Objective To study the safety and feasibility of modified laparoscopic Dixon surgery for rectal cancer. Methods In the procedure of modified laparoscopic Dixon surgery, the rectum with tumor was pulled out and cut and colon-rectum anastomosis was performed through anus. The clinical data of patients with rectal cancer between modified laparoscopic Dixon surgery (laparoscopy group) and open Dixon surgery (open group) were compared and analysed prospectively. The clinical data included operative time, volume of bleeding, number of lymph node dissection, volume of abdominal drainage, time to bowel gas passage, hospital stay and relative complications, such as anastomotic leakage, ureteral injury, dysuria and fecal incontinence. Results Fifty-eight cases were selected in this study between September 2007 and July 2008, including 25 laparoscopic surgery in laparoscopy group and 33 open surgery in open group. Patient’s data on gender, age, distance between tumor and anus edge, tumor diameter, tumor pathologic type and Dukes stage were similar between two groups by statistic analysis (Pgt;0.05). All the operations were performed successfully. Two cases experienced anastomotic leakage in laparoscopy group, while 1 case experienced anastomotic leakage in open group. All these patients got recovered by conservative treatment at last. No other complications were experienced, such as ureteral injury, dysuria, fecal incontinence, and so on. There were no significant differences in term of operative time, volume of bleeding and number of lymph node dissection between two groups (Pgt;0.05). The volume of abdominal drainage was less while the time to bowel gas passage and hospital stay were shorter in laparoscopy group than those in open group (P＜0.05). Conclusion This study reveals that it is safe and feasible to perform modified laparoscopic Dixon surgery for rectal cancer, and it presents the character of minimal invasion.
Objective To explore effectiveness of arthroscopic Eden-Hybinette procedure with Triple-Pulley and four point anti-rotation fixation technique in the treatment of recurrent anterior dislocation of shoulder joint. Methods A clinical data of 14 patients with recurrent anterior dislocation of shoulder joint and glenoid bone defect, who were met the selective criteria and admitted between February 2021 and February 2022, was retrospectively analyzed. All patients were treated with arthroscopic Eden-Hybinette procedure and the bone blocks were fixed by using Triple-Pulley and four point anti-rotation fixation technique. There were 9 males and 5 females with an average age of 31.2 years (range, 22-40 years). Shoulder dislocation occurred 4-10 times (mean, 6.8 times). The time from the initial dislocation to the admission was 1-6 years (mean, 3.3 years). The Instability Severity Index Score (ISIS) was 7.2±0.8, the Beighton score was 2.9±2.4, and the width ratio of glenoid bone defect was 26.64%±1.86%. Pre- and post-operative visual analogue scale (VAS) score, the University of Califonia-Los Angeles (UCLA) shoulder score, Constant score, and American Association of Shoulder and Elbow Surgeons (ASES) score were used to evaluate shoulder pain and function. The position, healing, resorption, and remodeling (glenoid area) of the bone blocks were evaluated by CT of shoulder joint. ResultsAll patients underwent surgery successfully without any serious complications. All patients were followed up 11.5-13.8 months (mean, 12.0 months). The VAS scores of shoulder joint after operation decreased compared to preoperative levels, while the UCLA score, Constant score, and ASES score all increased, with significant differences (P<0.05). And with the prolongation of time, the above indicators further improved, and the differences between different time points were significant (P<0.05). Imaging reexamination showed that the bone block completely filled the glenoid defect, with good position and no significant displacement. Over time, the bone block healed and partially absorbed and remodelled. The postoperative glenoid area increased significantly compared to preoperative area (P<0.05). With the prolongation of time, the glenoid area significantly decreased, but the difference was not significant between different time points (P>0.05). Conclusion For the recurrent anterior dislocation of shoulder joint, Triple-Pulley and four point anti-rotation fixation technique in Eden-Hybinette procedure can effectively prevent bone rotation, make fixation more reliable, and easy to operate and achieve good effectiveness.
ObjectiveTo compare the effectiveness of coracoclavicular ligament reconstruction between by using autologous plantaris tendon graft combined with hook plate fixation and allogeneic tendon graft combined with hook plate fixation for treating acromiocavicular joint dislocation. MethodsThirty-three patients with acromioclavicular joint dislocation who accorded with the inclusion criteria between January 2013 and June 2014 were assigned into 2 groups. The patients were treated with autologous plantaris tendon graft combined with hook plate fixation in group A (n=17), and with allogeneic tendon graft combined with hook plate fixation in group B (n=16). Thirteen-one patients was followed up more than 12 months (15 in group A and 16 in group B). There was no significant difference in gender, age, cause of injury, sides, time between injury and surgery, and type of dislocation (P>0.05). The assessments included operation time, hospitalization time, hospitalization expenses, shoulder range of motion, gap of acromioclavicular, Constant-Murley scores, and visual analogue scale (VAS) for pain. ResultsThe operation time of group A was significantly longer than that of group B, and the hospitalization expense was significantly lower than that of group B (P<0.05). There was no significant difference in hospitalization time (t=1.046, P=0.316). The incisions healed by first intention, and hook plate was removed after 3 months. The mean follow-up time was 21.3 months (range, 19-34 months) in group A and was 23.7 months (range, 18-37 months) in group B. X-ray examination showed no osteolysis. There was no significant difference in gap of acromiocavicular between 2 groups at preoperation, 1 week after operation, and last follow-up (P>0.05). No redislocation of acromioclavicular joint and rejection reaction occurred during follow-up. At last follow-up, there was no significant difference in shoulder range of motion, Constant-Murley score, and VAS score between 2 groups (P>0.05). ConclusionCoracoclavicular ligament reconstruction by autologous plantaris tendon or allogeneic tendon graft combined with hook plate fixation for the treatment of acromioclavicular joint dislocation can achieve good effectiveness. The appropriate treatment should be chosen according to the patient's economic situation.
ObjectiveTo observe effectivness and safeness of self-made dentation hook plate associated with hot-air balloon technique in treating Mutch Ⅰ or Ⅱ type isolated greater tuberosity fractures of humerus.MethodsBetween January 2016 and December 2018, 15 patients with Mutch Ⅰ or Ⅱ type greater tuberosity fractures were treated with self-made dentation hook plate associated with hot-air balloon technique. There were 9 males and 6 females with an average age of 45.1 years (range, 29-62 years). The injury causes included falling injury in 9 patients and traffic accident injury in 6 patients. According to Mutch classification, 4 cases were MutchⅠ type and 11 cases were Mutch Ⅱ type. There were 7 cases with anterior dislocation of shoulder. The time from injury to operation was 2-10 days (mean, 4.5 days).ResultsAll 15 patients were followed up 8-16 months, with an average of 13.5 months. There was no infection of incision, loss of reduction of fracture block, delayed union or nonunion. The average time of fracture union was 6.5 months (range, 4-8 months). One patient had axillary paralysis at 1 day after operation, and was treated with nutritional nerve therapy, the symptoms disappeared after 2.5 months. Three patients had slight subacromial impingement. After fracture healing, the hook plate was taken out in advance, and the pain and abnormal noise disappeared during shoulder abduction. At last follow-up, Costant-Murley score used to evaluate shoulder joint function was 88-100, with an average of 96.8; 8 cases were excellent, 7 cases were good, and the excellent and good rate was 100%. The internal fixator was removed after 8-16 months after the secondary operation with no re-fracture occurred.ConclusionThe self-made dentation hook plate associated with hot-air balloon technique is a safe and reliable method for the treatment of Mutch Ⅰ or Ⅱ type isolated greater tuberosity fracture of humerus.
Objective To construct inducible lentiviral vector containing human bone morphogenetic protein 2 (hBMP-2) gene and to study its expression in human umbil ical cord blood mesenchymal stem cells (HUMSCs). Methods hBMP-2 gene was ampl ified by PCR from a plasmid and was cloned into pDown by BP reaction. pLV/EXPN2-Neo-TRE-hBMP-2 and pLV/EXPN2-Puro-EF1A-reverse transactivator (rtTA) were obtained with GATEWAY technology, and then were sequenced and analyzed by PCR. The recombinant vectors were transfected into 293FT cells respectively through l ipofectamine, and the lentiviral viruses were harvested from 293FT cells, then the titer was determined. Viruses were used to infect HUMSCs in tandem. In order to research the influence of induction time and concentration, one group of HUMSCs was induced by different doxycl ine concentrations (0, 10, 100 ng/mL, and 1, 10, 100 μg/mL) in the same induction time (48 hours), and the other by the same concentration (10 μg/mL) in different time points (12, 24, 48, and 72 hours). The expression of target gene hBMP-2 was indentified by ELISA method. After 2-week osteogenic induction of transfected HUMSCs, the mineral ization nodes were detected with Al izarin bordeaux staining method. Results Therecombinant inducible lentiviral vectors (pLV/EXPN2-Neo-TRE-hBMP-2 and pLV/EXPN2-Puro-EF1A-rtTA) were successfully constructed. The lentiviruses were also obtained and mediated by 293FT cells, and the virus titers were 3.5 × 108 TU/mL and 9.5 × 107 TU/mL respectively. HUMSCs could expression hBMP-2 by induction of doxycycl ine. The expression of hBMP-2 reached the peak at 10 μg/mL doxycl ine at 48 hours of induction. After 2-week osteogenic induction, a lot of mineral ization nodes were observed. Conclusion The recombinant inducible lentiviral vectors containing hBMP-2 gene can be successfully constructed, which provide an effective and simple method for the further study of stem cells and animal experiment in vivo.
ObjectiveTo investigate effectiveness of arthroscopic superior capsular reconstruction using a “sandwich” patch combined with platelet-rich plasma (PRP) injection in treating massive irreparable rotator cuff tears. Methods A clinical data of 15 patients (15 sides) with massive irreparable rotator cuff tears, who were admitted between September 2020 and March 2023 and met the selective criteria, was retrospectively analyzed. There were 8 males and 7 females with an average age of 62.1 years (range, 40-80 years). The rotator cuff tears were caused by trauma in 7 cases and other reasons in 8 cases. The disease duration ranged from 5 to 25 months, with an average of 17.7 months. According to the Hamada grading, the rotator cuff tears were rated as grade 1 in 2 cases, grade 2 in 8 cases, and grade 3 in 5 cases. All patients were underwent superior capsular reconstruction using the “sandwich” patches (autologous fascia lata+polypropylene patch+autologous fascia lata) combined with PRP injection on patches. The pre- and post-operative active range of motion (ROM) of the shoulder joint, American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, University of California, Los Angeles Shoulder Rating Scale (UCLA) score, and visual analogue scale (VAS) score were recorded. The subacromial space was measured on the imaging and rotator cuff integrity was assessed based on Sugaya grading. Results All incisions healed by first intention after operation without any complications such as infection. All patients were followed up 12-18 months (mean, 14.4 months). At last follow-up, the active ROMs of flexion, abduction, external rotation, internal rotation of the shoulder joint, subacromial space, ASES score, Constant-Murley score, and UCLA score increased, and VAS score decreased, showing significant differences when compared with preoperative values (P<0.05). There was no significant difference in the Sugaya grading between last follow-up and immediately after operation (P>0.05). Conclusion For massive irreparable rotator cuff tears, arthroscopic superior capsular reconstruction using the “sandwich” patches combined with PRP injection can restore stability of the shoulder joint, relieve pain, promote rotator cuff healing, and achieve good short-term effectiveness.
Objective To study the effect of platelet lysate (PL) on chondrogenic differentiation of human umbil ical cord derived mesenchymal stem cells (hUCMSCs) in vitro. Methods Umbil ical cords were voluntarily donated by healthy mothers. The hUCMSCs were isolated by collagenase digestion and cultured in vitro. The surface markers of the cells were detected by flow cytometer. According to different components of inductive medium, the cultured hUCMSCs were divided into 3 groups: group A [H-DMEM medium, 10% fetal bovine serum (FBS), and 10%PL]; group B [H-DMEM medium, 10%FBS,10 ng/mL transforming growth factor β1 (TGF-β1), 1 × 10-7 mol/L dexamethasone, 50 μg/mL Vitamin C, and 1% insul intransferrin- selenium (ITS)]; and group C (H-DMEM medium, 10%FBS, 10 ng/mL TGF-β1, 1 × 10-7mol/L dexamethasone, 50 μg/ mL vitamin C, 1%ITS, and 10%PL). The hUCMSCs were induced in the mediums for 2 weeks. Toluidine blue staining was used to detect the secretion of chondrocyte matrix. Immunofluorescence method was used to identify the existence of collagen trpe II. The expressions of Aggrecan and collagen type II were detected by semiquantitative RT-PCR. Results Flow cytometer results showed that the hUCMSCs did not express the surface markers of hematopoietic cell CD34, CD45, and human leukocyte antigen DR, but expressed the surface markers of adhesion molecule and mesenchymal stem cells CD44, CD105, and CD146. Toluidine blue staining and immunofluorescence showed positive results in group C, weak positive results in group B, and negative results in group A. Semiquantitative RT-PCR showed the expressions of Aggrecan and collagen type II at mRNA level in groups B and C, but no expression in group A. The mRNA expressions of Aggrecan and collagen type II were higher in group C than in group B (P lt; 0.05). Conclusion Only 10%PL can not induce differentiation of hUCMSCs into chondrocytes, but it can be a supplement to the induced mediums. PL can improve hUCMSCs differentiating into chondrocytes obviously in vitro. This study provides new available conditions for constructing tissue engineered cartilage.