[Show abstract][Hide abstract] ABSTRACT: Percutaneous (minimally invasive) suturing is a promising option for Achilles tendon (AT) repair with low rerupture and infection rates. Sural nerve lesions are the major problem to avoid with the technique. A new device was therefore designed for suturing the AT, resulting in channel-assisted minimally invasive repair (CAMIR). The purpose of this study was to compare the clinical and functional outcomes of CAMIR with traditional open techniques.
Eighty two patients with AT rupture were included: 41 for CAMIR, 41 for open repair. All patients followed a standardized rehabilitation protocol. Follow-ups were at 12 and 24 months after surgery. Functional evaluation was based on the clinical American Orthopaedic Foot & Ankle Society score associated with neurologic deficit (sural nerve), calf circumference, range of motion (ROM), and isometric testing.
There was no difference between groups regarding plantar flexor strength, ankle ROM, or calf circumference. CAMIR significantly decreased the operative time compared to open repair (17 vs. 56 min, P < 0.0001). Mean scar length was greater in the open repair group (10 vs. 2 cm, P < 0.0001). There were no wound complications in the CAMIR group but four in the open repair group (P < 0.0001). No deep vein thrombosis, rerupture, or sural nerve injury occurred.
CAMIR and open repair yielded essentially identical clinical and functional outcomes. Sural nerve injuries can be minimized using CAMIR by carefully placing the suture channel with a stab incision and special trocar based on a modified Bunnell suture technique.
Preview · Article · Dec 2015 · Journal of Orthopaedic Surgery and Research
[Show abstract][Hide abstract] ABSTRACT: Background: This study aimed to develop a novel sealant gel and intravascular hollow soluble stent for nonsuture anastomosis of the carotid artery. Methods: New Zealand white rabbits received carotid artery anastomosis using this sealant gel, adhesive (cyanoacrylate), and stent. The control groups received either suture anastomosis or adhesive anastomosis but without this sealant gel. Biomechanical properties were compared between the adhesive and suture anastomoses. Patency of the carotid artery was monitored using Doppler ultrasonography until postoperative 5 months. Results: The adhesive group had significantly shorter anastomosis time than the suture group (4.8 ± 0.8 vs. 26.8 ± 7.1 min; P < 0 01). The adhesive anastomoses had significantly higher maximum stretching force (1.066 ± 0.193 vs. 0.586 ± 0.098; P < 0.05) and burst pressure (46.2 ± 7.95 vs. 28.56 ± 2.108; P < 0.01) than the suture anastomoses. All the arteries anastomosed using only the adhesive but not the sealant gel developed thromboses within 1 week after the surgery. However, only 3 out of 10 animals receiving anastomosis using both the sealant gel and adhesive developed thromboses. Conclusions: This novel sealant gel and hollow soluble stent can effectively prevent the infiltration of adhesive, and thus significantly decrease the risk of thrombosis. The adhesive anastomosis has significantly better biomechanical properties than the suture anastomosis.
No preview · Article · Nov 2015 · Journal of Biomaterials and Tissue Engineering
[Show abstract][Hide abstract] ABSTRACT: Background:
The aim of this study is to explore the clinical outcomes of anatomical allograft or fibula shaft augmentation with locking compression plates (LCPs) in elderly patients with four-part proximal humeral fracture (PHF).
A total of 22 elderly patients with four-part PHF underwent allograft augmentation with LCPs for treatment. Among them, 7 cases received anatomical allograft and 15 patients received fibula shaft. Constant-Murley score (CMS), the disability of the arm, shoulder and hand (DASH) score, and subjective ratings, radiographic imaging, range of motion (ROM), and complications were recorded as postoperative evaluations.
Although the ROM and strength were considerably limited compared with the normal side, there were no significant differences in pain and daily activity between the unaffected and affected sides at the last follow-up according to the CMS. Additionally, no significant differences were found in the subjective ratings and CMS and DASH scores between the patients augmented with fibular shaft and anatomical allograft. Among the 15 patients who received fibular shaft, one case developed avascular necrosis (AVN) and screw cutout, but satisfactory outcomes were obtained after removal of implant. Besides, varus displacement occurred in one case, the patient acquired good function without revision. There were no infection, bone nonunion, and hardware-related complications occurred in any case.
Both anatomical allograft and fibula shaft with LCPs showed relatively good clinical outcomes for elderly patients with four-part PHF.
Preview · Article · Jul 2015 · Journal of Orthopaedic Surgery and Research
[Show abstract][Hide abstract] ABSTRACT: Objective
To compare treatment results, complication rates between lateral and posterior approaches in surgical treatment of extra-articular distal humeral shaft fractures.
Material and methods
Between June 2008 and May 2012, a total of 56 patients with extra-articular distal humeral shaft fractures were treated by lateral and posterior approaches. 30 patients were operated by a lateral approach (Group I), and 26 patients were operated by a posterior approach (Group II). There was no statistical significance between the two groups in sex distribution, age, the mechanism of the injury, injured arms, AO/ASIF classification and the time from injury to surgery. (P > 0.05). Operation time, intraoperative bleeding volume, hospitalization, clinical outcomes and complications were compared between the two groups. The elbow functional results were evaluated by the Mayo Elbow Performance Score (MEPS).
All patients were followed up. The average of follow-up in Group I was 15.53 ± 2.636 months (range, 12-22 months), and in Group II was 16.12 ± 2.889 months (range, 12-22 months). There was no significant difference in the operation time, intraoperative bleeding time and hospitalization between the two groups (P > 0.05). In Group I, the mean time of bone union was 12.87 ± 1.852 weeks (range, 10-16 weeks), the mean degrees of elbow flexion was 139.20°±3.274° (range, 134°-146°), the mean degrees of elbow extension was 4.77°±1.906° (range, 0°-8°), and the mean points of MEPS was 87.00 ± 7.724(range, 70-100 points). In Group II, the mean time of bone union was 12.96 ± 2.218 weeks (range, 10-16 weeks), the mean degrees of elbow flexion was 137.85°±4.076° (range, 130°-145°), the mean degrees of elbow extension was 5.15°±2.327° (range, 0°-9°), and the mean points of MEPS was 86.15 ± 7.656 (range, 70-100 points). There was no significant difference in the bone union, range of elbow flexion, range of elbow extension and MEPS between the two groups (P > 0.05). The overall complication rate in Group I was lower than those in Group II (P = 0.041).
Both lateral and posterior surgical approaches acquired satisfied treatment results in management of extra-articular distal humeral shaft fractures, and there was a lower complication rate using the lateral approach.
[Show abstract][Hide abstract] ABSTRACT: Self and mutual-aiding occlusive dressing is a novel method to treat with the wounds in special circumstances. This study aims to prepare a new antimicrobial adhesive for the dressing and evaluate the application effects of the adhesive.
The main component of the new antimicrobial adhesive was 5% triclosan / cyanoacrylate (CA) antimicrobial adhesive. The adhesive was modified with carboxylic multi-walled carbon nanotubes (MWCNTs-COOH), multi-walled carbon nanotubes (MWCNTs), hydrophobic nano-silica, nitrile rubber, epoxy resin and polymethyl methacrylate (PMMA) respectively. The bond strength, toughness and viscosity of the modified adhesive in different concentrations were examined to select the optimal modifying material and the best ratio to prepare the new antimicrobial adhesive according to the results. After that, the antimicrobial property of the new antimicrobial adhesive was tested by filter paper method. At last, we disposed the injury models in rats using the new antimicrobial adhesive to examine the application effects.
In individual tests, the bond strength modification performance of 0.064% MWCNTS-COOH is the best, the bond strength is (14.71±1.48) Mpa. 8% nano-silica shows the best toughness modification performance, the Tg is (1.10±0.24)°C. The viscosity modification performance of 8% nano-silica is the best, the viscosity is (15 536.68±28.4) cP. However, consolidating three test results, 6% nano-silica/antimicrobial adhesive has the balanced bond strength, toughness and viscosity. Its bond strength is (14.03±1.92) Mpa, the Tg is (3.60±0.68)°C, and the viscosity is (5 278.87±31.68) cP. The inhibition zone diameter of 6% nano-silica/antimicrobial adhesive and antimicrobial adhesive group in Day 5 is (28.61±0.91) mm versus (28.24±2.69) mm (P > 0.05). In animal studies, both in blood routine test and pathological section, 6% nano-silica/antimicrobial adhesive group shows lower white blood cells count than gauze bandage group (P < 0.05).
6% nano-silica has the optimal effect of bond strength modification, toughness modification and viscosity modification, and the antimicrobial adhesive modified with it has a good antimicrobial property (resistant staphylococcus aureus).
No preview · Article · Apr 2014 · Chinese medical journal
[Show abstract][Hide abstract] ABSTRACT: When repairing nerves with adhesives, most researchers place glue directly on the nerve stumps, but this method does not fix the nerve ends well and allows glue to easily invade the nerve ends. In this study, we established a rat model of completely transected sciatic nerve injury and repaired it using a modified 1 cm-length conduit with inner diameter of 1.5 mm. Each end of the cylindrical conduit contains a short linear channel, while the enclosed central tube protects the nerve ends well. Nerves were repaired with 2-octyl-cyanoacrylate and suture, which complement the function of the modified conduit. The results demonstrated that for the same conduit, the average operation time using the adhesive method was much shorter than with the suture method. No significant differences were found between the two groups in sciatic function index, motor evoked potential latency, motor evoked potential amplitude, muscular recovery rate, number of medullated nerve fibers, axon diameter, or medullary sheath thickness. Thus, the adhesive method for repairing nerves using a modified conduit is feasible and effective, and reduces the operation time while providing an equivalent repair effect.
No preview · Article · Mar 2014 · Neural Regeneration Research
[Show abstract][Hide abstract] ABSTRACT: Currently, adhesive technique is popular in vascular repair but not widely used for defective vessels. This study aimed to determine the feasibility and effectiveness of repairing defective vessels with 2-octyl-cyanoacrylate and a homemade prosthetic component.
Homemade prosthetic component consisting of expanded polytetrofluoroethylene (ePTFE), terylene film, and homemade soluble hollow stent mixed with adhesive can replace autologous graft and suture in repairing defective vessels, can fix vessels better using the stent without occlusive bleeding. Forty male mongrel dogs were used, 20 for biomechanical tests and 20 for animal experiments. In the biomechanical test, dogs were randomly divided into two groups (n = 10 each), one group repaired on the two sides of the carotid arteries with 2-octyl-cyanoacrylate and homemade component and another group repaired with suture and ePTFE. Of the 40 specimens, 10 were used for adhesive and 10 for suture specimens for tension strength test, whereas the remaining specimens were used for bursting pressure test. In animal experiments, dogs were also divided into adhesive and suture groups (n = 10), only of the left carotid artery. Recording the operational time, bleeding or not. Vessels were tested using color Doppler ultrasound, the inner diameter was measured, and the degree of stenosis at 8 weeks was evaluated digital subtraction angiography (DSA) were also performed. Specimens were then analyzed histologically.
In the adhesive and suture groups, the specimens could afford atension strength of (23.80±1.51) N versus (24.60±1.08) N (P > 0.05), the bursting pressure was (52.03±2.43) kPa versus (50.04±3.51) kPa (P > 0.05), and the mean time of anastomosis was (15.20±0.55) minutes versus (25.97±0.58) minutes (P < 0.05). One dog in the adhesive group was bleeding from the suture. One dog from each group presented with thrombosis at 1 week. After measuring using ultrasound, the stenosis degree of all dogs were no more than 30% except the two thromboses. DSA and histological observation showed no obvious difference between the two groups.
Defective vascular anastomosis with 2-octyl-cyanoacrylate and our homemade prosthetic component is feasible, effective, timesaving, and easy to master.
No preview · Article · Mar 2014 · Chinese medical journal
[Show abstract][Hide abstract] ABSTRACT: To compare the effectiveness between locking compression plate (LCP) and locked intramedullary nail (IMN) for humeral shaft fractures of types B and C.
Between January 2010 and January 2012, 46 patients with humeral shaft fractures of types B and C were treated, and the clinical data were retrospectively analyzed. LCP was used for internal fixation in 22 cases (LCP group), and IMN in 24 cases (IMN group). There was no significant difference in gender, age, injury causes, the side of fracture, the site of fracture, the type of fracture, associated injury, and time from injury to operation between 2 groups (P > 0.05). The regular clinical examination and evaluation of radiography were done. Shoulder function was evaluated by Neer grading system and elbow function was evaluated by Mayo elbow performance score after operation.
The operation time and intraoperative blood loss in IMN group were significantly lower than those in LCP group (P < 0.05). There was no significant difference in hospitalization time between 2 groups (t=0.344, P=0.733). All patients were followed up 16.8 months on average (range, 12-24 months). At 6 months after operation, bone nonunion occurred in 1 patient of LCP group and in 2 patients of IMN group; the bone healing rate was 95.5% (21/22) in LCP group and 91.7% (22/24) in IMN group, showing no significant difference (chi2=0.000, P=1.000). Except for nonunion patients, the bone healing time was (11.77 +/- 0.75) weeks in LCP group and (11.38 +/- 0.82) weeks in IMN group, showing no significant difference (t=1.705, P=0.095). Between LCP and IMN groups, significant differences were found in radial nerve injury (4 cases vs. 0 case) and impingement of shoulder (0 case vs. 6 cases) (P < 0.05), but no significant difference in superficial infection (1 case vs. 0 case) and iatrogenic fracture (1 case vs. 2 cases) (P > 0.05). There was no significant difference in shoulder function and elbow
LCP fixation and IMN fixation for humeral shaft function at 1 year after operation between 2 groups (P > 0.05). fractures of types B and C can achieved satisfactory results. More attention should be paid to avoiding radial nerve injury by fixation of LCP; nail tail should be buried deeply into the cortex of the greater tuberosity and rotator cuff should be protected to decrease the rate of impingement of shoulder by fixation of IMN.
Full-text · Article · Dec 2013 · Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to assess a new soluble hollow stent used in an experimental sutureless adhesive bonding technique for microvascular anastomosis. Twenty-four New Zealand white rabbits were randomized into 2 groups. Twelve end-to-end anastomoses of carotid arteries were performed with glue and stent in group A. In control group B, 12 anastomoses were performed by manual suturing. Anastomoses were timed; immediate and late patency at 1 day, 7 days, and 3 weeks after surgery were evaluated by ultrasonography. Specimens were then analyzed histologically. This adhesive bonding technique took 7.02 ± 1.26 minutes to perform while the hand-sewn technique took 15.48 ± 2.10 minutes. Immediate and late patencies of the 2 groups were not statistically different. The new technique using glue and stent appeared to be timesaving, feasible, and efficient.
No preview · Article · Sep 2013 · The Journal of craniofacial surgery
[Show abstract][Hide abstract] ABSTRACT: The present study utilized samples from bilateral motor branches of the femoral nerve, as well as saphenous nerves, ventral roots, and dorsal roots of the spinal cord, to detect differential protein expression using two-dimensional gel electrophoresis and nano ultra-high performance liquid chromatography electrospray ionization mass spectrometry tandem mass spectrometry techniques. A mass spectrum was identified using the Mascot search. Results revealed differential expression of 11 proteins, including transgelin, Ig kappa chain precursor, plasma glutathione peroxidase precursor, an unnamed protein product (gi|55628), glyceraldehyde-3-phosphate dehydrogenase-like protein, lactoylglutathione lyase, adenylate kinase isozyme 1, two unnamed proteins products (gi|55628 and gi|1334163), and poly(rC)-binding protein 1 in motor and sensory nerves. Results suggested that these proteins played roles in specific nerve regeneration following peripheral nerve injury and served as specific markers for motor and sensory nerves.
No preview · Article · Feb 2012 · Neural Regeneration Research
[Show abstract][Hide abstract] ABSTRACT: To compare the effectiveness of internal fixation, hemiarthroplasty, and total hip arthroplasty in the treatment of displaced femoral neck fractures in elderly patients so as to provide the evidence for the selection of therapeutic methods.
Between May 2005 and April 2008, 108 elderly patients with displaced femoral neck fractures were treated by internal fixation with compression screw (IF group, n = 31), hemiarthroplasty (HA group, n = 37), and total hip arthroplasty (THA group, n = 40). In IF group, there were 8 males and 23 females with an average age of 73 years (range, 65-80 years); fractures were caused by tumbling (25 cases) and traffic accident (6 cases), including 17 cases of Garden type III and 14 cases of Garden type IV; and the time from injury to operation ranged from 8 hours to 13 days with an average of 4.2 days. In HA group, there were 10 males and 27 females with an average age of 74 years (range, 65-80 years); fractures were caused by tumbling (29 cases) and traffic accident (8 cases), including 21 cases of Garden type III and 16 cases of Garden type IV; and the time from injury to operation ranged from 1 to 14 days with an average of 4.4 days. In THA group, there were 11 males and 29 females with an average age of 73 years (range, 66-80 years); fractures were caused by tumbling (32 cases) and traffic accident (8 cases), including 23 cases of Garden type III and 17 cases of Garden type IV; and the time from injury to operation ranged from 2 to 14 days with an average of 5.6 days. There was no significant difference in general data among 3 groups (P > 0.05).
There were significant differences in operation time and blood loss among 3 groups (P < 0.05), and IF group was less than other 2 groups. All patients were followed up 1 year and 4 months to 2 years and 3 months with an average of 1 year and 8 months. In IF group, HA group, and THA group, the rates of early postoperative complications were 19.4% (6/31), 8.1% (3/37), and 7.5% (3/40), respectively; the rates of late postoperative complications were 29.0% (9/31), 13.5% (5/37), and 7.5% (3/40), respectively; and the reoperation rates were 29.0% (9/31), 10.8% (4/37), and 5.0% (2/40), respectively. The rates of the early postoperative complication, late postoperative complication, and reoperation rate were significantly higher in IF group than in HA group and THA group (P < 0.05), but there was no significant difference between HA group and THA group (P > 0.05). The mortality rates were 16.1% (5/31), 13.5% (5/37), and 15.0% (6/40) in IF group, HA group, and THA group, respectively; showing no significant difference (P > 0.05). According to Harris hip score, the excellent and good rates were 65.4% (17/26), 81.3% (26/32), and 85.3% (29/34) in IF group, HA group, and THA group, respectively; showing significant differences among 3 groups (P < 0.05).
According to patient's age, life expectancy, and general conditions, THA is a reasonable choice for the patients aged 65-80 years with displaced femoral neck fracture.
No preview · Article · Dec 2010 · Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery
[Show abstract][Hide abstract] ABSTRACT: To investigate the surgical treatment effectiveness of acetabular transverse and posterior wall fractures by Kocher-Langenbeck approach.
Between January 2002 and February 2009, 17 patients with acetabular transverse and posterior wall fractures were treated with Kocher-Langenbeck approach and fracture reduction and fixation. There were 12 males and 5 females with an average age of 33.4 years (range, 20-65 years). The disease causes were traffic accident in 16 cases and falling from height in 1 case. The disease duration was 6 hours to 11 days. According to Letournel classification, all fractures were rated as acetabular transverse and posterior wall fractures. Concomitant injuries included posterior hip dislocation in 3 cases, fracture of extremities in 8 cases, injury of sciatic nerve in 3 cases, craniocerebral injury in 1 case, and lienal rupture in 1 case.
The incisions healed primarily and no complication of infection and deep venous thrombosis occurred after operation. All patients were followed up 12 to 36 months with an average of 19 months. The X-ray films showed that fracture healed 3 to 5 months after operation. After operation, anatomic reduction was found in 9 cases, satisfactory reduction in 5 cases, and unsatisfactory reduction in 3 cases according to Matta et al criterion. According to modified grading system of Merle D'Aubigne and Postel, the results were excellent in 4 cases, good in 9, fair in 3, and poor in 1 at last follow-up with an excellent and good rate of 76.5%. The nerve function was recovered in patients with sciatic nerve injury at 12 months after symptomatic treatment. Traumatic arthritis occurred in 5 cases, avascular necrosis of the femoral head in 1, and heterotopic ossification in 5 between 9 weeks and 12 months after operation.
For acetabular transverse and posterior wall fractures, it is important to make adequate preoperative preparation, to get the imaging data, and to perform open reduction and internal fixation with Kocher-Langenbeck approach as early as possible.
No preview · Article · Dec 2010 · Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery