[Show abstract][Hide abstract] ABSTRACT: This study was designed to evaluate the influence of irrigation fluid on the patients' physiological response to arthroscopic shoulder surgery.
Patients who were scheduled for arthroscopic shoulder surgery were prospectively included in this study. They were randomly assigned to receive warm arthroscopic irrigation fluid (Group W, n = 33) or room temperature irrigation fluid (Group RT, n = 33) intraoperatively. Core body temperature was measured at regular intervals. The proinflammatory cytokines TNF-α, IL-1, IL-6, and IL-10 were measured in drainage fluid and serum.
The changes of core body temperatures in Group RT were similar with those in Group W within 15 min after induction of anesthesia, but the decreases in Group RT were significantly greater after then. The lowest temperature was 35.1 ± 0.4 °C in Group RT and 35.9 ± 0.3 °C in Group W, the difference was statistically different (P < 0.05). Hypothermia occurred in 31 out of 33 subjects in Group RT (31/33; 94 %), but was significantly lower in Group W (9/24; 27 %; P < 0.05). Serum TNF-α changes were undetectable postoperatively. No statistical significant differences in serum IL-1 and serum IL-10 levels were observed between groups. Serum IL-6 levels were significantly lower in Group W (P < 0.05). The levels of the above cytokines in drainage fluid were all significantly lower in Group W after surgery (P < 0.05).
Hypothermia occurs more often in arthroscopic shoulder surgery by using room temperature irrigation fluid compared with warm irrigation fluid. And local inflammatory response is significantly reduced by using warm irrigation fluid. It seems that warm irrigation fluid is more recommendable for arthroscopic shoulder surgery.
Archives of Orthopaedic and Trauma Surgery 05/2015; DOI:10.1007/s00402-015-2246-2 · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The development of a new generation of injectable bone cements that are bioactive and have enhanced osteogenic capacity for rapid osseointegration is receiving considerable interest. In this study, a novel injectable cement (designated Sr-BBG) composed of strontium-doped borate bioactive glass particles and a chitosan-based bonding phase was prepared and evaluated in vitro and in vivo. The bioactive glass provided the benefits of bioactivity, conversion to hydroxyapatite and the ability to stimulate osteogenesis while the chitosan provided a cohesive biocompatible and biodegradable bonding phase. The Sr-BBG cement showed the ability to set in situ (initial setting time = 11.6 ± 1.2 min) and a compressive strength of 19 ± 1 MPa. The Sr-BBG cement enhanced the proliferation and osteogenic differentiation of human bone marrow-derived mesenchymal stem cells (hBMSCs) in vitro when compared to a similar cement (BBG) composed of chitosan-bonded borate bioactive glass particles without Sr. Micro-computed tomography and histology of critical-sized rabbit femoral condyle defects implanted with the cements showed the osteogenic capacity of the Sr-BBG cement. New bone was observed at different distances from the Sr-BBG implants within 8 weeks. The bone-implant contact (BIC) index was significantly higher for the Sr-BBG implant than for the BBG implant. Together, the results indicate that this Sr-BBG cement is a promising implant for healing irregular-shaped bone defects using minimally invasive surgery.
[Show abstract][Hide abstract] ABSTRACT: Introduction Surgical reconstruction has been increasingly recommended for the surgical management of posterior cruciate ligament (PCL) ruptures. While the choice of tissue graft still remains controversial. Currently both hamstring tendon autograft (HTG) and ligament advanced reinforcement system (LARS) artificial ligament are widely used but there are seldom reports on the comparisons of their clinical results. Our study was aimed to assess the effectiveness of these two grafts. Materials and methods Thirty-five patients with unilateral PCL rupture were enrolled in this retrospectively study. Sixteen of them received arthroscopically assisted PCL reconstruction using hamstring tendon autografts (HTG group) and nineteen using LARS ligaments (LARS group). All cases were followed up for 46-57 months with a mean of 51 months. Follow-up examinations included radiographic assessment, Lysholm score, Tegner score, International Knee Documentation Committee (IKDC) rating scales and KT-1000 test. Results All patients improved significantly at the final follow-up compared with the examinational results preoperatively and there were no significant differences between HTG group and LARS group with respect to the results of radiographic assessment, Lysholm score, Tegner score, IKDC rating scales and KT-1000 test. Conclusions Similar good clinical results were obtained after PCL reconstruction using hamstring tendon autografts and LARS ligaments. Both LARS ligament and hamstring tendon autograft are ideal grafts for PCL reconstruction.
Archives of Orthopaedic and Trauma Surgery 11/2014; 134(12). DOI:10.1007/s00402-014-2104-7 · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In this study, three-dimensional (3D) magnetic Fe3O4 nanoparticles containing mesoporous bioactive glass/polycaprolactone (Fe3O4/MBG/PCL) composite scaffolds have been fabricated by 3D-printing technique. The physiochemical properties, in vitro bioactivity, anticancer drug delivery, mechanical strength, magnetic heating ability and cell response to Fe3O4/MBG/PCL scaffolds were systematically investigated. The results showed that Fe3O4/MBG/PCL scaffolds had uniform macropores of 400 μm, high porosity of 60 % and excellent compressive strength of 13-16 MPa. The incorporation of magnetic Fe3O4 nanoparticles into MBG/PCL scaffolds did not influence their apatite mineralization ability, but endowed excellent magnetic heating ability and significantly stimulated proliferation, alkaline phosphatase (ALP) activity, osteogenesis-related gene expression (RUNX2, OCN, BSP, BMP-2 and Col-1) and extra-cellular matrix (ECM) mineralization of human bone marrow-derived mesenchymal stem cells (h-BMSCs). Moreover, using doxorubicin (DOX) as a model anticancer drug, Fe3O4/MBG/PCL scaffolds exhibited a sustained drug release for use in local drug delivery therapy. Therefore, the 3D-printed Fe3O4/MBG/PCL scaffolds showed the potential multifunctionality of enhanced osteogenic activity, local anticancer drug delivery and magnetic hyperthermia.
[Show abstract][Hide abstract] ABSTRACT: Development of bioactive scaffolds with controllable architecture and high osteogenic capability for bone tissue engineering is hotly pursued. In this study, three-dimensional (3D) mesoporous bioactive glass (MBG) and poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) (PHBHHx) composite scaffolds with well-defined pore structures and high compressive strength (~5-12MPa) were synthesized by 3D printing technique. Compared to reported polymer-bonded MBG scaffolds, the incorporation of biocompatible PHBHHx polymer as particle binder enhanced their bioactive and osteogenic properties, including fast apatite-forming ability, and promoted human bone marrow-derived mesenchymal stem cells (hBMSCs) adhesion, proliferation, alkaline phosphatase (ALP) activity and bone-related gene expression. Furthermore, MBG/PHBHHx compostite scaffolds were explored to repair critical-size rat calvarial defects. The results showed that MBG/PHBHHx compostite scaffolds exhibited a controlled degradation rate and more significant potential to stabilize the pH environment with increasing PHBHHx ratio. At 8 weeks post-implantation, MBG/PHBHHx scaffolds were demonstrated to stimulate bone regeneration in the calvarial defects and have largely repaired them through analysis of micro-CT, sequential fluorescent labeling and histology. These results lay a potential framework for future study by using modified MBG/PHBHHx-based functional scaffolds to improve the osteogenic activity and bone defect restoration.
[Show abstract][Hide abstract] ABSTRACT: Nanotubes on Ti–35Nb–2Ta–3Zr alloy with different degrees of deformations in thickness were fabricated by anodization method. The effect of deformations on the morphology, crystal phase and grain size of nanotubes was investigated. Nanotube arrays with uniform diameter were achieved by using ethylene glycol (EG)/NH4F organic electrolyte, indicating the electrolyte composition will influence the arrangement of TiO2 nanotube arrays. With the increasing degree of deformation, the corrosion potential Ecorr of the alloys had a positive displacement, which suggested an enhanced anticorrosion ability and resulted in nanotubes with smaller diameter. After heat treatment, anatase TiO2 was obtained. Due to the existence of lattice distortion, the grain size of TiO2 nanotubes prepared by Ti–35Nb–2Ta–3Zr alloy with deformations was smaller than that of with no deformation. However, when the reductions of alloy increased, there was a tendency to make the grain size larger, which was probably caused by the restriction of the wall thickness of nanotubes. The study about the nanotubes formed on Ti–35Nb–2Ta–3Zr alloy with different deformations provides a basis for its application on the drug-loading by Ti alloy prosthesis artificial joint.
[Show abstract][Hide abstract] ABSTRACT: Functionalization of biomaterials with specific functional groups is one of the most straightforward strategies to induce specific cell responses to biomaterials. In this study, thiol (SH) and amino (NH2) functional groups have been successfully modified on the surfaces of mesoporous bioactive glass (MBG) scaffolds to form thiol-functionalized MBG (SH-MBG) and amino-functionalized MBG (NH2-MBG) scaffolds by a post-grafting technique. The effects of the functional groups on the structure, physicochemical and biological properties of MBG scaffolds were systematically investigated. The results showed that the functionalization of MBG scaffolds did not change their structures, and the SH-MBG and NH2-MBG scaffolds still had hierarchical pore architecture (macropores of 300–500 μm and mesopores of 3.5–4 nm) and high porosity (84–86%), similar to the MBG scaffolds. Furthermore, the SH-MBG and NH2-MBG scaffolds possessed similar apatite mineralization ability and biocompatibility compared to the MBG scaffolds. Importantly, the SH-MBG and NH2-MBG scaffolds significantly stimulated adhesion, proliferation and differentiation of human bone marrow-derived mesenchymal stem cells (hBMSCs). Therefore, functionalization of MBG scaffolds with SH and NH2 functional groups would be a viable way to tailor the surface characteristics for stimulating biological responses of hBMSCs, and the functionalized MBG scaffolds would be a promising bioactive material for bone tissue engineering applications.
Journal of Materials Chemistry B 01/2014; 3(8). DOI:10.1039/C4TB01287A · 4.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Joint stiffness is a common complication of elbow trauma. Treating elbow stiffness is challenging, especially in patients with severe elbow stiffness with distal humeral nonunion.To improve treatment outcomes, the authors applied a hinged external fixator after performing open reduction and internal fixation and evaluated the clinical outcome. Between 2005 and 2011, eleven patients with elbow stiffness and distal humeral nonunion underwent open arthrolysis, surgical reduction, internal fixation, hinged external fixation, and selective bone grafting. The ulnar nerve was anteriorly transposed in all patients. Elbow range of motion, Mayo Elbow Performance Score, and radiographs were assessed pre- and postoperatively. All patients achieved solid union in an average of 5.6 months. Preoperatively, mean flexion was 86.8°, mean extension was 45.5°, and mean total range of motion was 41.3°. Postoperatively, mean flexion was 125.9°, mean extension was 11.8°, and mean total range of motion was 114.1°. Mean Mayo Elbow Performance Score also significantly improved from 59 points preoperatively to 87.2 points postoperatively, and 6 patients were scored as excellent (more than 90 points), 3 good (75-90 points), and 2 fair (60-74 points) according to the Mayo Elbow Performace Score.A stiff elbow with distal humeral nonunion can be treated successfully using a unilateral hinged external fixator to supplement the open reduction and internal fixation. A hinged external fixator was an effective rehabilitation method for improving range of motion and maintaining joint stability.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to evaluate the use of total knee arthroplasty (TKA) using a computer-assisted navigation system for treating osteoarthritis with extra-articular deformity.
Between January 2006 and January 2009, computer-assisted navigation TKAs were performed on eight knees in eight patients, who had severe osteoarthritis with an ipsilateral extra-articular deformity. All patients were followed up for a minimum of 24 months. The involved knees were evaluated by function scores, Knee Society knee scores, and analyzing knee flexion before the operation and at the latest follow-up.
Postoperatively, the function scores, Knee Society knee scores, and knee flexion all improved significantly. The ideal mechanical axis of the lower extremity was obtained in all cases.
TKA using a computer-assisted navigation system might provide an efficient treatment for patients with osteoarthritis in combination with an extra-articular deformity.
European Journal of Orthopaedic Surgery & Traumatology 01/2013; 23(1):93-6. DOI:10.1007/s00590-011-0912-9 · 0.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In this retrospective study, we evaluated the efficacy of the reverse less invasive plating system (LISS) in the management of subtrochanteric fractures (STF) in elderly patients that are expected to be difficult to nail.
Fifty-five patients with STF were treated from April 2005 to December 2007. Of these, 26 (16 females and 10 males, age >65 years, average 79.8 ± 3) had nonpathologic fractures that were internally fixed with a LISS device. The average follow-up period was 24 months (range 15-30). The main outcome measures evaluated were pain, union, varus deformity and implant failure. Radiographic and clinical evidence of functional outcome and complications were also evaluated.
Mean perioperative blood loss was 120.5 ± 12 ml (range 65-285), and mean postoperative hospital stay was 7.8 ± 2 days (range 4-14). Using the reverse LISS plates led to complete union of STF in all of the 26 elderly patients without additional procedures. Conclusion: Due to advantages like high union rate, early postoperative mobilization and short operation time, the reverse LISS device offers an alternative management of STF in elderly patients unsuitable for nailing procedures.
Medical Principles and Practice 02/2012; 21(4):334-9. DOI:10.1159/000335986 · 1.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The microstructure and phase constitutions of TixNb3Zr2Ta alloys (x=35, 31, 27, 23) (wt%) were studied. With a lower niobium content the grain size of β phase in TixNb3Zr2Ta alloys increased significantly, and the TixNb3Zr2Ta system was more likely to form α″ phase and even α phase. Tensile tests showed that UTS of TixNb3Zr2Ta alloys improved as the Nb content was decreased. Cyclic loading-unloading tensile tests were carried on TixNb3Zr2Ta alloys. Ti23Nb3Zr2Ta and Ti27Nb3Zr2Ta alloys featured the best superelasticity among the alloys studied. The pseudoelastic strain ratio of Ti35Nb3Zr2Ta alloy decreased a lot as the cycle number increased. Ti31Nb3Zr2Ta alloy showed only minimum superelasticity. This is because Ti23Nb3Zr2Ta and Ti27Nb3Zr2Ta alloys had higher yield strength than Ti31Nb3Zr2Ta did, which allowed martensite phase to be induced. On the contrary, Ti31Nb3Zr2Ta alloy exhibited better shape memory property than Ti27Nb3Zr2Ta, Ti23Nb3Zr2Ta and Ti35Nb3Zr2Ta titanium alloys. β phase, α phase and α″ phase were found in Ti23Nb3Zr2Ta alloy by TEM observation. The dislocation density of α phase was much lower than that of β phase due to their crystal structure difference. This may explained why Ti23Nb3Zr2Ta with α phase possessed higher tensile strength. The incomplete shape recovery of Ti23Nb3Zr2Ta alloy after unloading resulted from two sources. Plastic deformation occurred in β phase, α phase and even α″ phase under dislocation slip mechanism, and incomplete decomposition of α″ martensitic phase resulted in unrecovered strain as well.
[Show abstract][Hide abstract] ABSTRACT: Local chronic inflammatory reaction plays an important role in the process of aseptic loosening of implants after total joint replacement. In addition, macrophage migration inhibitory factor (MIF) is a key upstream regulator of inflammation, and it is a significant regulator of inflammatory diseases. The purpose of this study is to investigate if the fibroblasts and macrophages in the interfacial membranes overexpress MIF.
The 15 tissue samples of interfacial membranes were obtained from the tissues around the aseptically loosened femoral implants adjacent to osteolytic lesion in 15 patients. The 15 control synovial samples of hip joints were obtained from 15 patients who underwent primary hip arthroplasty because of the fresh fracture of the femoral neck. The levels of MIF protein and mRNA were evaluated by ELISA assay, immunofluorescence labeling, and real-time RT-PCR. Fibroblasts and macrophages were identified by immunofluorescence labeling.
The levels of MIF protein and mRNA were significantly increased, as well as the numbers of MIF+ fibroblasts and macrophages in the interfacial membranes compared with the control synovium.
Not only the macrophages, but also the fibroblasts in interfacial membranes overexpress MIF. MIF may play a significant role in the process of aseptic-loosening implants after total joint replacement.
Journal of Surgical Research 10/2011; 176(2):484-9. DOI:10.1016/j.jss.2011.09.047 · 2.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Chronic synovitis of knee joints that cannot be treated by conservative measure effectively can be treated successfully by the operations through resecting the inflamed synovium. The operations include open synovectomy and arthroscopic synovectomy. The purpose of this study is to compare the two operations in alleviating symptoms and cosmetic effect. There were 42 patients in this study, and they suffered from chronic synovitis of knee joints, including rheumatoid arthritis and non-specific synovitis. Twenty-two knees of 22 patients underwent arthroscopic synovectomy with two to five approaches whose lengths were about 1.0 cm, and 20 knees of 20 patients underwent open synovectomy with two approaches whose lengths were more than 10.0 cm. Patients were evaluated by visual analog scale for pain at the 24th hour after operation. Patients were followed up for 16-20 months and were evaluated by the Ogilvie-Harris scoring system. This study showed that both arthroscopic synovectomy and open synovectomy successfully alleviated the symptoms and the short-term results are similar after operation. However, the scars in the patients of the former group were much shorter than the latter group. Pain intensity of patients underwent arthroscopic synovectomy was less than that of open synovectomy at the 24th hour after operation. Both operations could treat chronic synovitis successfully. However, the arthroscopic synovectomy is the preferred operation due to fast recovery, less postoperative pain, and excellent cosmetic effect.
Rheumatology International 03/2011; 32(6):1733-6. DOI:10.1007/s00296-011-1901-3 · 1.63 Impact Factor