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.
The application of stem cell therapy for ischemic heart disease has aroused widespread interest. There have been many experimental studies concerning a variety of tissue stem cells such as bone marrow，blood，skin and skeletalmuscle stem cells，and their origins, differentiation and protein expressions are compared. In recent years，it is found that adipose-derived stromal cells （ADSCs） have potential advantages over other types of stem cells in that they are widely available and easily harvested through a simple liposuction procedure，and have a high regenerative capacity and therapeuticpotential for myocardial infarction. This review describes molecular and biological properties of ADSCs，their differentiationpotential，and regenerative and therapeutic potential for myocardial repair.
Heart transplantation is a most efficacious therapy for end-stage heart failure, but acute rejection (AR) is the biggest problem to threat longer-term survival of post-transplant patients. Currently, endomyocardial biopsy is the gold standard for the diagnosis of AR. Due to limited sample size and different tissue locations, this invasive examination may cause sampling error and significant difference between biopsy-based diagnosis and AR severity. Therefore, we need a noninvasive and repeatable method to accurately diagnose and monitor AR after heart transplantation. Cardiovascular magnetic resonance can not only observe histological changes directly from the imaging when AR occurs, but also monitor and make diagnosis of AR by evaluating T2 relaxation time, cell labeling, cardiac functional parameters and morphological changes.
Ilizarov first reported the tibial transverse transport (TTT) for limb regeneration and functional reconstruction. The law of tension-stress could activate and enhance the regenerative potentials of living tissues, leading to growth or regeneration of muscles, fascia, blood vessels, and nerves simultaneously. Ilizarov discovered the phenomenon of rich vascular network formation during distraction osteogenesis process, but he did not apply this technique purposely to reconstruct microcirculation. Chinese orthopedic surgeons first used the TTT to treat lower extremity vascular lesions and diabetic foot ulcers. At present, some small sample clinical studies showed that the TTT could reconstruct microvascular network in the lower limbs of diabetic foot and promote the healing of foot ulcers. The use of TTT could significantly reduce the overall risk of diabetic foot complication especially the amputation risk. This expert consensus is initiated by the Chinese Association of Orthopaedic Surgeons (CAOS), Taskforce Group of Tibial Cortex Transverse Transport Technique for the Treatment of Diabetic Foot Ulcers. This expert consensus provides clear recommendations for indications, contraindications, principles for surgical procedures, preoperative and postoperative management, which maximize the success rate for TTT surgery in treatment of severe diabetic foot ulcers.
【摘要】 目的 探讨介入治疗股骨头无菌性坏死（ANFH）的疗效。 方法 纳入1996-2009年间确诊的ANFH患者15例，采用经外周动脉穿刺插管的方法，经血管造影明确供血血管的位置，经导管向其内灌注扩张血管药、舒筋活血中药和溶栓药物，以改善股骨头供血状况；并追踪随访1~3年，根据杨白明评定标准从疼痛、功能、X线片3个方面进行判定，观察其临床症状的改善。 结果 Ⅰ~Ⅲ期ANFH患者的临床症状减轻，甚至消失；痊愈50%，显效25%，有效15%。 结论 介入治疗Ⅰ~Ⅲ期ANFH的疗效显著。【Abstract】 Objective To investigate the curative effects of interventional therapy in aseptic necrosis of the femoral head (ANFH). Methods Fifteen patients with ANFH diagnosed from 1996 to 2009 were respectively analyzed. With peripheral arterial puncture methods from peripheral artery, the feeding artery was clarified by using angiography and infused the angiectasia agent, traditional Chinese medicine which could distend blood vessel and thrombolysin to improve blood supply of femoral head. All patients were followed up for one to three years to observe improvement of clinical symptoms. Results Clinical symptom of ANFH in stage Ⅰ-Ⅲ were alleviated or even disappeared, among whom 50% were removed, 25% were markedly effective, and 15% were effective. Conclusion Interventional therapy has significant curative effect in treating ANFH, especially for stage Ⅰ-Ⅲ.
ObjectiveTo explore the risk factors for surgical patients associated with postoperative nosocomial infection through monitoring the infection conditions of the patients, in order to provide a scientific basis for the development of hospital infection control measures in a second-grade class-A hospital in Chengdu City. MethodsWe conducted the survey with cluster sampling as the sampling method and the uniform questionnaire in the departments of orthopedic, neural and thoracic surgery from July 2011 to June 2012. The main parameters we observed were the patients'general and surgical conditions, antibiotics usage and hospital infection situation. Data were analyzed using the National Nosocomial Infection Surveillance Network software and chi-square test of single factors. ResultsIn this survey, we monitored 50 cases of postoperative hospital infection. The infection rate was 7.73% and the highest infection rate was in the Neurosurgery Department. The main site of infection was lower respiratory tract, followed by surgical site. The different usage time of antimicrobial drug in perioperative period resulted in different infection rates, and the difference was statistically significant (χ2=601.50, P<0.005). The rate of adjusted postoperative hospital infection was higher than pre-adjusted rate except that of the neurosurgery doctor 4. The risk factors associated with hospital postoperative infection in our hospital were:patients'conditions including underlying disease, emergency surgery, type of anesthesia, operative duration, hospital stay and postoperative drainage. Most of the hospital infection cases were caused by bacteria of the gram-negative bacilli, and the major pathogens were Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii in our hospital. ConclusionThe hospital should particularly strengthen the prevention and control of hospital infection in patients after neurosurgical operations. For patients with basic diseases, we should actively improve the patients'physical conditions before operation and control the primary lesion. Targeted control measures should be taken for different factors related to surgery. Reasonable selection of antimicrobial agents should be based on the epidemic strains in our hospital.
Objective To investigate the effect of the neuromuscular pedicle transplantation in prevention against atrophy in the denervated muscle. Methods Fortyeight SD rats were used to establish the right side tibialis anterior muscle denervation model. The long peroneal muscle neuromuscular pedicle was made as a treatment in 12 rats (Group A); the nerve shaft embedding was used in 12 rats (Group B); no treatment was used in 12 rats(Group C); the remaining 12 rats were used as normal controls (Group D). The gait analysis, electromyogram，muscle wet weight, and muscle fiber crosssectional area were used to determine and compare the effect of the operation at 6 and 12 weeks postoperatively. ResultsAt 6 weeks postoperatively, the parameters tested in Group A about the gait analysis (peroneal function index, PFI, －47.20±12.30), electromyogram, muscle wet weight (0.384 0±0.024 6 g)and muscle fiber cross-sectional area (1 040.98±120.54 μm2) were significantly better than those in Group C (PFI, -114.40±14.84; muscle wet weight, 0.173 0±0.019 1 g; muscle fiber cross-sectional area, 585.08±182.93 μm2,Plt;0.05), and the final two parameters were significantly better than those in Group B (0.294 0±0.056 4 g,763.92±82.68 μm2,Plt;0.05). At 12 weeks postoperatively, the musclefiber crosssectional area in Group A(1 360.10±261.45 μm2) had no significant difference from that in Group D (1 544.57±266.92 μm2，Pgt;0.05)，and most of the parameters tested in Group A were better than those in Groups B and C. Conclusion Neuromuscular pedicle transplantation has an excellent effect in prevention against atrophy in the denervated muscle, and the effect of neuromuscular pedicle transplantation is better than that of the nerve shaft embedding.