In order to observe the curative effect and general reaction of locally used adriamycin (ADM)-loaded chitosan drug delivery system on giant cell tumor of bone after curettage. The cavities of 4 cases of giant cell tumor after curettage were filled with ADM-loaded chitosan drug delivery system with 4 times the dosage usually used for intravenous application. After operation, the concentration of ADM in plasma on the 1st, 2nd and 5th day, and the functions of liver and kidney on the 1st week, 1st month and 6th month were all investigated. The results were that the concentration of ADM in plasma was (143.05 +/- 27.55) ng/ml, (52.17 +/- 11.28) ng/ml and (4.25 +/- 3.07) ng/ml respectively, and the functions of liver and kidney were all normal in 6 months. After a follow-up of 7-19 months, no local or general reactions were observed and X-ray showed no recurrence. Therefore, it was concluded that the locally used ADM-loaded chitosan delivery system was safe and effective in treatment of giant cell tumor of bone after curettage.
ObjectiveTo design and produce a lesser trochanteric reduction fixation system and verify its value and effectiveness. MethodsA lesser trochanteric reduction fixation system was designed and produced according to the anatomical features of the lesser trochanteric fractures. Sixty-six patients with intertrochanteric fractures of Evans type Ⅲ were included between January 2010 and July 2012. Of 66 patients, 32 were treated with dynamic hip screw (DHS) assisted with the lesser trochanteric reduction fixation system (study group), and 34 cases were treated with DHS only (control group). The 2 groups were comparable with no significant difference in gender, age, the reasons, and the types of the fractures (P>0.05). The operation time, intraoperative blood loss, neck-shaft angle, bone healing time, ratio of successful fixations, and the functional evaluation of the hip joint after operation were compared between 2 groups. ResultsThe study group had shorter operation time [(58.4±5.3) minutes] and less intraoperative blood loss [(186.3±6.6) mL] than the control group[(78.5±6.2)minutes and (246.2±8.7) mL], showing significant differences (t=-14.040, P=0.000; t=-31.145, P=0.000). There was no significant difference in neck-shaft angle between study group [(138.6±3.0)°] and control group [(139.4±2.9)°] (t=-1.044, P=0.301). The wounds healed by first intention in both groups. The 30 and 31 patients were followed up 12 to 24 months (mean, 15 months) in the study group, and 13 to 25 months (mean, 16 months) in the control group, respectively. All fractures healed well in 2 groups. The study group had significantly shorter healing time [(8.8±2.0) weeks] than the control group [(10.7±3.4) weeks] (t=-2.871, P=0.006). At 12 months after operation, coxa vara happened in 2 cases of the study group with a successful fixation ratio of 93.3% and in 10 cases of the control group with a successful fixation ratio of 67.7%, showing significant difference (χ2=6.319, P=0.022). According to Harris hip score, the excellent and good rate was 83.3% in the study group (25/30) and was 58.1% in the control group (18/31), showing significant difference (χ2=4.680, P=0.049). ConclusionThe application of the lesser trochanteric reduction fixation system can reduce stripping of the soft tissue around the fracture fragments, shorten the operation time and the healing time, and preserve the function of the hip joint maximumly.
Objective Supracondylar closing wedge osteotomy is a standard operation for the management of post-traumatic cubitus varus deformity. There are many fixation methods for the broken ends of bone. However, most of these fixation methods are fraught with various complications. To evaluate the methods and functional results of double volume internal fixation for correction of adult post-traumatic cubitus varus deformity. Methods The cl inical data were retrospectively reviewed, from 22 cases of adults post-traumatic cubitus varus deformity between June 2007 and December 2010.There were 16 males and 6 females, aged 18-29 years (mean, 21 years) and they all had a history of supracondylar fracture. The deformities of cubitus varus appeared at 6 months (range, 3 months to 1 year) after fracture, and the operations were carried out at 4-17 years (mean, 8 years) after deformity occurrence. The valgus angle were 16-25° (mean, 20.6°) and the Flynn functional scores were all poor before operation. Supracondylar closing wedge osteotomies were performed. Two reconstruction plates were moulded and placed to the media and lateral volumes of the humerus to fix the broken ends of the osteotomy surfaces. External fixation was not needed and early rehabil itation was performed postoperatively in all cases. Results Incisions healed by first intention. All cases were followed up 6 to 24 months (mean, 13 months). At last follow-up, the valgus angle was 0-10° (mean, 7.5°). All cases got bone union at 8-13 weeks (mean, 10 weeks) after operation. No related complications occurred, such as infection, nervous or vein injury, and loosening or breakage of internal fixator; and no cubitus varus recurred. The Flynn scores were excellent in 17 cases, good in 3 cases, and fair in 2 cases; the excellent and good rate was 91%. Conclusion The operation of supracondylar osteotomy with double plates internal fixation for the correction of adult post-traumatic cubitus varus deformity can rigidly stabil ize distal humerus, which is helpful to functional training just after operation and satisfactory restoration of the elbow function.
To research the operative method and the cl inical efficacy of repairing and reconstructing tendon and l igament with allograft tendon. Methods From September 2000 to May 2007, 164 cases with tendon and l igament injuries were treated, including 116 males and 48 females aged 21-47 years old (average 31.5 years old). There were 126 cases of anterior cruciate l igament injury, 18 cases of complete acromioclavicular dislocation, 10 cases of old dislocation of radialhead, 4 cases of Achilles tendon rupture, 2 cases of tibial is anterior muscle rupture, 2 cases of patellar tendon rupture, and 2 cases of rectus femoris rupture. Time interval between injury and hospital admission was 4-345 days (average 75 days). Allograft tendon 10-26 cm in length with suture anchor or absorbable interference screw was used to reconstruct the l igament and tendon. Results All wounds healed by first intention, except one case of rectus femoris rupture. All patients were followed for 10-36 months (average 21 months). The international knee documentation commitee and the Lysholm score of patients with anterior cruciate l igament injury 12 months after operation were significantly higher than that of before operation (P lt; 0.01). According to the Lazzcano and Karlsson score standard, 13 cases of complete acromioclavicular dislocation at 10-12 months after operation were graded as excellent and 5 cases were good. According to Arner Lindholm score standard, 3 cases of Achilles tendon rupture at 8-16 months after operation were graded as excellent and 1 case was good. For the patients with tibial is anterior muscle rupture, at 10-17 months after operation, the limitation of dorsal extension in ankle joint was 5°, and the muscle strength in the anterior tibial is muscle was decreased. For the patients with patellar tendon rupture, one completely restored the motion range of the knee joint 14 months after operation, the other had knee extension l imitation of 10° at 13 months after operation. For the patients with rectus femoris rupture, one had 15° of extension limitation at 18 months after operation, the other suffered limitation of both extension and genuflex at 12 months after operation. According to the Broberg-Morrey score standard, 7 caseswith old dislocation of radial head were graded as excellent and 3 cases were good at 3-36 months after operation. Conclusion Allograft tendon is a good material for repairing and reconstructing tendon and ligament injuries, but attention should be paid to postoperatively early exercise under appropriate protection and early management of local rejection.
Objective To precisely treat compl icated calcaneal fracture by 3D simulation through computer aid designed operation. Methods From November 2007 to March 2008, 38 patients of calcaneal fracture were treated. There were 29 males and 9 females aged 14-69 years old (average 29.8 years old). According to Sanders classification, there were 4 patients oftype I, 14 of type II, 12 of type III, and 8 of type IV. The time between injury and surgery was 3 hours to 5 days. The CT images of calcaneal fracture of 38 patients were put into computer for 3D reconstruction, then the Bouml;hler angles were measured and bone grafting angles were designed. According to the angle surveyed by the computer, the individual-oriented operation program was made, and then the operation was done under C-arm X-ray machine. Results The preoperative Bouml;hler angel was (34.58 ± 4.38)° in the normal side and (8.33 ± 12.62)° in the injured side, indicating there was significant difference (P lt; 0.05). During the process of the poking reduction by 3D simulation, when the bone rotating angle was (28.84 ± 6.51)°, the Bouml;hler angel was restored to (32.86 ± 1.72)°, indicating there was no significant difference when compared with the normal side before operation (P gt; 0.05), and significant difference compared with the injured side before operation (P lt; 0.05). Twenty-eight patients were followed up for 12-22 months (average 18 months). The Bouml;hler angel was restored to (32.41 ± 1.42)° 1 year after operation. According to the foot function scoring system made by American Ankle Surgery Association, 16 cases were graded as excellent, 10 as good, 1 as fair, 1 as poor, and the excellent and good rate was 92.9%. Conclusion Computer aid designed operation of compl icated calcaneal fracture by 3D simulation technique can restore the Bouml;hler angel and subtalar joint precisely. It is aneffective supplementary treatment method for calcaneal fracture.
ObjectiveTo evaluate the ectopic osteogenesis of recombinant human bone morphogenetic protein 2 (rhBMP-2) loaded chitosan (CS)/dextran sulfate (DS) by micro-CT. MethodsrhBMP-2/CS/DS microspheres were prepared by the ionic crosslinking and its shape was observed under the scanning electron microscope. The release of rhBMP-2 was determined from resultant microspheres by ELISA assay. Forty-eight Sprague Dawley male rats were randomly divided into 4 groups (n=12), quadriceps muscle bag model was made, gelatin sponge (group A), CS/DS microspheres (group B), rhBMP-2 (group C), and CS/DS/rhBMP-2 microspheres (group D) were implanted into the bags respectively. The tissue samples with heterotopic ossification were harvested for micro-CT scanning at 4, 8, 12, and 16 weeks. The tissue mineral density (TMD), bone volume fraction (BVF), trabecular thickness (Tb.Th), trabecular number (Tb.N), bone mineral density (BMD), and tissue mineral content (TMC) were measured. ResultsThe prepared rhBMP-2/CS/DS microspheres with smooth surfaces were spherical and evenly disperses without obvious agglomeration. At 2 hours, microsphere started a sudden release period in vitro; the release reached a peak at 2 days; and the release cycle lasted about 20 days. The rats survived to the end of the experiment. At each time point after operation, no radiation developed and no osteogenesis was observed by three dimensional reconstruction in groups A and B. However, radioactive strength and reconstructed bone tissue gradually increased in groups C and D, and group D had more radioautography and more bone tissues than group C. At each time point, TMD, BVF, Tb.Th, Tb.N, BMD, and TMC of groups A and B were zero. Ectopic bone formed with time, the other parameters showed an increasing trend except Tb.N in groups C and D, showing significant difference when compared with groups A and B at each time point (P < 0.05). There was no significant difference between groups C and D at 4 weeks (P>0.05); the parameters of group D were significantly higher than those of group C at 8-16 weeks (P < 0.05). ConclusionrhBMP-2/CS/DS microspheres have stronger ability of ectopic bone formation than single rhBMP-2.
Objective To evaluate the osteogenic effect of dextran sulfate/recombinant human bone morphogenetic protein 2/chitosan (DS/rhBMP-2/CS) combined with coralline hydroxyapatite (CHA) in repairing large segmental bone defects by radiographic feature. Methods Fifty-seven 24-week-old male New Zealand rabbits were prepared for establishing right radius bone defect model of 20 mm in length. In which 54 rabbits were randomly divided into 3 groups (n=18), and the CHA, DS/rhBMP-2/CS/CHA, and rhBMP-2/CHA artificial bone grafts were implanted into the bone defect in groups A, B, and C respectively; the remaining 3 rabbits were implanted nothing as blank control group. After operation, the gross condition of the animals was observed; at 4, 8, and 12 weeks after operation, X-ray film observation, Micro-CT scanning, and three-dimensional reconstruction were performed to obtain the volume of the new bone. Results The experimental animals recovered well and were in normal condition. X-ray observation showed that the bone healing in group B was better than that in groups A and C at each time point. At each time point after operation, the X-ray scores of group B were significantly higher than that of group A and group C (P<0.05); the scores of group C at 8 and 12 weeks after operation were significantly higher than that of group B (P<0.05). Micro-CT scanning and three-dimensional reconstruction observation showed that at each time point after operation in group A, the bone defect area had less bone formation and poor osteogenesis; in group B, there were many new bone tissues in bone defect area, and the bone remodeling was well, and gradually closed to normal bone morphology at 12 weeks; in group C, there were many new bone tissues in bone defect area, but the bone formation was general. The new bone volume of group B was significantly higher than that of group A and group C (P<0.05) at each time point after operation, and the score of group C was higher than that of group A at 8 weeks after operation (P<0.05). Conclusion The osteogenic effect of DS/rhBMP-2/CS/CHA sustained-release artificial bone is much better than that of single CHA and rhBMP-2/CHA, which can provide a new idea for treating bone defect by using bone tissue engineering in the future.