There were several methods, such as free single and folded fibulae autograft, composed tissue autograft, however, it is still very difficult to repair long segment bone defect. In December 1995, we used free juxtaposed bilateral fibulae autograft to repair an 8 cm of femoral bone defect in a 4 years old child in success. The key procedure is to strip a portion of the neighboring periosteal sleeve of juxtaposed fibulae to make bare of the opposite sides of the bone shafts, suture the opposite periosteal sleeves, keep the nutrient arteries, and reconstruct the blood circulation of both fibular by anastomosis of the distal ends of one fibular artery and vein to the proximal ends of the other fibular artery and vein, and anastomosis of the proximal ends of the fibular artery and vein to lateral circumflex artery and vein. After 22 months follow up, the two shafts of juxtaposed fibulae fused into one new bone shaft. The diameter of the new bone shaft was nearly the same as the diameter of the femur. There was only one medullary cavity, and it connected to the medullary cavity of femur. This method also cold be used to repair other long segment bone defect.
Objective To investigate the clinical outcomes of autologous platelet rich plasma (PRP) for anterior cruciate ligament (ACL) reconstruction. Methods Between August 2014 and August 2016, 42 patients with ACL ruptures who underwent arthroscopic ACL reconstruction were randomly divided into 2 groups: 21 patients received graft soaked with PRP (trial group) and 21 patients received routine graft in ACL reconstruction (control group). Because 6 patients failed to be followed up, 17 patients of trial group and 19 of control group were enrolled in the study. There was no significant difference in gender, age, body mass index, side, injury reason, disease duration, Kellgren-Lawrence grade, and preoperative visual analogue scale (VAS), Lysholm score, and International Knee Documentation Committee (IKDC) activity scores between 2 groups (P>0.05). VAS score, Lysholm score, and IKDC activity scores were used to evaluate pain and function at 3 and 12 months postoperatively. Further, second arthroscopy and MRI examination were performed at 12 months postoperatively. Results The patients in both groups were followed up 3 to 12 months with an average of 9.83 months. The VAS score, Lysholm score, and IKDC activity scores were significantly improved at 3 and 12 months after operation in 2 groups (P<0.05), and the scores of trial group were significantly better than those of control group at 3 months (P<0.05), but no significant difference was found between 2 groups at 12 months (P>0.05). No complications of effusion, infection, and allergy were observed in 2 groups during follow-up. MRI showed good position of ACL grafts and good signal quality of the graft in the majority of the cases. However, mixed hyperintense and presence of synovial fluid at the femoral bone-tendon graft interface were found in 3 patients of trial group and 4 patients of control group, indicating poor remodeling ligamentation. MRI score was 3.53±1.13 in trial group and was 3.21±0.92 in control group, showing no significant difference (t=0.936,P=0.356). The second arthroscopy examination showed ligament remodeling score was higher in trial group than control group (t=3.248,P=0.014), but no significant difference was found in synovial coverage score and the incidence of cartilage repair (t=2.190,P=0.064;χ2=0.090,P=0.764). Conclusion PRP application in allograft ACL reconstruction can improve knee function and relieve pain after operation, which may also accelerate graft remodeling.
Abstract:The use of pulmonary autograft was first reported in 1967 by Ross for the treatment of aortic valve disease in adults. Since that time, Ross procedure has been applied to a variety of forms of aortic stenosis and left ventricular outflow tract obstruction and mitral valve disease, Ross procedure has undergone several modifications, such as the root replacement method, inclusion cylinder technique, annular reduction, Konno root enlargement procedures and replacement of the mitral valve with a pulmonary autograft （Ross-Kabbani procedure or Ross Ⅱ procedure）. Advantages of Ross procedure in women of childbearing age, children and young adults include freedom from anticoagulation, appropriate sizing, cellular viability with growth potential proportional to somatic growth, acceptable long-term durability, excellent hemodynamic performance and decreased susceptibility to endocarditis. Surgical technical aspects, indications, selection criteria for the Ross procedure and its modifications, their applicability in the surgical management of aortic stenosis, left ventricular outflow tract obstruction and mitral valve disease and clinical outcome of Ross procedure are reviewed in this article.
Objective To evaluate the clinical effect of periosteal autograft in repair of ankylosis of elbow joint. Methods From May 1985 to November 1999, 18 cases of elbow joints ankylosis (6 cases of osteo-ankylosis, 12 cases of fibroankylosis) were treated by repairing articular surface with periosteal autografting. Out of 18 cases, 13 were caused by old dislocation and fracture of elbow joints, 3 by late rheumatoid arthritis, and 2 by old total joint tuberculosis. In this surgical approach, periosteum from upper end of tibia was transplanted into articular surface after correction of the elbow joint from ankylosis deformity, and continuous passive or active movement of the operated joint was adopted with skeletal traction through olecranon of ulna for 4 weeks after operation. All of the cases were followed up for 1-9 years, 5.2 years on average, before clinical evaluation. Results The elbow joints in 11 cases were restored to normal, the joints in 4 cases obtained active movement in the range of 100°-0°, and thejoints in the other 3 cases could only have limited movement because of severe muscular atrophy. Conclusion The articular surface in arthroplasty of elbow joint ankylosis could be effectively repaired by periosteal autograft, and the function of the joints could be obviously improved by continuous movement of the joints after operation with skeletal traction.
OBJECTIVE: To investigate the effective method to treat cicatricial baldness. METHODS: From 1993 to 1998, 21 cases with multi-region or great-dimensional cicatricial baldness were treated with scalp expanding and hair autografting. Among them, there were 17 males and 4 females, aged from 14 to 49 years old. The operation was divided into two stages, stage one meaned to embed the expander under the scalp and stage two meaned to sow the autogenous hair. RESULTS: All cases, no matter what the position and area, were repaired successfully. The biggest dimension of repaired baldness was 340 cm2, one expander exposed and one failed in expanding after operation and be corrected immediately. The normal hair direction changed in two cases. CONCLUSION: Combined use of scalp expanding and hair autografting is an effective method to treat multi-region or great dimensional cicarticial baldness.
ObjectiveTo investigate the effectiveness of U-shape titanium screw-rod fixation system with bone autografting for lumbar spondylolysis of young adults. MethodsBetween January 2008 and December 2011, 32 patients with lumbar spondylolysis underwent U-shape titanium screw-rod fixation system with bone autografting. All patients were male with an average age of 22 years (range, 19-32 years). The disease duration ranged from 3 to 24 months (mean, 14 months). L3 was involved in spondylolysis in 2 cases, L4 in 10 cases, and L5 in 20 cases. The preoperative visual analogue scale (VAS) and Oswestry disability index (ODI) scores were 8.0±1.1 and 75.3±11.2, respectively. ResultsThe operation time was 80-120 minutes (mean, 85 minutes), and the blood loss was 150-250 mL (mean, 210 mL). Primary healing of incision was obtained in all patients without complications of infection and nerve symptom. Thirty-two patients were followed up 12-24 months (mean, 14 months). Low back pain was significantly alleviated after operation. The VAS and ODI scores at 3 months after operation were 1.0±0.5 and 17.6±3.4, respectively, showing significant differences when compared with preoperative ones (t=30.523,P=0.000;t=45.312,P=0.000). X-ray films and CT showed bone fusion in the area of isthmus defects, with the bone fusion time of 6-12 months (mean, 9 months). During follow-up, no secondary lumbar spondyloly, adjacent segment degeneration, or loosening or breaking of internal fixator was found. ConclusionThe U-shape titanium screw-rod fixation system with bone autografting is a reliable treatment for lumbar spondylolysis of young adults because of a high fusion rate, minimal invasive, and maximum retention of lumbar range of motion.
The dynamic changeS of density of epidermal melanocytes in the full-thickness autografts of skinon guinea pigs were investigated by means of histochamical and autoradiographic techniques at variousjntervals during 3 months peried potoperatively,It was found that the increase of epidermalmelaneeytes was accompanied by hyperpigmentation of the skin grafts. Meanwhils,the amount of 3H-TdR taken by the melanocytes was increased. The results showed that the melanocytes poitive to Dopabecame...
Objective To introduce a clinical treatment for the reconstructionof calcaneal thalamus by bone autograft and subtalar arthrodesis for antiquatedintraarticular calcaneal fractures. Methods From July 2000 to October 2003, 11 cases with antiquated intraarticular calcaneal fractures were treated. Of the 11 cases, 9 were males and 2 females,whose ages ranged from21 to 48 years. All unilateral calcanei were involved in the 11 cases. The modified extended Lshaped approach lateral to calcaneus was adopted. The primary treatment was manipulation and immobilization with the reconstruction of calcaneal thalamus by bone autograft and subtalar arthrodesis. The average volume of the ilium for the autograft was 3.0 cm×2.5 cm×1.8 cm. Protruded osteophyte from the lateral wall of calcaneus were ablated in all 11 cases. Results All the 11 cases were followed up for 3 to 18 months, 11.5 monthson average. The reconstructed calcaneal thalamus was healed 10 to 12 weeks after the operation. Some of the patients could walk with load 8 weeks after the operation, and the average time for all the patients to walk with load was 13.2 weeks. There were 4 cases of excellent result, 5 cases of good result, and 2 cases of fair result, according to ZHANG Tieliang’s foot score system. Plain radiograph showed that Bohler angle, width of calcaneus and height of calcaneal thalamus were nearlyrestored to normal. Conclusion With the improvement of calcaneal abnormality and restoration of the shape and function of hind foot, reconstruction of calcaneal thalamus by bone autograft combined with subtalar arthrodesis is effective in treating antiquated intra-articular calcaneal fractures.
Objective To discuss the expression of α-melanocyte-stimulating hormone(α-MSH) mRNA in human medium thickness skin autografts and to investigatethe role of αMSH in hyperpigmented process of skin autografts. Methods The samples were from medium thickness skin autografts on neck of the patients after 1 year of surgery. The size of sample was about 1.0 cm×0.5 cm. RT-PCR technique was performed to detect the expression of α-MSH mRNA in medium thickness skinautografts and normal skin respectively. Masson-Fontana stain technique was performed to detect the contents of melanin in medium thickness skin autografts andnormal skin epidermis respectively. Results The expression ofα-MSH mRNA in medium thickness skin autografts was much ber than that in control normal skin, showing statistically significant difference (P＜0.01). The expression of α-MSH/β2-microglobulin mRNA in normal skin of donor area was no statistically significant differences compared with normal skin around recipient area. The contents of melaninin medium thickness skin autografts epidermis obviously increased when compared with that of control normal skin. The expression of α-MSH mRNA was positive correlated with the contents of melanin in epidermis. Conclusion The above results indicate that the expression of α-MSH increases greater in medium thicknessskin autografts than in cortrol samples and was correlated with the pigmentation of skin autografts. Overexpression of α-MSH may play an important role in hyperpigmented process of skin autografts.
Objective To detect the expression of melanocortin 1 receptor (MC-1R) and the melanin contents in human skin autografts and the normal skin, to elucide the role of MC-1R in hyperpigmented process of skin autografts. Methods Skin autografts and normal skin samples were obtained from skin graft on neck who need reoperation to release contractures after 1 year of operations. Immunohistochemical technique was performed to detect the expression and distribution of MC-1R in skin autografts(include full thickenss skin autografts, medium thickness skin autografts, and razorthin skin autografts) and normal skin respectively. MassonFontana staining technique was performedto detect the melanin contents in all sorts specimens respectively. Results The expression of MC-1R was located on cell membrane and cytoplasm of melanocyte and keratinocyte in epidermal. The expression of MC-1R in most skin autografts was much ber than that of control normal skins; the thinnerskin autografts were, the more obvious expressions of MC-1R in skin autografts were. The expressions of MC-1R in all sorts of skinautografts were of significant differences compared with that in normal skins(P＜0.01); the expression of MC-1R in normal skin of donor area was no significant differences compared with normal skin around recipient area(P＞0.01). The contents of melanin in skin autografts were increased obviously and there were significantdifferences compared with that in normal skins(P＜0.01); the contents of melanin among all sorts of skin autografts were of significant differences (P＜0.01). The thinner skin autografts were, the more melanin contents in skin autografts. The expression of MC-1R was positively correlated with the contents ofmelanin in epidermis. Conclusion The expression of MC-1R in skin autografts is significantly higher than that in normal skin and is correlated positively with the contents of melanin in skin autografts. Overexpression of MC-1R may play an important role in hyperpigmented process of skin autografts.