ObjectiveTo investigate the effectiveness of channel-assisted minimally invasive repair system (CAMIR) in treatment of the Myerson types Ⅰ and Ⅱchronic Achilles tendon rupture.MethodsBetween May 2016 and August 2017, 19 patients with Myerson types Ⅰ and Ⅱchronic Achilles tendon ruptures were treated with CAMIR. There were 14 males and 5 females, aged from 21 to 48 years, with an average age of 34.5 years. The disease duration was 5-9 weeks (mean, 7.5 weeks). The preoperative Thompson tests of affected ankles showed positive. There were 11 cases of Myerson type Ⅰwith the gaps of Achilles tendon defect of 1-2 cm (mean, 1.58 cm), and 8 cases of Myerson type Ⅱwith the gaps of Achilles tendon defect of 2.5-4.0 cm (mean, 3.16 cm). The ankle dorsiflexion and plantarflexion range of motion were measured before and after operation; the American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score was used to assess the patients’ ankle joint function.ResultsNo major blood vessels, nerves, and other tissue structures were damaged during the operation; 3 cases of Myerson type Ⅰ were converted to Myerson type Ⅱ according to the gaps of the defect after the scar tissue was removed during the operation. After operation, the depressed part of the Achilles tendon disappeared, the continuity of the tendon was restored, and the Thompson tests were negative. All 19 patients were followed up 12-25 months, with an average of 14 months. All incisions healed by first intention, and no infection and skin necrosis occurred; all the pre-injury activities and exercise were restored at 6 months after operation. During the follow-up period, no heel pain or re-rupture occurred. At last follow-up, except that there was no significant difference in ankle dorsiflexion range of motion of Myerson type Ⅰ patients (t=2.118, P=0.071), the AOFAS ankle and hindfoot score, ankle plantarflexion range of motion of Myerson types Ⅰ and Ⅱ patients, and ankle dorsiflexion range of motion of Myerson type Ⅱ patients were significantly improved when compared with preoperative values (P<0.05). According to AOFAS ankle and hindfoot function score, the ankle joint function of type Ⅰ patients was excellent in 7 cases and good in 1 case, and of type Ⅱ patients were excellent in 8 cases, good in 2 cases, and fair in 1 case.ConclusionCAMIR is safe and effective in the treatment of Myerson types Ⅰ and Ⅱ chronic Achilles tendon rupture with fewer complications and better functional recovery of ankle joint.
Objective To review the recent advances in treatment of aseptic femoral shaft nonunion. Methods The clinical studies about the treatments of aseptic femoral shaft nonunion in recent years were widely reviewed and analyzed. Results There are several surgical methods for aseptic femoral shaft nonunion. Due to uncertain clinical outcome, dynamization of nail should be carefully selected. The exchange nailing is suitable for the hypertrophic nonunion of the isthmal femoral shaft fracture. The exchange lateral plating is suitable for nonunion with obvious malformation. However, wave plate or dual plate should be chosen when the bone nonuinon is combined with the medial defect. The augmentation plating improves the success rate of nailing for femoral shaft nonunion, but it should be carefully selected for patients with obvious deformity or bone defect. Ilizarov technique is suitable for various bone nonunion, especially with complicated or large segmental bone defects. Induced membrane technique is also an important method for the treatment of bone nonunion with large bone defects. The clinical efficacy of the blocking screw remains to be supported by further evidence. Biological stimulants are mainly used for atrophic nonunion, and the clinical efficacy of them alone are still controversial. Conclusion Due to lack of comparative studies between different surgical methods, the orthopedist should choose the appropriate treatment according to the individual situations of the patient and the types of bone nonunion.
Objective To explore short-term effectiveness of floating island laminectomy surgery in treating thoracic spinal stenosis and myelopathy caused by ossification of the ligamentum flavum. Methods A total of 31 patients with thoracic spinal stenosis and myelopathy caused by ossification of the ligamentum flavum between January 2019 and April 2022 were managed with floating island laminectomy surgery. The patients comprised 17 males and 14 females, aged between 36 and 78 years, with an average of 55.9 years. The duration of symptoms of spinal cord compression ranged from 3 to 62 months (mean, 27.2 months). The lesions affected T1-6 in 4 cases and T7-12 in 27 cases. The preoperative neurological function score from the modified Japanese Orthopaedic Association (mJOA) was 4.7±0.6. Surgical duration, intraoperative blood loss, and complications were recorded. The thoracic MRI was conducted to reassess the degree of spinal cord compression and decompression after operation. The mJOA score was employed to evaluate the neurological function and calculate the recovery rate at 12 months after operation. Results The surgical duration ranged from 122 to 325 minutes, with an average of 204.5 minutes. The intraoperative blood loss ranged from 150 to 800 mL (mean, 404.8 mL). All incisions healed by first intention after operation. All patients were followed up 12-14 months, with an average of 12.5 months. The patients’ symptoms, including lower limb weakness, gait disorders, and pain, significantly improved. The mJOA scores after operation significantly increased when compared with preoperative scores (P<0.05), gradually improving with time, with significant differences observed among 1, 3, and 6 months (P<0.05). The recovery rate at 12 months was 69.76%±11.38%, with 10 cases exhibiting excellent neurological function and 21 cases showing good. During the procedure, there were 3 cases of dural tear and 1 case of dural defect. Postoperatively, there were 2 cases of cerebrospinal fluid leakage. No aggravated nerve damage, recurrence of ligamentum flavum ossification, or postoperative thoracic deformity occurred. ConclusionThe floating island laminectomy surgery is safe for treating thoracic spinal stenosis and myelopathy caused by ossification of the ligamentum flavum, effectively preventing the exacerbation of neurological symptoms. Early improvement and recovery of neurological function are achieved.
Objective To investigate the short-term effectiveness of the anterior and middle columns in thoracolumbar tuberculosis reconstructed with whole autogenous spinous process-laminar bone through posterior approach. Methods The retrospective study included 78 patients with thoracolumbar tuberculosis who underwent posterior approach surgery and anterior and middle column bone graft reconstruction between January 2012 and May 2023. Based on the type of autogenous bone graft used, patients were divided into group A (whole autogenous spinous process-laminar bone graft, 38 cases) and group B (autogenous structural iliac bone graft, 40 cases). There was no significant difference of baseline data, such as age, gender, disease duration, involved segment of spinal tuberculosis, and preoperative erythrocyte sedimentation rate (ESR), C reactive protein (CRP), Oswestry disability index (ODI), visual analogue scale (VAS) score, the American Spinal Injury Association (ASIA) grade, segmental kyphotic angle, and intervertebral height between the two groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage, hospital stays, ESR, CRP, VAS score, ODI, bone fusion time, ASIA grade for neurological status valuation, postoperative complications, change of segmental kyphotic angle, change of intervertebral height were recorded and compared between the two groups. Results The operation time in group A was significantly shorter than that in group B (P<0.05); there was no significant difference in intraoperative blood loss, postoperative drainage, and hospital stays between the two groups (P>0.05). All patients in the two groups were followed up 14-110 months (mean, 64.1 months); there was no significant difference in the follow-up time between the two groups (P>0.05). The ESR, CRP, ODI, and VAS score at each time point after operation in both groups significantly improved when compared with those before operation, and further improved with the extension of time, the differences were significant (P<0.05). There was no significant difference between the two groups (P>0.05) except that the VAS score of group A was significantly better than that of group B at 3 days after operation (P<0.05). There was no significant difference in fusion time between the two groups (P>0.05). The neurological function of most patients improved after operation, and there was no significant difference in ASIA grade between the two groups at last follow-up (P>0.05). There was no significant difference in segmental kyphosis angle and intervertebral height between the two groups at each time point (P>0.05), and no significant difference in segmental kyphosis angle, intervertebral height correction and loss were found between the two groups (P>0.05). In group A, there was 1 case of incision fat liquefaction and 1 case of incision infection; in group B, there was 1 case of deep venous thrombosis, 2 cases of pleural effusion, and 10 cases of pain in bone harvesting area; in both groups, there were 2 cases of gout caused by hyperuricemia. There was a significant difference in the incidence of pain in bone harvesting area between the two groups (P<0.05), and there was no significant difference in the incidence of other complications between the two groups (P>0.05). ConclusionWhole autogenous spinous process-laminar bone grafting is equivalent to structural iliac bone graft in reconstruction of the anterior and middle columns in thoracolumbar tuberculosis through posterior approach, effectively supporting the stability of the anterior and middle columns of the spine, while resulting in shorter operation time and less postoperative pain in bone harvesting area.
ObjectiveTo review the history, current situation, and progress of augmentation plate (AP) for femoral shaft nonunion after intramedullary nail fixation.MethodsThe results of the clinical studies about the AP in treatment of femoral shaft nonunion after intramedullary nail fixation in recent years were widely reviewed and analyzed.ResultsThe AP has been successfully applied to femoral shaft nonunion after intramedullary nail fixation since 1997. According to breakage of the previous nailing, AP is divided into two categories: AP with retaining the previous intramedullary nail and AP with exchanging intramedullary nail. AP is not only suitable for simple nonunion, but also for complex nonunion with severe deformity. Compared with exchanging intramedullary nail, lateral plate, and dual plate, AP has less surgical trauma, shorter healing time, higher healing rate, and faster returning to society. However, there are still some problems with the revision method, including difficulty in bicortical screw fixation, lack of anatomic plate suitable for femoral shaft nonunion, and lack of postoperative function and quality of life assessment.ConclusionCompared with other revision methods, AP could achieve higher fracture healing rate and better clinical prognosis for patients with femoral shaft nonunion. However, whether patients benefit from AP in terms of function and quality of life remain uncertain. Furthermore, high-quality randomized controlled clinical studies are needed to further confirm that AP are superior to the other revision fixations.
Objective To investigate the regulatory effect of somatostatin analogue (SMS201995,SMS) on proliferation and apoptosis in human cholangiocarcinoma cell line in vitro. MethodsProliferation curve, flow cytometry, agarose gel electrophoresis, Annexin VFITC and flow cytometric immunofluorescent technique were performed to identify the inhibitory effect on cell proliferation and the induction of apoptosis of human cholangiocarcinoma cells (SKChA1). ResultsSMS significantly reduced the SKChA1 cell growth by serum in long experiments and transiently accumulated it in G0/G1 phase. Dotplot analysis of cells duallabeled with Annexin VFITC and PI confirmed the induction of apoptosis by SMS in SKChA1 cells.AnnexinVFITC labeling was markedly enhanced following treatment with SMS for 24 h. DNA of treated SKChA1 cells appeared a ladder pattern characteristic of apoptosis. Besides, timedependent increase in bax and decrease in bcl2 occured during SMS treatment. Conclusion SMS could inhibit the proliferation activity and induce apoptosis of cholangiocarcinoma cell line SKChA1. The mechanisms of apoptosis might be correlated with the expression of apoptosisregulatory gene bax and bcl2.
ObjectiveTo review the literature about the clinical application and research progress on medial support augmentation of plate osteosynthesis for proximal humeral fractures, and to provide reference for clinical treatment.MethodsThe literature concerning medial support augmentation of plate osteosynthesis for proximal humeral fractures in recent years was extensively reviewed, as well as the biomechanical benefit and clinical advantage were analyzed thoroughly.ResultsMedial support augmentation of plate osteosynthesis for proximal humeral fractures is very important, especially in osteoporotic and/or comminuted fractures. Many medial support augmentation methods have been proposed which can be divided into extramedullary support and intramedullary support. It can also be divided into autogenous bone support and allogenic bone support according to the material and source, divided into medial column support, calcar support, and humeral head support according to the support site, and divided into fibular shaft support, femoral head support, anatomic fibula support according to the shape of the augmented fixation. At present, clinical and biomechanical researches show that medial support augmentation is an effective treatment for proximal humeral fractures.ConclusionAs an important treatment strategy for the treatment of proximal humeral fractures, the medial support augmentation of plate osteosynthesis gets the focus from the biomechanical studies and clinical treatment. However, there are still widespread controversies among orthopedic surgeons regarding the support mode, site, implant shape, and material of medial column support for augmentation of proximal humeral fractures. More high-quality clinical trials and biomechanical researches as well as multi-disciplinary integration, are needed to provide better strategy treatment for the treatment of proximal humeral fractures.