Zhou Xiang

West China School of Medicine, Hua-yang, Sichuan, China

Are you Zhou Xiang?

Claim your profile

Publications (53)59.96 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Vascularization of engineered bone tissue is critical for ensuring its survival after implantation, and it is the primary factor limiting its clinical use. A promising approach is to prevascularize bone grafts in vitro using endothelial progenitor cells (EPC) derived from peripheral blood. Typically EPC cells are added together with mesenchymal stem cells (MSC) that differentiate into osteoblasts. One problem with this approach is how to promote traditional tissue engineering bone survival with a minimally invasive approach method. Here we examined the effectiveness of administering to stimulate the release of peripheral blood stem cells. Cells were isolated by Ficoll density gradient centrifugation and identified as EPC and MSC based on morphology, surface markers, and functional analysis. EPC and MSC were co-cultured in several different ratios, and cell morphology and tube formation were assessed by microscopy. Expression of osteogenesis and vascularization markers was quantified by ELISA, PCR, histochemical and immunofluorescence staining. Increasing the proportion of EPC in the co-culture system led to greater tube formation and greater expression of endothelial cell marker CD31. An EPC:MSC ratio of 75:25 gave the highest expression of osteogenesis and angiogenesis markers. Co-cultures adhered to a three-dimensional scaffold of strontium-doped calcium polyphosphate and proliferated well. Our findings show that co-culturing peripheral blood-derived EPC and MSC may prove useful for generating prevascularized bone tissue for clinical use.
    Tissue engineering. Part A. 10/2014;
  • International Journal of Surgery. 10/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Repair of load-bearing bone defects remains a challenge in the field of orthopaedic surgery. In the current study, a surface microstructured porous titanium (STPT) successively treated with H2O2/TaCl5 solution and simulated body fluid was used to repair the critical-sized segmental bone defects in rabbit femur, and non-treated porous titanium (NTPT) and porous biphasic calcium phosphate ceramics (PBCP) were used as control, respectively. A 15 mm long implant was positioned in the femoral defect and stabilized by a plate and screws fixation. After implantation into the body for 1, 3 and 6 months, X-ray observation confirmed that porous titanium groups (NTPT and STPT) provided better mechanical support than PBCP group at the early stage. However, there was no obvious difference in the formed bony callus between PBCP and STPT groups in the later stage, and they both showed better shape of bony callus than NTPT group. Micro-CT and histomorphometric analysis for the samples of 6-month implantation demonstrated that more new bone formed in the inner pores of PBCP and STPT groups than that in NTPT group. Moreover, the biomechanical tests revealed that STPT group could bear larger compressive load than NTPT and PBCP groups, almost reaching the level of the normal rabbit femur. STPT exhibited the enhanced repairing effect on the critical-sized segmental bone defect in rabbit femur, meaning that it could be an ideal material for the repair of large bone defect in load-bearing site.
    Journal of Materials Science Materials in Medicine 03/2014; · 2.14 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This meta-analysis was conducted to investigate whether helical blade implant system had advantages in terms of cut-out rate when compared to screw implant system for trochanteric fractures of elderly population. The databases of MEDLINE, Cochrane Library and OVID were searched from inception to September 2013, and all randomized controlled trials comparing outcomes between helical blade system and screw system in treating trochanteric fractures were selected. Three researchers assessed the methodological quality and extracted data of the enrolled studies independently. Data were analysed using Review Manager 5.1 version. Six studies including 759 patients were involved. Results revealed that compared with screw group, blade group had similar outcomes of "centre-centre" position (95 % CI 0.89-1.06, P = 0.48) and tip-apex distance (95 % CI-0.08 to 1.31, P = 0.08). Cut-out and other complications were also comparable between the two groups (95 % CI 0.34-1.54, P = 0.41; 95 % CI 0.73-1.32, P = 0.90). Operation time and fluoroscopy time of blade group were significantly less than that of screw group (95 % CI -5.13 to -3.70, P < 0.00001; 95 % CI -32.50 to -27.07, P < 0.00001). Outcome of post-operative function was similar between two groups (95 % CI 0.94-1.15, P = 0.45). Blade group required less operation time and fluoroscopy time than that of screw group treating trochanteric fractures in the elderly, but the differences observed could be biased due to grouping and other limitations. Outcomes of cut-out complication, other complications, position of implant and post-operative function were similar between two groups.
    European Journal of Orthopaedic Surgery & Traumatology 02/2014; · 0.18 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract With the evergrowing number of people who work in visual display terminal, the work-related musculoskeletal disorders of the upper body are believed to be an important problem all over the world. The forearm support,which can keep the forearm and wrist in biomechanical posture, is a possible protective factor of the development of upper body syndrome. This meta-analysis examines the efficacy of forearm support in reducing upper body syndrome. The Cochrane Library, EMBASE, Ovid, Science direct, Springer-link, Google Scholar, CNKI database, Wanfang database were searched from inception until May 29th 2013. Studies relevant were included after the screen of title, abstract and the full text. Impact of bias was assessed independently by two authors.Four studies that met all the inclusion criteria were included finally. The combined results based on all studies suggested that statistically the forearm support had a unconspicuous effect on upper body syndrome (OR = 0.70, 95% CI: 0.49, 1.02).The result of subgroup suggested that forearm support have a significant effect on neck or shoulder syndrome (OR = 0.70, 95% CI: 0.43, 1.14) and the effect on upper extremity syndrome(OR = 0.76, 95% CI: 0.49, 1.19) is not significant. This meta-analysis suggested that the forearm support had statistically unconspicuous effect on preventing upper body syndrome on the whole.
    Archives of Environmental and Occupational Health 01/2014; · 1.19 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the effectiveness and safety of endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR) using a meta-analysis of data from randomized controlled trials. Electronic searches of the Cochrane Register of Controlled Trials (CENTRAL, Issue 11 of 12, Nov 2012), PUBMED (1980 to Dec 2012), and EMBASE (1980 to Dec 2012) were used to identify randomized controlled trials that evaluated endoscopic vs open methods for treatment of carpal tunnel syndrome. Studies to be used were independently identified by two researchers. The methodological quality of the studies was assessed by the Cochrane Collaboration tool for assessing risk of bias. Fifteen randomized controlled trials involving 1,596 hands were included. Based on the Cochrane Collaboration tool for assessing risk of bias, four studies were rated as high quality, five studies were rated as moderate quality, and six were rated as low quality. Our meta-analysis indicated that ECTR resulted in better recovery of pinch strength, earlier time of return to work, but a higher rate of reversible nerve problems (including neurapraxia and numbness) than OCTR. ECTR also resulted in a lower rate of irreversible nerve damage (P > 0.05), wound problems (including wound infection, wound hematoma and wound dehiscence) and reflex sympathetic dystrophy (P > 0.05) compared with OCTR. Our meta-analysis revealed no obvious statistical differences in relief of symptoms (pain and paraesthesia), recovery of grip strength and reoperation rate. Our meta-analysis of available randomized controlled trials demonstrated that ECTR and OCTR were similar in relief of symptoms, but ECTR resulted in better recovery of function and earlier return to work and was safer than OCTR.
    Archives of Orthopaedic and Trauma Surgery 01/2014; · 1.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: EDUCATIONAL OBJECTIVES As a result of reading this article, physicians should be able to: 1. Analyze the latest innovations in biomaterial scaffolds for the repair and regeneration of osteochondral defects. 2. Discuss the design and manufacture of biomaterial scaffolds. 3. Compare the advantages and disadvantages of stratified and nonstratified scaffolds. 4. Review the latest fixation methods of scaffolds in vivo. Due to their good biocompatibility and mechanical integrity, tissue engineering scaffolds have become a principal method of repair and regeneration of osteochondral defects. To improve their intrinsic properties, control their degenerative times, and enhance their cell adhesion and differentiation, numerous scaffold architectures and formation methods have been developed and tested, but the ideal scaffold design is still controversial. Moreover, scaffold fixation has a significant influence on repair and regeneration after implantation. The authors analyzed relative studies to address the latest scaffold designs, including biphasic scaffold, multilayered scaffold, and continuous nonstratified scaffold, and this article compares their advantages and disadvantages. In addition, the authors introduce a novel modified method for scaffold fixation known as magnetic fixation. Both stratified and nonstratified scaffolds can repair osteochondral defects, but continuous nonstratified scaffolds are more biomimetic compared with the native osteochondral structures, and they lead to a better regeneration of hyaline-like cartilage and structured bone tissue. Therefore, the authors suggest continuous nonstratified scaffolds are an effective option for treating osteochondral defects.
    Orthopedics 11/2013; 36(11):868-73. · 1.05 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The limited repair potential of articular cartilage, which hardly heals after injury or debilitating osteoarthritis, is a clinical challenge. The aim of this work was to develop a novel type I collagen (Col)/glycosaminoglycan (GAGs)-porous titanium biphasic scaffold (CGT) and verify its ability to repair osteochondral defects in an animal model with bone marrow stem cells (bMSCs) in the chondral phase. The biphasic scaffold was composed of Col/GAGs as chondral phasic and porous titanium as subchondral phasic. Twenty-four full-thickness defects through the articular cartilage and into the subchondral bone were prepared by drilling into the surface of the femoral patellar groove. Animals were assigned to one of the three groups: 1) CGT with bMSCs (CGTM), 2) only CGT, and 3) no implantation (control). The defect areas were examined grossly, histologically and by micro-CT. The most satisfied cartilage repairing result was in the CGTM group, while CGT alone was better than the control group. Abundant subchondral bone formation was observed in the CGTM and CGT groups but not the control group. Our findings demonstrate that a composite based on a novel biphasic scaffold combined with bMSCs shows a high potential to repair large osteochondral defects in a canine model.
    Materials science & engineering. C, Materials for biological applications. 10/2013; 33(7):3951-7.
  • [Show abstract] [Hide abstract]
    ABSTRACT: To investigate the protocols of combined culture of human placenta-derived mesenchymal stem cells (HPMSCs) and human umbilical vein endothelial cells (HUVECs) from the same and different individuals on collagen material,to provide the. Under voluntary contributions, HPMSCs were isolated and purified from human full-term placenta using collagenase IV digestion and lymphocyte separation medium, and confirmed by morphology methods and flow cytometry, and then passage 2 cells were cultured under condition of osteogenic induction. HUVECs were isolated from fresh human umbilical vein by collagenase I digestion and subcultured to purification, and cells were confirmed by immunocytochemical staining of von Willebrand factor (vWF). There were 2 groups for experiment. Passage 3 osteoblastic induced HPMSCs were co-cultured with HUVECs (1:1) from different individuals in group A and with HUVECs from the same individual in group B on collagen hydrogel. Confocal laser scanning microscope was used to observe the cellular behavior of the cell-collagen composites at 1, 3, 5, and 7 days after culturing. Flow cytometry showed that HPMSCs were strongly positive for CD90 and CD29, but negative for CD31, CD45, and CD34. After induction, alizarin red, alkaline phosphatase, and collagenase I staining were positive. HUVECs displayed cobble-stone morphology and stained positively for endothelial cell marker vWF. The immunofluorescent staining of CD31 showed that HUVECs in the cell-collagen composite of group B had richer layers, adhered and extended faster and better in three-dimension space than that of group A. At 7 days, the class-like microvessel lengths and the network point numbers were (6.68 +/- 0.35) mm/mm2 and (17.10 +/- 1.10)/mm2 in group A, and were (8.11 +/- 0.62) mm/mm2 and (21.30 +/- 1.41)/mm2 in group B, showing significant differences between the 2 groups (t = 0.894, P = 0.000; t = 0.732, P = 0.000). Composite implant HPMSCs and HUVECs from the same individual on collagen hydrogel is better than HPMSCs and HUVECs from different individuals in integrity and continuity of the network and angiogenesis.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 08/2013; 27(8):916-22.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Porous titanium with appropriate surface treatments can be osteoinductive. To investigate the effect of surface treatments of porous titanium on the attachment and differentiation of mesenchymal stem cells (MSCs), two kinds of surface microstructured porous titaniums, H2O2/TaCl5 treated one (HTPT), and H2O2/TaCl5 and subsequent simulated body fluid (SBF) treated one (STPT) were fabricated, and non-treated one (NTPT) was used as control. The morphology, specific surface area (SSA), pore distribution and mechanical strength of these materials were characterized respectively, and the results showed that H2O2/TaCl5 treatment led to a significant increase in both SSA and micropores of HTPT, and the further SBF immersion resulted in the formation of a layer of bone-like apatite on the surface of STPT. Although the surface treatments had a little negative impact on the compressive strength and elasticity modulus of porous titanium, the mechanical strength of HTPT or STPT was enough for the bone defect repair of the load-bearing sites. The protein adsorption and cell adhesion experiments confirmed that the microstructured surface notably enhanced porous titanium's protein binding capacity and promoted MSCs adhesion on the surface. More importantly, cell differentiation experiments proved that the microstructured surface evidently elevated the osteoblastic gene expressions of MSCs compared to NTPT. The enhanced biological effect by the surface treatments was more robust on STPT. Therefore, our results suggest that the microstructured surface has great potential for promoting MSCs differentiation towards osteoblasts, giving excellent support for the osteoinduction of porous titanium with appropriate surface treatments.
    Journal of Materials Science Materials in Medicine 06/2013; · 2.14 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVES: Total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) are treatment choices for end-stage shoulder osteoarthritis. The decision of whether to use TSA or HA is controversial. The objective of this study was to compare the effects of TSA and HA for shoulder osteoarthritis. METHODS: We conducted a search for clinical studies that had been published in any language in December 2012 or before. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and several other databases. Randomized and quasi-randomized controlled clinical studies that evaluated different methods were included. At least two review authors independently performed the study selection, data collection, and data extraction. The software Revman 5.1 was used for the statistical analysis. RESULTS: This study included 4 clinical trials. Two of the trials were published clinical trials, and the other 2 clinical trials were presented as unpublished abstracts. A total of 146 patients with 153 shoulders were included in the trials. Compared with HA, TSA presents with a higher UCLA shoulder scale (MD 3.10, 95% CI 1.13-5.08) and a higher ASES (MD 10.17, 95% CI 1.40-18.87). There was no significant difference between TSA and HA for revision (RR 0.35, 95% CI 0.10-1.19), WOOS (MD 9.10, 95% CI -2.72 to 20.92), and incidence of instability (RR 0.88, 95% CI 0.19-3.98). HA had a lower operation time (MD 39.00, 95% CI 17.05-60.95). CONCLUSION: The available evidence suggests that TSA is more effective than HA for patients with shoulder arthritis.
    Seminars in arthritis and rheumatism 06/2013; · 4.72 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Anterior cervical discectomy and fusion is a standard treatment for symptomatic cervical disc disease, but pseudarthrosis and accelerated adjacent-level disc degeneration may develop. Cervical disc arthroplasty was developed to preserve the kinematics of the functional spinal unit. Trials comparing arthroplasty with anterior cervical discectomy and fusion have shown unclear benefits in terms of clinical results, neck motion at the operated level, adverse events, and the need for secondary surgical procedures. Only randomized clinical trials were included in this meta-analysis, and the search strategy followed the requirements of the Cochrane Library Handbook. Two reviewers independently assessed the methodological quality of each included study and extracted the relevant data. Twenty-seven randomized clinical trials were included; twelve studies were Level I and fifteen were Level II. The results of the meta-analysis indicated longer operative times, more blood loss, lower neck and arm pain scores reported on a visual analog scale, better neurological success, greater motion at the operated level, fewer secondary surgical procedures, and fewer such procedures that involved supplemental fixation or revision in the arthroplasty group compared with the anterior cervical discectomy and fusion group. These differences were significant (p < 0.05). The two groups had similar lengths of hospital stay, Neck Disability Index scores, and rates of adverse events, removals, and reoperations (p > 0.05). The meta-analysis revealed that anterior cervical discectomy and fusion was associated with shorter operative times and less blood loss compared with arthroplasty. Other outcomes after arthroplasty (length of hospital stay, clinical indices, range of motion at the operated level, adverse events, and secondary surgical procedures) were superior or equivalent to the outcomes after anterior cervical discectomy and fusion. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
    The Journal of Bone and Joint Surgery 03/2013; 95(6):555-61. · 3.23 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In this study, porous titanium was treated by a hydrogen peroxide solution with (HT) or without (HO) tantalum chloride at a low temperature to endow its bioactivity. The microstructure, film stability and in vitro and in vivo bioactivity of HT-treated and HO-treated porous titanium were investigated, and the non-treated one was used as control. After HT treatment, a well-crystallized titania nanoparticle film consisting of anatase phase with good film stability was formed on the surface of porous titanium, and the tantalum element appeared in the film, while the HO-treated porous titanium surface showed a dual structure with well-aligned nanorods as an outer layer and condensed nanoparticles as an inner layer consisting of a mixture of well-crystallized anatase and rutile phases. In vitro bioactivity assessment showed that both HT- and HO-treated porous titanium possessed high apatite-forming ability. More importantly, after implantation in the dorsal muscles of dogs, the HT- and HO-treated implants induced ectopic bone formation in its inner pores after 5 months, while the non-treated one did not. The present study showed that HT-treated porous titanium possessed good film stability and bioactivity to be used as bone repair materials in clinic under load-bearing conditions.
    Biomedical Materials 02/2013; 8(2):025006. · 2.92 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background. The purpose of this meta-analysis was to find out whether the proximal femoral nail was better than the dynamic hip screw in the treatment of trochanteric fractures with respect to operation time, blood transfusion, hospital stay, wound complications, number of reoperation, and mortality rate. Methods. All randomized controlled trials comparing proximal femoral nail and dynamic hip screw in the treatment of trochanteric fractures were included. Articles and conference data were extracted by two authors independently. Data was analyzed using RevMan 5.1 version. Eight trials involving 1348 fractures were retrieved. Results. Compared with DHS fixation, PFN fixation had similar operation time (95% CI: -15.28-2.40, P = 0.15). Blood loss and transfusion during perioperative time were also comparable between the two fixations (95% CI: -301.39-28.11, P = 0.10; 95% CI: -356.02-107.20, P = 0.29, resp.). Outcomes of hospital stay (95% CI: -0.62-1.01, P = 0.64), wound complication (95% CI: 0.66-1.67, P = 0.82), mortality (95% CI: 0.83-1.30, P = 0.72), and reoperation (95% CI: 0.61-1.54, P = 0.90) were all similar between the two groups. Conclusion. PFN fixation shows the same effectiveness as DHS fixation in the parameters measured.
    The Scientific World Journal 01/2013; 2013:805805. · 1.73 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Radial head fractures are the most common type of elbow fracture and can severely affect the function of the elbow. There is uncertainty and controversy about when surgery is indicated as well as what type of surgical intervention is best. OBJECTIVES: To assess the effects of surgical interventions for treating radial head fractures in adults. We aimed to compare surgical versus non-surgical treatment, and different methods of surgical intervention. SEARCH METHODS: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (May 2012), the Cochrane Central Register of Controlled Trials (The Cochrane Library; 2012 Issue 4), MEDLINE (1946 to May 2012), EMBASE (1980 to 2012 Week 19) and trial registers (November 2011). No language restrictions were applied. SELECTION CRITERIA: All randomised and quasi-randomised controlled trials evaluating surgical interventions for treating radial head fractures. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, assessed risk of bias and extracted data. Where appropriate, results were pooled. MAIN RESULTS: We included three randomised controlled trials, involving a total of 251 participants. All three trials were at high risk of performance bias reflecting the fact that surgeons could not be blinded. One trial was at low risk of selection bias but was undermined by a high attrition bias, in part resulting from post-randomisation exclusions. There were incomplete details of methodology for the other two trials, which usually resulted in unclear risk of bias judgements.Two trials compared radial head replacement with open reduction and internal fixation (ORIF) for treating Mason type III radial head fractures. The trial authors reported outcomes at a mean of 2.8 years and 15 months respectively. There were significant differences between the two groups in favour of radial head replacement in the Broberg and Morrey elbow scores (92.1 versus 72.4, mean difference (MD) 19.70; 95% confidence interval (CI) 15.64 to 23.76; one trial, 45 participants), excellent or good Broberg and Morrey elbow scores (33/36 versus 16/31, risk ratio (RR) 1.88; 95% CI 1.27 to 2.77; two trials), and overall adverse events (6/36 versus 15/31, RR 0.33; 95% CI 0.14 to 0.77; two trials). No statistically significant difference was found between the two groups in any of the reported individual adverse events.One trial compared biodegradable pins with standard metal screws in treating radial head fractures of AO-classification 21 B2. The two types of fixation devices yielded similar results, with no significant between-group differences in the Broberg and Morrey scores (93.3 versus 90.9, MD 2.40; 95% CI -0.10 to 4.90), excellent or good Broberg and Morrey elbow scores (72/74 versus 56/61, RR 1.06; 95% CI 0.97 to 1.15), and adverse events (13/82 versus 16/82, RR 0.81; 95% CI 0.42 to 1.58) at two-year follow-up. AUTHORS' CONCLUSIONS: Only tentative conclusions can be drawn from the available evidence in this review. Compared with ORIF, there was some evidence that radial head replacement had better elbow function and fewer adverse events for Mason type III radial head fractures in the short term. However, the evidence is of low quality and it is unknown whether these results would apply in the longer term or more generally. Using biodegradable implants may be as good as metallic implants for fixation of some usually more stable fractures but more evidence is needed to confirm this. There is a need for good quality evidence for addressing the areas of uncertainty for the surgical treatment of radial head fractures.
    Cochrane database of systematic reviews (Online) 01/2013; 5:CD008987. · 5.70 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Many studies have shown that calcium phosphate ceramics (CP) have osteoconductive and osteoinductive properties; however, the exact mechanism of bone induction has not yet been reported. This study was performed to investigate if destroying immunological function will influence osteogenesis, to explain the mechanism which is unclear. In this study, twenty C57BL/6 mice were divided into two groups (n = 10), in group 1, a hydroxyapatite/β-tricalcium phosphate (HA/β-TCP) ceramic was implanted into both the left and right leg muscles of each mouse; in group 2, ten mice experienced lethal irradiation, then were injected bone marrow (BM) cells from green fluorescent protein (GFP) transgenic mice by tail veil, after bone marrow transplantation (BMT), heart, liver, spleen, lung, kidney, and muscle were harvested for biological analysis, after the GFP chimera model was established successfully, the same HA/β-TCP ceramic was implanted into both leg muscles of each mouse immediately after irradiation. 45 and 90 days after implantation, the ceramics of the two groups were harvested to perform with hematoxylin and eosin (HE) and immunohistochemistry (IHC) staining; the results showed that there was no bone formation in group 2, while new bone tissues were detected in group 1. Our findings suggest that the BM cell from GFP transgenic mice is a good biomarker and it could set a good platform for chimera model; it also shows that BM cell is one of cell resources of bone induction, and destruction of immune function will impede osteoinduction by CP. Overall, our results may shed light on clear mechanism study of bone induction in the future.
    Applied Surface Science 12/2012; 262:200–206. · 2.54 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To study the therapeutic effect of adjacent pedicle fascia flap filling and arthrodesis in the regional management of sinus tract in diabetic foot. From February 2007 to August 2010, 6 patients suffering diabetic foot with sinus tract were included. There were 4 male and 2 female patients, aged 47 to 68 (averaging 58.3 +/- 6.7). One case had the entrance of sinus tract in the heel, and its base located deep in the calcaneus. Three cases had the sinus tract in the vola or dorsum of the foot, in which 1 with a perforating tract connecting the vola and the dorsum. Another 2 cases were in the toes, both located around joints. Under the effective treatments of anti-infection, anti-coagulation and control of blood sugar, blood pressure as well as blood lipid level, the patients were subjected to surgical treatments of sinus tract, the sinuses in the heel, sole and dorsum of the feet were filled up with facial flap, and those in the toes were eliminated using arthrodesis. All the 6 patients received rational debridement. Four patients were treated with adjacent fascia flap filling, the other two were treated with arthrodesis. The sinus tracts healed 14-20 d after surgery in all patients. One patient developed skin necrosis at the edge of the incision in the dorsum of the foot and another whose sinus located in the toe suffered inflammation and exudation. Both patients recovered after dressing replacement, antiseptic therapy and blood sugar regulation for a period of time. Appropriately designed pedicle fascia flap can provide satisfactory healing for sinus in the heel, vola and dorsum, and arthrodesis is a safe and effective way for that in the toes. Rational debridement is the key prerequisite for healing of sinus tract in diabetic foot.
    Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition 09/2012; 43(5):766-9.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Subtrochanteric fractures of the femur complicated with segmental bone defects are uncommon injuries and challenging to manage. We evaluated the effect of reconstructing extensive bone defect in the subtrochanteric area (mean, 6.9 cm) with folded free vascularized fibular graft (FVFG). Between 2001 and 2007, 14 cases of subtrochanteric fractures complicated with huge bone defects treated by folded FVFG transfer in our hospital were retrospectively reviewed. The defect was reconstructed by folded FVFG transfer and locking plate stabilization in 10 patients with no sign of infection at admission (group 1). In the other four patients presented with infections (group 2), the defect was reconstructed by folded FVFG transfer and external fixator fixation. The average follow-up period was 67.4 months. Bone union was achieved in all of the cases at an average of 5.4 months (range, 4-6 months). Primarily, bone union was achieved in all of the cases in group 1, but one stress fracture occurred in group 2. The full weight bearing time was 5.4 months (range, 5-6 months) in group 1 and 8.5 months (range, 8-9 months) in group 2. Seven patients in group 1 had the locking plate removed in an average of 27 months (range, 18-38 months). In group 2, the external fixator removal time was 13 months (range, 10-18 months). There was no varus deformity at the final follow-up in group 1. The neck-shaft angle measured during the postoperative period and at final follow-up was 129.6 degrees and 129.4 degrees, respectively. In group 2, the neck-shaft angle at the final follow-up was significantly less than the angle measured at the postoperative period (115.5 vs. 129.5 degree, p = 0.021). The range of motion of the hip and knee joint (extend and flex) was 100 degrees or more in all patients at the final follow-up. The results of this study showed that huge subtrochanteric bone defects reconstructed by folded FVFG and locking plate were highly successful in achieving bone union, reducing risks of postoperative stress fracture and preventing malunion. When huge bone defects in the subtrochanteric area complicated with acute or chronic infections, the technique of external fixator offers an alternative to reconstruct the stability of the proximal femur after folded FVFG. However, because of the inadequate stabilization, the risks of varus malunion and postoperative stress fracture could be increased after external fixator fixation. V, therapeutic study.
    The journal of trauma and acute care surgery. 05/2012; 72(5):1404-10.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Reports investigating the association between the genetic polymorphism of glutathione S-transferase T1 (GSTT1) and the risk of rheumatoid arthritis (RA) have revealed conflicting results. To clarify the effect of GSTT1 polymorphism on the risk of developing RA, we carried out a meta-analysis using published data. Electronic searches were conducted to select studies. Reports were included if they were observational studies investigating the link between GSTT1 genotype and the risk of RA. The principal outcome measure was the odds ratio (OR) with 95% confidence interval (CI) for the risk of RA with GSTT1 null genotype. We identified 7 eligible studies including 2652 cases and 4117 controls. The combined results showed that there was not a statistically significant link between GSTT1 null genotype and RA. However, we observed an increased risk in heavy smokers (cigarette consumption >10 pack-years) with GSTT1 null polymorphism compared with never or light smokers (cigarette consumption ≤10 pack-years) with GSTT1 present. Moreover, compared to GSTT1 positive polymorphism with seronegative results, there was an increased risk in GSTT1 null polymorphism with seropositive results. The results from this meta-analysis suggested that GSTT1 null genotype is not association with an increased susceptibility to RA. However, GSTT1 null polymorphism may increase the risk of RA in relation to heavy smokers or seropositive results. Whether GSTT1 polymorphism may act in synergy with other genes or environmental factors remains to be studied more in depth.
    Clinical and experimental rheumatology 04/2012; 30(5):741-7. · 2.66 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Compartment syndrome of the thigh is a rare emergency often treated operatively. The purpose of this study was to evaluate the effects of nonoperative treatment for compartment syndrome of the thigh associated with acute renal failure after the 2008 Wenchuan earthquake. Nonoperative treatment, which primarily involves continuous renal replacement therapy, was performed in 6 patients (3 men and 3 women) who presented with compartment syndrome of the thigh associated with acute renal failure. The mean mangled extremity severity score (MESS) and laboratory data regarding renal function were analyzed before and after treatment, and the clinical outcome was evaluated at 17-month follow-up. Laboratory data regarding renal function showed improvements. All 6 patients survived with the affected lower limbs intact after nonoperative treatment. Follow-up revealed active knee range of motion and increased muscle strength, as well as a recovery of sensation. A positive linear correlation was found between MESS and the time required to achieve a reduction in swelling, as well as the time required for the recovery of sensation and knee range of motion (r>0.8; P<.05). Satisfactory clinical outcomes were obtained in patients with compartment syndrome of the thigh associated with acute renal failure.Urine alkalization, electrolyte and water balance, and continuous renal replacement therapy have played an important role in saving lives and extremities. Nonoperative treatment should be considered in the treatment of compartment syndrome of the thigh associated with acute renal failure.
    Orthopedics 04/2012; 35(4):e486-90. · 1.05 Impact Factor