Objective To observe the cl inical results of treatment of Schatzker V/VI tibial plateau fracture involved posteromedial condyle through combined posteromedial and anterolateral approach and fixed with two or three plates. Methods From April 2005 to April 2008, 18 cases of tibial plateau fracture involved posteromedial condyle were treated, including 14 males and 4 females with an average age of 38.5 years old (range, 18-62 years old). According to Schatzker classification, there were 12 cases of type V and 6 cases of type VI. The posteromedial condyle were involved in 13 cases and bilateral posterior condyle in 5 cases. All patients were given posteromedial fragment and medial condyle fracture reduction through posteromedial approach firstly, and then lateral condyle fracture reduction through anterolateral approach, and injury of meniscuses and cruciate l igaments were treated at the same time. Three plates (lateral, medial, posterior) were used in 10 cases and two plates (lateral, posteromedial) in 8 cases. Results All wounds achieved heal ing by first intention without compl ications such as infection, flap necrosis, osteofascial compartment syndrome, chronic osteomyel itis, nonunion. All patients were followed up for 12 to 48 months with an average of 24.4 months. The mean flexion of the knee was 118.4° (range, 100-130°) 1 year after operation. According to Iowa evaluation system, 12 patients got excellent results, 4 good, and 2 fair; the excellent and good rate was 88.9%. Conclusion Combined posteromedial and anterolateral approach and fixed with two or three plates is effective in treatment of the Schatzker V/VI tibial plateau fracture involved posteromedial condyle. Anatomical reduction and rigid internal fixation of the posteromedial fragment are critical to successful operation.
Objective To study the effect of the human umbilical cord blood on the content of trace elements in whole blood during fracture healing in rabbits and to explore the mechanism of promoting fracture healing. Methods The right tibial fracture model was made in 63 white New Zealand rabbits (aged, 4-5 months; weighing, 2.0-2.5 kg). The fracture site was treated with 3 mL human umbilical cord blood (group A, n=21) and 3 mL normal saline (group B, n=21) at 3 and 8 days after operation, and was not treated as a control (group C, n=21). At 1, 2, 3, 4, 5, and 6 weeks after operation, the X-ray and histological observations were done; the contents of zinc, copper, magnesium, ferrum, calcium, and phosphorus were detected. Results X-ray observation showed that the fracture healing speed of group A was significantly faster than that of groups B and C; the fracture healing X-ray score of group A was significantly higher than that of groups B and C at 2-6 weeks (P lt; 0.05). The histological observation indicated that new trabeculae and osteoid of group A were significantly more than those of groups B and C; at 2-5 weeks, the histological score of group A was significantly higher than that of groups B and C (P lt; 0.05); at 6 weeks, the score of group A was significantly higher than that of group B (P lt; 0.05), but no significant difference was found between groups A and C (P gt; 0.05). Changes trend of the trace elements in 3 groups after operation was basically consistent. The content of copper first decreased and then gradually increased; the contents of ferrum, zinc, and magnesium at different time points decreased, but were basically stable; the content of calcium first increased and then decreased; the content of phosphorus first decreased and then increased. The contents of copper, zinc, magnesium, ferrum, calcium, and phosphorus in group A were significantly higher than those in groups B and C at different time points (P lt; 0.05), but there was no significant difference between groups B and C (P gt; 0.05). Conclusion Injection of the human umbilical cord blood at the fracture end of rabbits can significantly slow down the loss of trace elements in whole blood, ensure the contents of necessary trace elements during fracture healing, which may be one of the mechanisms of the umbilical cord blood promoting fracture healing.
OBJECTIVE: To investigate the repairing result for the massive bony defects of upper and middle tibia and lower femur. METHODS: Since 1974, four types of pedicled-fibula transposition were performed to repair the massive bone defect of tibia and femur in 25 cases, which included; 9 cases with benign tumor of upper part of tibia were performed muscle-pedicled fibula transposition and knee fusion after tumor resection; 9 cases with extensive benign tumor or tumoroid lesion of tibia shaft were performed muscle-pedicled fibula transposition and tibia-fibula fusion after tumor resection; 2 cases with extensive benign tumor or tumoroid lesion of middle and lower parts of tibia were performed vascular pedicled fibula transposition and tibia-fibula fusion; 5 cases with benign tumor of distal femur were performed vascular pedicled fibula reversal transposition and knee fusion. RESULTS: After 3 months to 11 years follow-up, 23 cases showed bone healing at 6 months postoperatively. The other 2 cases showed bone healing at 12 months postoperatively. All cases had satisfactory functional rehabilitation. CONCLUSION: Pedicled-fibula transposition is a choice method for repairing massive defects of tibia and femur.
Objective To evaluate the survival condition and quantitative variation of mechanoreceptors in the tibial remnant of ruptured anterior cruciate l igament (ACL) in human knees. Methods Between April 2009 and May 2010, 60 patients who underwent arthroscopic ACL reconstruction were included and divided into 4 groups according to the time of injury, with 15 patients in each group. In group A, there were 14 males and 1 female aged 20-37 years (mean, 27 years); the injury was caused by traffic accident in 5 cases and by sports in 10 cases, and the time between injury and surgery was not more than 3 months. In group B, there were 14 males and 1 female aged 17-43 years (mean, 24 years); the injury was caused by traffic accident in 2 cases and by sports in 13 cases; and the time between injury and surgery was 3 to 6 months. In group C, there were 11 males and 4 females aged 16-53 years (mean, 28 years); the injury was caused by traffic accident in 2 cases and by sports in 13 cases; and the time between injury and surgery was 6 to 12 months. In group D, there were 12 males and 3 females aged 18-41 years (mean, 26 years); the injury was caused by sports in 11 cases, and the other 4 cases had no defined etiology; and the time between injury and surgery was more than 12 months. Specimens were donated by the volunteers from the anteromedial side of the ACL tibial remnant (40 sl ices per specimen) and stained via immunohistochemical method. The type, size, and quantity of mechanoreceptors were observed under l ight microscope. Results Totally 80 Ruffini-l ike corpuscles, 8 Pacini-l ike corpuscles, 5 atypical neural endings and no distinct Golgi organ-l ike corpuscles were observed under l ight microscope in 60 specimens (2 400 sl ices) of 4 groups. There was no obvious difference in size and type of mechanoreceptors among 4 groups. However,some degenerative and atrophic changes could be observed in the specimens of group D. The total number of echanoreceptors was 31 (35.2%) in group A, 22 (25.0%) in group B, 23 (26.1%) in group C, and 12 (13.7%) in group D. There was no significant difference (P gt; 0.05) in Ruffini-l ike corpuscles and Pacini-l ike corpuscles among 4 groups. Mechanoreceptors were found in 9,8, 9, and 6 patients in groups A, B, C, and D, respectively; the detection rates were 60.0%, 53.3%, 60.0%, and 40.0%, respectively; showing no significant difference (P gt; 0.05). Conclusion The mechanoreceptors in tibial residual of ruptured ACL have a long survival without obvious degeneration and atrophy within 12 months. So it may contribute to restoration of proprioceptive function after operation if the remnant is preserved during ACL reconstruction.
Objective To summarize the effectiveness of 3.5 mm T support plate fixation for simple postero-lateral tibial plateau fractures by posterolateral inverted L-shaped approach. Methods Between March 2011 and January 2016, 13 patients with simple posterolateral tibial plateau fracture were treated with 3.5 mm T support plate fixation by posterolateral inverted L-shaped approach. Of 13 cases, 6 were male and 7 were female, aged 28 to 52 years (mean, 43 years). The left side was involved in 5 cases and the right side in 8 cases. The causes of injury were traffic accidents in 6 cases, falls in 3 cases, and falling from height in 4 cases. All of patients had fresh closed fracture by X-ray, CT three dimensional reconstruction, and MRI. According to Schatzker classification, 4 cases were rated as type II and 9 cases as type III. The time between injury and operation was 5-9 days (mean, 7 days). Results One case had incision skin necrosis, which was cured after debridement and skin grafting; and primary healing was obtained in the other cases. The patients were followed up 10-16 months (mean, 13 months). The X-ray film showed that the fracture line was blurred at 3 months after operation, and disappeared at 12 months after operation. There was no complications of wound infection, major neurovascular injury, loosening or breakage of internal fixation, and dislocation of joint surface. The Hospital for Special Surgery (HSS) knee function score was 94 (range, 89-97) at last follow-up; all were excellent. Conclusion The 3.5 mm T support plate fixation by posterolateral inverted L-shaped approach is one of preferred surgical method for the treatment of simple posterolateral tibial plateau fractures.
ObjectiveTo evaluate the clinical therapeutic effect of support plates on Schatzker type Ⅳ tibial plateau fractures.MethodsPatients with Schatzker type Ⅳ tibial plateau fractures underwent support plates treatment between April 2013 and September 2014 by using the medial incision or posterior medial incision, if necessary, with other auxiliary incisions, with limited contact compression plate, 1/3 tubular plate or " T” plate to support the fracture. ResultsA total of 14 patients including 6 males and 8 females with an average age of (35.2±9.8) years (ranged from 20 to 52 years) were enrolled in this study and followed up for 12–25 months with an average of (16.3±4.0) months. The knee joints were flexed 80–130° with an average of (97.9±13.1)° one month after the surgery and 90–140° with an average of (119.3±12.1)° three months after the surgery. One year postoperatively, the mean Hospital of Special Surgery knee score ranged from 78 to 96 with an average of 88.4±4.9. Last follow-up assessment of knee function according to Rasmussen scoring system showed excellent in 8 cases, good in 4 cases, and fair in 2 cases; the excellent and good rate was 85.7%. No postoperative complications such as infection, nonunion, vascular nerve injury, or internal fixation failure occurred. ConclusionThe support plates for the treatment of Schatzker type Ⅳ tibial plateau fractures can maintain good reduction, prevent the secondary collapse of the tibial plateau, ensure that knee joint has good alignment, less complications with vascular or nerve injuries, and finally get a satisfied function recovery.
Objective To investigate the ability to repair goat tibia defect with marrow stromal stem cells (MSCs) and bio-derived bone, and the feasibility of the compounds as bone substitute material. Methods MSCs were cultured with the bioderived bone in vitro, and the 20 mm tibia defect of goat was made and fixedwith plate. Eighteen goats were divided into experimental group, control group and blankgroup. The defects were not filled with anything in blank group, with tissue engineering bone in experimental group and bio-derived bone in control group. Therepair capability was assessed by physical, X-ray and bone mineral density examinations8,12,16, and 24 weeks after operation. Results In experimental group, the defects were partially repaired 8 weeks, and completely repaired12 and 16 weeks; there was significant difference in bone density between experimental group and control group (P＜0.05) 8,12 and 16 weeks, but no significant difference 24 weeks. The defects of blank group were not repaired 24weeks. Conclusion The tissue engineering bone can efficiently repair bone defect, and its repair capability is better than that of bio-derived bone alone both in quantity and quality of boneformation.
ObjectiveTo explore the biological mechanisms of tibial transverse transport (TTT) for promoting microcirculation and tissue repair.MethodsThe clinical application and animal model study of TTT were reviewed.ResultsThe possible biological mechanisms of TTT for promoting microvascular network formation and tissue repair: ① Tibial corticotomy reduces intramedullary pressure and improves microcirculation; ② Tension stress stimulation promotes microvascular regeneration and accelerates the formation of new “transcortical vessels” network; ③ Systemic mobilization of stem cells, mediating local inflammation, etc.ConclusionTTT has been clinically proven to be effective for the management of lower limb ischemia and diabetic foot ulcers. The surgical procedure is relatively easy with little adverse effects on bone structures. The TTT has good application prospects despite the biological mechanisms of which still need further exploration.
Objective To investigate the biomechanics of a novel injectable calcium phosphate cement (CPC) composited by poly (lactic-co-glycolic acid) (PLGA) combined with double-screw fixation in repairing Schatzker II type tibial plateau fracture, so as to provide the mechanical basis for the clinical minimally invasive treatment. Methods Ten matched pairs of proximal tibia specimens were harvested from 10 elderly cadavers to prepare Schatzker II type tibial plateau fracture model. Fracture was fixed by forcing injection of CPC (experimental group) or autologous cancellous bone (control group) combined with double-screw fixation. The samples underwent axial compression on MTS 858 material testing machine to measure the load-displacement, the maximum load, and compressive stiffness. Results The novel CPC had good injectable property at room temperature, which could fill in bone defect fully and permeated into the surrounding cancellous bone. The average bone mineral density of tibial metaphysis was (0.639 ± 0.081) g/cm2 in the experimental group and (0.668 ± 0.083) g/ cm2 in the control group, showing no significant difference (t=1.012, P=0.331). The maximum load in the experimental group [(4 101 ± 813) N] was significantly higher than that in the control group [(692 ± 138) N] (t=3.932, P=0.001). The compressive stiffness was (1 363 ± 362) N/mm in the experimental group and was (223 ± 54) N/mm in the control group, showing significant difference (t=3.023, P=0.013). Conclusion The novel CPC can effectively restore the biomechanical properties of tibilal plateau in repairing Schatzker II type tibial plateau fracture by means of forcing injection combining with double-screw fixation. It could be used as an effective bone substitute in the clinical application.
Objective To introduce the arthroscopic technique of figure-of-eight suture fixation for tibial eminence fracture, and to report its clinical results. Methods From January 1998 to June 2001, 21 cases of tibial eminence fracture were treated arthroscopically with figure-of-eight suture fixation technique. Active rehabilitation began one week after operation. The patients were followed up 6-24 months. The reduction and union of fracture, knee laxity, range ofmotion, and total knee function were evaluated. Results All fracture healed without displacement six weeks after operation. Three months postoperatively, no knee laxity or instability was detected in all patients; full range of motion of the affected knee returned in all patients when compared with the normal side. Six months postoperatively, the Lysholm knee score was 93.4±2.7. Conclusion Arthroscopic treatment of tibial eminence fracture with figure-of-eight suture fixation technique is reliable for fracture reduction , fixation and early mobilization. Arthroscopy is conducive to diagnoses and treatment of associated knee arthropathy, reduces the morbidity associated with arthrotomy, and restores knee function to the greatest extent when combined with figure-of-eight suture fixationtechniques.