Objective To evaluate the effectiveness of arthroscopic debridement and release for post-traumatic arthritis of subtalar joint. Methods Between January 2011 and December 2014, 14 cases of post-traumatic arthritis of the subtalar joint underwent arthroscopic debridement and release, and the clinical data were retrospectively analyzed. All patients were male, aged 42 years on average (range, 32-62 years). Calcaneus fracture was caused by falling from height; 8 cases received conservative treatment and the other 6 cases received open reduction and internal fixation. The mean interval from injury to operation was 3.4 years (range, 2-7 years). The arthroscopic debridement and release were performed through lateral portals. The injury degree of articular cartilage was classified as grade 3 in 4 cases and grade 4 in 10 cases based on Outerbridge rating. The degree of pain was assessed by visual analogue scale (VAS) and the function of joint was assessed by the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Scale. Results All incisions healed by first intention and no complication occurred. The follow-up time was 18 months. Pain was relieved obviously; VAS was significantly decreased to postoperative 3.8±0.9 at 18 months from preoperative 7.7±1.2 (t=9.728,P=0.000), and AOFAS Ankle Hindfoot Scale was significantly increased to postoperative 59.1±8.8 from preoperative 37.6±8.2 (t=6.688,P=0.000). During follow-up, no patient was given arthrodesis and no worsened sign was found on the postoperative CT and MRI. Conclusion Arthroscopic debridement and release for post-traumatic arthritis of the subtalar joint can relieve clinical symptoms and delay subtalar arthrodesis.
Objective To evaluate the effectiveness of Ilizarov external fixation and ankle arthrodesis in the treatment of late traumatic ankle arthritis. Methods Between June 2013 and June 2015, 27 patients with late traumatic ankle arthritis were treated with Ilizarov external fixation technique. There were 16 males and 11 females with an age of 27-69 years (mean, 45.7 years). Sixteen cases were on the left side, 11 on the right side. All the patients suffered from traumatic ankle fractures or ligament damages caused by initial traumas. After 6 months of standard conservative treatment, the results was invalid and all patients had ankle joint pain and movement disorders. The disease duration was 3-39 years (mean, 11.5 years). According to Takakura ankle arthritis staging, there were 16 cases in stage 3 and 11 cases in stage 4. The tibial-talar angle before operation was (102.55±4.02) ° measured on conventional double-feet loading anteroposterior and lateral X-ray films. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle and foot joint score was 45.72±6.45, and the visual analogue scale (VAS) score was 8.61±1.96. Results All the patients were followed up 15-42 months (mean, 28.1 months). All ankles achieved bony fusion, the clinical healing time was 12.9 weeks on average (range, 11-18 weeks). No persistent bleeding in the incisions and needle tract occurred during the follow-up. There were 4 cases of mild needle infection, 2 cases of anterior dislocation of talus, and 3 cases with different degree of limited activity. No traumatic bone defect, bone disconnection, and false joint formation was observed. At 12 months after operation, the AOFAS ankle and foot joint score, VAS score, and tibial-talar angle were 80.53±9.14, 2.77±0.82, and (94.36±2.48)°, respectively, which were significantly improved when compared with preoperative ones (t=16.17, P=0.00; t=14.28, P=0.00; t=9.01, P=0.00). The effectivenss was excellent in 9 cases, good in 13 cases, and fair in 5 cases, with an excellent and good rate of 81.5%. Conclusion Satisfactory effectiveness can be obtained through Ilizarov external fixation and ankle arthrodesis in the treatment of traumatic ankle arthritis, showing certain application prospect, while long-term effectiveness should be comfirmed by large sample randomized controlled trials.
Objective To analyze the clinical features and preliminary outcome of posterior operation for traumatic lumbar spondylolisthesis. Methods The clinical data of 11 patients with traumatic lumbar spondylolisthesis who underwent surgeries between January 2008 and June 2012 were retrospectively analyzed. There were 6 male and 5 female patients, aged from 13 to 60 years with a median age of 38 years. The mechanism of injury included heavy pressure injury in 4 cases, falling injury from height in 4 cases, and traffic accident injury in 3 cases. The time of injury to operation was between 3 days and 13 years (median, 20 days). According to Frankel neurological function grading, 2 patients were rated as grade E, 4 as grade D, 3 as grade C, and 2 as grade B before operation; according to Meyerding spondylolisthesis grading, 4 cases were classified as degree I, 4 as degree II, 2 as degree III, and 1 as degree IV preoperatively. The affected segments included L4 in 3 and L5 in 8 patients. The surgical fixation segments were L4, 5 in 2 patients, L5, S1 in 7, and L4-S1 in 2. Eight patients underwent circumferential fusion, while 3 patients underwent posterolateral fusion. The reduction of spondylolisthesis and bone graft fusion were assessed on X-ray films and three-dimensional CT scans during follow-up. The clinical outcomes were evaluated by visual analogue scale (VAS) and Oswestry disability index (ODI) scores. Results All patients achieved primary healing of incision after operation. And all patients were followed up 6-40 months with a median time of 12 months. There was no pulling-out or breaking of internal fixation. The fusion rate was 100% on three-dimensional CT scans, and the fusion time was 3-6 months (mean, 4.5 months). The spondylolisthesis was degree 0 in 10 cases and degree I in 1 case according to Meyerding grading, showing significant difference when compared with preoperative spondylolisthesis grading (Z= — 2.979, P=0.003). The Frankel neurological function grading were E in 6, D in 3, and C in 2 at last follow-up, which were significantly improved when compared with preoperative one (Z= — 2.271, P=0.014). At 1 week after operation and last follow-up, VAS and ODI scores were significantly improved when compared with the preoperative scores (P lt; 0.05); however, no significant difference was found between at 1 week and at last follow-up (P gt; 0.05). Conclusion If lumbar X-ray films suggest multiple fractures of transverses in emergency combined with the mechanism of injury, it bly indicates the diagnosis of traumatic lumbar spondylolisthesis, moreover earlier decompression and fusion can provide the recovering of the neurological function and satisfactory preliminary effectiveness in these patients.
ObjectiveTo explore a method of three-dimensional (3D) printing technology for preparation of personalized rat brain tissue cavity scaffolds so as to lay the foundation for the repair of traumatic brain injury (TBI) with tissue engineered customized cavity scaffolds. MethodsFive male Sprague Dawley rats[weighing (300±10) g] were induced to TBI models by electric controlled cortical impactor. Mimics software was used to reconstruct the surface profile of the damaged cavity based on the MRI data, computer aided design to construct the internal structure. Then collagen-chitosan composite was prepared for 3D bioprinter of bionic brain cavity scaffold. ResultsMRI scans showed the changes of brain tissue injury in the injured side, and the position of the cavity was limited to the right side of the rat brain cortex. The 3D model of personalized cavity containing the internal structure was successfully constructed, and cavity scaffolds were prepared by 3D printing technology. The external contour of cavity scaffolds was similar to that of the injured zone in the rat TBI; the inner positive crossing structure arranged in order, and the pore connectivity was good. ConclusionCombined with 3D reconstruction based on MRI data, the appearance of cavity scaffolds by 3D printing technology is similar to that of injured cavity of rat brain tissue, and internal positive cross structure can simulate the topological structure of the extracellular matrix, and printing materials are collagen-chitosan complexes having good biocompatibility, so it will provide a new method for customized cavity scaffolds to repair brain tissue cavity after TBI.
ObjectiveTo explore the research progress of the cell sources and related signaling pathways of the wound-induced hair follicle neogenesis (WIHN) in recent years.MethodsThe literature related to WIHN in recent years was reviewed, and the cell sources and molecular mechanism were summarized and discussed.ResultsCurrent research shows that WIHN is a rare regeneration phenomenon in the skin of adult mammals, with multiple cell origins, both hair follicle stem cells and epithelial stem cells around the wound. Its molecular mechanism is complicated, which is regulated by many signaling pathways. Besides, the process is closely related to the immune response, the immunocytes and their related cytokines provide suitable conditions for this process.ConclusionThere are still many unsolved problems on the cellular origins and molecular mechanisms of the WIHN. Further study on the mechanisms will enhance the understanding of adult mammals’ hair follicle regeneration and may provide new strategy for functional healing of the human skin.
Objective To discuss the short-term effectiveness of total hip arthroplasty (THA) for post-traumatic osteoarthritis secondary to acetabular fracture. Methods Between January 2004 and March 2012, the clinical data was analyzed retrospectively from 12 cases (13 hips) of post-traumatic osteoarthritis secondary to acetabular fracture undergoing THA. Of 12 patients, 6 were male and 6 were female, with an average age of 55.6 years (range, 40-68 years). The locations were the left hip in 5 cases, the right hip in 6 cases, and bilateral hips in 1 case. The interval between acetabular fracture and THA was 65.7 months on average (range, 12-240 months). The preoperative hip Harris score was 48.8 ± 9.5. Results The incisions healed by first intention. No deep vein thrombosis and infection occurred postoperatively. Ten cases were followed up 1-7 years (mean, 4.8 years). The hip Harris score was 86.5 ± 8.6 at last follow-up, showing significant difference when compared with preoperative score (t=10.520, P=0.006). X-ray films showed no acetabular prosthesis instability. Stem subsidence (2 mm) occurred in 1 case, peri-prosthetic osteolysis in 2 cases, and heterotopic ossification in 2 cases (Brooker type I and type II in 1 case, respectively). Conclusion THA has satisfactory short-term effectiveness for post-traumatic osteoarthritis secondary to acetabular fracture. The good effectiveness is based on strict case selection, pathological evaluation, and the proper acetabular reconstruction.
Objective To explore the significance and the relationshi p between osteoporosis and the mRNA expressions of vascular endothel ial growth factor (VEGF) and bone morphogenetic protein 2 (BMP-2) in nontraumatic avascular necrosis of the femoral head (NONFH), so as to provide a theoretical basis for the pathogenesis and the cl inical treatment of NONFH. Methods Sixty-nine specimens of femoral head were collected from voluntary donators undergoing total hi p arthroplasty, including 37 cases of NONFH (NONFH group) and 32 cases of fresh femoral neck fracture (control group). In NONFH group, there were 26 males and 11 females with an average age of 57.3 years (range, 43-75 years), including 19 cases of steroid-induced avascular necrosis of the femoral head (ANFH), 16 cases of alcohol ic ANFH, and 2 cases of idiopathicANFH; according to Ficat staging system, there were 23 cases at stage III and 14 cases at stage IV. In control group, there were 23 males and 9 females with an average age of 58.6 years (range, 46-79 years). The NO level of serum, the Q value of femur, and the bone mineral density (BMD) of weight-bearing area were measured firstly. The bone tissues were harvested from weightbearing necrosis area and healthy area. The pathological change was observed by HE staining, the percentage of empty bone lacuna and the percentage of trabecular bone area were calculated. The mRNA expressions of VEGF and BMP-2 in femoral head were detected through in situ hybridization technique. Results There were significant differences (P lt; 0.05) in the NO level of serum, the Q value of femur, and the BMD between NONFH group and control group. In NONFH group, the femoral head showed irregular shape, the articular cartilage exfol iated and collapsed. In weight-bearing necrosis area, the bone trabeculae were sparse and non-intact with a great number of empty lacuna; necrotic bone trabeculae were decomposed and absorbed; no obvious bone regeneration and repair were observed. In weight-bearing healthy area, the fat cells in bone marrow showed prol iferation and hypertrophy. In control group, the femoral head had normal appearance, intact articular cartilage, and intact bone trabeculae with a regular arrange, and osteocytes were clearly seen. There were significant differences in the percentage of empty bone lacuna and the percentage of trabecular bone area between NONFH group and control group (P lt; 0.05). The mRNA expressions of VEGF and BMP-2 were positive in 2 groups. The positive area ratio, the absorbance value, and integral absorbancevalue of VEGF mRNA and BMP-2 mRNA in NONFH group were significantly lower than those in control group (P lt; 0.05);the grey scales of VEGF mRNA and BMP-2 mRNA in NONFH group were significantly higher than that in control group (P lt;0.05). Conclusion The pathological stage of osteoporosis may play an important role in the mechanism of the NONFH. The decrease of mRNA expressions of VEGF and BMP-2 in femoral head of NONFH is important reason that affect its bone mass, osteoporosis, rehabil itation, and reconstruction. It may be benefit to the reparative process of the necrosis femoral head to increase the mRNA expressions of VEGF and BMP-2 in the femoral head.