ObjectiveTo investigate the effectiveness of Bernese osteotomy for the treatment of developmental dysplasia of the hip (DDH) in adults. MethodsBetween August 2012 and April 2014, 16 patients with DDH were treated with Bernese osteotomy by S-P approach, and the clinical data were retrospectively analyzed. There were 4 males and 12 females with an average age of 27.8 years (range, 18-35 years). The left side was involved in 6 cases and the right side in 10 cases. The visual analogue scale (VAS) score was 4.8±0.5, and the Harris hip score was 81.2±5.4. The lateral center edge (CE) angle (the angle between the vertical center of the femoral head and the lateral edge of the acetabulum) was (6.5±8.7)°;the horizontal tilt angle was (25.6±5.9)°;and the femoral head extrusion index was 36.5%±6.5%. According to the Tonnis osteoarthritis classification, 12 hips were rated as Grade 0, 3 hips as Grade I, and 1 hip as Grade II. ResultsThe operation time was 90-135 minutes;the intraoperative blood loss was 400-800 mL;10 cases accepted blood transfusion and the amount of blood transfusion was 200-600 mL;the postoperative drainage volume was 100-300 mL;and the hospitalization time was 7-12 days. All the cases achieved primary healing of incision with no early complications. Two cases had numb in the lateral femoral cutaneous nerve innervating area. All patients were followed up 12-26 months (mean, 20 months). The X-ray examination showed osseous healing at osteotomy site, and the healing time was 12-16 weeks (mean, 13.5 weeks). No acetabulum fracture, heterotopic ossification, osteonecrosis, and internal fixation loosening occurred during follow-up. No progression of osteoarthritis or acetabular cystic change was observed. At last follow-up, the lateral CE angle was (27.7±6.8)°;the horizontal tilt angle was (16.2±4.8)°;the femoral head extrusion index was 19.7%±5.3%;VAS score was 0.8±0.3;the Harris hip score was 96.8±6.7;and all showed significant differences when compared with preoperative ones (P<0.05). ConclusionFor DDH adults, Bernese osteotomy can effectively increase the acetabulum tolerance, improve the joint function, and slow progress in osteoarthritis, and the short-term effectiveness is satisfactory.
ObjectiveTo explore the application value of MRS combined with VEEG on the surgical treatment of temporal lobe epilepsy. MethodsThere were 31 males and 20 females, age between 4 and 62 years.Their illness duration ranged from 4 to 10 years.The clinical manifestations showed complex partial seizure in 10 cases, secondary generalized seizure in 12 and generalized tonic-clonic seizure in 29. Based on their results of clinical manifestations, MRS and VEEG results, all the patients underwent anterior temporal lobectomy(including the most parts of the hippocampus and amydala). ResultsThe follow-up of 1~3 years after the operation showed seizure free in 36 cases(Engle Ⅰ), and significant improvement in 11(Engle Ⅱ), no improvement in 4 cases(Engle Ⅳ). The overall effective rate was 92.16%. ConclusionsMRS combined with VEEG has significant localization value for temporal lobe epilepsy. The prognosis of postoperative result is quiet good to the patient of typical temporal lobe epilepsy after anterior temporal lobectomy.
ObjectiveTo explore the strategy and outcome of surgery for the treatment of encephalomalacia with secondary intractable epilepsy. MethodsDuring the period of July 2009 and June 2015, 21 cases of encephalomalacia with secondary intractable epilepsy were performed operation. Among them there were 16 males and 5 females. Their ages ranged from 4 to 34 years, with their illness duration from 3 to 14 years. According to the results of MRI and video-EEG monitoring, all the patients were performed operation under the monitoring of ECoG. And the outcome was graded by Engle scales for analysis. ResultsECoG monitoring after the resection of encephalomalacia showed that there was still abnormal discharge. Enlarged cortical resection was performed in 10 cases, and cortical coagulation in 3、anterior temporal lobectomy + resection of the hippocampus and amygdala in 4、additional callosotomy in 4. The post-operative follow-up of 1~7 years showed that Grade Ⅰ was observed in 10 cases、Grade Ⅱ in 5 cases、Grade Ⅲ in 3 cases and Grade Ⅳ in 3 cases.The total surgical effectiveness was 85.7%. ConclusionTo the patients of encephalomalacia with secondary intractable epilepsy, the epileptic lesion should be resected besides the resection of encephalomalacia. And the surgical effectiveness is satisfactory.
ObjectiveTo investigate the effect of adipose-derived stem cells (ADSCs) combined with chitosan on the immediate retraction rate of rabbit expanded skin. MethodsADSCs were isolated from rabbit fresh fat under sterile conditions and cultured to the 3rd generation by methods of enzymatic digestion; the specific surface markers and the differentiation into epidermal cells and cartilage cells were identified. Forty New Zealand white rabbits (aged, 2-3 months) were randomly divided into 4 groups (n=10): control group (group A), ADSCs group (group B), chitosan group (group C), and ADSCs+chitosan group (group D). ADSCs cell suspension with the concentration of 5×106 cells/mL was prepared. The skin expansion model was made by embedding 30 mL dilator into the back of rabbit. Chitosan (2%, 5 mL) was coated on the surface of the dilator in groups C and D, and ADSCs cell suspension (1 mL) was injected into the skin in groups B and D. Conventional tissue expansion was performed to expected capacity at 4 weeks, and maintained for 1 week. The expanded skin was harvested to measure the immediate retraction rate, and the thickness of skin, epidermis, and fibrous capsule with HE staining. Masson staining was used to observe the characteristics of collagen in the fibrous capsule, and immunohistochemical staining for CD31 to determine the microvessel density (MVD). ResultsADSCs were successfully isolated, and had multiple differentiation ability. All the animals survived to the end of the experiment. The immediate retraction rate of group D was significantly lower than that of the other groups (P<0.05), groups B and C were significantly lower than group A (P<0.05), and group B was significantly lower than group C (P<0.05). The histological staining revealed that there were more mature fibroblasts and coarse collagen fibers with regular arrangement in groups A and B; there were more naive fibroblasts and tiny and sparse collagen fibers in groups C and D. The thickness of skin and epidermis, and MVD of groups B and D were significantly larger than those of groups A and C (P<0.05); the thickness of fibrous capsule of groups C and D was significantly less than that of groups A and B (P<0.05); but no significant difference was found in the above indexes between other groups (P>0.05). ConclusionADSCs can promote angiogenesis and regeneration of the expanded skin, have no effect on the fibrous capsule. Chitosan can inhibit the proliferation of fibrous capsule, so a combination of ADSCs and chitosan can inhibit the immediate retraction of the expanded skin.