【摘要】 目的 分析异基因造血干细胞移植术（allogeneic hematopoietic stem cell transplantation，allo-HSCT）后出血性膀胱炎（hemorrhagic cystitis，HC）相关的危险因素，动态监测受者尿BK病毒（BK virus，BKV），分析其与HC发病的关系。 方法 回顾性分析2003年3月-2008年1月期间接受allo-HSCT的121例患者的资料，选择8个临床参数[年龄、性别、疾病类型、移植时疾病状态、供者类型、预处理方案、急性移植物抗宿主病（acute graft-versus-host disease，aGVHD）、aGVHD的预防方案]作COX回归分析。采用SYBR Green染料实时荧光定量聚合酶链反应法对2006年9月-2008年1月42例allo-HSCT患者尿BKV载量进行动态监测，分析被检查者尿液BKV基因载量与HC发生以及严重程度的关系。 结果 121例患者中有24例发生HC，发病时间为术后0~63 d，中位时间40 d；持续时间7~150 d，中位时间22 d。Ⅱ~Ⅳ度aGVHD为HC的独立危险因素[RR=8.304，95%CI（1.223，56.396），P=0.030]。allo-HSCT受者尿液中BKV检出率为100%（42/42）。与正常人及未发生HC的allo-HSCT受者相比，HC患者尿中BKV基因载量具有更高平均峰值。 结论 Ⅱ~Ⅳ度aGVHD，尿中BKV DNA高载量与HC的发生有相关性。【Abstract】 Objective To identify the risk factors for hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and define the quantitative relationship between BK virus (BKV) DNA load with HC. Methods The medical records of 121 patients undergoing allo-HSCT from March 2003 to January 2008 were retrospectively analyzed. Eight clinical parameters were selected for COX regression analysis, including age, sex, underlying disease, disease status at transplant, donor type, conditioning regimen, acute graft-versus-host disease (aGVHD), and GVHD prophylaxis. From September 2006 to January 2008, mid-stream urine samples were continuously collected from 42 patients with allo-HSCT. SYBR green real-time polymerase chain reaction, technique was utilized to define the quantitative relationship between BKV DNA load and HC. Results Twenty-four out of 121 patients developed HC. The median time of onset was 40 days after HSCT, ranged from 0 to 63 days. The disease lasted for 7 to 150 days, with a median duration of 22 days. Grade Ⅱ-Ⅳ aGVHD [RR=8.304, 95% CI (1.223,56.396); P=0.030] was identified as an independent risk factor for the occurrence of HC. BKV excretion was detected in 100% (42/42) of the recipients of allo-HSCT. When compared with asymptomatic patients and allo-HSCT recipients without HC, patients with HC had a significantly higher mean peak BKV DNA load. Conclusions Patients are at an increased risk of developing HC if they have grade Ⅱ-Ⅳ aGVHD. A correlation between the load of BKV and incidence of HC may exist.
ObjectiveTo explore the effectiveness of knee extensor mechanism reconstruction in the treatment of recurrent patellar subluxation with bone anchor in adolescents. MethodsBetween January 2010 and December 2013, 20 patients with patellar subluxation were treated by knee extensor mechanism reconstruction with bone anchor. There were 11 males and 9 females, aged from 12 to 17 years (mean, 15.3 years). The left knee was involved in 12 cases and the right knee in 8 cases. The disease duration was 5-10 years (mean, 7 years). All the patients had knee pain and lateral subluxation of the patella. Preoperative Lysholm knee score was 71.4±4.7. All the patients received the MRI examination to exclude menisci or ligaments lesion. CT examination showed the tibial tuberosity trochlear groove spacing ranged from 15 to 20 mm (mean, 17 mm). X-ray film examination indicated that no varus or valgus was observed, and bony structure was normal. ResultsAll the incisions healed at first stage. The patients received follow-up of 12-24 months (mean, 13 months). Knee pain occurred in 2 cases and were cured after symptomatic treatment. The axial X-ray films showed good position of the patella and normal anatomic relationship of the patellofemoral joint. No anchor loosening and pulling out, internal fixation failure, pseudoarthrosis formation, and postoperative recurrent patellar subluxation occurred during follow-up. At 1 year, the Lysholm knee score was significantly improved to 94.2±3.4 (t=22.705, P=0.000). According to Insall criterion, the results were excellent in 9 cases, good in 9 cases, and fair in 2 cases, with an excellent and good rate of 90%. ConclusionThe bone anchor for extensor mechanism reconstruction is a convenient and reliable way to treat the recurrent patellar subluxation, with a satisfactory early effectiveness and less complications; however, its long-term effectiveness is required a further follow-up.
ObjectiveTo investigate the heterotopic osteogenesis of tissue engineered bone using the co-culture system of vascular endothelial cells (VECs) and adipose-derived stem cells (ADSCs) as seed cells.MethodsThe partially deproteinized biological bone (PDPBB) was prepared by fibronectin combined with partially deproteinized bone (PDPB). The ADSCs of 18-week-old Sprague Dawley (SD) rats and VECs of cord blood of full-term pregnant SD rats were isolated and cultured. Three kinds of tissue engineered bone were constructed in vitro: PDPBB+VECs (group A), PDPBB+ADSCs (group B), PDPBB+co-cultured cells (VECs∶ADSCs was 1∶1, group C), and PDPBB was used as control group (group D). Scanning electron microscopy was performed at 10 days after cell transplantation to observe cell adhesion on scaffolds. Forty-eight 18-week-old SD rats were randomly divided into groups A, B, C, and D, with 12 rats in each group. Four kinds of scaffolds, A, B, C, and D, were implanted into the femoral muscle bags of rats in corresponding groups. The animals were killed at 2, 4, 8, and 12 weeks after operation for gross observation, HE staining and Masson staining histological observation, and the amount of bone collagen was measured quantitatively by Masson staining section.ResultsScanning electron microscopy showed that the pores were interconnected in PDPB materials, and a large number of lamellar protein crystals on the surface of PDPBB modified by fibronection were loosely attached to the surface of the scaffold. After 10 days of co-culture PDPBB and cells, a large number of cells attached to PDPBB and piled up with each other to form cell clusters in group C. Polygonal cells and spindle cells were mixed and distributed, and some cells grew along bone trabeculae to form cell layers. Gross observation showed that the granulation tissue began to grow into the material pore at 2 weeks after operation. In group C, a large number of white cartilage-like substances were gradually produced on the surface of the material after 4 weeks, and the surface of the material was uneven. At 12 weeks, the amount of blood vessels on the surface of group A increased, and the material showed consolidation; there was a little white cartilage-like material on the surface of group B, but the pore size of the material did not decrease significantly; in group D, the pore size of the material did not decrease significantly. Histological observation showed that there was no significant difference in the amount of bone collagen between groups at 2 weeks after operation (F=2.551, P=0.088); at 4, 8, and 12 weeks after operation, the amount of bone collagen in group C was significantly higher than that in other 3 groups, and that in group B was higher than that in group D (P<0.05); there was no significant difference between group A and groups B, D (P>0.05).ConclusionThe ability of heterotopic osteogenesis of tissue engineered bone constructed by co-culture VECs and ADSCs was the strongest.
ObjectiveTo evaluate the performance, safety, and precision of the Yuanhua robotic-assisted total knee arthroplasty system (YUANHUA-TKA) through animal experiments, which will provide reference data for human clinical trials.MethodsSix 18-month-old goats, weighing 30-35 kg, were used in this study. The experimental study was divided into two parts: the preoperative planning and intraoperative bone resection. CT scans of the goats’ lower extremities were firstly performed before the experiments. Then the CT scans were segmented to generate the femoral and tibial three-dimensional (3D) models in the YUANHUA-TKA system. The volumes and angles of each resection plane on the femur and tibia were planned. The bone resection was finally implemented under the assistance of the YUANHUA-TKA system. After completing all bone resections, the lower extremities of each goat were taken to have CT scans. By comparing the femoral and tibial 3D models before and after the experiments, the actual bone resection volumes and angles were calculated and compared with the preoperative values.ResultsDuring the experiments, no abnormal bleeding was found; the YUANHUA-TKA system ran smoothly and stably and was able to stop moving and keep the osteotomy in the safe zone all the time. After the experiment, the resection planes were observed immediately and found to be quite flat. There was no significant difference between the planned and actual osteotomy thickness and osteotomy angle (P>0.05); the error of the osteotomy thickness was less than 1 mm, and the error of the osteotomy angle was less than 2°.ConclusionThe YUANHUA-TKA system can assist the surgeons to perform osteotomy following the planned thickness and angle values. It is expected to assist surgeons to implement more accurate and efficient osteotomy in the future clinical applications.
ObjectiveTo investigate the effectiveness of the posterior-posterior triangulation technique for arthroscopic posterior cruciate ligament (PCL) reconstruction by comparing with the anteroposterior approach.MethodsRetrospective analysis was performed on 40 patients who underwent arthroscopic PCL reconstruction between February 2016 and February 2020. The PCLs were reconstructed via anteroposterior approach in 20 patients (anteroposterior approach group) and posterior-posterior triangulation technique in 20 patients (posterior-posterior triangulation technique group). There was no significant difference in gender, age, cause of injury, injury side, disease duration, preoperative International Knee Documentary Committee (IKDC) score, and Lysholm score between the two groups (P>0.05). The operation time, surgical complications, and postoperative posterior drawer test, Lysholm score, and IKDC score were recorded and compared between the two groups.ResultsThe operation time was (65.25±10.05) minutes in the anteroposterior approach group and (56.15±8.15) minutes in the posterior-posterior triangulation technique group, and the difference was significant (t=3.145, P=0.003). All incisions healed by first intention, and there was no complication such as vascular and nerve injuries or infection. Patients were followed up (27.05±11.95) months in the anteroposterior approach group and (21.40±7.82) months in the posterior-posterior triangulation technique group, with no significant difference (t=1.770, P=0.085). At last follow-up, the posterior drawer tests were positive in 4 cases (3 cases of stageⅠand 1 case of stage Ⅱ) of the anteroposterior approach group and in 1 case (stageⅠ) of the posterior-posterior triangulation technique group, showing no significant difference between the two groups (P=0.342). At last follow-up, Lysholm score and IKDC score in both groups were significantly higher than those before operation (P<0.05). The above functional scores in the posterior-posterior triangulation technique group were significantly higher than those in the anteroposterior approach group (P<0.05). Imaging reexamination showed that the position, shape, and tension of the grafts were well in both groups, and the grafts were covered with the synovium in the posterior-posterior triangulation technique group, the meniscofemoral ligaments were well preserved. There was no re-rupture of the reconstructed ligament during follow-up.ConclusionCompared to the anteroposterior approach, the posterior-posterior triangulation technique provides a clearer view under arthroscopy, no blind spot, sufficient operating space, and relative safety. Moreover, it is easier to retain the remnant and the meniscofemoral ligaments, and can obtain good short-term effectiveness.
Objective To investigate the changes of knee joint kinematics after anterior cruciate ligament (ACL) reconstruction assisted by personalized femoral positioner based on the apex of deep cartilage (ADC). Methods Between January 2021 and January 2022, a total of 40 patients with initial ACL rupture who met the selection criteria were randomly divided into the study group (using the personalized femoral positioner based on ADC design to assist ACL reconstruction) and the control group (not using the personalized femoral positioner to assist ACL reconstruction), with 20 patients in each group. Another 20 volunteers with normal knee were collected as a healthy group. There was no significant difference in gender, age, body mass index, and affected side between groups (P>0.05). Gait analysis was performed at 3, 6, and 12 months after operation using Opti _ Knee three-dimensional knee joint motion measurement and analysis system, and the 6 degrees of freedom (flexion and extension angle, varus and valgus angle, internal and external rotation angle, anteroposterior displacement, superior and inferior displacement, internal and external displacement) and motion cycle (maximum step length, minimum step length, and step frequency) of the knee joint were recorded. The patients’ data was compared to the data of healthy group. Results In the healthy group, the flexion and extension angle was (57.80±3.45)°, the varus and valgus angle was (10.54±1.05)°, the internal and external rotation angle was (13.02±1.66)°, and the anteroposterior displacement was (1.44±0.39) cm, the superior and inferior displacement was (0.86±0.20) cm, and the internal and external displacement was (1.38±0.39) cm. The maximum step length was (51.24±1.29) cm, the minimum step length was (45.69±2.28) cm, and the step frequency was (12.45±0.47) step/minute. Compared with the healthy group, the flexion and extension angles and internal and external rotation angles of the patients in the study group and the control group decreased at 3 months after operation, and the flexion and extension angles of the patients in the control group decreased at 6 months after operation, and the differences were significant (P<0.05); there was no significant difference in the other time points and other indicators when compared with healthy group (P>0.05). In the study group, the flexion and extension angles and internal and external rotation angles at 6 and 12 months after operation were significantly greater than those at 3 months after operation (P<0.05), while there was no significant difference in the other indicators at other time points (P>0.05). There was a significant difference in flexion and extension angle between the study group and the control group at 6 months after operation (P<0.05), but there was no significant difference of the indicators between the two groups at other time points (P>0.05).Conclusion Compared with conventional surgery, ACL reconstruction assisted by personalized femoral positioner based on ADC design can help patients achieve more satisfactory early postoperative kinematic results, and three-dimensional kinematic analysis can more objectively and dynamically evaluate the postoperative recovery of knee joint.
Objective To study the feasibility of virtual intercondylar notchplasty by applying MRI two-dimensional (2D) images to reconstruct three-dimensional (3D) images and measure the size of intercondylar notch. Methods Thirty healthy volunteers who had no knee joint disease and surgery history were selected. There were 15 females and 15 males with an age range of 20-30 years, weight range of 45-74 kg, and height range of 150-185 cm. They were divided into male group and female group, and the knees of each group were divided into 2 subgroups (the left group and right group). MRI scan of the left and right knees was performed, and the 2D images of MRI were imported into Mimics10.01 medical image control system for 3D reconstruction. The related anatomical data as follows were measured from the 3D digital model and analyzed by statistical software: notch width (NW), condylar width (CW), and notch width index (NWI). Then the 3D knee images of patients with anterior cruciate ligament (ACL) injury were collected between January and March 2010, and 4 patients with narrow intercondylar notch (NWI≤0.2) were selected for reconstructing the 3D model of the knee and simulating the intercondylar notch plasty. Then, the volume of osteotomy in 3D model was calculated and applied in the ACL reconstruction surgery, and whether the graft had impingement with intercondylar notch or not was evaluated. Results There were significant differences in NW and CW between male group and female group (P≤lt;≤0.05), but no significant difference was found in the NWI (P≤gt;≤0.05). And there was no significant difference in NW, CW, and NWI between the left and right knees both in male group and female group (P≤gt;≤0.05). After ACL reconstruction and intercondylar notchplasty, the shape of intercondylar notch became normal (NWI≤gt;≤0.22), no impingement occurred between the graft and intercondylar notch under arthroscopy within 3-month follow-up. Conclusion The shape of intercondylar notch of 3D model based on MRI 2D images is similar to the real intercondylar notch. NWI is one of important indexes which can reflect the narrow level of intercondylar notch. The virtual intercondylar notchplasty may provide preoperative plan and guidence for ACL reconstruction operation to avoid the impingement between graft and intercondylar notch after surgery.
【摘要】 目的 研究以万珂为主化学疗法方案提高多发性骨髓瘤初发患者自体外周血造血干细胞采集的作用。 方法 回顾性分析2006年1月-2010年11月4例初发多发性骨髓瘤患者在万珂治疗后自体外周血造血干细胞采集的临床资料。疗效判定依据国际骨髓瘤工作组2006年疗效判断标准。 结果 经过万珂为主化学疗法方案治疗3~6个疗程（平均4个疗程）后，3例获得CR及以上疗效，均顺利实施了外周血造血干细胞采集；3例采集次数仅1次，1例为2次；平均获得CD34+细胞8.43×106/kg，完全达到采集要求。 结论 万珂为主化学疗法方案起效快、疗效好，可以提高初发多发性骨髓瘤患者的干细胞采集率。【Abstract】 Objective To explore the improvement of autologous stem cells collection in patients with newly-diagnosed multiple myeloma after Velcade-based chemotherapy. Methods The clinical data of four patients with multiple myeloma who underwent Velcade-based chemotherapy between January 2006 and November 2010 were retrospectively analyzed. The therapeutic effect was observed. Results After 3-6 courses (mean 4 courses) of Velcade-based chemotherapy, 3 patients obtained complete remission (CR) and above response, and the sufficient peripheral blood hematopoietic stem cells were collected successfully. The peripheral blood hematopoietic stem cells were collected once in three patients and twice in one patient. Sufficient number of hematopoietic stem cells (mean CD34 positive-cell 8.43×106/kg) were collected which fully met the collection requirements. Conclusion Velcade-based chemotherapy has advantages of fast action and good therapeutic effect, which can improve the collection of autologous stem cells in patients with newly-diagnosed multiple myeloma.