Objective To review the current development of the dynamic stabilization devices and their biomechanics as well as clinical application.Methods The related biomedical research papers at home and abroad were consulted and analyzed Results There were obvious advances in the theoretic foundation and the clinical application in treatment of the degenerative lumbar disorders with the dynamic stabilization devices, especially with the nonfusion dynamic stabilization devices. Conclusion The effectiveness of the dynamic stabilization devices have attracted more and more biomedical researchers, especially the posterior dynamic stabilization device, which has provided a new approach to treatment of the degenerative lumbar disorders.
【Abstract】 Objective To compare the short-term effects of arthroscopic partial meniscectomy in treating medial versuslateral meniscus injuries. Methods From January 2003 to January 2006, 207 patients with meniscus injury(without intraarticularligament injury) underwent arthroscopic partial meniscectomy. The medial meniscus injury group included 115 cases, 50males and 65 females; aged 14 to 78 years(mean 46.9 years); 66 left knees and 49 right knees. Twenty-six cases had injury histories,the delayed time from injury to surgery ranged from 6 d to 6 months (mean 2.1 months). The lateral meniscus injury group included92 cases, 18 males and 74 females; aged 16 to 62 years (mean 41.1 years); 57 left knees and 35 right knees. Twenty-four caseshad injury histories, the delayed time from injury to surgery ranged from 9 d to 6 months (mean 1.9 months). Lysholm score systemwas applied and the scors of pre- and post-operation and were compared between two groups. Results The period of followupranged from 12 to 45 months (mean 31.5 months). In medial meniscus injury group and lateral meniscus injury roup, theLysholm score increased from 61.3±16.9 and 57.4±17.6 preoperation to 95.0±7.9 and 93.3±7.4 postoperation respectively. Therewas statistically significant difference between preoperation and postoperation (P lt; 0.01), and there was no statistically significantdifference between two groups（P gt; 0.05）. The excellent and good rates for function of knee joint were 97.39% (excellent in 107cases, good in 5 cases and fair in 3 cases) in medial meniscus injury group and 100%(excellent in 80 cases and good in 12 cases)in lateral meniscus injury group. Conclusion Arthroscopic partial meniscectomy is a safe and effective treatment for meniscusinjury, there is no diference in short-term effects in treating medial versus lateral meniscus injuries.
Objective To investigate the effect of bFGF on denervated skeletal muscle in accelerating muscle satell ite cell prol iferation, supplying neurotrophic factors and reducing muscle atrophy. Methods Twenty-eight Wistar male rats weredivided into the experimental group and the control group randomly, whose left lower l imb sciatic nerve was excised to make animal models of denervated skeletal muscle. The sil ia gel tubes containing 0.1 g bFGF and normal sal ine were implanted into gastrocnemius in the experimental and control groups, respectively. After 14 and 30 days of operation, gross appearance was observed; muscle wet weight and potential ampl itude of gastrocnemius fibrillation were measured; histological observation and electron microscope observation were made. Results At 14 and 30 days after operation, gastrocnemius atrophy and adhesion were more obvious in the control group than those in the experimental group. At 30 days after operation, the potential amplitude of gastrocnemius fibrillation and muscle wet weight were experimental group (0.220 6 ± 0.301 0) μm and (2.475 7 ± 0.254 6) g in the experimental group, and (0.155 2 ± 0.050 3) μm and (1.459 1 ± 0.642 5) g in the control group. There was a significant difference between two groups (P lt; 0.05). At 14 and 30 days after operation, HE staining showed more muscle satell ite cell nucleiin gastrocnemius of the experimental group than that of the control group; Mallory staining showed more blue connective tissues in the control group than in the experimental group; PCNA staining showed more PCNA positive cell nuclei in the experimental group than in the control group; and the AgNO3 staining testified more grains of vitamin C and less connective tissue proliferation in the experimental group than in the control group. At 30 days after operation, the fiber diameter and the fiber area were (66.368 6 ± 12.672 7) μm and (2 096.112 9 ± 311.563 9) μm2 in the experimental group, (55.504 0 ± 4.945 0) μm and (1 418.068 0 ± 264.953 7) μm2 in the control group. The PCNA positive cell nuclei number was 116.200 ± 5.357 in the experimental group and 53.000 ± 3.937 in the control group, showing statistically significant difference between the two groups (P lt; 0.05). At 14 and 30 day after operation, ompared with control group, the muscle fiber in the experimental group arrangedly more regularly and had lessatrophy fiber and the connective tissue proliferation. Conclusion bFGF can stimulate the proliferation of muscle satell ite cells in denervated gastrocnemius, delay the muscle fiber atrophy and inhibit connective tissues proliferation in muscle fibers.
Objective To explore the effect of basic fibroblast growth factor（bFGF）and epidermal growth factor（EGF）on the growth of muscle derived stem cells(MDSCs). Methods MDSCs were isolated from hindlimb muscle of 15 new born Kunming mice through serial preplates. 2% fetal bovine serum-containing DMEM was used to induce MDSCs to differentiate into skeletal muscle lineage. The expressions of stem cell marker Sca-1 and skeletal musclecell marker αSarcomeric actin were examined by immunocytochemistry. The effect of bFGF and EGF on the proliferation of MDSCs was determined by MTT colorimetric microassay. The solo effect of bFGF or EGF at different concentrations (6.25,12.50, 25.00, 50.00, and 100.00 ng/ml) was examined at 96 h and the combined effect (100.00 ng/ml) was examined at 24,48,72 and 96 h.Results MDSCs were successfully isolated from the hindlimb of neonatal mice. Over 90% of MDSCs showed Sca-1 positive immunoreactivity. MDSCs could give rise to α Sarcomeric actin positive myotubes in differentiation cultures. The proliferative effect of bFGF and EGF on MDSCs increased with the elevated concentration.bFGF began to show significant proliferative effect at 12.50 ng/ml (P＜0.05). The effect increased significantly when the concentration reached 25.00 ng/ml from 12.50 ng/ml (P＜0.01) and reached a saturation point. The effect at 50.00 ng/ml or 100.00 ng/ml showed no significant increase when compared with thatat 25.00 ng/ml. EGF had a similar effect to bFGF except that the saturation concentration was 50.00 ng/ml. EGF showed significant effect at 72 h and bFGF at 96 h (Plt;0.01). When they were applied together, significant effect was shownat 24 h (Plt;0.01) and much higher effect was observed at 48, 72 and 96 h (Plt;0.05). Conclusion Both bFGF and EGF can promote the proliferation of MDSCs. The combined application reacts faster and ber.
Objective To evaluate the effect of reconstruction withautograft implantation in total hip arthroplasty(THA) with regional acetabular deficiency. Methods From 1991 to 2000, 39 cases of THA with acetabular deficiency were conducted. Autogenous bone implantation was used to reconstruct the deficient acetabulum. Of the 39 patients, 25 were males and 14 were females. The age ranged from 34 to 62(45.2 on average). There were21 cases of developmental dysplasia resulted deficiency, 14 cases of fracture of femoral neck complicated with head necrosis(10 hips) and fracture of acetabulum(4 hips). The resected femoral heads or autologous ilium were made the wedgeshaped graft and implanted into the deficient acetabulum, which included 12 cases with cement THA and 27 with cementless THA.Of all the cases, 24 were followed up 2 to 10 years(6.7 years on average). Harris scores before operation were 18 to 50(38.1 on average). Results The limbs were lengthened by 2.4 cm on average. No serious complications were observed in these patients. Comparedwith the scores before the operation, the average Harris scores after the operation were 92.1(Plt;0.01)and 86.3(Plt;0.05) in the one-year and the latest follow-up respectively. The rates for the good were 91.7% and 83.3% in the one-year and the latest follow-up respectively.Conclusion The acetabular reconstruction with autograft in THA will bring better stability in those patients with acetabular deficiency. It is of significance in maintaining a long-term function in the replaced hip.
Objective To evaluate the feasibility and significance of problem-based learning (PBL) in orthopedic internship. Methods A total of 315 students in grade 2002 were involved in PBL during their internship in the Department of Orthopedics at the First Affiliated Hospital of China Medical University, Shenyang, China. Teaching effectiveness was evaluated with a questionnaire and an ability examination. The results of PBL teaching during different semesters were compared, and the feasibil ity and significance of PBL were analyzed. Results Students who participated in PBL were in a dominant position and were more active in the learning process. The PBL pattern could improve students’ ability to identify, analyze and solve problems, and also contribute to fostering and enhancing their clinical thinking. This could help them solve the problems that emerged from the theory curriculum.Conclusions The PBL pattern used in the orthopedics internship has advantages and practical significance, which are applicable in modern medical teaching practice.
ObjectiveTo compare the effectiveness of robot assisted and C-arm assisted percutaneous kyphoplasty (PKP) in the treatment of single/double-segment osteoporotic vertebral compression fracture (OVCF).MethodsThe clinical data of 108 cases of single/double-segment OVCF who met the selection criteria between May 2018 and October 2019 were retrospectively analyzed. There were 65 cases of single-segment fractures, of which 38 cases underwent “TiRobot” orthopedic robot-assisted PKP (robot group), 27 cases underwent C-arm X-ray machine fluoroscopy-assisted PKP (C-arm group). There were 43 cases of double-segment fractures, including 21 cases in robot group and 22 cases in C-arm group. There was no significant difference in gender, age, T value of bone mineral density, fracture segment distribution, time from injury to operation, and preoperative visual analogue scale (VAS) score, vertebral kyphosis angle (VKA), and height of fractured vertebra (HFV) in the patients with single/double-segments fractures between robot group and C-arm group (P>0.05). The operation time, the fluoroscopy frequency of the surgeons and the patient, the fluoroscopy exposure time of the surgeons and the patient, the radiation dose of the C-arm; the VAS scores, VKA, HFV before operation, at 1 day and 6 months after operation; and the complications in the two groups were recorded and compared.ResultsAll patients underwent surgery successfully. The operation time of the single-segment robot group was significantly longer than that of the C-arm group (t=5.514, P=0.000), while the operation time of the double-segment robot group was not significantly different from that of the C-arm group (t=1.892, P=0.205). The single/double-segment robot group required three-dimensional scanning, so the fluoroscopy frequency, fluoroscopy exposure time, and radiation dose of C-arm received by the patient were significantly higher than those of the C-arm group (P<0.05); the fluoroscopy frequency and the fluoroscopy exposure time received by the surgeons were significantly less than those of the C-arm group (P<0.05). There was no infection, embolism, neurological injury, and adjacent segmental fractures. The single/double-segment robot group showed lower rate of cement leakage when compared with the C-arm group (P<0.05), all the cases of cement leakage happened outside the spinal canal. The VAS score, VKA, and HFV of the single/double-segment robot group and the C-arm group were significantly improved at 1 day and 6 months after operation (P<0.05), and the VAS score at 6 months after operation was further improved compared with that at 1 day after operation (P<0.05). At 1 day and 6 months after operation, there was no significant difference in VAS score between the single/double-segment robot group and the C-arm group (P>0.05). The VKA and HFV of robot group were significantly better than those of the C-arm group (P<0.05).ConclusionFor single/double-segment OVCF, robot assisted PKP has more advantages in correcting VKA and HFV, reducing fluoroscopy exposure of surgeons and bone cement leakage rate; C-arm assisted PKP has more advantages in reducing the operation time of single-segment OVCF and fluoroscopy exposure of patients during operation.
ObjectiveTo compare the effectiveness of robot-assisted (RA) minimally invasive surgery versus traditional fluoroscopy-assisted (FA) open posterior fixation surgery in treating thoracolumbar fractures with ankylosing spondylitis (AS). MethodsA clinical data of 21 cases of thoracolumbar fractures with AS who met the selection criteria between December 2016 and December 2023 was retrospectively analyzed. Ten cases underwent RA minimally invasive surgery group (RA group) and 11 cases underwent FA open posterior fixation surgery (FA group). There was no significant difference in gender, age, fracture segment distribution, fracture type, time from injury to surgery, visual analogue scale (VAS) score, and American Spinal Injury Association (ASIA) grading between RA group and FA group (P>0.05). The operation time, intraoperative blood loss, radiation exposure time, radiation dose, hospital stay, and complications of the two groups were recorded. According to Gertzbein-Robbins criteria, the accuracy of screw implantation was evaluated by CT within 1 week after surgery. During follow-up, pain and nerve function were evaluated by VAS score and ASIA grading. ResultsAll patients underwent surgery successfully, and there was no significant difference in operation time (P>0.05). The intraoperative blood loss and hospital stay in the RA group were significantly less than those in the FA group (P<0.05), and the radiation exposure time and radiation dose were significantly more than those in the FA group (P<0.05). A total of 249 pedicle screws were implanted in the two groups, including 118 in the RA group and 131 in the FA group. According to the Gertzbein-Robbins criteria, the proportion of clinically acceptable screws (grades A and B) in the RA group was significantly higher than that in the FA group (P<0.05). Patients in both groups were followed up 3-12 months, with an average of 6.8 months. The VAS scores of the two groups after surgery were significantly lower than those before surgery, and the differences were significant (P<0.05). The RA group had lower scores than the fluoroscopy group at 1 week and 3 months after surgery (P<0.05). There was no significant difference in neurological function grading between groups at 1 week and 3 months after surgery (P>0.05). In the FA group, 1 case of deep infection and 1 case of deep vein thrombosis of lower extremity occurred, while no complication occurred in the RA group, and there was no significant difference in the incidence of complications between groups (P>0.05). Conclusion Both RA minimally invasive surgery and FA open posterior fixation surgery can achieve good effectiveness. Compared with the latter, the former has more advantages in terms of intraoperative blood loss, hospital stay, and accuracy of pedicle screw insertion.