Objective To review the research progress of alcohol-induced osteonecrosis of the femoral head (ONFH). Methods Recent literature concerning alcohol-induced ONFH was reviewed and summarized. Results Alcohol-induced ONFH accounte for approximately 1/3 of total ONFH. Alcohol intake and the incidence of ONFH has a significant dose-effect relationship. There are some correlations between alcohol-induced ONFH and lipid metabolism, secretion of corticosteroid, and some gene of alcohol or lipid metabolism. Conclusion The relationships between alcohol and lipid metabolism, and between alcohol and steroid are still the main direction of the research of ONFH. Gene level researches can not demonstrate the pathogenesis, therefore further research should be carried on.
Objective To summarize the basic research and the cl inical use of small intestinal submucosa (SIS), which is used as a degradable material for tissue repair. Methods Recent l iterature concerning SIS at home and abroad was extensively reviewed, and current developments of the basic research and the cl inical use of SIS were investigated. Results SIShad many biological advantages in tissue repair, and was used to repair various tissue defects in animal trials. It had successful outcomes in many cl inical trials to repair hernia, anal fistula and Peyronie diseases. And it also had good results at the early stage to treat dilation of the anastomosis, urethroplasty, hypospadias, and other diseases, however, the long-term follow-up was needed. Conclusion SIS is one kind of good material for tissue repair, and has promising future in the cl inical use.
Objective To review the researches on the jointpreserving procedures for the treatment of the avascular necrosis (AVN) of the femoral head. Methods The latest original literatures about the joint-preserving procedures for the treatment of AVN of the femoral head were extensively reviewed. Results There were many surgical jointpreserving procedures to treat AVN of the femoral head, such as core decompression, bone grafting, and osteotomy. Most researchers achieved excellent clinical results by using the joint-preserving procedures to treat the early stages of AVN of the femoral head. Conclusion Treating AVN of the femoral head by the joint-preserving procedures, especially the free vascularized fibula grafting, can achieve an excellent longterm clinical outcome.
Objective Platelet-rich plasma (PRP) can promote the repair of soft tissue, wound, and bone defect. To investigate the effect of PRP on synovitis by establ ishing papain-induced osteoarthritis model of rabbit knee and interfering withPRP. Methods Twenty healthy 6-month-old rabbits (male or female, weighing 2.5-3.5 kg) were randomly divided into theexperimental group (n=10) and the control group (n=10). The whole blood (10 mL) was extracted from the central aural artery and PRP was prepared with the Landesberg’s method. Meanwhile, the platelet derived growth factor (PDGF), transforming growth factor (TGF), and vascular endothel ial growth factor (VEGF) concentrations in the circulating blood and PRP were measured. The 4% papain solution (0.3 mL) was injected into the knee joint cavity to establ ish the osteoarthritis model. After that, PRP (0.3 mL) was injected into the knee joints every week for 10 weeks in the experimental group, while normal sal ine of the same volume in the control group. At 2nd, 4th, 6th, 8th, and 10th weeks after the first injection, the erythrocyte sedimentation rate (ESR) and interleukin 1β (IL-1β) concentrations in the whole blood were tested, and the histological changes of the synovium were observed by HE staining and the Mankin scores were made. Results The blood cell counting showed that the platelet concentration of PRP was 6.8 times as that of the circulating blood. PDGF, TGF-β, and VEGF were 5, 8, and 7 times as those of the circulating blood, showing significant differences (P lt; 0.05). All animals survived to the end of experiment. There were significant differences in the ESR at 2nd, 6th, 8th, and 10th weeks and in the IL-1β at 4th, 6th, 8th, and 10th weeks between 2 groups (P lt; 0.05). In the control group, the synovium was edematous and thickened with fibrous effusion and pannus on surface; in the experimental group, the effusion of the synovium was decreased and less congestion and edema were observed at the 2nd week; the synovium was observed to be a bit thickened without obvious edema, with sl ight amount of yellowish joint fluid on surface and no conglutination at the 10th weeks. There were significant differences in the Mankin score at 4th, 6th, 8th,and 10th weeks (P lt; 0.05) between 2 groups. Conclusion PRP is beneficial to the alleviation of synovitis induced by papain according to restoring the damaged tissue and depressing the inflammatory factors.
Objective To introduce the effect of platelet-rich plasma (PRP) in the treatment of chronic tissue lesions. Methods The latest research papers concerning the relevant subject were reviewed and analyzed. Results In PRP, the platelets and cytokines, the interaction of them in the same proportion as they were in the body fluid, played promoting role in repairing the chronic damage of tissues. However, there was still way to go before PRP was appl ied for cl inical use in a widerrange. Conclusion PRP has quite a bright outlook in the treatment of chronic tissue lesions.
Objective To study the effect of platelet-rich plasma (PRP) on repairing chronic wounds of lower l imbs. Methods From May 2007 to November 2007, 47 patients suffering from chronic wounds of lower l imbs were treated. There were 41 males and 6 females, aged from 15 to 68 years (43.2 years on average). The disease was caused by tibiofibulafracture in 20 cases, calcaneus fracture in 4 cases, metatarsal fracture in 1 case, multiple open fracture of lower l imbs in 3 cases, tibia osteomyel itis in 10 cases, femur osteomyel itis in 1 case, soft tissue injury of ankle in 4 cases, infection after amputation in 2 cases, infection after foot orthomorphia in 1 case, and infection after calcaneus tendon neoplasty in 1 case. Their chronic wounds did not healed after 2 to 4 months of therapy. Among them, chronic wounds compl icated with fracture nonunion in 23 cases and positive bacterial culture result in 38 cases. Debridement and autogenous PRP gel injection were appl ied every 2 months and for twice. Results The patients were followed up for 4 months after the first PRP injection. Two months after the first PRP injection, chronic wounds contracted significantly in 34 patients with purulence and necrosis tissue cleaned up, circulation of soft tissue improved and exposed bone or muscle tissue covered by neogenetic granulation. No patient was completely cured. Two months after the second PRP injection, the average coverage rate was 79.3% ± 18.0%, the total cure rate was 29.8%. The volume of the chronic wounds decreased by (9.3 ± 4.9) mL after PRP therapy (2.5 ± 2.7) mL when compared with (11.8 ± 5.6) mL of before therapy, showing significant difference (P lt; 0.05). X-ray photograph showed that among the 23 cases of fracture nonunion, fracture healed completely in 9 cases; bony callus formation increased obviously in 12 cases; no significant change was observed in 2 cases. No aggravated sign of osteomyel itis was notified. Positive results of bacterial culture reduced to 15 cases. Conclusion PRP efficiently enhances the recovery of soft tissue defect and speeds up the chronic wounds heal ing oflower l imbs.
Objective To explore the effectiveness of mini external fixation device for comminuted open fractures of the metacarpal and phalange. Methods Between October 2009 and April 2011, 33 patients with comminuted open fractures of the metacarpal and phalange were treated with mini external fixation device. There were 25 males and 8 females, aged from 21 to 62 years with an average of 25.5 years. Of 33 cases, 7 were rated as Gustilo type II and 26 as Gustilo type IIIA; 20 cases were diagnosed as having simple metacarpal and phalangeal comminuted fractures and 13 cases as having combined interphalangeal or metacarpophalangeal joint fractures. Partial or complete rupture of tendon was observed in 18 cases. The time between injury and operation was 2-8 hours (mean, 3.7 hours). After one stage debridement and reduction, fracture was fixed with mini external fixation device. Results Primary healing of incision was obtained in 30 cases and no pin hole infection was found. Incision infection occurred in 3 cases and leaded to nonunion. Nonunion also occured in 2 cases of simple metacarpal and phalangeal fractures. The mean follow-up was 8 months (range, 6 months to 1 year). X-ray films showed fracture healing in 13 cases after 8 weeks (8 cases of simple metacarpal and phalangeal fractures and 5 cases of combined interphalangeal or metacarpophalangeal joint fractures), in 12 cases after 12 weeks (7 cases of simple metacarpal and phalangeal fractures and 5 cases of interphalangeal or metacarpophalangeal joint fractures), and in 3 cases of simple metacarpal and phalangeal fractures after 6 months. After removing the mini external fixation device and functional exercise, 3 cases of simple metacarpal and phalangeal comminuted fractures and 4 cases of combined interphalangeal or metacarpophalangeal joint fractures still had joint stiffness, but had no finger rotation and alignment deformity or chronic pain. According to the measurement of total active movement for 28 patients who obtained fracture healing, the results were excellent in 7 cases, good in 12 cases, fair in 5 cases, and poor in 4 cases, the excellent and good rate was 67.9%. Conclusion The mini external fixation device is a good technique for comminuted open fractures of metacarpal and phalange. In patients having comminuted open fractures with interphalangeal or metacarpophalangeal joint fracture, the results are fair or poor.
Objective To investigate the osteogenesis effects of angiopoietin 1 (Ang-1) gene transfected bone marrow mesenchymal stem cells (BMSCs) seeded on β tricalcium phosphate (β-TCP) scaffolds (tissue engineered bone) with platelet-rich plasma (PRP). Methods BMSCs were isolated from bone marrow tissue of rabbits. The Ang-1 gene was transfected into the BMSCs at passage 2 by lentivector, which were seeded on β-TCP scaffolds with PRP (0.5 mL) after 48 hours of transfection. Bilateral radial segmental bone defects (15 mm in length) were created in 20 3-month-old New Zealand rabbits. Then the tissue engineered bone with the Ang-1 gene transfected BMSCs (experimental group) and untransfected BMSCs (control group) were implanted into the defects in the right and left radius, respectively. X-ray, histology, immunohistochemistry, and biomechanics observations were done at 2, 4, 8, and 12 weeks after operation. Results In vitro, the transfected rate was over 90% and RT-PCR showed that the Ang-1 expression were significantly increased after transfection. The X-ray films showed that some callus formed at 4 weeks, partial bony union was observed at 8 weeks, and complete union at 12 weeks in experimental group; and bone union was not observed at 12 weeks in control group. HE staining showed that capillary appeared at 8 weeks and more capillaries were observed in new bone at 12 weeks in experimental group; only a few capillaries were observed at 12 weeks in control group. At 8 and 12 weeks, the microvascular density were (50.1 ± 7.8) /mm2 and (66.1 ± 3.5) /mm2 in experimental group and were 0 and (30.3 ± 7.2)/mm2 in control group, showing significant differences between 2 groups at 12 weeks (Z= —2.107, P=0.031). Immunohistochemistry examination showed that the positive cells can be found at 8 weeks in experimental group. And the biomechanical analysis showed that maximum loads of experimental group were significantly higher than those of control group in three-point bending test and compression test at 12 weeks (P lt; 0.05). Conclusion The tissue engineered bone with PRP and Ang-1 can increase the osteogenic properties by enhancing capillary regeneration, thus it can be used to repair radial segmental bone defects of rabbit.
Objective To compare the effectiveness of two minimally invasive methods: minimally invasive plating osteosynthesis (MIPO) and expandable intramedullary nail ing technique in treatment of middle third humeral shaft fractures. Methods The cl inical data were retrospectively analyzed and compared from 33 cases with middle third humeral shaft fractures between May 2004 and December 2008. All the patients were divided into 2 groups: 14 patients were treated with MIPOtechnique (group A) and 19 with expandable intramedullary nail ing technique (group B). In group A, there were 10 males and 4 females with an average age of 35 years (range, 21-51 years). The disease cause was traffic accident in 5 cases, tumbl ing in 6 cases, machine related trauma in 2 cases, crushed by a heavy object in 1 case. Six fractures were classified as AO type A, 6 as type B, and 2 as type C. The time from injury to operation was 3 to 11 days with an average of 5.9 days. In group B, there were 12 males and 7 females with an average age of 40 years (range, 19-68 years). The disease cause was traffic accident in 7 cases, tumbl ing in 8 cases, fall ing from height in 3 cases, crush injury in 1 case. Ten fractures were classified as AO type A, 8 as type B, and 1 as type C. The time from injury to operation was 2 to 6 days with an average of 4.2 days. There was no significant difference in general data between 2 groups (P gt; 0.05). Results The operation time was (104.6 ± 25.8) minutes in group A and (85.0 ± 35.7) minutes in group B, showing no significant difference (P gt; 0.05). Incision healed by first intention without iatrogenic radial nerve palsy in 2 groups. The patientswere followed up 21.4 months on average (range, 12-37 months) in group A and 20.5 months on average (range, 22-35 months) in group B. The X-ray films showed bony heal ing in all patients. The fracture union time was (16.4 ± 6.1) weeks in group A and (15.0 ± 2.5) weeks in group B, showing no significant difference (P gt; 0.05). The University of Cal ifornia Los Angeles (UCLA) End- Result scores were 34.1 ± 1.1 in group A and 31.8 ± 2.6 in group B and the Mayo Elbow Performance scores were 100 in group A and 97.6 ± 3.9 in group B; all showing significant differences (P lt; 0.05). Conclusion Good cl inical outcomes could be obtained when middle third humeral shaft fractures are treated by either MIPO or expandable intramedullary nail ing techniques. However, MIPO technique could offer better shoulder and elbow functional results.
Objective To investigate the surgical techniques and the cl inical outcomes of treating severe pronationexternal rotation ankle fractures combined with deltoid l igament injuries. Methods Between July 2005 and April 2007, 17 patients with grade-IV pronation-external rotation ankle fractures combined with deltoid l igament injuries were treated by open reduction and internal fixation with l igament repair by using suture anchors. There were 13 males and 4 femaleswith an average age of 36.5 years (21-56 years). All cases were closed injuries with l imitation of motion after initial physical examination. The X-ray and CT showed that all patients were characterized with lateral and posterior malleolus fractures and significant lateral shift of talus, but without medial malleous fracture before operation. All fractures were classified into grade-IV pronation- external rotation or type C according to Lauge-Hansen criterion and Danis-Weber standard respectively. The disease course was from 4 days to 7 days with an average of 5.6 days. Results All incisions healed by first intention Seventeen patients were followed up 11-24 months (mean 15.6 months). The X-ray films showed that all patients achieved bony heal ing. The heal ing time was 11-16 weeks (mean 14.8 weeks). According to the Baird-Jackson’s scoring system, the results were excellent in 5 cases, good in 9 cases, fair in 2 cases and poor in 1 case, the excellent and good rate was 82.4%. No operation compl ication occurred. Medial clear space was significantly decreased postoperatively compared with that before operation [(3.16 ± 0.37) mm vs. (4.87 ± 0.43) mm] (P lt; 0.01). In gravity stress radiographs, there was no significant difference in medial clear space between collateral ankle and injured ankle after operation [(3.47 ± 0.43) mm vs. (3.55 ± 0.44) mm] (P gt; 0.05). Conclusion It is emphasized that full attention should be given to reconstruction of medial l igament structures as well as open reduction and internal fixation in treating grade-IV pronation-external rotation ankle fractures combined with deltoid l igament injuries.