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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. · 3.27 Impact Factor
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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. · 2.16 Impact Factor
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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.
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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.
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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. · 2.15 Impact Factor
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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. · 2.66 Impact Factor
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ABSTRACT: We evaluate the clinical results of reconstructing massive juxta-articular defects of the distal femur (mean, 16.4 cm) with series-connected double-strut free-vascularized fibular grafting (FVFG) and external fixator fixation.
We retrospectively reviewed a consecutive series of 19 patients, who underwent FVFG transfer because of massive juxta-articular defects of distal femur. Sixteen cases had complete records and included in this study. Five patients underwent double-strut FVFGand 11 patients underwent series-connected double-strut FVFG. FVFG was performed from 2 months to 3 months after the clinica lsigns of the infection had subsided and erythrocyte sedimentation rates had returned to normal. Both fibulas (mean, 18.6 cm) were harvested to reconstruct the femoral defect, half-ring sulcated external fixator (Orthofix Srl, Italy), and K-wires were used to provide stabilization.
Five fibular grafts (15.6%) had vascular complications on flap monitoring. Fifteen of the sixteen reconstructed femurs (93.8%)united primarily. Stress fracture occurred in one patient. The mean duration to achieve union was 7.1 month (range, 4–18 months).Full weight-bearing walking was allowed 3 months after the confirmation of bone union (mean, 10 months; range, 7–22 months).The external fixator was removed 12.2 months (range, 10–16 months) postoperatively. The K-wires were removed 26.4 months(range, 23–30 months) postoperatively. There was no statistically significant difference of hypertrophic change between series-connected grafts and conventional double-strut grafts (27.18 vs. 24.43%, p = 0.186) and also between the three levels of the grafted fibula. Within the series-connected group, the difference of hypertrophic change between anterograde fibular grafts and retrograde fibular grafts was also not significant (25.24 vs. 29.12%, p = 0.178). The overall rate of knee stiffness (90 degree)was as high as 68.75% (11 of 16 patients).
Massive juxta-articular defects of the distal femur are difficult and uncommon injuries. The results of this study indicate that the huge femoral defect reconstructed by series-connected double-strut FVFG provide good results in achieving bone union, reducing stress fracture rate, and achieving leg length equality.
The journal of trauma and acute care surgery. 02/2012; 72(2):E71-6.
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ABSTRACT: To investigate the applications of fluoroscopy-based navigation in pelvic fractures and related surgical considerations.
From May 2010 to December, 16 patients with pelvic fractures were treated with computerized navigation. There were 12 males and 4 females with an average age of 37 years (ranged from 20 to 54 years). Fractures were caused by traffic accident in 5 cases, crush injury in 5 cases and falling from height in 6 cases. Based on the Tile classification, there were 15 cases of Tile C type and 1 case of Tile B type. In these patients, 4 patients were treated with sacroiliac screw fixation; 2 patients were treated with sacroiliac screw fixation, screw fixation for pubic symphysis diastasis and pubic fractures; 8 patients were treated with sacroiliac screw fixation and screw fixation for pubic fractures; 2 patients were treated with screw fixation for pubic fractures. The index such as screw inserting time, accurance of inserting screws, intra-operative blood losing, injuries of nerve, vascular and other organs, reduction conditions were observed.
A total of 36 screws were inserted. The average time was 20 min for each screw placement. The blood loss ranged from 10 to 20 ml. There were no wound infections, neurovascualr injuries and other organ injuries. The postoperative pelvic X-ray and three-dimensional CT showed that the fractures had good reduction and all the screws had good position.
Percutaneous screw fixation of pelvic fractures with fluoroscopy-based navigation have advantages such as little trauma, less blood loss, little complication, reliable fixation and no blood transfusion, which can reconstruct the stability of the pelvic ring, but need adequate preoperative reperation and high requirements for the surgeon.
Zhongguo gu shang = China journal of orthopaedics and traumatology 01/2012; 25(1):70-3.
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ABSTRACT: Intramedullary nailing is commonly used for treating fractures of the tibial shaft. These fractures are one of the most common long bone fractures in adults.
To assess the effects (benefits and harms) of different methods and types of intramedullary nailing for treating tibial shaft fractures in adults.
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and reference lists of articles to December 2009. The search was subsequently updated to September 2011 to assess the more recent literature.
Randomised and quasi-randomised controlled clinical studies evaluating different methods and types of intramedullary nailing for treating tibial shaft fractures in adults were included. Primary outcomes were health-related quality of life, patient-reported function and re-operation for treatment failure or complications.
At least two review authors independently performed study selection, risk of bias assessment, and data collection and extraction.
Nine randomised and two quasi-randomised clinical trials, involving a total of 2093 participants with 2123 fractures, were included. The evidence was dominated by one large multicentre trial of 1319 participants. Both quasi-randomised trials were at high risk of selection bias. Otherwise, the trials were generally at low or unclear risk of bias. There were very few data on functional outcomes; and often incomplete data on re-operations. The trials evaluated five different comparisons of interventions: reamed versus unreamed intramedullary nailing (six trials); Ender nail versus interlocking nail (two trials); expandable nail versus interlocking nail (one trial); interlocking nail with one distal screw versus with two distal screws (one trial); and closed nailing via the transtendinous approach versus the paratendinous approach (one trial).No statistically significant differences were found between the reamed and unreamed nailing groups in 'major' re-operations (66/789 versus 72/756; risk ratio (RR) 0.88, 95% confidence interval (CI) 0.64 to 1.21; 5 trials), or in the secondary outcomes of nonunion, pain, deep infection, malunion and compartment syndrome. While inconclusive, the evidence from a subgroup analysis suggests that reamed nailing is more likely to reduce the incidence of major re-operations related to non-union in closed fractures than in open fractures. Implant failure, such as broken screws, occurred less often in the reamed nailing group (35/789 versus 79/756; RR 0.42, 95% CI 0.28 to 0.61).There was insufficient evidence established to determine the effects of interlocking nail with one distal screw versus with two distal screws, interlocking nail versus expandable nail and paratendinous approach versus transtendinous approach for treating tibial shaft fractures in adults.Ender nails when compared with an interlocking nail in two trials resulted in a higher re-operation rate (12/110 versus 3/128; RR 4.43, 95% CI 1.37 to 14.32) and more malunions. There were no statistically significant differences between the two devices in the other reported secondary outcomes of nonunion, deep infection, and implant failure.One trial found a lower re-operation rate for an expandable nail when compared with an interlocking nail (1/27 versus 9/26; RR 0.11, 95% CI 0.01 to 0.79). The differences between the two nails in the incidence of deep infection or neurological defects were not statistically significant.The trial comparing one distal screw versus two distal screws found no statistically significant difference in nonunion between the two groups. However, it found significantly more implant failures in the one distal screw group (13/22 versus 1/20; RR 11.82, 95% CI 1.70 to 82.38).One trial found no statistically significant differences in functional outcomes or anterior knee pain at three year follow-up between the transtendinous approach and the paratendinous approach for nail insertion.
Overall, there is insufficient evidence to draw definitive conclusions on the best type of, or technique for, intramedullary nailing for tibial shaft fractures in adults. 'Moderate' quality evidence suggests that there is no clear difference in the rate of major re-operations and complications between reamed and unreamed intramedullary nailing. Reamed intramedullary nailing has, however, a lower incidence of implant failure than unreamed nailing. 'Low' quality evidence suggests that reamed nailing may reduce the incidence of major re-operations related to non-union in closed fractures rather than in open fractures. 'Low' quality evidence suggests that the Ender nail has poorer results in terms of re-operation and malunion than an interlocking nail.
Cochrane database of systematic reviews (Online) 01/2012; 1:CD008241. · 5.72 Impact Factor
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ABSTRACT: This paper is aimed to investigate the feasibility of applying the small intestine submucosa (SIS) as the scaffold in constructing tissue engineering cartilage in vitro. We obtained SIS from the small intestine of specific pathogen-free pigs. Then we isolated tunica submucosa layer from the mucosal, muscular, and serosal layers by gentle mechanic abrasion. The SIS was made acellular by combination of detergent and enzyme digestion. The chondrocytes were seeded onto the SIS and were cultured for 3 weeks. The cell growth, attachment and distribution were detected by histochemical stain, immunohistochemical stain and scan electron microscope. The chondrocytes could adhere and grow well on the matrix surface, and synthesize a large of the GAG and type U collagen. However, the chondrocytes grew only on the surface andsuperficial layer of the scaffold, they did not move into the inner part of the scaffold. It could be concluded that SIS has good cellular compatibility without cytotoxicity and provides temporary substrate to which these anchorage-dependent cells can adhere, and stimulate the chondrocytes anchored on the scaffold to proliferate and keep differentiated phenotype. Further study will be needed to promote the ability of chondrocyte chemotaxis in order to distribute the chondrocytes into the whole scaffold uniformly.
Sheng wu yi xue gong cheng xue za zhi = Journal of biomedical engineering = Shengwu yixue gongchengxue zazhi 06/2011; 28(3):521-5.
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ABSTRACT: Fractures of femoral fracture are among the most common fractures encountered in orthopedic practice. Intramedullary nailing is the treatment choice for femoral shaft fractures in adults. The objective of this article is to determine the effects of reamed intramedullary nailing versus unreamed intramedullary nailing for fracture of femoral shaft in adults.
Cochrane Central Register of Controlled Trials (October 2010), PubMed (October 2010) and EMBASE (October 2010) were searched. Randomized and quasi-randomized controlled clinical trials were included. After independent study selection by two authors, data were collected and extracted independently. The methodological quality of the studies was assessed. Pooling of data was undertaken where appropriate.
Seven trials with 952 patients (965 fractures) were included. Compared with unreamed nailing, reamed nailing was significantly lower reoperation rate (RR 0.25, 95% CI 0.11-0.59, P = 0.002), lower non-union rate (RR 0.20, 95% CI 0.05-0.77, P = 0.02) and lower delay union rate(RR 0.30, 95% CI 0.14-0.64, P = 0.002). There was no significant difference when comparing reamed nailing with unreamed nailing for implant failure (RR 0.51, 95% CI 0.16-1.61, P = 0.25), mortality(RR 0.94, 95% CI 0.19-4.58, P = 0.94) and acute respiratory distress syndrome(RR 1.53, 95% CI 0.37-6.29, P = 0.55). Unreamed nailing was significantly less blood loss (SMD 119.23, 95% CI 59.04-180.43, P = 0.0001).
Reamed intramedullary nailing has better treatment effects than unreamed intramedullary nailing for shaft fracture of femur in adults.
Archives of Orthopaedic and Trauma Surgery 05/2011; 131(10):1445-52. · 1.37 Impact Factor
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ABSTRACT: Clavicular fractures account for 2% to 2.6% of all fractures. Plating has been considered the gold standard for treating midshaft clavicular fracture. Intramedullary pinning and conservative treatments have also been commonly used. We hypothesized that intramedullary pinning and conservative treatments have the same treatment results compared with plating.
To evaluate the effect of plating vs intramedullary pinning or conservative treatment for midshaft clavicular fracture, the Cochrane Central Register of Controlled Trials (CENTRAL; Wiley Online Library, October 2010), PubMed (1950 to October 2010), and EMBASE (1980 to October 2010) were searched. Randomized and quasi-randomized controlled clinical studies evaluating plating vs intramedullary pinning or plating vs conservative treatment for midshaft clavicular fracture in adults were collected. After independent study selection by 2 authors, data were collected and extracted independently. The methodologic quality of the studies was assessed. Pooling of data was undertaken.
Four studies involving 305 clavicular fractures were included. There were no significant differences between plating and intramedullary pinning with regard to outcome for Oxford Shoulder Score, Constant Shoulder Score, nonunion, infection, fixation failure, and hardware removal. More symptomatic hardware events occurred with plating compared with intramedullary pinning. Reduced nonunion, malunion, and neurologic symptoms, as well as more satisfaction with ultimate appearance, were associated with plating than with conservative treatment.
This meta-analysis supports the treatment effects reported previously with plating for midshaft clavicular fractures. The outcome of this meta-analysis contradicted the findings reported previously with conservative treatment for midshaft clavicular fractures.
The available evidence suggests that there are no differences in treatment effects between plating and intramedullary pinning, but plating is associated with more side effects. Plating is associated with improved treatment effects when compared with conservative treatment.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 04/2011; 20(6):1008-15. · 1.93 Impact Factor
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International Orthopaedics 02/2011; · 2.03 Impact Factor
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ABSTRACT: OBJECTIVE To review the efficacy of reconstruction plate combined with tension band wiring for treating proximal ulna and olecranon fractures.
Between November 2004 and September 2009, 10 patients with proximal ulna and olecranon fractures were treated by reconstruction plate combined with tension band wiring. There were 6 males and 4 females with an average age of 45.3 years (range, 21-75 years). Five fractures were caused by traffic accident, 2 by falling from height, 2 by tumbling, and 1 by a machine strangulation. The locations were the left side and the right side in 5 cases respectively. One case was open fracture (Gustilo II) and the other 9 were closed fractures. Olecranon fractures included 4 cases of traverse fractures and 6 cases of comminuted fractures, and proximal ulna fractures included 6 cases of comminuted fractures and 4 cases of oblique fractures. The combined fractures included 6 radial head fractures, 4 coronoid process fractures, 2 proximal humerus fractures, and 3 scapula fractures; other injury included 1 elbow dislocation and 1 shoulder dislocation. Two patients had secondary operation; the other 8 patients received the primary operations and the time from injury to operation varied from 7 days to 20 days, with an average of 11 days.
One case had infection at the incision 1 week after operation, and recovered after 2 months of antibiotics and debridement; incisions healed by first intention in other 9 patients. All patients were followed up 12-64 months (mean, 40.5 months). The X-ray films showed that fracture healing was achieved at 10-24 weeks (mean, 12 weeks). There was no ulnar nerve symptom in all cases. Heterotopic ossification occurred in 1 case at 2 months and stiffness of the elbow in 1 case at 3 months after operation; they were both cured after symptomatic treatment. Proximal migration of Kirschner wires was found in 1 case at 6 months after operation, whose implants were taken out at 9 months after the first operation because fracture had healed. At last follow-up, the flexion and extension are of the elbow averaged 92.8 degrees (range, 23-130 degrees), and the arc of forearm rotation averaged 124.4 degrees (range, 42-175 degrees). According to the American Hospital for Special Surgery (HSS) evaluation method, the results were classified as excellent in 6 cases, good in 2, fair in 1, and poor in 1.
Treating proximal ulna and olecranon fractures by reconstruction plate combined with tension band wiring allows patients to do postoperative exercise early and could effectively avoid complications.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 01/2011; 25(1):17-20.
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ABSTRACT: In this study, a slurry foaming method was developed to fabricate porous titanium, and two different surface treatments were applied to investigate their effects on the osteoinduction of the implants. Three types of implants, that was porous titanium with no treatment, with chemical-thermal treatment (CTPT), and with acid-alkali treatment (AAPT), were implanted in the dorsal muscles of adult dogs for 3 and 5 months. After implantation for 3 months, new bone was only found in the inner pores of AAPT by histological analysis and field emission scanning electron microscopy observation. After implantation for 5 months, new bone was also found in CTPT, but it was absent in AAPT. This study not only confirmed that porous titanium with appropriate surface treatments could possess osteoinduction but also showed that its osteoinductive potential was tightly related to the surface treatment. As a simpler method, acid-alkali treatment could endow porous titanium with faster osteoinduction, and AAPT might have potential in clinical application.
Journal of Biomedical Materials Research Part B Applied Biomaterials 09/2010; 95(2):387-96. · 2.15 Impact Factor
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ABSTRACT: To investigate the medium-term curative effects of locking proximal humerus plate for the treatment of comminuted fractures of proximal humerus, and provide evidences for the clinical practice.
From August 2005 and April 2008, 23 patients with comminuted fractures of proximal humerus were treated with locking plates, including 12 males and 11 females, aged 27 to 76 years old (averaged 51.5 years old). There were 18 cases of traffic accident injuries, 4 cases of falls injuries, and 1 case injured after heavy pressure. According to Neer classification, 11 cases were three-part fractures, and 12 cases were four-part fractures. Outcomes were assessed with radiography and the Constant-Murley (C-M) shoulder evaluation.
All the patients got primary healing of incisions. Twenty-three patients were followed up, and the duration ranged from 17 to 49 months, with an average of 35.25 months. Twenty patients had fracture healing during 4 to 7 months after operation. There was no significant differences among 3, 6 and 12 months after operation in C-M scoring. The average C-M score was (79.85 +/- 17.23) points (38 to 100 points) at the 12th month after operation, 8 cases got an excellent result, 8 good, 5 fair, and 2 poor. In the LPHP plus bone graft group 6 cases got an excellent result, 4 good, 3 fair, and 1 poor; in LPHP fixation group 2 excellent, 4 good, 2 fair,and 1 poor.
The medium-term curative effect of the locking proximal humerus plate in the treatment of proximal humeral fractures is significant. For the comminuted fractures of proximal humerus combined with osteoporosis and bone defects, bone graft should be performed routinely.
Zhongguo gu shang = China journal of orthopaedics and traumatology 09/2010; 23(9):661-4.
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ABSTRACT: To explore related factors of cubital tunnel syndrome caused by cubitus valgus deformity so as to provide theoretical basis for the clinical treatment.
Between June 2002 and September 2008, 40 patients with cubital tunnel syndrome caused by cubitus valgus deformity underwent anterior subcutaneous ulnar transposition. Related factors was analysed through logistic regression analysis using scoring standard recommended by Yokohama City University.
All 40 patients were followed up 27.5 months on average (range, 12-75 months). The duration of cubitus valgus deformity, cubitus valgus deformity angle, and the duration of paraesthesia and muscular atrophy were identified as related factors for ulnar neuropathy and the odds ratios were 1.005 (P = 0.045), 9.374 (P = 0.000), and 4.358 (P = 0.010), respectively. The related prognosis factors were duration of paraesthesia and muscular atrophy, deformity angle, and age at surgery, with odds ratios of 8.489 (P = 0.000), 2.802 (P = 0.030), and 4.611 (P = 0.031), respectively.
Related factors for ulnar neuropathy are durations of cubitus valgus deformity, cubitus valgus deformity angle, and duration of paraesthesia and muscular atrophy. Related factors for prognosis include age at surgery, cubitus valgus deformity angle, and duration of muscular atrophy. Early anterior subcutaneous ulnar transposition should be performed in patients with cubital tunnel syndrome caused by cubitus valgus deformity.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 08/2010; 24(8):967-71.
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ABSTRACT: A 40-year-old woman had her right extremity avulsed at the proximal upper arm level and the wrist and hand of her left extremity irretrievably injured in a traffic accident. The right distal forearm was surgically amputated and replanted onto the stump of the left distal forearm. New strategy for nerve repair was applied and the function recovery of the cross-replanted hand was favorable. We thought that cross-extremity replantation was indicated when the patient suffered from bilateral total or subtotal amputation at different levels and orthotopic replantation was impossible.
Archives of Orthopaedic and Trauma Surgery 05/2010; 131(2):157-61. · 1.37 Impact Factor
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ABSTRACT: To investigate whether or not posterolateral rotatory instability of the elbow is due to type-I and type-II coronoid process fracture together with anterior bundle of medial collateral ligament (AMCL) injury so as to provide a theoretic basis for its clinical treatment.
Ten fresh-frozen upper extremities were collected from cadavera which was donated voluntarily with no evidence of fracture, dislocation, osteoarthritis, mechanical injury of the surrounding ligament and joint capsule. They included 9 males and 1 female with an average age of 25.1 years (range, 19-40 years), including 3 cases at left sides and 7 cases at right sides. All specimens were transected at the upper midhumeral and carpal levels preserving the distal radioulnar joints to get the bone-ligament specimens. An axial load of 100 N compressing the elbow joint was applied along the shaft of the forearm in the sagittal plane through the biomechanical study system. The load-displacement plot was measured and analyzed at elbow flexion of 90, 60, and 45 degrees and under four conditions (intact elbow, type-I coronoid process fracture, type-I coronoid process fracture with AMCL deficient, and type-II coronoid process fractures with AMCL deficient).
The posterior displacements were maximum at 90 degrees elbow flexion. Hence, the results at 90 degrees elbow flexion were analyzed: under condition of intact elbows, the posterior displacement was the smallest (2.17 +/- 0.42) mm and the posterolateral rotatory stability was the greatest; under condition of type-I coronoid process fracture, the posterior displacement was (2.20 +/- 0.41) mm, showing no significant difference compared with that of the intact elbow (P > 0.05); under condition of type-I coronoid process fracture with AMCL deficient, the posterior displacement was (2.31 +/- 0.34) mm, showing no significant difference compared with that of intact elbow (P > 0.05); and under condition of type-II coronoid process fracture with AMCL deficient, the posterior displacement was (2.65 +/- 0.38) mm, showing a significant difference compared with that of intact elbow (P < 0.05). There was no macroscopic ulnohumeral dislocation or radial head dislocation during the experiment.
An simple type-I coronoid process fracture or with AMCL deficient would not cause posterolateral rotatory instability of elbow and may not need to be repaired. But type-II coronoid process fractures with AMCL deficient can cause posterolateral rotatory instability of elbow, so the coronoid process and the AMCL should be repaired or reconstructed to restore posterolateral rotatory stability as well as valgus stability.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 02/2010; 24(2):215-8.
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ABSTRACT: To explore the preparing methods in vitro and test the clinical applicability of implantation in vivo of bone marrow stromal stem cells (BMSCs)-biphasic scaffold to repair defects of cartilage and subchondral bone and to compare the differences in repaired outcomes of composite, single biphasic scaffold and rabbits themselves.
The upper chondral phase and the lower osseous phase of the plugs, using poly-lactic-co-glycolic acid (PLGA), hydroxyapatite (HA), and other biomaterials, were fused into carrier scaffold, on which collagen type I (Col I) was coated. The surface and inner structure of biphasic scaffold were observed under scanning electron microscope (SEM). BMSCs was isolated from the bone marrow of tibia and femurs of young New Zealand rabbits using centrifuging and washing, and their morphologies and adherences were observed everyday. Then BMSCs were inoculated on the surface of scaffold to form BMSCs-scaffold composites. Osteochondral defects were surgically created on articular surface of femoral intercondylar of 30 New Zealand rabbits, which were divided into groups A, B and C. In group A, a biphasic osteochondral composite were implanted into defect, BMSCs and biphasic cylindrical porous plug of PLGA-HA-Col I in group B, and group C was used as a control without implant. Specimens were harvested to make macroscopic and histological observations at the 1st, 3rd, 6th, and 9th months after operation respectively; meanwhile immunohistological and micro-computed tomography (micro CT) examinations were performed and graded at the 9th month after operation.
SEM showed an excellent connection of holes in the biphasic scaffold infiltrated by Col I. Optical microscopy and SEM showed a good growth of BMSCs in scaffold without obvious cellular morphological changes and an accumulation in the holes. Macroscopic samples showed a resistant existence of defects of group C within 9 months; the scaffold completely degenerated and chondral-like tissue formed on articular surface with partly collapses and irregular defects in group A; and smoother surface without collapses and approach to normal with texture of new regeneration in group B. There were statistically significant differences in macroscopic results (P < 0.001), group B was superior to group A, and group C was the worst. The micro CT showed good repairs and reconstruction of subchondral bone, with a acceptable integration with newborn chondral-like tissue and host bone in group B. Quantificational analysis of relevant parameters showed no significant differences. Histological results showed inflammations located in defects at the 1st month, new tissue grew into scaffold at the 3rd month; new chondral-like tissue crept on the margin of defects and biphasic scaffold degenerated completely at the 6th month, and lots of collagen formed in subchondral bone with major fibrocartilage on chondral area at the 9th month after surgery in groups A and B. In groups A and B, immunohistological observations were weak positive for Col II and positive for Col I.
Biphasic scaffold implanted in body can induce and accelerate repair of defects of articular cartilages which are mainly filled with fibrocartilage, especially for subchondral bone. Scaffold combined with BMSCs has the best repairing effects 9 months after implantation.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 01/2010; 24(1):87-93.
