The canine saphaneous skin flap was used as a model in this experiment. The cutaneous autograft would give long-term survival, whereas the allograft without pretreatment would only survive 10. 2±1.9 days from its transplantation. If the pretreatment consisted of the use of immunosuppressive agent as PHA or infusion of dexamesone, the survival days of the allografts could be prolonged to 15.1±2.5 and 13.7±2.8, respectively(Plt;0.01). The histological examination gave the evidence that drug perfusion delayed the rejection.
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 evaluate clinical result of reconstructed thumb and finger with a free hallux nail flap(HNF) and frozen-phalanx-joint-tendon-sheath composite tissue allograft in 270 cases. METHODS: The patients were followed up with reexamination in the ambulant clinic, communication, X-ray photography, lab-examination, isotope 99mTc MDP and reoperation. The data were analyzed by statistics or proved by clinical observation, which were followed up for five years in average (ranging from five months to sixteen years). RESULTS: Enveloping the allogeneic finger composite tissue with self-HNF and pieces of phalanx of great toe, it could reconstruct a thumb or finger with good contour and nutrition. The excellent rate of opposition function of the reconstructed thumbs was 71.91%. The sense of the fingers recovered after 3 months to 8 months of operation. Two-point discrimination was 3 mm to 15 mm. The junction between implanted allo-phalanges and auto-phalanges could be hastened by implanted with vascularized autogenous phalanx pieces in the HNF. The isotope 99mTc MDP was used to take X-ray photography in 24 cases for four months to 9 years and seven months, which showed that the blood vessels grew into the allo-phalanges. However, the Charcot’s arthropathy of allogeneic joints and bony absorption still could be seen in some cases. That might be concerned with chronic abrasion of joint or chronic rejection of host to graft. CONCLUSION: The operation is fit for repairing the defect of thumb or finger in any degree. The implanted vascularized self-phalanx pieces can promote bone union, but it can not prevent the allogeneic joints from arthropathy or bone absorption
Objective To investigate effect of the removal of epithelium and mixed glands from the tracheal allografts on the graftimmunosuppression. Methods Fresh untreated tracheal allografts， cryopreserved tracheal allografts, and 10 off-epithelium tracheal allografts were obtained from 25 male SD rats. Fresh untreated tracheal allografts(40) were divided into 4 groups and dipped respectively in the solution of protease ⅩⅣ in 0, 0.1, 0.3 and 0.5 mg/ml at 4℃ for 12 hours. Thirty recipient male SD rats were randomly and equally divided into group A (fresh untreated tracheal allografts), group B(cryopreserved tracheal allografts), and group C(offepithelium tracheal allografts). The transplanted allografts were implanted into the abdominal cavity of other rats by being embedded in the greater omentum. Twenty-one days after transplantation, the tracheal graft segments were surgically removed, and then were initially fixed in cold 10% neutral buffered formalin solution for hematoxylineosin staining. Histological observation and lymphocyte infiltration were performed on the grafts to evaluate rejection. Results The 0.3 mg/ml protease ⅩⅣ could remove the epithelium and mixed glands of the grafts completely, but did no damage to cartilage. The cartilages of each group all survived and were revascularized. The lumens of group A were filled with granulation and necrosis tissue. In contrast, group B was filled with a few granulation tissues and group C was not at all. The number of lymphocyte infiltration in group A, B, and C was 29.16±2.69/HP, 15.17±2.19/HP, and 11.56±0.87/HP respectively. There was significant difference between group A and both group B and group C (Plt;0.05), and there was significant difference between group B and group C (Plt;0.05). Therefore, the grade of graftrejectionwas group Agt;group Bgt;group C. Conclusion The 0.3 mg/ml protease ⅩⅣ can completely remove the epithelium and mixed glands of grafts at 4℃ for 12 hours, and it preserves the normal structure of cartilage. The antigenicity of tracheal grafts can be greatly reduced by removing the epithelium and by the cryopreservation. The prior tracheal allograft in the omentum is feasible for the revascularization of the grafts.
OBJECTIVE: To study the characteristics of, morphology histology and ultrastructure of anterior cruciate ligament(ACL) autograft and two-step cryopreserved ACL allograft after transplantation. METHODS: Sixty New Zealand rabbits and sixty Japanese rabbits were randomly divided into two groups: ACL autograft group and two-step cryopreserved ACL allograft group. Immunosuppressant were not used after transplantation. The histology and ultrastructure of the ACL of transplantation and normal knee were observed after 4 weeks and 12 weeks, respectively. RESULTS: The rate of remodeling process was faster in ACL autograft than in two-step cryopreserved ACL allograft, but there was similar remodeling process between two groups 12 weeks after transplantation. The proportions of large-diameter fibers(gt; or = 80 nm) of ACL autograft and cryopreserved ACL allograft were 6% and 24% in the 4th week, and were 0 and 2% in the 12th week, respectively. The proportions of small-diameter of fibers(lt; 80 nm) of ACL autogrft and cryopreserved ACL allograft were 94% and 76% in the 4th week, and 100% and 98% in the 12th week, respectively. Histologic incorporation in ACL autograft was similar to that in cryopreserved ACL allograft. CONCLUSION: Two-step cryopreserved bone-ACL-bone allograft were similar to bone-ACL-bone autograft cryopreserved in remodeling process and histology. The rate of remodeling process was faster in ACL autograft than in cryopreserved ACL allograft.
ObjectiveTo explore the fusion effect of allograft Cages on transforaminal lumbar interbody fusion (TLIF).MethodsThe clinical data of 30 patients (38 vertebral segments) who underwent TLIF with allograft interbody fusion Cages between January 2015 and January 2017 were retrospectively analysed. There were 25 males and 5 females with an average age of 56.9 years (range, 44-72 years). The lesions included 20 cases of lumbar disc herniation, 7 cases of lumbar spondylolisthesis, and 3 cases of lumbar spinal stenosis. The operation section included 4 cases of L3, 4, 13 cases of L4, 5, 5 cases of L5, S1, 6 cases of L4, 5-L5, S1, and 2 cases of L3, 4-L4, 5. The disease duration was 6-36 months (mean, 12 months). The clinical effectiveness was evaluated by visual analogue scale (VAS) score, Oswestry disability index (ODI), and Japanese Orthopaedic Association (JOA) score at preoperation, 3 months and 6 months after operation, and last follow-up. The fusion rate was evaluated by anteroposterior and lateral X-ray films and CT three-dimensional reconstruction at 3 and 6 months after operation. The intervertebral space height was measured on anteroposterior and lateral X-ray films at preoperation, 3 days, 3 months, and 6 months after operation.ResultsThe operation time was 2.1-4.3 hours (mean, 3.1 hours), and the intraoperative blood loss was 150-820 mL (mean, 407.5 mL). The follow-up time was 8-25 months (mean, 16.4 months). One Cage split at 6 months after operation without Cage movement and neurologic symptoms; none of the other patients had Cage prolapse, displacement, and fragmentation. No local or systemic allergy or infection signs was found in all patients. No nerve compression or symptoms was observed during the follow-up. The postoperative VAS score, ODI score, and JOA score improved significantly when compared with preoperative scores (P<0.05); and the scores at 6 months and at last follow-up were significantly improved when compared with those at 3 months after operation (P<0.05); but no significant difference was found between at 6 months and at last follow-up (P>0.05). The fusion rate was 55.3% (21/38), 92.1% (35/38), and 100% (38/38) at 3 months, 6 months, and last follow-up postoperatively. The intervertebral space height was increased significantly at 3 days, 3 months, 6 months, and last follow-up postoperatively when compared with preoperative ones (P<0.05); and the loss of intervertebral space height was significant at last follow-up when compared with postoperative at 3 days (P<0.05).ConclusionThe allograft interbody fusion Cage contributes to the spine interbody fusion by providing an earlier stability and higher fusion rate.
ObjectiveTo review the research progress and clinical application of allograft bone spacer in cervical and lumbar interbody fusion. MethodsLiterature about allograft bone spacer in cervical and lumbar degenerative disease was reviewed and analyzed, including the advantages and disadvantages of allograft material, fusion rate, effectiveness, and complications. ResultsFusion rate and effectiveness of allograft bone spacers were similar to those of autograft and polyetheretherketone spacers, and they were recommended by many orthopedists. However, indications, long-term effectiveness, and complications were not clear. ConclusionFurther study on allograft bone spacer in cervical and lumbar interbody fusion should be focused on optimal indications and long-term effectiveness.
OBJECTIVE To explore the healing mechanism of full-thickness wound treating by the intermingled skin transplantation of large sheet allograft with autograft through studying the expression of laminin (LN). METHODS Thirty-six SD rats with 10% to 15% of total body surface area (TBSA) full-thickness were made. After 3 days, the devitalized tissue were excised and transplanted a large sheet of allograft from Wistar rats and islets of autografts were implanted 3 days later. On day 3, 5, 7, 14, 21 after allografting, the expression of LN in the grafts were detected by immunohistochemistry. RESULTS On the 7th day postallografting, LN, which played positive action of epidermal cell adhesion, still retained in the allodermis after the rejection of alloepidermis occurred. On the 14th day postallografting, there appeared scattered LN underneath the epidermal cells migrating from islets of autografts. On the 21st day postallografting, LN in the basement membrane of skin grafts had completely formed. CONCLUSION The intermingled transplantation of large sheet allograft with autograft may provide components of basement membrane for wound healing, which may help to improve the appearance and function of skin.
To analyze the effectiveness of anterior cruciate l igament (ACL) reconstruction with preserving the remnant ACL by allograft l igament. Methods Between January and July in 2008, 97 patients underwent ACL reconstruction with the allograft l igament. On the basis of the ACL’s condition, patients were divided into 2 groups. In the trial group (patients having remnant ACL, n=38), there were 27 males and 11 females with an average age of 24.3 years (range, 16-43 years); of them, 8 cases compl icated by menicus injury and 13 cases by Outbridge I degree cartilage injury; the time from injuryto operation was 3-20 weeks (mean, 8.6 weeks). In the control group (patients having no remnant ACL, n=59), there were 35 males and 24 females with an average age of 27.8 years (range, 18-48 years); of them, 16 cases compl icated by menicus injury and 23 cases by Outbridge I degree cartilage injury; the time from injury to operation was 4-44 weeks (mean, 12.7 weeks). All injuries were caused by sports in 2 groups. All patients had positive anterior drawer test and positive Lackman test. Before operation and 3, 8, 9, 15 months after operation, the function of the knee joint was evaluated by the International Knee Documentation Committee (IKDC) scale and Lysholm score. KT-2000 arthrometer was used to evaluate knee laxity. Results All incisions healed primarily, and no intraarticular infection occurred. Thirty-seven cases and 57 cases were followed up 15 months in the trial group and the control group, respectively. Knee instabil ity disappeared; the patients showed negative anterior drawer test and negative Lackman test. By the evaluation of KT-2000, the joint sl ippage of 2 groups were less than 2 mm at 3 and 6 months after operation, but it was more than 2 mm in 2 cases of the trial group and in 3 cases of the control group at 9 months after operation; and it was no change in the trial group and 2.5-4.0 mm (mean, 3.4 mm) in the control group at 15 months after operation. Both the IKDC scale and Lysholm score were higher in the trial group than in the control group 3 months after operation, but the differences were not significant (P gt; 0.05). Both the IKDC scale and Lysholm score were
OBJECTIVE To study the effect of combined application of external cyclosporine A (CsA) and CTLA4Ig in inhibiting rejection and inducing immune tolerance in composite tissue allograft. METHODS: The auricles with vessel pedicle were transplanted from Lewis rats to BN rats under microsurgery. CsA was spreaded on the surface of grafts in combination with administration of CTLA4Ig intraperitoneally after transplantation. The rejection response and survival time of grafts were observed, and the IL-2 level in serum was measured. RESULTS: The mean survival time was (7.8 +/- 1.7) days in control group. It was (15.2 +/- 1.9) days when recipients treated by CsA and (16.6 +/- 2.1) days by CTLA4Ig. Under the combination of CsA and CTLA4Ig, the mean survival time was significantly prolonged to (28.8 +/- 3.5) days (P lt; 0.05) with the lowest level of IL-2 in serum of recipients. CONCLUSION: The combined application of external CsA and CTLA4Ig inhibits rejection of allograft effectively, which can be a favorable therapy on composite tissue allo-transplantation.