactive human bone morphogenetic protein-4 by Escherichia coli genetic engineering and investigate the effect of the product, recombinant BMP-4, on the bone marrow stem cells. Methods cDNA of human morphogenetic protein-4 mature peptide was obtained by RT PCR from tissue of human placenta. The gene was constructed in the pET-22b(+) expression vector and expressed in Escherichia coli BL-21 after transformation and induction by IPTG. The harvested protein was proved to be bioactive by inducing ectopic bone information in mouse thigh. The protein was applied to induce the cultured bone marrow stem cell. Shape change of the cell, ability of ALP (alkaline phosphatase) and concentration of OC (osteocalcin) were investigated. Results SDS-PAGE revealed a new protein band that located in position of 14?103 after 4 hours induction, the new protein made 15% of total bacteria protein, the rhBMP-4 could induce the cultured bone marrow stem cell of New Zealand rabbit to differentiate into osteoblasts and form calcified node. The ability of ALP and concentration of OC of tested group increased significantly than that of the control group. Conclusion The bioactive rhBMP-4 can be produced by Escherichia coli genic engineering, this protein can induce bone marrow stem cells to differentiate into osteoblast cells.

An experimental study of apoptosis of the intervertebral disc cells of diabetic rats / 中华骨科杂志

Objective To study the apoptosis of the intervertebral disc cells and its related factors. Methods Thirty-six 4 months old male Sprague-Dawley(SD) rats weighing 230-261 g were randomly divided into streptozotocin (STZ)-induced group and control group. There were 18 rats in each group. The diabetes mellitus (DM) was induced by a single intraperitoneal injection of STZ solution (40 mg/kg), while in the control group, the same volume of the sodium citrate buffer was injected. The blood glucose level was measured 72 hours later by testing the blood samples from the tail vein. The standard for the diabetes mellitus was above 16.7 mmol/L. The rats were sacrificed 1, 3 and 4 months later with 6 at each time interval in two groups respectively. One lumbar intervertebral disc was obtained for the measurement of the apoptotic percentage with the flow cytometry, two discs for the measurement of the pentosidine with high performance liquid chromatography for each rat. Results The blood glucose levels of all the rats in the STZ-induced group were above 16.7mmol/L [(23.71?2.69) mmol/L] and was significantly higher than those of the control rats(P

Modified lateral parapatellar approach for total knee arthroplasty of valgus knee / 中华骨科杂志

Objective To explore a new approach giving soft tissue balance in valgus knee during total knee arthroplasty. Methods A modified lateral parapatellar approach with function of spontaneous release of lateral retinaculum was designed and used for valgus knee during total knee arthroplasty, by which knee joint was exposed with incision between the superficial and deep retinaculum layer together with lateral eversion of fat pad. After release of the constrained structures of the knee at lateral side such as lateral retinaculum, iliotibial band,lateral posterior capsule or lateral collateral ligament the prosthesis was implanted; the superficial and deep retinaculum layers were sutured back in proper tension position in order to maintain a normal patella femoral relationship and then the deep layer was closed. Within 2 weeks after operation CPM was instituted and ambulation was allowed with crutches 2 weeks after operation. Results All of 11 cases so treated healed up without skin problem. The valgus deformities were mostly corrected with a rate of 85.3% from average 10.2 degrees valgus preoperatively to average 1.5 degrees varus postoperatively. Two months postoperation the average range of motion reached 105 degrees and the knees were stable in level walking. Nine of 11 cases were able to go up and down stairs. Conclusion Modified lateral parapatellar approach was suitable for total knee arthroplasty with severe valgus deformity. [