ObjectiveTo evaluate the effectiveness of Cross-Union surgery for the treatment of pseudarthrosis of the tibia (PT) with neurofibromatosis type 1 (NF1). MethodsThe clinical data of 8 children of PT with NF1 who met the selection criteria between January 2018 and December 2023 was retrospectively analyzed. There were 5 boys and 3 girls, and the operative age ranged from 1.8 to 13.3 years with a median age of 3.5 years. According to Paley classification, there were 2 cases of type 2a, 2 cases of type 3, 2 cases of type 4a, and 2 cases of type 4c. There were 5 cases of first operation and 3 cases of re-fracture after previous operation. Six cases had leg length discrepancy before operation, and 2 of them had shortening over 2.0 cm. Except for 1 case of ankle fusion, the other 7 cases had ankle valgus. Preoperative coronal/sagittal angulation was recorded. Postoperative pseudarthrosis healing and refracture were observed. Leg length discrepancy and tibiotalar angle were measured and recorded before operation and at last follow-up. Inan imaging evaluation criteria was used to evaluate the imaging effect. ResultsAll patients were followed up 12-37 months (mean, 23.5 months). One pseudarthrosis failed to heal at 12 months after operation and healed at 3 months after reoperation, while the other pseudarthrosis healed with a healing rate of 87.5% and a healing time of 4-8 months (mean, 5.3 months). No refracture occurred during the follow-up. At last follow-up, there were 2 new cases with leg length discrepancy, which were 0.7 cm and 1.3 cm, respectively. In 2 cases with the leg length discrepancy more than 2.0 cm before operation, the improvement was from 4.1 cm and 12.6 cm to 2.1 cm and 9.0 cm, respectively. There was no significant difference in leg length discrepancy between pre- and post-operation in 8 cases (P>0.05). At last follow-up, 6 patients still had ankle valgus, and there was no significant difference in the tibiotalar angle between pre- and post-operation (P>0.05); the tibial coronal/sagittal angulation significantly improved when compared with that before operation (P<0.05). According to Inan imaging evaluation criteria, 1 case was good, 6 cases were fair, and 1 case was poor. Conclusion Cross-Union surgery is an effective method for the treatment of PT with NF1 in children, can achieve good bone healing results with a low risk of re-fracture. The surgery may not have significant effects on leg length discrepancy and ankle valgus, and further treatment may be required.
Objective To investigate the influence of collagen on the biomechanics strength of tissue engineering tendon. Methods All of 75 nude mice were madethe defect models of calcaneous tendons, and were divided into 5 groups randomly. Five different materials including human hair, carbon fibre (CF), polyglycolic acid (PGA), human hair and PGA, and CF and PGA with exogenous collagen were cocultured with exogenous tenocytes to construct the tissue engineering tendons.These tendons were implanted to repair defect of calcaneous tendons of right hind limb in nude mice as experimental groups, while the materials without collagenwere implanted to repair the contralateral calcaneous tendons as control groups. In the 2nd, 4th, 6th, 8th and 12th weeks after implantation, the biomechanicalcharacteristics of the tissue engineering tendon was measured, meanwhile, the changes of the biomechanics strength were observed and compared. Results From the 2nd week to the 4th week after implantation, the experimental groups were ber than the control groups in biomechanics, there was statistically significantdifference (Plt;0.05). From the 6th to 12th weeks, there was no statisticallysignificant difference between the experiment and control groups (Pgt;0.05). Positivecorrelation existed between time and intensity, there was statistically significant difference (Plt;0.05). The strength of materials was good in human hair,followed by CF, and PGA was poor. Conclusion Exogenous collagen can enhance the mechanics strength of tissue engineering tendon, and is of a certain effect on affected limb rehabilitation in early repair stages.
Objective To investigate the effect of topical treatment with antisense oligonucleotides（ASON）targeting tumor necrosis factor-alpha;（TNF-alpha;）on the pathological process of experimental herpes simplex virus type-Ⅰ（HSV-Ⅰ）induced chorioretinitis in mouse eye. Methods Fifty BALB/c mice were randomly divided into experimental and control group（twenty five mice in each group）.HSV chorioretinitis model was induced in each mouse by inoculating 1times;105 plaque-forming units （pfu） of HSV-Ⅰ（KOS strain）into anterior chamber of the right eye.In experimental group，Fluorescein isothiocyanate （FITC）-labeled ASON targeting TNF-alpha; 2 mu;l were injected sub-conjunctiva in the left eye1day before and 1 and 4 days after the infection;while phosphate buffer solution was injected in the same way in control group.The inflammation changes of the eyes in the 2 groups were observed and the clinical grades were assessed according to the extends of anterior-chamber inflammation，vasodilatation of cornea and iris，formation of cataract，and vitreous opacity. All of the mice were executed 10 days after the infection and were observed histologically. The contents of TNF-alpha; in retina and choroid were measured by enzyme-linked immunobsorbent assay（ELISA）. Results After the infection，acute inflammation appeared in the right eyes in both groups. The inflammation of the left eyes in experimental group was significantly milder than which in the control group.Twelve left eyes had necrotic chorioretinitis in different degrees in the control group while 2 left eyes had mild chorioretinitis in the experimental group. The difference of the number of inflammatory cells between the 2 groups was statistically significant in retina，choroid，and ciliary body（P＜0.05）and was not obvious in anterior chamber，vitreous cavity，and iris（P＞0.05）.The content of TNF-alpha; in choroid and retina was（60plusmn;1.25）pg in the experimental group and（305plusmn;1.03）pg in the control group（P＜0.05）. Conclusions TNF-alpha; ASON treating HSV-Ⅰinduced chorioretinitis may reduce the content of TNF-alpha; in affected mice eyes and decrease the inflammatory reaction. (Chin J Ocul Fundus Dis, 2006, 22: 245-248)
Objective To investigate the preventive effect of carbachol on the formation of postoperative intra-abdominal adhesion. Methods Forty-four Wistar rats were randomly divided into sham operation group (SO group, n=12), operation group (n=16) and carbachol treated group (carbachol group, n=16, carbachol 50 μg/kg). Animal model of abdominal adhesion was established by rubbing the procussus vermiformis of cecum with dry sterile gauze, and by clamping and scuffing abdominal wall. Half of rats were separately killed on day 7 and day 14 after surgery, respectively. The degree of adhesion was evaluated according to Phillips 5-scale grade and the feature of this model. The histopathological changes of adhesive tissues were observed and the content of collagen type Ⅰ in the tissues was detected by immunohistochemistry. Results The scores of intra-abdominal adhesion were significantly lower in the carbachol group than those in operation group both on 7 d and 14 d (P＜0.01). Mild inflammatory changes and less fibrous proliferation were observed in carbachol group microscopically. The contents of collagen type Ⅰ detected by immunohistochemistry were significantly lower in the carbachol group than those in operation group both on 7 d and 14 d (P＜0.01). There was no significant difference of the score of abdominal adhesion and content of collagen type Ⅰ in the same group between 7 d and 14 d (Pgt;0.05). Conclusion Carbachol may take a significant role in the prevention of postoperative abdominal adhesion in rat.
ObjectiveTo explore the plastic surgical treatment and the way to reduce hemorrhage for scalp and facial plexiform neurofibromas. MethodsBetween July 2004 and July 2013, 20 patients with scalp and facial plexiform neurofibromas (17 cases of neurofibromatosis type Ⅰ and 3 cases of plexiform neurofibroma) were treated, and the clinical data were retrospectively analyzed. There were 9 males and 11 females with an average age of 37 years (range, 18-56 years). The disease duration ranged from 8 to 56 years (mean, 19 years). The scalp was involved in 6 cases, the face in 7 cases, and both the scalp and face in 7 cases. The extent of involvement ranged from 4 cm×3 cm to 15 cm×13 cm. Obvious pigmentation was seen in 2 cases. Endovascular embolization was performed before surgical intervention in 4 cases. Preliminary sutures around the lesion were carried out in 18 cases having an involved range over 5 cm×5 cm. One-stage excision was performed in 17 cases, and two-stage excision in 3 cases. Wound repair and facial orthopedic treatment were performed after tumor excision. ResultsThe intraoperative blood loss was 100-500 mL (mean, 300 mL) for patients undergoing single operation. For 3 patients undergoing two-stage excision, the blood loss of the first operation was 500, 600, and 800 mL respectively, and the blood loss of the second operation was all 50 mL. Autologous blood transfusion of 200, 400, and 400 mL was performed in 3 cases respectively. The preliminary sutures were removed at 3-7 days (mean, 5 days) after operation. All the incisions healed primarily without secondary hemorrhage and hematoma, and the flap and skin graft survived totally. Fifteen patients were followed up 1 year to 7 years (mean, 2.5 years). All patients showed significant improvement in appearance. No significant progression, expanding, and sagging were observed. ConclusionEndovascular embolization and preliminary sutures around the lesion can be used to reduce hemorrhage in resection of plexiform neurofibroma in the scalp and face. Personalized surgical plan of benign neurofibromatosis should be made to reduce the tumor mass, to improve function and appearance.
摘要:目的:探讨Ⅰ型肾小管酸中毒( RTA) 患者的临床特征及误诊分析。方法: 回顾性分析我院51例Ⅰ型RTA患者的临床资料, 包括临床表现、实验室检查、诊断及误诊情况、并发症及治疗转归等。结果:Ⅰ型RTA 临床表现多样,复杂,无特异性,外院误( 漏)诊率高达64.7%,易并发或伴发多种疾病。 结论: 临床上应提高对Ⅰ型RTA的认识, 做出早期诊断和治疗。Abstract: Objective: To investigate the clinical features and misdiagnosis of distal renal tubular acidosis(RTA), or type 1 RTA. Methods: Data of 51 cases with type 1 RTA were analyzed retrospectively,including clinical features, laboratory examinations,diagnostic errors, complications and therapeutics. Results: The clinical features of type 1 RTA were complicated and were easy to be misdiagnoed.The misdiagnosis rate were as high as 64.7% in other hospitals.Conclusion: Type 1 RTA should be further recognized in clinic in order to make earlier diagnose and treatment.
Objective To evaluate and compare the outcomes of simple closed reduction, selective fragment excision after closed reduction, and emergency fragment excision and reduction in the treatment of Pipkin type I fracture of femoral head associated with posterior dislocation of the hip. Methods Between January 2002 and January 2008, 24 patients with Pipkin type I fracture of the femoral head associated with posterior dislocation of the hip were treated with simple closed reduction (closed reduction group, n=8), with selective fragment excision after closed reduction (selective operation group, n=8), and with emergency fragment excision and reduction (emergency operation group, n=8). In the closed reduction group, there were 6 males and 2 females with an average age of 37.6 years (range, 19-56 years); injuries were caused by traffic accident in 6 cases, by fall ing from height in 1 case, and by crushing in 1 case with a mean disease duration of 3.1 hours (range, 1.0-7.5 hours); and the interval from injury to reduction was (4.00 ± 2.14) hours. In the selective operation group, there were 7 males and 1 female with an average age of 37.3 years (range, 21-59 years); injuries were caused by traffic accident in 7 cases and by fall ing from height in 1 case with a mean disease duration of 3.2 hours (range, 1.0-6.0 hours); and the interval from injury to reduction was (3.90 ± 1.47) hours. In the emergency operation group, there were 5 males and 3 females with an average age of 35.5 years (range, 20-58 years); injuries were caused by traffic accident in 5 cases, by fall ing from height in 1 case, and by crushing in 2 cases with a mean disease duration of 3.3 hours (range, 1.5-6.5 hours); and the interval from injury to open reduction was (5.10 ± 2.04) hours. There was no significant difference in the age, gender, disease duration, and interval from injury to reduction among 3 groups (P gt; 0.05). Results All wounds in selective operation group and emergency operation group healed primarily. All the patients were followed up 24 to 58 months (mean, 38.7 months). According to Thompson-Epstein system, the excellent and good rates were 50.0% (4/8) in the closed reduction group, 87.5% (7/8) in the selective operation group, and 87.5% (7/8) in the emergency operation group at 24 months after operation, showing significant difference among 3 groups (χ2=9.803, P=0.020). Heterotopic ossification was found in 1 case (12.5%) of the closed reduction group, in 4 cases (50.0%) of the selective operation group, and in 4 cases (50.0%) of the emergency operation group, and avascular necrosis of femoral head was found in 2 cases (25.0%) of the closed reduction group; there was no significant difference in compl ications among 3 groups (P gt; 0.05). Conclusion The treatment of Smith-Petersen approach and fragment excision by selective operation or emergency operation has similar outcome, which are better than the treatment of simple closed reduction.
Objective To systematically evaluate posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression without duraplasty (PFD) for Chiari malformation type I (CM-I). Methods A meta-analysis was performed according to the guideline of the MOOSE statement. Relevant literature and references were electronically searched in CENTRAL, Science Citation Index Expanded, MEDLINE (Ovid), PubMed, CBM, CNKI and WanFang Data from 1993 to September 2011. Two reviewers independently identified literature according to inclusion and exclusion criteria. The included studies were evaluated using the Newcastle-Ottawa Scale. Original data were extracted and analyzed using RevMan 5.1 software. Besides, the level of evidence was assessed using the GRADE system. Results Ten studies involving 829 patients were included. The results of meta-analyses showed that: a) compared with patients undergoing PFD, patients undergoing PFDD had a significantly lower reoperation rate (RR=0.41, 95%CI 0.23 to 0.74, P=0.003), and a higher rate of syringomyelia decrease (RR=1.27, 95%CI 1.03 to 1.56, P=0.02). But there was no significant difference in clinical improvement (RR=1.11, 95%CI 0.95 to 1.28, P=0.18). b) compared with PFD, patients undergoing PFDD had a higher rate of cerebrospinal fluid–related complications (RR=6.3, 95%CI 2.71 to 14.67, Plt;0.000 1). There were no significant differences in the complication of occipital neuralgia and wound infection (Pgt;0.05). Based on GRADE system, the evidence was at Level C and we made a weak recommendation. Conclusion Posterior fossa decompression with duraplasty is associated with a lower risk of reoperation, a better effect of syringomyelia decrease and a greater risk for cerebrospinal fluid–related complications, compared with PFD. Due to the influencing factors of lower-quality included studies, a prudent choice is suggested, and also more high-quality, large-sample studies are need.
Objective To analyze the contents of collagen type Ⅰ, type Ⅲ and the ratio of collagen type Ⅰ to collagen type Ⅲ in posterior rectus sheath of different person. Methods One hundred and four tissues specimen of posterior rectus sheath were obtained during patients’ abdominal operation. The contents of collagen type Ⅰand type Ⅲ were detected by using immunohistochemistry methods. The differences of collagen contents between male and female, physical work group and non-physical work group, smoking group and non-smoking group were observed. The relationships between the contents of collagen and age, body mass index (BMI), and height were analyzed, respectively. Results ① The content of collagen typeⅠand the ratio of collagen type Ⅰ／Ⅲ were both lower in male than those in female （Plt;0.01）； there were no obvious differences in the content of collagen type Ⅲ and the total amount of collagen （Pgt;0.05）. ② There were no differences between physical work group and non-physical work group with the amount and the ratio of collagens （Pgt;0.05）. ③ When compared with non-smoking group, less collagen typeⅠ(Plt;0.01) and lower ratio of collagen Ⅰ／Ⅲ （Plt;0.05） were found in smoking group； but there was no difference with content of collagen Ⅲ（Pgt;0.05）, as well as the total amount of collagen （Pgt;0.05）. ④ The total amount of collagen, the content of collagen type Ⅰand the ratio of collagen Ⅰ／Ⅲ all decreased as age increases （r=0.341, 0.392, 0.212， P＜0.001, Plt;0.05）； no obvious change was observed in the content of collagen Ⅲ （r=0.089， Pgt;0.05）. ⑤ The content and ratio of collagen had no obvious relationships with BMI and height （Pgt;0.05）. Conclusion Smoking, gender and age are all influential factors of the content and ratio of collagens in the tissue.