OBJECTIVE: To study the treatment efficacy of vascularized periosteum graft and bone filling material for long bone defect. METHODS: Forty young and forty adult rabbits were divided into four groups respectively according to the bone filling materials. A 3 cm long segment was removed from the middle part of the rabbit radius to make a bone defect model. The periosteum was reserved and restored to set up a vascularized tubulate periosteum graft. On the left side, autogenous bone graft, decalcified allograft, tricalcium phosphate, and hydroxyapatite were used to fill in the bone defect respectively; on the right side, no bone filling material was used as controls. The repairing effect of bone defect was evaluated by roentogenography, biomechanical, and histological methods. RESULTS: In young rabbits, bone defects on both sides healed in the 6th week after operation. The bending strength of radius in the tricalcium phosphate group and in the hydroxyapatite group were lower in the 12th week and there was significant difference when compared with autogenous bone graft group, decalcified allograft group and control group (P lt; 0.05). The repairing mechanism included intramembranous and endochondral ossification, and intramembranous ossification was prevalent. In the adult rabbits, the repairing rates of bone defect were 50% in the autogenous bone graft group, 40% in the decalcified allograft group, 30% in the tricalcium phosphate group and in the hydroxyapatite group and 42.5% in the control group, respectively. CONCLUSION: In young rabbits, large bone defect can be repaired with vascularized tubulate periosteum graft with or without the combining use of bone filling materials. The bone filling material which will be substituted slowly is disadvantageous to the recovery of bone strength. In adult rabbits, vascularized tubulate periosteum graft combined with bone filling materials can not repair the large bone defect effectively.
Objective To investigate the advance in the management of skeletal trauma of the extremities. Methods The literature at home and abroad was reviewed, and the research findings withclinical experience in the therapeutic methods for fracture of the extremities were summarized.Results The concept on fracture management was renewed, the minimally invasive surgery (MIS) was developed and popularized, the implantation was improved, the navigation technique with computerassisted surgery was applied, and the tissue engineering was developed. The fracture mana gement was changed from the anatomical reduction with absolutely rigid fixation to the biological osteosynthesis with protection of the fracture environment. The minimally invasive surgical techniques included the minimally invasive plate osteosynthesis, intramedullary nailing, external fixation, arthroscopic surgery,and computer-assisted surgery. In concordance with the MIS principles, the newimplants, such as the locking compression plate, and the less invasive stabilization system were well designed and put into clinical practice so as to provide effective therapeutic results in treating osteoporotic fractures and complicated articular and/or metaphyseal fractures. In treatment of the delayed union or nonunion offractures, more effective techniques were employed, including the application of bone substitutes, which are degradable and have properties of bone conduction and induction. In the repair of segmental defects of the long tubular bone, the bonetransport and the vascularized bone grafts could work well. The investigation of the bone engineering revealed its great potentiality.Conclusion Fracture of the extremities is a common problem and its management should emphasize the recovery of the extremity function of the patient in addition to emphasis on the replacement and fixation of the biological structures. The combination of bone engineering and microsurgery represents the development tendency inthis field.
OBJECTIVE: To study the proliferation change of tunica intima and smooth muscle in artery after hydrolic dilation for potential clinical use. METHODS: Sixten adult New Zealand rabbits were randomly divided into 4 groups, named group A, B, C and D. Right carotid arteries of rabbits of those 4 groups were dilated by hydrolic dilation with different pressures with 0 kPa, 40 kPa, 80 kPa, and 120 kPa respectively. The arterial calibers, thickness of tunica intima and smooth muscle were analyzed by automatic medical photograph analyzer immediately, 1 week and 2 weeks later respectively. RESULTS: The arterial calibers in the experimental group were larger than those in control group after immediate hydrolic dilation and 1 week later (P lt; 0.01). At 2 weeks, the arterial calibers in group B and D has no significant difference compared to group A (P gt; 0.05), and those in group C were larger than that of group A (P lt; 0.01). There were no significant difference in thickness of tunica intima and smooth muscle between the experimental group and control group (P gt; 0.05) after immediate hydrolic dilation. At 1 and 2 weeks after dilation, there were no significant difference between group A and group B (Pgt; 0.05), and those in group C and D were all larger than those in group A (P lt; 0.01). No obvious proliferation of tunica intima were observed in group B at 2 weeks after hydrolic dialation, but the proliferation of tunica intima could be observed in group C and D, especially in group D. CONCLUSION: Caliber of artery can be expanded by hydrolic dilation with higher pressure, but the proliferation of tunica intima and smooth muscle may be occurred in hydrolic dilation with higher pressure over 80 kPa, therefore it is safe to use hydrolic dilation with pressure no more than 40 kPa.
To investigate the operative technique of treating Freiberg’s disease with dorsal wedge osteotomy and absorbable pin fixation, and to evaluate the cl inical outcome. Methods From June 2005 to June 2007, 8 patients with Freiberg’s disease were treated, including 2 males and 6 females aged 16-66 years old (average 36 years old). X-ray films revealed osteosclerosis, collapse of the metatarsal head and ischemic necrosis of the second metatarsal head. According toSmill ie classification system, there were 4 cases of stage II, 3 of stage III and 1 of stage IV. The duration of symptoms was 6-36 months (average 19 months). After dorsal wedge osteotomy, the metatarsal heads were rotated to reconstrust the joint surface, then 3-4 pieces of absorbable pin 1.5 mm in length were implanted for fixation. Results All wounds healed by first intention, and no early postoperative compl ications occurred. Five patients were followed for 11-35 months (average 14 months) and had significant pain rel ief. At 3 months after operation, the dorsal-flexion of metatarsophalangeal joint was improved by 0-50° (average 21°), and the plantar-flexion was increased by 0-10° (average 5°). X-ray films showed that solid union of the osteotomy was achieved in all patients at 8-13 weeks after operation (average 10 weeks). Average shortening of metatarsal was 1.7 mm (range 1.3-2.0 mm). All patients returned to sports and recreational activities at 4 months after operation, except one case of stage IV who had constant swelling and stiffness in the joint and was improved at 12 months after operation. Conclusion Dorsal wedge osteotomy in complex with absorbable pin fixation is an effective procedure for stage II and III Freiberg’s disease, because it is capable of reconstructing the metatarsophalangeal joint effectively, allowing early joint motion and avoiding a second operation.
Objective To compare the cl inical results of two plating osteosynthesis techniques, open reduction and plating ostosynthesis (ORPO) and minimal invasive plating osteosynthesis (MIPO), in surgical treatment of mid-distal humeralshaft fractures. Methods From March 2004 to October 2006, 40 cases of closed unilateral mid-distal humeral shaft fractures were surgically treated with MIPO or ORPO. In the MIPO treated group (n=19), there were 14 males and 5 females, with a mean age of 39.05 years. Fractures involved in middle humeral shaft in 10 cases and distal fragment in 9 cases. According to OTA classification, there were 3 cases of type A, 13 cases of type B and 3 cases of type C. Four cases compl icated by radial nerve palsies. In the ORPO treated group (n=21), there were 13 males and 8 females with a mean age of 39.05 years, including 14 cases of type A and 7 cases of type B fractures according to OTA classification. The fractures involved in middle humeral shaft in 13 cases and distal fragment in 8 cases. Five cases compl icated by radial nerve palsies. The time from injury to operation in both groups were 2 to 14 days. For patients in the MIPO group, fractures were closely reduced and fixated with an anterior placed plate inserted through two small incisions made at the anterior side of arm, away from fracture sites. The radial nerves were not exposed. For patients in the ORPO group, fractures were exposed, reduced, and fixated with an anterolateral or a posterior positioned plate after careful dissection and protection of radial nerve through an anterolateral or a posterior approach. The operation time, the occurrence of iatrogenic radial nerve palsy and the bone heal ing time were recorded. The functions of the affected shouldersand elbows were evaluated with UCLA end-result score and Mayo elbow perform index (MEPI), respectively. Results All the wounds in both groups healed primarily. There was no iatrogenic radial nerve palsies in the MIPO group after surgery; however, 5 cases of transient iatrogenic radial nerve palsies were identified in the ORPO group after surgery, and the function of radial nerve recovered in these cases at the last follow-up. Eighteen cases were followed up 14-44 months (mean 25.44 months) in MIPO group, and 19 cases were followed up 13-48 months (mean 32.11 months) in ORPO group. The mean bone heal ing time was 17.06 (12-32) weeks in MIPO group and 16.11 (8-58) weeks in ORPO group, showing no significant difference between two groups (P gt; 0.05). There was no nonunion and hardware failure in both groups. The mean forward flexion of the shoulder was 166.94° (150-170°) in MIPO group and 164.74° (130-170°) in ORPO group. The mean UCLA shoulder score was 34.78 (33-35) points in MIPO group and 34.42 (30-35) points in ORPO group. The mean range of motion of the elbow in MIPO and ORPO groups was 133.33° (120-140°) and 136.7° (120-140°), respectively. The MEPI in these two groups was 99.44 (90-100) and 99.74 (95-100) points, respectively. There was no statistically significant difference between two groups in all indexes mentioned above. Conclusion The good results could be obtained when ORPO and MIPO technique are appl ied to treat mid-distal humeral shaft fractures. MIPO technique has advantages to not expose the radial nerve and to decrease the occurrence of iatrogenic radial nerve palsies.
Objective To evaluate the security and effectiveness of minimal invasive fixation with three dimensional (3D) fluoro-images based on navigation system in the management of acetabular fractures. Methods Between August 2008 and January 2010, 12 patients with acetabular fractures were treated with percutaneous screw fixation under the guidance of 3D fluoro-images based on navigation system after closed reduction. There were 7 males and 5 females, aged 28-57 years (mean, 38.1 years). Fractures were caused by traffic accident in 9 cases, and fall ing from height in 3 cases. According to AO classification, there were 1 case of A2.2 type, 3 cases of A2.3 type, 2 cases of A3.2 type, 2 cases of A3.3 type, 1 case of B2.2 type, 1 case of B3.2 type, 1 case of C2.1 type, and 1 case of C2.3 type. The interval from injury to hospital ization was 4 hours to 3 days (mean, 1.2 days). Results Totally 28 screws were implanted. The average time to implant 1 screw was 24.8 minutes. Twenty-seven screws were placed correctly with a successful rate of 96.4%, only 1 screw was reinserted for deviation. All the screws were checked by the 3D fluoro-images, which showed they were not in the joint space after fixation. The results were the same as that by CT scanning. Incisions healed by first intention, and no implant failure occurred. All 12 patients were followed up 7 to 24 months with an average of 16.8 months. At last follow-up, fracture union was achieved in all patients with satisfactory screw fixation. Conclusion The minimal invasive fixation with 3D fluoro-images based on navigation system makes the surgery for the nondisplaced acetabular fracture more precise and time-saving, minimizes the surgery injury, and improves the cl inical results with less compl ications.
To explore the possibil ity of treating mid-distal humeral shaft fractures associated with radial nerve palsies with minimal invasive plating osteosynthesis (MIPO) techniques. Methods From April 2003 to October 2006, 10 patients with mid-distal humeral shaft fractures associated with radial nerve palsies were treated. All patients were male, aged 19-58 years. According to AO/ASIF classification, there were 4 cases of B1 type, 2 cases of B3 type, 1 case of A2 type, 1 caseof B2 type, 1 case of C3 type and 1 case of A3 type. A straight 4.5 mm dynamic compression plate was placed on the anterior aspect of humerus through two small incisions located on the anterior side of proximal and distal part of the arm. The radial nerve exploration was performed through a lateral small incision made on the fracture site. The fractures were then reduced by manual manipulation and the plate was fixated to the main fragments with 3 screws in each end of the plate. The postoperative compl ications, the bone heal ing time, and the recovery time of the radial nerve functions were recorded. The functions of the affected shoulder and elbow were assessed with UCLA and Mayo elbow performance score system respectively. Results All incision healed by first intention. Ten patients were followed up 9-36 months with an average of 15.7 months. The X-ray films showed that the union of fractures was achieved 12-16 weeks (13.6 weeks on average). The function of the radial nerves recovered completely 12-36 weeks (17.8 weeks on average) in 9 patients. The abductions of the affected shoulder were 150-170° (165° on average). The ROM of the elbows were 130-140° (135.5° on average). According to the UCLA shoulder scoring system, 9 patients achieved the excellent result and 1 patient achieved the good result. All the patients had the excellent results according to Mayo elbow performance score system. Conclusion The mid-distal humeral shaft fractures associated with radial nervepalsies can be treated with MIPO technique and the good results can be obtained.
【Abstract】 Objective To measure the changes of bone mineral density and bone micro-architecture of thefemoral head that harvested from the three-foot bearing ethanol destroyed canine model for osteonecrosis of femoral head, and discuss the influences of local injection of ethanol and biomechanical loading to the structural properties of the femoral head. Methods Twenty-four Beagles were divided randomly into four-foot bearing canines and three-foot bearing canines. One fore-l imb was fixed randomly in three-foot bearing canines. Osteonecrosis was induced in all experimental animals by local injection of 5 mL pure ethanol into one side of the femoral head. The hind l imbs injected with NS were acted as control group, that of three-foot canines injected with ethanol were acted as three-foot canine group, and that of four-foot canines injected with ethanol were acted as four-foot canine group. The contralateral femoral head was injected into equal amount of NS. Animals were sacrificed at the time intervals of 1, 3, 6, and 12 weeks after the injection of ethanol. Quantitative microcomputedtomography was used to characterize changes in bone micro-architecture and bone mineral density of femoralhead. Results The clear three-dimensional model of trabecular bone of necrotic femoral head were obtained. There were no significant differences among 3 groups according to the time l ine by 1 week after ethanol injection(P gt; 0.05). At 3 weeks after injection of ethanol, in three-foot canine group and four-foot canine group, the volume of BMC, BMD, BVF, and BS/BV increased gradually as the distance to the drill ing canal increased. There were significant differences between 3 regions (P lt; 0.05). At 6 weeks, in three-foot canine group and four-foot canine group, the volume of BMC, BMD,BVF, and Tb.N of region I and II decreased significantly compared with region III (P lt; 0.05). At 12 weeks, there are no differences among 3 groups (P gt; 0.05). There were significant decreases in BMD values, BVF, BS/BV, Tb.N, Tb.Sp and Tb.Th after the injection of pure ethanol. And, the changes were more and more obvious by the time l ine. These changes were differentiable at 3 weeks after injection of ethanol, and became obvious at 6 weeks. These changes were more obvious at the part that near the injection canal. The changes in threefoot canine group were more obvious than that in four-foot canine group. Conclusion Resorption of necrotic compact bone trabecular may weaken the structural properties of the femoral head. Moreover, remodel ing and repairing process of necrotic bone trabecular may be hampered by constant biomechanical loading that presented in three-foot bearing canines, and thereby further weaken the structural properties of the femoral head. Biomechanical loading may be one of the critical reasons that lead to the collapse of femoral head.
Objective To investigate the effect of various concentration of platelet-rich plasma (PRP) on osteogenic differentiation of rabbit skeletal muscle-derived stem cells (SMSCs) cultured in vitro. Methods Blood drawn from the central ear arteries of 9 one-year-old New Zealand white rabbits weighing 2.5-3.0 kg (male and female) was used to prepare PRP (Landesberg method). Full blood count and platelet count in PRP were tested. Soleus muscle of right hindl imb in rabbit was obtained and used to culture SMSCs in vitro. The cells at passage 3 were randomly divided into different groups: the experimental groups in which the cells were treated by conditioned culture media with various concentrations of autologousPRP (6.25%, 12.50%, 25.00%, 50.00%), and the control group in which the cells were treated with the media without PRP. At different time points after intervention, osteogenetic activity of the cells was detected by ALP staining observation, ALP activity detection was conducted, al izarin red staining for calcium nodules and immunofluorescence staining for osteocalcin were performed, and core binding factor α1 (Cbfα1) of osteogenic gene expression was tested by RT-PCR. Results The full blood PRP count and the platelet count in PRP was (3.06 ± 0.46) × 105/μL and (18.08 ± 2.10) × 105/μL, respectively. ALP staining: the cells in all the experimental groups were positive for the staining with many black sediment particles in cytoplasm; the cells in the control group were negative staining. ALP activity: all the experimental groups were higher than the control group (P lt; 0.05), the experimental group at 12.50% was superior to other experimental groups at each time point (P lt; 0.05). Al izarin red staining: at 14 days after culture, orange-red calcium nodules were evident in all the experimental groups; no orange-red calcium nodules were observed in the control group with a mineral ization rate of zero; there were significant difference between the experimental groups and the control group in terms of mineral ization rate (P lt; 0.05), the experimental group at 12.50% had a higher mineral ization rate than other experimental groups (P lt; 0.05). Immunofluorescence staining for osteocalcin: at 7 days after culture, the experimental groups were positive for the staining with yellow fluorescence in cytoplasm, and the result of the control group was negative. RT-PCR detection: no obvious changes of the gene expression were noted at 4, 12, and 24 hoursafter culture in the control group; the gene expression in all the experimental groups was significant superior to that of control group, especially at 12 hours, and the expression in the experimental group at 12.50% was the highest. Conclusion PRP can obviously promote the osteogenic differentiation of SMSCs cultured in vitro in a concentration-dependent manner, and the 12.50% is proved to be the ideal concentration.