ObjectiveTo observe the effectiveness of open release combined with distal radius fixation hinged external fixation for the treatment of elbow stiffness.MethodsA total of 77 patients with elbow stiffness caused by trauma were enrolled in this study between October 2014 and October 2015. The patients were divided into control group (39 cases) and observation group (38 cases) by random number table method. The patients in the observation group were treated with elbow joint opening and release combined with distal radial fixation hinged external fixation, while the control group was treated with traditional release. There was no significant difference in gender, age, disease causes, original damage diagnosis, the time from injury to operation, preoperative flexion and extension activity of elbow joint, and preoperative Mayo elbow joint function score between 2 groups (P>0.05). After operation, the function of elbow joint was evaluated by the flexion and extension activity of the elbow joint and the Mayo elbow joint function evaluation standard.ResultsThe incisions healed by first intention in 2 groups. In observation group, there were 1 case infection of nail tract, 2 cases ulnar nerve symptoms, 1 case elbow ossification, and 1 case moderate pain in the elbow; while in control group, there were 2 cases of infection of nail tract, 2 cases of ulnar nerve symptoms, and 3 cases moderate pain in the elbow. The patients in 2 groups were followed up 6 weeks to 12 months, with an average of 6 months. The flexion and extension activity of elbow joint and Mayo elbow joint function score at last follow-up were significantly improved when compared with preoperative ones (P<0.05); at last follow-up, the flexion and extension activity of elbow joint and Mayo elbow joint function score in observation group patients were significantly better than those in control group (P<0.05). According to the Mayo elbow function evaluation standard, the results were excellent in 27 cases, good in 10 cases, and fair in 1 case, with an excellent and good rate of 97.4% in observation group; and the results were excellent in 12 cases, good in 21 cases, fair in 4 cases, and poor in 2 cases, with an excellent and good rate of 84.6% in control group; showing no significant difference between 2 groups (P=0.108).ConclusionOpen release combined with distal radius fixation hinged external fixation can significantly improve the elbow function of patients with traumatic elbow stiffness, its recovery of elbow function was superior to the traditional release.
ObjectiveTo investigate the effect of Smad4 on the fibrosis of tendon derived fibroblasts (TDFs) induced by transforming growth factor β1(TGF-β1) by targeted regulation of miRNA219-5P (miR219-5P). MethodsThe tendons donated by the volunteers were harvested to isolate and culture TDFs. The 3rd generation cells were used for experiment. Chemically synthesized miR219-5P mimics, miR219-5P inhibitor, and negative control sequences were transfected into TDFs. The gene expression of miR219-5P in TDFs was detected by real-time PCR, and the protein expression of Smad4 in TDFs was detected by Western blot at 48 hours after transfection. The combining sites of miR219-5P and Smad4 in 3'UTR district were predicted by informatics software. Wild type and mutant type reporter gene expression vectors were constructed and then targeted verification was carried out by the luciferase reporter gene test. Transfected TDFs were then induced by TGF-β1. The proliferation activity of the cells were measured by the cell counting kit 8 after culturing for 24, 48, and 72 hours. The expressions of fibrosis related proteins in TDFs were detected by Western blot at 72 hours. ResultsAfter TDFs were transfected by miR219-5P mimics, miR219-5P expression was significantly up-regulated, but the expressions of Smad4 was decreased subsequently (P<0.05). Intracellular expression of miR219-5P was inhibited by miR219-5P mimics inhibitor, however, the protein expression of Smad4 was significantly increased (P<0.05). Luciferase reporter gene test showed that luciferase activities were significantly decreased in pGL3-WT-Smad4+mimics group, but were significantly increased in pGL3-WT-Smad4+inhibitor group when compared with pGL3-WT-Smad4 transfected group (P<0.05), but no significant difference was found between GL3-MT-Smad4+mimics and pGL3-MT-Smad4+inhibitor groups (P>0.05). Cell proliferation and the fibrosis related proteins were increased in TGF-β1 induced TDFs, however, decreased in TGF-β1 induced TDFs after transfected by miR219-5P inhibitor (P<0.01). ConclusionmiR219-5P can significantly inhibit fibrosis of TDFs induced by TGF-β1 by down-regulating Smad4 expression.