Objective To summarize operative procedure and the effectiveness of open reduction with internal fixation or radial head replacement for the treatment of Essex-Lopresti injury. Methods Between November 2002 and October 2010, 10 patients with Essex-Lopresti injury were treated. There were 8 males and 2 females with a mean age of 36 years (range, 20-56 years). Eight cases were fresh closed fracture within 2 days. According to Mason classification, 5 fracture were typeII, 3 were type III. The other 2 cases were old fracture within 3 months. Wrist joint X-ray revealed that all the patients had distal radioulnar joint dislocation. Open reduction with internal mini-plate or absorbable screw fixation was performed in 5 cases, and radial head replacement in 5 cases; meanwhile, the distal radioulnar joint was reducted and fixed. Results All incisions healed by first intention without infection or bone nonunion. The patients were followed up 7 to 24 months with an average of 14.7 months. The X-ray films showed fracture heal ing at 9-20 weeks (mean, 16.3 weeks); distal radioulnar joint was stable without shortening or shift of proximal radius. According to elbow cl inical evaluation system, the results were excellent in 5 cases, good in 3 cases, and fair in 2 cases. According to wrist cl inical evaluation, the results were excellent in 7 cases, good in 2 cases, and fair in 1 case. All patients had good elbow stabil ity, and recovered quickly. Conclusion Early diagnosis, operation, and functional exercises are important to obtain an excellent result in treating Essex-Lopresti injury.
ObjectiveTo investigate the mechanisms,diagnosis,and surgical procedures of simultaneous lesions of the rotator cuff and the brachial plexus. MethodsBetween July 2006 and June 2012,7 patients with rotator cuff tear associated with brachial plexus injury were treated.There were 3 males and 4 females with a mean age of 47.3 years (range,37-72 years).The reasons of injury were traumatic shoulder dislocation in 6 cases and falling injury from height in 1 case,with a mean disease duration of 17 days (range,5-31 days).The average American Shoulder and Elbow Surgeons (ASES) score was 55.86±9.42,and visual analogue scale (VAS) score was 7.14±1.35.There were 3 cases of large rotator cuff tears (>3 cm) and 4 cases of massive rotator cuff tears (>5 cm) according to Gerber standard;1 case had upper trunk injury of the brachial plexus and 6 cases had bundle branch injury of the brachial plexus according to GU Yudong's classification.The functional score of brachial plexus score was 7.43±1.27 according to the functional assessment standard by Hand Surgery Branch of Chinese Medical Association.All patients accepted arthroscopic rotator cuff repairing,and 1 case received surgical neurolysis of brachial plexus. ResultsAll incisions healed by first intention without complication.All the 7 patients were followed up 18 to 25 months (mean,20.4 months).The function,muscle strength,and sensation of the shoulder were improved obviously.The shoulder ASES score was 84.71±8.06 and was significantly better than preoperative score (t=-8.194,P=0.000).The VAS score was 2.71±1.50 and was significantly better than preoperative score (t=7.750,P=0.000).The functional score of brachial plexus was 14.00±1.16 and was significantly better than preoperative score (t=-11.500,P=0.000). ConclusionIt is difficult to simultaneously diagnose lesions of the rotator cuff and the brachial plexus;orthopedists should pay attention to possible patients to avoid missed diagnosis and diagnostic errors.Nerve nutrition,physical therapy,and arthroscopic rotator cuff repair can achieve good effectiveness.
Objective To compare the effectiveness of arthroscopic and open ankle arthrodeses. Methods The clinical data were retrospectively analyzed from 30 patients undergoing unilateral ankle arthrodesis between January 2008 and January 2011. Of 30 patients, 14 underwent arthroscopic ankle arthrodesis (arthroscopic group), and 16 underwent open ankle arthrodesis (open group). There was no significant difference in gender, age, lesion type, disease duration, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score between 2 groups (P gt; 0.05). The operation time, intraoperative blood loss, postoperative hospitalization days, postoperative AOFAS score, and bony union rate were observed to evaluate the effectiveness. Results The operation time of arthroscopic group was significantly longer than that of open group (P lt; 0.05); the intraoperative blood loss and postoperative hospitalization days of arthroscopic group were significantly less than those of open group (P lt; 0.05). Superficial infection of incision occurred in 1 case of open group, and healing of incision by first intention was obtained in the other patients. All patients were followed up 12 months. No screw breakage was observed. The X-ray films showed bony fusion in 13 cases (92.86%) of arthroscopic group and in 10 cases (62.50%) of open group at 3 months after operation, showing significant difference (χ2=3.850, P=0.049); but no significant difference was found (χ2=0.910, P=0.341) in bony fusion rate between the arthroscopic group (14/14, 100%) and open group (15/16, 93.75%) at 12 months after operation. The AOFAS scores at 1, 3, 6, and 12 months after operation were significantly higher than preoperative score in 2 groups (P lt; 0.05). There was no significant difference in AOFAS score between 2 groups at 1 and 3 months (P gt; 0.05), but significant differences were found at 6 and 12 months (P lt; 0.05). Conclusion The overall effectiveness of arthroscopic ankle arthrodesis is better than that of open ankle arthrodesis, which can decrease intraoperative blood loss, shorten hospitalization days, get higher bony fusion rate, and obtain good ankle function recovery.
Objective To investigate the effect of M2 microglia (M2-MG) transplantation on spinal cord injury (SCI) repair in mice. Methods Primary MG were obtained from the cerebral cortex of 15 C57BL/6 mice born 2-3 days old by pancreatic enzyme digestion and identified by immunofluorescence staining of Iba1. Then the primary MG were co-cultured with interleukin 4 for 48 hours (experimental group) to induce into M2 phenotype and identified by immunofluorescence staining of Arginase 1 (Arg-1) and Iba1. The normal MG were harvested as control (control group). The dorsal root ganglion (DRG) of 5 C57BL/6 mice born 1 week old were co-cultured with M2-MG for 5 days to observe the axon length, the DRG alone was used as control. Forty-two 6-week-old female C57BL/6 mice were randomly divided into sham group (n=6), SCI group (n=18), and SCI+M2-MG group (n=18). In sham group, only the laminae of T10 level were removed; SCI group and SCI+M2-MG group underwent SCI modeling, and SCI+M2-MG group was simultaneously injected with M2-MG. The survival of mice in each group was observed after operation. At immediate (0), 3, 7, 14, 21, and 28 days after operation, the motor function of mice was evaluated by Basso Mouse Scale (BMS) score, and the gait was evaluated by footprint experiment at 28 days. The spinal cord tissue was taken after operation for immunofluorescence staining, in which glial fibrillary acidic protein (GFAP) staining at 7, 14, and 28 days was used to observe the injured area of the spinal cord, neuronal nuclei antigen staining at 28 days was used to observe the survival of neurons, and GFAP/C3 double staining at 7 and 14 days was used to observe the changes in the number of A1 astrocytes. Results The purity of MG in vitro reached 90%, and the most of the cells were polarized into M2 phenotype identified by Arg-1 immunofluorescence staining. M2-MG promoted the axon growth when co-cultured with DRGs in vitro (P<0.05). All groups of mice survived until the experiment was completed. The hind limb motor function of SCI group and SCI+M2-MG group gradually recovered over time. Among them, the SCI+M2-MG group had significantly higher BMS scores than the SCI group at 21 and 28 days (P<0.05), and the dragging gait significantly improved at 28 days, but it did not reach the level of the sham group. Immunofluorescence staining showed that compared with the SCI group, the SCI+M2-MG group had a smaller injury area at 7, 14, and 28 days, an increase in neuronal survival at 28 days, and a decrease in the number of A1 astrocytes at 7 and 14 days, with significant differences (P<0.05). ConclusionM2-MG transplantation improves the motor function of the hind limbs of SCI mice by promoting neuron survival and axon regeneration. This neuroprotective effect is related to the inhibition of A1 astrocytes polarization.
Objective To evaluate the cl inical results of posterior microendoscopic foraminotomy in the treament of cervical radiculopathy and cervical intervertebral disc protrusion. Methods From February 2004 to June 2007, 24 cases of cervical radiculopathy received posterior microendoscopic foraminotomy. There were 16 males and 8 females, aging 42-68 years (59 years on average), including 16 cases of cervical radiculopathy and 8 cases of cervical intervertebral disc protrusion.The course of disease was 6-15 months. The affected intervertebral discs were C4, 5 in 8 cases, C5, 6 in 12 cases, and C6, 7 in 4 cases. The radiological examinations showed that 8 protrusions included 6 soft tissue protusions and 2 rigid tissue protusions, and that cervical radiculopathy were caused by yellow l igament hypertrophy, Luschka’s joint hyperplasia, and abnormal position of facet joint. According to Japanese Orthopedic Association (JOA), the score before operation was (12.60 ± 1.52) points. Results The operation time was 90 to 120 minutes (100 minutes on average), the bleeding during operation was 100 to 150 mL (120 mL on average). Nerve root pain were rel ieved completely in 19 cases and were rel ieved partly in 4 cases. One case of calcified nucleus pulposus had neurological traction injury and recovered completely after 3 months. All cases were followed up 24-36 months (28 months on average). The radiological examinations after operation showed the intervertebral disc site was decompressed completely and the height of intervertebral disc and the cervical segmental al ignment were normal. At 24 months postoperatively, the JOA score was (16.10 ± 0.29) points, showing significant difference when compared with that of preoperation (P lt; 0.01). Conclusion The posterior microendoscopic foraminotomy can get to the operation site with miniincision, decrease tissue damage during operation, and avoid narrow intervertebral space, so it has satisfactory cl inical results.
Objective To investigate whether the outlet of the femoral tunnel will cause iatrogenic injury to the medial collateral ligament (MCL) during posterior cruciate ligament reconstruction (PCLR) and estimate the safe angle of femoral tunnel placement. MethodsThirteen formaldehyde-soaked human knee joint specimens were used, 8 from men and 5 from women; the donors’ age ranged from 49 to 71 years, with an average of 61 years. First, the medial part of the femur was carefully dissected to clearly expose the region of the MCL course and attachment on the femoral medial aspect and to outline the anterior margin of the region with a marked line. The marked line divided the medial femoral condyle into an area with an MCL course and a bare bone area which is regarded relatively safe for no MCL course. Then, the posterior cruciate ligament (PCL) was cut to identify the femoral attachment of the PCL. After the knee joint was fixed at a 120° flexion angle, the process of femoral tunnel preparation for the PCL single-bundle reconstruction was simulated. The inside-out technique was used to drill the femoral tunnel from the PCL femoral footprint inside the knee joint with an orientation to exit the medial condyle of the femur, and the combination angle of the two planes, the axial plane and the coronal plane, was adapted to the process of drilling femoral tunnels at different orientations. The following 15 angle combinations were used in the study: 0°/30°, 0°/45°, 0°/60°, 15°/30°, 15°/45°, 15°/60°, 30°/30°, 30°/45°, 30°/60°, 45°/30°, 45°/45°, 45°/60°, 60°/30°, 60°/45°, 60°/60° (axial/coronal). The positional relationship between the femoral tunnel outlet on the femoral medial condyle and the marked line was used to verify whether the tunnel drilling angle was a risk factor for MCL injury or not, and whether the shortest distance between the femoral exit center and the marked line was affected by the various angle combinations. Furthermore, the safe orientation of the femoral tunnel placement would estimated. ResultsWhen creating the femoral tunnel for PCLR, there was a risk of damage to the MCL caused by the tunnel outlet, and the incidence was from 0 to 100%; when the drilling angle of the axial plane was 0° and 15°, the incidence of MCL damage was from 69.23% to 100%. There was a significant difference in the incidence of MCL damage among femoral tunnels of 15 angle combinations (χ2=148.195, P<0.001). By comparison between groups, it was found that when drilling femoral tunnels at 5 combinations of 45°/45°, 45°/60°, 60°/30°, 60°/45°, and 60°/60° (axial/coronal), the shortest distances between the tunnel exit and the marked line were significantly different than 0°/45°, 0°/60°, 15°/45°, 15°/60°, and 30°/30° (axial/coronal) (P<0.05). Additionally, after comparing the median of the shortest distance with other groups, the outlets generated by these 5 angles were farther from the marked line and the posterior MCL. ConclusionThe creation of the femoral tunnel in PCLR can cause iatrogenic MCL injury, and the risk is affected by the tunnel angle. To reduce the risk of iatrogenic injury, angle combinations of 45°/45°, 45°/60°, 60°/30°, 60°/45°, and 60°/60° (axial/coronal) are recommended for preparing the femoral tunnel in PCLR.
Objective To investigate the effects of removing microglia from spinal cord on nerve repair and functional recovery after spinal cord injury (SCI) in mice. MethodsThirty-nine 6-week-old female C57BL/6 mice were randomly divided into control group (n=12), SCI group (n=12), and PLX3397+SCI group (n=15). The PLX3397+SCI group received continuous feeding of PLX3397, a colony-stimulating factor 1 receptor inhibitor, while the other two groups were fed a standard diet. After 14 days, both the SCI group and the PLX3397+SCI group were tested for ionized calcium binding adapter molecule 1 (Iba1) to confirm that the PLX3397+SCI group had completely depleted the spinal cord microglia. The SCI model was then prepared by clamping the spinal cord in both the SCI group and the PLX3397+SCI group, while the control group underwent laminectomy. Preoperatively and at 1, 3, 7, 14, 21, and 28 days postoperatively, the Basso Mouse Scale (BMS) was used to assess the hind limb function of mice in each group. At 28 days, a footprint test was conducted to observe the gait of the mice. After SCI, spinal cord tissue from the injury site was taken, and Iba1 immunofluorescence staining was performed at 7 days to observe the aggregation and proliferation of microglia in the spinal cord. HE staining was used to observe the formation of glial scars at the injury site at 28 days; glial fibrillary acidic protein (GFAP) immunofluorescence staining was applied to astrocytes to assess the extent of the injured area; neuronal nuclei antigen (NeuN) immunofluorescence staining was used to evaluate neuronal survival. And 5-hydroxytryptamine (5-HT) immunofluorescence staining was performed to assess axonal survival at 60 days. Results All mice survived until the end of the experiment. Immunofluorescence staining revealed that the microglia in the spinal cord of the PLX3397+SCI group decreased by more than 95% compared to the control group after 14 days of continuous feeding with PLX3397 (P<0.05). Compared to the control group, the BMS scores in the PLX3397+SCI group and the SCI group significantly decreased at different time points after SCI (P<0.05). Moreover, the PLX3397+SCI group showed a further decrease in BMS scores compared to the SCI group, and exhibited a dragging gait. The differences between the two groups were significant at 14, 21, and 28 days (P<0.05). HE staining at 28 days revealed that the SCI group had formed a well-defined and dense gliotic scar, while the PLX3397+SCI group also developed a gliotic scar, but with a more blurred and loose boundary. Immunofluorescence staining revealed that the number of microglia near the injury center at 7 days increased in the SCI group than in the control group, but the difference between groups was not significant (P>0.05). In contrast, the PLX3397+SCI group showed a significant reduction in microglia compared to both the control and SCI groups (P<0.05). At 28 days after SCI, the area of spinal cord injury in the PLX3397+SCI group was significantly larger than that in SCI group (P<0.05); the surviving neurons significantly reduced compared with the control group and SCI group (P<0.05). The axonal necrosis and retraction at 60 days after SCI were more obvious. ConclusionThe removal of microglia in the spinal cord aggravate the tissue damage after SCI and affecte the recovery of motor function in mice, suggesting that microglia played a neuroprotective role in SCI.
Objective To compare the short-term effectiveness between primary cemented and uncemented total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH) after renal transplantation. Methods The clinical data were retrospectively analyzed from 18 patients (21 hips) with ONFH after renal transplantation undergoing cemented THA in 11 cases (13 hips) (cemented group) and uncemented THA in 7 cases (8 hips) (uncemented group) between February 2005 and February 2012. There was no significant difference in gender, age, disease duration, ONFH stage, preoperative Harris score, and bone density between 2 groups (P gt; 0.05). Postoperative complications were observed in 2 groups; the hip function was assessed based on Harris scores; X-ray film was used to observe the prosthetic situation. Results All the wounds healed by first intention. The patients were followed up 6-77 months (mean, 46 months) in the cemented group, and 4-71 months (mean, 42 months) in the uncemented group. Femoral prosthesis infection occurred in 1 case (1 hip) respectively in each group; hip dislocation, femoral prosthesis loosening, and acetabular prosthesis loosening occurred in 1 case (1 hip) of the cemented group, respectively. At last follow-up, the incidences of postoperative complications and revision rate of the cemented group were 30.7% (4/13) and 23.1% (3/13) respectively, which were significantly higher than those of the uncemented group [12.5% (1/8) and 0 (0/8)] (P=0.047, P=0.040). Harris score was significantly increased to 94.1 ± 3.7 in the uncemented group and 90.0 ± 4.2 in the cemented group, showing significant differences compared with the preoperative scores in 2 groups (P lt; 0.05), but there was no significant difference between 2 groups (t=1.815, P=0.062). Postoperative X-ray films showed that the initial position of the prosthesis was satisfactory. At last follow-up, the bone fixation, fibrous stability, and loosening of the femoral prosthesis and loosening of acetabular prosthesis occurred in 9 hips, 3 hips, 1 hip, and 1 hip of the cemented group, respectively; bone fixation of the femoral prosthesis and stability of acetabular prosthesis were observed in all hips of the uncemented group. There was no heterotopic ossification in 2 groups. Conclusion Uncemented THA after renal transplantation can obtain satisfactory short-term effectiveness, and uncemented THA is better than the cemented THA; however, the middle- and long-term effectivenesses need further observation．