Objective To observe the histomorphology and the biocompatibil ity of acellular nerve prepared by different methods, to provide the experimental evidence for the selection of preparation of acellular nerve scaffold. Methods Forty-eight adult Sprague Dawley rats, male or female, weighing 180-220 g, were selected. The sciatic nerves were obtained from 30 rats and were divided into groups A, B, and C (each group had 20 nerves). The acellular sciatic nerves were prepared by the chemical methods of Dumont (group A), Sondell (group B), and Haase (group C). The effect to remove cells was estimated by the degree of decellularization, degree of demyel ination, and intergrity of nerve fiber tube. The histocompatibil ity was observed by subcutaneous implant test in another 18 rats. Three points were selected along both sides of centre l ine on the back of rats, and the points were randomly divided into groups A1, B1, and C1; the acellular nerve of groups A, B, and C were implanted in the corresponding groups A1, B1, and C1. At 1, 2, and 4 weeks after operation, the rats were sacrificed to perform the general observation and histological observation. Results The histomorphology: apart of cells and the dissolved scraps of axon could be seen in acellular never in the group A, and part of Schwann cell basilar membrane was broken. In group B, the cells in the acellular never were not removed completely, the Schwann cell basilar membrane formed bigger irregular hollows, part of the Schwann cell basilar membrane was broken obviously. But in the group C, the cells were completely removed, the Schwann cell basilar membrane remained intactly. Group C was better than group A and group B in the degree of decellularization, degree of demyel ination, integrity of nerve fiber tube and total score, showing significant differences (P lt; 0.05). The subcutaneous implant test: there were neutrophils and lymphocytes around the acellular nerve in 3 groups at 1 week after implant. A few of lymphocytes were observed around the acellular nerve in 3 groups at 2 weeks after implant. The inflammation was less in groups A1, B1, and C1 at 4 weeks after implant, part of the cells grew into the acellular nerve and arranged along the Schwann cell basilar membrane. The reaction indexes of the inflammational cells in group A1 and group B1 were higher than that in group C1 at 1, 2, and 4 weeks after implant, showing significant differences (P lt; 0.01), but there was no significant difference between group A1 and group B1 (P gt; 0.05). Conclusion The acellular sciatic nerves prepared by Haase method has better acellular effect and the histocompatibil ity than those by the methods of Dumont and Sondell.
Objective To investigate the cl inical appl ication effect of the new bone harvester. Methods Between August 2006 and October 2009, 112 patients underwent autogenous il iac bone graft and were followed up. There were 71 males and 41 females with a median age of 42 years (range, 11-71 years), including 45 cases of comminuted fracture of the l imbs, 47cases of bone nonunion, and 20 cases of benign bone tumor. According to different methods of bone harvesting, the patients were divided into 5 groups: group A (n=32, with new bone harvester), group B (n=29, with tricortical bone harvester), group C (n=15, with internal lamina harvester), group D (n=23, with external lamina harvester), and group E (n=13, with bicortical il iac bone by saw). There was no significant difference in general data of 5 groups (P gt; 0.05). The incision length, operation time, and peri-operative bleeding volume were compared. At 4 days, 7 days, 60 days, and 1 year postoperatively, the pain degree was assessed using visual analogue scale (VAS), and the incidence rates of peri pheral nerve injury, fracture, haematoma, ventral hernia, il iac crest sag, and chronic pain were observed. Results The incision length and the operation time in group A was shorter than those in other groups, the peri-operative bleeding volume in group A was less than in other groups, the VAS in group A was the lowest among 5 groups, showing significant differences (P lt; 0.05). The occurrence rates of chronic pain and il iac crest sag in group A were lower than those in group B, showing significant differences at 1 year after operation (P lt; 0.01). There was no significant difference in the incidence rates of peripheral nerve injury, fracture, haematoma, ventral hernia, il iac crest sag, and chronic pain between group A and groups C, D, E (P gt; 0.05), and in the incidence rates of peri pheral nerve injury, fracture, haematoma, and ventral hernia between group A and group B (P gt; 0.05). The total compl ication in group A was the lowest among 5 groups, showing significant difference (P lt; 0.05). Conclusion The new bone harvester is minimally invasive bone harvester,which has the advantages of short operation time and incision length, less bleeding volume, low VAS and complications.
Objective To review the latest development of amniotic membrane andits application. Methods Related literatures on the development of amniotic membrane and its application were extensively reviewed and summarized. Results There were amniotic epithelial cells and many growth factors in the outer layer of amniotic membrane and there were many kinds of collagen in the basement. The special structure promoted the growth of many kinds of cells. It was widely used in ophthalmology. Conclusion As it is easily available, compatible, cheap in price, low in antigenicity, and able to promote the growth of many kinds of cells, with few ethical problems involved, amniotic membrane will be more and more widely applied.
Objective To review the information of platelet gel used in the basic and clinical research in reparative and reconstructive surgery.Methods Literature about platelet gel used on the basic and clinical research was obtained through searching medical data and Internet. The effect of platelet gel on repairing and reconstructing the function and structure of tissue and organ was analyzed. Results Platelet gel had many growth factors and had the ability to improve wound healing and regenesis of bone and other tissues. Conclusion Platelet gel is widely available and almost genuine and is able to improve regenesis of many kinds of tissues. Extensive and intensive research should be made on itsclinical application.
【摘要】 目的 探讨负压封闭吸引（vacuum sealing drainage，VSD）敷料在创伤性慢性骨髓炎治疗中的作用。 方法 2006年6月-2009年8月收治13例创伤后慢性骨髓炎有较多脓性渗出物患者，其中男9例，女4例；年龄8~56岁，平均34岁。车祸致胫骨开放性骨折9例；腓骨骨折1例；高处坠落致跟骨开放性骨折2例；股骨骨折1例，术后均合并慢性骨髓炎，病程11~35个月。于病灶清除后，先采用VSD治疗，待创面清洁、骨面有肉芽组织形成后，8例直接二期缝合伤口，4例通过带蒂肌皮瓣或皮瓣修复创面，1例采用背阔肌皮瓣游离移植修复创面。 结果 使用VSD平均吸引18 d，更换VSD平均2.1次。创面渗出物逐渐减少，创面面积减小，经二期缝合、皮瓣移植等方法封闭创面。13例患者经6~31个月随访，慢性创伤后骨髓炎均治愈，无复发。 结论 采用VSD治疗创伤性慢性骨髓炎具有引流充分、炎症控制快、创面肉芽组织生长快、骨髓炎复发率低的优点。【Abstract】 Objective To evaluate the clinical efficacy of vacuum sealing drainage (VSD) in managing traumatic chronic osteomyelitis. Methods Between June 2006 and August 2009, 13 patients with a lot of purulent exudates after traumatic chronic osteomyelitis were treated in our hospital. There were nine males and four females with their ages ranged from 8 to 56 years old, averaging at 34. Among these cases of traumatic chronic osteomyelitis, nine occurred after operation for open tibial fractures and one occurred after operation for open fibula fracture caused by traffic accident; two occurred after operation for open calcaneal fracture and one occurred after operation for femur fracture caused by falling. The course of the disease ranged from 11 to 35 months. After the focus of infection was debrided completely, they were treated with VSD. As soon as the wound surface was clear and the bone surface was covered with granulation tissue, eight patients were treated with secondary suture, four were treated with local skin flap transplantation or musculocutaneous flap transplantation, and one was treated with free latissimus dorsi musculo-cutaneous flap. Results The exudates in and the area of the wound were both decreased after VSD procedure on the wound for an average of 18 days and replacing the VSD for an average of 2.1 times. The wound was covered by second suture or flap transplantation. After a follow-up of 6-31 months, all 13 cases of traumatic chronic osteomyelitis were healed with no recurrence. Conclusion Application of VSD in treating traumatic chronic osteomyelitis can drain thoroughly, control inflammation faster, promote granulation tissue, and decrease the rate of recurrence.
Objective To summarize the short-term effectivness of type IV Pipkin fracture through transtrochanteric approach with trochanteric osteotomy. Methods Between January 2007 and January 2010, 15 cases of type IV Pi pkin fracture were treated through transtrochanteric approach with trochanteric osteotomy. There were 9 males and 6 females with an average age of 42.5 years (range, 27-55 years). The causes of fractures included traffic accident (12 cases), fall ing from height (2 cases), and heavy pound injury (1 case). The time from injury to hospital ization was 4 hours to 7 days (mean, 2.3 days). All patients had l imitation of activity in the injured hips. The X-ray films and CT three-dimensional reconstruction indicated posterior dislocation of the hip joints and fractures of the femoral head and acetabulum, with no fracture of femoral neck. The locations of the femoral head fractures were under the round l igament in 9 cases and above the round l igament in 6 cases. Compl ications were treated firstly in all patients. The time from hospital ization to operation ranged from 2 to 10 days (mean, 4.5 days). Results All patients got primary wound heal ing with no early compl ication. All the patients were followed up 12-48 months with an average of 26 months. All osteotomies and acetabular fractures healed within 6 to 8 weeks. All patients achieved heal ing of femoral head fracture after 6-10 months. Mild heterotopic ossification occurred in 2 cases at 3 months after operation which were left untreated; and necrosis of the femoral head occurred in 1 case at 8 months after operation, was treated by total hip arthroplasty. At last follow-up, the flexion of the injuried hips ranged from 60 to 120° (mean, 92.5°). Based on Thompson et al. scoring scales, the results were excellent in 5 cases, good in 7 cases, fair in 2 cases, and poor in 1 case; the excellent and good rate was 80%. Conclusion Treatment of type IV Pipkin fracture through transtrochanteric approach with trochanteric osteotomy can provide good visual ization and protection of the blood supply of the femoral head.
Objective To observe the outcome of arthroscopic meniscal plasty and suture repair to treat torn discoid lateral meniscus involving popl iteal hiatus. Methods Between January 2008 and May 2009, 21 cases of torn discoid lateral meniscus involving popl iteal hiatus were treated by arthroscopic surgery. There were 9 males and 12 females with an average ageof 22.5 years (range, 12-45 years), including 12 left knees and 9 right knees. Seven cases had the history of injury and other 14 cases had uncertain trauma. The average disease duration was 6.4 months (range, 3 months to 2 years). All patients complained knee pain or locking with positive McMurray test and mill ing test before surgery. All cases had torn discoid lateral meniscus, and the tear extended to the popl iteal hiatus, including 17 cases of complete type and 4 cases of incomplete type according to the Watanabe classification. After meniscal plasty, suture repair of torn popl iteal lateral hiatus was performed. The anterior part to hiatus was repaired by the outside-in technique, and the posterior part underwent repair of all inside technique by FasTFix. Results All wounds healed by first intention with no compl ications such as infection, stiffness of knee, or injury of common peroneal nerve. All patients were followed up 12-28 months with an average of 18 months. The symptoms of knee pain or locking disappeared postoperatively with negative McMurray test and mill ing test in all patients. The Lysholm score was improved from 54.0 ± 13.4 to 90.0 ± 6.6 at 12 months postoperatively, showing significant difference (t=— 12.00, P=0.00). Based on the improved Lysholm classification standard, the results were excellent in 14 cases, good in 5, and fair in 2; the excellent and good rate was 90.5%. Conclusion For torn discoid lateral meniscus involving popl iteal hiatus, based on meniscal plasty, suture repair of the popl iteal hiatus would contribute to preserve the peripheral part and restore its stabil ity.
Objective To investigate the repair method of type Ⅱc injury in the lateral meniscus popliteal tendon area based on the porcine knee joint. Methods Eighteen commercially available fresh porcine knee joints were randomly divided into 3 groups (n=6). After preparing a type Ⅱc injury in the lateral meniscus popliteal tendon area, and the anterior (group A), posterior (group B), or anterior and posterior (group C) of the popliteal hiatus (PH) was sutured by vertical mattress. The tension meter was used to apply gradient tensions of 2, 4, 6, 8, and 10 N along the tibial plateau horizontally, respectively, to pull the midpoint of the lateral meniscus popliteal tendon area. The displacement values before modeling, after modeling, and after suture were recorded. The reduction value of lateral meniscus displacement and reduction rate after suture were calculated and compared between groups. Results There was no significant difference between groups (P>0.05) in the displacement values before modeling, after modeling, and after suture under different tensions. There was no significant difference between groups A and C (P>0.05) in the reduction value of lateral meniscus displacement and reduction rate after suture under different tensions. The reduction value of lateral meniscus displacement and reduction rate after suture in group B were lower than those in groups A and C. The reduction value of lateral meniscus displacement under tension of 2 N and the reduction rates under tensions of 2, 4, and 6 N between groups A and B showed significant differences (P<0.05). The reduction value of lateral meniscus displacement and the reduction rate under tensions of 2, 4, and 6 N between groups B and C showed significant differences (P<0.05). Conclusion Suturing the anterior area of PH is the key to repairing type Ⅱc injury of lateral meniscus popliteal tendon area.
ObjectiveTo investigate the effectiveness of arthroscopic multi-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of anterior cruciate ligament (ACL) involving the anterior root of lateral meniscus (LM). Methods A retrospective analysis was conducted on the clinical data of 28 patients with tibial insertion avulsion fracture of ACL involving the anterior root of LM who were treated with arthroscopic multi-point fixation with anchor and suture between October 2017 and January 2023. There were 12 males and 16 females with the mean age of 26 years (range, 13-57 years). There were 20 cases of sports injury and 8 cases of traffic accident injury. In 2 cases of old fracture, the time from injury to operation was 45 days and 90 days, respectively; in 26 cases of fresh fracture, the time from injury to operation was 3-20 days (mean, 6.7 days). According to the Meyers-McKeever classification, there were 4 cases of type Ⅱ, 11 cases of type Ⅲ, and 13 cases of type Ⅳ. The preoperative Lysholm knee function score was 42.1±9.0, the International Knee Documentation Committee (IKDC) score was 40.0±7.3, and the Tegner score was 0.7±0.7. ResultsAll operations were successfully completed, and the incisions healed by first intention. All the 28 patients were followed up 5-60 months (mean, 20.4 months). During the follow-up, there was nocomplication such as infection, vascular or nerve injury, loosening or breakage of internal fixator, or stiffness of knee joint. Postoperative X-ray films showed satisfactory fracture reduction and firm fixation. All fractures healed clinically, and the healing time was 8-16 weeks (mean, 10.3 weeks). At last follow-up, Lachman test and anterior drawer test were negative. At last follow-up, Lysholm knee function score was 92.4±5.5, IKDC score was 91.6±4.4, and Tegner score was 5.2±1.1, which significantly improved when compared with preoperative scores (t=−22.899, P<0.001; t=−29.870, P<0.001; t=−19.979, P<0.001). ConclusionMulti-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of ACL involving the anterior root of LM can not only fix the LM, but also effectively reduce and fix the avulsion fracture, which can obtain good effectiveness.
Objective To discuss the application of anterior region suture of the popliteal hiatus (PH) under arthroscopy in the treatment of discoid lateral meniscus (DLM) injury with instability in the popliteal tendon region. Methods The clinical data of 53 patients (56 knees) with DLM injury who met the selection criteria between March 2014 and November 2022 were retrospectively analyzed. There were 15 males and 38 females, aged 8-55 years with an average age of 36.5 years. Fourteen cases had a history of trauma, while the remaining 39 cases had no clear history of trauma. The disease duration ranged from 1 day to 6 years, with an average duration of 15.6 months. According to the Watanabe classification, there were 40 knees of complete type and 16 knees of incomplete type. The preoperative International Knee Documentation Committee (IKDC) knee joint score was 51.2±8.3, the Lysholm score was 59.6±11.2, and the visual analogue scale (VAS) score was 4.7±1.3. After the arthroscopic meniscal plasty, the instability of the popliteal tendon region meniscus was checked by probing traction. Subsequently, the Out-inside technique or a combination of Out-inside and All-inside techniques was used to suture the anterior region of the PH. The stability of the meniscus after suturing was assessed, and if necessary, further suturing using the All-inside technique at the posterior region of the PH, the posterior horn of the meniscus, and using the Out-inside technique at the anterior horn of the meniscus was performed. Postoperative complications were recorded. The effectiveness was evaluated using pre- and post-operative IKDC scores, Lysholm scores, and VAS scores. Results After operation, knee joint pain, crepitus, and locking disappeared, with McMurray and grinding tests turning negative. All patients were followed up 12-93 months with an average of 57.5 months. There was no complication such as common peroneal nerve injury, deep vein thrombosis of the lower limbs, joint infection, or joint stiffness. At last follow-up, the IKDC knee joint score was 76.7±5.5, the Lysholm score was 94.0±4.1, and the VAS score was 1.1±0.8. The differences compared with preoperative scores were significant (t=−22.090, P<0.001; t=−23.704, P<0.001; t=19.767, P<0.001). Conclusion Suturing of the anterior region of the PH is crucial in the treatment of DLM injury with instability in the popliteal tendon region.