Objective To estimate clinical effect ofspin iliac deep vascular pedicled periosteum flap in repairing traumatic femoral neck of theca inside fracture in young and middleaged. Methods From April 1993 to September 2001, 12 cases of traumatic femoral neck fracture were given diaplastic operation with fixation of 3 centre hollow pressed bolt and were conducted under os traction bed and "C" arm X-ray machine. Spin iliac deep vascular pedicled periosteum flap wasstripped off, and transferred to the front of femoral neck fundus，then transplanted to the narrow inside of fracture through outer open door of articular capsule.Results All patients were followed up for 17 years. All fracture healedwithout femoral head necrosis, but mild arthritis appeared in 7 cases.Conclusion Vascular pedicled periosteum flap transfer of young and middle-aged femoral neck fracture, by decompression of femoral neck and reconstruction of blood circulation, can promote the fracture healing and decrease the wound and blood circulation destroy.
It is very difficult to repair large articular cartilage defect of the hip. From May 1990 to April 1994, 47 hips in 42 patients of large articuler cartilage defects were repaired by allograft of skull periosteum. Among them, 14 cases, whose femoral heads were grade. IV necrosis, were given deep iliac circumflex artery pedicled iliac bone graft simultaneously. The skull periosteum had been treated by low tempreturel (-40 degrees C) before and kept in Nitrogen (-196 degrees C) till use. During the operation, the skull periosteum was sutured tightly to the femoral head and sticked to the accetabulum by medical ZT glue. Thirty eight hips in 34 patients were followed up for 2-6 years with an average of 3.4 years. According to the hip postoperative criteria of Wu Zhi-kang, 25 cases were excellent, 5 cases very good, 3 cases good and 1 case fair. The mean score increased from 6.4 before operation to 15.8 after operation. The results showed, in compare with autograft of periosteum for biological resurface of large articular defect, this method is free of donor-site morbidity. Skull periosteum allograft was effective for the treatment of large articular cartilage defects in hip.
OBJECTIVE: To investigate the repairing effect of transplantation of allogeneic fetal bone in combination with a covering cryopreserved periosteal allograft to bone defect. METHODS: Twenty Long-eared white male rabbits were chosen as experimental model of bilateral 12 mm combined bony and periosteal radial defect. Cryopreserved allograft periosteum with allogeneic fetal bone were implanted in the left defect as experimental side and fetal bone was simply transplanted in the right defect as control side. Bone repair process in the two groups were compared by macroscopy, microscopy, roentgenograms and the contents of calcium and phosphate in the defect area at 2, 4, 8 and 12 weeks after transplantation. RESULTS: There was significant statistic difference in the contents of calcium and phosphate between the experimental and control sides at 4, 8 and 12 weeks after transplantation (P lt; 0.05). With time passing by, the contents of calcium and phosphate have the increasing trends. In the experimental group, lamella bone was seen and medullary canal recanalized at 8 weeks postoperatively. The histological section showed the bone lacuna and lamella bone were formed. CONCLUSION: It suggests that allogeneic fetal bone in combination with a covering cryopreserved periosteal allograft can promote bone repair, and allogeneic fetal bone is excellent bone substitute.
Objective To introduce the current situation and prospect of the tissue-autografting, such as the flaps, muscle flaps, and bone(periosteum) flaps, andits application in reparative and reconstructive surgery. Methods Based on our own experiences and combined with the review of the literature at home and abroad, the latest development of the tissue autografting was analyzed. Results The femoral anterolateral flap, latissimus dorsi muscle flap, upper arm lateral flap, scap flap, temporal fascial flap and perforator flap are the frequently used in clinic. Of all the perforator flap had such advantages as better repair of the recipient sites and less damage of the donor site. Beacause of more advantages of the free myocutaneous flap transplantation, it substituted thefree muscle transplantation. The atissimus dorsi muscle myocutaneous flap was the most frequently used in the transplant of the vessels, with preserved function of the thoracodorsal nerve or with repair of the defected tissues by the bridge. The most common donor sites of the bone were ribs，iliac bone，fibula andscapula, so the severe bone defects or the bone nonunion, femoral head ischemic necrosis, and the bone graft from the tumor removal could be managed with the bones from those sites. Conclusion The autografting in repairing the tissue defect has become one of the most important surgical techniques in reparative and reconstructive surgery.
ObjectiveTo evaluate the effect of tissue engineered periosteum on the repair of large diaphysis defect in rabbit radius, and the effect of deproteinized bone (DPB) as supporting scaffolds of tissue engineering periosteum. MethodsBone marrow mesenchymal stem cells (BMSCs) were cultured from 1-month-old New Zealand Rabbit and osteogenetically induced into osteoblasts. Porcine small intestinal submucosa (SIS) scaffold was produced by decellular and a series mechanical and physiochemical procedures. Then tissue engineered periosteum was constructed by combining osteogenic BMSCs and SIS, and then the adhesion of cells to scaffolds was observed by scanning electron microscope (SEM). Fresh allogeneic bone was drilled and deproteinized as DPB scaffold. Tissue engineered periosteum/DPB complex was constructed by tissue engineered periosteum and DPB. Tissue engineered periosteum was "coat-like" package the DPB, and bundled with absorbable sutures. Forty-eight New Zealand white rabbits (4-month-old) were randomly divided into 4 groups (groups A, B, C, and D, n=12). The bone defect model of 3.5 cm in length in the left radius was created. Defect was repaired with tissue engineered periosteum in group A, with DPB in group B, with tissue engineered periosteum/DPB in group C; defect was untreated in group D. At 4, 8, and 12 weeks after operation, 4 rabbits in each group were observed by X-ray. At 8 weeks after operation, 4 rabbits of each group were randomly sacrificed for histological examination. ResultsSEM observation showed that abundant seeding cells adhered to tissue engineered periosteum. At 4, 8, and 12 weeks after operation, X-ray films showed the newly formed bone was much more in groups A and C than groups B and D. The X-ray film score were significantly higher in groups A and C than in groups B and D, in group A than in group C, and in group B than in group D (P<0.05). Histological staining indicated that there was a lot of newly formed bone in the defect space in group A, with abundant newly formed vessels and medullary cavity. While in group B, the defect space filled with the DPB, the degradation of DPB was not obvious. In group C, there was a lot of newly formed bone in the defect space, island-like DPB and obvious DPB degradation were seen in newly formed bone. In group D, the defect space only replaced by some connective tissue. ConclusionTissue engineered periosteum constructed by SIS and BMSCs has the feasibility to repair the large diaphysis defect in rabbit. DPB isn't an ideal support scaffold of tissue engineering periosteum, the supporting scaffolds of tissue engineered periosteum need further exploration.
Objective To investigate the effect of autologous osteochondral tissue and periosteum transplantation on tendon-bone healing of rotator cuff in rabbits. Methods Twenty-four male New Zealand white rabbits were randomly divided into autologous osteochondral tissue and periosteum transplantation group (experimental group, n=12) and simple suture group (control group, n=12). Both groups were subjected to acute supraspinatus tendon injury and repaired with corresponding techniques. At 4, 8, and 12 weeks after operation, 4 specimens from each group were taken from the right shoulder joint for histological examination (HE staining, Masson staining, and Safranin O-fast green staining), and the left shoulder was subjected to biomechanical tests (maximum tensile load and stiffness). Results Both groups of animals survived until the completion of the experiment after operation. At 4 weeks after operation, both groups showed less collagen fibers and disorder at the tendon-bone junction. At 8 weeks, both groups showed reduced inflammation at the tendon-bone junction, with more organized and denser collagen fibers and chondrocytes. The experimental group showed better results than the control group. At 12 weeks, the experimental group showed typical tendon-bone transition structure, with increased generation of collagen fibers and chondrocytes, and the larger cartilage staining area. Both groups showed an increase in maximum tensile load and stiffness over time (P<0.05). The stiffness at 4 weeks and the maximum tensile load at 4, 8, and 12 weeks in the experimental group were superior to control group, and the differences were significant (P<0.05). There was no significant difference in stiffness at 8, 12 weeks between the two groups (P>0.05). Conclusion Autologous osteochondral tissue and periosteum transplantation can effectively promote the fiber and cartilage regeneration at the tendon-bone junction of rotator cuff and improve the biomechanical effect of shoulder joint in rabbits.
Objective To study the differentiation of the human osteoblasts during the construction of the tissue engineered periosteum with the human acellular amniotic membrane(HAAM).Methods To construct the tissue engineered periosteum (n=60) with HAAM, the human fetal osteoblasts were used. The fetal osteoblasts were cultured for 2, 4, 6, 8, and10 days, and then their total RNA was extracted, which were reversely transcripted to cDNA. The realtime PCR analysis was used to reveal Cbfal and Osterix, and the cycle threshold (Ct) was also measured. The simplycultured osteoblasts were used as the control group (n=20).Results The expression of Cbfa1 was higher in the experimental group on the 2nd day when compared with that on the 4th, 6th, and 8th day(P＜0.05). The same result existed on the 10th day when compared with that on the 4th and 8th day. The expression of Osterix increased and was highest on the 8th day when compared with the other results(P＜0.05). Both of the 2 gene expressions were decreased in the control group when compared with those in the experimental group, but with no significant difference(P＞0.05). Conclusion Cbfa1 and Osterix can be normally expressed by the osteoblasts after their integration with HAAM. As a scaffold, HAAM can be used to keep the osteoblast phenotype and differentiation with an osteoconductive ability. Such a cell-scaffold complex may provide a basis for the osteogenesis.
Objective To compare the effectiveness between the myo-periosteal fibular bone bridging and traditional transtibial amputation in the treatment of amputation below knee so as to provide theoretical basis for choosing transtibial amputation in clinical application. Methods Between November 2001 and November 2011, 38 patients with mangled lower extremity were treated by transtibial amputation. Among 38 patients, 17 (group A) underwent myo-periosteal fibular bone bridging (the operation techniques of an attached peroneal muscle myo-periosteal fibular strut bridge between the end of the tibia and fibula below knee amputation), and other 21 (group B) underwent traditional transtibial amputation. There was no significant difference in age, gender, injury cause, amputation cause, side, and disease duration between 2 groups (P gt; 0.05). The quality of life (QOL) was analyzed using 36-item short form health survey (SF-36), and prosthesis satisfaction by Trinity amputation and prosthesis experience scale (TAPES). Results Healing of incision by first intention was obtained in all patients of 2 groups; no necrosis, infection, or poor stumps was observed. The mean follow-up time was 22 months (range, 14-30 months) in group A, and 26 months (range, 15-30 months) in group B. The patients achieved good healing of bone bridging, no bone nonunion occurred. The healing time was (5.1 ± 1.1) months in group A and (3.3 ± 0.6) months in group B, showing significant difference between 2 groups (t=9.82, P=0.00). Spur occurred at the distal fibula in an 11-year-old boy of group B after 2 years of operation, which blocked use of prosthesis; prosthesis was well used in the other patients. After 12 months of operation, SF-36 score was 55.84 ± 14.01 in group A and 49.93 ± 12.78 in group B, showing significant difference (P lt; 0. 05); the physical functioning, social functioning, role-physical, vitality, body pain, general health scores in group A were significantly higher than those in group B (P lt; 0.05), but no significant difference was found in role-emotional and mental health scores between 2 groups (P gt; 0.05). TAPES score was 12.12 ± 2.23 in group A and 10.10 ± 2.00 in group B, showing significant difference (t=2.891, P=0.006). Conclusion It is a very effective method to treat traumatic amputation using an attached myo-periosteal fibular bone bridging between the end of the tibia and fibula below knee, which can afford better quality of life and prosthesis satisfaction.
OBJECTIVE: To explore the anatomic feature and clinical application of the bone (periosteum) flap pedicled with upper muscular branches of lateral femoral muscle. METHODS: The anatomic features and distribution of upper muscular branches of lateral femoral muscle were observed in the lower extremities of 40 adult cadavers. From February 1989 to February 1999, 7 cases with bone defect or nonunion of upper part of femur were treated with transfer of bone (periosteum) flap pedicled with upper muscular branches of lateral femoral muscle. RESULTS: The upper muscular branches of lateral femoral muscle originated from the transversal branch of lateral circumflex femoral artery. The musculoperiosteal branch and periosteal branch were originated at 16.8 +/- 3.0 cm below the greater trochanter. The diameter and length of musculoperiosteal branch were 1.4 to 1.7 mm and 2.7 to 5.6 cm, those of the periosteal branch were 0.4 to 0.6 mm and 1.2 to 1.5 cm respectively. Bone union achieved in 10 to 18 weeks after operation in all 7 cases after 18 to 42 months follow-up. The motion of hip joint reached 180 degrees in 4 cases, 120 degrees in 2 cases and 65 degrees in 1 case. The donor area recovered well. CONCLUSION: The bone (periosteum) flap pedicled with upper muscular branches of lateral femoral muscle is an effective alternative for repairing the bone defect or nonunion of the upper or middle part of femur.
Objective To study the effectiveness of anterior cruciate l igament (ACL) reconstruction using autologous periosteum wrapping tendon allograft by comparing with using simple tendon allograft. Methods Between March 2008 and November 2008, 68 patients with ACL injury were treated, who were in accordance with the inclusion criteria. They were divided into 2 groups randomly according to different treatment methods: ACL was reconstructed with autologous periosteum wrapping tendon allograft in 31 patients (test group) and with simple tendon allograft (control group) in 37 patients. There was no significant difference in gender, age, disease duration, the cause of injury, and functional score preoperatively between 2 groups (P gt; 0.05). Anatomic single-bundle ACL reconstruction was performed in 2 groups. Results Little exudation at tibial tunnel incision was found in 1 case respectively in both groups at 2 weeks after operation and was cured by dressing change and antibiotics. The other incisions healed by first intention. The patients were followed up 24-29 months (mean, 26 months) in the test group and 24-32 months (mean, 27 months) in the control group. CT showed bone tunnel enlargement in both groups at 2 years after operation, but the rate of the tunnel enlargement was less inthe test group (5/31, 16.1%) than in the control group (14/37, 37.8%), showing significant difference (χ2=3.948, P=0.047). At 2 years after operation, the results of Lachman test and pivot shift test were negative in 23 cases (74.2%) and 25 cases (80.6%) of the test group, and in 26 cases (70.3%) and 30 cases (81.1%) of the control group, respectively. KT-1000 examination showed the displacement of the test group [(1.74 ± 0.88) mm] was less than that of the control group [(2.36 ± 0.83) mm], showing significant difference (t= —2.979, P=0.004). There was no significant difference in Lysholm score, Hospital for Special Surgery (HSS) score, Tegner score, and International Knee Documentation Committee (IKDC) score between 2 groups at 2 years after operation (P gt; 0.05). Conclusion Compared with simple tendon allograft, ACL reconstruction with autologous periosteum wrapping tendon allograft can improve tendon-bone heal ing, and decrease the rate of bone tunnel enlargement, so it has good short-term outcome.