Objective To investigate the clinical outcomes of autologous platelet rich plasma (PRP) for anterior cruciate ligament (ACL) reconstruction. Methods Between August 2014 and August 2016, 42 patients with ACL ruptures who underwent arthroscopic ACL reconstruction were randomly divided into 2 groups: 21 patients received graft soaked with PRP (trial group) and 21 patients received routine graft in ACL reconstruction (control group). Because 6 patients failed to be followed up, 17 patients of trial group and 19 of control group were enrolled in the study. There was no significant difference in gender, age, body mass index, side, injury reason, disease duration, Kellgren-Lawrence grade, and preoperative visual analogue scale (VAS), Lysholm score, and International Knee Documentation Committee (IKDC) activity scores between 2 groups (P>0.05). VAS score, Lysholm score, and IKDC activity scores were used to evaluate pain and function at 3 and 12 months postoperatively. Further, second arthroscopy and MRI examination were performed at 12 months postoperatively. Results The patients in both groups were followed up 3 to 12 months with an average of 9.83 months. The VAS score, Lysholm score, and IKDC activity scores were significantly improved at 3 and 12 months after operation in 2 groups (P<0.05), and the scores of trial group were significantly better than those of control group at 3 months (P<0.05), but no significant difference was found between 2 groups at 12 months (P>0.05). No complications of effusion, infection, and allergy were observed in 2 groups during follow-up. MRI showed good position of ACL grafts and good signal quality of the graft in the majority of the cases. However, mixed hyperintense and presence of synovial fluid at the femoral bone-tendon graft interface were found in 3 patients of trial group and 4 patients of control group, indicating poor remodeling ligamentation. MRI score was 3.53±1.13 in trial group and was 3.21±0.92 in control group, showing no significant difference (t=0.936,P=0.356). The second arthroscopy examination showed ligament remodeling score was higher in trial group than control group (t=3.248,P=0.014), but no significant difference was found in synovial coverage score and the incidence of cartilage repair (t=2.190,P=0.064;χ2=0.090,P=0.764). Conclusion PRP application in allograft ACL reconstruction can improve knee function and relieve pain after operation, which may also accelerate graft remodeling.
Objective To make a comparison for the change of maximum tensile intensity and stiffness of a whole implant that is placed into bone tunnel with various lengths tendon, by using beagle dog’s autogenous flexor tendons to reconstruct anterior cruciate l igament (ACL). Methods Sixty male beagle dogs were included in the experiment (weighting 13-16 kg). Three dogs were used for intact flexor tendon of both knees (normal control group), 3 dogs for the intact ACL andfemur-graft-tibia complex (auto control group) and 54 dogs (108 knees) for models of reconstructed ACL (6 experimentalgroups according to different lengths of tendon: 5, 9, 13, 17, 21 and 25 mm in the bone tunnel). The tensile intensity and stiffness were measured after 45, 90 and 180 days separately after operation. Results In the normal control group, the maximum tensile intensity of the intact flexor tendon was (564.15 ± 36.18) N, the stiffness was (59.89 ± 4.28) N/ mm. In the auto control group, the maximum tensile intensity of the intact ACL was (684.75 ± 48.10) N, the stiffness was (74.34 ± 6.99) N/ mm, all ruptured through the intra-articular portion of the graft. The maximum tensile intensity of femur-graft-tibia complex in the auto control group was (301.92 ± 15.04) N, the stiffness was (31.35 ± 1.97) N/mm. After 45 days of operation, all failure occurred at the tibial or femoral insertion site. After 90 days of operation, 24 of the breakpoints were scattered in tendon-bone junction, 12 (3 in 17 mm group, 5 in 21 mm group, 4 in 25 mm group) ruptured through the intra-articular portion. After 180 days of the operation, all breakpoints were distributed inside joint of the implant. The maximum tensile intensity and the stiffness were ber in 17, 21 and 25 mm groups than in 5, 9 and 13 mm groups after operation (P lt; 0.05). Conclusion Tendon with 17 mm length, which will be implanted into bone tunnel, is an appl icable index, in reconstruction of ACL by autogenous tendons.
OBJECTIVE: To investigate the effective method to treat cicatricial baldness. METHODS: From 1993 to 1998, 21 cases with multi-region or great-dimensional cicatricial baldness were treated with scalp expanding and hair autografting. Among them, there were 17 males and 4 females, aged from 14 to 49 years old. The operation was divided into two stages, stage one meaned to embed the expander under the scalp and stage two meaned to sow the autogenous hair. RESULTS: All cases, no matter what the position and area, were repaired successfully. The biggest dimension of repaired baldness was 340 cm2, one expander exposed and one failed in expanding after operation and be corrected immediately. The normal hair direction changed in two cases. CONCLUSION: Combined use of scalp expanding and hair autografting is an effective method to treat multi-region or great dimensional cicarticial baldness.
There were several methods, such as free single and folded fibulae autograft, composed tissue autograft, however, it is still very difficult to repair long segment bone defect. In December 1995, we used free juxtaposed bilateral fibulae autograft to repair an 8 cm of femoral bone defect in a 4 years old child in success. The key procedure is to strip a portion of the neighboring periosteal sleeve of juxtaposed fibulae to make bare of the opposite sides of the bone shafts, suture the opposite periosteal sleeves, keep the nutrient arteries, and reconstruct the blood circulation of both fibular by anastomosis of the distal ends of one fibular artery and vein to the proximal ends of the other fibular artery and vein, and anastomosis of the proximal ends of the fibular artery and vein to lateral circumflex artery and vein. After 22 months follow up, the two shafts of juxtaposed fibulae fused into one new bone shaft. The diameter of the new bone shaft was nearly the same as the diameter of the femur. There was only one medullary cavity, and it connected to the medullary cavity of femur. This method also cold be used to repair other long segment bone defect.
Objective To investigate the feasibil ity of core fat transfer by comparing with traditional Coleman technique. Methods The fat was obtained from 11 patients scheduled for fat transfer by 2 ways: Coleman’s method and core fat graft. The latter was harvested by a modified 1 mL syringe. Then 48 nude mice at the age of 3-4 weeks, male or female, weighing 8.6-12.2 g, were divided into 2 groups randomly (n=24). The dorsal subcutaneous space was recipient site. In the experimental group, 0.5 mL core fat was transplanted into dorsal subcutaneous space; in the control group, 0.5 mL fatobtained by Coleman’s method was transplanted into the same site. The appearance of the back was observed after operation; fat specimens were procured at 1, 2, 4, and 8 weeks after operation for the gross, histological, and immunohistochemical observations; and the residual weight of free fat-graft was calculated by the difference between pre- and post-operative mouse weights. The glucose transportation quantities and cell viabil ity were measured immediately after obtaining fat. Facial augmentation procedure was performed with core fat graft in 11 patients with local depressed deformity between May 2010 and October 2011. Results The uplift of the back was maintained in the experimental group, but the back of mice became flat in the control group at 2 weeks postoperatively. There was no significant difference in the weight of fat-graft between 2 groups (P gt; 0.05). The residual weight of fat-graft in the experimental group was significantly higher than that in the control group at the other time (P lt; 0.05, except for 2nd week postoperatively). The histological observation showed good cell morphology and well-distributed vessels in the experimental group, but obvious destruction of the cells and most vessels at the edge of fatgraft in the control group. The normal fat cells in the experimental group were significantly more than those in the control group after operation (P lt; 0.05), except for 2nd week). The capillaries in the experimental group were fewer than those in the control group, showing significant differences at 1 week and 2 weeks (P lt; 0.05) and no significant difference at 4 and 8 weeks (P gt; 0.05). The glucose transportation quantities in the experimental group [(1.462 ± 0.080) mmol/L] was significantly higher than that in the control group [(1.153 ± 0.199) mmol/L] (t=3.317, P=0.021). The higher cell viabil ity was also proved in the experimental group. Eleven patients were followed up 2-9 months, and no obvious atrophy or collapses was observed at reci pient site. Conclusion Compared with Coleman technique, core fat graft can keep the structure and viabil ity of harvested fat tissue by avoiding certain damages of fat cell. Therefore, the earl ier anastomoses between the host and core graft fat can reduce tissue loss and improve the fat survival. So it is recommended for enblock fat graft.
Objective To discuss the expression of α-melanocyte-stimulating hormone(α-MSH) mRNA in human medium thickness skin autografts and to investigatethe role of αMSH in hyperpigmented process of skin autografts. Methods The samples were from medium thickness skin autografts on neck of the patients after 1 year of surgery. The size of sample was about 1.0 cm×0.5 cm. RT-PCR technique was performed to detect the expression of α-MSH mRNA in medium thickness skinautografts and normal skin respectively. Masson-Fontana stain technique was performed to detect the contents of melanin in medium thickness skin autografts andnormal skin epidermis respectively. Results The expression ofα-MSH mRNA in medium thickness skin autografts was much ber than that in control normal skin, showing statistically significant difference (P＜0.01). The expression of α-MSH/β2-microglobulin mRNA in normal skin of donor area was no statistically significant differences compared with normal skin around recipient area. The contents of melaninin medium thickness skin autografts epidermis obviously increased when compared with that of control normal skin. The expression of α-MSH mRNA was positive correlated with the contents of melanin in epidermis. Conclusion The above results indicate that the expression of α-MSH increases greater in medium thicknessskin autografts than in cortrol samples and was correlated with the pigmentation of skin autografts. Overexpression of α-MSH may play an important role in hyperpigmented process of skin autografts.
Objective To introduce a clinical treatment for the reconstructionof calcaneal thalamus by bone autograft and subtalar arthrodesis for antiquatedintraarticular calcaneal fractures. Methods From July 2000 to October 2003, 11 cases with antiquated intraarticular calcaneal fractures were treated. Of the 11 cases, 9 were males and 2 females,whose ages ranged from21 to 48 years. All unilateral calcanei were involved in the 11 cases. The modified extended Lshaped approach lateral to calcaneus was adopted. The primary treatment was manipulation and immobilization with the reconstruction of calcaneal thalamus by bone autograft and subtalar arthrodesis. The average volume of the ilium for the autograft was 3.0 cm×2.5 cm×1.8 cm. Protruded osteophyte from the lateral wall of calcaneus were ablated in all 11 cases. Results All the 11 cases were followed up for 3 to 18 months, 11.5 monthson average. The reconstructed calcaneal thalamus was healed 10 to 12 weeks after the operation. Some of the patients could walk with load 8 weeks after the operation, and the average time for all the patients to walk with load was 13.2 weeks. There were 4 cases of excellent result, 5 cases of good result, and 2 cases of fair result, according to ZHANG Tieliang’s foot score system. Plain radiograph showed that Bohler angle, width of calcaneus and height of calcaneal thalamus were nearlyrestored to normal. Conclusion With the improvement of calcaneal abnormality and restoration of the shape and function of hind foot, reconstruction of calcaneal thalamus by bone autograft combined with subtalar arthrodesis is effective in treating antiquated intra-articular calcaneal fractures.
ObjectiveTo investigate the effectiveness of U-shape titanium screw-rod fixation system with bone autografting for lumbar spondylolysis of young adults. MethodsBetween January 2008 and December 2011, 32 patients with lumbar spondylolysis underwent U-shape titanium screw-rod fixation system with bone autografting. All patients were male with an average age of 22 years (range, 19-32 years). The disease duration ranged from 3 to 24 months (mean, 14 months). L3 was involved in spondylolysis in 2 cases, L4 in 10 cases, and L5 in 20 cases. The preoperative visual analogue scale (VAS) and Oswestry disability index (ODI) scores were 8.0±1.1 and 75.3±11.2, respectively. ResultsThe operation time was 80-120 minutes (mean, 85 minutes), and the blood loss was 150-250 mL (mean, 210 mL). Primary healing of incision was obtained in all patients without complications of infection and nerve symptom. Thirty-two patients were followed up 12-24 months (mean, 14 months). Low back pain was significantly alleviated after operation. The VAS and ODI scores at 3 months after operation were 1.0±0.5 and 17.6±3.4, respectively, showing significant differences when compared with preoperative ones (t=30.523,P=0.000;t=45.312,P=0.000). X-ray films and CT showed bone fusion in the area of isthmus defects, with the bone fusion time of 6-12 months (mean, 9 months). During follow-up, no secondary lumbar spondyloly, adjacent segment degeneration, or loosening or breaking of internal fixator was found. ConclusionThe U-shape titanium screw-rod fixation system with bone autografting is a reliable treatment for lumbar spondylolysis of young adults because of a high fusion rate, minimal invasive, and maximum retention of lumbar range of motion.
The dynamic changeS of density of epidermal melanocytes in the full-thickness autografts of skinon guinea pigs were investigated by means of histochamical and autoradiographic techniques at variousjntervals during 3 months peried potoperatively,It was found that the increase of epidermalmelaneeytes was accompanied by hyperpigmentation of the skin grafts. Meanwhils,the amount of 3H-TdR taken by the melanocytes was increased. The results showed that the melanocytes poitive to Dopabecame...
ObjectiveTo explore the effect of the expanded capsule on the growth of autogenous costal cartilage. MethodsSixteen New Zealand white rabbits at the age of 3 months (weighing, 2.2-2.5 kg; male or female) were selected and four 15 mL tissue expanders were implanted on the back symmetrically. After 1 month, the expanded capsule formed, the tissue expanders were removed; the capsule of the left side was removed (experimental group), and the capsule of the right side was reserved (control group); meanwhile, the right 7th and 8th costal cartilage without the perichondrium was divided into segments and placed into the capsule of 2 groups symmetrically. At 4 and 8 weeks after transplantation, the cartilage was harvested for the general, weighing, and histological observations. ResultsOne rabbit died during the experiment, and the other 15 rabbits survived. The differences of cartilage weight between before and after transplantation showed more obvious increase in the experimental group[(0.003 4±0.002 7) g and (0.005 8±0.001 4) g] than those in the control group[(-0.000 3±0.001 9) g and (-0.003 9±0.005 3) g] at 4 and 8 weeks, showing significant differences between 2 gouprs (t=4.331, P=0.029; t=6.688, P=0.008). The change of cartilage weight at 8 weeks was significantly higher than that at 4 weeks in the experimental group (t=-3.098, P=0.001); but the change of cartilage weight at 8 weeks was significantly lower than that at 4 weeks in the control group (t=2.491, P=0.009). The histological observation showed that the activity of the cartilage was enhanced in 2 groups at 4 and 8 weeks when compared with normal cartilage, and more obvious change was observed in the experimental group than in the control group. And the acellular area was seen in the cartilage at 8 weeks in the control group. The Masson staining results showed that the color was deeper in the experimental group than in the control group. ConclusionThe removal of the expanded capsule during operation is beneficial to the growth of autogenous costal cartilage. The results can provide corresponding experimental guidance for the clinical problems.