ObjectiveTo review the bioactive strategies that enhance tendon graft healing after anterior cruciate ligament reconstruction (ACLR), and to provide insights for improving the therapeutic outcomes of ACLR. Methods The domestic and foreign literature related to the bioactive strategies for promoting the healing of tendon grafts after ACLR was extensively reviewed and summarized. ResultsAt present, there are several kinds of bioactive materials related to tendon graft healing after ACLR: growth factors, cells, biodegradable implants/tissue derivatives. By constructing a complex interface simulating the matrix, environment, and regulatory factors required for the growth of native anterior cruciate ligament (ACL), the growth of transplanted tendons is regulated at different levels, thus promoting the healing of tendon grafts. Although the effectiveness of ACLR has been significantly improved in most studies, most of them are still limited to the early stage of animal experiments, and there is still a long way to go from the real clinical promotion. In addition, limited by the current preparation technology, the bionics of the interface still stays at the micron and millimeter level, and tends to be morphological bionics, and the research on the signal mechanism pathway is still insufficient.ConclusionWith the further study of ACL anatomy, development, and the improvement of preparation technology, the research of bioactive strategies to promote the healing of tendon grafts after ACLR is expected to be further promoted.
OBJECTIVE: To observe the clinical results in the anterior stabile operation of spinal fracture using red blood salvage. METHODS: Nineteen cases with spinal fracture were performed the anterior decompress operation. Blood cell salvage were used during operation. Other 20 cases were also reviewed as control group, who were received the same operation without blood cell salvage. RESULTS: In the 19 cases, average volume of autologous transfusion was 536 ml. Only two cases had homologous transfusion requirements. In the control group, all cases needed homologous transfusion (averaged 947 ml). CONCLUSION: In the anterior decompress operation, the intraoperative blood salvage is highly effective in reducing transfusion and also improves the security of operation
ObjectiveTo investigate the cause of stoma recurrence after anterior resection of rectal cancer and discover the methods of prevention and treatment.MethodsA total 91 patients with stoma recurrence after anterior resection of rectal cancer (or Dixon) were analysed retrospectively between 1985 and 1996. Fourtyseven patients experienced reradical resection (Miles), 27 cases palliative resection, and 11 cases only exploration. Thirtytwo cases had been followed up for 5 years and obtained 1，3，5year survival rate for reradical radical resection (Miles). Diagnosis and treatment of stomal recurrence after Dixon were evaluated. ResultsOne, three and fiveyear survival rate of reradical resection (Miles) was 93%，77%，45% respectively.ConclusionTo amplify blindly the adaptation of Dixon is to raise the rate of stoma recurrence. Digital rectal examination and fiberopic colonoscopy (and biopsy) are very essential methods for the diagnosis of stoma recurrence, and we strive to do reradical resection (Miles) for the patients with stoma recurrence after Dixon’s operation.
Objective To evaluate the effect of polymethylmethacrylate (PMMA) augmentation on cervical stabil ity after anterior cervical interbody fusion (ACIF) before and after fatigue. Methods Twelve porcine cervical spines (C3-7) were subjected to testing angular displacement parameters, including the range of motion (ROM), neutral zone (NZ), and elastic zone (EZ), in nondestructive flexion and extension, right/left lateral bending, and left/right rotation on Motion Analysis motion capture system and MTS-858 servo-hydraul ic testing machine. Intact cervical spines served as control group (group A); oneleveldiscectomy and fusion was performed with anterior plate fixation based on group A as group B; flexion and extension,left/right lateral bending (5 000 cycles) fatigue testing based on group B as group C; the augmentation screw channel was used based on group C as group D; and flexion and extension, left/right lateral bending fatigue testing were performed based on group D as group E. Results The ROM, NZ, and EZ in group A were significantly different from those in other groups (P lt; 0.05) at flexion/extension, left/right bending, and left/right rotation. The ROM, NZ, and EZ in group B were significantly smaller than those in group C (P lt; 0.05) in flexion/extension, left/right bending, and left/right rotation, but there was no significant difference when compared with group D (P gt; 0.05). The ROM and NZ in flexion/extension and the EZ in flexion in group B were significant smaller than those in group E (P lt; 0.05), but there was no significant difference in the other indexes (P gt; 0.05). The ROM, NZ, and EZ in group C in flexion and extension, left/right lateral bending, and left/right rotation were significantly higher than those in groups D and E (P lt; 0.05). The ROM and NZ in flexion and extension and left/right lateral bending, and the ROM in left/right rotation, and the EZ in flexion and extension, right bending, and left/right rotation in group D were significantly smaller than those in group E (P lt; 0.05), but there was no significant difference in the other indexes (P gt; 0.05). Conclusion PMMA augmentation can significantly increase the instant cervical stabil ity and provide a biomechanics basis in cervical anterior plate fixation.
Objective To introduce and evaluate the efficacy of microsurgical decompression and titanium cage implants fusion with anterior plating in cervical spondylitic radiculopathy. Methods From September 2000 to September 2002, 54consecutive patients were treated with anterior microsurgical decompression followed by intervertebral fusion using a titanium cage packed with autogenous cancellous bone graft and an anterior cervical plating.There were 31 males and 23 females, with an average age of 45.2 years (38-65 years). The disease course was 5-19 months. The locations were C3,4 in 3 cases, C4,5 in 25, C5,6 in 21 and C6,7in 5 cases. The bony endplates were preserved to prevent cage subsidence. Thirty-nine cases suffered from monosegmental fusion and 15 cases did bisegmental fusion. The Cobb angle was 0.80±0.31° before operation. Results All wounds healed by first intention and no complications of vertebral artery injury, vertebralnerve injury and leakage of cerebrospinal fluid occurred. Dysphagia occurred within2 weeks in 2 cases, hoarseness occurred and recovered without treatment in 1 case, and pain in upper limbs aggravated and was relieved after 1 month of conservative treatment in 1 case. Fiftyfour patients were followed 12-36 months(16.4 months on average). The X-ray films showed no breakage of screws and robs and olisthy of implants. Fusion was achieved in 53 patients and the fusion rate was 98.2%. The Cobb angles were 5.50±0.22° after operation and 5.20±0.17° at final followup, showing significant differences when compared with before operation(Plt;0.01). According to Odom’s criteria, the resultswere excellent in 24 cases, good in 22 cases and fair in 8 cases, the excellentand good rate was 85.2%.Conclusion Anterior cervical microsurgical decompression is a safely and effectively treatment option in patients with cervical spondylitic radiculopathy caused by protrusion of intervertebral disc(1-2 discs) and by degenerative osteophyte. Titanium cage interbody fusion with concomitant use of anterior plating provides immediate biomechanical stability, successfully restores and maintains posterior interbody height and cervic、al lordosis to ensure satisfactory longtime outcomes.
Objective To compare the loss of anterior column heightand cervical Cobb angle with three different types of anterior cervical discectomy and fusion(ACDF). Methods A prospective randomized study was performed on 60 patients who had undergone ACDF with the autologous iliac crest graft (group A, n=20), the autogenous bone and the anterior cervical locking plates (group B, n=20), and Syncage-C filled with the local autograft reamings (group C, n=20) from January 1998 to January 2003. The patients diagnosed as having cervical radiculopathy (RP) and cervical spondylotic myelopathy (CSM) were indicated for ACDF. Of the patients, 41 were male and 19 female with a mean age of 57 years (range, 36-68) and their average course of disease was 6.2 months (range, 1-36). There were 36 one-level and 24 two-level fusions from C3,4 to C7,T1. Radiological measurements were performed on the cervical radiographs taken before operation, 7 days and 3 months after operation, and on the last day of the follow-up; then, the height and Cobb angle of the fused segment, functional restoration, and clinical outcome were evaluated in the three groups. Results The followup of more than 2 years (range,2-7) showed that the average loss of anterior column height and Cobb angle of the fused segments in groups A and B, which had not preserved the-endplate, hada greater increase than that in group C, which had preserved the endplate. Of the patients, 12 had autograft collapse, 3 autograft displacement, and 10 postural abnormality between the fused segments, most of which happened in groups A andB. The fusion rate was 93.3% (56 cases) according the strict arthrodesis critera; their excellent and good rate in the functional assessment was 83.3% (RP 90.4%, CSM 79.5%); the overall satisfactory (excellent and good) rates in groups A,B and C were 75%, 85% and 90%, respectively. Conclusion To increase the resistance to graft subsidence, which is a major reason for narrowness of the fused segments, and to maintain normal cervical curvature, we should improve our skills of bone grafting performance, preserve the endplate, carefully evaluate the degree of osteoporosis before operation, and use anterior cervical locking plate and /or fusion with Syncage-C when necessary.
Objective To evaluate the role of glenoid osseous structure on anterior stabil ity of shoulder so as to provide the biomechanical basis for cl inical treatment. Methods Ten fresh shoulder joint-bone specimens were collected from10 adult males cadavers donated voluntarily, including 4 left sides and 6 right sides. The displacements of the specimens were measured at 0° and 90° abduction of shoulder joint by giving 50 N posterior-anterior load under the conditions as follows: intact shoulder joint, glenoid l ip defect, 10% of osseous defect, 20% of osseous defect, and repairing osseous defect. Results For intact shoulder joint, glenoid l i p defect, 10% of osseous defect, 20% of osseous defect, and repairing osseous defect, the displacements were (10.73 ± 2.93), (11.43 ± 3.98), (13.58 ± 4.86), (18.53 ± 3.07), and (12.77 ± 3.13) mm, respectively at 0° abduction of shoulder joint; the displacements were (8.41 ± 2.10), (8.55 ± 2.28), (9.06 ± 2.67), (12.49 ± 2.32), and (8.55 ± 2.15) mm, respectively at 90° abduction of shoulder joint. There was no significant difference between intact shoulder joint and others (P gt; 0.05) except between intact shoulder joint and 20% of osseous defect (P lt; 0.05). Conclusion When shoulder glenoid l ip defects or the glenoid osseous defect is less than 20%, the shoulder stabil ity does not decrease obviously, indicating articular l igament complex is not damaged or is repaired. When glenoid osseous defect is more than 20% , the shoulder stabil ity decreases obviously even if articular l igament complex is not damaged or is repaired. Simultaneous repair of glenoid osseous defect andarticular l igament complex can recover the anterior stabil ity of the shoulder.
Objective To investigate the effect of complete anterior bundle of medial collateral ligament (MCL) on the valgus stability of the elbow after reconstruction and to assess the efficacy of artificial tendon and interference screw in reconstruction the anterior bundle of MCL. Methods The bone-tendon of the elbow were made in 12 adult upper limb specimens. There were 8 males and 4 females, left side and right side in half. Using biomechanic ways and pressure sensitive film, the valgus laxity, the stress area of the humeroulnar joint, and the intra-articular pressure were measured in integrated anterior bundle of MCL (control group, n=12) and reconstructed anterior bundle of MCL with artificial tendon and interference screw (experimental group, n=12) in elbow flexion of 0, 30, 60, and 90°. Results There was no significant difference in the valgus laxity within group and between groups in different flexion degrees (P gt; 0.05). No significant difference was found in the intra-articular pressure in elbow flexion of 30, 60, and 90° within group and between groups (P gt; 0.05) except in elbow flexion of 0° (P lt; 0.05). The stress area of the humeroulnar joint in 0° flexion was significantly larger than that in 30, 60, and 90° flexion in the control group (P lt; 0.05), but no significant difference was found within group and between groups in the other flexion degrees (P gt; 0.05). Conclusion The anterior bundle of MCL has important significance for maintaining the valgus stability of the elbow, after reconstructing the anterior bundle by using artificial tendon and interference screw, the medial stability of elbow can be recovered immediately.
Objective To compare the biomechanical properties of the anterior transpedicular screw-artificial vertebral body (AVB) and conventional anterior screw plate system (AP) in lower cervical spine by finite element study. Methods CT images (C1-T1) were obtained from a 38-year-old female volunteer. The models of intact C3-7 (intact group), AP fixation (AP group), and AVB fixation (AVB group) were established and analyzed by Mimics 14.0, Geomagic Studio 2013, and ANSYS 14.0 softwares. The axial force of 74 N and moment couple of 1 N·m were loaded on the upper surface and upper facet joint surfaces of C3. Under conditions of flexion, extension, lateral bending, and rotation, the Von Mises stress distribution regularity and maximum equivalent stree of AP and AVB groups were recorded, and the range of motion (ROM) was also analyzed of 3 groups. Results The intact model of lower cervical spine (C3-7) was established, consisting of 286 382 elements and 414 522 nodes, and it was successfully validated with the previously reported cadaveric experimental data of Panjabi and Kallemeyn. The stress concentrated on the connection between plate and screw in AP group, while it distributed evenly in AVB group. Between AP and AVB groups, there was significant difference in maximum equivalent stress values under conditions of 74 N axial force, flexion, extension, and rotation. AVB group had smaller ROM of fixed segments and larger ROM of adjacent segments than AP group. Compared with intact group, whole ROM of the lower cervical spine decreased about 3°, but ROM of C3, 4 and C6, 7 segments increased nearly 5° in both AP and AVB groups. Conclusion As a new reconstruction method of lower cervical spine, AVB fixation provides better stability and lower risk of failure than AP fixation.
ObjectiveTo investigate the application and technical essentials of computer-assisted navigation in the surgical management of periacetabular fractures and pelvic fractures. MethodsBetween May 2010 and May 2011, 39 patients with periacetabular or anterior and posterior pelvic ring fractures were treated by minimally invasive fixation under computer-assisted navigation and were followed up more than 2 years, and the clinical data were analyzed retrospectively. There were 21 males and 18 females, aged 15-64 years (mean, 36 years). Fractures were caused by traffic accident in 23 cases, crush injury in 6 cases, and falling from height in 10 cases. Of them, 6 cases had acetabular fractures; 6 cases had femoral neck fractures; 18 cases had dislocation of sacroiliac joint; and 15 cases had anterior pelvic ring injuries. All patients were treated with closed or limited open reduction and screw fixations assisted with navigation. ResultsEighty-nine screws were inserted during operation, including 8 in the acetabulum, 18 in the neck of the femur, 33 in the sacroiliac joint, and 30 in the symphysis pubis and pubic rami. The mean time of screw implanted was 20 minutes (range, 11-38 minutes), and the average blood loss volume was 20 mL (range, 10-50 mL). The postoperative pelvic X-ray and three dimensional CT scan showed good reduction of fractures and good position of the screws. No incision infection, neurovascular injury, or implant failure occurred. All patients were followed up 27-33 months with an average of 29.6 months. The patients could walk with full weight loading at 6-12 weeks after operation (mean, 8 weeks); at last follow-up, the patients could walk on the flat ground, stand with one leg, and squat down, and they recovered well enough to do their job and to live a normal life. ConclusionMinimally invasive fixation under computer-assisted navigation may be an excellent method to treat some specific types of periacetabular and anterior and posterior pelvic ring fractures because it has the advantages of less trauma and blood loss, lower complication incidence, and faster recovery.