ObjectiveTo review the research progress of tissue engineered ligament. MethodsThe literature in recent years on tissue engineered ligament in repair of anterior cruciate ligament (ACL) injury was extensively reviewed, including cell sources, scaffold materials, growth factors, and mechanical stimulation in tissue engineered ligament. ResultsTissue engineered ligament constructed by mesenchymal stem cells and ACL fibroblasts has been successfully used in animal experiments. It is crucial for qualified tissue engineered ligament to choose appropriate seed cells, scaffold, mechanical stimulation, and essential cytokines. To further optimize culture condition and how to realize the tissue engineered ligament in vivo better survival and prognosis need to be further studied. ConclusionEnormous progress has been made in tissue engineered ligament for repair and regeneration of ACL. With the development of biochemistry and scaffold materials, tissue engineered ligament will be used in clinic in the near future.
ObjectiveTo summarize the application status and progress of platelet-rich plasma (PRP) in clinical orthopedics. MethodsThe recent related literature concerning the application of PRP in clinical orthopedics was extensively reviewed and analyzed. ResultsRecently, a large number of clinical studies on PRP have been carried out, which are applied in bone defects or nonunion, spinal fusion, osteoarthritis and cartilage injuries, ligament reconstruction, muscle strain, tendon terminal diseases, and a variety of acute and chronic soft tissue injuries. Some results show certain effectiveness, while others demonstrate invalid. ConclusionEasily drawing, achieving autologous transplantation, and the biological repair potential of the musculoskeletal tissues make PRP to be widely used in clinical orthopedics. However, there are still no uniform standards accepted and reliable clinical guidelines about the application of PRP. Furthermore, a variety of PRP products and their respective indications are also different. The clinical evidences with the greater sample size and higher quality are still needed to further support the safety and effectiveness of PRP in clinical orthopedics.
ObjectiveTo review the research progress of the preparation and components of the platelet rich plasma (PRP). MethodsThe recent literature concerning the biological mechanism, preparation, and components of PRP was analyzed and summarized. ResultsThe biological function of PRP depends on a series of intricate cascade of cellular and molecular events. PRP contains different concentrations of platelets, which would release a large number of the activated molecules, and also contains a small amount of white blood cells and red blood cells. The preparation of PRP is based on platelet concentration. Different preparation techniques would lead to different platelet concentrations, recovery ratios, and components. ConclusionThere is no uniform standard for the preparation of PRP. Different preparation methods and technical parameters of PRP will get different components and different concentrations of PRP, which also provide a reference for cl inicians to select the most appropriate PRP for individual patient.
ObjectiveTo investigate the effectiveness of arthroscopic treatment of pigmented villonodular synovitis (PVNS) of the ankle. MethodsTwelve patients who were initially diagnosed as having PVNS of the ankle were treated between January 2005 and May 2012.There were 6 males and 6 females,aged 20-50 years (mean,35.4 years).Disease duration ranged from 6 months to 12 years (median,3.6 years).One case of recurrence was included.The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 55.5±7.6.According to degree and range of the PVNS lesions,4 cases of local PVNS were treated with arthroscopic debridement,and 8 cases of diffuse PVNS were treated with arthroscopically assisted arthrotomy;and local radiotherapy was given in all patients after operation. ResultsPrimary healing of incision was obtained in all patients.The mean follow-up time was 2.8 years (range,1-6 years).At 12 months after operation,no obvious pain,swelling,and limited range of motion of the ankle were observed.The AOFAS score was increased to 84.3±3.4 at 12 months,and it was significantly higher than that at preoperation (P<0.05) and at 3 months after operation (82.8±3.8)(P<0.05).There was no recurrence during follow-up. ConclusionArthroscopic arthrotomy combined with postoperative radiotherapy are recommended for PVNS of the ankle according to the PVNS lesion degree and range.And arthroscopically assisted surgery has many advantages of less traumas and hemorrhage,fast recovery,and less complications.
ObjectiveTo summarize the application status and progress of the strategies to augment tendon-to-bone healing. MethodsThe present researches focused on augmentation of tendon-to-bone healing were extensively reviewed. ResultsThe present strategies to augment healing of tendon-to-bone by enhancing the location environment, and increasing the cell numbers and relative growth factor. The mainly strategies include using calcium phosphate materials, biocompatible scaffolds and glue, growth factors, cell matrix, platelet-rich plasma, and periosteum. Although periosteum have been used in clinical and got some possitive effects, the others still not be used in clinical and needs further studies. ConclusionThere are many strategies to enhance the ability of tendon-to-bone healing, which got some positive results, but results of studies were varied. Thus, further fundamental research and clinical studies are required to achieve the best effects.
ObjectiveTo investigate the stability of unilateral fractured vertebral pedicle screw fixation in the treatment of thoracolumbar fracture. MethodsEighteen fresh calf thoracolumbar spine specimens (T11-L3) were obtained to establish the L1 burst fracture models with Panjabi's high speed trauma apparatus, and were divided into 3 groups:pedicle fixation for adjacent upper and lower vertebrae of fractured vertebra (4 pedicle screws in group A), combined with pedicle screw fixation for unilateral fractured vertebrae (5 pedicle screws in group B), and three-level 6 pedicle fixation (group C). Under normal, fractured, and reconstructed conditions, the range of motion (ROM) of adjacent upper and lower vertebrae of fractured vertebra were measured in flexion, extension, bilateral bending, and axial rotation. Axial stiffness under flexion-compression was measured on the MTS-858 testing system. ResultsThere was no significant difference in ROM and axial stiffness under normal and fractured conditions in all directions among groups (P<0.05), indicating load balance in the groups. ROM of groups B and C were significantly less than that of group A under reconstructed condition in all directions (P<0.05), but no significant difference was found between group B and group C (P>0.05). Biomechanical test showed that group B was significantly higher than group A in the axial stiffness value (P<0.05), but difference was not significant between group B and group C (P>0.05). ConclusionTranspedicular fixation of fractured vertebrae can enhance the stability of the spine. Both unilateral and bilateral fractured vertebral pedicle screw fixations have the same stability.
ObjectiveTo systematically review the efficacy between key hole approach versus large trauma craniotomy for patients with hypertensive intracerebral hemorrhage. MethodsSuch databases as The Cochrane Library (Issue 3, 2013), PubMed, EMbase, WangFang Data, CNKI and VIP was searched to identify randomized controlled trials (RCTs) on key hole approach versus large trauma craniotomy for patients with hypertensive intracerebral hemorrhage from January 2005 to June 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. ResultsA total of 13 studies involving 1 324 patients was included. The results of meta-analysis showed that, key hole approach was superior to large trauma craniotomy with significant differences in the fatality rate (OR=0.29, 95%CI 0.19 to 0.45, P < 0.000 01), incidence of postoperative complications (OR=0.35, 95%CI 0.21 to 0.57, P < 0.000 1), recovery time of consciousness (MD=-4.52, 95%CI-5.84 to-3.20, P < 0.000 01), neurologic impairment score after 1-month treatment (MD=-12.63, 95%CI-16.36 to-8.90, P < 0.000 01), total effectiveness (OR=3.79, 95%CI 2.54 to 5.66, P < 0.000 01), and postoperative living ability (ADL Grade I, Ⅱ). ConclusionKey hole approach is better than large trauma craniotomy for patients with hypertensive intracerebral hemorrhage. Due to limited quality and quantity of the included studies, the abovementioned conclusion still needs to be verified by conducting more high quality studies, especially conducting multicenter blinding RCTs with large sample-size.
ObjectiveTo explore the effect of programmed family nursing intervention on medication compliance in hypertensive patients. MethodsA total of 160 patients with hypertension treated between August 2012 and July 2013 in our hospital were chosen to be our study subjects. They were randomly divided into two groups:control group (n=80) and trial group (n=80). Patients in the control group were given routine nursing intervention for six months, while those in the trial group received six-month programmed family nursing intervention. Then, we compared the effect of blood pressure control and medication compliance between the two groups. ResultsThe effect of blood pressure control and medication compliance in the trial group after the intervention was better than that in the control group, and the difference was statistically significant (P<0.05). ConclusionThe programmed family nursing intervention is better than the routine nursing intervention in terms of effect of blood pressure control and patients' medication compliance, and it is an effective nursing method for hypertensive patients.
ObjectiveTo research the effect of recombinant adenovirus-bone morphogenetic protein 12 (Ad-BMP-12) transfection on the differentiation of peripheral blood mesenchymal stem cells (MSCs) into tendon/ligament cells. MethodsPeripheral blood MSCs were isolated from New Zealand rabbits (3-4 months old) and cultured in vitro until passage 3. The recombinant adenoviral vector system was prepared using AdEasy system, then transfected into MSCs at passage 3 (transfected group); untransfected MSCs served as control (untransfected group). The morphological characteristics and growth of transfected cells were observed under inverted phase contrast microscope. The transfection efficiency and green fluorescent protein (GFP) expression were detected by flow cytometry (FCM) and fluorescence microscopy. After cultured for 14 days in vitro, the expressions of tendon/ligament-specific markers were determined by immunohistochemistry and real-time fluorescent quantitative PCR. ResultsGFP expression could be observed in peripheral blood MSCs at 8 hours after transfection. At 24 hours after transfection, the cells had clear morphology and grew slowly under inverted phase contrast microscope and almost all expressed GFP at the same field under fluorescence microscopy. FCM analysis showed that the transfection efficiency of the transfected group was 99.57%, while it was 2.46% in the untransfected group. The immunohistochemistry showed that the expression of collagen type Ι gradually increased with culture time in vitro. Real-time fluorescent quantitative PCR results showed that the mRNA expressions of the tendon/ligament-specific genes (Tenomodulin, Tenascin-C, and Decorin) in the transfected group were significantly higher than those in untransfected group (0.061±0.013 vs. 0.004±0.002, t=-7.700, P=0.031; 0.029±0.008 vs. 0.003±0.001, t=-5.741, P=0.020; 0.679±0.067 vs. 0.142±0.024, t=-12.998, P=0.000). ConclusionAd-BMP-12 can significantly promote differentiation of peripheral blood MSCs into tendon/ligament fibroblasts and enhance the expressions of tendon/ligament-specific phenotypic differentiation, which would provide the evidence for peripheral blood MSCs applied for tendon/ligament regeneration.
Objective To evaluate the surgical procedure and short-term effectiveness of one-stage repair and reconstruction of knee dislocation with multiple ligament injuries (KDMLI). Methods Between September 2010 and April 2014, 9 cases (9 knees) of KDMLI were treated. There were 7 males and 2 females with an average age of 42 years (range, 27-57 years). Injury was caused by traffic accident in 3 cases, heavy-weight crushing in 3 cases, sports sprain in 2 cases, and falling from height in 1 case. The average time from injury to operation was 11 days (range, 3-19 days). The results of posterior drawer test and Lachman test were positive in all patients. The results of varus stress testing were three-degree positive in 4 cases, and the results of valgus stress testing were three-degree positive in 6 cases. The Lysholm score of knee was 27.2±6.3; the International Knee Documentation Committee (IKDC) score was 29.7±6.5; and the range of motion (ROM) was (52.6±12.8)°. All patients suffered from posterior cruciate ligament (PCL) injury and femoral avulsion injury of anterior cruciate ligament (ACL). Combined injuries included medial collateral ligament (MCL) injury in 4 cases (medial meniscus injury in 1 case), lateral collateral ligament (LCL) injury in 2 cases, and MCL and LCL injuries in 2 cases (medial meniscus and lateral meniscus injuries in 1 case). Autologous harmstring tendon was used to reconstruct PCL under arthroscopy combined with limited open in situ suture for repair of femoral avulsion injury of ACL, and repair of MCL, LCL, and other injury in one-stage operation. Results All incisions healed by first intention. Joint effusion of knee occurred in 1 case and was cured after removal of fluid combined with pressure bandage. All patients were followed up 12-36 months with an average of 22 months. At last follow-up, the result of posterior drawer test was negative in all patients. The results of Lachman test were one-degree positive in 2 cases; the result of varus stress testing was one-degree positive in 1 case; the results of valgus stress testing were one-degree positive in 2 cases; and flexion dysfunction of the knee was observed in 1 case. The Lysholm score of knee was 87.3±6.6; the IKDC score was 88.9±6.8; and the ROM was (121.7±12.3)°, all showing significant differences when compared with preoperative ones (t=44.246, P=0.000; t=37.903, P=0.000; t=19.894, P=0.000). Conclusion For KDMLI, one-stage repair and reconstruction using autologous harmstring tendon to reconst ruct PCL under arthroscopy combined with limited open in situ suture repair of femoral avulsion injury of ACL, and repair MCL, LCL, and other injury has such advantages as minimal invasiveness, reliable fixation, less complications, and fast recovery, which can significantly improve the stability, ROM, and function of knee and obtain good short-term effectiveness.