ObjectiveTo explore the effectiveness of high strength suture fixation in treatment of patellar transverse fracture.MethodsBetween June 2014 and June 2016, 38 patients with the patellar transverse fracture were treated with high strength suture internal fixation. There were 24 males and 14 females with the age of 26 to 64 years (mean, 45 years). There were 6 cases of accident injury and 32 cases of crashing injury. The time interval between injury and surgery was 2-8 days (mean, 5 days). The preoperative visual analogue scale (VAS) score, Lysholm score, and range of motion (ROM) of patients were 84.3±8.4, 44.5±7.2, and (62±12)°, respectively.ResultsAll patients’ incisions healed by first intention after operation. There was no neurovascular injury, deep venous thrombosis of lower limbs, or local foreign matter irritation reaction. The X-ray films showed that the reduction of patella and the location of internal fixator were good at 2 days after operation. All the 38 patients were followed up 12-18 months (mean, 16 months). All fractures healed and the healing time was 2-4 months (mean, 3 months). At last follow-up, according to the Böstman criteria, 36 patients were rated as excellent and 2 as good, with an excellent and good rate of 100%. The VAS score, Lysholm score, and ROM of patients were 10.2±6.6, 93.1±6.4, and (124±14)°, respectively, showing significant differences when compared with preoperative ones (t=42.759, P=0.000; t=31.099, P=0.000; t=20.727, P=0.000).ConclusionApplication of high strength suture fixation in the treatment of patellar transverse fracture has advantages of simple to operate, effective fixation, and less complication. It can avoid reoperation of removing the internal fixators. The satisfied ROM and function of the knee joint can be obtained after operation.
Objective To explore the effectiveness of arthroscopic binding fixation using suture through single bone tunnel for posterior cruciate ligament (PCL) tibial insertion fractures in adults. Methods Between October 2019 and October 2021, 16 patients with PCL tibial insertion fractures were treated with arthroscopic binding fixation using suture through single bone tunnel. There were 11 males and 5 females with an average age of 41.1 years (range, 26-58 years). The fractures were caused by traffic accident in 12 cases and sports in 4 cases. The time from injury to operation ranged from 2 to 10 days with an average of 6.0 days. The fractures were classified as Meyers-McKeever type Ⅱ in 4 cases and type Ⅲ in 9 cases, and Zaricznyi type Ⅳ in 3 cases. There were 2 cases of grade Ⅰ, 7 cases of grade Ⅱ, and 7 cases of grade Ⅲ in the posterior drawer test. There were 3 cases combined with lateral collateral ligament injury and 2 cases with meniscus injury. The visual analogue scale (VAS) score, Lysholm score, International Knee Documentation Committee (IKDC) score, and knee range of motion were used to evaluate knee joint function. The posterior drawer test and knee stability tester (Kneelax 3) were used to evaluate knee joint stability. The X-ray films were used to evaluate fracture reduction and healing. Results All incisions healed by first intention after operation. There was no incision infection, popliteal neurovascular injury, or deep venous thrombosis of lower limbs. All patients were followed up 6-12 months, with an average of 10 months. X-ray films at 6 months after operation showed the fractures obtained bone union. There were 11 cases of grade 0, 4 cases of gradeⅠ, and 1 case of grade Ⅱin posterior drawer test, showing significant difference when compared with preoperative results (Z=23.167, P<0.001). The VAS score, Lysholm score, IKDC score, knee range of motion, and the results of Kneelax3 examination all significantly improved when compared with preoperative results (P<0.05). Conclusion For adult patients with PCL tibial insertion fractures, the arthroscopic binding fixation using suture through single bone tunnel has the advantages of minimal trauma, good fracture reduction, reliable fixation, and fewer complications. The patient’s knee joint function recovers well.
【Abstract】 Objective To investigate the effect of salidroside on rat bone marrow mesenchymal stem cells (BMSCs)differentiation into the chol inergic nerve cells, so as to provide the theory basis of the combination of salidroside and stem cellsfor cl inical therapy of nervous system diseases. Methods BMSCs were isolated from 2 Wistar rats (aged 4-6 weeks, weighing 120 g), which were identified by CD34, CD45, CD90, and CD106 with flow cytometry. According to inducing method, BMSCs at passage 2 were divided into 3 groups: In groups A and B, BMSCs were induced by salidroside (20 μg/mL) and retinoic acid (5 μmol/mL) respectively for 1, 3, 6, and 9 days, in group C, BMSCs were cultured with serum-free DMEM/F12 medium as control. MTT assay was used to detect the cellular prol iferation activity. The immunofluorescence chemical technology was used to detect the expressions of nerver growth factor (NGF) and relevant marker molecule of nerve cells, including neuron-specific enolase (NSE), microtubule-associated protein 2 (MAP2), β-Tubulin III, gl ial fibrillary acidic protein (GFAP), and the marker of cholinergic neuron, such as Acetylcholine (Ach) and NGF. RT-PCR was used to detect mRNA expressions of NSE, β-Tubulin III, GFAP, brain derived neurotrophic factor (BDNF), and γ-aminobutyric acid (GABA). ELISA was used to detect the levels of BDNF and NGF, and the expression level of NGF protein was analyzed by Western blot. Results The results of the flow cytometry showed that the cultured cells were CD90 and CD106 positive, and CD34 and CD45 negative, which indicated that the cells were BMSCs. The cellular proliferation activity in groups A and B were significantly higher than that in group C at 6 days and 9 days (P lt; 0.05). RT-PCR results showed that the expression level of NSE, BDNF, β-Tubulin III, GFAP mRNA were increased in groupA at 6 days; In group B, that expression level of NSE mRNA was up-regulated at 6 days, that expression level of BDNF mRNA increased at 1 days and reached the peak at 6 days, and that expression level of β-Tubulin III mRNA was up-regulated at 3 days, which was significantly higher than that at the other time points, and than that in group C (P lt; 0.01). But no GABA mRNA expression was detected in each group. Immunofluorescence chemical technology staining showed that the positive rates of NSE, MAP2, β-Tubulin III, and GFAP were significantly higher in group A than those in group C at 3 days; the positive rates of Ach were significantly higher at 3, 6, and 9 days than those at 1 day in groups A and B, and in groups A and B than in group C (P lt; 0.01); the positive rates of NGF in groups A and B were significantly higher than those in group C (P lt; 0.01). The levels of BDNF and NGF in groups A and B were significantly higher than those in group C at 1, 3, 6, and 9 days (P lt; 0.01), but no significant difference of BDNF was found between groups A and B (P gt; 0.05). The expression level of NGF protein in groups A and B were significantly higher than that in group C (P lt; 0.01). The NGF expression reached the peak at 6 days in group A and at 3 days in group B. Conclusion Sal idroside could induce rat BMSCs differentiate into chol inergic nerve cells in vitro.