ObjectiveTo review the research progress of complications associated with open elbow arthrolysis so as to provide clinical reference for complication prevention and treatment. MethodsThe recent publications on open elbow arthrolysis and complications associated with it were extensively reviewed and analyzed. ResultsComplications associated with open elbow arthrolysis include ulnar nerve symptom and neuropathy, elbow instability, heterotopic ossification, and hematoma. Although some progress has been made in the complication prevention and treatment recently, there are still some challenges in the control of surgical trauma, intervention of heterotopic ossification and elbow instability after surgery, as well as postoperative analgesia due to the limitation of surgical techniques and the uncertain mechanism of these complications. ConclusionOpen elbow arthrolysis is safe and effective for elbow stiffness. However, more research on the mechanism of complications should be carried out, to further improve the overall effect of the surgery.
ObjectiveTo review the current progress of treatment of cubital tunnel syndrome (CTS). MethodsRecent relevant literature on the treatment of CTS was extensively reviewed and summarized. ResultsCTS is one of the most common peripheral nerve compression diseases.The clinical presentations of CTS consist of numbness and tingling in the ring and small fingers of the hand,pain in the elbow and sensory change following long-time elbow bending.Severe symptoms such as weakness or atrophy of intrinsic muscles of the hand and claw hand deformity may occur.The etiology of CTS is ulnar nerve compression caused by morphological abnormalities and nerve paralysis after elbow trauma.CTS can be treated by nonsurgical methods and surgery.Surgical options include in situ decompression,ulnar nerve transposition,medial epicondylectomy,and endoscopic release. ConclusionThere are multiple options to treat CTS,but the indication and effectiveness of each treatment are still controversial.Further studies are required to form a generally accepted treatment system.
ObjectiveTo explore the effectiveness and safety of open arthrolysis combined with internal fixator removal for post-traumatic elbow stiffness. MethodsA retrospective analysis was made on the data of 80 cases treated by open arthrolysis for elbow stiffness between January 2010 and December 2011. The patients were divided into 2 groups:no internal fixation group (group A, n=39) and internal fixation group (group B, n=41) according to whether they underwent internal fixator removal at the same time. No significant difference was found in age, gender, affected side, injury time, elbow rigidity grade, and severity of heterotopic ossification (HO) between 2 groups (P>0.05) except for original injury type (P<0.05). The effectiveness was evaluated by the occurrence of complications including ulnar nerve symptoms, HO recurrence and re-fracture, the elbow range of motion (ROM) and the Mayo elbow performance score (MEPS). ResultsThe mean follow-up duration was 15.7 months (range, 12-18 months) in group A and 16.1 months (range, 12-20 months) in group B. Ulnar nerve symptoms in 5 cases (12.8%) and HO reccurrence in 1 case (2.6%) occurred in group A, while ulnar nerve symptoms in 4 cases (9.8%), HO recurrence 1 case (2.4%), and refracture in 1 case (2.4%) occurred in group B. The incidence of each complication showed no significant difference between 2 groups (P>0.05). Both the ROM and the MEPS at last follow-up increased significantly when compared with preoperative ones in 2 groups (P<0.05). Besides, MEPS of group A was significantly higher than that of group B (t=2.36, P=0.02), but no significant difference was found in the ROM between 2 groups at last follow-up (t=0.40, P=0.69). Based on MEPS, the results were excellent in 16 cases, good in 16 cases, fair in 6 cases, and poor in 1 case in group A with an excellent and good rate of 82.1%;the results were excellent in 10 cases, good in 25 cases, fair in 4 cases, and poor in 2 cases in group B with an excellent and good rate of 85.4%. There was no significant difference in excellent and good rate between 2 groups (χ2=0.16, P=0.69). ConclusionOpen elbow arthrolysis combined with internal fixator removal for post-traumatic elbow stiffness is safe and effective. However, measures for prevention of re-fracture should always be taken into consideration.
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.